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Title: Chapters in the History of the Insane in the British Isles
Author: Tuke, Daniel Hack, 1827-1895
Language: English
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[Illustration: ORIGINAL BUILDING OF THE RETREAT, YORK. INSTITUTED 1792.
_From a Painting by Cave._] [_Frontispiece._]
CHAPTERS
IN THE
HISTORY OF THE INSANE
_IN THE BRITISH ISLES_
BY
DANIEL HACK TUKE, M.D., F.R.C.P.
PRESIDENT OF THE MEDICO-PSYCHOLOGICAL ASSOCIATION,
JOINT EDITOR OF "THE JOURNAL OF MENTAL SCIENCE," AND FORMERLY
VISITING PHYSICIAN TO THE YORK RETREAT
"I might multiply these instances almost indefinitely, but I
thought it was desirable just to indicate the state of things
that existed, in order to contrast the Past with the
Present."--EARL OF SHAFTESBURY.
_WITH FOUR ILLUSTRATIONS_
LONDON
KEGAN PAUL, TRENCH & CO., 1, PATERNOSTER SQUARE
1882
(_The rights of translation and of reproduction are reserved._)
DEDICATED TO
JONATHAN HUTCHINSON, F.R.S.,
PROFESSOR OF PATHOLOGY AND SURGERY, ROYAL COLLEGE OF SURGEONS, ENGLAND,
IN MEMORY OF
A LONG FRIENDSHIP.
PREFACE.
I think it was Pascal who said that the last thing an author does in
making a book is to discover what to put at the beginning. This
discovery is easily made in the present instance.
I wish to state that the range of this book, as its title implies, is
mainly restricted to the salient points of the historical sketch it
attempts to pourtray. To have written a complete History of the Insane
in the British Isles would have necessitated the narration of details
uninteresting to the general reader. Hence, as the periods and the
institutions of greatest importance have alone been brought into
prominence, others have been inevitably thrown into the shade. Thus
Bethlem Hospital has occupied much space as the centre around which
gathers a large amount of historic interest, having been with our
forefathers almost the only representative for many centuries of the
attempt to provide for the insane in England--the outward symbol of
nearly all they knew on the subject. To the Retreat at York, again,
considerable attention has been devoted in this history, as the cradle
of reform which made the year 1792 the date of the new departure in the
treatment of the unhappy class, on whose behalf the various charitable
and national acts recorded in this volume have been performed.
Lincoln and Hanwell also, which in the course of time were the scenes of
redoubled efforts to ameliorate the condition of the insane, have
received in these pages a large, but certainly not too large, measure of
praise; and the writer would have been glad could he have conveniently
found space for a fuller description of the good work done at the latter
establishment.[1]
Of no other malady would the history of the victims demand so constant a
reference to legislation. In the chapter devoted to it, the Earl of
Shaftesbury has formed the central figure, honourably distinguished, as
have been several other members of the legislature in the same cause,
both before and after the year 1828, when as Lord Ashley he seconded Mr.
Gordon's Bill, and first came publicly forward in support of measures
designed to advance the interests of the insane. A laborious and
sometimes fruitless examination of _Hansard_, from the earliest period
of lunacy legislation, has been necessary in order to present a
continuous narrative of the successive steps by which so great a success
has been achieved.
No one knows so well as the historian of an important and extended
movement like this, the deficiencies by which its recital is marred, but
I trust that I have at least succeeded in supplying a want which some
have long felt, in placing before the British reader the main outlines
of a history with which every friend of humanity ought to be acquainted.
Its interest, I need hardly urge, extends far beyond the pale of the
medical profession, and no one who has reason to desire for friend or
relative the kindly care or the skilful treatment required for a
disordered mind, can do otherwise than wish gratefully to recognize
those who, during well-nigh a century, have laboured to make this care
and this treatment what they are at the present day.
In conclusion, it remains for me to express my obligations to those who
have in various ways rendered me assistance in the prosecution of this
work. In addition to acknowledgments made in the following pages, I have
pleasure in thanking Dr. McDowall, of Morpeth, for the use of manuscript
notes of works bearing on the first chapter; as also Mr. S. Langley. I
have to thank Mr. Coote, of the Map Department at the British Museum,
and Mr. F. Ross, for help in preparing the chapter on Bethlem Hospital;
also Dr. W. A. F. Browne of Dumfries, and Dr. Clouston of the Edinburgh
Royal Asylum, for valuable information utilized in the chapter on the
history of the insane in Scotland. Lastly, in the preparation of this,
as of other works, I am greatly indebted to the ever-willingly rendered
assistance of Mr. R. Garnett, of the British Museum Reading Room.
4, CHARLOTTE STREET,
BEDFORD SQUARE,
_June 12, 1882_.
FOOTNOTES:
[1] The reader is referred to Dr. Conolly's "The Treatment of the Insane
without Mechanical Restraints" (1856) for more details.
CONTENTS.
CHAPTER PAGE
I. Medical and Superstitious Treatment of the
Insane in the Olden Time 1
II. Bethlem Hospital and St. Luke's 45
III. Eighteenth-Century Asylums--Foundation of the
York Retreat 92
IV. Course of Lunacy Legislation 147
V. Lincoln and Hanwell--Progress of Reform in
the Treatment of the Insane from 1844 to the
Present Time 204
VI. Our Criminal Lunatics--Broadmoor 265
VII. Our Chancery Lunatics 285
VIII. Our Idiots and Imbeciles 299
IX. Scotland 321
X. Ireland 393
XI. Progress of Psychological Medicine during the
last Forty Years: 1841-1881 443
Conclusion 502
Appendices 507
Index 537
CHAPTER I.
MEDICAL AND SUPERSTITIOUS TREATMENT OF THE INSANE IN THE OLDEN TIME.
Among our Saxon ancestors the treatment of the insane was a curious
compound of pharmacy, superstition, and castigation. Demoniacal
possession was fully believed to be the frequent cause of insanity, and,
as is well known, exorcism was practised by the Church as a recognized
ordinance. We meet with some interesting particulars in regard to
treatment, in what may be called its medico-ecclesiastical aspect, in a
work of the early part of the tenth century, by an unknown author,
entitled "Leechdoms, Wortcunning, and Starcraft of Early England," or,
as we should say, "Medicine, Herb Treatment, and Astrology." It forms a
collection of documents never before published, illustrating the history
of science in this country before the Norman Conquest.[2] It clearly
appears that the Saxon leeches derived much of their knowledge directly
from the Romans, and through them from the Greeks, but they also
possessed a good deal of their own. The herbs they employed bespeak
considerable acquaintance with botany and its application to medicine as
understood at that day. The classic peony was administered as a remedy
for insanity, and mugwort was regarded as useful in putting to flight
what this Saxon book calls "devil sickness," that is, a mental malady
arising from a demon. Here is a recipe for "a fiend-sick man" when a
demon possesses or dominates him from within. "Take a spew-drink, namely
lupin, bishopwort, henbane, cropleek. Pound them together; add ale for a
liquid, let it stand for a night, and add fifty libcorns[3] or cathartic
grains and holy water."[4] Here, at any rate, we have a remedy still
employed, although rejected from the English Pharmacopœias of 1746
and 1788--henbane or hyoscyamus--to say nothing of ale. Another mixture,
compounded of many herbs and of clear ale, was to be drunk out of a
church-bell,[5] while seven masses were to be sung over the worts or
herbs, and the lunatic was to sing psalms, the priest saying over him
the _Domine, sancte pater omnipotens_.
Dioscorides and Apuleius are often the sources of the prescriptions of
the Saxons, at least as regards the herb employed. For a lunatic it is
ordered to "take clove wort and wreathe it with a red thread about the
man's swere (neck) when the moon is on the wane, in the month which is
called April, in the early part of October; soon he will be healed."
Again, "for a lunatic, take the juice of teucrium polium which we named
polion, mix with vinegar, smear therewith them that suffer that evil
before it will to him (_before the access_), and shouldest thou put the
leaves of it and the roots of it on a clean cloth, and bind about the
man's swere who suffers the evil, it will give an experimental proof of
that same thing (_its virtue_)."[6]
It is greatly to be regretted that the virtues ascribed to peony, used
not internally, but in the following way, are not confirmed by
experience. "For lunacy, if a man layeth this wort peony over the
lunatic, as he lies, soon he upheaveth himself hole; and if he have this
wort with him, the disease never again approaches him."[7]
Mandrake, as much as three pennies in weight, administered in a draught
of warm water, was prescribed for witlessness; and periwinkle (_Vinca
pervinca_) was regarded as of great advantage for demoniacal possession,
and "various wishes, and envy, and terror, and that thou may have grace,
and if thou hast this wort with thee thou shalt be prosperous and ever
acceptable."
Then follows an amusing direction: "This wort shalt thou pluck thus,
saying, 'I pray thee, _Vinca pervinca_, thee that art to be had for thy
many useful qualities, that thou come to me glad, blossoming with thy
mainfulnesses; that thou outfit me so, that I be shielded and ever
prosperous, and undamaged by poisons and by wrath;' when thou shalt
pluck this wort, thou shalt be clean from every uncleanness, and thou
shalt pick it when the moon is nine nights old, and eleven nights, and
thirteen nights and thirty nights, and when it is one night old."[8]
For epilepsy in a child a curious charm is given in this book, used also
for "a dream of an apparition." The brain of a mountain goat was to be
drawn through a golden ring, and then "given to the child to swallow
before it tastes milk; it will be healed."[9]
Wolf's flesh, well-dressed and sodden, was to be eaten by a man troubled
with hallucinations. "The apparitions which ere appeared to him, shall
not disquiet him."[10]
Temptations of the fiend were warded off by "a wort hight red
niolin--red stalk--which waxeth by running water. If thou hast it on
thee and under thy head bolster, and over thy house doors, the devil may
not scathe thee, within nor without" (lviii.).
Again, we have a cure for mental vacancy and folly: "Put into ale
bishopwort, lupins, betony, the southern (or Italian) fennel, nepte
(catmint), water agrimony, cockle, marche; then let the man drink. For
idiocy and folly: Put into ale cassia, and lupins, bishopwort,
alexander, githrife, fieldmore, and holy water; then let him drink."
Although hardly coming under my theme, I cannot omit this: "Against a
woman's chatter: Taste at night fasting a root of radish, that day the
chatter cannot harm thee."
For the temptations of the fiend and for night (goblin) visitors, for
fascination, and for evil enchantments by song, they prescribed as
follows:--"Seek in the maw of young swallows for some little stones, and
mind that they touch neither earth nor water nor other stones; look out
three of them; put them on the man on whom thou wilt, him who hath the
need, he will soon be well."
The ceremonial enjoined in making use of a salve against the elfin race
and nocturnal goblin visitors (nightmare) is extremely curious. "Take
the ewe hop plant (probably female hop), wormwood, bishopwort, lupin,
etc.; put these worts into a vessel, set them under the altar, sing over
them nine masses, boil them in butter and sheep's grease, add much holy
salt, strain through a cloth, throw the worts into running water. If any
ill tempting occur to a man, or an elf or goblin night-visitors come,
smear his forehead with this salve, and put it on his eyes, and where
his body is sore, and cense him with incense, and sign him frequently
with the sign of the cross; his condition will soon be better"
(lxi.).[11]
There is no doubt that in these prescriptions a distinction was made
between persons who were regarded as possessed and those supposed to be
lunatics. For the latter, however, the ecclesiastical element came in as
well as the medical one. Herbs were prescribed which were to be mixed
with foreign ale and holy water, while masses were sung over the patient
"Let him drink this drink," say they, "for nine mornings, at every one
fresh, and no other liquid that is thick and still; and let him give
alms and earnestly pray God for his mercies." The union of ale and holy
water forms an amusing, though unintentioned, satire on the jovial monk
of the Middle Ages. I may remark that the old Saxon term "_wood_" is
applied in these recipes to the frenzied. It survives in the Scotch
"wud," _i.e._ mad.[12] Thus for the "wood-heart" it is ordered that
"when day and night divide, then sing thou in the Church, litanies, that
is, the names of the hallows (or saints) and the Paternoster." This was,
as usual, accompanied by the taking of certain herbs and drink. In some
instances, a salve was to be smeared on the temples and above the eyes.
Medicated baths were not omitted in their prescriptions. Thus for a
"wit-sick man," as they call him, they say, "Put a pail full of cold
water, drop thrice into it some of the drink, bathe the man in the
water, and let him eat hallowed bread and cheese and garlic and
cropleek, and drink a cup full of the drink; and when he hath been
bathed, smear with the salve thoroughly, and when it is better with him,
then work him a strong purgative drink," which is duly particularized.
It is unnecessary to give more of these quaint prescriptions, one of
which is a drink "against a devil and dementedness" (an illustration, by
the way, how the one idea ran into the other); those which I have given
will suffice to show the kind of pharmacopœia in use, with the Saxon
monk-doctor, for madness. But did their treatment consist of nothing
more potent or severe than herbs and salves and baths? It would have
been surprising indeed had it not. And so we find the following
decidedly stringent application prescribed:--"In case a man be lunatic,
take a skin of mere-swine (that is, a sea-pig or porpoise), work it into
a whip, and swinge the man therewith; soon he will be well. Amen."[13]
Before taking leave of this interesting book I think that the impression
left on the mind of the reader in regard to the circumstances under
which it was written, will be clearer, if I cite the following
description by the editor:--"Here," he says, "a leech calmly sits down
to compose a not unlearned book, treating of many serious diseases,
assigning for them something he hopes will cure them.... The author
almost always rejects the Greek recipes, and doctors as an herborist....
Bald was the owner of the book, Cild the scribe. The former may be
fairly presumed to have been a medical practitioner, for to no other
could such a book as this have had, at that time, much interest. We see,
then, a Saxon leech at his studies; the book, in a literary sense, is
learned; in a professional view not so, for it does not really advance
man's knowledge of disease or of cures. It may have seemed by the solemn
elaboration of its diagnoses to do so, but I dare not assert there is
real substance in it.... If Bald was at once a physician and a reader of
learned books on therapeutics, his example implies a school of medicine
among the Saxons. And the volume itself bears out the presumption. We
read in two cases that 'Oxa taught this leechdom;' in another, that
'Dun taught it;' in another, 'some teach us;' in another, an impossible
prescription being quoted, the author, or possibly Cild, the reedsman,
indulges in a little facetious comment, that compliance was not
easy."[14]
Some light is thrown on the treatment of the insane in early English
days by a study of the "Chronicles and Memorials of Great Britain and
Ireland during the Middle Ages," published under the direction of the
Master of the Rolls. The inference to be drawn, however, is only that
which we might have drawn already from what I have stated. It is
observed by Mr. Brewer, the editor of one of these works, written by
Giraldus of Wales, who was born 1147, "For the sick, if medicine was
required, there was none to be had except in the monastery; and in this
country, at all events, the monks were the only medical
practitioners."[15] That at that time chains were employed for the
insane is incidentally shown by the following story. Walter Mapes,
chaplain to Henry II., when living in Gloucestershire, in the Forest of
Dean, fell ill. The abbot of a Cistercian house visited him, and used
his utmost efforts to induce him to become a monk of their order. Mapes,
who was well known to be inimical to Religious Orders, thereupon called
his clerks and attendants (he was a canon and archdeacon), and said, "If
ever in my sickness, or on any other occasion, I ask for this habit, be
certain that it arises not from the exercise of my reason, but the
violence of my disease, as sick men often desire what is foolish or
prejudicial. But should it ever so happen that I resolutely insist on
becoming a monk then bind me with chains and fetters as a lunatic who
has lost his wits, and keep me in close custody until I repent and
recover my senses." ("Tanquam furibundum et mente captum catenis et
vinculis me statim fortiter astringatis, et arcta custodia," etc.[16])
That at this period the influence of the moon in producing lunacy was
recognized (as, indeed, when and where was it not?) is proved by
observations of the above writer, Giraldus of Wales, in his
"Topographica Hibernica," vol. v. p. 79. "Those," he observes, "are
called lunatics whose attacks are exacerbated every month when the moon
is full." He combats the interpretation of an expositor of Saint
Matthew, who said that the insane are spoken of by him as lunatics, not
because their madness comes by the moon, but because the devil, who
causes insanity, avails himself of the phases of the moon (_lunaria
tempora_). Giraldus, on the contrary, observes that the expositor might
have said not less truly that the malady was in consequence of the
humours being enormously increased in some persons when the moon is
full.
The name of Giraldus is associated with a celebrated holy well in
Flintshire, that of St. Winifred, said to be the most famous in the
British Isles. At her shrine he offered his devotions in the twelfth
century, when he says, "She seemed still to retain her miraculous
powers." The cure of lunacy at this well is not particularized, but it
is highly probable from the practice resorted to, as we shall see, at
others in Britain.[17]
I may here say that there is not much to be found in Chaucer (1328-1400)
bearing in any way upon the insane, though he occasionally uses the word
"wodeness" for madness, and "wood" or "wod" for the furiously
insane.[18] So again in an old English miscellany of the thirteenth
century, translated from the Latin, we read--
"Ofte we brennen in mod
And werden so weren wod;"
that is to say, "Oft do we burn in rage and become as it were mad."
I have, in examining that curious book, the "Vision of William
concerning Piers the Plowman," written in 1393 by William Langland,[19]
found one or two passages having reference to my subject which are worth
citing. The author, after saying that beggars whose churches are
brew-houses may be left to starve, adds that there are some, however,
who are idiotic or lunatic. He also says that men give gifts to
minstrels, and so should the rich help God's minstrels, namely,
lunatics. This is one of the rare instances in which the insane are
spoken of in kindly terms by the old writers, although it would be quite
unfair to regard what was doubtless harsh treatment as intentionally
cruel. Piers the Plowman speaks of men and women wanting in wit, whom he
styles "lunatik lollares," that is, persons who loll about, who care for
neither cold nor heat, and are "meuynge after the mone." He says that--
"Moneyless they walke
With a good wil, witless, meny wyde contreys
Ryght as Peter dade and Paul, save that they preche nat."
In many instances mistaken kindness, in others ignorance and
superstition, guided the past treatment of the insane. When residing in
Cornwall some years ago, I was interested in the traditions of that once
isolated county, and heard of a practice long since discontinued, which
illustrates this observation. It was called "bowssening" (or ducking)
the lunatic, from a Cornu-British or Armoric word, _beuzi_ or _bidhyzi_
meaning to baptize, dip, or drown.[20] There were, it seems, many places
where this custom was observed in Cornwall, but the one I now refer to
was at Altarnun, and was called St. Nun's Pool. It is situated about
eight miles from Launceston. Though the name of this saint gives the
impression of her being a nun, it appears that she was a beautiful girl,
with whom Cereticus, a Welsh prince, fell in love. According to
tradition, she was buried at Altarnun. The church was afterwards
dedicated to St. Mary. The water from the pool was allowed to flow into
an enclosed space, and on the surrounding wall the patient was made to
stand with his back to the water, and was then by a sudden blow thrown
backwards into it. Then (to quote a graphic description which has been
given of it), "a strong fellowe, provided for the nonce, tooke him and
tossed him up and downe alongst and athwart the water, untill the
patient by forgoing his strength had somewhat forgot his fury. Then was
he conveyed to the church, and certain masses sung over him, upon which
handling, if his right wits returned, St. Nunne had the thanks; but if
there appeared small amendment, he was bowssened againe and againe while
there remayned in him any hope of life, for recovery." Men who had
actually witnessed this treatment of lunacy related this narrative to
Carew, the author of the "Survey of Cornwall," published in 1769, and he
gives an explanation of the custom which is no doubt erroneous, but is
curious for other reasons. "It may be," he says, "this device took
original from the Master of Bedlam, who (the fable sayeth) used to cure
his patients of that impatience by keeping them bound in pools up to the
middle, and so more or less after the fit of their fury" (p. 123). The
present Master goes further, and keeps them up to the neck in a
prolonged warm bath!
The Vicar of Altarnun, Rev. John Power, in response to my inquiries, has
been good enough to ask the oldest men in the parish whether they
remembered the well being so used, but they do not. At the corner of a
meadow there is still an intermittent spring, flowing freely in wet
weather. The tank which was formerly on the spot has gone, the farmers
having removed the stone in order to mend the fences, and consequently
much of the water has been diverted into other channels, emptying
itself into the river St. Inny, which runs a few hundred yards in the
valley below. It seems probable that the working of a large stone quarry
in the hills above has cut off the main current of the spring.
To Carew's account Dr. Borlase adds that in his opinion "a similar
bowssening pit has existed at a well in St. Agnes' parish." Among other
Cornish wells which had healing virtues assigned them was St. Levan's,
and the insane, no doubt, partook of them. "Over the spring," says Dr.
Boase, "lies a large flat stone, wide enough to serve as a foundation
for a little square chapel erected upon it; the chapel is no more than
five feet square, seven feet high, the little roof of it of stone. The
water is reckoned very good for eyes, toothache, and the like, and when
people have washed, they are always advised to go into this chapel and
sleep upon the stone, which is the floor of it, for it must be
remembered that whilst you are sleeping upon these consecrated stones,
the saint is sure to dispense his healing influence." Madron Well
attained a great celebrity for healing diseases and for divining. "Girls
dropped crooked pins in to raise bubbles and divine the period of their
marriage."[21]
Mr. W. C. Borlase, M.P., informs me that at St. Kea, near Truro, within
the walls of the church, was a stone to which, within the memory of an
old gentleman who died only about two years ago, an inhabitant of the
parish, on becoming insane, was chained. He adds that just as Altarnun
is Nun's altar, the parish of Elerky is derived from St. Kea's altar
(Eller or Aller-kè).
Scotland was still more remarkable than Cornwall for its lunacy-healing
wells and extraordinary superstitions, surviving also to a much later
period; in fact, not yet dispelled by civilization and science. Every
one has heard of St. Fillan's Well (strictly, a pool) in Perthshire, and
knows the lines in "Marmion"--
"Then to Saint Fillan's blessed well,
Whose spring can frenzied dreams dispel,
And the crazed brain restore."
This well, derived from the river of that name in the vale of
Strathfillan, and consecrated by the saint who, according to tradition,
converted the inhabitants to Christianity,[22] has been ever since
distinguished by his name, and esteemed of sovereign virtue in curing
madness.
There was an abbot living in the Vale of St. Fillan in 1703. "He is
pleased," says Pennant, in his "Tour in Scotland" (vol. ii. p. 15), "to
take under his protection the disordered in mind; and works wonderful
cures, say his votaries, unto this day." It was, he says, a second
Bethesda. He wrote in 1774.
Mr. Heron, the author of a "Journey through Part of Scotland," made in
the year 1793, observes that in his day "about two hundred persons
afflicted in this way are annually brought to try the benefits of its
salutary influence. These patients," he continues, "are conducted by
their friends, who first perform the ceremony of passing with them
thrice round a neighbouring cairn; on this cairn they then deposit a
simple offering of clothes, or perhaps of a small bunch of heath.... The
patient is then thrice immerged in the sacred pool; after the immersion
he is bound hand and foot, and left for the night in a chapel which
stands near. If the maniac is found loose in the morning, good hopes are
conceived of his full recovery. If he is still bound, his cure remains
doubtful. It sometimes happens that death relieves him during his
confinement from the troubles of life."[23]
An Englishman who visited the spot five years afterwards (1798) says the
patient was fastened down in the open churchyard on a stone all the
night, with a covering of hay over him, and St. Fillan's bell put over
his head. The people believed that wherever the bell was removed to, it
always returned to a particular place in the churchyard next morning.
"In order to ascertain the truth of this ridiculous story, I carried it
off with me," continues this English traveller. "An old woman, who
observed what I was about, asked me what I wanted with the bell, and I
told her that I had an unfortunate relation at home out of his mind, and
that I wanted to have him cured. 'Oh, but,' says she, 'you must bring
him here to be cured, or it will be of no use.' Upon which I told her
he was too ill to be moved, and off I galloped with the bell." To make
this story complete, I should add that the son of this gentleman,
residing in Hertfordshire, restored to Scotland this interesting relic,
after the lapse of seventy-one years, namely, in 1869.
At Struthill, in Stirlingshire, was a well famous for its healing
virtues in madness. "Several persons," says Dalyell, "testified to the
Presbytery of Stirling in 1668, that, having carried a woman thither,
they had stayed two nights at an house hard by the well; that the first
night they did bind her twice to a stone at the well, but she came into
the house to them, being loosed without any help; the second night they
bound her over again to the same stone, and she returned loosed; and
they declare also, that she was very mad before they took her to the
well, but since that time she is working and sober in her wits." He adds
that this well was still celebrated in 1723, and votive offerings were
left; but no one then surviving knew that the virtues of the stone were
in request. The chapel itself was demolished in 1650, in order to
suppress the superstitions connected with this well.[24]
The virtues of St. Ronan's Well were renowned of old, and are still
credited. The lunatic walks round the Temple of St. Molonah, whose ruin
near the Butt of Lewis remains. He is sprinkled with water from the
well, is bound, and placed on the site of the altar for the night. A
cure is expected, if he sleep; if not, the fates are considered adverse,
and he returns home. My authority, Dr. Mitchell, records a case of
recovery.
There is in Ross-shire a small Island on Loch Maree, called Inch or
Innis Maree, where is a famous well, bearing the name of this saint,[25]
who lived at the beginning of the eighth century. This well was
celebrated for its virtues in the cure of mental disorders. Pennant, the
author already quoted, visited it in 1769, and gave a graphic
description of the superstitious practices connected with its supposed
sanctity. "The curiosity of the place," he writes, "is the well of the
saint, of power unspeakable in cases of lunacy. The patient is brought
into the sacred island, is made to kneel before the altar where his
attendants leave an offering in money; he is then brought to the well
and sips some of the holy water; a second offering is made; that done,
he is thrice dipped in the lake, and the same operation is repeated
every day for some weeks; and it often happens, by natural causes, the
patient receives relief, of which the saint receives the credit. I must
add that the visitants draw from the state of the well an omen of the
disposition of St. Maree; if his well is full they suppose he will be
propitious; if not, they proceed in their operations with fears and
doubts, but let the event be what it will, he is held in high
esteem."[26]
This practice was, no doubt, closely connected with the belief of the
inhabitants that the insane were possessed. "To preclude the demon from
lurking in the hair, a special water was sometimes used; the patient was
plunged over head and ears in a bath of Gregorian water,[27] and
detained there just up to the drowning point."[28] Dr. Mitchell
(Commissioner in Lunacy in Scotland) has given a most interesting
account of similar Scotch customs associated with their treatment of
their insane, practised from time immemorial, and therefore illustrating
the proceedings of a remote antiquity, pagan as well as Christian. But I
must content myself with a very brief reference to his descriptions.
Writing of the island of Maree in 1862, he states that about seven years
before a furious madman was brought there; "a rope was passed round his
waist, and with a couple of men at one end in advance, and a couple at
the other behind, like a furious bull to the slaughter-house, he was
marched to the Loch side and placed in a boat, which was pulled once
round the island, the patient being jerked into the water at intervals.
He was then landed, drank of the water, attached his offering to the
tree, and, as I was told, in a state of happy tranquillity went
home."[29]
Whittier has expressed in verse the virtues of the well of St. Maree, as
Scott those of St. Fillan:--
"And whoso bathes therein his brow,
With care or madness burning,
Feels once again his healthful thought
And sense of peace returning.
"O restless heart and fevered brain,
Unquiet and unstable,
That holy well of Loch Máree
Is more than idle fable."
Of another place, the island of Melista, in the Hebrides, it is stated
that, according to tradition, no one was ever born there who was not
from birth insane, or who did not become so before death. "In the last
generation, three persons had the misfortune for the first time to see
the light of day on this unlucky spot, and all three were mad. Of one of
them, who is remembered by the name of Wild Murdoch, many strange
stories are told. It is said that his friends used to tie a rope round
his body, make it fast to the stern of the boat, and then pull out to
sea, taking the wretched man in tow. The story goes that he was so
buoyant he could not sink; that they 'tried to press him down into the
water;' that he could swim with a stone fastened to him; that when
carried to the rocky holms of Melista or Greinan, round which the open
Atlantic surges, and left there alone, he took to the water and ran
ashore; and that when bound hand and foot, and left in a kiln, by a
miracle of strength he broke his bonds and escaped. It is thus they are
said to have treated him during his fits of maniacal excitement; and
there are many still alive who saw it all, and gave a helping hand....
The further story of Wild Murdoch will astonish no one. He murdered his
sister, was taken south, and died in an asylum, or, as the people say
and believe, in the cell of a gloomy prison, under which the sea-wave
came and went for ever."[30]
Curious ancient superstitions besides those connected with wells still
survive in the "land o' cakes." The same observant writer says that in
the north of Scotland they literally sacrifice a cock to a nameless but
secretly acknowledged power, whose propitiation is sought in the cure of
epilepsy. On the spot where the patient falls a black cock is buried
alive, along with a lock of the patient's hair, and some parings of his
nails. Let it not be supposed that this was done in some outlandish part
of the world. Dr. Mitchell assures us that this sacrifice was openly
offered recently in an improving town to which the railway now conveys
the traveller, and which has six churches and ten schools for a
population of about four thousand. If such things are done in the green
tree, what must have been done in the dry? We may safely read the past
in the present. In fact, Dalyell[31] states that in 1597 the "earding of
ane quik cok in the grund" was regarded as a cure of madness.
He also records the fact that a Scotch empiric of the seventeenth
century professed the cure of those "'visseit with frenacies, madness,
falling evil (epilepsy), persones distractit in their wittis, and with
feirful apparitiones, etc., and utheris uncouth diseases; all done be
sorcerie, incantation, devellische charmeing.' Above forty persons are
enumerated for whom he had prescribed, for which he was strangled and
burnt as too familiar with Satan."[32] The same author relates that a
poor woman having become frantic, the alleged author of the malady came,
and "laying hands on hir, she convaleschit and receivit hir sinsis
agane."[33] This was in 1616.
Insane persons were sometimes treated with holy water, to which _salt_
was added, with the idea that the devil abhorred salt as the emblem of
immortality (we have already had to notice this use of salt among the
Saxons). Hence it was "consecrated by the papists, as profiting the
health of the body, and for the banishment of demons." A certain
remedial "watter," used in Scotland by wise women or herbalists, is
supposed to have contained the same ingredient. Elspeth Sandisone, in
1629, was bereft of her senses. One Richart was thus accused of having
tried to cure her. "Ye call the remedie 'watter forspeking,' and took
watter into ane round cape and went out into the byre, and took sumthing
out of your purse lyk unto great salt, and did cast thairin, and did
spit thrie severall times in the samen; and ye confest yourself when ye
had done so, ye _aunchit in bitts_, quhilk is ane Norne terme, quhilk is
to say ye blew your braith thairin and thairefter ye sent it to the said
Elspeth with the servand woman of the hous, and bad that the said
Elspeth sould be waschit thairin, hands and feit, and scho sould be als
holl as ever scho was."[34]
I may give here a curious illustration of insanity being induced, not
cured, by superstition in Scotland. John Law's servant "rane wode" when
John Knox had retreated to St. Andrews during the civil contentions of
his later years. The story is thus quaintly told in Bannatyne's
"Journal" (p. 309). John Law of that city, being in Edinburgh Castle in
January, 1572, "the ladie Home wald neidis thraip in his face that he
was banist the said toune because that, in the yarde reasit (rose) sum
sanctis, among whome cam up the devill with hornis, which when his
servant Ritchart saw, rane wode, and so deit."[35]
But I must not dwell longer on the treatment of lunatics by the
Highlanders, or the superstitions of Scotland in this connection, and
will now say a few words in reference to Ireland.
It would be easy to narrate the stories which in Ireland connect popular
superstition with the treatment of the insane, but I will only refer to
one. The reader may have heard of the "Valley of the Lunatics," or
Glen-na-galt, in that country. It is situated in Kerry, near Tralee. It
was believed, not only in that county, but in Ireland generally, that
all lunatics would ultimately, if left to themselves, find their way to
this glen to be cured.[36] In the valley are two wells, called the
"Lunatic's Wells," or Tober-na-galt, to which the lunatics resort,
crossing a stream flowing through the glen, at a point called the
"Madman's Ford," or Ahagaltaun, and passing by the "Standing Stone of
the Lunatics" (Cloghnagalt). Of these waters they drink, and eat the
cresses growing on the margin; the firm belief being that the healing
water, and the cresses, and the mysterious virtue of the glen will
effectually restore the madman to mental health.
Dr. Oscar Woods, the medical superintendent of the District Lunatic
Asylum, Kilkenny, informs me that the superstition has nearly died out
since this asylum was opened, about thirty years ago. Dr. Woods gives a
different etymology, namely, _bright_, for _galt_; the valley in that
case deriving its name in contradistinction to that on the other side of
the hill, Emaloghue, on which the sun scarcely ever shines. He thinks
the superstition arose from persons labouring under melancholy going
from the sunless to the bright valley. "Why this place," wrote Dr. C.
Smith in 1756,[37] "rather than any other should be frequented by
lunatics, nobody can pretend to ascertain any rational cause, and yet no
one truth is more firmly credited here by the common people than this
impertinent fable." He, however, says that having regard to the awful
appearance of these desolate glens and mountains, none but madmen would
enter them! Recurring to the meaning of the word _galt_, a gentleman in
Ireland, a professor of Irish, states that _geilt_ is a mad person, one
living in the woods, and that _gealt_ is the genitive plural. It is
interesting to find, also, from the same source, that the Irish word for
the moon is _gealach_, indicating a probable etymological connection.
As to the origin of this superstition, it appears to be of very ancient
date. It is stated[38] that the Fenian tale, called "Cath Finntraglia,"
or "The Battle of Ventry," relates how Daire Dornmhar, "the monarch of
the world," landed at Ventry to conquer Erin, and was opposed in mortal
combat by Finnmac-Cumhail and his men. The battles were many and lasted
a year and a day, and at last the "monarch of the world" was completely
repulsed, and driven from the shores of Ireland. In the battle, Gall,
the son of the King of Ulster, only a youth, who had come to the help of
Finnmac-Cumhail, "having entered the battle with extreme eagerness, his
excitement soon increased to absolute frenzy, and, after having
performed astounding deeds of valour, fled in a state of derangement
from the scene of slaughter, and never stopped till he plunged into the
wild seclusion of this valley." The opinion is that this Gall was the
first lunatic who went there, and that with him this singular local
superstition originated, followed as it has been by innumerable
pilgrimages to the beautiful "Valley of Lunatics" and its wells.
A visitor to this valley in 1845 writes: "We went to see Glenagalt, or
the 'Madman's Glen,' the place, as our guide sagely assured us, 'to
which all the mad people in the world would face, if they could get
loose.' After pursuing for miles our romantic route, we came to the
highest part of the road, and turned a hill which completely shut out
Glen Inch; and lo! before us lay a lovely valley, sweeping down through
noble hills to Brandon Bay. The peak of the mighty Brandon himself ended
one ridge of the boundary, while high, though less majestic, mountains
formed the other; and this valley so rich and fertile, so gay with
cornfields, brown meadows, potato gardens, and the brilliant green of
the flax, so varied and so beautiful in the bright mingling of Nature's
skilful husbandry, was the 'Madman's Glen.' I felt amazed and
bewildered, for I had expected to see a gloomy solitude, with horrid
crags and gloomy precipices. Not at all; the finest and richest valley
which has greeted my eyes since we entered the Highlands of Kerry is
this--smiling, soft, and lovely.
"We took our leave of fair Glenagalt, and assuredly if any aspect of
external nature could work such a blessed change, the repose, peace, and
plenty of this charming valley would restore the unsettled brain of a
poor unfortunate."[39]
The late Professor Eugene O'Curry, in his work on the "Manners and
Customs of the Ancient Irish," published in 1873, makes no reference to
madness, idiocy, or possession. He refers to a sort of witchcraft under
the head of divination, where he gives an instance of a trance produced
by magical arts; of the mad rage of the hero, and of how, in the midst
of that rage, he was caught, as it were, by the hands and feet, through
Druidical incantations.[40]
Returning to England, let the reader imagine himself in London in the
early and middle part of the sixteenth century. There, in St. Giles's,
might have been seen a physician, Dr. Borde, who, born in 1490 in
Sussex, had made some practice in the metropolis, including that of
mental disorders. He had been a Carthusian monk, but was "dispensed of
religion," studied medicine, and followed the medical profession, first
at Glasgow, and then in London. What, it may be asked, would have been
his method of caring for lunatics? The answer may be found in a curious
book which he wrote, entitled "A Compendious Rygment or a Dyetry of
Helth," and published in 1542.[41] There are several references, of much
interest, to insanity. One chapter of the book is headed, "An order and
a dyett for them the whiche be madde and out of theyr wytte." In it the
doctor says, "I do advertyse every man the whiche is madde or lunatycke
or frantycke or demonyacke, to be kepte in safegarde in some close house
or chamber where there is lytell light; and that we have a keeper the
whiche the madde man do feare." The remainder is conceived in quite a
kindly spirit. The patient is to have no knife or shears; no girdle,
except a weak list of cloth, lest he destroy himself; no pictures of man
or woman on the wall, lest he have fantasies. He is to be shaved once a
month, to drink no wine or strong beer, but "warm suppynges three tymes
a daye, and a lytell warm meat." Few words are to be used except for
reprehension or gentle reformation.
This, then, is the way in which a well-intentioned doctor would take
care of a lunatic in the reign of Henry VIII. We wish that all the
treatment pursued had been as considerate. That it was not so we shall
see; but I would first add the curious experience of Dr. Borde in Rome,
which he visited, and where he witnessed the treatment of a lunatic
which was very singular, and founded on the vulgar notion of his being
possessed. He says that to a marble pillar near St. Peter's, persons
supposed to be possessed, that is, insane, were brought, and said to be
cured. A German lady was the patient when the English physician was the
spectator, and he describes her as being taken violently by some twenty
men to the pillar, or rather into it, for it appears to have contained a
chamber; "and after her did go in a priest, and did examine the woman in
this manner. 'Thou devil or devils, I adjure thee by the potential power
of the Father and the Son our Lord Jesus Christ, and by the virtue of
the Holy Ghost, that thou do show to me for what cause thou doest
possess this woman?'" What words were answered, Dr. Borde says he will
not write, "for men will not believe it, but would say it were a foul
and great lie." What he heard made him afraid to tarry, lest the demons
should have come out of her and entered into him. We are not left in
doubt as to his belief in the possession of lunatics. "I considering
this," he says, "and weke of faith and afeard crossed myself and durst
not hear and see such matters for it was so stupendous and above all
reason if I should write it." It is certainty a pity that the worthy
doctor did not stay longer to watch, and to record in his graphic
language, the effect of the treatment.
From the same motives lunatics in Great Britain were bound to holy
crosses. Sir David Lyndsay, in his poem called "Monarche," written
nearly four hundred years ago, says--
"They bryng mad men on fuit and horsse,
And byndes theme to Saint Mangose Crosse."
To this cross (at Lotherwerd, now Borthwick, county Edinburgh), says an
old writer, Jocelin, a monk of Furness, "many labouring under various
disorders, and especially the furious and those vexed with demons, are
bound in the evening; and in the morning they are often found sane and
whole, and are restored to their liberty."[42]
The resort to pillars of churches is illustrated by what an Augustine
Canon of Scone says, in a work on the rule of his foundation (Paris,
1508), for he protests against the desecration of churches, _with the
exception of curing lunatics_ in the way I have just described, as being
bound to the church pillars.
Nearly a hundred years after Dr. Borde wrote, that remarkable work was
published, "The Anatomy of Melancholy," by Burton. Some quaint lines and
a rough engraving on the title-page illustrate but too well the
treatment of the insane familiar to him, although not a physician; it
seems worse, instead of better, than that of the doctor of St. Giles.
"But see the madman rage downright
With furious looks, a ghastly sight!
Naked in chains bound doth he lie
And roars amain, he knows not why."
The first edition of Burton's work was published in 1621, five years
after the death of Shakespeare, who speaks, in "As You Like It" (Act
iii. sc. 2), of madmen deserving "a dark house and a whip," and in
"Twelfth Night" makes Sir Toby say of Malvolio (Act iii. scene 4),
"Come, we'll have him in a dark room and bound." The medical treatment
of melancholia contained in Burton consists mainly of herbs, as borage,
supposed to affect the heart, poppies to act on the head, eupatory
(teazel) on the liver, wormwood on the stomach, and endive to purify the
blood. Vomits of white hellebore or antimony, and purges of black
hellebore or aloes, are prescribed.
The famous "Herbal" of Gerarde, published in 1597, gives various
remedies for madness, but they are, unfortunately, copied for the most
part from Dioscorides, Galen, and other ancient writers. They are so far
of interest that they show what was accepted as the best-known drug
practice at the time in England in mental disorders. Under "A Medicine
against Madnesse" we have rhubarb and wild thyme, the latter being "a
right singular remedie to cure them that have had a long phrensie or
lethargie." He is here only following Aetius, and when he says, "Besides
its singular effects in splenetical matters, it helpeth any disease of
melancholy," he appears to follow Galen. Feverfew is said to be "good
for such as be melancholike, sad, pensive, and without speech." Syrup
made of flowers of borage "comforteth the heart, purgeth the melancholy,
and quieteth the phrenticke or lunaticke person." Hellebore, of course,
has its virtues recognized. Black hellebore, or the Christmas rose,
"purgeth all melancholy humors, yet not without trouble and difficultie,
therefore it is not to be given but to robustious and strong bodies as
Mesues teacheth. It is good for mad and furious men, for melancholy,
dull, and heavy persons, for those that are troubled with the falling
sickness (epilepsy)," and "briefely for all those that are troubled with
blacke choler, and molested with melancholy."[43]
Gerarde strongly commends "that noble and famous confection _Alkermes_,
made by the Arabians," containing the grains of the scarlet oak (_Ilex
coccigera_). "It is good against melancholy deseases, vaine
imaginations, sighings, griefe and sorrow without manifest cause, for
that it purgeth away melancholy humors" (p. 1343). Poultices applied to
the head, of mustard and figs, are recommended for epilepsy and
lethargy. Gerarde adopts from Apuleius the virtues of double yellow and
white batchelor's buttons, hung "in a linnen cloath about the necke of
him that is lunaticke, in the waine of the moone, when the signe shall
be in the first degree of Taurus or Scorpio."
Such are the principal remedies for insanity given by Gerarde, original
and second hand.
Returning to Burton, it should be said that among the causes of the
disease he distinctly recognizes the same uncanny influence that his
contemporaries Coke and Hale regarded as a legal fact--I mean
witchcraft. After saying that "many deny witches altogether, or, if
there be any, assert that they can do no harm," of which opinion, he
adds, "is our countryman (Reginald) Scot (of Kent),[44] but of the
contrary opinion are most lawyers, physicians, and philosophers," he
proceeds, "They can cause tempests, etc., which is familiarly practised
by witches in Norway, as I have proved, and, last of all, cure and cause
most diseases to such as they hate, _as this of Melancholy among the
rest_."[45]
It may be asked, What was the medical knowledge or practice at the time
of Coke and Hale, to which they would turn for direction when insanity
came before them in the courts of law? and I think a correct reply would
be best obtained by taking this wonderful book of Burton's, the works of
Sir Thomas Browne, who gave evidence before Hale, and what may be called
the case-book of the celebrated Court physician, Sir Theodore de
Mayerne. A Genevese, he settled in England in 1606, and was regarded as
the highest authority in mental and nervous affections. A medical work
of his was translated into Latin by Bonet. Mayerne's treatment was
certainly of a somewhat cumbrous character, and his patients must have
had an unusual and commendable amount of perseverance if they pursued it
thoroughly. The drugs probably cured in part, at least, from the duty
entailed upon the patients of collecting the numerous herbs which were
ordered for the composition of the mixture, and Sir Theodore truly and
naïvely remarks to one of his patients, "It will take some time before
you have mixed your medicine." It is clear that he was under the
influence of the old belief in the connection between the liver and
insanity, and the paramount importance of getting rid of the black bile.
Of one case he asserts that the root of all the griefs wherewith the
patient has been afflicted is a melancholy humour, generated in the
liver and wrought upon in the spleen. This humour is stated to be mixed
in the veins, and so extended to the brain, which this offensive enemy
of nature doth assault as an organical part. Hence, he says, it happens
that the principal functions of the soul do act erroneously. His
treatment consisted of emetics, purges, opening the veins under the
tongue, blisters, issues, and shaving the head, followed by a cataplasm
upon it, the backbone anointed with a very choice balsam of earthworms
or bats. One prescription for melancholia contains no less than
twenty-seven ingredients, to be made into a decoction, to which is to be
added that _sine quâ non_, the ever precious hellebore. Other remedies
were prescribed; in some cases the "bezoartick pastills," composed of an
immense number of ingredients, including the skull of a stag and of a
healthy man who had been executed. The commentary triumphantly made by
this lover of polypharmacy in the case in which this medicine was
administered, runs thus:--"These things being exactly performed, this
noble gentleman was cured." With certain modifications, the general
treatment here indicated was that in fashion at the period to which I
refer, and was based on a strong conviction of the presence of certain
peccant humours in the body, affecting the brain, which required
elimination.
Mayerne, of whom there is a portrait in the College of Physicians, was
physician to more crowned heads than has fallen to the lot of probably
any other doctor, namely, Henry IV. of France, James I. of England, his
queen, Anne of Denmark, Charles I., and Charles II. He introduced
calomel into practice. Dying in 1654/5, he was buried in the church of
St. Martin's-in-the-Fields, where a monument was erected to his
memory.[46]
The royal author of the book on Demonology (first published in
1597)--the high and mighty Prince James--gives sundry learned reasons
why witches are not to be regarded as mad, and why, therefore, the plea
of insanity should be rejected in the legal tribunals. Written in the
form of a dialogue between Philomathes and Epistemon, the latter, who
personates the king, says, "As to your second reason (that Witchcraft is
but very melancholique imagination of simple raving creatures), grounded
upon Physicke, in attributing the confessions or apprehensions of
Witches to a natural melancholique humour, any one that pleased
physikally to consider upon the natural humour of Melancholy, according
to all the physicians that ever writ thereupon, shall find that that
will be over short a cloake to cover their knavery with."[47]
James is very wroth with Reginald Scot and Wierus[48] for their
opposition to the prevalent belief, and urges, as proof of the existence
of witches ("which have never fallen out so clear in any age or
nation"), daily experience and their confessions. Reginald Scot had
dared to write, in his "Discovery of Witchcraft" (1584): "Alas, I am
sorry and ashamed to see how many die who being said to be bewitched,
only seek for magical cures, whom wholesome diet and good medicines
would have recovered.... These affections tho' they appear in the mind
of man, yet are they bred in the body and proceed from the humour which
is the very dregs of the blood; nourishing those places from whence
proceed fear, cogitations, superstitions, fastings, labours, and such
like."
It is striking to observe how much more enlightened this writer was than
a physician to whom I have already referred, Sir Thomas Browne. His
famous sentence, in which he gives full credence to witches, makes us
obliged to admit that when so distinguished a man entertained such
superstitious notions, we cannot be much surprised if contemporary
judges regarded many of the really insane as witches, although they had
before them the enlightened opinions of Reginald Scot.
The history of _incubi_, or "night-comers," is doubtless, to a large
extent, a narrative of the hallucinations, delusions, and automatic
thoughts of the insane, although to _what_ extent would be a difficult
question to determine, because some were assuredly frightened into the
confessions which they made; and, further, it is hard to say how much of
a certain belief was due to the current popular ignorance and credulity,
and how much to actual mental disease. Still the ignorant opinions of an
age find their _nisus_ and most rapid development in persons of weak or
diseased mind, and they form the particular delusion manifested; and at
a period when witches are universally believed in, there must be some
reason why one believes he or she has had transactions with Satan, and
another does not believe it. It is, indeed, impossible to read the
narratives of some of the unfortunate hags who were put to death for
witchcraft, without recognizing the well-marked features of the victims
of cerebral disorder. In this way I have no doubt a considerable number
of mad people were destroyed. Their very appearance suggested to their
neighbours the notion of something weird and impish; the physiognomy of
madness was mistaken for that of witchcraft, while the poor wretches
themselves, conscious of unaccustomed sensations and singular
promptings, referred them to the agency of demons. Strangely enough,
even an inquisitor--Nider, who died in 1440--gives many instances of
persons whose symptoms he himself recognized as those not of possession,
but of madness.
It is hardly necessary to say that the treatment of the unfortunate
lunatics and epileptics who were judged to be witches by James I. was
nothing else than death, and he thus coolly comments on this punishment:
"It is commonly used by fire, but that is an indifferent thing, to be
used in every country, according to the law or custom thereof."[49]
I cannot pass from this subject without doing honour to two men who
abroad, no less than Reginald Scot in Britain, opposed the immolation of
lunatics--Wierus, physician to the Duke of Cleves, who wrote a
remarkable work in 1567, and appealed to the princes of Europe to cease
shedding innocent blood; and Cornelius Agrippa,[50] who interfered in
the trial of a so-called witch in Brabant, having sore contention with
an inquisitor, who through unjust accusations drew a poor woman into his
butchery, not so much to examine as to torment her. When Agrippa
undertook to defend her, alleging there was no proof of sorcery, the
inquisitor replied, "One thing there is which is proof and matter
sufficient; for her mother was in times past burnt for a witch." When
Agrippa retorted that this had reference to another person, and
therefore ought not to be admitted by the judge, the inquisitor was
equal to the occasion, and replied that witchcraft was naturally
engrafted into this child, because the parents used to sacrifice their
children to the devil as soon as they were born. On this Agrippa boldly
exclaimed, "Oh, thou wicked priest, is this thy divinity? Dost thou use
to draw poor guiltless women to the rack by these forged devices? Dost
thou with such sentences judge others to be heretics, thou being a
greater heretic than either Faustus or Donatus?" The natural consequence
was that the inquisitor then threatened to proceed against the advocate
himself as a supporter of witches; nevertheless, he continued his
defence of the unhappy woman, who, whether a lunatic or not, was
delivered, we read, by him "from the claws of the bloody monk, who, with
her accuser, was condemned in a great sum of money, and remained
infamous after that time to almost all men."
Scot, who cites this case, shows great familiarity with examples of
melancholy and delusion, and from his work have been derived many of the
best known illustrations of the latter, including the delusions of being
monarchs, brute beasts, and earthen pots greatly fearing to be broken.
The old story of the patient who thought Atlas weary of upholding the
heavens and would let the sky fall upon him, is narrated by this author,
as well as that of the man who believed his nose to be as big as a
house.
It comes then, to this--to revert to the question, what was the medical
knowledge or practice at the time of Coke and Hale, to which they would
turn for direction when insanity came before them in the Courts of
Law?--that when the lawyers went to the doctors for light they got
surprisingly little help. They had better have confined themselves to
reading the old Greek and Roman books on medicine, of which the medical
practice of that period was but a servile imitation, and not have added,
from their belief in witchcraft, the horrible punishment of lunatics,
which in our country extended over the period between 1541 and 1736,
when the laws against witchcraft were abolished. The last judicial
murder of a witch in the British Isles (Sutherlandshire) was in 1722.
Leaving now the insane who were punished as witches, I pass on to remark
that in Percy's "Reliques of Ancient English Poetry," it is stated that
the English have more songs and ballads on the subject of madness than
any of their neighbours. "Whether," the writer proceeds, "there be any
truth in the insinuation that we are more liable to this calamity than
other nations,[51] or that our native gloominess hath peculiarly
recommended subjects of this class to our writers, we certainly do not
find the same in the printed collections of French and Italian songs."
Half a dozen so-called mad songs are selected. These refer to much the
same period as that we have been considering; and, in fact, we come upon
the "Old Tom of Bedlam," or Cranke or Abram man, who "would swear he had
been in Bedlam, and would talk frantickly of purpose," so notorious in
connection with the beggary which endeavoured to make capital out of the
asylum most familiar to our ancestors of the sixteenth and seventeenth
centuries. In this light the Bedlam beggars appear in "King Lear"--
"The country gives me proof and precedent
Of Bedlam beggars, who, with roaring voices,
Stick in their numb'd and mortify'd bare arms
Pins, wooden pricks, nails, sprigs of rosemary;"
and these enforce their charity by lunatic "bans," that is, by licences
to beg under the badge of the Star of Bethlehem.
Some doggerel from the most ancient of the Percy "Reliques" will serve
for a sample of the rest:
"Forth from my sad and darksome cell,
Or from the deepe abysse of Hell,
Mad Tom is come into the world againe,
To see if he can cure his distemper'd braine."
Tom appears to have brought away with him some of his fetters, then
sufficiently abundant in Bedlam:
"Come, Vulcan, with tools and with tackles,
To knocke off my troublesome shackles."
_This_ method of treatment--by fetters--has not, it may be well to
state, survived, like immersion, in the practice of the present Master
of Bedlam.
We learn from Shakespeare how "poor Tom that eats the swimming frog, the
toad, the tadpole, the wall-newt and the water [newt]; ... swallows the
old rat, and the ditch-dog;" and "drinks the green mantle of the
standing pool," was "whipped from tything to tything, and stocked,
punished, and imprisoned....
Mice, and rats, and such small deere
Have been Tom's food for seven long yeare."[52]
Whipping-posts were very common in the reign of Henry VIII., and we
suppose long before; certainly also much later. About the middle of the
seventeenth century an old poet, John Taylor, once a waterman on the
Thames, and hence called the "Water Poet," wrote:
"In London, and within one mile, I ween,
There are of jails and prisons full eighteen,
And _sixty whipping-posts_ and stocks and cages."
The whipping-post was sometimes called the "tree of truth." There is a
curious passage in Sir Thomas More's works, in which he orders a lunatic
to be bound to a tree and soundly beaten with rods.
"There was a tree in Sir Thomas More's garden, at which he so often beat
Lutherans, that it was called the 'tree of troth,'" says Burnet. This
was not the tree at which he had the poor lunatic flogged, for he says
that was in the street.
"It was a good plea in those days to an action for assault, battery, and
false imprisonment, that the plaintiff was a lunatic, and that therefore
the defendant had arrested him, confined him, and _whipped_ him."[53]
Whipping-posts may still be seen in some villages in England, in the
vicinity of stocks. Of course they were largely employed for idle
vagabonds, but many really insane people suffered. The following item
from the constable's account at Great Staughton, Huntingdonshire,
illustrates the custom of whipping wandering lunatics:--"1690/1. Paid in
charges, taking up a distracted woman, watching her and whipping her
next day, 8s. 6d."[54]
Let me here refer for a moment to the "brank."
The "brank" or "scold's bridle" was very probably used in former days
for lunatics--an instrument of torture which has received much
elucidation from my friend Dr. Brushfield, the late medical
superintendent of Brookwood Asylum. Indeed, it is certain that it, or a
similar gag, called the "witch's bridle," was employed for these
unfortunate suspects, of whom so many, as we have good reason to
conclude, were insane or hystero-epileptics. In the church steeple at
Forfar one was preserved, within recent times, with the date 1661.[55]
Archdeacon Hale many years ago suggested that the "brank" was used to
check noisy lunatics of the female sex; and in reference to this, Dr.
Brushfield remarks: "Medical officers of asylums can always point out
many female patients who, if they had been living a couple of centuries
back, would undoubtedly have been branked as scolds. One of the female
lunatics in the Cheshire Asylum gave me, a few days since, a very
graphic account of the manner in which she had been bridled some years
ago whilst an inmate of a workhouse."[56]
No doubt, in addition to branks and whipping-posts, the pillory and
stocks, and probably the ducking-stool, were made use of for unruly and
crazy people, who nowadays would be comfortably located in an asylum.
What now, let us ask in conclusion, are the practical inferences to draw
from the descriptions which I have given respecting the popular and
medical treatment of lunatics in the good old times in the British
Isles?
In the first place, we see that the nature of the malady under which the
insane laboured was completely misunderstood; that they often passed as
witches and possessed by demons, and were tortured as such and burnt at
the stake, when their distempered minds ought to have been gently and
skilfully treated. Some, however, were recognized by the monks as simply
lunatic, and were treated by the administration of herbs, along with, in
many instances, some superstitious accompaniment, illustrating, when
successful, the influence of the imagination.
Further, the medical treatment, so far as it made any pretension to
methods of cure, was either purely empirical, or founded upon the one
notion that descended from generation to generation from the earliest
antiquity--that there was an excess of bile in the blood, and that it
must be expelled by emetics or purgatives.
Again, there was the more violent remedy of flagellation, one always
popular and easy of application; equally efficacious, too, whether
regarded as a punishment for violent acts, or as a means of thrashing
out the supposed demon lurking in the body and the real cause of the
malady. And there was, of course, as the primary treatment, seclusion in
a dark room and fetters.
To anticipate what belongs to subsequent chapters, we may say here that
when the insane were no longer treated in monasteries, or brought to
sacred wells, or flogged at "trees of truth," they fared no better--nay,
I think, often worse--when they were shut up in mad-houses and crowded
into workhouses. They were too often under the charge of brutal keepers,
were chained to the wall or in their beds, where they lay in dirty
straw, and frequently, in the depth of winter, without a rag to cover
them. It is difficult to understand why and how they continued to live;
why their caretakers did not, except in the case of profitable patients,
kill them outright; and why, failing this--which would have been a
kindness compared with the prolonged tortures to which they were
subjected--death did not come sooner to their relief.
FOOTNOTES:
[2] Collected and edited by the Rev. Oswald Cockayne, M.A., 1865.
Published under the direction of the Master of the Rolls.
[3] Corn or seed to cure bewitching (Saxon). Supposed to be the seeds of
"wild saffron."
[4] _Op. cit._, vol. ii. p. 137; Leech Book, I. lxiii.
[5] That is, a small bell used in the church, probably the acolyte's.
St. Fillan's was twelve inches high. See _postea_.
[6] _Op. cit._, vol. i. p. 161.
[7] _Op. cit._, p. 171.
[8] _Op. cit._, pp. 313-315.
[9] _Op. cit._, p. 351 ("Medicina de quadrupedibus" of Sextus Placitus).
[10] _Op. cit._, p. 361.
[11] _Op. cit._, vol. ii. pp. 343, 143, 343, 307, and 345.
[12] Wodnes (Saxon) signifies madness. "Ance wod and ay waur," _i.e._
increasing in insanity. (See Jamieson's Scotch Dictionary, 1825: "Wodman
= a madman.")
[13] _Op. cit._, vol. ii. p. 335.
[14] Preface to vol. ii. p. xix.-xxiii.
[15] Vol. iv., preface, p. xxxiv.
[16] Vol. iv. p. 225.
[17] In Chambers's "Book of Days," in an article on "Holy Wells," it is
added to the above statement that in the seventeenth century St.
Winifred could boast of thousands of votaries, including James II.
[18] In the "Miller's Tale," the carpenter is befooled into looking like
a madman. "They tolden every man that he was wood," etc. (Percy
Society's edition, vol. i. p. 152).
[19] Early English Text Society, vol. iii. p. 163. See also Clarendon
Press Series, edited by Mr. Skeats. London, 1866.
[20] "Archæologia Britannica," by Ed. Lhuyd, 1707. The Armoric word for
mania is _diboelder_ or _satoni_; the Cornish, _meskatter_; the British,
_mainigh_, among others.
[21] These passages from Dr. Borlase and Dr. Boase will be found in the
valuable address at the Royal Institution of Cornwall, by W. C. Borlase,
F.S.A., 1878 (Journal of the Institution, 1878, No. xx. pp. 58, 59). It
forms a little work on Cornish Saints, and from it is derived the
statement made in regard to St. Nonna or Nun.
[22] Honoured both in Scotland and Ireland on account of his great
sanctity and miracles, he "exchanged his mortal life for a happy
immortality in the solitude of Sirach, not far from Glendarchy,
Scotland. His mother, Kentigerna, was also a woman of great virtues, and
honoured after her death for a Saint" ("Britannia Sancta, or Lives of
British Saints," 1745, p. 20).
[23] Vol. i. p. 282.
[24] "Darker Superstitions of Scotland," p. 82. Macfarlane,
"Geographical Collections," MS., vol. i. p. 154.
[25] Dr. Mitchell has clearly shown that St. Maree is a corruption of
Maelrubha, who came from Ireland, and not of Mary, as stated by Pennant.
[26] "Tour in Scotland and the Hebrides," vol. i. p. 332, edit. 1774.
[27] Or Gringorian water. In what respect it was special I do not know,
but holy water is said to have been so called because Gregory I.
recommended it so highly. "In case," says Rabelais, "they should happen
to encounter with devils, by virtue of the Gringoriene water they might
make them disappear" ("Gargantua," i. 43). See Brewer's "Dictionary of
Phrase and Fable."
[28] "On Various Superstitions in the North-West Highlands and Islands
of Scotland, especially in Relation to Lunacy," by Arthur Mitchell,
A.M., M.D., 1862; from the "Proceedings of the Antiquarian Society of
Scotland," vol. iv. The aphorism of Boerhaave, relating to the treatment
of lunatics, quoted by this writer, is entirely in keeping with the
practice described in the text, "Præcipitatio in mare, submersio in eo
continuata quamdiu ferre potest, princeps remedium est."
[29] _Op. cit._, p. 15.
[30] Mitchell, _op. cit._, p. 18. He adds it was Murdoch's "calamity to
live among an unenlightened people, a thousand years removed from the
kindly doctrines of the good Pinel." "I am not here detailing what
happened in the Middle Ages. It is of the nineteenth century--of what
living men saw that I write." In the _Inverness Courier_, August 31,
1871, is an extraordinary account of dipping lunatics in Lochmanur, in
Sutherlandshire, in the district of Strathnaver, at midnight: "About
fifty persons were present near one spot.... About twelve (affected with
various diseases) stripped and walked into the loch, performing their
ablutions three times. Those who were not able to act for themselves
were assisted, some of them being led willingly, and others by force.
One young woman, strictly guarded, was an object of great pity. She
raved in a distressing manner, repeating religious phrases, some of
which were very earnest and pathetic.... These utterances were enough to
move any person hearing them. Poor girl! What possible good could
immersion be to her?... No man, so far as I could see, denuded himself
for a plunge.... These gatherings take place twice a year, and are known
far and near to such as put belief in the spell. But the climax of
absurdity is in paying the loch in sterling coin.... I may add that the
practice of dipping in the loch is said to have been carried on from
time immemorial, and it is alleged that many cures have been effected by
it" (Correspondent of the _Courier_, who witnessed the scene on the 14th
of August, 1871).
[31] "Darker Superstitions of Scotland," p. 190.
[32] _Op. cit._, p. 60; from "Trial of Alexander Drummond in the
Kirktown of Auchterairdour," July 3, 1629.
[33] _Op. cit._, p. 61, "Trial of Marable Couper," June 13, 1616.
[34] _Op. cit._, p. 98.
[35] Dalyell, p. 550.
[36] Joyce's "Irish Names of Places," vol. i. p. 172.
[37] "Ancient and Present State of the County Kerry," p. 196.
[38] Joyce's "Irish Names of Places."
[39] "Letters from the Kingdom of Kerry, in the year 1845." Dublin,
1847.
[40] Vol. ii. p. 226. On witchcraft in Ireland see the "Annals of
Ireland," translated from the original Irish of the Four Masters, by
Owen Connellan, Esq. Dublin, 1846.
[41] His "Breviary of Helth" was published in 1547.
[42] This cross was made of sea sand, in the sixth century, by St.
Kentigern, called also St. Mungo. A collegiate church was erected there
in 1449. He healed the maniacal by the touch. See "The Legends of St.
Kentigern," translated by Rev. William Stevenson, D.D., Edinburgh, 1874;
and _Notes and Queries_, April 21, 1866.
[43] Page 976, ed. 1633. According to modern botanists, black hellebore
is not, as was for long supposed the Ἐλλεβορος μελας of Hippocrates.
Of several species growing in Greece, the medicinal virtues of
_Helleborus orientalis_ resemble most nearly those of the classic
descriptions of _H. niger_. See "The British Flora Medica," by B. H.
Barton, F.L.S., and T. Castle, M.D., 1877, p. 203.
[44] Scot was born near Smeeth, 1545. He was educated at Oxford, and
lived on his paternal estate. He was the son of Sir John Scot, of Scot's
Hall. Died 1599. His famous work, "The Discovery of Witchcraft, proving
the common opinions of Witches contracting with Divels, Spirits, or
Familiars to be but imaginary conceptions; wherein also the lewde
unchristian practices of Witchmongers in extorting Confessions, is
notably detected; whereunto is added a Treatise upon the nature and
substance of Spirits and Divels," was published in 1584. This is the
title of the second edition, which differs slightly from the first.
[45] _Op. cit._, p. 72.
[46] "Medical Councils," 1679; "Opera Medica," 1703.
[47] Edit. 1616. James says he wrote it "chiefly against the damnable
opinions of Wierus and Scot, the latter of whom is not ashamed in public
print to deny that there can be such a thing as witchcraft, and so
maintains the old error of the Sadducees in the denying of spirits."
[48] Johann Wierus, born at Grave on the Meuse, Brabant, published his
work against the prevalent view of witchcraft in 1567. See "Histoires,
Disputes, et Discours des Illusions, et Impostures des Diables, des
Magiciens infames, Sorciers, etc. Par Jean Wier, 1579." He died 1588, at
Tecklenburg. His works were printed in one volume in 1660.
[49] _Op. cit._, p. 234.
[50] Henry Cornelius Agrippa was born in 1486, at Cologne, and was the
contemporary of Paracelsus. Agrippa was the master of Wierus. He was
Town Advocate at Metz and secretary to the Emperor Maximilian.
Imprisoned for a year at Brussels, on the charge of magic, and
ceaselessly calumniated after his death. See Plancey's "Dict. Infern.,"
art. "Agrippa," and Thiers' "Superst." (vol. i. pp. 142, 143). See his
Memoir, by Professor Morley, 1856. He was a doctor of medicine as well
as law. He himself believed in witchcraft.
[51] As in Hamlet. "_There_" (England) "the men are as mad as he."
[52] "King Lear," Act iii. sc. 4.
[53] Lord Campbell's "Lives of the Lord Chancellors."
[54] _Notes and Queries_, vol. vi. p. 327, No. 153. A more extraordinary
entry occurs under the same date: "Paid Thomas Hawkins for whipping 2
people y{t} had the small-pox, 8d." Under date 1648: "Given to a woman
that was bereaved of her witts the 26 of Aprill, 1645, 6d." (_Op. cit._,
No. 242, July 22, 1854).
[55] According to Dr. Brushfield, torture was practised in Scotland
after it was used for the last time in England in 1640. No specimens of
the "brank" are known to exist in Ireland or Wales.
[56] "Obsolete Punishments," Part I., "The Brank," by T. N. Brushfield,
M.D., 1858, p. 20.
CHAPTER II.
BETHLEM HOSPITAL AND ST. LUKE'S.
The chief point of interest in the subject to which this chapter has
reference, centres in the questions where and what was the provision
made for the insane in England at the earliest period in which we can
discover traces or their custody?
Many, I suppose, are familiar with the fact of the original foundation
in 1247 of a Priory in Bishopsgate Street, for the Order of St. Mary of
Bethlem, but few are aware at what period it was used for the care or
confinement of lunatics, and still fewer have any knowledge of the form
of the building of the first Bethlem Hospital--the word "Bethlem" soon
degenerating into _Bedlam_.
Before entering upon the less known facts, I would observe that an
alderman and sheriff of London, Simon FitzMary, gave in the thirty-first
year of the reign of Henry III., 1247, to the Bishop and Church of
Bethlem, in Holyland, all his houses and grounds in the parish of St.
Botolph without Bishopsgate, that there might be thereupon built a
Hospital or Priory for a prior, canons, brethren, and sisters of the
Order of Bethlem or the Star of Bethlem, wherein the Bishop of Bethlem
was to be entertained when he came to England, and to whose visitation
and correction all the members of the house were subjected.[57]
The following is the wording of the original grant, slightly
abridged:--"To all the children of our Mother holy Church, to whom this
present writing shall come, Simon, the Son of Mary, sendeth greeting in
our Lord, ... having special and singular devotion to the Church of the
glorious Virgin at Bethelem, where the same Virgin brought forth our
Saviour incarnate, and lying in the Cratch,[58] and with her own milk
nourished; and where the same child to us being born, the Chivalry of
the Heavenly Company sange the new hymne, Gloria in excelsis Deo ... a
new Starre going before them. In the Honour and Reverence of the same
child, and his most meek mother, and to the exaltation of my most noble
Lord, Henry King of England, ... and to the manifold increase of this
City of London, in which I was born: and also for the health of my soul,
and the souls of my predecessors and successors, my father, mother and
my friends, I have given, and by this my present Charter, here, have
confirmed to God, and to the Church of St. Mary of Bethelem, all my
Lands which I have in the Parish of St. Buttolph, without Bishopsgate of
London, ... in houses, gardens, pools, ponds, ditches, and pits, and all
their appurtenances as they be closed in by their bounds, which now
extend in length from the King's high street, East, to the great Ditch,
in the West, the which is called Depeditch; and in breadth to the lands
of Ralph Dunnyng, in the North; and to the land of the Church of St.
Buttolph in the South; ... to make there a Priory, and to ordain a Prior
and Canons, brothers and also sisters, who in the same place, the Rule
and Order of the said Church of Bethelem solemnly professing, shall bear
the Token of a Starre openly in their Coapes and Mantles of profession,
and for to say Divine Service there, for the souls aforesaid, and all
Christian souls, and specially to receive there, the Bishop of Bethelem,
Canons, brothers, and messengers of the Church of Bethelem for ever
more, as often as they shall come thither. And that a Church or Oratory
there shall be builded, as soon as our Lord shall enlarge his grace,
under such form, that the Order, institution of Priors, &c. to the
Bishop of Bethelem and his successors shall pertain for evermore.... And
Lord Godfrey, Bishop of Bethelem, into bodily possession, I have
indented and given to his possession all the aforesaid Lands; which
possession he hath received, and entered in form aforesaid.
"And in token of subjection and reverence, the said place in London
shall pay yearly a mark sterling at Easter to the Bishop of Bethelem.
"This gift and confirmation of my Deed, & the putting to of my Seal for
me and mine heirs, I have steadfastly made strong, the year of our Lord
God, 1247, the Wednesday after the Feast of St. Luke the Evangelist."
From this it appears that Simon Fitzmary's land extended from the King's
Highway on the east (Bishopsgate Street without) to the fosse called
Depeditch on the west. The land of Saint Botolph Church bounded it on
the south, and the property of a Ralph Dunnyng on the north. The author
of "The History of St. Botolph" (1824), Mr. T. L. Smartt, suggests that
the old White Hart Tavern is a vestige of the hostelry. If not forming
part of the original hospital, it certainly led to it. Among the tokens
in the British Museum I find "Bedlem Tokens E.{K.}E. at Bedlam Gate,
1657," and the "Reverse at the White Hart." At an early period Bethlem
is styled "Bethlem Prison House," and the patients, "who sometimes
exceeded the number of twenty," are called prisoners. One token at the
British Museum is G.{H.}A. "at the Old Prison."
A considerable portion of this site is occupied at the present day by
Liverpool Street, and the railway stations which have sprung up there.
The topographer in search of the old site finds striking proofs of the
changes which six hundred years have brought with them--the steam, and
the shrill sounds of the Metropolitan, North London, and Great Eastern
Railways; while Bethlem Gate, the entrance to the hospital from
Bishopsgate Street, was, when I last visited the spot, superseded by
hoardings covered with the inevitable advertisement of the paper which
enjoys the largest circulation in the world. Depeditch is now Bloomfield
Street. The name of Ralph Dunnyng, whose property is mentioned in the
charter as bounding Bethlem on the north, is, I suppose, represented,
after the lapse of six centuries, by Dunning's Alley and Place.
There was a churchyard on the property, which was enclosed for the use
of adjoining parishes by Sir Thomas Rowe, Lord Mayor of London, at a
much later period (1569)--no doubt the ground where the inmates were
buried. The Broad Street Railway Station booking-office is situated upon
part of its site. In connection with this, I may refer to a statement in
Mr. Buckland's "Curiosities of Natural History," to the effect that a
skeleton, on which fetters were riveted, was found in 1863, in St. Mary
Axe, by some workmen engaged in excavations. Mr. Buckland states, on the
authority of Mr. Hancock, that Sir Thomas Rowe gave ground in St. Mary
Axe, for the use of Old Bethlem Hospital and certain adjoining parishes.
Mr. Buckland, therefore, concluded that the skeleton was that of a man
who had been a patient in Bedlam, and buried in his chains. He was on
one occasion good enough to place them at my disposal, but as I can find
no evidence that Sir T. Rowe did more than what I have above stated, I
think there is no connection proved between the skeleton in irons and
Bedlam.
In this churchyard was buried Lodowick Muggleton--an appropriate
resting-place, considering its proximity to a mad-house. Also John
Lilburne; four thousand persons, it is said, attending his funeral.
Mr. Roach Smith, who formerly lived in Liverpool Street, informs me that
on one occasion an incident proved the former existence of a
burial-ground on this spot. He writes, "Opposite my house (No. 5) on the
other side of the street was a long dead wall, which separated the
street from a long piece of garden-ground which faced some high houses
standing, probably, on the site of Bedlam. This garden may have stood on
the burial-ground. When my man buried in it a deceased favourite cat, he
said he came upon the remains of human skeletons. But revolution brought
about the disturbance of the cat which had disturbed some of old
London's people. A few years since the cat's coffin and her epitaph were
brought before the directors of a railway as a very puzzling discovery."
The engineers of the North London and Great Eastern Railways inform me
that many bones were dug up in excavating for the Broad Street and
Liverpool Street Stations.
The locality of the first Bethlem Hospital is, I hope, now clearly
before the reader. I will describe the form of the buildings shortly,
but will first trace the history of the convent to the time of Henry
VIII.
In the year 1330, eighty-three years after its foundation, it is
mentioned as a "hospital," in a licence granted by King Edward III., to
collect alms in England, Ireland, and Wales, but it must not be
inferred from this that it was _necessarily_ used for the sick, as the
word hospital was then, and long after, employed as "a place for shelter
or entertainment" (Johnson). It is so employed by Spencer in the "Faerie
Queen":--
"They spy'd a goodly castle plac'd
Foreby a river in a pleasant dale,
Which chusing for that evening's _Hospital_
They thither march'd."
Very shortly after this, viz. in 1346, the monastery or hospital was so
miserably poor that the master applied to the mayor, aldermen, and
citizens of London to be received under their protection. This was
agreed to, and it was governed afterwards by two aldermen, one chosen by
the mayor and the other by the monastery.
Then we come to an important event--the seizure of Bethlem by the Crown.
This was in 1375, the forty-eighth year of Edward III. It was done on
the pretext that it was an alien or foreign priory. There was not
therefore any seizing of the monastery by Henry VIII., as is usually
stated. That had been done already. The master of Bethlem stated at this
time that the annual value of the house was six marks; and that he paid
13s. 4d. a year to the Bishop of Bethlem, and 40s. rent to the Guildhall
for the benefit of the City. Disputes afterwards arose between the Crown
and the City as to their right to appoint the master of the house, but
the former triumphed, and Richard II., Henry IV., Henry VI., and Henry
VIII. insisted upon and exercised their right of presentation.
It appears that the City had let some house to the hospital for which
they received rent. And further, that afterwards, when disputes arose,
they actually pretended that the hospital itself was originally theirs.
I now call attention to the year 1403, the fourth year of Henry IV. It
seems that Peter, the porter of the house, had misbehaved himself in
some way, and it was deemed sufficiently important to necessitate an
"inquisition," to ascertain the condition and management of the
monastery. And it is here that we meet with the earliest indication of
Bethlem being a receptacle for the insane. I have examined the Report of
this Royal Commission, and find it stated that six men were confined
there who were lunatics (_sex homines mente capti_). The number,
therefore, was very small at that time. As might be expected, the
glimpse we get of their mode of treatment reveals the customary
restraints of former days. The inventory records "Six chains of iron,
with six locks; four pairs of manacles of iron, and two pairs of
stocks." I do not here, or elsewhere, find any reference to the use of
the whip. I may remark, by the way, that the Commissioners observe that
whereas originally the master of the house wore the Star of the Order of
Bethlem, the master at that time did not. The original star contained
sixteen points, which we may consider to indicate, appropriately, the
words _Estoile de Bethlem_.
On the arms of Bethlem[59] was also a basket of bread, in reference to
the Hebrew etymology, "House of Bread." The bread is described as
wastell cake, a word first met with in a statute 51 Hen. III., where it
is described as white bread well baked.
Chaucer says of the "Prioress"--
"Of small houndes hadde she, that she fedde
With roasted flesh, and milk and wastel brede."
The derivation of the word, according to Douce's "Illustrations of
Shakespeare," is from gasteau, now _gâteau_, anciently written gastel,
and, in the Picard dialect, ouastel or watel, a cake.
I would here draw attention to the site of St. Martin's Lane, and the
adjoining district. At the southwest corner of St. Martin's Lane, in the
angle formed by it and Charing Cross, was situated a religious (?)
house, of the foundation of which I can discover nothing. The point of
interest to us in connection with it is this: that at a very early
period lunatics were confined there. Stow, in his "Survey of London,"
etc., written in 1598, says, under "The Citie of Westminster," "From
thence is now a continuall new building of diuers fayre houses euen up
to the Earle of Bedford's house lately builded nigh to Iuy Bridge, and
so on the north side, to a lane that turneth to the parish church of S.
Martin's in the Field, in the liberty of Westminster. Then had ye an
house, wherein some time were distraught and lunatike people, of what
antiquity founded, or by whom, I have not read, neither of the
suppression; but it was said that some time a king of England, not
liking such a kind of people to remaine so neare his pallace, caused
them to be removed further off to Bethlem without Bishopsgate of London,
and to that Hospitall the said house by Charing Crosse doth yeth
remaine."[60]
I have spent considerable time in endeavouring to discover who this king
was, but without success. If we assume that this was the first time that
Bethlem received lunatics within its walls, we must refer the event to a
date prior to 1403, because we know, as I have pointed out, that there
were mad people in Bethlem at that date. One statement is that the
sovereign was Henry IV., and that is not improbable, but it may have
been Richard II. Whoever the king was, he appears to have been rather
fastidious, considering the proximity is not very close between Charing
Cross and any of the Royal Palaces. Possibly, as the Royal "Mewse" was
at Charing Cross, his Majesty, whenever he visited his falcons, which
were "mewed" or confined here--long before the same place was used for
stables--may have been disturbed by the sounds he heard.[61] It is
interesting in this connection to learn that Chaucer was clerk of the
Charing Cross Mews. On the site of the Mews stands now the National
Gallery, and the house for lunatics must have been situated in Trafalgar
Square, about where Havelock's equestrian statue stands.
Here I may note also, on the same authority, that there was in Edward
III.'s reign (1370) a hospital founded in the parish of Barking by
Robert Denton, "chaplen," "for the sustentation of poor Priests and
other men and women that were sicke of the Phrenzie, there to remaine
till they were perfectly whole and restored to good memorie."[62] I know
nothing further of this asylum. It must remain an undetermined question
whether there were any lunatics in Bedlam prior to the establishment of
the houses at Charing Cross and Barking. As, however, both these were
devoted to their exclusive care, and Bethlem at that period was not, I
think we must grant their priority as special houses for deranged
persons.
It will be observed that in the passage cited from Stow, the house at
Charing Cross is described as belonging to Bethlem Hospital. I have
ascertained that the Charing Cross property belonged to Bethlem Hospital
until 1830, when it was sold or exchanged in order to allow of the
improvements which were shortly afterwards made there in laying out
Trafalgar Square and building the National Gallery.
We know, then, that from about 1400--probably earlier--Bethlem received
lunatics, on however small a scale; and we have here an explanation of
the fact which has occasioned surprise, that before the time of the
charter of Henry VIII., whose name is inscribed over the pediment of the
existing building, the word "Bedlam" is used for a madman or mad-house.
Thus Tyndale made use of the word some twenty years before the royal
grant in his "Prologue to the Testament," a unique fragment of which
exists in the British Museum, where he says it is "bedlam madde to
affirme that good is the natural cause of yvell."
Speaking of Wolsey, Skelton, who died in 1529, says in his "Why come ye
not to Court?"--
"He grinnes and he gapes,
As it were Jacke Napes,
Such a mad Bedlam."
The familiar expression "Jackanapes" is evidently a corruption of the
above. The term occurs in "The Merry Wives of Windsor": "I vill teach a
scurvy jackanape priest to meddle or make."[63] The origin of the phrase
in _Jack-o'naibs_, a Saracen game of cards, seems doubtful. Any way, it
came to be used for a witless fellow, or Bedlamite.
And Sir Thomas More, in his treatise "De Quatuor Novissimis," says,
"Think not that everything is pleasant that men for madness laugh at.
For thou shalt in Bedleem see one laugh at the knocking of his own hed
against a post, and yet there is little pleasure therein." And, again,
in the "Apology" made by him in 1533 (thirteen years before the grant),
in which he gives a most curious account of the treatment of a poor
lunatic: He was "one which after that he had fallen into these frantick
heresies, fell soon after into plaine open franzye beside. And all beit
that he had therefore bene put up in Bedelem, and afterward by beating
and correccion gathered his remembraance to him and beganne to come
again to himselfe, being thereupon set at liberty, and walkinge aboute
abrode, his old fansies beganne to fall againe in his heade." Although
what follows has nothing to do with Bethlem, I cannot avoid quoting it,
as it illustrates so graphically the whipping-post treatment of that
day. "I was fro dyvers good holy places advertised, that he used in his
wandering about to come into the churche, and there make many mad toies
and trifles, to the trouble of good people in the divine service, and
specially woulde he be most busye in the time of most silence, while the
priest was at the secretes of the masse aboute the levacion." After
proof of his indecent behaviour, he proceeds, "Whereupon I beinge
advertised of these pageauntes, and beinge sent unto and required by
very devout relygious folke, to take some other order with him, caused
him, as he came wanderinge by my doore, to be taken by the connstables
and bounden to a tree in the streete before the whole towne, and ther
they stripped [striped] him with roddes therefore till he waxed weary
and somewhat lenger. And it appeared well that hys remembraunce was
goode ineoughe save that it went about in grazing [wool-gathering!] til
it was beaten home. For he coulde then verye wel reherse his fautes
himselfe, and speake and treate very well, and promise to doe afterward
as well." Sir Thomas More ends with this delicious sentence:--"And
verylye God be thanked I heare none harme of him now."[64]
To return to Bethlem Hospital. I can discover nothing of interest in
regard to it between 1403 and 1523; except, indeed, that I observe in
the "Memorials of London," 1276-1419, a man was punished for pretending
to be a collector for the hospital of "Bedlem," in 1412. He was to
remain for one hour of the day in the pillory, the money-box he had used
being "in the mean time placed and tied to his neck." At the date
mentioned above, 1523, Stephen Jennings, merchant taylor, previously
Lord Mayor of London, gave a sum of money in his will towards the
purchase of the patronage of Bethlem Hospital. Three and twenty years
later (1546) the citizens of London are said to have purchased "the
patronage thereof, with all the lands and tenements thereunto
belonging." But there is no evidence that they did give any money for
this patronage. Sir John Gresham, the Lord Mayor, petitioned the king in
this year to grant Bethlem Hospital to the City; and the king did grant
it along with St. Bartholomew's Hospital, on condition that the City
should expend a certain amount of money on new buildings in connection
with the latter. It is only in this sense, I believe, that they
"purchased" Bethlem Hospital; and further, it must be understood that
the City obtained the patronage or government only, and not the freehold
of the premises, although in process of time the Crown ceased to claim
or possess any property in the hospital.
In the indenture of the covenant made 27th December, 1546, between the
King and the City of London granting St. Bartholomew's Hospital and
Bethlem, there is no mention of appropriating the latter to the use of
lunatics (for this, as we have seen, had been done already), but it is
simply said "the king granted to the said citizens that they and their
successors should thenceforth be masters, rulers, and governors of the
hospital or house called Bethlem, and should have the governance of the
same and of the people there, with power to see and to cause the rents
and profits of the lands and possessions of the same hospital to be
employed for the relief of the poor people there, according to the
meaning of the foundation of the same, or otherwise as it should please
the king for better order to devise." The charter was granted on the
13th of January, 1547. The King died on the 29th. The value of the
estate at this period is said to have been £504 12s. 11d.[65]
I wish to reproduce here the form of the buildings of Bethlem (or, as we
ought now to designate it, Bethlem or Bethlehem Royal Hospital) at the
time of Henry VIII., and for long before and after that time. I have, I
believe, consulted every important map of old London, and have found it
no easy task to obtain a clear notion of the appearance of the building
at that period. No print of the first hospital is in existence; at
least, I have never been able to find it, or met with any one who has
seen it. I believe, however, that a good idea of the premises can be
formed from a study of the map of London by Agas, made not very long
after the death of Henry VIII. (1560), and now in the Guildhall, where
its careful examination has been facilitated by Mr. Overall, the
Librarian. From it I have represented an elevation of the hospital (see
engraving), which will, I believe, convey a fairly correct notion of the
extent and character of the premises. I am gratified to know that the
reader will see as distinct a representation of the first Bethlem as can
be framed from the old maps--the real old Bedlam of Sir Thomas More, of
Tyndale, and Shakespeare. Shakespeare, I may here say, uses the word
Bedlam six times. It will be seen there is a rectangular area surrounded
by buildings. In the centre is the church of the hospital. This was
taken down in the reign of Queen Elizabeth, and other buildings erected
in its place.
The oldest written description of any portion of the building which is
extant mentions "below stairs a parlour, a kitchen, two larders, a long
entry [corridor] throughout the house, and twenty-one rooms wherein the
poor distracted people lie; and above the stairs eight rooms more for
servants and the poor to lie in."[66]
It will be observed that there was a gate on the west side, and another
on the east.
[Illustration: PLAN OF THE FIRST BETHLEM HOSPITAL.
_From Agas._] [_Page 60._]
A map of ancient London was reconstructed, with great ingenuity and
labour, by the late Mr. Newton, 1855. But his reconstruction of Bethlem
and its surroundings contains several inaccuracies which have been
avoided in the accompanying view. The church in the quadrangle differs
completely from that given in Agas; and Newton fails to recognize the
character of the gate and its crenelated tower on the east side. There
appear to have been, at the time of Agas, no buildings on the west side
of the quadrangle, but in Braun and Hogenberg's or Stilliard's map,
there are houses not represented in the engraving. I must express my
great obligation to Mr. J. E. Gardner, of London, as also to Mr. J. B.
Clark, for the assistance rendered me in this attempt to recover the
outlines of the premises comprised under the true Old Bethlem.[67]
Eight years after the death of Henry VIII. (1555)--the second year of
Philip and Mary--it was ordered that the governors of Christ's Hospital
should be charged with the oversight and government of Bethlem, and
receive the account of rents, etc., instead of the City chamberlain; but
this arrangement lasted only a short time, for in September, 1557,
another change was made, and the management was transferred to the
governors of Bridewell (which had been given to the City by Edward VI.
in 1553), subject, of course, to the jurisdiction of the citizens. The
same treasurer was appointed for both. This union of the hospitals was
confirmed by the Act 22 Geo. III., c. 77, and continues, as is well
known, to the present day. It was not until this act passed that the
_paramount_ authority of the City ceased, and the government now in
force was established, by which it was distinctly vested in a
president, treasurer, the Court of Aldermen, and the Common Council, and
an unlimited number of governors, elected by ballot. So that now the
only sense in which Bethlem continues to belong to the City is that the
aldermen and common councilmen are _ex-officio_ governors. As there are
at the present time upwards of two hundred governors, they are in a
decided minority.[68]
Time was when Bethlem Hospital did not possess the magnificent income
which she now enjoys. She knew, as we have seen, what poverty meant; and
even if we make due allowance for the increased value of money we can
hardly read without surprise that in 1555 the income from all the
possessions of the hospital only amounted to £40 8s. 4d. Of course,
considerable sums were collected as alms. Nearly a century after, the
valuation of real estates showed an annual value of £470. Several
annuities had also been bequeathed, as that of Sir Thomas Gresham in
1575, for "the poor diseased in their minds in Bethlem."
The revenues, however, fell far short of the requirements of the
hospital--namely, about two-thirds of the yearly charge--and at a court
held in 1642 preachers were directed to preach at the Spital of St.
Mary, in Bishopsgate Street, informing the public of the need of
pecuniary help, and exciting them to the exercise of charity.
Again, in 1669 a deputation waited on the Lord Mayor to acquaint him
with the great cost of Bethlem, and to request that no patient should be
sent until the president was informed, in order that he might fix on the
weekly allowance, and obtain some security of payment.
I need not say that since the period to which I refer, the income of
Bethlem Hospital has, in consequence of gifts, and the enormously
greater value of house property in London, been immensely increased, and
that what with its annuities, its stocks of various kinds, and its
extensive estates, it is to-day in the position of doing, and without
doubt actually does, an immense amount of good.
Half a century after Henry VIII.'s death, Bethlem Hospital was reported
to be so loathsome as to be unfit for any man to enter. There were then
twenty patients. I do not know, however, that any action was taken in
consequence. Thirty-four years afterwards (1632), I observe that the
buildings were enlarged, and mention is made of "one messuage, newly
builded of brick at the charge of the said hospital, containing a
cellar, a kitchen, a hall, four chambers, and a garret, being newly
added unto the old rooms." Also, "a long waste room now being contrived
and in work, to make eight rooms more for poor people to lodge where
there lacked room before."[69]
In 1624, and I dare say at many other periods, the patients were so
refractory that it was necessary to call in the flax-dressers, whose
tenter-boards may be seen in the adjoining field in the maps of London
of this period, in order to assist the keepers in their duties!
Just about the same date (1632) I notice that an inquisition mentions
various sums being expended on fetters and straw. The governor at that
time, I should add, was a medical man. This is the first mention of such
being the case. His name was Helkins or Hilkiah Crooke. He was born in
Suffolk; graduated M.B. in 1599 and M.D. in 1604. He was a Fellow of the
College of Physicians, and was author of "A Description of the Body of
Man," etc. (1616). There is in the second edition of this work a small
whole-length portrait by Droeshout.[70]
Ten years later (1642) there was a still further addition to Bethlem.
Twelve rooms were built on the ground floor, over which there were eight
for lunatics. The hospital, however, only accommodated some fifty or
sixty patients, and it is observed in "Stow's Survey of London," that
besides being too small to receive a sufficient number of distracted
persons of both sexes, it stood on an obscure and close place near to
many common sewers.
The hospital was one day visited by Evelyn. He had been dining with Lord
Hatton, and writes on returning: "I stepped into Bedlam, where I saw
several poor miserable creatures in chains; one of them was mad with
making verses." This was on the 21st of April, 1657. Pepys does not
record a single visit to it himself, but on February 21, 1668, he enters
in his diary that "the young people went to Bedlam."[71]
Smith, in his "Ancient Topography of London," says--and the authority
for most of his statements was Mr. Haslam[72]--"The men and women in old
Bethlem were huddled together in the same ward." It was only when the
second Bethlem was built that they had separate wards.
In Hollar's Map of London, engraved 1667, which gives the most distinct
representation of Bethlem Hospital at that period, there are no
additional buildings given, although we know they had been made. Nor are
those inserted which were built on the site of the church in the centre
of the quadrangle.
I have in the previous chapter spoken of Bedlam beggars, and would add
here that they are represented as wearing about their necks "a great
horn of an ox in a string or bawdry, which when they came to an house
for alms, they did wind, and they did put the drink given them into
their horn, whereto they did put a stopple." This description by
Aubrey[73] illustrates "Poor Tom, thy horn is dry!" in "King Lear." So
in Dekker's "English Villanies" (1648) the Abram-man is described as
begging thus: "Good worship master! bestow you reward on a poor man who
hath been in Bedlam without Bishopsgate three years, four months, and
nine days, and bestow one piece of small silver towards his fees which
he is indebted there of £3 13s. 7½d. (or to such effect), and hath not
wherewith to pay the same but by the help of worshipful and
well-disposed people, and God to reward them for it." "Then," adds
Dekker, "will he dance and sing, and use some other antic and ridiculous
gestures, shutting up his counterfeit puppet play with this epilogue or
conclusion--'Good dame, give poor Tom one cup of the best drink. God
save the king and his Council, and the governor of this place.'"
Bedlam beggars were so great a nuisance, even in 1675, that the
governors gave the following public notice:--"Whereas several vagrant
persons do wander about the City of London and Countries, pretending
themselves to be lunaticks, under cure in the Hospital of Bethlem
commonly called Bedlam, with brass plates about their arms, and
inscriptions thereon. These are to give notice, that there is no such
liberty given to any patients kept in the said Hospital for their cure,
neither is any such plate as a distinction or mark put upon any lunatick
during their time of being there, or when discharged thence. And that
the same is a false pretence to colour their wandering and begging, and
to deceive the people, to the dishonour of the government of that
Hospital."[74]
I will now pass on to the close of the chapter of this the first Bethlem
Hospital, with the remark in passing that Charles I. confirmed the
charter of Henry VIII. in 1638,[75] and will direct attention to the
year 1674, when the old premises having become totally unfit for the
care--to say nothing of the treatment--of the inmates, it was decided to
build another hospital. The City granted a piece of land on the north
side of London Wall, extending from Moor Gate, seven hundred and forty
feet, to a postern opposite Winchester Street, and in breadth eighty
feet--the whole length of what is now the south side of Finsbury Circus.
At the present time the corner of London Wall and Finsbury Pavement,
Albion Hall, and the houses to the east, mark this spot, the grounds in
front of the hospital being, of course, situated in what is now Finsbury
Circus.
Smith's plates, in his "Ancient London," show the back and west wing of
the asylum very well; and an elevation showing its front, which looked
north towards what is now the London Institution, is represented in an
engraving frequently met with in the print shops. Circus Place now runs
through what was the centre of the building. The building, intended for
a hundred and twenty patients (but capable of holding a hundred and
fifty), was commenced in April, 1675, and finished in July of the
following year, at a cost of £17,000. It was five hundred and forty feet
long by forty feet broad.
Of this building, Gay wrote--
"Through fam'd Moorfields, extends a spacious seat,
Where mortals of exalted wit retreat;
Where, wrapp'd in contemplation and in straw,
The wiser few from the mad world withdraw."
Evelyn thus records his visit to the new hospital: "1678, April 18. I
went to see New Bedlam Hospital, magnificently built, and most sweetly
placed in Moorfields since the dreadful fire in London."[76]
"Sweetly" was not an appropriate term to use, as it proved, for it was
built on the ditch or sewer on the north side of London Wall, and this
circumstance led to the foundations ultimately proving insecure, not to
say unsavoury.
As the hospital was opened in 1676, it is noteworthy that it is now more
than two centuries since the first large asylum[77] was built for the
sole object of providing for the insane in England. This is the building
in Moorfields so familiar to our forefathers for nearly a century and a
half, and known as Old Bethlem by print-dealers, and, indeed, by almost
every one else; for the memories and traditions of the genuine Old
Bethlem, which I have endeavoured to resuscitate, have almost faded
away. Indeed, in 1815, when one of the physicians of the hospital (Dr.
Monro) was asked, at the Select Committee of the House of Commons,
whether there had not been such a building, he replied that he did not
know.
Let me bring before the reader the condition of Moorfields in those
days. Finsbury was so called from the fenny district in which it lay.
Skating was largely practised here. In the old maps Finsbury fields lie
on the north-east side of Moorfields. Now Finsbury Circus and Square
correspond to the site of a part of Moorfields. Formerly Moorfields
extended up to Hoxton, "but being one continued marsh, they were in 1511
made passable by proper bridges and causeways. Since that time the
ground has been gradually drained and raised."[78]
It was a favourite resort for archers. An association called the Archers
of Finsbury was formed in King Edward I.'s time. There is an old book on
archery, entitled "Ayme for Finsbury Archers," 1628. An anonymous poem
in blank verse, published in 1717, entitled "Bethlem Hospital,"
attributed to John Rutter, M.A., contains the following lines, referring
to the appropriation of the ground for drying clothes:--
"Where for the City dames to blaunch their cloaths,
Some sober matron (so tradition says)
On families' affairs intent, concern'd,
At the dark hue of the then decent Ruff
From marshy or from moorish barren grounds,
Caused to be taken in, what now _Moorfields_,
Shaded by trees and pleasant walks laid out,
Is called, the name retaining to denote,
From what they were, how Time can alter things.
Here close adjoining, mournful to behold
The dismal habitation stands alone."
The following is the description of the building given by Smith in his
"Ancient Topography of London":--"The principal entrance is from the
north, of brick and freestone, adorned with four pilasters, a circular
pediment, and entablature of the Corinthian Order. The King's arms are
in the pediment, and those of Sir William Turner above the front centre
window.... It certainly conveys ideas of grandeur. Indeed it was for
many years the only building which looked like a palace[79] in London.
Before the front there is a spacious paved court, bounded by a pair of
massy iron gates, surmounted with the arms of the Hospital. These gates
hang on two stone piers, composed of columns of the Ionic Order, on
either side of which there is a small gate for common use. On the top of
each pier was a recumbent figure, one of raving, the other of melancholy
madness, carved by Caius Gabriel Cibber. The feeling of this sculptor
was so acute, that it is said he would begin immediately to carve the
subject from the block, without any previous model, or even fixing any
points to guide him. I have often heard my father say that his master,
Roubiliac, whenever city business called him thither, would always
return by Bethlem, purposely to view these figures" (p. 32).
Under an engraving of these figures, drawn by Stothard, are the lines:--
"Bethlemii ad portas se tollit dupla columna;
Εἰκονα των εντoς χω λιθος εκτος εχει.
Hic calvum ad dextram tristi caput ore reclinat,
Vix illum ad lævam ferrea vinc'la tenent.
Dissimilis furor est Statuis; sed utrumque laborem
Et genium artificis laudat uterque furor."
_Lustus Westmonasteriensis._
Pope, in the "Dunciad," thus spitefully refers to them in connection
with the sculptor's son, Colley Cibber, the comedian:--
"Close to those walls where Folly holds her throne,
And laughs to think Monro would take her down,
Where o'er the gates by his famed father's hand
Great Cibber's brazen,[80] brainless brothers stand."
Nettled at being made the brother of two madmen, Cibber retaliated in a
philippic upon Pope, which it is said (with what truth I know not)
hastened his death.[81] It was entitled "A letter from Mr. Cibber to Mr.
Pope, wherein the New Hero's Preferment to his Throne in the 'Dunciad'
seems not to be accepted, and the Author of that Poem His more rightful
claim to it is asserted.
----'Remember Sauney's Fate,
Bang'd by the Blockhead whom he strove to beat.'
_Parodie on Lord Roscommon._
London, MDCCXLIV." And certainly Pope died a few months after, May,
1744. It is, however, highly improbable that he would in the slightest
degree care for this letter, though he might suffer some remorse for his
spiteful attack on so good-natured a fellow. Cibber says in this letter
that people "allow that by this last stale and slow endeavour to maul
me, you have fairly wrote yourself up to the Throne you have raised, for
the _immortal Dulness_ of your humble servant to nod in. I am therefore
now convinced that it would be ill-breeding in _Me_ to take _your_ seat,
Mr. Pope. Nay, pray, Sir, don't press me!... I am utterly conscious
that no Man has so good a Right to repose in it, as yourself. Therefore,
dear, good good Mr. Pope, be seated!... Whether you call me Dunce or
Doctor, whether you like me, or lick me, contemn, jerk, or praise me,
you will still find me the same merry Monarch I was before you did me
the Honour to put yourself out of Humour about me," etc.
These figures, now banished to South Kensington Museum, and there
incarcerated at the top of the building, and only seen by special
permission, are, of course, quite unsuitable for the entrance of the
hospital, but I would plead for their being placed somewhere in Bethlem,
their natural _habitat_. As works of art, the governors and officers
cannot but be proud of them. I suppose, however, their banishment is
intended as a public protest against the old system of treatment which
one of them exhibits, and from this point of view is no doubt
creditable. I would here observe that the figure of the maniac is
superior to that of the melancholiac, whose expression is rather that of
dementia than melancholia. I think that when Bacon, in 1820, repaired
this statue, he must have altered the mouth, because, in the engraving
by Stothard, this feature, and perhaps others, are more expressive.
At Bethlem Hospital there were also certain gates called the "penny
gates," and on each side of them was a figure of a maniac--one a male,
the other a female. "They are excellently carved in wood, nearly the
size of life, have frequently been painted in proper colours, and bear
other evidence of age. It is reported they were brought from Old
Bethlem. In tablets over the niches in which they stand, is the
following supplication:--'_Pray remember the poor Lunaticks and put your
Charity into the Box with your own hand._'"[82]
There was a portrait of Henry VIII. in the hospital, which was also said
to have been brought from the first Bethlem. A portrait is now in the
committee-room of the hospital.
The "penny gates" refer, no doubt, to the custom of allowing Bethlem to
be one of the sights of the metropolis, the admission of any one being
allowed for a penny, by which an annual income of at least £400 was
realized. The practice was discontinued in 1770. This amount is,
however, probably exaggerated, as it is difficult to believe that 96,000
persons visited the hospital in the course of the year. Ned Ward,
however, from whom I shall shortly quote, says the fee was 2d. in his
time. If so, 48,000 may be about correct.
In the "Rake's Progress," Hogarth represents two fashionable ladies
visiting this hospital as a show-place, while the poor Rake is being
fettered by a keeper. The doctor, I suppose, is standing by. The
deserted woman who has followed him in his downward course to the
hospital is by his side. The expression of the Rake has been said to be
a perfect representation of
"Moody madness laughing wild, amid severest woe."
A maniac lying on straw in one of the cells is a conspicuous figure.
There is a chain clearly visible.
In another cell is a man who believes himself a king, and wears a crown
of straw.
An astronomer has made himself a roll of paper for a telescope, and
imagines that he is looking at the heavens. The patient near him has
drawn on the wall the firing off a bomb, and a ship moored in the
distance. Ireland, in his notes on "Hogarth," says it was to ridicule
Whiston's project for the discovery of the longitude, which then
attracted attention, and had sent some people crazy. Then there is a mad
musician with his music-book on his head; a sham pope; and a poor man on
the stairs "crazed with care, and crossed by hopeless love," who has
chalked "Charming Betty Careless" upon the wall. One figure looks like a
woman, holding a tape in her hands, but is intended for a tailor.[83]
There is in Mr. Gardner's collection a print representing the interior
of one of the wards of Bethlem about the year 1745, when the hospital,
therefore, was in Moorfields. There are manacles on the arms of a
patient who is lying on the floor, but there are none on the legs, as
represented in Hogarth. With this interior, kindly placed at my disposal
by Mr. Gardner, the reader can compare an interior of the existing
institution, from a photograph, for the use of which I am indebted to
the present medical superintendent, Dr. Savage. The artist of the former
picture has evidently aimed at giving as pleasant an impression as
possible of the care bestowed on the inmates of Bethlem, but the
contrast is an interesting commentary on the past and present
appearance of an asylum gallery.
[Illustration: WARD IN BETHLEM HOSPITAL ABOUT 1745.
_Print in Mr. Gardner's collection._] [_Page 74._]
[Illustration: WARD IN BETHLEM HOSPITAL AT THE PRESENT DAY.
_From a Photograph._] [_Page 74._]
In a poem bearing the title of "Bedlam," and dated 1776, the writer,
after bestowing praise on the building, adds:--
"Far other views than these within appear,
And Woe and Horror dwell for ever here;
For ever from the echoing roofs rebounds
A dreadful Din of heterogeneous sounds:
From this, from that, from every quarter rise
Loud shouts, and sullen groans, and doleful cries;
* * * * *
Within the chambers which this Dome contains,
In all her 'frantic' forms, Distraction reigns:
* * * * *
Rattling his chains, the wretch all raving lies,
And roars and foams, and Earth and Heaven defies."
Ned Ward, in his "London Spy," gives a graphic account of his visit with
a friend to Bedlam:--"Thus," he says, "we prattled away our time, till
we came in sight of a noble pile of buildings, which diverted us from
our former discourse, and gave my friend the occasion of asking me my
thoughts of this magnificent edifice. I told him I conceived it to be my
Lord Mayor's palace, for I could not imagine so stately a structure to
be designed for any quality interior; he smiled at my innocent
conjecture, and informed me this was Bedlam, an Hospital for mad folks.
In truth, said I, I think they were mad that built so costly a college
for such a crack-brained society; adding, it was a pity so fine a
building should not be possessed by such who had a sense of their
happiness: sure, said I, it was a mad age when this was raised, and the
chief of the city were in great danger of losing their senses, so
contrived it the more noble for their own reception, or they would never
have flung away so much money to so foolish a purpose. You must
consider, says my friend, this stands upon the same foundation as the
Monument, and the fortunes of a great many poor wretches lie buried in
this ostentatious piece of vanity; and this, like the other, is but a
monument of the City's shame and dishonour, instead of its glory; come,
let us take a walk in, and view its inside. Accordingly we were admitted
in thro' an iron gate, within which sat a brawny Cerberus, of an
Indico-colour, leaning upon a money-box; we turned in through another
Iron-Barricado, where we heard such a rattling of chains, drumming of
doors, ranting, hollowing, singing, and running, that I could think of
nothing but Don Quevedo's Vision, where the lost souls broke loose and
put Hell in an uproar. The first whimsey-headed wretch of this lunatic
family that we observed, was a merry fellow in a straw cap, who was
talking to himself, 'that he had an army of Eagles at his command,' then
clapping his hand upon his head, swore by his crown of moonshine, he
would battle all the Stars in the Skies, but he would have some
claret.... We then moved on till we found another remarkable figure
worth our observing, who was peeping through his wicket, eating of bread
and cheese, talking all the while like a carrier at his supper, chewing
his words with his victuals, all that he spoke being in praise of bread
and cheese: 'bread was good with cheese, and cheese was good with bread,
and bread and cheese was good together;' and abundance of such stuff;
to which my friend and I, with others stood listening; at last he
counterfeits a sneeze, and shot such a mouthful of bread and cheese
amongst us, that every spectator had some share of his kindness, which
made us retreat."[84]
Many other dialogues with the inmates of Bedlam are given, but they are
evidently embellished, or altogether fictitious; true as I believe the
description of the building and the uproar within to be.
Mr. Harvey, from his recollections of the hospital in Moorfields, in the
early part of this century, thus writes in 1863: "When I remember
Moorfields first, it was a large, open quadrangular space, shut in by
the Pavement to the west, the hospital and its outbuildings to the
south, and lines of shops with fronts, occupied chiefly by dealers in
old furniture, to the east and north. Most of these shops were covered
in by screens of canvas or rough boards, so as to form an apology for a
piazza; and if you were bold enough, in wet weather, you might take
refuge under them, but it was at the imminent risk of your purse or your
handkerchief. It was interesting to inspect the articles exposed for
sale: here a cracked mirror in a dingy frame, a set of hair-seated
chairs, the horse-hair protruding; a table, stiff, upright easy chairs,
without a bottom, etc. These miscellaneous treasures were guarded by
swarthy men and women of Israel, who paraded in front of their narrow
dominions all the working day, and if you did but pause for an instant,
you must expect to be dragged into some hideous Babel of frowsy
chattels, and made a purchaser in spite of yourself. Escaping from this
uncomfortable mart to the hospital footway, a strange scene of utter
desertion came over you; long, gloomy lines of cells, strongly barred,
and obscured with the accumulated dust, silent as the grave, unless
fancy brought sounds of woe to your ears, rose before you; and there, on
each side of the principal entrance, were the wonderful effigies of
raving and moping madness, chiselled by the elder Cibber. How those
stone faces and eyes glared! How sternly the razor must have swept over
those bare heads! How listless and dead were those limbs, bound with
inexorable fetters, while the iron of despair had pierced the hearts of
the prisoned maniacs!"[85]
It was in 1733 that two wings were added for incurable patients, but
this proved insufficient in the course of time; and in 1793 an adjoining
plot of ground was obtained, and more accommodation provided. Only six
years later, however, surveyors appointed to inspect the premises
reported that the hospital was dreary, low, melancholy, and not well
aired; and in 1804 the condition of the building was so dangerous that
it was resolved to admit no more patients except those already
petitioned for.[86] As the asylum had been built upon the ancient ditch
of the city, a large portion of the foundation was insecure. Serious
settlements had taken place, and rendered it necessary to underpin the
walls.[87] When one looks at the palatial building represented in
engravings, one feels some surprise to find it described as so low and
dreary; but doubtless it was quite time to erect another asylum, and
seek a better and more open site.
I do not propose to enter upon the revelations made as to the internal
condition of Bethlem Hospital by the investigations of the Committee of
the House of Commons in 1815;[88] many are familiar with the prints
exhibited at this Committee, of poor Norris who was secured by chains as
there represented, consisting of (1) a collar, encircling the neck, and
confined by a chain to a pole fixed at the head of the patient's bed;
(2) an iron frame, the lower part of which encircled the body, and the
upper part of which passed over the shoulders, having on either side
apertures for the arms, which encircled them above the elbow; (3) a
chain passing from the ankle of the patient to the foot of the bed.
As to the treatment pursued at this time at Bethlem, the pith of it is
expressed in one sentence by Dr. T. Monro in his evidence before the
Committee. He had been visiting physician since 1783. "Patients," he
says, "are ordered to be bled about the latter end of May, according to
the weather; and after they have been bled, they take vomits, once a
week for a certain number of weeks; after that we purge the patients.
That has been the practice invariably for years long before my time; it
was handed down to me by my father, and I do not know any better
practice." If in all this we are disposed to blame Bethlem, let us still
more condemn the lamentable ignorance and miserable medical red-tapism
which marked the practice of lunacy in former times.
I may here remark that, prior to the Monros, Dr. Thomas Allen[89] was,
in 1679, visiting physician to Bethlem, and that, as I have observed
already, Helkins Crooke (1632) was the first medical man who is known to
have been at the head of this hospital. Dr. Tyson was physician from
1684 to 1703. Mr. Haslam was appointed resident apothecary in 1795, and
in 1815 gave evidence before the Committee of the House of Commons. At
that time he said there were a hundred and twenty-two patients; "not
half the number," he stated, "which we used to have." For these there
were three male and two female keepers: the former assisting the latter
when the female patients were refractory. Ten patients, he said, were at
that moment in chains, and we may be sure that the number was much
larger before public feeling had been aroused to demand investigation.
"The ultimatum of our restraint," said Mr. Haslam, "is manacles, and a
chain round the leg, or being chained by one arm; the strait waistcoat,
for the best of reasons, is never employed by us." Mr. Haslam, when
asked whether a violent patient could be safely trusted when his fist
and wrists were chained, replied, "Then he would be an innoxious
animal." Patients, however, were frequently chained to the wall in
addition to being manacled.
A brief reference here to Dr. Allen and Dr. Tyson will not be out of
place.
"To his [Dr. Allen's] credit let it be recorded," says Dr. Munk, "that
he refused to accede to a proposition which had met with general
approbation at the Royal Society (of which he was himself a Fellow), to
make the first experiment of the transfusion of blood in this country
'upon some mad person in Bedlam.'" He died in 1684.
Dr. Edward Tyson, F.R.S., was the author of various works, but none on
mental disease. His portrait is in the College. He died in 1708, aged
58, and was buried in St. Dionys Backchurch, where there is a monument
to his memory. He is the Carus of Garth's Dispensary.[90]
"In his chill veins the sluggish puddle flows,
And loads with lazy fogs his sable brows;
Legions of lunaticks about him press,
His province is lost Reason to redress."
Of the family whose hereditary connection with Bethlem is so remarkable,
it should be chronicled that Dr. James Monro was elected physician to
Bethlem, 1728; he died 1752. His son describes him as "a man of
admirable discernment, who treated insanity with an address that will
not soon be equalled." Dr. John Monro succeeded his father in this post.
"He limited his practice almost exclusively to insanity, and in the
treatment of that disease is said to have attained to greater eminence
and success than any of his contemporaries. In January, 1783, while
still in full business, he was attacked with paralysis.... His vigour,
both of body and mind, began from that time to decline. In 1787 his son,
Dr. Thomas Monro, was appointed his assistant at Bethlem Hospital, and
he then gradually withdrew from business."[91] He died in 1791, aged 77.
He was the author of "Remarks on Dr. Battie's Treatise on Madness,
1758." Dr. Thomas Monro was appointed physician to Bethlem in 1792, and
held that office till 1816; he died 1833, aged 73. His son, Dr. Edward
Thomas Monro, succeeded him.
We now arrive at the close of the second Act in the drama of the Royal
Hospital of Bethlehem. The scene of Act the Third is laid in St.
George's Fields. The area of land covered about twelve acres. Provision
was made for two hundred patients. In 1810 an Act of Parliament was
obtained (50 Geo. III., c. 198), by which the City was authorized to
grant the property to trustees for the governors of the hospital, for
the purpose of erecting a new one on an enlarged scale--on lease for
eight hundred and sixty-five years, at a yearly rent of 1s. The
Corporation entered upon the spot occupied by the old hospital in
Moorfields. The first stone was laid in St. George's Fields in April,
1812, and it was opened August, 1815, consisting of a centre and two
wings, the frontage extending five hundred and ninety-four feet. "The
former has a portico, raised on a flight of steps, and composed of six
columns of the Ionic order, surmounted by their entablature, and a
pediment in the tympanum on which is a relief of the Royal arms. The
height to apex is sixty feet." There is the following inscription:
"HEN. VIII. REGE FUNDATUM. CIVIUM LARGITAS PERFECIT."
The funds were derived from the following sources:--
£ s. d.
Grant from Parliament 72,819 0 6
Benefactions from Public Bodies 5,405 0 0
Private Individuals 5,709 0 0
Amount of Interest upon Balances in hand 14,873 4 8
Contributed from funds of Hospital 23,766 2 3
--------------------
£122,572 7 5
Even in this new building, opened before the conclusion of the labours
of the Select Committee of the House of Commons, 1815-16, the windows of
the patients' bedrooms were not glazed, nor were the latter warmed; the
basement gallery was miserably damp and cold; there was no provision for
lighting the galleries by night, and their windows were so high from the
ground that the patients could not possibly see out, while the
airing-courts were cheerless and much too small. Such was the
description given by a keen observer, Sydney Smith, from personal
inspection.[92]
Additional buildings were erected in 1838, the first stone being laid
July 26th of that year, when a public breakfast was given at a cost of
£464; and a narrative of the event at a cost of £140; a generous outlay
of charitable funds! We may be quite sure that no one who breakfasted at
Bethlem on this occasion had any reason to be reminded of Sir Walter
Scott's observation in a letter dated March 16, 1831: "I am tied by a
strict regimen to diet and hours, and, like the poor madman in Bedlam,
most of my food tastes of oatmeal porridge."
Of the site of the third Bethlem Hospital a few words will suffice. The
notorious tavern called "The Dog and Duck" was here, and there is still
to be seen in the wall to the right of the entrance to the hospital a
representation in stone of the dog, with the neck of a duck in its
mouth. It bears the date of 1716. In Mr. Timbs' "London" it is misstated
1617. Doubtless in olden time there was a pond here, for a duck hunt was
a common sport, and brought in much custom to the inn. After the Dog and
Duck, this site was occupied by a blind school, pulled down in 1811.
Shakespeare makes the Duke of York say in "Henry VI.":--
"Soldiers, I thank you all; disperse yourselves;
Meet me to-morrow in Saint George's Fields."
_2 Henry VI._, Act v. sc. 1.
The only other reference in Shakespeare to this locality indicates that
in his time there was a Windmill Inn in St. George's Fields, for he
makes Shallow say to Falstaff--
"O, Sir John, do you remember since we lay all night in the
Windmill, in Saint George's Fields?"--_2 Henry IV._, Act iii.
sc. 2.
The subsequent history of Bethlem Royal Hospital; the considerable
improvements which succeeded the investigation; the inquiry and
admirable Report of the Charity Commissioners in 1837, from which it
appears that at that time some of the patients were still chained, and
that the funds of Bethlem had been to no slight extent appropriated to
personal uses; its exemption from the official visitation of asylums
required by the Act of Parliament passed in 1845 (8 and 9 Vict., c.
100);[93] the unsatisfactory condition of the institution as revealed by
the investigations made in 1851 (June 28 to December 4); the placing of
the hospital in 1853 in the same position as regards inspection as other
institutions for the insane (16 and 17 Vict., c. 96); the sweeping away
of the old _régime_, and the introduction of a new order of things--the
great lesson to be learned from this history being, as I think, the
necessity of having lunatic asylums open to periodical visitation--and
last, but not least, the establishment of a Convalescent Hospital at
Witley within the last few years;--these important events I must content
myself with merely enumerating, but I cannot close this chapter without
expressing the satisfaction with which I regard the present management
of the hospital, all the more striking when we recall some of the past
pages of its history; nor can I avoid congratulating the resident
physician and the other officers of the institution upon this result.
ST. LUKE'S HOSPITAL.
To the foregoing account of Bethlem Hospital it is necessary to add a
brief reference to that of St. Luke's, which, in consequence of the
insufficiency of Bethlem, was established in 1751, by voluntary
subscription, and was situated on the north side of Upper
Moorfields,[94] opposite Bethlem Hospital, in a locality called Windmill
Hill, facing what is now Worship Street. It is stated that pupils were
allowed to attend the hospital in 1753. It appears that Dr. Battie, the
physician to the hospital, who also had a private asylum, was the first
in London to deliver lectures on mental diseases. He wrote "A Treatise
on Madness," in 1758, and in this work censured the medical practice
pursued at Bethlem. He was warmly replied to by Dr. John Monro, in a
book entitled "Remarks on Dr. Battie's 'Treatise on Madness.'" His
"Aphorismi de Cognoscendis et Curandis Morbis nonnullis ad Principia
Animalia accommodati" appeared in 1762. In 1763 he was examined before
the House of Commons as to the state of private mad-houses in England.
In April, 1764, he resigned, dying in 1776, from a paralytic stroke. His
character was described by Judge Hardinge, as follows:--"Battius, faber
fortunæ suæ, vir egregiæ fortitudinis et perseverantiæ, medicus
perspicax, doctus et eruditus integritatis castissimæ, fideique in
amicitiis perspectæ."
Dr. Battie did not escape satire:--[95]
"First Battus came, deep read in worldly art,
Whose tongue ne'er knew the secrets of his heart;
In mischief mighty, tho' but mean of size,
And like the Tempter, ever in disguise.
See him, with aspect grave and gentle tread,
By slow degrees approach the sickly bed;
Then at his Club behold him alter'd soon--
The solemn doctor turns a low Buffoon,
And he, who lately in a learned freak
Poach'd every Lexicon and publish'd Greek,
Still madly emulous of vulgar praise,
From Punch's forehead wrings the dirty bays."
Dr. Munk, to whose "Roll of the Royal College of Physicians" we are
indebted for these particulars, adds, "Eccentricity was strongly marked
throughout the whole of Dr. Battie's career; many strange and curious
anecdotes concerning him are on record," and he quotes from Nichol's
"Literary Anecdotes" (vol. i. p. 18, _et seq._) the following:--"He was
of eccentric habits, singular in his dress, sometimes appearing like a
labourer, and doing strange things. Notwithstanding his peculiarities,
he is to be looked upon as a man of learning, of benevolent spirit,
humour, inclination to satire, and considerable skill in his
profession."
In 1782 a new building was erected on a site formerly known as "The
Bowling Green," where St. Luke's now stands, in Old Street. It cost
£50,000, extended four hundred and ninety-three feet, and, although
built on the same plan as the former building, was a great improvement.
It was opened January 1, 1787; the patients, one hundred and ten in
number, having been removed from the first hospital.
Elmes says, "There are few buildings in the metropolis, perhaps in
Europe, that, considering the poverty of the material, common English
clamp-bricks, possess such harmony of proportion, with unity and
appropriateness of style, as this building. It is as characteristic of
its uses as that of Newgate, by the same architect" (George Dance,
jun.).[96]
"Immediately behind this hospital is Peerless Pool, in name altered from
that of 'Perillous Pond,' so called, says old Stow, from the numbers of
youths who had been drowned in it in swimming." So writes Pennant in his
"London," and adds that "in our time [1790] it has, at great expense,
been converted into the finest and most spacious bathing-place now
known; where persons may enjoy this manly and useful exercise with
safety. Here is also an excellent covered bath, with a large pond
stocked with fish, a small library, a bowling green, and every innocent
and rational amusement; so that it is not without reason that the
proprietor hath bestowed on it the present name."[97]
St. Luke's never got into ill repute like Bethlem. The investigation of
the House of Commons' Committee of 1815 did not reveal many abuses. If,
however, its condition at that period were compared with the
well-managed institution of to-day, the result would be a very
gratifying one. Thus, seventy years ago, the author of the "Description
of the Retreat," while preparing it, visited St. Luke's and discussed
the humane system of treatment of the insane with Mr. Dunstan, the
superintendent, whom he considered desirous to do his duty to them,
though he thought that, having made some steps on the road to
improvement, he had become too much satisfied with himself, and that,
having obtained a good character, he had become less solicitous about
the treatment, and inclined to suspect those who had gone a step beyond
him. "He was for many years a valuable attendant at Bethlem, but it
would be very easy to advance many degrees from the practice of that
establishment, and yet be at an inconceivable distance from
perfection."[98] Mr. Dunstan observed, "You carry kind treatment too far
at the Retreat--beyond safety. If you had many of our patients they
would turn you topsy-turvy presently." Mr. Tuke replied, "It is
certainly possible to carry a good general principle too far, but we
have very few accidents or escapes, and we have many patients who come
to us in a very violent state." Mr. Dunstan would not allow his visitor
to see some of the rooms, and insisted that he could not have seen the
worst cases at the Retreat when he visited it--"for I have men in this
place who would tear to pieces every means of precaution or security
which I saw there." The remainder of this manuscript of 1812 is worth
reading by any one who knows the St. Luke's of 1882. "There are three
hundred patients, sexes about equal; number of women formerly much
greater than men; incurables about half the number. The superintendent
has never seen much advantage from the use of medicine, and relies
chiefly on management. Thinks chains a preferable mode of restraint to
straps or the waistcoat in some violent cases. Says they have some
patients who do not generally wear clothes. Thinks confinement or
restraint may be imposed as a _punishment_ with some advantage, and, on
the whole, thinks fear the most effectual principle by which to reduce
the insane to orderly conduct. _Instance:_ I observed a young woman
chained by the arm to the wall in a small room with a large fire and
several other patients, _for having run downstairs to the committee-room
door_. The building has entirely the appearance of a place of
confinement, enclosed by high walls, and there are strong iron grates to
the windows. Many of the windows are not glazed, but have inner
shutters, which are closed at night. On the whole, I think St. Luke's
stands in need of a radical reform."
In 1841 the infirmaries at each end of St. Luke's were fitted up for the
reception of male and female patients. In 1842 a chaplain was appointed,
and the present chapel set apart for worship. Open fireplaces were
placed in each of the galleries. The old method of coercion was
abolished; padded rooms were made available for the treatment of the
paroxysm; additional attendants were hired; and an airing-ground was
laid out and set apart for the use of the noisy and refractory patients.
Wooden doors were substituted for the iron gates of the galleries, and
the removal of the wire guards from the windows inside of the galleries
added much to their cheerfulness. The bars on the doors of the bedrooms,
and the screens outside the windows of the galleries were also ordered
to be removed. In 1843 the reading-rooms for the male and female
patients were completed, and a library containing two hundred volumes
was supplied by the kindness of the treasurer; an amusement fund was
established for the purchase of bagatelle and backgammon boards, and
other games for the use of the patients. In 1845 the hospital came under
the provisions of the Lunacy Act (8 and 9 Vict., c. 100). Since the
Lunacy Act of that year, the affairs of the hospital have been subjected
to the control of the Commissioners, in addition to that of the House
Committee and Board of Governors. Gas was introduced in 1848 into the
hospital. In 1849 the pauper burial-ground at the back of the hospital
was closed.[99] Numerous improvements have been made in recent years,
especially in regard to the appearance of the galleries. The next
improvement will be, I hope, to build a third St. Luke's, in the
country.
FOOTNOTES:
[57] Dugdale's "Monasticon," vol. vi. pt. ii. pp. 621, 622. Rot. Claus.
de ann. 4 Hen. IV. Videsis bundell. de beneficii Alienig. de anno 48
Edw. III. Et. Pat. 11 Edw. II. p. 2, m. 24. The Hospital or Priory of
Bethlem must not be confounded with the Priory of St. Mary Spital, or
New Hospital of our Lady without Bishopsgate, founded 1197.
The following were Masters or Priors of the Hospital: Robert Lincoln, 12
Rich. II.; Robert Dale, 1 Hen. IV.; Edw. Atherton, 15 Hen. VI. He was
clerk of the closet to the King. John Arundel, 35 Hen. VI.; Thomas
Hervy, 37 Hen. VI.; John Browne, later in the same year; John Smeathe or
Sneethe, 49 Hen. VI. John Davyson was removed 19 Edw. IV., when Walter
Bate and William Hobbes were made custodes, with benefit of survivorship
as Master to either (Dugdale, _op. cit._, p. 622).
[58] French, _crèche_, a manger.
[59] Argent, two bars sable, a labell of five points, throughout gules,
on a chief azure, an estoile of sixteen points, or, charged with a plate
thereon, a cross of the third between a human skull, in a cup on the
dexter side, and a basket of bread, _i.e._ wastell cakes, all of the
fifth, on the sinister.
[60] Stow, edit. 1603, p. 452. On Bethlem, see p. 166.
[61] "More pity that the eagle should be mewid, while kites and buzzards
prey at liberty" (Shakespeare). As hawks were caged while moulting or
mewing (Fr. _mue_, from _mutare_), a mew or mews came to mean a place of
confinement. "Stable so called from the royal stables in London, which
were so named because built where the king's hawks were mewed or
confined" (Webster). Wordsworth has "violets in their secret mews." An
asylum might be correctly styled a "Lunatic Mews."
[62] _Op. cit._, p. 139.
[63] Act i. sc. 4.
[64] "The Workes of Sir Thomas More," vol. ii. p. 901. Edit. London,
1557.
[65] Malcolm's "Londinum Redivivum," 1803, vol. i. p. 351.
[66] Charity Commissioners' Report, 1837, from which much valuable
information has been derived.
[67] See note on Bethlem, Appendix A.
[68] "A contest had long subsisted between the Common Council of the
City of London and the acting governors of all the royal hospitals, the
former claiming a right to be admitted governors in virtue of the
several royal charters. This dispute has been happily settled by a
compromise which allows the admission of twelve of the Common Council to
each hospital," by the Act of 1782 (Bowen's "Historical Account of
Bethlem," 1783).
[69] Charity Commissioners' Report, 1837, p. 390.
[70] See Munk's "Roll of the Royal College of Physicians," vol. i. p.
177.
[71] Edit. 1877, vol. v. p. 472.
[72] Appointed apothecary to Bethlem, 1795.
[73] "Natural History of Wiltshire," p. 93.
[74] _London Gazette_, No. 1000.
[75] This charter appears to grant more than the mere patronage of the
hospital.
[76] Evelyn's Diary, vol. ii. p. 119 (edit. 1850).
[77] The houses in Charing Cross and Barking, while earlier than Bethlem
as receiving the insane exclusively, were, of course, on a very small
scale compared with the Moorfield Asylum.
[78] Noorthouck's "A New History of London," 1773.
[79] In fact, it was built on the plan of the Tuileries, which is said
to have greatly incensed Louis XIV.
[80] Not of brass, but of Portland stone. One of the figures was said to
represent Oliver Cromwell's porter, who was a patient in the first
Bedlam. In 1814 they were "restored" by Bacon (the younger).
[81] Pennant's "London," edit. 1793, p. 267.
[82] Smith, _op. cit._, p. 35.
[83] Cf. Ireland's "Hogarth," vol. i. p. 64, for description of this
plate.
[84] Page 61. Written in 1703.
[85] Malcolm, in his "Londinum Redivivum," 1803 (vol. i. p. 351), says,
"The back part of the hospital, next London Wall, is too near the
street. I have been much shocked at the screams and extravagances of the
sufferers when passing there. This circumstance is to be deplored, but
cannot now be remedied."
[86] Proceedings of the Committee and Reports from Surveyors respecting
the state of Bethlem Hospital in 1800 and 1804. London, 1805.
[87] Charity Commissioners' Report, 1837.
[88] Bethlem expended £606 in 1814 and 1816, in opposing the "Mad-house
Regulation Bill."
[89] See Dr. Munk's "Roll of the College of Physicians," vol. i. p. 361.
For notices of the Monros, see the same work. An interesting series of
portraits of this family are in the possession of the College.
[90] "Roll of the College of Physicians," by Dr. Munk, vol. i. p. 428.
[91] Dr. Munk.
[92] _Edinburgh Review_, 1817, p. 443.
[93] Exemption from the operation of previous Acts had been obtained by
22 Geo. III., c. 77, s. 58; 9 Geo. IV., c. 40; and 2 and 3 Will. IV., c.
107, s. 62.
[94] A view of the hospital may be seen in the Print Room of the British
Museum: vide manuscript "Index to Views," vol. viii. print 253. It is
anything but inviting. Print 257 exhibits the building in Old Street.
[95] "The Battiad," attributed to Moses Mendez, Paul Whitehead, and Dr.
Schomberg.
[96] See Thornbury's "Old and New London," vol. ii. p. 200.
[97] "Some Account of London," 3rd edit. 1793, p. 268.
[98] Manuscript memorandum of a visit to St. Luke's in 1812, by S. Tuke.
[99] These particulars are taken from St. Luke's Annual Report of 1851,
containing a retrospective sketch of its history, for the use of which
we are indebted to the present superintendent, Dr. Mickley. Statistics
of recovery are given for different periods, but the fallacies attending
such comparisons are so great that I have not cited the figures.
CHAPTER III.
EIGHTEENTH-CENTURY ASYLUMS--FOUNDATION OF THE YORK RETREAT.
There were in England, at the beginning of the eighteenth century,
private asylums for the insane, the beneficial treatment pursued in
which was loudly vaunted in the public ear; but I am afraid the success
was not equal to the promise or the boast. Thus, there was in London an
old manor house in Clerkenwell, previously the residence of the
Northampton family, which was converted into a private asylum by Dr.
Newton the herbalist. His work, "The Herbal," was published by his son
some years afterwards. There appeared in the _Post Boy_ (No. 741) in the
year 1700 an advertisement from Dr. Newton, which runs as follows:--"In
Clerkenwell Close, where the figures of Mad People are over the Gate,
liveth one who by the blessing of God cures all Lunatick, distracted, or
mad people; he seldom exceeds three months in the cure of the Maddest
person that comes in his house; several have been cured in a fortnight
and some in less time; he has cured several from Bedlam, and other
mad-houses in and about the city, and has conveniency for people of
what quality soever. No cure--No money."
A certain Dr. Fallowes published a work on insanity which attracted some
attention at this period, having for its title, "The Best Method for the
Cure of Lunatics, with some Accounts of the Incomparable Oleum
Cephalicum used in the same, prepared and administered."[100] The author
observes in his preface that "as this Kingdom perhaps most abounds with
lunaticks, so the greatest variety of distractions are to be seen among
us; for the spleen to which it has been observed this nation is
extremely subject, often rises up to very enormous degrees, and what we
call _Hypo_ often issues in Melancholy, and sometimes in Raving
Madness." The proper seat of madness, he adds, appears to be the brain,
"which is disturbed by black vapours which clog the finer vessels thro'
which the animal spirits ought freely to pass, and the whole mass of
blood, being disordered, either overloads the small veins of the brain,
or by too quick a motion, causes a hurry and confusion of the mind, from
which ensues a giddiness and at length a fury. The abundance of bile,
which is rarely found to have any tolerable secretion in such patients,
both begets and carries on the disorder." Again, it will be seen that
there is nothing more than the fashionable classic humoral pathology,
without any original observations, and, in fact, the book is little more
than a puff of his incomparable oleum cephalicum, "a noble medicine,"
which he professes to have discovered; "a composition so very curious,
which I have known the use and benefit of in so many instances, that I
can venture to assure it to be the best medicine in the world in all the
kinds of lunacy I have met with. It is of an excellent and most pleasant
smell, and by raising small pustules upon the head, which I always
anoint with it, opens the parts which are condensed and made almost
insensible by the black vapours fixed upon the brain; it confirms its
texture, strengthens the vessels, and gives a freedom to the blood and
spirit enclosing them.... When applied after the greatest fury and
passion, it never fails to allay the orgasm of the animal spirits, and
sweetly compose 'em.... The distemper will be soon discharged, and I
have known it frequently to produce a cure in the space of one month."
He tells the reader he has had £10 a quart for it, but in compassion for
the poor he has prepared a quantity to be sold at £4 a quart at his
house. He also boasts of his kind treatment, and says, "The rough and
cruel treatment which is said to be the method of most of the pretenders
to this cure, is not only to be abhorred, but, on the contrary, all the
gentleness and kindness in the world is absolutely necessary, even in
all the cases I have seen." He says that not only has he never used
violence, but that his patients have good and wholesome food in every
variety, and maintains that such entertainments as are fit for persons
of any degree or quality will be found in his house in Lambeth Marsh,
"where the air is neither too settled and thin, nor too gross." As
chalybeate waters and cold bathing are useful, they can be had near, at
the Lambeth waters and in the Southwark Park; and he closes his book by
declaring that he is "always ready to serve mankind upon such terms as
shall be acknowledged reasonable and proportioned to the character and
condition of every patient."
Whether the patients placed under his care were treated as
scientifically and kindly as at the well-known asylum now in Lambeth
Road does not admit of question, although the latter has not much to say
of the "black vapours fixed upon the brain," nor can it, I am afraid,
boast of such a panacea as the oleum cephalicum!
I may add that, contemporary with Dr. Fallowes, an anonymous physician
in London published "A Discourse of the Nature, Cause, and Cure of
Melancholy and Vapours," in which he prescribes for the former, among
other remedies, not only "salt armoniac" (_sic_), steel filings, red
coral, zedoary, xyloalics, but, strangest of all, _toasted silk_!
Had we no other means of knowing the treatment to which some at least of
the insane were subjected in the early part of the eighteenth century,
we might infer it from a single passage in Swift's "Tale of a Tub," in
which the author says, in a "Digression concerning Madness," that
original people, like Diogenes, would, had they lived in his day, be
treated like madmen, that is, would incur the danger of "phlebotomy, and
whips, and chains, and dark chambers, and straw."
This was written in 1704.
Another well-known writer of that period, Smollett, did not distinguish
himself for generous views in regard to the insane, and forms a complete
contrast to his contemporary, Defoe, in his ideas of what the
legislature ought to do for the insane--a contrast greatly to the credit
of the latter. Smollett thought it would be neither absurd nor
unreasonable for the legislature to divest all lunatics of the privilege
of insanity in cases of enormity--by which he evidently means violent or
homicidal acts--to subject them "to the common penalties of the law." He
maintains that the consequences of murder by a maniac may be as
pernicious to society as those of the most criminal and deliberate
assassination. The entire inability indicated by this sentiment to
distinguish between voluntary and involuntary acts, the result of
disease--between motives and consequences--is singularly well shown.
Unfortunately it was not peculiar to Smollett.
Eloquently did Daniel Defoe protest against the abuses of asylums in his
day.[101] The "True-Born Englishman" reprobates the practice of men
sending their wives to mad-houses at every whim or dislike, in order
that they might be undisturbed in their evil ways. He asserts that this
custom had got to such a head that the private mad-houses were greatly
on the increase in and near London. He might well characterize this
system as "the height of barbarity and injustice," and worse than "a
clandestine inquisition," and say that these houses, if not suppressed,
should at least be subjected to examination. "Is it not enough," he
asks, "to make any one mad to be suddenly clapped up, stripped, whipped,
ill fed, and worse used?" He says, "If this tyrannical inquisition,
joined with the reasonable reflections a woman of any common
understanding must necessarily make, be not sufficient to drive any soul
stark-staring mad, though before they were never so much in their right
senses, I have no more to say." He asks the reader to indulge for once
the doting of an old man while he lays down his remedy, and not to
charge him with the ambition to be a lawgiver. Defoe goes at once to the
point, and says that it should be no less than felony to confine any
person, under pretence of madness, without due authority. He calls upon
Queen Caroline to begin her auspicious reign with an action worthy of
herself. Addressing the ladies, he says, "Who can deny when you become
suitors? and who knows but at your request a Bill may be brought into
the House to regulate these abuses?" Defoe little knew the prejudice any
reasonable measure would arouse when he added, "I am sure no honest
member in either honourable House will be against so reasonable a Bill;
the business is for some public-spirited patriot to break the ice by
bringing it into the House, and I dare lay my life it passes." He would
have infallibly lost it.
This naturally brings us to the question of what has been done by
legislation, both for protecting the subject from being unjustly
incarcerated on the plea of insanity, and for the protection of lunatics
when confined in asylums. The only Act of Parliament, up to the year
1808, which bore upon the care and protection of the lunatic poor was
that passed in the year 1744, in the seventeenth year of George II. (17
Geo. II., c. 5). This authorizes any two justices to apprehend them, and
have them securely locked up and, as might be expected, chained. The
contrast between the spirit and the provisions of such an Act, and that
passed a century later, under the auspices of Lord Shaftesbury, brings
into strong relief the solid advance which has been made in a century,
in the face of constant opposition from interested persons, as well as
that which arises out of the mere apathy and lethargy of a large class
of the community.
It should be added, in justice to the framers of the Act of 1744, that
it refers to those who "are so far disordered in their senses that they
may be too dangerous to be permitted to go abroad." It is rather for the
protection of society than the care of the lunatic.
A Committee of the House of Commons was appointed in 1763, to inquire
into the state of the private mad-houses of the kingdom. On this
Committee sat Pitt and Fox,[102] Wilkes, Lord North, Mr. Grenville, and
Mr. T. Townshend--names which alone serve to secure one's interest, and
also to raise the expectation that something would be done. Their
Report, while evidently drawn up in a cautious manner, shows, as had
been insisted upon by Daniel Defoe, with what alarming facility the
liberty of the subject could be taken away on the plea of insanity, and
how frequently persons availed themselves of this facility in order to
get rid of a troublesome wife or daughter, or to obtain some selfish
object equally improper. Dr. Battie[103] gave it as his opinion that
sane persons were frequently confined in asylums, and mentioned a case
in which a gentleman, who had had his wife immured in one, justified
himself by saying that he understood the house to be a sort of
Bridewell, or place of correction. The same witness found one patient in
an asylum, who had been there for years, chained to his bed, without
ever having had the assistance of any physician before. He never heard
anything more of him, until he was told some time after that he had died
of fever, without having had further medical advice.
The Committee resolved, "That it is the opinion of this Committee that
the present state of the private mad-houses in this Kingdom requires the
interposition of the legislature."
The Resolution was agreed to by the House, and leave was given to bring
in a Bill for the Regulation of Private Mad-houses, its preparation
being left to Mr. Townshend and six other members of the House.
Unfortunately, no legislation followed the Report of this Committee; in
fact, no further action was taken for ten long years.
Two years after this Committee sat, a melancholy picture of the
condition of private asylums in England is given in the _Gentleman's
Magazine_, and we can well believe that it was not over-coloured when we
consider the evidence which had been given before the Committee.
The writer asserts that persons may be and are taken forcibly to these
houses without any authority, instantly seized by a set of inhuman
ruffians trained up to this barbarous profession, stripped naked, and
conveyed to a dark room. If the patient complains, the attendant
brutishly orders him not to rave, calls for assistants, and ties him
down to a bed, from which he is not released till he submits to their
pleasure. Next morning a doctor is gravely introduced, who, taking the
report of the keeper, pronounces the unfortunate person a lunatic, and
declares he must be reduced by physic. He is deprived of all
communication with the outer world, and denied the use of pen and paper.
Such usage, the writer goes on to say, without a formal warrant, is too
much even for the Inquisition in Spain or Portugal, and cries aloud for
redress in a land of liberty. One circumstance brought forcibly out is
similar to that which, occurring at York some years afterwards (1791),
led, as we shall see, to the foundation of an institution in which a
directly opposite course was pursued. "Patients," he says, "often cannot
be found out, because the master lets them bear some fictitious names in
the house; and if fortunately discovered by a friend, the master, or his
servants, will endeavour to elude his search and defeat his humane
intentions by saying _they have strict orders to permit no person to see
the patient_."
At an earlier period a lady was sent by her husband to a private asylum
simply because she was extravagant and dissipated. The account of this
affair is in manuscript, dated 1746, but the substance of it is given
by a gentleman in _Notes and Queries_, May 5, 1866. Two or three girls
were placed in the same house, in order to break off love affairs
disapproved by their friends.
Again, I observe the following entry in the _Gentleman's Magazine_ under
date Sunday, August 6, 1769:--"A gentleman near Whitehall, by the
assistance of four ruffians, forced his lady into a hackney coach, and
ordered the coachman to drive to a private mad-house, and there to be
confined."
The _Gentleman's Magazine_ writer's remedy for "a condition compared
with which none is so deeply calamitous; no distress so truly miserable;
no object so deserving of compassion, and none so worthy of redress,"
was a really effective Bill for the regulation of private mad-houses.
At last, in 1773, a Bill passed the Commons for the "Regulation of
Private Mad-houses," the Report of 1763 having been first read. But
again disappointment awaited this honest attempt to protect the insane
and those alleged to be insane. The Bill was thrown out, as too many
good Bills have been thrown out, by the House of Lords. One is reminded
of the saying of Daniel O'Connell, "If it took twenty years to do
nothing, how long would it take to do anything?" In the House of
Commons, Mr. Townshend said in the debate that facts had come to his
knowledge which would awaken the compassion of the most callous heart.
Mr. Mackworth said that the scenes of distress lay hid indeed in obscure
corners, but he was convinced that if gentlemen were once to see them,
they would not rest a day until a Bill for their relief was passed, and
protested that he would mind neither time nor trouble, but employ every
hour until some relief should be obtained. He asserted, as also did Mr.
Townshend, that it was the "gentlemen of the long robe" who prevented
any action being taken. Be this as it may, the Bill, as I have said, was
thrown out, while another,[104] which proved almost a dead letter, was
passed in the following year. It was required by this Act that licences
should be granted "to all persons who shall desire the same." Reports of
abuses were to be made to the College of Physicians, to be suspended in
the College for perusal "by whosoever should apply for that purpose;"
but the College had no power to punish delinquents. This Act is
characterized by the Commissioners in Lunacy as "utterly useless in
regard to private patients, though in terms directing visitations to be
made to lunatics," and as they observe, its provisions "did not even
apply to the lunatic poor, who were sent to asylums without any
authority except that of their parish officers." Its scope did not
extend beyond private mad-houses. For admission into these an order and
medical certificate were necessary. They were sent to the secretary of
the Commissioners, that is, five Fellows of the College appointed in
accordance with the Act. They did not license or inspect the provincial
private asylums, but these were directed to send copies of the order and
certificate to the Fellows.
It is not surprising, perhaps, that nothing was done all these years,
considering how many questions engrossed the public mind. These
comprised the exciting debates and the popular tumults connected with
Wilkes and Horne Tooke, the heated discussions on the question of the
freedom of reporting debates in Parliament, and the "Royal Marriage
Bill." Lord Clive and Warren Hastings were engaged in deeds in India
which were about to bring down upon them the philippics of Burke and Sir
Philip Francis--much more attractive than the carrying of a Lunatic Bill
through Parliament. And, above all, the struggle had commenced, though
blood had not been spilt, between this country and her American
colonies. Then again, there was the distraction caused by the remarkable
mental affection of the Earl of Chatham, on which it will be fitting,
and I think interesting, to dwell for a moment. He had become Prime
Minister in 1766, and the following year was attacked by his remorseless
enemy, the gout. Partially recovered, he returned to Parliament--so
partially, indeed, that he was "scarce able to move hand or foot."
Engaged in making certain changes in the ministry, he began (to employ
the descriptive language of Trevelyan[105]) "to be afflicted by a
strange and mysterious malady. His nerves failed him. He became wholly
unequal to the transaction of any public affairs, and secluding himself
in his own house, he would admit no visitors and open no papers on
business. In vain did his most trusted colleagues sue to him for one
hour's conversation. As the spring advanced, he retired to a house at
Hampstead, and was able at intervals to take the air upon the heath,
but was still at all times inaccessible to all his friends." His
brother-in-law, Mr. Grenville, wrote:[106] "Lord Chatham's state of
health is certainly the lowest dejection and debility that mind or body
can be in. He sits all the day leaning on his hands, which he supports
on the table; does not permit any person to remain in the room; knocks
when he wants anything; and, having made his wants known, gives a signal
without speaking to the person who answered his call to retire."
"Other accounts of a rather later period," says Lord Mahon, "state that
the very few who ever had access to him found him sedate and calm, and
almost cheerful, until any mention was made of politics, when he
started, trembled violently from head to foot, and abruptly broke off
the conversation. During many months there is no trace in his
correspondence of any letter from him, beyond a few lines at rare
intervals and on pressing occasions, which he dictated to his wife. Even
his own small affairs grew a burden too heavy for his enfeebled mind to
bear. He desired Mr. Nuthall, as his legal adviser, to make ready for
his signature a general power of attorney, drawn up in the fullest
terms, and enabling Lady Chatham to transact all business for him
(Chatham Correspondence, vol. iii. p. 282, August 17, 1767). At the
close of the summer he was removed from Hampstead to Burton Pynsent, and
thence to Bath, some benefit to his health being looked for from the
change. But all his own thoughts and wishes at this time were centred
in the purchase of Hayes. In that air he had enjoyed good health; in
that air he might enjoy it again. There, in former years, he had made
improvements which his memory fondly recalled--plantations, for example,
pursued with so much ardour and eagerness that they were not even
interrupted at nightfall, but were continued by torchlight and with
relays of labourers. To Hayes, again become his property, Lord Chatham
was removed in December, 1767. But there, during many months ensuing, he
continued to languish in utter seclusion, and with no improvement to his
health.
"It is scarcely to be wondered at that a malady thus mysterious and thus
long protracted should have given rise to a suspicion in some quarters
that it was feigned or simulated, with a view to escape the vexations or
avoid the responsibilities of office. This idea, however natural, was
certainly quite unfounded. But, on the other hand, we may not less
decisively discard the allegation of gout.... In truth, it was not gout,
but the absence of gout, which at this period weighed upon Lord Chatham.
On the 2nd of March he had arrived in London from Marlborough, still
lame, and no more than half recovered. There his new physician, Dr.
Addington, eager, no doubt, to restore him to his public duties with the
least delay, had rashly administered some strong remedies, which did
indeed dispel the gout from his limbs, but only to scatter it about his
body, and especially upon his nerves. This fact was discovered, and has
been recorded by two separate and equally shrewd observers at the time
(Lord Chesterfield to his son, December 19, 1767; Lord Orford,
'Memoirs,' ii. p. 451[107]). Hence arose the dismal and complete eclipse
which for upwards of a year his mental powers suffered. There was no
morbid illusion of the fancy, but there was utter prostration of the
intellect.... In September, 1767, Junius spoke of Lord Chatham as 'a
_lunatic_ brandishing a crutch.'"[108]
"In the autumn Lord Chatham's health grew stronger. Judging from the
event, we may conclude that the morbid humours had begun to leave his
nerves, and to concentrate for a fit--so long intermitted and so much
needed--of his hereditary gout. He was still entirely shut out from his
friends, and still unable to transact any business, but he could bear to
hear it mentioned, and could form some judgment of its tenor. In this
situation his mind, not yet restored to its full vigour, brooded over
suspicions and discontents, for which the behaviour of his colleagues
afforded him no just foundation."[109]
Lord Chatham now resigned the Privy Seal (October, 1768), which he had
held since July, 1766. "Until towards the middle of March, 1767, he had
been truly and in effect Prime Minister; since that time he had
been--_nothing_."
Lord Chatham's derangement was, however, at last dispelled. We find
that "a few weeks only after Lord Chatham's resignation, his gout, so
long interrupted, but for some time past giving symptoms of approach,
returned. Bowed down as he was by a far more grievous malady, it proved
to him a healing visitation. It raised his drooping spirits and strung
his feeble nerves. The clouds which had obscured that great intellect
wholly passed away. Never indeed did his splendid eloquence or his wise
and resolute counsels shine forth more brightly than during the next
following years."
It was in the year 1775 (November 29) that, on the American war
question, Lord Chatham emerged from his retirement--a year after the
Lunacy Act had passed.
Thirteen years later, his Sovereign fell a victim to the same disorder,
and it is probable that the attention thus drawn to the malady exerted a
beneficial influence upon public feeling, in the interests of those
labouring under the same affliction. The clerical and medical doctor,
Willis, who was at that time seventy years of age, was called in to
attend George III. in 1788. The King had had, as early as 1765, a slight
attack, but the fact was carefully concealed. Willis's treatment
consisted in bark, blistering, and an occasional dose of calomel.[110]
It is not necessary to enter here into the differences of opinion which
arose as to the conduct of the case, between himself and his colleagues,
Warren, Reynolds, and others. In February, 1789, the royal patient had
progressed so favourably that he was able to write a sensible letter to
Pitt, and on April 23rd of the same year he went to St. Paul's to offer
thanks for his recovery, amid a vast and enthusiastic multitude, thereby
running a great risk of a relapse. However, he had no return of the
complaint till 1801, when he recovered rapidly. In 1804 he again became
insane, and again recovered, the death of the Princess Amelia in 1810
causing the attack from which he never recovered. The subject of
insanity was therefore brought before the public again and again, for
some thirty years--longer, indeed, if we include Lord Chatham's
derangement--and brought before them in a way which excited their
commiseration in a marked degree.
It is worthy of notice that mechanical restraint was applied by Willis
to the King. "Nothing," observes the late Dr. Ray, "can more strikingly
indicate the change that has occurred since that time in respect to the
means of managing the insane, than the fact that for two or three months
the King was frequently subjected to mechanical restraint. There was
nothing in his condition which could be considered at the present time a
sufficient reason for its application."[111]
It may be observed here that John Wesley prescribed at this period for
madness, as well as for irreligion.[112] One of his remedies was that
the patient should be exclusively fed on apples for a month--a regimen
which recalls the starving treatment of epilepsy prescribed, at a
recent date, by Dr. Jackson, of Boston. Wesley's prescriptions for
"lunacy" and "raving madness" are given with almost as much confidence
of success as those we have cited from the Saxon leech-book.
"For Lunacy:
1. Give decoction of agrimony four times a day.
2. Or, rub the head several times a day with vinegar in which
ground ivy leaves have been infused.
3. Or, take daily an ounce of distilled vinegar.
4. Or, boil juice of ground ivy with sweet oil and white wine
into an ointment. Shave the head anointed therewith, and
chafe it in, warm, every other day for three weeks; bruise
also the leaves and bind them on the head, and give three
spoonfuls of the juice warm every morning.
☞ This generally cures melancholy. The juice alone taken
twice a day will cure.
5. Or, electrify. Tried.
For Raving Madness:
1. It is a sure rule that all madmen are cowards, and may be
conquered by binding only, without beating (Dr. Mead). He
also observes that blistering the head does more harm than
good. Keep the head close shaved, and frequently wash it with
vinegar.
2. Apply to the head clothes dipt in cold water.
3. Or, set the patient with his head under a great waterfall,
as long as his strength will bear; or pour water on his head
out of a tea-kettle.
4. Or, let him eat nothing but apples for a month.
5. Or, nothing but bread and milk. Tried."
In all hypochondriacal cases, and in obstinate madness, Wesley
recommended the following, wherein we see a return to the almost
inevitable hellebore: "Pour twelve ounces of rectified spirits of wine
on four ounces of roots of black hellebore, and let it stand in a warm
place twenty-four hours. Pour it off and take from thirty to forty drops
in any liquid, fasting."
Lastly, for all nervous disorders, he recurs to what was his favourite
remedy, and says, "But I am firmly persuaded that there is no remedy in
nature for nervous disorders of every kind, comparable to the proper
and constant use of the electrical machine."
I would direct the reader's attention to the condition of some asylums
at the latter end of the eighteenth century, as described by a prominent
character and noble philanthropist of that period.
The celebrated John Howard did not confine his attention to prisons, but
frequently took occasion to visit asylums in the course of his
philanthropic travels; and in his "Accounts of the Principal Lazarettos
in Europe, together with Further Observations on some Foreign Prisons
and Hospitals, and Additional Remarks on the Present State of those in
Great Britain and Ireland" (1789), he contrasts St. Luke's Hospital with
a hospital for lunatics at Constantinople, to the advantage of the
latter in some respects, although he states that there is very little
regard paid to cleanliness or the patients, while the former was neat
and clean. Of the Constantinople asylums, he says, "They are admirable
structures.... The rooms are all on the ground floor, arched, and very
lofty, having opposite windows, and opening under a corridor into a
spacious area." In the midst of the neglect of _human_ beings he was
astonished to find so much attention paid to _cats_, an asylum having
been provided for them near the Mosque of St. Sophia. Of St. Luke's he
says, "The cells were very clean and not offensive. The boxes on which
the beds of straw lie are on a declivity and have false bottoms. The
cells open into galleries, fifteen feet wide, and on each gallery was a
vault, which was not offensive.... Here are large airing grounds for
men and women; there is also a new but very inconvenient bath. Here are,
very properly, two sitting-rooms in each gallery, one for the quiet, the
other for the turbulent; but I could wish that the noisy and turbulent
were in a separate part of the house by day and by night.... Several
women were calm and quiet, and at needlework with the matron. A chapel
would be proper here for the advantage of recovering patients, as I have
seen in such houses abroad."
It would seem, then, that although Howard observes, "I greatly prefer
the asylum at Constantinople," he must refer to the less important
matter of the structure of the building. As also when mentioning St.
Patrick's or Swift's Hospital at Dublin, he says he should prefer the
Dol-huis at Amsterdam and the hospital at Constantinople, "where the
rooms open into open corridors and gardens, which is far better than
their opening into passages as here in England."[113]
In his previous work, 1784, Howard observes, speaking of English
prisons, "I must add here that in some few gaols are confined idiots and
lunatics. These serve for sport to idle visitors at assizes and other
times of general resort. Many of the Bridewells are crowded and
offensive, because the rooms which were designed for prisoners are
occupied by the insane (by the Irish Act, 3 Geo. III., such persons are
required to be kept separate). Where they are not kept separate, they
disturb and terrify other prisoners. No care is taken of them, although
it is probable that by medicines, and proper regimen, some of them
might be restored to their senses and to usefulness in life."[114]
We shall see more clearly, as we proceed, what was the condition of the
insane in England at the latter part of the eighteenth century.
A time then came--in the year 1792--fraught with an event as important
as it was unexpected, the beginning, on a small scale, of the reform
which ultimately took place in the condition of British asylums; a
reform slowly brought about by means which might have seemed very
inadequate for the purpose. But the poet warns us to
"Think naught a trifle, though it small appear;
Small sands the mountain, moments make the year,
And trifles life."
And does not Joseph de Maistre well say, "Aucune grande chose n'eut de
grands commencements"--nothing great ever began great?
I should premise that there was at York an asylum founded some fifteen
years before, on a charitable foundation, with it cannot be doubted, the
best intentions on the part of its promoters, but, unfortunately, its
management had been no better than the worst asylums of that day. It
happened that, in 1791, the friends of a patient who was confined there,
desiring to visit her, were refused admission, and suspicion was aroused
as to the treatment to which she was subjected, with (as the event
proved) only too much reason, and not, as sometimes happens at the
present time, without just occasion, and, indeed, on the most frivolous
and vexatious pretences. The knowledge that such is the case ought to
make us very careful how we sit in judgment on our predecessors in
regard to any charge brought against them. There is, however, undeniable
evidence, proof which cannot be evaded, and ultimately admitted by all,
that the asylum at York of which I speak was a frightful abode for
lunatics. The time had not come for its public exposure, but instead of
this it was proposed by a citizen of York--William Tuke--that an
institution should be erected where there should be no concealment, and
where the patients should be treated with all the kindness which their
condition allowed. His mind, full of common sense, suggestive, and not
seeing why the right thing should not be done--in fact, his creed being
that it must be done--he set resolutely to work to effect his purpose.
It became with him a question of humanity and right, and he resolved
that if he could be the means of effecting it, there should be an asylum
openly conducted and on humane principles. He talked over the project
with his friends, and having at last formed a definite plan, he brought
it forward before an assembly of the communion of which he was a
member--the Society of Friends. I should have stated that the patient in
the York Asylum to whom I have referred belonged to the same body. As
was natural, difficulties were at first suggested; but, having an iron
will, as well as a kind heart, he overcame them before long, and
eventually succeeded in his object. His feeling that something should
be done had been strengthened by a visit he had paid to St. Luke's
Hospital, where he saw the patients lying on straw and in chains. He was
distressed with the scene, and could not help believing that there was a
more excellent way. He resolved that an attempt should be made to
ameliorate their miserable condition. His proposition was made in the
spring of 1792. Adopted, and the funds provided, steps were taken for
erecting an institution in a healthy locality in the neighbourhood of
York. "The ground was elevated, and the situation afforded excellent air
and water, as well as a very extensive and diversified prospect." The
illustration (Frontispiece) will convey a better idea than any verbal
description of this unpretentious building. Its character as a labour of
love and humanity was embodied in an inscription written at the time,
which may be discovered whenever the foundation stone is disinterred:--
HOC FECIT
AMICORUM CARITAS IN HUMANITATIS
ARGUMENTUM
ANNO DÑI MDCCXCII.
Referring to the establishment of the Retreat, an American physician of
celebrity in the department of Psychological Medicine says, "Merit of
this kind is seldom duly appreciated by the world, for it does not
strike the imagination like that of brilliant discoveries in the
physical sciences, and the very reason that reforms like that in
question are so obviously sanctioned and confirmed by common sense and
the feelings of common humanity is apt to detract from the merit of
those who conceive them."[115]
There are several points to which I have devoted considerable labour
among the archives of the Retreat, and on which I have had the advantage
of frequently conversing with the author of the "Description of the
Retreat" in former years. Among these I may refer to an interesting
explanation of the origin of the now familiar term "Retreat" as applied
to a lunatic asylum. One day the conversation in the family circle
turned on the question, What name should be given to the proposed
institution? when my grandmother, who was much interested in the
establishment, quickly remarked that it should be called a _Retreat_. It
was at once seen that feminine instinct had solved the question, and the
name was adopted, "to convey the idea of what such an institution should
be, namely, a place in which the unhappy might obtain a refuge; a quiet
haven in which the shattered bark might find the means of reparation or
of safety;"--a term which became the parent of numberless imitations,
some of them, it must be confessed, only so called by a miserable irony.
It need hardly be remarked that this term had been from an early period
employed in the Church of Rome to indicate a place of resort for
meditation and penance during certain periods of the year.
Family tradition says that the wife of the projector of the Retreat--a
woman of great force of character--questioned at first his wisdom in
proposing the foundation of such an institution. He had (with her full
concurrence) already established a school for the higher education of
girls, among other projects which sprang from his fertile brain, and she
playfully told him that people would say he had had many children, and
that his last was an idiot. Here for once the woman's instinct failed,
and masculine sense succeeded. Some of his co-religionists also
discouraged the undertaking. "Looking back to the year 1792, and
considering the miserable condition of the insane in general at that
period, it appears to us almost strange that the proposal should have
met in the first instance with considerable opposition, and that the
institution had to struggle through many difficulties into
existence."[116]
The experiment began in earnest, on the opening of the establishment,
four years after it was instituted, the projector residing at and
superintending it, a short interval excepted, until the appointment of
Jepson, who, as well as his wife, the matron, were admirably adapted for
their posts. During this period, "the founder," says the historiographer
of the Retreat, "superintended the management of the patients, and
entered into their cases with great zeal, discrimination, and humanity."
Letters in my possession, written by him, attest this, and also the
difficulties which he encountered; for in one of them he writes, "All
men seem to desert me in matters essential." Happily, however, a
like-minded man, in many respects, was at last found in Jepson, who
became an excellent superintendent, and remained at his post until the
death of the founder, who to an advanced age continued, to quote his
grandson, "to pay very close attention to the institution, generally
visiting it several times a week."
It was early seen that work in the open air would be an important help
in the experiment, and enough land for a farm had been obtained. I
observe that, among other things, the fact particularly struck a Swiss
physician who visited the Retreat not long after it was opened. He
remarks on its presenting the appearance of a large rural farm, and on
its being surrounded by a garden. He was also struck by another
important feature: "There is no bar or grating to the windows."
"Cette maison est située à un mille de York au mileau d'une campagne
fertile et riante; ce n'est point l'idée d'une prison qu'elle fait
naître, mais plutôt celle d'une grande ferme rustique; elle est entourée
d'un jardin fermé. Point de barreau, point de grillages aux fenêtres, on
y a supplée par un moyen dont je rendrai compte ci-après.
"Vous voyez, que dans le traitement moral on ne considere pas les fous
comme absolument privés de raison, c'est-à-dire, comme inaccessibles aux
motifs de crainte, d'espérance, de sentiment et d'honneur, on les
considere plutôt, ce semble, comme des enfans qui ont un superflu de
force et qui en faisoient un emploi dangereux."[117]
Pinel had now been at work five years, and for the first time heard of
the management of the Retreat from the glowing account published by this
Swiss physician Dr. Delarive. The conductors of the Retreat first became
acquainted with Pinel's great work at the Bicêtre in Paris in 1806.
An incident related in honour of Jepson may fitly be introduced here. He
"had found the doctrine of subduing the insane by fear maintained in St.
Luke's Hospital, which was then esteemed, and probably justly, the best
public establishment of the kind in Great Britain; and he could not but
attach considerable value to its long and extensive experience. Soon
after entering upon his office, a very violent patient came under his
care. His friend and adviser (Tuke) was from home, and he determined for
once, upon his own responsibility, to act upon the prevalent notion. In
size he was not ill qualified to do the duty of a keeper upon the old
system, but his feelings and all the habits of his mind were opposed to
harsh methods. After the experiment he was so uneasy with himself, that
on retiring to bed he slept but little, and he resolved that, if the
course he had adopted was not in this case beneficial, he would entirely
abandon the system. On visiting the patient his opinion was that the
experiment had failed, and that it had left a painful and vindictive
feeling on the mind of the subject of it." It is added that henceforth
Jepson fully carried out, step by step, the views of the founder and his
friends.[118]
The earnestness with which the officers who were appointed entered into
the undertaking--the way in which they helped to make possible the
success so much desired by the founder--deserves our grateful
appreciation, and should preserve them from being in the least degree
thrown into the shade. To enter heartily into the ideas and schemes of
other people may be as meritorious as to originate them, and is often
much more irksome. It is neither necessary nor generous to exalt one
class of workers at the expense of the other. No doubt the originator of
the Retreat was one who also worked hard himself at what he had
initiated; but he could not have eventually succeeded if he had not been
able to attract to himself men who would devote their powers to the new
work in the same spirit as he did. Such men were Jepson and Fowler, the
latter of whom, the first visiting physician,[119] died five years after
his appointment. Such also was Dr. Cappe, his successor, who was cut off
in his prime deeply regretted--"a man equally esteemed for the gentle
urbanity of his manner, the excellence of his understanding and
dispositions, and his professional attainments."[120]
It is not always that the insane are able to appreciate the efforts made
to render them comfortable. It is all the more gratifying when it does
occur. A patient was admitted who had nearly lost the use of his limbs
from being chained, and for some time it was necessary to lead him
about like an infant. He was found to require no restraint, and was,
after a while, able to walk without assistance. When one of his friends
visited him and asked him what he called the place, he replied, with
great earnestness, "Eden, Eden, Eden!"
A man was admitted who had been for twenty years chained and naked; with
the exception of the occasional use of arm-straps, no personal restraint
was employed from the moment of his admission. He was soon induced to
wear clothes and adopt orderly habits.
One day a man of Herculean size was brought to the institution, and the
case is thus described by the author of the "Description": "He had been
afflicted several times before; and so constantly, during the present
attack, had he been kept chained, that his clothes were contrived to be
taken off and put on by means of strings, without removing his manacles.
They were, however, taken off when he entered the Retreat, and he was
ushered into the apartment where the superintendent and matron were
supping. He was calm. His attention appeared to be arrested by his new
situation. He was desired to join in the repast, during which he behaved
with tolerable propriety. After it was concluded, the superintendent
conducted him to his apartment, and told him the circumstances on which
his treatment would depend; that it was his anxious wish to make every
inhabitant in the house as comfortable as possible, and that he
sincerely hoped the patient's conduct would render it unnecessary for
him to have recourse to coercion. The maniac was sensible of the
kindness of his treatment. He promised to restrain himself, and he so
completely succeeded, that, during his stay, no coercive means were ever
employed towards him." When excited and vociferous, the superintendent
went to his room and sat quietly beside him. After a period of increased
irritation, the violent excitement subsided, and he would listen with
attention to the persuasions and arguments of his friendly visitor. "Can
it be doubted," asks Tuke, "that in this case the disease had been
greatly exasperated by the mode of management, or that the subsequent
kind treatment had a great tendency to promote his recovery?"
An architect, Mr. Stark, in visiting British asylums, when engaged in
preparing plans for the Glasgow Asylum, came to the Retreat. He thus
speaks in his "Remarks on the Construction and Management of Lunatic
Asylums": "In some asylums which I have visited, chains are affixed to
every table and to every bed-post; in others, they are not to be found
within the walls.... At the Retreat they sometimes have patients brought
to them frantic and in irons, whom they at once release, and by mild
arguments and gentle arts reduce almost immediately to obedience and
orderly behaviour. A great deal of delicacy appears in the attentions
paid to the smaller feelings of the patients. The iron bars which
guarded the windows have been avoided, and neat iron sashes, having all
the appearance of wooden ones, have been substituted in their places;
and when I visited them, the managers were occupied in contriving how to
get rid of the bolts with which the patients are shut up at night, on
account of their harsh, ungrateful sound, and of their communicating to
the asylum somewhat of the air and character of a prison. The effects of
such attentions, both on the happiness of the patients and the
discipline of the institution, are more important than may at first view
be imagined. Attachment to the place and to the managers, and an air of
comfort and of contentment, rarely exhibited within the precincts of
such establishments, are consequences easily discovered in the general
demeanour of the patients." "It is a government," Stark also observes,
"of humanity and of consummate skill, and requires no aid from the arm
of violence and the exertions of brutal force."[121] But Stark himself,
strange to say, is careful not to commit himself to the total abolition
of chains, adopted at the Retreat.
Two more brief testimonies from competent visitors who inspected the
institution may be permitted--one from Dr. Duncan of Edinburgh, when on
a tour of inspection of asylums in Britain; the other from a foreigner,
Dr. Naudi, then the "President of the Maltese Hospitals." The former
wrote, after visiting the Retreat, of the demonstration, "beyond
contradiction, of the very great advantage resulting from a mode of
treatment in cases of insanity much more mild than was before introduced
into almost any lunatic asylum, either at home or abroad. In the
management of this institution they have set an example which claims the
imitation, and deserves the thanks, of every sect and every nation. For,
without much hazard of contradiction from those acquainted with the
subject, it may be asserted that the Retreat at York is at this moment
the best-regulated establishment in Europe, either for the recovery of
the insane, or for their comfort when they are in an incurable state."
And Dr. Naudi, in broken but effective English, observed, "This house or
Retreat for the troubled in mind, I think, is one of the best things I
saw in England on the same subject; and having observed many others on
the Continent, I dare to say it is the best in all the world. The
situation of the building out of the town, a large garden around it, the
propriety of the rooms, the cleanliness of the patients, the way in
which they are kept, as for dressing, as for feeding them, is very
remarkable to be observed."
The institution had not been very long in full operation before the
success of the more enlightened treatment pursued in it was so patent,
that the same pleasure and astonishment which the Swiss doctor
experienced became general, and it was decided, in the hope of inducing
others to follow a like course, to publish an account of the means which
had been adopted in the treatment of the patients. This "Description of
the Retreat," by S. Tuke, containing "An Account of its Origin and
Progress, the Modes of Treatment, and a Statement of Cases," appeared in
1813.[122] Sydney Smith helped to bring the book into notice by his
favourable review of it in the _Edinburgh_. In it he says of the
Retreat:--
"The great principle on which it appears to be conducted is that of
kindness to the patients. It does not appear to them (the managers),
because a man is mad upon one particular subject, that he is to be
considered in a state of complete mental degradation, or insensible to
the feelings of kindness and gratitude. When a madman does not do what
he is bid to do, the shortest method, to be sure, is to knock him down;
and straps and chains are the species of prohibitions which are the
least frequently disregarded. But the Society of Friends seems rather to
consult the interest of the patient than the ease of his keeper, and to
aim at the government of the insane by creating in them the kindest
disposition towards those who have the command over them. Nor can
anything be more wise, humane, or interesting than the strict attention
to the feelings of their patients which seems to prevail in the
institution.... To the effects of kindness in the Retreat are superadded
those of constant employment. The female patients are employed as much
as possible in sewing, knitting, and domestic affairs; and several of
the convalescents assist the attendants. For the men are selected those
species of bodily employment most agreeable to the patient, and most
opposite to the illusions of his disease." He proceeds to say that in
this instance, "an example has been set of courage, patience, and
kindness which cannot be too highly commended or too widely diffused,
and which, we are convinced, will gradually bring into repute a milder
and better method of treating the insane."[123]
The author of the above work took an active part in the management of
the Retreat for more than forty years, strenuously aided in exposing the
abuses of the York Asylum, and exerted no inconsiderable influence upon
the movement on behalf of the insane, not only by the work referred to,
but by his writings on the construction of asylums.[124]
I find an entry in his journal, made in April, 1811, that he had begun
an Essay on the state of the insane poor for a periodical called the
_Philanthropist_. His indignation had been aroused by witnessing the
condition of pauper lunatics in a workhouse in the south of England. He
was led into a small yard at a short distance from the principal
building, in which were four cells. He found them large enough for one
person. At the further end of each was a platform of wood attached to
the wall, which was intended for the patient's bed. In two of the cells
all the light and air which could be admitted passed through an iron
grating in the door, so that the cold air could not be excluded without
entirely darkening the apartment. In each of these cells a female was
confined. "I cannot describe," he says, "my feelings and astonishment
when I perceived that the poor women were absolutely without any
clothes. The weather was intensely cold, and the evening previous to our
visit, the thermometer had been sixteen degrees below freezing. One of
these forlorn objects lay buried under a miserable cover of straw,
without a blanket or even a horse-cloth to defend her from the cold."
So of the others, one of whom had the leg chained to the platform at the
end of the cell. Bitter complaints were made of cold. Flannel dresses
were at once sent to the workhouse for these poor wretches, which they
wore, and invoked many blessings on the giver, who denounced the conduct
of the guardians and writes, "Surely, a mind, actuated by the virtuous
sympathies of our nature, would not have joined with comfort the warm
social circle, or repose his head on a soft pillow, whilst he knew that
any one was enduring so many privations, and so much misery which was
not only in his power but was his duty to relieve."
It should be stated that a Select Committee had been appointed (moved
for by Mr. Wynn) five years before (1806), to inquire into the state of
pauper lunatics in England. This Committee proposed the erection of
asylums in different parts of the kingdom, power being given to the
magistrates of any county to charge the expense upon the county rate,
all pauper lunatics within the district being conveyed thither and
maintained at the expense of their respective parishes, and it was
recommended that no asylum should contain more than 300 patients. At
that time there were 1765 lunatics in workhouses, or houses of industry,
483 in private custody, 113 in houses of correction, and 27 in gaols;
total, 2248.[125] Sir George Paul, who took an active interest in this
Committee, stated, in a letter to the Secretary of State, that there was
hardly a parish of any considerable extent in which there might not be
found some unfortunate human creature, who, if his ill-treatment had
made him "frenetic," was chained in the cellar or garret of a workhouse,
fastened to the leg of a table, tied to a post in an outhouse, or
perhaps shut up in an uninhabited ruin; or, if his lunacy were
inoffensive, was left to ramble, half-naked and half-starved, through
the streets and highways, teased by the rabble, and made the jest of the
vulgar, ignorant, and unfeeling. "I have witnessed," he says, "instances
of each of these modes of securing lunatics, under the Act 17 Geo. II.,
c. 5. Of all the lunatics in the kingdom, the one half are not under any
kind of protection from ill-treatment, or placed in a situation to be
relieved of their malady."
In the following year (1808) an Act (48 Geo. III., c. 96) was passed,
providing that it should be lawful for justices in every county in
England and Wales to take into consideration the propriety of providing
a lunatic asylum for the reception of patients within the county.
Referring to the Act 17 Geo. II. for the committal of vagrant lunatics,
the new Act provided that in case there should be an asylum established
for the county within which the lunatic belonged, then a warrant should
be issued for the removal of such lunatic to the asylum, and not
elsewhere; but if no asylum had been erected, then he was to be confined
in any house duly licensed under the authority of the Act of 14 Geo.
III. It will be seen that this legislation was not compulsory, and
therefore utterly failed in attaining the object of its promoters. It
only authorized magistrates to act.
This Act was amended in some points of importance in 1811.[126]
Overseers were obliged to produce a certificate of a medical man as to
the state of the lunatic. Justices were to make returns to the quarter
sessions of the cases brought before them, and medical superintendents
returns of the state of persons intrusted to their care, at least once a
year.
"The Description of the Retreat," then, of which Dr. Conolly writes in
1856, "For readers desirous to know the views which ought to prevail in
all lunatic asylums, I could not even now refer to any work in which
they are more perspicuously explained; in none are the details of
management, economic, medical, and moral, to be found more convincingly
set forth"--this work, happily, proved the means,[127] by the
extraordinary interest it excited in the experiment, and the contrast it
was but too well known to exhibit to the general condition of similar
institutions, of arousing attention, first to the abuses of the old
asylum at York, and then to others, until it was deemed desirable to
appoint a Committee of the House of Commons to investigate the subject
thoroughly. To this we shall refer in more detail, but may here observe
that the founder of the Retreat was one who gave evidence before it, and
the members, says an eye-witness, were evidently interested in seeing
the old man, then upwards of eighty, and hearing from his own lips some
of the facts relating to the success of the experiment at York. He
continued to devote himself to the interest of the institution, and died
in 1822, thirty years after he had broached the idea of its
establishment. It had, he said, some years before, succeeded far beyond
his expectations, and he felt a wish to contribute such information as
attentive observation had enabled him to make for the benefit of others.
This he did in various ways, one being a Letter to the governors of the
York Lunatic Asylum, in which he observes, "At the time of Lord
Erskine's Chancellorship, I noticed with much satisfaction his remarks
on the treatment of insane patients, especially in private mad-houses,
which he found was so generally severe, that in case they were but a
little deranged, it was sufficient to make them raving mad; and he
delivered it as his judgment that kind and conciliating treatment was
the best means to promote recovery. The latter part of this opinion I
have the satisfaction of asserting has been evidently proved correct in
the management of the Retreat, where coercion, though sometimes
necessary for feeding the patients and preserving them from injury to
themselves or others, is administered in the most gentle manner, and the
use of chains is never resorted to."
"In person," wrote a contemporary, "William Tuke hardly reached the
middle size, but was erect, portly, and of a firm step. He had a noble
forehead, an eagle eye, a commanding voice, and his mien was dignified
and patriarchal."
He was ninety when he died, and it may be added that Willan made a happy
hit when he said, on being consulted by him many years before, "There is
a pulse which will beat till ninety."
"Of no distemper, of no blast he died,
But fell like autumn fruit that mellowed long:
Even wondered at, because he dropt no sooner.
Fate seemed to wind him up for fourscore years;
Yet freshly ran he on ten winters more,
Till like a clock worn out with eating time,
The wheels of weary life at last stood still."
DRYDEN, _Œdipus_, Act iii. sc. 1.
French physicians have done justice generously and ungrudgingly to the
services rendered by the York reformers in the management of the insane.
Parchappe, late Inspector-General of the "Service des Aliénés" in
France, wrote: "La Retraite d'York, dont Samuel Tuke publia la
description en 1813, fut considérée comme l'école où les aliénistes
devaient s'instruire et comme le modèle auquel ils devaient se
conformer. La création et l'organisation de cet établissement a eu la
plus grande influence sur le développement des bonnes méthodes de
traitement et sur le perfectionnement des asiles en Angleterre."[128]
Ferrus, physician to Napoleon I., visited the English asylums in 1826,
in order to obtain some useful hints in the management of similar
institutions in France, and commends, in a passage which I shall quote,
the mild means of coercion resorted to at the Retreat. He speaks of it
as the first asylum in England which arrested the attention of
foreigners, and proceeds, "Mr. Tuke was a man for whom religion and
morality were practical virtues, and in whose eyes neither riches nor
poverty, imbecility nor genius, ought in the slightest degree to affect
the bonds which unite all men together in common. He thought, with
reason, that justice and force ought to be evinced, not by shouts and
menaces, but by gentleness of character and calmness of mind, in order
that the influence of these qualities might make themselves felt upon
all, even when excited by anger, intoxication, and madness. The
traditions of this friend of humanity are preserved in the house which
he founded. Everything, even down to the patients, is silent and
peaceful in this asylum, where some who are not members of the Society
of Friends are also admitted. Those admitted, be their religion or
social position what they may, whatever even their habits may have been,
influenced by the tranquillity of the place and the force of example,
find repose in this house, which much more resembles a convent of
Trappists than a mad-house; and if one's heart is saddened at the sight
of this terrible malady, we experience emotions of pleasure in
witnessing all that an ingenious benevolence has been able to devise to
cure or alleviate it.... The reputation of this institution is the best
established of any in England. We are assured that the number of cures
is considerable, and we willingly believe this, because the general
management of the house is favourable to the treatment of insanity."
Thirty years afterwards, when I paid a visit to Ferrus in Paris, he
recalled, with great animation, the impressions he at this period
received at the York Retreat.
Nor have the Americans been less grudging in their encomiums. Dr. Ray,
one of their most distinguished physicians devoted to the treatment of
the insane, whom I have already quoted, after visiting our asylums many
years ago, bore witness to the results of the reform "so thoroughly
effected at the York Retreat," and speaks of the founder as clear-headed
and warm-hearted, one "who, true to his faith, conceived the idea that
the insane, as well as the sane, could best be managed in the spirit of
peace and good will." And Dr. Pliny Earle observes, "It is now very
fully demonstrated that the idea of the amelioration of the condition of
the insane was original with Pinel and Tuke, and that for some time they
were actively pursuing their object, each uninformed of the action of
the other. It is no new thing for inventions, discoveries, and
innovations upon traditionary practices to originate almost
simultaneously in more than one place, showing that they are called for
by the times; that they are developments of science and humanity,
necessary evolutions of the human mind in its progress towards the
unattainable perfect, rather than what may be termed a gigantic or
monstrous production of one intellectual genius. Each perceived the
wretchedness, the misery, the sufferings of the insane around him; each
was moved to compassion; each resolved to effect a reform in their
treatment; each succeeded. The recognition of services to humanity is
due to each. To each we freely accord it."[129]
Dr. Brown, the late physician of the Bloomingdale Asylum, New York,
after visiting England in 1863, observes of the lunatic hospitals in
England, "There is one possessing historical fame and interest, which
yet retains its early popularity, as well as its excellent reputation
among medical men. The York Retreat, founded by the Society of Friends
at the close of the last century, and hallowed in the memory of every
one who appreciates the spirit of beneficence which originated it and
has ever since pervaded its halls, still pursues its sacred mission of
removing and relieving mental diseases. Nowhere did I observe clearer
evidence of intelligent and conscientious fulfilment of the humane
purposes of all such institutions. The older sections of the building
were being gradually replaced by new constructions, which conform
interiorly to the present standard of advancement; and as for that
personal devotion of the chief officers, on which the welfare of
patients must mainly depend, it was sufficiently apparent that the
genius and the earnestness of Tuke still abide among his
successors."[130]
Returning now to what in the history of the rise and development of the
modern treatment of the insane is of great importance, the guiding
principles of the treatment pursued at the York Retreat, and its
relation to what is understood as the non-restraint system, I would
observe that the first principle of all was an active humanity--the
highest form of it as embodied in the golden Christian rule. It has
often been said that the members of the community by whose principles he
was animated seem to think it necessary to act as well as to talk; to
carry out their principles into actual practice, as if they were really
intended to be applied to the ills of humanity. If some of his own
friends discouraged Tuke's benevolent designs, it may have arisen from
their not being convinced that a case had been made out for its
exercise. An accident, as it were, brought the fact of the
unsatisfactory condition of the asylums of his day forcibly before him.
Accustomed to do as well as to talk about doing, when he knew the
existence of an abuse, he set himself to work at once to prevent its
recurrence so far as the area of his own influence could extend.
Suspecting unkind treatment, he strove to have it replaced by kindness;
convinced that abuses and cruelty ever tend to spring up when public
surveillance is refused, he resolved to do away with all secresy in the
management of the proposed institution. Further, he "had a strong faith
in the dictates of an enlightened conscience and in the perfect wisdom
and love which direct every law of human duty."[131]
This principle not only accounts for the successful commencement of the
undertaking, but helps to explain the individual treatment of the
insane; for the patients were treated as human beings suffering under a
terrible affliction, toward whom it was a duty to extend consolation,
compassion, and kindness. This course necessarily led to the
demonstration that when so treated they were calmer and required
comparatively little restraint. The fact happily bore out the theory.
But a humane man may in the exercise of his humanity be injudicious, and
by so doing inflict much actual suffering. The surgeon who to avoid
inflicting pain should shrink from the complete removal of a malignant
tumour, would fail to relieve the patient as he ought to have done.
Therefore something more than humane feeling is required. Judgment must
be exercised. Now, judgment and that common sense, or mother wit, which
is so much better than mere routine practice, evidently characterized
the early treatment of the Retreat. As benevolent feeling naturally led
to the non-use of chains and the minimum resort to restraint which then
seemed possible, so common sense led to the avoidance of the periodical
bloodletting and emetics then in fashion. It is a remarkable fact that
even then it was seen that insanity rarely calls for depressing
remedies, and the observation was made and acted upon that excitement is
often relieved by a directly opposite treatment. They allowed a liberal
nourishing diet[132] in cases of violent mania; a free supply of meat,
or bread and cheese, and porter, was found of the greatest service at
supper in procuring sleep and reducing excitement. They had no faith in
specifics and nostrums in the cure of insanity, but medical treatment
was by no means despised, while a warm bath was found to be "of greater
importance and efficacy, in most cases of melancholia, than all the
other medical means which have been employed."[133]
With this, one cannot but contrast the old system, which was
emphatically empirical and unscientific. It was continued without change
from year to year, and it may truly be said that idleness and
selfishness, still more than ignorance, constituted the vices of the old
system. Those who treated the insane always encountered opposition by
brute force, instead of by energy and patience, which surmount
difficulties that to idleness are impassable mountains, and which
selfishness would not, if it could, overcome. Again, from the
commencement of the Retreat, the idea was entertained of making the
institution a home; and with this view the arrangement and surroundings
were made as cheerful and home-like as possible.
Another strong point was the employment of the patients; its vital
importance was forcibly felt from the first. Dr. Delarive, who inspected
the Retreat in 1798, particularly comments upon this novel feature of a
mad-house. He found that an experiment recently made, that of inducing
the patients to cultivate the land, giving to each a task proportionate
to his strength, had answered well. It was found that they were fond of
this exercise, and that they were much better after a day spent in this
work than when they had remained in the house, or when they had taken an
ordinary walk. Delarive went to see them at work, a sight so common now
in our asylums that it seems strange it should have excited his
surprise.
Of employment the author of the "Description" thus speaks: "The female
patients in the Retreat are employed as much as possible in sewing,
knitting, or domestic affairs; and several of the convalescents assist
the attendants. Of all the modes by which the patients may be _induced
to restrain themselves, regular employment is perhaps the most generally
efficacious_; and those kinds of employment are doubtless to be
preferred, both on a moral and a physical account, which are accompanied
by considerable bodily action, that are most agreeable to the patient,
and which are most opposite to the illusions of his disease."[134]
We find it insisted upon by those who had the management of the Retreat
that moral treatment is of the greatest importance; that gentleness must
take the place of violence;[135] that it is erroneous to suppose it
necessary to commence an acquaintance with lunatics by an exhibition of
physical strength; that every effort should be made to divert the mind
of melancholiacs by bodily exercise, walks, conversation, reading, and
other recreations; that the desire of esteem is a more powerful
principle to appeal to than fear; that the best form of restraint is
self-restraint; that patients should be treated as much as possible as
rational beings, but that little or no advantage arises from reasoning
with them on their particular delusions; that it is desirable to
encourage the influence of healthy religious principle over the mind of
the insane; that those who manage them should sedulously endeavour to
gain their confidence and esteem, to arrest their attention and fix it
on objects opposed to their delusions, to call into action every
remaining power and principle of the mind, and to remember that in the
wreck of the intellect the affections not unfrequently survive.
This recapitulation of the salient features of the practice of the
Retreat renders it easy to understand the position taken by the managers
of the institution in regard to mechanical restraints. When kindness
failed to subdue maniacal excitement, when medical remedies exerted no
calming influence, mild forms of restraint were reluctantly adopted,
rather than maintain a conflict between patient and attendant. It
appears from the Retreat archives that not more than five per cent.,
reckoning the night as well as the day, were restrained by strap or
waistcoat.[136] It is notorious that, at the same period, it was the
custom in some asylums, probably many, to chain to the bedstocks, at
night, every patient in the house. Ferrus, to whom I have referred, did
not find camisoles in use at St. Luke's in 1826, but "strong chains were
employed to hold the excited patients. These chains, fixed at different
heights to the sides of stoves (_chauffoirs_), have iron rings at the
end, by means of which the arms or the legs of the patient are rendered
completely immovable.... Far from fearing that a painful impression will
be produced on the patients by chains, they think, on the contrary, that
this apparatus exerts a beneficial influence upon them; that it
intimidates, humbles them, and removes all desire to attempt to get rid
of their fastenings." Ferrus says that at the Retreat he found a belt
was employed, softly padded, to which the arms were attached. "We do not
employ it in France," he says, "although it might in hot weather be
preferable to the camisole.... The Retreat offers all the resources of
art and the comforts of life (_douceurs de la vie_) compatible with the
condition of insane persons."
Coercion was regarded at the Retreat as an evil--that is to say, it was
"thought abstractedly to have a tendency to retard the cure, by opposing
the influence of the moral remedies employed"--but at the same time "a
necessary evil," an unhappy alternative in certain cases. Practically,
as we have seen, the amount of restraint was small; but no _rule_ of
practice was laid down that it should never be resorted to. The abstract
principle of non-restraint adopted at Lincoln and Hanwell was not
enunciated. "We greatly prefer," observes the author of the
"Description," "to lay down no absolute rule of non-restraint, but to
refer to our resident officers the exercise of a sound discretion in
each individual case." But the managers of the Retreat did undoubtedly
lay down as a fundamental principle that "_coercion will diminish or
increase as the moral treatment of the patient is more or less
judicious_;"[137] and therefore, although they did not anticipate that
personal restraint would be superseded by any other mode of treatment,
this principle is broad enough to embrace all that has since followed in
the way of non-restraint. The result, in the long run, of honestly
carrying out the doctrine to its legitimate consequences, will not very
widely differ from that reached by those who adopt "non-restraint" as an
abstract theory in the first instance.
Justice would scarcely be done to those who interested themselves in
mental diseases during the latter half of the eighteenth and the
commencement of the nineteenth century, if we did not give the titles of
some of the works bearing on insanity which issued from the press during
this period. A treatise on Madness was written in 1757 by Batty. Perfect
wrote "Methods of Cure in some Particular Cases of Insanity" in 1778,
and "Select Cases of Insanity" in 1787, and "Annals of Insanity"
fourteen years later. Perfect's treatment of insanity mainly consisted
in bleeding, setons, electricity, and the administration of emetics,
digitalis, and antimony. Dr. T. Arnold published his "Observations on
the Nature, etc., of Insanity," 1782. Harper published "A Treatise on
the Real Cause and Cure of Insanity" in 1789--a work ridiculed by Pinel.
Faulkner wrote his "Observations on the General and Improper Treatment
of Insanity" in 1790; and Pargeter his "Observations on Maniacal
Disorders" in 1792. What, if any, beneficial effect these works produced
upon the condition of the insane in the British Isles, I am unable to
say. Haslam wrote his "Observations on Madness" in 1798, and he was the
author of several other works; but, whatever their value and interest,
we know but too well the condition of the patients in the asylum of
which he was the apothecary. Crichton published his "Inquiry into the
Nature and Origin of Mental Derangement"--a work, certainly, of merit
and the result of practical observation. In 1802 appeared "De
intellectûs facultatum conditione in mentis Alienationis diversis
generibus," by Campbell (Edinburgh). Cox published his "Practical
Observations on Insanity" in 1804. (See Appendix B.)
* * * * *
Of Pinel, in relation to England, I must here say a few words.
The _Edinburgh Review_ of April, 1803, contains a review of Pinel's
work, which deserves attention from the tone in which it is, for the
most part, written. The Reviewer evidently thinks that England had very
little to learn from France. The York Retreat had, indeed, been in
active operation for some years, and the treatment pursued there might,
no doubt, have borne comparison with that at the Bicêtre, but to speak
of Great Britain as a whole having a decided superiority over other
countries in its moral treatment of maniacs was rather absurd. The
Reviewer regards Pinel as the first author on the Continent who is fully
sensible of the advantage of such moral treatment, and then observes,
"To medical readers in this country many of our author's remarks will
appear neither new nor profound, and to none will his work appear
complete.... It may be considered as a sketch of what has already been
done, with some notices of what the author intends to do; though he
seems frequently to wonder, with a smile of self-approbation, at what he
thinks his own discoveries." And again: "Dr. Pinel is desirous that
France should have some claim to a judicious treatment of the disease of
the mind, the honour of which has hitherto been exclusively confined to
England."
It is curious to find the Reviewer observing that Dr. Pinel appears to
display very little sagacity and precision in saying that in some cases
the brain is not affected. And again: "He conceives that the result of
the examination of the periods of life most subject to insanity is alone
sufficient to show how seldom it is owing to any organic affection of
the brain or the cranium. But in this opinion there is some
inconsistency. For he soon after states that in thirty-six dissections
he found nothing more remarkable than in the brain of apoplectic and
epileptic patients, or of persons who died from furor or convulsions.
Now, this is a confession that some deviations from the natural and
healthy appearances were observed; and this is all that is contended
for, and all that the present limited state of our knowledge authorizes
us to affirm." The Reviewer adds, no doubt with truth, "If no organic
affections are said to have been discovered, in some few instances, we
should not reason negatively from such dissections, perhaps cursorily
and ignorantly made, and with instruments ill adapted to detect minute
and apparently trivial deviations from the natural structure."
The following snarl is also noticeable:--"He informs us that he has
studied with considerable attention the writings of Locke, Harris,
Condillac, Smith, and Stewart; but the quotation of great names is not
always the surest proof of an accurate acquaintance with their works,
and we are inclined to think that there is some ground for doubt in the
present instance."
The Reviewer is severe on Pinel's classification, which in the main has
stood the test of all subsequent criticism to a remarkable degree. "It
may," he says, "be entitled to the praise of ingenuity, but we doubt
whether it is remarkable for its clearness and accuracy. Many of the
distinctions seem absurd, and others not well founded. The several kinds
of insanity are not distinct; they are only varieties of the same
affection. All the symptoms mentioned under these five heads occur in
the same patient. At different times he passes through all the
gradations from furious phrenzy to complete fatuity." This criticism
has, of course, great force as opposed to all symptomological
classifications whatever, but not specially or mainly to Pinel's.
On the point whether madness can in certain cases be cured, Pinel's
utterances are dismissed with downright contempt: "Instead of any new
light being thrown upon this important question, or any new rules of
conduct pointed out, our author gives a minute detail of two cases,
where any ancient female of ordinary capacity could have decided as well
as himself, and relates with laboured minuteness the contrary opinions
of some eminent physicians on a late memorable occasion in this
country." Pinel an old woman! It will probably be new to most, if not
all, of our readers that this illustrious man was regarded in this light
by the leading Review of our country, when his writings first became
known amongst us. The review ends, after crediting Pinel with some
merit, and commending his work as containing some profitable
instruction, with the exceedingly kind and patronizing observation that
"we are therefore inclined to make _an indulgent allowance_ (!) for the
imperfect execution of many parts of Dr. Pinel's essay, and to entertain
hopes of further information from his diligence and discernment" (!!).
Insular conceit could surely scarcely go further. However, the Edinburgh
Reviewer is forgotten and his name unknown; Pinel's name covered with
glory, although not a popular hero; for when I made a pilgrimage to his
grave in the great Paris cemetery, _Père la Chaise_, in 1878, I was a
solitary visitor, while crowds flocked to others, including that of
Thiers, which is in close proximity to it. I am glad to see it announced
that the _Société Médico-psychologique_ of Paris is about to erect--not
too soon--a statue to his memory.
The bold proceeding, as it seemed in those days, of freeing the
lunatics at the Bicêtre from their fetters, constitutes Pinel's title to
honour--an honour of which no man will succeed in robbing him. He will
be remembered when Dequin[138] is forgotten. Pinel, although his
writings would have made him eminent as a physician had he never
rendered his name illustrious in reference to the insane, did not, as a
study of his life abundantly proves, liberate the patients at the
Bicêtre from their chains in direct consequence of his medical knowledge
of insanity, but mainly, if not entirely, from the compassion which he
felt for their miserable condition. His knowledge, great before, was
vastly increased after he had placed the patients in a more favourable
state for medical observation; in fact, it is obvious that the
opportunities of scientific research, and specially of observing the
satisfactory progress of those labouring under the disease, were greatly
augmented from the moment he introduced a humane system of treatment.
Had my sketch comprised France as well as England, I should have
attempted to give a description of the work he performed in Paris. But I
must not be tempted to go beyond my subject, and as a matter of fact the
course of French and English reform in the treatment of the insane was
entirely distinct and independent.[139]
FOOTNOTES:
[100] "By Tho. Fallowes, M.D., at his House in Lambeth-Marsh, and to be
had there, or at Mr. Jones's Haberdasher in Hats, over against the
_Pump_ in _Chancery_ Lane, and nowhere else," 1705. A second edition
appeared in 1814.
[101] In his Review for 1706 there is a "Scheme for the Management of
Mad-houses," with a case of abuse.
[102] As will be seen by the date, the elder Pitt and Fox.
[103] The physician referred to at p. 87.
[104] 14 Geo. III., c. 49 (1774).
[105] "The Early History of Charles James Fox," by G. O. Trevelyan,
1880.
[106] Letter written July 30, 1767.
[107] "Lady Chatham also, when writing confidentially to Lord Shelburne
in the autumn of 1767, observes, 'I wish I could say there was any
material change in the state of my Lord's health, but we are forbid to
expect that, until he can have a fit of gout.'"
[108] "History of England from the Peace of Utrecht," vol. v. pp. 166,
188 (edit. 1853).
[109] Page 203.
[110] See "Evidence before the House of Commons." See also "Debates on
the Regency," Hansard, vol. xxvii.
[111] "American Journal of Insanity," July, 1855.
[112] See the last edition, corrected by himself (1780), of his
"Primitive Physic, or an Easy and Natural Method of curing most
Diseases."
[113] Page 82.
[114] "The State of the Prisons in England and Wales, with Preliminary
Observations," by John Howard, F.R.S., 3rd edit., 1784.
[115] Ray, _American Journal of Insanity_, vol. iv. p. 112.
[116] "Review of the Early History of the Retreat," by S. Tuke. 1846.
[117] "Lettre addressée aux Rédacteurs de la Bibliothèque Britannique
sur un nouvel établissement pour la guerison des Aliénés" (1798). Par
Dr. Delarive, p. 29.
[118] "Review of the Early History of the Retreat," p. 14.
[119] The physician who gave his name to the well-known solution of
arsenic. Author of a treatise on Arsenic, 1786, and one on Rheumatism in
1795. Jepson resigned in 1822, and died in 1836.
[120] "Description of the Retreat," by S. Tuke, p. 62.
[121] Pages 11, 12.
[122] The _British Review_ (vol. vi. No. xii.), in reviewing this book,
observed: "In 1813 Mr. Samuel Tuke published his 'Description of the
Retreat,' the celebrated work, the title of which we have placed among
others at the head of our article.... The Retreat has been conducted
from the beginning upon the principle that the utmost practicable degree
of gentleness, tenderness, and attention to the comforts and feelings of
the patients was in the first place due to them as human beings; and in
the next place was infinitely the most promising means of effecting
their recovery. The object of this work of Mr. Tuke was to describe the
system of management which had been pursued in the Retreat; to make
known the success which had attended it; and to point out more
distinctly than had ever yet been done, the principle upon which that
management was founded (the principle of gentleness, and of regard to
the feelings of the patients) as the grand principle which ought to
regulate the management of every establishment of the kind. The service
which Mr. Tuke professed to render to the public by his book was
assuredly of importance, and his book has performed it well.... In
having pointed out this as the governing principle, he has rendered a
service to humanity of the greatest importance. It is this
characteristic circumstance which will render the publication of his
book an era in the history of the treatment of this calamity. The book
has already met with great and almost universal attention. It has by the
nation been much more than approved; it has been applauded and admired."
The reviewer continues: "One thing we may venture to say, that it was
hardly possible for a book to be written in a manner less calculated to
give offence to anybody.... Yet this book gave prodigious offence. It
has been regarded as a libel upon the York Asylum, and an attack upon it
has appeared in the newspapers." This was a letter signed "Evigilator,"
who was in reality the superintendent of the above institution. This led
to a long and heated correspondence. About the same time a charge of ill
treatment of a patient in the York Asylum was made by a magistrate (Mr.
Godfrey Higgins of Doncaster), whose persistent endeavours to bring this
and other cases to the light of day were beyond praise, and happily
proved successful at last.
The writer has in his possession a mass of private letters which passed
between his father and Mr. Higgins on these cases, which indicate their
combined endeavours, made (under the fiercest opposition) to reform the
horrible abuses which had converted a well-intentioned charity into a
hell upon earth. Mr. Higgins was the author of a book on Mahomet, the
remarkable work on the Celtic Druids (1827), and of "Anacalypsis"
(1836).
[123] April, 1814, pp. 190, 194, 198.
[124] (1) "Practical Hints on the Construction and Economy of Pauper
Lunatic Asylums; including Instructions to the Architects who offered
Plans for the Wakefield Asylum, and a Sketch of the most approved
Design." York, 1815. (2) "On the Construction and Management of
Hospitals for the Insane," by Dr. Jacobi, with Introduction by Samuel
Tuke, 1841. Born 1784; died 1857. An Honorary Member of the
Medico-Psychological Association.
[125] The incompleteness of this Parliamentary return was shown by the
fact that, a few weeks afterwards, Sir Andrew Halliday found that in
Norfolk there were 112 instead of 42.
[126] 51 Geo. III., c. 74; also in 1815, May 2 (55 Geo. III., c. 46),
independently of the Report of the Select Committee. Overseers were to
make returns of all lunatics and idiots within their parishes. These
Acts do not touch "Private mad-houses"--only paupers.
[127] "What strenuous efforts fruitlessly combined to accomplish, a
little volume has at once achieved. I hardly need name Mr. Samuel Tuke's
account of the Retreat. Mr. Tuke's work, operating on a suspicious and
irritable mind, produced the letters signed 'Evigilator;' the public
attention became aroused, doubts and surmises were started. Either
confident in right, or daring in wrong, a general challenge was given;
that challenge was answered, with what results it is needless to add"
(_vide_ "Papers respecting the York Lunatic Asylum," by S. W. Nicoll,
Esq., 1816).
[128] "Les Principes à suivre dans la Fondation et la Construction des
Asiles d'Aliénés," Paris, 1853, p. 226.
[129] _American Journal of Insanity_, April, 1856.
[130] _Ibid._, October, 1863, p. 205.
[131] "Review of the Early History of the Retreat," by S. Tuke, 1846.
[132] Referring to the practice at the Retreat as given in the
"Description," the editor of the _Medical Repository_, 1817, after
observing, "We are told that in violent maniacal paroxysms, depletion
having failed to procure quiescence, a full meal of meat and good porter
for supper produced the desired effect, and that this mode has since
been very frequently and successfully employed," adds that if this be
true, the general system of well-known physicians, that of pursuing
depletion through "paroxysm and remission," cannot be right.
[133] Tuke's "Description," p. 113.
[134] Page 156.
[135] "If it be true that oppression makes a _wise_ man mad, is it to be
supposed that stripes and insults and injuries, for which the receiver
knows no cause, are calculated to make a _mad_ man wise? or would they
not exasperate his disease and excite his resentment" ("Description of
the Retreat," 1813, p. 144).
[136] Including cases in seclusion.
[137] "Description of the Retreat," S. Tuke.
[138] A Savoy physician who dedicated the second edition of his "La
Philosophie de la Folie," published in 1804, to Pinel. M. Brierre de
Boismont thinks the latter guilty of "the conspiracy of silence" in not
mentioning him in his work, but I do not think the conspiracy is proved.
[139] See Appendix C.
CHAPTER IV.
COURSE OF LUNACY LEGISLATION.
I now resume the thread of my history at the time of the exposure of the
abuses at the old York Asylum.
We have already intimated that the treatment adopted at the Retreat, and
made known to the public by various writers and by many visitors, but
more especially by the "Description," exerted a remarkable influence on
the subsequent inquiry and legislation. The success of the Retreat
excited the jealousy and antipathy of the superintendent of the York
Asylum; the discussion which ensued led to investigation; the
revelations which followed excited public opinion; the representatives
of the people undertook an inquiry by means of a Select Committee, which
finally necessitated legislation, and this legislation by successive
enactments wrought the wondrous and beneficial change which we now
witness. This sequence of events will be found to be borne out by facts,
by any one who will investigate the literature of lunacy from 1792 to
the present time. Sydney Smith says, writing in 1817,[140] that "the
new Establishment began the great revolution upon this subject, which
we trust the provisions of Parliament will complete.... In the course of
a few years the Institution had done so much by gentle methods, that a
modest and well-written volume, giving an account of it, excited
universal interest, and, in fact, achieved what all the talents and
public spirit of Mason and his friends had failed to accomplish. It had
still better effects. A very inoffensive passage in this book roused, it
seems, the animosity of the physician to the York Lunatic Asylum, and a
letter which this gentleman published in one of the York newspapers,
became the origin of a controversy among the governors of that
establishment, which terminated in August, 1814, after a struggle of
nearly two years, in the complete overthrow of the old system, and the
dismission of every officer of the asylum, except the physician himself.
The period is not remote when lunatics were regarded as beings
unsusceptible of mental enjoyment or of bodily pain, and accordingly
consigned without remorse, to prisons under the name of mad-houses--in
the contrivance of which nothing seems to have been considered, but how
to enclose the victim of insanity in a cell, and to cover his misery
from the light of day. But the success of the Retreat demonstrated, by
experiment, that all the apparatus of gloom and confinement was
injurious; and the necessity for improvement becoming daily more
apparent, a 'Bill for the Better Regulation of Mad-houses' was brought
into Parliament by Mr. Rose in 1813, but was nevertheless opposed and
finally withdrawn; and another Bill, in 1814,[141] though it passed the
Commons, was rejected by the House of Lords. The public, in fact, was
not yet aware of the atrocious evils which these Bills were intended to
remove; and it was not until now that the course was adopted, which, in
every case of public grievance, is the only sure one for obtaining
redress. A Committee of the House of Commons, appointed for the purpose
of inquiry in 1814, and revived in the following year, was fortunately
composed of men determined to do the business they had undertaken."[142]
Mr. Rose, on the 28th of April, 1815, again introduced the subject of
private mad-houses to Parliament, and, dwelling on the great abuses
connected with them, pointed out the necessity of their condition being
examined into by the House. He said that among the cases which had
recently come to his knowledge was that of a young woman who, although
requiring some restraint, was perfectly harmless. She was found chained
to the ground by both legs and arms, a degree of cruelty which was in no
respect justified. With a view of correcting such practices, he moved
"that a Committee be appointed to consider of provision being made for
the better regulation of mad-houses in England, and to report the same,
with their observations thereupon, to the House."[143] The motion was
agreed to.
The York Lunatic Asylum stood first upon the evidence before the Select
Committee. "It appears from the history of that institution, which was
published at the close of the controversy above alluded to, that the
victory of the reformers was not obtained without strong opposition;
for, at the very moment when the state of things that we shall presently
detail was flourishing in full enormity, their opponents were enabled to
carry a resolution of the governors, declaring that a lunatic, who
appears to have sustained gross injury, 'had been treated with all
possible care, attention, and humanity,' and censuring the parties who
brought forward the complaint.... On a subsequent day thirteen spirited
men (including Mr. Higgins and Mr. Tuke) determined to _enforce_
investigation; and, having qualified themselves as governors by paying
the requisite donation of £20 each, succeeded in obtaining the
appointment of a Committee to inquire into the complaints that had been
exhibited; which, after meeting for several successive days, and
examining witnesses, concluded by adopting Resolutions of censure upon
the proceedings proved before them."[144]
One day Mr. Higgins went to the asylum. After having seen all the
patients' rooms, he went with the steward to the kitchen. There he was
struck with "the retired appearance" of a door. He ordered a keeper to
unlock it. He perceived fear and hesitation. He repeated his order in
stronger language. The key not being readily forthcoming, Mr. Higgins
grew warm, and declared he would soon find a key that would open it at
the kitchen fireside. It was then opened. He went in, and discovered a
row of cells, four in number, which had been concealed from the
committee of investigation. On entering the first cell, he found it in a
state dreadful beyond description. The cell was about eight feet and a
half square, perfectly dark when the door was shut, and the stench
almost intolerable. He was told these cells were occupied at night by
thirteen women, who were then upstairs; where he found them in a room
twelve feet long by seven feet ten inches wide, with a window, which not
opening would not admit of ventilation. Sydney Smith well says, after
citing more horrible details than I have given, that he is aware of the
disgust which they will cause, but that he cannot spare his readers, and
asks of the most delicate of them whether it is more shocking that these
things should exist unknown, and consequently unredressed, than that
they should be told and punished, and _remembered for ever, as the only
means of preventing their recurrence_.
To enter into much detail is impossible. It must suffice to say that
case after case of gross neglect and cruelty was brought to light; that
while 365 patients had died, only 221 had been reported; that a patient
having been killed, his body was hurried away to prevent an inquest;
that when the accounts were examined, it was discovered that two sets of
books of receipts were kept, one of which was only presented to the
governors, and that the difference between the sums contained in the
two, amounting to some hundreds a year, found its way into the pocket of
the superintendent; and lastly we must record that one wing of the
asylum was burned, involving the deaths of patients and the destruction
of much that it was with good reason believed the authorities wished to
conceal.
Of the revelations made by the Committee of the House of Commons in
regard to Bethlem Hospital, we shall only briefly speak. We have already
sketched the history of this institution. For the most part it is to the
_second_ Bethlem--that in Moorfields--the minutes of evidence refer.
During the seven years prior to the investigation, the number of
patients averaged 238; the annual expenditure, £12,000. Mr. Haslam, the
resident apothecary, ruled supreme. He was responsible for the dreadful
condition in which the notorious Norris was discovered. "There is," says
Sydney Smith, "much evasive testimony, to shift from himself the burden
of this atrocious case; but his efforts tend rather to confirm than to
shake the conviction which the evidence produces.... The conduct of
Haslam with respect to several other patients was of a corresponding
description; and in the case of a gentleman whose death was evidently
accelerated by the severities he underwent, and of several other
persons, there is abundant proof of cruelty.... It is in proof that a
patient actually died, through mere neglect, from the bursting of the
intestines, overloaded for want of aperient medicine, and it is
expressly stated by Haslam himself that a person whom he asserts to have
been '_generally insane and mostly drunk_,' whose condition, in short,
was such 'that his hand was not obedient to his will,' was nevertheless
retained in the office of Surgeon, and continued to attend the patients
for a period of _ten years_--a statement so atrocious that, from any
other quarter, we should have rejected it as utterly incredible."[145]
The governors easily convinced themselves that no foundation whatever
existed for the charge of cruelty and bad management; that every degree
of permissible indulgence had been observed; that the hospital was
equal, if not superior, to any other asylum in England; that the mode of
confining the unhappy Norris appeared "to have been, upon the whole,
rather a merciful and humane, than a rigorous and severe imposition;" in
short, that "the general management of Bethlem, as affecting the health,
the cleanliness, and the comfort of the patients, was of a nature
_creditable to the governors and others concerned in its
administration_." What a picture of the standard of excellence held by
the managers of asylums at that period, not in Bethlem alone, but
generally!
To the question, "Has there not been a rule in the hospital, for a
certain number of years, that, in certain months of the year,
particular classes of the patients should be physicked, bled, bathed,
and vomited, at given periods?" the reply from Bethlem was in the
affirmative. Twice in the year the patients, with few exceptions, were
bled. "After they have been bled," said the physician, in evidence,
"they take vomits once a week for a certain number of weeks; after that,
we purge the patients. That has been the practice, invariably, for
years--long before my time."
In regard to the means of coercion employed, it was stated that the
patients "are generally chained to the wall with manacles." When inquiry
was made regarding the use of strait waistcoats, it was replied, "I do
not believe there are any strait waistcoats in Bethlem now, or very few
indeed; they generally use irons." The objection to strait waistcoats
was, that the patients "could not help themselves in strait waistcoats;
they are so excessively long in the hospital without being seen by
anybody, in a dark place; in winter, from four o'clock to six or seven
in the morning. If they were in a strait waistcoat they could not assist
themselves the least in the world." When, in the following year, the
head-keeper of Bethlem Hospital was asked, "Was it not the practice in
old Bethlem--not in the late gallery, but in the gallery pulled
down--for eight, ten, or more patients to be fastened to the tables,
almost in a state of perfect nakedness?" he replied, "Yes; they used to
think they tore their clothes all to pieces; some of them would do
that." "In point of fact, were they not fastened to the tables, sitting
in a state of perfect nudity?" Answer: "They used to be so at the
table; they were chained all round." In regard to the apparatus, so
ingeniously cruel, by which one of the patients (Norris) was chained ten
or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you
think that his confinement in that manner during the whole of that
period was necessary?" replied, "Decidedly."
The matron of Bethlem Hospital (who was elected January, 1815) gave
evidence that, when she was appointed, there were about twenty patients
under personal restraint, out of between fifty and sixty patients. "The
custom when I first went was only to get them up three days of the
week--never on meat days; they lie in bed four days in the week." She
also stated that one of the female patients had been chained for eight
years, but had not required restraint since she had been there.
Bethlem, however, was far from being the only place where patients were
treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a
private asylum at Bethnal Green, gave evidence to an attendant "kicking
the patients and thumping them sadly," and "beating one in his shirt
with a pair of boots, in a most dreadful manner." She named a female
patient who, when in a state of irritation, "was confined in a place in
the yard which was originally a pig-sty; it was run up high on purpose
for her. I have seen her confined there for three weeks together. She
has been ironed there in the crib with wrist-locks, and leg-locks, and a
chain two or three times across her body." An iron bar was placed
between her legs when she walked about, to prevent her escaping. "It
was confined to each ankle, with a chain coming up between her legs,
which was attached to her handcuffs." But, in addition to this frightful
restraint, we are informed that an attendant, at the instance of the
proprietor, would, "at sundry times," lock her down in her crib with
wrist-locks and leg-locks, and horsewhip her. "I have seen the blood
follow the strokes." Yet this patient is described as very harmless;
"you might sit and talk to her when she was in the highest state."
The Committee found that at a private asylum--Fonthill, Wilts--there was
in that year, out of fourteen patients, only one without fetters or
handcuffs, and only three out of their sleeping-rooms.[146]
At the Bethnal Green Asylum "several of the pauper women were chained to
their bedsteads, naked, and only covered with a hempen rug," and "the
accommodation for paupers was infamously bad, and required immediate
reform;" while in January of the same year it is reported that "some
pauper men were chained upon their straw beds with only a rug to cover
them, and not in any way defended from the external cold."[147]
Dr. John Weir was asked, at the Committee of 1815, to what he
attributed the difference of opinion among even enlightened men as to
the management of the insane. He replied that it was chiefly due to the
want of practical observation, as it is only by comparison that we are
enabled to appreciate the superiority of one institution over another.
He added that, until within the last eighteen years, the primary object
of almost every insane institution, whether of a public or private
description, had been merely the security of these pitiable objects;
comfort, medical and moral treatment, had been in a great measure
overlooked. "Happily, however, for that class of society, the Retreat at
York had at last convinced the world how much may be done towards the
amelioration of their condition."[148]
On the 11th of July, 1815, Mr. Rose brought up the Report of this
Committee. On moving that it be printed, he said that all who read the
Report must feel satisfied of the indispensable necessity of legislative
interference. The way in which lunatics were usually confined was that
of criminals, and their treatment was in general worse than the ordinary
treatment in jails. The number of persons appointed to take care of them
was in most cases utterly insufficient, in consequence of which the
greatest severity was too frequently resorted to.
The conclusions arrived at in this celebrated Report may be thus
summarized: That keepers of houses for the insane received a much
greater number of persons than they were calculated for, thus greatly
retarding their recovery; that the number of attendants being
insufficient, there was unavoidably a larger amount of restraint than
would otherwise be necessary; that outrageous patients were mixed with
the quiet and inoffensive; that there was an absence of medical
attention to the malady for which the patients were confined; that the
certificates on which patients were received into asylums were
insufficient, and that the visitation of private mad-houses was
defective.
The Report concluded that "some new provision of law is indispensably
necessary for ensuring better care being taken of insane persons, both
in England and Ireland, than they have hitherto experienced; the number
of whom appear to be very considerable, as the inquiries of the
Committee have convinced them that there are not in the country a set of
beings more immediately requiring the protection of the legislature than
the persons in this state, a very large proportion of whom are entirely
neglected by their relatives and friends. If the treatment of those in
the middling or in the lower classes of life shut up in hospitals,
private mad-houses, or parish workhouses, is looked at, your Committee
are persuaded that a case cannot be found where the necessity for a
remedy is more urgent."
The evidence taken before the Committee of 1815 was so full and
convincing that it would have seemed wholly unnecessary to have required
a further disclosure of the abuses rampant in the asylums of England,
but in consequence of the demand for further investigation before the
House of Commons committed itself to legislation, a mass of further
particulars was obtained in 1816 in regard to the state of various
institutions, including Bethlem Hospital and the York Asylum.
In February Mr. Rose had said in the House that, as chairman of the
Committee for inquiry into the conduct of mad-houses, he was instructed
to move for leave to bring in a Bill for the better regulation of such
establishments. But some gentlemen of the Committee being desirous that
further investigation should take place, he had acceded to their wish,
although the majority concurred with him in thinking that sufficient
evidence had already been adduced to justify the proposal of a Bill.
Therefore, he should propose, instead of a Bill, that a Committee be
appointed to consider of provision being made for the better regulation
of mad-houses in England, and report the same, with their observations
thereupon, to the House.
On May 28th Mr. Rose brought up the Report of the Committee, and
obtained leave to bring in a Bill pursuant thereto. This Bill was for
the repeal of the 14th and 55th of the King. He said[149] the Committee
had, after the most patient investigation, adopted the provisions of the
present Bill, which principally were, that instead of the physicians of
the neighbourhood, or those in or near the metropolis, together with a
neighbouring magistrate, being the inspectors of such establishments,
they should be twice a year examined, etc., by eight Commissioners
appointed by the Secretary of State for the Home Department throughout
the kingdom; the Commissioners to be assisted by two of the local
magistrates in each district, and with equal powers. There was also a
provision in the Bill relative to the erection of lunatic asylums in
counties, and the ordering the reception therein of pauper lunatics
allowed at present to range abroad, to their own and the public injury.
On the 17th of June, Mr. Rose moved that the clauses of this Bill be
taken into further consideration. Lord R. Seymour observed that when
Parliament in 1774 passed the "Bill for the Regulation of Licensed
Mad-houses," it must have meant to do three things: (1) To secure all
persons against unnecessary confinement; (2) to better the chance of
recovery of all such persons confined as being insane, as well by moral
treatment as by the use of medicine; and (3) to insure the restoration
of all who might become again of sound mind to society. But the
Mad-house Act, he said, does none of these three things, for it does not
empower the Commissioners to discharge a patient, however sound in mind;
nor does it furnish them with the means of enforcing the observance of
any improvement they may recommend. The Commissioners, indeed, may
withdraw the licence, but the keeper of such a house must again have it
on the next licensing day, if he wishes, upon giving the necessary
security. It was not surprising, therefore, that the greatest abuses
should have been found to prevail.
Mr. Wynn expressed a wish that magistrates should be empowered to
examine houses where only one patient was confined.[150]
This Bill passed the House, but was rejected by the House of Lords.
Thus all the mass of valuable and decisive evidence which had been
collected with so much labour, and had occupied the time and thought of
two Committees of the House of Commons, was, for the time, thrown away,
and the misery of the inmates of asylums allowed to go unrelieved. The
facts, however, had been made widely known. The inertia, torpor, and
indifference to human suffering--in short, the crime which characterized
the majorities who threw out the Bills calculated to remove the abuses
in asylums, had at last to give way to the popular demand. What was
gained by prolonging the dismal condition of these abodes of woe for
some years longer, I leave others to discover.
After the lapse of three years, namely, on the 10th of March, 1819, Mr.
Wynn[151] rose to move for leave to bring in a "Bill for the Regulation
of Mad-houses," and observed that, as this subject had been already
several times before the House, he did not feel it necessary to trespass
long upon its attention. It would be remembered, he said, that some
years ago the Report of a Committee had been laid before the House,
detailing such scenes of misery and wretchedness in mad-houses, as had
perhaps never been paralleled, and after such an exposure it was the
obvious duty of the House to follow up the Report by the adoption of
some legislative measure calculated to put an end to the evils
complained of. There was, however, no fault to be found with the
conduct of that House; for it had done its duty by repeatedly sending up
a Bill to the other House, which it had thought proper to reject.
Although no mad-houses could be legally opened without a licence, the
College of Physicians was not in possession of funds to prosecute. He
therefore proposed that a general Board of Inspection for mad-houses
should be appointed, and that the members of that Board should be at
liberty to visit such houses throughout the country, at different and
uncertain times, so as to ascertain the manner in which they were
conducted, and to report any existing evil to the Board, which should be
invested with power to enforce their correction. Mr. Wynn moved for
leave to bring in a Bill for repealing the Act of the 14th and 55th of
the King with respect to mad-houses, and for making other provisions for
their better regulation.[152]
Leave was given to bring in the Bill.
In June of the same year the Marquis of Lansdowne, speaking on the Bill
in the House of Lords, said that nothing could more forcibly appeal to
the humanity of their lordships than the state of the unfortunate
insane, and the legislative means of preventing abuses of the most
flagrant and revolting nature, which had long been too clearly proved.
Strange to say, however, the Lord Chancellor (Lord Eldon) opposed the
Bill, observing that there could not be a more false humanity than an
over-humanity with regard to persons afflicted with insanity. (Is not an
under-humanity nearly as false?) He admitted there were great abuses,
but the better way to remedy them would be to take a cool and
dispassionate view of the subject in a Committee, next session. As if
there had not been Committees enough! With regard to pauper lunatics,
the Lord Chancellor went so far as not only to admit there were great
abuses, but to agree to a short Bill, if desired, embodying the clauses
relating to them in the measure before the House.
The Bill was thrown out, only fourteen doing themselves the credit of
voting in its favour, while thirty-five voted against it. Majority
against the Bill, twenty-one.
An "Act for making Provision for the Better Care of Pauper Lunatics in
England"[153] was, however, passed (July 12, 1819), but it consisted of
three sections only, and does not appear to be an advance, in any
essential particular, upon previous Acts. The form of the medical
certificate for a pauper lunatic is prescribed.[154] Again, the Act is
permissive as regards the action of the justices in causing the
overseers to bring the lunatic before them, and calling in a medical man
to their assistance.
Four years afterwards, on June 30, 1823, the subject of private
mad-houses again came before the House. A petition from John Mitford for
an inquiry into the state of private mad-houses was ordered to lie on
the table. Mr. Wynn, as on a former occasion, spoke, and observed that
three Bills had, at recent periods, been sent up from that House to the
Lords, relative to the inspection of houses of this description. He
regretted to say they had not been passed. It is extraordinary that Mr.
Wynn should have ended his speech by saying that, although he believed
abuses might exist in some of these establishments, they were on the
whole well conducted. Mr. (afterwards Lord) Brougham said that he knew
Dr. Warburton, against whom charges had been brought, and that his
character stood equally high both for medical skill and for humanity!
Writing in 1827, Sir Andrew Halliday[155] says, "The evidence taken
before Mr. Rose's Committee, which sat for more than one session, must
be fresh in the recollection of every one of my readers.... He was at
great pains to prepare a Bill which, in the opinion of all who had heard
the evidence, and had taken a disinterested part in the investigation,
was well calculated to remedy every evil either ascertained or
anticipated. The subject was dispassionately canvassed in the Lower
House, and the Bill passed by the Commons, almost unanimously, three or
four several times; but it was uniformly rejected by the Lords, and
after Mr. Rose's death it got into Chancery, and there it has slept for
the last _nine years_. I do not mean this remark in any manner as a
jest; for, literally and truly, the late Lord Chancellor [Lord Eldon]
took the whole matter upon his own shoulders, and promised to prepare a
measure more suited to the exigencies of the sufferers than any that the
collected wisdom of the Commons of England, in Parliament assembled,
could think or devise.... The House of Commons has again taken up the
matter, and I trust they will not abandon it, even though they should be
opposed, until some provision is made against the recurrence of those
evils, very trifling in comparison of former times, which during their
last short inquiry were found still to exist." Sir A. Halliday points
out that, although twenty years had elapsed since Mr. Wynn's Act passed
(having received subsequently several amendments), asylums had only been
opened in the counties of York (Wakefield, 1818), Lancaster (1816),
Nottingham (1812), Norfolk (1814), Stafford (1818), Bedford (1812),
Gloucester (1823), Lincoln (1820), and Cornwall (1820)--nine out of the
fifty-two counties of England and Wales. Suffolk had just finished its
building, as had Chester a short time before. Only at that very time had
the magistrates of Middlesex, after two years' deliberation, announced
that a county asylum was necessary, although it had been proved by Lord
R. Seymour that 873 persons were suffering neglect and cruel treatment
for want of it!
Returns ordered by Parliament in 1826 show that there were 1321 persons
in private asylums, exclusive of those in London and within a radius of
seven miles; 1147 in public asylums, exclusive of those in St. Luke's
and Bethlem; and 53 in public jails; giving a total of 2521 for the
several counties of England and Wales. Those in private asylums in and
near London being estimated at 1761, and the asylums of St. Luke's and
Bethlem at 500, the gross total for England and Wales was 4782. Sir
Andrew Halliday did not hesitate to assert, after very careful inquiry,
that the number actually in confinement, not only in the asylums, but
with relations and keepers, exceeded 8000. He thought there were very
few in Wales, or in "the Celtic tribes in other portions of the
empire."[156]
Before leaving Halliday, I may add that he regarded Bethlem as, at this
period, well conducted, but as having "too much of the leaven of the
dark ages in its constitution, and too rigid a system of quackery, in
regard to its being seen and visited by respectable strangers." He adds
that in some respects "it is little better than when, in fact, it formed
one of the _lions_ of the metropolis, and the patients as wild beasts
were shown at sixpence for each person admitted." Of St. Luke's he
writes, "It is only fit to become a prison for confirmed idiots." He
would have been surprised to witness how much can be effected by
improvements of various kinds, although he might still wish that it
were supplemented by some appendage in the country, if not removed there
altogether.
A very important step was taken by Mr. R. Gordon in the House of Commons
in 1827 (June 13th), by drawing attention to the pauper lunatics in
Middlesex. He particularly referred to the dreadful state of misery of
the pauper lunatics in London in the parishes of Marylebone and St.
George's. When the overseers of the latter parish visited Dr.
Warburton's asylum at Bethnal Green, they found, he said, in a room
eighteen feet long, sixteen cribs,[157] with a patient in each crib,
some of them chained and fastened down, and all of them in a state of
great wretchedness. On one occasion, a visitor having gone there and
reported that there was nothing objectionable, he repeated his visit
next day, and discovered five rooms, in which the patients were in a
most horrid state of misery; and this although the day before he was
informed that he had seen everything. The unfortunate persons placed in
these cribs were kept from Saturday night until Monday; their food being
administered to them in the cribs. Mr. Gordon moved for a Select
Committee to inquire into the condition of pauper lunatics in Middlesex,
and for leave to bring in a Bill to amend 14 Geo. III. c. 49
(1774),[158] and to extend its provisions to pauper lunatics, to
consolidate all Acts relative to lunatics and asylums, and to make
further provisions thereto.
The Committee was appointed.
It specially directed its attention to the treatment of paupers in the
parishes of Marylebone, St. George, Hanover Square, and St. Pancras,
confined in the White House at Bethnal Green, belonging to Dr.
Warburton. Its condition was frightful, and the Committee observes that
if the White House is to be taken as a fair specimen of similar
establishments, it cannot too strongly or too anxiously express its
conviction that the greatest possible benefit will accrue to pauper
patients by the erection of a county lunatic asylum.
The Committee reports that the defects and abuses in the management of
houses for the reception of lunatics, to which the Select Committee of
1815 called the attention of the House of Commons, still exist in
licensed houses where paupers are received in the neighbourhood of the
metropolis, and that similar abuses elsewhere prevail. The evidence
established that there was no due precaution with respect to the
certificate of admission, the consideration of discharge, or the
application of any curative process to the mental malady. The Committee
therefore repeated the recommendations of the Committees of 1807 and
1815, and prepared a series of propositions as the basis of future
legislation, repealing a number of Acts and recommending the
consolidation, into one Act of Parliament, of the provisions for the
insane, as well as further facilitating the erection of county asylums,
and improving the treatment of pauper and criminal lunatics.
Dr. John Bright, secretary to the Commissioners, read from their records
one entry, describing the condition of Holt's house, Lewisham, in Kent.
In the year 1820, "in a close room in the yard, two men were shut by an
external bolt, and the room was remarkably close and offensive. In an
outhouse at the bottom of the yard, ventilated only by cracks in the
wall, were enclosed three females. The door was padlocked; upon an open
rail-bottomed crib herein, without straw, was chained a female by the
wrists, arms, and legs, and fixed also by chains to the crib. Her wrists
were blistered by the handcuffs; she was covered only by a rug. The only
attendant upon all the lunatics appeared to be one female servant, who
stated that she was helped by the patients."
Subsequent entries did not show any material improvement in the
condition of the house.
Dr. Bright summarized the defects in the Lunacy Laws at that period, as
regards the power vested in the Commissioners, as follows:--
"They are very defective in many points: in the first place, with
respect to the granting licences, there is only one day in the year in
which, according to the Act, the licences can be granted; then with
respect to persons to whom the licence may be granted, any person
applying for that licence is entitled to have one; again, any person
committing any offence, save and except the refusing admission to
Commissioners on their visitations, may be continued and is continued in
the exercise of such powers as that licence communicates to him; the
Commissioners have no power to disturb in the management of his house
any keeper of a house, whatever offences he may have committed, or
however unworthy he may appear to them to be. Supposing any person who
had, in the eyes of the Commissioners, acted improperly, to apply in
October, at the usual and the only period in the year for granting
licences, they conceive (and they are advised) that they are obliged to
grant a licence to that individual. There is another circumstance which
I think is very important, which is the certificate which is granted;
the Act is vague with respect to the medical person. It speaks of him as
physician, surgeon, or apothecary; it does not say 'duly authorized to
grant a licence,' and, in point of fact, a number of persons, calling
themselves apothecaries, do sign certificates, and the Commissioners do
not believe that they can prevent them so doing, or that the signature
is invalid; and, again, it often happens, and very improperly, as the
Commissioners think, that persons sign the certificate in two
capacities. For instance, a medical man is, or calls himself, the friend
of the person conveyed to the mad-house, and he signs again as a medical
person; again, the keeper of a mad-house, who happens to be a medical
person, signs a certificate, attesting the insanity of the party, and
receiving that party into his house. The Commissioners always reprobate
and endeavour to check such a practice, but not always successfully."
In the following year (February 19, 1828) Mr. Gordon, in pursuance of
the instructions of the Committee, brought in a Bill to amend the law
for the regulation of lunatic asylums. He said, among other things, that
the medical certificate to be signed by an apothecary was interpreted to
mean that it might be signed by any seller of drugs, and hence an
apprentice, as soon as his indentures had expired, might consign a man
to a mad-house. This reminds me of a mistake into which a distinguished
German alienist has recently fallen, not unnaturally, from our double
use of the word apothecary. He smiles at the absurdity of the British
law allowing a mere druggist to sign a certificate of insanity! Mr.
Gordon again refers to Dr. Warburton's house, and the patients in their
cribs "wallowing in their filth throughout the whole of Sunday," while
on Monday morning they were "in a state of nudity, covered with sores
and ordure, and were carried into the yard to be suddenly plunged into
cold water, even when ice was in the pails." The speaker added that it
was impossible, with the strongest language, to describe the horrors of
this place, and even maintained that the evidence before the Committee
showed that, however bad, this house was good as compared with others of
the same kind--if not much better than many of them.
He maintained that, unfortunately, the provision made by 14 Geo. III.,
c. 49, by which five Commissioners, appointed by the College of
Physicians, licensed and were bound to visit these houses yearly, and,
if they found anything improper, were directed to state to the College
what they had discovered, had never been attended to in practice; at
least, since 1800. The excuse for this negligence was that the complaint
to the College censors (placed on a card in their room) did no good, and
might therefore as well be abandoned. In fact, he found on inquiry that
the Commissioners had done nothing--literally and strictly nothing. He
then referred to a house where two patients were found lying in an
outhouse, and three others chained down by the arms, wrists, and legs.
Their wrists were blistered, and their persons covered only by rags.
This was within five miles of London. He concluded by moving for leave
to bring in a Bill "To Consolidate and Amend the several Acts respecting
County Lunatic Asylums, and to Improve the Treatment of Pauper and
Criminal Lunatics."
Lord Ashley seconded the motion, and leave was given to bring in the
Bill,[159] which passed the House.
In the Upper House Lord Malmesbury moved the second reading of the above
Bill. One object, he said, of the Lunatic Asylum Regulation Bill was to
give to counties more power in establishing asylums. For private
patients, two medical certificates and an order would now be required,
and the like for single patients. In regard to the existing College
Commissioners, he ridiculed the extraordinary circumstance that if, in
the course of their visits of inspection, they found what was
reprehensible in an asylum, they could not revoke the licence which they
themselves had given. It was proposed to take the power from the College
of Physicians and invest it in fifteen Metropolitan Commissioners
appointed by the Home Secretary.[160]
This Act (9 Geo. IV., c. 40), based on the Report of the Committee, was
passed July 15, 1828.[161]
The returns of pauper lunatics in England and Wales amounted to 9000,
being 6700 in excess of the corresponding return of 1807; but nobody
supposes that there had been that, or, in fact, any considerable
increase in the number of the insane poor, but simply greater accuracy
in obtaining statistics.
Referring back to this period, Lord Shaftesbury, in evidence given
before a Committee of the House of Commons thirty years later, and
dwelling upon the old _régime_, observed: "I mention these things
because they never could be seen now (1859), and I think that those who
come after us ought to know what things have existed within the memory
of man. At the present time, when people go into an asylum, they see
everything cleanly, orderly, decent, and quiet, and a great number of
persons in this later generation cannot believe there was ever anything
terrible in the management of insanity; and many say, 'After all, a
lunatic asylum is not so terrible as I believed.' When we begun our
visitations, one of the first rooms that we went into contained nearly a
hundred and fifty patients, in every form of madness, a large
proportion of them chained to the wall, some melancholy, some furious,
but the noise and din and roar were such that we positively could not
hear each other; every form of disease and every form of madness was
there; I never beheld anything so horrible and so miserable. Turning
from that room, we went into a court, appropriated to the women. In that
court there were from fifteen to twenty women, whose sole dress was a
piece of red cloth, tied round the waist with a rope; many of them with
long beards, covered with filth; they were crawling on their knees, and
that was the only place where they could be. I do not think that I ever
witnessed brute beasts in such a condition, and this had subsisted for
years, and no remedy could be applied to it. It was known to one or two
physicians at the Royal College, who visited the place once a year; but
they said, fairly enough, that, although they saw these things, they
could not amend them." Lord Shaftesbury, after giving a short _résumé_
of the condition of the old York Asylum, as well as of that of Bethnal
Green in 1827, went on to observe--a paragraph which will form the motto
of my work--"I might multiply these instances almost indefinitely, but I
thought it was desirable just to indicate the state of things that
existed, in order to contrast the Past with the Present."[162]
In the interval between the Act of 1828[163] and the next Act of
importance, several attempts were made at further legislation on the
part of Mr. Gordon and Lord Somerset. A Bill passed both Houses in
1832.[164] In one instance a Bill which passed the Commons was
characterized in the House of Lords as "one of the most abominable
pieces of legislation that ever was seen." It was "monstrous." "Their
lordships could never suffer such an abominable piece of legislation to
be thrust down their throats." It is scarcely necessary to say that the
lips from which this animated language proceeded were those of Henry
Brougham, then the Lord Chancellor. The Bill was, of course, rejected.
In 1842 Lord Somerset brought forward a motion on the inspection of
asylums, and pointed out that there was a very large class of persons to
whose inspection the Act of 1828 did not apply, viz. those in
confinement in their own houses, in separate lodgings, in public
institutions, as county asylums, and the hospitals of Bethlem and St.
Luke's. The object of his Bill was to extend the system of inspection in
force in the metropolitan licensed asylums to the provinces. Barristers,
he maintained, should be appointed, with a fixed salary, and not paid
for their hour's work and allowed to practise. It is worthy of record
that the returns at this period showed that there were about sixty or
seventy houses licensed for the reception of insane persons in the
country, and that there were actually twenty-five counties in England
where there was not a single asylum licensed for the reception of
lunatics, and not one in Wales.
This measure was characterized by Mr. Wakley as not only a very small
one, but as an insult to medical men, as it only proposed barristers as
the new Commissioners, adding that "in Scotland there was one system, in
Ireland there was another, and in England there were several, and among
them all there was not one which, on the whole, was entitled to the
sanction and approbation of the public, or which was worthy of the
adoption of the noble lord [Somerset]."
Lord Ashley approved of the Bill, and speaking of the work of the
Commissioners, he said, "They have aimed at a medium line of policy, and
an immense amount of human misery had been abated under the present law,
and by the industry of those who carry it into execution."
It was in this speech that Lord Ashley made an observation which has not
escaped the criticism of the medical profession, namely, "that a man of
common sense could give as good an opinion as any medical man he ever
knew," that is, "when it has been once established that the insanity of
a patient did not arise from the state of his bodily health."[165]
It should be stated that Mr. Wakley moved an amendment on the first
clause of the Bill, omitting "Barrister Commissioners," and inserting
"Medical Commissioners." He spoke of the total failure of the
Metropolitan Commission, and ultimately moved as an amendment that two
of the Commissioners to be appointed should not have their profession
stated, their appointment being left to the Lord Chancellor. This
amendment was carried by a majority of three, but in the Bill provision
was made for two more physicians and two more barristers.
On July 16th of the same year, on the motion that the order of the day
for the further consideration of the Lunatic Asylums Bill be proceeded
with, a member suggested its postponement until further discussion. Lord
Somerset replied that the Bill was framed for the purpose of procuring
further information on the subject, in order to legislate permanently
upon it. On the House going into Committee Lord Ashley expressed a hope
that the measure would tend to ameliorate the condition of the pauper
lunatics throughout the kingdom. On this occasion Lord Ashley observed,
in regard to the system of non-restraint, that he had formerly
entertained some doubts as to the practicability of carrying it out; but
that these doubts had been removed by a visit to the Hanwell Asylum.
Having witnessed the system pursued there, he said he could not speak
too highly either of the system itself, or the manner in which it was
carried out by Dr. Conolly.
Having passed through Committee, the Bill was read a third time on the
28th of July, 1842, and in this instance was not rejected by the House
of Lords.[166]
The Metropolitan Commissioners, invested with their enlarged powers,
made a most thorough inquiry into the condition of the asylums in
England and Wales, and presented a Report to Parliament in 1844, which
must always possess great historic interest and value.[167] It
constitutes the Doomsday Book of all that concerns institutions for the
insane at that time.
The state of some asylums visited by the Commissioners was frightfully
bad, notwithstanding the general progress which had been made since
public attention had been directed to abuses and the several Acts of
Parliament had been passed in order to remove them. These things,
however, it must be remembered, were survivals of the past, not fair
illustrations of the present; abuses which lingered on in spite of light
and knowledge, and required stringent pains and penalties to force those
who permitted them to abandon their practices.
On the 23rd of July, 1844, the indefatigable reformer of abuses
connected with the treatment of lunatics, Lord Ashley, moved for an
Address to the Crown, praying her Majesty to take into consideration the
Report of the Metropolitan Commissioners in Lunacy[168] to the Lord
Chancellor, presented to the House, the statute under which they acted
expiring next session. He commented upon there being no official
visitation of single houses. He believed that such a power "ought to be
confided to some hand that would hunt out and expose the many horrible
abuses that at present prevail." The only control was that if such
patient resided more than twelve months in a house, the owner was
compelled to communicate the name of that patient to the clerk of the
Commission; but for the most part no notice was taken of this law, and
it was frequently evaded by removing the patient, after a residence of
eleven months, to some other lodging.
At this period (January 1, 1844) the number of lunatics and idiots
chargeable to unions and parishes in England and Wales was 16,821. In
county asylums there was provision for only 4155, leaving 12,666 poor
insane, of whom there were in asylums under local Acts 89, in Bethlem
and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private
asylums, leaving in workhouses and elsewhere 9339. Although a few of the
existing county asylums were well adapted to their purpose, and a very
large proportion of them were extremely well conducted, yet some were
quite unfit for the reception of insane persons. Some were placed in
ineligible sites, and others were deficient in the necessary means of
providing outdoor employment for their paupers. Some also were ill
contrived and defective in their internal construction and
accommodation. Some afforded every advantage of science and treatment;
others were wholly deficient in these points. All of them, however, had
the advantage of constant supervision, and of not giving any profit to
the superintendent. Lord Ashley especially referred to the admirable
manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster,
and Gloucester were managed. "Why, then," his lordship asked, "are not
these institutions multiplied? At this moment there are twenty-one
counties in England and Wales without any asylum whatever, public or
private. The expense is one cause. In some cases the cost of
construction has been exceedingly great. The asylum most cheaply
constructed is that of Wakefield, of which the average cost per head was
£111, whilst the highest price was that of Gloucester, which had cost on
the first accommodation £357 per head. In many cases the cost of
construction had exceeded £200 per head. The cost of the Bedford Asylum,
for 180 patients, was £20,500; that of Gloucester, for 261 patients,
£51,366; that of Kent, for 300 patients, was £64,056; that of Hanwell,
for 1000 patients, was £160,000, exclusive of £36,000 paid since 1835
for furniture and fittings. On the other hand, the best-constructed
union-houses in the country had not cost more than £40 per head." Lord
Ashley maintained that although, no doubt, a lunatic asylum was
expensive, it ought not to be so to that enormous degree. The reason of
this difference he did not know, except that many of them had been
constructed with a great display of architecture, and some asylums were
far too large. Adopting the opinion of the Report of the Commissioners,
he maintained that no asylum for _curable_ lunatics should contain more
than 250 patients, and that perhaps 200 are as large a number as can be
managed with the most benefit to themselves and the public in one
asylum; and he quoted Dr. Conolly's stronger statement that 100 persons
were the highest number that could be managed with convenience in one of
these asylums. With regard to the number of private patients in
asylums, there were 3790, of whom 973 were in private metropolitan, and
1426 in private provincial asylums. The paupers in the private houses
were--metropolitan, 854; provincial, 1920. With respect to these, it was
a very serious question how far any house should be licensed to take
paupers for payment. The principle was very dangerous, and Lord Ashley
pointed out that if the superintendent only got seven or eight shillings
a week, he still must make a profit, and that there could be no doubt it
was so. Quoting the Report of the Commissioners again, he said that many
asylums had formerly been private houses; the mansion was sometimes
engrossed by the proprietor and a few private patients, while the
paupers were consigned to buildings formerly used as offices and
outhouses. After adducing evidence of the deplorable condition of
certain asylums, Lord Ashley asserted that the only remedy was the
multiplication of county asylums, and if advice and example failed, they
ought to appeal to the assistance of the law to compel the construction
of an adequate number of asylums over the whole country. It was the duty
of the State to provide receptacles for the incurable patients, apart
from those devoted to remedial treatment. Parochial authorities,
however, preferred keeping patients in the workhouse at an expense not
exceeding two shillings a week, rather than send them to the county
asylum, where the minimum charge was seven shillings a week.
It was true, Lord Ashley observed, that they could show but few
instances of restoration to reason. How, indeed, was it possible? They
could show, however, a mighty improvement in the condition of the
sufferers, the alleviation of their state, their occupations and
amusements (all, with some bright exceptions, of recent date), and that
the services of religion had infused a momentary tranquillity; but they
could show little else, and unless the Legislature should interfere and
bring these unfortunates by force within the reach of sympathy and care,
for every one restored to his senses we should see a hundred in whom the
light of reason would be extinguished for ever. The speaker went on to
say that there were two points of deep interest, to which the House
would do well to advert for a moment--the question of restraint, and the
admission and liberation of patients. "Upon restraint it was unnecessary
to dwell very long, as it was a matter of internal arrangement, and
beyond their immediate legislation; but he wished to direct the
attention of the House to the chapter in the Report which handled that
subject, that it might share the general satisfaction, and give praise
to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr.
Conolly, Dr. de Vitré, Dr. Charlesworth and many more, who had brought
all their high moral and intellectual qualities to bear on this topic,
and had laboured to make rational and humane treatment to be the rule
and principle of the government of lunacy."
Lord Ashley pointed out that the law required no medical certificate
whatever for a pauper patient, except when admitted into a private
asylum. It appears that in Wales at that time there were 1177 pauper
lunatics, 36 of whom were in English county asylums, and 41 in English
licensed houses, 90 in union workhouses, and 1010 living with their
friends, many of them being in a wretched condition. Lord Ashley quoted
a letter from one of the Commissioners, written in Wales, in which it
was stated, "We have met with one case which we think most atrocious. A.
B. was sent to the Hereford Asylum from near Brecon on November 28,
1843. She died on January 30th. She was in such a shocking state that
the proprietor wished not to admit her; she had been kept chained in the
house of a married daughter. From being long chained in a crouching
posture, her knees were forced up to her chin, and she sat wholly upon
her heels and her hips, and considerable excoriation had taken place
where her knees pressed upon her stomach. She could move about, and was
generally maniacal. When she died it required very considerable
dissection to get her pressed into her coffin! This might be taken as a
sample of Welsh lunatics."
The improvement in the condition of Dr. Warburton's asylum at Bethnal
Green, which was the original cause of the Commission of Inquiry being
appointed in 1827, now presented, it appears, a most agreeable picture
of what might be done by vigilant inspection. "Whereas in 1828 there
were commonly 150 to 200 of the patients restrained by leg-locks,
chains, and other fetters--certainly during the night--in 1844 there
were, out of 582 patients, only 5 whose violence rendered this species
of restriction necessary, and even the confinement or coercion resorted
to was of the most moderate description, and in the opinion of the
visiting officers most necessary."
Lord Ashley concluded his speech with the following eloquent
words:--"Sir, these subjects may be dull, and want the light and shade
of more exciting topics; but the expense which is incurred, the numbers
that suffer, and the nature of their sufferings, will perhaps justify
the present demand upon your time and patience. The House possesses the
means of applying a real and speedy remedy; these unhappy persons are
outcasts from all the social and domestic affections of private
life--nay, more, from all its cares and duties, and have no refuge but
in the laws. You can prevent by the agency you shall appoint, as you
have in many instances prevented, the recurrence of frightful cruelties;
you can soothe the days of the incurable, and restore many sufferers to
health and usefulness.... I trust, therefore, that I shall stand
excused, though I have consumed so much of your valuable time, when you
call to mind that the Motion is made on behalf of the most helpless, if
not the most afflicted, portion of the human race."[169]
Sir James Graham does not appear to have been affected by this appeal,
for, declining immediate action, he stated that the condition of pauper
lunatics would come under the consideration of the House next session.
He recommended the House to approach the subject of the inspection of
private houses with great caution.
In the summer of 1845 (June 6th) Lord Ashley returned to the subject,
and brought forward in the House of Commons two Bills for England and
Wales only, although he said, "I believe that not in any country in
Europe, nor in any part of America, is there any place in which pauper
lunatics are in such a suffering and degraded state as those in her
Majesty's kingdom of Scotland." After pointing out that the then
existing law was embodied in nine statutes, divisible into four
classes--County Asylums, Licensed Asylums and Public Asylums, Persons
found lunatic by inquisition, and Criminal Lunatics, he observed that
his Bill only touched the two first classes, and amended the single Act
contained under the first class, as also the three Acts contained under
the second class, namely, 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV.,
c. 64; and 5 and 6 Vict., c. 87; which various statutes were proposed by
him to be consolidated into one--"A Bill for the Regulation of the Care
and Treatment of Lunatics in England and Wales." After referring to the
state of the law as it existed under 14 Geo. III., the only law
regulating private asylums prior to Mr. Gordon's measure of 1828, Lord
Ashley proposed to establish a permanent Commission of Lunacy, giving
power of far more detailed and frequent visitation than previously, and
placing "hospitals" under proper regulation by requiring them to have
the same orders and certificates as in licensed asylums, and the same
visitation as in county asylums. The person signing the order of a
pauper patient would be required to examine him beforehand, and the
medical officer certifying his insanity was to see him within seven
days of his confinement. On admission the mental and bodily condition of
the patient, and in the event of his death, the cause thereof, were to
be stated. Injuries and acts of violence were to be recorded and a
case-book kept. A return was to be made of all single patients received
for profit.[170] Workhouses containing lunatics were to be subjected to
regular visitation. These were some of the provisions of the first Bill.
The second was an extension of the Act of 9 Geo. IV., c. 40, and was of
the highest importance, for the provision of county and borough asylums,
instead of being permissive, was made compulsory. Where insufficient
accommodation had been provided, it was required to increase it. It was
proposed to erect some separate buildings at less cost for incurable, or
rather chronic, cases. The above Bill was to be extended to boroughs
having separate quarter sessions, and to every place not contributing to
county rates. All lunatics not chargeable, whether wandering or
otherwise, were to be apprehended, and those whose friends were unable
to pay for them admitted as paupers. A quarterly inspection by a medical
man of lunatics not in asylums was required, and a list was to be sent
to the Commissioners in Lunacy.
Lord Ashley, after paying the tribute of respect and admiration due to
Pinel, referred in conclusion to the introduction of a humane system of
treatment into this country at York, adding that it must be grateful to
the feelings of the author of the "Description of the Retreat" "to
perceive that his example has obtained not only the approval, but the
imitation of the best and wisest men of this country, and, I may add, of
America."
Lord Ashley's Bill introduced for the first time a permanent Lunacy
Commission. It comprised six paid Commissioners at salaries of £1500
each, which, he observed, would be economical in the end. In Mr.
Gordon's Act the Commissioners were appointed for one year, to be
renewed annually, and consisted of ten unpaid members and five
physicians, who were paid at the rate of one guinea an hour for their
attendance, with power to carry into effect the new Act within the
metropolitan district. This act and the Commission were renewed in 1832,
when two barristers were added on the same terms. In 1834, having been
always a member of the Commission, Lord Ashley became the chairman. The
Act had been renewed periodically every three years until the year 1842,
when Lord Somerset brought in a Bill, the object of which was greatly to
extend the operation of the Metropolitan Commission. The number of
physicians was then augmented to seven, and the barristers to four; and
it was also provided that the Commissioners should receive five guineas
a day during the performance of their duties in the provinces.
Immediately after that Act (5 and 6 Vict., c. 87) the Commissioners had
entered upon their enlarged duties. The consequence was that in each
year the establishments visited by them were:
Visited once
a year.
Seventeen county asylums, or asylums brought within the
scope of 9 Geo. IV. (1828), (twelve county asylums, five
county and subscription asylums).
Eleven of mixed character (mostly by subscription and partly
by income from charitable foundations).
Two military and naval hospitals.
Visited twice
a year.
Ninety-nine houses licensed by justices in session (fifty-nine
receiving only private patients, forty private and pauper).
Visited four
times a year.
In metropolitan district:
Thirty-seven houses licensed by Metropolitan Commissioners
(thirty-three for private patients only; four for private
and pauper).
Total public and private asylums, January 1, 1844, 166.
The result of these investigations was, Lord Ashley observed, the Report
presented to the House last session, when he moved for an Address to the
Queen, but withdrew it upon the Government promising to bring in a Bill.
Ultimately, however, the Government had requested him to undertake it.
The two Bills, having passed the Houses of Parliament, received the
Royal assent on the 4th and 8th of August, 1845.[171] They have been
well called the Magna Charta of the liberties of the insane.
After these Acts had been in operation for eight years, it was found
that various amendments were needed, and in February, 1853, Lord St.
Leonards introduced, along with another Bill lessening the expense
arising out of lunacy inquisitions, one consolidating the laws
respecting asylums, and one amending Lord Shaftesbury's Act (c. 100).
They constitute the 16 and 17 Vict., c. 96 and c. 97.
The former, entitled "An Act to amend an Act passed in the ninth year
of Her Majesty 'for the Regulation of the Care and Treatment of
Lunatics,'" has reference mainly to private asylums and hospitals. The
same order and certificates which were required for admission into an
asylum were now necessary for single patients. It was enacted that
medical men should specify the facts upon which their opinion of a
patient's insanity was based, distinguishing those observed by
themselves from those communicated by others. Bethlem Hospital was by
the thirty-fifth section of this Act made subject to the provisions of
the Lunacy Acts.
The latter statute, entitled "An Act to Consolidate and Amend the Laws
for the Provision and Regulation of Lunatic Asylums for Counties and
Boroughs, and for the Maintenance and Care of Pauper Lunatics in England
and Wales," repealed the 8 and 9 Vict., c. 126; 9 and 10 Vict., c. 84;
and 10 and 11 Vict., c. 43. Many sections refer to the particular mode
of determining the manner in which an asylum shall be provided for the
paupers of a county and borough, whether for the county alone, or with
some other county or borough, or with the subscribers to any hospital,
or with the visiting committee of a county asylum for the joint use of
an existing asylum. The parish medical officer was directed to visit all
the paupers in it _every quarter_, whether in the workhouse or not, and
report to the guardians or overseer those who, in his judgment, might be
properly confined in an asylum. Thus the tendency of the Act was, in
this and other ways, calculated to add to the numbers under care, and,
therefore, to make the apparent increase of insanity greater. Three
classes of lunatics were contemplated by this Act, viz. pauper lunatics;
wandering lunatics, whether paupers or not; lunatics not paupers and not
wandering, who are cruelly treated or neglected. The Commissioners might
order the removal of a lunatic from an asylum, unless the medical
officer certified such patient to be dangerous; and the latter might be
overruled by the consent of two visiting justices to his discharge. A
large number of the sections of this Act provide in detail for the
settlement, etc., of pauper lunatics. Penalties were enacted in the
event of any superintendent or other officer of an asylum ill-treating
or neglecting a patient.[172]
* * * * *
One of those waves of suspicion and excitement which occasionally pass
over the public mind in regard to the custody of the insane, occurred in
1858. Sensational articles appeared in the papers, and novels were
written to hold up those connected with the care and treatment of the
insane to public obloquy. The author himself did not escape
animadversion, and was represented in a newspaper as a brutal mad-doctor
using a whip upon an unfortunate patient "in an institution of which
better things might have been expected." That the charge was the
offspring of a bewildered editor, who confused person and place in an
incredible manner, and was obliged to acknowledge that he had been the
victim of his own imagination, only shows how the paroxysms of sudden
passion and indignation to which John Bull is liable, may lead to the
most ridiculous mistakes. However, there must be some fire where there
is smoke, and one or two unfortunate events gave colour to the
assertion, persistently made, that asylums were the abodes of injustice
and cruelty. A Select Committee of the House of Commons was appointed in
February, 1859, to inquire into the operation of the Acts of Parliament
and Regulations for the Care and Treatment of Lunatics and their
Property, including Sir George Grey, Mr. Walpole, Mr. Whitbread, Mr.
Drummond, Mr. Kekewich, and others; and evidence was given by the Earl
of Shaftesbury, Mr. Barlow, Mr. Gaskell, Dr. Southey, Dr. Conolly, Dr.
Hood, Dr. Bright, Dr. Bucknill, Mr. Lutwidge, etc.
The Committee commence their Report with presenting the following
comparison of the number of lunatics in 1844, 1858, and 1859:--
-----------------------------------------+--------+--------+-------
Location. | 1844. | 1858. | 1859.
-----------------------------------------+--------+--------+-------
Private patients in asylums, hospitals, | | |
and licensed houses | 3,790 | 4,612 | 4,762
| | |
Pauper lunatics and idiots in asylums, | | |
hospitals, and licensed houses | 7,482 | 17,572 | 18,022
| | |
Pauper lunatics and idiots in workhouses | | |
(655) and with friends, etc. | 9,339 | 13,163 | 13,208
+--------+--------+--------
| 20,611 | 35,347 | 35,992
-----------------------------------------+--------+--------+--------
the last figure showing an increase of 15,000 over the number in 1844,
and being one in six hundred in the population. The Committee point out
that from 1808 to 1845 the justices had the power to provide, in every
county, proper houses for pauper lunatics, but were not obliged to do
so. There were in 1859 forty county asylums. Of seventy-one boroughs
bound to provide asylums, about forty had done so.
As to public asylums, the evidence brought forward convinced the
Committee that little alteration was required in the law, they being
"well looked after and carefully attended to." It was suggested that
they might be in some instances too large, and the staff of attendants
too small and not sufficiently paid. Also that it might be desirable to
erect, in connection with them, detached buildings of a simple and
inexpensive character for the reception of imbecile and chronic
patients.
It was considered that the chief evil for which a remedy was required
lay in the detention of a large number of pauper lunatics in workhouses,
amounting to 68,000 January 1st, 1857, and 7632 on January 1st, 1859.
"It cannot be denied that, with regard to those who are really lunatics,
there is a great absence of proper supervision, attendance, and medical
treatment. In some workhouses there are not even separate wards;
mechanical restraint is frequently applied, because the imperfect state
of the accommodation will not admit of a better mode of treatment; in
many cases, the medical officers of a union cannot have the special
knowledge requisite for the management of the insane; and it may
generally be concluded that the special appliances of a union workhouse
are not by any means equivalent, as to this class of inmates, to those
of a lunatic asylum." The Committee did not recommend the removal of
all cases, but that no person should be detained in a workhouse
respecting whose sanity a doubt existed, without a medical certificate,
renewable quarterly; that there should be distinct wards for such
patients, with distinct attendance; that the guardians should visit such
patients once a quarter, and make a special entry of their condition;
that the Commissioners should visit them at least once a year; and that
the same power of removing any patient to an asylum should be given to
the Commissioners as that possessed by the justices.
Lord Shaftesbury on this occasion recommended that magistrates should be
empowered to provide asylums by money raised on the security of the
rates, for all the non-pauper classes. "When I look into the whole
matter," he said, "I see that the principle of profit vitiates the whole
thing; it is at the bottom of all these movements that we are obliged to
counteract by complicated legislation, and if we could but remove that
principle of making a profit, we should confer an inestimable blessing
upon the middle classes, getting rid of half the legislation, and
securing an admirable, sound, and efficient system of treatment of
lunacy." The Committee, however, while encouraging such asylums founded
on private contributions, could not recommend that a burden should be
imposed on the ratepayers, or that their establishment should be
compulsory.
The Committee suggested as safeguards against the improper detention of
lunatics in private asylums (after dismissing the proposal to require
the sanction of a magistrate) various important precautions.
1. Worthy of consideration whether the certificate should be verified
before a magistrate, so as to enable him to determine whether the Act
has been complied with. 2. The certificate authorizing detention to be
limited to three months. 3. The order to state the time when the patient
was last seen, and not to be effective unless the applicant had seen the
patient within three months. 4. Copy of order and certificate to be sent
to the Commissioners within twenty-four hours, instead of within seven
days. 5. The patient to be visited as soon as possible by the
Commissioners or by some person acting directly under their authority.
6. The person who signs the order for admission to a private asylum to
visit the patient at least every six months--a clause in Mr. Gordon's
Act, but omitted in that of 1845. 7. Patients to have a _primâ facie_
right to receive visits from and correspond with friends. 8. To make it
penal for any medical man to receive a patient in a single house without
apprising the Commissioners of it.
Other suggestions of the Committee had reference to Chancery lunatics,
criminal lunatics, and the composition and powers of the Lunacy Board.
When this Committee met, the Acts in force were essentially similar to
what they now are (the only important subsequent statute being that of
1862), viz. for _public asylums_, the 16 and 17 Vict., c. 97, and 18 and
19 Vict., 105, and for _private asylums_, 8 and 9 Vict., c. 100, 16 and
17 Vict., c. 96, and 18 and 19 Vict., c. 105. According to these Acts,
the great principle which governs asylums where private patients are
kept may be said to be that no person can receive into his house more
than one patient, if he derives any profit therefrom, unless he has a
licence granted to him for that purpose, and submits to the regulations
which that licence implies.
Legislation followed in 1862, in the statute 25 and 26 Vict., c. 111,
entitled "An Act to amend the Law relating to Lunatics."[173]
It made pauper lunatics chargeable upon the common fund of the union,
instead of the particular parish. In addition to many matters of detail
in reference to the establishment of asylums, and an important section
in regard to the use of workhouses for chronic lunatics, additional
safeguards were given to prevent the improper admission of patients into
institutions for the insane, much care being shown in reference to the
abuse of private asylums. Persons signing orders for admission must have
seen the patient within one month. Certain persons were prohibited from
signing any certificate or order for the reception of any private
patient into a licensed or other house, viz. those receiving a
percentage on, or otherwise interested in, the payments to be made by
any patient received into such houses; as well as any medical attendant
as defined by the Lunacy Act of 1845. If defective medical certificates
were not amended within fourteen days, the Commissioners were empowered
to order the patient's discharge. On admission of patient, the
documents, with the exception of the "statement," were to be
transmitted to the Lunacy Board within one clear day, instead of after
two and before the expiration of seven, as formerly. Increased
visitation of asylums by Commissioners was provided, one of whom might
visit any asylum, hospital, or jail, in addition to the visits required
by two of them. Regulations were made in regard to patients being absent
on trial, the transmission of their letters, and the further protection
of single patients. These and some other sections were the outcome of
the suggestions of 1859-60.[174]
In 1874 a Poor Law Act granted four shillings per head out of the
Consolidated Fund to paupers in asylums, to the effects of which we
shall have to refer in the next chapter.
It is necessary now to chronicle the appointment of the Select Committee
of 1877, known as Mr. Dillwyn's Committee, the result, to a large
extent, of a feeling of uneasiness in the public mind, or rather, a
portion of it, relative to the too easy admission of patients into
asylums, and their too difficult exit, when once there. The grossest
charges were made against the proprietors of licensed asylums, and the
Commissioners themselves were charged with culpable laxity. As might be
expected, some changes in the law were suggested likely to prove
beneficial, and the Report of the Committee contained sundry
recommendations of importance. The charges, however, from which the
inquiry originated, fell to the ground; and had the appointment of the
Committee had no other result, the advantage would have been great, in
presenting a most gratifying contrast to the revelations which took
place fifty years before, in 1827.[175]
The conclusions at which the Committee arrived were that, "although the
present system was not free from risks which might be lessened, though
not wholly removed, by amendments in the existing law and practice, yet,
assuming that the strongest cases against the present system were
brought before them, allegations of _mala fides_ or of serious abuses
were not substantiated.... The Committee cannot avoid observing here,
that the jealousy with which the treatment of lunatics is watched at the
present day, and the comparatively trifling nature of the abuses
alleged, present a remarkable contrast to the horrible cruelty with
which asylums were too frequently conducted less than half a century
ago, to the apathy with which the exposure of such atrocities by
successive Committees of this House was received, both by Parliament and
the country, and to the difficulty with which remedial enactments were
carried through the legislature.... Nevertheless, the anomalous state of
the law, which undoubtedly permits forcible arrest and deportation by
private individuals and the fearful consequences of fraud or error,
have induced the Committee carefully to inquire whether any additional
safeguards may be devised."
Among the changes proposed (most of which are of the nature of
safeguards), or in some instances hinted at rather than proposed,
were:--an emergency certificate as in Scotland, signed by one medical
man, but if the patient remains in the asylum more than three days, two
fresh certificates to be obtained; in addition to report now required
after the admission of the patient, a careful statement to be prepared
from the case book and sent to the Lunacy Board at the end of the first
month; the order on which every patient is admitted to continue in force
for not more than three years, when a special report should be sent to
the Board by the superintendent, and repeated annually; the original
order to be given by a near relative as in Ireland, or some responsible
person who could be called to account; the patient being visited every
six months by the person signing the order, the "surest mode of guarding
against unduly prolonged detention consisting in frequent and careful
visitation of all places in which any lunatic is confined, with full
power placed in the hands of the Commissioners to order his discharge,
and in the more general adoption of the system of probationary release."
Reports to be sent to the Commissioners of patients kept under restraint
in private families or religious houses in the British Isles, not for
profit, provided that the reports are confidential, and the patients
confirmed lunatics, and not merely suffering under temporary
derangement. On showing good cause for such a course, any person, as in
Scotland, with the sanction of the Commissioners, to send two medical
men to test the condition of any patient under control. Personal
examination of patients, such as that made by the Chancery Visitors, to
be extended to them irrespective of the possession of property. "Either
the Chancery lunatics, who number less than a thousand, have too much
cure bestowed upon them, or the others, who exceed sixty-five thousand,
have far too little.... It seems physically impossible that, with the
present strength of the Lunacy Commissioners, minute supervision of
those who require it can be efficiently exercised." Amalgamation of the
two departments might obviate waste of power in visiting, stricter
supervision being also exercised over single patients, who are only
visited once a year, there being nothing in the Acts to necessitate even
this visitation. Transference of administration of property of persons
unable to manage it, without deprivation of liberty, suggested.
Particular workhouses to be devoted to harmless lunatics, who now crowd
the asylums, by a common action of the workhouse authorities within
certain areas. Voluntary boarders to be allowed to go to asylums,
whether they have already been in confinement or not, notice being sent
to the Lunacy Board of their admission. The existence of private asylums
to be left to the spontaneous action of the public, sufficient
accommodation in public asylums as in Scotland, Cornwall, and at
Cheadle, being encouraged and facilitated by enlargement of the powers
of magistrates, and other means calculated to extend this system.
Greater freedom of patients in asylums, and of their visitation by
friends, and in correspondence, are regarded as valuable securities
against the infringement of personal liberty. Whatever changes are made,
a consolidation of the Lunacy Acts would be most desirable. Such were
the main proposals.
These suggestions of the Committee have not yet borne fruit, but will,
no doubt, be of service in future lunacy legislation.
Mr. Dillwyn, in introducing his last Bill (May 25, 1881),[176] proposed
that no one should be confined as a lunatic except upon an order of the
justice of the peace; that no one should be incarcerated except at the
instance of a near relative, or of some solicitor of repute. There was
also provision that due notice should be given before a justice made the
order, and that the order must be authorized by two medical men, one of
whom should be the medical officer of the district. For violent lunatics
he proposed the Scotch law, which permitted an emergency certificate,
enabling persons who had paroxysms of lunacy to be detained for
twenty-four hours, but not longer, except on the order of some competent
authority. In the matter of discharges, he proposed that patients should
be discharged on the order of a Judge in Chambers, a stipendiary
magistrate, or a County Court judge, who should order two medical men to
visit the lunatic, and report on the case; and such judge, after
communicating with the Lunacy Commissioners, might order the lunatic to
be liberated within ten days. As to private asylums, Mr. Dillwyn knew
that the proposals he made bearing upon them would be met by the
argument of vested interests on the part of the proprietors, but he did
not think such interests ought to be exceptionally respected. He did not
wish to introduce compulsion, but proposed that justices should be
enabled to raise money by way of terminable annuities for the reception
in public asylums of those who could pay. Mr. Dillwyn on this occasion
was in a generous mood, for he observed that "he had nothing to say
against private asylums, which, on the whole, were very well conducted."
What he objected to was the interest which the proprietors had in
keeping their patients as long as possible. Mr. Dillwyn objected to the
present system of inspection, and made certain proposals with a view to
increase its efficiency--including a paid chairman of the Lunacy Board.
Mr. Dillwyn's Bill never reached the stage of the third reading, nor was
it discussed in committee; and the Government, which expressed a hope
that they might be able to take the matter in hand, has not yet found
time to bring in a Bill.
* * * * *
It will be seen from the foregoing sketch that the example of a better
system of treatment slowly but surely exercised a beneficial effect,
combined as it was by the exposure of the neglect and cruelty which for
the most part marked the treatment in asylums, workhouses, and also the
home care of the insane; that the demand for legislative inquiry and
interference followed; and that the system of inspection has, step by
step, been rendered stricter and more effective. First there was
introduced the visitation by the College of Physicians, through five of
its Fellows--a miserable failure. Then there was, in 1828, the
appointment of Metropolitan Commissioners, whose authority was in 1842
extended to the whole of England and Wales; and, last of all, was the
establishment of the Board of Lunacy Commissioners on the basis upon
which it is now constituted. So woefully slow, if eventually successful,
is the march of events in the progress of reform.
There have been several members of the legislature who have honourably
distinguished themselves by advocating in Parliament the claims of a
class whose unhappy characteristic it is that they are unable to
advocate their own cause, among whom may be mentioned Mr. T. Townshend,
Mr. Wynn, Mr. Rose, Mr. Gordon, Lord Somerset; but to no single
legislator is so great a debt of gratitude due as to Lord Shaftesbury,
whose untiring efforts, and conciliatory yet firm bearing, in bringing
forward his measures for the relief of the insane, combined with a
thorough mastery of the question and an intimate acquaintance with the
condition of houses for their care and treatment, have effected the
greatest good, and served to carry into extensive operation, principles
already enunciated, it is true, and even partially practised, but
requiring the strong arm of the law to enforce their recognition
throughout the Kingdom. The extent of obligation the insane and their
friends owe to Lord Shaftesbury, who for more than fifty years has
devoted himself to their interest, can only be fully estimated by those
who have carefully traced his unwearied assiduity in conducting measures
through Parliament, providing for the erection of lunatic asylums and
the proper visitation of their inmates, and who are acquainted with the
manner in which he has filled the office of Chairman of the existing
Lunacy Board since it was formed. At that period Mr. Sheil could say in
the House, without fear of contradiction, that "it may be truly stated
that the noble lord had added nobility even to the name of Ashley, and
that he had made humanity one of 'Shaftesbury's Characteristics.'"[177]
FOOTNOTES:
[140] _Edinburgh Review_, vol. xxviii. p. 433.
[141] The "Private Mad-house Bill" of 1814 was introduced, April 5th,
"to repeal and render more effectual the provisions of the Act of the
14th of the King." Mr. Rose said there were actually cases in which it
was found that the medical certificate was signed by the keeper of the
house. His Bill provided for the periodical visitation of private
mad-houses by magistrates. The Bill passed the Commons July 11, 1814.
Its author stated that it had been introduced the year before and amply
considered by a Committee of the House, who were unanimous for its
adoption, but I find no reference whatever in Hansard in 1813 to any
Bill or Committee (see Hansard, vol. xxvii.).
[142] The chief members of the Committee were Lord R. Seymour, Lord
Binning, the Right Hon. G. Rose, the Hon. H. G. Bennet, Mr. Western, Mr.
W. Smith, and the Hon. W. H. Lyttleton.
[143] Hansard, vol. xxx. p. 954.
[144] _Edinburgh Review_, vol. xxviii. p. 435.
[145] _Op. cit._, p. 441. "Even after the publication of the evidence,
it was not until the enormity of retaining the offending parties had
been expressly condemned in Parliament that Mr. Haslam, the apothecary,
was dismissed" (p. 443).
[146] Minutes, Select Committee of the House of Commons, 1815, pp. 43
and 44. See also Mr. J. B. Sharpe's edition of this Report, each subject
arranged under its distinct head, 8vo, pp. 411. London.
[147] _Ibid._, pp. 167, 168. In the Minutes of the Committee of 1816, it
is stated that in the same asylum the inmates were subjected to brutal
cruelties from the attendants; that they suffered very much from cold,
and were infested with vermin (p. 2, _et seq._).
It may be added, as showing the slowness of reform, that even when, in
1828, two medical superintendents were appointed at Bethnal Green, no
less than seventy, out of four hundred patients, were in irons; there
was no bath, no book or newspaper, and little or no employment.
[148] Minutes of Evidence, Select Committee on Mad-houses, 1815, p. 43.
[149] Hansard, vol. xxxi. p. 1146.
[150] Hansard, vol. xxxiv.
[151] Mr. Rose had recently died (1818). Though not immediately
successful, his labours deserve our cordial recognition.
[152] Hansard, vol. xxxix. p. 974.
[153] 59 Geo. III. c. 127.
[154] "I do hereby certify that by the directions of L. M. and N. O.,
Justices of the Peace for the county of H., I have personally examined
C. D., and that the said C. D. appears to me to be of insane mind."
Unfortunately a medical certificate in those days was not always of
great value. Too many were illiterate productions like the following, on
which a patient was admitted to Dr. Finch's asylum, Salisbury: "He{y}
Broadway A Potcarey of Gillingham Certefy that Mr. James Burt Misfortin
hapened by a Plow in the Hed which is the Ocaision of his Ellness and By
the Rising and Falling of the Blood And I think a Blister and Bleeding
and Meddesen Will be A Very Great thing but Mr James Burt wold not A
Gree to be don at Home. March 21, 1809. H{ay} Broadway."
[155] "A General View of the Present State of Lunatics and Lunatic
Asylums in Great Britain and Ireland."
[156] The cost of some of the asylums mentioned is worth
noting:--Bedford, with 180 beds, £20,500; Cornwall, with 172, £18,780;
Gloucester, with 120, £42,856; Lancaster, for 593, £100,695; Stafford,
for 120, £36,500; Nottingham, for 170, £36,800; Norfolk, for 220,
£50,000; Wakefield, for 420, £46,620. (Except Cornwall, land is
included.)
[157] In reply it was asserted that the room was twenty-six feet long,
and the number of cribs fifteen.
[158] In 1827 Sir A. Halliday wrote: "This Act, the inadequacy of which
has long been ascertained and fully exposed, is still the only law by
which mad-houses are licensed and regulated in England and Wales....
That it has remained so long upon the statute book must hereafter excite
astonishment; and that even now, there should exist so much difficulty
in having it altered and amended, is a fact scarcely to be credited. Yet
such is the fact; and thousands of our fellow-men have been hurried to
an untimely grave, in all the horrors of raving madness or helpless
fatuity, without its being possible to get their condition altered or
amended, merely because certain (we hope mistaken) prejudices were
entertained by an exalted individual whose voice was long paramount in
the senate; and we had almost added, through the influence of those who
have realized immense fortunes as wholesale dealers and traffickers in
this species of human misery."
[159] Hansard, vol. xviii. p. 583.
[160] Hansard, vol. xix. p. 195.
[161] See Appendix D.
[162] Minutes of Evidence of Select Committee of the House of Commons,
1859, p. 65.
[163] The Act of 1828 was amended by 2 and 3 Will. IV., c. 107.
[164] 2 and 3 Will. IV., c. 107. The Metropolitan Commissioners were,
under this Act, to be appointed by the Lord Chancellor instead of the
Home Secretary. Not less than four or more than five were to be
physicians, and two barristers.
[165] Hansard, vol. lxi. p. 806.
[166] 5 and 6 Vict., c. 87.
[167] Report of the Metropolitan Commissioners, 1844.
[168] For some of the details of this Report, see chapter v.
[169] Hansard, vol. lxxvi. p. 1274.
[170] These were to be visited by a small private Committee named by the
Lord Chancellor.
[171] 8 and 9 Vict., c. 100 and c. 126 (see Appendix E.)
[172] For more particular provisions in these Acts and that of 1855 (18
and 19 Vict., c. 105), containing some further amendments, see Appendix
F.
[173] See Appendix G.
[174] In the following year another statute (26 and 27 Vict., c. 110),
entitled "An Act to amend the Lunacy Acts," was passed, but only
consisted of three sections referring to one or two doubtful points in
the previous Act, which do not require notice. How many Acts of
Parliament are necessitated by the blundering obscurity of the person
who, as draughtsman, escapes criticism?
[175] For an analysis of the evidence, and considerations thereupon, the
writer may refer to an article in the _Contemporary Review_, October,
1877, entitled "Lunacy Legislation."
[176] "Parliamentary Debates," 3rd Series, vol. 261, p. 1278.
[177] Mr. Gordon died in 1864. In their Report of that year, the
Commissioners "deplore the death of their colleague, Mr. Robert Gordon,
whose name has been prominent, during the greater part of the last half
century, in connection with efforts to ameliorate the condition of the
insane," and add, "Down to the present time, Mr. Gordon has given to our
labours, constant and valuable personal aid; and his unwearied and
disinterested service, closed only by death, we must remember always
with respect and gratitude." It may be mentioned here that Mr. Wynn, to
whose exertions the Act of 1808 (p. 128) was due, lived to witness Lord
Ashley's Act of 1846 passed, and was present in the House during the
debate.
CHAPTER V.
LINCOLN AND HANWELL--PROGRESS OF REFORM IN THE TREATMENT OF THE INSANE
FROM 1844 TO THE PRESENT TIME.
Before presenting official evidence of the gradual progress in the
condition of the insane in England, we must interpose in our history a
brief reference to the development of what every one knows as the
non-restraint system of treating the insane. It is, no doubt, true that
restraint begins the moment a patient enters an asylum, under whatever
name it may be disguised, but by this term is technically meant the
non-use of mechanical restraint of the limbs by the strait waistcoat,
leg-locks, etc. If, as indeed it may be granted, it had its real origin
in the humane system of treatment introduced into England long
previously, it was in the first instance at Lincoln, and subsequently at
Hanwell, adopted as a universal method, and as a rule having almost the
sanctity of a vow.
The following table shows, in the clearest manner, by what gradual steps
the experiment was tried and carried on at the former asylum. Dr.
Charlesworth was the visiting physician and Mr. R. Gardiner Hill the
house surgeon.
------+--------+-------------+---------------+-----------------
Year.| Total | Total | Total number | Total number of
| number | number | of instances | hours under
| in the | restrained. | of restraint. | restraint.
| house. | | |
------+--------+-------------+---------------+-----------------
1829 | 72 | 39 | 1727 | 20,424
1830 | 92 | 54 | 2364 | 27,113¾
1831 | 70 | 40 | 1004 | 10,830
1832 | 81 | 55 | 1401 | 15,671½
1833 | 87 | 44 | 1109 | 12,003½
1834 | 109 | 45 | 647 | 6,597
1835 | 108 | 28 | 323 | 2,874
1836 | 115 | 12 | 39 | 334
1837 | 130 | 2 | 3 | 28
------+--------+-------------+---------------+-----------------
Here we observe that in 1829 more than half the number of the inmates
were subjected to mechanical restraint, while in 1836, out of 115
patients, only twelve were so confined, and in 1837 there were only two
out of 130.[178] The total disuse of mechanical restraints followed.
They were, however, resorted to on one or two occasions subsequently.
In connection with the foregoing, it must be mentioned that the entries
of the visitors and the reports of the physicians alike agree in
describing the condition of the patients as much improved, the quiet of
the house increased, and the number of accidents and suicides as
materially reduced in number.
It would appear that the mitigation of restraint, as evidenced by these
minutes (which commence with 1819), "was ever the principle," to use Mr.
Hill's own words, "pressed upon the attention of the Boards of the
Lincoln Asylum by its able and humane physician, Dr. Charlesworth, at
whose suggestion many of the more cruel instruments of restraint were
long since destroyed, very many valuable improvements and facilities
gradually adopted, and machinery set in motion which has led to the
unhoped-for result of actual abolition, under a firm determination to
work out the system to its utmost applicable limits." Mr. Hill became
house surgeon in 1835; and it will be seen, by the table already given,
that the amount of restraint (which, in consequence of Dr.
Charlesworth's exertions, had already remarkably decreased) became less
and less under the united efforts of these gentlemen, until the close of
the year 1837, when restraint was entirely abolished; and while, on the
one hand, as Mr. Hill frankly acknowledges, "to his [Dr. Charlesworth's]
steady support, under many difficulties, I owe chiefly the success which
has attended my plans and labours," while Dr. Charlesworth's great
merit, both before and after Mr. Hill's appointment, must never be
overlooked, it is due to the latter gentleman to admit that he was the
first _to assert the principle_ of the entire abolition of mechanical
restraint, as is stated in the "Fourteenth Annual Report of the Lincoln
Asylum," which report is signed by Dr. Charlesworth himself.
For a time there were, certainly, some drawbacks to the success of the
Lincoln experiment, from the serious physical effects (such as broken
ribs, etc.), which occasionally resulted from the struggles between
attendants and patients; and it is probable that, had not the experiment
been carried out on a much larger scale at Hanwell by Dr. Conolly, with
far greater success, a reaction would have ensued, of infinite injury
to the cause of the insane.
Dr. Conolly went to Hanwell in 1839; and in the first of an admirable
series of reports written by him, we read, "The article of treatment in
which the resident physician has thought it expedient to depart the most
widely from the previous practice of the asylum, has been that which
relates to the personal coercion, or forcible restraint, of the
refractory patients.... By a list of restraints appended to this report,
it will be seen that the daily number in restraint was in July so
reduced, that there were sometimes only four, and never more than
fourteen, at one time [out of eight hundred]; but, since the middle of
August, there has not been one patient in restraint on the female side
of the house; and since September 21st, not one on either side.... For
patients who take off or destroy their clothes, strong dresses are
provided, secured round the waist by a leathern belt, fastened by a
small lock.... No form of waistcoat, no hand-straps, no leg-locks, nor
any contrivance confining the trunk or limbs or any of the muscles, is
now in use. The coercion-chairs (forty in number) have been altogether
removed from the walls.... Several patients formerly consigned to them,
silent and stupid, and sinking into fatuity, may now be seen cheerfully
moving about the walls or airing-courts; and there can be no question
that they have been happily set free from a thraldom, of which one
constant and lamentable consequence was the acquisition of uncleanly
habits."
In a later report (October, 1844) Dr. Conolly observes, "After five
years' experience, I have no hesitation in recording my opinion that,
with a well-constituted governing body, animated by philanthropy,
directed by intelligence, and acting by means of proper officers
(entrusted with a due degree of authority over attendants properly
selected, and capable of exercising an efficient superintendence over
the patients), there is no asylum in the world in which all mechanical
restraints may not be abolished, not only with perfect safety, but with
incalculable advantage."
Four years ago when I visited the Lancaster Asylum, I was shown a room
containing the dire instruments of coercion formerly in use, and a most
instructive exhibition it was. At my request the superintendent, Dr.
Cassidy, has kindly provided me with the following list of these
articles: 1 cap with straps; 4 stocks to prevent biting; 2 muzzles
(leather) to cover face and fasten at the back of the head; 10 leather
gloves, of various forms, perforated with holes, and cuffs of leather or
iron; 14 double ditto, with irons for wrists; 1 kicking shoe; 11 leather
muffs with straps; 4 stout arm leathers (long sleeves with closed ends)
with cross-belt and chains; 8 heavy body straps, with shoulder-pieces,
waist-belts, cross-belts, and pairs of handcuffs attached by short
chains; 5 ditto of somewhat different make; 30 ditto, but with leather
cuffs; 2 waist straps with leather cuffs attached; 9 pairs of leather
cuffs padded; 11 pairs of leg-locks; a quantity of foot and hand cuffs
(iron), with chains and catches to fasten to a staple in the wall or
bedstead; 21½ pairs of padded leather handcuffs; a larger quantity of
handcuffs, single and double, of iron; 22 sets of strong body
fastenings, very heavy chains covered with leather and iron handcuffs; a
large quantity of broad leather straps; a bag of padlocks; keys for
handcuffs, etc.
Truly the iron must have entered into the soul of many a poor lunatic in
those days. Mr. Gaskell began at once to remove handcuffs, etc., on his
appointment as superintendent, February, 1840. The disuse of restraint
is chronicled in the annual report, dated June, 1841. He resigned,
January 16, 1849, to become a Commissioner in Lunacy.
The Metropolitan Commissioners in Lunacy, as we have seen in the
previous chapter, issued a Report which forms an epoch in the history of
the care and provision for the insane in England and Wales. It should be
stated that, previous to the date of its preparation in 1844, the
following asylums had been erected under the Acts 48 Geo. III., c. 96,
and 9 Geo. IV., c. 40.
------------------+--------------------------+-----------------
County. | Town. | Date of opening.
------------------+--------------------------+-----------------
Beds | Bedford | 1812
Chester | Chester | 1829
Cornwall | Bodmin | 1820
Dorset | Forston, near Dorchester | 1832
Gloucester | Gloucester | 1823
Kent | Barming Heath, Maidstone | 1833
Lancaster | Lancaster Moor | 1816
Leicester | Leicester | 1837
Middlesex | Hanwell | 1831
Norfolk | Thorpe, near Norwich | 1814
Nottingham | Nottingham | 1812
Stafford | Stafford | 1818
Suffolk | Melton, near Woodbridge | 1829
Surrey | Springfield, Wandsworth | 1841
York, West Riding | Wakefield | 1818
------------------+--------------------------+------------------
There were two asylums in operation at this date, which were declared
by local Acts county asylums, subject to the provisions of 9 Geo. IV.,
c. 40, viz. St. Peter's Hospital, Bristol, incorporated in the year
1696; and one at Haverfordwest, county of Pembroke, 1824.
The military and naval hospitals were two in number, viz.--
-------------------------+-----------+--------------------
Hospital. | Nature. | Date of opening.
-------------------------+-----------+--------------------
Fort Clarence, Chatham | Military | 1819
Haslar Hospital, Gosport | Naval | 1818
-------------------------+-----------+--------------------
Then there were the old hospitals of Bethlem and St. Luke's--the former
more specially devoted to the insane in 1547, removed from Bishopsgate
Street to Moorfields in 1676, and opened in St. George's Fields in 1815;
the latter opened July 30, 1751.
The other public lunatic hospitals, nine[179] in number, were--
--------------------+------------------------+------------------
Locality. | Name of Asylum. | Date of opening.
--------------------+------------------------+------------------
Exeter | St. Thomas' | 1801
Lincoln | Lunatic Asylum | 1820
Liverpool | „ „ | 1792
Northampton | General Lunatic Asylum | 1838
Norwich | Bethel Hospital | 1713
Oxford (Headington) | Warneford Asylum | 1826
York | Bootham Asylum | 1777
„ | The Retreat | 1796
--------------------+------------------------+------------------
The total number of recognized lunatics on the 1st of January, 1844,
were--
Private 4,072
Pauper 16,821
------
Total 20,893
They were thus distributed:--
GENERAL STATEMENT OF THE TOTAL NUMBER OF PERSONS ASCERTAINED TO BE
INSANE IN ENGLAND AND WALES, JANUARY 1, 1844.
----------------+----------------+------------------+-------------------
Where | Private | Paupers. | Total.
confined. | patients. | |
+---+-----+------+-----+-----+------+-----+------+------
|M. | F. |Total.| M. | F. |Total.| M. | F. |Total.
----------------+---+-----+------+-----+-----+------+-----+------+------
15 county | | | | | | | | |
asylums |130| 115| 245|1,924|2,231| 4,155|2,054| 2,346| 4,400
| | | | | | | | |
2 ditto under | | | | | | | | |
local acts | --| -- | -- | 38| 51| 89| 38| 51| 89
| | | | | | | | |
2 military and | | | | | | | | |
naval hospitals|164| 4| 168| -- | -- | -- | 164| 4| 168
| | | | | | | | |
2 Bethlem and | | | | | | | | |
St. Luke's | | | | | | | | |
Hospitals |178| 264| 442| 86| 35| 121| 264| 299| 563
| | | | | | | | |
9 other public | | | | | | | | |
asylums |249| 287| 536| 177| 166| 343| 426| 453| 879
| | | | | | | | |
Licensed houses:| | | | | | | | |
37 metropolitan|520| 453| 973| 360| 494| 854| 880| 947| 1,827
99 provincial |748| 678| 1,426| 947| 973| 1,920|1,695| 1,651| 3,346
| | | | | | | | |
Workhouses and | | | | | | | | |
elsewhere[180] | --| -- | -- |4,169|5,170| 9,339|4,169| 5,170| 9,339
| | | | | | | | |
Single patients | | | | | | | | |
under | | | | | | | | |
commission |172| 110| 282| -- | -- | -- | 172| 110| 282
+------+-----+------+-----+-----+------+-----+------+------
Total | 2,161|1,911| 4,072|7,701|9,120|16,801|9,682|11,031|20,893
-------------+------+-----+------+-----+-----+------+-----+------+------
The number of asylums amounted to 166.[181]
At this period there were thirty-three metropolitan licensed houses
receiving private patients only, and four which received paupers also.
The dates of opening of these thirty-three private asylums, so far as
known, were: three in the last century, to wit, in 1744, 1758, and 1759;
one in each of the following years, 1802, 1811, 1814, 1816, 1823, 1825,
1826, 1829, 1832, 1833, 1834, 1836, 1837, 1840, 1842, and 1843; and two
in 1830, 1831, 1838, and 1839.
Passing from London to the provinces, we find fifty-five provincial
licensed houses receiving private patients only, and forty-four
receiving paupers, of which one was in Wales (Briton Ferry, near
Swansea). The known dates of opening were: in 1718, Fonthill-Gifford in
Wilts; in 1744, Lea Pale House, Stoke, near Guildford; in 1766, Belle
Grove House, Newcastle-on-Tyne; in 1791, Droitwitch; and in 1792,
Ticehurst, Sussex; one in each of the following years, 1800, 1802, 1803,
1806, 1808, 1812, 1814, 1816, 1818, 1821, 1824, and 1829; two in each of
the years 1820, 1822, 1826, 1828, 1832, 1834, 1836, 1837, 1838, and
1842; three in each of the years 1825, 1831, 1839, and 1843; four in
1833; five in 1830, 1835, and 1840; and, finally, six in 1841. One of
the asylums opened in 1843 was that in Wales, containing only three
patients.
Of some asylums found by the Commissioners to be in a very disgraceful
state, one is described as "deficient in every comfort and almost every
convenience. The refractory patients were confined in strong chairs,
their arms being also fastened to the chair. One of these--a woman--was
entirely naked on both the days the Commissioners visited the asylum,
and without doubt during the night. The stench was so offensive that it
was almost impossible to remain there." In another, "in the small
cheerless day-room of the males, with only one (unglazed) window, five
men were restrained by leg-locks, called hobbles, and two were wearing,
in addition, iron handcuffs and fetters from the wrist to the ankle;
they were all tranquil. Chains were fastened to the floors in many
places, and to many of the bedsteads." The Commissioners report of
another house that "in one of the cells for the women, the dimensions of
which were eight feet by four, and in which there was no table and only
two wooden seats, we found three females confined. There was no glazing
to the window.... The two dark cells, which joined the cell used for a
day-room, are the sleeping-places for these three unfortunate beings.
Two of them sleep in two cribs in one cell.... There is no window and no
place for light or air, except a grate over the doors." The condition of
the floor and straw, on which the patients lay, it is unnecessary to
describe.
We should not be doing justice to the history of non-restraint if we did
not state in full what the Commissioners found at this period to be the
opinion of the superintendents of the asylums in England.
"During our visits," they say, "to the different asylums, we have
endeavoured to ascertain the opinions of their medical superintendents
in reference to the subject of restraint, and we will now state, in
general terms, the result of our inquiries. Of the superintendents of
asylums not employing mechanical restraint, those of the hospitals of
Lincoln, Northampton, and Haslar, and of the county asylum at Hanwell,
appear to consider that it is not necessary or advisable to resort to it
in any case whatever, except for surgical purposes. On the other hand,
the superintendent at Lancaster[182] hesitates in giving an opinion
decidedly in favour of the non-restraint system. He thinks that,
although much may be done without mechanical restraint of any kind,
there are occasionally cases in which it may not only be necessary, but
beneficial. The superintendent of the Suffolk Asylum considers that in
certain cases, and more especially in a crowded and imperfectly
constructed asylum, like the one under his charge, mechanical restraint,
judiciously applied, might be preferable to any other species of
coercion, as being both less irritating and more effectual. The
superintendent of the Gloucester Asylum states that he has adopted the
disuse of mechanical restraint, upon the conviction which his experience
has given him during a trial of nearly three years. Of the
superintendents of asylums who employ mechanical restraint, those of the
Retreat at York, of the Warneford Asylum, and of the hospitals at
Exeter, Manchester, Liverpool, and St. Luke's, consider that, although
the cases are extremely rare in which mechanical restraint should be
applied, it is, in some instances, necessary. Similar opinions are
entertained by the superintendents of the county asylums of Bedford,
Chester, Cornwall, Dorset, Kent, Norfolk, Nottingham, Leicester,
Stafford, and the West Riding of York. At the Retreat at York mechanical
or personal restraint has been always regarded as a 'necessary evil,'
but it has not been thought right to dispense with the use of a mild and
protecting personal restraint, believing that, independent of all
consideration for the safety of the attendants, and of the patients
themselves, it may in many cases be regarded as the least irritating,
and therefore the kindest, method of control. Eight of the
superintendents employing bodily restraint have stated their opinion to
be that it is in some cases beneficial as well as necessary, and
valuable as a precaution and a remedial agent; and three of them have
stated that they consider it less irritating than holding with the
hands; and one of them prefers it to seclusion.
"In all the houses receiving only private patients, restraint is
considered to be occasionally necessary, and beneficial to the
patients.... At the Cornwall Asylum, we found a man who voluntarily
wrapped his arm round with bands of cloth from the fear of striking
others. He untied the cloth himself at our request. We know the case of
one lady, who goes home when she is convalescent, but voluntarily
returns to the asylum when she perceives that her periodical attacks of
insanity are about to return, in order that she may be placed under some
restraint.
"Of the asylums entirely disusing restraint, in some of them, as we have
stated, the patients have been found tranquil and comfortable, and in
others they have been unusually excited and disturbed. Without, however,
attaching undue importance to the condition of the asylum at the time of
our visits, or to accidents that may happen under any system of managing
the insane, it is nevertheless our duty to call your Lordship's
attention to the fact that since the autumn of 1842 a patient and a
superintendent have been killed; a matron has been so seriously injured
that her life was considered to be in imminent danger (at Dr. Philp's
house at Kensington); another superintendent has been so bitten as to
cause serious apprehensions that his arm must have been amputated; and
two keepers have been injured so as to endanger their lives. These fatal
and serious injuries and accidents have been caused by dangerous
patients, and some of them in asylums where either the system of
non-coercion is voluntarily practised, or is adopted in deference to
public opinion."
The following is a brief summary of the arguments of medical officers
and superintendents advocating absolute non-restraint at that period:--
1. That their practice is the most humane, and most beneficial to the
patient; soothing instead of coercing him during irritation; and
encouraging him when tranquil to exert his faculties, in order to
acquire complete self-control.
2. That a recovery thus obtained is likely to be more permanent than if
obtained by other means; and that, in case of a tendency to relapse, the
patient will, of his own accord, be more likely to endeavour to resist
any return of his malady.
3. That mechanical restraint has a bad moral effect; that it degrades
the patient in his own opinion; that it prevents any exertion on his
part; and thus impedes his recovery.
4. That experience has demonstrated the advantage of entirely abolishing
restraint, inasmuch as the condition of some asylums, where it had been
previously practised in a moderate and very restricted degree, has been
greatly improved, with respect to the tranquillity and the appearance of
cheerfulness among the patients in general, after all mechanical
coercion has been discontinued.
5. That mechanical restraint, if used at all, is liable to great abuse
from keepers and nurses, who will often resort to it for the sake of
avoiding trouble to themselves; and who, even when well disposed towards
the patient, are not competent to judge of the extent to which it ought
to be applied.
6. The patient may be controlled as effectually without mechanical
restraint, as with it; and that the only requisites for enabling the
superintendents of asylums to dispense with the use of mechanical
restraint, are a greater number of attendants, and a better system of
classification amongst the patients; and that the additional expense
thereby incurred ought not to form a consideration where the comfort of
the patients is concerned.
On the other hand, the medical and other superintendents of lunatic
asylums who adopted a system of non-restraint as a general rule, but
made exceptions in certain extreme cases, urged the following reasons
for occasionally using some slight coercion:--
1. That it is necessary to possess, and to acquire as soon as possible,
a certain degree of authority or influence over the patient, in order to
enforce obedience to such salutary regulations as may be laid down for
his benefit.
2. That, although this authority or influence is obtained in a majority
of cases by kindness and persuasion, there are frequent instances where
these means entirely fail. That it then becomes necessary to have
recourse to other measures, and, at all events, to show the patient
that, in default of his compliance, it is in the _power_ of the
superintendent to employ coercion.
3. That a judicious employment of authority mixed with kindness (and
sometimes with indulgence) has been found to succeed better than any
other method.
4. That the occasional use of slight mechanical restraint has, in many
instances, been found to promote tranquillity by day and rest by night.
5. That it prevents, more surely than any supervision can effect, the
patient from injuring himself or the other patients.
6. That, particularly in large establishments, the supervision must be
trusted mainly to the attendants, who are not always to be depended on,
and whose patience, in cases of protracted violence, is frequently worn
out. That in such cases mild restraint insures more completely the
safety of the attendants, and contributes much to the tranquillity and
comfort of the surrounding patients.
7. That in many cases mild mechanical restraint tends less to irritate,
and generally less to exhaust the patient, than the act of detaining him
by manual strength, or forcing him into a place of seclusion, and
leaving him at liberty to throw himself violently about for hours
together.
8. That the expense of a number of attendants--not, indeed, more than
sufficient to restrain a patient during a violent paroxysm, but
nevertheless far beyond the ordinary exigencies of the establishment--is
impracticable in asylums where only a small number of paupers are
received.
9. That the occasional use of slight coercion, particularly in
protracted cases, possesses this additional advantage: that it gives the
patient the opportunity of taking exercise in the open air at times
when, but for the use of it, he would necessarily be in a state of
seclusion.
10. The system of non-restraint cannot be safely carried into execution
without considerable additional expense; a matter which will necessarily
enter into the consideration of those who are desirous of forming a
correct opinion as to the precise benefits likely to arise from the
adoption or rejection of such a system.
11. That the benefit to the patient himself, if indeed it exist at all,
is not the only question; but that it ought to be considered, whether
the doubtful advantage to himself ought to be purchased by the danger to
which both he and his attendants and other patients are exposed, when
restraint is altogether abolished.
And 12thly. That, when a patient is forced into and secluded in a small
room or cell, it is essentially coercion in another form, and under
another name; and that it is attended with quite as bad a moral effect,
as any that can arise from mechanical restraint.[183]
Passing on to 1847, we find the Commissioners in Lunacy, having acted
under the new powers conferred upon them by the two Acts passed since
the date of the Report of 1844 (8 and 9 Vict., cc. 100 and 126), able to
give a satisfactory sketch of the progress of reform in the condition of
asylums. "In several of the county asylums and hospitals," they observe,
"the adoption of a more gentle mode of management was originally
designed in the direction of these establishments, and was the result of
public opinion and of the example set by the managers of the Retreat
near York. A strong impression was made on the feelings and opinion of
the public in reference to the treatment of lunatics by the publication
of Mr. Tuke's account of the Retreat at York. The able writings of Dr.
Conolly have of late years contributed greatly to strengthen that
impression, and to bring about a much more humane treatment of lunatics
in many provincial asylums, than that which formerly prevailed."
Referring, then, to the Report of the Metropolitan Commissioners (1844)
it is observed that "proof is afforded therein that this amendment had
not extended itself to old establishments for the insane, and that much
severe and needless restraint continued to be practised in numerous
private, and in some public asylums. In many of the private asylums, and
more especially in those which received great numbers of pauper
patients, much mechanical coercion was practised, until it came to be in
great measure laid aside in consequence of the repeated advice and
interference of the Commissioners.... In private licensed asylums it
has been thought impracticable to avoid the occasional use of
mechanical coercion without incurring the risk of serious accidents.
Under these circumstances restraint of a mild kind is still practised,
but we look forward to its abolition, except, perhaps, in some
extraordinary cases, so far as pauper patients are concerned, when the
provisions of the Act for the establishment of county asylums shall have
been carried into effect. In the best-conducted county asylums it is now
seldom (and in a few establishments never) resorted to."[184]
At this period, the actual number of lunatics returned to the
Commissioners was only 18,814, but they estimated the number under some
kind of care, in England and Wales, at 26,516. There were--
-----------------------------------+----------+---------+----------
Location. | Private. | Pauper. | Total.
-----------------------------------+----------+---------+----------
In county asylums, hospitals, and | | |
licensed houses | 3,574 | 9,652 | 13,226
| | |
Bethlem, and in naval and military | | |
hospitals not subjected to | | |
visitation of Commissioners | 606 | -- | 606
| | |
Poor-law unions; placed under | | |
local Acts | -- | 8,986 | 8,986
| | |
Gilbert's unions, and other places | | |
not in union | -- | 176 | 176
| | |
Single patients found lunatic by | | |
inquisition | 307 | | 307
| | |
Ditto in private houses with | | |
persons receiving profit | 130 | -- | 130
| | |
Excess of pauper patients in | | |
workhouses, etc., estimated by | | |
visiting Commissioners as at | | |
least one-third over the number | | |
number returned by parish | | |
officers | -- | 3,053 | 3,053
| | |
Criminals in jails | -- | 32 | 32
+----------+---------+----------
Total | 4,617 | 21,899 | 26,516
-----------------------------------+----------+---------+----------
The number of patients found lunatic by inquisition was 542; their
incomes amounting to £280,000. In 1839 the corresponding numbers were
494 and £277,991.
The estimated annual amount expended at this time for maintenance of
lunatics, or administered on their behalf, exceeded £750,000, thus
distributed:
1. Cost of 9652 paupers in asylums, estimated at
8s. per week £200,762
2. Ditto of 8986 paupers in workhouses, etc., and
173 in parishes not in union (9159),
estimated at 3s. per week 71,440
3. Ditto of excess of 3053 paupers over the number
returned by the parish officer 23,813
4. Ditto of 3574 private patients in asylums, etc.,
at an average of 20s. per week 173,628
5. Income of 542 private patients found lunatic by
inquisition 280,000
6. Cost of 606 patients in Bethlem and the naval
and military hospitals, estimated at 10s.
per week 50,756
7. Ditto of 120 other single patients taken charge
of in separate houses at £100 a year 12,000
8. Thirty-two criminals in jails, estimated at 3s.
per week 249
--------
Total £777,648
Adding the expense of maintaining many families cast upon the parish in
consequence of the patient's insanity, and the expense of supporting
many called imbecile, and the interest of large sums invested in public
establishments, the Commissioners estimated the actual amount as little
less than £1,000,000.
In the same Report the Commissioners observe "that they have found that,
with some exceptions, the patients have apparently been humanely, and
sometimes very judiciously treated. There is no reason to apprehend that
the lunatic patient is now often subjected to cruelty or
ill-treatment.... The massive bars, and rings, and chains of iron
formerly resorted to are no longer seen. Any continued coercion is not
permitted. The name of every patient under restraint and in seclusion,
and the means by which such seclusion is effected, are recorded every
week in a journal. Thus the safeguards against lunatic patients being
subjected to harsh or unnecessary restraint from the cruelty, idleness,
or caprice of their attendants, have been multiplied, and the chances of
abuse reduced to a small amount."
The number of lunatics placed under mechanical restraint in licensed
houses in this year is given in the following table, it being premised
that wherever the number is not specified, "it may be assumed either
that there was no patient then under restraint, or that the number was
so small, and the restraint so trivial, as not to be deemed worthy of
special remark."[185]
------------------------------+-----------+-----------+------------
| Number of | | Under
Asylum. | patients. |Criminals. | restraint
| | | last visit.
------------------------------+-----------+-----------+------------
METROPOLITAN LICENSED HOUSES. | | |
| | |
Bethnal Green--Red House } | | |
White House } | 614 | 12 | 4
Bow--Grove Hall | 291 | -- | 2
Brompton--Earls Court | 32 | -- | 1
Camberwell--Camberwell House | 246 | 1 | 5
Clapham--Retreat | 15 | -- | 1
Clapton, Upper--Brook House | 42 | -- | 1
Fulham--Beaufort House | 5 | -- | 2
Hillingdon--Moorcroft House | 50 | -- | 1
Hoxton--Hoxton House | 416 | -- | 4
Kensington--Kensington House | 44 | -- | 2
Peckham--Peckham House | 409 | 4 | 4
Stoke Newington-- | | |
Northumberland House | 35 | -- | 1
------------------------------+-----------+-----------+------------
------------------------------+-----------+-----------+------------
| Number of | | Under
Asylum. | patients. |Criminals. | restraint
| | | last visit.
------------------------------+-----------+-----------+------------
PROVINCIAL LICENSED HOUSES. | | |
| | |
Derby--Green Hill House | 25 | -- | 1
Durham--Gateshead Fell | 92 | 8 | 1
Essex--High Beach | 34 | -- | 2
Gloucester--Fishponds | 45 | -- | 1
„ Northwoods | 29 | -- | 1
„ Fairford | 175 | 1 | 1
Hants--Grove Place | 78 | 1 | 1
Herefordshire--Whitchurch | 32 | 2 | 1
Kent--West Malling Place | 40 | -- | 3
Lancaster--Blakely House | 24 | -- | 1
Northumberland--Bell Grove | | |
House | 13 | -- | 1
Oxford--Witney | 11 | -- | 2
„ Hook-Norton | 57 | 1 | 2
Somerset--Bailbrook House | 92 | 3 | 10
Stafford--Oulton Retreat | 25 | -- | 2
„ Sandfield | 44 | -- | 1
Sussex--Ringmer | 3 | -- | 1
Warwick--Duddeston Hall | 87 | 3 | 6
„ Kingstown House | 91 | -- | 2
Wilts--Bellevue House | 181 | 5 | 5
„ Fiddington House | 193 | 3 | 3
Worcester--Droitwich | 91 | 2 | 2
York, East Riding--Hull and | | |
East Riding Refuge | 115 | 8 | 1
„ „ Hessle | 12 | -- | 1
„ West Riding--Castleton | | |
Lodge | 15 | -- | 1
„ „ Grove House | 41 | -- | 5
„ „ Heworth | 29 | -- | 1
------------------------------+-----------+-----------+------------
If for the purpose of comparison at different years we take one asylum,
Ringmer in Sussex, there were in November 1829, nineteen patients, of
whom five were under restraint by day, and seven by night. In 1830
(February) the number of patients was twenty, and of these eleven were
under restraint by day and six by night; while in October of the same
year, out of eighteen patients, there were nine under restraint. In
1831, there were twenty-two patients, ten of whom were under
restraint. Writing in 1848, the Commissioners enumerate the various
changes for the better which had then taken place, among which were--an
active medical superintendence; the abolition of excessive use of
mechanical restraint, there being sometimes only one or two, and
occasionally no patient whatever, under mechanical restraint; the
introduction of warm and cold baths; the cleanliness of the day-rooms
and dormitories; the addition of a good library, and various amusements
and means of occupation; and also an excellent dietary. Such is a sample
of the happy change which was, in many instances, brought about by
inspection.
The following classification of asylums in 1851 will show at a glance
the progress made in providing accommodation from time to time,
consequent upon legislation:--
1. Asylums existing prior to passing of Act 8 and 9 Vict., c. 126.
Accommodation for pauper lunatics at passing of the Act 5560
Additional accommodation provided therein since the
passing of the Act 1753
----
Total accommodation 7313
2. Asylums in progress of erection at passing of Act 8 and 9 Vict., c.
126, and since opened.
Number for which designed 997
Subsequent additions 206
----
Total present accommodation 1203
3. Asylums erected or provided under the provisions of the Act 8 and
9 Vict., c. 126, and now opened.
Accommodation for pauper lunatics 1114
4. Asylums in progress of erection under Act 8 and 9 Vict., c. 126,
and not yet opened.
Proposed accommodation for pauper lunatics 4299
Under provisions of previous Acts 6557
Under Act 8 and 9 Vict., c. 126 7372
------
Total 13,929
Exclusive of 192 in Northampton Hospital.
Asylums existing prior to or at the passing of Act 8 and 9 Vict., c.
126--
Beds., Herts and Hants., Chester, Cornwall, Devon, Dorset,
Gloucester, Kent, Lancaster (containing the largest number
of patients, 700), Leicester and Rutland, Middlesex
(Hanwell), Norfolk, Notts., Salop and Montgomery, Stafford,
Suffolk, Surrey, West Riding, Yorkshire, Bristol (borough).
Wales--Haverfordwest (town and county), Montgomery (see
Salop).
Asylums in progress of erection at the passing of this Act, and since
opened--
Oxford and Berks, Somerset, North and East Riding,
Yorkshire. Wales--Anglesea, Carnarvon, Denbigh, Flint,
Merioneth.
Total number for which designed 997
Additions since passing the Act 206
----
Total 1203
Counties in which no steps are taken to provide asylums--
Cumberland, Durham, Northampton, Sussex, Westmoreland.
Total accommodation 5560
Subsequent additions 1753
----
Total 7313
Asylums erected or provided under the above Act and now opened--
West Lancashire (Rainhill), East Lancashire (Prestwich, near
Manchester), Birmingham (borough), Kingston-upon-Hull.
For these asylums the accommodation provided in the first instance was
1114.
There were still upwards of fifty boroughs for whose pauper lunatics no
legal provision was made, and no asylum was then erected for the City of
London.
Under the head of mechanical restraint, the Commissioners now report
that it has still further diminished, and has in some houses been
absolutely abolished. However, in fifty entries made in the books of
thirty-six private asylums, abuses and defects are animadverted upon in
fifteen instances in regard to restraint, in twenty instances in regard
to bedding and clothing, nine in regard to diet, seven in regard to
cleanliness, and four in regard to management and treatment. They
observe that the number of lunatics in workhouses has diminished in a
very marked degree.
In this Report the Commissioners take the opportunity of animadverting,
also, upon the defective state of the law in regard to the property of
lunatics; the good effect of the Act 8 and 9 Vict., c. 100, being
lessened by this and other causes.
Turning to the year 1854, nearly ten years after the Act of 1845 had
been in fruitful operation, we find the Commissioners attaching
importance to the alterations recently made in the law of lunacy by the
three important statutes, 16 and 17 Vict., c. 70 (the "Lunacy Regulation
Act" of 1853) which refers to Chancery lunatics; 16 and 17 Vict., c. 90
(an amendment of the Act under which the Board was constituted); and 16
and 17 Vict., c. 97 (the "Lunatic Asylums Act," 1853).
These Acts, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and
the Acts relative to criminal lunatics, constituted at that period the
code of law of lunacy.
The following counties still remained unprovided for:--Sussex,
Cumberland, Westmoreland, Northumberland, Durham, Cambridge, Cardigan,
Carmarthen, Glamorgan, Pembroke.
New private asylums were no longer licensed for paupers, in consequence
of the accommodation provided for them in county asylums.
Complaints having been made of the treatment of patients at Hanwell, an
inquiry had been instituted, which, in the opinion of the Commissioners,
justified them. They appeared to have been due to the want of efficient
supervision of male patients.
This Report of the Commissioners gives a series of interesting replies
to a circular letter addressed to the superintendents and medical
proprietors of nearly all the asylums in England and Wales, on
non-restraint, upon which they observe, "as the general result which may
be fairly deduced from a careful examination and review of the whole
body of information thus collected, we feel ourselves fully warranted in
stating that the disuse of instrumental restraint, as unnecessary and
injurious to the patient, is practically the rule in nearly all the
public institutions in the kingdom, and generally also in the
best-conducted private asylums, even those where the restraint system,
as an abstract principle admitting of no deviation or exception, has not
in terms been adopted.
"For ourselves," they observe, "we have long been convinced, and have
steadily acted on the conviction, that the possibility of dispensing
with mechanical coercion in the management of the insane is, in a vast
majority of cases, a mere question of expense, and that its continued,
or systematic use in the asylums and licensed houses where it still
prevails must in a great measure be ascribed to their want of suitable
space and accommodations, their defective structural arrangements, or
their not possessing an adequate staff of properly qualified attendants,
and frequently to all these causes combined.
"Our matured views upon the subject will be best understood by stating
the course we have followed in the discharge of our functions as
visitors. In that capacity we have made it a principle to discourage, to
the utmost, the employment of instrumental restraint in any form.
Wherever we have found it in use, our uniform practice has been to
inquire minutely into the circumstances and reasons alleged for its
necessity, and to insist on recourse being had to those various other
means which experience has proved in other houses to be effective
substitutes for it....
"As respects the question of _seclusion_, its occasional use for short
periods, chiefly during paroxysms of epilepsy or violent mania, is
generally considered beneficial. At the same time, we would observe that
the facilities which seclusion holds out to harsh or indolent attendants
for getting rid of and neglecting troublesome patients under violent
attacks of mania, instead of taking pains to soothe their irritated
feelings, and work off their excitement by exercise and change of scene,
render it liable to considerable abuse; and that, as a practice, it is
open, though in a minor degree, to nearly the same objections which
apply to the more stringent forms of mechanical restraint. We are
therefore strongly of opinion that, when even seclusion is resorted to
as a means of tranquillizing the patient, it should only be employed
with the knowledge and direct sanction of the medical officer, and even
then be of very limited duration.
"Further experience, we think, has shown that, except for the reception
of epileptic patients during the continuance of their paroxysms, and in
a few cases where there is a determined propensity to suicide, the
utility of padded rooms is not so great as was at one time supposed; and
that, for cases of ordinary maniacal excitement, seclusion in a common
day-room or sleeping-room of moderate size, from which all articles that
might furnish instruments of violence or destruction have been removed,
and which is capable of being readily darkened, when required, by a
locked shutter, will, in general, be found to answer every useful
purpose."[186]
As ten years had elapsed since the first attempt of any value to present
the numbers of the insane in England (see page 211), it is of interest
to compare with the table referred to, the following statement of the
numbers on the 1st of January, 1854:--
GENERAL STATEMENT OF THE TOTAL NUMBER OF PERSONS ASCERTAINED TO BE
INSANE IN ENGLAND AND WALES, JANUARY 1, 1854.[187]
----------------+----------------+--------------------+--------------------
Where | Private | Paupers. | Total.
confined. | patients. | |
+---+-----+------+------+------+------+------+------+------
|M. | F. |Total.| M. | F. |Total.| M. | F. |Total.
----------------+---+-----+------+------+------+------+------+------+------
33 county and | | | | | | | | |
borough asylums |147| 146| 293| 5,791| 6,878|12,669| 5,938| 7,024|12,962
| | | | | | | | |
2 military and | | | | | | | | |
naval hospitals|199| 5| 204| -- | -- | -- | 199| 5| 204
| | | | | | | | |
2 Bethlem and | | | | | | | | |
St. Luke's | | | | | | | | |
Hospitals |235| 239| 474| 4| 7| 11| 239| 246| 485
| | | | | | | | |
22 other public | | | | | | | | |
asylums |467| 456| 923| 102| 103| 205| 569| 559| 1,128
| | | | | | | | |
Licensed houses:| | | | | | | | |
42 metropolitan|608| 598| 1,206| 418| 723| 1,141| 1,026| 1,321| 2,347
88 provincial |795| 738| 1,533| 593| 407| 1,000| 1,388| 1,145| 2,533
| | | | | | | | |
Workhouses and | | | | | | | | |
elsewhere | --| -- | -- | 5,326| 5,327|10,653| 5,326| 5,327|10,653
+-----+-----+------+------+------+------+------+------+------
Total |2,451|2,182| 4,633|12,234|13,445|25,679|14,685|15,627|30,312
--------------+-----+-----+------+------+------+------+------+------+------
In their ninth Report the Commissioners speak of continued progress,
and to show the beneficial effects of good and kind treatment, record
the case of a lady visited by them in a private asylum, where they found
her in a room by herself, in a sadly neglected condition, and very
frequently placed under mechanical restraint. Her habits were dirty, and
her opportunities of taking exercise few. In consequence of her
unsatisfactory condition the Commissioners ordered her removal to
another asylum (the York Retreat), and about twelve months afterwards
saw her there, and made an entry to the effect that since her admission
she had never been in restraint or seclusion; that her destructive and
dirty habits had been corrected by constant attention, exercise out of
doors, and association with other patients. The Commissioners found her
quiet, orderly, clean, well-dressed, and so much improved in appearance
that they had some difficulty at first in recognizing her.
It was inevitable, as a result of the attention directed to the
condition of the insane, and the greatly increased provision made for
them in consequence, that there should be an alarming apparent increase
of lunacy in the kingdom. In point of fact, the number of pauper
lunatics had increased sixty-four per cent. in the eight years ending
1855.
At this period there were 13,579 patients in county and borough asylums,
1689 in registered hospitals, 2523 in metropolitan and 2588 in
provincial licensed houses, and 114 in the Royal Naval Hospital.
The number of insane poor not in asylums was estimated at 10,500, of
whom about half were inmates of workhouses, and the remainder with
relations and strangers on an allowance from the parish.
There were various obvious explanations for the apparent increase of
lunacy, viz. the greatly enlarged accommodation; the prolongation of
life in consequence of kind care; the parochial authorities being
required to take immediate proceedings for placing violent and recent
cases under treatment; medical practitioners recognizing the nature of
cases of insanity better; facilities of post-office, railway, and press
bringing cases to light; medical officers being required to make
quarterly returns under 17 and 18 Vict., c. 97, s. 66; and the efforts
of the Commissioners to impress on guardians the importance of sending
recent cases to asylums.
The increase of private patients during eight years had been at the rate
of only fifteen per cent.; but the Commissioners point out that this
conveys an imperfect view of the relative increase of pauper and private
cases, inasmuch as a practice had sprung up by which persons who had
never been themselves in receipt of relief, and who are not infrequently
tradesmen or thriving artisans, had been permitted to place lunatic
relatives in the county asylums as pauper patients, under an arrangement
with the guardians for afterwards reimbursing to the parish the whole or
part of the charge for their maintenance.
"Indeed, it may be said with truth that, except among what are termed
the opulent classes, any protracted attack of insanity, from the heavy
expenses which its treatment entails, and the fatal interruption which
it causes to everything like active industry, seldom fails to reduce its
immediate victims, and generally also their families with them, to
poverty, and ultimately to pauperism."
The Commissioners add--and we draw special attention to the
statement--that "this is the main reason why, in our pauper lunatic
asylums, many inmates are to be met with who have formerly held a
respectable station in society, and who, in point of education and
manners, are greatly superior to the inmates of a workhouse."[188] Hence
we see how utterly fallacious is the conclusion constantly drawn from a
study of the mere figures themselves that insanity is, to the extent
indicated by them, more prevalent among the lower than the higher
classes of society.
The very great importance of obtaining good attendants for asylums
became a prominent subject now that the number of patients under
treatment had so vastly increased, and it was clearly seen that the
skill of the superintendent was of little avail unless effectually
carried out by a well-qualified staff of attendants. It was necessary
that they should be liberally remunerated, and that their position in
the house should be made comfortable. The Commissioners recommended the
appointment of head attendants of a superior class, whose duties should
not be restricted to any one ward, but who should be responsible for the
conduct of the other attendants. A well-educated lady had been found
most useful in asylums as a companion to female patients of the upper
classes. The Commissioners required notices to be transmitted to their
offices of all dismissals for misconduct of nurses or attendants, and of
the causes thereof; these notices being regularly filed for reference,
in the event of inquiries being made as to the characters of applicants
for employment.
Reviewing the condition of the insane generally at this time in
workhouses, the Commissioners were able to report that, upon the whole,
a sensible amelioration had taken place in their physical condition and
in their treatment. They abstained, however, from any official sanction
of the construction of lunatic wards in workhouses; for the patients
were not provided with any suitable occupation, the means for exercise
were generally wanting, and the attendants were too badly paid to allow
of a reliance being placed on their services.
The large number living with strangers or relatives on parish allowance
appeared to have seldom fallen within the personal observation of the
Commissioners, who had chiefly to depend upon the annual returns from
the clerks of the Board of Guardians, and on the quarterly returns from
the medical officers of the various districts,[189] whose returns were
so defective and irregular that no definite conclusion could be drawn
from their contents.
In their next Report the subject of workhouses still claimed the
attention of the Commissioners, and they complained that, in direct
contravention of the law, pauper patients were sent first to a
workhouse, instead of an asylum. The sixty-seventh section of the Act of
1853 was disregarded altogether. Hence, if the patient was found
manageable in the workhouse, he was detained there, or, if ultimately
sent to the asylum, much valuable time had been lost, and his chance of
cure greatly lessened. The Commissioners found their recommendations set
at defiance, for the most part, whenever the report of the medical
officer stated the patient to be "harmless." It was urged that the
lunatic wards in workhouses should be placed in the position of licensed
houses, and that the Commissioners and visitors should be invested with
the same power in regard to them as they possessed over these
establishments. But it became very clear that, however valuable the
recommendations of the Commissioners might, and, indeed, have ultimately
proved to be, they did not possess the authority of commands. At the
infirmary asylum at Norwich unceasing suggestions for improvement were
made for _ten years_, which were, "with very few exceptions,
systematically disregarded." Then, but not till then, did the
Commissioners appeal to the Secretary of State, to require the
authorities of Norwich to provide for their lunatic poor, according to
the statutes 8 and 9 Vict., c. 126, passed twelve years before. The Act
of 1853, having introduced some modification for boroughs of small
populations, left no further excuse for making proper provision. The
Commissioners from time to time issued circulars to the various asylums,
and intimated their intention to report to the Secretary of State (under
s. 29 of the Act) the cases of all boroughs wherein proper provision
had not been made for their pauper lunatics. "But even this last appeal
did not fare more successfully; and all our reiterated inquiries and
remonstrances have as yet made hardly a perceptible impression upon that
almost general neglect of the law which it was hoped they might repair."
As regards the important class of single patients, the Commissioners had
not found it practicable to visit them as they desired to do. Many,
however, had been visited. Some were found indifferently accommodated,
and otherwise in a very unsatisfactory state. The provisions of the law
were extensively evaded.[190]
As the views entertained and recommended by the Commissioners from time
to time are of importance in regard to the construction of asylums, it
may be observed that in their Report of 1857 they dwell on the evils of
very large buildings, on account of the loss of individual and
responsible supervision, the loss of the patient's individuality, and
the tendency of the rate of maintenance for patients to run higher.[191]
It was also maintained that the divided responsibility consequent on
such large institutions was injurious to management, and that the cures
of patients were actually fewer. It was considered that the limits to
the size of the Hanwell Asylum were reached, and indeed exceeded, viz.
for 1020, but room for 600 patients more was required. So at Colney
Hatch there were 1287 patients, while 713 more demanded admission. When,
in 1831, Hanwell was built for 500, it was thought sufficient to provide
for the whole of Middlesex! Two years after, however, it was full; in
another two years it was reported to contain 100 patients more than it
was built for, and after the lapse of another two years it had to be
enlarged for 300 more; Colney Hatch having been constructed for 1200
patients belonging to the same county, and opened in 1851; and yet,
within a period of less than five years, it became necessary to appeal
to the ratepayers for further accommodation, and the latest return
showed that, at the close of 1856, there were more than 1100 paupers
belonging to the county unprovided for in either of its asylums. "Hardly
had they been built, when the workhouses sent into each such a large
number of chronic cases as at once necessarily excluded the more
immediately curable, until the stage of cure was almost past; and the
doors of the establishment became virtually closed not long after they
were opened to the very inmates for whom only it was needful to have
made such costly provision." Hence the Commissioners urged separate and
cheaper asylums for old cases; but the committees of the asylums
objected. The Secretary of State induced the two parties to meet, but,
being unable to agree, the Commissioners reluctantly gave way.
In 1858 the amount of existing accommodation for pauper lunatics in the
counties and boroughs was--for males, 7516; females, 8715; total,
16,231; and the additions then being made to old asylums amounted
to--for males, 1172; females, 1309; total, 2481. The numbers for whom
additional asylums were then being made were--males, 1169; females,
1157; total, 2326. The sum of these totals being 21,048. There were, on
the 1st of January of this year, 17,572 pauper lunatics in asylums, of
whom as many as 2467 were still confined in private asylums. There were
now 33 county and 4 borough asylums, 15 registered hospitals, 37
metropolitan licensed houses, and 80 provincial licensed houses; also
the Royal Naval Hospital. The total number of inmates in these
establishments were (in the order enumerated) 15,163, 1751, 2623, 2647,
126, making a grand total of 22,310, including 295 patients found
lunatic by inquisition.
The Commissioners point out that a military asylum is a desideratum,
there being no provision for soldiers, while sailors were well cared for
at Haslar Hospital.
The following particulars will show at a glance the provision made at
this period for the insane in England and Wales:--
1. Boroughs having asylums: Birmingham, Bristol (in St. Peter's
Hospital), Hull.
2. Boroughs erecting or about to erect asylums: Maidstone, Bristol, City
of London.
3. Boroughs in union with counties: Cambridge, Colchester, Maldon,
Gloucester, Leicester, Grantham, Lincoln, Stamford, Hereford,
Nottingham, Abingdon, Oxford, Reading, Shrewsbury, Wenlock, Worcester.
4. Boroughs whose pauper lunatics are sent to asylums under contract or
arrangements between justices, etc.: Plymouth, Chichester, Portsmouth,
Southampton, Devizes, Salisbury, Chester, Derby, Barnstaple, Bideford,
Dartmouth, Exeter, South Molten, Tiverton, Tewkesbury, Bridgewater,
Bridgnorth, Ludlow, Penzance, Poole, Winchester, Newark, Oswestry, Bath,
Lichfield, Scarborough.
5. Boroughs which have not made any statutory provision for the care of
their pauper lunatics: Bedford, Newbury, Buckingham, Carmarthen,
Andover, Canterbury, Dover, Hythe, Rochester, Sandwich, Tenterden,
King's Lynn, Norwich, Thetford, Yarmouth, Northampton, Berwick-upon-Tweed,
Newcastle-upon-Tyne, New Radnor, Bury St. Edmunds, Ipswich, Guildford,
Hastings, York.
In 1862 the expense of pauper lunatics in asylums was thrown upon the
common fund of the union, instead of on the particular parish. The
effect was natural. Many patients were removed from workhouses to the
county asylums, some of whom might well have remained there. There could
be no objection to this, if the latter cost no more than the former; but
seeing that where the one costs £200 per bed, the other would only cost
£40, the effect is, from the point of view of the ratepayer, who usually
objects to contribute to the formation of a free library, a very serious
one.
Twenty years after the census of the insane made in 1844, and ten after
the period to which the table given at p. 230 refers, we find the
numbers as follow[192]:--
GENERAL STATEMENT OF THE TOTAL NUMBER OF PERSONS ASCERTAINED TO BE
INSANE IN ENGLAND AND WALES, JANUARY 1, 1864.
----------------+------------------+--------------------+--------------------
Where | Private | Paupers. | Total.
confined. | patients. | |
+-----+-----+------+------+------+------+------+------+------
| M. | F. |Total.| M. | F. |Total.| M. | F. |Total.
----------------+-----+-----+------+------+------+------+------+------+------
42 county and | | | | | | | | |
borough asylums| 118| 113| 231| 9,690|11,630|21,320| 9,808|11,743|21,551
| | | | | | | | |
1 military and | | | | | | | | |
naval hospital | 153| -- | 153| -- | -- | -- | 153| -- | 153
| | | | | | | | |
2 Bethlem and | | | | | | | | |
St. Luke's | | | | | | | | |
Hospitals | 264| 215| 479| -- | -- | -- | 264| 215| 479
| | | | | | | | |
13 other public | | | | | | | | |
asylums | 708| 591| 1,299| 170| 178| 348| 878| 769| 1,647
| | | | | | | | |
Licensed houses:| | | | | | | | |
37 metropolitan| 831| 649| 1,480| 253| 589| 842| 1,084| 1,238| 2,322
65 provincial | 987| 698| 1,685| 256| 192| 448| 1,243| 890| 2,133
| | | | | | | | |
Workhouses and | | | | | | | | |
elsewhere | -- | -- | -- | 8,125| 8,126|16,251| 8,125| 8,126|16,251
| | | | | | | | |
Broadmoor | -- | -- | -- | -- | 95| 95| -- | 95| 95
+-----+-----+------+------+------+------+------+------+------
Total[193] |3,061|2,226| 5,327|18,494|20,810|39,304|22,555|23,076|44,631
----------------+-----+-----+------+------+------+------+------+------+------
We must not pass by the year 1867 without recording that at this period
a statute important in its bearing on the provision made for the insane
poor of London was enacted. This was the Metropolitan Poor Act, which
established what are known as the Metropolitan District Asylums for
Imbeciles at Leavesden (Hertfordshire), Caterham (Surrey), Hampstead,
and Clapton. Legally these institutions are classed under workhouses.
Much difference of opinion exists as to the wisdom of having separate
institutions for the incurable. That there is great danger of
overlooking the fact that some incurable patients require quite as much
attention as the curable is certain; they may indeed, if neglected, be
reduced to a more pitiable condition than the latter; but this does not
prove that, under the present safeguards provided by the legislature,
there may not be a safe recourse to this mode of making provision for
this class of the insane. At any rate, it is of interest to know what
has been done in this direction during the last few years in England.
Asylums have been erected at Leavesden, near Watford, Herts; Caterham,
Surrey; and Darenth, near Dartford, Kent, there being at Darenth both
idiot schools and an institution for incurables.
These are the Metropolitan District Asylums.[194]
As the primary object in adopting this kind of accommodation is economy,
it is important to present a clear statement of the finances, omitting
shillings and pence.
Take Leavesden as the example, where the accommodation is for 2000
patients (M. 900, F. 1100). The land, which was purchased in 1867 and
1880, has cost £9401, the area being eighty-four acres. The laying out
the grounds, etc., cost £3000; the cost of building and drainage (up to
Michaelmas, 1878) was £121,674; the engineering works, fixtures, and
fittings cost £16,162; the furniture, bedding, and clothing, £16,235;
the architect's and surveyor's charges, and clerk of works, £5108;
solicitor's charges, printing, insurances, and all other charges, £1526;
the total being £173,118, or £86[195] per bed. Taking out the items of
furniture, bedding, and clothing, we have the sum of £77 per bed. How
striking the difference when compared with the expense of an ordinary
county asylum, the reader who has examined the figures given at page 166
will readily perceive.
Let us now pass on to the year 1870. We find the Commissioners able to
state, as the result of very minute and careful inspection, that the
Reports of their members during the previous year showed, on the whole,
that good progress continued to be made in the mode of managing "these
large and daily increasing institutions," and they add, "although in
some instances it has been our duty to comment on shortcomings and cases
of neglect, we have generally been able to bear testimony to the skill
and zeal evinced by the medical superintendents in the execution of
their very grave and difficult duties."[196] On the other hand, they
observe, "We regret that we shall have to describe several acts of
violence committed by attendants in county asylums, which in three
instances were followed by fatal results, but in only one of which,
although careful inquiries were instituted, such evidence was obtained
as would justify criminal proceedings."
The Report on the Liverpool Lunatic Hospital shows how far from
satisfactory one, at least, of these institutions was at that time:
"With few exceptions, the personal condition of the patients was found
to be very indifferent, and indeed the reason alleged why the females in
the lower wards were never on any occasion taken beyond the
airing-court, was that they had no clothes fit to be seen in. The
corresponding class of men was stated to be taken out as little as the
women, and both were said to be rarely visited by any friends having an
interest in them. The state of the furniture was discreditable in the
extreme, and there was a general absence of tidiness throughout the
hospital. The patients were, with few exceptions, quiet; not more than
four or five of the better class of either sex were reported to have the
opportunity of walking or driving out.... The seclusion in the fifteen
months which had elapsed since the previous visit applied to five males
on 62 occasions, and to 18 females on 132 occasions."[197]
The Commissioners speak of "the invariable success attendant on such
hospitals as have been built during the last few years, and specially at
Cheadle."
In regard to licensed houses within their jurisdiction, they were
reported to be "generally, as to the condition and management of such
houses, of a very satisfactory character;" while of the provincial
houses they say, "The Reports, for the most part, have not been
unfavourable as to their condition and management."[198]
In this Report the Commissioners comment on the operation of the
Metropolitan Poor Act of 1867, which threw the maintenance of lunatics
in asylums upon the common poor fund of the metropolis, and they observe
that "it has induced the boards of guardians to relieve themselves of
local charges, and this has greatly contributed to swell the removals
from workhouses to asylums, notwithstanding that the patients have in
large numbers been unable to be received nearer than in the county
asylums of Northumberland, Yorkshire, Staffordshire, and Somersetshire,
and although the rate of maintenance has ranged from 14s. to 17s. 6d.
per week."
As the cost of lunatics is so important a question, it may here be
stated that the total weekly cost per head in 1870 averaged in the
county asylums 9s. 3d., including maintenance, medicine, clothing, and
care. Under the maintenance account were comprised furniture and
bedding, garden and farm, and miscellaneous expenses. The other items
were provisions, clothing, salaries and wages, fuel, light and washing,
surgery and dispensary, wine, tea. In this estimate was reckoned the
deduction for moneys received for produce sold, exclusive of those
consumed in the asylum.
The weekly cost in the following registered hospitals was as follows:--
£ s. d.
Coton Hill 1 7 1½
Northampton 0 13 5¾
York Lunatic Hospital 0 18 0
York Retreat 1 1 2¾
It should be observed that Northampton was at this time essentially the
pauper asylum for the county.
* * * * *
We have already referred to the paramount importance of reliable
attendants. "Nothing is easier," the Commissioners observe, "for a man
in such a position, with unrestricted and uncontrolled power over the
habits and happiness of another, than to act cruelly without being
cruel." So long ago as 1851 a check was given to the conduct of
attendants by a decision of the courts in that year. An attendant had
been convicted of manslaughter on the evidence of a patient. This was
appealed against, but the conviction was sustained. Lord Campbell laid
it down that the only thing needful was for the patient to understand
the nature of an oath and what he was saying. "But although this ruling
has never since been disputed, the many subsequent attempts of the
Commissioners to exact a rigid responsibility for acts of violence or
cruelty in asylums have, through the indisposition of juries[199] to
accept the evidence principally available for proofs in such cases, more
frequently failed than succeeded."[200]
In each of the three previous years, proceedings had been taken against
attendants, and with very limited success. In the beginning of 1870,
however, a prosecution instituted by the magistrates of the Lancaster
Asylum against two attendants for manslaughter on the evidence of a
patient succeeded, and they were sentenced to seven years' penal
servitude, a result which the Commissioners regarded as the most
beneficial example within their experience. During the previous year,
eighty-eight male attendants had been dismissed from
service--fifty-three for drunkenness, insubordination, or neglect of
duty, and thirty-five for assaults on patients; four only of these
latter having had criminal prosecutions instituted against them, and of
the former not one. Of the number dismissed, fifteen were in licensed
houses, three in public hospitals, and the remaining seventy in county
asylums. During the same period thirty-four female attendants were
dismissed, of whom twenty-four were employed in county asylums. Eleven
had been guilty of violence or rough usage to patients, there having
been no prosecution in any instance. The Commissioners justly observe
that, while "there has been no greater work of mercy and humanity than
that which rescued the lunatic patients from stripes and filth, or
continued restraint and isolation, yet it will remain to some degree
still imperfect until he is also rescued from the possible chance of
being subjected to the unwatched or unchecked humours and caprices of
ignorant, careless, or cruel attendants."[201]
A striking instance of the respective powers of the Committees of
asylums and the Commissioners in Lunacy occurs in the Report of the
latter for 1870. Death from broken ribs had taken place in a county
asylum, and the Commissioners considered the cruelty of an attendant
established. They reported inadequate supervision of the wards, as well
as the attendants, in reply to which the committee of visitors asserted
that they would not enter into any discussion on a subject upon which
they considered themselves fully competent to determine how they should
discharge their own duties. The Commissioners found that they had no
alternative but to leave to the refractory committee the
responsibility, which they had shown no unwillingness to assume, of the
adoption or rejection of such recommendations. "The law which has
required us to investigate and report as to matters affecting the
management of county asylums, has invested us with no authority further
to enforce our views." In the same way their authority was set at naught
in an asylum where an idiot boy was found on the floor, strangled by a
pocket-handkerchief, effected, there was every reason to believe, by one
of the patients, and the Commissioners found that the deed could not
have been perpetrated if attendants had been properly dispersed through
the wards. The union authorities failed to get satisfaction from the
committee, and the Secretary of State was memorialized by the guardians,
who were backed up by the Commissioners, but in vain. Hence the
Commissioners complained of "the limits thus placed to all real
authority but that of the committee of visitors over establishments
whose inmates are necessarily most at the mercy of attendants, and in
which these cases of misconduct most frequently occur."[202]
We have alluded to this circumstance, not to indicate that at the
present time the committees of asylums set themselves in opposition to
the recommendations of the Commissioners, but our historical sketch
demands, in justice to the latter, who are often supposed to have
unlimited power, that it should be known that desirable reforms may not
be carried out in our asylums, and yet the fault may not lie at the door
of the Lunacy Commissioners. And it should be stated that recently Lord
Shaftesbury has publicly expressed his individual opinion that it is
better for the views and wishes of the Commissioners to appear in the
form of recommendations rather than commands.
* * * * *
Three years later, the condition of county and borough asylums was, with
few exceptions, satisfactory, and declared by the Commissioners to be
very creditable to the governing bodies and superintendents.
Improvements had taken place in many of these institutions, and there
was found to be a more general recognition of the humanizing and
beneficial influence of cheerful and well-furnished wards, on even the
most degraded patients. "Those at one time considered to be fit only to
be congregated together in the most dreary rooms of the asylum, with
tables and benches fastened to the floor, and with nothing to interest
or amuse them, are now in many asylums placed in wards as well furnished
as those occupied by the more orderly patients, with birds, aquariums,
plants, and flowers in them, and pictures on the walls; communicating
also with such wards are now very generally to be found well-planted and
well-kept airing-courts. The less strict classification of the patients
is also advantageously followed in many asylums, and in them what are
termed "refractory wards" are properly abolished. Where arrangements for
this purpose have been judiciously made and carried out with energy, the
best results have followed, in the way of an improved condition and more
orderly demeanour of those disposed to be turbulent, whilst the comfort
of patients of a more tranquil character has not been prejudicially
affected. The use of mechanical restraint in county and borough asylums,
unless for surgical reasons, such as to prevent patients removing
dressings or applications to wounds or injuries, or during the forcible
administration of food, is, with few exceptions, abolished. In
thirty-eight of the fifty-four asylums visited during the past year,
there was no record whatever of its employment. In the cases of
twenty-two patients, distributed over ten asylums, it had been resorted
to for the above-mentioned reasons, and in six asylums it had been used
to counteract violent suicidal or destructive propensities; the number
of patients restrained for these latter reasons (exclusive of Colney
Hatch and Wandsworth) having been one in the Macclesfield, nine in the
Glamorgan, six in the Prestwich, and one in the Norwich Borough Asylum.
In the Wandsworth Asylum it will be seen from the Report that, during a
period of about sixteen months, thirty-three men and twelve women were
recorded as having had their hands restrained by gloves for destructive
propensities; and four males and one female had worn restraint dresses
at night, two on account of their suicidal tendencies, and one for
violence. At the visit to Colney Hatch, a very dangerous male epileptic
was found restrained by wrist-straps and a belt, and from the register
it appeared that he had been thus constantly restrained during the day
for a period of nine months. Ten other male patients were also recorded
as having been restrained; one having had his hands fastened, and the
remainder having worn gloves, altogether on two hundred and fifty-three
occasions.... At the same visit nine men were found wearing special
strong canvas dresses, besides others who were clothed in an exceptional
manner."
The objections which for a long time have been felt to frequent resort
to seclusion find expression in this Report. The Commissioners, without
questioning the utility of seclusion in certain cases, stated their
conviction that "in a remedial point of view its value has been much
exaggerated, and that in many instances it is employed unnecessarily and
to an injurious extent, and for periods which are quite unjustifiable."
Patients regard it as a punishment; and attendants are apt to make it
take the place of constant supervision. Its frequent use indicates
defective asylum organization or management. The Report states that it
is no longer employed at the Durham, Stafford, Brentwood, and Brookwood
Asylums; and only rarely at the Wakefield, Oxford, Northumberland,
Carmarthen, Chester, Dorset, Glamorgan, Leicester, Lincoln, and Norfolk
County Asylums, and those for the boroughs of Ipswich and Leicester, and
for the City of London.
Legislation has exercised a great and, as some think, questionable
influence upon the relative proportion of the insane in workhouses and
asylums. The feeling that originally induced the Commissioners in Lunacy
to urge the transference of lunatics from workhouses to county asylums
was, no doubt, a laudable one, and in a large number of instances most
advantageous. The condition of the insane in workhouses, however,
became vastly improved, and it was impossible to deny that for many
harmless chronic cases they were, to say the least, sufficiently
comfortable in the workhouse. Then came the legislation of 1874,[203] by
which four shillings a week were allowed for every pauper lunatic in any
asylum or licensed house, being reimbursed to the unions and parishes
from which the patient was sent. Hence the strong inducement, in some
counties at least, for it certainly does not hold good in all, to
transfer lunatics detained in workhouses to the asylums, even when no
occasion whatever arises out of the mental condition of the patient to
justify such transference. The Commissioners themselves have recognized
the difficulty and disadvantage of the operation of this legislation,
and say in their twenty-ninth Report, 1875, that while this Act "may be
beneficial in promoting the removal to asylums of a certain number of
patients requiring such treatment, and who might possibly otherwise be
deprived of it ... it remains to be seen whether the alteration in the
incidents of the maintenance charged, will not also have the effect of
causing unnecessarily the transfer to asylums of chronic cases, such as
might be properly cared for in workhouses, thus rendering necessary, on
the part of counties and boroughs, a still larger outlay than heretofore
in providing additional asylum accommodation. The returns for the 1st of
January last tend to show that such results are not unlikely to
accompany the working of this new financial arrangement."[204] The Irish
inspectors in their report for 1875 calculate that the maximum number
who could properly be transferred from asylums to workhouses is seven or
eight per cent., and they make the observation, which no doubt is very
just, that many patients who are quiet and demeanable under trained
nurses in an asylum would become intractable elsewhere.
As we have now reached another decade, it will be well to afford the
reader the opportunity of comparing the population of asylums, and
workhouses, with that which we have given in 1844, 1854, and 1864.
GENERAL STATEMENT OF THE TOTAL NUMBER OF PERSONS ASCERTAINED TO BE
INSANE IN ENGLAND AND WALES, JANUARY 1, 1874.
----------------+------------------+--------------------+--------------------
Where | Private | Paupers. | Total.
confined.[205]| patients. | |
+-----+-----+------+------+------+------+------+------+------
| M. | F. |Total.| M. | F. |Total.| M. | F. |Total.
----------------+-----+-----+------+------+------+------+------+------+------
31 county and | | | | | | | | |
borough asylums| 194| 221| 415|14,238|16,718|30,956|14,432|16,939|31,371
| | | | | | | | |
3 military and | | | | | | | | |
naval | | | | | | | | |
hospitals, and | | | | | | | | |
Royal India | | | | | | | | |
Asylum | 342| 16| 358| -- | -- | -- | 342| 16| 358
| | | | | | | | |
2 Bethlem and | | | | | | | | |
St. Luke's | | | | | | | | |
Hospitals | 167| 268| 435| -- | -- | -- | 167| 268| 435
| | | | | | | | |
13 other public | | | | | | | | |
public asylums |1,107| 891| 1,998| 174| 165| 339| 1,281| 1,056| 2,337
| | | | | | | | |
Licensed houses:| | | | | | | | |
39 metropolitan|1,006| 787| 1,793| 257| 614| 871| 1,263| 1,401| 2,664
67 provincial | 772| 754| 1,526| 200| 323| 523| 972| 1,077| 2,049
| | | | | | | | |
1 Broadmoor | 267| 64| 331| 148| 41| 189| 415| 105| 520
| | | | | | | | |
Private single | | | | | | | | |
patients | 168| 268| 436| -- | -- | -- | 168| 268| 436
| | | | | | | | |
Workhouses: }| | | | | | | | |
Males, 6372; }| | | | | | | | |
females, 8646;}| | | | | | | | |
total, 15,018 }| | | | | | | | |
Elsewhere: }| -- | -- | -- | 9,084|12,773|21,857| 9,084|12,773|21,857
Males, 2712; }| | | | | | | | |
females, 4127;}| | | | | | | | |
total; 6839 }| | | | | | | | |
+-----+-----+------+------+------+------+------+------+------
Total[206] |4,023|3,269| 7,292|24,101|30,634|54,735|28,124|33,903|62,027
----------------+-----+-----+------+------+------+------+------+------+------
Referring to the numbers of the insane in 1875, the Commissioners
observe that they have increased beyond the growth of the population.
This had been mainly among paupers, there having been 16.14 of this
class in 1849, and 23.55 in 1875, per 10,000 of the population; while of
private patients the advance had only been from 2.53 to 3.09 during the
same period. The population increased from 1849 to 1875, 22.63 per cent.
Private patients increased 48.39 per cent., and pauper patients 77.47
per cent.
In regard to the treatment of the insane in Wales, it may be stated that
until the Denbigh Asylum was opened in November, 1847, there was no
institution for the reception of lunatics, except the small asylum at
Haverfordwest, and a house licensed in 1843 for private and pauper
patients in Glamorganshire.[207] Most of the paupers were kept in their
homes or workhouses; others sent to asylums. Before the Act was passed
making it compulsory on the counties to provide accommodation, several
philanthropic gentlemen, impressed with the desirability of having an
institution for private patients in North Wales, and where all the
officers should possess a knowledge of Welsh, which language alone the
vast majority of the inhabitants knew at that time, collected about
£8000. By this time the Act was passed, and the subscribers made over
their money to the counties, on condition that twenty-six separate beds
should be kept for private patients--several of themselves to be
members of the Committee. The private apartments form part of the same
building, but the inmates do not associate with the paupers. The total
accommodation was two hundred, and there was a great outcry at the
building of such a large place. About fifteen years ago, two wings were
added, each to hold one hundred beds, and last year an additional one of
one hundred and thirty beds.
It appears that many of the first patients received at the Denbigh
Asylum had been most cruelly treated at their own home, or where placed
with strangers; some being kept tied and in seclusion for years, and
shamefully neglected. The following is an extract from the first Medical
Report:--"In the case of one man, who was goaded by unkind and harsh
treatment into a state of ferocious mania (and who was brought into the
asylum manacled so cruelly that he will bear the marks of the handcuffs
while he lives), it is most gratifying to be enabled to state that he
gradually became confiding and tractable, and he is now as harmless as
any patient in the house. In another instance, a poor young creature,
who before her admission was tied down to her bed for months, quickly
discovered the difference between the treatment she had previously been
subject to and the kindness and freedom she experienced at the asylum,
and very soon gained confidence in those about her, and rapidly
recovered. Soon after her discharge from the asylum, she wrote to the
matron, to request to be taken back as a servant, and she is now an
excellent assistant in the wards, and a general favourite with the
patients. We have the satisfaction of stating that we have never been
obliged to resort to any mechanical restraint, beyond temporary
seclusion in a padded room, etc." Complaints occur in the earlier
reports of the disinclination either of friends or of the poor law
authorities to send in patients before they become unmanageable, and
many of those admitted arrived secured by handcuffs or tied down in
carts.
Take another extract from the Report for 1851. "We were requested to
turn into a respectable farmhouse, and upon going upstairs we were
horrified to find the farmer's wife with her hands secured, and a large
cart-rope tied round her body to keep her in bed. The room was filthy.
We found she had been in this state for nine months, and no proper
remedial measures taken. Surely some protection should be thrown over
such a sufferer!"
Again, in the Report for 1853: "One most atrocious case of an opposite
kind of treatment has fallen within our notice during the year. It is
most deplorable to contemplate, after the repeated generous efforts made
by the press, both Welsh and English, to diffuse useful knowledge upon
the subject of insanity, that in a Christian country, and in a populous
district, and with the knowledge of most of the neighbouring
inhabitants, a fellow-creature should have been permitted to be chained
by both his legs in a miserable shed for seven long years. The case is
so painfully interesting, that we will add to this Report the document
which was sent to the Lord Chancellor, who, at the instigation of the
Commissioners in Lunacy, issued an order for visiting the poor sufferer.
The Commissioners, with laudable alacrity, ordered a prosecution to be
instituted, and the principal offender was tried at the Carnarvonshire
assizes, convicted, and sentenced to be imprisoned.... What renders the
conduct of the friends of Evan Roberts more inexcusable is the fact of
his having been perfectly sane when visited, and having remained so ever
since.
_Denbigh, June 16, 1853._
"SIR,
"In obedience to the order of the Lord Chancellor, etc., I
have to report that I found Evan Roberts in a small shed, six
feet wide and nine feet four inches long, which had been
built for the purpose. The room had a small skylight in the
roof, and a window about a foot and a half square in the
gable, just above the bed, which admits of being partially
opened, but which was closed at the time of my visit, and, as
he (Evan Roberts) stated, was seldom opened. The room felt
very close and damp. There was no fireplace, or any other
means of ventilation except the door and window. The approach
to the room was through a sort of scullery, and very dark and
obscure. Evan Roberts was lying on a chaff bed on a wooden
bedstead, to which both his legs were chained, by fetters
fastened and riveted, just above his ankles.... The
appearance of the poor man was pale and pasty, like a plant
long deprived of air and solar influence. His bodily health
is tolerably good, and his condition rather inclined to be
fat and stout; he said his appetite was good, and that he was
not stinted in his food, such as it was. During a lengthened
interview, and a very close examination, I failed to discover
the existence of any hallucination or delusion of any kind;
on the contrary, he was very sensible and intelligent....
"I collected from his mother and sister that Evan Roberts was
forty-eight years of age; that he had been liable to
periodical mania for twenty-seven years, and which the mother
attributed to some injury to his head, received in a rural
affray; that at first the maniacal paroxysms were unfrequent,
but that they had become more violent and frequent as he
advanced in life. About seven years ago, his violence became
so great, that he threatened to murder his father and
brother; and it was at that time that he was first chained to
the bed. This restraint has never been relaxed, although both
mother and sister admitted that he was perfectly sane and
harmless for many weeks and months continuously. For the
first five years he was confined upstairs, and it was only
about two years ago that he was carried into the shed he now
occupies.... Finding that the poor fellow was awed by the
presence of his mother and sister, I requested them to
retire, as I wished to examine the alleged lunatic free from
their presence and interference. The mother for some time
refused to comply with my request; but upon being told that I
would report her refusal, she very doggedly complied. The
poor man then became less reserved; he complained bitterly of
the state in which the room had long been suffered to
remain....
"The poor man complained that the chaff in his bed was never
changed, or even shaken, except once, since his confinement
in the shed; and from the dampness of the room, and the
warmth of his body, it had become rotten, and like a wet
sod....
"R. LLOYD WILLIAMS.
"R. W. S. Lutwidge, Esq."
"The Commissioners in Lunacy applied to the Lord Chancellor for an order
to visit the farmer's wife mentioned in one of our former reports as
having been tied to her bed by a cart rope and her hands secured by a
muff. She was accordingly visited, and a report upon her case sent to
the Commissioners, who directed an inquiry to be made with a view to her
removal to an asylum. The family obtained information of this
investigation, and considerable amendment in the treatment of the
lunatic took place before the justices and the medical officer appointed
to visit her arrived, and no order for her removal was made. We have
reason to know that the poor creature is still under restraint, and her
hands secured; she is strapped to a chair, which is fastened to the leg
of a strong table."
We pass now to 1879, in order that we may consider the changes which had
taken place during the quinquennium succeeding the year in which we have
given a return of the number of insane in England and Wales, and their
distribution. The following figures are derived from the thirty-third
Report of the Lunacy Commissioners, and exhibit the total number of
registered lunatics, idiots, and persons of unsound mind on the 1st of
January, 1879:--In county and borough asylums, 38,871; naval and
military hospitals and Royal India Asylum, 342; Bethlem and St. Luke's
Hospitals, 430; other public asylums, 2407; metropolitan licensed
houses, 2664; provincial, 2049; Broadmoor, 483; workhouses (ordinary),
11,697; metropolitan district asylums, 4308; outdoor paupers, 6230;
private single patients, 472; total, 69,885; exclusive of 202 Chancery
lunatics in the charge of committees.
On the next page will be found the general distribution and numbers of
the insane, January 1, 1881. A more detailed statement will be given, in
the Appendix (K I.), of the county asylums and lunatic hospitals now
existing for the care and cure of the insane, with the numbers confined
therein.
On the 1st of January, 1881, the proportion per cent. maintained in
asylums, hospitals, and licensed houses was 64.91; in workhouses, 25.72;
and as outdoor paupers, 9.37.
As some of the tables of the Commissioners extend back twenty-three
years, exhibiting the number, sex, classification, and distribution of
all registered lunatics, January 1, 1859-1881, as also the ratio of the
total insane to the total population, we may derive much valuable
information for the purpose of our historical review.
Thus there were in England and Wales:--
-------------------------------+------------------+-----------------
Location. | Patients. | Patients.
| 1859. | 1881.
-------------------------------+------------------+-----------------
In county and borough asylums | 15,844 | 41,355
In registered hospitals | 1,855 | 2,948
In metropolitan private asylums| 2,551 | 2,511
In provincial „ „ | 2,465 | 2,115
In naval and military hospitals| |
and Royal India Asylum | 164 | 307
In Broadmoor Asylum for | Not opened | 491
criminal lunatics | till 1863 |
In workhouses-- | |
Ordinary workhouses | 7,963 | 12,093
Metropolitan district asylums| Not opened | 4,718
| till 1870 |
Residing with relatives or | 5,920 | 6,575
others (pauper and private) | |
+------------------+-----------------
|M. 16,756} |M. 32,973}
Total |F. 20,006} 36,762 |F. 40,140} 73,113
-------------------------------+------------------+-----------------
Of the 36,762 in 1859, 4980 were in private and 31,782 pauper patients.
Of the 73,113, in 1881, 7741 were private and 65,372 pauper patients. In
1859 the ratio of the total registered lunatics to the population (per
10,000) was 18.67, the ratio of private lunatics to population being
2.53, and of pauper lunatics to population 16.14. In 1881 the ratio of
the total lunatics of the population was 28.34, the ratio of private
lunatics to 25.34. These figures bring out very distinctly the fact that
the great increase of lunatics during the period between 1859 and 1881
is among the poor. It must, however, be repeated that insanity itself
brings with it pauperism to many who have once been independent and
educated, but who fall, through the misfortune entailed by the malady,
into the category of paupers.
An important table, introduced for the first time into the last Report
of the Commissioners, shows the annual ratio of fresh admissions to the
population; hence the transfers and the admissions into idiot asylums
are excluded. The value of this table consists in this--that, although
the gross admissions into asylums have increased, due in part to the
capitation grant of four shillings introduced in 1874, the ratio of the
yearly increase of the fresh admissions to the population has been
slight, showing, as the Commissioners observe, that the total number of
the insane under care during the twelve years embraced by the table is
"mainly due to accumulation, and not to a greater annual production of
insanity."[208] This table does not include workhouses.
Thus:--
-------+-------------+-------------------
| | Ratio per 10,000
Year. | Admissions. | of admissions to
| | the population.
-------+-------------+-------------------
1869 | 10,472 | 4.71
1870 | 10,219 | 4.54
1871 | 10,528 | 4.62
1872 | 10,604 | 4.59
1873 | 11,212 | 4.80
1874 | 11,912 | 5.03
1875 | 12,442 | 5.19
1876 | 12,857 | 5.30
1877 | 12,969 | 5.28
1878 | 13,343 | 5.36
1879 | 13,101 | 5.20
1880 | 13,240 | 5.19
-------+-------------+-------------------
It would thus appear that in 1880 scarcely one patient more per 20,000
persons in England and Wales was freshly admitted into asylums, etc. Had
there been no increase at all, after allowing for increase of
population, the number admitted in 1880 would have been 12,011. It was,
in fact, 13,240, _i.e._ 1229 more.
Taking the actual number of the insane in detention during the same
years shows a very different result, for accumulation is here included,
and swells the returns.
Thus:--
-------+-------------+-------------------
| | Ratio per 10,000
Year. | Under care. | of number in
| | detention to the
| | population.
-------+-------------+-------------------
1869 | 53,117 | 23.93
1870 | 54,713 | 24.31
1871 | 56,755 | 24.91
1872 | 58,640 | 25.42
1873 | 60,296 | 25.82
1874 | 62,027 | 26.23
1875 | 63,793 | 26.64
1876 | 64,916 | 26.78
1877 | 66,636 | 27.14
1878 | 68,538 | 27.57
1879 | 69,885 | 27.77
1880 | 71,191 | 27.94
-------+-------------+-------------------
In other words, there were eight more patients under care for every
20,000 of the population in 1880 than in 1869. Had there been no
increase in the number in detention, after allowing for increase of
population, the number in 1880 would have been 53,177. It was, in fact,
71,191, _i.e._ 18,014 more.
* * * * *
We have now traced step by step the remarkable progress effected in the
asylum care of our lunacy population. In concluding this chapter I
would, however, observe that it would be a grave and mischievous mistake
to suppose that, most valuable as is the provision for the insane by
asylums, there are not many cases which may be treated outside these
institutions with the greatest advantage. Some patients are best cared
for in their own homes, others in lodgings, and others in the houses of
medical men. The extent to which non-asylum treatment can be carried out
will be seen when we speak of Chancery patients. It will be observed
that the number of single private patients is 448.
In regard to the location of pauper lunatics in private dwellings, it
appears that while in England 6799, or 9.29 per cent., of their number
live with their relatives or are boarded in private dwellings, nearly
fifteen per cent. of insane paupers in Scotland are in private
dwellings, inspected by the Lunacy Board.
Dr. Lockhart Robertson has expressed the opinion that "the utmost limits
within which the county asylum can benefit, or is needed for the
treatment of the insane poor, is fifty per cent. of their number, and
that a further accumulation of lunatics there serve no practical
purpose, and hence is an unjustifiable waste of public money."[209]
After pointing out the success of the metropolitan district asylums at
Leavesden and Caterham, where upwards of four thousand chronic lunatics
are maintained at the rate of seven shillings a week, he expresses his
opinion that, if these arrangements were properly carried out, another
fourteen per cent., or forty per cent. of the incurable and harmless
pauper lunatics and idiots, might be placed in workhouses; his ideal
standard for the distribution of pauper lunatics being--in county
asylums, fifty per cent.; in workhouse wards, forty per cent.; leaving
ten per cent. for care in private dwellings.
The number of beds in county and borough asylums amounts to 40,000,
varying from 2000 to 250; the average cost per bed having been somewhat
under £200, and the weekly maintenance and clothing of each patient 9s.
9¼d. If to this be added the interest on the cost of construction and
asylum repair, the annual cost for each pauper lunatic in county asylums
amounts to about £40.
The number of patients discharged cured, in county and borough asylums
during the ten years 1871-1880, was 40.32 per cent. on the admissions,
and the mortality 10.46 on the mean number resident.
The number of beds in registered lunatic hospitals (about 3000) ranges
from 60 to 570, or, excluding idiot asylums, to 300, while the average
weekly cost ranges from 14s. to £2 2s. The charges on the buildings are
not included. For these Dr. Robertson adds five shillings a week, making
the average weekly cost of maintenance £1 10s. or, including asylum
construction and repairs, £1 15s.
The distribution of private patients, numbering 7741, was as follows on
the 1st of January, 1881:--In registered hospitals, 2800, or 36.17 per
cent.; in county asylums, 539, or 6.96 per cent.; in State asylums, 534,
or 6.88 per cent.; in private asylums, 3420, or 44.17 per cent.; in
private dwellings, 448, or 5.78 per cent.
The registered hospitals have, therefore, thirty-six per cent. of all
the private patients, an important fact in looking to the future
provision for this class in lieu of private asylums. Their statistics of
recovery and mortality are satisfactory. The recoveries per cent.
calculated on the admissions were 46.48 per cent. during the ten years
1871-1880; the annual mortality being 7.96 per cent.
As regards private asylums, there were forty-four per cent. of the
private patients in England and Wales cared for in these establishments.
The recoveries per cent. in private asylums during the decennial period
1871-1880 were--in the metropolitan division 31.43, and in the
provincial 35.11; the annual mortality being, in the metropolitan
private asylums 10.93, and in the provincial asylums 8.63. It should be
remembered, in contrasting these figures with those of registered
hospitals, that a considerable number of pauper patients are still sent
to private houses, and it may therefore be said that, so far as
difference in social position affects recovery and death, the comparison
is not altogether fair. At the same time, it is noteworthy that in the
pauper asylums, the percentage of recovery is higher than in the
metropolitan and provincial private asylums, and the percentage of
mortality lower than in the licensed houses of the metropolis.
Numerous general considerations arise from a retrospect of the history
which this and the preceding chapter contain, but they will more fitly
form a part of a subsequent chapter of this volume, when a sketch of the
results achieved by Psychological Medicine will be given, as presented
in the author's Presidential Address at University College.
FOOTNOTES:
[178] "A Lecture on the Management of Lunatic Asylums," etc., by Robert
Gardiner Hill. Published April, 1859 (delivered June 21, 1838). (See
Appendix H.)
[179] Including the wards in the Manchester Hospital.
[180] Including thirty male and three female criminal lunatics in jails,
according to the Parliamentary return for April, 1843.
[181] Exclusive of the lunatic ward of Guy's Hospital.
[182] Mr. Gaskell. See p. 209.
[183] Summary taken from the Report of the Metropolitan Commissioners,
1844.
[184] Second Report of the Commissioners in Lunacy, 1847, p. 224.
[185] Page 112. No return is made in regard to the inmates of other
asylums.
[186] Eighth Report of the Commissioners in Lunacy, p. 43.
[187] Exclusive of 226 single patients under commission.
[188] Page 35.
[189] Act of 1853, ss. 64 and 66.
[190] Page 44.
[191] For a table showing the cost per head in asylums of various sizes,
see Appendix I.
[192] Report of Commissioners in Lunacy, 1864.
[193] Exclusive of 159 single patients.
[194] Office of the Board, 37, Norfolk Street, Strand.
[195] Caterham cost a little more, viz., £89 a bed.
[196] Page 10.
[197] Page 35.
[198] Page 43.
[199] In the Commissioners' Report of 1871, p. 76, a case is reported in
which the jury would not convict a woman who had the charge of a lunatic
and admitted that "she strapped the patient once a month at the full of
the moon," of ill-usage, although Mr. Justice Willes summed up strongly
against her. In another case the Lunacy statute was disregarded, but
Baron Martin summed up very leniently, much to the disapproval, not to
say the disgust, of the Commissioners.
[200] Page 75.
[201] Page 81.
[202] Page 77.
[203] See page 196.
[204] Page 20.
[205] The order and description of these institutions have been given in
these decennial tables as far as possible in accordance with that of the
table of 1844, in order to facilitate comparison.
[206] Exclusive of 208 lunatics so found by inquisition who reside in
charge of their committees.
[207] For information in regard to Wales I am indebted Dr. W. Williams,
the late medical superintendent of the Denbigh Asylum.
[208] Report, page 3.
[209] See Address at International Medical Congress, _Journal of Mental
Science_, January, 1882.
CHAPTER VI.
OUR CRIMINAL LUNATICS--BROADMOOR.
No one at the present day is likely to underrate the importance and
interest of the subject of this chapter.
An Act was passed in regard to criminal lunatics in the year 1800 (39
and 40 Geo. III., c. 94). It was partially repealed in 1838 (1 and 2
Vict., c. 14); that is to say, so far as the former authorized
magistrates to commit to jails or houses of correction, persons
apprehended under circumstances denoting derangement of mind and the
purpose of committing a crime. The Act of 1838 made other provisions for
the safe custody of such persons. Persons in custody under the repealed
provision of the previous Act, or hereafter apprehended as insane or
dangerous idiots, might be sent to a lunatic asylum, hospital, or
licensed house; two justices of the place where such person is
apprehended having called to their assistance a medical man, and having
satisfied themselves that he is insane or a dangerous idiot; nothing,
however, herein contained preventing the relations from taking lunatics
under their own care.
This Act did not alter the laws relating to the discharge of persons
ceasing to be insane, or dangerous idiots, from any county asylum,
hospital, or licensed house.
In 1840 an Act was passed (3 and 4 Vict., c. 54) "for making further
Provision for the Confinement and Maintenance of Insane Prisoners."
It was enacted that if any person while in prison under sentence of
death, transportation, or imprisonment, or under a charge of any
offence, or for not finding bail, or in consequence of any summary
conviction, or under any other civil process, shall appear to be insane,
it shall be lawful for two justices to inquire, with the aid of two
medical men, as to the insanity of such person; and if it be duly
certified by such justices and medical men that he is insane, it shall
be lawful for one of the principal Secretaries of State to direct his
removal to such county asylum or other proper receptacle as the
Secretary of State may judge proper, to remain under confinement until
it shall be duly certified by two medical men to the Secretary of State
that such person has become of sound mind; whereupon he is authorized,
if such person remain subject to be continued in custody, to issue his
warrant to the person in whose charge he may be, directing that he shall
be removed to the prison from whence he has been taken, or if the period
of imprisonment has expired, then he shall be discharged. It was also
enacted that when a person charged with misdemeanors is acquitted on the
plea of insanity, he shall be kept in strict custody during Her
Majesty's pleasure, the jury being required to find specially whether
such person was insane at the time of the commission of such offence,
and to declare whether such person was acquitted by them on account of
such insanity.
The Earl of Shaftesbury introduced the subject of the provision for
criminal lunatics in the House of Lords in 1852, and moved for an
Address to Her Majesty on the expediency of establishing a State Asylum
for the care and custody of those who are denominated criminal lunatics.
He said that the subject had been never propounded before to them in a
specific form, and the custody of these criminals had been a great bar
to the improvement of public and private asylums. The Commissioners had
already reported on these evils in 1849, 1850, and 1851. The Government
alone had refused assistance. Having pointed out the four classes into
which they are divided, he stated that the statutes by which they were
confined were three in number, namely, 39 and 40 Geo. III., c. 94; 1 and
2 Vict., c. 14; 3 and 4 Vict., c. 54.
He directed attention to a fifth class, those affected with some
derangement of mind, who, unless restrained, were in danger of
committing offences. Under the last-named Act, they were treated as
criminals. Formerly any magistrate could commit them to jail, or other
place for safe custody under 39 and 40 Geo. III.; but by the Act of 3
and 4 Vict. their condition had been somewhat alleviated, inasmuch as it
required that two justices of the peace should commit the parties, under
medical advice, and that they should not be sent to jail, but to an
asylum or licensed house. None of these parties except those who had
been committed by the justices could be again discharged unless by
authority of the Secretary of State.
It appears that there were then 439 criminal lunatics in England and
Wales (360 males, 79 females); 138 for offences against life, 188 for
offences against property and person, short of attempts to murder, 40
for misdemeanor, 43 for want of sureties who had become afterwards
insane, and 30 summarily convicted for minor offences. Of this number
there were 103 in Bethlem Hospital, 59 in Fisherton House, Salisbury,
and the remainder in various asylums. After adducing reasons for the
non-association of criminal lunatics with ordinary patients, Lord
Shaftesbury insisted that the most efficient remedy was a State asylum;
and that this was confirmed by the success of Dundrum, Ireland.
In the course of his speech he eulogized the system of treatment--"the
great and blessed glory of modern science"--adopted by Pinel in France,
and by the York Retreat in England, adding, "_Oh, si sic omnia!_ It has
become the special pursuit of professors of this department of medicine
in the three kingdoms. By the blessing of God it has achieved miracles.
I have, perhaps, a right to say so, having officiated now as a
Commissioner in Lunacy for more than twenty years, and witnessed the
transition from the very depth of misery and neglect to the present
height of comfort and ease. The filthy and formidable prison is
converted into the cleanly and cheerful abode; the damp and gloomy
court-yard is exchanged for healthy exercise and labour in the field
and garden. Visit the largest asylum, and you will no longer hear those
frightful yells that at first terrified and always depressed the boldest
hearts. Mechanical restraint is almost unknown; houses where many were
chained during the day, and hundreds, I will assert, during the night,
have hardly a strait waistcoat or a manacle in the whole establishment;
and instead of the keeper with his whip and his bunch of leg-locks, you
may see the clergyman or the schoolmaster engaged in their soothing and
effective occupations."
The Earl of Derby promised the subject should not be lost sight of, and
the motion was withdrawn. He said that our criminal lunatics were
maintained at Bethlem at an annual cost of £34 per head, those at
Fisherton House at £30, and throughout the country at £26 per head. A
new asylum would cost £50,000, perhaps nearer £100,000, and he thought
that the same discipline and separate treatment might be carried out
just as well in a general as in a State asylum.
We pass on to the important Act of 1860 (23 and 24 Vict., c. 75), "to
make Better Provision for the Custody and Care of Criminal Lunatics."
After citing the Acts 39 and 40 Geo. III., c. 94; 3 and 4 Vict., c. 54;
5 and 6 Vict., c. 29; 6 and 7 Vict., c. 26--by the last two Acts of
which the Secretary of the State was empowered to order any convict in
Pentonville or Millbank prison becoming or found insane during
confinement to be removed to such lunatic asylum as he might think
proper--and stating in the preamble the expediency of making provision
for the custody and care of criminal lunatics in an asylum appropriated
to that purpose, this statute enacted that it shall be lawful to provide
an asylum for criminal lunatics, and for the Secretary of State to
direct to be conveyed to such asylum any person for whose safe custody,
during her pleasure Her Majesty is authorized to give order, or whom the
Secretary of State might direct to be removed to a lunatic asylum under
any of the before-mentioned Acts, or any person sentenced to be kept in
penal servitude who may be shown to the satisfaction of the Secretary of
State to be insane or unfit from imbecility of mind for penal
discipline; the Secretary of State being empowered to direct to be
removed to such asylum any person who, under any previous order of Her
Majesty or warrant of the Secretary of State, may have been placed in
any asylum.
It was enacted that nothing in this statute should affect the authority
of the Crown as to making other provision for the custody of a criminal
lunatic, as before the Act was passed.
Other sections refer to the government and supervision of the asylum,
the discharge of patients after their term of imprisonment has expired,
and for the visitation of the asylum by the Commissioners in Lunacy.
From this Act sprang the asylum we proceed to describe.
Every one who reads the newspaper is familiar with the common expression
occurring in the trials of prisoners who escape punishment on the ground
of insanity, "To be detained during Her Majesty's pleasure;" but very
few would be able to answer the question, What becomes of these persons?
Those who desire to know their destination may incline to accompany us
to Broadmoor in Berkshire, about four miles from the Bracknell station
on the South Western Railway, and thirty miles from London. This is the
State Criminal Asylum for England and Wales, and was erected nineteen
years ago (1863), in conformity with the Act passed in 1860, which, as
we have seen, provided that criminal lunatics should be separately cared
for by the State.
The site of the institution is well chosen, covers three hundred acres,
and commands an extensive and uninterrupted view. The building is of red
brick, with a chapel in the centre, and consists of three stories, with
distinct additional blocks at the extreme end. It is built on the
corridor plan, with day-rooms, and single and associated dormitories.
The windows alone indicate, from outside, the character of the building,
being protected by strong vertical iron bars. In some parts of the
building, for the females, these bars do not extend to the whole height
of the window, and escape would in such cases not be difficult. In other
parts of this division, and throughout the male division, the windows
are securely protected. In this and other ways the house is more secure
than it was formerly. I find in regard to escapes that, from the opening
of the asylum in 1863 up to the end of 1877, there have been not more
than twenty-three. During the last three years there have been none. The
majority were recaptured on the next or following day; one not till
three months; and four were never discovered. Four escaped from the
airing-court; three while out with a walking party; and four from
breaking the window-guard; while one escaped from his bedroom by making
an aperture in the wall. An attendant connived at one patient's escape,
was prosecuted, and convicted. I may add that prior to the opening of
Broadmoor, the proportion of escapes of criminal lunatics detained in
England elsewhere was much greater. The opening of Broadmoor has also
affected the mortality of this class, having reduced it materially. Some
probably regard this as an actual disadvantage; but whatever political
economists may say, medical science only sanctions, as yet at least, the
adoption of that course of hygiene and treatment which most conduces to
the prolongation of human life.
There were, when I visited Broadmoor, 500 inmates--400 men and 100
women, or thereabouts. When we consider that of these unfortunate
people, more than 300 have either murdered some one, or attempted to
murder or maim some one, it may well cause reflection, alike sad and
philosophical, on what a disordered brain may lead its possessor to do,
what acts to commit. Ninety had killed their own children as well as, in
some instances, the wife or husband; upwards of twenty, their wives;
eight, their mothers; four, their fathers; and one, both parents. And
another reflection may be made, to the credit of the institution, that
no case of actual murder has occurred since it was opened, and that,
taking the year before we write, good order was maintained, no
premeditated act of violence was committed, and there was no suicide.
And yet no mechanical restraint was resorted to, no fetters, no strait
waistcoats, no leg-locks or straps. Some patients are, of course,
secluded in a single room in which a bed made on the floor is the only
furniture allowed, and in which the window is protected by a shutter if
the patient breaks glass. The room is, when the shutter is closed, only
partially dark, as there are two small windows near the ceiling, out of
the patient's reach. By the side of the door is an inspection plate, or
narrow slit in the wall, with a movable glazed frame, opening outwards,
through which the occupant of the room can be observed when necessary.
These rooms are well ventilated, and are warmed by means of hot water. I
should not proceed further without stating that, in addition to the
class of cases to which I referred in the beginning of this
paper--those, viz., detained during Her Majesty's pleasure, including
those certified to be insane while awaiting their trial, or found insane
on arraignment, or acquitted on the ground of insanity, or reprieved on
this ground immediately after their sentence--besides these there are
convicts who become insane while undergoing their penal servitude. As a
rule, however, male convicts of this class are no longer sent to
Broadmoor; the superintendent[210] having discovered that it was
necessary to keep insane convicts distinct from the other class, to
secure their safe detention more completely and certainly; that is to
say, to separate lunatic criminals from criminal lunatics, or, as they
are usually called, "Queen's pleasure men"--a distinction sometimes
really as important as that which exists between a horse-chestnut and a
chestnut horse. It will be readily understood that the convicts--really
criminals, and often desperate criminals, they are--may differ widely
from those who in an access of insanity have committed a crime, and that
men who leave prison discipline at Pentonville, or elsewhere, to enjoy
the comparative comfort of asylum life at Broadmoor, are very likely
either to sham madness in order to stay there, or escape in order to
avoid having to complete, on recovery, their term of servitude. Anything
better than _that_. In insisting on this distinct classification and
accommodation, Dr. Orange did not, in the first instance, intend, I
suppose, to prevent the convict class being provided for at Broadmoor;
but having set the ball in motion, it went on and on; and instead of an
additional building being erected for the convict men, a regulation was
made in 1874 preventing their being sent in future to Broadmoor. For the
women of this class there was and is ample room, an additional wing
having been erected fifteen years ago.
Again, there is a reason, on the side of the prison authorities, why
convicts when insane should not be sent to Broadmoor. They are naturally
unwilling that the history of their previous treatment should be known
and scrutinized at another place. Hence they greatly prefer retaining
them in the prisons, or sending them to one in which provision has been
specially made for insane convict men.
It will probably occur to some to ask whether many or any of those who
are "Queen's pleasure men" (or women) are found to have been improperly
acquitted when subjected to the careful and prolonged medical scrutiny
which a residence at Broadmoor allows of; whether, in short, mercy,
based on medical knowledge, has mistakenly interfered with the proper
action of justice and law? In this matter the doctors and the lawyers
are frequently on opposite sides, and the former often find it hard work
to rescue an insane prisoner from the clutches of the law. On the other
hand, it may be admitted that, as regards some physicians at least, a
juster view is sometimes as necessary as it is on the part of the
lawyers. When absurd reasons are given in the witness-box for a
prisoner's insanity--reasons which would equally establish the madness
of many persons in society whom no one regards as insane--it is not
surprising that the judges are cautious in admitting the plea of
insanity on medical evidence. In seeking a reply to the above question,
it is satisfactory to find that if the evidence of medical experts tends
to induce juries to acquit on the ground of insanity those who are
responsible agents and ought to be punished, there have only been a few
scattered cases admitted which were "doubtful"--whether at Bethlem, when
criminal lunatics were sent there, before Broadmoor existed, or at the
latter, since it was opened. It is also a satisfaction to know that
cases of this kind have not been more frequent of late than formerly;
and this, although there has been in the present generation a marked
increase in the number acquitted on the ground of insanity. Thus from
1836 to 1848, the ratio of the insane to the prisoners tried was only
one in thirty-two; between 1848 and 1862 it was one in seventeen; and
between 1862 and 1874 as many as one in fourteen.[211] It is surely much
better that a man should occasionally escape the punishment he deserves,
than that any should be punished who labour under mental disease. To
show the difficulty of arriving at a conclusion as to the mental
responsibility of persons charged with crime, I may mention the case of
a schoolmaster who, not many years ago, used his cane on a boy in a very
savage manner, pursued him under the table, and destroyed the sight of
one eye. This man was sentenced to five years' penal servitude. He was,
of course, under the notice of the surgeon of the prison to which he was
sent, and was regarded by him as sane. The schoolmasters and
pupil-teachers, however, took the case up, and agitated for further
examination into the state of the man's mind. Dr. Orange was employed to
examine him, and, thoroughly familiar with criminal lunatics, succeeded
in discovering unmistakable proofs of insanity. In fact, he was so
poorly the morning of the day he committed this assault, so
uncomfortable in his head, and so irritable in mind, that he sent word
to the school to say that he was too ill to attend to his duties. It was
a school examination, however, and the authorities insisted upon his
going. They therefore were mainly to blame for the circumstance which
followed. This man was saved from punishment by Dr. Orange's
representations, and subsequent observation confirmed the opinion he
formed at the time, that he was not only irritable and suspicious, but
was labouring under a delusion. He was a dangerous lunatic, in short,
when he committed the offence.
In going through the wards I conversed with the superintendent on the
main points of interest in connection with the management of the
institution, and on some of the characteristics presented by those who
are admitted.
I remarked on the low mortality which I knew obtained there. "Ah," said
the doctor, laughing, "that goes against us, rather than for us. We are
blamed for keeping the patients too well!" Since the opening of the
asylum, the yearly average of death has been at the rate of 2.97 per
cent. of the number resident. As to diet it is no doubt difficult to
understand why this class should fare better, as they seem to do, than
ordinary patients in the county asylums. In one particular, indeed, a
change in the direction of economy has been made, and a very reasonable
change it is. It is connected with an important question which arises,
How far can the system of rewards for work be beneficially carried out?
It appears that until some ten years ago, the main reward for useful
work was a luncheon of bread-and-cheese and beer in the forenoon, with
another, though smaller, allowance of beer in the afternoon. Both these
allowances of beer (which were additional to the dinner supply) were
discontinued in 1875, and in lieu of them a small portion of the money
value of the work done was credited to the workers, with permission to
spend it on any trifling luxury they might desire. It was found that the
executed value of the work in the shoemakers' shop in 1876 was more
than that done in 1873 (the year before this experiment was tried), by
160 per cent., whilst in the tailors' shop the increase was 120 per
cent.; corresponding results being obtained in other departments. Hence,
in spite of the gratuities to the patients so employed, the yearly cost
has been considerably reduced. During one year the saving _in beer
alone_ amounted to £165, whilst the saving in paid labour was very much
greater.
Financial considerations must be a very important practical point in the
existence of Broadmoor. The State pays for it; an annual grant from the
House of Commons must be asked for, and the Government must be prepared
to show that the amount is not unreasonable. Now the weekly cost of the
inmates is eighteen shillings each. That of the inmates of our county
asylums averages about half a guinea. It may therefore not unreasonably
be asked, Why is this? What have the criminal lunatics done to deserve
so much more money being lavished upon them? The chief reason is, that a
greater proportion of attendants must be provided for this class, and
that is costly. At Broadmoor the proportion of attendants to patients is
one in five; in asylums generally, much less liberal, say one in eleven;
besides which, they are paid better (as they ought to be), at Broadmoor.
Ten years ago the cost per head was as high as twenty-three shillings a
week.
A considerable number of the inmates are, as has been intimated,
usefully employed. Thus, during the year, 167 men and women were
occupied in one way or other, in addition to reading and writing,
music, etc. Eighty-six were employed in making and repairing clothing
for patients, and bed and house linen for patients and attendants; 144
in cleaning the wards; 40 in the garden and on the farm; 29 in the
laundry; 26 in making or repairing uniform clothing, boots and shoes,
etc.; 17 in making and repairing furniture, mattresses, mats, carpets,
etc. I went into one room where there was a printing-press, and a
printer handed me the printed programme of a concert shortly to be held
in the asylum. The total value of the labour of patients alone amounted,
in 1881, to £2835.
In the carrying out of a system of labour so beneficial to the patient,
and so useful to the institution, relaxation and amusement are not
forgotten. The patients play at chess, draughts, billiards, bagatelle,
etc.; and out-of-door games comprise bowls, cricket, and croquet. There
is a library well supplied with papers and journals; and one patient was
pointed out who himself contributes to a magazine. There is a band which
includes seventeen patients, as well as some attendants, and enlivens
the inmates twice in the course of the week.
This sounds very pleasant, but honesty requires us to give the other
side of the picture, as portrayed in the words of Mr. Burt, the
chaplain; and perhaps nothing serves better to show how much credit is
due to the superintendent for the admirable management of an institution
containing such elements as these. He said (some years ago) that
although he had laboured in asylums and prisons for a long period, it
had never fallen to his lot before to witness depravity and unhappiness
in such aggravated forms. "In other asylums, when the mind resumes
anything like healthy action, there is hope of discharge; in prisons,
the period of detention, however long, has some definite duration; but
here the fear of relapse, and the terrible acts to which relapse may
lead, render the condition of release rarely attainable; for many the
period of detention is indefinite, and hope is almost excluded. In
prison, whatever may be the depravity, it is kept under some restraint
by reason and by fear of consequences; but here there are patients with
passions depraved to the utmost, upon whom neither reason, nor shame,
nor fear impose any restraint."
One Sunday, about fifteen years ago, during the Communion, and when the
chaplain was in the middle of the Collect for the Queen, an event took
place, the account of which I take from his own description. A patient
with a sudden yell rushed at Dr. Meyer (then the superintendent), who
was kneeling, surrounded by his family, close to the altar, and a deadly
blow was struck at his head with a large stone slung in a handkerchief.
The stone inflicted a serious injury, and the blow would have been
fatal, if it had not been somewhat turned aside by the promptness with
which the arm of the patient was seized by an attendant. A scene of so
dreadful a character has very rarely been witnessed in a Christian
church. Is it surprising that Mr. Burt cannot look back upon this
occurrence without horror, and that he has never felt able to say the
particular collect which was interrupted in so awful a manner?
Many are the moral lessons which might be enforced from a knowledge of
the cases admitted at Broadmoor, and their previous history. Among these
the evil of gross ignorance might well be illustrated by such an example
as this. Six years ago a farm labourer was tried in Warwickshire, for
murdering a woman eighty years of age.
He believed in witches and laboured under the delusion that this poor
old creature, with others in the village, held him under the spell of
witchcraft. Returning from his work one day, and carrying a pitchfork in
his hand, he saw this woman. He immediately ran at her, struck her on
the legs thrice, and then on the temple, till he knocked her down. From
these injuries she died. Well, it was found that he had the delusion
that he was tormented by witches, to which he attributed his bodily
ailments, and was ever ready with Scripture quotations in favour of
witchcraft. His mind, apart from delusions, was weak. The jury acquitted
him on the ground of insanity, and he was admitted at Broadmoor in
January, 1876.
One lesson there is which ought to be learnt from the history of many of
the cases sent to Broadmoor, and that is the extreme importance of not
disregarding the early symptoms of insanity. Had these been promptly
recognized, and those who suffered from them been subjected to medical
care and treatment, the acts they committed, the suffering they caused,
the odium they brought upon themselves and their families, would alike
have been prevented. The diffusion of a knowledge of the first
indications of this insidious disease, and of what it may culminate in,
is the only safeguard against the terrible acts which from time to time
startle the community, and which are found, when too late, to have been
perpetrated by those who ought to have been under medical restraint.
Bearing immediately upon this, is the fact that there were recently, out
of the cases of murder in Broadmoor, twenty-nine cases in which insanity
had been recognized before the act was committed, but the persons were
regarded as harmless, and thirty-three in which it was not regarded as
harmless, but insufficient precautions were taken. In seventy-five cases
no one had possessed sufficient knowledge to recognize it at all.
It must not be supposed that although the utility and success of
Broadmoor are so great, all has been done in the way of protecting
society which the necessity of the case requires. Far from it. There are
a vast number of weak-minded persons at large, most dangerous to the
community, some of whom have not yet been in prison, while others have.
In 1869 there were in Millbank one hundred and forty weak-minded, and
also twenty-five of an allied type, the "half sharp." Whether they have
been imprisoned or not, they ought to be placed under supervision of
some kind.
Two other practical suggestions: The number of instances in which life
is sacrificed, and the still larger number of instances in which threats
of injury or damage short of homicide, destroy family happiness, through
the lunacy of one of its members, renders it highly desirable that
greater facilities should exist for placing such persons under restraint
(we do not refer now to imbeciles) before a dreadful act is committed,
to say nothing of terminating the frightful domestic unhappiness. In
most of these cases there is but slight apparent intellectual disorder,
although careful investigation would frequently discover a concealed
delusion, and the greatest difficulty exists in obtaining a certificate
of lunacy from two medical men. They shrink from the responsibility.
Nothing is done. Prolonged misery or a terrible catastrophe is the
result. To avoid this, there might be a power vested in the
Commissioners in Lunacy to appoint, on application, two medical men,
familiar with insanity, to examine a person under such circumstances.
Their certificate that he or she ought to be placed under care should be
a sufficient warrant for admission into an asylum, and they should not
be liable to any legal consequences. It should not be necessary for the
signers of the certificate to comply with the usual formalities. The
Commissioners should have power to grant an application of this kind,
whether made by a member of the family or by a respectable inhabitant of
the place in which the alleged lunatic resides; his respectability, if
necessary, being attested by the mayor.
The other suggestion has reference to the strange and clumsy way in
which the English law goes to work to discover whether a man charged
with crime and suspected to be insane is so in reality. It is a chance
in the first place whether he is examined by a medical man at all. If he
can afford counsel, and the plea of insanity is set up, medical
testimony is adduced of a one-sided character, and, more likely than
not, counter medical evidence is brought forward by the prosecution.
Thus physicians enter the court as partisans, and being in a false
position, often present an unfortunate spectacle; while, worst of all,
the truth is not elicited.
Then, it not unfrequently happens that after the trial the thing is done
which should have been done previously; experts in insanity are employed
to decide upon the prisoner's state of mind. The court should call such
experts to their assistance at the trial, and, what is most important,
ample time should be allowed to examine the suspected lunatic. In France
the "Juge d'instruction" requests neutral experts to examine and report
upon the accused, and I have recently been assured by physicians in
Paris, with whom I have discussed this point, that the plan, on the
whole, works well. Is it too much to hope that common sense will guide
our own law-makers to introduce a similar practice?[212]
During the meeting of the International Medical Congress, 1881, a party
of distinguished men from other lands visited Broadmoor, including MM.
Foville and Motet, Professors Hitchcock, Ball, Tamburini, Dr. Müller,
and Dr. Whitmer. We shall always remember the day with pleasure. One
result was an interesting narrative of the visit by M. Motet of Paris.
We met at "Waterloo," and it was gratifying to think of the different
feelings under which representatives of the French and English
assembled, from those experienced on the battle-field to which the
station owes its name.
FOOTNOTES:
[210] Dr. William Orange.
[211] _Journal of the Statistical Society_, vol. xxxviii. (Guy).
Appendix K II.
[212] For detailed account of the French law, which in some particulars
may require greater safeguards, see article by the author, "Mental
Experts and Criminal Responsibility," _Journal of Mental Science_,
edited by Dr. D. Hack Tuke and Dr. George H. Savage, April, 1882. For
more information respecting criminal lunatics, see Appendix L.
CHAPTER VII.
OUR CHANCERY LUNATICS.
Of the relations of lunatics to that Court which Dickens describes as
having its decaying houses and its blighted lands in every shire, its
worn-out lunatic in every mad-house, and its dead in every churchyard,
we must briefly speak, and in many respects speak favourably. It may
have been true that "the Court of Chancery gives to moneyed might the
means abundantly of wearying out the right; so exhausts finances,
patience, courage, hope; so overthrows the brain and breaks the heart;
that there is not an honourable man among its practitioners who would
not give--who does not often give--the warning, 'Suffer any wrong that
can be done you, rather than come here!'" But whatever this "most
pestilent of hoary sinners" may have been in the past, it has, through
its Lord Chancellor's Visitors, performed its duty towards its "worn-out
lunatics," not only "in every mad-house," but in many a home in which
they enjoy as much liberty as possible, while the property of which they
are incompetent to take charge, is carefully administered by the Lord
Chancellor. In his Address at the eighth section of the International
Congress, Dr. Lockhart Robertson pointed out that 34.6 per cent. of the
Chancery lunatics are treated in private dwellings. Hence 65.4 per cent.
are in asylums--a striking contrast to 94 per cent. of private patients
in asylums under the Lunacy Commissioners. Dr. Robertson concludes that
some 30 per cent. of these are, therefore, in asylums needlessly, and
hence wrongly. The fact is important, and will attract, it is to be
hoped, more attention than hitherto, although I can hardly see that it
follows that all these patients referred to are "wrongly confined," or
would be better elsewhere. I would, however, reiterate what has been
insisted upon in a former chapter, that, essential as asylums are, a
large number of patients may be comfortably placed under other and less
restrictive conditions.
By what steps we have arrived at our present, on the whole, satisfactory
if incomplete, legislation for the protection of the property of the
insane, is an inquiry by no means unprofitable and uninteresting, and I
propose in a short chapter to trace them rapidly, with a brief reference
to successive Acts of Parliament.[213]
It is needful to premise that Blackstone's definition of an idiot was
"that he is one who hath had no understanding from his nativity, and
therefore is by law presumed never likely to attain any." "He is not an
idiot if he hath any glimmering of reason, so that he can tell his
parents, his age, or the like common matters." From such a condition the
law clearly distinguished the lunatic, or _non compos mentis_, who is
"one who hath had understanding, but by disease, grief, or other
accident hath lost the use of his reason." The lunatic was assumed to
have lucid intervals, these depending frequently, it was supposed, upon
the change of the moon. Others who became insane--or, as it was
expressed, "under frenzies"--were also comprised under the term _non
compos mentis_.
The law varied in accordance with these distinctions, the charge of the
lunatic being intrusted to the king, and the custody of the idiot and
his lands vested in the feudal lord, though eventually, in consequence
of flagrant abuses, it was transferred to the Crown in the reign of
Edward I. by an Act now lost, which was confirmed by Edward II., 1324.
This marks the earliest Act extant (17 Edward II., c. 9) passed for the
benefit of mentally affected persons. The words run:--"The king shall
have the custody of the lands of natural fools, taking the profits of
them without waste or destruction, and shall find them their
necessaries, of whose fee soever the lands be holden. And after the
death of such idiots he shall render them to the right heirs; so that by
such idiots no alienation shall be made, nor shall their heirs be
disinherited."[214]
The same Act legislates for lunatics--those who before time had had
their wit and memory. "The king shall provide, when any happen to fail
of his wit, as there are many having lucid intervals, that their lands
and tenements shall be safely kept without waste and destruction, and
that they and their household shall live and be maintained completely
from the issues of the same; and the residue beyond their reasonable
sustentation shall be kept to their use, to be delivered unto them when
they recover their right mind; so that such lands and tenements shall in
no wise within the time aforesaid be aliened; nor shall the king take
anything to his own use. And if the party die in such estate, then the
residue shall be distributed for his soul by the advice of the
ordinary."[215]
The necessity had arisen in early times of deciding upon sufficient
evidence whether a man were or were not an idiot, and the old common law
required trial by jury. If twelve men found him to be a pure idiot, the
profits of his lands and person were granted to some one by the Crown,
having sufficient interest to obtain them. The king, of course, derived
some revenue from this source. A common expression used long after the
custom had died out, "begging a man for a fool," indicated the character
of this unjust law. In James I.'s reign Parliament discussed the
question of investing the custody of the idiot in his relations,
allowing an equivalent to the Crown for its loss, but nothing was done.
It is said[216] that this law was rarely abused, because of the
comparative rarity of a jury finding a man a pure idiot, that is to say,
one from his birth, the verdict generally involving _non compos mentis_
only, and therefore reserving the property of the lunatic for himself
entire until his recovery, and in the event of his death, for his heirs,
in accordance with the statute of Edward II. already given.
Recurring to the appointment of a jury, in order to trace the course of
legislation subsequently to the present time, it should be observed that
the Lord Chancellor was petitioned to inquire into an alleged idiot or
lunatic's condition, the petition being reported by affidavits; and if
satisfied of the _primâ facie_ evidence, he issued a writ _de idiotâ_ or
_lunatico inquirendo_ to the escheator or sheriff of his county to try
the case by jury. The form of this writ was various. It surmised that an
idiot or fatuous person existed, one who had not sufficient power to
govern himself, his lands, tenements, goods, or cattle, and ordered
inquiry to be made whether such was really the fact, and if so, whether
at another time; if the latter, at what time, and by what means; if
there were lucid intervals; and who was his next heir, and his
age.[217]
In another form it is surmised that a certain person is so impotent and
_non compos mentis_ that he is unable to take care of himself or his
goods, and inquiry is simply directed to the point whether he is an
idiot and _non compos_, as asserted in the petition.[218]
And in another writ the escheator or sheriff is to inquire whether the
person in regard to whom the writ is issued has been a pure idiot from
his birth to the present time; whether through misfortune, or in any
other manner, the patient afterwards fell into this infirmity; and if
so, through what particular misfortune or other cause it happened, and
at what age.[219]
If a jury found a man to be an idiot, he had the right to appeal, and to
appear in person or by deputy in the Court of Chancery, and pray to be
examined there or before the king and his Council at Westminster. Should
this fresh examination fail to prove him an idiot, the former verdict
before the sheriff was declared void.
In more recent times three Commissioners appointed by the Lord
Chancellor issued a writ _de lunatico inquirendo_. The jury found
whether the person was or was not insane, and the Lord Chancellor
received the verdict through the above Commissioners. In time this
course was found inconvenient and cumbrous, and in the reign of William
IV. (stat. 3 and 4, c. 36, s. 1), in the year 1833, the Lord Chancellor
was authorized to cause commissions "to be addressed to any one or more
persons to make inquisitions thereon, and return the same into the Court
of Chancery, with the same power as was before possessed by three or
more Commissioners in such Commission named."[220]
By stat. 5 and 6 Vict., c. 84, the Lord Chancellor was authorized to
appoint two barristers called "the Commissioners in Lunacy," to whom all
writs _de lunatico inquirendo_ were to be addressed, and who should
perform the duties then performed by Commissioners named in commissions
in the writ. In 1845 the title was changed from Commissioners to
"Masters in Lunacy" (8 and 9 Vict. c. 100). It was previously the
practice to refer all matters connected with the person and estates of
the lunatic, after he was found so under commission, to the ordinary
Masters in Chancery. These were transferred to the new Masters in
Lunacy. All inquisitions were still held before a jury.
It will be seen, then, that although formerly, when a person was found
to be an idiot or a lunatic, he was placed under a committee appointed
by the king, in the course of time objection was taken to this course
on account of the suspicion of partiality attaching to his appointment,
and the king transferred his right to the Lord Chancellor.[221]
These Acts direct proceedings for a commission to be taken as
follows:--The petition for a commission, duly supported by medical and
other affidavits, is to be lodged with the Secretary of Lunatics, for
the Lord Chancellor's inspection. If satisfactory and unopposed, the
petition is endorsed and the commission issues. If a _caveat_ is
entered, liberty is given to attend and to oppose it, and the inquiry is
held in the most convenient place. A jury of twenty-four persons is
summoned to determine the case, by the sheriff, instructed by the Master
in Lunacy. The jury and the Master being assembled, and the former
sworn, the Master in Lunacy is to explain to the jury what they have to
try; and if the person is found to be a lunatic, the time at which he
became so, and whether he has lucid intervals. After counsel have been
heard, and the alleged lunatic examined, the Master is to sum up, and
the verdict, which must be concurred in by twelve, is then given.
The inquisition is now filled up and signed by the twelve jurymen, the
Master annexing a duplicate copy to the commission; and they are
endorsed with the words, "The execution of this commission appears by
the inquisition hereunto annexed."[222]
Then, next in order of legislation comes the Act of 1853 (16 and 17
Vict., c. 70). Certain clauses in the Act of 1842, by which the Lord
Chancellor exercised jurisdiction on account of the expense involved in
a commission, were repealed, having been found to work inconveniently.
Under the new Act an inquisition was held, in unopposed cases, before a
Master alone in by far the larger proportion of cases. A petition was to
be presented by any relative, and in special cases by a stranger,
supported by medical and other evidence, along with an affidavit of
notice having been given to the lunatic, calling his attention to the
provision of the Act under which he could demand a jury. If no such
demand was made, the documents were to be submitted to the Lord
Chancellor or the lords justices, who directed an inquiry, if they saw
no reason for further evidence. If the demand, on the contrary, was
made, the petition was to be set down for hearing in open court, when an
inquiry was either ordered or dismissed; in the former case, before a
jury or without one, at the court's discretion. In the event of the
petition being unopposed, the order made by the Lord Chancellor for
inquiry was to be directed to a Master in Lunacy, and conducted as
nearly as possible as if there were a jury, the lunatic being seen in
every case. Master Barlow has related one exception in which he could
not see the lunatic (a lady) without breaking through the door; a
solicitor appeared on her behalf, and Mr. Barlow tried to make him
produce his client, but being told that serious risk of her jumping out
of the window would be incurred, the attempt was wisely abandoned. When
such an inquiry was completed and the commission signed, the Master in
Lunacy was to ascertain certain particulars, as the committees of the
person and estate which the family proposed to appoint, the amount of
the property, etc. A report was then to be made to the Lord Chancellor
certifying these particulars. The Chancery Visitors were to undertake
the supervision of the lunatic, these consisting of two medical men (as
previously), a lawyer, and nominally the two Masters _ex officio_. The
visitation was only annual. The salary of the medical and legal Visitors
was not more than £500 per annum, as they were not, as now, obliged to
relinquish practice.
Reference has been made in the fourth chapter to the important Select
Committee of 1859-60. This Committee not only collected evidence in
regard to "the Care and Treatment of Lunatics," but also in regard to
the protection of their property. A mass of interesting evidence was
given, including a statement of the working of the law at that time by
Master Barlow. Proof was not wanting that some reforms were required,
and the outcome of this inquiry was "The Lunacy Regulation Act" of 1862
(25 and 26 Vict., c. 86), a statute to be construed as part of "The
Lunacy Regulation Act" of 1853, to which we have already referred.
The only novel points in the Act of 1862 which we shall mention here are
these: That when the Lord Chancellor, entrusted under the previous Act,
orders an inquiry before a jury, he may direct the trial to take place
in one of the superior courts of common law at Westminster, the verdict
having the same force as an inquisition under a commission of lunacy
returned into the Court of Chancery; that in an inquiry before a Master
without a jury, it shall be lawful for the alleged lunatic, upon the
hearing of any petition, to demand an inquiry by a jury, the demand
having the same effect as if made by notice filed with the registrar in
accordance with the previous Act; that the inquiry should be confined to
the question whether the subject of the inquiry was at the time of such
inquiry of unsound mind, and incapable of managing himself or his
affairs, no evidence as to anything said or done by such person, or as
to his demeanor or state of mind at any time more than two years before,
being receivable as a proof of insanity, unless the judge or Master
shall direct otherwise; that to save the property of lunatics, when of
small amount, from ruinous expense, the Lord Chancellor, if satisfied by
the report of a Master or the Commissioners in Lunacy or otherwise, that
any person is of unsound mind and incapable of managing his affairs,
may, when the lunatic does not oppose the application, and his property
does not exceed £1000 in value or £50 per annum, apply it for his
benefit in a summary manner without directing any inquiry under a
commission of lunacy; that the Lord Chancellor may apply the property of
persons acquitted on the ground of insanity for their benefit; that
Chancery lunatics should be visited four times a year by one of the
Visitors, the interval between such visits not exceeding four months,
with the exception of those in public or private asylums or hospitals,
who need not be visited oftener than once a year; that the Visitor
shall report once in six months to the Lord Chancellor the number of
visits made, the number of patients seen, and the number of miles
travelled; an annual report being made to Parliament thereof, together
with a return of sums received for travelling or other expenses; that
the sections of the former Act in regard to visitation being repealed,
two medical and one legal Visitor shall be appointed, with salaries of
£1500 each and a superannuation allowance.
In practice, it may be said that, in the first instance, the Court
endeavours to satisfy itself that in the event of an inquiry, it is for
the benefit of the alleged lunatic, and that there is a fair probability
that the verdict will find him of unsound mind and incapable of managing
himself or his affairs, by ordering him to be examined by a medical man,
or by making a personal examination.
It seems strange that, notwithstanding these various Acts, and
especially that of 1862, there should still be occasion for improvement
in providing for the care of the property of insane persons. Yet so it
is; and one of the Lord Chancellor's Visitors, Dr. Lockhart Robertson,
has so recently as 1881 stated that "the important requisite of a cheap
and speedy method of placing the property of lunatics under the
guardianship of the Lord Chancellor has yet to be attained," and he
quoted Master Barlow's evidence before the Dillwyn Committee of 1877: "I
am a great advocate for a great reform in lunacy (Chancery) proceedings;
I would facilitate the business of the procedure in the office and
shorten it in such a way as to reduce the costs." Various important
suggestions will be found in the evidence given before the above
Committee by the present Visitors and an ex-Visitor, Dr. Bucknill, who
has also, in his brochure on "The Care of the Insane, and their Legal
Control," advocated radical changes in the official management of the
insane. In addition to the establishment of State asylums for the upper
and middle classes, he proposes that two central lunacy authorities
should administer the laws, severally relating to the rich and the poor.
The present Board of Commissioners would cease to exist; the Lord
Chancellor, under the Royal prerogative, would preside over the
former--the non-pauper--and the Local Government Board would exercise
authority over the entire pauper class. By this means the existing
system, under which the Chancery lunatics are cared for, "rooted," as
Dr. Bucknill points out, "in the foundations of the English
constitution," would be greatly extended, and "the present entanglement
of authorities, always costly and sometimes conflicting," would cease.
It remains to be seen whether these proposals can or will be carried
out, and if so, whether they will prove as beneficial in practice as
they are doubtless attractively harmonious and symmetrical in theory.
* * * * *
It remains to add the number of Chancery lunatics in England and Wales
at the present time, namely 992, who were thus distributed on January 1,
1881:--
-----------------------------------------+-----+-----+------
Location. | M. | F. |Total.
-----------------------------------------+-----+-----+------
County and borough asylums | 22 | 10 | 32
Registered hospitals | 102 | 66 | 168
Metropolitan licensed houses | 123 | 119 | 242
Provincial „ „ | 104 | 82 | 186
Naval and military and East India Asylums| 2 | -- | 2
Criminal asylums | 3 | -- | 3
Private single patients | 55 | 80 | 135
+-----+-----+------
| 411 | 357 | 768
Residing in charge of their committees | -- | -- | 224
| | +------
Total | | | 992
-----------------------------------------+-----+-----+------
The percentages on the incomes of Chancery lunatics amounts to about
£22,000, an amount which goes far to cover the cost, not only of the
Masters and Registrar, but also the Visitors; viz. Masters in Lunacy,
£12,805; Registrar, £2,216; Visitors, £8,317; total, £23,339.[223]
FOOTNOTES:
[213] Free use has been made of Shelford's "Law concerning Lunatics,
etc.," and Elmer's "Practice in Lunacy," 1877.
[214] "Rex habet custodiam terrarum fatuorum naturalium, capiendo exitus
earundem sine vasto et destructione et inveniet eis necessaria sua de
cujus cumque fœdo terre ille fuerint; et post mortem eorum reddat eas
(eam) rectis hæredibus ita quod nullatenus per eosdem fatuos alienentur
vel (nec quod) eorum hæredes exheredentur."
[215] "Item habet providere (Rex providebit) quando aliquis qui prius
habuit (habuerit) memoriam et intellectum non fuerit compos mentis suæ,
sicut quidam sunt per lucida intervalla quod terre et tenementa eorumdem
(ejusdem) salvo custodiantur sine vasto et destructione, et quod ipse et
familia sua de exitibus eorundem vivant et sustineantur competenter; et
residuum ultra sustentationem eorundem rationabilem custodiatur ad opus
ipsorum liberandum eis (eisdem) quando memoriam recuperaverint. Ita quod
predicte terre et tenementa infra prædictum tempus non nullatemus
alienentur nec Rex de exitibus aliquid percipiat ad opus suum; et si
obievit in tale statu tunc illud residuum distribuatur pro animâ per
consilium ordinariorum (ordinarii)" (see Shelford, p. 624).
[216] Blackstone, vol. i. p. 304 (edit. 1783).
[217] "Fatuus et idiota existit, ita quod regimini sui ipsius terrarum,
tenementorum, bonorum, et catallorum suorum non sufficit." "Si A. fatuus
et idiota sit, sicut prædictum est, necne; et si sit, tunc utrum a
nativitate suâ, aut ab alio tempore; et si ab alio tempore, tunc a quo
tempore; qualiter et quomodo; et si lucidis gaudeat intervallis ... et
quis propinquoir hæres ejus sit, et cujus ætatis."
[218] "Quia A. idiota, et adio impotens ac mentis suæ non compos
existit, quod regimini sui ipsius, terrarum, vel aliorum bonorum non
sufficit." "Si idiota sit, et mentis suæ non compos, sicut prædictum
est, necne."
[219] "A nativitatis suæ tempore semper hactenus purus idiotâ extiterit
... an per infortunium vel alio modo in hujus modi infirmitatem postea
inciderit; ... an si per infortunium vel alio modo, tunc per quod
infortunium, et qualiter, et quomodo, et cujus ætatis fuerit."
[220] Shelford, p. 94.
[221] Blackstone, vol. iii. p. 427.
[222] Shelford, p. 122.
[223] See Appendix M.
CHAPTER VIII.
OUR IDIOTS AND IMBECILES.
Attention has of late been freshly drawn to this unfortunate class. We
propose in this chapter to give some particulars respecting their past
history, their numbers, their location, and the claims, not yet
sufficiently recognized, which they have upon the public and the State,
with a few suggestions in regard to the legislation required to meet
these claims.
The terms "idiots" and "imbeciles" are popularly employed with great
vagueness, and the latter by even medical men in more senses than one.
Among the Greeks an idiot was a private, as opposed to a public or a
professional person. He was unskilled, unlearned; and early English
writers use it in this sense. Thus Wiclif translates 1 Cor. xiv. 16,
"For if thou blessist in speyrit; who filleth the place of an _idiot_,
hou schal he sae amen on thi blessyng." Chaucer similarly employs the
word. It is easy to understand its gradual transition to the exclusive
sense in which it has for long been employed.
It is not necessary to distinguish between idiocy and imbecility (Lat.,
weakness, feebleness) further than this, that an idiot is at the very
bottom of the scale of beings born with defective mental powers, while
he who labours under imbecility or feeble mindedness is understood to be
one much less completely deprived of power. Strictly speaking, these
terms ought to be rigidly restricted to states of mind at birth, but
this has been found to be practically inconvenient, if not impossible,
because changes occurring in the brain in very early life impair the
functions of that organ so completely as to induce the same helpless
condition which is found in congenital cases. We dismiss now one
distinction which has been drawn between idiocy and imbecility--that the
former is, and that the latter is not, necessarily congenital; one
arising from the supposition that infantile mental deficiency is less
likely to be so grave an affection than that which has been present from
the moment of existence. Besides, the term is constantly being applied
in common parlance to those who, originally of sound mind, have in adult
life lost their faculties.
It is most important that a clear distinction should be preserved
between these adult cases and those which date from birth or childhood.
The former are labouring under _dementia_, not _amentia_. They are
demented persons, or, as they are called in our asylums, dements. They
are not always, but they are for the most part, harmless lunatics. It is
confusing to call them imbeciles, now that this term has become
restricted by medical writers to those who are, or once were,
feeble-minded children. There are, of course, all degrees of mental
defect possible at birth or in childhood, between that of the most
degraded idiot and of a child who is said to be not very bright. With a
large majority, however, something can be done to improve the mental
condition, whereas with demented persons there is no ground for
expecting improvement. The past history of the condition and treatment
of idiots differs in some respects widely from that of the insane.
Happily in many countries, especially in the East, they have been
regarded as objects of special affection and care--as sacred beings
possessing a certain weird, if not divine, element in their nature.
Though helpless and involving much trouble, they do not exasperate or
terrify their relations in the same way as the furious maniac. As a
rule, they do not suggest the same exercise of force and use of fetters
as the ordinary lunatic. Still, in many instances, no doubt, weak-minded
and wayward children have been harshly treated and beaten.
But whether regarded as specially favoured by Heaven, or treated as
stupid children, they were never subjected to any special training for
education until recent times.
St. Vincent de Paul is regarded as the first who made any effort to
train idiots. This was in the Priory of St. Lazarus. He failed, however,
as was to be expected, to make much progress in the work. Itard
followed, also a Frenchman. He strove to educate the celebrated idiot
called the Savage of the Aveyron, and by doing so hoped to solve the
problem of determining what might be the amount of intelligence and the
nature of the ideas in a boy who from birth had lived entirely separate
from human beings. Although he regarded his effort as a failure, he no
doubt exerted considerable influence in inducing others to make the same
attempt with a more practical aim, and with a better understanding of
the material upon which it was proposed to work. M. Belhomme published a
work in 1824 on the subject of educating idiots. Four years later some
were taught at the Bicêtre, and the school there became famous. Falret,
in 1831, adopted the same course at the Salpêtrière, but we believe the
school was not sustained for a long period. Another physician of Paris,
Voisin, taking up the subject as an enthusiastic phrenologist, also
worked hard at idiot-teaching. None, however, devoted themselves so
fully, and for so long to this work as the late Dr. Seguin, who so long
ago as 1839 published, with Esquirol, a pamphlet on idiocy, and has only
recently passed away. For some years he taught idiots in Paris, and in
1846 published a work entitled "Traitement moral, Hygiène, et Education
des Idiots." He resided for many years in New York, and made, while in
America, valuable contributions to the literature of idiocy.
America has certainly not been behindhand in her efforts to raise the
condition of idiots. In 1818 an attempt was made to instruct them at the
Asylum for the Deaf and Dumb at Hartford. It is said they were taught to
communicate by the sign language.
To George Sumner the credit is due of having called attention powerfully
to the subject in 1845. He had recently visited Paris, and gave a
description of the idiot schools there. Dr. Woodward and Dr. Backus
shortly after took up the question; the latter became in that year a
senator of New York, and in 1846 introduced a Bill providing an idiot
asylum or school. It was five years, however, before one was opened.
This was at Albany, as an experiment; but it was eventually established
at Syracuse, as the New York Asylum for Idiots. In 1855 a new building
was erected in New York, the number provided for being 150. The first to
superintend the institution was Dr. Hervey B. Wilbur. Accommodation was
subsequently made for 225. In 1875 the average attendance at this school
was 210; of these 180 were supported by the State, the remainder paying
altogether or in part. The expenditure was 45,407 dollars; the cost per
head for board and instruction being 200 dollars.
At the same period that New York took the initiative (1846), a
commission was appointed by the Massachusetts Legislature to inquire
into the condition of the idiot population of this state, and to report
as to what was necessary to be done. The report being favourable to
action, a wing in the Blind Institution at South Boston was appropriated
to an idiot training school. This was in October, 1848. In 1850 this
school underwent a transformation, being incorporated as the
"Massachusetts School for Idiotic and Feeble-minded Youth," and placed
under the charge of the well-known Dr. S. G. Howe, the instructor of
Laura Bridgman. "We are happy to say," he observes in a report of this
school, "that in its experience there have been hardly any so low as to
be beyond the reach of some elevating influence, none, or next to none,
so fixed in their degradation as to be unrecoverable."
Dr. H. B. Wilbur states that no provision is made for a large proportion
of idiots in America; the present training institutions being quite
inadequate to the applications made. The consequence is that many are
placed in jails or almshouses. Recommendations have been made that these
custodian cases should have either special asylums provided for them, or
separate departments connected with lunatic asylums or training idiot
institutions. It is calculated that there must be fully 38,000 idiots in
the United States.
It would be wrong to pass over Germany without stating that much
persevering and successful work has been accomplished by Herr Sägert and
others. We were more struck with the results he obtained, when we
visited his school in Berlin in 1853, than with anything we witnessed
elsewhere on the Continent.
In Switzerland there are training schools at Basle, Berne, Zurich,
Lausanne (two), and Etoy. They provide for about eighty cases.[224]
In our own country[225] we believe we must signalize Bath as the first
town in which a school, or rather a home, for idiots was opened.
Established on a very small scale (only four cases in the first
instance) by the Misses White in 1846, it has flourished to the present
day. Two years later, an idiot asylum was established at Park House,
Highgate, whose founders, however, did not know of the home at Bath. It
had its branch at Colchester, and eventually developed into the great
institution at Earlswood, near Redhill, opened in 1855. The Earlswood
report for the past year states that there are altogether 561 inmates,
of whom 400 are supported gratuitously, and of the remainder upwards of
70 pay less than the actual cost of their maintenance. One of the
inmates discharged in May had since held the situation of nurse in a
family; another was becoming an expert shoemaker; and a former female
inmate was employed as a teacher in an elementary school. Earlswood is
under the efficient charge of Dr. Grabham. In connection with Earlswood,
we ought to recognize the considerable influence which a continental
institution exerted in helping to excite that interest in the education
of idiots which, among other influences, induced the Rev. Andrew Reed,
D.D., to urge the erection of a large building for the training of
idiots. We refer to Dr. Guggenbühl's institution for cretins, on the
Abendberg, near Interlachen, which undoubtedly did more good in this
indirect way than by curing the cretins placed there. At any rate, there
was a certain mystery connected with the work done at this school, which
left an unsatisfactory impression on ourselves when we visited it in
1862, and which struck many others in the same way. At his death, in
1863, the institution was closed. Essex Hall, Colchester, in the first
instance a branch of the Highgate Asylum, ultimately (1859) became the
institution for the eastern counties. Mr. Millard, who has devoted
himself to the arduous work of training idiots for many years, is the
superintendent, and had the original charge (with a matron) of the
idiots when first placed at Park House, Highgate. The inmates number
ninety-seven. In 1864 an institution was opened at Starcross, near
Exeter, through the efforts of the Earl of Devon, for the idiotic class
in the western counties. There are now eighty pupils there.
In the course of the same year the Northern Counties Asylum for Idiots
and Imbeciles was established at Lancaster. Its origin is thus given by
Dr. de Vitré, the chairman of the committee: "A member of the Society of
Friends, with moderate pecuniary means, but possessing a large amount of
Christian benevolence, offered to give the sum of £2000 for the purpose
of erecting an asylum for idiots in Lancashire. The gift was a noble one
and handsomely offered, but useless standing alone." Donations were
consequently solicited, and they were obtained, the result being the
establishment of the above institution, which now has 445 inmates, and
is under the care of Dr. Shuttleworth.
Dorridge Grove Asylum, at Knowle, was opened in 1866, and, although on
an exceedingly small scale, may be regarded as the institution for the
central or midland counties. Its establishment in the first instance was
due to Dr. Bell Fletcher and Mr. Kimbell.
We have now enumerated the institutions for idiots and imbeciles which
are supported in part or altogether by charity. They were, no doubt,
mainly intended, not for the highest, nor yet for the very lowest class
of society, but rather for the upper lower class and the lower middle
class. This idea has, however, by no means been carried out in practice,
for, in consequence of the State having failed to make provision for the
education and training of idiots and imbeciles, charitable institutions
have become disproportionately filled with persons of a different class
from that for which they are properly designed, and the difficulty
attending admission has acted as a barrier to the latter availing
themselves of the provision intended for them.
There are six of these charitable or voluntary institutions in England
and Wales, the number cared for being as follows:--
Under 20 Over 20
years of years of
age. age.
Earlswood 295 266
Lancaster 370 75
Essex Hall 57 40
Star Cross 72 8
Bath 30 --
Knowle 45 --
---- ----
869 389
the total being 1258.
For the higher class, an admirable private institution has for some
years been in operation at Normansfield, near Hampton Wick, under the
care of Dr. and Mrs. Down, who were formerly at Earlswood. There are
about one hundred inmates.
Lastly, for the pauper class in the metropolis a school for imbeciles
has for some time been carried on, first at Clapton, and now at Darenth
(Kent), under the superintendence of Dr. Beach. The house will
accommodate five hundred. It should be stated that this institution, as
well as those at Caterham and Leavesden for incurable lunatics,
originated in the Act 30 Vict. c. 6, and that these establishments are
under the Metropolitan Asylums Board, subject to the Local Government
Board. There are sixty members, of whom fifteen are nominated by the
last-mentioned Board, the remainder being elected by the metropolitan
unions.
Taking the numbers under training in these three divisions, the
charitable or voluntary institutions, the private institution, and that
for paupers, we find the total to be somewhat about eighteen hundred.
Scotland and Ireland have various institutions for idiots and imbeciles,
which may be briefly enumerated. In the former an idiot school was
established at Baldovan, near Dundee, in 1853. It was on the estate of
Sir John Ogilvie. There are forty-seven inmates. In 1862 an institution
was opened at Larbert, Stirlingshire, by a society formed for that
object, called the "Scottish National Institution for the Education of
Imbecile Children." Dr. Brodie, who now, we believe, has a private
institution at Liberton, near Edinburgh, for ten pupils, was the first
superintendent. It was superintended by Dr. Ireland from 1870 to 1881.
In January, 1881, there were one hundred and twenty-four inmates.[226]
Thus only about a hundred and eighty idiots and imbeciles are in
training institutions in Scotland.
In Ireland the only institution for training idiots was founded in
1868, in consequence of Dr. Henry Stewart handing over his asylum at
Lucan, together with a donation (payable under certain conditions) of
£5000, to certain trustees. It is called the "Stewart Institution for
the Training, Education, and Maintenance of Idiotic and Imbecile
Children."
A large mansion at Palmerston, in the neighbourhood of Dublin, was in
1875, when we visited it, being adapted to the requirements of an
asylum, and to it the idiots have been removed from Lucan. It was
recently stated that in Ireland seventy per cent. of the idiots and
imbeciles are at large, twenty-one per cent. in workhouses, and only
seven per cent. in asylums.
We are now in a position to estimate the opportunities afforded in
England for the systematic training of a class of unhappy beings, unable
to help themselves and calling loudly for help from both men of science,
philanthropists, and legislators. Let us see how far these opportunities
meet the want, and what becomes of those idiots and imbeciles for whom
no distinct provision is made. Unfortunately, the statistics of idiocy
are very imperfect, partly owing to the reluctance of their relatives to
acknowledge such a defect in the family, and partly from there being no
distinction made in the annual Report of the Lunacy Commissioners
between idiots and lunatics.
Taking, however, the census of 1871, in which a return of idiots was
made, as the basis, we find the number in England and Wales to be at
that time 29,452. Inquiry of the parents of known idiots has so often
resulted in the discovery that they had not been returned, that it has
been considered fair to add one-fourth to the above figures, thus
bringing them up to 36,815, of whom 14,162 would be under twenty years
of age, and therefore suitable objects for training, and 22,653 twenty
years old and upwards. To these should be added five per cent. for
increase of population since 1871, making the numbers, respectively,
14,869 and 23,786, or a total of 38,655, or 1 to 616 of the population.
Of these, then, 1147, or about three per cent., are in training schools
provided by charity. The remainder are either at home, in lunatic
asylums, workhouses, or boarded out. We have found it impossible to
arrive at any satisfactory result in attempting to apportion them to
these various allotments. We know, however, that the census of 1871
gives 3456 as the number in asylums, and 7976 as the number in
workhouses, including in the term the metropolitan district asylums.
This would leave, out of the number of idiots reported by the census,
about 18,000 with their friends or boarded out, or 18,900 at the present
time, in consequence of the increase of population. We have, however,
but scant faith in the correctness of these relative amounts. All we
really know is the number receiving definite teaching or training, and
an approximation--nothing more--to the gross number of idiots and
imbeciles in the land. The next point is to determine the number who
belong to the class, already indicated, which we have to legislate and
provide for--the poor and the class immediately above them. The wealthy
can send their children to private institutions; those who belong to an
intermediate class to voluntary establishments, which would, in the
event of the proposed legislation being carried into effect, be
sufficient. It appears that about two-thirds of the idiots and imbeciles
were chargeable to the poor rates, according to the census. Two-thirds
of 38,655 yield 25,776. It is estimated that one-fifth of the remainder,
that is to say 2176, may be added to comprise the class just above
paupers and needing public help in the way proposed. Adding these
figures together, we get in round numbers 28,000, for whom it is
desirable for the State more or less to provide, in the way of training
schools and custodial establishments. Those who are now in workhouses
and in lunatic asylums would be removed from them, and so far would
relieve the latter from their present crowded condition. This object
would be still further gained if harmless lunatics, as proposed by the
Charity Organization Committee, should be legislated for in the same way
as idiots and imbeciles, and removed from asylums to separate
institutions, as has been done at Caterham and Leavesden. The number of
this class needing public administration is calculated at 7615.
Confining still our attention to England and Wales, where, as we have
seen, voluntary effort has only succeeded in providing training schools
for about three per cent. of the idiot and imbecile class, we desire to
draw attention to the action taken by the Charity Organization Society
of London, arising out of a consciousness of the inadequacy of this
provision. In the summer of 1877 a sub-committee of this Society entered
very fully into the consideration of this subject in all its bearings,
and continued week by week, for some months, to discuss the various
questions which presented themselves. Sir Charles Trevelyan, who
originated the inquiry, observed that "he had rarely, if ever, known a
subject so completely threshed out."
The most important conclusions arrived at were--that a small proportion
of idiots and imbeciles can be so far improved as to support themselves,
that a larger proportion may be trained to do some useful work, and that
the remainder can be rendered happier and not so burdensome to others.
On inquiry, it was found that about two per cent. of the cases admitted
at Earlswood were cured so as to be able to support themselves. At one
period in the history of this institution, when certain very
unfavourable classes were rejected, as many as ten per cent. were so
trained and improved. That this should be the maximum proportion will
surprise those who have been misled by the _ad captandum_ statements
sometimes put forward to the public, no doubt with laudable and
benevolent motives. This amount of success, disheartening as it seems at
first, is not to be despised; but the strength of an appeal, whether to
the charitable public or to the State, to provide for the training of
idiots, lies in elevating them to the highest level of which their
organization admits, curing them of offensive habits, affording them
some positive happiness, and shielding them from unkind and irritating
treatment.
It is the judgment of the above-mentioned Committee that idiots ought to
be treated distinctively from other classes, whether the blind, or
lunatics in asylums and workhouses, or children in schools, and that
they should not be boarded out.
For those idiots and imbeciles who have been trained up to a certain
point, beyond which it is impossible to advance them, suitable
institutions or departments of institutions--adult custodial
asylums--are suggested. Those idiots who are young, and can be taught,
should be kept, as a general rule, distinct from adult idiots, in
training schools. These two classes of institutions should be united, if
possible, under the same superintendence.
The action to which we have already referred as having been taken by the
Metropolitan Asylum Board, arising out of the Act of 1870, forms a
useful experiment for the consideration and possible guidance of those
engaged in endeavouring to provide for the training and custody of
idiots and imbeciles, not in the metropolis alone, but the country.
After full discussion, the Charity Organization Committee resolved "that
the arrangement which has been made for idiots, imbeciles, and harmless
lunatics in the Metropolitan Asylum District is applicable in its main
principles to the rest of England, viz. that they should be removed from
workhouses and county lunatic asylums, and that young persons of those
classes should be suitably educated and trained." Seeing that experience
clearly proves that the voluntary principle is a failure, or at least
wholly inadequate, for it only touches the fringe of the difficulty, it
becomes absolutely necessary that the State should step in and
supplement charitable effort. The Acts at present in force are possibly
sufficiently elastic to provide for the want, if there was a
determination on the part of the authorities in the various counties to
avail themselves of them; but it is quite certain that no steps will be
taken to do so, unless a new Act makes a distinct and special provision
for the education and training of the idiot classes.
It appeared just to the Committee that not only should the local rates
provide, as they do at the present time, for the charge of this class,
but that assistance should be granted out of the public revenue; the
best mode for such assistance being in the form of advances for the
buildings required on easy terms, liberal capitation grants for young
people under training, and grants of less amount for adults.
It is obvious that an idiot, while under the process of education, is at
least as much entitled to the capitation grant allowed by the Education
Department as the school children of the non-idiotic class.
A certain sum would also be received from the families of some of the
inmates of the training schools and custodial institutions. It is
proposed that those families which, although able to pay their way under
ordinary circumstances, could not possibly defray the entire cost,
should pay according to their means. As in the case of the blind and the
deaf and dumb, it is considered that the relief given to children should
not be counted as parochial relief to their parents.
The question arose in the Committee whether those who are able to pay
for the whole of their maintenance should be admitted, but no definite
opinion was arrived at; there being much to be said on both sides of the
question. No doubt such a course might interfere with private
institutions, and might in some instances lead to filling up the room of
an asylum which ought to be occupied by the needier classes--a complaint
frequently made (whether justly or unjustly) against the lunatic
hospitals of America. At the same time, the principle of making the
payments of the higher supplement those of the lower classes is a sound
one, and has been found to answer in such institutions as the York
Retreat. But those who have had most experience of the friends of idiots
know that they are much less willing to pay handsomely for their
training or care than they would be for an insane member of the family.
The occurrence of insanity in a family, especially if manifesting itself
in the form of outrageous violence or of suicide, alarms the relatives,
and forces them to place the patient in an asylum at almost any cost. In
the case of idiotic or imbecile children, they are easily secluded, or
placed with some one willing to take charge of them, without
necessitating the restraint of an asylum.
Idiot establishments, supported by the weekly payments of the rich, are
not therefore proposed; and although there may be cases in which the
cost of training and maintenance may be properly paid, this course would
not be allowed to wealthy persons, who are really able to pay higher
terms in a private asylum.
With regard to a very important aspect of the subject--the governing
bodies of these asylums for idiots--it is not proposed that they should
be the same as in the case of county asylums, but that they should
consist of representatives of the local magistrates, representatives of
the local guardians, and, thirdly, of persons appointed by the Crown.
Following the example of the Metropolitan Asylums Board, it is proposed
to erect large institutions capable of accommodating not more than two
thousand adults, and schools containing not more than five hundred
children, that is to say, idiots and imbeciles up to twenty years of
age.
In this large number of adults, however, is included the proposed
provision for harmless lunatics, for whom it is desired to legislate at
the same time. With these we are not concerned in the present chapter.
It may be remembered, however, that by adopting the "block" system of
construction of asylums, harmless lunatics can be placed with facility
in one department, and adult idiots in another.
It is very desirable that these new institutions should be inspected,
like other asylums, by the Commissioners in Lunacy; they should be
inspected and reported upon to the Local Government Board.
Among the advantages likely to result from the adoption of the scheme
thus briefly sketched out, may be mentioned that those institutions
which, like Earlswood, have been founded by benevolent individuals for
the middle class and the stratum beneath it, will have much more room
for the class intended, and that the troublesome and expensive canvass,
now become such an intolerable nuisance, will in all probability be
done away with.
The Act 16 and 17 Vict., c. 97, defines "lunatic" to include "every
person being an idiot," and the second section obliges justices to
provide accommodation for pauper lunatics. Section 30 of the same Act
empowers justices to build additional asylums where necessary, and
should they fail to do so, the Home Secretary, on the recommendation of
the Commissioners, may enforce it. Further, the Act 25 and 26 Vict., c.
43, empowers boards of guardians to send pauper children to schools
certified by the Local Government Board, and the word "school" is
defined by section 10 to extend to any institution for the instruction
of idiots. Lastly, the Act 31 and 32 Vict., c. 122, permits guardians,
with the consent of the Local Government Board, to send an idiotic
pauper to an asylum or establishment for the reception and relief of
idiots maintained at the charge of the county rate or by public
subscription.
These enactments, however, do not oblige the justices to provide
training schools for idiots, or to make distinct provision for them and
lunatics. They are, no doubt, permitted to do so, but the expense
involved would be so great that it can hardly be expected such a course
will be pursued, unless assisted by grants from the imperial exchequer.
The permission to send idiots to idiot schools supported by the rates or
by charity, amounts practically to nothing, because they are so few in
number, and are crowded already.
Legislation, therefore, is required to substitute "shall" for "may,"
and to lessen the burden which would fall upon the rates, if the right
course for the good of the idiots and imbeciles is to be thoroughly
carried out in England and Wales.
We cannot close this chapter without remarking on the satisfactory
change of sentiment which has taken place in regard to this deplorable
class. There may be times when, desiring to see "the survival of the
fittest," we may be tempted to wish that idiots and imbeciles were
stamped out of society. But, as Mr. Darwin has somewhere said, there is
a compensation for the continued existence of so pitiable a population
in our midst, in the circumstance that our sympathies are called forth
on their behalf; a commentary on the precept that those who are strong
should help the weak. The change in feeling above mentioned cannot be
more strongly illustrated than by imagining for a moment that, at the
present day, any leading divine should give utterance to the following
sentiments uttered by the great German Reformer. "Idiots," says he, "are
men in whom devils have established themselves, and all the physicians
who heal these infirmities as though they proceeded from natural causes
are ignorant blockheads, who know nothing about the power of the demon.
Eight years ago, I myself saw a child of this kind which had no human
parents, but had proceeded from the devil. He was twelve years of age,
and in outward form exactly resembled ordinary children.... But if any
one touched him, he yelled out like a mad creature, and with a peculiar
sort of scream. I said to the princes of Anhalt, with whom I was at the
time, '_If I had the ordering of things here, I would have that child
thrown into the Moldau, at the risk of being held its murderer._' But
the Elector of Saxony and the princes were not of my opinion in the
matter."
ADDENDUM.
Mr. Millard has prepared the following tabular statement, which shows at
a glance the information a reader is likely to require in recommending
asylums for this unfortunate class.
ASYLUMS FOR IDIOTS AND IMBECILES.
------------+---------------+---------------+-------------------------
Name and | Cases | How | Conditions,
place. | admitted. | admitted. | remarks, etc.
------------+---------------+---------------+-------------------------
METROPOLITAN| | |
PAUPER | | |
ASYLUMS: | | |
Leavesden, }|Adult idiots, |Through the }|
Herts. }|imbeciles and |boards of }|Residence in Middlesex.
Caterham, }|harmless |guardians. }|
Surrey. }|lunatics. | }|
| | |
Darenth, |Youthful idiots| Ditto. | Ditto.
Dartford, |and imbeciles. | |
Kent. | | |
VOLUNTARY INSTITUTIONS FOR IDIOTS AND IMBECILES.
ASYLUM FOR |Idiots and |By votes of |Election cases must be
IDIOTS, |imbeciles above|subscribers at |under 16 years of age and
Earlswood, |the pauper |half-yearly |unable to pay 50 guineas
Redhill, |class. |elections. |per annum. There is a
Surrey. | |By payments |special election list for
| |commencing at |cases paying 15 guineas
| |50 guineas per |per annum. The term of
| |annum, |election is for five
| |exclusive of |years; afterwards cases
| |clothing. |may be re-elected, some
| | |for life. Cases admitted
| | |at high rates of payment
| | |have special privileges.
| | |
| | |Medical Superintendent,
| | |Dr. Grabham. Secretary,
| | |Mr. W. Nicholas. Office,
| | |36 King William Street,
| | |London Bridge, E.C.
| | |
ROYAL ALBERT|Idiots and |Private cases |Cases elected, or
ASYLUM, |imbeciles, both|by votes of |admitted upon payment at
Lancaster. |private and |subscribers |£21 per annum with £5 5s.
|pauper cases, |_without |per annum for clothing,
|the latter not |canvassing_; |and pauper cases, must
|to exceed |or at |belong to the seven
|one-tenth of |reduced |northern counties, viz.
|the whole |payment. Also, |Lancashire, Yorkshire,
|number in |upon high rates|Cheshire, Westmoreland,
|the asylum. |of payment. |Cumberland, Durham, or
| |Pauper cases |Northumberland, and be
| |through the |hopeful of improvement.
| |boards of |The term of election is
| |guardians, who |for seven years. No
| |obtain the |canvassing allowed. The
| |Government |charge made for pauper
| |allowance of |cases is the sum charged
| |4s. per week |for admission into the
| |towards the |County Lunatic Asylum,
| |payment. |with 3 guineas extra for
| | |clothing. Full payment
| | |cases are admitted at 50
| | |guineas per annum and 10
| | |guineas extra for
| | |clothing. Cases admitted
| | |at higher rates have
| | |special privileges.
| | |
| | |Medical Superintendent,
| | |Dr. Shuttleworth.
| | |Secretary, Mr. James
| | |Diggens, Lancaster.
| | |
EASTERN |Idiots and |By votes of |Election cases must
COUNTIES |imbeciles |subscribers |reside in Essex, Suffolk,
ASYLUM FOR |above the |at |Norfolk, or
IDIOTS AND |pauper |half-yearly |Cambridgeshire. The term
IMBECILES, |class. |elections. |of election is for five
Colchester. | |By payments |years. Cases may be
| |commencing |re-elected, some for
| |at £50 per |life. Charge for payment
| |annum, |cases, admissible from
| |exclusive of |any locality, £50 per
| |clothing. |annum and £10 for
| | |clothing. Cases admitted
| | |at higher rates have
| | |special privileges.
| | |
| | |Superintendent, Mr. W.
| | |Millard. Secretary, Mr.
| | |J. J. C. Turner. Offices
| | |of Asylum, Station Road,
| | |Colchester.
| | |
WESTERN |Idiots and |By payments |Private cases that are
COUNTIES |imbeciles, |of 5s. or |admitted at 5s. per week
IDIOT |both private |10s. per |and pauper cases must
ASYLUM, |and pauper |week. Pauper |belong to the counties of
Starcross, |cases. |cases 5s. |Devonshire, Dorsetshire,
Exeter | |per week, |Cornwall, or
| |towards |Somersetshire. Cases are
| |which 4s. |admitted also upon a
| |per week is |higher rate than 10s. per
| |allowed by |week and have special
| |Government. |privileges.
| | |
| | |Superintendent and
| | |Secretary, Mr. W. Locke,
| | |Asylum, Starcross,
| | |Exeter.
| | |
MIDLAND |Idiots and |By election |Cases admitted by
COUNTIES |imbeciles |with payment |election with £10 per
IDIOT |belonging to |the of £10 |annum, or upon the
ASYLUM, |lower and |per annum. |reduced rate of payment,
Knowle, |higher |By reduced |£27 per annum and £5 for
Birmingham. |middle |and full |clothing, must belong to
|classes. |rates of |the counties of
| |payment. |Leicestershire,
| | |Shropshire,
| | |Staffordshire,
| | |Warwickshire, or
| | |Worcestershire. The full
| | |rate of payment is £54
| | |per annum and £10 extra
| | |for clothing. Cases are
| | |also admitted at higher
| | |rates, with special
| | |privileges. Cases may be
| | |re-elected.
| | |
| | |Superintendent, Miss
| | |Stock. Secretary, Mr. W.
| | |G. Blatch, Knowle,
| | |Birmingham.
| | |
THE BATH |Youthful |By payment |The ordinary rate of
INSTITUTION |idiots and |of £25 or |payment is £25 per annum,
FOR |imbeciles |£50 per |exclusive of clothing.
FEEBLE- |under 15 |annum, |Cases paying £50 per
MINDED |years of |exclusive of |annum have special
CHILDREN, |age. |clothing. |privileges. No medical
35, | | |certificates are required
Belvedere, | | |within seven days of
Bath. | | |admission, as needed for
| | |other asylums.
| | |
| | |Superintendent, Miss
| | |Heritage.
------------+---------------+---------------+-------------------------
In two or three counties there are branch asylums connected
with the county lunatic asylums, where pauper imbeciles and
harmless lunatics are placed; but training schools for pauper
idiots are not provided, except in Middlesex.
FOOTNOTES:
[224] Particulars respecting Switzerland and Germany were obtained for
the Charity Organization Committee by Drs. Ireland and Beach.
[225] It is due to the late Dr. Poole, of Montrose, to state that so
early as 1819 he drew attention to the education of idiots in an article
in the _Edinburgh Encyclopædia_.
[226] Dr. Ireland has now removed from Larbert to Preston Lodge,
Prestonpans, near Edinburgh, and receives imbeciles into his house.
CHAPTER IX.
SCOTLAND.
Our reference in a previous chapter to the singular superstitions
connected with the treatment of the insane in Scotland, renders it
unnecessary to do more than point out in this place the substratum of
popular opinion and feeling, upon which the infusion of new ideas and a
scientific system of treatment had to work. To some extent it was the
same in other countries, but judging from the records of the past, as
given or brought to light by writers like Heron, Dalyell, and Dr.
Mitchell, no country ever exceeded Scotland in the grossness of its
superstition and the unhappy consequences which flowed from it. When we
include in this the horrible treatment of the insane, from the prevalent
and for long inveterate belief in witchcraft, we cannot find language
sufficiently strong to characterize the conduct of the people, from the
highest to the lowest in the land, until this monstrous belief was
expelled by the spread of knowledge, the influence of which on conduct
and on law some do not sufficiently realize.
The lunatic and the witch of to-day might aptly exclaim--
"The good of ancient times let others state;
I think it lucky I was born so late."
As regards the property of the insane, the Scotch law, from a remote
period, appears to have been that the ward and custody of it belonged to
the prince as _pater patriæ_. In the beginning of the fourteenth
century, the keeping and custody of persons of "furious mind," by a
statute of Robert I., devolved upon their relatives, and, failing them,
on the justiciar or sheriff of the county. The custody of "fatuous
persons" is said to have been committed to the next agnate (nearest male
relative on the father's side), while that of the "furious" was
entrusted to the Crown, "as having the sole power of coercing with
fetters."[227]
An Act passed in 1585, c. 18, in consequence of abuses in regard to the
nominations of tutors-at-law, provided that the nearest agnate of the
lunatic should be preferred to the office of tutor-at-law. The practice
was originally to issue one brieve, applicable to both furiosity and
fatuity. The statute just mentioned continues the _regula regulans_, as
to the appointment of tutors-at-law for lunatics.
Passing over two centuries, I must observe that in 1792 Dr. Duncan (the
physician mentioned at p. 122 of this work), then President of the Royal
College of Physicians of Edinburgh, laid before that body a plan for
establishing a lunatic asylum in the neighbourhood of Edinburgh. That
plan, after due consideration, met with the unanimous approval of the
Colleges of Physicians and Surgeons, and a subscription was at once set
on foot to carry it into execution, nearly every Fellow of both Colleges
contributing something. But enough money was not then raised to start
the project in a practical way. Fourteen years afterwards, the attention
of the legislature was directed to the provision for the insane in
Scotland, when (in 1806) an Act (46 Geo. III., c. 156) was passed for
appropriating certain balances arising from forfeited estates in that
country to two objects, not apparently allied--the use of the British
fisheries and the erecting a lunatic asylum in Edinburgh--ichthyology
and psychology. The Act provided, among other clauses, that the Barons
of Exchequer should pay out of the unexhausted balance or surplus of the
moneys paid to them in 1784, by the Act 24 Geo. III., c. 57 (relating to
forfeited estates placed under the board or trustees), the sum of £2000
to the city of Edinburgh towards erecting a lunatic hospital. A royal
charter was obtained in 1807, and subscriptions were raised not only
from Scotland, but England, and even India, Ceylon, and the West Indies.
Madras alone subscribed £1000. The idea of the originators of the
institution was a charitable and very far-reaching one. They made
provision for three classes--paupers, intermediate, and a third in which
the patient had a servant to attend him. It may be mentioned that the
establishment of the Retreat of York and its success were constantly
referred to in appealing to the public for subscriptions. The building
which is now the "East House" was opened in 1813, and the plan of that
building was greatly superior to the prison-like arrangement of some of
the asylums built twenty or thirty years afterwards. From the beginning
the teaching of mental disease to students was considered, as well as
the cure and care of the inmates. The management was a wise one. There
were three governing bodies--the "ordinary managers," for transacting
the ordinary business; the "medical board" of five, consisting of the
President and three Fellows of the Colleges of Physicians and Surgeons;
and the "extraordinary managers," consisting of official and
representative men in and about Edinburgh, who had, along with the
ordinary managers, the election of the board every year. At first there
was a lay superintendent and visiting physicians.
Then there was an Act "regulating mad-houses in Scotland" (55 Geo. III.,
c. 69), passed in the year 1815--that important epoch in lunacy
legislation in the British Isles--brought in by the Lord Advocate of
Scotland (Mr. Colquhoun), Mr. W. Dundas, and General Wemyss, and which
received the royal assent, after several amendments from the House of
Lords, June 7, 1815.
This Act provided that sheriffs should grant licences for keeping
asylums; that no person should keep one without a licence; that the
money received for licences should form part of the rogue money in the
county or stewartry, and that out of it all the expenses required for
the execution of the Act should be defrayed; that inspectors should be
elected within a month after the passing of the Act, and thereafter
should annually inspect asylums twice a year--four by the Royal College
of Physicians in Edinburgh from their ordinary resident members, and
four by the faculty of physicians and surgeons in Glasgow from their
ordinary resident members; that sheriffs should ascertain whether
patients are properly confined; that the sheriff should make an order
for the reception of lunatics, upon a report or certificate signed by a
medical man (no statutory form was ordered for the medical certificates
or the warrants of the sheriffs; a medical man signing a certificate
without due examination of the patient was to forfeit £50); that the
sheriff or stewart might set persons improperly detained at liberty;
that a licence might be recalled upon report made to the sheriff by two
of the inspectors; that the sheriff might make rules for the proper
management of asylums; that the Act should not extend to public
hospitals, nor to single patients; that the Procurator Fiscal should
enforce the Act and recover penalties. The friends of patients were
required to pay an annual fee £2 2s.
Such were the main provisions of this Act, which proved to be an
important advance in the right direction, though far from perfect. It
was amended by 9 Geo. IV., c. 34, and 4 and 5 Vict., c. 60. The three
Acts were repealed and other provisions made by the 20 and 21 Vict., c.
71, an "Act for the Regulation, Care, and Treatment of Lunatics, and for
the Provision, Regulation, and Maintenance of Asylums."
I may add here, though anticipating the future course of events, that
the General Board of Commissioners in Scotland was established by the
Acts 20 and 21 Vict., c. 71, and 21 and 22 Vict., c. 54, both Acts
being amended by 25 and 26 Vict., c. 54, and 27 and 28 Vict., c. 59, the
latter continuing the appointment of Deputy Commissioners, and making
provisions for salaries, etc. The statutes now in force in Scotland are
the 20 and 21 Vict., c. 71; 21 and 22 Vict., c. 89; 25 and 26 Vict., c.
54; 27 and 28 Vict., c. 59; Act for the protection of property of
persons under mental incapacity, 12 and 13 Vict., c. 51; Act providing
for the custody of dangerous lunatics in Scotland, 4 and 5 Vict., c. 60
(repealed and other provisions made by fore-mentioned Acts); Act to
amend the law relating to lunacy in Scotland and to make further
provision for the care and treatment of lunatics, 29 and 30 Vict., c.
51; Act to amend the law relating to criminal and dangerous lunatics in
Scotland, 34 and 35 Vict., c. 55 (1871).
But we must retrace our steps to pursue the course of legislation a
little more in detail.
On the 3rd of February, 1818, a Bill for the erecting of district
lunatic asylums in Scotland for the care and confinement of lunatics,
brought in by Lord Binning and Mr. Brogden, was read the first time. A
few days after, a petition of the noblemen, gentlemen, freeholders,
justices for the peace, Commissioners of Supply, and other heritors of
the county of Ayr was presented against it, setting forth that the
petitioners, "from the first moment that they were made acquainted with
the principle and provisions of the proposed Bill, were deeply alarmed
for their own interests and those of Scotland in general, by the
introduction of a measure uncalled for and inexpedient, novel in its
application and arrangement, and substituting regulations of compulsion,
to the exclusion of the more salutary exertions of spontaneous charity,
and this, too, at a time when, by the gradual progress of enlightened
philanthropy, so many admirable institutions have been so lately
established in various parts of Scotland by voluntary contributions; and
that the petitioners are most willing to pay every just tribute of
respect to the humane views which may have dictated the proposed
measure, but they are satisfied that it must have owed its origin to
exaggerated and false representations of the state of the lunatics in
Scotland, and an unjust and groundless assumption of a want of humanity
in the people of Scotland toward objects afflicted with so severe a
calamity. The House cannot fail to remark that the proposed Bill
recognizes a systematic assessment, which it has been the wise policy of
our forefathers to avoid in practice, and that, too, to an amount at the
discretion of Commissioners ignorant of local circumstances, and perhaps
the dupes of misinformation; entertaining, as the petitioners do, deep
and well-grounded repugnance to the means proposed for carrying this
measure into execution, partly injudicious and partly degrading to the
landholders of Scotland, for it does appear to be a humiliating and, the
petitioners may venture to say, an unconstitutional Act, which would
place the whole landholders in Scotland in the situation of being taxed
for any object and to any amount at the discretion of any set of
Commissioners whatever; the petitioners therefore, confiding in the
wisdom of the House, humbly pray that the proposed Bill for providing
places for the confinement of lunatics in Scotland may not pass into
law."
Another petition against the Bill, from the magistrates and council of
the royal burgh of Ayr, was presented and read, praying that the same
may not pass into a law; or that if the House should think proper to
pass the said Bill, they would exempt the burgh and parish of Ayr from
its enactments.
Later on, another petition of the magistrates and town council of the
royal burgh of Montrose was presented against the Bill; and subsequently
one from Stirlingshire, Renfrew, Wigton, Edinburgh, Elgin, Glasgow,
Perth, Dumfries, and many other places.
The second reading was again and again deferred until the 1st of June,
when it was ordered "that the Bill be read a second time upon this day
three months." Thus persistent obstruction triumphed.
Sir Andrew Halliday, who took from an early period a lively interest in
the insane, writes in 1827: "I cannot but regret that the public refused
the adoption of a law for erecting district or county establishments,
proposed some years ago by that excellent nobleman, Lord Binning. The
rejection of this Act arose, I believe, neither from the parsimony nor
the poverty of the freeholders, but from a dread of introducing into the
kingdom that system which has been denominated the nightmare of England,
the poor's rates."[228]
How much legislation was needed at this period is well shown by the
description, by a philanthropist, of the condition of the lunatics in
the Perth Tolbooth, for which I am indebted to the late lamented Dr.
Lauder Lindsay, who observes: "Here is exactly what Mr. J. J. Gurney
says, and it is of special interest to us, as showing the sort of
provision made for the comfort of our local insane prior to the
establishment of the Murray Royal Institution in 1877, nine years
afterwards. In all probability Mr. Gurney's report, which was published
in his 'Notes on a Visit made to some of the Prisons of Scotland,' led
directly or indirectly to Mr. Murray's fortune being devoted to the
institution of an Hospital for the Insane. 'The old Jail of Perth is
built over a gateway in the middle of the town. Although this dark and
wretched building had been for some time disused as a prison, it was not
at the period of our visit' (Mr. Gurney's sister, Mrs. Fry, accompanied
him) 'without its unhappy inhabitants. We found in it two lunatics in a
most melancholy condition; both of them in solitary confinement, their
apartments dirty and gloomy; and a small dark closet, connected with
each of the rooms, filled up with a bed of straw. In these closets,
which are far more like the dens of wild animals than the habitations of
mankind, the poor men were lying with very little clothing upon them.
They appeared in a state of fatuity, the almost inevitable consequence
of the treatment to which they were exposed. _No one resided in the
house_ to superintend these afflicted persons, some man, living in the
town, having been appointed to feed them at certain hours of the day.
They were, in fact, treated _exactly as if they had been beasts_. A few
days after our visit, one of these poor creatures was found dead in his
bed. I suppose it to be in consequence of this event that the other,
though not recovered from his malady, again walks the streets of Perth
without control. It is much to be regretted that no medium can be found
between so cruel an incarceration and total want of care.'"
A return, signed "H. Hobhouse," was made in this year (1818) from the
parochial clergy in Scotland, showing the number of lunatics in each
county, and other particulars, which now possesses considerable interest
historically. The most important figures are as follows:--
TABLE
SHOWING THE NUMBER OF INSANE, ETC., IN THE SCOTCH SHIRES IN 1818 AND THE
NUMBER IN ASYLUMS.
--------------------------+----------------------------------
|
| Number of insane and idiots.
Shire. +-------+--------+--------+--------
| Male. |Female. | Total. | In
| | | |asylums.
--------------------------+-------+--------+--------+--------
Aberdeen | 197 | 226 | 423 | 41
Argyle | 171 | 122 | 293 | 9
Ayr | 110 | 104 | 214 | 14
Banff | 62 | 86 | 148 | 6
Berwick | 38 | 28 | 66 | 3
Bute | 32 | 27 | 59 | 1
Caithness | 45 | 29 | 74 | 0
Clackmannan and Cromarty | 20 | 19 | 39 | 1
Dumbarton | 44 | 38 | 82 | 6
Dumfries | 84 | 79 | 163 | 15
Edinburgh | 132 | 153 | 285 | 148
Elgin | 32 | 47 | 79 | 4
Fife | 115 | 127 | 242 | 11
Forfar | 122 | 154 | 276 | 37
Haddington | 44 | 36 | 80 | 9
Inverness | 130 | 110 | 240 | 10
Kincardine | 52 | 58 | 110 | 5
Kinross | 6 | 9 | 15 | 1
Kirkcudbright | 42 | 35 | 77 | 5
Lanark | 156 | 193 | 349 | 28
Linlithgow | 25 | 35 | 60 | 1
Nairn | 4 | 20 | 24 | 0
Orkney and Shetland | 67 | 62 | 129 | 0
Peebles | 12 | 16 | 28 | 0
Perth | 179 | 134 | 313 | 17
Renfrew | 94 | 81 | 175 | 24
Ross | 107 | 103 | 210 | 4
Roxburgh | 52 | 56 | 108 | 10
Selkirk | 6 | 6 | 12 | 0
Sterling | 58 | 64 | 122 | 4
Sutherland | 36 | 27 | 63 | 1
Wigton | 30 | 40 | 70 | 4
+-------+--------+--------+--------
| 2304 | 2324 | 4628 | 417
--------------------------+-------+--------+--------+--------
From this table it will be seen that the total number was 4628, of whom
2304 were males and 2324 females. With regard to their distribution,
there were--
In public asylums 258
In private asylums 158
With friends 1357
At large 2855
----
Total 4628
Two thousand one hundred and forty-nine were maintained wholly or in
part by the parish. Fifty parishes failed to send any return. In one
parish in the city of Edinburgh, from which we have no return, were
situated the "Edinburgh Bedlam" and the Charity Workhouse. In these two
places were confined eighty-eight lunatics and idiots. From Glasgow the
returns did not include ninety-five lunatics and idiots confined in the
Glasgow Asylum and Towns Hospital; 187 patients must therefore be added
to the foregoing, making a total of 4815.
Considering the period at which it was made, this is a very remarkable
return, and was much more complete than some later ones; for instance,
in 1826 the Parliamentary returns were ridiculously below these figures,
and Sir Andrew Halliday could only after diligent inquiry bring up the
number to 3700.[229]
Two years later (1828), a Bill was brought into the House of Commons to
amend the Act 55 Geo. III., c. 69,[230] by the Lord Advocate, Mr. H.
Drummond, and Mr. Robert Gordon. It passed the House of Lords, and
received the royal assent June 27th.
This constituted the Act 9 Geo. IV., c. 34, and reduced the fees paid
for persons confined from £2 2s. to 10s. 6d.; admission and discharge
books were ordered to be kept in every asylum, and an entry made of
every act of coercion; the books of the asylum were to be submitted to
the inspectors; no insane person was to be received into a hospital
without a warrant from the sheriff, who was to inspect hospitals; houses
were to be visited by medical men--those containing less than one
hundred patients, in case such house should not be kept by a physician
or surgeon, were to be visited twice in every week by a physician or
surgeon--signing in a register the condition of the house and state of
health of the patients; a register was also to be kept by the resident
physician or surgeon, and such register was to be regularly laid before
the inspectors, who were required to sign the same in testimony of its
production; ministers were empowered to visit mad-houses in their
parishes; regulations were made as to persons with whom lunatics were
privately confined; the justices might appoint three of their number to
inspect hospitals and private mad-houses; lastly, a weekly register was
to be kept in each house, and to be laid before the inspectors, stating
the number of curable and incurable cases, and the number under
restraint, the necessity thereof being certified by a medical man.
I wish to record here that, so far back as 1838, some of the Scotch
asylums were remarkable for the extent to which labour was introduced.
Being engaged in writing an introduction to Jacobi's work "On the
Construction of Asylums," the editor (Mr. S. Tuke) visited the asylums
of Scotland in that year, accompanied by Mr. Williams, the visiting
medical officer of the York Retreat, and found at Perth, Dundee, and
Aberdeen, the men's wards nearly empty, so large a proportion of their
inmates were in one way or other engaged in labour. "At Perth," he
writes, "more than twenty came in together to dinner from the labours of
the farm; others were employed in the garden and about the premises. At
Dundee at nine o'clock in the morning, out of fifty-seven men patients
of the lower class, twelve were engaged in stone-breaking, eight in
gardening, thirteen in weaving, one in tailoring, two as shoemakers,
whilst a few were engaged in the preparation of tow for spinning, and
several in the various services of the house. In the Aberdeen Asylum, in
which the labour system is extensively introduced, we were particularly
pleased with the state of the lowest class of women patients--chiefly in
an idiotic and demented state. All of these but one, and she was in a
state of temporary active mania, were employed in picking wool or some
other simple occupation. Indeed, in the three asylums which I have just
mentioned, the state of the lowest class of patients offers a striking
contrast to that in which they have been usually found in our asylums.
Those dismal-looking objects, cringing in the corners of the rooms or
squatting on the ground, almost lost to the human form, are here not to
be seen. I must not omit to mention that at Aberdeen the manager had
succeeded in inducing the higher class of patients to engage in
gardening, etc. At Glasgow the governors were contemplating arrangements
for the more extensive introduction of the labour system. In all these
asylums the superintendents expressed their decided conviction of the
benefit which, in a great variety of ways, was derived from the
employment of the patients, more especially in outdoor labour."
In connection with the Dundee and Glasgow asylums, the great services
rendered by Dr. McIntosh ought not to be forgotten, as also those of Dr.
Poole (Montrose), Dr. Malcolm (Perth), and Dr. Hutcheson (Gartnavel).
Scotland south of Edinburgh and Glasgow had not, until 1839, any
retreat or place of confinement for the insane, except six squalid stone
cells attached to the public hospital of Dumfries. Violent or vagrant
lunatics were physically restrained in their own houses, allowed to roam
at large, or incarcerated in prisons or police stations. In the year
mentioned, the Crichton Institution was opened for the reception of
patients of all ranks and means, from the pauper to the peer, in other
words, at rates of board from £17 to £350. In those days the building
was regarded as magnificent, commodious, and much in advance of the
prevalent psychiatry in Scotland, in the provision for the restoration
of mental and physical health, and for securing the comfort and
happiness of the inmates. The funds providing this building and
surrounding fields, had been bequeathed by Dr. Crichton, of Friars
Carse, Dumfriesshire, to his widow, who determined the precise
application of the magnificent legacy, which it is reported amounted to
£120,000. The benevolent foundress caused the structure to have the
Bible as a foundation, instead of a stone, and announced her solemn
intention that the establishment should be conducted, not merely in
accordance with science, but the principles of Christian philanthropy.
The first medical superintendent, Dr. W. A. F. Browne, who had made a
critical examination of European asylums, and had acted as the chief
officer in the Montrose Lunatic Asylum during four years, opened the
Crichton Institution in 1839, with what were regarded as sound but
advanced views, and with the resolution of carrying into effect all
that had been discovered or suggested for the amelioration, cure, and
care of those who might require treatment or seclusion.
Before the close of the first year of his management, there would appear
to have been about a hundred individuals, of various stations and in
various mental conditions, consigned to his charge. For these and the
gradually increasing numbers of the population, he instituted daily
exercise, amusement, occupation in the open air and in the grounds of
the establishment, and during winter or inclement weather, billiards,
bagatelle, "summer ice," and walking in the protected balconies
connected with every ward or gallery in the house. Collections of books
were contemporary with the laboratory, and the medical officers
invariably carried a catalogue, along with a prescription book, in their
daily medical visits to every patient. As a rule, remuneration was
ordained for every description of labour, whether it was mental or
manual, and might take a pecuniary or honorary form. From the
commencement no personal restraint was resorted to, although the medical
director did not bind himself either by rules or avowed opinions to
prohibit mechanical resources, should they appear to be demanded for the
preservation of life or strength, or quiet, or in any respect as a
remedial agent. In 1840 a medical assistant or pupil was appointed. The
experiment proved eminently successful, and the course thus foreshadowed
has been universally adopted, and improved upon by increase in the
number of such fellow labourers, by the addition of clinical clerks, and
so forth. The next advance was in instituting recorded observations of
the state of patients during the night as well as the day; in the
addition of carriages as a means of enjoyment and distraction, one of
these being an omnibus, so that groups of the inmates might be conveyed
to distant parts of the surrounding country; and in the multiplication
of hygienic and moral influences, music, painting, translation, study of
medicine, acquisition of languages, teaching, reading prayers, etc. The
next stage of development may be described as the separation of
different classes of patients; provision for the agitated, for
abstainers; mental culture for all capable of receiving impressions,
lectures, public readings, the production of a monthly periodical which
is still continued. Of this institution we shall have to speak again.
An Act to alter and amend certain Acts regulating mad-houses in
Scotland, and to provide for the custody of dangerous lunatics, was
passed in June, 1841 (4 and 5 Vict., c. 60). It amended 55 Geo. III., c.
69, and 9 Geo. IV., c. 34. A penalty of £200 and the expenses of
recovering the same might be imposed on persons sending any lunatic to a
mad-house without a licence; persons convicted of receiving lunatics
without a licence, or the required order, might be imprisoned in default
of penalty; the sheriff on application of the Procurator Fiscal might
commit dangerous lunatics; the expenses were to be defrayed out of the
rogue money, if the person had not the means of defraying, or if it
could not be recovered out of his estate, then the same was to be
defrayed by the parish which would be liable for the maintenance of
such lunatic if he or she were a pauper; lunatics might be removed on
application by the Procurator Fiscal; parish pauper lunatics were to be
confined in public hospitals; if no public hospital in the county, the
sheriff might send lunatics to an adjoining county; the death of a
lunatic was to be intimated to the sheriff in writing by the person
keeping the licensed mad-house; fees of licences might be diminished if
the moneys received exceeded the sums required for carrying this Act
into execution.
A form of register was to be kept in all licensed mad-houses in
Scotland, indicating the house; where situated and kept; names and
designations of individuals confined; date of reception; at whose
instance confined, and on whose medical certificate; whether curable or
incurable; date of removal or discharge, and authority for either; date
of death; disease or cause of death, and duration of disorder; name of
medical practitioner; when first called to give special attendance, and
how often he afterwards visited the deceased, with the place of burial.
We must not omit to mention that in 1848 further legislation was
attempted--an attempt, the failure of which was frequently deplored in
the debates of succeeding years. A good Bill designed to amend the law
of Scotland relative to the care and custody of the insane, and to
regulate existing asylums, and to establish asylums for pauper lunatics,
was brought in by the Lord Advocate (Lord Rutherfurd), Sir George Grey,
and the Secretary at War. After the second reading it was referred to a
Select Committee, which included the names of the Lord Advocate, Lord
Ashley, Sir James Graham, Mr. E. Ellice, Mr. Stuart Wortley, and Mr. H.
Drummond. Petitions now poured in from almost every shire in Scotland,
and the Bill had unfortunately to be withdrawn. Undaunted, the Lord
Advocate made another attempt in the following year, but with the same
result.
It is not necessary to dwell longer on the condition of the insane, or
the legislation adopted on their behalf, till we come to the year 1855,
which proved to be the commencement of a new departure in the care taken
for them by the State. Unfortunately, in spite of legal enactments, the
state of the insane in Scotland, at this time, outside the asylums was
as bad as it could be, and even in some asylums it was deplorable. At
this period a well-known American lady, Miss Dix, who devoted her life
to the interests of the insane, visited Scotland, and the writer had the
opportunity of hearing from her own lips, on her return from her
philanthropic expedition, the narration of what she saw of the cruel
neglect of the pauper lunatics in that country. She caused so much
sensation by her visits and her remonstrances, accompanied by the
intimation that she should report what she had witnessed at
head-quarters in London, that a certain official in Edinburgh decided to
anticipate "the American Invader," as Dr. W. A. F. Browne called her.
Miss Dix was, however, equal to the occasion, and, hurriedly leaving the
scene of her investigations, she took the night mail to London, and
appeared before the Home Secretary on the following day, when the
gentleman from Edinburgh was still on the road, quite unconscious that
the good lady had already traversed it.[231] The facts she laid before
the Home Office were so startling that they produced a marked effect,
and, notwithstanding counter allegations, the conclusion was very soon
arrived at that there was sufficient _primâ facie_ evidence to justify
an inquiry. A Royal Commission was appointed, dated April 3, 1855, "to
inquire into the condition of lunatic asylums in Scotland, and the
existing state of the law of that country in reference to lunatics and
lunatic asylums."
The statutes forming the code of lunacy law for Scotland at that period
were, for all practical purposes, the 55 Geo. III., c. 69; 9 Geo. IV.,
c. 34; and 4 and 5 Vict., c. 60.
The number of ascertained patients at this period (1855) amounted to
7403. The classification was as follows:--Private patients, 2732;
paupers, 4642; criminals, 29 = 7403. Curable, 768; incurable, 4032;
congenital idiots and imbeciles, 2603 = 7403. Males, 3736; females, 3667
= 7403. The proportion of the insane and idiots to the population was 1
in 390. The number of congenital idiots was greatest in proportion to
the population in those counties remote from influences that incite to
mental activity--the Highland population containing more than three
times the number found in an equal Lowland population.
The 2732 private patients were thus distributed: In chartered asylums,
652; licensed houses, 231; poor-houses, 9; reported houses, 10; school
for idiots, 12; unlicensed houses, 18; with relatives, 1453; with
strangers, 297; not under any care, 50; total, 2732.
The 4642 paupers were thus distributed: In chartered asylums, 1511;
licensed houses, 426; poor-houses, 667; reported houses, 31; school for
idiots, 3; unlicensed houses, 6; with relatives, 1217; with strangers,
640; not under any care, 141; total, 4642.
The receptacles for the insane were thus distributed:--
A. Chartered asylums. The Royal Asylums at Aberdeen, Dundee, Edinburgh,
Glasgow, Montrose; the Crichton Institution, Dumfries, including the
Southern Counties Asylum; James Murray's Royal Asylum, Perth.
B. Public asylums not incorporated. The only institution of the kind,
that of Elgin, was exclusively for paupers.
C. Poor-houses with separate wards for the insane (twelve given in the
table).
D. Prisons. The only one specially adapted for the reception of the
insane was the lunatic department of the general prison at Perth.
E. Poor-houses without separate wards for the insane (fourteen given).
F. Private asylums (twenty-three in number).
G. Private houses reported to the sheriff.
H. Houses of relatives and strangers.
I. Schools for idiots. Baldovan, near Dundee; and Gayfield Square,
Edinburgh.
This Commission did not report until 1857, and unhappily the evidence
more than justified the necessity of the appointment of the Committee,
and of a sweeping measure of reform. The difficulty in selecting
passages from the Report is to know where to stop. We shall restrict
ourselves within moderate bounds; and first let us cite the reference to
the condition of the insane and idiotic not in asylums. "It is obvious,"
says the Report, "that an appalling amount of misery prevails throughout
Scotland in this respect. When estimating the condition of the insane
not in establishments, it should be remembered that the details
furnished by us give only an imperfect representation of the true state
of matters. They form only a part of the picture of misery; and, had we
been able to extend our investigations, it would, we are convinced, have
assumed a much darker shade.
"A practice prevails in some workhouses, as in a few of the licensed
asylums, of fastening the hands behind the back, by which much
unnecessary pain is inflicted on the patient."
Of the methods employed in _asylums_ to repress violence, etc., the
Report thus speaks:--
"_Instrumental Restraint and Seclusion._--Personal restraint by the
application of the strait waistcoat, or of the straps or muffs, is
almost entirely banished from the chartered asylums; but we have reason
to think that seclusion for long periods is frequently used. This remark
applies more especially to the asylums of Montrose, Glasgow, Aberdeen,
and Edinburgh. In Montrose we found, on one occasion, eleven patients in
seclusion out of a population of 174, several of them having been so
secluded for considerable periods, and one woman for several months; and
it is to be observed that the seclusion rooms in this asylum are _mere
cells, with stone floors and darkened windows_, and that the patients
who are placed in them are frequently allowed no other covering than
blankets, and no other bedding than loose straw cast on the floor."
Here is a picture of the way in which one asylum was conducted: "We have
grounds for fearing that the patients suffered from cold. The house is
carelessly conducted and the state of the patients very unsatisfactory.
The bed-frames, which are about the ordinary size with only spars of
wood at the lower part, were dilapidated and saturated with filth; and
the quantity of straw in them was very scanty and mixed with refuse; it
was wet, offensive, and broken into small portions, and had clearly not
been renewed for a considerable time. A certain number of the patients,
males as well as females, were stripped naked at night, and in some
cases two, and in one case even three, of them were placed to sleep in
the same bed-frame, on loose straw, in a state of perfect nudity." The
proprietor in his evidence says, "I never go into the rooms at night.
The floor is constantly soaked with wet. There is an epileptic lad who
is frequently fastened to the rings in the wall. The nurses keep the
muffs in their custody. I dare say half of the dirty patients would
sleep naked; seven would, therefore, sleep with others, I cannot say
that more did not sleep together in a state of nudity. _I consider the
treatment is proper for them._"
Again: "The bad treatment of the patients, and the very unsatisfactory
treatment of the patients, are not fully known to the official
inspectors. Indeed, it would appear that in some houses the instruments
of restraint are systematically removed from the persons of the patients
after the arrival of the sheriff at the asylum, for we find in Dr.
Renton's evidence that, speaking of L---- Asylum, in which two male
patients are kept constantly in restraint by means of handcuffs, he
says, 'There are not many patients under restraint at L----.' And,
further, in reference to Mrs. B----'s house at N----, he states, 'In
Mrs. B----'s house I don't think there are many cases of restraint.
There is a Miss W---- lately come, and a Miss M----. I don't think
restraint is used to them.' We have ascertained, however, that these two
patients were frequently restrained. These instances might be
multiplied.
"_Rent is saved_ by placing patients in small houses, making them use
the same rooms both as day and sleeping accommodation; they are also
crowded into small airing-courts, inadequate to afford proper exercise
and a proper separation of the sexes. The inmates during the winter
months pass the greater part of each twenty-four hours in their bed,
_whereby candle-light is saved_. In L---- Asylum, the patients are not
allowed candle-light at any season.
"We cannot doubt that in many instances practices obviously wrong, and
detrimental to the patients, have been adopted in licensed houses,
because an increased profit would thereby be obtained by the
proprietor."
In short, both as regards licensed houses and unlicensed houses, the
Report winds up by giving a dismal picture; for, as to the former, "they
are crowded in an extreme degree, profit is the principal object of the
proprietors, and the securities against abuse are very inadequate;" and
as to the latter, they "have been opened as trading concerns, for the
reception of certain classes of patients who are detained in them
without any safeguard whatever against ill-treatment and abuse." Strange
to say, the persons properly authorized to inspect, did not avail
themselves of the powers of inspection granted them by law; and the
officials chose to interpret the law "in conformity with their
respective views." Such was the unfortunate condition into which Scotch
lunacy had drifted, at so comparatively recent a date as 1857, and out
of which those who drew up the Report--Alexander E. Monteith, James
Coxe, Samuel Gaskell, and William George Campbell--proposed to deliver
it by the following remedial measures:--The erection of district or
county asylums for pauper lunatics, including accommodation for the
insane belonging to the labouring classes, who are not strictly
paupers. Likewise, more suitable accommodation for criminal lunatics.
Means for insuring greater caution and discrimination as regards the
licensing of houses for the reception of the insane; for imposing some
check upon the licensing of new houses; and for conferring powers to
close those already opened for paupers so soon as public asylums shall
be erected, or at any other time, if not properly conducted. Regulations
by which all pauper lunatics not in asylums shall be brought under
proper visitation and care, and periodical reports be made as to their
condition by medical men, so as to afford a safeguard against abuse and
ill-treatment, and secure the ready and careful transmission of all
proper cases to asylums. An accurate definition of the powers and duties
of sheriffs in reference to the insane, so as to secure a more uniform
practice and united action amongst them. Rules for the guidance of the
Board of Supervision, parochial boards, inspectors of poor, and district
medical officers in all matters relating to the management of the
insane. More complete regulations in reference to medical certificates;
to prevent interested parties signing them; to specify the length of
time the document shall remain in force; and to require a statement of
the facts or evidence upon which the opinion as to the patient's
insanity is founded. Also a limitation of the time during which the
sheriff's order shall remain in force, previous to the admission of the
patient, and also in case of escape. The formation of a complete system
of schedules and returns, together with full records of all admissions,
discharges, deaths, and accidents. Also the institution of registers
and case-books, showing the medical treatment pursued in each case, and
whether, and to what extent, restraint and seclusion were employed.
Comprehensive regulations applicable to licensed houses and poor-houses,
while continuing to receive lunatics, for securing to the patients
sufficient medical and other attendance; kind and appropriate treatment;
proper diet, clothing, bedding, exercise, and recreation; and adequate
means of religious consolation. A requirement that, on recovery,
patients shall be discharged by the medical attendant of the
establishment. Restrictions on the removal of pauper patients by
inspectors before recovery. Precautions for preventing injustice in
transporting aliens. Better regulations as to dangerous and criminal
patients. Measures by which persons labouring under insanity may
voluntarily place themselves under care in an asylum. Special
regulations for prolonging control over cases of insanity arising from
intoxication. Enactments for extending further protection to the
property of lunatics, and for insuring the proper application of their
funds. The imposition of suitable penalties for infringement of the law,
and power to modify them according to circumstances. Powers to raise
sufficient funds for the purposes of the Act. The creation of a
competent board, invested with due authority, to whom the general
superintendence of the insane in Scotland shall be entrusted, including
power to license houses for the reception of the insane; to visit all
asylums, licensed houses, poor-houses, and houses containing only single
patients; to order the removal of patients to or from an asylum, or
from one asylum to another; to give leave of absence to convalescent
patients; to regulate the diet in asylums and licensed houses for pauper
patients; to make regulations for their management, etc., etc.; with
direction to report to the Secretary of State for the Home Department.
The formation of local boards for the management of individual asylums,
which shall act in conjunction with the general board.
Legislation followed in due time.
On the 29th of May, 1857, Mr. Ellice,[232] the member for St. Andrew's,
asked the Government what steps they intended to take for securing to
pauper lunatics in Scotland proper protection and maintenance, in order
to alleviate the sufferings of the persons to whom the recent Report of
the Commissioners of Inquiry into the state of Lunatics in Scotland
related. He was ashamed to have to admit that in that country,
unfortunately, the state of things had been lamentably different from
England and Ireland, where boards had been appointed under which,
generally speaking, the law for the protection of lunatics had been
satisfactorily administered. In Scotland, instead of a Board of
Commissioners specially appointed to take care of lunatics, the charge
had devolved upon the sheriffs of counties and the Board of Supervision,
which latter body stood in the place of the Poor Law Board in this
country. He charged the Scotch authorities with an almost total neglect
of the duties which were incumbent upon them under the law, which "in a
great measure was very ample for the protection of the great proportion
of the pauper lunatics in Scotland, if it were properly administered."
The powers and duties of the sheriffs, as laid down in the Act, were
amply sufficient. Yet the granting of licences, which was their duty,
formed the exception, and, in fact, houses were opened generally without
any licence whatever; the patients were detained without any order, or
without even any medical certificate; if they died, their friends were
not informed of their deaths, which were not reported to any constituted
authority, "the unfortunate persons disappearing in that mass of misery
and filth which he should shortly depict." The pauper lunatics were
under the charge of the parochial boards. These were under the control
of the Board of Supervision, sitting in Edinburgh, and similar to the
Poor Law Board in London. The statute enacted that whenever any poor
person chargeable on the parish should become insane, the parochial
board should, within fourteen days of his being certified, take care
that he was properly lodged in an asylum. The Board of Supervision had,
under the same Act, peculiar power with respect to lunatics, and it was
competent for them to dispense with an asylum, and allow the patient to
remain with his friends under due inspection.
The Board of Supervision had absolute powers to dismiss any inspectors
of the poor neglecting their duty to pauper lunatics. They acknowledged
their obligation. In their first Report (1847) they, among other
positive statements, affirm that they, in all cases in which they
dispensed with the removal of pauper lunatics to asylums, were careful
to preserve the necessary safeguards against abuse, by requiring a
satisfactory medical certificate as to treatment, and so on. Mr. Ellice
then showed that "these statements had no foundation in fact; that they
were positively untruths, and entirely deceptive, year after year, as to
the real state of the lunatics in Scotland." In subsequent Reports the
Board boasted that it had endeavoured, not unsuccessfully, to improve
the condition of the insane, but Mr. Ellice showed that "the condition
and treatment of the pauper lunatics was diametrically opposite to what
was there stated." He knew that more legislation would be promised by
the Government, but the thing was to see that the law was enforced, and
that due notice should be taken of the conduct of the authorities who
had neglected their duties. He asked that a direct condemnation should
be passed upon them, and that they should be compelled, as in duty
bound, to protect pauper lunatics from continued neglect and abuse. The
member for Aberdeen characterized the Report of Commissioners regarding
the state of the insane in his county as "one of the most horrifying
documents he had ever seen."[233] It was "a state of things which they
could not before have believed to prevail in any civilized country, much
less in this country, which laid peculiar claims to civilization, and
boasted of its religious and humane principles."[234] "Distressing as
were the cases which he had mentioned, there were others ten times worse
remaining behind--so horrible, indeed, that he durst not venture to
shock the feelings of the House by relating them."[235] Sir George Grey,
after saying that the Report on the treatment of lunatics in Scotland
contained statements of facts calculated to cast very great discredit
upon that portion of the United Kingdom, admitted that the Board of
Supervision was not free from blame, but thought the Report proved that
the guilt must be shared by the parochial boards, the inspectors of the
poor, the sheriffs, the clergy, the justices of the peace, and by the
Commissioners of Supply. By this ingenious homœopathic dilution of
the blame, it was easy to show that individual responsibility was
infinitesimal, and could not, therefore, be detected and punished in the
way it so richly merited. Sir George Grey promised to introduce a Bill
calculated to remove the defects in the law established by the Reports,
and deplored the fate of the Bill brought in by Lord Rutherfurd,[236]
when Lord Advocate, which would, in his opinion, have remedied all the
evils now complained of. It was "referred to a Select Committee, but the
opposition roused to it in Scotland, on the miserable ground of the
expense it would incur, proved fatal to the measure. I trust the
disgrace that now attaches to Scotland in this matter will be removed,
and that this and the other House of Parliament will cordially
co-operate with the Government in the adoption of those measures that
are necessary for the relief and protection of the unfortunate class of
persons referred to in the Report."[237] Mr. H. Drummond, who said he
had assisted Lord Rutherfurd to pass his Bill, also deplored its
rejection. "Both he and the Lord Advocate were beaten by the systematic
opposition of every single person who was connected with the
administration of the system in Scotland. They would not give the
returns sought for ... and the ground of the opposition was the dread of
the dirty expense which might be incurred. From one to the other it
appeared that the object of care in Scotland was property, not persons.
The way in which they treated the poor in Scotland was perfectly
scandalous, and in nothing did the system appear so bad as in the
treatment of pauper lunatics, the rich lunatics being sufficiently well
taken care of." Mr. Drummond asked how it was "that throughout the whole
of Scotland there was not one clergyman who could find time to visit
these poor creatures? True, there was one, but when he went to the
asylum he was refused admittance; and why? Because he was a Papist. The
Poor Law, as managed by the Board of Supervision, had been well defined
to be 'a law for depriving the poor of their just rights.'"[238] Sir
Edward Colebrooke, as one of the members for Scotland in the previous
Parliament, took his share of the blame that attached to the House in
reference to Scotch asylums. In the Report issued in 1844, it was
recommended that more stringent provisions should be introduced into the
law, but they had not been attended to. Mr. Kinnaird, the member for
Perth, thought that the Scotch members owed a debt of gratitude to Mr.
Ellice for the manner in which he had laid the disgraceful feature in
the administration of the Scotch Poor Law before the House. He was glad
to find that the Perth Asylum was not one which had disgraced
Scotland.[239] The Lord Advocate rejoiced at the publication of the
Report, and the statements of Mr. Ellice, from the bottom of his heart,
because the state of things had for a long time been a disgrace and a
scandal to Scotland. "The people of that country had known that it was a
disgrace and a scandal, and he regretted to add that it was not the
first time that statements had been made similar to those to which they
had just listened. Had Lord Rutherfurd's Bill of 1848 been passed, this
disgraceful state of things would have been put an end to. But not a
single petition was presented in its favour, while twelve of the largest
and most important counties of Scotland petitioned against it! That
noble-minded lady, Miss Dix, went to Edinburgh and visited the asylums
at Musselburgh. After seeing them, she said there was something wrong,
and she wished to be allowed to visit them at the dead of night, when
she would not be expected. He felt a difficulty about giving a
permission of that kind to a non-official person, and accordingly she
applied to the Home Secretary. When asked by him his opinion of the
subject, he at once stated that the whole system with regard to the
treatment of lunacy in Scotland was utterly disgraceful, and that the
evil could only be reached by a Commission of Inquiry. The facts were
now so clearly proved that if he proposed the very remedy which was
rejected in 1848, it would be adopted by both Houses of Parliament
without any important opposition."
A Government Bill was brought in by the Lord Advocate, June 9, 1857, "to
alter and amend the laws respecting lunatics in Scotland." In
introducing it, he summarized the then law as follows:--The sheriffs of
the counties, the justices, and some other parties had the power and
duty of inspection once or twice a year; certain registers were ordered
to be kept and certain regulations made. But there was no uniformity;
every sheriff might interpret the Act as he pleased, and there was no
obligation to erect asylums for the maintenance of lunatics. The duty
was thrown on the Procurator Fiscal of seeing the Act executed, but no
power was given him to ascertain whether it was executed or not, and
there was no power of visitation. He need not say that these safeguards
entirely failed, and the remedy he now proposed was that there should be
appointed a Commission, an inspector-general who should be a medical
man, a secretary, and a clerk; and that these should constitute the
Lunacy Board for Scotland, though not under that name. They would have
the power of granting and refusing licences for asylums. The sheriffs
and the justices would retain the powers conferred on them already.
Scotland would be divided into districts, in which asylums would be
erected by an assessment laid on for the purpose. The Lord Advocate made
a sort of formal defence of the Board of Supervision, of which he
himself had been a member, and pointed out that in their first Report
they had stated that the accommodation in the asylums was not equal to
that required for one-tenth of the number of pauper lunatics. Sir John
McNeill, who presided over the Board, when examined before the Select
Committee on Miscellaneous Expenditure in 1848, stated this fact
strongly. Mr. Ellice, however, adhered to the remarks he had previously
made, reasserted his accusations, and repeated that if the question were
put to a jury, they would come to no other decision than that gross
culpability existed on the part of the authorities, and he only
regretted that the Government had not had the courage to say that the
Board of Supervision had deserved the condemnation of the House. Leave
was given to bring in the Bill.[240]
On the second reading[241] (June 9, 1857) no serious opposition was
offered to the Bill, although an attempt was made to show that the
Commission had been carried away by exaggerated statements. Mr. Bruce,
the member for Elginshire, who alleged this, hoped the Bill would not be
hurried through the House that session. Mr. Blackburn, the member for
Stirlingshire, said he agreed with every Scotch member that a permanent
board would be of no use; it would be coercing the people by
centralization. Mr. Cowan, member for Edinburgh, said that he had been
requested to present a petition, signed by the Lord Provost and
magistrates of Edinburgh, seeking for delay, but he did not like to
incur that responsibility, and would therefore support the second
reading. Mr. Dunlop, the member for Greenock, assumed, for the sake of
argument, that all persons in Scotland had done their duty; but even if
this were so, it was impossible but that cruelty and ill-treatment must
have taken place when they considered the way in which pauper lunatics
were treated, and he rejoiced that another session was not likely to
pass over without something being done to remove what was at once a
national calamity and a national crime, from Scotland.[242] Mr. Mackie,
the member for Kirkcudbrightshire, protested against the creation of a
new Board and the expensive machinery contemplated by the Bill. Sir
William Dunbar, the member for Wigton, agreed, and maintained that the
existing system was sufficient to insure all that was required. Sir John
Ogilvy, member for Dundee, said a strong feeling existed in Scotland
that the Board of Supervision furnished an efficient machinery capable
of supplying all the defects of the present system, without the creation
of a new Board. Mr. Hope Johnstone, member for Dumfriesshire, enforced
these remonstrances, by stating that he had representations made to him
from every quarter in opposition to the appointment of a new Board. Mr.
Drummond hereupon made an observation, greatly to his credit, which
deserves to be remembered. He said that the question was not so much
what would be the most expensive as what would be the most efficient
machinery. There were plenty of representatives of the ratepayers in
that House, _but no representatives of the lunatics of Scotland_. They
seemed to have no friends there, while really they were the persons who
stood most in need of being represented.
The Act (20 and 21 Vict., c. 71) was passed August 25, 1857. It was
entitled "An Act for the Regulation of the Care and Treatment of
Lunatics, and for the Provision, Maintenance, and Regulation of Lunatic
Asylums in Scotland." It repealed the Acts 55 Geo. III., c. 69; 9 Geo.
IV., c. 34; and 4 and 5 Vict., c. 60.
To give a complete analysis of this most valuable Act, which consists of
no less than 114 sections, would be wearisome to the reader. Its chief
provisions were these:--
A Board of Commissioners in Lunacy for Scotland was to be appointed,
consisting of three unpaid and two paid Commissioners; the Secretary of
State was empowered to appoint one or two medical men as Deputy
Commissioners; public asylums founded after the passing of this Act were
to be subject to it; the duties of the Commissioners as to inspection
were laid down; the sheriff was to visit and inspect asylums; private
asylums were to be licensed by the Board; the patient was to be admitted
by order of the sheriff on medical certificates; five shillings were to
be paid for the sheriff's order for the admission of a patient not being
a pauper, and half that sum for a pauper; the medical certificate was to
specify the facts on which opinion of insanity was founded; no
certificate was to be granted without examination, under penalty not
exceeding £50, and if falsely granted, under a penalty not exceeding
£300; houses where lunatics were detained under the order of the
sheriff might be visited by the Board; one medical man was to be
resident in every asylum licensed for a hundred patients or more, and a
physician was obliged to visit daily those for more than fifty patients;
those for fifty or less were to be visited at least twice in every week.
Scotland was divided into districts, set forth in a schedule, and a
district board was to be appointed within six months, which should
inquire into the necessities of the district; the Board was to require
the district boards to provide district asylums; the provisions of 2 and
3 Vict., c. 42, were to be applied to this Act; district asylums were to
be vested in district boards, and district inspectors were to be
appointed.
Power was given to Public Works Loan Commissioners to lend money for
purposes of the Act, provision being made for the money borrowed being
paid off within thirty years.
In case the district asylum could accommodate more than the lunatics of
the district, other lunatics, it was enacted, might be admitted.
Whether the property of a lunatic was or was not under judicial
management, if it was not property applied for his benefit, application
was to be made to the Court of Session.
Provision was also made for cases where insanity stands in bar of trial;
the finding of the Court that the prisoner cannot be tried, to be
followed by an order to be kept in strict custody during her Majesty's
pleasure; a lunatic acquitted of a criminal charge on the ground of
insanity, to be kept in custody by order of court in such place as it
may see fit, during her Majesty's pleasure; prisoners exhibiting
insanity when in confinement to be removed to an asylum, to remain there
until it should be certified to one of her Majesty's Principal
Secretaries of State by two medical men that such person has become of
sound mind; whereupon the Secretary of State was authorized, if such
person's term of imprisonment had not ended, to issue his warrant to the
superintendent, directing that such person should be removed back to
prison, and if no longer subject to imprisonment, that he should be
discharged.
With regard to the liberation of patients from asylums, the certificates
of two medical men approved by the sheriff were required, eight days'
notice being given to the person at whose instance such lunatic was
detained; the patient released to be entitled to a copy of order,
certificate, etc., on which he was confined.
The punishment of maltreating any lunatic was a fine not exceeding £100,
or imprisonment for any period not exceeding six months, without
prejudice to action for damages.
Power was granted to the Secretary of State to order a special
visitation of any place where a lunatic was represented to be confined.
The inspectors of the poor were to give intimation of pauper lunatics
within their parishes.
The importance of this Act is enhanced by the fact that its framers had
the advantage of a knowledge of the working of the great Acts of 1845
and 1852 in England and Wales.
Availing ourselves now of the first Report of the Commissioners[243]
who were appointed under the foregoing Act, we shall present a statement
of the number and distribution of the insane in Scotland on the 1st of
January, 1858.
-------------------+--------+----------+----------+--------+---------
Location. | Males. | Females. | Total. |Private.| Paupers.
-------------------+--------+----------+----------+--------+---------
In public asylums | 1226 | 1154 | 2380 | 786 | 1596
In private asylums | 330 | 415 | 745 | 219 | 526
In poor-houses | 352 | 487 | 839 | 6 | 833
In private houses | 810 | 974 | 1784 | -- | 1784
+--------+----------+----------+--------+---------
Total | 2718 | 3030 | 5748[244]| 1011 | 4739
-------------------+--------+----------+----------+--------+---------
The above table does not include private single patients; their number
could not be accurately ascertained.
The Commissioners, as might be expected, report the state of the insane
to have altered little since the Report of the Royal Commission. In the
pauper licensed houses, if not in others, the overcrowding was great,
though diminishing. "The patients, when within doors, are generally
found sitting in cheerless rooms, ranged on benches, listless and
without occupation; and when out of doors, they are usually lounging
sluggishly about the airing-courts, or are crouching in corners." Among
favourable indications noted by the Commissioners it is pleasant to read
the following:--"Mechanical restraint has been entirely banished from
the licensed houses, and patients who are recorded in the Report of the
Royal Commissioners as almost always under restraint, are now habitually
free from their bonds. The improvement in the condition of these cases
under the more humane treatment now in use has been most remarkable, and
is especially exemplified in the case of A. S----, a patient in M----
Asylum."
Subsequent Acts were passed, called for by the experience of the
Commissioners in regard to the working of the Act of 1857, some
imperfections in which were naturally discovered in the course of years.
The Lord Advocate and Sir George Grey brought in a Bill in 1862 to make
further provision respecting lunacy in Scotland, which received the
royal assent July 29 (25 and 26 Vict., c. 54).
By this Act, consisting of twenty-five sections, the Board was empowered
to license lunatic wards of workhouses; to sanction the reception of
pauper lunatics in workhouses; to grant special licences for reception
in houses of not more than four lunatics; to grant licences to
charitable institutions for imbecile children without fee; to sanction
detention of pauper lunatics in asylums beyond the limits of their
district; to take such steps as the Board may consider requisite towards
providing accommodation for the district, etc., etc. Not to cite other
sections, certain provisions of the recited Acts as were inconsistent
with the Act were repealed, and the General Board of Commissioners was,
of course, continued.
In their Report of this year (1862) the Commissioners observe, relative
to the supposed increase of insanity, "Judging from the evidence which
the tables afford, the increase is almost entirely due to the
accumulation of the numbers of the insane, and certainly not, to any
marked degree, to a greater disposition in modern times to mental
disease; for while in the years 1858, 1859, 1860, and 1861, the
_admissions_ into asylums scarcely varied in number, the patients
resident in such establishments showed every year a large and steady
increase. Thus, on January 1, 1858, their number amounted to 3765; on
January 1, 1859, to 4114; on January 1, 1860, to 4350; and on January 1,
1861, to 4462."
We have already noted the fact that more idiocy appears to be found in
the counties least exposed to mental activity. In this Report, however,
the Commissioners state that, as regards lunacy, its occurrence is
considerably more frequent in _urban_ than in _rural_ districts. The
word _occurring_ is here used advisedly in contradistinction to existing
lunacy. The explanation offered by the Commissioners is that there is a
greater proportion of recoveries and deaths taking place among the
patients of the rural district. They contrast the number of pauper
lunatics intimated from urban populations with the number intimated from
rural districts, and they find that in the former, the occurrence of
pauper lunacy as compared with its occurrence in the latter, is as 100
to 54, whereas the proportion of existing pauper lunatics, January 1,
1861, in the corresponding districts was as 100 to 106. The
Commissioners regarded as urban those parishes containing towns, or
parts of towns, having more than 20,000 inhabitants, and as rural all
other parishes.
We need not dwell on the Act passed in 1864 (27 and 28 Vict., c. 59) to
continue the Deputy Commissioners in Lunacy in Scotland, and to make
further provision for their salaries and the clerk of the Board.
In 1866 another Act was passed (29 and 30 Vict., c. 51) to amend the
Acts relating to lunacy in Scotland, and to make further provision for
the care and treatment of lunatics. One or two of the provisions made
merit notice. Any person keeping a lunatic in a private house, although
not for gain, longer than one year, was obliged, if the malady required
compulsory confinement or restraint or coercion, to report to the Board,
that it might make inspection and obtain an order for the removal of
such lunatic to an asylum. Regulations were made as to persons entering
voluntarily as boarders, whose mental condition is not such as to render
it legal to grant certificates of insanity. Letters from patients to the
Board, and from the Board to patients, were to be delivered unopened.
Power was given to apply to the Court of Sessions to obtain improved
treatment and care of any lunatic. Patients committed as dangerous
lunatics might be liberated on the certificates of two medical men,
approved by the Procurator Fiscal, that such lunatic may be discharged
without risk of injury to the public or the lunatic. This is a valuable
provision. Power was given to the directors of asylums to grant
superannuations to officers, etc.
The above Statute, passed in 1866 to amend the Acts relating to lunacy,
was succeeded, in a few years, by another statute having reference to a
special class of the insane. Of this later Act in 1871 (34 and 35 Vict.,
c. 55) to amend the laws relating to criminal and dangerous lunatics in
Scotland, it may be well to record the most important provisions. These
were to apply to persons detained by judgment prior to the Act 20 and 21
Vict., c. 71. The lunatic department in the general prison at Perth was
to be relieved from overcrowding by removing the insane prisoners to
district, chartered, or private licensed asylums, with consent of
managers of chartered and private asylums. As to the disposal of persons
becoming insane in local prisons, these were to be removed to a lunatic
asylum by a warrant of the sheriff; all asylums in which pauper lunatics
were maintained by contract being bound to provide for the reception of
such prisoner. The Act was to apply to any lunatic charged with assault
or any offence, although not coming within the definition of a pauper.
There was in 1874 an interesting Parliamentary return, showing the total
number of pauper lunatics in each of the three divisions of the United
Kingdom, and the estimated annual amount of the proposed grant of four
shillings per head per week towards the maintenance of pauper lunatics
in asylums. The figures are as follows:--
A. In county, borough, royal, district, parochial, and private licensed
asylums--
England 31,799
Ireland 7,140
Scotland 4,428
------
Total 43,367
B. In work houses and elsewhere--
England 21,413
Ireland 3,125
Scotland 2,077
------
Total 26,615
Total of A and B in England 53,212
„ Ireland 10,265
„ Scotland 6,505
------
Total 69,982
Annual amount of four shillings weekly capitation grant towards
maintenance of those in A:
England £330,710[245]
Ireland 74,256
Scotland 46,051
--------
£451,071
The proportion per cent. of patients in A on the total number of pauper
lunatics is, for--
England 60 per cent.
Ireland 70 „
Scotland 68 „
Of the 6505 Scotch pauper lunatics, there were--
In public asylums 1930
In district asylums 1763
In private asylums 77
In parochial asylums 746
In lunatic wards of poor-houses 557
----
5073
In private dwellings under sanction of the Board, viz.--
With relatives 875}
With strangers 529} 1432
Alone 28}
----
6505
A return was also made of the average weekly cost of each lunatic at
that time--
s. d.
In public asylums 9 2¼
In district asylums 9 9½
In private asylums 11 1
In parochial asylums 8 4¼
In lunatic wards of poor-houses 6 8½
--------
Total in establishments 9 0½
With relatives 4 0
With strangers 5 6
Alone 3 5½
--------
Total in private dwellings 4 3¾
There should be added to the above an expenditure for all pauper
lunatics of threepence a head per week, being the cost of certificates
of lunacy, expenses of transport, etc.
Twenty-one years after the appointment of the Lunacy Commissioners,
their Report of 1878 enables us to mark the progress which had been made
during this period in the accommodation afforded for the insane in
Scotland. The labours of the Commissioners had been followed by highly
satisfactory results, and it would be difficult to speak too highly of
the value of their Reports during these twenty years.
On January 1, 1878, 1569 patients were maintained from private sources,
7473 by parochial rates, and 55 at the expense of the State.
Twenty years before, the distribution of the insane was as follows. In a
parallel column is seen a like return for 1878.
--------------------------------+-----+-----------+-----+-----------
| |Proportion | |Proportion
Location. | |to 100,000 | |to 100,000
|1858.| of |1878.| of
| |population.| |population.
--------------------------------+-----+-----------+-----+-----------
In Royal and district asylums |2380}| |5449}|
In private asylums | 745}| 131 | 208}| 206
In parochial asylums and lunatic| }| | }|
wards of poor-houses | 839}| | 736}|
In private dwellings |1804 | 60 |1493 | 42
In lunatic department of general| | | |
prison | 26 | | 55 |
In training schools | 29 | | 156 |
+-----+-----------+-----+-----------
|5823 | 191 |9097 | 247
--------------------------------+-----+-----------+-----+-----------
At the present time[246] the numbers and distribution of the insane in
Scotland are as follows:--
NUMBER OF LUNATICS IN SCOTLAND ON JANUARY 1, 1881.
-------------------+--------------+------------------+------------------
Location. | Private. | Pauper. | Total.
+---+---+------+-----+-----+------+-----+-----+------
| M.| F.|Total.| M. | F. |Total.| M. | F. |Total.
-------------------+---+---+------+-----+-----+------+-----+-----+------
19 Royal and | | | | | | | | |
district asylums |670|584| 1,254|2,244|2,422| 4,666|2,914|3,006| 5,920
6 private asylums | 49|108| 157| -- | -- | -- | 49| 108| 157
6 parochial asylums|-- |-- | -- | 599| 743| 1,342| 599| 743| 1,342
14 lunatic wards of| | | | | | | | |
poor-houses |-- |-- | -- | 324| 390| 714| 324| 390| 714
Private dwellings | 41| 72| 113| 604| 912| 1,516| 645| 984| 1,629
+---+---+------+----+------+------+-----+-----+------
|760|764| 1,524|3,771|4,467| 8,238|4,531|5,231| 9,762
Lunatic department | | | | | | | | |
of General | | | | | | | | |
Prison, Perth |-- |-- | -- | -- | -- | -- | 38| 17| 55
3 training schools | | | | | | | | |
for imbeciles | 72| 49| 121| 51| 23| 74| 123| 72| 195
+---+---+------+-----+-----+------+-----+-----+------
Totals |832|813| 1,645|3,822|4,490| 8,312|4,692|5,320|10,012
-------------------+---+---+------+-----+-----+------+-----+-----+------
We have in this chapter had to record a melancholy condition of things
as regards the insane, not only out of asylums, but in them; such a
condition as fully justified Lord Shaftesbury employing exceptionally
strong language in reference to the treatment of lunatics in
Scotland.[247] But this is happily now only _history_, and assuredly the
physicians who superintend the Scotch asylums have done their utmost to
wipe out the stain which at one time dishonoured their country's
treatment of those who had lost or had never possessed their reason;
while the Lunacy Commissioners deserve the highest praise for their
continuous and efficient labours in the difficult work to which they
have devoted themselves. The efficiency of the asylums in Scotland is
now such, owing in great measure to the action taken in 1857, that
foreigners, not to say the English themselves, may cross the Tweed to
learn from the physicians of the mind, important lessons in the care and
cure of the insane. The chartered asylums of that country have for a
long period received encomiums from those who have visited them.
Of the Dumfries institution I have already spoken, and would add, in
proof of the pains taken by the former superintendent, Dr. Browne, to
break the monotony of asylum life, that he introduced private
theatricals, in which vaudevilles and farces were performed by and for
the lunatics, and even before the public. A practice still beneficially
preserved is that of making excursions to places noted for their natural
beauty or antiquity, even temporary vacations at the seaside or
elsewhere, constituting valuable novelties and auxiliaries in these
ministrations to the mind diseased. Such resources, in connection with
dramatic festivities, attendance on all accessible entertainments in the
neighbouring town, were utilized in affording a stimulus or a solace to
inmates of the cultivated classes; nor were the higher aids yielded by
religious services and instructions neglected, and, with unwonted
liberality of sentiment, chaplains representing the three grand sections
into which Christianity is divided, Presbyterianism, Episcopacy, and
Catholicism, were appointed, and exercised their functions, it is
believed, wisely and discreetly in their respective spheres. The benefit
of this step suggested a resort to frequent intercourse between the
different ranks of patients, with associates from the external world,
and the creation of all arrangements which could recall or assimilate
such a place of seclusion with home, rational liberty, and natural
pursuits. Whilst the mingling of distinct grades was employed as a
remedy, rigid classification was enforced, founded upon position in
society, as well as upon the phase or stage of disease. In furtherance
of this view it was resolved to remove the paupers and poorer inmates
from the original structure, and to erect a distinct apartment, capable
of containing four hundred individuals, within the grounds, provided
with all necessary requirements, but to be conducted with the most rigid
economy and consideration of the resources of the country, as well as of
the habits of the patients. This movement was made, and a hospital was
added, conducted, however, by the same superintendent and upon precisely
the same principles as regulated the Crichton Institution proper. We
speak confidently upon this and other points, because there is before
us a series of valuable annual reports, containing not exclusively the
history of the progress of the institution, but the results, medical and
moral, of the superintendent. For the behoof of both houses a museum of
natural history was formed, and proved a considerable attraction in
stormy weather, or to lazy or lethargic observers. While in such a
climate it was inevitable that indoor objects of interest should be
supplied, attempts to draw those under treatment from the deteriorating
atmosphere of seclusion were not wanting. Parole was accessible to the
trustworthy, under suitable attendants; patients were allowed to travel
long distances, and for specific purposes, such as angling, botanizing,
and so forth; their presence was permitted in the _fête champêtre_ and
in country sports, and every effort was made to give to anniversaries,
public and private, a prominent place in the annual calendar. But fun
and frolic seem to have occupied but a subordinate place, as
composition, re-education of every kind, classes for drawing,
flower-making, dancing, singing, joining in concerts, are repeatedly
insisted upon. But while these engagements availed in winter,
promenades, dances on the green, bowling, quoiting, the care of pet
animals, and, for a few, interest in the botanic garden, diversified the
summer months. These constitute a pleasing and encouraging part of the
picture, but it should be broadly and boldly confessed that there were
agitated and intractable spirits in the community that could not be
tranquillized or guided by such agencies, and that, although restraint
in its vulgar and repulsive aspects was not adopted, seclusion, padded
rooms, and the conservative bed were occasionally in use. During the
last twenty years the asylum has been under the superintendence, first
of Dr. Gilchrist, trained within its walls, and secondly of Dr. Adam,
but while there has been undoubted progress, the improvements and
ameliorations have been, to a certain extent, the evolution or
development of the views and facts which have been above enumerated.
I would add to what has already been said of the Royal Edinburgh Asylum,
that the managers appointed Dr. McKinnons, the first
physician-superintendent, in 1840, with complete administrative and
medical authority. He was a man of advanced ideas, as his reports show.
On his death in 1846, Dr. Skae was appointed his successor, and remained
at his post till 1873, when Dr. Clouston became
physician-superintendent. Dr. Skae extended the reputation of the
institution and consolidated its position. His reports were always
medical and philanthropic, and, as regards the general public, educative
and interesting. By attracting public sympathy and not becoming too
official, it has always carried out the original intention of its
founders to provide for all classes, and has now no less than eight
hundred patients who pay from £30 up to £500 a year. It has a Charity
Fund of £10,000; its buildings are scattered, and number nine for
patients. Like an old cathedral, it now shows, in common with
long-established institutions, such as the York Retreat, the successive
ideas of various men and various times, and one would really regret to
see the original shell of these charitable hospitals, though antiquated
and a little inconvenient, ruthlessly destroyed to make way for modern
structures. In the Edinburgh Asylum are large corridor wards, pavilion
wings of different kinds, cottages and cottage hospitals, a mansion in
its own grounds, and a seaside house twelve miles off, to which over a
hundred and twenty patients go annually. Its present superintendent has
still further extended the reputation of this asylum.
Were the object of this work to describe institutions for the insane,
instead of giving a general historical sketch of the progress of reform,
I should have added notices of other excellent institutions, as those of
Gartnavel, Glasgow, so ably superintended by Dr. Yellowlees, and the
Lenzie Asylum, where Dr. Rutherford has done wonders.
Of the Scotch royal or chartered asylums and their far-seeing and
philanthropic founders it is not easy to speak too highly. For a small
country and a poor people to have provided six asylums for all classes
before the lunacy legislation of the present day was inaugurated, shows
at least that, if it did not initiate a movement in favour of humanity,
it could see how good a thing it was to follow in the same path. At the
present time in Scotland, through the foresight of the man who
established institutions "for all classes," and combined business with
philanthropy in making the rich help the poor, there is plenty of
middle-class asylum accommodation.
Perhaps nothing could more strongly show what a change has come over
the condition of the insane in Scotland, and the praiseworthy efforts
now made by those who are responsible for it, than the excellent Report
of the Commissioners, published in 1881.[248] "It is well worth the
careful perusal of every one who is interested in the treatment of the
insane. In addition to the usual information, there is an attempt made
carefully to describe what is special to Scotland in the management of
asylums and in the treatment of the insane. In short, the 'Scotch
System' is analyzed, and in concise terms we are told what it is and
what results have followed. In the body of the Report, under the heading
of 'Recent Changes in the Modes of Administering Scotch Asylums,' we
have fourteen pages that well deserve and will attract much attention.
They will stand as a landmark in the history of the treatment of mental
disease. That portion of the Report is a most carefully written piece of
true scientific work, containing the facts themselves, the history of
their application, the inferences to be deduced from them, and the
reasons why the particular results have happened, or the medical
philosophy of the matter....
"There were in Scotland on the 1st of January, 1881, 10,012 insane or
idiotic persons known to the Scotch Board, being an increase of 378 over
the number of 1880. The greater part of this increase, which is an
unusually large one for a year, consists of rate-paid lunacy. Scotland
still holds the honourable position of maintaining a far larger
proportion of its insane and private patients than either of the other
divisions of the United Kingdom. In Ireland (assuming that all the
inmates of private asylums are private patients) 5.5 per cent. only of
the insane are supported out of their own means or by their relatives.
In England 10.7 per cent. are so supported, while in Scotland 16.4 per
cent. are in this category. Of this most remarkable fact we have seen no
adequate explanation. Is it the poverty of Ireland and England that
place them so far below Scotland in this matter? or the want of asylum
accommodation at low rates of board? or the lack of self-respect and
natural affection in the peoples?...
"There were forty-nine voluntary patients admitted to Scotch asylums
during the year, and the Commissioners express a favourable opinion as
to this provision of the Scotch lunacy law. The recovery-rate in the
asylums was 41 per cent. for the year, and the death-rate on the average
numbers resident 7.6 per cent.... The reports of the Commissioners'
visits to asylums are, on the whole, of a favourable character. There is
a cheerful ring about them, a hopeful spirit as to the remedies for
present defects, and an encouraging yet stimulating tone towards the
medical staff that shows a healthy confidence.
"We now come to the really original and important part of the Report:--
"'_Recent Changes in the Modes of Administering Scotch Asylums._--The
most important changes that have taken place of late have been
manifested chiefly in three directions:--
"'(1) In the greater amount of liberty accorded to the patients; (2) in
the increased attention that is devoted to their industrial occupation;
and (3) in the more liberal arrangements that are made for their
comfort.
"'Each of these changes has been a distinct improvement, and has
conferred important benefits on the insane; but the effect of each has
been made much more complete from the support it has obtained by being
associated with the others. For instance, the removal of restrictions
upon liberty could not have been carried so far had steps not been taken
to engage the energies of the patients in such occupations as tend both
to check the morbid current of their thoughts and to prevent them from
fretting at the control to which they must always be more or less
subjected, while it is no less true that the comforts with which they
are now surrounded render them both more able and more willing to engage
in healthful occupations....
"'_The Abolition of Airing-Courts._--Circumstances such as these,
perhaps, prevent any immediate prospect of the universal abolition of
walled airing-courts; but the advantages which result from their disuse
are now widely recognized. Most of the public asylums in Scotland are
already without them, while in several, where they still exist, they are
seldom used. One of the advantages which airing-courts with walls were
thought to possess was their supplying a place where patients suffering
from maniacal excitement might work off their morbid energy in safety.
It can scarcely be denied, however, that the association in confined
areas of patients in this state, either with one another or with other
patients in calmer mental states, is attended with various
disadvantages. The presence of one such patient may be the cause of a
great amount of excitement, and a source of irritation and annoyance to
those confined in an airing-court along with them. After the disuse of
the airing-courts, it was found that such patients could be treated
satisfactorily in the wider space of the general grounds. It was found
by placing them more immediately in companionship with the attendants,
and by keeping them from collision with other patients, that they could
be made to vent much of their excitement with less disorder, and could
often be saved a considerable amount of it altogether.
"'_The Open-Door System._--It is only of late years that the disuse of
locked doors has been regarded as forming an important feature in the
administration of an asylum. Detached houses, or limited sections of the
main buildings, the inmates of which consisted chiefly of patients
requiring little supervision, have long been conducted in some
institutions without locked doors. But the general practice of all large
asylums has been to keep the doors of the various wards strictly under
lock and key....
"'When an attendant could no longer trust to locked doors for the
detention of troublesome and discontented patients, it became necessary
that he should keep himself aware at all times of where they were and
what they were doing. And it therefore became his interest to engage
them in such occupations as would make them contented, to provide an
orderly outlet for their energies, and to divert their minds from
thoughts of escape. The relations of an attendant to his patient thus
assumed less of the character of a gaoler, and more the character of a
companion or nurse; and it was eventually found that this change in the
character of the form of control could be adopted in the treatment of a
much larger number of the patients than was at first anticipated. It is
not difficult to over-estimate the extent to which a desire to escape
affects the minds of patients in asylums. The number who form a definite
purpose of this kind really constitutes only a very small proportion of
them. The special watchfulness required of attendants in guarding
against determined efforts to escape, therefore, need be directed to a
few only of those under their charge, and it soon becomes habitual to
the attendants to keep themselves aware of where those patients are,
about whom they entertain doubt. And it should be borne in mind, in
regard to this kind of watchfulness, that its very persistency renders
it more easily kept up than if it could be occasionally relaxed. It
appeared further that the disuse of locked doors had an influence on
some of the patients in diminishing the desire to escape. Under the
system of locked doors, a patient with that desire was apt to allow his
mind to be engrossed by the idea of watching for the opportunity of an
open door, and it was by no means infrequent to find such a patient
watching with cat-like eagerness for this chance. The effect of the
constantly open door upon such a patient, when the novelty of the thing
had worn off, was to deprive him of _special_ chances of escape on which
to exercise his vigilance, since, so far as doors were to be considered,
it was as easy to escape at one time as another; and it was found that
the desire often became dormant and inoperative if not called into
action by the stimulus of _special_ opportunity. It is, indeed, a thing
of common experience that the mere feeling of being locked in is
sufficient to awaken a desire to get out. This happens both with the
sane and the insane; but it is certain that the mental condition of many
patients in asylums renders them likely to be influenced in an especial
manner by such a feeling. With many, however, the desire to escape dies
away when it ceases to be suggested by forcing upon their attention the
means of preventing it.
"'It is year by year becoming more clearly recognized that many
advantages result from the working of the open-door system, and it has
now been adopted to a greater or less extent in most of the Scotch
asylums....
"'_Liberty on Parole._--The practice of permitting certain patients to
walk or work in the grounds without constant supervision, and of
permitting some to take exercise beyond the grounds on _parole_, has
been general in Scotch asylums for many years, but it is now much more
extensively adopted in them than it used to be. Like the other removals
of restrictions to which we have referred, this has found favour in the
eyes of superintendents on account of the beneficial effect which it
has on the patients, not merely in making their residence in an asylum
less irksome, but also by improving their mental condition. The fears
which were naturally entertained that this form of relaxation of control
would be followed by an increase in the number of accidents and escapes,
have not proved to be well founded.
"'In determining the desirability of any kind of restrictive discipline
and supervision, it has to be considered, among other things, whether
the irritation that it occasions may not render the danger of accidents
from violent conduct greater than it would be if such discipline were
not enforced....
"'_Benefits arising from the Removal of Restrictions._--The beneficial
effects arising from the removal of the various forms of restrictions on
liberty are no doubt due, in great measure, to the increased attention
that is given to the features of each patient's condition, for it is
only after a careful study of the disposition and tendencies of a
patient that a trustworthy opinion can be formed as to the amount of
liberty that he is fit to enjoy. But it must also be recognized that the
freedom from irksome discipline and restriction tends to remove one of
the sources of violent conduct in asylums, and consequently to diminish
the number of accidents which result from it. Many patients have, under
the freer conditions of their life, become calm and orderly in behaviour
to whom the imprisonment in wards under lock and key, the confinement
within high-walled airing-courts, and even the feeling of being under
the constant supervision of attendants, were sources of irritation and
excitement and causes of violent conduct.
"'There are other advantages which spring from this relinquishing of
some of the physical means of detention. One of these, the importance of
which will be readily appreciated, is the inducement it affords, not
only to superintendents, but to every one concerned in the management of
the patients, to acquire a full and correct knowledge of the mental
condition and character of each patient. It not only increases the
interest they have in ascertaining how far, and in what ways, each
patient is fit to be trusted, but it strengthens in a very practical
manner their motives for endeavouring to secure his contentment and
orderly behaviour. The judging of what is required for these purposes
inevitably involves a good deal of intelligent observation of each
patient, not only on admission, but during the whole time he is resident
in the asylum. It becomes of practical importance to those in charge to
note changes in his mental condition, whether in the direction of
improvement or the reverse; and thus favourable or unfavourable symptoms
are observed and considered which in other circumstances might receive
little attention. The general effect of the change of system is to raise
the position of the attendants from being mere servants who carry out
more or less efficiently the orders of the superintendent to that of
persons who have a direct interest in promoting the improvement of the
patients, and who find it an advantage to themselves to carry out, to
the best of their ability, whatever instructions they receive with that
end in view. A good attendant must always have had more or less of this
character, it is true; but even good attendants are stimulated under the
freer system to become still better.
"'_Industrial Occupation._--One effect of the removal of physical
restrictions has been to stimulate as well as aid the superintendents of
asylums in their efforts to develop the industrial occupation of the
patients. The disadvantages of prolonged idleness, to the insane as well
as to the sane, and the advantages that result from such occupation as
gives exercise to the physical and mental energies without overstraining
them, are too obvious to require discussion. It was consequently an
important result of the disuse of walled airing-courts and of the
open-door system, that it became necessary to engage the attention of
patients who were inclined to escape, and also of the much larger number
who might wander away without any such definite purpose, so as to keep
them under control and supervision. It did not require much study of the
mental state of the patients, nor indeed much attention of any kind on
the part of their attendants, to insure their safe custody, when the
conditions of their life were either to be locked within their wards, to
be confined within the high walls of airing-courts, or to be marched in
military order at stated periods for exercise. Under such conditions,
there was no strong motive for inducing those patients to work who
showed no disposition to do so of their own accord. The morbid
excitement, the apathies, or the gloomy feelings of many patients were
allowed to remain unchecked, and not unfrequently the mental disease
was intensified rather than alleviated. The more restless patients often
spent much of their day in pacing the galleries or the airing-courts,
nursing their morbid irritability, while others lounged on the benches
or crept into corners, and so drifted downwards through the dreary
stages of physical and mental decay. It does not require much
consideration to show that it would tend to improve all such patients,
both in their bodily and mental health, if they were engaged in some
regular occupation during a reasonable portion of their time....
"'_The Industrial System cannot be adapted to all Classes of
Patients._--But there are patients, both among those of the private and
among those of the pauper class, whom it is undesirable, and whom it
would also be wrong, to engage in work. There are cases, for instance,
in which, for various reasons, such as physical weakness, it would be
directly injurious to the patients to be engaged in active or fatiguing
work; and it would be unsatisfactory if it were found that the efforts
to develop the industrial system in asylums led to such patients being
pressed to work....
"'_Advantage of the Farm as a Source of Occupation._--... The number of
persons available for work on an asylum farm is always great; and in
those asylums where full advantage has been taken of the opportunities
which the farm affords, it is found that the directions in which the
labour of patients may be utilized are much more numerous and various
than at first sight may appear. For instance, one large outlet for their
labour is supplied by the use of spade husbandry in circumstances in
which the ordinary farmer would use the plough. Another outlet is to be
found in the cultivation of crops of garden vegetables, which the
ordinary farmer does not usually undertake. The carrying out of
improvements on the farm or estate also gives employments of various
kinds, and it is here, perhaps, that what may be called the elasticity
of land as a source of labour for asylum inmates becomes more evident.
If the land attached to an asylum is of any considerable extent, it will
nearly always happen that important re-arrangements are deemed
desirable; and when there is a disposition to encourage improvements of
this kind, it is generally found that they afford a very abundant and
varied source of labour. Road-making, embanking, draining, fencing,
planting, and even building, are generally found to be required; and in
connection with these things, and with the work more accurately included
under the term agricultural, there are subsidiary forms of industry
developed. Indeed, the different kinds of work afforded by the
re-arrangements and improvements on an estate prove of great value in
asylum administration, for they afford some of the simplest kinds of
outdoor labour. Many patients can be engaged in such occupations as
digging and wheeling, who can with difficulty be engaged in less simple
kinds of work; and by securing an ample supply of such simple work the
number of patients who share in the benefits of active healthy labour in
the open air is much increased....
"'It is impossible to dismiss the subject of asylum farms without some
reference to the way in which they contribute to the mental health of
the inmates by affording subjects of interest to many of them. Even
among patients drawn from urban districts, there are few to whom the
operations of rural life present no features of interest; while to those
drawn from rural districts the horses, the oxen, the sheep, and the
crops are unfailing sources of attraction. The healthy mental action
which we try to evoke in a somewhat artificial manner, by furnishing the
walls of the rooms in which the patients live, with artistic decoration,
is naturally supplied by the farm. For one patient who will be stirred
to rational reflection or conversation by such a thing as a picture,
twenty of the ordinary inmates of asylums will be so stirred in
connection with the prospects of the crops, the points of a horse, the
illness of a cow, the lifting of the potatoes, the laying out of a road,
the growth of the trees, the state of the fences, or the sale of the
pigs.
"'_Importance of Active Physical Work for Women._--... An attempt,
attended with considerable success, has been made in some asylums to
supply this deficiency by the development of the work of the laundry and
washing-house....
"'There are two directions in which the worth of the washing-house may
be developed. One is by obtaining work from outside sources, as has been
done in some institutions, where a considerable amount of washing and
dressing is done for persons living in the neighbourhood. Another
direction is by avoiding the use in the washing-house of all machinery
which diminishes the amount of hand labour. And we are disposed to
regard both these modes as deserving of encouragement....
"'_Difficulties met with in carrying out Improvements._--... In relaxing
restrictions upon the liberty of the insane, there is a certain amount
of prejudice in the public mind to be met and overcome. There is a
feeling of timidity in regard to persons labouring under insanity, which
leads to their being regarded as without exception and in all
circumstances unfit to be trusted with any degree of liberty. As a
result of this, there is a tendency, when a patient in an asylum
inflicts injury on others or on himself, to blame the superintendent for
having permitted the patient to have such liberty of action as made the
inflicting of the injury possible; and there is consequently a
temptation, to a superintendent who wishes to avoid adverse public
criticism, to adopt restrictive measures of the most complete character.
"'It was under the influence of such views that strait jackets,
manacles, and chains were used before the introduction of what is called
the system of non-restraint. When such restraints were used it was said
that no blame could be attached to persons in charge of a patient for
any violent deed which might be perpetrated, because it was held that
every possible precaution had been taken to prevent it. The error that
lurked beneath this statement was not perceived. It was not recognized
that in taking precautions against one set of evils, other evils of a
graver character were created. Even the evils which it was sought to
avoid were not avoided. The first man from whom Pinel removed the
manacles had, with those very manacles, killed one of his keepers. The
superintendent who really takes most precautions against violence is not
the man who applies the most complete restrictions upon liberty, but he
who weighs the general results of different modes of treatment, and
selects that which proves in practice most successful in decreasing the
number of violent acts.
"'We cannot hope, in carrying out any system, to exclude the effect of
mistakes in judgment and neglects of duty....
"'One difficulty for which no satisfactory solution has yet been found
is the finding of employment for male patients during bad weather, when
little outdoor occupation is to be had. It would be of great advantage
if some simple indoor occupation, adapted to the peculiarities of the
insane, were devised which could be taken up occasionally when outdoor
occupation failed....
"'_Increased Comfort of Asylums._--It is satisfactory to record our
conviction that all the changes just alluded to have tended not only to
facilitate the administration of asylums, and to produce greater
contentment among the inmates, but also, to exert a real curative
influence. The scenes of turbulence and excitement which used to be of
frequent occurrence in asylums have become much less frequent, and in
the asylums where the changes in question have been most fully carried
out, such scenes are comparatively rare. It does not admit of doubt that
the occurrence of these fits of excitement had a deteriorating effect on
the mental condition of the patients, and often retarded, if they did
not in some cases prevent, their recovery. It is not unusual now to
pass through all the wards of some of the larger asylums without
observing a single instance of disorderly behaviour, and we believe this
is properly attributed to such changes as have just been noted. It is
true that excitement may, to some extent, be kept in check by the use of
calmative drugs; but we believe we are justified in saying that this
practice is largely followed in no Scotch asylum, while it is scarcely
adopted at all in those in which manifestations of excitement are least
frequent, in which restrictions on liberty are most completely
withdrawn, and in which industrial occupation has its greatest
development.'"
Lastly in regard to that most important point, on which Dr. Fraser thus
speaks:--
"'_The Influences which are at present operating on the Boarding out of
Lunatics._-- ... The influences which, from my experience and
observation, I believe to be operating upon these methods of provision
for the insane, especially upon the pauper portion, seem to me to be as
follows:--
"'1. The efforts of medical officers of institutions to discharge
chronic lunatics whom they consider suitable for being cared for in
private dwellings.
"'2. The action of inspectors of poor in either initiating the removal
of suitable cases, or in seconding the efforts of medical
superintendents in this direction.
"'3. The amount and accessibility of asylum accommodation in each
district.
"'4. The rate of maintenance in asylums.
"'5. The supply of suitable guardians.
"'6. The influence of the grant in aid.
"'_The Action of Medical Officers of Asylums._-- ... Owing to my having
had at one time the superintendence of the asylum for Fife and Kinross,
I am able to deal more satisfactorily with the statistics of this
district than with those of other parts of the country. From a return
which I have been favoured with, I find that the efforts to send out
patients in this district have been effective and successful. During
1880 there have been discharged improved eighteen patients, five of whom
were committed to the care of friends, and thirteen of whom were placed
under the guardianship of strangers....
"'The question which naturally suggests itself is--What would be the
result were this practice possible in every institution, and in every
district? On calculation I find that, had an equal proportion of the
inmates of all asylums been similarly transferred to private care, no
less than four hundred and three patients would have been removed from
institutions to care in private dwellings, whereas the fact is that only
sixty-eight were so transferred. Only one patient out of the eighteen
who were transferred from the Fife and Kinross Asylum has had to be
returned to the asylum, and he was one of those who were boarded with
friends....
"'_The Action of Inspectors of Poor._--The efforts of medical
superintendents of asylums may do much, but it must be recognized that
the success and extension of the boarding system is largely, if not
mainly, in the hands of the inspectors of poor. Their action is
threefold: (1) they may initiate the removal of their chronic insane
from institutions; they may co-operate with asylum officers in readily
removing such lunatics as these officers intimate to be fit for being
boarded out, and in procuring suitable guardians and homes for them; and
(3) they may, by well-directed efforts, instead of hurrying every
lunatic into an asylum, as the practice with some is, provide in like
manner for those idiotic and insane paupers who, even when they first
become chargeable, do not require asylum treatment and care....
"'Economy, one of the proper objects of parochial administration, is
attained by this method of providing for the insane poor, and not only
is it economical, as I will immediately show, but for a large proportion
of chronic lunatics it is efficient and beneficial. From a return with
which I have been favoured from the City Parish, Edinburgh, the average
cost, inclusive of supervision and every other item of expenditure, for
the insane boarded with strangers is £19 a year. The asylum rate during
the last five years has been £27 per annum.
"'_The Amount and Accessibility of Asylum Accommodation in each
District._-- ... It has now become a matter of everyday observation,
that where there is ample asylum accommodation the boarding out of the
insane is either entirely neglected or avoided, or but languidly
attempted....
"'It follows that ample asylum accommodation though in itself a service
and a safeguard to society, is yet apt to be an inducement to wasteful
parochial administration....
"'_The Rate of Maintenance in Asylums._--In Dumfriesshire, where special
circumstances have kept the asylum rate exceptionally low, and where
agricultural avocations are well paid, the guardians require a high rate
of board, and thus the cost of boarding out, when clothing, medical
visits, and other expenses are included, is nearly equal to the rate of
maintenance in the asylum for the district.
"'It therefore stands to reason that where the asylum rate is near to
that required for outdoor care, the economic inducement to board out
will apply only to those patients who have friends willing to have the
charge of them. It thus appears that a low rate of maintenance in an
asylum is practically prejudicial to the liberty of the chronic insane.
"'_The Supply of Guardians._--This feature of the system of boarding out
the insane will appear to many to be all-important. The excuse which
inspectors frequently advance for their lack of co-operation with
medical officers of asylums is their inability to find suitable
guardians. It is, however, an excuse which my experience does not permit
me to regard as valid or sympathize with....
"'_The Influence of the Government Grant._--I feel I need do no more
than mention this agency in increasing the number on the roll of single
patients. The way in which it has led to this increase has been fully
treated of in the published Reports of the Board....'"
Among the foregoing excerpts from the elaborate Report of the
Commissioners, much, it will be seen, bears on the important question of
the "cottage treatment" of the insane. In this direction, at least in
the way of attempting to form a sort of lunatic colony (though on a very
minute scale) after the manner of Gheel, Scotland has acted more
definitely than England. Opinion is divided on the subject, and the
measure of success can hardly be said to have been yet determined.
Whatever this may be, the counter disadvantages must not be overlooked.
Kennoway, in Fifeshire, where the experiment has been tried on a small
scale, has had its supporters and detractors. Dr. John Smith, well known
for his long practical experience of lunacy, and Dr. J. B. Tuke, at that
time the superintendent of the admirably managed Fife and Kinross
Asylum, visited Kennoway some years ago, and the report[249] of the
latter was certainly anything but favourable; in fact, that the saving
effected was by means detrimental to the lunatic. Notwithstanding, he
arrived at the conclusion that the system might be employed with
advantage in certain cases, if accompanied by stringent supervision. Dr.
Arthur Mitchell, in his evidence before the Parliamentary Committee of
1877, so valuable on all the points to which he spoke, replied to the
question why the patients boarded out had decreased in number, if the
board approved of the system, that he, although warmly approving of it,
was the person who had largely caused this decrease, the reason being
that it was found there were a great number of persons totally
unsuitable for private dwellings, and others were ill cared for. Hence
it was necessary to weed them out. This observation does not specially
apply to villages like Kennoway, but to the boarded-out cases, wherever
placed.[250]
Much more of interest might be taken from this Report, but the foregoing
will suffice to bring before the reader the salient points in the
management of the insane in Scotland at the present day, by which he can
judge for himself of the contrast between the present and the past. My
main object is with the latter, but it can only be understood by a
sketch, however brief, of the former, in each of the three divisions of
the United Kingdom.
FOOTNOTES:
[227] These particulars are given in the Report of the Royal Lunacy
Commission for Scotland, 1857, on the authority of Sir Thomas Craig.
[228] "A General View of the Present State of Lunatics and Lunatic
Asylums in Great Britain and Ireland," by Sir Andrew Halliday, M.D., p.
28.
[229] _Op. cit._, p. 27.
[230] "An Act to Regulate Madhouses in Scotland."
[231] "The Commission was entirely due to Miss Dix's exertion. After
visiting the lunatic asylums of E----, she proceeded to Scotland, where
her suspicions were aroused by the great difficulty she experienced in
penetrating into the lunatic asylums of S----; but when she did gain
access, she found that the unfortunate inmates were in a most miserable
condition. She came to London and placed herself in communication with
the Secretary of State for the Home Department, and with the Duke of
Argyll; and at her instance, and without any public movement on the
subject, a Royal Commission was appointed to inquire into the state of
the lunatic asylums of Scotland. No one, we are sure, could read the
Report of the Commission without feeling grateful to that lady for
having been instrumental in exposing proceedings which were disgraceful
to this or to any civilized country."--Mr. Ellice, M.P., "Parliamentary
Debates," vol. cxlv. p. 1025.
[232] "Parliamentary Debates," 3rd Series, vol. cxlv. p. 1020.
[233] Page 1025.
[234] Page 1027.
[235] Page 1035.
[236] See p. 338.
[237] Page 1042.
[238] Page 1043.
[239] Page 1044.
[240] Page 1468.
[241] "Parliamentary Debates," 3rd Series, vol. cxlvi. p. 1169.
[242] Page 1185.
[243] They were Melgund, chairman; G. Young, George Moir, James Cox, and
W. A. F. Browne.
[244] If certain other figures be added, this total is 5823. See table
on a subsequent page.
[245] This sum now amounts to nearly half a million.
[246] Twenty-third Report of the Commissioners, 1881.
[247] See passage quoted in the last chapter of this book.
[248] The succeeding quotation constitutes the analysis given of this
Report in the _Journal of Mental Science_ for January, 1882.
[249] _Journal of Mental Science_, January, 1870.
[250] Dr. Fraser observes (Report, p. 124): "Dr. Arthur Mitchell, in
his work on the insane in private dwellings, shows that this method of
providing for the chronic insane is--1st, the best thing for the
patient; and, 2nd, the best thing for the country; and in that opinion I
heartily concur."
CHAPTER X.
IRELAND.
I have already spoken of the singular tradition which for so long a
period invested the Glen-na-galt, near Tralee, with the character of
possessing healing virtues in madness. The change which in our practical
age has taken place in Kerry, by the substitution of a well-ordered
asylum at Killarney, for popular superstitious practices, represents
what has been going on throughout the whole of Ireland during the last
half century or more. After examining all the Acts bearing on the
provision for the insane from the earliest period, and the evidence
given before Parliamentary Committees, I must say I find a very large
amount of strenuous effort and labour devoted to the improvement of the
condition of lunatics, miserably situated as they formerly were in
general, when confined in houses of industry or at home in hovels, where
their needs could not possibly be attended to, even when, as was
doubtless frequently the case, they were regarded with great affection.
Sometimes they were looked upon as possessed, and then the appropriate
forms of the Church of Rome were employed.
In the evidence given before the Select Committee on the Lunatic Poor
in Ireland in 1817, Mr. John Leslie Foster, a governor of the Richmond
Asylum,[251] stated that he had seen two or three lunatics in one bed in
the house of industry. There were fifty or sixty in one room. In the
same room a lunatic was chained in a bed, the other half of which was
occupied by a sane pauper, and the room was so occupied by beds that
there was scarcely space to move in it.
Mr. Rice stated that when he visited the Clonmel Asylum in 1814-15, the
patients were not clothed; some were lying in the yard on the straw in a
state of nakedness. At Limerick he found the accommodation for the
patients "such as we should not appropriate for our dog-kennels." There
was one open arcade, behind which cells were constructed with stone
floors, without any mode of heating or of ventilation, and exposed
during the whole of the winter to the extremities of the weather.
Thirteen cells were provided for thirty-three lunatics and idiots. As
some were furious, the usual mode of restraint consisted of passing
their hands under their knees, fastening them with manacles, securing
their ankles by bolts, passing a chain over all, and lastly attaching
them firmly to the bed. "In this state, I can assure the Committee from
my own knowledge, they have continued for years, and the result has been
that they have so far lost the use of their limbs that they are utterly
incapable of rising." The rooms over the cells were appropriated to the
sick. Mr. Rice found twenty-four persons lying in one room, some old,
some infirm, and in the centre of the room a corpse; one or two were
dying. In the adjoining room he found a woman in a state of distraction,
the corpse of her child left upon her knees for two days; it was almost
putrid. "There was not to be found one attendant who would perform the
common duties of humanity. The most atrocious profligacy in another
branch of the establishment prevailed."
The condition of a lunatic member of a family among the poor is thus
graphically described by a member of the Committee which prepared this
valuable Report: "There is nothing so shocking as madness in the cabin
of the peasant, where the man is out labouring in the fields for his
bread, and the care of the woman of the house is scarcely sufficient for
the attendance on the children. When a strong man or woman gets the
complaint, the only way they have to manage is _by making a hole in the
floor of the cabin_, not high enough for the person to stand up in, with
a crib over it to prevent his getting up. The hole is about five feet
deep, and they give this wretched being his food there, and there he
generally dies. Of all human calamity I know of none equal to this, in
the country part of Ireland, which I am acquainted with."
In the physician's report of one asylum for 1816, he speaks of the
miserable objects who wander over the face of the country, or are
inmates of jails and hospitals. Such do not appear to have taken refuge
in any Glen-na-galt.
The first asylum for the insane in Ireland (and the only one before the
Richmond Asylum) was that founded in Dublin by Swift, whose act would
probably have been little known or forgotten, but for the familiar lines
in which he himself has immortalized it:--
"He gave the little wealth he had
To build a house for fools or mad,
To show by one satiric touch
No nation needed it so much."
This asylum was opened in 1745, the population being then between three
and four millions. What really induced the Dean of St. Patrick's to
perform this act was the knowledge that there was no charitable asylum
for the insane--nothing more; at any rate, I am not aware that he
contemplated the introduction of any improved method of treatment, or
would have thought that chains were unsuitable means of restraint. It
appears that his attention had been called to the need of an asylum by
"The Proposal" of Sir William Fownes. Swift bequeathed the whole of his
estate and effects, subject to certain small legacies, to be laid out in
the purchase of land for a hospital large enough for the reception of as
many idiots and lunatics as the income of the said lands and effects
should be sufficient to maintain.
From its historical associations I was interested in visiting this
asylum some years ago, but there is nothing otherwise of special
interest in the institution. Writing in 1861,[252] the Inspectors of
Irish Asylums observe, "Though subject to our inspection, it is not a
regularly licensed asylum, being on a charitable foundation. It is
unfortunately situated in a most inappropriate locality, and very
deficient, from its original construction, in many necessaries." And the
Lunacy Inquiry Commission of 1879 observe, "We feel ourselves compelled
to state that St. Patrick's Hospital, though possessing an ample
endowment, with an accumulated fund in bank of £20,000, and situated in
the metropolis, is yet in many respects one of the most defective
institutions for the treatment of the insane which we have visited....
The patients wash in tubs in the day-rooms, the water having to be
carried all through the house, as no supply is laid on; the hospital is
not lighted with gas 'for fear of explosion'! and passages nearly four
hundred feet long have, on winter evenings, no other light than that
which is afforded by three or four small candles." The house was badly
warmed, and the ventilation far from satisfactory.
Further, while the Dean's will did not contemplate the payments of
patients, boarders were admitted at an early period, and this policy
went to such a length that while in 1800 there were a hundred and six
free and only fifty-two paying patients, there were in 1857 eighty-eight
paying patients, and only sixty-six free. As the Commission naïvely
remark, "if the diminution of free patients and the increase of paying
patients are to continue, it may one day result that no inmates of Dean
Swift's Hospital will be maintained entirely out of his bequest, which
certainly does not appear to have been in the contemplation of the
founder."[253] A somewhat brighter picture might have been expected when
one reflects that, according to the original charter, the government of
the hospital was vested in the Primate, Lord Chancellor, Archbishop of
Dublin, Dean of St. Patrick's, Dean of Christ Church, Physician to the
State, and Surgeon-General, and seven other persons whose successors
were to be elected by a majority of the governors, each of whom was
required to be a fit person.
An asylum was erected at Limerick about 1777, and at Cork in 1788.
The Cork Asylum was built on the strength of an unrepealed section in an
old Jail Act (27 Geo. III., c. 39. s. 8), which allowed of sums of
public money to be "presented" by grand juries for the use of lunatic
asylums, without limit, and permitted magistrates to commit to them any
individuals, if idiots or insane. It did not provide, however, for the
government of the establishment when formed, or for an account of how
the money was spent. No medical certificates were required--the
magistrate's power was unlimited. Fortunately, however, the Cork Asylum
was in good hands (Dr. Hallaran), thanks to which, and not to the law,
the institution was as well conducted as in those days it could be. So
much was this the case that Mr. Rice stated before the Committee of the
House of Commons in 1817, that it was the best managed he had ever seen
or heard of, realizing, he added, all the advantages of the York
Retreat. He, however, protested against the system under which it, like
other asylums, was conducted as radically wrong; its success was a
success of circumstances, almost of accident.
This Prison Act was at this date the only law which regulated Irish
asylums, the only statute by which they could be carried on. All, in
fact, depended upon the humanity, skill, and conscientiousness of the
superintendent.[254] I believe, as a matter of fact, Cork was the only
county which made use of it.
So far back as 1804, a Select Committee of the House of Commons was
appointed to consider the provision for the insane in Ireland, and
reported that the provisions of the Act 27 Geo. III., c. 39, empowering
grand juries to present the sums necessary for support of a ward for
idiots and lunatics, have not been complied with, and that the demand
for admission into houses of industry greatly exceeds the accommodation
or funds appointed for their support, and that it does not appear that
any institution, maintained in any degree at the public expense, exists
in any other part of Ireland than Dublin, Cork, Waterford, and Limerick,
for their reception. The Committee resolved that the attention and care
necessary for the effectual relief of these distressed objects cannot be
efficaciously extended to them whilst they are connected with
institutions of a very different nature, and that the establishment of
four asylums for idiots and lunatics, one in each of the provinces of
Ireland, would be a measure highly beneficial.
The result of this Report was that on the 21st of March, 1805, leave
was given to bring in a Bill for establishing in Ireland four provincial
asylums, appropriated exclusively to lunatics and idiots--thus providing
for a thousand patients. This excellent Bill shared the fate of so many
Bills for English lunatics, and did not become law.
It is worthy of remark that in the Report of the Select Committee (1815)
to inquire into the state of English mad-houses, it is stated that the
necessity of making some further provision for insane persons appeared
to be more urgent in Ireland than in England, as, "with the exception of
two public establishments and some private houses, there are no places
appropriated separately for the insane."
In 1810 the Government urged upon the House of Commons the necessity of
affording some relief to the neglected condition of the insane poor in
Ireland, the result being that grants were made for building an asylum
in Dublin, called "The Richmond Lunatic Asylum" (55 Geo. III., c. 107).
It was opened in 1815, and proved a great boon to the district. Two
years afterwards, Mr. John Leslie Foster, one of the governors, in
evidence before the Select Committee of the House of Commons on the
lunatic poor in Ireland, referred to the humane system of treatment
introduced at the York Retreat, "the good effects of which are
illustrated in a publication[255] of Mr. Tuke," and said, "This system
appearing to the governors of the Richmond Lunatic Asylum to be founded
in good sense, they determined on trying the experiment in their new
institution, and beg to add, as a proof of this, that there is not in
the Richmond Asylum, to the best of my belief, a chain, a fetter, or a
handcuff. I do not believe there is one patient out of twenty confined
to his cell, and that of those who are confined to their cells, in the
great number it is owing to derangement of their bodily health rather
than to the violence of mania." He speaks of the superintendent as the
"moral governor," whose particular business it is to attend to the
comforts of the patients, to remove from them causes of irritation, to
regulate the degrees of restraint, and to provide occupation for the
convalescent.
The Richmond Asylum did not serve, as was hoped and expected at that
time, to supply accommodation for a large portion of Ireland. To the
amazement of those who had induced Parliament to make what they deemed
so ample a provision, it was soon found that not only was the asylum
full to overflowing, but the house of industry was soon as full as
before, and that as to finding accommodation for those at a distance, it
was altogether out of the question. At first, sanguine hopes were raised
by the large number of recent cases discharged cured, and the common but
fallacious inference was drawn that, had all the chronic cases in the
houses of industry or at large been fortunate enough to be placed under
asylum treatment in the first stage of their malady, they would also
have been cured in like proportion. Unfortunately, the accumulation of
incurables, even in asylums, opened the eyes of many to the fallacy of
this inference.[256] Other asylums were, therefore, it was seen,
required.
"Your Committee," observe the Select Committee of the House of Commons
of 1817,[257] "beg leave to call the attention of the House to the
detailed opinion expressed by the governors of the Richmond Asylum, that
the only mode of effectual relief will be found in the formation of
district asylums, exclusively appropriated to the reception of the
insane." It appeared that, with the exception of the Dublin institution,
that at Cork, and one at Tipperary, there was not provision made for
more than one hundred lunatics throughout the whole of Ireland. The
Committee proposed that, in addition to the asylums in Dublin and Cork,
there should be built four or five additional asylums, capable of
containing a hundred and twenty to a hundred and fifty lunatics each.
They recommended that powers should be given to the Government to divide
Ireland into districts, and that the expense should be borne by the
counties included within the several districts. The consequence of this
Report was the Act 57 Geo. III., c. 136,[258] afterwards repealed, but
re-enacted with amendments by the 1 and 2 Geo. IV., c. 33; 6 Geo. IV.,
c. 54; and 7 Geo. IV., c. 14. These statutes enacted that the cost of
asylums, advanced from the Consolidated Fund, was to be ultimately paid
by the counties; that all the principal officers were to be appointed by
the Lord Lieutenant, the general superintendence being vested in a Board
of Commissioners, named by the Government but acting gratuitously; that
the asylums should be brought under the annual review of the
inspectors-general of prisons by the 7 Geo. V., c. 74, and should be
noticed in the reports submitted annually to Parliament. The
inspectors-general had power to enter private as well as public asylums.
The first really effective Act of Parliament, directing the erection of
asylums for the insane poor in Ireland, was, then, that which we have
mentioned as passed in the year 1821, and formed the 1 and 2 Geo. IV.,
c. 33.[259] The Lord Lieutenant (not the justices, as in England) was
authorized to establish any number of these asylums (to accommodate not
less than one hundred and not more than one hundred and fifty paupers)
when and where it seemed expedient, while for this purpose eight
Commissioners were nominated to superintend the execution of the work.
Some years elapsed before asylums were built. Then nine, capable of
accommodating nine hundred and eighty patients, were commenced at
Armagh, Ballinasloe, Carlow, Clonmel, Limerick, Londonderry,
Maryborough, and Waterford, for their respective districts, some being
composed of no less than five counties. It is stated that such was the
dislike of the humbler classes to the name of mad-houses, that they
were not fully occupied until 1835. The eight Commissioners retired, and
the Board of Works took their duties upon them, and acted until 1861,
when the 18 and 19 Vict., c. 109, enacted that two members of the Board,
including the chairman, and the two Inspectors of the insane, should be
appointed Commissioners of general control and correspondence.[260]
The grand juries of assizes were to present such sums as should be
required for asylums. In 1826 an Act was passed (7 Geo. IV., c. 74)
which continued and extended the former provisions, viz. that the
inspectors-general of prisons should be inspectors of lunatic asylums in
Ireland; that no person should keep a house for the reception of insane
persons unless licensed; that justices of the peace might grant them;
that no person should be received into or retained in a licensed or
unlicensed house without an order and the certificate of a medical man
not interested in such houses; that licensed houses not kept by a
physician should be visited by a medical man once a fortnight; that the
inspector must visit such houses once in six months, and may make
special visits, and after two such visits may liberate a patient; and
that the inspectors should make an annual report to the Lord Lieutenant
and Lord Chancellor. This Act did not apply to public asylums. It was to
commence and take effect in the county and city of Dublin, and to remain
in force till August 1, 1845. It may be well to note here that in 1826
"the numbers of lunatics and idiots in every public asylum in Dublin,
and in every asylum in Ireland,"[261] erected under the provisions of
the Act 1 and 2 Geo. IV., c. 33, and 55 Geo. III., c. 107, were only as
follows:--
CITY OF DUBLIN.
Under what Act
Lunatics. maintained.
Richmond Lunatic Asylum 252 55 Geo. III., c. 107.
House of Industry Lunatic Asylum 461
---
713
ERECTED UNDER 1 AND 2 GEO. IV., c. 33.
Lunatics. Idiots.
District Lunatic Asylum, Armagh 52 6
The following table shows, at a glance, the number of lunatic and idiots
confined in 1826, and maintained in the public institutions, supported
wholly or in part by grand jury presentments in Ireland.
----------------------------+---------+-------+---------------------------
| | | Under what Act
Location. |Lunatics.|Idiots.| maintained.
----------------------------+---------+-------+---------------------------
Antrim County Jail | 1 | 2 |Prison Acts.
„ House of Correction | 2 | 1 | Ditto.
Carlow County Jail | 3 | -- | Ditto.
Cavan County Jail | 7 | 1 | Ditto.
Cork County and City | | |
Lunatic Asylum | 234 | 38 |27 Geo. III., c. 39, s. 8.
Clare Lunatic Asylum | 12 | 1 | Ditto.
Donegal Lunatic Asylum | 12 | 6 | Ditto.
Down County Jail | 10 | 3 |Prison Acts.
Fermanagh County Jail | 1 | -- | Ditto.
Kildare County Jail | 1 | -- | Ditto.
Kilkenny County Jail | 2 | -- | Ditto.
„ City Jail | 7 | 1 | Ditto.
„ House of Correction| 8 | -- |Prison Acts.
King's County Jail | 4 | -- | Ditto.
Leitrim County Jail | 3 | 1 | Ditto.
Limerick County Jail | 1 | -- | Ditto.
„ House of Industry | 59 | 3 |46 Geo. III., c. 95.
Londonderry County Infirmary| 13 | 12 |45 Geo. III., c. 3, s. 1.
Longford County Jail | | 2 |
Mayo Bridewell | 17 | 5 |
Meath County Jail | 1 | -- |Prison Acts.
Queen's County Jail | 1 | -- |26 Geo. III., c. 27, s. 4
Roscommon County Jail | 20 | 2 |Prison Acts.
Sligo County Jail | 5 | 4 | Ditto.
Tipperary House of Industry | 26 | 13 |46 Geo. III., c. 95, s. 2.
Tyrone County Jail | -- | 10 |Prison Acts.
Waterford County and City | | |
House of Correction | 49 | 44 |46 Geo. III., c. 95, s. 2
Wexford House of Industry | 27 | 11 |
+---------+-------+
| 546 | 160 |
----------------------------+---------+-------+--------------------------
The accumulation of incurables pressed heavily upon the Richmond Asylum,
where, as I have said, the most sanguine hopes were at first raised as
to the cure of the great majority of the patients. The governor thus
wrote in 1827 to the Right Hon. W. Lamb:--
"In reference to the paragraph in Mr. Spring Rice's letter [to Mr. Lamb]
which suggests the inquiry how far the asylums in Ireland have proved
effectual, I am directed to state that a very considerable accumulation
of incurable lunatics has taken place in this asylum within the last few
years, and for the reception of whom the House of Industry is
inadequate. In consequence the Richmond Lunatic Asylum, which was
established for the relief of curable lunatics, is at present occupied
by one hundred and seventeen patients, whom the medical officer deems
incurable. I am likewise directed to state that, notwithstanding the
relief afforded by two provincial asylums now open for the reception of
patients, viz. Limerick and Armagh, the number of applicants for
admission to this asylum has not diminished."[262]
One is amused, even while wading through these dry Parliamentary returns
on a painful subject, by meeting with such a passage as the following,
written by Dr. Thomas Carey Osborne in his report of the Cork Asylum.
Speaking of the symptoms of a young maniac, cured by electricity, he
says, "When in the yard, he would look intently on the sun if permitted,
until the _albuginea_ became scarlet, and the tears flowed down the
cheeks, unconscious of inconvenience." His report is very pedantic, full
of quotations from the Scriptures, Shakespeare, and other poets. His
style is shown in what he says of Dr. Hallaran, his excellent
predecessor in office at the Cork Asylum for more than thirty years,
when he informs his reader that the "infuriated maniac and the almost
senseless idiot expressed sorrow for his decease and deplored him as a
friend."
One case reported by the doctor is worth recording. He had been some
years under treatment, and his insanity was attributed to the loss of a
hooker off the western coast, his only property, which he had purchased
after much toil as a fisherman. His character was melancholic, and he
conducted himself with propriety. He was appointed door-keeper, and
filled his situation with such kindness and good humour that he was
generally esteemed. He had the whimsical illusion of having been
introduced into the world in the form of a salmon, and caught by some
fisherman off Kinsale. He was found one morning hanging by a strip of
his blanket to an old mop nail, which he had fixed between the partition
boards of his cell, having taken the precaution of laying his mattress
under him to prevent noise in case of his falling.[263]
In 1827 the total number of persons in confinement was reported to be:--
---------------------------------+-----------+---------+-----------
Location. | Lunatics. | Idiots. | Totals.
---------------------------------+-----------+---------+-----------
Richmond Asylum | 168 | 112 | 280
Lunatic ward of House of Industry| 442 | -- | 442
Private asylums (4) near Dublin | 101 | -- | 101
City and County Asylum, Cork | 138 | 64 | 202
Asylum at Waterford | 103 | -- | 103
" Armagh | 64 | -- | 64
Jail at Lifford | 18 | -- | 18
Private house, Downpatrick | 17 | -- | 17
County Infirmary, Derry | 12 | -- | 12
Old Jail, Roscommon | 19 | -- | 19
Asylum, Ennis | 14 | -- | 14
" Kilkenny | 14 | -- | 14
House of Industry, Tipperary | 32 | -- | 32
" Waterford | 57 | 48 | 105
" Wexford | 37 | -- | 37
Asylum, Limerick | 74 | -- | 74
Dean Swift's Hospital | 50 | -- |(about) 50
+-----------+---------+------------
Total | 1360 | 224 | 1584
---------------------------------+-----------+---------+------------
Sir Andrew Halliday, aware that these numbers bore no proportion to the
actual number of insane and idiots in Ireland, reckoned the number at
three thousand.
In 1830 the Richmond Asylum, Dublin, was converted into a District
Lunatic Asylum for the city of Dublin by the Act 11 Geo. IV., c.
22.[264]
Passing on to 1842, the Solicitor-General for Ireland in that year
introduced a "Bill for amending the Law relating to Private Lunatic
Asylums in Ireland," which became law August 12, 1842. It is not
necessary, however, to give its details in this place, and I shall
proceed to notice the important Report of the Committee of the House of
Lords, with minutes of evidence, which was issued in 1843.[265] A table
is given of the district asylums and the Cork Asylum, from which it
appears that at that period the number amounted to ten, viz. Armagh,
Belfast, Carlow, Clonmel, Connaught, Limerick, Londonderry, Maryborough,
Richmond, and Waterford.
These ten district asylums contained upwards of 2000 patients, although
built to contain only 1220. As 688 were found to be incurable, the
Committee reiterated the warning given at the Committee of 1817, that if
fresh provision were not made, the institutions would shortly become
"asylums for mad people, and not hospitals for the cure of insanity." As
to the treatment, it is reported that "the system of management adopted
in the district asylums appears to have been, with the exception of one
case of gross misconduct and abuse, very satisfactory.... A humane and
gentle system of treatment has been generally adopted, the cases
requiring restraint and coercion not exceeding two per cent. on the
whole. The system is one which, if applied exclusively to the cure of
the malady, and if the asylums were relieved from the pressure produced
by the increasing number of incurables, appears to the Committee in its
essential points to be deserving of confidence and of approval; but,
unless so relieved by some alteration of the present law and of the
present practice, the admission of new cases must necessarily be
limited, and may ultimately be restricted within very narrow bounds
indeed. The necessity of some change in this respect is admitted by all
the witnesses, as well as proved by the documentary evidence before the
Committee. The number of persons refused admission for want of room has
in the present year amounted to one hundred and fifty-two."
At this period, beside the district asylums, there were Swift's
Hospital, and other establishments provided for the custody of pauper
lunatics, supported by local taxation, and connected more or less with
the old houses of industry. At Kilkenny, Lifford, Limerick, Island
Bridge, and in Dublin (the House of Industry) local asylums existed,
characterized as "miserable and most inadequate places of confinement,"
and were under the authority of the grand juries, the funds being raised
by presentment or county rate. "The description given of these latter
most wretched establishments not only proves the necessity of
discontinuing them as speedily as accommodation of a different kind can
be provided, but also exemplifies the utter hopelessness, or rather the
total impossibility, of providing for the due treatment of insanity in
small local asylums. No adequate provision is made, or is likely to be
made in such establishments, for the medical or moral treatment of the
unfortunate patients. Hence the necessity of a coercive and severe
system of treatment. The chances of recovery, if not altogether
extinguished, are at least reduced to their very lowest term.... Whilst
a general improvement has taken place in the management of the insane
throughout other establishments of Ireland, these local asylums, if
indeed they deserve such a name, have continued in the most wretched
state." Evidence of the strongest kind is given to impress upon
Parliament the necessity of an immediate discontinuance of this part of
the system.
It would carry us too far to enter at length into this evidence. One or
two facts must suffice as examples of the rest. At Wexford, where, in
the cells for lunatics, there were two patients in restraint, one of
whom was chained to a wall, Dr. White, the Inspector of Prisons, thus
described the latter: "When I went to his cell with the keeper and the
medical officer, I asked to go in. He was naked, with a parcel of loose
straw about him. He darted forward at me, and were it not that he was
checked by a chain round his leg, and was fastened by a hook to the
wall, he would have caught hold of me, and probably used violence. I
asked how it was possible they could allow a man to remain in such a
state; they said they were obliged to do so, as the funds were so
limited that they had not money to buy clothes for him, and that if they
had clothes they would have let him out.... I went to another cell, and
though the individual was not chained, he was nearly in as bad
circumstances as the other. Altogether these two cases were the most
frightful I ever witnessed. I could not describe the horror which seized
me when I saw them. I went into a room, a very gloomy-looking room, very
low, and in this room there was a fireplace, which was guarded by one of
those large grate-protectors that are very high up; I looked around and
heard some one moaning, and on the top of this screen I saw two
unfortunate lunatics stretched out; they were trying to warm themselves
through the bars of the grating; the room was so dark that I could not
see them at first, and here they were allowed to creep about and to lie
in this kind of unprotected manner." In reply to the question, "Was
there any moral superintendence?" Dr. White said, "There was both a male
and female keeper, but they appeared to me totally unfit for the
discharge of their duties."
The number of lunatics confined in jails was found by the inquiry of
1843 to have increased, partly in consequence of the Act 1 and 2 Vict.,
c. 27, for the more effectual provision for the prevention of offences
by insane persons. Two justices were authorized, acting with the advice
of a medical man, to commit to jail any person apprehended under
circumstances denoting derangement of mind and a purpose of committing
crime. A subsequent clause authorized the Lord Lieutenant to transfer
such person, as well as convicts, to a lunatic asylum. No steps had been
taken to ascertain whether, on the one hand, the jails afforded any
accommodation whatever for such lunatics, or whether, on the other,
convict lunatics could be properly received into the district asylums.
The statute operated widely. Previous to it, in 1837, there had been
only thirty-seven lunatics in jails, while by the year 1840 they had
augmented to one hundred and ten, of whom eighty-one were maniacs,
seventeen were idiots, and twelve were epileptics; while by the 1st of
January, 1843, the number amounted to two hundred and fourteen. Of these
only forty had been convicted of any criminal offence, showing that the
application of the Act had gone much beyond the intention of its
framers. Thus it was that "the numbers crowding the county jails were
truly distressing, and were made the subject of universal complaint by
the local authorities."[266]
The Lords' Committee, of course, insisted on the necessity of
discontinuing the committal of lunatics to jails and bridewells, and
amending the Act 1 Vict., c. 27, which had led to such serious abuses;
the inexpediency of appropriating the union workhouses or houses of
industry to the custody or treatment of the insane; the necessity of
providing one central establishment for criminal lunatics, under the
immediate control and direction of the Government of Ireland, to be
supported from the same funds and under the system adopted in respect
to criminal lunatics in England; the necessity of increasing the
accommodation for pauper lunatics in Ireland, and of providing for the
cases of epilepsy, idiocy, and chronic disease by an increased number of
the district asylums, by enlargement of these asylums, or by the
erection of separate establishments, specially appropriated for these
classes of patients.[267]
At this Committee Dr. Conolly gave the results of his non-restraint
experience at Hanwell since September, 1839.
The following tabular statement, delivered in at the Committee by the
Rev. E. M. Clarke, presents a valuable picture of the state of lunacy in
Ireland on the 1st of January, 1843:--
1. Population of Ireland in 1841 8,175,238
2. Total insane confined January 1, 1843 3,529
3. Total curable, comprised in No. 2 1,055
4. Total incurable, ditto 2,474
5. Total curable (not including private
asylums) confined January 1, 1843 848
6. Number for which the district asylums
were first built 1,220
7. Number confined in district asylums,
January 1, 1843 2,061
8. Confined in other than district asylums,
January 1, 1843 1,468
9. Number confined in thirty-two jails,
January 1, 1843 211
10. Number confined in workhouses, March 31,
1843 557
11. Number of curable cases confined in
thirty-two jails, January 1, 1843 78
12. Number of curable cases in district
asylums, January 1, 1843 698
13. Number of incurable cases in district
asylums, January 1, 1843 1,368
A correspondence took place between the Irish Government and the
managers of the district asylums on the subject of the Report of the
House of Lords' Committee on the state of the lunatic poor, commencing
November, 1843, by a letter from Lord Elliott to the superintendents,
asking for their opinion. These unanimously endorsed the conclusions
arrived at by the Committee, and, in some instances entering into the
mode of inspection of asylums by the two inspectors-general of prisons
at their half-yearly visitation of gaols, asserted that "it must from a
variety of causes be of no use whatever."
The Irish Government also opened a correspondence in 1844 with the grand
juries of each county, and their opinion was asked as to the eligibility
of the sites proposed for new asylums. As the Acts of Parliament limited
the number of patients in any single asylum, it was sought to remove
this obstacle by an Act in 1845, 8 and 9 Vict., c. 107. This Act also
provided for the erection of a central asylum for criminal lunatics,
which carried out one important recommendation of the Lords' Committee.
The Cork Asylum was at the same time added to the district asylums.
In 1846 an Act (9 and 10 Vict., c. 115) was passed to amend the laws as
to district asylums in Ireland, and to provide for the expenses of
inspection of asylums.
From a return made in this year (1846) showing the total number of
lunatics in the district, local, and private asylums and jails on the
1st of January during each of the previous ten years, I observe that in
1837 there was a total of 3077, and in 1846 a total of 3658, thus
distributed:--
------+-----------+-----------+-----------+----------+----------
Year.| District | Local | Private | Jails. | Total.
| Asylums. | Asylums. | Asylums. | |
------+-----------+-----------+-----------+----------+----------
1837 | 1610 | 1236 | 152 | 79 | 3077
1846 | 2555 | 562 | 251 | 290 | 3658
+-----------+-----------+-----------+----------+----------
| Inc. 945 | Dec. 674 | Inc. 99 | Inc. 211 | Inc. 581
------+-----------+-----------+-----------+----------+----------
Of the 3658, as many as 2473 were incurable, leaving only 1185 curable
patients. For 1846 there is also a return of the number in poor-houses,
1921; wandering idiots and simpletons, 6217; lunatics under the care of
Court of Chancery not in asylums, 76; making a total of 11,872, of whom
327 only were private patients.
In the following year the annual report of the Inspectors thus speaks of
non-restraint: "The non-restraint system has been introduced, and is
generally acted on, mechanical restraint being seldom applied except
where the patients are very violent, and even then it is not often
resorted to, as a temporary seclusion is now substituted as a more
effectual means of tranquillizing the patients without the risk of
personal injury often resulting from the application of bodily
restraint, and arrangements are being made to have apartments fitted up
for this purpose in each asylum."
The percentage of cures and mortality during the previous seven years
was as follows:--Per cent. on the admissions, 38.65; mortality
calculated on average number resident, 8.39--not an unsatisfactory
return.
In 1849 the proportion of lunatics (_i.e._ ascertained) to the
population in Ireland was 1 to 900, while in Scotland it was 1 to 740,
and in England 1 to 870.
In their report of this year, the Inspectors of Asylums express their
regret that no provision exists for the insane who, not being paupers,
are legally inadmissible into the public institutions, and are unable to
meet the charges made in private asylums, the only mixed institutions
being St. Patrick's Hospital and the Retreat in Dublin, managed by the
Society of Friends.
The number of patients in the district asylums in 1851 (exclusive of
Cork, 394) was as follows:--
No. Opened.
Armagh 131 1824
Belfast 269 1829
Carlow 197 1832
Clonmel 197 1834
Ballinasloe 312 1833
Limerick 340 1827
Londonderry 223 1829
Maryborough 192 1833
Richmond 279 1815
Waterford 115 1835
----
Total 2255
In 1855[268] the Act 18 and 19 Vict., c. 76, continued the Private
Asylum Act of 5 and 6 Vict. The 9 and 10 Vict., c. 79, and 14 and 15
Vict., c. 46, were continued till 1860. The Act 18 and 19 Vict., c.
109, made further provisions for the repayment of advances out of the
consolidated fund for the erection and enlargement of asylums for the
lunatic poor in Ireland. Seven asylums had been built under the Board of
Works since 1847.
By far the most important attempt to take steps for the reform of Irish
lunacy was the appointment of a Royal Commission in 1856, to inquire
into the state of lunatic asylums and other institutions for the custody
and treatment of the insane in Ireland. Among the Commissioners of
Inquiry were Mr. Lutwidge, Mr. Wilkes, and Dr. Corrigan. The Report was
issued in 1858. They found that on January 1, 1857, the total number of
patients in asylum districts amounted to 5225, of whom 1707 were in
workhouses, 166 in jails, and 3352 at large, while the inmates of
district asylums numbered only 3824. They therefore urged the pressing
need of additional accommodation. They proposed that the Irish law
should be assimilated, with respect to single patients, to the 16 and 17
Vict., c. 97, s. 68, the police being empowered to bring before a
magistrate any wandering lunatic, and justices of the peace having power
on sworn information to cause such person to be brought before them.
They also regarded as absolutely necessary a total alteration of the
rules affecting the manager and physician of an asylum, previous rules
having been drawn up in contemplation of the former officer not being a
medical man. Among other recommendations, there were proposals in
reference to private asylums, for which no legislative enactment was
passed prior to 1826 (7 Geo. IV., c. 74),[269] and no special law for
licensing them or securing their proper management until 1842, when the
statute of 5 and 6 Vict., c. 123, enacted that the Inspectors-General of
Prisons, whose duty it was to inspect private asylums, should be
Inspectors of Lunatic Asylums--a function which, with others connected
with asylums, was by the 8 and 9 Vict., c. 107, transferred to the then
newly appointed Inspectors of Lunatics. The Commission proposed that the
power of issuing licences should be transferred from the justices to the
Inspectors of Lunatics; that the licence should require that some
medical man should reside on the premises; that any abuse, ill
treatment, or wilful neglect of a lunatic by the superintendent or any
other person employed in the care of lunatics, should be deemed a
misdemeanour, and punished accordingly; and that, for inspection,
licensed houses should be visited by one or more of the Commissioners
four times a year. Many other important recommendations were made by the
Commission, some of which bore fruit in subsequent Irish legislation,
but to how limited an extent is evident from the recommendations of
another Commission, to which we shall shortly refer.
The Commissioners notice the culpable disregard with which the rule of
the Privy Council, which requires that "the manager is to take charge of
the instruments of restraint, and is not, under any pretence, to allow
the unauthorized use of them to any person within the establishment; all
cases placed under restraint, seclusion, or other deviation from the
ordinary treatment, being carefully recorded by him in the daily report,
with the particular nature of the restraint or deviation resorted to,"
has in many instances been treated. So also had the rule that the
superintendent was to enter in the Morning Statement Book "the names of
those in restraint or seclusion, and the causes thereof." Some managers
were not aware of the existence of the rule, while others deemed it a
sufficient compliance with the rules to leave the instruments of
restraint in charge of the keepers, trusting to their integrity to
report the cases in which they were used. In one asylum a female patient
was strapped down in bed with body-straps of hard leather, three inches
wide, and twisted under the body, with wrist-locks, strapped and locked,
and with wrists frayed from want of lining to straps, and was seriously
ill, but yet no record had been made in the book. "Wrist-locks and
body-straps were hung up in the day-room, for application at the
attendants' pleasure. A male patient was strapped down in bed; in
addition, he was confined in a strait waistcoat with the sleeves knotted
behind him; and as he could only lie on his back, his sufferings must
have been great; his arms were, moreover, confined with wrist-locks of
hard leather, and his legs with leg-locks of similar kind; the strapping
was so tight that he could not turn on either side; and any change of
position was still more effectually prevented by a cylindrical stuffed
bolster of ticken, of about ten inches thick, which ran round the sides,
and top, and bottom of the bed, leaving a narrow hollow, in the centre
of which the lunatic was retained, as in a box, without power to turn
or move. On liberating the patient and raising him, he was very feeble,
unable to stand, with pulse scarcely perceptible, and feet dark red and
cold; the man had been under confinement in this state for four days and
nights;" yet the manager stated he was not aware of his having all these
instruments of restraint upon him, and no record of the case appeared in
the book.
At another asylum the Commissioners found a bed in use for refractory
patients, in which there was an iron cover which went over both rails,
sufficiently high to allow a patient to turn and twist, but not to get
up.
Before leaving the Report of the Commissioners of 1858, we may add that,
during the period comprised between the date of the Committee of 1843
and this Commission, the number of district asylums was increased from
ten to sixteen, affording additional room for 1760 patients, exclusive
of Dundrum and a large addition to the Richmond Asylum. Thus:--
-------------+------------------------------------------
| When first opened.
Name of +-------+----------------------+-----------
asylum. | | | Number of
| Date. | Cost including site. | beds.
-------------+-------+----------------------+-----------
| | £ s. d. |
Cork | 1852 | 79,827 1 5 | 500
Kilkenny | 1852 | 24,920 12 1 | 150
Killarney | 1852 | 38,354 8 3 | 250
Mullingar | 1855 | 37,716 15 9 | 300
Omagh | 1853 | 41,407 12 2 | 310
Sligo | 1855 | 39,769 0 7 | 250
+-------+----------------------+-----------
Total 261,995 10 3 | 1760
--------------------------------------------+-----------
The Report of the Commission recommended that parts of the workhouses
should be adapted and used for some of the incurable class of patients.
This was not done, and we cannot be surprised, seeing the unfortunate
state of these abodes. But, in addition to the removal of incurable
cases to workhouses, the Commissioners recommended additional buildings
in connection with existing asylums, for the reception of cases which,
although incurable, might yet, from their habits or dangerous tendency,
be considered improper cases to be removed from institutions especially
devoted to the treatment of insanity. They were satisfied that the
number of district asylums would be found more and more inadequate for
the wants of the country.
There was a Select Committee of the House of Commons on lunatics in
1859.[270] In the minutes of evidence great stress is laid upon the
necessity of providing, in Irish asylums, accommodation for the class
immediately above paupers, whose friends were willing to pay a small
additional sum for their maintenance; and also establishing district
asylums, similar to the chartered asylums in Scotland. Two years later
(1861), and three after the Royal Commission, the Act 24 and 25 Vict.,
c. 57, continued the various Acts respecting private and public asylums
(5 and 6 Vict., c. 123; 18 and 19 Vict., c. 76). The subsequent Act of
1867 (30 and 31 Vict., c. 118) provided for the appointment of the
officers of district asylums, and amended the law relating to the
custody of dangerous lunatics and idiots. These were not to be sent to
any jail in the land after January 1, 1868. Dangerous lunatics
previously had to pass through jails, instead of going direct to
asylums. The 31 and 32 Vict., c. 97, made provision for the audit of
accounts of district asylums, and is of no general interest.
During three years (1866-69) six additional asylums were erected,
viz.:--
-------------+------------------------------------------
| When first opened.
Name of +-------+----------------------+-----------
asylum. | | | Number of
| Date. | Cost including site. | beds.
-------------+-------+----------------------+-----------
| | £ s. d. |
Ennis | 1868 | 51,316 8 6 | 260
Letterkenny | 1866 | 37,887 5 3 | 300
Downpatrick | 1869 | 60,377 6 5 | 300
Castlebar | 1866 | 34,903 14 11 | 250
Monaghan | 1869 | 57,662 5 5 | 340
Enniscorthy | 1868 | 50,008 0 6 | 288
+-------+----------------------+-----------
Total 292,155 1 0 | 1738
--------------------------------------------+-----------
Returning to 1861, the tenth report of the Inspectors of Asylums, issued
in that year, gives much important information on the state of lunacy in
Ireland at that time, but there are only two points to which it is
necessary to refer here. The writers, Drs. Nugent and Hatchell, speak
indignantly of the shameful manner in which the friends of lunatics in
confinement neglect them, "as if their malady entailed a disgrace on
those connected with them ... months--nay, years--passing without an
inquiry being made by a brother for a brother, or a child for a parent."
After stating that during the previous ten years four new asylums had
been licensed, the Inspectors recur to the importance of supplying
asylums for patients who, unable to pay the ordinary charge of a private
asylum, not being paupers, are ineligible for admission into public
asylums.
In 1874 a new code of rules, issued by the Privy Council, contained many
important regulations. Of it, however, the late Dr. Robert Stewart[271]
observed, "On the whole, we cannot speak very highly of the tact or
wisdom shown by the Lord Lieutenant and Privy Council in the framing of
the new code of regulations."[272] In this code the duties of the
medical superintendents of Irish asylums are minutely laid down.
In 1878 a Lunacy Inquiry Commission was appointed by the Lord Lieutenant
of Ireland, the Report of which in the following year, after an
examination of a large number of witnesses, contains much valuable
information as to various questions connected with the asylums and the
provision for the insane poor, present and future. The following "most
distressing case," recorded by the Commission, speaks loudly of the need
of increased provision for the insane poor in Ireland:--
"On approaching a small farmhouse at a place called ----, I heard," says
Dr. Robertson, "a most peculiar howling noise, and, to my horror, when I
came near the house I saw a lunatic _stark naked_, confined to a room,
and looking through the wooden bars that closed the windows, for there
was no glass whatever. He is about nineteen years of age, and I heard
from his mother that up to ten or eleven years he was a most intelligent
boy; but at that age he suddenly lost the power of speech and became
moody and abstracted, wandering about the fields alone, and constantly
uttering a low, muttering noise, and with incessant tendency to
mischief. By careful watching, the family prevented him injuring himself
and others, until of late he has got so strong and unmanageable, and his
inclination for destruction is so great, that they have been obliged to
confine him in the room I have described. He breaks the window directly
it is glazed, tears his bed-clothes into shreds, and won't allow a
stitch of clothing to remain on his body; besides, his habits are most
disgusting."[273] The incumbent of the parish wrote: "This case is
indeed only suited for a lunatic asylum. The form which his lunacy has
assumed is most shocking, and is detrimental to morality." An English
tourist happening to see this case had him removed to the Monaghan
Asylum. One cannot but remark that what an English tourist did, the
proper authorities ought to have done. The law appears to have been
sufficient for the occasion.
The members of the Commission were not content with hearsay evidence.
"We took occasion ourselves," they report, "to visit several of these
cases in different parts of the country. Some of them we found in a
deplorably neglected condition; others disturbing the arrangements of a
whole family, the head of which would willingly contribute a small sum
towards maintenance in some suitable place of refuge. It admits of no
doubt that many a case, if taken in hand at an early stage, might have
been restored to society, instead of lapsing into hopeless, incurable
insanity. Serious evil often results from the freedom with which idiots
of both sexes are permitted to wander abroad, often teased and goaded to
frenzy by thoughtless children, often the victims of ill treatment or
the perpetrators of offences far worse. The interests of the public, no
less than of the insane, require that means should be adopted to
ascertain that all of that class are properly cared for. That can only
be done by substituting the visit of a medical man for that of the
constable, and a professional report for the incomplete return that is
now made."
The chief conclusions were, that while it would not be proper to
dispense wholly with any workhouse, portions of some might be dispensed
with for sane paupers, and appropriated for the accommodation of a
certain class of the insane. Over-crowding, it was proposed, should be
relieved by the removal of lunatics to _auxiliary asylums_. School
buildings belonging to certain workhouses were suggested as auxiliary
asylums, as in Dublin, Cork, etc. For the better cure, relief, and
treatment of the lunatic and idiotic poor, a complete reorganization of
the whole lunacy administration was regarded as essential, viz. that
under the provisions of s. 15 of 8 and 9 Vict., c. 107, the existing
district asylums should be classified, reserving one or more, as might
be required, in each province as "lunatic hospitals," especially for
the curative treatment of the insane; that the remaining district
asylums should be appropriated as "lunatic asylums" for the
accommodation of the chronic insane requiring special care, a certain
number of this class being accommodated in the "lunatic hospitals," as
about fifty of each sex would be required for the service of those
establishments; that the inspection of the "lunatics at large" should be
made one of the duties of the dispensary medical officers, who should be
remunerated for this duty, and whose certificate that any one of this
class is neglected or improperly cared for, should be made the ground
for action by the lunacy authorities; that the accommodation for the
third or harmless class, who are at present in lunatic asylums, in
workhouses, or at large in a neglected state, be provided by the
appropriation of spare workhouse buildings, a sufficiency of which is to
be found in each province, thus also meeting the very general complaint
of guardians being compelled to maintain superfluous workhouse
accommodation; and that all expenditure upon the building or enlargement
of district asylums should be suspended.
By this means, each province would be provided with _three_ classes of
lunatic establishments: (1) One or more lunatic hospitals for the cure
of insanity in an early stage; (2) first-class asylums, in which the
chronic cases requiring special care would be treated; (3) second-class
or "workhouse auxiliary asylums" for harmless lunatics. The Commission
expressed a strong opinion that the whole lunacy administration of
Ireland should be placed under the general control of the Local
Government Board.
I may add that the estimated cost of the first class was £26 per head;
that of the second class, £20; and that of the third, £14 6s. Of this
scheme it must be said that, excellent as it is in intention, it is not
in some of its provisions without danger in the direction of lowering
the condition of the insane poor, as regards comfort and medical
supervision, not, indeed, below what they are in some Irish workhouses,
but below the standard aimed at in the best county asylums. "Let it be
understood that there is no recommendation to constitute anything like
an auxiliary asylum, such as Leavesden or Caterham, where large numbers,
being brought together, can be kept at a cheap rate, and can at the same
time be properly treated under medical care. No provision is made for
the necessary supervision, medical or otherwise. The dispensing medical
officer is to visit the insane at large, but those in workhouses are to
be left to the tender mercies of attendants. The amount of care and
comfort these unfortunate beings are to enjoy can be imagined by the
fact that the Commission considers that £14 6s. a year will be the cost
of their maintenance, after paying attendants, whilst the cost of those
in the second-class establishments is to be £20, or about £6 less than
what they cost at present."[274]
In their review of the results of past lunacy legislation in Ireland the
Commission make the melancholy statement that "although several years
ago the legislature made provision for the classification of
asylums,[275] and the Inspectors of Lunacy concur with other witnesses
of the highest authority in thinking that such classification would be
attended with the utmost advantage--would, in fact, meet the
difficulties of asylum administration--yet not only has no attempt ever
been made to give effect to the provisions of that law, but"--strangest
of all--"the Lunacy Inspectors appear to have been unaware of its
existence!"[276]
The Commission found that the evil of overcrowding with incurable cases,
complained of by the Committee of 1843, and by the Royal Commission of
1858, "has continued to the present day not merely unchecked, but in a
more aggravated form than ever." In 1856 there were 1168 curable and
2656 incurable patients in Irish asylums, while in 1877 these numbers
were, respectively, 1911 and 6272, the percentages being in the former
year, curable 30.5, incurable 69.5, while in the latter year the
corresponding percentages were 23.3 and 76.7. Taking the patients not
only in asylums, but in workhouses also, the total in 1856 (or more
correctly 1857) was as follows: curable, 1187; incurable, 4468;
percentages, 20.9 and 79.1. In 1877, curable, 1911; incurable, 9644;
percentages, 16.5 and 83.4--a frightful revelation of incurable lunacy.
The Inspectors complain that the Act 30 and 31 Vict. has caused this
increase of unsuitable cases,[277] but, as the Commission observe, it
has simply increased an existing evil, and not produced a new one.
Besides, "how otherwise are these unhappy people to be dealt with? Has
any other accommodation been provided for them? Though not suitable
cases for curative hospitals, they are, at all events, suitable cases
for care and humane treatment, and not until provision for such
treatment is made, ought the door of the asylum to be shut against
them."[278]
The condition of workhouses is proved by this Report to be most
unsuitable for the reception of the insane; yet they contained in 1879
one quarter of the pauper lunatics of the country. It was desirable to
remove a large number of these somewhere, and the only suitable place
was the district asylum. Dr. Lalor, in his evidence before this
Commission, says in regard to this increased number of admissions under
the 30 and 31 Vict., "I think it is an immense advantage, because before
that Act there was a great number of persons kept out who ought to be
sent into lunatic asylums, but there was not sufficient machinery for
doing so." Dr. Lalor then goes on to say that they have not in Ireland
the same provision as in England for taking up merely wandering lunatics
not chargeable to the rates. This witness, I should add, is strongly in
favour of larger asylums for even curable cases, and would classify the
institutions for the insane into three classes, the curable, the
improvable, and the incurable. For curable and improvable cases of
lunacy, including those requiring special care, and for the training and
education of imbeciles and idiots chiefly of the juvenile classes, he
would have the same asylum; for the incurable and unimprovable, he would
have another. He would leave it to a central body to distinguish the
cases, and would allow that such a body might find it more convenient to
class the juvenile idiots and imbeciles under the second division.
At the date of this Commission there were 22 district asylums,
containing 8073 patients. There were 150 workhouses, with 3200 insane
inmates. In Dundrum[279] were 166 criminal insane, and in private
asylums about 680 patients, making a total of 12,200. In addition to
these, the inspectors obtain a return of every idiot, imbecile and
epileptic, at large, from the police, not being under the supervision of
the Lunacy Board; the number in 1878 was 6200, bringing up the figures
to 18,400.
That practical effect might be given to the recommendations contained in
this Report, Lord O'Hagan called attention to them in a speech delivered
in the House of Lords, August, 1879, in which he said, "Let me ask the
attention of the House to the case of neglected lunatics in Ireland. It
is the most pressing, as it is the most deplorable." He cited the
statement of the Royal Commission of 1858, that there were 3352 lunatics
at large, of whom no fewer than 1583 were returned as "neglected;" and
the recent statement of the Irish Lunatic Inquiry Commission that within
the last twenty years the number of that class had increased by more
than a hundred per cent.--from 3352 to 6709--without "any diminution in
the proportion of those who may still be classified as neglected." Lord
O'Hagan referred to the case of a naked lunatic in a farmhouse, which we
have quoted at p. 424, and maintained that some four thousand lunatics
were in a condition "better or worse according to circumstances." We
cannot but think that the speaker generalized a little too much. He was
right, however, in his contention that none of the neglected cases "are
protected by any intervention of the law from exhibiting themselves in
as shocking an aspect."
"Only," observed Lord O'Hagan, "when the life of George III. was
threatened by a lunatic in England, did Parliament interfere and send
the insane to jails; only in 1838, when it was discovered that jails
were not fit receptacles for them, was provision made for committing
them to asylums; and only in the Consolidating Act of 1853 were
provisions made for such inspection and report as were needful for their
protection and the safety of their neighbours. I lament to say that
Ireland was left without even the benefit of the Act of 1799 until 1838,
and that the advantages which the Act of that year gave to England were
not extended to her lunatics until 1867; whilst you will scarcely
believe that the salutary reforms of 1853 have not to this hour been
made operative in Ireland."
Lord O'Hagan asked for identical legislation for Ireland and England,
the want of this having caused "incalculable mischief."
After observing that the Commission proposed the classification of
asylums for the purpose of curative treatment, the care of chronic
cases, and the allocation of workhouses as auxiliaries for the benefit
of the quiet and harmless, Lord O'Hagan referred to the fact that "the
Commission and the Inspectors of Lunacy differed as to material points
on the _modus operandi_, the inspectors desiring the extension of
district asylums, and the Commission not agreeing with this view; the
consequence being that at that time their extension was suspended." The
speaker did not presume to decide between them, but simply called upon
the Government to recognize the responsibility which the Report of the
Commission had cast upon them.
The Lord Chancellor (Lord Cairns) replied that the Report was engaging
the attention of the Government; that he trusted it would not be in the
category of those Reports "which have gone before" and produced no
result; but that he could not give any further answer.[280]
The Lord Chancellor of Ireland (Lord O'Hagan) brought in on the 20th of
January, 1880, the "County Court Jurisdiction in Lunacy Bill
(Ireland),"[281] which not only passed the House of Lords, but was read
a third time in the House of Commons, August 17th of that year.[282]
Lord O'Hagan's measure had for its object to protect the interests of
lunatics possessed of small properties, beyond the control of Chancery
on account of the expense incurred thereby. There were in Ireland under
the jurisdiction of the Lord Chancellor, committed to him by the Queen's
sign manual, 229. By the operation of the Act of 1871, introduced by
Lord O'Hagan, the guardianship then provided had worked admirably. But
there remained those who had very small property. Of the 642 persons
then in private asylums, 143 only were under the guardianship of the
Lord Chancellor, and the remainder might be presumed to have small
properties. In the district asylums there were 55 paying patients, 20 of
whom were under the Court of Chancery. Those on whose behalf Lord
O'Hagan addressed the House of Lords were estimated at 724. The property
of most of these "was left to the mercy of relations or strangers, who
did with these unhappy people what they would." While in the previous
year 1276 patients had been sent to district, and 141 to private
asylums, only 24 had been brought within the protection of the Lord
Chancellor. As much as £3189 was received from patients in the district
asylums in a year. The Bill now introduced gave protection to the class
in question by vesting in the County Court judges a new jurisdiction,
viz. in lunacy within the areas of the various courts, in cases in which
the property of the lunatic should not exceed the sum of £700 in money
value, or £50 a year--sums taken from the Lunacy Regulation Act of 1871,
which provided that the Lord Chancellor might be at liberty not to
impose upon lunatics having property of that value, the same fees and
obligations that were insisted upon in the case of more wealthy persons.
Lord O'Hagan regarded his Bill as only part of a larger measure to which
he looked forward.[283]
A Bill was introduced into the House of Commons, but without passing
into an Act, by Mr. Litton, member for Tyrone, entitled "The Lunacy Law
Assimilation (Ireland) Bill," on the 6th of April, 1881,[284] and it may
be worth while to observe what, according to so comparatively recent a
speaker on the subject, is now wanted to improve the condition of Irish
lunatics. After pointing out that, according to the Report of the
Commission of 1879, there were on January 1, 1878, about 11,000 lunatics
provided for, the number at large, inadequately cared for, was 6709, of
whom more than 3000 were actually neglected, as against 1583 in the year
1857; and after reviewing the legislation of 1 and 2 Geo. IV., by which
district asylums were established; the 1 and 2 Vict., c. 47, by which
dangerous lunatics may be committed to jails; the 8 and 9 Vict., by
which they might be transferred to Dundrum; the 30 and 31 Vict., c. 118
(1867), by which the first provision for sending this class of lunatics
to jail was repealed; the 38 and 39 Vict. c. 67 (1875), by which it was
provided that chronic lunatics not being dangerous might be consigned to
the poor-houses--Mr. Litton showed that there was no attempt at
classification in poor-houses, and that they only accommodated 3365
persons, and further that, in spite of the last Act, the asylums were
crowded with chronic and incurable cases, and had but little room for
recent cases. He deplored the want of supervision of the neglected
lunatics referred to, many of whom were subjected to cruel treatment. He
therefore preferred to extend to Ireland the provisions of ss. 66 to 68,
70 to 72, and 78 to 81 of the English Act, 16 and 17 Vict., c. 97,
subject to certain changes which were explained in the Bill. He doubted
whether powers to enlarge the existing asylums would meet the
difficulty, and it would be very costly and lengthy. It was proposed to
adopt the system of boarding out which had been in operation in
Scotland; due provision was made for their inspection. It was also
needful to give to poor-law guardians power to afford relief to the head
of a family one of whose members was insane (as in England), which was
now impossible, unless the head of the family was so afflicted.
The fact that all committals of dangerous lunatics on the warrant of two
magistrates must be cases in which the latter are satisfied that a
lunatic had shown an intent to commit an indictable crime leads, it is
stated, to many persons who, although dangerous, have not shown the
above intent, being kept out of asylums until they have passed into a
chronic state. However this may be, the number committed in Ireland as
dangerous lunatics is enormous, being in one year (1877) 1204 out of
1343 admissions, the truth being that numbers are classified as
dangerous who are not so.
Mr. Litton's Bill provided (1) for the supervision of neglected
lunatics; (2) the boarding out in suitable places, under the direction
of the governors of district asylums, of such patients as they might
select for that purpose; (3) an alteration in the law of committal, so
as to allow of patients being admitted before they became incurable; and
(4) power to the poor-law guardians to give outdoor relief under the
circumstances stated.[285]
The Bill had the approval of the Social Science Congress committee, and
of Lord O'Hagan, but on account of the pressure of other business never
reached the House of Lords.[286] It should be added that the Government,
in the person of the Solicitor-General, expressed a hope that they would
be able to bring in a Bill of larger scope, one more fully covering the
ground traversed by the Royal Commission of 1879.
The sketch now made, slight as it is, will serve to show that Ireland
formed no exception to the neglect to which the insane were subjected,
especially in the poor-houses and jails; that when attention was
strongly drawn to the better treatment of the insane in England, partly
by the publication of a work describing how this was to be carried out,
and partly by the evidence given before the Select Committee of the
House of Commons in 1815, the Irish Government took up the question of
reform, and resolutely set about putting their own house in order.
Select Committees collected valuable evidence which bore fruit in
efficient legislative enactments, and there seems to have been
singularly little opposition to the introduction of improved methods of
treatment and new buildings in place of the old. The Richmond Asylum
from the first led the way in enlightened modes of treatment, and at the
present time this institution, under the long and able management of Dr.
Lalor, is a credit to Ireland; the more so that here, more efficiently
than in any asylum I have visited in the British Isles, the employment
of the patients in school work has been introduced and prosecuted to a
successful issue.[287]
One other feature of the history of this movement in Ireland has already
been alluded to, but merits attention again, and that is the additional
proof afforded of the inevitable tendency to the accumulation of cases,
instead of their recovery on a large scale, as was at first hoped and
expected, not in Ireland alone, but in England. The frequency of relapse
was, in the outburst of delight accompanying the recovery of some cases
hopelessly incurable under the old system, not suspected, and the bitter
disappointment which this fact involves had yet to be experienced, and
is, indeed, scarcely realised at this moment. In one of the Irish
Reports, the circumstance is alluded to that, taking all the discharges
of patients on account of recovery, the cures amounted to the gratifying
number of seventy per cent. Had this proportion been sustained, and had
these patients retained their mental health, there would have been
little need of additional asylums. Patients from all quarters, their
homes, poor-houses, and even jails, might have been drafted for a season
into these temples of health, and, having passed the charmed threshold,
been restored in a few months to the outer world, never to return.
If this pleasant illusion is dispelled by the course of events in
Ireland, how much more strikingly must it be so in England? for the
former country is almost altogether free from that most hopeless of all
mental affections, the general paralysis of the insane--the plague of
all other civilized countries--and has fewer epileptics.
There are now in Ireland 43 district and private asylums, with a
population of insane persons amounting to 9289. There are 163
poor-houses in which there are insane and idiotic persons.
The insane under the jurisdiction of the Inspectors on the 1st of
January, 1881, were thus distributed:--
In district asylums 8,667
In the Dundrum or Criminal Asylum 180
At Palmerston House 19[288]
In private licensed houses 622[289]
In 163 union workhouses 3,573
------
Total 13,061[290]
As many as 1270 patients were received as dangerous lunatics under the
30 and 31 Vict., c. 118.
Will nothing be done to simplify admission? "Had the Bill introduced by
Mr. Litton during the past session become law, the admission order
universally used in England would have extended to Ireland, so that in
time the present confusion and difficulty experienced in obtaining
admission to Irish asylums might have been removed by the substitution
of one simple order for the complicated machinery at present in
existence. The Inspectors, however, seem to consider that the
introduction of the Bill extending protection under the 16 and 17 Vict.,
c. 97, to the insane who are at present not under State provision, would
be to fill hospitals for the insane with unpromising cases, at a
considerable increase of expenditure, to the exclusion of others more
urgent or more hopeful. The answer to this seems plain, that if the
accommodation for the insane is inadequate, every effort should be made
to provide increased means of protection for those who are unable to
care for themselves. It cannot surely be reasonably maintained that
because the accommodation is inadequate for the want of the insane
population, for that reason no further legislation should be put in
force for their better protection, nor does the supposition that
mistakes might occur in sending people to asylums who do not require to
be deprived of their freedom, deserve more serious consideration. That
such mistakes may and will occur for all time cannot be doubted, but
there cannot be any reason to suppose that because increased supervision
is provided, these mistakes would become more frequent. Such has not
been found the case in England, where this Act has been in force for
many years."[291]
The best thing we can hope for the effectual care of the insane in
Ireland is legislation in the direction indicated by Lord O'Hagan and
Mr. Litton.
ADDENDUM.
TABLE A.
NUMBER OF PATIENTS IN DISTRICT ASYLUMS, JANUARY 1, 1881.
-------------+----------+-------------+--------
Asylum. | Males. | Females. | Total.
-------------+----------+-------------+--------
Armagh | 100 | 96 | 196
Ballinasloe | 266 | 197 | 463
Belfast | 262 | 201 | 463
Carlow | 137 | 116 | 253
Castlebar | 174 | 115 | 289
Clonmel | 213 | 197 | 410
Cork | 450 | 420 | 870
Down | 197 | 141 | 338
Ennis | 140 | 121 | 261
Enniscorthy | 157 | 143 | 300
Kilkenny | 129 | 114 | 243
Killarney | 178 | 124 | 302
Letterkenny | 200 | 99 | 299
Limerick | 235 | 244 | 479
Londonderry | 147 | 124 | 271
Maryborough | 155 | 118 | 273
Monaghan | 244 | 159 | 403
Mullingar | 240 | 194 | 434
Omagh | 284 | 201 | 485
Richmond | 451 | 571 | 1022
Sligo | 200 | 141 | 341
Waterford | 126 | 146 | 272
+----------+-------------+--------
| 4685 | 3982 | 8667
-------------+----------+-------------+--------
WORKHOUSES.
Insane and Idiots.
Ulster 1054
Munster 1036
Leinster 1170
Connaught 313
----
3573
In jails 3
In Dundrum 180
TABLE B.
NUMBER OF PATIENTS IN PRIVATE ASYLUMS, JANUARY 1, 1881.
-------------------------------------+------+--------+------
|Males.|Females.|Total.
-------------------------------------+------+--------+------
Armagh Retreat | 16 | 9 | 25
Bloomfield Retreat, Co. Dublin | 14 | 27 | 41
Cittadella, Co. Cork | 15 | 9 | 24
Cookstown House, Piltown, Co. Dublin | 1 | 3 | 4
Course Lodge, Co. Armagh | -- | 12 | 12
Elm Lawn, Co. Dublin | -- | 3 | 3
Esker House, ditto | -- | 3 | 3
Farnham House, ditto | 31 | 23 | 54
Hampstead House, ditto | 23 | 1 | 24
Hartfield House, ditto | 29 | -- | 29
Highfield House, ditto | -- | 14 | 14
Lindville, Co. Cork | 13 | 19 | 32
Lisle House, Co. Dublin | -- | 3 | 3
Midland Retreat, Queen's Co. | 4 | 7 | 11
Orchardstown House, Co. Dublin | 5 | 6 | 11
St. Patrick's (Swift's), Dublin City | 38 | 63 | 101
Rose Bush House, Co. Dublin | 2 | -- | 2
Stewart Institution, ditto | 45 | 67 | 112
Verville, ditto | -- | 19 | 19
St. Vincent's, ditto | -- | 95 | 95
Woodbine Lodge, ditto | -- | 3 | 3
+------+--------+------
Totals | 236 | 386 | 622
-------------------------------------+------+--------+------
FOOTNOTES:
[251] Dublin. See _postea_.
[252] "Tenth Report of the District, Criminal, and Private Lunatic
Asylums in Ireland."
[253] Page 34.
[254] See Report of Select Committee, etc., 1817.
[255] "Description," etc., 1813.
[256] "The accumulation of the number of incurable cases which
necessarily must have occurred from time to time in these asylums, had
also been overlooked, and has consequently led to the embarrassment
which is felt at present with respect to the best mode of providing for
them."--Report of the Inspectors, 1843.
[257] "Report from the Select Committee on the Lunatic Poor in Ireland,
with Minutes of Evidence taken before the Committee, 1817."
[258] "An Act to provide for the Establishment of Asylums for the
Lunatic Poor in Ireland, 1817." Introduced by Mr. V. Fitzgerald, but
prepared By Mr. Thos. Spring Rice, M.P. for Limerick.
[259] Repealing 57 Geo. III., c. 106, and 1 Geo. IV., c. 98.
[260] See Twenty-seventh Report of Inspectors of Asylums, May 1, 1878.
[261] Parliamentary Return, ordered to be printed, April 19, 1826.
[262] Parliamentary Papers, Correspondence, etc., between the Home
Office and the Irish Government during 1827 on Public Lunatic Asylums.
[263] First Annual Report of the City of Cork Asylum, dated March 1,
1827.
[264] For particulars in regard to the condition of the insane in
Ireland in this year, see "Report of the Select Committee appointed to
take into consideration the state of the poorer classes in Ireland in
relation to Lunatic Asylums, 1830."
[265] "The Report of the Lords' Committee appointed to consider the
state of the lunatic poor in Ireland, and to report to the House."
[266] Report of the Lords' Committee.
[267] Orders in Council were in consequence issued for the erection of
the new district asylums, under the statutes 1 and 2 Geo. IV. and 7 Geo.
IV., c. 14, which will be found on another page.
[268] This Act was preceded by the Select Committee of Lunatic Asylums
(Ireland), moved by Colonel Dunne. Dr. Nugent, the Inspector of Asylums,
gave in his evidence a minute description of the system under which
asylums have been erected in Ireland, and stated that the expenditure on
the seven asylums built since 1847 amounted £313,973. In the same year a
Commission was appointed to inquire into the erection of district
lunatic asylums, which reported in 1856.
[269] The Prisons Act.
[270] See p. 191. Irish lunacy is only incidentally noticed in this
evidence, which had primary reference to England.
[271] The medical superintendent of the Belfast Asylum, one of the
best-managed institutions of Ireland.
[272] _Journal of Mental Science_, April, 1875.
[273] Dr. Robertson to the Inspector of Lunacy, Report, p. lxxxvii.
[274] From editorial article in _Journal of Mental Science_, July, 1879.
[275] 8 and 9 Vict., c. 107, s. 15.
[276] Page lxii.
[277] Patients being sent to asylums on the pretext of their being
"dangerous lunatics" when not so. See p. 435.
[278] Page lxviii.
[279] The Dundrum Central Criminal Asylum, recommended by the Committee
of the House of Lords in 1843, and established by the 8 and 9 Vict., c.
107, was built at a cost of £19,547, and was opened in 1850 on the south
side of the city of Dublin, capable then of holding only 120 inmates.
When the writer visited it in 1875, he was very favourably impressed
with its condition. Dr. McCabe was at that time superintendent, and has
been succeeded by Dr. Ashe.
[280] "Parliamentary Debates," 3rd series, vol. ccxlviii., August, 1879,
p. 1822.
[281] Ibid., vol. ccliv., July, 1880, p. 892.
[282] Ibid., vol. cclv., August, 1880.
[283] _Op. cit._, p. 894.
[284] "Parliamentary Debates," 3rd series, vol. cclx. p. 802.
[285] _Op. cit._, vol. cclx. p. 810.
[286] It was withdrawn July 8, 1881.
[287] See "The Richmond Asylum Schools," by Dr. D. Hack Tuke, _Journal
of Mental Science_, October, 1875. Also an article in the _Journal_,
April, 1882, by Mr. Fox, the master of the school.
[288] Only those supported by Government. The total number was 112.
[289] In 1873 the number was greater, viz. 664.
[290] The inspectors make a total of 13,051.
[291] _Journal of Mental Science_, January, 1882.
CHAPTER XI.
PROGRESS OF PSYCHOLOGICAL MEDICINE DURING THE LAST FORTY YEARS:
1841-1881.[292]
If, gentlemen, History be correctly defined as Philosophy teaching by
examples, I do not know that I could take any subject for my Address
more profitable or fitting than the Progress of Psychological Medicine
during the forty years which, expiring to-day, mark the life of the
Association over which, thanks to your suffrages, I have the honour to
preside this year--an honour greatly enhanced by the special
circumstances under which we assemble, arising out of the meeting in
this metropolis of the International Medical Congress. To it I would
accord a hearty welcome, speaking on behalf of this Association, which
numbers amongst its honorary members so many distinguished alienists,
American and European. Bounded by the limits of our four seas, we are in
danger of overlooking the merits of those who live and work beyond them.
I recall the observation of Arnold of Rugby, that if we were not a very
active people, our disunion from the Continent would make us nearly as
bad as the Chinese. "Foreigners say," he goes on to remark, "that our
insular situation cramps and narrows our minds. And this is not mere
nonsense either. What is wanted is a deep knowledge of, and sympathy
with, the European character and institutions, and then there would be a
hope that we might each impart to the other that in which we are
superior."
Do we not owe to France the classic works of Pinel and of
Esquirol--justly styled the Hippocrates of Psychological Medicine--works
whose value time can never destroy; and have not these masters in
Medical Psychology been followed by an array of brilliant names familiar
to us as household words, Georget, Bayle, Ferrus, Foville, Leuret,
Falret, Voisin, Trélat, Parchappe, Morel, Marcé, who have passed
away,[293] and by those now living who, either inheriting their name or
worthy of their fame, will be inscribed on the long roll of celebrated
psychologists of which that country can boast.
If Haslam may seem to have stumbled upon General Paralysis, we may well
accord to French alienists the merit of having really discovered the
disorder which, in our department, is the most fascinating, as it has
formed the most prominent object of research, during the last forty
years.
To mention Austria and Germany, is to recall Langermann,
Feuchtersleben, Reil, Friedreich, Jacobi, Zeller, Griesinger, Roller,
and Flemming, who, full of years and honours, has now passed away.
Has not Belgium her Guislain, Holland her Schroeder van der Kolk, and
Italy her Chiaruggi?
And when I pass from Europe to the American continent, many well-known
names arise, at whose head stands the celebrated Dr. Rush. Woodward,
Bell, Brigham, and Howe (whose many-sided labour included the idiot)
will be long remembered, and now, alas! I have to include among the dead
an honoured name, over whom the grave has recently closed. Saintship is
not the exclusive property of the Church. Medicine has also her
calendar. Not a few physicians of the mind have deserved to be
canonized; and to our psychological Hagiology, I would now add the name
of Isaac Ray. With his fellow-workers in the same field, among whom are
men not less honoured, I would venture to express the sympathy of this
Association in the loss they have sustained. Nor can I pass from these
names, although departing from my intention of mentioning only the dead,
without paying a tribute of respect to that remarkable woman, Miss Dix,
who has a claim to the gratitude of mankind for having consecrated the
best years of her varied life to the fearless advocacy of the cause of
the insane, and to whose exertions not a few of the institutions for
their care and treatment in the States owe their origin.
Abroad, psychological journalism has been in advance of ours.
The French alienists established in 1843 their _Annales
Médico-Psychologiques_ (one of whose editors, M. Foville, is with us
to-day), five years before Dr. Winslow issued his Journal, the first
devoted to medical psychology in this country, and ten years before our
own _Journal_ appeared, in 1853.
The Germans and Americans began their Journals in the following
year--1844; the former, the _Allgemeine Zeitschrift für Psychiatrie_,
and the latter the _American Journal of Insanity_.
I believe that our Association has precedence of any other devoted to
Medical Psychology, and it is an interesting fact that its establishment
led to that of the corresponding Association in France--a society whose
secretary, M. Motet, I am glad to see among my auditors. The Association
of Medical Superintendents of American Institutions for the Insane was
instituted in 1844; that of Germany in 1864, the subject of Psychology
having previously formed a section of a Medical Association.
Returning to our own country, I may observe that when Dr. Hitch, of the
Gloucester Asylum, issued the circular which led to the formation of
this Association in 1841, almost half a century had elapsed since the
epoch (1792) which I may call the renaissance of the humane treatment of
the insane, when the Bicêtre in France, and the York Retreat in England,
originated by their example an impulse still unspent, destined in the
course of years to triumph, as we witness to-day. This triumph was
secured, in large measure, by the efforts of two men who, forty years
ago, shortly after the well-known experiment at Lincoln, by the late
Mr. Robert Gardiner Hill, were actively engaged in ameliorating the
condition of the insane. Need I say that I refer to Lord Shaftesbury and
Dr. Conolly? The nobleman and the physician (alike forward to recognize
the services of the pioneers of 1792), each in his own sphere having a
common end in view, and animated by the same spirit, gave an impetus to
the movement, the value and far-reaching extent of which it is almost
impossible to exaggerate. Lord Shaftesbury,[294] celebrating his
eightieth birthday this year, still lives to witness the fruits of his
labours, of which the success of the well-known Acts with which his name
is associated, will form an enduring memorial. Dr. Conolly was in his
prime. He had been two years at Hanwell, and was contending against
great difficulties with the courageous determination which characterized
him. I do not hold the memory of Conolly in respect, merely or
principally because he was the apostle of non-restraint, but because,
although doubtless fallible (and indiscriminate eulogy would defeat its
object), he infused into the treatment of the insane a contagious
earnestness possessing a value far beyond any mere system or dogma. His
real merit, his true glory, is to have leavened the opinions and
stimulated the best energies of many of his contemporaries, to have
stirred their enthusiasm and inflamed their zeal, to have not only
transmitted but to have rendered brighter the torch which he seized from
the hands of his predecessors. He desired to be remembered after his
death by asylum superintendents as one who sincerely wished to place the
insane in better hands than those in which he too generally found them;
and I hold that, whatever may be our views on what we have chosen to
call non-restraint, we may cordially unite in fulfilling his desire.
As the non-restraint system--a term, it must be confessed, which cannot
boast of scientific precision, but is well understood--has been the
leading, and often engrossing, topic of discussion during the period now
under review, I must not omit a brief reference to it. No one will call
in question the statement as an historical fact that the Commissioners
in Lunacy and the medical superintendents of asylums in this country
are, with few exceptions, in favour of non-restraint. Dr. Lauder
Lindsay--for whose death, as well as that of Dr. Sherlock and of Dr.
White Williams, during the last year, the tribute of sorrowful regret
ought, in passing, to be paid--Dr. Lindsay, I say, had only a small
following in Great Britain. In Germany, on the other hand, although
Griesinger looked favourably upon the system, and Westphal has advocated
it, and Brosius has translated Conolly's standard work into German,
there has not been a general conversion, as may be seen by the
discussion which took place in 1879, at meetings of the Psychological
Society in Berlin and Heidelberg. In France, again, although Morel gave
it the sanction of his name, and Magnan has practised it recently, there
has been within the last twelve months a striking proof of
anti-non-restraint opinion among the French physicians, in an
interesting discussion at the Société Médico-Psychologique. I wish here
only to chronicle the fact, and would urge the necessity of not
confounding honest differences of opinion with differences of humane
feeling. The non-restrainer is within his right when he practises the
system carried to its extremest lengths. He is within his right when he
preaches its advantages to others. But he is not within his right if he
denounces those physicians, equally humane as himself, who differ from
him in opinion and practice. I therefore unite with the observation of
Dr. Ray, by whom, as well as by the majority of his
fellow-psychologists, the non-restraint system as a doctrine was not
accepted, when he wrote thus in 1855, "Here, as well as everywhere else,
the privilege of free and independent inquiry cannot be invaded without
ultimate injury to the cause."[295]
The arguments in favour of mechanical restraint are clearly set forth by
Dr. John Gray, of the Utica Asylum, in his annual report of the present
year.
Leaving this subject let me recall to your recollection that when this
Association was formed, the care of the insane in England and Wales was
regulated by the Gordon-Ashley Act of 1828,[296] which, among other
reforms, had substituted for the authority of five Fellows of the
College of Physicians, who performed their duties in the most slovenly
manner, fifteen metropolitan Commissioners in Lunacy. I find, on
examining the Annual Report of these Commissioners issued in 1841, that
it does not extend over more than one page and a half! It is signed by
Ashley, Gordon, Turner, Southey, and Proctor. They report the number
confined in the thirty-three asylums within their jurisdiction as 2490.
Their verdict on inspecting them is expressed in half a dozen words,
namely, that the "result is upon the whole satisfactory."
"The business of this Commission," they say, "has very much increased,
partly by more frequent communications with the provinces (over which,
however, they have no direct legal control), and partly by the more
minute attention directed by the Commissioners to individual cases with
a view to the liberation of convalescent patients upon trial ... and the
consequence has been that many persons have been liberated who otherwise
would have remained in confinement."
That a state of things in which such an occurrence was possible should
be described as on the whole satisfactory, is somewhat remarkable, and
in reading this paragraph we cannot but contrast with it the very
different result of the investigation made by the Committee of the House
of Commons in 1877.
Again, nothing more strikingly marks the change which has taken place in
the inspection of asylums than the contrast between the last Report of
the Lunacy Commissioners, consisting of a bulky volume of more than four
hundred pages, and that of 1841, of a page and a half. In fact, the
Reports of the Commissioners form the best evidence to which I can refer
of the progress made from year to year in the provision for the insane,
and the gradual but uninterrupted amelioration of their condition.
An important advance was made in 1842 by the Act 5 and 6 Vict., c. 87,
which provided that provincial houses were to be visited by the
Metropolitan Commissioners, as well as those in their own district. They
were also to report whether restraint was practised in any asylum, and
whether the patients were properly amused and occupied. Not only was a
great step forward made by thus extending the inspecting power of these
Commissioners to the provinces, but their memorable Report on the state
of the asylums in England and Wales in 1844 led to the highly important
legislation of the following year (introduced by Lord Ashley)--the Act 8
and 9 Vict., c. 100, which along with the Acts of 1853 (16 and 17 Vict.,
cc. 96, 97)[297] and 1862 (25 and 26 Vict., c. 111) form, as you are
well aware, the Code of Lunacy Law under which, for the most part, the
care of the insane is determined and their protection secured.
I should like to have been able to state the number of recognized
lunatics in England and Wales forty years ago, but no return exists
which shows it. The nearest approach is to be found in the Report just
referred to of the Metropolitan Commissioners (1844), in which the
number of ascertained lunatics in England and Wales is stated to be
about 20,000, of whom only 11,272 were confined in asylums, whereas now
there are nearly 55,000. It is difficult to realize that there were then
only some 4000 patients in county asylums, these being 15 in number, and
that there were 21 counties in England and Wales in which there were no
asylums of any kind, public or private. At the present time, instead of
20,000 ascertained lunatics and idiots, we have 73,113--an increase
represented by the population of the City of York--instead of 15 county
asylums we have 51, with scarcely less than 40,000 patients, instead of
4000; while the provincial licensed houses have decreased from 99 to 59,
and the metropolitan increased by 2. The total number of asylums in
England and Wales in 1844 was 158,[298] now it is 175--excluding those
(3) erected under Hardy's Act. I need not say that these figures do not
necessarily point to an increase of lunacy, but may merely represent the
increased accommodation which ought to have been provided long before.
Into the general question of the spread of insanity I feel that it would
be impossible to enter satisfactorily now.
Recurring to the Metropolitan Commissioners' Report, I must observe that
while an immense advance took place between 1828, when they were
appointed, and 1844, the subsequent advance between the latter date and
now is such that we cannot but recognize the extremely beneficial
operation of the legislation which has marked this period. It must also
be gratifying to Scotch asylum superintendents, knowing as they do the
satisfactory condition of the insane in their country in 1881, to be
able to measure the progress made since Lord Ashley, in his speech in
1844, moved for an address to the Crown, praying her Majesty to take
into consideration the Commissioners' Report, for he there observes, "I
believe that not in any country in Europe, nor in any part of America,
is there any place in which pauper lunatics are in such a suffering and
degraded state as those in her Majesty's kingdom of Scotland." I need
not do more than chronicle the fact, in passing, that the reform in
Scotland dates, to a large extent, from the appointment of a Royal
Commission in 1855, and the action of the Board of Lunacy Commissioners
which was established in consequence. Legislation for Ireland and the
appointment of inspectors have likewise proved very beneficial in that
country. But restricting my remarks to England and Wales, I would
observe that the establishment by the Act of 1845 of the Lunacy Board as
at present constituted, and the rendering it compulsory upon counties to
provide asylums for pauper lunatics, are the chief causes of the
improvement to which I have referred, so far, at least, as it has been
brought about by legislation.
I will not dwell in detail on the lunacy legislation of these years. To
have said less would have been to overlook the salient and most
important facts of the period. To have said more would have been to
travel over the ground so ably occupied by Dr. Blandford in his
Presidential Address three years ago. He, by-the-by, complained of the
ever-increasing difficulty each President finds in selecting a subject
for his discourse, and then immediately proceeded to effectually lessen
the chances of his successors. What the last occupant of this Chair will
be able to discover new for his address I do not know. I can only think
of the funeral oration over this Association at its obsequies--when its
"dying eyes are closed," its "decent limbs composed," and its "humble
grave adorn'd,"
"By strangers honour'd, by survivors mourn'd."
On the Board of the Commissioners in Lunacy have sat two members of our
profession (one still living), to whose services I wish more especially
to refer. I allude to Dr. Prichard and Mr. Gaskell.
Apart from his official work, the former will always be remembered in
the republic of letters by his learned contributions to anthropology and
the literature of mental diseases, in which he is more especially
identified with the doctrine of Moral Insanity. Chronicler of the period
in which he enunciated or rather developed it, I cannot avoid a brief
reference to a theme which has caused so much heated discussion. As an
impartial historian I am bound to admit that his views are still by no
means unanimously adopted, and that I am only expressing my own
sentiments when I avow that what Latham says of Prichard's "Researches
into the Physical History of Mankind"--"Let those who doubt its value,
try to do without it"--applies to the teaching contained in the
remarkable treatise entitled "Different Forms of Insanity in relation to
Jurisprudence," published in 1842. We may well be dissatisfied with some
of the illustrations of the doctrine it supports. We may express in
different terms the generalization he has made as to the relation of
intellect and emotion; but I am greatly mistaken if we shall not from
time to time be confronted by facts which instantly raise the question
which presented itself with so much force to his acute mind, and which
does not appear to me to be successfully met by those who controvert the
conclusions at which Prichard arrived. The necessity of admitting in
some form or other the mental facts in dispute, is well illustrated by
the recent work by Krafft-Ebing on mental disorders. For what does this
practised mental expert do? He, although the supporter of mental
solidarity and the integrity of the Ego--adverse, therefore, to the
psychology in which the theory has been enshrined--feels that he must
admit into his classification some term which describes certain
emotional or volitional disorders, and can discover none better than
"moral insanity"--a practical, though reluctant, admission of the value
of Prichard's views after their discussion for forty years. I might also
refer as an indication of opinion to a most excellent article in the
last number of the _Journal_ by Dr. Savage, who, while recognizing the
abstract metaphysical difficulty of conceiving moral as distinct from
intellectual insanity, fully admits as a clinical fact the form of
mental disease for which Prichard contended, and had he been living he
would doubtless have claimed this article as a striking proof of the
vitality of his opinions.
One is certainly disposed to exclaim, if observation on the one hand
compels us to admit certain mental facts, and the metaphysician on the
other declares them to be unmetaphysical, so much the worse for
metaphysics!
Mr. Gaskell, in addition to his good work as a reformer at the Lancaster
Asylum, where may yet be seen preserved quite a museum of articles of
restraint formerly in use in that institution, and his efficient labours
as a Commissioner, was also, it may not be generally known, the real
cause of the practical steps taken in this country to educate the idiot.
It was in 1847 that he wrote some articles in _Chamber's Journal_,
giving an account of Seguin's Idiot School at the Bicêtre, which he had
visited and been greatly interested in. These articles had the effect of
inducing Dr. Andrew Reed to interest himself in the establishment of a
school for idiots in England. The Highgate and Colchester Asylums for
idiots were instituted--the origin, as it proved, of the great
establishment at Earlswood. All, therefore, that has been done for this
pitiable class has been effected during the last forty years. The
indefatigable Seguin has passed away during the last twelve months. He
pursued to the last, with unabated zeal, a study possessing attractions
for only a limited number, and advocated the claims of idiots and
imbeciles with unceasing energy in the Old World and the New.
Fortunately his mantle has descended upon a worthy successor in the
person of his son, Dr. E. Seguin, of New York.
* * * * *
It has necessarily happened that the direction of public attention to
the larger and better provision for the insane in all civilized lands
has led to much consideration, and inevitably some difference of
opinion as regards the form and arrangement of asylums. But all will
admit that their construction has undergone a vast improvement in forty
years. The tendency at the present moment is to attach less importance
to bricks and mortar, and the security of the patient within a walled
enclosure, than to grant the largest possible amount of freedom, in
asylums, compatible with safety. The more this is carried out, the
easier, it is to be hoped, will it be to induce the friends of patients
to allow them to go in the earliest stage of the disorder to an asylum,
as readily as they would to a hydropathic establishment or an ordinary
hospital, to which end medical men may do much by ignoring the stupid
stigma still attaching to having been in an asylum. The treatment of the
insane ought to be such that we should be able to regard the asylums of
the land as one vast Temple of Health, in which the priests of
Esculapius, rivalling the Egyptians and Greeks of old, are constantly
ministering, and are sacrificing their time and talents on the altar of
Psyche.[299]
Most heartily do I agree with Dr. Kirkbride when he says that "Asylums
can never be dispensed with--no matter how persistently ignorance,
prejudice, or sophistry may declare to the contrary--without
retrograding to a greater or less extent to the conditions of a past
period with all the inhumanity and barbarity connected with it. To
understand what would be the situation of a people without hospitals
for their insane, it is only necessary to learn what their condition was
when there were none."[300]
In advocating the prompt and facile recourse to an asylum, I include, of
course, the cottage treatment of the insane so long ago resorted to by
Dr. Bucknill, and extended in so admirable a manner by my immediate
predecessor in this chair, whose practical observations last year on the
villas and cottages at Cheadle rendered his address one of the most
valuable that has been delivered. Moreover, I would not say a word in
disparagement of the placing of suitable cases in the houses of medical
men, or in lodgings, under frequent medical visitation.[301] I also
recognize the value of intermediate or border-land institutions, so long
as they are conducted with the sanction of the Commissioners and open to
their inspection.
The modern advocacy of the open-door system has been recently brought
under the notice of the Association by Dr. Needham, with the view of
obtaining a general expression of opinion on a practice, to the wisdom
of which he is disposed to demur.
But a less regard for mere bricks and mortar, the removal of high
boundary walls and contracted airing-courts, or the introduction of the
open-door system, do not lessen the importance of properly constructed
asylums. The works of Jacobi in Germany, Kirkbride in America, Parchappe
in France, and Conolly in England, must retain their value as classical
productions on this subject; while the contributions recently made by
Dr. Clouston present not only the general principles of asylum
construction, but the minute details of building, in the light of the
knowledge and experience of the present day.
I was fortunate in being able to render M. Parchappe some service when
he visited England to examine the construction of our asylums. Those who
formed his acquaintance on the occasion of this visit may remember his
mixed feelings on visiting them, how he demurred on the one hand to what
he regarded as too costly and ornamental, while, on the other hand, he
liked the English arrangement of the buildings better than the
Esquirol-Desportes system. I need not point out that those who have had
the planning of the county asylums in England have objected, as well as
Parchappe, to the distribution of isolated pavilions upon parallel
lines. Parchappe, while far from believing it to be indispensable to
make asylums monuments fitted to excite admiration for the richness of
their architecture, and indisposed to emulate our asylums, which, he
says, only belong to princely mansions, turns nevertheless from the
square courts and the isolated pavilions of Esquirol to apostrophize the
former in these glowing terms:--
"How much more suited to reanimate torpid intelligence and feeling, or
to distract and console melancholy among the unfortunate insane, these
edifices majestic in their general effect and comfortable in their
details, these grandiose parks, with luxuriant plantations and verdant
flowery lawns, whose harmonious association impresses upon English
asylums an exceptional character of calm and powerful beauty!"
Whether a stranger, having read this florid description of our asylums,
would not, on visiting them, be a little disappointed, I will not stop
to inquire. Probably during this or the following week, some of
Parchappe's compatriots may answer the question for themselves.
The fundamental question of the separation of the curable and incurable
classes has in different countries been earnestly discussed during the
last forty years. Kirkbride has entered his "special and earnest
protest" against this separation; his own countryman, Dr. Stearns, on
the other hand, has lately advocated it. In Germany, where, following
the lead of Langermann and Reil, complete separation of the curable in
one building was first realized under Jacobi at Siegburg, there has been
a complete reversion to the system of combining the two classes in one
institution. Parchappe, who opposed the separation of these classes, as
illusory if justice is done to the incurable in the construction of the
building provided for them, and mischievous if this is denied them, was
constrained to admit, however, in view of the enormous number of
lunatics in the Department of the Seine, that it was the least of two
evils to separate the epileptic and the idiotic from the curable.
In England the separation principle has been recognized in Hardy's Act
(30 Vict., c. 6) for the establishment in the metropolis of asylums for
the sick, insane, and other classes of the poor, 1867; and, again, in
the erection of such an asylum as Banstead for Middlesex--and I am
informed by Dr. Claye Shaw, who, from holding the office of
superintendent there, and formerly superintending the Metropolitan
District Asylum of Leavesden, is well calculated to judge, that the
experiment has proved successful, that the patients do not suffer, and
that the office of superintendent is not rendered unendurable. Regarded
from an economic point of view, it has been found practicable to provide
buildings at a cost of between £80 and £90 per bed, which, though not
æsthetic, are carefully planned for the care and oversight of the
inmates. This includes not only the land, but furnishing the asylum.
Five years ago this Association unanimously adopted a resolution,
expressing satisfaction that the Charity Organization Society had taken
up the subject of the better provision, in the provinces, for idiots,
imbeciles, and harmless lunatics, and the following year carried a
resolution, also unanimous, that the arrangement made for these classes
in the metropolitan district is applicable in its main principles to the
rest of England. But it does not follow that the separation of these
classes from the county asylums should be so complete, either as
respects locality or the governing board, as in the metropolitan
district; and, further, the Association expressed a strong opinion that
the boarding-out system, although impracticable in the urban districts,
should be attempted wherever possible in the country; the greatest care
being taken to select suitable cases, unless we wish to witness the
evils which Dr. Fraser has so graphically depicted in his report for
1877 of the Fife and Kinross Asylum. If pauper asylums can, without
injury to families, be relieved by harmless cases being sent home to the
extent Dr. Duckworth Williams has succeeded in doing in Sussex, and if,
as he proposes, they were periodically visited, their names being
retained on the asylum books, the enlargement of some asylums might be
rendered unnecessary.
But what, gentlemen, would be the best-contrived separation of cases,
what would the best-constructed asylum avail, unless the presiding
authority were equal to his responsible duties? Now, it is one of the
happy circumstances connected with the great movement which has taken
place in this and other countries, that men have arisen in large numbers
who have proved themselves equal to the task. We witness the creation of
an almost new character--the asylum superintendent.
One Sunday afternoon, some years ago, Dr. Ray fell asleep in his chair
while reading old Fuller's portraits of the Good Merchant, the Good
Judge, the Good Soldier, etc., in his work entitled "The Holy and
Profane State," and, so sleeping, dreamed he read a manuscript, the
first chapter of which was headed, "The Good Superintendent." Awakening
from his nap by the tongs falling on the hearth, the doctor determined
to reproduce from memory as much of his dream as possible for the
benefit of his brethren. One of these recovered fragments runs
thus:--"The Good Superintendent hath considered well his qualifications
for the office he hath assumed, and been governed not more by a regard
for his fortunes than by a hearty desire to benefit his fellow-men....
To fix his hold on the confidence and goodwill of his patients he
spareth no effort, though it may consume his time and tax his patience,
or encroach seemingly on the dignity of his office. A formal walk
through the wards, and the ordering of a few drugs, compriseth but a
small part of his means for restoring the troubled mind. To prepare for
this work, and to make other means effectual, he carefully studieth the
mental movements of his patients. He never grudges the moments spent in
quiet, familiar intercourse with them, for thereby he gaineth many
glimpses of their inner life that may help him in their treatment.... He
maketh himself the centre of their system around which they all revolve,
being held in their places by the attraction of respect and
confidence."[302]
And much more so admirable that it is difficult to stay one's hand. You
will, I think, agree with me that what Dr. Ray dreamed is better than
what many write when they are wide awake, and those familiar with Dr.
Ray's career, and his character, will be of the opinion of another
Transatlantic worthy (Dr. John Gray, of Utica) that in this act of
unconscious cerebration the dreamer unwittingly described himself--
"'The Good Superintendent!' Who is he?
The master asked again and again;
But answered himself, unconsciously,
And wrote his own life without a stain."
In what a strange land of shadows the superintendent lives! But for his
familiarity with it, its strangeness would oftener strike him. It
becomes a matter of course that those with whom he mixes in daily life
are of imperial or royal blood--nay, more, possess divine
attributes--and that some who are maintained for half a guinea a week
possess millions and quadrillions of gold. He lives, in truth, in a
world inhabited by the creatures of the imagination of those by whom he
is constantly surrounded--a domain in which _his_ views of life and
things in general are in a miserable minority--a phantom world of ideal
forms and unearthly voices and mysterious sounds, incessantly disputing
his authority, and commanding his patients in terms claiming
supernatural force to do those things which he orders them to leave
undone, and to leave undone those things which he orders them to do;
commanding them to be silent, to starve themselves, to kill, to mutilate
or hang themselves; in short, there is in this remarkable country,
peopled by so many thousand inhabitants, an _imperium in imperio_ which
renders the contest continuous between the rival authorities struggling
for supremacy, sometimes, it must be confessed, ending in the triumph of
the ideal forms, and the phantom voices, and the visionary sights, which
may be smiled at in our studies, and curiously analyzed in our
scientific alembics, but cannot be ignored in practice without the
occurrence of dire catastrophes, and the unpleasant realization of the
truth that idealism, phantasy, and vision may be transformed into
dangerous forms of force. It may be said, indeed, that the appropriate
motto of the medical superintendent is--"_Insanitas insanitatum, omnia
insanitas._"
With such an _entourage_ it is not surprising if the first residence in
an asylum as its responsible head--especially an asylum in the olden
days--should disconcert even a physician. A German psychologist once
declared, after passing his first night in an institution as
superintendent, that he could not remain there; he felt overwhelmed with
his position. Yet this physician remained not only over the next night,
but for thirty-five years, to live honoured and venerated as Maximilian
Jacobi, and departing to leave behind him "footprints on the sands of
time," from seeing which, others, in a similar hour of discouragement,
may again take heart.
I cannot pass from this subject without enforcing, as a practical
comment, the necessity of asylum physicians having a very liberal supply
of holidays, so as to insure a complete change of thought from not only
the objective but the subjective world in which they live, and this
before the time comes when they are unable to throw off their work from
their minds, as happened to a hard-working friend of mine, who, even
during his holiday among the Alps, must needs dream one night that he
was making a post-mortem upon himself, and on another night rose from
his bed in a state of somnambulism to perform certain aberrant and
disorderly acts, not unlike what his patients would have performed in
the day.
I have heard it suggested that superintendents should have six weeks'
extra holiday every third year, five of them to be spent in visiting
asylums. Whether this is the best way of acquiring an interchange of
experience or not, I will not decide, but no doubt the feeling, how
desirable it is men should compare notes with their fellow-workers,
prompted the founders of our Association (which was expected to be more
peripatetic than has proved to be the case) to determine that its
members should at its annual meetings carefully examine some institution
for the insane.
It is not too much to say that only second in importance to a good
superintendent is a good attendant, and of him also Dr. Ray dreamed in
his Sunday afternoon vision, and his description is equally excellent.
I am sure that it will be admitted that the last forty years have seen a
vast improvement in the character of attendants, and among them are to
be found many conscientious, trustworthy men and women, forbearing to
their charge and loyal to their superintendent. It is not the less true
that for asylums for the middle and higher classes the addition of
companionship of a more educated character is desirable, and it is
satisfactory to observe that there is an increasing recognition of its
importance, as evidenced by the Reports of our asylums.[303]
* * * * *
One word now in regard to the advance in our classification of mental
disorders, though I hardly dare to even touch thus lightly upon so
delicate a subject, for I have observed that it is one of those
questions in our department of medicine--dry and unexciting as it may
at first sight seem to be--which possess a peculiar polemical charm.
Few circumstances are more noteworthy than the attacks which have been
made upon the citadel of the Pinel-Esquirol classification, the
symptomatological expression of the disease--attacks not new forty years
ago, but renewed with great force and spirit by Luther Bell in America,
and subsequently by Schroeder van der Kolk in Holland, Morel in France,
and Skae in Britain. When Dr. Bell asserted that this system of symptoms
"would not bear the test of accuracy as regards the cause of the disease
or the pathological condition of the sufferer;" that the forms in use
"were merely the changing external symptoms, often having scarcely a
diurnal continuance before passing from one to another," and
constituting a division useless as regards moral or medical
treatment--he expressed in a nutshell all the objections since urged
against the orthodox classification by the other alienists I have
mentioned. These, however, substituted a mixed ætiological or
pathogenetic classification, which Bell did not, and this classification
is, in its essential characters, on its trial to-day. The wave of
thought which bore these attempts to the surface, was a wholesome
indication of the desire to look beneath the mere symptom right down to
the physical state which occasioned it, and upon which the somatic
school of German alienists had long before laid so much stress. The
movement has been useful, if for no other reason than that it has
concentrated attention afresh and more definitely upon the conditions
which may stand in causal relation with the mental disorder, nor has it
been without its influence in affecting the terms generally employed in
the nomenclature of insanity. At the same time it is very striking to
observe how the great types of mental disorder adopted and in part
introduced by the great French alienists have essentially held their
ground, and if their citadel has had in some points to parley with a
foeman worthy of their steel, and even treat with him as an honourable
rival, they remain still in possession, and their classification of
symptoms seems likely to remain there for long to come. As such, these
types are partly founded upon clinical and, to some extent, pathological
observation, and may well be allowed with a few additional forms to
stand side by side with a somato-ætiological nomenclature, as it grows
up slowly and cautiously, reared on scientific observation and research;
and had Skae been living he would have rejoiced to hear Mr. Hutchinson
assert the other day that in all diseases, "our future classification
must be one of causes and not external symptoms, if we would desire to
construct anything like a natural system, and trace the real relation of
diseases to their origin."
* * * * *
In a sketch, however brief, of the progress of Psychological Medicine
since the foundation of this Association in 1841, it would be a serious
omission not to notice the important contributions of the late Professor
Laycock shortly before as well as after that year. In 1840 he first
promulgated the opinion that "the brain, although the organ of
consciousness, is subject to the laws of reflex action, and in this
respect does not differ from other ganglia of the nervous system."[304]
And in a paper read before the British Association, September, 1844, he
observed, "Insanity and dreaming present the best field for
investigating the laws of that extension of action from one portion of
the brain to the other, by which ideas follow each other in sequence,
giving as an illustration the case of a patient at the York Retreat,
whose will being suspended, he expressed ideas as they spontaneously
arose in associated sequence, the combination being singularly varied,
but traceable to a common root or centre of impulse." "Researches of
this kind," Laycock continues, "whether instituted on the insane, the
somnambulist, the dreamer, or the delirious, must be considered like
researches in analytical chemistry. The re-agent is the impression made
on the brain; the molecular changes following the applications of the
re-agent are made known to us as ideas."[305]
Time will not allow me to cite other passages in these remarkable
papers, or later ones; but these are sufficient to show the germ at that
early period of the doctrine of cerebral reflex action, and the
unconscious cerebration of Carpenter, the seeds having been already sown
by Unzer and Prochaska, and arising out of it, that of automatic states
occasioned or permitted by the abeyance of a higher restraining
power--the Will, according to Laycock, in the case he employs as an
illustration of his doctrine. His teaching in regard to mental and
nervous disorders due to vaso-motor disturbance also deserves
recognition.
Dr. Henry Monro, again, in a treatise published in 1851, put forward a
theory of the pathology of insanity, the essence of which was that the
cerebral masses having lost their static equilibrium exhibit in their
functions two different degrees of deficient nervous action
(coincidently), viz. irritable excess of action and partial paralysis.
He maintained that these two states do not fall alike upon all the seats
of mental operations, but that there is "a partial suspension of action"
of "higher faculties, such as reason and will," while there is an
irritable excess of action of the seats of the more elementary
faculties, such as conception, etc., and hence delusions and the
excessive rapidity of successive ideas. Dr. Monro compares this
condition to a case of paralysis, combined with convulsions; and
discusses the question whether the temporary and partial paralysis
occurring as he supposes in insanity, "results directly and entirely
from excessive depression of the nervous centres of those higher
faculties, or partly in an _indirect_ manner from nervous energy being
abstracted to other parts which are in more violent exercise at the
time."[306]
This, it will be seen, is a still clearer statement of the doctrine that
insanity is caused by the depression or paralysis of the higher nervous
centres and excessive action of others.
As is well known, Dr. Hughlings Jackson, whose views regarding active
states of nerve structures as liberations of energy or discharges, are
familiar to us all, has adopted and extended Laycock's doctrine, which
he designates as "one of inestimable value," and has urged the
importance of Monro's doctrine of negative and positive states in cases
of insanity, using the term "insanity" in an exceedingly wide sense. He
has pointed out that Anstie and Thompson Dickson have also stated the
doctrine that so-called "exaltation of faculties" in many morbid states
is owing to "insubordination from loss of control," and that the same
was said in effect by Symonds, of Bristol. Adopting the hypothesis of
evolution as enunciated by Herbert Spencer, Dr. Hughlings Jackson thinks
that cases of insanity, and indeed all other nervous diseases, may be
considered as examples of Dissolution, this being, I need not say, the
term Spencer uses for the process which is the reverse of Evolution.
Insanity, then, according to this view, is dissolution beginning at the
highest cerebral centres, which centres, according to Jackson, represent
or re-represent the whole organism. There are distinguishable, he
believes, cases of uniform dissolution, the process affecting the
highest centres nearly uniformly, and cases of partial dissolution in
which only some parts of these centres are affected. The dissolution,
again, whether uniform or partial, varies in "depth;" the deeper it is,
the more general are the manifestations remaining possible. The degree
of "depth" of dissolution is, however, but one factor in this
comparative study of insanity. Another is the rapidity with which it is
effected. To this, Dr. Jackson attaches extreme importance, believing
that degrees of it account for degrees of activity of those nervous
arrangements next lower than those _hors de combat_ in the dissolution.
Another factor is the kind of person to whom dissolution "comes." And
the last factor is the influence of circumstances on the patient
undergoing mental dissolution. All factors should, of course, be
considered in each case, or, as Dr. Jackson characteristically puts it,
"insanity is a function of four variables." I refer to these opinions to
show the direction in which some modern speculation on the nature of
insanity tends, that thus tracing the course of thought in recent years
we may see how, step by step, certain views have been reached, some of
them generally adopted, others regarded as still requiring proof before
they can be accepted.
The negative and positive view of the nature of insanity receives
support, I think, from the phenomena of Hypnotism which, about forty
years ago, attracted, under the name of Mesmerism, so much attention in
England in consequence of the proceedings of Dr. Elliotson in the
hospital and college where we meet to-day. This was in 1838, and Braid's
attention was arrested by what he witnessed in 1841. It is no reason
because we have re-christened mesmerism that we should ignore the merit
of those who, as to matters of fact, were in the right, however mistaken
their interpretation may have been.
Elliotson recorded some striking examples of induced hallucinations and
delusions, and in an article in the _Journal_ in 1866, I endeavoured to
show how suggestive similar instances which I then reported are in
relation to certain forms of insanity, and also in relation to sudden
recovery from mental disease; the conclusion being forced upon us that
there may be cases in which no change takes place in the brain which the
ablest microscopist is likely to detect, but a dynamic change--one more
or less temporary in the relative functional power of different cerebral
centres, involving loss or excess of inhibition.
Nor can I, in connection with the reference to cerebral localization,
allow to pass unrecorded the researches of Fritsch, Hitzig, and Ferrier,
on account of the intimate, although only partial relation in which they
stand to mental pathology--a relation promising to become more
intelligible and therefore more important as the true meaning of the
psycho-motor centres becomes better understood; for that we are only on
the threshold of this inquiry must be evident, when men like Goltz,
Munk, and other investigators call in question the conclusions which
have been arrived at.
But be the final verdict what it may, when I look back to the time when
"Solly on the Brain" was our standard work, and then turn to Ferrier's
treatise on its functions, to the remarkable works of Luys, and to Dr.
Bastian's valuable contribution to the International Series, I cannot
but feel how unquestionable has been the advance made in the physiology
of the brain, strangely bent as Nature is on keeping her secrets
whenever the wonderful nexus which binds together, yet confounds not,
mind and brain, is the subject of investigation.
* * * * *
The past forty years have witnessed a great change in the recognition of
mental disease as an integral part of disorders of the nervous system,
and medical psychology is less and less regarded as a fragment detached
from the general domain of medicine. Contributions from all lands have
conspired to produce this effect, the somatic school of psychologists in
Germany having exerted, probably, the most influence. And we are proud
to number in France among our roll of associates a physician who, not
only by his pathological researches into diseases of the brain and cord,
but by his clinical study of affections closely allied to mental
derangement, has by the brilliant light he has thrown upon the whole
range of diseases of the nervous system, advanced the recognition of
which I have just spoken. I need not say that I refer to our
distinguished honorary member, Professor Charcot.
No one will deny that the relations of mind and brain, physiologically
and pathologically considered, have in our own country been ably handled
by Dr. Maudsley. Those who most widely differ from some of his
conclusions will acknowledge this ability, and that his works are
expressed in language which, with this author, is certainly not employed
to conceal his thoughts. To trace the influence of these writings, and
those of Herbert Spencer, Bain, and others of the same school, on the
current belief of psychologists would, however, carry me far beyond the
legitimate limits of an address, but I may be allowed to observe that
here, as elsewhere, we must not confound clearly ascertained facts in
biology and mental evolution with the theories which are elaborated from
them. The former will remain; the latter may prove perishable hay and
stubble, and when we overlook or ignore this distinction, it must be
admitted that we expose ourselves to the just rebuke of the celebrated
Professor of Berlin when he protests against "the attempts that are made
to proclaim the problems of research as actual facts, the opinion of
scientists as established science, and thereby to put in a false light
before the eyes of the less informed masses, not merely the methods of
science, but also its whole position in regard to the intellectual life
of men and nations." He is surely right when he insists that if we
explain attraction and repulsion as exhibitions of mind, we simply throw
Psyche out of the window and Psyche ceases to be Psyche;[307] and when,
allowing that it is easy to say that a cell consists of minute
particles, and these we call plastidules, that plastidules are composed
of carbon and hydrogen, oxygen, nitrogen, and are endued with a special
soul, which soul is the product of some of the forces which the chemical
atom possesses, he affirms that this is one of those positions which is
still unapproachable, adding, "I feel like a sailor who puts forth into
an abyss, the extent of which he cannot see;" and, again, "I must enter
my decided protest against the attempt to make a premature extension of
our doctrine in this manner--never ceasing to repeat a hundred-fold a
hundred times, 'Do not take this for established truth.'"[308]
We all believe in cerebral development according to what we call natural
laws or causes, and in the parallel phenomena of mind; as also in the
arrested and morbid action of brain-power by infractions of laws or by
causes no less natural. In this sense we are all evolutionists. The
differences of opinion arise when the ultimate relations of matter and
mind are discussed, and when a designing force at the back of these laws
is debated. But these questions in their relation to mental evolution,
as to evolution in general, do not enter the domain of practical
science, and are not affected by the degree of remoteness, according to
our human reckoning, of this force or "Ultimate Power."
It will not be denied that at least the foundations of the pathology of
insanity have been more securely laid in cerebral physiology during the
last forty years, in spite of the fact that the relation of the minute
structure of the brain to its functions, and the nature of the force in
operation, still elude our grasp. The so-called disorders of the mind
having been brought within the range of the pathologist, what can he
tell us now of the post-mortem lesions of the insane? Can he give a
satisfactory reply to the question asked by Pinel in his day, "Is it
possible to establish any relation between the physical appearances
manifested after death, and the lesions of intellectual function
observed during life?"[309]
It is a little more than forty years since Lélut published his work
entitled "The Value of Cerebral Alterations in Acute Delirium and
Insanity," and Parchappe his "Recherches," to be followed by other works
containing valuable contributions to the pathological anatomy of mental
disease. To attempt to enumerate the contributions to this department
abroad and at home would be simply impossible on the present occasion. I
cannot, however, omit to notice how early Dr. Bucknill was in the field,
as his laborious examination of a number of brains of the insane to
determine the amount of cerebral atrophy and the specific gravity, bear
witness, as also his demonstration of the changes which take place, not
only in the brain and its membranes, but in the cord, in general
paralysis; these observations, along with those of Dr. Boyd, having been
fully confirmed by subsequent observers.
I recall here, with interest, a visit I paid eight and twenty years ago
to Schroeder van der Kolk at Utrecht, whom I found full of enthusiasm
(although racked at the time with neuralgia) in the midst of his
microscopical sections. And this enthusiasm I cannot but suspect
insensibly coloured what he saw in the brains and cords of the insane,
or he would hardly have said, as he did say, that he had never failed
during a quarter of a century to find a satisfactory explanation after
death of the morbid mental phenomena observed during life.
It must not, however, be forgotten that Parchappe, just forty years ago,
was able to speak as strongly in regard to the brains of general
paralytics; and that of others he said that it would be nearer the truth
to assert that you can, than that you cannot, distinguish between a sane
and an insane brain.
Since that period microscopes of higher power have been sedulously
employed by European and American histologists, and in our country the
example set by Lockhart Clarke has been followed by many able and
successful investigators. I had intended to enumerate in some detail the
gains of pathological anatomy in cerebro-mental diseases, and to
endeavour to apportion to those who have cultivated this field of
research their respective merits; but I find it better to consider what
is the practical result of these researches. I may, however, so far
depart from this course as to mention the memoirs of Dr. J. B. Tuke in
the _Edinburgh Medical Journal_ of 1868 and 1869, and elsewhere, on
account of their importance in the history of the morbid histology of
insanity.
Returning to the practical question of the knowledge now possessed by
the cerebral pathologist, I will put into the witness box Professor
Westphal and Dr. Herbert Major, as having enjoyed and utilized large
opportunities for making microscopic and macroscopic examinations of the
insane, and not being hasty--some think the former too slow--to admit
the presence of distinctive lesions.
Now, Professor Westphal informs me that he is unable to trace, in the
majority of post-mortems of the insane who have not suffered from
general paralysis, any morbid appearance of the brain or its membranes,
either with the naked eye or the microscope. He maintains that it would
be impossible to designate amongst a hundred miscellaneous brains those
which have belonged to insane persons, if the cases of general paralysis
had been eliminated.
Dr. Major speaks guardedly; but inclines to think that, even putting
aside general paralytics, the sane may be _generally_ distinguished from
the insane brain. His experience at Wakefield shows that in only
seventeen per cent. of the autopsies (excluding general paralysis) the
brain showed no decided morbid change. "It must be always remembered,"
Dr. Major writes, "that the difficulty is not to distinguish between the
insane brain on the one hand and a perfectly healthy and vigorous sane
brain on the other--the difference between these two extremes is, in my
own experience, most striking and startling. The difficulty is to
distinguish between the insane brain and that of an individual sane, but
in whom the brain is (as in time it may be) anæmic, wasted, or even with
tracts of softening. Still," he adds, "I think, generally speaking, the
sane organ may be distinguished from the insane, the decision turning
largely on the _degree_ of the degenerative or other morbid change."
Again, taking only cases of general paralysis, Professor Westphal holds
that in by far the greater number of brains of insane persons dying in
an advanced stage, morbid appearances similar to those which he has
described in Griesinger's "Archiv. I.," etc., can be traced; the morbid
appearances of the cord occurring more constantly than those of the
brain.
Dr. Major found that of the post-mortems of paralytics, all displayed
appreciable morbid lesions, although in five per cent. of cases they
were not typical of general paralysis.
Then coming definitely to the question whether these pathologists have,
to any considerable extent, been able to connect the morbid appearances
found in cases of insanity with the symptoms, including motor troubles,
Dr. Major says that at present he cannot; and Professor Westphal says
that he regards "the connection of morbid symptoms with the changes
found after death as exceedingly uncertain and doubtful."
I should observe that Dr. Major grounds his statements upon his own
recent experience and observation at Wakefield, and that he is not
disputing the greater preference shown by certain lesions in general
paralysis for particular localities; but only that he does not yet see
his way to connect them with the abnormal symptoms present during life.
The researches carried on by Dr. Mickle, contributed to our _Journal_
(January, 1876), and those of Dr. Crichton Browne, published with
illustrations in the "West Riding Reports," must be regarded along with
M. Voisin's large work and Hitzig's article in Ziemssen's "Cyclopædia,"
as placing before us whatever evidence can be adduced on the relations
between the pathology of general paralysis and cerebral physiology.
Hitzig, who from his investigations into the cerebral motor centres,
and his position in an asylum for the insane, ought to be qualified to
judge, surmises that those localities of the brain by the electrical
irritation of which in animals he produced epileptiform attacks bearing
the closest resemblance to the attacks of paralytics, are affected in
general paralysis. He thinks, moreover, that as destruction of these
cortical spots causes disturbance of motion, resembling the symptoms
pathognomonic of grey degeneration of the posterior columns observed in
general paralysis, there is an added reason for assuming this
connection.
Dr. Mickle in his recent excellent work on general paralysis has
exercised much cautious discrimination in admitting the relation between
the symptoms and the alleged psycho-motor centres, and while his
researches in a rich field of observation at the Grove Hall Asylum lead
him to find some cerebral lesion in every case, especially in the
fronto-parietal region, he cautions against the "too ready indictment of
motor centres in the cerebral cortex as answerable for the most frequent
and characteristic motor impairment, that of the lips, tongue, face, and
articulatory organs generally;" fully believing, however, that in the
production of these symptoms the cortical lesion is at the very least an
important factor. "Whether the principal mental symptoms can be entirely
referred," he says, "to the organic changes in certain frontal (and
parietal) convolutions--the motor to those of the so-called cortical
motor zone--the sensory to those of certain portions of the
temporo-sphenoidal and parietal--must remain a matter of question,"
while in regard to the convulsive attacks, Dr. Mickle has in some cases
been "unable to trace a harmony between these and the results of
physiological experiment; in other cases they have seemed to harmonize
fairly."[310] Dr. Mickle informs me that in the insane other than
general paralytics, he has in the majority found some lesion in the
brain and membranes.[311]
These results of research in cerebro-mental pathological anatomy and
physiology may not seem, when placed side by side with the sanguine
opinions of Schroeder van der Kolk and Parchappe, to present so
triumphant a proof of progress and solid gain as might be desired or
expected, and much, we must admit, has to be done before Pinel's
question can be answered with the fulness we should wish. Nevertheless
the advance is very considerable, and the best proof of the accumulating
knowledge of the morbid histology of the brain and cord in the insane
will, I think, be given this week by the collection of microscopical
preparations of Gudden, Holler, etc., brought together by the untiring
energy of Dr. Savage, including his own at Bethlem Hospital. I have but
to point out how impossible such an exhibition would have been forty
years ago to give significance to the contrast between 1841 and 1881;
thanks to those who, although they may still often see as "through a
glass darkly," have so wonderfully advanced the application of
microscopic examination to the tissue of the brain, and prepared such
beautiful sections of diseased brain and cord.
Another proof of progress might have been given, had time allowed of a
reference to what has been done in the study of the brains of idiots,
both morphologically and histologically, by Mierzejewski, Luys, and
others, these results being sufficient to prove, had we no other
evidence, the fundamental truth of cerebro-mental pathology--the
dependence of healthy mind on healthy brain.
We are surely justified in expecting that by a prolonged examination of
every part of the brain structure, and the notation of the mental
symptoms, we shall arrive in future at more definite results; that the
locality of special disorders will be discovered, and that the
correlation of morbid mental and diseased cerebral states will become
more and more complete, that the scientific classification of mental
maladies may be one day based upon pathological as well as clinical
knowledge, and psychology be founded, in part at least, upon our
acquaintance with the functions of the brain. Let us hope, also, even
though it be a hope in the sense rather of desire than of expectation,
that by these discoveries the successful treatment of mental disorders
may be proportionately advanced.
* * * * *
I would now turn to the very important question whether the treatment
of the insane has advanced since 1841?
Of course, so far as this includes moral treatment and management, it
has advanced in all civilized countries in a manner calculated, all will
admit, to cause the liveliest feelings of satisfaction. Putting aside
_moral_ treatment, we cannot boast, it must be confessed, of the same
unanimity of judgment. If, however, it must be admitted that as respects
details, _Tot capita, tot sensus_, it will be allowed that,
notwithstanding the so many heads, and the as many opinions, the general
principles of treatment based upon a just view of the general pathology
of insanity, are accepted by all. There were too many who, forty years
ago, bled freely for mania, and I remember Conolly, at even a later
period, complaining of the number of patients brought to him hopelessly
demented in consequence of the heroic treatment to which, when maniacal,
they had been subjected by men who, no doubt, still believed with
Paracelsus when he said, "What avails in mania except opening a vein?
Then the patient will recover. This is the arcanum. Not camphor, not
sage and marjoram, not clysters, not this, not that, but phlebotomy."
Well, this treatment by the Paracelsuses of 1841 has been supplanted by
the more rational therapeutics which we witness in 1881.
Dr. Stokes, the highly respected superintendent of the Mount Hope
Retreat, Baltimore, thus writes in his last annual report: "Forty years
ago, when this institution was opened, large blood-lettings--in the
standing, recumbent, or sitting posture, to the amount of thirty or
forty ounces--were recommended in acute mania, followed up by local
depletion, by leeches, to the number of twenty or thirty, to the
temples. The moral treatment, hygienic measures, exercise, and suitable
occupation were almost wholly ignored. Drastic purgatives, ... the
shower bath, large and frequent doses of tartarized antimony, and
mercury to the extent of producing ptyalism, were the most popular
remedial agents in the treatment of insanity. This, in general terms,
was the system advocated and practised when, forty years ago, this
institution entered upon its godlike mission."
If the success of the treatment of insanity bore any considerable
proportion to the number of the remedies which have been brought
forward, it would be my easy and agreeable duty to record the triumphs
of medicine in the distressing malady which they are employed to combat.
But this, unhappily, is not the case. Hypodermic injections of morphia,
the administration of the bromides, chloral hydrate, hyoscyamine,
physostigma, cannabis indica, amyl nitrite, conium, digitalis, ergot,
pilocarpine, the application of electricity, the use of the Turkish bath
and the wet pack, and other remedies too numerous to mention, have had
their strenuous advocates during late years. Each remedy, however, let
us hope, leaves a certain residuum of usefulness behind it, though
failing to fulfil all the hopes raised on its first trial.
Dr. Ramskill lately avowed his opinion in my hearing that the advent of
the bromide has done infinite mischief. Others, attacking chloral, would
maintain that while the bromide has slain its thousands, chloral hydrate
has slain its tens of thousands. In spite of this, however, Dr.
Ramskill, doubtless, continues to employ the bromide; and who would wish
to be deprived of chloral, or any other drug, because of its abuse?
"For nought so vile that on the earth doth live,
But to the earth some special good doth give;
Nor aught so good, but strained from that fair use,
Revolts from true birth, stumbling on abuse."
Employed without discrimination, regarded as a talisman in insomnia and
excitement--petted, in short, when it ought to have been
restrained--chloral became for a time the spoilt child of psychological
medicine, and, like other spoilt children, it has disappointed the fond
hopes of its parents.
When it is possible for a physician in asylum practice to write as Dr.
Pritchard Davies has written this year in our _Journal_, "On Chemical
Restraint," to the effect that chloral, the bromides, and other
sedatives are unnecessary, or even injurious; when, on the other hand,
we have Dr. Hills replying that his experience at the Norfolk Asylum
leads him to an entirely opposite conclusion; and Dr. Stokes, in
America, writing thus in his report, after 7425 patients have been under
treatment in his asylum, "without wishing to undervalue the great
importance of an efficient system of moral treatment, great results can
only be expected from a patient and persevering administration of
powerful remedial agencies"--I say when such contrary opinions can be
expressed by practical men, one feels how impossible it is to dogmatize
upon the good effected by pharmaceutical remedies in insanity, and how
far we are yet from witnessing a consensus of opinion in regard to their
value.
It must be frankly granted that Psychological Medicine can boast, as
yet, of no specifics, nor is it likely, perhaps, that such a boast will
ever be made. It may be difficult to suppress the hope, but we cannot
entertain the expectation, that some future Sydenham will discover an
anti-psychosis which will as safely and speedily cut short an attack of
mania or melancholia as bark an attack of ague.
Rather must we rest satisfied with the general advance in treatment in a
scientific direction. Most of us know asylums where, within forty years
and much less, tartarized antimony was in daily use in large doses as a
quietus, and where croton oil was administered in addition to black
draughts to a surprising extent, all these remedies being now employed
only on the rarest occasions. Take an actual example, one of many, in a
particular asylum. A few years ago a patient, who had been much excited
and very troublesome, was treated in season and out of season with
strong purgatives and sedatives. It so happened that he then fell under
a new _régime_, which consisted in knocking off all these medicines and
placing him under one attendant's entire supervision. The result was
that he became as quiet and docile, though not cured, as any of the
inmates of the asylum, and has remained so to the present time. But we
may go further, and say that some cases of insanity are cured now which
a few years ago would have remained uncured. Indeed, in relation to the
associated bodily state, it may be said that specific treatment has been
adopted. Remedies, like iodide of potassium, in large doses, are
employed in cases in which, from the increased attention directed in
recent years to the somatic ætiology of insanity, a causal relation
between the physical and mental condition has been recognized, and the
mental symptoms have disappeared in the most marked manner; and so again
in gouty melancholia, relief has been obtained by appropriate remedies
and diet. These are illustrations of the directly scientific application
of medicine to medical psychology, and it is in this direction we must
hope for a really satisfactory advance.
On the other hand, there are the successes obtained by the employment of
drugs without our being able to say why or how they have exerted a
curative agency; and it is obvious that as the number of drugs has so
much increased during the period over which my survey extends, the
chances of hitting on the right remedy are proportionately increased.
How often we see one, two, or three drugs exhibited in mania without any
result, while a fourth acts like a charm. Only by studying in detail the
special characteristics of each case, can we hope to find a clue which
will serve as a guide to the treatment of a subsequent one.
In this country, Dr. Clouston has distinctly advanced our knowledge of
the action and uses of narcotic remedies by experiments made to
determine the effect on maniacal excitement of single doses of certain
remedies, stimulants, and food; of, again, the effect on mania of
prolonged courses of certain narcotic medicines, along with clinical
observations on the effects of the same medicines in all kinds of
insanity, and has determined the equivalent value of opium, bromide of
potassium, and cannabis indica in the treatment of insanity.
Dr. Savage has experimented with one drug at a time on a number of
patients, and has already given to the profession some valuable results
in "Guy's Hospital Reports," and the _Journal of Mental Science_. "The
West Riding Asylum Medical Reports" of Dr. Crichton Browne also contain
some important experiments with drugs by himself and others; and in this
connection I would notice the excellent clinical notes issued from time
to time by Dr. Williams and other officers of the Haywards Heath Asylum,
which are well worthy of more permanent record in the archives of the
Association. I cannot, indeed, understand any one seriously maintaining
that we are practically no better off in our medicinal resources now
than we were forty years ago.
Whatever differences of opinion may exist in regard to the advantages
gained by the introduction of new drugs, one thing is clear, that the
employment and, let me add, the repose of patients, well-ordered
arrangements, and the tact of the superintendent will oftentimes do more
to reduce the amount of excitement and noise in an asylum than tons of
chloral and bromide. For example, any one who has visited Hanwell knows
that Dr. Rayner anticipates and prevents post-epileptic mania to a very
large extent by the simple expedient of keeping patients in bed after
their fits, just as he finds forced alimentation of patients rarely
necessary when rest is resorted to. It is striking to see how, even in
an over-grown asylum and an old building, the results of good management
and treatment can be highly satisfactory, and worthy of an institution
of such historic fame.
* * * * *
But, after all, the question faces us, are there or are there not more
insane persons cured in 1881 than in 1841?
One's first impulse, of course, is to take the statistics of recovery
for a certain number of the more recent, and compare them with those of
the earlier years, or to take the recoveries of the past forty and place
them side by side with those of the previous forty years. The attempt,
however, is fraught with so many fallacies that it is dangerous to make
such a comparison. In a report of Bethlem Hospital, issued in 1841, Sir
Alexander Morison stated--not as anything exceptional--that seventy per
cent. of the patients had been discharged cured; while an examination of
the recoveries at this hospital for the last ten years shows a much
smaller proportion per cent. But I cannot accept these comparisons as
proving anything one way or the other, as various causes, quite apart
from the comparative success of treatment at different periods, may
explain the difference. Take a single asylum, like Hanwell, and compare
the recoveries of a later with an earlier period. I find a population so
fluctuating in character, in regard to curability, that the comparison
becomes utterly worthless, and although it is true that during the last
quinquennium 28.1 per cent. have recovered, as against 26.3 per cent.
during the first quinquennium of the past forty years, in spite of there
having been more incurables received during the later period, the result
is not so satisfactory when we divide into certain periods the whole
time during which Hanwell has been open (omitting the first four years).
It then appears that during two previous periods the recoveries were
higher than 28.1 per cent., viz. from 1840 to 1849 and from 1865 to
1874. Thus:--
1835-39 (inclusive) 25.3
1840-49 28.5
1850-54 25.2
1855-64 27.9
1865-74 30.4
1875-79 26.3
Or in quinquennial periods throughout:--
1835-39 (inclusive) 24.8
1840-44 26.3
1845-49 32.1
1850-54 25.2
1855-59 30.7
1860-64 27.0
1865-69 30.4
1870-74 30.5
1875-79 26.3
If to escape the fallacies connected with the comparison of different
periods of the same asylum, we go to the Lunacy Blue Books, we do not
get any reliable figures before 1870, on account of transfers having
been previously included in the admissions, so that a fair comparison
of recent and former recoveries worked on the admissions is impossible.
I have before me the statistics of the Siegburg Asylum, thanks to Dr.
Ripping, from its opening to its close; and I find that the recoveries
during the first twenty-five years amounted to forty-two per cent., and
during the twenty-five years ending with the year 1877, they were
forty-six per cent., thus showing an increase of four per cent. in the
more recent period. As this asylum, now closed, has admitted curable
cases only, these figures are among the few valuable statistics which I
have been able to procure.
I have not succeeded in obtaining satisfactory comparative results by
adopting, in the mixed asylums of England and Wales, the plan of working
the recoveries, not on the total admissions, but on those only deemed
curable; but to explain this fully would involve me in more detail than
the occasion warrants.
I would add that in the United States, where reasons have been assigned
why the statistics of asylums exhibit apparently fewer recoveries in the
later than the earlier period of the last forty years, Dr. Pliny Earle
has done good service by the remarkable contribution he has made to the
question of the curability of insanity,[312] corroborating, at the same
time, the somewhat unfavourable conclusion as to permanent recovery
which Dr. Thurnam, in a work which will always be a Pharos to guide
those who sail on waters where so many are shipwrecked, arrived at,
after a laborious examination of the after history of cases discharged
recovered from the York Retreat. It is likewise anything but reassuring
to find that, out of the total number of lunatics under care in England
and Wales, there are at this moment only 3592 who are deemed
curable.[313]
* * * * *
Such, gentlemen, is my Retrospect of the Past. Meagre it has necessarily
been, though occupying more of your time than I could have wished, but
the number of subjects demanding reference must be my excuse.
We found, at the commencement of the period we have traversed, the
accommodation provided for the insane scandalously insufficient, and the
condition of many of the existing asylums calling loudly for a radical
reform.
We witness to-day, throughout the kingdom, a large number of
institutions in admirable working order, reflecting the greatest credit
upon their superintendents and committees.
We found a wholly inadequate system of inspection.
We witness now a Board of Commissioners, which, without forfeiting the
good will of the superintendents, carefully inspects the asylums
throughout the provinces as well as the metropolis--as carefully and
thoroughly, at any rate, as the same number of men originally appointed
to examine into the condition of some 20,000 patients can fulfil a like
duty for above 70,000.
We found a resolute attempt being made to carry out and extend the
humane system of treatment inaugurated nearly half a century before in
France and England.
To-day we witness its success.
And had I had time to sketch the progress in the provision made for
criminal lunatics, we should have found that just forty years ago was
the commencement of what Dr. Nicolson has named the "Reactionary
Period"--during which this Association petitioned the Government (in
1851) to establish a criminal lunatic asylum--followed in 1860 by the
"Period of Centralization" or that of Broadmoor--an institution to-day
so efficiently superintended by Dr. Orange.
And in what consists the superiority of the new over the old system of
treatment--the nineteenth over the eighteenth century?
The old system was mainly one of brute force--the child alike of
ignorance and fear.
The new does not indeed dispense with force, but it is a maxim of the
reformed school, from which no one, whose opinion carries weight in
psychological medicine, whether in America or in Europe, would dissent,
that it should be reduced to the lowest possible point, consistent with
safety and the good of the patient, and that humanity should dictate the
means of repressing, or rather guarding against, violence, both as
regards their amount and character.
The old system subjected patients, who underwent any medical treatment
at all, to a miserable routine, often determined by the season of the
year and the phases of the moon, rather than the condition of the
patient.
The new does not pretend to possess a universal formula, or to have
discovered the psychologist's stone, but strives to treat each patient
according to individual indications.
The old system desired secrecy; the new is not afraid of publicity.
The old system, in short, believed in harshness and darkness; the creed
of the new is, "I believe in sweetness and light."
Such are the results achieved for Psychological Medicine.
* * * * *
If this be the Retrospect of the Past, what is the Prospect of the
Future? Will the progress of the last forty or the last ninety years be
maintained? I trust it will, but one need not be a pessimist to be
sensible that the humane treatment of the insane may have its ebb as
well as its flow; that so far from its being true that there is a
constant and certain tendency to humanity, there is also a strange
tendency to relapse into inhuman ways. Vigilance is and always will be
required, for if it be allowed to slumber, we but too well know that
there is only one direction in which things will go when left to
themselves--and that is downhill.
The functions--the mission--of this Association may be regarded from a
threefold point of view: first, in relation to insanity and the insane;
secondly, in relation to its members; thirdly, in relation to the
public.
I.--Under the first are comprised what in the original rules, drawn up
by the founders of this Association forty years ago, were stated to be
its objects, namely, "Improvement in the management of asylums and the
treatment of the insane;" and further, "The acquirement of a more
extensive and more correct knowledge of insanity."
Added to the improved management of asylums is the necessity now for
making appropriate provision for idiots and imbeciles, and their
education so far as practicable, grappling at the same time with the
problem how best to provide for the mass of incurable pauper patients in
the provinces, and the extension of middle-class asylums, and of
cottages in connection with the central institution.
There are, of course, various ways in which the welfare of the patients
in asylums can be promoted, by the attention directed by the Association
to special points of importance. To instance only one, the occupation of
patients, including systematic teaching which Dr. Lalor has so
successfully developed in the Richmond Asylum, Dublin. Though very much
has been done, there is, all, I think, will agree, room for more
sustained effort in this direction. "There is one monster in the
world--the idle man," are the words of one who has lately passed beyond
the reach of praise or blame, which ought ever to be in the minds of
those who direct our asylums. It may be that if more were done in
future in the spirit of this apophthegm of the Sage, if not the Saint,
of Chelsea, there would be less chance of patients chewing the cud of
bitter reflection and dwelling upon the delusions by which they are
haunted and harassed.
In proportion as we feel the inadequacy of our means of cure, we must
recognize the necessity of studying the ætiology of insanity, including
that _damnosa hæreditas_, which is the cause of causes in so large a
number of the cases coming under our treatment. But what induced the
ancestral taint? It behoves us to pay more and more attention to those
laws of inheritance in general to which Mr. Hutchinson has recently
directed attention in his suggestive lectures at the College of
Surgeons.
When M. Baillarger proposed that a similar association to this should be
established in France, he gave, among other reasons, the advantage which
would accrue from discussing this very question. "Every one," he said,
"is assuredly decided upon the influence of heredity in the production
of insanity (Mr. Buckle had not then written); but in this primary
question, how many secondary ones there are which remain unsolved."
Since he thus wrote, his own countrymen, Morel and Lucas, have, by their
researches, advanced our knowledge, and rendered the task of their
successors in the same field easier.
Intemperance also, as a cause as distinct from a symptom of insanity,
requires to be more thoroughly examined into, and I am happy to say Dr.
Hayes Newington, than whom no one could be better fitted for the task,
has prepared a series of questions arranged in a tabular form, which
has been before the Statistical Committee, and will appear in the
_Journal_.
Again, there remains for the future the continued research into the
causal connection between certain mental symptoms or disorders and
accompanying lesions of the brain and cord. Dr. Spitzka, of New York, in
the prize essay which he is about to publish, enters carefully into this
inquiry, and I am hopeful that his industry and talent will be rewarded
by marked success. These and kindred investigations might, no doubt, be
pursued in a more methodical manner than is always the case in English
asylums. To this end, the appointment of a pathologist, as at Wakefield
in our own country, and at the Utica Asylum in America, ought to become
general.
Clinical teaching in our asylums admits of much greater development,
though they may not be able to meet the demands made upon them, should
examinations be required in medical psychology by the examining bodies.
To-day the student has fortunately a very different position from that
which fell to his lot forty years ago. He has at his command means of
research then unknown, as the ophthalmoscope and sphygmograph, and all
the modern improvements in the microscope and in preparing sections; and
can he not experiment on knee jerks, and a host of reflex and electric
phenomena never dreamt of by his predecessors? He has, moreover, the
stimulus begotten of the sense that enough has been discovered to
indicate how much precious treasure lies hidden beneath the ground he
now treads, like the gold-digger whose ardour is quickened and labour
repaid by the discovery of the minutest particle of the metal of which
he is in search.
II. The second relation in which this Association stands--to its
members--suggests that we must needs be alive to legislation affecting
the rights of those who are engaged in this department of medicine. This
association is not a trades union, but there are various points bearing
on their position which have to be considered, as in connection with a
Bill like Mr. Dillwyn's, or the matters discussed two years ago at the
annual meeting, when brought forward by Dr. Murray Lindsay. It is true
that for him who has taken mental science, in its widest sense, as his
mistress; for him who has wooed her for her own sake, knowing full well
that for him she may hold no dowry in hand or pocket, there is the
supreme pleasure arising from study and observation themselves--that
recompense which is better than gold, and more precious than rubies. All
this is true; but none the less the superintendents of asylums have a
right to expect not only that their services shall be adequately
remunerated when in harness, but that they may count with certainty upon
a fair provision in the evening of life.
III. With regard, thirdly, to the influence of this Association on
public opinion, we should be strangely faithless to our mission, if we
were not the expositors of the principles in accordance with which the
insane ought to be regarded; if we did not endeavour to enlighten the
community in the doctrines of true psychological science, and in that
philanthropy which is as far asunder as the poles from the fitful
pseudo-philanthropy from which our country is unfortunately not free,
the wild, ill-regulated, hysterical clamour with which we are
epidemically visited, as injurious to the lunatic as it is to the
interests of society at large.
This Association, further, ought to continue to bring before the lawyer
what it regards as the just test of criminal responsibility; to entreat
the educator not to defeat the object of his noble profession by
exactions which transgress the limits by which Nature has bounded human
capacity; and to warn parents, as Dr. Brigham did in his day with so
much zeal, of the dangers to mental health arising from precocious
forcing during the early growth of the brain, and with a tenfold greater
necessity than when he wrote, in presence of the illimitable folly of
examining boards, some of them medical, the members of which have not
even the poor excuse of ignorance; and last, but not least, to counsel
the teacher of religion against the peculiar dangers which attend his
exalted mission, remembering that--
"Virtue itself turns vice, being misapplied."
Various, then, are the functions of our Association. But what, asks the
late Sir James Stephen, the eloquent writer in the _Edinburgh_ is a
party, political or religious, without a Review? and he replies, "A bell
without a clapper." Such a bell would this Association have been without
its _Journal_, and it must gratefully attribute much of its success to
the ability with which in the first instance Dr. Bucknill, and
subsequently Drs. Robertson, Maudsley, Sibbald, and Clouston, have
helped to make an otherwise clapperless bell articulate.
Through this organ of the Association, for which, speaking for my
colleague and myself, I would venture to ask your loyal co-operation,
much scientific work can be brought before the profession, many
questions can be systematically discussed, and the invaluable experience
of the superintendents of asylums on practical points be presented to
its readers and permanently preserved.
The objects I have mentioned as calling for further attention, and many
more, belong to the future of Psychological Medicine, and as I began my
address with proposing to review the period bounded by the years 1841
and 1881, I will close it with expressing the hope that when a successor
of mine in this office reviews the then vanished period between 1881 and
1921, he will be able to report an accelerated ratio of progress
compared with that of the time I have attempted, so inadequately, to
survey.
And may the Medico-Psychological Association, which I trust will always
be identified with this progress, be about to enter, after its
wanderings, "forty years long," a land flowing with milk and honey, won
by conquests over ignorance, superstition, and cruelty--the triumphs of
the application of humanity and medical science to the relief of mental
weakness and suffering.
FOOTNOTES:
[292] Presidential Address, delivered at the Annual Meeting of the
Medico-Psychological Association, held at University College, London,
August 2, 1881.
[293] I here do homage to the dead. Calmeil, Baillarger, and Brierre de
Boismont still live, at an advanced age. (Since this address was given,
the last named has died. See eloquent tribute to his memory by M. Motet,
in _Journal of Mental Science_, April, 1882.)
[294] As will be seen by the history of lunacy reform contained in this
volume, Lord Shaftesbury's interest in the movement extends back as far
as 1828.
[295] _American Journal of Insanity_, April, 1855.
[296] 9 Geo. IV., c. 40.
[297] Amended by 18 and 19 Vict., c. 105 (1855). Acts referring to
Lunacy Commissions and Chancery Patients, 16 and 17 Vict., c. 70; 25 and
26 Vict., c. 86 (1862).
[298] If parts of workhouses, etc., be included, 166. See p. 211.
[299] I should find it difficult to point to a more striking
illustration of these remarks than the good work being done at the
Lenzie Asylum by Dr. Rutherford.
[300] "On the Construction, Organization, etc., of Hospitals for the
Insane," by Thomas S. Kirkbride, M.D., LL.D. (Philadelphia, 1880), p.
300.
[301] On the large degree to which patients, as shown by the experience
of the Chancery Visitors, can be treated satisfactorily outside asylums,
see pp. 261 and 286; also Dr. Bucknill's trenchant little book, "Care of
the Insane and their Legal Control," 1880.
[302] "Ideal Characters of the Officers of a Hospital for the Insane,"
by I. Ray, M.D. Philadelphia, 1873.
[303] See Dr. Baker's Annual Reports of the York Retreat, and Dr. Rees
Philipps's last Report of the Wonford Asylum, Exeter, etc., etc.
[304] "A Treatise on the Nervous Diseases of Women," by Thomas Laycock,
M.D., 1840, chapter ix. p. 107.
[305] _British and Foreign Medical Review_, January, 1845, p. 311.
[306] "Remarks on Insanity, its Nature and Treatment," p. 14.
[307] "I agree with Mr. Martineau in repudiating the materialistic
hypothesis as utterly futile."--Herbert Spencer, _Contemporary Review_,
June, 1872.
[308] "Die Freiheit der Wissenschaft im Modernen Staat," by Rudolf
Virchow. Berlin, 1877.
[309] Preface to his work on Mental Alienation, p. 20.
[310] "General Paralysis of the Insane," by Wm. Julius Mickle, M.D.,
M.R.C.P. London, 1880.
[311] Among the groups of cases in which they were more decidedly
present is that comprising many due to syphilis; that in which
degenerative changes follow upon hæmorrhagic softening, and another in
which they succeed to occlusion of vessels and its immediate results. In
another, degeneration and atrophy follow, the brain state conditioning
acute insanity; and in another they are secondary to brain injury, not
to mention many other groups.
[312] In the same department the services of another American alienist,
Dr. Edward Jarvis, ought not to be forgotten. Among other works, his
Report on the Idiotic and Insane in Massachusetts, 1854, was of great
value.
[313] It is a remarkable fact, showing the mass of incurable cases
which have accumulated, that the number of curable cases now is only
about 1000 more than it was in 1844 (2519).
CONCLUSION.
In completing the task which the author has attempted in the foregoing
chapters in the History of the Insane in the British Isles, he is only
too conscious that, in the endeavour to be concise as well as
comprehensive, he has made many omissions. With every desire to be fair
to all who have been engaged either in originating or in advancing the
improved treatment of those who, suffering cruelly from a malady
involving their very nature and being, have also been treated cruelly by
their fellows, the writer fears that some names which ought to have been
recorded and some institutions which ought to have been honourably
mentioned, have been passed over in silence. Apart from unintentional
oversight, it is not always easy to find in the Temple of Fame the
precise niche in which to place the figure that would rightfully fill
it, and the consequence is that the pedestal, as in some of our great
public edifices, remains unoccupied. It may be said, however, in
extenuation of any such omission, that it did not fall within the scope
of this book to chronicle all the establishments which, in more humane
methods of treatment, have been in advance of others, still less to
complete the history up to the present day of those which have been
mentioned. As it proceeded, the work has entered more into detail than
was originally designed; thus, in the chapter on Scotland the sketch is
filled in with particulars somewhat out of proportion to that attempted
in the earlier chapters.
Again, in crediting various asylums, as Lincoln, Hanwell, and Lancaster,
with introducing non-restraint, the author has not found space for more
than a reference to the meritorious course pursued at an early period at
the Suffolk Asylum, the Gloucester Asylum, and at Northampton from its
opening (1838), and at the Haslar Hospital.[314]
The writer would have been glad, had the proposed limits of the book
admitted of it, to describe much more fully the rise and growth of those
charitable institutions, the endowed or registered hospitals for the
insane, which have in England formed so important, and, on the whole, so
successful, an experiment in providing care and treatment for the insane
of the poor but non-pauper class, supplemented as they have been by the
payments of the rich. At the present moment, the principle and the
method by which these institutions are governed attract much earnest
attention, and appear to not a few to afford the best alternative
provision for the middle and upper classes, as against asylums carried
on by private enterprise. It may be so. Abuses which in former days were
possible, could not occur under the legislative restrictions of our
time; but it must not be overlooked that their annals have disclosed,
in some instances, abuses as great and inhumanities as shocking as any
that have disgraced the history of private houses. How abominably even
such institutions have been managed, has already been depicted in a
notorious example; how admirably, might have been shown, had space
allowed, as regards the same institution in the hands of men who, like
Dr. Needham, have maintained the reforms previously introduced within
its once dishonoured walls, and carried forward that humane system of
treatment which, Phœnix-like, arose from its ashes. The author would
have liked to do justice to other hospitals--as that at Northampton,
which under Dr. Bayley's remarkable power of organization has proved so
great a success; that at Cheadle, which under Mr. Mould's exhaustless
energy has shown how the various needs of different phases of mental
disorder may be met by various modifications in the provision made for
their care outside the walls of the asylum, thus combining cottage
treatment with the control of the central establishment; and, lastly,
that at Coton Hill, Stafford, which now and for many years has been
superintended by Dr. Hewitson--an institution due to a wave of public
feeling in favour of an institution for those in reduced circumstances,
which bore this practical fruit after some temporary discouragement.
Of the work done by county asylum superintendents it is impossible to
speak too highly; in fact, it would be difficult to know when to stop,
were one to be mentioned. Superintendents of the vast asylums of
Middlesex, Lancashire, and Yorkshire deserve the recognition of
services performed day by day with faithful diligence, not always
sufficiently appreciated, and not always without peril, as instanced in
the case of the late superintendent of Brookwood, Dr. Brushfield.[315]
As of those whose hourly labour is performed in these and other
institutions, so of those who were labourers, however humble, in the
early days of asylum reform at the close of the last and the beginning
of the present century, it must never be forgotten that work unobserved
by the public eye, but conscientiously performed for the unfortunate
class which, to a large extent, is unable to appreciate or thank the
kindly hand which shields them from cruelty or saves them from neglect,
will find its reward in the conscience; and also in the increased
happiness of those whom it benefits, though it may not set the worker on
any pinnacle of fame. It is to such that the author of "Romola" refers
when speaking of the "valiant workers whose names are not registered
where every day we turn the leaf to read them, but whose labours make a
part, though an unrecognized part, of our inheritance, like the
ploughing and the sowing of past generations."
FOOTNOTES:
[314] See Report of the Metropolitan Commissioners. 1844.
[315] Since the above was in type, another example has occurred in the
case of Dr. Orange, who has been assaulted by a criminal lunatic, and
narrowly escaped serious injury.
APPENDIX A.
(Page 61.)
In addition to the maps of Ralf Agas (cir. 1560?) and Braun and
Hogenberg (1572), there is an earlier view of London and Westminster by
Anthony van der Wyngrede, 1543, in the Bodleian Library, Oxford, but it
is worthless for the purpose of tracing the outline of Bethlem. No
additional light is thrown on the buildings by the view of London and
Westminster in Norden's "Speculum Brittanniæ," engraved by Pieter van
dem Keere, 1593. It appears to be agreed that, whatever the date or
designer of the so-called "Agas" may be, it is "the earliest reliable
survey of London." Virtue's reprint is dated 1737. Mr. Overall's
"Facsimile from the original in the possession of the Corporation of the
City of London" was published in 1874. It is, however, only by a careful
study of the original with a magnifying glass and a good light, that the
outline of the Bethlem buildings can be made out.
Smith, in his "Topography of London" (1816), p. 36, says that the only
plan of London showing the first Bethlem which he had been able to meet
with is that by Hollar. This map showed Moorfields divided into
quarters, with trees surrounding each division, the site of the second
Bethlem being then an uninterrupted space, and a cluster of five
windmills standing on the site of the north side of Finsbury, a part of
which in Mr. Smith's memory was called Mill Hill. Hollar's rare map
(1666 or 1667) is so much later than Agas, that we have not followed its
distribution of the buildings. In Faithorne's map, published a few years
earlier (1658), from a survey in 1640, "Bedlame" is represented as a
quadrangle, with a gate in the wall on the south side. There is a very
clear outline of the first Bethlem in Lee and Glynne's map of London (in
Mr. Gardner's collection), published at the Atlas and Hercules, Fleet
Street, without date. This map is also in the British Museum. Mr. Coote,
of the Map Department, fixes the date at about 1705. Rocque's map of
London (1746) shows Bethlem distinctly. This map, and Ogilby's, formed
the basis of Mr. Newton's "London in the Olden Time," 1855.
With regard to the story of the skeleton in irons and Sir T. Rowe's
burying-ground, mentioned at p. 49, it is not disputed that he was
concerned in the burying-ground of Bethlem; but the skeleton appears to
have been found some distance from this spot. What is stated in Strype's
"Stow" (Bk. ii. p. 96, edit. 1720), is that in 1569 "Sir Thomas Rowe
caused to be enclosed with a wall about one acre, being part of the said
hospital of Bethlem, to wit, on the west, on the bank of Deep Ditch,
parting the hospital from Moorfields. This he did for burial in case of
such parishes of London as wanted ground convenient within their
parishes. This was called New Churchyard near Bethlem."
There are some very fine prints of the _second_ Bethlem Hospital in the
Print Room of the British Museum. Of these (to which Mr. Crace's
collection is a recent valuable addition), and the prints in Mr.
Gardner's private collection and the Guildhall Library, the following
list has been prepared. I have again to thank Mr. Gardner and Mr. Coote
for their assistance. I have also to thank Mr. Crace for allowing me to
see his prints before they were removed to the British Museum.
VIEWS OF BETHLEM HOSPITAL.
1. Inscribed "Hospitium Mente Captorum Londinense. Frontispicium
Hospitii (vulgo Bedlam dicti) mente captis destinati, sub auspiciis
colendissimi viri Gulielmi Turner Equitis aurati Senatoris non ita
pridem Prætoris Londini Præsidis dignissimi nec non Beniamini Ducane
Armigeri Thesaurarii fidelissimi; cæterorumque ejusdem Hospitii
Gubernatorum A.D. MDCLXXV mense Aprili fundati, anno sequento mensi Juli
consummati." R. White sculp. Printed by John Garrett, 1690. 47 in. by
22½ in. Crace Collection, 26/3; Guildhall Library.
2. A New Prospect of y{e} North Side of y{e} City of London, with new
Bedlam, and Moorefields (showing New St. Paul's). 1710. 58 in. by 22½
in.
This print is a later edition of one by J. Nutting, 1689, in which old
St. Paul's is shown. Crace Collection, 26/1.
3. On a scroll, "Hospitium mente captorum Londinense." New Bedlam in
Moorefields. Soly fec. Sold by H. Overton, cir. 1730. 22¾ in. by 16½ in.
Gardner Collection; British Museum.
4. Painting of Bethlem Hospital (fresco) in one of the rooms of the
Foundling Hospital, by Haytley. 1746.
5. The Hospital of Bethlem (L'Hospital de Fou). A view showing also
Moorgate. J. Maurer del.; T. Bowles sculp. 1747. 16 in. by 10½ in.
Gardner Collection; Crace Collection, 26/6; Guildhall Library.
6. Hospital of Bedlam. Smaller copy of Bowles's print. Gardner
Collection.
7. Interior of Bedlam, by Hogarth. 1735. Gardner Collection.
8. Bethlehem, a Poem, with a view of Bethlehem. By J. Clark. 1749.
9. Bethlehem in Moorfields. 1752. By B. Cole.
10. The Hospital called Bedlam. 1754. Gardner Collection.
11. View of Hospital of Bethlehem. 6 in. by 10 in. Robert Sayer, cir.
1760.
12. Visit to Bedlam. R. Newton. 1794.
13. Mezzotint of Bethlehem, by Malton. 1798. 11 in. by 9 in.
14. Bethlem Hospital as it appeared in 1811 (proof). Arnold del.;
Watkins sculp. Guildhall Library.
15. London Wall and Bethlehem Hospital. Etching by J. T. Smith. 1812.
16. South-west View of Bethlem Hospital and London Wall, 1814. Smith
del. et sculp. Guildhall Library.
17. Two clever water-colour drawings of Bethlem. Gardner Collection.
18. Water-colour drawing of gate with the recumbent figures by Cibber.
Richardson. Gardner Collection.
19. The two figures on the pediment of the gate by Cibber. Stothard
del.; Sharp sculp. 1783. Guildhall Library.
20. The same. Burell sculp. 1805. 6½ in. by 4½ in. Crace Collection.
21. The same engraved by Warren in Hughson's "London," vol. iii. p. 81.
Gardner Collection.
22. A portrait of William Norris as confined in Bethlem Hospital. Arnold
fec. 1814.
23. New Bedlam in Moorfields, 6½ in. by 9½ in., and another 5½ in. by 6½
in. No date or name of artist. Gardner Collection.
24. Das Narren Hospital Bethlehem. Dutch print. No date. Gardner
Collection.
25. Plan of Moorfields and Bethlem Hospital. Gardner Collection.
26. New Bedlam in Moorfields. 10½ in. by 7 in. Very early view. No date.
Gardner Collection.
27. The New Prospect of Bedlam, Moorfields. By John King. 10 in. by 4
in. No date (costume cir. Will. III.).
28. The Hospital of Bethlehem. 9 in. by 14 in. No date. Gardner
Collection.
29. Curious and quaint drawing of Moorfields and Bethlehem. 13 in. by 21
in. Gardner Collection.
30. Bethlehem Hospital, by Toms. 7½ in. by 15. Gardner Collection.
31. Three views. Hospital de Bethlem; New Bedlam; Bethlehem. Gardner
Collection.
32. Bethlehem in St. George's Fields. Ground Plan of New Bethlem
Hospital. Basire sculp. 1819. This, with five other views by Shepherd,
etc., are in the Guildhall Library.
VIEWS OF ST. LUKE'S.
1. "Enthusiasm displayed." The Rev. John Whitfield preaching under a
tree in Upper Moorfields, with view of "St. Luke's Hospital for
Lunaticks" in the background. J. Griffiths pinx.; R. Tranker sculp.
1750. 19¾ in. by 15 in. Gardner Collection; Crace Collection, 33/19.
2. Elevation of St. Luke's Hospital in a pamphlet entitled "Reasons for
the Establishing, etc., of St. Luke's." 1765. Guildhall Library.
3. Another elevation. J. Dance arch. et sculp. 1784. 15 in. by 4½ in.
Gardner Collection; Crace Collection, 33/15.
4. Front view of the New St. Luke's Hospital, lately erected in the City
Road. Deeble del. et sculp. 1785. Gardner Collection; Guildhall Library.
5. St. Luke's Hospital, Old Street Road. A coloured print from a drawing
by F. A. Shepherd. 1814. 8 in. by 5¼ in. Original drawing in the Gardner
Collection; Crace Collection, 33/16.
6. Lunatic Hospital of St. Luke's. Aquatint. Gardner Collection.
7. Front View of the New St. Luke's Hospital. No date. Gardner
Collection.
8. Ditto. Ditto. 15 in. by 5 in. Gardner Collection.
9. Sepia drawing of St. Luke's. Gardner Collection.
10. Two original drawings by John Carter. Gardner Collection.
11. Lunatick Hospital of St. Luke, published by Ackermann. 1815.
Gardner Collection; Guildhall Library.
12. St. Luke's Hospital, Old Street Road. Shepherd del.; Sands sculp.
1815. Gardner Collection; Guildhall Library.
13. St. Luke's Hospital. Higham del. et sculp. 1817. Guildhall Library.
14. Lunatic Hospital, St. Luke's. S.W. view. T. H. Shepherd del.; J.
Gough sculp. 1837. 5¾ in. by 3½ in. Gardner Collection; Crace
Collection, 33/18.
15. Interior of St. Luke's. Rowlandson and Pugin del. et sculp.; Stahler
aquat. 1809. Gardner Collection; Guildhall Library.
APPENDIX B.
(Page 142.)
In reference to the writers on insanity at the close of the eighteenth
century, Dr. Pargeter, in the work referred to at p. 142, after dwelling
slightly on the pathology, causation, and nature of insanity, becomes
disheartened and exclaims, "Here our researches must stop, and we must
declare that wonderful are the works of the Lord and His ways past
finding out" (p. 15). Of asylums he says, "The conduct of public
hospitals or institutions for the reception of lunatics needs no remark;
the excellence in the management of them is its own encomium" (p. 123).
Of private madhouses under the management of regular physicians, he
ventured to say that "people might securely trust that in them the
afflicted would be judiciously and tenderly treated, and also managed by
servants selected and instructed with such judgment as will make them as
zealous of their own character and reputation, as of the honour of their
employers. In such hands we may place implicit confidence; and a perfect
assurance that in such an abode dwells nothing offensive or obnoxious
to humanity--here no greedy heir, no interested relations will be
permitted to compute a time for the patient's fate to afford them an
opportunity to pillage and to plunder. But such dwellings are the seats
of honour, courtesy, kindness, gentleness, mercy, and whatsoever things
are honest and of good report." Such was the comfortable satisfaction
with which a worthy man in 1792 regarded the condition of the insane in
English asylums in that year. He admits, however, that in private
asylums kept by illiterate persons, compassion as well as integrity is
oftentimes to be suspected, and quotes a passage from a paper written in
1791, which asserts that "if the gaolers of the mind do not find a
patient mad, their oppressive tyranny soon makes him so."
The work written by Dr. Mason Cox (Fishponds, near Bristol) was the best
medical treatise of the day on insanity. Unlike Cullen, he objects to
"stripes" in the treatment of the insane. On the cold bath he says,
"Even so late as Boerhaave we have the most vague directions for its
employment; such as keeping the patient immersed till he is almost
drowned, or while the attendants could repeat the Miserere.... The mode
recommended and so successfully practised by Dr. Currie of Liverpool is
certainly the best, that of suddenly immersing the maniac in the very
acme of his paroxysm; and this may be easily accomplished if the
patient, previously secured by a strait waistcoat, be fixed in a common
Windsor chair by strong broad straps of leather or web girth" (p. 135,
3rd edit., 1813). The author observes that it is certainly worth trying
whether keeping a patient for days in succession in a state of
intoxication would be beneficial, where every other means has failed (p.
75).
APPENDIX C.
(Page 146.)
ASYLUMS IN OPERATION IN 1792.
Bethlem Hospital. Used for lunatics about 1400.
St. Luke's Hospital. Founded 1751.
Liverpool Royal Lunatic Hospital, associated with the Royal Infirmary.
1792.
Manchester Royal Lunatic Hospital, in connection with the Royal
Infirmary. 1706. (Removed to Cheadle, 1849.)
Bethel Hospital, Norwich. 1713.
The Lunatic Ward of Guy's Hospital. 1728. (New building, 1797.)
The York Lunatic Hospital, Bootham. 1777.
St. Peter's Hospital, Bristol. Incorporated 1696.
Brooke House, Clapton (Dr. Monro's). 1759.
Hoxton Asylum. 1744.
Fonthill-Gifford, Hindon, Wilts. 1718.
Droitwich Asylum. 1791.
Belle Grove House, Newcastle-on-Tyne. 1766.
Lea Pale House, Stoke, near Guildford. 1744.
Ticehurst, Sussex. 1792.
The number of lunatics in London and in the country, returned under the
Act of 1774 (14 Geo. III., c. 49), from that year to the projection of
the York Retreat (1792), was 6405; and from 1792 to the Select Committee
of 1815, 12,938.
In 1775 the number registered during the year was 406; and in 1791,
after various rises and falls, it was also 406.
In 1792 the number rose to 491, and in 1815 to 850; the lowest being 414
in 1807, and the highest 700 in 1812.
The above list of asylums shows how scanty was the provision made for
the care of the insane at the time of the foundation of the York
Retreat. I may here add that, in addition to the notice taken of this
experiment by the writers on the Continent mentioned in the text, the
attention of the Germans was forcibly directed to it by Dr. Max. Jacobi,
of Siegburg. He visited York, and, much struck by what he witnessed
there, translated into German the greater part of the "Description of
the Retreat." The late superintendent of the Retreat, Dr. Kitching, who
filled that office for many years with much efficiency, spent a
considerable time at the Siegburg Asylum, comparing notes with Dr.
Jacobi.
APPENDIX D.
(Page 173.)
9 GEO. IV., C. 40 (1828).
The fifteen persons appointed Commissioners in Lunacy for the
metropolitan district, five of whom were physicians, were paid £1 an
hour, and were appointed for one year. They were to meet quarterly for
the purpose of granting licences, those in the provinces being granted
by justices at quarter sessions, where three or more justices were to be
elected to visit the provincial licensed houses, together with at least
one medical Visitor.
Three of the Commissioners were to visit licensed houses in the
metropolitan district four times a year.
Two justices to visit licensed houses in the provinces, accompanied by
the medical Visitor, four times a year.
An annual report was to be prepared and presented to the Secretary of
State for the Home Department.
Private patients were not to be admitted to asylums without the
certificates of two medical men and an order; the certificates being in
force fourteen days before admission.
Pauper patients were not to be admitted without one medical certificate
and the order of two justices, or an overseer and clergyman.
The proprietor of an asylum had to transmit a copy of documents to the
Commissioners or justices, as the case might be.
Single patients to be received on like order and certificates. No
regular visitation of this class instituted.
It should be stated that among the previous Acts, now repealed, there
was a small Act passed May 2, 1815, notwithstanding the failure of Mr.
Rose to induce Parliament to undertake legislation based on the evidence
given before the Committee of that year. This was the Act 55 Geo. III.,
c. 46, entitled, "An Act to amend an Act 48 Geo. III., c. 96 (1808),
being an Act for the better Care and Maintenance of Lunatics being
Paupers or Criminals in England."
The committee of visiting justices of lunatic asylums were to be elected
annually.
Subscribers to lunatic asylums erected by voluntary contributions, who
should unite with any county, might elect a committee of governors to
act with committee of visiting justices.
Justices to fix sums to be expended in purchase of lands, houses, etc.,
or in erecting buildings.
Overseers of the poor to return lists of all lunatics and idiots within
their parishes, verified on oath and accompanied with a medical
certificate.
When any asylum could accommodate more lunatics, magistrate might order
an addition under certain regulations.
APPENDIX E.
(Page 188.)
8 AND 9 VICT., C. 100 (1845).
The following are the clauses of the Act which provide for the expense
of carrying out its provisions.
By this statute it was enacted, after repealing 2 and 3 Will. IV., c.
107; 3 and 4 Will. IV., c. 64; 5 and 6 Will. IV., c. 22; 1 and 2 Vict.,
c. 73; 3 Vict., c. 4; 5 and 6 Vict., c. 87, that the Commissioners in
Lunacy under 5 and 6 Vict., c. 84, should be henceforth called "the
Masters in Lunacy," and that new Commissioners in Lunacy should be
appointed. The Commissioners were to grant licences for the reception of
lunatics within a certain jurisdiction of the metropolis; justices of
the peace in general or quarter sessions licensing houses for the
reception of lunatics and appointing Visitors in all other parts of
England and Wales, including a medical man. For every licence granted a
sum to be paid of ten shillings for every private patient and two
shillings and sixpence for every pauper, or so much more as shall make
up the sum of fifteen pounds, these moneys being applied towards the
payment of the expenses of the Commissioners or any charge incurred by
their authority. The secretary of the Commissioners to make out an
annual account of moneys received and paid by him in the execution of
the Act, to be laid before the Lords Commissioners of the Treasury, the
balance (if any) to be paid into the Exchequer to the account of the
Consolidated Fund, such accounts being laid before Parliament every
year, the Treasury being empowered to pay out of the Consolidated Fund
any balance of payments over receipts which may be necessary. With
regard to the application of moneys received by the clerk of the peace
for provincial licences, they were to be applied towards the payment of
the clerk to the Visitors for the county, and the remuneration of the
medical Visitors, and other expenses incurred in the execution of the
Act, the accounts being laid before the justices at the general or
quarter sessions, who shall direct the balance (if any) to be paid into
the hands of the treasurer of the county or borough in aid of the rate;
any balance of payment over receipts being paid out of the county or
borough funds.
There was paid into the Exchequer in the year ending March 31, 1880,
£1376 for licences in the metropolitan district, besides £18 stamps.
Lunacy Board expenses, £15,064.
I have not any accurate returns of the amounts received from the
provincial houses, but on a rough estimate these licences produce to the
counties in the aggregate £1452, and £30 to the Imperial Exchequer, per
annum.
In the following year, August 26, 1846, an Act was passed "to amend the
Law concerning Lunatic Asylums and the Care of Pauper Lunatics in
England," and was to be construed with 8 and 9 Vict., c. 126. There were
only twelve sections. It was passed to clear up doubts which had been
entertained as to the meaning of certain clauses in the above Act. It
was repealed by 16 and 17 Vict., c. 97.
APPENDIX F.
(Page 190.)
After the legislation of 1853, the Acts referred to at p. 190 and p. 188
constituted, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and
the Acts relative to criminal lunatics, the then code of Lunacy Law.
Lord St. Leonards' first Act, p. 188 (16 and 17 Vict., c. 70), enacts
that when the Commissioners shall report to the Lord Chancellor that
they are of opinion that the property of any lunatic, not so found by
inquisition, is not duly protected, or the income thereof not duly
applied for his benefit, such report shall be deemed tantamount to any
order or petition for inquiry supported by evidence, and the case shall
proceed as nearly as may be in all respects as therein directed upon the
presentation of a petition for inquiry.
The next Act (16 and 17 Vict., c. 96) prescribes amended forms of orders
and certificates, notices of admission, and of the medical visitation
book.
The requirements on the part of the medical man signing the certificate
are laid down.
Empowers proprietors or superintendents of licensed houses (with consent
of Commissioners) to entertain as a boarder any patient desiring to
remain after his discharge, or any relation or friend of a patient.
Authorizes amendment of any order or certificate within fourteen days
after admission of patient.
Permits the Commissioners to allow medical visitation of single patients
less frequently than once a fortnight.
Empowers one or more Visitors to visit single patients at request of
Commissioners, and report to them their condition.
Directs that the medical man who visits a single patient shall make an
annual report to the Commissioners of the mental and bodily health of
such patient.
Empowers the Lord Chancellor to discharge single patients.
Directs that notice of the recovery of every patient shall be sent to
his friends, or in case of a pauper to his parish officers, and in case
of death of a patient in any hospital or licensed house, a statement of
the cause, etc., to the coroner.
Authorizes transfer of a private patient (with consent of two
Commissioners) from one asylum, hospital, or licensed house to another,
without any fresh order or certificate, and similarly as to single
patients.
Empowers the Lord Chancellor, on the representation of the
Commissioners, to require a statement of the property and application
of the income of any person detained as a lunatic under an order and
certificates.
Extends to the Commissioners the powers vested in the private committee,
as to single patients, by the Act 8 and 9 Vict., c. 100, s. 111.
Repeals s. 27 of 8 and 9 Vict., c. 100, as to the visitation of
workhouses; and enacts that one or more Commissioners shall visit such
workhouses as the Board shall direct.
Authorizes the Commissioners in urgent cases to employ any competent
person to visit any lunatic and to report to them.
Directs committee of every hospital to submit regulations to the
Secretary of State for approval, and to send a copy to Commissioners.
Empowers Commissioners, with sanction of the Secretary of State, to make
regulations for the government of licensed houses.
Enacts that Bethlem Hospital shall be subject to the provisions of Act 8
and 9 Vict., c. 100.
The third Act (16 and 17 Vict., c. 97) repeals the several Acts then in
force respecting county and borough lunatic asylums, and re-enacts most
of the provisions therein contained, with certain additions and
improvements.
It authorizes justices of boroughs, instead of providing asylums for
their own use, or in arranging with counties, etc., to contract with the
Visitors of any asylum for the reception of their pauper lunatics, in
consideration of certain payments.
The powers of the Visitors were enlarged in many ways.
When a county or borough asylum can accommodate more than its own pauper
lunatics, the Visitors are empowered to permit the admission of the
pauper lunatics of any other county or borough, or lunatics who are not
paupers, but proper objects to be admitted into a public asylum, such
non-pauper patients to have the same accommodation, in all respects, as
the pauper lunatics.
The Visitors are directed to appoint a medical officer to be
superintendent of the asylum.
They are empowered to grant superannuation annuities to the officers
and servants.
They are directed to make an annual report to the general or quarter
sessions of the state of the asylum.
Every pauper lunatic, not in an asylum, hospital, or licensed house, is
to be visited every quarter by the medical officer of the parish or
union, who is to make return thereof; and the medical officer is to be
paid two shillings and sixpence for every visit.
The forms of orders, statements, and medical certificates are amended,
and the medical officers of unions are permitted to sign certificates.
The medical man certifying is required to state his qualification, when
and where the patient was examined, and to specify facts indicating
insanity; distinguishing facts observed by himself from those
communicated to him by others.
Visitors are empowered to order the removal of pauper patients to and
from asylums, and also to discharge or permit the absence on trial of
any patient. The Commissioners are empowered to direct the removal of
any lunatic from any asylum, hospital, or licensed house to any other.
The person signing the order for admission of a private patient into an
asylum may discharge such patient, subject, in the case of dangerous
lunatics, to the consent of the visiting justices. Any person having
authority to discharge a private patient is empowered (with consent of
two Commissioners) to transfer him to another asylum or to the care of
any person.
Orders and certificates, if defective, may be amended within fourteen
days.
Patients escaping may be retaken within fourteen days.
This statute did not re-enact the clause contained in the Act it
repealed respecting workhouses.
18 AND 19 VICT., C. 105 (1855).
In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the
Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth
Years of Her Majesty, for the Regulation of the Care and Treatment of
Lunatics."
By this statute it was enacted that any single county or borough might
unite with the subscribers to a registered hospital, and that the
proportion of expenses between any county and borough might be fixed
with reference to accommodation likely to be required.
Other sections provide in detail for the maintenance of county and
borough asylums, and other matters which it is unnecessary to enumerate.
APPENDIX G.
(Page 195.)
A short summary is added of the provisions in force at the time of the
Select Committee of 1859-60, for the protection of private patients.
They remain essentially the same.
In the metropolis, the power of licensing is exclusively in the hands of
the Metropolitan Commissioners. In the provincial districts it rests
with the justices at quarter sessions. These licenses are annually
renewed, and they may be revoked by the Lord Chancellor. The patients
are admitted upon an order signed by some relative or friend, with a
statement of all the particulars of the case. This statement must be
supported by the certificates of two medical practitioners, who, having
examined the patient separately within seven days previous to the
reception, state that he is a person of unsound mind, and a proper
person to be detained under care and treatment. It must also specify the
grounds upon which their opinion has been formed, viz. the facts
observed by themselves or communicated by others. After two and before
the expiration of seven clear days, the proprietor or superintendent of
the licensed house must transmit to the Commissioners, and also to the
visiting justices, if the licensed house is within their jurisdiction, a
copy of the order and certificates. The licensed house must be visited
by two of the Commissioners, four times at least every year, if it lies
within their immediate jurisdiction; and if beyond, it must be visited
four times at least by Visitors appointed by the justices, one of whom
shall be a medical man, and twice at least by two of the Commissioners.
In the course of such visits, inquiries are directed to be made as to
the occupation, amusement, classification, condition, and dietary of the
different patients, and also whether a system of non-coercion has been
adopted or not; and where it shall appear, either to the Commissioners
or to the visiting justices, that a patient is detained without
sufficient cause, they have the power, under certain conditions, of
ordering his discharge. When a patient recovers, the proprietor or
superintendent is required to send notice of such recovery to the person
who signed the order for his reception; and if such patient is not
discharged or removed within fourteen days, the proprietor is required
immediately to transmit a similar notice to the Commissioners or
visiting justices, as the case may be. When a patient dies, the medical
practitioner who attended such patient during his illness is to cause a
statement to be entered in the case-book, setting forth the time and
cause of death, and the duration of the disease of which the patient
died, and a copy of such statement, within two days, must be transmitted
to the coroner. In addition to these specific provisions, the
Commissioners have power from time to time to make regulations for the
government of any of these licensed houses, and they must report
annually to the Lord Chancellor the number of visits they have made, the
number of patients they have seen, the state and condition of the house,
the care of the patients therein, and such other particulars as they may
think deserving of notice (p. vi.).
25 AND 26 VICT., C. 111, "THE LUNACY ACTS AMENDMENT ACT, 1862."
In consequence of the importance of the Act of 1862, the Commissioners
issued the following circular noting its chief provisions:--
_Private Patients._
Sec. 23.--The order must be dated within one month prior to reception;
the person signing the order must himself have seen the patient within
one month prior to its date; and a statement of the time and place when
the patient was so seen must be appended to the order.
Sec. 25.--When possible, every order must contain the name and address
of one or more relations of the lunatic, to whom notice of the death of
a lunatic must be sent.
Sec. 24.--Besides the persons hitherto prohibited from signing
certificates and orders, the following also are now disqualified:--Any
person receiving any percentage on or otherwise interested in the
payments for patients, and the medical attendant as defined in the
Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.
Sec. 26.--Where a patient received as a pauper is made a private
patient, no fresh order or certificate is required, and _vice versâ_.
Sec 28.--With the exception of the statement by the medical officer as
to a patient's mental and bodily condition, all the documents heretofore
required to be sent to the Commissioners after two or before seven clear
days from the reception of the patient, must in future be sent within
one clear day from such reception. The medical officer's statement is,
as heretofore, not to be sent until after two and before seven clear
days.
_Letters of Patients._
Sec 40.--Without special directions to the contrary, letters addressed
to the Commissioners, committees of Visitors, committees of a hospital,
and the Visitors of licensed houses, must be forwarded unopened. Other
letters must also be forwarded, unless, by an endorsement thereon, the
superintendent or other person having charge of patients should prohibit
their transmission. Letters so endorsed to be laid before Commissioners,
committees, or Visitors at next visit.
Sec. 38.--Absence on trial may be permitted to patients, in the same way
as leave of absence for the benefit of health is permitted under s. 86,
c. 100.
Sec. 43.--In the absence of any person qualified to discharge, a
discharge or removal may be ordered by the Commissioners.
_Pauper Patients._
Sec. 25.--The order must contain the name and address of one or more
relations of the lunatic, and notice of the death of the lunatic must be
sent to such relation.
Sec. 38.--A pauper permitted to be absent on trial from a licensed house
or hospital may have such an allowance made to him by order of the
Commissioners, Visitors, or committees as would be charged for him were
he in the house or hospital.
_Licensed Houses and Hospitals._
Secs. 14 and 15.--No fresh licence can be granted by justices without
inspection and report by the Commissioners. Notices of alterations in
houses licensed by justices must be given to Commissioners. Their report
must be considered by the justices before licence is granted or
alterations are consented to.
Sec. 16.--The physician, surgeon, or apothecary not being a licensee,
where any such is by law required to reside in or visit a licensed
house, must in the metropolitan district be approved of by the
Commissioners, and in the provincial district by the visiting justices.
A penalty is imposed on any person infringing the terms of his licence
as to numbers, sex, or class.
Sec. 18.--With consent of two of the Commissioners, or, in the case of
the provincial licensed houses, of two of the Visitors, a person who
may have been a patient within five years immediately preceding, may be
received as a boarder into a licensed house (extension of c. 96, s. 6).
Sec. 29.--Licensed houses may be visited at any time by one or more of
the Commissioners or Visitors, but in the metropolitan district they
must be so visited twice in the year, in addition to the present visits
by two Commissioners, and in the provincial districts similarly by
Visitors. Commissioners and Visitors visiting singly have substantially
the same powers of inspection and inquiry as when visiting together. To
these the sixty-second section of the Act does not apply.
Sec. 39.--A penalty is now imposed on any officer or servant conniving
at an escape.
Sec. 43.--In the absence of any person qualified under ss. 72, 73, c.
100, the Commissioners may order discharge or removal of a patient.
Sec. 38.--Absence on trial may be permitted to patients, in the same way
as leave of absence for the benefit of health is permitted under s. 86,
c. 100.
_Medical Certificates._
Sec 27.--Where medical certificates have been returned with a written
direction of the Commissioners for amendment, and such amendment shall
not have been made within fourteen days, the Commissioners may order the
patient's discharge.
Sec. 22.--Lunatics so found by inquisition may be received without
certificate on an order of the committee, accompanied by an official
copy of the order appointing such Committee.[316]
_Workhouses._
The Poor Law Board issued a circular at the same time. The only
paragraph which it is of interest to cite here is the following:--"The
eighth section empowers the Visitors of any asylum and the guardians of
any parish or union within the district for which the asylum has been
provided, if they shall see fit, to make arrangements, subject to the
approval of the Commissioners in Lunacy and the President of the Poor
Law Board, for the reception and care of a limited number of _chronic
lunatics_ in the workhouse of such parish or union, to be selected by
the superintendent of the asylum and certified by him to be fit and
proper so to be removed. The Board are at present not aware of any
workhouse in which any such arrangement could conveniently be made; but
they will be ready to consider any such proposals on the subject when
the Visitors of the Board of Guardians of any union shall find it
convenient or practicable to act upon this clause."
FOOTNOTES:
[316] Seventeenth Report of Commissioners in Lunacy, 1863.
APPENDIX H.
(Page 205.)
Extract from the _British and Foreign Medical Review_, January, 1840:--
"In this particular there is apparently no asylum in England which
presents so remarkable a model as that of Lincoln. Of all the works that
have appeared on the subject of lunatic houses since the publication of
Mr. Tuke's account of the Retreat, there is none which contains matter
more deserving of attention than that recently published by Mr. Hill.
His lecture is little more than a simple commentary on the resolutions
of the board of management of the Lincoln Asylum for twenty years past;
during which period, under the superintendence of Dr. Charlesworth, and
latterly with the vigilant co-operation of Mr. Hill himself, as house
surgeon, almost every kind of bodily restraint is stated to have
gradually fallen into disuse as superfluous, a mere substitute for want
of watchful care.... If the Lincoln Asylum can present a model of this
kind, which all may visit and examine, the services of Dr. Charlesworth
to the cause of humanity and in behalf of the insane, already
considerable, will only be second to that of him who first released them
from their chains."
On this Mr. Hill observes, July 8, 1840:--
"At last the first Medical Review in Europe took up the subject, and
placed most deservingly Dr. Charlesworth in a striking position as to
the non-restraint system, and also honoured myself with approbation."
The following extracts from the Orders in the Lincoln Asylum books[317]
are essential to the right understanding of the introduction of
non-restraint there. Dr. Charlesworth was visiting physician from its
opening in 1821; Mr. Hill was appointed house surgeon in 1835.
"1828. _Ordered_--That the use of the strait waistcoat be discontinued
in this institution except under the special written order of the
physician of the month.
"1828, October 13. Ordered and resolved--That the physicians be
requested to consider whether it be possible to make any improvement in
the means of restraint now in use, and especially for obviating the use
of the strait waistcoat."
Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829,
April:--
"The governors have particularly directed their views to the subject of
coercion and restraint, well aware of their injurious consequences to
the patients.... The construction of the instruments in use having also
been carefully examined, they have destroyed a considerable proportion
of those that were not of the most improved and least irritating
description, and hope hereafter to introduce still further amelioration
into this department."
Extract from the House Visitor's Report, 1829, August 17:--
"Every attention seems to be paid to the patients, whose general state
has, I understand, for some time past, been so generally good that it
is gratifying to say that the strait waistcoat has almost become
useless."
Extract from the Seventh Annual Report, 1831, March 28:--
"Heretofore it was conceived that the only intention of a receptacle for
the insane was the safe custody of the unhappy objects, by any means,
however harsh and severe. These views are now passing away, and the fair
measure of a superintendent's ability, in the treatment of such
patients, will be found in the small number of restraints which are
imposed. The new director has answered this test in a very satisfactory
manner."
The new director here referred to was Mr. Henry Marston. The following
note is appended to this report:--
"As early as the 24th day of November last (viz. Nov., 1830, five years
before Mr. Hill's appointment), there was not any patient in the house
under restraint, unless one wearing a collar, which leaves all the limbs
quite at liberty, can be so considered. This gratifying occurrence has
taken place more than once since that time."
Extract from the Ninth Annual Report, 1833, April:--
"It is unceasingly an object in this institution, and should form a
prominent point in the annual reports, to dispense with or improve as
much as possible the instruments of restraint."
Extract from the House Visitor's Report, 1834, August 4th to 10th
inclusive:--
"I have much satisfaction in being able to state that not a single male
patient has been under restraint since the 16th of July, and not one
female patient since the 1st of August, and then only for a few hours."
At this time Mr. Hadwen held the appointment of house surgeon.
Extract from the Governor's Memorandum Book, 1835, July 8th:--
"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen
during the period of fifteen months that he held the situation of house
surgeon of this institution, feel called upon to express their high
approbation of the very small proportion of instances of restraint which
have occurred amongst the patients under his care."
Extract from _Edinburgh Review_, April, 1870:--
"But to Conolly belongs a still higher crown, not merely for his courage
in carrying out a beneficent conception on a large scale and on a
conspicuous theatre, but for his genius in expanding it. To him, hobbles
and chains, handcuffs and muffs, were but material impediments that
merely confined the limbs; to get rid of these he spent the best years
of his life; but beyond these mechanical fetters he saw there were a
hundred fetters to the spirit, which human sympathy, courage, and time
only could remove.
"Perfect as was the experiment carried out at Lincoln Asylum, the
remoteness of that institution from the great centre of life, and the
want of authority in its author, would no doubt have prevented its
acceptance for years by the physicians of the great county asylums so
long wedded to old habits. It was for some time treated as the freak of
an enthusiastic mind, that would speedily go the way of all such
new-fangled notions; and no doubt it would, had not an irresistible
impulse been given to it by the installation of Dr. Conolly at Hanwell,
where, with a noble ardour, he at once set to work to carry out in the
then largest asylum in the kingdom the lesson he had learned at
Lincoln."
Dr. Conolly's works bearing on mental disorders, in addition to his
"Lectures on Insanity," were as follows:--
1. "An Inquiry concerning the Indications of Insanity, with Suggestions
for the better Protection and Care of the Insane." 1830.
2. "The Construction and Government of Lunatic Asylums and Hospitals for
the Insane." 1847.
3. "The Treatment of the Insane without Mechanical Restraints." 1856.
See "Memoir of Dr. Conolly." By Sir James Clark. 1869.
FOOTNOTES:
[317] As given in the _Journal of Mental Science_, July, 1870.
APPENDIX I.
(Page 236.)
The Commissioners give, in their Report for 1857, a table in support of
the statement at p. 236, but it is not borne out by the _average_ of the
six largest and six smallest county asylums.
--------------+---------------------+---------------------
| Daily average | Average weekly cost
Asylum. | number of patients. | per head.
--------------+---------------------+---------------------
| | s. d.
Colney Hatch | 1257 | 9 10
Hanwell | 1020 | 10 5¾
Surrey | 934 | 8 8¾
Wakefield | 803 | 7 4
Lancaster | 710 | 8 1½
Prestwich | 509 | 7 10
+---------------------+---------------------
| Average} 872 | Average} 8 8½
| number} | cost }
| |
Dorset | 155 | 8 1
Denbigh | 189 | 9 8¾
Bucks | 192 | 10 8
Notts | 216 | 10 5
Cornwall | 238 | 8 3¾
Chester | 278 | 8 6
+---------------------+---------------------
| Average} 211 | Average} 9 3
| number} | cost}
--------------+---------------------+---------------------
APPENDIX K I.
(Page 258.)
The sketch of the rise and growth of county asylums and registered
hospitals would not be complete without giving the provision obtained,
up to the present time, by means of rates on the one hand and private
charity on the other. We are not concerned here with private asylums.
The following are the asylums and charitable hospitals in England and
Wales, January 1st, 1881, with the number of patients.
_Counties._--Beds., Herts, and Hunts. (913); Berks (420), Bucks. (421),
Cambridge (421); Carmarthen, Cardigan, and Pembroke (335); Chester--at
Chester (521), ditto at Macclesfield (632); Cornwall (582); Cumberland
and Westmoreland (447); Denbigh, Anglesea, Carnarvon, Flint, and
Merioneth (427); Derby (404), Devon (800), Dorset (469), Durham (944),
Essex (932), Glamorgan (581), Gloucester (662), Hants (792), Hereford
(364), Kent--at Maidstone (1253), ditto at Canterbury (692);
Lancaster--at Lancaster Moor (1118), ditto at Rainhill (675), ditto at
Prestwich (1211), ditto at Whittingham (1260); Leicester and Rutland
(463), Lincoln (600); Middlesex--at Banstead (1702), Colney Hatch
(2173), Hanwell (1841); Monmouth, Brecon, and Radnor (537); Norfolk
(619), Northampton (557), Northumberland (432), Notts (280), Oxford
(471), Salop and Montgomery (50), Somerset (733); Stafford--at Stafford
(645), ditto at Burntwood (529); Suffolk (401); Surrey--at Wandsworth
(1028), ditto at Brookwood (1050); Sussex (802), Warwick (644), Wilts
(586), Worcester (766); York--North Riding, York (525); ditto West
Riding, Wakefield (1400); ditto West Riding, Sheffield (1125); ditto
East Riding, Beverley (260).
_Boroughs._--Birmingham (676), Bristol (387), Hull (163), Ipswich (249),
Leicester (392), City of London (380), Newcastle-on-Tyne (248), Norwich
(171), Nottingham (262), Portsmouth (375).
_Metropolitan District Asylums._--Leavesden, Herts (1990); Darenth, Kent
(687); Caterham, Surrey (2039).
_Hospitals._--Manchester Royal Lunatic Hospital, Cheadle (183); Wonford
House, Exeter (93); Barnwood House, Gloucester (111); Lincoln Lunatic
Hospital (56); St. Luke's Hospital (199); Bethel Hospital, Norwich (74);
St. Andrew's Hospital, Northampton (314); Nottingham Lunatic Hospital
(66); Warneford Asylum, Oxford (68); Coton Hill, Stafford (146); Bethlem
Hospital (265); Bootham Asylum, York (187); The Retreat, York (151).
_Idiot Establishments._ See chapter viii., pp. 307-319.
_Naval and Military Hospitals and India Asylum._--Royal Military
Hospital, Netley (34); Royal India Lunatic Asylum, Ealing (105); Royal
Naval Hospital, Yarmouth (168).
_Criminal Asylum._--Broadmoor (491). See chapter vi.
The total number of ascertained lunatics and idiots in England and
Wales, January 1st, was as follows:--
----------------+------------------+--------------------+--------------------
| Private. | Pauper. | Total.
+-----+-----+------+------+------+------+------+------+------
Location. | M. | F. |Total.| M. | F. |Total.| M. | F. |Total.
----------------+-----+-----+------+------+------+------+------+------+------
61 county and | | | | | | | | |
borough | | | | | | | | |
asylums | | | | | | | | |
(51 and 10) | 230| 309| 539|18,427|22,389|40,816|18,657|22,698|41,355
| | | | | | | | |
16 registered | | | | | | | | |
hospitals |1,454|1,346| 2,800| 92| 56| 148| 1,546| 1,402| 2,948
| | | | | | | | |
Licensed houses:| | | | | | | | |
35 Metropolitan |1,030| 836| 1,866| 198| 447| 645| 1,228| 1,283| 2,511
59 Provincial | 738| 816| 1,554| 257| 304| 561| 995| 1,120| 2,115
| | | | | | | | |
3 naval and | | | | | | | | |
military and | | | | | | | | |
hospitals, | | | | | | | | |
Royal India | | | | | | | | |
Asylum | 288| 19| 307| -- | -- | -- | 288| 19| 307
| | | | | | | | |
1 criminal | | | | | | | | |
lunatic asylum| | | | | | | | |
(Broadmoor) | 172| 55| 227| 199| 65| 264| 371| 120| 491
| | | | | | | | |
Workhouses: | | | | | | | | |
Ordinary | | | | | | | | |
workhouses | -- | -- | -- | 5,211| 6,882|12,093| 5,211| 6,882|12,093
| | | | | | | | |
Metropolitan | | | | | | | | |
district | | | | | | | | |
asylums | -- | -- | -- | 2,144| 2,574| 4,718| 2,144| 2,574| 4,718
| | | | | | | | |
Private single | | | | | | | | |
patients | 175| 273| 448| -- | -- | -- | 175| 273| 448
| | | | | | | | |
Outdoor paupers | -- | -- | -- | 2,358| 3,769| 6,127| 2,358| 3,769| 6,127
+-----+-----+------+------+------+------+------+------+------
--- | | | | | | | | |73,113
175 Total |4,087|3,654| 7,741|28,886|36,486|65,372|32,973|40,140|[318]
----------------+-----+-----+------+------+------+------+------+------+------
FOOTNOTES:
[318] Exclusive of 224 Chancery patients residing with their committees.
APPENDIX K II.
(Page 276.)
It should have been stated in the text that the ratio of the insane
there given to the number of those tried, only refers to those tried for
murder. I am indebted to Dr. Guy for the following additional figures,
extracted from the last volume of the Judicial Statistics:--
------------------------------+-----+-----+-----+-----+-----+------
|1875.|1876.|1877.|1878.|1879.|1880.
------------------------------+-----+-----+-----+-----+-----+------
Sentenced to death | 33 | 32 | 34 | 20 | 34 | 28
Executed | 18 | 22 | 22 | 15 | 16 | 13
Subsequently certified as | | | | | |
insane and sent to Broadmoor| 1 | 1 | 2 | 1 | 4 | 1
------------------------------+-----+-----+-----+-----+-----+------
The following figures for 1878 are of interest:--
Removed by order of Secretary of State, acquitted as insane 33.2
Ditto, becoming insane after trial 22.2
Ditto, becoming insane after committal 23.5
Ditto, found or declared insane 20.9
Committed by justices--dangerous lunatics 0.2
-----
100.0
The last figure is in striking contrast with the return from Ireland,
where, on account of the peculiarity of the law, the justices committed
1276 as dangerous lunatics, out of 1393 sent to asylums in the same
year.
APPENDIX L.
(Page 284.)
Since Broadmoor was opened, in 1863, to January 1, 1881, the number of
persons admitted was 1322; the re-admissions were 27, making 1349 cases.
The number discharged recovered was 108; the number recovered and sent
back to prison to finish their sentences, 59; making a total of
recoveries of 167, or 12.37 per cent. of the admissions. There were
transferred to other asylums, being still insane, 452; and 234 died, or
2 per cent. on average number resident. Twenty-one patients escaped and
were recaptured, 3 escaped and were not recaptured. The number remaining
January 1, 1881, was 490.
Of these, 19 were affected with epilepsy; 13 with paralysis; and 4 with
epilepsy and paralysis.
The principal crimes were as follows:--For murder, 220; attempt to
murder, 122; arson, 28; larceny and petty theft, 25; insubordination as
soldiers, 18; burglary and housebreaking, 16; manslaughter, 10.
With reference to the period at which insanity was recognized, 39 were
certified to be insane whilst awaiting trial or judgment; 117 were found
insane by jury on arraignment; 244 were acquitted on the ground of
insanity; 13 were reprieved on the ground of insanity; and 77 were
certified insane whilst undergoing sentence of penal servitude.
Of 230 who had committed homicide, 93 had killed their own children; 23
their wives; 8 women to whom engaged; 7 the mother, and 4 the father;
while 18 had killed fellow patients in asylums.
APPENDIX M.
(Page 298.)
The following are some of the statistics of the duties performed in the
office of the Masters in Lunacy during the year ending October 31,
1879:--
Orders for inquiry in Commissions of Lunacy executed by
Masters in Lunacy 115
Reports made to the Lord Chancellor 248
Summonses for proceedings before the Masters 5739
REGISTRAR IN LUNACY.
Petitions presented for hearing 253
Ditto for orders for inquiry, and for orders under Lunacy
Regulation Act, 1862 179
Orders made for inquiry (Commissioners in Lunacy) 119
Number of orders made in pursuance of the Lunacy Regulation
Act, 1862, for the application of properties of small
amounts for the maintenance of lunatics 51
CASH ACCOUNTS.
Amount of receipts included in accounts and affidavits
of committees and receivers of lunatics' estates,
taken and passed by the Masters £882,481
Amount of disbursements and allowances thereon 766,220
Percentage on lunatics' incomes under general order 21,140
Amount of stock directed to be transferred into court 144,439
Amount of stock directed to be sold or transferred out 325,925
Amount of stock directed by orders in lunacy to be
transferred, or otherwise than into court 2,092,038
_Judicial Statistics_, 1880.
INDEX.
A.
Abendberg, the, 305
Aberdeen Asylum, 333, 334, 343
Abram men, 39, 40, 65
Accumulation of insane, 261, 362, 402, 429, 438, 493
Adam, Dr., 379
Admissions into asylums, 260
Aetius, 30
Agas's map, 60, 507
Agrippa, Cornelius, 36, 38
Ahagaltaun, 23
Airing-courts, 375
Ale, 2, 4, 5
Alkermes, 31
Allen, Dr. T., 80, 81
Altarnun, 11
America, 445
---- and idiots, 302
Amsterdam Hospital, 111
Amusements, 336
Apparition, treatment of, 4
Apples in insanity, 109
Apuleius, 2, 31
Argyll, Duke of, 340
Armagh, 403, 417
Armoric word for mania, 11
Arnold, Dr. T., 141
----, Dr. (Rugby), 442
Ashe, Dr., 431
Ashley, Lord, 170, 176, 177, 178, 180, 184, 339, 449, 451
Asylums in 1792, Appendix C;
in 1844, pp. 209-212;
in 1851, p. 225;
in 1858, 238;
in 1881, Appendix K I
Attendants, 233, 244, 466
Aubrey, 65
Austria, 444
Auxiliary asylums (Ireland), 426
Ayrshire petition against lunacy reform, 327
B.
Backus, Dr., 302
Bacon's restoration of Cibber's statues, 71
Baillarger, 444, 497
Bain, Mr., 474
Baker, Dr., 466
Baldovan Idiot School, 308
Ball, Professor, 284
Ballinasloe, 403, 417
Balsam of bats, 33
---- of earthworms, 33
Banstead, 460
Barking, asylum at, 55, 68
Barlow, Master, 191, 293, 294, 296
Bastian, Dr., 473
Bath, school for imbeciles, 304, 307, 320
Baths in insanity, 6, 12, 137, 485
Battie, Dr., 82, 86, 87
Batty, Dr., 141
Bayle, 444
Bayley, Mr., 504
Beach, Dr., 304, 308
Bedford Asylum, 165, 166, 180, 214
"Bedlam," synonymous with mad-house, 56;
lines on, 75
---- Gate, 48, 49
Belfast Asylum, 417, 424
Belgium, 445
Belhomme, M., 302
Bell, Dr. Luther, 445, 467
----, St. Fillan's, 2, 15, 16
Benefits arising from the removal of restrictions, 379
Bennet, Hon. H. G., 149
Bethel Hospital, 210
Bethlem Hospital, 12, 45, 85, 152, 166, 400, 507
----, plates of, 60, 74;
prints of, Appendix A
Bethnal Green Asylum, 155, 156, 167, 168, 174, 183
Bezoartick pastills, 33
Bicêtre, the, 302, 446
Bile, 33, 43, 93
Bill of 1773, 101
Binning, Lord, 149, 326, 328
Bishopsgate Street, 45
Blackburn, Mr., 355
Blandford, Dr., 453
Blood-letting, 484
Board of Lunacy, 453, 493, 518
---- of Supervision (Scotland), 348, 349, 351, 352, 354, 355
---- of Works (Ireland), 404
Boarding out of lunatics, 387
Boase, Dr., 13
Boerhaave, 18
Boismont, Brierre de, 145, 444
Bootham Asylum (York Asylum), 210
Borage, 30
Borde, Dr., 26
Borlase, Mr. W. C., 13
----, Dr., 13
Bowen's Bethlem, 62
Bowling Green, the, 87
Bowssening lunatics, 11, 513
Boyd, Dr., 477
Braid, Mr. James, 472
Brank, the, 42
Braun's map, 60
Bread and milk in insanity, 109
Bridewell, 61
Bridle, scold's, 42
Brigham, Dr., 445, 500
Bright, Dr., 167
_British Review_, 123
British word for mania, 11
Broadmoor, 240, 252, 265, 494, Appendix L
Broadway, H., his medical certificate, 163
Brodie, Dr., 308
Brogden, Mr., 326
Brookwood Asylum, 42, 505
Brosius, 448
Brougham, Lord, 164, 175
Brown, Dr. (N. Y.), 134
Browne, Sir T., 31, 35
----, Dr. W. A. F., 335, 339, 368
----, Dr. Crichton, 480, 489
Bruce, Mr., 355
Brushfield, Dr., 42, 505
Buckland, Mr., 49
Bucknill, Dr., 191, 297, 458, 477, 500
Burt, Mr., 279
Burton, 29, 30, 31
Butt of St. Lewes, 16
C.
Cairns, Lord, 433
Calmeil, 444
Campbell, Lord, 245
Cappe, Dr., 118
Carlow Asylum, 403, 417
Carmarthen Asylum, 250
Carpenter, Dr., 469
Cassidy, Dr., 208
Castlebar Asylum, 423
Caterham Asylum, 240, 241, 262, 308, 319
Cath Finntraglia, 24
Census of insane, 1844, 179, 211, 451;
1847, 221;
1854, 230;
1858, 191;
1859, 259;
1864, 240;
1874, 252;
1879, 258;
1881, 259, 533
---- (Scotch), 1818, 330;
1855, 340;
1858, 360;
1874, 364;
1881, 367, 368, 373
---- (Ireland), 1827, 408;
1843, 414;
1881, 439, 441
Cerebral reflex action, 469
Certificate, illiterate, 163
Chains, 8, 40, 52, 64, 95, 154, 155
Chamber of Horrors at Lancaster, 208
Chancery lunatics, 199, 222, 285, 298, Appendix M
---- (Ireland), 434
Charcot, 474
Charing Cross, asylum at, 53, 68
Charity Commissioners' Report on Bethlem, 60, 79, 85
---- Organization Committee on idiots, 311, 313, 461
Charles I., 66
Charlesworth, Dr., 182, 204, 206, 527
Chatham, Earl of, 98, 103-7
Chaucer, 10, 53, 54
Cheadle Lunatic Hospital, 199, 243, 458, 504
Cheshire Asylum, 42, 165, 214, 250
Chiaruggi, 445
Christ's Hospital, 61
Christmas Rose, 30
Chronicles of Great Britain during Middle Ages, 8
Church-bell, 2, 15
Cibber, Caius Gabriel, 70, 78
City and Bethlem, 58, 61, 67, 82
Clapton. _See_ Darenth
Clark, J. Benwell, 61
Clarke, Lockhart, 478
----, Rev. E. M., 414
Classification of insanity, 467
Clerkenwell Close, 92
Cloghnagalt, 23
Clonmel Asylum, 394, 417
Clouston, Dr., 371, 488, 501
Cock, sacrifice of a, 20, 21
Code of rules (Irish) issued by Privy Council, 424
Coin paid to a Scotch loch, 20
Coke, 31, 32, 38
Colebrooke, Sir E., 352
College of Physicians, 102, 162, 170, 174, 449
Colney Hatch Asylum, 236, 249
Colquhoun, Mr., 324
Comfort of asylums, increased, 386
Commission, Lunacy Inquiry (Irish), 1877, 397
Commissioners in Lunacy, 187, 220, 235, 242, 246, 493
---- (Ireland), 403
Committee (House of Commons), 1763, 98;
1808, 127;
1814, 1815, 149, 157;
1816, 158, 159;
1827, 167;
1859, 191, Appendix G;
1877, 196, 294
---- (Ireland), 1804, 399;
1817, 394, 402;
1859, 402
---- (Scotch), 1848, 338, 339
---- House of Lords (Ireland), 1830, 409, 413;
1855, 417
Congress, International Medical, 284, 286
Connaught Asylum, 409
Conolly, Dr., 177, 180, 182, 191, 206, 207, 220, 414, 447, 448, 459,
484, Appendix H
Constantinople asylums, 110
Construction of asylums, 236
Coote, Mr., 508
Cork Asylum, 398, 407, 415, 420
Cornish word for mania, 11
Cornwall, treatment in, 11
---- Asylum, 165, 166, 199, 214, 215
Corrigan, Dr., 418
Corsellis, Dr., 182
Cost of asylums, 166, 180, 239, 241, 262, 461
---- of maintenance of lunatics, 222, 244, 269, 278, 366, Appendix I
---- of pauper lunatics transferred from parish to union, 239
Coton Hill Lunatic Hospital, 244, 504
Cottage treatment (Devon Asylum), 458
County asylums, 1844, 209, 211
Couper, Marable, 21
Course of Lunacy Legislation, 147
Cowan, Mr., 355
Cox, Dr., 142, 513
----, Mr. James (afterwards Sir James Coxe), 360
Crace, Mr., 508
Crichton, Dr. (Friars Carse), 335
----, Mrs., 335
----, Dr., 142
Criminal lunatics, 265
Crooke, Hilkiah, 64, 80
Cross, sign of the, 5
Crosses, lunatics bound to, 28
Cullen, Dr., prescribes stripes, 513
Currie, Dr., 513
D.
Daire Dornmhar, 24
Dalyell, 16, 21
Dangerous lunatics (Ireland), 423, 436, 534
Darenth Asylum, 241
---- Idiot Schools, 307, 319
Dark room, 29, 44
Darwin on idiots, 318
Davies, Dr. Pritchard, 486
Defoe, Daniel, 96
Dekker, 65
Delarive, Dr., 117, 137
Demoniacal possession, 1, 5, 9, 18, 27, 43
Demonology, 34
Denbigh Asylum, 253, 254
Denton, Robert, 55
Depeditch, 48, 49
Depletion in insanity, 136, 137, 484
Derby, Earl of, 269
"Description of the Retreat," 115, 123, 129, 400, 515
Desportes, 459
"Devil sickness," 2
Devon, Earl of, 306
Dickens on the Court of Chancery, 285
Dickson Thompson, Dr., 471
Diet in insanity, 136
Difficulties met with in carrying out improvements, 385
Dillwyn, Mr., 196, 200, 499
---- Committee, 196, 296, 450
Dioscorides, 2, 30
"Dissolution," 471
District asylums (Scotland), 358
Divination, 26
Dix, Miss, 338, 353, 445
"Dog and Duck," 84
Dorridge Grove Asylum, 306
Dorset Asylum, 214, 250
Down, Dr., 307
Downpatrick Asylum, 423
Drummond, Mr. H., 191, 332, 339, 351, 356
----, Alex., trial of, 21
Dublin Asylum. _See_ Richmond
Ducking stools, 34
Dumfries Asylum, 335, 368
Dunbar, Sir William, 356
Duncan, Dr., 122, 322
Dundas, Mr. W., 324
Dundee Asylum, 333
Dundrum Asylum, 180, 268, 431, 435
Dunlop, Mr., 356
Dunne, Col., 417
Dunstan, Mr., 89
Durham Asylum, 250
Dwellings, insane in private, 262
E.
Earle, Dr. Pliny, 492
Earlswood, 305, 319
_Edinburgh Review_ on Pinel, 142
Edinburgh Royal Asylum, 322, 323, 343, 371, 372
Edward VI., 61
Eldon, Lord, 162, 165
Electricity, 110
Elgin Asylum, 341
Ellice, Mr. E., 339, 348, 350, 352, 353, 355
Elliotson, Dr., 472
Elmes on St. Luke's, 88
Empiric, a Scotch, 21
Employment of patients, 137, 278, 333, 336, 489
Ennis Asylum, 423
Enniscorthy Asylum, 423
Epilepsy, 4, 20, 31-37, 489
Erskine, Lord, 130
Esquirol, 302, 448, 459, 467
Essex Hall, 305, 320
---- Asylum (Brentwood), 250
Evelyn's visit to Bethlem, 64, 68
"Evigilator" (Dr. Best), 124
Evolution, 471, 475
Exeter Lunatic Hospital, 214
Exorcism, 28
F.
Fallowes, Dr., 93
Falret, 302, 444
Farm labour, 138, 334, 382
Faulkner, Dr., 142
Fellows of College (Commissioners), 102, 167
Ferrier, Dr., 473
Ferrus, 132, 133, 444
Feuchtersleben, 445
Feverfew, 30
Fife and Kinross Asylum, 388, 391, 462
Fig poultices, 31
Finnmac-Cumhail, 24
Finsbury Circus, 67, 68
Fisherton House, 268
FitzMary, Simon, 45
Fletcher, Dr. Bell, 306
Fonthill-Gifford Asylum, 156, 212
Forfar, 42
Fort Clarence Hospital, 210
Foster, Mr. J. Leslie, 394, 400
Foville, 444
----, M. Achille, 284, 446
Fowler, Dr., 119
Fownes, Sir William, 396
Fox (Lord Holland), 98
----, Mr. John, on schools for the insane, 438
France, 142, 301, 444
Fraser, Dr., 387, 462
Friedreich, 445
Friends, Society of, 113, 125, 132, 134, 306
Fritsch, 473
Fry, Mrs., 329
Furness, 28
G.
Galen, 30
Gall, son of King of Ulster, a lunatic, 25
Galt, etymology of, 24
Gardner, Mr. J. E., 62, 74, Appendix A
Garth's Dispensary, 81
Gartnavel, 372
Gaskell, Mr., 191, 209, 214, 454, 456
Gay, 67
Gealach, etymology of, 24
_Gentleman's Magazine_, 99, 101
George III., insanity of, 107, 108
Georget, 444
Gerarde, 30
Germany, 304, 444
Gilchrist, Dr., 371
Giraldus of Wales, 8, 9
Glamorgan Asylum, 249, 250
Glasgow Asylum, 332, 334, 343
Glen-na-galt, 23, 25, 393
Gloucester Asylum, 165, 166, 179, 180, 214, 503
Godfrey, Bishop of Bethlehem, grant to, 47
Goltz, 473
Gordon, Mr. R., 166, 169, 171, 187, 202, 203, 332, 449
Grabham, Dr., 305, 319
Graham, Sir James, 184, 339
Grand Juries' presentments (Ireland), 404, 405
Grant, capitation, 196, 251, 364, 390
Gray, Dr. (Utica), 449, 463
Great Staughton, 41
Gregorian water, 18
Grenville, Mr., 98
Gresham, Sir J., 58, 61
Grey, Sir George, 191, 338, 351, 361
Griesinger, 448
Grove Hall Asylum, 481
Gudden, 482
Guislain, 445
Gurney, Mr. J. J., 329
Guy, Dr., 534
Guy's Hospital Lunatic Ward, 211
H.
Hale, 31, 32, 38
Hallaran, Dr., 398, 407
Halliday, Sir A., 127, 164, 165, 166, 167, 328
Hanwell Asylum, 177, 179, 180, 206, 207, 213, 228, 236, 489
Hardinge, Judge, on Dr. Battie, 86
Hardy's Act, 460
Harper, Dr., 142
Harvey, Mr., on Moorfields, 77
Haslam, Mr., 65, 80, 142, 152, 444
Haslar Hospital, 210, 213, 503
Hatchell, Dr., 423
Haverfordwest Asylum, 210, 253
Haywards Heath Asylum, 489
Hebrides, 19
Hellebore, 30, 31, 109
Henbane, 2
Henry VIII., portrait of, 73;
treatment of insane in his reign, 27;
grant of Bethlem, 58, 59
Herb treatment of insane, 1
Hereford Asylum, 183
Heron, Mr., 14
Higgins, Mr. G., 124, 150
Highgate Asylum, 305
Hill, Mr. R. Gardiner, 204, 205, 206, 447, Appendix H
Hills, Dr., 486
Hitch, Dr., 182, 446
Hitchcock, Professor, 284
Hitzig, 473, 480
Hogarth's Bethlem, 73, 74, 509
Hogenberg's map, 61
Hole in floor of cabin for lunatic, 395
Holidays, essential for superintendents, 465
Hollar's map, 65, 507
Holler, 482
Holy water, 2, 5
---- wells, 9, 11, 13, 14, 16, 19, 21
Hood, Dr., 191
Hop, 5
Hospitals, lunatic, 210, 263
Howard, John, 110-112
Howe, Dr. S. G., 303, 445
Humieres, Mrs., evidence of, 155
Humours, influence of, 9, 33, 34
Hutcheson, Dr., 334
Hutchinson, Mr. Jonathan, 468, 497
Hypnotism, 472
I.
Idiots, 286, 299, 309, 483
Imbeciles, 299
Inch Maree, 17, 18
Increase of lunacy, apparent, 232, 253, 260
Incubi, 36
Industrial system, 381, 382
Inspectors of the poor, action of, in boarding out, 385
International Medical Congress, 443
Invocation to periwinkle, 3
Ipswich Borough Asylum, 250
Ireland, 23, 393
----, Dr., 304, 308
Ireland's Hogarth, 74
Irish Lunacy Inquiry Commission, 1878, 424-431
Island Bridge Asylum, 410
Itard, M., 301
Ivy ointment, 109
J.
Jacke Napes, 56
Jackson, Dr. (Boston), 109
----, Dr. Hughlings, 471
Jacobi, Dr., 126, 333, 445, 459, 460, 465, 515
Jails, lunatics in (Ireland), 412
James I., 34
Jarvis, Dr. E., 492
Jepson, G., 116, 118
Jocelin, 28
Johnstone, Mr., 356
Junius on Chatham, 106
K.
Kekewich, Mr., 191
Kennoway, 391
Kent Asylum, 180, 214
Kerry, 393
Kilkenny Asylum, 410, 421
Killarney Asylum, 339
Kimbell, Mr., 306
Kinnaird, 352
Kirkbride, Dr., 457, 458, 459, 460
Kitching, Dr., 515
Knowle, idiot asylum at, 306, 320
Kolk, Schroeder van der, 445, 467, 477, 482
Krafft-Ebing, 455
L.
Lalor, Dr., 430, 438, 496
Lamb, Rt. Hon. W., 406
Lancaster Idiot Asylum, 306, 319
---- Asylum, 165, 166, 179, 208, 214, 245
Langermann, 460
Lansdowne, Marquis of, 162
Larbert Institution, 308
Latham, Dr., 454
Law, John, his servant, 22
Laycock, Professor, 468
Laying on of hands, 21
Leavesden Asylum, 240, 241, 262, 308, 319, 461
Leech, Saxon, 7
Leechdoms, Saxon, 1
Legislation, 97, 449, Appendices D-G
Leicester Asylum, 214, 250
Lélut, 477
Leonards, Lord St., 188, 518
Letterkenny Asylum, 423
Leuret, 444
Libcorns, 2
Liberton Institution, 308
Lifford Asylum, 410
Lilburne, John, 50
Limerick Asylum, 394, 398, 399, 410, 417
Lincoln County Asylum, 250
---- Lunatic Hospital, 165, 166, 179, 204, 206, 213, 250, 447,
Appendix H
Lindsay, Dr. Lauder, 448
----, Dr. Murray, 499
Litton, Mr., 434, 437, 439, 441
Liverpool Asylum, 210, 214, 242
---- Street, 48, 50
Location of insane, 1844, 191, 211;
1847, 221;
1858, 1859, 191, etc.
Loch Maree, 17, 18
Lochmanur, scene at, in 1871, 20
London, City of, asylum, 250
_London Spy_, 75
Londonderry Asylum, 417
Lord Chancellor, 175, 257
---- Chancellor's Visitors, 285
Lotherwerd, 28
Lucas, M., 497
Luke's Hospital. _See_ Saint
Lunatics are God's minstrels, 10
"Lunatik lollares," 11
Luther on Idiots, 318
Lutwidge, Mr., 191, 257, 418
Luys, Dr., 473, 483
Lyndsay, Sir David, 28
Lyttleton, Hon. W. H., 149
M.
Macclesfield Asylum, 249
McCabe, Dr., 431
McIntosh, Dr., 334
Mackie, Mr., 356
McKinnons, Dr., 371
Mackworth, Mr., 101
McNeill, Sir John, 355
Madman's Glen, 24
---- Ford, 23
Madmen, cowards, 109
Madron Well, 13
Maelrubha, 17
Magnan, 448
Mahon, Lord, 104
Maistre, Joseph de, 112
Major, Dr. Herbert, 478, 479, 480
Malcolm, on Bethlem, 78
----, Dr., 334
Malmesbury, Lord, 170
Manchester Hospital, 210, 214
Mandrake, 3
Maniacs, how treated at the Retreat, 120, 121
Mapes, Walter, 8
Marcé, 444
Maree, St., 17
Martin, Baron, 245
Maryborough Asylum, 408, 417
Masses sung, 2, 5, 6, 12
Masters in Lunacy, 291, Appendix M
Maudsley, Dr., 474, 501
Mayerne, Sir T., 32, 34
Mead, Dr., 109
_Medical Repository_, 136
Medico-psychological Association, functions of, 495
Melgund, Lord, 360
Melista, 19
Mesmerism, 472
Metropolitan Commissioners, 173-175, 177, 178 (Report), 187, 209, 220,
(Report of 1841) 450, 515
---- Poor Act, 240, 241, 243
Meuynge after the mone, 11
Mewing of hawks, 54
Mewse, Royal, at Charing Cross, 54
Meyer, Dr., assault upon, 280
Mickle, Dr., 480, 481, 482
Mickley, Dr., 91
Middlesex Asylum, 165, 167
Mierzejewski, 483
Millard, Mr., 306, 319, 320
Millbank, 282
"Miller's Tale," 10
Mitchell, Dr. Arthur, 17, 18, 20, 21, 391, 392
Mitford, John, petition of, 164
Monks and the monastery in insanity, 8
Monro, Dr. Edward, 82
----, Dr. Henry, 470
----, Dr. James, 71, 81
----, Dr. John, 81, 86
----, Dr. Thomas, 68, 79, 82
Montrose Asylum, 343
Moon, 2, 4, 9, 11, 24, 31
Moir, Mr. G., 360
Monaghan Asylum, 423
Moorfields, 67, 68, 69, 86, 507
Moorgate, 67, 69
Moral insanity, 454
More, Sir T., 41, 56, 60
Morel, 444, 448, 467, 497
Motet, M., 284, 444, 446
Mould, Mr., 458, 503
Mount Hope Retreat, 484
Muggleton, Lodowick, 50
Müller, Dr., 284
Mullingar Asylum, 421
Munk, 473
----, Dr., 64, 80, 81, 87
Murray Royal Institution, 329, 341
Musselburgh Asylums, 353
N.
Naudi, Dr., 122, 123
Needham, Dr., 458, 504
Newington, Dr. Hayes, 497
Newton, Mr., his map, 60, 61, 508
----, Dr., 92
Nicoll, Mr. S. W., 129
Nicolson, Dr., 494
Nider, 36
Night goblin visitors (nightmare), 5
Niolin, red, 4
Non-restraint, 139, 177, 182, 204, 205, 213, 216, 220, 221, 223, 226,
228, 240, 342, 360, 416, 448, 494
Norfolk Asylum, 165, 166, 214, 250
Norman Conquest, treatment before the, 1
Normansfield, 307
Norris, case of, 79
Northampton Lunatic Hospital, 210, 213, 244, 504
Northumberland Asylum, 250
Norwich Asylum, 235, 249
Nottingham Asylum, 165, 166, 214, 486
Nugent, Dr., 417, 423
O.
Occurring insanity, 260
O'Curry, Professor, 26
Ogilvie, Sir John, 308, 356
O'Hagan, Lord, 432, 434, 435, 437, 441
Oleum cephalicum, 93
Oliver Cromwell's porter, 71
Omagh Asylum, 421
Open-door system, 376-378
Orange, Dr. William, 273, 276, 494
Osborne, Dr., 407
Overall, Mr., 60, 507
P.
Palmerston house for idiots, 309, 439
Paracelsus, 484
Parchappe, 131, 444, 459, 460, 478, 482
Pargeter, 142, 512
Park House, Highgate, 305, 456
Parole, liberty on, 378
Pathology of insanity, 476
Paul, Sir George, 127
Pauper lunatics in private dwellings, 262, 392
Peerless Pool, 88
Pennant, 17, 88
Penny gates at Bethlem, 71, 73
Peony, its virtue in insanity, 2, 3
Pepys and Bethlem, 65
Percy Reliques, 39, 40
Perfect, Dr., 141
Periwinkle, 3
Perth Asylum, 333
---- Tolbooth, 329
Philanthropist, the, 126
Philip, Dr., his asylum, 216
Philipps, Dr. Rees, 466
Phlebotomy, 95, 484
Piers the Plowman, 10
Pillory, insane treated at, 27, 29
Pinel, 118, 133, 142-46, 186, 268, 467, 482
Pitt. _See_ Lord Chatham
Plastidules, 475
Poole, Dr., 304, 334
Pools, insane placed in, 12
Poor Law Act, 1874, 196
Pope, on Colley Cibber, 70
Possession, demoniacal, 1, 5, 9, 18, 43, 393
Posts, whipping, 41, 57
Poultices, 31
Power, Rev. John, 12
Preston Lodge, institution for imbeciles, 308
Prestwich Asylum, 226, 249
Prichard, Dr., 454
Priest employed in treatment, 2
Principles pursued at the Retreat, 135
Prison Act in Ireland, 399
Private asylums, 99, 193, 194, 199, 201, 211, 212, 223, 264
---- dwellings, 262, 286, 458
---- patients, how distributed, 263
Prochaska, 469
Proctor, Mr. (Barry Cornwall), 450
Progress of Psychological Medicine, 1841-81, 443
Properties, small, 295
Property, protection of, 286
Prospect of the future, 495
Psycho-motor centres, 481
Q.
Quarterly visitation of pauper lunatics, 189
Queen's pleasure men, 274
R.
Radish, a cure for female chatter, 4
Rainhill Asylum, 226
Rake's Progress, 73, 509
Ramskill, Dr., 485
Ray, Dr., 108, 133, 449, 462, 463, 466
Rayner, Dr., 489
Recent changes in mode of administering Scotch asylums, 374
Recoveries in county asylums, private asylums, and lunatic hospitals,
263, 264
Recovery, statistics of, 263, 490
Reed, Rev. Andrew, 305, 456
Reil, 444, 460
Religious services, 369
Renton, Dr., 344
Rest in bed 489, 490
Restraint, abuse of, in Ireland, 420
Retreat. _See_ York Retreat
Retrospect of the Past, 493
"Review of the Early History of the Retreat," 135
Reynolds, Dr., 107
Rice, Mr. T. Spring, 394, 398, 402, 406
Richart, accused, 22
Richmond Lunatic Asylum, Dublin, 400, 401, 406, 409, 417, 421, 438, 496
Ringmer Asylum, 224
Ripping, Dr., 492
Robert Evan, case of, 256
Robertson, Dr. Lockhart, 262, 263, 286, 296, 500
----, Dr. (Ireland), 424
Rome, treatment of a lunatic in, 27
Rose, Right Hon. G., 148, 149, 157, 159, 161, 202, 516
Roubiliac, 70
Rowe, Sir Thomas, 49, 508
Royal Commission (Ireland), 1856, 418
---- Asylums (Scotch), 341
---- Commission (Scotch) 1855, 340;
report of, 342
Rural insanity, 362
Rush, Dr., 445
Rutherford, Dr., 372, 457
Rutherfurd, Lord, 338, 351, 352, 353
Rutter, J., his lines on Bethlem, 69
S.
Sägert, Herr, 304
Saints, Cornish, 13
Salpêtrière, 302
Salt, 5, 21
Salve employed against the elfin race, 5;
and for the "wood-heart," 6
Sandisone, Elspeth, 22
Savage, Dr., 74, 284, 455, 482, 489
Savage of the Aveyron, 301
Saxons, treatment of insane by the, 1
Saxony, Elector of, 319
Scarlet oak, 31
Schools for the insane, 438
Scone, Augustan canon of, 28
Scot, Reginald, 31, 33, 37, 38
Scotch Board of Lunacy, 325, 347, 354
---- Commissioners, Report of, 1858, 360;
1878, 366;
1881, 373
---- system, analyzed, 373
Scotland, 14, 185, 321, 453
Seclusion, 139, 250, 273, 342
Seguin, Dr., 302, 456
----, Dr. E., 456
Select Committee. _See_ Committee
Seymour, Lord R., 160, 165
Shaftesbury, Earl of, 173, 191, 202, 248, 267, 268, 447
Shakespeare, 29, 40, 54, 56, 60, 65, 84
Shaw, Dr. Claye, 461
Sheil, Mr., 203
Sherlock, Dr., 448
Shuttleworth, Dr., 306
Sibbald, Dr., 501
Siegburg Asylum, 460, 492, Appendix C
Silk, toasted, 95
Single patients, 186, 236, 262, 286
Skae, Dr., 371, 467
Skelton, 56
Skull of man executed, 33
Sligo Asylum, 421
Smart, Mr. T. L., 48
Smith, Mr., his notice of Bethlem, 65, 67, 69, 73, 507
----, Dr. C., 24
----, Mr. C. Roach, 50
----, Dr. John, 391
----, Sydney, 83, 123, 147, 151, 152
----, Mr. W., 149
Smollett, 96
Solly, 473
Somerset, Lord R., 175, 176, 177, 187, 202
Southey, Dr., 191, 450
Specifics in insanity, 486
Spencer, Herbert, 474, 475
Spitzka, Dr., 498
St. Agnes, 13
St. Bartholomew's Hospital, 58
St. Botolph, 45, 48
St. Fillan, 2, 14
St. George's Fields, 82, 84
St. Kea, 13
St. Kentigern, 14, 29
St. Levan, 13
St. Luke's Hospital, 86-91, 110, 113, 118, 166, 214, Appendix A
St. Mangose, 28
St. Maree, 17, 19
St. Martin's Lane, 53
St. Mary of Bethlem, 45
St. Molonah, 16
St. Nun, 11
St. Peter's Hospital, 210
St. Ronan, 16
St. Thomas' Asylum (Exeter), 210
St. Vincent de Paul, 301
St. Winifred, 9, 10
Stafford Asylum, 165, 214, 250
Stag's skull, 33
Star of Bethlem, 52
Starcraft (Saxon), 1
Starcross Institution, 306, 320
Stark, Mr., 121
Stearns, Dr., 460
Stewart, Dr. Henry, 309
----, Dr. Robert, 424
Stilliard's map, 61
Stocks, 43, 52
Stokes, Dr. (Baltimore), 484, 486
Stothard, 70
Stow, 53, 55, 88, 508
Strathfillan, 14
Struthill, 16
Submersion, 18, 19, 20, 513
Suffolk Asylum, 165, 214, 503
Sumner, George, 302
Superintendent of asylum, his strange mental environment, 464
----, the good, 460
Superstitions, Scotch, 14, 22
Surrey Asylum (Brookwood), 250, 505
----, (Wandsworth), 249
Swallows, stones from maw of, 5
Swift, Dean, 95
Swift's Asylum, 111, 396
Switzerland and idiots, 304
Symonds, Dr. J. Addington, 471
T.
"Tale of a Tub," 95
Tamburini, Professor, 284
Temple of St. Molonah, 16
Temptations of the fiend, 4
Thornbury's "London," 88
Thurnam, Dr., 492
Timbs' London, 84
Tober-na-galt, 23
Tokens (Bedlam), 48
Tom of Bedlam, 39, 40, 65, 66
Tooke, Horne, 103
Torture in Scotland, 42
Townshend, Mr. T., 98, 99, 101, 202
Treatment of insane, advance in, 484, 490
"Tree of truth," 41
Trélat, 444
Trevelyan, Sir Charles, 312
----, Mr., 103
Tuileries, Bethlem copied the, 70
Tuke, William, 113-116, 130, 131, 133, 134, 135
----, Samuel, 89, 121, 125, 126, 150, 182, 187, 220, 333, 400
----, J. Batty, 391, 478
Turkish bath, 485
Tyndale, 56, 60
Tyson, Dr., 80, 81
U.
University College, London, 443
Unzer, 468
Urban insanity, 362
V.
Vale of St. Fillan, 14
Valley of Lunatics, 22
Ventry, battle of, 24
Virchow, 475, 476
Visitation of Asylums, 188
Vitré, Dr. de, 182, 306
Voisin, 302, 444
----, M. Aug., 480
Voluntary patients, 374
---- restraint, 215
Votive offerings, 16
W.
Wakefield Asylum, 165, 166, 179, 180, 214, 250
Wakley, Mr., 176
Wales, 182, 253
Walpole, Mr., 191
Wandsworth Asylum, 249
Warburton, Dr., 164, 167, 168, 171, 183
Ward, Ned, 73, 75
Warneford Asylum, 210, 214
Warren, Dr., 107
Wastell cake, 53
Waterford Asylum, 399, 417
Weir, Dr., 156
Wells. _See_ Holy
Wemyss, General, 324
Wesley, John, 108, 109
Western, Mr., 149
Westminster play, lines on Bethlem, 70
Westphal, 448, 478, 479, 480
Wexford, cells for lunatics, 411
Whipping insane, 7, 41, 42, 43, 57, 95, 513
Whitbread, Mr., 191
White, Dr., 411
----, Misses, 304
White Hart Tavern, 48
Whitmer, Dr., 284
Whittier, on St. Maree, 19
Wiclif, 299
Wierus, 35, 37
Wilbur, Dr. H. B., 303, 304
Wild Murdoch, 19
Wilkes, Mr., 98, 103, 418
Willes, Mr. Justice, 245
Williams, Mr. (afterwards Dr.), visiting physician to the Retreat, 333
----, Dr. Duckworth, 462, 489
----, Dr. W., 448
----, Dr. W., (Denbigh Asylum), 253
----, Mr. R. L., 257
Willis, Dr., 107
Windmill Hill, 86
---- Inn, 84
Winslow, Dr. Forbes, 446
Witch's bridle, 42
Witchcraft, 26, 31, 32, 34, 43
Witley, 85
"Wodnes" and "Wodman," 6
Wolf's flesh, 4
Wolsey, 56
Wonford Asylum, 466
"Wood," 6, 10
Wooden statues at Bethlem, 72
Woods, Dr. Oscar, 23
Woodward, Dr., 302, 445
Wordsworth, 54
Work, physical importance of, for women, 384
Workhouses, 126, 192, 199, 234, 250
---- (Irish), 430, 441
Wortcunning (Saxon), 1
Wortley, Mr. Stuart, 339
"Wud," 6
Wynn, Mr., 127, 128, 160, 161, 162, 164, 202, 203
Y.
Yellowlees, Dr., 372
York Asylum, 112, 124, 150, 174, 210, 244
---- Retreat, 113-125, 135, 187, 214, 220, 231, 244, 268, 323, 446, 493,
515. _See_ Frontispiece
Young, Mr. G., 360
Z.
Ziemssen's "Cyclopædia," 480
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Except when index entries did not match the body of the text,
irregularities in capitalization and hyphenation have not been
corrected. Alternate spellings (e.g. Ogilvy vs. Ogilvie), possible
errors in quoted passages (e.g. remembraance), and mathematical errors
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p. 211: moved footnote marker in table from before "Workhouses and
elsewhere" to after
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maintenance)
p. 304: Etvy to Etoy
p. 308 and p. 537/538 (Index): Boldovan to Baldovan, and moved index
entry to correct alphabetical order
p. 340: aslyums to asylums (lunatics and lunatic asylums)
p. 356: Kircudbrightshire to Kirkcudbrightshire
p. 394: Clonwell to Clonmel (Clonmel Asylum)
p. 444: pychologists to psychologists (celebrated psychologists)
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p. 533: chapter v to chapter vi (See chapter vi.)
p. 538: 1858, 1859, 191, 259; to 1858, 191; 1859, 259; (Index entry for
"Census of insane")
p. 539: Colebrook to Colebrooke (Index entry)
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p. 546: added C. (Index entry for "Smith, Mr. C. Roach")
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p. 548: moved Index entry for "Willes, Mr. Justice" to correct
alphabetical order (originally between "Willis, Dr." and "Windmill
Hill")
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