LUNACY LAWS.—RESOLUTION.

HC Deb 25 April 1882 vol 268 cc1446-76

MR. STANLEY LEIGHTON

, in rising to call attention to the impropriety and danger of permitting private persons to make pecuniary profit by keeping in their custody lunatics of the wealthier classes; and to the unfairness of requiring the ratepayers to maintain lunatics of the middle and lower classes; and to move, "That all lunatics ought to be committed to the keeping of the State," said, the Lunacy Laws were in such an anomalous state that the very gravest abuses were possible under them—abuses which, if these laws did not actually encourage, they certainly permitted. The present system, if system it could be called, had grown up during 40 years without revision or re-consideration, as a whole, and was wrong in principle, in practice, and in detail. He feared he would succeed in creating but little interest on the subject among the occupants of the Front Benches on either side of the House, for the official mind upon this question was absolutely dead. The President of the Local Government Board and the Home Secretary, who might be called the heads of the lunatics—he meant in their official capacity—cared for none of these things; and he had almost the same complaint to make of the lethargy of their Predecessors in Office. But he would warn the Government that the country was once roused to the fearful abuses that prevailed, and that the country might be roused again. The law divided lunatics into two classes, rich and poor—a mere arbitrary division without a true distinction. The rich lunatics were handed over to a body of private speculators, who made profit out of their detention. The poorer class—that was, the class below those who could pay £70 or £80 a-year to the owners of licensed houses—were placed in the category of paupers. He did not wish to speak harshly of persons, but only of the principle; he should mention no names; but he could not help speaking strongly of a system that encouraged speculation and large expenditure in licensed houses, with a view to the profit of their owners. The money so invested must pay interest. The owners of these licensed houses were anxious to receive lunatics, and found it difficult to release them. It was not easy to make up one's mind to get rid of a patient who was paying £1,000 a-year. What a temptation was thus placed before poor human nature! It was quite possible to retard the cure of a lunatic by the administration of drugs, and it was almost impossible to prove that any wrong had been done. He asked the Government to take away from the owners of these houses a great temptation. The law must necessarily permit, with regard to lunacy, the forcible arrest of individuals. Prompt measures were necessary without a long inquiry. Therefore, additional precaution was necessary to guard against undue detention. A Scotch Commissioner in Lunacy had said that the question of the detention of lunatics was generally determined by the convenience and comfort of others, not of the patient. That was a point he wished the House to realize. The discharge of a lunatic was a loss to the proprietors; and could they expect a man to clear out his own boarding-house? Inspection was provided, it was true; but the staff of Inspectors was small and overworked, and wholly inadequate to remedy the evils. Prevention was better than cure. Surely it was better to remove temptation. What he would propose in regard to the rich was that there should be a State proprietary of these licensed houses. That the State should gradually take over the establishments—it must be remembered they were more than self-supporting; they yielded a large profit from the payments of the patients—and pay the Medical Superintendent, who would then have no interest in the detention of lunatics, a fixed and adequate salary. Let all vested interest be recognized, and let the change be gradual, the house remaining in the same privacy, and in the care of the same medical man, if he was efficient. The only difference would be that the temptation of self-interest would be removed from the proprietors, whose vested interest would be saved, and that the profit would be utilized for those lunatics who were not able to pay for their maintenance. He was not proposing a mere ideal remedy for a theoretical grievance—real grievances were there. The Commissioners themselves in their Report said— There is an uneasy feeling, somewhat widely spread, that further safeguards are needed for the protection of persons alleged to be insane. These were words founded on actual experience. He would give out of the last Lunacy Report two instances, one in which the Commissioners were compelled to require the resignation of the assistant medical man, so grievous was the dissatisfaction at his conduct. Another case he wished particularly to bring before the notice of the House. The Commissioners reported in respect of one licensed private lunatic asylum— Very considerable discontent was discovered among the patients, and numerous charges of cruel practices were brought forward. The cruelty was proved; it consisted in putting blisters on the nape of the necks of unruly pa- tients, which afforded opportunities, apparently freely used, of causing pain by roughly dressing the patients. It appears also that tartar emetic was freely used to bring the patients into a low and weak state. None of the applications of tarter emetic or blisters were recorded in the books. He brought forward those two cases from last year's Report of the Commissioners to prove that all things were not so well conducted in private asylums as many supposed. He had no wish to make a sensational speech; he only wished the Government to deal with this matter before a passionate feeling arose in the country on the subject. If he showed some reason why the State should take over the superintendence of private licensed asylums, it would follow almost as a necessary consequence that it should deal in the same way with the poor who were taken care of in the pauper asylums. Under the present system, all lunatics who could not afford to pay £80 or £100 a-year were placed in pauper asylums. The arrangements with, respect to those asylums were simply chaotic, for there were no less than six conflicting authorities; they were the Home Secretary, the President of the Local Government Board, the Courts of Quarter Sessions, the Boards of Guardians, the Visiting Committees, and the Commissioners appointed by Government. Those different bodies were constantly in conflict. Again, a different system as to the care of lunatics existed in each of the Three Kingdoms. Moreover, pauper lunatic asylums were filled with persons belonging to the middle classes, comprising officers of the Army and Navy, clergymen, and literary men. If it were a hardship and a cruelty to associate pauperism and insanity, surely it was a hardship and an injustice to the ratepayers to make them provide for the insanity of the middle classes. The lunacy of the country was increasing; 1,500 persons were added every year to the list of pauper lunatics. Lancashire had recently been compelled to spend £80,000 on new buildings; Gloucestershire, £25,000; Shropshire, £46,000; Middlesex, £40,000; and Kingston-upon-Hull, £50,000. He might be told that this proposal was nothing but centralization; but, at the present moment, lunatic asylums were, in reality, governed from the Home Office, and local bodies bad little or nothing to do in the matter. Nor did he think it possible that these institutions could be properly governed by the local authorities. If the Government were to take over the pauper lunatic asylums, they would be able to introduce a system of classification. At present all cases, whether acute or chronic, were thrust together into one large building very much to the injury of the lunatics themselves; the result being that the recoveries in pauper asylums were less numerous than in licensed houses. If the State took over all asylums, they would be able to create a regular gradation of payment, according to scale. They would be able to get rid of the present abominable system of subvention to the local rates, which the Prime Minister had declared to be the worst possible system that could exist with regard to rates. They did not want another subvention, but they demanded that Departments which properly belonged to the nation should be taken off the rates altogether. It might be said that he was bringing two questions forward at the same time; that was not the case, for he was calling attention to the whole system of the Lunacy Laws, which arbitrarily and wrongly divided lunatics into the two classes of rich and poor—an unsound and indefensible system. If his proposal were supported, they would succeed in dissociating pauperism and insanity, which would be a blessing to the poorer classes; at the same time, they would relieve the ratepayers of a most unjust burden. With regard to the rich, their detention as lunatics would be dissociated from any idea of private profit or speculation; thus a benefit would be conferred upon rich and poor, and a scandal removed from the laws of this country. The hon. Gentleman concluded by moving the Resolution of which he had given Notice.

MR. GURDON

, in seconding the Motion, said, that among all the cases of unjust burdens cast upon the owners of real property, the maintenance of lunatics was the most unjust of all. What possible reason was there that the expenditure for the maintenance of lunatics should fall exclusively upon the owners of real property? Could it be contended for a moment that the owners of real property furnished a larger proportion of lunatics than the owners of other property? Lunacy was a national misfortune, and ought to be under national management and supported by national expenditure. To a certain extent the late Government recognized the fact by a subvention in aid of the maintenance of lunatics; but, like other subventions, it was not an unmixed good. The first result was that a large number of imbeciles were transferred from the Unions to the lunatic asylums—certainly not an economical proceeding. What they wanted was that the management and cost of maintenance of lunatics should be taken over by the State. He thought there was a far stronger case for State management of lunatic asylums than of prisons and police. There was no local provision for dealing with lunatics. The Visiting Justices of counties had really no power in the matter; the power was really in the hands of the Lunacy Commissioners. If the State took over the care and maintenance of lunatics, there would be the minimum of interference and the maximum of relief to the local ratepayers. He was quite willing to admit that the best private asylums were well managed; but, unfortunately, there were second and third-rate, and even in the best regulated among them there could not be such a thorough inspection and publicity as were desirable, and there was, in consequence, an uneasy feeling in the public mind on the subject. There was this important consideration to be borne in mind, that the proprietor of a private asylum had every inducement to keep a rich patient as long as he could; whereas in a public institution he would be discharged as soon as possible.

Motion made, and Question proposed, "That all lunatics ought to be committed to the keeping of the State."—(Mr. Stanley Leighton.)

MR. DILLWYN

said, he did not wish to go into the question whether the maintenance of lunatics ought to fall upon the State or the local rates. His own feeling was in favour of the charges being borne by the rates. While not agreeing with his hon. Friend on that question, he did think that there was great danger in permitting private asylums to keep lunatics of the wealthier classes. He did not say no private asylums should be allowed; but he thought there should not be such a monopoly as now existed of the custody of the wealthier lunatics in the hands of private proprietors. The law at present was most unsatisfactory. If he were an unscrupulous person, he did not see that there was anything to prevent his incarcerating anyone in a private asylum if it was his interest to do so. There were good and bad private asylums; and if he went to a bad one, he might offer to pay handsomely, say,£1,000 a-year, and he would be told that he must get the certificate of two medical men, and the asylum proprietor would probably add—"I can recommend you medical men for the purpose." The trick was then done, and the unfortunate victim was taken to the asylum vi et armis. That was the law at the present moment. He had carried the second reading of a Bill on the subject, and he was in hopes that the Government would deal with a question which was a scandal and disgrace to the country. The question had been before Committees of the House, and there was no excuse for the Government's not having dealt with it before now. They were bound to do so. Until Government took the matter up nothing would be done; and he hoped they would at last take the matter up in earnest, and deal with it as a Government alone could do.

MR. SALT

said, that his experience was of public more than of private asylums. Private asylums ought, no doubt, to be under most careful supervision; but they had to consider not only the characters of asylums, but the wishes of those who honestly desired to do their best for their afflicted friends. There were cases in private families where the friends of the lunatic would be strongly indisposed to hand him over to the officials of the State. Private asylums ought to be subject to the inspection both of the Lunacy Commissioners and of the magistrates. Besides, medical men owning the best private asylums had, from their position and wealth, more opportunity to exercise a wise discretion, and to carry out the best methods of treatment, regardless of expense, than the officials of a public asylum, who were only paid a moderate salary. Although he was prepared to go a long way with his hon. Friend (Mr. Stanley Leighton), yet he could not say that, in his opinion, private asylums should never be permitted under any circumstances whatever. The best private establishments should be maintained, while those of an inferior character should gradually be suppressed. He believed there were some strong reasons why public asylums should be maintained by the State. As a financial matter, a good deal was to be said for it; and, moreover, such a course would be likely to get rid of some of the difficulties which now existed in regard to the removal of lunatics. There was one matter connected with the question to which he wished to draw particular attention. Whether lunatics were retained in private or public asylums, there should be a periodical visitation of them by the magistrates. It had been said that the magistrates were of no service in such a case, because they possessed no technical knowledge; but he felt sure—and he spoke from experience—that the occasional inspection of asylums by magistrates had a most beneficial effect. He thought that their acknowledgments were due to the hon. Gentleman the Member for North Shropshire for having drawn attention to this important subject.

MR. GREGORY

said, that in the course of his professional life he had happened to have some experience as to the custody of lunatics, and he ventured to say that nothing could be more conducive to their health, happiness, and cure than the treatment bestowed upon them in a well-managed asylum. He admitted that there might be private asylums that required more direction and control, or it might be that some of them deserved extinction. He knew a striking case that came under his own experience of an old lady who was, by order of the Court of Chancery, detained as a lunatic in a private asylum, and she gradually recovered, and the Medical Superintendent declared that she was not a fit subject for the Institution, and that she must be removed. When this was explained to the old lady, she said that she was willing to be guided by her friends if they desired her removal, and to have the Commission of Lunacy superseded; but she expressed her preference for remaining at the asylum where she had spent so many happy years, and a private arrangement gratifying her wishes was made. He knew one private asylum in his own neighbourhood which was most admirably managed. There were grounds, gardens, and plantations surrounding the premises, and there were bil- liard-rooms and concerts and other entertainments provided, and everything was done to promote the health and happiness, and, if possible, cure, of the patients. He questioned if this would be the case under the State. The management of asylums would then be managed under certain inflexible rules, and there would be one uniform system of treatment and control, which would not be beneficial in the interests of the patients, and there would not be the same varied experience in the efforts to cure their malady. He admitted that better management might be enforced by the Inspectors now appointed by the State; and with properly qualified Inspectors and control there would be nothing to complain of. He believed that those who managed private asylums were, as a rule, men who, out of respect for humanity and their own positions, would not do anything wrong against those left in their charge. With regard as to who was to pay for the support of pauper lunatics, that, in his opinion, was entirely another question; but the question now before the House was one of control and management. He doubted very much, however, whether the change now proposed would promote the interests of the country. In any case, if the present proposal was adopted an immense responsibility would necessarily be incurred by the Government, or the Department of it upon which the maintenance and control of all the present asylums throughout the country was to be thrown.

DR. FARQUHARSON

only wished to say one word upon the subject before the House, as he had no wish to keep the House from the important discussion that was to follow, and that was that in the main he agreed with his hon. Friend that it might be desirable to change the law upon this question in some respects. He emphatically dissented from any argument brought against medical men using their position to keep patients in lunatic asylums. They had heard something of the retarding of cure by drugs; but the Royal Commission from which evidence had been given did not bear out that assertion. The temptation, although great, had been thoroughly resisted. The temptation in the case of medical men in private practice to get more out of their patients was also great; but that had likewise been resisted. He would not say more, as he had no desire to keep the House from the very important discussion which was to follow.

MR. ROUND

said, he wished to say a word in favour of the Motion now before the House, and to thank the hon. Member for North Shropshire (Mr. Stanley Leighton) for calling attention to the important question of the cost and treatment of lunatics. He looked at the question from the ratepayers' point of view, and he never could see why the whole cost of providing for insane persons should be thrown upon one description of property—namely, houses and land, while six-sevenths of the income of the country were exempt from any contribution. He thought lunacy was always considered a national calamity, and he remembered the Prime Minister saying, when he introduced the Irish Church Disestablishment Bill in 1869, and was alluding to the surplus funds, that "the maintenance of lunatics was a duty of the community." These poor people were not drawn from one particular class, and he thought it unfair that the whole burden of their maintenance should be thrown upon ratepayers. At the present time the agricultural interest was suffering from an unprecedented depression, and he believed the ratepayers in the county he represented felt strongly on this subject. He thought that the increase of insane persons, and the necessary increase in buildings for their reception, was attracting attention, as in many counties a second asylum was now found to be required. In 1879 the cost of building asylums amounted to£290,000, in 1880 to£358,000, and in 1881 to£370,000. The whole cost in connection with lunacy was about£1,250,000. He wished to draw the attention of the Secretary of the Local Government Board to the difficulty of ascertaining the total cost from the present Returns and Reports. He had first to examine the accounts of the County Treasurer, then the Local Taxation accounts, and also the Lunacy Commission Report. He suggested that the information of the total cost of lunacy should be given in one Return. His own county was peculiarly unfortunate in respect of lunacy charges, for it was saddled with the cost of the maintenance of almost all pauper lunatics who were brought from India and landed on the Essex side of the Thames; and he hoped the Indian Government and the Local Government Board would give some further relief in this respect. He feared that there was a retrograde feeling in the present Parliament on the subject of local taxation. He remembered that the last Liberal Parliament, elected in 1868, supported by a majority of 100 a Resolution that many of these local charges should be borne by the whole community. He had looked at the Division List on that occasion, and saw the name of the President of the Local Government Board (Mr. Dodson) amongst the majority. He trusted, therefore, that he would not refuse his support to the present Motion, and he earnestly pressed the consideration of the whole matter upon the attention of the Government.

MR. HIBBERT

said, he fully recognized the inconvenience and expense to which the county represented by the hon. Member for East Essex (Mr. Round) had been put through the landing in the county of lunatics from India, and he could assure him that the Local Government Board would do all in their power to relieve the county of this additional burden as far as they could. The Motion of the hon. Member for North Shropshire (Mr. Stanley Leighton) was chiefly directed to two points—to the question of private asylums, and to the taking over by the country of the lunatics in the country generally. With respect to the first question, he did not think the hon. Member would secure a majority in that House. He had listened very carefully to his remarks, and had only been able to gather two cases of hardship—one of cruelty, and one of unjust detention, in the private lunatic asylums in the country. Many of them, perhaps, were not satisfactory; but, as everyone knew, there were private asylums and private asylums. A very strong case would have to be made out before the Government abolished the system in this country and took over to themselves the care of the whole body of lunatics. There were no less than 6,300 private asylums in the country. [Mr. STANLEY LEIGHTON: 6,300! There cannot be so many.] He (Mr. Hibbert) was reading from the Commissioners' Report, which gave 2,880 registered private lunatic asylums, and 3,420 licensed houses for the reception of lunatics, making 6,300 in all; and he did not think the Government, after their experience of the expense of taking over the prisons, would be ready to adopt the same course with the lunatic asylums. Nor did he think that any case had been made out against the public lunatic asylums. He had himself been for many years a Visitor of a large one in Lancashire, and he thought he agreed with his hon. Friend that they were the better of the two. They required, however, great care in inspection, and greater care, perhaps, should be exercised in sending patients to them. While fully admitting that, he thought it must be well known to the House that it was almost useless for the Government to bring forward a Bill to remedy these defects with any fair chance of placing it upon the Statute Book. He must admit that there had been a very considerable increase in the number of lunatics. In private asylums the number had risen from 6,454, in 1871, to 7,741, in 1881; in public asylums from 56,735 to 73,113—a very large increase indeed. Much of this increase, however, was due to the subvention given a few years ago to lunatic asylums, and the Commissioners had pointed out that the Act of 1874 had tended to remove lunatics to public asylums. Many had been sent thither whom the managers felt disinclined to receive, on the ground that those institutions were to be regarded as curative institutions, and that confirmed lunatics ought not to be sent there. In this view, two establishments would be required—one for the hopeless cases, and one for patients who might recover; and such a system was not without its advantages. With respect, however, to the principal proposal of the hon. Member, the proposal that the State should take over the public asylums and thereby transfer the expense from the ratepayers to the country, he did not think the House would sanction any such proposal. It was evident, from the statement made last night, that the funds at the disposal of the Government were not large, and additional taxation would have to be proposed if any such scheme were contemplated. He did not think the pauper lunatic class ought to be treated differently to the pauper class in general. No doubt, some hon. Members were in favour of a subvention to the outdoor poor; personally, speaking for himself and not for the Government, he should be very sorry to see the State paying anything directly in aid of the poor. That would be a very dangerous and difficult step to take. If the Government undertook the treatment of all the lunatics, there was no reason why they should not act similarly towards the blind or the deaf-and-dumb class. It had been said that the magistrates had very little control in the matter. He did not agree with that statement; they certainly would have much less if asylums came under Government management. On these grounds, therefore, he could not, on the part of the Government, support the proposal of the hon. Member; and he should be obliged, if a division were taken, to vote against it.

MR. BERESFORD HOPE

said, that, having had opportunities of closely watching the working of a private asylum, he should be able to bring down the subject from the world of romance to the level of indisputable fact. Horrifying pictures had been drawn by the hon Member for Swansea (Mr. Dillwyn) of the treatment of lunatics. The House had heard from him of gentlemen who were desirous of spending£1,000 a-year for their own sinister purposes. They had heard how much a-year would go to the ruffianly madhouse keeper, how much to the doctor or surgeon, and how much to the Visiting Magistrates; and, no doubt, the House was carried away by such a picture, which was worthy of a novel by Zola. But, for the consolation of those who had relations with£1,000 a-year—which they were willing to spend to persecute them—he would explain to the hon. Member for Swansea and to the House the process by which a gentleman could be confined in such an asylum. In the first place, he must be handed over to the madhouse keeper by some other person; and it was not everyone who had£1,000 a-year and was willing to expend it in making someone else miserable. Then came the doctor who kept the madhouse, and then the two doctors who signed the certificate knowing that signing a false certificate would entail the utter ruin of their character. Then, again, any lunatics in an asylum were at liberty to write to the Commissioners, and this they could do over the heads of the keepers. How many cases of systematic cruelty and neglect had been heard of? Was the hon. Member for Swansea prepared to say that there had been more cases of assault in private than in public asylums? He had figures to prove the contrary. Then, another argument on which the hon. Member dwelt was that the doctors of these private asylums were tempted by motives of gain to keep their patients longer than patients in public asylums; but the actual facts were that, whereas in public asylums the average period of detention was rather more than three years and seven months, in private asylums it was less than two years and five months; so that the balance was in favour of the private asylum. In fact, he believed the tendency was to let the patients out too soon. How could these injurious charges be brought against a body of highly-educated gentlemen, who spent their lives in the pursuit of science and in works of charity, of their being actuated by low and base motives? The private asylums ought not to be abolished; but the treatment of lunatics should be left to private enterprize and science, as in the case of the treatment of other maladies, and the competition of private enterprize ought not to be discouraged. The old superstition that there was some wide difference between diseases of the mind and diseases of the body was vanishing away before scientific research. The great improvement of medical science in our days was vitally encouraged by personal competition. If they abolished this in the case of "mad doctors," they made them an inferior class, and they struck a disastrous blow at the growth of medical science in regard to the treatment of the insane. The great name of Lord Shaftesbury had been invoked during this discussion; he had fought the battle of the lunatics, and years ago his voice was raised against private asylums. Five years ago a Committee sat upon the subject. As no one had yet quoted a sentence from the Report of the proceedings before that Committee, he would now quote one. As the name of Lord Shaftesbury had been used in connection with that subject, he would quote what was said by that noble Lord in his evidence before the Committee. Lord Shaftesbury's evidence was to the effect that the state of things in private asylums had greatly improved since 1859; that he could not now say of them what he had said before that date, and that there had been continuous advance and improvement since that date. He (Mr. Beresford Hope) wished also to point out that the private asylums were more successful than the public ones. The percentage of cures in the former was 50 per cent of the whole number, whereas in the public institutions it was only 44 per cent. He quite agreed that it might be desirable to extend the powers of the magistrates, to extend the system of medical examinations, and to make it more careful and scientific. But if we were to go into the question of subvention by the State where were we to stop, and where was the money to be found? Was it to be found in an additional guinea on carriages, or by a tax on adulterated tea?

MR. HIBBERT

said, he wished to correct the statement he had made as to the number of private asylums. The number ought to be 153.

SIR R. ASSHETON CROSS

said, that he had had great experience of the subject, as for many years he had been Chairman of a Visiting Committee of Magistrates. He regretted the absence from his place of the right hon. and learned Gentleman the Home Secretary, as it was a question especially belonging to his Department, and he himself had had much to do with the question at the Home Office. There was a divided jurisdiction on the question of Lunacy, which belonged partly to the Lord Chancellor, partly to the Home Secretary, and partly also to the Local Government Board. He had been particularly engaged on the question some three years ago; and it struck him there were three points especially requiring attention—first, to see that there were sufficient safeguards to protect sane people from being taken into private asylums; secondly, to see that they were properly treated; and, thirdly, that there should be proper means to obtain their discharge when cured. When on the Visiting Committee he had found that many persons were detained who ought to be let out, and he was instrumental in letting them out. He had obtained the appointment of a Select Committee, and that Committee in its Report dwelt on the very points which he had mentioned. The public were not convinced, as they ought to be convinced, that proper precautions were taken before a person was confined in an asylum. He could not conceive anything more terrible than that a person who was not insane should be placed in an asylum out of which it was extremely difficult to get; and they could not be too careful in protecting persons against interested relatives. The Committee suggested that the certificate ought to be granted by two medical men; that the first order to commit should be confined to a limited period, and that a fresh examination of the patient should take place every year. That was a valuable recommendation, as the most important results of a good treatment were seen at an early stage of the disease. Then the Committee advised that precautions should be taken to prevent sane persons from being locked up, and that means should be secured for letting the patients out as soon as ever they were cured. He hoped the Government would take the matter into their serious consideration and carry these recommendations into effect. He had no doubt the Visiting Justices did excellent service in the matter and procured the release of many persons wrongfully detained, as he had himself done when the Chairman of a Visiting Committee. He desired to have a more certain assurance than at present that nobody would be confined in the present asylums who ought not to be confined there. As to the treatment which they received when they were confined there, little complaint was to be made. The Lunacy Commissioners came down and sometimes took things for granted. He was bound to say that once upon a time he paid a visit suspecting something to be wrong. He came down at 8 o'clock on a Sunday morning, when there were no Inspectors, and when he could see things for himself. He took a friend with him, and they did find a considerable amount of wrong going on. He believed that something like this would tend more than anything else to keep things right. He hoped his right hon. Friend would meet these observations in the spirit in which they were made.

MR. THOMAS COLLINS

(who rose amid cries of "Agreed!") said, he was surprised at the impatience that was shown on the other side of the House. He thought it should be recollected that when it was said that persons were improperly detained, there were other cases, perhaps more frequent, when persons actually lunatics were allowed out of the asylum. He would allude to the case of Maclean. That man had been let out, and the result of that might have been much more serious than it was The question which the hon. Member for Shropshire (Mr. Stanley Leighton) had raised was a very large one; but he thought he had acted very unwisely in the interest he had at stake in mixing up two distinct propositions. They had some very strong language from the hon. Member for Shropshire and the hon. Member for Swansea (Mr. Dillwyn), but they had no facts. A larger proportion of persons who went to the private asylums were restored to health than was the case in public asylums. He did not say that this proved that the public asylums were worse managed than the private asylums. Wealthy relatives of patients in private asylums might more frequently remove them, and this might account for the fact to which he had called attention. He contended that to hand over all lunatics to the control of the State would be a retrograde step, and that, at any rate, it would be a change for which public opinion was not yet prepared. Already the State was superseding individual action far more than was wholesome. Every year attempts were made in that House to make the State everything and the individual nothing. It appeared to him that the hon. Member for North Shropshire would have been better advised if he had restricted his Resolution to the question of the cost of pauper lunatics. In his mention of that topic the hon. Member had expressed his decided dislike to the principle of subventions; but did he mean that the whole cost of the maintenance of this class of lunatics should be borne by the locality itself? A great deal had been said of the increase of lunacy in the country, and, no doubt, the subvention given by the last Parliament had increased the demand for more accommodation in the county asylums. In the West Riding of Yorkshire, where the population was 1,800,000, a second asylum had lately been established, and within the last few months a site had been provided for a third; but the fact was, not that lunatics had increased of late years, but that they were better cared for now than formerly. He would rather have seen the lunatic asylums than the gaols transferred to the Treasury. He would not recommend the hon. Member for Shropshire to press his Resolution as it stood; but would suggest that he might consent to an amendment of it, and he invited some hon. Member to move an Amendment, so that they might then debate a definite issue.

VISCOUNT EMLYN

said, that the request made by the hon. Member for North Shropshire (Mr. Stanley Leigh-ton) appeared to be a very large one. As to those who were maintained in private asylums, he quite agreed with the Secretary to the Local Government Board that the hon. Member failed to make out a case for the change he proposed. The cases he brought forward went to prove, not that the cost of maintenance ought to be transferred to Imperial funds, but that the supervision was not sufficient. He granted that it might be better; but all that we had a right to ask was that private and public asylums should be carefully, regularly, and efficiently supervised. He could not support the suggestion that private asylums should receive more assistance from the State. It was very difficult to discriminate between persons of the middle class and those of the lower class, and to draw a line separating one from the other. His hon. Friend proposed that all lunatics should be committed to the keeping of the State. With that he could not agree, for the proposal, if adopted, would have a tendency to lower the middle classes. Their object should be to make the middle class independent, and not to reduce it to the level of the pauper class. At the same time, necessary supervision should be exercised, in order to make sure that middle-class lunatics were not ill-treated or improperly confined. It was a mistake to suppose that lunatics of that class were maintained at the cost of the ratepayers. Where accommodation had been provided in pauper lunatic asylums for future tenants, the Visiting Justices had been ready to extend to those middle-class lunatics who approach nearly to the pauper class the assistance of which they stood in need, and had allowed them to enter asylums on payment at a remunerative rate. It could not, under such circumstances, be said that persons belonging to the middle class were thrown upon the rates. One complaint which was made was that subventions granted by the State to local authorities encouraged extravagance. It was not true, however, that the subvention of 4s. per lunatic had led to extravagance. A contrary tendency had, in fact, been apparent. An hon. Member had referred to the question of the removal of lunatics. On that subject he would say no more than that he hoped that when the question of the removal of paupers should be taken in hand the question of the removal of lunatics would be dealt with also. He was of opinion that a better classification of lunatics was needed, in order that the criminal lunatics now kept in the county asylums might be separated from ordinary pauper lunatics. The inconvenience of the present system would not be remedied by sweeping away all local control and handing over the asylums to the Imperial Government Bearing in mind the troubles and sorrows caused to paupers by lunacy, he questioned whether they would benefit by being deprived of the local interest attaching to their cases. He thought that some supervision by the magistrates should be maintained over these institutions; but he considered there was no necessity for the sweeping changes recommended by his hon. Friend.

MR. DODSON

said, that his right hon. and learned Friend the Home Secretary was absent owing to an unavoidable engagement, and not to any want of interest in that debate. The right hon. Member for South-West Lancashire (Sir R. Assheton Cross) had called attention to three important points—namely, the conditions under which lunatics were admitted, their treatment, and the mannor of their release. But the Report of the Committee which sat on the matter was not unfavourable to the existing system. So far as he was acquainted with the evidence, there was scarcely one proved case of undue detention for the sake of profit to the proprietor of an asylum, and not a single case of detention through the action of interested relatives or friends. If that be so, the existing system could not be said to be a bad one in that particular. So few Members had spoken in favour of the terms of the Resolution that he thought the hon. Member had better soon go to a division or withdraw his Motion. Under the present system many lunatics were paid for by their friends, whereas the hon. Member wished to throw the expense of their maintenance on the State. [Mr. STANLEY LEIGHTON: That is not my proposal.] The hon, Member's proposal was that all lunatics should be committed to the keeping of the State. It appeared to him (Mr. Dodson), however, that the duty of the State with regard to these persons began and ended with the work of inspecting the places in which lunatics were confined to see if cases of oppression occurred. He could not see why the State should maintain all lunatics—[An hon. MEMBER: That is not suggested.]—well, he could not see why all lunatics should be "committed to the keeping of the State," which were the hon. Member's own words. He failed to see why it should be the duty of the State to undertake the charge of these persons any more than of persons suffering from infectious diseases. In his opinion, the State already undertook too many duties, several of which would be better left to the management of local authorities. With regard to the other part of the proposal of the hon. Member for Shropshire (Mr. Stanley Leighton)—namely, "the unfairness of requiring the ratepayers to maintain lunatics of the middle and lower classes," he understood it to mean that the State should completely, or to a greater extent than now, come to the assistance and support of the ratepayers. He would not enter into the question whether the subvention given by the State of late years had or had not been beneficial in its operation, or answered the purposes for which it was intended; but the hon. Member for Shropshire had, no doubt, heard the Budget of the Chancellor of the Exchequer, and was perfectly well aware that the Government were not at present in a position to supply the means he referred to. Under the circumstances, he thought the debate should now be allowed to come to a conclusion, either by a division or the withdrawal of the Motion.

MR. SCLATER-BOOTH

said, he thought the right hon. Gentleman had hardly done justice to the complaints which had been made with very great force from time to time in this House, and, notably, by his right hon. Friend (Sir R. Assheton Cross) on the Front Opposition Bench within a few minutes, in regard to the condition of private lunatic asylums, and the uncertainty, to say the least of it, which existed in the public mind in regard to proper care being exercised in the discharge from the asylums of persons cured. The hon. Member for Swansea (Mr. Dillwyn) had, no doubt, met with very great support in the action he had taken for years past on this branch of the subject. After the Report of the Select Committee it could not be said that they were not familiar with the subject, and his own opinion was that all apprehension ought to be removed from the public mind in regard to these private asylums; and though he was not in favour of the State taking these lunatics into its charge—and into its pay, as it were—he certainly thought the ideal system they ought to aim at was a system by which lunatics belonging to the wealthy and middle-class families might have that ample security which the poor enjoyed in pauper lunatic asylums—namely, the security that it was not to the interest of any human being in the asylum to retain them in it one minute after they were cured. In a public asylum the interest of all the officials was to discharge the patients as soon as possible; but in the private asylums this state of things was reversed, and his view was that no lunatics should be intrusted to those who were pecuniarily interested in their maintenance. It did not follow that the lunatics themselves or their relations or property should not be charged with the cost of their maintenance, or that they should not be kept in a manner adequate to their position and means. They need not be maintained at the cost of the public—that was the short way of putting it; and his hon. Friend was not, he thought, open to the charge of desiring to relieve the better class lunatics from the obligation of maintaining themselves, or relieve their relatives of the obligation of maintaining them. With regard to pauper asylums, for many years he had taken an interest in this subject, not only on account of his long connection with the Local Government Board, but because he had been for many years Chairman of a pauper lunatic asylum in his own county—one of the best managed asylums in the Kingdom. He was strongly convinced of the great advantages which had attended the establishment of these pauper lunatic asylums, and he thought it a very serious and onerous obligation on the local authorities that they should have been obliged, without any assistance from the State, to maintain these institutions. He looked with the greatest satisfaction to the part he had taken in this matter. The right hon. Gentleman was not enamoured of subventions; but there could be no doubt that in this particular case they had worked a vast amount of good. The amount was so small that it did not interfere with the Guardians in the exercise of the discretionary power of maintaining pauper lunatics in their homes or in workhouses, if they were fit to remain there. The cost of maintaining pauper lunatics at home or in the workhouse would still be less than half the amount it cost to maintain them in the asylum. He did not think anything could be more conducive to the interests of the poor as a body than that the State should relieve the ratepayers of some portion of the cost of keeping pauper lunatics. The institutions in which they were maintained were controlled by Government officials—the control being in no respect in the hands of the Guardians. It seemed to him it would be easy to have an extension of that principle, and that there would be no difficulty in providing for the maintenance of the whole of the lunatics of the country in that way. By this means the incomes of the managers, superintendents, and medical and other officers would be secured, and it would not be to the interest of anyone to keep a patient in an asylum after he was cured. He would not detain the House any longer, except to express the opinion that, although the terms of his hon. Friend's Motion were open to some question, their general object was worthy of the support of the House.

MR. R. H. PAGET

begged to thank the hon. Member for Shropshire (Mr. Stanley Leighton) for having opened this interesting discussion on a question which all who had ever had anything to do with lunatic asylums must feel to be of considerable importance. He wished to say a word with regard to middle-class lunatics, to which allusion was made in the Resolution of the hon. Member. No class was placed in such a position of difficulty as the middle class, when members of their families were unfortunately afflicted with lunacy. It was well known that the expense of private asylums was so great as to render it impossible for all but the rich and well-to-do to have recourse to them; and, at the same time, it was felt that middle-class lunatics were not proper persons to be received into asylums maintained at the expense of the rates. They were considered an unfair burden on the rates; but the difficulty was there were no other asylums open to them, those of a private character being too expensive for them to resort to. Some very pertinent questions had been addressed to the Government on this question; and, without wishing for a moment to degrade or pauperize a class which was specially independent, he would say this—that the State should take some step to alleviate their unfortunate position. It had been brought to their notice to-night that under the State-subvention system lunatic asylums had become very full, and that in many cases it had been found necessary to make a considerable extension of buildings. He would venture to offer this for the consideration of the Local Government Board—that the time had now arrived when steps should be taken to remove from our pauper lunatic asylums the class of idiots. The question had been raised before in the House, and he very much regretted that, hitherto, no vigorous attempt had been made to effect this object. Everyone who had visited pauper lunatic asylums must know this—that in every one of these asylums there was a considerable class of idiots. They were as well looked after as the circumstances of the asylums would permit; but they were a hindrance to the discipline of the institutions, and there was no provision for improving the existing state of things. Everyone who was acquainted with the subject must know that idiots would and could be far better maintained in separate asylums. If this was true—as undoubtedly it was—of the adult idiots, it was ten-fold more true with regard to those unhappy idiots of a more youthful age. The experience of Earlswood and other idiot asylums showed what could be done when young children, in that unhappy state of idiotcy, were taken by the hand and carefully trained and brought up. Instead of living lives of misery and helplessness, their latent faculties might be trained, and they could be made useful members of society—their faculties might be developed, and an extraordinary change might take place in their mental condition. This could only be done in institutions set aside for the training of these children, and at present there was no such provision made for their treatment. [An hon. MEMBER: There is in the Metropolis.] He (Mr. R. H. Paget) thanked the hon. Member for reminding him that provision of this kind had been made in the Metropolis; but it was not the case in the rest of England. He considered it one of the greatest blots in our arrangements for the care of lunatics that we had no such provision throughout the country; and now, whilst they were debating the whole question of the care of lunatics, was a fit opportunity for calling attention to the matter. He hoped, before the discussion terminated, to hear from some of those who were officially connected with the subject that they were prepared to take some steps to deal with this point, as he ventured to say that no more humane object could commend itself to the mind of the most philanthropic person than taking in hand and training those unhappy persons who had been idiots from their birth. It must be remembered that the maintenance of these persons in the present pauper asylums was one of the reasons why those institutions were so full. If they could be sent to proper asylums, where they ought to be maintained and trained, there would be more room in the pauper lunatic asylums. People talked about overcrowding, and the necessity of building; but what was it that had led so much to the overcrowding of lunatic asylums? Was it not this? Did not everyone who had been connected with the management of these asylums know this, that it was a constant practice to send aged, senile paupers into the lunatic asylums—paupers suffering simply from a decay of the mental faculties, who were not fit persons for the hospital treatment of lunatic asylums? Their condition was that of advanced years and of mental and physical decay. Cases of this kind were known to everyone—they were occurring every day. Large numbers of these poor creatures were sent into the asylums, to remain there months, or weeks, or days, until they were released by death from their sufferings. Why were these people received into the asylums? Why, because Boards of Guardians now received inducement to take them which was not offered them before. Perhaps it was not so much an inducement, and it might be more cor- rect to say that that which was a positive hindrance before had now been removed. The President of the Local Government Board would do well to take this matter into his careful consideration. If the right, hon. Gentleman could see any way to exercising his authority, and producing new legislation under which places could be established for the care and maintenance of these people suffering simply from failure of mental faculties consequent, in most cases, upon advanced age, he would relieve the pauper lunatic asylums of a vast number of those who now crowded them out, and would obviate one of the great evils that were now complained of—namely, the necessity for largely increasing buildings and the staff of the asylums. There was one other remark he wished to make, which tended in the same direction, and it was this. He was not in the House at the time, but he understood from those who were that, in an official speech this evening, an opinion was expressed hostile to the idea of any State subvention in aid of the indoor poor. [Mr. HIBBERT: I simply expressed my own private opinion.] He was sorry the hon. Member entertained such an opinion, and trusted he might be able to convert him. He (Mr. R. H. Paget) believed that if State subventions were given in aid of outdoor poor, it would be by no means difficult to persuade the various Boards of Guardians not to consider the various Union-workhouses as belonging to a given local authority, but as belonging, as a whole, to the Poor Law authorities. He believed there were a great many vacant places and beds in some Union-workhouses, whilst others were overcrowded. If they were no longer isolated, but were classified and brought together, he believed it would be found that in many districts one or more of them could be dispensed with. If buildings of this kind could be dispensed with for Poor Law purposes, what more fit and proper use could be made of them than to fit one up as an asylum for the training of idiots, another for the care of harmless lunatics, and so on? These afflicted persons, in such institutions, could, no doubt, be maintained at a more moderate rate than they were at present in the pauper asylums. It would be a great advantage to free the lunatic asylums of harmless imbeciles. There would then be ample room in them for the treatment of that class for whom they were intended, and they could then be used in their proper capacity—namely, as great hospitals. A lunatic asylum should be a hospital for the care of persons afflicted with disease; and when the disease reached a stage from which there was no hope of recovery, and when all that was desired for a patient was that he should be carefully tended and well fed, the patients should be sent off to these buildings he had described. When the authorities had done this, they would have done all that humanity could demand. But the thing must be done in this way. It was in vain to say "Oh! send these people off to the various Union-workhouses." They knew that to be wrong—they knew the poor imbeciles and idiots deteriorated there. [A laugh.] The President of the Local Government Board might laugh at this, but it had been actually proved to be the case. It had been proved within his own experience. Some years ago, in Somersetshire, their lunatic asylums being full, and it being necessary for them to send a number of people to another institution for a time, they, with the greatest anxiety and care, selected a definite number of the most harmless lunatics, whom it was thought could be transferred to workhouses without injury to their physical or mental condition. Before sending them out the precaution was taken to put them in the scales and weigh them. At the expiration of about two months the majority of them were brought back. But what was their condition? Why, they had all deteriorated, mentally and physically, and in every case they had lost largely in bodily weight. Nothing could be plainer than that the Union-workhouses was no place for them. The necessary appliances were not there. The necessary diet and care was wanting; and in the case he had mentioned the unhappy lunatics were all injured by their residence in the workhouse. Now, the whole result of the subvention which had been so much decried had been to do that which the Lunacy Commissioners for years past had told them they ought to do. Take these isolated instances of imbecility from the workhouses where they were badly treated—or, he would not say where they were badly treated, but where the circumstances were un- favourable to their treatment—and place them in the great hospitals for lunacy, which were, and ought to be, the proper asylums for such people. He must apologize to the House for having spoken somewhat warmly on this matter, but what he had stated he knew from his personal experience. He knew the injury that was done to these idiots and imbeciles when they were sent to the workhouses. He felt it was a step which ought not to be taken; and, so far as the 4s. a-week subvention had had the effect of freeing the workhouses and sending these people into the asylums, it had been one of unmixed good. As regarded this particular Motion of his hon. Friend, he could not help regretting that the hon. Member had got two or three subjects rather mixed up in it. He (Mr. R. H. Paget) could not agree to it as it stood. He could not assent to the proposition at the end, "that all lunatics ought to be committed to the keeping of the State." He believed there was much the State ought to do in regard to middle-class lunatics, in regard to idiots, and in regard to the maintenance of the more harmless cases of lunatics in asylums, which might be linked on to, or connected in some way with, the great pauper asylums. This debate would have been of great value if it had had the effect of drawing the attention of those who were responsible in this matter to the fact that the Lunacy Laws were not so entirely satisfactory that there was not room for improvement, in more ways than one, and of teaching them that they were not to sit still and hug themselves in a sense of complacency, believing that all was good, and that there was no room for reform. There was plenty of room for reform, and he trusted that those in authority, and those who had the power to bring in useful legislation on the matter, would not be slow to deal with that which he ventured to assert was of great and urgent necessity, affecting, as it did, the welfare of a class whose ease commanded the sympathies of all those who were actuated by the ordinary feelings of humanity.

SIR TREVOR LAWRENCE

said, he was a Member of the Committee which sat on this subject in 1877 and 1878, and had attended almost all the meetings. He had heard a vast amount of evidence, and had given it a great deal of consideration, therefore he trusted he might be allowed to say a few words on the subject. If there was one thing which was conclusively proved during the inquiry, it was that the accusations brought against the private lunatic asylums were entirely without foundation. The hon. Member for Swansea, at whose instance, in a great measure, the Committee was appointed, after having investigated the facts, and taken a great deal of trouble to bring before the Committee the most promising cases, as he thought them—as showing the manner in which business was carried on in those places—came himself to the conclusion that no case had been made out against the private lunatic asylums. He would appeal to the Solicitor General, who was also a Member of that Committee, to bear him out when he said that no case was made out against the keepers of the private lunatic asylums. Every Member who had seen the interior of those asylums must be well aware that the greatest possible skill and the largest possible outlay was brought to bear within them on the treatment of the insane. Let anyone who doubted that statement pay a visit, for example, to the very admirable asylum of Dr. Newington—it would not be a long distance to go. He would ask anyone who had been over that establishment whether, if he was unfortunate enough to have a relative afflicted with lunacy, that would not be a place he would like to send him to? If there was any body of men to whom the thanks of these poor suffering people were due, it was the Commissioners of Lunacy, of whom Lord Shaftesbury was the head. If he might venture the remark, instead of there being a number of sane people shut up in lunatic asylums, there were many out of their minds at large who ought to be in confinement. He was sure hon. Gentlemen who received much correspondence would fully bear him out, when he said that a very considerable number of letters they received emanated from persons who ought to be under some restraint or other. There was one very important consideration in connection with the maintenance of private lunatic asylums. If the Motion of his hon. Friend were to be carried, the result would be that those persons who ought to be brought under the influence of immediate treatment would be kept as long as possible from the influence of that treatment, in the hope that the stigma supposed to be involved would be avoided, and that the family to which the lunatic belonged would be free from it. One of the advantages of private asylums was that they provided admirable treatment for the insane without real publicity. With regard to public asylums, his hon. Friend the Member for Mid Somerset (Mr. R. H. Paget), was right when he advocated the separation of the imbecile and idiots from lunatics. The county of Surrey, which he had the honour to belong to and to assist in representing, had large asylums, and they were constantly being called upon to build others for imbecile paupers and idiots, who, so far as treatment or security were concerned, might as well be out of them. There was no question of security; they were only put there to be taken care of; and if the President of the Local Government Board could see his way to separate imbeciles from lunatics he would do much to help the cure of the insane. One of the great difficulties about private asylums was the liberation of patients at the right moment. Mental disease was not like bodily disease. Bodily disease was over when it had been gone through; but mental disease very often passed away for a time, and then returned. Many cases were brought before the Committee which showed the necessity of extreme care and caution in liberating lunatics. With regard to the point of having patients in public asylums, it was well known, also, that pauper lunatics were occasionally found in private asylums. In Surrey, when their asylums had been gradually getting full, it had been necessary for the authorities to pay a large sum for the purpose of getting some patients in private asylums. He was one of those persons who thought that the Department which his right hon. Friend (Mr. Dodson) represented was already very greatly overburdened; and he was sure nothing could be worse and less desirable, in the interest of the lunatics themselves, or the community in general, than that the lunatics should be handed over to the Local Government Board. If his hon. Friend went to a division he should most certainly vote against the Motion.

COLONEL MAKINS

said, he was glad that neither the condition of the atmosphere outside the House nor the depress- ing nature of the discussion itself, nor the visible impatience of some hon. Gentlemen opposite, had prevented them having a most valuable and interesting debate on this Motion. He was prepared to go into the question more particularly as to the very great variation in the cost of maintenance of lunatics in different parts of the country; and he was prepared to adduce figures with reference to that point, in order to show how necessary it was that hon. Gentlemen who took an interest in the subject should take the matter into their consideration. If the debate had done anything it had shown the great necessity which existed for a classification of the inmates in our lunatic asylums. If the right hon. Gentleman the President of the Local Government Board would take into his consideration the desirability of the separation of the imbeciles and idiots from the more pronounced lunatics, the time which had been spent on this debate would not have been thrown away. As to private lunatic asylums, he admitted the force of the remarks that had been made by his right hon. Friend the Member for the University of Cambridge (Mr. Beresford Hope) and by his hon. Friend the Member for Mid Surrey (Sir Trevor Lawrence). There was no doubt that many of the proprietors of private asylums did conduct them in a most excellent way, and did provide shelter for those among the upper classes of society who were unhappily afflicted with lunacy. At the same time, there were objections which might be raised to the continuance of private asylums, and he thought one of them was the question of finance. If the inmates of private asylums were transferred to public lunatic asylums, not, of course, as paupers, not as patients to be aid for by the country or the ratepayers, but as patients under the care of the State, there would not only be a cessation of many anomalies, but he believed a large fund might be raised, which would go to the relief of the rates. He was not prepared to support the Resolution at the present moment; but he would not say the Resolution was not entitled to reasonable support. It was a Resolution which sooner or later would have to be considered by the House. The hon. Gentleman the Secretary to the Local Government Board (Mr. Hibbert) agreed with him as to the necessity for classification. He did not think he need pursue the question.

Notice taken, that 40 Members were not present; House counted, and 40 Members being found present,

COLONEL MAKINS

said, he was sorry to find that the hon. Member for Northampton (Mr. Labouchere) had so little sympathy with the mental sufferings of his fellow-creatures. He should, however, endeavour to meet the wishes of the hon. Gentleman, as far as he could, by abbreviating his remarks. He would not trouble the House with the statistics which he had prepared with reference to the variations in the cost of lunatics in different parts of the country, except to point out that, whereas the cost of lunatics in boroughs was 11s. 4⅛d., and in counties, 9s. 6¼d.; in private asylums, which were generally under philanthropic management, it was very much greater. Therefore, he thought that even in that respect there would be a considerable advantage to the community if the management of lunatic asylums throughout the country was brought within the purview of some central authority. He was one of those who objected very much to the principle of centralization; but he thought this was one of the cases in which an exception might be made. He had to express the earnest hope that the Government would take into consideration this important subject, and would take an early opportunity of bringing the matter before the House in a legislative form and upon the authority of the Government.

MR. WARTON

said, he must protest against the introduction of a little clôdture by the President of the Board of Trade in reply to the hon. Member for North Shropshire (Mr. Stanley Leighton).

Question put.

The House divided:—Aves 34; Noes 81: Majority 47.—(Div. List, No. 72.)