It is necessary now to chronicle the appointment of the Select Committee of 1877, known as Mr. Dillwyn's Committee, the result, to a large extent, of a feeling of uneasiness in the public mind, or rather, a portion of it, relative to the too easy admission of patients into asylums, and their too difficult exit, when once there. The grossest charges were made against the proprietors of licensed asylums, and the Commissioners themselves were charged with culpable laxity. As might be expected, some changes in the law were suggested likely to prove beneficial, and the Report of the Committee contained sundry recommendations of importance. The charges, however, from which the inquiry originated, fell to the ground; and had the appointment of the Committee had no other result, the advantage would have been great, in presenting a most gratifying contrast to the revelations which took place fifty years before, in 1827.[175]
The conclusions at which the Committee arrived were that, "although the present system was not free from risks which might be lessened, though not wholly removed, by amendments in the existing law and practice, yet, assuming that the strongest cases against the present system were brought before them, allegations of mala fides or of serious abuses were not substantiated.... The Committee cannot avoid observing here, that the jealousy with which the treatment of lunatics is watched at the present day, and the comparatively trifling nature of the abuses alleged, present a remarkable contrast to the horrible cruelty with which asylums were too frequently conducted less than half a century ago, to the apathy with which the exposure of such atrocities by successive Committees of this House was received, both by Parliament and the country, and to the difficulty with which remedial enactments were carried through the legislature.... Nevertheless, the anomalous state of the law, which undoubtedly permits forcible arrest and deportation by private individuals and the fearful consequences of fraud or error, have induced the Committee carefully to inquire whether any additional safeguards may be devised."
Among the changes proposed (most of which are of the nature of safeguards), or in some instances hinted at rather than proposed, were:—an emergency certificate as in Scotland, signed by one medical man, but if the patient remains in the asylum more than three days, two fresh certificates to be obtained; in addition to report now required after the admission of the patient, a careful statement to be prepared from the case book and sent to the Lunacy Board at the end of the first month; the order on which every patient is admitted to continue in force for not more than three years, when a special report should be sent to the Board by the superintendent, and repeated annually; the original order to be given by a near relative as in Ireland, or some responsible person who could be called to account; the patient being visited every six months by the person signing the order, the "surest mode of guarding against unduly prolonged detention consisting in frequent and careful visitation of all places in which any lunatic is confined, with full power placed in the hands of the Commissioners to order his discharge, and in the more general adoption of the system of probationary release." Reports to be sent to the Commissioners of patients kept under restraint in private families or religious houses in the British Isles, not for profit, provided that the reports are confidential, and the patients confirmed lunatics, and not merely suffering under temporary derangement. On showing good cause for such a course, any person, as in Scotland, with the sanction of the Commissioners, to send two medical men to test the condition of any patient under control. Personal examination of patients, such as that made by the Chancery Visitors, to be extended to them irrespective of the possession of property. "Either the Chancery lunatics, who number less than a thousand, have too much cure bestowed upon them, or the others, who exceed sixty-five thousand, have far too little.... It seems physically impossible that, with the present strength of the Lunacy Commissioners, minute supervision of those who require it can be efficiently exercised." Amalgamation of the two departments might obviate waste of power in visiting, stricter supervision being also exercised over single patients, who are only visited once a year, there being nothing in the Acts to necessitate even this visitation. Transference of administration of property of persons unable to manage it, without deprivation of liberty, suggested. Particular workhouses to be devoted to harmless lunatics, who now crowd the asylums, by a common action of the workhouse authorities within certain areas. Voluntary boarders to be allowed to go to asylums, whether they have already been in confinement or not, notice being sent to the Lunacy Board of their admission. The existence of private asylums to be left to the spontaneous action of the public, sufficient accommodation in public asylums as in Scotland, Cornwall, and at Cheadle, being encouraged and facilitated by enlargement of the powers of magistrates, and other means calculated to extend this system. Greater freedom of patients in asylums, and of their visitation by friends, and in correspondence, are regarded as valuable securities against the infringement of personal liberty. Whatever changes are made, a consolidation of the Lunacy Acts would be most desirable. Such were the main proposals.
These suggestions of the Committee have not yet borne fruit, but will, no doubt, be of service in future lunacy legislation.
Mr. Dillwyn, in introducing his last Bill (May 25, 1881),[176] proposed that no one should be confined as a lunatic except upon an order of the justice of the peace; that no one should be incarcerated except at the instance of a near relative, or of some solicitor of repute. There was also provision that due notice should be given before a justice made the order, and that the order must be authorized by two medical men, one of whom should be the medical officer of the district. For violent lunatics he proposed the Scotch law, which permitted an emergency certificate, enabling persons who had paroxysms of lunacy to be detained for twenty-four hours, but not longer, except on the order of some competent authority. In the matter of discharges, he proposed that patients should be discharged on the order of a Judge in Chambers, a stipendiary magistrate, or a County Court judge, who should order two medical men to visit the lunatic, and report on the case; and such judge, after communicating with the Lunacy Commissioners, might order the lunatic to be liberated within ten days. As to private asylums, Mr. Dillwyn knew that the proposals he made bearing upon them would be met by the argument of vested interests on the part of the proprietors, but he did not think such interests ought to be exceptionally respected. He did not wish to introduce compulsion, but proposed that justices should be enabled to raise money by way of terminable annuities for the reception in public asylums of those who could pay. Mr. Dillwyn on this occasion was in a generous mood, for he observed that "he had nothing to say against private asylums, which, on the whole, were very well conducted." What he objected to was the interest which the proprietors had in keeping their patients as long as possible. Mr. Dillwyn objected to the present system of inspection, and made certain proposals with a view to increase its efficiency—including a paid chairman of the Lunacy Board. Mr. Dillwyn's Bill never reached the stage of the third reading, nor was it discussed in committee; and the Government, which expressed a hope that they might be able to take the matter in hand, has not yet found time to bring in a Bill.
It will be seen from the foregoing sketch that the example of a better system of treatment slowly but surely exercised a beneficial effect, combined as it was by the exposure of the neglect and cruelty which for the most part marked the treatment in asylums, workhouses, and also the home care of the insane; that the demand for legislative inquiry and interference followed; and that the system of inspection has, step by step, been rendered stricter and more effective. First there was introduced the visitation by the College of Physicians, through five of its Fellows—a miserable failure. Then there was, in 1828, the appointment of Metropolitan Commissioners, whose authority was in 1842 extended to the whole of England and Wales; and, last of all, was the establishment of the Board of Lunacy Commissioners on the basis upon which it is now constituted. So woefully slow, if eventually successful, is the march of events in the progress of reform.
There have been several members of the legislature who have honourably distinguished themselves by advocating in Parliament the claims of a class whose unhappy characteristic it is that they are unable to advocate their own cause, among whom may be mentioned Mr. T. Townshend, Mr. Wynn, Mr. Rose, Mr. Gordon, Lord Somerset; but to no single legislator is so great a debt of gratitude due as to Lord Shaftesbury, whose untiring efforts, and conciliatory yet firm bearing, in bringing forward his measures for the relief of the insane, combined with a thorough mastery of the question and an intimate acquaintance with the condition of houses for their care and treatment, have effected the greatest good, and served to carry into extensive operation, principles already enunciated, it is true, and even partially practised, but requiring the strong arm of the law to enforce their recognition throughout the Kingdom. The extent of obligation the insane and their friends owe to Lord Shaftesbury, who for more than fifty years has devoted himself to their interest, can only be fully estimated by those who have carefully traced his unwearied assiduity in conducting measures through Parliament, providing for the erection of lunatic asylums and the proper visitation of their inmates, and who are acquainted with the manner in which he has filled the office of Chairman of the existing Lunacy Board since it was formed. At that period Mr. Sheil could say in the House, without fear of contradiction, that "it may be truly stated that the noble lord had added nobility even to the name of Ashley, and that he had made humanity one of 'Shaftesbury's Characteristics.'"[177]
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