Twenty-second Annual Report of the General Board of Commissioners in Lunacy in Scotland. 1879
(Second Notice.)
The closing of a number of private asylums in Scotland has exercised an important bearing on the distribution of the insane population, and especially in reference to the poorer classes. The Commissioners report that ” it is possible that a certain proportion of this great increase in the number of pauper lunatics is due to the greater tendency that there has been to place insane persons on the Poor Eoll owing to the decrease in the number of private asylums, and the increase in the amount of accommodation provided in district and parochial asylums.” It is further added that ” the class of private asylums which received patients at the lowest rates have now entirely disappeared in Scotland, and the accommodation proREVIEWS AND BIBLIOGRAPHICAL NOTICES. 119 vided in district and parochial asylums is of an excellent character. The friends of a patient of the poorer class, therefore, who are willing, though not legally bound, to pay for his treatment in any asylum, and who would formerly have paid for him as a private patient in a private asylum, now allow him to be treated in a district asylum and paid for out of the rates.” The state of things indicated by these statements does not appear to us as satisfactory as .the report would attempt to show. It does somewhat qualify its approval, however, and at page 58, expresses an opinion that further means of accommodating poor patients of slender means, without submitting them to technical pauperisation, should be provided. It is, however, perfectly clear that the abolition of the private asylum in part has been the means of bringing a mass of patients, not properly fitted by associations to endure the ” herding” treatment to which the utterly destitute are submitted, for economic reasons, into a condition against which they must instinctively rebel; and further it has had the effect of throwing an unjust burden on the country, such as the tax payer may with some considerable justice complain of. The increase of rates thus made necessary would have been prevented had a wise precaution been exercised in amending the irregularities of private asylums, in place of altogether suppressing them. The prevalence of insanity is unfortunately a general one, and its influence would even be felt in the lower as in the higher ranks of society. As a matter of fact the poorer classes are more likely, always, to be subject to the conditions favouring the progress of mental disease; the modes of existence, and disregard of sanitary laws, being of the kind to assist any hereditary or acquired tendency to illness which, in a better preserved organism, might be effectually combated. Many of these poor too, are, from the nature of their surroundings, just those whom we should expect to find amongst the earliest and readiest victims of insanity. This factor, in the great problem of the treatment of the insane, will always be a great and important one; and one of the best evidences afforded by these annual reports is the indication of the entire appreciation in which the Commissioners hold it. Pauper lunacy will always contribute largely to swell the expenses of poor relief; as it is reduced will the cost to the commuity of maintaining state asylums undergo diminution, and hence the anxiety with which the expensive condition of the indigent inmates of asylums is regarded.
The humanising influence exerted over the insane by the presence of ladies amongst them, and as their daily associates, is a familiar experience with every proprietor or superintendent of a private asylum ; so well recognised is the fact now, that in most private institutions more reliance is placed on the family influence than on any other mode of effecting improvement. We, therefore, note with satisfaction that the Commissioners Report of Laughton Hall Asylum near Edinburgh, how “the employment of ladies to be companions to, as well as to superintend, the lady patients is said to be attended with considerable benefit to the patients. The same element in administration has now been introduced into the management of the gentlemen’s division of the establishment, which is now, in addition to the usual male attendance, under the charge of two ladies. These ladies join the gentlemen at their meals and they are described as exercising a beneficial influence generally on the social life of the division.”
The indications afforded in this volume of the almost total disuse of the harsher coercive measures is another gratifying proof of the vast improvements made in the modern treatment of lunatics, as compared with that usual a generation since. And even in those places such as the Stirling District Asylum, where restraint and seclusion are more frequently resorted to, to quell refractory patients, we have certain assurance that the powers invoked are employed with the utmost regard for the patient, and in a way to which the only possible exception to be taken is that contained in the objection to any form of restraint whatever. There can be no question that this treatment, the open-door system is, for ordinary cases, the best suited to insure improvement; how soon improvement can take place under such circumstances we have sufficient proof afforded in those instructive tables commonly found attached to American Hospital Reports, but not usually accompanying those issued in this country. These tables describe the number of times each patient has been re-committed, when more than one commitment has been made, and from them we are enabled to conclude the frequency with which patients are inconsiderately discharged, either as cured or as improved. This feature of asylum management is in great part to blame for the public misapprehensions regarding these institutions. If patients were not so frequently sent away ” cured,” only to undergo more or less speedy relapse, there would be heard less of the unmeaning nonsense that is being constantly directed against asylums in the uninformed lay press.
The general tone of the report is cheerful; it sufficiently shows that the best endeavours are being made throughout the asylums of Scotland to do as much as possible towards improving the condition of the unfortunate beings committed to them. Wherever improvements seemed to be suggested, or to be demanded, whether of buildings or of internal administration, they have been forthwith introduced as far as possible ; and judging from the pages of the Commissioners’ Beport, there is every reason to rest satisfied, both with the condition of the patients, and with the earnest fulfilment of their duties toward them by their caretakers. Of the admirable and careful and conscientious manner in which the Commissioners have achieved their special work it is impossible to speak too highly or too gratefully. The reports themselves are storehouses of information to the alienist and to the humanitarian alike; the authors of them deserve the gratitude of every well-wisher to the unfortunate beings in whose concern they are wholly essayed.
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