in a general hospital. That a small Advisory Board, preferably associated with the Board of Control, should be available for consultation by Visiting Committees when making these appointments. [Para. 19.] (iv) That the number of assistant medical officers should be increased, and full facilities given for study leave (this is urgently needed at Prestwich); that a proportion of the medical staff in mental hospitals should be recruited from those who have had some previous general experience as house-surgeon or housephysician; that the appointment of consultants and of a visiting dental surgeon to all large mental hospitals is desirable. [Paras. 20, 24.] (v) That the Departmental Committee on the Nursing Service should be asked to consider the following suggestions: (a) some distinction should be made between the two duties of mental nurses, namely, nursing proper and social duties; that the hours devoted to the former should be relatively few, but that more time should be given to the latter; and that the present rigid system. involving short shifts of duty should be discontinued: (b) the mental nursing service requires co-ordination with the general body of nursing, and steps should be taken to attract a better class of probationer, particularly in the case of female nurses: (c) every institution should have at least one fully qualified hospital nurse on its staff. That at Prestwich the lectures for nurses should be re-started immediately, if this has not already been done. [Para. 21.] (vi) That seclusion requires a more precise definition by the Board of Control; and that the practice in regard to seclusion for short periods at Prestwich should receive the attention of the authorities. [Para. 22.] (vii) That the diet of mental hospitals generally and at Prestwich in particular requires improvement in the direction of greater variety; and that patients who are allowed to stay up after 8 o'clock should be given some light refreshment during the evening. [Para. 25.] (viii) That the employment of patients in workshops and the occupation of patients who might otherwise do nothing, would be improved, especially in regard to the variety of work, by the appointment of & special officer at each institution to act as Occupations Officer; that the possibility of the payment of commensurate remuneration to patients doing useful work should be considered. That at Prestwich the organisation of employment, occupation and outdoor exercise of patients requires further development. [Paras. 26, 27.] (ix) That Visiting Committees should consider the desirability of providing letter boxes in which patients can post their letters; and that in every ward a notice should be posted up informing patients of their right to forward letters unopened to the authorities prescribed by Section 41 of the Lunacy Act, 1890. [Para. 29.] (x) That the organisation of after-care work needs to be considerably strengthened and extended, particularly in the provinces, with a view to facilitating the discharge of patients who, though not fully recovered, could dispense with institutional care if suitable sheltered conditions were provided outside. That notices should be placed in the waiting rooms of public mental hospitals to inform friends and relations of patients of the provisions of Section 79 of the Lunacy Act, 1890, empowering them to make application for the discharge of a patient. [Para. 30.] (xi) That the provision of facilities for the early treatment of incipient mental disorder without certification, though not within our terms of reference, would in our opinion be of great value to the community. [Para. 31.] (xii) That the possibilities of co-ordinating the higher research work by concentrating it in a few fully equipped institutions, which could be used as training centres, should receive careful consideration. [Para. 31.] (xiii) That the Visiting Committees should be strengthened by the co-option of persons who have special qualifications and time to devote to the work; failing special legislation, this could be effected to a large extent if the authorities availed themselves of the powers provided in Sections 28 and 66 of the Mental Deficiency Act, 1913; that apart from official Visiting Committees, Local Authorities should consider the desirability of authorising a small unofficial committee of responsible persons to visit their mental hospitals from time to time and report thereon; that greater facilities should be allowed for friends and relatives to see patients in the wards of mental hospitals. [Para. 32.] (xiv) That additional assistance is necessary to enable the Commissioners of the Board of Control to carry out the heavy duties now devolving upon them. [Para. 33.] (xv) That the attention of the authorities should be drawn to the following: (a) the character of the arrangements for the daily toilet in mental hospitals : (b) the number of hours during which patients are kept in bed: (c) the importance of tact and consideration on the part of officers and other members of the staff of mental hospitals in dealing with the friends and relatives of patients: (d) the possibility of facilitating the transfer of certain chronic patients. [Para. 34.] Conclusion. 38. (i) We are satisfied that the present provision for the care and treatment of the insane is humane and efficient, and that the personal care of the individual patient compares favourably with that in any other country; but we have attempted to indicate certain directions in which improvements and developments could be effected with advantage. It is, of course, obvious that these would involve increased expenditure, and if the community does not feel justified in incurring this, the critics of our mental hospitals must remember that it is the community itself which imposes limitations on the extent to which the efficiency of these institutions can be developed. (ii) We desire to express our appreciation of the assistance given us in the course of our enquiry; and in particular we desire to thank the Commissioners of the Board of Control, the staff of the Ministry of Health, the Medical Superintendents and the staff of a large number of menta! hospitals, and the witnesses who have appeared before us. In conclusion, we wish to place on record our great obligation to our Secretary, and to thank him cordially for the courtesy, ability, and unremitting industry with which he has assisted us during this enquiry, which has involved a great deal of patient work, both in the collection and co-ordination of material, often of a highly technical character, and in the drafting of this Report. We have the honour to be, P. BARTER, Sir, Your obedient Servants, (Chairman). R. PERCY SMITH. BEDFORD PIERCE. Secretary. APPENDIX I. WITNESSES HEARD IN PUBLIC. A. H. TREVOR, Esq. C. HUBERT BOND, Esq., C.B.E., M.D. C. Cox, Esq. A. M. DONALDSON, Esq. A. W. SALE, Esq. J. T. CAMPBell, Esq. R. H. O. MEARS, Esq. SIR NORVAL H. HELME. J. T. TRAVIS-CLEGG, Esq. J. R. SMITH, Esq. J. G. TAGGART, Esq. The REV. J. G. Deighton. C. KNOX BOND, Esq., M.R.C.S., L.R.C.P. L. A. WEATHERLEY, Esq., M.D. DR. SARA WHITE. D. OGILVY, Esq., M.D. Miss E. D. VICKERS. E. MASON, Esq. The REV. J. J. BROWNHILL. The REV. H. KIRKLAND-WHITTAKER, M.A., M.D. L. O. FULLER, Esq., M.R.C.S., L.R.C.P. G. E. PEACHELL, Esq., M.D., M.R.C.S., L.R.C.P. Miss BARTLEET. Miss WILLIAMS. Miss CLARK. SIR, APPENDIX II. CORRESPONDENCE WITH DR. LOMAX. Ministry of Health, Whitehall, S.W. 1. I am directed to enclose for your information a copy of an official announcement which is being issued. The Committee would be glad to hear evidence from you in regard to the statements made in your book "The Experiences of an Asylum Doctor," and I am to enquire whether you could assist them by attending for that purpose on Thursday, 2nd February, at 10 a.m., at the Ministry of Health. I am to state that the Committee would be obliged if you could furnish them beforehand with a précis of the evidence which you would like to submit and I am to ask that such a statement may be forwarded to me not later than Monday, 23rd January. Should there be any point on which you would desire further information I should be happy to explain personally, and could see you at this office on any day convenient to yourself, between the hours of 11 and 1, if you will be good enough to give me one or two days' notice of your intention to call. I was away yesterday and your letter was wrongly * addressed. Hence the delay in my reply, which I regret. I am prepared to give evidence before the Enquiry, but I am none the less surprised at the wording of its terms of reference and their scope. The terms of reference speak of charges" brought by me. The only "charges" I bring in my book are charges" against the System, not against individuals. I saw the futility of bringing charges against individuals and individual asylums. I say (p. 19), One of the chief charges I bring against the System." Again, "I bring no such charge against any individual officer." Even in my general indictment in the last chapter (pp. 250-252), I bring no charges against anyone except as agents, and more or less involuntary agents, of the System. I merely expose a certain state of affairs. I say, "It was the spectacle I saw." Further, I should like to emphasize the fact, repeated more than once in my book, that my asylum story was founded entirely on my experiences at Prestwich Asylum. My experience of the System was gained in two asylums and was the same in both, but my story was founded upon one asylum and one asylum only. I was only at the Bracebridge Asylum for seven weeks seven years ago, and my memory for events there is vague. So much for the "charges" alluded to. You ask me for a précis of the evidence you would like to submit." I propose to submit no such précis. All the evidence before the Committee is contained in my book, and I shall attempt to justify any statement made in it. I cannot be made to assume the responsibility of bringing definite charges against anything but the System, and I have no other evidence to give, except that supplied in my book. It is difficult for me to understand the attitude of the Ministry of Health in this matter. Sir Alfred Mond, in replying to a question in the House of Commons on 3rd August last, stated that: "The Visiting Committee of the Asylum at which Dr. Lomax was employed as locum tenens, and to which he evidently referred, had been asked by the Board of Control for their observations. When these had been received he would consider what further action was necessary." Has the Board of Control made these observations, and is the appointment of the present Committee the result of it? If so, the Board of Control has presumably satisfied itself of the existence of facts which should be enquired into. The Ministry are then in possession of these facts and presumably intend to enquire into them. In this case why ask me for a précis? I am quite prepared to be examined on these facts, and, if possible, to defend my statements. " * In the Medical Directory Dr. Lomax's address is Uncommunicated.'' |