5

H.—7

MEDICAL SUPEBINTENDENTS' EEPOETS.

AUCKLAND ASYLUM. Sir,— I have the honour to forward my report for 1897. I assumed office on the Ist April of that year. On account of the unfortunate ill-health of my predecessor, and his hurried arrangements for a long sea voyage, I was unable to receive the reins of office directly from his hands; but my previous knowledge of the patients and the general working of the institution made my task at the outset much easier than even I had anticipated, and rendered this more or less unnecessary. It is not often that an altered official relationship brings with it an universal cordial support, and my case was no exception to the rule. The opposition I encountered was, nevertheless, insignificant and easily overcome ; and I feel it a matter for great gratification that I have all along received the loyal support of all that was best on the staff, and been able to add others who co-operate with the older members in working harmoniously with me, and, to a large extent, subordinating individual good to the good of the institution. I take this opportunity of thanking Dr. Fox, the Assistant Medical Officer, who is most devoted, and the staff generally for their sympathy and interest. The average number of patients resident during the year was 424 : males, 271; females, 153. The number remaining in the Asylum at the end of the year was 433. This gives the remarkably small increase for the year of only 9 patients. The increase for 1896 was 33 patients. The admissions totalled 89 : males, 55; females, 34. Of these 44 males and 27 females were admitted for the first time. In 1896 the admissions numbered 102. The discharges were : 38 recovered, 6 relieved, and 1 not improved, giving a percentage of recoveries on the admissions of 42-69, as compared with 3039 for 1896. The reduction in the admission rate is probably due to the collapse of the mining boom, with its mental tension and subsequent disappointments, and to the more healthy prosperity which since then has existed over the greater part of the area from which our patients are derived. This reduction is unquestionably a matter for congratulation. Whether we must congratulate ourselves upon the large increase in the discharge rate is another matter. When we consider that of the 38 discharged recovered 25 were under the age of forty years and 31 under fifty it were perhaps well that we should suspend our rejoicings. The immediate social and economic advantages to the individual and the country must be weighed, amongst other things, against the possibility of the propagation of hereditarily enfeebled brains, and knowing intimately, as I do, the mental characteristics and social environment of those discharged, I can have no possible doubt that some at least will return to the Asylum, and in the meantime reproduce their kind with disastrous effects. The death rate calculated on the average number resident during the year was 849 per cent., as compared with 9-32 per cent for 1896. Our rate for last year was approximately the same as the average, 8-7 per cent., for the asylums of Great Britain for the period 1886-95. It is nevertheless abnormally high. Apart from the deaths from tubercular diseases, I cannot at present account for the high mortality. One factor is probably to be found in climatic conditions. On reference to the vital statistics of the colony it will be found that the rate in Auckland is usually higher than in the other large centres of population, and we naturally anticipate a slightly higher rate in this as compared with the other large asylums of the colony. It must be my endeavour during my tenure of office to ascertain the cause of, and, if possible, make a reduction in, our large obituary list. The tubercular death rate for the year was 25 per cent, of total deaths. The average for the Auckland Provincial District, from which our patients mostly come, was, for 1894-95, approximately 97 per cent, of total deaths, and for Auckland City and suburbs, where they reside, 12-3 per cent. The figures, which I have not at hand, will hardly differ for 1896-97. It is, of course, absurd to strictly compare these with the rates of a large institution, but they will serve to show that the Asylum rate is extraordinary. It is unnecessary to comment. The cause is obvious, the cure equally obvious. The saddest event of the year was the escape and subsequent suicide of a profoundly melancholic patient. Much has already been said on the case, and I shall only add that all here concerned have felt the matter very acutely, and I am confident that nothing will be left undone to prevent, if possible, the recurrence of such a catastrophe. During the year two patients received fractures of the neck of the thigh-bone. Both were thrown from their seats by other patients, and in both old age predisposed to the fracture. These were the only serious accidents. After assuming control I at once considered the desirability of introducing women patients into the kitchen instead of men. With your concurrence the reform was effected, and lam pleased to say has given me great satisfaction. One of the difficulties connected with this Asylum in providing suitable employment for the women has been overcome, and the kitchen is now a curative agent of more than ordinary importance. By its means one patient who was indolent and rapidly drifting into a state of hopeless insanity became active and intelligent, and was soon discharged, and I have noticed a beneficial effect in several other cases. A poultry-station has been established during the year, and a large amount of other work has been begun which, when completed, will in my opinion effect considerable improvement. The new reservoir and pumping-station have been completed, and our water-supply is now an admirable one. I anticipate a considerable saving. The event of the year was the opening of the new wing on the male side. The Resident Engineer merits our thanks for the admirable way in which he has finished the work. Personally, I have to thank him and his officers for the courtesy they have shown in acceding to my suggestions