OBSERVATIONS. (Hansard, 17 July 1863)

§ MR. BLAKE

said, he would beg to call attention to the defects in the moral treatment of insanity in the great majority of Irish District Lunatic Asylums; and to ask the Chief Secretary for Ireland, whether the executive Government of Ireland intend taking any, and what steps, to render those Institutions less irksome to the patients and more conducive to their recovery? As that was the third year he had brought the subject under the notice of Parliament, and had placed a work he had written containing his views regarding the moral treatment of insanity in the hands of the greater number of the Members, he would not occupy the House very long, more particularly as he intended next year, and indeed every year while he remained in Parliament, bringing the matter forward, until the defects he complained of were remedied. Almost immediately on the present Chief Secretary's accession to office, he had called his attention to the drawbacks which existed in the asylums. The right hon. Baronet had paid a good deal of attention to his representations, had accompanied him to the best of the English asylums, and had visited some others that he suggested and promised that on going to Ireland he would do his best to remedy whatever appeared to him calling for Amendment. To do him justice, he had kept his word. Some important improvements had been introduced, he believed in a great measure owing to the interest which the Chief Secretary showed in the matter—amongst them, appointing only medical men to the office of resident managers, and intrusting them with the chief responsibility. He had also visited many of the asylums, and this, together with the keeping of the matter alive in Parliament, had been productive of much good, as many of the asylums were undoubtedly improving 979 that had been at a complete standstill before. However, much yet remained to be done before the asylums would be what they ought as regarded moral curative treatment, and it was for the purpose of inducing the right hon. Baronet to continue the good work he had so well commenced, and making boards of governors and the country generally aware of what still remained to be done to render those excellent institutions more valuable, that he brought forward his present Motion. His only ground of complaint against the majority of the asylums was that there was a great deficiency in the way of suitable occupation and recreation for the patients. In all other respects the asylums were most unexceptionable. Great care and humanity was shown towards the patients—they were well clothed and fed—hardly any instance of cruelty or neglect ever occurred, and the administration of them, both as regarded the Government Inspectors and the Local Boards, was honestly conducted. It was therefore a very great pity, when a little trouble on the part of the Inspectors, and a very small outlay by the Local Boards, which would be repaid tenfold by results, would render those institutions the first in the kingdom, that the proper means were not adopted. With two or three exceptions, the asylums were deplorably deficient both in the appliances as well as a proper system for agreeably occupying the patients. All writers and authorities on the subject concurred as to the absolute necessity of suitable employment and amusements for the insane, both as a means of alleviating the tedium of their lives and promoting their recovery. Except in the instances alluded to—and he was by no means prepared to admit that oven they came up to the right standard—he contended that the patients were not, so far as the moral treatment was concerned, treated consistently with the best acknowledged principles. To prevent any controversy on this point, he would, although well acquainted with nearly all the asylums, entirely exclude his own experience regarding them, and confine himself to official documents to support his statements. The first to which he would refer was the Report of the Royal Commission, appointed in 1856, to examine into the state of the Irish Asylums— 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 980 purposes. We are sorry to be obliged to add, that we tear 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. Nearly twenty medical officers of asylums and others gave evidence before the Commission as to the inadequacy of the means of occupation and amusement; but, notwithstanding this, and the strong recommendation of the Commissioners, years rolled on, and very little, if anything, appeared to have been done to amend matters, and from the Reports of the Inspectors it would seem as if there was nothing to complain of in this respect. Indeed, a paragraph in their Report for 1861 was calculated to lead to the idea that there were ample resources for the patients, as they reported that— 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 attended to, means of amusement were not neglected. This was the opinion of the Inspectors in 1861, from which he ventured to differ so much that he brought the subject before 981 Parliament, and set forth very strongly the real condition of the asylums, and what they ought to be. A considerable change seemed to come over the opinion of the Inspectors, as in their next Report, that of 1862, they stated— 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. With the concurrent testimony of the Royal Commission, the local officers of asylums, and lastly, the Report of the Inspectors last year as to the deficiency in the important particular he alluded to, he thought he need not trouble the House with further proof to induce them to believe that a very great defect existed in the Irish asylums as regarded moral treatment. That fact admitted, it was clearly the duty of the Government to remedy the evil—as much of the responsibility rested on them, as they not only appointed the Inspectors and local medical officers, but the nomination of the boards of management was in the hands of the Lord Lieutenant. He had no doubt, if the Inspectors earnestly applied themselves to the task, that, with very little trouble, a great deal could be accomplished in a short time. On a former occasion the right hon. Baronet had urged that the work of reformation lay chiefly with the local boards, as it depended on them whether the necessary expenses should be incurred. That was quite true; but a number of country gentlemen, or persons engaged in business, were not supposed to know what was essential for the due treatment of insanity, and it was clearly the duty of the Inspectors to point it out to them. He believed that, with very few exceptions, the boards of governors in Ireland were most willing to do whatever was necessary in the way of affording the patients the means of recreation and occupation, if the Inspectors would only explain 982 what was required. He had often, when visiting asylums, remonstrated with governors with whom he was acquainted, on the deficiencies he observed; and their invariable answer had been, "We were not aware of this before, and supposed, when the Inspectors made no remark, that everything was all right." The asylum at Water-ford, of which he was a governor for many years, was, until very lately, about as backward as any other in Ireland, as regarded moral curative treatment; and yet he could assert, that until the subject was brought before Parliament, neither the visitors' hook in the asylum, in which the Inspectors recorded their opinions, in the Report furnished to Parliament, or in communications with the board, was there anything to show that the Government officials did not consider that everything as regarded the diverting of the patients' minds, and affording them salutary occupation, was unobjectionable; and what held good with respect to Waterford, it was reasonable to suppose was the same as regarded other places. If the improvement of asylums depended so much on local boards, the latter should be informed as to the requisites in an asylum for properly carrying out the moral treatment. He would probably be sneered at for trying, as it might be alleged, to make every governor a lunatic doctor. That was by no means his intention, and he was sure that the House would concur with him that every gentleman appointed to the office should be made acquainted with a few simple principles as regarded the requisites to aid the carrying out of a proper system of moral treatment. If it came within their province to decide whether they would or would not provide these, they ought to know what they were, and the reason for their being required. A half sheet of printed matter would inform every governor what he ought to know, or the same thing could be hung on the wall of the board-room or laid on the table, and members of the committee would then know whether patients were treated in conformity with correct principles, or whether the institution contained sufficient appliances for the purpose. The cost of this for all Ireland would be about two or three pounds, and as many hours trouble on the part of the Inspectors to draw up the table. As the hon. Baronet might, as before, seek to establish the superiority of the Irish asylums on the credit of two or three good ones, be would at once cheerfully admit that Richmond, Belfast, Sligo, Kilkenny, 983 and, he believed, Armagh and Londonderry, were in advance of the others; but that was just the reason that the Inspectors ought to exert themselves to bring the others up to them. The Chief Secretary would also probably cite the greater number of recoveries in the Irish asylums as a proof that they were much better managed than those in England. But if all the circumstances were looked into, that fact did not establish any superiority, because the Irish asylums were much better circumstanced for effecting recoveries than those in England, as in the former country, as a rule, the patients were placed under treatment for their malady at a much earlier period of the disease than in England. The reason was that in Ireland there was no outdoor relief for the insane, and where asylums were situated, from the high reputation they enjoyed, they were sent, generally speaking, by their friends at once into them, and the chances of recovery were therefore much greater; but in England their friends were often paid to keep them. When they became too violent for them, they were drafted into the workhouse, and finally arrived at the lunatic asylums in three-fourths of the instances chronic cases. In page 64 of his pamphlet on insanity he had remarked on this part of the subject— Owing to the unwise system pursued by the parochial authorities, the asylums have become so choked up with chronic cases that only 14 per cent, on the entire number in confinement, are curable; whilst on the other hand, no outdoor relief for the insane being permitted in Ireland, no inducement to keep them at home is thus held out; and, except in a few districts, where there is deficient accommodation, a comparatively small number of really curable cases are retained long in jails and workhouses. Besides this, I believe a greater amount of harmless patients, when recovery appears hopeless, are transmitted to the workhouse, than in England; the consequence is, that in Ireland the curable cases amount to 25 per cent on the entire number. If, therefore, on the average number under treatment in England 14 per cent are curable, and out of these 10 per cent on the entire number are cured, there ought to be, on the same calculation, within a fraction of 18 per cent of recoveries on the whole average number under treatment in Ireland, whilst there is, in reality, only 16. Continuing the calculation on the number amenable to recovery, it will be found that on the same principle the English asylums would be on an equal footing with the Irish, if the cures reached a fraction under 9 per cent, whilst actually the recoveries are 10 per cent. With regard to cures on admissions, if we bear in mind that 'the facility of cures and the proportion of recoveries bear a direct ratio to the shortness of time that has elapsed from the origin of the complaint to the commencement of the treatment,' and could accurately calculate the state of 984 curability of patients on their reception into the asylums of both countries, I have no doubt it would be found that Ireland was so much better off, as regards the curability of the admissions, that the recoveries were really less than what they ought to be. To show the benefit of a good system, he need only instance the fact, that whilst at Colney Hatch the recoveries were rarely beyond 15 per cent, sometimes as low as seven, at Leicester they had amounted to three times that number. There was nothing more incumbent on the executive Government than to improve the Central Asylum at Dundrum—in fact, to make it a model asylum, where candidates for the office of resident physician could learn their business. There the Government and Inspectors had it all their own way, uncontrolled by local boards, and yet he could positively state that three years ago, when he visited it, there seemed to be no difference between it and the worst of the other asylums. When the asylum immediately under Government management was in that state, was it to be wondered that others should be so deficient? In some instances, where local boards were disposed to withhold from patients whatever was calculated to solace them or promote their recovery, he thought Government were just as much called on to interfere as if there had been an interference with their medical treatment. The authorities concurred that judicious religious ministration was most comforting and advantageous to patients, and yet in the intelligent town of Belfast the board of governors refused to have chaplains or religious service in the asylum, because, owing to some fanatical religious demonstration in that part of Ireland, several persons had become religiously insane It might, no doubt, be prudent to be cautious how religion was touched on with those poor people, but surely it was very hard to deprive others who would be benefited from having the advantage of being present at religious observances. In conclusion, he heartily thanked the right hon. Baronet for what he had done to ameliorate the condition of the poor lunatic. It was a great and noble work, and he hoped he would persevere in it, as much remained to be done, but that much could with a little energy be easily accomplished. He hoped, as a further step, he would be induced to adopt the suggestion he had ventured to offer him regarding the informing Boards of Governors of the leading principles with respect to moral treatment. Very simple as the matter might appear, 985 he had no doubt, if properly carried out, it would be productive of most beneficial results.