The only data at hand to calculate the gross increase of the insane in
this country, year by year, or over a series of years, are those contained
in the Official Reports of the Commissioners in Lunacy and of the Poor-Law
Board. These, as we have just shown in the preceding chapter, are
incomplete as records of the state of lunacy, since they take no notice of
numerous patients not in recognized asylums. Moreover, the annual summary
of the returns made by the Commissioners of insane patients confined in
Asylums and Licensed Houses, represents a compound quantity, made up of
the increment by accumulation in past years, and of the fresh cases
admitted in any particular year, and remaining at its close. The same is
true of the figures supplied by the Poor-Law Board. Now, though these
summaries are useful to show the rate of accumulation of the insane in the
various receptacles for them, annually or over any fixed period, they do
not tell us how many persons are attacked by madness in any year, or other
space of time; or, in other words, they do not inform us whether there is
an actual increase, or a decrease in the annual number of persons becoming
insane.
This question of the simple increase or decrease of insanity cannot be
correctly answered. It is elucidated in some measure, so far as licensed
institutions for the insane are concerned, by the tables of admission for
different years furnished by the Reports of the Lunacy Commissioners; and
it may be assumed to be partially answered by the returns of the number of
lunatics in workhouses published by the Poor-Law Board, after an allowance
made for the diminution caused by deaths which have taken place in the
twelvemonth; but no means whatever exist of discovering the number of
persons annually attacked with mental disorder, who do not fall under the
cognizance of the public boards.
With the materials in hand, let us in the first place examine the results
which follow from a comparison of the Lunacy statistics of the
Commissioners, instituted at intervals of more or fewer years. By this
course we shall attain, not indeed an estimate of the progressive increase
of our insane population, but a valuable comparative return of the number
of those enjoying the advantages of asylum care and management in
different years. The summary presented in each annual report shows that
there were in
_Males._ _Females._ _Total._
1843--Private patients 1,989 1,801 = 3,790 }
Pauper patients 3,532 3,950 = 7,482 } = 11,272
1853--Private patients 2,331 2,099 = 4,430 }
Pauper patients 5,916 7,066 = 12,982 } = 17,412
1858--Private patients 2,508 2,230 = 4,738 }
Pauper patients 7,985 9,587 = 17,572 } = 22,310
From these tables it therefore appears that the accumulation of insane
persons in Asylums in the ten years between 1843 and 1853, equalled 6140;
and in the five years between 1853 and 1858, 4898; or progressed at the
rate of 614 per annum in the ten years, and of 979·6 (or in round numbers
980) per annum in the five years under review, or upwards of 50 per cent.
faster in the latter space of time.
In their Twelfth Report (1858) the Commissioners in Lunacy attempt to
calculate the probable demands for asylum accommodation on the 1st of
January 1860, from the increased number of lunatics in the space of one
year, from January 1st, 1857, to January 1st, 1858, amounting to 915. But
as we have pointed out in a paper in the "Journal of Mental Science" (vol.
v. 1859, p. 249), the conclusion drawn from such data must be fallacious.
For instance, a calculation on the result of one year's statistics is
evidently worth little. There are many causes at work in asylums which
materially affect the relative number of admissions and discharges, and
consequently produce an inequality in the rate of increase viewed year by
year. Moreover, where the same plan of calculation has been adopted in
determining what asylum accommodation was necessary, experience has soon
exhibited the fallacy, and both the admissions and the demands for
admission have far exceeded the total reckoned upon. To arrive at a nearer
approximation to the truth, the augmentation in the number of lunatics
ought to be noted for a space of several years; and to make the deduction
more satisfactory, the increase of the general population, the conditions
of the period affecting the material prosperity of the people, and its
political aspects; and, lastly, the mere circumstance of the opening of
new asylums,--a circumstance always followed by an unexpected influx of
patients, need be taken into account.
In the preceding considerations only the returns of lunatics in Asylums,
Hospitals, and Licensed Houses are discussed; but, as we have seen, there
is an almost equally large number detained in workhouses, or boarded with
their relatives, or other persons, at the expense of their parishes, whose
increase or decrease is a matter of kindred importance. On reviewing the
returns of their numbers at periods when they have been taken cognizance
of by the Lunacy Commission, we find that there were in workhouses and
elsewhere, together, in
1843 9,339
_In Workhouses._ _With Friends
and elsewhere._
1847 4,490 3,465 = 7,955
1857 6,800 5,497 = 12,297
exhibiting an increase of 4342 in the ten years between 1847 and 1857, and
a decrease in the four between 1843 and 1847 of 1384, owing, doubtless, to
the opening of new asylums during that space of time. The returns of the
two classes of Pauper Lunatics together being both so infrequently made,
and, as before shown (p. 8), open to criticism on account of their
incompleteness, we shall attempt to arrive at a more correct estimate of
increase than that just made. In the first place, with respect to Union
Workhouses, the Summary of Indoor Paupers, published by the Poor Law
Commission (10th Report, p. 196), affords the necessary data. According to
this tabular statement, we find, that, there were on the 1st of January in
each of the ensuing years the following numbers of pauper lunatics:--
1847 4,490
1849 4,842
1850 4,659
1851 5,029
1852 4,744
1853 4,954
1854 5,459
1855 5,960
1856 6,480
1857 6,488
1858 6,947
These columns show, that since 1847 the minimum number of insane, at a
corresponding date in each year, occurred in 1850. Once indeed since, but
at a different period of the year, viz. on July 1st, 1851, the number fell
to 4574, or 75 less than at the date before named. Two or three years
excepted, the increment has been progressive; at one time, indeed, much
more rapidly so than at another. The fluctuations observable are, in the
first place, due to the opening of new, or the repletion of existing,
asylum accommodation; and in a lesser degree, to the rise or fall of
pauperism in the community at large, or to an increased mortality at
times, as, for example, in 1849, when cholera prevailed--an event which in
part, at least, explains the smaller figure of insane inmates in 1850.
But whatever the fluctuations observable year by year may be, there is a
most distinct increase in the space of any five or ten years selected
from the list, suggestive of the unwelcome fact that, notwithstanding the
very large augmentation of asylum accommodation and the reduction of
numbers by death, the rate of accumulation has proceeded in a ratio
exceeding both those causes of decrease of workhouse inmates combined.
Thus, to take the decennial period between 1847 and 1857, we discover an
increase of just 2000, or an average annual one of 200; and, what is
remarkable, as large a total increase, within a few units, is met with in
the quinquennial period between 1853 and 1858, and consequently the yearly
average on the decennial period is doubled; viz. 400 instead of 200. This
doubling of the average in the last five years would be a more serious
fact, were it not that in 1853 the number of workhouse inmates had been
reduced upon 1851, and had only slightly advanced above that of 1849.
Rejecting the maximum rate of accumulation, we will calculate the average
of the last three years cited, from 1855 to 1858, a period during which
there has been no notable cause of fluctuation, and no such increase of
population as materially to affect the result, and for these reasons
better suited to the purpose. In this space of time the increment equalled
987, or an average of 329 per annum; which may fairly be considered to
represent the rate of accumulation of lunatics in Union Workhouses at the
present time.
The absence of returns of lunatics in the workhouses of parishes under
local Acts, is an obstacle to a precise computation of them; however, on
the assumption that the proportion of lunatics in those workhouses to the
population (1,500,000) of the parishes they belong to, is equal to that of
those in Union Workhouses to the estimated population (18,075,000) of the
Unions, and that the average increase is proportionate in the two cases,
this increase should equal 1/12th of 329, or somewhat more than 27, per
annum; making the total average rate of accumulation in workhouses at
large 356 annually.
Unfortunately, no separate record is regularly kept of those poor insane
persons who are boarded with friends or others, and their number has been
only twice published, viz. in 1847 and 1857, when, as seen in a preceding
page, it was, respectively, 3465 and 5497. These two sums exhibit an
increase of 2032 to have accrued in the ten years included between those
dates, or an average one of 203 per annum.
We have, above, calculated the average annual increase on those in Union
Workhouses and those with friends, at 434 annually; and consequently that
of the latter being 203, the yearly increase of the former stands,
according to the returns employed, at 231. However, we have proved that
the average increase, in Union Workhouses, has reached in the last three
years the amount of 329, and in workhouses at large 356, which, added to
203, produces 559, or in round numbers, 560, as the sum-total of
accumulation of pauper lunatics not in Asylums, Hospitals, or Licensed
Houses. Adding the annual rate of increase of the insane in Asylums, viz.
980, to that among paupers, unprovided with asylum accommodation, 560, we
obtain the total accumulation per annum of 1540 lunatics reported to the
public boards. To this sum there should rightly be added the accumulative
increase among insane persons not known to those boards, and which, in the
absence of any means to ascertain its amount, may be not extravagantly
conceived to raise the total to 1600.
We come now to the second part of our present task, viz. to discover the
comparative number of new cases in several past years, so as to obtain an
answer to the question,--Has there been an increase of the annual number
of persons attacked with lunacy during that period? for previous figures
leave no doubt there is an augmented ratio of insane persons in the
population of the country. At the outset of this inquiry an insuperable
difficulty to a correct registration of the number arises from the
circumstance that, during any term of years we may select, the
accommodation for the insane has never, even for one year, been fixed, but
has been progressively increased by the erection of new, and the
enlargement of old asylums. This occurrence, necessarily, very materially
affects the returns made by the Commissioners of the number of admissions
into asylums and Licensed Houses. Even if the comparison of the annual
admissions into any one County Asylum only, were of value to our purpose,
the same difficulty would ensue by reason of the enlargement of the
institution from time to time, and of the circumstance that, as it
progressively filled with chronic cases, the number of admissions will
have grown smaller. Likewise, the farther that the inquiry is extended
back, the more considerable will this difficulty in the desired
computation be. In short, it may be stated generally, that the proportion
of admissions will vary almost directly according to the accommodation
afforded by asylums, and the inducements offered to obtain it.
On the other hand, the consequences of the variations in asylum
accommodation upon the total of admissions are to a certain extent
compensated for by the fluctuations they produce upon the number of
lunatics not provided for in asylums; for this reason, that where a County
Asylum opens for the reception of patients, the majority of these are
withdrawn from Licensed Houses and workhouses, and thereby a reduction is
effected in the number of inmates of those establishments.
After the above considerations, it is clear that an estimate of the
number of insane persons in any year, as gathered from the statistics of
those brought under treatment in asylums or elsewhere, can be only an
approach to the truth. Still it is worth while to see what results follow
from an examination of the Returns of Admissions, as collected by the
Commissioners in Lunacy. It would be of no service to extend the inquiry
far backward in time, on account of the rapidity with which asylum
accommodation has been enlarged; we will therefore compare the admissions
over the space of four years, viz. 1854, 1855, 1856, and 1857, during
which the changes in asylums have been less considerable.
_Table of Admissions._
1854--County and Borough Asylums 4,620
Hospitals 868
Licensed Houses 2,161
-----
Total 7,649
-----
1855--County and Borough Asylums 4,342
Hospitals 828
Licensed Houses 2,196
-----
Total 7,366
-----
1856--County and Borough Asylums 4,538
Hospitals 777
Licensed Houses 2,091
-----
Total 7,406
-----
1857--County and Borough Asylums 4,781
Hospitals 790
Licensed Houses 2,324
-----
Total 7,895
-----
There is a remarkable degree of uniformity in the sum of admissions in
each of these four years; and if each several sum could be taken to
represent the accession of new cases of insanity in the course of the
year, there would appear no actual progressive increase of the disease in
the community during the four years considered. The average of the
admissions for that period is 7579; those therefore of 1854 and 1857 are
in excess, and those of 1855 and 1856 are within it. The widest
difference is observed in 1857, when a sudden rise takes place, which, by
the way, is not explicable by the greater provision of asylum
accommodation in that year than in the three preceding. Yet this increase
is not so striking when viewed in relation to the totals of other years;
for it exceeds the average only by 316, a sum little greater than that
expressing the decrease of 1855 upon the total of 1854.
It is difficult to decide what value should be assigned to these results,
deducible from a comparison of the yearly admissions, in determining the
question of the increase of insanity, viewed simply as that of the
comparative number attacked year by year,--it would, however, seem a not
unreasonable deduction from them, that the proportion of persons attacked
by mental disorder advances annually at a rate little above what the
progressive increase of population is sufficient to explain. If this be
so, the increase by accumulation of chronic and incurable cases becomes so
much the more remarkable, and an investigation of the circumstances
promoting, and of those tending to lessen, that accumulation, so much the
more important.
There are, as heretofore remarked, very many insane persons who are not
sent to asylums or private houses, at least to those in this country, and
whose relative number yearly it is impossible, in the absence of all
specific information, to compute. Although the agitation of the public
mind respecting private asylums, and the facility and economy of removing
insane persons abroad, may have latterly multiplied the number of such
unregistered patients, yet there is no reason to assume that their yearly
positive increase is other than very small.
The pauper lunatics living in workhouses have as yet been omitted from the
present inquiry. Their yearly number is affected not only by the
introduction of fresh cases, but also by removals to asylums and by
deaths; or, in other words, it is a compound quantity of new inmates
received and of the accumulation of old. However, the returns above quoted
(p. 13) show that between 1855 and 1858 there was an increase of almost
exactly 1000, or, as before calculated, an average of 329 annually. The
Poor Law Board Report unfortunately gives no returns of the annual
admissions; hence we do not possess the means of discovering what
proportion of the growing increase observed is due year by year to the
accession of fresh inmates. The advancing growth in numbers of those
pauper insane receiving out-door relief is not clearly discoverable: from
the few data in possession, as before quoted (p. 14), about 200 are
annually added.
It appears pretty clearly, then, that there are at least 1600 reported
lunatics added to the insane population of the country yearly, and of
this increase only 60, or 1 in 26·66, are supported out of their own
resources in asylums; the remainder, with some few exceptions, falling
upon the rates for their entire maintenance.
It would therefore be difficult to exaggerate the importance of the
question of the provision for the insane poor in this country, both to the
political economist and to the legislator. There are certainly more than
1300 persons yearly so affected in mind as to be unfit or unable to take
care of themselves, and to obtain their own livelihood, and who, under
this distressing infliction of Providence, demand the care and charity of
their neighbours, and the succour of the State, properly to protect and
provide for them. To perform this duty at the least cost, compatible with
justice to these afflicted individuals, involves a tax upon the community
of which few persons have any adequate conception. Supposing, by way of
illustration, that the number mentioned required the accommodation of an
asylum, the cost of providing it, according to the system hitherto in
vogue, would nearly equal that incurred in the establishment and
maintenance of the Middlesex County Asylum at Colney Hatch, or a sum of
£300,000 for land, buildings, and fittings (equal, at 5 per cent. to a
yearly rental of £15,000), and an annual charge of £30,000 for
maintenance. The example of Colney Hatch, chosen for illustration, is a
very fair one, and the figures used in round numbers are actually within
the average expenditure in and for the establishment of County Asylums in
this country, as may be seen on reference to Appendix D. (Commissioners'
Report, 1854), and to the table of asylums in course of erection, printed
at p. 2 of their Twelfth Report (1858).
On applying these results to the total number of pauper lunatics in
Asylums, which, according to the return on the 1st of January 1858,
amounted to 15,000, the sum of £4,500,000 (not including interest) will
have been expended in providing them accommodation, and an annual charge
incurred of £450,000 for their care and maintenance. All this, too, is
independent of the cost on account of those maintained in Licensed Houses,
in workhouses, and in lodgings with friends or others, the amount of which
we do not possess sufficient information to determine.
The Commissioners in Lunacy, in their elaborate Report in 1844, took the
population of England and Wales at 16,480,082, and reckoned on the
existence of 20,893 lunatics on the 1st January of that year, of whom
16,542 were paupers. The latter, they calculated, stood in the proportion
of 1 to 1000 in the population, or, more correctly, 1 in 997; and the
total lunatics as 1 to 790. On the 1st of January 1857, they found the
pauper lunatics to be in the proportion of 1 in 701; whilst pauper and
private together equalled 1 in 600, to the estimated population,
19,408,364. Adopting the figures arrived at in the preceding discussion,
viz. that there are 41,000 insane persons in this country, and assuming
the population on the 1st of January, 1859, to have been 19,800,000, the
proportion of the insane would be as high as 1 in 483 persons.
This much-enlarged ratio of insanity to the population admits of several
explanations, without a resort to the belief that the disease is actually
and fearfully on the increase. As before said, we regard the accumulation
of chronic and incurable lunatics to be the chief element in raising the
total number, and this accumulation is favoured by all causes operating
against the cure of insanity; by the increased attention to the disease,
and by all those conditions improving the value of life of the insane,
supplied, at the present day, in accordance with the improved views
respecting their wants, and the necessity of placing them under conditions
favourable for their health, care and protection. On the operation of
these causes, favouring the multiplication of insane persons in the
community, we shall, however, not at present further enter, but proceed to
inquire how far the existing provision for the insane is adequate to their
requirements.
Before entering on this inquiry, a few words are wanting to convey a
suggestion or two respecting the collection of the statistics of pauper
lunatics. It is most desirable we should be able to discover, from the
official returns of the public boards, with precision, what number of
insane persons is wholly or partially chargeable to the Poor Rates, what
to Borough, and what to County Rates. The returns of the Poor-Law Office
ought not to be marred by the omission of the statistics of parishes,
which by local or special acts escape the direct jurisdiction of the
board. If the central board be denied a direct interference in their
parochial administration, it ought to be informed of the number of their
chargeable poor, including lunatics. It is equally unsatisfactory, that
the pauper registry kept by the Poor-Law Board is not rendered complete by
the record of all those chargeable to counties and boroughs, as this could
be so readily done by the clerks of county and borough magistrates.
An amendment, too, is desirable in the practice of the Poor-Law Office of
reckoning together in their tables pauper lunatics in asylums among the
recipients of out-door relief with those boarded with their friends or
elsewhere, whence it is impossible to gather the proportion of such class.
This technicality of considering workhouse inmates as the only recipients
of _in-door_ relief, to the exclusion of asylum patients who are in
reality receiving it in an equal degree, although in another building than
the workhouse, is an official peculiarity we can neither explain nor
approve; and it appears to us most desirable that lunatic paupers in
asylums should be arranged in a distinct column, and that the same should
be done with those living with their friends or others. By the adoption of
this plan the questions of the number of the pauper insane, of their
increase and decrease, whether in asylums or elsewhere, and of the
adequacy of accommodation for them, could be ascertained by a glance at
the tables. We would likewise desire to see those paupers belonging to
parishes not in union and under Local Acts, and those chargeable to
Counties and Boroughs, tabulated in a similar manner.
A practical suggestion, connected with the statistics of insanity, we owe
to Mr. Purdy, viz. that section 64 of the "Lunatic Asylums' Act, 1853" (16
& 17 Vict. cap. 97) should be amended by the insertion of a few words
requiring the clerks of unions to make the returns of the number of
chargeable lunatics on a specified day, as on the first of January in each
year. This practice was formerly enjoined, and probably its omission from
the Act now in force was accidental. The present enactment requires that
the clerks of unions "shall, on the first day of January in every year, or
as soon after as may be, make out and sign a true and faithful list of all
lunatics chargeable to the union or parish;" and the only alteration
required is the addition of two or three words at the end of this
paragraph, such as:--'on the first day of January of that year.' The want
of a fixed date of this kind, Mr. Purdy says, imposes great trouble in
getting the clerks to make their returns with reference to the same day in
the several unions and parishes.
CHAP. III.--STATE OF THE PRESENT PROVISION FOR THE INSANE IN ASYLUMS.--ITS
INADEQUACY.
In their Report for 1857, the Commissioners in Lunacy have presented us
with a memorandum of the present accommodation afforded in County Asylums,
and of that in course of being supplied, and have attempted further a
calculation of the probable requirements on the 1st of January 1860. The
former may be accepted as nearly correct, but the latter affords, as
before noticed, a rough, and not sufficiently accurate, estimate.
Their statement is, that on the 1st of January, 1858, 16,231 beds were
provided in public asylums; that, by the projected enlargement of existing
institutions, 2481 others would be obtained, and, by the completion of
eight asylums in course of erection, there would be added 2336 more--a
total of 4817, on or before January 1860. Of the increase in additional
buildings, 1000 beds, or thereabouts, would not be ready at so early a
date as that named; and in calculating existing provision, need be
deducted from the total of 2,336; consequently the accommodation in
County Asylums would, according to the Commissioners, in this year, 1859,
reach 20,000, and in 1860, 21,048.
The County Asylum accommodation on January 1st, 1858, expressed by the sum
of 16,231, exceeded the total of pauper lunatics returned as actually
partaking its advantages at that date, viz. 14,931, by the large number of
1300; showing a surplus to that amount, including beds, in infirmary
wards. What may be the precise number of the last, or, in other words, of
those generally inapplicable to ordinary cases, labouring under no
particular bodily infirmity, we cannot tell, but we feel sure that 1000 of
them would be available; in fact, the whole number by classification might
be rendered so. Be this so or not, the Commissioners have omitted any
reference to this present available accommodation, in calculating what may
be necessary in 1860.
On the other hand, they have rather over-estimated the future provision in
asylums, by adding together that in the Beds., Herts., and Hunts. Asylum
now in use, viz. 326, with that to be secured in the new one, viz. 504,
instead of counting on the difference only, 178, as representing the
actual increase obtained,--for the intention is to disuse the old
establishment as a county institution.
To proceed. The Commissioners calculate on an addition of 4817 beds to the
number provided in January 1858 (according to our correction, in round
numbers, 4500), and proceed to say, that "if to this estimate ... we apply
the ratio of increase in the numbers requiring accommodation observable
during the last year, some conclusion may be formed as to the period for
which these additional beds are likely to be found sufficient to meet the
constantly increasing wants of the country, and how far they will tend
towards the object we have sought most anxiously to promote ever since the
establishment of this Commission, namely, the ultimate closing of Licensed
Houses for pauper lunatics. On the 1st of January, 1857, the number of
pauper lunatics in County and Borough Asylums, Hospitals, and Licensed
Houses, amounted to 16,657. On the 1st of January, 1858, this number had
increased to 17,572, showing an increase during the year of 915 patients;
and of the total number 2467 were confined in the various metropolitan and
provincial Licensed Houses.
"Assuming, then, that during the next two years the progressive increase
in the number of pauper lunatics will be at least equal to that of the
year 1857, it follows, that on the 1st of January, 1860, accommodation for
1830 additional patients will be required; and if to this number be added
the 2467 patients who are now confined in Licensed Houses, there will
remain, to meet the wants of the ensuing year, only 520 vacant beds. It is
obvious, therefore, that if Licensed Houses are to be closed for the
reception of pauper lunatics, some scheme of a far more comprehensive
nature must be adopted in order to provide public accommodation for the
pauper lunatics of this country."
This conclusion must indeed be most unwelcome and discouraging to the
rate-payers, and to the magistracy, in whose hands the Government reposes
the duty of providing for the due care of pauper lunatics in County
Asylums. To the latter it must be most dispiriting, when we reflect on the
zeal and liberality which have generally marked their attempts to secure,
not merely the necessary accommodation, but that of the best sort, for the
insane poor of their several counties. It is, indeed, an astounding
statement for the tax-payer to hear, that, after the expenditure of one or
two millions sterling to secure the pauper lunatics of this country the
necessary protection, care, and treatment, and the annual burden for
maintenance, that a far more comprehensive scheme is demanded. No wonder
that the increase of insanity is viewed as so rapid and alarming; no
wonder that every presumed plan of saving expense by keeping patients out
of asylums should be readily resorted to.
The value of the conclusion, and of the facts whereon it rests, certainly
merit careful examination; and after the investigation made as to the
number of the insane, and their rate of increase and accumulation, such an
examination can be more readily accomplished.
To revert to the figures put forward by the Commissioners, of the number
of beds existing in asylums on the 1st of January, 1858, and of that to be
furnished by 1860. They reckoned on 16,231 beds at the former date, and on
the addition of 4817 by the year 1860, or a total of 21,048. We have,
however, shown, that in January 1858 there were 1300 vacant beds, and that
there was an over-estimate of the future increase by about 300, leaving,
without reckoning the number in progress, 1000 to meet coming claims. This
sum being therefore added, gives a total of 22,048 to supply the wants of
the pauper insane between the 1st of January, 1858, and the completion of
the new asylums in 1860. Using the average increase adopted by the
Commissioners, viz. 915 per annum, there would be at the commencement of
the year 1860, 1830 applicants for admission, to be added to the 2467
confined in Licensed Houses, whom the Lunacy Commissioners are so anxious
to transfer to county institutions, making in all 4297. But according to
our corrected valuation, there would be in the course of 1860, room for
5817 patients, that is, a surplus accommodation for 1520.
It must be admitted as incorrect on the part of the Commissioners, in the
Report just quoted, to calculate on the whole number of beds obtained by
new buildings, as available in January 1860, when, in all probability,
1000 of them will not be ready much before the close of the year; still,
after making allowance for the increased number of claimants accruing
between that date and the opening of the new asylums, there would,
according to the data used, remain vacancies for some thousand or more,
instead of the 520 reckoned upon by the Commissioners.
Our review, therefore, is thus far favourable, and suggestive of the
possibility of a breathing time before the necessity of a scheme of a "far
more comprehensive nature" need be adopted. But, alas! the inquiries
previously gone into concerning the number and increase of the insane
render any such hope fallacious, and prove that the Commissioners have
very much underestimated the number to be duly lodged and cared for in
asylums; unless indeed, after having secured the transfer of those now in
Licensed Houses to County Asylums, they should consider their exertions on
behalf of the unfortunate victims of mental disorder among the poor
brought to a close. Such an idea, however, is, we are persuaded, not
entertained by those gentlemen, who have, on the contrary, in their
Reports frequently advocated the provision of asylums for all the pauper
insane with few exceptions, and distinctly set forth the objections to
their detention in workhouses.
In fact, every well-wisher for the lunatic poor, is desirous to see
workhouses disused as receptacles for them, and it naturally appears more
important to transfer some of their inmates to proper asylums than to
dislodge those detained in Licensed Houses, where, most certainly, the
means of treatment and management available are superior to those existing
in workhouse wards.
But our efforts on behalf of the insane poor must not cease even when
those in workhouses are better cared for, since there then remains that
multitude of poor mentally disordered patients scattered among the
cottagers of the country, indifferently lodged, and not improbably,
indifferently treated, sustained on a mere pittance unwillingly doled out
by Poor-Law Guardians, and under no effectual supervision, either by the
parish medical officers or by the members of the Lunacy Board. Some
provision surely is necessary for this class of the insane; some effectual
watching over their welfare desirable; for the quarterly visits required
by law (16 & 17 Vict. cap. 97, sect. 66) to be made to them by the
overworked and underpaid Union Medical Officers cannot be deemed a
sufficient supervision of their wants and treatment. These visits, for
which the noble honorarium of 2_s._ 6_d._ is to be paid, whatever the
distance the medical officer may have to travel,--are intended by the
clause of the Act to qualify the visitor to certify "whether such lunatics
are or are not properly taken care of, and may or may not properly remain
out of an asylum;" but practically nothing further is attained by them
than a certificate that the pauper lunatic still exists as a burden upon
the parish funds; and even this much, as the Commissioners in Lunacy
testify, is not regularly and satisfactorily obtained. A proper inquiry
into the condition of the patient, the circumstances surrounding him, the
mode of management adopted, and into the means in use to employ or to
amuse him, cannot be expected from a parish medical officer at the
remuneration offered, engaged as he is in arduous duties; and, more
frequently than not, little acquainted with the features of mental
disease, or with the plans for its treatment, alleviation, or management.
Even in the village of Gheel in Belgium, which has for centuries served as
a receptacle for the insane, where there is a well-established system of
supervision by a physician and assistants, and where the villagers are
trained in their management, those visitors who have more closely looked
into its organization and working, have remarked numerous shortcomings and
irregularities. But compared with the plan of distributing poor demented
patients and idiots, as pursued in this country, in the homes of our
poorer classes and peasantry, unused to deal with them, too often
regarding them as the subjects of force rather than of persuasion and
kindness, and under merely nominal medical oversight four times a year,
Gheel is literally "a paradise of fools." Indeed a similar plan might with
great advantage be adopted, particularly in the immediate vicinity of our
large County Asylums.
But to return to the particular subject in question, viz. the proportion
of insane poor in workhouses and elsewhere who should rightly find
accommodation in asylums, a class of lunatics, as said before, not taken
into account by the Commissioners in their estimate of future
requirements.
We let pass the inquiry, what should be done for the 8000 poor imbecile
and idiotic paupers boarded in the homes of relatives or others, and
confine our observations to the 7947 inmates of workhouses. Now, although
we entertain a strong conviction of the evils of workhouses as receptacles
for the insane, with very few exceptions,--a conviction we shall presently
show good grounds for, yet, instead of employing our own estimate, we
shall endeavour to arrive at that formed by the Lunacy Commissioners, of
the proportion of lunatics living in them, for whom asylum accommodation
should be provided.
The principal and special Report on Workhouses, in relation to their
insane inmates, was published in 1847, and in it the Commissioners observe
(p. 274), that they believe they "are warranted in stating, as the result
of their experience, that of the entire number of lunatics in
workhouses,--two-thirds at the least--are persons in whom, as the mental
unsoundness or deficiency is a congenital defect, the malady is not
susceptible of cure, in the proper sense of the expression, and whose
removal to a curative Lunatic Asylum, except as a means of relieving the
workhouse from dangerous or offensive inmates, can be attended with little
or no benefit. A considerable portion of this numerous class, not less
perhaps than a fourth of the whole, are subject to gusts of passion and
violence, or are addicted to disgusting propensities, which render them
unfit to remain in the workhouse.... But although persons of this
description are seldom fit objects for a curative asylum, they are in
general capable of being greatly improved, both intellectually and
morally, by a judicious system of training and instruction; their dormant
or imperfect faculties may be stimulated and developed; they may be
gradually weaned from their disgusting propensities; habits of decency,
subordination, and self-command may be inculcated, and their whole
character as social beings may be essentially ameliorated."
In their Ninth Report (1855), speaking of those classed in the Workhouse
In-door Relief Lists, under the head of Lunatics or Idiots, they
observe:--"These terms, which are themselves vague and comprehensive, are
often applied with little discrimination, and in practice are made to
include every intermediate degree of mental unsoundness, from imbecility
on the one hand, to absolute lunacy or idiotcy on the other; and, in point
of fact, a very large proportion of the paupers so classed in workhouses,
especially in the rural districts, and perhaps four-fifths of the whole,
are persons who may be correctly described as harmless imbeciles, whose
mental deficiency is chronic or congenital, and who, if kept under a
slight degree of supervision, are capable of useful and regular
occupation. In the remainder, the infirmity of mind is for the most part
combined with and consequent upon epilepsy or paralysis, or is merely the
fatuity of superannuation and old age; and comparatively few come within
the description of lunatics or idiots, as the terms are popularly
understood."
Lastly, in the Eleventh Report (1857), the class of pauper insane, whose
detention in workhouses is allowable, is indicated in the following
paragraph:--"They (workhouses) are no longer restricted to such pauper
lunatics as requiring little more than the ordinary accommodation, and
being capable of associating with the other inmates, no very grave
objection rests against their receiving.... But these are now unhappily
the exceptional cases."
These extracts are certainly not precise enough to enable us to state,
except very approximatively, what may be the estimate of the Lunacy
Commissioners of the numbers who should be rightly placed in asylums. That
first quoted appears to set aside one-third as proper inmates of a
curative asylum, and amenable to treatment; and then to describe a fourth
of the remaining two-thirds, that is, one-sixth, as proper objects of
asylum care. On adding these quantities, viz. one-third to one-sixth, we
get as the result, one-half as the proportion of workhouse insane
considered to be fit subjects for asylums.
The second quotation by itself is of little use to our purpose, except in
conjunction with the third one and with the context, as printed in the
Report from which it is taken, relative to the general question of the
evils of workhouses as receptacles for the insane. So examined in
connection, the published statements and opinions of the Commission, lead
to the conclusion that the great majority of the insane in workhouses
should rightly enjoy the advantages of the supervision, general
management, nursing, and dietary of asylums.
However, to escape the possible charge of attempting to magnify the
deficiency of asylum accommodation, we will, for the time, assume that
only one-half of the lunatic inmates of workhouses require asylum
treatment; even then we had some 4000 to be provided with it at the
beginning of 1858, and should have at the least 4500 by January 1860.
Having now reduced the estimate of the demands for asylum care to figures,
it is practicable to calculate how far those demands can be met by the
existing provision in asylums and what may be its deficiency.
On the one side, there will be, at the most moderate computation, made as
far as possible from data furnished by the Reports of the Lunacy
Commissioners, 4500 inmates of workhouses, who should, on or before
January 1st, 1860, obtain asylum care and treatment. On the other, there
will be, as above shown, about 1000 beds unoccupied at the date mentioned,
after accommodation is afforded to the pauper residents in Licensed
Houses, and to the number of insane resulting from accumulation and
increase in the course of two years from January 1858. The consequence is,
that in January 1860, there will remain some 3500 pauper lunatics
unprovided for in proper asylums.
In the course of the preceding arguments, we have kept as closely as
possible to data furnished by the Lunacy Commissioners' Reports, and
withal have made out, satisfactorily we trust, that the provision supplied
by existing asylums and by those now in progress of erection, is
inadequate to the requirements of the insane population of this country.
The idea of its inadequacy would be very greatly enhanced by the
employment of the statistical conclusions we have arrived at respecting
the number of the insane and their rate of accumulation, and by the
reception of the views we entertain against their detention, with
comparatively few exceptions, in other receptacles than those specially
constructed and organized for their care and treatment. The truth of our
opinions we shall endeavour to establish in subsequent pages; and
respecting the rate of accumulation of pauper cases, we feel confident
that 1800 per annum is within the truth. To meet this increase, both the
asylums in existence and those in course of erection are undoubtedly
inadequate, and, as the necessary result, workhouse pauper inmates must
continue to multiply.
If the opinion were accepted that public asylum accommodation should be
provided for all the pauper poor, not many more than one-half are at
present found to be in possession of it, that is, 17,000 of the 33,000 in
the country. Hence it would be required, to more than double the present
provision in asylums for pauper lunatics, to give room for all and to meet
the rapid annual rate of accumulation.