A. _Causes external to Asylums._

The chief cause belonging to this first class is that of delay in

submitting recent cases to asylum care and treatment. This delay, as we

have sufficiently proved, operates most seriously by diminishing the

curability of insanity, and thereby favours the accumulation of chronic

lunatics. It takes place in consequence either of the desire of friends to

keep their invalid relatives at their homes; or of the economical notions

of Poor-Law Officers, who, to avoid the greater cost of asylums, detain

pauper lunatics in workhouses. Other causes of incurability and of the

accumulation of incurables are found in injudicious management and

treatment before admission, and in the transmission of unfit cases to

asylums. To discuss the several points suggested in these considerations

will require this chapter to be subdivided; and first we may treat of the

Detention of Patients in their own homes.

§ _Detention of Patients in their own homes._

Although the immense importance of early treatment to recent cases of

insanity is a truth so well established and so often advocated, yet the

public generally fail to appreciate it, and from unfortunate notions of

family discredit, from false pride and wounded vanity, delay submitting

their afflicted relatives to efficient treatment. Unless the disorder

manifest itself by such maniacal symptoms that no one can be blind to its

real character, the wealthier classes especially will shut their eyes to

the fact they are so unwilling to recognize, and call the mental

aberration nervousness or eccentricity; and as they are unwilling to

acknowledge the disorder, so are they equally indisposed to subject it to

the most effectual treatment, by removing the patient from home, and the

exciting influence of friends and surrounding circumstances in general, to

a properly organized and managed asylum. Usually a patient with sufficient

resources at command, is kept at home as long as possible, at great cost

and trouble; and if he be too much for the control of his relatives and

servants, attendants are hired from some Licensed House to manage him; the

only notion prevailing in the minds of his friends being that means are

needed to subdue his excitement and to overcome his violence. There are,

in fact, no curative agencies at work around him, but on the contrary,

more or fewer conditions calculated to exalt his furor, to agitate and

disquiet his mind, and to aggravate his malady. The master of the house

finds himself checked in his will; disobeyed by his servants; an object of

curiosity, it may be, of wonder and alarm; and sadly curtailed in his

liberty of action. The strange attendants forced upon him are to be

yielded to only under passionate protests, and probably after a struggle.

In all ways the mental disorder is kept up if not aggravated, and every

day the chances of recovery are diminished. Perhaps matters may grow too

bad for continued residence at home, or the malady have lasted so long,

that the broken-up state of family and household can no longer be

tolerated, and a transfer from home is necessitated. Yet even then removal

to an asylum,--the only step which can hold out a fair prospect of

recovery, is either rejected as quite out of the question, or submitted to

usually after still longer delay,--a "trial" being made of a lodging with

a medical man or other person, probably with an asylum attendant. By this

plan certainly the patient is saved from the presence and excitement of

his family, and placed under altered conditions, calculated to exercise in

some respects a salutary influence on his mind; still many others are

wanting, and no guarantee is attainable of the manner in which he is

treated; for as a single patient, and as is usually the case, restrained

without certificates, he is almost invariably unknown to the

Commissioners, and virtually unprotected, even though a medical man be

paid to attend him occasionally. At last, however, except for a few, the

transfer to the asylum generally becomes inevitable, and too often too

late to restore the disordered reason; and years of unavailing regret fail

to atone for time and opportunity lost.

The same unwillingness to subject their insane friends to asylum care and

treatment pervades, moreover, the less wealthy classes, and even the

poorer grades of the middle class of society. Madness, to their

conceptions likewise, brings with it a stigma on the family, and its

occurrence must, it is felt, be kept a secret. Hence an asylum is viewed

as an evil to be staved off as long as possible, and only resorted to when

all other plans, or else the pecuniary means, are exhausted. If it be the

father of the family who is attacked, the hope is, that in a few days or

weeks he may resume his business or return to his office, as he might

after ordinary bodily illness, without such loss of time as shall endanger

his situation and prospects, and without the blemish of a report that he

has been the inmate of a madhouse. If it be the wife, the hope is similar,

that she will shortly be restored to her place and duties in her family.

Should progress be less evident than desired, a change away from home will

probably be suggested by the medical attendant, and at much expense and

trouble carried out. But too frequently, alas! the hopes are blighted and

the poor sufferer is at length removed with diminished chance of cure to

an asylum.

For the poorer members of the middle class, and for many moving in a

somewhat higher circle of society, whom the accession of mental disorder

impoverishes and cuts off from independence, there are, it is most deeply

to be regretted, few opportunities of obtaining proper asylum care and

treatment. In very many instances, the charges of even the cheapest

private asylum can be borne for only a limited period, and thus far, at

the cost of great personal sacrifices and self-denial. Sooner or later no

refuge remains except the County Asylum, where, it may be, from the

duration of his disorder, the patient may linger out the remainder of his

days. How happy for such a one is it--a person unacquainted with the

system of English County Asylums, might remark--that such an excellent

retreat is afforded! To this it may be replied, that the public asylum

ought not to be the _dernier ressort_ of those too poor to secure the best

treatment and care in a well-found private establishment, and yet too

respectable to be classed and dealt with as paupers entirely and

necessarily dependent on the poor's rate. Yet so it is under the operation

of the existing law and parochial usages, there is no intermediate

position, and to reap the benefits of the public asylum, the patient must

be classed with paupers and treated as one. His admission into it is

rendered as difficult, annoying, and degrading as it can be. His friends,

worn out and impoverished in their charitable endeavours to sustain him in

his independent position as a private patient, are obliged to plead their

poverty, and to sue as paupers the parish officials for the requisite

order to admit their afflicted relative to the benefits of the public

asylum as a Pauper Lunatic. In short, they have to pauperize him; to

announce to the world their own poverty, and to succumb to a proceeding

which robs them of their feelings of self-respect and independence, and by

which they lose caste in the eyes of their neighbours. As for the patient

himself, unless the nature and duration of his malady have sufficiently

dulled his perception and sensibilities, the consciousness of his position

as a registered pauper cannot fail to be prejudicial to his recovery;

opposed to the beneficial influences a well-regulated asylum is calculated

to exert, and to that mental calm and repose which the physician is

anxious to procure.

In the class of cases just sketched, we have presumed on the ability of

the friends to incur the cost of private treatment for a longer or shorter

period; but many are the persons among the middle classes, who if

overtaken by such a dire malady as insanity, are almost at once reduced to

the condition of paupers and compelled to be placed in the same category

with them. As with the class last spoken of, so with this one, the law

inflicts a like injury and social degradation, and at the same time

operates in impeding their access to proper treatment.

No one surely, who considers the question, and reflects on the necessary

consequences of the present legal requirement that, for a lunatic to enjoy

the advantages of a public asylum, towards which he may have for years

contributed, he must be formally declared chargeable to the rates as a

pauper,--can deny the conclusion that it is a provision which must entail

a social degradation upon the lunatic and his family, and act as a great

impediment to the transmission of numerous recent cases to the County

Asylum for early treatment.

It will be urged as an apology for it, that the test of pauperism rests on

a right basis; that it is contrived to save the rate-payer from the charge

of those occupying a sphere above the labouring classes, who fall, as a

matter of course, upon the parochial funds whenever work fails or illness

overtakes them. It is, in two words, a presumed economical scheme.

However, like many other such, it is productive of extravagance and loss,

and is practically inoperative as a barrier to the practice of imposition.

If it contributes to check the admission of cases at their outbreak into

asylums, as no one will doubt it does, it is productive of chronic

insanity and of permanent pauperism; and, therefore, besides the

individual injury inflicted, entails a charge upon the rates for the

remaining term of life of so many incurable lunatics.

If, on the contrary, our public asylums were not branded by the

appellation "Pauper;" if access to them were facilitated and the

pauperizing clause repealed, many unfortunate insane of the middle class

in question, would be transmitted to them for treatment; the public asylum

would not be regarded with the same misgivings and as an evil to be

avoided, but it would progressively acquire the character of an hospital,

and ought ultimately to be regarded as a place of cure, equivalent in

character to a general hospital, and as entailing no disgrace or discredit

on its occupant.

The Commissioners in Lunacy, in their Ninth Report (1855, p. 35), refer to

the admissions into County Asylums, of patients from the less rich classes

of society reduced to poverty by the occurrence of the mental malady, and

hint at their influence in swelling the number of the chronic insane,

owing to their transfer not taking place until after the failure of their

means and the persistence of their disorder for a more or less

considerable period. This very statement is an illustration in point; for

the circumstance deplored is the result of the indisposition on the part

of individuals to reduce their afflicted relatives to the level of paupers

by the preliminaries to, and by the act of, placing them in an asylum

blazoned to the world as the receptacle for paupers only; an act, whereby,

moreover, they advertise to all their own poverty, and their need to ask

parish aid for the support of their poor lunatic kindred.

On the continent of Europe and in the United States of America we obtain

ample evidence that the plan of pauperizing patients in order to render

them admissible to public asylums, is by no means necessary. Most

continental asylums are of a mixed character, receiving both paying and

non-paying inmates, and care is taken to investigate the means of every

applicant for admission, and those of his friends chargeable by law with

his maintenance. Those who are paid for are called "pensioners" or

boarders, and are divided into classes according to the sum paid, a

particular section of the asylum being assigned to each class. Besides

those pensioners who pay for their entire maintenance, there are others

whose means are inadequate to meet the entire cost, and who are assessed

to pay a larger or smaller share of it. Lowest in the scale of inmates are

those who are entirely chargeable to the departmental or provincial

revenue, being devoid of any direct or indirect means of support. Probably

the machinery of assessment in the continental states might not accord

with English notions and be too inquisitorial for adoption _in toto_; but

at all events, on throwing open public asylums for the reception of all

lunatics who may apply for it, without the brand of pauperism being

inflicted upon them, some scheme of fairly estimating the amount they

ought to contribute to their maintenance should be devised. For the richer

classes a plan of inquisition into their resources is provided, and there

seems no insuperable difficulty in contriving some machinery whereby those

less endowed with worldly goods might, at an almost nominal expense, have

their means duly examined and apportioned to their own support and that of

their families. Overseers and relieving officers are certainly not the

persons to be entrusted with any such scheme, nor would we advocate a

jury, for in such inquiries few should share; but would suggest it as

probably practicable that the amount of payment might be adjudged by two

or three of the Committee of Visitors of the Asylum with the Clerk of the

Guardians of the Union or Parish to which the lunatic belonged.

In the United States of America, every tax-payer and holder of property is

entitled as a tax-payer, when insane, to admission into the Asylum of the

State of which he is a citizen. He is considered as a contributor to the

erection and support of the institution, and as having therefore a claim

upon its aid if disease overtake him. The cost of his maintenance is borne

by the township or county to which he belongs, and the question of his

means to contribute towards it is determined by the county judge and a

jury. Most of the asylums of the Republic also receive boarders at fixed

terms, varying according to the accommodation desired; hence there are

very few private asylums in the States. In the State of New York there is

a special legal provision intended to encourage the early removal of

recent cases to the asylum; whereby persons not paupers, whose malady is

of less than one year's duration, are admitted without payment, upon the

order of a county judge, granted to an application made to him, setting

forth the recent origin of the attack and the limited resources of the

patient. Such patients are retained two years, at the end of which time

they are discharged, their friends being held responsible for the

removal. Their cost in the asylum is defrayed by the county or parish to

which they belong.

We have said above, that the requirement of the declaration of pauperism

is ineffectual in guarding the interests of the rate-payer against the

cost of improper applicants. Indeed, the proceeding adopted to carry it

out is both absurd and useless, besides being, as just pointed out,

mischievous in its effects.

In the interpretation clause of "the Lunatic Asylums' Act, 1853," it is

ordered that a "Pauper shall mean every person maintained wholly or in

part by, or chargeable to, any Parish, Union, or County." Hence when

insanity overtakes an unfortunate person who is not maintained by a parish

or union, it is required that he be made chargeable to one, or, as we have

briefly expressed the fact, that he be pauperized. To effect this object,

the rule is, that the patient shall reside at least a day and a night in a

workhouse. This proceeding, we repeat, carries absurdity on the face of

it. Either it may be a mere farce privately enacted between the parish

officers and the friends of the patient, to the complete frustration of

the law so far as the protection of the rate-payers is contemplated; or,

it may be made to inflict much pain and annoyance on the applicants by the

official obstructiveness, impertinent curiosity, obtuseness, and possible

ill-feeling of the parish functionaries in whose hands the law has

practically entrusted the principal administration of the details

regulating the access to our public asylums.

It is no secret among the superintendents of County Asylums, that by

private arrangements with the overseers or guardians of parishes, cases

gain admission contrary to the letter and spirit of the law, and to the

exclusion of those who have legally a prior and superior claim. We have,

indeed, the evidence of the Lunacy Commissioners, to substantiate this

assertion. In their Ninth Report (1855, p. 34) they observe,--"In some

districts a practice has sprung up, by which persons, who have never been

themselves in receipt of parochial relief, and who are not unfrequently

tradesmen, or thriving artisans, have been permitted to place lunatic

relations in the County Asylums, as pauper patients, under an arrangement

with the guardians for afterwards reimbursing to the parish the whole, or

part, of the charge for their maintenance. This course of proceeding is

stated to prevail to a considerable extent in the asylums of the

metropolitan counties, and its effect in occupying with patients, not

strictly or originally of the pauper class, the space and accommodations

which were designed for others who more properly belong to it, has more

than once been made the subject of complaint."

Desiring, as we do, to see our County Asylums thrown open to the insane

generally, by the abolition of the pauper qualification, it is rather a

subject of congratulation that cases of the class referred to do obtain

admission into them, even when contrary to the letter of the law. But we

advance the quotation and assertion above to show, that the pauperizing

provision of the Act is ineffective in the attainment of its object; and

to remark, that the opportunities at connivance it offers to parochial

officials, must exercise a demoralizing influence and be subversive of

good government. If private arrangements can be made between the

applicants for an assumed favour, and parish officers, who will undertake

to say that there shall not be bribery and corruption?

Sufficient, we trust, has been said to demonstrate the evils of the

present system of pauperizing patients to qualify them for admission into

County Asylums, and the desirability of opening those institutions to all

lunatics of the middle classes whose means are limited, and whose social

position as independent citizens is jeopardized by the existence of their

malady. This class of persons, as before said, calls especially for

commiseration and aid; being so placed, on the one hand, that their

limited means must soon fail to afford them the succour of a private

asylum; and on the other, with the door of the public institution closed

against them, except at the penalty of pauperism and social degradation.

What we would desire is, that every recent case of insanity should at once

obtain admission into the public asylum of the county or borough, if

furnished with the necessary medical certificates and with an order from a

justice who has either seen the patient or received satisfactory evidence

as to his condition (see remarks on duties of district medical officers),

and obtained from the relatives an undertaking to submit to the assessment

made by a commission as above proposed, or constituted in any other manner

thought better; or the speedy admission of recent cases might otherwise be

secured by prescribing their attendance and that of their friends before

the weekly Committee of the Visitors of the Asylum, by whom the order for

reception might be signed on the requisite medical certificates being

produced, and the examination for the assessment of the patient's

resources formally made, with the assistance possibly of some

representative of the parish interests,--such for instance as the Clerk to

the Board of Guardians.

In the County Courts the judges are daily in the habit of ordering

periodical payments to be made in discharge of debts upon evidence offered

to them of the earnings or trade returns of the debtor; and there seems no

_a priori_ reason against the investigation of the resources of a person

whose friends apply for his admission into a County Asylum. It is for

them to show cause why the parish or county should assume the whole or the

partial cost of the patient's maintenance, and this can be done before the

Committee of the Asylum or any private board of inquiry with little

annoyance or publicity. Rather than raise an obstacle to the admission of

the unfortunate sufferer, it would be better to receive him at once and to

settle pecuniary matters afterwards.

We must here content ourselves with this general indication of the

machinery available for apportioning the amount of payment to be made on

account of their maintenance by persons not paupers, or for determining

their claim upon the Asylum funds. Yet we cannot omit the opportunity to

remark that the proceedings as ordered by the existing statute with a

similar object are incomplete and unsatisfactory. These proceedings are

set forth in _sects._ xciv. and civ. (16 & 17 Vict. cap. 97). The one

section of the Act is a twin brother to the other, and it might be

imagined by one not "learned in the law," that one of the two sections

might with little alteration suffice. Be this as it may, it is enacted

that if it appear to two Justices (_sect._ xciv.) by whose order a patient

has been sent to an asylum, or (_sect._ civ.) "to any Justice or Justices

by this Act authorized to make any order for the payment of money for the

maintenance of any Lunatic, that such Lunatic" has property or income

available to reimburse the cost of his maintenance in the asylum, such

Justices (_sect._ xciv.) shall apply to the nearest known relative or

friend for payment, and if their notice be unattended to for one month,

they may authorize a relieving officer or overseer to seize the goods, &c.

of the patient, whether in the hands of a trustee or not, to the amount

set forth in their order. _Sect._ civ. makes no provision for applying to

relatives or friends in the first instance, but empowers the justice or

justices to proceed in a similar way to that prescribed by _sect._ xciv.,

to repay the patient's cost; with the additional proviso that, besides the

relieving officer or overseer, "the Treasurer or some other officer of the

County to which such Lunatic is chargeable, or in which any property of

the Lunatic may be, or an officer of the Asylum in which such Lunatic may

be," may proceed to recover the amount charged against him.

Concerning these legal provisions, we may observe, that the state of the

lunatic's pecuniary condition is left to accidental discovery. The

justices signing the order of admission (_sect._ xciv.) have no authority

given them to institute inquiries, although they may learn by report that

the patient for whom admission is solicited is not destitute of the means

of maintenance. Nor are the justices who make the order for payment

(_sect._ civ.) in any better position for ascertaining facts. There is,

in short, no authorized and regular process for investigating the

chargeability of those who are not actually in the receipt of parochial

relief on or before application for their admission into the County

Asylum, or who must necessarily be chargeable by their social position

when illness befalls them. Again, according to the literal reading of the

sections in question, no partial charge for maintenance can be proposed;

no proportion of the cost can be assessed, where the patient's resources

are unequal to meet the whole. Lastly, the summary process of seizing the

goods or property of any sort, entrusted to those who are most probably

the informers of the justices, namely overseers and relieving officers;

and, by _sect._ civ., carried out without any preliminary notice or

application, and without any investigation of the truth of the reports

which may reach the justices, is certainly a proceeding contrary to the

ordinary notions of equity and justice.

§ _Detention of Patients in Workhouses._

In the case of the insane poor, whose condition, circumstances, and social

position have been such that whenever any misfortune, want of work, or

sickness has overtaken them, the workhouse affords a ready refuge, the

requirement of pauperization to qualify for admission to the County Asylum

is in itself no hardship and no obstacle to their transmission to it.

Probably the prevailing tactics of parish officers may at times contribute

to delay the application for relief, but the great obstacle to bringing

insane paupers under early and satisfactory treatment in the authorized

receptacle for them--the County Asylum, is the prevalence of an economical

theory respecting the much greater cheapness of workhouse compared with

asylum detention. The practical result of this theory is, that generally

where a pauper lunatic can by any means be managed in a workhouse, he is

detained there. If troublesome, annoying, and expensive, he is referred to

the County Asylum; this is the leading test for the removal; the

consideration of the recent or chronic character of his malady is taken

little or no account of.

In fresh cases the flattering hope is that the patients will soon recover,

and that the presumed greater cost of asylum care can be saved; in old

ones the feeling is that they are sufficiently cared for, if treated like

the other pauper inmates, just that amount of precaution being attempted

which may probably save a public scandal or calamity.

To the prevalence of these economical notions and practice may be

attributed the large number of lunatics detained in workhouses (nearly

8000), and the equally large one living with their friends or others. Now

it is very desirable to inquire whether these theories of the superior

economy of workhouses compared with asylums as receptacles for the insane,

are true and founded on facts. This question is in itself twofold, and

leaves for investigation, first, that of the mere saving in money on

account of maintenance and curative appliances; and secondly, that of the

comparative fitness or unfitness, the advantages or disadvantages, the

profit or loss, of the two kinds of institutions in relation to the

welfare, the cure, and the relief of the poor patients placed in them.

These questions press for solution in connexion with the subject of the

accumulation of lunatics and the means to be adopted for its arrest, or,

what is equivalent to this, for promoting the curability of the insane.

On making a comparative estimate of charges, it is essential to know

whether the same elements of expenditure are included in the two cases; if

the calculated cost per head for maintenance in workhouses and asylums

respectively comprises the same items, and generally, if the conditions

and circumstances so far as they affect their charges are rightly

comparable. An examination we are confident, will prove that in no one of

these respects are they so.

In the first place, the rate of maintenance in an asylum is calculated on

the whole cost of board, clothing, bedding, linen, furniture, salaries,

and incidental expenditure; that is, on the total disbursements of the

establishment, exclusive only of the expenditure for building and repairs,

which is charged to the county. On the contrary, the "in-maintenance" in

workhouses comprises only the cost of food, clothing, and necessaries

supplied to the inmates (see Poor-Law Board Tenth Report, p. 144). The

other important items reckoned on in fixing the rate of cost per head in

asylums are charged to the "establishment" account of the workhouse, and

are omitted in the calculation of the rate of maintenance. Reference to

the Tables given in the Poor-Law Board Returns (Tenth Report, p. 61,

sub-column _e_ and a portion of _f_) will prove that the expenditure on

account of those other items must be nearly or quite equal to that

comprehended under the head of "in-maintenance" cost.

We have no means at hand to calculate with sufficient precision what sum

should be added to the "in-maintenance" cost of paupers per head in

workhouses, but it is quite clear that the figures usually employed to

represent it, cannot be rightly compared with those exhibiting the weekly

charge of lunatics in asylums. At the very least half as much again must

be added to a workhouse estimate before placing it in contrast with asylum

cost.

Since the preceding remarks were written, Dr. Bucknill has favoured us

with the Thirteenth Report of the Devon Asylum, in which he has discussed

this same question and illustrated it by a special instance. To arrive at

the actual cost of an adult sane pauper in a union-house, he gathered "the

following particulars relative to the house of the St. Thomas Union in

which this asylum is placed; a union, the population of which is 49,000,

and which has the reputation of being one of the best managed in the

kingdom. The cost of the maintenance of paupers in this union-house is

2_s._ 6_d._ per head, per week, namely, 2_s._ 2_d._ for food and 4_d._ for

clothing. The establishment charges are 1_s._ 0-1/2_d._ per head, per

week, making a total of 3_s._ 6-1/2_d._ for each inmate. The total number

of pauper inmates during the twelfth week of the present quarter was 246;

and of these 116 were infants and children, and 130 youths above sixteen

and adults. A gentleman intimately acquainted with these accounts, some

time since calculated for me that each adult pauper in the St. Thomas's

Union-house cost 5_s._ a week. Now the average cost of all patients in the

Devon Asylum at the present time is 7_s._ 7_d._, but of this at least

2_s._ must be set down to the extra wages, diet, and other expenses

needful in the treatment of the sick, and of violent and acute cases,

leaving the cost of the great body of chronic patients at not more than

5_s._ 7_d._ a week. Now if a sane adult pauper in a union-house costs even

4_s._ 6_d._ a week, is it probable that an insane one would cost less than

5_s._ 7_d._? For either extra cost must be incurred in his care, or he

must disturb the discipline of the establishment, and every such

disturbance is a source of expense."

This quotation is really a reiteration of Dr. Bucknill's conclusions as

advanced in 1857, in an excellent paper in the 'Asylum Journal' (vol. iv.

p. 460), and as a pendent to it the following extract from this paper is

appropriate; viz. "that the cost of a chronic lunatic properly cared for,

and supplied with a good dietary, in a County Asylum, is not greater than

that of a chronic lunatic supplied with a coarse and scanty dietary, and

detained in neglect and wretchedness as the inmate of a union workhouse."

Another most important circumstance to be borne in mind when the cost of

workhouses and asylums is contrasted, is that in the former establishments

more than two-thirds of the inmates are children. Thus the recipients of

in-door relief on the 1st of January, 1858, consisted, according to the

Poor-Law Returns, of 74,141 adults, and 50,836 children under sixteen

years of age. Now as the rate of maintenance is calculated on the whole

population of a workhouse, adults and children together, it necessarily

follows that it falls much within that of asylums, in which almost the

whole population is adult. This very material difference in the character

of the inmates of the two institutions may fairly be valued as equivalent

to a diminution of one-fourth of the expense of maintenance in favour of

workhouses; and without some such allowance, the comparison of the cost

per head in asylums and union-houses respectively is neither fair nor

correct.

Again, there is another difference between asylums and workhouses, which

tells in favour of the latter in an economical point of view, whilst it

proves that the expenditure of the two is not rightly comparable without

making due allowance for it along with the foregoing considerations. This

difference subsists in the character of the two institutions respectively;

namely, that in the asylum the movements of the population are slight,

whereas in the workhouse they are very considerable by the constant

ingress and egress of paupers; driven to it by some passing misfortune or

sickness, it may be for a week or two only or even less, and discharging

themselves so soon as the temporary evil ceases to operate or the disorder

is overcome: for the poor generally, except the old and decrepit who

cannot help themselves, both dread a lodging in the workhouse, and escape

from it as soon as possible; in fact, even when they have no roof of their

own to shelter them, they will often use the union accommodation only

partially, leaving it often by day and returning to it by night. All this

implies a large fluctuation of inmates frequently only partially relieved,

whether in the way of board or clothing; and consequently when the average

cost per head of in-door paupers is struck, it appears in a greater or

less degree lower than it would have done had the same constancy in

numbers and in the duration and extent of the relief afforded prevailed as

it does in asylums.

The effect of the fluctuations in population in union-houses ought, we

understand, to be slight, if the "Orders in Council" laid down to guide

parochial authorities in the calculation of the cost of their paupers,

were adhered to; viz. that for all those belonging to any one parish in

union, who may have received in-door relief during the year or for any

less period of time, an equivalent should be found representing the number

who have been inmates throughout the year; or the total extent of relief

be expressed by estimating it to be equal to the support of one

hypothetical individual for any number of years equivalent to the sum of

the portions of time the entire number of the paupers of the particular

parish received the benefits of the establishment. We do not feel sure

that these plans of calculating the cost per head are faithfully and fully

executed; the rough method of doing so, viz. by taking the whole cost of

"in-maintenance" at the end of the year and dividing it by the number of

its recipients, and assuming the quotient to represent the expenditure

for each. Whether this be the case or not, these daily changes among its

inmates, the frequent absence of many for a great part of the day and the

like, are to be enumerated among the circumstances which tend to keep down

expenditure of workhouses; and which are not found in asylums.

There is yet another feature about workhouses which distinguishes them

from asylums, and is of considerable moment in the question of the

comparative cost of maintenance in the two: this is, the circumstance of

the population of workhouses being of a mixed character, of which the

insane constitute merely a small section; while, on the contrary, that of

asylums is entirely special, and each of its members to be considered a

patient or invalid demanding particular care and special appliances.

Therefore, _a priori_, no comparison as to their expenditure can justly be

drawn between two institutions so dissimilar. Yet even this extent of

dissimilarity between them is not all that exists; for the union-house is

so constituted by law as to serve as a test of poverty; to offer no

inducements to pauperism, and to curtail the cost of maintenance as far as

possible. It has properly no organization for the detention, supervision,

moral treatment and control, nor for the nursing or medical care of the

insane; and when its establishment is attempted it is a step at variance

with its primary intention, and involves an extra expenditure.

Consequently, before overseers or guardians can with any propriety

contrast the workhouse charges of maintenance with those of asylums, it is

their business to estimate what an adult pauper lunatic costs them per

week, instead of, as usual, quoting the cost per head calculated on the

whole of the inmates, old and young, sane and insane.

Once more, even after a fair estimate of the cost of an adult insane

inmate of a workhouse is obtained, there is still another differential

circumstance favourable to a less rate than can be anticipated in asylums;

for this reason:--that in the former institutions the practice is to

reject all violent cases, the major portion of recent ones, and,

generally, all those who give particular annoyance and trouble; whilst the

latter is, as it rightly should be, regarded as the fitting receptacle for

all such patients;--that is, in other words, those classes of patients

which entail the greatest expense are got rid of by the workhouses and

undertaken by the asylums.

Dr. Bucknill has well expressed the same circumstances we have reviewed,

in the following paragraph (Report, Devon Asylum, 1858, p. 13):--"In

estimating the cost of lunatic paupers in asylums, the important

consideration must not be omitted, that the charge made for the care and

maintenance of lunatics in County Asylums is averaged upon those whose

actual cost is much greater, and those whose actual cost is less than the

mean; so that it would be unfair for the overseers of a parish to say of

any single patient that he could be maintained for a smaller sum than that

charged, when the probability is that there are or have been patients in

the asylum from the same parish, whose actual cost to the asylum has been

much greater than that charged to the parish. I have shown, that the

actual cost of chronic patients in an asylum exceeds that of adult paupers

in union-houses to a much smaller extent than has been stated: but if all

patients of this description were removed from the asylum, the inevitable

result must be that the average cost of those who remained would be

augmented, so that the pecuniary result to the parishes in the county

would be much the same. The actual cost of an individual patient, if all

things are taken into calculation, is often three or four times greater

than the average. Leaving out of consideration the welfare of the

patients, it would be obviously unfair to the community, that a parish

having four patients in the asylum, the actual cost of two of whom was

12_s._ a week, and of the other two only 4_s._ a week, should be allowed

to remove the two who cost the smaller sum, and be still permitted to

leave the other two at the average charge of 8_s._"

The conclusion of the whole matter is, that _cæteris paribus_, _i. e._

supposing workhouses to be equally fitting receptacles for the insane as

asylums, the differential cost of the two can only be estimated when it is

ascertained that the items of maintenance are alike in the two, and after

that an allowance is made for the different characters of their population

and of their original purpose; that is, in the instance of workhouses, for

the very large number of juvenile paupers; for the great fluctuations in

the residents; for the mixed character of their inmates, of sane and

insane together, and the small proportion of insane, and for the exclusion

of the most expensive classes of such patients. Let these matters be

fairly estimated, and we doubt much if, even _primâ facie_, it can be

shown that the workhouse detention of pauper lunatics is more economical

than that of properly constructed and organized asylums.

Should we even be so far successful as to make Poor-Law Guardians and

Overseers perceive that the common rough-and-ready mode of settling the

question of relative cost in asylums and workhouses, by contrasting the

calculated rate per head for in-door relief with that for asylum care, is

not satisfactory; we cannot cherish the flattering hope that they will be

brought to perceive that, simply in an economical point of view, no saving

at all is gained by the detention of the insane in workhouses. Those

Poor-Law officials generally are so accustomed to haggle about fractional

parts of a penny in voting relief, to look at an outlay of money only

with reference to the moment, forgetful of future retribution for false

economy, and to handle the figures representing in their estimate the

economical superiority of the workhouse for the insane, when they desire

to silence an opponent;--that the task of proving to them that their

theory and practice are wrong, is equivalent to the infelicitous endeavour

to convince men against their will.

Still, however unpromising our attempt may appear, it is not right to

yield whilst any legitimate arguments are at hand; and our repertory of

them, even of those suited to a contest concerning the pounds, shillings,

and pence of the matter, is not quite exhausted; for we are prepared to

prove, that asylum accommodation can be furnished to the lunatic poor at

an outlay little or not at all exceeding that for workhouses.

Now this point to be argued, the cost of asylum construction, is not, like

the foregoing considerations, chiefly the affair of Poor-Law Guardians and

Overseers, but concerns more particularly the County Magistrates, inasmuch

as it is defrayed out of the County instead of the Poor Rate. But although

this is the case, there is no doubt that the very great expense of

existing asylums has acted as an impediment to the construction of others,

and has seemed to justify, to a certain extent, the improper detention of

many insane persons in workhouses: for, on one side, asylums are found to

have cost for their construction and fittings, £150, £200, and upwards per

head, whilst on the other, workhouses are built at the small outlay, on an

average, of eighty-six such establishments, of £22 per head. The "Return"

made to the House of Commons, June 15, 1857, "of the cost of building

Workhouses in England and Wales, erected since 1840," shows indeed a very

wide variation of cost in different places, from £13 per head for the

Congleton Union House; £14 for the Erpingham; £16 for the Stockton and

Tenterden, to £47 for the Kensington; £50 for the Dulverton; £59 for the

City of London; £60 for St. Margaret Westminster; and £113 for the

Paddington. This enormous difference of expenditure on workhouse

lodging,--for, unlike asylum costs, it does not include fittings,

extending from £13 to £113 per inmate,--is really inexplicable, after

allowing for the varying ideas of parish authorities as to what a

workhouse should be, and for the slight differences in the cost of

building materials and labour in some parts of the country than in others.

Either some workhouses must be most miserable and defective habitations

even for paupers, or others must be very extravagant and needlessly

expensive in their structure.

There is this much to be said in explanation of the contrast of cost in

different workhouses, that in those belonging to large town populations,

infirmary accommodation becomes an item of importance and involves

increased expenditure, whilst in those situated in agricultural districts,

this element of expense is almost wanting. Moreover it is in town

workhouses generally that lunatic inmates are found, who, if not in the

infirmary, are lodged in special wards, often so constructed as to meet

their peculiar wants, and therefore more costly than the rest of the

institution occupied by the ordinary pauper inmates. This is the same with

saying that where workhouses are used as receptacles for the insane, it

greatly enhances the cost of their construction.

It will be evident to every thinking person that the costs of asylum and

of workhouse construction are not fairly comparable. The asylum is a

special building; an instrument of treatment; peculiarly arranged for an

invalid population, affording facilities for classification, recreation,

and amusements; and fitted with costly expedients for warming and

ventilation; whereas the workhouse is essentially a refuge for the

destitute, necessarily made not too inviting in its accommodation and

internal arrangements; suited to preserve the life of sound inmates who

need little more than the shelter of a roof and the rude conveniences the

majority of them have been accustomed to. Now these very characteristics

of workhouses are among the best arguments against the detention of

lunatics within these buildings; but of these hereafter.

There is doubtless a permissible pride in the ability to point to a

well-built asylum, commanding attention by its dimensions and

architectural merits, and we would be the last to decry the beauties and

benefits of architecture, and know too, that an ugly exterior may cost as

much or more than a meritorious one; yet we must confess to misgivings

that there has been an unnecessary and wasteful expenditure in this

direction. Nevertheless it is with asylums as with railways, the present

race of directors are reaping instruction from the extravagances and

errors its predecessors fell into.

The change of opinion among all classes respecting the character and wants

of the insane and their mode of treatment, is of itself so great, that

many of the structural adaptations and general dispositions formerly made

at great cost, are felt to be no longer necessary, and the very correct

and happy persuasion daily gains ground, that the less the insane are

dealt with as prisoners, and treated with apprehension and mistrust, the

more may their accommodation be assimilated to that of people in general,

and secured at a diminished outlay.

All this suggests the possibility of constructing asylums at a much less

cost than formerly, and of thereby lessening the force of one of the best

pleas for using workhouses as receptacles for the insane. The possibility

of so doing has been proved both theoretically and practically. In an

essay 'On the Construction of Public Asylums,' published in the "Asylum

Journal" for January 1858 (vol. iv. p. 188), we advocated the separation

of the day- from the night-accommodation of patients, and the abolition of

the system of corridors with day- and sleeping-rooms, or, as we briefly

termed it, "the ward-system," and showed that by so doing a third of the

cost of construction might be saved, whilst the management of the

institution would be facilitated, and the position of the patients

improved. By a careful estimate, made by a professional architect, with

the aid of the necessary drawings, for a building of considerable

architectural pretension, it was calculated that most satisfactory,

cheerful, and eligible accommodation could be secured, including

farm-buildings, and fittings for warming, ventilation, drainage, gas, &c.,

at the rate of £90 per head for patients of all classes, or at one-half of

the ordinary cost.

Experience has shown that chronic lunatics, at least, can be accommodated

in an asylum at a lower rate, in fact, at little more than half the

expense that we calculated upon.

Like other County Asylums, the Devon became filled with patients; still

they came, and after attempts to cram more into the original edifice, by

slight alterations, and by adding rooms here and there, it was at length

found necessary to make a considerable enlargement. Instead of adding

floors or wings to the old building, which would have called for a

repetition of the same original expensive construction of walls, and of

rooms and corridors, the Committee, with the advice of their excellent

physician, wisely determined to construct a detached building on a new

plan, which promised every necessary convenience and security with

wonderful cheapness; and, for once in a way, an architect's cheap estimate

was not exceeded. Instead of £200 or £250 per head, as of old,

accommodation was supplied at the rate of £38: 10_s._ per patient,

including fittings for all the rooms and a kitchen:--a marvel, certainly,

in asylum construction, and one which should have the effect of reviving

the hopes and wishes of justices, once at least so laudably entertained,

to provide in County Asylums for _all_ pauper lunatics of the county.

It is only fair to remark, that, as Dr. Bucknill informs us (Asylum

Journal, 1858, p. 323), this new section of the Devon Asylum is dependent

on the old institution for the residences of officers, for chapel,

dispensary, store-rooms, &c. "It is difficult," writes Dr. Bucknill, "to

estimate the proportion which these needful adjuncts to the wards of a

complete asylum bear to the expense of the old building; they can

scarcely, however, be estimated at so high a figure as one-eighth of the

whole." But, as a set-off against the increased cost per patient involved

in supplying the necessary offices described by Dr. Bucknill, we may

mention that there are twenty single sleeping-rooms provided in the

building, and that a greater cost was thereby entailed, than many would

think called for, where only chronic, and generally calm patients, were to

be lodged.

These illustrations of what may be done in the way of obtaining good

asylum accommodation for pauper lunatics at no greater rate, we are

persuaded, than that incurred in attempting to provide properly for them

in workhouses, furnish a most valid reason for discontinuing their

detention in the latter, and the more so, if, as can be demonstrated, they

are unfit receptacles for them.

The possibility of constructing cheap asylums being thus far proved, the

question might be put, whether the internal cost of such institutions

could not be lessened? We fear that there is not much room for reform in

this matter, if the patients in asylums are rightly and justly treated,

and the officers and attendants fairly remunerated. In producing power, an

asylum exceeds a workhouse, and therein derives an advantage in

diminishing expenditure and the cost of maintenance. On the other hand,

the expenditure of a workhouse is much less in salaries, particularly in

those given to its medical officer and servants, a form of economy which

will never repay, and, we trust, will never be tried in asylums. Warming,

ventilation, and lighting are less thought of, little attempted, and

therefore less expensive items in workhouse than in asylum accounts. With

respect to diet and clothing, workhouses ought to exhibit a considerable

saving; but this saving is rather apparent than real, and certainly in the

wrong direction; for lunatics of all sorts require a liberal dietary, warm

clothing, and, from their habits frequently, more changes than the

ordinary pauper inmates; yet these are provisions, which, except there is

actual sickness or marked infirmity, the insane living in a workhouse do

not enjoy; for they fare like the other inmates, are clothed the same, and

are tended or watched over by other paupers; the saving, therefore, is at

the cost of their material comfort and well-being. Excepting, therefore,

the gain to be got by the labours of the patients, there is no set-off in

favour of asylum charges; in short, in other respects none can be obtained

without inflicting injury and injustice. On the other hand, workhouse

expenditure need be raised if the requisite medical and general treatment,

nursing, dietary, employment, and recreation are to be afforded; which is

the same as saying, that workhouses, if receptacles for the insane at all,

should be assimilated to asylums,--a principle, which, if admitted and

acted upon, overturns at once the only argument for their use as such,

viz. its economy.

The perception on the part of parochial authorities, that something more

than the common lodging and attendance of the workhouse is called for by

the insane inmates, has led to the construction of "Lunatic Wards" for

their special accommodation, a scheme which may be characterized as an

extravagant mistake, whether viewed in reference to economical principles

or the welfare of the patients. If structurally adapted to their object,

they must cost as much as a suitable asylum need; and if properly

supervised and managed, if a sufficient dietary be allowed, and a proper

staff of attendants hired, no conceivable economical advantage over an

asylum can accrue. On the contrary, as Dr. Bucknill has remarked (Asylum

Journal, vol. iv. p. 460), any such attempts at an efficient management of

the insane in small and scattered asylums attached to Union Workhouses,

will necessarily increase their rate of maintenance above that charged in

a large central establishment, endowed with a more complete organization

and with peculiar resources for their management.

Dr. Bucknill returns to the discussion of this point in his just published

report (Rep. Devon Asylum, 1858, p. 11). He puts the question, "Would a

number of small asylums, under the denomination of lunatic wards, be more

economical than one central asylum?" and, thus proceeds to reply to

it:--"The great probability is that they would not be; 1st, on account of

the larger proportion of officials they would require; 2nd, on account of

the derangement they would occasion to the severe economy which is

required by the aim and purpose of union-houses as tests of destitution.

Where lunatics do exist in union-houses in consequence of the want of

accommodation in the County Asylum, the Commissioners in Lunacy insist

upon the provision of what they consider things essential to the proper

care of insane persons wherever they be placed. The following are the

requirements which they insisted upon as _essential_ in the Liverpool

Workhouse:--a sufficient staff of responsible paid nurses and attendants;

a fixed liberal dietary sanctioned by the Medical Superintendent of the

asylum; good and warm clothing and bedding; the rooms rendered much more

cheerful and better furnished; the flagged court-yards enlarged and

planted as gardens; the patients frequently sent to walk in the country

under proper care; regular daily medical visitation; and the use of the

official books kept according to law in asylums. If the direct cost of

such essentials be computed with the indirect cost of their influence upon

the proper union-house arrangements, it will require no argument to prove

that workhouse lunatic wards so conducted would effect no saving to the

ratepayers. The measures needed to provide in the union-house kitchen a

liberal dietary for the lunatic wards and a restricted one for the sane

remainder, to control the staff of paid attendants, to arrange frequent

walks into the country for part of the community, while the other part was

kept strictly within the walls;--these would be inevitable sources of

disturbance to the proper union-house discipline, which would entail an

amount of eventual expenditure not easily calculated."

If, on economical grounds, the system of Lunatic Wards has no evident

merit, none certainly can be claimed for it on the score of its adaptation

to their wants and welfare.

Indeed, the argument for workhouse accommodation, on the plea of economy,

loses all its weight when the well-being of the insane is balanced against

it. For, if there be any value in the universally accepted opinions of

enlightened men, of all countries in Europe, of the requirements of the

insane, of the desirability for them of a cheerful site, of ample space

for out-door exercise, occupation and amusement, of in-door arrangements

to while away the monotony of their confinement and cheer the mind, of

good air, food and regimen, of careful watching and kind nursing, of

active and constant medical supervision and control, or to sum up all in

two words, of efficient medical and moral treatment,--then assuredly the

wards of a workhouse do not furnish a fitting abode for them.

The unfitness of workhouses for the detention of the insane, and the evils

attendant upon it, have been repeatedly pointed out by the Commissioners

in Lunacy in their annual reports, and by several able writers. We were

also glad to see from the report of his speech, on introducing the Lunatic

Poor (Ireland) Bill into the House of Commons, that Lord Naas is strongly

opposed to the detention of the insane in workhouses, and therein agrees

with the Irish Special Lunacy Commissioners (1858, p. 18), who have placed

their opinion on record in these words:--"It appears to us that there can

be no more unsuitable place for the detention of insane persons than the

ordinary lunatic wards of the Union Workhouses." This is pretty nearly the

same language as that used by the English Commissioners in 1844, viz. "We

think that the detention in workhouses of not only dangerous lunatics, but

of all lunatics and idiots whatever, is highly objectionable."

To make good these general statements, we will, at the risk of some

repetition, enter into a few particulars. On the one hand, the presence of

lunatics in a workhouse is a source of annoyance, difficulty, and anxiety

to the official staff and to the inmates, and withal of increased expense

to the establishment. If some of them may be allowed to mix with the

ordinary inmates, there are others who cannot, and whose individual

liberty and comfort must be curtailed for the sake of the general order

and management, and of the security and comfort of the rest.

Some very pertinent observations occur in the Report of the Massachusetts

Lunacy Commission (_op. cit._ p. 166), on the mixing of the sane and

insane together in the State Almshouses, which correspond to our Union

Workhouses. They report that the superintendents "were unanimous in their

convictions that the mingling of the insane with the sane in these houses

operated badly, not only for both parties, but for the administration of

the whole institution." Further on, the Commissioners observe (p. 168),

"By this mingling the sane and insane together, both parties are more

disturbed and uncontrollable, and need more watchfulness and interference

on the part of the superintendent and other officers.... It has a

reciprocal evil effect in the management of both classes of inmates. The

evil is not limited to breaches of order; for there is no security against

violence from the attrition of the indiscreet and uneasy paupers with the

excitable and irresponsible lunatics and idiots. Most of the demented

insane, and many idiots, have eccentricities; they are easily excited and

disturbed; and nothing is more common than for inmates to tease, provoke,

and annoy them, in view of gratifying their sportive feelings and

propensities, by which they often become excited and enraged to a degree

to require confinement to ensure the safety of life.... The mingling of

the state paupers, sane and insane, makes the whole more difficult and

expensive to manage. It costs more labour, watchfulness, and anxiety to

take care of them together than it would to take care of them separately."

These sketches from America may be matched in our own country; and they

truthfully represent the reciprocal disadvantages of mixing the sane and

insane together in the same establishment.

Even supposing the presence of insane in workhouses involved, on the one

hand, no disadvantages to the institutions, or to the sane inmates; yet on

the other, the evils to the lunatic inhabitants would be condemnatory of

it; for the insane necessarily suffer in proportion as the workhouse

accommodation differs from that of asylums; or, inversely, as the

economical arrangements and management of a workhouse approach those of an

asylum. They suffer from many deficiencies and defects in locality and

organization, in medical supervision and proper nursing and watching, in

moral discipline, and in the means of classification, recreation, and

employment.

Workhouses are commonly town institutions; their locality often

objectionable; their structure indifferent and dull; their site and their

courts for exercise confined and small, and their means of recreation and

of occupation, especially out of doors, very limited. Petty officers of

Unions so often figure before the world, and have been so admirably

portrayed by Dickens and other delineators of character, on account of

their peculiarities of manner and practice, that no sketch from us is

needed to exhibit their unfitness as guardians and attendants upon the

insane. As to workhouse nurses, little certainly can be expected from

them, seeing that they are only pauper inmates pressed into the service;

if aged, feeble and inefficient; if young, not unlikely depraved or

weak-minded; always ignorant, and it may be often cruel; without

remuneration or training, and chosen with little or no regard to their

qualifications and fitness.

However satisfactory the structure of the ward and its supervision might

be rendered, its connexion with a Union Workhouse will be disadvantageous

to the good government and order of the establishment, as above noticed,

and detrimental to the welfare of the insane confined in it. Thus it must

be remembered that very many of the lunatic inmates have been reduced to

seek parochial aid solely on account of the distressing affliction which

has overtaken them; before its occurrence, they may have occupied an

honourable and respectable position in society, and, consequently, where

consciousness is not too much blunted, their position among paupers--too

often the subjects of moral degradation--must chafe and pain the

disordered mind and frustrate more or less all attempts at its

restoration. To many patients, therefore, the detention in a workhouse is

a punishment superadded to the many miseries their mental disorder

inflicts upon them; and consequently, when viewed only in this light,

ought not to be tolerated.

Of all cases of lunacy, the wards of a workhouse are least adapted to

recent ones, for they are deficient of satisfactory means of treatment,

whether medical or moral, and the only result of detention in them to be

anticipated, must be to render the malady chronic and incurable. Yet

although every asylum superintendent has reported against the folly and

injury of the proceeding, and notwithstanding the distinct and strong

condemnation of it by the Commissioners in Lunacy, the latter, in their

Report for 1857, have to lament an increasing disposition, on the part of

Union officers, to receive and keep recent cases in workhouses. Moral

treatment we hold to be impossible in an establishment where there are no

opportunities of classification, no proper supervision and attendance, and

no means for the amusement and employment of the mind; but where, on the

contrary, the place and organization are directly opposed to it, and the

prospects of medical treatment are scarcely less unfavourable. An

underpaid and overworked medical officer, in his hasty visits through the

wards of the workhouse daily, or perhaps only three or four times a week,

very frequently without any actual experience among the insane, cannot be

expected to give any special attention to the Pauper Lunatics, who are

mostly regarded as a nuisance in the establishment, to be meddled with as

little as possible, and of whose condition only unskilled, possibly old

and unfeeling pauper nurses, can give any account. Indeed, unless reported

to be sick, it scarcely falls into the routine of the Union medical

officer regularly to examine into the state and condition of the pauper

lunatics. These remarks are confirmed by the statement of the Lunacy

Commissioners, in their 'Further Report,' 1847 (p. 276), that pauper

inmates, "in their character of lunatics merely, are rarely the objects of

any special medical attention and care," and that it "was never found

(except perhaps in a few cases) that the medical officer had taken upon

himself to apply remedies specially directed to the alleviation or cure of

the mental disorder. Nor was this indeed to be expected, as the workhouse

never can be a proper place for the systematic treatment of insanity."

It would unnecessarily extend the subject to examine each point of

management and organization affecting the well-being of the insane in

detail, in order to show how unsuitable in all respects a workhouse must

be for their detention; yet it may be worth while to direct attention to

one or two other matters.

Except when some bodily ailment is apparent, the lunatic fare like the

ordinary inmates; that is, they are as cheaply fed as possible, without

regard to their condition as sufferers from disease, which, because

mental, obtains no special consideration. It is in the power of the

medical officer, on his visits, to order extra diet if he observes any

reason in the general health to call for it; but the dependent position of

this gentleman upon the parish authorities, and his knowledge that extra

diet and its extra cost will bring down upon him the charge of

extravagance and render his tenure of office precarious, are conditions

antagonistic to his better sentiments concerning the advantages of

superior nutriment to his insane patients.

Moreover, the cost of food is a principal item in that of the general

maintenance of paupers, and one wherein the guardians of the poor believe

they reap so great an economical advantage over asylums. But this very

gain, so esteemed by poor-law guardians, is scouted as a mistake and

proved an extravagance, _i. e._ if the life and well-being of the poor

lunatics are considered, by the able superintendents of County Asylums.

Dr. Bucknill has well argued this matter in a paper "On the Custody of the

Insane Poor" (Asylum Journal, vol. iv. p. 460), and in the course of his

remarks says,--"The insane cannot live on a low diet; and while they

continue to exist, their lives are rendered wretched by it, owing to the

irritability which accompanies mental disease. The assimilating functions

in chronic insanity are sluggish and imperfect, and a dietary upon which

sane people would retain good health, becomes in them the fruitful source

of dysentery and other forms of fatal disease."

In his just published Report, already quoted, the same excellent physician

remarks (p. 9),--"A good diet is essential to the tranquil condition of

many idiots and chronic lunatics, and is, without doubt, a principal

reason why idiots are easily manageable in this asylum, who have been

found to be unmanageable in union houses. The Royal Commission which has

recently reported on the Lunatic Asylums in Ireland states this fact

broadly, that 'the ordinary workhouse dietary is unsuited and insufficient

for any class of the insane.' It is therefore my opinion, founded upon the

above considerations, that neither the lunatics nor the idiots in the list

presented are likely to retain their present state of tranquillity, and to

be harmless to themselves and others, if they are placed in union houses,

unless they are provided with those means which are found by experience to

ensure the tranquillity of the chronic insane, and especially with a

sufficient number of trustworthy attendants, and with a dietary adapted to

their state of health. I have thought it desirable to ascertain the

practice of charitable institutions especially devoted to the training of

idiots, and I find that a fuller dietary is used in them than in this

asylum."

Until a recent date, it was the custom in workhouses, with few exceptions,

to allow most of their insane inmates to mingle with the ordinary pauper

inmates of the same age and sex, and in general to be very much on the

same footing with them "in everything that regards diet, occupation,

clothing, bedding, and other personal accommodation" (Report, 1847, p.

276).

This mingling of the sane and insane, having been found subversive of good

order and management, gave rise first to the plan of placing most of the

latter class in particular wards, many of them in the infirmary, and,

subsequently, owing to the advance of public opinion respecting the wants

of the insane, to the construction, in many unions, of special lunatic

wards, emulating more or less the character and purposes of asylums. The

false economy of this plan has been already exposed; and although the

Lunacy Commissioners have always set their faces against lunatic wards,

yet their construction has of late been so rapid as to call forth a more

energetic denunciation of it:--"Impressed strongly (the Commissioners

write, Report, 1857, p. 17) with a sense of their many evils, it became

our duty, during the past year, to address the Poor-Law Board against the

expediency of affording any encouragement or sanction to the further

construction, in connexion with Union Workhouses, of lunatic wards."

The evils of lunatic wards, alluded to in the last-quoted paragraph, are

thus enlarged upon in another page of the same Report (p. 15):--"It is

obvious that the state of the workhouses, as receptacles for the insane,

is becoming daily a subject of greater importance. They 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. Indeed it

will often happen that residence in a workhouse, under such conditions, is

beneficial to patients of this last-mentioned class; by the inducements

offered, from the example of those around them, to engage in ordinary

domestic duties and occupations, and so to acquire gradually the habit of

restraining and correcting themselves. But these are now unhappily the

exceptional cases. Many of the larger workhouses, having lunatic wards

containing from 40 to 120 inmates, are becoming practically lunatic

asylums in everything but the attendance and appliances which ensure the

proper treatment, and above all, in the supervision which forms the

principal safeguard of patients detained in asylums regularly constituted.

"The result is, that detention in workhouses not only deteriorates the

more harmless and imbecile cases to which originally they are not

unsuited, but has the tendency to render chronic and permanent such as

might have yielded to early care. The one class, no longer associating

with the other inmates, but congregated in separate wards, rapidly

degenerate into a condition requiring all the attendance and treatment to

be obtained only in a well-regulated asylum; and the others, presenting

originally every chance of recovery, but finding none of its appliances or

means, rapidly sink into that almost hopeless state which leaves them

generally for life a burthen on their parishes. Nor can a remedy be

suggested so long as this workhouse system continues. The attendants for

the most part are pauper inmates, totally unfitted for the charge imposed

upon them. The wards are gloomy, and unprovided with any means for

occupation, exercise, or amusement; and the diet, essential above all else

to the unhappy objects of mental disease, rarely in any cases exceeds that

allowed for the healthy and able-bodied inmates."

The subject had previously received their attention, and is thus referred

to in their Ninth Report (p. 38):--"They are very rarely provided with any

suitable occupation or amusement for the inmates. The means of healthful

exercise and labour out of doors are generally entirely wanting, and the

attendants (who are commonly themselves paupers) are either gratuitous, or

so badly organized and so poorly requited, that no reliance can be placed

on the efficiency of their services. In short, the wards become in fact

places for the reception and detention of lunatics, without possessing any

of the safeguards and appliances which a well-constructed and well-managed

lunatic asylum affords. Your Lordship, therefore, will not be surprised to

learn that while we have used our best endeavours to remedy their obvious

defects and to ameliorate as far as possible the condition of their

inmates, we have from the first uniformly abstained from giving any

official sanction or encouragement to their construction."

They further make this general observation:--"So far as the lunatic and

idiotic inmates are concerned, the condition of the workhouses which have

separate wards expressly appropriated to the use of that class, is

generally inferior to that of the smaller workhouses, and in some

instances extremely unsatisfactory."

Dr. Bucknill, whose excellent remarks on lunatic wards in their economical

aspect we have already quoted, has very ably canvassed the question of

their fitness as receptacles for the insane, and, in a paper in the

'Asylum Journal' (vol. iii. p. 497), thus treats on it:--"It is deserving

of consideration, whether the introduction of liberally-conducted lunatic

wards into a Union Workhouse would not interfere with the working of the

latter in its legitimate scope and object. A workhouse is the test of

destitution. To preserve its social utility, its economy must always be

conducted on a parsimonious scale. No luxuries must be permitted within

its sombre walls; even the comforts and conveniences of life must be

maintained in it below the average of those attainable by the industry of

the labouring poor. How can a liberally-conducted lunatic ward be

engrafted upon such a system? It would leaven the whole lump with the

taint of liberality, and the so-called pauper bastile would, in the eyes

of the unthrifty and indolent poor, be deprived of the reputation which

drives them from its portals."

There is a general concurrence among all persons competent to form any

opinion on the matter, that workhouses are most unfit places for the

reception of recent cases of insanity. On the other hand, there is a

prevalent belief that there is a certain class of the insane, considered

"harmless," for whom such abodes are not unsuitable. The Lunacy

Commissioners, in the extract from the Eleventh Report above quoted,

partake in this opinion: let us therefore endeavour to ascertain, as

precisely as we can, the class of patients intended, and the proportion

they bear to the usual lunatic inmates of Union Workhouses.

In their 'Further Report' for 1847, the Commissioners enter into a

particular examination of the characters of the lunatics found in

workhouses, and class them under three heads (p. 257):--1st, those who,

from birth, or from an early period of life, have exhibited a marked

deficiency of intellect as compared with the ordinary measure of

understanding among persons of the same age and station; 2ndly, those who

are demented or fatuous; that is to say, those whose faculties, not

originally defective, have been subsequently lost, or become greatly

impaired through the effects of age, accident, or disease; and 3rdly,

those who are deranged or disordered in mind, in other words, labouring

under positive mental derangement, or, as it is popularly termed,

"insanity." Those in whom epilepsy or paralysis is complicated with

unsoundness of mind, although their case requires a separate

consideration, do not in strictness constitute a fourth class, but may

properly be referred, according to the character of their malady and its

effects upon their mental condition, to one or other of these three

classes.

Further on in the Report, after remarking on the difficulties besetting

their inquiry, they write (p. 274):--

"We believe, however, we are warranted in stating, as the result of our

experience thus far, that of the entire number of lunatics in workhouses,

whom we have computed at 6020 or thereabouts, two-thirds at the least, or

upwards of 4000, would be properly placed in the first of the three

classes in the foregoing arrangement; or, in other words, 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; and it is the common practice, when accommodation can be

procured, to effect the removal of such persons to a lunatic asylum, where

their vicious propensities are kept under control, and where, if they

cannot be corrected, they at least cease to be offensive or dangerous. 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."

The conclusion to be deduced from these extracts is, that one-fourth or

two-thirds, that is, one-sixth of the whole number of occupants in

workhouses of unsound mind, found in 1846, were unfit for those

receptacles, and demanded the provision of institutions in which a moral

discipline could be carried out, and their whole condition, as social

beings, ameliorated and elevated. A further examination of the data

supplied in the same Report will establish the conviction that, besides

the proportion just arrived at, requiring removal to fitting asylums,

there is another one equally large demanding the same provision.

In this number are certainly to be placed all those of the third class

"labouring under positive mental derangement," and who, although reported

as "comparatively few" in 1846, have subsequently been largely multiplied,

according to the evidence of the 'Eleventh Report' (_ante_, p. 56). Those,

again, "in whom epilepsy or paralysis is complicated with unsoundness of

mind," are not suitable inmates for workhouse wards. No form of madness is

more terrible than the furor attendant on epileptic fits; none more

dangerous; and, even should the convulsive affection have so seriously

damaged the nervous centres that no violence need be dreaded, yet the

peril of the fits to the patient himself, and their painful features,

render him an unfit inmate of any other than an establishment provided

with proper appliances and proper attendants. As to the paralytic insane,

none call for more commiseration, or more careful tending and

nursing--conditions not commonly to be found in workhouses.

The Commissioners in Lunacy have not omitted the consideration of

workhouses as receptacles for epileptics and paralytics, and have arrived

at the following conclusions:--After treating, in the first place, of

epileptics whose fits are slight and infrequent, and the mental

disturbance mild and of short duration, they observe that, as such persons

"always require a certain amount of supervision, and as they are quite

incompetent, when the fits are upon them, to take care of themselves, and

generally become violent and dangerous, it would seem that the workhouse

can seldom be a suitable place for their reception, and that their

treatment and care would be more properly provided for in a chronic

hospital especially appropriated to the purpose."

Concerning paralytics, they state that they are far less numerous than

epileptics, and being for the most part helpless and bedridden, are

treated as sick patients in the infirmary of the workhouse. Their opinion

is, however, that a chronic hospital would be a more appropriate

receptacle for them,--a conclusion in which all must coincide, who know

how much can be done to prolong and render more tolerable their frail and

painful existence, by good diet and by assiduous and gentle nursing,--by

such means, in short, as are not to be looked for in establishments where

rigid economy must be enforced, and pauper life weighed against its cost.

To turn now to the second class of workhouse Lunatic Inmates, the demented

from age, accident, or disease: these, we do not hesitate to say, are not

suitably accommodated in workhouses, for, like the paralytic, they require

careful supervision, good diet and kind nursing; they are full-grown

children, unable to help or protect themselves, to control their habits

and tendencies; often feeble and tottering, irritable and foolish, and,

without the protection and kindness of others, the helpless subjects of

many ills. For such, the whole organization of the workhouse is unsuited;

even the infirmary is not a fitting refuge; for, on the one hand, they are

an annoyance to the other inmates, and, on the other, pauper nurses--whose

office is often thrust upon them without regard to their fitness for

it,--are not fitting guardians for them. In fine, where age, accident or

disease has so deteriorated the mental faculties, we have a complication

of physical and mental injury to disqualify the patient from partaking

with his fellow-paupers in the common accommodation, diet, and nursing.

In the reverse order which we have pursued, the first class of congenital,

imbecile, and idiotic inmates comes to be considered last. This happens by

the method of exclusion adopted in the argument; for the second and third

classes have been set aside as proper inmates of some other institution

than a workhouse, and it now remains to inquire, who among the

representatives of the first class are not improperly detained in

workhouses. This class includes, as already seen, some two-thirds of the

whole number of inmates mentally disordered; and among whom, we presume,

are to be found those individuals who may, in the Commissioners' opinion,

mix advantageously with the general residents of the establishment. The

number of the last cannot, we believe, be otherwise than very small; for

the very supposition that there is imbecility of mind, is a reason of

greater or less force, according to circumstances, for not exposing them

to the contact of an indiscriminate group of individuals, more especially

of that sort to be generally found in workhouses. The evils of mingling

the sane and insane in such establishments have already been insisted

upon; and besides these, such imbecile patients as are under review, lack

in workhouses those means of employment and diversion which modern

philanthropy has suggested to ameliorate and elevate their physical and

moral condition.

Lastly, if the remaining members of this class be considered, in whom the

imbecility amounts to idiocy, the propriety of removing them from the

workhouse will be questioned by few. Indeed, will any one now-a-days

advocate the "_laissez faire_" system in the case of idiots? Experience

has demonstrated that they are improveable, mentally, morally, and

physically; and if so, it is the duty of a christian community to provide

the means and opportunities for effecting such improvement. It cannot be

contended that the workhouse furnishes them; on the contrary, it is

thoroughly defective and objectionable by its character and arrangements,

and, as the Commissioners report, (_op. cit._ p. 259) a very unfit abode

for idiots.

On looking over the foregoing review of the several classes of lunatic

inmates of workhouses distinguished by the Commissioners in Lunacy, the

opinion to be collected clearly is, that only a very few partially

imbecile individuals among them are admissible into workhouses, if their

bodily health, their mental condition, their due supervision and their

needful comforts and conveniences are to be duly attended to and provided

for. In accordance with the views we entertain, as presently developed, of

the advantages of instituting asylums for confirmed chronic, quiet, and

imbecile patients, we should permit, if any at all, only such imbecile

individuals as residents in workhouses, who could pass muster among the

rest, without annoyance, prejudice or discomfort to themselves or others,

and be employed in the routine occupations of the establishment.

So much is heard among poor-law guardians and magistrates about a class of

"harmless patients" suitably disposed of in workhouses and rightly

removeable from asylums, that a few remarks are called for concerning

them. To the eye of a casual visitor of an asylum, there does certainly

appear a large number of patients, so quiet, so orderly, so useful and

industrious, that, although there is something evidently wrong about their

heads, yet the question crosses the mind, whether asylum detention is

called for in their case. The doubt is not entertained by the experienced

observer, for he knows well that the quiet, order, and industry observable

are the results of a well-organized system of management and control; and

that if this fails, the goodly results quickly vanish to be replaced by

the bitter fruits generated by disordered minds. The "harmless" patient of

the asylum ward becomes out of it a mischievous, disorderly, and probably

dangerous lunatic. In fact, the tranquillity of many asylum inmates is

subject to rude shocks and disturbances, even under the care and

discipline of the Institution; and the inoffensive-looking patient of

to-day may, by his changed condition, be a source of anxiety, and a

subject for all the special appliances it possesses, to-morrow.

Any Asylum Superintendent would be embarrassed to select a score of

patients from several hundred under his care whom he could deliberately

pronounce to be literally "harmless" if transferred to the workhouse. He

might be well able to certify that for months or years they have gone on

quietly and well under the surrounding influences and arrangements of the

asylum, but he could not guarantee that this tranquillity should be

undisturbed by the change to the wards of the workhouse; that untrained

attendants and undesirable associates should not rekindle the latent

tendency to injure and destroy; that defective organization and the

absence of regular and regulated means of employment and recreation should

not revive habits of idleness and disorder; or that a less ample dietary,

less watchfulness and less attention to the physical health, should not

aggravate the mental condition and engender those disgusting habits, which

a good diet and assiduous watching are known to be the best expedients to

remedy.

Dr. Bucknill has some very cogent remarks on this subject in his last

Report of the Devon Asylum (p. 6). "The term 'harmless patients,' or in

the words of the statute, those 'not dangerous to themselves or others'

(he writes), I believe to be inapplicable to any insane person who is not

helpless from bodily infirmity or total loss of mind: it can only with

propriety be used as a relative term, meaning that the patient is not so

dangerous as others are, or that he is not known to be refractory or

suicidal. It should not be forgotten, that the great majority of homicides

and suicides, committed by insane persons, have been committed by those

who had previously been considered harmless; and this is readily explained

by the fact, that those known to be dangerous or suicidal are usually

guarded in such a manner as to prevent the indulgence of their

propensities; whilst the so-called harmless lunatic or idiot has often

been left without the care which all lunatics require, until some mental

change has taken place, or some unusual source of irritation has been

experienced, causing a sudden and lamentable event. In an asylum such

patients may truly be described as not dangerous to themselves or others,

because they are constantly seen by medical men experienced in observing

the first symptoms of mental change or excitement, and in allaying them by

appropriate remedies; they are also placed under the constant watchfulness

and care of skilful attendants, and they are removed from many causes of

irritation and annoyance to which they would be exposed if at large, in

villages or union houses.

"It not unfrequently happens that idiots who have lived for many years in

union houses, and have always been considered harmless and docile, under

the influence of some sudden excitement, commit a serious overt act, and

are then sent to an asylum. One of the most placid and harmless patients

in this asylum, who is habitually entrusted with working tools, is a

criminal lunatic, of weak intellect, who committed a homicide on a boy,

who teased him while he was breaking stones on the road. If this is the

case with those suffering only from mental deficiency, it is evidently

more likely to occur in those suffering from any form of mental disease,

which is often liable to change its character, and to pass from the form

of depression to one of excitement. For these reasons I am convinced that

all lunatics, and many strong idiots, can only be considered as 'not

dangerous to themselves or others,' when they are placed under that amount

of superintendence and care which it has been found most desirable and

economical to provide for them in centralized establishments for the

purpose.

"For the above reasons, I am unable to express the opinion that any insane

patients who are not helpless from bodily infirmity or total loss of mind

are _unconditionally_ harmless to themselves and others. I have, however,

made out a list of sixty patients who are incurable, and who are likely,

_under proper care_, to be harmless to themselves and others.

"Of the patients in this list who are lunatic, only nine have sufficient

bodily strength to be engaged in industrial pursuits. The remaining

twenty-three are so far incapacitated by the infirmities of old age, or by

bodily disease, or by loss of mental power, that they are unable to be

employed, and require careful nursing and frequent medical attendance. The

patients who have sufficient bodily strength to be employed, are also with

the least degree of certainty to be pronounced harmless to themselves and

others. As the result of long training, they willingly and quietly

discharge certain routine employments under proper watch; but it is

probable, that if removed from their present position, any attempts made

to employ them by persons unaccustomed to the peculiarities of the insane,

will be the occasion of mental excitement and danger.

"The twenty-eight idiots have, with few exceptions, been sent to the

asylum from union houses, where it has been found undesirable to detain

them, on account either of their violent conduct, or of their dirty

habits, or some other peculiarity connected with their state of mental

deficiency; habits of noise or indecency for instance."

Probably the following extract from the Report of the Committee of the

Surrey Asylum (1856) may have more weight with some minds than any of the

arguments and illustrations previously adduced, to prove that the

detention of presumed "harmless patients" in workhouses will not answer.

The declaration against the plan on the part of the Surrey magistrates is

the more important, because they put it into practice with the persuasion

that it would work well. But to let them speak for themselves, they

write,--"The committee adverted at considerable length in their last

Annual Report to the circumstance of the asylum being frequently unequal

to the requirements of the County, and of their intention to attempt to

remedy the defect by discharging all those patients, who, being harmless

and inoffensive, it was considered might be properly taken care of in

their respective union houses.

"The plan has been tried, and has not been successful. Patients who, under

the liberal and gentle treatment they experience in the asylum, are quiet

and tractable, are not necessarily so under the stricter regulations of a

workhouse; indeed, so far as the experiment has been tried, the reverse

has been found to be the case; most of the patients so discharged having

been shortly afterwards returned to the asylum, or placed in some other

institution for the insane, in consequence of their having become, with

the inmates of the workhouse, 'a mutual annoyance to each other.' Any

arrangement, short of an entire separation from the other inmates of the

workhouse, will be found to be inefficient." This is the same as saying

that if lunatics are to reside in workhouses, a special asylum must be

instituted in the establishment for their care, and the comfort and safety

of the other inmates.

If the well-being of the insane were the only question to be settled, no

difficulty would attend the solution, for experience has most clearly

evidenced the vast advantages of asylums over workhouses as receptacles

for insane patients, whatever the form or degree of their malady. Dr.

Bucknill has some very forcible remarks in his paper on "The Custody of

the Insane Poor" (Asylum Journal, vol. iv. p. 460), with illustrative

cases; and in his Report last quoted, reverts to this subject of the

relative advantages of asylums and workhouses; but we forbear to quote, if

only from fear of being thought to enlarge unduly upon a question which

has been decided long ago by the observation and experience of all those

concerned in the management of the pauper insane; viz. that whatever the

type and degree of mental disorder and of fatuity, its sufferers become

improved in properly managed asylums, as intellectual, moral, and social

beings upon removal from workhouses; and by a reverse transfer, are

deteriorated in mind, and rendered more troublesome and more costly. To

the workhouse the lunatic ward is an excrescence, and its inmates an

annoyance: in its organization, there is an absence or deficiency of

almost all those means conducive to remedy or remove the mental infirmity,

and the very want of which contributes as much as positive neglect and

maltreatment to render the patient's condition worse, by lowering his

mental and moral character. But such deterioration or degradation is not

an isolated evil, or the mere negation of a better state; for it acts as a

positive energy in developing moral evil, and brings in its train

perverseness, destructiveness, loss of natural decency in habits,

conversation and conduct, and many other ills which render their subjects

painfully humiliating as human beings, and a source of trouble, annoyance,

and expense to all those concerned with them.

In a previous page we have sought to determine what was the proportion of

lunatic inmates found by the Lunacy Commissioners in workhouses considered

to be not improperly detained in them, and have estimated it at one-half

of the whole number. The foregoing examination, however, of the adaptation

of workhouses for the several classes of lunatics distinguishable, leads

to the conviction that a very much less proportion than one-half ought to

be found in those establishments. For our own part, we would wish to see

the proportion reduced by the exclusion of most of its component members,

reckoned as "harmless" patients; a reduction which would well nigh make

the proportion vanish altogether. What is to be done with the lunatics

removed from workhouses, is a question to be presently investigated.

But before proceeding further, some consideration of the legal bearings of

workhouse detention of lunatics is wanting, for it has been advanced by

some writers that such detention is illegal.

Now, in the first place, it must be admitted that a workhouse is not by

law, nor in its intent and purpose, a place of imprisonment or detention.

Its inmates are free to discharge themselves, and to leave it at will when

they no longer stand in need of its shelter and maintenance. Whilst in it,

they are subject to the general rules of workhouse-government, and to a

superior authority, empowered, if not by statute, yet by orders of the

Poor-Law Board, or by Bye-Laws of the Guardians, to exercise discipline by

the enforcement of penalties involving a certain measure of punishment.

Temporary seclusion in a room may be countenanced, although not positively

permitted by law; but prolonged confinement, the deprivation of liberty,

and a persistent denial of free egress from the house, are proceedings

opposed to the true principles of English law.

Yet it may be that a plea for their detention might be sustained in the

case of sick or invalid patients (with whom the insane would be numbered)

under certificate of the parochial medical officer, provided no friend

came forward to guarantee their proper care, or that they could not show

satisfactorily the means of obtaining it; for, of such cases, the

workhouse authorities may be considered the rightful and responsible

guardians, required in the absence of friends to undertake their charge

and maintenance. Upon such grounds, probably, cause might be shown for the

detention of the greater part of workhouse lunatic inmates, although there

is no Act of Parliament explicitly to sanction it. Should such a plea be

admitted, the notion, entertained by Dr. Bucknill, that an action would

lie for false imprisonment against the Master and Guardians of the

workhouse, would be found erroneous.

The Lunacy Commissioners presented some remarks on this question,

indicating a similar view to that just advanced in their 'Further Report,'

1847. For instance (p. 287, _op. cit._), they observed:--