Further Enquiry Needed.

Manawatu Herald, 15 November 1892, Page 2

Further Enquiry Needed.

Last Friday an inquest was held at the Mount View Asylum, Wellington, on the body of a Chinese patient who died there on Wednesday. Mr Robinson, E.M., held the inquest. Dr. Fooks, Medical Superintendent of the Asylum, stated that when the deceased was admitted be was suffering from acute mania, and was exceedingly violent, so much so. that he had to be confined in a straitwaistcoat the first night. Even then he managed to throw himself against the walls and knock himself about. Consequently he was removed to the padded room. The day following his committal he became quieter, and the straightjacket was removed, but he was still kept in the padded cell. He would keep no olothes on, and would take very little food. Ha remained in about the same condition for several days, with occasional outbursts of violence, until the 2nd of this month, when he seemed to have some difficulty in breathing' He also seemed weaker. On ex* amining his chest, witness found that several ribs were broken on each side. Nothing was done for the fractured ribs, because witness thought it would be more dangerous to interfere with the man than to leave things as they were. He seemed to grow weaker, but not markedly so until the evening of the Bth inst., witness last saw him alive. He died the next morning at abcnt 9 o'clock. Yesterday, on making &post mortem examination of the body, witness found long-standing purulent inflammation of the membranes of the brain, and much congestion of the brain itself. Five of the ribs were fractured on the left side, and four on the right, with the breast bone broken across the middle. The left side of the chest was filled with blood and the

lung collapsed, and the right lung congested. Other organs were fairly normal. The immediate cause of death was the hoemorrhage into the lung. A blood vessel was cut by one of the broken ribs. No bruising was apparent externally until the morn - ing pi: 3rd Novenlber: .Witness wad unable to say when the ribs were fractured, but they might have been broken for several days before the bruised appearance would come to the surface. The bones were veiy soil;, which was not uncommon in nervous diseases. It was quite pos» sible that disease broke the rib-i by flinging himself against the door or wall of his room. His arms were confined against his chest by the sfcraitjacket. He was about 40 years of age, and four of his friends came to see him when he died. There was no bruise on the cheat such as Would probably have appeared on it had the ribs been broken by atiybhe kneeling on him. Three attendants gave similar evidence when the jury returned a ver diet to the effect that the deceased died of htemorrhage in the lung, • the consequence of fracture of the ribs sustained while in a state of acute mania, but how or by what means occasioned, there was no evidence to show. The jurors, however, were inclined to believe that the fractures Were occasioned by the patient dashing himself against the door of a cell in which he was confined. The Evening Post in its Saturdays issue comments very strongly upon the case, saying — No one can have read the tragic story of the death of Ah Cliing as told at the inquest, and reported in our columns, without a most unpleasant tooling bofn^ excited Whet brought up in Court, indeed, he wai even more childlike and bland tkan his countrymen usually are. The only violence of which he was accused was having shaken the handle of a door at the residence of a householder who objected to early marketing. Ah Ching apparently, however, did not like being sent to the Asylum, and gave the constables who took him there some little trouble. When he got to the Asylum he was pronounced to be suffering from acute mania — certainly very suddenly developed — and he began throwing himself about his room or cell in a manner which led someone — it is not quite certain who it was, but it was not the Medical Officer, who did not see the patient till next morning -to prescribe the strait-waistcoat. It took four men to put this becoming garment on the unwilling Chinaman, but when attired in it he was apparently permitted to play ball with his own body, bouncing it against the floor ' and walls. This wa3 on the 24th October. On the following day the strait-waistcoat was removed, and the patient placed in a padded room. On the 2nd of November, seven days afterwards, he was discovered to be physically, as well as mentally, affected, and an examination showed that he had several ribs broken on each side. On the following day he died, and the post mortem examination revealed that four ribs were fractured on one side, five on the other, and his breastbone was broken across. How these injuries occurred is an official mystery Admitting that, as is not unusual in oases of mental disease, the bones were exceptionally soft or brittle, we | may be excused for doubting the physical possibility of even a Chinaman bouncing his strait-waistcoat-encased body against either the walls or floor of a room in such a manner as to break his breast-bone, four ribs on one side, and five on the other, and the padded cell must be very imperfectly adapted to its purpose if suoh injuries could be self-inflicted by an occupant. Persons who are familiar with what may be termed madhouse literature, from the novels of Charles Reade and the reports of Lunacy Commissions down to fre-quently-recorded inquests in the English papers, will be familiar with many cases of similar injuries sustained by the insane, and also with the conclusions arrived at by competent authorities as to how such injuries are usually sustained or inflicted. The fact of the injuries not being accompanied by any external braises is of itself not without a certain significance to experts. If, instead of being a friendless Chinamen Ah Ching had been a European with influential friends or relatives, we do not think his death and the injuries leading thereto would have been dismissed quite so perfunctorily as they were at the inquest. There would have been further enquiry as to how the injuries were or could be occasaioned. What happened to Ah Ching, however, might possibly happen also to any European, whatever his worldly position, who might unfortunate enough to suffer loss of reason, an affliction from which no class enjoys immunity. . . . It would also be well if the possibility of such injuries as Ah Ching suffered from remaining undetected for presumably some days after they were sustained, could be provided against. Altogether, we think the case of this poor Chinaman shows that, humane and excellent as the management of the lunatic asylums of the colony undoubtedly is, there still remains some room for improvement. In this morning's NZ. Tims

appears a copy of an otfieia l repor t by Dr Macgregor to the Hon. W. P. Reeves. He examined all on oath and arrives at the following conclusions : — Three points of the utmost im- , porcance were left by the inquest in a state, of di^iuietin** obscurity s 1. Was the man left all the night of the 2-1 th in an ordinary sleeping room, whore it was possible for such a violent patient to injure himselt when he ought to have been put in the padded room ? 2. Was it tine that the doctor did not see him till next morning ? !5. How were his ribs broken '? As regards the first point he seemed quite quiet for about an hour and a half after being placed in his room, and as the padded room was occupied by an epileptic patient, the head attendant thought he would do qtiiet .we'll lii i all ordinary" roonii It is only now and agaiii, at long intervals, that a case of such uncontrollable and paroxysmal violence as this occurs in ordinary asylum experieuce, and it is clear that very soon after the paroxysm occurred he was transferred to the padded room, I cannot, therefore, blame anyone for more than an error of judgment on this point. Anyone might have made such a mistake, trusting to the ordinary experience in such casesi The deplorable resulti however, showed that lie ought to have been put in the padded room at once. As regards the second point, 1 cannot understand why it was not made clear at the inquest that the doctor did see the patient about 10 o'clock on the night of his admission and satisfied himself that he was well cared for. Finally, 1 think there is no doubt that the man broke his ribs and breastbone by climbing as his arms j were free, ou to the window sill and throwing himself on the floor as described in the evidence. I made the most careful and searching enquiries as to whether, in their struggles, any of the attendants had put their kuees on his chysfc, and I am satisfied they did not* As regards the use of the straitjacket, in this case no experienced person would hesi'ate a moment. It was the right thing to do. This mode of restrainst is never used in any of our asylums except in extreme cases, and never without a record being made of the fact.