TREATMENT OF INSANE PERSONS IN ENGLAND AND WALES.

HC Deb 06 June 1845 vol 81 cc180-202

Lord Ashley

, in rising to bring forward the two Bills of which he had given notice, said: My Motion requires some preliminary explanation. By the two Bills I intend to effect the repeal of many existing Acts respecting the treatment of Lunatics, and substitute such other enactments in their place, as time and circumstances have rendered necessary. Before entering into the general principle of my Motion, I wish to observe that my proposition will apply only to England and Wales. I wish that circumstances enabled me to extend the Bills to Ireland and Scotland; for 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. I assume in the first place, that the House, or at least a considerable portion of those hon. Members who may honour me with their attention, have read the Report of the Commissioners in Lunacy made in the last Session of Parliament; and I will also assume that it is unnecessary for me to repeat the statement which I made in the course of last year on the subject which I now seek to bring under your notice. You will allow it, perhaps, to form a part of my present speech. It is ne- cessary I should begin by reminding you that the laws affecting lunatics may be divided into four classes, and that that law, as it now stands, is embodied in nine several Statutes. These nine several Statutes may be divided, as I have said, into four classes; first, those which are relative to county asylums; second, those relating to licensed asylums, public asylums, and the visitation of those respectively; third, relative to persons found lunatic by inquisition, the appointment of visitors, and of a "commission in lunacy," to perform duties formerly discharged by Masters in Chancery; fourth, relative to criminal lunatics. Now, I do not intend to touch more than the first two of these classes. I mean to amend the single act contained under Class 1, as well as to amend and combine the three which are contained under Class 2. The three Bills contained under Class 2 are as follows:—2nd and 3rd of William IV., c. 107; 3rd and 4th of William IV., c. 64: and 5th and 6th of Victoria, c. 87. These various Statutes I propose to consolidate into one, entitled "A Bill for the Regulation of the Care and Treatment of Lunatics in England and Wales;" and I must solicit, for a topic in itself uninviting and dry, your forbearance and indulgent attention. But before I proceed further with this part of the subject, I may be permitted for a moment to recur to the state of the law as it existed under the 14th of George III., the only law for the regulation of private asylums previously to 1828. In those days there was no power of punishing any offence—there was not even the power of revoking or refusing any license. There was also extreme laxity in the signature of certificates, one only being deemed sufficient; and that might be, nay, it often was, signed by a person not duly qualified, or by the proprietor of the madhouse in his medical capacity; and to the care of this person the alleged lunatic was consigned. Houses licensed under this Act were not required to be visited more than once a year. There was no power to discharge any patient who might prove to be of sound mind. Licenses could be granted only on one day in the year. Pauper lunatics were sent without medical certificates; there was no return of pauper patients made to the Board; and no plans were required of houses previously to the granting of licenses. There were no returns of the cases of lunatics kept singly in houses for gain; there were no visits of medical persons to the patients required. A measure was then introduced by Mr. Gordon, in 1828, to remedy these defects; and no enactment on your Statute book has been attended with more satisfactory results. I stated them at some length in my speech of last year. Evasions, no doubt, will be found wherever temptation and opportunity are combined; we can only pretend to mitigate, not to abolish, the evil. Now, the first of the Bills which I intend to submit to the consideration of the House, will establish a permanent Commission, and thereby secure the entire services of competent persons. It will give the power of far more detailed and frequent visitation, and fix the limits of expense, now regularly increasing. It will place "hospitals" or subscription asylums under proper regulations, by requiring them to have the same orders and certificates as are necessary in licensed houses, and by subjecting them to the same visitations as county asylums. My Bill will also provide an additional security against the improper detention of pauper patients, by requiring that the person signing the order for their confinement shall personally examine them beforehand, and that the medical officer who certifies as to their insanity shall see them within seven days previous to their confinement. I may add that neither of these safeguards exists at present. I propose, also, that my measure should compel every person receiving a patient to state his condition, mental as well as bodily, when first admitted, and the cause of his death when he dies. It will also direct that every injury and act of violence happening to a patient shall be recorded, and will require a case-book to be kept, thereby affording additional securities against mismanagement, and showing how far the patients have the benefit of medical treatment. It will also authorize the visitors to enforce a proper supply of food (in licensed houses) to pauper patients, who are at present fed at the discretion of the proprietor. Further, it will enable the visitor to order the admission of a patient's friends; at present, they are admitted or excluded at the caprice of the person who signs the order for the patient's confinement. It likewise will enable the visitors to sanction the temporary removal of a patient in ill health to the sea-side, or elsewhere. It, moreover, will enforce an immediate private return of all single patients received for profit, and authorize the members of a small private committee, named by the Lord Chancellor, to visit them, if necessary. This is the provision of the law in France; in that country licenses are prescribed for every house, and certificates and visitors for every lunatic. The abuses and cruelties perpetrated in these retreats for single patients would surpass the belief of the House. I have said before, and I say again, that should it please God to afflict me with such a visitation, I would greatly prefer the treatment of paupers in an establishment like that of the Surrey Asylum, to the treatment of the rich in almost any one of those receptacles. These returns are universally evaded at present, the law rendering it unnecessary to make any return, unless the patient has been confined for twelve months. The Bill will give the Chancellor power to protect the property of lunatics against whom a Commission has not issued by a summary and inexpensive process, and it subjects all workhouses in which any lunatic is kept to regular visitation. The second Bill which I intend to lay before the House is called for by the Report of the Commissioners, and the facts which I produced in my statement of last year; and, presuming that the House will accept this for granted, I think it may not be necessary for me to go over the evidence that was then laid before the House; nevertheless, I do feel it necessary to call the attention of the House to the principal defects which are pointed out by our Report as to pauper lunatics and county asylums. First, that there are 40 counties in England, and only 16 county asylums; and 12 counties in Wales, and only one disgraceful borough asylum. Of the 24 counties in England having no asylums, one has 500, two upwards of 400, three upwards of 300, seven upwards of 200, and 11 nearly one hundred lunatics each; and Wales has 1,000 lunatics. The second is, that of the 16 counties which have asylums, one has 800, one has 600, one has 500, one more than 300, three more than 200, and the rest more than 100 lunatics, for whom there is no accommodation in the asylums which have been erected, and no other receptacle. The third defect is, that all the existing asylums are full of incurables, or persons said to be incurable. The fourth defect is, that no system has been adopted in the county asylums to give preference to urgent cases, or those capable of cure. The fifth fault in the present state of the law is, the detention of lunatics in workhouses, where there is no sufficient medical or moral treatment. At the Union workhouse of Redruth, there were 40, and of Leicester 30 lunatics; and at Birmingham, not in the Union, 70 lunatics. The sixth is, there is no real visitation or true account of those lunatics who are not in asylums; for example, the lunatics of North and South Wales, and those in England not in asylums, being 9,339, with their friends or in workhouses. I think I may now proceed to illustrate the necessity for these alterations by reference to one or two cases. I find, from the Report before me, that in the Leicester Union workhouse— There were thirty insane persons, of whom three males and nine females were dangerous lunatics, in the strict sense of the word, and most unfit inmates of the place; and where, as we were informed, they had been long detained, in spite of the remonstrances of the visiting surgeon and some of the magistrates. In the parish workhouse at Birmingham, there were seventy-one insane persons, subject to insanity in various forms, several of them being epileptics, liable, after their paroxysms of epilepsy, to fits of raving madness, during which they were usually excessively violent and furiously maniacal. Take the case of the private house at Derby visited in 1842:— The straw in the paupers' beds was found filthy, and some of the bedding was in a disgusting condition from running sores, and was of the worst materials, and insufficient; two cells in which three sick epileptic paupers slept were damp, unhealthy, and unfit for habitation; the beds of some of the private patients were in an equally bad state; nearly all the provisions of the law for the regulation of licensed asylums were violated… The magistrates of the borough, who are its visiting justices, had not visited the house for the space of a year minus eight days. … In 1843 it was again in a very bad state; the paupers were still occupying what had been the coachhouse and stables; the rooms were low, comfortless, and ill-ventilated, and one of the apartments most offensive. It has been visited within the last six weeks of the present year; the Commissioners report that the condition of the private patients was improved, but that of the paupers was so bad that another communication must be made by the Board to the magistrates of the borough. Now, here is an excellent sample—though there are exceptions I admit—of the mode and measure of provincial visitation by the provincial magistracy. I am speaking in reference to the visitation of private asylums only; the supervision and care of the county asylums are, on the whole, extremely satisfactory. But look at this: the justices in the preceding year visited the asylum but once; they received a shock, no doubt, by the spectacle they witnessed, and they took a good course to avoid a repetition of it; for, says the Report, "during the last year no visiting justices were appointed." It is very true, that many private asylums are of a superior character; but the tendency of such establishments is to this state of things. Every one must perceive that the pittance of seven shillings or eight shillings a week given to the proprietor of an asylum for the maintenance and cure of a pauper lunatic, is altogether insufficient; the proprietor actually and justifiably looks to realize a profit; and, however great his humanity, which I have seen in frequent instances, will not generally go beyond that point which will leave him an adequate return for himself. I will now, by a very striking example, illustrate the deplorable condition in which some of the pauper lunatics in Wales have been placed. I will mention the case of Mary Jones, who was consigned, be it observed, to the care of her mother. The Report made upon her case I will now read, with the permission of the House:— We went to the cottage between eight and nine o'clock in the evening, accompanied, at our request, by Dr. Lloyd Williams, who interpreted to us the answers given to questions put through him. In a dark and offensive room over a blacksmith's forge, upon opening a bolted door, we discovered the miserable object of our search. The only window was closed up by boards, between which little air could find admission, and only a feeble glimmering of light. In the middle of this loathsome chamber was Mary Jones, the lunatic, on a foul pallet of chaff or straw; and here she had been confined for a period of fifteen years and upwards. She was seated in a bent and crouching posture on her bed of nauseous and disgusting filth. Near to her person, and just within her reach, was a cup, into which she was accustomed to pass her excretions, which she emptied from time to time into a chamber utensil. This last vessel contained a quantity of feculent matter, the accumulation of several days. By her side were the remnants of some food of which she had partaken. Within a few feet of the pallet, which was on the floor, stood a large earthen jar, nearly full of fetid urine, the produce of the three other persons in the cottage. It had, as stated by the mother, been placed there in order that it might, from the warmth of the room, undergo a more speedy decom- position for the purpose of being used in dying wool. The stagnant and suffocating atmosphere, and the nauseous effluvia which infected it, were most intolerable. Listen to the effects of this treatment:— Thus long and close confinement had produced in Mary Jones's person the most frightful distortions. The chest bone protruded forwards five or six inches beyond its natural place, and there was an excoriation of the parts below. The legs were bent backwards, and the knee joints were fixed and immoveable. The ankles and feet were also greatly twisted and deformed. She was emaciated in the last degree; her pulse was feeble and quick; and her countenance, still pleasing, was piercingly anxious, and marked by an expression of despair. Her garments were loathsome, and from her person was emitted a most offensive odour. … For about ten years past she had been confined to the dismal chamber in which we found her, the window of which had been boarded during nearly the whole of that time. Now, observe the whole enormity of this case: this poor woman was removed to the hospital; what says Dr. Williams? We have the clearest evidence that if this poor creature had been properly treated in the first instance, she would have been completely cured. He adds:— August 14, 1844.—After I wrote to you yesterday I gave her (i.e. Mary Jones,) some money to buy calico, and I was gratified to find that she took a needle and thread and commenced sewing very tidily. On the authority of Dr. Williams, of Denbigh, I am enabled to say, that she must have been at one time fully capable of cure, and that she still had sufficient intellect to enjoy existence, when she was placed in favourable circumstances. It is time that I should now come to that part of my statement which has reference to the alterations that I intend to propose. The second Bill which I shall ask leave to introduce will be an extension of the Act of the 9th of Geo. IV. c. 40. We have taken this Act for our basis, and have been scrupulous in departing as little as possible from its provisions: the Act is far from perfect, but I must speak with deference of a law that has laid the foundation of such asylums as Surrey, Hanwell, and others. The principal amendments are these: — 1st. Instead of permitting, I propose to require, every county and borough which has no asylum, to provide one, either for itself, or in union with some other county or borough. 2nd. That every county which has an asylum, but insufficient accommodation, is to provide further accommodation. This is according to the law in France: every department in that country is compelled to furnish adequate receptacles for its insane poor. 3rd. In erecting new asylums, and providing further accommodation where it is required, regard should be had to the proportion of curable and chronic lunatics; I purposely avoid the use of the term "incurable." Separate buildings I propose should be provided for the chronic at a less cost, and parts of the workhouses, with the consent of the Poor Law Commissioners, may be adapted, in which case they are to be separated from the other part of the building, and to be deemed county asylums. 4th. Counties having asylums may unite with other counties not having one. 5th. To extend the Act to boroughs having courts of separate quarter sessions, and to every place not contributing to county rates. 6th. To assist magistrates in erecting asylums, and ascertaining the proportionate numbers of curable and chronic lunatics, and providing separate buildings for them; and for diminishing the expense of building asylums, the plans are to be submitted to the Commissioners in Lunacy, and the estimates to the Secretary of State; it is provided also that asylums for boroughs may be erected without the boundaries of the borough. 7th. The time for the repayment of money borrowed for building asylums I propose to extend from fourteen to thirty years. 8th. General rules for the government of asylums should be submitted to the Secretary of State. 9th. Copies of the accounts of asylums are to be sent to the Secretary of State. We also propose that all recent cases of lunacy are to be sent immediately to an asylum: this is an indispensable provision, for it is clear that if such cases are met with instant attention, the number of cures will be, as I shall presently state, in the proportion of from 70 to 90 per cent.; whereas if they are suffered, by neglect, to become chronic or inveterate cases, the amount curable is scarcely anything per cent., or at the very outside, and under the most favourable results, only from 6 to 8 per cent. We next provide for the reception of all lunatics who are not chargeable, whether wandering or otherwise; they are to be apprehended, and those whose friends cannot pay for them are to be admitted into the asylum as paupers. Our next provision is, that a quarterly inspection of all lunatics who are not in asylums is to take place by a medical man, who shall return lists of them, describing their condition, to the Commissioners in Lunacy. Amongst other provisions appertaining to this part of the Bill is one by which every pauper lunatic shall, in the first place, be deemed to belong to the parish from which he is sent, until he shall be proved to belong to another; and, with reference to this proviso, a clause will be introduced in order to protect counties from this casual charge becoming permanent, in cases where adjudications shall be made respecting lunatic paupers; and, lastly, power is to be given to remove chronic lunatics to the asylums provided for such cases. These are the main enactments: the others may be reserved for a future stage of the Bill. But after the proposed institution of hospitals for recent and chronic cases, I must detain you a short time—I will proceed to state, in the first instance, what the facts are which have been observed with respect to the actual state of the pauper lunatics in the great county asylum of Hanwell, in Middlesex. In that asylum there were, in the month of March, 1844, 984 patients, of whom thirty only were reported to be curable. There were waiting for admission 429 pauper lunatics, all of whom were, in consequence of the delay in applying a curative treatment, fast becoming incurable. Within the first three months of 1844 there were no less than forty lunatic patients to whom admission was refused into the Hanwell asylum, making in the whole year 160 patients. Of these, supposing that 6 per cent. were curable, there would remain permanently thrown upon the county of Middlesex for support, no less than 150 lunatics in each year. The second instance to which I shall refer, is that of the Lunatic Asylum of the county of Lancaster, which contained, in the year 1844, about 600 lunatics. Of these nearly all had been previously detained in the workhouses of their different parishes so long as to greatly diminish all probability of their cure. In the whole county there were then waiting for admission into the asylum about 500 lunatics, for whom no room whatever could be made. I next turn to the Surrey Lunatic Asylum, where I find on the 1st of January, 1844, no less then 382 patients, of whom 362 were reported as incurable, whilst there were in private asylums and elsewhere in the county 209 lunatics waiting for admission. I take these very magnificent establishments, because they afford striking examples of the want of provision for the treatment of recent cases, and they likewise offer the most convincing proofs of the increase of incurable lunatics throughout the counties, in consequence of the neglect of early treatment. Let us now look to the treatment pursued in other asylums, and contrast the effects of recent attention with those where the cases have experienced neglect of longer or shorter date. I refer in this respect to the Report of the Dorset County Lunatic Asylum, made at the Epiphany Sessions for the year 1845, which states that there had been discharged during that year twenty-three lunatics as cured, of whom seventeen had been admitted in the same year. And what did the superintendent say with respect to this fact? He reports thus:— This is a larger number of recoveries than has taken place in any year since the opening of the institution, and may be attributed to a greater number than formerly being admitted in the incipient stage of the disorder. Of sixteen persons who had been admitted during the first three months of their attack no less than thirteen were cured, making 81 per cent. In cases even of relapse, the proportion of cures was not less than 58 per cent., and in the cases themselves the disorder had existed for more than three but less than twelve months. In St. Luke's Hospital the cures during 1843 amounted to 63° per cent., and in 1842 to 70¼ per cent., the cases in many instances having been of several months' standing. I find, too, in a paper recently read before the Medical Society, communicated by Dr. Forbes Winslow, a gentleman who has paid much attention to this class of disorders, and who is justly entitled to be heard, an opinion that a large proportion of the many thousand incurable lunatics in England and Wales had been reduced to this melancholy state by the neglect to which they had been subjected in the incipient state of the malady. In fact, that nine out of ten cases recovered if subjected to treatment within the first three months of the attack. There is similar testimony in other countries: from the Reports of the State Lunatic Asylum of New York for the year 1844, sent to me by Dr. Brigham, I find it stated, that— Few things relating to the management and treatment of the insane are so well established as the necessity of their early treatment…… By examining the records of well-conducted asylums it appears that more than eight out of ten of the recent cases recover, while not more than one in six of the old cases are cured. And I find the same facts reported by the physicians of the Hartford Lunatic Asylum, in the United States. Many impediments, however, are thrown in the way of the speedy application of the curative treatment in cases of pauper lunacy—first, no magistrate, in any county having a public asylum, has it in his power to authorize the transmission of pauper lunatics to a private asylum for treatment in case the county asylum should be too full to receive them. The law has been so determined by a late decision in the Court of Queen's Bench, which renders it additionally necessary for the Government to apply themselves to a removal of existing difficulties; the parish authorites, moreover, are indolent, indifferent, or they seek to avoid the expense; but, after all, the main impediment lies in the want of adequate accommodation. And whence is this defect? It may be traced to the past and present fear of the enormous cost to be incurred in the construction of asylums. Here, then, I appproach the financial part of our project; and, although I admit that this is a most dry and uninviting topic, I still am under the necessity of entering upon some details respecting this branch of the subject, as it is of the most essential importance; and hon. Members will allow that without some explanation on this head I shall have but little hope for any Bill. The main impediments in the way of constructing county asylums has been, I have already said, and at present is, the fear of the enormous expense supposed to be necessarily attendant upon such undertakings. Now, the county asylum at Hanwell has cost in all the sum of 196,000l. On the original cost the rate per head for 1,000 patients was 160l., and on 800 patients 245l. The Surrey Asylum cost 85,000l., or 237l. per head for each patient. But this is far too large an estimate to be taken as an allowance of the cost per head; it is the opinion of the Commissioners that 80l. per head would be an ample allowance for the construction of lunatic asylums, and to provide that the enlightened curative system in the treatment of patients recom- mended by the best authorities be adopted and acted upon. Of this we shall be able to furnish ample proofs in the Committee on the Bill. The great error, as it has appeared to us, in the construction of lunatic asylums, is that they are all built upon the presumption that every one of the patients is of the same character, requiring the same minute care and the same precautions. This view of the question greatly enhances the expenses; but we look at the matter in a totally different way. We make a distinction between the different classes of lunatics; we provide a distinction between chronic cases and recent cases. For chronic cases of lunacy we provide good diet, warmth, clothing, air and exercise; and, in addition, occupation, which we recommend to be of the healthiest description—I mean occupation in the open air, such as gardening, or on farms. But the chronic patients do not require the same careful supervision which the recent cases would constantly call for, nor do they require the same medical attention as the patients who are under curative treatment demand; and, therefore, the care and attention shown to them is not by any means so costly as that of the patients who are undergoing the whole of the curative process, and towards whom every minute precaution and care must be constantly observed. Let us take, therefore, the proportions of these respective classes of patients, and adapt them to the estimates for building new asylums. Suppose we take 12,500 pauper lunatics to be the number requiring accommodation. From this number deduct 10 per cent. for the harmless lunatics, who may safely be left at home under the care of their relations, but also under medical supervision. Of the remainder, 40 per cent. are considered to be curable, and 60 per cent. are chronic or inveterate cases. Apply this to a county asylum having 300 lunatics; deduct 10 per cent., there will be 270 left; of these 40 per cent., or 108, are curable, and to be admitted into the "recent case" hospital: the remainder, 60 per cent., or 162, are patients for the chronic department of the asylum. The gross expense of such an asylum would be as follows:—taking the recent cases at 80l. per head, they would amount to 8,640l.; and taking the chronic cases at 50l. per head, they would be 8,100l.: making in the whole 16,740l. for these two classes; but, as all cases of epilepsy and of violent patients must be under especial Care in the recent case hospital, I will add one-sixth of the whole expense, or 3,290l., to the sum already mentioned as the cost of this extra care, by which the sum total for 300 patients in an asylum will be 20,030l. We propose to extend the term of repayment, out of the county rates, of the cost of these asylums from fourteen to thirty years; thus the annual burden on the county rates in the case I have referred to would only be 666l. Now, compare the burden which our plan would impose, with that under the present system; the average expense of construction of eleven county asylums has been 170l. per head. Thus, under the old plan, an asylum for 300 lunatics cost 51,000l.; under the new plan, as I have just shown, it will cost 20,030l. Take then the gross expense of providing for 12,500 lunatics, at 170l. per head, it would be 2,125,000l. throughout England and Wales; whilst under our plan it would be 813,750l., being a difference of 1,311,250l., leaving for the thirty-six counties in England and Wales unprovided with asylums an average of 22,604l. (and in many counties much less), repayable in thirty years. Now if we look to the number of chronic cases, and to the mode of their treatment, we cannot wonder at the enormous expense which lies on the counties. There are pauper lunatics in asylums, say 7,000; in workhouses and elsewhere, 10,000; curable in asylums, 20 per cent., or 1,400; in workhouses, 20 per cent., 2,000; making together 3,400. Incurable in asylums, 5,600; in workhouses, 8,000; making together 13,600. Now, the average duration of the lives of lunatics has been calculated by Dr. Conolly at ten years, which is a very low average. Observe this; the following would be the average annual cost at 20l. per head:—60 per cent. of 5,600 (or 3,660) lunatics in asylums, at 20l. per head, would have cost, for one year, if cured, 67,200l.; if allowed to become incurable, and they live the average of ten years, 672,000.; in same way, 60 per cent. of 8,000 (or 4,500) lunatics, would have cost 96,000l.; if incurable, 960,000l. Now, with respect to the duration of life in an insane person, I am strongly persuaded that the average of ten years is far too low a basis to calculate upon. Dr. Hitch, of Gloucester, says that insanity by no means shortens life, and he gives tables to show this. He asserts that out of 105 deaths, there were sixteen above fifty years of age, seventeen above sixty, and seventeen above seventy, being nearly 50 per cent. of the whole mortality. I may here call attention to another feature in the economy of the plan which we propose, namely, that exhibited in the case of the Hanwell Asylum, which is, in fact, the case of every asylum. By the present system, the cures only average 6 per cent. instead of 60. The number of applications refused every year is 160. There are thus 150 incurable lunatics thrown upon the county annually, instead of sixty-four, being an annual difference of ninety-six. Now, had these been sent and cured within the first six months, they would have cost at the annual rate of 16l. 11s. 6¾d. each, or 1,591l. 10s. But supposing them to become incurable, and live the usual period, the cost would be 31,830l. This system prevailing throughout the whole kingdom, the present plan would reduce the additions to the chronic lists from ninety-four to thirty annually; and the calculations which I have laid before the House show that in Middlesex alone there would be an annual saving of 30,000l. This is a saving which, in the course of ten years, will more than cover the whole additional outlay for the construction of a new asylum. But this is not all the good that will result from our plan. By recovering the patient, not only will the expense of his maintenance for life in a lunatic asylum be avoided, but he will be restored to his occupation—and his family, instead of being thrown upon the parish for support, will again look to him for their means of existence; for the system which we propose to substitute for the present one will effect a cure in seventy cases out of every hundred. But other and very great advantages will arise by reducing the size of these asylums. They are far too large for an efficient administration of the curative process. There must be, to ensure success, a minute attention to diet, exercise, and classification—the patients must be seen daily, sometimes hourly, and occasionally, in certain circumstances, during the night. No one man can undertake the charge of more than 300 patients: the experience of all practical men is concurrent on this point: no one presses it more vigorously than Dr. Conolly. Hear the testimony of Dr. Julius, an eminent physician at Berlin: Every public or private institution," he writes, "has certain limits in which it must be restricted." He insists particularly "on schools, hospitals, and, more than all, penitent- tiaries and lunatic asylums, as places where the individualising treatment of every case will contribute much, and more than anything, to its success. He proceeds to lament the extension of Hanwell, and adds, that— This institution, excellent as it is, warns mankind not to enlarge asylums beyond the limits which are traced by the moral and physical powers of the individual that has to guide and manage it. Our present business, however, is to affirm that poor lunatics ought to be maintained at the public charge. I entertain, myself, a very decided opinion that none of any class should be received for profit; but all, I hope will agree that paupers, at any rate, should not be the subjects of financial speculation. How is it possible that the proprietor of the house should out of 8s. a week give the patient everything that is required—full diet, ample space of house and grounds, all the expensiveness of the non-restraint system, and realize in the remainder an adequate return for himself and his family? The thing is next to impossible, and ought not to be attempted. And now, Sir, it seems to me unneccessary to weary the House any further by preliminary matter; for whatever remains and requires explanation, may be made the subject of discussion, should the House be pleased to permit the introduction of these Bills, and the subsequent consideration of them in Committee. Still more is it unnecessary to urge upon this House—an assembly of educated, humane, and Christian ment—the duty of coming forward to the aid and protection of this utterly helpless class, who, under the marked visitation of a wise though inscrutable Providence, demand an unusual measure of our sympathy. Sir, it is remarkable and very humiliating, the long and tedious process by which we have arrived at the sound practice in the treatment of the insane, which now appears to be the suggestion of common sense and ordinary humanity. The whole history of the world, until the era of the Reformation, does not afford an instance of a single receptacle assigned to the protection and care of these unhappy sufferers, whose malady was looked upon as hardly within the reach or hope of medical aid. If dangerous, they were incarcerated in the common prisons; if of a certain rank in society, they were shut up in their houses under the care of appointed guardians. Chains, and whips, and darkness, and solitude, were the approved and only remedies. The practice has descended to our own day; and Dr. Conolly assures us that he has formerly witnessed Humane English physicians daily contemplating helpless insane patients bound hand and foot, and neck, and waist, in illness, in pain, and in the agonies of death, without one single touch of compunction, or the slightest approach to a feeling of acting either cruelly or unwisely. They thought it impossible to manage insane people in any other way. Sir, the honour of these discoveries, and the first practice of them, belongs unquestionably to the French nation; it is to the genius and humanity of their professors that we owe such mighty advances in the science of mental disorders. Some improvements were attempted in the early part of the last century; but it was reserved for Pinel, in the centre of Paris, in the very moment of the reign of terror, to achieve a work which, for genius, courage, and philanthropy, must ever rank him amongst the very principal of mankind. The narrative is so graphic and interesting, that I must entreat permission to detain the House by the recital of a few passages:— Pinel undertook what appeared to be the rash enterprise of liberating the dangerous lunatics of the Bicêtre. He made application to the commune for permission. Couthon offered to accompany him to the great bedlam of France. They were received by a confused noise; the yells and angry vociferations of 300 maniacs mixing their sounds with the echo of clanking chains and fetters, through the dark and dreary vaults of the prison. Couthon turned away with horror, but permitted the physician to incur the risk of his undertaking. He resolved to try his experiments by liberating fifty madmen, and began by unchaining twelve. The first was an English officer, who had been bound in his dungeon forty years, and whose history everybody had forgotten. His keepers approached him with dread; he had killed one of their comrades by a blow with his manacles. Pinel entered his cell unattended, and told him that he should be at liberty to walk at large, on the condition of his promising to put on the camisole or strait waistcoat. The maniac disbelieved him, but obeyed his directions mechanically. The chains of the miserable prisoner were removed; the door of his cell was left open. Many times he was seen to raise himself and fall backwards—his limbs gave way; they had been fettered during forty years. At length he was able to stand, and to stalk to the door of his dark cell, and gaze, with exclamations of wonder and delight, on the beautiful sky. Good God, Sir, what an instance of needless suffering! He spent the day in walking to and fro, was no more confined, and during the remaining two years which he spent at Bicêtre, assisted in the management of the house. The next madman liberated was a soldier of the French guard, who had been in chains ten years, and was the object of general terror. His disorder had been kept up by cruelty and bad treatment. When liberated, he assisted Pinel in breaking the chains of his fellow-prisoners. He became immediately kind and attentive, and was ever after the devoted friend of his deliverer.….The result was beyond all hope. Tranquillity and harmony succeeded to tumult and disorder; even the most furious maniacs became tractable. This was indeed a man to be honoured by every nation under heaven! Would to God that such were the character, the motive and end, of all our rivalry with that great people! Well would it be for mankind, if, by our mutual harmony, we kept the world at peace, while we prosecuted, and enforced their noble discoveries. I could furnish to the House many recent instances of similar triumphs in our own country; but I will not now detain them by the narrative. The system passed from France into this country; but was of slow growth. We are mainly indebted for it to the Society of Friends, and that remarkable family of the Tukes, who founded the Retreat at York, soon after the victories of Pinel in France. Samuel, the son of William Tuke, is still alive, a man of singular capacity and benevolence; and surely he must be gratified 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; for I have here very copious documents sent to us by Dr. Brigham, the eminent physician of the State Asylum of New York, which show the zealous and liberal efforts of the local governments in these great and necessary undertakings. But, Sir, to secure not only the progress, but even the continuance of this improved condition, we have need of a most active and constant supervision; if this be denied, or even abated, the whole system will relapse. There is the strongest tendency, and it is not unnatural, amongst the subordinate officers of every asylum to resort to coercion; it gratifies all the infirmities of pride, of temper, and indolence. The disclosures of the former state of the public hospital at Bedlam, of the private one at York, and more recently of a large portion of the country, in our Report of last year, sufficiently attest how indispensable are the provisions we have suggested for visitation and publicity. Such arrangements will supersede the necessity of much minute legislation; on no one point is Mr. Tuke more hearty in his concurrence, with a view to prevent the return of those disgraceful practices which have both afflicted and dishonoured mankind. Clearly then, Sir, it is our duty and our interest too, while we have health and intellect—"Mens sana in corpore sano," leisure and opportunity—it is our duty and our interest, I say, to deliberate upon these things before the evil days come, and the years of which we shall say that we have no pleasure in them. Here we are sitting in deliberation to-day, to-morrow we may be the subjects of it; causes as slight apparently as they are sudden, varying through every degree of intensity—a fall, a fever, a reverse of fortune, a domestic calamity, will do the awful work, and then, "farewell King!" The most exalted intellects, the noblest affections, are transformed into fatuity and corruption, and leave nothing but the sad though salutary lesson, how frail is the tenure by which we hold all that is precious and dignified in human nature. But, Sir, it is the temper of our times—and most heartily ought we to thank God for it—and especially of our own country, to view all such things as incentives to earnest and vigorous action. I invite you, therefore, in this spirit, to accept or to amend the proposition I have submitted to your consideration; and be assured that it is not in the order of Providence that such labour should be altogether without fruits; for one of two results you cannot fail of attaining; either you will behold the blessings of happiness and health revisiting the homes of the emancipated sufferers, or you will enjoy the satisfaction of having laboured with disinterestedness and zeal for those who cannot make you the least compensation. The noble Lord concluded by moving for leave to bring in the Bills.

Sir J. Graham

Sir, I rise with sincere satisfaction to second the Motion of my noble Friend. The House will remember—it would be impossible in justice to forget—the speech which my noble Friend made on this subject towards the close of last Session. That speech made on me and on every one who heard it the deepest impression; and I gave to the House and to my noble Friend an assurance, on the part of the Government, that it was impossible any longer to neg- lect a subject so important, so touching, so connected with feelings the most painful, but at the same time the most humane of our common nature. I declared then to the House that the attention of the Government should be directed to the subject. I wish I could have commanded more time to have bestowed on it; but I have had the satisfaction of receiving in the most cordial manner the assistance of my noble Friend, and in common with him I have, during the interval of the recess, directed my consideration carefully to this matter, and the fruits of that consideration are now before the House. With reference to Ireland, I may stale that my right hon. Friend the Secretary for Ireland has introduced a Bill on this very subject, extending to that portion of the Empire many of the most important provisions now about to be introduced into England; and with regard to Scotland, though I do not say that the proposals contained in the Bill of my right hon. Friend the Lord Advocate meet the whole of my noble Friend's views, still it is intended to meet a very important part, viz., the treatment of pauper lunatics in Scotland. Having thus just glanced at those measures, I shall say no more, except with reference to this Bill. I have the satisfaction of stating to the House that the measures which my noble Friend seeks to introduce have been carefully considered by Her Majesty's Government; that they have come under the view of the Lord Chancellor, within whose jurisdictions such matters more especially fall: and that I believe all the measures which my noble Friend wishes to introduce are introduced with the Lord Chancellor's entire approbation. That portion of the measure which is connected with the care of pauper lunatics has also been carefully considered by Her Majesty's Government, and the provisions sought to be introduced with reference to pauper lunatics meet with their entire concurrence. With reference to the subject generally, I also, in common with my Colleagues, considered that these Bills deserved our support; and though some of the details may perhaps require some alteration, yet, generally speaking, we determined to give the Bill, as a Government, our most cordial support. Now, Sir, I must say that we are deeply indebted to my noble Friend for the assistance which he gave me in this matter. I have said, with truth, that I could not de- vote as much time as was necessary to this important inquiry; but, even if I could, there are many qualities which my noble Friend possesses which I could not have brought into action. His great experience, his indefatigable zeal, and above all, his humane heart, have induced him to pursue this subject (from which many men would be disposed to turn aside) with a degree of assiduity and kindness which are above all praise, and which entitle his Opinions to be regarded as an authority upon the subject. I have therefore been very happy to act in concert with him. It would be impertinent in me, after the very able and impressive speech which my noble Friend has just delivered, to waste your time by going into the details of the Bill, which will be more advantageously considered in the course of its progress through the House; but, at the same time, I may mention one or two important matters, in which I more especially agree with him. The first to which I allude attaches the greatest importance to a constant supervision of all these asylums—with that I wholly concur; and I am of opinion that a constant supervision cannot be secured by unpaid Commissioners. I concur also in the necessity of some supervision, and even of the frequent visitation of private establishments, though they should contain very few or only one patient. On that subject last year I entertained some doubts; but the result of the inquiries which I have since made has led me to the conclusion that, on the whole, restricted as such visitation will be, it would be useful and even necessary. I also agree with my noble Friend in the necessity for the erection of establishments for patients whose cases have assumed a chronic form, as distinguished from those whose maladies are of a more recent date. It is impossible to resist, I think, the evidence which he has brought forward with regard to the melancholy manner in which the institutions of the country are at present choked by incurable cases, to the almost utter exclusion of curable cases. I must also express my opinion, that even should the calculations of my noble Friend with reference to the saving of expense not be sustained in every particular, yet it is a paramount duty that ample provision should be made to obtain the cure if possible—and where not possible, to secure the safe custody and comfort of those unhappy persons, under circumstances of as little restraint as their melancholy condition will allow; and I may add, that I know of no object to which the wealthy could more praiseworthily contribute in their desire to relieve the condition of suffering humanity. My noble Friend has observed that improvement in the treatment of the disease has been slow. I am bound to say that though slow it has been progressive; and I see with great satisfaction in the House to-night my right hon. Friend the Member for the county of Montgomery (Mr. Wynn), who at an early period of his life devoted much of his valuable time to this important subject. I hope and believe that the proceedings of this day will be most satisfactory to his feelings. I always admired the course which he pursued with regard to this subject, and I am glad to see that the time has come when his wishes will be accomplished. The time, I think has arrived when what was permissive shall be compulsory—when the counties throughout England and Wales shall be compelled by law to find sufficient means and accommodation for the cure and custody of those unhappy persons to whom my noble Friend's measures refer, and for whose relief and benefit my right hon. Friend was the first to obtain the intervention of Parliament. I might detain the House longer, but I think it will suffice that I say no more now than that I have the greatest pleasure in seconding the Motion of my noble Friend.

Viscount Clements

said, he had no doubt that the Bills that would be introduced for England would please both sane and insane; but he had to complain that the measure intended for Ireland, so far as he knew of it, was neither as liberal nor as comprehensive as could be desired.

Mr. F. Maule

was glad to hear the right hon. Baronet declare it to be his opinion and the opinion of the Government, that the time was come when this subject could be no longer neglected. He had listened with extreme interest to the speech of the noble Lord, characterized as it was by those deep feelings of humanity which had marked the whole course of his policy in that House, and established for him the reputation of desiring to legislate, not upon the ground of mere party interest, but upon the broad basis of humanity and Christian feeling. He entirely concurred in all the principles which the noble Lord had laid down in reference to the measures he was about to introduce, and in none more readily than that which went to make them compulsory. But he was anxious to see that principle extended to Scotland; and he entreated the right hon. Baronet and the noble Lord to institute some searching inquiry into the management of lunatics in Scotland—not pauper lunatics only, but lunatics in general. He believed he was correct in saying, that there was not an asylum in Scotland which could be compelled to receive a lunatic. What he would suggest to the Government was the simple process, without loss of time, of appointing a Commission to examine and report to that House the whole state of the question in Scotland. There was much in the proposed Bills that might be made applicable to that part of the country: and he was certain that the sense of the people of Scotland, as well as of England, would show itself favourable to the consideration of the question upon the score of humanity, without reference to expense.

The Lord Advocate

had also heard the statement of the noble Lord with the greatest pleasure and satisfaction. It would, perhaps, be recollected, that when he had occasion to announce the measure which had been alluded to by the right hon. Baronet, he expressed his dissatisfaction at the present state of the law. He knew at that time that the present measures were contemplated by the noble Lord. He had since endeavoured, privately as well as publicly, to obtain correct information upon the subject as regarded Scotland. That very morning he had received notice of an intended deputation with reference to the question of establishing lunatic asylums, applicable to the northern counties of Scotland. He stated this in order to let the hon. Gentleman see that the question in connexion with Scotland had not been lost sight of.

Sir G. Strickland

spoke of the great difficulties which magistrates frequently encountered in the discharge of their duty, owing to the want of public lunatic asylums, and expressed his satisfaction that the proposed measures were to be not only general, but compulsory He was sure that in the end the compulsory system would be found to be the most economical as well as the most humane.

Mr. Henley

expressed his thanks to the noble Lord for bringing forward these measures.

Mr. Brotherton

felt, that the noble Lord was entitled to the gratitude of the country for having brought these measures forward. In dealing with these details there were two points which he wished to impress upon the noble Lord and the Government. One was, the great importance of treating cases early. In order to do so, he thought it desirable, that some facilities should be afforded of sending persons to the intended asylums who were not exactly paupers, such as mechanics and other labourers, who might not have means enough to bear the expense of a private asylum, and who, if properly treated in the early stage of their complaint, might in a short time be restored to their previous position and state of mind. He was sure that such a provision would be highly beneficial. The other point to which be should call attention was the necessity of not overcrowding these asylums, or making them larger than was requisite for the accommodation of a number of persons not exceeding 300. In the county of Lancaster there were from 600 to 800 lunatics without any fit provision for their peculiar and melancholy condition—most of them being placed in workhouses, owing to the expense of sending them to the asylums. In first treating cases, he thought that a distinction should be made between recent and chronic cases; and he approved of the noble Lord's proposition for sending them, in the first instance, to a place where there was a possibility of their being cured, and afterwards to another asylum at a less expense.

Leave given to bring in the Bills.