Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

In the carrying out of a system of labour so beneficial to the patient, and so useful to the institution, relaxation and amusement are not forgotten. The patients play at chess, draughts, billiards, bagatelle, etc.; and out-of-door games comprise bowls, cricket, and croquet. There is a library well supplied with papers and journals; and one patient was pointed out who himself contributes to a magazine. There is a band which includes seventeen patients, as well as some attendants, and enlivens the inmates twice in the course of the week.

This sounds very pleasant, but honesty requires us to give the other side of the picture, as portrayed in the words of Mr. Burt, the chaplain; and perhaps nothing serves better to show how much credit is due to the superintendent for the admirable management of an institution containing such elements as these. He said (some years ago) that although he had laboured in asylums and prisons for a long period, it had never fallen to his lot before to witness depravity and unhappiness in such aggravated forms. "In other asylums, when the mind resumes anything like healthy action, there is hope of discharge; in prisons, the period of detention, however long, has some definite duration; but here the fear of relapse, and the terrible acts to which relapse may lead, render the condition of release rarely attainable; for many the period of detention is indefinite, and hope is almost excluded. In prison, whatever may be the depravity, it is kept under some restraint by reason and by fear of consequences; but here there are patients with passions depraved to the utmost, upon whom neither reason, nor shame, nor fear impose any restraint."

One Sunday, about fifteen years ago, during the Communion, and when the chaplain was in the middle of the Collect for the Queen, an event took place, the account of which I take from his own description. A patient with a sudden yell rushed at Dr. Meyer (then the superintendent), who was kneeling, surrounded by his family, close to the altar, and a deadly blow was struck at his head with a large stone slung in a handkerchief. The stone inflicted a serious injury, and the blow would have been fatal, if it had not been somewhat turned aside by the promptness with which the arm of the patient was seized by an attendant. A scene of so dreadful a character has very rarely been witnessed in a Christian church. Is it surprising that Mr. Burt cannot look back upon this occurrence without horror, and that he has never felt able to say the particular collect which was interrupted in so awful a manner?

Many are the moral lessons which might be enforced from a knowledge of the cases admitted at Broadmoor, and their previous history. Among these the evil of gross ignorance might well be illustrated by such an example as this. Six years ago a farm labourer was tried in Warwickshire, for murdering a woman eighty years of age.

He believed in witches and laboured under the delusion that this poor old creature, with others in the village, held him under the spell of witchcraft. Returning from his work one day, and carrying a pitchfork in his hand, he saw this woman. He immediately ran at her, struck her on the legs thrice, and then on the temple, till he knocked her down. From these injuries she died. Well, it was found that he had the delusion that he was tormented by witches, to which he attributed his bodily ailments, and was ever ready with Scripture quotations in favour of witchcraft. His mind, apart from delusions, was weak. The jury acquitted him on the ground of insanity, and he was admitted at Broadmoor in January, 1876.

One lesson there is which ought to be learnt from the history of many of the cases sent to Broadmoor, and that is the extreme importance of not disregarding the early symptoms of insanity. Had these been promptly recognized, and those who suffered from them been subjected to medical care and treatment, the acts they committed, the suffering they caused, the odium they brought upon themselves and their families, would alike have been prevented. The diffusion of a knowledge of the first indications of this insidious disease, and of what it may culminate in, is the only safeguard against the terrible acts which from time to time startle the community, and which are found, when too late, to have been perpetrated by those who ought to have been under medical restraint.

Bearing immediately upon this, is the fact that there were recently, out of the cases of murder in Broadmoor, twenty-nine cases in which insanity had been recognized before the act was committed, but the persons were regarded as harmless, and thirty-three in which it was not regarded as harmless, but insufficient precautions were taken. In seventy-five cases no one had possessed sufficient knowledge to recognize it at all.

It must not be supposed that although the utility and success of Broadmoor are so great, all has been done in the way of protecting society which the necessity of the case requires. Far from it. There are a vast number of weak-minded persons at large, most dangerous to the community, some of whom have not yet been in prison, while others have. In 1869 there were in Millbank one hundred and forty weak-minded, and also twenty-five of an allied type, the "half sharp." Whether they have been imprisoned or not, they ought to be placed under supervision of some kind.

Two other practical suggestions: The number of instances in which life is sacrificed, and the still larger number of instances in which threats of injury or damage short of homicide, destroy family happiness, through the lunacy of one of its members, renders it highly desirable that greater facilities should exist for placing such persons under restraint (we do not refer now to imbeciles) before a dreadful act is committed, to say nothing of terminating the frightful domestic unhappiness. In most of these cases there is but slight apparent intellectual disorder, although careful investigation would frequently discover a concealed delusion, and the greatest difficulty exists in obtaining a certificate of lunacy from two medical men. They shrink from the responsibility. Nothing is done. Prolonged misery or a terrible catastrophe is the result. To avoid this, there might be a power vested in the Commissioners in Lunacy to appoint, on application, two medical men, familiar with insanity, to examine a person under such circumstances. Their certificate that he or she ought to be placed under care should be a sufficient warrant for admission into an asylum, and they should not be liable to any legal consequences. It should not be necessary for the signers of the certificate to comply with the usual formalities. The Commissioners should have power to grant an application of this kind, whether made by a member of the family or by a respectable inhabitant of the place in which the alleged lunatic resides; his respectability, if necessary, being attested by the mayor.

The other suggestion has reference to the strange and clumsy way in which the English law goes to work to discover whether a man charged with crime and suspected to be insane is so in reality. It is a chance in the first place whether he is examined by a medical man at all. If he can afford counsel, and the plea of insanity is set up, medical testimony is adduced of a one-sided character, and, more likely than not, counter medical evidence is brought forward by the prosecution. Thus physicians enter the court as partisans, and being in a false position, often present an unfortunate spectacle; while, worst of all, the truth is not elicited.