391 



LUNATIC ASYLUMS. 



LUNATIC ASYLUMS. 



382 



ending December 31, 1858, it appears that there are 44 county and 

 borough asylums now in England (2 of them, Cumberland and Glamor- 

 gan, not yet (I860; open). The only large town not possessing one is 

 the city of London, notwithstanding the repeated remonstrances of the 

 commissioners; but one is about to be erected at last at Dartford. 

 There are 38 metropolitan and 74 provincial licensed houses; with 13 

 hospitals which receive lunatics, including the one at Earlswoqd for 

 idiots only. The following is the summary as given in the Commis- 

 sioners' Report for the year ending December 31, 1858 : 



In the year there had been 8146 admissions; and 4942 discharges, 

 of which 3d79 were recoveries, of which 1399 were males ai> 

 females. Of the patients remaining, 2779 were deemed curable. 

 '06 death*, of which 1274 were of males, and 1032 

 females : 7 females and 5 males had committed suicidr. 



The report of the commissioners on their visitations was on the 



whole favourable. The chief complaint was the want of space for 



exercising grounds ; the neglect of providing night assistants, which 



inmiswonera strongly urge, aa the best means of counteracting 



Patienti chargeable to counties and boroughs, and also certain criminal 

 patients, arc not included in the above totals. 



the habits of dirty patients and for the prevention of accidents ; and 

 the insufficiency of the pay to secure able and trustworthy assistants. 

 On the whole, they find that the system of personal restraint has been 

 nearly altogether abandoned, and that of solitary confinement greatly, 

 but not as they think sufficiently lessened. Their efforts, however, 

 have not been altogether effectual. Some remnants of the old system 

 I remain, in spite of their remonstrances, in the private asylums. They 

 ' thus describe one : " The premises present a cheerless aspect. Many 

 of the rooms have no windows, and are entirely dark. Some are lined 

 with sheet-iron. The windows are guarded with heavy iron bars, 

 and those, with the iron gates and railings, give the place a most 

 jail-like appearance. Some of the sitting-rooms are without furniture, 

 except fixed forms, and boards against the walls for tables. In these 

 the floors are flagged, and the windows placed high up near the ceiling. 

 There are out-buildings, where the patients are placed without attend- 

 ants, and where no means for warming exist. The airing-court walls 

 are high, and obstruct the view of the surrounding country." This is 

 the state after some improvements had been made, and after repeated 

 remonstrances. 



Of the Asylum for Idiots at Earlswood, the reports published by the 

 directors speak most favourably, though that of the Lunacy Com- 

 missioners is not altogether so commendatory. It recommends more 

 attention to the improvement of the physical condition of the patients, 

 with more of out-of-door exercise, thus developing their feeble intellect, 

 with less pressure upon it by scholastic tuition ; adding, in a report of 

 February 23, 1859, that these recommendations have been adopted, and 

 that its present management reflects credit upon the officials. At that 

 date there were upon the premises 279 pupils, 187 of whom were males, 

 and 92 females. The institution has been remarkably successful in 

 developing the intellect, so as to make the patients at least useful 

 and well ordered, in humble branches of industry, consequently 

 more happy themselves, and a less burden to their friends and 

 families. 



In Scotland, the custody of the insane was, like every other matter 

 which demands both magisterial and executive intervention, connected 

 with the system of local courts. The law on the subject is now em- 

 bodied in the 20 & 21 Viet. c. 71, as amended by the 21 & 22 

 Viet. c. 89, and the system of management of the insane in Scotland 

 has, both in a purely medical and in an administrative point of 

 view, been vastly improved. Until a comparatively late period the 

 statute law was nearly inoperative, from a strong prejudice against 

 the enforcement of general rules relating to the treatment of the 

 insane, and the consequent toleration for breaches of the statutory 

 regulations. The rule adopted in practice was, that insane persons 

 were allowed to go at large until they had proved themselves 

 dangerous to the lives of their neighbours, and that when confinement 

 was in any case resorted to, the proceedings were not very rigidly 

 investigated. There are now 8 public asylums, 24 private asylums, and 

 27 poorhouees, in which lunatics are maintained, and there are 1784 

 paupers kept in private houses. The total number of lunatics at the 

 end of 1858, was 5748, of whom 2718 were males, and 3030 females; 

 of this total 4737 were paupers. In the year, 188 males and 182 

 females had died. There had been 244 males and 379 females dis- 

 charged recovered, and 198 males and 216 females not recovered. The 

 admissions in the year were, 705 males and 921 females. In 1859, the 

 number had been a little over 5000, of whom 392 died, and 497 were 

 cured. The proportion of cures to deaths had been improving every 

 year since 1856. 



In Ireland, two inspectors of lunatic asylums, with the requisite 

 assistants, have been appointed ; and the erection of county lunatic 

 asylums has been zealously carried forward. There are now 16 dis- 

 trict asylums in operation, several of them being for the reception of 

 patients from two or more counties which have associated themselves 

 for that purpose ; and a central one at Dundrum, county of Dublin. 

 Between 1855 and 1860, there was expended on the construction of 

 such asylums the sum" of 356.114/. The ninth report of the inspectors 

 of Irish lunatic asylums, gives the total number of the insane of all 

 i kinds on March 31, 1859, as 11,218, of this number (at the end of 1857), 

 4262 were at large, there not being sufficient accommodation for them 

 in asylums at that time ; the number being no doubt greatly reduced 

 in the interval. Of the remainder, 2087 males and 2003 females were 

 in the district asylums ; 89 males and 41 females were in the central 

 asylums ; in jails, 116 males and 107 females; in poorhouses (April 2, 

 1859), 722 males and 1324 females ; and in private asylums (December 

 31, 1858), 254 males and 213 females; giving a total of 3268 males 

 and 3688 females under care and supervision. There are, in addition, 

 44 women and 30 men in the Dublin Hospital for Incurables. The 

 general management, treatment of the patients, and construction of 

 the buildings, are similar to those adopted in Great Britain, modified in 

 some unimportant details by peculiar circumstances. 



So many public asylums having been built, there has been a great 

 variety of construction. The chief requisites insisted on by the com- 

 missioners, are light, ventilation, proper means of warming, conve- 

 nience and cheerfulness in the furniture, and, above all, ample means 

 for out-door exercise. The only doubtful part of the arrangement is 

 the dormitories, some good authorities preferring open wards, as 

 admitting the most effective superintendence at night ; others advo- 

 cating separate sleeping apartments, as being less likely to admit of any 



