SCOTLAND.
Our reference in a previous chapter to the singular superstitions
connected with the treatment of the insane in Scotland, renders it
unnecessary to do more than point out in this place the substratum of
popular opinion and feeling, upon which the infusion of new ideas and a
scientific system of treatment had to work. To some extent it was the
same in other countries, but judging from the records of the past, as
given or brought to light by writers like Heron, Dalyell, and Dr.
Mitchell, no country ever exceeded Scotland in the grossness of its
superstition and the unhappy consequences which flowed from it. When we
include in this the horrible treatment of the insane, from the prevalent
and for long inveterate belief in witchcraft, we cannot find language
sufficiently strong to characterize the conduct of the people, from the
highest to the lowest in the land, until this monstrous belief was
expelled by the spread of knowledge, the influence of which on conduct
and on law some do not sufficiently realize.
The lunatic and the witch of to-day might aptly exclaim--
"The good of ancient times let others state;
I think it lucky I was born so late."
As regards the property of the insane, the Scotch law, from a remote
period, appears to have been that the ward and custody of it belonged to
the prince as _pater patriae_. In the beginning of the fourteenth
century, the keeping and custody of persons of "furious mind," by a
statute of Robert I., devolved upon their relatives, and, failing them,
on the justiciar or sheriff of the county. The custody of "fatuous
persons" is said to have been committed to the next agnate (nearest male
relative on the father's side), while that of the "furious" was
entrusted to the Crown, "as having the sole power of coercing with
fetters."[227]
An Act passed in 1585, c. 18, in consequence of abuses in regard to the
nominations of tutors-at-law, provided that the nearest agnate of the
lunatic should be preferred to the office of tutor-at-law. The practice
was originally to issue one brieve, applicable to both furiosity and
fatuity. The statute just mentioned continues the _regula regulans_, as
to the appointment of tutors-at-law for lunatics.
Passing over two centuries, I must observe that in 1792 Dr. Duncan (the
physician mentioned at p. 122 of this work), then President of the Royal
College of Physicians of Edinburgh, laid before that body a plan for
establishing a lunatic asylum in the neighbourhood of Edinburgh. That
plan, after due consideration, met with the unanimous approval of the
Colleges of Physicians and Surgeons, and a subscription was at once set
on foot to carry it into execution, nearly every Fellow of both Colleges
contributing something. But enough money was not then raised to start
the project in a practical way. Fourteen years afterwards, the attention
of the legislature was directed to the provision for the insane in
Scotland, when (in 1806) an Act (46 Geo. III., c. 156) was passed for
appropriating certain balances arising from forfeited estates in that
country to two objects, not apparently allied--the use of the British
fisheries and the erecting a lunatic asylum in Edinburgh--ichthyology
and psychology. The Act provided, among other clauses, that the Barons
of Exchequer should pay out of the unexhausted balance or surplus of the
moneys paid to them in 1784, by the Act 24 Geo. III., c. 57 (relating to
forfeited estates placed under the board or trustees), the sum of L2000
to the city of Edinburgh towards erecting a lunatic hospital. A royal
charter was obtained in 1807, and subscriptions were raised not only
from Scotland, but England, and even India, Ceylon, and the West Indies.
Madras alone subscribed L1000. The idea of the originators of the
institution was a charitable and very far-reaching one. They made
provision for three classes--paupers, intermediate, and a third in which
the patient had a servant to attend him. It may be mentioned that the
establishment of the Retreat of York and its success were constantly
referred to in appealing to the public for subscriptions. The building
which is now the "East House" was opened in 1813, and the plan of that
building was greatly superior to the prison-like arrangement of some of
the asylums built twenty or thirty years afterwards. From the beginning
the teaching of mental disease to students was considered, as well as
the cure and care of the inmates. The management was a wise one. There
were three governing bodies--the "ordinary managers," for transacting
the ordinary business; the "medical board" of five, consisting of the
President and three Fellows of the Colleges of Physicians and Surgeons;
and the "extraordinary managers," consisting of official and
representative men in and about Edinburgh, who had, along with the
ordinary managers, the election of the board every year. At first there
was a lay superintendent and visiting physicians.
Then there was an Act "regulating mad-houses in Scotland" (55 Geo. III.,
c. 69), passed in the year 1815--that important epoch in lunacy
legislation in the British Isles--brought in by the Lord Advocate of
Scotland (Mr. Colquhoun), Mr. W. Dundas, and General Wemyss, and which
received the royal assent, after several amendments from the House of
Lords, June 7, 1815.
This Act provided that sheriffs should grant licences for keeping
asylums; that no person should keep one without a licence; that the
money received for licences should form part of the rogue money in the
county or stewartry, and that out of it all the expenses required for
the execution of the Act should be defrayed; that inspectors should be
elected within a month after the passing of the Act, and thereafter
should annually inspect asylums twice a year--four by the Royal College
of Physicians in Edinburgh from their ordinary resident members, and
four by the faculty of physicians and surgeons in Glasgow from their
ordinary resident members; that sheriffs should ascertain whether
patients are properly confined; that the sheriff should make an order
for the reception of lunatics, upon a report or certificate signed by a
medical man (no statutory form was ordered for the medical certificates
or the warrants of the sheriffs; a medical man signing a certificate
without due examination of the patient was to forfeit L50); that the
sheriff or stewart might set persons improperly detained at liberty;
that a licence might be recalled upon report made to the sheriff by two
of the inspectors; that the sheriff might make rules for the proper
management of asylums; that the Act should not extend to public
hospitals, nor to single patients; that the Procurator Fiscal should
enforce the Act and recover penalties. The friends of patients were
required to pay an annual fee L2 2s.
Such were the main provisions of this Act, which proved to be an
important advance in the right direction, though far from perfect. It
was amended by 9 Geo. IV., c. 34, and 4 and 5 Vict., c. 60. The three
Acts were repealed and other provisions made by the 20 and 21 Vict., c.
71, an "Act for the Regulation, Care, and Treatment of Lunatics, and for
the Provision, Regulation, and Maintenance of Asylums."
I may add here, though anticipating the future course of events, that
the General Board of Commissioners in Scotland was established by the
Acts 20 and 21 Vict., c. 71, and 21 and 22 Vict., c. 54, both Acts
being amended by 25 and 26 Vict., c. 54, and 27 and 28 Vict., c. 59, the
latter continuing the appointment of Deputy Commissioners, and making
provisions for salaries, etc. The statutes now in force in Scotland are
the 20 and 21 Vict., c. 71; 21 and 22 Vict., c. 89; 25 and 26 Vict., c.
54; 27 and 28 Vict., c. 59; Act for the protection of property of
persons under mental incapacity, 12 and 13 Vict., c. 51; Act providing
for the custody of dangerous lunatics in Scotland, 4 and 5 Vict., c. 60
(repealed and other provisions made by fore-mentioned Acts); Act to
amend the law relating to lunacy in Scotland and to make further
provision for the care and treatment of lunatics, 29 and 30 Vict., c.
51; Act to amend the law relating to criminal and dangerous lunatics in
Scotland, 34 and 35 Vict., c. 55 (1871).
But we must retrace our steps to pursue the course of legislation a
little more in detail.
On the 3rd of February, 1818, a Bill for the erecting of district
lunatic asylums in Scotland for the care and confinement of lunatics,
brought in by Lord Binning and Mr. Brogden, was read the first time. A
few days after, a petition of the noblemen, gentlemen, freeholders,
justices for the peace, Commissioners of Supply, and other heritors of
the county of Ayr was presented against it, setting forth that the
petitioners, "from the first moment that they were made acquainted with
the principle and provisions of the proposed Bill, were deeply alarmed
for their own interests and those of Scotland in general, by the
introduction of a measure uncalled for and inexpedient, novel in its
application and arrangement, and substituting regulations of compulsion,
to the exclusion of the more salutary exertions of spontaneous charity,
and this, too, at a time when, by the gradual progress of enlightened
philanthropy, so many admirable institutions have been so lately
established in various parts of Scotland by voluntary contributions; and
that the petitioners are most willing to pay every just tribute of
respect to the humane views which may have dictated the proposed
measure, but they are satisfied that it must have owed its origin to
exaggerated and false representations of the state of the lunatics in
Scotland, and an unjust and groundless assumption of a want of humanity
in the people of Scotland toward objects afflicted with so severe a
calamity. The House cannot fail to remark that the proposed Bill
recognizes a systematic assessment, which it has been the wise policy of
our forefathers to avoid in practice, and that, too, to an amount at the
discretion of Commissioners ignorant of local circumstances, and perhaps
the dupes of misinformation; entertaining, as the petitioners do, deep
and well-grounded repugnance to the means proposed for carrying this
measure into execution, partly injudicious and partly degrading to the
landholders of Scotland, for it does appear to be a humiliating and, the
petitioners may venture to say, an unconstitutional Act, which would
place the whole landholders in Scotland in the situation of being taxed
for any object and to any amount at the discretion of any set of
Commissioners whatever; the petitioners therefore, confiding in the
wisdom of the House, humbly pray that the proposed Bill for providing
places for the confinement of lunatics in Scotland may not pass into
law."
Another petition against the Bill, from the magistrates and council of
the royal burgh of Ayr, was presented and read, praying that the same
may not pass into a law; or that if the House should think proper to
pass the said Bill, they would exempt the burgh and parish of Ayr from
its enactments.
Later on, another petition of the magistrates and town council of the
royal burgh of Montrose was presented against the Bill; and subsequently
one from Stirlingshire, Renfrew, Wigton, Edinburgh, Elgin, Glasgow,
Perth, Dumfries, and many other places.
The second reading was again and again deferred until the 1st of June,
when it was ordered "that the Bill be read a second time upon this day
three months." Thus persistent obstruction triumphed.
Sir Andrew Halliday, who took from an early period a lively interest in
the insane, writes in 1827: "I cannot but regret that the public refused
the adoption of a law for erecting district or county establishments,
proposed some years ago by that excellent nobleman, Lord Binning. The
rejection of this Act arose, I believe, neither from the parsimony nor
the poverty of the freeholders, but from a dread of introducing into the
kingdom that system which has been denominated the nightmare of England,
the poor's rates."[228]
How much legislation was needed at this period is well shown by the
description, by a philanthropist, of the condition of the lunatics in
the Perth Tolbooth, for which I am indebted to the late lamented Dr.
Lauder Lindsay, who observes: "Here is exactly what Mr. J. J. Gurney
says, and it is of special interest to us, as showing the sort of
provision made for the comfort of our local insane prior to the
establishment of the Murray Royal Institution in 1877, nine years
afterwards. In all probability Mr. Gurney's report, which was published
in his 'Notes on a Visit made to some of the Prisons of Scotland,' led
directly or indirectly to Mr. Murray's fortune being devoted to the
institution of an Hospital for the Insane. 'The old Jail of Perth is
built over a gateway in the middle of the town. Although this dark and
wretched building had been for some time disused as a prison, it was not
at the period of our visit' (Mr. Gurney's sister, Mrs. Fry, accompanied
him) 'without its unhappy inhabitants. We found in it two lunatics in a
most melancholy condition; both of them in solitary confinement, their
apartments dirty and gloomy; and a small dark closet, connected with
each of the rooms, filled up with a bed of straw. In these closets,
which are far more like the dens of wild animals than the habitations of
mankind, the poor men were lying with very little clothing upon them.
They appeared in a state of fatuity, the almost inevitable consequence
of the treatment to which they were exposed. _No one resided in the
house_ to superintend these afflicted persons, some man, living in the
town, having been appointed to feed them at certain hours of the day.
They were, in fact, treated _exactly as if they had been beasts_. A few
days after our visit, one of these poor creatures was found dead in his
bed. I suppose it to be in consequence of this event that the other,
though not recovered from his malady, again walks the streets of Perth
without control. It is much to be regretted that no medium can be found
between so cruel an incarceration and total want of care.'"
A return, signed "H. Hobhouse," was made in this year (1818) from the
parochial clergy in Scotland, showing the number of lunatics in each
county, and other particulars, which now possesses considerable interest
historically. The most important figures are as follows:--
TABLE
SHOWING THE NUMBER OF INSANE, ETC., IN THE SCOTCH SHIRES IN 1818 AND THE
NUMBER IN ASYLUMS.
--------------------------+----------------------------------
|
| Number of insane and idiots.
Shire. +-------+--------+--------+--------
| Male. |Female. | Total. | In
| | | |asylums.
--------------------------+-------+--------+--------+--------
Aberdeen | 197 | 226 | 423 | 41
Argyle | 171 | 122 | 293 | 9
Ayr | 110 | 104 | 214 | 14
Banff | 62 | 86 | 148 | 6
Berwick | 38 | 28 | 66 | 3
Bute | 32 | 27 | 59 | 1
Caithness | 45 | 29 | 74 | 0
Clackmannan and Cromarty | 20 | 19 | 39 | 1
Dumbarton | 44 | 38 | 82 | 6
Dumfries | 84 | 79 | 163 | 15
Edinburgh | 132 | 153 | 285 | 148
Elgin | 32 | 47 | 79 | 4
Fife | 115 | 127 | 242 | 11
Forfar | 122 | 154 | 276 | 37
Haddington | 44 | 36 | 80 | 9
Inverness | 130 | 110 | 240 | 10
Kincardine | 52 | 58 | 110 | 5
Kinross | 6 | 9 | 15 | 1
Kirkcudbright | 42 | 35 | 77 | 5
Lanark | 156 | 193 | 349 | 28
Linlithgow | 25 | 35 | 60 | 1
Nairn | 4 | 20 | 24 | 0
Orkney and Shetland | 67 | 62 | 129 | 0
Peebles | 12 | 16 | 28 | 0
Perth | 179 | 134 | 313 | 17
Renfrew | 94 | 81 | 175 | 24
Ross | 107 | 103 | 210 | 4
Roxburgh | 52 | 56 | 108 | 10
Selkirk | 6 | 6 | 12 | 0
Sterling | 58 | 64 | 122 | 4
Sutherland | 36 | 27 | 63 | 1
Wigton | 30 | 40 | 70 | 4
+-------+--------+--------+--------
| 2304 | 2324 | 4628 | 417
--------------------------+-------+--------+--------+--------
From this table it will be seen that the total number was 4628, of whom
2304 were males and 2324 females. With regard to their distribution,
there were--
In public asylums 258
In private asylums 158
With friends 1357
At large 2855
----
Total 4628
Two thousand one hundred and forty-nine were maintained wholly or in
part by the parish. Fifty parishes failed to send any return. In one
parish in the city of Edinburgh, from which we have no return, were
situated the "Edinburgh Bedlam" and the Charity Workhouse. In these two
places were confined eighty-eight lunatics and idiots. From Glasgow the
returns did not include ninety-five lunatics and idiots confined in the
Glasgow Asylum and Towns Hospital; 187 patients must therefore be added
to the foregoing, making a total of 4815.
Considering the period at which it was made, this is a very remarkable
return, and was much more complete than some later ones; for instance,
in 1826 the Parliamentary returns were ridiculously below these figures,
and Sir Andrew Halliday could only after diligent inquiry bring up the
number to 3700.[229]
Two years later (1828), a Bill was brought into the House of Commons to
amend the Act 55 Geo. III., c. 69,[230] by the Lord Advocate, Mr. H.
Drummond, and Mr. Robert Gordon. It passed the House of Lords, and
received the royal assent June 27th.
This constituted the Act 9 Geo. IV., c. 34, and reduced the fees paid
for persons confined from L2 2s. to 10s. 6d.; admission and discharge
books were ordered to be kept in every asylum, and an entry made of
every act of coercion; the books of the asylum were to be submitted to
the inspectors; no insane person was to be received into a hospital
without a warrant from the sheriff, who was to inspect hospitals; houses
were to be visited by medical men--those containing less than one
hundred patients, in case such house should not be kept by a physician
or surgeon, were to be visited twice in every week by a physician or
surgeon--signing in a register the condition of the house and state of
health of the patients; a register was also to be kept by the resident
physician or surgeon, and such register was to be regularly laid before
the inspectors, who were required to sign the same in testimony of its
production; ministers were empowered to visit mad-houses in their
parishes; regulations were made as to persons with whom lunatics were
privately confined; the justices might appoint three of their number to
inspect hospitals and private mad-houses; lastly, a weekly register was
to be kept in each house, and to be laid before the inspectors, stating
the number of curable and incurable cases, and the number under
restraint, the necessity thereof being certified by a medical man.
I wish to record here that, so far back as 1838, some of the Scotch
asylums were remarkable for the extent to which labour was introduced.
Being engaged in writing an introduction to Jacobi's work "On the
Construction of Asylums," the editor (Mr. S. Tuke) visited the asylums
of Scotland in that year, accompanied by Mr. Williams, the visiting
medical officer of the York Retreat, and found at Perth, Dundee, and
Aberdeen, the men's wards nearly empty, so large a proportion of their
inmates were in one way or other engaged in labour. "At Perth," he
writes, "more than twenty came in together to dinner from the labours of
the farm; others were employed in the garden and about the premises. At
Dundee at nine o'clock in the morning, out of fifty-seven men patients
of the lower class, twelve were engaged in stone-breaking, eight in
gardening, thirteen in weaving, one in tailoring, two as shoemakers,
whilst a few were engaged in the preparation of tow for spinning, and
several in the various services of the house. In the Aberdeen Asylum, in
which the labour system is extensively introduced, we were particularly
pleased with the state of the lowest class of women patients--chiefly in
an idiotic and demented state. All of these but one, and she was in a
state of temporary active mania, were employed in picking wool or some
other simple occupation. Indeed, in the three asylums which I have just
mentioned, the state of the lowest class of patients offers a striking
contrast to that in which they have been usually found in our asylums.
Those dismal-looking objects, cringing in the corners of the rooms or
squatting on the ground, almost lost to the human form, are here not to
be seen. I must not omit to mention that at Aberdeen the manager had
succeeded in inducing the higher class of patients to engage in
gardening, etc. At Glasgow the governors were contemplating arrangements
for the more extensive introduction of the labour system. In all these
asylums the superintendents expressed their decided conviction of the
benefit which, in a great variety of ways, was derived from the
employment of the patients, more especially in outdoor labour."
In connection with the Dundee and Glasgow asylums, the great services
rendered by Dr. McIntosh ought not to be forgotten, as also those of Dr.
Poole (Montrose), Dr. Malcolm (Perth), and Dr. Hutcheson (Gartnavel).
Scotland south of Edinburgh and Glasgow had not, until 1839, any
retreat or place of confinement for the insane, except six squalid stone
cells attached to the public hospital of Dumfries. Violent or vagrant
lunatics were physically restrained in their own houses, allowed to roam
at large, or incarcerated in prisons or police stations. In the year
mentioned, the Crichton Institution was opened for the reception of
patients of all ranks and means, from the pauper to the peer, in other
words, at rates of board from L17 to L350. In those days the building
was regarded as magnificent, commodious, and much in advance of the
prevalent psychiatry in Scotland, in the provision for the restoration
of mental and physical health, and for securing the comfort and
happiness of the inmates. The funds providing this building and
surrounding fields, had been bequeathed by Dr. Crichton, of Friars
Carse, Dumfriesshire, to his widow, who determined the precise
application of the magnificent legacy, which it is reported amounted to
L120,000. The benevolent foundress caused the structure to have the
Bible as a foundation, instead of a stone, and announced her solemn
intention that the establishment should be conducted, not merely in
accordance with science, but the principles of Christian philanthropy.
The first medical superintendent, Dr. W. A. F. Browne, who had made a
critical examination of European asylums, and had acted as the chief
officer in the Montrose Lunatic Asylum during four years, opened the
Crichton Institution in 1839, with what were regarded as sound but
advanced views, and with the resolution of carrying into effect all
that had been discovered or suggested for the amelioration, cure, and
care of those who might require treatment or seclusion.
Before the close of the first year of his management, there would appear
to have been about a hundred individuals, of various stations and in
various mental conditions, consigned to his charge. For these and the
gradually increasing numbers of the population, he instituted daily
exercise, amusement, occupation in the open air and in the grounds of
the establishment, and during winter or inclement weather, billiards,
bagatelle, "summer ice," and walking in the protected balconies
connected with every ward or gallery in the house. Collections of books
were contemporary with the laboratory, and the medical officers
invariably carried a catalogue, along with a prescription book, in their
daily medical visits to every patient. As a rule, remuneration was
ordained for every description of labour, whether it was mental or
manual, and might take a pecuniary or honorary form. From the
commencement no personal restraint was resorted to, although the medical
director did not bind himself either by rules or avowed opinions to
prohibit mechanical resources, should they appear to be demanded for the
preservation of life or strength, or quiet, or in any respect as a
remedial agent. In 1840 a medical assistant or pupil was appointed. The
experiment proved eminently successful, and the course thus foreshadowed
has been universally adopted, and improved upon by increase in the
number of such fellow labourers, by the addition of clinical clerks, and
so forth. The next advance was in instituting recorded observations of
the state of patients during the night as well as the day; in the
addition of carriages as a means of enjoyment and distraction, one of
these being an omnibus, so that groups of the inmates might be conveyed
to distant parts of the surrounding country; and in the multiplication
of hygienic and moral influences, music, painting, translation, study of
medicine, acquisition of languages, teaching, reading prayers, etc. The
next stage of development may be described as the separation of
different classes of patients; provision for the agitated, for
abstainers; mental culture for all capable of receiving impressions,
lectures, public readings, the production of a monthly periodical which
is still continued. Of this institution we shall have to speak again.
An Act to alter and amend certain Acts regulating mad-houses in
Scotland, and to provide for the custody of dangerous lunatics, was
passed in June, 1841 (4 and 5 Vict., c. 60). It amended 55 Geo. III., c.
69, and 9 Geo. IV., c. 34. A penalty of L200 and the expenses of
recovering the same might be imposed on persons sending any lunatic to a
mad-house without a licence; persons convicted of receiving lunatics
without a licence, or the required order, might be imprisoned in default
of penalty; the sheriff on application of the Procurator Fiscal might
commit dangerous lunatics; the expenses were to be defrayed out of the
rogue money, if the person had not the means of defraying, or if it
could not be recovered out of his estate, then the same was to be
defrayed by the parish which would be liable for the maintenance of
such lunatic if he or she were a pauper; lunatics might be removed on
application by the Procurator Fiscal; parish pauper lunatics were to be
confined in public hospitals; if no public hospital in the county, the
sheriff might send lunatics to an adjoining county; the death of a
lunatic was to be intimated to the sheriff in writing by the person
keeping the licensed mad-house; fees of licences might be diminished if
the moneys received exceeded the sums required for carrying this Act
into execution.
A form of register was to be kept in all licensed mad-houses in
Scotland, indicating the house; where situated and kept; names and
designations of individuals confined; date of reception; at whose
instance confined, and on whose medical certificate; whether curable or
incurable; date of removal or discharge, and authority for either; date
of death; disease or cause of death, and duration of disorder; name of
medical practitioner; when first called to give special attendance, and
how often he afterwards visited the deceased, with the place of burial.
We must not omit to mention that in 1848 further legislation was
attempted--an attempt, the failure of which was frequently deplored in
the debates of succeeding years. A good Bill designed to amend the law
of Scotland relative to the care and custody of the insane, and to
regulate existing asylums, and to establish asylums for pauper lunatics,
was brought in by the Lord Advocate (Lord Rutherfurd), Sir George Grey,
and the Secretary at War. After the second reading it was referred to a
Select Committee, which included the names of the Lord Advocate, Lord
Ashley, Sir James Graham, Mr. E. Ellice, Mr. Stuart Wortley, and Mr. H.
Drummond. Petitions now poured in from almost every shire in Scotland,
and the Bill had unfortunately to be withdrawn. Undaunted, the Lord
Advocate made another attempt in the following year, but with the same
result.
It is not necessary to dwell longer on the condition of the insane, or
the legislation adopted on their behalf, till we come to the year 1855,
which proved to be the commencement of a new departure in the care taken
for them by the State. Unfortunately, in spite of legal enactments, the
state of the insane in Scotland, at this time, outside the asylums was
as bad as it could be, and even in some asylums it was deplorable. At
this period a well-known American lady, Miss Dix, who devoted her life
to the interests of the insane, visited Scotland, and the writer had the
opportunity of hearing from her own lips, on her return from her
philanthropic expedition, the narration of what she saw of the cruel
neglect of the pauper lunatics in that country. She caused so much
sensation by her visits and her remonstrances, accompanied by the
intimation that she should report what she had witnessed at
head-quarters in London, that a certain official in Edinburgh decided to
anticipate "the American Invader," as Dr. W. A. F. Browne called her.
Miss Dix was, however, equal to the occasion, and, hurriedly leaving the
scene of her investigations, she took the night mail to London, and
appeared before the Home Secretary on the following day, when the
gentleman from Edinburgh was still on the road, quite unconscious that
the good lady had already traversed it.[231] The facts she laid before
the Home Office were so startling that they produced a marked effect,
and, notwithstanding counter allegations, the conclusion was very soon
arrived at that there was sufficient _prima facie_ evidence to justify
an inquiry. A Royal Commission was appointed, dated April 3, 1855, "to
inquire into the condition of lunatic asylums in Scotland, and the
existing state of the law of that country in reference to lunatics and
lunatic asylums."
The statutes forming the code of lunacy law for Scotland at that period
were, for all practical purposes, the 55 Geo. III., c. 69; 9 Geo. IV.,
c. 34; and 4 and 5 Vict., c. 60.
The number of ascertained patients at this period (1855) amounted to
7403. The classification was as follows:--Private patients, 2732;
paupers, 4642; criminals, 29 = 7403. Curable, 768; incurable, 4032;
congenital idiots and imbeciles, 2603 = 7403. Males, 3736; females, 3667
= 7403. The proportion of the insane and idiots to the population was 1
in 390. The number of congenital idiots was greatest in proportion to
the population in those counties remote from influences that incite to
mental activity--the Highland population containing more than three
times the number found in an equal Lowland population.
The 2732 private patients were thus distributed: In chartered asylums,
652; licensed houses, 231; poor-houses, 9; reported houses, 10; school
for idiots, 12; unlicensed houses, 18; with relatives, 1453; with
strangers, 297; not under any care, 50; total, 2732.
The 4642 paupers were thus distributed: In chartered asylums, 1511;
licensed houses, 426; poor-houses, 667; reported houses, 31; school for
idiots, 3; unlicensed houses, 6; with relatives, 1217; with strangers,
640; not under any care, 141; total, 4642.
The receptacles for the insane were thus distributed:--
A. Chartered asylums. The Royal Asylums at Aberdeen, Dundee, Edinburgh,
Glasgow, Montrose; the Crichton Institution, Dumfries, including the
Southern Counties Asylum; James Murray's Royal Asylum, Perth.
B. Public asylums not incorporated. The only institution of the kind,
that of Elgin, was exclusively for paupers.
C. Poor-houses with separate wards for the insane (twelve given in the
table).
D. Prisons. The only one specially adapted for the reception of the
insane was the lunatic department of the general prison at Perth.
E. Poor-houses without separate wards for the insane (fourteen given).
F. Private asylums (twenty-three in number).
G. Private houses reported to the sheriff.
H. Houses of relatives and strangers.
I. Schools for idiots. Baldovan, near Dundee; and Gayfield Square,
Edinburgh.
This Commission did not report until 1857, and unhappily the evidence
more than justified the necessity of the appointment of the Committee,
and of a sweeping measure of reform. The difficulty in selecting
passages from the Report is to know where to stop. We shall restrict
ourselves within moderate bounds; and first let us cite the reference to
the condition of the insane and idiotic not in asylums. "It is obvious,"
says the Report, "that an appalling amount of misery prevails throughout
Scotland in this respect. When estimating the condition of the insane
not in establishments, it should be remembered that the details
furnished by us give only an imperfect representation of the true state
of matters. They form only a part of the picture of misery; and, had we
been able to extend our investigations, it would, we are convinced, have
assumed a much darker shade.
"A practice prevails in some workhouses, as in a few of the licensed
asylums, of fastening the hands behind the back, by which much
unnecessary pain is inflicted on the patient."
Of the methods employed in _asylums_ to repress violence, etc., the
Report thus speaks:--
"_Instrumental Restraint and Seclusion._--Personal restraint by the
application of the strait waistcoat, or of the straps or muffs, is
almost entirely banished from the chartered asylums; but we have reason
to think that seclusion for long periods is frequently used. This remark
applies more especially to the asylums of Montrose, Glasgow, Aberdeen,
and Edinburgh. In Montrose we found, on one occasion, eleven patients in
seclusion out of a population of 174, several of them having been so
secluded for considerable periods, and one woman for several months; and
it is to be observed that the seclusion rooms in this asylum are _mere
cells, with stone floors and darkened windows_, and that the patients
who are placed in them are frequently allowed no other covering than
blankets, and no other bedding than loose straw cast on the floor."
Here is a picture of the way in which one asylum was conducted: "We have
grounds for fearing that the patients suffered from cold. The house is
carelessly conducted and the state of the patients very unsatisfactory.
The bed-frames, which are about the ordinary size with only spars of
wood at the lower part, were dilapidated and saturated with filth; and
the quantity of straw in them was very scanty and mixed with refuse; it
was wet, offensive, and broken into small portions, and had clearly not
been renewed for a considerable time. A certain number of the patients,
males as well as females, were stripped naked at night, and in some
cases two, and in one case even three, of them were placed to sleep in
the same bed-frame, on loose straw, in a state of perfect nudity." The
proprietor in his evidence says, "I never go into the rooms at night.
The floor is constantly soaked with wet. There is an epileptic lad who
is frequently fastened to the rings in the wall. The nurses keep the
muffs in their custody. I dare say half of the dirty patients would
sleep naked; seven would, therefore, sleep with others, I cannot say
that more did not sleep together in a state of nudity. _I consider the
treatment is proper for them._"
Again: "The bad treatment of the patients, and the very unsatisfactory
treatment of the patients, are not fully known to the official
inspectors. Indeed, it would appear that in some houses the instruments
of restraint are systematically removed from the persons of the patients
after the arrival of the sheriff at the asylum, for we find in Dr.
Renton's evidence that, speaking of L---- Asylum, in which two male
patients are kept constantly in restraint by means of handcuffs, he
says, 'There are not many patients under restraint at L----.' And,
further, in reference to Mrs. B----'s house at N----, he states, 'In
Mrs. B----'s house I don't think there are many cases of restraint.
There is a Miss W---- lately come, and a Miss M----. I don't think
restraint is used to them.' We have ascertained, however, that these two
patients were frequently restrained. These instances might be
multiplied.
"_Rent is saved_ by placing patients in small houses, making them use
the same rooms both as day and sleeping accommodation; they are also
crowded into small airing-courts, inadequate to afford proper exercise
and a proper separation of the sexes. The inmates during the winter
months pass the greater part of each twenty-four hours in their bed,
_whereby candle-light is saved_. In L---- Asylum, the patients are not
allowed candle-light at any season.
"We cannot doubt that in many instances practices obviously wrong, and
detrimental to the patients, have been adopted in licensed houses,
because an increased profit would thereby be obtained by the
proprietor."
In short, both as regards licensed houses and unlicensed houses, the
Report winds up by giving a dismal picture; for, as to the former, "they
are crowded in an extreme degree, profit is the principal object of the
proprietors, and the securities against abuse are very inadequate;" and
as to the latter, they "have been opened as trading concerns, for the
reception of certain classes of patients who are detained in them
without any safeguard whatever against ill-treatment and abuse." Strange
to say, the persons properly authorized to inspect, did not avail
themselves of the powers of inspection granted them by law; and the
officials chose to interpret the law "in conformity with their
respective views." Such was the unfortunate condition into which Scotch
lunacy had drifted, at so comparatively recent a date as 1857, and out
of which those who drew up the Report--Alexander E. Monteith, James
Coxe, Samuel Gaskell, and William George Campbell--proposed to deliver
it by the following remedial measures:--The erection of district or
county asylums for pauper lunatics, including accommodation for the
insane belonging to the labouring classes, who are not strictly
paupers. Likewise, more suitable accommodation for criminal lunatics.
Means for insuring greater caution and discrimination as regards the
licensing of houses for the reception of the insane; for imposing some
check upon the licensing of new houses; and for conferring powers to
close those already opened for paupers so soon as public asylums shall
be erected, or at any other time, if not properly conducted. Regulations
by which all pauper lunatics not in asylums shall be brought under
proper visitation and care, and periodical reports be made as to their
condition by medical men, so as to afford a safeguard against abuse and
ill-treatment, and secure the ready and careful transmission of all
proper cases to asylums. An accurate definition of the powers and duties
of sheriffs in reference to the insane, so as to secure a more uniform
practice and united action amongst them. Rules for the guidance of the
Board of Supervision, parochial boards, inspectors of poor, and district
medical officers in all matters relating to the management of the
insane. More complete regulations in reference to medical certificates;
to prevent interested parties signing them; to specify the length of
time the document shall remain in force; and to require a statement of
the facts or evidence upon which the opinion as to the patient's
insanity is founded. Also a limitation of the time during which the
sheriff's order shall remain in force, previous to the admission of the
patient, and also in case of escape. The formation of a complete system
of schedules and returns, together with full records of all admissions,
discharges, deaths, and accidents. Also the institution of registers
and case-books, showing the medical treatment pursued in each case, and
whether, and to what extent, restraint and seclusion were employed.
Comprehensive regulations applicable to licensed houses and poor-houses,
while continuing to receive lunatics, for securing to the patients
sufficient medical and other attendance; kind and appropriate treatment;
proper diet, clothing, bedding, exercise, and recreation; and adequate
means of religious consolation. A requirement that, on recovery,
patients shall be discharged by the medical attendant of the
establishment. Restrictions on the removal of pauper patients by
inspectors before recovery. Precautions for preventing injustice in
transporting aliens. Better regulations as to dangerous and criminal
patients. Measures by which persons labouring under insanity may
voluntarily place themselves under care in an asylum. Special
regulations for prolonging control over cases of insanity arising from
intoxication. Enactments for extending further protection to the
property of lunatics, and for insuring the proper application of their
funds. The imposition of suitable penalties for infringement of the law,
and power to modify them according to circumstances. Powers to raise
sufficient funds for the purposes of the Act. The creation of a
competent board, invested with due authority, to whom the general
superintendence of the insane in Scotland shall be entrusted, including
power to license houses for the reception of the insane; to visit all
asylums, licensed houses, poor-houses, and houses containing only single
patients; to order the removal of patients to or from an asylum, or
from one asylum to another; to give leave of absence to convalescent
patients; to regulate the diet in asylums and licensed houses for pauper
patients; to make regulations for their management, etc., etc.; with
direction to report to the Secretary of State for the Home Department.
The formation of local boards for the management of individual asylums,
which shall act in conjunction with the general board.
Legislation followed in due time.
On the 29th of May, 1857, Mr. Ellice,[232] the member for St. Andrew's,
asked the Government what steps they intended to take for securing to
pauper lunatics in Scotland proper protection and maintenance, in order
to alleviate the sufferings of the persons to whom the recent Report of
the Commissioners of Inquiry into the state of Lunatics in Scotland
related. He was ashamed to have to admit that in that country,
unfortunately, the state of things had been lamentably different from
England and Ireland, where boards had been appointed under which,
generally speaking, the law for the protection of lunatics had been
satisfactorily administered. In Scotland, instead of a Board of
Commissioners specially appointed to take care of lunatics, the charge
had devolved upon the sheriffs of counties and the Board of Supervision,
which latter body stood in the place of the Poor Law Board in this
country. He charged the Scotch authorities with an almost total neglect
of the duties which were incumbent upon them under the law, which "in a
great measure was very ample for the protection of the great proportion
of the pauper lunatics in Scotland, if it were properly administered."
The powers and duties of the sheriffs, as laid down in the Act, were
amply sufficient. Yet the granting of licences, which was their duty,
formed the exception, and, in fact, houses were opened generally without
any licence whatever; the patients were detained without any order, or
without even any medical certificate; if they died, their friends were
not informed of their deaths, which were not reported to any constituted
authority, "the unfortunate persons disappearing in that mass of misery
and filth which he should shortly depict." The pauper lunatics were
under the charge of the parochial boards. These were under the control
of the Board of Supervision, sitting in Edinburgh, and similar to the
Poor Law Board in London. The statute enacted that whenever any poor
person chargeable on the parish should become insane, the parochial
board should, within fourteen days of his being certified, take care
that he was properly lodged in an asylum. The Board of Supervision had,
under the same Act, peculiar power with respect to lunatics, and it was
competent for them to dispense with an asylum, and allow the patient to
remain with his friends under due inspection.
The Board of Supervision had absolute powers to dismiss any inspectors
of the poor neglecting their duty to pauper lunatics. They acknowledged
their obligation. In their first Report (1847) they, among other
positive statements, affirm that they, in all cases in which they
dispensed with the removal of pauper lunatics to asylums, were careful
to preserve the necessary safeguards against abuse, by requiring a
satisfactory medical certificate as to treatment, and so on. Mr. Ellice
then showed that "these statements had no foundation in fact; that they
were positively untruths, and entirely deceptive, year after year, as to
the real state of the lunatics in Scotland." In subsequent Reports the
Board boasted that it had endeavoured, not unsuccessfully, to improve
the condition of the insane, but Mr. Ellice showed that "the condition
and treatment of the pauper lunatics was diametrically opposite to what
was there stated." He knew that more legislation would be promised by
the Government, but the thing was to see that the law was enforced, and
that due notice should be taken of the conduct of the authorities who
had neglected their duties. He asked that a direct condemnation should
be passed upon them, and that they should be compelled, as in duty
bound, to protect pauper lunatics from continued neglect and abuse. The
member for Aberdeen characterized the Report of Commissioners regarding
the state of the insane in his county as "one of the most horrifying
documents he had ever seen."[233] It was "a state of things which they
could not before have believed to prevail in any civilized country, much
less in this country, which laid peculiar claims to civilization, and
boasted of its religious and humane principles."[234] "Distressing as
were the cases which he had mentioned, there were others ten times worse
remaining behind--so horrible, indeed, that he durst not venture to
shock the feelings of the House by relating them."[235] Sir George Grey,
after saying that the Report on the treatment of lunatics in Scotland
contained statements of facts calculated to cast very great discredit
upon that portion of the United Kingdom, admitted that the Board of
Supervision was not free from blame, but thought the Report proved that
the guilt must be shared by the parochial boards, the inspectors of the
poor, the sheriffs, the clergy, the justices of the peace, and by the
Commissioners of Supply. By this ingenious homoeopathic dilution of the
blame, it was easy to show that individual responsibility was
infinitesimal, and could not, therefore, be detected and punished in the
way it so richly merited. Sir George Grey promised to introduce a Bill
calculated to remove the defects in the law established by the Reports,
and deplored the fate of the Bill brought in by Lord Rutherfurd,[236]
when Lord Advocate, which would, in his opinion, have remedied all the
evils now complained of. It was "referred to a Select Committee, but the
opposition roused to it in Scotland, on the miserable ground of the
expense it would incur, proved fatal to the measure. I trust the
disgrace that now attaches to Scotland in this matter will be removed,
and that this and the other House of Parliament will cordially
co-operate with the Government in the adoption of those measures that
are necessary for the relief and protection of the unfortunate class of
persons referred to in the Report."[237] Mr. H. Drummond, who said he
had assisted Lord Rutherfurd to pass his Bill, also deplored its
rejection. "Both he and the Lord Advocate were beaten by the systematic
opposition of every single person who was connected with the
administration of the system in Scotland. They would not give the
returns sought for ... and the ground of the opposition was the dread of
the dirty expense which might be incurred. From one to the other it
appeared that the object of care in Scotland was property, not persons.
The way in which they treated the poor in Scotland was perfectly
scandalous, and in nothing did the system appear so bad as in the
treatment of pauper lunatics, the rich lunatics being sufficiently well
taken care of." Mr. Drummond asked how it was "that throughout the whole
of Scotland there was not one clergyman who could find time to visit
these poor creatures? True, there was one, but when he went to the
asylum he was refused admittance; and why? Because he was a Papist. The
Poor Law, as managed by the Board of Supervision, had been well defined
to be 'a law for depriving the poor of their just rights.'"[238] Sir
Edward Colebrooke, as one of the members for Scotland in the previous
Parliament, took his share of the blame that attached to the House in
reference to Scotch asylums. In the Report issued in 1844, it was
recommended that more stringent provisions should be introduced into the
law, but they had not been attended to. Mr. Kinnaird, the member for
Perth, thought that the Scotch members owed a debt of gratitude to Mr.
Ellice for the manner in which he had laid the disgraceful feature in
the administration of the Scotch Poor Law before the House. He was glad
to find that the Perth Asylum was not one which had disgraced
Scotland.[239] The Lord Advocate rejoiced at the publication of the
Report, and the statements of Mr. Ellice, from the bottom of his heart,
because the state of things had for a long time been a disgrace and a
scandal to Scotland. "The people of that country had known that it was a
disgrace and a scandal, and he regretted to add that it was not the
first time that statements had been made similar to those to which they
had just listened. Had Lord Rutherfurd's Bill of 1848 been passed, this
disgraceful state of things would have been put an end to. But not a
single petition was presented in its favour, while twelve of the largest
and most important counties of Scotland petitioned against it! That
noble-minded lady, Miss Dix, went to Edinburgh and visited the asylums
at Musselburgh. After seeing them, she said there was something wrong,
and she wished to be allowed to visit them at the dead of night, when
she would not be expected. He felt a difficulty about giving a
permission of that kind to a non-official person, and accordingly she
applied to the Home Secretary. When asked by him his opinion of the
subject, he at once stated that the whole system with regard to the
treatment of lunacy in Scotland was utterly disgraceful, and that the
evil could only be reached by a Commission of Inquiry. The facts were
now so clearly proved that if he proposed the very remedy which was
rejected in 1848, it would be adopted by both Houses of Parliament
without any important opposition."
A Government Bill was brought in by the Lord Advocate, June 9, 1857, "to
alter and amend the laws respecting lunatics in Scotland." In
introducing it, he summarized the then law as follows:--The sheriffs of
the counties, the justices, and some other parties had the power and
duty of inspection once or twice a year; certain registers were ordered
to be kept and certain regulations made. But there was no uniformity;
every sheriff might interpret the Act as he pleased, and there was no
obligation to erect asylums for the maintenance of lunatics. The duty
was thrown on the Procurator Fiscal of seeing the Act executed, but no
power was given him to ascertain whether it was executed or not, and
there was no power of visitation. He need not say that these safeguards
entirely failed, and the remedy he now proposed was that there should be
appointed a Commission, an inspector-general who should be a medical
man, a secretary, and a clerk; and that these should constitute the
Lunacy Board for Scotland, though not under that name. They would have
the power of granting and refusing licences for asylums. The sheriffs
and the justices would retain the powers conferred on them already.
Scotland would be divided into districts, in which asylums would be
erected by an assessment laid on for the purpose. The Lord Advocate made
a sort of formal defence of the Board of Supervision, of which he
himself had been a member, and pointed out that in their first Report
they had stated that the accommodation in the asylums was not equal to
that required for one-tenth of the number of pauper lunatics. Sir John
McNeill, who presided over the Board, when examined before the Select
Committee on Miscellaneous Expenditure in 1848, stated this fact
strongly. Mr. Ellice, however, adhered to the remarks he had previously
made, reasserted his accusations, and repeated that if the question were
put to a jury, they would come to no other decision than that gross
culpability existed on the part of the authorities, and he only
regretted that the Government had not had the courage to say that the
Board of Supervision had deserved the condemnation of the House. Leave
was given to bring in the Bill.[240]
On the second reading[241] (June 9, 1857) no serious opposition was
offered to the Bill, although an attempt was made to show that the
Commission had been carried away by exaggerated statements. Mr. Bruce,
the member for Elginshire, who alleged this, hoped the Bill would not be
hurried through the House that session. Mr. Blackburn, the member for
Stirlingshire, said he agreed with every Scotch member that a permanent
board would be of no use; it would be coercing the people by
centralization. Mr. Cowan, member for Edinburgh, said that he had been
requested to present a petition, signed by the Lord Provost and
magistrates of Edinburgh, seeking for delay, but he did not like to
incur that responsibility, and would therefore support the second
reading. Mr. Dunlop, the member for Greenock, assumed, for the sake of
argument, that all persons in Scotland had done their duty; but even if
this were so, it was impossible but that cruelty and ill-treatment must
have taken place when they considered the way in which pauper lunatics
were treated, and he rejoiced that another session was not likely to
pass over without something being done to remove what was at once a
national calamity and a national crime, from Scotland.[242] Mr. Mackie,
the member for Kirkcudbrightshire, protested against the creation of a
new Board and the expensive machinery contemplated by the Bill. Sir
William Dunbar, the member for Wigton, agreed, and maintained that the
existing system was sufficient to insure all that was required. Sir John
Ogilvy, member for Dundee, said a strong feeling existed in Scotland
that the Board of Supervision furnished an efficient machinery capable
of supplying all the defects of the present system, without the creation
of a new Board. Mr. Hope Johnstone, member for Dumfriesshire, enforced
these remonstrances, by stating that he had representations made to him
from every quarter in opposition to the appointment of a new Board. Mr.
Drummond hereupon made an observation, greatly to his credit, which
deserves to be remembered. He said that the question was not so much
what would be the most expensive as what would be the most efficient
machinery. There were plenty of representatives of the ratepayers in
that House, _but no representatives of the lunatics of Scotland_. They
seemed to have no friends there, while really they were the persons who
stood most in need of being represented.
The Act (20 and 21 Vict., c. 71) was passed August 25, 1857. It was
entitled "An Act for the Regulation of the Care and Treatment of
Lunatics, and for the Provision, Maintenance, and Regulation of Lunatic
Asylums in Scotland." It repealed the Acts 55 Geo. III., c. 69; 9 Geo.
IV., c. 34; and 4 and 5 Vict., c. 60.
To give a complete analysis of this most valuable Act, which consists of
no less than 114 sections, would be wearisome to the reader. Its chief
provisions were these:--
A Board of Commissioners in Lunacy for Scotland was to be appointed,
consisting of three unpaid and two paid Commissioners; the Secretary of
State was empowered to appoint one or two medical men as Deputy
Commissioners; public asylums founded after the passing of this Act were
to be subject to it; the duties of the Commissioners as to inspection
were laid down; the sheriff was to visit and inspect asylums; private
asylums were to be licensed by the Board; the patient was to be admitted
by order of the sheriff on medical certificates; five shillings were to
be paid for the sheriff's order for the admission of a patient not being
a pauper, and half that sum for a pauper; the medical certificate was to
specify the facts on which opinion of insanity was founded; no
certificate was to be granted without examination, under penalty not
exceeding L50, and if falsely granted, under a penalty not exceeding
L300; houses where lunatics were detained under the order of the
sheriff might be visited by the Board; one medical man was to be
resident in every asylum licensed for a hundred patients or more, and a
physician was obliged to visit daily those for more than fifty patients;
those for fifty or less were to be visited at least twice in every week.
Scotland was divided into districts, set forth in a schedule, and a
district board was to be appointed within six months, which should
inquire into the necessities of the district; the Board was to require
the district boards to provide district asylums; the provisions of 2 and
3 Vict., c. 42, were to be applied to this Act; district asylums were to
be vested in district boards, and district inspectors were to be
appointed.
Power was given to Public Works Loan Commissioners to lend money for
purposes of the Act, provision being made for the money borrowed being
paid off within thirty years.
In case the district asylum could accommodate more than the lunatics of
the district, other lunatics, it was enacted, might be admitted.
Whether the property of a lunatic was or was not under judicial
management, if it was not property applied for his benefit, application
was to be made to the Court of Session.
Provision was also made for cases where insanity stands in bar of trial;
the finding of the Court that the prisoner cannot be tried, to be
followed by an order to be kept in strict custody during her Majesty's
pleasure; a lunatic acquitted of a criminal charge on the ground of
insanity, to be kept in custody by order of court in such place as it
may see fit, during her Majesty's pleasure; prisoners exhibiting
insanity when in confinement to be removed to an asylum, to remain there
until it should be certified to one of her Majesty's Principal
Secretaries of State by two medical men that such person has become of
sound mind; whereupon the Secretary of State was authorized, if such
person's term of imprisonment had not ended, to issue his warrant to the
superintendent, directing that such person should be removed back to
prison, and if no longer subject to imprisonment, that he should be
discharged.
With regard to the liberation of patients from asylums, the certificates
of two medical men approved by the sheriff were required, eight days'
notice being given to the person at whose instance such lunatic was
detained; the patient released to be entitled to a copy of order,
certificate, etc., on which he was confined.
The punishment of maltreating any lunatic was a fine not exceeding L100,
or imprisonment for any period not exceeding six months, without
prejudice to action for damages.
Power was granted to the Secretary of State to order a special
visitation of any place where a lunatic was represented to be confined.
The inspectors of the poor were to give intimation of pauper lunatics
within their parishes.
The importance of this Act is enhanced by the fact that its framers had
the advantage of a knowledge of the working of the great Acts of 1845
and 1852 in England and Wales.
Availing ourselves now of the first Report of the Commissioners[243]
who were appointed under the foregoing Act, we shall present a statement
of the number and distribution of the insane in Scotland on the 1st of
January, 1858.
-------------------+--------+----------+----------+--------+---------
Location. | Males. | Females. | Total. |Private.| Paupers.
-------------------+--------+----------+----------+--------+---------
In public asylums | 1226 | 1154 | 2380 | 786 | 1596
In private asylums | 330 | 415 | 745 | 219 | 526
In poor-houses | 352 | 487 | 839 | 6 | 833
In private houses | 810 | 974 | 1784 | -- | 1784
+--------+----------+----------+--------+---------
Total | 2718 | 3030 | 5748[244]| 1011 | 4739
-------------------+--------+----------+----------+--------+---------
The above table does not include private single patients; their number
could not be accurately ascertained.
The Commissioners, as might be expected, report the state of the insane
to have altered little since the Report of the Royal Commission. In the
pauper licensed houses, if not in others, the overcrowding was great,
though diminishing. "The patients, when within doors, are generally
found sitting in cheerless rooms, ranged on benches, listless and
without occupation; and when out of doors, they are usually lounging
sluggishly about the airing-courts, or are crouching in corners." Among
favourable indications noted by the Commissioners it is pleasant to read
the following:--"Mechanical restraint has been entirely banished from
the licensed houses, and patients who are recorded in the Report of the
Royal Commissioners as almost always under restraint, are now habitually
free from their bonds. The improvement in the condition of these cases
under the more humane treatment now in use has been most remarkable, and
is especially exemplified in the case of A. S----, a patient in M----
Asylum."
Subsequent Acts were passed, called for by the experience of the
Commissioners in regard to the working of the Act of 1857, some
imperfections in which were naturally discovered in the course of years.
The Lord Advocate and Sir George Grey brought in a Bill in 1862 to make
further provision respecting lunacy in Scotland, which received the
royal assent July 29 (25 and 26 Vict., c. 54).
By this Act, consisting of twenty-five sections, the Board was empowered
to license lunatic wards of workhouses; to sanction the reception of
pauper lunatics in workhouses; to grant special licences for reception
in houses of not more than four lunatics; to grant licences to
charitable institutions for imbecile children without fee; to sanction
detention of pauper lunatics in asylums beyond the limits of their
district; to take such steps as the Board may consider requisite towards
providing accommodation for the district, etc., etc. Not to cite other
sections, certain provisions of the recited Acts as were inconsistent
with the Act were repealed, and the General Board of Commissioners was,
of course, continued.
In their Report of this year (1862) the Commissioners observe, relative
to the supposed increase of insanity, "Judging from the evidence which
the tables afford, the increase is almost entirely due to the
accumulation of the numbers of the insane, and certainly not, to any
marked degree, to a greater disposition in modern times to mental
disease; for while in the years 1858, 1859, 1860, and 1861, the
_admissions_ into asylums scarcely varied in number, the patients
resident in such establishments showed every year a large and steady
increase. Thus, on January 1, 1858, their number amounted to 3765; on
January 1, 1859, to 4114; on January 1, 1860, to 4350; and on January 1,
1861, to 4462."
We have already noted the fact that more idiocy appears to be found in
the counties least exposed to mental activity. In this Report, however,
the Commissioners state that, as regards lunacy, its occurrence is
considerably more frequent in _urban_ than in _rural_ districts. The
word _occurring_ is here used advisedly in contradistinction to existing
lunacy. The explanation offered by the Commissioners is that there is a
greater proportion of recoveries and deaths taking place among the
patients of the rural district. They contrast the number of pauper
lunatics intimated from urban populations with the number intimated from
rural districts, and they find that in the former, the occurrence of
pauper lunacy as compared with its occurrence in the latter, is as 100
to 54, whereas the proportion of existing pauper lunatics, January 1,
1861, in the corresponding districts was as 100 to 106. The
Commissioners regarded as urban those parishes containing towns, or
parts of towns, having more than 20,000 inhabitants, and as rural all
other parishes.
We need not dwell on the Act passed in 1864 (27 and 28 Vict., c. 59) to
continue the Deputy Commissioners in Lunacy in Scotland, and to make
further provision for their salaries and the clerk of the Board.
In 1866 another Act was passed (29 and 30 Vict., c. 51) to amend the
Acts relating to lunacy in Scotland, and to make further provision for
the care and treatment of lunatics. One or two of the provisions made
merit notice. Any person keeping a lunatic in a private house, although
not for gain, longer than one year, was obliged, if the malady required
compulsory confinement or restraint or coercion, to report to the Board,
that it might make inspection and obtain an order for the removal of
such lunatic to an asylum. Regulations were made as to persons entering
voluntarily as boarders, whose mental condition is not such as to render
it legal to grant certificates of insanity. Letters from patients to the
Board, and from the Board to patients, were to be delivered unopened.
Power was given to apply to the Court of Sessions to obtain improved
treatment and care of any lunatic. Patients committed as dangerous
lunatics might be liberated on the certificates of two medical men,
approved by the Procurator Fiscal, that such lunatic may be discharged
without risk of injury to the public or the lunatic. This is a valuable
provision. Power was given to the directors of asylums to grant
superannuations to officers, etc.
The above Statute, passed in 1866 to amend the Acts relating to lunacy,
was succeeded, in a few years, by another statute having reference to a
special class of the insane. Of this later Act in 1871 (34 and 35 Vict.,
c. 55) to amend the laws relating to criminal and dangerous lunatics in
Scotland, it may be well to record the most important provisions. These
were to apply to persons detained by judgment prior to the Act 20 and 21
Vict., c. 71. The lunatic department in the general prison at Perth was
to be relieved from overcrowding by removing the insane prisoners to
district, chartered, or private licensed asylums, with consent of
managers of chartered and private asylums. As to the disposal of persons
becoming insane in local prisons, these were to be removed to a lunatic
asylum by a warrant of the sheriff; all asylums in which pauper lunatics
were maintained by contract being bound to provide for the reception of
such prisoner. The Act was to apply to any lunatic charged with assault
or any offence, although not coming within the definition of a pauper.
There was in 1874 an interesting Parliamentary return, showing the total
number of pauper lunatics in each of the three divisions of the United
Kingdom, and the estimated annual amount of the proposed grant of four
shillings per head per week towards the maintenance of pauper lunatics
in asylums. The figures are as follows:--
A. In county, borough, royal, district, parochial, and private licensed
asylums--
England 31,799
Ireland 7,140
Scotland 4,428
------
Total 43,367
B. In work houses and elsewhere--
England 21,413
Ireland 3,125
Scotland 2,077
------
Total 26,615
Total of A and B in England 53,212
" Ireland 10,265
" Scotland 6,505
------
Total 69,982
Annual amount of four shillings weekly capitation grant towards
maintenance of those in A:
England L330,710[245]
Ireland 74,256
Scotland 46,051
--------
L451,071
The proportion per cent. of patients in A on the total number of pauper
lunatics is, for--
England 60 per cent.
Ireland 70 "
Scotland 68 "
Of the 6505 Scotch pauper lunatics, there were--
In public asylums 1930
In district asylums 1763
In private asylums 77
In parochial asylums 746
In lunatic wards of poor-houses 557
----
5073
In private dwellings under sanction of the Board, viz.--
With relatives 875}
With strangers 529} 1432
Alone 28}
----
6505
A return was also made of the average weekly cost of each lunatic at
that time--
s. d.
In public asylums 9 2-1/4
In district asylums 9 9-1/2
In private asylums 11 1
In parochial asylums 8 4-1/4
In lunatic wards of poor-houses 6 8-1/2
--------
Total in establishments 9 0-1/2
With relatives 4 0
With strangers 5 6
Alone 3 5-1/2
--------
Total in private dwellings 4 3-3/4
There should be added to the above an expenditure for all pauper
lunatics of threepence a head per week, being the cost of certificates
of lunacy, expenses of transport, etc.
Twenty-one years after the appointment of the Lunacy Commissioners,
their Report of 1878 enables us to mark the progress which had been made
during this period in the accommodation afforded for the insane in
Scotland. The labours of the Commissioners had been followed by highly
satisfactory results, and it would be difficult to speak too highly of
the value of their Reports during these twenty years.
On January 1, 1878, 1569 patients were maintained from private sources,
7473 by parochial rates, and 55 at the expense of the State.
Twenty years before, the distribution of the insane was as follows. In a
parallel column is seen a like return for 1878.
--------------------------------+-----+-----------+-----+-----------
| |Proportion | |Proportion
Location. | |to 100,000 | |to 100,000
|1858.| of |1878.| of
| |population.| |population.
--------------------------------+-----+-----------+-----+-----------
In Royal and district asylums |2380}| |5449}|
In private asylums | 745}| 131 | 208}| 206
In parochial asylums and lunatic| }| | }|
wards of poor-houses | 839}| | 736}|
In private dwellings |1804 | 60 |1493 | 42
In lunatic department of general| | | |
prison | 26 | | 55 |
In training schools | 29 | | 156 |
+-----+-----------+-----+-----------
|5823 | 191 |9097 | 247
--------------------------------+-----+-----------+-----+-----------
At the present time[246] the numbers and distribution of the insane in
Scotland are as follows:--
NUMBER OF LUNATICS IN SCOTLAND ON JANUARY 1, 1881.
-------------------+--------------+------------------+------------------
Location. | Private. | Pauper. | Total.
+---+---+------+-----+-----+------+-----+-----+------
| M.| F.|Total.| M. | F. |Total.| M. | F. |Total.
-------------------+---+---+------+-----+-----+------+-----+-----+------
19 Royal and | | | | | | | | |
district asylums |670|584| 1,254|2,244|2,422| 4,666|2,914|3,006| 5,920
6 private asylums | 49|108| 157| -- | -- | -- | 49| 108| 157
6 parochial asylums|-- |-- | -- | 599| 743| 1,342| 599| 743| 1,342
14 lunatic wards of| | | | | | | | |
poor-houses |-- |-- | -- | 324| 390| 714| 324| 390| 714
Private dwellings | 41| 72| 113| 604| 912| 1,516| 645| 984| 1,629
+---+---+------+----+------+------+-----+-----+------
|760|764| 1,524|3,771|4,467| 8,238|4,531|5,231| 9,762
Lunatic department | | | | | | | | |
of General | | | | | | | | |
Prison, Perth |-- |-- | -- | -- | -- | -- | 38| 17| 55
3 training schools | | | | | | | | |
for imbeciles | 72| 49| 121| 51| 23| 74| 123| 72| 195
+---+---+------+-----+-----+------+-----+-----+------
Totals |832|813| 1,645|3,822|4,490| 8,312|4,692|5,320|10,012
-------------------+---+---+------+-----+-----+------+-----+-----+------
We have in this chapter had to record a melancholy condition of things
as regards the insane, not only out of asylums, but in them; such a
condition as fully justified Lord Shaftesbury employing exceptionally
strong language in reference to the treatment of lunatics in
Scotland.[247] But this is happily now only _history_, and assuredly the
physicians who superintend the Scotch asylums have done their utmost to
wipe out the stain which at one time dishonoured their country's
treatment of those who had lost or had never possessed their reason;
while the Lunacy Commissioners deserve the highest praise for their
continuous and efficient labours in the difficult work to which they
have devoted themselves. The efficiency of the asylums in Scotland is
now such, owing in great measure to the action taken in 1857, that
foreigners, not to say the English themselves, may cross the Tweed to
learn from the physicians of the mind, important lessons in the care and
cure of the insane. The chartered asylums of that country have for a
long period received encomiums from those who have visited them.
Of the Dumfries institution I have already spoken, and would add, in
proof of the pains taken by the former superintendent, Dr. Browne, to
break the monotony of asylum life, that he introduced private
theatricals, in which vaudevilles and farces were performed by and for
the lunatics, and even before the public. A practice still beneficially
preserved is that of making excursions to places noted for their natural
beauty or antiquity, even temporary vacations at the seaside or
elsewhere, constituting valuable novelties and auxiliaries in these
ministrations to the mind diseased. Such resources, in connection with
dramatic festivities, attendance on all accessible entertainments in the
neighbouring town, were utilized in affording a stimulus or a solace to
inmates of the cultivated classes; nor were the higher aids yielded by
religious services and instructions neglected, and, with unwonted
liberality of sentiment, chaplains representing the three grand sections
into which Christianity is divided, Presbyterianism, Episcopacy, and
Catholicism, were appointed, and exercised their functions, it is
believed, wisely and discreetly in their respective spheres. The benefit
of this step suggested a resort to frequent intercourse between the
different ranks of patients, with associates from the external world,
and the creation of all arrangements which could recall or assimilate
such a place of seclusion with home, rational liberty, and natural
pursuits. Whilst the mingling of distinct grades was employed as a
remedy, rigid classification was enforced, founded upon position in
society, as well as upon the phase or stage of disease. In furtherance
of this view it was resolved to remove the paupers and poorer inmates
from the original structure, and to erect a distinct apartment, capable
of containing four hundred individuals, within the grounds, provided
with all necessary requirements, but to be conducted with the most rigid
economy and consideration of the resources of the country, as well as of
the habits of the patients. This movement was made, and a hospital was
added, conducted, however, by the same superintendent and upon precisely
the same principles as regulated the Crichton Institution proper. We
speak confidently upon this and other points, because there is before
us a series of valuable annual reports, containing not exclusively the
history of the progress of the institution, but the results, medical and
moral, of the superintendent. For the behoof of both houses a museum of
natural history was formed, and proved a considerable attraction in
stormy weather, or to lazy or lethargic observers. While in such a
climate it was inevitable that indoor objects of interest should be
supplied, attempts to draw those under treatment from the deteriorating
atmosphere of seclusion were not wanting. Parole was accessible to the
trustworthy, under suitable attendants; patients were allowed to travel
long distances, and for specific purposes, such as angling, botanizing,
and so forth; their presence was permitted in the _fete champetre_ and
in country sports, and every effort was made to give to anniversaries,
public and private, a prominent place in the annual calendar. But fun
and frolic seem to have occupied but a subordinate place, as
composition, re-education of every kind, classes for drawing,
flower-making, dancing, singing, joining in concerts, are repeatedly
insisted upon. But while these engagements availed in winter,
promenades, dances on the green, bowling, quoiting, the care of pet
animals, and, for a few, interest in the botanic garden, diversified the
summer months. These constitute a pleasing and encouraging part of the
picture, but it should be broadly and boldly confessed that there were
agitated and intractable spirits in the community that could not be
tranquillized or guided by such agencies, and that, although restraint
in its vulgar and repulsive aspects was not adopted, seclusion, padded
rooms, and the conservative bed were occasionally in use. During the
last twenty years the asylum has been under the superintendence, first
of Dr. Gilchrist, trained within its walls, and secondly of Dr. Adam,
but while there has been undoubted progress, the improvements and
ameliorations have been, to a certain extent, the evolution or
development of the views and facts which have been above enumerated.
I would add to what has already been said of the Royal Edinburgh Asylum,
that the managers appointed Dr. McKinnons, the first
physician-superintendent, in 1840, with complete administrative and
medical authority. He was a man of advanced ideas, as his reports show.
On his death in 1846, Dr. Skae was appointed his successor, and remained
at his post till 1873, when Dr. Clouston became
physician-superintendent. Dr. Skae extended the reputation of the
institution and consolidated its position. His reports were always
medical and philanthropic, and, as regards the general public, educative
and interesting. By attracting public sympathy and not becoming too
official, it has always carried out the original intention of its
founders to provide for all classes, and has now no less than eight
hundred patients who pay from L30 up to L500 a year. It has a Charity
Fund of L10,000; its buildings are scattered, and number nine for
patients. Like an old cathedral, it now shows, in common with
long-established institutions, such as the York Retreat, the successive
ideas of various men and various times, and one would really regret to
see the original shell of these charitable hospitals, though antiquated
and a little inconvenient, ruthlessly destroyed to make way for modern
structures. In the Edinburgh Asylum are large corridor wards, pavilion
wings of different kinds, cottages and cottage hospitals, a mansion in
its own grounds, and a seaside house twelve miles off, to which over a
hundred and twenty patients go annually. Its present superintendent has
still further extended the reputation of this asylum.
Were the object of this work to describe institutions for the insane,
instead of giving a general historical sketch of the progress of reform,
I should have added notices of other excellent institutions, as those of
Gartnavel, Glasgow, so ably superintended by Dr. Yellowlees, and the
Lenzie Asylum, where Dr. Rutherford has done wonders.
Of the Scotch royal or chartered asylums and their far-seeing and
philanthropic founders it is not easy to speak too highly. For a small
country and a poor people to have provided six asylums for all classes
before the lunacy legislation of the present day was inaugurated, shows
at least that, if it did not initiate a movement in favour of humanity,
it could see how good a thing it was to follow in the same path. At the
present time in Scotland, through the foresight of the man who
established institutions "for all classes," and combined business with
philanthropy in making the rich help the poor, there is plenty of
middle-class asylum accommodation.
Perhaps nothing could more strongly show what a change has come over
the condition of the insane in Scotland, and the praiseworthy efforts
now made by those who are responsible for it, than the excellent Report
of the Commissioners, published in 1881.[248] "It is well worth the
careful perusal of every one who is interested in the treatment of the
insane. In addition to the usual information, there is an attempt made
carefully to describe what is special to Scotland in the management of
asylums and in the treatment of the insane. In short, the 'Scotch
System' is analyzed, and in concise terms we are told what it is and
what results have followed. In the body of the Report, under the heading
of 'Recent Changes in the Modes of Administering Scotch Asylums,' we
have fourteen pages that well deserve and will attract much attention.
They will stand as a landmark in the history of the treatment of mental
disease. That portion of the Report is a most carefully written piece of
true scientific work, containing the facts themselves, the history of
their application, the inferences to be deduced from them, and the
reasons why the particular results have happened, or the medical
philosophy of the matter....
"There were in Scotland on the 1st of January, 1881, 10,012 insane or
idiotic persons known to the Scotch Board, being an increase of 378 over
the number of 1880. The greater part of this increase, which is an
unusually large one for a year, consists of rate-paid lunacy. Scotland
still holds the honourable position of maintaining a far larger
proportion of its insane and private patients than either of the other
divisions of the United Kingdom. In Ireland (assuming that all the
inmates of private asylums are private patients) 5.5 per cent. only of
the insane are supported out of their own means or by their relatives.
In England 10.7 per cent. are so supported, while in Scotland 16.4 per
cent. are in this category. Of this most remarkable fact we have seen no
adequate explanation. Is it the poverty of Ireland and England that
place them so far below Scotland in this matter? or the want of asylum
accommodation at low rates of board? or the lack of self-respect and
natural affection in the peoples?...
"There were forty-nine voluntary patients admitted to Scotch asylums
during the year, and the Commissioners express a favourable opinion as
to this provision of the Scotch lunacy law. The recovery-rate in the
asylums was 41 per cent. for the year, and the death-rate on the average
numbers resident 7.6 per cent.... The reports of the Commissioners'
visits to asylums are, on the whole, of a favourable character. There is
a cheerful ring about them, a hopeful spirit as to the remedies for
present defects, and an encouraging yet stimulating tone towards the
medical staff that shows a healthy confidence.
"We now come to the really original and important part of the Report:--
"'_Recent Changes in the Modes of Administering Scotch Asylums._--The
most important changes that have taken place of late have been
manifested chiefly in three directions:--
"'(1) In the greater amount of liberty accorded to the patients; (2) in
the increased attention that is devoted to their industrial occupation;
and (3) in the more liberal arrangements that are made for their
comfort.
"'Each of these changes has been a distinct improvement, and has
conferred important benefits on the insane; but the effect of each has
been made much more complete from the support it has obtained by being
associated with the others. For instance, the removal of restrictions
upon liberty could not have been carried so far had steps not been taken
to engage the energies of the patients in such occupations as tend both
to check the morbid current of their thoughts and to prevent them from
fretting at the control to which they must always be more or less
subjected, while it is no less true that the comforts with which they
are now surrounded render them both more able and more willing to engage
in healthful occupations....
"'_The Abolition of Airing-Courts._--Circumstances such as these,
perhaps, prevent any immediate prospect of the universal abolition of
walled airing-courts; but the advantages which result from their disuse
are now widely recognized. Most of the public asylums in Scotland are
already without them, while in several, where they still exist, they are
seldom used. One of the advantages which airing-courts with walls were
thought to possess was their supplying a place where patients suffering
from maniacal excitement might work off their morbid energy in safety.
It can scarcely be denied, however, that the association in confined
areas of patients in this state, either with one another or with other
patients in calmer mental states, is attended with various
disadvantages. The presence of one such patient may be the cause of a
great amount of excitement, and a source of irritation and annoyance to
those confined in an airing-court along with them. After the disuse of
the airing-courts, it was found that such patients could be treated
satisfactorily in the wider space of the general grounds. It was found
by placing them more immediately in companionship with the attendants,
and by keeping them from collision with other patients, that they could
be made to vent much of their excitement with less disorder, and could
often be saved a considerable amount of it altogether.
"'_The Open-Door System._--It is only of late years that the disuse of
locked doors has been regarded as forming an important feature in the
administration of an asylum. Detached houses, or limited sections of the
main buildings, the inmates of which consisted chiefly of patients
requiring little supervision, have long been conducted in some
institutions without locked doors. But the general practice of all large
asylums has been to keep the doors of the various wards strictly under
lock and key....
"'When an attendant could no longer trust to locked doors for the
detention of troublesome and discontented patients, it became necessary
that he should keep himself aware at all times of where they were and
what they were doing. And it therefore became his interest to engage
them in such occupations as would make them contented, to provide an
orderly outlet for their energies, and to divert their minds from
thoughts of escape. The relations of an attendant to his patient thus
assumed less of the character of a gaoler, and more the character of a
companion or nurse; and it was eventually found that this change in the
character of the form of control could be adopted in the treatment of a
much larger number of the patients than was at first anticipated. It is
not difficult to over-estimate the extent to which a desire to escape
affects the minds of patients in asylums. The number who form a definite
purpose of this kind really constitutes only a very small proportion of
them. The special watchfulness required of attendants in guarding
against determined efforts to escape, therefore, need be directed to a
few only of those under their charge, and it soon becomes habitual to
the attendants to keep themselves aware of where those patients are,
about whom they entertain doubt. And it should be borne in mind, in
regard to this kind of watchfulness, that its very persistency renders
it more easily kept up than if it could be occasionally relaxed. It
appeared further that the disuse of locked doors had an influence on
some of the patients in diminishing the desire to escape. Under the
system of locked doors, a patient with that desire was apt to allow his
mind to be engrossed by the idea of watching for the opportunity of an
open door, and it was by no means infrequent to find such a patient
watching with cat-like eagerness for this chance. The effect of the
constantly open door upon such a patient, when the novelty of the thing
had worn off, was to deprive him of _special_ chances of escape on which
to exercise his vigilance, since, so far as doors were to be considered,
it was as easy to escape at one time as another; and it was found that
the desire often became dormant and inoperative if not called into
action by the stimulus of _special_ opportunity. It is, indeed, a thing
of common experience that the mere feeling of being locked in is
sufficient to awaken a desire to get out. This happens both with the
sane and the insane; but it is certain that the mental condition of many
patients in asylums renders them likely to be influenced in an especial
manner by such a feeling. With many, however, the desire to escape dies
away when it ceases to be suggested by forcing upon their attention the
means of preventing it.
"'It is year by year becoming more clearly recognized that many
advantages result from the working of the open-door system, and it has
now been adopted to a greater or less extent in most of the Scotch
asylums....
"'_Liberty on Parole._--The practice of permitting certain patients to
walk or work in the grounds without constant supervision, and of
permitting some to take exercise beyond the grounds on _parole_, has
been general in Scotch asylums for many years, but it is now much more
extensively adopted in them than it used to be. Like the other removals
of restrictions to which we have referred, this has found favour in the
eyes of superintendents on account of the beneficial effect which it
has on the patients, not merely in making their residence in an asylum
less irksome, but also by improving their mental condition. The fears
which were naturally entertained that this form of relaxation of control
would be followed by an increase in the number of accidents and escapes,
have not proved to be well founded.
"'In determining the desirability of any kind of restrictive discipline
and supervision, it has to be considered, among other things, whether
the irritation that it occasions may not render the danger of accidents
from violent conduct greater than it would be if such discipline were
not enforced....
"'_Benefits arising from the Removal of Restrictions._--The beneficial
effects arising from the removal of the various forms of restrictions on
liberty are no doubt due, in great measure, to the increased attention
that is given to the features of each patient's condition, for it is
only after a careful study of the disposition and tendencies of a
patient that a trustworthy opinion can be formed as to the amount of
liberty that he is fit to enjoy. But it must also be recognized that the
freedom from irksome discipline and restriction tends to remove one of
the sources of violent conduct in asylums, and consequently to diminish
the number of accidents which result from it. Many patients have, under
the freer conditions of their life, become calm and orderly in behaviour
to whom the imprisonment in wards under lock and key, the confinement
within high-walled airing-courts, and even the feeling of being under
the constant supervision of attendants, were sources of irritation and
excitement and causes of violent conduct.
"'There are other advantages which spring from this relinquishing of
some of the physical means of detention. One of these, the importance of
which will be readily appreciated, is the inducement it affords, not
only to superintendents, but to every one concerned in the management of
the patients, to acquire a full and correct knowledge of the mental
condition and character of each patient. It not only increases the
interest they have in ascertaining how far, and in what ways, each
patient is fit to be trusted, but it strengthens in a very practical
manner their motives for endeavouring to secure his contentment and
orderly behaviour. The judging of what is required for these purposes
inevitably involves a good deal of intelligent observation of each
patient, not only on admission, but during the whole time he is resident
in the asylum. It becomes of practical importance to those in charge to
note changes in his mental condition, whether in the direction of
improvement or the reverse; and thus favourable or unfavourable symptoms
are observed and considered which in other circumstances might receive
little attention. The general effect of the change of system is to raise
the position of the attendants from being mere servants who carry out
more or less efficiently the orders of the superintendent to that of
persons who have a direct interest in promoting the improvement of the
patients, and who find it an advantage to themselves to carry out, to
the best of their ability, whatever instructions they receive with that
end in view. A good attendant must always have had more or less of this
character, it is true; but even good attendants are stimulated under the
freer system to become still better.
"'_Industrial Occupation._--One effect of the removal of physical
restrictions has been to stimulate as well as aid the superintendents of
asylums in their efforts to develop the industrial occupation of the
patients. The disadvantages of prolonged idleness, to the insane as well
as to the sane, and the advantages that result from such occupation as
gives exercise to the physical and mental energies without overstraining
them, are too obvious to require discussion. It was consequently an
important result of the disuse of walled airing-courts and of the
open-door system, that it became necessary to engage the attention of
patients who were inclined to escape, and also of the much larger number
who might wander away without any such definite purpose, so as to keep
them under control and supervision. It did not require much study of the
mental state of the patients, nor indeed much attention of any kind on
the part of their attendants, to insure their safe custody, when the
conditions of their life were either to be locked within their wards, to
be confined within the high walls of airing-courts, or to be marched in
military order at stated periods for exercise. Under such conditions,
there was no strong motive for inducing those patients to work who
showed no disposition to do so of their own accord. The morbid
excitement, the apathies, or the gloomy feelings of many patients were
allowed to remain unchecked, and not unfrequently the mental disease
was intensified rather than alleviated. The more restless patients often
spent much of their day in pacing the galleries or the airing-courts,
nursing their morbid irritability, while others lounged on the benches
or crept into corners, and so drifted downwards through the dreary
stages of physical and mental decay. It does not require much
consideration to show that it would tend to improve all such patients,
both in their bodily and mental health, if they were engaged in some
regular occupation during a reasonable portion of their time....
"'_The Industrial System cannot be adapted to all Classes of
Patients._--But there are patients, both among those of the private and
among those of the pauper class, whom it is undesirable, and whom it
would also be wrong, to engage in work. There are cases, for instance,
in which, for various reasons, such as physical weakness, it would be
directly injurious to the patients to be engaged in active or fatiguing
work; and it would be unsatisfactory if it were found that the efforts
to develop the industrial system in asylums led to such patients being
pressed to work....
"'_Advantage of the Farm as a Source of Occupation._--... The number of
persons available for work on an asylum farm is always great; and in
those asylums where full advantage has been taken of the opportunities
which the farm affords, it is found that the directions in which the
labour of patients may be utilized are much more numerous and various
than at first sight may appear. For instance, one large outlet for their
labour is supplied by the use of spade husbandry in circumstances in
which the ordinary farmer would use the plough. Another outlet is to be
found in the cultivation of crops of garden vegetables, which the
ordinary farmer does not usually undertake. The carrying out of
improvements on the farm or estate also gives employments of various
kinds, and it is here, perhaps, that what may be called the elasticity
of land as a source of labour for asylum inmates becomes more evident.
If the land attached to an asylum is of any considerable extent, it will
nearly always happen that important re-arrangements are deemed
desirable; and when there is a disposition to encourage improvements of
this kind, it is generally found that they afford a very abundant and
varied source of labour. Road-making, embanking, draining, fencing,
planting, and even building, are generally found to be required; and in
connection with these things, and with the work more accurately included
under the term agricultural, there are subsidiary forms of industry
developed. Indeed, the different kinds of work afforded by the
re-arrangements and improvements on an estate prove of great value in
asylum administration, for they afford some of the simplest kinds of
outdoor labour. Many patients can be engaged in such occupations as
digging and wheeling, who can with difficulty be engaged in less simple
kinds of work; and by securing an ample supply of such simple work the
number of patients who share in the benefits of active healthy labour in
the open air is much increased....
"'It is impossible to dismiss the subject of asylum farms without some
reference to the way in which they contribute to the mental health of
the inmates by affording subjects of interest to many of them. Even
among patients drawn from urban districts, there are few to whom the
operations of rural life present no features of interest; while to those
drawn from rural districts the horses, the oxen, the sheep, and the
crops are unfailing sources of attraction. The healthy mental action
which we try to evoke in a somewhat artificial manner, by furnishing the
walls of the rooms in which the patients live, with artistic decoration,
is naturally supplied by the farm. For one patient who will be stirred
to rational reflection or conversation by such a thing as a picture,
twenty of the ordinary inmates of asylums will be so stirred in
connection with the prospects of the crops, the points of a horse, the
illness of a cow, the lifting of the potatoes, the laying out of a road,
the growth of the trees, the state of the fences, or the sale of the
pigs.
"'_Importance of Active Physical Work for Women._--... An attempt,
attended with considerable success, has been made in some asylums to
supply this deficiency by the development of the work of the laundry and
washing-house....
"'There are two directions in which the worth of the washing-house may
be developed. One is by obtaining work from outside sources, as has been
done in some institutions, where a considerable amount of washing and
dressing is done for persons living in the neighbourhood. Another
direction is by avoiding the use in the washing-house of all machinery
which diminishes the amount of hand labour. And we are disposed to
regard both these modes as deserving of encouragement....
"'_Difficulties met with in carrying out Improvements._--... In relaxing
restrictions upon the liberty of the insane, there is a certain amount
of prejudice in the public mind to be met and overcome. There is a
feeling of timidity in regard to persons labouring under insanity, which
leads to their being regarded as without exception and in all
circumstances unfit to be trusted with any degree of liberty. As a
result of this, there is a tendency, when a patient in an asylum
inflicts injury on others or on himself, to blame the superintendent for
having permitted the patient to have such liberty of action as made the
inflicting of the injury possible; and there is consequently a
temptation, to a superintendent who wishes to avoid adverse public
criticism, to adopt restrictive measures of the most complete character.
"'It was under the influence of such views that strait jackets,
manacles, and chains were used before the introduction of what is called
the system of non-restraint. When such restraints were used it was said
that no blame could be attached to persons in charge of a patient for
any violent deed which might be perpetrated, because it was held that
every possible precaution had been taken to prevent it. The error that
lurked beneath this statement was not perceived. It was not recognized
that in taking precautions against one set of evils, other evils of a
graver character were created. Even the evils which it was sought to
avoid were not avoided. The first man from whom Pinel removed the
manacles had, with those very manacles, killed one of his keepers. The
superintendent who really takes most precautions against violence is not
the man who applies the most complete restrictions upon liberty, but he
who weighs the general results of different modes of treatment, and
selects that which proves in practice most successful in decreasing the
number of violent acts.
"'We cannot hope, in carrying out any system, to exclude the effect of
mistakes in judgment and neglects of duty....
"'One difficulty for which no satisfactory solution has yet been found
is the finding of employment for male patients during bad weather, when
little outdoor occupation is to be had. It would be of great advantage
if some simple indoor occupation, adapted to the peculiarities of the
insane, were devised which could be taken up occasionally when outdoor
occupation failed....
"'_Increased Comfort of Asylums._--It is satisfactory to record our
conviction that all the changes just alluded to have tended not only to
facilitate the administration of asylums, and to produce greater
contentment among the inmates, but also, to exert a real curative
influence. The scenes of turbulence and excitement which used to be of
frequent occurrence in asylums have become much less frequent, and in
the asylums where the changes in question have been most fully carried
out, such scenes are comparatively rare. It does not admit of doubt that
the occurrence of these fits of excitement had a deteriorating effect on
the mental condition of the patients, and often retarded, if they did
not in some cases prevent, their recovery. It is not unusual now to
pass through all the wards of some of the larger asylums without
observing a single instance of disorderly behaviour, and we believe this
is properly attributed to such changes as have just been noted. It is
true that excitement may, to some extent, be kept in check by the use of
calmative drugs; but we believe we are justified in saying that this
practice is largely followed in no Scotch asylum, while it is scarcely
adopted at all in those in which manifestations of excitement are least
frequent, in which restrictions on liberty are most completely
withdrawn, and in which industrial occupation has its greatest
development.'"
Lastly in regard to that most important point, on which Dr. Fraser thus
speaks:--
"'_The Influences which are at present operating on the Boarding out of
Lunatics._-- ... The influences which, from my experience and
observation, I believe to be operating upon these methods of provision
for the insane, especially upon the pauper portion, seem to me to be as
follows:--
"'1. The efforts of medical officers of institutions to discharge
chronic lunatics whom they consider suitable for being cared for in
private dwellings.
"'2. The action of inspectors of poor in either initiating the removal
of suitable cases, or in seconding the efforts of medical
superintendents in this direction.
"'3. The amount and accessibility of asylum accommodation in each
district.
"'4. The rate of maintenance in asylums.
"'5. The supply of suitable guardians.
"'6. The influence of the grant in aid.
"'_The Action of Medical Officers of Asylums._-- ... Owing to my having
had at one time the superintendence of the asylum for Fife and Kinross,
I am able to deal more satisfactorily with the statistics of this
district than with those of other parts of the country. From a return
which I have been favoured with, I find that the efforts to send out
patients in this district have been effective and successful. During
1880 there have been discharged improved eighteen patients, five of whom
were committed to the care of friends, and thirteen of whom were placed
under the guardianship of strangers....
"'The question which naturally suggests itself is--What would be the
result were this practice possible in every institution, and in every
district? On calculation I find that, had an equal proportion of the
inmates of all asylums been similarly transferred to private care, no
less than four hundred and three patients would have been removed from
institutions to care in private dwellings, whereas the fact is that only
sixty-eight were so transferred. Only one patient out of the eighteen
who were transferred from the Fife and Kinross Asylum has had to be
returned to the asylum, and he was one of those who were boarded with
friends....
"'_The Action of Inspectors of Poor._--The efforts of medical
superintendents of asylums may do much, but it must be recognized that
the success and extension of the boarding system is largely, if not
mainly, in the hands of the inspectors of poor. Their action is
threefold: (1) they may initiate the removal of their chronic insane
from institutions; they may co-operate with asylum officers in readily
removing such lunatics as these officers intimate to be fit for being
boarded out, and in procuring suitable guardians and homes for them; and
(3) they may, by well-directed efforts, instead of hurrying every
lunatic into an asylum, as the practice with some is, provide in like
manner for those idiotic and insane paupers who, even when they first
become chargeable, do not require asylum treatment and care....
"'Economy, one of the proper objects of parochial administration, is
attained by this method of providing for the insane poor, and not only
is it economical, as I will immediately show, but for a large proportion
of chronic lunatics it is efficient and beneficial. From a return with
which I have been favoured from the City Parish, Edinburgh, the average
cost, inclusive of supervision and every other item of expenditure, for
the insane boarded with strangers is L19 a year. The asylum rate during
the last five years has been L27 per annum.
"'_The Amount and Accessibility of Asylum Accommodation in each
District._-- ... It has now become a matter of everyday observation,
that where there is ample asylum accommodation the boarding out of the
insane is either entirely neglected or avoided, or but languidly
attempted....
"'It follows that ample asylum accommodation though in itself a service
and a safeguard to society, is yet apt to be an inducement to wasteful
parochial administration....
"'_The Rate of Maintenance in Asylums._--In Dumfriesshire, where special
circumstances have kept the asylum rate exceptionally low, and where
agricultural avocations are well paid, the guardians require a high rate
of board, and thus the cost of boarding out, when clothing, medical
visits, and other expenses are included, is nearly equal to the rate of
maintenance in the asylum for the district.
"'It therefore stands to reason that where the asylum rate is near to
that required for outdoor care, the economic inducement to board out
will apply only to those patients who have friends willing to have the
charge of them. It thus appears that a low rate of maintenance in an
asylum is practically prejudicial to the liberty of the chronic insane.
"'_The Supply of Guardians._--This feature of the system of boarding out
the insane will appear to many to be all-important. The excuse which
inspectors frequently advance for their lack of co-operation with
medical officers of asylums is their inability to find suitable
guardians. It is, however, an excuse which my experience does not permit
me to regard as valid or sympathize with....
"'_The Influence of the Government Grant._--I feel I need do no more
than mention this agency in increasing the number on the roll of single
patients. The way in which it has led to this increase has been fully
treated of in the published Reports of the Board....'"
Among the foregoing excerpts from the elaborate Report of the
Commissioners, much, it will be seen, bears on the important question of
the "cottage treatment" of the insane. In this direction, at least in
the way of attempting to form a sort of lunatic colony (though on a very
minute scale) after the manner of Gheel, Scotland has acted more
definitely than England. Opinion is divided on the subject, and the
measure of success can hardly be said to have been yet determined.
Whatever this may be, the counter disadvantages must not be overlooked.
Kennoway, in Fifeshire, where the experiment has been tried on a small
scale, has had its supporters and detractors. Dr. John Smith, well known
for his long practical experience of lunacy, and Dr. J. B. Tuke, at that
time the superintendent of the admirably managed Fife and Kinross
Asylum, visited Kennoway some years ago, and the report[249] of the
latter was certainly anything but favourable; in fact, that the saving
effected was by means detrimental to the lunatic. Notwithstanding, he
arrived at the conclusion that the system might be employed with
advantage in certain cases, if accompanied by stringent supervision. Dr.
Arthur Mitchell, in his evidence before the Parliamentary Committee of
1877, so valuable on all the points to which he spoke, replied to the
question why the patients boarded out had decreased in number, if the
board approved of the system, that he, although warmly approving of it,
was the person who had largely caused this decrease, the reason being
that it was found there were a great number of persons totally
unsuitable for private dwellings, and others were ill cared for. Hence
it was necessary to weed them out. This observation does not specially
apply to villages like Kennoway, but to the boarded-out cases, wherever
placed.[250]
Much more of interest might be taken from this Report, but the foregoing
will suffice to bring before the reader the salient points in the
management of the insane in Scotland at the present day, by which he can
judge for himself of the contrast between the present and the past. My
main object is with the latter, but it can only be understood by a
sketch, however brief, of the former, in each of the three divisions of
the United Kingdom.
FOOTNOTES:
[227] These particulars are given in the Report of the Royal Lunacy
Commission for Scotland, 1857, on the authority of Sir Thomas Craig.
[228] "A General View of the Present State of Lunatics and Lunatic
Asylums in Great Britain and Ireland," by Sir Andrew Halliday, M.D., p.
28.
[229] _Op. cit._, p. 27.
[230] "An Act to Regulate Madhouses in Scotland."
[231] "The Commission was entirely due to Miss Dix's exertion. After
visiting the lunatic asylums of E----, she proceeded to Scotland, where
her suspicions were aroused by the great difficulty she experienced in
penetrating into the lunatic asylums of S----; but when she did gain
access, she found that the unfortunate inmates were in a most miserable
condition. She came to London and placed herself in communication with
the Secretary of State for the Home Department, and with the Duke of
Argyll; and at her instance, and without any public movement on the
subject, a Royal Commission was appointed to inquire into the state of
the lunatic asylums of Scotland. No one, we are sure, could read the
Report of the Commission without feeling grateful to that lady for
having been instrumental in exposing proceedings which were disgraceful
to this or to any civilized country."--Mr. Ellice, M.P., "Parliamentary
Debates," vol. cxlv. p. 1025.
[232] "Parliamentary Debates," 3rd Series, vol. cxlv. p. 1020.
[233] Page 1025.
[234] Page 1027.
[235] Page 1035.
[236] See p. 338.
[237] Page 1042.
[238] Page 1043.
[239] Page 1044.
[240] Page 1468.
[241] "Parliamentary Debates," 3rd Series, vol. cxlvi. p. 1169.
[242] Page 1185.
[243] They were Melgund, chairman; G. Young, George Moir, James Cox, and
W. A. F. Browne.
[244] If certain other figures be added, this total is 5823. See table
on a subsequent page.
[245] This sum now amounts to nearly half a million.
[246] Twenty-third Report of the Commissioners, 1881.
[247] See passage quoted in the last chapter of this book.
[248] The succeeding quotation constitutes the analysis given of this
Report in the _Journal of Mental Science_ for January, 1882.
[249] _Journal of Mental Science_, January, 1870.
[250] Dr. Fraser observes (Report, p. 124): "Dr. Arthur Mitchell, in
his work on the insane in private dwellings, shows that this method of
providing for the chronic insane is--1st, the best thing for the
patient; and, 2nd, the best thing for the country; and in that opinion I
heartily concur."