Chapters in the History of the Insane in the British Isles Part 29

The acc.u.mulation of incurables pressed heavily upon the Richmond Asylum, where, as I have said, the most sanguine hopes were at first raised as to the cure of the great majority of the patients. The governor thus wrote in 1827 to the Right Hon. W. Lamb:--

"In reference to the paragraph in Mr. Spring Rice's letter [to Mr. Lamb]

which suggests the inquiry how far the asylums in Ireland have proved effectual, I am directed to state that a very considerable acc.u.mulation of incurable lunatics has taken place in this asylum within the last few years, and for the reception of whom the House of Industry is inadequate. In consequence the Richmond Lunatic Asylum, which was established for the relief of curable lunatics, is at present occupied by one hundred and seventeen patients, whom the medical officer deems incurable. I am likewise directed to state that, notwithstanding the relief afforded by two provincial asylums now open for the reception of patients, viz. Limerick and Armagh, the number of applicants for admission to this asylum has not diminished."[262]

One is amused, even while wading through these dry Parliamentary returns on a painful subject, by meeting with such a pa.s.sage as the following, written by Dr. Thomas Carey Osborne in his report of the Cork Asylum.

Speaking of the symptoms of a young maniac, cured by electricity, he says, "When in the yard, he would look intently on the sun if permitted, until the _albuginea_ became scarlet, and the tears flowed down the cheeks, unconscious of inconvenience." His report is very pedantic, full of quotations from the Scriptures, Shakespeare, and other poets. His style is shown in what he says of Dr. Hallaran, his excellent predecessor in office at the Cork Asylum for more than thirty years, when he informs his reader that the "infuriated maniac and the almost senseless idiot expressed sorrow for his decease and deplored him as a friend."

One case reported by the doctor is worth recording. He had been some years under treatment, and his insanity was attributed to the loss of a hooker off the western coast, his only property, which he had purchased after much toil as a fisherman. His character was melancholic, and he conducted himself with propriety. He was appointed door-keeper, and filled his situation with such kindness and good humour that he was generally esteemed. He had the whimsical illusion of having been introduced into the world in the form of a salmon, and caught by some fisherman off Kinsale. He was found one morning hanging by a strip of his blanket to an old mop nail, which he had fixed between the part.i.tion boards of his cell, having taken the precaution of laying his mattress under him to prevent noise in case of his falling.[263]

In 1827 the total number of persons in confinement was reported to be:--

---------------------------------+-----------+---------+----------- Location. | Lunatics. | Idiots. | Totals.

---------------------------------+-----------+---------+----------- Richmond Asylum | 168 | 112 | 280 Lunatic ward of House of Industry| 442 | -- | 442 Private asylums (4) near Dublin | 101 | -- | 101 City and County Asylum, Cork | 138 | 64 | 202 Asylum at Waterford | 103 | -- | 103 " Armagh | 64 | -- | 64 Jail at Lifford | 18 | -- | 18 Private house, Downpatrick | 17 | -- | 17 County Infirmary, Derry | 12 | -- | 12 Old Jail, Roscommon | 19 | -- | 19 Asylum, Ennis | 14 | -- | 14 " Kilkenny | 14 | -- | 14 House of Industry, Tipperary | 32 | -- | 32 " Waterford | 57 | 48 | 105 " Wexford | 37 | -- | 37 Asylum, Limerick | 74 | -- | 74 Dean Swift's Hospital | 50 | -- |(about) 50 +-----------+---------+------------ Total | 1360 | 224 | 1584 ---------------------------------+-----------+---------+------------

Sir Andrew Halliday, aware that these numbers bore no proportion to the actual number of insane and idiots in Ireland, reckoned the number at three thousand.

In 1830 the Richmond Asylum, Dublin, was converted into a District Lunatic Asylum for the city of Dublin by the Act 11 Geo. IV., c.

22.[264]

Pa.s.sing on to 1842, the Solicitor-General for Ireland in that year introduced a "Bill for amending the Law relating to Private Lunatic Asylums in Ireland," which became law August 12, 1842. It is not necessary, however, to give its details in this place, and I shall proceed to notice the important Report of the Committee of the House of Lords, with minutes of evidence, which was issued in 1843.[265] A table is given of the district asylums and the Cork Asylum, from which it appears that at that period the number amounted to ten, viz. Armagh, Belfast, Carlow, Clonmel, Connaught, Limerick, Londonderry, Maryborough, Richmond, and Waterford.

These ten district asylums contained upwards of 2000 patients, although built to contain only 1220. As 688 were found to be incurable, the Committee reiterated the warning given at the Committee of 1817, that if fresh provision were not made, the inst.i.tutions would shortly become "asylums for mad people, and not hospitals for the cure of insanity." As to the treatment, it is reported that "the system of management adopted in the district asylums appears to have been, with the exception of one case of gross misconduct and abuse, very satisfactory.... A humane and gentle system of treatment has been generally adopted, the cases requiring restraint and coercion not exceeding two per cent. on the whole. The system is one which, if applied exclusively to the cure of the malady, and if the asylums were relieved from the pressure produced by the increasing number of incurables, appears to the Committee in its essential points to be deserving of confidence and of approval; but, unless so relieved by some alteration of the present law and of the present practice, the admission of new cases must necessarily be limited, and may ultimately be restricted within very narrow bounds indeed. The necessity of some change in this respect is admitted by all the witnesses, as well as proved by the doc.u.mentary evidence before the Committee. The number of persons refused admission for want of room has in the present year amounted to one hundred and fifty-two."

At this period, beside the district asylums, there were Swift's Hospital, and other establishments provided for the custody of pauper lunatics, supported by local taxation, and connected more or less with the old houses of industry. At Kilkenny, Lifford, Limerick, Island Bridge, and in Dublin (the House of Industry) local asylums existed, characterized as "miserable and most inadequate places of confinement,"

and were under the authority of the grand juries, the funds being raised by presentment or county rate. "The description given of these latter most wretched establishments not only proves the necessity of discontinuing them as speedily as accommodation of a different kind can be provided, but also exemplifies the utter hopelessness, or rather the total impossibility, of providing for the due treatment of insanity in small local asylums. No adequate provision is made, or is likely to be made in such establishments, for the medical or moral treatment of the unfortunate patients. Hence the necessity of a coercive and severe system of treatment. The chances of recovery, if not altogether extinguished, are at least reduced to their very lowest term.... Whilst a general improvement has taken place in the management of the insane throughout other establishments of Ireland, these local asylums, if indeed they deserve such a name, have continued in the most wretched state." Evidence of the strongest kind is given to impress upon Parliament the necessity of an immediate discontinuance of this part of the system.

It would carry us too far to enter at length into this evidence. One or two facts must suffice as examples of the rest. At Wexford, where, in the cells for lunatics, there were two patients in restraint, one of whom was chained to a wall, Dr. White, the Inspector of Prisons, thus described the latter: "When I went to his cell with the keeper and the medical officer, I asked to go in. He was naked, with a parcel of loose straw about him. He darted forward at me, and were it not that he was checked by a chain round his leg, and was fastened by a hook to the wall, he would have caught hold of me, and probably used violence. I asked how it was possible they could allow a man to remain in such a state; they said they were obliged to do so, as the funds were so limited that they had not money to buy clothes for him, and that if they had clothes they would have let him out.... I went to another cell, and though the individual was not chained, he was nearly in as bad circ.u.mstances as the other. Altogether these two cases were the most frightful I ever witnessed. I could not describe the horror which seized me when I saw them. I went into a room, a very gloomy-looking room, very low, and in this room there was a fireplace, which was guarded by one of those large grate-protectors that are very high up; I looked around and heard some one moaning, and on the top of this screen I saw two unfortunate lunatics stretched out; they were trying to warm themselves through the bars of the grating; the room was so dark that I could not see them at first, and here they were allowed to creep about and to lie in this kind of unprotected manner." In reply to the question, "Was there any moral superintendence?" Dr. White said, "There was both a male and female keeper, but they appeared to me totally unfit for the discharge of their duties."

The number of lunatics confined in jails was found by the inquiry of 1843 to have increased, partly in consequence of the Act 1 and 2 Vict., c. 27, for the more effectual provision for the prevention of offences by insane persons. Two justices were authorized, acting with the advice of a medical man, to commit to jail any person apprehended under circ.u.mstances denoting derangement of mind and a purpose of committing crime. A subsequent clause authorized the Lord Lieutenant to transfer such person, as well as convicts, to a lunatic asylum. No steps had been taken to ascertain whether, on the one hand, the jails afforded any accommodation whatever for such lunatics, or whether, on the other, convict lunatics could be properly received into the district asylums.

The statute operated widely. Previous to it, in 1837, there had been only thirty-seven lunatics in jails, while by the year 1840 they had augmented to one hundred and ten, of whom eighty-one were maniacs, seventeen were idiots, and twelve were epileptics; while by the 1st of January, 1843, the number amounted to two hundred and fourteen. Of these only forty had been convicted of any criminal offence, showing that the application of the Act had gone much beyond the intention of its framers. Thus it was that "the numbers crowding the county jails were truly distressing, and were made the subject of universal complaint by the local authorities."[266]

The Lords' Committee, of course, insisted on the necessity of discontinuing the committal of lunatics to jails and bridewells, and amending the Act 1 Vict., c. 27, which had led to such serious abuses; the inexpediency of appropriating the union workhouses or houses of industry to the custody or treatment of the insane; the necessity of providing one central establishment for criminal lunatics, under the immediate control and direction of the Government of Ireland, to be supported from the same funds and under the system adopted in respect to criminal lunatics in England; the necessity of increasing the accommodation for pauper lunatics in Ireland, and of providing for the cases of epilepsy, idiocy, and chronic disease by an increased number of the district asylums, by enlargement of these asylums, or by the erection of separate establishments, specially appropriated for these cla.s.ses of patients.[267]

At this Committee Dr. Conolly gave the results of his non-restraint experience at Hanwell since September, 1839.

The following tabular statement, delivered in at the Committee by the Rev. E. M. Clarke, presents a valuable picture of the state of lunacy in Ireland on the 1st of January, 1843:--

1. Population of Ireland in 1841 8,175,238 2. Total insane confined January 1, 1843 3,529 3. Total curable, comprised in No. 2 1,055 4. Total incurable, ditto 2,474 5. Total curable (not including private asylums) confined January 1, 1843 848 6. Number for which the district asylums were first built 1,220 7. Number confined in district asylums, January 1, 1843 2,061 8. Confined in other than district asylums, January 1, 1843 1,468 9. Number confined in thirty-two jails, January 1, 1843 211 10. Number confined in workhouses, March 31, 1843 557 11. Number of curable cases confined in thirty-two jails, January 1, 1843 78 12. Number of curable cases in district asylums, January 1, 1843 698 13. Number of incurable cases in district asylums, January 1, 1843 1,368

A correspondence took place between the Irish Government and the managers of the district asylums on the subject of the Report of the House of Lords' Committee on the state of the lunatic poor, commencing November, 1843, by a letter from Lord Elliott to the superintendents, asking for their opinion. These unanimously endorsed the conclusions arrived at by the Committee, and, in some instances entering into the mode of inspection of asylums by the two inspectors-general of prisons at their half-yearly visitation of gaols, a.s.serted that "it must from a variety of causes be of no use whatever."

The Irish Government also opened a correspondence in 1844 with the grand juries of each county, and their opinion was asked as to the eligibility of the sites proposed for new asylums. As the Acts of Parliament limited the number of patients in any single asylum, it was sought to remove this obstacle by an Act in 1845, 8 and 9 Vict., c. 107. This Act also provided for the erection of a central asylum for criminal lunatics, which carried out one important recommendation of the Lords' Committee.

The Cork Asylum was at the same time added to the district asylums.

In 1846 an Act (9 and 10 Vict., c. 115) was pa.s.sed to amend the laws as to district asylums in Ireland, and to provide for the expenses of inspection of asylums.

From a return made in this year (1846) showing the total number of lunatics in the district, local, and private asylums and jails on the 1st of January during each of the previous ten years, I observe that in 1837 there was a total of 3077, and in 1846 a total of 3658, thus distributed:--

------+-----------+-----------+-----------+----------+---------- Year.| District | Local | Private | Jails. | Total.

| Asylums. | Asylums. | Asylums. | | ------+-----------+-----------+-----------+----------+---------- 1837 | 1610 | 1236 | 152 | 79 | 3077 1846 | 2555 | 562 | 251 | 290 | 3658 +-----------+-----------+-----------+----------+---------- | Inc. 945 | Dec. 674 | Inc. 99 | Inc. 211 | Inc. 581 ------+-----------+-----------+-----------+----------+----------

Of the 3658, as many as 2473 were incurable, leaving only 1185 curable patients. For 1846 there is also a return of the number in poor-houses, 1921; wandering idiots and simpletons, 6217; lunatics under the care of Court of Chancery not in asylums, 76; making a total of 11,872, of whom 327 only were private patients.

In the following year the annual report of the Inspectors thus speaks of non-restraint: "The non-restraint system has been introduced, and is generally acted on, mechanical restraint being seldom applied except where the patients are very violent, and even then it is not often resorted to, as a temporary seclusion is now subst.i.tuted as a more effectual means of tranquillizing the patients without the risk of personal injury often resulting from the application of bodily restraint, and arrangements are being made to have apartments fitted up for this purpose in each asylum."

The percentage of cures and mortality during the previous seven years was as follows:--Per cent. on the admissions, 38.65; mortality calculated on average number resident, 8.39--not an unsatisfactory return.

In 1849 the proportion of lunatics (_i.e._ ascertained) to the population in Ireland was 1 to 900, while in Scotland it was 1 to 740, and in England 1 to 870.

In their report of this year, the Inspectors of Asylums express their regret that no provision exists for the insane who, not being paupers, are legally inadmissible into the public inst.i.tutions, and are unable to meet the charges made in private asylums, the only mixed inst.i.tutions being St. Patrick's Hospital and the Retreat in Dublin, managed by the Society of Friends.

The number of patients in the district asylums in 1851 (exclusive of Cork, 394) was as follows:--

No. Opened.

Armagh 131 1824 Belfast 269 1829 Carlow 197 1832 Clonmel 197 1834 Ballinasloe 312 1833 Limerick 340 1827 Londonderry 223 1829 Maryborough 192 1833 Richmond 279 1815 Waterford 115 1835 ---- Total 2255

In 1855[268] the Act 18 and 19 Vict., c. 76, continued the Private Asylum Act of 5 and 6 Vict. The 9 and 10 Vict., c. 79, and 14 and 15 Vict., c. 46, were continued till 1860. The Act 18 and 19 Vict., c.

109, made further provisions for the repayment of advances out of the consolidated fund for the erection and enlargement of asylums for the lunatic poor in Ireland. Seven asylums had been built under the Board of Works since 1847.

By far the most important attempt to take steps for the reform of Irish lunacy was the appointment of a Royal Commission in 1856, to inquire into the state of lunatic asylums and other inst.i.tutions for the custody and treatment of the insane in Ireland. Among the Commissioners of Inquiry were Mr. Lutwidge, Mr. Wilkes, and Dr. Corrigan. The Report was issued in 1858. They found that on January 1, 1857, the total number of patients in asylum districts amounted to 5225, of whom 1707 were in workhouses, 166 in jails, and 3352 at large, while the inmates of district asylums numbered only 3824. They therefore urged the pressing need of additional accommodation. They proposed that the Irish law should be a.s.similated, with respect to single patients, to the 16 and 17 Vict., c. 97, s. 68, the police being empowered to bring before a magistrate any wandering lunatic, and justices of the peace having power on sworn information to cause such person to be brought before them.

They also regarded as absolutely necessary a total alteration of the rules affecting the manager and physician of an asylum, previous rules having been drawn up in contemplation of the former officer not being a medical man. Among other recommendations, there were proposals in reference to private asylums, for which no legislative enactment was pa.s.sed prior to 1826 (7 Geo. IV., c. 74),[269] and no special law for licensing them or securing their proper management until 1842, when the statute of 5 and 6 Vict., c. 123, enacted that the Inspectors-General of Prisons, whose duty it was to inspect private asylums, should be Inspectors of Lunatic Asylums--a function which, with others connected with asylums, was by the 8 and 9 Vict., c. 107, transferred to the then newly appointed Inspectors of Lunatics. The Commission proposed that the power of issuing licences should be transferred from the justices to the Inspectors of Lunatics; that the licence should require that some medical man should reside on the premises; that any abuse, ill treatment, or wilful neglect of a lunatic by the superintendent or any other person employed in the care of lunatics, should be deemed a misdemeanour, and punished accordingly; and that, for inspection, licensed houses should be visited by one or more of the Commissioners four times a year. Many other important recommendations were made by the Commission, some of which bore fruit in subsequent Irish legislation, but to how limited an extent is evident from the recommendations of another Commission, to which we shall shortly refer.

The Commissioners notice the culpable disregard with which the rule of the Privy Council, which requires that "the manager is to take charge of the instruments of restraint, and is not, under any pretence, to allow the unauthorized use of them to any person within the establishment; all cases placed under restraint, seclusion, or other deviation from the ordinary treatment, being carefully recorded by him in the daily report, with the particular nature of the restraint or deviation resorted to,"

has in many instances been treated. So also had the rule that the superintendent was to enter in the Morning Statement Book "the names of those in restraint or seclusion, and the causes thereof." Some managers were not aware of the existence of the rule, while others deemed it a sufficient compliance with the rules to leave the instruments of restraint in charge of the keepers, trusting to their integrity to report the cases in which they were used. In one asylum a female patient was strapped down in bed with body-straps of hard leather, three inches wide, and twisted under the body, with wrist-locks, strapped and locked, and with wrists frayed from want of lining to straps, and was seriously ill, but yet no record had been made in the book. "Wrist-locks and body-straps were hung up in the day-room, for application at the attendants' pleasure. A male patient was strapped down in bed; in addition, he was confined in a strait waistcoat with the sleeves knotted behind him; and as he could only lie on his back, his sufferings must have been great; his arms were, moreover, confined with wrist-locks of hard leather, and his legs with leg-locks of similar kind; the strapping was so tight that he could not turn on either side; and any change of position was still more effectually prevented by a cylindrical stuffed bolster of ticken, of about ten inches thick, which ran round the sides, and top, and bottom of the bed, leaving a narrow hollow, in the centre of which the lunatic was retained, as in a box, without power to turn or move. On liberating the patient and raising him, he was very feeble, unable to stand, with pulse scarcely perceptible, and feet dark red and cold; the man had been under confinement in this state for four days and nights;" yet the manager stated he was not aware of his having all these instruments of restraint upon him, and no record of the case appeared in the book.

At another asylum the Commissioners found a bed in use for refractory patients, in which there was an iron cover which went over both rails, sufficiently high to allow a patient to turn and twist, but not to get up.

Before leaving the Report of the Commissioners of 1858, we may add that, during the period comprised between the date of the Committee of 1843 and this Commission, the number of district asylums was increased from ten to sixteen, affording additional room for 1760 patients, exclusive of Dundrum and a large addition to the Richmond Asylum. Thus:--

-------------+------------------------------------------ | When first opened.

Name of +-------+----------------------+----------- asylum. | | | Number of | Date. | Cost including site. | beds.

-------------+-------+----------------------+----------- | | s. d. | Cork | 1852 | 79,827 1 5 | 500 Kilkenny | 1852 | 24,920 12 1 | 150 Killarney | 1852 | 38,354 8 3 | 250 Mullingar | 1855 | 37,716 15 9 | 300 Omagh | 1853 | 41,407 12 2 | 310 Sligo | 1855 | 39,769 0 7 | 250 +-------+----------------------+----------- Total 261,995 10 3 | 1760 --------------------------------------------+-----------

The Report of the Commission recommended that parts of the workhouses should be adapted and used for some of the incurable cla.s.s of patients.

This was not done, and we cannot be surprised, seeing the unfortunate state of these abodes. But, in addition to the removal of incurable cases to workhouses, the Commissioners recommended additional buildings in connection with existing asylums, for the reception of cases which, although incurable, might yet, from their habits or dangerous tendency, be considered improper cases to be removed from inst.i.tutions especially devoted to the treatment of insanity. They were satisfied that the number of district asylums would be found more and more inadequate for the wants of the country.

There was a Select Committee of the House of Commons on lunatics in 1859.[270] In the minutes of evidence great stress is laid upon the necessity of providing, in Irish asylums, accommodation for the cla.s.s immediately above paupers, whose friends were willing to pay a small additional sum for their maintenance; and also establis.h.i.+ng district asylums, similar to the chartered asylums in Scotland. Two years later (1861), and three after the Royal Commission, the Act 24 and 25 Vict., c. 57, continued the various Acts respecting private and public asylums (5 and 6 Vict., c. 123; 18 and 19 Vict., c. 76). The subsequent Act of 1867 (30 and 31 Vict., c. 118) provided for the appointment of the officers of district asylums, and amended the law relating to the custody of dangerous lunatics and idiots. These were not to be sent to any jail in the land after January 1, 1868. Dangerous lunatics previously had to pa.s.s through jails, instead of going direct to asylums. The 31 and 32 Vict., c. 97, made provision for the audit of accounts of district asylums, and is of no general interest.

During three years (1866-69) six additional asylums were erected, viz.:--

-------------+------------------------------------------ | When first opened.

Name of +-------+----------------------+----------- asylum. | | | Number of | Date. | Cost including site. | beds.

-------------+-------+----------------------+----------- | | s. d. | Ennis | 1868 | 51,316 8 6 | 260 Letterkenny | 1866 | 37,887 5 3 | 300 Downpatrick | 1869 | 60,377 6 5 | 300 Castlebar | 1866 | 34,903 14 11 | 250 Monaghan | 1869 | 57,662 5 5 | 340 Enniscorthy | 1868 | 50,008 0 6 | 288 +-------+----------------------+----------- Total 292,155 1 0 | 1738 --------------------------------------------+-----------

Returning to 1861, the tenth report of the Inspectors of Asylums, issued in that year, gives much important information on the state of lunacy in Ireland at that time, but there are only two points to which it is necessary to refer here. The writers, Drs. Nugent and Hatch.e.l.l, speak indignantly of the shameful manner in which the friends of lunatics in confinement neglect them, "as if their malady entailed a disgrace on those connected with them ... months--nay, years--pa.s.sing without an inquiry being made by a brother for a brother, or a child for a parent."

After stating that during the previous ten years four new asylums had been licensed, the Inspectors recur to the importance of supplying asylums for patients who, unable to pay the ordinary charge of a private asylum, not being paupers, are ineligible for admission into public asylums.