MHS Archives: Report of the Canadian National Committee for Mental Hygiene to the Manitoba Public Welfare Commission (1919)
Appendix to the Second Interim Report of Manitoba Public Welfare Commission, February 1919 [Manitoba Legislative Library, SpR 1917 Public Welfare]
In July, 1918, Lieut.-Col. Colin K. Russell, Vice-president of the Canadian National Committee for Mental Hygiene, received a letter from the Public Welfare Commission of the Province of Manitoba stating that the Honourable Thos. H. Johnson, Attorney General and Chairman of the Public Welfare Commission, had asked that the Canadian National Committee for Mental Hygiene should make a simdy of conditions in Manitoba, particularly in reference to hospitals for the insane and other institutions where mental defectives were housed. The study was also to cover such questions as the examination of child delinquents, Juvenile Courts, etc. It was indicated that the Committee would be given a free hand to make a survey in any way in which it·desired, and. every facility would be placed at its disposal for the purpose. The Executive of the Canadian National Committee, when assured that this was being undertaken with the full sanction and approval of the Manitoba Government, instructed the Medical Director and Associate Medical Director and the Social Worker to go to Manitoba and undertake the survey as soon as possible. Some time was lost in completing arrangements, but early in October the survey was commenced, and pursued diligently until finished.
The scope of investigation was outlined as follows, and although it was not found possible to cover all of the programme as at first arranged, still a mass of interesting information was gleaned, part of which will be included in the following report. It would make the survey too bulky to include all of the facts and figures obtained, but these will be available for the purposes of the Canadian National Committee for Mental Hygiene.
Scope of Investigation.
1. Survey of Hospitals for Insane.
2. Survey of the "Portage la Prairie Home for Incurables."
3. Survey of the "East Kildonan Home for Feeble-minded Children."
4. Survey of Gaols (Winnipeg and Portage la Prairie—if time permits, also gaols at Morden, Brandon, Minnedosa and Dauphin).
5. Survey of Reformatories.
6. Survey of Stony Mountain Penitentiary.
7. Examination of 50 consecutive cases appearing before Juvenile Court.
8. Examination of 50 cases appearing before Police Court.
9. Survey of Institutions for Normal Children and Primary Schools.
10. Survey of Institutions for Dependent Poor.
11. Study of all Legislation dealing with Insane, Feebleminded and Epileptic.
12. Study of medical education and provision made for psychiatry.
13. A visit to the Huetterite Colony at Bernard.
Facts to be Gleaned from Survey.
1. Number of Insane, feeble-minded and epileptic in Province.
Reports of Investigation.
1. A full report of the survey will be submitted to the Public Welfare Commission of the Manitoba Government, and will include the presentation of an adequate policy of dealing with the insane, feeble-minded and epileptic of the Province.
The Public Welfare Commission did everything possible to make our visit a memorable and pleasant one, and assisted us in many ways in obtaining information that might have been difficult to get without their help. The different members of the Manitoba Government were also most obliging and sympathetic, and showed that they were truly interested in the great humanitarian problems being investigated. They gave us a free hand, did not attempt to conceal anything no matter how unpleasant the result of the survey promised to be, and showed an anxiety to adopt suggestions that was refreshjng in a country where criticism of any public institution might be construed as an attack upon the Government. Knowing that we were expected to speak frankly, we have not hesitated to do so, realizing that the Province is ripe for some such needed reforms. The Honourable Thos. H. Johnson, and the Honourable Dr. Thornton, and Mr. A. Percy Paget; were particularly helpful to us; and to them, the members of the Public Welfare Commission, as well as many others, we owe a debt of gratitude.
In undertaking a survey such as the present it must be made plain that the function of the Canadian National Committee for Mental Hygiene is not that of simply pointing out faults or defects, but rather that of showing, wherever possible, how reforms and advances may be made. It is inevitable in a new and rapidly developing community that crudities must be found in complex organisations such as those of institutions designed for the care and treatment of the insane. For some reason difficult to explain on any rational basis, the majority of people look on the insane simply as a burden to the State. There is little real sympathy shown for them, and expenditures for the betterment of this unhappy class are grudgingly and unwillingly made. It is rarely that the average man can be induced to regard the insane as sick and diseased, and the human sympathy so lavishly squandered oh patients cared for in general hospitals is seldom conveyed to the mentally afflicted. If this be the case in old and supposedly well organized communities, it is easily understood that conditions are apt to be far from ideal in newer centres, and custodial care in Canada has apparently been the mark to which some Governments have been willing to rise. Some spasmodic but feeble efforts were made ten years ago in the East to make definite advances along broader lines, but politics and lack of sustained interest soon suppressed these manifestations of an awakening public conscience. Governments feel the strain of supplying funds to maintain the incurable insane, and it is a difficult matter to make them see that money can be saved by adopting a wise policy of prevention or early cure. If it is true, as can be easily demonstrated, that every incurable patient detained in the Provincial Hospital for the insane in the long run costs that Government $5,000 to $7,000, it is not a difficult problem to calculate the saving to be effected by dealing as intelligently with insanity as we do with smallpox or other preventable diseases. Of course, we are at once met with the argument that nearly all cases of insanity are incurable from the outside. We do not know that. It is a most unfair argument, lacking proof. Surely if preventive medicine ever had a sphere in which its justification can be proved beyond question, it must be in this particular field, and the policy of locking the stable door after the horse is stolen is particularly obnoxious in this age of social reforms. Medicine has not performed its duty in most hospitals for the insane, which are so frequently merely houses of detention for herds of diseased humanity, where the individual is lost sight of, and where little is done to save him from sinking to the deadly level so easily reached by those who have not had the helping hand extended to them. Contrast the well equipped, up-to-date hospital for the insane with the depressing and poorly organized detention houses of the Province of Manitoba, and the truth of the statement will be at once apparent. Then again, if it is true that prevention is to play the most important role in the elimination of one of the blots on our civilization, surely every effort made to study and care for the children showing manifestations of a tendency to develop insanity must not only prove commendable but essential in a progressive Province.
Recent investigations make it plain that while hospitals for the insane are a necessity under present conditions, it is only a matter of time when preventive medicine will greatly lessen the burden to be carried by the people in the way of supplying maintenance. The hope of the Canadian National Committee is to point the way along which progress is to pe made.
What do we find in the Province of Manitoba in the way of advanced treatment of its insane ·population? Possibly the simplest way of dealing with conditions as they are is to make suggestions regarding what should be done to make conditions as they ought to be. It is scarcely fair to criticise those in charge for the existence of manifest abuses which are the outcome of a defective and incomplete organization, which is so constituted that it must of necessity provoke loss of confidence on the part of the public. As is pointed out by the Superintendent of the Brandon Hospital for the Insane in his report for 1916, the methods of commitment of a patient are inhuman, and the gaol system an abomination. Surely it is clearly understood that insanity is a disease, not a crime, and everything that can be done to minimize mental suffering should be cheerfully undertaken by a sympathetic Government. Many of the insane dread the stigma of having to endure public examination before a magistrate, and why they should be denied the privilege of voluntary commitment, when they have insight enough to ask for it, is a mystery. Voluntary commitment should be a part of an improved system which aims at cure rather than custodial care. In other words, the first step necessary in getting away from the "hard idea" is to give the individual who has an appreciation of his condition an opportunity to help himself. Of course, the majority of patients admitted to hospitals for the insane will have to be certified to, but to this why add the humiliation of having to appear before a magistrate and to be committed to a common gaol? No argument can convince those who have had experience, that gaol guardianship is ever necessary with the insane. Such a system simply perpetuates a wrong and antagonizes every thoughtful person in the community. However, when we come to deal with the problem of the acutely insane we shall have much more to say on this subject.
The hospitals for the insane in Manitoba are organized without the slightest regard to the demands of modern science. They have neither staff nor equipment to make them anything more than custodial institutions, and proper medical treatment is not provided. It may be argued that, with the General Hospital at Winnipeg, the necessity of further equipment at Brandon and Selkirk is obviated. Such an impression is erroneous. The Psychopathic Department will of course be an excellent one, but if it is to have but twenty-five beds it will not begin to meet the requirements of a Province in which the population is over five hundred thousand. One hundred beds for acute cases are necessary to provide proper accommodation, it follows that the hospitals for the insane should be equipped to meet the overflow from what must inevitably become simply a reception hospital of limited capacity. What inducement can there be to any accomplished young psychiatrist to join the staff of either Brandon or Selkirk at the present time, where they are without facilities for the accomplishment of necessary work? In a hospital for the insane, laboratories are just as essential as they are in a general hospital, and it must be· remembered that the advances in psychiatry are inevitably to be the outcome of elaborate chamical, physiological and psychological studies, and clinical investigations are only part of the necessary organization. With the staffs as limited as they are in Brandon and Selkirk, what possible chance is there of even ordinary clinical investigation? Even a casual glance at the histories taken will show that not even the faintest attempt at scientific accuracy has been made, and the classification adopted belongs to an era long past. How could it be otherwise, though, with a lack of staff of trained physicians?
Conditions found in the Home for Incurables at Portage la Prairie.—It is almost inconceivable that such a state of affairs as we met there could exist in the present age—things which go to show what can develop where adequate inspection and supervision are not supplied. Truly the old adage, "out of sight out of mind," seems to have been reversed to read, "out of mind out of sight." Think of the cruelty of herding these poor creatures together in small rooms, without occupation, without classification or the slightest attempt to inject a single ray of happiness into their lives. This in itself is reprehensible; but what must we say of the inhumanity which consigns human creatures? The reply is that such creatures would never have reached the level to which they have sunk had they been intelligently cared for in the early stages of disease. They are not to be found in institutions properly managed, where the individual is carefully considered. We found this hopeless mental attitude nearly everywhere we went in Manitoba, and yet it is evident that just as soon as a progressive people are shown their sins of omission they will insist on a complete reconstruction of the whole system of the care of the insane and defective. Manitoba is ripe to make perhaps greater advances than any other Province in the Dominion, and now that it realizes its defects will remedy them and institute reforms that must have their effect on the whole of Canada. The fact that a Psychopathic Hospital is being erected in Winnipeg to-day shows the progressiveness of the Western people, and marks the beginning of a new era in the history of psychiatry in this country. It simply means that such an institution, if properly officered and managed, will educate the people and the medical profession to regard mental disease from a new point of view.
The Care and Treatment of the Defective Classes.
A perusal of the different reports appended will show conclusively that Manitoba has not dealt satisfactorily with the defective classes and has not made the best kind of provision for their care. (This criticism might fairly be applied to almost every other Province in Canada.) Idiots are in many cases housed in the Home for Incurables at Portage la Prairie, but defectives of different grades are found in almost every institution examined—gaols, homes, schools, industrial schools, etc. No settled policy seems to exist in regard to them, and their presence in such institutions as the industrial schools simply negatives any attempts made to achieve results worth working for. A community not alive to the importance of dealing intelligently with its defectives is a community bound to suffer greatly in the long run, as the problem of the defectives is perhaps the most important of all social questions. The reason why is not difficult to arrive at, as the majority of criminals come under this heading. Even a glance at the :figures compiled in the institutions visited in Manitoba shows the truth of this statement. Then again, prostitution is, to a great extent, carried out by the high and low grade imbeciles. In our own experience more than sixty per cent of the prostitutes examined, and the number is large, have proved to be mentally defective. As these women are accountable for fully seventy-five per cent of the venereal diseases rampant, it is not difficult to understand why it is so important to segregate defectives in colonies, at an early age. If this policy were carried out with intelligence and courage by the State, the tide of criminality and specific disease would ebb at a rapid rate. Even from the dollars and cents standpoint the saving to be effected is enormous. Then again, the presence of defectives in public school is baneful to the defectives themselves and the scholars who are normal. Children are quick to learn either good or evil; and the presence of even two or three defectives of certain type in a large school is apt to demoralize a number of the pupils. This is not theory, but a statement founded on instance after instance in well-known public schools which have come under the observation of those making the Manitoba survey. Of course, these children should be weeded out by competent psychiatrists, and the proper disposition of the weaklings determined on. We say psychiatrists rather than psychologists, because no matter how competent a psychologist may be, he is invariably at fault when called on to investigate certain types of school children, who are never understood by their teachers and who need special treatment. The children referred to are those who constitute probably six per cent of the abnormals found in schools. They are suffering from various psychoses, chiefly dementia praecox. Unless diagnosed and placed in environment of suitable character their doom is soon sealed, and it is cruel and inhuman to force them to attempt tasks which easily prove their undoing. The more we saw of Manitoba and its problems the more we realized that the need of help from well trained psychiatrists was urgent. Apparently the profession of the Province has not made psychiatry a live issue in medical education, and young men have not been attracted to its study. With the advent of a psychopathic hospital and the absorption of the medical school by the University of Manitoba, psychiatry will assume its proper place in the curriculum of medical studies, and the importance of this branch of medicine be recognized by the public as well as the profession. Fortunately, the Province of Manitoba is young enough and alert enolil.gh to take advantage of the possibilities, and no doubt will adopt a progressive policy in dealing with the defective problem that will be a model for other Provinces to imitate.
We were not able to get much material or more than general statements on which to base conclusions regarding the prevalence of venereal diseases in different centres in Manitoba, as apparently the hospitals have not taken steps to gather elaborate statistics as yet. From the medical profession, though, it was learned that conditions similar to those in the East probably exist, and as prostitution is common in large centres we can easily make reasonable deductions. It is evident that a Venereal Disease Act is desirable in Manitoba. That prostitution flourishes vigorously in Winnipeg was abundantly plain, but it is less conspicuous on the streets than in the large eastern cities, and is, on the whole, probably under better control than in Montreal and Toronto. At the same time we feel that a careful investigation of certain types of hotels would provide much interesting study and lead to a betterment of conditions.
J. S. Chambers, M.D., Medical Superintendent.
The main hospital is a red brick building of’ striking appearance, built on a bench overlooking the Assiniboine River, about one and three-quarters of a mile from the centre of the city. Its construction is evidently satisfactory, but the place does not conform to modern. ideas, as it pays little or no attention to classification, and the wards are altogether too large to enable the medical staff to give the individual patients opportunity to receive necessary treatment. The wards are dark, dismal, and without anything to vary the monotony of the patients’ lives. Even on a bright day, such as that on which we made our visit, artificial light was necessary to relieve the darkness of the wards.
The walls are bare and devoid of pictures, and the lack of employment leaves the patients without means of making use of their time satisfactorily, the result being a deadly apathy of most distressing character from one end of the institution to the other. The absence of balconies is to be regretted. The amusement hall is large, and, like the rest of the institution, scrupulously clean and well kept, but we could not get away from the fact that Brandon Asylum was simply an exaggerated development of the "herd" idea of the treatment of the insane. The building lends itsell to that method of care. No adequate provision for the acutely insane exists, but what need of such provision with a staff of trained workers far too small to deal satisfactorily even with a limited number of admissions of acute character. This is not to be construed into a criticism of the present management, as Dr. Chambers is evidently keenly alive to the necessities of a different form of organization. He has but recently taken charge of this Asylum, and being alone in an institution caring for 700 patients, cannot be expected to do much more than attend to the thousand and one demands of administration. That this Asylum is splendidly managed from the point of admlnistration is evident at every turn, and if cleanliness and good order were the acid test of institutional efficiency in the care of the insane, Brandon could be given 100%.
Custodial care was apparently the idea prominent in the minds of those who planned the institution, but even from that standpoint the buildings are open to criticism. There are no laboratories in Brandon, and even the postmortem room has been taken over to provide sleeping accommodation for employees. These facts alone show defects in organization surprising in the light of modern demands. Many minor faults in construction exist, and while two small hospital wards are used they are not the type to commend themselves, being poorly equipped, etc.
The staff at the time of our visit consisted of one medical officer. It is difficult to understand how one man, no matter how well qualified, could be expected to attempt, much less succeed, in carrying on the work of an institution as large as that of Brandon. It is unfair to the patients and more than unfair to the medical superintenden, that is, if the Asylum is to rise to a higher level than that of a glorified poorhouse.
The present Superintendent is a man of many accomplishiments, but cannot do the impossible, and the wonder is that serious complications have not arisen, as no human being is capable of carrying on twenty-four hours’ work a day. As we view the situation, it is undoubtedly wrong to allow such an inadequate staff to attempt to do work that will tax the energies of say four men at the very least. It ·may be urged that the war has made it impossible to obtain young male practitioners who will be tempted to occupy asylum positions at the small salaries offered. The remedy is comparatively simple, and will be referred to in another part of the report.
The trained nurse is not largely in evidence, although there are two individuals with some qualifications, one in charge of the hospital ward, the other on night duty. In other wards the work of the institution is being done by an untrained staff. It is acknowledged everywhere that the specially trained nurse has been the greatest factor in humanizing hospitals for the insane, and it is to be regretted that this arrangement has not been adopted in Brandon. Then again, no attempt is made to have female nurses in the male wards, a reform likely to produce the most beneficial results.
The male attendants are of the class so commonly found in asylums for chronics, apparently doing work with some degree of efficiency but having little esprit de corps. Although most of them are uniformed, yet the absence of collars in nearly every instance left an unpleasant impression on us, as in a military age such as this, an attempt at neatness seems necessary when a uniform is worn. Evidently the night service is carefully done, as the number of attendants provided is adequate, providing their knowledge is sufficient.
The amount of restraint used is comparatively small, although serious objection must be taken to some of the forms employed, the cage-like restraint beds being open to severe criticism. They are not only hideous in appearance, and out of keeping with the spirit of the age, but in our opinion unnecessary. It would be difficult to supply any adequate argument to justify their continuance. Seclusion is commonly resorted to, and the rooms used for this purpose are offensive, dark and practically without light. Possibly there are cases of insanity in which seclusion must be resorted to, but they are by no means common, and with the advent of the well trained nurse, seclusion will disappear and the muff and camisole be relegated to the scrap heap. Restraint is abolished in the best of modern institutions. Employment and hydro-therapeutics are found to be the answer to the statement that restraint is a necessary evil. We would state that, in our opinion, restraint is an unnecessary abuse.
Deportment of Patients.
The large number of patients sitting about the wards, idle, uninterested and unemployed, made a most unpleasant impression on us. We felt that the true function of the hospital was being overlooked, and that the inmates were not being induced to make the best of their lives. Again the advent of the trained nurse will remedy all the evils attendant on this method of caring for the insane.
Very few patients were excited or noisy, and while two or three black eyes were in evidence, there was no reason to believe that they were the outcome of violence on the part of the attendants. None of the patients complained of cruelty, and as far as we could ascertain there was little or no criticism by the patients of their supervisors.
The airing courts at Brandon have the faults these conveniences for apathetic attendants invariably possess. Airing courts, to be justified, must be several acres in extent, well wooded, and so arranged that the patients must have constant supervision and care from attendants. The moment an airing court is so constructed that an attendant can sit comfortably at a gate and leave an unruly mob of patients to its own devices, the court becomes a centre of demoralization and disorder. Well wooded grounds, without gaol-like fences and walls, are far preferable to such arrangements as those we found at Brandon.
A few continuous baths and one electric bath are available for treatment. Without specially trained nurses and an alert medical staff; continuous baths are apt to be of questionable value, as they may easily become sources of danger and abuse. However, it is encouraging to find that they are installed in Brandon, and will be available when the institution is put on a more advanced footing.
A large farm of nearly a thousand acres makes it a simple matter to furnish occupation to a number of patients, but the opportunity is to all appearances not taken advantage of to the fullest extent, if we are to judge by the number of inmates sitting unoccupied in the wards for men. In the women’s wards little industry was in evidence, although we found some twenty-two patients at work in the laundry.
At Brandon we learned of the method of admitting patients to an of the institutions for the Insane in Manitoba. This method, to which extended reference will be made in another part of the report, is not to be commended, as it really classifies insanity as a crime rather than a disease, and humiliates both friends and patients.
Nationality of Patients.
It was interesting to learn that, of a population of 711 patients resident on June 30th, 1918, only 261 were Canadians—slightly over 36%, 27% were British by birth, 37% of foreign birth (9% of these being of Scandinavian origin), and 12% from Austria-Hungary.
Discharges are made largely by the probational method, which is an excellent one, although it makes the classification of recoveries, improved and unimproved, somewhat difficult, as the Superintendent bases his conclusions largely on the reports of the friends of patients, a method not conducive to scientific accuracy. After all, what constitutes a recovery from an attack of insanity is a matter of difference of opinions, even among psychiatrists.
Date of visit: October 18, 1918.
This Asylum, which has been in existence many years, is much smaller than that at Brandon. It cares for the insane of the City of Winnipeg, and the patients coming from that section of Manitoba lying east of Portage la Prairie. The district from which this Asylum draws its cases can be more accurately defined as a line running north of Poplar Point, the northern limit being at Gimli.
Accommodation for 400 patients. At the date of our visit 357 inmates were being cared for, and during the year there had been 240 admissions, and between 240 and 250 had been discharged as cured or improved. As the probational system of discharge—an admirable one—is employed, the diagnosis of "cured" is largely made in the statements of friends, and cannot be regarded as scientifically accurate. Two hundred and twenty three of the cases under treatment were males.
The building was erected more than thirty years ago, but was well planned as a home for the chronic insane—am:ply lighted and with corridors which are of good width. Bright and attractive balconies are a feature to be greatly commended, just as the absence of these indispensable adjuncts was to be regretted at Brandon. They are as great a necessity in hospitals for the insane as they are in general hospitals, and when they do not exist the health and happiness of the patients are greatly interfered with. The floors of the hospital were clean, but so much worn that many of them should be replaced.
At present, Dr. Rice is acting as Medical Superintendent, owing to the absence of the former Superintendent, Dr. Chambers, who has been transferred to Brandon. Dr Rice, who was most kind in his endeavor to show us everything about the institution, receives daily assistance from a visiting physician, but of course such an arrangement is inadequate and unsatisfactory.
There are about 400 acres of land in connection with this institution, and evidently the patients are extensively employed in agricultural pursuits.
It was pleasing to find a majority of the patients at Selkik employed in different occupations, and it was apparent that this institution was fulfillmg its function as an asylum where custodial care was being carried on successfully, and with due regard to the comfort and welfare of those placed there for treatment. Of course, under such a system recoveries will take place, especially when the individual is not completely lost sight of.
One Superintendent, and ordinarily one assistant, constitute the medical staff. It goes without saying that such a staff is inadequate where the admissions reach such a large total as 250 in the year.
This is made up of 34 male attendants and 25 female attendants. The trained nurse does not exist here, and the method of supervision is simply that of caring for the patients without a knowledge of the methods of producing the best results with the individuals most likely to be beneted by scientific care and nursing.
Histories and Records.
No attempt is made to keep accurate histories and complete records of cases, and no stimulus for research exists.
The airing courts are comparatively free from objection, as they are large and well wooded. Why it should be found necessary to use fences is a mystery, as the only function a fence can perform is that of enabling the attendants to relax their vigllance in caring for troublesome and restless patients.
Restraint was not much in evidence. Dr. Rice stated, however, that in selected cases seclusion, in small, well-lighted rooms was resorted to, and that a restraint sheet and camisole were sometimes employed. Restraint and seclusion were under the immediate control of the Superintendent.
The continuous bath is used pretty constantly in cases of restlessness and excitement—admirable under trained assistants, but of questionable value with employees who have no intelligent conception of its function, and who are apt not to realize its dangers and abuses.
Classification of Patients.
In the men’s section the patients were divided into four groups; in the women’s section into two groups. No routine exaimination of patients are made on admission. No laboratory equipment exists, and post-mortem examinations are rare, six being performed last year.
Dr. Rice severely condemned the form of admission througih the gaol, and after what we saw in the Winnipeg Gaol of the treatment of those unfortunate enough to have to pass through its dreary portals, we can easily understand the cruelty and worry imposed on them by an ill-devised law. Dr. Rice felt that recovery was often prejudiced and retarded by such inhumane treatment, and we concurred in his conclusions.
Relationship with Brandon.
The Selkirk Hospital is under separate management from the Hospital at Brandon, but since the monthly admissions to the latter institution are small (only 2 in the last month), many patients are transferred from Selkirk to Brandon.
Nationalities of Patients.
During the year ending December 1, 1917, the nationality of patients was as follows:-
Since December 1st, 1917; the nationalities represented are as follows:-
The patients are provided with four pianos, billiard tables, and it was noted that in all the corridors there were pictures on the walls.
In some rooms an arrangement of two beds in a room was found. This is a most dangerous practice, and has led to many tragedies in asylums for the insane. No matter how quiet the patients, the practice is open to criticism. In small rooms where seclusion is employed, the radiators should be covered with locked wire screens, easily removed for purposes of cleaning radiators.
Selkirk is on the whole admirably managed as a custodial institution, but totally unfitted to meet the modern demands of a hospital for the insane of advanced type. The managemenrt are to be heartily congratulated on having achieved such excellent results with such meagre equipment and resources.
On October 15th we made a brief survey of Portage la Prairie Gaol, a clean and well-kept building, built after a rigid penitentiary plan, the general airing room for men being grated over, giving a most dismal and depressing effect. The department for women is little better than a dungeon, depending on electricity for light. Fortunately there was but one female prisoner, a defective girl, who is already the mother of two illegitimate children, and who should be removed to an industrial school. Her mental age was seven by the Binet-Simon tests.
About a dozen male prisoners were seen, five of them boys, one of whom was a low grade imbecile who had come to Canada as a Barnardo boy. One Austrian was markedly insane, and evidenced illusions and delusions.
Four boys were reported as having been in the Industrial Home, and some of them expressed a preference for gaol life, feeling that idleness was better than being employed. Certainly gaol was not the proper place for these lads, and it seemed unfortunate that they should be detained in an environment unsuitable for their treatment. Nine prisoners were examined as to their mental status—five were defectives, one a border-line case, two apparently normal, and one insane.
Restraint is used with the violent insane, muffs being the form chiefly in evidence, although a somewhat novel and ingenious but cruel apparatus was exhibited as having been employed on at least one occasion. Again it was explained to us that the detention of the insane is but for brief periods.
The sanitary arrangements of the cells are excellent, but the lighting is deficient—twelve small windows for seventeen cells. The prisoners seem happy and are evidently well cared for. There are 34 cells, and the punishment consists of bread and water from three to six weeks.
Nationality of prisoners during last year:-
October 15th, 1918.
Brandon Gaol is a much brighter building than that at Portage la Prairie; is well kept and under intelligent management. The same polite treatment accorded us in almost every institution visited in Manitoba was given us here. Fourteen prisoners were in residence, all males, and of these eleven were examined as to their mental status. Two were insane, one a murderer, the other a chronic case of dementia praecox suffering from sexual delusions which led to his incarceration, and the others were defectives of marked character.
Perhaps the most severe reflection on the gaol system of Manitoba was the finding of three little boys nine years of age in one of the cells. These children were being detained for a week until some legal process could be gone through. To make matters worse, these children were somewhat defective.
Brandon Gaol has accommodation for 103 male and 7 female prisoners. The same story as that told in the other gaols regarding the detention of the insane was repeated here, and muffs were used where restraint was thought necessary.
Admissions since November 1st, 1917 :-
A brief survey of the Winnipeg Gaol was undertaken largely with the idea of obtaining information regarding the care and treatment of insane prisoners. In view of the fact that a statement had been made to the effect that, while in theory all insane prisoners must pass through the gaol as a matter of form, in reality few were submitted to this indignity, it was better to know the truth. Apparently the requirements of the law are lived up to with a rigidity that must impose hardships on those unfortunate enough to lose their reason; and when it is stated that sixty-four insane prisoners were committed to the Winnipeg Gaol in the three months prior to our visit, little comment is necessary. Multiply that number by four and compare the total with the admission to the various asylums during the year, and the belief grows that the great majority of insane persons pass through the gaols. True, they are as a rule detained for a comparatively short time, but the shock and disgrace imposed on persons whio have not been even suspected of committing crime can scarcely be described as a humanitarian method of treating mental disease. Just what happens to the persons incarcerated pending their removal is of interest. If they are fortunate enough to be quiet, nothing unpleasant, beyond the humiliation of being confined in a gaol will occur. If they are disturbed they will be restrained by mechanical means, which are objectionable, offensive and unjustifiable. In other words, we are strongly of the opinion that the gaol authorities should not be called on to undertake the care of mental cases requiring intelligent treatment in a psychopathic hospital. Much as we depreciate the conditions as found, we realize that it is scarcely fair to censure the officials who have a task imposed on them which they are not trained to undertake. They simply do their best to meet an awkward situation.
In order to arrive at an idea of the mentality of some of the 80 prisoners confined in the gaol at the time of our visit, the officials kindly gave us opportunity to talk with eleven, or as many more as might be desired. Of these eleven, seven were palpably defective and four suffering from different psychoses. One poor girl, marked insane, was confined in a cell without a bed, there being apparently no realization that a mentally unbalanced patient for whom punishment was not the proper treatment was being dealt with. Just why this girl was not sent to an asylum, rather than to a gaol where she was serving a sentence, was difficult to understand, as there could be no question as to her insanity. She had illusions, hallucinations and delusions.
Nationality of Prisoners.
The figures showing the nationality of the prisoners confined in the Winnipeg Gaol for a period of three months furnish some food for thought in connection with the subject of immigration. They are as follows:-
One of the most pleasing surveys made in Manitoba was that of Grace Hospital, an institution under the jurisdiction of the Salvation Army. While this hospital is doing maternity work in general, incidentally it looks after a very large number of unmarried mothers and their illegitimate children. Only those who have had a broad experience in social work and in clinics can realize how difficult it is to accomplish much with the classes to be dealt with, especially when the legal point of view is so different from that of medicine in regard to responsibility, and frames its laws accordingly. The Lady Superintendent of Grace Hospital has a clear knowledge of the problems with which she has to deal, and with the facilities at hand she has accomplished wonders. She fully realizes how important it is for the welfare of the State to isolate the majority of the mothers of illegitimate children, and to keep the others under the most constant supervision. The attitude of the general public to the girl who has gone astray is that of antipathy and aversion; few realize that a large percentage of these are deserving of the deepest sympathy and pity, to say nothing of practical assistance which we prevent them from being exposed to further temptations, and save the State from the care of an increased number of defectives. How important that is from the social and economic point of view only those who understand the situation can tell. To illustrate this, no better method than reporting the analysis of the mentality of twenty-four mothers of illegitimate children in Grace Hospital at the time of our visit can be suggested. Of these, twenty-one proved to be mentally defective, one was insane, and two were on the borderline—truly a striking showing to anyone not familiar with the situation, and yet not surprising to those who know the facts as ordinarily observed in lying-in institutions.
As is so often the case, too, the nature of the employment of these girls was similar to that found in other centres. Sixteen were domestics in towns four from factories, one waitress and three farm domestics. In other words practically all, if not all, were from poorly-paid occupations, and of course, some were habitual prostitutes. At once the inexperienced theorist is likely to jump to the conclusion that low wages were the contributing cause to the downfall of these girls; but those who are familiar wiih the facts are well aware that these unfortunates are forced by mental disability to choose poorly paid vocations. They cannot do otherwise, as they are not in a position to compete with those of better mentality.
For the most part the twenty-four girls examined belonged to the low-grade Moron group. The outlook after discharge is, therefore, dark, unless suitable provision can be made for the patients in farm colonies for the feeble-minded. As is apparent, these girls are a menace to themselves and the community, as they are likely to add to the number of defectives and also to become active centres for the spreading of venereal diseases. None of those examined evidenced the slightest shame in regard to their condition, and some were mothers of several illegitimate children. The majority were between the ages of fourteen and twenty-one. The foreign born largely outnumbered the native born.
A maternity hospital, accommodating 175 patients. A considerable number of patients were unmarried mothers. On date of investigation, of 160 cases cared for, 37 were unmarried mothers.
A definite policy is pursued in connection with the mothers of illegitimate children. Before admission a stipulation is made with the patient by means of which an agreement is reached to nurse the baby in the hospital for a minimum period of three months, and an assurance to at least help support the baby after that. The Lady Superintendent, Major Paine, has perfected a system by means of which the patient is, when possible, made to feel a sense of responsibility for her child, and on leaving the institution a suitable situation is sought. If the child is in good mental and physical health, adoption is sometimes secured.
The staff consists of the Lady Superintendent and 24 nurses. There is a training school in connection with the hospital, three years constituting the course.
The hospital building is large, commodious and well equipped for the work in hand. In addition to public wards there are private and semi-private rooms. The tariff for the latter is $2.50 per day, and $3.00 for private. There are excellent facilities for the care of artificially fed babies, breast feeding being adopted for all cases in which this is prudent.
The Lady Superintendent confers with all cases seeking admission, and satisfies herself concerning the personal history.
There is no Social Service department connected with the hospital, but, as has been stated, suitable situations are sought for unmarried mothers, and Salvation Army Corps officers in their respective localities attempt to exert a guiding influence over returned girls in their territory. Correspondence is also employed in some cases.
During the last year, 153 illegitimate babies were born, and there were 7 deaths. The causes of the latter were as follows:-
Nationality of Unmarried Mothers.
During the past year the records show the following results:-
Ages of Unmarried Mothers during Past Year.
In a separate building upwards of 25 children are being cared for by the hospital authorities. These ohildren were for the most part illegitimate, and born in the institution. Some of them will be eventually adopted. These children are neatly dressed, clean, and in the best of health and spirits. Apparently every care is furnished.
A general hospital, with 50 beds and an obstetrical division with accommodation for 75 patients. Contagious diseases are not treated.
The hospital was built by the Roman Catholic Church, but has really become undenominational, although the Sisters of the Misericordia are in charge. The hospital is financed by the Provincial and Municipal grants for public ward patients, and pay patients contribute $1.75 per day for public ward and from $3.00 to $5.00 per day for private wards.
Officers and Management.
Mother St. Fortunate is in charge, and 13 sisters act as supervisors of wards. Some of them have had a nurse's training.
There is a Superintendent of Nurses and a staff of 28 pupils and graduates. Probationers serve three months, and those desiring a general training remain three years in the training school and receive $4.00 per month. There is provision for a special obstetrical training of a year's duration.
Public ward patients are attended by Dr. Hogan, who lives indoor but has an outside practice as well, and by Dr. Meindl, who resides outside.
At the present time 15 unmarried girls, ranging in age from 14 to 30, are receiving obstetrical care. These patients remain in the hospital for three weeks following confinement, and are then often sent to St. Norbert's Home with their child, where they remain for six months. For others an attempt is made to find employment when needed. According to the Winnipeg City Guide of 1918, the mothers of illegitimate children must either pay $100 for the adoption of the infant or must stay and nurse the child for three months, after which time patient is free to take or leave the infant. At the present time six babies are in the hospital without their mothers. In due course they will probably be sent to their Infant's Home at St. Norbert.
No social service work is done either in locating father of child, or in follow-up work.
The hospital building is a well-built structure, and the wards and operating rooms are clean and fairly well equipped.
Survey of Individual Cases.
Of the fourteen cases examined, seven were mentally defective, four border-line, and three apparently normal. The border-line cases demonstrated mild defect.
Conclusions and Recommendations.
Since the great proportion of unmarried mothers cared for are of defective mentality, it is evident that farm colony care is needed after departure from the hospital.
Note.—No yearly report is made.
This institution was visited on two occasions—October 8th and October 15th, 1918.
The training school receives boys, committed by the courts for delinquency, from Manitoba, Saskatchewan and Alberta. The boys range in age from 10 to 18. The average sentence is 3 years. The institution is a correctional and custodial one.
The institution was built by the Manitoba Government at an expense of upwards of $300,000. It is maintained by the Manitoba Government, but Saskatchewan and Alberta pay the per capita cost of their cases. The latter amounts, at present, to approximately $2.50 per day.
A principal is in charge. At the present time Rev. F. W. McKinnon holds office. Mr. McKinnon was a Baptist clergyman, and is thoroughly interested in the boy problem. He keeps in touch with recent developments in other parts of Canada and the United States. He has been particularly influenced by the work of Mr. Osborne, formerly of Sing Sing Prison, and believes in self-government and the granting of a large measure of freedom, with the boys placed upon their honour. Mr. McKinnon deplores the fact that, owing to the nature of his main building, he is unable to segregate the boys according to age, mental capacity, and nature of delinquency. He holds that for the purposes of his school the present plant is unsuitable, and that an organization built upon the cottage plan would be much superior.
The principal has a staff of 21 assistants. At present he has but one teacher; formerly he had two. There are instructors in tailoring, carpentry, baking, farming and dairying.
The plant consists of a large modern, attractive-looking administration building, a modern, well-equipped school, a building devoted to occupational teaching, a barn, stables, and a covered rink.
The main building contains offices, waiting-rooms for visitors, private quarters for the staff, kitchen, a dining-room for the boys; reading-rooms, dormitories, assembly hall, etc. There is accommodation for 175 boys, but at the present time only 81 are cared for. On this account a number of the dormitories are not used.
The school building contains four class-rooms, but only two of these are used. In fact, one class-room is all that is necessary for the present number of boys who are receiving instruction.
In the basement there is a swimming pool, and the boys are given opportunity of using this every Saturday. On the top floor there is a large assembly hall. This was intended primarily for entertainments, such as concerts, moving picture shows, etc.
The building devoted to occupations contains rooms for tailoring, carpentry and bootmaking, In addition there is a heating plant in the building. The barn and stables are modern structures, and the latter houses many horses and cows.
The school is situated on the outskirts of Portage la Prairie, with a large artificial river in front. Some 300 acres belong to the institution, and are used for gardening, farming and pasturing.
Instruction, Discipline, etc.
Most of the boys who have not completed the 8th grade in the schools receive instruction for .half of each day in the primary school. The teacher in charge takes a keen interest in her work, and was able to give a good account of the various characteristics of her pupils.
As has been mentioned above, instruction is given in tailoring, carpentry, baking, farming and dairying. Until recently a bootmaker was also on the staff. Since the boys are committed to the institution for three years, it is possible for many of them to leave the institution fairly well trained in one of the various occupations mentioned. The principal feels, however, that the three year limit should be extended to five years.
As far as discipline is concerned, the principal resorts to the plan of giving the boys the utmost freedom, and as has been said, he places them on their honour. Occasionally boys escape, and it is stated that when they return the. measures taken are not sufficiently harsh. It was interesting to learn, however, that two boys who recently escaped and who were again charged with burglary, requested the Judge to send them to jail in Portage la Prairie rather than return to the Training School. Unfortunately this was done. The apparent reason for the attitude of the boys lay in the fact that they would be made to work at the school, whereas the jail seemed to offer chances for idleness.
A boys' court is held in the school, with the boys acting as judge, attorney, jury, etc.
Survey of Individual Cases.
Number of cases examined, 26. (Only boys suspected of mental abnormality were referred for investigation.)
Classification of Cases.
Nationality of Abnormals.
Nature of Delinquency Among Abnormals.
Summary and Conclusions.
Twenty-six decimal sixty-six per cent of the cases cared for are abnormal mentally. It is evident that these boys should not be sent on parole at the expiration of a three-year sentence. Undoubtedly these cases should not be allowed to mix with boys of sound mentality. It also seems wise to segregate the majority in an institution caring for mental abnormals.
The nationality of seventeen of the twenty-six abnormals was determined, and demonstrated that eleven were foreign born. The attention of the Federal authorities dealing with immigration should be brought to bear upon this important finding.
Since the institution is less than one-half full, since it is unsuitable, according to the Principal, for the particular needs of delinquent boys, since the per capita cost of $2.50 per day is prohibitively high for the nature of the work on hand, and since there is reluctance on the part of Winnipeg, Saskatchewan and Alberta to commit further cases, it therefore seems prudent to consider the advisability of using the institution as a training school for the feeble-minded. The lay-out of the buildings reminds one of the training school for the feeble-minded at Waverley, Massachusetts, and it would appear that a comparatively small amount of money would make it suitable for the care of the defective class. This matter will be fully discussed when making recommendations for the improvement of conditions at this school.
An institution for the reception of delinquent girls referred to it by the Courts, the Children's Aid Society, various other organizations, and also by individuals.
Building and Grounds.
The building is a modern brick structure, four and a half storeys in height, with fire escapes and other devices to secure the safety of the inmates. Six acres of land constitute the grounds, which furnish a certain amount of occupation for the girls under detention. As the Home is comparatively near to the city and the grounds are unfenced, it is difficult to have proper supervision of the inmates, and escape is a simple matter.
There is accommodation for forty girls.
Present Number of Inmates.
Those who are able do a little farming, knitting, needle and laundry work for the Home, but no organized attempt is made to develop or teach useful industries or to help the delinquents acquire a knowledge of different handicrafts. The laundry is, for example, located in a small, cold room, and is not equipped in such a manner that commercial work might be attempted. The staff is made up of a matron and three assistants.
Summary of Investigation.
Other data not included in above:
Organized eight years.
Conclusions and Recmmnendations.
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