much in them to praise as well as to condemn. When men of reputation,
acknowledged skill, and character--such as Drs. Conolly, Forbes Winslow,
Sutherland, and Munro, of London; Drs. Hitch, Noble, Newington, Fox, in
the provinces, have the management of private asylums, the public need be
under no apprehension of patients being improperly received, illegally
detained, or cruelly and unscientifically treated. The licensed houses in
the metropolitan district directly under the control of the Lunacy
commissioners, amounting to forty-one in number, represent, without doubt,
the fairest specimens of these establishments. Liable as they are at any
moment to the inspection of the commissioners, and presided over as many
of them are by the most eminent members of the profession, they are
generally maintained in a high state of efficiency. They are principally
devoted to the care of the higher classes of the community, and afford
perhaps the nearest approach yet made to a perfect method of treatment,
being conducted in most cases on the principle of a private family. The
bolts, bars, high walls, and dismal airing-courts of the public asylum
are either unknown, or so hidden as no longer to irritate the susceptible
mind of the lunatic. The unwise division of the sexes is not as a rule
adopted. Scrupulous attention to dress and all the forms of polite society
are enjoined alike for their own sake, and as a method of interesting
patients in the daily life of the community. When we partook of the
hospitalities of one of these establishments, we could detect nothing in
the countenances or the appearance of the guests which was characteristic
of their condition: the restless eye, the incoherent conversation, the
sudden movement of the peculiarly formed head, which our preconceived
notions led us to expect, were none of them observable. One individual
indeed there was whom we mentally concluded to be certainly mad. Yet,
singular to say, this gentleman was the only sane individual in the room,
besides ourselves and the medical superintendent; and on further
acquaintance, having told our ill-placed suspicions, he frankly confessed
that he had in his own mind paid ourselves a similar compliment. The eager
glance of curiosity natural to inquisitive strangers was the nearest
approach in this lunatic party to the outward appearance of lunacy. So
much for the "unmistakeable" countenance of the insane! It is not to be
supposed that the more violent can be allowed this social freedom even in
private establishments, or that madness is different in a metropolitan
licensed house from what it is in a public asylum; but we unhesitatingly
assert that in the vast majority of cases the large amount of freedom and
the absence of any prison-like characteristics have an undoubted effect,
not only in calming the mind of the patient, but in expediting his
recovery. Hence the per-centage of cures in a high-class private asylum
are immeasurably beyond those of any public establishment. The
pleasure-ground, out-of-door games, carriage and riding parties,
billiards, whist and evening parties, all contribute their aid in
restoring the unhinged mind. We have seen four or five patients leave the
doors of one of these licensed metropolitan houses (the establishment of
Dr. Forbes Winslow, "Sussex House," Hammersmith), and remain out for hours
without any attendant, their word of _honour_ being the only tie existing
between them and the asylum.[18]
The condition of a few of the provincial licensed houses is still
glaringly bad, and shows that old ideas, with respect to insanity, are not
entirely obsolete. The Report of the Commissioners of Lunacy for 1856,
relates circumstances which lead us back to the old days of Bedlam. Thus
at Hanbury House the Commissioners found "one young lady fastened by
webbing wristbands to a leathern belt; she was also tied down to her chair
by a rope." Again, they found on their last visit to the Sandford Asylum,
in December, 1855, "a patient just dead, his body exhibiting sores and
extensive sloughs, arising necessarily, we think, from want of
water-pillows or other proper precautions. The room has a stone or plaster
floor, and is without a fire." It is, however, encouraging to find that,
as far as personal restraint goes, the very worst of our private asylums
are far superior to some of the best of the public asylums of France. Dr.
Webster, our great authority on this point, gives in Dr. Winslow's
Psychological Journal, the results gleaned in his visits to these
establishments in the August and September of 1850:--
"Forty male lunatics out of 1464 then resident were in _camisole_
(strait-waistcoats), some being also otherwise restrained, thereby
giving an individual in restraint to every 33-1/4 male inmates, or
three per hundred. Amongst the female lunatics, again, the proportion
was somewhat larger, 72 persons of that sex, out of the total 1902
resident patients, being under medical coercion; thus making one
female in restraint to every 26-1/3 inmates, or at the rate of 3·78
per cent. In contrast with this report respecting the above-named
French provincial asylums, I would now place an official statement of
the practice pursued at Bethlehem Hospital during the same period. At
this establishment, where formerly the strait-waistcoat, with various
kinds of personal coercion, were even in greater use than on the other
side of the Channel, _not one_ insane patient, among an average
population of 391 lunatics, was under constraint of any description
during the five weeks ending the 25th of September, when I first
visited that institution after my return from the Continent, and which
embraced the whole time referred to in this memorandum."
From these curious facts it will be seen that we are far in advance of our
French, and, we may also add, of our other continental neighbours.[19]
When the beneficent thought struck the great Pinel to knock off the
fetters of the English captain, he sounded a note which reverberated
through Europe, and the poor insane captives issued from their dungeons in
which they had been so long immured as the prisoners emerge from their
prison to the divine strains of Beethoven's "Fidelio." But when this vast
step was accomplished there still remained an immense amount of coercion
scarcely less injurious than the old darkness and chains, and to
Englishmen is mainly due the credit of abolishing it. Nor shall we rest
where we are. It is our belief as well as our hope that, before another
generation has gone by, the last vestige of restraint, in the shape of
dismal airing-courts, and outside walls, which serve to wound the spirit
rather than to enslave the limbs, will pass for ever among us, and only be
remembered with the hobbles and the manacles of the past.
It has been asserted by some psychologists that lunacy is on the increase,
and that its rapid development of late years has been consequent upon the
increased activity of the national mind. This statement is certainly
startling and calculated to arrest the attention of all thoughtful men. Is
it true that civilisation has called to life a monster such as that which
appalled Frankenstein? Is it a necessity of progress that it shall ever be
accompanied by that fearful black rider which, like Despair, sits behind
it? Does mental development mean increased mental decay? If these
questions were truly answered in the affirmative, we might indeed sigh for
the golden time when
"Wild in woods the noble savage ran,"
for it would be clear that the nearer humanity strove to attain towards
divine perfection, the more it was retrograding towards a state inferior
to that of the brute creation. A patient examination, however, of the
question entirely negatives such a conclusion. Dr. Ray, of the United
States, in taking the opposite view of the case, says:--
"If we duly consider the characteristics of our times, we shall there
find abundant reason for the fact that insanity has been increasing at
a rate unparalleled in any former period. In every successive step
that has led to a higher degree of civilisation; in all the means and
appliances for developing the mental resources of the race; in the
ever-widening circle of objects calculated to influence desire, and
impel to effort, we find so many additional agencies for tasking the
mental energies, and thereby deranging the healthy equilibrium which
binds the faculties together, and leads to an harmonious result. The
press and the rostrum, the railway and the spinning-jenny, the steam
engine and the telegraph, republican institutions and social
organizations, are agencies more potent in preparing the mind for
insanity than any or all of those vices and casualties which exert a
more immediate and striking effect."
Such is the burthen of the story of all those psychologists who believe
that insanity is fast gaining upon us; but if "in the ever-widening circle
of objects calculated to influence desire and impel to effort, we find so
many additional agencies for tasking the mental energies, and thereby
deranging the healthy equilibrium which binds the faculties together," it
should appear that those classes of society which are in the van of
civilization should be the chief sufferers. Bankers, great speculators,
merchants, engineers, statesmen, philosophers and men of letters--those
who work with the brain rather than with their hands,--should afford the
largest proportion to the alleged increase of insanity. How does the
matter really stand? In the Report of the Commissioners in Lunacy for the
year 1847 we find the total number of private patients of the middle and
upper classes then under confinement in private asylums, amounted to
4,649. Now, if we skip eight years, and refer to the Report of 1855, we
find that there were only 4,557 patients under confinement, or about 96
less, notwithstanding the increase of population during that period. If we
compare the number of pauper lunatics under confinement at these two
different periods, we shall find a widely-different state of things; for
in 1847 there were 9,654 in our public and private asylums, whilst in 1855
they numbered 15,822. In other words, our pauper lunatics would _appear_
to have increased 6,170 in eight years, or upwards of 64 per cent. It is
this extraordinary increase of pauper lunatics in the county asylums which
has frightened some psychologists from their propriety, and led them to
believe that insanity is running a winning race with the healthy
intellect. But these figures, if they mean anything, prove that it is not
the intellect of the country that breeds insanity, but its ignorance, as
it cannot be for one moment contended that the grent movements now taking
place in the world originate with the labouring classes. We shall be told,
we know, that there is a constant descent of patients from private asylums
to the public asylums; that the professional man and the tradesman, after
expending the means of his friends and family for a year or two, in the
vain hope of a speedy cure, becomes necessarily in the end a pauper
lunatic, and that this stream aids to swell the numbers in the county
institution. Allowing its due weight to this explanation--and those who
know public asylums are well aware how small, comparatively speaking, is
the educated element--yet as the same disturbing element in the
calculation obtained at both periods, we may safely conclude that the
figures are not thereby essentially altered.
A still more convincing proof that mental ruin springs rather from mental
torpidity than from mental stimulation, is to be found by comparing the
proportion of lunatics to the population in the rural and the
manufacturing districts. Sir Andrew Halliday, who worked out this
interesting problem in 1828,[20] selected as his twelve non-agricultural
counties--Cornwall, Cheshire, Derby, Durham, Gloucester, Lancaster,
Northumberland, Stafford, Somerset, York (West Riding), and Warwick, which
contained a population at that time of 4,493,194, and a total number of
3,910 insane persons, or one to every 1,200. His twelve agricultural
counties were Bedford, Berkshire, Bucks, Cambridge, Hereford, Lincoln,
Norfolk, Northampton, Oxford, Rutland, Suffolk, and Wilts, the total
population of which were 2,012,979, and the total number of insane persons
2,526--a proportion of 1 lunatic to every 820 sane. Another significant
fact elicited was, that whilst in the manufacturing counties the idiots
were considerably less than the lunatics, in the rural counties the idiots
were to the lunatics as 7 to 5! Thus the Hodges of England who know
nothing of the march of intellect, who are entirely guiltless of
speculations of any kind, contribute far more inmates to the public
lunatic asylums than the toil-worn artisans of Manchester or Liverpool,
who live in the great eye of the world, and keep step with the march of
civilization, even if they do but bring up its rear. Isolation is a
greater cause of mental ruin than aggregation--our English fields can
afford _crétins_ as plentifully as the upland valleys of the mountain
range, seldom visited by the foot of the traveller; whilst, on the other
hand, in the workshop and the public assembly, "As iron weareth iron, so
man sharpeneth the face of his friend."
If we required further proof of the groundless nature of the alarm that
mental activity was destroying the national mind, we should find it in the
well-ascertained fact that the proportion of lunatics is greater among
females than males. It may also be urged that Quakers, who pride
themselves on the sedateness of their conduct, furnish much more than
their share; but for this singular result their system of intermarriage is
doubtless much to blame. Still the fact remains, that within a period of
eight years, extending from 1847 to 1855, an increase of 64 per cent. took
place in our pauper lunatic asylums. These figures, however, afford no
more proof of the increase of pauper lunatics than the increase of
criminal convictions since the introduction of a milder code of laws and
the appointment of the new police afford a proof of increased crime. As
the commissioners very justly observe, medical practitioners of late years
have taken a far more comprehensive as well as scientific view of insanity
than formerly; and many forms of the disease now fall under their care
that were previously overlooked, when no man was considered mad unless he
raved, or was an idiot. But the great cause of the increase of lunatics in
our asylums is to be ascribed to the erection of the asylums themselves.
With the exception of three or four Welsh counties, and two or three in
the north of England, there is not a shire in England which does not
possess some palatial building. These establishments, in which restraint,
speaking in the ordinary acceptance of the term, is unknown, and in which
the inmates are always treated with humanity, have drained the land of a
lunatic population which before was scattered among villages or
workhouses, amounting, according to the computation of the commissioners,
to upwards of 10,500--just as the deep wells of the metropolitan brewers
have drained for miles around the shallow wells of the neighbourhood in
which they are situated. For the same reason the number of lunatic paupers
has declined in registered hospitals since 1847 from 384 to 185, and in
"licensed houses" from 3,996 to 2,313. Upon the whole, we may safely
predict that, when these disturbing causes have ceased to act, the annual
returns of the commissioners will show that, as the treatment of insanity
is every day better understood, so the pauper lunatics in our public
asylums, instead of increasing in a ratio for beyond that of the general
population, show a diminished proportion. Already there are symptoms that
the flood is returning to its proper level; for while the lunatics of all
classes in the public asylums, licensed houses, and in the Royal Hospital
at Haslar, were 20,493 in 1855, they had only advanced in 1856 to 20,764,
which is an increase in the twelvemonth of but 271.
THE LONDON COMMISSARIAT.
If, early on a summer morning before the smoke of countless fires had
narrowed the horizon of the metropolis, a spectator were to ascend to the
top of St. Paul's, and take his stand upon the balcony, that with gilded
rail flashes like a fringe of fire upon the summit of the dome, he would
see sleeping beneath his feet the greatest camp of men upon which the sun
has ever risen. As far as he could distinguish by the morning light he
would behold stretched before him the mighty map of the metropolis; and
could he ascend still higher, he would note the stream of life overflowing
the brim of hills which enclose the basin in which it stands.
In the space swept by his vision would lie the congregated habitations of
two millions and a half of his species--but how vain are figures to convey
an idea of so immense a multitude. If Norway, stretching from the Frozen
Ocean down to the southern extremity of the North Sea, were to summon all
its people to one vast conclave, they would number little more than half
the souls within the London bills of mortality. Switzerland, in her
thousand valleys, could not muster such an army; and even busy Holland,
within her mast-thronged harbours, humming cities, and populous plains,
could barely overmatch the close-packed millions within sound of the great
bell at his feet. As the spectator gazed upon this extraordinary prospect,
the first stir of the awakening city would gradually steal upon his ear.
The rumbling of wheels, the clang of hammers, the clear call of the human
voice, all deepening by degrees into a confused hum, would proclaim that
the mighty city was once more rousing to the labour of the day, and the
blue columns of smoke climbing up to heaven that the morning meal was at
hand. At such a moment the thought would naturally arise in his mind,--In
what manner is such an assemblage victualled? By what complicated wheels
does all the machinery move by which two millions and a half of human
beings sit down day by day to their meals as regularly and quietly as
though they only formed a sung little party at Lovegrove's on a summer's
afternoon? As thus he mused respecting the means by which the supply and
demand of so vast a multitude is brought to agree, so that every one is
enabled to procure exactly what he wants, at the exact time without loss
to himself or injury to the community, thin lines of steam, sharply marked
for the moment, as they advanced one after another from the horizon and
converged towards him would indicate the arrival of the great commissariat
trains, stored with produce from all parts of these isles and from the
adjacent continent. Could his eye distinguish in addition the fine threads
of that far-spreading web which makes London the most sensitive spot on
the earth, he would be enabled to take in at a glance the two
agents--steam and electricity--which keep the balance true between the
wants and the supply of London.
If our spectator will now descend from his giddy height, and will
accompany us among the busy haunts of men, we will attempt to point out to
him whence those innumerable commodities, which he has seen pouring into
the town, have been obtained, the chief marts to which they are consigned,
and the manner in which they are distributed from house to house. Had
London like Paris its _octroi_, the difficulty of our task would be
limited to the mere display of official figures, but, thanks to a free
policy, we have no such means of getting at strictly accurate estimates,
and must therefore content ourselves with the results of patient inquiry
among the foremost carriers--the railway companies--aided by such other
information as we have been able to procure. For the sake of convenience,
and of sequence, let us imagine that the principal daily meal is
proceeding, and, according to the order of the courses, we will endeavour
to trace the various edibles to their source--the fish to its sea--the
beast to its pasture--the wild animal to its lair--the game to its
cover--and the fruit to its orchard; to point out how they are netted,
fattened, bagged, gathered, and conveyed to their ultimate
destination--the _great red lane_ of London humanity. Let us begin with
fish, and that unrivalled fish-market which all the world is aware rears
its head by London Bridge.