HC Deb 01 August 1862 vol 168 cc1088-92
MR. BLAKE

rose to call attention to the defects in the moral treatment of insanity in the public lunatic asylums of Ireland. He had brought the subject under the notice of the House a year ago, on the accession of the right hon. Member for Tamworth to the office of Chief Secretary of Ireland, and that it was but just towards the right hon. Baronet to state that he had fulfilled the promise which he then made, and that notwithstanding the many claims upon his attention, he had found time to inquire into it, and that the beneficial change by which additional powers were given to the resident physicians in asylums was due to his interference. He (Mr. Blake) was, however, of opinion that the exertions of the right hon. Baronet ought not to stop there, as it was most desirable that further steps should be taken to carry out improvements in the moral curative treatment of the insane. All important authorities on the subject coincided in expressing an opinion that nothing so much conduced to the recovery of the insane as judicious occupation and recreation. This being conceded, the next question was, whether the means adopted in Ireland were sufficient for the purpose. Upon this subject he would take the liberty of referring to the evidence taken before the Commissioners in 1856. The Commissioners devoted twelve months to the subject, and the result was a very able and elaborate Report, in which they laid considerable stress upon the advantages to accrue from occupation and recreation. On this subject they say— In the new asylums recreation halls have been provided, but, excepting in a few cases, as the new Richmond and Sligo asylums, we found that they were either not used, or were devoted to other purposes. We are sorry to be obliged to add that we fear this has generally resulted from the manager or governors not attaching sufficient importance to the amusement of the patients as a portion of their treatment. We hope that this idea will be dispelled, and that the great want of any amusing occupation for the patients, which is particularly observable throughout the asylums (with few exceptions) will, before long, cease to be a subject of unfavourable comment. At present, whatever attempts have been made in a few instances, and especially at Richmond and Sligo, in the way of evening entertainments, &c., nothing has been done to mitigate the bare and cheerless character of the apartments usually occupied by the inmates. In corridor or day room, the lunatic sees nothing but the one undiversified bare wall—giving to these hospitals, intended for the restoration of the alienated mind, an air of blankness and desolation more calculated to fix than to remove the awful disease under which it labours. It cannot be denied, notwithstanding the care and attention which appear generally to be given by the managers and visiting physicians to the patients under their charge, that, on the whole, the lunatic asylums of Ireland wear more the aspect of places merely for the secure detention of lunatics than of curative hospitals for the insane. Probably it is by some considered, that the inmates being poor, the ratepayers should not be called on to provide for them comforts and appliances beyond their position; and something, perhaps, of the idea prevails, that the lunatic asylum should not, by the comfort it provides for its inmates, cease to be a test, like the workhouse, for those who seek it as an asylum. But it is almost needless to point out that the cases are by no means analogous, and it would be as consistent to prevent the surgeons of our county infirmaries or fever hospitals giving expensive medicines or comforts to patients, as to refuse to provide for the lunatic what may contribute to his cure. Besides, we believe it better economy to relieve the rates, by the cure of the lunatic, than to burden them with his permanent maintenance, by perpetuating his insanity. When he brought this subject under the notice of the House last Session, the right hon. Baronet the Chief Secretary for Ireland said— I readily admit, that in addition to kindly treatment, it is highly desirable that the monotony and desolation of mind endured by patients in lunatic asylums should be relieved by occupation and amusement. I do not think that the recommendations contained in the Report of the Commission of Inquiry to which the hon. Member [for Waterford] has adverted, and which sat in 1858, have been sufficiently attended to. The Commissioners urged the necessity and advantage of introducing a system of recreation and amusement into lunatic asylums; but the hon. Member must know that the remedy for the evils which he has pointed out is a matter not within the province of the Government, but depends upon the local boards. The district lunatic asylums are governed by boards, which are sustained by local rates; and although it is true that the law gives the Lord Lieutenant considerable powers, yet it is obvious that it would not be desirable that he should exercise them, except in extreme cases. The hon. Member says that the monotony of lunatic asylums should be relieved by books and music. No doubt such means of recreation and amusement would be very valuable, but their introduction depends upon the Board of Directors of each asylum; and if the Lord Lieutenant were to exercise the power conferred upon him by the law, I am afraid such exercise would be regarded by the local boards as an unwarrantable interference with the rights and authority of the cesspayers." [3 Hansard, clxiv., 1851–2.] Here, then, was the opinion of inspectors, of medical officers, of the Royal Commissioners, and of the right hon. Baronet himself, that the means of providing occupation and amusement were insufficient. Since the matter has been brought under the notice of the Irish Government, the Chief Secretary had turned his attention to the subject, and the result was that the very admirable Report of the inspectors, published in the present year, con- tained an admission that there was a deficiency in the Irish asylums of those agencies to the curative system, which all the persons whose opinions were entitled to weight had recommended. In the Report dated 1862 the inspectors say— Our object in introducing the educational condition of the inmates of the different district asylums, and in which the illiterate more than double those who have received a fair amount of education, was to exhibit their previous social position, and to show the beneficial working of these institutions in producing habits of order, neatness, and even some approach to refinement among the insane classes; while the number daily employed in and out of doors serves to prove the encouragement given to industrial occupations. On this latter head, however, we feel satisfied that great room for improvement still exists, and that suitable occupations could be devised for a much greater proportion of patients than at present; for nothing can be more injurious to the insane themselves than idleness, and that listless mode of existence, particularly within doors, which we regret to observe is too much tolerated. In the absence of industrial employment, pastimes ought to be more generally provided. The Report of the previous year, however, contains a paragraph somewhat inconsistent with the above— As a general rule the patients in district asylums are industriously employed, both in and out of doors; and while their comforts and sanitary condition are carefully attended to, the means of amusement are not neglected. It might, he was aware, be said by the right hon. Baronet the Chief Secretary for Ireland, that as the percentage of recoveries was greater in Ireland than in England, the treatment in Ireland was better. He admitted, that as a whole, the Irish asylums were better than the English; but there were in England some half a dozen asylums which were superior to all others in England or in Ireland. They were those of Derby, Leicester, Gloucester, Somersetshire, Yorkshire, and, above all, Bethlehem. In order to show that in Ireland there were to be found circumstances and conditions favourable to the cure of the insane, he would briefly point out to the House the value of Irish asylums over English in the way of effecting cures. In Ireland there was no system of out-door relief for the insane poor, while in England 2s. or 3s. per week were allowed for the support of those afflicted persons. When, however, they became too troublesome to their friends, they were taken to the workhouse, where they cost about 5s. per head per week; and when they became too troublesome there, they were removed to the county asylum. It would thus be seen that in England they were not placed under the curative system until the very last moment, and when their prospects of recovery were greatly diminished. There were in England 20,000 insane persons in public asylums, of whom 17,000 were incurable, whereas in Ireland there were, according to the last Report, 4,388, of whom 3,265 were curable, and 1,253 only were considered incurable. He might state that in some of the English asylums—Colney Hatch, near London, for instance—the highest number of cures recorded was 25 per cent. while in the county asylum at Derby it was 50 per cent. The recommendations of the Royal Commissioners of 1856 were, he thought, worthy of the attention of the Government. They were—1. That the resident physician should have the general management, and be responsible for the medical and moral treatment; 2. Vesting appointment of officers in governors; 3. Compulsory appointment of chaplains; 4. Transfer of the charge of support of lunatics to poor rates; 5. Providing increased occupation and amusement; 6. Improved dietary; 7. Less employment of restraint; 8. Clinical instruction; 9. Removal of lunatics from workhouses and jails; 10. Central board of management; 11. Removal of incurable cases to workhouses. The hon. Gentleman concluded by inquiring, Whether it was the intention of the Government to take steps to carry into effect the principal recommendations contained in the Report of the Commissioners of Inquiry into the state of the Lunatic Asylums of Ireland (1856)?