240 



I he Review of Reviews. 



March 20, 1906. 



prived of all happiness? A man suffering from can- 

 cer or other incurable bodily disease is not allowed 

 to die without everything being done to render his 

 last days as bright as possible. Why, then, I ask, 

 should the case so often be different with one suf- 

 fering from an incurable mental malady ? We have 

 deprived him of his liberty, though he has com- 

 mitted no offence against the laws of his country. 

 To be insane is not a crime. To have an affec- 

 tion of the brain is no more disgraceful than 

 to have disease of the lungs, heart or any other 

 organ of the body. It is no more due to the fault 

 of the patient himself than are these maladies. 

 The brain is the organ of the body which con- 

 trols our every thought and action. Surely, then, 

 if deraaged or upset from any cause it should re- 

 ceive at least as much care and attention as any 

 other organ of the body when similarly attacked. 

 Its structure is marvellously intricate, and, should it 

 become affected, it requires the most careful hand- 

 ling, and, if so handled, especially in the early stages, 

 it will in many cases result in complete and per- 

 manent recovery. An intricate piece of machinery of 

 any description when out of gear is treated with 

 the greatest gentleness if it is to go again. So it 

 should be with the brain, which is a far more deli- 

 cate piece of mechanism than the hand of man 

 ever constructed. 



What, then, in a general way, are the conditions 

 necessary for the proper treatment of a patient 

 whose brain has become deranged ? 



(a) Pleasantly situated, airy, well-ventilated sleep- 



ing and living rooms. 



(b) Bright and commodious exercise grounds, sug- 



gesting as little as possible confinement or 

 imprisonment. 



(c) Interesting and healthy occupation — reproduc- 



tive where possible — for minds and bodies. 



(d) Means for the proper classi-fication and super- 



vision of the various forms of mental disease. 



(e) A sufficiency of medical officials to ensure in- 



dividual care and attention. 



(/) An efficient and reliable nursing staff. The 

 importance of this condition cannot be over- 

 stated. In my opinion, the first qualities of 

 a good mental nurse are the possession of 

 tact, temper and patience. In addition a 

 nursing certificate is desirable, and the train- 

 ing necessary for it should be obtainable in 

 any up-to-date Asylum. Mere certification, 

 however, without the qualities mentioned, will 

 never provide a satisfactory mental nurse. 



(g) Ample recreation, both indoor and out. 



(h) Suitable clothing and food ; the latter selected 

 with a view to individual requirement, pro- 

 I>erly cooked and so ser\'ed as to enable a 

 patient to partake of it and keep his self- 

 respect. 



(/) And last but by no means least, provision for 

 the amusement and recreation of nurses and 



attendants when off duty. Their work is 

 often trying and irksome in the extreme, and 

 the nature of it necessitates their being on 

 duty for long periods at a time. If properly 

 performed, they must have pleasant relaxa- 

 tion or inevitably break down. 

 Do we find these conditions even approximately 

 folfilled in many Australian Asylums? With the ex- 

 ception of those of New South Wales — which in 

 manv respects form an honourable exception— un- 

 fortunately no. Thus in Victorian Hospitals for 

 Insane, where there are in round numbers 4500 in- 

 mates, I say they are disgracefully huddled together, 

 for the most part in altogether unsuitable and badly- 

 equipped buildings, that the large majority of the 

 patients spend their time in dull and dreary yards, 

 prison-like in the extreme, that they are badly fed 

 and grotesquely clothed, that the treatment they re- 

 ceive for their mental malady is practically nil, and 

 that the deadly monotony of the lives they lead is 

 simply heartbreaking. About one-third of the nurs- 

 ing staff is now, and has been for years past, on 

 temporary engagement. What inducement is there, 

 therefore, for nurses and attendants so employed to 

 make themselves proficient in the care of the men- 

 tally-affiicted. I have heard it said as an argument 

 in favour of keeping a large portion of the staff 

 on temporary engagement that those so employed 

 often do their work better than do some of the per- 

 manent staff. Let the machinerj- for getting rid of 

 the unsuitable, whether permanently or temporarily 

 engaged, be rendered as little cumbersome as pos- 

 sible, and that argument will be no longer heard. 

 There are among: our staff — as there always will be 

 in a large body of men and women — some black 

 sheep, but, take them as a whole, our nurses and 

 attendants compare favourably with those working in 

 a similar capacit)' in any part of the world. 



I do not intend to go into the details of the hard- 

 ships patients in many of our Asylums undergo. 

 They are in many cases astounding and astonishing. 

 But had I the desire, I have not the space. One 

 question alone I will refer to. Without doubt, fear 

 of a coroner often prevents an actively suicidal 

 patient from obtaining that chance of recovery which 

 is his due. Only recently I saw in an Asylum a 

 man far on the road to hopeless dementia who had 

 been confined in a strait-jacket every night for seve- 

 ral years, and simply because he had manifested 

 some suicidal tendency. I have not the slightest 

 hesitation in saying that such restraint precluded in 

 his case all chance of recover}'. We should, I think, 

 in justice to our patients, be prepared to allow any 

 suicidal case reasonable liberty if by so doing we 

 give it a chance of recovery and prevent it drifting 

 rapidly to dementia. 



And now, finally, I come to the question — How 

 best can the public be enlightened so as to ensure 

 reform in the conditions under which our unhappy 

 insane exist? Something, surely, must be done, and 



