Footnotes:

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 Ashleyreturned 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 hisinsanity 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 thiscountry 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:

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 passedin 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 itevery 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 insanitygreater. 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 whichJohn 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:—

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 everycounty, 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 allcases, 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 aprimâ facieright 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. forpublic asylums, the 16 and 17 Vict., c. 97, and 18 and 19 Vict., 105, and forprivate 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 whichgoverns 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 Committeecontained 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 ofmala fidesor 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 fearfulconsequences 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. Onshowing 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 extendthis 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 tendays. 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 renderedstricter 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 bythose 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:[Skip][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: "HeyBroadway 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. HayBroadway."[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]SeeAppendix 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, seechapter 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 (seeAppendix E.)[172]For more particular provisions in these Acts and that of 1855 (18 and 19 Vict., c. 105), containing some further amendments, seeAppendix F.[173]SeeAppendix 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 theContemporary 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.

[Skip]

[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.

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: "HeyBroadway 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. HayBroadway."

[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]SeeAppendix 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, seechapter 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 (seeAppendix E.)

[172]For more particular provisions in these Acts and that of 1855 (18 and 19 Vict., c. 105), containing some further amendments, seeAppendix F.

[173]SeeAppendix 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 theContemporary 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.

Beforepresenting 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.

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 firstto assert the principleof 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, areaction 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 ofhandcuffs, 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.

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.—

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—

The total number of recognized lunatics on the 1st of January, 1844, were—

They were thus distributed:—

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 thefollowing 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 wererestrained 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, believingthat, 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 anda 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 conditionof 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:—

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