Did not a necessity for an improved and extended organization on behalf of the interests of the insane exist, the plea of its cost would probably defeat an attempt to establish it, notwithstanding the plainest proofs of its contingent advantages, and of the fact that sooner or later its adoption would be imperative. But, looking at the question merely with reference to the cost entailed, we believe, that this would not be considerable, and that, as a new burden, it would indeed be very small: for, as we have pointed out, there are certain moneys now paid under Acts of Parliament, which would, by the organization advocated, become available towards defraying its expenses. For instance, the fee of ten shillings per annum, payable for the quarterly visits to every pauper lunatic not in asylums, would revert to the district officers; as likewise would the fee payable to the physician called upon by the visitors to the licensed houses in every county. We have also proposed a fee to be paid for a quarterly visit to all county patients in lunatic asylums, and to all private patients provided for singly, and are of opinion that a payment should be made for each lunatic or ‘nervous’ patient, when registered as such, whether pauper or not; the sum, in the case of a pauper, however, of a smaller amount than that for a private lunatic.
Considering the character and extent of the supervision and attention proposed to be rendered, and the numerous advantages, direct and indirect, which would necessarily accrue from the establishment of the organization suggested, there are certainly good grounds for enforcing payment for services rendered, so as to make the whole scheme nearly, or quite, self-supporting. To repeat one observation before concluding this chapter,—it should be so ordered, that all moneys levied on account of the visits of district medical officers, and of registration, should be paid to the credit of the Lunacy Board, through the medium of which those officers would receive their salaries.
Chap. X.—On the Lunacy Commission.
We put forward our remarks upon this subject with all becoming deference; yet it was impossible to take a review of the state of Lunacy and of the legal provision for the insane without referring to it. Indeed, in previous pages several observations have fallen respecting the duties and position of the Commission of Lunacy, and the operation and powers of this Board have also formed the topic of many remarks and discussions in other books, as well as in journals, and elsewhere.
There appears to be in the English character such an aversion to centralization as to constitute a real impediment to systematic government. Various questions in social science are allowed, as it were, to work out their own solution, and are not aided and guided towards a correct one by an attempt at system or organization. Confusion, errors, and miseries must prevail for a time, until by general consent an endeavour to allay them is agreed upon, and a long-procrastinated scheme of direction and control is submitted to, and slowly recognized as a long-deferred good. Such is the history of the care and treatment of the insane. After ages of neglect, evils had so accumulated and so loudly cried for redress, that some plan of conveying relief became imperative; and it is only within our own era, that the first systematic attempt at legislation for the insane was inaugurated. From time to time experience has shown the existence of defects, and almost every Parliament has been called upon to amend or to repeal old measures, and to enact new ones, to improve and extend the legal organization for the care and treatment of lunatics and of their property.
One most important part of this organization was the establishment of the Lunacy Commission, which has given cohesion and efficacy to the whole. To the energy and activity of this Board are mainly due the immense improvements in the treatment of the insane which characterize the present time, and contrast so forcibly with the state of things that prevailed before this central authority was called into power. The official visitation by its members of all the asylums of the country has imparted a beneficial impulse to every superintendent; the Commissioners have gone from place to place, uprooting local prejudices, overturning false impressions, and transplanting the results of their wide experience and observation on the construction and organization of asylums, and on the treatment of the insane, by means of their written and unwritten recommendations, and by their official reports, which form the depositories of each year’s experience.
An attempt to show the manifold advantages of this central Board would be here out of place; but we may, for example’s sake, adduce the recent investigation into the condition of lunatics in workhouses, as one of many excellent illustrations of the benefits derived from an independent central authority. But, whilst illustrating how much and how long the supervision of independent visitors has been, and, in fact, still is needed over lunatics in those receptacles, it also proves that the existing staff is inadequate to fulfil the task. We have, indeed, suggested the appointment of a class of district medical officers who would relieve the Commissioners from the greatest part of the labour of inspecting workhouse lunatic wards, but we would not thereby entirely absolve them from this duty. An annual visit from one Commissioner to each Union-house containing more than a given number of lunatics would not be too much; and, to make this visit effectual, the Commissioner should be armed with such plenary powers as to make his recommendations all but equivalent to commands, though subject to appeal. At present the Lunacy Commissioners are practically powerless; the law orders their visits to be made, and sanctions their recommendations, but gives neither to them nor to the officers of the Poor Law Board the power to insist on their advice being attended to if no reasonable grounds to the contrary can be shown. In this matter, therefore, a reform of the law is called for. The court of appeal from the views of the Commissioners might be formed of a certain number of the members of the Poor Law Board and of the Lunacy Commission, combined for the purpose when occasion required.
The proposition has been made (p. 179) to institute a Committee of Visitors of Workhouses, chiefly selected from the county magistracy; and it is one that will no doubt be generally approved. But to the further proposition, that the supervision of workhouse lunatics should be entirely entrusted to these Committees, and that the Commissioners in Lunacy should not be at all concerned in it, we do not agree; for, in the first place, we wish to see the Lunacy Commissioners directly interested in every lunatic in the kingdom, and acquainted with each one by their own inspection or by that of special officers acting immediately under their authority; and, in the second place, we desire to retain the visitation of the members of the Commission in the capacity of independent and experienced inspectors. The advantages of an independent body of visitors, as stated in the Commissioners’ ‘Further Report,’ 1847 (p. 93), chiefly with reference to asylums (see p. 192), have much the same force when applied to the visitors of workhouses,—that is, if the insane in these latter receptacles are to be placed on an equality, as far as regards public protection and supervision, with their more fortunate brethren in affliction detained in asylums. But, besides the arguments based on the advantages accruing from an independent and experienced body of visitors, there is yet another to be gathered from the past history of workhouses and their official managers: for among the members of Boards of Guardians, to whom the interests of the poor in workhouses are confided, are to be found, in a large number of parishes, magistrates holding the position of ordinary or of honorary guardians; and, notwithstanding this infusion of the magisterial element, we find that almost incredible catalogue of miseries revealed to us by the Lunacy Commissioners to be endured by the greater number of lunatics in workhouses. In fact, to assign the entire supervision of workhouse lunatic inmates to a committee of visiting Justices is merely to transfer the task to another body of visitors, who have little further recommendations for the office than the Boards of Guardians as at present constituted. From these and other considerations, we advocate not only the visitation of lunatics in workhouses by the district medical officers proposed, but also, at longer intervals, by one or more of the Commissioners or of their assistants; and, if this idea is to be realized, an increase of the Commission will be necessary, at least until Union-houses are evacuated of their insane inmates.
The beneficial results flowing from the visitation of asylums by the Lunacy Commissioners is a matter of general assent; and the opinion is probably as widely shared, that this visitation should be rendered more frequent. A greater frequency of visits would allay many public suspicions and prejudices regarding private asylums, and would, we believe, be cheerfully acquiesced in by asylum proprietors, who usually desire to meet with the countenance and encouragement of the Commissioners in those arrangements which they contrive for the benefit of their patients. The proceeding in question would, likewise, furnish the Commissioners with opportunities for that more thorough and repeated examination of cases, particularly of those which are not unlikely to become the subject of judicial inquiries. The ability to do this might, indeed, often save painful and troublesome law processes; for, surely, the careful and repeated examinations of the Commissioners, skilled in such inquiries, when terminating in the conclusion that the patient is of unsound mind, and rightly secluded, should be accounted a sufficient justification of the confinement, and save both the sufferer and his friends from a public investigation of the case.