The Dillwyn Committee
Art. XIV.?. ” Ex niliilo nihil fit.
Noxious exhalations become innocuous when mingled freely with fresh air. The Sun of Truth dissipates every mirage! The appointment of the Committee to inquire into the operation of the Lunacy Laws originated in imaginary grievances, morbid fancies, actual delusions, and in the hostility and antipathies of those who had been subjected to asylum restraint. These miasmata invaded a sensitive and susceptible nature, were manifested in an annual paroxysm of plaints and petitions in Parliament, and, ultimately, through the long-recognised efficacy of importunity, through the incessant drop, dropping on the marble heart of authority, secured, in a soft and yielding moment, a public recognition from the Secretary of State. A Committee was appointed, consisting, we think, of fifteen members, has sat patiently and perseveringly throughout the past summer, but has at length ” died and made no sign “?in other words, has published no Beport, except in the form of a bulky testament (582 pages) of dreary lucubrations. Their time has been wasted, or, at least, might have been more profitably employed; there have passed before them motley groups of Lunacy Commissioners and ex-lunatics, of knights and nobodies ; there have been ventilated every imaginable form and colour of extravagant theories, crude and cruel accusations, and Utopian projects. There was no demand for a revision of the law, there was no cry to go to the country with, except from unhealthy imaginations; and the whole procedure has been fraught with evil, in exposing the shortcomings and inefficiency of some of the high and mighty guardians to whom the supervision of the insane has been confided, in creating distrust and suspicion in the public mind, in disturbing and perplexing with fear of change the already overburdened hearts of those practically intrusted with the care and custody of this class, and in exciting vain and visionary and pernicious expectations in the inmates of asylums, who have lived for months in suspense and anticipa- tion of a general jail (Coxe) delivery. Yet the inquiry, even in its incomplete state, has been productive of a modicum of good. Clouds and mists have been dissipated, and there stand forth sharp and clear the facts testified by all the witnesses, except those actuated by personal motives, that the law as at present administered is substantially equitable and humane; that sufficient protection is afforded to’those labouring under mental disease ; that, while errors of judgment and infor- malities may occur, it is next to impossible that the illegal admission or detention of lunatics in public or private asylums can take place ; that, practically, only ten instances of supposed illegality in which the interference of the Commissioners was necessary have occurred during the last thirty years; and that no case is at present known to exist by any of the witnesses. It has been further proved that the county asylums are most creditably and beneficially conducted both in respect to the health, happiness, and restoration of the patients; and that private establishments have been latterly so improved that, although all are not worthy of unqualified approbation, tbey are not open to charges of conspiracy, cruelty, or mismanagement; and that the attendants in both these kinds of hospital, although still below the standard desirable, have improved in trustworthi- ness and character and might be improvable by more liberal wages and by special training.
It is not our present purpose to deal with these general propositions, nor with the grave indictment preferred bv the complainants, or pursuers as they may be called ; and we shall confine our observations to what maybe fairly denounced a unplnlosophical, unprofessional, and unfair or rash in tb! testimony of certain of the official witnesses who are certainl? not experts. In the first rank of offenders may be arraigned Dr Eobertson, Lord Chancellor’s Visitor. This gentleman, with a Quixotic craving for mare’s nests and windmills has had tw hardihood to say: ?I think lunatics generally are detained too long in asylums ; and I think a large n^mber ^f lunatic who in asylums probably one third, might be out of asylums. I am speaking of private patients new” (Q. 892); aud again: ?I said that one-third of the Chancery patients were already out, and I thought that of he other (private) patients one-third ought to follow the example of the Ch
Under private care, not discharged recovered’” f 1016 and 1046) Were this a speculative haphazard opinion t might be treated with forbearance. ?ut what can be th w of f taste, delicacy, or fraternal courtesy of an inculpation of all the Lunacy Commissioners ? for, if 0ue.third of’all the rfvate patients in England although mad, be not mad enough to require seclusion, but would be better while augmenting the stipend of a pauper curate, or supplementing the niggard fees of a country practitioner, what can excuse or justify the Com- missioners in failing to exercise the power which they un- doubtedly possess of removing these unfortunate captives to a more suitable residence ? It is true that this Visitor may claim a power of penetrating into the condition of such patients that ordinary mortals do not possess; that, as a Spiritualist (7254), he looks through the diseased mind, and may detect, in that trans- parent medium, the presence or absence of flaws, fractures, cracks, crotchets which a mere physician could reach solely through symptoms and by protracted observation. We are, however, inclined to conjecture that the inquisitor arrives at his conclusions by intuition, as he does not seem to have placed himself even en rapport with these persons, and boldly confesses that, in visiting private asylums, he limits his inquiries to Chancery patients ; that he does not see the other patients except by chance; that he does not see them to speak to or converse with them ; he makes no inquiry into the manage- ment of lunatics generally ; he does not make inquiries at these asylums for his own satisfaction, or to enable him to form a judgment as to their management, or as to their inmates; nor does he take any means of ascertaining the nature of the classes of inmates at the private asylums, besides the Chancery patients, and he has no means of knowing it. Physiognomy is, moreover, employed by this visitor in determining what half-mad patients should be discharged from an asylum, as he affirms that his estimate as to improper detention is guided (6851), “By my observation of the demeanour of the patients whom I see in the asylums, many of whom appear to me to be very harmless people, who would do very well outside.” It is highly probable that by such a crux was Dr Eobertson guided in regard to the patients removed from Sussex House, as we cannot conceive any principle of diagnosis upon which an individual whose memory was entirely abolished, and whose knowledge had consequently passed away, could justifiably be held to be im- proved.
These humiliating confessions amount to this: that, in spite of avowed ignorance, a judgment is formed of the capability of thousands of lunatics to derive benefit by removal from that shelter and treatment which have been selected by their relatives, sanctioned by their medical advisers, and tacitly acknowledged to be expedient by the Commissioners.
Dr Bucknill, with that chivalrous temerity which tempted him to run a tilt against almost the whole body of Alienists in America,* or with that itch for innovation and the air-libre system which be seems to have caught in Scotland, pronounces an enthusiastic encomium upon the reputed absence of bolts, bars, and locks in the asylum of the county of Fife; where, it is popularly believed, the whole population is, in their own patois, ” fifish ” or demented, and where, if all restrictions and the influences of seclusion be withdrawn from the management of the insane, a portion, and a large portion, of the means of cure are inaccessible or unavailing. On being questioned as to the introduction of ladies as& nurses into hospitals, he says, ‘ The introduction of ladies as nurses has not been much done in this country. In Scotland there is only one large private asylum, and in that the nursing in the ladies’ house is conducted entirely by ladies, and it is made, to an extent which is surprising, like an ordinary residence. There are no locked doors in it; there is free egress and ingress for all the inmates all the day through. That is the adoption of a plan which was first carried out in the Fife and Kinross Asylum (Q. 1819).
It is almost cruel to upset this Utopian fabric; but the work of destruction is not ours, but that of Sir James Cose, who, on having Dr Bucknill’s words read to him, answers, ? I do not know an pr t ]um ^ ^ d ^ plicable (2 30). - There is no high class of nurses, no volun- teers, in Scotland (2073). It is quite obvious that Dr Buck- mil must have been impressed by some potential improvement which may prove a Chateau en Espao-ne.
The worthy old knight, Sir JamesCoxe, Medical Commissioner m Lunacy, Scotland, is known to be more of a lawver than a medicmer, more familiar with ?the law than the prophets ” ? but we were not prepared to find him so antagonistic to physicians, so sceptical of their powers, experience, and usefulness, and so much disposed to prefer the moral treatment instituted by an old turnkey in his model asylum of Banff, to ministrations by his own profession. He appears to labour under the malady designated by one of his countrymen “red-tape worm,” somi of the symptoms of which are forgetfulness, formalism, suspicion. Of these we shall give illustrations.
I. Sir James, although a supporter of the localisation of groups of lunatics m the village of Kennaway, and of what is ludicrously called the Scotch system,” says : ? I am not much an advocate for having what they call colonies ; of having them all concentrated in villages, nor of employing Orkney or one of the Northern Islands as a separate colony, nor have I ever heard of such a proposal; I think that would be rather a miserable existence; nor has it been suggested by any of our Board - (2141 2142, 2143) Yet it is astLding i discover m the Appendix (page 221) to a Report (1860) of which the witness admits he wrote portions, and which he assuredly signed, ” this miserable existence ” is actually proposed ?? “But a large number of the so-called harmless lunatics, for whom a regular asylum is not absolutely necessary, will not be satisfactorily provided for till something of the nature of a local institution exists. It appears to me that this desideratum would be supplied if the county (which is too poor to erect an asylum for its pauper lunatics) were renting a whole township; expending other ?25 on each house; seeking out fit persons as tenants; and then boarding with them, at fixed rates, those idiotic or demented paupers whose natural guardians are dead or too old or infirm to care for them, or such as cannot for any reason with propriety remain at home. This township should not be far from Lerwick If cottagers willing to under- take the duty of guardians could not be found in Shetland, I am of opinion that by advertisement many would be found in Scotland ready to go and settle there, especially if, for some years, they were to sit rent free, or nearly so. And I would expect such persons to be found chiefly among the pensioner (old soldier) class.” … . ” The Shetland cottage or hut is of the rudest description. It is usually built of undressed stone, with a cement of clay or turf. Over the rafters is laid a covering of pones, divots or flaas, and above this again a thatch of straw, bound down with ropes of heather, weighted at the ends with stones as a protection against the high winds which are so prevalent. Chimneys and windows are rarely to be seen. One or more large holes in the roof permit the escape of the smoke and at the same time admit light. Open doors, the thatched roof, and loose joinings every- where insure a certain ventilation, without which the dwellings would often be more unhealthy than many in the lanes of our large cities.”
II. ” The witness asserts that all his colleagues have been of his opinion as to the boarding-out system” (2161). It is marvellous that Sir James should have utterly forgotten the reputed author of ‘(xheel in the North’ (Journal of Mental Science*) and the consternation which that article was reported to have produced. But, after a searching, we had almost said scorching, cross-examination by that most able member of the Committee, Dr Lush, in which he is compelled to acknowledge that he was the writer of paragraphs in the Keport of the Board of Lunacy for 1860, above alluded to, containing sad exposures of the condition of the pauper lunatics in 1858-59, of which the following may be accepted as characteristic:?There were “49 cases of misery and neglect, 27 cases of violence and restraint, 36 cases of illegitimacy and erotic propensities, 19 cases of dangerous wandering lunatics, and four cases of accidents” (2169)?he is finally squeezed into the statement: ” Dr Browne did not share in our views ” as to boarding out… “Dr Browne’s views were very decided. I have heard him say that the worst case in an asylum was better than the best out of an asylum” (2395 and 2401). We do not here comment upon the good or bad taste of venturing to quote the opinion of a colleague who could have no opportunity of defending himself, supposing that Sir James’ recollection of words is as treacherous as his recollection of facts; nor do we pretend to know what Dr Browne’s precise meaning was, although we can readily imagine it to have been to the effect that a pauper inmate of a well-constituted hospital under medical and moral treatment and constant supervision, who is well lodged, well fed, well clothed, well trained, even well amused, would be better both in position and prospects than if placed in the wretched dwellings, resembling those of ” the finest peasantry in the world,’” indifferently protected from the weather, poorly dressed and nourished, without treatment of any description, without inspection by officials except at rare intervals, and what is afforded by intercourse with the unedu- cated, rough, but, it may be, kind members of the household.
This is not the place, nor is it our province, to criticise the boarding-out system as pursued in Scotland. It has, of course, existed there as elsewhere from time immemorial; in fact, since lunatics required domestic care. But we must protest against the colony of Kennaway being represented and recommended to foreigners, as it was to ourselves, as a specimen of this plan. If not kept for show, this favoured spot has been shown ; it has been patronised and all statements to the contrary notwith- standing petted, fostered, and?we are not entitled to affirm unworthily?fostered by the Board of Lunacy; the cottages, families, and their insane charges have been selected, and the whole entourage has been sustained at a high standard by frequent visitation, and by the general interest and attention directed to the experiment. But let the inquirer examine this oasis, and pass to the desert beyond, he will find the accom- modation and maintenance of the insane members of the community closely to resemble those of the sane members, whose homes and habits are not famed for comfort, cleanliness, refinement, or temperance (Lord Shaftesbury, 11,263). III. Sir James’ obliviousness is further exemplified in his reply ?” I do not remember exactly how it was brought to his know- ledge “?to the question : ” How would the information of such an informality (that of detaining a patient twelve hours after the expiration of a certificate of emergency) reach the patient; by what means would the patient know of a matter which apparently was between the medical superintendent and your Board; that there was such a state of things that he could exact from the medical superintendent who, in good faith, had received a patient, a fine of ?200 ? ” (2376).
It would appear, however, from the evidence of Dr Gilchrist, Medical Superintendent, Crichton Institution, Dumfries, where the case referred to occurred, that this information must have been communicated to the solicitor of the patient in a letter from the Board of Lunacy, of which Sir James is the principal member, and that the result was the mulcting of the witness in the sum of ^150 !! (4194). We have our own opinion as to the kindness and forbearance of such a course towards a public officer of long-established reputation, whose act, if mistaken, was humane ; and we shall leave to higher authorities to determine whether what appears to be partisan interference by a public Board was a procedure ultra or contra vires. The victim retaliates in no other way than by stating to the Committee that the Board so acting is not ” satisfactory” to superintendents &c.; and that, although it might not have been right in him to make the statement except with considerable qualifications, ” it is, I think, generally the impression of the medical superintendents that the Board interfere a little more than they might do in special matters of details, which should be left to the medical superintendent, who is supposed to have the skill and experience necessary to deal with them ” (4197 and 4343).
IV. With that idiosyncracy which cuts cloth not according to what you have, but according to what you ought to have, and converts an object hoped for into an object realised, Sir James Coxe rather recklessly assures the Committee that he does not think it possible that any lunatic in a private dwelling can be left unvisited for two years together, except in Orkney and Shetland (2419). The exposure of this inaccuracy is drawn from two sources: 1. Sir James’colleague estimates that some of the paupers boarded out are not visited for two years (10,134); and 2. During 1876 the Deputy Commissioners (Nineteenth Annual Report of the General Board of Lunacy) visited 1,066 out of 1,400, the actual number of this class; so that 334 were left for a long period to the tender mercies of the “great unwashed,” to the visitations of a parish doctor, and. of an inspector without knowledge, who is not required to report to the Board even when accidents occur, which of course must not be attributed to harshness, but to the national jperfervidum ingenium Scotorum.
V. Sir James Coxe manifests throughout the whole of his evidence a striking distrust of medical officers, a disposition to dispense with or minimise their services in attendance upon the insane, and a decided preference for asylums superintended by laymen. This estrangement culminates in his reply to the ques- tion (2321), ” Are you of opinion that there are any means by which lunacy may be aggravated or converted into dementia by the administration of drugs or medicines ?” He says: ” I think there are drugs which would injuriously affect a patient if he got them frequently ; might convert lunacy into dementia; there are many cases in hospitals and asylums where chloral is administered ; I think that has a tendency to produce dementia, given inadvertently, not to produce dementia, but to soothe the patient; is injurious if the administration be prolonged; bromide of potassium is not so injurious; laudanum, or any other narcotic, administered for a length of time, would have a prejudicial effect, but chloral especially so.”
1 his^ beats Brinvilliers ! Her slow poison extinguished life; these injurious drugs destroy reason! It is rather a cool insinua- tion, coming f101^ a person who was never a medical superin- tendent nor an officer in an asylum, who never had any special training, who never entered an asylum nor spent an hour with a lunatic until he became a Commissioner, who has no means of knowing the practice in such establishments, as, although able to ascertain the number of patients under medical treatment in a given asylum;?microscopic though some of his inquiries are, he has no means of knowing in what that treat- ment consists, whether in the exhibition of chloroform, chloral, or castor oil. ^ hen taken in connection with the context, these phrases are tantamount to the suggestion that all or many, or some of his professional brethren at the head of asylums are so ignorant, or so negligent, or so callously cruel as to prescribe and push remedies which are calculated to destroy that intelligence which they were supposed to restore, and to produce one of those diseases?the last and most formidable of a long series which physicians, hospitals, the whole principles and practice of medicine were intended to prevent, to remove, or to mitigate. Of course this libel and the collateral suggestions introduced by other witnesses?that drugs may be given in order to excite, intoxicate, or confuse patients when about to be ex- amined are scornfully repudiated by all the other medical men examined. It is probable that this grave and groundless calumny may be dealt with by the profession at large, or by some of those associations called Psychological; but at present it is only necessary to record our wonder and sorrow that a Fellow of the Eoyal College of Physicians, Edinburgh, and a Commissioner of twenty years’ standing, should have uttered sentiments which implicate the skill and honesty of that large body of men over whom he may be said to exercise a sort of parental care.
Commissioner Mitchell is a man of culture, astuteness, and versatile genius. He reconciles lectureships on mental disease and archeology, which, by a curious fancy, he con- nects with his ordinary pursuits, with his official duties; he is a writer, as we understand, upon meteorology and consanguineous marriages, on proverbial sayings and anti- quities ; and is likewise responsible for the advocacy of educa- tion as a means of preventing insanity in one of the Blue Books issued by the Board of which he is a member. But, unfortunately, like his colleague, he was not in a position to acquire any special knowledge of the practical aspects of insanity until he became a Deputy Commissioner, and unless cursory and almost perfunctory visits to lunatics in private houses could have imparted this knowledge. He has supplied us with a most clear and comprehensive vidimus and vindica- tion of the Lunacy Laws in Scotland, which work well and, in fact, according to him, go on as ” merry as a marriage bell but it is matter of regret that no medical superintendents were called from Scotland, except Dr Gilchrist, who, with his cele- brated Institution, seem to be the betes noires of the Board of Lunacy, when it is possible that these bells would have rung out another tune. The popularity of the English, as contrasted with the Scotch Commissioners, might prove a puzzle to psycho- logists, had we not the assurance that the latter discharge their ” invidious” duties in a liberal, conciliatory, kindly spirit, while the latter are devoted to the hard and sharp administration of the law, to formal and economic details, and, alas, crotchets.
It is less a protective than a detective force; the inquisitors of which it is composed unavoidably detecting what, according to their views, are delinquencies and delinquents, of which the painful narratives respecting Murthly, Elgin, &c. Asylums, in their recent Reports, may serve as examples. But the most notorious of these causes celebres is what is called the Isle of Man case. We are compelled to recur to this episode, as Dr Mitchell has entered upon what appears to us an inexplicable explanation of the facts. Without attempting to analyse his formidable array of dates, we would quote, first, the dignified words of Dr Gilchrist upon the principal link in the chain of events, contained in a printed Statement by him, circulated contemporaneouly, we believe, with his appearance before the Dillwyn Committee:? “5th. The writer leaves it to others to judge whether it is one of the duties of Her Majesty’s Commissioners in Lunacy to use their knowledge and authority for the benefit of one party, and the possible defeat of another in a pending lawsuit”; secondly, we must express our concurrence in the opinion of Dr Lush (10,200) that there was, ” I will not say a breach of privilege, but a sort of a breach of official confidence on the part of the Board of Lunacy ” in communicating the informa- tion as to the informality respecting the certificate of emergency in the case of Mr. Wilson to his local agents, and thus enabling the latter to carry to a successful issue a prosecu- tion against Dr Gilchrist, who, whatever might be his moral or legal responsibility in other respects, was detaining a lunatic for that lunatic s protection, and whose error, if error there was, was known to the Board under the seal and secrecy of official confidence: thirdly, we cannot comprehend how the words of the oath or obligation taken by every Commissioner ” before he acts in the execution of his duty,” ” I will keep secret all such matters as shall come to my knowledge in the execution of my office, except when required to divulge the same by legal authority, or so far as I shall feel myself called upon to do so for the better execution of the duty imposed upon me by the said Act, can be interpreted so as to justify the disclosure of information to persons who are not under the control of, nor in any way connected with the Board of Lunacy; nor can we understand in what way ” the better execution of the duties imposed by the Act” could be promoted by such a revelation as that gratuitously made. It is highly improbable that a similar interference with the laws of humanity, under the pretext of the better execution of the laws of the land, will be ventured upon, even should Dr Gilchrist repeat his “in- formality.”
Di. Mitchell is necessarily and naturally a champion of the boarding-out system. But he seems to lay some claim to having been its discoerer or originator or foster-father, a claim which Ave are not disposed to dispute, although we believe the system to have been coeval with the period when the Nebuchadnezzars of other days weie sent to g’rass, and found shelter in some hovel from ” the dews of heaven.” The Doctor has visited Grheel and gathered some suggestions from what he saw. We have like- wise visited this psychological curiosity?for it is little more? but found all barren. Had his visit taken place forty years ago, he would have found dirt, picturesque licence, and restraint in the ascendant; restraint in its domestic and most repulsive aspect, where iron rings were fixed in every mantelpiece, to which the insane boarder was constantly or frequently chained. Had his visit been twenty years later he would have still heard the clank of chains and bolts in the street, seen the furious fixed in open oubliettes near the church, the beds of many consisting of chopped straw and tan, &c. &c. Now, we are convinced that these pictures could not have been the prototypes of the Scotch system, whatever its defects in respect to supervision and accom- modation may be. But had this pilgrimage been made within the last twenty years?that is, subsequently to the advent of Dr Bulckens?Dr Mitchell would have inspected an arrange- ment totally differing from Kennaway, and realising a plan long since proposed and reproduced before the Committee, in which an asylum forms a centre, around which villages or groups of cottages are arranged, containing lunatics in different stages of the disease, under the care of attendants or peasants or farmers, who are regularly visited by medical officers, and from which they can be removed to the hospital properly so called, should changes in the physical or mental condition necessitate such a step. We have always conceived, that while some portion of the success really achieved in this curious community might arise from the hereditary training, and quiet, docile temperament of the guardians, the influence of the religious element has been undervalued ; for, assuredly, whether the influence of faith in the relics of St. Dymphna be attributed to imagination or to a direct divine inspiration, it was real and beneficial. Whether ? this superstition, or sacred power, has fled before the torch of science we do not know, but it is melancholy to find that this means has not eliminated another of the agents by which the insane population was formerly kept under subjection and in order; as a witness declares (1403) that, in the central asylum, physical restraint at present exists ” to an amount altogether unknown in this country, but in other cases I found them very well and comfortably accommodated, and enjoying a very large amount of liberty.” We are certain that such a mixed state of good and evil would not be tolerated in Scotland, for we are assured that the Pauper Lunatics there might be left for years unvisited, ” so trustworthy are their guardians an intimation Avhich will confirm the hopes of our economists that the office of Deputy Commissioner may be altogether dispensed with. Yet, during his novitiate or chrysalis state as Deputy, Commissioner Mitchell seems to have cherished most sanguine and catholic views as to the project of which he is a propagandist. We know that the Mania Transitoria passes away rapidly, but we were scarcely prepared for the assertion : ” I never heard the sug- gestion that something in the nature of the Gheel establish- ment might be established in one of the Northern Islands, such as Shetland” (10,257), seeing that the respondent was un- doubtedly the author of the scheme mentioned on page 315, where it is proposed that ” a township should be rented near to Lerwick, where guardians should be induced to emigrate from Scotland, where the huts are described as nearly as wretched as wigwams, where the whole country is poverty-stricken, where the population is not in a condition capable of affording suitable attendants,” where, to repeat the words of Sir James Coxe, ” the existence would be rather miserable.” It is a matter for con- gratulation that this peat-bog Utopia is now disowned ; but, from our indistinct recollections of the shielings and ” auld clay biggings ” in ” the land of the mountain and the flood,” we are inclined to question whether any of these would corre- spond with our southern ideas of what Gheel ought to be, or with The cottage homes of England! By thousands on her plains, They are smiling o’er the silvery brooks, And round the hamlet fanes.?Hejians. The extreme poverty of the inventive faculty in devising means for the reception of the insane is very striking. Of course this limit is imposed by pecuniary considerations ; but it is very doubtful whether, first, the construction of a village for the incurable industrious around an asylum of ordinary dimensions would prove more expensive than a multiplication of blocks ; second, whether the addition of farms or convalescent homes within a certain area, and at a short distance from the hospital for acute cases, might not prove more economical than the palatial structures at present provided; or, third, whether even the addition of large tenements of simple, unornamental form for chronic cases, within the grounds of the asylum proper ?all these being under the superintendence of the same medical and other officers might not meet the wants and the wishes alike ot the curators of the insane, the ratepayers, and the general public.
There is ever on the lips, and we doubt not in the hearts, of this and other optimists, the plea that the insane would be happier if in possession of complete or partial freedom, that is, if emancipated from the restrictions and regulations of asylum life. This is an assumption, and founded upon a very narrow basis. To the melancholic all surroundings are indifferent; consciousness bears the burden of misery, terror, remorse, everywhere ; and if the excited maniac, the vain-glorious mono- maniac, the idiot, the dement, the general paralytic, &c., be de- ducted from the inmates of an asylum, there will remain but a small minority who could be affected by such a change.’ It is, however, altogether an error to suppose that seclusion is but another name for unhappiness, and that complaints and de- mands for liberation are outpourings against the hardships of captivity, although they may sometimes be accepted as signs of returning reason. Perfect contentment and resignation are, more frequently than reclamation, prognostics of dementia. But assuredly there are higher and more important objects than happiness, according to the estimate of the sane and the free. These are the re-establishment of self-control, intelligence, use- fulness ; or, failing complete recovery, the arrestment of pro- gressive degeneration and the training of partially enfeebled or perverted powers in such modes of action as are consistent with the interests of the individual and of society. The real ques- tion at issue is not whether the chronic insane can be made happier, but more reasonable in an asylum or out of it. We now close our remarks upon the speculations of these Doctrinaires?we cannot call them Doctors, unless it be doctores dubitantium?and we are cheered on turning to the testimony of such witnesses as Mr. Percival, Commissioners Wilkes and Phillips, Chancery Visitor Dr Crichton Browne, distinguished as it is by sound sense, discrimination, and ex- perience in the medical and moral requirements of the insane ; and above all to the mature knowledge, and the practical wisdom of that veteran philanthropist, Lord Shaftesbury. He states very distinctly that he knows of no instances which go to prove the truth of the allegation that lunatics have been unjustly confined in asylums, and that, although he once suspected that the duration of seclusion might be. protracted beyond what was absolutely necessary, he has now altered his views entirely; and that, in consequence of constant inspection, of the improvement in the character and position of those en- trusted with the care of the insane,” and of the influence of public opinion, the tendency now is to discharge prematurely. Considering the general tendencies of human nature, the desire for gain may have suggested conspiracies for the purpose of detaining wealthy patients, but he believes that in ninety-nine cases out of the hundred such attempts are impossible; and that the complaints of plots and harsh treatment may generally be traced to the delusions and mental state of the patient. He conceives that in every case lunatics even chronic lunatics?should pass from the asylum to the workhouse, and not from the workhouse to the asylum; and that the best mode of disposal for cases which had been subjected to treatment for a sufficient length of time would be transference from the asylum proper to a succursal house detached from but connected therewith; that such a building should form a part of every county institution, as was originally intended in the Act of 1845 ; and that it might even be adopted, under a modification of the law, for private patients who could afford to pay some- what more than what is charged for paupers.
He is of opinion that deaths by suicide and homicide would be greatly diminished by early confinement in an asylum ; that medical men alone can arrive at a reliable opinion or prognosis in those cases where alienation is first disclosed by an overt and criminal act; and that juries are not, under such circumstances, reliable, as they are guided to a conclusion exclusively by the overt act.
He attributes the proportionally small number of discharges to the unsuitableness of the homes and of the guardians ^to which partially recovered lunatics must be sent; and in relation to the correspondence of inmates of asylums with their friends or other persons m the external world, he conceives that the present safeguards for the transmission of such communications are adequate ; discountenances the addition of a postal clerk to the Board of Lunacy, whose duty it would be to examine all letters forwarded by superintendents, and to select such as should be forwarded, and likewise the introduction of Postal Boxes as in American asylums, through which letters would pass, without even the knowledge of the officers, to persons beyond the walls ; but, among many weighty arguments against innovation, strangely enough omits to mention that the perusal of letters written by patients affords the most valuable informa- tion as to the real mental condition of the writers to their medical advisers.
He admits that houses on the principle of those at Caterham and Leavesden, even although for chronic cases, are too large- is an advocate for small asylums, but such advocacy has been and ever will be constrained by pecuniary considerations He regards non-restraint as coincident with good treatment, but admits that it necessitates the employment of a greater number ot cifctcRclciiits.
He regards the present mode of admission into asylums as securing personal liberty to a sufficient extent; and is opposed to the practice in Scotland, where, in addition to medical certi- ficates, a ju( ge gives, either in his ministerial or judicial capacity, authority for sequestration.
While entertaining theoretical views opposed to private asylums, his opinions upon this subject have undergone great modifications since 1859; he is convinced that licensed houses must and should exist, that certain classes of society will always prefer such a mode of disposing of their insane relatives, and, however much the number of such establishments may be di- minished, 01 may be affected by the creation of composite or middle-class institutions, there will always remain a certain pro- portion of excellent and well-managed retreats of this kind ; he is not desirous of any increase either in the staff of Commissioners or in the frequency of inspections, which, he suspects, may be carried too far, and protests against any amalgamation of the Visitors of Chancery Lunatics with the Commissioners in Lunacy, or any junction of these bodies with that of Local In- spectors, as threatening the formation of a Parliament in which there would be much talk and little work.
He holds that licensed houses now vie with Hospitals, and, ” were anyone of my family or myself requiring seclusion, I would rather by far go into a licensed house than be put under single care, and in such circumstances I would prefer a medical man or a clergyman, as when patients are committed to attend- ants, I cannot conceive anything more thoroughly abominable.” He is opposed to the formation of a corps of Deputy Com- missioners, or dependence on second-hand evidence, and looks upon the existing machinery as perfectly satisfactory. This is, confessedly, an imperfect epitome of Lord Shaftes- bury’s statements, which are so voluminous and valuable, that no digest could do adequate justice to their importance.
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