Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

The site of the institution is well chosen, covers three hundred acres, and commands an extensive and uninterrupted view. The building is of red brick, with a chapel in the centre, and consists of three stories, with distinct additional blocks at the extreme end. It is built on the corridor plan, with day-rooms, and single and associated dormitories. The windows alone indicate, from outside, the character of the building, being protected by strong vertical iron bars. In some parts of the building, for the females, these bars do not extend to the whole height of the window, and escape would in such cases not be difficult. In other parts of this division, and throughout the male division, the windows are securely protected. In this and other ways the house is more secure than it was formerly. I find in regard to escapes that, from the opening of the asylum in 1863 up to the end of 1877, there have been not more than twenty-three. During the last three years there have been none. The majority were recaptured on the next or following day; one not till three months; and four were never discovered. Four escaped from the airing-court; three while out with a walking party; and four from breaking the window-guard; while one escaped from his bedroom by making an aperture in the wall. An attendant connived at one patient's escape, was prosecuted, and convicted. I may add that prior to the opening of Broadmoor, the proportion of escapes of criminal lunatics detained in England elsewhere was much greater. The opening of Broadmoor has also affected the mortality of this class, having reduced it materially. Some probably regard this as an actual disadvantage; but whatever political economists may say, medical science only sanctions, as yet at least, the adoption of that course of hygiene and treatment which most conduces to the prolongation of human life.

There were, when I visited Broadmoor, 500 inmates—400 men and 100 women, or thereabouts. When we consider that of these unfortunate people, more than 300 have either murdered some one, or attempted to murder or maim some one, it may well cause reflection, alike sad and philosophical, on what a disordered brain may lead its possessor to do, what acts to commit. Ninety had killed their own children as well as, in some instances, the wife or husband; upwards of twenty, their wives; eight, their mothers; four, their fathers; and one, both parents. And another reflection may be made, to the credit of the institution, that no case of actual murder has occurred since it was opened, and that, taking the year before we write, good order was maintained, no premeditated act of violence was committed, and there was no suicide.

And yet no mechanical restraint was resorted to, no fetters, no strait waistcoats, no leg-locks or straps. Some patients are, of course, secluded in a single room in which a bed made on the floor is the only furniture allowed, and in which the window is protected by a shutter if the patient breaks glass. The room is, when the shutter is closed, only partially dark, as there are two small windows near the ceiling, out of the patient's reach. By the side of the door is an inspection plate, or narrow slit in the wall, with a movable glazed frame, opening outwards, through which the occupant of the room can be observed when necessary. These rooms are well ventilated, and are warmed by means of hot water. I should not proceed further without stating that, in addition to the class of cases to which I referred in the beginning of this paper—those, viz., detained during Her Majesty's pleasure, including those certified to be insane while awaiting their trial, or found insane on arraignment, or acquitted on the ground of insanity, or reprieved on this ground immediately after their sentence—besides these there are convicts who become insane while undergoing their penal servitude. As a rule, however, male convicts of this class are no longer sent to Broadmoor; the superintendent[210] having discovered that it was necessary to keep insane convicts distinct from the other class, to secure their safe detention more completely and certainly; that is to say, to separate lunatic criminals from criminal lunatics, or, as they are usually called, "Queen's pleasure men"—a distinction sometimes really as important as that which exists between a horse-chestnut and a chestnut horse. It will be readily understood that the convicts—really criminals, and often desperate criminals, they are—may differ widely from those who in an access of insanity have committed a crime, and that men who leave prison discipline at Pentonville, or elsewhere, to enjoy the comparative comfort of asylum life at Broadmoor, are very likely either to sham madness in order to stay there, or escape in order to avoid having to complete, on recovery, their term of servitude. Anything better than that. In insisting on this distinct classification and accommodation, Dr. Orange did not, in the first instance, intend, I suppose, to prevent the convict class being provided for at Broadmoor; but having set the ball in motion, it went on and on; and instead of an additional building being erected for the convict men, a regulation was made in 1874 preventing their being sent in future to Broadmoor. For the women of this class there was and is ample room, an additional wing having been erected fifteen years ago.

Again, there is a reason, on the side of the prison authorities, why convicts when insane should not be sent to Broadmoor. They are naturally unwilling that the history of their previous treatment should be known and scrutinized at another place. Hence they greatly prefer retaining them in the prisons, or sending them to one in which provision has been specially made for insane convict men.

It will probably occur to some to ask whether many or any of those who are "Queen's pleasure men" (or women) are found to have been improperly acquitted when subjected to the careful and prolonged medical scrutiny which a residence at Broadmoor allows of; whether, in short, mercy, based on medical knowledge, has mistakenly interfered with the proper action of justice and law? In this matter the doctors and the lawyers are frequently on opposite sides, and the former often find it hard work to rescue an insane prisoner from the clutches of the law. On the other hand, it may be admitted that, as regards some physicians at least, a juster view is sometimes as necessary as it is on the part of the lawyers. When absurd reasons are given in the witness-box for a prisoner's insanity—reasons which would equally establish the madness of many persons in society whom no one regards as insane—it is not surprising that the judges are cautious in admitting the plea of insanity on medical evidence. In seeking a reply to the above question, it is satisfactory to find that if the evidence of medical experts tends to induce juries to acquit on the ground of insanity those who are responsible agents and ought to be punished, there have only been a few scattered cases admitted which were "doubtful"—whether at Bethlem, when criminal lunatics were sent there, before Broadmoor existed, or at the latter, since it was opened. It is also a satisfaction to know that cases of this kind have not been more frequent of late than formerly; and this, although there has been in the present generation a marked increase in the number acquitted on the ground of insanity. Thus from 1836 to 1848, the ratio of the insane to the prisoners tried was only one in thirty-two; between 1848 and 1862 it was one in seventeen; and between 1862 and 1874 as many as one in fourteen.[211] It is surely much better that a man should occasionally escape the punishment he deserves, than that any should be punished who labour under mental disease. To show the difficulty of arriving at a conclusion as to the mental responsibility of persons charged with crime, I may mention the case of a schoolmaster who, not many years ago, used his cane on a boy in a very savage manner, pursued him under the table, and destroyed the sight of one eye. This man was sentenced to five years' penal servitude. He was, of course, under the notice of the surgeon of the prison to which he was sent, and was regarded by him as sane. The schoolmasters and pupil-teachers, however, took the case up, and agitated for further examination into the state of the man's mind. Dr. Orange was employed to examine him, and, thoroughly familiar with criminal lunatics, succeeded in discovering unmistakable proofs of insanity. In fact, he was so poorly the morning of the day he committed this assault, so uncomfortable in his head, and so irritable in mind, that he sent word to the school to say that he was too ill to attend to his duties. It was a school examination, however, and the authorities insisted upon his going. They therefore were mainly to blame for the circumstance which followed. This man was saved from punishment by Dr. Orange's representations, and subsequent observation confirmed the opinion he formed at the time, that he was not only irritable and suspicious, but was labouring under a delusion. He was a dangerous lunatic, in short, when he committed the offence.

In going through the wards I conversed with the superintendent on the main points of interest in connection with the management of the institution, and on some of the characteristics presented by those who are admitted.

I remarked on the low mortality which I knew obtained there. "Ah," said the doctor, laughing, "that goes against us, rather than for us. We are blamed for keeping the patients too well!" Since the opening of the asylum, the yearly average of death has been at the rate of 2.97 per cent. of the number resident. As to diet it is no doubt difficult to understand why this class should fare better, as they seem to do, than ordinary patients in the county asylums. In one particular, indeed, a change in the direction of economy has been made, and a very reasonable change it is. It is connected with an important question which arises, How far can the system of rewards for work be beneficially carried out?

It appears that until some ten years ago, the main reward for useful work was a luncheon of bread-and-cheese and beer in the forenoon, with another, though smaller, allowance of beer in the afternoon. Both these allowances of beer (which were additional to the dinner supply) were discontinued in 1875, and in lieu of them a small portion of the money value of the work done was credited to the workers, with permission to spend it on any trifling luxury they might desire. It was found that the executed value of the work in the shoemakers' shop in 1876 was more than that done in 1873 (the year before this experiment was tried), by 160 per cent., whilst in the tailors' shop the increase was 120 per cent.; corresponding results being obtained in other departments. Hence, in spite of the gratuities to the patients so employed, the yearly cost has been considerably reduced. During one year the saving in beer alone amounted to £165, whilst the saving in paid labour was very much greater.

Financial considerations must be a very important practical point in the existence of Broadmoor. The State pays for it; an annual grant from the House of Commons must be asked for, and the Government must be prepared to show that the amount is not unreasonable. Now the weekly cost of the inmates is eighteen shillings each. That of the inmates of our county asylums averages about half a guinea. It may therefore not unreasonably be asked, Why is this? What have the criminal lunatics done to deserve so much more money being lavished upon them? The chief reason is, that a greater proportion of attendants must be provided for this class, and that is costly. At Broadmoor the proportion of attendants to patients is one in five; in asylums generally, much less liberal, say one in eleven; besides which, they are paid better (as they ought to be), at Broadmoor. Ten years ago the cost per head was as high as twenty-three shillings a week.

A considerable number of the inmates are, as has been intimated, usefully employed. Thus, during the year, 167 men and women were occupied in one way or other, in addition to reading and writing, music, etc. Eighty-six were employed in making and repairing clothing for patients, and bed and house linen for patients and attendants; 144 in cleaning the wards; 40 in the garden and on the farm; 29 in the laundry; 26 in making or repairing uniform clothing, boots and shoes, etc.; 17 in making and repairing furniture, mattresses, mats, carpets, etc. I went into one room where there was a printing-press, and a printer handed me the printed programme of a concert shortly to be held in the asylum. The total value of the labour of patients alone amounted, in 1881, to £2835.