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

In this number are certainly to be placed all those of the third class “labouring under positive mental derangement,” and who, although reported as “comparatively few” in 1846, have subsequently been largely multiplied, according to the evidence of the ‘Eleventh Report’ (ante, p. 56). Those, again, “in whom epilepsy or paralysis is complicated with unsoundness of mind,” are not suitable inmates for workhouse wards. No form of madness is more terrible than the furor attendant on epileptic fits; none more dangerous; and, even should the convulsive affection have so seriously damaged the nervous centres that no violence need be dreaded, yet the peril of the fits to the patient himself, and their painful features, render him an unfit inmate of any other than an establishment provided with proper appliances and proper attendants. As to the paralytic insane, none call for more commiseration, or more careful tending and nursing—conditions not commonly to be found in workhouses.

The Commissioners in Lunacy have not omitted the consideration of workhouses as receptacles for epileptics and paralytics, and have arrived at the following conclusions:—After treating, in the first place, of epileptics whose fits are slight and infrequent, and the mental disturbance mild and of short duration, they observe that, as such persons “always require a certain amount of supervision, and as they are quite incompetent, when the fits are upon them, to take care of themselves, and generally become violent and dangerous, it would seem that the workhouse can seldom be a suitable place for their reception, and that their treatment and care would be more properly provided for in a chronic hospital especially appropriated to the purpose.”

Concerning paralytics, they state that they are far less numerous than epileptics, and being for the most part helpless and bedridden, are treated as sick patients in the infirmary of the workhouse. Their opinion is, however, that a chronic hospital would be a more appropriate receptacle for them,—a conclusion in which all must coincide, who know how much can be done to prolong and render more tolerable their frail and painful existence, by good diet and by assiduous and gentle nursing,—by such means, in short, as are not to be looked for in establishments where rigid economy must be enforced, and pauper life weighed against its cost.

To turn now to the second class of workhouse Lunatic Inmates, the demented from age, accident, or disease: these, we do not hesitate to say, are not suitably accommodated in workhouses, for, like the paralytic, they require careful supervision, good diet and kind nursing; they are full-grown children, unable to help or protect themselves, to control their habits and tendencies; often feeble and tottering, irritable and foolish, and, without the protection and kindness of others, the helpless subjects of many ills. For such, the whole organization of the workhouse is unsuited; even the infirmary is not a fitting refuge; for, on the one hand, they are an annoyance to the other inmates, and, on the other, pauper nurses—whose office is often thrust upon them without regard to their fitness for it,—are not fitting guardians for them. In fine, where age, accident or disease has so deteriorated the mental faculties, we have a complication of physical and mental injury to disqualify the patient from partaking with his fellow-paupers in the common accommodation, diet, and nursing.

In the reverse order which we have pursued, the first class of congenital, imbecile, and idiotic inmates comes to be considered last. This happens by the method of exclusion adopted in the argument; for the second and third classes have been set aside as proper inmates of some other institution than a workhouse, and it now remains to inquire, who among the representatives of the first class are not improperly detained in workhouses. This class includes, as already seen, some two-thirds of the whole number of inmates mentally disordered; and among whom, we presume, are to be found those individuals who may, in the Commissioners’ opinion, mix advantageously with the general residents of the establishment. The number of the last cannot, we believe, be otherwise than very small; for the very supposition that there is imbecility of mind, is a reason of greater or less force, according to circumstances, for not exposing them to the contact of an indiscriminate group of individuals, more especially of that sort to be generally found in workhouses. The evils of mingling the sane and insane in such establishments have already been insisted upon; and besides these, such imbecile patients as are under review, lack in workhouses those means of employment and diversion which modern philanthropy has suggested to ameliorate and elevate their physical and moral condition.

Lastly, if the remaining members of this class be considered, in whom the imbecility amounts to idiocy, the propriety of removing them from the workhouse will be questioned by few. Indeed, will any one now-a-days advocate the “laissez faire” system in the case of idiots? Experience has demonstrated that they are improveable, mentally, morally, and physically; and if so, it is the duty of a christian community to provide the means and opportunities for effecting such improvement. It cannot be contended that the workhouse furnishes them; on the contrary, it is thoroughly defective and objectionable by its character and arrangements, and, as the Commissioners report, (op. cit. p. 259) a very unfit abode for idiots.

On looking over the foregoing review of the several classes of lunatic inmates of workhouses distinguished by the Commissioners in Lunacy, the opinion to be collected clearly is, that only a very few partially imbecile individuals among them are admissible into workhouses, if their bodily health, their mental condition, their due supervision and their needful comforts and conveniences are to be duly attended to and provided for. In accordance with the views we entertain, as presently developed, of the advantages of instituting asylums for confirmed chronic, quiet, and imbecile patients, we should permit, if any at all, only such imbecile individuals as residents in workhouses, who could pass muster among the rest, without annoyance, prejudice or discomfort to themselves or others, and be employed in the routine occupations of the establishment.

So much is heard among poor-law guardians and magistrates about a class of “harmless patients” suitably disposed of in workhouses and rightly removeable from asylums, that a few remarks are called for concerning them. To the eye of a casual visitor of an asylum, there does certainly appear a large number of patients, so quiet, so orderly, so useful and industrious, that, although there is something evidently wrong about their heads, yet the question crosses the mind, whether asylum detention is called for in their case. The doubt is not entertained by the experienced observer, for he knows well that the quiet, order, and industry observable are the results of a well-organized system of management and control; and that if this fails, the goodly results quickly vanish to be replaced by the bitter fruits generated by disordered minds. The “harmless” patient of the asylum ward becomes out of it a mischievous, disorderly, and probably dangerous lunatic. In fact, the tranquillity of many asylum inmates is subject to rude shocks and disturbances, even under the care and discipline of the Institution; and the inoffensive-looking patient of to-day may, by his changed condition, be a source of anxiety, and a subject for all the special appliances it possesses, to-morrow.

Any Asylum Superintendent would be embarrassed to select a score of patients from several hundred under his care whom he could deliberately pronounce to be literally “harmless” if transferred to the workhouse. He might be well able to certify that for months or years they have gone on quietly and well under the surrounding influences and arrangements of the asylum, but he could not guarantee that this tranquillity should be undisturbed by the change to the wards of the workhouse; that untrained attendants and undesirable associates should not rekindle the latent tendency to injure and destroy; that defective organization and the absence of regular and regulated means of employment and recreation should not revive habits of idleness and disorder; or that a less ample dietary, less watchfulness and less attention to the physical health, should not aggravate the mental condition and engender those disgusting habits, which a good diet and assiduous watching are known to be the best expedients to remedy.

Dr. Bucknill has some very cogent remarks on this subject in his last Report of the Devon Asylum (p. 6). “The term ‘harmless patients,’ or in the words of the statute, those ‘not dangerous to themselves or others’ (he writes), I believe to be inapplicable to any insane person who is not helpless from bodily infirmity or total loss of mind: it can only with propriety be used as a relative term, meaning that the patient is not so dangerous as others are, or that he is not known to be refractory or suicidal. It should not be forgotten, that the great majority of homicides and suicides, committed by insane persons, have been committed by those who had previously been considered harmless; and this is readily explained by the fact, that those known to be dangerous or suicidal are usually guarded in such a manner as to prevent the indulgence of their propensities; whilst the so-called harmless lunatic or idiot has often been left without the care which all lunatics require, until some mental change has taken place, or some unusual source of irritation has been experienced, causing a sudden and lamentable event. In an asylum such patients may truly be described as not dangerous to themselves or others, because they are constantly seen by medical men experienced in observing the first symptoms of mental change or excitement, and in allaying them by appropriate remedies; they are also placed under the constant watchfulness and care of skilful attendants, and they are removed from many causes of irritation and annoyance to which they would be exposed if at large, in villages or union houses.