Course Of Lunacy Legislation

I now resume the thread of my history at the time of the exposure of the

abuses at the old York Asylum.



We have already intimated that the treatment adopted at the Retreat, and

made known to the public by various writers and by many visitors, but

more especially by the "Description," exerted a remarkable influence on

the subsequent inquiry and legislation. The success of the Retreat

excited the jealousy a d antipathy of the superintendent of the York

Asylum; the discussion which ensued led to investigation; the

revelations which followed excited public opinion; the representatives

of the people undertook an inquiry by means of a Select Committee, which

finally necessitated legislation, and this legislation by successive

enactments wrought the wondrous and beneficial change which we now

witness. This sequence of events will be found to be borne out by facts,

by any one who will investigate the literature of lunacy from 1792 to

the present time. Sydney Smith says, writing in 1817,[140] that "the

new Establishment began the great revolution upon this subject, which

we trust the provisions of Parliament will complete.... In the course of

a few years the Institution had done so much by gentle methods, that a

modest and well-written volume, giving an account of it, excited

universal interest, and, in fact, achieved what all the talents and

public spirit of Mason and his friends had failed to accomplish. It had

still better effects. A very inoffensive passage in this book roused, it

seems, the animosity of the physician to the York Lunatic Asylum, and a

letter which this gentleman published in one of the York newspapers,

became the origin of a controversy among the governors of that

establishment, which terminated in August, 1814, after a struggle of

nearly two years, in the complete overthrow of the old system, and the

dismission of every officer of the asylum, except the physician himself.

The period is not remote when lunatics were regarded as beings

unsusceptible of mental enjoyment or of bodily pain, and accordingly

consigned without remorse, to prisons under the name of mad-houses--in

the contrivance of which nothing seems to have been considered, but how

to enclose the victim of insanity in a cell, and to cover his misery

from the light of day. But the success of the Retreat demonstrated, by

experiment, that all the apparatus of gloom and confinement was

injurious; and the necessity for improvement becoming daily more

apparent, a 'Bill for the Better Regulation of Mad-houses' was brought

into Parliament by Mr. Rose in 1813, but was nevertheless opposed and

finally withdrawn; and another Bill, in 1814,[141] though it passed the

Commons, was rejected by the House of Lords. The public, in fact, was

not yet aware of the atrocious evils which these Bills were intended to

remove; and it was not until now that the course was adopted, which, in

every case of public grievance, is the only sure one for obtaining

redress. A Committee of the House of Commons, appointed for the purpose

of inquiry in 1814, and revived in the following year, was fortunately

composed of men determined to do the business they had undertaken."[142]



Mr. Rose, on the 28th of April, 1815, again introduced the subject of

private mad-houses to Parliament, and, dwelling on the great abuses

connected with them, pointed out the necessity of their condition being

examined into by the House. He said that among the cases which had

recently come to his knowledge was that of a young woman who, although

requiring some restraint, was perfectly harmless. She was found chained

to the ground by both legs and arms, a degree of cruelty which was in no

respect justified. With a view of correcting such practices, he moved

"that a Committee be appointed to consider of provision being made for

the better regulation of mad-houses in England, and to report the same,

with their observations thereupon, to the House."[143] The motion was

agreed to.



The York Lunatic Asylum stood first upon the evidence before the Select

Committee. "It appears from the history of that institution, which was

published at the close of the controversy above alluded to, that the

victory of the reformers was not obtained without strong opposition;

for, at the very moment when the state of things that we shall presently

detail was flourishing in full enormity, their opponents were enabled to

carry a resolution of the governors, declaring that a lunatic, who

appears to have sustained gross injury, 'had been treated with all

possible care, attention, and humanity,' and censuring the parties who

brought forward the complaint.... On a subsequent day thirteen spirited

men (including Mr. Higgins and Mr. Tuke) determined to enforce

investigation; and, having qualified themselves as governors by paying

the requisite donation of L20 each, succeeded in obtaining the

appointment of a Committee to inquire into the complaints that had been

exhibited; which, after meeting for several successive days, and

examining witnesses, concluded by adopting Resolutions of censure upon

the proceedings proved before them."[144]



One day Mr. Higgins went to the asylum. After having seen all the

patients' rooms, he went with the steward to the kitchen. There he was

struck with "the retired appearance" of a door. He ordered a keeper to

unlock it. He perceived fear and hesitation. He repeated his order in

stronger language. The key not being readily forthcoming, Mr. Higgins

grew warm, and declared he would soon find a key that would open it at

the kitchen fireside. It was then opened. He went in, and discovered a

row of cells, four in number, which had been concealed from the

committee of investigation. On entering the first cell, he found it in a

state dreadful beyond description. The cell was about eight feet and a

half square, perfectly dark when the door was shut, and the stench

almost intolerable. He was told these cells were occupied at night by

thirteen women, who were then upstairs; where he found them in a room

twelve feet long by seven feet ten inches wide, with a window, which not

opening would not admit of ventilation. Sydney Smith well says, after

citing more horrible details than I have given, that he is aware of the

disgust which they will cause, but that he cannot spare his readers, and

asks of the most delicate of them whether it is more shocking that these

things should exist unknown, and consequently unredressed, than that

they should be told and punished, and remembered for ever, as the only

means of preventing their recurrence.



To enter into much detail is impossible. It must suffice to say that

case after case of gross neglect and cruelty was brought to light; that

while 365 patients had died, only 221 had been reported; that a patient

having been killed, his body was hurried away to prevent an inquest;

that when the accounts were examined, it was discovered that two sets of

books of receipts were kept, one of which was only presented to the

governors, and that the difference between the sums contained in the

two, amounting to some hundreds a year, found its way into the pocket of

the superintendent; and lastly we must record that one wing of the

asylum was burned, involving the deaths of patients and the destruction

of much that it was with good reason believed the authorities wished to

conceal.



Of the revelations made by the Committee of the House of Commons in

regard to Bethlem Hospital, we shall only briefly speak. We have already

sketched the history of this institution. For the most part it is to the

second Bethlem--that in Moorfields--the minutes of evidence refer.

During the seven years prior to the investigation, the number of

patients averaged 238; the annual expenditure, L12,000. Mr. Haslam, the

resident apothecary, ruled supreme. He was responsible for the dreadful

condition in which the notorious Norris was discovered. "There is," says

Sydney Smith, "much evasive testimony, to shift from himself the burden

of this atrocious case; but his efforts tend rather to confirm than to

shake the conviction which the evidence produces.... The conduct of

Haslam with respect to several other patients was of a corresponding

description; and in the case of a gentleman whose death was evidently

accelerated by the severities he underwent, and of several other

persons, there is abundant proof of cruelty.... It is in proof that a

patient actually died, through mere neglect, from the bursting of the

intestines, overloaded for want of aperient medicine, and it is

expressly stated by Haslam himself that a person whom he asserts to have

been 'generally insane and mostly drunk,' whose condition, in short,

was such 'that his hand was not obedient to his will,' was nevertheless

retained in the office of Surgeon, and continued to attend the patients

for a period of ten years--a statement so atrocious that, from any

other quarter, we should have rejected it as utterly incredible."[145]



The governors easily convinced themselves that no foundation whatever

existed for the charge of cruelty and bad management; that every degree

of permissible indulgence had been observed; that the hospital was

equal, if not superior, to any other asylum in England; that the mode of

confining the unhappy Norris appeared "to have been, upon the whole,

rather a merciful and humane, than a rigorous and severe imposition;" in

short, that "the general management of Bethlem, as affecting the health,

the cleanliness, and the comfort of the patients, was of a nature

creditable to the governors and others concerned in its

administration." What a picture of the standard of excellence held by

the managers of asylums at that period, not in Bethlem alone, but

generally!



To the question, "Has there not been a rule in the hospital, for a

certain number of years, that, in certain months of the year,

particular classes of the patients should be physicked, bled, bathed,

and vomited, at given periods?" the reply from Bethlem was in the

affirmative. Twice in the year the patients, with few exceptions, were

bled. "After they have been bled," said the physician, in evidence,

"they take vomits once a week for a certain number of weeks; after that,

we purge the patients. That has been the practice, invariably, for

years--long before my time."



In regard to the means of coercion employed, it was stated that the

patients "are generally chained to the wall with manacles." When inquiry

was made regarding the use of strait waistcoats, it was replied, "I do

not believe there are any strait waistcoats in Bethlem now, or very few

indeed; they generally use irons." The objection to strait waistcoats

was, that the patients "could not help themselves in strait waistcoats;

they are so excessively long in the hospital without being seen by

anybody, in a dark place; in winter, from four o'clock to six or seven

in the morning. If they were in a strait waistcoat they could not assist

themselves the least in the world." When, in the following year, the

head-keeper of Bethlem Hospital was asked, "Was it not the practice in

old Bethlem--not in the late gallery, but in the gallery pulled

down--for eight, ten, or more patients to be fastened to the tables,

almost in a state of perfect nakedness?" he replied, "Yes; they used to

think they tore their clothes all to pieces; some of them would do

that." "In point of fact, were they not fastened to the tables, sitting

in a state of perfect nudity?" Answer: "They used to be so at the

table; they were chained all round." In regard to the apparatus, so

ingeniously cruel, by which one of the patients (Norris) was chained ten

or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you

think that his confinement in that manner during the whole of that

period was necessary?" replied, "Decidedly."



The matron of Bethlem Hospital (who was elected January, 1815) gave

evidence that, when she was appointed, there were about twenty patients

under personal restraint, out of between fifty and sixty patients. "The

custom when I first went was only to get them up three days of the

week--never on meat days; they lie in bed four days in the week." She

also stated that one of the female patients had been chained for eight

years, but had not required restraint since she had been there.



Bethlem, however, was far from being the only place where patients were

treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a

private asylum at Bethnal Green, gave evidence to an attendant "kicking

the patients and thumping them sadly," and "beating one in his shirt

with a pair of boots, in a most dreadful manner." She named a female

patient who, when in a state of irritation, "was confined in a place in

the yard which was originally a pig-sty; it was run up high on purpose

for her. I have seen her confined there for three weeks together. She

has been ironed there in the crib with wrist-locks, and leg-locks, and a

chain two or three times across her body." An iron bar was placed

between her legs when she walked about, to prevent her escaping. "It

was confined to each ankle, with a chain coming up between her legs,

which was attached to her handcuffs." But, in addition to this frightful

restraint, we are informed that an attendant, at the instance of the

proprietor, would, "at sundry times," lock her down in her crib with

wrist-locks and leg-locks, and horsewhip her. "I have seen the blood

follow the strokes." Yet this patient is described as very harmless;

"you might sit and talk to her when she was in the highest state."



The Committee found that at a private asylum--Fonthill, Wilts--there was

in that year, out of fourteen patients, only one without fetters or

handcuffs, and only three out of their sleeping-rooms.[146]



At the Bethnal Green Asylum "several of the pauper women were chained to

their bedsteads, naked, and only covered with a hempen rug," and "the

accommodation for paupers was infamously bad, and required immediate

reform;" while in January of the same year it is reported that "some

pauper men were chained upon their straw beds with only a rug to cover

them, and not in any way defended from the external cold."[147]



Dr. John Weir was asked, at the Committee of 1815, to what he

attributed the difference of opinion among even enlightened men as to

the management of the insane. He replied that it was chiefly due to the

want of practical observation, as it is only by comparison that we are

enabled to appreciate the superiority of one institution over another.

He added that, until within the last eighteen years, the primary object

of almost every insane institution, whether of a public or private

description, had been merely the security of these pitiable objects;

comfort, medical and moral treatment, had been in a great measure

overlooked. "Happily, however, for that class of society, the Retreat at

York had at last convinced the world how much may be done towards the

amelioration of their condition."[148]



On the 11th of July, 1815, Mr. Rose brought up the Report of this

Committee. On moving that it be printed, he said that all who read the

Report must feel satisfied of the indispensable necessity of legislative

interference. The way in which lunatics were usually confined was that

of criminals, and their treatment was in general worse than the ordinary

treatment in jails. The number of persons appointed to take care of them

was in most cases utterly insufficient, in consequence of which the

greatest severity was too frequently resorted to.



The conclusions arrived at in this celebrated Report may be thus

summarized: That keepers of houses for the insane received a much

greater number of persons than they were calculated for, thus greatly

retarding their recovery; that the number of attendants being

insufficient, there was unavoidably a larger amount of restraint than

would otherwise be necessary; that outrageous patients were mixed with

the quiet and inoffensive; that there was an absence of medical

attention to the malady for which the patients were confined; that the

certificates on which patients were received into asylums were

insufficient, and that the visitation of private mad-houses was

defective.



The Report concluded that "some new provision of law is indispensably

necessary for ensuring better care being taken of insane persons, both

in England and Ireland, than they have hitherto experienced; the number

of whom appear to be very considerable, as the inquiries of the

Committee have convinced them that there are not in the country a set of

beings more immediately requiring the protection of the legislature than

the persons in this state, a very large proportion of whom are entirely

neglected by their relatives and friends. If the treatment of those in

the middling or in the lower classes of life shut up in hospitals,

private mad-houses, or parish workhouses, is looked at, your Committee

are persuaded that a case cannot be found where the necessity for a

remedy is more urgent."



The evidence taken before the Committee of 1815 was so full and

convincing that it would have seemed wholly unnecessary to have required

a further disclosure of the abuses rampant in the asylums of England,

but in consequence of the demand for further investigation before the

House of Commons committed itself to legislation, a mass of further

particulars was obtained in 1816 in regard to the state of various

institutions, including Bethlem Hospital and the York Asylum.



In February Mr. Rose had said in the House that, as chairman of the

Committee for inquiry into the conduct of mad-houses, he was instructed

to move for leave to bring in a Bill for the better regulation of such

establishments. But some gentlemen of the Committee being desirous that

further investigation should take place, he had acceded to their wish,

although the majority concurred with him in thinking that sufficient

evidence had already been adduced to justify the proposal of a Bill.

Therefore, he should propose, instead of a Bill, that a Committee be

appointed to consider of provision being made for the better regulation

of mad-houses in England, and report the same, with their observations

thereupon, to the House.



On May 28th Mr. Rose brought up the Report of the Committee, and

obtained leave to bring in a Bill pursuant thereto. This Bill was for

the repeal of the 14th and 55th of the King. He said[149] the Committee

had, after the most patient investigation, adopted the provisions of the

present Bill, which principally were, that instead of the physicians of

the neighbourhood, or those in or near the metropolis, together with a

neighbouring magistrate, being the inspectors of such establishments,

they should be twice a year examined, etc., by eight Commissioners

appointed by the Secretary of State for the Home Department throughout

the kingdom; the Commissioners to be assisted by two of the local

magistrates in each district, and with equal powers. There was also a

provision in the Bill relative to the erection of lunatic asylums in

counties, and the ordering the reception therein of pauper lunatics

allowed at present to range abroad, to their own and the public injury.



On the 17th of June, Mr. Rose moved that the clauses of this Bill be

taken into further consideration. Lord R. Seymour observed that when

Parliament in 1774 passed the "Bill for the Regulation of Licensed

Mad-houses," it must have meant to do three things: (1) To secure all

persons against unnecessary confinement; (2) to better the chance of

recovery of all such persons confined as being insane, as well by moral

treatment as by the use of medicine; and (3) to insure the restoration

of all who might become again of sound mind to society. But the

Mad-house Act, he said, does none of these three things, for it does not

empower the Commissioners to discharge a patient, however sound in mind;

nor does it furnish them with the means of enforcing the observance of

any improvement they may recommend. The Commissioners, indeed, may

withdraw the licence, but the keeper of such a house must again have it

on the next licensing day, if he wishes, upon giving the necessary

security. It was not surprising, therefore, that the greatest abuses

should have been found to prevail.



Mr. Wynn expressed a wish that magistrates should be empowered to

examine houses where only one patient was confined.[150]



This Bill passed the House, but was rejected by the House of Lords.



Thus all the mass of valuable and decisive evidence which had been

collected with so much labour, and had occupied the time and thought of

two Committees of the House of Commons, was, for the time, thrown away,

and the misery of the inmates of asylums allowed to go unrelieved. The

facts, however, had been made widely known. The inertia, torpor, and

indifference to human suffering--in short, the crime which characterized

the majorities who threw out the Bills calculated to remove the abuses

in asylums, had at last to give way to the popular demand. What was

gained by prolonging the dismal condition of these abodes of woe for

some years longer, I leave others to discover.



After the lapse of three years, namely, on the 10th of March, 1819, Mr.

Wynn[151] rose to move for leave to bring in a "Bill for the Regulation

of Mad-houses," and observed that, as this subject had been already

several times before the House, he did not feel it necessary to trespass

long upon its attention. It would be remembered, he said, that some

years ago the Report of a Committee had been laid before the House,

detailing such scenes of misery and wretchedness in mad-houses, as had

perhaps never been paralleled, and after such an exposure it was the

obvious duty of the House to follow up the Report by the adoption of

some legislative measure calculated to put an end to the evils

complained of. There was, however, no fault to be found with the

conduct of that House; for it had done its duty by repeatedly sending up

a Bill to the other House, which it had thought proper to reject.

Although no mad-houses could be legally opened without a licence, the

College of Physicians was not in possession of funds to prosecute. He

therefore proposed that a general Board of Inspection for mad-houses

should be appointed, and that the members of that Board should be at

liberty to visit such houses throughout the country, at different and

uncertain times, so as to ascertain the manner in which they were

conducted, and to report any existing evil to the Board, which should be

invested with power to enforce their correction. Mr. Wynn moved for

leave to bring in a Bill for repealing the Act of the 14th and 55th of

the King with respect to mad-houses, and for making other provisions for

their better regulation.[152]



Leave was given to bring in the Bill.



In June of the same year the Marquis of Lansdowne, speaking on the Bill

in the House of Lords, said that nothing could more forcibly appeal to

the humanity of their lordships than the state of the unfortunate

insane, and the legislative means of preventing abuses of the most

flagrant and revolting nature, which had long been too clearly proved.

Strange to say, however, the Lord Chancellor (Lord Eldon) opposed the

Bill, observing that there could not be a more false humanity than an

over-humanity with regard to persons afflicted with insanity. (Is not an

under-humanity nearly as false?) He admitted there were great abuses,

but the better way to remedy them would be to take a cool and

dispassionate view of the subject in a Committee, next session. As if

there had not been Committees enough! With regard to pauper lunatics,

the Lord Chancellor went so far as not only to admit there were great

abuses, but to agree to a short Bill, if desired, embodying the clauses

relating to them in the measure before the House.



The Bill was thrown out, only fourteen doing themselves the credit of

voting in its favour, while thirty-five voted against it. Majority

against the Bill, twenty-one.



An "Act for making Provision for the Better Care of Pauper Lunatics in

England"[153] was, however, passed (July 12, 1819), but it consisted of

three sections only, and does not appear to be an advance, in any

essential particular, upon previous Acts. The form of the medical

certificate for a pauper lunatic is prescribed.[154] Again, the Act is

permissive as regards the action of the justices in causing the

overseers to bring the lunatic before them, and calling in a medical man

to their assistance.



Four years afterwards, on June 30, 1823, the subject of private

mad-houses again came before the House. A petition from John Mitford for

an inquiry into the state of private mad-houses was ordered to lie on

the table. Mr. Wynn, as on a former occasion, spoke, and observed that

three Bills had, at recent periods, been sent up from that House to the

Lords, relative to the inspection of houses of this description. He

regretted to say they had not been passed. It is extraordinary that Mr.

Wynn should have ended his speech by saying that, although he believed

abuses might exist in some of these establishments, they were on the

whole well conducted. Mr. (afterwards Lord) Brougham said that he knew

Dr. Warburton, against whom charges had been brought, and that his

character stood equally high both for medical skill and for humanity!



Writing in 1827, Sir Andrew Halliday[155] says, "The evidence taken

before Mr. Rose's Committee, which sat for more than one session, must

be fresh in the recollection of every one of my readers.... He was at

great pains to prepare a Bill which, in the opinion of all who had heard

the evidence, and had taken a disinterested part in the investigation,

was well calculated to remedy every evil either ascertained or

anticipated. The subject was dispassionately canvassed in the Lower

House, and the Bill passed by the Commons, almost unanimously, three or

four several times; but it was uniformly rejected by the Lords, and

after Mr. Rose's death it got into Chancery, and there it has slept for

the last nine years. I do not mean this remark in any manner as a

jest; for, literally and truly, the late Lord Chancellor [Lord Eldon]

took the whole matter upon his own shoulders, and promised to prepare a

measure more suited to the exigencies of the sufferers than any that the

collected wisdom of the Commons of England, in Parliament assembled,

could think or devise.... The House of Commons has again taken up the

matter, and I trust they will not abandon it, even though they should be

opposed, until some provision is made against the recurrence of those

evils, very trifling in comparison of former times, which during their

last short inquiry were found still to exist." Sir A. Halliday points

out that, although twenty years had elapsed since Mr. Wynn's Act passed

(having received subsequently several amendments), asylums had only been

opened in the counties of York (Wakefield, 1818), Lancaster (1816),

Nottingham (1812), Norfolk (1814), Stafford (1818), Bedford (1812),

Gloucester (1823), Lincoln (1820), and Cornwall (1820)--nine out of the

fifty-two counties of England and Wales. Suffolk had just finished its

building, as had Chester a short time before. Only at that very time had

the magistrates of Middlesex, after two years' deliberation, announced

that a county asylum was necessary, although it had been proved by Lord

R. Seymour that 873 persons were suffering neglect and cruel treatment

for want of it!



Returns ordered by Parliament in 1826 show that there were 1321 persons

in private asylums, exclusive of those in London and within a radius of

seven miles; 1147 in public asylums, exclusive of those in St. Luke's

and Bethlem; and 53 in public jails; giving a total of 2521 for the

several counties of England and Wales. Those in private asylums in and

near London being estimated at 1761, and the asylums of St. Luke's and

Bethlem at 500, the gross total for England and Wales was 4782. Sir

Andrew Halliday did not hesitate to assert, after very careful inquiry,

that the number actually in confinement, not only in the asylums, but

with relations and keepers, exceeded 8000. He thought there were very

few in Wales, or in "the Celtic tribes in other portions of the

empire."[156]



Before leaving Halliday, I may add that he regarded Bethlem as, at this

period, well conducted, but as having "too much of the leaven of the

dark ages in its constitution, and too rigid a system of quackery, in

regard to its being seen and visited by respectable strangers." He adds

that in some respects "it is little better than when, in fact, it formed

one of the lions of the metropolis, and the patients as wild beasts

were shown at sixpence for each person admitted." Of St. Luke's he

writes, "It is only fit to become a prison for confirmed idiots." He

would have been surprised to witness how much can be effected by

improvements of various kinds, although he might still wish that it

were supplemented by some appendage in the country, if not removed there

altogether.



A very important step was taken by Mr. R. Gordon in the House of Commons

in 1827 (June 13th), by drawing attention to the pauper lunatics in

Middlesex. He particularly referred to the dreadful state of misery of

the pauper lunatics in London in the parishes of Marylebone and St.

George's. When the overseers of the latter parish visited Dr.

Warburton's asylum at Bethnal Green, they found, he said, in a room

eighteen feet long, sixteen cribs,[157] with a patient in each crib,

some of them chained and fastened down, and all of them in a state of

great wretchedness. On one occasion, a visitor having gone there and

reported that there was nothing objectionable, he repeated his visit

next day, and discovered five rooms, in which the patients were in a

most horrid state of misery; and this although the day before he was

informed that he had seen everything. The unfortunate persons placed in

these cribs were kept from Saturday night until Monday; their food being

administered to them in the cribs. Mr. Gordon moved for a Select

Committee to inquire into the condition of pauper lunatics in Middlesex,

and for leave to bring in a Bill to amend 14 Geo. III. c. 49

(1774),[158] and to extend its provisions to pauper lunatics, to

consolidate all Acts relative to lunatics and asylums, and to make

further provisions thereto.



The Committee was appointed.



It specially directed its attention to the treatment of paupers in the

parishes of Marylebone, St. George, Hanover Square, and St. Pancras,

confined in the White House at Bethnal Green, belonging to Dr.

Warburton. Its condition was frightful, and the Committee observes that

if the White House is to be taken as a fair specimen of similar

establishments, it cannot too strongly or too anxiously express its

conviction that the greatest possible benefit will accrue to pauper

patients by the erection of a county lunatic asylum.



The Committee reports that the defects and abuses in the management of

houses for the reception of lunatics, to which the Select Committee of

1815 called the attention of the House of Commons, still exist in

licensed houses where paupers are received in the neighbourhood of the

metropolis, and that similar abuses elsewhere prevail. The evidence

established that there was no due precaution with respect to the

certificate of admission, the consideration of discharge, or the

application of any curative process to the mental malady. The Committee

therefore repeated the recommendations of the Committees of 1807 and

1815, and prepared a series of propositions as the basis of future

legislation, repealing a number of Acts and recommending the

consolidation, into one Act of Parliament, of the provisions for the

insane, as well as further facilitating the erection of county asylums,

and improving the treatment of pauper and criminal lunatics.



Dr. John Bright, secretary to the Commissioners, read from their records

one entry, describing the condition of Holt's house, Lewisham, in Kent.

In the year 1820, "in a close room in the yard, two men were shut by an

external bolt, and the room was remarkably close and offensive. In an

outhouse at the bottom of the yard, ventilated only by cracks in the

wall, were enclosed three females. The door was padlocked; upon an open

rail-bottomed crib herein, without straw, was chained a female by the

wrists, arms, and legs, and fixed also by chains to the crib. Her wrists

were blistered by the handcuffs; she was covered only by a rug. The only

attendant upon all the lunatics appeared to be one female servant, who

stated that she was helped by the patients."



Subsequent entries did not show any material improvement in the

condition of the house.



Dr. Bright summarized the defects in the Lunacy Laws at that period, as

regards the power vested in the Commissioners, as follows:--



"They are very defective in many points: in the first place, with

respect to the granting licences, there is only one day in the year in

which, according to the Act, the licences can be granted; then with

respect to persons to whom the licence may be granted, any person

applying for that licence is entitled to have one; again, any person

committing any offence, save and except the refusing admission to

Commissioners on their visitations, may be continued and is continued in

the exercise of such powers as that licence communicates to him; the

Commissioners have no power to disturb in the management of his house

any keeper of a house, whatever offences he may have committed, or

however unworthy he may appear to them to be. Supposing any person who

had, in the eyes of the Commissioners, acted improperly, to apply in

October, at the usual and the only period in the year for granting

licences, they conceive (and they are advised) that they are obliged to

grant a licence to that individual. There is another circumstance which

I think is very important, which is the certificate which is granted;

the Act is vague with respect to the medical person. It speaks of him as

physician, surgeon, or apothecary; it does not say 'duly authorized to

grant a licence,' and, in point of fact, a number of persons, calling

themselves apothecaries, do sign certificates, and the Commissioners do

not believe that they can prevent them so doing, or that the signature

is invalid; and, again, it often happens, and very improperly, as the

Commissioners think, that persons sign the certificate in two

capacities. For instance, a medical man is, or calls himself, the friend

of the person conveyed to the mad-house, and he signs again as a medical

person; again, the keeper of a mad-house, who happens to be a medical

person, signs a certificate, attesting the insanity of the party, and

receiving that party into his house. The Commissioners always reprobate

and endeavour to check such a practice, but not always successfully."



In the following year (February 19, 1828) Mr. Gordon, in pursuance of

the instructions of the Committee, brought in a Bill to amend the law

for the regulation of lunatic asylums. He said, among other things, that

the medical certificate to be signed by an apothecary was interpreted to

mean that it might be signed by any seller of drugs, and hence an

apprentice, as soon as his indentures had expired, might consign a man

to a mad-house. This reminds me of a mistake into which a distinguished

German alienist has recently fallen, not unnaturally, from our double

use of the word apothecary. He smiles at the absurdity of the British

law allowing a mere druggist to sign a certificate of insanity! Mr.

Gordon again refers to Dr. Warburton's house, and the patients in their

cribs "wallowing in their filth throughout the whole of Sunday," while

on Monday morning they were "in a state of nudity, covered with sores

and ordure, and were carried into the yard to be suddenly plunged into

cold water, even when ice was in the pails." The speaker added that it

was impossible, with the strongest language, to describe the horrors of

this place, and even maintained that the evidence before the Committee

showed that, however bad, this house was good as compared with others of

the same kind--if not much better than many of them.



He maintained that, unfortunately, the provision made by 14 Geo. III.,

c. 49, by which five Commissioners, appointed by the College of

Physicians, licensed and were bound to visit these houses yearly, and,

if they found anything improper, were directed to state to the College

what they had discovered, had never been attended to in practice; at

least, since 1800. The excuse for this negligence was that the complaint

to the College censors (placed on a card in their room) did no good, and

might therefore as well be abandoned. In fact, he found on inquiry that

the Commissioners had done nothing--literally and strictly nothing. He

then referred to a house where two patients were found lying in an

outhouse, and three others chained down by the arms, wrists, and legs.

Their wrists were blistered, and their persons covered only by rags.

This was within five miles of London. He concluded by moving for leave

to bring in a Bill "To Consolidate and Amend the several Acts respecting

County Lunatic Asylums, and to Improve the Treatment of Pauper and

Criminal Lunatics."



Lord Ashley seconded the motion, and leave was given to bring in the

Bill,[159] which passed the House.



In the Upper House Lord Malmesbury moved the second reading of the above

Bill. One object, he said, of the Lunatic Asylum Regulation Bill was to

give to counties more power in establishing asylums. For private

patients, two medical certificates and an order would now be required,

and the like for single patients. In regard to the existing College

Commissioners, he ridiculed the extraordinary circumstance that if, in

the course of their visits of inspection, they found what was

reprehensible in an asylum, they could not revoke the licence which they

themselves had given. It was proposed to take the power from the College

of Physicians and invest it in fifteen Metropolitan Commissioners

appointed by the Home Secretary.[160]



This Act (9 Geo. IV., c. 40), based on the Report of the Committee, was

passed July 15, 1828.[161]



The returns of pauper lunatics in England and Wales amounted to 9000,

being 6700 in excess of the corresponding return of 1807; but nobody

supposes that there had been that, or, in fact, any considerable

increase in the number of the insane poor, but simply greater accuracy

in obtaining statistics.



Referring back to this period, Lord Shaftesbury, in evidence given

before a Committee of the House of Commons thirty years later, and

dwelling upon the old regime, observed: "I mention these things

because they never could be seen now (1859), and I think that those who

come after us ought to know what things have existed within the memory

of man. At the present time, when people go into an asylum, they see

everything cleanly, orderly, decent, and quiet, and a great number of

persons in this later generation cannot believe there was ever anything

terrible in the management of insanity; and many say, 'After all, a

lunatic asylum is not so terrible as I believed.' When we begun our

visitations, one of the first rooms that we went into contained nearly a

hundred and fifty patients, in every form of madness, a large

proportion of them chained to the wall, some melancholy, some furious,

but the noise and din and roar were such that we positively could not

hear each other; every form of disease and every form of madness was

there; I never beheld anything so horrible and so miserable. Turning

from that room, we went into a court, appropriated to the women. In that

court there were from fifteen to twenty women, whose sole dress was a

piece of red cloth, tied round the waist with a rope; many of them with

long beards, covered with filth; they were crawling on their knees, and

that was the only place where they could be. I do not think that I ever

witnessed brute beasts in such a condition, and this had subsisted for

years, and no remedy could be applied to it. It was known to one or two

physicians at the Royal College, who visited the place once a year; but

they said, fairly enough, that, although they saw these things, they

could not amend them." Lord Shaftesbury, after giving a short resume

of the condition of the old York Asylum, as well as of that of Bethnal

Green in 1827, went on to observe--a paragraph which will form the motto

of my work--"I might multiply these instances almost indefinitely, but I

thought it was desirable just to indicate the state of things that

existed, in order to contrast the Past with the Present."[162]



In the interval between the Act of 1828[163] and the next Act of

importance, several attempts were made at further legislation on the

part of Mr. Gordon and Lord Somerset. A Bill passed both Houses in

1832.[164] In one instance a Bill which passed the Commons was

characterized in the House of Lords as "one of the most abominable

pieces of legislation that ever was seen." It was "monstrous." "Their

lordships could never suffer such an abominable piece of legislation to

be thrust down their throats." It is scarcely necessary to say that the

lips from which this animated language proceeded were those of Henry

Brougham, then the Lord Chancellor. The Bill was, of course, rejected.



In 1842 Lord Somerset brought forward a motion on the inspection of

asylums, and pointed out that there was a very large class of persons to

whose inspection the Act of 1828 did not apply, viz. those in

confinement in their own houses, in separate lodgings, in public

institutions, as county asylums, and the hospitals of Bethlem and St.

Luke's. The object of his Bill was to extend the system of inspection in

force in the metropolitan licensed asylums to the provinces. Barristers,

he maintained, should be appointed, with a fixed salary, and not paid

for their hour's work and allowed to practise. It is worthy of record

that the returns at this period showed that there were about sixty or

seventy houses licensed for the reception of insane persons in the

country, and that there were actually twenty-five counties in England

where there was not a single asylum licensed for the reception of

lunatics, and not one in Wales.



This measure was characterized by Mr. Wakley as not only a very small

one, but as an insult to medical men, as it only proposed barristers as

the new Commissioners, adding that "in Scotland there was one system, in

Ireland there was another, and in England there were several, and among

them all there was not one which, on the whole, was entitled to the

sanction and approbation of the public, or which was worthy of the

adoption of the noble lord [Somerset]."



Lord Ashley approved of the Bill, and speaking of the work of the

Commissioners, he said, "They have aimed at a medium line of policy, and

an immense amount of human misery had been abated under the present law,

and by the industry of those who carry it into execution."



It was in this speech that Lord Ashley made an observation which has not

escaped the criticism of the medical profession, namely, "that a man of

common sense could give as good an opinion as any medical man he ever

knew," that is, "when it has been once established that the insanity of

a patient did not arise from the state of his bodily health."[165]



It should be stated that Mr. Wakley moved an amendment on the first

clause of the Bill, omitting "Barrister Commissioners," and inserting

"Medical Commissioners." He spoke of the total failure of the

Metropolitan Commission, and ultimately moved as an amendment that two

of the Commissioners to be appointed should not have their profession

stated, their appointment being left to the Lord Chancellor. This

amendment was carried by a majority of three, but in the Bill provision

was made for two more physicians and two more barristers.



On July 16th of the same year, on the motion that the order of the day

for the further consideration of the Lunatic Asylums Bill be proceeded

with, a member suggested its postponement until further discussion. Lord

Somerset replied that the Bill was framed for the purpose of procuring

further information on the subject, in order to legislate permanently

upon it. On the House going into Committee Lord Ashley expressed a hope

that the measure would tend to ameliorate the condition of the pauper

lunatics throughout the kingdom. On this occasion Lord Ashley observed,

in regard to the system of non-restraint, that he had formerly

entertained some doubts as to the practicability of carrying it out; but

that these doubts had been removed by a visit to the Hanwell Asylum.

Having witnessed the system pursued there, he said he could not speak

too highly either of the system itself, or the manner in which it was

carried out by Dr. Conolly.



Having passed through Committee, the Bill was read a third time on the

28th of July, 1842, and in this instance was not rejected by the House

of Lords.[166]



The Metropolitan Commissioners, invested with their enlarged powers,

made a most thorough inquiry into the condition of the asylums in

England and Wales, and presented a Report to Parliament in 1844, which

must always possess great historic interest and value.[167] It

constitutes the Doomsday Book of all that concerns institutions for the

insane at that time.



The state of some asylums visited by the Commissioners was frightfully

bad, notwithstanding the general progress which had been made since

public attention had been directed to abuses and the several Acts of

Parliament had been passed in order to remove them. These things,

however, it must be remembered, were survivals of the past, not fair

illustrations of the present; abuses which lingered on in spite of light

and knowledge, and required stringent pains and penalties to force those

who permitted them to abandon their practices.



On the 23rd of July, 1844, the indefatigable reformer of abuses

connected with the treatment of lunatics, Lord Ashley, moved for an

Address to the Crown, praying her Majesty to take into consideration the

Report of the Metropolitan Commissioners in Lunacy[168] to the Lord

Chancellor, presented to the House, the statute under which they acted

expiring next session. He commented upon there being no official

visitation of single houses. He believed that such a power "ought to be

confided to some hand that would hunt out and expose the many horrible

abuses that at present prevail." The only control was that if such

patient resided more than twelve months in a house, the owner was

compelled to communicate the name of that patient to the clerk of the

Commission; but for the most part no notice was taken of this law, and

it was frequently evaded by removing the patient, after a residence of

eleven months, to some other lodging.



At this period (January 1, 1844) the number of lunatics and idiots

chargeable to unions and parishes in England and Wales was 16,821. In

county asylums there was provision for only 4155, leaving 12,666 poor

insane, of whom there were in asylums under local Acts 89, in Bethlem

and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private

asylums, leaving in workhouses and elsewhere 9339. Although a few of the

existing county asylums were well adapted to their purpose, and a very

large proportion of them were extremely well conducted, yet some were

quite unfit for the reception of insane persons. Some were placed in

ineligible sites, and others were deficient in the necessary means of

providing outdoor employment for their paupers. Some also were ill

contrived and defective in their internal construction and

accommodation. Some afforded every advantage of science and treatment;

others were wholly deficient in these points. All of them, however, had

the advantage of constant supervision, and of not giving any profit to

the superintendent. Lord Ashley especially referred to the admirable

manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster,

and Gloucester were managed. "Why, then," his lordship asked, "are not

these institutions multiplied? At this moment there are twenty-one

counties in England and Wales without any asylum whatever, public or

private. The expense is one cause. In some cases the cost of

construction has been exceedingly great. The asylum most cheaply

constructed is that of Wakefield, of which the average cost per head was

L111, whilst the highest price was that of Gloucester, which had cost on

the first accommodation L357 per head. In many cases the cost of

construction had exceeded L200 per head. The cost of the Bedford Asylum,

for 180 patients, was L20,500; that of Gloucester, for 261 patients,

L51,366; that of Kent, for 300 patients, was L64,056; that of Hanwell,

for 1000 patients, was L160,000, exclusive of L36,000 paid since 1835

for furniture and fittings. On the other hand, the best-constructed

union-houses in the country had not cost more than L40 per head." Lord

Ashley maintained that although, no doubt, a lunatic asylum was

expensive, it ought not to be so to that enormous degree. The reason of

this difference he did not know, except that many of them had been

constructed with a great display of architecture, and some asylums were

far too large. Adopting the opinion of the Report of the Commissioners,

he maintained that no asylum for curable lunatics should contain more

than 250 patients, and that perhaps 200 are as large a number as can be

managed with the most benefit to themselves and the public in one

asylum; and he quoted Dr. Conolly's stronger statement that 100 persons

were the highest number that could be managed with convenience in one of

these asylums. With regard to the number of private patients in

asylums, there were 3790, of whom 973 were in private metropolitan, and

1426 in private provincial asylums. The paupers in the private houses

were--metropolitan, 854; provincial, 1920. With respect to these, it was

a very serious question how far any house should be licensed to take

paupers for payment. The principle was very dangerous, and Lord Ashley

pointed out that if the superintendent only got seven or eight shillings

a week, he still must make a profit, and that there could be no doubt it

was so. Quoting the Report of the Commissioners again, he said that many

asylums had formerly been private houses; the mansion was sometimes

engrossed by the proprietor and a few private patients, while the

paupers were consigned to buildings formerly used as offices and

outhouses. After adducing evidence of the deplorable condition of

certain asylums, Lord Ashley asserted that the only remedy was the

multiplication of county asylums, and if advice and example failed, they

ought to appeal to the assistance of the law to compel the construction

of an adequate number of asylums over the whole country. It was the duty

of the State to provide receptacles for the incurable patients, apart

from those devoted to remedial treatment. Parochial authorities,

however, preferred keeping patients in the workhouse at an expense not

exceeding two shillings a week, rather than send them to the county

asylum, where the minimum charge was seven shillings a week.



It was true, Lord Ashley observed, that they could show but few

instances of restoration to reason. How, indeed, was it possible? They

could show, however, a mighty improvement in the condition of the

sufferers, the alleviation of their state, their occupations and

amusements (all, with some bright exceptions, of recent date), and that

the services of religion had infused a momentary tranquillity; but they

could show little else, and unless the Legislature should interfere and

bring these unfortunates by force within the reach of sympathy and care,

for every one restored to his senses we should see a hundred in whom the

light of reason would be extinguished for ever. The speaker went on to

say that there were two points of deep interest, to which the House

would do well to advert for a moment--the question of restraint, and the

admission and liberation of patients. "Upon restraint it was unnecessary

to dwell very long, as it was a matter of internal arrangement, and

beyond their immediate legislation; but he wished to direct the

attention of the House to the chapter in the Report which handled that

subject, that it might share the general satisfaction, and give praise

to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr.

Conolly, Dr. de Vitre, Dr. Charlesworth and many more, who had brought

all their high moral and intellectual qualities to bear on this topic,

and had laboured to make rational and humane treatment to be the rule

and principle of the government of lunacy."



Lord Ashley pointed out that the law required no medical certificate

whatever for a pauper patient, except when admitted into a private

asylum. It appears that in Wales at that time there were 1177 pauper

lunatics, 36 of whom were in English county asylums, and 41 in English

licensed houses, 90 in union workhouses, and 1010 living with their

friends, many of them being in a wretched condition. Lord Ashley quoted

a letter from one of the Commissioners, written in Wales, in which it

was stated, "We have met with one case which we think most atrocious. A.

B. was sent to the Hereford Asylum from near Brecon on November 28,

1843. She died on January 30th. She was in such a shocking state that

the proprietor wished not to admit her; she had been kept chained in the

house of a married daughter. From being long chained in a crouching

posture, her knees were forced up to her chin, and she sat wholly upon

her heels and her hips, and considerable excoriation had taken place

where her knees pressed upon her stomach. She could move about, and was

generally maniacal. When she died it required very considerable

dissection to get her pressed into her coffin! This might be taken as a

sample of Welsh lunatics."



The improvement in the condition of Dr. Warburton's asylum at Bethnal

Green, which was the original cause of the Commission of Inquiry being

appointed in 1827, now presented, it appears, a most agreeable picture

of what might be done by vigilant inspection. "Whereas in 1828 there

were commonly 150 to 200 of the patients restrained by leg-locks,

chains, and other fetters--certainly during the night--in 1844 there

were, out of 582 patients, only 5 whose violence rendered this species

of restriction necessary, and even the confinement or coercion resorted

to was of the most moderate description, and in the opinion of the

visiting officers most necessary."



Lord Ashley concluded his speech with the following eloquent

words:--"Sir, these subjects may be dull, and want the light and shade

of more exciting topics; but the expense which is incurred, the numbers

that suffer, and the nature of their sufferings, will perhaps justify

the present demand upon your time and patience. The House possesses the

means of applying a real and speedy remedy; these unhappy persons are

outcasts from all the social and domestic affections of private

life--nay, more, from all its cares and duties, and have no refuge but

in the laws. You can prevent by the agency you shall appoint, as you

have in many instances prevented, the recurrence of frightful cruelties;

you can soothe the days of the incurable, and restore many sufferers to

health and usefulness.... I trust, therefore, that I shall stand

excused, though I have consumed so much of your valuable time, when you

call to mind that the Motion is made on behalf of the most helpless, if

not the most afflicted, portion of the human race."[169]



Sir James Graham does not appear to have been affected by this appeal,

for, declining immediate action, he stated that the condition of pauper

lunatics would come under the consideration of the House next session.

He recommended the House to approach the subject of the inspection of

private houses with great caution.



In the summer of 1845 (June 6th) Lord Ashley returned to the subject,

and brought forward in the House of Commons two Bills for England and

Wales only, although he said, "I believe that not in any country in

Europe, nor in any part of America, is there any place in which pauper

lunatics are in such a suffering and degraded state as those in her

Majesty's kingdom of Scotland." After pointing out that the then

existing law was embodied in nine statutes, divisible into four

classes--County Asylums, Licensed Asylums and Public Asylums, Persons

found lunatic by inquisition, and Criminal Lunatics, he observed that

his Bill only touched the two first classes, and amended the single Act

contained under the first class, as also the three Acts contained under

the second class, namely, 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV.,

c. 64; and 5 and 6 Vict., c. 87; which various statutes were proposed by

him to be consolidated into one--"A Bill for the Regulation of the Care

and Treatment of Lunatics in England and Wales." After referring to the

state of the law as it existed under 14 Geo. III., the only law

regulating private asylums prior to Mr. Gordon's measure of 1828, Lord

Ashley proposed to establish a permanent Commission of Lunacy, giving

power of far more detailed and frequent visitation than previously, and

placing "hospitals" under proper regulation by requiring them to have

the same orders and certificates as in licensed asylums, and the same

visitation as in county asylums. The person signing the order of a

pauper patient would be required to examine him beforehand, and the

medical officer certifying his insanity was to see him within seven

days of his confinement. On admission the mental and bodily condition of

the patient, and in the event of his death, the cause thereof, were to

be stated. Injuries and acts of violence were to be recorded and a

case-book kept. A return was to be made of all single patients received

for profit.[170] Workhouses containing lunatics were to be subjected to

regular visitation. These were some of the provisions of the first Bill.



The second was an extension of the Act of 9 Geo. IV., c. 40, and was of

the highest importance, for the provision of county and borough asylums,

instead of being permissive, was made compulsory. Where insufficient

accommodation had been provided, it was required to increase it. It was

proposed to erect some separate buildings at less cost for incurable, or

rather chronic, cases. The above Bill was to be extended to boroughs

having separate quarter sessions, and to every place not contributing to

county rates. All lunatics not chargeable, whether wandering or

otherwise, were to be apprehended, and those whose friends were unable

to pay for them admitted as paupers. A quarterly inspection by a medical

man of lunatics not in asylums was required, and a list was to be sent

to the Commissioners in Lunacy.



Lord Ashley, after paying the tribute of respect and admiration due to

Pinel, referred in conclusion to the introduction of a humane system of

treatment into this country at York, adding that it must be grateful to

the feelings of the author of the "Description of the Retreat" "to

perceive that his example has obtained not only the approval, but the

imitation of the best and wisest men of this country, and, I may add, of

America."



Lord Ashley's Bill introduced for the first time a permanent Lunacy

Commission. It comprised six paid Commissioners at salaries of L1500

each, which, he observed, would be economical in the end. In Mr.

Gordon's Act the Commissioners were appointed for one year, to be

renewed annually, and consisted of ten unpaid members and five

physicians, who were paid at the rate of one guinea an hour for their

attendance, with power to carry into effect the new Act within the

metropolitan district. This act and the Commission were renewed in 1832,

when two barristers were added on the same terms. In 1834, having been

always a member of the Commission, Lord Ashley became the chairman. The

Act had been renewed periodically every three years until the year 1842,

when Lord Somerset brought in a Bill, the object of which was greatly to

extend the operation of the Metropolitan Commission. The number of

physicians was then augmented to seven, and the barristers to four; and

it was also provided that the Commissioners should receive five guineas

a day during the performance of their duties in the provinces.

Immediately after that Act (5 and 6 Vict., c. 87) the Commissioners had

entered upon their enlarged duties. The consequence was that in each

year the establishments visited by them were:



Visited once

a year.



Seventeen county asylums, or asylums brought within the

scope of 9 Geo. IV. (1828), (twelve county asylums, five

county and subscription asylums).



Eleven of mixed character (mostly by subscription and partly

by income from charitable foundations).



Two military and naval hospitals.



Visited twice

a year.



Ninety-nine houses licensed by justices in session (fifty-nine

receiving only private patients, forty private and pauper).



Visited four

times a year.



In metropolitan district:

Thirty-seven houses licensed by Metropolitan Commissioners

(thirty-three for private patients only; four for private

and pauper).



Total public and private asylums, January 1, 1844, 166.



The result of these investigations was, Lord Ashley observed, the Report

presented to the House last session, when he moved for an Address to the

Queen, but withdrew it upon the Government promising to bring in a Bill.

Ultimately, however, the Government had requested him to undertake it.



The two Bills, having passed the Houses of Parliament, received the

Royal assent on the 4th and 8th of August, 1845.[171] They have been

well called the Magna Charta of the liberties of the insane.



After these Acts had been in operation for eight years, it was found

that various amendments were needed, and in February, 1853, Lord St.

Leonards introduced, along with another Bill lessening the expense

arising out of lunacy inquisitions, one consolidating the laws

respecting asylums, and one amending Lord Shaftesbury's Act (c. 100).

They constitute the 16 and 17 Vict., c. 96 and c. 97.



The former, entitled "An Act to amend an Act passed in the ninth year

of Her Majesty 'for the Regulation of the Care and Treatment of

Lunatics,'" has reference mainly to private asylums and hospitals. The

same order and certificates which were required for admission into an

asylum were now necessary for single patients. It was enacted that

medical men should specify the facts upon which their opinion of a

patient's insanity was based, distinguishing those observed by

themselves from those communicated by others. Bethlem Hospital was by

the thirty-fifth section of this Act made subject to the provisions of

the Lunacy Acts.



The latter statute, entitled "An Act to Consolidate and Amend the Laws

for the Provision and Regulation of Lunatic Asylums for Counties and

Boroughs, and for the Maintenance and Care of Pauper Lunatics in England

and Wales," repealed the 8 and 9 Vict., c. 126; 9 and 10 Vict., c. 84;

and 10 and 11 Vict., c. 43. Many sections refer to the particular mode

of determining the manner in which an asylum shall be provided for the

paupers of a county and borough, whether for the county alone, or with

some other county or borough, or with the subscribers to any hospital,

or with the visiting committee of a county asylum for the joint use of

an existing asylum. The parish medical officer was directed to visit all

the paupers in it every quarter, whether in the workhouse or not, and

report to the guardians or overseer those who, in his judgment, might be

properly confined in an asylum. Thus the tendency of the Act was, in

this and other ways, calculated to add to the numbers under care, and,

therefore, to make the apparent increase of insanity greater. Three

classes of lunatics were contemplated by this Act, viz. pauper lunatics;

wandering lunatics, whether paupers or not; lunatics not paupers and not

wandering, who are cruelly treated or neglected. The Commissioners might

order the removal of a lunatic from an asylum, unless the medical

officer certified such patient to be dangerous; and the latter might be

overruled by the consent of two visiting justices to his discharge. A

large number of the sections of this Act provide in detail for the

settlement, etc., of pauper lunatics. Penalties were enacted