Lunacy in Ireland
278 Art. XI.?. The Twenty-third Report of tlie District, Criminal, and Private Lunatic Asylums in Ireland for 1874 has been forwarded to us. It is replete with interesting matter relating to the condition of Lunacy and Lunatic Asylums in Ireland.
The following summary is given of the registered and un- registered lunatics during the year:? 1872 1873 In Public Asylums …. 7,140 7,347 In Private do. …. 647 664 In Gaols ……. - In Poorhouses ….. 2,966 3,130 In Lucan, supported by Government 30 25 In Central Asylum for Criminal Luna- tics, …… 175 160 Total number of registered insane . 10,958 11,326 Insane at large ….. 7,219 6,981 Total in Ireland … 18,177 18,307 This table indicates an increase of registered lunatics at the close of 1873, as compared with the number at the same date in the preceding year.
The following remarks by the Commissioners are worthy of special notice:?
” The population of Ireland was returned at 5,493,547 on the 31st December, 1870, while upon the 31st December, 1872, it was calculated at 5,458,925, or a falling-off by emigration of 34,622 in the two years. For the purposes of a general approximation we shall assume, in the ab- sence of the figures of the Census estimate for 1873, that a like ratio has been maintained, as among the sane and the insane; the total number of the latter in 1871 being 18,327, or about 3 in each thousand of the population; in 1872 it was 18,177, and in 1873, 18,303.
” Under these circumstances, and looking to the fluctuations in the amount of the inhabitants of different localities, and which must naturally influence the extent of mental disease in them, we are there- fore inclined to believe that lunacy is not only not on the increase since 1871 in Ireland, but that when old and chronic patients now in asylums and elsewhere?who eight-and-twenty years ago constituted a portion of the percentages of the population of Ireland when it was nearly 2,000,000 greater than at present?shall have died off, a certain decrease is likely to result in the absolute number of our insane; while in Eng- land the advance within the same period of three years, in those ‘ re- puted to be of unsound mind,’ was 3,387, or from 58,640 to 62,027. ” No doubt an indulgence in the use of ardent spirits, and unfortu- nately of the most deleterious quality, is becoming more prevalent from day to day in this country, instigating its victims to the wildest acts of violence and depravity?maddening, without actual delusions, and ter- minating for the most part in epilepsy, or disease of the brain, but not in genuine lunacy.
” Melancholy, however, as may be the immediate consequences of drunkenness to those unceasingly addicted to it, the results are occa- sionally far more deplorable in regard to the offspring of inebriate parents, who are born imbecile, idiotic, mutes, or malformed, as we have known to be the case in two or even three members of the same family.
“We shall now analyse the general result of treatment in District Asylums during the year under review. On the 31st December, 1872, their inmates amounted to 7,140. In 1873, at the corresponding period, there were 7,347, or an increase of 207. The admissions during the years 1872 and 1873 respectively were 2,165 and 2,277, being an in- crease of 112 in the latter; the total discharges in 1872, 1,364?in 1873, 1,398, or 34 more. The total deaths show an increase of 27, as compared with those in the year 1872, and the escapes, 15 in ‘72, were 8 less in ‘73. As the daily average number under treatment in 1872 was 7,107, and in 1873, 7,254, making allowance for the increase, the percentage difference on any of the above items is scarcely perceptible. It is satisfactory, however, to observe that the recoveries, whether judged of by actual admissions or the number under treatment, fully sustain the previous favourable character of Irish District Asylums.
“The recoveries during the year 1873 amounted to 1,031?547 males and 487 females,?or nearly 11 percent, upon the total (9,417) under treatment during the twelvemonth. The aggregate deaths in the same period were 665?368 males and 297 females?six resulting from accidental causes. The mortality?or 7*10 per cent, on the entire num- ber in Asylums, and for the most part among the aged and infirm?is under the general average elsewhere.
” We would here, from a further experience, take the opportunity to repeat that a percentage upon total numbers is in every respect pre- ferable, because practically more veritable, than one based upon a daily average of patients?unquestionably to one on admissions only, as is almost uniformly adopted in regard to cures; for the last method may involve the fallacy of supposing that the recoveries had taken place ex- clusively among the admissions, while it might happen that within a given, but exceptional, year there had been more cures than admissions, and in the event of a severe epidemic even deaths might chance to be in excess of both.
” Analysed according to the usual mode, the recoveries during the past twelve months in Irish Public Asylums would realise 45 percent., and the improvements, as represented by discharged patients, 3?be- tween both fully 58 per cent, on admissions.
” So far, then, as the important objects for which these institutions have been established are to be judged of by statistics, but above all by their affording a refuge to our fellow-creatures as places of judicious treatment and safety, as well as the indirect but certain benefits accruing to society at large, by checking, as far as human means can, the propa- gation of mental disease, so hereditary in its character, their working during the year 1873 has been satisfactory and successful.”
There are twenty-two District Asylums in Ireland, and tlie description of them in the Report contains particulars relating to the following heads:? State of the Asylum. Accommodation. Admissions. Discharges. Deaths. Recoveries. Employments. Amusements. Religion. Classification. Diet. Officers. Expenditure, showing cost per head. Books and accounts. Attendance of Gover- nors. General observations.
The condition of these Asylums appears, from the Eeport, to be satisfactory. A considerable number of lunatics are confined in work- houses, and one-half of those so confined are idiots or epileptic imbeciles. Speaking of the condition of these inmates, the Commissioners say :?
” The various inmates here adverted to and visited by us in the course of the twelvemonth just expired, we are happy to report, are generally treated with great consideration, and their creature enjoy- ments, so far as the limited accommodation in workhouses admits of, humanely attended to. Indeed, for many years past, a growing libera- lity, encouraged by the Commissioners of the Local Government Board, has been observable, on the part of local boards. In many if not most unions the dietary is not only ample but of excellent quality, and where, from a paucity of those afflicted inmates, paid attendants are not em- ployed to take charge of them, well-conducted and intelligent paupers are substituted. Occasionally, too, we find, when there are no regular wards for the classes in question, that imbeciles, harmless idiots, and epileptics are industriously occupied throughout the house, and sleep with the ordinary paupers. Twenty years ago it was different, but now more benevolence is exercised by sane inmates to their afflicted companions. The main deficiency consists in the want of day-room provision, and outdoor opportunities for air, exercise, and suitable occupations. To dwell further on workhouse arrangements as they affect the insane, would only involve a repetition of opinions fully ex- pressed by us in antecedent reports. On our different visits to these institutions we point out any improvements on behalf of those who come within the sphere of our inspection, and which we feel bound to say, as a rule, are not overlooked.”
We regret to find that there are, according to the returns made by the police, 6,981 persons mentally afflicted at large throughout the whole of Ireland, and out of this number 2,157 do not come within the category of pauper lunatics, the re- mainder (4,824) belonging to that class, and 1,800 are females. ” In a moral, and equally so in a social, point of view, the hereditary character of insanity being considered, this latter important fact is well worthy of attention, and we consequently read vert to the subject.”
The following interesting history is given of the life and death of the oldest criminal lunatic in Ireland, who died in the Central Criminal Asylum :?
” Amongst the deceased there was one to whose history we would readvert, in the instance of Captain S , who died early in August. Taking the date of his offence into account, he was the oldest criminal lunatic in the kingdom. He was transferred to Dundrum, on its opening, from the Cork Asylum, of which he had been an inmate for nearly twenty-two years; having been acquitted so far back as 1829, on the ground of insanity, of the murder of seven men?the whole crew, in fact, with the exception of two boys, of a vessel then under his command, and on its return from Bermuda. There never existed a doubt as to the complete irresponsibility of the unfortunate man. Possessing originally a very decided character, but becoming the subject of mental disease, from continuous excitement and want of sleep for nearly a fortnight, he laboured under delusions as to an intended mutiny amongst his shipmates. After inducing them, in proof of their subordination, and of the absence of such intention, to alloAv themselves to be tied down with ropes on deck, in which position they lay for nearly an hour, the first mate showing the example; when approaching Cork harbour, with an iron bar, he deliberately murdered them in succession. After some time he recovered his reason in the District Asylum. He was remarkable for a uniform kindness of dis- position towards his fellow-patients. His piety was also very con- spicuous, being constantly engaged reading the Bible and religious works. Occasionally, however, he had violent relapses, preceded by a taciturnity unbroken for several days, save by quotations of an incoherent character, or the repetition of nautical phrases. For a few years before his death his memory and mental powers perceptibly declined. He died from senile decay, being considerably over 80 years of age. The brain, of small size, was found to be perfectly healthy, and the component parts in a normal proportion. The only morbid indication noticeable was a slight opacity of the membrane covering the middle and posterior portion of the organ, thus strongly indicating that grave mental affec- tions can exist for a long series of years without any appreciable lesion of structure.”
The following remarks are made by the Commissioners relative to the condition of Private Asylums:? ” The condition of Private Asylums in Ireland, as contrasted in the last and the year preceding, offers but little difference with regard to the aggregate number of patients in them. On the 31st of November, 1872, they amounted to 645?293 males and 852 females; at the like date in 1873, to 305 males and 359 females. The admissions last year consisted of 88 males and 89 females, so far indicating the proximate rate o? insanity between both sexes in the better classes of society. Taking the inmates of Private Asylums at the close of 1872, and those admitted in the subsequent twelvemonth, independent of Chancery patients and others elsewhere in private families, 822 were under treatment, and subject to our official inspection and examination. 0? these 12G were discharged?27 males and 38 females as cured, and 18 males and 19 females improved; while 12 males and a like number of females were removed by their friends, still labouring under mental disease; one (a female) escaped, while 18 males and 13 females died? none, however, from accident, or suddenly.
” The recoveries speak favourably, being a full average on admissions and previous residents; at the same time that the mortality, not quite 4 per cent, on the whole under treatment, is little over that among the general public.
” With reference to the interior organisation of licensed houses for the mentally affected in this country, some institutions are materially in anvance of others, much of course depending on the class of patients in them, and the salaries given for care and maintenance, which vary considerably; consequently, as may be expected, there is not a uni- formity of appearance or of domestic comforts to be found in them either as to furniture, scale of dietary, mode of serving it, &c., &c.; and, indeed, it could not well be otherwise, when it is borne in mind that while in some establishments from ^100 to ^300 is allowed for patients, in others the stipends are not half so much?often, too, irregu- larly paid.
” Taken, however, one with another, they may reasonably be re- garded as fulfilling a truly beneficial object towards the afflicted to be found in them, and who, were they located at home, or placed out with irresponsible parties, and officially unvisited, might in the first instance, through mistaken affection, and a concession to delusions which immediate relatives, parents, sisters, and brothers would not have the courage or judgment to contend with, or, in the second, from an opposite cause, neglect and too close confinement, have a disease permanently fixed on them. Were it not for the advantages derivable from regular asylum treatment, a wholesome isolation from friends, and a removal from previous causes of excitement ? certain it is, and our experience supports the fact, and more from the operation of private than of public institutions for the insane, that the main probabilities of a restoration to health depends on early treat- ment, be it even attended with the abnegation of previous social com- forts or enjoyments. That such abnegation should be as limited as possible, and for curative purposes alone, is one of the paramount duties of inspection; and, also, that at all times a willing ear should be afforded to the complaints and delusions even of the insane, who, too often neglected by relatives, look to us for sympathy and protection.
” On our frequent visits to Private Asylums, independent of inquiring into the actual state of mind of the individuals detained in them, we do not fail to advert to any noticeable deficiency or requirement, and to suggest such improvements as in our estimation are calculated to bene- fit the inmates, an interference occasionally not uncalled for. At Citta- della, near Cork, the proprietor has just erected a commodious and well-devised building for twelve ladies, with flower-gardens in front, the apartments previously occupied by them being restricted in size; and at Lindeville, in the same county, Dr Osborne, under our direc- tions, has materially renovated his establishment for twenty-eight patients. The two private asylums near Armagh, Course Lodge and The Retreat, are now very satisfactorily conducted, without any preten- sions, simply and efficiently. In the Queen’s County the two licensed houses?one for gentlemen, the other for ladies, a mile distant from each other, and standing in a pleasing locality on detached and open grounds belonging to the Visiting Physician to the District Asylum, are alike well maintained in every respect; while many of those in the vicinity of Dublin are in a very creditable state, as we have stated in previous reports. Within the past eighteen months, the President of the College of Physicians has expended a large sum of money, not only in structural enlargements and alterations, but in improving the gardens and extensive pleasure-grounds attached to both his asylums, contain- ing, between the males and females, fifty-two inmates. Besides private houses, for which licences under the statute are annually taken out, there are three important institutions of a mixed character?Swift’s or St. Patrick’s Hospital; The Retreat, belonging to the Society of Friends; and Richmond Retreat, conducted by a religious community, and for females only : all these, however, make no distinction whatever of creed in their admissions. As they accommodate not only paying patients, but others free on the foundations, no licence is required of them under the statute. We have every reason to approve of the management of these institutions. The Stewart Asylum for Imbecile and Idiot Chil- dren is still occupied at Lucan Spa; the commodious and in every respect well-suited residence intended for them, and with ample extent of land around it, not being as yet quite habitable, or sufficiently furnished.
” Looking to the general working of private licensed houses in this country during the past year, we are gratified at being enabled to re- port that not a single cause of complaint sufficient to need an official inquiry wras preferred to the Executive or to the Inspectors; neither was there an instance of improper detention. Some few patients were admitted on certificates not fully prepared, but the irregularities, on being noted, were speedily rectified. From the frequency of our in- spections, abuses of the Act could not well take place, the provisions of which, as a rule, are carefully attended to ; the proprietors of asylums being fully sensible, and none more so, that the success of their respec- tive houses depends on a good name, to which kindness towards the afflicted under their care is essential.
” Before concluding our observations, we would beg to state that the 5th & 6th Victoria, cap. 123, by which alone private asylums are regulated in Ireland, is not so comprehensive in its provisions as could be desired. So far as interior supervision by the inspectors is con- cerned, there exist legitimate powers at command ; but in regard to the right of detention, save in the case of lunatics under the Court of
Chancery, none is authorised against common law. Hence the owner of a Private Asylum is liable at any moment to an action for false im- prisonment in this country, on the plea of harbouring a paid-for lunatic, however marked his malady. Indeed the same principle, if it be one, holds good in our public institutions for the insane, if the party de- tained is not deposed to as being absolutely dangerous to himself or others. The anomaly was sustained in a trial here, when an acknow- ledged maniac obtained substantial damages against the Governors of the Metropolitan District Asylum, at a trial in the Court of Queen’s Bench.
” Again, there is no provision in Ireland, as in England, for allow- ing convalescents, out on a temporary probation, to be protected during its continuance from incidental consequences. Nothing is occa- sionally more practically useful than such an opportunity to test the mind prior to absolute freedom being accorded. Neither in case of an escape is there a legal power of capture or recovery. These deficien- cies, from the result of experience, we should wish to see remedied, and especially on behalf of the insane themselves, and the protection of pro- perty. It appears to us most desirable that in certain doubtful cases the inspectors should have power to allow convalescents abroad, under cautious restrictions in each case, and after a personal examination, to verify cures.
” The inmates of an asylum may appear in it, as it were, suspiciously reasonable for weeks, or even months, when in a less number of days, free to act, and uncontrolled by advice, they become palpable lunatics, often, too, to the serious inconvenience of their relatives, and to their own detriment.”
CENTRAL ASYLUM, DUNDRU1I.
” The Central Asylum for insane persons charged with offences in Ireland, and capable of accommodating 120 males and 65 females, exhibits a decrease in the number of its inmates during the past year. On the 1st of January, 1873, it contained 175 patients. During the year 16 were admitted, 21 were discharged, and there were 9 deaths, leaving, on the 31st December, 121 males and 39 females, or a total of 160, as against 175 on the 1st of January. It will be observed that, though the male side is generally occupied to its limit, there is an ample margin for the reception of females; but, in order to render the Institution equal to the requirements of the country, we have from its opening deemed it advisable to exercise a selective discretion, by limiting the number of admissions to individuals who appear to us to be suitable cases, either from the grave character of the offences with which they were charged, or, if such offences were of a minor nature, whose antecedent circumstances were indicative of dangerous tendencies. This restriction upon the number of admissions, without interfering with the legitimate objects of the Institution, has been attended with a considerable savng o the Treasury.
” The inmates of the Dundrum Asylum admit of two divisions. Within the first Ave would include individuals?fortunately, the most numerous?who, while labouring under insanity, have committed offences more or less serious. The essential point to be remembered with regard to these sufferers is, that the disease itself, depriving their acts of legal or moral responsibility, condones the criminality. We find from experience that such patients are not, as a general rule, more difficult of management than the inmates of ordinary asylums. Within the second we would enumerate those persons who, subsequent to conviction, either while resident in prisons or gaols, or located at Spike Island, and undergoing terms of imprisonment or penal servitude, when certified to have become insane, are transferred to the Central Asylum. In their regard the sequence of events has been punishment supervening upon crime, with the superadded complication of insanity, whether real or assumed. It is a remarkable fact that persons of this class not unfrequently bring Avith them to the Asylum the same obstinacy, impatience of restraint, and perversity of feeling, which had rendered them unmanageable under prison discipline. Sometimes the existence of the alleged insanity in these individuals is really very doubtful?their persistent disregard of discipline, their unwillingness to profit by the lessons of experience, and their mischievous disposition having led to the conclusion that their conduct must be attributable to a mental or moral obliquity, although they betray no intellectual delusions; and, indeed, we can hardly be surprised if, under these cir- cumstances, an opinion should elsewhere be entertained that such im- practicables were fit subjects for asylum treatment. Their admission, however, to Dundrum in some instances constitute an unpleasant and unprofitable addition to the ordinary inmates of the institution.” In the copious Appendices to the Report there is a vast mass of carefully-arranged statistics, from which we extract a few details.
The total number of patients that have been treated during the year 1873 in District Asylums is 5,119 males, and 4,298 females; of this number, 547 males and 484 females were dis- charged recovered, and 368 males and 297 females have died during the year. The causes of death are worthy of note :? M. F. Total.
Abdominal affections … 42 40 82 Cerebral and cerebro-spinal affections 91 55 146 Thoracic affections . Heart disease Debility and old age Fever and other diseases Accidents, violence, or suicide 104 95 199 15 15 30 92 72 164 16 19 35 8 1 9
It will be remarked how very disproportionate are the male and female deaths from cerebral and spinal diseases. An instructive table is given, showing the educational condition of the patients:?:
Well-educated Can read and write well Can read and write indifferently Can read only. Cannot read or write Unknown …. M. F. Total. 272 203 475 759 610 1,369 1,059 609 1,668 672 716 1,388 963 948 1,911 242 294 536
On investigation of the trades of the inmates of the District Asylums, we find that a very large proportion belonged to the agricultural class.
We must draw the special attention of our readers to an elaborate table, in which is given the supposed causes, both moral and physical, of the insanity; and by analysis of it we have drawn up the following table :? Moral causes :? ? M. F. Total. Poverty and reverse of fortune Grief, fear, and anxiety . Love, jealousy, and seduction .
Domestic afflictions and quarrels Religious excitement Mental excitement, study Illtreatment …. Pride ….. Anger ….. Physical causes :? Intemperance and irregular living Cerebral disease Congenital idiocy, &c. Sunstroke, effects of climate . Febrile affection Bodily diseases and injuries . Abuse of medicine Sedentary habits 159 115 274 208 314 522 95 131 226 85 105 190 119 130 249 46 26 72 11 26 37 12 13 25 3 8 11 738 868 1,606 345 97 442 193 134 327 106 79 185 135 18 153 45 46 91 225 157 382 8 4 12 17 1 18 1,074 536 1,610
These tables refer to 7,347 lunatics in asylums on 31st Dec., 1873, and, besides the before-enumerated causes, 551 male and 629 females are recorded as hereditary, and in 1,604 males and 1,547 females no cause is attributed; thus, in more than half of the patients, we are ignorant of the cause of their malady. The physical and moral causes are very equally divided, and of the former intemperance is one of the chief, whilst amongst the latter may be mentioned grief and anxiety.
Many more interesting statistical tables are given, and the New Code of Privy Council Regulations concludes the Report, which is worth careful study and perusal.
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