Chapters in the History of the Insane in the British Isles Part 24

Another pet.i.tion against the Bill, from the magistrates and council of the royal burgh of Ayr, was presented and read, praying that the same may not pa.s.s into a law; or that if the House should think proper to pa.s.s the said Bill, they would exempt the burgh and parish of Ayr from its enactments.

Later on, another pet.i.tion of the magistrates and town council of the royal burgh of Montrose was presented against the Bill; and subsequently one from Stirlingshire, Renfrew, Wigton, Edinburgh, Elgin, Glasgow, Perth, Dumfries, and many other places.

The second reading was again and again deferred until the 1st of June, when it was ordered "that the Bill be read a second time upon this day three months." Thus persistent obstruction triumphed.

Sir Andrew Halliday, who took from an early period a lively interest in the insane, writes in 1827: "I cannot but regret that the public refused the adoption of a law for erecting district or county establishments, proposed some years ago by that excellent n.o.bleman, Lord Binning. The rejection of this Act arose, I believe, neither from the parsimony nor the poverty of the freeholders, but from a dread of introducing into the kingdom that system which has been denominated the nightmare of England, the poor's rates."[228]

How much legislation was needed at this period is well shown by the description, by a philanthropist, of the condition of the lunatics in the Perth Tolbooth, for which I am indebted to the late lamented Dr.

Lauder Lindsay, who observes: "Here is exactly what Mr. J. J. Gurney says, and it is of special interest to us, as showing the sort of provision made for the comfort of our local insane prior to the establishment of the Murray Royal Inst.i.tution in 1877, nine years afterwards. In all probability Mr. Gurney's report, which was published in his 'Notes on a Visit made to some of the Prisons of Scotland,' led directly or indirectly to Mr. Murray's fortune being devoted to the inst.i.tution of an Hospital for the Insane. 'The old Jail of Perth is built over a gateway in the middle of the town. Although this dark and wretched building had been for some time disused as a prison, it was not at the period of our visit' (Mr. Gurney's sister, Mrs. Fry, accompanied him) 'without its unhappy inhabitants. We found in it two lunatics in a most melancholy condition; both of them in solitary confinement, their apartments dirty and gloomy; and a small dark closet, connected with each of the rooms, filled up with a bed of straw. In these closets, which are far more like the dens of wild animals than the habitations of mankind, the poor men were lying with very little clothing upon them.

They appeared in a state of fatuity, the almost inevitable consequence of the treatment to which they were exposed. _No one resided in the house_ to superintend these afflicted persons, some man, living in the town, having been appointed to feed them at certain hours of the day.

They were, in fact, treated _exactly as if they had been beasts_. A few days after our visit, one of these poor creatures was found dead in his bed. I suppose it to be in consequence of this event that the other, though not recovered from his malady, again walks the streets of Perth without control. It is much to be regretted that no medium can be found between so cruel an incarceration and total want of care.'"

A return, signed "H. Hobhouse," was made in this year (1818) from the parochial clergy in Scotland, showing the number of lunatics in each county, and other particulars, which now possesses considerable interest historically. The most important figures are as follows:--

TABLE

SHOWING THE NUMBER OF INSANE, ETC., IN THE SCOTCH SHIRES IN 1818 AND THE NUMBER IN ASYLUMS.

--------------------------+---------------------------------- | | Number of insane and idiots.

Shire. +-------+--------+--------+-------- | Male. |Female. | Total. | In | | | |asylums.

--------------------------+-------+--------+--------+-------- Aberdeen | 197 | 226 | 423 | 41 Argyle | 171 | 122 | 293 | 9 Ayr | 110 | 104 | 214 | 14 Banff | 62 | 86 | 148 | 6 Berwick | 38 | 28 | 66 | 3 Bute | 32 | 27 | 59 | 1 Caithness | 45 | 29 | 74 | 0 Clackmannan and Cromarty | 20 | 19 | 39 | 1 Dumbarton | 44 | 38 | 82 | 6 Dumfries | 84 | 79 | 163 | 15 Edinburgh | 132 | 153 | 285 | 148 Elgin | 32 | 47 | 79 | 4 Fife | 115 | 127 | 242 | 11 Forfar | 122 | 154 | 276 | 37 Haddington | 44 | 36 | 80 | 9 Inverness | 130 | 110 | 240 | 10 Kincardine | 52 | 58 | 110 | 5 Kinross | 6 | 9 | 15 | 1 Kirkcudbright | 42 | 35 | 77 | 5 Lanark | 156 | 193 | 349 | 28 Linlithgow | 25 | 35 | 60 | 1 Nairn | 4 | 20 | 24 | 0 Orkney and Shetland | 67 | 62 | 129 | 0 Peebles | 12 | 16 | 28 | 0 Perth | 179 | 134 | 313 | 17 Renfrew | 94 | 81 | 175 | 24 Ross | 107 | 103 | 210 | 4 Roxburgh | 52 | 56 | 108 | 10 Selkirk | 6 | 6 | 12 | 0 Sterling | 58 | 64 | 122 | 4 Sutherland | 36 | 27 | 63 | 1 Wigton | 30 | 40 | 70 | 4 +-------+--------+--------+-------- | 2304 | 2324 | 4628 | 417 --------------------------+-------+--------+--------+--------

From this table it will be seen that the total number was 4628, of whom 2304 were males and 2324 females. With regard to their distribution, there were--

In public asylums 258 In private asylums 158 With friends 1357 At large 2855 ---- Total 4628

Two thousand one hundred and forty-nine were maintained wholly or in part by the parish. Fifty parishes failed to send any return. In one parish in the city of Edinburgh, from which we have no return, were situated the "Edinburgh Bedlam" and the Charity Workhouse. In these two places were confined eighty-eight lunatics and idiots. From Glasgow the returns did not include ninety-five lunatics and idiots confined in the Glasgow Asylum and Towns Hospital; 187 patients must therefore be added to the foregoing, making a total of 4815.

Considering the period at which it was made, this is a very remarkable return, and was much more complete than some later ones; for instance, in 1826 the Parliamentary returns were ridiculously below these figures, and Sir Andrew Halliday could only after diligent inquiry bring up the number to 3700.[229]

Two years later (1828), a Bill was brought into the House of Commons to amend the Act 55 Geo. III., c. 69,[230] by the Lord Advocate, Mr. H.

Drummond, and Mr. Robert Gordon. It pa.s.sed the House of Lords, and received the royal a.s.sent June 27th.

This const.i.tuted the Act 9 Geo. IV., c. 34, and reduced the fees paid for persons confined from 2 2s. to 10s. 6d.; admission and discharge books were ordered to be kept in every asylum, and an entry made of every act of coercion; the books of the asylum were to be submitted to the inspectors; no insane person was to be received into a hospital without a warrant from the sheriff, who was to inspect hospitals; houses were to be visited by medical men--those containing less than one hundred patients, in case such house should not be kept by a physician or surgeon, were to be visited twice in every week by a physician or surgeon--signing in a register the condition of the house and state of health of the patients; a register was also to be kept by the resident physician or surgeon, and such register was to be regularly laid before the inspectors, who were required to sign the same in testimony of its production; ministers were empowered to visit mad-houses in their parishes; regulations were made as to persons with whom lunatics were privately confined; the justices might appoint three of their number to inspect hospitals and private mad-houses; lastly, a weekly register was to be kept in each house, and to be laid before the inspectors, stating the number of curable and incurable cases, and the number under restraint, the necessity thereof being certified by a medical man.

I wish to record here that, so far back as 1838, some of the Scotch asylums were remarkable for the extent to which labour was introduced.

Being engaged in writing an introduction to Jacobi's work "On the Construction of Asylums," the editor (Mr. S. Tuke) visited the asylums of Scotland in that year, accompanied by Mr. Williams, the visiting medical officer of the York Retreat, and found at Perth, Dundee, and Aberdeen, the men's wards nearly empty, so large a proportion of their inmates were in one way or other engaged in labour. "At Perth," he writes, "more than twenty came in together to dinner from the labours of the farm; others were employed in the garden and about the premises. At Dundee at nine o'clock in the morning, out of fifty-seven men patients of the lower cla.s.s, twelve were engaged in stone-breaking, eight in gardening, thirteen in weaving, one in tailoring, two as shoemakers, whilst a few were engaged in the preparation of tow for spinning, and several in the various services of the house. In the Aberdeen Asylum, in which the labour system is extensively introduced, we were particularly pleased with the state of the lowest cla.s.s of women patients--chiefly in an idiotic and demented state. All of these but one, and she was in a state of temporary active mania, were employed in picking wool or some other simple occupation. Indeed, in the three asylums which I have just mentioned, the state of the lowest cla.s.s of patients offers a striking contrast to that in which they have been usually found in our asylums.

Those dismal-looking objects, cringing in the corners of the rooms or squatting on the ground, almost lost to the human form, are here not to be seen. I must not omit to mention that at Aberdeen the manager had succeeded in inducing the higher cla.s.s of patients to engage in gardening, etc. At Glasgow the governors were contemplating arrangements for the more extensive introduction of the labour system. In all these asylums the superintendents expressed their decided conviction of the benefit which, in a great variety of ways, was derived from the employment of the patients, more especially in outdoor labour."

In connection with the Dundee and Glasgow asylums, the great services rendered by Dr. McIntosh ought not to be forgotten, as also those of Dr.

Poole (Montrose), Dr. Malcolm (Perth), and Dr. Hutcheson (Gartnavel).

Scotland south of Edinburgh and Glasgow had not, until 1839, any retreat or place of confinement for the insane, except six squalid stone cells attached to the public hospital of Dumfries. Violent or vagrant lunatics were physically restrained in their own houses, allowed to roam at large, or incarcerated in prisons or police stations. In the year mentioned, the Crichton Inst.i.tution was opened for the reception of patients of all ranks and means, from the pauper to the peer, in other words, at rates of board from 17 to 350. In those days the building was regarded as magnificent, commodious, and much in advance of the prevalent psychiatry in Scotland, in the provision for the restoration of mental and physical health, and for securing the comfort and happiness of the inmates. The funds providing this building and surrounding fields, had been bequeathed by Dr. Crichton, of Friars Ca.r.s.e, Dumfriesshire, to his widow, who determined the precise application of the magnificent legacy, which it is reported amounted to 120,000. The benevolent foundress caused the structure to have the Bible as a foundation, instead of a stone, and announced her solemn intention that the establishment should be conducted, not merely in accordance with science, but the principles of Christian philanthropy.

The first medical superintendent, Dr. W. A. F. Browne, who had made a critical examination of European asylums, and had acted as the chief officer in the Montrose Lunatic Asylum during four years, opened the Crichton Inst.i.tution in 1839, with what were regarded as sound but advanced views, and with the resolution of carrying into effect all that had been discovered or suggested for the amelioration, cure, and care of those who might require treatment or seclusion.

Before the close of the first year of his management, there would appear to have been about a hundred individuals, of various stations and in various mental conditions, consigned to his charge. For these and the gradually increasing numbers of the population, he inst.i.tuted daily exercise, amus.e.m.e.nt, occupation in the open air and in the grounds of the establishment, and during winter or inclement weather, billiards, bagatelle, "summer ice," and walking in the protected balconies connected with every ward or gallery in the house. Collections of books were contemporary with the laboratory, and the medical officers invariably carried a catalogue, along with a prescription book, in their daily medical visits to every patient. As a rule, remuneration was ordained for every description of labour, whether it was mental or manual, and might take a pecuniary or honorary form. From the commencement no personal restraint was resorted to, although the medical director did not bind himself either by rules or avowed opinions to prohibit mechanical resources, should they appear to be demanded for the preservation of life or strength, or quiet, or in any respect as a remedial agent. In 1840 a medical a.s.sistant or pupil was appointed. The experiment proved eminently successful, and the course thus foreshadowed has been universally adopted, and improved upon by increase in the number of such fellow labourers, by the addition of clinical clerks, and so forth. The next advance was in inst.i.tuting recorded observations of the state of patients during the night as well as the day; in the addition of carriages as a means of enjoyment and distraction, one of these being an omnibus, so that groups of the inmates might be conveyed to distant parts of the surrounding country; and in the multiplication of hygienic and moral influences, music, painting, translation, study of medicine, acquisition of languages, teaching, reading prayers, etc. The next stage of development may be described as the separation of different cla.s.ses of patients; provision for the agitated, for abstainers; mental culture for all capable of receiving impressions, lectures, public readings, the production of a monthly periodical which is still continued. Of this inst.i.tution we shall have to speak again.

An Act to alter and amend certain Acts regulating mad-houses in Scotland, and to provide for the custody of dangerous lunatics, was pa.s.sed in June, 1841 (4 and 5 Vict., c. 60). It amended 55 Geo. III., c.

69, and 9 Geo. IV., c. 34. A penalty of 200 and the expenses of recovering the same might be imposed on persons sending any lunatic to a mad-house without a licence; persons convicted of receiving lunatics without a licence, or the required order, might be imprisoned in default of penalty; the sheriff on application of the Procurator Fiscal might commit dangerous lunatics; the expenses were to be defrayed out of the rogue money, if the person had not the means of defraying, or if it could not be recovered out of his estate, then the same was to be defrayed by the parish which would be liable for the maintenance of such lunatic if he or she were a pauper; lunatics might be removed on application by the Procurator Fiscal; parish pauper lunatics were to be confined in public hospitals; if no public hospital in the county, the sheriff might send lunatics to an adjoining county; the death of a lunatic was to be intimated to the sheriff in writing by the person keeping the licensed mad-house; fees of licences might be diminished if the moneys received exceeded the sums required for carrying this Act into execution.

A form of register was to be kept in all licensed mad-houses in Scotland, indicating the house; where situated and kept; names and designations of individuals confined; date of reception; at whose instance confined, and on whose medical certificate; whether curable or incurable; date of removal or discharge, and authority for either; date of death; disease or cause of death, and duration of disorder; name of medical pract.i.tioner; when first called to give special attendance, and how often he afterwards visited the deceased, with the place of burial.

We must not omit to mention that in 1848 further legislation was attempted--an attempt, the failure of which was frequently deplored in the debates of succeeding years. A good Bill designed to amend the law of Scotland relative to the care and custody of the insane, and to regulate existing asylums, and to establish asylums for pauper lunatics, was brought in by the Lord Advocate (Lord Rutherfurd), Sir George Grey, and the Secretary at War. After the second reading it was referred to a Select Committee, which included the names of the Lord Advocate, Lord Ashley, Sir James Graham, Mr. E. Ellice, Mr. Stuart Wortley, and Mr. H.

Drummond. Pet.i.tions now poured in from almost every shire in Scotland, and the Bill had unfortunately to be withdrawn. Undaunted, the Lord Advocate made another attempt in the following year, but with the same result.

It is not necessary to dwell longer on the condition of the insane, or the legislation adopted on their behalf, till we come to the year 1855, which proved to be the commencement of a new departure in the care taken for them by the State. Unfortunately, in spite of legal enactments, the state of the insane in Scotland, at this time, outside the asylums was as bad as it could be, and even in some asylums it was deplorable. At this period a well-known American lady, Miss Dix, who devoted her life to the interests of the insane, visited Scotland, and the writer had the opportunity of hearing from her own lips, on her return from her philanthropic expedition, the narration of what she saw of the cruel neglect of the pauper lunatics in that country. She caused so much sensation by her visits and her remonstrances, accompanied by the intimation that she should report what she had witnessed at head-quarters in London, that a certain official in Edinburgh decided to antic.i.p.ate "the American Invader," as Dr. W. A. F. Browne called her.

Miss Dix was, however, equal to the occasion, and, hurriedly leaving the scene of her investigations, she took the night mail to London, and appeared before the Home Secretary on the following day, when the gentleman from Edinburgh was still on the road, quite unconscious that the good lady had already traversed it.[231] The facts she laid before the Home Office were so startling that they produced a marked effect, and, notwithstanding counter allegations, the conclusion was very soon arrived at that there was sufficient _prima facie_ evidence to justify an inquiry. A Royal Commission was appointed, dated April 3, 1855, "to inquire into the condition of lunatic asylums in Scotland, and the existing state of the law of that country in reference to lunatics and lunatic asylums."

The statutes forming the code of lunacy law for Scotland at that period were, for all practical purposes, the 55 Geo. III., c. 69; 9 Geo. IV., c. 34; and 4 and 5 Vict., c. 60.

The number of ascertained patients at this period (1855) amounted to 7403. The cla.s.sification was as follows:--Private patients, 2732; paupers, 4642; criminals, 29 = 7403. Curable, 768; incurable, 4032; congenital idiots and imbeciles, 2603 = 7403. Males, 3736; females, 3667 = 7403. The proportion of the insane and idiots to the population was 1 in 390. The number of congenital idiots was greatest in proportion to the population in those counties remote from influences that incite to mental activity--the Highland population containing more than three times the number found in an equal Lowland population.

The 2732 private patients were thus distributed: In chartered asylums, 652; licensed houses, 231; poor-houses, 9; reported houses, 10; school for idiots, 12; unlicensed houses, 18; with relatives, 1453; with strangers, 297; not under any care, 50; total, 2732.

The 4642 paupers were thus distributed: In chartered asylums, 1511; licensed houses, 426; poor-houses, 667; reported houses, 31; school for idiots, 3; unlicensed houses, 6; with relatives, 1217; with strangers, 640; not under any care, 141; total, 4642.

The receptacles for the insane were thus distributed:--

A. Chartered asylums. The Royal Asylums at Aberdeen, Dundee, Edinburgh, Glasgow, Montrose; the Crichton Inst.i.tution, Dumfries, including the Southern Counties Asylum; James Murray's Royal Asylum, Perth.

B. Public asylums not incorporated. The only inst.i.tution of the kind, that of Elgin, was exclusively for paupers.

C. Poor-houses with separate wards for the insane (twelve given in the table).

D. Prisons. The only one specially adapted for the reception of the insane was the lunatic department of the general prison at Perth.

E. Poor-houses without separate wards for the insane (fourteen given).

F. Private asylums (twenty-three in number).

G. Private houses reported to the sheriff.

H. Houses of relatives and strangers.

I. Schools for idiots. Baldovan, near Dundee; and Gayfield Square, Edinburgh.

This Commission did not report until 1857, and unhappily the evidence more than justified the necessity of the appointment of the Committee, and of a sweeping measure of reform. The difficulty in selecting pa.s.sages from the Report is to know where to stop. We shall restrict ourselves within moderate bounds; and first let us cite the reference to the condition of the insane and idiotic not in asylums. "It is obvious,"

says the Report, "that an appalling amount of misery prevails throughout Scotland in this respect. When estimating the condition of the insane not in establishments, it should be remembered that the details furnished by us give only an imperfect representation of the true state of matters. They form only a part of the picture of misery; and, had we been able to extend our investigations, it would, we are convinced, have a.s.sumed a much darker shade.

"A practice prevails in some workhouses, as in a few of the licensed asylums, of fastening the hands behind the back, by which much unnecessary pain is inflicted on the patient."

Of the methods employed in _asylums_ to repress violence, etc., the Report thus speaks:--

"_Instrumental Restraint and Seclusion._--Personal restraint by the application of the strait waistcoat, or of the straps or m.u.f.fs, is almost entirely banished from the chartered asylums; but we have reason to think that seclusion for long periods is frequently used. This remark applies more especially to the asylums of Montrose, Glasgow, Aberdeen, and Edinburgh. In Montrose we found, on one occasion, eleven patients in seclusion out of a population of 174, several of them having been so secluded for considerable periods, and one woman for several months; and it is to be observed that the seclusion rooms in this asylum are _mere cells, with stone floors and darkened windows_, and that the patients who are placed in them are frequently allowed no other covering than blankets, and no other bedding than loose straw cast on the floor."

Here is a picture of the way in which one asylum was conducted: "We have grounds for fearing that the patients suffered from cold. The house is carelessly conducted and the state of the patients very unsatisfactory.

The bed-frames, which are about the ordinary size with only spars of wood at the lower part, were dilapidated and saturated with filth; and the quant.i.ty of straw in them was very scanty and mixed with refuse; it was wet, offensive, and broken into small portions, and had clearly not been renewed for a considerable time. A certain number of the patients, males as well as females, were stripped naked at night, and in some cases two, and in one case even three, of them were placed to sleep in the same bed-frame, on loose straw, in a state of perfect nudity." The proprietor in his evidence says, "I never go into the rooms at night.

The floor is constantly soaked with wet. There is an epileptic lad who is frequently fastened to the rings in the wall. The nurses keep the m.u.f.fs in their custody. I dare say half of the dirty patients would sleep naked; seven would, therefore, sleep with others, I cannot say that more did not sleep together in a state of nudity. _I consider the treatment is proper for them._"