ON THE STATE OF LUNACY AND THE
LEGAL PROVISION FOR THE INSANE,
WITH OBSERVATIONS ON THE
CONSTRUCTION AND ORGANIZATION
OF ASYLUMS.
BY JOHN T. ARLIDGE, M.B., A.B. (LOND.),
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS;
ASSOCIATE OF KING'S COLLEGE, LONDON; PHYSICIAN
TO THE WEST OF LONDON HOSPITAL; FORMERLY
MEDICAL SUPERINTENDENT OF ST. LUKE'S HOSPITAL,
AND PHYSICIAN TO THE SURREY DISPENSARY, ETC.
LONDON:
JOHN CHURCHILL, NEW BURLINGTON STREET.
1859.
PRINTED BY TAYLOR AND FRANCIS,
RED LION COURT, FLEET STREET.
TO THE RIGHT HONOURABLE
THE EARL OF SHAFTESBURY,
CHAIRMAN OF THE COMMISSION OF LUNACY,
WHOSE LONG-CONTINUED AND UNTIRING EFFORTS
IN BEHALF OF THE INSANE HAVE EARNED FOR
HIM THE HIGHEST ESTEEM AND ADMIRATION OF
ALL WHO FEEL INTERESTED IN THE WELFARE OF
THAT CLASS OF THE AFFLICTED,
THIS TREATISE IS, BY PERMISSION,
RESPECTFULLY DEDICATED BY HIS LORDSHIP'S
MOST OBEDIENT HUMBLE SERVANT,
THE AUTHOR.
PREFACE.
The writer of a book is usually expected to show cause for its
production,--a custom which, however commendable as a sort of homage to
his readers for challenging their attention to his lucubrations, must
often put the ingenuity of an author to the test. Indeed the writer of
this present treatise would feel some embarrassment in accounting for its
production, did he not entertain the conviction that he has, in however
imperfect a manner, supplied a work on several important subjects which
have never before been so placed before the public, and which, moreover,
occupy just now a most prominent position among the topics of the day.
In the last Parliament, up to the period of its dissolution, a Special
Committee of the House of Commons was engaged in examining into the
condition of lunatics and the laws of lunacy; and the present Government
has re-appointed the Committee, in order to resume the inquiry preparatory
to the introduction of new enactments into the Legislature. The subjects
treated of in the following pages relate to the same matters which have
engaged the attention of Parliament, and elicited the special inquiry
mentioned, viz. the present state of Lunacy and of the legal provision for
the Insane with reference to their future wants.
In order to a better appreciation of the existing provision for the
insane, and of its defects, the author has introduced certain preliminary
chapters on the number of the insane, on the increase of insanity, on the
inadequacy of the existing public provision for the insane, and on the
curability of insanity. In reviewing the character and extent of the
provisions for the insane, the course adopted has been to regard them in
reference to their effects on recovery, and to discover the conditions
inimical to it, whether without or within asylums. Hence the evils of
private treatment and of workhouse detention of lunatics, particularly of
the latter, have largely claimed attention. The condition of pauper
lunatics boarded with their friends or with strangers demanded special
notice, as did the long-complained-of evils of sending unfit cases to the
county asylums, often to the exclusion of recent and curable ones, which
might by proper treatment be restored to health and society. Turning to
the consideration of our public asylums, considered as curative
institutions, the disposition to extend them to an unmanageable size, and
to substitute routine for treatment, has called for animadversion, as an
error pregnant with numerous evils to their afflicted inmates. Another
error pointed out is that of appointing too small a medical staff to
asylums; and in proving this, as well as in estimating the proper size of
asylums, the experience and opinions of both English and foreign
physicians are copiously referred to.
The future provision for the insane forms an important chapter, which, in
order to consider the several schemes proposed, is divided into several
sections, viz. concerning the propriety of building separate asylums for
recent and for chronic cases--of constructing distinct sections--of
distributing certain patients in cottage homes--of erecting separate
institutions for epileptics and for idiots.
The registration of lunatics has appeared to the author's mind of so great
necessity and value that he has devoted several pages to unfold his views
and to meet probable objections; and, in order to render the plan
effectual, he has propounded as a complementary scheme the appointment of
District Medical Officers, and entered into detail respecting the duties
to be imposed upon them.
Viewing the Commission of Lunacy as the pivot upon which any system of
supervising and protecting all classes of lunatics must turn, it became
necessary to examine into the capability of the present Board for its
duties; and the result of that examination is, that this Board is
inadequate to the effectual performance of the duties at present allotted
to it, and that it would be rendered still more so by the adoption of any
scheme for a thoroughly complete inspection and guardianship of all
lunatics. This conclusion suggests the proposition to enlarge the
Commission, chiefly or wholly, by the appointment of Assistant
Commissioners, charged particularly with the duties of Inspectors.
The concluding chapter, on asylum construction, may be considered
supplementary. Its chief intent is to develope a principle generally
ignored, although (unless the arguments in support of it fail) one of
great importance if asylums are to serve, not as simple refuges for
lunatics, but as instruments for treating them.
This _résumé_ of the heads of subjects discussed in the ensuing pages
will, on the one hand, show that the present is not to be reckoned as a
medical treatise, but as one addressed to all who are interested either in
the legislation for Lunatics or in their well-being and treatment; and, on
the other, make good, it is trusted, the assertion that it occupies an
untrodden field in the literature of insanity, and that its matter is
good, even should its manner be thought not so.
Assuming the publication of the book to be justifiable, it only remains
for the author to add that he has not undertaken its composition without
bringing to the task thirteen years' study and practical experience among
the insane, treated in private houses, in licensed houses, and in public
asylums, together with the fruits of observation gathered from the
visitation of most of the principal asylums of France, Germany, and Italy.
In conclusion, he hopes that this small volume may in some measure
contribute towards the amelioration of the condition of the insane, who
have such especial claims on public sympathy and aid.