5

H.—B

could possibly make the largest income, as by a strong liking for the special department of medicine they have selected, and disinclination or inaptitude for the laborious life of a practitioner; and few Asylum Superintendents would be induced to throw up their appointments and go into practice for the sake of one or two more hundreds a year. It does not appear that much, if anything, can be saved by dispensing with a Medical Superintendent in a large Asylum. Men must be paid according to their responsibility, whether they have had the training which best fits them for it or not. The Superintendent of the Dunedin Asylum has a salary of £400 a year, and the visiting Medical Officer of £200. Assuredly neither officer is overpaid; but it does not appear that anything is gained here by shirking the appointment of a resident Medical Officer. In Christchurch the Superintendent gets £300, which is very inadequate pay for his responsible and arduous duties ; and the visiting Medical Officer gets £300; but here again neither economy nor efficiency is better secured by dividing the available sum of £600 between a non-medical Superintendent, whose resources are overtaxed because he has not the education of a medical man, and a Visiting Physician, whose position as such disables him from discharging the duties and assuming the responsibilities which would belong to him were he resident, than if a Medical Superintendent had been engaged at £500 and a clerk at £100. It is the experience of all civilized countries that the management of an Asylum of 200 patients fully occupies the attention of an active, intelligent physician, devoting his whole time to his work. The majority of Asylums over this size have more than one Medical Officer; and one cannot but entertain feelings of uneasiness and distrust in seeing what is universally regarded as medical work performed by non-medical men. A merely Visiting Physician, unless he be a man of unusual force of character, is apt, so far as tho general management is concerned, to lapse into the position of a dummy. The real management of the patients must rest with the man who is resident on tho spot, and it depends greatly on him whether a Visiting Physician can have his wishes carried out, or whether he must remain a helpless spectator of what he can neither approve nor suppress. Almost all that is creditable in the management of the New Zealand Asylums is the work of their Superintendents ; and probably none would be more willing to bear witness to this than the Medical Officers of these institutions. But Asylums so large as those of Christchurch and Dunedin now are overstrain the powers of non-professional men ; and so sure as knowledge is power, so sure is it that competent Medical Superintendents will accomplish better results than non-medical ones, no matter how zealous, kind-hearted, and devoted these may be. Over and above the benefit which would accrue to the Asylums themselves by their being placed under the charge of medical men, there can be no doubt that it would be of great importance to the colony that there should be in it even two or three men of energy and ambition, with time and opportunity to engage in the scientific study of so great and costly a national misery as insanity. Centeal Asylum. It has naturally occurred to many persons who have given their attention to the provision made for the insane and its defects in this country, that it would be much better to have one large central Asylum for the whole colony than several small ones as at present. This idea is based upon the suppositions that such an institution could be more efficiently officered, that its arrangements could be more elaborate and highly organized, that its management would be cheaper, and that above all the patients could be better treated, that more of the curable would bo cured, and that the incurable would at least be happier and better looked after than in small Asylums. Similar beliefs formerly prevailed in England, but experience has not confirmed them ; on the contrary, there is probably now no one opinion in which authorities on the subject of insanity are more unanimous, than that small and moderate-sized Asylums are preferable to large ones, and are both cheaper and more efficient. A central Asylum large enough for the wants of this colony would require to accommodate over 1,000 patients, and in three years from this date it would be crowded and require to be enlarged. To an Asylum of this size for New Zealand there are two sets of objections, those which apply to large Asylums in any country, and the far stronger ones which would apply to it as a central Asylum for the colony. The following quotation from the valuable Report on Lunatic Asylums, by Dr. Manning, Inspector of Lunacy, New South Wales, is so much to the point that no excuse is required for giving it at length : — " The English Commissioners of Lunacy are of opinion that an Asylum to contain 400 to 500 patients is the best size, but that on an emergency they may be enlarged to contain 600 to 700 patients without sacrificing the special characters which all modern Asylums should possess. When there are more than 700 patients the expenses increase, and all individual treatment vanishes. The Superintendent can only know the patients en masse and not individually, and the establishment grows out of effective supervision, although the number of attendants may bo increased. This opinion may bo found in the Reports of the Commissioners, again and again stated during the last ten years. Thus, in 1857 they state: 'It has always been the opinion of this Board that Asylums beyond a certain size are objectionable. They forfeit the advantage, which nothing can replace, whether iv general management or the treatment of disease, of individual and responsible supervision. To the cure and alleviation of insanity, few aids are so important as those which may be derived from vigilant observation of individual peculiarities; but where the patients are so numerous that no Medical Officer can bring them within range of his personal examination and judgment, such opportunities are altogether lost, and amid the workings of a great machine tho physician as well as the patient loses his individuality. When to this is also added what experience has of late years shown, that the absence of a single and undivided responsibility is equally injurious to the general management, and the rate of maintenance for the patients iv large buildings has a tendency to run higher than in buildings of a smaller size, it would seem as if the only tenable plea for erecting them ought to be abandoned. To the patients, undoubtedly they bring no corresponding benefit. The more extended they are the more abridged become their means of cure; and this which should be the first object of an Asylum, and by which alone any check can be given to the present gradual and steady increase in the number of pauper lunatics requiring accommodation is unhappily no longer the leading characteristic of Colney Hatch or Hanwell.' In 1863 they write: ' The difficulties attending the