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of the Act in its present form, &c.— They deem it unnecessary to detain your Lordship with a detail of inaccuracies of verbal expressions in the Act, although such are numerous, and productive of much inconvenience in the execution of it.--That various defects in the provisions of the Act generally do exist, appears from the minutes of the commissioners--the necessity for their frequent recourse to legal advice and the publications of the proceedings of courts of law. Your Lordship’s recent information in the county of Wilts is one proof, among many, that similar defects are felt in the more distant counties of England.—That the verbal expression of those provisions is not in all instances clearly made, may be illustrated by an opinion of the late Lord Kenyon in 1782, which begins thus ;_' I cannot give a receipt to provide for the inaccuracies of an ill-penned law.'
In endeavouring to form an estimate of the information which the labours of this Committee have furnished to the legislature, the imperfections of the existing law must be regarded as the article by far the most important. It is true the public had not, by the benefit of the press, been left without intelligence on the subject so long. The more remarkable deficiencies of the existing provisions were well pointed out some years ago, in a valuable little tract by Mr. Parkinson of Hoxton. But it is certain that the evils left without a remedy by the law had not till now been pressed upon the attention of the legislature with that publicity and force which, on certain subjects, appear to be necessary to put. it in action. This being accomplished, we may reasonably hope that the proper consequences will ensue.
In one respect the information which the Committee have collected is a source of high and immediate satisfaction. In the greater part of the houses, or establishments, appropriated for the custody of the insane, the treatment which they have experienced is fully proved to have been better, and that really to a singular degree, than under the remarkable imperfection of the provisions for securing goodness of treatment, could, a priori, have been expected.
The most enormous, by far, of the instances of abuse and misconduct have been found, not in the private, but the public establishments, or hospitals for the insane.
On the state of the private houses, Mr. Wakefield, a gentleman whose active philanthropy has led him to a close inspection of most of the receptacles in England for the insane, appears, in the Committee's minutes of evidence, to have spoken as follows: “ In closing the account which I have given of houses of this sort, I beg to say, that the general feeling which I have upon the subject, is-that there is great merit due to many individuals, for the humanity which they exercise to the unfortunate persons under their care; and that I should be very much hurt, if any observation, which I made, in any place, should tend to injure the character or the business of a keeper of a madhouse.”
With respect to all classes of patients, but with respect to the poorest in particular, a judgment can be formed of the conduct of the owner of the asylum, only upon a comparison of the accommodation which he affords with the pay which he receives. This material point, the authors of the questions put to the witnesses appear sometimes to have been in some danger of overlooking. If this error in any degree taints the legislative enactment; if it requires the keepers of houses for the insane to do more for the poor than what the pay allowed for them will afford, the effect will be, that these keepers must refuse to admit the poor, who, in that case, must either be allowed to wander dangerously and wretchedly about the country, or be consigned to the inhumane treatment which they have hitherto experienced in workhouses and in gaols.
On some questions, which seemed to imply a demand for more accommodations to the poorer class of patients than the money paid for them would allow, Dr. Powell, as Secretary to the Commissioners, observed; “ When we are told a man has this sort of accommodation, we may say, and do say, it is bad, it is not the accommodation he ought to have: but when the keeper tells us, I am allowed but ten shillings a week for every thing I do for this man, we must be satisfied. They have told us, they cannot afford to do more: and I have rather wondered they have done so much.”—This is spoken generally; it is given as the average character of the houses visited by the Committee of the College of Physicians; and, most undoubtedly, it is high praise.
Dr. Latham, one of the Commissioners, or visiting physicians, says, “ It always struck us, that there were more patients confined in a given space than there ought to be. And the observation which the keepers made in reply, is this, That really the sum which they receive is so very trilling, that they cannot afford better accommodation.-One may think the paupers rather more crowded than is right; but the sum paid for this accommodation is, in truth, so very trifling, that you cannot expect the same accommodation for the paupers as for those that pay better. I consider that all the madhouses under the present regime are more calculated for places of confinement than places of cure.”—To the question, « Are you of opinion, if more attention were paid to the cure of patients, that it might not in some instances succeed ?" He answered, “ My opinion is, it certainly would. In answering that question I am far from imputing blame to the keepers of the madhouses. I rather impute blame to the relatives of the unfortunate people themselves; who shut them up there, in order that they may be out of the way. In nine cases out of ten, that is the fact; they get them away from their family into safe keeping. I have no hesitation in saying, that, in nine cases out of ten, there is very little attention paid on the part of their relations to those that are confined. And, if they were placed in proper situations, where their minds could be attended to, and where they could have a little more bodily exercise, they might more frequently be relieved."
This fact, of the little regard which is paid to the feelings of insane relatives, in the present state of the civilization and morality of our own country-a fact extending to so great a proportion as nine in ten, is worthy of the attention both of the statesman and the philosopher. A gentleman, who gave evidence before the Committee with much appearance of intelligence and humanity, Mr. Thomas Bakewell, the keeper of a house for the reception of insane persons at Spring Vale, in Staffordshire, confirms the existence of the fact by some striking particulars : “ I am convinced that a lady of fashion and fortune withheld the means of cure from an elder sister, in consequence of expense; though that sister's own income was more than sufficient to procure the best means the country afforded. She is now kept at an obscure place, at a very small expense, and under very improper treatment, as I conceive.— I knew an instance of a person of very respectable family, who became insane soon after giving birth to a son. Such cases are generally supposed easy of recovery, as merely a temporary irritation. She was packed up into a back garret, where she was coarsely fed, and coarsely clothed, while the husband enjoyed every luxury that money could purchase, in the house below; till that son became of age and had her released. I know another family, who have kept a brother for seven years in confinement, without any means of recovery, for the sake, as I fully believe, of his property, though they are all in opulent circumstances. I have known an instance of a son very evidently taking measures to prevent the recovery of his father; and have known several instances of people in opulence taking measures to prevent the recovery of their own brothers. I have seen evident proofs of vexation and disappointment in a wife, on the unexpected recovery of her" husband; the same in a husband, on the unexpected recovery of his wife, and in a mother on the unexpected recovery of a son. I have now in the house a woman, who has been confined in a dark
garret, without the comforts of a fire, for the best part of twenty years: her husband confessed to me that he had not seen her for many years: the servant told me, that nobody saw her
but herself; and she only to take her food, and take away the necessaries: the woman was perfectly inoffensive.”
If the Committee had put questions to ascertain a fact, of which they seem not to have been aware; to ascertain, how very large a proportion of the patients in St. Luke's, a public charity, an asylum maintained by subscription, intended solely for the reception of people too poor to pay for themselves, and where all are alike treated as paupers, are not poor, but the relatives of persons in comparative affluence, they would have met with a most remarkable proof, at once, of the shameless disposition to prey upon every description of public property, which distinguishes our age and country, and of the gross insensibility which, on the slightest temptations, one set of relatives display to the
feelings of another.
The tendency to good treament of the helpless people under their care, which is found to distinguish generally the keepers of private madhouses, is secured by an important circumstance, which forms a characteristic difference between their situation, and that of the public institutions maintained by charity. The prosperity of keepers of private madhouses depends upon the satisfaction which they give; and the satisfaction which they give must in general be proportionate to the goodness of their conduct. They, in truth, are subject to the inspection of the public, upon a pretty extensive scale; for not only the relatives of the patients are incessantly visiting, some of whom are really and intensely interested in the welfare of the patients to whom they belong; but those of the patients themselves who are there for a season, and go away cured, are most efficient witnesses and reporters of the conduct which is pursued. In the case of the keepers of private madhouses, the public have all the benefit of competition, the effects of which are so remarkable, that whenever it is enabled fully and freely to operate, few evils arising from abuse exist. In the case of this class of the houses for the insane, the chief danger against which the act would have to provide, would be that of collusion between the keeper and the relatives of the patients, when the intentions of those relatives happen not to be good. Now, in this case, the difficulty is not great; for the principal dangers of abuse appear to be two only--that persons may be confined who ought not to be; secondly, that they may be confined at an expense, at which comforts, or the more expensive means of cure cannot be afforded.
The case of the public and charitable asylums is essentially and strikingly different. The interests of the managers in these establishments have little, if any, dependence upon the goodness of their conduct; as their emoluments are not likely to be greater, when their conduct is good, than when it is bad, when the persons under their care are comfortable, than when they are lamentably otherwise. One thing which they may be expected to do pretty universally is—to consult their own ease; even where they have not any grosser motives to misconduct. But this motive is in very many cases, and in this especially, capable of producing almost all the effects which result from the most wicked motives. It produces neglect with all its fatal consequences; and it is the great cause of cruelty, even in its most active and abominable shapes. As to neglect, in what manner that proceeds from the love of ease, it requires no illustration to make appear. But in what manner is it that cruelty to a madman is chiefly shown? Is it not in the severity of his confinement? in the chains and dungeons in which he is held ? Now the temptation to unnecessary restraint, upon a man who, requiring to be looked after when he has a certain degree of liberty, needs no looking after where he is under a certain degree of confinement,--the unceasing, the powerful temptation to keep him under that degree of confinement is, the love of ease. To constancy of undue confinement add, what is also derived from the love of ease, constancy of neglect when under that confinement, and you have the source of almost all the atrocities, to which the management of madhouses is liable. Even to blows, when that enormity is committed, the keeper is more frequently provoked by some invasion of his case, than by all other causes taken together.
To this motive, then, which appears—when the affair is seen to the bottom-to be the grand source of misconduct in madhouses, the interest of the owners, acting under the incitement of competition, affords in the case of the private houses a great and probably the best possible antidote. In the case of the great public institutions, this antidote is altogether wanting; and there is hardly any thing whatsoever to supply its place.
If we look to pecuniary corruption, which is the only other motive, of which in producing misconduct in madhouses the influence will be supposed to be great, no place is left for it in the case of private houses; the profits of which, competition is quite sure to reduce to their lowest possible terms ;-or, which is the same thing in other words, it is quite competent to ensure to the patients the full amount of all the accommodations which the pay they bring with them can afford. That, of public charities on the other hand, the constitution is but too apt to afford ample scope for pecuniary corruption, our countrymen have extensive experience. And in the charitable institutions for the reception of the insane, we shall not find this very feebly at work among