Lunacy In England
248 Art. VI.?
The thirty-third Report of the Commissioners in Lunacy has just been issued. We have great satisfaction in testifying to the intrinsic value of the matter contained in its pages. At the present time, when so much preposterous nonsense is written in connection with Lunacy and the Acts of Parliament bearing upon it, both in the medical as well as public press, we welcome the contents of the Report, as being the result of experience obtained by gentlemen whose sole object is to study the welfare of the insane, and to superintend the general management of asylums and hospitals for those mentally afflicted, and not of outsiders, who as a rule are ignorant of the very elements upon which they profess to enlighten others. The following summary gives the classification and distri- bution of patients on the Commissioners’ register :?
Where maintained on January 1, 1879 Private M. F. Pauper F. Total In county and borough asylums In registered hospitals . In licensed houses: Metropolitan Provincial In naval and military hospitals and Royal India Asylum In Criminal Lunatic Asylum (Broadmoor) . In workhouses: Ordinary workhouses . Metropolitan district asylum Private single patients Outdoor paupers Total . 216 1,422 1,058 790 325 184 4,187 260 1,298 862 825 280 3,591 476 2,720 1,920 1,615 342 233 17,462 69 174 238 20,933 48 382 316 472 5,014 1,971 2,378 6,683 2,337 3,852 7,778 27,496 34,611 38,395 117 11.697 4,308 6,230 17,678 1,491 1,232 1,028 325 374 5,014 1,971 192 2,378 21,193 1,346 1,244 1,141 17 109 6,683 2,337 280 3,852 38,871 2,837 2,476 2,169 11,697 4,308 472 6,230 62,107 31,683 38,202 69,885
There were 202 lunatics found so by inquisition, which are not included in the summary given. Private patients have increased in county and borough asylums by 13, in registered hospitals by 40, and in licensed houses by 63.
Pauper patients have increased in county and borough asylums by 1,098, in registered hospitals by 19, and in licensed houses by 16, decreasing, however, in ordinary workhouses by 162, and in the Metropolitan Asylums of Leavesden, Caterham, and Darenth by 98. Both these statistics refer to a comparison between private and pauper patients on the register of January 1, 1878 and 1879.
The statistical tables are now given which were commenced ten years ago and have gradually and progressively been im- proved and added to.
Of the various causes for Insanity intemperance is again at the head of the list, and stands out -per se with a large propor- tion of cases. Among the others may be mentioned venereal disease, self-abuse, overwork, change of life and puberty, previous attacks, sunstroke, &c.
The total number of patients in asylums and as “single patients” on January 1, 1879, was 47,650, of whom 4,187 males and 3,591 females were private patients, and 18,133 males and 21,739 females were paupers. The total admissions during 1878 were 15,102, but 10*14 per cent, of these were transfers.
Out of 8,796 discharged from asylums, 5,332 are returned as recovered, showing a large proportion, and during the year 4,715 patients died in asylums.
On January 1, 1878, there were 17,116 males and 20,647 females in county and borough asylums, and the admissions during the year were 11,604 (5,807 males and 5,797 females). Out of 6,471 discharged, 4,247 are registered as recovered. The recoveries during the year as compared with the ad- missions are at the rate of 40*3 per cent, for both series. The Commissioners pass on to consider the improvements which have taken place at the various public asylums. A new asylum is to be erected in Essex, at a cost of ?65,000. It is to provide accommodation for 150 patients of both sexes.
The county asylum of Derbyshire is to be enlarged. An auxiliary asylum is to be built in Gloucestershire, and also one in connection with the Lancaster, Prestwich, Eainhill, and ^ hittingham Asylums. In consequence of the termination in the lease of about 40 acres of land occupied by the Committee of Visitors of the Leicestershire and Kutland Asylum it is proposed to remove it to another site. Improvements are to be made at Hanwell and Colney Hatch.
The Commissioners comment severely on the unhealthy locality of the Hull Asylum, which never appearefree from some epidemic, and suggests its removal to some healthy locality: ” We cannot sufficiently deplore the inactivity which permits the continuance of the asylum on this unhealthy spot.” The following suicides have occurred, particulars of which we give in extenso:?
” W. K., a man 71 years of age, was admitted into the Bucks County Asylum on December 28, 1876. This was the second time he had been placed under treatment in an asylum. He had never been considered suicidally disposed, nor shown any signs of violence either towards himself or others, and was in consequence trusted to go into the garden alone, and even on some occasions had been permitted to go to Aylesbury un- attended to visit his friends. In the garden of the asylum there is a space about 80 yards square, enclosed by a boarding 4 feet high, and in the boarding is a door fastened by a padlock, and kept locked. This space is used for propagating plants and cuttings, and there is in it also a water tank, enclosed in brick- work, which is capable of holding water to the depth of rather more than two feet. This tank was covered by a frame, and able to be secured by a padlock, which it was the gardener’s duty to see was in proper order and duly fastened.
” On Sunday, May 5, W. K., after attending Divine ser- vice, obtained leave to go into the garden, where he was left by himself. As he did not return to his dinner, a search was in- stituted, and he was found drowned in this tank. He had got over the boarding which surrounds the tank, where he found the cover of the tank not properly secured, and was thus enabled to destroy himself. The gardener stated in his evidence before the coroner that he had taken the padlock from the tank to fasten the gate with, as the one attached to the gate was out of repair. The verdict of the jury did not attribute blame to anyone, but we felt that some serious notice ought to be taken of the gardener’s conduct, as it was owing to his carelessness and neglect of orders that the patient had the opportunity of com- mitting suicide afforded him, and we expressed our opinions on the matter to the Committee.
“At the County Asylum at Chester, in March 1878, a patient named J. L. was admitted, the statement of particulars describing him as subject to epilepsy and of suicidal propensi- ties. He was sent to the ward set apart for such cases. ” On May 21 he was in a restless, anxious state of mind. He ate his dinner and returned to the ward. It was then the attendants’ dinner hour, and the charge attendant was left by himself in the ward. Expecting in a few minutes to be called to his own dinner, he placed his knife and fork in the breast pocket of his coat. He was walking down the corridor, talking to and endeavouring to quiet the patient, when the latter suddenly seized the knife from the attendant’s pocket, and then and there cut his own throat. The attendant, with the assistance of some of the patients, wrested the knife from J. L.’s hand, and immediately summoned medical assistance, which was speedily obtained. In spite of treatment, death ensued on the 24th of the month.
” It appearing that the number of attendants for the ward in question was only three, while the patient’s placed there amounted to 37, mostly of the epileptic and suicidal class, an arrangement which explains how all the patients were left during the dinner hour in charge of one man, we urged upon the Com- mittee of Visitors an addition to the staff. At the visit of our colleagues in July, it was found that our recommendation had been adopted, but it was then suggested that the table knives for attendants ought either to be secured immediately after meals in a locked box placed in the messroom ; or, if left in the attendant’s hands, to be kept in the bedrooms, and they should have proper cases.
” W. 3VL, admitted into the asylum on November 1, 1876, died on November 15, 1878, in the following circum- stances.
” This patient was an epileptic, and at times subject to fits of great excitement. On November 14, after dining, he, without any reason, went across the room and struck one of the patients. Four attendants then removed him, struggling violentl}T, to another ward, when, immediately on being loosed, he seized a chair and turned upon the attendants, who ran away and shut the door after them, leaving W. M. alone in the ward. On looking through the keyhole he was seen beating the table with the chair. Assistance was called, and six atten- dants entered the ward No. 12 ; the patient then ran away into a passage, where he again turned and attacked the attendants. He then rushed up a staircase, and, on reaching the first land- ing, turned round and held the attendants at bay. One of the attendants telling the others to follow him, picked up a chair, and carried it, legs upwards, towards the patient. There then appears to have been a severe struggle, W. M. and the attend- ants eventually falling 4 all in a heap’ on the stairs, the deceased being beneath the others. He was then conveyed to a ward, struggling all the time. Shortly after this he had a severe fit in the presence of the head attendant, who had by this time been summoned, and who did not see any reason to report the occur- rence to the medical officers till seven in the evening, as there were no signs indicating that the man had been injured in the struggle, though he had been very sick and had gone to bed about four o’clock. On being visited by the medical officer at seven, no special indications of serious mischief were observed, but shortly after symptoms of collapse appeared, and the patient died early on the morning of November 15. The post- mortem examination disclosed rupture of the abdominal aorta and small intestines.
” On reviewing the circumstances of this case, it seemed to us that there had been a great want of judgment on the part of the attendants in placing this patient, in the first instance, in the empty ward, where he was able to obtain possession of the chair, which in his hands became a dangerous weapon, and where he was in a position to effect mischief. Had the patient been placed at once in a single room, the consequences which actually resulted could not have ensued. We also considered that, in not reporting the occurrence to one of the medical officers with as little delay as possible, the attendants had committed a breach of the existing regulations for the government of the asylum, for which they should be severely reprimanded. We strongly recommended that a further regulation should be made, requir- ing the head attendant at once to report to the medical super- intendent, or a medical officer, any case of violence which might come to his knowledge. It ought not to be left to the dis- cretion of a head attendant, however deserving of general con- fidence, and of whatever length of experience, whether to report such occurrence or to refrain from reporting.
” Owing to the neglect of an attendant to close the door of a pantry, where she had placed the knife and fork she had just used in cutting up the dinners of the patients belonging to the ward, a female patient at the Eainhill Asylum was enabled, unperceived, to obtain possession of a knife, and to retire therewith to a water closet.
” She was missed almost directly, and was very quickly found, but not soon enough to prevent her from cutting her throat, and that so severely, as to cause her death on the following day, November 15.
” This patient, though not stated on her admission in August 1878 to be suicidal, had been an inmate of the asylum on a former occasion, and from her antecedents and depressed state of mind, was kept under more or less close observation, and was not entrusted with knife or scissors.
” The attendant to whose carelessness this suicide was due, had been for two years and a half a good servant of the asylum, and shortly before the fatal occurrence had been assaulted by two violent patients, producing, not unnaturally, a certain amount of ‘ flurry.’ In all the circumstances, Dr. Rogers thought it sufficient to point out very strongly to the attendant the deplorable consequences of her neglect, and to transfer her to another ward, where the patients require less constant vigilance.
” At the Whittingham Asylum there have been three deaths by suicide in the course of the past year.
” In the first instance, a male patient, E. K., destroyed himself on March 7 by poison, which he obtained in the follow- ing way. The patient was suicidal, but apparently much improved in mental condition. He was employed in the joiners’ shop, and on the day named was engaged in assisting Walter Walsh, who was the foreman joiner at the asylum, in some work at the superintendent’s house. Some of the wards being infested with rats, the superintendent had procured rat poison for the purpose of destroying them. A portion of this poison was, from time to time, given out to Walsh, with in- structions to place it in the rat holes after all the patients had retired to bed, and to remove, early in the morning, any of the poison that might remain.
” From Walsh’s evidence, taken on the coroner s inquest, it appeared that he had in his coat pocket, on March 7, a box of the rat poison ; that he took off his coat and threw it on the ground when at work at the superintendent’s house, and forgetting the presence of the poison, subsequently asked E. K. to get him a tool out of a pocket of the coat. In doing this E. K. obtained possession of the poison, some of which he took, and he was shortly afterwards found in a closet by an attendant, who noticed that he was trembling and that there was vomit on the flags. The medical officers were summoned, and suspecting that the patient had taken an irritant poison, applied the usual remedies, but about midnight E. K. died. ” Walsh stated in his evidence that he had got the box of poison from a cupboard in the joiners’ shop, and placed it in his pocket on the Monday preceding March 7 (which was a Thursday), and that he had kept it in his pocket during the interval.
” There appeared to us to have been a very censurable degree of negligence on the part of Walsh, who had been made fully acquainted with the patient’s suicidal propensity. We called the attention of the Visitors to the case, and subse- quently learnt that Walsh had been 4 severely reprimanded for his conduct.’
” The second case was that of a female patient, M. B., aged 74 years, admitted into the asylum in February 1878, and who committed suicide there on July 23. She had not been suspected of suicidal tendencies, and had been placed at night in a single room. In the early morning of the day just mentioned, she was found dead, having hung herself by a handkerchief and the string of an apron, which she had con- cealed, to the bar of the window, the glass of which she had broken during the night.
” The third death by suicide at the Whittingham Asylum was that of a male patient, admitted on May 4. As he was described as suicidal he was placed in the special dor- mitory (containing 67 patients) at night, from the date of his admission up to the 17th of the same month, when, owing to his noisy habits and disturbing the other occupants of the dormitory, he was transferred to a single room adjoining, which admitted of constant inspection through a window in the panel. The next night, the 18th, he was again placed in the single room, and his hands were put into locked gloves to prevent self-injury. He was seen standing near the window by the attendant about 11p.m., when he asked to have his gloves removed. This was not done, and the attendant went to the other end of the dormitory to assist a man in a fit; after that he returned to the room occupied by the patient, and, finding him in bed, went in to see him, and then disco- vered that he had torn a strip off his sheet and had contrived to fasten it round his neck. He died about 11p.m., almost immediately after the strip had been removed. The night attendant in charge of these 67 epileptic and suicidal cases had no assistance except that of a patient. We expressed a strong opinion that there ought to be two competent paid night attendants for a dormitory containing so large a number of patients of such a class, but in the circumstances we did not consider that any blame could properly be attached to the attendant.
“Besides these cases of suicide two other deaths at the Whittingham Asylum deserve mention. A male patient, aged 64, died on March 15 from the effects of injuries received by falling from a window of the infirmary. The coroner’s jury considered there was no evidence to show that the patient intended to destroy himself, but that he might have been merely attempting to escape from the asylum. The size of the pane of glass through which the patient fell was 19 by 15 inches, and only one pane was broken. The medical superintendent informed us that no similar casualty had taken place since the opening of the asylum. The windows, however, containing these large panes of glass have been pro- tected, since the occurrence of this casualty, by slight rods of iron, which at a little distance escape ordinary observation.” Suicides have also taken place at Han well, Staffordshire, Wandsworth, Brookwood, Warwick, Yorkshire, Leicester, and Newcastle-upon-Tyne Asylums. We are of opinion that many of the suicides taking place in these asylums are due to the reluctance for using moderate restraint which exists in some superintendents.
We also give particulars of two suicides which took place at two of our Registered Hospitals, Barnwood House and Coton Hill. ” The first to which we have to call attention was the case of a married lady, aged 57, who was admitted into Barnwood House on March 5, 1878, in a state of acute mania. She was not then reported by her husband as suicidal, but the nature of her delusions induced the authorities at Barnwood House to fear that she might become so. A written intimation to this effect was therefore given to the attendants, as well as verbal caution that due care should be exercised.
“On October 4 the patient rose in the morning and dressed. The attendant in charge asked if she was ready to come downstairs; she said she was. The attendant led the way downstairs, supposing that Mrs. D. was following her, with the four other ladies under her care.
” The attendant, after entering the sitting room and making the tea, noticed for the first time the absence of Mrs. D. Search was made, and she was found dead in a water closet, into which she had slipped unobserved. She was hanging by her small cambric handkerchief to the handle of the door. ” The coroner’s jury attributed no blame to anyone.
” The other suicide to which we have referred took place at Coton Hill. Mr. N. was admitted a patient on Saturday, February 23, 1878. He was not described as suicidal in the statement accompanying the order for his reception, or in the medical certificates, but he was considered by the medical officers to be so disposed, for verbal instructions were at once given to the head attendant that he was not to be lost sight of. The patient slept badly during the night after his admission, but got up and dressed himself, and appeared quiet on the next (Sunday) morning. He had breakfast, and after it lay down to rest on a sofa in the breakfast room, an attendant named Edwin Rogers being then in charge. Rogers left the room, ‘to prepare things for dinner,’ as he stated, and Mr. N. took advantage of his absence to strip himself naked and then to throw himself through a window, breaking the glass, and falling down a height of 17 or 18 feet into the garden below. On taking him up it was found that he was bleeding profusely from a wound in the throat, caused during his passage through the window, or afterwards self-inflicted with a piece of the broken glass, and he died in the afternoon of the same day. A coroner’s inquest was held, and after finding a verdict in accordance with the above facts, the jury expressed their opinion that blame attached to Rogers for leaving deceased contrary to orders.”
The following tabular statement shows the number of single private patients registered, and the changes which have occurred since the commencement of the year:? Number, 1st January 1878 Registered during the year Discharged and removed . ,, of whom recovered Died …. Remaining 1st January 1879 Males 188 77 55 6 18 192 286 99 85 14 20 280 474 176 140 20 38 472
“Ofthese 472 patients remaining on January 1, 1879, 135, namely, 59 of the male sex and 76 of the female sex, were lunatics so found by inquisition, and placed by order of their committees in unlicensed houses, whose reception is notified to us under the provisions of the Act 25 & 26 Vic. c. Ill, s. 22. This leaves as patients to be regularly visited by members of this Board 337 ; namely, 133 males and 204 females.
” Besides these, there are 202 other lunatics so found by inquisition, who are understood to be residing with their com- mittees.
” Thus, in all, there were, on January 1, 1879, 337 such lunatics residing elsewhere than in asylums, registered hos- pitals, and licensed houses.
” The removal of a large number of chronic lunatics from hospitals and licensed houses, with a view of placing them in private abodes, has been occasionally advocated as a measure likely to be advantageous to the patients.
” There may be many cases now in establishments for the insane no longer needing active treatment, or very constant supervision, who might receive sufficient attention and care at their own homes, in charge of their nearest relatives, if these were able and willing to receive them ; but as to ‘ single charge’ by strangers, all our experience goes to this, that although in favourable circumstances patients so placed are made happy and comfortable, yet that a large number of them are less well looked after, and are not better satisfied with their position than they would be in an asylum or other institution.
” The fact is that persons really well qualified to take charge of the insane, and willing to do so for a pecuniary recompense, are comparatively few ; fewer still are those who would accept such charge at the low rates often current in licensed houses and hospitals, where not only do the poorer patients participate as a matter of course in many luxuries provided for the richer, but where both rich and poor can be maintained and treated at less cost than singly by reason of their aggregate number.”
Infringements of the lunacy law has been met with the immediate action of the Commissioners in Lunacy. In several of these instances prosecutions have been initiated. Various attendants have been fined and prosecuted for ill- treating patients, and instances are given of the detention of persons of unsound mind in unlicensed houses without the necessary certificates.
The Commissioners now pass on to consider the Report of the Lunacy Committee appointed last year, and make some valuable remarks on the consolidation and amendment of the Lunacy Acts to which we refer in our chapter, ” Lunacy Laws.” Mr. Wilkes and Mr. Campbell have resigned their appoint- ments as Visiting Commissioners, though still remaining on the Board as honorary Commissioners, and Dr W. Rhys Williams and William Edward Frere, Esq., have succeeded to these posts. The two former gentlemen have done valuable work in the lunacy cause, and it is a great satisfaction to know that though free from the active work of a Commissioner, they will, from their long experience, render great assistance in any question before the Board.
This excellent Report concludes with the usual statistical tables of asylums and notices of the public hospitals visited. We are of opinion that the information and data here contained are of the greatest value, and, as we have previously stated, are the result of experience.
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