HC Deb 17 March 1842 vol 61 cc797-807
Lord G. Somerset

rose to bring forward the motion of which he had given notice, relative to the inspection of lunatic asylums in England and Wales, licensed by the magistrates at quarter-sessions. It was notorious to every gentleman who had paid any attention to this subject, that various attempts had been made to regulate these houses for the reception of insane people, and that the attention of the House had frequently been called to the subject, especially by the right hon. Gentleman near him (Mr. C. W.W. Wynn), and not without beneficial result; and at length the system now in existence had been established, after parliamentary inquiry. The House was not perhaps aware of the main provisions of the act then passed, which were still in force, and therefore, he trusted, he should be excused for shortly stating them, in order the more easily to explain the proposition for which he intended to move. The great object of the act passed in 1828, and subsequently subjected to several amendments, was to take care first, that there should be proper houses, of a proper character, licensed for the reception of insane people; the next object was to cause those houses to be conducted on such principles as would conduce to the comfort, and insure the proper treatment, of the inmates; another object was to prevent persons not in a state of insanity being placed in confinement; and, lastly, to prevent persons properly placed in lunatic asylums being kept there after their recovery. But he was ready to admit, that there was a very large class of persons, with regard to whom that act made no provision, and with regard to whom the sympathies of the House must always be strongly excited: he meant those individuals who were either kept in confinement in their own houses, in separate lodgings, or in public institutions, such as county asylums, and the hospitals of Bethlehem and St. Luke's. With regard to these parties, he did not intend to offer any suggestions whatever. He meant to confine his attention to those individuals who were kept in the licensed asylums in the country, and not in the metropolitan districts. By the act to which he had referred all licensed houses were brought under two separate and distinct authorities —namely, a certain portion under the authority of a commission of twenty individuals, five of whom were physicians, two barristers, and the rest gentlemen who, without remuneration, dedicated their time and trouble to this object. All licensed asylums in the county of Middlesex, and in the various parishes adjoining in Surry, Kent, and Essex, were placed entirely under the superintendence and management of the gentlemen of this commission. Nearly one-half of the licensed asylums were situated in the metropolitan district, and about the same number of persons was confined in these as in the private asylums throughout the country. The remainder of the houses licensed throughout the rest of England were placed under a different jurisdiction; they were licensed by the magistrates at quarter-sessions, and placed under the superintendence of physicians and magistrates then appointed to visit them; and who devoted their time to this work of humanity. But it was impossible to suppose that the same regularity of attention and advantage could be derived from this superintendence of the county magistrates with the occasional assistance of medical practitioners, as could be obtained from the regularly appointed commissioners. He did not mean to cast any reflections on those who discharged the duty of visiting the country asylums, who, if placed in the same position as the metropolitan commissioners, would be just as valuable; it was of the system that he could not approve. He would not therefore abrogate the present mode of inquiry and visitation in the country, but super add individuals of experience and knowledge on a similar system to that carried out in the metropolitan districts, in order to obtain greater regularity and efficiency in the visitations. One of the most important duties that could devolve upon the visiters was, to see that the house which was licensed for a certain number of individuals should not receive a greater number of patients than it was licensed to take. Without particularizing cases, he was prepared to show from returns he had received, that in more than one instance more patients had been received in licensed asylums than was warranted. Nothing also was more important than that the visiting magistrates should be regular in their visits to these houses; but the returns showed, that in many counties, in some years, the three annual visits provided for by law, none had been made. This showed that some remedy was wanting; and that remedy ought not to be left to the gratuitous exertions of individuals, but should be pro- vided by imposing on some parties official responsibility, and securing the certainty and regularity of superintendence which official responsibility was likely to lead to. He did not wish to create any prejudice against the proprietors of lunatic asylums, for he had seen amongst them, during three or four years' experience, a strong disposition to act with humanity and every degree of kindness and good feeling; but he urged, on the general principles of human nature, that it was of importance, that these individuals should be actuated by a salutary apprehension of the inspection of intelligent and independent individuals. On the other hand, he would not have the commissioners or visiters interfere in the medical treatment of patients. He believed, that no system could work better than that of the London commission. The medical, legal, and other gentlemen of that commission, had vied with each other in their exertions to render their superintendence as efficient as possible. They had not only done a great deal of good by their exertions, but had prevented much harm. Nothing could be more valuable than the services of the barristers who had been appointed on the commission during the whole period of their appointment. His object was, by the bill he wished to introduce, to appoint that some of the commissioners acting in London should make circuits of inspection to the asylums in the country districts. He had not the slightest doubt but that the habits of business which these gentlemen would have acquired would be found most valuable; and their being also a part of the London commission would act as a check on their proceedings in the country; and the advice of their fellow-commissioners in London would be very useful to them in the proper discharge of their duties. He had now to consider whether it would be desirable to have medical or legal gentlemen, as paid commissioners, to make circuits through the country. He was of opinion, that it was not so desirable to appoint medical men; as generally, though there were some brilliant exceptions, they were not distinguished by the habits of exactness which legal men acquired from their education; and also because it would be difficult to get any medical gentlemen of first rate ability—and others he should be sorry to see appointed—to give up their practice, and dedicate the whole of their time to the duties of their situation; more especially as it was not in his (Lord G. Somerset's) power for various reasons to move that the bill should be more than of temporary duration. What he proposed to do was this—that instead of the legal commissioners being appointed, as they now were—allowed to practise, and only paid for the hours they devoted to this duty— that they should dedicate the whole of their time to the duties of the situation, and be paid by such a salary as should insure the appointment of proper individuals of high legal attainments, and which at the same time should not be so large a salary as to encroach on that fair economy which was proper to be observed. He proposed, therefore, that legal gentlemen should be appointed with a fixed salary; that so long as they continued on the commission they should devote the whole of their time to the duties of the situation, and to their duties on the London commission. He proposed, that these commissioners should, once at least in every four months, visit every licensed asylum for the reception of insane persons in the country. It appeared from returns made, that there were somewhere about sixty or seventy houses licensed for the reception of insane persons in the country. It was rather curious to observe, that in about twenty-five counties—in all the counties in Wales, and some others in England—there was not a single licensed asylum for the reception of insane persons. Consequently, without allowing more than fair time for relaxation for health, he conceived the barrister-commissioner would have proper time to visit regularly every asylum in the metropolitan district four times, and in the country district three times a year. It was not his intention to do away with the visits of the magistrates in the country district as established by law. He thought, that the barristers, from their experience acquired in London, and from their knowledge of the law, would make the local magistrates more active in the discharge of their duties, and that the result would be a very regular superintendence on the part of the magistrates as well as by the commissioners. Every licensed asylum in the country would thereby be visited six times each year; and he thought also, from the greater degree of exertion which would be caused amongst the country gentlemen, that they would be induced to be more frequent in their attendance than the law required. On the visits to be made by these individuals, he proposed that their attention should be specifically directed to various matters—first to the state and description of the licensed house; next, to the treatment of the patients; then to an examination of the certificates, and more especially how far the patients were fitting or otherwise for removal to a lunatic asylum. Such were some of the principal duties which he meant to devolve on these barrister-commissioners. At present it was a most cumbrous process which the law provided, in order to get a person out of the licensed houses; he believed the only course to be pursued at present was, to make an application to the magistrates at quarter-sessions; and thus in the country three or four months sometimes elapsed before the unfortunate individual could be released. Now, what he proposed to do in this respect, would be to accelerate the process in the metropolitan districts by the amount of fifteen days. This he proposed to effect by two operations. At present the law required, that there should be four days' notice before the meeting of the commissioners in the metropolitan district could take place. This notice he proposed to reduce to twenty-four hours. The visits to the patient, prior to his release, were now three in number, with an interval of fifteen days between each. The third visit he proposed by this bill to do away with, and that the commissioner should have power to let out the individual if he so thought fit. With regard to the country districts, he proposed reserving all the powers of the visiting magistrates as they now stood; but that the barrister-commissioner should be allowed, and specially enjoined, to consider the state of mind of every person in the licensed houses, and if he had a doubt of the insanity of any of them, he might proceed, after two visits, with an interval of fourteen days between them, to release such individual on his (the commissioner's) own authority, aided by the opinion of a medical man, to be called in for that purpose. There were various other small particulars which would be contained in the bill, all tending to the comfort of the unhappy patients confined in the licensed houses of reception, and which went to regulate the mode of visitation. He would here observe, that he, together with his noble Friend the Member for Dorsetshire, had considered how far it was possible to provide against the improper confinement of persons not in lunatic asylums. They had thought it desirable, if possible, to devise some means more stringent than at present existed to prevent parties being improperly confined, and they had just considered whether it would not be possible to make regulations as to the competency of the party who should sign the certificate, without which no party could be confined. In London they found it would not be very difficult to accomplish this, but in the country the difficulty would practically be such that he was not willing to throw any obstacle in the way of the certificate which necessarily accompanied persons sent to licensed houses of reception. The present certificates would therefore remain as they were at present. Neither did he mean to attempt to regulate the care of a very large class of individuals who were in confinement in private dwelling-houses, and who suffered much more serious grievances than the patients confined in well-regulated licensed houses. The class of persons to whom he alluded were left in the care of individuals over whom there existed little or no power of supervision, and therefore he admitted their case required very serious consideration, and he would very gladly, if it were possible, devise some remedy for the evils. But he remembered when the first act on the subject had been introduced in 1828, and on discussions upon subsequent measures, founded on reports of select committees of the House, great consideration had been given to the possibility of interfering with patients of that description; and on the whole, looking at the delicacy of an interference with the feelings both of the patients so confined, and of their friends and relations who had the care of them, it had been thought not to be advisable to attempt to regulate further than the present law did, persons so confined in private houses. This decision had been come to out of delicacy to the sufferers themselves, to whom the visits of strangers might be irksome. As to the feelings of the relatives of these parties, they presented a great difficulty in the way of such a visitation as would be effectual. What was the fact? Why, that the very reason they did not send the patients to the licensed houses was, because they would be there exposed to the constant visits of the commissioners and public authorities, and therefore they preferred doing that which was most inconvenient— namely, to keep them at home. He did not mean by the measure to attempt to interfere with the public institutions, such as Bedlam, St. Luke's, and the county hospital. He believed that, generally speaking, those hospitals were very well conducted, though he did not think it would be a bad thing to have an inquiry into the manner in which those institutions were conducted. He would admit at once that in proposing this measure he did not do all that he thought could be done in the matter, but he could not help expecting that by doing what he now proposed there would be laid the foundation of a better general system, and that after the information which the commissioners would acquire by their communications with the country, the whole subject would be brought to a focus before the London board. From this great good would arise, and eventually Parliament would be enabled to legislate upon this important subject on a broader and more extensive basis. It might be known to the House that a noble and learned Friend of his had proposed in another place a bill to lessen the costs and expenses attending the conduct of a commission of lunacy. He thought eventually a very useful union might be effected between the commissioners his noble and learned Friend meant to appoint under that bill, and the commissioners who were to inspect the lunatic asylums throughout the kingdom. But, on the other hand, he was of opinion that it would not be advisable to attempt to carry out that principle at present. He thought the experiment of his noble and learned Friend in the other House should be carried out before any amalgamation of the two classes of commissioners should be made, and he desired also to see how his own proposition worked before he ventured to adopt that which, in the end, might be thought useful and desirable. He was aware that in this manner he had confined himself to narrow limits, but still he could not but think that he had gone as far as, under the circumstances, he ought to go. He admitted that his proposition was very short of the wishes of some Gentlemen he saw opposite, and that it did not extend so far as he himself could wish; but, as a precedent of something more extensive, he thought even this little might be useful. With these observations, he would now move for leave to bring in a bill to provide for the more effectual inspection of houses licensed by the magistrates in quarter-sessions for the reception of insane persons in England and Wales.

Mr. Wakley

returned his thanks to the noble Lord for having given his attention to this subject—a subject which had very long indeed demanded the best consideration of the Government of the country, and which had the strongest claims upon both the sympathy and the time of Parliament. When he had said this, he must express the disappointment he felt at the measure the noble Lord had proposed. The noble Lord had said, and he agreed with him—that this was a small measure indeed, compared with what was required and called for—nay, he (Mr. Wakley) thought that the measure was too insignificant to admit of any designation at all. Look at the state of the law with reference to lunatics in England, in Ireland, and in Scotland. 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 the adoption of the noble Lord. Now, the returns of the labours of the commissioners were before the House, and upon another and an early occasion he would take the opportunity of calling the attention of the House to what they had done, for he did not wish to condemn them without making a statement of facts which would justify him in doing so. The proposal of the noble Lord was, in substance, this—that there should be appointed two commissioners, to visit the licensed houses for the reception of insane persons out of the metropolitan districts. Now, what were licensed lunatic asylums? They were hospitals—houses of reception for the treatment of persons afflicted with the most grievous disease to which humanity could be subject. And what did the noble Lord propose? He proposed to appoint two barristers as medical visitors to these hospitals—two gentlemen of the legal profession were to be selected to visit the hospitals in this country. He did not suppose the noble Lord intended this proposition as an insult to the medical profession; but, if it had been so intended, one of a more marked character could scarcely have been offered. Was the noble Lord aware that the whole evil of the present system consisted in the medical treatment; his proposal did not touch that cause of complaint, or any of the defects of the present system. If there were competent inspectors of a medical education to inspect, examine, and to scrutinize the medical treatment, and to see the means of cure, then an advantage would arise to the unfortunate patients who now suffered grievous and painful neglect. The noble Lord had said he did not mean to touch the great institutions, nor to extend the measure to persons confined singly. Now, looking at the number of persons bereft of reason, and who were in a state of confinement without the means of communicating with their friends, he thought something more comprehensive was necessary, to meet an evil of such magnitude. He thanked the noble Lord for the time and attention he had paid to the question, but he must entreat him not to propose the second reading until some distant day, and in the mean time, if the House would permit him, he would lay the whole case of the asylum treatment of lunatics and the report of the metropolitan commissioners before it, and would then ask the Government if they would refuse to appoints commission to investigate the whole subject with a view to legislating upon it for England, Ireland, and Scotland. He repeated that the measure now proposed would not remedy one of the existing evils. The visitations appointed by the bill were not numerous enough. As he meant to ask the attention of the House to the whole subject immediately after Easter, he begged the noble Lord to postpone further proceedings on the bill till he should have made his statement.

Mr. Hawes

was disappointed with the measure, which he thought so small as hardly to be worth producing. The appointment of barristers to judge whether a lunatic should or should not be retained in an asylum was absurd. The public hospitals ought to be rendered liable to inspection. At present a different system of inspection was adopted in each; in some there was no system at all. The noble Lord had not told them what amount of salary he proposed to give the barristers; this was a very important point, because if they were to obtain legal functionaries of any reputation, they must pay them well. He thought there was no objection, if there must be a legal inspector at all, to joining a medical one with him. The inspectors ought to have more power than at present, which the bill did not give. He hoped considerable time would be given before the second reading, in order that hon. Members might give a full consideration to the subject; but he would much rather that the bill were sus- pended, in order that the London board of commissioners might have time to take into their consideration the subject of the bill, and that a more extensive and efficient measure might be framed in pursuance of their suggestions than this could ever be.

Lord Ashley

wished the measure had gone somewhat further. However, even under the present law, the House was unaware, he was sure, of the very great improvement that had been effected. No one could be properly acquainted with the defects of the provincial system but one who had seen the working of the metropolitan system. In the former there was no effective visitation whatever. A very large proportion of the houses occupied as asylums were not reported on, and no knowledge was to be had respecting them. The consequence was, that the London commissioners in respect of them were wholly unable to carry out the great objects of the statute. They had not the power of tracing lunatics through the provincial houses, and therefore could not tell what was done with them. That power it was desirable they should have. The proper sphere of the board, however, was to control, not to suggest. It would baffle the ingenuity of the Member for Finsbury (Mr. Wakley) to institute a practicable system of uniformity for all the asylums in the country. Take the system of non-coercion, it would be impossible to enforce its adoption in all asylums. The great expense would be an effectual obstacle in many cases. It should be remembered that persons having the care of lunatics were seldom highly paid for their services, and they had little inducement to try experiments of new modes of treatment. From his own observation, however, he was able to testify to the great good affected at the Hanwell Asylum by this system, where the coercion had been reduced at least two-thirds. With respect to the question of legal inspectors, he must say, speaking from the experience he had had in visiting these houses, that although so far as health was concerned the opinion of a medical man was of the greatest importance, yet it having been once established that the insanity of a patient did not arise from the state of his bodily health, a man of common sense could give as good an opinion as any medical man he ever knew. But it was found of very great importance, in many instances, to have a person as inspector who had been brought up to the law. With respect to the certificate, there was no one point in the whole range of these operations on which it was so difficult to come to a conclusion as on the certificate. If the law were applicable only to the large towns, he should think they might make several improvements in it; but applicable as it was to the whole country, where there was often only one medical man within a range of several miles, you must take whoever you could get, and instead of having certificates from men of five years' standing, they were often obliged to take those of men of one or two years. Hon. Gentlemen opposite said, that there was too great a facility for incarcerating these unfortunate persons; he went elsewhere, and found persons of equal feeling asserting that such was the state of things that there was no regard for the public safety— madmen were walking about in all directions. What, then, were the commissioners to do? They had 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 carried it into execution.

Mr. C. Williams Wynn

thought the measure did not go far enough, but that what it did would be of considerable benefit to the community. The bill, on the whole, had his approbation, and he would give the measure his best attention, so as to render it as beneficial as possible.

Leave granted.