21

H.—B.

to the class of cases themselves nor the want of energy in the management, but in reality to the small quantity of land, which is the ultimate cause of all the principal defects in this Asylum and its management. The worst feature to which this leads is the extent to which confinement in the Asylum courts, seclusion, and mechanical restraint are resorted to. It is impossible but that, among the many discontented, quarrelsome, and violent patients who are crowded together in the yards, with no outlet for the nervous energy developed by their abundant diet, there must be frequent quarrels and fights, and violent assaults. On one of the days of my inspection there were no less that twelve men in seclusion, and eight of these had their arms secured by means of sheets fastened round their chests; and three women were in seclusion, and one who was in the airing court had her arms restrained in the manner described. Some of these patients are exceedingly dangerous, and three of the men, who are extremely powerful and of a downright murderous disposition, live almost continually in seclusion, being only let out occasionally for short intervals while the other patients are not in the yards. It is manifest that the condition of these formidable wretches is positively aggravated by their treatment; but one is bound to admit that in the present crowded state of the Asylum there would be more foolhardiness than courage or humanity in allowing them to mix with tho other patients. About one half of the women engage in industrial occupation. Some ninety men and thirty women join in recreations and attend a weekly dance which is given in the recreation hall. There are twenty-five men and sixteen women who cannot wash, dress, nor feed themselves ; and seventeen men and fourteen women of wet or dirty habits. The staff consists of—Medical Officer (non-resident), at £200; Keeper (with unfurnished house and board), at £400 ; Matron, ditto, at £100; 12 male attendants, with rations, at £100; 8 female attendants, including cook and laundress, at £50; 1 under laundress, at £40. There is no night attendant. It is believed that, owing to the construction of the house, the duties of a night attendant could not be discharged without disturbing the dormitories. The staff is, in my opinion, very insufficient for so large an Asylum. The Keeper is manifestly overworked; he has a large amount of clerking work, most of which he does after 11 p.m., and he is often at work till 1.30 in the morning. He sleeps in his office, so as to be constantly at hand when wanted. He has never had a week's holiday since he entered on duty, and is frequently not oft* the premises for three months at a time. The Matron is also very hard worked, and zealous hi the discharge of her duties. The Medical Officer, who devotes much time and attention to his duties, has latterly moved into a house adjoining the Asylum grounds, so that he is practically resident, but he has not the powers which should certainly belong to the resident Medical Officer of so large an Asylum. The various registers required by the statute are kept with much care and accuracy, and the medical case book is also very well kept.

Auckland Asylum. Inspected 23rd, 25th, 26th, and 30th January, and 2nd February. The number of patients, entered in the medical journal on the 20th January, was —males, 104; females, 61 —total, 165. Of these, sixty-one males and thirty-six females are entered as confined to the airing courts, unemployed, and not joining in recreation ; twelve males and twelve females as being of wet or dirty habits, and unable to wash, dress, or feed themselves ; none as under restraint; two females as in seclusion ; none as wearing strong dresses or locked boots ; and none as confined to the house or to bed. These figures were found on inquiry to be inaccurate ; but even taking them as they are they indicate a want of energy in the management. Although no entry ofthe use of restraint occurs in the journal, it was found that one male patient slept in a straight jacket every night, and had done so almost continuously for several months past; that a female patient, seen with her arms restrained on the 2nd instant, was generally so restrained; and that another female patient was frequently in seclusion for periods of from ten to twenty days at a time, during the greater part of which she was also under mechanical restraint. No entries of these applications of restraint occur in the journal. Neither the Medical Officer nor the Keeper were aware that the male patient referred to was restrained at night. The attendant in charge of the female patient said that she had not reported to the Medical Officer that she had put a jacket on her—that it was not the custom to do so —that he was left to find it out for himself on going his rounds. These instauces of restraint may have been quite justifiable on medical grounds, but they should have been immediately made known to, and sanctioned by, the Medical Officer, who alone should have the power aud responsibility of imposing restraint or seclusion ; and they should be entered in the journal. When it is stated that sixty-one of the men are unemployed, confined to the airing court, and not joining in recreation, the inference is left that the remaining forty-three are employed, take exercise beyond the airing ground, and join in recreation; but this is far from being the case. The actual number employed, as stated by the senior attendant, is—working in the garden, 5-6; pumping water or cutting firewood, 7-8 ; in the kitchen, 3-4; in making beds or ward work, 3-6—total, 18-24. He stated positively that " none whatever beyond that number are employed." The Keeper states that some twelve more than that number are employed in cutting wood or pumping; but it was repeatedly found that reliable information could not be got from the Keeper. None of the men, except those engaged in pumping or cutting wood, or in the garden, take exercise beyond the airing courts ; but it was formerly the custom to send parties of about sixteen men to the seaside to bathe. So far from forty-three men engaging in recreation, there are no means of amusement or recreation in the whole of the male department, nor have there been any for many months past. With reference to the women, it appears that about twelve are in the habit of taking a walk beyond the Asylum bounds, but that all the rest are confined to the airing court. There is a piano on the female side. The proportion of patients who wet their beds is large, especially among the women. It should be one ofthe principal duties of the night nurses to raise most of the wet patients at intervals during