MENTAL HOSPITALS OF THE DOMINION. MEDICAL SUPERINTENDENTS' REPORTS FOR 1915.

Appendix to the Journals of the House of Representatives, 1916 Session I, H-07a

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1916. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION. MEDICAL SUPERINTENDENTS' REPORTS FOR 1915.

Presented to both Houses of the General Assembly by Command of His Excellency.

The Inbpbotor-Obnbeal to the Hon. the Minister in Chab&i of the Department fob 'nno Care of Mental Defectives. Sir, — I have the honour to present the annual reports addressed to me by the Medical Superintendents of the four larger institutions. These reports, which are not statutory, were not included in my annual report because that report was presented at ,an unusually early date, and was printed when one report only had come to hand. I have, &0.. Hon. G. W. Russell. Frank Hay.

MEDICAL SUPERINTENDENTS' REPORTS. Auckland Mental Hospitals. Dr. R. M. Beattie reports : — On the 31st December, 1915, we had in this hospital 948 patients. During the year 131 male and 90 female patients were admitted. As usual, the majority of the males were single and of the females married. Most of the patients were between the ages of thirty and sixty years —the period of greatest vigour and strain. Of the admissions, 4 males and 8 females were voluntary patients. So far the voluntary system has not been a success in Auckland, the deprivation of liberty and the imagined reflection proving largely insuperable barriers. From the hospital—that is to say, the curative—point of view I am not satisfied that any benefit has resulted. The recovery-rate —47'96 per cent. —is above the average. The death-rate was 9'19 per cent. Senile decay and chronic brain-disease accounted for 44 of the 8G deaths. I regret that too many senile cases are still admitted to this Hospital, exhibiting in some cases a desire to shirk home responsibility. The general work of the Hospital and the farm has been carried on with a fair measure of success. Difficulties have naturally arisen, owing to war conditions, in finding suitable employees, and we have now more than ever to rely upon the older members of the staff, whose work is to be commended. I regret that more of the single men have not seen fit to volunteer for military service. Nine have done so :of these, one—J. H. Button—was killed in action, and two others were invalided home. The new drainage system is approaching completion. This will enable us to connect with the city and suburban system, and relieve us of a difficulty with which we have had to contend for many years. Both new auxiliaries are now in occupation. They are quite inadequate to meet our requirements. The new female refractory ward is much overcrowded, whilst on the male sidt accommodation is considerably cramped, and. the infirmary ward so much so that its successful administration is impossible. During the year we lost the services of Miss S. Campbell, our Matron. She retired worn out after years of strenuous labour performed without a grumble and with the single purpose of loyalty and fidelity. Our expenses have increased by over £3,000. Wages accounted for £728 of this amount, and rations, due to enhanced prices, for £2,650

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For Dr. Tizard and myself, who have been here without assistance for the whole year, the work has proved somewhat of an overstrain, but Ave cheerfully submit to a condition which has arisen from an Empire crisis. Our thanks are due to the Herald, Miss Fleming, Mr. Macpherson, and others who have assisted us in various ways, and to the District Inspector and Official Visitors. Sunnysidh Mental Hospital. Dr. St. L. H. Gribben reports : — At the beginning of 1915 there were 683 patients on the books, of whom 354 were males and 329 females. During the year there were admitted 69 males and 78 females, and at the end of the year there were remaining 702 patients, an increase of 19 for the year. There were 46 deaths, giving an average death-rate of 6'8 per cent, of the number resident. There were 73 recoveries—37 males and 36 females —giving a rate of 49'6 per cent, on the admissions. Having taken charge only in September, my report must necessarily be brief. Work is proceeding on the Nurses' Home, which should be ready for occupation within two or three months. Progress on the new Reception Block has been slow, I understand, because carpenters are urgently required for military camps. Certain alterations in connection with the kitchen-yard and scullery which were urgently required have been undertaken. The kitchen itself also urgently requires attention. The buying and killing of our own meat has been in operation for a month, and there is reason to believe it will be quite successful. To carry out this proposition to advantage I would urge the necessity of acquiring more land, which could be made a first-class investment for the Department. Consequent upon this departure in regard to meat certain changes have been made, and the kitchen is now under the charge of a nurse. This departure is working admirably. The provisions against fire are inadequate, and urgently require attention. The fire-alarm system is of no use, and the apparatus for fire-fighting is antiquated and cumbersome. On the 5th October Dr. Lee joined the N.Z.M.C., and left the country on active service within a few days. The general health of the patients has been good. Unfortunately, a large number of senile cases continue to be admitted, and I beg to suggest that the Charitable Aid Boards should definitely take charge of this type of case, which represents only a physiological decay. In addition to the ordinary entertainments, Haywards' Picture Enterprises (Limited) have generously volunteered to give a monthly performance free of charge. These entertainments have been highly appreciated by the jsatients, and have amused a large number of patients who are not able to go beyond the grounds. I am indebted to a number of ladies in Christchurch for the supply of books and magazines for the amusement of the patients. The officers in charge of the different departments have worked hard and loyally, and I have to thank them and the staff generally for their co-operation in carrying on the work of the place. Skaolifp Mental Hospital. Dr. F. Truby King reports : — In the beginning of the year there were 946 patients and at the close 975, an increase of 29. The number of new patients was 121, the readmissibns 27, and the transfers from other institutions 7. The patients discharged relieved and recovered were 62 —that is just over 50 per cent, on -the number of new admissions, or just over 40 per cent, on the combined new admissions and readmissions. Eleven voluntary patients were admitted during the year. The total number of patients under treatment was 1,101, and the number of deaths 54, the mortality being 5 per cent., the same as last year. Twenty of the patients who died were between seventy and over ninety years of age. The general health has been good, and the work of the institution has been efficiently carried out in spite of the great handicaps of our losing a very large proportion of the best attendants as volunteers to the Expeditionary Forces. Another effect of the war has been to slow down the progress of building and other improvements, this arising from the difficulty of getting enough firstclass artisans, the frequent changes of personnel, and the economic requirements naturally enforced on us by the Government. However, in spite of drawbacks the all-round necessities have been fairly well met, and it cannot be said that so far the comfort and welfare of the patients have been very much affected by the state of war. The farm and garden have been exceedingly well run, and the provision of meat by the farm-manager, instead, of resorting to outside contracts, has been highly successful from every point of view. We have had a better average quality of meat than heretofore, and the pecuniary saving has been a large one. The fishing-station has again done well, the fish caught during the year being just on a quarter of a million pounds weight. In the coming season we anticipate securing a much larger proportion of groper, which, taken all round, is the best local fish for use in the fresh state in large institutions. Our most urgent needs are still —(1) Improved bathing facilities; (2) proper accommodation for tuberculous patients; (3) a separate quarter for so-called "criminal lunatics"; (4) further accommodation for female patients; (5) additions and improvements to the main kitchen; (6) refrigerator for fish, &c. Orokonui Branch Mental Hospital and The Camp auxiliary have been well conducted throughout the j'ear. I have to thank Dr. Gr.Ty and other medical colleagues and the staff for excellent work. Religious services have been held by various denominations throughout the year. The thanks of the authorities are due to the Otago Daily Times and Witness Company and to the Evening Star Company for newspapers supplied free, and also to other donors and entertainers who have contributed to the amenities of our institutions.

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Pobirua Mental Hospital. Dr. Gray Hassell reports : — During 1915 the total number of patients under treatment was 1,197, and the average number resident 948. Of the 251 admitted, 196 (119 males and 77 females) were admitted for the first time, a decline of about 11 per cent, in comparison with the previous year. 104 were discharged recovered, which makes a recovery-rate of 4L4 per cent, of the number admitted. 71 died, a ratio of nearly 7"5 per cent, of the average number in residence. The deaths included 12 from general paralysis, II from tubercular disease, and 20 who were upwards of seventy years •of age. One of these had been forty-two years in Auckland and Porirua Mental Hospitals. The general health of patients has been good. There has been comparatively little sickness in the wards. Typhoid fever, which in former years seemed so difficult to eradicate, was entirely absent. We have, however, two typhoid-carriers continuously quarantined under as comfortable conditions us circumstances will allow ; one of them is a carrier of many years' standing, and until discovered and quarantined was, I think, the chief source of infection. I regret to have to record an unusual number of fatal accidents. A frail old man who had been over twenty years in the Mental Hospital was asphyxiated at dinner by food blocking the air-passages. Although medical aid was immediately summoned, efforts to save his life were unavailing. Two deaths from suicide occurred, and, as is usual, the tragedies happened not in those cases which are obviously suicidal and are under special and close supervision, but in those which are hardly suspected of being suicidal at all. Both deaths were by hanging. One took place in the daytime in a lavatory adjoining a large day-room in occupation by patients and attendants, and the other in the night, the patient breaking through the window of his dormitory and escaping. Although closely followed by attendants the patient evaded them in the darkness and was subsequently found in some native bush about a quarter of a mile away, but life was extinct. The last fatality to which I have to refer was one which gave me much concern, because it was entirely due to the negligence of an attendant. A demented old man required bathing in the early morning. The attendant in charge of this patient took him to the ward bathroom and, in defiance of the precautions laid down in our bathing rules, allowed the patient to get into a bath of scalding water, and the greater part of one side of the patient was severely scalded. The patient was then dressed, and was up and about all day never complaining. He was too demented, to complain, but his condition was discovered in the evening, and he died next day. The attendant concealed what he had done, but before the Coroner's inquest was closed confessed his responsibility. He was summarily dismissed, and utimately stood his trial at the Supreme Court on a charge of manslaughter. He was, however, acquitted by the jury, who, I understand, took the view that, although there was carelessness or negligence, there was no criminal intention on the part of the attendant. Such a case as this gives one a very unpleasant impression, but I may be allowed to observe that in the course of the year at this Hospital there are fully fifty thousand warm baths given to patients, and many at all hours of the day and night, and that the above is the only accident of the kind which has taken place since the institution was founded. The activities of our community have been run on the usual lines, the farm, the gardens, &c, being developed and benefited by the industry of patients, who have themselves benefited by healthy and useful occupation. For the women there is less variety of work, and practically none out-of-doors. On this account I have organized for them daily excursions ami walkingparties of the milder and curable cases, with beneficial results. In the first half of the year I fortunately had the assistance of Dr. Gribben, whose ability and experience I appreciated all the more because for some months prior to his coming I was without a resident assistant. Dr. Redpath was on duty for about two months in the autumn, and did good work. He left to join the Army Medical Service, and is now on duty in Mesopotamia. Dr. Hodgson was transferred from Seacliff in May, and is still here; he has maintained the high reputation he brought with him. Di\ Reid joined our staff in September and remained six months, when he was appointed to the Army Medical Service, and is now, I believe, on duty in France. He proved himself a capable and painstaking officer, and I regretted losing his services. In the staff of attendants and nurses some difficulty was found in maintaining the numbers in adequate strength, especially towards the end of the year. The shortage was particularly noticeable in the female nursing staff, where the reduction at one time was as low as 50 per cent. War conditions governed the situation. Most of our young attendants had joined the Army, and the vacancies were filled as best we could by married men and by single men ineligible for military duty. Why there was so much difficulty in filling vacancies in the female nursing staff was less obvious, but I dare say it was partly due to the prosperous financial condition of the Dominion, and partly to women nowadays replacing men in business offices and other channels of employment, and so depleting the market.

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