This inquiry must be preliminary to any consideration of the provision
made or to be made for the Insane. In carrying it out, we have chiefly to
rely upon the annual Reports of the Commissioners in Lunacy along with, so
far as pauper lunatics are concerned, those of the Poor-Law Board.
However, these reports do not furnish us with complete statistics, and the
total number of our insane population can be only approximately
ascertained. The Lunacy Commission is principally occupied with those
confined in public asylums and hospitals, and in Licensed Houses, and
publishes only occasional imperfect returns of patients detained in
workhouses or singly in private dwellings. On the other hand, the Poor-Law
Board charges itself simply with the enumeration of pauper lunatics
supported out of poor-rates, whether in asylums or workhouses, or living
with friends or elsewhere. Hence the returns of neither of these public
Boards represent the whole case; and hence, too, the chief apparent
discrepancies which occur when those returns are compared.
To show this, we may copy the tables presented in Appendix H of the Report
of the Commissioners in Lunacy for 1857, p. 81.
"Increase of Lunatics of all classes during the last
five years, according to Commissioners' Reports 3932
1852 1857
Paupers 12,982 16,657
Private Patients 4,430 4,687
------ ------
17,412 21,344
"According to returns published by Poor Law Board
during same period 6535
1852 1857
County and Borough Asylums 9,412 13,488
Licensed Houses 2,584 1,908
Workhouses 5,055 6,800
With friends or elsewhere 4,107 5,497
------ ------
21,158 27,693."
This very considerable difference of 2603 patients between the two
estimates is mainly due--as reference to the summary (at p. 53) proves--to
the omission, on the part of the Lunacy Commissioners, of those resident
in workhouses and "with friends, or elsewhere," reckoned in the Table of
the Poor-Law Board. This explanation, however, is only partial, for, after
allowing for it, the two estimates are found to diverge very considerably.
Thus, on adding the numbers in the categories last named, viz. 5055 + 4107
= 9162, in 1852,--and 6800 + 5497 = 12,297, in 1857 to the total given by
the Commissioners in each of those years, viz. to 17,412 and 21,344,
respectively, we obtain a total of 26,574 in 1852, and one of 33,641 in
1857; a variation of 5416 in the former, and of 5948 in the latter year,
from the results given in the Table presented by the Poor-Law Board. Much
of this wide difference is explicable by the Board last mentioned not
having reckoned the private patients, who amounted in 1852 to 4430, and in
1857 to 4687. Still, after all attempts to balance the two accounts, there
is a difference unaccounted for, of 986 in 1852, and of 1261 in 1857.
No clue is given in the official documents to the cause of this
discrepancy, and we are left in doubt which estimate of our lunatic
population is the more correct. The excess occurs in the Commissioners'
Returns; for on adding together, in each year in question, the numbers
reported by the Poor-Law Board, as detained in County and Borough Asylums
and in Licensed Houses, we find that the totals respectively are less
than the whole number of paupers as calculated by the Lunacy
Commissioners, by the precise difference we have made out, viz. 986 in
1852 and 1261 in 1857. Of the two returns before us, we accept that of the
Lunacy Commission, viz. that there were, including those in workhouses,
and with friends or elsewhere, 26,574 reported Lunatics in 1852, and
33,641 in 1857; and account for this larger total by the fact that the
Poor-Law Board Returns apply only to Unions and omit the lunacy statistics
of many single parishes, under local acts, and some rural parishes under
'Gilbert's Act,'--containing in them together above a million and a half
people more than are found in unions. Moreover, the Poor-Law Board returns
do not include County and Borough Patients. Looking to these facts, the
excess of 986 in 1852, and of 1261 in 1857, over and above the totals
quoted from the Summary of the Poor-Law Board, is not surprising; indeed,
taking the average usually allowed of one lunatic in every 700, the number
in one million and a half would be above 2000; that is, more than half as
many again as 1261; a result, which would indicate the Commissioners'
total to be within the truth.
We have just used the term 'reported lunatics,' for, besides those under
certificates and those returned as chargeable to parishes, comprised in
the foregoing numbers, there are very many of whom no public board has
cognizance. Most such are private patients supported by their own means,
disposed singly in the residences of private persons, throughout the
length and breadth of the country, and, with few exceptions, without the
supervision, in reference to their accommodation and treatment, of any
public officer. The Lunacy Commissioners justly deplore this state of
things; lament their inability, under existing Acts, to remedy it, and
confess that not a tithe of such patients is reported to them, according
to the intention of the law (16 & 17 Vict. cap. 96. sect. xvi.). It would
appear that less than 200 such cases are known to them; and it would not
be an extravagant or unwarrantable estimate to calculate their whole
number at about half that of the inmates of Licensed Houses, viz. at 2000.
This number would comprise those found lunatic by Inquisition, not
enumerated in the Commissioners' summary, although under the inspection of
the "Medical Visitors of Lunatics." According to the returns moved for by
Mr. Tite "of the total number of Lunatics in respect of whom Commissions
in Lunacy are now in force," there were, on the 27th July, 1858, 602 such
lunatics, and 295 of them were, according to the Commissioners' tables,
detained in asylums or Licensed Houses, leaving 347 not reckoned upon. In
addition to this class of the insane there is an unascertained small
number of persons of unsound mind in the horde of vagrant paupers, alluded
to occasionally in the Lunacy Commissioners' Reports.
The number of Criminal Lunatics in asylums is noted in the returns, but
that of those in jails is not reckoned. Although this is comparatively
small, owing to the usual custom of transferring prisoners, when insane,
to asylums, yet, at any one period, a proportion sufficient to figure in a
calculation of the whole insane population of the country will always be
found. Nay more, besides such scattered instances in County Prisons, there
is a very appreciable number in the Government Jails and Reformatories, as
appears from the returns presented to Parliament (Reports of the Directors
of Convict Prisons, 1858.)
The prisons included in these reports are:--Pentonville, Millbank,
Portland, Portsmouth, Dartmoor, Parkhurst, Chatham, Brixton, Fulham
Refuge, and Lewes. In the course of 1857, 216 persons of unsound mind were
confined, some for a longer or shorter period, others for the whole of the
year, in one or other of those prisons. Making allowance for those of the
216 who by removal from one prison to another (a transfer apparently of
common occurrence, the rationale of which we should find it difficult to
explain), might be reckoned twice, it may be safely stated that at least
150 were in the prison-infirmaries in question the whole year. In fact,
the Infirmary of Dartmoor Prison has wards specially appropriated to
insane patients, and actually constitutes a criminal asylum of no
insignificant magnitude. For instance, the report tells us that on the 1st
of January, 1857, there remained in that prison 102 cases; that 41 were
received during the year; 37 discharged (where, or how, we are not told,
except of 3, who were sent to Bethlem Hospital); and 106 remained on the
1st of January 1858.
It is also worth noting that in this Dartmoor Prison Infirmary, 38
epileptics remained on January 1st, 1857; 22 were admitted, 13 discharged,
and 47 remained on January 1st, 1858. The total of epileptics coming under
notice in the infirmaries of the several prisons in question, in the
course of 1857, amounted to 135. The remarks on some of these cases of
epilepsy by the medical officers, are sufficient to show that the
convulsive malady has seriously affected the mental health, and that they
might rightly be placed in the category of the insane.
However, having no wish to enhance the proportion of the subjects for
Lunatic Asylums, we will deal only with those enumerated as mentally
disordered. These amounted, according to the preceding calculations, in
the Government Prisons, to 150, and it would seem no exaggerated estimate
to assert that an equal number may be found in the various other prisons
and reformatories throughout the country. To put the matter in another
form, 300 lunatics are to be found in English prisons at any date that a
census may be taken. Consequently this sum of 300 must be added in
calculating the total of insane persons in this kingdom.
To establish still further the proposition with which we set out, that our
public statistics of Insanity are incomplete, the history of every County
Asylum might be adduced: for, notwithstanding very considerable pains have
been taken, on the proposition to build a new asylum, to ascertain the
probable number of claimants, and a wide margin over and above that
estimate has been allowed in fixing on the extent of accommodation
provided, yet no sooner has the institution got into operation, than its
doors have been besieged by unheard-of applicants for admission, and
within one-half or one-third of the estimated time, its wards have been
filled and an extension rendered imperative. Such is a _résumé_ of the
general history of English County Asylums, attested in the strongest
manner by that of the Middlesex, the Lancashire, and the Montgomery
Asylums; and confirmatory of the fact of the augmentation of insanity in
the country at a rate exceeding, more or less, that collected from county
returns and public statistics. It is, moreover, to be observed, that the
official statistics represent the total of lunatics existing on one
particular day, usually the first of January, in each year, and take no
account of those many who are admitted and discharged within the year, and
who rightly should be reckoned in an estimate of the total number of the
insane belonging to that period.
The average daily number resident in asylums would be a more correct
representation of their insane population than the total taken on any one
day, although it would fail to show the lunacy of the year.
Lastly, to illustrate the point discussed, to indicate how imperfect our
present estimate of the prevalence of insanity most probably is, and to
show the difficulties and defects of any ordinary census, we may appeal to
the experience of the special commission charged by the legislature of
Massachusetts to examine the statistics of Lunacy and the condition of
Asylums in that State, as recorded in their report, published in 1855.
"In 1848" (they write, p. 18), "a committee of the Legislature, appointed
to 'consider the whole subject connected with insanity within the
commonwealth,' ascertained and reported the number of insane in this State
to be 1512, of whom 291 were able to furnish the means of their own
support, and 1156 were unable to do so, and the pecuniary condition of 65
was not ascertained.
"In making that survey in 1848, the Commissioners addressed their letters
of inquiry 'to the municipal authorities of every city and town in the
commonwealth.'
"These public officers had direct means of knowing the number and
condition of the pauper insane, and probably this part of the report was
complete; but they had no other facilities of knowing the condition of
those lunatics who were in private families, and supported by their own
property or by their friends, than other men not in office, and could only
speak of those who were within their circle of personal acquaintance.
Consequently the report included only a part of the independent insane who
were then actually in, or belonged to, the State."
"In 1850 (p. 11), the marshals, the agents of the national government who
were appointed to take the census, visited every family; and, among other
items of information, they asked for the insane and idiots in the
household.
"By this personal and official inquiry, made of some responsible member of
every family, the marshals obtained the account of only 1680 insane
persons and 791 idiots, which is but little more than two-thirds of the
number ascertained by this Commission.
"Making all due allowance for the increase of population, and consequently
of the insane and idiots, these figures undoubtedly show far less than the
real amount of lunacy and idiotcy at that time, and render it extremely
probable that many concealed the facts that the law required them to state
to the marshals."
Thus the marshals discovered the number of insane to be in 1850 nearly
double that returned in 1848, and from their apparently searching inquiry,
it might have been presumed that they had made a near approximation to the
truth in the figures they published. However, the most pains-taking and
varied investigations of the Special Commissioners in 1854, prove the
marshals to have much underrated the number, for the result arrived at
was, that in the autumn of the year just named, there were 3719 lunatics,
of whom 1087 were idiots, in the State of Massachusetts.
The partial explanation of the divergence in numbers, viz.:--"that it is
probable that many of the families refused or neglected to report to the
marshals the insane and idiots who were in their households,"--is of
itself an indication of one of the impediments to a correct enumeration of
the insane members of a community, even when such is attempted under
favourable circumstances. It is one likewise which, however operative in
the United States, where the public asylums are open to, and resorted to
by, all classes of the community, must be still more so in this country,
where family pride endeavours in every way to ignore and keep secret the
mental affliction of a member, as though it were a plague spot. Besides
this, in no English census yet taken, has the enumeration of the insane
constituted a special subject of inquiry.
This illustration from American experience, coupled with the
considerations previously advanced, suffice to demonstrate that the
published statistics of insanity in England and Wales are incomplete and
erroneous, and that the machinery hitherto employed for collecting them
has been imperfect. The corollary to this conclusion is, that the number
of lunatics mentioned in the public official papers is much below the real
one. However, the facts and figures in hand justify the attempt to fix a
number which may be taken to represent _approximatively_ the total insane
population of this kingdom.
In their last Report (1858), the English Commissioners in Lunacy state
that, on January 1st, 1858, there were confined in asylums, hospitals, and
Licensed Houses, 17,572 pauper, and 4738 private patients, exhibiting an
increase of 915 pauper and of 51 private cases upon the returns of the
year preceding.
Pauper lunatics in workhouses are stated (10th Annual Report of the Poor
Law Board, 1858) to have numbered 6947, and those receiving out-door
relief 12,756; making a total of 20,703. By the kindness of Mr. Purdy, the
head of the Statistical Department of the Poor-Law Office, we are enabled
to explain that it is the custom of the office to reckon pauper lunatics
in Asylums and Licensed Houses among those receiving out-door relief;
consequently the sum of 12,756 comprises both those patients provided for
as just specified, and others boarded with their friends or elsewhere. We,
however, learn further, from the same excellent authority, that, owing to
the imperfection of the periodical returns, only a comparatively small
portion of the pauper insane confined in Asylums and Licensed Houses is
included in that total. Indeed, the fact of its being very much smaller
than that of the lunatics in Asylums and Licensed Houses, clearly enough
shows that the latter are not reckoned in it except partially.
Considering that the Poor Law Board obtain no record of the pauper
insanity in one million and a half of the population of England and Wales,
nor of the number of insane belonging to counties and boroughs,--for this
reason, that their cost of maintenance is not directly defrayed out of the
poor-rates, there must necessarily be a much greater number in workhouses
at large than the 6947 mentioned, and no inconsiderable proportion of poor
lunatics dispersed abroad in the country not enumerated in the 5500
counted as existing in January 1st, 1857. On these grounds, we assume 8000
as an approximative figure to represent the total of insane poor not under
confinement in Asylums and Workhouses, believing fully that it will be
found, on the publication of the returns for this year (1859), within the
mark.
Private patients not in Asylums, or Licensed Houses, often confined
without certificates, and the majority unknown to the Lunacy
Commissioners, we have put down, at a moderate estimate, at 2000. The
present state of the law does not enable the Commissioners or others to
discover these, often, we fear, neglected patients: and, on the other
hand, the operation of the laws regulating asylums, and the feeling evoked
by certain public trials of individuals confined in Licensed Houses, have,
together, combined to render them more numerous, by inducing friends to
keep them at home, to send them abroad to Continental institutions, or to
place them under the care of private persons or attendants in lodgings.
This completes our enumeration; and the figures stand thus, on the 1st of
January, 1858:--
_Pauper._ _Private._ _Total._
In Asylums and Licensed Houses 17,572 4,738 22,310
In Workhouses 6,947 ... 6,947
With Friends, or elsewhere 8,000 2,000 10,000
In Prisons, Vagrants, &c. 300 ... 300
------- ------- -------
32,819 6,738 39,557
To extend the estimate to the commencement of the present year (1859), we
require to add the gross increase of lunatics during 1858 to the total
just arrived at: 39,557. What this increase may be cannot be decisively
stated; but to anticipate the estimate of it, which we shall presently
arrive at, viz. 1600 per annum, the result is, that _on the 1st of
January_ 1859 there were in England and Wales, in round numbers, 41,000
persons of unsound mind, or, to employ the legal phraseology, lunatics and
idiots.
It perhaps should be explained, and more particularly with reference to
those detained in workhouses or supported by their parishes at their own
houses, that besides idiots, or those congenitally deficient, a very large
proportion of them is composed of weak and imbecile folk, who would, in
olden times, have been considered and called "fools," and not lunatics,
and been let mix with their fellow-men, serve as their sport or their
dupes, and exhibit their hatred and revenge by malicious mischief and
fiendish cruelty. But, thanks to modern civilization and benevolence,
these poor creatures are rightly looked upon as proper objects for the
supervision, tending and kindness of those whom Providence has favoured
with a higher degree of intelligence. This act of philanthropy, effected
at a great cost, elevates at the same time, very materially, the ratio of
insane persons to the population, and thereby gives cause of alarm at the
prevalence of mental disorder, and makes our sanitary statistics contrast
unfavourably with those of foreign lands, where the same class of the sick
poor has not been so diligently sought out and brought together with a
view to their moral and material well-being.