COURSE OF LUNACY LEGISLATION.
I now resume the thread of my history at the time of the exposure of the
abuses at the old York Asylum.
We have already intimated that the treatment adopted at the Retreat, and
made known to the public by various writers and by many visitors, but
more especially by the "Description," exerted a remarkable influence on
the subsequent inquiry and legislation. The success of the Retreat
excited the jealousy and antipathy of the superintendent of the York
Asylum; the discussion which ensued led to investigation; the
revelations which followed excited public opinion; the representatives
of the people undertook an inquiry by means of a Select Committee, which
finally necessitated legislation, and this legislation by successive
enactments wrought the wondrous and beneficial change which we now
witness. This sequence of events will be found to be borne out by facts,
by any one who will investigate the literature of lunacy from 1792 to
the present time. Sydney Smith says, writing in 1817,[140] that "the
new Establishment began the great revolution upon this subject, which
we trust the provisions of Parliament will complete.... In the course of
a few years the Institution had done so much by gentle methods, that a
modest and well-written volume, giving an account of it, excited
universal interest, and, in fact, achieved what all the talents and
public spirit of Mason and his friends had failed to accomplish. It had
still better effects. A very inoffensive passage in this book roused, it
seems, the animosity of the physician to the York Lunatic Asylum, and a
letter which this gentleman published in one of the York newspapers,
became the origin of a controversy among the governors of that
establishment, which terminated in August, 1814, after a struggle of
nearly two years, in the complete overthrow of the old system, and the
dismission of every officer of the asylum, except the physician himself.
The period is not remote when lunatics were regarded as beings
unsusceptible of mental enjoyment or of bodily pain, and accordingly
consigned without remorse, to prisons under the name of mad-houses--in
the contrivance of which nothing seems to have been considered, but how
to enclose the victim of insanity in a cell, and to cover his misery
from the light of day. But the success of the Retreat demonstrated, by
experiment, that all the apparatus of gloom and confinement was
injurious; and the necessity for improvement becoming daily more
apparent, a 'Bill for the Better Regulation of Mad-houses' was brought
into Parliament by Mr. Rose in 1813, but was nevertheless opposed and
finally withdrawn; and another Bill, in 1814,[141] though it passed the
Commons, was rejected by the House of Lords. The public, in fact, was
not yet aware of the atrocious evils which these Bills were intended to
remove; and it was not until now that the course was adopted, which, in
every case of public grievance, is the only sure one for obtaining
redress. A Committee of the House of Commons, appointed for the purpose
of inquiry in 1814, and revived in the following year, was fortunately
composed of men determined to do the business they had undertaken."[142]
Mr. Rose, on the 28th of April, 1815, again introduced the subject of
private mad-houses to Parliament, and, dwelling on the great abuses
connected with them, pointed out the necessity of their condition being
examined into by the House. He said that among the cases which had
recently come to his knowledge was that of a young woman who, although
requiring some restraint, was perfectly harmless. She was found chained
to the ground by both legs and arms, a degree of cruelty which was in no
respect justified. With a view of correcting such practices, he moved
"that a Committee be appointed to consider of provision being made for
the better regulation of mad-houses in England, and to report the same,
with their observations thereupon, to the House."[143] The motion was
agreed to.
The York Lunatic Asylum stood first upon the evidence before the Select
Committee. "It appears from the history of that institution, which was
published at the close of the controversy above alluded to, that the
victory of the reformers was not obtained without strong opposition;
for, at the very moment when the state of things that we shall presently
detail was flourishing in full enormity, their opponents were enabled to
carry a resolution of the governors, declaring that a lunatic, who
appears to have sustained gross injury, 'had been treated with all
possible care, attention, and humanity,' and censuring the parties who
brought forward the complaint.... On a subsequent day thirteen spirited
men (including Mr. Higgins and Mr. Tuke) determined to _enforce_
investigation; and, having qualified themselves as governors by paying
the requisite donation of L20 each, succeeded in obtaining the
appointment of a Committee to inquire into the complaints that had been
exhibited; which, after meeting for several successive days, and
examining witnesses, concluded by adopting Resolutions of censure upon
the proceedings proved before them."[144]
One day Mr. Higgins went to the asylum. After having seen all the
patients' rooms, he went with the steward to the kitchen. There he was
struck with "the retired appearance" of a door. He ordered a keeper to
unlock it. He perceived fear and hesitation. He repeated his order in
stronger language. The key not being readily forthcoming, Mr. Higgins
grew warm, and declared he would soon find a key that would open it at
the kitchen fireside. It was then opened. He went in, and discovered a
row of cells, four in number, which had been concealed from the
committee of investigation. On entering the first cell, he found it in a
state dreadful beyond description. The cell was about eight feet and a
half square, perfectly dark when the door was shut, and the stench
almost intolerable. He was told these cells were occupied at night by
thirteen women, who were then upstairs; where he found them in a room
twelve feet long by seven feet ten inches wide, with a window, which not
opening would not admit of ventilation. Sydney Smith well says, after
citing more horrible details than I have given, that he is aware of the
disgust which they will cause, but that he cannot spare his readers, and
asks of the most delicate of them whether it is more shocking that these
things should exist unknown, and consequently unredressed, than that
they should be told and punished, and _remembered for ever, as the only
means of preventing their recurrence_.
To enter into much detail is impossible. It must suffice to say that
case after case of gross neglect and cruelty was brought to light; that
while 365 patients had died, only 221 had been reported; that a patient
having been killed, his body was hurried away to prevent an inquest;
that when the accounts were examined, it was discovered that two sets of
books of receipts were kept, one of which was only presented to the
governors, and that the difference between the sums contained in the
two, amounting to some hundreds a year, found its way into the pocket of
the superintendent; and lastly we must record that one wing of the
asylum was burned, involving the deaths of patients and the destruction
of much that it was with good reason believed the authorities wished to
conceal.
Of the revelations made by the Committee of the House of Commons in
regard to Bethlem Hospital, we shall only briefly speak. We have already
sketched the history of this institution. For the most part it is to the
_second_ Bethlem--that in Moorfields--the minutes of evidence refer.
During the seven years prior to the investigation, the number of
patients averaged 238; the annual expenditure, L12,000. Mr. Haslam, the
resident apothecary, ruled supreme. He was responsible for the dreadful
condition in which the notorious Norris was discovered. "There is," says
Sydney Smith, "much evasive testimony, to shift from himself the burden
of this atrocious case; but his efforts tend rather to confirm than to
shake the conviction which the evidence produces.... The conduct of
Haslam with respect to several other patients was of a corresponding
description; and in the case of a gentleman whose death was evidently
accelerated by the severities he underwent, and of several other
persons, there is abundant proof of cruelty.... It is in proof that a
patient actually died, through mere neglect, from the bursting of the
intestines, overloaded for want of aperient medicine, and it is
expressly stated by Haslam himself that a person whom he asserts to have
been '_generally insane and mostly drunk_,' whose condition, in short,
was such 'that his hand was not obedient to his will,' was nevertheless
retained in the office of Surgeon, and continued to attend the patients
for a period of _ten years_--a statement so atrocious that, from any
other quarter, we should have rejected it as utterly incredible."[145]
The governors easily convinced themselves that no foundation whatever
existed for the charge of cruelty and bad management; that every degree
of permissible indulgence had been observed; that the hospital was
equal, if not superior, to any other asylum in England; that the mode of
confining the unhappy Norris appeared "to have been, upon the whole,
rather a merciful and humane, than a rigorous and severe imposition;" in
short, that "the general management of Bethlem, as affecting the health,
the cleanliness, and the comfort of the patients, was of a nature
_creditable to the governors and others concerned in its
administration_." What a picture of the standard of excellence held by
the managers of asylums at that period, not in Bethlem alone, but
generally!
To the question, "Has there not been a rule in the hospital, for a
certain number of years, that, in certain months of the year,
particular classes of the patients should be physicked, bled, bathed,
and vomited, at given periods?" the reply from Bethlem was in the
affirmative. Twice in the year the patients, with few exceptions, were
bled. "After they have been bled," said the physician, in evidence,
"they take vomits once a week for a certain number of weeks; after that,
we purge the patients. That has been the practice, invariably, for
years--long before my time."
In regard to the means of coercion employed, it was stated that the
patients "are generally chained to the wall with manacles." When inquiry
was made regarding the use of strait waistcoats, it was replied, "I do
not believe there are any strait waistcoats in Bethlem now, or very few
indeed; they generally use irons." The objection to strait waistcoats
was, that the patients "could not help themselves in strait waistcoats;
they are so excessively long in the hospital without being seen by
anybody, in a dark place; in winter, from four o'clock to six or seven
in the morning. If they were in a strait waistcoat they could not assist
themselves the least in the world." When, in the following year, the
head-keeper of Bethlem Hospital was asked, "Was it not the practice in
old Bethlem--not in the late gallery, but in the gallery pulled
down--for eight, ten, or more patients to be fastened to the tables,
almost in a state of perfect nakedness?" he replied, "Yes; they used to
think they tore their clothes all to pieces; some of them would do
that." "In point of fact, were they not fastened to the tables, sitting
in a state of perfect nudity?" Answer: "They used to be so at the
table; they were chained all round." In regard to the apparatus, so
ingeniously cruel, by which one of the patients (Norris) was chained ten
or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you
think that his confinement in that manner during the whole of that
period was necessary?" replied, "Decidedly."
The matron of Bethlem Hospital (who was elected January, 1815) gave
evidence that, when she was appointed, there were about twenty patients
under personal restraint, out of between fifty and sixty patients. "The
custom when I first went was only to get them up three days of the
week--never on meat days; they lie in bed four days in the week." She
also stated that one of the female patients had been chained for eight
years, but had not required restraint since she had been there.
Bethlem, however, was far from being the only place where patients were
treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a
private asylum at Bethnal Green, gave evidence to an attendant "kicking
the patients and thumping them sadly," and "beating one in his shirt
with a pair of boots, in a most dreadful manner." She named a female
patient who, when in a state of irritation, "was confined in a place in
the yard which was originally a pig-sty; it was run up high on purpose
for her. I have seen her confined there for three weeks together. She
has been ironed there in the crib with wrist-locks, and leg-locks, and a
chain two or three times across her body." An iron bar was placed
between her legs when she walked about, to prevent her escaping. "It
was confined to each ankle, with a chain coming up between her legs,
which was attached to her handcuffs." But, in addition to this frightful
restraint, we are informed that an attendant, at the instance of the
proprietor, would, "at sundry times," lock her down in her crib with
wrist-locks and leg-locks, and horsewhip her. "I have seen the blood
follow the strokes." Yet this patient is described as very harmless;
"you might sit and talk to her when she was in the highest state."
The Committee found that at a private asylum--Fonthill, Wilts--there was
in that year, out of fourteen patients, only one without fetters or
handcuffs, and only three out of their sleeping-rooms.[146]
At the Bethnal Green Asylum "several of the pauper women were chained to
their bedsteads, naked, and only covered with a hempen rug," and "the
accommodation for paupers was infamously bad, and required immediate
reform;" while in January of the same year it is reported that "some
pauper men were chained upon their straw beds with only a rug to cover
them, and not in any way defended from the external cold."[147]
Dr. John Weir was asked, at the Committee of 1815, to what he
attributed the difference of opinion among even enlightened men as to
the management of the insane. He replied that it was chiefly due to the
want of practical observation, as it is only by comparison that we are
enabled to appreciate the superiority of one institution over another.
He added that, until within the last eighteen years, the primary object
of almost every insane institution, whether of a public or private
description, had been merely the security of these pitiable objects;
comfort, medical and moral treatment, had been in a great measure
overlooked. "Happily, however, for that class of society, the Retreat at
York had at last convinced the world how much may be done towards the
amelioration of their condition."[148]
On the 11th of July, 1815, Mr. Rose brought up the Report of this
Committee. On moving that it be printed, he said that all who read the
Report must feel satisfied of the indispensable necessity of legislative
interference. The way in which lunatics were usually confined was that
of criminals, and their treatment was in general worse than the ordinary
treatment in jails. The number of persons appointed to take care of them
was in most cases utterly insufficient, in consequence of which the
greatest severity was too frequently resorted to.
The conclusions arrived at in this celebrated Report may be thus
summarized: That keepers of houses for the insane received a much
greater number of persons than they were calculated for, thus greatly
retarding their recovery; that the number of attendants being
insufficient, there was unavoidably a larger amount of restraint than
would otherwise be necessary; that outrageous patients were mixed with
the quiet and inoffensive; that there was an absence of medical
attention to the malady for which the patients were confined; that the
certificates on which patients were received into asylums were
insufficient, and that the visitation of private mad-houses was
defective.
The Report concluded that "some new provision of law is indispensably
necessary for ensuring better care being taken of insane persons, both
in England and Ireland, than they have hitherto experienced; the number
of whom appear to be very considerable, as the inquiries of the
Committee have convinced them that there are not in the country a set of
beings more immediately requiring the protection of the legislature than
the persons in this state, a very large proportion of whom are entirely
neglected by their relatives and friends. If the treatment of those in
the middling or in the lower classes of life shut up in hospitals,
private mad-houses, or parish workhouses, is looked at, your Committee
are persuaded that a case cannot be found where the necessity for a
remedy is more urgent."
The evidence taken before the Committee of 1815 was so full and
convincing that it would have seemed wholly unnecessary to have required
a further disclosure of the abuses rampant in the asylums of England,
but in consequence of the demand for further investigation before the
House of Commons committed itself to legislation, a mass of further
particulars was obtained in 1816 in regard to the state of various
institutions, including Bethlem Hospital and the York Asylum.
In February Mr. Rose had said in the House that, as chairman of the
Committee for inquiry into the conduct of mad-houses, he was instructed
to move for leave to bring in a Bill for the better regulation of such
establishments. But some gentlemen of the Committee being desirous that
further investigation should take place, he had acceded to their wish,
although the majority concurred with him in thinking that sufficient
evidence had already been adduced to justify the proposal of a Bill.
Therefore, he should propose, instead of a Bill, that a Committee be
appointed to consider of provision being made for the better regulation
of mad-houses in England, and report the same, with their observations
thereupon, to the House.
On May 28th Mr. Rose brought up the Report of the Committee, and
obtained leave to bring in a Bill pursuant thereto. This Bill was for
the repeal of the 14th and 55th of the King. He said[149] the Committee
had, after the most patient investigation, adopted the provisions of the
present Bill, which principally were, that instead of the physicians of
the neighbourhood, or those in or near the metropolis, together with a
neighbouring magistrate, being the inspectors of such establishments,
they should be twice a year examined, etc., by eight Commissioners
appointed by the Secretary of State for the Home Department throughout
the kingdom; the Commissioners to be assisted by two of the local
magistrates in each district, and with equal powers. There was also a
provision in the Bill relative to the erection of lunatic asylums in
counties, and the ordering the reception therein of pauper lunatics
allowed at present to range abroad, to their own and the public injury.
On the 17th of June, Mr. Rose moved that the clauses of this Bill be
taken into further consideration. Lord R. Seymour observed that when
Parliament in 1774 passed the "Bill for the Regulation of Licensed
Mad-houses," it must have meant to do three things: (1) To secure all
persons against unnecessary confinement; (2) to better the chance of
recovery of all such persons confined as being insane, as well by moral
treatment as by the use of medicine; and (3) to insure the restoration
of all who might become again of sound mind to society. But the
Mad-house Act, he said, does none of these three things, for it does not
empower the Commissioners to discharge a patient, however sound in mind;
nor does it furnish them with the means of enforcing the observance of
any improvement they may recommend. The Commissioners, indeed, may
withdraw the licence, but the keeper of such a house must again have it
on the next licensing day, if he wishes, upon giving the necessary
security. It was not surprising, therefore, that the greatest abuses
should have been found to prevail.
Mr. Wynn expressed a wish that magistrates should be empowered to
examine houses where only one patient was confined.[150]
This Bill passed the House, but was rejected by the House of Lords.
Thus all the mass of valuable and decisive evidence which had been
collected with so much labour, and had occupied the time and thought of
two Committees of the House of Commons, was, for the time, thrown away,
and the misery of the inmates of asylums allowed to go unrelieved. The
facts, however, had been made widely known. The inertia, torpor, and
indifference to human suffering--in short, the crime which characterized
the majorities who threw out the Bills calculated to remove the abuses
in asylums, had at last to give way to the popular demand. What was
gained by prolonging the dismal condition of these abodes of woe for
some years longer, I leave others to discover.
After the lapse of three years, namely, on the 10th of March, 1819, Mr.
Wynn[151] rose to move for leave to bring in a "Bill for the Regulation
of Mad-houses," and observed that, as this subject had been already
several times before the House, he did not feel it necessary to trespass
long upon its attention. It would be remembered, he said, that some
years ago the Report of a Committee had been laid before the House,
detailing such scenes of misery and wretchedness in mad-houses, as had
perhaps never been paralleled, and after such an exposure it was the
obvious duty of the House to follow up the Report by the adoption of
some legislative measure calculated to put an end to the evils
complained of. There was, however, no fault to be found with the
conduct of that House; for it had done its duty by repeatedly sending up
a Bill to the other House, which it had thought proper to reject.
Although no mad-houses could be legally opened without a licence, the
College of Physicians was not in possession of funds to prosecute. He
therefore proposed that a general Board of Inspection for mad-houses
should be appointed, and that the members of that Board should be at
liberty to visit such houses throughout the country, at different and
uncertain times, so as to ascertain the manner in which they were
conducted, and to report any existing evil to the Board, which should be
invested with power to enforce their correction. Mr. Wynn moved for
leave to bring in a Bill for repealing the Act of the 14th and 55th of
the King with respect to mad-houses, and for making other provisions for
their better regulation.[152]
Leave was given to bring in the Bill.
In June of the same year the Marquis of Lansdowne, speaking on the Bill
in the House of Lords, said that nothing could more forcibly appeal to
the humanity of their lordships than the state of the unfortunate
insane, and the legislative means of preventing abuses of the most
flagrant and revolting nature, which had long been too clearly proved.
Strange to say, however, the Lord Chancellor (Lord Eldon) opposed the
Bill, observing that there could not be a more false humanity than an
over-humanity with regard to persons afflicted with insanity. (Is not an
under-humanity nearly as false?) He admitted there were great abuses,
but the better way to remedy them would be to take a cool and
dispassionate view of the subject in a Committee, next session. As if
there had not been Committees enough! With regard to pauper lunatics,
the Lord Chancellor went so far as not only to admit there were great
abuses, but to agree to a short Bill, if desired, embodying the clauses
relating to them in the measure before the House.
The Bill was thrown out, only fourteen doing themselves the credit of
voting in its favour, while thirty-five voted against it. Majority
against the Bill, twenty-one.
An "Act for making Provision for the Better Care of Pauper Lunatics in
England"[153] was, however, passed (July 12, 1819), but it consisted of
three sections only, and does not appear to be an advance, in any
essential particular, upon previous Acts. The form of the medical
certificate for a pauper lunatic is prescribed.[154] Again, the Act is
permissive as regards the action of the justices in causing the
overseers to bring the lunatic before them, and calling in a medical man
to their assistance.
Four years afterwards, on June 30, 1823, the subject of private
mad-houses again came before the House. A petition from John Mitford for
an inquiry into the state of private mad-houses was ordered to lie on
the table. Mr. Wynn, as on a former occasion, spoke, and observed that
three Bills had, at recent periods, been sent up from that House to the
Lords, relative to the inspection of houses of this description. He
regretted to say they had not been passed. It is extraordinary that Mr.
Wynn should have ended his speech by saying that, although he believed
abuses might exist in some of these establishments, they were on the
whole well conducted. Mr. (afterwards Lord) Brougham said that he knew
Dr. Warburton, against whom charges had been brought, and that his
character stood equally high both for medical skill and for humanity!
Writing in 1827, Sir Andrew Halliday[155] says, "The evidence taken
before Mr. Rose's Committee, which sat for more than one session, must
be fresh in the recollection of every one of my readers.... He was at
great pains to prepare a Bill which, in the opinion of all who had heard
the evidence, and had taken a disinterested part in the investigation,
was well calculated to remedy every evil either ascertained or
anticipated. The subject was dispassionately canvassed in the Lower
House, and the Bill passed by the Commons, almost unanimously, three or
four several times; but it was uniformly rejected by the Lords, and
after Mr. Rose's death it got into Chancery, and there it has slept for
the last _nine years_. I do not mean this remark in any manner as a
jest; for, literally and truly, the late Lord Chancellor [Lord Eldon]
took the whole matter upon his own shoulders, and promised to prepare a
measure more suited to the exigencies of the sufferers than any that the
collected wisdom of the Commons of England, in Parliament assembled,
could think or devise.... The House of Commons has again taken up the
matter, and I trust they will not abandon it, even though they should be
opposed, until some provision is made against the recurrence of those
evils, very trifling in comparison of former times, which during their
last short inquiry were found still to exist." Sir A. Halliday points
out that, although twenty years had elapsed since Mr. Wynn's Act passed
(having received subsequently several amendments), asylums had only been
opened in the counties of York (Wakefield, 1818), Lancaster (1816),
Nottingham (1812), Norfolk (1814), Stafford (1818), Bedford (1812),
Gloucester (1823), Lincoln (1820), and Cornwall (1820)--nine out of the
fifty-two counties of England and Wales. Suffolk had just finished its
building, as had Chester a short time before. Only at that very time had
the magistrates of Middlesex, after two years' deliberation, announced
that a county asylum was necessary, although it had been proved by Lord
R. Seymour that 873 persons were suffering neglect and cruel treatment
for want of it!
Returns ordered by Parliament in 1826 show that there were 1321 persons
in private asylums, exclusive of those in London and within a radius of
seven miles; 1147 in public asylums, exclusive of those in St. Luke's
and Bethlem; and 53 in public jails; giving a total of 2521 for the
several counties of England and Wales. Those in private asylums in and
near London being estimated at 1761, and the asylums of St. Luke's and
Bethlem at 500, the gross total for England and Wales was 4782. Sir
Andrew Halliday did not hesitate to assert, after very careful inquiry,
that the number actually in confinement, not only in the asylums, but
with relations and keepers, exceeded 8000. He thought there were very
few in Wales, or in "the Celtic tribes in other portions of the
empire."[156]
Before leaving Halliday, I may add that he regarded Bethlem as, at this
period, well conducted, but as having "too much of the leaven of the
dark ages in its constitution, and too rigid a system of quackery, in
regard to its being seen and visited by respectable strangers." He adds
that in some respects "it is little better than when, in fact, it formed
one of the _lions_ of the metropolis, and the patients as wild beasts
were shown at sixpence for each person admitted." Of St. Luke's he
writes, "It is only fit to become a prison for confirmed idiots." He
would have been surprised to witness how much can be effected by
improvements of various kinds, although he might still wish that it
were supplemented by some appendage in the country, if not removed there
altogether.
A very important step was taken by Mr. R. Gordon in the House of Commons
in 1827 (June 13th), by drawing attention to the pauper lunatics in
Middlesex. He particularly referred to the dreadful state of misery of
the pauper lunatics in London in the parishes of Marylebone and St.
George's. When the overseers of the latter parish visited Dr.
Warburton's asylum at Bethnal Green, they found, he said, in a room
eighteen feet long, sixteen cribs,[157] with a patient in each crib,
some of them chained and fastened down, and all of them in a state of
great wretchedness. On one occasion, a visitor having gone there and
reported that there was nothing objectionable, he repeated his visit
next day, and discovered five rooms, in which the patients were in a
most horrid state of misery; and this although the day before he was
informed that he had seen everything. The unfortunate persons placed in
these cribs were kept from Saturday night until Monday; their food being
administered to them in the cribs. Mr. Gordon moved for a Select
Committee to inquire into the condition of pauper lunatics in Middlesex,
and for leave to bring in a Bill to amend 14 Geo. III. c. 49
(1774),[158] and to extend its provisions to pauper lunatics, to
consolidate all Acts relative to lunatics and asylums, and to make
further provisions thereto.
The Committee was appointed.
It specially directed its attention to the treatment of paupers in the
parishes of Marylebone, St. George, Hanover Square, and St. Pancras,
confined in the White House at Bethnal Green, belonging to Dr.
Warburton. Its condition was frightful, and the Committee observes that
if the White House is to be taken as a fair specimen of similar
establishments, it cannot too strongly or too anxiously express its
conviction that the greatest possible benefit will accrue to pauper
patients by the erection of a county lunatic asylum.
The Committee reports that the defects and abuses in the management of
houses for the reception of lunatics, to which the Select Committee of
1815 called the attention of the House of Commons, still exist in
licensed houses where paupers are received in the neighbourhood of the
metropolis, and that similar abuses elsewhere prevail. The evidence
established that there was no due precaution with respect to the
certificate of admission, the consideration of discharge, or the
application of any curative process to the mental malady. The Committee
therefore repeated the recommendations of the Committees of 1807 and
1815, and prepared a series of propositions as the basis of future
legislation, repealing a number of Acts and recommending the
consolidation, into one Act of Parliament, of the provisions for the
insane, as well as further facilitating the erection of county asylums,
and improving the treatment of pauper and criminal lunatics.
Dr. John Bright, secretary to the Commissioners, read from their records
one entry, describing the condition of Holt's house, Lewisham, in Kent.
In the year 1820, "in a close room in the yard, two men were shut by an
external bolt, and the room was remarkably close and offensive. In an
outhouse at the bottom of the yard, ventilated only by cracks in the
wall, were enclosed three females. The door was padlocked; upon an open
rail-bottomed crib herein, without straw, was chained a female by the
wrists, arms, and legs, and fixed also by chains to the crib. Her wrists
were blistered by the handcuffs; she was covered only by a rug. The only
attendant upon all the lunatics appeared to be one female servant, who
stated that she was helped by the patients."
Subsequent entries did not show any material improvement in the
condition of the house.
Dr. Bright summarized the defects in the Lunacy Laws at that period, as
regards the power vested in the Commissioners, as follows:--
"They are very defective in many points: in the first place, with
respect to the granting licences, there is only one day in the year in
which, according to the Act, the licences can be granted; then with
respect to persons to whom the licence may be granted, any person
applying for that licence is entitled to have one; again, any person
committing any offence, save and except the refusing admission to
Commissioners on their visitations, may be continued and is continued in
the exercise of such powers as that licence communicates to him; the
Commissioners have no power to disturb in the management of his house
any keeper of a house, whatever offences he may have committed, or
however unworthy he may appear to them to be. Supposing any person who
had, in the eyes of the Commissioners, acted improperly, to apply in
October, at the usual and the only period in the year for granting
licences, they conceive (and they are advised) that they are obliged to
grant a licence to that individual. There is another circumstance which
I think is very important, which is the certificate which is granted;
the Act is vague with respect to the medical person. It speaks of him as
physician, surgeon, or apothecary; it does not say 'duly authorized to
grant a licence,' and, in point of fact, a number of persons, calling
themselves apothecaries, do sign certificates, and the Commissioners do
not believe that they can prevent them so doing, or that the signature
is invalid; and, again, it often happens, and very improperly, as the
Commissioners think, that persons sign the certificate in two
capacities. For instance, a medical man is, or calls himself, the friend
of the person conveyed to the mad-house, and he signs again as a medical
person; again, the keeper of a mad-house, who happens to be a medical
person, signs a certificate, attesting the insanity of the party, and
receiving that party into his house. The Commissioners always reprobate
and endeavour to check such a practice, but not always successfully."
In the following year (February 19, 1828) Mr. Gordon, in pursuance of
the instructions of the Committee, brought in a Bill to amend the law
for the regulation of lunatic asylums. He said, among other things, that
the medical certificate to be signed by an apothecary was interpreted to
mean that it might be signed by any seller of drugs, and hence an
apprentice, as soon as his indentures had expired, might consign a man
to a mad-house. This reminds me of a mistake into which a distinguished
German alienist has recently fallen, not unnaturally, from our double
use of the word apothecary. He smiles at the absurdity of the British
law allowing a mere druggist to sign a certificate of insanity! Mr.
Gordon again refers to Dr. Warburton's house, and the patients in their
cribs "wallowing in their filth throughout the whole of Sunday," while
on Monday morning they were "in a state of nudity, covered with sores
and ordure, and were carried into the yard to be suddenly plunged into
cold water, even when ice was in the pails." The speaker added that it
was impossible, with the strongest language, to describe the horrors of
this place, and even maintained that the evidence before the Committee
showed that, however bad, this house was good as compared with others of
the same kind--if not much better than many of them.
He maintained that, unfortunately, the provision made by 14 Geo. III.,
c. 49, by which five Commissioners, appointed by the College of
Physicians, licensed and were bound to visit these houses yearly, and,
if they found anything improper, were directed to state to the College
what they had discovered, had never been attended to in practice; at
least, since 1800. The excuse for this negligence was that the complaint
to the College censors (placed on a card in their room) did no good, and
might therefore as well be abandoned. In fact, he found on inquiry that
the Commissioners had done nothing--literally and strictly nothing. He
then referred to a house where two patients were found lying in an
outhouse, and three others chained down by the arms, wrists, and legs.
Their wrists were blistered, and their persons covered only by rags.
This was within five miles of London. He concluded by moving for leave
to bring in a Bill "To Consolidate and Amend the several Acts respecting
County Lunatic Asylums, and to Improve the Treatment of Pauper and
Criminal Lunatics."
Lord Ashley seconded the motion, and leave was given to bring in the
Bill,[159] which passed the House.
In the Upper House Lord Malmesbury moved the second reading of the above
Bill. One object, he said, of the Lunatic Asylum Regulation Bill was to
give to counties more power in establishing asylums. For private
patients, two medical certificates and an order would now be required,
and the like for single patients. In regard to the existing College
Commissioners, he ridiculed the extraordinary circumstance that if, in
the course of their visits of inspection, they found what was
reprehensible in an asylum, they could not revoke the licence which they
themselves had given. It was proposed to take the power from the College
of Physicians and invest it in fifteen Metropolitan Commissioners
appointed by the Home Secretary.[160]
This Act (9 Geo. IV., c. 40), based on the Report of the Committee, was
passed July 15, 1828.[161]
The returns of pauper lunatics in England and Wales amounted to 9000,
being 6700 in excess of the corresponding return of 1807; but nobody
supposes that there had been that, or, in fact, any considerable
increase in the number of the insane poor, but simply greater accuracy
in obtaining statistics.
Referring back to this period, Lord Shaftesbury, in evidence given
before a Committee of the House of Commons thirty years later, and
dwelling upon the old _regime_, observed: "I mention these things
because they never could be seen now (1859), and I think that those who
come after us ought to know what things have existed within the memory
of man. At the present time, when people go into an asylum, they see
everything cleanly, orderly, decent, and quiet, and a great number of
persons in this later generation cannot believe there was ever anything
terrible in the management of insanity; and many say, 'After all, a
lunatic asylum is not so terrible as I believed.' When we begun our
visitations, one of the first rooms that we went into contained nearly a
hundred and fifty patients, in every form of madness, a large
proportion of them chained to the wall, some melancholy, some furious,
but the noise and din and roar were such that we positively could not
hear each other; every form of disease and every form of madness was
there; I never beheld anything so horrible and so miserable. Turning
from that room, we went into a court, appropriated to the women. In that
court there were from fifteen to twenty women, whose sole dress was a
piece of red cloth, tied round the waist with a rope; many of them with
long beards, covered with filth; they were crawling on their knees, and
that was the only place where they could be. I do not think that I ever
witnessed brute beasts in such a condition, and this had subsisted for
years, and no remedy could be applied to it. It was known to one or two
physicians at the Royal College, who visited the place once a year; but
they said, fairly enough, that, although they saw these things, they
could not amend them." Lord Shaftesbury, after giving a short _resume_
of the condition of the old York Asylum, as well as of that of Bethnal
Green in 1827, went on to observe--a paragraph which will form the motto
of my work--"I might multiply these instances almost indefinitely, but I
thought it was desirable just to indicate the state of things that
existed, in order to contrast the Past with the Present."[162]
In the interval between the Act of 1828[163] and the next Act of
importance, several attempts were made at further legislation on the
part of Mr. Gordon and Lord Somerset. A Bill passed both Houses in
1832.[164] In one instance a Bill which passed the Commons was
characterized in the House of Lords as "one of the most abominable
pieces of legislation that ever was seen." It was "monstrous." "Their
lordships could never suffer such an abominable piece of legislation to
be thrust down their throats." It is scarcely necessary to say that the
lips from which this animated language proceeded were those of Henry
Brougham, then the Lord Chancellor. The Bill was, of course, rejected.
In 1842 Lord Somerset brought forward a motion on the inspection of
asylums, and pointed out that there was a very large class of persons to
whose inspection the Act of 1828 did not apply, viz. those in
confinement in their own houses, in separate lodgings, in public
institutions, as county asylums, and the hospitals of Bethlem and St.
Luke's. The object of his Bill was to extend the system of inspection in
force in the metropolitan licensed asylums to the provinces. Barristers,
he maintained, should be appointed, with a fixed salary, and not paid
for their hour's work and allowed to practise. It is worthy of record
that the returns at this period showed that there were about sixty or
seventy houses licensed for the reception of insane persons in the
country, and that there were actually twenty-five counties in England
where there was not a single asylum licensed for the reception of
lunatics, and not one in Wales.
This measure was characterized by Mr. Wakley as not only a very small
one, but as an insult to medical men, as it only proposed barristers as
the new Commissioners, adding that "in Scotland there was one system, in
Ireland there was another, and in England there were several, and among
them all there was not one which, on the whole, was entitled to the
sanction and approbation of the public, or which was worthy of the
adoption of the noble lord [Somerset]."
Lord Ashley approved of the Bill, and speaking of the work of the
Commissioners, he said, "They have aimed at a medium line of policy, and
an immense amount of human misery had been abated under the present law,
and by the industry of those who carry it into execution."
It was in this speech that Lord Ashley made an observation which has not
escaped the criticism of the medical profession, namely, "that a man of
common sense could give as good an opinion as any medical man he ever
knew," that is, "when it has been once established that the insanity of
a patient did not arise from the state of his bodily health."[165]
It should be stated that Mr. Wakley moved an amendment on the first
clause of the Bill, omitting "Barrister Commissioners," and inserting
"Medical Commissioners." He spoke of the total failure of the
Metropolitan Commission, and ultimately moved as an amendment that two
of the Commissioners to be appointed should not have their profession
stated, their appointment being left to the Lord Chancellor. This
amendment was carried by a majority of three, but in the Bill provision
was made for two more physicians and two more barristers.
On July 16th of the same year, on the motion that the order of the day
for the further consideration of the Lunatic Asylums Bill be proceeded
with, a member suggested its postponement until further discussion. Lord
Somerset replied that the Bill was framed for the purpose of procuring
further information on the subject, in order to legislate permanently
upon it. On the House going into Committee Lord Ashley expressed a hope
that the measure would tend to ameliorate the condition of the pauper
lunatics throughout the kingdom. On this occasion Lord Ashley observed,
in regard to the system of non-restraint, that he had formerly
entertained some doubts as to the practicability of carrying it out; but
that these doubts had been removed by a visit to the Hanwell Asylum.
Having witnessed the system pursued there, he said he could not speak
too highly either of the system itself, or the manner in which it was
carried out by Dr. Conolly.
Having passed through Committee, the Bill was read a third time on the
28th of July, 1842, and in this instance was not rejected by the House
of Lords.[166]
The Metropolitan Commissioners, invested with their enlarged powers,
made a most thorough inquiry into the condition of the asylums in
England and Wales, and presented a Report to Parliament in 1844, which
must always possess great historic interest and value.[167] It
constitutes the Doomsday Book of all that concerns institutions for the
insane at that time.
The state of some asylums visited by the Commissioners was frightfully
bad, notwithstanding the general progress which had been made since
public attention had been directed to abuses and the several Acts of
Parliament had been passed in order to remove them. These things,
however, it must be remembered, were survivals of the past, not fair
illustrations of the present; abuses which lingered on in spite of light
and knowledge, and required stringent pains and penalties to force those
who permitted them to abandon their practices.
On the 23rd of July, 1844, the indefatigable reformer of abuses
connected with the treatment of lunatics, Lord Ashley, moved for an
Address to the Crown, praying her Majesty to take into consideration the
Report of the Metropolitan Commissioners in Lunacy[168] to the Lord
Chancellor, presented to the House, the statute under which they acted
expiring next session. He commented upon there being no official
visitation of single houses. He believed that such a power "ought to be
confided to some hand that would hunt out and expose the many horrible
abuses that at present prevail." The only control was that if such
patient resided more than twelve months in a house, the owner was
compelled to communicate the name of that patient to the clerk of the
Commission; but for the most part no notice was taken of this law, and
it was frequently evaded by removing the patient, after a residence of
eleven months, to some other lodging.
At this period (January 1, 1844) the number of lunatics and idiots
chargeable to unions and parishes in England and Wales was 16,821. In
county asylums there was provision for only 4155, leaving 12,666 poor
insane, of whom there were in asylums under local Acts 89, in Bethlem
and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private
asylums, leaving in workhouses and elsewhere 9339. Although a few of the
existing county asylums were well adapted to their purpose, and a very
large proportion of them were extremely well conducted, yet some were
quite unfit for the reception of insane persons. Some were placed in
ineligible sites, and others were deficient in the necessary means of
providing outdoor employment for their paupers. Some also were ill
contrived and defective in their internal construction and
accommodation. Some afforded every advantage of science and treatment;
others were wholly deficient in these points. All of them, however, had
the advantage of constant supervision, and of not giving any profit to
the superintendent. Lord Ashley especially referred to the admirable
manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster,
and Gloucester were managed. "Why, then," his lordship asked, "are not
these institutions multiplied? At this moment there are twenty-one
counties in England and Wales without any asylum whatever, public or
private. The expense is one cause. In some cases the cost of
construction has been exceedingly great. The asylum most cheaply
constructed is that of Wakefield, of which the average cost per head was
L111, whilst the highest price was that of Gloucester, which had cost on
the first accommodation L357 per head. In many cases the cost of
construction had exceeded L200 per head. The cost of the Bedford Asylum,
for 180 patients, was L20,500; that of Gloucester, for 261 patients,
L51,366; that of Kent, for 300 patients, was L64,056; that of Hanwell,
for 1000 patients, was L160,000, exclusive of L36,000 paid since 1835
for furniture and fittings. On the other hand, the best-constructed
union-houses in the country had not cost more than L40 per head." Lord
Ashley maintained that although, no doubt, a lunatic asylum was
expensive, it ought not to be so to that enormous degree. The reason of
this difference he did not know, except that many of them had been
constructed with a great display of architecture, and some asylums were
far too large. Adopting the opinion of the Report of the Commissioners,
he maintained that no asylum for _curable_ lunatics should contain more
than 250 patients, and that perhaps 200 are as large a number as can be
managed with the most benefit to themselves and the public in one
asylum; and he quoted Dr. Conolly's stronger statement that 100 persons
were the highest number that could be managed with convenience in one of
these asylums. With regard to the number of private patients in
asylums, there were 3790, of whom 973 were in private metropolitan, and
1426 in private provincial asylums. The paupers in the private houses
were--metropolitan, 854; provincial, 1920. With respect to these, it was
a very serious question how far any house should be licensed to take
paupers for payment. The principle was very dangerous, and Lord Ashley
pointed out that if the superintendent only got seven or eight shillings
a week, he still must make a profit, and that there could be no doubt it
was so. Quoting the Report of the Commissioners again, he said that many
asylums had formerly been private houses; the mansion was sometimes
engrossed by the proprietor and a few private patients, while the
paupers were consigned to buildings formerly used as offices and
outhouses. After adducing evidence of the deplorable condition of
certain asylums, Lord Ashley asserted that the only remedy was the
multiplication of county asylums, and if advice and example failed, they
ought to appeal to the assistance of the law to compel the construction
of an adequate number of asylums over the whole country. It was the duty
of the State to provide receptacles for the incurable patients, apart
from those devoted to remedial treatment. Parochial authorities,
however, preferred keeping patients in the workhouse at an expense not
exceeding two shillings a week, rather than send them to the county
asylum, where the minimum charge was seven shillings a week.
It was true, Lord Ashley observed, that they could show but few
instances of restoration to reason. How, indeed, was it possible? They
could show, however, a mighty improvement in the condition of the
sufferers, the alleviation of their state, their occupations and
amusements (all, with some bright exceptions, of recent date), and that
the services of religion had infused a momentary tranquillity; but they
could show little else, and unless the Legislature should interfere and
bring these unfortunates by force within the reach of sympathy and care,
for every one restored to his senses we should see a hundred in whom the
light of reason would be extinguished for ever. The speaker went on to
say that there were two points of deep interest, to which the House
would do well to advert for a moment--the question of restraint, and the
admission and liberation of patients. "Upon restraint it was unnecessary
to dwell very long, as it was a matter of internal arrangement, and
beyond their immediate legislation; but he wished to direct the
attention of the House to the chapter in the Report which handled that
subject, that it might share the general satisfaction, and give praise
to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr.
Conolly, Dr. de Vitre, Dr. Charlesworth and many more, who had brought
all their high moral and intellectual qualities to bear on this topic,
and had laboured to make rational and humane treatment to be the rule
and principle of the government of lunacy."
Lord Ashley pointed out that the law required no medical certificate
whatever for a pauper patient, except when admitted into a private
asylum. It appears that in Wales at that time there were 1177 pauper
lunatics, 36 of whom were in English county asylums, and 41 in English
licensed houses, 90 in union workhouses, and 1010 living with their
friends, many of them being in a wretched condition. Lord Ashley quoted
a letter from one of the Commissioners, written in Wales, in which it
was stated, "We have met with one case which we think most atrocious. A.
B. was sent to the Hereford Asylum from near Brecon on November 28,
1843. She died on January 30th. She was in such a shocking state that
the proprietor wished not to admit her; she had been kept chained in the
house of a married daughter. From being long chained in a crouching
posture, her knees were forced up to her chin, and she sat wholly upon
her heels and her hips, and considerable excoriation had taken place
where her knees pressed upon her stomach. She could move about, and was
generally maniacal. When she died it required very considerable
dissection to get her pressed into her coffin! This might be taken as a
sample of Welsh lunatics."
The improvement in the condition of Dr. Warburton's asylum at Bethnal
Green, which was the original cause of the Commission of Inquiry being
appointed in 1827, now presented, it appears, a most agreeable picture
of what might be done by vigilant inspection. "Whereas in 1828 there
were commonly 150 to 200 of the patients restrained by leg-locks,
chains, and other fetters--certainly during the night--in 1844 there
were, out of 582 patients, only 5 whose violence rendered this species
of restriction necessary, and even the confinement or coercion resorted
to was of the most moderate description, and in the opinion of the
visiting officers most necessary."
Lord Ashley concluded his speech with the following eloquent
words:--"Sir, these subjects may be dull, and want the light and shade
of more exciting topics; but the expense which is incurred, the numbers
that suffer, and the nature of their sufferings, will perhaps justify
the present demand upon your time and patience. The House possesses the
means of applying a real and speedy remedy; these unhappy persons are
outcasts from all the social and domestic affections of private
life--nay, more, from all its cares and duties, and have no refuge but
in the laws. You can prevent by the agency you shall appoint, as you
have in many instances prevented, the recurrence of frightful cruelties;
you can soothe the days of the incurable, and restore many sufferers to
health and usefulness.... I trust, therefore, that I shall stand
excused, though I have consumed so much of your valuable time, when you
call to mind that the Motion is made on behalf of the most helpless, if
not the most afflicted, portion of the human race."[169]
Sir James Graham does not appear to have been affected by this appeal,
for, declining immediate action, he stated that the condition of pauper
lunatics would come under the consideration of the House next session.
He recommended the House to approach the subject of the inspection of
private houses with great caution.
In the summer of 1845 (June 6th) Lord Ashley returned to the subject,
and brought forward in the House of Commons two Bills for England and
Wales only, although he said, "I believe that not in any country in
Europe, nor in any part of America, is there any place in which pauper
lunatics are in such a suffering and degraded state as those in her
Majesty's kingdom of Scotland." After pointing out that the then
existing law was embodied in nine statutes, divisible into four
classes--County Asylums, Licensed Asylums and Public Asylums, Persons
found lunatic by inquisition, and Criminal Lunatics, he observed that
his Bill only touched the two first classes, and amended the single Act
contained under the first class, as also the three Acts contained under
the second class, namely, 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV.,
c. 64; and 5 and 6 Vict., c. 87; which various statutes were proposed by
him to be consolidated into one--"A Bill for the Regulation of the Care
and Treatment of Lunatics in England and Wales." After referring to the
state of the law as it existed under 14 Geo. III., the only law
regulating private asylums prior to Mr. Gordon's measure of 1828, Lord
Ashley proposed to establish a permanent Commission of Lunacy, giving
power of far more detailed and frequent visitation than previously, and
placing "hospitals" under proper regulation by requiring them to have
the same orders and certificates as in licensed asylums, and the same
visitation as in county asylums. The person signing the order of a
pauper patient would be required to examine him beforehand, and the
medical officer certifying his insanity was to see him within seven
days of his confinement. On admission the mental and bodily condition of
the patient, and in the event of his death, the cause thereof, were to
be stated. Injuries and acts of violence were to be recorded and a
case-book kept. A return was to be made of all single patients received
for profit.[170] Workhouses containing lunatics were to be subjected to
regular visitation. These were some of the provisions of the first Bill.
The second was an extension of the Act of 9 Geo. IV., c. 40, and was of
the highest importance, for the provision of county and borough asylums,
instead of being permissive, was made compulsory. Where insufficient
accommodation had been provided, it was required to increase it. It was
proposed to erect some separate buildings at less cost for incurable, or
rather chronic, cases. The above Bill was to be extended to boroughs
having separate quarter sessions, and to every place not contributing to
county rates. All lunatics not chargeable, whether wandering or
otherwise, were to be apprehended, and those whose friends were unable
to pay for them admitted as paupers. A quarterly inspection by a medical
man of lunatics not in asylums was required, and a list was to be sent
to the Commissioners in Lunacy.
Lord Ashley, after paying the tribute of respect and admiration due to
Pinel, referred in conclusion to the introduction of a humane system of
treatment into this country at York, adding that it must be grateful to
the feelings of the author of the "Description of the Retreat" "to
perceive that his example has obtained not only the approval, but the
imitation of the best and wisest men of this country, and, I may add, of
America."
Lord Ashley's Bill introduced for the first time a permanent Lunacy
Commission. It comprised six paid Commissioners at salaries of L1500
each, which, he observed, would be economical in the end. In Mr.
Gordon's Act the Commissioners were appointed for one year, to be
renewed annually, and consisted of ten unpaid members and five
physicians, who were paid at the rate of one guinea an hour for their
attendance, with power to carry into effect the new Act within the
metropolitan district. This act and the Commission were renewed in 1832,
when two barristers were added on the same terms. In 1834, having been
always a member of the Commission, Lord Ashley became the chairman. The
Act had been renewed periodically every three years until the year 1842,
when Lord Somerset brought in a Bill, the object of which was greatly to
extend the operation of the Metropolitan Commission. The number of
physicians was then augmented to seven, and the barristers to four; and
it was also provided that the Commissioners should receive five guineas
a day during the performance of their duties in the provinces.
Immediately after that Act (5 and 6 Vict., c. 87) the Commissioners had
entered upon their enlarged duties. The consequence was that in each
year the establishments visited by them were:
Visited once
a year.
Seventeen county asylums, or asylums brought within the
scope of 9 Geo. IV. (1828), (twelve county asylums, five
county and subscription asylums).
Eleven of mixed character (mostly by subscription and partly
by income from charitable foundations).
Two military and naval hospitals.
Visited twice
a year.
Ninety-nine houses licensed by justices in session (fifty-nine
receiving only private patients, forty private and pauper).
Visited four
times a year.
In metropolitan district:
Thirty-seven houses licensed by Metropolitan Commissioners
(thirty-three for private patients only; four for private
and pauper).
Total public and private asylums, January 1, 1844, 166.
The result of these investigations was, Lord Ashley observed, the Report
presented to the House last session, when he moved for an Address to the
Queen, but withdrew it upon the Government promising to bring in a Bill.
Ultimately, however, the Government had requested him to undertake it.
The two Bills, having passed the Houses of Parliament, received the
Royal assent on the 4th and 8th of August, 1845.[171] They have been
well called the Magna Charta of the liberties of the insane.
After these Acts had been in operation for eight years, it was found
that various amendments were needed, and in February, 1853, Lord St.
Leonards introduced, along with another Bill lessening the expense
arising out of lunacy inquisitions, one consolidating the laws
respecting asylums, and one amending Lord Shaftesbury's Act (c. 100).
They constitute the 16 and 17 Vict., c. 96 and c. 97.
The former, entitled "An Act to amend an Act passed in the ninth year
of Her Majesty 'for the Regulation of the Care and Treatment of
Lunatics,'" has reference mainly to private asylums and hospitals. The
same order and certificates which were required for admission into an
asylum were now necessary for single patients. It was enacted that
medical men should specify the facts upon which their opinion of a
patient's insanity was based, distinguishing those observed by
themselves from those communicated by others. Bethlem Hospital was by
the thirty-fifth section of this Act made subject to the provisions of
the Lunacy Acts.
The latter statute, entitled "An Act to Consolidate and Amend the Laws
for the Provision and Regulation of Lunatic Asylums for Counties and
Boroughs, and for the Maintenance and Care of Pauper Lunatics in England
and Wales," repealed the 8 and 9 Vict., c. 126; 9 and 10 Vict., c. 84;
and 10 and 11 Vict., c. 43. Many sections refer to the particular mode
of determining the manner in which an asylum shall be provided for the
paupers of a county and borough, whether for the county alone, or with
some other county or borough, or with the subscribers to any hospital,
or with the visiting committee of a county asylum for the joint use of
an existing asylum. The parish medical officer was directed to visit all
the paupers in it _every quarter_, whether in the workhouse or not, and
report to the guardians or overseer those who, in his judgment, might be
properly confined in an asylum. Thus the tendency of the Act was, in
this and other ways, calculated to add to the numbers under care, and,
therefore, to make the apparent increase of insanity greater. Three
classes of lunatics were contemplated by this Act, viz. pauper lunatics;
wandering lunatics, whether paupers or not; lunatics not paupers and not
wandering, who are cruelly treated or neglected. The Commissioners might
order the removal of a lunatic from an asylum, unless the medical
officer certified such patient to be dangerous; and the latter might be
overruled by the consent of two visiting justices to his discharge. A
large number of the sections of this Act provide in detail for the
settlement, etc., of pauper lunatics. Penalties were enacted in the
event of any superintendent or other officer of an asylum ill-treating
or neglecting a patient.[172]
* * * * *
One of those waves of suspicion and excitement which occasionally pass
over the public mind in regard to the custody of the insane, occurred in
1858. Sensational articles appeared in the papers, and novels were
written to hold up those connected with the care and treatment of the
insane to public obloquy. The author himself did not escape
animadversion, and was represented in a newspaper as a brutal mad-doctor
using a whip upon an unfortunate patient "in an institution of which
better things might have been expected." That the charge was the
offspring of a bewildered editor, who confused person and place in an
incredible manner, and was obliged to acknowledge that he had been the
victim of his own imagination, only shows how the paroxysms of sudden
passion and indignation to which John Bull is liable, may lead to the
most ridiculous mistakes. However, there must be some fire where there
is smoke, and one or two unfortunate events gave colour to the
assertion, persistently made, that asylums were the abodes of injustice
and cruelty. A Select Committee of the House of Commons was appointed in
February, 1859, to inquire into the operation of the Acts of Parliament
and Regulations for the Care and Treatment of Lunatics and their
Property, including Sir George Grey, Mr. Walpole, Mr. Whitbread, Mr.
Drummond, Mr. Kekewich, and others; and evidence was given by the Earl
of Shaftesbury, Mr. Barlow, Mr. Gaskell, Dr. Southey, Dr. Conolly, Dr.
Hood, Dr. Bright, Dr. Bucknill, Mr. Lutwidge, etc.
The Committee commence their Report with presenting the following
comparison of the number of lunatics in 1844, 1858, and 1859:--
-----------------------------------------+--------+--------+-------
Location. | 1844. | 1858. | 1859.
-----------------------------------------+--------+--------+-------
Private patients in asylums, hospitals, | | |
and licensed houses | 3,790 | 4,612 | 4,762
| | |
Pauper lunatics and idiots in asylums, | | |
hospitals, and licensed houses | 7,482 | 17,572 | 18,022
| | |
Pauper lunatics and idiots in workhouses | | |
(655) and with friends, etc. | 9,339 | 13,163 | 13,208
+--------+--------+--------
| 20,611 | 35,347 | 35,992
-----------------------------------------+--------+--------+--------
the last figure showing an increase of 15,000 over the number in 1844,
and being one in six hundred in the population. The Committee point out
that from 1808 to 1845 the justices had the power to provide, in every
county, proper houses for pauper lunatics, but were not obliged to do
so. There were in 1859 forty county asylums. Of seventy-one boroughs
bound to provide asylums, about forty had done so.
As to public asylums, the evidence brought forward convinced the
Committee that little alteration was required in the law, they being
"well looked after and carefully attended to." It was suggested that
they might be in some instances too large, and the staff of attendants
too small and not sufficiently paid. Also that it might be desirable to
erect, in connection with them, detached buildings of a simple and
inexpensive character for the reception of imbecile and chronic
patients.
It was considered that the chief evil for which a remedy was required
lay in the detention of a large number of pauper lunatics in workhouses,
amounting to 68,000 January 1st, 1857, and 7632 on January 1st, 1859.
"It cannot be denied that, with regard to those who are really lunatics,
there is a great absence of proper supervision, attendance, and medical
treatment. In some workhouses there are not even separate wards;
mechanical restraint is frequently applied, because the imperfect state
of the accommodation will not admit of a better mode of treatment; in
many cases, the medical officers of a union cannot have the special
knowledge requisite for the management of the insane; and it may
generally be concluded that the special appliances of a union workhouse
are not by any means equivalent, as to this class of inmates, to those
of a lunatic asylum." The Committee did not recommend the removal of
all cases, but that no person should be detained in a workhouse
respecting whose sanity a doubt existed, without a medical certificate,
renewable quarterly; that there should be distinct wards for such
patients, with distinct attendance; that the guardians should visit such
patients once a quarter, and make a special entry of their condition;
that the Commissioners should visit them at least once a year; and that
the same power of removing any patient to an asylum should be given to
the Commissioners as that possessed by the justices.
Lord Shaftesbury on this occasion recommended that magistrates should be
empowered to provide asylums by money raised on the security of the
rates, for all the non-pauper classes. "When I look into the whole
matter," he said, "I see that the principle of profit vitiates the whole
thing; it is at the bottom of all these movements that we are obliged to
counteract by complicated legislation, and if we could but remove that
principle of making a profit, we should confer an inestimable blessing
upon the middle classes, getting rid of half the legislation, and
securing an admirable, sound, and efficient system of treatment of
lunacy." The Committee, however, while encouraging such asylums founded
on private contributions, could not recommend that a burden should be
imposed on the ratepayers, or that their establishment should be
compulsory.
The Committee suggested as safeguards against the improper detention of
lunatics in private asylums (after dismissing the proposal to require
the sanction of a magistrate) various important precautions.
1. Worthy of consideration whether the certificate should be verified
before a magistrate, so as to enable him to determine whether the Act
has been complied with. 2. The certificate authorizing detention to be
limited to three months. 3. The order to state the time when the patient
was last seen, and not to be effective unless the applicant had seen the
patient within three months. 4. Copy of order and certificate to be sent
to the Commissioners within twenty-four hours, instead of within seven
days. 5. The patient to be visited as soon as possible by the
Commissioners or by some person acting directly under their authority.
6. The person who signs the order for admission to a private asylum to
visit the patient at least every six months--a clause in Mr. Gordon's
Act, but omitted in that of 1845. 7. Patients to have a _prima facie_
right to receive visits from and correspond with friends. 8. To make it
penal for any medical man to receive a patient in a single house without
apprising the Commissioners of it.
Other suggestions of the Committee had reference to Chancery lunatics,
criminal lunatics, and the composition and powers of the Lunacy Board.
When this Committee met, the Acts in force were essentially similar to
what they now are (the only important subsequent statute being that of
1862), viz. for _public asylums_, the 16 and 17 Vict., c. 97, and 18 and
19 Vict., 105, and for _private asylums_, 8 and 9 Vict., c. 100, 16 and
17 Vict., c. 96, and 18 and 19 Vict., c. 105. According to these Acts,
the great principle which governs asylums where private patients are
kept may be said to be that no person can receive into his house more
than one patient, if he derives any profit therefrom, unless he has a
licence granted to him for that purpose, and submits to the regulations
which that licence implies.
Legislation followed in 1862, in the statute 25 and 26 Vict., c. 111,
entitled "An Act to amend the Law relating to Lunatics."[173]
It made pauper lunatics chargeable upon the common fund of the union,
instead of the particular parish. In addition to many matters of detail
in reference to the establishment of asylums, and an important section
in regard to the use of workhouses for chronic lunatics, additional
safeguards were given to prevent the improper admission of patients into
institutions for the insane, much care being shown in reference to the
abuse of private asylums. Persons signing orders for admission must have
seen the patient within one month. Certain persons were prohibited from
signing any certificate or order for the reception of any private
patient into a licensed or other house, viz. those receiving a
percentage on, or otherwise interested in, the payments to be made by
any patient received into such houses; as well as any medical attendant
as defined by the Lunacy Act of 1845. If defective medical certificates
were not amended within fourteen days, the Commissioners were empowered
to order the patient's discharge. On admission of patient, the
documents, with the exception of the "statement," were to be
transmitted to the Lunacy Board within one clear day, instead of after
two and before the expiration of seven, as formerly. Increased
visitation of asylums by Commissioners was provided, one of whom might
visit any asylum, hospital, or jail, in addition to the visits required
by two of them. Regulations were made in regard to patients being absent
on trial, the transmission of their letters, and the further protection
of single patients. These and some other sections were the outcome of
the suggestions of 1859-60.[174]
In 1874 a Poor Law Act granted four shillings per head out of the
Consolidated Fund to paupers in asylums, to the effects of which we
shall have to refer in the next chapter.
It is necessary now to chronicle the appointment of the Select Committee
of 1877, known as Mr. Dillwyn's Committee, the result, to a large
extent, of a feeling of uneasiness in the public mind, or rather, a
portion of it, relative to the too easy admission of patients into
asylums, and their too difficult exit, when once there. The grossest
charges were made against the proprietors of licensed asylums, and the
Commissioners themselves were charged with culpable laxity. As might be
expected, some changes in the law were suggested likely to prove
beneficial, and the Report of the Committee contained sundry
recommendations of importance. The charges, however, from which the
inquiry originated, fell to the ground; and had the appointment of the
Committee had no other result, the advantage would have been great, in
presenting a most gratifying contrast to the revelations which took
place fifty years before, in 1827.[175]
The conclusions at which the Committee arrived were that, "although the
present system was not free from risks which might be lessened, though
not wholly removed, by amendments in the existing law and practice, yet,
assuming that the strongest cases against the present system were
brought before them, allegations of _mala fides_ or of serious abuses
were not substantiated.... The Committee cannot avoid observing here,
that the jealousy with which the treatment of lunatics is watched at the
present day, and the comparatively trifling nature of the abuses
alleged, present a remarkable contrast to the horrible cruelty with
which asylums were too frequently conducted less than half a century
ago, to the apathy with which the exposure of such atrocities by
successive Committees of this House was received, both by Parliament and
the country, and to the difficulty with which remedial enactments were
carried through the legislature.... Nevertheless, the anomalous state of
the law, which undoubtedly permits forcible arrest and deportation by
private individuals and the fearful consequences of fraud or error,
have induced the Committee carefully to inquire whether any additional
safeguards may be devised."
Among the changes proposed (most of which are of the nature of
safeguards), or in some instances hinted at rather than proposed,
were:--an emergency certificate as in Scotland, signed by one medical
man, but if the patient remains in the asylum more than three days, two
fresh certificates to be obtained; in addition to report now required
after the admission of the patient, a careful statement to be prepared
from the case book and sent to the Lunacy Board at the end of the first
month; the order on which every patient is admitted to continue in force
for not more than three years, when a special report should be sent to
the Board by the superintendent, and repeated annually; the original
order to be given by a near relative as in Ireland, or some responsible
person who could be called to account; the patient being visited every
six months by the person signing the order, the "surest mode of guarding
against unduly prolonged detention consisting in frequent and careful
visitation of all places in which any lunatic is confined, with full
power placed in the hands of the Commissioners to order his discharge,
and in the more general adoption of the system of probationary release."
Reports to be sent to the Commissioners of patients kept under restraint
in private families or religious houses in the British Isles, not for
profit, provided that the reports are confidential, and the patients
confirmed lunatics, and not merely suffering under temporary
derangement. On showing good cause for such a course, any person, as in
Scotland, with the sanction of the Commissioners, to send two medical
men to test the condition of any patient under control. Personal
examination of patients, such as that made by the Chancery Visitors, to
be extended to them irrespective of the possession of property. "Either
the Chancery lunatics, who number less than a thousand, have too much
cure bestowed upon them, or the others, who exceed sixty-five thousand,
have far too little.... It seems physically impossible that, with the
present strength of the Lunacy Commissioners, minute supervision of
those who require it can be efficiently exercised." Amalgamation of the
two departments might obviate waste of power in visiting, stricter
supervision being also exercised over single patients, who are only
visited once a year, there being nothing in the Acts to necessitate even
this visitation. Transference of administration of property of persons
unable to manage it, without deprivation of liberty, suggested.
Particular workhouses to be devoted to harmless lunatics, who now crowd
the asylums, by a common action of the workhouse authorities within
certain areas. Voluntary boarders to be allowed to go to asylums,
whether they have already been in confinement or not, notice being sent
to the Lunacy Board of their admission. The existence of private asylums
to be left to the spontaneous action of the public, sufficient
accommodation in public asylums as in Scotland, Cornwall, and at
Cheadle, being encouraged and facilitated by enlargement of the powers
of magistrates, and other means calculated to extend this system.
Greater freedom of patients in asylums, and of their visitation by
friends, and in correspondence, are regarded as valuable securities
against the infringement of personal liberty. Whatever changes are made,
a consolidation of the Lunacy Acts would be most desirable. Such were
the main proposals.
These suggestions of the Committee have not yet borne fruit, but will,
no doubt, be of service in future lunacy legislation.
Mr. Dillwyn, in introducing his last Bill (May 25, 1881),[176] proposed
that no one should be confined as a lunatic except upon an order of the
justice of the peace; that no one should be incarcerated except at the
instance of a near relative, or of some solicitor of repute. There was
also provision that due notice should be given before a justice made the
order, and that the order must be authorized by two medical men, one of
whom should be the medical officer of the district. For violent lunatics
he proposed the Scotch law, which permitted an emergency certificate,
enabling persons who had paroxysms of lunacy to be detained for
twenty-four hours, but not longer, except on the order of some competent
authority. In the matter of discharges, he proposed that patients should
be discharged on the order of a Judge in Chambers, a stipendiary
magistrate, or a County Court judge, who should order two medical men to
visit the lunatic, and report on the case; and such judge, after
communicating with the Lunacy Commissioners, might order the lunatic to
be liberated within ten days. As to private asylums, Mr. Dillwyn knew
that the proposals he made bearing upon them would be met by the
argument of vested interests on the part of the proprietors, but he did
not think such interests ought to be exceptionally respected. He did not
wish to introduce compulsion, but proposed that justices should be
enabled to raise money by way of terminable annuities for the reception
in public asylums of those who could pay. Mr. Dillwyn on this occasion
was in a generous mood, for he observed that "he had nothing to say
against private asylums, which, on the whole, were very well conducted."
What he objected to was the interest which the proprietors had in
keeping their patients as long as possible. Mr. Dillwyn objected to the
present system of inspection, and made certain proposals with a view to
increase its efficiency--including a paid chairman of the Lunacy Board.
Mr. Dillwyn's Bill never reached the stage of the third reading, nor was
it discussed in committee; and the Government, which expressed a hope
that they might be able to take the matter in hand, has not yet found
time to bring in a Bill.
* * * * *
It will be seen from the foregoing sketch that the example of a better
system of treatment slowly but surely exercised a beneficial effect,
combined as it was by the exposure of the neglect and cruelty which for
the most part marked the treatment in asylums, workhouses, and also the
home care of the insane; that the demand for legislative inquiry and
interference followed; and that the system of inspection has, step by
step, been rendered stricter and more effective. First there was
introduced the visitation by the College of Physicians, through five of
its Fellows--a miserable failure. Then there was, in 1828, the
appointment of Metropolitan Commissioners, whose authority was in 1842
extended to the whole of England and Wales; and, last of all, was the
establishment of the Board of Lunacy Commissioners on the basis upon
which it is now constituted. So woefully slow, if eventually successful,
is the march of events in the progress of reform.
There have been several members of the legislature who have honourably
distinguished themselves by advocating in Parliament the claims of a
class whose unhappy characteristic it is that they are unable to
advocate their own cause, among whom may be mentioned Mr. T. Townshend,
Mr. Wynn, Mr. Rose, Mr. Gordon, Lord Somerset; but to no single
legislator is so great a debt of gratitude due as to Lord Shaftesbury,
whose untiring efforts, and conciliatory yet firm bearing, in bringing
forward his measures for the relief of the insane, combined with a
thorough mastery of the question and an intimate acquaintance with the
condition of houses for their care and treatment, have effected the
greatest good, and served to carry into extensive operation, principles
already enunciated, it is true, and even partially practised, but
requiring the strong arm of the law to enforce their recognition
throughout the Kingdom. The extent of obligation the insane and their
friends owe to Lord Shaftesbury, who for more than fifty years has
devoted himself to their interest, can only be fully estimated by those
who have carefully traced his unwearied assiduity in conducting measures
through Parliament, providing for the erection of lunatic asylums and
the proper visitation of their inmates, and who are acquainted with the
manner in which he has filled the office of Chairman of the existing
Lunacy Board since it was formed. At that period Mr. Sheil could say in
the House, without fear of contradiction, that "it may be truly stated
that the noble lord had added nobility even to the name of Ashley, and
that he had made humanity one of 'Shaftesbury's Characteristics.'"[177]
FOOTNOTES:
[140] _Edinburgh Review_, vol. xxviii. p. 433.
[141] The "Private Mad-house Bill" of 1814 was introduced, April 5th,
"to repeal and render more effectual the provisions of the Act of the
14th of the King." Mr. Rose said there were actually cases in which it
was found that the medical certificate was signed by the keeper of the
house. His Bill provided for the periodical visitation of private
mad-houses by magistrates. The Bill passed the Commons July 11, 1814.
Its author stated that it had been introduced the year before and amply
considered by a Committee of the House, who were unanimous for its
adoption, but I find no reference whatever in Hansard in 1813 to any
Bill or Committee (see Hansard, vol. xxvii.).
[142] The chief members of the Committee were Lord R. Seymour, Lord
Binning, the Right Hon. G. Rose, the Hon. H. G. Bennet, Mr. Western, Mr.
W. Smith, and the Hon. W. H. Lyttleton.
[143] Hansard, vol. xxx. p. 954.
[144] _Edinburgh Review_, vol. xxviii. p. 435.
[145] _Op. cit._, p. 441. "Even after the publication of the evidence,
it was not until the enormity of retaining the offending parties had
been expressly condemned in Parliament that Mr. Haslam, the apothecary,
was dismissed" (p. 443).
[146] Minutes, Select Committee of the House of Commons, 1815, pp. 43
and 44. See also Mr. J. B. Sharpe's edition of this Report, each subject
arranged under its distinct head, 8vo, pp. 411. London.
[147] _Ibid._, pp. 167, 168. In the Minutes of the Committee of 1816, it
is stated that in the same asylum the inmates were subjected to brutal
cruelties from the attendants; that they suffered very much from cold,
and were infested with vermin (p. 2, _et seq._).
It may be added, as showing the slowness of reform, that even when, in
1828, two medical superintendents were appointed at Bethnal Green, no
less than seventy, out of four hundred patients, were in irons; there
was no bath, no book or newspaper, and little or no employment.
[148] Minutes of Evidence, Select Committee on Mad-houses, 1815, p. 43.
[149] Hansard, vol. xxxi. p. 1146.
[150] Hansard, vol. xxxiv.
[151] Mr. Rose had recently died (1818). Though not immediately
successful, his labours deserve our cordial recognition.
[152] Hansard, vol. xxxix. p. 974.
[153] 59 Geo. III. c. 127.
[154] "I do hereby certify that by the directions of L. M. and N. O.,
Justices of the Peace for the county of H., I have personally examined
C. D., and that the said C. D. appears to me to be of insane mind."
Unfortunately a medical certificate in those days was not always of
great value. Too many were illiterate productions like the following, on
which a patient was admitted to Dr. Finch's asylum, Salisbury: "He{y}
Broadway A Potcarey of Gillingham Certefy that Mr. James Burt Misfortin
hapened by a Plow in the Hed which is the Ocaision of his Ellness and By
the Rising and Falling of the Blood And I think a Blister and Bleeding
and Meddesen Will be A Very Great thing but Mr James Burt wold not A
Gree to be don at Home. March 21, 1809. H{ay} Broadway."
[155] "A General View of the Present State of Lunatics and Lunatic
Asylums in Great Britain and Ireland."
[156] The cost of some of the asylums mentioned is worth
noting:--Bedford, with 180 beds, L20,500; Cornwall, with 172, L18,780;
Gloucester, with 120, L42,856; Lancaster, for 593, L100,695; Stafford,
for 120, L36,500; Nottingham, for 170, L36,800; Norfolk, for 220,
L50,000; Wakefield, for 420, L46,620. (Except Cornwall, land is
included.)
[157] In reply it was asserted that the room was twenty-six feet long,
and the number of cribs fifteen.
[158] In 1827 Sir A. Halliday wrote: "This Act, the inadequacy of which
has long been ascertained and fully exposed, is still the only law by
which mad-houses are licensed and regulated in England and Wales....
That it has remained so long upon the statute book must hereafter excite
astonishment; and that even now, there should exist so much difficulty
in having it altered and amended, is a fact scarcely to be credited. Yet
such is the fact; and thousands of our fellow-men have been hurried to
an untimely grave, in all the horrors of raving madness or helpless
fatuity, without its being possible to get their condition altered or
amended, merely because certain (we hope mistaken) prejudices were
entertained by an exalted individual whose voice was long paramount in
the senate; and we had almost added, through the influence of those who
have realized immense fortunes as wholesale dealers and traffickers in
this species of human misery."
[159] Hansard, vol. xviii. p. 583.
[160] Hansard, vol. xix. p. 195.
[161] See Appendix D.
[162] Minutes of Evidence of Select Committee of the House of Commons,
1859, p. 65.
[163] The Act of 1828 was amended by 2 and 3 Will. IV., c. 107.
[164] 2 and 3 Will. IV., c. 107. The Metropolitan Commissioners were,
under this Act, to be appointed by the Lord Chancellor instead of the
Home Secretary. Not less than four or more than five were to be
physicians, and two barristers.
[165] Hansard, vol. lxi. p. 806.
[166] 5 and 6 Vict., c. 87.
[167] Report of the Metropolitan Commissioners, 1844.
[168] For some of the details of this Report, see chapter v.
[169] Hansard, vol. lxxvi. p. 1274.
[170] These were to be visited by a small private Committee named by the
Lord Chancellor.
[171] 8 and 9 Vict., c. 100 and c. 126 (see Appendix E.)
[172] For more particular provisions in these Acts and that of 1855 (18
and 19 Vict., c. 105), containing some further amendments, see Appendix
F.
[173] See Appendix G.
[174] In the following year another statute (26 and 27 Vict., c. 110),
entitled "An Act to amend the Lunacy Acts," was passed, but only
consisted of three sections referring to one or two doubtful points in
the previous Act, which do not require notice. How many Acts of
Parliament are necessitated by the blundering obscurity of the person
who, as draughtsman, escapes criticism?
[175] For an analysis of the evidence, and considerations thereupon, the
writer may refer to an article in the _Contemporary Review_, October,
1877, entitled "Lunacy Legislation."
[176] "Parliamentary Debates," 3rd Series, vol. 261, p. 1278.
[177] Mr. Gordon died in 1864. In their Report of that year, the
Commissioners "deplore the death of their colleague, Mr. Robert Gordon,
whose name has been prominent, during the greater part of the last half
century, in connection with efforts to ameliorate the condition of the
insane," and add, "Down to the present time, Mr. Gordon has given to our
labours, constant and valuable personal aid; and his unwearied and
disinterested service, closed only by death, we must remember always
with respect and gratitude." It may be mentioned here that Mr. Wynn, to
whose exertions the Act of 1808 (p. 128) was due, lived to witness Lord
Ashley's Act of 1846 passed, and was present in the House during the
debate.