The hospital wards were particularly bright and comfortable and the work of the nursing staff is well performed. This was specially noticeable in the quietude and scrupulous cleanliness of the many markedly demented senile patients who are under treatment.

The medical needs of the patients receive the most careful and skilled attention.

At the second visit the grounds were seen at their best, and many of the patients not only exercise in these beautiful grounds but several of them voluntarily work in the gardens and on the lawns with obvious benefit to their bodily and mental health.

There were many evidences that the management is efficient and characterised by kindly tactfulness which is well reflected in the general contentment of the patients.

Royal Edinburgh Asylum.

Inspected 5th and 6th May and 6th, 7th and 8th December, 1926.

(Average number of patients resident during year, 721-0.)

There has been a considerable increase in the number of voluntary patients admitted to this institution, and this may be taken as an indication of its reputation for treatment of patients suffering from mild mental disorders.

The medical care of the patients attains the usual high standard, and the nursing and general arrangements could not be improved upon and are most praiseworthy.

In studying the individual cases the medical staff have the advantage of a well-equipped clinical laboratory where the elaborate investigations necessary to complete a diagnosis are conducted, and everything possible is done to ameliorate or cure the mental affections from which the patients suffer.

It is observed with approbation that there has not been any use of restraint or seclusion. This is in accordance with modern humane practice, and it may be stated that there has been no record of either restraint or seclusion for a period of eight years.

All parts of the institution were found in excellent order, clean and hygienic, and the surroundings of the patients are made as comfortable and attractive as possible. There is an abundant supply of literature, newspapers and games to occupy leisure moments.

The redecoration and painting that has been in progress in the West House is now completed and the effects are very pleasing. The whole of the alterations reflect great credit on all concerned and indicate that much thought and care has been bestowed upon them. Several of the smaller dormitories have been converted into large dormitories so that the continuous supervision of patients is more adequate.

The hospital equipment throughout the institution is of the most advanced type.

At Craig House the hospital atmosphere is rightly the dominant one. For every patient it is of the best type whatever may be the necessary claim in respect of classified accommodation and other considerations. In these latter aspects the conditions are likewise of a most commendable description.

Mention is made of the clinic recently initiated at the Edinburgh Royal Infirmary. It is meeting with great success in diagnosing and countering early manifestations of mental breakdown, and is carried on by the Physician Superintendent and the medical staff.

The class in Occupational Therapy at Craig House was visited. The patients were markedly interested in the work which will doubtless undergo steady development in an institution in which every suggested method of treatment that may lead to a beneficial result is promptly and fully explored.

The administration of the institution with its manifold exacting and onerous duties is carried on with energy, efficiency and praiseworthy

earnestness.

1

Glasgow Royal Asylum.

Inspected 1st March and 10th August, 1926.

(Average number of patients resident during year, 434.5.)

There is abundant evidence that a high standard of medical care obtains in this institution, and the enthusiasm of the Medical Officers is very marked. The inter-clinics, which are held by the Medical Superintendent and his assistants and which are attended by Glasgow physicians, are a special feature of the methods employed to extend the knowledge of mental diseases. At present one of the medical assistants is attending a six months' course at the John Hopkins Hospital Mental Clinic in Baltimore, U.S.A., and when he returns another assistant will be sent to take the course.

The general health of the patients was found to be good and in every respect their material comforts are adequately provided for.

Excellent progress continues to be made in improving and as far as possible modernising the interior of the institution. The new schemes of decoration are particularly pleasing.

At the second visit ten ladies were in residence at the seaside home at Skelmorlie. The advantages of this beautiful Home are much appreciated by the relays of patients sent there from the main institution.

The nursing care throughout the institution was observed to be highly efficient.

At the second visit 128 patients were attending the class of Occupational Therapy, which continues its excellent curative work. Many of the other patients are voluntarily employed at varied work in the wards and in the garden or grounds with manifest advantage to their bodily and mental health.

All parts of the institution were found in excellent order, and it was apparent that nothing is left undone by the management to subserve the interests and welfare of the patients.

The management is characterised as energetic and most efficient.

Montrose Royal Asylum.

Inspected 14th June and 7th and 8th October, 1926.

(Average number of patients resident during year, 718-0.)

A large part of this institution has been repainted and redecorated in tasteful and suitable colours, and this has added notably to the brightness of the surroundings of the patients.

The new fire stairs introduced at the villas are of a suitable description, and in the event of an outbreak of fire patients can now leave the buildings most conveniently without danger of injury through any panic.

The five new bedrooms, now completed at Carnegie House, were inspected and found to be well adapted to the requirements of patients.

Four new cottages are being erected for the married staff of the institution, and the planning of these cottages has been done with much skill.

The general health of the inmates is reported as being good, and they were neatly clothed and tidy in appearance.

The medical staff know intimately the history and physical and mental states of the several patients, and minister to them with praiseworthy care and attention.

The dental room, which has been established in the hospital, is thoroughly equipped for its purposes, and a Visiting Dentist comes regularly once a week.

Appliances for the treatment of mental and physical conditions by ultra-violet therapy have been installed and are, already, in the opinion of the Medical Officers, proving of marked advantage.

All patients who are physically and mentally fit to be employed are occupied at varied labours as much as possible in the open air so that they benefit not only from the healthy conditions of employment but also from the fact that their minds are taken away from their mental cares and troubles by work which calls forth their interest and attention.

It is suggested that in the case of those patients who are unemployed on account of their mental condition there might be some scope for the use of Occupational Therapy.

The institution continues to be managed in a capable and conscientious

manner.

James Murray's Royal Asylum, Perth.

Inspected 12th January and 25th November, 1926.

(Average number of patients resident during year, 121-5.)

Favourable comment is made on the condition of this Asylum. The furnishings and decoration are being thoughtfully and artistically added to, and the whole institution presents a comfortable, pleasing and home-like appearance.

There were no complaints affecting the administration and the general atmosphere of contentment was very noticeable.

The intimate knowledge of and attention given to the needs and requirements of the patients continue to keep abreast of modern humane methods.

It was noted that a special lamp for treatment by means of ultraviolet rays has been introduced and is already proving of benefit in the treatment of certain cases.

A large number of patients are employed in varied occupations, and the art and craft class has an attendance of no fewer than 35 patients. The value of Occupational Therapy has been commented on in previous reports. Its value can now be practically ascertained by seeing the work done by the patients taking part in it and the beneficial results that have accrued to them both physically and mentally.

The Nurses' dining-hall was inspected. It is much appreciated by the staff. The alterations taking place on the male side whereby a new extended day-room and dormitory accommodation will be provided were seen in progress, and when completed they will prove most useful additions to the resources of the institution.

The medical and nursing care attracted very favourable attention. The management is represented as being keenly interested and progressive and the staff is competent and kindly.

Aberdeen City District Asylum.

Inspected 20th May and 13th and 14th October, 1926.

(Average number of patients resident during year, 636-0.)

It is learned that some modification of the existing verandahs attached to the new hospitals is under consideration. This is highly desirable in order to facilitate the open-air treatment of patients during the day and to permit, if necessary, the continuous open-air treatment of cases of pulmonary phthisis.

The hospitals were found in excellent order and the nursing is efficient and kindly.

The two new villas have been completed and that for the females is in occupation. These villas have each accommodation for 60 patients. They are on the same general principle as the older types of villa but have wider corridors and stairs and the structural equipment has many modern features. The occupied villa was fully inspected and was found to be admirably suited to its purpose, namely, the housing of newly convalescent cases not yet sufficiently trustworthy for full parole. The furnishings are on that comfortable and artistic scale which is general throughout the institution.

In view of this extended accommodation it will be necessary in the first place to consider the readjustment as much as possible to the normal of the accommodation in those villas, which were to some extent overcrowded.

Attention is called to the previous reports in which mention is made of the presence in the institution of many patients whose unsoundness of mind is largely of the nature of mental defect. It is understood, for example, that many patients, chargeable to the district, who are discharged from Baldovan Institution are admitted ultimately to Kingseat. It is not improbable that unless some definite and separate provision is made by the District Board for the care and training of adult defectives, these extensions, which were necessary in view of the

tendency to overcrowding and the particular system on which the Asylum is built, may soon be fully in use and the total accommodation occupied and that not altogether by the types of mental disability for which the structural arrangements and special direction and staffing of an Asylum are necessary.

The Nurses' Home was also inspected. The additions to it that have recently been made are in every way satisfactory, and all the female staff are now accommodated in comfortable quarters removed entirely from their working atmosphere.

The dietary of the patients is favourably commented upon, and it is evident that they are well fed.

The patients were found to be employed in adequate numbers, and they gave evidence in their general healthy appearance that they are properly exercised and cared for in the open air. They were also observed to be comfortably and suitably clad. The appearance of the female patients was particularly pleasing.

The medical direction and administration are characterised by much ability and earnestness.

Argyll and Bute District Asylum.

Inspected 9th June and 5th November, 1926.

(Average number of patients resident during year, 402-0.)

A good deal of inconvenience to the staff and to the patients has been experienced as the result of putting in the new heating system. This has now been completed, and the inconvenience will soon be a thing of the past. Meantime, the opportunity has been taken to renew the flooring of some of the sitting-rooms which have been temporarily vacated and to repaint many parts of the institution. Several of the sitting-rooms and dormitories have already been repainted, and the effect of using bright and artistic colours was very marked when contrasted with the older parts which are awaiting redecoration. The bright and cheerful effect which the repainting of the hospital has produced was very noticeable.

The general health of the patients is reported as being good, and they are well and comfortably clad. Their dietary was also considered highly satisfactory.

It is recommended that the District Board consider the propriety of instituting some form of regular inspection and attention to the needs of the patients in the matter of dentistry. Looking to the situation of the Asylum, it may not be as easy to make this provision as is the case in other Asylums near large centres, but it is hoped that some arrangement may be made for the necessarily regular visits of a qualified dentist.

The amount of substantial work done for the institution by the patients has always been a noteworthy feature, and the active employment of such patients as are physically and mentally capable of doing work receives the utmost attention and was reflected in the beneficial effect it has on the patients' health, both mental and physical, and the generally contented attitude of the patients.

It is observed with satisfaction that there are no entries in the Registers of Restraint and Seclusion, and there has been no case of accident or escape.