Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

Returning to 1861, the tenth report of the Inspectors of Asylums, issued in that year, gives much important information on the state of lunacy in Ireland at that time, but there are only two points to which it is necessary to refer here. The writers, Drs. Nugent and Hatchell, speak indignantly of the shameful manner in which the friends of lunatics in confinement neglect them, "as if their malady entailed a disgrace on those connected with them ... months—nay, years—passing without an inquiry being made by a brother for a brother, or a child for a parent."

After stating that during the previous ten years four new asylums had been licensed, the Inspectors recur to the importance of supplying asylums for patients who, unable to pay the ordinary charge of a private asylum, not being paupers, are ineligible for admission into public asylums.

In 1874 a new code of rules, issued by the Privy Council, contained many important regulations. Of it, however, the late Dr. Robert Stewart[271] observed, "On the whole, we cannot speak very highly of the tact or wisdom shown by the Lord Lieutenant and Privy Council in the framing of the new code of regulations."[272] In this code the duties of the medical superintendents of Irish asylums are minutely laid down.

In 1878 a Lunacy Inquiry Commission was appointed by the Lord Lieutenant of Ireland, the Report of which in the following year, after an examination of a large number of witnesses, contains much valuable information as to various questions connected with the asylums and the provision for the insane poor, present and future. The following "most distressing case," recorded by the Commission, speaks loudly of the need of increased provision for the insane poor in Ireland:—

"On approaching a small farmhouse at a place called ——, I heard," says Dr. Robertson, "a most peculiar howling noise, and, to my horror, when I came near the house I saw a lunatic stark naked, confined to a room, and looking through the wooden bars that closed the windows, for there was no glass whatever. He is about nineteen years of age, and I heard from his mother that up to ten or eleven years he was a most intelligent boy; but at that age he suddenly lost the power of speech and became moody and abstracted, wandering about the fields alone, and constantly uttering a low, muttering noise, and with incessant tendency to mischief. By careful watching, the family prevented him injuring himself and others, until of late he has got so strong and unmanageable, and his inclination for destruction is so great, that they have been obliged to confine him in the room I have described. He breaks the window directly it is glazed, tears his bed-clothes into shreds, and won't allow a stitch of clothing to remain on his body; besides, his habits are most disgusting."[273] The incumbent of the parish wrote: "This case is indeed only suited for a lunatic asylum. The form which his lunacy has assumed is most shocking, and is detrimental to morality." An English tourist happening to see this case had him removed to the Monaghan Asylum. One cannot but remark that what an English tourist did, the proper authorities ought to have done. The law appears to have been sufficient for the occasion.

The members of the Commission were not content with hearsay evidence. "We took occasion ourselves," they report, "to visit several of these cases in different parts of the country. Some of them we found in a deplorably neglected condition; others disturbing the arrangements of a whole family, the head of which would willingly contribute a small sum towards maintenance in some suitable place of refuge. It admits of no doubt that many a case, if taken in hand at an early stage, might have been restored to society, instead of lapsing into hopeless, incurable insanity. Serious evil often results from the freedom with which idiots of both sexes are permitted to wander abroad, often teased and goaded to frenzy by thoughtless children, often the victims of ill treatment or the perpetrators of offences far worse. The interests of the public, no less than of the insane, require that means should be adopted to ascertain that all of that class are properly cared for. That can only be done by substituting the visit of a medical man for that of the constable, and a professional report for the incomplete return that is now made."

The chief conclusions were, that while it would not be proper to dispense wholly with any workhouse, portions of some might be dispensed with for sane paupers, and appropriated for the accommodation of a certain class of the insane. Over-crowding, it was proposed, should be relieved by the removal of lunatics to auxiliary asylums. School buildings belonging to certain workhouses were suggested as auxiliary asylums, as in Dublin, Cork, etc. For the better cure, relief, and treatment of the lunatic and idiotic poor, a complete reorganization of the whole lunacy administration was regarded as essential, viz. that under the provisions of s. 15 of 8 and 9 Vict., c. 107, the existing district asylums should be classified, reserving one or more, as might be required, in each province as "lunatic hospitals," especially for the curative treatment of the insane; that the remaining district asylums should be appropriated as "lunatic asylums" for the accommodation of the chronic insane requiring special care, a certain number of this class being accommodated in the "lunatic hospitals," as about fifty of each sex would be required for the service of those establishments; that the inspection of the "lunatics at large" should be made one of the duties of the dispensary medical officers, who should be remunerated for this duty, and whose certificate that any one of this class is neglected or improperly cared for, should be made the ground for action by the lunacy authorities; that the accommodation for the third or harmless class, who are at present in lunatic asylums, in workhouses, or at large in a neglected state, be provided by the appropriation of spare workhouse buildings, a sufficiency of which is to be found in each province, thus also meeting the very general complaint of guardians being compelled to maintain superfluous workhouse accommodation; and that all expenditure upon the building or enlargement of district asylums should be suspended.

By this means, each province would be provided with three classes of lunatic establishments: (1) One or more lunatic hospitals for the cure of insanity in an early stage; (2) first-class asylums, in which the chronic cases requiring special care would be treated; (3) second-class or "workhouse auxiliary asylums" for harmless lunatics. The Commission expressed a strong opinion that the whole lunacy administration of Ireland should be placed under the general control of the Local Government Board.

I may add that the estimated cost of the first class was £26 per head; that of the second class, £20; and that of the third, £14 6s. Of this scheme it must be said that, excellent as it is in intention, it is not in some of its provisions without danger in the direction of lowering the condition of the insane poor, as regards comfort and medical supervision, not, indeed, below what they are in some Irish workhouses, but below the standard aimed at in the best county asylums. "Let it be understood that there is no recommendation to constitute anything like an auxiliary asylum, such as Leavesden or Caterham, where large numbers, being brought together, can be kept at a cheap rate, and can at the same time be properly treated under medical care. No provision is made for the necessary supervision, medical or otherwise. The dispensing medical officer is to visit the insane at large, but those in workhouses are to be left to the tender mercies of attendants. The amount of care and comfort these unfortunate beings are to enjoy can be imagined by the fact that the Commission considers that £14 6s. a year will be the cost of their maintenance, after paying attendants, whilst the cost of those in the second-class establishments is to be £20, or about £6 less than what they cost at present."[274]

In their review of the results of past lunacy legislation in Ireland the Commission make the melancholy statement that "although several years ago the legislature made provision for the classification of asylums,[275] and the Inspectors of Lunacy concur with other witnesses of the highest authority in thinking that such classification would be attended with the utmost advantage—would, in fact, meet the difficulties of asylum administration—yet not only has no attempt ever been made to give effect to the provisions of that law, but"—strangest of all—"the Lunacy Inspectors appear to have been unaware of its existence!"[276]