ANNUAL REPORT OF THE MEDICAL SUPERINTENDENT OF THE ASYLUM FOR THE INSANE, KINGSTON, FOR THE

YEAR ENDING SEPTEMBER 30th, 1899.

To R. Christie, Esq., Inspector of Asylums and Public Charities of Ontario.

SIR,-In accordance with the statutory requirement, I have the honor to submit the forty-fourth annual report of this Hospital (the twenty-second since it became a Provincial institution), for the year ending September 30tb, 1899.

As has been the case for many years, the chronics admitted far outnumbered those suffering from acute insanity, fifty-three having been insane for more than a year, seven of them in fact for more than twenty years. Of the so-called recent cases many were of the subacute type, consequently far less likely to recover than those who had acute insanity. Of late years the admissions to Rock wood have largely been suffering from chronic and subacute forms of insanity, while acute disease seems to be lessening.

It is a matter of regret that the number of patients admitted from the gaols has increased in a marked manner, in spite of annual protest against the use of the warrant system. It is seldom indeed that a case is so urgent that a resort to confinement in gaol is necessary, and no superintendent will refuse admission to an acute patient, no matter how overcrowded the wards are. It is a regrettable fact that while the Government of Ontario has been anxious and willing to give care and protection to the insane of the Province, the general public has ordinarily shown a limp interest in the affairs of this afflicted class, unless it be the criminal insane, to whom it evidences a vindictiveness quite surprising, when compared with the attitude of the general public of other countries. That thirty-three patients, nine of them women, should have had to pass through the gaols before reaching this institution, is a reproach to the people of the district from which we receive our admissions. It not only means that these unfortunates had to submit to the degradation of incarceration in the common gaol, but also means that the expenses of medical examination and transportation to the hospital were assumed by the municipal and provincial authorities. Several patients were even admitted from Kingston gaol, one at least, even after the friends were offered medical certificates and urged to bring their relative directly to the institution. We know as a matter of fact that the medical profession is not so degraded that it will refuse to perform an act of charity when called on to do so. It certainly cannot be, that medical men are anxious to make

an occasional fee out of the Government, even at the cost of incarcerating a poor mental weakling in the common gaol for weeks or perhaps months. We must look then for other reasons to account for "man's inhumanity to man."

The longer one studies the remarkable statistical tables issued in connection with asylum reports, the more he becomes convinced that figures will occasionally lie, in spite of the honest effort of those who are asked to compile them. Nowhere does the truth of this statement become more manifest than in the table showing what are supposed to be the causes of insanity. These statistics are of no real value to anyone, unless to the enthusiastic faddist who has a particular theory to elucidate, and who can, if he looks far enough in the right quarters, discover anything he wishes. They are to a large extent compiled from the statements of the relatives of patients, and who can blame them if the family skeletons are not paraded for the benefit of the public gaze.

Under the "hereditary" headings, not one half of those who have inherited the fatal tendency to mental instability are to be found; on the other hand, domestic afflictions, religious excitement, and other similar causes are called on to do more than double duty, while physical causes are largely overlooked.

Take the heading, religious excitement. It is doubtful if many, or indeed any cases of insanity can be directly traced to religious excitement, although this cause may have had an indirect influence in its development. Last year five patients were admitted whose insanity was said to have been caused by religion. In this district there has been for some time past a so-called religious movement, characterized by much excitement and manifestations of emotion. Of course such excitement is the lever which disturbs the balance of the unstable brain, and when the physical health is, in addition, impaired, the result is not to be wondered at. As a matter of fact, when the condition of the patients whose insanity was said to have been caused by religion is analyzed, we find just what might have been expected-first, hereditary taint, second, poor physical health. Such people are, of course, the last who should venture near the emotional meetings, unfortunately they are the ones most likely to be attracted. Religion, using the word in its highest sense, probably never caused insanity in any one, although I have not the slightest doubt it has frequently prevented it.

DISCHARGES.

Little is to be said regarding the discharges, beyond the fact that considering the unfavorable character of the admissions, the proportion of recoveries may be considered as eminently satisfactory, large, in fact, if based on the number of acute cases received. The greatest possible care has been taken to include nothing but the names of those who can truly be called recovered, and in nearly every instance the patient has been discharged on probation, not only with the idea of avoiding unnecessary expense to the friends in case of relapse, but also with the purpose of having the recovery confirmed at the end of a reasonable period.

Many patients suffering from recurrent types of mental disease, look on the proba tional system of discharge as a great boon, and are most particular when leaving for home during the quiescent period, to have the bonds carefully executed and renewed when possible. In all asylum experience nothing is more pathetic than the periodical return of these probationers when they feel that a paroxysm of excitement is about to recur.

DEATHS.

As is usual, phthisis and general paresis were the cause of many deaths. One death was the result of an unfortunate accident, full details of which were furnished you at the time of its occurrence. A patient, named Joseph Bailey, forced open the doors of a dumb-waiter, and in attempting to escape, fell a distance of forty feet, fracturing his skull and arm. He died a few hours afterwards. A full enquiry was held by the Coroner, and a suggestion made to the effect that in view of the fact that this dumb-waiter opens into a main corridor, some mechanical device should be adopted, which would prevent a

recurrence of a similar accident, in case of the doors of the waiter being forced open. After a good deal of trouble, a satisfactory plan of overcoming the trouble has been adopted.

Another death resulted from an injury to the esophagus. William Williams, a chronic patient, of more than average intelligence, attempted to swallow a piece of gristle, and in doing so injured his œsophagus. Severe inflammation followed, and after a

brief illness the patient died.

Two deaths from impacted gall stones are recorded. The first case was operated on promptly, without avail; the second proved fatal in a few hours after its development.

SMALL ALYLUM FOR CRIMINALS.

At

In a former report I urged upon the Government the advisability of putting up a small building, under the management of one of the Provincial Asylums, for the insane of the criminal class. Each Province should care for its insane criminals, who are now housed in most unsuitable quarters in the Kingston Penitentiary. Surely special provision should be made for these unfortunates. The necessity for such a building is brought home to us with peculiar force, by our proximity to the Kingston Penitentiary Asylum. When the sentence of an insane convict belonging to the Province of Ontario expires, it is generally a matter of convenience that he should be transferred to Rockwood. Ordinarily, the insane convict is not much more trouble than any other insane person, but when we come to dealing with the homicidal criminal lunatic it is a very different thing. It is almost criminal to allow them to mix with the patients of such an institution as this, and the evil effects of such association are ever present. These human monsters are of course quite irresponsible, and should be kindly cared for, although carefully secluded from their fellow beings, who do not suffer from the criminal instinct. this date two such criminals, from Kingston Penitentiary, a man and a woman, make the lives of every patient in two wards more or less unhappy. These degenerates not only use language of the most shocking character, and disseminate the most degrading ideas, but they make repeated attempts at homicide without the least provocation. In a comparatively open building such as our main hospital is, it becomes a serious question, not only to know how to care for these patients, but to secure even a moderate amount of isolation from the others. My predecessor met his death at the hands of a man of this type, my own experiences have been such, that the dangers of having these patients in an asylum for the non-criminal classes are not unknown. It is not idle speculation, and as a matter of right the harmless insane should not be exposed to the homicidal outbursts of irresponsible criminals. When the question of further accommodation for the insane comes up, as it must before long, this subject should receive very serious consideration, and an effort made to clear the wards of the different hospitals for the insane of those patients of the homicidal and criminal types. The number must be very small, hence the question of proper accommodation for them cannot prove serious.

TRAINING SCHOOL FOR NURSES.

The Training School for Nurses has been in existence for eleven years, and the benefits of its work can now be fairly estimated. Enthusiastic as we were over its possibilities, none of us had any conception of the splendid results that would follow its establishment. We can fairly say that since the development of the hospital idea, we have truly had a hospital rather than an asylum, and the condition of the patients has been improved in every way. The nurses themselves have benefited, and the list of graduates appended shows that those who have left us have done exceedingly well, and those who remained are comfortably situated.

GRADUATES ROCKWOOD TRAINING SCHOOL FOR NURSES.

Class 1890.

Miss T. Gallagher, assistant matron, Rockwood Hospital, Kingston.

Minnie Spence, Matron of Missionary Hospital, Port Essington, B.O.
Catharine Etherington, married.

Sarah Hawkins, supervisor, Rockwood Hospital, Kingston.

Mrs. Victoria Orr, matron, Verdun Hospital, Montreal.

Miss Mary Forsythe, married.

"Mary Crossley, married.

Miss Emma Veale, lady superintendent, Infants' Home, Kingston.

66 Stella Stuart, married.

Miss Violet E. Stuart, married.

Class 1894.

"Roberta Graham, lady superintendent, Androscoggin Hospital, Berlin, New Hampshire.

Miss Nina Orser, supervisor, Rockwood Hospital, Kingston.

Class 1895.

Helen Whalen, sister of charity, House of Providence, Kingston.
Nellie McDougall, married.

Georgina Nugent, supervisor, Rockwood Hospital, Kingston. "" Mabel Ward, married.

Mrs. Jennie Morton, nurse, Rockwood Hospital, Kingston.
Miss Jennie Porter, nurse, Rockwood Hospital, Kingston.

Class 1897.

Miss Agnes Goodearle. nurse, Grey Towers Sanitarium, Stamford. May Ethel Porter, supervisor, Rockwood Hospital, Kingston. "Mary Mitchell, private nursing.

Nellie Jackson, supervisor, Rockwood Hospital, Kingston.