On the State of Lunacy and the Legal Provision for the Insane / With Observations on the Construction and Organization of Asylums

by J. T. Arlidge

Now this point to be argued, the cost of asylum construction, is not, like the foregoing considerations, chiefly the affair of Poor-Law Guardians and Overseers, but concerns more particularly the County Magistrates, inasmuch as it is defrayed out of the County instead of the Poor Rate. But although this is the case, there is no doubt that the very great expense of existing asylums has acted as an impediment to the construction of others, and has seemed to justify, to a certain extent, the improper detention of many insane persons in workhouses: for, on one side, asylums are found to have cost for their construction and fittings, £150, £200, and upwards per head, whilst on the other, workhouses are built at the small outlay, on an average, of eighty-six such establishments, of £22 per head. The “Return” made to the House of Commons, June 15, 1857, “of the cost of building Workhouses in England and Wales, erected since 1840,” shows indeed a very wide variation of cost in different places, from £13 per head for the Congleton Union House; £14 for the Erpingham; £16 for the Stockton and Tenterden, to £47 for the Kensington; £50 for the Dulverton; £59 for the City of London; £60 for St. Margaret Westminster; and £113 for the Paddington. This enormous difference of expenditure on workhouse lodging,—for, unlike asylum costs, it does not include fittings, extending from £13 to £113 per inmate,—is really inexplicable, after allowing for the varying ideas of parish authorities as to what a workhouse should be, and for the slight differences in the cost of building materials and labour in some parts of the country than in others. Either some workhouses must be most miserable and defective habitations even for paupers, or others must be very extravagant and needlessly expensive in their structure.

There is this much to be said in explanation of the contrast of cost in different workhouses, that in those belonging to large town populations, infirmary accommodation becomes an item of importance and involves increased expenditure, whilst in those situated in agricultural districts, this element of expense is almost wanting. Moreover it is in town workhouses generally that lunatic inmates are found, who, if not in the infirmary, are lodged in special wards, often so constructed as to meet their peculiar wants, and therefore more costly than the rest of the institution occupied by the ordinary pauper inmates. This is the same with saying that where workhouses are used as receptacles for the insane, it greatly enhances the cost of their construction.

It will be evident to every thinking person that the costs of asylum and of workhouse construction are not fairly comparable. The asylum is a special building; an instrument of treatment; peculiarly arranged for an invalid population, affording facilities for classification, recreation, and amusements; and fitted with costly expedients for warming and ventilation; whereas the workhouse is essentially a refuge for the destitute, necessarily made not too inviting in its accommodation and internal arrangements; suited to preserve the life of sound inmates who need little more than the shelter of a roof and the rude conveniences the majority of them have been accustomed to. Now these very characteristics of workhouses are among the best arguments against the detention of lunatics within these buildings; but of these hereafter.

There is doubtless a permissible pride in the ability to point to a well-built asylum, commanding attention by its dimensions and architectural merits, and we would be the last to decry the beauties and benefits of architecture, and know too, that an ugly exterior may cost as much or more than a meritorious one; yet we must confess to misgivings that there has been an unnecessary and wasteful expenditure in this direction. Nevertheless it is with asylums as with railways, the present race of directors are reaping instruction from the extravagances and errors its predecessors fell into.

The change of opinion among all classes respecting the character and wants of the insane and their mode of treatment, is of itself so great, that many of the structural adaptations and general dispositions formerly made at great cost, are felt to be no longer necessary, and the very correct and happy persuasion daily gains ground, that the less the insane are dealt with as prisoners, and treated with apprehension and mistrust, the more may their accommodation be assimilated to that of people in general, and secured at a diminished outlay.

All this suggests the possibility of constructing asylums at a much less cost than formerly, and of thereby lessening the force of one of the best pleas for using workhouses as receptacles for the insane. The possibility of so doing has been proved both theoretically and practically. In an essay ‘On the Construction of Public Asylums,’ published in the “Asylum Journal” for January 1858 (vol. iv. p. 188), we advocated the separation of the day- from the night-accommodation of patients, and the abolition of the system of corridors with day- and sleeping-rooms, or, as we briefly termed it, “the ward-system,” and showed that by so doing a third of the cost of construction might be saved, whilst the management of the institution would be facilitated, and the position of the patients improved. By a careful estimate, made by a professional architect, with the aid of the necessary drawings, for a building of considerable architectural pretension, it was calculated that most satisfactory, cheerful, and eligible accommodation could be secured, including farm-buildings, and fittings for warming, ventilation, drainage, gas, &c., at the rate of £90 per head for patients of all classes, or at one-half of the ordinary cost.

Experience has shown that chronic lunatics, at least, can be accommodated in an asylum at a lower rate, in fact, at little more than half the expense that we calculated upon.

Like other County Asylums, the Devon became filled with patients; still they came, and after attempts to cram more into the original edifice, by slight alterations, and by adding rooms here and there, it was at length found necessary to make a considerable enlargement. Instead of adding floors or wings to the old building, which would have called for a repetition of the same original expensive construction of walls, and of rooms and corridors, the Committee, with the advice of their excellent physician, wisely determined to construct a detached building on a new plan, which promised every necessary convenience and security with wonderful cheapness; and, for once in a way, an architect’s cheap estimate was not exceeded. Instead of £200 or £250 per head, as of old, accommodation was supplied at the rate of £38: 10s. per patient, including fittings for all the rooms and a kitchen:—a marvel, certainly, in asylum construction, and one which should have the effect of reviving the hopes and wishes of justices, once at least so laudably entertained, to provide in County Asylums for all pauper lunatics of the county.

It is only fair to remark, that, as Dr. Bucknill informs us (Asylum Journal, 1858, p. 323), this new section of the Devon Asylum is dependent on the old institution for the residences of officers, for chapel, dispensary, store-rooms, &c. “It is difficult,” writes Dr. Bucknill, “to estimate the proportion which these needful adjuncts to the wards of a complete asylum bear to the expense of the old building; they can scarcely, however, be estimated at so high a figure as one-eighth of the whole.” But, as a set-off against the increased cost per patient involved in supplying the necessary offices described by Dr. Bucknill, we may mention that there are twenty single sleeping-rooms provided in the building, and that a greater cost was thereby entailed, than many would think called for, where only chronic, and generally calm patients, were to be lodged.

These illustrations of what may be done in the way of obtaining good asylum accommodation for pauper lunatics at no greater rate, we are persuaded, than that incurred in attempting to provide properly for them in workhouses, furnish a most valid reason for discontinuing their detention in the latter, and the more so, if, as can be demonstrated, they are unfit receptacles for them.