Medical Proprietors Of Private Asylumss
The remarks which have appeared in the British Medical Journal during the year, in reference to Private Asylums and their Proprietors, render it imperative for us to make some observations on the subject, in order to dispel an erroneous impression which appears to have imbued the public mind. In the issue of that Journal for May 3 we read: ” It cannot be too much insisted upon that the allegation against the pro- prietors of private asylums is not that of mala fides in taking, detaining, and confining persons of sound mind as lunatics, but that they detain persons of unsound mind whose confine- ment within their walls is unnecessary and unlawful.”
We must confess that we are at a loss to understand the latter part of this paragraph. It is a difficult thing to conceive how it is possible to ” detain persons of an unsound mind ” in an unlawful manner. If an individual is of unsound mind, and placed legally under lunacy certificate, surely it is lawful to ?detain such a patient until the lunacy disappears, or until the person who signed the ” order” authorises the discharge from the institution. And yet this is brought forward as what the proprietors of private asylums are guilty of. From the style of the various articles, proprietors of asylums may be said to resemble second-class hotel keepers, whose interest and whose sole desire is to make as much profit out of the inmates with as small an outlay as possible, and to make only an outward show, without any consideration for those committed to their charge. They have been styled ” adventurers.” In order to strengthen a possibility of a case, the evidence given by Lord Shaftesbury be- fore the Committee in 1859 is quoted. We may, however, remind the readers of these articles that the treatment of lunatics at the present time differs materially from what it did twenty years ago, and it appears strange that resource should have been made to this in order to prejudice the public mind. Let us, however, quote Lord Shaftesbury’s evidence, as given before the Select Committee of last year, as an extraordinary contradiction to what he said in 1859, and which is quoted in the British Medical Journal, in reference to the following question put to his Lordship by the Chairman of the Committee, the Hon. Stephen Cave, as to the abolition of asylums : “The case has been stated in two ways to us; one is, that if you have all the private asylums abolished you get rid of the interest which the superintendent has in the insanity of the patient; but, on the other hand, you get rid of the interest which he also has in making his asylum popular by good and generous treatment of the patient ?” To which Lord Shaftesbury replies: ” No doubt. Their object is, it is assumed, by good treatment and by the number of cures, and everything of that kind, to incite rich patients; and their object, it is also assumed, is to turn out, the poorer patients as soon as they can. Unquestionably, there exists a principle, and desire of profit, and so long as there are licensed asylums on any great scale, the public will always conceive that the principle of profit will, of necessity, predomi- nate. And, indeed, the state of things before 1859 was very bad indeed. But at present, from a variety of causes, the licensed houses are in a far. better condition in every sense of the word ; more is expended on them by the proprietors, and I must do them the justice to say that the change is very great, and so far as the evidence I gave in 1859 is concerned, I should not give it now. I can speak in high terms of many licensed houses and proprietors, but I will also add, that if you relax your vigilance ever so little, whether it be of licensed houses or of hospitals, or of county asylums, the whole thing will speedily go back to its former level.”
In reply to a question put to Lord Shaftesbury in reference to the improvement in private asylums, his Lordship said : I should like to show you what a great improvement has been made in that respect; I do not know I should go so far as to enact that by law. In the first place, such an enact- ment would shut out many proprietors who keep excellent establishments ; and, next, because it often happens that the proprietor is a man of capital, and can provide all that is necessary, and then he will appoint as his medical superin- tendent a first-rate medical man. Now we have a great number of very first-rate medical men who have no capital at all, and therefore could not set up a house. Therefore, though it is desirable that the proprietor should be a medical man, yet I would not so bind it down by law that he should be so, for the reason I have just mentioned; I will show the honourable Member how that system has been growing up, and with great public advantage. Comparing the year 1845 with the year 1876, I find that the number of resident medical proprietors was 53 per cent, in 1845 upon the whole number, and in 1876, 66 per cent. It is going on in a very satisfactory way. The improvement in the licensed houses under the medical pro- prietors is very great in a variety of ways, not only as to amuse- ments that are provided, but the greater amount of domestic life, so to speak’; the system of boarders also has been much encouraged, and with benefit. It very often happens that a husband comes to reside for a time with his wife as a boarder, and the wife resides with the husband. There are a thousand things in the licensed houses now that are of the highest possible order for the amusement and comfort of the patients. Somebody asked how that has arisen. It has arisen by the influence of many things combined; it has arisen from public opinion. Public opinion is very much alive to these things compared with what it was. It was utterly dead ; and even as far back as 1859 people were not easily moved to consider these matters, but of late years it is astonishing to what an extent they have been inquiring into it. All that movement acts upon the minds of the superintendents and others. Again, there has been increased visitation. Then there has been what the honourable gentleman has just referred to, a great increase in the proportion of resident medical men, and they are far better men. I wish the Committee could have seen some of the persons who were in charge of the lunatic asylums when we first began this work; any more uncouth, more ignorant, more coarse, and more inadequate to the duty it is impossible to con- ceive. Then, again, the character of attendants is very much improved indeed. I think the honourable Member for Swansea made a remark that he supposed it was owing to the Commis- sioners being more attentive to their duties. I think that was rather a harsh question, and with due deference to that honour- able member I should like to say the Commissioners have not been more attentive to their duties ; they were always attentive to their duties ; they were always attentive from the very be- ginning. That I can answer for.”
Sir Trevor Lawrence put the following question to his Lordship:
” So far as your Lordship’s experience goes, are you of opinion that lunatics are better treated in the public asylums than in the private licensed houses??Not now; they were so, I have no doubt, at one time. I am quite sure that there is admirable treatment now in many of the licensed houses. There is good treatment in’ very many of the hospitals; but I should say licensed houses vie perfectly with the hospitals.” Again, as to the abolition ? of private asylums : ” I am decidedly against their being done away with by the prohibition of the law, because, as I said before, I am certain some licensed houses ought to exist. There are a great number of people who will prefer them for their relations. The treatment that you get^ the licensed house where it is well conducted will always be more of the domestic character. I was saying that by the extension of the hospital system, that is of the public system,?I believe a great number of the inferior houses will be eliminated andf.got rid of, and the few that would survive would be very good.”
” Are you of opinion that it would be prejudicial to advance in the treatment of mental disease to do away with licensed houses ??Most undoubtedly.”
The Editor of this journal issued a circular to asylum pro- prietors, in consequence of which the British Medical Journal made another attack upon asylums and their proprietors. Dr Winslow, however, in speaking of the remarks on the circular, says:
” With regard to your remarks on the circular letter which I forwarded to the proprietors of asylums, I consider that the time has now come for the formation of some society for the MEDICAL PROPRIETORS OF PRIVATE ASYLUMS. 317 protection of the mutual interests of those officially connected with private asylums, as we cannot depend on receiving the unanimous support of the medical journals, who have compared private asylums to hotels, and who have taken up the cudgels against us, rendering it imperative that some such society should be formed to maintain the integrity of our call- ing. We are all interested in one common object?the welfare of our patients and their restoration to a sound state of mind and body. I pronounce the base insinuations that have been brought forward, in some of the public as well as medical journals, as groundless and false; and I challenge those who are opposed to private asylums to adduce one single instance of the illegal detention or confinement of persons wrongfully in these institutions; and what strengthens my assertion is the fact that the late Lunacy Committee, in their report now before Parliament, stated that, notwithstanding the several accusations brought against private asylums, in no instance was mala fides proved ; and this statement was not given after a trivial inves- tigation, but after an inquiry of very lengthened duration, extending over a whole session, and examining witnesses on both sides.
” This of itself should have put a stop to the credibility of the accusations that have been made, but which, from time to time, crop up afresh, without, however, a single iota of evidence to support them.
” You state that we should depend for our protection upon the medical profession generally. I say, in reply to this, that we have not received that support to which we are justly entitled ; and we must, therefore, endeavour to obtain assistance elsewhere. I am, consequently, forming an association for the protection, not only of our general welfare, but of that which to every Englishman is more dear: his reputation and his honour. And in stating this, I endorse the opinion of a large proportion of those medical men with whom I have been in communication, both public and private asylum proprietors, who naturally are indignant at the aspersions which have been so plentifully directed against them. It is a difficult matter, however, to suggest improvements in the system, as all asylums are already under such efficient supervision; but, if anything could be done at the present time to prevent the possibility of wrongful insinuations, by further protecting the proprietors and medical superintendents of private asylums, it would be hailed with satisfaction by a large body of men who have the interests at heart of those committed to their care, and whose only crime is to Fetter strong madness in a silken thread, Charm ache with air, and agony with words.
What a holy and honourable calling is this! and those who labour in the field should not be harassed and baffled in their endeavours to ‘ minister to a mind diseased.’ ” Is it just that the proprietors of private asylums should be especially held up to opprobrium ? The study of mental science is the highest specialty, and gentlemen engaged in it are no more likely to make a market of their patients than those engaged in any other branch of the profession. Without in the slightest degree wishing to detract from the merits of the super-, intendents of public asylums, who number amongst their class some of the leading cerebral psychologists of the day, it should not be forgotten that the proprietors of private asylums have to deal with the educated classes, who essentially require more intellectual acquirements to cope with their maladies than those who have only paupers to treat, and the maligners of private asylum proprietors should be reminded that some of the most illustrious members of the profession have been proprietors of private asylums, and when we mention such distinguished names as those of the late Drs. Forbes Winslow, Conolly, Sutherland; and of Drs. Maudsley, Blandford, Boyd, Tuke, Wood, Lush &c.; and that of the accomplished scholar, Dr Steward, late of Southall Park, who was selected by the Royal College of Physicians to deliver in Latin the Hunterian Oration in 1855; and remembering the remarks made by Lord Shaftesbury, we emphatically affirm that there is no justification for the asper- sions which have been so freely cast upon the proprietors of private asylums.
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