WEST RIDING MENTAL HOSPITAL,
17th February, 1944.
There are now 2,334 patients in this Hospital, 1,073 men and 1,261 women, a total which includes 107 men and 116 women who are here on a voluntary basis, and 2 men and 3 women who are temporary patients. In addition, 5 men and 16 women are at present away on trial. The degree of overcrowding on the female side is somewhat lessthan it was at the time of the last Commissioners’ visit;on the male side the position is substantially the same.
During 1943 there were no fewer than 741 direct admissions, 318 men and 423 women, 318 of these cases having come to the hospital straight from home. The total includes 137 male and 141 female voluntary and 6 male and 8 female temporary patients. in the same period 424 patients, 187 men and 237 women, departed or were discharged, and 138, 49 men and 89 women went out on leave or trial. With such very large admission and discharge rates, the medical staff, and the much depleted nursing staff, must be carrying a very heavy burden.
The shortage of nurses here is most serious, and in the wards the under-staffing is evident. Before the war, for that partof the hospital still used for mental patients, there were 156 male and 180 female nurses, while there were then fewer patients than there are to-day. At present there are 113 male and 99 female nurses. Sixteen of the men and 19 of the women do duty at night. Sixty-nine male and 56 female nurses are certificated or registered as mental nurses, and in addition 15 of the men and 14 of the women have passed the preliminary examination.
The wards are particularly clean and well kept, and they are a credit to the nurses: indeed we desire to record our appreciation of the work which nurses are doing here,on both sides of the hospital, in very trying circumstances.
In recent months it has been found it necessary for administrative reasons to check-lock the outer doors of the hospital at night. This is a matter which we have felt bound to investigate from the point of view of the safety of the patients. It should he borne in mind that this hospital has no fire watching scheme, and should incendiary bombs be dropped it is likely that fires will be started simultaneously in several parts of the buildings. It is evident that there is danger to patients, as well as to staff sleeping in wards, if access to the ward gardens can only be had by the intervention of a member of the night staff who may be some considerable distance away from the endangered ward or who, by reason of fire or bomb damage, may be unable to reach it. Various ways of avoiding this danger suggest themselves, but the means to be adopted is a matter to be decided by the Visiting Committee. We have only to point out the danger inseparable from the present arrangements.
Dr. Walker, the Medical Superintendent, agrees with us that it would be informative if our Board were to analyse in detail the patients’ dietary, and arrangements will be made to have this done. We have not therefore paid any special attention to this most important matter at the present visit, but in examining the weekly diet lists we notice a tendency to serve identical meals on the same days in each week. This of course can very easily be remedied, and we know that the point will receive attention. The baskets in which the sliced bread is delivered to the Villas are not satisfactory because they cannot be effectively cleaned. Either washable linings for the baskets should be provided, or else wooden trays, like those used in the main building, should be used. There are other much better ways of delivering bread to the wards, but since the necessary tins and metal cannot be obtained during the war, there would be no point in describing them now. Another matter which should receive attention when supplies of knives and forks are again available is the absence of these necessary implements from all but very few wards in the hospital.
Spoons only are in general use,There is a fair stock of books in the library, but no new books have been purchased for many years, as reliance was placed on the supply of second hand volumes from the Red Cross and other libraries. In the wards there are far too few books for the number of patients, and the supply of newspapers is quite inadequate, e.g., in a ward of 158 patients this morning there were only 3 newspapers. There should be no difficulty at present in getting the few extra newspapers really needed, and we hope that the Committee will feel able to spend a few pounds each year on the purchase of new books.
From the statistics supplied to us it appears that 780 male and 783 female patients are regarded as employed in the hospital, figures which, on the face of it, could be regarded as satisfactory. But no fewer than 500 of the men and 456 women are returned as assisting in wards only, so that, apparently, the average number of ward workers in each male ward is 33 and in each female ward 28, figures which obviously do not represent the true state of affairs. Indeed, it is very evident to anyone visiting the wards that, after deducting those patients who are physically unable to work, there are far too many patients without any employment or occupation. The female occupation centre is temporarily closed, but some of the work is still being done in the wards, and at the small male centre some 25 patients make toys or do some furniture repairs. A word of praise is due to those who look after the ward gardens, entirely with patient labour, on the male side, but we are sorry that there are not allotments for those male and female patients who would derive benefit from cultivating them.
Although slightly lower than in 1942, the death rate for 1943 was still higher than the expected average rate for all our mental hospitals in that year. The rate for males was 12.1 per cent., that for females 12.2 per cent., and the mean rate 12.2 per cent.
In 1943, 289 patients died; many of them were very old, 71 of them being over 70 at the time of death. Pneumonia and circulatory disease accounted for 106 deaths. Tuberculosis is still demanding much attention here. The disease was responsible for the deaths of 12 men and 11 women in 1943; there are at present 16 men and 21 women under treatment. During the past five years there has, generally speaking, been a tendency for both the numbers of deaths and the numbers of patients notified to rise.
Notifications from 1938 to 1943 were as follows:1938, 22 cases; 1939, 19 cases; 1940, 15 cases; 1941, 23 cases; 1942, 30 cases; and in 1943 29 cases. The corresponding figures for the deaths in each of these years are 12, 9, 23, 21, 25, and, as has already been stated, 23 for 1943.
The nursing of tuberculosis patients is carried out in open air conditions, but although efforts are made to keep separate crockery for these cases it would be better if a small supply of patterned crockery, readily distinguishable from the plain crockery in general use, could be provided for them. Both the crockery and the sputum cups should be sterilised after use; merely washing them in warm water is inadequate.
Small outbreaks of dysentery have been recorded here in every year since 1940,’ and while the number of patients affected does not call for any particular concern (the biggest outbreak took place this year and affected 23 patients) some uneasiness must be felt concerning the wide distribution of the cases. Active dysentery during the present outbreak has risen in no fewer than 11 wards, 4 male and 7 female. For this reason we have gone carefully into the question of ward hygiene, segregation and bacteriological examinations of old and recent cases. We have made a number of recommendations to Dr. Walker and he has agreed to give them his careful consideration. We understand that the laboratory assistant is prepared to undertake the considerable amount of extra work which our recommendations will necessitate.
Other epidemics and zymotic diseases occurring in 1943 were influenza 160 cases (8 deaths), erysipelas 7 cases, and diphtheria 2 cases.
Thirtv-two women and 4 men have sustained fractures since the ‘last visit. This marked disparity between the twosexes is difficult to explain, though it is true that the shortage of staff is considerably more acute on the female side.
Eight inquests have been held.
Dr. R. C. Walker has as his Deputy, Dr. Kingston, while Drs. Ryan and Carty are still the Assistant Medical Officers.
N. C. CROFT COHEN,
T. R. FORSYTHE,Commissioners of the Board of Control.
OBSERVATIONS OF THE COMMITTEE ON THE REPORT OF THE COMMISSIONERS OF THE BOARD OF CONTROL ON THEIR VISIT TO THE HOSPITAL ON THE 17th FEBRUARY, 1944.
Page 2. Paragraph 2.
Check locking of Outer doors.
The Committee have agreed to discontinue the check locking of outer doors for three months, after which they will
receive a report from the Medical Superintendent.
Page 2. Paragraph 3.
Tendency to serve identical meals.
This view is not accepted by the Committee.
Delivery of Food.
The Committee will take the necessary steps to provide suitable facilities for delivery of bread.
Supply of Knives and Forks.
The Medical Superintendent will give consideration to the possibility of increasing issues.
Page 3. Paragraph 1.
(a) Supply of Newspapers.
(b) Allotments for patients.
The Committee welcome these suggestions and have given instructions for the recommendations to be put into effect.
Page 4. Paragraph 1.
Supply of Patterned Crockery.
The Committee agree to the suggestion, but in view of National restrictions it may be difficult to carry out, but every endeavour will be made to obtain a supply of a distinguishable design from another Hospital.