Part 20

One of the most important points in reference to insane paupers, as we have already intimated, is the bringing them as speedily as possible under treatment. The reluctance of the lunatic himself to be removed is usually extreme, and it is marvellous what ingenuity he will often employ to thwart the design. Southey relates that a madman who was being conveyed from Rye to Bedlam slept in the Borough. He suspected whither he was going, and, having contrived by rising early to elude his attendant, he went to Bedlam, and told the keepers that he was about to bring them a patient. "But," said he, "in order to lead him willingly, he has been persuaded that I am mad, and accordingly I shall come as the madman. He will be very outrageous when you seize him, but you must clap on a strait-waistcoat." The device completely succeeded. The lunatic returned home, the sane man was shut up, and until he was exchanged at the end of four days, remained in his strait-waistcoat, having doubtless exhibited a violence which amply justified its use. The aversion of the sufferer himself to be taken away coincides with an equal aversion on the part of his relatives and friends to send him from home, nor do they take the step till the madness grows intolerable. Precious time is thus lost at the outset, and when the removal occurs it is mostly to the workhouse. Here the patient is usually kept during the remainder of the curable stage of his malady. The parochial authorities are generally guided by an immediate consideration for the pockets of the rate-payers, rather than by any care for the welfare of the lunatic; and, as they can maintain him in the "house" at three shillings a-week--when they would have to pay nine if they transferred him to the county asylum--in the workhouse he remains until he becomes so dirty or troublesome in his habits that the guardians are willing to pay the difference to get rid of him. The first few months of the disease, within the narrow limits of which full 60 per cent. of the recoveries take place, are thus allowed to run to waste. Months fly by, and the victim subsides into the class of incurables. This produces a second evil. As the drafts of incurables are perpetually flowing into the asylums, they become "blocked up" in the course of a few years, and are converted into houses for the detention of hopeless cases. To this condition three-fourths of the asylums are already reduced, and the efforts of philanthropic medicine are brought to a dead lock by the short-sightedness of the parish authorities, who do not consider that for the sake of saving a few shillings in the board of Betty Smith in the first weeks of her craziness, they are converting her into a chronic burthen, seeing that she will probably live on to a good old age in the asylum, and cause them an ultimate expenditure of hundreds of pounds. To the swifter removal after the outbreak of the disorder we must look for a permanent remedy; but in the mean time something must be done to disembarrass the public asylums of the dead-weight of hopeless cases, if we seriously intend to take advantage of the curative appliances we already possess. The commissioners seem inclined to favour the erection of separate asylums for those who are beyond the reach of medical art. To us it seems that the more economical plan would be to apportion certain wards in the various workhouses for the reception of chronic cases, and to draft off the idiots alone to special establishments. By this means our water-logged asylums would speedily right themselves, and again become what they should never have ceased to be--hospitals for the _cure_ of the insane. At present we encourage an elaborate system for the manufacture of life-long lunatics. It is well known that the cures of early cases of insanity throughout England amount to 45 per cent., and at Bethlehem and St. Luke's, where no others are received, the cures have amounted to 62 per cent. and 72 per cent. respectively; whereas at Colney Hatch, Hanwell, and the Surrey County Asylum, the three great receptacles for the weepings of the metropolitan workhouses, the average cures do not exceed 15 per cent. If we take the lowest averages of cures, there is still a difference of 30 per cent. of human creatures who sink down into the cheerless night of chronic dementia and idiotcy, or who dream away the remainder of their lives in hopeless childishness. Another ground of complaint is, that a degree of clerk's work is imposed upon the medical superintendents of large asylums which is quite inconsistent with a proper discharge of their chief duty--the recovery of their patients. Irrespective of the routine-labour of making daily and quarterly and yearly reports, which is very considerable, they have far more to do in their strictly professional capacity than they can possibly accomplish. The three great asylums near the metropolis contain upwards of 3,000 patients, or the population of a good-sized country town; and their moral and physical training is confided to exactly six medical men, or as many as will be found in an hospital of a hundred beds! It is needless to observe how little attention can be paid to each individual, and that the more promising patients must be inevitably swamped in the sea of hopeless lunatics. As long as our asylums remain mere houses of detention, the want of medical superintendence is not so apparent; but immediately these establishments are restored to their proper functions, we predict that the evil will become too glaring to last.

In many boroughs the authorities have entirely evaded the requirements of the Act of Parliament relative to their insane pauper poor, and have not only neglected to erect proper asylums, but have resisted for years the attempts of the commissioners to compel them to do their duty. In all such cases the lunatics not only suffer the ills consequent upon insufficient care, but when too numerous for home accommodation are subjected to a system of _transportation_, which is not only disgraceful to the municipal authorities themselves, but to the age for permitting it. True to their economical instincts, the guardians of the poor often "farm out" their insane paupers to the proprietor of some private asylum, quite regardless of distance. The commissioners, justly indignant at this sordid practice, state in one of their Reports that--

"At present, large numbers of these patients are sent to licensed houses far from their homes, to distances (sometimes exceeding, and often scarcely less than, 100 miles) which their relations and friends are unable to travel. The savings of the labouring poor are quite insufficient, in most cases, to defray the expense of such journeys, and their time (constituting their means of existence) cannot be spared for that purpose. The consequence has been, that the poor borough lunatic has been left too often to pass a considerable portion of his life, _and in some cases to die, far from his home, and without any of his nearest connexions having been able to comfort him by their occasional presence_. The visits of his parish officers are necessarily cursory and unfrequent, and he is, in fact, cast upon the humanity of strangers, whose prosperity depends upon the profits which they derive from maintaining him and others of his class."

This is a system which we are confident is as illegal as it is heartless, and we are astonished that bodies of Englishmen should dare to insult the miseries of lunatics by thus punishing them and their friends for their affliction. There were not long since twenty-five insane paupers at Camberwell House, London, who had been sent from Southampton, a distance of eighty miles, though the Hants County Asylum is situated within sixteen miles of the borough. Seventeen persons were in like manner banished from Great Yarmouth to Highbridge House, near London, and their relations, who had to travel 146 miles to see them, passed, in the course of their journey, the Norfolk and Essex County Asylums, both of which establishments had many vacancies and would willingly have received them. The pauper lunatics of Ipswich, King's Lynn, Dover, Canterbury, Portsmouth, and various other boroughs, are in the same way transferred by the local authorities to some of the metropolitan licensed houses.

The feelings of the poor for their afflicted relatives are often of the deepest kind, and the utmost distress is entailed upon them by these cruel separations from those they love. In one case, a native of Ipswich, too poor to go by the railway, walked to London and back on foot, a distance of 140 miles, for the sole purpose of visiting his wife, who had been wickedly banished to Peckham House, London. In other cases parents have pleaded so piteously to be conveyed to their children, that the commissioners have suggested that the expenses should be paid out of the parish funds, but the authorities who had contrived the original proceeding in order to save two or three shillings a head, could not of course be induced to furnish money for so sentimental a purpose. The commissioners have resolutely refused their sanction to such disgraceful transactions whenever they have come within their knowledge and jurisdiction--one instance out of many which prove that, however much the borough authorities may denounce them as a centralized power, they have done excellent service in checking local ignorance, selfishness, and inhumanity.

If we now turn to consider the condition of private asylums, we shall find much in them to praise as well as to condemn. When men of reputation, acknowledged skill, and character--such as Drs. Conolly, Forbes Winslow, Sutherland, and Munro, of London; Drs. Hitch, Noble, Newington, Fox, in the provinces, have the management of private asylums, the public need be under no apprehension of patients being improperly received, illegally detained, or cruelly and unscientifically treated. The licensed houses in the metropolitan district directly under the control of the Lunacy commissioners, amounting to forty-one in number, represent, without doubt, the fairest specimens of these establishments. Liable as they are at any moment to the inspection of the commissioners, and presided over as many of them are by the most eminent members of the profession, they are generally maintained in a high state of efficiency. They are principally devoted to the care of the higher classes of the community, and afford perhaps the nearest approach yet made to a perfect method of treatment, being conducted in most cases on the principle of a private family. The bolts, bars, high walls, and dismal airing-courts of the public asylum are either unknown, or so hidden as no longer to irritate the susceptible mind of the lunatic. The unwise division of the sexes is not as a rule adopted. Scrupulous attention to dress and all the forms of polite society are enjoined alike for their own sake, and as a method of interesting patients in the daily life of the community. When we partook of the hospitalities of one of these establishments, we could detect nothing in the countenances or the appearance of the guests which was characteristic of their condition: the restless eye, the incoherent conversation, the sudden movement of the peculiarly formed head, which our preconceived notions led us to expect, were none of them observable. One individual indeed there was whom we mentally concluded to be certainly mad. Yet, singular to say, this gentleman was the only sane individual in the room, besides ourselves and the medical superintendent; and on further acquaintance, having told our ill-placed suspicions, he frankly confessed that he had in his own mind paid ourselves a similar compliment. The eager glance of curiosity natural to inquisitive strangers was the nearest approach in this lunatic party to the outward appearance of lunacy. So much for the "unmistakeable" countenance of the insane! It is not to be supposed that the more violent can be allowed this social freedom even in private establishments, or that madness is different in a metropolitan licensed house from what it is in a public asylum; but we unhesitatingly assert that in the vast majority of cases the large amount of freedom and the absence of any prison-like characteristics have an undoubted effect, not only in calming the mind of the patient, but in expediting his recovery. Hence the per-centage of cures in a high-class private asylum are immeasurably beyond those of any public establishment. The pleasure-ground, out-of-door games, carriage and riding parties, billiards, whist and evening parties, all contribute their aid in restoring the unhinged mind. We have seen four or five patients leave the doors of one of these licensed metropolitan houses (the establishment of Dr. Forbes Winslow, "Sussex House," Hammersmith), and remain out for hours without any attendant, their word of _honour_ being the only tie existing between them and the asylum.[18]

The condition of a few of the provincial licensed houses is still glaringly bad, and shows that old ideas, with respect to insanity, are not entirely obsolete. The Report of the Commissioners of Lunacy for 1856, relates circumstances which lead us back to the old days of Bedlam. Thus at Hanbury House the Commissioners found "one young lady fastened by webbing wristbands to a leathern belt; she was also tied down to her chair by a rope." Again, they found on their last visit to the Sandford Asylum, in December, 1855, "a patient just dead, his body exhibiting sores and extensive sloughs, arising necessarily, we think, from want of water-pillows or other proper precautions. The room has a stone or plaster floor, and is without a fire." It is, however, encouraging to find that, as far as personal restraint goes, the very worst of our private asylums are far superior to some of the best of the public asylums of France. Dr. Webster, our great authority on this point, gives in Dr. Winslow's Psychological Journal, the results gleaned in his visits to these establishments in the August and September of 1850:--

"Forty male lunatics out of 1464 then resident were in _camisole_ (strait-waistcoats), some being also otherwise restrained, thereby giving an individual in restraint to every 33-1/4 male inmates, or three per hundred. Amongst the female lunatics, again, the proportion was somewhat larger, 72 persons of that sex, out of the total 1902 resident patients, being under medical coercion; thus making one female in restraint to every 26-1/3 inmates, or at the rate of 3·78 per cent. In contrast with this report respecting the above-named French provincial asylums, I would now place an official statement of the practice pursued at Bethlehem Hospital during the same period. At this establishment, where formerly the strait-waistcoat, with various kinds of personal coercion, were even in greater use than on the other side of the Channel, _not one_ insane patient, among an average population of 391 lunatics, was under constraint of any description during the five weeks ending the 25th of September, when I first visited that institution after my return from the Continent, and which embraced the whole time referred to in this memorandum."

From these curious facts it will be seen that we are far in advance of our French, and, we may also add, of our other continental neighbours.[19] When the beneficent thought struck the great Pinel to knock off the fetters of the English captain, he sounded a note which reverberated through Europe, and the poor insane captives issued from their dungeons in which they had been so long immured as the prisoners emerge from their prison to the divine strains of Beethoven's "Fidelio." But when this vast step was accomplished there still remained an immense amount of coercion scarcely less injurious than the old darkness and chains, and to Englishmen is mainly due the credit of abolishing it. Nor shall we rest where we are. It is our belief as well as our hope that, before another generation has gone by, the last vestige of restraint, in the shape of dismal airing-courts, and outside walls, which serve to wound the spirit rather than to enslave the limbs, will pass for ever among us, and only be remembered with the hobbles and the manacles of the past.

It has been asserted by some psychologists that lunacy is on the increase, and that its rapid development of late years has been consequent upon the increased activity of the national mind. This statement is certainly startling and calculated to arrest the attention of all thoughtful men. Is it true that civilisation has called to life a monster such as that which appalled Frankenstein? Is it a necessity of progress that it shall ever be accompanied by that fearful black rider which, like Despair, sits behind it? Does mental development mean increased mental decay? If these questions were truly answered in the affirmative, we might indeed sigh for the golden time when

"Wild in woods the noble savage ran,"

for it would be clear that the nearer humanity strove to attain towards divine perfection, the more it was retrograding towards a state inferior to that of the brute creation. A patient examination, however, of the question entirely negatives such a conclusion. Dr. Ray, of the United States, in taking the opposite view of the case, says:--

"If we duly consider the characteristics of our times, we shall there find abundant reason for the fact that insanity has been increasing at a rate unparalleled in any former period. In every successive step that has led to a higher degree of civilisation; in all the means and appliances for developing the mental resources of the race; in the ever-widening circle of objects calculated to influence desire, and impel to effort, we find so many additional agencies for tasking the mental energies, and thereby deranging the healthy equilibrium which binds the faculties together, and leads to an harmonious result. The press and the rostrum, the railway and the spinning-jenny, the steam engine and the telegraph, republican institutions and social organizations, are agencies more potent in preparing the mind for insanity than any or all of those vices and casualties which exert a more immediate and striking effect."

Such is the burthen of the story of all those psychologists who believe that insanity is fast gaining upon us; but if "in the ever-widening circle of objects calculated to influence desire and impel to effort, we find so many additional agencies for tasking the mental energies, and thereby deranging the healthy equilibrium which binds the faculties together," it should appear that those classes of society which are in the van of civilization should be the chief sufferers. Bankers, great speculators, merchants, engineers, statesmen, philosophers and men of letters--those who work with the brain rather than with their hands,--should afford the largest proportion to the alleged increase of insanity. How does the matter really stand? In the Report of the Commissioners in Lunacy for the year 1847 we find the total number of private patients of the middle and upper classes then under confinement in private asylums, amounted to 4,649. Now, if we skip eight years, and refer to the Report of 1855, we find that there were only 4,557 patients under confinement, or about 96 less, notwithstanding the increase of population during that period. If we compare the number of pauper lunatics under confinement at these two different periods, we shall find a widely-different state of things; for in 1847 there were 9,654 in our public and private asylums, whilst in 1855 they numbered 15,822. In other words, our pauper lunatics would _appear_ to have increased 6,170 in eight years, or upwards of 64 per cent. It is this extraordinary increase of pauper lunatics in the county asylums which has frightened some psychologists from their propriety, and led them to believe that insanity is running a winning race with the healthy intellect. But these figures, if they mean anything, prove that it is not the intellect of the country that breeds insanity, but its ignorance, as it cannot be for one moment contended that the grent movements now taking place in the world originate with the labouring classes. We shall be told, we know, that there is a constant descent of patients from private asylums to the public asylums; that the professional man and the tradesman, after expending the means of his friends and family for a year or two, in the vain hope of a speedy cure, becomes necessarily in the end a pauper lunatic, and that this stream aids to swell the numbers in the county institution. Allowing its due weight to this explanation--and those who know public asylums are well aware how small, comparatively speaking, is the educated element--yet as the same disturbing element in the calculation obtained at both periods, we may safely conclude that the figures are not thereby essentially altered.

A still more convincing proof that mental ruin springs rather from mental torpidity than from mental stimulation, is to be found by comparing the proportion of lunatics to the population in the rural and the manufacturing districts. Sir Andrew Halliday, who worked out this interesting problem in 1828,[20] selected as his twelve non-agricultural counties--Cornwall, Cheshire, Derby, Durham, Gloucester, Lancaster, Northumberland, Stafford, Somerset, York (West Riding), and Warwick, which contained a population at that time of 4,493,194, and a total number of 3,910 insane persons, or one to every 1,200. His twelve agricultural counties were Bedford, Berkshire, Bucks, Cambridge, Hereford, Lincoln, Norfolk, Northampton, Oxford, Rutland, Suffolk, and Wilts, the total population of which were 2,012,979, and the total number of insane persons 2,526--a proportion of 1 lunatic to every 820 sane. Another significant fact elicited was, that whilst in the manufacturing counties the idiots were considerably less than the lunatics, in the rural counties the idiots were to the lunatics as 7 to 5! Thus the Hodges of England who know nothing of the march of intellect, who are entirely guiltless of speculations of any kind, contribute far more inmates to the public lunatic asylums than the toil-worn artisans of Manchester or Liverpool, who live in the great eye of the world, and keep step with the march of civilization, even if they do but bring up its rear. Isolation is a greater cause of mental ruin than aggregation--our English fields can afford _crétins_ as plentifully as the upland valleys of the mountain range, seldom visited by the foot of the traveller; whilst, on the other hand, in the workshop and the public assembly, "As iron weareth iron, so man sharpeneth the face of his friend."