| 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 fête champêtre 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 £30 up to £500 a year. It has a Charity Fund of £10,000; 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.