Chapters in the History of the Insane in the British Isles Part 12

Strange to say, however, the Lord Chancellor (Lord Eldon) opposed the Bill, observing that there could not be a more false humanity than an over-humanity with regard to persons afflicted with insanity. (Is not an under-humanity nearly as false?) He admitted there were great abuses, but the better way to remedy them would be to take a cool and dispa.s.sionate view of the subject in a Committee, next session. As if there had not been Committees enough! With regard to pauper lunatics, the Lord Chancellor went so far as not only to admit there were great abuses, but to agree to a short Bill, if desired, embodying the clauses relating to them in the measure before the House.

The Bill was thrown out, only fourteen doing themselves the credit of voting in its favour, while thirty-five voted against it. Majority against the Bill, twenty-one.

An "Act for making Provision for the Better Care of Pauper Lunatics in England"[153] was, however, pa.s.sed (July 12, 1819), but it consisted of three sections only, and does not appear to be an advance, in any essential particular, upon previous Acts. The form of the medical certificate for a pauper lunatic is prescribed.[154] Again, the Act is permissive as regards the action of the justices in causing the overseers to bring the lunatic before them, and calling in a medical man to their a.s.sistance.

Four years afterwards, on June 30, 1823, the subject of private mad-houses again came before the House. A pet.i.tion from John Mitford for an inquiry into the state of private mad-houses was ordered to lie on the table. Mr. Wynn, as on a former occasion, spoke, and observed that three Bills had, at recent periods, been sent up from that House to the Lords, relative to the inspection of houses of this description. He regretted to say they had not been pa.s.sed. It is extraordinary that Mr.

Wynn should have ended his speech by saying that, although he believed abuses might exist in some of these establishments, they were on the whole well conducted. Mr. (afterwards Lord) Brougham said that he knew Dr. Warburton, against whom charges had been brought, and that his character stood equally high both for medical skill and for humanity!

Writing in 1827, Sir Andrew Halliday[155] says, "The evidence taken before Mr. Rose's Committee, which sat for more than one session, must be fresh in the recollection of every one of my readers.... He was at great pains to prepare a Bill which, in the opinion of all who had heard the evidence, and had taken a disinterested part in the investigation, was well calculated to remedy every evil either ascertained or antic.i.p.ated. The subject was dispa.s.sionately canva.s.sed in the Lower House, and the Bill pa.s.sed by the Commons, almost unanimously, three or four several times; but it was uniformly rejected by the Lords, and after Mr. Rose's death it got into Chancery, and there it has slept for the last _nine years_. I do not mean this remark in any manner as a jest; for, literally and truly, the late Lord Chancellor [Lord Eldon]

took the whole matter upon his own shoulders, and promised to prepare a measure more suited to the exigencies of the sufferers than any that the collected wisdom of the Commons of England, in Parliament a.s.sembled, could think or devise.... The House of Commons has again taken up the matter, and I trust they will not abandon it, even though they should be opposed, until some provision is made against the recurrence of those evils, very trifling in comparison of former times, which during their last short inquiry were found still to exist." Sir A. Halliday points out that, although twenty years had elapsed since Mr. Wynn's Act pa.s.sed (having received subsequently several amendments), asylums had only been opened in the counties of York (Wakefield, 1818), Lancaster (1816), Nottingham (1812), Norfolk (1814), Stafford (1818), Bedford (1812), Gloucester (1823), Lincoln (1820), and Cornwall (1820)--nine out of the fifty-two counties of England and Wales. Suffolk had just finished its building, as had Chester a short time before. Only at that very time had the magistrates of Middles.e.x, after two years' deliberation, announced that a county asylum was necessary, although it had been proved by Lord R. Seymour that 873 persons were suffering neglect and cruel treatment for want of it!

Returns ordered by Parliament in 1826 show that there were 1321 persons in private asylums, exclusive of those in London and within a radius of seven miles; 1147 in public asylums, exclusive of those in St. Luke's and Bethlem; and 53 in public jails; giving a total of 2521 for the several counties of England and Wales. Those in private asylums in and near London being estimated at 1761, and the asylums of St. Luke's and Bethlem at 500, the gross total for England and Wales was 4782. Sir Andrew Halliday did not hesitate to a.s.sert, after very careful inquiry, that the number actually in confinement, not only in the asylums, but with relations and keepers, exceeded 8000. He thought there were very few in Wales, or in "the Celtic tribes in other portions of the empire."[156]

Before leaving Halliday, I may add that he regarded Bethlem as, at this period, well conducted, but as having "too much of the leaven of the dark ages in its const.i.tution, and too rigid a system of quackery, in regard to its being seen and visited by respectable strangers." He adds that in some respects "it is little better than when, in fact, it formed one of the _lions_ of the metropolis, and the patients as wild beasts were shown at sixpence for each person admitted." Of St. Luke's he writes, "It is only fit to become a prison for confirmed idiots." He would have been surprised to witness how much can be effected by improvements of various kinds, although he might still wish that it were supplemented by some appendage in the country, if not removed there altogether.

A very important step was taken by Mr. R. Gordon in the House of Commons in 1827 (June 13th), by drawing attention to the pauper lunatics in Middles.e.x. He particularly referred to the dreadful state of misery of the pauper lunatics in London in the parishes of Marylebone and St.

George's. When the overseers of the latter parish visited Dr.

Warburton's asylum at Bethnal Green, they found, he said, in a room eighteen feet long, sixteen cribs,[157] with a patient in each crib, some of them chained and fastened down, and all of them in a state of great wretchedness. On one occasion, a visitor having gone there and reported that there was nothing objectionable, he repeated his visit next day, and discovered five rooms, in which the patients were in a most horrid state of misery; and this although the day before he was informed that he had seen everything. The unfortunate persons placed in these cribs were kept from Sat.u.r.day night until Monday; their food being administered to them in the cribs. Mr. Gordon moved for a Select Committee to inquire into the condition of pauper lunatics in Middles.e.x, and for leave to bring in a Bill to amend 14 Geo. III. c. 49 (1774),[158] and to extend its provisions to pauper lunatics, to consolidate all Acts relative to lunatics and asylums, and to make further provisions thereto.

The Committee was appointed.

It specially directed its attention to the treatment of paupers in the parishes of Marylebone, St. George, Hanover Square, and St. Pancras, confined in the White House at Bethnal Green, belonging to Dr.

Warburton. Its condition was frightful, and the Committee observes that if the White House is to be taken as a fair specimen of similar establishments, it cannot too strongly or too anxiously express its conviction that the greatest possible benefit will accrue to pauper patients by the erection of a county lunatic asylum.

The Committee reports that the defects and abuses in the management of houses for the reception of lunatics, to which the Select Committee of 1815 called the attention of the House of Commons, still exist in licensed houses where paupers are received in the neighbourhood of the metropolis, and that similar abuses elsewhere prevail. The evidence established that there was no due precaution with respect to the certificate of admission, the consideration of discharge, or the application of any curative process to the mental malady. The Committee therefore repeated the recommendations of the Committees of 1807 and 1815, and prepared a series of propositions as the basis of future legislation, repealing a number of Acts and recommending the consolidation, into one Act of Parliament, of the provisions for the insane, as well as further facilitating the erection of county asylums, and improving the treatment of pauper and criminal lunatics.

Dr. John Bright, secretary to the Commissioners, read from their records one entry, describing the condition of Holt's house, Lewisham, in Kent.

In the year 1820, "in a close room in the yard, two men were shut by an external bolt, and the room was remarkably close and offensive. In an outhouse at the bottom of the yard, ventilated only by cracks in the wall, were enclosed three females. The door was padlocked; upon an open rail-bottomed crib herein, without straw, was chained a female by the wrists, arms, and legs, and fixed also by chains to the crib. Her wrists were blistered by the handcuffs; she was covered only by a rug. The only attendant upon all the lunatics appeared to be one female servant, who stated that she was helped by the patients."

Subsequent entries did not show any material improvement in the condition of the house.

Dr. Bright summarized the defects in the Lunacy Laws at that period, as regards the power vested in the Commissioners, as follows:--

"They are very defective in many points: in the first place, with respect to the granting licences, there is only one day in the year in which, according to the Act, the licences can be granted; then with respect to persons to whom the licence may be granted, any person applying for that licence is ent.i.tled to have one; again, any person committing any offence, save and except the refusing admission to Commissioners on their visitations, may be continued and is continued in the exercise of such powers as that licence communicates to him; the Commissioners have no power to disturb in the management of his house any keeper of a house, whatever offences he may have committed, or however unworthy he may appear to them to be. Supposing any person who had, in the eyes of the Commissioners, acted improperly, to apply in October, at the usual and the only period in the year for granting licences, they conceive (and they are advised) that they are obliged to grant a licence to that individual. There is another circ.u.mstance which I think is very important, which is the certificate which is granted; the Act is vague with respect to the medical person. It speaks of him as physician, surgeon, or apothecary; it does not say 'duly authorized to grant a licence,' and, in point of fact, a number of persons, calling themselves apothecaries, do sign certificates, and the Commissioners do not believe that they can prevent them so doing, or that the signature is invalid; and, again, it often happens, and very improperly, as the Commissioners think, that persons sign the certificate in two capacities. For instance, a medical man is, or calls himself, the friend of the person conveyed to the mad-house, and he signs again as a medical person; again, the keeper of a mad-house, who happens to be a medical person, signs a certificate, attesting the insanity of the party, and receiving that party into his house. The Commissioners always reprobate and endeavour to check such a practice, but not always successfully."

In the following year (February 19, 1828) Mr. Gordon, in pursuance of the instructions of the Committee, brought in a Bill to amend the law for the regulation of lunatic asylums. He said, among other things, that the medical certificate to be signed by an apothecary was interpreted to mean that it might be signed by any seller of drugs, and hence an apprentice, as soon as his indentures had expired, might consign a man to a mad-house. This reminds me of a mistake into which a distinguished German alienist has recently fallen, not unnaturally, from our double use of the word apothecary. He smiles at the absurdity of the British law allowing a mere druggist to sign a certificate of insanity! Mr.

Gordon again refers to Dr. Warburton's house, and the patients in their cribs "wallowing in their filth throughout the whole of Sunday," while on Monday morning they were "in a state of nudity, covered with sores and ordure, and were carried into the yard to be suddenly plunged into cold water, even when ice was in the pails." The speaker added that it was impossible, with the strongest language, to describe the horrors of this place, and even maintained that the evidence before the Committee showed that, however bad, this house was good as compared with others of the same kind--if not much better than many of them.

He maintained that, unfortunately, the provision made by 14 Geo. III., c. 49, by which five Commissioners, appointed by the College of Physicians, licensed and were bound to visit these houses yearly, and, if they found anything improper, were directed to state to the College what they had discovered, had never been attended to in practice; at least, since 1800. The excuse for this negligence was that the complaint to the College censors (placed on a card in their room) did no good, and might therefore as well be abandoned. In fact, he found on inquiry that the Commissioners had done nothing--literally and strictly nothing. He then referred to a house where two patients were found lying in an outhouse, and three others chained down by the arms, wrists, and legs.

Their wrists were blistered, and their persons covered only by rags.

This was within five miles of London. He concluded by moving for leave to bring in a Bill "To Consolidate and Amend the several Acts respecting County Lunatic Asylums, and to Improve the Treatment of Pauper and Criminal Lunatics."

Lord Ashley seconded the motion, and leave was given to bring in the Bill,[159] which pa.s.sed the House.

In the Upper House Lord Malmesbury moved the second reading of the above Bill. One object, he said, of the Lunatic Asylum Regulation Bill was to give to counties more power in establis.h.i.+ng asylums. For private patients, two medical certificates and an order would now be required, and the like for single patients. In regard to the existing College Commissioners, he ridiculed the extraordinary circ.u.mstance that if, in the course of their visits of inspection, they found what was reprehensible in an asylum, they could not revoke the licence which they themselves had given. It was proposed to take the power from the College of Physicians and invest it in fifteen Metropolitan Commissioners appointed by the Home Secretary.[160]

This Act (9 Geo. IV., c. 40), based on the Report of the Committee, was pa.s.sed July 15, 1828.[161]

The returns of pauper lunatics in England and Wales amounted to 9000, being 6700 in excess of the corresponding return of 1807; but n.o.body supposes that there had been that, or, in fact, any considerable increase in the number of the insane poor, but simply greater accuracy in obtaining statistics.

Referring back to this period, Lord Shaftesbury, in evidence given before a Committee of the House of Commons thirty years later, and dwelling upon the old _regime_, observed: "I mention these things because they never could be seen now (1859), and I think that those who come after us ought to know what things have existed within the memory of man. At the present time, when people go into an asylum, they see everything cleanly, orderly, decent, and quiet, and a great number of persons in this later generation cannot believe there was ever anything terrible in the management of insanity; and many say, 'After all, a lunatic asylum is not so terrible as I believed.' When we begun our visitations, one of the first rooms that we went into contained nearly a hundred and fifty patients, in every form of madness, a large proportion of them chained to the wall, some melancholy, some furious, but the noise and din and roar were such that we positively could not hear each other; every form of disease and every form of madness was there; I never beheld anything so horrible and so miserable. Turning from that room, we went into a court, appropriated to the women. In that court there were from fifteen to twenty women, whose sole dress was a piece of red cloth, tied round the waist with a rope; many of them with long beards, covered with filth; they were crawling on their knees, and that was the only place where they could be. I do not think that I ever witnessed brute beasts in such a condition, and this had subsisted for years, and no remedy could be applied to it. It was known to one or two physicians at the Royal College, who visited the place once a year; but they said, fairly enough, that, although they saw these things, they could not amend them." Lord Shaftesbury, after giving a short _resume_ of the condition of the old York Asylum, as well as of that of Bethnal Green in 1827, went on to observe--a paragraph which will form the motto of my work--"I might multiply these instances almost indefinitely, but I thought it was desirable just to indicate the state of things that existed, in order to contrast the Past with the Present."[162]

In the interval between the Act of 1828[163] and the next Act of importance, several attempts were made at further legislation on the part of Mr. Gordon and Lord Somerset. A Bill pa.s.sed both Houses in 1832.[164] In one instance a Bill which pa.s.sed the Commons was characterized in the House of Lords as "one of the most abominable pieces of legislation that ever was seen." It was "monstrous." "Their lords.h.i.+ps could never suffer such an abominable piece of legislation to be thrust down their throats." It is scarcely necessary to say that the lips from which this animated language proceeded were those of Henry Brougham, then the Lord Chancellor. The Bill was, of course, rejected.

In 1842 Lord Somerset brought forward a motion on the inspection of asylums, and pointed out that there was a very large cla.s.s of persons to whose inspection the Act of 1828 did not apply, viz. those in confinement in their own houses, in separate lodgings, in public inst.i.tutions, as county asylums, and the hospitals of Bethlem and St.

Luke's. The object of his Bill was to extend the system of inspection in force in the metropolitan licensed asylums to the provinces. Barristers, he maintained, should be appointed, with a fixed salary, and not paid for their hour's work and allowed to practise. It is worthy of record that the returns at this period showed that there were about sixty or seventy houses licensed for the reception of insane persons in the country, and that there were actually twenty-five counties in England where there was not a single asylum licensed for the reception of lunatics, and not one in Wales.

This measure was characterized by Mr. Wakley as not only a very small one, but as an insult to medical men, as it only proposed barristers as the new Commissioners, adding that "in Scotland there was one system, in Ireland there was another, and in England there were several, and among them all there was not one which, on the whole, was ent.i.tled to the sanction and approbation of the public, or which was worthy of the adoption of the n.o.ble lord [Somerset]."

Lord Ashley approved of the Bill, and speaking of the work of the Commissioners, he said, "They have aimed at a medium line of policy, and an immense amount of human misery had been abated under the present law, and by the industry of those who carry it into execution."

It was in this speech that Lord Ashley made an observation which has not escaped the criticism of the medical profession, namely, "that a man of common sense could give as good an opinion as any medical man he ever knew," that is, "when it has been once established that the insanity of a patient did not arise from the state of his bodily health."[165]

It should be stated that Mr. Wakley moved an amendment on the first clause of the Bill, omitting "Barrister Commissioners," and inserting "Medical Commissioners." He spoke of the total failure of the Metropolitan Commission, and ultimately moved as an amendment that two of the Commissioners to be appointed should not have their profession stated, their appointment being left to the Lord Chancellor. This amendment was carried by a majority of three, but in the Bill provision was made for two more physicians and two more barristers.

On July 16th of the same year, on the motion that the order of the day for the further consideration of the Lunatic Asylums Bill be proceeded with, a member suggested its postponement until further discussion. Lord Somerset replied that the Bill was framed for the purpose of procuring further information on the subject, in order to legislate permanently upon it. On the House going into Committee Lord Ashley expressed a hope that the measure would tend to ameliorate the condition of the pauper lunatics throughout the kingdom. On this occasion Lord Ashley observed, in regard to the system of non-restraint, that he had formerly entertained some doubts as to the practicability of carrying it out; but that these doubts had been removed by a visit to the Hanwell Asylum.

Having witnessed the system pursued there, he said he could not speak too highly either of the system itself, or the manner in which it was carried out by Dr. Conolly.

Having pa.s.sed through Committee, the Bill was read a third time on the 28th of July, 1842, and in this instance was not rejected by the House of Lords.[166]

The Metropolitan Commissioners, invested with their enlarged powers, made a most thorough inquiry into the condition of the asylums in England and Wales, and presented a Report to Parliament in 1844, which must always possess great historic interest and value.[167] It const.i.tutes the Doomsday Book of all that concerns inst.i.tutions for the insane at that time.

The state of some asylums visited by the Commissioners was frightfully bad, notwithstanding the general progress which had been made since public attention had been directed to abuses and the several Acts of Parliament had been pa.s.sed in order to remove them. These things, however, it must be remembered, were survivals of the past, not fair ill.u.s.trations of the present; abuses which lingered on in spite of light and knowledge, and required stringent pains and penalties to force those who permitted them to abandon their practices.

On the 23rd of July, 1844, the indefatigable reformer of abuses connected with the treatment of lunatics, Lord Ashley, moved for an Address to the Crown, praying her Majesty to take into consideration the Report of the Metropolitan Commissioners in Lunacy[168] to the Lord Chancellor, presented to the House, the statute under which they acted expiring next session. He commented upon there being no official visitation of single houses. He believed that such a power "ought to be confided to some hand that would hunt out and expose the many horrible abuses that at present prevail." The only control was that if such patient resided more than twelve months in a house, the owner was compelled to communicate the name of that patient to the clerk of the Commission; but for the most part no notice was taken of this law, and it was frequently evaded by removing the patient, after a residence of eleven months, to some other lodging.

At this period (January 1, 1844) the number of lunatics and idiots chargeable to unions and parishes in England and Wales was 16,821. In county asylums there was provision for only 4155, leaving 12,666 poor insane, of whom there were in asylums under local Acts 89, in Bethlem and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private asylums, leaving in workhouses and elsewhere 9339. Although a few of the existing county asylums were well adapted to their purpose, and a very large proportion of them were extremely well conducted, yet some were quite unfit for the reception of insane persons. Some were placed in ineligible sites, and others were deficient in the necessary means of providing outdoor employment for their paupers. Some also were ill contrived and defective in their internal construction and accommodation. Some afforded every advantage of science and treatment; others were wholly deficient in these points. All of them, however, had the advantage of constant supervision, and of not giving any profit to the superintendent. Lord Ashley especially referred to the admirable manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster, and Gloucester were managed. "Why, then," his lords.h.i.+p asked, "are not these inst.i.tutions multiplied? At this moment there are twenty-one counties in England and Wales without any asylum whatever, public or private. The expense is one cause. In some cases the cost of construction has been exceedingly great. The asylum most cheaply constructed is that of Wakefield, of which the average cost per head was 111, whilst the highest price was that of Gloucester, which had cost on the first accommodation 357 per head. In many cases the cost of construction had exceeded 200 per head. The cost of the Bedford Asylum, for 180 patients, was 20,500; that of Gloucester, for 261 patients, 51,366; that of Kent, for 300 patients, was 64,056; that of Hanwell, for 1000 patients, was 160,000, exclusive of 36,000 paid since 1835 for furniture and fittings. On the other hand, the best-constructed union-houses in the country had not cost more than 40 per head." Lord Ashley maintained that although, no doubt, a lunatic asylum was expensive, it ought not to be so to that enormous degree. The reason of this difference he did not know, except that many of them had been constructed with a great display of architecture, and some asylums were far too large. Adopting the opinion of the Report of the Commissioners, he maintained that no asylum for _curable_ lunatics should contain more than 250 patients, and that perhaps 200 are as large a number as can be managed with the most benefit to themselves and the public in one asylum; and he quoted Dr. Conolly's stronger statement that 100 persons were the highest number that could be managed with convenience in one of these asylums. With regard to the number of private patients in asylums, there were 3790, of whom 973 were in private metropolitan, and 1426 in private provincial asylums. The paupers in the private houses were--metropolitan, 854; provincial, 1920. With respect to these, it was a very serious question how far any house should be licensed to take paupers for payment. The principle was very dangerous, and Lord Ashley pointed out that if the superintendent only got seven or eight s.h.i.+llings a week, he still must make a profit, and that there could be no doubt it was so. Quoting the Report of the Commissioners again, he said that many asylums had formerly been private houses; the mansion was sometimes engrossed by the proprietor and a few private patients, while the paupers were consigned to buildings formerly used as offices and outhouses. After adducing evidence of the deplorable condition of certain asylums, Lord Ashley a.s.serted that the only remedy was the multiplication of county asylums, and if advice and example failed, they ought to appeal to the a.s.sistance of the law to compel the construction of an adequate number of asylums over the whole country. It was the duty of the State to provide receptacles for the incurable patients, apart from those devoted to remedial treatment. Parochial authorities, however, preferred keeping patients in the workhouse at an expense not exceeding two s.h.i.+llings a week, rather than send them to the county asylum, where the minimum charge was seven s.h.i.+llings a week.

It was true, Lord Ashley observed, that they could show but few instances of restoration to reason. How, indeed, was it possible? They could show, however, a mighty improvement in the condition of the sufferers, the alleviation of their state, their occupations and amus.e.m.e.nts (all, with some bright exceptions, of recent date), and that the services of religion had infused a momentary tranquillity; but they could show little else, and unless the Legislature should interfere and bring these unfortunates by force within the reach of sympathy and care, for every one restored to his senses we should see a hundred in whom the light of reason would be extinguished for ever. The speaker went on to say that there were two points of deep interest, to which the House would do well to advert for a moment--the question of restraint, and the admission and liberation of patients. "Upon restraint it was unnecessary to dwell very long, as it was a matter of internal arrangement, and beyond their immediate legislation; but he wished to direct the attention of the House to the chapter in the Report which handled that subject, that it might share the general satisfaction, and give praise to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr.

Conolly, Dr. de Vitre, Dr. Charlesworth and many more, who had brought all their high moral and intellectual qualities to bear on this topic, and had laboured to make rational and humane treatment to be the rule and principle of the government of lunacy."

Lord Ashley pointed out that the law required no medical certificate whatever for a pauper patient, except when admitted into a private asylum. It appears that in Wales at that time there were 1177 pauper lunatics, 36 of whom were in English county asylums, and 41 in English licensed houses, 90 in union workhouses, and 1010 living with their friends, many of them being in a wretched condition. Lord Ashley quoted a letter from one of the Commissioners, written in Wales, in which it was stated, "We have met with one case which we think most atrocious. A.

B. was sent to the Hereford Asylum from near Brecon on November 28, 1843. She died on January 30th. She was in such a shocking state that the proprietor wished not to admit her; she had been kept chained in the house of a married daughter. From being long chained in a crouching posture, her knees were forced up to her chin, and she sat wholly upon her heels and her hips, and considerable excoriation had taken place where her knees pressed upon her stomach. She could move about, and was generally maniacal. When she died it required very considerable dissection to get her pressed into her coffin! This might be taken as a sample of Welsh lunatics."

The improvement in the condition of Dr. Warburton's asylum at Bethnal Green, which was the original cause of the Commission of Inquiry being appointed in 1827, now presented, it appears, a most agreeable picture of what might be done by vigilant inspection. "Whereas in 1828 there were commonly 150 to 200 of the patients restrained by leg-locks, chains, and other fetters--certainly during the night--in 1844 there were, out of 582 patients, only 5 whose violence rendered this species of restriction necessary, and even the confinement or coercion resorted to was of the most moderate description, and in the opinion of the visiting officers most necessary."

Lord Ashley concluded his speech with the following eloquent words:--"Sir, these subjects may be dull, and want the light and shade of more exciting topics; but the expense which is incurred, the numbers that suffer, and the nature of their sufferings, will perhaps justify the present demand upon your time and patience. The House possesses the means of applying a real and speedy remedy; these unhappy persons are outcasts from all the social and domestic affections of private life--nay, more, from all its cares and duties, and have no refuge but in the laws. You can prevent by the agency you shall appoint, as you have in many instances prevented, the recurrence of frightful cruelties; you can soothe the days of the incurable, and restore many sufferers to health and usefulness.... I trust, therefore, that I shall stand excused, though I have consumed so much of your valuable time, when you call to mind that the Motion is made on behalf of the most helpless, if not the most afflicted, portion of the human race."[169]

Sir James Graham does not appear to have been affected by this appeal, for, declining immediate action, he stated that the condition of pauper lunatics would come under the consideration of the House next session.

He recommended the House to approach the subject of the inspection of private houses with great caution.

In the summer of 1845 (June 6th) Lord Ashley returned to the subject, and brought forward in the House of Commons two Bills for England and Wales only, although he said, "I believe that not in any country in Europe, nor in any part of America, is there any place in which pauper lunatics are in such a suffering and degraded state as those in her Majesty's kingdom of Scotland." After pointing out that the then existing law was embodied in nine statutes, divisible into four cla.s.ses--County Asylums, Licensed Asylums and Public Asylums, Persons found lunatic by inquisition, and Criminal Lunatics, he observed that his Bill only touched the two first cla.s.ses, and amended the single Act contained under the first cla.s.s, as also the three Acts contained under the second cla.s.s, namely, 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV., c. 64; and 5 and 6 Vict., c. 87; which various statutes were proposed by him to be consolidated into one--"A Bill for the Regulation of the Care and Treatment of Lunatics in England and Wales." After referring to the state of the law as it existed under 14 Geo. III., the only law regulating private asylums prior to Mr. Gordon's measure of 1828, Lord Ashley proposed to establish a permanent Commission of Lunacy, giving power of far more detailed and frequent visitation than previously, and placing "hospitals" under proper regulation by requiring them to have the same orders and certificates as in licensed asylums, and the same visitation as in county asylums. The person signing the order of a pauper patient would be required to examine him beforehand, and the medical officer certifying his insanity was to see him within seven days of his confinement. On admission the mental and bodily condition of the patient, and in the event of his death, the cause thereof, were to be stated. Injuries and acts of violence were to be recorded and a case-book kept. A return was to be made of all single patients received for profit.[170] Workhouses containing lunatics were to be subjected to regular visitation. These were some of the provisions of the first Bill.

The second was an extension of the Act of 9 Geo. IV., c. 40, and was of the highest importance, for the provision of county and borough asylums, instead of being permissive, was made compulsory. Where insufficient accommodation had been provided, it was required to increase it. It was proposed to erect some separate buildings at less cost for incurable, or rather chronic, cases. The above Bill was to be extended to boroughs having separate quarter sessions, and to every place not contributing to county rates. All lunatics not chargeable, whether wandering or otherwise, were to be apprehended, and those whose friends were unable to pay for them admitted as paupers. A quarterly inspection by a medical man of lunatics not in asylums was required, and a list was to be sent to the Commissioners in Lunacy.

Lord Ashley, after paying the tribute of respect and admiration due to Pinel, referred in conclusion to the introduction of a humane system of treatment into this country at York, adding that it must be grateful to the feelings of the author of the "Description of the Retreat" "to perceive that his example has obtained not only the approval, but the imitation of the best and wisest men of this country, and, I may add, of America."

Lord Ashley's Bill introduced for the first time a permanent Lunacy Commission. It comprised six paid Commissioners at salaries of 1500 each, which, he observed, would be economical in the end. In Mr.

Gordon's Act the Commissioners were appointed for one year, to be renewed annually, and consisted of ten unpaid members and five physicians, who were paid at the rate of one guinea an hour for their attendance, with power to carry into effect the new Act within the metropolitan district. This act and the Commission were renewed in 1832, when two barristers were added on the same terms. In 1834, having been always a member of the Commission, Lord Ashley became the chairman. The Act had been renewed periodically every three years until the year 1842, when Lord Somerset brought in a Bill, the object of which was greatly to extend the operation of the Metropolitan Commission. The number of physicians was then augmented to seven, and the barristers to four; and it was also provided that the Commissioners should receive five guineas a day during the performance of their duties in the provinces.