of bodily restraint " shall include all instruments and appliances whereby the free movements of the body or of any of the limbs. of a lunatic are restrained or impeded, but that the following instruments and appliances only shall be made use of for such purposes : I. A jacket or dress, made of strong linen or some other strong material (a) laced or buttoned down the back having long outside. sleeves fastened to the dress only at the shoulders, with closed ends to which tapes may be attached for tying behind the back when the arms have been folded across the chest; or (b) of some other pattern approved under the seal of the Board; a sample bearing the seal of the Board being in this case kept at the institution or workhouse for inspection. II. Gloves without fingers, so fastened at the wrists that they cannot be removed by the wearer, and made of linen, leather (chamois or other), or some strong material, padded or otherwise. III. Sheets or towels, when tied or fastened to the sides or ends of a bed or to other objects. IV. If, in the opinion of the medical officer or medical practitioner who gives the certificate required by the section, some other mechanical means of bodily restraint is necessary in a particular case where the circumstances are exceptional, such means may be used with the previous sanction of the Board for such period as they may authorise. It is essential to the safe employment of any of these forms of restraint, except No. II., that the patient be visited frequently by a medical officer, that he be kept under continuous special supervision by an attendant, and that under no circumstances he be left unattended; and it is hereby so ordered. The following are not to be considered as mechanical means of bodily restraint within the section, but shall only be used under medical order, and a record of their use shall be made on the clinical records : (a) The continuous bath. A cover shall not be used unless the aperture therein for the patient's head is large enough for his body to pass through. (b) The dry and wet pack. No straps or ligatures of any kind shall be used, and the patient shall be released for necessary purposes at intervals not exceeding two hours. (c) Splints, bandages, and other like appliances when used in accordance with recognised surgical practice for operations or the treatment of fractures or other local injuries, and not so as to interfere with the free move- (d) Gloves, if so fastened as to be removable by the wearer. The Board direct that at each visit of Commissioners or a Commissioner to an asylum, hospital, licensed house, or workhouse, or to a single patient, all instruments and mechanical appliances which may have been employed in the application of bodily restraint to a lunatic since the last preceding visit, together with any Order that may have been made under Article IV. of this Regulation sanctioning the use of exceptional means, be produced to the Visiting Commissioners or Commissioner by the medical superintendent, resident medical officer, resident licensee, or master of the workhouse, or the person having charge of the single patient. It will be seen that the section requires that in every case where mechanical restraint is applied, a medical certificate describing the mechanical means used, and stating the grounds upon which the certificate is founded, be signed in asylums and hospitals by the medical superintendent, in licensed houses by the resident or visiting medical practitioner, in workhouses by the medical officer, and in the case of single patients, by the medical attendant; that a full record of every case of restraint be kept from day to day; and that a copy of such records and certificates be sent to the Board at the end of every quarter. In framing this Regulation, in which they have defined the “mechanical means" which may alone be used in the imposition of restraint, the Board have merely discharged the duty cast upon them by the enactment quoted above; and they desire to guard themselves most strictly against the supposition that they have thereby given any greater countenance to the employment of this form of treatment than they have hitherto shown. While recognising, as the enactment recognises, the possible occurrence of cases in which its employment may be necessary and consistent with humanity, they remain of opinion that the application of mechanical restraint should always be restricted within the narrowest possible limits, that it should not be long continued without intermission, and that it should be dispensed with immediately it has effected the purpose for which it was employed. This Regulation shall come into operation on the first day of April, 1925, on and from which day the Regulation of the 25th of June, 1913, (a) shall cease to have effect, and a copy shall be inserted at the beginning of every register of mechanical restraint and seclusion. Circular 616 MINISTRY OF HEALTH, Whitehall, S.W. 1. August, 1925. TUBERCULOSIS ORDER OF 1925 (No. 2). MEAT INSPECTION. SIR, I am directed by the Minister of Health to transmit for the information of the Council a copy of the Tuberculosis Order of 1925 (No. 2), made by the Minister of Agriculture and Fisheries, together with the circular letter issued by him to all Local Authorities for the purposes of the Diseases of Animals Acts. It will be within the knowledge of the Council that the principal order (the Tuberculosis Order of 1925), which will come into operation on the 1st September next, provides for the slaughter of animals affected with certain specified forms of tuberculosis. By reason of Article 7 of the Public Health (Meat) Regulations, 1924, the provisions of those Regulations as to notice of slaughter, etc., would not apply in the case of an animal slaughtered in pursuance of the Order, but the amending Tuberculosis Order now issued provides that notice of intention to slaughter shall be given to the Sanitary Authority as well as to the owner of the animal in cases where it is intended that the carcase, or any part thereof, should be disposed of for human consumption, and that no part of the carcase shall be removed from the premises for that purpose except with the permission in writing of the Medical Officer of Health or other competent officer. It will be seen that the Ministry of Agriculture and Fisheries recommend that sufficient time should be allowed to elapse before the animal is slaughtered to enable the Medical Officer of Health or other competent officer to be present at the post mortem examination and the Minister hopes therefore that arrangements will be made for the attendance of such an officer in every case. He wishes further to remind Local Authorities that the animals to be slaughtered under the Tuberculosis Order are animals which are known or believed to be diseased and consequently that special attention should be paid to their inspection before any parts of the carcase or organs are passed for human consumption. The criteria which should guide the inspecting officer are set out |