PETITION. PAPERS MOVED FOR. (Hansard, 26 June 1863)

§ THE EARL OF SHAFTESBURY

, after presenting a Petition from residents in Newington, Lambeth, Rotherhithe, &c., in favour of the removal of this Hospital from its present site, said: This Petition represents the opinion of the whole mass of the population who live on the other side of the water; and I bring this question before your Lordships because the property is public property, and the Governors of the Hospital are public functionaries. In doing so I wish to point out the necessity for taking immediate steps to effect the removal of Bethlehem Hospital to some place better adapted for the care and treatment of lunatic patients. Of late years great progress has been made in the system of treatment, and it is found that a cheerful situation, open space, plenty of means of 1498 air and exercise, are absolutely required. For a large class of those patients, cultivation of the ground, by the plough or spade husbandry, and for others in a more elevated condition of life, pleasant walks, and the means of practising horticulture and the cultivation of plants are of primary importance. For these purposes it is impossible to find a worse situation than the one occupied by Bethlehem Hospital; and although, with the enormous revenues which are attached to the institution, it ought to be the model not only in England, but in Europe, it certainly is far from being a model, whether in site, construction, or treatment. The whole site is not more than seventeen acres, and it is situated amid a dense and rapidly-increasing population. The windows of adjoining buildings overlook the gardens, and exercise in the open air free from observation is impossible. As to anything like agricultural occupation, it is manifestly out of the question, and there is no sufficient space for gardening. About four years ago, so strong was the opinion of the Commissioners of Lunacy on the subject of the site, that when an application was made by the corporation of London, in asserting the right to send their pauper lunatics to Bethlehem, they reported as follows:— Having reference to the question of the reception into Bethlehem Hospital of the pauper lunatics of the City, the Commissioners are decidedly of opinion that such an arrangement would, for many reasons, be most undesirable and objectionable. The site of the Hospital and the limited amount of land available for the exercise and occupation of the patients are among the reasons which may at once be specified. Entertaining these views, the Commissioners, acting consistently with the course they have uniformly taken in this matter, and with the reasons they have given for suggesting the removal of the institution from its present populous locality into the country, trust that Mr. Secretary Walpole will not encourage the expectation that the appropriation of Bethlehem Hospital to the purposes of a City pauper asylum would ever receive the sanction of the Secretary of State. The Commissioners are of opinion, that even were the Hospital premises in the possession of the City authorities, they would be entirely unfit for the proper care and treatment of their insane poor. In 1858, the Commissioners (of whom I have the honour to be one) told the corporation, that the Commissioners would not allow them to send their pauper lunatics to Bethlehem, because it was not adapted to the care and attention of lunatics which was essential to their health. We also take exception to the present construction of the building. We maintain that it is most unfit for the purpose. In har- 1499 mony with the principles now entertained, such buildings should be cheerful, open to the sun, and with nothing to depress the spirits. Without moral treatment, medical treatment will often fail, and moral treatment alone will often succeed without Medical treatment. This building was constructed at a time when strait waistcoats were in vogue, and every patient was immured in a gloomy cell Though net intended for a prison, it was constructed upon the same principles as a prison. We say— A most important Objection to Bethlehem Hospital, as a place for the treatment and cure of insanity, remains to be noticed—namely, the urn fitness, according to modern opinions, of the building, in respect to its construction and arrangements. The general aspect of the hospital, externally add internally, notwithstanding the efforts made within the last few years to enliven the long corridors and day-rooms, cannot but exercise a depressing influence upon the inmates, whose means of outdoor exercise are so limited and inadequate. The Commissioners, in the case of asylums for pauper lunatics, Would never sanction plans upon the principle of Bethlehem Hospital. We do not deny that at various times the governors, in conformity with our recommendations, have endeavoured to improve the hospital; but the place is utterly in-capable of improvement. It is not fit, in any sense of the word, for the reception of lunatics, and we therefore recommend its removal, There is another consideration of great importance. The number of lunatics is growing greater every year. Whether it has actually increased in comparison with the increase of population is not determined yet. Whether it is that more cases are discovered, or that there is a greater readiness to send them to asylums, I cannot say; but the number is certainly increasing, and it is therefore a matter of great importance that we should have the means of enlarging this hospital. At the present time, apart from the criminal lunatics, who number about 130, there are in Bethlehem more than 200 ordinary patients, for Whose support the hospital has an income a few pounds short of £20,000 a year. The average number of ordinary patients in Bethlehem is 240. The development which the increase in the number of lunatics requires can never take place in this hospital so long as it remains on its present site. There is another development needed—the development of the System pursued at the hospital. At present Bethlehem acts upon a most exclusive system, almost unknown in any other hospital. A vast number of cases—the most distressing cases, 1500 which require most careful treatment—are entirely excluded. But We must call on the governors of Bethlehem to relax that system, and that relaxation cannot take place until the hospital is removed, because the cases now shutout are just the cases which require additional facilities for air and exercise. On this point we have the strongest opinion of nearly all the medical profession, I know but two who differ, and you have the opinion of the Commissioners, who have now an experience of more than twenty-five years; you have the opinion of Dr. Webster, who has travelled all over the Continent; and you have the opinion of Dr. Conolly, who more than any other man has devoted himself to the scientific treatment of lunatics, and who wrote a letter to us full of valuable knowledge and experience, which will be found in the appendix to our last Report, and in which he presses for the removal of the hospital. It is of the Utmost consequence, too, that we should seize every possible opportunity of having a body of medical men skilled in the scientific treatment of lunatics. Though there are some very eminent men engaged in this branch of the profession, there are very few compared with the great mass of the profession. It seems to be a received opinion in this country that because a medical mail understands the treatment of the human body, he must therefore understand the remedies applicable to the human mind; but we know that nineteen-twentieths of the medical men of the country understand little more of the scientific treatment of lunatics than they do of Hebrew and Chaldee. It is most desirable, with a view to remove that evil, that we should found a school Where men can be trained in this branch of the profession, and nowhere could it be so well founded as in connection with the great Royal charity of Bethlehem. Various objections have been urged against the removal of the hospital. Among other things, it has been said that its removal to a distance would throw obstacles in the way of the visits of friends to patients. In the first place, friends are not over-fond of visiting patients, and a short distance of ten miles would be no obstacle to those who really desired to visit a patient. Again, the great bulk of the patients are not metropolitan, but come from the country, so that that objection entirely loses its force. The next argument is that to take the patients into the country would deprive them of the varied amusement they enjoy 1501 in looking at the fine shops On Newington Causeway. It is very questionable whether it is desirable to take lunatics out into the bustling streets; but, supposing there may be a few cases in which it is desirable, they are far outnumbered by those who ought only to take exercise in seclusion, and who at present are deprived of all recreation because there is no seclusion in the grounds of Bethlehem, which are overlooked by the surrounding houses. Again, it is said that the charity ought not to be put to any expense in removing the hospital. I demur to that argument to begin with. The hospital is founded with public money, for public purposes; and if the public think it would be beneficial for the hospital to be removed into the country, the public has a right to decide that it shall be removed. But, so far from any expense being in curred, I am prepared to show that instead of being losers the governors of Bethlehem would, to a certain extent, be gainers if they accepted the offer of £150,000 which has been made to them. I am not here to say that they are bound to accept it, though undoubtedly it is a large sum, and it is an opportunity, perhaps, which will not occur again, for it is not always that a rich body like the governors of St. Thomas's Hospital are looking about for a site. It is a magnificent sum, and for it the governors would be able to build a magnificent asylum for at least 500 patients on the new principle, and would be left with from £10,000 to £20,000 in hand. The Manchester Hospital, with fifty-two acres of land and accommodation for 100 patients, cost £30,208, and the Stafford Asylum, with thirty acres of land and accommodation for 140 patients, cost £39,926. Thus, for a sum of £70,000 you can purchase an estate of eighty-two acres, and erect an asylum sufficient for 240 patients. The offer made to the governors of Bethlehem by St. Thomas's Hospital is £150,000. Taking, as a basis of calculation, what has been done elsewhere, at Stafford and Manchester, you might construct an asylum capable of accommodating 480 patients for £140,000, and have a sum of £10,000 in hand. Your Lordships will see that for an asylum like Bethlehem you do not require as large a quantity of land as for a county asylum, because in the latter establishment the greater number of patients are agricultural labourers, for whom agricultural occupation is required; while in Bethlehem the patients are of various classes. There is another point which is worthy of some 1502 attention. Clinical lectures hate been established both at Bethlehem and St. Luke's, but there has been little or no attendance at those lectures; while, on the contrary, the clinical lectures established by Dr. Conolly at Hanwell have been largely attended. It is always found that where there are facilities for the residence of pupils, clinical lectures are better attended; and if Bethlehem was removed to the country, arrangements might be made or accommodating resident students. It is boasted that in Bethlehem there is a greater proportion of cures to the number of patients admitted, and a smaller morality, than in other asylums; but this might to a great degree be accounted for by the rules under which patients were received. In the first place, the governors make it a rule to receive none but recent cases, which are those in which there is the greatest chance of recovery. They do not admit any one who has been afflicted with lunacy longer than twelve months previously to the time of admission. By this rule a good many hundreds are excluded from the benefits of this great charity. In the next place, they will not admit any one who has been discharged uncured from another hospital. They will not admit pregnant women, idiots, or patients afflicted with paralysis or epileptic or convulsive fits. What a mass of human suffering is excluded by that rule! Again, they reject all whose condition threatens speedy dissolution, or requires the permanent and exclusive attendance of a nurse, or who from disease or physical infirmity, are unfit to associate with other patients My Lords, the persons excluded by that rule belong to a class of insane who, perhaps, are in the most distressed condition, and appeal most strongly to our compassion. We have been labouring for years to establish middle-class asylums for the reception of patients above the condition of paupers, but whose families cannot afford to pay the minimum amount charged in the private asylums. In these asylums there is no accommodation to be had under, at least, a guinea a week; but this is a very large sum to persons of small income, or to a struggling man with a large family. We have been endeavouring to establish asylums which, by means of sums received from patients, supplemented by an endowment or a public grant, would be able to admit patients of the middle class, and with small means, at 3s., 4s., or 5s. a week. This system prevails very much 1503 in Scotland, where it has proved a Godsend; and wherever such asylums have been founded in this country they have realized all that have been expected from them. If Bethlehem were removed to the country, it might be made the means of alleviating the sufferings of a large number of the lower and middle class insane. I think the public have a right to ask from the Governors of Bethlehem the full benefit of the magnificent revenue in their possession. They have a revenue amounting to within a few pounds of £20,000 a year, and they have property in London which is sure to increase in value; yet, in the hospital there are seldom more than 200 patients, besides the criminal lunatics, and for a period of years the average number has not exceeded 240. I believe that with these funds the governors ought to be able to maintain 480 or 500 patients; and if they adopted the system of admitting persons whose friends would pay a certain sum towards their maintenance, the number might be increased to 600. Under these circumstances, I cannot see en what grounds the governors can refuse to accept the offer of St. Thomas's Hospital, which is one such as may never be made to them again. On this question, however, they seem totally opposed to the representations which have been made, and offer no valid argument in support of the course they are taking. Dr. Conolly, in a letter which he has written on this subject, says— A new Bethlehem, judiciously situated and planned, might be a model, a school of instruction, and a benefit for ever. We should then possess a public asylum in which the intentions of the charitable founders and the exertions of humane and scientific physicians would not be frustrated, and where, above all, the amplest possible means would be furnished, and their application perpetuated, for the relief of the most terrible of all forms of human misfortune. My Lords, I cannot do better than conclude with these words. I do hope that you will receive this Petition with favour, and will lend the aid of your countenance and support to this good and just demand. We cannot do wrong to a single individual by insisting on this demand. On the other hand, we may do a large amount of good to the most suffering portion of humanity, and therefore I do entreat your Lordships that you will assure these poor people, who are anxious that the hospital should be there and that Bethlehem should be removed to the country, that your sympathies are with them, and that you will do all that in you lies for the relief of suffering hu- 1504 manity, and the fulfilment of the intentions of the noble individual by whose bounty the hospital was founded. The noble Earl concluded by moving for—

1. The Annual Amount of the Revenues during the last Ten Years administered by the Authorities of Bethlehem Hospital:
2. Total Amount of Money received by the Hospital from Parliamentary Payments:
3. Average Number of Patients in the Hospital in each Year for Ten Years, apart from the Criminal Patients:
4. The Total Number of Governors of the Hospital:
5. Number of Special Meetings since January 1863 in reference to the removal of Bethlehem Hospital, and Number of Governors present on each occasion:
6. The Questions proposed and the Divisions taken: