303
Art. VII.?CONDITION OF LUNACY IN ENGLAND AND WALES. The thirtieth annual Report of the Commissioners in Lunacy has just appeared, containing a complete record of all facts connected with lunacy in this country. AVe find that on January 1st, 1876, there were on the official books of the Commissioners 64,916 registered lunatics, showing an increase of 1,123 over that of the year preceding. Of this number 7,509 are registered as private patients, and 57,407 as paupers. There are also 245 lunatics found so by inquisition, and residing in charge of their committees. They are not included in the category alluded to above. The average annual increase of lunacy during the past ten years has been 1,726 ; that is to say, 149 private patients, and 1,577 of the pauper class. It is worthy of remark that the total increase of the past year over the one preceding has been less than in any other year of the series commencing in 1859. " Among the pauper patients are included only those maintained wholly or in part by, or chargeable to, parishes, unions, counties, or boroughsand among private patients are included those maintained at the cost of the State, at the Royal India Asylum at Yarmouth, Naval Hospital at Netley Abbey, Grove Hall, Bow, and Broadmoor Criminal Asylum. The increase during the year of private patients is 119, as compared with 98 last year, and an increase of 1,004 of paupers, as compared with 1,668. The private patients have increased by 51 in licensed houses, 70 in registered hospitals, 19 in county and borough asylums, and by 3 in the naval, military, and India asylums. There has been a decrease in number by 19 in Broadmoor Criminal Asylum, and by 2 in single patients under private care. The increase of pauper patients is in county and borough asylums by 1,606 ; in Broadmoor Criminal Asylum by 19; in workhouses by 133; and at the same time this class has decreased in registered hospitals by 72, in licensed houses by 352, and the outdoor paupers are reduced by 330. In the last Report the Commissioners noticed with satisfaction that the practice of sending male convicts to Broadmoor has been discontinued, and during the past year this class of patients has been provided for at Woking Invalid Prison, and
304 as
a
CONDITION OF LUNACY
consequence,
private patients
a
decrease has occurred in the number of
at Broadmoor?accounted
for,
no
doubt, by
deaths and removals to county asylums of convicts whose sentences have expired. The large increase of 1,606 paupers in county and borough asylums, and the considerable decrease of 352 of this class in licensed houses, is in a great measure explainable by the opening of the second Kent Asylum at Chartham, and of additional wards at the New Lancashire Asylum at Whittingham, as well as by the completion of considerable enlargements of the Surrey Asylum, both at Brickwood and Wandsworth. The decrease of 72 paupers and the corresponding increase in the number of private patients in registered hospitals are chiefly due to changes which have taken place at the Northampton hospitals, and it is expected that when these changes are here completed the whole of the paupers will be removed from this institution, and it will be exclusively devoted to private patients. There are 15,509 patients classed as in workhouses. Of this number 4,205 were in the Metropolitan District Asylums for Imbeciles at Leavesden, Caterham, Hampstead, and Clapton. These institutions were, by the Metropolitan Poor Act, 1867, declared to be workhouses for the purposes of the Lunacy Acts. The Report contains twelve interesting tables relating to the distribution of the insane during the last sixteen years, and supplies detailed information as to the classification, and numbers of the insane in England, together with the ratio which they bear to the population; the admissions, discharges, and deaths, with the statistics of recoveries and mortality of patients detained under certificates in asylums, hospitals, licensed houses, and under single care. By a careful perusal of these tables we find that the proportion of lunatics as compared with the population is 26*78 ratio per 10,000, whereas in 1866 it was 22*26 ; the population at present being 24,244,010, whereas in 1866 it was 21,409,684. The number discharged as recovered during the past year, by reference to Table IV., we find to be 4,909, as compared with 4,828 in the preceding year, whereas the deaths have been 4,592. We see with regret by Tables V. VI. and VII. that the recoveries are nearly 4 per cent, lower than those of the year previous, and 1 *5 per cent, below the average of the last 17 years. The mortality also has been somewhat unfavourable, being about ?5 per cent, higher than that of the previous year and than the average mortality of the last fifteen years. The proportion of patients contained in the county and borough asylums who on the 1st of January were considered curable amounted to 7*17 per cent, of the total number, as
IN ENGLAND AND WALES.
305
compared with 7*47 of the number resident on the 1st of January, 1875. The Report contains a general description of the various county and borough asylums. The Cambridge Asylum at Fulborne continues dangerously overcrowded. We are at a loss to understand why the suggestions made so frequently by the Commissioners concerning this asylum have not been carried out and a second medical officer appointed ; the matter has been frequently brought forward by Dr. Bacon, the Medical Superintendent, but the authorities at present have ignored these constant appeals for further medical aid, and, as a consequence, should anything serious occur at the asylum, they will have but themselves to blame in the matter. An epidemic of erysipelas broke out in February and March 1875 at tbis asylum, in consequence of the overcrowding of the patients, and if the long-delayed enlargement is not soon effected, the patients' health will materially suffer. We have had many opportunities of visiting this asylum, and can testify to the onerous duties of the Medical Superintendent, who does his utmost to further the interest of the establishment and the well-being of the patients committed to his charge; but if his exertions are not properly supported by the governing bodies, his laudable efforts must be
but futile. The condition of the patients on admission to the Carmarthen Asylum is considered to be most unsatisfactory. The following passage occurs in the entry made on the visit to this asylum, relative to the condition of patients on admission :? " We are informed that the condition of patients when brought to the asylum continues in the majority of cases to be most unsatisfactory, giving evidence of neglect, want of nourishment, and rough usage. An old woman was admitted to-day, while we were in the house, and we afterwards saw her in bed; she was extremely feeble, and bore upon her person numerous marks of violence, and there was strong reason to think that she had broken ribs. This woman was brought to the asylum by a policeman, and was not accompanied by any female ; and we are sorry to report that this most objectionable mode of bringing patients here is the rule, with but few exceptions, from the Cardigan Union. It is needless to point out the impropriety of entrusting an insane woman during a long journey to the sole charge ot' a policeman; but there remains the further and very strong objection to the practice, which applies equally to both sexes, that the removal of the patient to the asylum by a policeman impresses them with the idea that they are prisoners, and about to undergo punishment, instead of being sent to a hospital for care and treatment."
306
?
CONDITION OF LUNACY
A case of suicide is related as having taken place at the Cheshire Asylum, and also at Durham. This latter asylum is about to be considerably enlarged. Two suicides have occurred at the Lancashire Asylum, one by a patient cutting his throat with a knife, the other by strangulation; in both instances the attendants appear to have been to blame. Another suicide has taken place at the Whittingham Asylum. A suicide which has taken place at the Littlemore Asylum, Oxfordshire, is reported as follows :? " A. C., a single woman, set. 34, had been an inmate of the Littlemore Asylum since May 1875. As she was reported to be suicidally disposed, a special card of caution was passed with her from ward to ward, but the asylum authorities did not consider, from her conduct, that she seriously contemplated either escape or self-destruction. In the evening, however, of Saturday, 11th September, she contrived to escape from the grounds where, with other patients, she was taking exercise. She was missed almost immediately; but although the police and the neighbours were given notice of the escape, she w as not A little before six on Monday she was seen found all Sunday. near the river by two men, who followed her while she ran across one meadow by the waterside, through a hedge and over a ditch (dry), across a second meadow, at which point she Here she jumped into the juncwas stopped by a deep ditch. tion of the ditch with the river, the water being nearly up to her armpits. The first man who followed jumped in, though unable to swim; but the bottom being very muddy, he could not reach the woman unless she held out her hand; this he asked her to do, but she thrice refused, began struggling, and lost her footing. By this time the second man had come up ; and he, with a ladder floating in the water, succeeded in reaching the patient; but she was already under water, a considerable way out from the bank, the stream being rather strong at that point. Between them she was got out of the water, not dead, yet unable to speak. The men carried her to the nearest inn, about 300 yards. During her passage thither she groaned and breathed several times. They believed she was in the water about three minutes. Dr. Sankey was called, and was on the spot by half-past six, but she was then to all appearance dead, and every effort to restore life was in vain." A patient at the North Eiding Asylum, Yorkshire, destroyed himself through the carelessness of an attendant. Reference is made to the extension of the Birmingham Asylum, and to an epidemic of typhoid fever, which occurred at the Bristol Asylum, owing to the impurity of the drinking water. Immediate measures were suggested by the Commissioners
IN
ENGLAND
AND
WALES.
307
for remedying the evil, and negotiations with the Bristol Waterworks Company were set on foot. " An attempt at suicide took place at the Bristol Asylum. " The facts connected with the case are remarkable, and interesting from a purely medical point of view, affording a remarkable instance of the recurrence after a lapse of years of .a morbid propensity once developed in the mind of a patient of the melancholic type with a suicidal tendency; and also as showing how much may be done by skill and care to remedy an injury which at first sight seems likely to prove fatal. " The particulars which follow we give nearly as reported to us by the medical superintendent:? " A female patient, E. W., set. 43, was admitted for the third time to the Bristol Asylum on the 15th June, 1875. "On the occasion of her first residence there in 1863, she swallowed (with a distinct suicidal intention) the entire contents of a domino box, 54 dominoes in all, 50 of which were recovered by vomiting, along with fragments of stone weighing 14 oz., while four dominoes and some stones passed through A full account of this incident will be found in the intestines. the report of the late medical superintendent to the Committee of Visitors of the Asylum for the year 1863. " E. W. was soon after discharged from the Bristol Asylum, for transfer to that belonging to Somersetshire, where she was chargeable, but she escaped on the road, and was not retaken. Between this date and 1871 she appears not to have been under care and treatment. In May of that year she was re-admitted to the Bristol Asylum, still with suicidal tendencies, and after two actual attempts, she was again removed to Wells, and disthence recovered, in 1873. charged " After another interval, she returned, as above stated, to the Bristol Asylum in 1875, twelve years subsequently to the swallowing of the dominoes, which circumstance was, we believe, quite forgotten in the asylum, where many changes in the staff, including the appointment of a new medical superintendent, had occurred. The certificates again give a history of renewed suicidal attempts. " On the 31st July, 1875, early in the morning, she got possession of the fifteen shutter screws belonging to No. 12 Ward, and in the course of three quarters of an hour she swallowed thirteen of them. The screws were new ones; and thirteen of the same pattern weighed 24^oz. avoirdupois weight. She made a confession before the screws had been missed, and stated the number to be thirteen. To prevent injury to the coats of the stomach, Dr. Thompson, on hearing of what had happened, administered a mess of tapioca pudding and gruel, of
308 which, without
CONDITION OF LUNACY
much
persuasion,
she
took
a
very
large
quantity.
" inches long, ? inch thick The screws consist of a body with a square head, and with a raised collar nearly f inch in diameter. " It will be seen that to attempt to recover by the oesophagus one of those swallowed was out of the question, and it was any even doubted if the pyloric valve would take up any one of them and pass it on. On the 10th of September, however, the patient passed some of the screws by the bowel, and on the 4th of February she passed the last of the thirteen in the same The dates of ejection were 10th September, 19th manner. 26th November, 27th November, 3rd December, 3rd October, January, 9th January, 19th January, 20th January, 3rd February, 3rd February, 4th February, and 4th February. " During these months the patient suffered much pain, which she said was of a spasmodic nature, and very like to labour pain (she had had children). The treatment was chiefly dietetic, but in addition she had, night and morning, subcutaneous injections of morphia. At first purgatives were avoided, but ounce doses of olive oil were given once a day, and enemata " occasionallv. Latterly the medical officers became more bold," and gave large doses of castor oil, and it was after this bolder treatment that the screws came away the faster. On the 3rd of August E. W. passed a large piece of an earthenware chamber utensil by the bowel, which was followed by severe hemorrhage, but only once did her temperature rise over the The weight of the recovered screws was average point. 19f ounces, showing a loss of 4f ounces. "' The poor woman,' Dr. Thompson observes, ' is a melancholiac of the most abject type, and with a touch of moral obliquity. I do not think she wished to commit suicide, but rather to draw attention to herself, and to cause trouble.' This opinion is, of course, entitled to full consideration, but it is to be observed that during the preparation of the present report, the Wells Asylum, where E. W. now is, has been visited, and that on this occasion she admitted to one of our colleagues that her object was to destroy herself. She appeared in fair bodily health, though still in a state of extreme mental de-
pression."
A murder of an attendant has occurred at the Leicester An attendant of the name of John Smith was stabbed by G-eorge Fordham, a pauper patient, in the abdomen, and died in consequence of the injuries received in about an hour and a half. The patient was 62 years of age, and previous to admission had been an inmate of the Leicester Union Work-
Asylum.
IN
ENGLAND AND WALES.
309
house for some time, being transferred to the asylum on account On admission he was of violent and dangerous propensities. and quarrelsome, passionate making groundless and exaggerated complaints, and was subject to epileptic seizures. Nine months after his admission he was overheard to say that he would hunt the attendant, Smith, to death, even if it were fifty years hence. He killed the attendant with a carving knife which he had procured from a cupboard, and which singularly enough had been left unlocked by Smith. After the discovery of the murder, Fordham exclaimed, "I have had my revenge: you can hang me now as soon as you like." The coroner's jury returned a verdict of wilful murder, and he was committed for trial at the winter assizes at Leicester. The prisoner pleaded not guilty. The facts connected with the murder were undisputed, but the counsel for the defence urged an acquittal on the ground of insanity. Mr. Justice Denman, who tried the case, pointed out to the jury that the mere fact of his labouring under a delusion was not a sufficient excuse in law to justify an acquittal on the" ground of insanity. The judge, in summing up, stated that where a man committed a crime for some supposed grievance if he knew that what he was doing was contrary to law, he was to be held responsible for his actions. If a man killed another while under a delusion that he himself was about to be killed, and that he was acting in self-defence, he would not be punishable; but if a man did so for some supposed injury to his character or fortune, then the man would be responsible. If the jury were satisfied that although Fordham was suffering from delusions he knew what he was doing, and was not merely taking life under an erroneous impression that he was defending his own life, but killing because he felt himself injured in some form or other, it would be their duty to find him guilty." The prisoner was found guilty of murder, but with a strong recommendation to mercy, by a jury who considered that, notwithstanding he occasionally suffered from delusions, at the time he committed the deed he knew he was doing a wrong act. He was sentenced to death in the usual form, but was afterwards reprieved, and sentenced to penal servitude for life. The absurdity of the rule of law laid down in cases of insanity is here very apparent. We read of a lunatic, who is legally confined under a certificate, being taken from the asylum and arraigned as an ordinary criminal of sound mind, ?and although his insanity was never disputed, is sentenced to death. The doctrine between a knowledge of right and wrong among the insane is frequently brought forward as an argument against an acquittal upon the ground of insanity, but
310
CONDITION OF LUNACY
must confess that the theory is a very absurd one, and as the majority of lunatics are perfectly cognisant of it, it is to be hoped that a statute will soon be passed repealing- the present existing law regarding the trying of lunatics which we can only
we
regard
as a
disgrace
to
our
country.
At the commencement of the year there were 2,796 lunatics confined in registered hospitals, of which number 1,340 were males and 1,241 females belonging to the private class of patients, whereas 115 were males and 100 females paupers. The general condition of these hospitals may be considered favourable, with one or two exceptions. A few suicides are reported at some of the hospitals, but this is only to be expected when the number of lunatics in one establishment is considerable. There are 39 private asylums in the Metropolitan district licensed by the Commissioners, and 62 beyond their immediate jurisdiction licensed by the justices. The condition of these asylums may generally be stated as satisfactory. On the 1st of January last there were 399 patients confined under certificate in unlicensed houses, and of this number 129 were Chancery patients. One suicide is reported as taking at of a Weston-super-Mare patient under the care of place We are of opinion that it is far more advisa medical man. able to place patients in asylums than under private care, in the former of which they have greater chances of proper treatment and care. On the 1st January, 1876, there were 15,509 lunatics confined in workhouses, being an increase of 133 over the number This number includes 4,205 patients resident in last year. the Metropolitan District Asylums at Leavesden, Caterham, Hampstead, and Clapton, which are still regarded as workhouses. The Commissioners report on the whole favourably of the condition of the lunatic wards in workhouses, and with respect to the accommodation and diet supplied to the inmates. The relieving officers of some of the parishes appear to entirely disregard the provisions of the 67th section of the Lunacy Act, and patients labouring under all varieties of insanity are sent to the workhouses, no subsequent steps being taken by them to promote their removal to an asylum ; the result of this practice is that many lunatics are so confined without having any treatment, until they either die or their case becomes chronic. On this point the Commissioners say : "We have constantly drawn attention to this subject, both in our Annual Reports and in others ways, but we regret to say with comparatively little effect; and in any future legislation we think that more stringent provisions should be made to
IN
311
ENGLAND AND WALES.
prevent delay in sending patients to asylums, and also to restrict, as a general rule, the admission of cases into the work-
unless they have passed through the asylum, and are certified by the medical superintendent as being harmless and chronic, and suitable for removal." The relieving officers appear entirely to ignore the law by which they are required to give knowledge to a justice of the peace within three days of their obtaining information that a pauper lunatic is resident in their parish, and should be summarily proceeded against. The Commissioners do this where evidence of any wilful neglect of duty has taken place, but as a rule the technical difficulties in obtaining a conviction are insurmountable, as they are under the control of the board of guardians. The Report contains many instances of the evils attending the indiscriminate reception and detention of insane persons in workhouses, cases being given which have come to the knowledge of the Board casually, no official intimation of accident or death being sent to them. Two male patients destroyed themselves at the Marland one by cutting his throat with a Workhouse, Rochdale never razor, having previously evinced any suicidal tendencies. The second case was sent to the workhouse by the relieving officer with the usual order, " of unsound mind," and at the back of this " order " was written by the master, " Attempted suicide; brother cut his throat; cousin hanged himself." In this case no' notice was given by the relieving officer to a justice, pursuant to the provision of the 67th section of the Act, and there is no doubt but that the suicide was caused by the lunatic being placed in a workhouse instead of being removed direct to an asylum. The medical officer failed to detect that the patient was suffering from suicidal melancholia, and hence the fatal catastrophe. Other cases are quoted in the Report, all of which testify to the neglect of duties by the relieving officers. The following cases illustrate the mischief done by placing lunatics suffering from acute mania in workhouses, instead of at once removing them to an asylum. We give the verbatim account of each case; the neglect of duties by the relieving officers will be apparent without any comments at our hands: "1. A native of Zanzibar, who was brought to Southampton in the capacity of a wet nurse, became insane and violent, and her master applied to the relieving officer to remove her from the house, agreeing to repay to the Union the cost of her maintenance. The relieving officer, " in the hope (as the guardians stated subsequently) that the woman would shortly be able to
house,
PART. II.
VOL. II.?NEW SERIES.
X
312
CONDITION
OF
LUNACY
service," forcibly took her to the workhouse as a pauper chargeable to Southampton, where she was classed as a lunatic. It is to be observed that the only possible justification for this proceeding, namely difficulty in obtaining the attendance of a justice at the employer's abode to examine the woman, and order her removal to an asylum, was never put forward. The patient remained in the workhouse for six days, the relieving officer meanwhile neglecting his express duty, under the Lunacy Act, of giving notice of such case within three days to a justice of the peace, until requested to give such notice by the medical officer of the workhouse. The woman had then been six days taking little food, and in a constant state of excitement and violence. The justice's order was given the same day, and on the next, when the relieving officer came to remove her as a pauper to the asylum, she was found to be resume
"
in
so
exhausted
a
state that it was considered unsafe to
remove
afterwards she died, having been ten days in the workhouse. There was no inquest in the case, nor any public enquiry into the circumstances, which only casually came under our notice upon visiting the workhouse, when a female imbecile who assisted in taking charge of the patient above referred to, was found with traces of a severe wound on the face, which, upon enquiry, was ascertained to have been caused by a bite inflicted upon her by the insane African. Had this patient been placed, as she should have been, under treatment in an asylum, instead of being kept in the workhouse, her life would probably have been saved. The whole of the facts were communicated by us to the Local Government Board, and they had some correspondence with the guardians, who contented themselves with the assertion?and it was nothing more?that the deceased was not a pauper when brought by the relieving officer to the workhouse, and with the statement, which, as has been shown, was untrue, that the Lunacy Acts had been 4 strictly with.' complied " 2. The second was a case in which a double murder followed workhouse treatment of a lunatic. " A man of the labouring class resided with his aged parents. He had suffered from sunstroke, and was in receipt of a sick allowance from a provident club. He began to act strangely, 'tore up a petticoat as bewitched, and threatened his mother.' The overseer of the parish, a neighbour, requested the medical officer of the district to see the man; the doctor came immediately, but the man had then left home and gone to London. The doctor at once went to the overseer, and told him ' he must have him found.' The man returned from London next day, and was then found wandering in the fields, and he was taken to the over-
her, and
two
days
IN
ENGLAND
AND
313
WALES.
seer's residence. The medical officer was again sent for, and saw him the same day; the man appeared to him to be in a wild and insane state, ' and he ordered him to be kept under supervision that night, and advised his prompt removal to a place of safety.' The overseer kept the man till next morning, and then took him, against his will, to the Lexden Union Workhouse, where, on the overseer's order, he was admitted as insane, and in a state of excitement. In the workhouse the man gave expression to a delusion that he was married to the overseer's daughter, but appeared to be otherwise rational, and gradually recovered from his excitement. The medical officer of the workhouse classed the man as insane in the medical relief book, but after nineteen days' stay in the workhouse, he discharged him, and the The medical officer man then went back to his parents' house. of the district there saw him a few days after, and, as he testified, 'not much altered, for upon my visit to him, which was for a bodily disease, he told me in his peculiar way that he could see blood.' He at once informed the lunatic's mother that it was not safe for his parents to be with him alone. A few days afterwards both were savagely murdered by the lunatic, acting under delusions of an insane character. " Had the overseer in this case not taken this lunatic to the workhouse, but complied strictly with the Lunacy Acts, there is every reason to believe that the lunatic would have been sent by a magistrate to an asylum, where the experience of the medical officer would have prevented such a premature discharge. We should have prosecuted the overseer had we not been advised that as he had acted under medical instructions in taking the lunatic to the workhouse as a place of safety instead of before a justice, the penalty inflicted would be probably nominal. "3. A male patient, J. P., about 36 years of age, who had been an inmate of the imbecile ward of the Bury Union Workhouse for about twelve months previously, became violent and maniacal on or about the 26th June, 1875. On 1st July he was removed from the workhouse, and admitted into the Prestwich Asylum. On examining him upon admission, he was found to be severely bruised, and to have one or more broken ribs. He died on the 8th July. A post mortem examination showed that in fact six ribs were broken, and the verdict of the coroner's jury attributed his death to the effect of these injuries ; but the jury were unable to say when, how, or by what means they were caused. Little doubt, however, could be felt but that the ribs were broken either at the workhouse or during the short journey from thence to the asylum, for there was no reason to suppose that the mischief could have occurred after admission there. x
2
314
CONDITION OF LUNACY Y-
"An enquiry was instituted by the guardians, at the suggestion of the Local Government Board, whom we had addressed The attendants in the imbecile ward, the workon the subject. house medical officer, and other officials, besides the patient's sister, who had been in the habit of visiting him, were all examined. Little additional evidence, however, was obtained as to the cause of the injuries; what evidence there was led rather to the conclusion that they were sustained in the course of the drive, in a cab, from the workhouse to the asylum. The relieving officer, assisted by the head attendant, or male the removal, during which the nurse of the ward, effected patient appears to have been much excited, and knocking himself about. " There was nothing to point to any intentional ill-usage of the deceased in the workhouse ; but it is matter of comment that earlier steps were not taken to remove him to the asylum. ' Page, the nurse,' in his evidence before the guardians, stated that J. P. had ' shown symptoms about a week before ; but that on Saturday, 26th June, he was fit for no other place' than a single room, in which he was placed and restrained with gloves. One of Page's assistants in the imbecile ward carried the commencement of the attack of mania still further back, averring that the patient was ' going bad for a fortnight' before he was ' put in the single room, and that for the last eight or nine violent.' he became very days "No explanation was offered of the delay in the removal. Even if the necessity for this step was not apparent sooner (and the evidence would lead us to believe it must have been), it is difficult to justify the retention of this patient in the single room of the workhouse, under restraint, from Saturday, 26th
June,
to
Thursday,
1st
July."
A few cases of illegal detention of persons of unsound mind have been brought before the notice of the Commissioners, and in one instance it was found necessary to prosecute. The case was as follows:?Miss Peyton, set. 63, was living under the From evidence care of Mr. and Mrs. Grovier at Sidmouth. which subsequently came out, it appeared that at one time she was tolerably prosperous, but through intemperate habits she She placed her lost her occupation and expended her savings. to in the who handed it hands of a ?25, relative, all, amounting over to the Groviers, with the consent of Miss Peyton, on the understanding that she was provided with accommodation in an adjoining house. A room was taken for her at the rate of Is. 6d. per week. Three months after her occupation of this room she was visited by the before-mentioned relative, accompanied by one
IN
ENGLAND
AND
315
WALES.
of the guardians of the parish, who gave the following description of what they saw :? " That, in reply to the question of how she was, she gave an unintelligible, wild and chattering answer; that, on the rug which she had over her being turned up, the smell was so offensive that it was impossible to remain in the room; that the bed and sacking under her were sodden with filth; and that in a corner of the room was a heap of filthy and offensive feathers." On the following day she was again examined by a medical man and a police constable, who confirmed the accuracy of the description of her state. An opinion was expressed that she was of unsound mind, and forthwith she was removed to the County Asylum, as a person of unsound mind, not under proper care and control, and was then, according to the opinion of the medical superintendent, in a state of senile dementia. The patient died within three weeks of admission. The Groviers were consequently proceeded against for taking charge of a person of unsound mind for profit, and for wilful neglect, violating the 90th sec. of 8 and 9 Vic. c. 100. The case was heard before Mr. Justice Quain, when the defendants were indicted for wilful neglect as well as for the illegal care of a person of unsound mind, for profit. The questions submitted to the j ury were:? 1st. Was Thomasine Peyton a person of unsound mind at any time during her stay in the house, to the knowledge of the defendants? 2nd. Did they at any time whilst in the house take the care or charge of her as a person of unsound mind ? 3rd. If so, did they do so for profit ? 4th. Did they wilfully neglect her ? All these questions being answered in the negative, the de-
fendants
were
discharged.
under the influence of drink, for injuring and fracturing a rib of a patient confined in the Wilts County Asylum. He was tried at the Assizes, and sentenced to four months' impriAn attendant named
was
Marsh,
proceeded against by the visitors
sonment.
The
sioners
following circular letter has been sent by hospital and licensed house :?
the Commis-
to every
Office of Commissioners in Lunacy : 19 Whitehall Place, S.W., March
To
Proprietors of
Licensed Houses, and Others the Insane.
The Commissioners in Lunacy, having
requirements
engaged
reason
of section 40 of the Act 25 & 26
to
Vic.,
1, 1875.
in the Care of
suppose that the c.
Ill, regulating
316
CONDITION OF LUNACY IN ENGLAND AND WALES.
the transmission of the correspondence of private patients in asylums, and licensed houses, and of single patients, are not always carefully observed, desire to call attention to the language of the section, of which a copy is subjoined. It will be remarked that no power is given to the person signing the order of reception, or to any other person (save the Commissioners, or Committee, or Visitors), to sanction restrictions on the correspondence of a private patient; and it follows that no instructions received from any other person other than the Commissioners, Committee, or Visitors could be pleaded as a justification of any alleged breach of the provisions of the section. It is often desirable, for the patient's own sake, to place some Where this is done, however, the check on his correspondence. greatest care should (on every account) be taken strictly to follow the directions of the Act.
hospitals
By Order,
C. S.
Perceval, Secretary.
The Report concludes with the usual appendices and descriptions of the various hospitals and county asylums, containing a full report of each one. The Blue Book appears to increase in "bulk every year, and contains most valuable information carefully obtained by the Commissioners, which speak as to the zealous and earnest efforts of the Board to place before the Lord Chancellor every fact relating to the treatment of the insane; and it is a matter of congratulation that in no country are the interests and welfare of that helpless class of humanity so protected as in
England.
Art. VII.?CONDITION OF LUNACY IN ENGLAND AND WALES. The thirtieth annual Report of the Commissioners in Lunacy has just appeared, containing a complete record of all facts connected with lunacy in this country. AVe find that on January 1st, 1876, there were on the official books of the Commissioners 64,916 registered lunatics, showing an increase of 1,123 over that of the year preceding. Of this number 7,509 are registered as private patients, and 57,407 as paupers. There are also 245 lunatics found so by inquisition, and residing in charge of their committees. They are not included in the category alluded to above. The average annual increase of lunacy during the past ten years has been 1,726 ; that is to say, 149 private patients, and 1,577 of the pauper class. It is worthy of remark that the total increase of the past year over the one preceding has been less than in any other year of the series commencing in 1859. " Among the pauper patients are included only those maintained wholly or in part by, or chargeable to, parishes, unions, counties, or boroughsand among private patients are included those maintained at the cost of the State, at the Royal India Asylum at Yarmouth, Naval Hospital at Netley Abbey, Grove Hall, Bow, and Broadmoor Criminal Asylum. The increase during the year of private patients is 119, as compared with 98 last year, and an increase of 1,004 of paupers, as compared with 1,668. The private patients have increased by 51 in licensed houses, 70 in registered hospitals, 19 in county and borough asylums, and by 3 in the naval, military, and India asylums. There has been a decrease in number by 19 in Broadmoor Criminal Asylum, and by 2 in single patients under private care. The increase of pauper patients is in county and borough asylums by 1,606 ; in Broadmoor Criminal Asylum by 19; in workhouses by 133; and at the same time this class has decreased in registered hospitals by 72, in licensed houses by 352, and the outdoor paupers are reduced by 330. In the last Report the Commissioners noticed with satisfaction that the practice of sending male convicts to Broadmoor has been discontinued, and during the past year this class of patients has been provided for at Woking Invalid Prison, and
304 as
a
CONDITION OF LUNACY
consequence,
private patients
a
decrease has occurred in the number of
at Broadmoor?accounted
for,
no
doubt, by
deaths and removals to county asylums of convicts whose sentences have expired. The large increase of 1,606 paupers in county and borough asylums, and the considerable decrease of 352 of this class in licensed houses, is in a great measure explainable by the opening of the second Kent Asylum at Chartham, and of additional wards at the New Lancashire Asylum at Whittingham, as well as by the completion of considerable enlargements of the Surrey Asylum, both at Brickwood and Wandsworth. The decrease of 72 paupers and the corresponding increase in the number of private patients in registered hospitals are chiefly due to changes which have taken place at the Northampton hospitals, and it is expected that when these changes are here completed the whole of the paupers will be removed from this institution, and it will be exclusively devoted to private patients. There are 15,509 patients classed as in workhouses. Of this number 4,205 were in the Metropolitan District Asylums for Imbeciles at Leavesden, Caterham, Hampstead, and Clapton. These institutions were, by the Metropolitan Poor Act, 1867, declared to be workhouses for the purposes of the Lunacy Acts. The Report contains twelve interesting tables relating to the distribution of the insane during the last sixteen years, and supplies detailed information as to the classification, and numbers of the insane in England, together with the ratio which they bear to the population; the admissions, discharges, and deaths, with the statistics of recoveries and mortality of patients detained under certificates in asylums, hospitals, licensed houses, and under single care. By a careful perusal of these tables we find that the proportion of lunatics as compared with the population is 26*78 ratio per 10,000, whereas in 1866 it was 22*26 ; the population at present being 24,244,010, whereas in 1866 it was 21,409,684. The number discharged as recovered during the past year, by reference to Table IV., we find to be 4,909, as compared with 4,828 in the preceding year, whereas the deaths have been 4,592. We see with regret by Tables V. VI. and VII. that the recoveries are nearly 4 per cent, lower than those of the year previous, and 1 *5 per cent, below the average of the last 17 years. The mortality also has been somewhat unfavourable, being about ?5 per cent, higher than that of the previous year and than the average mortality of the last fifteen years. The proportion of patients contained in the county and borough asylums who on the 1st of January were considered curable amounted to 7*17 per cent, of the total number, as
IN ENGLAND AND WALES.
305
compared with 7*47 of the number resident on the 1st of January, 1875. The Report contains a general description of the various county and borough asylums. The Cambridge Asylum at Fulborne continues dangerously overcrowded. We are at a loss to understand why the suggestions made so frequently by the Commissioners concerning this asylum have not been carried out and a second medical officer appointed ; the matter has been frequently brought forward by Dr. Bacon, the Medical Superintendent, but the authorities at present have ignored these constant appeals for further medical aid, and, as a consequence, should anything serious occur at the asylum, they will have but themselves to blame in the matter. An epidemic of erysipelas broke out in February and March 1875 at tbis asylum, in consequence of the overcrowding of the patients, and if the long-delayed enlargement is not soon effected, the patients' health will materially suffer. We have had many opportunities of visiting this asylum, and can testify to the onerous duties of the Medical Superintendent, who does his utmost to further the interest of the establishment and the well-being of the patients committed to his charge; but if his exertions are not properly supported by the governing bodies, his laudable efforts must be
but futile. The condition of the patients on admission to the Carmarthen Asylum is considered to be most unsatisfactory. The following passage occurs in the entry made on the visit to this asylum, relative to the condition of patients on admission :? " We are informed that the condition of patients when brought to the asylum continues in the majority of cases to be most unsatisfactory, giving evidence of neglect, want of nourishment, and rough usage. An old woman was admitted to-day, while we were in the house, and we afterwards saw her in bed; she was extremely feeble, and bore upon her person numerous marks of violence, and there was strong reason to think that she had broken ribs. This woman was brought to the asylum by a policeman, and was not accompanied by any female ; and we are sorry to report that this most objectionable mode of bringing patients here is the rule, with but few exceptions, from the Cardigan Union. It is needless to point out the impropriety of entrusting an insane woman during a long journey to the sole charge ot' a policeman; but there remains the further and very strong objection to the practice, which applies equally to both sexes, that the removal of the patient to the asylum by a policeman impresses them with the idea that they are prisoners, and about to undergo punishment, instead of being sent to a hospital for care and treatment."
306
?
CONDITION OF LUNACY
A case of suicide is related as having taken place at the Cheshire Asylum, and also at Durham. This latter asylum is about to be considerably enlarged. Two suicides have occurred at the Lancashire Asylum, one by a patient cutting his throat with a knife, the other by strangulation; in both instances the attendants appear to have been to blame. Another suicide has taken place at the Whittingham Asylum. A suicide which has taken place at the Littlemore Asylum, Oxfordshire, is reported as follows :? " A. C., a single woman, set. 34, had been an inmate of the Littlemore Asylum since May 1875. As she was reported to be suicidally disposed, a special card of caution was passed with her from ward to ward, but the asylum authorities did not consider, from her conduct, that she seriously contemplated either escape or self-destruction. In the evening, however, of Saturday, 11th September, she contrived to escape from the grounds where, with other patients, she was taking exercise. She was missed almost immediately; but although the police and the neighbours were given notice of the escape, she w as not A little before six on Monday she was seen found all Sunday. near the river by two men, who followed her while she ran across one meadow by the waterside, through a hedge and over a ditch (dry), across a second meadow, at which point she Here she jumped into the juncwas stopped by a deep ditch. tion of the ditch with the river, the water being nearly up to her armpits. The first man who followed jumped in, though unable to swim; but the bottom being very muddy, he could not reach the woman unless she held out her hand; this he asked her to do, but she thrice refused, began struggling, and lost her footing. By this time the second man had come up ; and he, with a ladder floating in the water, succeeded in reaching the patient; but she was already under water, a considerable way out from the bank, the stream being rather strong at that point. Between them she was got out of the water, not dead, yet unable to speak. The men carried her to the nearest inn, about 300 yards. During her passage thither she groaned and breathed several times. They believed she was in the water about three minutes. Dr. Sankey was called, and was on the spot by half-past six, but she was then to all appearance dead, and every effort to restore life was in vain." A patient at the North Eiding Asylum, Yorkshire, destroyed himself through the carelessness of an attendant. Reference is made to the extension of the Birmingham Asylum, and to an epidemic of typhoid fever, which occurred at the Bristol Asylum, owing to the impurity of the drinking water. Immediate measures were suggested by the Commissioners
IN
ENGLAND
AND
WALES.
307
for remedying the evil, and negotiations with the Bristol Waterworks Company were set on foot. " An attempt at suicide took place at the Bristol Asylum. " The facts connected with the case are remarkable, and interesting from a purely medical point of view, affording a remarkable instance of the recurrence after a lapse of years of .a morbid propensity once developed in the mind of a patient of the melancholic type with a suicidal tendency; and also as showing how much may be done by skill and care to remedy an injury which at first sight seems likely to prove fatal. " The particulars which follow we give nearly as reported to us by the medical superintendent:? " A female patient, E. W., set. 43, was admitted for the third time to the Bristol Asylum on the 15th June, 1875. "On the occasion of her first residence there in 1863, she swallowed (with a distinct suicidal intention) the entire contents of a domino box, 54 dominoes in all, 50 of which were recovered by vomiting, along with fragments of stone weighing 14 oz., while four dominoes and some stones passed through A full account of this incident will be found in the intestines. the report of the late medical superintendent to the Committee of Visitors of the Asylum for the year 1863. " E. W. was soon after discharged from the Bristol Asylum, for transfer to that belonging to Somersetshire, where she was chargeable, but she escaped on the road, and was not retaken. Between this date and 1871 she appears not to have been under care and treatment. In May of that year she was re-admitted to the Bristol Asylum, still with suicidal tendencies, and after two actual attempts, she was again removed to Wells, and disthence recovered, in 1873. charged " After another interval, she returned, as above stated, to the Bristol Asylum in 1875, twelve years subsequently to the swallowing of the dominoes, which circumstance was, we believe, quite forgotten in the asylum, where many changes in the staff, including the appointment of a new medical superintendent, had occurred. The certificates again give a history of renewed suicidal attempts. " On the 31st July, 1875, early in the morning, she got possession of the fifteen shutter screws belonging to No. 12 Ward, and in the course of three quarters of an hour she swallowed thirteen of them. The screws were new ones; and thirteen of the same pattern weighed 24^oz. avoirdupois weight. She made a confession before the screws had been missed, and stated the number to be thirteen. To prevent injury to the coats of the stomach, Dr. Thompson, on hearing of what had happened, administered a mess of tapioca pudding and gruel, of
308 which, without
CONDITION OF LUNACY
much
persuasion,
she
took
a
very
large
quantity.
" inches long, ? inch thick The screws consist of a body with a square head, and with a raised collar nearly f inch in diameter. " It will be seen that to attempt to recover by the oesophagus one of those swallowed was out of the question, and it was any even doubted if the pyloric valve would take up any one of them and pass it on. On the 10th of September, however, the patient passed some of the screws by the bowel, and on the 4th of February she passed the last of the thirteen in the same The dates of ejection were 10th September, 19th manner. 26th November, 27th November, 3rd December, 3rd October, January, 9th January, 19th January, 20th January, 3rd February, 3rd February, 4th February, and 4th February. " During these months the patient suffered much pain, which she said was of a spasmodic nature, and very like to labour pain (she had had children). The treatment was chiefly dietetic, but in addition she had, night and morning, subcutaneous injections of morphia. At first purgatives were avoided, but ounce doses of olive oil were given once a day, and enemata " occasionallv. Latterly the medical officers became more bold," and gave large doses of castor oil, and it was after this bolder treatment that the screws came away the faster. On the 3rd of August E. W. passed a large piece of an earthenware chamber utensil by the bowel, which was followed by severe hemorrhage, but only once did her temperature rise over the The weight of the recovered screws was average point. 19f ounces, showing a loss of 4f ounces. "' The poor woman,' Dr. Thompson observes, ' is a melancholiac of the most abject type, and with a touch of moral obliquity. I do not think she wished to commit suicide, but rather to draw attention to herself, and to cause trouble.' This opinion is, of course, entitled to full consideration, but it is to be observed that during the preparation of the present report, the Wells Asylum, where E. W. now is, has been visited, and that on this occasion she admitted to one of our colleagues that her object was to destroy herself. She appeared in fair bodily health, though still in a state of extreme mental de-
pression."
A murder of an attendant has occurred at the Leicester An attendant of the name of John Smith was stabbed by G-eorge Fordham, a pauper patient, in the abdomen, and died in consequence of the injuries received in about an hour and a half. The patient was 62 years of age, and previous to admission had been an inmate of the Leicester Union Work-
Asylum.
IN
ENGLAND AND WALES.
309
house for some time, being transferred to the asylum on account On admission he was of violent and dangerous propensities. and quarrelsome, passionate making groundless and exaggerated complaints, and was subject to epileptic seizures. Nine months after his admission he was overheard to say that he would hunt the attendant, Smith, to death, even if it were fifty years hence. He killed the attendant with a carving knife which he had procured from a cupboard, and which singularly enough had been left unlocked by Smith. After the discovery of the murder, Fordham exclaimed, "I have had my revenge: you can hang me now as soon as you like." The coroner's jury returned a verdict of wilful murder, and he was committed for trial at the winter assizes at Leicester. The prisoner pleaded not guilty. The facts connected with the murder were undisputed, but the counsel for the defence urged an acquittal on the ground of insanity. Mr. Justice Denman, who tried the case, pointed out to the jury that the mere fact of his labouring under a delusion was not a sufficient excuse in law to justify an acquittal on the" ground of insanity. The judge, in summing up, stated that where a man committed a crime for some supposed grievance if he knew that what he was doing was contrary to law, he was to be held responsible for his actions. If a man killed another while under a delusion that he himself was about to be killed, and that he was acting in self-defence, he would not be punishable; but if a man did so for some supposed injury to his character or fortune, then the man would be responsible. If the jury were satisfied that although Fordham was suffering from delusions he knew what he was doing, and was not merely taking life under an erroneous impression that he was defending his own life, but killing because he felt himself injured in some form or other, it would be their duty to find him guilty." The prisoner was found guilty of murder, but with a strong recommendation to mercy, by a jury who considered that, notwithstanding he occasionally suffered from delusions, at the time he committed the deed he knew he was doing a wrong act. He was sentenced to death in the usual form, but was afterwards reprieved, and sentenced to penal servitude for life. The absurdity of the rule of law laid down in cases of insanity is here very apparent. We read of a lunatic, who is legally confined under a certificate, being taken from the asylum and arraigned as an ordinary criminal of sound mind, ?and although his insanity was never disputed, is sentenced to death. The doctrine between a knowledge of right and wrong among the insane is frequently brought forward as an argument against an acquittal upon the ground of insanity, but
310
CONDITION OF LUNACY
must confess that the theory is a very absurd one, and as the majority of lunatics are perfectly cognisant of it, it is to be hoped that a statute will soon be passed repealing- the present existing law regarding the trying of lunatics which we can only
we
regard
as a
disgrace
to
our
country.
At the commencement of the year there were 2,796 lunatics confined in registered hospitals, of which number 1,340 were males and 1,241 females belonging to the private class of patients, whereas 115 were males and 100 females paupers. The general condition of these hospitals may be considered favourable, with one or two exceptions. A few suicides are reported at some of the hospitals, but this is only to be expected when the number of lunatics in one establishment is considerable. There are 39 private asylums in the Metropolitan district licensed by the Commissioners, and 62 beyond their immediate jurisdiction licensed by the justices. The condition of these asylums may generally be stated as satisfactory. On the 1st of January last there were 399 patients confined under certificate in unlicensed houses, and of this number 129 were Chancery patients. One suicide is reported as taking at of a Weston-super-Mare patient under the care of place We are of opinion that it is far more advisa medical man. able to place patients in asylums than under private care, in the former of which they have greater chances of proper treatment and care. On the 1st January, 1876, there were 15,509 lunatics confined in workhouses, being an increase of 133 over the number This number includes 4,205 patients resident in last year. the Metropolitan District Asylums at Leavesden, Caterham, Hampstead, and Clapton, which are still regarded as workhouses. The Commissioners report on the whole favourably of the condition of the lunatic wards in workhouses, and with respect to the accommodation and diet supplied to the inmates. The relieving officers of some of the parishes appear to entirely disregard the provisions of the 67th section of the Lunacy Act, and patients labouring under all varieties of insanity are sent to the workhouses, no subsequent steps being taken by them to promote their removal to an asylum ; the result of this practice is that many lunatics are so confined without having any treatment, until they either die or their case becomes chronic. On this point the Commissioners say : "We have constantly drawn attention to this subject, both in our Annual Reports and in others ways, but we regret to say with comparatively little effect; and in any future legislation we think that more stringent provisions should be made to
IN
311
ENGLAND AND WALES.
prevent delay in sending patients to asylums, and also to restrict, as a general rule, the admission of cases into the work-
unless they have passed through the asylum, and are certified by the medical superintendent as being harmless and chronic, and suitable for removal." The relieving officers appear entirely to ignore the law by which they are required to give knowledge to a justice of the peace within three days of their obtaining information that a pauper lunatic is resident in their parish, and should be summarily proceeded against. The Commissioners do this where evidence of any wilful neglect of duty has taken place, but as a rule the technical difficulties in obtaining a conviction are insurmountable, as they are under the control of the board of guardians. The Report contains many instances of the evils attending the indiscriminate reception and detention of insane persons in workhouses, cases being given which have come to the knowledge of the Board casually, no official intimation of accident or death being sent to them. Two male patients destroyed themselves at the Marland one by cutting his throat with a Workhouse, Rochdale never razor, having previously evinced any suicidal tendencies. The second case was sent to the workhouse by the relieving officer with the usual order, " of unsound mind," and at the back of this " order " was written by the master, " Attempted suicide; brother cut his throat; cousin hanged himself." In this case no' notice was given by the relieving officer to a justice, pursuant to the provision of the 67th section of the Act, and there is no doubt but that the suicide was caused by the lunatic being placed in a workhouse instead of being removed direct to an asylum. The medical officer failed to detect that the patient was suffering from suicidal melancholia, and hence the fatal catastrophe. Other cases are quoted in the Report, all of which testify to the neglect of duties by the relieving officers. The following cases illustrate the mischief done by placing lunatics suffering from acute mania in workhouses, instead of at once removing them to an asylum. We give the verbatim account of each case; the neglect of duties by the relieving officers will be apparent without any comments at our hands: "1. A native of Zanzibar, who was brought to Southampton in the capacity of a wet nurse, became insane and violent, and her master applied to the relieving officer to remove her from the house, agreeing to repay to the Union the cost of her maintenance. The relieving officer, " in the hope (as the guardians stated subsequently) that the woman would shortly be able to
house,
PART. II.
VOL. II.?NEW SERIES.
X
312
CONDITION
OF
LUNACY
service," forcibly took her to the workhouse as a pauper chargeable to Southampton, where she was classed as a lunatic. It is to be observed that the only possible justification for this proceeding, namely difficulty in obtaining the attendance of a justice at the employer's abode to examine the woman, and order her removal to an asylum, was never put forward. The patient remained in the workhouse for six days, the relieving officer meanwhile neglecting his express duty, under the Lunacy Act, of giving notice of such case within three days to a justice of the peace, until requested to give such notice by the medical officer of the workhouse. The woman had then been six days taking little food, and in a constant state of excitement and violence. The justice's order was given the same day, and on the next, when the relieving officer came to remove her as a pauper to the asylum, she was found to be resume
"
in
so
exhausted
a
state that it was considered unsafe to
remove
afterwards she died, having been ten days in the workhouse. There was no inquest in the case, nor any public enquiry into the circumstances, which only casually came under our notice upon visiting the workhouse, when a female imbecile who assisted in taking charge of the patient above referred to, was found with traces of a severe wound on the face, which, upon enquiry, was ascertained to have been caused by a bite inflicted upon her by the insane African. Had this patient been placed, as she should have been, under treatment in an asylum, instead of being kept in the workhouse, her life would probably have been saved. The whole of the facts were communicated by us to the Local Government Board, and they had some correspondence with the guardians, who contented themselves with the assertion?and it was nothing more?that the deceased was not a pauper when brought by the relieving officer to the workhouse, and with the statement, which, as has been shown, was untrue, that the Lunacy Acts had been 4 strictly with.' complied " 2. The second was a case in which a double murder followed workhouse treatment of a lunatic. " A man of the labouring class resided with his aged parents. He had suffered from sunstroke, and was in receipt of a sick allowance from a provident club. He began to act strangely, 'tore up a petticoat as bewitched, and threatened his mother.' The overseer of the parish, a neighbour, requested the medical officer of the district to see the man; the doctor came immediately, but the man had then left home and gone to London. The doctor at once went to the overseer, and told him ' he must have him found.' The man returned from London next day, and was then found wandering in the fields, and he was taken to the over-
her, and
two
days
IN
ENGLAND
AND
313
WALES.
seer's residence. The medical officer was again sent for, and saw him the same day; the man appeared to him to be in a wild and insane state, ' and he ordered him to be kept under supervision that night, and advised his prompt removal to a place of safety.' The overseer kept the man till next morning, and then took him, against his will, to the Lexden Union Workhouse, where, on the overseer's order, he was admitted as insane, and in a state of excitement. In the workhouse the man gave expression to a delusion that he was married to the overseer's daughter, but appeared to be otherwise rational, and gradually recovered from his excitement. The medical officer of the workhouse classed the man as insane in the medical relief book, but after nineteen days' stay in the workhouse, he discharged him, and the The medical officer man then went back to his parents' house. of the district there saw him a few days after, and, as he testified, 'not much altered, for upon my visit to him, which was for a bodily disease, he told me in his peculiar way that he could see blood.' He at once informed the lunatic's mother that it was not safe for his parents to be with him alone. A few days afterwards both were savagely murdered by the lunatic, acting under delusions of an insane character. " Had the overseer in this case not taken this lunatic to the workhouse, but complied strictly with the Lunacy Acts, there is every reason to believe that the lunatic would have been sent by a magistrate to an asylum, where the experience of the medical officer would have prevented such a premature discharge. We should have prosecuted the overseer had we not been advised that as he had acted under medical instructions in taking the lunatic to the workhouse as a place of safety instead of before a justice, the penalty inflicted would be probably nominal. "3. A male patient, J. P., about 36 years of age, who had been an inmate of the imbecile ward of the Bury Union Workhouse for about twelve months previously, became violent and maniacal on or about the 26th June, 1875. On 1st July he was removed from the workhouse, and admitted into the Prestwich Asylum. On examining him upon admission, he was found to be severely bruised, and to have one or more broken ribs. He died on the 8th July. A post mortem examination showed that in fact six ribs were broken, and the verdict of the coroner's jury attributed his death to the effect of these injuries ; but the jury were unable to say when, how, or by what means they were caused. Little doubt, however, could be felt but that the ribs were broken either at the workhouse or during the short journey from thence to the asylum, for there was no reason to suppose that the mischief could have occurred after admission there. x
2
314
CONDITION OF LUNACY Y-
"An enquiry was instituted by the guardians, at the suggestion of the Local Government Board, whom we had addressed The attendants in the imbecile ward, the workon the subject. house medical officer, and other officials, besides the patient's sister, who had been in the habit of visiting him, were all examined. Little additional evidence, however, was obtained as to the cause of the injuries; what evidence there was led rather to the conclusion that they were sustained in the course of the drive, in a cab, from the workhouse to the asylum. The relieving officer, assisted by the head attendant, or male the removal, during which the nurse of the ward, effected patient appears to have been much excited, and knocking himself about. " There was nothing to point to any intentional ill-usage of the deceased in the workhouse ; but it is matter of comment that earlier steps were not taken to remove him to the asylum. ' Page, the nurse,' in his evidence before the guardians, stated that J. P. had ' shown symptoms about a week before ; but that on Saturday, 26th June, he was fit for no other place' than a single room, in which he was placed and restrained with gloves. One of Page's assistants in the imbecile ward carried the commencement of the attack of mania still further back, averring that the patient was ' going bad for a fortnight' before he was ' put in the single room, and that for the last eight or nine violent.' he became very days "No explanation was offered of the delay in the removal. Even if the necessity for this step was not apparent sooner (and the evidence would lead us to believe it must have been), it is difficult to justify the retention of this patient in the single room of the workhouse, under restraint, from Saturday, 26th
June,
to
Thursday,
1st
July."
A few cases of illegal detention of persons of unsound mind have been brought before the notice of the Commissioners, and in one instance it was found necessary to prosecute. The case was as follows:?Miss Peyton, set. 63, was living under the From evidence care of Mr. and Mrs. Grovier at Sidmouth. which subsequently came out, it appeared that at one time she was tolerably prosperous, but through intemperate habits she She placed her lost her occupation and expended her savings. to in the who handed it hands of a ?25, relative, all, amounting over to the Groviers, with the consent of Miss Peyton, on the understanding that she was provided with accommodation in an adjoining house. A room was taken for her at the rate of Is. 6d. per week. Three months after her occupation of this room she was visited by the before-mentioned relative, accompanied by one
IN
ENGLAND
AND
315
WALES.
of the guardians of the parish, who gave the following description of what they saw :? " That, in reply to the question of how she was, she gave an unintelligible, wild and chattering answer; that, on the rug which she had over her being turned up, the smell was so offensive that it was impossible to remain in the room; that the bed and sacking under her were sodden with filth; and that in a corner of the room was a heap of filthy and offensive feathers." On the following day she was again examined by a medical man and a police constable, who confirmed the accuracy of the description of her state. An opinion was expressed that she was of unsound mind, and forthwith she was removed to the County Asylum, as a person of unsound mind, not under proper care and control, and was then, according to the opinion of the medical superintendent, in a state of senile dementia. The patient died within three weeks of admission. The Groviers were consequently proceeded against for taking charge of a person of unsound mind for profit, and for wilful neglect, violating the 90th sec. of 8 and 9 Vic. c. 100. The case was heard before Mr. Justice Quain, when the defendants were indicted for wilful neglect as well as for the illegal care of a person of unsound mind, for profit. The questions submitted to the j ury were:? 1st. Was Thomasine Peyton a person of unsound mind at any time during her stay in the house, to the knowledge of the defendants? 2nd. Did they at any time whilst in the house take the care or charge of her as a person of unsound mind ? 3rd. If so, did they do so for profit ? 4th. Did they wilfully neglect her ? All these questions being answered in the negative, the de-
fendants
were
discharged.
under the influence of drink, for injuring and fracturing a rib of a patient confined in the Wilts County Asylum. He was tried at the Assizes, and sentenced to four months' impriAn attendant named
was
Marsh,
proceeded against by the visitors
sonment.
The
sioners
following circular letter has been sent by hospital and licensed house :?
the Commis-
to every
Office of Commissioners in Lunacy : 19 Whitehall Place, S.W., March
To
Proprietors of
Licensed Houses, and Others the Insane.
The Commissioners in Lunacy, having
requirements
engaged
reason
of section 40 of the Act 25 & 26
to
Vic.,
1, 1875.
in the Care of
suppose that the c.
Ill, regulating
316
CONDITION OF LUNACY IN ENGLAND AND WALES.
the transmission of the correspondence of private patients in asylums, and licensed houses, and of single patients, are not always carefully observed, desire to call attention to the language of the section, of which a copy is subjoined. It will be remarked that no power is given to the person signing the order of reception, or to any other person (save the Commissioners, or Committee, or Visitors), to sanction restrictions on the correspondence of a private patient; and it follows that no instructions received from any other person other than the Commissioners, Committee, or Visitors could be pleaded as a justification of any alleged breach of the provisions of the section. It is often desirable, for the patient's own sake, to place some Where this is done, however, the check on his correspondence. greatest care should (on every account) be taken strictly to follow the directions of the Act.
hospitals
By Order,
C. S.
Perceval, Secretary.
The Report concludes with the usual appendices and descriptions of the various hospitals and county asylums, containing a full report of each one. The Blue Book appears to increase in "bulk every year, and contains most valuable information carefully obtained by the Commissioners, which speak as to the zealous and earnest efforts of the Board to place before the Lord Chancellor every fact relating to the treatment of the insane; and it is a matter of congratulation that in no country are the interests and welfare of that helpless class of humanity so protected as in
England.
