Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

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 £17 to £350. 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 £120,000. 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 £200 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 primâ 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.