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THE CARE OF THE INSANE 
 
 AND THEIR 
 
 LEGAL CONTROL 
 
THE 
 
 CARE OF THE INSANE 
 
 AND THEIR 
 
 LEGAL CONTROL 
 
 JOHN CHARLES BUCKNILL 
 
 M.D. LoND., F.R.S. 
 
 Fellow a-id Censor of t/te Royal College of Physicians ; Late T.07-d Chancellor's Visitor of 
 J.jaiaiics; a Visiting Justice of the Warwickshire Connty Lunatic Asyhijn ; anda Governor 
 of BethUm Hospital ; formerly Medical Superintendent of the Devon Cojaity Lutiatic Asyhini ; 
 Hojiorary Me772ber of the Aynerican Associati07i of Medical Stiferintende7tts of Asyht77is 
 and of the Societe M edico-Psychologigne of Paris ; P7'eside7it of the British Medico-Psycho- 
 logical A ssociatio7i i7i iS6o; Lu7>ileia7i Lecturer oti the Law of Insanity in iSyS ; Joi7tt- 
 Editor of "■ Brai7t^' and forf7ierly Editor of " The Jourjial of Medical Science;" Joi7tt- 
 Awthor of " The Ma7Z!ial of ' Psychological Medici7te," and Author of " The Mad Folk of 
 Shakesfea7-e," " The Sugde7i Prize Essay 07i Crimi7ial Resfi07isihility," " Notes on American 
 Asylu7ns-," " Habitual Drunke7i7iess and Insane D7'U7ika7'ds,'' &•(. 
 
 MACMILLAN AND CO 
 
 i8So 
 
 The Right of Translation and ReJ>rodtiction is Resen:ei 
 
LONDON : 
 
 R. Clay, Sons, and Taylor, 
 
 BREAD STREET HILL, E.G. 
 
PREFACE. 
 
 The following pages contain the articles, revised 
 and enlarged, on Lunacy Law Reform which ap- 
 peared during the course of last year in the British 
 Medical Joiwnal. They are reprinted partly in 
 answer to an objection which has repeatedly been 
 made by the proprietors of private lunatic asylums 
 to their arguments, that they were of little weight, 
 seeing that they were anonymous ; and partly 
 because the subject with which they deal has been 
 announced by the Government as one demanding 
 immediate legislation. The objection taken to the 
 articles because they were in the first instance 
 published anonymously was perhaps a fair feint to 
 use against them ; but their authorship from the 
 first has not been a secret, and as in these pages 
 opinions are expressed which must seem to need the 
 authority of special knowledge, the medical profession 
 at large has a right to be assured by whom they are 
 propounded ; and the Author in this republication 
 not only declares his responsibility, but the earnest- 
 ness and sincerity with which he entertains the 
 opinions thus put forward the result of a very varied 
 
vi PREFACE. 
 
 experience of thirty-nine years, during which he has 
 enjoyed the largest opportunities of observing the 
 care and treatment of the insane in every part of 
 the country, both in pubHc and private asylums and 
 in domestic hfe. The Author cannot expect that in 
 questions so debatable and debated, and involving so 
 many personal interests as those which he has here 
 discussed, but that his opinions will be warmly con- 
 troverted, and he is too well acquainted with the vis 
 inertics of established systems to believe that they 
 will be readily adopted. But if they only hasten 
 the inevitable hour when the public will declare that 
 the most helpless and pitiable of their fellow-subjects 
 shall no longer be confined and detained as a pro- 
 fitable private business, and if they only lead this 
 great open profession of medicine to question the 
 right by which it permits a most important class of 
 diseased persons to be sequestered from its care, the 
 publication of these pages will not have been in vain. 
 The Author owes some explanation to two classes 
 of persons for the freedom with which he has stated 
 his opinions. In the first place he has to express his 
 regret that he has been compelled to include in that 
 which may appear a general censure those medical 
 men who are as honestly engaged in the treatment of 
 mental diseases, even in private asylums, as medical 
 men in any other sphere of their art and science. The 
 Author, well knowing that there are such men, has 
 always felt sympathy for them, and it was of these he 
 was thinking when before the Select Committee of 
 1877 he declared that he should be very sorry to see 
 all private asylums abolished. But a few personal ex- 
 ceptions ought not to bate the breath of needful criti- 
 cism applied to a system intrinsically and generally 
 
PREFACE. VII 
 
 bad. And it is improbable that any legislation will 
 interfere with the legitimate work of the true physi- 
 cian. Rather is it likely to reinstate him in his right 
 sphere of dignity and usefulness if he should have 
 wandered from it by becoming the keeper instead of 
 curer of diseased persons. Those physicians who 
 are really skilled in one of the most difficult depart- 
 ments of the medical art, the treatment of mental 
 disease, need scarcely fear that legislation will ever tie 
 their hands as physicians. Nor is it likely that the 
 common or statute law will prevent them from keep- 
 ing private hospitals for willing and consenting 
 patients. It is in their character of custodians, and 
 in their association with capitalists and speculators in 
 the business of confining and detaining the inmates 
 of these institutions against their will, that physicians 
 engaged in the treatment of the insane must expect 
 to be criticised by their professional brethren and by 
 the public, and controlled by the law and its officers, 
 without much regard to that professional dignity of 
 which they have not themselves been too careful. 
 
 The Author also admits the debt of an explanation 
 to the Earl of Shaftesbury and to the Board of 
 Commissioners in Lunacy, over which his lordship 
 has presided since its establishment in 1845. When 
 we read the well-authenticated descriptions of what 
 lunatic asylums were when Lord Shaftesbury com- 
 menced his herculean task of cleansing them ; when 
 we think of his steady application to the labour of 
 reforms, and to the more irksome labour of main- 
 taining the good ground gained from relapse into 
 the evil from which it had been won ; when we 
 think of the mere routine of official duties in behalf 
 of those who could not repay them even by thanks, 
 
VI n PREFACE. 
 
 and of the unofficial work in season and out of 
 season, in the House of Commons and the House of 
 Lords, in offices and committee-rooms, everywhere 
 but in place ; and when we think of the genius and 
 eloquence and power of the man who has devoted 
 himself to this life-long labour, it is but very little 
 to say that every one, whether interested or not in 
 the well-being of the insane, must reverence such an 
 example of unweariness in well-doing. 
 
 " PrEesenti tibi maturos largiinur honores." 
 
 But the task which Lord Shaftesbury has carried 
 thus far is one which can never be perfected until the 
 art and science of medicine have reached their 
 extreme limits; and in challenging the interest and 
 co-operation of all who are able to understand the 
 wants of the insane, and to assist in ameliorating 
 their condition, he himself invites criticism of the 
 past and suggestions for the future. This free 
 mindedness with regard to outside criticism is the 
 truest wisdom, and nothing can be more unwise 
 than the opposite feeling, so common in official 
 circles, that it must be right because we have done 
 it, and what you say against the laws which we 
 administer you say against us — the old " fallacy of 
 authority," as it was denounced by Bentham. It 
 is an error to which the least experienced and 
 thoughtful officials are most liable, but a man with 
 Lord Shaftesbury's vast experience and wide grasp 
 of principles, a statesman more than a politi- 
 cian, and above all a social reformer, must recognize 
 that there is no finality in the march of science 
 applied to such a subject as the care and treat- 
 ment of the insane. The last Parliamentary inquiry 
 
PREFACE. IX 
 
 into the operation of the Lunacy Laws may have 
 been hasty and premature in its inception as it 
 was long drawn out and superficial in its course. 
 But, protracted as it was, the witnesses examined 
 were by no means all those who were necessary 
 for the purpose of obtaining full and true answers 
 to the interrogations of Parliament ; for persons 
 with the temper of martyrs are scarcely those 
 who are least likely to have been insane ; although 
 persons who have been insane and know it are the 
 least likely to come forward publicly after their 
 recovery to complain either of undue detention or 
 of ill-treatment. No one was content, and the sub- 
 ject was not even shelved, although the impression 
 went abroad that such was the intention of the re- 
 port ; the inevitable result being that the feeling of 
 the public has since become more uneasy and dis- 
 trustful even than before. Nor was this unnatural, 
 seeing that the one thing really proved in the tedious 
 inquiry was the existence of great differences of 
 opinion on the more important questions between 
 Scotch Commissioners and English Commissioners 
 in Lunacy, and between the latter and the Lord 
 Chancellor's visitors. And there seemed to be little 
 consistency anywhere except among the proprietors 
 of private asylums, who defended their interests with 
 courage and ability, and the solidarity generated by 
 a common danger. 
 
 The origin, action, and conclusions of this Select 
 Committee, from the terms of its appointment to 
 the comments of the Commissioners in their last 
 report, are singularly loose and illogical, as if every 
 one who touched the subject was bound to become 
 a little incoherent. The reference was " To inquire 
 
X PREFACE. 
 
 into the operation of the Lunacy Law so far as 
 regards the security afforded by it against Violations 
 of Personal Liberty." But the very object of the 
 Lunacy Law is to authorize violations of personal 
 liberty, under certain circumstances and formalities. 
 Under this strange reference the Select Committee 
 proceeded to investigate, (i) The possibility of im- 
 prisonments under the false allegation of lunacy ; 
 
 (2) Of restraint calculated to retard cure ; and 
 
 (3) Of undue obstacles to release when sanity has 
 been restored. They never proposed and they never 
 attempted to investigate the more difficult but vastly 
 more important questions as bearing upon violations 
 of personal liberty, whether harmless lunatics are not 
 unduly deprived of liberty, or whether undue obstacles 
 are not opposed to the release of persons who are 
 almost restored to sanity. They started with that 
 stereotyped prejudice that a lunatic is a lunatic and 
 an asylum the best place for him ; and they con- 
 cluded, "assuming that the strongest cases against 
 the present system were brought before them, alle- 
 gations of mala fides, or of serious abuses, were not 
 substantiated." That is to say, they did not find 
 what they could admit to be abuses according to 
 the rules they had laid down. The whole commu- 
 nity might have influenza, but if cholera and the 
 plague were absent there was no need for anxiety. 
 Upon this conclusion, however, the Commissioners of 
 Lunacy in their 33rd Report published last August, 
 remark that "such language, guarded though it 
 be, is, we repeat, not unsatisfactory to us, on whom 
 necessarily rests much of the responsibility for the 
 due administration of the Lunacy Law," and so 
 for the present the matter is supposed to rest ; 
 
PREFACE. XI 
 
 with a few suggestions of change in the law made 
 by the Commissioners, which are certainly not of 
 that radical sort which they " are not disposed to 
 advocate." They are quite satisfied that the " pre- 
 sent system of certification affords ample safeguards 
 as well against the admission of persons of sound 
 mind as from the discharge of the insane patients 
 without undue detention." How the system of cer- 
 tification provides for the discharge of patients at all 
 is not explained, but it appears that it does so, and in 
 a manner with which the Commissioners " are quite 
 satisfied." Still the medical certificates are '' certainly 
 susceptible of improvement." It has long been the 
 practice of the Commissioners to require that the 
 names of persons furnishing facts indicative of in- 
 sanity not observed by the certifier himself should be 
 given on the certificate. The Author has pointed out 
 that this most important requirement is merely a 
 regulation of the Commissioners, and that disobedi- 
 ence to it would not invalidate a certificate ; and the 
 Commissioners now very properly declare that " we 
 should be glad to have both names and addresses 
 under a statutory requirement in all cases." As to 
 the orders for Reception, the Commissioners suggest 
 the substitution of the word "authority" for "order" 
 They think it undesirable that this authority should 
 be given by a friend, acquaintance, or a servant, 
 unless no relation can be found, which fact should be 
 stated, and they suggest that the authority for re- 
 ception should contain an undertaking by the person 
 signing it to visit the lunatic either personally or by 
 deputy once in six months. Another alteration is 
 suggested, the need of which the Author was made 
 aware of in his capacity of Visiting Justice to the 
 
Xll PREFACE. 
 
 Warwick Asylum, to which institution all the pauper 
 lunatics from the Coventry Union were certified and 
 sent by a comfortable official clique of union officers, 
 namely, the relieving officer, the union doctor, and 
 the union chaplain. The Commissioners propose to 
 erase this blot by making it a condition of the 
 validity of an order signed by an officiating clergy- 
 man and relieving officer that 'notice should have 
 first been given to a justice, and that it should be 
 stated in the order why the justice could not act. 
 
 In defence of proprietary lunatic asylums, the Com 
 missioners declare respecting the " incarceration of 
 sane persons, or the prolonged detention for cor- 
 rupt motives of insane persons who have entirely 
 recovered their reason, under the strict super- 
 vision and the safeguards which the Lunacy Acts 
 provide no such abuses are possible." But these 
 assurances do not meet the allegation that " the 
 temptation exists to keep profitable patients longer 
 than necessary," and the assertion that no cases of 
 undue detention were discovered is not easily re- 
 concilable with the evidence. • The Commissioners 
 explicitly admit that the keeping of private asy- 
 lums is a business when they urge that persons so 
 employed " are competing with each other and with 
 the hospitals in a business which, to be remune- 
 rative, must be conducted on principles of ordinary 
 prudence and common honesty." No doubt there 
 is a rivalry as to who shall get the patients, but 
 is there any rivalry as to who shall discharge them ? 
 A discharged patient is like a dead customer, and the 
 rivalry of cures is an argument which can scarcely 
 be discussed seriously. In the first place the value 
 of the statistics of cures in proprietary asylums is 
 
PREFACE. Xlll 
 
 problematical, for there is no compulsion to ticket a 
 man rightly whose friends decide upon removing 
 him ; and there is no inducement, as in county 
 asylums, to avoid discharging patients as cured lest 
 they should speedily return to betray a blundering 
 diagnosis. What becomes of the patients discharged 
 from licensed houses, who can tell ? Not the Commis- 
 sioners, certainly, for Lord Shaftesbury says that in 
 one year 131 patients to whom the Commissioners 
 had given leave of absence from metropolitan asylums, 
 " never came back ; we never inquired after them ; we 
 were glad they did not return to the asylum." [Ques- 
 tion 1 1,278]. A pauper patient uncured is almost sure 
 to be brought back to an asylum because he cannot 
 earn his living, but a patient who is removed from a 
 private asylum uncured may remain out supported 
 by his means or his friends. If the Commissioners 
 do not know what becomes of patients discharged on 
 trial from their asylums, still less can they know any- 
 thing of those who have been ostensibly discharged 
 cured. And if the statistics of private asylums are 
 so unreliable, of what weight is the Commissioners' 
 argument that " every cure becomes the best adver- 
 tisement of the establishment in which it is effected .-*" 
 Lord Coleridge upset this argument from the bench 
 by getting a Commissioner as a witness to admit 
 the great desire of the friends of lunatics to keep 
 the calamity secret, a desire which was even aug- 
 mented in case of cure, and the Commissioners' 
 reply that the number of cures was known does not 
 apply to the language of their Report, which speaks 
 of "every cure that can be shown becomes, in fact, 
 the best advertisement." " That the licensed houses 
 supply at present a social want " may well be admitted 
 
xlv PREFACE. 
 
 seeing that no earnest effort has yet been made to 
 " substitute other and better establishments," but the 
 doubt expressed that asylums erected at the public 
 cost " would not be more acceptable to the friends 
 of wealthy patients than the hospitals, which do not 
 receive many lunatics of large fortune," is scarcely 
 worthy of a public board taking a large view of the 
 policy most advantageous for the whole community. 
 If the friends of lunatics of large fortune no longer had 
 the opportunity of locking up such lunatics in houses 
 competing with each other in a remunerative business, 
 if they should be so prejudiced as to dislike asylums 
 erected at the public cost, they would still have the 
 alternative of employing the lunatic's wealth in 
 placing him in an establishment of his own as a 
 single patient, an alternative which the Lord Chan- 
 cellor would be very likely to insist upon, unless the 
 lunatic of large fortune was, in some way or other, 
 restrained from his beneficial jurisdiction. 
 
 Without considering for the moment that greater 
 evil which arises from " the temptation to keep pro- 
 fitable patients longer than necessary " in houses 
 where a remunerative business is carried on, it is 
 surprising that the Commissioners do not seem to 
 recognize the burthen of excessive payment in behalf 
 of lunatics in private houses which falls upon the 
 inmates and their relatives ; for there can be no 
 doubt that the average payments in a hospital are 
 50 per cent, less than the payments for equivalent 
 accommodation where it can be obtained in a private 
 asylum. 
 
 It was urged at the discussion on the Author's paper 
 on Private Asylums read before the British Medical 
 Association that the secrecy which obtained in 
 
PREFACE. XV 
 
 proprietary asylums with regard to their inmates was 
 a great inducement to the friends of hmatics to place 
 them in these institutions ; but the Author replied 
 that there certainly was no more secrecy in proprietary 
 asylums than in hospitals for the insane, both insti- 
 tutions being visited officially by governors or visitors, 
 and the officials of the one being as much under the ob- 
 ligation of secrecy as the proprietors of the other, and 
 that one curious inducement not to desire secrecy does 
 not exist in public establishments which is sometimes 
 seen in operation in the private houses, namely, that 
 the presence of some distinguished inmate becomes 
 known as a kind of advertisement. To both places 
 the observations of Lord Shaftesbury apply : — 
 
 " Some persons might be afraid that these [hospitals 
 for the insane] would lead to publicity, and destroy 
 the privacy which they now seek. But I really, do 
 not believe that that result would at all take place. I 
 do not see that there would be the slightest publicity 
 greater than there is now. Many persons whose 
 families are afflicted with lunacy think that they are 
 keeping the fact in entire privacy ; but it is an error. If 
 there is an insane relative in any family it is invariably 
 known. The world may not know where he is ; but 
 no family ever succeeded in suppressing a knowledge 
 of the fact that there was a mad member connected 
 with it." [Question 556. 1859]. 
 
 Hospitals for the insane, therefore, such as we 
 have among us at Northampton, Cheadle, Gloucester, 
 Nottingham, Leicester, Stafford, York, Exeter, &c., 
 with at least equal privacy as regards the individual 
 patients, afford equal or superior accommodation 
 and treatment for half the cost of that to be had in 
 proprietary asylums ; and their salaried officers are 
 
XVI PREFACE. 
 
 under no " temptation to keep profitable patients 
 longer than necessary." These form a class of insti- 
 tutions so different in most important respects to 
 proprietary asylums that we cannot understand Lord 
 Shaftesbury's opinion that the latter " vie with them 
 perfectly." That any one of them " in the hands 
 of a weak committee might easily be worked so as 
 to become an establishment mainly for the per- 
 sonal benefit of the resident staff" is undeniable, 
 and the suggestions which the Commissioners have 
 made for the improvement of the laws respecting 
 those institutions are highly commendable. One 
 most important suggestion, however, may be added, 
 namely, that the central authority in lunacy should 
 have the power at any time of nominating a certain 
 proportion of the members of the governing body, 
 and of filling up vacanies occurring in that body 
 which are left unfilled. Moreover an official audit of 
 accounts should be exacted, ' These remarks apply 
 to the existing hospitals, which have been founded 
 by the benevolent efforts of a former generation, 
 and which do not seem likely to be repeated ; 
 and the Commissioners very prudently decline to 
 predict whether Parliament or the country would 
 authorize a compulsory charge on the county rate to 
 multiply such establishments at the present time. In 
 1859 Lord Shaftesbury earnestly recommended that 
 this should be done, in his admirable evidence from 
 Questions 507 to 562, but the Committee in their 
 Report, while acknowledging "the great deference 
 which is due to Lord Shaftesbury's opinion," came to 
 the conclusion that "the apprehension of a burthen 
 to be imposed upon the [county] ratepayers would 
 render such an enactment inoperative ; and they 
 
PREFACE. XVU 
 
 cannot recommend the establishment of them upon 
 a compulsory system," 
 
 The Select Committee of 1877 came to a different 
 conclusion, adopting the moderate opinion of those 
 witnesses who, looking forward to the time when there 
 would be sufficient accommodation for all classes of 
 the insane in public institutions, believed that there 
 would be no demand for licensed houses for the upper 
 and middle classes through the spontaneous action of 
 the public in removing the inmates of such houses to 
 the public institutions, and the Committee " suggest 
 that legislative facilities should be afforded, by enlarge- 
 ment of the powers of magistrates or otherwise, for 
 the extension of this system," to wit, of public institu- 
 tions for the insane of the upper and middle classes. 
 Such appears to be the meaning of the involved 
 paragraph in which this Committee have conveyed 
 their conclusions and suggestions on the most im- 
 portant question, whether or not the licensed houses 
 ought to be left in possession, or suddenly abolished, 
 or gradually suppressed. The verdict is adverse to 
 them, and the sentence is suppression by supercession. 
 
 It is of minor importance how the supercession 
 shall be effected ; whether by the operation of the 
 magistrates and the county rates, or " otherwise," 
 as the Author believes to be best. But it may be 
 observed in passing that the county-rate scheme 
 did not commend itself to the older Select Com- 
 mittee of very able and practical men. There are 
 many counties in which a hospital for the insane of 
 the middle and upper classes is not at all wanted, 
 either from lack of patients or because they already 
 possess an institution of the kind. In others a 
 compulsory measure would be felt to be oppressive, 
 
XVlll PREFACE. 
 
 and voluntary legislation would be inoperative. More- 
 over county hospitals for the insane -would probably 
 be of one type, like county asylums ; whereas hos- 
 pitals established in the first instance, as the Author 
 proposes, by Government, might be, and ought to be, 
 of different kinds and capacities ; some for the insane 
 of small means, others for " those lunatics of large 
 fortune " who so much influence the opinion of the 
 Commissioners in favour of the present system. But 
 whatever the authority and the source of supply 
 fixed upon for the work, it is essential that the legis- 
 lative enactments should not be of that kind of 
 bastard law which is called permissive, and which 
 cannot in such a matter but lead to delay and mis- 
 management and disappointment. No one can well 
 be more opposed than the Author to interfering and 
 unnecessary legislation outside the proper functions 
 of Government ; but surely if anything beyond the 
 defence of the country and the punishment of crimes 
 does come within the proper function of Government, 
 the provision of means by which persons who have to 
 be incarcerated for long periods shall be properly in- 
 carcerated will come within the most stringent limit 
 of right and needful State duty. If the State is right 
 in undertaking the imprisonment of a man who has 
 commiitted an offence, on what ground would it be 
 wrong in undertaking the imprisonment of a man 
 whose liberty would be dangerous to the community .'* 
 If lunatics might legally be imprisoned for other 
 reasons than safe keeping, say for medical treat- 
 ment for themselves, or for the comfort of other 
 persons, the duty of State interference would not be 
 so obvious. But the legal justification being danger, 
 it would scarcely seem to admit of question that the 
 
PREFACE. X.1X 
 
 State ought to provide officers and places of deten- 
 tion whereby the security of the public nnay be 
 ensured by restraining the liberty of individuals. 
 Lunatics who, being dangerous to themselves or 
 others, refuse to be forcibly deprived of their liberty, 
 ought only to be confined in State asylums, while 
 space and range enough might be left in licensed 
 houses of the very highest character, which Lord 
 Shaftesbury is so anxious to preserve, for harmless 
 patients who are voluntary inmates. The public are, 
 perhaps, not fully aware of the extent to which the 
 residence of the inmates in two or three of the best 
 asylums is already voluntary.^ The proprietor of 
 two of these places has recently published his 
 success in abolishing locked doors throughout his 
 two asylums, the result being that "there have been 
 no attempts to escape, and, what is more curious 
 to remark, those patients who used formerly to stand 
 near the doors on the watch for a chance have now 
 given up the habit. Many whose intellect is but slightly 
 or only occasionally impaired, and many others who 
 have been discharged recovered, have expressed the 
 immense sense of relief they have experienced from 
 the change." In conjunction with this open-door 
 system of management, the enhghtened. proprietor of 
 these private asylums " advocates in every instance 
 where it is possible the plan of voluntary seclusion,." 
 i.e. residence. A considerable numter of his patients 
 are residents on their own application; under the proviso 
 that they shall be discharged three days after making 
 another application to that effect, and the system 
 "has been most beneficial in cases in which the mental 
 aberration is only partial," as "the relations of the 
 1 Report on Saughton Hall and Balgreen Asylums, 1S79. 
 
 b 2 
 
XX PREFACE. 
 
 patient are necessarily of a more assuring character 
 than in the ordinary confinements under order and 
 medical certificates." " It is in any way the most 
 comfortable method of dealing with a certain class 
 of cases. It certainly fulfils most thoroughly all the 
 conditions of treatment based on non-restraint." Two 
 large as3'lums for paupers, also in Scotland, are con- 
 ducted on this open-door system, and the principle has 
 long been acted upon, as far as English laws permit, 
 in the excellent ]\Ianor House Asylum at Chiswick. 
 It is interesting to observe that a great authority on 
 the principles of law, Professor Amos, in his recent 
 ■work, Fifty Years of the English Constitution, ex- 
 plains the anomalies of practice in the law afi^ecting 
 lunatics upon the supposition or legal fiction that 
 a certain amount of assent on the part of the 
 lunatic is attained, or reasonably assumed to the 
 aggressions made upon him for his own protection 
 (p. 460). But vrhen such things are being done and 
 becoming known, how much longer can the authorities 
 uphold the wooden system of treating all lunatics 
 alike ? How long will the manufacture of " asylum- 
 made lunatics " be permitted to continue for the support 
 of a remunerative business .^ How long will morbidly 
 sensitive minds be subjected without dire necessity to 
 trials which even the strongest cannot endure without 
 danger and disaster } Lord Shaftesbury, speaking of 
 the number of medical men and attendants who 
 become insane under the strain of associating with 
 lunatics, says, " The Committee can well imagine 
 what it must be to be perpetually in the presence of 
 lunacy, some of them in the most excited state, and 
 some most despondent, and never hardly to pass a 
 night in which they are not disturbed ; it has the 
 
PREFACE. xxi 
 
 most lowering and most miserable effect upon the 
 nervous system." [Question 781.] 
 
 Can it be wondered at, if such be the effect upon 
 stout and insensible minds that the '^ aninuda blandiila 
 vagida " of lunacy, introverted by such associations 
 should shrivel and perish? Even in the vast alms- 
 house establishments where public thrift must deal on 
 the most economic terms with the ever-increasing 
 multitude of our destitute insane, great care ought to 
 be taken that this danger is averted as much as possi- 
 ble by skilful classification and dispersion, and in this 
 direction the Author has long laboured by means of 
 the system he introduced of isolated and cottage 
 wards. But after all a congregation even of pauper 
 lunatics is a great, though doubtless an unavoidable 
 evil, while a system which compasses the herding 
 together of lunatics of large fortune, or even of com- 
 petent means, for any purpose but the important one 
 of public safety, is but a mouldy method of routine 
 and prejudice. For opulent patients certainly, the 
 smaller the asylum is the less the objection to it, 
 and one would have thought that in the interests of 
 the insane no objection could have been taken to 
 the asylum recently licensed by the Sussex magis- 
 trates for four male patients, " well situated in a 
 fine country, and standing in grounds of 100 acres, 
 the house containing good and well-proportioned 
 rooms." But the Commissioners "are averse from 
 the multiplication of houses licensed for three or 
 four patients. They supply no urgent demand and 
 cause great waste of public time in the visitation 
 which they entail." 
 
 What reception then can the Author expect from the 
 Commissioners forhis opinion that for harmless lunatics 
 
xxii PREFACE. 
 
 of large fortune, or even of competent means, asylums 
 licensed for two or three inmates, or still better well- 
 regulated domestic life as single patients, are infi- 
 nitely preferable both for curative treatment and for 
 happiness. Fortunately the Author can point to the 
 single-patient system, as carried out under the autho- 
 rity of the Lord Chancellor, with untold blessings 
 to the great majority of those who enjoy it, and with- 
 out regard to the great consumption of time which is 
 entailed by the visitation of those single lunatics four 
 times a year by the Lord Chancellor's visitors, and as 
 many times by the committees of the person, where- 
 ever the lunatics may dwell. 
 
 Thus it will be seen that the Author's scheme of a 
 reformed treatment of the insane of the upper and 
 middle classes comprises: 1st, the establishment of 
 State asylums no more public than the existing insti- 
 tutions, some for the opulent insane for whom asylum 
 restraint is needful, and others for the less opulent 
 insane for whom asylum restraint and the economy of 
 resources is needful. 2nd, the organization of do- 
 mestic treatment for the quiet and harmless insane as 
 single patients under satisfactory medical management 
 and official inspection. 3rd, the reorganization of 
 the best existing private lunatic asylums and of any 
 new ones for three or four patients, resembling that 
 one in Sussex, which the Commissioners have anim- 
 adverted upon ; the entrance to such asylums to be 
 voluntary, and the detention not to exceed a mode- 
 rate and fixed period after an inmate has given 
 written notice applying for discharge. 
 
 These are no new-fangled notions or visionary 
 ideas of what might be, but has never been, put to the 
 test of experience. Every part of the scheme has 
 
PREFACE. xxiii 
 
 been put to the test of trial, and already exists in the 
 most successful practice. The system of State 
 asylums is general throughout the United States and 
 universal in Holland, having in the latter country 
 been made to replace the old bad system of private 
 asylums by the devoted energy of one man, the 
 great physiologist and philanthropist, Schroeder van 
 de Kolk. In Scotland, moreover, a kindred system 
 exists in the excellent chartered asylums of that 
 country. In our own country also State asylums 
 already exist for special classes of the insane : for in- 
 sane sailors at Yarmouth, for insane Indian servants 
 at Ealing, for persons found insane on trial, at Broad- 
 moor. The second branch of the proposed system 
 exists in excellent organization and success with re- 
 gard to the single Chancery patients, and with little 
 organization or success under the Commissioners who 
 give single patients one visit a year, even that not 
 being required by the statute. The third branch of 
 the proposed system is already in actual operation 
 and approved success in some few asylums, and par- 
 tially in others where the system of voluntary boarders 
 is being tentatively carried out ; and one of the posi- 
 tive recommendations of the Select Committee is 
 that the existing restrictions of the law to voluntary 
 boarders in private asylums should be removed. The 
 whole scheme therefore is new in none of its details ; 
 it is only new in its method and the proposed extent 
 of its application. 
 
 The adoption of this system would carry with it 
 the necessity of large rearrangements, both of classi- 
 fication, including certification, and of official inspec- 
 tion and control. These would, however, seem to 
 be necessary under any circumstances. The present 
 
XXIV PREFACE. 
 
 system of certification cannot be defended. The 
 public are thoroughly distrustful of it, and the medi- 
 cal profession are so alarmed and dissatisfied that 
 numbers of the leading members of the profession 
 are refusing to certify under any circumstances. And 
 if the Commissoners should continue to dwell in their 
 paradise of contentment it may perchance become 
 depopulated through the operation of a general strike 
 among the doctors. 
 
 The rearrangement of official supervision and 
 control is also a necessity which it will be impossible 
 long to postpone. The present system is in the 
 highest degree artificial and makeshift. Every w^all 
 in the edifice has a settlement, and every timber is 
 warped. The oldest and highest of the authorities, 
 that of the Queen's Prerogative, does its work well, 
 barring and excepting the law's cost and delay ; but 
 the work it has to do is but a small portion of that 
 which it would have to do but for purely artificial 
 distinctions which bring one man in complete posses- 
 sion of one thousand and one pounds under its rule, 
 and leave another in the incomplete possession of a 
 thousand times as much outside its jurisdiction. It 
 cannot be true, and cannot be expected to continue 
 as accepted, that out of 70,000 lunatics in the country 
 only one thousand have a right to that royal protec- 
 tion which was intended in the time of King Ed- 
 ward 11. to be thrown over those lunatics whose 
 feudal interests touched the king ; if not indeed over 
 all lunatics Avhom the king as the father of his 
 country was bound to protect. Shall this Magna 
 Charta for the insane dwindle into a solicitor's vade- 
 mecum in the management of choice properties .'' 
 
 It is to be remarked that the Commission in 
 
PREFACE. XXV 
 
 lunacy started in 1845 with the same strength of staff 
 which it now possesses, although the number of 
 insane persons in asylums has increased from 11,272 
 in 1844 to 47,178 in 1879. The visitation also has 
 been largely increased, so that, notwithstanding the 
 Commissioners may have their work more in hand in 
 consequence of the reforms they have effected and the 
 better methods they have introduced, there can be no 
 doubt that their actual work has greatly increased, 
 and that even since i860, when the Select Committee 
 was so desirous to increase the strength of the Com- 
 missioners, either by adding to their number or by 
 the appointment of Inspectors to act under their 
 control. The Committee in that Report expressed 
 the " doubt whether it will be in the power of the 
 Board, as at present constituted, effectually to dis- 
 charge the increased duties to be entrusted to it. 
 But as they collect from the evidence of the chair- 
 man that the Commissioners themselves are of 
 opinion that they could do so without any perma- 
 nent addition either to their number or their staff, 
 your Committee have abstained from recommending, 
 without proof of its necessity, that such additions 
 should be made." 
 
 In 1877 Lord Shaftesbury adhered to his opinion. 
 [Question 11,509], " Notwithstanding that the duties 
 are falling more heavily on the Commissioners every 
 year, you would still prefer that they should remain 
 at their present number and not be increased i* — For 
 the present I am so. I have just suggested that 
 which would give a very great relief, namely, that 
 the visiting magistrates of every district should visit 
 once or twice a year the single patients in their 
 own districts." Moreover, in his evidence in 1859 
 
XXVI PREFACE. 
 
 and i860 Lord Shaftesbury urged upon the Select 
 Committee other alterations of the law, which would 
 have had the effect of giving great relief to the Com- 
 missioners, so that they might effectually discharge 
 their increased duties of visiting asylums. These 
 recommendations were that the Commissioners should 
 be relieved from the duty of visiting the insane in 
 workhouses ; that in future new licenses should only 
 be granted to asylums within easy reach of a railway 
 station, and that Chancery and single patients should 
 only be permitted to reside within the same acces- 
 sible localities, and that the Commissioners should be 
 empowered to employ some one for some weeks in 
 the year to finish up any asylum or single case visita- 
 tion which, under the pressure of business, had not 
 been completed by the Commissioners themselves. 
 None of these recommendations having been adopted 
 either by the Committee or by the legislature, it would 
 appear that Lord Shaftesbury's opinion as to the 
 competency of his Board for the effectual discharge of 
 their duties was qualified by conditions which have 
 not been fulfilled. It has always appeared to the 
 Author that Lord Shaftesbury's great apprehensions 
 that his small and dignified Board might, by any 
 addition to its numbers, be converted into what he 
 calls a noisy parliament, would be groundless under 
 his own strong control or that of any worthy suc- 
 cessor ; but at the present time the influence of 
 his opinion in this matter has secured the great 
 advantage of leaving the ground open for a new and 
 more efficient arrangement. 
 
 Lord Shaftesbury has served through two lunacy 
 periods, from 1828 to 1845, which may be called the 
 period of abuse, and from 1845 to the present time, 
 
PREFACE. • XXVll 
 
 which may be called the period of reform. From the 
 near future another period must commence which 
 may be called that of reconstruction. But it seems 
 impossible to believe that the care of the insane can 
 continue to be controlled by the present entangle- 
 ment of authorities, always costly, and sometimes 
 conflicting ; the old authority of the Queen's Prero- 
 gative, the new authority of the Commissioners in 
 Lunacy, the ubiquitous authority of the magistracy, 
 and the rising authority of the Local Government 
 Board and the guardians of the poor, expressing 
 itself in Caterham and Leavesden, and in Mr. Sclater- 
 Booth's Local Government Bill, for the present with- 
 drawn. A commission is not usually considered a 
 permanent arrangement, and this one in particular, 
 established to deal with temporary evils, stands be- 
 tween two very powerful opposites — the old authority 
 over lunatics with property, and the new one, claim- 
 ing, and certain to obtain, power over lunatics with 
 none. The consideration of the latter point must be 
 deferred to a more convenient season, but seeing 
 that in the combination of pauperism with lunacy the 
 former element is unquestionably the more weighty 
 and pressing one, it would seem clear that the con- 
 trol of the care and maintenance of pauper lunatics 
 must eventually pass into the hands of that central 
 authority which presides over the pauper class gene- 
 rally, and that the guardians of the poor, more or 
 less assisted, guided, and checked by the magistracy, 
 must be permitted to have an active share in the 
 administration of the laws affecting those destitute 
 persons who are insane. When this impending change 
 is completed it will be quite needful that the Local 
 Government Board should comprise persons well 
 
XXVlli PREFACE. 
 
 acquainted with lunacy and the needs of the insane ; 
 and no persons could be more appropriately chosen 
 for this responsible office than some of the gentlemen 
 who now hold office as Commissioners in Lunacy. 
 It will not be difficult to consolidate the laws affecting 
 destitute persons who are insane, and to place their 
 execution under the authority of the Local Govern- 
 ment Board thus strengthened. 
 
 The advisability of this change being admitted, it 
 will be difficult to make any show of good reason 
 why all other lunatics sho'^ld not be placed under one 
 authority, and that of the Queen's Prerogative exer- 
 cised by the Lord Chancellor and the Lords Justices 
 being the oldest, the most powerful, and the most 
 adapted to comprehensive enlargement, there can 
 be little doubt that this is the one which ought to 
 absorb the other. 
 
 The Queen's Prerogative in Lunacy is exercised by 
 the Lord Chancellor and the Lords Justices, by the 
 Registrar in Lunacy and his staff, the Masters in 
 Lunacy and their staff, and the Visitors in Lunacy 
 and their staff. The cost of the three offices, in- 
 cluding pensions, but excluding interest on cost of 
 offices in the Courts of Justice, is as follows : — 
 
 Registrar in Lunacy, £2,21'/. 
 
 Masters in Lunacy, ;^i2,8o5. 
 
 Visitors in Lunacy, ^^8,317. 
 
 The cost of the Commissioners in Lunacy is 
 ;^i8_,i69, making altogether a total of ;^4i,5o8. 
 
 This total, however, does not include any portion 
 of the salaries of the Lord Chancellor and the Lords 
 Justices, although in estimating the whole cost of 
 the central authority in Lunacy it ought to do so. 
 Neither does it include any portion of the cost of 
 
PREFACE. xxix 
 
 the Local Government Board, although that Board 
 and its officers are engaged in the care of pauper 
 lunatics not in asylums. Neither does it include the 
 cost of the medical officers and clerks employed by 
 the visitors of proprietary asylums, nor those costs of 
 the visitation of county asylums which fall upon the 
 county rates. A very large proportion of the visita- 
 tion of lunatics, both public and private, is discharged 
 by the unpaid magistracy, but if the costs of the 
 above-mentioned duties, which are not gratuitous, 
 were to be estimated, and added to the above- 
 mentioned total for the public offices as the whole 
 cost, a total would be arrived at which would pro- 
 bably commend itself as quite a respectable amount 
 even for the efficient discharge of such an important 
 duty as the supervision of the manner in which the 
 insane of all classes are treated and maintained. The 
 system whereby an asylum may be visited at the 
 same moment by the Lord Chancellor's Visitors, the 
 Visiting Commissioners, and the Visiting Justices, is 
 not economical of public time and money. The two 
 former authorities especially are, to say the least, 
 placed in an unmethodical and unthrifty relation to 
 each other. The Author, in his evidence in 1877, 
 refused to admit that there was an antagonism or 
 jealousy between the two Boards of Chancery Visitors 
 and Commissioners, but he was compelled to admit 
 that they were not at all co-operative, and Avhen 
 pressed he referred to an instance in which he. had 
 found a Chancery lunatic very badly treated in a 
 private lunatic asylum. In order to obtain speedy re- 
 dress, and as there was no Committee of the Person to 
 whom to complain, he wrote to inform the Commis- 
 sioners in Lunacy of the facts ; but those gentlemen. 
 
XXX PREFACE. 
 
 instead of exerting their own powers, thought fit to 
 remit the complaint to the Lord Chancellor, which 
 the visitor could more properly have done himself. 
 The result was a rebuke from the Chancellor for irre- 
 gular proceedings. So much the Author had to 
 confess to the Select Committee, who had the right 
 to question him. While feeling himself under the 
 restraint of an old official not voluntarily to mention 
 any circumstances to illustrate his opinions, he is 
 at least at liberty to express the opinion that the two 
 Boards, as at present organized, are not only non- 
 co-operative, but that the two systems, though not 
 the Boards, are antagonistic. 
 
 Under one system no interference with the personal 
 liberty or the civil rights of any subject is even 
 attempted until after a judicial investigation in which 
 the liability to error is rather in the excess of caution 
 and forbearance. Under the other system any one of 
 the Queen's subjects may be deprived of his liberty, 
 captured, confined, and detained, by the proprietor of 
 a licensed house or his servants upon the order of 
 any person whatsoever, either a British subject or an 
 alien, either an adult or an infant, either a relative or 
 a stranger, either an equal in social rank, or a 
 menial substitute ; the only conditions being that he 
 has seen the alleged lunatic within one month of 
 making the order, and that this is supported by the 
 certificates of two men qualified to practise and 
 practising the medical profession. 
 
 Under one system, no person's liberty and civil 
 rights are interfered with unless he has been found 
 by a competent tribunal of unsound mind, and unable 
 to manage himself and his affairs. Under the other 
 s}-stem this question is not ra'sed, but any person can 
 
PREFACE. xxxi 
 
 be indefinitely imprisoned who, in the opinion of two 
 medical men, is a lunatic, or idiot, or person of un- 
 sound mind, and "a proper person to be taken charge 
 of and detained under care and treatment." 
 
 Under one system, a scheme or method of the 
 lunatic's maintenance or mode of life, regarding even 
 minute details, is drawn up in the Master's office and 
 approved by the Lords Justices, and a lunatic with a 
 property of fifty-one pounds a year in possession 
 enjoys the privilege of having it expended to the 
 best advantage under the careful direction of the 
 highest legal authorities in the realm. Under the 
 other system there is no power nor endeavour to 
 provide any system of maintenance or mode of living, 
 and the immediate heir of the largest property may 
 be confined at the lowest rate in the poorest possible 
 asylum. 
 
 Under one system, a lunatic's property is effectually 
 protected from designing and dishonest persons, and 
 he cannot marry or enter into any contract. Under 
 the other system there is no such protection, although 
 many persons with mental infirmity have been in- 
 carcerated in asylums for the purpose of preventing 
 improper expenditure or undesired dispositions of pro- 
 perty. But it does not appear that even confinement 
 in an asylum is any real protection, or that the circu- 
 lar of the Commissioners in Lunacy forbidding the 
 proprietors of asylums to permit their lunatic inmates 
 to sign cheques, deeds, or other documents affecting 
 property, is anything but a well-meant official action, 
 but quite unsupported by any legal authority, and 
 therefore quite invalid. 
 
 Under one system, the lunatic is allowed to enjoy 
 the largest amount of personal liberty which is' 
 
xxxu PREFACE. 
 
 consistent with his own personal safety and that of the 
 public. Under the other system the lunatic's personal 
 liberty is often restrained to prevent civil acts which 
 are not dangerous, and which are not void, but only 
 in his case voidable. 
 
 Under one system, the Lords Justices place the 
 personal charge and care of the lunatic in the hands 
 of the most suitable person they can discover, passing 
 over in this respect the nearest relatives if they are 
 unfit for the duty. They require these Committees 
 of the Person to visit the lunatic, wherever he may 
 be, at least once every three months, and to make a 
 report of the lunatic's condition and treatment ever}'- 
 six months. Under the other system no one in par- 
 ticular has charge of the lunatic, and no relative or 
 friend is required to visit him, although a lunatic 
 lady may be detained in an asylum, even without 
 the knowledge of her husband, until she dies. 
 What power there is remains with that casual person 
 who signs the order. 
 
 Under the one system, the visitors of lunatics are 
 required to report to the Lord Chancellor as to the 
 mental state and bodily condition of each individual 
 lunatic at each visit ; to declare whether or not every- 
 thing is done which can be done for his welfare ; to 
 recommend any change which may seem advisable ; 
 and if he has recovered, to report his recovery forth- 
 with. Under the other system, the visiting Commis- 
 sioners are not required to speak to, much less to 
 exam.ine, every lunatic. They consider that in "a 
 large asylum there are very few cases indeed that 
 require personal conversation. It is right to see them, 
 and see that they are in good bodily condition and 
 properly taken care of, but as to communication with 
 
PREFACE, xxxiii 
 
 them, the larger proportion of them are wholly unfit 
 for it ; they are not open to anything of the kind." 
 [Question 11329, 1859.] As to the diagnosis and 
 report of a. patient's recovery, ''no Commissioner 
 would venture to give an opinion if he were sent for 
 on a sudden, merely saying ' that a patient had re- 
 covered, and we want your opinion as to whether he 
 should not be discharged.' " [Question 413, i860.] 
 
 Under the one system, 34"6 per cent, of the lunatics 
 are under home treatment in private dwellings, and 
 65*4 per cent, in asylums. Under the other system, 
 5 "9 per cent, only of the private patients are under 
 home treatment in private dwellings, and 94* i per 
 cent, are confined in asylums. 
 
 Finally, the one system, rooted in the foundations 
 of the English constitution, is consistent with, and a 
 part of, the law of the land, and it is presided over 
 by the chiefs of the law, who are entrusted with power 
 to make necessary orders and regulations having the 
 force of Acts of Parliament, and the subordinate 
 officers are compelled to act up to, but within the 
 strict limits of, their duty. But the other system is 
 a thing of yesterday, or, more strictly speaking, it is 
 thirty-five years old. It is a Commission established 
 to remedy certain abuses which it has remedied, and 
 which otherwise must have been remedied in some 
 other manner. It is established upon statutes which 
 have been so interpreted as to sanction the incar- 
 ceration of harmless and quiet lunatics in direct 
 opposition to the common law. Beyond the letter 
 of the statutes it is devoid of power, although 
 modifications in the statutes can be made from 
 time to time to suit the system. [Question 11245.] 
 The officials of the system have, nevertheless, been 
 
XXXlV PREFACE. 
 
 compelled to let some powers entrusted to them lie 
 dormant for years, and to assume others which they 
 do not possess, and they have had to make various 
 proposals for large and fundamental changes of official 
 duty. Can there be a doubt which of these two sys- 
 tems is best worth preserving .-' In reality there is 
 no choice, for either the present wasteful system 
 of opening one furrow with two ploughs must con- 
 tinue, or the old Prerogative authority must absorb 
 the Commission, for the reverse proceeding is clearly 
 and absolutely impracticable. The Commission, on 
 the other hand, would be easily and beneficially 
 absorbed into the Lord Chancellor's system, some of 
 the present members of the Commission being trans- 
 ferred to the old Prerogative authority, enlarged and 
 empowered to inspect and protect all insane persons 
 who are not paupers. A serious attempt to realise 
 this idea, with its counterpart relating to pauper luna- 
 tics, would no doubt have been quite beyond the 
 reference of the Select Committee, but would it not 
 be worthy of the great Lord Chancellor who has 
 put his hand to the amendment and consolidation of 
 the lunacy laws .-* The i\uthor earnestly prays that 
 he may be favourably induced so to consider it. 
 
 The great injustice and suffering which to a large 
 extent is inflicted upon harmless and quiet lunatics 
 who are confined in asylums without need, is an 
 arraignment of the present system which can only 
 be answered by a great change. Individual instances 
 of such suffering would appeal more forcibly to 
 the public sentiment than any assertion of the 
 general fact, and Lord Cairns himself has taught the 
 lesson, when, in presiding at the Literary Fund Din- 
 ner last year, to illustrate the difficulty of eliciting 
 
PREFACE. XXXV 
 
 sympathy by abstract descriptions, he appealed to 
 Sterne, who, faiUng to get near enough to the misery 
 of imprisonment by describing it in the abstract, drev/ 
 the Captive in his immortal sketch. And so the 
 orator proceeded to describe the captive as he might 
 be seen " wasted with long expectation and confine- 
 ment, counting the dismal days and nights he had 
 spent, lifting for a moment his hopeless eye, and 
 casting it down in despair, and going on with the work 
 of his affliction." And Lord Cairns proceeded, "If 
 I could show you an individual case, if I could put 
 before you a man of genius, cultivation, and learning, 
 of a sensitive and honourable spirit, devoted and 
 toiling in his profession, and making it the support 
 of himself and of those dependent upon him, and 
 if I could show you such a one struck down for a 
 time by one of those calamities to which we are 
 all subject in health or means ; " and if instances 
 of lunatics were permissible the great statesman 
 might have perfected his simile from that circle of 
 sorrow and suffering. He might have said. If I 
 might in these days show you such a man under 
 circumstances resembling those of Sterne's captive, 
 I should have to take you to the lunatic asylum, 
 and point out that cultivated and sensitive gentle- 
 man, deserted by his friends, who seldom give them- 
 selves any trouble about his condition, perpetually 
 in the presence of lunatics, which has the most 
 miserable and most lowering effect upon the nervous 
 system, under the^ control of rough men of m.enial 
 station, hired at a cheap rate, who use coarse 
 language to him and push him about, [3253 — 3279, 
 1877], wasting with long expectation and confine- 
 ment, counting the dismal days and nights, hopeless 
 
xxxvi PREFACE. 
 
 and in despair ; — thus, he would have painted a 
 picture so touching that he must have moved his 
 audience to a height of pity and resolve that no 
 pains should be spared to limit and confine such 
 misery within the strictest bounds of unavoidable 
 necessity, to prevent the slightest addition to the 
 anguish often inseparable from mental disease, to 
 liberate all insane captives whose freedom would not 
 be dangerous, and to surround those who remained 
 with every safeguard of disinterestedness, humanity, 
 and public responsibility. 
 
CONTENTS. 
 
 Difference between the inmates of the old mad-houses and the 
 modern asylums — The former containing only obvious and 
 dangerous cases of lunacy, the latter containing great numbers 
 of quiet and harmless patients whose insanity it is often difficult 
 to determine . 
 
 II. 
 
 The need of public interest in the management of asylums — The 
 tendency of officialism to maintain existing methods — The 
 difference of duty of the Commissioners and the Visitors of 
 lunatics — Universal complaint of bad treatment in asylums — 
 The English Gheel of opulent limatics, and the comparative 
 happiness of insane persons under domestic care — The inefficient 
 visitation of single patients — Nervous patients^ — Official views 
 
 opposed to medical interests 
 
 III. 
 
 Certificates of insanity and orders of detention — Contrast between 
 those required for a pauper and a not pauper lunatic, the 
 former, less needful of stringency, being the most stringent — 
 Objections to the jealousy of medical men which is shown in 
 forbidding them to act in consultation — Objections to the cer- 
 tificates being the same for all kinds of lunatics in all kinds of 
 treatment — Suggestions for their reform . . 
 
XXXVlll CONTENTS. 
 
 IV. 
 
 Medical certificates should only be evidence upon wMch magis- 
 ti-ates should act — Needful limitations of power of confinement 
 — Power of confinement by relatives — Medical ^^sitation of 
 single patients — Committees of the person — Objections to the 
 order of detention — Objections to the power of capture and 
 confinement given to proprietors of asylums and their servants 
 — Objections to unlimited power of relatives — Advantages of 
 the Scotch procedure — Necessity for magisterial action in the 
 confinement of all lunatics 30 
 
 V. 
 
 The legal justification of confining insane persons is danger — 
 Cases of Nottidge v. Ripley and Fletcher v. Fletcher — Commis- 
 sioners' opposition to the laws of the courts — Commissioners' 
 reasons why insane persons, not dangerous, should be confined — 
 Commissioners not reporting to Lord Chancellor of lunatics 
 with property not duly protected — Commissioners' objections to 
 inquisitions — Casus omissus of law regarding lunatics dependant 
 upon opulent relatives— Scotch definitions of a lunatic ... 46 
 
 VI. 
 
 Dr. Conollj^s denunciation of proprietary asylum?, also Lord 
 Shaftesbury's — Commissioners' satisfaction with these places in 
 1S47 — Their account of mi>doings in them in 1875 — Comrais- 
 sioners' neglect of medical considerations — Lord Shaft esbur)''s 
 evidence in 1859 and in 1877 — Opinions of Lord Ashley, Mr. 
 Lutwidge, Tsix. Gaskell, I\Ir. Wilkes, and Mr. Campbell . . 59 
 
 VII. 
 
 Memorandum to the Lord Chancellor respecting proprietary 
 asylums — Opinions respecting asylums and dome-tic treatment 
 of Lord Chancellor's visitors — Necessity of more individual in- 
 spection of lunatics in asylums — Recovered patients sometimes 
 unduly detained in asylums— Motives for placing patients in 
 asylums — Dr. Mitchell's evidence thereupon — Proposed removal 
 of quiet cases into domestic life 7 6 
 
CONTENTS, XXXIX 
 
 VIII. 
 
 The two projects of reform, Mr. Dillwyn's by buying up pro- 
 prietary asylums, and Lord Sliaftesbury's by establishing com- 
 peting hospitals at the public expense — Objections to purchase 
 of asylums — Proprietary asylums mostly in bad sites, and of 
 bad construction — Different kinds of proprietary asylums . . 
 
 IX. 
 
 The best remedy the establishment of State asylums for the upper 
 and middle classes — Memorandum to the Lord Chancellor on 
 State asylums for Chancery lunatics — Extension of this project 
 — Estimate of numbers to provide for, and of cost — Proposed 
 Parliamentary Commission to establish State asylums . . . 
 
 X. 
 
 Dr. Maudsley's opinions on indiscriminate locking up of insane 
 persons in asylums, on the discomforts of asylums and the 
 tyranny of attendants — Dr. Blandford's opinion that many 
 insane persons are infinitely happier out of asylums, and ought 
 to be removed from them — The late Dr. A. Sutherland's statis- 
 tics of cure under domestic treatment — Mr. Percival's and 
 Dr. Lockhart Robertson's opinions of domestic treatment — This 
 treatment does prevail i a the initiatory stages — Carried on by 
 general practitioners — Exceptions in suicidal and dangerous 
 patients — Absence of medical treatment in asylums — Chronic 
 harsnless patients and Chancery cases in domestic life . . 
 
 XI. 
 
 Grounds on which the medical profession is interested in the 
 management of asylums — Tendency of recent laws to sequester 
 the insane from the care of the medical profession' generally — 
 Difference between ownership in a business and professional 
 engagements — Misleading analogy between the fees of medical 
 men and the profits of asylum proprietors — The late Mr. 
 Wakley's opinion of proprietary asylums — Imprisonment for 
 private profit authorized by no other English law — Difficulty of 
 
xl CONTENTS. 
 
 PAGE 
 
 ascertaining the treatment of patients or their recovery in pro- 
 prietary asylums — Some asylum physicians honourable and 
 disinterested — Medical certificates ought to be statements of 
 evidence merely — The; civU power alone ought to order con- 
 finement — Commissioners ought not to be administrators in, 
 and inspectors only beyond, metropolitan district — Two central 
 lunacy authorities should administer the law severally relating 
 lo destitute and not destitute lunatics — The Board of Commis- 
 sioners in Lunacy should cease to exist, the Commissioners 
 being distributed between the Local Government Board for 
 the supervision of destitute lunatics, and the Lord Chancellor's 
 lunacy offices for the supervision of all other lunatics . . . 121 
 
CARE OF THE INSANE 
 
 AND THEIR 
 
 LEGAL CONTROL. 
 
 I. 
 
 "THE FASHION OF THE TIME HAS CHANGED." 
 
 " Watch what main currents draw the years," says 
 the Poet Laureate ; and one of the strongest now ob- 
 servable is surely, the reform of domestic institutions, 
 which are judged to be inadequate in their working 
 to the humanity, or justice, or economy of the age. 
 It matters not greatly who are the ins and who are 
 the outs of office when the current of opinion sets 
 steadily in the direction of some change which the 
 public conscience demands in the laws regulating the 
 treatment of any class of the community. The change 
 will have to be made. 
 
 For years past, signs have not been wanting — 
 indeed, he who runs may read them without glasses — 
 that the public conscience has been tender and sore 
 as to the customs and laws which the sane majority 
 has sanctioned for what is called the care and treat- 
 ment, but to speak more truly for the custody and 
 
 B 
 
2 CARE OF THE INSANE. 
 
 control, of that which is still fortunately the insane 
 minority of the people. The early history of this 
 matter, even within the present century, is so ghastly 
 and disgraceful, that it may be passed by on the same 
 plea which Macaulay used, to excuse himself for 
 ignoring the early history of the country, namely, 
 that it is one of kites and wolves. Yet the horrible 
 disclosures of the Parliamentary Committees which 
 sat in 1815 and 1845 may be referred to in evidence 
 of the pressing necessity which cried aloud for the 
 earlier legislative enactments. The statutes still bear 
 deep traces of this haste to remedy urgent evils : and 
 this is a point which is well worthy of consideration at 
 the present time. It was like opening an abscess before 
 it was mature, and the wound has become erysipela- 
 tous. Perhaps it is not quite correct to say that the 
 legislation was premature, but certainly it was adapted 
 for a very different state of things from that which 
 now exists, and it came to occupy the place of larger 
 and better measures. In these days a big, ripe, un- 
 complicated abuse has become a rarity, and almost 
 always the legislative doctor has to adapt his remedies 
 to a combination of the disease and the results of 
 previous treatment. This is emphatically the case 
 with lunacy abuses, which, having their original seat 
 in the great ignorance and frequent brutahty of the 
 old-fashioned madhouse-keeper, have been modified, 
 under the treatment of the lunacy laws, into the milder 
 but far more complicated difficulties of the existing 
 complaint. Institutions for the insane have grown to 
 be what they are under the sanction and protection of 
 the law. Our fathers called them Madhouses, and 
 never dreamed but that people obviously mad, and 
 for the most part maniacs, would alone be incarcerated 
 
" THE FASHION OF THE TIME HAS CHANGED." 3 
 
 in them. We call them Licensed Houses for the re- 
 ception of the insane, and many of them are called 
 Retreats, as if residence in them were for the most 
 part voluntary. And the change of name is not un- 
 justified by the change which has taken place in the 
 thing named. We have some accounts of the kind 
 of inmates who filled the few madhouses which existed 
 before the alleviating action of the lunacy laws. It 
 may be that, in rare instances, the rude iniquity of 
 the times might have led to the incarceration of a 
 rufiian who was not mad ; but outrageous madness 
 was the rule, and the detention of patients after they 
 had become tranquil and harmless was against the 
 rule. Nowadays, our numerous asylums swarm 
 with a motley crowd of persons of weak mind or 
 low spirits ; with tranquil and reasonable persons said 
 to be liable to excitement ; with persons said to have 
 suicidal tendencies if they are not always under 
 supervision ; with paralytics and epileptics, and 
 with persons in various stages of mental decay ; no 
 doubt all of them, with very rare exceptions, persons 
 of unsound mind, but not madmen or lunatics, or 
 even insane persons, as our fathers understood these 
 terms. 
 
 Disease of the brain, causing mania, probably pro- 
 duced very much the same symptoms, if let alone, 
 before 1845, as those which it produces now. It was 
 interfered with at that date by means of chains and 
 fetters ; it is often interfered with now by the adminis- 
 tration of hydrate of chloral and bromide of potas- 
 sium, and other narcotic and depressing remedies. 
 But the different treatment of maniacs will not account 
 for the difference existing between the old dens and the 
 new asylums. That can only be the result of a widely 
 
 B 2 
 
4 CARE OF THE INSANE. 
 
 difterent class of inmates, after the largest allowance 
 has been made, as in all justice it ought to be made, 
 for the tranquilizing result of greater care, skill, and 
 humanity. But the point is this — that the law pro- 
 viding that madmen, dangerous to themselves and 
 others, shall be secluded in madhouses for absolutely 
 needful care and protection, has been extended in 
 its application to large classes of persons who would 
 never have been considered lunatics when this legis- 
 lation was entered upon. Since 1845, medical science 
 has discovered whole realms of lunacy, and the nicer 
 touch of a finikin civilization has shrunk from the con- 
 tact of imperfect fellow-creatures, and thus the mani- 
 fold receptacles of lunacy are filled to overflow with a 
 population more nearly resembling that which is still 
 at large. When recognizable lunacy was painted in 
 glaring colours, there Avas little need of painstaking 
 investigation. There is more need for it now that 
 delicate tints of mental unsoundness indicate the 
 " proper persons to be taken charge of and detained 
 under care and treatment," such care and treatment 
 really meaning imprisonment and control ; for of late 
 years the face of authority has been set hard against 
 care and treatment of insane patients out of asylums. 
 Care and treatment do not now mean the watchful- 
 ness and eftbrts of medical men as directed to the 
 cure of other diseases, but they mean the abstraction 
 of a most important class of diseased persons from the 
 wide and catholic interests of the medical profession, 
 to be relegated to the custody, control, and profit of 
 privileged persons, a large proportion of whom do not 
 belong to the medical profession. The situation is en- 
 tirely altered. The old brutalities have become rare and 
 exceptional under the regime of the Commissioners, 
 
" THE FASHION OF THE TIME HAS CHANGED. 5 
 
 and instead thereof another evil has been evolved, 
 and the asylum system in its whole vast extent has 
 encompassed an ever-increasing multitude, numbers 
 of whom might well be enjoying moderate freedom 
 and comparative happiness in their own homes. This, 
 in truth, is the incandescent centre of '' the most 
 burning question of the day," as Mr. E. A. Millar, Q.C., 
 calls " the law affecting the custody and control of 
 lunatics," in his very able address on jurisprudence, 
 read last year before the Social Science Congress. 
 This is the conviction so deeply impressed upon the 
 public conscience, that it has refused to be smoothed 
 out, even by the labours of the Select Committee of 
 the House of Commons. 
 
 It is remarkable, but has not perhaps been re- 
 marked, that almost all the argument which has been 
 put forth in defence of the present most defective 
 system of admission into asylums is grounded upon 
 the assumption that great speed is necessary for the 
 purpose of securing the early and curative treatment 
 of acute cases. It is urged, not without reason, that 
 if " the law's delay," as it was known to Hamlet and 
 is not unknown to us, be allowed to intervene before 
 the incarceration of a lunatic, a precious period of 
 curable disease may be for ever lost ; and if any con- 
 siderable proportion of the unfortunates committed 
 to detention in asylums were recent and curable 
 cases, the argument would to that extent be valid 
 on condition that curative treatment were systema- 
 tically employed in private asylums. 
 
 On this supposition, the greatest possible facility for 
 the committal of lunatics to asylums maybe advocated ; 
 and any medical man on the Register as ignorant of 
 lunacy as he may be of the higher mathematics may 
 
6 CARE OF THE INSANE. 
 
 still be authorized to certify away the liberty of the 
 subject in the most dainty cases of mental diagnosis. 
 Formerly, anyman calling himself a medical man might 
 do this, but his action was almost always confined to 
 acute cases, the nature of which might easily have 
 been understood by a constable, churchwarden, or any 
 other Jack-in-office, and was, therefore, likely to be 
 right and useful. But, if it be true that nowadays 
 a large proportion of persons committed to asylums 
 are not obviously and glaringly mad, it would follow 
 that persons alone who are conversant with mental 
 disease ought to be allowed to testify to their condi- 
 tion ; and if, further, a large proportion of persons 
 committed to asylums are not acute but chronic 
 cases, not, therefore, in any immediate need of cura- 
 tive treatment, it would seem also to follow that the 
 above plea for immediate and facile action without 
 the intervention of the law's delay is not capable of 
 being sustained. 
 
II. 
 
 THE PREROGATIVE OF ASYLUMDOM. 
 
 What is really the matter with those lunacy laws 
 which may be found in Mr. Fry's seven hundred and 
 seventy-one closely printed pages, and which, in their 
 relation to the libert)'- of the subject, have undergone 
 what purports to be a thorough investigation, the 
 record of which may be found in the thick folio of a 
 recent Blue Book .? Mr. Phillips sees little else than 
 perfection in them, and a "great change for the better 
 in the management of asylums " since 1862, "due to 
 our (the Commissioners') activity to some extent, and 
 to the strong public opinion which is always bearing 
 upon the management of asylums." " The public look 
 after these matters much better than they used to do 
 in former times." " I think all inquiry is good." 
 These are gracious admissions on the part of the 
 Commissioner, and should reconcile him to the un- 
 diminished anxiety which the public and the profes- 
 sion still manifest in the administration of the lunac}/ 
 laws, and especially in the management of proprietary 
 asylums. There is a common and natural tendency 
 on the part of officials to become attached to the laws 
 under which they live and move and have their being. 
 
8 CARE OF THE INSANE. 
 
 It is not the good workman who finds fault with his 
 tools ; but the employer surely may both criticise them 
 and the work they effect. The tradition of the Com- 
 missioners in Lunacy has always inclined towards the 
 detention of the insane in asylums, and the tradition 
 of a public office is a very persistent force. They 
 were appointed, in the first instance, to control the 
 misdeeds of asylum-keepers, and their supervision of 
 asylums still comprises almost the whole of their 
 statutory duty. They do, indeed, pay an annual visit 
 to a number of single patients certificated ; but this 
 duty is self-imposed, and it may be said that, if 
 asylums do not exist for the Commissioners, at least 
 Commissioners exist for asylums. Therefore, it is not 
 wonderful that almost all the testimony emanating 
 from the Commissioners' office, which has been given 
 before the Select Committee of Commons in 1877, 
 has had an obvious bias towards the maintenance 
 of that system under which, since the Committee 
 in 1859, the roll of lunatics in asylums (pauper and 
 private), had increased 115 per cent, while the total 
 lunacy in the country during those seventeen years 
 had only increased "jG per cent, the admissions into 
 asylums rising from 4"6 per annum per 10,000 of the 
 population in 1866 to 5 "9 in 1875. 
 
 On the other hand, the tradition of the Lord Chan- 
 cellor's lunacy offices is opposed to the incarceration of 
 any lunatic in an asylum for whom due protection and 
 the enjoyment of life can be provided outside. This 
 tradition, no doubt, has come down from very ancient 
 times ; but modern practice has maintained it, and the 
 experience of to-day justifies the liberty which our 
 forefathers, amid all the abuses of the time, granted to 
 lunatics, who were not frantic or dangerous. The 
 
THE PREROGATIVE OF ASYLUMDOM. 9 
 
 example of Chancery lunatics in domestic life would 
 surely make any man conversant with it question the 
 wholesale need of asylum restraint, and its influence 
 was well expressed by Dr. Lockhart Robertson before 
 the Select Committee, in his reply to Question 1,091 : 
 " Has the opinion you have formed, that it is desirable 
 to remove as much as possible patients from asylums, 
 been based upon the knowledge which you have ac- 
 quired since your appointment as Lord Chancellor's 
 visitor ? — Most wonderfully. I could never have be- 
 lieved that patients who were such confirmed lunatics 
 could be treated in private families in the way that 
 Chancery lunatics are, if I had not personally watched 
 these cases." 
 
 The statute requires the Lord Chancellor's visitors 
 to visit, see, and report upon every Chancery lunatic 
 in domestic treatment four times a year, and every one 
 in an asylum only once a year. As there is usually 
 more than one Chancery patient in an asylum, the 
 visitation of such a patient generally entails no travel- 
 ling and little trouble ; whereas his removal to domes- 
 tic treatment often imposes upon the visitor a long 
 quarterly journey. The law, therefore, offers a strong 
 personal inducement to the Lord Chancellor's visitors 
 to accumulate their wards in asylums, and it is in the 
 teeth of this unintentional bribe to opposite action 
 that the Lord Chancellor's visitors so far encourage 
 domestic treatment, that one-third of their lunatics 
 may be found in mansions, farm-houses, and cottages 
 in such enjoyment of life, that the luxuries of the 
 most showy asylum would be misery to most of them. 
 No doubt some Chancery lunatics under domestic 
 care are ill chosen for it, and others are placed amidst 
 unfavourable surrounding's and with unfit g^uardians. 
 
10 CARE OF THE INSANE. 
 
 The visitors have less power than ought to be given to 
 them, in determining what lunatics need the restraint 
 of asylums and those for whom domestic care is 
 suitable. The affections, the prejudices, and often the 
 selfishness, of relatives interfere too much. Still, 
 there is a broad selection both of patients and of 
 places and persons fitted for their treatment ; or, to 
 speak more accurately, there is the power of unfavour- 
 able report, which in most cases results in right selec- 
 tion — the selection of the fittest and of the richest — 
 although this latter is by no means a constant quality, 
 so that the foot of the visitor treads the threshold of 
 the palace and that of the hovel. In a favourable in- 
 stance, the visitor reports that a Chancery lunatic in 
 an asylum would be secure and happy in domestic 
 life ; to which he may, perhaps, be able to add, that 
 the probability of recovery also would be increased ; 
 and if the change be made, the visitor follows it with 
 his criticism and responsibility, seeing what good or 
 harm he may have done, and trying by his advice to 
 augment the one or to annul the other. This is a very 
 different system to that which the defective state of 
 the law compels the Commissioners to pursue towards 
 patients for whom asylum life may seem to them no 
 longer desirable. Question 1 1,278 indicates this dif- 
 ference: " We gave leave of absence during the year 
 1876 in the metropolitan licensed houses to 614 per- 
 sons : of these, 131 never came back. We never 
 inquired after them ; very glad they did not return to 
 the asylum." In this manner " a great amount of 
 liberation is effected." The Commissioners have not 
 the power to remove a patient who is convalescent but 
 not cured, or any other suitable case, from an asylum 
 into domestic care, nor would they have any practical 
 
THE PREROGATIVE OF ASYLUMDOM, II 
 
 control over his treatment if it were done. Were it 
 otherwise, it is to be hoped there would be a vast 
 addition made to that Gheel of Lord Chancellor's 
 lunatics — scattered, indeed, but existing in our midst, 
 with which the Belgian institution cannot compare, — 
 a system which, imperfect as it is, solves the problem 
 of making the lives of many lunatics comfortable, 
 secure, and, as far as their sad malady will permit, 
 contented, and, strange to say, on the whole, happy. 
 What a comment is their condition upon that fearful 
 but undeniable statement of Mr. Cave (in Question 
 9,660), and the painful reply to it, which amounts to a 
 confession that, with all the improved treatment which 
 the Commissioners have been able to compass, the 
 lunatics under their supervision suffer under a general 
 and miserable sense of injustice. "There is," said 
 the Right Hon. Chairman of the Select Committee, 
 *' an almost universal complaint made by lunatics of 
 bad treatment in asylums. I suppose you hardly ever 
 find any who do not fancy that they did suffer un- 
 justly while they were confined in an asylum." 
 "Almost every insane man," says Mr. Phillips in 
 reply, ''thinks he is sane, and everything connected 
 with his detention as an insane man he looks upon as 
 wrong." 
 
 Every unprejudiced person conversant with asylum 
 life will endorse Mr. Cave's assertion. Every one 
 acquainted with domestic treatment will feel assured 
 that Mr. Phillips's explanation only applies to asylum 
 lunacy, and that it is, to a great extent, the misery of 
 imprisonment which begets the strong sense of wrong. 
 The aversion which most lunatics have to asylums is 
 no doubt not altogether a rational sentiment. But, 
 if we reflect that, with what mind he has left, a lunatic 
 
12 CARE OF THE INSANE 
 
 feels the stigma of detention in an asylum ; that, 
 moreover, the restraint of limited quarters and narrow 
 bounds is irksome to him ; that he resents the in- 
 evitable association of distasteful companions, per- 
 haps not more insane than himself, but different, and 
 therefore offensive ; and, if he be a man of culture 
 and position, that subjection to the men who for low 
 wages accept the duties of attendants, is often felt by 
 him to be unspeakably degrading ; and that to all this 
 may be added the conviction that he is deserted by 
 those who owe him personal care and tenderness, — we 
 shall scarcely need to follow Mr. Phillips in attribut- 
 ing all his complaints and his sense of wrong to insane 
 conceptions. To the lunatic under proper care in 
 domestic life everything is changed. He need feel no 
 brand upon him ; he is a member of an English home 
 circle of sane people who, even in the exercise of a 
 wise selfishness, must strive to make him contented, 
 and who often, by the mere habit of geniality, do 
 make him happy. When patients and guardians are 
 suitable, even the meagre comforts of a cottage home, 
 which would compare badly with the whitewashed 
 spruceness of a workhouse ward, become precious to 
 the weary and wasted mind to which rest and a 
 modicum of sympathy are worth more than all else 
 which a spoiled life can hold. Errors and omissions 
 are of course excepted ; for even among Chancery 
 patients some few are neglected and ill-treated, and 
 some are in domestic life who are ill-chosen for that 
 sphere. But many lunatics are very child-like; and a 
 striking illustration of this subject may be drawn 
 from the beneficial change which has in various places 
 been effected by the system of boarding-out work- 
 house children, who in the workhouses have " a leaden 
 
THE PREROGATIVE OF ASYLUMDOM. 1 3 
 
 hue and sickly look, with inert, cowed, sullen, and 
 morose temperaments," and in whom, according to the 
 testimony of Sir William Johnston, formerly Lord 
 Provost of Edinburgh, such a change is wrought, that 
 " there was hardly a face we could recognize, so healthy, 
 hearty, and changed were they by having breathed 
 the free air and exercised both their bodies and minds 
 amidst their companions in the country." " The un- 
 merited stigma of workhouse-boy does not attach." 
 ''The moral gain cannot possibly be estimated." (See 
 The Boarding-Out System, in Scotland. By William 
 Anderson. Menzies and Co.) Nothing is more 
 hateful to an adult Englishman than to live in an 
 institution. Passing by life in gaols, and even in 
 workhouses, as too harsh a comparison, what has 
 broken up the great national almshouses of Green- 
 wich and Chelsea, but experience of the feeling that 
 Englishmen would rather be pinched in a cottage 
 than pampered in a palace, if the latter implied a 
 crowded life in common. 
 
 Of course, it is understood that the domestic care 
 of lunatics requires constant and careful supervision. 
 Ignorance and indolence are too common in the world 
 not to endanger the good treatment of such helpless 
 beings as lunatics, even by their natural friends and 
 relatives; and when the duties of guardianship are 
 discharged by paid agents, watch and guard against 
 the temptations of selfishness ought, on principle, to be 
 as strictly maintained when a patient is kept for pro- 
 fit as a single patient in a private residence as when 
 he is detained for profit in a licensed house. The lia- 
 bility to detention after the need for it has altogether 
 passed is indeed greatly diminished in the private 
 residence, and the mischief of it diluted ; for, as a rule, 
 
14 CARE OF THE INSANE. 
 
 the single patient is sane or insane in the eyes of his 
 little world, from which the asylum patient is hidden ; 
 and if the former, he being at large be held under cer- 
 tificates somewhat longer than need be, the restriction 
 of liberty is little felt, whereas needless detention in 
 an asylum is the source of profound wretchedness. 
 
 If " patients are put away at a distance to live only 
 with attendants " and subjected to the appearance 
 only of supervision, neglect and cruelty are indeed 
 the jjrobable result ; but this is not what is now under- 
 stood by the domestic care and treatment of the insane. 
 Of the 460 single patients visited once a year by the 
 Commissioners, it would indeed be sanguine to believe 
 that the treatment is always satisfactory ; for the 
 Commissioners have no statutory obligation to visit 
 them at all ; they have no statutory powers to inter- 
 fere with their treatment when they do visit them ; and, 
 except by means of an order obtained from the Lord 
 Chancellor, they cannot even procure the liberation of 
 any of them whom they find to have recovered or not to 
 be insane. The weary work of visiting these 460 single 
 patients, even once a year, by the Commissioners was 
 the subject of urgent complaint to the Select Com- 
 mittee ; and it was somewhat naively suggested that 
 in the country, where the visitation of one such patient 
 often involves the labour of a day and a journey of 
 thirty or forty miles, it should be performed by the 
 justices, who are unpaid, and who get much of the 
 labour and little of the credit of lunacy work through- 
 out the country. When he is wanted, there are few 
 things to which the justice of the peace is not deemed 
 competent, but when he is thought to be superfluous 
 his defects appear. Thus, he is said to be the proper 
 person to undertake the visitation of all the single 
 
THE PREROGATIVE OF ASYLUMDOM. 1 5 
 
 patients in the country ; and yet he is unfit to sign the 
 order for admitting a private patient into an asylum, 
 because he is by no means equal to the deputy-sheriff 
 of a Scotch county, but only " the common magistrate 
 of the county who sits in petty sessions, a man of 
 comparative inferiority." He has to deal with all the 
 difficult cases of private lunacy, the wandering lunatics, 
 the lunatics not under proper care and control, the 
 lunatics neglected or improperly treated ; but to sign 
 or countersign the everyday papers of private asylum 
 lunacy — for that height of responsibility it is declared 
 that his social status and his mental capacity do not 
 fit him. 
 
 The real visitation, however, of single patients 
 under certificates is the statutory visit and report 
 once a fortnight of a medical man (8 and 9 Vic. c. 
 TOO, s. 90). This enactment forms the only substan- 
 tial protection of single patients from ill-treatment ; 
 and it is one of which the profession has the right to 
 be jealous, for it forms its last hold upon a vast class 
 of diseased persons which has for the most part been 
 removed without intention from the immediate care 
 and cognisance of the profession. And this last 
 stronghold also is being undermined ; for, by the 
 statute of 1862, Chancery lunatics, who were formerly 
 subjected to it, were withdrawn from it by an altera- 
 tion of the law which the Lord Chancellor's visitors 
 have been known greatly to regret. Furthermore, 
 strict adherence to this enactment is not always 
 encouraged by the Commissioners, who sometimes 
 recommend, in cases of doubtful fitness, that their 
 powers should be invoked to remit this fortnightly 
 visitation. "When a legal Commissioner recommends 
 the remission of the fortnightly medical visits to a 
 
1 6 CARE OF THE INSANE. 
 
 single patient suffering from general paralysis, whom 
 he has seen in a tranquil period, it is, no doubt, 
 because he cannot foresee that within a fortnight the 
 patient will be in a state of maniacal excitement or 
 recurring convulsions. But this is only a small in- 
 stance of the officialism which overrides the profession 
 in lunacy matters. Let the profession — that is, the 
 members of the profession — ask themselves whether 
 they are willing wholly to resign the treatment of 
 mental disease into the hands of officials and a class 
 of licensed men who carry on the business of board- 
 ing lunatics, of which class only 66 per cent, belong 
 to the profession, many of them no doubt, in spirit 
 and in truth, but many others in such a sense that 
 their medical qualities are hidden under their great 
 economical and financial abilities. Let the mem- 
 bers of the profession at large reflect upon what it 
 really means to surrender all guidance and treatment 
 of disease affecting the mind ; the influence in society 
 and influence in families which they lose thereby ; 
 the difficulty of treating many bodily diseases if they 
 be warned off the mental preserve ; the impossibility 
 of keeping the bounds, or even of knowing them. 
 The weight of a great opinion was given to the 
 Select Committee, that constantly "lunatics are kept 
 in unlicensed places under the name of nervous 
 patients " ; and it was suggested " that all persons 
 taking nervous patients should notify that to the 
 Commissioners, and the Commissioners should then 
 come down and see whether the patient w^as a nervous 
 patient or a lunatic. If he were a nervous patient, 
 he would be left where he was ; if a lunatic patient, 
 he would be put under certificate." There is ex- 
 cellent sense and undoubted truth in these remarks 
 
THE PREROGATIVE OF ASYLUMDOM. 1/ 
 
 from the official point of view ; but let the profession 
 reflect upon what they may come to mean in the 
 future, if no stand be made for the rightful position 
 of the profession in the treatment of all kinds of 
 disease. The visiting physicians of asylums have 
 been elbowed out of existence ; the insane members 
 of the richer classes have been accumulated in in- 
 stitutions, where they have become the property 
 of capitalists ; and the single patients, residing law- 
 fully under certificates in English homes, and the 
 frequent visitation of medical men in ordinary 
 practice, are regarded as if they were rebels to 
 the great prerogative of asylumdom. 
 
III. 
 
 WflY, THIS IS A CERTIFICATE. 
 
 If any one of common sense could be quite ignorant 
 of the lunacy laws which hang over his head, and were 
 asked upon what kind of formality it would seem to 
 him right that a man should be deprived of his liberty 
 on account of unsoundness of mind, he would be very 
 likely to commence his reply by laying dov/n the 
 broad principle that, such necessity being conceded, 
 all subjects of the Queen ought, in such a matter at 
 least, to be dealt with alike. But, if he were told 
 that this would be inconvenient, because, the great 
 bulk of insane persons being maintained out of public 
 funds, there was the greatest possible inducement not 
 to deprive them of their liberty for one moment 
 longer than was absolutely needful, while the re- 
 mainder, being persons of private means, were liable 
 for various reasons to be deprived of their liberty 
 without absolute need for such a step, he would, no 
 doubt, be inclined to say that, in the former case, the 
 conditions might be formal, but in the latter, every 
 security which a careful investigation could afford 
 Giieht to be taken. 
 
WHY, THIS IS A CERTIFICATE. 1 9 
 
 But if he were told that this principle was reversed 
 in practice, and that a destitute lunatic could not be 
 confined in a public institution, under the charge of 
 public officials, and maintained there out of public 
 funds, except upon the intervention of the officer who 
 administers these funds, and the order of a magistrate, 
 while a rich lunatic could be locked up in a private 
 place of confinement upon the order of any person, 
 who might be an alien, an infant, or a man of straw, 
 with whom the owner of the place chose to make 
 a pecuniary agreement, the man of common sense 
 would not be unlikely to conclude that, " for ways 
 that are strange," our legislature at least equaled that 
 of the " heathen Chinee." If the forms of admission 
 for a private patient and those for a pauper patient 
 were mutually interchanged, some reason might be 
 assigned for their difference. It might be thought 
 right that two medical men instead of one should 
 testify to the necessity for care and treatment which 
 would be a public burthen, while the sanction of 
 public officials should be invoked for an incarcera- 
 tion contrary to the spirit of the laws, and liable to 
 be imposed from unworthy motives. If the form of 
 admission of a private patient be examined, a strange 
 structure it will be found. The two certifying medical 
 men, whose action ought to be united thought in 
 counsel, hke the head of gold, are made to stand 
 apart, like the thighs of brass ; but the feet of clay 
 on which the image rests is clearly the order " of the 
 undersigned," who may be anybody. 
 
 On what intelligible ground should the "physician, 
 surgeon, or apothecary" in actual practice, personally 
 examine the patient "separately from any other 
 medical practitioner " ? It seems, if one thinks of it, 
 
 C 2 
 
20 CARE OF THE INSANE. 
 
 a strange embodiment of jealousy and distrust ; for 
 in other instances where the opinions of two or more 
 medical men are required, the opposite course is taken 
 in order to secure the great advantage of combined 
 observation. When, in any other form of disease, it 
 is desired to confirm the opinion of one medical man 
 by that of another, what would be thought of the 
 wisdom of a proposal that each man should examine 
 the patient separately } When medical men examine 
 a patient together, they usefully check each other, and 
 are of the greatest mutual assistance in observing 
 correctly, and estimating rightly, the symptoms of 
 disease, a consideration of the greatest importance in 
 cases of mental disease, whereof the main symptoms 
 are words spoken by the patient, which often convey 
 a different meaning to the minds of different people. 
 If the lunacy laws had not been imbued with distrust 
 of the medical profession, they would never have 
 contained an enactment abrogating all the advantages 
 of medical consultation. Rather would they have 
 enacted that the examination . should be a joint one, 
 the opinion concurrent, and the report thereof, or 
 certificate, mutual. 
 
 When the patient has been got into an asylum, a 
 different estimate of joint examinations is adopted ; 
 for no patient can be discharged out of the asylum, 
 by the Commissioners, except upon a joint exami- 
 nation made by two of them, repeated at an interval 
 of not less than fourteen days, and a concurrent 
 opinion upon the point at issue. If it were as easy to 
 get a man out of an asylum as to get him into one, 
 the forms of admission would not, perhaps, be so 
 important as they are ; but when the exit is hedged 
 in with legal difficulties, the entrance ought surely to 
 
WHY, THIS IS A CERTIFICATE. 21 
 
 be guarded with an equal amount of care and fore- 
 thought ; and this hindrance to that most useful prac- 
 tice of consultation and mutual action which prevails 
 in the medical profession ought, for one thing, to be 
 removed. 
 
 The next point which attracts attention in these 
 forms is that strange conjunction of ideas upon 
 which the theory of private lunacy law seems to be 
 based, namely, that a person who is a lunatic, or an 
 idiot, or a person of unsound mind, is also always a 
 proper person to be taken charge of and detained 
 under care and treatment. There are really three 
 ideas jumbled in this part of the certificate, as if they 
 were correlative, namely, unsoundness of mind, care 
 and treatment, and detention ; whereas the things 
 themselves are quite distinct, separable, and inde- 
 pendent. Unsoundness of mind may, and ofren does, 
 exist, without the need of any " care and treatment ; " 
 and even when care and treatment are required for 
 it, there is very often not the slightest necessity for 
 detention. 
 
 It is, to say the least, very remarkable that no 
 distinction is made in the form of admission between 
 the person of unsound mind who only needs common 
 care and a little kindness in domestic life, and the 
 lunatic who needs to be detained in an asylum under 
 lock and key. 
 
 With regard to the first of these notions, what- 
 ever the interpretation clause of the statute may 
 say, there is a distinction made by common assent 
 between a lunatic and a person of unsound mind. 
 A person whose mental faculties are simply en- 
 feebled by disease or natural decay, is of unsound 
 mind, but it would be quite wrong to call hira 
 
22 CARE OF THE INSANE. 
 
 a lunatic ; and yet nineteen out of twenty of the 
 admission-papers which the Commissioners accept for 
 the detention of people in lunatic asylums, simply 
 affirm that such persons are of unsound mind. But 
 this condition, which would suffice to justify care, and 
 even a little control, in domestic life, is surely insuffi- 
 cient to justify detention under lock and key in an 
 asylum. The second amendment, therefore, which 
 seems needful in the certificate — so called probably 
 because it so often asserts things which are not cer- 
 tain — is to require the reporting medical signatories 
 to distinguish, Avith some degree of definition, the 
 kind of mental disease which they have found ; or at 
 least whether it be lunacy, or idiocy, or unsoundness 
 of mind ; whether it be disease, or defect, or decay. 
 And this w^ould lead up to a third and most important 
 amendment of what must appear, to any mind un- 
 possessed with the lunacy creed of the day, a great 
 and palpable error of the existing form, namely, the 
 omission to require the medical examiners to report 
 what kind of care and treatment they consider need- 
 ful. At present, these professional reporters, whose 
 opinion is registered with nice precision, have to give 
 exactly the same form of certificate for an imbecile 
 youth, residing with his mother, with money in his 
 pocket, and whose property, under trustees, helps to 
 keep the house, but who needs no more treatment 
 than a little loving care and guidance, as that cer- 
 tificate which they must give to the homicidal or 
 suicidal lunatic, or the 'raving maniac, for whose safe 
 keeping a special building and a staff of skilled at- 
 tendants would seem to be needful. A more rough- 
 and-ready scheme could scarcely have been devised 
 than these indiscriminating medical certificates. The 
 
WHY, THIS IS A CERTIFICATE. 23 
 
 same for the asylum, the hospital, and the home ; the 
 same for the lunatic, the imbecile, and the infirm of 
 mind. They were devised, and have been most 
 effectually used under the idea of bringing them, that 
 is, the insane population, into the asylums, with an 
 equal misunderstanding, of medical science and 
 social right. 
 
 Therefore the third amendment which is needed to 
 convert these formal certificates into something like 
 medical reports worthy of confidence, and drawn 
 with the purpose of guiding action, would be to 
 require that they should indicate the kind of care 
 and treatment which, in the opinion of the reporters, 
 is needful in the particular case. They ought at 
 least to distinguish between care and treatment in 
 domestic life and care and treatment in an asylum, 
 for the difference between the two is enormous ; 
 and a medical man who has given a well-inten- 
 tioned certificate, under the belief that it would 
 be used as a justification for gentle control in the 
 former, is liable to find it utilized for imprisonment 
 in an institution. But, even beyond this broad dis- 
 tinction, it would seem to be reasonable and right 
 that the medical men upon whose report the liberty 
 of an Englishman is about to be restricted should 
 have the power, and should bear the responsibility, of 
 indicating the particular persons to whose care and 
 treatment, or (to get rid of an ambiguous euphemism) 
 to whose control they would be willing to subject 
 their patient. There are asylums and asylums, as 
 there are homes and homes ; and merely to say " Let 
 him have care and treatment " is just as vague as to 
 say " Give his medicine in some convenient vehicle," 
 which, as the story goes, may mean a wheelbarrow. 
 
24 CARE OF THE INSANE. 
 
 When a physician, having given a certificate for the 
 home-treatment of some weak-minded creature, finds 
 him put into asylum-durance upon it, he has a great 
 right to complain. But also, when the physician 
 recommends care and treatment, surely it ought to be 
 care and treatment of which he has some knowledge ; 
 and, if it be personal care, as in insanity it mostly is, 
 then he ought to be able to specify the care of some 
 person or persons whom he knows. A medical man 
 who would send a patient to the seaside, without 
 saying whether it was Bournemouth or Scarborough 
 which he would recommend, would be careful and 
 judicious in comparison with one who would think 
 that he had done his whole duty by blindly signing 
 papers capable of such various interpretations and 
 use as the existing lunacy-certificates. The medical 
 man may have given his certificate for what he 
 thought an urgent but temporary purpose of treat- 
 ment in a particular institution which he trusts, and, 
 by the system of transfers, under the same papers his 
 patient may be made to go the round of asylums so 
 long as his life lasts or the lunacy laws endure. No 
 wonder that it was stated before the Select Com- 
 mittee that the best men in the medical profession 
 were more and more in the habit of refusing to sign 
 these certificates of lunacy. It is not from fear of 
 consequences to themselves that they do this ; for to 
 these they are no more liable than the operating 
 surgeon or obstetrician, if they use due skill and 
 diligence. But the reason is, that these know what 
 they do, while the certifier in lunacy does not know. 
 The remedy for this great evil is, that the certificate 
 or report upon a lunatic or a person of unsound mind 
 should be explicit in its recommendation of the 
 
WHY, THIS IS A CERTIFICATE. 2$ 
 
 particular place and persons by whom the care and 
 treatment should be applied, and that it should only 
 be available for the one purpose for which it was 
 granted. That is to say, it should be competent 
 and necessary for the certifying medical men to 
 testify in writing, according to duly prescribed form, 
 that, in their opinion, N or M being a lunatic, it 
 would be right for him to be placed in an asylum, 
 which they should name; or that, N or M being a 
 person of unsound mind, it would be right for him 
 to be placed under the care of certain private persons 
 whom they should name. And it ought certainly 
 also to be competent to them to name a period 
 during which such certificate ought to run and not 
 longer ; for it is clearly wrong that a medical man 
 cannot place a mental patient under legal care and 
 treatment without the feeling that, on account of some 
 small remains of his present malady, he may be con- 
 signing him to a prolonged detention. No medical 
 man who reflected upon what he was doing could 
 perform such an act without twinges of conscience 
 and tremors of self-respect ; and, if these forms be 
 not modified in the liberal spirit of professional con- 
 sultation and report, it needs no miraculous gift of 
 prophecy to foretell that, discredited with the pro- 
 fession at large, they will become more and more the 
 perquisite of hack certifiers-— hangers-on upon the 
 asylum system. 
 
 Another essential amendment of the present forms 
 is that the grounds for detention in an asylum, and 
 even the grounds for control under domestic care, 
 should be stated by the medical men who recommend 
 either the one or the other to be employed. 
 
 Custom-blindness (which is worse than colour- 
 
26 CARE OF THE INSANE. 
 
 blindness, because it blurs the outline of things as 
 they are) often leads official people to associate un- 
 soundness of mind Avith detention under care and 
 treatment as correlative, if not identical, conditions ; 
 but with the general public it is not so, and still 
 less with the medical profession, and still less again 
 with that of the law. 
 
 With regard to the medical men who are responsible 
 for advising detention in an asylum, it is but just that 
 they should be allowed the opportunity of stating the 
 reasons upon which they give so momentous a profes- 
 sional judgment. With regard to the patients, it is most 
 unjust that such a judgment should be passed upon 
 them without the grounds of it being stated, and sub- 
 mitted to some authority capable of revising it. With 
 regard to the public, it is most unsatisfactory that a 
 great secret power should be exercised over its liberties 
 without a clear explanation of its necessity being 
 put on record in each instance. And, therefore, it 
 would appear to be imperative to a proper certifica- 
 tion of a lunatic for detention in an asylum, that the 
 reasons for which such detention is needful should 
 be fully stated upon the face of the documents, and 
 distinguished from the facts which simply indicate 
 lunacy. It maybe that the late Chief Baron, adopting 
 the dictum of the eminent counsel who is now the Lord 
 Chief Justice of England, expounded the law in the 
 case of Nottidge v. Ripley and Another on lines 
 which would require a broad and liberal interpreta- 
 tion. But, notwithstanding the pamphlets of ex- 
 postulation which it produced, the above is still a 
 leading case in the matter, and a judicial precedent ; 
 and it cannot be doubted that no person of unsound 
 mind may by common law be rightfully confined in 
 
WHY, THIS IS A CERTIFICATE. 2/ 
 
 an asylum, if it can be proved that he is perfectly 
 manageable, safe, and harmless in the enjoyment of 
 his liberty. The opposite conditions would seem 
 to include all legal justification of what is called 
 care and treatment in an asylum ; but, however 
 this may be, the deficiency of the present forms 
 in omitting all mention of the reasons for detention, 
 and the absolute need of amending them in this 
 respect, must be apparent to every open mind. But 
 even what may be called the milder recommendation 
 of the medical reporters, iho^ detentio viitior oi dom.e5i\c 
 life, ought not to be given without the statement of 
 the reasons upon which it is founded. What is meant 
 by care and treatment even of a single patient in 
 domestic life is, of course, control. The smooth words 
 are a mere blind, and, if an imbecile or a person of 
 unsound mind needs no control, which includes pro- 
 tection, he needs no interference of the authorities 
 with the management of his person, whatever may 
 be the case with that of his property. What are the 
 specific facts observed by the reporting medical men 
 which should justify detention in an asylum, or those 
 which should only lead to the milder control of 
 domestic care, it scarcely comes within the scope of 
 these articles to indicate. They are the proper subject 
 of the diagnosis of insanity with reference to treat- 
 ment. There are, however, some few cases of insanity* 
 in which the symptoms are so far concealed or inter- 
 mitting, that it may become needful for the reporting 
 medical men to avail themselves,v-in corroboration of 
 their own observations, of facts communicated to them 
 by others ; and, in such cases, in amendment of the 
 present forms, it would seem to be desirable that the 
 statements made by other persons to the medical men 
 
28 CARE OF THE INSANE. 
 
 should be signed by the persons who make them ; and 
 that they should be so made and signed with the 
 knowledge that the superior authority, by whom the 
 validity of the paper must be determined, has the 
 power to require them to be verified by statutory 
 declaration. In this manner a great amount of loose, 
 inaccurate, and untrustworthy statement would be 
 eliminated, which greatly discredits the present system 
 of hearsay evidence. To put the proposition in other 
 words, the statute now requires that the certifying 
 medical man shall specify the facts upon which he 
 has formed his opinion, " and shall distinguish in such 
 certificate facts observed by himself from facts com- 
 municated to him by others ; and no person shall be 
 received into any registered hospital, licensed house, 
 or as a single patient, under any certificate which 
 purports to be founded only upon facts communicated 
 by others" (i6 and 17 Vic, c. 96, s. 10). The Com- 
 missioners do indeed require that the name or names 
 of " others " communicating facts shall be stated in 
 the certificate ; but this is merely an official regulation, 
 and not a statutory requirement. The strict effect of 
 the statute is that the certifying medical men may be 
 satisfied with the merest modicum of fact observed by 
 themselves, supplementing it by hearsay evidence 
 from persons whose names even they are not required 
 to supply. They are thus placed in the position of 
 weighing the bearing and trustv^^orthiness of un- 
 attested statements, which is quite a wrong one 
 for them to occupy. But if their informants were 
 required to sign their statements, with the know- 
 ledge that they might immediately be called upon 
 to swear to them, the position would certainly be 
 altered for the better. 
 
WHY, THIS IS A CERTIFICATE. 29 
 
 There is a curious enactment (16 and 17 Vic, c. 96, 
 sec. 12), as to what medical men may not sign certi- 
 ficates — namely, no father, brother, son, partner, or 
 assistant of the proprietor of the asylum to which 
 the patient is sent ; and, in the Amendment Act of 
 1862, any person receiving a percentage, or otherwise 
 interested in the payments, is also excluded, but 
 nothing is said of a father-in-law, or a brother-in- 
 law, or a cousin, or of female medical relatives. The 
 omission of the father-in-law has been peculiarly 
 unfortunate. It would perhaps be better to leave 
 disabilities of this kind to the determination of a 
 regulating authority, whose action should precede 
 and not follow the use of the document. 
 
 What that authority should be, must be discussed 
 in another article. At present, the medical certifiers 
 are but the servants of the man who signs the order ; 
 who may himself be a servant, or even, as Mr. Percival 
 suggested to the Select Committee, an infant (Question 
 337). He may be a phantom or a tyrant, a delusive 
 name or a mischievous reality ; and it was fully ad- 
 mitted by the Commissioners that he could not be 
 maintained in his present position unless power were 
 given to them to depose him and to nominate his suc- 
 cessor. It would be much better that the revolution 
 should be thorough and effected by law. 
 
IV, 
 
 THE POWER OF THE KEYS. 
 
 If the reforms suggested in the last article were 
 adopted, the present bald certificates might be 
 exchanged for trustworthy medical evidence, and the 
 pretence of independent examinations, well known to 
 lunacy doctors, and well described by one who had 
 suffered from it (Minutes of Evidence, Questions 9215 
 and 9216), whereby a few questions are put while first 
 one doctor and then another disappears for a moment 
 behind a side-screen, would pass into well merited 
 oblivion. If these reforms were adopted, the demands 
 for a public inquiry in each case of subjecting an 
 insane person to detention or to control, which have 
 lately been rife in the criticisms of the lay press, 
 would probably be discontinued ; especially if this 
 medical evidence were used as evidence only, and as 
 the needful foundation of magisterial action, and if 
 this reform were accompanied by such other reforms 
 of the lunacy law and its administration as would 
 appease the well-founded fears of the public, that 
 harmless insane persons are sometimes incarcerated 
 uDon inadequate grounds or for unreasonable periods. 
 
THE POWER OF THE KEYS. 3 1 
 
 It is, of course, understood that the common law 
 will justify a medical man for restraining and con- 
 trolling a patient who is delirious from fever, wounds, 
 poison, drink, or any other cause including insanity, 
 his defence being that he has used due skill and 
 diligence in the necessary exercise of his art. This 
 is the justification for the needful restraint of a mad- 
 man for a limited time for purposes of care and 
 treatment under the common law. But the statute 
 law introduces limitations to this right, namely, 
 limitations as to number and as to profit, so that 
 not more than one insane person can be detained 
 under care and treatment except in certain places 
 licensed for this purpose, and so that not even one 
 insane person can be received and kept for profit 
 in any place whatsoever, unless certain forms be 
 observed. The statute law does not forbid, prevent, 
 or punish the continuous restraint of a lunatic who is 
 not actually neglected or ill-treated, and who is under 
 what may be deemed care and control, unless he be 
 received and kept for profit. There is no law to 
 prevent a Mr. Rochester from locking up his mad 
 wife in the attic of his mansion with a keeper, as 
 described in Jane Eyre., But if he had confined 
 her alone and in a state of nudity in a cellar, clearly 
 the law would have reached him, for she would have 
 been neglected and ill-treated, and not have been 
 under proper care and control ; and how it was that 
 a metropolitan magistrate recently failed to deal with 
 the instance of this latter kind, which was referred to 
 by one of the honourable members of the Select 
 Committee, it is difficult to see. Whether any person 
 like Mr. Rochester should still be allowed to make a 
 private oubliette for a mad member of his family, is 
 
32 CARE OF THE INSANE. 
 
 very questionable. The recommendation of the 
 Select Committee, that confidential reports of con- 
 firmed lunatics under restraint in private families or 
 religious houses should be sent to the Commissioners, 
 would be of no value, unless associated with visitation- 
 The first and primary question would seem to be, 
 whether every insane person who is deprived of liberty 
 ought or ought not to be under the supervision of 
 the State. The Earl of Shaftesbury answered this 
 question, before the Select Committee on Lunatics, 
 1858, with statesmanlike caution (Questions 304- 
 305). " I do not say whether it would be right or 
 wrong. I do not think it desirable to introduce our 
 powers into a strictly private house ; if a husband 
 have charge of a wife in his own house, or a wife 
 have charge of a husband, or parents have charge of 
 children, or children of parents, I do not think that 
 public opinion would allow of any intrusion in such 
 cases." 
 
 The statute, however, takes no cognisance of pro- 
 pinquity of blood in this matter ; and a mother 
 cannot receive and keep her insane son for a profit, 
 except under certificates and order. It is profit and 
 not kindred which rules the action or abstention of 
 the State, and profit is often a difificult thing to prove. 
 A considerable improvement, therefore, of the statute 
 would seem to be offered by the simple adoption of 
 Lord Shaftesbury's views, making certificates unneces- 
 sary for the care and control of the insane by the 
 relatives whom he nam.es, but requiring them with the 
 accompaniment of sufficient State supervision where- 
 ever an insane person is kept by any other person. 
 And this law, thus simplified, ought to be adminis- 
 tered impartially, so as to give no occasion for such 
 
THE POWER OF THE KEYS. 33 
 
 invidious remarks as the following one made by 
 the Journal of Mental Science for April, 1879, page 48. 
 " The Commissioners take credit," says this writer, 
 " in their annual reports, for the zeal with which 
 they hunt out these cases ; and the institution of a 
 criminal prosecution in a ' sensational ' case, from 
 time to time, serves to foster public appreciation of 
 their activity and usefulness." 
 
 With the above doubtful exceptions, no single 
 lunatic ought to be detained or restrained without 
 medical certificates for more than a brief and fixed 
 period. In recent and sudden cases, one certificate 
 might be allowed to suffice for a short time, until the 
 consultation and regular report of two medical men 
 and the magistrate's order could be provided, ^he 
 transmission to the central authority of the latter, 
 followed and completed by the fortnightly visita- 
 tion and report, as at present fixed by the statute, 
 should be the only protection against statutory 
 penalties. 
 
 In the case of a single patient under certificates, 
 there surely need be no order, either of a magistrate 
 or of any other person. The medical visitation 
 and report ought to protect the person controlling a 
 single lunatic only against prosecution under the 
 statute, but not against civil proceedings for damages. 
 If that most unhappy section of the Lunacy Act 
 1845 (Section 99) be repealed, the medical report, 
 the fortnightly visitation and report, and the common 
 law of action for damages, would be sufficient to 
 protect single cases under domestic care. These 
 domestic cases ought to be considered as especially 
 under medical treatment and supervision, and, as 
 a rule, there should be neither magistrate's nor any 
 
 D 
 
34 CARE OF THE INSANE. 
 
 Other person's order for such treatment. In many- 
 cases, however, it would be a vast improvement upon 
 the present system to give to the Commissioners, 
 or to the central lunacy authority of the future whom- 
 soever it may be, the power of appointing a relative 
 or friend or other person to hold towards the private 
 patient, either in domestic care or in asylum confine- 
 ment, the same position, not as the man who signs 
 the order, but as the Committee of the Person of a 
 Chancery lunatic — a person appointed and remov- 
 able by the authority, a suitable and proper person 
 for the charge, who would undertake to visit the 
 patient periodically, to report on his condition, and 
 to carry out the reasonable recommendations of the 
 authority as to care and treatment. Many single 
 cases and asylum cases also would need no such 
 person — simple, easy, and tractable cases, short and 
 curable cases, and others undefinable; but, in pro- 
 longed and difficult cases, requiring careful considera- 
 tion and painstaking, the substitution of a Committee 
 of the Person who would undertake to visit and to 
 exercise efficient supervision, under good official 
 control, for the man who signed the order, would be 
 an incalculable improvement. 
 
 When domestic care and medical supervision and 
 treatment, implying some control but not much, 
 are insufficient for the requirements of the case, and 
 the patient has to be made an asylum lunatic, the 
 sanction for that which no disguises can make any- 
 thing less than the loss of liberty by imprisonment 
 ought surely to be that of the State speaking through 
 one of its public ser\ants. Medical opinion must 
 still, no doubt, be the main reason for detention, 
 though considerations of the public safety which are 
 
THE POWER OF THE KEYS. 35 
 
 not medical may buttress it ; but, for the welfare of 
 the patients, the liberties of the people, and the 
 dignity of the profession, it must be conceded that 
 the interested or delusive sanction now afforded by 
 the order of detention must be supplanted by some- 
 thing of more authority. The Commissioners in 
 Lunacy, indeed, plead for the status quo ; it is not 
 easy to discover wherefore, seeing that the Commis- 
 sion is overladen with that most burthensome kind of 
 responsibility, the management of people over whom 
 it has little power, of whom these signatories of 
 orders for asylum detention form a mutinous body, 
 in which each man shirks or fights for his own hand. 
 The proprietor of a licensed house has a more 
 intelligible reason for upholding the man who signs 
 the order, seeing that generally he is the other party 
 to a business agreement ; and, if the proprietor some- 
 times accepts a man of straw as the ostensible person 
 with whom he contracts, he may be trusted to look 
 behind him to some one else who is tangible and 
 solvent. But the public want some one else who is 
 solvent in moral responsibility, which cannot be as- 
 sumed of the man who signs the order. 
 
 If the Commissioners had arrived at the well-con- 
 sidered conviction that the present system was really 
 good in principle, they would probably, at least in the 
 metropolitan district, where their powers are practi- 
 cally unlimited, have submitted it to reasonable regu- 
 lations. They would not have permitted people to be 
 detained in asylums under their rule, under the orders 
 of men living on the other side of the world, or of 
 servants of the family, or of innkeepers, of lawyers* 
 clerks, and other casual people whose position and 
 character afford no guarantee for the right use of 
 
 D 2 
 
7^6 CARE OF THE INSANE. 
 
 their great powers. If in any way dissatisfied with 
 the admission-papers the Commissioners can order 
 the discharge of the patient, and with this power 
 in their hands they have actually amended the 
 statutory admission-papers by their regulation as to 
 the requirement of the names of " other " persons 
 communicating facts which indicate insanity. It is 
 not that the unregulated system has worked well, for 
 in many instances it has worked grievously ill ; for if, 
 to the credit of the medical profession, it can truly be 
 said that the instances in which persons who are not 
 insane have been received into asylums are exceed- 
 ingly rare, it can scarcely be denied that, owing to 
 the ignorance, negligence, or selfishness of persons 
 who sign the order, or of those who instigate them, 
 imprisonment in asylums is often needlessly imposed, 
 and is often wrongfully prolonged upon improper 
 objects. 
 
 The power of caption, which the order confers upon 
 the owner of an asylum and his servants, is another 
 invasion of the liberty of the subject which is a great 
 scandal. The statute relating to pauper lunat'cs 
 provides for their conveyance to the county asylum 
 by the proper official. The order of the sheriff in 
 Scotland provides for the conveyance of both pauper 
 and private lunatics to the asylum ; and in neither 
 case has tlie medical superintendent any power over a 
 lunatic until he has been duly received and admitted 
 into the institution. But in England the statute gives 
 the power of caption of any private lunatic to the 
 owner or superintendent of any licensed house or 
 hospital, or to his servants ; so that, for seven days 
 after the order and certificates are signed, the owner 
 of an asylum or his servants may search for, seize. 
 
THE POAVER OF THE KEYS. IJ 
 
 and convey, bound hand and foot if need be, any- 
 private lunatic from Carlisle to Penzance. No wonder 
 that this " taking " of private lunatics has from time 
 to time afforded incidents which have shocked the 
 public sentiment of humanity, decency, and right. 
 The enactment under which it is practised is a won- 
 derful example of what the English pubhc will bear 
 when the sufferers are a small and helpless class and 
 many powerful interests are engaged in keeping things 
 quiet. The power and protection conferred upon the 
 proprietors of asylums and their servants by the 
 ninety-ninth section of the Lunacy Act of 1845 is 
 without parallel in anything else remaining in the 
 Statutes at Large. It makes one wonder in what age 
 and country we are living ; for it not only authorizes 
 a private man to receive, as a matter of profitable 
 business, any lunatic or alleged lunatic of whom certain 
 papers have been signed, and to detain him " until he 
 die or be remioved or discharged by due authority," 
 but against all civil actions for " taking, confining, 
 detaining, or retaking " such an alleged lunatic, it 
 gives him the right to plead such order and certificates 
 if correct, as a justification. Surely some judicial 
 sanction ought to be essential before such protected 
 powers are acquired by private people over the 
 liberties of the least of the Queen's subjects. Surely 
 the question must arise in all fair minds, whether such 
 powers ought to be conferred upon private people 
 under any circumstances or sanction whatever. 
 Gracious amenities and benignities of life in a free 
 land ! Did any one, savouring your sweetness, ever 
 consider the full meaning of the sentence passed upon 
 the liberties of Englishmen in the harsh lines of this 
 enactment, without a shudder at what may be done 
 
38 CARE OF THE INSANE. 
 
 with impunity under the aegis of legalized injustice ? 
 The common law of the land, laid down in repeated 
 and unquestioned judgments by the greatest judges, 
 is, that no one but a dangerous lunatic shall be 
 locked up in an asylum ; but this enactment of 1845 
 has for a generation made private war upon the 
 liberties of the innocent and the helpless, who are 
 no more dangerous than children, no more in need 
 of imprisonment than the deaf and the blind. 
 Whatever else be done or left undone in lunacy 
 law reform, the charter of private imprisonment 
 contained in 8 and 9 Vic, c. 100, sec. 99, must be 
 repealed, and all insane persons who are harmless 
 restored to the full possession of the common-law 
 rights of Englishm.en. 
 
 But those lunatics who are not harmless must be 
 still sent to asylums by authority. A medical 
 opinion and report are not an authority for such de- 
 tention. Would it be right and expedient to con- 
 stitute the order of relatives and friends, under 
 regulation and definition, such authority .-* or would it 
 be best to place the power and responsibility upon 
 the shoulders of the magistrate .'' The sentim.ental 
 argument in favour of the action of near relatives in 
 this matter is, of course, extremely strong, and no 
 one would wish to run counter to the domestic affec- 
 tions in so great a calamity as madness in a family. 
 But the arguments in favour of the existing order, 
 which were urged upon, the Select Committee, were 
 not founded upon such unstable ground as sentiment, 
 which, in the face of the law for pauper lunatics and 
 the certainty that domestic vice must be reckoned 
 upon to take its turn with domestic virtue in the 
 dealings of relatives with lunatics, could not be 
 
THE POWER OF THE KEYS. 39 
 
 maintained. The voice of affection is as potent in 
 the homes of the destitute as in those of the rich, 
 and yet in the former it is overruled by that of the 
 magistrate. The bias of affection would in all classes 
 tend to retain harmless cases of insanity under the 
 home rooftree. The bias of the evil brood of bad 
 passions would be to immure them in the conceal- 
 ment of an asylum ; to get rid of trouble ; to diminish 
 expense ; sometimes to have freedom for misconduct. 
 There would be no hardship felt by a loving relative 
 that the action of the magistrate relieved him from a 
 most painful duty. There might be annoyance felt 
 by a selfish or vicious relative that the action of the 
 magistrate interfered with a heartless exercise of 
 authority. In the pleadings for the relatives to sign 
 the order, the great value of their responsibility before 
 the law was urged ; but it was forgotten that neither 
 husband nor wife can bring actions for dam.ages 
 against each other, and that actions between parents 
 and children would be difficult and scandalous ; and 
 that regard to future rights of procedure on the part of 
 a lunatic would, on this argument, exclude the nearest 
 relatives from the signatories of the order. Under 
 this view of the value of the order, any substantial 
 householder would be preferable to a near relative. 
 The governors of Bethlem and of other hospitals for 
 the insane do, in fact, require the endorsement of the 
 statutory forms by substantial householders, in view 
 of certain responsibilities — removal, burial, etc. In 
 point of fact, therefore, the sentimental argument for 
 the maintenance of the power of relatives to inflict 
 imprisonment upon their relatives is a sentimental 
 argument and nothing more ; nothing more, unless 
 when it is something worse — the desire to possess a 
 
40 GARE OF THE INSANE, 
 
 power for selfish purposes, or the foolish and feeble 
 desire of secrecy and concealment. 
 
 The framers of the Scotch lunacy law, who, coming 
 after their English compeers, have had the opportunity 
 of avoiding some of their mistakes, gave a wide berth 
 to this private power of imprisonment ; and over the 
 border, therefore, the friend or relative who desires to 
 place a lunatic in an asylum, having obtained medical 
 certificates of his insanity and that he ought to be 
 placed in an asylum, has to petition the sheriff, upon 
 whose order the lunatic is conveyed to the asylum and 
 detained there. The Scotch lunacy law, and the way 
 in which it works, can be best studied in the admirable 
 evidence of Dr. Mitchell, one of the Commissioners. 
 To Question 9,872 he says : " Under the Scotch laws, 
 the procedure for authorizing the admission of patients 
 into asylums rests on the idea that the step is one 
 which involves a loss of personal liberty ; accordingly, 
 in Scotland, the persons who can authorize admission 
 of any patient into an asylum are persons who are en- 
 trusted with the power of taking away personal liberty 
 for other reasons than lunacy." That is the principle, 
 and, no doubt, the sound and constitutional one. Dr. 
 Mitchell proceeds to explain that the petition to the 
 sheriff must be accompanied by two certificates granted 
 by registered medical men, bearing that they have 
 separately examined the patient and found him, first, 
 a lunatic, and secondly, a proper person to be placed in 
 an asylum. The sheriff may refuse the petition for a 
 great variety of reasons, and often does so, " dealing 
 with the petition as he deals with any other petition 
 which prays him to exercise an authority conferred 
 upon him by the State." Dr. Mitchell further states : 
 *'It naturally forms a feature of such a procedure 
 
THE POWER OF THE KEYS. 4I 
 
 which rests upon such an idea, that it is exactly the 
 same whether the person to be admitted is in affluent 
 circumstances or is a pauper ; whether he is to be 
 placed in a private or a public asylum. This uni- 
 formity of procedure in regard to all classes of asylums 
 and all classes of patients is an important feature in 
 the Scotch law, and it appears to me that it is a feature 
 which cannot be absent from any lunacy laws which 
 are sound. On this procedure, more than ninety- 
 seven per cent, of all lunatics in Scotch asylums have 
 been admitted. I believe that it satisfies the public, 
 who do not find it cumbrous, or a hindrance to the 
 early and quiet treatment of patients; and I also be- 
 lieve that the contentment of many patients is pro- 
 moted by a knowledge of the fact that it has been 
 necessary for their friends to obtain an order from a 
 high public functionary for their admission into, and 
 their detention in, an asylum. Many patients feel that 
 they have been taken to an asylum against their will ; 
 that they are kept there against their will by force of 
 necessity. They feel this to be imprisonment, and 
 talk of it as imprisonment ; and it satisfies them, to 
 some extent, to know that their personal liberty has 
 not been taken away without an order from a sheriff, 
 to whom they can appeal, and to whom they do appeal 
 sometimes with success." The evidence both of Dr. 
 Mitchell and Sir James Coxe makes it clear that the 
 sheriffs do exercise their functions in this matter, not 
 ministerially, but judicially; and, therefore, it is only' 
 open to criticise the system as it is thus administered. 
 The Earl of Shaftesbury did so criticise it (Question 
 11,605), on the ground that such a judicial act would 
 exonerate the medical certifiers, the man who signed 
 the order, and the man who received the patient ; so 
 
42 CARE OF THE INSANE. 
 
 that however bad the papers might have been, it would 
 take from the patient the right of legal redress when 
 he obtained his liberty. The whole thing was endorsed 
 by the magistrate, and must pass as unquestionable. 
 But, notwithstanding his lordship's deep and far-reach- 
 ing knowledge of lunacy matters, we must venture to 
 question the correctness of his law on this point. Of 
 course, the man of the order and his responsibilities 
 are superseded by the Scotch system ; but the judicial 
 act of the magistrate would scarcely exonerate medical 
 certifiers who had not used due skill and diligence, 
 neither does the English method lay any legal re- 
 sponsibility upon them if they have exercised these 
 qualities. And, with regard to the man who admits 
 the patient, it is certain, from the Scotch evidence, 
 that he is liable to action for damages if the formalities 
 of admission be not strictly observed. 
 
 It is difficult to conceive the poss'bility of drafting 
 a statute by which the hand of common law could be 
 more tightly bound from giving redress for question- 
 able confinement in an asylum than the existing one ; 
 " the man in the street " who, perhaps, had signed 
 the order, being the only target left to be shot at. 
 But Lord Shaftesbury's earnest desire that an injured 
 man should have his remedy is a precious promise of 
 reform in this direction. Every one who has been 
 falsely shut up as a lunatic, private or pauper, ought 
 to have his civil remedy untrammeled. The action of 
 the magistrate ought to cover nothing more than the 
 reception of the lunatic, and his detention for such 
 time as might reasonably be deemed sufficient to 
 ascertain his mental state. If wrongfully detained 
 after this time, the pauper even ought to have his 
 remedy for damages inflicted mala fide against the 
 
THE POWER OF THE KEYS. 43 
 
 visiting justices, who can sue and be sued through 
 their clerk. The private patient in a hospital for the 
 insane ought to have his remedy against the gover- 
 nors through suit also against their clerk. The private 
 patient confined in a licensed house ought to have his 
 remedy against the proprietor and licensee. 
 
 Another argument used by Lord Shaftesbury was, 
 that the Com.missioners could not overrule admission- 
 papers which had been endorsed by a magistrate ; but 
 surely his lordship underrates the powers of his Board, 
 seeing that the Commissioners have provided them- 
 selves with the power of ordering pauper lunatics 
 under a magistrate's order to be discharged from 
 county asylums, sane or insane, if the papers be not 
 formally correct. In any matter on which Lord 
 Shaftesbury feels strongly about lunatics, there is sure 
 to be in his view some sound reason, founded in good 
 sense and humanity ; and in this instance it seems to 
 be his objection to the interference of the civil power 
 with the medical treatment of the insane. [Questions 
 115-24.] But it seems an inevitable necessity, this 
 connection of lunacy with the police and with the 
 magistracy. In their own domain, what are the Com- 
 missioners themselves but magistrates in the daily 
 discharge of the police functions of civil government 
 regulating the treatment of the insane ? With regard, 
 indeed, to their principal and original functions and 
 powers — namely, the goyernance of licensed houses 
 in the metropolitan district — the Commissioners find 
 their exact analogue in the Boards of Visiting Justices 
 appointed at Quarter Sessions to be the governing 
 bodies of licensed houses in the provincial counties. 
 When it is considered that throughout the country 
 38,871 lunatics are under the immediate care and 
 
44 CARE OF THE INSANE. 
 
 control of the magistracy, confined under theii orders 
 in county and borough asylums, and that, out of the 
 4,645 private lunatics in licensed houses, 2,169 are ^-^so 
 under the immediate care and control of the magis- 
 tracy in the provinces ,* when it is also considered what 
 onerous and delicate duties are imposed by the law 
 upon magistrates with regard to private lunatics who 
 are neglected, or not under proper care and control, or 
 are wandering, and in other matters of lunacy law too 
 numerous to mention, — one would have thought that 
 the Commissioners would have eagerly desired the aid 
 and assistance of that most important and influential 
 body of Her Majesty's subjects and servants to whose 
 faithfulness and diligence the primary administration 
 of the law is confided : its aid and assistance in no new 
 direction, but simply in extending their present duties 
 to sufferers from a calamity so great that it needs no 
 increase from the influence of class legislation. 
 
 Therefore abolish the man who signs the order ; and 
 in the case of a private, as of a pauper patient, let it be 
 signed by the magistrate, not ministerially, but judi- 
 cially. The statute ought to declare, and the form to 
 ensure, that the magistrate shall feel himself called 
 upon to form a real judgment upon the evidence placed 
 before him, and to require, if need be, its amendment 
 either in form or substance. In Scotland, the magis- 
 trate — that is, the sheriff-depute — does not personally 
 examine the patient, dealing with the case upon the 
 testimony alone ; while in England the magistrate is 
 required personally to examine a pauper patient. The 
 difference in practice may probably arise from the 
 circumstance that the duty is performed by one offi- 
 cial in each Scotch county, whereas in England it is 
 confided to a considerable number ; so that in the one 
 
THE POWER OF THE KEYS. 45 
 
 case personal examination would cause great delay and 
 inconvenience, and in the other none. Certainly the 
 English practice appears the more commendable ; for, 
 in a matter so purely personal, the personal examina- 
 tion would seem to be of high value. In Chancery 
 lunacy, the Master, sitting as a judge, must see and 
 examine the alleged, lunatic at the inquisition ; and on 
 writ of supersedeas, the Lords Justices themselves per- 
 sonally examine the man who has recovered. The 
 Commissioners in Lunacy, on the other hand, neither 
 see their lunatics on admission nor on discharge, and 
 many private lunatics pass through their confinement 
 in licensed houses without ever seeing either magistrate 
 or commissioner. 
 
V. 
 
 INSANE AND NOT DANGEROUS. 
 
 The import of admission-papers, or as they might 
 more correctly be called commitment papers, can 
 only be appreciated by a full understanding of 
 the detention and confinement which they involve. 
 If asylums were really hospitals, insanity a brief dis- 
 ease, and no continuous restraint of personal liberty 
 required in its treatment, it is not obvious that com- 
 mitment papers v/ould be at all needful. But the 
 less that asylums are hospitals, and the more they 
 are places of prolonged confinement and restraint, 
 the more imperative is the necessity that commit- 
 ment to them should be guarded by the action of 
 recognized authority ; and the more facile the im- 
 position of restraint, the greater the safeguards ought 
 to be that it shall not be unduly prolonged. 
 
 There are three distinct questions to be considered 
 in this relation, namely, (i) the kind of people who 
 may be committed to asylums ; (2) the condition of 
 their release ; (3) the restraint to which they may be 
 subjected. 
 
 On the perusal of medical writings on lunacy and 
 
INSANE AND NOT DANGEROUS. 47 
 
 the evidence given by officials in lunacy before Parlia- 
 mentary Committees, one cannot fail to be impressed 
 with the great importance which is attached to deten- 
 tion in asylums as a means of treatment of disease. 
 The one great argument in favour of facile confine- 
 ment is, that the speedy treatment of mental disease 
 may thereby be provided. This idea so pervades 
 these expressions of opinion on this subject, that it 
 appears to be assumed that the main and primary 
 object of confinement is the treatment of disease. 
 But, strange as it may, perchance, appear to many 
 well-instructed medical men, this assumption has no 
 legal foundation whatever. The purpose of the law, 
 as expounded by the judges of the law without ex- 
 ception, looks not in the slightest degree to the 
 treatment of disease as authorizing and justifying 
 the confinement of an insane person. The sole pur- 
 pose of the law is to provide for the safety of the 
 public and the individual. Safety is the one sole 
 object which the law of England recognizes as the 
 aim and purpose of confining the insane. Where 
 there is no danger, there can be no legal justification 
 of confinement ; and, without doubt, any harmless 
 and safe person, however insane, would be entitled 
 to damages for confinement in an asylum, even if 
 by such confinement he had received the greatest 
 medical benefit in regard of his disease. The dama- 
 ges might be so small as to be represented by the 
 smallest coin of the realm, but to damages on the 
 point of law he would be entitled. 
 
 In the case of Nottidge v. Ripley and another, this 
 principle was laid down as unquestionable law. At 
 this trial, for the detention of a lady who was ad- 
 mitted to have been suffering from insane delusions. 
 
48 CARE OF THE INSANE. 
 
 the Lord Chief Baron, in summing up, said : "As to 
 the plea of justification — namely, that the plaintiff 
 was a lunatic, and not capable of taking care of 
 herself, and was in such a state of mind as to be 
 likely to injure herself and other persons, and that it 
 was in consequence of being in that state that they 
 had put her in a place of safety — that plea was not 
 made out. Now, he was bound to say that the law 
 was correctly laid down by the learned counsel who 
 had just sat down " (Mr. Cockburn, now Lord Chief 
 Justice), " namely, that if the jury considered upon 
 the evidence, that the lady was not in such a state as 
 to be dangerous to herself and others, then the plea 
 to that effect not having been m^ade out, the verdict 
 ought to be for the plaintiff upon that issue. The 
 defendants were not in any way justified in adopting 
 the course they had taken, unless the jury should think 
 that the plaintiff was of unsound mind and dangerous 
 to herself and others. If the jury should be of 
 opinion that the plaintiff was not in that state of 
 danger, it was clear that the verdict upon the second 
 plea must be for the plaintiff. There could be no 
 doubt that, if the lady was not insane and dangerous, 
 a most unjustifiable outrage had been committed 
 upon her by the defendants in their own persons. 
 They might have instituted an inquiry by Commis- 
 sion ; but they had not done so ; and, therefore, they 
 had made themselves liable to such a verdict as the 
 jury might think fit to impose upon them." The 
 verdict was for £S'^ damages, the jury expressing the 
 opinion that the defendants had not been actuated 
 by any unworthy or mercenary motives. (The Times 
 June 27th, 1849.) 
 
 In the proceedings in Fletcher v. Fletcher, January 
 
INSANE AND NOT DANGEROUS. 49 
 
 1 8th, 1859, which were still more important, because it 
 was a case of argument on demurrer before the Judges of 
 the Queen's Bench sitting z>z l^anco, under the presidency 
 of a future Lord Chancellor, this principle was broadly 
 reaffirmed. In this argument, the real issue was the 
 somewhat technical one as to whether the plea was 
 admissible that the person who had been confined in 
 an asylum /lad conducted himself as a person of un- 
 sound mind, &c. ; whereas it was successfully con- 
 tended that the plea ought to have been that he was 
 of unsound mind. The argument /ri? was conducted 
 by Mr. (now Justice) Lush, who maintained that, "at 
 the common law, to be a valid justification, it must 
 be alleged and shown that the person confined was a 
 lunatic, and dangerous." Mr. Bovill, who argued the 
 demurrer contra, did not deny that this was the law. 
 Chief Justice Campbell said: " By the common law 
 of England, it is only a person of unsound mind, and 
 dangerous to himself or others, that may be restrained 
 of his liberty by another. Such is taken to be the 
 law from the case in Bro Abr, down to the last case 
 on the subject." Justice Wightman said : " At com- 
 mon law, any one taking up another as a lunatic, in 
 order to justify himself must show that he was a 
 dangerous lunatic." Justice Crompton and Justice 
 Hall concurred. References were made to many 
 previous judgments, especially to Elliot v. Allen, \\\ 
 which it was admitted by the learned judges that 
 " the law was assumed to be undoubted on this 
 point." (28 Z. y. /^., 134.) 
 
 This important argument before the full Court of 
 the Judges of the Queen's Bench, in which the 
 law of the land with regard to the confinement of 
 lunatics has been most recently declared on the 
 
 E 
 
50 CARE OF THE INSANE. 
 
 highest authority, has been somewhat remarkably 
 passed sub silentio by the Commissioners in Lunacy ; 
 although in the former less important instance, above 
 quoted, af a jury trial, the ruling of the judge excited 
 both official, medical, and legislature remonstrance ; 
 the first, in a letter to the Lord Chancellor from the 
 Commissicsners in Lunacy, ordered to be printed by 
 the House of Commons, ist August, 1849; the 
 second, in a published remonstrance to the Lord 
 Chief Baron by Dr. Conolly ; and the third in remarks 
 made by Lord Monteagle and Lord Brougham in the 
 House of Lords. The substance of all these attacks 
 upon the exposition of the law by one of its chiefs, 
 is, that obedience to the law would be exceedingly 
 inconvenient, inasmuch as, " amongst the many per- 
 sons confined as being lunatics, those who have already 
 proved themselves to be dangerous are comparatively 
 few in number" (Commissioners' letter) ; or,, to repeat 
 the words of Lord Monteagle, "the great majority of 
 persons detained in custody in lunatic asylums were 
 no more dangerous to themselves or others than any 
 noble lord who' was in the habit of addressing that 
 House." The statute law is silent on the subject of 
 a lunatic being dangerous or otherwise, except in the 
 statement appended to the order of admission. In 
 this statement, the person giving authority for the 
 confinement of a lunatic is required to state whether 
 the lunatic is suicidal or dangerous to others. It 
 would be interesting and important to know the 
 proportion of admission-papers which contains the 
 statement that the lunatic is dangerous. 
 
 It will have been observed that Lord Chief Justice 
 Campbell and the puisne judges who concurred with 
 him decLircd that no person of unsound mind who 
 
INSANE AND NOT DANGEROUS. 5 I 
 
 v/as not dangerous could legally be either taken up as 
 a lunatic or restrained of his liberty or confined. This 
 declaration of the law, therefore, covers not only the 
 taking, but the detaining and confining of insane 
 persons ; and therefore it would appear that, even if 
 a person be originally taken up as a dangerous 
 lunatic, if he should afterwards become not dangerous, 
 his further detention will be illegal. (Note p. 57.) 
 
 This opinion was very positively expressed by the 
 judge in the Nottidge case, in the examination of one 
 of the Commissioners who was a witness. " The Lord 
 Chief Baron said : Mr. Milne, was this lady in such 
 a state of mind as to be dangerous to herself and 
 others .'' — Mr. Milne : Not so far as I was aware of. 
 Not so far as I know. — Lord Chief Baron : If she 
 were not so, then how was it that you kept her in 
 this asylum for seventeen months ? — Mr. Milne : My 
 lord, it was no part of my duty to keep her there. I 
 was only to liberate her if I saw good and sufficient 
 reason for adopting that course. — Lord Chief Baron : 
 It is my opinion that you ought to liberate every 
 person who is not dangero\is to himself or others. 
 If the notion has got abroad that any person may be 
 confined in a lunatic asylum or a madhouse who has 
 any absurd or even mad opinion upon any religious 
 subject, and is safe and harmless upon every other 
 topic, I altogether and entirely differ with such an 
 opinion, and I desire to impress that opinion with 
 as much force as I can in the hearing of one of the 
 Commissioners." (See note, p. 57.) 
 
 It would be curious to ascertain how many patients 
 the Commissioners have recommended to be dis- 
 charged who have not recovered, and for what reasons 
 they have ever done so. In their letter to the Lord 
 
 E 2 
 
52 CARE OF THE INSANE. 
 
 Chancellor above referred to, the Commissioners, 
 having admitted that the dangerous lunatics are few, 
 state that the far greater number confined in asylums 
 consist of " (i) those who are sent into lunatic estab- 
 lishments for the purpose of treatment, with a view 
 to the alleviation or cure of their malady ; (2) those 
 who from disease of mind are incapable of self- 
 government, and who therefore require at certain 
 periods (perhaps generally), the most careful super- 
 vision and control ; and (3) those who are incapable 
 of taking care of themselves and their affairs, and are 
 likely, therefore, to sustain serious injury if left at 
 large and unprotected." 
 
 On the necessity of the treatment of harmless 
 patients in private lunatic asylums, an opinion diver- 
 gent from that here indicated may certainly be enter- 
 tained. Any comment upon the second category 
 of harmless patients may fairly be excused on the 
 ground that it is not possible to understand what kind 
 of harmless patients are indicated as those who, being 
 "incapable of self-government," "require the most 
 careful supervision and control." The third category, 
 of " those who are incapable of taking care of them- 
 selves or their affairs," is as vague as it is wide ; but 
 if for such incapables some kind of club-life be 
 desirable, as tending to the increase of comfort and 
 the decrease of cost — then at least let it be some 
 legalized form of association dissociated from all 
 the opprobrium and misery of asylum detention in 
 company with dangerous lunatics. 
 
 Outside of the legal justification, therefore, the 
 Commissioners maintain that an insane person, not 
 dangerous, may be confined in an asylum for treat- 
 ment, for supervision, and for care, but, as it would 
 
INSANE AND NOT DANGEROUS, 53 
 
 seem, on condition that, if released, he would be " left 
 at large and unprotected," and deprived of treatment, 
 supervision, and care. In a subsequent page, the 
 Commissioners declare that they will promote the 
 liberation of a patient of weak mind, who " appears 
 to be perfectly harmless," " if he have a comfortable 
 home, or friends disposed to receive or protect him 
 and his property from injury ; but where this is want- 
 ing, the Commissioners do not think themselves 
 justified in removing the patient from the shelter of 
 an asylum, and leaving him at large and unprotected." 
 The consideration is thoughtful and humane, but it is 
 forced upon the Commissioners by the shortcomings 
 of the statute. There are few patients who can be 
 safely discharged, even from the warm wards of a 
 general hospital, into the east wind of the street. If 
 the Commissioners could lead their patients to some- 
 thing like a home, where care and protection would 
 be provided for them, the fear of discharging patients 
 not dangerous for the reason assigned would be re- 
 moved. It must, however, not be forgotten that the 
 common law limiting the confinement of lunatics to 
 those who are dangerous applies to their confinement 
 in any place and to any restrictions upon their liberty, 
 and that strictly a man may not put his hand upon 
 the shoulder of a lunatic who is not dangerou^' without 
 committing an assault, or lock him in his bedroom 
 without false imprisonment. That such a law cannot 
 be executed is obvious. It is smothered in its own 
 absurdity as regards the proper treatment of the 
 insane at home, and only on account of its application 
 to patients detained in asylums is it important from 
 its direct antagonism to the operation of the statutes. 
 It expresses the lawyer's view of interference with the 
 
54 CARE OF THE INSANE. 
 
 insane, founded upon the facts of life when society 
 was young and simple, in opposition to the doctor's 
 view of what must be done to prevent mischief among 
 the tender and complex interests of modern life. In 
 the spring-time of the common law, a great lawyer 
 or doctor who had become insane might not be dan- 
 gerous if he were not violent ; but such a man at the 
 present day, who went about town babbling, not of 
 green fields but of family secrets, would certainly not 
 be harmless. The Commissioners, in their letter, have 
 made the mistake of adopting the word harmless as 
 the opposite of the legal term dangerous, which it is 
 not. A man is not harmless who is mischievous or 
 in any way injurious or harmful to himself or others; 
 but it by no means follows that a man not harmless 
 must be dangerous. By this term dangerous, the 
 lawyers mean liable to inflict physical, not moral, 
 injury. By _this limitation of the term dangerous 
 to physical danger, the antagonism of the common 
 to statute law is rendered the more absolute, and the 
 necessity of new enactments to reconcile the two laws 
 the more imperative. Indeed, the common law, the 
 statute law, and the royal prerogative in lunacy 
 matters are in such a hopeless state of entanglement, 
 that it would seem that nothing short of codification 
 can possfbly succeed in loosening and smoothing out 
 their knotted intricacies and confusions. 
 
 It will be observed that all the above arguments apply 
 only to insane persons, having or enjoying property. 
 The confinement of destitute persons of unsound mind 
 rests on quite a different footing. Their welfare must 
 be combined with considerations of public thrift and 
 convenience. But the well-being of an insane per- 
 son who has property surely ought not to be made 
 
INSANE AND NOT DANGEROUS. 55 
 
 by official authority deperrdent upon the disposition 
 of friends to receive and protect him and his property 
 from injury. Neither is it so left when the law is 
 obeyed. A lunatic of property who is at large may 
 remain unprotected through default of his friends. 
 But a lunatic under cognisance of the Commissioners 
 cannot remain with property " not duly protected," ex- 
 cept by inaction of the Commissioners, whose bounden 
 duty it is to invoke the jurisdiction of the Lord Chan- 
 cellor. The reasons they give for withholding the 
 exercise of their statutory powers in this respect is 
 that " proceedings by commission are, generally 
 speaking, advisable only where the insanity is likely 
 to be of a permanent character, and the property of 
 the lunatic is of such a nature as to require them." 
 Moreover, they object that these proceedings are 
 costly and public. But it is to be remarked that 
 the Lords Justices, acting with the Lord Chancellor 
 under the sign manual, are the appointed judges of 
 the propriety of commissions ; and that the Commis- 
 sioners have the simple duty imposed upon them of 
 reporting to the Lord Chancellor that the property 
 of any person alleged to be, or detained as, a lunatic 
 is not duly protected or the income not duly applied 
 for his benefit. The words relating to the application 
 of the income were added in the later statute. (8 
 and 9 Vic, c. lOO, s. 94; 16 and 17 Vic, c 70, 
 sec 54.) 
 
 The Commissioners conclude their objections to 
 commissions of inquiry by the remark that " It is 
 obvious that the finding of a jury is in no case essential 
 in order legally to justify the confinement of a person 
 of unsound mind." This is quite true, in so far that 
 very few commissions are held before juries; but it 
 
56 CARE OF THE INSANE. 
 
 is not correct, save and except for dangerous lunatics, 
 that the finding of a commission of inquiry is not 
 essential to legal detention. The Lord Chief Baron 
 was perfectly right in declaring that a commission 
 of inquiry ought to have been held on Miss Nottidge ; 
 and a large proportion of the harmless patients in 
 private asylums are in the same position as the one 
 in which that lady was illegally placed. Many are 
 the devices to evade the law : illegal payments by 
 trustees to unauthorized persons ; illegal authorities 
 to receive rents, extorted from insane persons ; illegal 
 transactions of bankers, conveniently ignorant of their 
 customers' mental state ; but, above all, powers of 
 attorney acted upon, if not given, after the insanity. 
 The number of insane persons of property who ought 
 to be under the Lord Chancellor's well-informed pro- 
 tection, but whom the Commissioners leave in the 
 unprotected shelter of asylums, is very large. Surely 
 it would not be a great thing, and would be a most 
 useful one, for the Commissioners to require informa- 
 tion of the property of all persons detained and taken 
 charge of as lunatics, and to report thereupon to the 
 Lord Chancellor, who through his registrar and medical 
 visitors would make inquiries as to their due protection. 
 As an instance, it was stated in evidence at a recent 
 trial that a gentleman with an income of ;^4,ocxD was 
 confined in a metropolitan asylum upon a stipend of 
 £'^60 ; and, seeing that his wife admitted that she 
 had expended £i,QOO a year, or thereabouts, in 
 millinery and jewels, it might be thought that he and 
 his property were not duly protected. A speedy and 
 handy proceeding in Chancery for the protection and 
 utilization of the property of persons whose insanity 
 promises to be of short duration is one of the crying 
 
INSANE AND NOT DANGEROUS. 57 
 
 needs of the lunacy law ; but it is a bad expedient 
 for legal officials to let the law entrusted to them be 
 dormant because it is costly and cumbrous. 
 
 Besides those dangerous lunatics who may be legally 
 confined under the common law and the statutes, and 
 those Chancery lunatics who may be legally confined 
 under the authority of the Lord Chancellor, there is a 
 residiimn of not dangerous lunatics having no property 
 who are maintained by relatives who have means to 
 do so. Under the canons of construction, the lunacy 
 statutes may possiby be held to justify the detaining 
 and taking charge of such lunatics notwithstanding 
 the prohibition of the common law. This may be 
 the case, and it certainly is the fact that they are so 
 detained; but it is impossible that this vast gap — 
 this huge casus omissus — should be allowed to con- 
 tinue, throwing more than a doubt upon the legality 
 of the detaining, and taking charge under the strictest 
 obedience to the forms of statute, of any insane 
 person who is not either dangerous or found lunatic 
 by inquisition. 
 
 NOTE. 
 
 P. 51. A similar question arose even with regard to pauper lunatics 
 on the first operation of the Scotch Lunacy Statute in 1858. The 
 Board of Supervisors for the Relief of the Poor, differing from the new 
 Board of Lunacy, as to the definition of the statutory term "lunatic," 
 took the opinion of the following eminent counsel thereupon, namely, 
 John Inglis, James Moncrieff, and George Ross, Esqrs. Their joint 
 opinion ran as follows : — 
 
 I. "We are of opinion that the words of the statute require, in 
 the definition of a lunatic, unfitness to be at large as regards either the 
 individual's own personal safety and conduct, or the personal safety and 
 
58 CARE OF THE INSANE. 
 
 property of others. The two elements in each alternative of the defini" 
 tion must be combined. But these may often be unusually developed 
 as to one of the elements only vv^hich necessarily implies danger as 
 regards the other. In other words, unless the unfitness as regards con- 
 duct also threaten personal danger to the individual himself, or the 
 unfitness as regards the property of others also threaten danger to the 
 persons of others, the definition of the statute will not be satisfied." 
 
 2. " We are of opinion that paupers who from weakness or fatuity 
 of mind are unable to manage their own affairs, are not compre- 
 hended under the definition of the word lunatic given by the statute." 
 — Appendix to First Report of Commissioners in Lunacy for Scotland, 
 page 119. 
 
 The legal diihculty of placing insane paupers, not dangerous and 
 therefore not lunatics, in asylums was sought to be removed by the in- 
 terpretation clause of the Scotch Lunacy Act of 1862, by which it was 
 declared that a lunatic was any lunatic idiot or insane person certified 
 to be a lunatic by two medical men. The remedy, however, has over- 
 shot the necessity ; for now it is maintained that even a dangerous 
 lunatic is not a lunatic until after he has been certified. 
 
VI. 
 
 TROPRIETARY ASYLUMS. 
 
 " Every lunatic asylum should be the property of 
 the State, and be controlled by public officers." Such 
 was one of the maxims in which the late Dr. Conolly 
 epitomised his Suggestiojis for the better Protection and 
 Care of the Insane, when, after five years of experience 
 as " Inspecting- Physician of the Lunatic Houses for 
 the County of Warwick," he wrote his first eloquent, 
 humane, and thoughtful work on insanity. Dr. 
 Conolly grounded his maxims of reform upon facts 
 which he adduced and summarised in the following 
 conclusions : " That the present regulations regarding 
 the insane are at once inefficient for the protection of 
 the insane themselves, and dangerous to the public ; 
 that it results from them that some are improperly 
 confined, and others improperly at large ; that, whilst 
 the eccentric are endangered, those actually mad are 
 often allowed a dangerous liberty ; that the public are 
 dissatisfied, and medical men harassed and perplexed." 
 " Other evils arising out of the present manner of pro- 
 viding for lunatics are, that they are often confided 
 to persons who are unacquainted with bodily and 
 
60 CARE OF THE INSANE. 
 
 mental disorders, and who neglect such treatment as 
 might conduce to recovery ; that it is the interest of 
 such persons to keep patients under their care who 
 ought not to be so confined ; that, by associating 
 lunatics with lunatics, the general chances of recovery 
 are much diminished." 
 
 A considerable reform has taken place in the regu- 
 lations regarding the insane since the above important 
 opinions were published, but not the less are "the 
 public dissatisfied and medical men harassed and 
 distressed " ; for the evils of neglected curative treat- 
 ment, of interest in unnecessary confinement, and of 
 the chances of recovery diminished by associating 
 lunatics with lunatics, have greatly increased in their 
 dimensions, though they have doubtless diminished in 
 their intensity. 
 
 Nothing which Dr. Conolly ever wrote does more 
 credit to his head and his heart than these opinions 
 on a subject that was destined to make his name 
 famous ; early opinions, it is true, and published 
 before advancing years and personal interests had 
 made him indulgent to the evils he had denounced, 
 and induced to say, like another great reformer, 
 reclining upon his well-earned laurels, " Rest and 
 be thankful." 
 
 Another name illustrious on the roll of benefactors 
 of the race of men must also be cited. It is scarcely 
 possible to discuss any question in lunacy without 
 reference, tacit or expressed, to the actions and 
 opinions of the Earl of Shaftesbury. Before the 
 actions of such a man, while still among us, criticism 
 must be dumb, lest a temperate account may sound 
 like adulation. But his opinions, which must to a 
 great degree be those of his Board, challenge that 
 
PROPRIETARY ASYLUMS. 6l 
 
 criticism of disputed questions which his hberal mind 
 will freely accept. If he have given a somewhat dif- 
 ferent estimate of the demerits of proprietary lunatic 
 asylums, in his evidence before the Select Committee 
 of 1877, from that which he gave before the Select 
 Committee of 1859, his lordship's candid and reason- 
 able explanation of the fact must be fully and frankly 
 accepted — namely, that, owing to the constant vigi- 
 lance of his Board and to the numerous changes 
 which have taken place in the persons who own pro- 
 prietary asylums, there has been a considerable im- 
 provement in the condition of these places during the 
 eighteen years which intervened between his earlier 
 and later evidence ; an improvement, however, which 
 his lordship declares would not endure if his Board 
 were to " relax their vigilance ever so little," for if that 
 be done, " the whole thing will speedily go back to 
 its former level." 
 
 Lord Shaftesbury takes great credit to the Com- 
 missioners for the vigilance with which they have 
 exercised their authority over the proprietary asylums, 
 and for the change which has taken place in their con- 
 dition ; so that the evidence given in 1859 could not 
 be fairly given at the present day. It is natural that 
 the Commissioners should exalt their office, and be 
 content with the excellent work they have done with 
 diligence and faithfulness in the public interest, re- 
 joicing over the improvements they have been able to 
 effect, even if they do so painfully feel that the edifice 
 of these reforms is a house built upon the sand. But 
 would it not be more wise to construct stable founda- 
 tions than to sustain and adorn a structure which will 
 speedily go back to its former level, unless it be main- 
 tained by unrelaxing vigilance .'' Would it not be 
 
62 CARE OF THE INSANE. 
 
 well, in so vast and varied a task as the supervision 
 of the insane, forgetting those things which are be- 
 hind, and, reaching forth to those things which are 
 before, to be a little less content with imperfect and 
 precarious achievement ? There is a passage in the 
 Commissioners' second Report, published in 1847, 
 under the title of a Further Report, the consideration 
 of which may lead to the reflection that, in a long 
 journey, under a task of grave responsibility, fitting 
 lialting-places for self-congratulation are few and far 
 between. In this paragraph, the Commissioners say : 
 " We are now desirous of satisfying your lordship, as 
 far as we are able, that whatever defects may still be 
 found in lunatic establishments, the amount of im- 
 provement that has taken place of late years in the 
 accommodation and comforts provided for the insane 
 has been great and general." Without comment upon 
 the real condition of lunatic establishments when this 
 comforting assurance was conveyed to the Lord 
 Chancellor, it is enough to state that it was made 
 when the Commissioners were unconsciously only 
 commencing the great work before them. Perhaps 
 their estimate of its progress towards completion, as 
 it may be gathered from the evidence of 1877, is 
 equally premature. Perhaps the Commissioners 
 would have been more wise toward the public and 
 more just to themselves if, before the Select Com- 
 mittee, they had repudiated the unmerited position of 
 apparent defenders of imperfect laws, and if, while 
 they still have with them the great chief to whose 
 opinions no Government can refuse deference, they 
 had shown a comprehensive forethought of the legis- 
 lative requirements of the insane. 
 
 It would, however, be most unjust to the Com.mis- 
 
PROPRIETARY ASYLUMS. 63 
 
 sioners to assume that, because they did not condemn 
 the proprietary asylums before the ParHamentary 
 Committee, they are satisfied with their condition 
 from their own point of view. Their Report pubhshed 
 in 1875, pages 39 to 50, contains an array of "occur- 
 rences in these houses deserving of particular notice," 
 which proves that, however great the changes from a 
 worse state may have been, the present condition of all 
 kinds and varieties of proprietary asylums is far from 
 satisfactory to the official mind. Proprietary Asylum 
 No. I, they report, "has been greatly improved by the 
 erection of a larger hall for recreation." In No. 2, "the 
 internal condition has not been amended satisfac- 
 torily, too little attention being paid to necessary 
 repairs and alterations." In No, 3, "we have found 
 cause to suggest that an assistant medical officer be 
 appointed." In No. 4, " a good deal has been done, 
 though more remained to be done, to improve the 
 condition of this house as to decorative repair and 
 the renovation of the bedding." In Nos. 4, 5, 6, 7, 
 and 8, transfers of licence are noted. In No. 9, "we 
 have had to express our dissatisfaction at the fre- 
 quent changes which have taken place in the post of 
 assistant medical officer, several appointments having 
 been manifestly made of gentlemen possessing but 
 little professional experience. We hope, in our next 
 report, to be able to state that effectual means have 
 been taken to establish a proper system of constant 
 observation of the suicidal and epileptic patients." 
 In Nos. 10, iir 12, changes in the licence are re- 
 corded. In No. 13 a gentleman of advanced years 
 committed suicide by hanging ; " due vigilance had 
 not, in our opinion, been exercised." In No. 14, 
 " improvements have been made in the buildings." 
 
64 CARE OF THE INSANE. 
 
 In No. 15, a lady committed suicide under arrange- 
 ments which the Commissioners designate as "simply- 
 delusive, and ought never to be relied upon as safe." 
 In No. 16, "a demented patient, aged ']6, in feeble 
 health," was stated by his son to have been " ill- 
 treated and severely injured." Appended [to the 
 son's letter] was a certificate of a medical man, testi- 
 fying to " several wounds, bruises, and bed-sores upon 
 the person of the patient." After " a careful inquiry, 
 we came to the conclusion that there was no evidence 
 to support a charge of intentional ill-treatment, or 
 even of gross carelessness ; but we were far from ex- 
 onerating those concerned from all blame." In Nos. 
 17, 18, and 19, changes in the licence are recorded. 
 In No. 20, "we were unable again to report favour- 
 ably ; most of the rooms require renovation as to 
 paint, paper, and furniture." In No. 21, "the pro- 
 prietor has not applied for the renewal of his licence." 
 
 In No. 22, it was found that Dr. had "very 
 
 wrongly neglected to make proper entries in the 
 medical visitation-book as to seclusion." In No. 23, 
 change in licence; In No. 24, the male division and 
 also the state of the bedrooms, " unfavourably noticed 
 last year, was found to be satisfactory." A death by 
 suicide is reported, " the arrangements made for 
 the supervision of this patient were culpably lax." In 
 No. 25, a death by suicide occurred, but the coroner's 
 jury exonerated all persons from blame. In No. 26, 
 " more frequent and efficient visitation of the wards 
 by night" is recommended. In No. 27, " we have 
 found cause to complain of the deficiency of attend- 
 ants ; the arrangements being unsuitable for the re- 
 ception of suicidal, violent, and dangerous cases, it 
 would seem proper to confine this licence to the 
 
PROPRIETARY ASYLUMS. 6$ 
 
 reception of patients of the quiet and harmless class ! " 
 In No. 28, " the dining-rooms and other parts of 
 the house are unsatisfactory;" there is "a want of 
 proper attendants." In No. 27 the Hcence has been 
 dropped. In No. 29, " the conduct of this house 
 had for some time been unsatisfactory to us. An 
 inquest was held here on the housekeeper of the 
 proprietor ; she died of haemorrhage after child- 
 birth, in circumstances discreditable to the proprie- 
 tor, etc. ; licence was not renewed." In Nos. 30, 31, 
 and 32, changes in licence are reported. In No. 
 33, ''we urged that the practice of bathing two pa- 
 tients in the same water ought to be discontinued." 
 In No. 34, a suicide by hanging is reported ; the 
 coroner's jury attached no blame to any person. In 
 No. 35 (Midland Idiot Asylum), "from deficient 
 water-supply, want of furniture, rough state of 
 grounds, we found it impossible to report as to fit- 
 ness for occupation ; " " this is essentially a charitable 
 institution." In No. 36, "the suicide of a gentleman 
 gave rise to a prosecution, at our instance, of the at- 
 tendant on whom the chief blame appeared to rest." 
 In No. 37, "the condition has for some time past 
 been reported as extremely unsatisfactory. Much 
 renovation is required, but the proprietor is reluctant 
 to carry out any of the improvements necessary to 
 place this house in a fit state for the reception of 
 patients." 
 
 When it is considered how large a proportion of 
 these " occurrences in these houses deserving of parti- 
 cular notice" have reference to the renovation and 
 decoration of the buildings, to " paint, paper, and 
 furniture," it must be admitted that the condition of 
 these houses as buildings does not, on the whole, 
 
 F 
 
66 CARE OF THE INSANE. 
 
 appear, from this recent report of the Commissioners, 
 to be satisfactory and reassuring. But if so much 
 " more is expended upon them by the proprietors " 
 as receptacles and residences, while these comments 
 have to be made, what must have been their con- 
 dition beforetime .-* " Very bad indeed ; " as Lord 
 Shaftesbury admits. With the exception of a com- 
 ment on one asylum, as to several appointments of 
 inexperienced medical officers, there is not one re- 
 mark, throughout the above long list, of a medical 
 or qiiasi-nx&diCdX character ; and all reference to 
 the objections above quoted from Dr. Conolly, to the 
 system of proprietary asylums, are conspicuous by 
 their absence. 
 
 If the Commissioners had embarked upon the task 
 of investigating the qualifications of the proprietors 
 with regard to their acquaintance with bodily and 
 mental disorders ; to their employment or neglect 
 of such treatment as miight conduce to recovery; to 
 their detention of lunatics who ought not to be 
 confined in asylums ; and to the diminution of the 
 chances of recovery by the association of lunatics 
 with lunatics, what might not then have been the 
 list of "occurrences deserving of particular notice" 
 within the course of the official year .'' There is no 
 comparison between the importance of those things 
 which ought to have been done and the things stated 
 to have been left undone. (See note, p. 74.) 
 
 In the early years of the commission, wide and 
 scientific views of medical hygiene and medical 
 treatment were to be found in the Reports, worthy of 
 such able and eminent physicians as Dr. Turner and 
 Dr. Prichard ; but of late the medical spirit has been 
 drowned in the flood of official duty, and it is in vain 
 
PROPRIETARY ASYLUMS. 6/ 
 
 now that we look for any signs of the consideration 
 of lunacy questions from a medical point of view. It 
 is to be hoped that some day the commission will 
 return to its allegiance to medical science, without 
 which it can neither lay the sure foundation nor crown 
 the edifice of its reforms. We shall then have ac- 
 counts of a very different character, not upon the 
 " paint, paper, and furniture " of receptacles for the 
 insane, but upon the curative treatment of patients in 
 hospitals for the insane, and of convalescents and out- 
 patients, and of mental disease dealt with generally 
 with the intent and purpose of curing or abating it. 
 But, whatever may have been the changes of fact for 
 the better in the state of proprietary asylums, as dis- 
 tinguished from that of their inmates, from that con- 
 dition when, after the commission had been at work 
 for more than a quarter of a century, it was "very 
 bad indeed," the principles which Lord Shaftesbury 
 denounced remain unchanged, and unchanged they 
 must remain so long as human nature retains its im- 
 perfections. The vigilance of the Commissioners 
 cannot alter the bias of nature, and it was upon 
 arguments grounded upon this persistent influence 
 his lordship denounced the detention of insane 
 persons in private establishments for the profit of 
 the proprietors. A republication of the whole of his 
 evidence would be too long for these pages ; but 
 it is impossible to conceive anything more weighty 
 and convincing than his argument against "that 
 vicious principle of profit" which he denounces. — 
 " Half of the provisions [in our Lunacy Acts] " he 
 says, " are made to enable the Commissioners to 
 fight against the selfishness of persons who open 
 these asylums. When a certain diet, for instance, 
 
 F 2 
 
68 CARE OF THE INSANE. 
 
 is prescribed, what security is there that that diet 
 is given ? We know that a certain course of medi- 
 cine is necessary, but what security is there that 
 that course of medicine is undergone by the patient ? 
 And it is, therefore, in their power to retard the 
 cure of their patients indefinitely, and the tempta- 
 tion is inordinately great, and it is more than human 
 nature can ordinarily stand." [Question 504.] 
 
 " If a patient is manifestly cured, then the dis- 
 charge must take place ; but what I say is this, that 
 it is in the power of the medical superintendents [of 
 private asylums] not to hasten the cure, but to retard 
 the cure ; and there are many remedies that they 
 will not give, and there are things that may be done 
 that they will not do." [Question 505.] "With re- 
 gard to the attendants in those houses, the principle 
 of profit keeps dov.'n the wages, and the attendants 
 in them have not the highest qualifications." [Ques- 
 tion 506.] 
 
 Lord Shaftesbury takes care to include under his 
 condemnation the keeping of insane patients for profit 
 either as the inmates of licensed houses or as single 
 patients ; and it is clearly the unprofessional re- 
 muneration for boarding a patient at which he strikes, 
 not at fees or payments for professional services. It 
 is at this business of keeping lunatics, and not at the 
 professional relation of medical men with the insane 
 and its legitimate remuneration, at which he directs 
 his severe and weighty censure. 
 
 Indeed, on this point he states- emphatically, " I 
 have been told that I entertained most undue sus- 
 picions of that great [medical] profession. I have no 
 suspicion of them as medical men ; but my suspicions 
 are of the medical men only when they are proprietors 
 
PROPEIETARY ASYLUMS. 69 
 
 of lunatic asylums into which patients are taken for 
 profit. I am perfectly ready to admit that there are 
 some of the best men in that department of the pro- 
 fession that one can meet with. I am perfectly ready 
 to admit that there are a great many medical pro- 
 prietors who now, under the operation of this Act, 
 are governed in a great measure by their own good 
 feelings, and they have brought their houses to a very 
 great degree of excellence ; but even the very best of 
 them must be under this influence of the profit to be 
 made out of the patients." [Question 494.] 
 
 On reading the above extracts of evidence, not the 
 strongest in expression, given in 1859, one cannot be 
 surprised that his lordship's sense of the great and 
 various improvements he specified, which under the 
 advice of his Board have been made in the condi- 
 tion of proprietary asylums, should have led him to 
 declare in 1877 that, "so far as the evidence I gave 
 in 1859 ^s concerned, I should not give it now." 
 His view of the principle of profit, however, seems to 
 have undergone but little modification, although it is 
 now recognized more as the feeling of the public. 
 
 "There exists a principle and desire of profit ; and, 
 so long as there are licensed asylums on any great 
 scale, the public will always conceive that the principle 
 of profit will of necessity predominate." [Question 
 
 ii>357. 1877-] 
 
 Mr. Dillwyn : "Your lordship's opinion is that it 
 greatly depends upon, administrative action to correct 
 or counteract the- vicious principle [of profit] which; is 
 ever striving to reassert itself.''" Lord Shaftesbury : 
 " I think it does, unless you can introduce such a 
 system as to make the hospital system universal, then 
 to some extent the principle of profit is eliminated ; 
 
JO CARE OF THE INSANE. 
 
 and I should be very glad to see it, and I only wish 
 to retain a certain number of [licensed] houses which, 
 as I said before, will then be of the very highest 
 order." [Question 11,509.] 
 
 But, why is the principle of profit, the great motive 
 power of the world's work, so mischievous in its 
 application to the care and control of the insane } 
 Why should not a lunatic be kept for profit as freely 
 as a child at a boarding-school, or a sane adult at a 
 boarding-house .-' Lord Shaftesbury sees that there 
 is a wide though general distinction to be drawn. 
 
 Mr. Dillwyn : "You still condemn the principle of 
 it as strongly as ever } " — " Yes ; as applicable to this 
 particular form, this subject-matter of lunacy. I 
 know many persons will say the principle of profit 
 enters into a great number of pursuits and profes- 
 sions ; no doubt it does, but there is something 
 very peculiar in the condition of lunacy, something 
 specially demanding more than ordinary care." [Ques- 
 tion 11,506.] 
 
 This "something," which led John Stuart Mill to 
 declare that an insane person should everywhere be 
 regarded as a proper object of the care of the State, is 
 his dependence, his helplessness, and his incapacity 
 to give evidence regarding himself. A child also 
 is dependent, but the love of parents for their chil- 
 dren is so general that it forms one of the broadest 
 foundations of social order. Yet, the control of 
 parents is not unlimited, as the Factory and Edu- 
 cation Acts prove. Moreover, children are not im- 
 prisoned in schools for unlimited periods, neither 
 are they incapable of giving testimony which is ac- 
 cepted as reliable regarding themselves. Towards 
 lunatics, on the other hand, the affection of relatives 
 
PROPRIETARY ASYLUMS. , 7 1 
 
 is too often in abeyance, and the patients are 
 " altogether abandoned " to the care of others. Lord 
 Shaftesbury gave very strong evidence on this point 
 in 1858, urging upon the Committee that the thirty- 
 sixth clause of the Act of 1828, which had somehow 
 dropped out of the subsequent Act, should be re- 
 enacted, by which clause the person under whose 
 authority a private patient had been confined was 
 compelled to visit the patient " once at least in every 
 six months during his confinement." [Question 226.] 
 See note, p. 74. 
 
 The Lord Chancellor exacts such visitation from 
 Committees of the Person every three months ; but 
 there is no law or regulation respecting the individual 
 visitation of patients in asylums who are not under 
 the Lord Chancellor's care. If they are not "alto- 
 gether abandoned," " the friends very seldom do 
 come," and the only visitation to which they have a 
 legal right is that official inspection when the whole 
 regiment is reviewed and each rank and file looked 
 at in his turn. Even the correspondence of patients 
 in private asylums is restricted. " I dare say that 
 very often they are prevented from writing to their 
 friends in a way that is really cruel and unjust." 
 [Question 224, 1859.J If the friends were to visit, 
 as many of them do, there is no certainty in such 
 asylums that they would be able to obtain any accu- 
 rate information of the treatment of the patient, since 
 even the Commissioners declare their inability to do 
 so. " We have the power in the licensed houses to 
 fix the dietary, and we often have done so ; but whe- 
 ther they observe it is a difficult thing to say. And 
 there is an evil again, as a profit is to be made out of 
 the whole matter; when our backs are turned, how do 
 
72 CARE OF THE INSANE. 
 
 we know what they will do ? " (Question 402.) When 
 the friends do visit, which is "very seldom," and " very 
 seldom that they give themselves any trouble about 
 the condition of the patient, the proprietor would take 
 care to trim up the room, put the patient on a clean 
 shirt, and make his relatives believe that he was fairly 
 kept." [Question 913.] All these things thus stated 
 by Lord Shaftesbury to the Select Committee of 1859 
 may, no doubt, be much better now than they were 
 at that time, as they might have been much better, 
 according to the Commissioners, at that date than 
 they were in 1847, when the second self-satisfied 
 Report of the Commissioners to the Lord Chancellor 
 was made ; yet there is no assurance that the im- 
 provement is permanent, but, according to Lord 
 Shaftesbury, quite the contrary. "You think, if the 
 vigilance of the Commissioners is relaxed ever so 
 little, things would relapse into their old form .-' " " I 
 think so [said his lordship] ; and I look not only 
 to the vigilance of the Commissioners, but to the 
 vigilance of the public. I want everybody to be alive 
 to the matter." [Question 11,507, 1877.] 
 
 It ought to be needless to point out that Lord 
 Shaftesbury's evidence in 1877 was not inconsistent 
 with that which he gave in 1859. Indeed, he said ex- 
 pressly in 1877: "I, entertain all the opinions I then 
 [in 1859] entertained in respect both of licensed houses 
 and hospitals ; but I should -.be very sorry to see an 
 enactment that prohibited licensed houses altogether." 
 [Question 11,352.] There are few, if any, wide in- 
 terests respecting which a great variation in the detail 
 of evidence would not be rendered needful by the lapse 
 of eighteen years. But the principle which underlies 
 Lord Shaftesbury's testimony of both dates remains, 
 
PROPRIETARY ASYLUMS. 73 
 
 and the conclusion drawn is identical. This further 
 cause of variation ought not to be overlooked, that 
 the Select Committee of 1877 was appointed to in- 
 quire into the lunacy laws so far as regards the 
 security afforded by them against violations of per- 
 sonal liberty; while the Select Committee of 1859 
 was appointed to inquire into the operation of the 
 lunacy laws generally. The questions being different, 
 the answers might be expected to vary. In this 
 later inquiry, the reference might be considered to 
 show that suspicion unjust to the work of Lord 
 Shaftesbury and his colleagues was entertained? 
 and to forebode hostile changes in the law. In 
 the earlier inquiry, a considerable change in the 
 law was anticipated as needful, and it was his lord- 
 ship's duty to indicate the principles on which these 
 changes ought to be made. That he did so with 
 uncommon courage, knowledge, and perspicuity, is 
 known to all who have studied the Blue Book which 
 his evidence mainly has redeemed from oblivion. 
 In many respects, his opinions therein expressed 
 were adopted in drafting the new statutes of 1862 ; 
 although as respects proprietary asylums, on which 
 subject he spoke more strongly than on any other 
 subject, his opinions were not adopted by the legis- 
 lature. His earnest recommendation that hospitals 
 for the well-to-do insane should be established at 
 the public cost was not adopted ; nor were such 
 obviously just, needful, and easy regulations as the 
 one above referred to respecting the visitation of 
 lunatics by their friends, nor that one respecting the 
 renewal of certificates after a patient had been de- 
 tained in an asylum for three months. [Question 201.] 
 Lord Shaftesbury's opinions in 1859 were perhaps in 
 
74 CARE OF THE INSANE. 
 
 advance of the time. There might have been what 
 he calls a "temporary exhibition of feeling on the 
 part of the public," but the wind of public opinion 
 had not filled the sails of legislative resolve ; now 
 there are signs that it will blow steadily, though it 
 may not be a trade wind. To a great extent Lord 
 Shaftesbury has himself been the vEolus, for there 
 can be no doubt that his opinions, cloud-compelling 
 or dispersing, have shaped the thought of the present 
 day : thought which is becoming anxious in its agree- 
 ment with his earnest desire — " I look to the vigi- 
 lance of the public ; I want everybody to be alive to 
 the matter." But good law, well administered, leaves 
 the public mind at rest ; and it is the defect of law 
 in unsettled countries which compels men to form 
 vigilance committees. 
 
 NOTES. 
 
 P. 66. Mr. Lutwidge, in his evidence before the Select Committee in 
 1859, frankly declared that the Commissioners were not in the habit of 
 interfering in the course of medical treatment which insane patients in 
 asylums undergo. It is no part of their duty, and they take no formal 
 action about it, although with reference to treatment generally, such 
 as diet, restraint, lodging, and so forth, they do tal<e action. Also 
 they offer advice as to such general treatment, but not as to physic. 
 [Questions 2106 et seq.] 
 
 P. 71. It may be well to support the above opinion, even of so high 
 and pure an authority as Lord Shaftesbury, upon the leading principle 
 which ought to be the foundation of all proposals for change in the 
 detention of the insane. 
 
 On the 6th of June, 1845, Lord Shaftesbury, then Lord Ashley, said, 
 in the House of Commons, " Our present business is to aihrm that 
 poor lunatics ought to be maintained at the public charge. I entertain, 
 myself, a very decided opinion that none of any class should be received 
 
PROPRIETARY ASYLUMS. 75 
 
 for profit ; but all, I hope, will agree that paupers at any rate should not 
 be the objects of financial speculation." At the present time, how- 
 ever, I, no pauper lunatics are still confined in proprietary asylums as 
 objects of financial speculation. 
 
 In 1857 Mr. Gaskell and Mr. Campbell, two of the English Com- 
 misiioners in Lunacy, acting in conjunction with Lord Monteith and Sir 
 James Coxe as Her Majesty's Commissioners appointed to inquire into 
 the state of lunatic asylums in Scotland, reported to Her Majesty as 
 follows : — "Where economy on the one hand and profit on the other 
 are in undisguised operation as the main motives of conduct, there 
 can be no doubt that pauper lunatics in licensed houses are exposed to 
 the danger of privation and neglect," (p. 125). In 1858 Mr. Wilkes 
 and Mr. Lutwidge, other two of the Commissioners in Lunacy, acting 
 as Her Majesty's Commissioners of Inquiry into the state of lunatic 
 asylums in Ireland, reported to Her Majesty, " It cannot but be 
 observable in a private asylum how limitedly the patients' wants seem 
 to be discerned when they are not absolute necessities ; how little the 
 agreeable is studied where it is not the essential ; and how strong the 
 tendency must be to restraint, since the opposite system, if carried out, 
 will necessarily require an increased number of attendants, at increased 
 cost, and therefore diminished profit, to the proprietor. In fact, without 
 seeking to reproach any, we fear it must be confessed by all, that 
 where profit is the aim, it will too generally be pursued to the prejudice 
 of those from whom it is derived. With these views we would desire 
 to see institutions established for the reception of that class of lunatics 
 whose social position places them above receiving support from public 
 funds, or seeking to be maintained by private charity, and yet whose 
 humble means will not admit of their being placed, as single patients, 
 where funds as well as friends will not be wanting to ensure their 
 comfort," (p. 32). 
 
 Mr. W. G. Campbell, the Commissioner, again expressed his opinion 
 in evidence before the Select Committee in i860, " I am fully aware of 
 the defective and very unadvisable arrangement of having a licensed 
 house for the detention of insane persons, because the treatment of the 
 insane involves the detention of the person. The fact of a pei-son 
 receiving another for profit, and having the power to de^ rive him of his 
 liberty, is, I think, a most objectionable arrangement." 
 
 The Commissioners iiave expressed doubts and foretold difficulties as 
 to the best method of providing a remedy for this most objectionable 
 arrangement, but they do not appear to have deviated from the great 
 principle which, in the above termi, they have so strongly emphasized. 
 
VII. 
 
 PROPRIETARY ASYLUMS. 
 
 Ix the Appendix to the ]\Iinutes of Evidence given 
 before the Select Committee on the Lunacy Laws, 
 1877, will be found a table showing the proportion 
 per cent, of private patients under the Lord Chancellor 
 and under the Commissioners in Lunacy in England 
 and Wales who were respectively in asylums or in 
 private dwellings in the year 1875, from which it 
 appears that of the Lord Chancellor's lunatics 65 '4 
 per cent, were in asylums and 34'6 in home-treatment 
 in private dwellings. Of the English Commissioners' 
 lunatics, 94-1 per cent, were in asylums and 5 '9 P^r 
 cent, in home-treatment. The remarkable difference 
 existing betvs^een the proportion of private patients 
 under different authorities who are retained in asylums 
 or under home-treatment in private dwellings cannot 
 be accounted for by the greater wealth of the Lord 
 Chancellor's lunatics. Many of the Chancery patients 
 are persons of slender means ; indeed, Dr. Lockhart 
 Robertson, in reply to the inquiry whether the pay- 
 ment in asylums was not larger in the case of Chancery 
 lunatics, said : " I do not know that it is larger. The 
 
PROPRIETARY ASYLUMS. JJ 
 
 Chancery lunatics are not a rich class. No ; I should 
 think the payment was about the average." [Question 
 879.] But there can be no doubt that, owing to the 
 great cost of proceedings in the Lord Chancellor's 
 offices, inquisitions are frequently dela}'ed so long 
 as hopes of recovery appear to exist ; and that, con- 
 sequently, the average character of the malady in 
 Chancery lunatics is more chronic and incurable than 
 in certificated lunatics. 
 
 But neither the property nor the chronicity of the 
 Lord Chancellor's patients can account for the wide 
 difference existing being the 34'6 per cent, of those who 
 are in home-treatment, compared with the 5*9 of the 
 Commissioners' patients who are in home-treatment. 
 The real cause of the difference is referable to the dif- 
 ferent opinions which appear to be entertained in the 
 two lunacy offices as to the care and treatment of the 
 insane. The opinion of the Commissioners, expressed 
 in their reports and their .evidence passim, and even 
 more emphatically by the above figures, is, that the 
 care and treatment of the insane in asylums is to be 
 preferred to their care and treatment at home or in 
 private dwellings. The chiefs of the lunacy depart- 
 ment of the royal prerogative — namely, the Lord 
 Chancellor and the Lords Justices- — influenced partly 
 by the traditions and practice of their office and 
 partly by the opinions of their subordinate officers, 
 take a different view of the question, which is forcibly 
 expressed in the fact that the proportion of their 
 lunatics under home-treatment is six times as great 
 as that of the Commissioners' lunatics. The Lord 
 Chancellor and the Lords Justices have given no 
 evidence of their opinion beyond this fact, for which 
 they are ultimately responsible. The opinion, however, 
 
y8 CARE OF THE INSANE. 
 
 of the secondary officials of the department may be 
 gathered from a memorandum submitted to the Lord 
 Chancellor, and to be found in the second Appendix 
 to the Report of the Select Committee. This memo- 
 randum from the Board of Visitors to the Lord 
 Chancellor, after referring to a previous memorandum 
 having reference to the condition and treatment of 
 patients in a particular asylum, assured his lordship 
 that "thirteen years' working of this Act has led the 
 visitors to the conclusion that the one yearly visit to 
 the asylum patients is insufficient for the due protec- 
 tion of these patients ; while, on the other hand, the 
 quarterly visits to the patients in private dwellings is 
 as much in excess of their requirements." It is further 
 stated that " the Chancery lunatics in private dwellings 
 are quiet and harmless cases of dementia and im- 
 becility of many years' standing, and whose habits 
 and mode of life change little year by year ; and they 
 and their guardians are, from long intercourse, equally 
 well known to the visitors. On the other hand, the 
 Chancery patients in asylums are more recent cases^ 
 and hence more likely to recover than those in private 
 dwellings, while in the inferior private asylums they 
 are more liable to improper treatment. It is obviously 
 a greater hardship that a patient in an asylum, if 
 recovered or if improperly treated, should remain 
 under such conditions for any length of time from 
 want of visitation, than if such patient were in a 
 private dwelling. As a matter of fact, these patients 
 frequently complain to us that they are so rarely 
 visited, and are thus deprived of opportunities of 
 obtaining redress for their grievances. We are thus 
 led respectfully to submit to the Lord Chancellor this 
 suggestion : that the visitation of all the Chancery 
 
PROPRIETARY ASYLUMS. 79 
 
 lunatics be equalized," etc. Signed, " W. N. Nicholson, 
 Chairman of the Board." 
 
 In this remarkable memorandum, the visitors ap- 
 pear to commit themselves definitely to the following 
 opinions : i. The "quiet and safe" Chancery patients 
 are, as a rule, taken care of in private dwellings, 
 where their treatment is so satisfactory to the visitors 
 that an official visit once a quarter is considered to be 
 in excess of the requirements for their due protection, 
 notwithstanding that the Chancery single patients 
 are exempted from the fortnightly visit and report of 
 a medical attendant, to which single patients under 
 certificates are subjected. 2. Lunatics are more liable 
 to improper treatment in the inferior private asylums 
 than they are in private dwellings. 3. The recovery 
 of a Chancery lunatic, detained in an asylum, is liable 
 to be overlooked for a considerable time until the 
 annual examination of the visitor be made. 4. The 
 sufferings of a person in an asylum, either from ill- 
 treatment or from detention after recovery, are ob- 
 viously greater than those which would be endured 
 under similar circumstances in a private dwelling. 
 5. Where there is a deficiency of visitation, the right 
 course to adopt is to increase it, and not to transfer 
 the duty to some other body. 
 
 It would be interesting and important to know in 
 what the improper treatment of Chancery patients in 
 asylums, referred to by the visitors, mainly consists. 
 The reports of the visitors are secret under the statute ; 
 but the substance of them is conveyed to the Com- 
 mittees whenever recommendation of improved treat- 
 ment is made in them. The visitors do not exercise 
 any control over the conduct and management of 
 asylums ; and, therefore, it may be supposed that 
 
80 CARE OF THE INSANE. 
 
 their reports do not frequently refer to the architec- 
 tural and upholstery business of asylums. They have 
 not even to consider and report upon the condition of 
 their patients collectively in any asylum, but upon the 
 state of mind, condition of body, the treatment, com- 
 fort and enjoyment of his means, of every individual 
 patient, and to declare in each case that nothing more 
 can be done for the well-being- of each patient than is 
 done; or, in case of inability to make such a declara- 
 tion, they are compelled to report to the Board the 
 grounds of their dissatisfaction. As regards the wel- 
 fare of the individual lunatic, and especially as regards 
 his protection from needless confinement, it may well 
 be that the single visit of the Lord Chancellor's visitor 
 may be of more value than the multipled visitations 
 of officials who mainly regard the lunatics in a mass, 
 who visit the patients rather than each patient, and 
 the asylums rather than the patients. It is no in- 
 justice to the Commissioners to say that their onerous 
 and varied duties prevent them from giving that 
 minute attention to the mental condition and the 
 treatment of each patient under their supervision, 
 which would be needful if they had to make a report 
 upon the mental and bodily state and the require- 
 ments of each patient. Whenever cases of doubt and 
 difficulty are brought under their notice, they may 
 spare no pains. They do frequently grant private 
 interviews to patients Avho request them, and who are 
 fit subjects for such interviews; and they also grant 
 interviews not private with almost any patients who 
 make the demand, and who, as a rule, are the most 
 captious and querulous and troublesome inmates of 
 every asylum. But under this plan, a depressed, a 
 reserved, or a convalescing patient, who has not 
 
PROPRIETARY ASYLUMS. 8 1 
 
 regained the strength and boldness of health, is ex- 
 trennely likely to be overlooked, although he is exactly 
 the patient whose removal from the unsanitary sur- 
 roundings of an asylum is most needful for his perfect 
 recovery. There is a tide in the affairs of madness 
 which, seized at flood, leads on to fortune, the precious 
 fortune of health ; neglected, all the life is spent in 
 shoals and shallows. This is no poetical hyperbole ; 
 for, in all sobriety of statement, it may be affirmed 
 that, in most cases of insanity, there is a time 
 when an entire change of surroundings effects the 
 happiest change in the mental state — sometimes 
 resulting in perfect recovery, oftentimes resulting 
 in permanent improvement. If this state be over- 
 looked, it passes into one or other of the chronic 
 forms of insanity, and the last state of that man 
 is worse than the first. It might be that the pro- 
 prietor of a private asylum would say to the visit- 
 ing Commissioners : " Here are some patients who 
 have not recovered, but they are so much improved 
 that they would be likely to recover under domestic 
 care, which their ample means can liberally provide. 
 They are reserved and retiring, but, if you will 
 examine them, I think you will advise their removal." 
 It might be that the proprietor of a private asylum 
 would thus aid the Commissioners in the discharge of 
 their most important duties ; and in those instances 
 where the proprietor of an asylum is more a physician 
 than a man of business, such cases might be and are 
 so dealt with, without the aid of the Commissioners. 
 But, in default of such disinterested action, the tran- 
 sitory 7iisus of returning sanity is exhausted, and 
 these unhappy people remain until they die " asylum- 
 made lunatics." 
 
 G 
 
82 CARE OF THE INSANE. 
 
 The detention in asylums of patients who have 
 absolutely recovered is not a common occurrence. 
 For many reasons, a sane person is not a welcome in- 
 mate in a proprietary asylum. He is almost certain to 
 be a keen and hostile observer — " a chiel amang ye 
 takin' notes" — or at least a troublesome and persis- 
 tent claimant for his liberty. Recovered patients are 
 much more frequently detained for a while in county 
 asylums, and with good reason ; for the prolonged 
 detention there is almost sure to be for the patient's 
 own benefit, or for the public interest and safety ; 
 and the superintendent, feeling himself placed above 
 the suspicion of corrupt motives, is not afraid to 
 exercise a large discretion. But recovered patients 
 are sometimes met with in proprietary asylums, if the 
 examination of the patients be made in such a 
 manner that the state of mind of each patient be 
 ascertained. The Author, in his evidence before 
 the Select Committee, stated that, while he was 
 the Lord Chancellor's visitor, he had met with five 
 cases of persons who were detained in asylums 
 under the imputation of insanity a considerable time 
 after they had recovered, although, with one ex- 
 ception, they were not originally put into the asy- 
 lums while sane. [Questions 1,771, 1,890, 1,891.] 
 If five such cases could be found by the Author 
 from among the five-hundred Chancery patients, the 
 average number which he visited in asylums, the 
 total number of patients detained under the imputa- 
 tion of insanity when they were recovered among the 
 four thousand six hundred patients in proprietary 
 asylums might be forty-six, which would not be an 
 altogether insignificant matter, although it is fully 
 admitted that this evil is but a small one compared 
 
PROPRIETARY ASYLUMS. 83 
 
 with the magnitude of that other evil of detaining in 
 asylums unsuitable patients who have not recovered. 
 This is the great evil at which public opinion should 
 strike, notwithstanding the shield of authority which 
 has been thrown over it. It is upon this wrong that 
 the proprietary asylums thrive, and it is this wrong 
 which the Select Committee ought to have searched, 
 no" like a pocket of hops by a square inch of sample, 
 but by an examination of the bulk — by a thorough in- 
 vestigation, which it never attempted. The reference 
 to the Committee was to inquire into the operation of 
 the lunacy laws so far as regards the security afforded 
 by it against violations of personal liberty. What 
 greater violation of personal liberty can be conceived 
 than to imprison a man in a lunatic asylum kept for 
 profit by a private proprietor, unless such imprison- 
 ment is lawful and necessary ; lawful not only accord- 
 ing to doubtful interpretations of the forms of statutes 
 which omit to state the law, but according to the 
 great common law of the land ; necessary not for the 
 convenience of relatives, but for the safety of the 
 public and the protection of the patient ? 
 
 It cannot be too much insisted upon that the 
 allegation against the proprietors of private asylums 
 is not that of jna/a fides in taking, detaining, and 
 confining persons of sound mind as lunatics ; but that 
 they detain persons of unsound mind, whose con- 
 finement within their walls is unnecessary and un- 
 lawful. Very curiously, the Select Committee do 
 not appear to have had their attention directed to the 
 common law, since they have assumed throughout 
 the inquiry that the whole of the lunacy law was 
 contained in the ragged tessellation of statutes which 
 they superficially examined. The law of confmement, 
 
 G 2 
 
84 CARE OF THE INSANE. 
 
 therefore, is not to be found in the Blue Book. The 
 necessity of confinement even is but sparingly alluded 
 to ; the assumption throughout the inquiry seeming 
 to be that patients who had not perfectly recovered 
 were rightly detained ; and hence it was, as the 
 Committee reported, that " much of the evidence 
 amounted to little more than complaints of hesitation 
 among superintendents and relatives to believe in 
 the perfect recovery of patients." 
 
 With one remarkable exception, there is nowhere 
 to be found in this Blue Book on violation of liberty 
 any attempt to account for those abundant instances 
 of it in which patients who are not dangerous are in- 
 carcerated in asylums. The exception occurs in the 
 evidence of Dr. Mitchell, the Scotch Commissioner 
 [Questions 9,927 to 9,936] ; and applying for the 
 most part to the detention of patients in Scotch 
 chartered asylums under the sheriffs' order, which is so 
 much less open to suspicion than their detention in 
 private establishments, that it will lose nothing in 
 the weight of its candid admissions by comparison 
 with the English practice. Dr. Mitchell observes: "I 
 scarcely require to say that a large number of patients 
 are sent to asylums neither in the hope of cure nor 
 to promote their happiness and well-being ; they are 
 sent to promote the comfort of other people, or as a 
 matter of convenience. It is not intended to injure 
 patients who are thus sent ; on the contrary, care may 
 be, and generally is, taken to secure for them every 
 reasonable comfort and advantage. I do not allude 
 to this because I think the motive for such removals 
 necessarily bad ; on the contrary, I think it often 
 good ; it springs occasionally from nothing more than 
 a sense of justice to the healthy, whose prosperity and 
 
PROPRIETARY ASYLUMS. 85 
 
 comfort may be destroyed by the presence among 
 them of an insane relative. . , . The determination 
 of whether an insane relative ought or ought not to 
 be sent to an asylum often depends upon consider- 
 ations apart from the mere existence of insanity, 
 apart even from its character. These considerations 
 of convenience, however, may be carried so far as to 
 be unjust to patients whose insanity is but slightly 
 marked, and who feel the restraints of an asylum 
 very irksome. Ordinary mental enfeeblement is now 
 more frequently certified to be lunacy than formerly. 
 There is a change in this subject^both on the part of 
 the community and of medical men." 
 
 " I frequently saw patients, during one visit to a 
 county, at home and provided for under private care ; 
 a year elapsed, and on going back I found that those 
 patients had been removed to asylums. The reasons 
 I was interested in knowing. There might be a 
 change in the patient's condition, but that was seldom 
 the reason. It much more frequently happened, the 
 cases being chronic cases, that the removal was due 
 to some change which had occurred in the domestic 
 arrangements, some one's death, or perhaps the loss 
 of money, or perhaps even the acquisition of money. 
 The reasons were extremely various, but they were 
 not generally reasons which related to the patient's 
 own condition or his insanity. They were often, I 
 thought, good and sufficient reasons. I frequently 
 thought that, on the whole, it was an advantage to 
 the patient that he had been removed. At other 
 times, I thought that, with a little forbearance, and 
 with a Httle attempt to adapt the new circumstances 
 to the patient's case, the old arrangements might 
 have been undisturbed." 
 
86 CARE OF THE INSANE. 
 
 Dr. Mitchell having stated his opinion that the 
 legitimate grounds for sending a patient to an asylum 
 Avere either that he was dangerous, or that he was 
 likely to be cured by being sent there, or that he 
 needed such special care as cannot be given out of 
 an asylum, replied to the Chairman's remark, " That 
 opens the door to a very wide question, as to whether 
 persons who might be taken care of elsewhere ought 
 to be sent to asylums .''" — " Yes, I feel that ; and I think 
 that the fact that this wide field [extended view of 
 insanity] prevails is a reason for greater care in super- 
 vising the admissions to asylums so as to prevent the 
 undue detention of persons whose happiness would be 
 greater out of asylums." 
 
 Chairman : " The degree of inconvenience which 
 might be experienced by friends owing to the pre- 
 sence of a lunatic would be a question which would 
 admit of most varied interpretation .-* " — " Yes ; I 
 think so." 
 
 Sir Trevor Lawrence : " Is it not in your opinion 
 the case that the vast majority of lunatics would be, 
 or, at all events, would consider themselves, happier 
 outside the asylum than inside ? " — Dr. Mitchell : " I 
 think there are very few people who find asylum life 
 pleasant." 
 
 In vain may the evidence of the English Com- 
 missioners and their thirty-three annual reports be 
 searched for information and opinions of this cha- 
 racter, but the action of the Lord Chancellor and of 
 the Lords Justices does indicate their perception of 
 the rights of the insane in contrast to the con- 
 venience of their relatives and their appreciation of the 
 value of domestic in comparison vrith asylum treat- 
 ment ; and the evidence of the Lord Chancellor's 
 
PROPRIETARY ASYLUMS. 87 
 
 medical visitors fully supports and justifies the action 
 of their chiefs. 
 
 Dr. Robertson says : " One-third of the certified 
 lunatics might be spread over the country, but the 
 other two-thirds require asylum treatment, and I 
 thought for those public asylums ought to be pro- 
 vided." [Question 1,1 19.] 
 
 Dr. Crichton Browne says : " I hold two- thirds to 
 be about the proper proportion of dangerous cases 
 and lunatics requiring asylum treatment. I should 
 think nearly two-thirds do require asylum treatment." 
 [Question 1,305.] 
 
 It has already been shown that, as regards Chancery 
 lunatics, a somewhat larger proportion than a third is 
 already spread over the country, and the remarks of 
 Dr. Robertson are obviously intended to apply only to 
 certified lunatics in proprietary asylums and hospitals 
 for the insane who are not Chancery lunatics. The 
 residue of private certified lunatics who would be left 
 in private asylums after pauper and Chancery luna- 
 tics and that one-third of cases who are asserted 
 to be improperly detained being deducted, the dififi- 
 culty of providing for the residue would not be a 
 formidable one ; and that it ought to be so re- 
 duced can scarcely admit of doubt. The detention 
 of pauper lunatics in private asylums is an admitted 
 abuse solely due to default of the authorities. The 
 detention of Chancery lunatics in private asylums 
 and hospitals would be terminated by the establish- 
 ment of the special institutions which have been 
 so strongly recommended by the Lord Chancellor's 
 visitors ; and the discharge into domestic care 
 and control of that proportion of asylum inmates 
 which the highest authorities declare unsuitable for 
 
88 CARE OF THE INSANE. 
 
 asylum treatment is a measure of justice and 
 humanity which cannot be long delayed. When this 
 emancipation has taken place, the care and treat- 
 ment of the remaining patients could be provided 
 for in various ways, the consideration of which must 
 be considered in another chapter. 
 
VIII. 
 
 " UNDER WHICH KING, BEZONIAN ? " 
 
 There are two rival projects before the public for 
 the transferrence of asylums for the rich from the 
 hands of private proprietors to those of salaried 
 officials. The first, which may be called the com- 
 peting project, has been most ably advocated by the 
 noble Chairman of the Board of Commissioners in 
 Lunacy, and consists in the establishment at the 
 public expense of hospitals for the insane, the com- 
 petition of which, it is assumed, would abolish the 
 bad proprietary asylums and improve the better ones, 
 so that only private asylums of admitted excellence 
 would remain. The second, which may be called 
 the purchasing project, is the intention of a Bill now 
 before Parliament, introduced by Mr. Dillwyn, Sir 
 George Balfour, and Mr. Herschell, O.C., by which 
 it is proposed to enact that justices of the peace 
 may purchase proprietary asylums in their several 
 districts, with moneys raised upon the county or 
 borough rates. Strong arguments may be employed 
 for the principle of each of these projects. For the 
 latter, it may be said that it would be the more 
 
90 CARE OF THE INSANE. 
 
 simple and speedy ; that, if the large sum of money 
 requisite for its completion were easily available, it 
 would at once cut the knot of a perplexing social 
 difficulty, and that all persons claiming vested rights 
 would obtain due compensation, and that, if the 
 purchase were made compulsory, as it would need 
 to be, the reform would cover the whole ground of 
 the abuse, and the rescue of the insane from private 
 proprietors be complete. For Lord Shaftesbury's 
 less ambitious project, it may be argued that it would 
 be far less costly to the public ; that, being less hasty 
 in its operation, it would be less liable to deviate from 
 prudent and wise methods, and that it would allow any 
 portions of the proprietary system viable through 
 exceptional excellence to survive. These arguments 
 are certainly not so striking as those in favour of 
 the rival project ; but, on the other hand, the ob- 
 jections and difficulties will, on examination, appear 
 to be far less insurmountable. 
 
 The first and greatest objection to the purchasing 
 project is that, with a certain number of exceptions, 
 proprietary asylums are not worth purchase. There are 
 scarcely half a dozen proprietary asylums which could, 
 by any expenditure of skill and money, be converted 
 into moderately good hospitals for the insane. The 
 remainder of them are quite incapable of such con- 
 version from various causes. Most of them are 
 altogether too small for such conversion, and are 
 placed on sites far too narrow and inconvenient. 
 Some of the largest of them are in the midst of 
 towns and cities. Not a few of them consist of 
 ancient buildings, inconvenient to use, expensive to 
 repair, and utterly inadequate to supply those con- 
 ditions of comfort within doors, and of free movement 
 
"UNDER WHICH KING, BEZONIAN ?'" 91 
 
 out of doors, which the customers of the pubHc would 
 undoubtedly exact, and which the public would feel 
 bound to supply to the well-to-do inmates of its own 
 institutions. Consider what it is thought right to 
 give to a pauper patient in a good county asylum in 
 the way of house-room, fittings, and grounds, with 
 that which another patient receives for three or four 
 times as much payment in one of the shabbier private 
 asylums, and the idea of converting proprietary into 
 public asylums will appear impracticable. If some 
 benevolent Peabody were to buy them up — the pro- 
 prietary asylums — -and make a present of them to the 
 nation, the only possible thing which the nation could 
 do with them would be to sell them again for what 
 the sites would fetch, and expend the proceeds as 
 far as they would go in the erection of such buildings 
 as the public could feel its conscience justified in using 
 for the detention against their will of innocent persons 
 accustomed to the pleasures and luxuries of life. In 
 only a small number of instances have proprietary 
 asylums been constructed for their purpose, and these 
 instances have, for the most part, been conspicuous 
 failures. When it is considered that the object of the 
 architect appears to have been the erection of a pre- 
 tentious building, and then to arrange it in such 
 manner that it would be most profitable to its pos- 
 sessor in the letting of separate or associated apart- 
 ments, it m.ay easily be seen that such a construction 
 would not be a good investment for the public as a 
 hospital for the insane. But with these few exceptions, 
 asylums have not been built for their purpose, but 
 consist of old mansions, or of adventure schools which 
 have not survived the development of public school 
 competition. Some of them have been converted into 
 
92 CARE OF THE INSANE. 
 
 really good buildings for private treatment, more of 
 them are moderately good, but the great majority are 
 hopelessly inconvenient in construction, gloomy in 
 occupation, and costly to keep in repair. It is not 
 needful to say what ought to be done to any authority 
 who should authorize the purchase of buildings of the 
 latter class Avith public money for conversion into hos- 
 pitals. Even the sites would be most undesirable for 
 purchase. Most of them are far too small, and many 
 of them are in the midst of towns and cities, and 
 worth up to i^2,ooo an acre for building purposes ; a 
 lock up of capital which may well answer the purpose 
 of a private asylum proprietor, but which would be 
 quite unjustifiable on the part of the public, even if 
 there were no objection to the use of a minute oasis 
 in a desert of bricks and mortar for the confinement 
 of innocent people at this time of day, when con- 
 valescent hospitals for the poor, and public schools 
 for the needy, are deported into the glorious life- 
 giving freedom of the country. Proprietary asylums, 
 considered as buildings, rub along as private specu- 
 lations, doing more or less good under more or less 
 difficulties ; but the acquisition of them as a whole 
 for the purpose of conversion into public hospitals 
 would be as wise as if the Government had bought 
 up old merchant-ships for conversion into ocean- 
 going steamers. Modern machinery might have been 
 thrust into them, but would never have fitted into 
 them, and they would have been spoiled for the old 
 work and useless for the new. Apart from the pur- 
 chase of the buildings, fittings, plant, furniture, and 
 grounds, the purchase of the goodwill of these pro- 
 prietary asylums must be considered ; and the first 
 reflection which suggests itself is, that to purchase 
 
" UNDER WHICH KING, BEZONIAN ? " 93 
 
 with public money the goodwill of a good institution 
 may not be needful, while to purchase the goodwill 
 of bad institutions would be absurd. Some com- 
 pensation may be right and expedient for abolishing 
 even a bad institution, but to call a payment of this 
 kind the purchase of a goodwill is a contradiction 
 in terms. 
 
 Proprietar}^ asylums differ so widely from each 
 other, that no information can be gained by con- 
 sidering this part of the question in the abstract, and 
 it would be inconvenient to study it in the particular. 
 But the whole class of such asylums may be divided 
 into sub-classes, of which kinds may be given, not 
 representing any particular institution, but repre- 
 senting a group ; and in this manner the question 
 may, perhaps, be considered with the probability of 
 coming to a right conclusion. First, there are those 
 asylums which are instruments in the hands of true 
 physicians for the cure of mental disease. Outside 
 members of the profession have free access to patients 
 in asylums of this kind, and often, advise in their 
 treatment. There is a free and most wholesome 
 readiness of exchange of patients between the asylum 
 and home life, into which the care of the asylum 
 physician follows them. The patients, therefore, are 
 very far from feeling that they will remain ,.in the 
 asylum "until they die;" nor is their liberty re- 
 strained, while they remain, more than is absolutely 
 necessary for their safety. After having been dis- 
 charged, they are frequently not unwilling to return. 
 Consequently, the place has very little of the air of 
 detention about it, and the inmates are not depressed 
 but free spoken, in comparison with the sullen people 
 one meets with in other asylums. They are patients 
 
94 CARE OF THE INSANE. 
 
 less than captives. The greatest distinction ought to 
 be drawn between the true asylum physician and the 
 mere asylum proprietor. The worth of the goodwill 
 of such a place is in the heart and brains of its pos- 
 sessor ; and to purchase the asylum under the idea 
 that its real value would be acquired, would be as 
 futile as to buy Joachim's fiddle in the expectation of 
 getting his music. Such an asylum must be and ought 
 to be a survival under any change in the law, Then 
 there are asylums of another kind, which belong to 
 liberal-minded and sensible persons, who are satisfied 
 with the responsibilities of ownership and content 
 with a good return from capital invested or property 
 bequeathed, and depute the best agents to be obtained 
 by careful selection and handsome salaries to discharge 
 the duties of management. The medical superinten- 
 dents, with full powers, do the best they can for the 
 welfare of their patients in every respect. The result 
 is that such asylums obtain repute, and are generally 
 furnished with their complement of inmates. The 
 sale of such asylums to the State would be a perfectly 
 honest and feasible transaction, but it might only be 
 desirable to expend public money in such a manner in 
 order to prevent those lapses which arise upon changes 
 in the ownership of such property. Under the con- 
 tinuance of good management, such a.sylums might 
 survive competition. Another kind of asylums gene- 
 rally represents the unfavourable aspect of the busi- 
 ness element, although it is not alleged that any one 
 asylum presents all the features of the class. In 
 asylums of this kind, every art is used to attract 
 patients, and every device employed to keep them. 
 There is often a great deal of show and tinsel about 
 these establishments, and the proprietors exhibit to 
 
"UNDER WHICH KING, BEZONIAN ? " 95 
 
 visitors the pretty things which ought to make patients 
 happy, were they not a perverse generation, apt to 
 discover the motives which rule these places, and to 
 feel intensely that they are captives and not patients. 
 Moreover, the purpose of these places being to receive 
 much and expend little, the attendants are poorly 
 paid and of bad quality, the food is common, and the 
 service mean. No amount of beer and tobacco will 
 smooth the troubled waters of discontent among gen- 
 tlemen who feel themselves not only captives for a 
 sordid purpose, but unsphered from their social rank 
 by poor and low surroundings. Escapes, or attempts 
 to escape, are of course frequent, and when the friends 
 propose removal, every method of hindrance is used. 
 In asylums of this kind, the unwelcome indications of 
 approaching recovery are frequently overlooked or 
 disputed. To purchase the goodwill of such asylums 
 would be wasteful and unwise, for what could the 
 public do with them .'' 
 
 Another kind of asylums consist of the large cheap 
 asylums, some of them containing several hundreds 
 of patients. Some examples of this kind are so much 
 better than others, that it Is not easy to find common 
 characteristics which shall be true of the worst and 
 not unjust to the best of them. Although institutions 
 of this kind are conducted on the strictest business 
 principles, and large profits made by small economies, 
 the spirit of unjust detention does not predominate in 
 them, It not being worth while to care much for the 
 loss of a few patients paying small sums, whose 
 vacant places would' soon be filled up by other 
 patients of the same class. With a strange dis- 
 regard for the requirements of large numbers of the 
 • insane when collected together, asylums of this kind 
 
g6 CARE OF THE INSANE. 
 
 are placed in the dingy suburban wilderness of brick 
 and mortar, and the proprietors are unable to employ 
 the potent tranquilizing influence of wide out-of- 
 door space. Large numbers of lunatics have to 
 be controlled in them under great disadvantage by 
 attendants of low quality, and stinted in number 
 by the economies of the place. The shabby and 
 rickety buildings are enormously overcrowded, and 
 the narrow grounds, with an air of Vauxhall by day- 
 light, are utterly inadequate to the out-of-door enjoy- 
 ment of the patients. It would be well, indeed, if 
 the State were to gain possession of these places for 
 the purpose of closing them. But, their existence 
 being entirely caused by defect of hospital accommo- 
 dation for the insane of small means, their abolition 
 ought not to precede the erection of sufficient public 
 hospitals for those who need them most ; and the 
 double expenditure of public money involved in the 
 purchase of the old and the substitution of new 
 buildings can scarcely be advocated. 
 
 Another kind of asylums having a distinct charac- 
 teristic may be perceived in those houses licensed by 
 the Commissioners themselves, or by Justices of the 
 Peace under their recommendation, for the detention 
 of " quiet and harmless cases only." By some per- 
 sons it has been contended that no lunatics are really 
 free from danger ; but the action of the Commissioners 
 in licensing houses for harmless cases only, is a 
 sufficient reply to this casuistical reason for placing 
 restraint upon all insane persons. The reason why 
 quiet and harmless cases should be confined and 
 detained in asylums is not so apparent ; and the 
 position of the State in purchasing asylums licensed 
 for such cases only might raise a curious question 
 
"UNDER WHICH KING, BEZONIAN ? " 97 
 
 of ethics, if not of law. Common and case law 
 declare that such persons ought not to be confined, 
 while the statute law provides places in which 
 they are confined ; and therefore, if the State were 
 to purchase the goodwill of such places, it would 
 seem to purchase the proprietary right to break its 
 own laws. The remark of course applies to the 
 purchase of any private asylum in so far as it 
 may contain patients who are not dangerous ; but 
 the perplexity is most cross-grained in the instance 
 of the asylums licensed by the authorities of the 
 State to confine and detain such cases only as the 
 law of the State declares ought not to be confined 
 at all. If while the common law made gaming an 
 offence, the legislature were first to license and re- 
 gulate gaming-houses, and then to purchase their 
 goodwill, the inconsistency would not be greater. 
 
 There is a large remainder of asylums which have 
 no characteristic features ; poor places from which 
 the owners, lay or medical, male or female, derive a 
 livelihood in differing but not distinctive ways ; they 
 are too various in their peculiarities to be classed. 
 As the trade or the medical spirit may predominate, 
 the welfare of the patients is more or less submerged 
 under the strong current of profit. 
 
 H 
 
IX. 
 
 "I DID STEER TOWARD THIS REMEDY." 
 
 By a most remarkable concurrence of opinion, 
 which is evidently the result of independent conviction, 
 all persons who have right to speak with authority on 
 the best remedy for the evils of private trade in lunacy 
 have advocated the extension of the system of public 
 asylums for that purpose. The Lord Chancellor's 
 Visitors, the Commissioners in Lunacy, the Royal 
 Commissioners on Irish Asylums, and many other 
 official and experienced persons, have with one accord 
 fixed upon this remedy ; and the Select Committee 
 of 1877, in its compromising report, endorsed this 
 opinion by recommending to Parliament " that legis- 
 lative facilities should be afforded by the enlargement 
 of the powers of magistrates or otherwise for the 
 extension of the system" "of public institutions for 
 all classes, such as exist in Scotland, in Cornwall, and 
 at Cheadle in Cheshire," so that eventually " there 
 would be no demand for licensed houses for the upper 
 and middle classes." Arguments may be advanced 
 against making either the Scotch chartered a.sylums, 
 the English hospitals for the insane, or the solitary 
 
"I DID STEER TOWARD THIS REMEDY." 99 
 
 instance of a county asylum for paying patients 
 which exists in Cornwall, exact models for imitation 
 of the new public asylums for paying patients which 
 are now needed in this country. Excellent as all 
 these institutions are in their own sphere of work, 
 they none of them meet the requirements of the 
 existing emergency ; and there is no reason to believe 
 that permissive " enlargement of the powers of magis- 
 trates," which is the project of Mr. Dillwyn's Bill, 
 would not be that which the Select Committee of 1859 
 declared it would be, namely, " inoperative." If so, 
 therefore, a wise provision of public institutions for 
 all classes must be " otherwise ; " and it is curious that 
 the Committee should have omitted existing models 
 which are far more to their purpose than those they 
 have cited, although such models are plainly enough 
 shown to be the right examples in an important paper 
 printed by the Committee in the Appendix to their 
 Report. This class of asylums are the State asylums, 
 of which Broadmoor and the India Asylum at Ealing 
 and the Naval Asylum at Yarmouth are excellent 
 examples in this country, and of which the State 
 asylums of the United States of America, accommo- 
 dating patients of all classes, so that fewer than three 
 hundred patients are confined in private asylums in 
 all that vast community, are an example abroad. 
 
 The paper above referred to is a " Memorandum 
 on the Establishment of Three State Asylums for 
 the Chancery Lunatics," presented to the Lord Chan- 
 cellor, and signed by Dr. Bucknill, Dr. Lockhart 
 Robertson, and Dr. Crichton Browne ; and it recom- 
 mends that " three State asylums should be provided 
 for the care and treatment of the Chancery lunatics," 
 and each with an accommodation for two hundred 
 
 H 2. 
 
100 CARE OF THE INSANE. 
 
 patients, within fifty miles of London, each with an 
 estate of one hundred acres, at a total estimated cost 
 of ^300 per patient." If the estabhshment of such 
 State asylums for Chancery lunatics would be right, 
 it is difificult to see on what principle such institutions 
 should be confined to Chancery lunatics. Rather, it 
 would seem that, as Chancery lunatics are already 
 provided with costly and elaborate means of protec- 
 tion which are not enjoyed by ordinary lunatics, their 
 further protection by means of separate State asylums 
 for their use is less needful for them than for paying 
 patients who are not under the care of the Court. 
 All lunatics who either possess property or who have 
 relatives possessing property who are bound to sup- 
 port them, ought to be under the protection of those 
 to whom the Sovereign has deputed Her prerogative 
 in this matter; while all lunatics maintained at the 
 public cost may well be left under the protection of 
 the Local Government Board. This is a social classi- 
 fication founded upon a real difference ; but the 
 accident of a lunatic's property being accessible 
 or not, protected or not, being an artificial distinction 
 upon which it is absurd to establish differences of 
 jurisdiction, and still more so to arrange varieties 
 of treatment, the logical division will no doubt at 
 some time be recognized ; and, meanwhile, it is de- 
 sirable that State asylums should be founded upon the 
 wide and reasonable basis of receiving all lunatics 
 who pay for their maintenance. Probably the three 
 physicians who signed the memorandum saw this 
 clearly enough, but did not feel themselves justified 
 in extending the scope of their recommendations 
 beyond the borders of that which might seem to be 
 their peculiar province ; but it is most earnestly to be 
 
"I DID STEER TOWARD THIS REMEDY." lOI 
 
 hoped that the Commissioners in Lunacy will adopt 
 and endorse the recommendation with regard to all 
 paying patients, and thus bring to a practical issue 
 the general views they have so emphatically expressed 
 as to the necessity of the establishment of public 
 asylums for all classes. 
 
 The task is not tremendous. No one has proposed 
 to establish State asylums for all paying patients, but 
 only for so many as would enable the authorities to 
 discontinue their licence to all owners of asylums 
 who do not fulfil their implied contract between their 
 patients, the public, and themselves, which is to give 
 their patients the possession and enjoyment of all 
 possible sources of comfort, security, and recovery. 
 The total number of private patients in licensed 
 houses on the ist of January 1878 was 3,472; but 
 from these ought to be deducted the soldiers at 
 Bow Asylum and the imbecile children in the schools 
 (which are only asylums in an official sense) of Nor- 
 mansfield, Kenton, Colchester, and Knowle, amount- 
 ing to an aggregate of 661 patients, and leaving the 
 total number of private patients, including Chancery 
 patients in licensed houses, at only 2,811. And this 
 existing total is already on the wane from various 
 causes, of which the steadily increasing preference 
 of the public for the insane hospitals is the most 
 observable. To what extent these admirable institu- 
 tions, which are not likely to be increased in numbers, 
 are likely to be increased in their capacity of accom- 
 modation, and to what extent the tranquil and slightly 
 insane inmates of private asylums may, under a 
 change of public and professional opinion, which may 
 occur any day, pass into domestic care, it is impossible 
 to estimate. But not forgetting 'the probable operation 
 
I02 CARE OF THE INSANE. 
 
 of these influences, it would seem fair and reasonable 
 to leave half of the aggregate to be dealt with in the 
 first instance by existing methods and the survival 
 of the best proprietary asylums, and to make State 
 provision for only 1,450 of the insane of the upper 
 and middle classes at present confined in those pro- 
 prietary asylums which ought to be speedily closed. 
 Should the future management of the best asylums 
 not justify the plea for their preservation which good 
 authorities have urged, they also ought to be dealt 
 with subsequently, and all insane persons be thus 
 placed either under public or domestic care. 
 
 It would not be needful or right to estimate the 
 cost for building and establishing new State asylums 
 for paying patients of all classes so high as the Lord 
 Chancellor's medical advisers have properly fixed their 
 estimate for Chancery lunatics. The average pay- 
 ments of this latter class for maintenance in pro- 
 prietary asylums is ^^25 3 annually for each lunatic. 
 But the large number of insane persons of small means 
 who are confined in the worst proprietary asylums 
 suffer more from the want of suitable accommodation 
 than those who are comparatively opulent, and their 
 claims for State interference and relief are more 
 urgent ; and if ^300 per patient would be an adequate 
 sum for building State asylums for Chancery lunatics, 
 who are paying an average of ^^25 3 a year for main- 
 tenance, the sum of ^200 per patient would be a fair 
 estimate for building State asylums for the paying 
 insane of all classes, a large proportion of whom 
 are comparatively poor. The estimate therefore 
 would contemplate an expenditure of ^290,000 for 
 building State asylums for 1,450 paying patients, far 
 less than the sum which Colney Hatch asylum for 
 
"I DID STEER TOWARD THIS REMEDY. IG3 
 
 paupers has cost, far less than one modern man-of-war 
 has cost. And this money if advanced by the State 
 could most certainly be repaid to the State, interest 
 and capital, within the customary thirty years, out of 
 the payments of the patients, and after they had re- 
 ceived the most liberal treatment. If the owners of 
 licensed houses calculate upon repayment of their pur- 
 chase-money out of the profits of four years, the State, 
 being owner, might very fairly arrange to repay itself 
 within thirty years, unless, indeed, the State preferred 
 to employ some of its receipts from the insane in the 
 extension of its benevolent protection over this class 
 of sufferers. 
 
 The most ready and efficient instrument by which 
 these proposed State asylums could be established 
 would seem to be a Parliamentary Commission, con- 
 taining an independent medical and legal element 
 and an efficient contingent from the existing boards 
 of lunacy ; and the main duties of such a Commission 
 would be — 
 
 1. To enter into contracts for the purchase of sites 
 and the erection and furnishing of buildings for State 
 asylums, and to pay for the same with money ad- 
 vanced from the consolidated fund. 
 
 2. To repay interest and sinking fund for the debt 
 so contracted from a percentage taken from the pay- 
 ments of patients received into such State asylums. 
 
 3. To make rules for the governance of such State 
 asylums, and the payments of the patients. 
 
 4. To appoint the persons to form a governing body 
 for each State asylum, 
 
 5. To determine what licensed houses for the 
 reception of lunatics shall be closed, and upon what 
 conditions. 
 
I04 CARE OF THE INSANE. 
 
 6. To summon and examine upon oath witnesses, 
 and to require the production of documents relating 
 to matters within the reference of the Commission. 
 
 7. To prepare statutory amendments on the lunacy 
 laws and reports to Parliament. 
 
 Each State asylum should have a separate Govern- 
 ing Body, composed of gentlemen and professional 
 men, ready and willing to discharge the unpaid 
 duties of control, similar to those now discharged 
 by the Committees of Management appointed by 
 the Governors of Hospitals for the Insane, save 
 and excepting one duty which some of these 
 committees permit themselves to discharge in con- 
 travention of the original purpose of their insti- 
 tutions — namely, that of making a large profit. 
 It is to be hoped that the contagion of the spirit 
 of trade would find no entrance into the State asy- 
 lums, and that there would be no rivalry between 
 them except the generous rivalry of earnest endea- 
 vour to relieve the greatest amount of suffering. The 
 Lord Chancellor's advisers recommend that each of 
 the State asylums for Chancery lunatics should con- 
 tain two hundred patients. (See note, p. 107.) This 
 may be a good medium size ; but State asylums on 
 the wider basis should some of them be larger, and 
 some perhaps smaller ; some should be plain and 
 economical, some more luxurious and costly. The 
 present system of proprietary asylums, whereby under 
 the same roof some wealthy patients are pampered 
 and many poor patients are stinted, causes envious 
 heart-burnings, Avhich may most advantageously be 
 avoided by the apportionment of payment to the 
 variety of accommodation provided in different 
 institutions. 
 
"I DID STEER TOWARD THIS REMEDY." 105 
 
 Carried out with wise forethought, and with the 
 single purpose of benefiting a most suffering and 
 pitiable class of the community, who are "so much 
 at the mercy of others," as Mr. Wilkes says, this 
 scheme would seem to offer a thoroughly practical 
 solution of a great social difficulty. Moreover, it 
 promises to remove a great professional scandal ; for 
 there can be no room for doubt that the great and 
 beneficent profession of medicine does suffer in its 
 honour before the public, and in its self-respect before 
 the tribunal of the corporate conscience, for the state 
 of affairs into which it has unwittingly drifted in its 
 relations to persons afflicted with mental disease. This 
 position is most unjust to the profession at large, and 
 even to that portion of the profession which has de- 
 voted itself to the study and relief of mental disease ; 
 for, while there are fewer than one hundred medical 
 men engaged in what may, without injustice, be called 
 the business of lunacy, there are " more than five 
 hundred medical appointments held in the three 
 kingdoms in connection with the treatment of mental 
 diseases," and no doubt a much greater number of 
 medical men engaged more or less in the private treat- 
 ment of mental disease, not one of whom has ever 
 touched one farthing of profit from the business of 
 keeping lunatics. That the keeping of lunatics in 
 licensed houses for profit is a business and not a 
 profession, is at once obvious from an inspection of 
 the names of the persons licensed to carry it on. It 
 appears from the last report of the Commissioners in 
 Lunacy that, out of the ninety-eight proprietary asy- 
 lums in England and Wales, forty-nine are licensed to 
 medical men alone, and twenty-one are licensed to 
 medical men in partnership with laymen or women ; 
 
I06 CARE OF THE INSANE. 
 
 and of the remainder, ten are licensed to laymen, and 
 eighteen to women alone. But these figures, remark- 
 able as they are, give a most inadequate idea of the 
 inconsiderable amount of pecuniary interest which 
 the medical profession possesses in the business of 
 keeping lunatics. Few of the larger proprietary asy- 
 lums which are licensed to medical men are in reality 
 the property of the licensees. Large shares in them, 
 and oftentimes the whole of the property, belong to lay- 
 men or to women, the medical licensee being a salaried 
 person, with undefined powers and duties. Lord 
 Shaftesbury said, in his evidence of 1859, Question 
 82, " Medical men would be the fittest persons to be 
 the proprietors of these houses, and to have the entire 
 charge of them ; but it often happens that the fittest 
 medical men have no capital at all, and they have not 
 the means of undertaking this charge, whereas other 
 persons, who are not fit to have the charge themselves, 
 have the capital. " 
 
 It cannot be doubted, therefore, that this business 
 of keeping diseased persons for profit in places of 
 confinement is heterogeneous to the medical profes- 
 sion, except in so far as the medical profession is 
 responsible to the community for abuses in the treat- 
 ment of all diseased persons, that is to say, responsible 
 to the extent of its power in amending such abuses ; 
 and therefore it is that the medical profession has a 
 duty to itself and a mission to society in the reform of 
 a law which encourages a " vicious principle " of treat- 
 ment of a most suffering and pitiable class of diseased 
 persons. To " minister to a mind diseased " is now as 
 strictly within the scope of medical art as any minis- 
 trations to the diseased body ; and the responsibility 
 lies upon the whole medical profession, untainted with 
 
" I DID STEER TOWARD THIS REMEDY." 10/ 
 
 any indirect gains or advantages, to bring within its 
 fold those most unhappy persons who, in the helpless- 
 ness of their incompetence, lie " so much at the mercy 
 of others," and have been too much sequestrated from 
 the beneficent action of a profession which exists for 
 the purpose of alleviating human suffering, and not 
 for the purpose of keeping any people in safe custody ; 
 of a profession which subsists upon remuneration for 
 services freely sought and accepted, and not upon pay- 
 ments by third parties for the board, lodging, and 
 detention of unwilling captives. 
 
 NOTE, 
 
 P. 104. Memorandum to the Lord Chancellor on the Establishment 
 of Three State Asylums for the Chancery Lunatics. (See Appendix to 
 Select Committee Report, 1877.) 
 
 1. There are 676 lunatics, wards of the Court of Chancery, now 
 living, scattered in the several private asylums and registered hospitals 
 in England and Wales, for whose maintenance upwards of 100,000/. a 
 year is spent under the sanction of the Court. These patients are 
 visited once a year by the Lord Chancellor's Visitors in Lunacy, who 
 have however no voice in the selection of the asylum, nor do they 
 exercise any control over its conduct and management. 
 
 2. It has been suggested to the Select Committee in evidence, that a 
 more efficient supervision and control would be exercised by the visitors 
 over the treatment of the Chancery lunatics in asylums if State asylums 
 were provided for their reception under the control of the Board of 
 Visitors. A precedent for this suggestion is given by the East India 
 Asylum at Ealing, established by the Secretary of State and Council 
 for India for the care and treatment of the insane officers and soldiers 
 of the Indian army. Again, the Board of Admiralty have a similar 
 asylum at Great Yarmouth for the insane officers and sailors of the 
 Royal Navy. 
 
 3. It is suggested that three State asylums be provided for the care 
 and treatment of the Chancery lunatics, each with accommodation for 
 200 patients. 
 
I08 CARE OF THE INSANE. 
 
 These asylums should be situated in the three several districts, north, 
 south, and west, into which the visitation of the Chancery patients is by 
 the Lord Chancellor divided, and each asylum should be ■\\ithin some 
 fifty miles of London, for the greater facility of frequent visitation by 
 the committees, visitors, and friends of the patients. Accommodation 
 should be provided partly in the asylum and partly in detached villas in 
 the grounds. Each asylum should have an estate of loo acres. 
 
 4. The total outlay for land, buildings, fitting, and furnishing, may, 
 without any risk of erroi", be estimated at 300/. per patient. This sum, 
 by a graduated annual payment (as in the case of the pauper county 
 asylums), might be repaid to the Treasury, capital and interest, in 
 thirty years. 
 
 The annual maintenance cost for each patient, including repairs of 
 the fabric, may, with a wide margin, be stated at 150/. a year. This 
 sum would include the annual repayment of the capital. 
 
 The maintenance cost at Bethlehem Hospital — the most costly of the 
 lunatic hospitals — is only 77/, per patient. The estimate of 150/. per 
 patient at the Chancery asylums leaves thus a wide margin for con- 
 tingencies. 
 
 The average yearly payments now made by the Chancery lunatics in 
 the several private asylums, is 253/., inclusive of extras, as carriage 
 exercise, clothing, &c. &c. The sum necessary to meet the average 
 annual estimate of 150/. is thus already provided and sanctioned by the 
 Court. No loss, therefore, would be entailed on the Treasury by the 
 advance of the necessary capital. 
 
 5. It is suggested that, in the first instance, one State asylum for 
 200 Chancery lunatics be provided, at a total outlay not exceeding 
 60,000/. This asylum should be built in the south district, in which 
 there is now the largest number of Chancery lunatics in private asylums 
 and where the want of such an establishment is most felt. 
 
 It may be situated in any of the southern (home) counties within 
 fifty miles of London, on an estate of about 1 00 acres. 
 
 6. The India Asylum at Ealing is under the control of the Secretary 
 of State and Council for India, and so likewise should this proposed 
 Chancery asylum be placed under the control of the Lord Chancellor 
 and of the Board of Visitors. , The detail government of the asylum 
 would, as in the case of the lunatic hospitals and of the Ealing (India) 
 Asylum, be in the hands of the physician and resident medical super- 
 intendent. 
 
 The financial detail would also be managed, as at Ealing, in the 
 office at the asylum, and presents no unusual difficulties. 
 
"I DID STEER TOWARD THIS REMEDY." IO9 
 
 7. It is assumed that the medical visitors, with their great experience 
 in lunacy, would not fail to place this State Chancery AsyJum, as 
 regards each detail of treatment and management, in the first rank of 
 English public asylums, and afford to the lunatic wards of the Court 
 every curative appliance known to science. 
 
 (Signed) J. C. Bucknill, M.D., F.R.S. 
 C. LocKHART Robertson, M.D. 
 J. Crichton Browne, M.D. 
 
 London, iiM April. 1877. 
 
X. 
 
 HOUSEHOLD HARMONY. 
 
 "After many moody thoughts, 
 At last, by notes of household harmony, 
 They quite forget their loss of liberty." 
 
 The domestic care and treatment of the insane is 
 a subject well worthy of a treatise, and can only be 
 briefly referred to in these pages. When a Comm.is- 
 sioner in Lunacy in 1859 stated his opinion "that, as 
 a general rule, persons who are of unsound mind and 
 unfit, by reason of mental infirmity, to be at large, or 
 to take care of themselves, ought to be in an asylum " 
 [Question 2,243], he only expressed the thought 
 accepted at the time, but of late more and more dis- 
 puted. Yet as early as 1867 Dr. Maudsley, in his 
 work on the Physiology and Pathology of the Mind, 
 (p. 426), denounced "the system, which cannot be just, 
 of indiscriminate sequestration — of locking up a person 
 in an asylum simply because he is mad." Referring to 
 the objection that the lunatic might be better treated 
 there than in a private residence, he wrote — " The 
 quarter from which this objection is urged taints it 
 with suspicion ; I never heard it put forward but by 
 those who are interested in the continuance of the 
 
HOUSEHOLD HARMONY. Ill 
 
 present state of things — those who make it appear 
 to fail entirely to appreciate the strength of the passion 
 for liberty which there is in the human breast ; and as 
 I feel most earnestly that I should infinitely prefer a 
 garret or a cellar for lodgings, with bread and water 
 only for food, than to be clothed in purple and fine 
 linen, and to fare sumptuously every day as a prisoner, 
 I can well believe that all the comforts which the in- 
 sane person has in his captivity are a miserable com- 
 pensation for his entire loss of liberty, — that they are 
 petty things which weigh not at all against the mighty 
 suffering of a lifelong imprisonment. I would put it 
 to those who lay stress on the comforts of asylums, 
 whether they sufficiently consider the discomforts of 
 them, apart from the imprisonment which they are 
 by the nature of the case. Is it not a common thing 
 to hear from an insane person bitter complaints of the 
 associations which he has in the asylum, and of the 
 scenes of which he is an unwilling witness — scenes 
 which cannot fail to occur, notwithstanding the best 
 classification, when all sorts and conditions of mad- 
 ness are congregated together.'' What can be conceived 
 more affecting to a man who has any intelligence and 
 sensibility left than the vulgar tyranny of an ignorant 
 attendant — a tyranny which the best management 
 cannot altogether prevent in a large asylum .-' And 
 I might go on to enumerate many more of the un- 
 preventible miseries of life in an asylum, which, when 
 superintendent of one, forced themselves painfully 
 upon my attention, and often made me sick at 
 heart." 
 
 In 1 87 1 Dr. Blandford said in his treatise oii In- 
 sanity and its Treatment (p. 370) — " There are patients 
 with amjale means, who make the fortunes of asylum 
 
112 CARE OF THE INSANE. 
 
 proprietors, whose lives would be infinitely happier 
 did they live beyond asylum walls." " How are you 
 to know if a patient is capable of living beyond the 
 walls of an asylum ? The answer is simple : Give 
 him a trial. Many unpromising cases I have known 
 to benefit so much by the change that they would 
 scarcely have been recognized. As the last genera- 
 tion did away with the fetters and mechanical re- 
 straints used in asylums, so let the present release 
 from the restraints of an asylum all those capable of 
 enjoying a larger amount of liberty and a freer atmo- 
 sphere than that in which they now fret and chafe." 
 
 The late Dr. Alexander Sutherland, examined by 
 the Select Committee in 1859, said that he had had 
 185 patients, as single patients, under attendants in 
 private houses, and of the first 100 patients 74 had 
 been cured, 20 had been uncured, and 6 had died ; 
 and of the last received 85 patients, more than 74 
 per cent, had been cured. The greater number of 
 cures had been efifected upon an average within the 
 year. These patients had been of all classes, and he 
 was sure that it was not only the most likely mode 
 by which a cure could be effected, but that it was 
 the kindest way of treatment. He visited these 
 patients twice a week, and if the cases were acute, 
 every day. Whenever he recommended such patients 
 to be sent to an asylum the relations were very reluc- 
 tant to agree to it ; as there is a very great preju- 
 dice against the name .of an asylum. These patients 
 of Dr. Sutherland's were mostly treated in lodgings 
 in St. John's Wood. [Questions 2,072 et seq.] 
 
 In 1878 the proportion of recoveries claimed to 
 have taken place in licensed houses was 9*35 per cent. 
 of the number under treatment. 
 
HOUSEHOLD HARMONY. II3 
 
 The opinion of the Secretary of the Lunatics' 
 Friends' Association, expressed to the Select Com- 
 mittee in i860, is very decided : — "Are you not aware 
 that there are many private houses where only one 
 patient is kept, and that it is very desirable, on the 
 score of humanity, to diminish the number of those 
 private houses ? — I am not of that opinion. I wholly 
 disagree with Lord Shaftesbury in that respect, that 
 confinement in single houses is generally to be de- 
 precated. I am more of the opinion of Dr. Suther- 
 land, that it is the best way of treating all patients." 
 [Question 357.] 
 
 Lord Shaftesbury's disapproval of the single-patient 
 system appears to have been founded upon his per- 
 sonal knowledge of the manner in which it was abused 
 at a time when almost all lunatics were treated 
 infamously. If he would investigate the mode of life 
 of m.any Chancery single patients living in their own 
 or their friends' houses, or with doctors and others, or 
 even as lodgers with well-chosen companions, at the 
 present time, he would change his opinion, as Dr. 
 Lockhart Robertson was compelled to do by such an 
 experience. 
 
 " Has the opinion you have formed, that it is desir- 
 able to remove as much as possible patients from 
 asylumiS, been based upon the knowledge you have 
 acquired since your appointment as a Lord Chan- 
 cellor's Visitor ? — Most wonderfully. I could never 
 have believed that patients who were such confirmed 
 lunatics could be treated in private families in the way 
 that Chancery lunatics are, if I had not personally 
 watched their cases." 
 
 " Is your experience of private asylums corrobo- 
 rated by your experience of public asylums ? Do you 
 
 I 
 
114 CARE OF THE INSANE. 
 
 hold the same opinion with regard to them as to 
 private patients? — I do; I think the patients are 
 happier and better out of them if they can be re- 
 moved out. — Happier ? — Certainly, happier. — Do you 
 mean better behaved i* — Happier in the enjoyment of 
 such pleasure and joy in life as is left to them." 
 [Questions i,ogi, et seq.] 
 
 But it is not merely the happy change which takes 
 place in confirmed lunatics when they are judiciously 
 removed from the dreary detention of the asylum into 
 domestic life, it is the efficiency of the domestic treat- 
 ment of lunacy during the whole course of the disease 
 which constitutes its greatest value, and of this the 
 Author's fullest and latest experience has convinced 
 him that the curative influences of asylums have been 
 vastly overrated, and that those of isolated treatment 
 in domestic care have been greatly undervalued. It 
 has long been the accepted doctrine that insanity can 
 only be treated curatively in asylums. But it must 
 not be forgotten that most of the works on the treat- 
 ment of insanity have been written by medical men 
 connected with asylums, who, without insincerity, 
 might express opinions founded upon their own 
 limited knowledge. A wider knowledge of insanity 
 as it occurs among the upper and middle classes 
 would have taught them that a very considerable 
 number of cases of actual insanity run a short course 
 and recover in domestic life with no great amount 
 of treatment, and that not perhaps of a very scien- 
 tific kind. As it is, the family doctor often treats and 
 cures a case of lunacy almost without knowing it. 
 Without paying that attention to the mental condi- 
 tion which he ought to do, he treats the failure of 
 bodily health upon which it depends, and the patient 
 
HOUSEHOLD HARMONY. II5 
 
 frequently recovers in mind and body. In other cases, 
 which are destined not to be transitor}^, the family 
 doctor of necessity has to treat, and to treat at home, 
 the disease in its most important phase — that of in- 
 itiation and incubation. How little do the physicians 
 of asylums know of the earliest stages of mental 
 disease ; and yet it is frequently in those stages alone 
 that the disease is curable. But it is in these stages 
 that the general physician or the family doctor does 
 treat the developing disease — treats it at home and 
 cures it. He treats the young maid with her green 
 and yellow melancholy ; or the youth, pale, irritable and 
 recluse, with averted eyes which speak of evil habits ; 
 or the desponding man with bile-poisoned blood ; or 
 the woman in her autumn days, for the first time 
 losing her cheerfulness ; and many other varieties of 
 ailment becoming insanity ; and the number of such 
 cases which are cured under ordinary medical treat- 
 ment bears no mean proportion to those which pass 
 into the asylum and may be cured or confirmed 
 according to the accidents of care, skill, and good 
 fortune which no one can foresee or estimate. Some 
 physician, with the garnered wisdom of many years, is 
 not unfrequently able to say of a patient in whom 
 mental changes have only been incidentally remarked 
 as accompanying ill health, " This is a case which is 
 likely to become insanity. I must not call it the fully- 
 developed disease, for there are no facts on which I 
 could sign a certificate." Nor will he wait until the 
 disease is mature before he commences treatment — 
 under great difficulties, perhaps, for no control can be 
 imposed at this stage; and yet the results of treat- 
 ment are far more frequently successful than could by 
 any means have been anticipated. 
 
 I 2 
 
Il6 CARE OF THE INSANE. 
 
 But supposing that the patient has become un- 
 questionably insane, what are the capacities of domes- 
 tic treatment, and what are the exceptions in which 
 it should never be resorted to ? It has been laid 
 down as a rule by good authorities, that homicidal 
 and suicidal patients should always be sent to asylums, 
 and it is worth quite as much as medical rules usually 
 are : that is to say, it is properly applicable to the great 
 majority of cases. It is needful to restrain the man 
 wnth delusions of persecution and insane ideas of 
 revenge within strict guard and narrow confines, 
 because the overt act of such a man comes without 
 warning ; it is not ahvays needful to imprison lunatics 
 whose danger arises from ordinary violence accom- 
 panied by excitement which may come on with abun- 
 dant warning and with long intervals of tranquillity. 
 With regard to suicidal patients, it is right to place a 
 lunatic with delusions leading to self-destruction in the 
 greatersecurity of an asylum; but it would be stupidly 
 cruel to lock a man up in an asylum who had 
 attempted his life under the depression caused by 
 cholaemia or some other temporary influence, which 
 medical treatment will remove in a few days or 
 Aveeks. 
 
 Many a suicidal patient can live as safely with two 
 faithful and skilful attendants in a villa or a cottage 
 as in any asylum, and in the free air he will walk or 
 drive, employ or amuse himself in various ways, and 
 recover without the asylum brand or the asylum 
 danger of falling more and more into subjective 
 ways of thought, and shunting into the sad list of 
 incurables. 
 
 There being few medical rules without exceptions, 
 the rule against placing single patients with attendants 
 
HOUSEHOLD HARMONY. 117 
 
 only as companions is open to the important exception 
 that when the conduct of the attendants is under the 
 full supervision of a competent medical man, such a 
 provision is often the most convenient and satisfactory 
 one for the medical treatment of a recent case. No 
 doubt such an arrangement may be abused if bad at- 
 tendants are employed and are not properly looked after 
 by the medical man in charge. But with skilful and 
 faithful attendance and supervision, the plan " supplies 
 at present a social want," which is as much as the Com- 
 missioners have to say for licensed houses. There can 
 be no doubt that a great variety of cases of recent in- 
 sanity may be treated, and frequently are treated, most 
 successfully, in houses or apartments taken for the use 
 of the patient in town or in country, according to the 
 prevailing need for constant medical attendance and 
 supervision, or for free air, space, and exercise. Asy- 
 lum detention begets a routine life with a wonderful 
 oblivion of medical resources. Narcotics and seda- 
 tives are used with more or less audacity now, as 
 depressing medicines were used a generation ago ; but 
 the persistent efforts to relieve, by medicine, those 
 bodily conditions upon which the morbid mental 
 states depend, which were practised in asylums within 
 even recent memory, have now gone out of vogue, and 
 even the belief in them seems to be dead and gone. In 
 many of the asylums now a patient may get well if he 
 will under good hygienic influences; but as for any sys- 
 tematic attempts to aid nature by the resources of the 
 medical art — except those in a few well-known insti- 
 tutions where the love of medical science survives — one 
 would almost as soon expect to see them made as to 
 meet with the older practices of mechanical restraint. 
 Indeed it is not certain that to blister a patient's 
 
Il8 CARE OF THE INSANE. 
 
 head in the hope of saving him from dementia would 
 now be thought a cruelty. But in the treatment 
 of single cases by any capable and conscientious 
 physician it is quite different. Treatment is the 
 physician's raison d' etre, and even mad patients are 
 very frequently intelligent enough to know whether 
 efforts are or are not being made for their benefit. 
 Discharged patients will tell you that they have been 
 months in an asylum without having been spoken to 
 by a medical man, but a single patient cannot escape 
 the individual attention of the medical man in attend- 
 ance whom the statute requires to visit once a fort- 
 night, and who in recent cases may and does visit his 
 patient as frequently as he thinks needful and right. 
 Friends and relatives may and do reside with the 
 single patient under active treatment, although their 
 presence is often harmful, and then a well-chosen com- 
 panion and trustworthy attendants must suffice ; but 
 in all varieties of circumstances the distinctive feature 
 is medical treatment. A very different phase of 
 lunacy life is that of the chronic single patient living 
 in a family, his own or some other. There is no official 
 record of lunatics living with their own families ex- 
 cept of those upon whom inquisitions have been held ; 
 but from the frequent history of cases that have been 
 living at home for years and years clearly enough 
 insane, the number cannot be inconsiderable. They 
 are not usually the best examples of home treatment, 
 for relations are apt to be either too severe or too 
 indulgent, and there may be no check or guidance, 
 official or medical. Still every person whose know- 
 ledge of society is wide and varied must have known 
 insane persons living with considerable enjoyment of 
 life in the bosom of their own families. 
 
HOUSEHOLD HARMONY. , II9 
 
 Another distinct class of single patients are those 
 under the control of the Lord Chancellor and the in- 
 spection of his officers. Of these it has been truly 
 said that "their condition is eminently satisfactory, 
 and such as it is impossible it could be in the best 
 asylums" (Maudsley, op. cit.). Many of them indeed 
 are maintained in the position and habits of gentle- 
 men, and in the enjoyment of the ordinary pleasures 
 of life, whether in town or country. 
 
 Another distinct class of single patients are those 
 fortunate lunatics whose friends have had the wisdom 
 and the feeling to remove them from asylums and to 
 place them " in private families, where after a time 
 they truly become part of the family, and are con- 
 sidered in all its arrangements not otherwise than as 
 a member of it afflicted with some incurable bodily 
 disease would be." They are "happier amongst sane 
 people, and under the circumstances of private life, 
 than when surrounded by all degrees and kinds of 
 lunacy, and subjected to the monotonous routine and 
 oppressive regulations of an asylum " (Maudsley, op. 
 cit.). 
 
 It is quite a mistake to suppose that the domestic 
 care and treatment of the insane is necessarily costly. 
 No doubt money removes difficulties, and many 
 patients who are not tranquil or trustworthy enough 
 for domestic life in a cottage could be thoroughly 
 well taken care of with good attendants in the house 
 of a doctor, or in an establishment of their own. But 
 the experience of the Lord Chancellor's visitors proves 
 that judiciously selected cases of tranquil lunacy may 
 be made more comfortable and happy in very homely 
 places of residence, and at a very moderate cost. 
 Therefore the development of this system is not for 
 
I20 CARE OF THE INSANE. 
 
 the advantage of the rich alone, but for that of all 
 lunatics who are easily manageable and are not 
 dangerous, and it is in the development of this 
 system of domestic treatment that the greatest 
 promise lies of the largest possible amelioration 
 of the unhappy lot of those afflicted with mental 
 disease. 
 
XL 
 
 YOU MAY WEAR YOUR RUE WITH A DIFFERENCE.* 
 
 The questions connected with this subject, which 
 you have requested me to introduce to you, are so 
 numerous and comph'cated, that I must attempt some 
 dehmitation of them by asking you to consider, in 
 the -first place, on what grounds medical men generally 
 are interested in the existence of proprietary lunatic 
 asylums, and in the laws under which they are 
 established and to some extent regulated. If it be 
 true, as is maintained in the most recently published 
 work on lunacy law, that " insanity is a purely re- 
 lative term, at times employed to designate condi- 
 tions of the mind which are only diseases in the same 
 sense that general debility is a disease, or in the same 
 sense that bodily fatigue or want of change of air are 
 diseases, and that every passion and emotion may, in 
 prolonged excess, be said to constitute a degree of 
 mental disorder " — if this be true, I cannot claim for 
 the medical profession the right to arrogate any 
 
 ^ This chapter was an Address given by the Author to the South 
 Metropolitan Branch of the Britisla Medical Association, February 1 7th, 
 1880. 
 
122 CARE OF THE INSANE. 
 
 authoritative judgment upon the manner in which 
 such " conditions of the mind " should be dealt with. 
 But if insanity be a bodily disease, then medical men 
 have a clear right to discuss, and finally to decide 
 upon, the proper manner of its treatment ; and the 
 necessity, utility, and management of proprietary 
 lunatic asylums clearly come within the scope of such 
 discussion. I think that not only the conviction of 
 the profession, but the opinion of the public, will affirm 
 the latter proposition, notwithstanding the operation of 
 laws which have come down to us from times when 
 insanity was thought to be something apart from 
 disease — laws which have indeed been patched and 
 enlarged as the crying needs of the time demanded, 
 but which substantially deal with persons suffering 
 from diseases affecting the mental powers in a different 
 manner from that which is customary with regard to 
 all other diseased persons. 
 
 The operation of these laws has tended, and still 
 more and more tends, to sequester the insane from 
 the care and treatment of the medical profession at 
 large; to render more and more perplexing, dan- 
 gerous, and difficult the medical treatment of any 
 single case of lunacy ; to herd lunatics together in 
 special institutions where they can be more easily 
 visited and accounted for by the authorities, and to 
 create a class of men whom these authorities can 
 make responsible to themselve-.i for the confinement 
 and detention of the insane, according to certain 
 regulations, but whom they do not and cannot make 
 responsible for their proper medical treatment. It 
 would, I think, be an excellent subject for one of our 
 future discussions to inquire to what extent the 
 herding- together of lunatics is as beneficial as it is 
 
WEAR RUE WITH A DIFFERENCE. 1 23 
 
 economical, even in those most creditably managed 
 institutions for our destitute insane, which are more 
 almshouses than hospitals — I mean the county 
 asylums. But our present inquiry is restricted to 
 institutions for the not destitute insane, institutions 
 which certainly are not almshouses, and which, I am 
 prepared to maintain, are not hospitals. In what 
 manner shall we regard these places for the confine- 
 ment and detention of diseased persons, and to 
 what degree are we called upon to extend our feel- 
 ings of professional brotherhood and sympathy to the 
 men who own them .'' Surely none of us can fail to 
 feel and respond to the " strong claim on the kindly 
 fellowship and protection of the whole profession " of 
 all medical "practitioners" honourably engaged in 
 the treatment of the insane, and surely we should deny 
 and resent any " inconvenient and unfair aspersions 
 which have been made upon their conduct." But 
 surely, also, there is a line of distinction to be drawn 
 between the practitioner and the proprietor ; and 
 although fairness is due to every one, I dp not see, 
 unless perchance I may be the proprietor of an asylum, 
 why I should be bound to extend fellowship and pro- 
 tection to every one of that class. To take a parallel 
 instance ; say that I am a ship-doctor, one of a most 
 useful class of practitioners, towards whom we all feel 
 the fullest professional fellowship. But I am also 
 owner of the ship, or of shares in shipping ; surely 
 I have no claim upon your fellowship as a shipowner. 
 Doubtless the cause of the jumble of ideas on this 
 subject which is entertained by the public, and from 
 which the profession is not free, is, that doctors are 
 generally associated with asylums, and asylums with 
 doctors ; but, in reality, the pecuniary interest of 
 
124 CARE OF THE INSANE. 
 
 medical men in private asylums is much smaller than 
 you would suppose to be possible. There are ninety- 
 eight private asylums in England and Wales ; and of 
 these, forty-nine — being just one half — are licensed 
 to medical men alone, the remaining half being 
 licensed to laymen or to women, or to medical men 
 in partnership for this purpose with laymen or with 
 women. Moreover, of the asylums licensed to medical 
 men, the proprietors of many of the most important 
 ones are capitalists, or speculators, or trustees, or 
 inheritors, or hilt-deep mortgagees to whom they 
 are not licensed, and whose names do not appear. 
 
 There are, therefore, two classes of persons connected 
 with private asylums who stand towards us in very 
 different relations. First, there are the practitioners, 
 whether paid by fee or by salary, to whom the whole 
 profession owes kindly fellowship and protection ; and 
 secondly, there are the proprietors of asylums, who 
 may or may not be medical men, and whom we may 
 fairly be allowed to criticise — whom, indeed, it is our 
 strict duty to criticise — in the interest of our profession, 
 of the public, and of those diseased persons whom 
 they are permitted to hold in confinement. 
 
 Now a great deal of misleading analogy has been 
 drawn between the action of medical men, who in the 
 ordinary practice of their profession receive payment 
 in fees for their services, and that of the proprietors 
 of lunatic asylums, who receive payment for the main- 
 tenance and detention of their inmates, which pay- 
 ment, in so far as it exceeds the cost of such mainte- 
 nance, is their profit. I can perhaps scarcely do better, 
 to illustrate this constantly recurring analogy, than 
 by quoting two passages from recent works on the 
 subject of lunacy law reform. Dr. William Wood, in 
 
WEAR RUE WITH A DIFFERENCE. 1 25 
 
 his recent pamphlet on the Lunacy Lazv, expresses his 
 opinion that " if care be taken that no patient shall 
 be improperly placed in an asylum, there is no serious 
 wrong inflicted on him if one who has been admitted 
 under these precautions be kept for some time after his 
 apparent recovery" ; on the ground, as he explains, of 
 the possibility of relapse. Dr. Wood proceeds to say : 
 " Unworthy motives are not attributed to the surgeon 
 who prolongs his attendance on a patient who has 
 broken his leg, and who thinks it his duty to watch 
 and guard against imprudence and premature use of 
 the limb, though the bone has united. Why should 
 not a physician in charge of an insane person, and 
 why should not the friends of a patient, have the same 
 measure of justice meted out to them as is without 
 hesitation accorded to the surgeon V (P. 57.) 
 
 Now, without commenting upon this justification 
 of one of the peccadilloes of private lunatic asylums, 
 the detention of patients after their apparent recovery, 
 it must be observed that any surgeon who did act 
 in the manner supposed would most certainly have 
 unworthy motives attributed to him. Only, to make 
 the analogy fit the case, this surgical patient must be 
 put in such a condition that he can in no way help 
 himself, and he must also be supposed to be incapable 
 of saying to the surgeon that he had had enough of 
 him, and also it should be assumed of him that his 
 surgeon was paid by a third party, whose interest it 
 might be that the bone should not speedily unite — of 
 a child away from its parents, for instance, lying at 
 an hotel. But, in reality, the fees of medical men, 
 even under the old system of charging for medicines, 
 are not profits. They are charges for work and skill 
 made upon, and paid by,-voluntary agents, whereas 
 
126 CARE OF THE INSANE. 
 
 the profit of a private asylum proprietor is that portion 
 of the payment which is in excess of the cost, and 
 which is great in proportion to the diminution of cost, 
 and valuable in proportion to its continuance ; and, 
 in the well-considered words of Mr. Wilkes and Mr. 
 Lutwidge, reporting to Her Majesty on this very ques- 
 tion, '■' We fear it must be confessed by all that, where 
 profit is the aim, it will too generally be pursued 
 to the prejudice of those from whom it is derived." 
 (Report of Royal Commission on Lunatic Asylums 
 in Ireland, 1S5S, p. 32.) Or, in the vehement words 
 of Lord Shaftesbury : " This vicious principle of profit 
 runs through the whole." " I have no doubt that in 
 the majority of instances, where they are acting on 
 that abominable principle of profit, they screw them 
 down to the lowest possible point." (P. iCO, Select 
 Com. Report, 1S59.) 
 
 I said that I should make two quotations to illus- 
 trate the analogy which is often drawn between the 
 action of medical men in the open profession, and of 
 men, medical or not medical, dealing with diseased 
 persons in asylums. The second quotation is from a 
 speech of the late Mr. Wakley. I quote from that 
 work — full of information and suggestion in lunacy 
 matters — The Care and Cu7'e of the Insane, by Dr. 
 J. Mortimer Granville, according to whose quotation 
 from Hansard, 3rd series, vol. 59, Mr. W^'akley, in 
 August, 1 841, said in the House of Commons: "I 
 entreat the House to observe the operation of the law 
 as regards lunatics. Suppose I have a relation who 
 is possessed of a large fortune. I perceive certain 
 eccentricities in the conduct of that individual. From 
 the great aftection I have for that relative, and the 
 still greater affection I have for his property, I cause 
 
WEAR RUE WITH A DIFFERENCE. 12/ 
 
 a commission of lunacy to be issued out, and, dis- 
 covering him to be insane, place him in confinement. 
 Then what motive of action is given, under the present 
 system, to the person in whose charge the lunatic is 
 placed } Why, it calls into operation the principle of 
 selfishness common to human nature. The proprietor 
 of the asylum will argue that he gets ^400 a-year for 
 the charge of the gentleman so long as he remains 
 under that roof; and if he recovered, then he, the 
 proprietor, would lose that annual amount. Suppose 
 an honourable gentleman were to go to a doctor 
 and say, ' My liver is diseased, and so long as it 
 remains so I will give you ;^I00 a-year!' What 
 motive in such case would be given to the doctor .'' " 
 
 The quotation proves how forcibly the situation 
 was even then comprehended by this " clear thinker 
 and bold speaker," although, to construct his analogy, 
 he was obliged to suppose the existence of such an 
 agreement as is never made in the open medical pro- 
 fession. I have heard that, in China, medical men 
 are paid salaries so long as their patients remain in 
 good health ; but a stated income received from a 
 patient during the continuance of disease is, so far as 
 I know, a thing unheard of out of asylums. I beg 
 you to observe that all I have been saying has refer- 
 ence to the unchanging, and I fear unchangeable, 
 principles which underlie human activities. I might 
 have a good deal to say on the details of asylum 
 management, if I thought it needful or desirable to 
 do so ; but I desire to put aside every word which 
 may be construed to have a personal reference, and 
 to ask your opinion, on the broad ground of principle, 
 whether it is right that diseased and helpless persons 
 should be detained and confined in asylums for the 
 
128 CARE OF THE INSANE. 
 
 profit of private individuals ; the amount of that 
 profit depending upon what these individuals choose 
 to expend upon the comfort and enjoyment of their 
 inmates, and its continuance upon the duration of the 
 disease, or what they choose to think its duration ? 
 May I not fairly ask you to consider what can pos- 
 sibly justify the existence of these institutions for 
 private imprisonment, owned and kept by private 
 people, lay and medical, male and female ; there being 
 nothing like a parallel instance in which the liberty 
 of Englishmen is submitted to such control ? In 
 former times, indeed, debtors were permitted to be 
 kept in durance by sheriff's officers ; but a sheriff's 
 officer was not quite a private individual, and the 
 thing was felt to be a scandal, and was abolished. 
 Control over the liberty of children is to a certain 
 extent transferred from their natural guardians to 
 schoolmasters ; but this only lasts for a few months 
 at a time, and the restraint imposed is a very different 
 thing from the detention of a lunatic until he be dis- 
 charged or die. But, the existence of these institu- 
 tions being unquestionable, may I not further ask 
 what good reasons can be given by medical men for 
 sending patients to them ? We know pretty well 
 what the motives of relatives are for so doing : sepa- 
 ration from and safe guarding of the patient, secrecy, 
 and perhaps the hope of cure. But have we, as 
 medical men, any clear knowledge of the medical 
 treatment carried on for purposes of cure in these 
 places .'' Have we, as medical men, any assurance 
 that secrecy will be observed when it is right, and 
 not attempted when it is wrong .'' Above all, can we 
 have any confidence that when, with or without 
 medical treatment, our patients have recovered in 
 
WEAR RUE WITH A DIFFERENCE. 1 29 
 
 these places, we shall be permitted to know the fact ? 
 or, if we should be so bold as to think that we have 
 observed it for ourselves, are we sure that we shall not 
 be contradicted and deceived ? Are we sure that our 
 recovered patients will not be indefinitely detained, 
 under the supposition that they only appear to have 
 recovered, and may possibly have a relapse ? Per- 
 haps I may be wrong in the opinion that, under the 
 best treatment and the most auspicious circumstances, 
 patients do not often attain to perfect recovery in 
 asylums, any more than they do so in fever- hospitals ; 
 the last touch of treatment wanted being the cordial 
 restorative of home or the tonic of liberty. But do 
 not the proprietors of asylums often recognize the 
 persistence of symptoms of insanity in patients who 
 appear to us to have recovered, which no one else can 
 observe .'* If the matter were not too sad and serious, 
 I could amuse you by descriptions of the manner in 
 which I have myself been kept at bay in my diagnosis 
 of recovery ; for although, upon sufficient evidence, 
 you may make up your mind with certitude as to the 
 existence of mental disease, it requires great pains 
 and patience and knowledge of your people to avoid 
 being misled as to the possible existence of symptoms 
 which you may not be capable of observing or of 
 denying. Suppose, for instance, that the proprietor 
 tells you that your patient, who appears to have re- 
 covered, has had a slight stroke, with a little facial 
 palsy and some slight mental obfuscation, which 
 passed off the day before yesterday ; or that he has 
 had two or three slight epileptic seizures, and has 
 been a little fierce and angry just after them ; or that 
 he hears voices at night and denies them in the morn- 
 ing, — upon what principles of diagnosis are you to 
 
 K 
 
130 CARE OF THE INSANE. 
 
 determine that the gentleman is drawing upon his 
 invention for his statements, and that he will not be 
 inconsolable should the relapse occur which he assures 
 you that he is anticipating ? 
 
 But, as I have referred, however slightly, to my own 
 unfavourable experience, let me also say that I have 
 met with and had the pleasure of knowing some men 
 who are the proprietors of asylums, who are as honour- 
 able and truthful and just as any men in existence ; 
 who forget their profits, and, as physicians, treat their 
 patients with unfailing humanity and generosity and 
 skill ; whose doors are freely open for patients to 
 leave with the earliest indication that change will be 
 to the patients' advantage ; whose asylums are some- 
 what like lunatic clubs, in which the residence of 
 patients is to a great extent voluntary ; whose excel- 
 lent practice, were it general, would go far to redeem 
 a bad system ; and whose active usefulness must 
 survive any reasonable and beneficent change in the 
 lunacy law. Of the present position of such men or 
 of such a man in such a system, one can only say, 
 " Que diable allait-il faire dans cette galere .'' " 
 
 But what to do } 
 
 In the first place, I may broadly state my opinion 
 that no change of the law can be satisfactory which 
 does not contemplate the eventual abolition of all 
 proprietary lunatic asylums. The deprivation of the 
 personal liberty of any of the Queen's subjects is an 
 affair of the State, and must only be undertaken by 
 the State. From that axiom there must be no 
 flinching. Such asylums as I have last described 
 may survive, under some other name, as voluntary 
 retreats for persons of defective or damaged mind. 
 For lunatics who must be confined against their will. 
 
WEAR RUE WITH A DIFFERENCE. I31 
 
 asylums ought to be provided by the State, and 
 managed by boards of governors. Moreover, the 
 care and treatment of quiet and harmless cases of 
 insanity by the open medical profession in domestic 
 life, as single, or double, or treble cases, ought to be 
 encouraged by the law and its administrators, and 
 not discouraged, as it is at present. 
 
 The discussion of the large question of certification 
 may well be postponed to another opportunity ; only 
 I may observe that I think that no modification of the 
 present certificate-system will suffice to make it safe 
 to the practitioner or satisfactory to the public. The 
 medical man ought to be put firmly upon his right 
 footing as the exponent of scientific opinion ; and 
 the action taken upon evidence of that opinion in 
 so grave a matter as that of depriving a man of his 
 liberty ought to be no less than that of the civil 
 power, whatever may be determined for the best as 
 to the judge, or the court, or to the form of inquiry. 
 
 Moreover, great changes are needful in the admin- 
 istration of the lunacy laws. The Commissioners in 
 Lunacy are administrators in the metropolitan dis- 
 trict, and inspectors only in the remainder of England 
 and Wales ; and it is very certain that the worst 
 asylums to be found in the country are under their 
 immediate jurisdiction. If their Board is to survive 
 a thorough reform of the lunacy laws, they ought at 
 least to resign the control of the metropolitan asy- 
 lums, and to install the justices of the peace of the 
 counties of Middlesex, Surrey, Kent, and Essex in 
 the same authority which the justices of the peace 
 possess in all other counties, the Commissioners 
 themselves exercising everywhere an uniform power 
 of inspection, report, and superintendence. But a 
 
132 CARE OF THE INSANE. 
 
 more extensive change is still nnore needful and 
 important, which would render needless this local and 
 partial change. There are socially and logically but 
 two classes of lunatics in the community, those who 
 are destitute and those who are not ; and there ought, 
 accordingly, to be only two authorities to administer 
 the lunacy laws, and two laws for them to administer 
 as they severally regard these two distinct classes of 
 the insane. The present division of authority be- 
 tween the Lord Chancellor's Officers in Lunacy, the 
 Commissioners in Lunacy, the Local Government 
 Board and the Boards of Guardians, the Visiting 
 Justices of County Asylums and the Visitors of 
 Provincial Licensed Houses, the Boards of Cleve- 
 den and Caterham, &c. , is intricate, confused, and 
 mischievous. Instead of this, the Local Govern- 
 ment Board, or the Minister of Health, whenever he 
 may be appointed, ought to be placed in authority 
 over all subordinate authorities having control over 
 the care and maintenance of all destitute lunatics ; 
 and the Lord Chancellor's Officers in Lunacy, or, to 
 speak with more technical accuracy, the Lord Chan- 
 cellor with all his subordinate officers in lunacy, under 
 the Royal Prerogative, ought to have authority over 
 all other lunatics and persons charged with their care 
 and control. This change would leave no sphere of 
 action for the present Board of Commissioners in 
 Lunacy, the members of which might well be dis- 
 tributed between the two new and enlarged authori- 
 ties, half of them going to the Local Governm.ent 
 Board, and half of them to the Lord Chancellor. 
 Upon this broad basis, the details of lunacy law 
 reform could be built up with symmetry, science, and 
 effect ; but, without some broad basis of this kind. 
 
WEAR RUE WITH A DIFFERENCE. 1 33 
 
 founded upon a logical principle, any reform of the 
 lunacy laws which we may expect will be but some 
 tinkering of the old pot where the light of day most 
 inconveniently shines through its rust-eaten sides. Be 
 assured, however, that the longer reform is delayed 
 the more comprehensive it will be when it does come; 
 for the history of social policy is the opposite of that 
 of the Sibylline leaves, and generally the longer you 
 wait for it the larger it becomes. In the meanwhile, 
 be it our duty, both collectively and individually, to 
 strive that this most pitiable and helpless class of 
 diseased persons, from whom the profits of proprietary 
 lunatic asylums are derived, shall not suffer longer 
 than we can help under the disadvantages of this 
 worn-out old law. Sequestrated as they have been 
 from our professional care, they are still, as diseased 
 persons, the proper objects of our interest and regard; 
 and we owe it to them, not less than to ourselves and 
 to our profession, to strive that the law which governs 
 their care and treatment shall be conceived and exe- 
 cuted in the spirit of benevolence, of the scientific 
 knowledge of disease, and of those relations which 
 the ethics of our profession teach as being consistent 
 with the true dignity and welfare of both medical 
 practitioner and patient. 
 
 THE END. 
 
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 EDITED BY 
 
 J. C. BUCKNILL, M.D., M.E.C.P., F.B.S. 
 
 J. CRICHTON-BBOWNE, M.D., F.R.S.E. 
 
 D. FERRIER, M.D., F.R.C.P., F.R.S. 
 
 J. HUGHLINGS-JACKSON, M.D., F.R.C.P. ; 
 
 CoNTENTS-^Oiiginal Articles, consisting mainly of Clinical and Pathological Records 
 and Anatomical and Physiological Researches, Human and Comparative, on 
 the Nervous System. Signed Critical Digests and Reviews of Clinical, Experi- 
 mental and other Researches in this department of Science, both at home and 
 abroad. Foreign Correspondence. It will be the object of "Brain" to keep 
 its readers well abreast of modem progress in Neurology, and to advance the 
 knowledge of a class Of disease respecting which it is universally admitted that 
 much has yet to be learnt. 
 
 THE JOURNAL OF PHYSIOLOGY. 
 
 (With the co-operation in England of Prof A. GAMGEE, F.R.S., of Manchester; 
 Prof W. RUTHERFORD, F.R.S.. of Edinburgh; Prof. J. B. SANDERSON, 
 F.R.S., of London; and in America of Prof. H. P. BOWDITCH, of Boston ; 
 Prof. H. N. MARTIN, of Baltimore ; and Prof. H. C. WOOD, of Philadelphia) by 
 
 DE. MICHAEL FOSTEE, F.E.S., 
 
 Of Trinity College, Cambridge. 
 
 It is proposed to publish it in parts, not at rigidly fixed times, but according to 
 the supply of material. Every effort, however, will be made to prevent any 
 unnecessary irregularity in the appearance of the successive parts. About four or 
 six parts, the exact number depending on the size of the several parts, will form a 
 volume of about 500 pages. The volume will not necessarily coincide with the 
 year ; its issue, like that of the constituent parts, will depend on the abundance 
 of contributions. 
 
 The subscription-price for the volume, post free, will be, when paid in advance — 
 
 For Great Britain or America £1 Is., or $5,25 (gold). 
 
 Each part, as well as each volume, may also be obtained in the usual way through 
 the trade, at the rate of £1 lis. 6d. per volume, the exact price of each part, 
 being dependent on its size, &o. 
 

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