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ceding the last, to which, dictated in a great measure by the College of Physicians, we have found an allusion in the present Report. From this error we perceive indications, that the present meritorious Committee are pretty effectually weaned; we have, therefore, but little apprehension that it will disgrace a new act of parliament.
There are strong reasons against trusting this inspection to any confined body, with an esprit du corps ; but stronger reasons against the College of Physicians than almost any other that can be named. The physicians are of all men those of whom the interests, in this case, are most likely to stand in opposition to their duty. The quantity of medical practice which is required in madhouses, and the quantity of medical fees which is extracted out of them, are both very great. The favour of the keepers of these houses is to a physician, therefore, a matter of great importance; and an understanding between them and the visiting physicians is a natural result.
Besides, the constitution of the College of Physicians forms another decisive objection. It excludes all the physicians bred at the most celebrated medical school in the world, -the University of Edinburgh; and a very large proportion of the most eminent of the medical practitioners in London.
The error of resorting to physicians for the inspection of madhouses seems to have arisen from the belief, that it was by medicine that the mental disease was to be cured. Experience seems to have ascertained that medicine, unless as in the case of other individuals, for their bodily complaints, is almost or altogether unavailing with regard to the insane; and that the physician, as such, has no peculiar qualification for judging of the management of a madhouse.
Against another error, into which, under the direction of the College of Physicians, the framers of the bill to which we have twice alluded were drawn, that of exempting from inspection the public madhouses, the legislature are now, by the evidence this Committee has laid before them, pretty effectually secured. So far from not standing in need of inspection, of all the places for the reception of the insane, the public establishments are those which stand in need of it the most.
Besides the misconduct of those who have the management of houses for the reception of the insane, there are other causes of the undue suffering borne by this helpless portion of the race, for which the legislature should perform all that is possible towards providing a remedy.
In the first place, there is a considerable proportion of persons bereft of their reason, who are not placed in any situation which is fit for them. Some are allowed to wander about, at their own
discretion. In Ireland this is the case with almost all, excepting the very dangerous, and the rich. Others are confined in parish work-houses; and some in gaols. The sufferings of all these classes are in general extreme. And in many cases the annoyance is immense which they create to other people. It is undoubtedly of the last importance, that no insane person should either be abandoned to his own wayward inclinations, or be confined in such exceptionable places as a workhouse or a prison.
Something has recently been done by the legislature to compel parishes, where a county asylum for the insane exists, to send thither their deranged paupers. If a law were made to compel parishes to send to some licensed madhouse the whole of their pauper insane, it would accelerate prodigiously the building of county asylums. In one respect public establishments of this description would be desirable. The buildings might be skilfully adapted to the purpose for which they are designed: whereas the houses which have been hitherto employed by the owners of private establishments, have been built for other purposes, and are never well adapted to the confinement of the insane. What constitutes the excellence of a building for this purpose is the facilities which it affords to inspection. We are extremely happy to perceive that the Committee have annexed to their Report the plan of a building for the confinement of the insane, upon the panopticon principle--a building so contrived, that from a central spot every part of it is visible, and, as often as necessary, every inmate whom it contains. Upon the virtues of this admirable contrivance we have at present no opportunity to dilate. It is sufficiently evident what powers it yields to the stated master or superintendent, to check every instance of malversation on the part of servants; and what powers it affords to inspectors of all descriptions to detect abuses on the part of those to whom the government of the house belongs. Without such a contrivance as this, no vigilance on the part of the governing individuals can prevent innumerable instances of negligence, and other kinds of misconduct, in their subservient agents.
Mr. Samuel Tuke, in his Pamphlet entitled “ Practical Hints," &c. disapproves, we see, of the panopticon principle. We are not much surprised at this; for though he has well described the Retreat at York, and done a great service by holding up the principle of mildness and beneficence, as the grand principle of management in the cure of the insane; he is evidently not a man of great force, or great reach of mind. Besides, he has a plan of his own; and it is difficult for men of stronger minds than Mr. Tuke to like a better plan, when it would supersede another by which their fancy is already engrossed.
His reason, however, for disapproving the panopticon principle in the construction of madhouses is curious. It would not be agreeable to the servants to be always seen. To bad servants assuredly it would not; and for that very reason it ought to be so much the more agreeable to those to whom the feelings of the patients are a matter of regard. To really good servants the being seen is not a punishment, but a reward; because they are then assured that their merits are not concealed, and that they shall receive the applause which they deserve. Besides, it would be easy to afford to the servants in a panopticon madhouse any degree whatsoever of privacy, which their comfort might seem to require; at the same time that the master would enjoy the inestimable advantage of placing them all under his inspection, as often as he chose.
Whenever the houses of private owners are built upon the best principle, there is in them a security for good management, a security which never can be obtained in public establishments, the power of competition, on which too great a value can hardly ever be set.
There is another important cause of undue suffering to the insane, a cause of which the inquiries of the Committee have set abundant evidence before them; we mean, the absence of sufficient pay to afford the accommodations which well-being requires. We have seen that in the houses of private owners at least, this is almost the only cause of undue suffering; for it is attested by the visiting commissioners, that more is done by them for their money than the commissioners can easily see how it is possible to do. Such are the beneficial effects of competition! This, however, is a cause of suffering, which extends to the most numerous portion by far of this pitiable class of our fellow creatures. It deserves the most serious consideration of the legislature. Whether they will deem it expedient to compel parishes both to send their in sane paupers to a madhouse, and to afford with them a sufficient compensation for comfortable accommodations, we much doubt. But there is one thing which, at any rate, they may easily do; and which we conjure them, by every thing dear to the human mind, to do; and that is, if they perform nothing to better the condition of these sufferers, to do nothing to make it worse. They are already deprived of accommodations necessary to well-being, for want of money sufficient to pay for them. Do not, then, tax these unhappy beings; tearing from them a fresh portion of their inadequate accommodations ! It is absurd to regard a tax upon a madhouse as a tax upon the master. Think of an act of parliament to tax madness !--and pauper madness, maintained by charity !-a tax upon pauperism !-a tax upon charity! And yet not only does the existing act impose taxes upon madhouses (and one of the principal objects of the visiting physicians is to act as surveyors for the levying of this tax, which forms a fund chiefly at their disposal), but, under their direction, according to the bill to which we have already so often alluded, brought into parliament in the session which preceded the last, a still more oppressive tax was about to be imposed. It is, therefore, of urgent importance to warn the legislature against this egregious solecism in legislation.
It has been ascertained by the evidence before the Committee, that an evil exists of great magnitude in the vices of relatives, who, from avarice and other motives, without the excuse of poverty, withhold from the insane the accommodations which they require. It is not easy to discover any unobjectionable remedy to this evil, except one, and that is, the sanative power of publicity. Let in light upon the circumstances of madhouses. Render it impossible for relatives to prevent such misconduct from being made known to the world, and you may rest assured that it will very rarely take place. Competition and publicity; these are the grand rectifying principles throughout the business of society. Where these are enabled to act with unimpeded force, the course of human affairs is easily kept in the best possible order.
There are two other things which, though not exactly in their place, we cannot forbear even yet to mention.
The first is, that all servants and other officers in houses of every description for the insane, should be effectually interdicted from taking fees, or other gratuities, in any shape, on account of the patients. The servants should be paid by their masters, and have no other pay. The mischief which is occasioned by fees paid to the instruments of confinement in this country, in gaols and other places, is prodigious. The legislature, at the instance of a member of the madhouse committee, has at last opened its eyes to the enormity of gaol fees, and has taken a large stride towards their abolition. We hope it will perceive the same necessity for abolishing what partakes so much of the nature of gaol fees, gratuities to the servants in madhouses. If a keeper hopes to be paid for good behaviour to a patient, it is a premium for bad behaviour till the payment is extorted. It is an infallible cause of neglect and cruelty to those who are already the greatest sufferers, those who have nothing to pay. Besides, the habit of taking fees has a bad effect upon the general character: it produces a greedy, grasping, unsatisfied, mercenary, selfish, unfeeling disposition.
The next of the two things which we have still a desire to point out for attention, is the source of evil which is necessarily opened in permitting any of the leading officers of the great charitable institutions for the insane, to set up private madhouses of their own, or to become sharers in the emoluments of the madhouses of any other person. A temptation is thus created to convert the public madhouse into a recruiting house for the private one. Who sees not to what abuses this paves the way? The doctors Monro and Sutherland, the two physicians of Bethlem and St. Luke's, in the metropolis, have each of them private madhouses of their own; and Mr. Dunstan, the master of St. Luke's has a connection with Mr. Warburton, the greatest owner of private madhouses in the kingdom. All this does require legislative interference.