Lunacy In England
251 Art. VIL? Thirty-sixth Report of the Commissioners in Lunacy.
Tiie Commissioners’ Report for 1881 is a most important document, on account particularly of the evidence it yields confirmatory of the suspected increase in lunacy in this country. The numbers representative of the past two years are singularly instructive in this respect, a difference of 1,729 existing between them, the total for 1881 being 74,842. Of these 7,753 were private, and 67,089 were pauper patients; but in addition to them, and not included in the total numbers, must be reckoned 230 lunatics resident in private houses under the personal supervision of their committees, and 140 male prisoners, who, having become insane whilst undergoing sentences of penal servitude, are kept under treatment in the wards of convict prisons.
A significant fact is that the large increase noticed in the number of lunatics last year is almost entirely among the pauper classes, the private patients having remained comparatively stationary. The figures for 1?81 show an increase of 1,801 as compared with those relating to 1880, the average annual increase of pauper patients for the preceding ten years having been only 1,507. The Commissioners do not venture into any explanation of this increase, which is sufficiently considerable to excite attention among those who are accustomed to watch the consequences of such movements as have agitated the popular mind during the last year or two. That it is no improper stretch of comparison to associate the increase with those emotional revivals rendered so familiar of late by the frequency of their occurrence, will be readily ceded ; but though w7e may thus easily arrive at an explanation of the increasing growth in the number of the insane, this will do but little towards offering a means of amending the evil. In this connection it is instructive to note the preparations being made, under instructions from the Commissioners, for increasing the capacity of asylums provided in certain counties for the reception of such lunatics, chiefly, as are a care to the State. These enlargements are in many cases very considerable indeed, but only sufficiently so to meet the pressure for accommodation experienced in the centres at which thev are bein<r made.
252 LUNACY IN ENGLAND.
The Cornwall Asylum at Bodmin is to be increased by the addition of certain buildings whichwill accommodate 170 patients and include a (lining hall and offices, the cost of the whole being estimated at ?11,500.
At Glamorgan an auxiliary asylum to relieve the difficulty now felt in the county of Glamorgan for making suitable provision for the lunatic paupers, is to be erected on a piece of land the purchase of which, 127 acres, for ?7,200 has been duly approved. The proposed asylum is situated one and a-lialf miles from the existing institution. A possible difficulty in connection with water supply prompted the Commissioners to make inquiries respecting the point, on the satisfactory settlement ot which the works will be proceeded with. The increase of lunacy in Lancashire has long been exercising an influence in the asylums of that county, and it is with a feeling of relief that information will be received to the effect that increased accommodation for 3,147 is about to be provided in the four principal institutions. Thus :?
At Lancaster Moor . . for 670 patients. At Ramhill . . ? 1,000 ? At Prestwich . . ? 803 ? At Whittingham . . ? 674 ? Total . . 3,147 ?
The Somerset County Asylum is to receive additional accommodation for 80 female patients in the shape of a detached building at a cost of ?6,300, according to estimate. In the county of Suffolk the demand for increased space has become so urgent that the Commissioners have felt themselves compelled to report the matter to the Secretary of State, their representations in two successive years to the local authorities being unproductive. The Commissioners thus report of it:? ‘?In 1880 the great overcrowding of this asylum was remedied by the temporary expedient of a transfer, duly approved and for two years, of 50 patients to the Ipswich Borough Asylum. In July of that year the Committee of Justices proposed to extend the asylum estate, which is one of the smallest in England containing only 30 acres freehold and six leasehold, by the purchase of about 14 acres of adjoining land,and to build thereon a block for 150 patients; but it was not until February 1881 that this proposition was submitted to the Secretary of State, and by him referred to us for our opinion. We recommended the scheme for approval, subject to the Committee being quite satisfied as to the sufficiency of the water supply both as to quantity and quality, and as to the means of dealing with the sewage, two important points, as to which a death from typhoid fever having occurred in the asylum, we entertained grave apprehensions, which the sequel has unfortunately justified. We recommended, on further correspondence, that the Justices should obtain a full report from a professional engineer on Loth subjects.
” This was done, and in April, upon perusal of that Eeport, we thought that the question of the sufficiency of the water supply was satisfactorily answered; w7e were less satisfied as to the probable quality of the water and the means of disposal of the sewage. This, however, though clearly not the best arrangement absolutely, seemed likely to be fairly satisfactory and might, we thought, be adopted, it being, as we understood, impracticable to obtain more land in a proper position for increasing the sewage farm.
” In the anticipation that no difficulty would arise in meeting certain requirements founded on suggestions from the professional engineer, we proceeded to examine the plans for the additional block which had meantime been prepared. ” Whilst the plans, however, were under discussion, a very serious outbreak of diarrhoea occurred at the asylum, which reached its height in August and September, 1881,, in which month there were 18 arid 3(5 cases respectively, which in two and five instances terminated fatally.
“The Committee, at our suggestion, had a further analysis of the asylum water, and called in Dr Corfield, officer of health of St. George’s, Hanover Square, to advise them as to the sanitary state of the asylum.
” His report entirely condemned the existing sewage system, and it was manifest that the water was by no means above suspicion.
” In these circumstances, to have added to the asylum population would have been most impropei’, and the question of the enlargement remained, therefore, in suspense at the end of the year, until such time as the existing asylum should be pronounced to be in a thoroughly healthy state.” Numerous improvements and additions, not involving increase of accommodation, however, have been made in connection with very many of the borough and county asylums, and to these particulars, the Commissioners devote a certain portion of their report.
The question of suicides receives prominence from the fact that during the year dealt with in this report, no fewer than 17 deaths by suicide occurred in county and borough asylums. In three cases the patients were away on trial, a fact that should be carefidly considered in its bearing “>n the fallacy likely to be committed by too soon regarding cure as having taken place in persons afflicted with suicidal mania. One of these cases was that of a patient away from Carmarthen Asylum on probation; at the time of his admission he was not supposed to have suicidal tendencies, although he was depressed, and had stated to the certifying medical man that he wished to go to the asylum as lie did not know what he might be tempted to do with himself, and that it was his only chance of getting better. He was at that time impressed with the idea that his wife had misconducted herself previous to her marriage, some 20 years ago. The medical superintendent reported him to be much improved since admission, but that he suffered from melancholia, and was of unsound mind. While in the asylum he had not shown either homicidal or suicidal tendencies, and when discharged ivas apparently quite well. The last phrase is most significant, the case indeed in all its details affording a pregnant warning of the dangers of hasty pronunciamentos on the question of cure of the insane.
The second example of suicide on trial is from the Chester Asylum. A male pauper patient was admitted in May 1881 in a state of great depression, and expressing intention of destroying himself. Under treatment, however, he so much improved that, his family soliciting it, he was discharged on probation for a month, just before the expiration of which time lie shot himself with a pistol. No intimation of a relapse had been received at the asylum, and the evidence taken at the inquest showed that he remained apparently well to the last.
The third example of self-destruction by a probation patient is that of an inmate of the West Riding Asylum, the friends in this case also having importuned for a discharge. For a time the patient went on well, but eventually died from narcotic poisoning, chloral having been the suspected agent of destruction. That appearances may most deceptively suggest anything rather than the actual condition of mind of an intending suicide has been too frequently and too fully proved to admit of doubt; one case in particular, at the Devon Asylum, proves the truth of this; it is that of a female patient who was admitted in March and was treated as a suicidally disposed person. The day before her death she had been very cheerful, had been twice to church, and had taken a long walk. Early in the following morning she was found suspended to a transverse iron bar placed outside the window of a single room for protection. A nurse had spoken to her about half an hour previously, and had received a cheerful answer.
The ingenuity exhibited by insane persons bent on suicide in devising means for carrying out their self-destructive desire is oftentimes marvellous. Hanging appears to be more frequently resorted to than any other single mode of death, and in many of the cases narrated by the Commissioners, of suicides in borough and county asylums, the amount of calculation and arrangement involved in fulfilling the design of the suicide is in the highest degree remarkable. At the Devon Asylum a male pauper, who had himself fears of what might happen, having been placed to sleep in a single room, was visited by an attendant several times during the night on which the deed was committed. At 3.30 he was seen all right in bed, at 4.40 he was discovered suspended from the shutter of the window by means of two handkerchiefs and a boothice fixed to a nail which he had passed through a hole in the shutter. Cominenti lg on this suicide, the Commissioners justly observe:? ” Casualties of this nature are mainly due to the want of proper arrangements for the continuous supervision of suicidal patients, and it is obvious that the visits of the ordinary night attendant every one or two hours afford no security against suicidal attempts.” In another ca?e of hanging, a patient in the Durham County Asylum succeeded in destroying life by means of a sheet attached to the window frame of the room. Here, too, the death occurred in a single room, as also was the case in several other instances, thus leading to the conclusion enunciated by the Commissioners, that single rooms offer considerable facilities for committing suicide, and are not at all suitable for occupation by any patients concerning whom any doubts are experienced.
A pauper patient in the Lancaster Asylum displayed an unusual amount of circumspection in planning his own destruction, which, by a succession of accidents, he was able to carry to fulfilment, lieing employed in the carpenter’s shop, he secreted the bits of a plane he was working with about his person, and with this implement, carefully concealed until required, he succeeded in cutting his own throat fatally, a task, it must be admitted, of almost insuperable difficulty under the circumstances. This man had been employed for more than eighteen months in the carpenter’s shop, and no blame could be attached to any attendant on account of his death, he being permitted to dress and undress himself.
One patient was killed by decapitation on the railway, he having just previously escaped from the Whittingham Asylum. This was returned as suicide by the coroner’s jury, but as an accident by the medical superintendent of the asylum. At the Salop Asylum two fatal casualties occurring during the year, in one of which death from choking, and in the other death accelerated by fracture of several ribs, call for particular notice.
Coroners’ inquests were held in both cases, and they were the subjects of correspondence between the Board and the medical superintendent.
In the first, which occurred in January, the patient named Cooke, 68 years of age, died four days after admission, the immediate cause of death being suffocation in taking food, which was being administered to him by the night attendant. The jury being also of opinion that the suffocation had been accelerated by fractured ribs.
The patient had been very violent before removal from the workhouse, as Avell as after admission into the asylum, where he was placed in No. 5 ward. The fractures of the ribs were not detected during life, and were only ascertained at the postmortem examination, and the manner in which the injuries were sustained was never clearly made out. It appeared in the course of the inquiry that the night attendant had fed the patient whilst the latter was lying on his back, instead of raising him up first; a want of judgment which was commented upon as very probably having contributed to produce the fatal suffocation.
The other death from fractured ribs occurred on the 11th of April, to a patient named Jones, 50 years of age, and admitted on the 3rd January also into No. 5 ward. He had no fractures or serious injuries on admission, and it was never precisely ascertained how and when they occurred. The coroner’s jury returned a verdict to the effect that death was due to exhaustion after mania, accelerated by fractures of the ribs, and congestion of the lungs; how such injuries were caused there was not sufficient evidence before them to show, but they attached no blame to any of the attendants. At the statutory inspection of the asylum by two members of the Board, on the 12th, 13th, and 14th of May, a special inquiry was held into the circumstances attending this death. The Commissioners examined on oath the medical superintendent, the assistant medical officer, the late head attendant (then storekeeper), and eleven attendants, being all the persons who had charge of Jones during his residence in the asylum. They also examined, but not upon oath, three male patients, who seemed to be the only patients likely to give trustworthy testimony as to the treatment of Jones. The latter was a powerful man, very uncertain in his conduct, excitable, and often violent and destructive.
A severe fall six days before death, the result of a struggle with the charge attendant of No. 5 ward, might have caused the injuries to the ribs, which were of recent date. The fall was not reported until the following day, and then only verbally, to the medical superintendent, and no reference was made to it in the charge attendant’s written evening report of the day on which it happened. The Commissioners did not consider the attendants of No. 5 ward numerically insufficient whilst Jones was under care there, but that during a vacancy which occurred at this time for several weeks in the post of chief attendant, the supervision of the attendants was inadequate. Reviewing all the circumstances, and having regard to the fact that this was the second case of tractured bones in No. 5 ward within a short period, and to the absence of any satisfactory explanation of how the injuries were caused, it was recommended that F. Gardner, the charge attendant, be removed to a less responsible position. He was shortly afterwards dismissed, and prosecuted to conviction by the Committee for striking a patient.
At Winson Green Asylum a male pauper lunatic, admitted with decided suicidal tendencies, having shortly before fractured his leg by jumping out of a window, threw himself from a ladder, and fractured his skull, thus causing his own death. The step ladder, from which the fatal leap was taken down some stone stairs, had been left in a passage way for some time, and to its accessibility the jury attributed the accident. They also thought that two or three attendants were not sufficient for 57 patients, many of whom were of suicidal tendency. These conclusions were endorsed by the Commissioners, but the Asylum Committee dissented from them, as they might not unnaturally be presupposed to do.
The great danger of allowing patients in asylums under any circumstances to have razors in their possession was strongly illustrated in the death of L. A., a pauper patient in this same asylum. This patient was admitted on the 28th of October, 1881, having recently become insane, and was stated to be both dangerous and suicidal, having previously attempted to cut his throat. On the morning of November the 22nd he destroyed himself by cutting his throat with a razor which he found in the room of another patient (J. S.), who had been allowed for several years to shave himself unknown to the medical officers, and to have two razors in his possession. L. A. seems to have passed the room occupied by J. S. and noticed him shaving himself, and taking the opportunity of watching him leave the room without closing the door, entered it, and finding the drawer open in which J. S. kept his razor, seized it, and immediately cut his throat. Two years before an order seems have been issued interdicting the use of razors by patients. The charge attendant of the ward (Joseph York) in which L. A. was placed was subsequently dismissed by the Committee of Visitors for neglect of duty.
In reviewing the report of the Commissioners for 1880 we dwelt somewhat at length on the great waste of opportunities of pathological investigation consequent on the neglect shown in performing post-mortem examinations when possible. In their last report the Commissioners are able to announce a great improvement in this respect as regards the year 1881. Of the total of 4,715 deaths in borough and county asylums, 2,789 were the subjects of autopsies, giving a proportion of 59 per cent., whereas in 1880 only 37 per cent, of the dead bodies were thus examined. In many asylums the higher figure given above is exceeded, but in others again, unfortunately, this branch of investigation is more or less ignored and neglected. In the words of the report, “Their value from a pathological point of view, and as a means of detecting injuries which may have escaped notice during life, is now generally admitted, and we hope to find the example so well set in some asylums universally followed.”
A female patient in the Lincoln Lunatic (Registered) Hospital, committed suicide by stabbing herself with a sharppointed knife, in the throat; but the death which occurred two days after the infliction of the wound was attributed by the medical superintendent to other causes.
Respecting licensed houses, both metropolitan and provincial, the report is generally satisfactory, the instances in which the Commissioners speak unfavourably being few and exceptionable. At Hoxton House, smallpox by some means found its way in, early in the year, but no death occurred from the disease. The same may be said of Bethnal House, of the attendants at which institution the Commissioners complain as being inferior to the class that should contribute such servants. The fault, however, seems entirely due to deficient wages, and so to be remediable ; alteration for the better is also sought for in the staff of attendants at Camberwell House, which is otherwise well reported on.
Concerning the licensed houses receiving private patients only, the report is, as a rule, most favourable. An unfortunate case of suicide occurred at Manor House, Chiswick, this being one of three such deaths within the metropolitan area. The first case occurred at Bethnal House, where a pauper patient hanged himself by his scarf attached to a grated ventilator in a water-closet. In the second case, that of a female patient at Camberwell House, hanging was again the mode of death chosen by the suicide, who was considered so far recovered as to be allowed home occasionally on leave for a day at a time. The third case was that of a gentleman at Manor House, Chiswick, who was permitted to shave himself daily in the presence of an attendant. One morning he seized the opportunity of cutting the side of his neck, and died a few hours later from loss of blood and collapse. Four other suicides occurred, one being that of a lady discharged ” relieved ” from a provincial licensed house; one that of a single patient in an unlicensed house, and the other two being those of patients at Dunstan Lodge and Ticehurst Asylum respectively. A ” fatal casualty” took place at Kingsdown House, when a male patient, after climbing to the roof of the house, in the temporary absence of the attendant, fell to the ground and was killed instantaneously. It is doubtful if the act was intentionally suicidal in character, although the patient had exhibited suicidal tendency but was ” improved.”
The death of Mr. William George Campbell, who resigned the duties of Commissioner in 1879, is noticed in feeling terms in the report, which in every way maintains the high character these documents enjoy in general estimation for their intrinsic value and invariably careful preparation. PART II. VOL. VI[J. NEW SERIES.
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