52

Auckland Provincial Government Gazette.

shortcomings in the treatment of the insane are not owing so much to want of knowledge, as to want of power. It is very easy to give directions as to the treatment of a maniacal patient who has been many nights without sleep, who raves and storms, and tears up and destroys his clothing, and shows himself wholly incapable of understanding anything said to him, but how are these directions to be followed out? It is simply absurd to think of dealing with a patient in the storm of a maniacal paroxysm, as with any one possessed of the smallest power of self-control. The treatment I have followed and by which I abide, notwithstanding all the varying views on the subject, has been simply this: I place the patient during a paroxysm in a padded, or other single room, as the case may be, leave some food and drink, and close the door. This is a paroxysm of acute mania. The patient probably imagines that he is going to be flogged, hanged, or shot; nothing can be done in the way of argument; it is absolutely worse than useless. Leave the patient alone—no meddling interference. Upon this I choose to dwell, because I am most directly and decidedly opposed to another plan, namely, that of placing nurses or attendants in the room with a patient, to hold or restrain him from injuring himself during the paroxysm. This I have always looked upon as adding fuel to the fire, and I have for many years opposed, and do now oppose, such a method of treatment, especially in an Asylum where proper rooms are to be had. Let the attendant remain outside the door of the apartment, but let him never attempt to argue with, or restrain by manual force, a patient in a paroxysm of acute mania, when means of seclusion can be had. The poor patient is fighting, as it were, with his own delusions. A calm generally follows, when the patient is at once allowed to enjoy as much liberty as is compatible with his safety.

There is one practical subject perhaps peculiar to this Asylum, to which I beg to draw your Honor’s attention, because it seriously militates against the comfort, if not also against the possible chances of recovery of several (in an asylum point of view) quiet patients. It is the mixing up, or placing in the immediate vicinity of Europeans, certain Maori patients. After a few years’ experience in this Asylum, I find that these Maori patients, especially females, are decidedly the most noisy during the night. I write this article at midnight, on the 28th January, 1874, after a visit to the patients, and I find that the only disturbance amongst 140 patients is caused by two Maori women, who cry out incessantly, to the great annoyance and injury of the poor patients in their vicinity, who cannot obtain a night’s rest, owing to their endless howlings. I submit that a few whares apart from the other patients, would not only be more suitable for these noisy Maoris, but more conducive to the recovery of the other patients.

ATTENDANTS.

I must candidly admit that the attendants employed in this Asylum, during the past year, have discharged their duties in a most satisfactory manner. These duties were of a most peculiar character, and few persons who have not resided in an Asylum can form any idea of their nature and extent. The amount of patience and endurance of opposition to their efforts to render the patients even ordinary service has been remarkable, and I am happy to be able to report that no injury worthy of note has been inflicted on any patient during the past year. Considering the number of cases treated, and the want of sleeping accommodation in the wards, which compelled us to place several patients in the corridors and day rooms, the absence of any injury to any patient is on the whole remarkable. I believe it to have been chiefly owing to the careful selection of the patients who were placed outside the wards, and the inspection of the night watchman, aided when necessary by the Resident Surgeon and other hands. There is one very important subject to which I beg to draw the attention of your Honor’s Government, and it is this: The attendants occupy the rooms respectively appointed for them, but if married and having families, they cannot enjoy the privileges of married life, hence many complaints have been made by married attendants who found themselves compelled to reside wholly apart from their families. I beg to submit that the proposition which I first heard from Dr. Paley, during his visit to the Colony, should be entertained. It was that cottages or residences, for the attendants and their families, should be placed on the grounds, as is the practice at the Yarra Bend Asylum, in the Colony of Victoria. I believe this practice would be of great advantage to this Asylum, and would be more profitable than building a wall 12 or 14 feet high around the grounds, as I believe has been already proposed. The cost of a wall surrounding these grounds of upwards of twenty acres would be very heavy.

OUTER FENCE AND EXERCISING GROUNDS.

The fact that the feeblest patient in this Asylum, either male or female, can with the greatest ease pass from the Asylum grounds to the public road, or to the adjoining paddocks, might render it a remarkable circumstance that so few have effected an escape, in point of fact none have been lost, although a few have been missing for a few hours, and one or two only for some days. The question arises, what is Asylum treatment? Are the inmates to be locked up in cells or yards? or are they to be allowed as much liberty as is compatible with their safe keeping? The latter view seems to be that of the English Commissioners in Lunacy, and with such view I heartily coincide, whether it has reference to curable or incurable cases. In the first it is indispensable to recovery, in the last it ministers to the comfort of a class, upon whom society, whilst exercising a necessary control, has no legitimate authority to inflict any punishment whatever. Hence the grounds attached to an Asylum should be protected by an outer fence, that as many patients as possible might enjoy, if not real, at least seeming liberty, and have permission to roam about without incessant orders from their keepers, which I feel certain has a prejudicial influence over the disturbed and enfeebled intellect. So far as the curative treatment of the insane enters into consideration regarding Asylum management, I hold it to be simply absurd to look for recovery, whilst the patient is subjected to a stricter discipline than that of a common criminal prison. But in order to secure the full amount of benefit to be derived from medical treatment in an Asylum, it is imperative that the patients’ personal liberty should be as slightly infringed on as possible. The feelings caused by rigid restraint, which it is certain very many patients in an Asylum experience, is altogether subversive of any efforts towards moral curative treatment. I therefore submit that at least eight cottages, for the occupation of married attendants and their families, should be erected around the grounds of this Asylum. The occupants (i.e. the wives and families of attendants) should have a direct interest in the general oversight of patients, so far as the giving notice of patients escaping, or the occurrence of anything irregular. They should also interest themselves in every matter concerning the welfare of the patients. I am under the impression that a system so carried out would be beneficial to the patients, and possibly much more profitable than brick or scoria walls, 12 or