In many boroughs the authorities have entirely evaded the requirements of the Act of Parliament relative to their insane pauper poor, and have not only neglected to erect proper asylums, but have resisted for years the attempts of the commissioners to compel them to do their duty. In all such cases the lunatics not only suffer the ills consequent upon insufficient care, but when too numerous for home accommodation are subjected to a system of transportation, which is not only disgraceful to the municipal authorities themselves, but to the age for permitting it. True to their economical instincts, the guardians of the poor often “farm out” their insane paupers to the proprietor of some private asylum, quite regardless of distance. The commissioners, justly indignant at this sordid practice, state in one of their Reports that—
“At present, large numbers of these patients are sent to licensed houses far from their homes, to distances (sometimes exceeding, and often scarcely less than, 100 miles) which their relations and friends are unable to travel. The savings of the labouring poor are quite insufficient, in most cases, to defray the expense of such journeys, and their time (constituting their means of existence) cannot be spared for that purpose. The consequence has been, that the poor borough lunatic has been left too often to pass a considerable portion of his life, and in some cases to die, far from his home, and without any of his nearest connexions having been able to comfort him by their occasional presence. The visits of his parish officers are necessarily cursory and unfrequent, and he is, in fact, cast upon the humanity of strangers, whose prosperity depends upon the profits which they derive from maintaining him and others of his class.”
This is a system which we are confident is as illegal as it is heartless, and we are astonished that bodies of Englishmen should dare to insult the miseries of lunatics by thus punishing them and their friends for their affliction. There were not long since twenty-five insane paupers at Camberwell House, London, who had been sent from Southampton, a distance of eighty miles, though the Hants County Asylum is situated within sixteen miles of the borough. Seventeen persons were in like manner banished from Great Yarmouth to Highbridge House, near London, and their relations, who had to travel 146 miles to see them, passed, in the course of their journey, the Norfolk and Essex County Asylums, both of which establishments had many vacancies and would willingly have received them. The pauper lunatics of Ipswich, King’s Lynn, Dover, Canterbury, Portsmouth, and various other boroughs, are in the same way transferred by the local authorities to some of the metropolitan licensed houses.
The feelings of the poor for their afflicted relatives are often of the deepest kind, and the utmost distress is entailed upon them by these cruel separations from those they love. In one case, a native of Ipswich, too poor to go by the railway, walked to London and back on foot, a distance of 140 miles, for the sole purpose of visiting his wife, who had been wickedly banished to Peckham House, London. In other cases parents have pleaded so piteously to be conveyed to their children, that the commissioners have suggested that the expenses should be paid out of the parish funds, but the authorities who had contrived the original proceeding in order to save two or three shillings a head, could not of course be induced to furnish money for so sentimental a purpose. The commissioners have resolutely refused their sanction to such disgraceful transactions whenever they have come within their knowledge and jurisdiction—one instance out of many which prove that, however much the borough authorities may denounce them as a centralized power, they have done excellent service in checking local ignorance, selfishness, and inhumanity.
If we now turn to consider the condition of private asylums, we shall find 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 33¼ 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 26⅓ 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,”