(2) Admissions by Transfer.

The number of patients transferred from one establishment to another during 1926 was 218, which is 43 less than the previous year for the five and 376 less than the average

years

1920-24.

(3) Admission of Voluntary Patients.

Voluntary patients are persons who, with the sanction of the Board, granted on a simple application signed by the patient, voluntarily enter asylums for treatment of mental disorder. They cannot be detained for more than three days after giving notice of their intention or desire to leave. They are not certified as insane and are not registered as lunatics, but a record is made of their names and other particulars regarding them. The whole number of such persons admitted into asylums in 1926 was 628. The average number admitted for the ten years 1917-26 was 357. The number resident on 1st January, 1927, was 721.

DISCHARGES FROM ESTABLISHMENTS.

(1) Discharges of the Recovered.

During 1926 185 private patients were discharged recovered, which is 16 less than the number in the preceding year, and 79 less than the average of the five years 1920-24. The number of pauper patients discharged recovered was 969, which is 18 more than in the preceding years 1920-24. year, and 34 less than the average for the five

(2) Discharges of the Unrecovered.

The number of private patients discharged unrecovered, excluding transfers, during 1926, was 133, which is 5 less than last year, and 53 less than the average of the five years 1920-24. The number of pauper patients discharged unrecovered was 258, which is 29 less than the number so discharged in the preceding year, and is 38 less than the average for the five years 1920-24.

DEATHS IN ESTABLISHMENTS.

The number of private patients who died in establishments during 1926 was 222, which is 21 less than last year, and 52 less than the average of the five years 1920-24. The number of pauper patients who died was 1,164, which is 19 less than last year, and 182 below the average of the five years 1920-24.

The death-rate for private and pauper patients in establishments per cent. of the average number resident for the year 1926 was 8.3, as compared with 8-6 in the previous year.

The causes of death are shown in Table X. of the Appendix.

REMOVALS FROM ESTABLISHMENTS ON STATUTORY PROBATION. At 1st January, 1926, 63 patients were absent from asylums on Of these 36 have been probation, with the sanction of the Board. finally discharged as recovered, 7 were sent back, and 20 remained, on the expiry of the period, under the care of friends. In the course of 1926, 98 patients were discharged on probation. Of these, 17 have been finally discharged as recovered, 4 whose period of probation has expired remain under the care of friends, 25 have been returned to asylums, and 2 died. The number still on probation at the close of the year was 50.

SHERIFFS' ORDERS.

The table on pages 14 and 15 of the Appendix gives the statutory return exhibiting the number of orders granted by Sheriffs for the admission of lunatics into any Public, Private, District, or Parochial Asylum, or House, stating the Asylum or House to which such order referred, during the year ended 31st December, 1926. The number of orders granted during the year was 2,958.

LICENCES GRANTED BY THE BOARD FOR ESTABLISHMENTS.

The number of licences granted by us for the continuance or establishment of private asylums, lunatic wards of poorhouses, and certified institutions for mental defectives, and the transfer of any licence from one establishment to another, during the year ended 31st December, 1926, are shown in Table XI of the Appendix. The licence for the temporary accommodation of mental defectives in the Craiglockhart Poorhouse, Edinburgh, has been withdrawn, and the patients have all been transferred to the new institution at Gogarburn.

CHANGES AMONG ATTENDANTS AND SERVANTS IN EACH
ESTABLISHMENT.

The number of attendants and servants who left, were dismissed, or died, during 1926, was 1,329, which is 50 less than the number for the previous year. The number who resigned their situations voluntarily is 1,034, which is 14 more than last year.

In addition to the 1,034 who resigned voluntarily 64 left on account of ill-health, 17 died during their term of service, 67 left without notice, 41 were dismissed for incompetence or unsuitability, 35 whose services were no longer required were not re-engaged, and 71 were dismissed for misconduct.

ESCAPES FROM ESTABLISHMENTS.

The whole number of escapes during 1926 was 123. Of these, 46 were brought back within twenty-four hours, 33 within a week, and 20 after a week. There were 24 still absent on the expiry of twenty-eight days from the date of escape. Of the 24 patients not brought back, 1 was removed from the asylum registers as recovered, 15 as relieved, 7 as not improved, and I died.

ACCIDENTS IN ESTABLISHMENTS.

The total number of accidents to patients reported to us as having taken place during the year 1926 was 129-which is 3 more than last year. Thirteen of the accidents ended fatally, 4 of them being due to suicide. All were reported to the Crown authorities. Of the deaths by suicide, 1 was caused by hanging, 1 by cut throat, and 2 were caused by taking poison. Of the 9 accidental deaths not attributable to suicide, 1 was due to choking over food, 1 to being run over by a train while on parole, 2 to fractured skulls from falls after fits, 1 to burns received owing to night-dress catching fire, I to septicaemia and shock following a burning accident, 1 to shock and injuries received while jumping from a bedroom window, I to asphyxia caused by the patient turning over on her face while in a fit, and 1 from complications following on a fractured leg.

There were 9 cases of attempted suicide-6 by cut throat, 1 by hanging, 1 by severing the radial artery of the wrist, and 1 by patient throwing himself in front of a passing cattle float. In 52 cases the accidents involved fracture of bones or dislocation of joints, and in 27 cases of injuries to the head. In addition to these, 28 miscellaneous accidents to patients were reported, of which 8 were severe and 20 were slight.

There were also reported during the year 4 accidents to nurses, I accident to an attendant, and 2 accidents to servants-1 of which was fatal and was caused by the servant colliding with a motor-bus, while cycling. An assault on an attendant by a patient was also reported.

III. PRESENT CONDITION OF ESTABLISHMENTS FOR THE INSANE.

Establishments for the insane in Scotland comprise: (a) Royal and District; (b) Private, and (c) Parochial Asylums; (d) Lunatic Wards of Poorhouses; and (e) the Department for Criminal or State Patients in Perth Prison.

The reports by the Medical Commissioners of their inspection of the different establishments have, as usual, been presented to and considered by the Board. For reasons of economy these reports are not presented in full in the Appendix, as was the custom before the war. They are entered in the appropriate books at the respective establishments on the occasion of the statutory visits of the Medical Commissioners, and a copy of each report is preserved for reference at the offices of the Board.

As a general rule, the management of these establishments reflects credit upon the officials, and almost without exception a satisfactory standard of efficiency appears to be maintained. The official registers are stated to be properly and accurately kept.

The following remarks in the case of each of the various establishments are based upon the Medical Commissioners' reports :

(a) ROYAL AND DISTRICT ASYLUMS.

Aberdeen Royal Asylum.

Inspected 9th December and 3rd June, 1926.

(Average number of patients resident during year, 804-5.)

A comprehensive scheme of improvements has recently been carried out in this establishment embodying recommendations made in previous reports.

The hospitals have been markedly improved by the addition of the new verandahs where open-air treatment can be given. These new verandahs are well adapted for this purpose.

Very important factors in the treatment of the patients have been added to the resources of the institution by the establishment of an X-ray equipment and apparatus for treatment by means of ultra-violet rays and diathermy.

It is too soon to speak of the results obtained from the use of this modern equipment, but there is no doubt of its great value, particularly with respect to nervous and mental affections.

A well-equipped dental room has been provided and a qualified dentist visits the institution once weekly. There is also a small operating theatre where any operations required are done by a Visiting Surgeon.

The medical and nursing care of all the patients is well informed and of a skilled description.

At the second visit there was an unusual absence of noisy excitement, and this is perhaps to be attributed to the enthusiastic manner in which Occupational Therapy is being carried out. This particular form of treatment has been found most beneficial for those patients who, on account of their mental condition, were unable to be employed at the usual domestic work or out-of-doors, and who unfortunately had nothing to engage their attention or divert their thoughts from themselves and their mental troubles. Occupational Therapy has proved of marked benefit in these directions. There is a trained Instructor in connection with the work, and a number of patients were seen happily engaged at interesting, varied and useful occupations.

There is an ample supply of reading material and numerous amusements and entertainments, all of which are much appreciated by the patients who are able to participate in them.

A difficulty which has long existed in the proper serving of food to the hospitals has been remedied by the installing of an electric trolley which conveys the food direct from the main kitchen to the hospital kitchen.

Considerable thought has been given to the dietary, particularly in the very important matter of variety. At present the dinner arrangements ensure a variety for each day in every four weeks. On the second day of the first visit it was gratifying to find that 400 of the patients were served with fried fish instead of the steamed fish which is usual in large institutions. This innovation, extremely welcome to the patients, has been brought about without any additional expensive apparatus, but of necessity with a great amount of extra work for the kitchen staff. Fried potatoes are also served on occasions as a change, and there was abundant evidence of zealous co-operation in ministering to the welfare of the patients in this matter of variety in dietary.

All the patients at Daviot were found in their usual satisfactory condition.

The management of the institution is characterised by a progressive spirit, and the evidence of the desire to keep the care and treatment of the patients abreast of modern views was noted with approbation.

Crichton Royal Institution.

Inspected 8th June and 9th and 10th November, 1926.

(Average number of patients resident during year, 739-0.)

It was observed at the second visit to this institution that the number of voluntary inmates admitted during the previous six months exceeded the numbers admitted under certificate by 17. The changes which had taken place among the voluntary inmates indicated that practically all the voluntary inmates admitted at the beginning of the six months had been discharged as recovered or have been much improved.

All the voluntary inmates belong to the private class. There is nothing to prevent parishes sending in patients chargeable to them on a voluntary basis except the fact that the Lunacy Grant is only paid when patients are certified.

This consideration prevents patients from obtaining care and treatment in early stages of their affection. In the long run it would be more economical to individual parishes to send their patients in voluntarily as it would undoubtedly prevent many of these patients from becoming permanent inmates of the institution.

The Nurses' Home and the dining rooms for patients and staff, which have just been completed in association with Crichton Hall, were inspected. Alike in structural arrangements and equipment the provision is on the most generous lines.

The hospital in connection with the first department is making progress towards completion and should prove a very valuable adjunct to the institution. The Matron in charge of the intermediate and hird departments has left after many years' service, and in her place two Matrons have been appointed-one for each department. Both these new appointments have been filled by highly trained and carefully selected nurses.

The hospital arrangements throughout the whole institution are efficient in a very high degree. Many of the patients, both recent and convalescent, expressed their satisfaction and showed it by their cheerful contented demeanour.

The medical care is carried on with energy and in accordance with all modern accepted methods of treatment, while the nursing is of the highest and best description.

There has been no entry in the Register of Restraint and Seclusion, and as illustrating the humane methods for the care and treatment of the large number of inmates of this institution it is interesting to point out that for the past ten years there has been no use of restraint or seclusion.

Open-air treatment and exercise are taken advantage of to the greatest possible extent, and the conditions in which the beautiful grounds of the institution were found at the first visit must have a beneficial influence in restoring the patients to health or ameliorating their condition.

All parts of the institution were found in excellent order, the sittingrooms and day-rooms were bright with plants and flowers and the surroundings of the dormitories were such as to conduce to restful conditions and comfortable sleep.

The impression was formed that the management of the institution continues to be of a most efficient and conscientious description.

Dundee Royal Asylum.

Inspected 12th January and 27th July, 1926.

(Average number of patients resident during year, 59.5.)

The condition of this Asylum in every respect was found to be most satisfactory. The furnishings are artistic and comfortable and the arrangements in the "sitting-rooms, bed-rooms, and dining-hall are maintained at a high standard much appreciated by the patients.