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 YOLTJNTAEY PATIENTS 
 
 ASYLUMS. 
 
 BY 
 
 STANLEY HAYISTES, M.D. Er>iN^., 
 
 MEDICAL SUPERINTENDENT OF LAVERSTOCK HOUSE ASYLUM, NEAR SALISBURY. 
 
 GEO. P. BACON, LEWES.
 
 YOLTJNTAEY PATIENTS IN ASYLUMS. 
 
 STANLEY HAYNES, M.D. Edin. 
 
 (Read at the Quarterly Meeting of the Medico-Psychological Association, 
 held at the Royal Medico- C Mr urgical Society, October 2 8, i86g.) 
 
 It has appeared to me highly desirable, if not requisite, 
 that there should be some extension of the present system for 
 the admission of boarders into establishments for the insane, 
 and that the anomalous and confusing condition of the existing 
 laws referring to them, by which each division of our country 
 has its enactments at variance with the others, should be 
 amended in such a manner that all parts of Great Britain and 
 Ireland should be subject to one scheme of legislation on the 
 subject. 
 
 I propose to indicate the existing requirements of the 
 lunacy acts respecting boarders, to show the advances already 
 made and the imperfections now experienced, to offer some 
 proofs of an extension of the law being necessary, and to 
 make some suggestions for further legislation concerning the 
 semi-sane we meet with in psychological practice. I 
 believe there is great, if not urgent, room for improvement, 
 though it cannot be denied there are many obstacles to impede 
 a satisfactory settlement of a difficult and delicate topic. Many 
 persons who are not of unsound mind, but who find their 
 mental health is endangered or weakened, might, by an ex- 
 pansion of the present lunacy laws, be received into asylums 
 as voluntary patients or boarders, with strong probability of
 
 4 Voluntary Patients in Asylums, 
 
 speedy recovery, protection from danger to themselves and 
 others, absence of predisposing and exciting causes and the 
 means of satisfying morbid cravings, with diminution of 
 family disturbances and enmities, and with a due regard to 
 that popular bugbear, the " liberty of the subject." 
 
 It is so abundantly proved, by the reports of the Com- 
 missioners in Lunacy and the experience of all connected 
 with the care of the insane, that the proportion of recoveries 
 is in direct ratio to early treatment, that it seems unnecessary 
 to discuss this topic. 
 
 Scarcely a week passes without the intelligence in the 
 newspapers of some suicide or homicide, arson or other crime, 
 committed under the impulse of what is termed " temporary 
 insanity," and in too many cases it is evident, not only to 
 medical men but to general readers, that the perpetrator 
 should have been treated as of unsound mind and the crime 
 thereby prevented. I may here remark upon the enormous 
 amount of crime directly caused by the unthinking and 
 extremely injudicious manner in which accounts of terrible 
 crimes are detailed and sensationalized in many of the news- 
 papers : we know how some persons will dwell upon the most 
 horrible particulars of any tragedy they may become aware of 
 until they form the idea they might be actors in similar 
 scenes, and how the thought once entertained is frequently 
 succeeded by a repetition of the deed which originated it. 
 Psychologists will not be sm-prised if the recent massacres 
 at Pantin and at Wood Green are imitated in other places. 
 If records in the newsj)apers, circulating amongst our poor 
 and criminal classes, were confined to the fact of any parti- 
 cular crime having been committed, no details being given 
 of the mode in which they had been perpetrated, much crime 
 would be prevented; unfortmiately, the insertion of the 
 details insures a large sale. 
 
 Those who study insanity and have intimate relations 
 with its victims know how fearfully strong are the impulses 
 under which deplorable and — very often — preventable 
 acts are committed, and many have borne record in their 
 writings of the frequency of such morbid motives. Some of 
 those who suffer from dangerous ideas have a most lively 
 horror of them and wish to be prevented from obeying them, 
 but the present state of oui- English law does not permit the 
 reception of such persons into asylums unless certificates of 
 lunacy and other documents have been previously signed, 
 or unless they have been certified patients in some asylum 

 
 hy Stanley Haynes, M.D. 5 
 
 within five years ; it is only in asylums that I believe such 
 individuals can be treated safely. (As I shall presently 
 explain, the Scotch law differs from the English.) I enter- 
 tain the strong conviction that if our laws were modified to 
 permit the admission, under due restrictions, of such persons 
 as voluntary patients when certificates cannot be obtained, 
 and that if the amended law were made known, many of 
 them would enter asylums and place themselves under disci- 
 pline and treatment, on account of the feeling* of intense 
 relief they would experience on having avoided the tempta- 
 tions to which they were subject, and the knowledge that 
 while under supervision they would be free from danger to 
 themselves and others. It frequently happens that when it 
 is considered advisable to place a member of a family or other 
 friend in an asylum there is a prejudice on the part of the 
 patient that family ties or friendly fe< dings have been 
 loosened, if not ruptured, and much bitterness of spirit and 
 heartburning, not to speak of enmities, have been caused, to 
 last, perhaps, as long as the patient lives. In numerous 
 other cases those interested in the mental invalids have felt 
 the strongest antipathy against taking any steps for their 
 security, on account of the natural dislike to subject them to 
 any curtailment of their personal liberties, thq cognisance of 
 the evil feelings sometimes aroused, the moral and legal re- 
 sponsibility of the procedure and, in too many cases^ the 
 prejudice still existing against asylums, but which is now, 
 happily, subsiding, because it is known asylum care and 
 treatment are characterised by humanity and an advanced 
 stage of medical knowledge, and that a close supervision is, 
 very properly, maintained over all asylums for the insane by 
 the authorities appointed by the government. If the volun- 
 tary system of admission into asylums were extended many 
 of the difficulties I have mentioned would be lessened or 
 abolished. 
 
 I have termed the liberty of the subject a "popular bug- 
 bear " because it is so well protected by existing legislation, 
 if fully carried out — as it is by the Commissioners in Lunacy 
 — that little or no abuse of it can occur without the know- 
 ledge of the authorities ; unless, indeed, it is in religious I 
 houses, in hydropathic establishments or in the case of ' 
 patients kept without payment or at home. The recent pro- 
 secutions by the Board of Lunacy have j)roved very beneficial 
 with regard to single patients for whom payments are made. 
 It seems fairly open to serious consideration whether com- 
 missioners should not be appointed to inspect all the inmates
 
 6 Voluntary Patients in Asylums, 
 
 of monasteries and convents, and all houses into which dipso- 
 maniacs are received, and whether the Commissioners in 
 Lunacy should not be supplied, under heavy penalties, with 
 the names, addresses, and other particulars of all insane 
 persons in residences out of their present jurisdiction. While 
 freely admitting the general excellence of religious communi- 
 ties, and the great advantages of hydropathic establishments, 
 I think it is questionable whether some of their inmates 
 are not — more or less — of deficient mental power, sufficient 
 to bring them and their properties within the care and 
 protection of the State, and whether they should not 
 be thrown open to the authorities in the same manner as 
 lunatic asylums are, instead of being, practically, uncon- 
 trolled. But this is a digression, for which I hope to 
 be excused on account of the importance I attach to its 
 subject. 
 
 Let us now examine the various systems of legislation 
 pertaining to voluntary patients. And, first, let us take that 
 of England. 
 
 Until 1853 no person could be received into a licensed 
 house as a, boarder, and such houses were consequently closed 
 to all but patients.* In the Lunacy Act of that year,t pro- 
 vision was made that any patient discharged from a licensed 
 house might be retained in it as a boarder if the previous 
 assent in writing of two of the Commissioners had been ob- 
 tained ; and also that a relative or friend of any patient might, 
 by means of a similar assent, be received therein as a 
 boarder. This was for the benefit of patients who had been, 
 or were, certified, and the period of residence as boarder or 
 companion was specified in the assent, which the Com- 
 missioners could extend or revoke. It will be noticed 
 that the object of a patient's relative or friend residing 
 in an asylum was for the sake of companionship and con- 
 solation, and was not intended as any advantage to the 
 mental health of the companion. Up to that time boarders 
 of any kind were unknown in any institution for the insane, 
 and it will be observed that a person, under the Act of 1853, 
 could not be admitted into a licensed house as a voluntary 
 patient for his own mental infirmity, but that its enactments 
 were limited to him who was either resident at the time in 
 the house, or who had a friend willing to be his companion 
 there. 
 
 * Definition of " Patient," see Appendix. 
 
 f 16 & 17 Vict., c. 96, s. vi. Fry's Lunacy Acts (1864), p. 322.
 
 by Stanley Haynes, M.D. 7 
 
 By the Lunacy Acts Amendment Act of 1862,^ superinten- 
 dents of licensed houses are permitted to receive as boarders 
 those who have been patients in any asylum within five years 
 immediately preceding, if the assent, which is granted for a 
 specified time, of two or more Commissioners or Visitors have 
 been previously obtained. This was a great improvement on 
 the previous Act ; but it continues to shut out from licensed 
 houses and public asylums all those who, though feeling the 
 advisability of asylum treatment, have never been certified. 
 Registered hospitalsf for the insane have a great advantage 
 over licensed houses and asylums in this respect, that those 
 who wish to reside in them may do so. J 
 
 The enactments regarding boarders apply only to licensed 
 houses and to registered hospitals, so that the poorest, who 
 perhaps have more need to become voluntary patients than 
 those higher in the social scale, are debarred from entering 
 English asylums — i.e.^ public pauper asylums — unless they 
 are received as certified patients. 
 
 Writing of hospitals for the insane the Commissioners have 
 thus expressed themselves § — 
 
 " It would appear advisable to render admission into them 
 less difficult, if not in every case, yet at least in those where 
 the patients suffer from sudden and uncontrollable impulses 
 to commit violence or suicide, and who desire to place them- 
 selves under care and treatment. But besides persons of un- 
 sound mind, for whose medical care and treatment hospitals 
 are primarily intended, it has occurred to us that it would 
 be very desirable if arrangements were made for the recep- 
 tion therein of persons, of whom we have reason to know 
 there are many, not insane, who, being conscious of a want of 
 power of self-control, or of the addiction to intemperate 
 habits, or fearing an attack or a recurrence of mental malady, 
 and being in all respects free agents, are desirous of residing 
 as voluntary boarders in an institution for the insane." 
 
 If it be desirable, as it most assuredly is, to facilitate the 
 admission of the persons described by the Commissioners in 
 the above extract into hospitals, surely it is no less to be 
 
 * 25 and 26 Vict., c. Ill, s. xviii. See Appendix, 2. 
 
 t Definitions of " Licensed House," "Asylum," " Kegistered Hospital," in 
 8 and 9 Vict., c. 100, s. cxiv. See Appendix, 3. 
 
 X See Case and Opinion in Appendix, F (p. 107), iTth Keport of Commissioners 
 in Lunacy, 1863. 
 
 § iTth Report of Commissioners in Lunacy, 1863, p. 12.
 
 8 Voluntary Patients in Asylums, 
 
 wished that similar privileges may be extended to licensed 
 houses, and to county, borough, and other public asylums — 
 to affluent, middle-class, and pauper boarders, as well as to 
 hospital ones. It may be urged that the admission of paupers 
 as boarders into asylums would increase public asylum ex- 
 f>enditure but, in-espective of the fact that the plan is actually 
 adopted in Scotland, I am satisfied it would be cheaper to their 
 counties or boroughs to admit them when they wish than to 
 wait until they require certification, or have committed some 
 illegal act. A suggestion made by the Scottish Commis- 
 sioners, in their Report for 1861 (p. xxxvii), with regard to 
 paupers liberated on trial, may be introduced here, as bearing 
 on this point. It is that " It would be advisable, in the cases 
 of paupers, to retain the patient's name on the poor-roll during 
 the period of his probation, and also to grant him a liberal 
 alimentary allowance, with the view of securing his continued 
 proper care and treatment and consolidating his convalescence. 
 We are satisfied that statutory authority, to enter into ar- 
 rangements of this kind, would be followed by important 
 benefits to the patients. The knowledge that the means of 
 subsistence were secure for a certain period woidd enable 
 them gradually to resume the duties of life, and would tend 
 to protect them against a relapse which, under existing cir- 
 cumstances, not unfrequently t?ikes j)lace, and oiten leads to 
 suicide." I bring forward this generous and enlightened 
 suggestion because it appears only reasonable to suppose that 
 when such amenities are proposed by Commissioners in 
 Lunacy for the benefit of certified patients, they would not 
 have any objection to very poor persons, who wish to become 
 volmitary patients, being placed on poor-rolls, and their names 
 being kept on them for a time after discharge. It should be 
 considered also that boarders in public asylums would partly, 
 if not in some cases entirely, repay their expense by their 
 labour. 
 
 Having considered the English, I propose now to indicate 
 the Scotch legislation concerning boarders. It will save time 
 if I mention the enactments now in force, without describing 
 the previous ones.^ 
 
 By the Lunacy {Scotland) Act, 1866,t persons who are de- 
 sirous of submitting themselves to treatment, but whose men- 
 tal condition is not such as to render it legal to grant certifi- 
 
 * 25 and 26 Vict., c. 54, s. vi., Lunacy {Scotland) Act, 1862. 
 t 29 and 30 Vict., c. 51.
 
 hy Stanley Haynes, M.D. 9 
 
 cates of insanit}^ are admitted as boarders into Scotch asylums 
 — public as well as private — if tliej have previously written 
 to the Commissioners and have obtained the written assent of 
 one of them, subject to provisions that such boarders must be 
 seen by the Commissioners at each visit ; that unless the 
 boarder becomes a patient he cannot be detained more than 
 three days after giving notice of his intention or desire to 
 leave ; and that notices of admission, discharge, or death shall 
 be sent to the Commissioners as in the case of patients. 
 Also, that in the event of such boarders becoming patients, 
 the certificants must not be in any way connected with the 
 asylum. Nothing is specified concerning the duration of 
 time granted by the assent, the renewal, or the revocation 
 of it. 
 
 Under the existing state of the law there is a reluctance to 
 receive boarders into Scotch asylums, in consequence of the 
 want of control, and therefore of benefit in many cases. Of 
 dipsomaniacs as voluntary patients the Commissioners have 
 
 reported"^ "The chief impediment is the want 
 
 of the power of compulsory detention. It is undeniable that 
 much mischief is caused to the health of the individual affected, 
 and to the property and comfort of his family, from the irre- 
 sistible tendency to the abuse of stimulants, and the question 
 of legalizing compulsory control, where such a tendency exists, 
 is one in favour of which powerful arguments may be ad- 
 vanced. At the same time it is not desirable to bring mere 
 drunkards within the scope of the lunacy laws ; and there 
 will frequently be a difl&culty in determining where vicious 
 indulgence ends and disease begins." 
 
 In Ireland there are not any enactments respecting boarders 
 in asylums, and their reception therein is consequently not 
 recognised by law. In two or three instances within a period 
 of, perhaps, ten years persons have been found residing volun- 
 tarily in licensed houses by the Inspectors of Lunacy — who 
 correspond to our Commissioners — but no objection has been 
 made, the Inspectors being satisfied that no restrictions were 
 placed on the freedom of egress of such residents whenever 
 they wished. In at least one of the public asylums relapsed 
 patients sometimes seek re-admission voluntarily, and they 
 are received and treated like the other inmates. 
 
 Previous to 1838 f voluntary patients could be admitted 
 into asylums in France, provided they were received into a 
 
 * lOth Lunacy Eeport, 1868, p.lxv. 
 t Loi de 30 Juin, 1838.
 
 10 Voluntary Patients in Asylums, 
 
 special department, in wliicli tliey would be kept free from 
 contact with, any of the insane ; but in that year the per- 
 mission was revoked, because it was found so inconvenient : 
 under it the boarders could go out or leave at any time, how- 
 ever seriously affected, and any benefits derivable from asylum 
 residence were therefore illusory. 
 
 As some proof of the necessity for legislation in England 
 for those who wish to become boarders I may mention that 
 the number in Scotland of those admitted, who voluntarily 
 sought admission, was in 18G4 twelve, of whom eight were 
 received as boarders, and four as patients ; in 1865 eight, of 
 whom three were admitted as voluntary residents ; in 1866 
 fifteen voluntary patients were received ; in 1867 seventeen, 
 fourteen of whom were received into public, and three into 
 private asylums ; and that last year the number rose to thirty- 
 one — making a total of eighty-three in five years. My 
 esteemed teacher and friend. Dr. Skae, has recorded in his 
 reports of the Royal Edinburgh Asylum, at Morningside — 
 from which I wish I had time now to give many valuable ex- 
 tracts* — that in 1858 he received three applications from per- 
 sons entreating to be admitted ; in 1859, four ; in 1860, one ; 
 in 1861 and 1862, several; in the year 1863 a considerable 
 number, of whom three were admitted as voluntary residents ; 
 in 1864 eigbt applications were made, and in 1865 several ; 
 and that in 1866 ten were taken to the asylum at their own 
 request, or went seeking admission, and of these five had 
 previously been inmates. He received other applications in 
 1867 and 1868. This is the experience of only one superin- 
 tendent, and demonstrates how large a number seek admis- 
 sion in Scotland. It should, however, be considered that 
 some went from other countries. Were the Scotch system 
 extended to the other portions of our empire there is 
 little doubt the number of voluntary applications for admis- 
 sion would be considerable ; and I believe that if the scheme 
 I suggest were adopted it would be very large. I base this 
 assumption on the proportion of the populations to the 
 countries : Scotland has a comparatively small population, 
 but we have found her asylums received eighty-three volun- 
 tary patients in five years, and that the number is progres- 
 sively increasing. At present persons desirous of obtaining 
 asylum protection, and who have never been patients, have to 
 
 » Royal Edinburgh Asylum Reports for 1858, p. 25 ; 1859, p. 19-21 ; 1860, p. 
 22; 18G1, p. 15; 1862, p. 18; 1863, pp. 14 and 17; 1864, p. 18; and for 
 1865, p. 16.
 
 by Stanley Hatnes, M.D. 11 
 
 go to Scotland for it. During tlie past two years I have re- 
 ceived applications respecting voluntary boarders ; three per- 
 sons were admitted, having been former patients, the others 
 could not, because they had never been certified. I expect to 
 hear many English superintendents receive similar and 
 numerous applications, and also have to decline them. 
 
 I believe the old adage that " prevention is better than 
 eure " is as true of mental as of physical morbid conditions ; 
 that many a case of absolute certifiable insanity could be 
 warded off by the early treatment of unhealthy symptoms, 
 and that when opportunities occur for checking them we 
 should, and ought to, have the means of placing the sufferer 
 under the most favourable conditions for recovery. I do not 
 pretend to affirm that all persons with over- wrought mental 
 energies require rest in an asylum — far from it ; but I do 
 think that when such persons wish to enter asylums they 
 should be free to do so. There is something very calmative 
 and beneficial to the disturbed mind in a well-managed 
 asylum ; the regularity and routine, discipline and order, 
 presence of skilled attendants, the means for amusements 
 and exercise, the absence of exciting causes, are in themselves 
 sufficient for the recovery of many of the inmates ; while 
 voluntary patients know they are free agents, and have con- 
 fidence that all will be done that can be to restore them to 
 health. 
 
 With regard to dipsomaniacs Dr. Symonds, the President 
 of the Social Science Congress at Bristol, has this month read 
 a paper on " Proposed Legislative Prevention of Drunken- 
 ness," and for argument assumes that a drunken man is in 
 an unsoimd state of mind, and should be guarded from evil 
 to himself and others as much as a lunatic. He proposed a 
 resolution, which was carried with but one dissentient, viz. : 
 " That dipsomaniacs should be liable to deprivation of liberty, 
 with a view to their protection and reformation." Were any 
 enactments made legalising such deprivation, there can be 
 little doubt many persons would voluntarily enter asylums in 
 preference to being sent to them, and as it seems probable we 
 must soon provide retreats for oinomaniacs, it becomes a 
 question of some moment whether we should not enable their 
 managers to detain those confided to their charge. 
 
 Professor Gairdner believes that in intractable cases of 
 drunkenness " the person of the drunkard might be placed 
 under restraint in properly-regulated establishments, like the 
 ' inebriate asylums ' of America, under State inspection and
 
 12 Voluntary Patients in Asylums, 
 
 control." Many arguments could be advanced in favour of 
 this suggestion, and I think a strong one is that if all dipso- 
 maniacs — i. e.j all those who labour under uncontrollable im- 
 pulse to alcoholic excess — were deprived of liberty, there 
 would be a considerable diminution of hereditary tendency 
 towards mental and physical imperfections : moral and intel- 
 lectual idiocy and insanity, epilepsy and allied disorders, 
 criminality and intoxication on the one side, scrofula and 
 tuberculosis, rachitis and chorea, neuralgic and other nervous 
 affections on the other. The appointment of a commissioner 
 to visit and report upon the American " inebriate asylums " 
 would be productive of much valuable information to our 
 Government, and would probably be succeeded by imjjortant 
 results. 
 
 I have endeavoured to prove the extent and the deficiency 
 of legislation respecting boarders or voluntary patients in 
 asylums and other establishments for the insane, and to point 
 out the necessity for its enlargement, and wish now to 
 indicate the mode in which I would suggest its amend- 
 ment. 
 
 Let there be one system of lunacy law for all the divisions 
 of the British dominions. " There are no less than forty-one 
 acts affecting the insane subjects of Her Majesty in England 
 and Wales."* 
 
 Confining my remarks to legislation on boarders, I would 
 urge that — 
 
 1 . It may be lawful for the proprietor or superintendent of 
 any establishment — whether asylum, hospital, or licensed house 
 — for the reception of lunatics f to receive and keep in such es- 
 tablishment as a voluntary boarder any person who shall ex- 
 press a desire, in writing, addressed to the proprietor or 
 superintendent, to become a boarder, X without any certificate 
 or assent being previously obtained. 
 
 2. Every such boarder shall be produced to the Commis- 
 sioners in Lunacy, or Visitors, at each statutory visit. 
 
 3. The superintendent or proprietor shall, within twelve 
 hours of verbal or written notice from any boarder, furnish such 
 boarder with a form of notice of intention to leave, § and 
 shall permit him or her to leave on the day named in such 
 notice. 
 
 * 22nd Report of the Commissioners in Lunacy (England), 1868, p. 90. 
 
 t As defined by 8 and 9 Vict., c. lOO, s. c\iv. See Appendix. 1. 
 
 X Appendix. Schedule A. § Appendix, iioiiedule B.
 
 hj Stanley Hatnes, M.D. 13 
 
 4. The superintendent or proprietor shall send notice"^ to the 
 Commissioners or Inspectors of Lunacy, to the District Board 
 of Lunacy in the case of asylums and hospitals, and to the 
 Clerk to the Visitors and to the Medical Visitor in the case 
 of licensed houses, within twenty-four hours of the reception 
 of any boarder. 
 
 5. The superintendent or proprietor f shall enter the recep- 
 tion of all boarders in a reception book to be kept for such pur- 
 pose, and send notice of leaving, with state and address of the 
 boarder, or of death, to the authorities mentioned in the last 
 paragraph, the same as for certified patients. 
 
 6. The superintendent shall send a statement of the condition 
 of every boarder to the Commissioners or Inspectors of Lunacy 
 at the expiration of every three months from the reception of 
 such boarder. 
 
 7. The Medical Visitor shall see every boarder in a hospital 
 or licensed house, free from the superintendent, medical as- 
 sistant, or proprietor, within three days of reception ; the fee 
 for such visitation to be paid by the boarder. 
 
 8. A boarder entering a private asylum may make arrange- 
 ment as to payment with the proprietor or superintendent, 
 who shall be able to enforce such payment to him by law. A 
 boarder entering any other establishment for the insane may 
 agree to pay such sum, in whole or in part, as «iay be agreed 
 upon between him and the managers thereof; when he or she 
 can only pay in part the balance shall be charged upon the 
 common fund of such establishments. In the case of pauper 
 patients the payment shall be made by the parish to which he 
 or she belongs, and shall be of the same amount as for patients. 
 (This may be objected to by some ratepayers, but I believe it 
 will be found wiser to charge parishes with the maintenance 
 of boarders than to run the risk of such persons becoming 
 patients, and therefore, by reason of commission of crime, 
 medical certificates and other expenses, proving more ex- 
 pensive.) 
 
 It would be better, whenever a boarder may be certified 
 and so become an ordinary patient, that he should be trans- 
 ferred to another asylum — that he should not be admitted at 
 all as a patient into any asylum into which he had gone as 
 a boarder — unless he expressed a strong wish to remain. 
 
 * Appendix. Schedule C. 
 
 ■f The last pages of the existing '* Admission Book " would suffice for this 
 purpose ; or the receptions might be entered with the admissions in red ink and 
 without numbers, to distinguish them.
 
 14 Voluntary Patients in Asylums^ 
 
 It may be thought I take an extreme view of the impor- 
 tance of persons being* able, of their own will, to enter 
 asylums for treatment of incipient or slight or latent attacks 
 of mental disorder, but when we reflect that 2,000 suicides 
 occur annually in Great Britain, and that very many of them 
 are preventable, it is but just to suppose that, were asylums 
 thrown open in the manner I have indicated, and with the 
 precautions against abuse I have suggested, some of the 
 persons with suicidal tendencies would become boarders and 
 so have their lives saved and, instead of being losses to society 
 and to the State, be gains to them by recovering from their 
 abnormal conditions and resuming their previous positions in 
 the world. If we assume only a few suicides would thereby be 
 annually prevented it would be matter for sincere congratu- 
 lation and comfort. Those who have studied insanity in its 
 various forms know these arguments apply as strongly to 
 homicides as to suicides, and that the homicide frequently 
 becomes the suicide, as is but too often proved by newspaper 
 reports. While I have been writing this paper the country 
 has been horrified by the poisoning of a fondly-loved wife 
 and four children, and of the poisoner ; such cases excite no 
 surprise in the psychologist, because he knows that those who 
 are most attached to their kindred during mental health are 
 the most likely to destroy them, and often themselves also, if 
 their minds lose their equilibrium. 
 
 We read almost every week of some person having com- 
 mitted homicide or suicide, or both, and the evidence before 
 the coroner frequently proves that the culprit had been of 
 altered manner and behaviour before the commission of the 
 act, but had not been deemed sufficiently insane to justify 
 removal to an asylum. It is my firm belief, supported by 
 personal knowledge, that some of those persons would volun- 
 tarily enter asylums if they knew they could be received on 
 simply going to them and asking to be admitted, stating 
 their reasons. If asylums were thus assimilated to general 
 hospitals, more real and general knowledge of them would 
 spread amongst the public, existing vulgar prejudices would 
 consequently be destroyed, and great benefit would result to 
 the partially insane as well as to the mass of asylum inmates. 
 At present there is a lamentable amount of ignorance 
 throughout the general public regarding asylums and the 
 treatment pursued in them, and it is therefore much to be 
 wished that it were commonly known how the inmates are 
 treated, and what liberties and advantages they enjoy; then
 
 hy Stanley Haynes, M.D. 15 
 
 those who have left asylums would be humanely treated out 
 of them as in them, and the sensitive convalescent would not 
 be taunted and viewed vdth suspicion by those about him, 
 and no stigma would attach to him, because it would be 
 known that in many cases physical debility or disease has 
 caused the appearance of mental symptoms instead of the 
 more ordinary signs of corporeal disorder. 
 
 In conclusion, I wish to protect myself from those who 
 may think I urge an extended system of boardership in 
 asylums from interested motives ; my objects are to alleviate 
 suffering, diminish danger, and protect valuable lives, and my 
 endeavour has been to show how boarders could be received 
 into all classes of institutions for the insane in all parts of 
 Great Britain, if not throughout the British empire ; for I 
 know no sufficient reason why the scheme I have sketched 
 out could not be adopted in India, Canada, Australia, 
 and all other of our possessions. That I am not unduly pre- 
 judiced in favour of asylum superintendents, but that the 
 subject has been regarded from the public point of view also 
 is, I venture to hope, proved by the precautions I have out- 
 lined against any abuse. Many, no doubt, will think that in 
 all cases a medical certificate of the boarder's mental condi- 
 tion should be obtained, but it is not required in Scotland, 
 nor do I deem it necessary or advisable, because the majority 
 of those who seek asylum treatment only manifest their true 
 state by their own perceptions, and are consequently in such 
 a condition that nothing conclusive can be certified of them ; 
 besides which, the giving of any certificate would place the 
 certificant in a very painful position with the boarder : further, 
 I do not suppose any person would attempt to become a 
 boarder in an asylum unless he felt he required treatment 
 and rest in one. 
 
 APPENDIX 
 
 1. Definition of Patient (8 & 9 Vict., c. 100, s. cxiv ). " Every person 
 received or detained as a lunatic or taken care or charge of as a lunatic." De- 
 finition of Lunatic. '* Lunatic shall mean every insane person, and every person 
 being an idiot or lunatic or of unsound mind." Fnfs Lunacy Acts, 1864, 
 p. 305. 
 
 2. Op. cit., p. 509. "It shall be lawful for the proprietor or superin- 
 tendent of any licensed house, with the previous assent in writing of two or
 
 16 Voluntary Patients in Asylums. 
 
 more of the Commissioners, or in the case of a house licensed by justices of, two 
 or more of the visitors, to entertain and Iteep in such house as a boarder for such 
 time as may be specified in the assent any person who may have been within five 
 years immediately preceding the giving of such assent a patient in any asylum, 
 hospital or licensed house or under care as a single patient." 
 
 3. Definitions of "Licensed House," "Asylum," and "Registered 
 Hospital," Viile 8 & 9 Vict., c. 100, s. cxiv. "'Licensed House' shall mean 
 a house licensed under the provisions of this Act or of some Act hereby repealed 
 for the reception of lunatics." (2 & 3 W. IV , c. 107 ; 3 & 4 W. IV., c. 64 ; 
 6 & 6 W. IV., c. 22 ; 1 & 2 Vict., c. 73 ; 5 Vict., c. 4 ; 5 & 6 Vict., c. 87.) " ' Asy- 
 lum ' shall mean any lunatic asylum .... for the care and mainten- 
 ance of pauper and criminal lunatics in England." " ' Hospital,' shall mean any 
 hospital or part of an hospital or other house or institution (not being an asylum) 
 wherein lunatics are received, and supported wholly or partly by voluntary 
 contributions, or by any charitable bequest or gift, or by applying the excess of 
 payments of some patients for or towards the support provision or benefit of 
 other patients." 
 
 SCHEDULE A. 
 
 FORM OF WISH TO BECOME A BOARDER. 
 
 I, A B., of occujjation, desire to reside in your establishment as a 
 
 boarder, and hereby agree to abide by any regulations you may impose on me, 
 provided that I can terminate such boardership by giving you not less than three 
 clear days' written notice of my intention to leave. 
 Dated this day of 18 
 
 A.B. 
 Witness, C. B, 
 To 
 
 Superintendent (or Proprietor) of 
 
 SCHEDULE B. 
 
 FORM OF NOTICE OF INTENTION TO LEAVE. 
 
 I, A. B., now a boarder under your supervision, hereby give you notice of my 
 
 intention to leave your establishment, and to resume my perfect liberty on the 
 
 day of 18 . And I hereby exonerate you from all 
 
 responsibility and consequences respecting such cessation of your supervision 
 
 over me. 
 
 Dated this day of 18 . 
 
 A. B. 
 To 
 
 Superintendent (or Proprietor) of 
 
 SCHEDULE C. 
 
 FORM or NOTICE OF RECEPTION OP BOARDER, 
 
 I hereby give you notice that A. B. of ^occupation) was received into 
 
 this establishment as a boarder on the day of 18 , and 
 
 I hereby transmit a copy of the request on which he was received. 
 Dated this day of 18 
 
 E. F. 
 Superintendent (or Proprietor) of 
 To the Commissioners in Lunacy.
 
 7-!v?r :."■,?.'!-

 
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