It was in this speech that Lord Ashley made an observation which has not escaped the criticism of the medical profession, namely, "that a man of common sense could give as good an opinion as any medical man he ever knew," that is, "when it has been once established that the insanity of a patient did not arise from the state of his bodily health."[165]
It should be stated that Mr. Wakley moved an amendment on the first clause of the Bill, omitting "Barrister Commissioners," and inserting "Medical Commissioners." He spoke of the total failure of the Metropolitan Commission, and ultimately moved as an amendment that two of the Commissioners to be appointed should not have their profession stated, their appointment being left to the Lord Chancellor. This amendment was carried by a majority of three, but in the Bill provision was made for two more physicians and two more barristers.
On July 16th of the same year, on the motion that the order of the day for the further consideration of the Lunatic Asylums Bill be proceeded with, a member suggested its postponement until further discussion. Lord Somerset replied that the Bill was framed for the purpose of procuring further information on the subject, in order to legislate permanently upon it. On the House going into Committee Lord Ashley expressed a hope that the measure would tend to ameliorate the condition of the pauper lunatics throughout the kingdom. On this occasion Lord Ashley observed, in regard to the system of non-restraint, that he had formerly entertained some doubts as to the practicability of carrying it out; but that these doubts had been removed by a visit to the Hanwell Asylum. Having witnessed the system pursued there, he said he could not speak too highly either of the system itself, or the manner in which it was carried out by Dr. Conolly.
Having passed through Committee, the Bill was read a third time on the 28th of July, 1842, and in this instance was not rejected by the House of Lords.[166]
The Metropolitan Commissioners, invested with their enlarged powers, made a most thorough inquiry into the condition of the asylums in England and Wales, and presented a Report to Parliament in 1844, which must always possess great historic interest and value.[167] It constitutes the Doomsday Book of all that concerns institutions for the insane at that time.
The state of some asylums visited by the Commissioners was frightfully bad, notwithstanding the general progress which had been made since public attention had been directed to abuses and the several Acts of Parliament had been passed in order to remove them. These things, however, it must be remembered, were survivals of the past, not fair illustrations of the present; abuses which lingered on in spite of light and knowledge, and required stringent pains and penalties to force those who permitted them to abandon their practices.
On the 23rd of July, 1844, the indefatigable reformer of abuses connected with the treatment of lunatics, Lord Ashley, moved for an Address to the Crown, praying her Majesty to take into consideration the Report of the Metropolitan Commissioners in Lunacy[168] to the Lord Chancellor, presented to the House, the statute under which they acted expiring next session. He commented upon there being no official visitation of single houses. He believed that such a power "ought to be confided to some hand that would hunt out and expose the many horrible abuses that at present prevail." The only control was that if such patient resided more than twelve months in a house, the owner was compelled to communicate the name of that patient to the clerk of the Commission; but for the most part no notice was taken of this law, and it was frequently evaded by removing the patient, after a residence of eleven months, to some other lodging.
At this period (January 1, 1844) the number of lunatics and idiots chargeable to unions and parishes in England and Wales was 16,821. In county asylums there was provision for only 4155, leaving 12,666 poor insane, of whom there were in asylums under local Acts 89, in Bethlem and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private asylums, leaving in workhouses and elsewhere 9339. Although a few of the existing county asylums were well adapted to their purpose, and a very large proportion of them were extremely well conducted, yet some were quite unfit for the reception of insane persons. Some were placed in ineligible sites, and others were deficient in the necessary means of providing outdoor employment for their paupers. Some also were ill contrived and defective in their internal construction and accommodation. Some afforded every advantage of science and treatment; others were wholly deficient in these points. All of them, however, had the advantage of constant supervision, and of not giving any profit to the superintendent. Lord Ashley especially referred to the admirable manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster, and Gloucester were managed. "Why, then," his lordship asked, "are not these institutions multiplied? At this moment there are twenty-one counties in England and Wales without any asylum whatever, public or private. The expense is one cause. In some cases the cost of construction has been exceedingly great. The asylum most cheaply constructed is that of Wakefield, of which the average cost per head was £111, whilst the highest price was that of Gloucester, which had cost on the first accommodation £357 per head. In many cases the cost of construction had exceeded £200 per head. The cost of the Bedford Asylum, for 180 patients, was £20,500; that of Gloucester, for 261 patients, £51,366; that of Kent, for 300 patients, was £64,056; that of Hanwell, for 1000 patients, was £160,000, exclusive of £36,000 paid since 1835 for furniture and fittings. On the other hand, the best-constructed union-houses in the country had not cost more than £40 per head." Lord Ashley maintained that although, no doubt, a lunatic asylum was expensive, it ought not to be so to that enormous degree. The reason of this difference he did not know, except that many of them had been constructed with a great display of architecture, and some asylums were far too large. Adopting the opinion of the Report of the Commissioners, he maintained that no asylum for curable lunatics should contain more than 250 patients, and that perhaps 200 are as large a number as can be managed with the most benefit to themselves and the public in one asylum; and he quoted Dr. Conolly's stronger statement that 100 persons were the highest number that could be managed with convenience in one of these asylums. With regard to the number of private patients in asylums, there were 3790, of whom 973 were in private metropolitan, and 1426 in private provincial asylums. The paupers in the private houses were—metropolitan, 854; provincial, 1920. With respect to these, it was a very serious question how far any house should be licensed to take paupers for payment. The principle was very dangerous, and Lord Ashley pointed out that if the superintendent only got seven or eight shillings a week, he still must make a profit, and that there could be no doubt it was so. Quoting the Report of the Commissioners again, he said that many asylums had formerly been private houses; the mansion was sometimes engrossed by the proprietor and a few private patients, while the paupers were consigned to buildings formerly used as offices and outhouses. After adducing evidence of the deplorable condition of certain asylums, Lord Ashley asserted that the only remedy was the multiplication of county asylums, and if advice and example failed, they ought to appeal to the assistance of the law to compel the construction of an adequate number of asylums over the whole country. It was the duty of the State to provide receptacles for the incurable patients, apart from those devoted to remedial treatment. Parochial authorities, however, preferred keeping patients in the workhouse at an expense not exceeding two shillings a week, rather than send them to the county asylum, where the minimum charge was seven shillings a week.
It was true, Lord Ashley observed, that they could show but few instances of restoration to reason. How, indeed, was it possible? They could show, however, a mighty improvement in the condition of the sufferers, the alleviation of their state, their occupations and amusements (all, with some bright exceptions, of recent date), and that the services of religion had infused a momentary tranquillity; but they could show little else, and unless the Legislature should interfere and bring these unfortunates by force within the reach of sympathy and care, for every one restored to his senses we should see a hundred in whom the light of reason would be extinguished for ever. The speaker went on to say that there were two points of deep interest, to which the House would do well to advert for a moment—the question of restraint, and the admission and liberation of patients. "Upon restraint it was unnecessary to dwell very long, as it was a matter of internal arrangement, and beyond their immediate legislation; but he wished to direct the attention of the House to the chapter in the Report which handled that subject, that it might share the general satisfaction, and give praise to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr. Conolly, Dr. de Vitré, Dr. Charlesworth and many more, who had brought all their high moral and intellectual qualities to bear on this topic, and had laboured to make rational and humane treatment to be the rule and principle of the government of lunacy."
Lord Ashley pointed out that the law required no medical certificate whatever for a pauper patient, except when admitted into a private asylum. It appears that in Wales at that time there were 1177 pauper lunatics, 36 of whom were in English county asylums, and 41 in English licensed houses, 90 in union workhouses, and 1010 living with their friends, many of them being in a wretched condition. Lord Ashley quoted a letter from one of the Commissioners, written in Wales, in which it was stated, "We have met with one case which we think most atrocious. A. B. was sent to the Hereford Asylum from near Brecon on November 28, 1843. She died on January 30th. She was in such a shocking state that the proprietor wished not to admit her; she had been kept chained in the house of a married daughter. From being long chained in a crouching posture, her knees were forced up to her chin, and she sat wholly upon her heels and her hips, and considerable excoriation had taken place where her knees pressed upon her stomach. She could move about, and was generally maniacal. When she died it required very considerable dissection to get her pressed into her coffin! This might be taken as a sample of Welsh lunatics."