"BEHIND THE SHUT DOOR."
[We publish the following article because we believe that publicity is the work proper to a newspaper. We have had no opportunity of verifying any of the statements contained in it, and it is with an open mind that we set it before our readers. We hope that they will also be given an opportunity of hearing the other side.— Ell. Spectator.] THE Maudsley Hospital, said to be the last word in the modern treatment of mental and nervous disorder, is now open, and is hailed on all sides as the opening of a new era in psycho-therapy. Eminent alienists and neurologists conducted over it on the day of the official opening (January 31st) by the Minister of Health con- gratulated the London County Council authorities responsible for its metamorphosis from a shell-shock hospital to a temple of research and home of recovery for nerve-racked patients who might thus escape the terrible fate of losing their reason.
This Hospital is undoubtedly the best we can do in England. Its pathological laboratory, its perpetual warm baths, its various electrical apparatus, including the psycho-galvanometer for testing the emotions, are the most up-to-date available, and its legislative victory in obtaining powers to deal with mental cases without certification is undoubtedly a commendable feature ; while the staff of four assistant medical officers (one of whom is a woman) for 157. patients means that the doctors will only. have about 40 patients each instead. Of 800 to 400, which is the usual number in mental hospitals as we know them. The provision of 62 nurses (50 of them women) also means one nurse to every two or three patients, which means practically individual attention.
The number of doctors and nurses in proportion to the patients appears far greater than called for by Dr. Montagu Lomax, who has stated that one nurse should be able to look after ten patients. It should be borne in mind, however, that the Maudsley Hospital has a large out- patient department, with facilities for treatment by hydro-therapy, electricity massage and remedial exer- cises.
It has been stated in the Press that the continuous hot baths are a substitute for padded rooms. I heard the explanation of their use as it was given to the particular Press representative responsible, and gained quite' a different impression 1 The effect of these continuous warm baths is sedative, conducive to sleep, and therefore a substitute for drugs. But to put the violent patient into a hot bath instead of a padded cell, and to keep him in the bath, would provide fresh possibilities of coercion which it must surely be the desire of the Maudsley authori- ties to avoid. We have heard too much of patients' heilds being held under water (as Dr. Lomax says, rules would not be printed to forbid this did it never happen) and would like to see it guarded against in this super-Mental Hospital.
It seems the Maudsley has its padded room, with observation aperture all complete, like any other asylum, though the medical superintendent, Dr. Mapother, is reported to have said he would rather be without it. Other small single rooms on the ground floor were described by a nurse as " converted padded rooms " and by a doctor as single rooms 'for' patients needing seclusion. (The initiated will know what this means.) Their walls, padded when the hospital was used for shell- shocked soldiers, are now brown and bare, and distinctly depressing, while in many cases the spy-holes are still there—an uncomfortable thought for patients in an early state of nervous breakdown.
• The Maudsley carries out so many of the reforms urged by Dr. Lomax and others that one hardly likes to criticize it before it has had a chance of proving its ability to save sufferers from incipient insanity from the ghastly fate of the certified lunatic.
Thirteen bedrooms for women private patients able to pay from £6 6s. to £7 7s. a week are available, of which I was shown over five, all extremely close to the tramlines of Denmark Hill. Noise of this nature is hardly conducive to recovery for cases of nervous breakdown, of which insomnia is so distressing a symptom. The site occupies more than four acres, and it is quite possible to get away from noisy tramlines and traffic to the quiet peace which one would have thought essential for nerve sufferers.
The whole building has been redecorated and refur- nished throughout, and while it is in excellent taste, one wonders why no attempt has been made to furnish certain rooms in certain colours known for their restful and recuperative effect. It also seems a pity that no attempt has been made to lay down the new rubberized linoleum that makes for the silent footfall instead of the ordinary brown linoleum that is far less silent (though more hygienic) than a carpet, and that will need to be kept polished like a mirror and then will show nearly every mark or scratch. Knowing the ways of nurses, I have visions of patients being asked to sit still and not move about in order that they may not dim the glory of the newly polished floor I In the super-Mental Hos- pital one hopes for improvement in small things as well. as large, and for nerve patients where quiet is so necessary I would like to see rubber-bound doors that could not bang—a nurse banged one violently behind her while I was there. I would like to see bathrooms where one could have privacy—not four baths in a row, innocent of screens, like those shown to us. Few of the patients who come here will be paupers ; they will be made to pay according to their means if they come from the London area ; if from outside it they must pay £5 a week for a bed in the ward, cheek by jowl with the next. Here I quote the remark of an eminent neurologist : 1` The beds in the women's wards are rather thick on the ground"; though in the men's wards there was ample cubic space.
Perhaps these things will be remedied : it is in that hope that I record them. But it is rather discouraging to think that this super-Mental Hospital is far from perfect. I have seen worse, but I have seen better, in all but the voluntary aspect, for which the London County Council has obtained special legislative powers. Scotland's lunacy administration is more efficient than ours. Morningside, Edinburgh, is known throughout the world ; but there is another, the Crichton Royal, at Dumfries, with a 75 percentage of voluntary boarders. Space forbids a description of its many excellent features, including beds on verandahs and an excellent patho- lbgical laboratory. From the point of view of the private patient the great difference is this : In England, unless you can afford upwards of £5 5s. a week, you are put in a ward with many others and are liable to be herded with repulsive cases; in Scotland, it is possible from about £2 10s. a week to obtain the most up-to-date treatment and the privacy of a bedroom to yourself— what is more, baths to yourself—in institutions every bit as well equipped as the Maudsley, run on " open- door " lines and standing on a hilltop, instead of in the doubtful salubrity of Denmark Hill.