THE 4usfrallan Medical Yournal MARCH 15, 1886. Original -Article. NOTES OF A VISIT TO THE KEW ASYLUM. By W. MOORE, M.D., M.S., Melb. Dermatologist, Melbourne Hospital. The Kew Asylum has lately been brought frequently before the public by criticisms from various quarters ; but it is to be feared that the public generally, and even the members of the medical profession, know very little of the Asylum as regards its internal arrangements, its methods of treating and caring for the insane, and the results obtained. The Asylum stands in the midst of very extensive grounds, and, from its elevated position, commands a wide view of the surround- ing district. There are two main parts of the building, one for the male, the other for the female inmates, separated by a large hall, which is so arranged that it serves for a theatre, a dancing hall, and also for a church, a screen then shutting off the stage from the rest of the hall. On the east of the hall are the men's quarters, consisting of long (somewhat narrow) day rooms, with single dormitories built along one side, and large dormitories at the end. Off these rooms are the bathrooms, lavatories, &c. All the rooms are well ventilated, the small dormitories being Provided with a large ventilator leading into the day room, and being ventilated on the free side by a window and ventilator. A few pictures on the walls of the day rooms, the number of which might with advantage be increased, somewhat relieve the dulness which necessarily attaches itself to very large poorly- fu rnished rooms. The sameness of the dormitories is relieved by Painting the walls in lively colours. The beds are very comfortable, and, like everything all through the Asylum, scrupulously clean. E ach bed is provided with a straw under-mattress, a firm hair M attress, and the requisite number of sheets and blankets, with a good thick quilt. The small dormitories are ordinary bedrooms for patients who are noisy and would disturb the others. In the do rmitory for epileptics, the beds are raised just off the floor, in order to insure against injury from falling out of bed. The baths • VIII. No. 3. 98 Australian Medical Journal. MatcH 15, 1886 are of wood, and, being kept well cleaned, are quite dry and smooth, and free from anything approaching greasiness. The shower-baths are of the same height as ordinary showers, and are so arranged that by pulling a string from outside, a copious shower falls from a tub placed above the bather. Unless the weather is persistently wet, the patients are kept in the open air throughout the day. Many are engaged about the farm ; and those who are unfit, or who cannot be induced to work, are allowed to wander about in the yards under the charge of a few attendants. These enclosures are rough and bare, and might, with advantage, be planted with trees and flowers much more than they are. The newly-admitted patients are kept by them- selves for a time, until their peculiarities are understood ; or, if likely to recover soon, until recovery has taken place. If possible, a patient is never permitted to go into the large yards, but has some work allotted to him. In the women's quarters, the internal arrangements are much the same. A great number of women find employment in the laundry, and seem quite contented and even happy at their work. Others are engaged in sewing, and a great number of the worst patients, both men and women, are occupied picking oakum ; and it is astonishing that so many, who might be expected to be noisy, are wonderfully quiet over their work. The women's day rooms are more cheerful than those of the men, and in these rooms a few women sit quietly sewing. In the male wards, with over 490 patients, there are only about six in bed. Among the females there are more, though only a small number. For a long time there has not been a bed-sore in the institution, which shows that great care must be bestowed upon the general paralytics. The medical attendants recognise the importance of employment as a means of furthering recovery, hence all the work about the institution is done by the patients, with the assistance of the ordinary attendants. All the clothing, the absence of any attempt at uniformity of which strikes one agreeably, is made of strong material by the patients, thus furnishing tailoring as work for the men. A farm also furnishes employment for many, and provides the institution with almost all the vegetables needed, with eggs, partly with butter, and occasionally with beef. In this way 255 males out of a total of 492 are kept employed, whilst the laundry, sewing, &c., keep 245 females, out of a total of 411, in employment. MARCH 15, 1886 Australian Medical Journal. 99 In a very large institution like this, where all classes of patients are received indiscriminately, the results of treatment should not be expected to show a large percentage of recoveries ; and the only way of coming to an opinion as to whether these results are good or bad, is to compare them with the results in similar institutions. In 13 Asylums in England and Wales, each c rontaining over 700 and under 1000 patients, the percentage of ecoveries on the number of admissions varied, in 1884, from 30 '6 in the Devon Asylum, to 52.1 in the Norfolk. In the Kew Asylum the percentage of recoveries on admissions has been, in the last five years, as follows :-1880, 66.46 ; 1881, 36.41 1882, 72.39 ; 1883, 50.89 ; 1884, 55.17. Thus, the results at Kew are seen to compare very favourably with those of the cirEnglish Asylums. And that this is not entirely due to cumstances affecting the patients previous to their admission, (e.g., their surroundings, the quantity and quality of food, &c.), 18 clearly indicated by comparing the percentage of recoveries in the Victorian Asylum with those not only of England and Wales, but also of New South Wales and South Australia. The Percentage of recoveries on admissions are : Victoria, 52.01 ; New South Wales, 36.91; South Australia, 39.71 ; England and Wales, 39.41. Here we have the percentage of recoveries in New South Wales less than that in England and Wales, whilst that of South Australia is almost the same as the latter. In the Percentage of deaths, Victoria compares favourably with England and Wales and the other colonies. Thus, the percentage of deaths °11 the average number resident was, for 1884, in Victoria, 6.97 ; New South Wales, 7.43 ; South Australia, 9.50 ; England and Wales, 9.11. These facts in themselves are a sufficient answer to the adverse criticisms which have been so persistently circulated. It has been said that the Barrack system is a mistake, and that lunatics should be treated in cottages. In England the Asylums, old and recent, are on the Barrack plan, as also in this colony, where the results of treatment are so good. In the Yarra Bend, in addition to a number of large wards and several yards ; there are some cottages. It must be remembered that only a limited number of cases can be treated in cottages, and these are, of course, as a rule quiet and harmless, but equally, as a rule, quite incurable. Further, a great extension of the cottage system would involve a greatly increased expenditure, as the number of -tendants would need to be multiplied considerably. Heller , it is G 100 Australian Medical Journal. MARCH 15, 1886 evident that the cottage system is never likely to be much adopted in Lunatic Asylums which receive patients indiscriminately. Several alterations which have already been decided on will increase the efficiency of the Kew Asylum, and will also afford more space which is urgently needed. Separate rooms for very noisy patients are now in course of erection, and it is intended shortly to build wards for the idiot patients. Then the Asylum, though far from perfect, will be well fitted for the purpose for which it was intended. i.otittp. fittoria. ORDINARY MONTHLY MEETING. WEDNESDAY, 3RD MARCH, 1886. (Hall of the Society, 8 p.m.) Present : Drs. Jamieson, Allen, Moloney, Gray, Tweeddale, Workman, Springthorpe, Neild, W. Moore, J. Robertson, Peipers, Bowen, T. N. Fitzgerald, J. Jackson, Iredell, A. J. Wood, A. S. Aitchison, C. S. Ryan, Fyffe, Alsop, Cox, J. Williams, Elsner, and Griffiths. The President, Dr. JAMIESON, occupied the chair. Dr. DOYLE was presented as a visitor. The minutes of the preceding meeting were read and confirmed. The HoN. SECRETARY reported that the Government Statist had forwarded to the Society a copy of the last issue of the Victorian Year Book, the receipt of which had been duly acknowledged. Several, photographs of cases of elephantiasis of the scrotum, before and after operation, were laid upon the table. Copies can be obtained from Mr. Chuck. The HON. SECRETARY also reported that one gentleman, who was nominated for election as a member of the Society at the last meeting, had unexpectedly left the colony on a visit to England, and that his name had consequently been withdrawn by his proposer and seconder. NEW MEMBERS. The following gentlemen were elected members of the Society : —Dr. William Christian Daish, M.B. Melbourne, of Malvern, proposed by Professor Allen and seconded by Dr. Neild ; MEARca 15, 1886 A ustralian Medical Journal. 101 Dr. Alexander Sydney Joske, M.B. et Ch. B.