Lunacy In England
295 Art. X.?
We have just received the Thirty-first Report of the Commis- sioners in Lunacy. Every year we see an increase in the number of lunatics on the official books of the Commissioners. On the 1st of January this year there were 66,636 persons of unsound mind in England and Wales, being an increase of 1,720 upon that of the previous year; this number is exclusive of 252 Chancery patients residing with committees. The following is the summary of the classification and distribution of persons of unsound mind :?
Where maintained Private M. F. T Pauper Total 31. F. M.
In county and borough asylums In registered hospitals In licensed houses In naval and military hospl tals and Koyal India Asylum In State Criminal Asylum Private single patients . In workhouses .
Out-door paupers Total 196 1,370 1,807 343 196 175 242 1,267 1,650 15 53 283 438 2,637 3,457 358 249 458 16,066 50 471 6,836 2,461 19,019 44 794 9,202 3,851 35,085 94 1,265 16,038 6,312 16,262 1,420 2,278 343 390 175 6,836 2,461 19,261 1,311 2,444 15 104 283 9,202 3,851 35,523 2,731 4,722 358 494 458 16,038 6,312 3,510 7,597 32,961 59,039 30,165 36,471 66,636
The average increase of the last ten years has been 1,755. Of the stated number of lunatics 7,597 are private patients and 59,039 paupers. By this we see that the number of the former class of patients has’increased by 88, and of the latter by 1,632. As compared with the previous year, the Report contains some valuable statistical tables, and we wish to draw especial atten- tion to Tables 14 and 15 ; these refer especially to the various causes of insanity, as obtained by the Commissioners from certain data obtained from the superintendents of the various asylums. On this important subject we read as follows :?
We have long been desirous, concurrently with the publication of details as to the number, classification, and distribution of the insane of setting forth some statistics as to the causes of insanity. Consider- able difficulties, however, have always stood in our way, The only sources of information in our possession were the statements of ” sup- posed causes” annexed to the Statutory Orders of reception, signed either by the friends of private patients, or by the relieving officer in the case of paupers. These, as our experience shows, are too conjec- tural to be depended upon for statistical purposes. On consideration there appeared little hope of procuring trustworthy returns as to the prevalent causes of insanity without the co-operation of the medical superintendents of the County and Borough Asylums, many of whom, in their annual reports to their committees of visitors, had already been accustomed to give a table of causes of insanity verified by their own inquiries, though differing in form and detail in each institution. Hence, though naturally reluctant to add to the labour of these gentlemen, we determined, early last year, to ask, not only the medical superintendents of asylums, but also the medical officers of all other institutions (except workhouses) receiving insane patients, to keep (for one year only, and as an experiment) a special register on a certain prescribed uniform plan, to be forwarded to our office at the end of the year for examination and tabulation. The help thus requested was, with one exception, at once promised, and in the solitary instance where it was at first refused, it was subsequently given, so that the returns ultimately became so far complete as to include particulars relative to all the admissions of 1876 into County and Borough and State Asylums, Registered Hospitals, and Licensed Houses in England and Wales. We desire here to offer our best thanks to all those who have thus so wil- lingly and ably assisted us. The keeping of our register demanded, in every case, patient inquiry and observation, and in the larger asylums must doubtless have involved the expenditure of considerable time and trouble.
Of the chief causes enumerated may be mentioned intem- perance, with a large percentage both as an exciting as well as a predisposing cause of insanity. Of 3,141 patients admitted into private asylums during the past year, 453 are stated to have become insane from intemperance; the second in rotation being mental anxiety and worry, the number here being 311. Of the various causes for insanity occurring in county hospitals and borough asylums, out of 11,011 patients 1,661 are stated to have been driven mad from drink. It is appalling to see the great ravages made by intemperance on our fellow creatures, and yet we have no power to restrain the victims from con- tinuing their excesses. The tables referred to are a most valuable addition to the study of psychological research, and are most carefully drawn up and arranged for easy reference. There is one very valuable table to which we wish to draw especial attention, and the first of this kind we have as yet seen. We refer to that in which the professions and occupations are given as bearing directly on the various assigned causes of insanity. After carefully considering the various causes of insanity, the Report gives the occupations and professions and orders of those admitted in the asylums during the past year. The Commissioners draw attention again to the defective watching of epileptic cases during the night in several asylums, and particularly in county and borough asylums. The Report contains accounts of various suicides which have occurred in asylums during the past year, and some instances appear to us to have been caused by neglect. The death by violence of a patient in the Durham County Asylum having given rise to much correspondence by the Commissioners, we append par- ticulars of the case.
The death of a patient named T. D. in this asylum, on the 4th of January, gave rise to much correspondence between ourselves, the Secretary of State, and the Visitors of the asylum, and led eventually to a special inquiry by two members of the Board.
The facts of the case, as stated at the inquest, which was im- mediately held, were shortly these:
The patient, who was suffering from general paralysis, was in a restless and unsettled state of mind, and was therefore placed in No. 4, the refractory ward. On the evening of the 2nd of January it was alleged that he attempted to pull another patient, M. M., from his chair, but that the patient seized him by the legs, threw him violently on the floor, and then jumped upon him. The attendant in charge, named Gunner, who was at the other end of the room, immediately ran across, but was not in time to stop the assault. Shortly afterwards T. D. mo- lested another patient, had another fall, and Avas kicked by the person with whom he interfered. The next morning the attention of the assistant medical officer was called to T. D. on account of a cut at the back of his head having been noticed ; but this was not of a severe character, nor Avere any serious consequences apprehended until the evening of the same day, when the patient appeared to be very unwell, and after careful examination it was discovered that there were extensive frac- tures of the ribs and other injuries, from which he died on the morning of the 4th. The jury found that death was caused by M. M. jumping upon the deceased’s chest, and they did not ascribe any blame to any of the officers or attendants. Upon the evidence so given it appeared to us that there was no ground for further proceedings. At the same time we considered that the attendant Gunner was much to be cen- sured for not having immediately reported the assault. In consequence, however, of communications addressed to the Home Office by the guardians of the union to which T. D. belonged, the Secretary of State requested us to make a special inquiry into the matter. Accordingly, two members of our Board held the inquiry at the Asylum on the 24th February, in the course of which a patient, J. W., gave evidence that, subsequently to the time of the alleged assault by M. M., he had witnessed an assault by two of the attendants (of whom Gunner was one) and a patient on T. D., the alleged cause of which he stated to be the unruly conduct and bad language of T. D. towards the attendants and other patients. Our colleagues were of opinion that the fatal injuries had been received at this time, and not at the time spoken to by Gunner. They considered, however, that the mental condition of J. W. was such that, though before them he was able to give his evidence satisfactorily, he would probably be incapacitated by excitement from repeating that testimony in the witness box. They could not, therefore, recommend that proceedings should be taken against Gunner and the other attendants (Gunner resigned his situation on the day after the inquest), but in communicating their report to the Visitors of the asylum, they urged that a careful watch should be kept on the other attendant, who remained in their employment. This has been done, and reports have been subsequently furnished to us, in which the Visitors state their thorough confidence in him.
We see that many of the county asylums have been enlarged, and that plans have been submitted to the Commissioners for further alterations in structure. These have taken place in the Cambridge, Essex Glamorgan, Kent, Northampton, Somerset, Surrey, Warwick, Wiltshire, and York Asylums. The cost of patients per head, including clothing, care, and medicine, averaged 9a. lOJd, and in borough asylums Us. lid., making an average together of lOg. Igd. The cost of patents in thesi asylums is greater than last year, and this is chiefly in conse- quence of the high price of provisions. The patients in the registeied hospitals on the 1st of January amounted to 2 731 and the admissions during the year were 450 males and 488 females; the discharges were 819, of whom 322 were discharged as recovered. The deaths were 184. The recoveries that hive taken place in the hospitals have been at the rate of 40-7 ner cent, as compared with the admissions of the year The mor tality upon the average number daily resident during the year in the 16 hospitals is 6-6 per cent.
In the provincial and metropolitan asylums, amounting in all to 100 in number, there were 2,278 males and 2,444 females on the 1st of January 1877.
There were 16,038 persons of unsound mind detained in work- houses on the 1st of January. During the year the Commissioners have visited 309 of these workhouses. We contend that this is not a proper place for a person of unsound mind to he placed, and sufficient accommodation should be furnished in our asylums for these inmates. W e append a case of suicide occurring at one of these workhouses:? ?
A suicide at Market Ilarborough Workhouse, in August last, further demonstrates the danger of dealing with recent cases by re- moval to a workhouse. A relieving officer was, it seems, told that a young man m his district was “not quite right”; he called in the medical officer of the Union to see him ; that gentleman was unwilling to certify for the man s removal to an asylum, but the person with whom the man lodged would not allow him to remain in her house any longer, therefore the man was brought to the workhouse under an order, it seems, of the guardians. According to the evidence given at the coroner’s inquest by the woman with whom the young man lodged, he had wished to get out of the window, and he had threatened to drown himself. The master of the workhouse denied any knowledge that the man had shown any disposition to destroy himself. At 3 p.jik next day, the lunatic cut his throat in the workhouse, with a razor abstracted by him from a cupboard in a room the door of which was not kept locked. We may add that this occurred in a workhouse, the master of which, subsequently writing on this case to the Commis- sioners, took considerable credit to himself for having taken extra pre- caution on account of a previous report by one of the members of this Board, which had attracted his notice.
The Report contains an account of prosecution of various attendants for ill-treatment and neglect of patients. A fine of ?20 and imprisonment in some of these cases has been inflicted. One case is cited in which a prosecution by the Visitors was made in consequence of a patient receiving a blow from an attendant and causing a fracture of one of his ribs in conse- quence. He was fined ?15, but, in default, he was sentenced to two months’ imprisonment.
The Commissioners draw attention to improvements which have taken place in some of the private licensed houses, and to the transfer of licences.
On the 1st of January there were 458 persons of unsound mind taken care of as single patients. We are much opposed to patients remaining under certificate in private houses, if it is possible to treat the cases in asylums. We give the following case of the death of a lady,’ who, though decidedly suicidal, was removed from an asylum and placed as a single patient in a medical man’s house. Some people have a certain prejudice to asylums; but it is far more preferable to place lunatics in well*- managed institutions than to allow them to be detained under the supervision ot two attendants in a private house. It is an obvious fact that such a case is unsuitable to be treated as a private patient.
A lady, formerly a patient in Brooke House, was transferred on the 13th of December 1875, at the request of her brother, as a single patient to the care of Dr Dawson, of Brighton, and two days after- wards she destroyed herself by throwing herself out of her bedroom window on the second floor, fracturing her thigh and skull. Previous to sanctioning the transfer of this lady, we received, in reply to our usual letter, a statement from Mr. Adams, of Brooke House, dated 27th No- vember, that she was suffering from melancholia, was in good bodily health, and a proper person to be transferred to single charge. Upon subsequent inquiry, however, it transpired that the patient, who on ad- mission laboured under suicidal melancholia, had put her head through a pane of glass a few days before she was removed to Brighton, and tried to get possession of a piece of the glass; and the day after she went into a cutler’s shop with her nurse and secreted a knife, with which, on her return, she tried to cut her throat. We considered that these facts should have been at once communicated to us, when no doubt we should have declined to sanction the removal of this lady to single care, and we expressed to Mr. Adams our great surprise that he should have omitted doing this. In reply, he stated that he detailed fully those occurrences to the friends of the patient, and explained to them the risk there would be m removing her, and also to Dr Dawson he com- municated his opinion that she ought to have two nurses, should be watched at night should not be allowed the use of sharp knives or scissors, and should be kept under special supervision. Two nurses were indeed engaged specia ly to attend upon the patient, but only one was m the room when she threw herself out of the window, which she was powerless to prevent That the most ordinary precaution of placing stops on the window, so as to prevent the sashes from being opened more than a few inches, showed great want of care on the part of Dr Dawson in dealing with a patient so disposed to destroy herself. The Report contains a complete list of all public and.private asylums and the full entries made by the Commissioners in the books of the various county asylums and large hospitals Our space will not permit us to discuss these at length; but, from a careful perusal of the Commissioners’ entries, we are of opinion that the care of the insane is considered in everyway in the public asylums of England. The Commissioners’ Report, taken as a whole, is a faithful account of the condition of lunacy in England and W ales, and is the result of the combined efforts of gentlemen who devote their energy and skill to protect this unhappy class of human beings. The contents of the Report is a wonderful contrast to the extraordinary fallacies and untruths stated by many witnesses before the Lunacy Committee, a consideration of which we propose in our next issue to discuss in detail.
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