1308 THE AFTER-CARE OF DISCHARGED PAUPER LUNATICS.
of an elected Fellow more than he does. His personal devotion
to surgery both as a teacher and a practitioner and the embodi- I
I
ment in him of all that completes our conception of a genial
American gentleman point him out as worthy to receive the
compliment paid to him by his College. It is to this genial
quality of his nature that he owes not only his large circle of
friends in Great Britain and other European countries, but
the fact that he has been able to associate with himself as
editor so many distinguished compatriots in the compilation
onehis splendid System of Surgery" written throughout by
American surgeons. -
THE AFTER-CARE OF DISCHARGED PAUPER
LUNATICS.
No patients require more special aid and after-care on
leaving the institutions where they have had to remain
under treatment and until recovery than the pauper insane.
The After-care Association for poor persons discharged
recovered from asylums for the insane is the only charity
of its kind in the United Kingdom and during the few years
of its existence its scope and sphere of work and usefulness
have steadily increased. The annual report of the council
of the association for the year ending Dec. 31st, 1898, is a
record of satisfactory progress. The work undertaken
by the society can never be expected to become very popular
in the strict sense of the word, nor can its progress be judged
by comparing it with other charities as its difficulties
are very much greater-viz., in affording help to those poor
people who have recovered from insanity and whose chances
of a livelihood in a struggling age are greatly diminished
if not altogether lost. Thus, during the twelve months of
1898 there were 186 cases from different parts of the country
before the council, as compared with 147 in the same period
in 1897, and this is by far the largest number ever brought
under the notice of the council in one year. Of these 131 were
women and 55 were men. Convalescents have been assisted
in such ways as past experience has shown to be best-viz., by
being boarded out in cottages in the country, by finding occu-
pation for them, or by grants of money, clothing, &c. Some
have been placed in domestic service, a procedure which
requires much care and knowledge for its successful carrying
out, as all employers have to be interviewed and the
cases for placing out very judiciously selected, especially in
the case of young females. All are visited periodically by
officers of the association and it speaks well for this
branch of the association’s labours that a very large majority
of cases so placed out and helped to help themselves have
retained their situations, while the failures during the year
have been comparatively few. The boarding-out of suitable
convalescents in cottage homes in the country has been con-
tinued with much success. These houses are mostly situated
in the south of England and are inspected by the secretary
before anyone is sent, and they are also visited from time to
time by him at short inteivals. Last year the council of
the association decided to send particulars of the work
of the association to various boards of guardians in
England and Wales requesting information regarding
all patients discharged as recovered from public asylums
to workhouses, so that inquiry might be made into
those cases likely to be benefited by the After-care Asso-
ciation and it is gratifying to note from the readiness of
several boards to give such information that success in this
direction seems probable. We note that among the unions
which subscribe to the funds of the association are those of
Clapham, Wandsworth, Fulham, and Paddington and that
among the City Guilds, &c., which give donations towards it
are the Worshipful Companies of Mercers, Fishmongers,
Salters, Clothworkers, Skinners, Merchant Taylors, and
Leathersellers. Cases have been assisted from among the dis-
charged patients of all the London County Asylums and of
the various public asylums of Middlesex, Essex, Kent, Sussex,
and other southern counties. The scope of the association,
however, goes further north and convalescents from Notting-
ham, Lancashire, &c., have also been recipients of its
bounties. A few concrete instances will serve to show
the kind of work done for discharged paupers who have
recovered from insanity. Case 598.-A young orphan girl
discharged recovered from an asylum boarded out and
trained for domestic service and a suitable situation sub-
sequently found for her. Case 589.-A girl deserted by
her parents for many years boarded out at the seaside
after recovery from an attack of insanity and afterwards
placed in a suitable situation. Case 20.-A lad who had
been in an asylum since the age of seven years boarded
out for several weeks and placed in a suitable situation.
Case 602.-A man from a London asylum was assisted by
the association to obtain rest and change and to recruit his
mind and body and was afterwards taken back by his
old employers. Owing to increase of work since January,
1899, the council has been obliged to appoint a second lady
visitor at a salary of .B40 per annum so that the visiting and
placing of female convalescents may be efficiently carried
out. The council earnestly appeals for additional help either
in the way of personal service, funds, or otherwise. It is
evident from the report that the work done-quiet and
unobtrusive though it be-during the past year has been the
most successful in its annals, but it needs the warm coöpera.
tion and assistance of officers and authorities of the various
public and private asylums and boards of guardians of the
poor throughout the country for its continued success. Surely
no charitable body deserves better than the one which helps
recovered lunatics to live so that they may not relapse and
lose their reason again, but may continue " clothed and in
their right mind." The offices of the association are at
Church House, Dean’s Yard, Westminster, S.W., and the
address of the honorary secretary is Chaplain’s House,
Colney Hatch, N. - ,
THE COLONIAL NURSING INSTITUTION.
IN a letter to the daily press Mrs. Chamberlain asks
permission to draw attention to the Colonial Nursing Asso-
ciation. It was to supply the known want of any provision
for good nursing in the colonies, and especially those which
lie within the tropics, that the Colonial Nursing Association
was formed in 1896 with a small fund, raised by private
subscription, and with the intention of encouraging and
organising the supply of trained nurses in cases where the
localities had been unable to secure this provision. The
association carefully selects the nurses, pays their passage
out, and guarantees their salary for a term of years. It
arranges the conditions and terms of service and furnishes
all information on the subject. Wherever possible the
expenses are provided locally, and the residents in the
colonies are expected to pay for themselves as soon as the
initial difficulties have been surmounted. The movement
has the cordial support of the authorities of the Colonial
Office who have taken advantage of the organisation to
provide nurses for Government institutions maintained in
Hong-Kong, Cyprus, Trinidad, Bahamas, the Gold Coast,
Lagos, the Niger Protectorate, and other places, while the
following colonies and settlements have been supplied
through the agency of the association with nurses for
private patients-viz., Mauritius, Perak, Selangor, East
Griqualand, Cyprus, Ceylon, and Bangkok. Six other
colonies have applied for aid and will be similarly supplied
during the present year. Money is wanted, but a sum not
exceeding .65000 would be sufficient, in the opinion of the
committee, to meet all wants. Subscriptions will be received
by the Honorary Treasurer, Colonial Nursing Association,
Imperial Institute, London, W. We hope that the associa-
tion will not confine itself to sending out European
nurses but will also endeavour to train up a school of native