And 12thly. That, when a patient is forced into and secluded in a small room or cell, it is essentially coercion in another form, and under another name; and that it is attended with quite as bad a moral effect, as any that can arise from mechanical restraint.[183]

Pa.s.sing on to 1847, we find the Commissioners in Lunacy, having acted under the new powers conferred upon them by the two Acts pa.s.sed since the date of the Report of 1844 (8 and 9 Vict., cc. 100 and 126), able to give a satisfactory sketch of the progress of reform in the condition of asylums. "In several of the county asylums and hospitals," they observe, "the adoption of a more gentle mode of management was originally designed in the direction of these establishments, and was the result of public opinion and of the example set by the managers of the Retreat near York. A strong impression was made on the feelings and opinion of the public in reference to the treatment of lunatics by the publication of Mr. Tuke's account of the Retreat at York. The able writings of Dr.

Conolly have of late years contributed greatly to strengthen that impression, and to bring about a much more humane treatment of lunatics in many provincial asylums, than that which formerly prevailed."

Referring, then, to the Report of the Metropolitan Commissioners (1844) it is observed that "proof is afforded therein that this amendment had not extended itself to old establishments for the insane, and that much severe and needless restraint continued to be practised in numerous private, and in some public asylums. In many of the private asylums, and more especially in those which received great numbers of pauper patients, much mechanical coercion was practised, until it came to be in great measure laid aside in consequence of the repeated advice and interference of the Commissioners.... In private licensed asylums it has been thought impracticable to avoid the occasional use of mechanical coercion without incurring the risk of serious accidents.

Under these circ.u.mstances restraint of a mild kind is still practised, but we look forward to its abolition, except, perhaps, in some extraordinary cases, so far as pauper patients are concerned, when the provisions of the Act for the establishment of county asylums shall have been carried into effect. In the best-conducted county asylums it is now seldom (and in a few establishments never) resorted to."[184]

At this period, the actual number of lunatics returned to the Commissioners was only 18,814, but they estimated the number under some kind of care, in England and Wales, at 26,516. There were--

-----------------------------------+----------+---------+---------- Location. | Private. | Pauper. | Total.

-----------------------------------+----------+---------+---------- In county asylums, hospitals, and | | | licensed houses | 3,574 | 9,652 | 13,226 | | | Bethlem, and in naval and military | | | hospitals not subjected to | | | visitation of Commissioners | 606 | -- | 606 | | | Poor-law unions; placed under | | | local Acts | -- | 8,986 | 8,986 | | | Gilbert's unions, and other places | | | not in union | -- | 176 | 176 | | | Single patients found lunatic by | | | inquisition | 307 | | 307 | | | Ditto in private houses with | | | persons receiving profit | 130 | -- | 130 | | | Excess of pauper patients in | | | workhouses, etc., estimated by | | | visiting Commissioners as at | | | least one-third over the number | | | number returned by parish | | | officers | -- | 3,053 | 3,053 | | | Criminals in jails | -- | 32 | 32 +----------+---------+---------- Total | 4,617 | 21,899 | 26,516 -----------------------------------+----------+---------+----------

The number of patients found lunatic by inquisition was 542; their incomes amounting to 280,000. In 1839 the corresponding numbers were 494 and 277,991.

The estimated annual amount expended at this time for maintenance of lunatics, or administered on their behalf, exceeded 750,000, thus distributed:

1. Cost of 9652 paupers in asylums, estimated at 8s. per week 200,762

2. Ditto of 8986 paupers in workhouses, etc., and 173 in parishes not in union (9159), estimated at 3s. per week 71,440

3. Ditto of excess of 3053 paupers over the number returned by the parish officer 23,813

4. Ditto of 3574 private patients in asylums, etc., at an average of 20s. per week 173,628

5. Income of 542 private patients found lunatic by inquisition 280,000

6. Cost of 606 patients in Bethlem and the naval and military hospitals, estimated at 10s.

per week 50,756

7. Ditto of 120 other single patients taken charge of in separate houses at 100 a year 12,000

8. Thirty-two criminals in jails, estimated at 3s.

per week 249 -------- Total 777,648

Adding the expense of maintaining many families cast upon the parish in consequence of the patient's insanity, and the expense of supporting many called imbecile, and the interest of large sums invested in public establishments, the Commissioners estimated the actual amount as little less than 1,000,000.

In the same Report the Commissioners observe "that they have found that, with some exceptions, the patients have apparently been humanely, and sometimes very judiciously treated. There is no reason to apprehend that the lunatic patient is now often subjected to cruelty or ill-treatment.... The ma.s.sive bars, and rings, and chains of iron formerly resorted to are no longer seen. Any continued coercion is not permitted. The name of every patient under restraint and in seclusion, and the means by which such seclusion is effected, are recorded every week in a journal. Thus the safeguards against lunatic patients being subjected to harsh or unnecessary restraint from the cruelty, idleness, or caprice of their attendants, have been multiplied, and the chances of abuse reduced to a small amount."

The number of lunatics placed under mechanical restraint in licensed houses in this year is given in the following table, it being premised that wherever the number is not specified, "it may be a.s.sumed either that there was no patient then under restraint, or that the number was so small, and the restraint so trivial, as not to be deemed worthy of special remark."[185]

------------------------------+-----------+-----------+------------ | Number of | | Under Asylum. | patients. |Criminals. | restraint | | | last visit.

------------------------------+-----------+-----------+------------ METROPOLITAN LICENSED HOUSES. | | | | | | Bethnal Green--Red House } | | | White House } | 614 | 12 | 4 Bow--Grove Hall | 291 | -- | 2 Brompton--Earls Court | 32 | -- | 1 Camberwell--Camberwell House | 246 | 1 | 5 Clapham--Retreat | 15 | -- | 1 Clapton, Upper--Brook House | 42 | -- | 1 Fulham--Beaufort House | 5 | -- | 2 Hillingdon--Moorcroft House | 50 | -- | 1 Hoxton--Hoxton House | 416 | -- | 4 Kensington--Kensington House | 44 | -- | 2 Peckham--Peckham House | 409 | 4 | 4 Stoke Newington-- | | | Northumberland House | 35 | -- | 1 ------------------------------+-----------+-----------+------------

------------------------------+-----------+-----------+------------ | Number of | | Under Asylum. | patients. |Criminals. | restraint | | | last visit.

------------------------------+-----------+-----------+------------ PROVINCIAL LICENSED HOUSES. | | | | | | Derby--Green Hill House | 25 | -- | 1 Durham--Gateshead Fell | 92 | 8 | 1 Ess.e.x--High Beach | 34 | -- | 2 Gloucester--Fishponds | 45 | -- | 1 Northwoods | 29 | -- | 1 Fairford | 175 | 1 | 1 Hants--Grove Place | 78 | 1 | 1 Herefordshire--Whitchurch | 32 | 2 | 1 Kent--West Malling Place | 40 | -- | 3 Lancaster--Blakely House | 24 | -- | 1 Northumberland--Bell Grove | | | House | 13 | -- | 1 Oxford--Witney | 11 | -- | 2 Hook-Norton | 57 | 1 | 2 Somerset--Bailbrook House | 92 | 3 | 10 Stafford--Oulton Retreat | 25 | -- | 2 Sandfield | 44 | -- | 1 Suss.e.x--Ringmer | 3 | -- | 1 Warwick--Duddeston Hall | 87 | 3 | 6 Kingstown House | 91 | -- | 2 Wilts--Bellevue House | 181 | 5 | 5 Fiddington House | 193 | 3 | 3 Worcester--Droitwich | 91 | 2 | 2 York, East Riding--Hull and | | | East Riding Refuge | 115 | 8 | 1 Hessle | 12 | -- | 1 West Riding--Castleton | | | Lodge | 15 | -- | 1 Grove House | 41 | -- | 5 Heworth | 29 | -- | 1 ------------------------------+-----------+-----------+------------

If for the purpose of comparison at different years we take one asylum, Ringmer in Suss.e.x, there were in November 1829, nineteen patients, of whom five were under restraint by day, and seven by night. In 1830 (February) the number of patients was twenty, and of these eleven were under restraint by day and six by night; while in October of the same year, out of eighteen patients, there were nine under restraint. In 1831, there were twenty-two patients, ten of whom were under restraint. Writing in 1848, the Commissioners enumerate the various changes for the better which had then taken place, among which were--an active medical superintendence; the abolition of excessive use of mechanical restraint, there being sometimes only one or two, and occasionally no patient whatever, under mechanical restraint; the introduction of warm and cold baths; the cleanliness of the day-rooms and dormitories; the addition of a good library, and various amus.e.m.e.nts and means of occupation; and also an excellent dietary. Such is a sample of the happy change which was, in many instances, brought about by inspection.

The following cla.s.sification of asylums in 1851 will show at a glance the progress made in providing accommodation from time to time, consequent upon legislation:--

1. Asylums existing prior to pa.s.sing of Act 8 and 9 Vict., c. 126.

Accommodation for pauper lunatics at pa.s.sing of the Act 5560 Additional accommodation provided therein since the pa.s.sing of the Act 1753 ---- Total accommodation 7313

2. Asylums in progress of erection at pa.s.sing of Act 8 and 9 Vict., c.

126, and since opened.

Number for which designed 997 Subsequent additions 206 ---- Total present accommodation 1203

3. Asylums erected or provided under the provisions of the Act 8 and 9 Vict., c. 126, and now opened.

Accommodation for pauper lunatics 1114

4. Asylums in progress of erection under Act 8 and 9 Vict., c. 126, and not yet opened.

Proposed accommodation for pauper lunatics 4299 Under provisions of previous Acts 6557 Under Act 8 and 9 Vict., c. 126 7372 ------ Total 13,929 Exclusive of 192 in Northampton Hospital.

Asylums existing prior to or at the pa.s.sing of Act 8 and 9 Vict., c.

126--

Beds., Herts and Hants., Chester, Cornwall, Devon, Dorset, Gloucester, Kent, Lancaster (containing the largest number of patients, 700), Leicester and Rutland, Middles.e.x (Hanwell), Norfolk, Notts., Salop and Montgomery, Stafford, Suffolk, Surrey, West Riding, Yorkshire, Bristol (borough).

Wales--Haverfordwest (town and county), Montgomery (see Salop).

Asylums in progress of erection at the pa.s.sing of this Act, and since opened--

Oxford and Berks, Somerset, North and East Riding, Yorkshire. Wales--Anglesea, Carnarvon, Denbigh, Flint, Merioneth.

Total number for which designed 997 Additions since pa.s.sing the Act 206 ---- Total 1203

Counties in which no steps are taken to provide asylums--

c.u.mberland, Durham, Northampton, Suss.e.x, Westmoreland.

Total accommodation 5560 Subsequent additions 1753 ---- Total 7313

Asylums erected or provided under the above Act and now opened--

West Lancashire (Rainhill), East Lancashire (Prestwich, near Manchester), Birmingham (borough), Kingston-upon-Hull.

For these asylums the accommodation provided in the first instance was 1114.

There were still upwards of fifty boroughs for whose pauper lunatics no legal provision was made, and no asylum was then erected for the City of London.

Under the head of mechanical restraint, the Commissioners now report that it has still further diminished, and has in some houses been absolutely abolished. However, in fifty entries made in the books of thirty-six private asylums, abuses and defects are animadverted upon in fifteen instances in regard to restraint, in twenty instances in regard to bedding and clothing, nine in regard to diet, seven in regard to cleanliness, and four in regard to management and treatment. They observe that the number of lunatics in workhouses has diminished in a very marked degree.

In this Report the Commissioners take the opportunity of animadverting, also, upon the defective state of the law in regard to the property of lunatics; the good effect of the Act 8 and 9 Vict., c. 100, being lessened by this and other causes.

Turning to the year 1854, nearly ten years after the Act of 1845 had been in fruitful operation, we find the Commissioners attaching importance to the alterations recently made in the law of lunacy by the three important statutes, 16 and 17 Vict., c. 70 (the "Lunacy Regulation Act" of 1853) which refers to Chancery lunatics; 16 and 17 Vict., c. 90 (an amendment of the Act under which the Board was const.i.tuted); and 16 and 17 Vict., c. 97 (the "Lunatic Asylums Act," 1853).

These Acts, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and the Acts relative to criminal lunatics, const.i.tuted at that period the code of law of lunacy.