/^W*4A tM*~>^R- \l> , [i.j CIRCULAR LETTER TO THE Jmtoital $femtoi[fi 4 &* f#stota (tatwl tfa $m^ 4 ^f»!iiMub)^ie|>; <^>;.*\ Cr. ^•'v \ /"\. K / >• RELATIVE TO -? ",",-,. THE PUBLIC HOSPITAL AND LUNATIC ASYLUM OF KINGSTON. / LEWIS QTJIER BOWERBANK, M. D. 1 have told Most bitter truths, but without bitterness, Nor deem my zeal or factious or mistimed ; For never can true courage dwell with them, Who, playing tricks with conscience, dare not look At their own vices. We have been too long Dupes of a deep delusion." COLERIDGK, a 4\>\mxh\ Writer TO THE INDIVIDUAL MEMBERS OF THE LEGISLATIVE COUNCIL, AND OF THE HOUSE OF ASSEMBLY, OF JAMAICA. Sir, I take leave to address you relative to the condition and management of the Public Hospital and Lunatic Asylum of Kingston. The subject has been prominently before the commu- nity during the last few months—First, by means of my three printed letters to the Commissioners of these In- stitutions—Second, by a published communication of the House-Surgeon, addressed to myself—And third, by the republication and extensive discussion of the con- tents and merits of these respective pamphlets, from time to time, in the columns of the public press. It having been my object that my pamphlets should reach the hands of all public functionaries and other influential persons throughout the island, I had them widely distributed> and forwarded a copy to the address of each member of the Legislature. I shall therefore assume that you received yours, and that you are in some measure aware of the history, progress, and merits of the controversy. 4 In my first letter, I addressed the Commissioners—On the nature of a Hospital in general—Its advantages, and to whom—Its requirements—and lastly, I entered on a consideration of the Public Hospital and Lunatic Asylum of Kingston, in particular. In doing so, it was my duty to point out numerous defects and abuses, of whose ex- istence I was aware 7* and to enquire whether others, of which I had heard, did really exist; and if they did, whether it was with the knowledge and sanction of the Commissioners I no where required my ipse dixit to be conclusive. I called upon the Commissioners to examine for them- selves, and to ascertain the truth, and I offered my evi- dence if required. In my second and third communications, I detailed the effects which my first letter had produced on the Commissioners and the MedicalOfficers of the Institution. First.—How, on the very day of its appearance, the House-Surgeon—himself deeply implicated in the various abuses therein set forth—assumed to himself the right, unknown to the Commissioners, to request " that the Editors of the press, and the public, would suspend judgment upon this plausible but disingenuous produc- tion, addressed to the Commissioners of these Institu- tions, until [he] should publish a reply." Second—How the Assistant House-Surgeon vented his anger and indignation upon me, by returning, soiled and dirty, the copy of my pamphlet that I had forwarded to him the day before, with my compliments: and how he turned out of the Hospital, the nurses of Lady Barkly's Training Institution and the Kingston Lying-in Hospital. Third.--Ho tv the Commissioners, after allowing the nurses of the said Institution to be ejected, and to be de- barred from attending for the space of one month, pre- sumed in a resolution, agreed to at a meeting of their Board, and forwarded to the Secretary of theNurse-train. ing Institution.to declare a statement contained in my first letter to them, to be " incorrect," without first instituting any enquiry, or assigning any reason.—How the i ommis- sioners, by a miserable equivocation, attempted to extri- cate their officer from the just condemnation due to his rash and presumptuous act.—And how I, indignant at the above un-English-like conduct of the Commissioners, addressed a letter to the Chairman, protesting against such treatment, and drew forth from him a most strange and unsatisfactory answer. Fourth.—How, on the 14th May, a pamphlet by the House-Surgeon of the Public Hospital and Lunatic Asy- lum, appeared, addressed to myself, and purporting to be a "Reply" to my first letter to the Commissioners. Such, Sir, may be said to have been the official and public acts of the Commissioners and the Medical Offi- cers of these Institutions, from the 5th April (the ap- pearance of my first letter) to the 26th May, the date of the issue of my last: and each of which acts, I have already in my two last pamphlets alluded to. You will, however, allow me to observe here, that the act of the House-Surgeon was, to say the least of it, in- trusive. My letter, by his own shewing, was addressed to the Commissioners, and not to him. It was also inde- licate on his part to interfere, inasmuch as he himself was deeply implicated in many of the abuses set forth. The onus of exculpating him, rested upon the Commis. h sioners in order to vindicate themselves from the impu- tation of having sanctioned, by not having repudiated and disallowed, the abuses alluded to. Besides, his thus coming forth unasked, looks very much as if he considered the Commissioners fas well as his Medical colleagues) incompetent to perform their duties, and unable to defend themselves. The acts of the Assistant House-Surgeon were ung-en- tlemanly and revengeful, but could in no way injure me. His turning away the nurses however, certainly denoted a thorough contempt for the authority of the Commis- sioners ; particularly as this was the second time of his taking upon himself thus to disobey the orders, nay, to frustrate the intentions, of his emplovers. The conduct of the Commissioners themselves in allow- ing the nurses thus to be banished from the wards of the Hospital for one month, without interfering, to say the least of it, displayed an indifference to the public weal__ ill-becoming public men, guardians of the public institu- tions. It also displayed a feeling of disinclination, or unwillingness, or timidity,to exercise their authority over their officials. The part they ultimately took was undig- nified. I will here add, that though in the Resolution previously quoted, they " regret" the act of the Assis- tant-House Surgeon, still they inconsistently confirm and ratify it. Nay, according to their own version they exceed it ; he, as they pretend, expelled the nurses from the dispensary only—they, while regretting this, not only acquiesce in it, but go beyond, and expel them from the Hospital altogether, by the following resolution—as re- ma kable for its want of firmness and of spirit, as the for- mer was for it j want of justice and fairness. "That during the present state of feeling of the officers of the two In- stitutions—the Commissioners of the Public Hospital are of opinion that no advantage will accrue to the nurses of Lady Barklv's Institution by their continued attend- ance at the Hospital." Thus they at once cut off the single advantage derived by the general community from the existence of the Public Hospital.* And lastly, I wrould observe, that the so-called Reply of the House-Surgeon (sanctioned, waited for, and ap- proved of by the Commissioners) was no reply whatever to my letter addre-sed to the Board Written in the author's pedantic and egotistical style ; replete with inu- endos and bursts of mock indignation ; embellished here and there with the clever and sarcastic hits of an im- plicated ex-Commissioner of the Public Hospital ; it was intended merely to create a diversion—to draw off attention from the subject—to cast dust into the eyes of the public, so that they might not behold the reality in all its naked deformity. As regards the intrinsic merits of this " brochure,'' I will not here say more than, that, if what the author states and insinuates was true, his course was, not to waste his valuable time in scribbling, but at once to have * As the above was preparing for the press, I have been shewn an official communication from Dr. Lawson, Deputy Inspector of Army Hospitals in this island, addressed to the Secretary of Lady BarkW/s Nurse-Training Institution. It states that the Secretary of btate for War, having authorized the employment of Nurses from Lady Barkly's Institution for attendance on serious cases of sickness among officers or European soldiers, he (Dr, Lawson) is directed by the Major-General Commanding to ascertain what number of nurses might be obtained for such purposes. It will thus be seen that this unjustifiable, undignified, and petty act of the Commissioners of the Public Hospital is not only detrimental to the good of the community, but is calculated to mar the humane and libera! intentions of the Minister for War. a demanded an enquit v, and, face to face to have dared me to the proof. His laboured and vain attempt to prove that my first letter to the Commissioners was only a plea on which to make an insidious attack upon him in the discharge of his public duties, is too absurd ; as ridiculous is it, as his insinuation, that I wish for the appointment of Medical Superintendent of the New Lunatic Asylum. I trust, in this communication to prove to you. Sir, that a great portion of the contents of my pamphlet, which he has thought proper to contra- dict, is merely, word for word, a reiteration of his own written opinions—and, if I succeed in doing this, you will see that I shall have no difficulty in disposing of his testimony, and in establishing the correctness of my statements before any impartial tribunal. Besides the results above detailed, my proceedings, in this matter, caused other movements on the part of the Commissioners and the Medical Officers, both previous, and subsequent to the date of my last letter. Thus immediately after the appearance of my first pamphlet, the most strenuous exertions were made to to supply the deficiencies, and to correct the abuses which I had made known—the Board of Commissioners declining to have an immediate and extra meeting for examination of my assertions, on the plea of waitino- for the publication of the House-Surgeon's reply to them. Thus again—at one of the meetings of the Board, it was agreed that one of the cesspools (which had not been cleaned for many months (fourteen,) should be emptied and for this purpose an advertisement was inserted in the newspapers, for tenders- Some weeks after, it was re- solved to empty the second cesspool, and at the same 9 time to rectify its very faulty construction ; which, how- ever had been allowed to continue for years previously. This one likewise had not been cleansed for months (six- teen), and during that period, to prevent its overflowing, positively the liquid portions were regularly drawn off by the inmates of the Lunatic Asylum, and were thrown upon the lawn within the premises, to the disgust and sickening of the officials and patients. I here give the latter advertisement. " Public Hospital, July 14, 1858." " Tenders will be received by the undersigned till 2 o clock, p.m. on Thursday next, from persons willing to contract to empty one of the cesspools at this Institution, and to dig the same down to the stratum of sand or gravel, and also to underpin the walls of the said cesspool. Further information will be given on application at the Institution. By order, H. GARSIA, Clerk to Commissioners." On both occasions of opening the tenders, the Com missioners refused the lowest, although sent in by a pre- viously oft-accepted contractor and approved workman, on the plea that he had supplied me with information in drawing up my letter to the Commissioners—an un- founded suspicion, and false assertion. More recently still, certain of the Commissioners and the House-Surgeon paid a formal and official visit to the Naval Hospital at Port-Royal, for the purpose of witness- ing the condition, management, and internal economy of that splendid Institution—a laudible curiosity, which it is a pity they did not long ago yield to. Besides these public acts, which speak for themselves, others have been performed by these gentlemen, in con- sequence of the appearance of my letters, which, though 10 undertaken by virtue of their office as Commissioners, still were not made public Thus they gave intimation to the officials within the Institution, that if any of their num- ber should be discovered carrying information out of the premises, of what occurred within, he or she should be forthwith dismissed. Statements and charges contained in my letters, have been allowed by the Commissioners, at their meetings, to be garbled and contradicted by the parties interested, without any enquiry being instituted, or notice taken of remonstrance made in consequence. Soon after the appearance of my second letter, a female lunatic—a material witness to a monstrous abuse therein hinted at, and the existence of which was known to some at least of the Commissioners—was discharged from the Inst tution, although she had been long unnecessarily de- tained there, from motives of personal interest to parties connected with the Asylum. In my second letter, I have already detailed the case of a young woman who came up from the country to seek admittance into the Hospital, and who, on its beino- made known that she went from my yard, was forthwith driven like a dog from the gates. Let these, from among many other instances, suffice. I will now pass on to another series of acts perpetrated by these gentlemen, in their individual or private capacity. Thus—my actions have been by them impugned, and have been openly attributed to personal and improper motives—such as disappointment—dislike to color__ hatred to race—professional jealousv__and other similar false absurdities, really too ridiculous and too contempti. ble to require further comment, much less refutation. 11 Others again, with the House-Surgeon, have denied my right to move in such an enquiry—to constitute myself "Censor-General of the island." Some have accused me of unprofessional conduct in exposing the misdeeds of a member of the profession to which I belong,—others have insinuated that I have written from hearsay, and not from personal knowledge of the condition of these Institutions —others again, that I have exaggerated matters, and therefore am not worthy of credit. To these latter remarks I would merely observe, that as a citizen, and a contributor to the public revenue, I have a right to enquire into public affairs, and a right to expose the abuses of offices and the misdeeds of offi- cers. Public institutions, and public men, are public property, and are liable to the scrutiny and investigation of every one. As a Churchwarden for the parish and city of Kingston, it was my duty to constitute myself; nay, by those who elected me Churchwarden I was con- stituted ipso facto, a " censor*' of its public and charitable Institutions—no less of the Public Hospital and Lunatic Asylum, than of the ''Leprosy or Elephantiasis" Hospital. As a professional man whose attention has been long directed to the subject, T have a perfect right to enquire into the management, and to address the guardians of in- stitutions intended for the promotion of the public health. As regards the charge of unprofessional conduct—this I deny: and I maintain that, filling the position I do, in the profession and in the community, I should have been unworthy of both, had I longer hesitated to expose the shameful and crying abuses which daily tended more and more to disgrace the profession to which I belong ; and which, from the open and bare-faced way in which 12 they had recently been committed, were becoming the subjects of common scandal. But these are subjects for after consideration. First let the chai'ges be investigated .aid proved to be false or true ; by that time the whole subject will be laid bare, and persons be in a better position to form and express their opinions of my conduct, both private and profes- sional. As to the remaining charges against me, they are too futile to stand examination. Besides, it matters little or nothing to the Commissioners what my motives were, or whence my information was derived. Whether my statements are exaggerated or even incorrect, is the only question at issue that affects the public weal; and this question, from personal and party considerations and without fair enquiry, the Commissioners have taken upon them to decide in the affirmative. This is not how these gentlemen should have dealt with a great public interest—they should have demanded proof of my charges with the view to correct abuses that might be proved to exist ; or to expose and silence false accusations. Had they taken that course and found that I had been actuated by improper motives, it would have been in their power to expose my conduct to public cen- sure ; and had I attempted to prove on oath what was false, they would have had the power to call upon the proper authority to indict me for perjury. But, Sir, let me ask you, was it likely that a person situated as I am, would waste his time in making idle, frivolous charges, which, when enquired into must break down ? or is it likely that I would offer to prove on oath what I knew was false, and might consign me to deserved and ignominious punishment ? The Commis- 13 sioners of the Public Hospital know well that 1 have held, and do hold, offices of trust, to which I have been from time to time appointed by the Governor ol the island, by the House of Assembly, by the Medical Profession, and by the Municipal and Parochial Authorities. They know well too, that I have never yet disgraced one such appointment, and they might reasonably have concluded from past knowledge of me, that rather than have the office (and with it my name) sullied, I would resign it. They know well too, that many of the most influential and respectable persons in this community, during the last twenty-two years, have placed confidence in my word, and have respected my opinion. On this occasion they have found it convenient to im- pugn my motives ; and under such a refuge, have they attempted to screen themselves from that searching in- vestigation which it was their duty to the public, and to their own characters, to have instituted as soon as possi- ble after the appearance of the charges. A natural enquiry presents itself—Why have the Com- missioners thus acted ? Why do they shrink from an offi- cial notice of my letters ? Why do they act thus covertly ? Does truth seek concealment? What is that tbat shuns the light ? Will they venture to acknowledge that under pretence of being conscious of the imperfect condition of these Institutions, they intended to submit the whole matter for revision to the Legislature at their next meet' ing, and that for this reason they took no notice of my communications ? If they do, then will revelations be made that will convict them of greater faithlessness. Having reasons to suspect that a scheme was on foot, 14 I wrote as follows, at page 100 of my first letter, when urging the necessity of an enquiry being instituted : " Let this be done at once—to wait till the Legislature meets is wrong—ere that, fresh victims, other patients, other lunatics, other immigrants, may be added to the list of those who have died from the effects of preventa- ble diseases in the wards of the Hospital. And in that case, Gentlemen, according to all reason, according to all law, Divine and human, you, as the guardians of these charities, will have incurred a fearful responsibility." If such really was their intention, why did they not proclaim it officially and openly ? Why did they profess to wait for the House-Surgeon's reply ? Why did they deny the accuracy of my statements ? which they would not take up. Have not they, or some of them, enquired into the truth of my statements, and have they not been confirmed by their own officials ? nay, in some instances have not the abuses complained of, been, as far as prac- ticable, remedied ? And has this not been done secret- ly, with the view of denying my averments ? It will thus be seen, Sir, that no redress is to be had from the Commissioners of the Public Hospital and Lu- natic Asylum. They will not enquire fairly : they seek to screen their friends and themselves, and they catch at any apparent error with which (without enquiry as to my proof) to construct a shield—they endeavour to repress enquiry and hinder evidence. Instead of 'pounc- ing on the Institutions at once, to see if things were as I represented them, they gave time for removal of existing evils, and for supply of deficiencies, to enable the House- Surgeon to lay a basis for his abusive pamphlet, and whereon tf> erect cou radictions to my statements. 1 r> To appeal to the Executive Committee, that Legisla- tive- Proteus, would be only to appeal to the same per- sons in another chamber. I have appealed to the highest authority in the island, but I did so in vain. His Excellency the Governor pleaded powerlessness- He appeared to me unwilling to co-oper- ate with me—to give me any encouragement; in fact he impressed me with the idea that he wished to avoid the subject* In the meantime, Sir, the abuses complained of, or most of them, have continued in spite of denying, hiding and glossing. fresh victims to mismanagement have fallen, and our unfortunate fellow men, bereft of reason, have been doomed to drag1 on their miserable existence. Thus situated, I have felt for some time past, that my last hope of obtaining justiee in this island in the cause of humanity, lies in an appeal to the Legislature. In making this appeal, I am induced to depart from the usual custom, and instead of awaiting the assemblng of the Legislature in Session, and then coming by petition or memorial before the several branches thereof, collec- tively ; I have deemed it best to address myself, in the (irst instance, to the individual members in the present communication. And I have selected this early period for doing so, in the hope of inducing gentlemen to put themselves at once in a state of preparation, and of suggesting some methods, and furnishing some materials by which they may be as- * In a correspondence that has recently taken place, His Excellency has declared my opinion (above expressed) as to his seutinjents and feel- ings, to be erroneous; and has professed his willingness "to take what- ever steps appear to him to be proper in the matter." 16 listed in becoming so prepared, for entertaining the sub- ject, and dealing with it effectively, when it shall come before them in their legislative capacity—as, from some quarter, come it undoubtedly will. I appeal to you then, Sir, as a man occupying a most important and responsible position, which connects you with all that concerns the interests and welfare, not only of your own constituency (in the case of a member of Assembly) but of the entire community. By the influence, of which, from whatever cause, you have become possessed, you are necessarily involved in a corresponding amount of obligation to seek by all means the promotion of the general good. The intrinsic importance of the subject before us is great. As I have attempted in my first pamphlet to demonstrate, the advantages of a well-conducted Hospital accruing to a community are very extensive and very general ; and, on the contrary, the evils arising from a badly-constructed, improperly-managed Institution, are very fearful—are destructive of life, and productive of pauperism and misery. No one, I conceive, can call in question the utility of such Institutions; nay, the absolute necessity for them, in this island; particularly in this, the chief mercantile city of the British dominions in these seas. And more especially when we consider the numerical disproportion of medical men to the population throughout the island; and the fact, that strenuous efforts are about being made to turn the tide of immigration to our shores. Independent, however, of the claims these Institutions have upon your attention, as sources of such blos>ino-s to the suffering poor—of protection and relief to the afflicted 17 lunatic and his friends—of advantage to the medical profession, to science, and to the entire community— they also deserve your anxious care and solicitude in consequence of the heavy expenditure and great outlay of the public money, which they annually occasion. Finally, Sir, if no higher considerations can affect us, let us yield to pure selfishness. We have lived to see instances, not a few, among the once wealthy, genteel, and influential of both sexes, which lift up the voice of warning to us, that whatever may just now be our means or our position, it is not beyond the bounds of possibility that sorpe of ourselves or of our families may one day, and that not very distant, require to seek a refuge in the Public Hospital of Kingston, or more melancholy still, in the contiguous Lunatic Asy^im. However apathetic then, or callous we may be where the interests and suf- ferings of others only are affected, pray let us imagine that their case may become our own, and for self-protec- tion and self-preservation, let us be up and bestir our- selves. I will here suggest the following method of making yourself acquainted with the condition of these Institu- tions. From the position you hold in your own district, the probabilities are; that you have been called upon to grant recommendations of admission to the Public Hospital of Kingston, to your poor neighbours or parishioners, or to seamen suffering from the effects of disease or accident; or perhaps, in your magisterial capacity, you have affixed your name to a document authorising the removal of a maniac from his home and friends, and the consign- ment of him to the Lunatic Asylum of Kingston. 18 I would entreat you, Sir, during the period that re- mains previous to the Legislative session, to turn your attention to the subject, in order that you may be pre- pared to take part in it, and either to verify and correct the abuses said to exist, or to show clearly to the public that there are no legitimate grounds of complaint, and thus to re-establish confidence. And to this end, allow me to suggest that you make all the enquiries you can in your oW7n locality and neigh- bourhood, as to the real condition of these Institutions ; that you seek out those whom you may have at some previous period been the means of sending there, and ascertain from them, or their friends, or from others who can afford information, the opinion they have formed of these Institutions, and the treatment they received there. Visit also the vessels in your ports, and obtain from those on board, all you can relative to the condition, management, and internal economy of the Public Hos- pital. It may be, Sir, I would respectfully observe—that in granting such recommendations of admission for the sick, or such commitments of the insane, you have done so in a-matter-of-course-way—taking it for granted that the Institutions were fitted fer their purposes. If this be so, I now put you on your guard that they are not what they ought to be—are not what they profess to be. It may be too, that as a member of the House of As- sembly, you have witnessed, year after year, the formal presentation of the Annual Returns of the Public Hospi- tal and Lunatic Asylum of Kingston ; and either by your 19 affirmative vote, or silent assent, have sanctioned the same. It is quite possible, Sir, that amid the multiplicity of matters annually brought before you, and in the hurry of business, and the excitement consequent thereon—you may not have turned your attention to these Institutions further than listening to the details of their general ex- penditure, and the customary record of their general management. And that you may have taken it for granted that they being liberally supported by the Public Revenue, and presided over by a Board of competent Commissioners, selected by recognised authority, were conducted as they ought to be. In order that you may become competent to judge whether your past impressions were correct or not, I would urge upon you, if practica- ble, to make yourself acquainted with the Annual Returns of the Public Hospital and Lunatic As} lum for a series of years past, as published in the volumes of the Votes of the House of Assembly. After instituting the enquiries and examinations, which I have suggested, you will come to your Legislative duties with a better knowledge of the teal state of these Insti- tutions, at any rate of their practical working, than you are nowT likely to obtain by visiting them or by convers- ing with the Commissioners or officials connected with them, for reasons which I shall now state. A general invitation has already been issued to per sons to repair to these Institutions ; the same will be found in the House-Surgeon's reply to my first letter to the Commissioners. That invitation wTas issued just six weeks after the appearance of my letter—and after six weeks of time to prepare. Why was it not issued the C 20 same week ? nay, the same day? Why did it not form a portion of the House-Surgeon's request to Editors of the press, and to the public "just" as my first letter was "put into his hands?'' That manoeuvre would have told. But it would have been dangerous. A similar invitation was also, I understand, circulated by the Chairman of the Commissioners. But both invitations required, and therefore were issued after, great preparations. So soon as you arrive in town you may expect to be specially invited to view the condition of the Institutions. For this reason, I forewarn you to be " fore-armed." When you shall be ushered into the yards and wards, you will be shewn improvements j but you may not be told, except you ask, that these were supplied in conse- quence ofDr- Bowerbank's "stir,'' nor even subsequently to it. Perhaps you may even be allowed to draw such an inference as this—" Dr. Bowerbank asserted so and so, but see! how false !'' Accept the invitation, Sir, or, if need be, invite your- self. But have your facts beforehand ; be familiar with the Medical Reports, and have your eyes and your wits about you. Do not be gulled with what is superficial—look at the in, as well as the oid-side of the platter—at the interior, as well as the whited exterior of the sepulchre. Remem- ber that foul air, overcrowded wards, filthy cesspools, bad drainage, and defective ventilation will aggravate and pro- long suffering—will retard convalescence__will generate disease—will destroy life. Remember too that a polished floor, a whitewashed wall or gutter—even anew mattrass covered with a clean sheet, do not constitute all the re- quirements for a sick person—do not insure plenty of 21 pure air—good and careful nursing by night as well as by day—careful administration of prescribed medicines— appropriate, well-cooked food. The semblance—the shadow of these latter requirements cannot be so easily put on. Here, even to the superficial observer, the mere passer by, eye-service in these respects, must and will soon fail. No, Sir, all the whitewash in the world* daubed upon the walls and in the gutters and drains of the Kingston Hospital and Lunatic Asylum, will not remove their phy- sical plague-spot, or make them as they ought *to be— life-preserving. Nor will the brushing up of every part of it. undo one past neglect, or alter the truth of one statement contained in my letters—nor will the assumed official indifference and official silence, or the private in- * "Remember that it is not every whitewashed place that is clean, or every deodorized spot that is scentless. Filth may be hid from the sight, and stench from the smell; but still both are there, cloaked and concealed. On this subject let me quote the terse opinion of the Editor of that well- known periodical the " Lancet," published only on the 28th of last month. See Lancet No. ix. Vol. ii. 28th August, 1858.—" What a fine beneficent thing is a foul stench. A most beneficent provision, indeed, which fore- warns us of the approach of the deadly file of diseases ambushing in miasmata. Then do not let us kill the heralds of the hostile army, and persuade ourselves, that, because there is no trumpeting, the enemy is not at hand. The stench is the foregnard of disease, our sense of smell—the scout that gives us warning. If we strangle the spies, we deprive ourselves of the safeguard which nature has given us. When we smell the ill-savour of stagnant marsh, or rotten church-yard, or ruinous drain, it is a warning that fever is at hand. Common sense dic- tates the remedy. Cast out the enemy bodily ; clean, drain, and purify. It is a question of pounds against lives. At this time of day that ought no longer to be an open question. It would seem to have been decided long ago. * * * * Yet hundreds fall prematurely beneath the stroke of disease, which money might have saved ; thousands suffer from maladies susceptible of removal or amelioration by hygienic precaution. * * * * Evidently the work of the sanitary reformer is only commencing; the alphabet of his science is the dictum which we here strongly enunciate— that there be no tampering with the evidences of filth, but a total removal of it; no surface- work; no mere superficial pretences of deodoizing and whitewashing, but that the work be done thoroughly and finally." 22 sinuations of the Commissioners, or the officious and in- delicate interference of the officials of these institutions, remove the moral poison which rankles in its constitu- tion ; and causes it to be a reproach to every one con- nected with it- We have already seen that my representations have done some good. As further examples, I would here mention the use, if not the introduction, of screens into the wards, to be placed around the beds of the dying— the alteration of 0\e gutters of the dead room-—the more frequent and regular visits of the House-Surgeon—the more abundant supply of mattrasses-and surgical opera- tions are now performed without months of delay—for all which, the patients have been indebted to my efforts (no matter what my motives, or what the main spring of my actions) The poor people acknowledge it; they whisper it in the wards of the hospital, and, when discharged, they proclaim it in the streets. Sir, so far, in spite of discouragement, in spite of slan- der, I have done my duty in the cause of mercy and hu- manity, and conscious of the justice of my cause, and the rectitude of my conduct, and the purity and singleness of my motives, I will persevere—flinching from no res- ponsibility—but openly and fearlessly doing my best to get these damning sins of the land removed. It is for you, Sir, and the other members of the Legis- ture, to determine whether such things shall still con- tinue. It is for each of you to consider, whether the present condition of this fine island is due to such, and similar malpractices. If report says true, the condition of these establishments differs but little from other pub- lic institutions and departments of the government, Jf 23 such is the case, can we, as a people, expect to thrive ? Will a just, but terrible Creator for ever withhold the penalty due to the violation of His laws? I entreat you, Sir, to think calmly and dispassionately over these (natters. As a member of the House of As- sembly, you have an unpleasant part to act; but come to your place with a firm determination in this respect at least, to be guided by your own sense of duty, irre- spective of all political and party feeling. Your country expects this of you. The community will have their eyes upon you; the attention of the British Government, of the British people, is directed towards you. I will now proceed to furnish you with some material whereon to form an opinion as to the condition in which these- Institutions were at the time of my moving in the matter, and as to the correctness of my statements con- cerning them, as made in my first communication. As it may be inconvenient to many to search out the annual Reports ; and as t.ome of these, not having been printed, can only be referred to at the office of the Clerk of Assembly; and as,moreover,I have been accused by the House-Surgeon, in his so-called reply, of garbling these returns—of twisting evidence to suit my own purposes— of misrepresenting the state of the old buildings—of ex- aggerating the condition of the cesspools, and the defects of the drainage and ventilation of the wards- -of drawing false inferences as to the aggravation and generation of certain diseases within these Institutions—and of mis- stating the mortality arising from surgical operations performed within the Hospital; I have, in Appendix A, given an exact copy of the notes attached to the remarks appended to each annual Return for a series of years 24 embracing almost the whole time that Dr. Scott has been one of the medical officers. I must explain, that an Annual Report is presented by the Medical Officers of the Institution to the House of Assembly. This is now required by law : but for a series of years it has been the custom ; and the prepara- tion of such report has been considered to be the duty of the House-Surgeon. To the year ending 31st October, 1842, the Annual Return consisted of a tabulated list of patients remaining in the Institution at the date of the last report; of the number admitted during each month, these being ar- ranged under the different diseases for which they were admitted ; together with columns showing the total num- ber admitted during the year, and the grand total treated; and lastly, the numbers discharged and dead, and those remaining under treatment at date of Report. This table included the patients of the Hospital and the inmates of the Lunatic Asylum. In the Return presented on the 31st October, 1843, Dr. Alexander Campbell, the then House-Surgeon, appended an extra and special report on the condition of the inmates in the Lunatic Asylum ; and added " Remarks" explanatory of some of the head- ings of diseases for which patients were admitted into the Hospital. This is still the plan pursued, with the addition, at times, of some geneial observations or notes in conclusion, as to the general condition of the Institu- tions during the past year. I would observe that these Returns are defective in many respects in the information they afford, and are far behind similar returns in like Institutions in the Mother-Country and elsewhere. Thus, there is no re- 25 gular classification of diseases for which the patients are admitted, or of which they die. The causes of death are very incorrectly given in many instances, and in this respect the returns are frequently calculated to mislead. Under the heading " discharged" no explanation is given, as is generally done, whether the person was dismissed cured, or relieved, or incurable ; or whether he dis- charged himself, or was sent out for misconduct, etc. I have reason to believe that latterly, at any rate, a large proportion of patients have discharged themselves, dis- gusted and dissatisfied at the treatment received in the Hospital; and that othe' s too have been removed almost in articulo mortis—to die elsewhere ;—but this appears in no part of the report. Nor are the relative numbers of the sexes in the hospital stated; a very material point to be known, when we are informed that the female hos- pital will only hold 33 patients; and when the House- Surgeon takes upon himsell to deny that twenty-two patients are sometimes crowded at night into a small confined room without ventilation, called after that bird of ill omen, "' John Crow Ward." I do not think it re- quisite to insert the " Remarks'' themselves. These, since the year 1844-45, have become very lengthy. It would answer little purpose here to introduce the tabul- ated Returns themselves for the different years, and would occupy too much space. In the appendix of my first letter will be found the one for the year 1855-50. I, however, give in the following table, a summary of the Returns for the same series of years as are comprised in the Appendix A ; viz., 1844-45, to the end of 1857, being, as already stated, almost the entire period during which Dr. Scott has been House-Surgeon. 26 No.of i'a-i No admit- Grand No of l N... No. re- Years. . 1 tieuts re-' ted during Total of Patients 1 died maining niainiwi^ i the year Cases iischarg'd at 1 at last treated date of Return. | 1 Report 1844-45 252 709 1 961 629 105 227 1815-40 227 798 1025 602 164 259 1816-47 259 903 ! 1162 690 172 300 1817-48 300 1342 1642 964 303 375 1848-49 375 1445 1820 1060 302 438 1849-50 438 1880 2118 1405 399 314 1850-51 314 1283 1597 984 262 351 1851-52 351 1529 1880 1179 316 385 1852-53 385 2064 2149 1472 562 415 1853--»4 1 * 18-51-55 ) 1855-56 238 1346 1632 1075 280 277 1856-57 277 1710 1987 1377 333 277 * No Returns. In this summary, it will be found that no return is made for the years terminating 30th September, 1854, and 30th September, 1855. Not finding them in the volumes of the Votes of Assembly for those years, I made application at the office of the Clerk of Assembly, but was there informed that they had never been furnished. Thinking it probable that the Commissioners of the Hos- pital might possess the originals, or copies of them, T addressed a letter to the Chairman ; in reply to which, after stating that, on receiving my note, he also had searched the Votes of the House, and had made applica- tion at the Clerk of Assembly's Office, but in vain, he adds__" I remember that a difference of opinion existed as to whether the Clerk to the Commissioners, or the Medical Officers should prepare the return, the law then in force being silent on the subject; and this, I appre- hend, is the reason why no return was made in either of the years mentioned." Subsequently, in looking over the volume of Votes for 27 1854-55, at page 209, under date bth February, 1855, I found the following :— "Ordered—That the House-Surgeon of thePublicHos- pital do forthwith make the annual return to the House, of the patients admitted and treated in the Public Hos- pital and Lunatic Asylum in the city of Kingston, from 12th October, 1853, to 10th September, 1851, and the results of such treatment." It is to be inferred that this order of the House has never been complied with, and that therefore this valua- ble and important information has been lost to the public. In January, 1847, the Commissioners of the Public Hospital, through their Chairman, the Ilonble. Dowell O'Reilly, presented a Report to the House of Assembly, on the condition of these Institutions ; and annexed to it a letter from some of the members of the Medical Faculty of Kingston, containing their opinions on the sanitary state of the Public Hospital. See Vol. of Votes of Assembly for 1846-47, page 281. In appendix B, these two documents will be found. On reding over the remarks of the Medical officers, one cannot fail to be struck with the almost lugubrious strain that pervades them froir beginning to end. They are in great part, made up of complainings, and of the reiteration of cries for the removal of evils. There is at the same time a nervous anxiety displayed, to attribute the resulting mortality to the condition of the patients at the time of their admission : as Dr. Scott, in his Re- ply, expresses it, " to certain unfavourable conditions inherent in the cases themselves." There are four principal subjects of these complain- 28 ings, to which I beg your especial attention, as you peruse the Appendices A and B. They are:— I. The situation and construction of these Institutions. II. The yards and premises attached to them. III. Their over-crowded state- And IV. The results arising from these conditions. I can quote but a few specimens taken here and there, by way of example, and for illustration of my meaning:— I. The situation and construction of the buildings. In 1845.—" The present buildings are not at all adapted to the treatment of insane patients." First page of Appendix. In 1846.—In the Hospital.—" One of the wards, which is a mere shed, is entirely paved with brick, and conse- quently must be injurious to the patients." Ibid. This very ward, thus condemned, I must add, remains now, in 1858, in the same condition precisely, though it is never afterwards alluded to. A proof this, that the mere silence of the medical officers as to the existence of an evil, is no conclusive evidence of its having been removed or remedied. « In 1850.—"The old wards are neither healthy nor well situated." Page 8. Inl856.—In theHospital andLunaticAsyhim,—" Not- withstanding these [repairs J the state of decay of some portions of them, and the actual rottenness of a great part of the roofs and shingling, render them scarcely habitable during heavy rains." Page 12. In 1857.—" The roofing of the old male Hospital is in a decayed state, in consequence of which the inmates are exposed to inclemencies of the weather, whilst the 29 female Hospital is totally unfit for the purposes of a hos- pital." Page 14. II. The yards and premises attached to them. In 1856.—" There is still an absence of proper drain- age ............ The cesspools............as well as the drains are nuisances............ Occasionally theefflvium from them............is intolerable." P.p. 12, 13. In 1857.^—"Much water continues to lodge about the buildings......... but this can only be effectually guarded against by .........a general and more perfect system of drainage. The cesspools, as stated in former returns,... act injuriously upon the patients.and their removal would contribute materially to the healthiness of the Institu- tution." Page 14. III. Their over-crowded state. In 1846. — " The hospital is, in general, by far too much over-crowded.........the cells [of the lunatic asylum] are small,iil-ventilated,and always over-crowded." Pp.3,4; In 1852. — " The Institutions'' will hold of patients and lunatics 345, or if the piazzas are occupied f(which is not advisable) 369, ......... whereas at times, there has been as many as 500 inmates exclusive of ser- vants within the walls." P. 9. On reference to the sum- mary it will be found that that mischievous system was not only continued, but greatly increased up to 1855. In 1856__-* No difficulty has been experienced in car- ing out the law, in regard to the limitation in the num- bers of patients to three hundred." Page. 13. IV. The results arising from these conditions. In 1846.—" The present buildings are so imperfect, and so badly constructed that they interfere materially with the efficient treatment of the inmates. P. 4. " A 30 very large number of persons, who came into Hospital for other diseases, suffered from attacks of diarrhoea and dys- entery, which may be considered as endemial in the Hos- pital in its present state.'' First page. Among the causes assigned, are the " over-crowded state of the hospital, which of itself must prove extremely detrimental." " The ground floors" being " too near the earth.' " The noisome malaria arising from the cess- pools, and badly constructed drains, which produce very deleterious effects'' In 1849.—" From this cause (over-crowding) the want of proper drainage, the malaria arising from the privies and cesspools, which from their construction can only be emptied at intervals .........erysipelas has at tacked several of the patients, and proved fatal in those cases where the constitution was impaired by previous disease.'' Page 1. In 1852.—" Scurvy, cellular inflammation, and bowel complaints, induced by malaria, still infest the Institu- tions ......... Several of the patients who undergo opera- tions, and who, in a healthy atmosphere would to a cer- tainty do well,sink under this affection [bowel complaint."] Page 9. In 1856. —" The cesspools.........as well as the drains, are nuisances, and are greatly concerned in creating and fostering certain diseases which have almost become en- demic to the hospital." Page 112- The opinions of the Medical Faculty (called for by the Commissioners of 1847, and set forth in Appendix B.) are of course applicable whenever and wherever the cir- cumstances exist on which they were based. As lar then, as the Public Hospital and Lunatic Asylum of 1858 cor 31 respond with what they were in 1847, so f*r the opinion expressed in the latter year concerning them, may be re- garded as now uttered. For example-- " The crowded condition of the wards .......'.___ is highly injurious to the sick—prevents their classification —often frustrates the medical treatment - and generates new cases of disease, especially diarrhoea and dysentery." " The excretions of the sick, and other residents in the hospital, and the decaying animal and vegetable mat- ter accumulating there, are either allowed to remain on the spot in privies, or are removed outside by uncovered gutters, being carried no further than to a large cesspool behind the principal buildings ......... and from these sources, the air acquires a morbific influence. "The morbific action of the air thus affected, is indis- putable, and the fact is now gaining the attention it de- serves in all countries, in reference both to the sick and healthy." " The great benefits to be derived from a well-con- ducted Island Hospital can never be realized, whilst the air in and around it is liable to be tainted, not only with the effiuvia from the bodies of the over-crowded sick, but from the proximity of decomposing organic matter in its most dangerous and disgusting forms." Pages 16, 17. In confirmation of these latter remarks, I will refer you, Sir, to some observations in Appendix C, upon the important, but often-mistaken subjects of ventilation, and drainage. They are taken from the writings of the most practical men of the day, and are well worthy of vour careful consideration in r< lation to the subject be- fore us. They will shew too, that if I have a " special horror of cesspools,'" as Dr. Scott sneeringly observes, I am not remarkable for singularity. 32 I may be expected here to notice the class of patients received into the Hospital—as so much stress is laid by the Medical officers upon this, as the cause for the large mortality. As I previously stated, I maintain that hither- to the deaths of the debilitated, the destitute, and the aged, cannot be said to constitute the chief mortality occurring in the Hospital. I willingly allow that many of the persons sent, are most improper subjects to be ad- mitted. This, however, has always been the case hither- to, in this Hospital, as its earliest reports shew us ; but in its recent and present overcrowded condition, it would be far better,for their own sakes, and more humane,to refuse them admission—better for them to linger of their mala- dy, and to die in their own hovels, than to be poisoned themselves by polluted air, and, at the same time, by over-crowding the wards, to be generating poison for others. It has been the practice for the Medical officers fthey not practising midwifery) to refuse admission to pregnant and parturient females,'' on the plea of the place not being " congenial to them." Why not be as kind and considerate to others, whose cases, not "amenable to medicines,'' can derive no benefit, but must incur great risk ? Sad experience has taught us the necessity of laws be- ing framed to restrict the number of persons to be carried in public conveyances, or ships of transport, of whole- some bounds being put for the public good, to the greed and recklessness of trading companies or individuals • but little could it have been supposed that in these davs restrictions were necessary to prevent the over-crowding of government receptacles for the sick. Surely this might have been left to the discretion, the humanity and the 33 sense of propriety of Commissioners and Medical Officers: but, no Sir, it has been found requisite in the Public Hospital and Lunatic Asylum of Kingston, Jamaica, to fix a limit by law. This limit is at present 300; and even this is far too high for the capabilities of the place. To admit immigrants and other persons arriving in impaired health from a voyage, to an over-crowded Hos- pital, is wrong. The experience of the Kingston Hospi- tal confirms the assertion, and the following remark of the Medical Officers, to the Commissioners, on (5th May, 1848, proclaims its truth :—" Should any of these unfor- tunate beings again arrive here, under similar circum- stances, we think they should not be admitted into this Institution till the improvements which are in progress have been completed, and additional accommodation has been afforded, as when patients are taken in here, whose constitutions are broken down by disease, and die, they are almost invariably carried off by bowel complaint." Tn May 1857> 18 persons from the Slaver, captured by the "Arab" were sent there. At the time of the return, 17 were dead, and one remained in Hospital. See Appen- dix No. XL,—Vol. of Votes 1856-57. Surely this ex- periment has been tried often enough, and should not be repeated. In his reply to my letter to the Commissioners ; the House-Surgeon blames me for not having compared the condition and management of these institutions at a period anterior to his appointment, with a period subse- quent to the same- I did not do so ; for though, in writing to the Commissioners, I dealt with his office, I did not think of him. I needed no comparison. I wished to pourtray the present and passing state of mat- 31 ters. If I made use of by-gone references, it was to illustrate something present. I myself knewr the condition of these Institutions at a date prior to that in which he visited them. My first visit to them was in 1836—and let me observe, I had previously visited asylums for the insane in England, Scotland and Prussia. But I have now taken the House-Surgeon's hint, and have instituted some comparisons between the past and the present, which, if they prove at all " odious,'' he is precluded from objecting to- The following table is a summary of the Annual Returns of patients treated, and of those who died, in the Public Hospital and Lunatic Asylum, for several years before Dr. Scott's appointment in April 1844, and for the entire period since— Years. Grand Total 1 No. who Percentage of 1 of Patients. 1 1038 died. 130 Mortality 1838-39 12.52 1839-40 1028 162 15.75 1840-41 1082 132 12.19 1841-42 1017 84 8.25 1842-43 1028 96 9.33 1843-44 1045 128 12.24 1844-45 961 105 10.92 1845-46 1025 164 16.00 1846-47 1162 172 14.8 1847.48 1642 303 18.45 1848-49 1820 302 16.59 1849-50 2118 399 18.S3 1150-51 1597 262 16.4 1851-52 1880 316 16.8 1852-53 2449 562 22.94 1853-54 1854-55 1855-56 1632 288 17.15 1856-57 1987 are here very 333 striking-: 10.7.-, Two things first, the incr number of patients received into the hospital two or three years after Dr- Scott's appointment ; and, secondly, the 35 accompanying increased, percentage of mortality ; two glaring facts—standing in the relation to each other of cause and effect—and yet carried on progressively, till a place fit only to hold, at the furthest, 369, is, as Dr. Milroy informs us at the outbreak of cholera loaded with 510 suffering human beings, besides servants. This has only been recently checked by Legislative enactment; and all this time too, we are now informed, the respon- sibility, the active superintendence, depended upon one person (living a great part of this time out of the institu- tion,and engaged in,private practice) for his colleagues, he informs us at page 42 of his Reply, were incompetent from physical infirmities, and for the greater part of the time, the apothecary was a non-professional man By some, the fact of the cholera years being included in this table for comparison, may be objected to. But here I would differ in opinion These institutions did not admit cases of cholera, but the disease sprang up within them from pre-existing causes, as the medical officers tell us in their Remarks of 1850. Under such circumstances this disease becomes a test of the sanitary status of the place. " Cholera" says the Registrar General of England " is a health-inspector that speaks in language which nobody can misunderstand. It visits the prisoner in the hulks. on the polluted river—the neglected lunatic, in his cell — the crowded workhouse—the sides of stagnant sewers— the undrained city—theuncleaned street—the cellars and the attics, as well as the fair and open quarters which strangers frequent and admire. The oversights, the errors, the crimes of persons, who, in responsible offices, have charge of the health and life of men, are proclaimed aloud by this inexorable voice ' K 36 In such institutions—hospitals and lunatic asylums— the percentage of mortality in the one, and of cures or discharges in the other, are generally considered to be the criteria of their management—though there are some ex- ceptions to this rule. In the same institution, however, under similar regulations, a low percentage taking the place of a high one, surely denotes the adoption of sani- tary or other improvements ; and, vice versa, a high per- centage succeeding to a low one, cceteris paribus, points to some sanitary or other error having occurred, or supervened. In this latter category stands the Kingston Hospital and Lunatic Asylum, in spite too of the fearful picture, drawn by Dr. Scott, of their condition previous to his appointment—and in spite of the glowing and boastful description of improvements since effected. This is shown with regard to the Lunatic Asylum— to which institution, for avoiding prolixity, I shall confine my subsequent remarks—by the following table, which shews the annual returns of the inmates, with per- centage of discharges and deaths respectively from Sept. 1838 to Sept. 18-57. CD 00 00 OD 00 _i 4^. >i- »4j. •— 33 «) 05 W * tO tsS H^ — I—i CI *- 00 00 >+»■ ►*■ CO OS t<3 i— © CD X fcS OS to ►- OS «o -o CO © CO hd CO il 05 W * 5" 3 CD 3 3 rt- 3 3 H -* c-t- CD cr 3 cr G- CD cr 1—1 CD P CD 2. i-t- CD Cj» C^ o CT 05 -3 CD -s O a P 3 CO CD P s cr CD o8 CD ■3 »-> 3 p H" CD =3 cr CD 3 3 rf-cr CD P CD CD p 3* CD cr O 3 p 3 cr "■*a rr CD cr r*- to' CD •■* en *< CD 3- P n CD cr r+- C b O p cd o -s 4 P c-t-CD o CD CD o >3 P 1 W G- CU o P G G. CO 3 c-t-3 CO o 3 G CD cr cr P CO O rc p CO p r+- P T1 CT cr V CD G-P 3 G- p *T3 "3 O i—i. >3 3 CD CD 1 n CD P 1 a -s CO w 00000000000000000000000000000000000000 0SOl(^ti3Mi-O®aiM(»W*Wk3l-O!0Q0 t\S »- >— kO ls3 kO »— h* H-> «-* >-~ »_i^.— MfflWt»wO»JO)Mt«OHOi-'i-H ---^JtCfcOCS — QOOJCOCJicOcOtOCiOi a 3H — i—• —■ m to to *- ba *- •— ►— »—i aMcooviuiasoi^^Qociiacisi^ ^ iss bs ^ "►*>• to iss co ^t bo bo © ks co "os 38 These results are very remarkable. While in the first period, the discharges are 25 per cent, and the deaths 9 ; in the second period they change places, the per centage of discharges is less than half, and that of deaths is much more than double! On thus comparing the annual mortality of the in- mates of the Lunatic Asylum, previous to the year 1844, the percentage will be found very much smaller than that subsequently; and further, the discharges during the first period are more numerous than during the second. During the latter period, the increased number of pa- tients admitted, is very striking- -aud this is a circum- stance which it is difficult to account for, when we bear in mind the different opinions entertained by the successive Medical attendants, as to the capability of this estab- lishment. Thus in 183<>, in his evidence given before a committee of the House of Assembly, Dr. Easton, the House-Surgeon, states, "There are about 49 maniacs in the Asylum, and about 30 maniacs in the Hospital;'" and again, " I consider it totally difficult to pursue any mode of treatment but that of restraint, in consequence of the want of accommodation." He adds, " The Asylum is not in a rit state to receive or benefit maniacs, in conse- quence of four or five being confined together." On the same occasion, Dr. Charles Mackglashan, the Surgeon of these Institutions, states, "The present Asy- lum is not calculated to receive (with due attention to the safety and management of the patients) more than one half of the number that are now within the walls (79). There are not sufficient facilities for keeping it clean ; the sexes cannot be kept altogether apart from each other ; the number of keepers and servants is not suffi. 39 cient; the building is so constructed that patients, if not locked up, might easily escape.' Appendix 37, 1836-37. On the same occasion too, Dr. Bancroft, the Physician to the Hospital and Asylum, states, " The want of proper and sufficient accommodation for lunatics in the zisylum, 1 cannot but consider as a grievous evil to the patients themselves, and as a detriment to the island. The pre- sent establishment consists of two equal and parallel brick buildings, one hundred and twenty feet in length, and sixteen in breadth ; each containing a series of twelve rooms, and a piazza about eight feet wide around the whole. The rooms are all likewise equal, and thirteen and a half feet long by nine feet in breadth. The ac- commodation, therefore, is limited to twenty-four rooms in the whole ; but of these, one is necessarily occupied by the keeper, and nine or ten more are generally appropri- ated to single patients, some of whom, from their station in society, have a claim to the indulgence, while the others are violent or mischievous maniacs who require to be con- fined wholly by themselves, and as there are commonlyfrom 45 to 50 lunatics who must be kept within the Asylum, there will be 35 or 40 of these who must be distributed in the remaining thirteen or fourteen rooms; which therefore never contain less than two, generally three, and not un- frequently four people; care being always taken to put only those into one room, who are most likely to agree with each other. This kind of arrangement, it will be perceived, is now unavoidable ; but it is nevertheless a most objec- tionable and injurious one. Lunatics, in the precarious state of mind in which many of those placed in the Asylum continue for a greater or shorter time, require for their cure a more or less constant solitary confinement. Even when 4o they have become quiescent and are carefully kept se- cluded, they too frequently get re-excited without any apparent external cause; b"t this is much more likely to happen inpatients recently tranquillized, if they be asso- ciated with others at all disturbed; their minds being readily unsettled by even slight ebullitions in their com- panions; and it is certain that frequent relapses of this sort will greatly retard, and may even effectually hinder the recovery of such patients, whereby their stay in the Hospi- tal must be prolonged, and their charge to the public con- siderably increased. In other cases however, which are perpetually happening, and which cannot indeed be avoided under existing circumstances, when two persons under excitement a re kept together, the maniacal explosions of the one seldom fail to aggravate the condition of the other ; angry passions arise, and blows are given, or a more silent revenge may be taken. It has, for instance, happened in this Asylum that one of the maniacs has been found dead in the morning, who, doubtless, had been killed by bis companion. From placing'male luna- tics together there is also reason to apprehend that sodo- my has been committed." In my first letter to the Commissioners, I introduced a letter which Dr. Bancroft addressed to that board in 1836 ; and in which very much the same evidence is adduced. I also on a previous occasion transcribed a letter of Dr. Magrath to the Commissioners, bearing date 29th August 1845 in which the following statement is made: "There are but ten disposable cells to accommodate thirty six female patients, and fourteen for thirty-seven males, at present in these buildings. Moreover, there are 41 twenty other lunatics, viz.—nine females and eleven ir}ales, in the wards of "the hospital, where they cause serious inconvenience, and at times considerable annoyance to the other inmates/' In his evidence before a Committee of the House of Assembly, on the 9th Feb. 1854, this gentleman, in stat- ing the number of patients, the Public Hospital is capa- ble of properly accommodating, says, " In the male wards 69, in the female wards 38." Dr. Scott, in his Reply to my 1st letter to the Com- missioners of the Public Hospital, at page 13, in alluding to the visitation of cholera in 1850, writes, " at that period, there were sixty-six males, and seventy-nine females in the Asylum," and then adds, " There is not now(19thApril 1858>)the overcrowding and huddling you imagine. There are at present. 56 males, and 53 females, in the institution—one male and a female (both quiet) in the male and female hospitals undergoing medical treatment.'' Dr. Milroy, in his Report on cholera, states, that the first person attacked in the Asylum in 1850, was one in a cell with thirteen others.* * A.s showing the effect of overcrowding, 1 have added the few following years, when a smaller number of patients altogether were admitted into these institutions. The much lower mortality occurring among the luna- tics is very striking Years. 1827-28 1833-34 1834-35 1835-30 4836.37 TotalNo. |admitted into two Institu-tions. Total Deaths No. of | No. of Lunatics 1 Dis-admitted charges. Percentage of discharges No. of Deaths. 929 902 763 884 983 117 78 33 42.30 I 68 88 26 29.54 5 86 91 14 15.38 6 87 112 30 26.78 7 100 111 26 23.42 6 Percentage. of deaths. ~L2lT~ 5.68 6.59 6.25 5.40 \2 The loll »\viug table will tend, in some measure, t^ show ho* the lunatics have been disposed of for some years past in the Asylum and Hospital. It exhibits the num- ber treated during each year, from Sept. 1838 to Sept. 1857 inclusive ; with the number remaining in the insti- tution on date of Return -distinguishing the sexes. It also shews the number of patients belonging to the upper class of society,and the distribution of the numbers in the Hospital and Asylum. Total No IV- Years Inmates in Sex main-1 ing-[date of Sex. No of Upper No in JNo. ii Hosp the M iF M. F. Class Asylum tal year. _... 1 Return 77 - - "-■ 1838-39 116 1839-40 115 73 1840-41 112 68 1841-42 99 79 1842-43 159 93 GO 92 54 3m 9 67 22 1843-44 135 77 58 77 . 41 36 8 61 16 1844-45 129 GO 60 92 44 48 9 71 21 1845-46 163 77 86 101 50 51 9 91 10 1846-47 178 92 86 116 57 59 12 109 7 1847-48 201 96 105 122 54 68 12 122 4 1848-49 216 103 113 133 61 72 10 127 6 1849-50 232 ] UG 116 60 30 30 4 56 .1 4 1850-51 132 75 57 94 47 47 4 89 5 1851-52 197 118 79 132 71 58 7 128 ! 4 1852-53 221 114 107 129 72 57 121 5 1853-54 1854-55 1855-56 157 81 73 | 103 49 54 97 6 1856-57 170 H7 83, 109 0 4 55 106 3 The foregoing statements surely speak for themselves, and need no further comment. I now refer you to the following abstracts of two Lu- natic Asylum reports—1842-43, and 1848-49. I have selected these years—the first as being the one immedi ately preceding Dr. Scott's appointment; the other as being several years subsequent to his becoming House- Surgeon, and yet antecedent to the visitation of Cholera. 43 During the former year (1842-43), we are told 159 lunatics were admitted into the Institution ; of whom 53 were discharged___ Of these, 30 are considered to have been perfectly cured. 9 have relapsed and are under treatment. 12 have been removed by friends. 2 have escaped and not been heard of. 53 14 died 92 remain 169 Of these 92 remaining, it is emphatically added, "none are under restraint." 1 has been confined 28 years 26 20 19 18 17 15 12 10 3 have been confined 9 years. 2 3 6 1 3 8 44 92 7 6 5 4 3 2 under 2 In the latter year (1848-49) 216 were admitted to the Institution. Of whom 28 were removed by their friends, and were regarded as cured. 55 died. 133 remain. 216 3 who escaped were apprehended and brought back to the Institution. Of these 133 remaining— 2 have been confined 18 years, i 2 have been confined 5 years. 15 12 11 10 9 9 11 20 76 133 under 44 I quoted in my first pamphlet, a letter of Dr. McFa- dyen, written to the Building Commissioners of the New Asylum, in 1843, in which, he speaks with severity of the treatment to which the lunatics were subject. Refer- ring to this, Dr. Scott (at page 22 of his Reply) exul- tingly responds—" a female patient, who, at the time this letter was written, was the object of the Doctor's anxious solicitude, is still an inmate of the Asylum ; and it may fairly be inferred, that if she had undergone a like treatment, from the year 1844, it is not probable that she would now be alive.'' Dr. Scott, therefore, considers the longevity in the lunatic asylum, to be a test of the " treatment" received there. If then, in spite of the enormities " witnessed" by him ^as described in " Reply" pp. 6, 13, 14,) five persons out of ninety-two, had up to 1843, managed to survive 19, 20, 26 and 28 years, how is it to be accounted for, that in 1849, under Dr. Scott's comparatively bland and almost faultless treatment, only two persons out of 133 had reached 18 years as the maximum of asylum life? Some way of accounting for this remarkable fact, therej of course, must be. But until it is made evident, I sus- pect " it may fairly be inferred" that if the " monster evils" of the one period have been removed, they have been replaced by others, less obvious perhaps, and there- fore presenting a less " horrid spectacle," but like all secret and concealed foes, more unerring in their aim, and more deadly in their thrust- As you have already seen, the medical officers give a melancholy picture of the sanitary condition of the asy- lum. Its ill-ventilated cells—their cold dank stone pave- 45 ments deluged with water every morning in dry and in wet weather—the fearful over-crowding—its cesspools and drains—all help to explain why the unfortunates diminish in number—why diseases, such as bowel com- plaint, erysipelas, cellular inflammation, dropsy, gan- grene, congestive pneumonia, scurvy, etc- infest the place. But in the midst of all this, how cheering is the repeated assurance, that since the inmates have been employed at light labour ... moderate work ... under medical supervi- sion—they have improved both mentally and physically; and that at the same time great benefit has accrued tothe institution itself. How delightful too, the glad intelligence, " it is now scarcely ever deemed necessary to employ res- traint ; when the patients are unruly, confining them to their cells for a few hours generally produces the desired effect." But why then has the mortality increased ? why have the discharges diminished ? No, Sir, the medical officers, non resident, may be sincere in what they state, or write—but their statements, their writings are incorrect—figures prove them so- Our poor fellow- creatures bereft of reason, and deprived of liberty, are not happier than they were. The place itself is unsuited to their reception—to their treatment—to their cure. But labour has not always been light—been moderate—been under medical supervision. Read, Sir, Appendix 11 of the volume of the Votes for the year 1852-53, and you will find good reason to believe that however the employ- ing of the lunatics may have proved advantageous to the Institution, and to other persons, it has not proved so to the unfortunates themselves. Study, Sir, the history of poor Shakespeare, therein detailed, ; observe the unsatis- factory check to the inquiry; and then judge of the 46 nature of the labour- Consult the annexed tables, and then say, whether you think the purchase of land in 1845 was a blessing to them—then say, whether this acquisi- tion has indeed released the lunatic asylum from the ver- dict of the Commissioners, who pronounce it to have been [until then J a disgrace to the island. Is it possible that the restraint of the stocks, the shackle, the hand- cuff, and the straight waistcoat—visible instruments— have disappeared, —have given way to the unlimited and unauthorised employment of the ducking tank, the douche, the whip, and the fist ? But I warn you, Sir, not to be led away with the no- tion that the mortality among the lunatics has really diminished during the last year or so. Appeal ances may be unreal. Let us hear something first of the discharges and the escapes. I have reserved till now, one subject connected with these poor people. The importance ol it to the question of the condition of the lunatics is great; but, Sir, it is also of importance in another point of view. The House- Surgeon has voluntarily come forth to deny my state- ments. He has done so pretty roundly : but whether his accuracy is to be depended on may be questioned, from what I shall show :— At page 22 of his Reply, he puts to me the following question: "What proof have you, that any one has been killed within the walls of the Asylum since 1844? Where is the evidence which you say some persons can furnish from personal experience, as to the " horrors of these hells ?" At page 18—• It is not true that the lunatics are now left at night to fight and murder each other, as every 47 precaution is taken to guard against such untoward oc- currences j but as it is not my wish to conceal any ca- sualty that has occurred among the patients, I will men- tion, that in the year 1847 (as may be seen in the Return for that year), there was a death in the Asylum from strangulation, but whether it was homicidal or suicidal did not appear at the Coroner's Inquest, which was held over the body. This solitary case is the onlv death by violence, which has happened during my connection with the Asylum, and it is most unjust to infer that such painful events still occur, merely because Dr. Bancroft deposed to their happening in the year 1836. It has happened, occasionally, that homicidal and suicidal acts are committed in the best regulated Asylums in England and America. Prior to my appointment they had some times occurred in the Asylum, and it was to some of these that Dr. Bancroft alluded, when he stated—l It has, for instance, happened in this Asylum, that one of the ma- niacs has been found dead in the morning, who, doubt- less, had been killed by his companion.'" At page 58—"I affirm that the Medical hecordsof the Public Hospital and Lunatic Asylum, imperfect though they may be in some respects, are neither invalidated by an indefinite grouping of ailments and diseases, nor by the suppression of deaths." The following is the Coroner's Register of the case of strangulation referred to by Dr. Scott :— " No. 46. Inquisition taken at an Inquest, on the 21st day of Sept. 1847, at the Public Hospital, on the body of Letitia West (late a lunatic in the Lunatic Asylum). Verdict__-' Strangulation, caused by a ligature applied around the neck by some person or persons unknown ; 48 but supposed by one of the patients of the Institution, confined in the same cell. Age, 26 years.'" Upon this case, and its bearing on Dr. Scott's asser- tions, I make a few remarks. His version of the matter is this—" there was a death in the asylum from strangulation, but whether it was homicidal or suicidal did not appear at the Coroner's Inquest." The verdict of the jury is a flat contradiction of this. The question with them evidently was not •' Is it homi- cide, or is it suicide ?" as Dr. Scott's words would lead us to conclude. They declare positively that the woman was killed " by some person or persons unknown,"—lan- guage that never would be used in reference to self-mur- der. The only uncertainty in their minds, was as to the perpetrator of the deed—whom therefore, they usupposedv to be " one of the patients of the institution confined in the same cell■', Another remark is this- -We look in vain in Dr.Scott's statement, for light on points very material to be known in order to arrive at a correct conclusion. Not a hint does he give of the locality, or the time, or the circum- stances under which this mysterious death occurred. It is only from the verdict of the jury, which I have groped out,that we gather that the time—was night', the locality, a " cell;" and the circumstances—she was confined there- in with several " of the [other] patients of the institu- tion,'' Another remarkable feature is the difference between Dr. Scott's language, and that employed under similar circumstances, by Dr. Bancroft, as quoted at page 19 of the " Reply,'' 49 " It did not appear," says Dr. Scott, "at the Coroners Inquest, whether it was homicidal or suicidal." u One of the maniacs has been found dead in the morning" says Dr. Bancroft, " who, doubtless, has been killed by his companion." How striking the contrast between the open, candid avowal of the one, and the cautious " not proven* of the other. A fourth remark is—that in those davs, according to the verdict " Lunatics were left at night to right and murder each other.'' For even if we suppose the ligature to have been applied by the woman's own hand, it is manifest that the same defective care which prevented the involuntary stertor and struggles from being heard, would also have prevented their being heard had the same kind of death been inflicted by another person. Unless therefore, the " every precaution taken to guard against such untoward occurences''which Dr. Scott speaks of, is of a superior kind to what was employed on the occasion in question, there can be little doubt as to the possible, if not the actual, results. I have discovered several other Coroner's Inquests held on patients in these institutions, which I now pro- ceed to give* * I would here express my thanks to John R. Brice Esquire the Coron- er of St. Andrews, for the readiness with which he responded to my request for information. As also to Dr. Altman, the Coroner of Kingston, who, though he hesitated at first about opening a box belonging to his predeces- sor in office, ultimately granted my request partially. This latter circum- stance has brought me acquainted with the fact, that the proceedings of Coroners are their private property. Surely Sir, this ought not to be the case. These important documents ought, I submit, to be made public rec- ords, which they might easily be, by being written on paper of one size, and be lodged in the Secretary's or some other public office, to be bound up to- gether, for reference. 50 Case 2.—"No. 1006. Inquisition on the 26th Aug., 1854, at the Public Hospital, on the body of Paranal, a female Coolie (late a patient). Verdict—' Accidentally falling down a well, &c. &c. Aged, 60 years.''' Whether this calamity was really accidental, or was self-destruction, it is a proof of gross neglect on the part of the persons in charge, that it should have happened. Case 3.—On the 18th November, 1854, an Inquest was held at the Admiral's penn, (whither the patients of the Hospital had been transferred in consequence of the outbreak of Cholera,) on the body of a Chinaman. The verdict returned was—" That the said Chinaman came to his death by hanging himself." Case 4.—" No. 1041. Inquest oh 30th Nov., 1854, at the Public Hospital, on the body of Peregrine Stewart, a lunatic. Verdict,—" Hung himself whilst labouring under mental aberration, being then a lunatic in the Asylum in this city.''' This, Sir, is to my knowledge, a fearful case, and will, if fully enquired into, of itself prove the radical bad man- agement of the Institution. Case 5.—" No. 170. Inquisition on the 16th Nov. 1856, at Committee Hall in the Public Hospital, on the body of Mary Smith. Verdict—* Died from the effects of an attack of Epilepsy while in the bath.' Age, 25 years.''' Here again, to say the least of it, suspicion exists; and even if it did not, what neglect and want of supervision is implied. And let me inform you, Sir, that this woman might have had 20 epileptic seizures previously, and 40 subsequently, and not have died, had she not been in this said tank. And where were the attendants " while" an 51 epileptic patient was " in the bathP* Of course the jury were led by the evidence of the House-Surgeon. Does this case not present circumstances which look much like what he has often laid at my door—the "suppressio veri ?'' Of the cases which formed the subject of Coroner's Inquests, those numbered 2, 3, and 4 occurred during the periods for which the returns were withheld from the House of Assembly. What would have been said of them, had returns been made, it is of course impossible for me to divine. Though it is not probable that they would have been more fully detailed than those which took place before and since. The bearing of these latter, i.e. cases 1 and 5, upon the Annual Returns, made by the Medical officers, appears to be of importance. The only information they contain regarding the causes or the manner of death is the fol- lowing :— In the Return for 1846-47, we read among the deaths, " One from strangulation." And in the Return for 18.56- 57, two are entered as having died during the year of " diseases of brain and epilepsy." I presume that one of the two was No. 5 ; but it is bare presumption, for there is nothing to give a hint that one of the two died " in the bath," i.e. in the tank. Now one would suppose the purpose of the Annual Returns to be, to put the Members of the Assembly in complete possession of all facts and circumstances rela- tive to the Institutions and the patients therein, more especially all unusual and extraordinary occurrences. But I ask, Sir, what amount of the actual circumstances attending the two cases in 1847 and 1856, could the 52 words "strangulation"and "diseases of brain and epilep- sy" set before any person, even a member of the Medical profession ? Amongst a large number of deaths, and of their causes expressed in medical phraseology, the words occur, "one of strangulation." Not one non-professional person in a hundred probably, would pause to reflect on the meaning of the word ' strangulation." Many perhaps would con- found it with strangulation from hernia, and not a few even with " strangury.Jj Surely, Sir, the House of Assembly ought to have been informed in the very words of the verdict in both cases. Even the vague sentence " suffocation from a foreign body," occurring in the Return of 1845-46, is sun-light compared with language employed in the other two cases. Dr. Scott declares, concerning the death from strangu- lation, " this solitary case is the only death by violence which has happened during my connection with the Asylum/' 1 have produced four others, as recent as 18.54 and 1856, which I submit, establish that his assertion is no evidence that many others might not be found if there was full opportunity of ransacking the Coroner's Regis- try. But, Sir, let it be asked whether inquests have been held on all cases of sudden death or emergency in the Asylum. I believe the answer will be " No.'' There is a peculiar diseased condition to which insane persons are subject, termed " Maniacal Exhaustion," but sure it is, that lunatics, like sane persons, may die from common exhaustion. In the Return for 1848r4{), 53 no less than twenty are entered as having died of " ma- niacal exhaustion, two of old age and exhaustion, and one of sudden collapse." Now let it be asked, How do these cases die ? Where do they die ? and When do they die ? Are they generally found dying or dead in the morning, after a night passed in an over-crowded filthy cell, in which there has been fighting and no assistance rendered, no nursing provided ? If so, it is strange that they should die of exhaustion ? Before concluding this subject I would observe that particular stress is laid upon the practicability, so soon as the lunatics are removed from the present Asylum to the new Asylum, to convert these buildings into a female hospital; but let it be borne in mind that the Medical officers distinctly state—that these buildings though they may answer such a purpose temporarily, will not do so permanently. See Appendix A, p.p. 11 and 12. Re- member too they have been declared unsuited for their purpose, on account of bad construction—want of venti- lation—bad drainage—proximity to the cesspool j bear in mind that their roofs are rotten and decayed—that the yard is confined, and that the cells are paved with stone. In order to serve as a female hospital, they must be alto- gether reconstructed. We have already had enough and more than enough of temporising. Hundreds have lost their lives by delay—by making shifts—by employing "temporarily'' as a hospital, " John Crow Wards" places, totally unfit for such a purpose. If we are to have a hospital let it be disease-curing—life-preserving-and not disease-generating—life-destroying. I would urge you, Sir, to examine carefully into the financial matters of the Institutions. See if the books 54 and accounts are better kept than they were in 1854* when Mr. A, A. Alberga gave evidence as to their very faulty condition before a Committee of the House of As- sembly. See Volume of Votes 1 853-54. Look well into the expenditure.—Examine each item --call for the various specifications for contracts.—Ex- amine them—look well into the receipts of Hospital dues and fees. I here annex a table of the annual expenditure of these Institutions, together with the average daily expense of each inmate, for a series of years. On perusing these care- fully, and comparing them with the Table of admissions and deaths at page 34, much material for serious con- sideration will be found to present itself, and another fatal effect of overcrowding, viz., " pinching of the daily allowance1'—clearly set forth. No. in Hospital Total Expenditure Per diem. Years. on day of last for the Year. each Patient. Return. 1842-43 230 7,780 6 10 1 10 1843-44 278 7,683 6 11 1 63 1844-45 252 7,364 18 6 1 7 1845-46 227 7,345 If) 8 1 9 184G-47 259 7,470 13 1 1 6f 1847-48 300 8,461 10 8 1 H 1848-49 375 8,486 9 6 1 21 1849-50 438 9,802 4 3 1 2* 1850-51 314 7,670 1 9 I 4 1851-52 351 8,939 3 5 1 H 1852-53 385 7,657 0 1 1 l 1853-54 { • i 1854-55 { 8,674 5 1 9,370 13 0 1855-56 286 8,525 10 10 1 7* 1856-57 277 8,485 13 0 1 8 'No Returns In computing this table, the number in hospital on the day of the last Return is taken as the daily average •).,) throughout the year- During the first few years indeed until 1845, building repairs, etc. were included in the expenditure Since this period, special grants have been allowed for those purposes. Let me here call your notice to the following state- ments as regards the expenditure for wood as fuel, during the years 1855-56, and 1856-57. 1855-56, Nov. A N. DeGraff for fuel wood 3 2 6 Feby. Thomas Harrison ...... 6 2 6 March. " 9 3 9 April " 6 2 6 May " 9 3 9 June " 9 3 n July B 2 6 Aug. 6 2 6 Sept. " 9 3 9 Oct. 6 2 6 1856-57, Nov. Thomas Harrison for fuel wood G 2 6 Dec. " ...... 3 1 3 Feb. " 4 5 9 Feb. Janet Bogle for wood .. 5 15 0 March " 9 19 6 April " 17 8 6 June " u 12 0 July 8 1 0 ____ << 2 9 0 Aug " 19 12 0 Sept 16 16 0 Oct. 21 0 0 £70 10 £120 3 0 A glance at the two accounts will show that the last exceeds the first by £50, and that the excess is caused by Janet Bogle supplying the wood in the room of Thos. Harrison. Ask, Sir, who is Janet Bogle. Does she sup- plv any other item but wood? Dos she also furnish milk ?* Is she directly or indirectly connected with any * Strange.reports are abroad as to the supply of Milk—reports deeply affecting some of the Commissioners On reference to Appendix No. 2 for the year 1856-57, you will find the following statement relative.to this item :— 3C> one of the Commissioners of these Institutions? Do any other of the Commissioners directly or indirectly supply other necessary articles ? Ask these questions ; ascertain the truth; then, Sir, enquire whether such facts are known to, are sanctioned by the other Commission- ers. Whether the existence of such irregularities, such improprieties have been made known to the Executive Authorities, and in the advancing light thus dawning upon you, you may be able to discover reasons why my pamphlets and myself have met with no favor nor en- couragement. Read well the law in force, xix. Vic. chap- 4th, entitled "An Act to regulate the Public Hsopital and Lunatic Asylum in the city of Kingston and for other purposes." Mark well the provisions and requirements of the Commissioners and different officials—and then say whether these are fulfilled as regards the spirit and the letter. £ s D. November, Edward Nosworthy for Milk 7 19 9 December Ditto Ditto Ditto 6 10 11 January Ditto Ditto Ditto 6 6 3 February March Janet Bogle do do for Milk ... 6 6 do .62 5 April May June do do do do do do do do do . 8 7 . 14 19 . 12 7 6 6 0 July August September October do do do do do do do do do do do do . 15 12 . 18 5 . 15 8 . 8 8 0 0 6 7 In enquiring into this matter, you will very likely be told that the whole affair has been satisfactorily explained—That the Executive Author- ities are satisfied as to its correctness. If such is the case, it ou^ht not to be. Examine into it; take the evidence of those that can and will tell you all about it; and you will find that a properly conducted enquiry will lead to a fearful ex-posure of jobbery and peculation—sufficient to excite the indignation of every honest man in the island. -)/ In a note at page 1.5, I have alluded to a correspon- dence with His Excellency the Governor, as having then recently taken place. Is is necessary that I should men- tion to you that that correspondence has been subsequently prolonged, aud that His Excellency has since extended it to the Royal Society of Arts, and to the Chaplain of the Public Hospital—the non-termination of these is the cause of my not appending it to this communica- tion—but Sir, in any enquiry which may be instituted the production of the whole of this correspondence wil! be of the utmost importance. I will only add here that it has been all along most unsatisfactory to me and has tended to confirm the impression I had formed that His Excellency the Governor shrunk from the unpleasant and painful task he was called upon to engage in. I have the honour to be, Sir, Your obedient humble servant, LEWIS Q. BOWERBANK. Kiiu/ston. 27 th September. 1858. * APPENDIX. 1* ''5 ♦" < ^ t #* t y * V* * * APPENDIX A. NOTES or Observations by the Medical Officers, appended to their Annual Reports of the Public Hospital and Lunatic Asylum, presented to the House of Assembly, For the Year 1844-45. " The present buildings are not at all adapted to the treatment of insane patients ; whenever any of these unfortunate persons be- come seriously ill, it is necessary for their safety and comfort to remove them to the wards of the hospital, to the great annoyance and detriment of the other patients. (Signed) J. MAGRATH, Surgeon. JAS, SCOTT, House-Surgeon." For the Year 1845-46. " Independently of the patients admitted labouring under bowel complaints, a very large number of persons, who came into hospital for other diseases, suffered from attacks of diar- rhoea and dysentery, which may be considered as endemial in the hospital in its present state. Two principal causes appear to render these complaints numerous and fatal in this institution—these are, the state of the hospital, and the condition of the persons usually at- tacked bythese diseases. The hospital is, in general, by far too much over-crowded, which, of itself must prove extremely detrimental— the ground floors are too near the earth; indeed, until the lower wards were excavated in the month of August, by order of the Commissioners, the floors almost touched the soil, and had no ventilation beneath. One of the wards, which is a mere shed, is entirely paved with brick and consequently must be injurious to the patients, particularly in damp weather. The esspools are in the immediate vicinity of some of the wards, and the drains are badly constructed.—With every care, a noisome malaria cannot be prevented arising from them, which produces very deleterious effects. Very many of the patients, that are admitted into this institution, are persons whose constitutions are broken down by intemperance and consequent disease. Several of this class both Europeans and natives, have been in the hospital repeatedly. In them the mu- 4 cous coat of the alimentary canal is extremely prone to disease, and when they are exposed to the above exciting causes, this part is sure to suffer, and the powers of life being feeble, many of them fall victims to attacks of diarrhoea or dysentery. The Commis- sioners have afforded every assistance to the Medical Officers in effecting such improvements as were practicable, but the present buildings are so imperfect, and so badly constructed that they in- terfere materially with the efficient treatment of the inmates. Many of the lunatics were in a very bad state of health when admit- ted. A considerable number died of bowel complaints, and these generally were aged,or persons of broken constitutions. Thebuildings, as was stated in a former report, are not adapted for the treatment of insane persons. The cells are small, ill-ventilated, and always over-crowded; and in consequence of this state, the debilitated pa- tients are rendered extremely liable to attacks of bowel complaint, and to. an erysipelatous swelling of their lower extremities. Since the addition to the institution of the newly purchased land, many of the inmates have been employed, with great benefit to themselves, and advantage to the institution—the men in erecting fences, clearing grounds, performing carpenters' work, etc.—and the fe- males have latterly assisted in washing for both establishments. Many of these also now make a portion of, and repair their own garments. (Signed) J. MAGRATH, Surgeon. JAMES SCOTT, House-Surgeon. " For the Year 1846-47. " In consequence of the alterations made in the wards, and the absence of the usual fall of rain during the last year, the number of cases of bowel complaints, originating in the hospital, has been much less, and more amenable to treatment than was the case pre- viously. The increase of patients labouring under pthisis is con- siderable, and this disease apparently is becoming more prevalent throughout the island. The generality of the patients admitted labouring under chronic complaints, are persons whose constitu- tions are completely broken down by disorganization of the different viscera, which will account for the great mortality in that class. The hospital is now more crowded than ever, and several Coolies having been lately admitted in a state of debility from disease and want of proper food, it is feared the number will be still further augmented; as many, whose illness was not considered sufficiently serious, were* refused admission owing to the want of proper accom- modation. From a similar cause,and a scarcity of ground provisions, several patients were attacked in the hospital with a mild form of scurvy—which, however, yielded to appropriate treatment. 5 From the lunatics having latterly been more employed under a properly regulated system, and from the unusual dryness of the season, their health has, generally speaking, improved, and fewer cases of bowel complaints have occurred, although in some degree the same causes as formerly—namely the crowded state of the cells, as well as the exhausted condition of many of them on admission, predisposes them to attacks of this nature. Many are brought into the Asylum in a state of great excitement, aggravated by the employment of too great, and often unnecessary, physical restraints and several of them sink in a short time from the consequent ex- haustion, whilst others are admitted in a state of both mental and bodily prostration from which they never recover. The Asylum is now more crowded than it has ever yet been. (Signed) J. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." For the Year 1847-48. " There has been a considerable increase in the number of pa- tients admitted into the Public Hospital this year. Owing to this circumstande and the consequent increased want of accommodation, scurvy has prevailed more extensively than it ever did before; and although it has been combated by appropriate remedies and regi- men, it has evidently exerted a baneful influence on patients whose constitutions were already impaired by disease. The admissions of patients labouring under pthisis, are, as was anticipated, increased, and a very large proportion of them came into hospital at an ad- vanced stage of the disease, when medicine had no effect in con- trouling it. The same class of persons labouring under chronic and irremediable visceral disease, continues to be received, and in- creases the mortality in an extraordinary manner. Many die shortly after admission, and others linger for a time, in an utter hopeless state. The Coolies when admitted into the hospital, were all in a state of great wretchedness ; emaciated, and many with foul sloughing ulcers, covered with itch, and their feet filled with chigoes ; they were placed in a separate department of the hospi- tal and were supplied with appropriate food and stimulants, when required. Latterly, when the number of serious cases increased, an intelligent countryman of theirs was appointed to superintend and interpret for them in order that their wants and feelings mi"-ht be fully understood by the Medical Officers, and that they mi°ht be induced by him to comply with the directions which were uecessary in their treatment. Many of these people applied for admission, upon the plea of destitution, but none were received except those labouring under some disease. The rate of mortality amongst the Coolies, is to be accounted for by the want of stamina 6 in their constitutions in a great measure depending on their previ- ous privations, so that in a crowded hospital, several of the ulcers assumed a sloughy character, and owing to a scorbutic disposition, and a want of energy in their system, they were unable to bear up against the disease, which in many instances terminated in spha- celus, or death of the parts. The number under treatment during the year was 265, of whom 143 were discharged, 41 died, and 81* remain in the hospital. In the month of March, 44 African immigrants were received into the hospital, and in August, 16 others were also admitted. The mortality amongst these was immense—as of the first number 38 died, and of the latter 12 died. The diseases of which they died appear under the head of Remarks,—although several of them survived for some time after their admission, there is no doubt that their previous privations of proper air, food, and exercise in the slave ship, and in the barracoons, together with the length of the voyage to this country, and being supplied with food to which they were unaccustomed, so completely undermined their powers and de- stroyed their constitutions, that medicine and appropriate nourish- ment proved utterly useless. Two wards of the New Hospital are so nearlv completed that in a short time it is expected they will be ready for the reception of patients; this will afford material relief to the overcrowded state of the old buildings, which are becoming yearly less adapted for the purposes of a hospital. It will of course be necessary to pave the yard of the New Hospital, and even that part of it in the neigh- bourhood of these wards. That once done, they might forthwith be occupied. The patients [lunatics] continue to be employed as heretofore with considerable advantage to themselves and to the Institution. The whole washing of the Hospital and Asylum is done by'the females under superintendents, and a large quantity ef clothing is also made up by them. The males are employed in various useful occupations. A large number were admitted in a weak and broken state of health, several of whom died within a short period of their admission—others sunk from exhaustion, aggravated by a scorbutic diathesis consequent upon the crowded state of the buildings. Scurvy prevailed much more extensively among the inmates of the Asylum this year—as it did in the Public Hospital—than at any former period, and it was met by appropriate treatment and regimen. The deaths .from bowel complaints were less numerous than in former years, although they were evidently influenced by the scor- butic affection.' (Signed) JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." / For the Year 1848-49. " The two wards of the New Hospital were completed and occu- pied at the commencement of this year, these being in a state to receive patients proved a fortunate circumstance, as just at that time, several very bad cases of fever were received from the shipping. Notwithstanding this increased accommodation, the Hospital con- tinues to be overcrowded, in consequence of the increased influx of patients. From this cause, the want of proper drainage, the malaria arising from the privies and cesspools which, from their con- struction, can only be emptied at intervals, and from, we have no doubt, a peculiar constitution of the atmosphere, which has existed for some months past, in addition to the bowel complaints that have been hitherto endemic in the wards, erysipelas has attacked several of the patients, and proved fatal in those cases where the constitu- tion was impaired by previous disease. As stated in the last year's report, the same class of persons labouring under chronic and irre- mediable visceral disease continue to be received, and consequently renders the mortality considerable. 205 Coolies were under treat- ment during the year; 147 have been discharged; 20 died; and 32 are now in Hospital. The greater number of these persons, when admitted, were broken down by privation, and many of them came in with their limbs in such a state of disease, from neglect, as to render all remedial means nugatory. Those to whom it was advisable to give a chance of life by amputation, generally speak- ing, had not sufficient stamina to ensure recovery. The Lunatic Asylum as well as the Hospital is becoming more and more crowded. In addition to the bowel complaints, to which the inmates are subject, and which in several instances proved fatal, erysipelas attacked many of them, and carried off six individuals. The patients are as usual usefully employed, and it is still found that moderate labour contributes materially to improve their men- tal and bodily health. It is now scarcely ever deemed necessary to employ restraint when the patients are unruly : confining them to their cell for a few hours generally produces the desired effect. (SiKiied) JOS. MAGRATH. Surgeon. JAS. SCOTT, House-Surgeon." For the Year 1849-50.* "Although several improvements were made about the Hospital and Asylum immediately previous to the appearance of cholera in • The following is an extract from a commnnication of the Medical Offi- cers of the Public Hospital and Lunatic Asylum, addressed to the Board of Commissioners, in March 1850—just six months before the appearance of Cholera in this inland. I have copied it from Dr. O. Milro/s Report of 8 the island, they proved inadequate to destroy the causes that fomented the disease, which, we have no reason to think, was in- troduced into the establishment by infection. The Epidemic having found its way to Kingston, produced its most baneful effects in places where it was fostered by certain influences, and unfortunate- ly some of the worst kind existed in this Institution, more particu- larly in the Lunatic Asylum, the cells of which were excessively crowded and incapable of being properly ventilated, and where, consequently, the disease appeared in its most malignant form, carrying off its victims, in a few hours, in defiance of all remedial measures. The mortality amongst the patients suffering from chronic diseases is very considerable; but it could not be otherwise, when so many are admitted in a hopeless state from disorganization of the viscera. As there is every prospect of an increase in the number of per- sons applying for admission, it is absolutely necessary that enlarged accommodation should be afforded, if possible, by carrying out the entire plan of the New Hospital. The old wards are neither healthy nor well-situated. Proper drains and sewers should be es- tablished, and such alterations made in the privies as would render them capable of being kept constantly free from foul emanations. It has proved to be a most unfortunate circumstance, that the New Lunatic Asylum was not in a state to receive the patients previous to the appearance of Cholera, as in consequence of the very crowded state and improper construction of the cells in the, buildings now occupied by them, our worst fears have been realized. (Signed) JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." For tee Year 1850-51. "We have little to say this year, in addition to our Reports of for- mer years, relative to the state of the Public Hospital and Lunatic Asylum, except that the female patients in the hospital are increas- ing in number, and urgently require increased accommodation, which the Commissioners have promised to afford by the erection of Cholera in Jamaica. It is upon " the necessity that exists for the removal of the cesspools, and for establishing a proper system of drainage, to carry off the filth and superfluous water from the Institution. Several fatal complaints, tfuch as bowel disease, erysipelas, and scurvy, originate in the Hospital for want of proper drainage. During the cooler seasons of the year they are not so prevalent; but in the warm weather now approaching, and the pre- sent crowded state of the establishment, should an effectual system of drain- age not be adopted, we dread the most serious consequences." 9 other wards. If the Lunatics were removed to the Xew Asvlum, the buildings now occupied by them might, with some alterations be rendered available temporarily for a certain class of patients. (Signed JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon " For the Year 1351-52. " Notwithstanding the considerable improvements that have been made in both the Public Hospital and Lunatic Asylum within the last few years, scurvy, cellular inflammation, and bowel com- plaints induced by malaria,still infest these institutions. The former two diseases appear only during or after wet weather, but diarrhoea and dysentery are endemial and carry off a large number of those that die, being always most prevalent during and after heavy rains. Owing to the scarcity of medical men in the country, and other causes, disease is neglected or improperly treated in the onset, in consequence of which a great many when admitted, are in a hope- less state, so injured in constitution as to be unable to withstand the disease of the alimentary canal of which they are so peculiarly susceptible. Several of the patients who undergo operations, and who in a healthy atmosphere would to a certainty do well, sink under this affection, and many admitted with bad ulcers (frequent- ly complicated with disease of bone) and with impaired constitu- tion, have a repetition of attacks which often finally prove fatal.' In fine, wherever the health is seriously impaired by chronic dis- ease of any kind, the patient runs additional risk of bowel com- plaint and its consequences. This proneness to bowel complaint interferes most materially with the administration of active purga- tive medicines, which are frequently the best remedies, in the course of many diseases. The generally over-crowded state of the Institutions adds materially to the vitiation of the atmosphere, and requires to be decisively remedied either by an increase of accommodation, or by limiting the number of admissions. The male wards of the Hospital are only capable of accommo- dating 205 patients, or by placing beds in the piazzas, which is not advisable, 229. The female wards, such as they are, ate calculated to contain 33 beds. The male lunatic cells will hold 69 inmates, and the female cells, 38—making the total of patients and lunatics 345, or if the piazzas are occupied 369, which is the utmost number,(with a due regard to the preservation of a pure atmosphere) the Institution is capable of containing, whereas at times, there have been as many as 500 inmates, exclusive of servants within its walls. The space recommended in Military Hospitals in tropical climates, is from 700 to 900 10 cubic feet for each man. The old wards of the Hospital on the ground floor are the most unhealthy, those at the West end are bounded by Rose-lane, whence communication is kept up with the patients, which the utmost vigilance cannot at all times prevent, the lane itself is also in wet weather a fertile source of malaria, whilst the riot and noise of the inhabitants is, at times, most injurious to the inmates of these wards. The buildings of the female Hospital are ill-adapted for the accommodation of the patients, and so much out of repair, that during the late inclement weather the inmates suffered materially, whilst the yard in which these buildings are situated was a perfect quagmire. The new wards answer extremely well, and with a trifling al- teration in the windows and slight repair of a part of the gutter- ing, would be unexceptionable.-—Were it possible to complete the buildings according to the plan laid down, the Hospital would be a blessing, and an oinameut to the island. The making of* efficient drains and sewers will tend materially, and indeed is essentially necessary to improve the sanitary state of the Institution. The waste water is generally deposited in a cesspool which, although due care is taken to have it emptied occasionally, is in itself a nuisance. During heavy rain the drains repeatedly get choked and burst—and the cesspool is so rapidly filled, as to become then utterly useless, whilst the premises are for the time, a perfect swamp, except where they are paved or terraced.. An alteration in the construction of the privies is also urgently required, as in their present state, they add to the insalubrity of the atmosphere. The introduction of the river-water on the premises has been a most useful measure, and as it may be made to pass through the pipes in a considerable volume, it could be used most efficiently in keeping the drains and main-sewer pro- perly clear—there being a gradual descent from the Hospital to the sea. A large proportion of hopeless cases, such as are never received into European General Hospitals—viz.—persons in the last stage of consumption, of renal dropsy, &c. have been admitted into this Institution for years past, and latterly, since the Kingston Parochial Hospital has been closed, and poverty increased whilst the support afforded to the paupers is lessened—this class of patients has not only become more numerous, but people merely broken down by want and old age seek admission. Not a week passes now without several such persons presenting themselves, many of whom the resident Surgeon is forced to admit lest they should die before thev could be taken back to their abodes. 11 If the New Asylum were in a state to receive the lunatics— the cells that these at present occupy could (by making a few alterations) be converted into wards for the reception of a certain class of petients, and although they would be unfit for perma- nent occupation, they might be used until more appropriate buildings could be erected. Of the deaths that occurred during the twelve months, 60 took place amongst the 351 patients that remained in the Institution on the 1st October, 1851—the remaining took place amongst the patients admitted during the current year ending 30th Sep- tember, 1852. (Signed) JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." For the Year 1852-53. " Few, if any improvements, have been made on the premises during the last year; the cesspools remain as there are no drains, and the female Hospital is scarcely habitable in wet weather ; we believe all this to be the consequence of the want of funds— which we trust will soon be removed.—Should Cholera or any other epidemic disease again assail us, the want of proper drains and the existence of the cesspools, will, in all probability, occa- sion a fearful mortality. As heretofore a considerable number of persons broken down by old age and disorganised viscera, irre- mediable by medicines, are daily admitted, a large proportion of which class was formerly attended, either at their own houses, or were treated in a Parochial Asylum wherever one existed. In- deed many requiring Medical treatment are every day refused ad- mission where their diseases do not appear to be of a sufficiently Scrious nature. Were all, who present themselves for admission taken in theHospital would soon become a pest-house. Many of the a£ed are admitted merely through fear of their dying in the streets or before they could be returned to their own homes.— There are seldom less than 400 patients in the Institution, m- ' eluding the lunatics, and there have been as many as 500, the numbers fluctuating between these extremes-vvhde, it » only ranable of properly accommodating three hundred and forty-five —and on an emergency, twenty-four beds may be placed in the piazzas of the new male ward, as was done in the late epidemic of Yellow Fever. A larsrer number of lunatics than usual has been discharged th« vear Many of them are brought to the Asylum in broken K lth who when attacked with bowel complaints are frequently the victims of it. We find that employing them in light labour, d r Medical direction contributes much to the restoration of 12 their mental and bodily health, whilst restraint, except of the moat temporary nature is never required or practised. Whenever the New Lunatic Asylum is in a state to admit of the removal of the lunatics to it, a double advantage will be gained,—-there will be more space for varied labor there, and the building in which they are at present confined may with some alteration be fitted up for the temporary reception of a certain class of Hospital patients as has been before suggested. (Signed) JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." For the Years 1853-54, and 1854-55. These returns, as previously stated, were never supplied. For the Year 1855-56. " In reference to the condition of the Public Hospital and Lunatic Asylum, it may be remarked that the buildings generally are in an improved state—the Executive Committee' having during the year effected considerable repairs throughout both Institutions. Notwithstanding these however, in conse- quence of the state of decay of some portions of them, and the actual rottenness of a great part of the roofs and shingling ren- dering them scarcely habitable during heavy rains,—there ought to be a further outlay of money, so as to make them secure against any inclemencies of the weather, and thus ensure comfort to the patients. With regard to the buildings used as a female Hospital, these were taken some years ago for the temporary oc- cupation of patients, until a more suitable place could be provided for them. Year after year they have been condemned on account of their construction, and unfitness for the reception of sick persons. Now their state of decay must make the question of their re-construction or abandonment one for consideration, as the patients treated in them labour under serious disadvantages. On the removal of the lunatics to the New Lunatic Asylum, the buildings now occupied by them might be converted into a Hos- pital for females. Some alterations are urgently required to the windows of the new buildings, to allow proper ventilation through the wards which are appropriated to fever and other medical cases. There is still an absence of proper drainage about the buildings, so that any superfluous water is imperfectly carried off. —The cesspools of which there are two, into which this flows, as well as the drains, are nuisances, and are greatly concerned in creating and fostering certain diseases which have almost become endemic to the Hospital—occasionally the effluvium from them, 13 notwithstanding they are periodically emptied, is intolerable, and acts prejudicially upon the inmates. Almost the same class of patients as hitherto has been admit- ted during the year into the Hospital, notwithstanding the 16th clause of the Act regulating the Hospital and Asylum, which directs that no person, labouring under any incurable disorder, shall be received into the Hospital. A great number of patients who have been received, and have died in the Institution, have been necessarily admitted on account of their having been brought to the gates in an exceedingly low state from old age and debility, and disease; in fact, in an almost dying state, many of them scarcely having strength to reach their wards. Upon enquiry, it has been ascertained that they were persons without homes: some of them have been picked up in the streets, or found lying on the piazzas, and all of them labouring under the greatest privations, there being no parochial asylum into which they could have been received, or to which they could be taken, if refused admission; and of which institution the majority would have been the proper inmates, whilst some of them belonged to the distant parishes. The mortality amongst them has therefore been great. No difficulty has been experienced in carrying out the law, in regard to the limitation in the number of patients to three hun- dred, and on the whole, the new mode of admitting them has been an improvement upon the former method. But for the reasons just mentioned, the present system would have deter- mined most effectually, that which is a desideratum, viz^the introduction of a legitimate class of patients into the Public Hospital. The lunatics have, as usual, been generally employed at light work about the Hospital and Asylum, and this has tended to the improvement of their health, mentally and physically. The number in the Asylum has been under the average of former years, and several have been discharged and delivered to their relatives and friends. It is satisfactory to observe that the per- centage of mortality has been considerably below that which has been shown in previous annual returns, and which may be attributed to the circumstance of there having been less diarrhoea, dysentery, and scurvy amongst them than formerly, although the patients of the Public Hospital suffered much during the year from the first two of these diseases. (Signed) JOS. MAGTtATH, Surgeon. JAS. SCOTT, House-Surgeon." 14 For the Year 1856-57. "Soma further improvements havebeen made about theHospi- tal premises, especially the new buildings, through which proper ventilation of the wards has been established by an alteration of the windows. The drains having received attention, and two new ones have been laid down; the lodgment of foul water has been prevented, although much water continues to lodge about the buildings, especially after heavy rains ; but this can only be effectually "guarded against by the establishment of a general and more perfect system of drainage. The cesspools, as stated in former returns, from their proximity and relative situation, act injuriously upon the patients, and their removal would con- tribute materially to the healthiness of the Institution. The old male and the female Hospitals also demand early attention. The roofing of the former is in a decayed state, in consequence of which the inmates are exposed to inclemencies of the weather, whilst the latter is totally unfit for the purposes of a Hospital; but the old Lunatic Asylum will doubtless be converted into a Hospital, so soon as the lunatics shall be removed, for the reception of the female patients. Several nurses from the Nurse-training Institution were em- ployed at the Hospital, whose services were found valuable. Were a similar class of nurses permanently attached to this In- stitution, under the sole controul ot the medical officers, im- mense benefits would be conferred on the patients. (Signed) JOS. MAGRATH, Surgeon. JAS. SCOTT, House-Surgeon." « APPENDIX B. RERORT of Hospital Commissioners in 1847, to the House of Assembly, with opinion of Members of the Medical Faculty of Kingston, on the state of the Public Hospital of Kingston. See Vol. of Votes of Assembly, 1846-47, p. 281. "The Commissioners appointed for the superintendence and man- agement of the Public Hospital and Lunatic Asylum of Kingston, under the Act 8th, Victoria Chap. 29, feel it incumbent on them to report to the Honourable House of Assembly the progress of their efforts to improve the same, and to elevate the condition of the inmates. On the nomination of your Commissioners, they at once entered upon the discharge of the duties of their office with cheerfulness, viewing the liberal grant from the public of £8000 per annum for its support as the earnest of their intention to carry out in the most effectual manner the purposes contemplated in passing the vote. The state of the Institution at that period, was of the most pain- ful description, and awakened to intensity the sympathies of your Committee, the insufficiency of accommodation for the great num- ber of patients having introduced many unavoidable evils, which aggravated the condition of the unfortunate persons seeking relief from disease and poverty, by rendering the chance of recovery to the unhappy sufferers very precarious and difficult. In adverting to the Asylum in particular, the Commissioners do not hesitate to pronounce it to have been a disgrace to the island until the legislature made a grant, at their solicitation, in 1845, to purchase land to enlarge the same. The Commissioners, while they now report the ample room to extend the Hospital, deeply regret to state the present building is in a most dilapidated state, as well as totally inadequate to the accommodation of the number of patients crowded into it; the foul atmosphere from the effluvia of so many human bodies, added to tne filth of nearlv three hundred people remaining stagnant in cesspools, without" drains for carrying it away, are evils which call ^Ycw Commissioners find so many distressing difficulties opposed to the success of the medical officers for the benefit of the patients, in the want of accommodation and cleanliness, that they feel called 16 upon in the fulfilment of their duty to the public and to humanity, to submit the same to your honourable house, claiming their im- immediate attention thereto; and they feel strengthened in their ex- pectation that their appeal will not be in vain, supported as it is, by the report of a number of the most respectable medical men, who have examined the institution, as by their certificate annexed, which truly represents the urgency of the case. Your Commissioners are fully impressed with the conviction that immigration, with the growing popularity of the Institution for surgical operations to the poor, is leading to a great increase of patients, and the want of accommodation. The Commissioners have in conclusion tQ inform the House, that the decayed state of the buildings, and their total inadequacy in every respect to the purposes intended, have induced them to pro- cure a plan of such a Hospital as a body of Medical gentlemen consider desirable, which they now offer to the notice of the House, in hope that the means will be granted for its gradual completion. (Signed) DOWELL O'REILLY, Chairman." "To the Commissioners of the Public Hospital and Lunatic Asylam. Kingston, January 25, 1847. Gentlemen, We the undersigned Medical Practitioners, have at you* request inspected the Public Hospital, and have agreed to deliver the following opinions— 1st. That the present buildings are altogether inadequate and unsuitable for the reception and wholesome accommodation of the large number ot sick persons which the Hospital usually contains. 2nd. That the crowded condition of the wards (even as at pre- sent when there is no prevailing unhealthiness) is highly injurious to the sick—prevents their classification—often frustrates the medical treatment, and generates new cases of disease—especially diarrhoea and dysentery. j ^ 3rd. That the excretions of the sick, and other residents in the Hospital, and the decaying animal and vegetable matter accumulat- ing there, as in all places which are the abodes of large masses of human beings, are either allowed to remain on the spot in privies, or are removed outside by uncovered gaiters, being carried no fur- ther than to a large cesspool behind the principal buildings, (so near as absolutely to touch them) and that from these sources, the air acquires a morbific influence. 17 4th. That the morbific action of the air thus affected, is indispu- table, and the fact is now gaining the attention it deserves in all countries, in reference both to the sick and healthy. 5th. That buildings of appropriate construction and affording extended accommodation, with sufficient sewers and drains, are urgently required—inasmuch as the great benefits to be derived from a well-conducted Island Hospital can never be realised, whilst the air in and around it is liable to be tainted, not only with the effluvia from the bodies of the overcrowded sick, but from the prox- imity of decomposing organic matter in its most dangerous and disgusting forms. We have the honour to be, Gentlemen, Your obedient Servants, (Signed) JOHN FERGUSON, M.D. v A. HENRIQUES JAS. MC'FADYEN, M.D. ANDREW DUNN, M.D. J. A. MAGRATH." a APPENDIX C. EXTRACTS from the Writings of Dr- C. J. B. Williams, Dr. Copland, Dr. G. Milroy, and Dr. Carpenter, on Drainage, Cesspools. Ventilation. and Over-crowding. At page 55 of the 3rd edition of " The Principles of Medicine," Dr. Williams writes:—"Defective drainage necessarily pro- duces an active state of the influences above specified, namely, filth and foul air; but it also implies circumstances that may exceed these in pernicious operation. The soil which drains from habitations contains, in addition to excrement, dirty water, the washings and remnants of animal and vegetable matters used as food, and other offal; all these are mixed together and stagnant in the corrupting slough that is retained in cesspools and privies. The stench which exhales when these receptacles are opened, gives some idea of the deleterious influence they originate, and the fearfully poisonous nature of the emitted gases is often proved by the sudden faintness and sickness, nausea, vomiting, and diarrhoea, which attacks persons en- gaged in emptying them. Instances have occurred of indi- viduals being speedily asphyxiated by the gases of cesspools; and others are on record in which, although the result was not immediately fatal, congestive or typhoid pneumonia ensued, which passed into gangrene in the first stage. (Chomel), the precise nature of the gases evolved in these circumstances, has not been fully ascertained; but they obviously contain much sulphuretted and carburetted hydrogen ; these however, although known to be highly noxious, do not compose the most danger- ous ingredients of these offensive effluvia. It is no wonder, then, that every ill-drained house has a Pandora's box ready to pour forth its evils whenever occasion offers ; and always oozing them out in degrees, sufficient for the impairment of the health of the inhabitants and the gradual excitement of cachectic and other chronic diseases. Hence it is, as appears in the several sanitary reports before cited, that the mortality rises in a re- markable proportion in all those districts of towns where sewer- age is absent or inefficient. The worst nuisance of this descrip- tion is the cesspool without a drain from it; unemptied for months or years, and often imperfectly covered, it continually poisons both air and water; and typhoid fever, diarrhoea, cholera, 19 dysentery, dyspepsia/inappetency, general weakness, and malnu- trition, are results of its pestiferous operation acting in different degrees. Scarcely less injurious, and even more insidious in its operation, because the effluvium is less offensive, is the untrapped drain. * * * *#*## It is surprising how ignorant servants and their employers, and even professional men, seem to be on this point, although one which so immediately concerns their health and comfort. I have visited in many houses where illness, or impeded convalescence, low nervous fevers, bowel complaints, influenzas, neuralgia, and headaches, besides other ailments, have been induced by this cause." Dr. Copland, in his Medical Dictionary, Vol. III., page 235, —article, " Pestilence"—after describing the evils accruing from cesspools without outlets or drains for carrying off their contents, wrjtes :—" U is supposed that the circumstance of cesspools and drains containing animal matters in a state of decay, being covered over, is a sufficient protection from their injurious influ- ences. But they are not hermetically sealed. There is a con- stant generation and extrication ot foul gases from them, and these gases and the air contaminated by them, are constantly passing off between the boards and crevices of the stones which cover them." If such is the case in temperate climates, what must it be in a climate like ours—especially when these cesspools are allowed to remain untouched for fourteen and sixteen months, receiving the refuse, &c, of from 1500 to 2000 people? In a recently published pamphlet entitled, " On the Sickness and Mortality in the French Army during the Campaign in Turkey and the Crimea," by Gavin Milroy, M. D., we find it 8tate(j .__" Ventilation should be so arranged that fresh, pure, air should reach every inmate, and that the vitiated respired air of all should be carried off continually by night and by day. Unless this most essential of all requirements is invariably and unceasingly provided, nothing but mischief must ensue. Far better that the sick, and especially the sick from fever, should be scattered about in large court-yards, or upon any open clean and dry ground, and be put under canvass or any sort of shelter! however imperfect, and with the want of every comfort around them, than that they should ever be accumulated wuhin a buying where there is not an adequate amount of space for a Duiumig where a pure atmosphere cannot be maintained each inmate oi where J P n^ air at aI, times in the by the constant ren wil, compensate for tne want of twenty-tour hours. ^ & ^^ tQ an ever.beuetil.eilt p„,_ this prune necessar),heiebehdf) whj|e ^ ^ vidence, may always ana eve y 20 value of every other curative agency or influence will be tenfold enhanced." What matters it then, if the new buildings of the Public Hos- pital are now freely ventilated, if they are in themselves " unex- ceptionable," so long as they stand in a " swamp," in the midst of drains, privies, and cesspools, reeking out their " intolerable effluvia V Of minor consequence to fresh air, but most cheering and invigorating to the convalescent, is light—" the light of day;"—but for want of bonnets and blinds to the windows", so as to regulate its admission, the inmates of the New Fever Wards are exposed to the fierce and fiery glare of a tropical sun. At page 300 of the 5th edition of Dr. Carpenter's Principles of Human Physiology, after describing the effects of over-crowd- ing—such as occurred in 1756, at the well known " Black Hole of Calcutta"—he observes:—" It cannot be too strongly im- pressed upon the Medical Practitioner, however, and through him, upon the public in general, that the continued respiration of an atmosphere charged in a far inferior degree with the ex- halations from the lungs and skin, is among the most potent of all the "predisposing causes" of disease, and especially of those zymo- tic diseases, whose propagation seems to depend upon the pre- sence of fermentible matter in the blood. And it is not difficult to find a complete and satisfactory explanation of it. For, as the presence of even a small percentage of carbonic acid in the respired air, is sufficient to cause a serious diminution in the amount of carbonic acid thrown off, and of oxygen absorbed, it follows that those ozidating processes, which minister to the elimination of effete matter from the system, must be imperfectly performed, and that an accumulation"of substances tending to putrescence must take place in the blood. Hence there will pro- bably be a considerable increase in the amount of such matters in the pulmonary and cutaneous exhalation ; and the unrenewed air will become charged not only with carbonic acid, but also with organic matter in a state of decomposition, and will thus favor the accumulation of both these morbific substances in the blood, instead of effecting that constant and complete removal of them, which it is one of the chief ends of the respiratory process to accomplish. It has been customary to consider the conse- quences of imperfect respiration, as being exerted merely in promoting an accumulation of carbonic acid in the system, and in thus depressing the vital powers, and rendering it prone to the attacks of disease. But the deficiency of oxygenation, and the consequent increase of putrescent matter in the body, must be admitted as, at least, a concurrent agency; and when it is borne in mind that the atmosphere in which a number of per- 21 sons have been confined for some time, becomes actually offen- sive to the smell, in consequence of the accumulation of such exhalations, and that accumulation exerts precisely the same influence upon the spread of zymotic disease, as that which is afforded by the diffusion of a sewer-atmosphere through the respired air, it scarcely admits of reasonable doubt, that the pernicious effect of overcrowding is exerted yet more through its tendency to promote putrescence in the system, than through the obstruction it creates to the due elimination of carbonic acid from the blood. For it is to be remembered, that whilst the complete oxidation of the effete matters will carry them off by the lungs in the form of carbonic acid and water, leaving urea and other highly azotised products to pass off by the kidnies, an imperfect oxidation will only convert them into those pecu- liarly offensive products which characterize the faecal excretion.* # # # * # It is impossible, however, for any one who carefully examines the evidence, to hesitate for a moment in the conclusion, that, by due attention to the various means of pro- moting atmospheric purity, and especially by efficient ventila- tion and sewarage, the rate of mortality may be enormously de- creased, the amount and severity of sickness lowered in at least an equal proportion, and the fatality of epidemics almost com- pletely annihilated. And it cannot be too strongly borne in mind, that the efficacy of .«uch preventive measures has been most fully substantiated in regard to many of the very diseases in which the curative power of medical treatment has seemed most doubtful; as for example, in cholera and malignant fevers." With a firm conviction of the truth of the above remarks, and of the immense mischief likely to arise from the neglect or breach of any of them ; and flattered rather than abashed by the sentence passed upon me by my self-appoint<>d judge, the House- Surgeon of the Public Hospital and Lunatic Asylum,—that my mind is a " hypercritical" one—I will agsiin express my opinion ; That in any hospital or receptacle for the sick, imperfect or defective ventilation or drainage should (if practicable) be reme- died at any cost: allowing it to continue, being wrong; and beincr, besides, a penny-wise and a pound-foolish policy. * Tt is a remarkable confirmation of Professor Liebig's analogy between erfect oxidation of effete matters within the body, and that combus- the imp ^ ^ furnace insufficiently supplied with air, which causes a ~}on °.. £ g0Qt and various empyreumatic products, that a set of acids have deposit Stadeler in the urine of the eow, bearing a remarkable anal- been 10 „_j^n0Wn products of destructive distillation, and one of them ac- ogy to vv -^^ with the carbolic acid, previously known as one of the tually iu» «_ . geo (jregorv's Handbook of Chemistry, p. 450. ingredient.-* 01 m« -■ a 22 That where, in any hospital, these existing evils cannot be remedied ; where, moreover, the site and construction have been condemned as unhealthy and unsuited to its purpose; and where the greater portion of it is so decayed and rotten as to expose the inmates to the inclemencies of the weather; its further use as a hospital, should cease; And that, under any circumstances, to over-crowd a hospital is wrong, but to thrust into one, with imperfect or defective ventilation or drainage, three times as many as it is capable of holding, is criminal, is murderous.