ANNUAL REPORT ON LUNATIC ASYLUMS.
11
given in the fluid form to a great extent, and it has this further advantage that
it does not encourage petty theft on the part of an attendant who can more easily
secrete a piece of bread or other solid food than fluid food, when lying by a
patient's side who is unable to eat it." One of the greatest advantages of the
new rules is that it gives the Medical officer the power of dieting a patient on
' extras ' alone so that there need not be any waste as would be the case when
the diet is restricted to the old rigid scales.
13. NURSING OF THE SICK.—There are no sick nurses in any of the asylums and
the sick are nursed by the attendants under the close supervision of the Medical
subordinates. These attendants not being trained as hospital servants are not at
all fitted for this duty. In the Calicut Asylum great difficulty was felt in carrying
out the instructions of the Medical officer as there was no separate establishment
for the hospital; since my inspection in August last, an attendant has been
detailed exclusively for hospital work. I have submitted certain proposals to
Government regarding the improvement of the nursing in the hospital of the
Madras Lunatic Asylum. I am the more convinced of the necessity of this after a
study of the different casualty reports received from this asylum as they clearly
show the great advantage it would be to the patients to have skilled nurses looking
after them during their illness.
14. ESTABLISHMENT—(a) General.—Owing to increase in the daily average
strength of the Vizagapatam Asylum one temporary male day attendant was made
permanent and one temporary male day attendant was taken on during the year.
In the asylum at Calicut one first-class attendant was detailed for hospital duty.
The Superintendent of the Asylum remarks that the clerk and steward, the store-
keeper and the head-keeper performed their duties to his 'satisfaction' and that
the male and female keepers, &c, 'have, on the whole, done their work well.'
In the Madras Asylum, the Superintendents in charge were Surgeon-Major
Thornhill, from 1st to 24th January 1894 ; Surgeon-Major J. W. Evans, from 24th
January to 16th November 1894; and Surgeon-Major D. Elcum from November
17th to the end of the year. Surgeon-Major Evans has spoken well of all the
establishment, with the exception of the steward whose faults he sums up under
' passive resistance;' but Surgeon-Major Elcum does not concur in this opinion
and says that as at present constituted the Steward's department is insufficiently
provided and a second assistant steward and a linen clerk are necessary to carry
out the work of this department efficiently. I was so convinced of this after a long
and troublesome investigation I carried out in October last regarding the charges
made by Surgeon-Major Evans against the steward that I submitted certain
proposals to Government in my T.4/36 of 29th November with the view of giving the
steward more assistance; until this assistance is available, I do not consider it is
possible to expect the duties of the steward to be carried out efficiently.
Both the matron and the assistant matron are well spoken of, for the efficient
performance of their duties, by Surgeons-Major Evans and Elcum. Surgeon-Major
Elcum concurs with Surgeon-Major Evans in his opinion that the European
attendants have done their work satisfactorily being now more careful in super-
vision of the patients' clothing and asylum property. The Superintendent states
that the establishment of the hospital should be separate from that of the general
asylum and should consist of trained men, better paid, for the duties of attendants
on the sick. This will be done if my suggestions regarding nursing are sanctioned.
A highly-trained and properly-paid European or Eurasian appears necessary
to relieve the Superintendent of the details of administration of the asylum. Such
an appointment was sanctioned for the General Hospital in the year 1874 and the
Head Steward there, who is now a European, has been the greatest assistance to
the Senior Medical officer. I have not made any proposition regarding such an
appointment on account of the financial difficulties of Government, but I am fully
convinced that if the Superintendent and his Assistant were relieved of a great
deal of the detail of administrative work they would both be able to devote more of
their professional knowledge to the actual treatment of the insanes ; it must be
remembered that the whole asylum is but an hospital for mental diseases many of
which are curable under efficient medical care and attention.