Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

The Commission found that the evil of overcrowding with incurable cases, complained of by the Committee of 1843, and by the Royal Commission of 1858, "has continued to the present day not merely unchecked, but in a more aggravated form than ever." In 1856 there were 1168 curable and 2656 incurable patients in Irish asylums, while in 1877 these numbers were, respectively, 1911 and 6272, the percentages being in the former year, curable 30.5, incurable 69.5, while in the latter year the corresponding percentages were 23.3 and 76.7. Taking the patients not only in asylums, but in workhouses also, the total in 1856 (or more correctly 1857) was as follows: curable, 1187; incurable, 4468; percentages, 20.9 and 79.1. In 1877, curable, 1911; incurable, 9644; percentages, 16.5 and 83.4—a frightful revelation of incurable lunacy. The Inspectors complain that the Act 30 and 31 Vict. has caused this increase of unsuitable cases,[277] but, as the Commission observe, it has simply increased an existing evil, and not produced a new one. Besides, "how otherwise are these unhappy people to be dealt with? Has any other accommodation been provided for them? Though not suitable cases for curative hospitals, they are, at all events, suitable cases for care and humane treatment, and not until provision for such treatment is made, ought the door of the asylum to be shut against them."[278]

The condition of workhouses is proved by this Report to be most unsuitable for the reception of the insane; yet they contained in 1879 one quarter of the pauper lunatics of the country. It was desirable to remove a large number of these somewhere, and the only suitable place was the district asylum. Dr. Lalor, in his evidence before this Commission, says in regard to this increased number of admissions under the 30 and 31 Vict., "I think it is an immense advantage, because before that Act there was a great number of persons kept out who ought to be sent into lunatic asylums, but there was not sufficient machinery for doing so." Dr. Lalor then goes on to say that they have not in Ireland the same provision as in England for taking up merely wandering lunatics not chargeable to the rates. This witness, I should add, is strongly in favour of larger asylums for even curable cases, and would classify the institutions for the insane into three classes, the curable, the improvable, and the incurable. For curable and improvable cases of lunacy, including those requiring special care, and for the training and education of imbeciles and idiots chiefly of the juvenile classes, he would have the same asylum; for the incurable and unimprovable, he would have another. He would leave it to a central body to distinguish the cases, and would allow that such a body might find it more convenient to class the juvenile idiots and imbeciles under the second division.

At the date of this Commission there were 22 district asylums, containing 8073 patients. There were 150 workhouses, with 3200 insane inmates. In Dundrum[279] were 166 criminal insane, and in private asylums about 680 patients, making a total of 12,200. In addition to these, the inspectors obtain a return of every idiot, imbecile and epileptic, at large, from the police, not being under the supervision of the Lunacy Board; the number in 1878 was 6200, bringing up the figures to 18,400.

That practical effect might be given to the recommendations contained in this Report, Lord O'Hagan called attention to them in a speech delivered in the House of Lords, August, 1879, in which he said, "Let me ask the attention of the House to the case of neglected lunatics in Ireland. It is the most pressing, as it is the most deplorable." He cited the statement of the Royal Commission of 1858, that there were 3352 lunatics at large, of whom no fewer than 1583 were returned as "neglected;" and the recent statement of the Irish Lunatic Inquiry Commission that within the last twenty years the number of that class had increased by more than a hundred per cent.—from 3352 to 6709—without "any diminution in the proportion of those who may still be classified as neglected." Lord O'Hagan referred to the case of a naked lunatic in a farmhouse, which we have quoted at [p. 424], and maintained that some four thousand lunatics were in a condition "better or worse according to circumstances." We cannot but think that the speaker generalized a little too much. He was right, however, in his contention that none of the neglected cases "are protected by any intervention of the law from exhibiting themselves in as shocking an aspect."

"Only," observed Lord O'Hagan, "when the life of George III. was threatened by a lunatic in England, did Parliament interfere and send the insane to jails; only in 1838, when it was discovered that jails were not fit receptacles for them, was provision made for committing them to asylums; and only in the Consolidating Act of 1853 were provisions made for such inspection and report as were needful for their protection and the safety of their neighbours. I lament to say that Ireland was left without even the benefit of the Act of 1799 until 1838, and that the advantages which the Act of that year gave to England were not extended to her lunatics until 1867; whilst you will scarcely believe that the salutary reforms of 1853 have not to this hour been made operative in Ireland."

Lord O'Hagan asked for identical legislation for Ireland and England, the want of this having caused "incalculable mischief."

After observing that the Commission proposed the classification of asylums for the purpose of curative treatment, the care of chronic cases, and the allocation of workhouses as auxiliaries for the benefit of the quiet and harmless, Lord O'Hagan referred to the fact that "the Commission and the Inspectors of Lunacy differed as to material points on the modus operandi, the inspectors desiring the extension of district asylums, and the Commission not agreeing with this view; the consequence being that at that time their extension was suspended." The speaker did not presume to decide between them, but simply called upon the Government to recognize the responsibility which the Report of the Commission had cast upon them.

The Lord Chancellor (Lord Cairns) replied that the Report was engaging the attention of the Government; that he trusted it would not be in the category of those Reports "which have gone before" and produced no result; but that he could not give any further answer.[280]

The Lord Chancellor of Ireland (Lord O'Hagan) brought in on the 20th of January, 1880, the "County Court Jurisdiction in Lunacy Bill (Ireland),"[281] which not only passed the House of Lords, but was read a third time in the House of Commons, August 17th of that year.[282]