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Lunacy in England. (England's Irren-Wesen.) Address at the Opening of Section VIII (Mental Diseases) of the International Medical Congress
Published online by Cambridge University Press: 19 February 2018
Extract
Gentlemen,—In now opening the eighth section of this great International Medical Congress, and in offering to the alienists of Europe and America our cordial welcome to London, I must ask leave to explain to you that it is only by the accident of official position as senior physician to the Lord Chancellor, who, under the Royal prerogative and by statute, has in England the guardianship of all lunatics and persons of unsound mind, that I occupy to-day this presidential chair. But for the desire of the Executive Committee thus to recognise the paramount authority of the Lord Chancellor in our department of medicine, I cannot doubt that the place I now fill would have been allotted to our most distinguished English writer on lunacy, Dr. J. C. Bucknill, one of the vice-presidents of this Congress, whose writings and whose name are a household word in all the asylums where the English tongue is spoken. Called from my official position rather than from personal fitness to preside in this section, I may the more venture to ask at your hands a generous interpretation of my efforts, so to guide your deliberations here that they may advance the science and practice of this department of medicine in which we are all enrolled.
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- Part I.—Original Articles
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- Copyright © Royal College of Psychiatrists, 1882
References
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The Alleged Increase of Lunacy, “Journal of Mental Science,”
April, 1869.
A Farther Note on the alleged Increase of Lunacy, “Journal of Mental Science,” January, 1871.Google Scholar
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In the Report of the Scotch Commissioners in Lunacy for 1880, this question of the apparent increase of insanity is ably discussed, and dealt with in a careful statistical inquiry. I can only here give their conclusion:—”We have frequently pointed out that the difference in these rates of increase is not necessarily due to an increasing amount of mental disease, but is probably due in a large measure to what is only an increasing readiness to place persons as lanatics in establishments.”
Google Scholar
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A return was ordered by the House of Commons to be printed August 14, 1878, of the cost of construction of each of the county asylums, the number of beds, the annual and weekly maintenance rate, the percentage of recoveries, deaths, &c. Unfortunately it has been, as regards England, carelessly prepared, and no abstract or summary of its contents or averages are given. It is impossible to make out clearly in which asylums the yearly repairs are included in the total cost of construction, and in which they are omitted. The Quarter Sessions of Warwickshire have made no return at all ! In contrast, in the same Parliamentary paper, stand the clear tables and summary relating to the public asylums of Scotland. From the English return we can only gather an approximate estimate of the cost of construction, amount of land, salaries, cures, &c., no average being given.Google Scholar
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“In June, 1839, Dr. Conolly was appointed resident physician at Hanwell. In September be had abolished all mechanical restraints. The experiment was a trying one, for this great asylum contained 800 patients. But the experiment was successful; and continued experience proved incontestably that in a well-ordered asylum the use even of the strait-waistcoat might be entirely discarded. Dr. Conolly went further than this. He maintained that such restraints are in all cases positively injurious; that their use is utterly inconsistent with a good system of treatment; and that, on the contrary, the absence of all such restraints is naturally and necessarily associated with treatment such as that of lunatics ought to be, one which substitutes mental for bodily control, and is governed in all its details by the purpose of preventing mental excitement, or of soothing it before it bursts out into violence. He urged this with feeling and persuasive eloquence, and gave in proof of it the results of his own experiment at Hanwell. For, from the time that all mechanical restraints were abolished, the occurrence of frantic behaviour among the lunatics became less and less frequent. Thus did the experiments of Charlesworth and Conolly confirm the principles of treatment inaugurated by Daquin and Pinel, and prove that the best guide to the treatment of lunatics is to be found in the dictates of an enlightened and refined benevolence. And so the progress of science, by way of experiment, has led men to rules of practice nearer and nearer to the teachings of Christianity. To my eyes a pauper lunatic asylum, such as may now be seen in our English counties, with its pleasant grounds, its airy and cleanly wards, its many comforts, and wise and kindly superintendence, provided for those whose lot it is to bear the double burden of poverty and mental derangement—I say this sight is to me the most blessed manifestation of true civilization that the world can present.”—The Harveian Oration, 1866, by George E. Paget, M.D., Cantab., Regius Professor of Medicine in the University of Cambridge.Google Scholar
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“The Treatment of the Insane without Mechanical Restraint,” by Conolly, John, M.D. Edin., D.C.L.
London: Smith, Elder, & Co.
1856.Google Scholar
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There is a unanimous concurrence of opinion on the part of the Lunacy officials and the Visiting Justices, that the grant from the Consolidated Fund of 4s. a week made by Lord Beaconsfield's Government in 1874, for every pauper lunatic detained in the county asylums, has led to a needless increase in the admission there of aged lunatics and idiot children, who were and can with equal facility be kept in the workhouses. This grant has risen year by year, and in the estimates of 1881–82 is placed at £425,000. Instead of relieving the landed interest, as this ill-considered attempt to shift part of their burden on the fund-holders was intended, it has actually increased the county rate by the forced enlargements and extension of the county asylums. The editor of The Times, in 1874 and 1878, allowed me at some length co direct attention to this yearly increasing misdirection of the public funds. It is to be hoped that when the heavy local taxation of England is readjusted, this outlet of wasteful expenditure may not be overlooked.Google Scholar
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The success of the Metropolitan District Asylums at Leavesden and Caterham, which contain 4,000 chronic lunatics maintained at the rate of 7s. a week, shows how, even in so difficult a place as London, the treatment of chronic and harmless pauper lunatics in workhouse wards is to be accomplished, with a large saving to the ratepayers and a relief to the crowded wards of the county asylums, which are thus made available for the curative treatment of acute and recent cases.Google Scholar
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The fabric charges are not included in these figures. Another 5s. a week must be added to complete this estimated weekly cost of maintenance.Google Scholar
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In the “Journal of Mental Science” for July, 1876, there is a very interesting sketch of the History of Bethlem Hospital since 1247, by Dr.Tuke, Hack
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I brought this whole subject before the Brighton Medical Society in 1862, in a paper on “The Want of a Middle-class Asylum in Sussex,” subsequently inserted in the “Journal of Mental Science” for
January, 1863.Google Scholar
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“The Lunacy Acts: containing the statutes relating to Private Lunatics, Pauper Lunatics, Criminal Lunatics, Commissioners of Lunacy, Public and Private Asylums, and the Commissioners in Lunacy; with an Introductory Commentary, &c.” By Fry, Danby P., of Lincoln's Inn, Barrister-at-Law. Second edition. London, 1877.Google Scholar
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I may be pardoned if I venture here to refer to the annual reports of the Commissioners in Lunacy for Scotland, as containing an amount of well-digested statistical information regarding the lunacy of the kingdom, which we search for in vain elsewhere.Google Scholar
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