GENERAL REPORT ON LUNATIC ASYLUMS IN NEW ZEALAND. (BY DR. PALEY.)

Appendix to the Journals of the House of Representatives, 1874 Session I, H-01

1

1874. NEW ZEALAND.

GENERAL REPORT ON LUNATIC ASYLUMS IN NEW ZEALAND. (BY DR. PALEY.)

Presented to both Souses of the General Assembly by Command of Sis Excellency.

Dr. Paley to the Hon. the Colonial Secretary. 27, Bedford Place, Russell Square, Sir,— London, 25th November, 1873. Referring to your letter of the 31st of August, 1872, I have the honor to inform you that, in compliance with the request contained therein, I made inspection of the Lunatic Asylums at Auckland, Wellington, Nelson, Christchurch, and Dunedin, on the dates severally set forth in the reports hereto appended. Following the guidance of your letter I made careful inquiry into the state of the buildings, their adaptability or otherwise to the purpose to which they are applied, and the condition in which they are kept; also into the mode of treatment adopted towards the patients, the discipline maintained, and the suitableness generally for the position they hold of the staff, medical and lay, employed at each Asylum inspected by me. The results of my examination, together with consequent observations and suggestions, are embodied in papers marked Appendix 1, letters A to E, which I now beg to submit for your consideration. I regret that owing to the short time at my disposal in New Zealand I found it impossible to visit the Asylums at Hokitika, New Plymouth, and Napier. I learned, however, that a new Asylum was in course of construction at Hokitika, and that the number of insane at New Plymouth and Napier was so small that it did not seem necessary at that time to construct a separate building for their reception. With reference to the supervision and management of the Asylums in your Colony, I was led to the conclusion, in the course of my investigations, that it was highly desirable to adopt a system of uniformity based on well recognized principles. With this view I venture to offer in Appendix 2 certain recommendations, the adoption of which will, I believe, tend to ameliorate the condition of the patients, and render more effective the action of those who are intrusted with their care. The question of providing for all the insane of your Colony by the construction of one or more Central Asylums, though not specially mentioned in your letter, seems to arise so naturally in revising the whole subject, that it would seem an omission if it were passed by in silence. The chief advantages of a Central Asylum are—l. Facility of supervision; 2. Economy of management. The objections to it (as affecting New Zealand at the present time) are, —1. Difficulty of conveying patients from distant places. 2. Removal of patients beyond reach of personal communication with their friends. Transit of insane persons of every class (whatever the kind of mental disorder under which they labour), is attended with more or less risk to themselves and those around them. In many cases their conveyance from place to place involves great danger, and when their disease is maniacal in character and there is concomitant physical prostration, it becomes a matter of difficulty to sustain life during a long journey. When it is necessary for patients to travel by sea, all danger to their health and all difficulties to their attendants are very much enhanced; they are often unavoidably subjected to such bodily inconvenience, if not suffering, as may even have the effect of rendering them permanently and incurably unsound in their minds. The separation of patients from relations, friends, home, and local interest, deprives them of a very powerful and important means of restoration to sound reason. The first approach of many insane persons to convalescence is indicated by a re-awakened anxiety about their homes and their belongings; and nothing so much tends to help their progress towards recovery as the presence and personal sympathy of relations or friends in whom they can have confidence and trust. On the whole, then, I am of opinion that it is advisable, in the interests of the insane, to retain the local Asylums in those districts which contain the greatest number of patients, re--I—H. 1.

H.-l

2

constructing them on approved plans, and, where necessary, reorganizing them on a proper basis. In closing this communication, I beg permission to state that the delay which has occurred in the transmission of it has been caused by hindrances wholly beyond my control, and of which I had not the smallest anticipation when I left New Zealand. At that time I hoped to be able to send in my report very soon after I returned to Victoria, and I can now only trust that you will have the goodness to excuse the unavoidable omission. In conclusion, permit me to say that if at any future time you should desire any information or assistance it is in my power to give in connection with your Asylums, my best services will be at your disposal. I have, &c, E. Paley, Inspector of Lunatic Asylums for Victoria. The Hon. the Colonial Secretary, Wellington, N.Z.

APPENDIX I.—A. Wellington Lunatic Asylum, Karori. On the 29th of August, 1872, and again on the 4th of September following, I visited and inspected this Asylum, minutely examining every part of it, and making inquiry into various matters connected with its management. At the time of my visit the building contained 13 male and 13 female patients, who who were under the charge of a keeper with two male assistants, and of a matron with one female assistant. I saw and spoke to all the patients, of whom one man and one woman were confined to bed by slight illness, and two women were in seclusion on account of violence. One man was employed in the kitchen helping the cook, the rest (except the one in bed) were sitting listlessly in a small day room or walking in a dull enclosed yard. A few of the women were busy with knitting or with needlework, and looked better dressed and cared for than the men. I saw the dinner on the female side served to the patients. It was well cooked, good in quality, and sufficient in quantity. It appeared to me, however, that a few additions in the way of table appliances might be made with advantage and comfort to the patients. Thus, they might have table-cloths, knives and forks, plain cruet-stands, &c, and the joints and puddings might be placed on the table in separate dishes, and carved and distributed by the attendants as in a a private home. I was informed, in reply to questions,— (I.J That a surgeon visited the Asylum two or three times a week; but as he lived at a distance of four miles, and no stock of drugs was kept on the premises, it was not usual for the patients to have medicines (except ordinary aperients) administered to them. 2. That patients were sometimes personally restrained by a strait waistcoat or a restraint chair, and that these were used at the discretion of the keeper or the matron in the absence of the medical attendant. Here I would recommend that the medical visitations be made frequently, but at no fixed period of the day, and that it be an instruction to the medical attendant to record in a book the date, hour, and duration of each visit, and to make entry of the disorder for which he prescribes medicines, the medicines he prescribes, and the effects thereof. With regard to personal restraint, I would advise that, whenever resorted to, it be recorded by the keeper or the matron in a " Restraint Book," to be produced to the medical attendant at every visit, and initialled by him. I think it highly advisable that there be kept at the Asylum a small stock of the drugs in most frequent use in the treatment of insanity, and a few such surgical instruments and appliances as are often needed in dealing with the insane. Amongst the latter are apparatus for administering food —sub-cutaneous injection syringe, enema apparatus, Eesophagus bougies and probangs, catheters, india-rubber cushions of various sizes and shapes, india-rubber mattrasses, &c. With reference to the present Asylum at Karori as a place for the care and treatment of the insane, I purposely refrain from offering any comment or observation, inasmuch as it has already been officially condemned as unsuitable in every respect, and the authorities of the Province of Wellington have already taken in hand the construction of a new Asylum on an eligible site and on an approved plan. I may state, however, that my opinion is quite in accord with the view of those who have advised that the home at Karori be abolished as an Asylum for the insane, and I am glad also to take this opportunity of acknowledging the facilities which were afforded me during my stay in Wellington of seeing the plans and site for the new building. The plan is good, the site easy of access but at the same time elevated and cheerful, and there is enough space for all purposes of exercise, recreation, and work. I would advise that the water supply be made full and constant over every part of the building, and that hydrants and hose be placed at convenient points, with service at such a pressure as will afford means of directing a copious stream of water against any given place at a moment's notice. In order to make the grounds picturesque and pleasant for the patients, I would suggest that a plan, prepared by a practical landscape gardener, be placed in the hands of the keeper, with an

3

H.—l

insti'uction to work it out by the labour of his staff and patients, as soon as possible after he shall have entered on possession. The objects to be attained are, cheerful and varied grounds, having a free look-out over surrounding scenery, with sheltered walks and seats for feeble and infirm inmates. It is very advisable also to fence a piece of ground suitable for a vegetable garden, which will give healthy occupation to one or two working patients, and afford, at a nominal cost, a wholesome and acceptable addition to the diet scale of the home. It only remains now for me to refer briefly to the strength of staff necessary for the Asylum under consideration. I am of opinion that there should never be fewer than two male attendants in addition to the keeper, and two female attendants in addition to the matron, for ordinary day duty. Two men should always be on duty on the male side, and two women on the female side. Thus, if a male attendant be absent on leave, or on account of sickness, the keeper should remain in readiness to act in the absence of his subordinate; and so also with the matron in respect to the female division. When the patients of either sex number more than twenty, an additional attendant should be appointed to that division, and an attendant should be added in future for every increase of ten patients. Neither the keeper nor the matron should be counted in the strength of the attendants' staff. It will be necessary for the proper conduct of the Asylum to appoint, in addition to those above named, a cook and a laundress, the duties of these two offices being such as cannot be laid even in pai't upon the attendants without leading sooner or later to neglect of their own proper work, viz. the personal care and management of the patients. But insane persons, for various reasons, should be watched and tended by night as well as by day, and the duty of night-watching is never properly and efficiently done except by one who is able to be at rest by day. Perhaps the best provision for carrying out this work amongst the present small number of patients in the Wellington Asylum would be to appoint a man who should go through his own division at stated intervals, giving medicine or food, or whatever he might be ordered, to the male patients, and making a round of observation outside the female division, but not entering any of the women's rooms unless accompanied by the matron or a female attendant. For it cannot be too strongly stated, or too often repeated, that the practice of allowing the men of an Asylum staff to assist in the personal management and control of female patients is utterly wrong in principle, and often very hurtful in its consequences. When the number of female patients shall have increased so much as to warrant a separate night nurse being maintained for the female division, no time should be lost in appointing a suitable woman, and confining the services of the male night watchman to his own side of the Asylum. E. Paley.

APPENDIX I.—B. Auckland Lunatic Asylum. I visited this Asylum on the 7th, 9th, and 11th of September, 1872, saw all the patients, and inspected every part of the premises. At the time of my visit, there were 80 male and 37 female patients on the books of the Asylum. They were generally in fair health, and (excepting two of the females) were tranquil and orderly in their behaviour. I found no one under mechanical restraint, but two women were confined to their rooms on account of maniacal excitement. Several of the male patients were employed in outdoor work and in the general duties of the home and wards ; and many of the women were engaged in needlework in the day rooms. I was informed that the women made all their own wearing apparel, and repaired the clothing of the men. The dress of the former was satisfactory as to neatness and cleanliness, but the clothes of some of the latter were not in a creditable condition. The bedding in most of the rooms was clean, of good quality, and sufficient in quantity. In two of the two dormitories, however, which were occupied by paralyzed and epileptic patients, it appeared to me that there was wanted a much more frequent change of bed and bedding. The air in these rooms was impure and offensive, and contrasted remarkably with that of other parts of the Asylum. The building now occupied by patients consists of one wing of an Asylum originally planned for 200 patients. The second wing not having been built as designed, it has become necessary to place female patients on the upper floor, and males on the lower floor of the completed portion. The numbers thus accommodated are considerably in excess of the proportion properly allowable for the cubic space. In several of the dormitories, I ascertained that the space was under 500 cubic feet per bed, a measurement wholly insufficient for comfort and health in a climate like that of Auckland. Another objection to the existing arrangement is, that feeble, infirm, and epileptic females are of necessity placed on the upper floor, and are thus practically without means of taking air and exercise out of doors, by reason of the difficulty of having them taken up and down stairs. When it is considered that there are now in the occupied part of the Asylum 18 more patients (in addition to their attendants) than it was intended to hold, that the gross number admitted in 1871 was 79, as against 40, 50, and 52 in the years 1868,1869, and 1870 respectively,

4

H.—l

that the total remaining at the end of 1871 was 118, whilst it was but 79 at the end of 1868, it will be seen that the demand for more room is urgent and imperative, and that it must be liberally and promptly met, if it be desired to avoid the sickness and irritation and discomfort which inevitably arise in an over-crowded asylum for the insane. I am decidedly of opinion that the best course the Government of Auckland can take in this matter is to begin at once to build the second wing of the Asylum, and to push it on to completion with the least possible delay. lam aware that a large outlay would be required for such a work, but I do not hesitate to urge it, for I am satisfied it is right, alike on humanitarian and on economic grounds, to provide at the onset proper and permanent shelter for the insane, and not to meet pressing calls for accommodation by temporary structures, which are always unsatisfactory to officers and patients, and which always prove most expensive in the end. In the course of my inspection, I was particularly struck by the cheerless and comfortless aspect of the day room for male patients, as also by the unsuitableness of the airing courts, which were small, without any shelter from sun or rain, and so shut in by buildings and walls that no view of the surrounding country could be had from them. With regard to the day room, I would suggest that it be furnished in a plain comfortable way, with seats having backs, arm chairs and tables, at which the patients could read or otherwise amuse themselves in the evening or in wet weather. The walls of the room should be coloured, and it should be made bright and cheerful in appearance, by placing in it pictures, potplants, birds, &c. As to the airing-yards, I would recommend that a shed be built in each as a shelter from heat and rain; also that extended means of exercise be given by enclosing a portion of ground on the slope at the back of the building, the boundary wall forming a ha-ha fence at the foot of the bank, and allowing a free view over it. On inquiry I received the following information as to water supply and drainage : — The building has three sources of water supply : 1. Rain water tanks; 2. A well; 3. A creek. The well water was reported unfit for domestic purposes, being rendered foul by percolation from one of the house drains. Thus, when the rain water tanks are emptied (and this happens, of course, in hot weather when water is most needed), the whole supply for all purposes has to be carried in a water-cart from the creek, and the quantity procurable by the labour at the disposal of the superintendent is insufficient to meet the sanitary requirements of the inmates. This condition of things is not satisfactory, and I would recommend that underground tanks should be constructed, of sufficient capacity to store a supply in seasons of ordinary rainfall, and that these tanks should be provided with force pumps, by means of which service cisterns at the top of the buildings could be filled, and the pipes laid from the cisterns to all parts of the Asylum. I would also advise that the well water should be made available by removing the house drain which now runs near to it, and preventing any soakage of sewer water in future, by laying earthen pipes large enough to carry the whole sewage direct to the ground under cultivation at the bottom of the slope, where it might be at the same time utilized and rendered innocuous, by applying it to the irrigation of the growing crops. In walking over the Asylum grounds while investigating the drainage system, I found that an intercepting sewage tank had been made at the rear of the building, and that the overflow from it had saturated the surrounding ground to such an extent as to render it very foul and offensive; and I was told that, in certain states of the wind, the atmosphere of the Asylum was rendered impure by the exhalation from it. I think this tank should be abolished, and the sewage conveyed (as before suggested) in earthen pipes direct to the cultivation ground. I beg now to submit the following recommendation for consideration, observing only that my opinions on the several points adverted to have been formed on personal investigation and experience; and that I believe the suggestions, if adopted, will have a tendency to promote the comfort and well-being of the staff and the patients. 1. Provide increased means of amusement for patients, such as bagatelle, chess, draughts, &c., which should be placed in the convalescent wards, and books, newspapers, and standard periodicals, which should be kept in " reading rooms," one being set apart in the male, and one in the female division of the Asylum, for the use of attendants and patients of either sex. Occasional evening meetings for dancing, music, singing, theatrical performances, &c., are of great use in cheering and humanizing insane persons, who are melancholy, morose, and. inclined to habits of solitude. At these, officers, attendants, and patients of both sexes should meet and take part, together with such visitors as may be deemed admissible by the authorities. In my opinion, the plan of paying the cost of these amusements by the sale of tickets, and by voluntary contributions is not a good one, because it is uncertain in its working, and because under it the officers must necessarily have great difficulty in refusing admission, even to ineligible persons after they have paid the price of their ticket. It would be much better, I think, to place a sum in the estimates to be disbursed by the Medical Superintendent with the concurrence of the Inspector, in purchases for library, books, and amusements for patients, the accounts, supported by vouchers, being rendered monthly or quarterly as might be directed. Under this head might be charged the cost of outdoor excursions, visits of patients to places of amusement in the neighbouring town, and of outdoor games, such as cricket, quoits, skittles, bowls, &c, for the men; and La Grace, battledore, &c, for the women. It is quite justifiable to make such outlay a charge in the

H.—l

5

estimates, for it is incurred in carrying out a very important part of the moral treatment of the insane, and it is beyond dispute or doubt that in many instances it furnishes the essential basis for recovery. 2. Provide extended means of employment, both for men and women. Male patients should be employed, under proper supervision, to do whatever useful work is required to be done in an asylum. There is always work for skilled tradesmen as well as for rough labourers. Now, inasmuch as employment is an element in their treatment, whilst their labour effects a saving in the management of the home they live in, it is necessary to empower the Medical Superintendent to provide proper tools for carpenters, bricklayers, painters, tailors, shoemakers and to provide from time to time materials necessary for their work. Some small indulgences are looked for, and should be given to such patients, as, e.g., a little extra diet or tobacco, a little extra liberty to walk beyond bounds, or to sit up later at night, a better suit of clothes for Sundays, and so on. The female patients should do all the work which would naturally fall to their share if they were out of doors, viz. household work in their own division, washing, making and mending clothes for the whole establishment, and doing such fancy work for the decoration of the rooms as may come within the scope of their capabilities. It is well to make it a matter of duty for attendants to work with their patients, and to this end there should be amongst the male attendants a few artisans; and amongst the females, some dressmakers, machinists, tailoresses, and the like. 3. Complete carriage road from front gate to building, so as to give a place'for exercise of convalescent and strong patients, who are now kept indoors except in very fine weather. In connection with this work, a post and rail fence should be put up along the^ plantation, which might then be more thickly planted with success. 4. Provide small fire-engine with hose, buckets, and ladders. 5. Appoint a male and a female night attendant to be on duty and move through their respective divisions at stated intervals between 7 or 8 p.m. and 6 or 7 a.m.,* and to do no duty by day. Insane persons ought to be watched at night, and attendants who are on day duty cannot properly watch them. With regard to day attendants, the proportion to patients should be not less than one to every ten, exclusive of head and night attendants. 6. Place night lamps in all galleries and dormitories,, making the night attendants responsible for keeping them lighted and for putting them out before they go off duty. 7. Appoint all attendants (who should be selected by the Superintendent and approved by the Inspector) on probation for three months. At the end of this term the probationer to be confirmed in the appointment or relieved from duty, according as the report of the Medical Superintendent is favourable or otherwise as to fitness and capacity. The age of men on appointment should be from thirty to thirty-five years, and that of women from twentvfive to thirty years. With regard to salaries of attendants, I would suggest that those of the men commence at a higher rate than at present, say at £65, and that they be allowed a yearly increment of £5, until they are in receipt of .£IOO a year. The salaries of the women might commence at £40, and they might be given a yearly increment of £2 until they reached £50 a year. The attendants, in addition to salary, should have quarters in the Asylum, rations, fuel, light, and water; and I would recommend, in addition, that three or four of the senior men who are married should be allowed each a cottage within the Asylum precincts, on condition that they hold themselves ready to do duty whenever they may be called upon by the officers on an emergency. This privilege of free quarters for wife and family is much valued by good Asylum servants; and the prospect of obtaining it as a reward for length of service and meritorious conduct has the effect of retaining deserving men, and of preventing those frequent changes which inevitably take place in a staff to which no prospective advantages are held out. E. Paley.

APPENDIX l.—C. Nelson Lunatic Asylum. 14th September, 1872. I have this day made an official inspection of the Nelson Asylum, have seen all the patients and examined minutely every part of the building occupied by them, as well as the airing yards and grounds appropriated to their use. At the time of my visit there were 45 patients on the roll, viz. 30 males and 15 females. Ten of the men were engaged in gardening, wood-cutting, and helping in the general work of the house. One man was secluded on account of his dangerous and destructive tendencies; one was confined to bed by general paralysis; and the rest were exercising in a small enclosed yard where there was nothing to interest or amuse them. Of the 15 female patients, four were occupied by household duties; two (idiots, subject to epilepsy) were shut up in a small yard, from which I was told they were never taken except to the rooms in which they slept. The remainder of the women were without occupation of any kind. With the exceptions above stated, the patients were in fair bodily health, and, for the most

H.—l

6

part, sufficiently neat and clean in dress and person. Making allowance for defects attributable to the numerical insufficiency of the staff, and to the faulty construction, of the building, the establishment was in a tolerably satisfactory condition. I feel it my duty, however, to offer the following observations and suggestions respecting the Asylum. The buildings, in my opinion, are altogether inadequate to the safe keeping and proper treatment of insane persons. Originally designed for a totally different purpose, additions have been made from time to time under pressing necessities, but these having formed no part of a well-devised general plan, are in nearly every respect wanting in the essential characters of a hospital for the insane. After very careful examination and consideration, I would advise that no further outlay be made on the existing buildings, except for such repairs as may be absolutely and urgently necessary to preserve them in a temporarily habitable condition. In place of the present structure, I would recommend that a new Asylum be built on elevated ground behind the old site, and that as much land be secured in its immediate vicinity as will give ample space for airing courts, gardens, and pleasure grounds, for the recreation and employment of the patients, as well as pasturage for one or two horses and some cows for the service of the establishment. Nothing more conduces to the health and happiness of insane persons, who have been used to agricultural life, than regular work on a small Asylum farm. In many cases the employment is curative in its agency, whilst it has this additional recommendation, that under judicious management it materially contributes towards the maintenance of the institution. The following was the strength of the resident staff at the time of my visit: —1 keeper, who is also general manager; 1 matron, who is also general housekeeper and cook; 3 male assistants, and 1 female assistant. I learned on inquiry that the salary of the keeper was £150 a year; of the matron, £70; of the male assistants, from £60 to £70 each; and of the female assistant (a girl fifteen years old), £30. Quarters and rations are also allowed to each member of the resident staff. I was informed that the keeper always slept on the premises, as also did one of the male assistants, but that two of the latter were allowed to go home every night, unless they were kept on duty for a special case by order of the keeper. I was further told that the matron and the female assistant always slept on the premises; but if either of them were absent on leave at any time during the day, and difficulty arose with a female patient, it was the practice to call for help from the keeper or one of the male staff. I was surprised to find that no systematic provision was made for watching the patients or premises by night. It is highly desirable to make arrangements for supplying this deficiency without delay, partly with a view to the proper care of epileptic and feeble patients, who need attention in the night as well as in the day, but chiefly to protect the inmates from the fearful consequences which must ensue if a fire were to take place at a time when they were locked within their rooms and no one was on the alert. I think a man (in addition to the present staff) should be specially employed for night duty. He should move through the male division, and round the outside of the female divisions, at frequent intervals. His movements should be checked by means of tell-tale clocks placed at suitable points, and he should have very exact instructions as to his course of proceeding in case of fire. With regard to the female staff, I would suggest that two additional assistants be appointed who should assist the matron as occasion may require in the care of the patients, and in the general domestic duties of the house. It is wrong in principle, and utterly objectionable in practice, to employ male assistants in the management of excited insane women. If suitable female assistants were selected, of ages between twenty-five and thirty-five years, there would be no need for them to seek assistance from the male staff unless under very rare and exceptional circumstances. In answer to questions about supplies of medical comforts, provisions, clothing, bedding, &c, I was told by the keeper,—l. That the medical officer ordered whatever he considered necessary for the proper treatment of invalid patients. 2. That provisions were supplied under contract, but that there was no fixed dietary scale. I would recommend the adoption of a regular diet scale in accordance with the almost universal usage in large institutions. 3. That clothing and bedding were purchased by the keeper, who passed accounts monthly. These articles appeared to be good in quality and sufficient in quantity. I would, however, suggest the advisability of taking supply by contract, as tending to secure uniformity and economy of service. Medical visitation of the Asylum is made daily (as I was informed) by Dr. Boor, the resident surgeon of the adjacent hospital. This arrangement appears to work well, and may be deemed satisfactory for the present small number of patients. Increase of number, and the opening of a new establishment, will, however, in all probability necessitate, at no distant period, a complete change in the mode of medical attendance and management. E. Paley.

APPENDIX I.—D. . Dunedin Lunatic Asylum. On the 22nd of August, and on the 25th, 26th, and 27th of September, 1872,1 made official

7

H.—l

inspection of this Asylum, seeing all the patients, and examining the various single rooms, day rooms, dormitories, and airing courts appropriated to their use. I also saw the kitchen, laundry, store, and other offices of the establishment. At the time of my visit there were on the books 160 patients, of whom 110 were men and 50 women. The staff consisted of 1 visiting medical officer, 1 superintendent, 1 matron, 9 male attendants, 6 female attendants. The patients were orderly, clean, and well cared for in appearance, and the whole establishment bore evidence of watchful care and skilful management. I saw many of the male patients employed in forming a new airing court for the women and a cricket-ground for the men. I also observed many of the female patients engaged in knitting, in needlework, and in various household duties; whilst some amused themselves with books or fancy-work. Many of the patients, however, whose mental state did not admit of their being thus usefully or pleasantly occupied, were unavoidably confined to the day rooms or the airing courts, which latter being small, enclosed by buildings and high fences, and in some parts overlooked by passers by in the high ground of the Public Domain, which adjoins the Asylum Reserve, are very ill adapted for the exercise or the recreation of the insane. The Asylum Reserve consists of ten acres, on which stand the buildings, airing courts, garden, &c. Comparing this quantity of land with that which is recommended by the best authorities^ and which is generally found in connection with Asylums in Great Britain, in France, and in America, it must be pronounced insufficient for the number of patients now under care at Dunedin. Writing on this subject in his report on the Dunedin Asylum for 1871-72, Dr. Hulme, the visiting medical officer, says, — " There are many in the airing courts who could be usefully employed, if there were scope for them to woi'k; and I may point out that the limited extent of the grounds is becoming insufficient to give work for the increasing number of patients, and would suggest that a farm, say of 100 acres, within three miles of Dunedin, be provided in connection with the Asylum, which would give employment to the chronic or incurable male patients. Such an undertaking would assist to make the institution more self-supporting, and give a wider circle to its inmates; even a holiday from time to time to the Asylum farm would have a beneficial effect on the convalescent patients. " At present there could be selected from the male division of the institution not less than thirty incurable patients, in good bodily health, and who, from appearance, may live for years. By drafting them to a farm under the care of three experienced attendants used to agriculture, their cost would be lessened, while at the same time the Asylum would be benefitted by the farm produce, which it has now to purchase. The surplus produce (if any) could be sold or supplied to other institutions depending on the Government." Thus on economic grounds, Dr. Hulme, as I think, makes a case for establishing an Asylum in conjunction with a farm at a short distance from the existing establishment. But there are other reasons, stronger than those of economy, to be advanced in advocacy of the proposed course. It is a fact, with regard to healthy persons of the labouring class confined in Asylums on account of chronic insanity, that suitable work in the open air has a soothing, pacifying effect, and tends to induce recovery if that be attainable, whilst enforced idleness, in a circumscribed space, causes irritability and restlessness, which often result in outbursts of violence; and the patient is thus too often shut out from all hopes of a cure, which might have been accomplished under more favourable conditions. Hence it is necessary, on medical grounds, and for reasons of humanity, that more space and additional means of healthful employment for their patients be placed at the disposal of those who are charged with the care and treatment of the insane population of Otago. If it be decided to give effect to the above suggestions, I would advise that plans be made for an Asylum on the block or pavilion system, to accommodate, when completed, 250 patients; the site for the building being selected with a view to extension whenever increase of numbers may render that a necessity. The stables and homestead, with one block of the permanent structure, being ready for occupation, a party of patients might be drafted off (as proposed by Dr. Hulme), take up their abode at the Asylum, and be set to work at once on the land, any skilled labour being used on the building. As successive portions became added, fresh drafts of patients might be taken to inhabit them. The existing Asylum would thus be relieved of all pressure on its space; and I would then strongly recommend that steps be taken to establish it in permanence as an institution which should receive, — 1. Middle-class insane persons, with means of support, either of their own or of friends. 2. Convalescent patients from the Public Asylum for a term of probation before their final discharge. 3. Inebriates, whether committed under the Act or voluntarily submitting themselves for curative treatment. The middle-class private patients might with advantage have a separate part of the house set aside for their use, where they could be insured all necessary privacy, and be provided with home-like comforts and surroundings, the want of which is often severely felt by them when they are compelled to be in the midst of a mixed Asylum population, with habits, feelings, and education altogether inferior to their own. Convalescent patients (of whom there would probably never be a large number at one time) could be usefully employed in helping the attendants of the middle-class patients.

H.—l

8

Inebriates should have rooms apart from those occupied by the other inmates, with whom they ought not to associate in their daily life, nor even be allowed to come into contact, except on the invitation and in the presence of some of the officers of the institution. I should not be understood to include in the class " inebriates " those who are accustomed to be temporarily maddened by a drunken debauch, nor those who are under a passing delirium as the result of a more prolonged excess in alcohol. I would be understood to mean only the dipsomaniac proper, who has periodic cravings for over-indulgence in alcohol which he is utterly unable to resist, and for the cure of which morbid appetite it is necessary to place him for some time beyond reach of temptation and under appropriate medical treatment. In conclusion, I beg to state my conviction that the establishment of such an Asylum home for middle-class insane persons of small means would be a great boon to many living outside the district or Province in which it was placed, and under careful and judicious management would soon become a self-supporting institution. E. Paley.

APPENDIX I.—E. SUNNYSIDE AsYLTJM, CHRISTCHURCH, CANTERBURY. On the 26th of August, the 30th of September, and on the Ist of October, 1872, I visited and made official inspection of this Asylum. I saw all the patients, 116 in number, viz. 78 men and 38 women. At the time of my visit the staff consisted of 1 keeper, 1 matron, 1 clerk, 6 male attendants, 3 female attendants, and 1 cook. The various rooms and airing grounds occupied by the patients were minutely examined, as also were the kitchen, stores, and several offices of the Asylum. The patients generally were neat as to dress and person, and there was no undue excitement amongst them; but the space available for them throughout the Asylum was manifestly insufficient, and nearly every dormitory was very much overcrowded with beds. It is satisfactory, however, to report that provision was being made for increased accommodation by putting up a substantial building of concrete, to which, when finished, it was proposed to draft the female patients, many of whom could then be usefully employed in the laundry, which was also in course of erection. The rooms vacated by the female patients will be occupied by the men until the male division of the new building is fit for use, when they will be transferred in turn, and the existing Asylum will no longer be required for its present purposes. I would strongly recommend that certain of the more substantial and comfortable parts only of this structure be retained for future use, and that the remainder be taken down as soon as possible. It seems to me that the front rooms might, at very little expense, be made comfortable for middle-class private patients, and that separate accommodation might also be found for patients of the " inebriate" class. But Ido not advise that a large number of patients be again collected in a building which, in spite of all care, is liable at any time to be destroyed by fire, for I believe that, in such an event, many of the inmates must inevitably lose their lives. With regard to the staff of attendants, I am of opinion the numbers should be increased by two men and two women; and I think when the new laundry is opened, a laundress should be appointed to manage it. At present the female attendants overlook the laundry work, and I venture to suggest that it would be better to make this a separate duty, and to confine the services of the attendants to the personal charge of their patients. In the course of my inspection I was much struck with the varied means of amusement provided for the patients, and with the ingenuity of the keeper in bringing so many resources to bear in this desirable direction. I would recommend that every help and encouragement be given in this matter; and I cordially indorse the opinion of the Inspector, as given in his report of 26th June, 1872, "that numerous expeditions to a distance from the Asylum have done much to improve the mental condition of those who were on their way towards recovery." I was informed that an average of 70 patients attended Divine service; about 76 were generally able to take part in recreation; and 55 were employed in miscellaneous works about the grounds and buildings. In connection with the new building, I think it would be found advantageous to have a working plan prepared for laying out the grounds and approaches, so that the work of planting, &c, might be commenced without loss of time; and it would be a great comfort to the invalid and infirm patients if they were provided with easy garden seats in shady spots in various parts of the enclosure. An examination of the different kinds of food used in the Asylum satisfied me that the quality was good; and seeing the dinner served in some of the wards, I considered the quantity of provisions abundant, and that they were cooked with care. The medical service of the Asylum is performed by a gentleman living in Christchurch, who visits every day, or more frequently in case of need; and I was informed that any medical extras ordered for sick or feeble patients were freely supplied to them. Several valuable suggestions which have been offered by the Inspector (Mr. Hamilton) have

9

H.—l

received careful consideration, and certain of them are embodied in the summary of general recommendations attached to these papers. E. Paley.

APPENDIX 2. Provisions recommended for the Supervision and Management of Lunatic Asylums in New Zealand. 1. Appoint a duly qualified medical practitioner, having knowledge and experience in the treatment of the insane and the management of Asylums, to be the Inspector of all the Asylums in the Colony. 2. Appoint a resident Medical Superintendent to every Asylum containing 100 patients or upwards. 3. Let every Asylum containing fewer than 100 patients be visited at least once a day by a qualified medical practitioner. 4. Appoint a local Inspector of every Lunatic Asylum, who shall receive a salary and shall perform the duties prescribed by the Lunacy Act. 5. Provide for every asylum (in addition to medical attendant, steward, matron, cook, laundresses, &c.) a staff consisting of one attendant to every ten patients ; let there be a male night attendant for each male division, and a female night attendant for each female division; let night attendants be free from day duty, and let no male attendant or servant or patient be allowed in the female division of the Asylum, or vice versa, without an order from the responsible officer of the establishment. 6. Make provision for the reception and treatment of middle-class private patients apart from paupers, and prohibit the association of inebriate patients with other insane persons of any class. 7. Allow idiots and imbeciles who are dangerous to themselves or others, and are thereby unfit to be at large, to be admitted for care.and treatment into the Public Asylum of the Colony. 8. Give to all who are employed in Asylum duties a regular increment of salary up to a fixed maximum, and make provision for superannuation allowances such as are to be found in the Victoria Lunacy Statute. E. Paley. ?y Authority: Geobge Didsbubx, Gorernment Printer, Wellington.—lB74. Price 9d.~\ . .