Private Asylums
285 Art. X.?.
There are existing in the Metropolitan district 39 Private Asylums licensed for the reception of lunatics, the Provincial number being 60.
During the year most unjustifiable and unwarrantable at- tacks have been made against these institutions and their pro- prietors by not only the lay papers, but also by the British Medical Journal. It must be a subject for congratulation to all those connected directly or indirectly with private asylums to read the remarks of the Commissioners in Lunacy in their last Report. Much correspondence has taken place on the question. The Medical Press and Circular, when speaking on the subject says:?
” The unjustifiable and indiscriminate attacks which a large portion of the daily press has recently levelled against private lunatic asylums makes it incumbent on us to expose the senseless fallacies of those who have joined in the blatant cry against the proprietors of these establishments, amongst whom can be num- bered some of the greatest philanthropists of the age; and the wholesale slanderers of a humane and honourable class should be reminded, that it is to these we are chiefly indebted for the great improvements which have taken place of late years in the treatment of the insane.
” Without the slightest wish to detract from the great merits ?f our public pauper asylums, we think it fair that the special advantages of small private asylums should be duly recognised, and it will relieve the minds of those who have relatives in them to learn that they are not the ‘ hells’ that some poor deluded individuals would lead us to suppose.
” It must be evident to every candid observer that in a public asylum where there is a proportion of three or four medical men to several hundred patients, it is impossible to give that par- ticular attention to each case which it would receive where^ one person had the superintendence of a limited numbei of patients only. particular symptoms of some subtle form of mental a serration must often be overlooked in so vast a crowd. In a Private asylum the duties of the superintendent are most anxious and arduous. His whole existence is mixed up with tbat of the Patients; he has to share their meals and their amusements. We is therefore necessarily subjected, not only to frequent petty annoyances, but it sometimes even happens that his life is placed in jeopardy. These molestations can be borne, but it must certainly be trying to his patience to have to endure the unprovoked slander of ignorant scribblers at a time when he believes himself usefully and benevolently employed in relieving the sufferings of his fellow creatures.
” The most scrutinising inquiry by the Dillwyn Committee of the House of Commons has satisfactorily shown that no instance of mala fides could be proved against any proprietor of a private lunatic asylum.
” One of our contemporaries has likened private asylums in part to hotels ; we were not before aware that a stranger could enter an institution of this sort and order a bed and bitter beer. ” Private asylums at the present day differ very materially from what they were some years ago before the legislature took up the question; and in spite of what we read of in the papers, we state emphatically that it is impossible, under the existing state of our law, to confine or detain a person unjustly in a private asylum.
” The unhappy sufferers are treated with the greatest kind- ness and consideration, and it is the aim and effort of the proprietor and superintendent not to detain his patient unjustly, but to do all in his power to restore reason, and ‘ minister to a mind diseased.’”
The Commissioners make the following remarks on Private Asylums:?
“In our Twenty-fifth Report (for 1871) we took occasion to describe each licensed house then open in the metropolitan district; and in the Twenty-sixth Keport we gave particulars of those licensed by justices, prefaced by a general sketch of the character and condition of these proprietary establishments. We there stated that they were very different from what such houses had been within the memory of several members of our board, and that their gradual improvement had been very great.
“We can now report that, since 1872, a few only of the houses then referred to have been closed, and those few, with a single exception, in consequence of the death or retirement of the proprietors. Within certain limits, beyond which activity would defeat its object, our criticism of the details of manage- ment of licensed houses becomes year by year more and more searching; and although the amount of order, good manage- ment, comfort, and attention to the wants of the patients varies much, and is not everywhere thoroughly satisfactory, yet the general improvement continues, and consequently the standard aimed at becomes higher and higher.
” A good deal of unfavourable comment has lately been made upon the licensed houses and their proprietors, both before the Select Committee of the House of Commons (whose report we shall have occasion presently to notice) and else- where. Some witnesses called by the Committee went so fax- as to ‘ urge the immediate abolition of all such houses, on the ground of the temptation to keep profitable patients longer than necessary.’
” A system which places the insane in charge of persons who derive profit from their detention, is no doubt objectionable in theory ; and in practice (like many other things) may be open to abuse. But so far as regards the licensed houses in England and Wales, which alone come under our observation, we are convinced that, under the strict supervision and the safeguards which the Lunacy Acts provide, no such abuses are possible as have been in some quarters seriously alleged, such as the ‘ in- carceration ‘ of sane persons, or the prolonged detention for corrupt motives of insane persons who have entirely recovered their reason.
” Nor are the proprietors of licensed houses open to the sweeping charges of dishonesty and self-seeking which have been brought against them as a body. It should not be for- gotten that these persons to some extent are competing with each other and with the hospitals in a business which, to be remunerative, must be conducted on principles of ordinary prudence and common honesty.
” Moreover, in the vast majority of cases (admitting that instances to the contrary might possibly be found), the speedy cure of an insane patient is, on pecuniary, if on no higher grounds, an object of the greatest importance to the persons with whom it rests to decide where to place him under treat- ment, and every cure that can be shown becomes in fact the hest advertisement of the establishment in which the cure is effected.
” Our own opinion is that the licensed houses supply at present a social want; and that their abolition, without the substitution of other and better establishments, would assuredly multiply cases of illegal charge and consequent neglect and ill- treatment of lunatics, and would also lead to the clandestine removal of many such persons to foreign parts.
” Were asylums for the reception of private patients erected at the public cost, we doubt whether such institutions would be more acceptable to the friends of wealthy patients than the hospitals now registered under the Lunacy Acts, which do not receive many lunatics of large fortune. What these substitutes should be is a matter of more difficulty. Certainly the ex- 288 PRIVATE ASYLUMS. perience of past years does not show any disposition on the part of the public to increase the number of institutions such as the present hospitals, founded on the principle of ‘ applying the excess of payments of some patients for or towards the support, provision, or benefit of other patients.’ * (8 & 9 Vict, c. 100, s. 114.)
” These views, it will be seen, are much in accordance with the conclusions of the Select Committee appearing in page vi. of their report. The entire passage is as follows:? “’ The Committee found the greatest diversity of opinion with regard to private licensed houses. Some witnesses urged the immediate abolition of all such houses, on the ground of the temptation to keep profitable patients longer than necessary. Others as confidently stated that such houses supplied an ac- knowledged want, that there was a greater percentage of cures among patients under private care than among those in public asylums, and that it was the interest of the proprietors of pri- vate asylums to maintain the character of their establishments; while in public asylums, though the temptation to detain un- duly for the sake of profit could hardly be said to exist, yet that paid officials might lose personal interest in the good and careful management of these institutions. Other witnesses, again, took a view between these two extremes, and considered that no alteration of the law in this respect was necessary, but that the matter had better be left to the spontaneous action of the public; that the time might arrive when there would be suffi- cient accommodation in public institutions for all classes, such as exist in Scotland, in Cornwall, and at Cheadle in Cheshire.f When that time arrived it was possible that there would be no demand for licensed houses for the upper and middle classes, nor would lunatics be kept any longer in the wards of work- houses, which, it was represented, are often, especially in Ire- land, most unfit for the purpose. In this opinion the Committee concur, and they would suggest that legislative facilities should be afforded, by enlargement of the powers of magistrates, or otherwise, for the extension of this system.’
” Before leaving this head of our report, we will enter into a few particulars which may throw further light on the present position of the licensed houses. The number of patients in * The only two Hospitals which were not in existence in 1859, are Barnwood House, which took its rise from the separation of the charity” element from the “”S Asylunat Gloucester, and the Royal Albert Asylum for Idiots. 1 ]6 Comm’ttee appear to refer to:?1. The “Chartered Asylums” of ^cot and; 2. The detached building at the Cornwall County Asylum in connection ? ty’ w^ere Pr’vate patients are received at low rates; and, 3. The c 100 Manchester lunatic Hospital” at Cheadle, registered under 8 & 9 Vict. PRIVATE ASYLUMS. 289
licensed houses (if we exclude the paupers, the inmates of idiot institutions, and the insane soldiers received in Grove Hall under a contract with the War Office) are 1,432 in the metro- politan district and 1,455 in the provinces; altogether 2,887 persons. The houses in and about London are 37, but these include four where idiots only are received. Those in the country are 60; they also include four receiving idiots only. Of the 33 metropolitan houses (excluding those which receive idiot children only) 13 have 30 patients and upwards. In the provinces, with 12 exceptions, the number of private patients does not, in any one house, exceed 30. Many licensees in town and country have fewer than 20 cases under their charge, and some are limited to the reception of two or three individuals being brothers or sisters.
” The charges for care and treatment in licensed houses of course vary much, according to the extent of the accommoda- tion and style of living. We find that the present average payment for “each patient in the 89 licensed houses which receive lunatic private patients, as distinguished from idiots, is approximately as follows :?
” In 32 of the houses, receiving about 1,300 patients, the average payment is under ?100 per annum. ” In 22, receiving about 750, the average payment is from ?100 to ?150 per annum.
“Thirty shillings and two guineas weekly, are ordinary charges in houses of this class, but a large proportion of patients are received there at rates not exceeding one guinea, while comparatively few pay more than three guineas a week. To obtain admission for a private patient into any licensed house for a payment below thirty shillings a week is, however, not easy, and it is almost impossible if the patient be very infirm, noisy, destructive, or of dirty habits.
” In the remaining 35 houses the charges are higher. “In 18 of these, the average payments range from ?150 to ?200.
” In 13 from ?200 to ?280. ” In 4, from ?280 to ?330, and in one house they reach ?470, including cost of carriages, and other expensive luxuries. “Against the highest sums demanded in the first-class houses we should mention this set-off, viz.y that in most of them there are cases of very long standing whose cost of maintenance actually exceeds the small payments which can be obtained for their support from the surviving members of their families.
” Further particulars as to the extent of the licence of each bouse, and as to the average number of patients resident, during 1878, are given, as heretofore, in the Appendix (B). ” In some of these establishments are occasionally living, by our special permission, relatives or connection of patients. We think that the association of such persons is often most beneficial. We also think that an additional guarantee is afforded for the proper care and treatment of all the insane inmates of a licensed house by the presence among them, and sharing their everyday life and general treatment, of one or more visitors of sound mind interested in checking malad- ministration, acting as so many watchful eyes over the attendants, and not restrained from complaint to us or to the proprietors by any fear of personal consequences. We therefore do all in our power to encourage the residence of such friends, and in one of the larger ‘ private asylums’ in London several are always staying.
“In the house just mentioned, and in many others, are also voluntary boarders residing by similar permission, being usually persons liable to recurrent insanity who feel the advantage of a regulated life, with constant access to medical advice. At our periodical visits we satisfy ourselves that they have not relapsed into certifiable unsoundness of mind, and that their stay is entirely their own wish. The presence of these indi- viduals in licensed houses is another valuable check upon improper proceedings there, and affords some proof that the general management of the establishment (of which, while insane, the boarder has usually had experience) is not objection- able to him.”
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