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, 1923. The number of orders granted during the year was 3318.

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, 1923, is shown in Table XI. of Appendix A.

CHANGES AMONG ATTENDANTS AND SERVANTS IN EACH
ESTABLISHMENT.

The number of attendants and servants who left, were dismissed, or died, during 1923, was 1467, which is 57 more than the number for the previous year. The number who resigned their situations voluntarily is 1097, which is 20 more than last year.

In addition to the 1097 who resigned voluntarily 69 left on account of ill-health, 11 died during their term of service, 121 left without notice, 39 were dismissed for incompetence or unsuitability, 11 whose services were no longer required were not re-engaged, and 119 were dismissed for misconduct.

ESCAPES FROM ESTABLISHMENTS.

The whole number of escapes during 1923 was 150. Of these, 62 were brought back within twenty-four hours, 51 within a week, and 12 after a week. There were 25 still absent on the expiry of twenty-eight days from the date of escape. Of the 25 patients not brought back, 5 were removed from the asylum registers as recovered, 11 as relieved, 9 as not improved, and none died.

ACCIDENTS TO PATIENTS IN ESTABLISHMENTS.

The total number of accidents to patients reported to us as having taken place during the year 1923 was 101. This shows an increase of 14 compared with the number for 1922. Twelve of the accidents ended fatally, 5 of them being due to suicide. All were reported to the Crown Authorities except one case, the principal cause of whose death was Senile Decay and the secondary cause a fracture of the femur caused by . slipping and falling on the floor. Of the deaths by suicide, 1 was caused by hanging, 1 by cut throat, 1 by strangulation, 1 by precipitation from a height and 1 by the patient throwing himself before a moving Railway Train. Of the 7 accidental deaths not attributable to suicide, 1 was due to drowning, 1 to suffocation in a corn bin in which the patient had shut himself in a spirit of mischief, 1 to choking over food, 1 to being knocked down by a Railway Train, 1 died of congestion of the lungs due to exposure and lack of food while absent by escape, and 2 patients who fell

and sustained fractures of the femur died from pneumonia and senile decay respectively. There were 5 cases of attempted suicide, 3 by cut throat, 1 by precipitation from a height, and 1 by throwing himself in front of a loaded farm cart. In 65 cases the accidents involved fracture of bones or dislocation of joints and in 8 cases injuries to the head. In addition to these, 11 miscellaneous accidents to patients were reported, of which 5 were severe and 6 were slight. There were also reported during the year 4 accidents sustained by 3 attendants and 1 servant.

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 would appear 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 5th and 6th June, and 25th September, 1923.

Satisfaction is expressed with the medical and nursing staff, their intimate knowledge of the conditions and needs of all the patients, the excellent state in which the hospital wards in particular were found and the absence of noisy excitement and complaint. The adinission rate now exceeds 200 per annum and this fact, together with the large number of patients in the institution, make it essential that a third Assistant Medical Officer should be appointed. With the progress of medical science, the methods of investigation necessary for an adequate diagnosis of the conditions of the several patients are more complicated and occupy much time, and the suggested addition to the staff would meet these increasing demands. It is believed that much benefit would ultimately be derived by the patients from this appointment.

It was learned with approval that it is proposed to introduce · electrical and hydro-therapeutic appliances at Elmhill. These have been found to be of much benefit in nervous complaints generally and should prove equally beneficial in mental disorders.

Some complaints which had been lodged by patients regarding the quality and variety of parts of the dietary were carefully investigated and certain recommendations under this head having been made to the Medical Superintendent were given effect to.

The general health of the patients is good, and the condition of the institution throughout was found satisfactory.

The management of the branch asylum at Daviot continues to merit the favourable opinions expressed in previous reports. Almost without exception the patients are working and are all contented.

The administration of the institution is represented as being able and active.

Crichton Royal Institution.

Inspected 24th May, and 11th and 12th December, 1923.

The high reputation in which this institution is held is seen in the increasing numbers of patients who enter of their own free will, in the high recovery rate of such patients, and the numerous expressions of gratitude that were heard from many of them. Of the 125 private patients who entered the institution during the period of 7 months prior to the second visit, 86 or almost 70 per cent. did so voluntarily.

The medical and nursing care of all the patients continues to be of a high order, and the equipment and staffing of the various departments are of a most efficient description.

It is gratifying to note that facilities have been afforded for pathological work and investigation, and for the elaborate and highly technical appliances and means required to diagnose the causes of the mental disorders from which all patients admitted suffer. The laboratory is fully equipped for clinical and pathological examinations and is in charge of a thoroughly competent and experienced observer.

The religious requirements of the patients are met by the attentions of clergymen of all denominations who regularly visit their respective charges and conduct services every Sunday in the beautiful Church which is a feature of the institution.

The residential house for the female staff of the Third Division is practically completed and will soon be in occupation. It has been planned with great forethought and will doubtless be much appreciated by the staff.

The recreation ground is now complete and in use, and some very useful, as well as ornamental, additions have also been made to the gardens.

The institution all over was found in excellent order and everything seen testified to the thought and energy displayed by the management towards the welfare and comfort of the inmates.

Dundee Royal Asylum.

Inspected 7th February, and 31st July, 1923.

Excellent order prevailed in all parts of the institution at both visits. The sitting-rooms were bright with plants and flowers, and the bedroom and dormitory accommodation were of the most commendable description.

In general the patients were observed to be enjoying good health and showed evidence of being properly exercised in the open

The medical and nursing attention is regarded with approbation, and in the hospital wards it was evident that the most humane and modern methods for the care and treatment of mental disorders prevail. The management is reported as being highly competent.

Royal Edinburgh Asylum.

Inspected 9th, 10th and 11th May, and 12th December, 1923.

Since 8th November, 1922, the West House has ceased to be the Reception Hospital for the Edinburgh district in consequence of the re-opening of Bangour Asylum. As formerly, the patients now resident belong to the private class with the exception of the aided patients from Orkney and about 100 inmates retained under an agreement with the Edinburgh District Board of Control.

It is fitting that reference should be made to the labours of the staff of West House during a period of over seven years in which the new cases from Edinburgh district alone totalled 2,200. The annual number of admissions to the institution in these years was sometimes as high as 500. During this time no one of the details embodied in the principles of treatment carried out in the institution would appear to have been surrendered to the stress or unavoidable overcrowding.

It is satisfactory to note that a scheme of reconstruction is being carried out at West House which is designed to modernise the building. The scheme includes central heating, electric lighting, redecorating and refurnishing, new bathrooms, lavatories and other improvements.

The residential home for the night nursing staff of Craig House was inspected. It has been comfortably furnished and artistically decorated. Its situation will ensure the staff being completely removed in their off duty hours from all association with their working atmosphere.

The patients generally were found in good health and free from unusual excitement and noise. There was a noteworthy absence of complaint which can only be associated with the excellent supervision of all departments by highly trained and competent women nurses-a feature which has always been prominent in the management of this institution.

The highly satisfactory conditions associated with the dining arrangements, and the food supplied to the patients were most favourably commented on.

There is an ample supply of literature for all patients and the entertainments are numerous and suitable while the outdoor exercising of such patients as are physically or mentally unfitted to work is adequately provided for.

The hospitals are said to be well appointed and the nursing of the patients, as well as the medical service, is represented as being capable and conscientious.

It is recommended that a fire escape staircase be placed in the female hospital at Craig House as the only means of exit from it is a wooden staircase.

The management of the institution maintains its reputation for progress and is characterised as energetic and efficient.

Glasgow Royal Asylum.

Inspected 12th and 13th January, and 29th June, 1923.

Reference is made to an important improvement which has been effected in the Male Hospital Wards of the East House of this institution. Formerly admission to these wards was gained by descending a stair of a cramped and uninviting description. It is now made direct from the grounds; the main entrance has been provided with the necessary reception and nurses' offices. New lavatories and bathroom have been fitted in the corridor which formerly contained single rooms; a day-room has been provided which, with two wards nearest the entrance, will be divided from the rest of the hospital and regarded as the Reception Hospital. It is now possible to have every newly admitted patient thoroughly examined and isolated, if necessary, before being placed in the hospital. This is a very great advantage as the majority of the recoveries take place in the earlier stages of mental disorders and a thorough knowledge of the physical and mental states of newly admitted patients must always be the basis of scientific care and treatinent.

It was learned with approval that the erection of a winter garden may be carried into execution. Associated with this there ought to be facilities for hydro-therapeutic, massage and electric treatment. more efficient means can be placed in the hands of a physician for mental disorders.

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Favourable comment is made on the large number of patients who were engaged in varied occupations, mainly out-of-doors. The increasing extent to which occupational therapy is used is a new and admirable feature. For many years the advantages of farm and garden work for men and domestic work for women have been recognised from curative and ameliorative aspects and many patients have been so employed. There are, however, many patients not physically fitted for these strenuous labours or whose mental disorder such, for instance, as epilepsy, requires that they should be under constant supervision. all such cases the occupational therapy is being tried with excellent results. Patients were seen under a competent instructress making baskets, toys, rugs, etc., and weaving cloth. So successful has the treatment been that it is proposed to erect a special building within the grounds of the establishment where manifold light occupations can be carried out. The site and ground plan of this building were seen and they seem to be admirably adapted for their purpose.

In

All parts of the Institution were found in excellent order and the material wants of the patients are fully attended to.

An opportunity was taken of inspecting the new department of the Institution at Skelmorlie. The new house is a self-contained house placed in delightful and health-giving surroundings. It has been tastefully and pleasingly decorated and furnished, and is lit by electricity generated by an oil engine which has been installed in one of the outhouses. It should prove to be an ideal home for patients who are convalescing and for those whose condition is sometimes aggravated by the surroundings of a large institution.

The impression left at both visits was that the institution is being managed with thoughtfulness and energy, that it is distinctly progressive and that everything that is being done subserves the interests of the patients.