[249] _Journal of Mental Science_, January, 1870.

[250] Dr. Fraser observes (Report, p. 124): "Dr. Arthur Mitch.e.l.l, in his work on the insane in private dwellings, shows that this method of providing for the chronic insane is--1st, the best thing for the patient; and, 2nd, the best thing for the country; and in that opinion I heartily concur."

CHAPTER X.

IRELAND.

I have already spoken of the singular tradition which for so long a period invested the Glen-na-galt, near Tralee, with the character of possessing healing virtues in madness. The change which in our practical age has taken place in Kerry, by the subst.i.tution of a well-ordered asylum at Killarney, for popular superst.i.tious practices, represents what has been going on throughout the whole of Ireland during the last half century or more. After examining all the Acts bearing on the provision for the insane from the earliest period, and the evidence given before Parliamentary Committees, I must say I find a very large amount of strenuous effort and labour devoted to the improvement of the condition of lunatics, miserably situated as they formerly were in general, when confined in houses of industry or at home in hovels, where their needs could not possibly be attended to, even when, as was doubtless frequently the case, they were regarded with great affection.

Sometimes they were looked upon as possessed, and then the appropriate forms of the Church of Rome were employed.

In the evidence given before the Select Committee on the Lunatic Poor in Ireland in 1817, Mr. John Leslie Foster, a governor of the Richmond Asylum,[251] stated that he had seen two or three lunatics in one bed in the house of industry. There were fifty or sixty in one room. In the same room a lunatic was chained in a bed, the other half of which was occupied by a sane pauper, and the room was so occupied by beds that there was scarcely s.p.a.ce to move in it.

Mr. Rice stated that when he visited the Clonmel Asylum in 1814-15, the patients were not clothed; some were lying in the yard on the straw in a state of nakedness. At Limerick he found the accommodation for the patients "such as we should not appropriate for our dog-kennels." There was one open arcade, behind which cells were constructed with stone floors, without any mode of heating or of ventilation, and exposed during the whole of the winter to the extremities of the weather.

Thirteen cells were provided for thirty-three lunatics and idiots. As some were furious, the usual mode of restraint consisted of pa.s.sing their hands under their knees, fastening them with manacles, securing their ankles by bolts, pa.s.sing a chain over all, and lastly attaching them firmly to the bed. "In this state, I can a.s.sure the Committee from my own knowledge, they have continued for years, and the result has been that they have so far lost the use of their limbs that they are utterly incapable of rising." The rooms over the cells were appropriated to the sick. Mr. Rice found twenty-four persons lying in one room, some old, some infirm, and in the centre of the room a corpse; one or two were dying. In the adjoining room he found a woman in a state of distraction, the corpse of her child left upon her knees for two days; it was almost putrid. "There was not to be found one attendant who would perform the common duties of humanity. The most atrocious profligacy in another branch of the establishment prevailed."

The condition of a lunatic member of a family among the poor is thus graphically described by a member of the Committee which prepared this valuable Report: "There is nothing so shocking as madness in the cabin of the peasant, where the man is out labouring in the fields for his bread, and the care of the woman of the house is scarcely sufficient for the attendance on the children. When a strong man or woman gets the complaint, the only way they have to manage is _by making a hole in the floor of the cabin_, not high enough for the person to stand up in, with a crib over it to prevent his getting up. The hole is about five feet deep, and they give this wretched being his food there, and there he generally dies. Of all human calamity I know of none equal to this, in the country part of Ireland, which I am acquainted with."

In the physician's report of one asylum for 1816, he speaks of the miserable objects who wander over the face of the country, or are inmates of jails and hospitals. Such do not appear to have taken refuge in any Glen-na-galt.

The first asylum for the insane in Ireland (and the only one before the Richmond Asylum) was that founded in Dublin by Swift, whose act would probably have been little known or forgotten, but for the familiar lines in which he himself has immortalized it:--

"He gave the little wealth he had To build a house for fools or mad, To show by one satiric touch No nation needed it so much."

This asylum was opened in 1745, the population being then between three and four millions. What really induced the Dean of St. Patrick's to perform this act was the knowledge that there was no charitable asylum for the insane--nothing more; at any rate, I am not aware that he contemplated the introduction of any improved method of treatment, or would have thought that chains were unsuitable means of restraint. It appears that his attention had been called to the need of an asylum by "The Proposal" of Sir William Fownes. Swift bequeathed the whole of his estate and effects, subject to certain small legacies, to be laid out in the purchase of land for a hospital large enough for the reception of as many idiots and lunatics as the income of the said lands and effects should be sufficient to maintain.

From its historical a.s.sociations I was interested in visiting this asylum some years ago, but there is nothing otherwise of special interest in the inst.i.tution. Writing in 1861,[252] the Inspectors of Irish Asylums observe, "Though subject to our inspection, it is not a regularly licensed asylum, being on a charitable foundation. It is unfortunately situated in a most inappropriate locality, and very deficient, from its original construction, in many necessaries." And the Lunacy Inquiry Commission of 1879 observe, "We feel ourselves compelled to state that St. Patrick's Hospital, though possessing an ample endowment, with an acc.u.mulated fund in bank of 20,000, and situated in the metropolis, is yet in many respects one of the most defective inst.i.tutions for the treatment of the insane which we have visited....

The patients wash in tubs in the day-rooms, the water having to be carried all through the house, as no supply is laid on; the hospital is not lighted with gas 'for fear of explosion'! and pa.s.sages nearly four hundred feet long have, on winter evenings, no other light than that which is afforded by three or four small candles." The house was badly warmed, and the ventilation far from satisfactory.

Further, while the Dean's will did not contemplate the payments of patients, boarders were admitted at an early period, and this policy went to such a length that while in 1800 there were a hundred and six free and only fifty-two paying patients, there were in 1857 eighty-eight paying patients, and only sixty-six free. As the Commission navely remark, "if the diminution of free patients and the increase of paying patients are to continue, it may one day result that no inmates of Dean Swift's Hospital will be maintained entirely out of his bequest, which certainly does not appear to have been in the contemplation of the founder."[253] A somewhat brighter picture might have been expected when one reflects that, according to the original charter, the government of the hospital was vested in the Primate, Lord Chancellor, Archbishop of Dublin, Dean of St. Patrick's, Dean of Christ Church, Physician to the State, and Surgeon-General, and seven other persons whose successors were to be elected by a majority of the governors, each of whom was required to be a fit person.

An asylum was erected at Limerick about 1777, and at Cork in 1788.

The Cork Asylum was built on the strength of an unrepealed section in an old Jail Act (27 Geo. III., c. 39. s. 8), which allowed of sums of public money to be "presented" by grand juries for the use of lunatic asylums, without limit, and permitted magistrates to commit to them any individuals, if idiots or insane. It did not provide, however, for the government of the establishment when formed, or for an account of how the money was spent. No medical certificates were required--the magistrate's power was unlimited. Fortunately, however, the Cork Asylum was in good hands (Dr. Hallaran), thanks to which, and not to the law, the inst.i.tution was as well conducted as in those days it could be. So much was this the case that Mr. Rice stated before the Committee of the House of Commons in 1817, that it was the best managed he had ever seen or heard of, realizing, he added, all the advantages of the York Retreat. He, however, protested against the system under which it, like other asylums, was conducted as radically wrong; its success was a success of circ.u.mstances, almost of accident.

This Prison Act was at this date the only law which regulated Irish asylums, the only statute by which they could be carried on. All, in fact, depended upon the humanity, skill, and conscientiousness of the superintendent.[254] I believe, as a matter of fact, Cork was the only county which made use of it.

So far back as 1804, a Select Committee of the House of Commons was appointed to consider the provision for the insane in Ireland, and reported that the provisions of the Act 27 Geo. III., c. 39, empowering grand juries to present the sums necessary for support of a ward for idiots and lunatics, have not been complied with, and that the demand for admission into houses of industry greatly exceeds the accommodation or funds appointed for their support, and that it does not appear that any inst.i.tution, maintained in any degree at the public expense, exists in any other part of Ireland than Dublin, Cork, Waterford, and Limerick, for their reception. The Committee resolved that the attention and care necessary for the effectual relief of these distressed objects cannot be efficaciously extended to them whilst they are connected with inst.i.tutions of a very different nature, and that the establishment of four asylums for idiots and lunatics, one in each of the provinces of Ireland, would be a measure highly beneficial.

The result of this Report was that on the 21st of March, 1805, leave was given to bring in a Bill for establishing in Ireland four provincial asylums, appropriated exclusively to lunatics and idiots--thus providing for a thousand patients. This excellent Bill shared the fate of so many Bills for English lunatics, and did not become law.

It is worthy of remark that in the Report of the Select Committee (1815) to inquire into the state of English mad-houses, it is stated that the necessity of making some further provision for insane persons appeared to be more urgent in Ireland than in England, as, "with the exception of two public establishments and some private houses, there are no places appropriated separately for the insane."

In 1810 the Government urged upon the House of Commons the necessity of affording some relief to the neglected condition of the insane poor in Ireland, the result being that grants were made for building an asylum in Dublin, called "The Richmond Lunatic Asylum" (55 Geo. III., c. 107).

It was opened in 1815, and proved a great boon to the district. Two years afterwards, Mr. John Leslie Foster, one of the governors, in evidence before the Select Committee of the House of Commons on the lunatic poor in Ireland, referred to the humane system of treatment introduced at the York Retreat, "the good effects of which are ill.u.s.trated in a publication[255] of Mr. Tuke," and said, "This system appearing to the governors of the Richmond Lunatic Asylum to be founded in good sense, they determined on trying the experiment in their new inst.i.tution, and beg to add, as a proof of this, that there is not in the Richmond Asylum, to the best of my belief, a chain, a fetter, or a handcuff. I do not believe there is one patient out of twenty confined to his cell, and that of those who are confined to their cells, in the great number it is owing to derangement of their bodily health rather than to the violence of mania." He speaks of the superintendent as the "moral governor," whose particular business it is to attend to the comforts of the patients, to remove from them causes of irritation, to regulate the degrees of restraint, and to provide occupation for the convalescent.

The Richmond Asylum did not serve, as was hoped and expected at that time, to supply accommodation for a large portion of Ireland. To the amazement of those who had induced Parliament to make what they deemed so ample a provision, it was soon found that not only was the asylum full to overflowing, but the house of industry was soon as full as before, and that as to finding accommodation for those at a distance, it was altogether out of the question. At first, sanguine hopes were raised by the large number of recent cases discharged cured, and the common but fallacious inference was drawn that, had all the chronic cases in the houses of industry or at large been fortunate enough to be placed under asylum treatment in the first stage of their malady, they would also have been cured in like proportion. Unfortunately, the acc.u.mulation of incurables, even in asylums, opened the eyes of many to the fallacy of this inference.[256] Other asylums were, therefore, it was seen, required.

"Your Committee," observe the Select Committee of the House of Commons of 1817,[257] "beg leave to call the attention of the House to the detailed opinion expressed by the governors of the Richmond Asylum, that the only mode of effectual relief will be found in the formation of district asylums, exclusively appropriated to the reception of the insane." It appeared that, with the exception of the Dublin inst.i.tution, that at Cork, and one at Tipperary, there was not provision made for more than one hundred lunatics throughout the whole of Ireland. The Committee proposed that, in addition to the asylums in Dublin and Cork, there should be built four or five additional asylums, capable of containing a hundred and twenty to a hundred and fifty lunatics each.

They recommended that powers should be given to the Government to divide Ireland into districts, and that the expense should be borne by the counties included within the several districts. The consequence of this Report was the Act 57 Geo. III., c. 136,[258] afterwards repealed, but re-enacted with amendments by the 1 and 2 Geo. IV., c. 33; 6 Geo. IV., c. 54; and 7 Geo. IV., c. 14. These statutes enacted that the cost of asylums, advanced from the Consolidated Fund, was to be ultimately paid by the counties; that all the princ.i.p.al officers were to be appointed by the Lord Lieutenant, the general superintendence being vested in a Board of Commissioners, named by the Government but acting gratuitously; that the asylums should be brought under the annual review of the inspectors-general of prisons by the 7 Geo. V., c. 74, and should be noticed in the reports submitted annually to Parliament. The inspectors-general had power to enter private as well as public asylums.

The first really effective Act of Parliament, directing the erection of asylums for the insane poor in Ireland, was, then, that which we have mentioned as pa.s.sed in the year 1821, and formed the 1 and 2 Geo. IV., c. 33.[259] The Lord Lieutenant (not the justices, as in England) was authorized to establish any number of these asylums (to accommodate not less than one hundred and not more than one hundred and fifty paupers) when and where it seemed expedient, while for this purpose eight Commissioners were nominated to superintend the execution of the work.

Some years elapsed before asylums were built. Then nine, capable of accommodating nine hundred and eighty patients, were commenced at Armagh, Ballinasloe, Carlow, Clonmel, Limerick, Londonderry, Maryborough, and Waterford, for their respective districts, some being composed of no less than five counties. It is stated that such was the dislike of the humbler cla.s.ses to the name of mad-houses, that they were not fully occupied until 1835. The eight Commissioners retired, and the Board of Works took their duties upon them, and acted until 1861, when the 18 and 19 Vict., c. 109, enacted that two members of the Board, including the chairman, and the two Inspectors of the insane, should be appointed Commissioners of general control and correspondence.[260]

The grand juries of a.s.sizes were to present such sums as should be required for asylums. In 1826 an Act was pa.s.sed (7 Geo. IV., c. 74) which continued and extended the former provisions, viz. that the inspectors-general of prisons should be inspectors of lunatic asylums in Ireland; that no person should keep a house for the reception of insane persons unless licensed; that justices of the peace might grant them; that no person should be received into or retained in a licensed or unlicensed house without an order and the certificate of a medical man not interested in such houses; that licensed houses not kept by a physician should be visited by a medical man once a fortnight; that the inspector must visit such houses once in six months, and may make special visits, and after two such visits may liberate a patient; and that the inspectors should make an annual report to the Lord Lieutenant and Lord Chancellor. This Act did not apply to public asylums. It was to commence and take effect in the county and city of Dublin, and to remain in force till August 1, 1845. It may be well to note here that in 1826 "the numbers of lunatics and idiots in every public asylum in Dublin, and in every asylum in Ireland,"[261] erected under the provisions of the Act 1 and 2 Geo. IV., c. 33, and 55 Geo. III., c. 107, were only as follows:--

CITY OF DUBLIN.

Under what Act Lunatics. maintained.

Richmond Lunatic Asylum 252 55 Geo. III., c. 107.

House of Industry Lunatic Asylum 461 --- 713

ERECTED UNDER 1 AND 2 GEO. IV., c. 33.

Lunatics. Idiots.

District Lunatic Asylum, Armagh 52 6

The following table shows, at a glance, the number of lunatic and idiots confined in 1826, and maintained in the public inst.i.tutions, supported wholly or in part by grand jury presentments in Ireland.

----------------------------+---------+-------+--------------------------- | | | Under what Act Location. |Lunatics.|Idiots.| maintained.

----------------------------+---------+-------+--------------------------- Antrim County Jail | 1 | 2 |Prison Acts.

House of Correction | 2 | 1 | Ditto.

Carlow County Jail | 3 | -- | Ditto.

Cavan County Jail | 7 | 1 | Ditto.

Cork County and City | | | Lunatic Asylum | 234 | 38 |27 Geo. III., c. 39, s. 8.

Clare Lunatic Asylum | 12 | 1 | Ditto.

Donegal Lunatic Asylum | 12 | 6 | Ditto.

Down County Jail | 10 | 3 |Prison Acts.

Fermanagh County Jail | 1 | -- | Ditto.

Kildare County Jail | 1 | -- | Ditto.

Kilkenny County Jail | 2 | -- | Ditto.

City Jail | 7 | 1 | Ditto.

House of Correction| 8 | -- |Prison Acts.

King's County Jail | 4 | -- | Ditto.

Leitrim County Jail | 3 | 1 | Ditto.

Limerick County Jail | 1 | -- | Ditto.

House of Industry | 59 | 3 |46 Geo. III., c. 95.

Londonderry County Infirmary| 13 | 12 |45 Geo. III., c. 3, s. 1.

Longford County Jail | | 2 | Mayo Bridewell | 17 | 5 | Meath County Jail | 1 | -- |Prison Acts.

Queen's County Jail | 1 | -- |26 Geo. III., c. 27, s. 4 Roscommon County Jail | 20 | 2 |Prison Acts.

Sligo County Jail | 5 | 4 | Ditto.

Tipperary House of Industry | 26 | 13 |46 Geo. III., c. 95, s. 2.

Tyrone County Jail | -- | 10 |Prison Acts.

Waterford County and City | | | House of Correction | 49 | 44 |46 Geo. III., c. 95, s. 2 Wexford House of Industry | 27 | 11 | +---------+-------+ | 546 | 160 | ----------------------------+---------+-------+--------------------------