CARE AND TREATMENT.

State briefly your views on the care and treatment of the insane, with special reference to these points:

1. GENERAL CHARACTER OF MEDICAL TREATMENT. Upon admission every case is given a thorough examination and the patient's general condition noted. It is an established rule that every patient upon admission should at once be bathed and furnished with a clean suit of clothing and underclothing throughout. In the majority of cases a mild laxative or cathartic is indicated and prescribed. The patient is then placed under observation and special medical records made upon his condition. The patient's habits of eating and sleeping and his conduct during the night and day are carefully noted and treatment varied accordingly. When necessary, extra diet is prescribed. During the past year several patients have been admitted in a very feeble condition, so that they were at once placed in bed. Aside from special physical disease the medical treatment may be said to be an administration of laxatives and the general use of tonics, sedatives occasionally and nourishing diet.

2. Medicines, how prescribed, dispensed and how and by whom administered, whether by "single dose" system or otherwise.

Medicines are prescribed by a physician, usually upon his morning round, and also to a lesser degree upon the occasion of the afternoon visit, the morning visit being the chief visit of the day. Prescriptions are always written in a book kept for that purpose in the dispensary, and are thence transcribed in a prescription record which shows the medication of each individual case. The medicines are administered by a physician who goes about the wards, accompanied by a supervisor, three times daily for that purpose, the only exception to the rule being those patients who are working out and for whom some simple remedy as a single dose may have been prescribed, and also such patients as occasionally require a dose of medicine at night by order of the attending physician. All medicines are prescribed by "single dose" system and administered as above described.

3. What class of medicines, if any, are kept on the wards and in whose custody kept? State if poisonous drugs of any kind are kept on the wards and what precautions are taken in the use of the same.

No medicines are kept upon the wards unless in the exceptional cases above mentioned. Whenever it is necessary to do so, they are

locked up in a cupboard provided for that purpose in the attendant's room. No poisonous drugs are allowed upon the wards, and on occasions arising for their use the precaution is always taken to have the bottle at once returned to the dispensary.

4. Extra diet for sick and feeble, stating variety provided, by whom ordered, and the method of insuring its reaching those for whom it was ordered.

The extra diet for sick and feeble consists largely of milk, eggs, various preparations of beef, such as beef tea, beef meal and soups, toast, oysters, rice, etc., the staples being milk, eggs and preparations of beef. The extra diet is always ordered by the attending physician and it is the duty of the supervisor to see that it is properly delivered when specially ordered. This he does by giving the order to the cook with the names of the patients; also to the dining-room man, who sends it upon the wards. The attendant upon the ward is also notified. This applies only to occasional orders. The regular diet list is revised weekly, and a summary of the articles contained therein is given to the cook. The names of the patients receiving such extra diet are also prepared in a list which is furnished the attendant in charge of the dining-room, who sees that the diet is properly distributed. These lists are prepared by the attendant physicians and signed by the medical superintendent, a fresh list being prepared weekly.

5. Artificial feeding or forced alimentation; state the rule of practice as to (a) methods of feeding; (b) on whose order and by whom done; (c) usual length of time permitted to elapse after a patient refuses to eat before feeding is resorted to; (d) how often the feeding process is usually repeated in a given case during the day or twenty-four hours; (e) forms in which foods are forcibly administered.

(a) The only method in use here is that of the soft nasal tube. During the past two years it has been necessary to feed but one patient for any length of time. Forced alimentation in her case extended over a year, until she resumed eating of her own accord. In a few other cases food has been administered by the occasional use of the tube. The method in use is to insert the tube previously covered with vaseline, and after its insertion to pour into the funnel affixed at one end whatever preparation of food it is deemed best to give.

(b) Forced feeding is resorted to only by order of the attendant physician and the food is administered by him.

(c) The usual length of time permitted to elapse varies. As a rule I do not permit a patient to go more than three or four days, unless some good reason exists for so doing. It is known, however, that the patient refuses food merely through willful perversion, feeding would be resorted to in shorter time.

(d) Patients are fed but twice a day. Owing to the unnatural manner of giving the food and the danger often attendant upon this method of feeding, I consider that twice a day is sufficiently often. More frequent feeding has, in my hands, resulted in indigestion. It has therefore been our practice to give large amounts twice daily, a dozen eggs and a quart of milk being usually digested.

(e) The forms of food administered are as follows: Eggs, milk, syrup, salt, pepponized beef, extract of beef, beef cocoa, beef meal, and occasionally sherry wine and whisky, with such medicines as are

necessary.

MORAL TREATMENT.

1. State the facilities provided and methods in vogue for the entertainment and diversion of patients, including (a) amusement hall, its location, capacity, kind of entertainments for which it is adapted, and whether used for religious worship; (b) variety and average frequency of entertainments given therein; (e) band of music, and if so, whether composed of patients or employes, or both, or whether hired for the occasion; (d) number and kind of musical instruments provided for the use of patients, exclusive of those used by the band; (e) from what fund are amusements maintained or provided; (ƒ) average number of patients who attend entertainments; and if a record of the number is kept; (g) frequency and denomination of religious worship, and average number of patients who attend such worship and compensation paid to clergymen; state approximately the number of patients of Roman Catholic faith and what provision, if any, is made for their spiritual requirements, including amount of compensation paid for the same; (h) rule as to arrangement for attention to the spiritual needs of the seriously sick and dying; (i) greenhouses, if any, and the estimated cost of same, to what extent approximately are flowers and foliage plants supplied to the wards, and what class of wards are so supplied; (j) generally, the extent to which the wards are supplied with pictures, bric-abrac and other ornaments, also, song birds, if any, and if these

things are supplied to any extent to the "disturbed wards;" (k) have you a patients' library, and, if so, the number of volumes contained therein, and, approximately, the number of patients who indulge in reading books; how is the library maintained? () State approximately the number of newspapers, magazines, etc., that are taken or received for patients' use; (m) practice as to taking patients out of doors for exercise; are disturbed patients regularly taken out, and how frequently? (n) Has your hospital a base-ball club, and, if so, what proportion of it is composed of patients? (0) State any other means of amusement or diversion provided for patients.

(a) The amusement hall is located in the centre building over the dining-room, and is accessible from both wings without the patients being required to go out of doors. Its seating capacity is about 150. It is provided with a stage, curtain, foot-lights and dressing-rooms attached, and is adapted for ordinary theatrical amusements, concerts, stereopticons and religious worship, both Catholic and Protestant.

(b) Entertainments are given during ten months in the year with an average frequency of once a week. Entertainments usually consist of farces, concerts, stereopticon exhibitions, occasionally a lecture and variety exhibitions, both vocal, instrumental and theatrical.

(c) There is no band of music attached to the asylum.

(d) We have provided for the use and entertainment of the patients one small organ upon the wards and one large organ in the chapel, also a piano and one or two violins for the men.

(e) We have no fund to provide amusement for the patients. We employ an organist who attends the weekly religious services in the chapel, and is also expected to furnish amusements during the year. The people of Auburn have always been generously inclined to give gratuitous service in this direction.

(f) The average number of patients who attend the entertainments is 110, and the record of such attendance is kept upon the monthly sheet in each ward.

(g) The Protestant form of religious worship (Methodist at present) is observed during ten months of the year by weekly service in the chapel. The average number of patients attending such worship is ninety-five, and the clergyman who officiates is also the prison chaplain. He is paid a salary by the prison department, and, in addition to his work at Auburn prison, is expected to attend to services at the asylum and to the religious needs of such patients as desire him.

The approximate number of patients of the Roman Catholic faith is 124. They are under the spiritual care of Rev. Father Seymour, of the Holy Family church, in whose parish the asylum is situated. This duty is vicariously performed by priests attached to the church, who hold religious services about once in four or six weeks, and, in addition attend to all the wants of the sick and dying of the Catholic faith. Whatever compensation they may receive for these services is paid to them by the prison department proper.

(h) It is an established rule that whenever a patient is sick, should he be a Protestant and request the services of a minister of the Gospel, the chaplain shall be notified, or some other clergyman in town, should the patient express a preference. Whenever a patient of the Catholic faith is seriously sick, a priest is notified invariably, whether the patient requests it or not, inasmuch as it is often a satisfaction to relatives and friends, as a part of their faith, to learn that the dying had received the last rites of the church and absolution.

(i) We have one small propagating-house ($125), one large greenhouse ($600) attached to the asylum, of sufficient size to furnish flowers and foliage plants to the wards, dining-rooms, chapel and elsewhere, both summer and winter. Every ward in the house is constantly supplied with plants, and also the dining-room, and, in addition, the chapel is furnished with cut flowers weekly and whenever there is an entertainment. Upon such days as Easter, Thanksgiving and Christmas, a more elaborate display is made in the chapel and dining-rooms. The windows are supplied with potted plants and hanging baskets, which are entirely unguarded except upon the two most disturbed wards, where a low wire netting about four feet high separate the plants from the main hall.

() The wards are abundantly supplied with pictures and other adornments, but very little bric-a-brac is used. Upon two halls there are plaster busts, and upon the woman's wards are lambrequins, hanging curtains and various adornments about the rooms and beds of the women patients. Nearly every hall and the dining-room is supplied with song birds, of which we have a large number. Three of the wards only are without them. The disturbed wards are largely supplied with pictures, plants and mottoes, and upon one of them is an aquarium containing gold fish with a fountain of running

water.

(k) We have a patients' library, which contains about 550 volumes. The number of patients availing themselves of its use is probably twelve and a half per cent. We have no fund for obtaining a library, but it has been added to largely by private dona