Chapters in the History of the Insane in the British Isles Part 11

[125] The incompleteness of this Parliamentary return was shown by the fact that, a few weeks afterwards, Sir Andrew Halliday found that in Norfolk there were 112 instead of 42.

[126] 51 Geo. III., c. 74; also in 1815, May 2 (55 Geo. III., c. 46), independently of the Report of the Select Committee. Overseers were to make returns of all lunatics and idiots within their parishes. These Acts do not touch "Private mad-houses"--only paupers.

[127] "What strenuous efforts fruitlessly combined to accomplish, a little volume has at once achieved. I hardly need name Mr. Samuel Tuke's account of the Retreat. Mr. Tuke's work, operating on a suspicious and irritable mind, produced the letters signed 'Evigilator;' the public attention became aroused, doubts and surmises were started. Either confident in right, or daring in wrong, a general challenge was given; that challenge was answered, with what results it is needless to add"

(_vide_ "Papers respecting the York Lunatic Asylum," by S. W. Nicoll, Esq., 1816).

[128] "Les Principes a suivre dans la Fondation et la Construction des Asiles d'Alienes," Paris, 1853, p. 226.

[129] _American Journal of Insanity_, April, 1856.

[130] _Ibid._, October, 1863, p. 205.

[131] "Review of the Early History of the Retreat," by S. Tuke, 1846.

[132] Referring to the practice at the Retreat as given in the "Description," the editor of the _Medical Repository_, 1817, after observing, "We are told that in violent maniacal paroxysms, depletion having failed to procure quiescence, a full meal of meat and good porter for supper produced the desired effect, and that this mode has since been very frequently and successfully employed," adds that if this be true, the general system of well-known physicians, that of pursuing depletion through "paroxysm and remission," cannot be right.

[133] Tuke's "Description," p. 113.

[134] Page 156.

[135] "If it be true that oppression makes a _wise_ man mad, is it to be supposed that stripes and insults and injuries, for which the receiver knows no cause, are calculated to make a _mad_ man wise? or would they not exasperate his disease and excite his resentment" ("Description of the Retreat," 1813, p. 144).

[136] Including cases in seclusion.

[137] "Description of the Retreat," S. Tuke.

[138] A Savoy physician who dedicated the second edition of his "La Philosophie de la Folie," published in 1804, to Pinel. M. Brierre de Boismont thinks the latter guilty of "the conspiracy of silence" in not mentioning him in his work, but I do not think the conspiracy is proved.

[139] See Appendix C.

CHAPTER IV.

COURSE OF LUNACY LEGISLATION.

I now resume the thread of my history at the time of the exposure of the abuses at the old York Asylum.

We have already intimated that the treatment adopted at the Retreat, and made known to the public by various writers and by many visitors, but more especially by the "Description," exerted a remarkable influence on the subsequent inquiry and legislation. The success of the Retreat excited the jealousy and antipathy of the superintendent of the York Asylum; the discussion which ensued led to investigation; the revelations which followed excited public opinion; the representatives of the people undertook an inquiry by means of a Select Committee, which finally necessitated legislation, and this legislation by successive enactments wrought the wondrous and beneficial change which we now witness. This sequence of events will be found to be borne out by facts, by any one who will investigate the literature of lunacy from 1792 to the present time. Sydney Smith says, writing in 1817,[140] that "the new Establishment began the great revolution upon this subject, which we trust the provisions of Parliament will complete.... In the course of a few years the Inst.i.tution had done so much by gentle methods, that a modest and well-written volume, giving an account of it, excited universal interest, and, in fact, achieved what all the talents and public spirit of Mason and his friends had failed to accomplish. It had still better effects. A very inoffensive pa.s.sage in this book roused, it seems, the animosity of the physician to the York Lunatic Asylum, and a letter which this gentleman published in one of the York newspapers, became the origin of a controversy among the governors of that establishment, which terminated in August, 1814, after a struggle of nearly two years, in the complete overthrow of the old system, and the dismission of every officer of the asylum, except the physician himself.

The period is not remote when lunatics were regarded as beings unsusceptible of mental enjoyment or of bodily pain, and accordingly consigned without remorse, to prisons under the name of mad-houses--in the contrivance of which nothing seems to have been considered, but how to enclose the victim of insanity in a cell, and to cover his misery from the light of day. But the success of the Retreat demonstrated, by experiment, that all the apparatus of gloom and confinement was injurious; and the necessity for improvement becoming daily more apparent, a 'Bill for the Better Regulation of Mad-houses' was brought into Parliament by Mr. Rose in 1813, but was nevertheless opposed and finally withdrawn; and another Bill, in 1814,[141] though it pa.s.sed the Commons, was rejected by the House of Lords. The public, in fact, was not yet aware of the atrocious evils which these Bills were intended to remove; and it was not until now that the course was adopted, which, in every case of public grievance, is the only sure one for obtaining redress. A Committee of the House of Commons, appointed for the purpose of inquiry in 1814, and revived in the following year, was fortunately composed of men determined to do the business they had undertaken."[142]

Mr. Rose, on the 28th of April, 1815, again introduced the subject of private mad-houses to Parliament, and, dwelling on the great abuses connected with them, pointed out the necessity of their condition being examined into by the House. He said that among the cases which had recently come to his knowledge was that of a young woman who, although requiring some restraint, was perfectly harmless. She was found chained to the ground by both legs and arms, a degree of cruelty which was in no respect justified. With a view of correcting such practices, he moved "that a Committee be appointed to consider of provision being made for the better regulation of mad-houses in England, and to report the same, with their observations thereupon, to the House."[143] The motion was agreed to.

The York Lunatic Asylum stood first upon the evidence before the Select Committee. "It appears from the history of that inst.i.tution, which was published at the close of the controversy above alluded to, that the victory of the reformers was not obtained without strong opposition; for, at the very moment when the state of things that we shall presently detail was flouris.h.i.+ng in full enormity, their opponents were enabled to carry a resolution of the governors, declaring that a lunatic, who appears to have sustained gross injury, 'had been treated with all possible care, attention, and humanity,' and censuring the parties who brought forward the complaint.... On a subsequent day thirteen spirited men (including Mr. Higgins and Mr. Tuke) determined to _enforce_ investigation; and, having qualified themselves as governors by paying the requisite donation of 20 each, succeeded in obtaining the appointment of a Committee to inquire into the complaints that had been exhibited; which, after meeting for several successive days, and examining witnesses, concluded by adopting Resolutions of censure upon the proceedings proved before them."[144]

One day Mr. Higgins went to the asylum. After having seen all the patients' rooms, he went with the steward to the kitchen. There he was struck with "the retired appearance" of a door. He ordered a keeper to unlock it. He perceived fear and hesitation. He repeated his order in stronger language. The key not being readily forthcoming, Mr. Higgins grew warm, and declared he would soon find a key that would open it at the kitchen fireside. It was then opened. He went in, and discovered a row of cells, four in number, which had been concealed from the committee of investigation. On entering the first cell, he found it in a state dreadful beyond description. The cell was about eight feet and a half square, perfectly dark when the door was shut, and the stench almost intolerable. He was told these cells were occupied at night by thirteen women, who were then upstairs; where he found them in a room twelve feet long by seven feet ten inches wide, with a window, which not opening would not admit of ventilation. Sydney Smith well says, after citing more horrible details than I have given, that he is aware of the disgust which they will cause, but that he cannot spare his readers, and asks of the most delicate of them whether it is more shocking that these things should exist unknown, and consequently unredressed, than that they should be told and punished, and _remembered for ever, as the only means of preventing their recurrence_.

To enter into much detail is impossible. It must suffice to say that case after case of gross neglect and cruelty was brought to light; that while 365 patients had died, only 221 had been reported; that a patient having been killed, his body was hurried away to prevent an inquest; that when the accounts were examined, it was discovered that two sets of books of receipts were kept, one of which was only presented to the governors, and that the difference between the sums contained in the two, amounting to some hundreds a year, found its way into the pocket of the superintendent; and lastly we must record that one wing of the asylum was burned, involving the deaths of patients and the destruction of much that it was with good reason believed the authorities wished to conceal.

Of the revelations made by the Committee of the House of Commons in regard to Bethlem Hospital, we shall only briefly speak. We have already sketched the history of this inst.i.tution. For the most part it is to the _second_ Bethlem--that in Moorfields--the minutes of evidence refer.

During the seven years prior to the investigation, the number of patients averaged 238; the annual expenditure, 12,000. Mr. Haslam, the resident apothecary, ruled supreme. He was responsible for the dreadful condition in which the notorious Norris was discovered. "There is," says Sydney Smith, "much evasive testimony, to s.h.i.+ft from himself the burden of this atrocious case; but his efforts tend rather to confirm than to shake the conviction which the evidence produces.... The conduct of Haslam with respect to several other patients was of a corresponding description; and in the case of a gentleman whose death was evidently accelerated by the severities he underwent, and of several other persons, there is abundant proof of cruelty.... It is in proof that a patient actually died, through mere neglect, from the bursting of the intestines, overloaded for want of aperient medicine, and it is expressly stated by Haslam himself that a person whom he a.s.serts to have been '_generally insane and mostly drunk_,' whose condition, in short, was such 'that his hand was not obedient to his will,' was nevertheless retained in the office of Surgeon, and continued to attend the patients for a period of _ten years_--a statement so atrocious that, from any other quarter, we should have rejected it as utterly incredible."[145]

The governors easily convinced themselves that no foundation whatever existed for the charge of cruelty and bad management; that every degree of permissible indulgence had been observed; that the hospital was equal, if not superior, to any other asylum in England; that the mode of confining the unhappy Norris appeared "to have been, upon the whole, rather a merciful and humane, than a rigorous and severe imposition;" in short, that "the general management of Bethlem, as affecting the health, the cleanliness, and the comfort of the patients, was of a nature _creditable to the governors and others concerned in its administration_." What a picture of the standard of excellence held by the managers of asylums at that period, not in Bethlem alone, but generally!

To the question, "Has there not been a rule in the hospital, for a certain number of years, that, in certain months of the year, particular cla.s.ses of the patients should be physicked, bled, bathed, and vomited, at given periods?" the reply from Bethlem was in the affirmative. Twice in the year the patients, with few exceptions, were bled. "After they have been bled," said the physician, in evidence, "they take vomits once a week for a certain number of weeks; after that, we purge the patients. That has been the practice, invariably, for years--long before my time."

In regard to the means of coercion employed, it was stated that the patients "are generally chained to the wall with manacles." When inquiry was made regarding the use of strait waistcoats, it was replied, "I do not believe there are any strait waistcoats in Bethlem now, or very few indeed; they generally use irons." The objection to strait waistcoats was, that the patients "could not help themselves in strait waistcoats; they are so excessively long in the hospital without being seen by anybody, in a dark place; in winter, from four o'clock to six or seven in the morning. If they were in a strait waistcoat they could not a.s.sist themselves the least in the world." When, in the following year, the head-keeper of Bethlem Hospital was asked, "Was it not the practice in old Bethlem--not in the late gallery, but in the gallery pulled down--for eight, ten, or more patients to be fastened to the tables, almost in a state of perfect nakedness?" he replied, "Yes; they used to think they tore their clothes all to pieces; some of them would do that." "In point of fact, were they not fastened to the tables, sitting in a state of perfect nudity?" Answer: "They used to be so at the table; they were chained all round." In regard to the apparatus, so ingeniously cruel, by which one of the patients (Norris) was chained ten or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you think that his confinement in that manner during the whole of that period was necessary?" replied, "Decidedly."

The matron of Bethlem Hospital (who was elected January, 1815) gave evidence that, when she was appointed, there were about twenty patients under personal restraint, out of between fifty and sixty patients. "The custom when I first went was only to get them up three days of the week--never on meat days; they lie in bed four days in the week." She also stated that one of the female patients had been chained for eight years, but had not required restraint since she had been there.

Bethlem, however, was far from being the only place where patients were treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a private asylum at Bethnal Green, gave evidence to an attendant "kicking the patients and thumping them sadly," and "beating one in his s.h.i.+rt with a pair of boots, in a most dreadful manner." She named a female patient who, when in a state of irritation, "was confined in a place in the yard which was originally a pig-sty; it was run up high on purpose for her. I have seen her confined there for three weeks together. She has been ironed there in the crib with wrist-locks, and leg-locks, and a chain two or three times across her body." An iron bar was placed between her legs when she walked about, to prevent her escaping. "It was confined to each ankle, with a chain coming up between her legs, which was attached to her handcuffs." But, in addition to this frightful restraint, we are informed that an attendant, at the instance of the proprietor, would, "at sundry times," lock her down in her crib with wrist-locks and leg-locks, and horsewhip her. "I have seen the blood follow the strokes." Yet this patient is described as very harmless; "you might sit and talk to her when she was in the highest state."

The Committee found that at a private asylum--Fonthill, Wilts--there was in that year, out of fourteen patients, only one without fetters or handcuffs, and only three out of their sleeping-rooms.[146]

At the Bethnal Green Asylum "several of the pauper women were chained to their bedsteads, naked, and only covered with a hempen rug," and "the accommodation for paupers was infamously bad, and required immediate reform;" while in January of the same year it is reported that "some pauper men were chained upon their straw beds with only a rug to cover them, and not in any way defended from the external cold."[147]

Dr. John Weir was asked, at the Committee of 1815, to what he attributed the difference of opinion among even enlightened men as to the management of the insane. He replied that it was chiefly due to the want of practical observation, as it is only by comparison that we are enabled to appreciate the superiority of one inst.i.tution over another.

He added that, until within the last eighteen years, the primary object of almost every insane inst.i.tution, whether of a public or private description, had been merely the security of these pitiable objects; comfort, medical and moral treatment, had been in a great measure overlooked. "Happily, however, for that cla.s.s of society, the Retreat at York had at last convinced the world how much may be done towards the amelioration of their condition."[148]

On the 11th of July, 1815, Mr. Rose brought up the Report of this Committee. On moving that it be printed, he said that all who read the Report must feel satisfied of the indispensable necessity of legislative interference. The way in which lunatics were usually confined was that of criminals, and their treatment was in general worse than the ordinary treatment in jails. The number of persons appointed to take care of them was in most cases utterly insufficient, in consequence of which the greatest severity was too frequently resorted to.

The conclusions arrived at in this celebrated Report may be thus summarized: That keepers of houses for the insane received a much greater number of persons than they were calculated for, thus greatly r.e.t.a.r.ding their recovery; that the number of attendants being insufficient, there was unavoidably a larger amount of restraint than would otherwise be necessary; that outrageous patients were mixed with the quiet and inoffensive; that there was an absence of medical attention to the malady for which the patients were confined; that the certificates on which patients were received into asylums were insufficient, and that the visitation of private mad-houses was defective.

The Report concluded that "some new provision of law is indispensably necessary for ensuring better care being taken of insane persons, both in England and Ireland, than they have hitherto experienced; the number of whom appear to be very considerable, as the inquiries of the Committee have convinced them that there are not in the country a set of beings more immediately requiring the protection of the legislature than the persons in this state, a very large proportion of whom are entirely neglected by their relatives and friends. If the treatment of those in the middling or in the lower cla.s.ses of life shut up in hospitals, private mad-houses, or parish workhouses, is looked at, your Committee are persuaded that a case cannot be found where the necessity for a remedy is more urgent."

The evidence taken before the Committee of 1815 was so full and convincing that it would have seemed wholly unnecessary to have required a further disclosure of the abuses rampant in the asylums of England, but in consequence of the demand for further investigation before the House of Commons committed itself to legislation, a ma.s.s of further particulars was obtained in 1816 in regard to the state of various inst.i.tutions, including Bethlem Hospital and the York Asylum.

In February Mr. Rose had said in the House that, as chairman of the Committee for inquiry into the conduct of mad-houses, he was instructed to move for leave to bring in a Bill for the better regulation of such establishments. But some gentlemen of the Committee being desirous that further investigation should take place, he had acceded to their wish, although the majority concurred with him in thinking that sufficient evidence had already been adduced to justify the proposal of a Bill.

Therefore, he should propose, instead of a Bill, that a Committee be appointed to consider of provision being made for the better regulation of mad-houses in England, and report the same, with their observations thereupon, to the House.

On May 28th Mr. Rose brought up the Report of the Committee, and obtained leave to bring in a Bill pursuant thereto. This Bill was for the repeal of the 14th and 55th of the King. He said[149] the Committee had, after the most patient investigation, adopted the provisions of the present Bill, which princ.i.p.ally were, that instead of the physicians of the neighbourhood, or those in or near the metropolis, together with a neighbouring magistrate, being the inspectors of such establishments, they should be twice a year examined, etc., by eight Commissioners appointed by the Secretary of State for the Home Department throughout the kingdom; the Commissioners to be a.s.sisted by two of the local magistrates in each district, and with equal powers. There was also a provision in the Bill relative to the erection of lunatic asylums in counties, and the ordering the reception therein of pauper lunatics allowed at present to range abroad, to their own and the public injury.

On the 17th of June, Mr. Rose moved that the clauses of this Bill be taken into further consideration. Lord R. Seymour observed that when Parliament in 1774 pa.s.sed the "Bill for the Regulation of Licensed Mad-houses," it must have meant to do three things: (1) To secure all persons against unnecessary confinement; (2) to better the chance of recovery of all such persons confined as being insane, as well by moral treatment as by the use of medicine; and (3) to insure the restoration of all who might become again of sound mind to society. But the Mad-house Act, he said, does none of these three things, for it does not empower the Commissioners to discharge a patient, however sound in mind; nor does it furnish them with the means of enforcing the observance of any improvement they may recommend. The Commissioners, indeed, may withdraw the licence, but the keeper of such a house must again have it on the next licensing day, if he wishes, upon giving the necessary security. It was not surprising, therefore, that the greatest abuses should have been found to prevail.

Mr. Wynn expressed a wish that magistrates should be empowered to examine houses where only one patient was confined.[150]

This Bill pa.s.sed the House, but was rejected by the House of Lords.

Thus all the ma.s.s of valuable and decisive evidence which had been collected with so much labour, and had occupied the time and thought of two Committees of the House of Commons, was, for the time, thrown away, and the misery of the inmates of asylums allowed to go unrelieved. The facts, however, had been made widely known. The inertia, torpor, and indifference to human suffering--in short, the crime which characterized the majorities who threw out the Bills calculated to remove the abuses in asylums, had at last to give way to the popular demand. What was gained by prolonging the dismal condition of these abodes of woe for some years longer, I leave others to discover.

After the lapse of three years, namely, on the 10th of March, 1819, Mr.

Wynn[151] rose to move for leave to bring in a "Bill for the Regulation of Mad-houses," and observed that, as this subject had been already several times before the House, he did not feel it necessary to trespa.s.s long upon its attention. It would be remembered, he said, that some years ago the Report of a Committee had been laid before the House, detailing such scenes of misery and wretchedness in mad-houses, as had perhaps never been paralleled, and after such an exposure it was the obvious duty of the House to follow up the Report by the adoption of some legislative measure calculated to put an end to the evils complained of. There was, however, no fault to be found with the conduct of that House; for it had done its duty by repeatedly sending up a Bill to the other House, which it had thought proper to reject.

Although no mad-houses could be legally opened without a licence, the College of Physicians was not in possession of funds to prosecute. He therefore proposed that a general Board of Inspection for mad-houses should be appointed, and that the members of that Board should be at liberty to visit such houses throughout the country, at different and uncertain times, so as to ascertain the manner in which they were conducted, and to report any existing evil to the Board, which should be invested with power to enforce their correction. Mr. Wynn moved for leave to bring in a Bill for repealing the Act of the 14th and 55th of the King with respect to mad-houses, and for making other provisions for their better regulation.[152]

Leave was given to bring in the Bill.

In June of the same year the Marquis of Lansdowne, speaking on the Bill in the House of Lords, said that nothing could more forcibly appeal to the humanity of their lords.h.i.+ps than the state of the unfortunate insane, and the legislative means of preventing abuses of the most flagrant and revolting nature, which had long been too clearly proved.