LUNATIC ASYLUMS. (continued 2)

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 33¼ 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 26⅓ 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

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.”

If we required further proof of the groundless nature of the alarm that mental activity was destroying the national mind, we should find it in the well-ascertained fact that the proportion of lunatics is greater among females than males. It may also be urged that Quakers, who pride themselves on the sedateness of their conduct, furnish much more than their share; but for this singular result their system of intermarriage is doubtless much to blame. Still the fact remains, that within a period of eight years, extending from 1847 to 1855, an increase of 64 per cent. took place in our pauper lunatic asylums. These figures, however, afford no more proof of the increase of pauper lunatics than the increase of criminal convictions since the introduction of a milder code of laws and the appointment of the new police afford a proof of increased crime. As the commissioners very justly observe, medical practitioners of late years have taken a far more comprehensive as well as scientific view of insanity than formerly; and many forms of the disease now fall under their care that were previously overlooked, when no man was considered mad unless he raved, or was an idiot. But the great cause of the increase of lunatics in our asylums is to be ascribed to the erection of the asylums themselves. With the exception of three or four Welsh counties, and two or three in the north of England, there is not a shire in England which does not possess some palatial building. These establishments, in which restraint, speaking in the ordinary acceptance of the term, is unknown, and in which the inmates are always treated with humanity, have drained the land of a lunatic population which before was scattered among villages or workhouses, amounting, according to the computation of the commissioners, to upwards of 10,500—just as the deep wells of the metropolitan brewers have drained for miles around the shallow wells of the neighbourhood in which they are situated. For the same reason the number of lunatic paupers has declined in registered hospitals since 1847 from 384 to 185, and in “licensed houses” from 3,996 to 2,313. Upon the whole, we may safely predict that, when these disturbing causes have ceased to act, the annual returns of the commissioners will show that, as the treatment of insanity is every day better understood, so the pauper lunatics in our public asylums, instead of increasing in a ratio for beyond that of the general population, show a diminished proportion. Already there are symptoms that the flood is returning to its proper level; for while the lunatics of all classes in the public asylums, licensed houses, and in the Royal Hospital at Haslar, were 20,493 in 1855, they had only advanced in 1856 to 20,764, which is an increase in the twelvemonth of but 271.