HC Deb 01 July 1864 vol 176 cc628-39

rose to call the attention of the Chief Secretary for Ireland to the necessity which exists for amending the Laws relating to the administration of Lunatic Asylums in Ireland, and for making better provision for the care of Imbeciles confined in the Union Workhouses; and to inquire whether he will introduce a Bill next Session to remedy the defects complained of? For the last three years he had each Session called the attention of Government to the serious defects which existed in the moral treatment, with a few exceptions, in the Lunatic Asylums of Ireland; and in his efforts to have a proper system introduced, he had never been fortunate to obtain much support from the Irish Members. Nevertheless, the question had gained ground, and some good results had followed. He should do the Chief Secretary for Ireland the justice to say that the representations which he had made to him on the subject had not been disregarded, as he had given a good deal of attention to it, both by visiting asylums and endeavouring, as far as he could, to effect a reform in the direction which he had frequently pointed out to him as most necessary. He considered it was only just towards the Inspectors of Lunatic Asylums, as well as towards some of the Managers of these institutions in the country, to say that within the last two years an undoubted improvement had taken place in many of the asylums, so far as regarded increased suitable occupation and amusement for the patients, although in some much remained to be done. It was also very pleasing to see in the last published Report of the Inspectors, that that portion of the treatment in each of the asylums had a prominent place in their remarks. On the present occasion he would only allude to it incidentally in suggesting some legislation which he thought would materially aid the carrying out improved moral treatment. If the suggestions he was about to offer for amending the laws relating to Lunatic Asylums had not the merit for the most part of originality, they had at least what was much better, which was the fact of many of them being so manifestly necessary that they had been recommended for adoption by much higher authority than he was. Nearly all would be found in the Report of the Royal Commissioners appointed in 1857 to inquire into the state of the Irish Asylums, which consisted of men of great ability and eminence, amongst them one of the foremost physicians in the empire, Dr. Corrigan. Subsequently the noble Lord the Member for Cockermouth (Lord Naas), then Chief Secretary for Ireland, introduced a Bill, in which also might be found many of his (Mr. Blake's) suggestions on the present occasion. The Royal Commission recommended that the asylums should be under the direction of a central board, to consist of three salaried members, who should also act as Inspectors—two to be of the medical profession, one of the legal. To that recommendation he would add three more Commissioners, who should be salaried, so far as paying them one or two guineas each for every time they attended a meeting of the board: this would not entail a cost of more than a couple of hundred a year, and would be certain to secure a punctual attendance. To this Commissioner he would delegate nearly all the duties now performed by the Privy Council in reference to asylums, and would, in certain cases, give the Lord Lieutenant a veto. As things then stood, nearly all the control devolved on the Inspectors; as the Lord Lieutenant and the Privy Council must necessarily be influenced by their recommendations; and without at all intending to disparage those gentlemen, for whom he entertained the highest respect, he thought it would be far better to have some other gentlemen associated with them in the direction of the asylums, especially as their duties would every day increase from the additional asylums in progress of construction. The present board of control would, of course, merge into the new Commission. He thought that, for purposes of inspection, Ireland ought to be divided into two districts, assigning one to each Inspector, who would thus have a greater responsibility than at present, and more inducements to forward the asylum intrusted to him. It would promote a desirable emulation, as each Inspector would naturally endeavour not to have the asylum of his district inferior to those of his colleague. Power should also be given to the Lord Lieutenant to appoint for particular purposes, when occasion called for it, a special Commissioner to hold investigations and report. This would prove most useful at times when there might be a great difference of opinion between a local board and the Inspectors, and when it would be desirable to have the assistance of a person who would be certain to be totally unprejudiced. Two-thirds of the governors of asylums ought to be appointed by the grand jury, and in certain instances by town councils; or, in the event of transferring the maintenance of lunatics to the poor rates—as ought to be done—the appointment to be made by the guardians. One-third of the boards might be left to be nominated by the Lord Lieutenant, which would be always sufficient to secure a fair representation from the gentry. It was manifestly unfair, that whilst the asylums were maintained from grand jury rates, that that body had no voice whatever in appointing those who were to administer them. There were many other objections to vesting such power in the hands of the Government. Dr. Nugent, in his evidence before the Royal Commission, stated that the governors were usually appointed on the recommendation of the Inspectors. Such a practice was most undesirable. It was for the interest of the asylums that the governors should in every respect be wholly independent of either Inspectors or local medical officers. If the Government were usually guided in their selection by the recommendation of the Inspectors, it was not going too far to assume that the latter, in their turn, were often influenced in their selection by the local officers; and it was only natural that the latter would not recommend any one likely to be unfriendly to them, or who would not accord in their views. He believed the independence and efficiency of many local boards was much impaired by the mode in which they were appointed. To a board constituted in the way he had suggested, he would give the appointment of all the superior officers, subject to the approval of the central board or the Lord Lieutenant. On this subject the Royal Commissioners justly observed— As regards the appointment of superior officers, resident and medical physician, &c, we consider they should be left to the governors. The evidence we have received is to a great, perhaps preponderating extent, opposed to this power being given to the governors. But, as a general principle, we do not see why the executive Government should interfere in these matters, or that its interference has, or is likely to lead to, a better selection of officers than would be made by the local authorities. It is true, as has been stated, that the appointment of these officers may tend to local contention, and that private feeling may prevail to the prejudice of the institution. We think there is not a little reason to believe that political influence might lead to an equally unfortunate result. Out of the 4,506 patients in asylums, only 1,135 were returned as probably curable; and of the 3,371 incurable, there were many in a state of hopeless idiotcy, and, unfortunately, occupied the place of many insane confined in gaols or workhouses, or with their families, who, if placed early under curative treatment, might have a chance of recovery, which was lessened every hour they were out of the asylum. Some arrangement ought to be made by which many of the hopeless tranquil cases, where the mind had sunk into fatuity or idiotcy, belonging to two or more counties, could be sent to special institutions, and thus relieve the asylums of their care, and make room for hopeful cases. Power should be given to magistrates to commit dangerous lunatics direct to asylums, instead of sending them to prison, where they could not be so well cared for, or have the same chance of recovery. Boards should be empowered to receive and enforce payment from patients capable of contributing in the whole or part for their maintenance. There was considerable doubt as to the law on the subject, which ought to be settled. In some places, boards sought and obtained payment from parties capable of paying, whilst elsewhere they considered themselves not entitled to do so. A great burden was, therefore, thrown on the ratepayers—for example, at Limerick there appeared to be seven patients well able to pay who were supported out of the rates. Boards should also be empowered to send strange lunatics to their own localities. In the larger towns, particularly seaports, persons after only residing a short time, or perhaps only passing through, were sent to the asylum, and became a charge on a district to which they did not belong. Central boards should have the power of fixing the dietaries of asylums. The quantity and description of food was a most important element in the treatment of insanity, and on no account should be left to the discretion of local boards, who, as a rule, could not be competent to determine what should be given to patients. The dietary table in various institutions varied considerably; and in some instances the Inspectors had remarked on the insufficiency. These gentlemen and the other Commissioners should have the power of absolutely determining on the dietary; and on them should also devolve the duty of laying down regulations for the moral treatment, and ordering to be provided all necessary appliances for the occupation and amusement of the patients. The judicious employment and recreation of a lunatic was the most important part of the curative treatment; and those who, like the Inspectors, were supposed to be best informed as to what was necessary to soothe and restore the diseased mind to its healthy state, should have as ample powers to have everything provided for the purpose as to insist that good and sufficient medicine was furnished for the bodily ailments of the patients. It would be most desirable if the Inspectors would, as he believed they were bound to do by Act of Parliament, furnish to each member of the local boards a copy of the Report relative to his own asylum. The expense would be very small, and the probable advantages considerable, as governors would then be made aware of the state of progress and requirements of their asylum, of which many knew very little. Many governors never even once attended the asylum from their appointment—often extending over a period of twenty years; several others, perhaps, once in two or three years. There ought, therefore, to be an enactment by which governors who, not being either ill or away from the locality, absent themselves from a certain number of stated meetings in succession, should forfeit their position on the board. As some medical I officers of asylums excused themselves from taking their patients outside the asylum for exercise and recreation, on the ground that it would be illegal to do so, the practice ought to be legalized, as, with proper precaution, there was little or no danger to be apprehended, and the gratification and advantage to the patients was considerable. No doubt the system pursued in an asylum should be a good one before patients were brought to that tranquil, orderly state when they could be trusted outside; indeed, it was a great test of their progress; and it was, therefore, a great pity that incompetent or inefficient medical officers were afforded an excuse which their convenient interpretation of the law furnished them for not following the example of more zealous and better qualified officers. While on this point of the subject, he would allude to the great necessity in all future appointments of resident medical officers in making a theoretical and practical knowledge of the treatment of insanity an absolute condition; and that no one should be eligible unless he produced a certificate of having, for at least six months, resided in or attended and watched the practice in an hospital for the insane for that period. Besides this, they should undergo an examination before the Inspectors without whose certificate of competency they could not be appointed. As a rule, under every Government political influence went before every other consideration in making the appointments, and the unfortunate lunatics were the sufferers. Means of clinical instruction should be provided in some of the larger asylums. The criminal one would probably be best, as being altogether under Government control. There was nothing the Royal Commissioners more strongly urged than the absolute necessity which existed for clinical instruction; but this recommendation, as well as others equally useful, had been totally disregarded. The chaplaincy question was one which imperatively called for legislation. Fortunately, the only instance where a board had persisted in refusing to appoint a chaplain was that of Belfast; but even that was sufficient to call for the interference of the Legislature. He believed, without exception, every eminent authority concurred in recommending judicious religious ministration as a most important agent in promoting the happiness and recovery of the insane; in fact, an essential link in the chain of curative treatment. Some few boards in Ireland had for a time resisted the appointment of chaplains—sometimes supported in their views by the medical officers—but they gradually gave in, and all had acknow- ledged that beneficial results had followed. Belfast alone still stood out. The Commissioners had closely inquired into the question, and reported strongly in favour of chaplains being appointed. The Inspectors, in their annual Reports, did the same. Successsive Lord Lieutenants had made the appointments; but, owing to the state of the law, the board successfully resisted the payment of the salaries. The Catholic and Protestant Bishops, and, he believed, one Presbyterian member of the board, were in favour of chaplains. On yesterday he had a conversation with the Right Rev. Dr. Knox, Protestant Bishop of Down, on the subject, who told him that whilst the Protestant chaplain had been acting, his flock appeared to derive much comfort and benefit, and no unpleasantness of any kind had occurred. His Lordship also stated that he had written to all the asylums in Ireland to ascertain whether the appointment of chaplains had turned out satisfactorily, and the answers were in the affirmative. From the communications the Most Rev. Dr. Denvir had favoured him with on the subject, he found him equally anxious as the Protestant Bishop to be enabled to afford the portion of his congregation in the asylum spiritual ministrations. He trusted, therefore, with all this concurrent testimony on the subject, that the Chief Secretary for Ireland would give an assurance that Government would take steps to afford the poor inmates of the Belfast Asylum the same means of religious consolation that the insane of every institution of the kind in the empire were in possession of, with acknowledged comfort and advantage. There was only one more reference he would make to Lunatic Asylums. In whatever Bill might be introduced to amend the laws relating to them, there ought to be a clause placing their maintenance on the poor rates. It was a strange and unjust anomaly that, while a sane pauper was maintained at the joint expense of landlord and tenant, he would, if he became insane, become chargeable altogether on the tenant. Having occupied so much time on the subject of Lunatic Asylums, he should touch very briefly on the second part of his Motion relative to idiots. For that unfortunate class there was, unhappily, no adequate provision for their care in Ireland. They were, unfortunately, very numerous, being nearly equal to the lunatic class; and whilst for the latter there were sixteen public asylums and several others in course of construction, besides many private institutions, there was not a single one for idiots. The pauper ones were placed in workhouses, and the others were at large or with their families, but no effort whatever was made to endeavour to cultivate those faculties of their mind which were not obliterated. Until lately it was thought that this unfortunate class were incapable of cultivation, but experiment had proved the contrary. The hon. Member having read a description of the improved condition of the patients at Earlswood, many of whom had been so far instructed as to be able to go out and earn their living, and an extract from the Report of the Census Commissioners in 1861, proceeded to say that he could not conclude without thanking the House for the very patient hearing they had given him on a subject which he felt conscious was far from being generally interesting; but he trusted his having trespassed at such length would be excused when he assured them that bringing such subjects before Parliament was almost the only way of having evils remedied or reforms accomplished. He hoped he would receive an assurance from the right hon. Baronet that he would introduce measures next Session to remedy the laws relating to Lunatic Asylums, and also to initiate something for the benefit of the more unfortunate class of whom he last spoke. The right hon. Baronet would probably tell him that much that he had suggested regarding lunatics could be accomplished by the Privy Council rules. No doubt that was true, but he respectfully asked why the Privy Council did not do what was necessary? If they did so, there need not be legislation on all the points he had touched on; and an act would only be required for what the Council could not effect. Although he felt he had but feebly pleaded on behalf of those for whom he felt the deepest compassion and interest, he ventured to hope that he had made it manifest to the House that humanity and policy alike called on us to endeavour to mitigate still further the misfortunes of those whom Providence in its wisdom had visited with the most fearful of all afflictions.


said, he doubted the expediency of giving the appointment of officers to the governors of asylums, as owing to the violence of party feeling in Ireland they could not be sure that in every case the best men would be em- ployed. He was not fond of central boards, and any change in the direction of striking off governors who did not attend ought to be made very carefully, as the ratepayers of outlying districts were not the less entitled to representation. He believed that the Irish Lunatic Asylums were in general very admirably conducted; but there was one point to which he attached very great importance—namely, the training of the resident physician. He thought these officers should receive a special training, and that they should acquire a practical knowledge of the treatment and cure of the insane by residence and study in some of the great lunatic establishments in England.


said, he willingly bore testimony to the zeal and humane spirit which had actuated his hon. Friend the Member for Walerford in bringing the matter before the House. He could not, however, agree with his hon. Friend that further legislation on this subject was needed. The fact that this subject had not been lost sight of by the Irish Government was proved by the circumstance that since 1821 fifteen separate Acts of Parliament had been passed specially dealing with the treatment of the insane poor of Ireland. He quite concurred with the hon. Member for Clonmel in thinking that the resident physicians should be educated with a more especial eye to the duties they had to perform; but even in the present day, with the aid of the consulting physicians, they were able to deal with the unfortunate persons under their charge in a manner much more satisfactory than was formerly the case. Not having been able to catch as accurately as he could desire the observations which had fallen from the hon. Member for Waterford, the written outline of the points in which he felt interested, furnished by his hon. Friend, would enable him to deal in detail with those various matters. As regarded the appointment of a central board, his idea was that the local authorities, with the supervision of the central Government, ought to have the main direction of the institutions. Dr. Nugent and Dr. Hatchell, the present Inspectors of Lunatic Asylums, performed their duties to the satisfaction of the public, and he was always anxious that the poor inmates should be treated with every consideration. Under the existing rules and regulations the Lord Lieutenant had power to direct a special inquiry, and only recently a case occurred at Clonmel which Dr. Hatchell was sent down to investigate.


said, what he contemplated was the appointment of a special Inspector, distinct from the regular officials.


said, he did not think the division of Ireland into districts like those rendered compulsory by the Prisons Act would be advisable in the case of Lunatic Asylums. It was important that it should not be known beforehand what Inspector was to hold the inquiry. With regard to appointments, it was proposed in 1859 by the Ministry of that day to vest these in the governors; but the measure was strongly opposed by Liberal Members, and the present arrangement, which gave to each of the political parties in turn a share of the patronage, was, he thought, preferable. There were 16,000 of these poor creatures altogether in district Lunatic Asylums, poor houses, gaols, and private asylums. A great many boards were taking steps for affording recreation and amusement to these poor patients. It was also of great importance that chaplains should be provided for these institutions. That subject had occupied the attention of successive Lord Lieutenants. The Earl of Clarendon, the Earl of Eglinton, the Earl of St. Germans, and the present Lord Lieutenant, agreed that every Lunatic Asylum ought to have a chaplain attached to it. The Belfast Asylum was now the only one without a chaplain. Representations had been made to the board of the asylum that the patients ought to have the advantage of devotional services, but the board had hitherto resisted these appeals. Bearing in mind the great advantages that had resulted in other establishments from the services of clergymen of different denominations, he could not but think it very desirable that the deficiency should be supplied. At Londonderry, after holding out for a long time, the board agreed to make the trial. They had since reported that the effect of the ministrations of the chaplain upon the minds of the poor patients was most remarkable. It was thought that religious controversies might arise; but Roman Catholic, Presbyterian, and Episcopalian ministers attended at different hours, and the proceedings were conducted with perfect harmony. The majority of the cases in these asylums were chronic, and the patients were collected and rational, except in regard to the particular delusion in which their insanity was manifested. In the Report presented to the Lord Chancellor by the Commissioners of Lunacy in England, of whom Lord Shaftesbury was chairman, it was stated that the patients looked forward with pleasure to the performance of Divine service, and regarded their exclusion from it as a privation. They added that the prayers of the Church exercised a soothing influence even upon insane hearers. A great deal had been done of late to promote the cure and comfort of this unhappy class of persons. There were at present seventeen Lunatic Asylums in active operation. Six other Lunatic Asylums were now being built; so that the complaints that these patients were placed in gaols would soon be obviated. When these six additional Lunatic Asylums were opened, 235 of the 389 insane persons now confined in gaols would be removed to them, leaving the balance in the Dublin district. He had been in communication with the grand juries, and something would, he hoped, be done to relieve the Richmond Asylum from the pressure that fell upon it from the Dublin district. The imbeciles confined in the union workhouses in Ireland were not less than 2,400, two-thirds of whom were women. They were for the most part in a state of harmless imbecility, and it would be better to leave them there. The Boards of Guardians were giving them an increased dietary, and it was not desirable to establish large asylums for the reception of these hopeless idiots. The cost of a patient in a Lunatic Asylum averaged £20, while the cost of an insane pauper in a union workhouse was only £10. To transfer these harmless imbeciles from the workhouse to the Lunatic Asylum would, therefore, be attended by great expense, without any corresponding good. He trusted that after this explanation the hon. Gentleman would not press the subject any further.


said, he did not agree with the right hon. Gentleman in the satisfaction which he expressed with reference to the centralized power. They were unanimous in Ireland in their wish to manage their local affairs themselves. In his own county they were most anxious to have the appointment of the governors, or some of the governors, because they wanted to check extravagance; but though he had been many years a Member of Parliament, the Irish Executive had taken care that he should have nothing to do with the management of the Lunatic Asylum in his county. He desired to draw attention to one point, which was the difficulty that existed at the present moment in getting a criminal lunatic removed to an asylum. He hoped the Government would take the subject into consideration, in order to remedy the inconvenience.


said, he agreed with almost all that had fallen from the right hon. Baronet the Chief Secretary, and that no unfortunate people were better taken care of than the lunatics of Ireland. He thought, however, that the taxpayers ought to have some control over the appointment of governors and medical officers.


bore testimony, as governor of an asylum, to the fact that the inmates were well cared for. The only fault he had to find with the management of the institutions was the difficulty of getting people in. When a person was suddenly struck with madness, a week or a fortnight might elapse before he could be got into an asylum. He would suggest that, as medical officers were at hand, a certificate of insanity might be obtained without delay, and the afflicted person removed at once to the institution.