« ForrigeFortsæt »
dormitories. We could mention many instances which have come to our knowledge of patients breaking through windows and letting each other down by sheets; breaking through ceilings and getting from the roof; slipping through the door while the attendants were busied with other patients, &c. For determined suicidal and escaping patients, a few single rooms must be provided. Two per cent. will be enough, or ten for an asylum of 500.
3. Chronic patients suffering from temporary excitement or illness. Accessions of maniacal excitement occurring during the course of chronic insanity, incapacitate patients for the occupation of dormitories in a scarcely less degree than acute mania. The management of bodily illness differs greatly in various asylums. In some, dormitories are fitted up as infirmary wards; in others, patients suffering from occasional illness are treated in the wards where they usually reside. The latter plan has the advantage of leaving the patient who has an attack of diarrhoea or bronchitis to the care of attendants to whom he is accustomed and attached. Probably, the best system is a medium between the two; the infirmary being employed for serious illness of long duration, and the common wards for the slighter varieties of indisposition. For the treatment of such cases, a few single rooms are needful. A few more, also, are needful in the infirmary ward itself, for the use of patients suffering from diseases which render separation advisable. Diseases causing nauseous effluvia, asthenic gangrene of the back or the lungs, dysentery, &c., diseases of a more or less contagious nature, erisypelas, typhus, psora, &c. In an asylum of 500 people, not less than fifteen single sleeping rooms ought to be available for cases occurring under this head.
4. Patients whose education or habits would render the use of a dormitory a painful infliction upon their delicacy or self-esteem. We trust that none of our readers will welcome this class with a sneer. Certainly, no one who has had the charge of a county asylum will feel inclined to do so. He will too well know, from a painful experience, how hard is the lot of many men bred in luxury and affluence, of many women nurtured in gentleness and delicacy, whom the decrees of a hard fate have compelled to associate in the wards of a lunatic asylum, with the rude sons and daughters of toil. To associate with them by day is often a severe trial, modified, however, by the orderly arrangements of an institution which, to a great extent, repress and prevent the boisterous rudeness and vulgarity common in the lower classes. But to associate
with them at night, in a large dormitory, is a far greater trial, and one which cannot be softened. To sleep in a dormitory at all, for the first time in one's life perhaps, would be a most painful shock to persons of delicate feeling, to dress and undress in the presence of others, to have no moment for privacy, for the exercises of devotion, would drive many a sane woman out of her senses, and many an insane woman frantic. The proportion of patients corresponding to the above description varies greatly in different county asylums. It is largest where the asylum population is to a great extent drawn from great towns, and it is comparatively small in the agricultural counties. An asylum for 500 patients in an agricultural county, would not contain more than ten or fifteen of such patients. A metropolitan asylum would con tain a much larger proportion. The importance of providing single rooms for patients of this class is advocated by Dr. Conolly, our highest authority on asylum management, in the following terms:
"In all asylums the proportion of single bedrooms appears to me to be too small; and I always recommend architects to have such rooms for at least two-thirds the number of patients to be received into any proposed asylum. A few dormitories, containing not more than four or five beds in each, are useful in an asylum. The timid and the melancholy are best placed in such rooms for the night, and those disposed to suicide are safer with others than alone. But in favour of large dormitories, I do not know one good reason that can be advanced. Those who sleep in them are generally discontented. The air of such large sleeping rooms becomes indescribably oppressive when the patients have been two hours in bed; and it never becomes quite fresh and pure, although all the windows and doors are open, in the longest and finest day. One patient, accidentally noisy, disturbs the repose of fourteen or fifteen; and out of that number there is often some one noisy. One man suddenly irritated, or any one patient suddenly starting out of a dream, may rush on his nearest neighbour and injure him severely. Such accidents are very incidental to dormitories; and in those houses in which they are said to produce no inconvenience, I suspect that all who are likely to be troublesome are fastened to their beds. The violent patients must, of course, be in single rooms, and if dirty patients are herded together at night, a dormitory becomes perfectly disgusting; and as for the clean, and orderly, and tranquil and convalescent patients, no complaint is so constantly on their lips, as that which arises from
their not having a single room, and, consequently, not having a single moment to themselves, or any place where they can be quiet, or, in their frequently uttered words, where they can even say their prayers without interruption. I would, therefore, have at least two-thirds of the bed-rooms single rooms, very few and small dormitories, and no large dormitories for any class of patients."
"In the Derby plan, the proportion of single bed-rooms was rather less than two-thirds; but the Commissioners condemned even this proportion as unnecessary. With great deference to the Commissioners, I consider this to be a serious mistake." (Conolly on the Construction and Managament of Lunatic Asylums, p. 24.)
The above estimates have been arrived at from the careful consideration of 500 patients inhabiting an asylum in an agricultural county. They are not, therefore, mere guesses at the proportions of the classes enumerated, they are estimates founded upon the actualities of an asylum population. The estimates are made rather under than over the mark, since the deficiency of single room accommodation in the asylum where they have been made, has occasioned a constant effort on the part of the medical officers to dispense with the use of single rooms wherever it was possible to do so without injury to the patient. Had a larger number of single rooms been available, there is little doubt that a greater need for their employment would have impressed itself upon us. One learns to do without the things one cannot have. The proportion of 168 single rooms to 500 patients, is, we believe, the lowest proportion with which it is right to supply any asylum. The proportion, however, may judiciously be made to differ in the wards appropriated to the two sexes, and in those used by different classes of patients. The women ought to have a larger proportion of single rooms than the men. In the asylum where we write, this proportion is unfortunately reversed; and the habitual state of the male and female wards at night, affords a remarkable proof of the value of single rooms in preventing nocturnal disturbance. The male wards contain 76 single rooms to 236 patients; and on passing through them at night, it is the rarest occurrence to hear any sound, except that of deep breathing, or a wakeful patient muttering or talking low to himself. In the female wards there are 53 single rooms to 293 beds; and in passing through them at night, it is a common occurrence to hear loud wranglings and disputes in the dormitories. On the female side there is twenty times more noise at night in the
course of the year than on the male side. The pernicious effect of this nocturnal disturbance and loss of rest, upon the mental health of the patients, cannot be doubted. Sleep and tranquility are the pivots of mental treatment; and a hospital for the insane, built upon principles which in any degree diminish the means of ensuring these to its inmates, is built upon principles utterly adverse to its main object. The dormitory system, applied to too great an extent throughout any hospital for the insane, would, on this account, be a deplorable error.
The only circumstance in which this exclusive dormitory system is feasible, is in making provision for particular classes of insane patients. In a wing for the use of patients regularly employed in agriculture or handicrafts, single sleeping rooms may well be dispensed with; the lower floor may be used for day rooms, and the upper floor be occupied by dormitories. For such patients, even a three-story building is less objectionable than for the general purposes of an asylum. If for such patients the third story is used for dormitories, after the rooms are cleaned and the beds are made in the morning, the floor will be entirely left until evening. There will be no patients lingering in bed and calling the attention of the attendants from their duties below. The upper stairs will only be climbed once a day. The lower story may be used for work-shops; the middle story for day rooms. plan has answered with male patients in regular work. We should be sorry, however, to try it with women. Many a female patient will work well at the wash-tub, who is quite unfit for a dormitory.
Our conclusions are: 1st, That at least one-third of the beds in a County Asylum, ought to be provided in single rooms. 2nd, That a two-story building, with single sleeping rooms opening into wide corridors, affords the best general arrange
3rd, That a three-story building, with living rooms on the third story, is decidedly objectionable.
4th, That a three-story building, with sleeping accommodation alone on the third story, is objectionable as a general arrangement.
5th, That working male patients require less foot space in their day rooms, and can generally dispense with single sleeping rooms. For such patients, therefore, a three-story building, with dormitories alone in the third story, has the recommendation of economical construction, and is not objectionable on other grounds.
Flemish Interiors, by the writer of "A Glance behind the Grilles." Longmans, 1856.
Notes on Belgian Lunatic Asylums, by John Webster, M.D., F.R.S. Part I. Journal of Psychological Medicine, January, 1857.
A small volume styled "Flemish Interiors," being notes of a tour of religious enquiry through Belgium, written by some recent convert to the Roman system, is a very readable book, and contains some interesting observations on the establishments for the insane, under the care of the religious orders in Belgium. These observations we were led to compare with a paper by Dr. Webster, in the present number of the "Psychological Journal," on the lunatic Asylums of Belgium; and the contrast between the hard dry facts of the man of science, and the bright colours which the religious votary throws over the same scenes, seemed to us worthy of being brought out in our pages.
As it happens both Dr. Webster and the writer of the "Flemish Interiors," start at the same place; at the old town of Bruges, so replete with memories of the glorious days of the low countries. Many of our readers will recall the musings of the transatlantic poet, on the summit of the grand old belfry of Bruges, when as the summer morn is breaking, he stood on that lofty tower, the city slumbering at his feet, and
Visions of the days departed, shadowy phantoms filled my brain ;
I beheld the pageants splendid, that adorned those days of old;
Stately dames, like Queens attended, knights who bore the Fleece of Gold.
I beheld the Flemish weavers, with Namur and Juliers bold,
Marching homeward from the bloody battle of the spurs of gold, &c., &c. Very different is the story of that fallen city now. Its valour and its commerce have alike passed Westward, and freedom and despotism carry on to-day their eternal warfare uninfluenced by the "braves Belges ;" while, with a population of less than one third of its ancient numbers
In Bruges town is many a street,
VOL. III. NO. 21.