It does not seem necessary to trace the slight changes in the law relating to pauper lunatics, or in the orders and circulars of the Central Authority. There appears to have been no alteration in the relation of the Central Authority to the Lunacy Commissioners, practically no steps being taken to initiate policy except upon the suggestion of the latter, whose standard of accommodation and treatment continues steadily to rise for pauper as for non-pauper lunatics.
The only point of interest is the continuance, virtually unchanged, of the three methods of treatment, viz. maintenance in the workhouse, treatment in a lunatic asylum, or grant of outdoor relief.
The number of persons of unsound mind in the workhouse continued practically undiminished, without any steps being taken to prevent their retention among the aged, the sick, and the children, who came more and more to make up the workhouse population.[716] There were, in fact, three classes of cases in which a lunatic might be detained in a workhouse. Firstly, there is the old provision, under which "the visitors of any asylum may, with the consent of the Local Government Board and the Commissioners, and subject to such regulations as they respectively prescribe, make arrangements with the guardians of any union for the reception into the workhouse of any chronic lunatics, not being dangerous, who are in the asylum, and have been selected and certified by the manager of the asylum as proper to be removed to the workhouse."[717] Secondly, "where a pauper lunatic is discharged from an institution for lunatics, and the medical officer of the institution is of opinion that the lunatic has not recovered, and is a proper person to be kept in a workhouse as a lunatic, the medical officer shall certify such opinion, and the lunatic may thereupon be received and detained against his will in a workhouse without further order, if the medical officer of the workhouse certifies in writing that the accommodation in the workhouse is sufficient."[718] Thirdly, if it is necessary for the welfare of a lunatic, or for the public safety, that he should immediately be placed under care and control, pending regular proceedings for his removal, he may be taken to a workhouse (if there is proper accommodation therein) by a constable, relieving officer, or overseer, and may be detained there for three days, during which time the proceedings are to be taken; and in any case in which a summary reception order has been or might be made, he may be further detained on a justice's order till he can be removed, provided that the period does not exceed fourteen days.[719] Moreover, any other lunatic might be "allowed to remain in a workhouse as a lunatic" if "the medical officer of the workhouse certifies in writing: (a) that such a person is a lunatic, with the grounds for the opinion; and (b) that he is a proper person to be allowed to remain in a workhouse as a lunatic; and (c) that the accommodation in the workhouse is sufficient for his proper care and treatment, separate from the inmates of the workhouse not lunatics, unless the medical officer certifies that the lunatic's condition is such that it is not necessary for the convenience of the lunatic or of the other inmates that he should be kept separate." Such a certificate signed by the medical officer is sufficient authority for detaining the lunatic in a workhouse for fourteen days, but no longer, unless within that time a justice signs an order for his detention. Failing such a certificate, or, after fourteen days, such an order, or if at any time the lunatic ceases to be "a proper person to be allowed to remain in a workhouse," he becomes "a proper person to be sent to an asylum," and proceedings are to be taken accordingly.[720]
Meanwhile the Central Authority continued to permit the grant of outdoor relief in cases of lunacy; and about 5000 were always so maintained.
Regulations for the boarding-out of pauper lunatics first appear in the Act of 1889. "Where application is made to the committee of visitors of an asylum by any relative or friend of a pauper lunatic confined therein that he may be delivered over to the custody of such relative or friend, the committee may, upon being satisfied that the application has been approved by the guardians of the union to which the lunatic is chargeable, and, in case the proposed residence is outside the limits of the said union, then also by a justice having jurisdiction in the place where the relative or friend resides, and that the lunatic will be properly taken care of, order the lunatic to be delivered over accordingly." The authority liable for such a lunatic's maintenance is to pay an allowance for his support to the person who undertakes his care; the medical officer of the district is to visit him and report to the visiting committee every quarter, and two visitors may at any time order the lunatic to be removed to the asylum.[721] Any two Commissioners have also the right to visit any pauper lunatic or alleged lunatic not in an institution for lunatics or in a workhouse, and call in a medical practitioner; if the latter signs a certificate, and they think fit, the Lord Chancellor may direct that the lunatic be received into an institution.[722]
For the paupers of unsound mind in the Metropolis there was even a fourth alternative, namely, the "district asylums" of the Metropolitan Asylum Board. On the opening of the Darenth Asylum, the Central Authority quoted, without disapproval, the following remarks of the Lunacy Commissioners: "The withdrawal, for proper care, of helpless children of this kind [idiots] from the households of many of the industrious and deserving poor is a frequent means of warding off pauperism in the parents."[723] We do not find, however, any more explicit statement on this point. What the Central Authority continued to press on the Boards of Guardians was, not so much the importance of relieving the struggling poor from the burden of their insane or idiotic dependants, nor yet the freeing of the workhouses from the presence of persons of unsound mind; but rather of appropriate discrimination. "It is of great importance not merely to exclude from the [district] asylums those who, by reason of violence or irritability, are proper subjects for the county asylum, but also those who, from old age or disease, are unfit for the journey to the asylum, or who, from the slight degree to which their mind is affected, might more properly remain in the workhouse."[724] "The removal of helpless, bedridden persons, whose mental weakness is, in many cases, the result of old age, to asylums situated a considerable distance from the Metropolis, is calculated, on the one hand, to be injurious to the persons thus removed, and, on the other, to occupy the district asylums with a different class of persons from that for which they were constructed."[725] Imbecile children are to be kept in the workhouse till they are five years old, and may then be sent to the asylum at Darenth.[726] Outside the Metropolis there is no specialised Poor Law provision for idiots, who, if not received into the county asylum, must either be placed in non-Poor-Law institutions at considerable expense, or detained in the workhouse. In 1885 the Central Authority even suggested that harmless and aged lunatics had, on grounds of economy, better be retained in the workhouse, rather than removed to an asylum.[727] We hear incidentally of a Special Order in 1900 under which certain chronic lunatics were actually transferred from the Suffolk County Asylum to the workhouse of the Mildenhall Union.[728] As late as 1905 we find the Central Authority expressing regret that so many cases of senile imbecility were removed from the workhouses to asylums.[729]
Under this policy the number of paupers of unsound mind receiving outdoor relief diminished very slightly, being 4736 on 1st January 1906; those in the asylums of the Metropolitan Asylums Board and in county and borough lunatic asylums rose to no fewer than 92,409; whilst those in workhouses nevertheless did not fall off from the total of thirty-five years previously, being, in fact, on 1st January 1906, 11,484, or an average of nineteen in each workhouse.[730]
Towards the latter part of the time we begin to find the inspectors, somewhat in disaccord with the suggestions of the Central Authority itself, protesting against the presence in the workhouses even of the chronic lunatic, the harmless idiot, or the senile imbecile, on the new ground that their presence caused annoyance to the sane inmates—annoyance which had, for seventy years, been apparently either unnoticed or not considered. "I am sorry to say," reported Mr. Preston-Thomas in 1901, "that in all but six of the workhouses in my district imbeciles mix freely with the other workhouse inmates. Many of them are mischievous, noisy, or physically offensive.