Chapters in the History of the Insane in the British Isles Part 30

In 1874 a new code of rules, issued by the Privy Council, contained many important regulations. Of it, however, the late Dr. Robert Stewart[271]

observed, "On the whole, we cannot speak very highly of the tact or wisdom shown by the Lord Lieutenant and Privy Council in the framing of the new code of regulations."[272] In this code the duties of the medical superintendents of Irish asylums are minutely laid down.

In 1878 a Lunacy Inquiry Commission was appointed by the Lord Lieutenant of Ireland, the Report of which in the following year, after an examination of a large number of witnesses, contains much valuable information as to various questions connected with the asylums and the provision for the insane poor, present and future. The following "most distressing case," recorded by the Commission, speaks loudly of the need of increased provision for the insane poor in Ireland:--

"On approaching a small farmhouse at a place called ----, I heard," says Dr. Robertson, "a most peculiar howling noise, and, to my horror, when I came near the house I saw a lunatic _stark naked_, confined to a room, and looking through the wooden bars that closed the windows, for there was no gla.s.s whatever. He is about nineteen years of age, and I heard from his mother that up to ten or eleven years he was a most intelligent boy; but at that age he suddenly lost the power of speech and became moody and abstracted, wandering about the fields alone, and constantly uttering a low, muttering noise, and with incessant tendency to mischief. By careful watching, the family prevented him injuring himself and others, until of late he has got so strong and unmanageable, and his inclination for destruction is so great, that they have been obliged to confine him in the room I have described. He breaks the window directly it is glazed, tears his bed-clothes into shreds, and won't allow a st.i.tch of clothing to remain on his body; besides, his habits are most disgusting."[273] The inc.u.mbent of the parish wrote: "This case is indeed only suited for a lunatic asylum. The form which his lunacy has a.s.sumed is most shocking, and is detrimental to morality." An English tourist happening to see this case had him removed to the Monaghan Asylum. One cannot but remark that what an English tourist did, the proper authorities ought to have done. The law appears to have been sufficient for the occasion.

The members of the Commission were not content with hearsay evidence.

"We took occasion ourselves," they report, "to visit several of these cases in different parts of the country. Some of them we found in a deplorably neglected condition; others disturbing the arrangements of a whole family, the head of which would willingly contribute a small sum towards maintenance in some suitable place of refuge. It admits of no doubt that many a case, if taken in hand at an early stage, might have been restored to society, instead of lapsing into hopeless, incurable insanity. Serious evil often results from the freedom with which idiots of both s.e.xes are permitted to wander abroad, often teased and goaded to frenzy by thoughtless children, often the victims of ill treatment or the perpetrators of offences far worse. The interests of the public, no less than of the insane, require that means should be adopted to ascertain that all of that cla.s.s are properly cared for. That can only be done by subst.i.tuting the visit of a medical man for that of the constable, and a professional report for the incomplete return that is now made."

The chief conclusions were, that while it would not be proper to dispense wholly with any workhouse, portions of some might be dispensed with for sane paupers, and appropriated for the accommodation of a certain cla.s.s of the insane. Over-crowding, it was proposed, should be relieved by the removal of lunatics to _auxiliary asylums_. School buildings belonging to certain workhouses were suggested as auxiliary asylums, as in Dublin, Cork, etc. For the better cure, relief, and treatment of the lunatic and idiotic poor, a complete reorganization of the whole lunacy administration was regarded as essential, viz. that under the provisions of s. 15 of 8 and 9 Vict., c. 107, the existing district asylums should be cla.s.sified, reserving one or more, as might be required, in each province as "lunatic hospitals," especially for the curative treatment of the insane; that the remaining district asylums should be appropriated as "lunatic asylums" for the accommodation of the chronic insane requiring special care, a certain number of this cla.s.s being accommodated in the "lunatic hospitals," as about fifty of each s.e.x would be required for the service of those establishments; that the inspection of the "lunatics at large" should be made one of the duties of the dispensary medical officers, who should be remunerated for this duty, and whose certificate that any one of this cla.s.s is neglected or improperly cared for, should be made the ground for action by the lunacy authorities; that the accommodation for the third or harmless cla.s.s, who are at present in lunatic asylums, in workhouses, or at large in a neglected state, be provided by the appropriation of spare workhouse buildings, a sufficiency of which is to be found in each province, thus also meeting the very general complaint of guardians being compelled to maintain superfluous workhouse accommodation; and that all expenditure upon the building or enlargement of district asylums should be suspended.

By this means, each province would be provided with _three_ cla.s.ses of lunatic establishments: (1) One or more lunatic hospitals for the cure of insanity in an early stage; (2) first-cla.s.s asylums, in which the chronic cases requiring special care would be treated; (3) second-cla.s.s or "workhouse auxiliary asylums" for harmless lunatics. The Commission expressed a strong opinion that the whole lunacy administration of Ireland should be placed under the general control of the Local Government Board.

I may add that the estimated cost of the first cla.s.s was 26 per head; that of the second cla.s.s, 20; and that of the third, 14 6s. Of this scheme it must be said that, excellent as it is in intention, it is not in some of its provisions without danger in the direction of lowering the condition of the insane poor, as regards comfort and medical supervision, not, indeed, below what they are in some Irish workhouses, but below the standard aimed at in the best county asylums. "Let it be understood that there is no recommendation to const.i.tute anything like an auxiliary asylum, such as Leavesden or Caterham, where large numbers, being brought together, can be kept at a cheap rate, and can at the same time be properly treated under medical care. No provision is made for the necessary supervision, medical or otherwise. The dispensing medical officer is to visit the insane at large, but those in workhouses are to be left to the tender mercies of attendants. The amount of care and comfort these unfortunate beings are to enjoy can be imagined by the fact that the Commission considers that 14 6s. a year will be the cost of their maintenance, after paying attendants, whilst the cost of those in the second-cla.s.s establishments is to be 20, or about 6 less than what they cost at present."[274]

In their review of the results of past lunacy legislation in Ireland the Commission make the melancholy statement that "although several years ago the legislature made provision for the cla.s.sification of asylums,[275] and the Inspectors of Lunacy concur with other witnesses of the highest authority in thinking that such cla.s.sification would be attended with the utmost advantage--would, in fact, meet the difficulties of asylum administration--yet not only has no attempt ever been made to give effect to the provisions of that law, but"--strangest of all--"the Lunacy Inspectors appear to have been unaware of its existence!"[276]

The Commission found that the evil of overcrowding with incurable cases, complained of by the Committee of 1843, and by the Royal Commission of 1858, "has continued to the present day not merely unchecked, but in a more aggravated form than ever." In 1856 there were 1168 curable and 2656 incurable patients in Irish asylums, while in 1877 these numbers were, respectively, 1911 and 6272, the percentages being in the former year, curable 30.5, incurable 69.5, while in the latter year the corresponding percentages were 23.3 and 76.7. Taking the patients not only in asylums, but in workhouses also, the total in 1856 (or more correctly 1857) was as follows: curable, 1187; incurable, 4468; percentages, 20.9 and 79.1. In 1877, curable, 1911; incurable, 9644; percentages, 16.5 and 83.4--a frightful revelation of incurable lunacy.

The Inspectors complain that the Act 30 and 31 Vict. has caused this increase of unsuitable cases,[277] but, as the Commission observe, it has simply increased an existing evil, and not produced a new one.

Besides, "how otherwise are these unhappy people to be dealt with? Has any other accommodation been provided for them? Though not suitable cases for curative hospitals, they are, at all events, suitable cases for care and humane treatment, and not until provision for such treatment is made, ought the door of the asylum to be shut against them."[278]

The condition of workhouses is proved by this Report to be most unsuitable for the reception of the insane; yet they contained in 1879 one quarter of the pauper lunatics of the country. It was desirable to remove a large number of these somewhere, and the only suitable place was the district asylum. Dr. Lalor, in his evidence before this Commission, says in regard to this increased number of admissions under the 30 and 31 Vict., "I think it is an immense advantage, because before that Act there was a great number of persons kept out who ought to be sent into lunatic asylums, but there was not sufficient machinery for doing so." Dr. Lalor then goes on to say that they have not in Ireland the same provision as in England for taking up merely wandering lunatics not chargeable to the rates. This witness, I should add, is strongly in favour of larger asylums for even curable cases, and would cla.s.sify the inst.i.tutions for the insane into three cla.s.ses, the curable, the improvable, and the incurable. For curable and improvable cases of lunacy, including those requiring special care, and for the training and education of imbeciles and idiots chiefly of the juvenile cla.s.ses, he would have the same asylum; for the incurable and unimprovable, he would have another. He would leave it to a central body to distinguish the cases, and would allow that such a body might find it more convenient to cla.s.s the juvenile idiots and imbeciles under the second division.

At the date of this Commission there were 22 district asylums, containing 8073 patients. There were 150 workhouses, with 3200 insane inmates. In Dundrum[279] were 166 criminal insane, and in private asylums about 680 patients, making a total of 12,200. In addition to these, the inspectors obtain a return of every idiot, imbecile and epileptic, at large, from the police, not being under the supervision of the Lunacy Board; the number in 1878 was 6200, bringing up the figures to 18,400.

That practical effect might be given to the recommendations contained in this Report, Lord O'Hagan called attention to them in a speech delivered in the House of Lords, August, 1879, in which he said, "Let me ask the attention of the House to the case of neglected lunatics in Ireland. It is the most pressing, as it is the most deplorable." He cited the statement of the Royal Commission of 1858, that there were 3352 lunatics at large, of whom no fewer than 1583 were returned as "neglected;" and the recent statement of the Irish Lunatic Inquiry Commission that within the last twenty years the number of that cla.s.s had increased by more than a hundred per cent.--from 3352 to 6709--without "any diminution in the proportion of those who may still be cla.s.sified as neglected." Lord O'Hagan referred to the case of a naked lunatic in a farmhouse, which we have quoted at p. 424, and maintained that some four thousand lunatics were in a condition "better or worse according to circ.u.mstances." We cannot but think that the speaker generalized a little too much. He was right, however, in his contention that none of the neglected cases "are protected by any intervention of the law from exhibiting themselves in as shocking an aspect."

"Only," observed Lord O'Hagan, "when the life of George III. was threatened by a lunatic in England, did Parliament interfere and send the insane to jails; only in 1838, when it was discovered that jails were not fit receptacles for them, was provision made for committing them to asylums; and only in the Consolidating Act of 1853 were provisions made for such inspection and report as were needful for their protection and the safety of their neighbours. I lament to say that Ireland was left without even the benefit of the Act of 1799 until 1838, and that the advantages which the Act of that year gave to England were not extended to her lunatics until 1867; whilst you will scarcely believe that the salutary reforms of 1853 have not to this hour been made operative in Ireland."

Lord O'Hagan asked for identical legislation for Ireland and England, the want of this having caused "incalculable mischief."

After observing that the Commission proposed the cla.s.sification of asylums for the purpose of curative treatment, the care of chronic cases, and the allocation of workhouses as auxiliaries for the benefit of the quiet and harmless, Lord O'Hagan referred to the fact that "the Commission and the Inspectors of Lunacy differed as to material points on the _modus operandi_, the inspectors desiring the extension of district asylums, and the Commission not agreeing with this view; the consequence being that at that time their extension was suspended." The speaker did not presume to decide between them, but simply called upon the Government to recognize the responsibility which the Report of the Commission had cast upon them.

The Lord Chancellor (Lord Cairns) replied that the Report was engaging the attention of the Government; that he trusted it would not be in the category of those Reports "which have gone before" and produced no result; but that he could not give any further answer.[280]

The Lord Chancellor of Ireland (Lord O'Hagan) brought in on the 20th of January, 1880, the "County Court Jurisdiction in Lunacy Bill (Ireland),"[281] which not only pa.s.sed the House of Lords, but was read a third time in the House of Commons, August 17th of that year.[282]

Lord O'Hagan's measure had for its object to protect the interests of lunatics possessed of small properties, beyond the control of Chancery on account of the expense incurred thereby. There were in Ireland under the jurisdiction of the Lord Chancellor, committed to him by the Queen's sign manual, 229. By the operation of the Act of 1871, introduced by Lord O'Hagan, the guardians.h.i.+p then provided had worked admirably. But there remained those who had very small property. Of the 642 persons then in private asylums, 143 only were under the guardians.h.i.+p of the Lord Chancellor, and the remainder might be presumed to have small properties. In the district asylums there were 55 paying patients, 20 of whom were under the Court of Chancery. Those on whose behalf Lord O'Hagan addressed the House of Lords were estimated at 724. The property of most of these "was left to the mercy of relations or strangers, who did with these unhappy people what they would." While in the previous year 1276 patients had been sent to district, and 141 to private asylums, only 24 had been brought within the protection of the Lord Chancellor. As much as 3189 was received from patients in the district asylums in a year. The Bill now introduced gave protection to the cla.s.s in question by vesting in the County Court judges a new jurisdiction, viz. in lunacy within the areas of the various courts, in cases in which the property of the lunatic should not exceed the sum of 700 in money value, or 50 a year--sums taken from the Lunacy Regulation Act of 1871, which provided that the Lord Chancellor might be at liberty not to impose upon lunatics having property of that value, the same fees and obligations that were insisted upon in the case of more wealthy persons.

Lord O'Hagan regarded his Bill as only part of a larger measure to which he looked forward.[283]

A Bill was introduced into the House of Commons, but without pa.s.sing into an Act, by Mr. Litton, member for Tyrone, ent.i.tled "The Lunacy Law a.s.similation (Ireland) Bill," on the 6th of April, 1881,[284] and it may be worth while to observe what, according to so comparatively recent a speaker on the subject, is now wanted to improve the condition of Irish lunatics. After pointing out that, according to the Report of the Commission of 1879, there were on January 1, 1878, about 11,000 lunatics provided for, the number at large, inadequately cared for, was 6709, of whom more than 3000 were actually neglected, as against 1583 in the year 1857; and after reviewing the legislation of 1 and 2 Geo. IV., by which district asylums were established; the 1 and 2 Vict., c. 47, by which dangerous lunatics may be committed to jails; the 8 and 9 Vict., by which they might be transferred to Dundrum; the 30 and 31 Vict., c. 118 (1867), by which the first provision for sending this cla.s.s of lunatics to jail was repealed; the 38 and 39 Vict. c. 67 (1875), by which it was provided that chronic lunatics not being dangerous might be consigned to the poor-houses--Mr. Litton showed that there was no attempt at cla.s.sification in poor-houses, and that they only accommodated 3365 persons, and further that, in spite of the last Act, the asylums were crowded with chronic and incurable cases, and had but little room for recent cases. He deplored the want of supervision of the neglected lunatics referred to, many of whom were subjected to cruel treatment. He therefore preferred to extend to Ireland the provisions of ss. 66 to 68, 70 to 72, and 78 to 81 of the English Act, 16 and 17 Vict., c. 97, subject to certain changes which were explained in the Bill. He doubted whether powers to enlarge the existing asylums would meet the difficulty, and it would be very costly and lengthy. It was proposed to adopt the system of boarding out which had been in operation in Scotland; due provision was made for their inspection. It was also needful to give to poor-law guardians power to afford relief to the head of a family one of whose members was insane (as in England), which was now impossible, unless the head of the family was so afflicted.

The fact that all committals of dangerous lunatics on the warrant of two magistrates must be cases in which the latter are satisfied that a lunatic had shown an intent to commit an indictable crime leads, it is stated, to many persons who, although dangerous, have not shown the above intent, being kept out of asylums until they have pa.s.sed into a chronic state. However this may be, the number committed in Ireland as dangerous lunatics is enormous, being in one year (1877) 1204 out of 1343 admissions, the truth being that numbers are cla.s.sified as dangerous who are not so.

Mr. Litton's Bill provided (1) for the supervision of neglected lunatics; (2) the boarding out in suitable places, under the direction of the governors of district asylums, of such patients as they might select for that purpose; (3) an alteration in the law of committal, so as to allow of patients being admitted before they became incurable; and (4) power to the poor-law guardians to give outdoor relief under the circ.u.mstances stated.[285]

The Bill had the approval of the Social Science Congress committee, and of Lord O'Hagan, but on account of the pressure of other business never reached the House of Lords.[286] It should be added that the Government, in the person of the Solicitor-General, expressed a hope that they would be able to bring in a Bill of larger scope, one more fully covering the ground traversed by the Royal Commission of 1879.

The sketch now made, slight as it is, will serve to show that Ireland formed no exception to the neglect to which the insane were subjected, especially in the poor-houses and jails; that when attention was strongly drawn to the better treatment of the insane in England, partly by the publication of a work describing how this was to be carried out, and partly by the evidence given before the Select Committee of the House of Commons in 1815, the Irish Government took up the question of reform, and resolutely set about putting their own house in order.

Select Committees collected valuable evidence which bore fruit in efficient legislative enactments, and there seems to have been singularly little opposition to the introduction of improved methods of treatment and new buildings in place of the old. The Richmond Asylum from the first led the way in enlightened modes of treatment, and at the present time this inst.i.tution, under the long and able management of Dr.

Lalor, is a credit to Ireland; the more so that here, more efficiently than in any asylum I have visited in the British Isles, the employment of the patients in school work has been introduced and prosecuted to a successful issue.[287]

One other feature of the history of this movement in Ireland has already been alluded to, but merits attention again, and that is the additional proof afforded of the inevitable tendency to the acc.u.mulation of cases, instead of their recovery on a large scale, as was at first hoped and expected, not in Ireland alone, but in England. The frequency of relapse was, in the outburst of delight accompanying the recovery of some cases hopelessly incurable under the old system, not suspected, and the bitter disappointment which this fact involves had yet to be experienced, and is, indeed, scarcely realised at this moment. In one of the Irish Reports, the circ.u.mstance is alluded to that, taking all the discharges of patients on account of recovery, the cures amounted to the gratifying number of seventy per cent. Had this proportion been sustained, and had these patients retained their mental health, there would have been little need of additional asylums. Patients from all quarters, their homes, poor-houses, and even jails, might have been drafted for a season into these temples of health, and, having pa.s.sed the charmed threshold, been restored in a few months to the outer world, never to return.

If this pleasant illusion is dispelled by the course of events in Ireland, how much more strikingly must it be so in England? for the former country is almost altogether free from that most hopeless of all mental affections, the general paralysis of the insane--the plague of all other civilized countries--and has fewer epileptics.

There are now in Ireland 43 district and private asylums, with a population of insane persons amounting to 9289. There are 163 poor-houses in which there are insane and idiotic persons.

The insane under the jurisdiction of the Inspectors on the 1st of January, 1881, were thus distributed:--

In district asylums 8,667 In the Dundrum or Criminal Asylum 180 At Palmerston House 19[288]

In private licensed houses 622[289]

In 163 union workhouses 3,573 ------ Total 13,061[290]

As many as 1270 patients were received as dangerous lunatics under the 30 and 31 Vict., c. 118.

Will nothing be done to simplify admission? "Had the Bill introduced by Mr. Litton during the past session become law, the admission order universally used in England would have extended to Ireland, so that in time the present confusion and difficulty experienced in obtaining admission to Irish asylums might have been removed by the subst.i.tution of one simple order for the complicated machinery at present in existence. The Inspectors, however, seem to consider that the introduction of the Bill extending protection under the 16 and 17 Vict., c. 97, to the insane who are at present not under State provision, would be to fill hospitals for the insane with unpromising cases, at a considerable increase of expenditure, to the exclusion of others more urgent or more hopeful. The answer to this seems plain, that if the accommodation for the insane is inadequate, every effort should be made to provide increased means of protection for those who are unable to care for themselves. It cannot surely be reasonably maintained that because the accommodation is inadequate for the want of the insane population, for that reason no further legislation should be put in force for their better protection, nor does the supposition that mistakes might occur in sending people to asylums who do not require to be deprived of their freedom, deserve more serious consideration. That such mistakes may and will occur for all time cannot be doubted, but there cannot be any reason to suppose that because increased supervision is provided, these mistakes would become more frequent. Such has not been found the case in England, where this Act has been in force for many years."[291]

The best thing we can hope for the effectual care of the insane in Ireland is legislation in the direction indicated by Lord O'Hagan and Mr. Litton.

ADDENDUM.

TABLE A.

NUMBER OF PATIENTS IN DISTRICT ASYLUMS, JANUARY 1, 1881.

-------------+----------+-------------+-------- Asylum. | Males. | Females. | Total.

-------------+----------+-------------+-------- Armagh | 100 | 96 | 196 Ballinasloe | 266 | 197 | 463 Belfast | 262 | 201 | 463 Carlow | 137 | 116 | 253 Castlebar | 174 | 115 | 289 Clonmel | 213 | 197 | 410 Cork | 450 | 420 | 870 Down | 197 | 141 | 338 Ennis | 140 | 121 | 261 Enniscorthy | 157 | 143 | 300 Kilkenny | 129 | 114 | 243 Killarney | 178 | 124 | 302 Letterkenny | 200 | 99 | 299 Limerick | 235 | 244 | 479 Londonderry | 147 | 124 | 271 Maryborough | 155 | 118 | 273 Monaghan | 244 | 159 | 403 Mullingar | 240 | 194 | 434 Omagh | 284 | 201 | 485 Richmond | 451 | 571 | 1022 Sligo | 200 | 141 | 341 Waterford | 126 | 146 | 272 +----------+-------------+-------- | 4685 | 3982 | 8667 -------------+----------+-------------+--------

WORKHOUSES.

Insane and Idiots.

Ulster 1054 Munster 1036 Leinster 1170 Connaught 313 ---- 3573

In jails 3 In Dundrum 180

TABLE B.

NUMBER OF PATIENTS IN PRIVATE ASYLUMS, JANUARY 1, 1881.

-------------------------------------+------+--------+------ |Males.|Females.|Total.

-------------------------------------+------+--------+------ Armagh Retreat | 16 | 9 | 25 Bloomfield Retreat, Co. Dublin | 14 | 27 | 41 Cittadella, Co. Cork | 15 | 9 | 24 Cookstown House, Piltown, Co. Dublin | 1 | 3 | 4 Course Lodge, Co. Armagh | -- | 12 | 12 Elm Lawn, Co. Dublin | -- | 3 | 3 Esker House, ditto | -- | 3 | 3 Farnham House, ditto | 31 | 23 | 54 Hampstead House, ditto | 23 | 1 | 24 Hartfield House, ditto | 29 | -- | 29 Highfield House, ditto | -- | 14 | 14 Lindville, Co. Cork | 13 | 19 | 32 Lisle House, Co. Dublin | -- | 3 | 3 Midland Retreat, Queen's Co. | 4 | 7 | 11 Orchardstown House, Co. Dublin | 5 | 6 | 11 St. Patrick's (Swift's), Dublin City | 38 | 63 | 101 Rose Bush House, Co. Dublin | 2 | -- | 2 Stewart Inst.i.tution, ditto | 45 | 67 | 112 Verville, ditto | -- | 19 | 19 St. Vincent's, ditto | -- | 95 | 95 Woodbine Lodge, ditto | -- | 3 | 3 +------+--------+------ Totals | 236 | 386 | 622 -------------------------------------+------+--------+------

FOOTNOTES:

[251] Dublin. See _postea_.