"'The Supply of Guardians.—This feature of the system of boarding out the insane will appear to many to be all-important. The excuse which inspectors frequently advance for their lack of co-operation with medical officers of asylums is their inability to find suitable guardians. It is, however, an excuse which my experience does not permit me to regard as valid or sympathize with....
"'The Influence of the Government Grant.—I feel I need do no more than mention this agency in increasing the number on the roll of single patients. The way in which it has led to this increase has been fully treated of in the published Reports of the Board....'"
Among the foregoing excerpts from the elaborate Report of the Commissioners, much, it will be seen, bears on the important question of the "cottage treatment" of the insane. In this direction, at least in the way of attempting to form a sort of lunatic colony (though on a very minute scale) after the manner of Gheel, Scotland has acted more definitely than England. Opinion is divided on the subject, and the measure of success can hardly be said to have been yet determined. Whatever this may be, the counter disadvantages must not be overlooked. Kennoway, in Fifeshire, where the experiment has been tried on a small scale, has had its supporters and detractors. Dr. John Smith, well known for his long practical experience of lunacy, and Dr. J. B. Tuke, at that time the superintendent of the admirably managed Fife and Kinross Asylum, visited Kennoway some years ago, and the report[249] of the latter was certainly anything but favourable; in fact, that the saving effected was by means detrimental to the lunatic. Notwithstanding, he arrived at the conclusion that the system might be employed with advantage in certain cases, if accompanied by stringent supervision. Dr. Arthur Mitchell, in his evidence before the Parliamentary Committee of 1877, so valuable on all the points to which he spoke, replied to the question why the patients boarded out had decreased in number, if the board approved of the system, that he, although warmly approving of it, was the person who had largely caused this decrease, the reason being that it was found there were a great number of persons totally unsuitable for private dwellings, and others were ill cared for. Hence it was necessary to weed them out. This observation does not specially apply to villages like Kennoway, but to the boarded-out cases, wherever placed.[250]
Much more of interest might be taken from this Report, but the foregoing will suffice to bring before the reader the salient points in the management of the insane in Scotland at the present day, by which he can judge for himself of the contrast between the present and the past. My main object is with the latter, but it can only be understood by a sketch, however brief, of the former, in each of the three divisions of the United Kingdom.
Footnotes:
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[227] These particulars are given in the Report of the Royal Lunacy Commission for Scotland, 1857, on the authority of Sir Thomas Craig.
[228] "A General View of the Present State of Lunatics and Lunatic Asylums in Great Britain and Ireland," by Sir Andrew Halliday, M.D., p. 28.
[229] Op. cit., p. 27.
[230] "An Act to Regulate Madhouses in Scotland."