State of Lunacy in England
603 Art. YIII.-
The Thirteenth Report of the Commissioners in Lunacy, recently published, is of considerable interest, notwithstanding that it follows so rapidly upon, and has had several of its details antici- pated by, evidence published in the report of the Select Com- mittee on Lunatics which sat during the late Parliament. The contents of the Commissioners’ Report do not well admit of being abstracted, but we shall endeavour to indicate some of the more important particulars given.
Since the 31st March, 1858, three of the public Asylums an- nounced last year as in course of erection have been opened, to wit, those for Durham, Cambridge, and Northumberland. The United Asylum for the county and borough of Cambridge, and the Isle of Ely, is situated about 3^ miles from Cambridge, and it ” is built upon a site moderately elevated, commanding extensive views. The land consists of about 57 acres; the surface is fine loam on a chalk subsoil. The building is designed to accommodate 250 patients.” (p. 5.) The Asylum for the county of Durham is situated at Sedgefield, about 11 miles from Durham, and is esti- mated to accommodate 312 patients?157 males and 155 females. ” The cost of erection of the Asylum was 31,480Z.; viz.?land, 52 acres, 4000Z., and buildings and fittings, 27,4801. The total average cost per patient being thus about 100Z.
” The Asylum consists of a main building of three stories, and two separate blocks of two stories each, in connexion respectively with the workshops and laundry, and containing day-rooms on the ground, and associated dormitories on the upper floor.
” In the centre of the main building, the principal approach to which is from the north, are the superintendent’s residence and the general dining-hall, over which is the Chapel. The male and female patients occupy respectively the western and eastern divisions of the Asylum. ” The second floor of the main building is occupied only at night. ” According to the original design there were on the second floor in each division three dormitories opening into a passage towards the north. Upon further consideration the partition walls were omitted, and the upper story on each side was converted into a large dormi- tory containing 50 beds, and warmed by open fires.
” The several wards are heated by open fires only. The dining- hall and Chapel are warmed by a hot-water apparatus.”?(p. 12.) The Commissioners report favourably of the condition of the patients already admitted into both asylums, and of the arrange- ments ; and they also make several minor suggestions to promote the efficiency of the institutions.
With one or two exceptions the condition of the public asylums, and the patients contained in them, throughout the kingdom, is very favourable ; and the details given by the Commissioners in respect of each asylum, give a most satisfactory impression as to the persistent efforts of the different asylum authorities to keep up or improve the efficiency of the establishments. Moreover, the suggestions of the Commissioners show that not even the veriest minutiae of management and arrangement escape their eyes.
The Haverfordwest asylum, however, is still characterized by glaring unfitness and mismanagement. In our notice of the Twelfth Report of the Commissioners, we pointed out how this asylum had set the Commissioners at defiance since 1854, and how towards the end of 1857 the interference of the Secretary of State was requested, and the medical officer was superseded. Little benefit, it would now appear, has resulted from this change, and the asylum still retains its discreditable character. The West-Riding of York Asylum is exempted from a favourable notice by a high rate of mortality, and many defects in the internal arrangements and management. How needless this is, and we hope that it may now be said was, is made manifest by a note appended to the Commissioners’ Report, which tells us, that since the comparatively recent appointment of Mr. Cleaton, as medical superintendent of the asylum, the general condition and manage- ment ” have been reported as materially improved.” (p. 41.) Certain remarks of the Commissioners on the medical staff’ of the huge, overgrown, yet still increasing Colney Hatch Asylum, are well worthy of attention.
” The medical staff at this large asylum at present consists only of two medical superintendents, each of whom has an assistant, who acts as dispenser. These gentlemen have the entire medical and moral control and care of 1285 patients. It is manifest that anything like individual treatment must be limited to a very small proportion of the cases, and we fear that, with the mass of the patients, the superintend- ents must necessarily depend mainly upon the good conduct and trust- worthiness of the attendants. Moreover, the chance of cure must, as we apprehend, be greatly reduced; such chance being still further diminished by the fact that, during the last six months, there has been no medical assistant on the male side.”
Only one or two examples of. restraint, and those of the slightest character, are reported from the different asylums. The Commissioners again urge the necessity which exists for additional asylum accommodation, and on the most eligible modes of making such provision they have the following remarks. ” The mode by which additions have been made to county asylums varies in different counties. As a rule, we have suggested the erection of detached buildings of a simple and inexpensive character, rather than additions to the main structure, on the ground that additions must generally partake of the character of the original building, and thus often entail the necessity of erecting new wards of too expensive a con- struction. Such wards are, as we think, quite unnecessary for many of the chronic and idiotic cases which accumulate in all large asylums, and are not required for those patients who can be regularly employed in active occupations. Above all, we have invariably found that patients removed from the long galleries of an asylum, to the more home-like apartments of a detached building, have not only presented a more cheerful and comfortable appearance, but have themselves expressed their satisfaction at the change.”
These suggestions cannot be too highly commended. A progressive improvement in the condition and management of the metropolitan licensed lioCises is reported, and it is stated that ” the entries made by the Commissioners at the several pro- vincial houses are for the most part favourable. Pour houses have been closed in the provincial districts during the year, and one new license granted.”
The Commissioners make known the circumstances which guide them in granting licenses, and they urge that it is important that they should have legal power to demand from the proprietors of licensed houses accounts of the payments made for, and amounts expended upon, patients. Thus, it is evident that tlie offensive and unjustifiable imputations respecting the probity of proprietors of licensed houses, which were made by the Earl of Shaftesbury in his evidence before the Select Committee on Lunatics, and upon which he based a similar proposition, are indulged also by the other Commissioners in Lunacy. We treated of this matter in our last number, but we may repeat here a remark we then made concerning the 2Gth clause of the proposed Bill to ” Amend the Law concerning the Care and Treatment of Lunatics,” which was submitted to the Select Committee, and which provided that the proprietors of licensed houses, and persons having charge of single patients, should furnish information to the Commissioners as to payment for patients:?
” This clause does not provide that due and sufficient cause being shown, warranting the suspicion of neglect of a patient, the Commis- sioners shall have the power of requiring an account to be submitted to them of the receipts from and expenditure for the patient, but gives them an unlimited power of requiring such accounts to be laid before them, when, how, and for whatever cause they might think fit! Such a proposition as this evidently emanates from the same suspicious spirit which infects the whole of Lord Shaftesbury’s evidence respecting medical men practising in lunacy. It is not a lond fide provision, and would 110 doubt, if it were enacted, have the same fate as all vexatious legislative provisions; but in the meantime, it, and the rest of the clauses of the bill conceived in the same spirit, would have a diametri- cally opposite effect to that which they were intended to have.”?p. 407.
The great importance of having competent attendants in an asylum, the value of night attendants, the signification to he at- tached to the word ” seclusion” in the Lunacy Act, and the indispensahleness of a good, nutritious diet among pauper lunatics, are discussed hy the Commissioners. They have issued a useful circular concerning the qualification of attendants ; and they hold that ” any amount of compulsory isolation in the day- time, whereby a patient is confined in a room, and separated from all associates, should he considered as seclusion, and recorded accordingly.”
Certain remarks concerning the property of lunatics deserve consideration :?
” We avail ourselves of this occasion urgently to press upon your Lordship’s attention, with a view to early legislation, the great hard- ship and injustice entailed upon a large number of the insane and their families by the present dilatory and expensive provisions of the law for the administration of the property and income of insane per- sons of very limited means, more especially those whose mental malady is of a temporary, and probably curable character.
” One of the objects of the ‘ Lunacy Regulation Act, 1853,’ was to provide a remedy for this great evil. The result of that enactment, in this respect, has entirely disappointed public expectation. The 120th section, which was specially designed to meet the cases referred to, has proved practical^ inoperative, by reason of the large and ruinous expense attending the necessary proceedings. We are informed by the Registrar in Lunacy that in no case can the requisite autho- rity to represent the lunatic be obtained at a less cost than 751. The provision is therefore illusory, and inapplicable as respects that large class, peculiarly objects of compassion, whose families are, as a first result of the disorder which has afflicted themselves, overwhelmed with misery, and frequently reduced to pauperism.
“These observations have especial reference to persons of limited life incomes, and to small tradesmen; and, as a striking illustration of our views, to the cases of poor governesses, whose anxious calling often induces temporary insanity, and who may have accumulated savings to a trifling amount, and prudently invested them in the funds.
” We would further observe, that legislation is required not only with reference to the interests of lunatics and their families, but for the protection of public companies, tenants, and others, owing divi- dends, rents, and other debts, and ready and desirous to pay them on receiving a legal discharge.
<! We may mention, among many others which have been brought under our notice, the case of a Fire Insurance Company indebted to a lunatic upon a policy, and unable,’ without circuitous, inconvenient, and expensive proceedings, to relieve themselves from their liability.
” It is not within our province to indicate the mode by which the property and income of the class of the insane to whom we have ad- verted could best be rendered available for their benefit and that of their families, but we deem it our duty strongly to express our opinion that, in all cases such as those under consideration, legal provision of an expeditious and inexpensive kind ought to be made for investing some person with authority to act for the Lunatic, as civilly dead. We ven- ture further to submit that, unless and until a relative or friend be found, competent and willing to act in that capacity, the duty should devolve upon a public officer, in the nature of an official committee.” We commend to notice the formation of a fund by the Com- missioners, for the relief of those pauper lunatics who, ” as repeatedly happens,” when entitled to a discharge from an asylum, have neither friend nor workhouse to receive them. A donation of 300L, and subscriptions to the amount of 100Z. by the Commissioners and their Secretary, form the nucleus of this fund, which is entirely a matter of voluntary contribution. The Colney Hatch and Hanwell Asylums have special funds for the purpose which have worked most beneficially.
The state of single patients is considered by the Commissioners, and, foiled in their efforts to carry out as rapidly as they could wish, improvements which they deem to be necessary in the management and control of such patients, as well as to perform a sufficiently extensive visitation by which unjust and improper treatment would be prevented, the Commissioners express the following opinion:?
” It is our conviction that the law will continue to be extensively violated or evaded, as respects this most helpless and neglected class of the insane, until medical practitioners are required, under a severe penalty, to give notice, to this office of the names and residences of all persons who shall, for a given period, have been professionally attended to by them, as insane patients. We believe that such an enactment would produce numerous disclosures, which, in the absence of such a legal provision, medical practitioners are reluctant to volun- teer.”?(p. 78.)
We feel assured that the proposition implied in this opinion will prove most offensive to the medical profession, and that por- tion of the public next to them whom it most concerns. Nay, it is tolerably certain that, if the Commissioners’ suggestion be acted on, a piece of vexatious and inutile legislation will be the result. Can anything be more obnoxious to the feelings than the notion that the medical man should, in reference to lunacy, be transformed into a compulsory informer ? That the bond of confidence which exists between the patient and his friends or relatives and the doctor in the earlier stages of lunacy is to be at once and abruptly broken ? That the many reasons which, at the outset, may induce a family to wish that threatened, or manifest, and perhaps temporary lunacy in a member of the CN.r-, COS state of Lunacy in England.
family, may be kept private, ancl into which reasons we have no right to pry, should by an arbitrary legal enactment be made ot no avail, and that families are to be made distressingly aware that no privacy can be maintained unless the medical man be kept out of the house ! That the fact of lunacy may subject a household to legal inspection ! Think of the neglect in early attendance, and of the quackery that such a state of things would induce. But apart from these objections, which are not to be lightly unheeded, there are others, and if anything more formidable ones. Granting (for the sake of argument) that the condition ol single patients is, in many instances, as unsatisfactory as the Commissioners state, we entirely disbelieve that the method in which they seek to overcome the evil is the right one; nay, more, we assert that it is manifestly erroneous. The law already makes it a misdemeanour for any person to receive a lunatic into his house for profit, without making known the same to the Commissioners, and without a certificate of lunacy; and it calls upon every medical man attending upon sucli a patient to report upon the condition of the said patient once annually to the Commissioners. We have here evidently the germ of the Commissioners’ recent suggestion, and it is equally evi- dent that the medical man has not hitherto considered himself warranted in so entirely ignoring the wishes of the patient or his friends as to fulfil the expectations of the statute. Is there any probability that the threat of fine would in anywise alter bis con- duct in this respect? The Commissioners have found that the police functions assigned to the doctor by the Act have not been carried out; who is to exercise police functions upon him, if the suggestion of the Commissioners should pass into law ? Unless the Commissioners propose to give part of the penalty to the informer, we see no chance of the success of such an enactment, except as a source of irritation. Moreover, will the families who may have the misfortune to have insane members, or a tendency to insanity among them, consent to so arbitrary an inter- ference with a question of private judgment ? We fancy not. Rest assured that the Sangrado principle applied to lunacy will never act. Law, and yet again law, and still more law, is an empirical method of procedure which can lead to no good. Lunatics are already sufficiently well larded with law. What, then, is wanted ? First, a much better state of feeling respect- ing lunacy and lunatics among the people in general, than now exists. But how is this to be brought about if the Commis- sioners persist in speaking of and legislating respecting lunacy, as if medical men, in reference to it, were simply ogres ? The confidence between the medical profession and the Commissioners is weakened on the one hand, and between the public and medical men on the other, and the unhappy patient?the incipient lunatic, or single patient, as a necessary result, is victimized.
Friends are frightened of calling in the medical man, in the first place?frightened of the asylum, in the second place?frightened of the certificate of lunacy, in the third place?and even the, to the public, mysterious Lunacy Commi ssioners, known only by trenchant Acts of Parliament, assume a dreadful and portentous character. How unfitted the law is to deal with the intricate workings of lunacy matters, is well shown in an instance contained in the present Report of the Commissioners. They tell us of a licensed house existing in the kingdom, conducted on principles diametri- cally opposed to those now received as the right ones. Why do not the Commissioners close it, then ?
” In this case we have reason to believe that no intentional harsh- ness or neglect has occurred on the part of the proprietor, tvho doubt- less considers himself justified in pursuing a course of treatment, and in providing a species of accommodation, which forms an exception to , those of all similar establishments in the kingdom. Had it not been for this belief on our part, we should have thought it our duty some time ago to taJce steps to prevent the renewal of licence.’”?(p. 52.) And yet the Commissioners, who can thus admit the private opinion of an individual, in his own interest, to outweigh the written, specified law, would enact a law to compel men to entirely set aside their own private judgment and the judgment of others ! Let the Commissioners seek to obtain the confidence of the medical profession, and to spread a just knowledge of the require- ments of the insane in the kingdom, and we have no doubt that they will much more readily and satisfactorily attain their aim, in respect to single patients, and the welfare of private lunatics generally^”than by vexatious legal enactments. The great diffi- culty in the way of exercising a satisfactory control over single patients, is the feeling of the friends; and this will only be overcome by kindly remonstrances and watchfulness, not by compulsion; and we believe that the Commissioners under- rate their own powers in wishing to have additional legislation upon private patients. Indeed, from the instance we have quoted, and we could give other instances, it is evident the Com- missioners have more law than they can well make use of. We know how steadily improvements are going on in the treatment of the insane, under the watchful care of the Board. Doubtless it may have been disheartened by difficulties, but we have infinitely more confidence in those difficulties being overcome by vigilant care than by legislation. We have spoken thus strongly of two measures suggested by the Commissioners, in their Report; for in the present state of things we estimate the persistent, indi- vidual, and collective action of those gentlemen at a much higher rate than that of additional enactments.
The Report terminates by quoting a legal opinion that lunatics, declared so by inquisition, and placed in the position of single patients, are to be treated as such; with some remarks on the propriety of ensuring the visits of friends to lunatics in asylums, and an account of the difficulties which still impede the erec- tion of an asylum for the city of London.
The appendix of the Report contains two series of statistical tables, the one referring to patients in asylums, the other to pauper lunatics and idiots.
The first tables are arranged upon a better and more compre- hensive plan than in previous Reports, and we trust are to be taken as an indication that the Commissioners are about to place the statistics of insanity in good and proper order; but it is to be regretted that the tables are printed in a scrawling, ungainly fashion.
On the following page is the summary of the tables, and we have added the totals for the previous year.
These figures show a total increase of 001 patients admitted during the year 1858, and an increase of 350 pauper lunatics as compared with 915 during 1857.
The abstract of annual returns of pauper lunatics and idiots belonging to the several unions in England and Wales, on the 1st January, 1859, gives the following results:? England, Wales… Total. Number of Patients. 28,104 1,754 29,858 In County or Borough Asylums. 14,194 359 14,553 In Registered Hospitals, or Licensed Houses. 1,922 175 2,097 In Work- houses. 7,410 232 7,642 In Lodg- ings, or Boarded Out. Residing with Relatives 767 345 1,112 3,811 643 4,454
? Returns from the Poor-Law Commissioners, published in previous numbers of the Lunacy Commissioners’ Reports, give as the number of pauper lunatics and idiots chargeable to parishes in 1847 and 1857, the following figures 1847?18,065 1S57?27,693 1859?29,858 Much of the increase in the foregoing numbers is due to greater care in recording cases of pauper lunacy. SSUJVLJUAKi.
Number of Patients 1st Jan. 1858. Private. County and Bo-) rough Asylums, j Hospitals Metropolitan LiO censed Houses. $ Provincial Li-) censed Houses/ Royal Naval hos-” pital j M. 134 762 675 719 2290j 126 F. [Total. 2177 2177 231 1492 1305 1439 4167 126 4593 Pauper. M. 6777’ 95] 491 550! 7913, F. 8112 79 827 9507 7913,9507 Total. 14,889 174 131S1 1039 17,420| 17,420 1st Jany. 1857 1 Males…9962 Females…11275 Total Lunatics. 15,120 1666 2623 2478 21,887 126 22,013 21,237 Admissions during the YearJ 1858. M. F. 2572 473] 605 4541 Total. 40034104 39 4042:4104] 3S95 3999 4985 904 1166 1052 8107 39 8146 7895
Discharges during the Ye;w 1858. Total Number. M. F. i Total.
11871427 253 354 422 494 393 397 2614 607 916 790 2255 2672 15 ? 4927 15 2270 2672 2279 2588 5197 Number : Recovered. M. F. 1078 207 203 192 1386 1680: 13| ? 1399 16S0 1299,1566 Total. 1965 341 360 400 3066 13 Deaths during the Year 1858. Total Number. 12611032, 13 From Suicide. Act | Actcom- committed in mitted before Asylum, j Admission. Total.! M. 1649 105 322 217 F. Tot.’ M. 2293 | 5 { 7 12 ? 13 - j 3079 ‘12741032 2865 12311926 2306 1 5 ; 7 2168 ? 11 ! 3 12 - 14 1 Tot.
From Accidents or Violence Incurred in Asylum.
F. Tot. 17 Incurred before Admis sion. M. F. PATIENTS REMAINING 1ST JANUAItT, 1859. County and Borough Asylums… Hospitals Metropolitan Licensed Houses.. Provincial Licensed Houses Royal Naval Hospital.. Patients remaining 1st January, 1858 .. Private.
M. 122 874 663 862 2521 137 105 766 624 2231 2231 2508 I 2230 Total. 227 1640 1287 1598 Pauper. M. 4752 137 4889 4738 8169 7985 9853 9853 9587 Total, 15,615 218 1264 925 18,022 18,022 17,572 Total Lunatics. 15,842 1858 2551 2523 22,774 137 22,911 22,310 Number deemed Curable. 879 137 140 209 1365 17 1382 F. 794 202 191 204 1391 1391 Total. 1673 339 331 413 2756 17 2773 Found Lunatic by Inquisition. M. 178 F. Total. 11 34 132 123 300 300 Criminals. M. ! F. 242 122 31 137 43 532 150 532 150 Total. 326 140 36 180
Chargeable to Coun- ties or Boroughs.
M. F. 644 710 84 109 Total. 1354 119 179 903 I 1652 749 [ 903 1652 Included in Total Lunatics. 1255 I 1528 | 171 I 124 | 295 [ 490 | 143 ] 633 | 694 | 796 [ 1490
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.