Conclusion





In completing the task which the author has attempted in the foregoing

chapters in the History of the Insane in the British Isles, he is only

too conscious that, in the endeavour to be concise as well as

comprehensive, he has made many omissions. With every desire to be fair

to all who have been engaged either in originating or in advancing the

improved treatment of those who, suffering cruelly from a malady

involving their very nature and being, have also been treated cruelly by

their fellows, the writer fears that some names which ought to have been

recorded and some institutions which ought to have been honourably

mentioned, have been passed over in silence. Apart from unintentional

oversight, it is not always easy to find in the Temple of Fame the

precise niche in which to place the figure that would rightfully fill

it, and the consequence is that the pedestal, as in some of our great

public edifices, remains unoccupied. It may be said, however, in

extenuation of any such omission, that it did not fall within the scope

of this book to chronicle all the establishments which, in more humane

methods of treatment, have been in advance of others, still less to

complete the history up to the present day of those which have been

mentioned. As it proceeded, the work has entered more into detail than

was originally designed; thus, in the chapter on Scotland the sketch is

filled in with particulars somewhat out of proportion to that attempted

in the earlier chapters.



Again, in crediting various asylums, as Lincoln, Hanwell, and Lancaster,

with introducing non-restraint, the author has not found space for more

than a reference to the meritorious course pursued at an early period at

the Suffolk Asylum, the Gloucester Asylum, and at Northampton from its

opening (1838), and at the Haslar Hospital.[314]



The writer would have been glad, had the proposed limits of the book

admitted of it, to describe much more fully the rise and growth of those

charitable institutions, the endowed or registered hospitals for the

insane, which have in England formed so important, and, on the whole, so

successful, an experiment in providing care and treatment for the insane

of the poor but non-pauper class, supplemented as they have been by the

payments of the rich. At the present moment, the principle and the

method by which these institutions are governed attract much earnest

attention, and appear to not a few to afford the best alternative

provision for the middle and upper classes, as against asylums carried

on by private enterprise. It may be so. Abuses which in former days were

possible, could not occur under the legislative restrictions of our

time; but it must not be overlooked that their annals have disclosed,

in some instances, abuses as great and inhumanities as shocking as any

that have disgraced the history of private houses. How abominably even

such institutions have been managed, has already been depicted in a

notorious example; how admirably, might have been shown, had space

allowed, as regards the same institution in the hands of men who, like

Dr. Needham, have maintained the reforms previously introduced within

its once dishonoured walls, and carried forward that humane system of

treatment which, Phoenix-like, arose from its ashes. The author would

have liked to do justice to other hospitals--as that at Northampton,

which under Dr. Bayley's remarkable power of organization has proved so

great a success; that at Cheadle, which under Mr. Mould's exhaustless

energy has shown how the various needs of different phases of mental

disorder may be met by various modifications in the provision made for

their care outside the walls of the asylum, thus combining cottage

treatment with the control of the central establishment; and, lastly,

that at Coton Hill, Stafford, which now and for many years has been

superintended by Dr. Hewitson--an institution due to a wave of public

feeling in favour of an institution for those in reduced circumstances,

which bore this practical fruit after some temporary discouragement.



Of the work done by county asylum superintendents it is impossible to

speak too highly; in fact, it would be difficult to know when to stop,

were one to be mentioned. Superintendents of the vast asylums of

Middlesex, Lancashire, and Yorkshire deserve the recognition of

services performed day by day with faithful diligence, not always

sufficiently appreciated, and not always without peril, as instanced in

the case of the late superintendent of Brookwood, Dr. Brushfield.[315]



As of those whose hourly labour is performed in these and other

institutions, so of those who were labourers, however humble, in the

early days of asylum reform at the close of the last and the beginning

of the present century, it must never be forgotten that work unobserved

by the public eye, but conscientiously performed for the unfortunate

class which, to a large extent, is unable to appreciate or thank the

kindly hand which shields them from cruelty or saves them from neglect,

will find its reward in the conscience; and also in the increased

happiness of those whom it benefits, though it may not set the worker on

any pinnacle of fame. It is to such that the author of "Romola" refers

when speaking of the "valiant workers whose names are not registered

where every day we turn the leaf to read them, but whose labours make a

part, though an unrecognized part, of our inheritance, like the

ploughing and the sowing of past generations."





FOOTNOTES:



[314] See Report of the Metropolitan Commissioners. 1844.



[315] Since the above was in type, another example has occurred in the

case of Dr. Orange, who has been assaulted by a criminal lunatic, and

narrowly escaped serious injury.









APPENDIX A.



(Page 61.)





In addition to the maps of Ralf Agas (cir. 1560?) and Braun and

Hogenberg (1572), there is an earlier view of London and Westminster by

Anthony van der Wyngrede, 1543, in the Bodleian Library, Oxford, but it

is worthless for the purpose of tracing the outline of Bethlem. No

additional light is thrown on the buildings by the view of London and

Westminster in Norden's "Speculum Brittanniae," engraved by Pieter van

dem Keere, 1593. It appears to be agreed that, whatever the date or

designer of the so-called "Agas" may be, it is "the earliest reliable

survey of London." Virtue's reprint is dated 1737. Mr. Overall's

"Facsimile from the original in the possession of the Corporation of the

City of London" was published in 1874. It is, however, only by a careful

study of the original with a magnifying glass and a good light, that the

outline of the Bethlem buildings can be made out.



Smith, in his "Topography of London" (1816), p. 36, says that the only

plan of London showing the first Bethlem which he had been able to meet

with is that by Hollar. This map showed Moorfields divided into

quarters, with trees surrounding each division, the site of the second

Bethlem being then an uninterrupted space, and a cluster of five

windmills standing on the site of the north side of Finsbury, a part of

which in Mr. Smith's memory was called Mill Hill. Hollar's rare map

(1666 or 1667) is so much later than Agas, that we have not followed its

distribution of the buildings. In Faithorne's map, published a few years

earlier (1658), from a survey in 1640, "Bedlame" is represented as a

quadrangle, with a gate in the wall on the south side. There is a very

clear outline of the first Bethlem in Lee and Glynne's map of London (in

Mr. Gardner's collection), published at the Atlas and Hercules, Fleet

Street, without date. This map is also in the British Museum. Mr. Coote,

of the Map Department, fixes the date at about 1705. Rocque's map of

London (1746) shows Bethlem distinctly. This map, and Ogilby's, formed

the basis of Mr. Newton's "London in the Olden Time," 1855.



With regard to the story of the skeleton in irons and Sir T. Rowe's

burying-ground, mentioned at p. 49, it is not disputed that he was

concerned in the burying-ground of Bethlem; but the skeleton appears to

have been found some distance from this spot. What is stated in Strype's

"Stow" (Bk. ii. p. 96, edit. 1720), is that in 1569 "Sir Thomas Rowe

caused to be enclosed with a wall about one acre, being part of the said

hospital of Bethlem, to wit, on the west, on the bank of Deep Ditch,

parting the hospital from Moorfields. This he did for burial in case of

such parishes of London as wanted ground convenient within their

parishes. This was called New Churchyard near Bethlem."



There are some very fine prints of the second Bethlem Hospital in the

Print Room of the British Museum. Of these (to which Mr. Crace's

collection is a recent valuable addition), and the prints in Mr.

Gardner's private collection and the Guildhall Library, the following

list has been prepared. I have again to thank Mr. Gardner and Mr. Coote

for their assistance. I have also to thank Mr. Crace for allowing me to

see his prints before they were removed to the British Museum.





VIEWS OF BETHLEM HOSPITAL.



1. Inscribed "Hospitium Mente Captorum Londinense. Frontispicium

Hospitii (vulgo Bedlam dicti) mente captis destinati, sub auspiciis

colendissimi viri Gulielmi Turner Equitis aurati Senatoris non ita

pridem Praetoris Londini Praesidis dignissimi nec non Beniamini Ducane

Armigeri Thesaurarii fidelissimi; caeterorumque ejusdem Hospitii

Gubernatorum A.D. MDCLXXV mense Aprili fundati, anno sequento mensi Juli

consummati." R. White sculp. Printed by John Garrett, 1690. 47 in. by

22-1/2 in. Crace Collection, 26/3; Guildhall Library.



2. A New Prospect of y{e} North Side of y{e} City of London, with new

Bedlam, and Moorefields (showing New St. Paul's). 1710. 58 in. by 22-1/2

in.



This print is a later edition of one by J. Nutting, 1689, in which old

St. Paul's is shown. Crace Collection, 26/1.



3. On a scroll, "Hospitium mente captorum Londinense." New Bedlam in

Moorefields. Soly fec. Sold by H. Overton, cir. 1730. 22-3/4 in. by

16-1/2 in. Gardner Collection; British Museum.



4. Painting of Bethlem Hospital (fresco) in one of the rooms of the

Foundling Hospital, by Haytley. 1746.



5. The Hospital of Bethlem (L'Hospital de Fou). A view showing also

Moorgate. J. Maurer del.; T. Bowles sculp. 1747. 16 in. by 10-1/2 in.

Gardner Collection; Crace Collection, 26/6; Guildhall Library.



6. Hospital of Bedlam. Smaller copy of Bowles's print. Gardner

Collection.



7. Interior of Bedlam, by Hogarth. 1735. Gardner Collection.



8. Bethlehem, a Poem, with a view of Bethlehem. By J. Clark. 1749.



9. Bethlehem in Moorfields. 1752. By B. Cole.



10. The Hospital called Bedlam. 1754. Gardner Collection.



11. View of Hospital of Bethlehem. 6 in. by 10 in. Robert Sayer, cir.

1760.



12. Visit to Bedlam. R. Newton. 1794.



13. Mezzotint of Bethlehem, by Malton. 1798. 11 in. by 9 in.



14. Bethlem Hospital as it appeared in 1811 (proof). Arnold del.;

Watkins sculp. Guildhall Library.



15. London Wall and Bethlehem Hospital. Etching by J. T. Smith. 1812.



16. South-west View of Bethlem Hospital and London Wall, 1814. Smith

del. et sculp. Guildhall Library.



17. Two clever water-colour drawings of Bethlem. Gardner Collection.



18. Water-colour drawing of gate with the recumbent figures by Cibber.

Richardson. Gardner Collection.



19. The two figures on the pediment of the gate by Cibber. Stothard

del.; Sharp sculp. 1783. Guildhall Library.



20. The same. Burell sculp. 1805. 6-1/2 in. by 4-1/2 in. Crace

Collection.



21. The same engraved by Warren in Hughson's "London," vol. iii. p. 81.

Gardner Collection.



22. A portrait of William Norris as confined in Bethlem Hospital. Arnold

fec. 1814.



23. New Bedlam in Moorfields, 6-1/2 in. by 9-1/2 in., and another 5-1/2

in. by 6-1/2 in. No date or name of artist. Gardner Collection.



24. Das Narren Hospital Bethlehem. Dutch print. No date. Gardner

Collection.



25. Plan of Moorfields and Bethlem Hospital. Gardner Collection.



26. New Bedlam in Moorfields. 10-1/2 in. by 7 in. Very early view. No

date. Gardner Collection.



27. The New Prospect of Bedlam, Moorfields. By John King. 10 in. by 4

in. No date (costume cir. Will. III.).



28. The Hospital of Bethlehem. 9 in. by 14 in. No date. Gardner

Collection.



29. Curious and quaint drawing of Moorfields and Bethlehem. 13 in. by 21

in. Gardner Collection.



30. Bethlehem Hospital, by Toms. 7-1/2 in. by 15. Gardner Collection.



31. Three views. Hospital de Bethlem; New Bedlam; Bethlehem. Gardner

Collection.



32. Bethlehem in St. George's Fields. Ground Plan of New Bethlem

Hospital. Basire sculp. 1819. This, with five other views by Shepherd,

etc., are in the Guildhall Library.





VIEWS OF ST. LUKE'S.



1. "Enthusiasm displayed." The Rev. John Whitfield preaching under a

tree in Upper Moorfields, with view of "St. Luke's Hospital for

Lunaticks" in the background. J. Griffiths pinx.; R. Tranker sculp.

1750. 19-3/4 in. by 15 in. Gardner Collection; Crace Collection, 33/19.



2. Elevation of St. Luke's Hospital in a pamphlet entitled "Reasons for

the Establishing, etc., of St. Luke's." 1765. Guildhall Library.



3. Another elevation. J. Dance arch. et sculp. 1784. 15 in. by 4-1/2 in.

Gardner Collection; Crace Collection, 33/15.



4. Front view of the New St. Luke's Hospital, lately erected in the City

Road. Deeble del. et sculp. 1785. Gardner Collection; Guildhall Library.



5. St. Luke's Hospital, Old Street Road. A coloured print from a drawing

by F. A. Shepherd. 1814. 8 in. by 5-1/4 in. Original drawing in the

Gardner Collection; Crace Collection, 33/16.



6. Lunatic Hospital of St. Luke's. Aquatint. Gardner Collection.



7. Front View of the New St. Luke's Hospital. No date. Gardner

Collection.



8. Ditto. Ditto. 15 in. by 5 in. Gardner Collection.



9. Sepia drawing of St. Luke's. Gardner Collection.



10. Two original drawings by John Carter. Gardner Collection.



11. Lunatick Hospital of St. Luke, published by Ackermann. 1815.

Gardner Collection; Guildhall Library.



12. St. Luke's Hospital, Old Street Road. Shepherd del.; Sands sculp.

1815. Gardner Collection; Guildhall Library.



13. St. Luke's Hospital. Higham del. et sculp. 1817. Guildhall Library.



14. Lunatic Hospital, St. Luke's. S.W. view. T. H. Shepherd del.; J.

Gough sculp. 1837. 5-3/4 in. by 3-1/2 in. Gardner Collection; Crace

Collection, 33/18.



15. Interior of St. Luke's. Rowlandson and Pugin del. et sculp.; Stahler

aquat. 1809. Gardner Collection; Guildhall Library.









APPENDIX B.



(Page 142.)





In reference to the writers on insanity at the close of the eighteenth

century, Dr. Pargeter, in the work referred to at p. 142, after dwelling

slightly on the pathology, causation, and nature of insanity, becomes

disheartened and exclaims, "Here our researches must stop, and we must

declare that wonderful are the works of the Lord and His ways past

finding out" (p. 15). Of asylums he says, "The conduct of public

hospitals or institutions for the reception of lunatics needs no remark;

the excellence in the management of them is its own encomium" (p. 123).

Of private madhouses under the management of regular physicians, he

ventured to say that "people might securely trust that in them the

afflicted would be judiciously and tenderly treated, and also managed by

servants selected and instructed with such judgment as will make them as

zealous of their own character and reputation, as of the honour of their

employers. In such hands we may place implicit confidence; and a perfect

assurance that in such an abode dwells nothing offensive or obnoxious

to humanity--here no greedy heir, no interested relations will be

permitted to compute a time for the patient's fate to afford them an

opportunity to pillage and to plunder. But such dwellings are the seats

of honour, courtesy, kindness, gentleness, mercy, and whatsoever things

are honest and of good report." Such was the comfortable satisfaction

with which a worthy man in 1792 regarded the condition of the insane in

English asylums in that year. He admits, however, that in private

asylums kept by illiterate persons, compassion as well as integrity is

oftentimes to be suspected, and quotes a passage from a paper written in

1791, which asserts that "if the gaolers of the mind do not find a

patient mad, their oppressive tyranny soon makes him so."



The work written by Dr. Mason Cox (Fishponds, near Bristol) was the best

medical treatise of the day on insanity. Unlike Cullen, he objects to

"stripes" in the treatment of the insane. On the cold bath he says,

"Even so late as Boerhaave we have the most vague directions for its

employment; such as keeping the patient immersed till he is almost

drowned, or while the attendants could repeat the Miserere.... The mode

recommended and so successfully practised by Dr. Currie of Liverpool is

certainly the best, that of suddenly immersing the maniac in the very

acme of his paroxysm; and this may be easily accomplished if the

patient, previously secured by a strait waistcoat, be fixed in a common

Windsor chair by strong broad straps of leather or web girth" (p. 135,

3rd edit., 1813). The author observes that it is certainly worth trying

whether keeping a patient for days in succession in a state of

intoxication would be beneficial, where every other means has failed (p.

75).









APPENDIX C.



(Page 146.)





ASYLUMS IN OPERATION IN 1792.



Bethlem Hospital. Used for lunatics about 1400.



St. Luke's Hospital. Founded 1751.



Liverpool Royal Lunatic Hospital, associated with the Royal Infirmary.

1792.



Manchester Royal Lunatic Hospital, in connection with the Royal

Infirmary. 1706. (Removed to Cheadle, 1849.)



Bethel Hospital, Norwich. 1713.



The Lunatic Ward of Guy's Hospital. 1728. (New building, 1797.)



The York Lunatic Hospital, Bootham. 1777.



St. Peter's Hospital, Bristol. Incorporated 1696.



Brooke House, Clapton (Dr. Monro's). 1759.



Hoxton Asylum. 1744.



Fonthill-Gifford, Hindon, Wilts. 1718.



Droitwich Asylum. 1791.



Belle Grove House, Newcastle-on-Tyne. 1766.



Lea Pale House, Stoke, near Guildford. 1744.



Ticehurst, Sussex. 1792.



The number of lunatics in London and in the country, returned under the

Act of 1774 (14 Geo. III., c. 49), from that year to the projection of

the York Retreat (1792), was 6405; and from 1792 to the Select Committee

of 1815, 12,938.



In 1775 the number registered during the year was 406; and in 1791,

after various rises and falls, it was also 406.



In 1792 the number rose to 491, and in 1815 to 850; the lowest being 414

in 1807, and the highest 700 in 1812.



The above list of asylums shows how scanty was the provision made for

the care of the insane at the time of the foundation of the York

Retreat. I may here add that, in addition to the notice taken of this

experiment by the writers on the Continent mentioned in the text, the

attention of the Germans was forcibly directed to it by Dr. Max. Jacobi,

of Siegburg. He visited York, and, much struck by what he witnessed

there, translated into German the greater part of the "Description of

the Retreat." The late superintendent of the Retreat, Dr. Kitching, who

filled that office for many years with much efficiency, spent a

considerable time at the Siegburg Asylum, comparing notes with Dr.

Jacobi.









APPENDIX D.



(Page 173.)





9 GEO. IV., C. 40 (1828).



The fifteen persons appointed Commissioners in Lunacy for the

metropolitan district, five of whom were physicians, were paid L1 an

hour, and were appointed for one year. They were to meet quarterly for

the purpose of granting licences, those in the provinces being granted

by justices at quarter sessions, where three or more justices were to be

elected to visit the provincial licensed houses, together with at least

one medical Visitor.



Three of the Commissioners were to visit licensed houses in the

metropolitan district four times a year.



Two justices to visit licensed houses in the provinces, accompanied by

the medical Visitor, four times a year.



An annual report was to be prepared and presented to the Secretary of

State for the Home Department.



Private patients were not to be admitted to asylums without the

certificates of two medical men and an order; the certificates being in

force fourteen days before admission.



Pauper patients were not to be admitted without one medical certificate

and the order of two justices, or an overseer and clergyman.



The proprietor of an asylum had to transmit a copy of documents to the

Commissioners or justices, as the case might be.



Single patients to be received on like order and certificates. No

regular visitation of this class instituted.



It should be stated that among the previous Acts, now repealed, there

was a small Act passed May 2, 1815, notwithstanding the failure of Mr.

Rose to induce Parliament to undertake legislation based on the evidence

given before the Committee of that year. This was the Act 55 Geo. III.,

c. 46, entitled, "An Act to amend an Act 48 Geo. III., c. 96 (1808),

being an Act for the better Care and Maintenance of Lunatics being

Paupers or Criminals in England."



The committee of visiting justices of lunatic asylums were to be elected

annually.



Subscribers to lunatic asylums erected by voluntary contributions, who

should unite with any county, might elect a committee of governors to

act with committee of visiting justices.



Justices to fix sums to be expended in purchase of lands, houses, etc.,

or in erecting buildings.



Overseers of the poor to return lists of all lunatics and idiots within

their parishes, verified on oath and accompanied with a medical

certificate.



When any asylum could accommodate more lunatics, magistrate might order

an addition under certain regulations.









APPENDIX E.



(Page 188.)





8 AND 9 VICT., C. 100 (1845).



The following are the clauses of the Act which provide for the expense

of carrying out its provisions.



By this statute it was enacted, after repealing 2 and 3 Will. IV., c.

107; 3 and 4 Will. IV., c. 64; 5 and 6 Will. IV., c. 22; 1 and 2 Vict.,

c. 73; 3 Vict., c. 4; 5 and 6 Vict., c. 87, that the Commissioners in

Lunacy under 5 and 6 Vict., c. 84, should be henceforth called "the

Masters in Lunacy," and that new Commissioners in Lunacy should be

appointed. The Commissioners were to grant licences for the reception of

lunatics within a certain jurisdiction of the metropolis; justices of

the peace in general or quarter sessions licensing houses for the

reception of lunatics and appointing Visitors in all other parts of

England and Wales, including a medical man. For every licence granted a

sum to be paid of ten shillings for every private patient and two

shillings and sixpence for every pauper, or so much more as shall make

up the sum of fifteen pounds, these moneys being applied towards the

payment of the expenses of the Commissioners or any charge incurred by

their authority. The secretary of the Commissioners to make out an

annual account of moneys received and paid by him in the execution of

the Act, to be laid before the Lords Commissioners of the Treasury, the

balance (if any) to be paid into the Exchequer to the account of the

Consolidated Fund, such accounts being laid before Parliament every

year, the Treasury being empowered to pay out of the Consolidated Fund

any balance of payments over receipts which may be necessary. With

regard to the application of moneys received by the clerk of the peace

for provincial licences, they were to be applied towards the payment of

the clerk to the Visitors for the county, and the remuneration of the

medical Visitors, and other expenses incurred in the execution of the

Act, the accounts being laid before the justices at the general or

quarter sessions, who shall direct the balance (if any) to be paid into

the hands of the treasurer of the county or borough in aid of the rate;

any balance of payment over receipts being paid out of the county or

borough funds.



There was paid into the Exchequer in the year ending March 31, 1880,

L1376 for licences in the metropolitan district, besides L18 stamps.

Lunacy Board expenses, L15,064.



I have not any accurate returns of the amounts received from the

provincial houses, but on a rough estimate these licences produce to the

counties in the aggregate L1452, and L30 to the Imperial Exchequer, per

annum.



In the following year, August 26, 1846, an Act was passed "to amend the

Law concerning Lunatic Asylums and the Care of Pauper Lunatics in

England," and was to be construed with 8 and 9 Vict., c. 126. There were

only twelve sections. It was passed to clear up doubts which had been

entertained as to the meaning of certain clauses in the above Act. It

was repealed by 16 and 17 Vict., c. 97.









APPENDIX F.



(Page 190.)





After the legislation of 1853, the Acts referred to at p. 190 and p. 188

constituted, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and

the Acts relative to criminal lunatics, the then code of Lunacy Law.



Lord St. Leonards' first Act, p. 188 (16 and 17 Vict., c. 70), enacts

that when the Commissioners shall report to the Lord Chancellor that

they are of opinion that the property of any lunatic, not so found by

inquisition, is not duly protected, or the income thereof not duly

applied for his benefit, such report shall be deemed tantamount to any

order or petition for inquiry supported by evidence, and the case shall

proceed as nearly as may be in all respects as therein directed upon the

presentation of a petition for inquiry.



The next Act (16 and 17 Vict., c. 96) prescribes amended forms of orders

and certificates, notices of admission, and of the medical visitation

book.



The requirements on the part of the medical man signing the certificate

are laid down.



Empowers proprietors or superintendents of licensed houses (with consent

of Commissioners) to entertain as a boarder any patient desiring to

remain after his discharge, or any relation or friend of a patient.



Authorizes amendment of any order or certificate within fourteen days

after admission of patient.



Permits the Commissioners to allow medical visitation of single patients

less frequently than once a fortnight.



Empowers one or more Visitors to visit single patients at request of

Commissioners, and report to them their condition.



Directs that the medical man who visits a single patient shall make an

annual report to the Commissioners of the mental and bodily health of

such patient.



Empowers the Lord Chancellor to discharge single patients.



Directs that notice of the recovery of every patient shall be sent to

his friends, or in case of a pauper to his parish officers, and in case

of death of a patient in any hospital or licensed house, a statement of

the cause, etc., to the coroner.



Authorizes transfer of a private patient (with consent of two

Commissioners) from one asylum, hospital, or licensed house to another,

without any fresh order or certificate, and similarly as to single

patients.



Empowers the Lord Chancellor, on the representation of the

Commissioners, to require a statement of the property and application

of the income of any person detained as a lunatic under an order and

certificates.



Extends to the Commissioners the powers vested in the private committee,

as to single patients, by the Act 8 and 9 Vict., c. 100, s. 111.



Repeals s. 27 of 8 and 9 Vict., c. 100, as to the visitation of

workhouses; and enacts that one or more Commissioners shall visit such

workhouses as the Board shall direct.



Authorizes the Commissioners in urgent cases to employ any competent

person to visit any lunatic and to report to them.



Directs committee of every hospital to submit regulations to the

Secretary of State for approval, and to send a copy to Commissioners.



Empowers Commissioners, with sanction of the Secretary of State, to make

regulations for the government of licensed houses.



Enacts that Bethlem Hospital shall be subject to the provisions of Act 8

and 9 Vict., c. 100.



The third Act (16 and 17 Vict., c. 97) repeals the several Acts then in

force respecting county and borough lunatic asylums, and re-enacts most

of the provisions therein contained, with certain additions and

improvements.



It authorizes justices of boroughs, instead of providing asylums for

their own use, or in arranging with counties, etc., to contract with the

Visitors of any asylum for the reception of their pauper lunatics, in

consideration of certain payments.



The powers of the Visitors were enlarged in many ways.



When a county or borough asylum can accommodate more than its own pauper

lunatics, the Visitors are empowered to permit the admission of the

pauper lunatics of any other county or borough, or lunatics who are not

paupers, but proper objects to be admitted into a public asylum, such

non-pauper patients to have the same accommodation, in all respects, as

the pauper lunatics.



The Visitors are directed to appoint a medical officer to be

superintendent of the asylum.



They are empowered to grant superannuation annuities to the officers

and servants.



They are directed to make an annual report to the general or quarter

sessions of the state of the asylum.



Every pauper lunatic, not in an asylum, hospital, or licensed house, is

to be visited every quarter by the medical officer of the parish or

union, who is to make return thereof; and the medical officer is to be

paid two shillings and sixpence for every visit.



The forms of orders, statements, and medical certificates are amended,

and the medical officers of unions are permitted to sign certificates.



The medical man certifying is required to state his qualification, when

and where the patient was examined, and to specify facts indicating

insanity; distinguishing facts observed by himself from those

communicated to him by others.



Visitors are empowered to order the removal of pauper patients to and

from asylums, and also to discharge or permit the absence on trial of

any patient. The Commissioners are empowered to direct the removal of

any lunatic from any asylum, hospital, or licensed house to any other.



The person signing the order for admission of a private patient into an

asylum may discharge such patient, subject, in the case of dangerous

lunatics, to the consent of the visiting justices. Any person having

authority to discharge a private patient is empowered (with consent of

two Commissioners) to transfer him to another asylum or to the care of

any person.



Orders and certificates, if defective, may be amended within fourteen

days.



Patients escaping may be retaken within fourteen days.



This statute did not re-enact the clause contained in the Act it

repealed respecting workhouses.





18 AND 19 VICT., C. 105 (1855).



In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the

Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth

Years of Her Majesty, for the Regulation of the Care and Treatment of

Lunatics."



By this statute it was enacted that any single county or borough might

unite with the subscribers to a registered hospital, and that the

proportion of expenses between any county and borough might be fixed

with reference to accommodation likely to be required.



Other sections provide in detail for the maintenance of county and

borough asylums, and other matters which it is unnecessary to enumerate.









APPENDIX G.



(Page 195.)





A short summary is added of the provisions in force at the time of the

Select Committee of 1859-60, for the protection of private patients.

They remain essentially the same.



In the metropolis, the power of licensing is exclusively in the hands of

the Metropolitan Commissioners. In the provincial districts it rests

with the justices at quarter sessions. These licenses are annually

renewed, and they may be revoked by the Lord Chancellor. The patients

are admitted upon an order signed by some relative or friend, with a

statement of all the particulars of the case. This statement must be

supported by the certificates of two medical practitioners, who, having

examined the patient separately within seven days previous to the

reception, state that he is a person of unsound mind, and a proper

person to be detained under care and treatment. It must also specify the

grounds upon which their opinion has been formed, viz. the facts

observed by themselves or communicated by others. After two and before

the expiration of seven clear days, the proprietor or superintendent of

the licensed house must transmit to the Commissioners, and also to the

visiting justices, if the licensed house is within their jurisdiction, a

copy of the order and certificates. The licensed house must be visited

by two of the Commissioners, four times at least every year, if it lies

within their immediate jurisdiction; and if beyond, it must be visited

four times at least by Visitors appointed by the justices, one of whom

shall be a medical man, and twice at least by two of the Commissioners.

In the course of such visits, inquiries are directed to be made as to

the occupation, amusement, classification, condition, and dietary of the

different patients, and also whether a system of non-coercion has been

adopted or not; and where it shall appear, either to the Commissioners

or to the visiting justices, that a patient is detained without

sufficient cause, they have the power, under certain conditions, of

ordering his discharge. When a patient recovers, the proprietor or

superintendent is required to send notice of such recovery to the person

who signed the order for his reception; and if such patient is not

discharged or removed within fourteen days, the proprietor is required

immediately to transmit a similar notice to the Commissioners or

visiting justices, as the case may be. When a patient dies, the medical

practitioner who attended such patient during his illness is to cause a

statement to be entered in the case-book, setting forth the time and

cause of death, and the duration of the disease of which the patient

died, and a copy of such statement, within two days, must be transmitted

to the coroner. In addition to these specific provisions, the

Commissioners have power from time to time to make regulations for the

government of any of these licensed houses, and they must report

annually to the Lord Chancellor the number of visits they have made, the

number of patients they have seen, the state and condition of the house,

the care of the patients therein, and such other particulars as they may

think deserving of notice (p. vi.).





25 AND 26 VICT., C. 111, "THE LUNACY ACTS AMENDMENT ACT, 1862."



In consequence of the importance of the Act of 1862, the Commissioners

issued the following circular noting its chief provisions:--





Private Patients.



Sec. 23.--The order must be dated within one month prior to reception;

the person signing the order must himself have seen the patient within

one month prior to its date; and a statement of the time and place when

the patient was so seen must be appended to the order.



Sec. 25.--When possible, every order must contain the name and address

of one or more relations of the lunatic, to whom notice of the death of

a lunatic must be sent.



Sec. 24.--Besides the persons hitherto prohibited from signing

certificates and orders, the following also are now disqualified:--Any

person receiving any percentage on or otherwise interested in the

payments for patients, and the medical attendant as defined in the

Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.



Sec. 26.--Where a patient received as a pauper is made a private

patient, no fresh order or certificate is required, and vice versa.



Sec 28.--With the exception of the statement by the medical officer as

to a patient's mental and bodily condition, all the documents heretofore

required to be sent to the Commissioners after two or before seven clear

days from the reception of the patient, must in future be sent within

one clear day from such reception. The medical officer's statement is,

as heretofore, not to be sent until after two and before seven clear

days.





Letters of Patients.



Sec 40.--Without special directions to the contrary, letters addressed

to the Commissioners, committees of Visitors, committees of a hospital,

and the Visitors of licensed houses, must be forwarded unopened. Other

letters must also be forwarded, unless, by an endorsement thereon, the

superintendent or other person having charge of patients should prohibit

their transmission. Letters so endorsed to be laid before Commissioners,

committees, or Visitors at next visit.



Sec. 38.--Absence on trial may be permitted to patients, in the same way

as leave of absence for the benefit of health is permitted under s. 86,

c. 100.



Sec. 43.--In the absence of any person qualified to discharge, a

discharge or removal may be ordered by the Commissioners.





Pauper Patients.



Sec. 25.--The order must contain the name and address of one or more

relations of the lunatic, and notice of the death of the lunatic must be

sent to such relation.



Sec. 38.--A pauper permitted to be absent on trial from a licensed house

or hospital may have such an allowance made to him by order of the

Commissioners, Visitors, or committees as would be charged for him were

he in the house or hospital.





Licensed Houses and Hospitals.



Secs. 14 and 15.--No fresh licence can be granted by justices without

inspection and report by the Commissioners. Notices of alterations in

houses licensed by justices must be given to Commissioners. Their report

must be considered by the justices before licence is granted or

alterations are consented to.



Sec. 16.--The physician, surgeon, or apothecary not being a licensee,

where any such is by law required to reside in or visit a licensed

house, must in the metropolitan district be approved of by the

Commissioners, and in the provincial district by the visiting justices.



A penalty is imposed on any person infringing the terms of his licence

as to numbers, sex, or class.



Sec. 18.--With consent of two of the Commissioners, or, in the case of

the provincial licensed houses, of two of the Visitors, a person who

may have been a patient within five years immediately preceding, may be

received as a boarder into a licensed house (extension of c. 96, s. 6).



Sec. 29.--Licensed houses may be visited at any time by one or more of

the Commissioners or Visitors, but in the metropolitan district they

must be so visited twice in the year, in addition to the present visits

by two Commissioners, and in the provincial districts similarly by

Visitors. Commissioners and Visitors visiting singly have substantially

the same powers of inspection and inquiry as when visiting together. To

these the sixty-second section of the Act does not apply.



Sec. 39.--A penalty is now imposed on any officer or servant conniving

at an escape.



Sec. 43.--In the absence of any person qualified under ss. 72, 73, c.

100, the Commissioners may order discharge or removal of a patient.



Sec. 38.--Absence on trial may be permitted to patients, in the same way

as leave of absence for the benefit of health is permitted under s. 86,

c. 100.





Medical Certificates.



Sec 27.--Where medical certificates have been returned with a written

direction of the Commissioners for amendment, and such amendment shall

not have been made within fourteen days, the Commissioners may order the

patient's discharge.



Sec. 22.--Lunatics so found by inquisition may be received without

certificate on an order of the committee, accompanied by an official

copy of the order appointing such Committee.[316]





Workhouses.



The Poor Law Board issued a circular at the same time. The only

paragraph which it is of interest to cite here is the following:--"The

eighth section empowers the Visitors of any asylum and the guardians of

any parish or union within the district for which the asylum has been

provided, if they shall see fit, to make arrangements, subject to the

approval of the Commissioners in Lunacy and the President of the Poor

Law Board, for the reception and care of a limited number of chronic

lunatics in the workhouse of such parish or union, to be selected by

the superintendent of the asylum and certified by him to be fit and

proper so to be removed. The Board are at present not aware of any

workhouse in which any such arrangement could conveniently be made; but

they will be ready to consider any such proposals on the subject when

the Visitors of the Board of Guardians of any union shall find it

convenient or practicable to act upon this clause."





FOOTNOTES:



[316] Seventeenth Report of Commissioners in Lunacy, 1863.









APPENDIX H.



(Page 205.)





Extract from the British and Foreign Medical Review, January, 1840:--



"In this particular there is apparently no asylum in England which

presents so remarkable a model as that of Lincoln. Of all the works that

have appeared on the subject of lunatic houses since the publication of

Mr. Tuke's account of the Retreat, there is none which contains matter

more deserving of attention than that recently published by Mr. Hill.

His lecture is little more than a simple commentary on the resolutions

of the board of management of the Lincoln Asylum for twenty years past;

during which period, under the superintendence of Dr. Charlesworth, and

latterly with the vigilant co-operation of Mr. Hill himself, as house

surgeon, almost every kind of bodily restraint is stated to have

gradually fallen into disuse as superfluous, a mere substitute for want

of watchful care.... If the Lincoln Asylum can present a model of this

kind, which all may visit and examine, the services of Dr. Charlesworth

to the cause of humanity and in behalf of the insane, already

considerable, will only be second to that of him who first released them

from their chains."



On this Mr. Hill observes, July 8, 1840:--



"At last the first Medical Review in Europe took up the subject, and

placed most deservingly Dr. Charlesworth in a striking position as to

the non-restraint system, and also honoured myself with approbation."



The following extracts from the Orders in the Lincoln Asylum books[317]

are essential to the right understanding of the introduction of

non-restraint there. Dr. Charlesworth was visiting physician from its

opening in 1821; Mr. Hill was appointed house surgeon in 1835.



"1828. Ordered--That the use of the strait waistcoat be discontinued

in this institution except under the special written order of the

physician of the month.



"1828, October 13. Ordered and resolved--That the physicians be

requested to consider whether it be possible to make any improvement in

the means of restraint now in use, and especially for obviating the use

of the strait waistcoat."



Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829,

April:--



"The governors have particularly directed their views to the subject of

coercion and restraint, well aware of their injurious consequences to

the patients.... The construction of the instruments in use having also

been carefully examined, they have destroyed a considerable proportion

of those that were not of the most improved and least irritating

description, and hope hereafter to introduce still further amelioration

into this department."



Extract from the House Visitor's Report, 1829, August 17:--



"Every attention seems to be paid to the patients, whose general state

has, I understand, for some time past, been so generally good that it

is gratifying to say that the strait waistcoat has almost become

useless."



Extract from the Seventh Annual Report, 1831, March 28:--



"Heretofore it was conceived that the only intention of a receptacle for

the insane was the safe custody of the unhappy objects, by any means,

however harsh and severe. These views are now passing away, and the fair

measure of a superintendent's ability, in the treatment of such

patients, will be found in the small number of restraints which are

imposed. The new director has answered this test in a very satisfactory

manner."



The new director here referred to was Mr. Henry Marston. The following

note is appended to this report:--



"As early as the 24th day of November last (viz. Nov., 1830, five years

before Mr. Hill's appointment), there was not any patient in the house

under restraint, unless one wearing a collar, which leaves all the limbs

quite at liberty, can be so considered. This gratifying occurrence has

taken place more than once since that time."



Extract from the Ninth Annual Report, 1833, April:--



"It is unceasingly an object in this institution, and should form a

prominent point in the annual reports, to dispense with or improve as

much as possible the instruments of restraint."



Extract from the House Visitor's Report, 1834, August 4th to 10th

inclusive:--



"I have much satisfaction in being able to state that not a single male

patient has been under restraint since the 16th of July, and not one

female patient since the 1st of August, and then only for a few hours."



At this time Mr. Hadwen held the appointment of house surgeon.



Extract from the Governor's Memorandum Book, 1835, July 8th:--



"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen

during the period of fifteen months that he held the situation of house

surgeon of this institution, feel called upon to express their high

approbation of the very small proportion of instances of restraint which

have occurred amongst the patients under his care."



Extract from Edinburgh Review, April, 1870:--



"But to Conolly belongs a still higher crown, not merely for his courage

in carrying out a beneficent conception on a large scale and on a

conspicuous theatre, but for his genius in expanding it. To him, hobbles

and chains, handcuffs and muffs, were but material impediments that

merely confined the limbs; to get rid of these he spent the best years

of his life; but beyond these mechanical fetters he saw there were a

hundred fetters to the spirit, which human sympathy, courage, and time

only could remove.



"Perfect as was the experiment carried out at Lincoln Asylum, the

remoteness of that institution from the great centre of life, and the

want of authority in its author, would no doubt have prevented its

acceptance for years by the physicians of the great county asylums so

long wedded to old habits. It was for some time treated as the freak of

an enthusiastic mind, that would speedily go the way of all such

new-fangled notions; and no doubt it would, had not an irresistible

impulse been given to it by the installation of Dr. Conolly at Hanwell,

where, with a noble ardour, he at once set to work to carry out in the

then largest asylum in the kingdom the lesson he had learned at

Lincoln."



Dr. Conolly's works bearing on mental disorders, in addition to his

"Lectures on Insanity," were as follows:--



1. "An Inquiry concerning the Indications of Insanity, with Suggestions

for the better Protection and Care of the Insane." 1830.



2. "The Construction and Government of Lunatic Asylums and Hospitals for

the Insane." 1847.



3. "The Treatment of the Insane without Mechanical Restraints." 1856.



See "Memoir of Dr. Conolly." By Sir James Clark. 1869.





FOOTNOTES:



[317] As given in the Journal of Mental Science, July, 1870.





Bethlem Hospital And St Luke's Course Of Lunacy Legislation facebooktwittergoogle_plusredditpinterestlinkedinmail

Feedback