109

v

J

DISCUSSION" ON PRIVATE LUNATIC ASYLUMS. At a meeting of the South London District of the Metropolitan Counties Branch of the British Medical Association on January 21, Dr. Alfred Carpenter in the chair, Dr. Bucknill read the

following Paper :?

>

questions connected with this subject, which your worthy Secretary has requested me to introduce to you, are so numerous and complicated, that I must attempt some delimitation of them by asking you to consider, in the first place, on what grounds medical men generally are interested in the existence of private lunatic asylums, and in the laws under which they are established and to some extent regulated. If it be true, as is maintained in the most recently published work on lunacy law, that " insanity is a purely relative term, at times employed to designate conditions of the mind, which are only diseases in the same sense that general debility is a disease, or in the same sense that bodily fatigue or want of change of air are diseases, and that every passion and emotion may, in prolonged excess, be said to constitute a degree of mental disorder"?if this be true, I cannot claim for the medical profession the upon the manner right to arrogate any authoritative judgment " in which such " conditions of the mind should be dealt with. But if insanity be a bodily disease, then medical men have a clear right to discuss, and finally to decide upon, the proper manner of its treatment; and the necessity, utility, and management of private lunatic asylums clearly come within the scope of such a discussion. I think that not only the conviction of the profession, but the opinion of the public, will affirm the latter proposition, notwithstanding the operation of laws which have come down to us from times when insanity was thought to be something apart from disease?laws which have indeed been patched and enlarged as the crying needs of the time demanded, but which substantially deal with persons suffering from diseases affecting the mental powers in a different manner from that which is customary with regard to all other diseased persons. The operation of these laws has tended, and still more and and more tends, to sequester the insane from the care ar>d treatment of the medical profession at large to render more and more perplexing, dangerous, and difficult the medical treatment of any single case of lunacy to herd lunatics togeThe

?

FRIVATE LUNATIC ASYLUMS.

110

ther in special institutions where they can be more easily visited and accounted for by the authorities, and to create a class of to themmen whom these authorities can make responsible selves for the confinement and detention of the insane, according to certain regulations, but whom they do not and cannot make responsible for their proper medical treatment. It would, 1 think, be an excellent subject for one of our future discussions to inquire to what extent the herding together of lunatics is beneficial or mischievous, even in those most creditably managed institutions for our destitute insane, which are more almshouses than hospitals?I mean the county asylums. But our present inquiry is restricted to institutions for the not destitute insane, institutions which certainly are not almshouses, and which I am prepared to maintain are not hospitals. In what manner shall we regard these places for the confinement and detention of diseased persons, and to what decree extend our feelings of professional are we called upon to brotherhood and sympathy to the men who own them ? Surely " none of us can fail to feel and respond to the strong claim on " and of the whole the kindly fellowship protection profession of all medical "practitioners" honourably engaged in the treatment of the insane, and surely we should deny and resent " inconvenient and unfair aspersions which have been any made upon their conduct." But surely, also, there is a line of distinction to be drawn between the practitioner and the proprietor ; and although fairness is due to every one, I do not see, unless perchance I may be the proprietor of an asylum, why I should be bound to extend fellowship and protection to' every one of that class. To take a parallel instance: say that I am a ship-doctor, one of a most useful class of practitioners towards whom we all feel the fullest professional But I am also owner of the ship, or of shares in shipping; surely, I have no claim upon your fellowship as a Doubtless the cause of the jumble of ideas on this subject which is entertained by the public, and from which the profession is not free, is, that doctors are generally associated with asylums, and asylums with doctors ; but in reality the pecuniary interest of medical men in private asylums is much smaller than you would suppose to be possible. There are ninety-eight private asylums in England and Wales; and of these forty-nine?being j ust one-half?are licensed to medical men alone, the remaining half being licensed to lay men or to women or to medical men in partnership for this purpose with lay men Moreover, of the asylums licensed to medical or with women. of many of the most important ones are men, the proprietors ^

fellowship.' shipowner.'

capitalists,

or

speculators,

or

trustees,

or

inheritors,

or

hilt-deep

PRIVATE

mortgagees,

to whom

they

.111

LUNATIC ASYLUMS. are

not

licensed, and

whose

names

do

not appear. There are,

therefore, two classes of persons connected with private asylums who stand towards us in very different relations. First, there are the practitioners, whether paid by fee or by salary, to whom the whole profession owes kindly fellowship and protection; and, secondly, there are the proprietors of asylums, who may or may not be medical men, and whom we may fairly be allowed to criticise?whom, indeed, it is our strict duty to criticise?in the interests of our profession, of the public, and of those diseased persons whom they are permitted to hold in confinement.

Now, a great deal of misleading analogy has been drawn between the action of medical men, who in the ordinary practice of their profession receive payment in fees for their services, and that of the proprietors of lunatic asylums, who receive payment for the maintenance and detention of their inmates, which payment, in so far as it exceeds the cost of such maintenance, is their profit. I can perhaps scarcely do better, to illustrate this constantly recurring analogy, than by quoting two passages from recent works on the subject of lunacy law reform. Dr. William Wood, in his recent pamphlet on the Lunacy Law, expresses his " opinion that if care be taken that no person shall be improin an asylum, there is no serious wrong inflicted on perly placed him if one who has been admitted under these precautions be kept some time after his apparent recovery," on the ground, as he explains, of the possibility of relapse. Dr. Wood proceeds to " Unworthy motives are not attributed to the surgeon who say: prolongs his attendance on a patient who has broken his leg, and who thinks it his duty to watch and guard against imprudent and premature use of the limb, though the bone has united. Why should not a physician in charge of an insane person, and why should not the friends of a patient, have the same measure of justice meted out to them as is without hesita" tion accorded to the surgeon ? (P. 57.) Now, without commenting upon the justification of one of the peccadilloes of private lunatic asylums, the detention of patients after their apparent recovery, it must be observed that any surgeon who did act in the manner supposed would most certainly have unworthy motives attributed to him. Only, to make the analogy fit the case, this surgical patient must be put in such a condition that he can in no way help himself, and he must also be supposed to be incapable of saying to the surgeon that he had had enough of him; and also it should be assumed of him that his surgeon was paid by a third party, whose interest it might be that the bone should not speedily unite?

112

PRIVATE

LUNATIC

ASYLUMS.

away from its parents, for instance, lying at an hotel. reality, the fees of medical men, even under the old system of charging for medicines, are not profits. They are charges for work and skill made upon, and paid by, voluntary agents, whereas the profit of a private asylum proprietor is that portion of the payment which is in excess of the cost, and which is great in proportion to the diminution of cost, and valuable in proportion to its continuance ; and, in the well-considered words of Mr. Wilkes and Mr. Lutwidge, reporting to Her Majesty on this very question, " We fear it must be confessed by all that, where profit is the aim, it will too generally be pursued to the prejudice of those from whom it is derived." (Report of Royal Commission on Lunatic Asylums in Ireland, 1858, p. 32.) Or, in the vehement words of Lord Shaftesbury: This vicious the I of runs whole." have no doubt through principle profit that in the majority of instances, where they are acting on that abominable principle of profit, they screw them down to the lowest possible point." (P. 100, Select Com. Report, 1859.) I said that I should make two quotations to illustrate the analogy which is often drawn between the action of medical men in the open profession, and of men, medical or not medical, dealing with diseased persons in asylums. The second quotation is from a speech of the late Mr. Wakley. I quote from that work?full of information and suggestion in lunacy matters ?The Care and Cure of the Insane, by Dr. J. Mortimer Granville, according to whose quotation from Hansard, 3rd series, vol. 59, Mr. Wakley, in August 1841, said, in the House of Commons : I entreat the House to observe the operation of the law as regards lunatics. Suppose I have a relation who is possessed of a large fortune. I perceive certain eccentricities

of a child

But,

in

"

"

"

From the great affection I in the conduct of that individual. have for that relative, and the still greater affecticn I have for his property, I cause a commission of lunacy to be issued out, and, discovering him to be insane, place him in confinement. Then what motive of action is given, under the present system, to the person in whose charge the lunatic is placed ? Why, it calls into operation the principle of selfishness common to human nature. The proprietor of the asylum will argue that he gets ?400 a-year for the charge of the gentleman so long as he remains under that roof; and if he recovered, then he, the proprietor, would lose that annual amount. Suppose an honourable gentleman were to go a doctor and say, 'My liver is diseased, and so long as it remains so I will give you ?100 a-year!' " what motive in such case would be given to the doctor ? The quotation proves how forcibly the situation was even " clear thinker and bold speaker ;" then comprehended by this

PRIVATE

LUNATIC

113

ASYLUMS.

to construct his analogy, he the existence of such an agreement as is

to suppose made in the open medical profession. I have heard that, in China, medical men are paid salaries so long as their patients remain in good health ; but a stated income received from a patient during the continuance of disease is, so far as I know, a thing unheard of out of asylums. I beg you to observe that all I have been saying has reference to the unchanging, and I fear unchangeable, principles which underlie human activities. I might have a good deal to say on the details of asylum management, if I thought it needful or desirable to do so; but I desire to put aside every word which may be construed to have a personal reference, and to ask your opinion, on the broad ground of principle, whether it is right that diseased and helpless persons should be detained and confined in asylums for the profit of private individuals; the amount of that profit depending upon what these individuals choose to expend upon the comfort and enjoyment of their inmates, and its continuance upon the duration of the disease, or what they choose to think its duration. May I not fairly ask you to consider what can possibly justify the existence of these institutions for private imprisonment, owned and kept by

although,

was

obliged

never

private people, lay and medical, male and female; there being nothing like a parallel instance in which the liberty of English-

In former times, indeed, men is submitted to such control ? debtors were permitted to be kept in durance by sheriffs' officers ; but a sheriff's officer was not quite a private individual, and the thing was felt to be a scandal, and was abolished. Control over the liberty of children is to a certain extent transferred from their natural guardians to schoolmasters ; but this only lasts for a few months at a time, and the restraint imposed is a very different thing from the detention of a lunatic until he be discharged or die. But, the existence of these institutions being unquestionable, may I not further ask what good reasons can be given by medical men for sending patients to them ? We know pretty well what the motives of relatives are for so doing: separation from and safe guarding of the patient, But have we, as secrecy, and perhaps the hope of cure. medical men, any clear knowledge of the medical treatment carried on for purposes of cure in these places ? Have we, as medical men, any assurance that secrecy will be observed when it is right, and not attempted when it is wrong ? Above all, can we have medical confidence that with or without when, any treatment, our patients have recovered in these places, we shall be permitted to know the fact ? Or, if we should be so bold as to think that we have observed it for ourselves, are we sure that we shall not be contradicted and deceived ? Are we sure that our PART I.

VOL.

VI.

NEW SERIES.

I

114

PRIVATE

LUNATIC ASYLUMS.

patients will not be indefinitely detained, under tlie supposition that they only appear to have recovered, and may possibly have a relapse? Perhaps I may be wrong in the opinion that, under the best treatment and the most auspicious circumstances, patients do not often attain to perfect recovery in asylums, any more than they do so in fever hospitals; the last touch of treatment wanted being the cordial restorative of home or the tonic of liberty. But do not the proprietors of asylums often recognise the persistence of symptoms of insanity in patients who appear to us to have recovered, which no one

recovered

else can observe ? If the matter were not too sad and serious, I could amuse you by descriptions of the manner in which I have myself been kept at bay in my diagnosis of recovery; for although, upon sufficient evidence, you may make up your mind with certitude as to the existence of mental disease, it

requires great pains and patience and knowledge of your people to avoid being misled as to the possible existence of symptoms which you may not be capable of observing or of denying. Suppose, for instance, that the proprietor tells you that your patient, who appears to have recovered, has had a slight stroke, with a little facial palsy and some slight mental obfuscation, which passed off the day before yesterday; or that he has had two or three slight epileptic seizures, and has been a little fierce and angry just after them; or that he hears voices at night and denies them in the morning?upon what principles of diagnosis are you to determine that the gentleman is drawing upon his invention for his

statements,

and that he will not be inconsolable should

the

relapse occur which he assures you that he is anticipating? But, as I have referred, however slightly, to my own unfavourable experience, let me also say that I have met with and had the pleasure of knowing some men who are the proprietors of asylums who are as honourable and truthful and just as any men in existence; who forget their profits, and, as physicians, treat their patients with unfailing humanity and generosity and skill; whose doors are freely open for patients to leave with the earliest indication that change will be to the patients' advantage; whose asylums are somewhat like lunatic clubs, in which the residence of patients is to a great extent voluntary; whose excellent practice, were it general, would go far to redeem a

bad system; and whose active usefulness must survive any reasonable and beneficent change in the lunacy law. Of the present position of" such men or of such a man in such a system" one can only say, Que diable allait-il faire dans cette galere ? But what to do ? In the first place, I may broadly state my opinion that no change of the law can be satisfactory which does not contemplate

115

PRIVATE LUNATIC ASYLUMS.

The the eventual abolition of all private lunatic asylums. of the the of of Queen's subjects deprivation personal liberty any is an affair of the State, and must only be undertaken by the State. From that axiom there must be no flinching-. Such asylums as I have last described may survive, under some other name, as voluntary retreats for persons of defective or damaged mind. For lunatics who must be confined against their will asylums ought to be provided by the State, and managed by boards of governors. Moreover, the care and treatment of quiet and harmless cases of insanity by the open medical profession in domestic life, as single, or double, or treble cases, ought to be encouraged by the law and its administrators, and not discouraged, as it is at present. It may be very convenient to Commissioners that the insane should be gathered together in large herds or groups; but it is not to the advantage of anyone else except the custodians ; and the Commissioners must eventually conform to the requirements of the age, and prepare to inspect the treatment of the insane wherever it is most convenient for the insane to be treated. And the idea of making everything smooth and easy for official visitation, which reached its climax in a proposal that for the convenience of the Commissioners every asylum should be close to a railway station, must be replaced by wider views of official duty. The discussion of the large question of certification may well be postponed to another opportunity ; only I may observe that 1 think that no tinkering of the present certificate system will suffice to make it safe to the practitioner or satisfactory to the public. The medical man ought to be put firmly upon his right footing as the exponent of scientific opinion : and the action taken upon evidence of that opinion in so grave a matter as that of depriving a man of his liberty ought to be no less than that of the civil power, whatever may be determined for the best as to the judge, or the court, or to the form of inquiry. Moreover, great changes are needful in the administrators of the lunacy laws. The Commissioners in Lunacy are administrators in the metropolitan district, and inspectors only in the remainder of England and Wales ; and it is very certain that the worst asylums to be found in the country are under their immediate jurisdiction. If their Board is to survive a thorough reform of the lunacy laws they ought at least to resign the control of the metropolitan asylums, and to instal the justices of the peace of the counties of Middlesex, Surrey, Kent, and Essex in the same authority which the justices of the peace possess in all other counties, the Commissioners themselves exercising everywhere an uniform power of inspection, report, and superintendence. But a more extensive change is still more i

2

116

PEIVATE

LUNATIC

ASYLUMS.

important, which would render needless this local partial change. There are socially and logically but two classes of lunatics in the community?those who are destitute and those who are not; and there ought, accordingly, to be only two authorities to administer the lunacy laws, and two laws for them to administer, as they severally regard these two distinct classes of the insane. The present division of authority between the Lord Chancellor's Officers in Lunacy, the Comm'ssioners in Lunacy, the Local Government Board and the Boards of Ghiardians, the Visiting Justices and Visitors of Asylums, the Boards of Clevedon and Caterham, &c., is intricate, confused, and mischievous. Instead of this, the Local Government Board, or the Minister of Health, when he is appointed, ought to be placed in authority over all subordinate authorities having needful and

and

control over the care and maintenance of all destitute lunatics; and the Lord Chancellor's Officers in Lunacy, or, to speak with more technical accuracy, the Lord Chancellor, with all his subordinate Officers in Lunacy, under the Royal Prerogative, ought to have authority over all other lunatics and persons charged with their care and control. This change would leave no sphere of action for the present Board of Commissioners in Lunacy, the members of which might well be distributed between the two new and enlarged authorities, half of them going to the Local Government Board, and half of them to the Lord Chancellor. Upon this basis, the details of lunacy law reform could be built up with symmetry, science, and effect; but, without some broad basis of this kind, founded upon a logical principle, any reform of the lunacy laws which we may expect will be but some tinkering of the old pot where the light of day most inconveniently shines through its rust-eaten sides. Be assured, however, that the longer reform is delayed the more comprehensive it will be when it does come ; for the history of social politics is the opposite of that of the Sibylline leaves, and generally the longer you wait for it the larger it becomes. In the meanwhile be it our duty, both collectively and individually, to strive that this most pitiable and helpless class of diseased persons, from whom the profits of private lunatic asylums are derived, shall not suffer longer than we can help under the disadvantages of this worn-out old law. Sequestrated as they have been from our professional care, they are still, as diseased persons, the proper objects of our interest and regard ; and we owe it to them, not less than to ourselves ana to our profession, to strive that the law which governs their care and treatment shall be conceived and executed in the spirit of benevolence, of the scientific knowledge of disease, and of the true relations which the ethics of our profession teach as being consistent with the true dignity and welfare of both medical practitioner and patient.

PRIVATE LUNATIC ASYLUMS.

117

Mr. Nelson Hardy, Honorary District Secretary, read a letter from Dr. Lush, M.P., in favour of the abolition of private asylums. The Chairman said that he protested strongly against any of the work referred to being thrown upon the Local Government Board. There ought to be a Minister of Health in this country, on whom should devolve the care of all institutions connected with the health of the people. He did not think that it was a matter that the Local Government Board could possibly deal with in a proper spirit. The medical profession should themselves take the matter in hand, and should press strongly upon the Government the views that were put forward lately by Mr. Powell in his address on Public Health, so as to obtain from the Government a recognition of the rights of the medical profession and the appointment ofa Minister of Health. One of the things that should be placed under his care was the management of the insane. He supported the observation made by Dr. Bucknill with reference to the multitude of authorities that had the control of the poor lunatic. The expense that those authorities threw upon the State was much too large. He was taking part in the building of a third asylum for Surrey, to hold one thousand patients ; and the requirements of the Commissioners and of the Local Government Board had been such, in his opinion, as to lead to an enormously increased, and he thought unnecessary, He had strong expense in connection with that building. with regard to the herding together of large numbers of lunatics: still the law required it; but the sooner some of the

opinions

lunacy laws were altered (which ought to be done by medical aid) the better. Dr. Newington (Ticehurst) said that the question was not whether proprietors of private asylums had honesty of purpose, but whether they were obliged by law to have honesty of action ?whether there was not a sufficient guarantee for their honesty. Several charges had been made against them. One was made some

years ago, and it

said, first, that

originated

in

some

terrible facts.

It was

people were shut up ; and, secondly, that they were ill-treated by those who had charge of them. No doubt, previously to Mr. Warburton's Bill (he believed in 1828), sane

there was a vast amount of wrong done. But since then there had been various select committees, and those charges were practically abandoned by all who had any right to speak in the

matter, including Dr. Bucknill himself, the Visitors, and also the Commissioners. Even the philanthropists did not state that there was now anything like shutting up of sane people, or that to those who were shut cruelty up. A third charge was, the patients were detained after that had If were cured. they been true for many years, one absurd effect would be that the asylums would be blocked up. He would put before the meet-

118

PRIVATE

LUNATIC ASYLUMS.

a few figures extending over ten years, which he thought would put the case rather the other way. The average yearly residence in county asylums was in round numbers 32,000, and the admissions were 10,000?a proportion of 31. In the hospitals there were 785 admissions, and an average residence of 1,887 ; showing a proportion of 2-|. In private asylums there was an average residence of 4,445, the yearly admissions being 1,835 ; giving a proportion of 2f. Thus, in county asylums the proportion was 3A-, and in hospitals and private asylums together 2-|. In other words, supposing the various classes of asylums were absolutely empty, and there were no deaths or removals, it would take 3^ years to fill the county asylums ; 2^years to fill the hospitals ; and 2f years to fill the private asylums. Another view was still more convincing. The average residence in the county asylums was 32,231; the discharges and deaths together amounted to 8,893. The average residence in hospitals was 1,887 ; discharges and deaths, 786. In private asylums the average residence was 4,445 ; discharges and deaths, 1,856. These proportions showed that, supposing no more admissions took place for a certain time, it would take three years and seven months to empty county asylums; two years and five months to empty hospitals; and two years and He found also that four months to empty private asylums. there were nearly 12,000 more in county asylums than there In hospitals there were five fewer patients were ten years ago. than there were ten years ago. In private asylums there were fewer That showed that now than there were ten years ago by 237. there was neither a stagnation nor a tendency to block up. It had been said that proprietors of private asylums did not wish to cure their patients, because it was better to keep them as patients. The average rate of yearly cure was calculated by dividing the admissions by the cures ; that was, supposing an asylum admitted one hundred patients in a year, and discharged forty-two, the rate of cure was put down at forty-two. The average rate of the cure of lunatic patients was between 38 and 40 per cent.; in private asylums it was about 32 per cent. Those figures, however, must not be taken alone. Dr. Thurnam brought out some tables, and Dr. Needham had followed, taking twenty-six or twenty-eight years of the more recent results. On the Select Committee of 1877, Mr. Wilkes, in his evidence, produced some figures which he had elaborated from reports of thirteen county asylums ; and it was shown that 54 per cent, of the patients taken into asylums within one year of the seizure should be cured, and that between 5 and 7 per cent, was all that could be expected to be cured after the first year. To compare with these figures he had not any extended returns from private asylums, as these did not publish printed reports; and he had

ing

PRIVATE LUNATIC ASYLUMS.

110

to take one hundred cases from his asylum Of these patients 31 were already cured, and 6 were patients that were curable ; if 4 were cured, there would be 35 cured out of 100. That would answer the objection that there was not a wish to cure the patients. If the figures were read in a prope1* way the private asylum proprietors did as much work towards recovery as their colleagues did in the public asylums or hospitals. As to the question of self-interest, the great fallacy in all this argument was that, because a man's interest might lead him to do wrong, he was bound to do it. He did not see why private asylum proprietors should be necessarily wanting in honesty. A man's interest might lie one way, but there was no necpssity for him to follow it. It was assuming that he had no moral integrity whatever. As to private patients, there were only about three thousand really private patients; a considerable number ought not to be placed in that category. For instance, at Grrove Hall there were 452 soldiers, paid for by the Government, and who therefore ought not to be regarded as private patients. With regard to single patients, it appeared that the cures were 9 per cent. "With regard to the originators of the charges, there were patients who always had grievances against the private asylum proprietors, and a few of these had lately abused them ; but against their statements could be put the kindness shown by other patients. As to the lay newspaper writers, their experience must be borrowed, and their information came through the narrow channel of a few people. The medical profession must depend for most of their knowledge on what they were told by other people. A writer in a medical with an old editorial tradition; but he had started weighted paper (Dr. Newington) believed he had not had any practical knowledge of insanity to back up his theoretical opinions. He would answer Dr. Bucknill by quoting his opinions given before the Select Committee. He had expressed in his paper a wish to abolish private asylums. In answer to question 1,910 before the Select Committee, " Would it not be desirable to get rid of " private houses by degrees ? he observed, " I should be very to see them sorry got rid of." Dr. Bodington (Kingswinford) said that he desired to bear testimony to the endeavour which Dr. Bucknill had made to treat the subject in a moderate and temperate manner. A great deal of heat had been imported into the controversy, not by the private proprietors of asylums, but by agitators against them. It was very desirable that members of the same profession, occupying different callings, should treat one another with temper, moderation, and forbearance. Dr. Bucknill did not to the analogy between bear out his with

therefore been

at Ticehurst.

quite

obliged

argument

regard

120

PRIVATE

LUNATIC

ASYLUMS.

and their profits and ordinary practiIn all callings there were some dishonourable men, but it was hoped many more honourable ones. Dr. Bucknill first stated that a number of charges might be made against proprietors, and then he took as exceptions a certain number of honourable men whom he had known. If private asylums were to be defended, they must be defended upon the ground of the medical proprietors being equally honourable with the rest of the profession. It seemed to him hard that, because the present private asylum proprietors happened to be the incumbents of offices which had been handed down to them from time immemorial, they should be attacked as if they were a special race of pariahs not worthy to be associated with ordinary decent people. In the last report of the Commissioners there was some excellent testimony that medical proprietors of asylums were men of at least equal honour and equal sensitiveness to their honour with any other body of men. Dr. Hicks said that he was one of the proprietors to whom Dr. Bucknill had referred. He was not prepared to hear all He was anxious to he had heard ; but he was not surprised. hear what statements Dr. Bucknill was going to make, and what facts he was going to bring forward to support those statements. Dr. Bucknill had brought forward cases in support of the system of private patients. If Dr. Bucknill had any facts to bring forward he ought to have done so; but he had not. Two years ago he (Dr. Hicks) appeared, with Dr. Bucknill, to prosecute a medical man for keeping a single case. It was a case under the care of a private medical man, and Dr. Bucknill's report proved that it was a most detestable one?such as could not possibly have occurred in any private asylum in this country, and such as, he would venture to say, had never been reported in this country. He believed Dr. Bucknill had appeared on other occasions to prosecute cases of this kind; and yet he now stated that private asylums were most detestable places ; that the proprietors were the black sheep of the profession; and that their patients should be scattered far and wide, leaving them without government, protection, or anything else. The private cases were not perhaps visited once a year, while the private asylums were visited six times in a year, and every possible contingency had to be reported to the Commissioners. Dr. Bucknill had told him, on the occasion referred to, that he would like to have a private asylum in the suburbs of London, but that the Commissioners would not sanction it. [Dr. Bucknill denied that he had said this.] Dr. Hicks said that he was a proprietor, and he did his utmost to act honourably, and had never given cause of complaint. There were also other pro-

private asylum proprietors tioners and their profits.

PRIVATE LUNATIC ASYLUMS.

piietors

who bad had

121

complaint brought against them; and with keeping patients longer than ley ought to do, a:nd that they did it from personal motives; lat the proprietors had not attempted to discharge cases when they were cured. Mr. W. Gr. Balfour did not think that the argument for an against private asylums was likely to do much good. Last session yet Dr. Bucknill

rio

charged them

Mr. Dilhvyn introduced into Parliament a Bill containing every one of the things which Dr. Bucknill had proposed as reme les for existing evils. He did not see what was the use

eeP}n& UP ,^ls sor^ ?f warfare. He would rather bring the meeting a resolution that it accepted Mr. Dillwyn's as a measure of reform in lunacy law, and that they should to

e fore i

proceed a

consider its clauses. Ihe Chairman said that the meeting could hardly take up resolution, because no notice had been given. What they

Bucknill's paper. Any matters brought *s?uss*nS" was f^616. orwar the paper Mr. Balfour would be in m

lr

sa*d that the

justified

opposing.

had before it a set of or half-truths. What Dr. Bucknill said about was m a asy great measure true; but he had given only a rut is. He did not say how many patients the proprietors ia or ?40 or ?G0 a year, which would not pay for their epp ie did not tell of the good actions of the asylum proprie ors. These statements that were being made were only atoi a ing the public, and the patients and the asylum keeping proprietors in a state of dissatisfaction and discontent. He ^le ar^c^es which had appeared in the British ec real Journal on the subject. A new Bill would be introuced next session, founded upon Mr. Dillwyn's. He suggested f aPP?intment of a Committee to take Mr. Dillwyn's Bill

?j* j ^facts one-sided

meeting

ums^

-

,

.

into

consideration.

Mr. Nelson Hardy said that they could not go off from the iscussion of the paper read into another thing, which would require some time. There were two courses open : they might a journ the discussion for a on the other hand, or, fortnight; a er hearing Dr. Bucknill's reply, they might consider this iscussion closed, and start on the next occasion with the consideration of Mr. Dillwyn's Bill. moved the adjournment of the discussion, 3Pr* i Ii. Lodington seconded the motion for the adjournment, e would ask Dr. Bucknill to acknowledge that he had made a mistake in the recent trial to which he had referred in regard o ice-Chancellor Malins. He believed that the great majority oi medical asylum proprietors were in favour of abolition. In that he quite agreed with Dr. Bucknill.

^?od

122

PRIVATE

LUNATIC ASYLUMS.

Dr. Bucknill entirely concurred in what the Chairman had said with regard to the Minister of Health. He had only mentioned the Local Grovernment Board as the authority in possession; but, if the Grovernment were determined to appoint a Minister of Health, it would be quite right that that minister should have authority over the destitute insane throughout the country. Dr. Newington's speech had made a great impression upon him. His statistics were exceedingly interesting and valuable ; but there was a difference in the statistics of a large number of small institutions scattered over the country, many of which had neither clerks nor boards to regulate the moveHe remembered a superintendent of a ments of patients. county asylum in the old days who got a reputation for a great proportion of recoveries ; but, after a while, it was found that he had a certain number of patients whom he discharged as cured every December and readmitted them every January. He was very much struck by what Lord Shaftesbury said in his evidence in 1877, that they sent out a great number of patients What became of on trial whom they never heard any more of. them ? They were certainly not understood to be cured. As regarded Dr. Hicks's statement, if he had thought fit to apply for a licence, the Commissioners in Lunacy would have been most willing to give him one. The resolution for the adjournment was carried unani-

mously.

At an adjourned meeting of the South London District of the Metropolitan Counties Branch, on Wednesday, February 4, the discussion on this subject was resumed by Mr. W. Gr. Balfour, who read the following paper :? At the last meeting of this Society, Dr. Bucknill fully explained to you what are regarded as the defects and shortcomings of private asylums and their proprietors. These defects and shortcomings are denied by asylum proprietors, who believe that they have no existence except in the lively imaginations of a few chronic lunatics, whose insanity is of a type that unfits them to associate in the same buildings with their fellows more honestly afflicted. With such conflicting assertions put before them, it is not a matter for wonder that the public have a dim idea that all is not as it should be as regards the care and treatment of the insane ; that they readily pay attention to any description of a private asy\um, however farfetched, that is put before them in the lay an cf medical papers; and that they too easily believe what they hear. When a veteran in lunacy like Dr. Bucknill throws the weight of his vast experience into the question, and, by writing and speaking, joins in the crusade against private asylums, not

PRIVATE LUNATIC ASYLUMS.

123

only the public,

but even our own profession, have their faith the value of these institutions shaken, and entertain grave uoubts as to the worth of their in

proprietors.

Unfortunately

for all interested in the treatment of the insane, there is not one of the charges brought against private asy urns and those who have to do with them which might not >e rue. for us all, these charges cannot Fortunately, however, e substantiated. Dr. Bucknill and those with whom he associates himself in this matter fail to distinguish between W an

Discussion on Private Lunatic Asylums.

Discussion on Private Lunatic Asylums. - PDF Download Free
20MB Sizes 0 Downloads 29 Views