In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth Years of Her Majesty, for the Regulation of the Care and Treatment of Lunatics."
By this statute it was enacted that any single county or borough might unite with the subscribers to a registered hospital, and that the proportion of expenses between any county and borough might be fixed with reference to accommodation likely to be required.
Other sections provide in detail for the maintenance of county and borough asylums, and other matters which it is unnecessary to enumerate.
A short summary is added of the provisions in force at the time of the Select Committee of 1859-60, for the protection of private patients. They remain essentially the same.
In the metropolis, the power of licensing is exclusively in the hands of the Metropolitan Commissioners. In the provincial districts it rests with the justices at quarter sessions. These licenses are annually renewed, and they may be revoked by the Lord Chancellor. The patients are admitted upon an order signed by some relative or friend, with a statement of all the particulars of the case. This statement must be supported by the certificates of two medical practitioners, who, having examined the patient separately within seven days previous to the reception, state that he is a person of unsound mind, and a proper person to be detained under care and treatment. It must also specify the grounds upon which their opinion has been formed, viz. the facts observed by themselves or communicated by others. After two and before the expiration of seven clear days, the proprietor or superintendent of the licensed house must transmit to the Commissioners, and also to the visiting justices, if the licensed house is within their jurisdiction, a copy of the order and certificates. The licensed house must be visited by two of the Commissioners, four times at least every year, if it lies within their immediate jurisdiction; and if beyond, it must be visited four times at least by Visitors appointed by the justices, one of whom shall be a medical man, and twice at least by two of the Commissioners. In the course of such visits, inquiries are directed to be made as to the occupation, amusement, classification, condition, and dietary of the different patients, and also whether a system of non-coercion has been adopted or not; and where it shall appear, either to the Commissioners or to the visiting justices, that a patient is detained without sufficient cause, they have the power, under certain conditions, of ordering his discharge. When a patient recovers, the proprietor or superintendent is required to send notice of such recovery to the person who signed the order for his reception; and if such patient is not discharged or removed within fourteen days, the proprietor is required immediately to transmit a similar notice to the Commissioners or visiting justices, as the case may be. When a patient dies, the medical practitioner who attended such patient during his illness is to cause a statement to be entered in the case-book, setting forth the time and cause of death, and the duration of the disease of which the patient died, and a copy of such statement, within two days, must be transmitted to the coroner. In addition to these specific provisions, the Commissioners have power from time to time to make regulations for the government of any of these licensed houses, and they must report annually to the Lord Chancellor the number of visits they have made, the number of patients they have seen, the state and condition of the house, the care of the patients therein, and such other particulars as they may think deserving of notice (p. vi.).
In consequence of the importance of the Act of 1862, the Commissioners issued the following circular noting its chief provisions:—
Sec. 23.—The order must be dated within one month prior to reception; the person signing the order must himself have seen the patient within one month prior to its date; and a statement of the time and place when the patient was so seen must be appended to the order.
Sec. 25.—When possible, every order must contain the name and address of one or more relations of the lunatic, to whom notice of the death of a lunatic must be sent.
Sec. 24.—Besides the persons hitherto prohibited from signing certificates and orders, the following also are now disqualified:—Any person receiving any percentage on or otherwise interested in the payments for patients, and the medical attendant as defined in the Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.
Sec. 26.—Where a patient received as a pauper is made a private patient, no fresh order or certificate is required, and vice versâ.
Sec 28.—With the exception of the statement by the medical officer as to a patient's mental and bodily condition, all the documents heretofore required to be sent to the Commissioners after two or before seven clear days from the reception of the patient, must in future be sent within one clear day from such reception. The medical officer's statement is, as heretofore, not to be sent until after two and before seven clear days.
Sec 40.—Without special directions to the contrary, letters addressed to the Commissioners, committees of Visitors, committees of a hospital, and the Visitors of licensed houses, must be forwarded unopened. Other letters must also be forwarded, unless, by an endorsement thereon, the superintendent or other person having charge of patients should prohibit their transmission. Letters so endorsed to be laid before Commissioners, committees, or Visitors at next visit.
Sec. 38.—Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.
Sec. 43.—In the absence of any person qualified to discharge, a discharge or removal may be ordered by the Commissioners.
Sec. 25.—The order must contain the name and address of one or more relations of the lunatic, and notice of the death of the lunatic must be sent to such relation.
Sec. 38.—A pauper permitted to be absent on trial from a licensed house or hospital may have such an allowance made to him by order of the Commissioners, Visitors, or committees as would be charged for him were he in the house or hospital.
Secs. 14 and 15.—No fresh licence can be granted by justices without inspection and report by the Commissioners. Notices of alterations in houses licensed by justices must be given to Commissioners. Their report must be considered by the justices before licence is granted or alterations are consented to.
Sec. 16.—The physician, surgeon, or apothecary not being a licensee, where any such is by law required to reside in or visit a licensed house, must in the metropolitan district be approved of by the Commissioners, and in the provincial district by the visiting justices.
A penalty is imposed on any person infringing the terms of his licence as to numbers, sex, or class.
Sec. 18.—With consent of two of the Commissioners, or, in the case of the provincial licensed houses, of two of the Visitors, a person who may have been a patient within five years immediately preceding, may be received as a boarder into a licensed house (extension of c. 96, s. 6).
Sec. 29.—Licensed houses may be visited at any time by one or more of the Commissioners or Visitors, but in the metropolitan district they must be so visited twice in the year, in addition to the present visits by two Commissioners, and in the provincial districts similarly by Visitors. Commissioners and Visitors visiting singly have substantially the same powers of inspection and inquiry as when visiting together. To these the sixty-second section of the Act does not apply.
Sec. 39.—A penalty is now imposed on any officer or servant conniving at an escape.
Sec. 43.—In the absence of any person qualified under ss. 72, 73, c. 100, the Commissioners may order discharge or removal of a patient.
Sec. 38.—Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.
Sec 27.—Where medical certificates have been returned with a written direction of the Commissioners for amendment, and such amendment shall not have been made within fourteen days, the Commissioners may order the patient's discharge.
Sec. 22.—Lunatics so found by inquisition may be received without certificate on an order of the committee, accompanied by an official copy of the order appointing such Committee.[316]
The Poor Law Board issued a circular at the same time. The only paragraph which it is of interest to cite here is the following:—"The eighth section empowers the Visitors of any asylum and the guardians of any parish or union within the district for which the asylum has been provided, if they shall see fit, to make arrangements, subject to the approval of the Commissioners in Lunacy and the President of the Poor Law Board, for the reception and care of a limited number of chronic lunatics in the workhouse of such parish or union, to be selected by the superintendent of the asylum and certified by him to be fit and proper so to be removed. The Board are at present not aware of any workhouse in which any such arrangement could conveniently be made; but they will be ready to consider any such proposals on the subject when the Visitors of the Board of Guardians of any union shall find it convenient or practicable to act upon this clause."
[316] Seventeenth Report of Commissioners in Lunacy, 1863.
Extract from the British and Foreign Medical Review, January, 1840:—
"In this particular there is apparently no asylum in England which presents so remarkable a model as that of Lincoln. Of all the works that have appeared on the subject of lunatic houses since the publication of Mr. Tuke's account of the Retreat, there is none which contains matter more deserving of attention than that recently published by Mr. Hill. His lecture is little more than a simple commentary on the resolutions of the board of management of the Lincoln Asylum for twenty years past; during which period, under the superintendence of Dr. Charlesworth, and latterly with the vigilant co-operation of Mr. Hill himself, as house surgeon, almost every kind of bodily restraint is stated to have gradually fallen into disuse as superfluous, a mere substitute for want of watchful care.... If the Lincoln Asylum can present a model of this kind, which all may visit and examine, the services of Dr. Charlesworth to the cause of humanity and in behalf of the insane, already considerable, will only be second to that of him who first released them from their chains."
On this Mr. Hill observes, July 8, 1840:—
"At last the first Medical Review in Europe took up the subject, and placed most deservingly Dr. Charlesworth in a striking position as to the non-restraint system, and also honoured myself with approbation."
The following extracts from the Orders in the Lincoln Asylum books[317] are essential to the right understanding of the introduction of non-restraint there. Dr. Charlesworth was visiting physician from its opening in 1821; Mr. Hill was appointed house surgeon in 1835.
"1828. Ordered—That the use of the strait waistcoat be discontinued in this institution except under the special written order of the physician of the month.
"1828, October 13. Ordered and resolved—That the physicians be requested to consider whether it be possible to make any improvement in the means of restraint now in use, and especially for obviating the use of the strait waistcoat."
Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829, April:—
"The governors have particularly directed their views to the subject of coercion and restraint, well aware of their injurious consequences to the patients.... The construction of the instruments in use having also been carefully examined, they have destroyed a considerable proportion of those that were not of the most improved and least irritating description, and hope hereafter to introduce still further amelioration into this department."
Extract from the House Visitor's Report, 1829, August 17:—
"Every attention seems to be paid to the patients, whose general state has, I understand, for some time past, been so generally good that it is gratifying to say that the strait waistcoat has almost become useless."
Extract from the Seventh Annual Report, 1831, March 28:—
"Heretofore it was conceived that the only intention of a receptacle for the insane was the safe custody of the unhappy objects, by any means, however harsh and severe. These views are now passing away, and the fair measure of a superintendent's ability, in the treatment of such patients, will be found in the small number of restraints which are imposed. The new director has answered this test in a very satisfactory manner."
The new director here referred to was Mr. Henry Marston. The following note is appended to this report:—
"As early as the 24th day of November last (viz. Nov., 1830, five years before Mr. Hill's appointment), there was not any patient in the house under restraint, unless one wearing a collar, which leaves all the limbs quite at liberty, can be so considered. This gratifying occurrence has taken place more than once since that time."
Extract from the Ninth Annual Report, 1833, April:—
"It is unceasingly an object in this institution, and should form a prominent point in the annual reports, to dispense with or improve as much as possible the instruments of restraint."
Extract from the House Visitor's Report, 1834, August 4th to 10th inclusive:—
"I have much satisfaction in being able to state that not a single male patient has been under restraint since the 16th of July, and not one female patient since the 1st of August, and then only for a few hours."
At this time Mr. Hadwen held the appointment of house surgeon.
Extract from the Governor's Memorandum Book, 1835, July 8th:—
"Resolved,—That this Board, in acknowledging the services of Mr. Hadwen during the period of fifteen months that he held the situation of house surgeon of this institution, feel called upon to express their high approbation of the very small proportion of instances of restraint which have occurred amongst the patients under his care."
Extract from Edinburgh Review, April, 1870:—
"But to Conolly belongs a still higher crown, not merely for his courage in carrying out a beneficent conception on a large scale and on a conspicuous theatre, but for his genius in expanding it. To him, hobbles and chains, handcuffs and muffs, were but material impediments that merely confined the limbs; to get rid of these he spent the best years of his life; but beyond these mechanical fetters he saw there were a hundred fetters to the spirit, which human sympathy, courage, and time only could remove.
"Perfect as was the experiment carried out at Lincoln Asylum, the remoteness of that institution from the great centre of life, and the want of authority in its author, would no doubt have prevented its acceptance for years by the physicians of the great county asylums so long wedded to old habits. It was for some time treated as the freak of an enthusiastic mind, that would speedily go the way of all such new-fangled notions; and no doubt it would, had not an irresistible impulse been given to it by the installation of Dr. Conolly at Hanwell, where, with a noble ardour, he at once set to work to carry out in the then largest asylum in the kingdom the lesson he had learned at Lincoln."
Dr. Conolly's works bearing on mental disorders, in addition to his "Lectures on Insanity," were as follows:—
1. "An Inquiry concerning the Indications of Insanity, with Suggestions for the better Protection and Care of the Insane." 1830.
2. "The Construction and Government of Lunatic Asylums and Hospitals for the Insane." 1847.
3. "The Treatment of the Insane without Mechanical Restraints." 1856.
See "Memoir of Dr. Conolly." By Sir James Clark. 1869.
[317] As given in the Journal of Mental Science, July, 1870.
The Commissioners give, in their Report for 1857, a table in support of the statement at p. 236, but it is not borne out by the average of the six largest and six smallest county asylums.
| Asylum. | Daily average number of patients. |
Average weekly cost per head. |
|||
|---|---|---|---|---|---|
| s. | d. | ||||
| Colney Hatch | 1257 | 9 | 10 | ||
| Hanwell | 1020 | 10 | 5¾ | ||
| Surrey | 934 | 8 | 8¾ | ||
| Wakefield | 803 | 7 | 4 | ||
| Lancaster | 710 | 8 | 1½ | ||
| Prestwich | 509 | 7 | 10 | ||
| Average number | 872 | Average cost | 8 | 8½ | |
| Dorset | 155 | 8 | 1 | ||
| Denbigh | 189 | 9 | 8¾ | ||
| Bucks | 192 | 10 | 8 | ||
| Notts | 216 | 10 | 5 | ||
| Cornwall | 238 | 8 | 3¾ | ||
| Chester | 278 | 8 | 6 | ||
| Average number | 211 | Average cost | 9 | 3 | |
The sketch of the rise and growth of county asylums and registered hospitals would not be complete without giving the provision obtained, up to the present time, by means of rates on the one hand and private charity on the other. We are not concerned here with private asylums.
The following are the asylums and charitable hospitals in England and Wales, January 1st, 1881, with the number of patients.
Counties.—Beds., Herts, and Hunts. (913); Berks (420), Bucks. (421), Cambridge (421); Carmarthen, Cardigan, and Pembroke (335); Chester—at Chester (521), ditto at Macclesfield (632); Cornwall (582); Cumberland and Westmoreland (447); Denbigh, Anglesea, Carnarvon, Flint, and Merioneth (427); Derby (404), Devon (800), Dorset (469), Durham (944), Essex (932), Glamorgan (581), Gloucester (662), Hants (792), Hereford (364), Kent—at Maidstone (1253), ditto at Canterbury (692); Lancaster—at Lancaster Moor (1118), ditto at Rainhill (675), ditto at Prestwich (1211), ditto at Whittingham (1260); Leicester and Rutland (463), Lincoln (600); Middlesex—at Banstead (1702), Colney Hatch (2173), Hanwell (1841); Monmouth, Brecon, and Radnor (537); Norfolk (619), Northampton (557), Northumberland (432), Notts (280), Oxford (471), Salop and Montgomery (50), Somerset (733); Stafford—at Stafford (645), ditto at Burntwood (529); Suffolk (401); Surrey—at Wandsworth (1028), ditto at Brookwood (1050); Sussex (802), Warwick (644), Wilts (586), Worcester (766); York—North Riding, York (525); ditto West Riding, Wakefield (1400); ditto West Riding, Sheffield (1125); ditto East Riding, Beverley (260).
Boroughs.—Birmingham (676), Bristol (387), Hull (163), Ipswich (249), Leicester (392), City of London (380), Newcastle-on-Tyne (248), Norwich (171), Nottingham (262), Portsmouth (375).
Metropolitan District Asylums.—Leavesden, Herts (1990); Darenth, Kent (687); Caterham, Surrey (2039).
Hospitals.—Manchester Royal Lunatic Hospital, Cheadle (183); Wonford House, Exeter (93); Barnwood House, Gloucester (111); Lincoln Lunatic Hospital (56); St. Luke's Hospital (199); Bethel Hospital, Norwich (74); St. Andrew's Hospital, Northampton (314); Nottingham Lunatic Hospital (66); Warneford Asylum, Oxford (68); Coton Hill, Stafford (146); Bethlem Hospital (265); Bootham Asylum, York (187); The Retreat, York (151).
Idiot Establishments. See chapter viii., pp. 307-319.
Naval and Military Hospitals and India Asylum.—Royal Military Hospital, Netley (34); Royal India Lunatic Asylum, Ealing (105); Royal Naval Hospital, Yarmouth (168).
Criminal Asylum.—Broadmoor (491). See chapter vi.
The total number of ascertained lunatics and idiots in England and Wales, January 1st, was as follows:—
| Location. | Private. | Pauper. | Total. | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| M. | F. | Total. | M. | F. | Total. | M. | F. | Total. | ||
| 61 | county and borough asylums (51 and 10) | 230 | 309 | 539 | 18,427 | 22,389 | 40,816 | 18,657 | 22,698 | 41,355 |
| 16 | registered hospitals | 1,454 | 1,346 | 2,800 | 92 | 56 | 148 | 1,546 | 1,402 | 2,948 |
| Licensed houses— | ||||||||||
| 35 | Metropolitan | 1,030 | 836 | 1,866 | 198 | 447 | 645 | 1,228 | 1,283 | 2,511 |
| 59 | Provincial | 738 | 816 | 1,554 | 257 | 304 | 561 | 995 | 1,120 | 2,115 |
| 3 | naval and military hospitals, and Royal India Asylum | 288 | 19 | 307 | — | — | — | 288 | 19 | 307 |
| 1 | criminal lunatic asylum (Broadmoor) | 172 | 55 | 227 | 199 | 65 | 264 | 371 | 120 | 491 |
| Workhouses— | ||||||||||
| Ordinary workhouses | — | — | — | 5,211 | 6,882 | 12,093 | 5,211 | 6,882 | 12,093 | |
| Metropolitan district asylums | — | — | — | 2,144 | 2,574 | 4,718 | 2,144 | 2,574 | 4,718 | |
| Private single patients | 175 | 273 | 448 | — | — | — | 175 | 273 | 448 | |
| Outdoor paupers | — | — | — | 2,358 | 3,769 | 6,127 | 2,358 | 3,769 | 6,127 | |
| 175 | Total | 4,087 | 3,654 | 7,741 | 28,886 | 36,486 | 65,372 | 32,973 | 40,140 | 73,113[318] |
[318] Exclusive of 224 Chancery patients residing with their committees.
It should have been stated in the text that the ratio of the insane there given to the number of those tried, only refers to those tried for murder. I am indebted to Dr. Guy for the following additional figures, extracted from the last volume of the Judicial Statistics:—
| 1875. | 1876. | 1877. | 1878. | 1879. | 1880. | |
|---|---|---|---|---|---|---|
| Sentenced to death | 33 | 32 | 34 | 20 | 34 | 28 |
| Executed | 18 | 22 | 22 | 15 | 16 | 13 |
| Subsequently certified as insane and sent to Broadmoor | 1 | 1 | 2 | 1 | 4 | 1 |
The following figures for 1878 are of interest:—
| Removed by order of Secretary of State, acquitted as insane | 33.2 |
| Ditto, becoming insane after trial | 22.2 |
| Ditto, becoming insane after committal | 23.5 |
| Ditto, found or declared insane | 20.9 |
| Committed by justices—dangerous lunatics | 0.2 |
| 100.0 |
The last figure is in striking contrast with the return from Ireland, where, on account of the peculiarity of the law, the justices committed 1276 as dangerous lunatics, out of 1393 sent to asylums in the same year.
Since Broadmoor was opened, in 1863, to January 1, 1881, the number of persons admitted was 1322; the re-admissions were 27, making 1349 cases. The number discharged recovered was 108; the number recovered and sent back to prison to finish their sentences, 59; making a total of recoveries of 167, or 12.37 per cent. of the admissions. There were transferred to other asylums, being still insane, 452; and 234 died, or 2 per cent. on average number resident. Twenty-one patients escaped and were recaptured, 3 escaped and were not recaptured. The number remaining January 1, 1881, was 490.
Of these, 19 were affected with epilepsy; 13 with paralysis; and 4 with epilepsy and paralysis.
The principal crimes were as follows:—For murder, 220; attempt to murder, 122; arson, 28; larceny and petty theft, 25; insubordination as soldiers, 18; burglary and housebreaking, 16; manslaughter, 10.
With reference to the period at which insanity was recognized, 39 were certified to be insane whilst awaiting trial or judgment; 117 were found insane by jury on arraignment; 244 were acquitted on the ground of insanity; 13 were reprieved on the ground of insanity; and 77 were certified insane whilst undergoing sentence of penal servitude.
Of 230 who had committed homicide, 93 had killed their own children; 23 their wives; 8 women to whom engaged; 7 the mother, and 4 the father; while 18 had killed fellow patients in asylums.
The following are some of the statistics of the duties performed in the office of the Masters in Lunacy during the year ending October 31, 1879:—
| Judicial Statistics, 1880. | |
| Orders for inquiry in Commissions of Lunacy executed by Masters in Lunacy | 115 |
| Reports made to the Lord Chancellor | 248 |
| Summonses for proceedings before the Masters | 5739 |
| Registrar in Lunacy. | |
| Petitions presented for hearing | 253 |
| Ditto for orders for inquiry, and for orders under Lunacy Regulation Act, 1862 | 179 |
| Orders made for inquiry (Commissioners in Lunacy) | 119 |
| Number of orders made in pursuance of the Lunacy Regulation Act, 1862, for the application of properties of small amounts for the maintenance of lunatics | 51 |
| Cash Accounts. | |
| Amount of receipts included in accounts and affidavits of committees and receivers of lunatics' estates, taken and passed by the Masters | £882,481 |
| Amount of disbursements and allowances thereon | 766,220 |
| Percentage on lunatics' incomes under general order | 21,140 |
| Amount of stock directed to be transferred into court | 144,439 |
| Amount of stock directed to be sold or transferred out | 325,925 |
| Amount of stock directed by orders in lunacy to be transferred, or otherwise than into court | 2,092,038 |