Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

Before leaving Halliday, I may add that he regarded Bethlem as, at this period, well conducted, but as having "too much of the leaven of the dark ages in its constitution, and too rigid a system of quackery, in regard to its being seen and visited by respectable strangers." He adds that in some respects "it is little better than when, in fact, it formed one of the lions of the metropolis, and the patients as wild beasts were shown at sixpence for each person admitted." Of St. Luke's he writes, "It is only fit to become a prison for confirmed idiots." He would have been surprised to witness how much can be effected by improvements of various kinds, although he might still wish that it were supplemented by some appendage in the country, if not removed there altogether.

A very important step was taken by Mr. R. Gordon in the House of Commons in 1827 (June 13th), by drawing attention to the pauper lunatics in Middlesex. He particularly referred to the dreadful state of misery of the pauper lunatics in London in the parishes of Marylebone and St. George's. When the overseers of the latter parish visited Dr. Warburton's asylum at Bethnal Green, they found, he said, in a room eighteen feet long, sixteen cribs,[157] with a patient in each crib, some of them chained and fastened down, and all of them in a state of great wretchedness. On one occasion, a visitor having gone there and reported that there was nothing objectionable, he repeated his visit next day, and discovered five rooms, in which the patients were in a most horrid state of misery; and this although the day before he was informed that he had seen everything. The unfortunate persons placed in these cribs were kept from Saturday night until Monday; their food being administered to them in the cribs. Mr. Gordon moved for a Select Committee to inquire into the condition of pauper lunatics in Middlesex, and for leave to bring in a Bill to amend 14 Geo. III. c. 49 (1774),[158] and to extend its provisions to pauper lunatics, to consolidate all Acts relative to lunatics and asylums, and to make further provisions thereto.

The Committee was appointed.

It specially directed its attention to the treatment of paupers in the parishes of Marylebone, St. George, Hanover Square, and St. Pancras, confined in the White House at Bethnal Green, belonging to Dr. Warburton. Its condition was frightful, and the Committee observes that if the White House is to be taken as a fair specimen of similar establishments, it cannot too strongly or too anxiously express its conviction that the greatest possible benefit will accrue to pauper patients by the erection of a county lunatic asylum.

The Committee reports that the defects and abuses in the management of houses for the reception of lunatics, to which the Select Committee of 1815 called the attention of the House of Commons, still exist in licensed houses where paupers are received in the neighbourhood of the metropolis, and that similar abuses elsewhere prevail. The evidence established that there was no due precaution with respect to the certificate of admission, the consideration of discharge, or the application of any curative process to the mental malady. The Committee therefore repeated the recommendations of the Committees of 1807 and 1815, and prepared a series of propositions as the basis of future legislation, repealing a number of Acts and recommending the consolidation, into one Act of Parliament, of the provisions for the insane, as well as further facilitating the erection of county asylums, and improving the treatment of pauper and criminal lunatics.

Dr. John Bright, secretary to the Commissioners, read from their records one entry, describing the condition of Holt's house, Lewisham, in Kent. In the year 1820, "in a close room in the yard, two men were shut by an external bolt, and the room was remarkably close and offensive. In an outhouse at the bottom of the yard, ventilated only by cracks in the wall, were enclosed three females. The door was padlocked; upon an open rail-bottomed crib herein, without straw, was chained a female by the wrists, arms, and legs, and fixed also by chains to the crib. Her wrists were blistered by the handcuffs; she was covered only by a rug. The only attendant upon all the lunatics appeared to be one female servant, who stated that she was helped by the patients."

Subsequent entries did not show any material improvement in the condition of the house.

Dr. Bright summarized the defects in the Lunacy Laws at that period, as regards the power vested in the Commissioners, as follows:—

"They are very defective in many points: in the first place, with respect to the granting licences, there is only one day in the year in which, according to the Act, the licences can be granted; then with respect to persons to whom the licence may be granted, any person applying for that licence is entitled to have one; again, any person committing any offence, save and except the refusing admission to Commissioners on their visitations, may be continued and is continued in the exercise of such powers as that licence communicates to him; the Commissioners have no power to disturb in the management of his house any keeper of a house, whatever offences he may have committed, or however unworthy he may appear to them to be. Supposing any person who had, in the eyes of the Commissioners, acted improperly, to apply in October, at the usual and the only period in the year for granting licences, they conceive (and they are advised) that they are obliged to grant a licence to that individual. There is another circumstance which I think is very important, which is the certificate which is granted; the Act is vague with respect to the medical person. It speaks of him as physician, surgeon, or apothecary; it does not say 'duly authorized to grant a licence,' and, in point of fact, a number of persons, calling themselves apothecaries, do sign certificates, and the Commissioners do not believe that they can prevent them so doing, or that the signature is invalid; and, again, it often happens, and very improperly, as the Commissioners think, that persons sign the certificate in two capacities. For instance, a medical man is, or calls himself, the friend of the person conveyed to the mad-house, and he signs again as a medical person; again, the keeper of a mad-house, who happens to be a medical person, signs a certificate, attesting the insanity of the party, and receiving that party into his house. The Commissioners always reprobate and endeavour to check such a practice, but not always successfully."

In the following year (February 19, 1828) Mr. Gordon, in pursuance of the instructions of the Committee, brought in a Bill to amend the law for the regulation of lunatic asylums. He said, among other things, that the medical certificate to be signed by an apothecary was interpreted to mean that it might be signed by any seller of drugs, and hence an apprentice, as soon as his indentures had expired, might consign a man to a mad-house. This reminds me of a mistake into which a distinguished German alienist has recently fallen, not unnaturally, from our double use of the word apothecary. He smiles at the absurdity of the British law allowing a mere druggist to sign a certificate of insanity! Mr. Gordon again refers to Dr. Warburton's house, and the patients in their cribs "wallowing in their filth throughout the whole of Sunday," while on Monday morning they were "in a state of nudity, covered with sores and ordure, and were carried into the yard to be suddenly plunged into cold water, even when ice was in the pails." The speaker added that it was impossible, with the strongest language, to describe the horrors of this place, and even maintained that the evidence before the Committee showed that, however bad, this house was good as compared with others of the same kind—if not much better than many of them.