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to dirt will be greatly lessened; above all, the small extent of corridor will make an immense difference to the labour of the attendants in cleaning, compared with that which now falls to their lot.

Again, the drying of floors after washing them is always a difficulty, particularly in winter, and is the more felt in the case of the bed-rooms, which have, when single-bedded or small, little draft of air over their floors, and consequently dry slowly. This difficulty is augmented when, as it often happens, it is necessary for them to be kept locked, to prevent the intrusion of their occupants or of others. The ill-effects of frequently wetted floors in apartments constantly occupied, and therefore dried during occupation, have been fully recognised and admitted by hospital surgeons, and have impressed some so strongly that, to escape them, they have substituted dry rubbing and polished floors to avoid the pail and scrubbing brush. By the arrangements submitted, however, this difficulty in washing the floors is removed, since there is no constant occupancy of the rooms, and therefore ample time for drying permitted.

Further, the distribution of food, of medicine, and of stores, is more easy and rapid; the collection, and the serving of the patients at meals, greatly simplified and expedited. The regularity of management in many minor details will likewise be promoted. As the majority of the patients are quite removed from proximity to their sleeping rooms, the temptation and inducement to indulge in bed by day, or before the appointed hour at night, will be removed, as will also the irregularity frequently seen in wards some time before the hour of bed, of patients prematurely stowed away in their beds, and of others disrobing, whilst the remainder of the population is indulging in its amusements, its gossips, or in the "quiet pipe," before turning in.

Lastly, my own experience convinces me that there is no plan so effectual for keeping otherwise restless and refractory patients in order, as that of bringing them together into a room, under the immediate influence and control of an attendant, who will do his best to divert or employ them. I am, let it be understood, only now speaking of their management when necessarily in-doors; for where there is no impediment to it, there is nothing so salutary to such patients as out-door exercise, amusement, and employment. On the contrary, to turn refractory patients loose into a large corridor, I hold to be generally bad. Its dimensions suggest movement; the patient will walk fast, run, jump, or dance

about, and will, under the spur of his activity, meddle with others, or with furniture, and the like; and if an attendant follow or interfere, irritation will often ensue. But not so in a room with an attendant at hand. Some would say, such a patient is well placed in a corridor, for he there works off his superabundant activity. But this I do not admit; for I believe the undue activity may be first called forth by his being placed in a corridor; and besides, it is rare that a patient, particularly if a recent case, has any strength to waste in such abnormal activity. And lastly, it is better to restrict the exhibition of such perverted movement to the exercising grounds, or better still to divert it to some useful purpose by occupation; for in a ward such exhibitions are contagious.

These remarks bear upon the question of the purpose and utility of corridors as places for exercise, concerning which 1 have, at a previous part of this paper, expressed myself as having a poor opinion, and in the plan produced, have treated corridors mainly as passages or means of communication.

6. A less staff of attendants required. If the foregoing propositions stating the advantages of the system propounded, be admitted, the corollary that a less staff of attendants will suffice, must likewise be granted, and needs not, per se, a separate demonstration.

7. The actual cost of construction of an Asylum on the plan set forth will be greatly diminished. It has just been shown that the proposed plan will insure a more ready and economical management, and if structural details could be here entered upon, in connexion with an estimate of costs for work and materials, it could without difficulty be shown, that the cost of accommodation per head, for the patients, would fall much under that entailed by the plan of building generally followed. The professional architect who assisted me, made a most careful estimate of the cost of carrying out the particular plan I prepared, designed to accommodate 220 patients, and calculated that every expense of construction, including drainage of the site, gas apparatus, &c., would be covered by £19,000, i.e. at the rate of less than £90 (£87) per head.

That a considerable saving must attend the system propounded will be evident from the fact that, instead of a corridor, at least 12 feet wide, on the first floor as constructed on the prevailing plan, one of 6 feet, simply as a passage for communication, is all that is required, and thus a saving of about that number of feet in the thickness or depth of the building, in each story above the ground floor, is directly

gained. A similar, though smaller advantage, is likewise obtained on the ground floor, for the corridor there need be nothing more than an external appendage and of little cost to construct.

A further saving would attend the construction of an asylum on the plan set forth, both from the concentration of the several parts for night and day use respectively, and from the rejection of the ward-system. The construction of almost all the sleeping accommodation on one floor would render many provisions for safety and convenience unnecessary,-for instance, in the construction of the windows. So the substitution of what may be termed divisions, or quarters for wards, would do away with the necessity of many arrangements requisite for apartments, when intended for use, both by night and day. As constructed commonly, each ward is a complete residence in itself, replete with every requisite for every day life, except indeed in the culinary department, and the consequence is, there is a great repetition throughout the institution of similar conveniences and appurtenances. Indeed, in the plan I have drawn out, the influence of example or general usage has led me to introduce many repetitions of several accessory rooms which, in fact, I believe to be uncalled for. For instance, I have assigned a bath-room to each division, although I consider that a room, well-placed, to contain several baths, ie. in French phrase, a "salle des Bains," would more conveniently serve the purpose of the whole ground-floor inmates, and be always cheaper. Yet if this notion of a "bath-house" be unacceptable to English Asylum Superintendents, a smaller number of bath-rooms, than represented in my outlines would assuredly suffice. The same may be said of the lavatories, sculleries, and store-rooms.

8. The plan removes most of the objections to the erection of a second-floor or third-story.

These objections generally owe their force to the difficulty of assuring the inmates of a third-story their due amount of attention, and their fair share of out-door exercise, and of much in-door amusement, without entailing such trouble upon all parties concerned that a frequent dereliction or negligence of duty is almost a necessary consequence.

Dr. Bucknill (Asylum Journal, vol. iii., 1857, p. 387, et seq.,) has well argued against the erection of a third-story, on economical grounds; and remarks that "practically, in asylums built with a multiplicity of stories, the patients who live aloft are, to a considerable extent, removed from the enjoyment of air and exercise, and the care and sympathy of

their fellow-men. They are less visited by the asylum officers, and they less frequently and fully enjoy the blessings of out-door recreation and exercise. Those below will have many a half-hour's run from which they are debarred; the half-hours of sunshine on rainy days, the half-hours following meals, and many of the scraps of time which are idly, but not uselessly spent in breathing the fresh air."

The force of these considerations is certainly sufficient to condemn the appropriation of a third story to the day and night uses of any patients, according to the "ward-system" in operation, but they have no weight when the floor is occupied only for sleeping. I must confess I cannot appreciate the chief objection of Dr. Bucknill (op. cit. pp. 388, 389,) to the use of a third floor for sleeping-rooms only; for I do not see the reason why "the use of a whole story for sleeping room renders the single-room arrangement exceedingly inconvenient:" for surely, on the common plan of construction, a row of single rooms might extend the whole length of the floor on one side of a corridor, equally well as on the floors beneath.

Without desiring to enter on the question of the relative merits of single-room and of dormitory accommodation, which it is the special object of the paper quoted to examine, I may remark that the addition of a third story, when the plan I have advocated is carried out, obviates the generally admitted objections to such a proceeding. The same arrangement of apartments may obtain in it as on the bed-room floor below, and the proportion of single rooms to dormitories, viz., onethird of the whole sleeping accommodation to the former, insisted upon by Dr. Bucknill, can be readily supplied. Attention would only be required to allow in the plan sufficient day-room space on the ground-floor, a requirement to be met without difficulty.

The existence of a third-story is no necessary feature in my plan, and I have adverted to it for the sole purpose of showing that the ordinary objections to it are invalid, when the arrangement and purposes of its accommodation are carried out upon the general principle of construction proposed in this

paper.

A hint from Dr. Bucknill's excellent remarks on the advantage of being able to utilize spare half-hours must not be lost. Two flights of stairs, he well states, constitute a great obstacle to a frequent and ready access to the open air, and I am sure he would allow even one to be a considerable impediment to it, and consequently, that an asylum

with no stairs interposing between the patients and their pleasure grounds would possess the advantage of facilitating their enjoyment of them.

In conclusion, I must be allowed to observe that, in many particulars, the foregoing principles of construction, have been recognised by several foreign asylum physicians, and, as I was pleased to find, after I had elaborated them in my own mind, and had drawn out the particular design alluded to in previous pages, coincided with those which had the able advocacy of Mr. Samuel Hill, of the North-Riding County Asylum. Although, in some points, my notions of Asylum construction have been anticipated by others, yet they have not hitherto, so far as I know been very prominently put forward nor arrested very general attention: consequently, I shall flatter myself that I am doing some service by this paper, if it only ventilate the subject.

On Forced Alimentation. By DR. HARRINGTON TUKE.
(Continued from page 37.)

In the former part of this essay, I have dwelt at some length on the various causes that may induce a patient suffering under mental derangement to refuse food; and I imagine it is not difficult to gather, from what I have already said as to the treatment of such a case, that my opinion is strongly in favor of " Forced Alimentation." As a general rule I consider that less harm can accrue from even too early mechanical interference, than must happen if the patient be left unaided till the vital powers have become enfeebled, and symptoms of dangerous exhaustion have set in. At the same time, I trust I have made it clear that I look upon the forcible administration of food to be the last resource, and only to be used when all persuasion has failed, and everything that experienced tact can suggest has been tried in vain.

Any expert surgeon can without much difficulty feed a reluctant patient by force. It is the higher office of the practitioner in lunacy to overcome morbid repugnance to food by gentle and patient soothing, and to combat the dangerous and distressing delusions of his patients, if possible, without having recourse to coercive and apparently harsh measures.

It may be thought that I over-estimate the number of cases of insanity in which refusal of food is a prominent symptom

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