To the Editor
Correspondence.
Dear sir,
In your last number, the Rev. A. H. Baverstock writes in favour of the small home and against the suggestion in .my recent article that large Institutions will be compulsory on local authorities. I would like to thank him for the very courteous way in which he deals with me. With much that he says I sympathise, but the question is a practical one, not one about which we must let our feelings run away with us. I speak from personal knowledge of running small homes as well as an Institution when I say that, though I admit there are some advantages in the small home, chiefly those of more varied diet and less routine, their effect on a defective is largely imaginary and on the whole I do not think they compensate for its disadvantages. My experience is that the happiness of the patients depends considerably more on the personality of those immiediately over them than on whether they are in a small home or in an Institution. During the war it was not possible to enlarge this Institution by building, and my Committee met the demand for beds by taking large houses in the neighbourhood; I have now under my care three branches of 60 beds each and one of forty beds in addition to the parent Institution. The practical points raised in this letter and the conclusions I came to in my article are the result of my experience in running these.
If an authority has to provide for say only a thousand defectives, would Mr. Baverstock really in practice suggest putting them into twenty-five houses of 40 patients each dotted about the country ? Is it practical to have twenty-five Matrons, twenty-five cooks, laundry maids, gardeners, needlewomen, etc., twenty-five kitchen fires, etc., and miany times twenty-five! retail tradesmen supplying twenty-five separate houses at retail prices, when all these activities can be concentrated in one place and the supplies bought wholesale? The twenty-five homes are bound to be in separate places as otherwise you have merely an Institution under another name.
Another practical difficulty: in an Institution much of the work is done by the patients, the higher grades doing the skilled work, the lower grades the unskilled. It is waste to put high grades to do work that can be done by low grades. With small homes, classification in an area will be by the home and in any individual home the patients will be of one type. In the higher grade homes you will have an overplus of la,tour doing little, or wasting itself on low grade tasks. In the low grade homes all the labour will be paid labour and the cost will be as heavy as running a hospital. Again, if in the h’igh grade hemes you arrange that each heme sha’ll confine itself to one trade (the expense of providing instructors will make any other course impossible) think what work it will entail to send the boots from twenty-four homes all over the county every week to the one home that does the toot repairs and so on, through all the activities of the various homes.
Amongst these, thousand defectives would be about 250 requiring school instruction. Hew is it possible; to supply this, to supervise it, to coordinate it, in small homes? Another point is the impossibility of supervising a number of small places, the time wasted in travelling and the difficulty in obtaining staff good enough to undertake the greater responsibility. Again, there is more life, more going on, more to see in an Institution ; a small home can be v,ery monotonous and deadening. I realise Mr. Baverstock may say I a,m thinking too much of the expense, but I submit these points are not merely ones of cost; they are practical points the future administrator will have to look out for. The number of defectives to, be provided for in Institutions is so very much larger than most people imagine that the expense will in any case be almost prohibitive and an authority will be compelled to consider it.
I am, ctc., F. Douglas Turner, Medical Superintendent. Royal Eastern Counties’ Institution, Colchester.
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