§ House in Committee (on re-commitment).
§ Clause 27 (Amendments as to single patients).
§ THE LORD CHANCELLOR (Lord HERSCHELL), in moving to leave out subsection (1) and insert the following subsection:—
After the passing of this Act, no order shall be made for the reception of a lunatic as a single patient in the house of a medical practitioner except by the Judge in Lunacy, and every such order shall be obtained in such manner and subject to such conditions as the General Orders in Lunacy for the time being direct,said, he had endeavoured to amend the Bill and to frame this clause so as to meet some of the objections which had been raised by their Lordships, and gave facilities for excepting altogether from the operation of the clause the case of a patient suffering from insanity of a temporary character, who was detained on a certificate of a medical man in a private asylum. He believed that such cases were not frequent, and he quite agreed that it was most undesirable to impose more restrictions in regard to them than there existed at present. Again, he would exempt from the operation of the clause the case of those persons decayed from old age, many of whom were detained by their own desire in the houses of medical men, who, under the provisions of the Bill, would still be permitted to take single cases into their houses by order of a Judge in Chambers. With this object he wished to amend the clause by inserting words to that effect.
§
Moved, in Clause 27, page 19, to leave out sub-section (1) and insert—
After the passing of this Act, no order shall be made for the reception of a lunatic as a single patient in the house of a medical practitioner except by the Judge in Lunacy, and every every such order shall be obtained in such manner and subject to such conditions as the General Orders in Lunacy for the time being direct."—(The Lord Chancellor.)
§ THE EARL OF SELBORNEsaid, that he was prepared to acquiesce in the present proposal.
THE EARL OF MILLTOWNasked if the "house" of a medical practitioner meant the house where he resided? As was well known, it was the practice with many practitioners to own several houses which were occupied by tenants; and he would suggest that it should be clearly understood that the patient could only be detained in the house in which the medical man resided.
§ THE LORD CHANCELLORsaid, he so intended it, and he would further consider the form of the words before the stage of Report, in order to see that the wording carried out that view.
§ Motion agreed to.
§ Clause, as amended, agreed to, and ordered to stand part of the Bill.
§ Clause 42 (No new licences to be granted).
§ THE LORD CHANCELLOR (Lord HERSCHELL), in moving the insertion, at the beginning of the clause, of two new sub-sections, the first of which empowered the Commissioners or Justices to renew the licence where a house had been in all respects well conducted, and the second provided for the case where, at the passing of the Act, arrangements might be in progress to establish a new house for the reception of lunatics, in the place of one in respect of which a licence had already been granted, said, he believed that the system of private lunatic asylums was wrong and mischievous in principle; and this opinion he had formed from an estimate of human nature, that where there was presented a great pecuniary temptation in one direction and man's duty called in another, especially when the performance of that duty depended on the exercise of intelligence, care, and skill, a tendency existed for the pecuniary interest somewhat to dim the vision and activity of intelligence. He rested his 237 opinion also upon the opinions of gentlemen who had devoted the greater part of their lifetime to the actual work of visiting these asylums, and who were satisfied that no amount of visitation from the outside would be a complete protection to the patient against improper detention, so long as the medical man keeping the asylum had an interest in its conduct. But this view was in advance of what the public were yet prepared for, and at once to put an end to a system to which the public were accustomed, and of which many felt the beneficial use, would be impossible. While he hoped the gradual extinction of private asylums would be one result of the Bill, he was not prepared to shut his eyes and ears to what had been brought before him as to the injustice which might be done to those who had invested large sums in many of those private asylums if the House were to put an end to them, even at the end of the lives of those who at present kept them. He, therefore, reserved all vested interests. The only observation he would add was that in certain cases it might be expedient in the interest of the patients themselves that it should be permissible to remove them from one place to another, and that the Commissioners should be enabled to grant licences even to the successors of the present licensees, and in respect not only of the original but also of the substituted licence. This would not interfere with the principle of the Bill or permit the creation of any new vested interests. He would bring in an Amendment to this effect on the Report.
§ Moved, in page 29, insert at the beginning of the clause the following subsections:—
- "(1.) If the commissioners, or in the case of a house licensed by justices the justices, are of opinion that a house licensed for the reception of lunatics has been in all respects well conducted by the licensee or licensees, the commissioners or justices may upon the expiry of the license from time to time renew the licence for that house to the former licensee or licensees, or any one or more of them, or to his or their successors in business.
- "(2.) If at the passing of this Act any licensee or licensees shall have made arrangements to establish a new house for the reception of lunatics in the place of a house in respect of which a licence has already been granted, and the commissioners, or if the house is within the jurisdiction of justices the justices, are of opinion that such new house will be more
238 suited for the purpose than the old house, and are also of opinion that the old house has been in all respects well conducted, the commissioners or justices may grant to the licensee or licensees of the old house, or any one or more of them, a licence for the new house, and may from time to time renew the same to the original licensee or licensees, or any one or more of them, or to his or their successors in business. - "(3.) Save as aforesaid."—(The Lord Chancellor.)
§ THE EARL OF SELBORNEsaid, he thought the proposal of the noble and learned Lord was reasonable and just; but he hoped that the cases in which such removal might be authorized should not be specified in the Bill, but should be left to the discretion of the Commissioners.
§ THE LORD CHANCELLORsaid, he was quite ready to consider his noble and learned Friend's suggestion.
§ Motion agreed to.
§ On Question, "That the Clause stand part of the Bill?"
§ LORD GRIMTHORPE, in moving to omit the clause from the Bill, said, that if he could agree to the major proposition which underlay the clause he should agree with the Amendments. He admitted that the clause had been very much improved by the noble and learned Lord Chancellor; but he objected altogether to the lines on which it proceeded. He had made inquiries with the view of ascertaining whether there was any foundation for the complaints that were made against private asylums, and he was satisfied there were no substantial grounds for the prevalent impression which had gone abroad against them. It was assumed that the only motive which operated on the minds of the keepers of these asylums was the desire to keep their patients as long as possible. But was general professional reputation disregarded? Were not the keepers of asylums anxious to secure as large an amount of success as possible in the treatment of their patients? There was no evidence to show that the latter motives were weaker than the former. The more they succeeded the greater would be their reputation. He asserted that patients were not, as a matter of fact, kept longer in private asylums than in public asylums. In an article in The Nineteenth Century of February, 1885, Dr. Bucknill stated 239 that there was the greatest diversity of opinion expressed before Mr. Dillwyn's Committee, some of the witnesses condemning while others approved of private asylums; and he very oddly added that the Committee was dominated by Members who knew more about the subject than the Chairman, who had wanted to suppress those asylums. Dr. Bucknill had expressed himself in favour of these asylums in 1878 and 1880; but in 1885 he changed his mind, although he had not adduced a single fact to explain the change. The late Lord Shaftesbury had, in 1859, expressed an unfavourable opinion of these asylums; but, after a careful examination, he also changed his mind the other way, and in 1878 gave the good reason for it to the Committee, that there had been a great improvement, and he as strongly advocated as he had previously condemned them. He had recently read a pamphlet by the keeper of one of these asylums, which, if its figures were accurate, established a very strong case. It was there stated that the average of "removals" for all causes during five years in public asylums was 26 or 27 per cent. whereas in private establishments it was 41 per cent. or 50 per cent higher than in the public institutions. Yesterday he received from the two asylums of the West Riding two other sets of figures which practically concurred with these, for out of nearly 3,000 inmates their "deliveries" were only 29 and 30 per cent. If, therefore, they found half as many people again discharged from private asylums as from public asylums, he asked what foundation was there for the allegation to which he had referred? He was speaking entirely in the interests of the public. He had no prejudice about the matter, and, until a few months ago, he never received any information on the subject; but having known four or five patients who had been in different private asylums—and they all stated that they were well treated—he had come to the conclusion that there was no reason to complain of the asylums in which they were kept. People sent their friends to private asylums because they believed they were better treated there than in public asylums. It might be thought that they were all influenced by sensational novels; and people who read these things probably thought the stories fairly represented what went on 240 in private lunatic asylums; but there was no ground for the imputations, and he could not see why the existing competition between private and public asylums should be interfered with.
§ Moved, "To omit the Clause."—(The Lord Grimthorpe.)
§ THE LORD CHANCELLOR (Lord HERSCHELL)said, that the late Lord Shaftesbury, in a letter written last year, stated that as the result of 50 years' experience he retained his opinion that the system of proprietary houses was bad, and desired to see it extinguished. His noble and learned Friend (Lord Grimthorpe) had quoted certain figures as showing that there were more frequent discharges from private asylums. He should imagine that the removals from one private asylum or licensed house to another were much more frequent than the removals from one public asylum to another. Consequently the number of removals might not be the same as the number of discharges; besides, there might be considerable difference in the character of the cases sent to public and private asylums, as probably a majority of the more serious cases were sent to the former. Consequently, they could not regard such statistics as being conclusive. If there were an appreciable number of cases in which persons were wrongly detained, that was a sufficient reason for the present legislation. A medical man who visited a licensed house did not like to bring matters forward against a brother medical man, unless he had absolute proof. In illustration of this, he would mention a case where the Visitor felt satisfied that a patient whom he had seen was sane and ought to be discharged. But the proprietor of the asylum said—"If you heard the threats which he utters against his wife at night you would not consent to his release." In these circumstances the Visitor would not assume the responsibility of discharging the man; but he induced the relatives to remove him to another asylum, where he was watched at night for three months. During that time the man said nothing about his wife. On being discharged five years ago, he went home, and he had been living with his wife in complete happiness ever since. The point of the story that struck him was the illustration it 241 afforded of the impossibility of a medical man who was visiting a patient taking upon himself the responsibility of discharging him in the face of statements made by the medical officer of the asylum. In the interests of the public he thought it would be best not to create any new vested interests, so that after a time public opinion should come to the conclusion that a system of public asylums was better than that of private licensed houses.
THE EARL OF MILLTOWNsaid, that the noble and learned Lord had stated that the late Lord Shaftesbury altered the opinion which he expressed before the Select Committee in 1869 against the system of private asylums. So far from that, only two years ago in that House Lord Shaftesbury declared that he had not altered his opinion as to the evil principle of permitting individuals to acquire pecuniary interests in the detention of patients. He said that the whole system of private asylums was utterly abominable and indefensible, and acted most injuriously to the interests of the community.
§ VISCOUNT CRANBROOKsaid, that as the Bill originally stood some amendment was, in his opinion, required in it; but the noble and learned Lord in charge of the measure had done as much as they could expect in the direction of meeting their wishes. As now amended, the Bill would produce this result—that if public opinion in any locality was strongly in favour of retaining private asylums they would continue, while if public opinion was against them they would be replaced by public asylums. By keeping a careful watch on private licensed houses public opinion might to some extent become favourable to them and enable them to protract their existence. He had heard many unsatisfactory accounts of public asylums, and it was inevitable that some cases of neglect should occur in them which were not likely to happen in licensed houses, where it was to the interest of the owners that the patients should be treated kindly. On the other hand, a very strong feeling existed as to the impolicy of giving individuals an interest in detaining patients in confinement, and he should recommend the noble and learned Lord to withdraw his Motion.
§ Motion (by leave of the Committee) withdrawn.
242§ Question put, and agreed to.
§ Clause, as amended, ordered to stand part of the Bill.
§ On Clause 43 (Amendments as to licensed houses).
§ THE LORD CHANCELLOR (Lord HERSCHELL), in moving the omission of Sub-section 9, said, that, as the clause now stood, Local Authorities were bound within a term of five years to remove any pauper patients whom they might be keeping in licensed houses. It had been represented to him that in certain cases provision had been made in private asylums for the reception of pauper patients, and that they would suffer considerable pecuniary loss by this provision. Of course, it might be said that a person who had been in the habit of keeping an asylum to receive a number of pauper patients must take his chance as to continuing to do so, and that would justify him in leaving the clause as it was. On the other hand, he thought that the Local Authorities might be trusted to provide asylums for lunatics under the Bill to a much greater extent than they had hitherto done. He had, however, no strong opinion on the point.
§ Moved, "To omit Sub-section 9."—(The Lord Chancellor.)
§ THE EARL OF SELBORNEsaid, that he was mainly responsible for the clause, which appeared in the Bill introduced into the House last year. His object in recommending it was that pauper lunatics should be kept at as little expense as possible to the ratepayers, provided they were properly treated.
§ Motion agreed to.
§ Clause, as amended, ordered to stand part of the Bill.
§ Clauses 44 to 58, inclusive, agreed to.
§ Clause 59 (Powers of Secretary of State to enforce provisions for providing asylums).
§ On the Motion of The LORD CHANCELLOR, Clause struck out of the Bill.
§ Clause 60 (Power to borrow).
§ Moved, "To omit the Clause."—(The Lord Chancellor.)
§ VISCOUNT CRANBROOKsaid, he had previously called the attention of the noble and learned Lord (the Lord Chancellor) to the cases of lunatics who had 243 property from which the authorities had great difficulty, after having been put to charges in respect of the lunatics, in recouping themselves for their outlay, the executors in many instances keeping the property; and he would now ask him whether he was prepared to introduce any provision with regard to the repayment to the County Authorities out of the property of deceased lunatics of the expenses they might have been put to in respect of such lunatics, as it had been found that in such cases there was no means of recovering the costs?
§ THE LORD CHANCELLOR, in thanking the noble Viscount for referring to the matter, said, that he would, on the Report, introduce a provision dealing with it.
§ Motion agreed to; Clause omitted accordingly.
§ Remaining Clauses agreed to.
§ Schedule agreed to.
§ The Report of the Amendments to be received on Tuesday next; and Bill to be printed as amended. (No. 53.)