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 associations I was interested in visiting this asylum some years ago, but there is nothing otherwise of special interest in the institution. 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 accumulated fund in bank of L20,000, and situated in the metropolis, is yet in many respects one of the most defective institutions 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 passages 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 naively 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 institution 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 circumstances, 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 institution, 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 institutions 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 illustrated 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 institution, 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 accumulation 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 institution, 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 principal 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 passed 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 classes 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 assizes were to present such sums as should be required for asylums. In 1826 an Act was passed (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 institutions, 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 + - -

The accumulation of incurables pressed heavily upon the Richmond Asylum, where, as I have said, the most sanguine hopes were at first raised as to the cure of the great majority of the patients. The governor thus wrote in 1827 to the Right Hon. W. Lamb:—

"In reference to the paragraph in Mr. Spring Rice's letter [to Mr. Lamb] which suggests the inquiry how far the asylums in Ireland have proved effectual, I am directed to state that a very considerable accumulation of incurable lunatics has taken place in this asylum within the last few years, and for the reception of whom the House of Industry is inadequate. In consequence the Richmond Lunatic Asylum, which was established for the relief of curable lunatics, is at present occupied by one hundred and seventeen patients, whom the medical officer deems incurable. I am likewise directed to state that, notwithstanding the relief afforded by two provincial asylums now open for the reception of patients, viz. Limerick and Armagh, the number of applicants for admission to this asylum has not diminished."[262]

One is amused, even while wading through these dry Parliamentary returns on a painful subject, by meeting with such a passage as the following, written by Dr. Thomas Carey Osborne in his report of the Cork Asylum. Speaking of the symptoms of a young maniac, cured by electricity, he says, "When in the yard, he would look intently on the sun if permitted, until the albuginea became scarlet, and the tears flowed down the cheeks, unconscious of inconvenience." His report is very pedantic, full of quotations from the Scriptures, Shakespeare, and other poets. His style is shown in what he says of Dr. Hallaran, his excellent predecessor in office at the Cork Asylum for more than thirty years, when he informs his reader that the "infuriated maniac and the almost senseless idiot expressed sorrow for his decease and deplored him as a friend."

One case reported by the doctor is worth recording. He had been some years under treatment, and his insanity was attributed to the loss of a hooker off the western coast, his only property, which he had purchased after much toil as a fisherman. His character was melancholic, and he conducted himself with propriety. He was appointed door-keeper, and filled his situation with such kindness and good humour that he was generally esteemed. He had the whimsical illusion of having been introduced into the world in the form of a salmon, and caught by some fisherman off Kinsale. He was found one morning hanging by a strip of his blanket to an old mop nail, which he had fixed between the partition boards of his cell, having taken the precaution of laying his mattress under him to prevent noise in case of his falling.[263]

In 1827 the total number of persons in confinement was reported to be:—

- - - - Location. Lunatics. Idiots. Totals. - - - - Richmond Asylum 168 112 280 Lunatic ward of House of Industry 442 442 Private asylums (4) near Dublin 101 101 City and County Asylum, Cork 138 64 202 Asylum at Waterford 103 103 " Armagh 64 64 Jail at Lifford 18 18 Private house, Downpatrick 17 17 County Infirmary, Derry 12 12 Old Jail, Roscommon 19 19 Asylum, Ennis 14 14 " Kilkenny 14 14 House of Industry, Tipperary 32 32 " Waterford 57 48 105 " Wexford 37 37 Asylum, Limerick 74 74 Dean Swift's Hospital 50 (about) 50 - - Total 1360 224 1584 - - -

Sir Andrew Halliday, aware that these numbers bore no proportion to the actual number of insane and idiots in Ireland, reckoned the number at three thousand.

In 1830 the Richmond Asylum, Dublin, was converted into a District Lunatic Asylum for the city of Dublin by the Act 11 Geo. IV., c. 22.[264]

Passing on to 1842, the Solicitor-General for Ireland in that year introduced a "Bill for amending the Law relating to Private Lunatic Asylums in Ireland," which became law August 12, 1842. It is not necessary, however, to give its details in this place, and I shall proceed to notice the important Report of the Committee of the House of Lords, with minutes of evidence, which was issued in 1843.[265] A table is given of the district asylums and the Cork Asylum, from which it appears that at that period the number amounted to ten, viz. Armagh, Belfast, Carlow, Clonmel, Connaught, Limerick, Londonderry, Maryborough, Richmond, and Waterford.

These ten district asylums contained upwards of 2000 patients, although built to contain only 1220. As 688 were found to be incurable, the Committee reiterated the warning given at the Committee of 1817, that if fresh provision were not made, the institutions would shortly become "asylums for mad people, and not hospitals for the cure of insanity." As to the treatment, it is reported that "the system of management adopted in the district asylums appears to have been, with the exception of one case of gross misconduct and abuse, very satisfactory.... A humane and gentle system of treatment has been generally adopted, the cases requiring restraint and coercion not exceeding two per cent. on the whole. The system is one which, if applied exclusively to the cure of the malady, and if the asylums were relieved from the pressure produced by the increasing number of incurables, appears to the Committee in its essential points to be deserving of confidence and of approval; but, unless so relieved by some alteration of the present law and of the present practice, the admission of new cases must necessarily be limited, and may ultimately be restricted within very narrow bounds indeed. The necessity of some change in this respect is admitted by all the witnesses, as well as proved by the documentary evidence before the Committee. The number of persons refused admission for want of room has in the present year amounted to one hundred and fifty-two."

At this period, beside the district asylums, there were Swift's Hospital, and other establishments provided for the custody of pauper lunatics, supported by local taxation, and connected more or less with the old houses of industry. At Kilkenny, Lifford, Limerick, Island Bridge, and in Dublin (the House of Industry) local asylums existed, characterized as "miserable and most inadequate places of confinement," and were under the authority of the grand juries, the funds being raised by presentment or county rate. "The description given of these latter most wretched establishments not only proves the necessity of discontinuing them as speedily as accommodation of a different kind can be provided, but also exemplifies the utter hopelessness, or rather the total impossibility, of providing for the due treatment of insanity in small local asylums. No adequate provision is made, or is likely to be made in such establishments, for the medical or moral treatment of the unfortunate patients. Hence the necessity of a coercive and severe system of treatment. The chances of recovery, if not altogether extinguished, are at least reduced to their very lowest term.... Whilst a general improvement has taken place in the management of the insane throughout other establishments of Ireland, these local asylums, if indeed they deserve such a name, have continued in the most wretched state." Evidence of the strongest kind is given to impress upon Parliament the necessity of an immediate discontinuance of this part of the system.

It would carry us too far to enter at length into this evidence. One or two facts must suffice as examples of the rest. At Wexford, where, in the cells for lunatics, there were two patients in restraint, one of whom was chained to a wall, Dr. White, the Inspector of Prisons, thus described the latter: "When I went to his cell with the keeper and the medical officer, I asked to go in. He was naked, with a parcel of loose straw about him. He darted forward at me, and were it not that he was checked by a chain round his leg, and was fastened by a hook to the wall, he would have caught hold of me, and probably used violence. I asked how it was possible they could allow a man to remain in such a state; they said they were obliged to do so, as the funds were so limited that they had not money to buy clothes for him, and that if they had clothes they would have let him out.... I went to another cell, and though the individual was not chained, he was nearly in as bad circumstances as the other. Altogether these two cases were the most frightful I ever witnessed. I could not describe the horror which seized me when I saw them. I went into a room, a very gloomy-looking room, very low, and in this room there was a fireplace, which was guarded by one of those large grate-protectors that are very high up; I looked around and heard some one moaning, and on the top of this screen I saw two unfortunate lunatics stretched out; they were trying to warm themselves through the bars of the grating; the room was so dark that I could not see them at first, and here they were allowed to creep about and to lie in this kind of unprotected manner." In reply to the question, "Was there any moral superintendence?" Dr. White said, "There was both a male and female keeper, but they appeared to me totally unfit for the discharge of their duties."

The number of lunatics confined in jails was found by the inquiry of 1843 to have increased, partly in consequence of the Act 1 and 2 Vict., c. 27, for the more effectual provision for the prevention of offences by insane persons. Two justices were authorized, acting with the advice of a medical man, to commit to jail any person apprehended under circumstances denoting derangement of mind and a purpose of committing crime. A subsequent clause authorized the Lord Lieutenant to transfer such person, as well as convicts, to a lunatic asylum. No steps had been taken to ascertain whether, on the one hand, the jails afforded any accommodation whatever for such lunatics, or whether, on the other, convict lunatics could be properly received into the district asylums. The statute operated widely. Previous to it, in 1837, there had been only thirty-seven lunatics in jails, while by the year 1840 they had augmented to one hundred and ten, of whom eighty-one were maniacs, seventeen were idiots, and twelve were epileptics; while by the 1st of January, 1843, the number amounted to two hundred and fourteen. Of these only forty had been convicted of any criminal offence, showing that the application of the Act had gone much beyond the intention of its framers. Thus it was that "the numbers crowding the county jails were truly distressing, and were made the subject of universal complaint by the local authorities."[266]

The Lords' Committee, of course, insisted on the necessity of discontinuing the committal of lunatics to jails and bridewells, and amending the Act 1 Vict., c. 27, which had led to such serious abuses; the inexpediency of appropriating the union workhouses or houses of industry to the custody or treatment of the insane; the necessity of providing one central establishment for criminal lunatics, under the immediate control and direction of the Government of Ireland, to be supported from the same funds and under the system adopted in respect to criminal lunatics in England; the necessity of increasing the accommodation for pauper lunatics in Ireland, and of providing for the cases of epilepsy, idiocy, and chronic disease by an increased number of the district asylums, by enlargement of these asylums, or by the erection of separate establishments, specially appropriated for these classes of patients.[267]

At this Committee Dr. Conolly gave the results of his non-restraint experience at Hanwell since September, 1839.

The following tabular statement, delivered in at the Committee by the Rev. E. M. Clarke, presents a valuable picture of the state of lunacy in Ireland on the 1st of January, 1843:—

1. Population of Ireland in 1841 8,175,238 2. Total insane confined January 1, 1843 3,529 3. Total curable, comprised in No. 2 1,055 4. Total incurable, ditto 2,474 5. Total curable (not including private asylums) confined January 1, 1843 848 6. Number for which the district asylums were first built 1,220 7. Number confined in district asylums, January 1, 1843 2,061 8. Confined in other than district asylums, January 1, 1843 1,468 9. Number confined in thirty-two jails, January 1, 1843 211 10. Number confined in workhouses, March 31, 1843 557 11. Number of curable cases confined in thirty-two jails, January 1, 1843 78 12. Number of curable cases in district asylums, January 1, 1843 698 13. Number of incurable cases in district asylums, January 1, 1843 1,368

A correspondence took place between the Irish Government and the managers of the district asylums on the subject of the Report of the House of Lords' Committee on the state of the lunatic poor, commencing November, 1843, by a letter from Lord Elliott to the superintendents, asking for their opinion. These unanimously endorsed the conclusions arrived at by the Committee, and, in some instances entering into the mode of inspection of asylums by the two inspectors-general of prisons at their half-yearly visitation of gaols, asserted that "it must from a variety of causes be of no use whatever."

The Irish Government also opened a correspondence in 1844 with the grand juries of each county, and their opinion was asked as to the eligibility of the sites proposed for new asylums. As the Acts of Parliament limited the number of patients in any single asylum, it was sought to remove this obstacle by an Act in 1845, 8 and 9 Vict., c. 107. This Act also provided for the erection of a central asylum for criminal lunatics, which carried out one important recommendation of the Lords' Committee. The Cork Asylum was at the same time added to the district asylums.

In 1846 an Act (9 and 10 Vict., c. 115) was passed to amend the laws as to district asylums in Ireland, and to provide for the expenses of inspection of asylums.

From a return made in this year (1846) showing the total number of lunatics in the district, local, and private asylums and jails on the 1st of January during each of the previous ten years, I observe that in 1837 there was a total of 3077, and in 1846 a total of 3658, thus distributed:—

- - - Year. District Local Private Jails. Total. Asylums. Asylums. Asylums. - - - 1837 1610 1236 152 79 3077 1846 2555 562 251 290 3658 - - - Inc. 945 Dec. 674 Inc. 99 Inc. 211 Inc. 581 - - -

Of the 3658, as many as 2473 were incurable, leaving only 1185 curable patients. For 1846 there is also a return of the number in poor-houses, 1921; wandering idiots and simpletons, 6217; lunatics under the care of Court of Chancery not in asylums, 76; making a total of 11,872, of whom 327 only were private patients.

In the following year the annual report of the Inspectors thus speaks of non-restraint: "The non-restraint system has been introduced, and is generally acted on, mechanical restraint being seldom applied except where the patients are very violent, and even then it is not often resorted to, as a temporary seclusion is now substituted as a more effectual means of tranquillizing the patients without the risk of personal injury often resulting from the application of bodily restraint, and arrangements are being made to have apartments fitted up for this purpose in each asylum."

The percentage of cures and mortality during the previous seven years was as follows:—Per cent. on the admissions, 38.65; mortality calculated on average number resident, 8.39—not an unsatisfactory return.

In 1849 the proportion of lunatics (i.e. ascertained) to the population in Ireland was 1 to 900, while in Scotland it was 1 to 740, and in England 1 to 870.

In their report of this year, the Inspectors of Asylums express their regret that no provision exists for the insane who, not being paupers, are legally inadmissible into the public institutions, and are unable to meet the charges made in private asylums, the only mixed institutions being St. Patrick's Hospital and the Retreat in Dublin, managed by the Society of Friends.

The number of patients in the district asylums in 1851 (exclusive of Cork, 394) was as follows:—

No. Opened. Armagh 131 1824 Belfast 269 1829 Carlow 197 1832 Clonmel 197 1834 Ballinasloe 312 1833 Limerick 340 1827 Londonderry 223 1829 Maryborough 192 1833 Richmond 279 1815 Waterford 115 1835 —— Total 2255

In 1855[268] the Act 18 and 19 Vict., c. 76, continued the Private Asylum Act of 5 and 6 Vict. The 9 and 10 Vict., c. 79, and 14 and 15 Vict., c. 46, were continued till 1860. The Act 18 and 19 Vict., c. 109, made further provisions for the repayment of advances out of the consolidated fund for the erection and enlargement of asylums for the lunatic poor in Ireland. Seven asylums had been built under the Board of Works since 1847.

By far the most important attempt to take steps for the reform of Irish lunacy was the appointment of a Royal Commission in 1856, to inquire into the state of lunatic asylums and other institutions for the custody and treatment of the insane in Ireland. Among the Commissioners of Inquiry were Mr. Lutwidge, Mr. Wilkes, and Dr. Corrigan. The Report was issued in 1858. They found that on January 1, 1857, the total number of patients in asylum districts amounted to 5225, of whom 1707 were in workhouses, 166 in jails, and 3352 at large, while the inmates of district asylums numbered only 3824. They therefore urged the pressing need of additional accommodation. They proposed that the Irish law should be assimilated, with respect to single patients, to the 16 and 17 Vict., c. 97, s. 68, the police being empowered to bring before a magistrate any wandering lunatic, and justices of the peace having power on sworn information to cause such person to be brought before them. They also regarded as absolutely necessary a total alteration of the rules affecting the manager and physician of an asylum, previous rules having been drawn up in contemplation of the former officer not being a medical man. Among other recommendations, there were proposals in reference to private asylums, for which no legislative enactment was passed prior to 1826 (7 Geo. IV., c. 74),[269] and no special law for licensing them or securing their proper management until 1842, when the statute of 5 and 6 Vict., c. 123, enacted that the Inspectors-General of Prisons, whose duty it was to inspect private asylums, should be Inspectors of Lunatic Asylums—a function which, with others connected with asylums, was by the 8 and 9 Vict., c. 107, transferred to the then newly appointed Inspectors of Lunatics. The Commission proposed that the power of issuing licences should be transferred from the justices to the Inspectors of Lunatics; that the licence should require that some medical man should reside on the premises; that any abuse, ill treatment, or wilful neglect of a lunatic by the superintendent or any other person employed in the care of lunatics, should be deemed a misdemeanour, and punished accordingly; and that, for inspection, licensed houses should be visited by one or more of the Commissioners four times a year. Many other important recommendations were made by the Commission, some of which bore fruit in subsequent Irish legislation, but to how limited an extent is evident from the recommendations of another Commission, to which we shall shortly refer.

The Commissioners notice the culpable disregard with which the rule of the Privy Council, which requires that "the manager is to take charge of the instruments of restraint, and is not, under any pretence, to allow the unauthorized use of them to any person within the establishment; all cases placed under restraint, seclusion, or other deviation from the ordinary treatment, being carefully recorded by him in the daily report, with the particular nature of the restraint or deviation resorted to," has in many instances been treated. So also had the rule that the superintendent was to enter in the Morning Statement Book "the names of those in restraint or seclusion, and the causes thereof." Some managers were not aware of the existence of the rule, while others deemed it a sufficient compliance with the rules to leave the instruments of restraint in charge of the keepers, trusting to their integrity to report the cases in which they were used. In one asylum a female patient was strapped down in bed with body-straps of hard leather, three inches wide, and twisted under the body, with wrist-locks, strapped and locked, and with wrists frayed from want of lining to straps, and was seriously ill, but yet no record had been made in the book. "Wrist-locks and body-straps were hung up in the day-room, for application at the attendants' pleasure. A male patient was strapped down in bed; in addition, he was confined in a strait waistcoat with the sleeves knotted behind him; and as he could only lie on his back, his sufferings must have been great; his arms were, moreover, confined with wrist-locks of hard leather, and his legs with leg-locks of similar kind; the strapping was so tight that he could not turn on either side; and any change of position was still more effectually prevented by a cylindrical stuffed bolster of ticken, of about ten inches thick, which ran round the sides, and top, and bottom of the bed, leaving a narrow hollow, in the centre of which the lunatic was retained, as in a box, without power to turn or move. On liberating the patient and raising him, he was very feeble, unable to stand, with pulse scarcely perceptible, and feet dark red and cold; the man had been under confinement in this state for four days and nights;" yet the manager stated he was not aware of his having all these instruments of restraint upon him, and no record of the case appeared in the book.

At another asylum the Commissioners found a bed in use for refractory patients, in which there was an iron cover which went over both rails, sufficiently high to allow a patient to turn and twist, but not to get up.

Before leaving the Report of the Commissioners of 1858, we may add that, during the period comprised between the date of the Committee of 1843 and this Commission, the number of district asylums was increased from ten to sixteen, affording additional room for 1760 patients, exclusive of Dundrum and a large addition to the Richmond Asylum. Thus:—

-+ When first opened. Name of + -+ + - asylum. Number of Date. Cost including site. beds. -+ -+ + - L s. d. Cork 1852 79,827 1 5 500 Kilkenny 1852 24,920 12 1 150 Killarney 1852 38,354 8 3 250 Mullingar 1855 37,716 15 9 300 Omagh 1853 41,407 12 2 310 Sligo 1855 39,769 0 7 250 + -+ + - Total 261,995 10 3 1760 + -

The Report of the Commission recommended that parts of the workhouses should be adapted and used for some of the incurable class of patients. This was not done, and we cannot be surprised, seeing the unfortunate state of these abodes. But, in addition to the removal of incurable cases to workhouses, the Commissioners recommended additional buildings in connection with existing asylums, for the reception of cases which, although incurable, might yet, from their habits or dangerous tendency, be considered improper cases to be removed from institutions especially devoted to the treatment of insanity. They were satisfied that the number of district asylums would be found more and more inadequate for the wants of the country.

There was a Select Committee of the House of Commons on lunatics in 1859.[270] In the minutes of evidence great stress is laid upon the necessity of providing, in Irish asylums, accommodation for the class immediately above paupers, whose friends were willing to pay a small additional sum for their maintenance; and also establishing district asylums, similar to the chartered asylums in Scotland. Two years later (1861), and three after the Royal Commission, the Act 24 and 25 Vict., c. 57, continued the various Acts respecting private and public asylums (5 and 6 Vict., c. 123; 18 and 19 Vict., c. 76). The subsequent Act of 1867 (30 and 31 Vict., c. 118) provided for the appointment of the officers of district asylums, and amended the law relating to the custody of dangerous lunatics and idiots. These were not to be sent to any jail in the land after January 1, 1868. Dangerous lunatics previously had to pass through jails, instead of going direct to asylums. The 31 and 32 Vict., c. 97, made provision for the audit of accounts of district asylums, and is of no general interest.

During three years (1866-69) six additional asylums were erected, viz.:—

-+ When first opened. Name of + -+ + - asylum. Number of Date. Cost including site. beds. -+ -+ + - L s. d. Ennis 1868 51,316 8 6 260 Letterkenny 1866 37,887 5 3 300 Downpatrick 1869 60,377 6 5 300 Castlebar 1866 34,903 14 11 250 Monaghan 1869 57,662 5 5 340 Enniscorthy 1868 50,008 0 6 288 + -+ + - Total 292,155 1 0 1738 + -

Returning to 1861, the tenth report of the Inspectors of Asylums, issued in that year, gives much important information on the state of lunacy in Ireland at that time, but there are only two points to which it is necessary to refer here. The writers, Drs. Nugent and Hatchell, speak indignantly of the shameful manner in which the friends of lunatics in confinement neglect them, "as if their malady entailed a disgrace on those connected with them ... months—nay, years—passing without an inquiry being made by a brother for a brother, or a child for a parent."

After stating that during the previous ten years four new asylums had been licensed, the Inspectors recur to the importance of supplying asylums for patients who, unable to pay the ordinary charge of a private asylum, not being paupers, are ineligible for admission into public asylums.

In 1874 a new code of rules, issued by the Privy Council, contained many important regulations. Of it, however, the late Dr. Robert Stewart[271] observed, "On the whole, we cannot speak very highly of the tact or wisdom shown by the Lord Lieutenant and Privy Council in the framing of the new code of regulations."[272] In this code the duties of the medical superintendents of Irish asylums are minutely laid down.

In 1878 a Lunacy Inquiry Commission was appointed by the Lord Lieutenant of Ireland, the Report of which in the following year, after an examination of a large number of witnesses, contains much valuable information as to various questions connected with the asylums and the provision for the insane poor, present and future. The following "most distressing case," recorded by the Commission, speaks loudly of the need of increased provision for the insane poor in Ireland:—

"On approaching a small farmhouse at a place called ——, I heard," says Dr. Robertson, "a most peculiar howling noise, and, to my horror, when I came near the house I saw a lunatic stark naked, confined to a room, and looking through the wooden bars that closed the windows, for there was no glass whatever. He is about nineteen years of age, and I heard from his mother that up to ten or eleven years he was a most intelligent boy; but at that age he suddenly lost the power of speech and became moody and abstracted, wandering about the fields alone, and constantly uttering a low, muttering noise, and with incessant tendency to mischief. By careful watching, the family prevented him injuring himself and others, until of late he has got so strong and unmanageable, and his inclination for destruction is so great, that they have been obliged to confine him in the room I have described. He breaks the window directly it is glazed, tears his bed-clothes into shreds, and won't allow a stitch of clothing to remain on his body; besides, his habits are most disgusting."[273] The incumbent of the parish wrote: "This case is indeed only suited for a lunatic asylum. The form which his lunacy has assumed is most shocking, and is detrimental to morality." An English tourist happening to see this case had him removed to the Monaghan Asylum. One cannot but remark that what an English tourist did, the proper authorities ought to have done. The law appears to have been sufficient for the occasion.

The members of the Commission were not content with hearsay evidence. "We took occasion ourselves," they report, "to visit several of these cases in different parts of the country. Some of them we found in a deplorably neglected condition; others disturbing the arrangements of a whole family, the head of which would willingly contribute a small sum towards maintenance in some suitable place of refuge. It admits of no doubt that many a case, if taken in hand at an early stage, might have been restored to society, instead of lapsing into hopeless, incurable insanity. Serious evil often results from the freedom with which idiots of both sexes are permitted to wander abroad, often teased and goaded to frenzy by thoughtless children, often the victims of ill treatment or the perpetrators of offences far worse. The interests of the public, no less than of the insane, require that means should be adopted to ascertain that all of that class are properly cared for. That can only be done by substituting the visit of a medical man for that of the constable, and a professional report for the incomplete return that is now made."

The chief conclusions were, that while it would not be proper to dispense wholly with any workhouse, portions of some might be dispensed with for sane paupers, and appropriated for the accommodation of a certain class of the insane. Over-crowding, it was proposed, should be relieved by the removal of lunatics to auxiliary asylums. School buildings belonging to certain workhouses were suggested as auxiliary asylums, as in Dublin, Cork, etc. For the better cure, relief, and treatment of the lunatic and idiotic poor, a complete reorganization of the whole lunacy administration was regarded as essential, viz. that under the provisions of s. 15 of 8 and 9 Vict., c. 107, the existing district asylums should be classified, reserving one or more, as might be required, in each province as "lunatic hospitals," especially for the curative treatment of the insane; that the remaining district asylums should be appropriated as "lunatic asylums" for the accommodation of the chronic insane requiring special care, a certain number of this class being accommodated in the "lunatic hospitals," as about fifty of each sex would be required for the service of those establishments; that the inspection of the "lunatics at large" should be made one of the duties of the dispensary medical officers, who should be remunerated for this duty, and whose certificate that any one of this class is neglected or improperly cared for, should be made the ground for action by the lunacy authorities; that the accommodation for the third or harmless class, who are at present in lunatic asylums, in workhouses, or at large in a neglected state, be provided by the appropriation of spare workhouse buildings, a sufficiency of which is to be found in each province, thus also meeting the very general complaint of guardians being compelled to maintain superfluous workhouse accommodation; and that all expenditure upon the building or enlargement of district asylums should be suspended.

By this means, each province would be provided with three classes of lunatic establishments: (1) One or more lunatic hospitals for the cure of insanity in an early stage; (2) first-class asylums, in which the chronic cases requiring special care would be treated; (3) second-class or "workhouse auxiliary asylums" for harmless lunatics. The Commission expressed a strong opinion that the whole lunacy administration of Ireland should be placed under the general control of the Local Government Board.

I may add that the estimated cost of the first class was L26 per head; that of the second class, L20; and that of the third, L14 6s. Of this scheme it must be said that, excellent as it is in intention, it is not in some of its provisions without danger in the direction of lowering the condition of the insane poor, as regards comfort and medical supervision, not, indeed, below what they are in some Irish workhouses, but below the standard aimed at in the best county asylums. "Let it be understood that there is no recommendation to constitute anything like an auxiliary asylum, such as Leavesden or Caterham, where large numbers, being brought together, can be kept at a cheap rate, and can at the same time be properly treated under medical care. No provision is made for the necessary supervision, medical or otherwise. The dispensing medical officer is to visit the insane at large, but those in workhouses are to be left to the tender mercies of attendants. The amount of care and comfort these unfortunate beings are to enjoy can be imagined by the fact that the Commission considers that L14 6s. a year will be the cost of their maintenance, after paying attendants, whilst the cost of those in the second-class establishments is to be L20, or about L6 less than what they cost at present."[274]

In their review of the results of past lunacy legislation in Ireland the Commission make the melancholy statement that "although several years ago the legislature made provision for the classification of asylums,[275] and the Inspectors of Lunacy concur with other witnesses of the highest authority in thinking that such classification would be attended with the utmost advantage—would, in fact, meet the difficulties of asylum administration—yet not only has no attempt ever been made to give effect to the provisions of that law, but"—strangest of all—"the Lunacy Inspectors appear to have been unaware of its existence!"[276]

The Commission found that the evil of overcrowding with incurable cases, complained of by the Committee of 1843, and by the Royal Commission of 1858, "has continued to the present day not merely unchecked, but in a more aggravated form than ever." In 1856 there were 1168 curable and 2656 incurable patients in Irish asylums, while in 1877 these numbers were, respectively, 1911 and 6272, the percentages being in the former year, curable 30.5, incurable 69.5, while in the latter year the corresponding percentages were 23.3 and 76.7. Taking the patients not only in asylums, but in workhouses also, the total in 1856 (or more correctly 1857) was as follows: curable, 1187; incurable, 4468; percentages, 20.9 and 79.1. In 1877, curable, 1911; incurable, 9644; percentages, 16.5 and 83.4—a frightful revelation of incurable lunacy. The Inspectors complain that the Act 30 and 31 Vict. has caused this increase of unsuitable cases,[277] but, as the Commission observe, it has simply increased an existing evil, and not produced a new one. Besides, "how otherwise are these unhappy people to be dealt with? Has any other accommodation been provided for them? Though not suitable cases for curative hospitals, they are, at all events, suitable cases for care and humane treatment, and not until provision for such treatment is made, ought the door of the asylum to be shut against them."[278]

The condition of workhouses is proved by this Report to be most unsuitable for the reception of the insane; yet they contained in 1879 one quarter of the pauper lunatics of the country. It was desirable to remove a large number of these somewhere, and the only suitable place was the district asylum. Dr. Lalor, in his evidence before this Commission, says in regard to this increased number of admissions under the 30 and 31 Vict., "I think it is an immense advantage, because before that Act there was a great number of persons kept out who ought to be sent into lunatic asylums, but there was not sufficient machinery for doing so." Dr. Lalor then goes on to say that they have not in Ireland the same provision as in England for taking up merely wandering lunatics not chargeable to the rates. This witness, I should add, is strongly in favour of larger asylums for even curable cases, and would classify the institutions for the insane into three classes, the curable, the improvable, and the incurable. For curable and improvable cases of lunacy, including those requiring special care, and for the training and education of imbeciles and idiots chiefly of the juvenile classes, he would have the same asylum; for the incurable and unimprovable, he would have another. He would leave it to a central body to distinguish the cases, and would allow that such a body might find it more convenient to class the juvenile idiots and imbeciles under the second division.

At the date of this Commission there were 22 district asylums, containing 8073 patients. There were 150 workhouses, with 3200 insane inmates. In Dundrum[279] were 166 criminal insane, and in private asylums about 680 patients, making a total of 12,200. In addition to these, the inspectors obtain a return of every idiot, imbecile and epileptic, at large, from the police, not being under the supervision of the Lunacy Board; the number in 1878 was 6200, bringing up the figures to 18,400.

That practical effect might be given to the recommendations contained in this Report, Lord O'Hagan called attention to them in a speech delivered in the House of Lords, August, 1879, in which he said, "Let me ask the attention of the House to the case of neglected lunatics in Ireland. It is the most pressing, as it is the most deplorable." He cited the statement of the Royal Commission of 1858, that there were 3352 lunatics at large, of whom no fewer than 1583 were returned as "neglected;" and the recent statement of the Irish Lunatic Inquiry Commission that within the last twenty years the number of that class had increased by more than a hundred per cent.—from 3352 to 6709—without "any diminution in the proportion of those who may still be classified as neglected." Lord O'Hagan referred to the case of a naked lunatic in a farmhouse, which we have quoted at p. 424, and maintained that some four thousand lunatics were in a condition "better or worse according to circumstances." We cannot but think that the speaker generalized a little too much. He was right, however, in his contention that none of the neglected cases "are protected by any intervention of the law from exhibiting themselves in as shocking an aspect."

"Only," observed Lord O'Hagan, "when the life of George III. was threatened by a lunatic in England, did Parliament interfere and send the insane to jails; only in 1838, when it was discovered that jails were not fit receptacles for them, was provision made for committing them to asylums; and only in the Consolidating Act of 1853 were provisions made for such inspection and report as were needful for their protection and the safety of their neighbours. I lament to say that Ireland was left without even the benefit of the Act of 1799 until 1838, and that the advantages which the Act of that year gave to England were not extended to her lunatics until 1867; whilst you will scarcely believe that the salutary reforms of 1853 have not to this hour been made operative in Ireland."

Lord O'Hagan asked for identical legislation for Ireland and England, the want of this having caused "incalculable mischief."

After observing that the Commission proposed the classification of asylums for the purpose of curative treatment, the care of chronic cases, and the allocation of workhouses as auxiliaries for the benefit of the quiet and harmless, Lord O'Hagan referred to the fact that "the Commission and the Inspectors of Lunacy differed as to material points on the modus operandi, the inspectors desiring the extension of district asylums, and the Commission not agreeing with this view; the consequence being that at that time their extension was suspended." The speaker did not presume to decide between them, but simply called upon the Government to recognize the responsibility which the Report of the Commission had cast upon them.

The Lord Chancellor (Lord Cairns) replied that the Report was engaging the attention of the Government; that he trusted it would not be in the category of those Reports "which have gone before" and produced no result; but that he could not give any further answer.[280]

The Lord Chancellor of Ireland (Lord O'Hagan) brought in on the 20th of January, 1880, the "County Court Jurisdiction in Lunacy Bill (Ireland),"[281] which not only passed the House of Lords, but was read a third time in the House of Commons, August 17th of that year.[282]

Lord O'Hagan's measure had for its object to protect the interests of lunatics possessed of small properties, beyond the control of Chancery on account of the expense incurred thereby. There were in Ireland under the jurisdiction of the Lord Chancellor, committed to him by the Queen's sign manual, 229. By the operation of the Act of 1871, introduced by Lord O'Hagan, the guardianship then provided had worked admirably. But there remained those who had very small property. Of the 642 persons then in private asylums, 143 only were under the guardianship of the Lord Chancellor, and the remainder might be presumed to have small properties. In the district asylums there were 55 paying patients, 20 of whom were under the Court of Chancery. Those on whose behalf Lord O'Hagan addressed the House of Lords were estimated at 724. The property of most of these "was left to the mercy of relations or strangers, who did with these unhappy people what they would." While in the previous year 1276 patients had been sent to district, and 141 to private asylums, only 24 had been brought within the protection of the Lord Chancellor. As much as L3189 was received from patients in the district asylums in a year. The Bill now introduced gave protection to the class in question by vesting in the County Court judges a new jurisdiction, viz. in lunacy within the areas of the various courts, in cases in which the property of the lunatic should not exceed the sum of L700 in money value, or L50 a year—sums taken from the Lunacy Regulation Act of 1871, which provided that the Lord Chancellor might be at liberty not to impose upon lunatics having property of that value, the same fees and obligations that were insisted upon in the case of more wealthy persons. Lord O'Hagan regarded his Bill as only part of a larger measure to which he looked forward.[283]

A Bill was introduced into the House of Commons, but without passing into an Act, by Mr. Litton, member for Tyrone, entitled "The Lunacy Law Assimilation (Ireland) Bill," on the 6th of April, 1881,[284] and it may be worth while to observe what, according to so comparatively recent a speaker on the subject, is now wanted to improve the condition of Irish lunatics. After pointing out that, according to the Report of the Commission of 1879, there were on January 1, 1878, about 11,000 lunatics provided for, the number at large, inadequately cared for, was 6709, of whom more than 3000 were actually neglected, as against 1583 in the year 1857; and after reviewing the legislation of 1 and 2 Geo. IV., by which district asylums were established; the 1 and 2 Vict., c. 47, by which dangerous lunatics may be committed to jails; the 8 and 9 Vict., by which they might be transferred to Dundrum; the 30 and 31 Vict., c. 118 (1867), by which the first provision for sending this class of lunatics to jail was repealed; the 38 and 39 Vict. c. 67 (1875), by which it was provided that chronic lunatics not being dangerous might be consigned to the poor-houses—Mr. Litton showed that there was no attempt at classification in poor-houses, and that they only accommodated 3365 persons, and further that, in spite of the last Act, the asylums were crowded with chronic and incurable cases, and had but little room for recent cases. He deplored the want of supervision of the neglected lunatics referred to, many of whom were subjected to cruel treatment. He therefore preferred to extend to Ireland the provisions of ss. 66 to 68, 70 to 72, and 78 to 81 of the English Act, 16 and 17 Vict., c. 97, subject to certain changes which were explained in the Bill. He doubted whether powers to enlarge the existing asylums would meet the difficulty, and it would be very costly and lengthy. It was proposed to adopt the system of boarding out which had been in operation in Scotland; due provision was made for their inspection. It was also needful to give to poor-law guardians power to afford relief to the head of a family one of whose members was insane (as in England), which was now impossible, unless the head of the family was so afflicted.

The fact that all committals of dangerous lunatics on the warrant of two magistrates must be cases in which the latter are satisfied that a lunatic had shown an intent to commit an indictable crime leads, it is stated, to many persons who, although dangerous, have not shown the above intent, being kept out of asylums until they have passed into a chronic state. However this may be, the number committed in Ireland as dangerous lunatics is enormous, being in one year (1877) 1204 out of 1343 admissions, the truth being that numbers are classified as dangerous who are not so.

Mr. Litton's Bill provided (1) for the supervision of neglected lunatics; (2) the boarding out in suitable places, under the direction of the governors of district asylums, of such patients as they might select for that purpose; (3) an alteration in the law of committal, so as to allow of patients being admitted before they became incurable; and (4) power to the poor-law guardians to give outdoor relief under the circumstances stated.[285]

The Bill had the approval of the Social Science Congress committee, and of Lord O'Hagan, but on account of the pressure of other business never reached the House of Lords.[286] It should be added that the Government, in the person of the Solicitor-General, expressed a hope that they would be able to bring in a Bill of larger scope, one more fully covering the ground traversed by the Royal Commission of 1879.

The sketch now made, slight as it is, will serve to show that Ireland formed no exception to the neglect to which the insane were subjected, especially in the poor-houses and jails; that when attention was strongly drawn to the better treatment of the insane in England, partly by the publication of a work describing how this was to be carried out, and partly by the evidence given before the Select Committee of the House of Commons in 1815, the Irish Government took up the question of reform, and resolutely set about putting their own house in order. Select Committees collected valuable evidence which bore fruit in efficient legislative enactments, and there seems to have been singularly little opposition to the introduction of improved methods of treatment and new buildings in place of the old. The Richmond Asylum from the first led the way in enlightened modes of treatment, and at the present time this institution, under the long and able management of Dr. Lalor, is a credit to Ireland; the more so that here, more efficiently than in any asylum I have visited in the British Isles, the employment of the patients in school work has been introduced and prosecuted to a successful issue.[287]

One other feature of the history of this movement in Ireland has already been alluded to, but merits attention again, and that is the additional proof afforded of the inevitable tendency to the accumulation of cases, instead of their recovery on a large scale, as was at first hoped and expected, not in Ireland alone, but in England. The frequency of relapse was, in the outburst of delight accompanying the recovery of some cases hopelessly incurable under the old system, not suspected, and the bitter disappointment which this fact involves had yet to be experienced, and is, indeed, scarcely realised at this moment. In one of the Irish Reports, the circumstance is alluded to that, taking all the discharges of patients on account of recovery, the cures amounted to the gratifying number of seventy per cent. Had this proportion been sustained, and had these patients retained their mental health, there would have been little need of additional asylums. Patients from all quarters, their homes, poor-houses, and even jails, might have been drafted for a season into these temples of health, and, having passed the charmed threshold, been restored in a few months to the outer world, never to return.

If this pleasant illusion is dispelled by the course of events in Ireland, how much more strikingly must it be so in England? for the former country is almost altogether free from that most hopeless of all mental affections, the general paralysis of the insane—the plague of all other civilized countries—and has fewer epileptics.

There are now in Ireland 43 district and private asylums, with a population of insane persons amounting to 9289. There are 163 poor-houses in which there are insane and idiotic persons.

The insane under the jurisdiction of the Inspectors on the 1st of January, 1881, were thus distributed:—

In district asylums 8,667 In the Dundrum or Criminal Asylum 180 At Palmerston House 19[288] In private licensed houses 622[289] In 163 union workhouses 3,573 ——— Total 13,061[290]

As many as 1270 patients were received as dangerous lunatics under the 30 and 31 Vict., c. 118.

Will nothing be done to simplify admission? "Had the Bill introduced by Mr. Litton during the past session become law, the admission order universally used in England would have extended to Ireland, so that in time the present confusion and difficulty experienced in obtaining admission to Irish asylums might have been removed by the substitution of one simple order for the complicated machinery at present in existence. The Inspectors, however, seem to consider that the introduction of the Bill extending protection under the 16 and 17 Vict., c. 97, to the insane who are at present not under State provision, would be to fill hospitals for the insane with unpromising cases, at a considerable increase of expenditure, to the exclusion of others more urgent or more hopeful. The answer to this seems plain, that if the accommodation for the insane is inadequate, every effort should be made to provide increased means of protection for those who are unable to care for themselves. It cannot surely be reasonably maintained that because the accommodation is inadequate for the want of the insane population, for that reason no further legislation should be put in force for their better protection, nor does the supposition that mistakes might occur in sending people to asylums who do not require to be deprived of their freedom, deserve more serious consideration. That such mistakes may and will occur for all time cannot be doubted, but there cannot be any reason to suppose that because increased supervision is provided, these mistakes would become more frequent. Such has not been found the case in England, where this Act has been in force for many years."[291]

The best thing we can hope for the effectual care of the insane in Ireland is legislation in the direction indicated by Lord O'Hagan and Mr. Litton.

ADDENDUM.

TABLE A.

NUMBER OF PATIENTS IN DISTRICT ASYLUMS, JANUARY 1, 1881.

- - Asylum. Males. Females. Total. - - Armagh 100 96 196 Ballinasloe 266 197 463 Belfast 262 201 463 Carlow 137 116 253 Castlebar 174 115 289 Clonmel 213 197 410 Cork 450 420 870 Down 197 141 338 Ennis 140 121 261 Enniscorthy 157 143 300 Kilkenny 129 114 243 Killarney 178 124 302 Letterkenny 200 99 299 Limerick 235 244 479 Londonderry 147 124 271 Maryborough 155 118 273 Monaghan 244 159 403 Mullingar 240 194 434 Omagh 284 201 485 Richmond 451 571 1022 Sligo 200 141 341 Waterford 126 146 272 - 4685 3982 8667 - -

WORKHOUSES.

Insane and Idiots.

Ulster 1054 Munster 1036 Leinster 1170 Connaught 313 —— 3573

In jails 3 In Dundrum 180

TABLE B.

NUMBER OF PATIENTS IN PRIVATE ASYLUMS, JANUARY 1, 1881.

- Males. Females. Total. - Armagh Retreat 16 9 25 Bloomfield Retreat, Co. Dublin 14 27 41 Cittadella, Co. Cork 15 9 24 Cookstown House, Piltown, Co. Dublin 1 3 4 Course Lodge, Co. Armagh 12 12 Elm Lawn, Co. Dublin 3 3 Esker House, ditto 3 3 Farnham House, ditto 31 23 54 Hampstead House, ditto 23 1 24 Hartfield House, ditto 29 29 Highfield House, ditto 14 14 Lindville, Co. Cork 13 19 32 Lisle House, Co. Dublin 3 3 Midland Retreat, Queen's Co. 4 7 11 Orchardstown House, Co. Dublin 5 6 11 St. Patrick's (Swift's), Dublin City 38 63 101 Rose Bush House, Co. Dublin 2 2 Stewart Institution, ditto 45 67 112 Verville, ditto 19 19 St. Vincent's, ditto 95 95 Woodbine Lodge, ditto 3 3 Totals 236 386 622 -

FOOTNOTES:

[251] Dublin. See postea.

[252] "Tenth Report of the District, Criminal, and Private Lunatic Asylums in Ireland."

[253] Page 34.

[254] See Report of Select Committee, etc., 1817.

[255] "Description," etc., 1813.

[256] "The accumulation of the number of incurable cases which necessarily must have occurred from time to time in these asylums, had also been overlooked, and has consequently led to the embarrassment which is felt at present with respect to the best mode of providing for them."—Report of the Inspectors, 1843.

[257] "Report from the Select Committee on the Lunatic Poor in Ireland, with Minutes of Evidence taken before the Committee, 1817."

[258] "An Act to provide for the Establishment of Asylums for the Lunatic Poor in Ireland, 1817." Introduced by Mr. V. Fitzgerald, but prepared By Mr. Thos. Spring Rice, M.P. for Limerick.

[259] Repealing 57 Geo. III., c. 106, and 1 Geo. IV., c. 98.

[260] See Twenty-seventh Report of Inspectors of Asylums, May 1, 1878.

[261] Parliamentary Return, ordered to be printed, April 19, 1826.

[262] Parliamentary Papers, Correspondence, etc., between the Home Office and the Irish Government during 1827 on Public Lunatic Asylums.

[263] First Annual Report of the City of Cork Asylum, dated March 1, 1827.

[264] For particulars in regard to the condition of the insane in Ireland in this year, see "Report of the Select Committee appointed to take into consideration the state of the poorer classes in Ireland in relation to Lunatic Asylums, 1830."

[265] "The Report of the Lords' Committee appointed to consider the state of the lunatic poor in Ireland, and to report to the House."

[266] Report of the Lords' Committee.

[267] Orders in Council were in consequence issued for the erection of the new district asylums, under the statutes 1 and 2 Geo. IV. and 7 Geo. IV., c. 14, which will be found on another page.

[268] This Act was preceded by the Select Committee of Lunatic Asylums (Ireland), moved by Colonel Dunne. Dr. Nugent, the Inspector of Asylums, gave in his evidence a minute description of the system under which asylums have been erected in Ireland, and stated that the expenditure on the seven asylums built since 1847 amounted L313,973. In the same year a Commission was appointed to inquire into the erection of district lunatic asylums, which reported in 1856.

[269] The Prisons Act.

[270] See p. 191. Irish lunacy is only incidentally noticed in this evidence, which had primary reference to England.

[271] The medical superintendent of the Belfast Asylum, one of the best-managed institutions of Ireland.

[272] Journal of Mental Science, April, 1875.

[273] Dr. Robertson to the Inspector of Lunacy, Report, p. lxxxvii.

[274] From editorial article in Journal of Mental Science, July, 1879.

[275] 8 and 9 Vict., c. 107, s. 15.

[276] Page lxii.

[277] Patients being sent to asylums on the pretext of their being "dangerous lunatics" when not so. See p. 435.

[278] Page lxviii.

[279] The Dundrum Central Criminal Asylum, recommended by the Committee of the House of Lords in 1843, and established by the 8 and 9 Vict., c. 107, was built at a cost of L19,547, and was opened in 1850 on the south side of the city of Dublin, capable then of holding only 120 inmates. When the writer visited it in 1875, he was very favourably impressed with its condition. Dr. McCabe was at that time superintendent, and has been succeeded by Dr. Ashe.

[280] "Parliamentary Debates," 3rd series, vol. ccxlviii., August, 1879, p. 1822.

[281] Ibid., vol. ccliv., July, 1880, p. 892.

[282] Ibid., vol. cclv., August, 1880.

[283] Op. cit., p. 894.

[284] "Parliamentary Debates," 3rd series, vol. cclx. p. 802.

[285] Op. cit., vol. cclx. p. 810.

[286] It was withdrawn July 8, 1881.

[287] See "The Richmond Asylum Schools," by Dr. D. Hack Tuke, Journal of Mental Science, October, 1875. Also an article in the Journal, April, 1882, by Mr. Fox, the master of the school.

[288] Only those supported by Government. The total number was 112.

[289] In 1873 the number was greater, viz. 664.

[290] The inspectors make a total of 13,051.

[291] Journal of Mental Science, January, 1882.



CHAPTER XI.

PROGRESS OF PSYCHOLOGICAL MEDICINE DURING THE LAST FORTY YEARS: 1841-1881.[292]

If, gentlemen, History be correctly defined as Philosophy teaching by examples, I do not know that I could take any subject for my Address more profitable or fitting than the Progress of Psychological Medicine during the forty years which, expiring to-day, mark the life of the Association over which, thanks to your suffrages, I have the honour to preside this year—an honour greatly enhanced by the special circumstances under which we assemble, arising out of the meeting in this metropolis of the International Medical Congress. To it I would accord a hearty welcome, speaking on behalf of this Association, which numbers amongst its honorary members so many distinguished alienists, American and European. Bounded by the limits of our four seas, we are in danger of overlooking the merits of those who live and work beyond them. I recall the observation of Arnold of Rugby, that if we were not a very active people, our disunion from the Continent would make us nearly as bad as the Chinese. "Foreigners say," he goes on to remark, "that our insular situation cramps and narrows our minds. And this is not mere nonsense either. What is wanted is a deep knowledge of, and sympathy with, the European character and institutions, and then there would be a hope that we might each impart to the other that in which we are superior."

Do we not owe to France the classic works of Pinel and of Esquirol—justly styled the Hippocrates of Psychological Medicine—works whose value time can never destroy; and have not these masters in Medical Psychology been followed by an array of brilliant names familiar to us as household words, Georget, Bayle, Ferrus, Foville, Leuret, Falret, Voisin, Trelat, Parchappe, Morel, Marce, who have passed away,[293] and by those now living who, either inheriting their name or worthy of their fame, will be inscribed on the long roll of celebrated psychologists of which that country can boast.

If Haslam may seem to have stumbled upon General Paralysis, we may well accord to French alienists the merit of having really discovered the disorder which, in our department, is the most fascinating, as it has formed the most prominent object of research, during the last forty years.

To mention Austria and Germany, is to recall Langermann, Feuchtersleben, Reil, Friedreich, Jacobi, Zeller, Griesinger, Roller, and Flemming, who, full of years and honours, has now passed away.

Has not Belgium her Guislain, Holland her Schroeder van der Kolk, and Italy her Chiaruggi?

And when I pass from Europe to the American continent, many well-known names arise, at whose head stands the celebrated Dr. Rush. Woodward, Bell, Brigham, and Howe (whose many-sided labour included the idiot) will be long remembered, and now, alas! I have to include among the dead an honoured name, over whom the grave has recently closed. Saintship is not the exclusive property of the Church. Medicine has also her calendar. Not a few physicians of the mind have deserved to be canonized; and to our psychological Hagiology, I would now add the name of Isaac Ray. With his fellow-workers in the same field, among whom are men not less honoured, I would venture to express the sympathy of this Association in the loss they have sustained. Nor can I pass from these names, although departing from my intention of mentioning only the dead, without paying a tribute of respect to that remarkable woman, Miss Dix, who has a claim to the gratitude of mankind for having consecrated the best years of her varied life to the fearless advocacy of the cause of the insane, and to whose exertions not a few of the institutions for their care and treatment in the States owe their origin.

Abroad, psychological journalism has been in advance of ours.

The French alienists established in 1843 their Annales Medico-Psychologiques (one of whose editors, M. Foville, is with us to-day), five years before Dr. Winslow issued his Journal, the first devoted to medical psychology in this country, and ten years before our own Journal appeared, in 1853.

The Germans and Americans began their Journals in the following year—1844; the former, the Allgemeine Zeitschrift fuer Psychiatrie, and the latter the American Journal of Insanity.

I believe that our Association has precedence of any other devoted to Medical Psychology, and it is an interesting fact that its establishment led to that of the corresponding Association in France—a society whose secretary, M. Motet, I am glad to see among my auditors. The Association of Medical Superintendents of American Institutions for the Insane was instituted in 1844; that of Germany in 1864, the subject of Psychology having previously formed a section of a Medical Association.

Returning to our own country, I may observe that when Dr. Hitch, of the Gloucester Asylum, issued the circular which led to the formation of this Association in 1841, almost half a century had elapsed since the epoch (1792) which I may call the renaissance of the humane treatment of the insane, when the Bicetre in France, and the York Retreat in England, originated by their example an impulse still unspent, destined in the course of years to triumph, as we witness to-day. This triumph was secured, in large measure, by the efforts of two men who, forty years ago, shortly after the well-known experiment at Lincoln, by the late Mr. Robert Gardiner Hill, were actively engaged in ameliorating the condition of the insane. Need I say that I refer to Lord Shaftesbury and Dr. Conolly? The nobleman and the physician (alike forward to recognize the services of the pioneers of 1792), each in his own sphere having a common end in view, and animated by the same spirit, gave an impetus to the movement, the value and far-reaching extent of which it is almost impossible to exaggerate. Lord Shaftesbury,[294] celebrating his eightieth birthday this year, still lives to witness the fruits of his labours, of which the success of the well-known Acts with which his name is associated, will form an enduring memorial. Dr. Conolly was in his prime. He had been two years at Hanwell, and was contending against great difficulties with the courageous determination which characterized him. I do not hold the memory of Conolly in respect, merely or principally because he was the apostle of non-restraint, but because, although doubtless fallible (and indiscriminate eulogy would defeat its object), he infused into the treatment of the insane a contagious earnestness possessing a value far beyond any mere system or dogma. His real merit, his true glory, is to have leavened the opinions and stimulated the best energies of many of his contemporaries, to have stirred their enthusiasm and inflamed their zeal, to have not only transmitted but to have rendered brighter the torch which he seized from the hands of his predecessors. He desired to be remembered after his death by asylum superintendents as one who sincerely wished to place the insane in better hands than those in which he too generally found them; and I hold that, whatever may be our views on what we have chosen to call non-restraint, we may cordially unite in fulfilling his desire.

As the non-restraint system—a term, it must be confessed, which cannot boast of scientific precision, but is well understood—has been the leading, and often engrossing, topic of discussion during the period now under review, I must not omit a brief reference to it. No one will call in question the statement as an historical fact that the Commissioners in Lunacy and the medical superintendents of asylums in this country are, with few exceptions, in favour of non-restraint. Dr. Lauder Lindsay—for whose death, as well as that of Dr. Sherlock and of Dr. White Williams, during the last year, the tribute of sorrowful regret ought, in passing, to be paid—Dr. Lindsay, I say, had only a small following in Great Britain. In Germany, on the other hand, although Griesinger looked favourably upon the system, and Westphal has advocated it, and Brosius has translated Conolly's standard work into German, there has not been a general conversion, as may be seen by the discussion which took place in 1879, at meetings of the Psychological Society in Berlin and Heidelberg. In France, again, although Morel gave it the sanction of his name, and Magnan has practised it recently, there has been within the last twelve months a striking proof of anti-non-restraint opinion among the French physicians, in an interesting discussion at the Societe Medico-Psychologique. I wish here only to chronicle the fact, and would urge the necessity of not confounding honest differences of opinion with differences of humane feeling. The non-restrainer is within his right when he practises the system carried to its extremest lengths. He is within his right when he preaches its advantages to others. But he is not within his right if he denounces those physicians, equally humane as himself, who differ from him in opinion and practice. I therefore unite with the observation of Dr. Ray, by whom, as well as by the majority of his fellow-psychologists, the non-restraint system as a doctrine was not accepted, when he wrote thus in 1855, "Here, as well as everywhere else, the privilege of free and independent inquiry cannot be invaded without ultimate injury to the cause."[295]

The arguments in favour of mechanical restraint are clearly set forth by Dr. John Gray, of the Utica Asylum, in his annual report of the present year.

Leaving this subject let me recall to your recollection that when this Association was formed, the care of the insane in England and Wales was regulated by the Gordon-Ashley Act of 1828,[296] which, among other reforms, had substituted for the authority of five Fellows of the College of Physicians, who performed their duties in the most slovenly manner, fifteen metropolitan Commissioners in Lunacy. I find, on examining the Annual Report of these Commissioners issued in 1841, that it does not extend over more than one page and a half! It is signed by Ashley, Gordon, Turner, Southey, and Proctor. They report the number confined in the thirty-three asylums within their jurisdiction as 2490. Their verdict on inspecting them is expressed in half a dozen words, namely, that the "result is upon the whole satisfactory."

"The business of this Commission," they say, "has very much increased, partly by more frequent communications with the provinces (over which, however, they have no direct legal control), and partly by the more minute attention directed by the Commissioners to individual cases with a view to the liberation of convalescent patients upon trial ... and the consequence has been that many persons have been liberated who otherwise would have remained in confinement."

That a state of things in which such an occurrence was possible should be described as on the whole satisfactory, is somewhat remarkable, and in reading this paragraph we cannot but contrast with it the very different result of the investigation made by the Committee of the House of Commons in 1877.

Again, nothing more strikingly marks the change which has taken place in the inspection of asylums than the contrast between the last Report of the Lunacy Commissioners, consisting of a bulky volume of more than four hundred pages, and that of 1841, of a page and a half. In fact, the Reports of the Commissioners form the best evidence to which I can refer of the progress made from year to year in the provision for the insane, and the gradual but uninterrupted amelioration of their condition.

An important advance was made in 1842 by the Act 5 and 6 Vict., c. 87, which provided that provincial houses were to be visited by the Metropolitan Commissioners, as well as those in their own district. They were also to report whether restraint was practised in any asylum, and whether the patients were properly amused and occupied. Not only was a great step forward made by thus extending the inspecting power of these Commissioners to the provinces, but their memorable Report on the state of the asylums in England and Wales in 1844 led to the highly important legislation of the following year (introduced by Lord Ashley)—the Act 8 and 9 Vict., c. 100, which along with the Acts of 1853 (16 and 17 Vict., cc. 96, 97)[297] and 1862 (25 and 26 Vict., c. 111) form, as you are well aware, the Code of Lunacy Law under which, for the most part, the care of the insane is determined and their protection secured.

I should like to have been able to state the number of recognized lunatics in England and Wales forty years ago, but no return exists which shows it. The nearest approach is to be found in the Report just referred to of the Metropolitan Commissioners (1844), in which the number of ascertained lunatics in England and Wales is stated to be about 20,000, of whom only 11,272 were confined in asylums, whereas now there are nearly 55,000. It is difficult to realize that there were then only some 4000 patients in county asylums, these being 15 in number, and that there were 21 counties in England and Wales in which there were no asylums of any kind, public or private. At the present time, instead of 20,000 ascertained lunatics and idiots, we have 73,113—an increase represented by the population of the City of York—instead of 15 county asylums we have 51, with scarcely less than 40,000 patients, instead of 4000; while the provincial licensed houses have decreased from 99 to 59, and the metropolitan increased by 2. The total number of asylums in England and Wales in 1844 was 158,[298] now it is 175—excluding those (3) erected under Hardy's Act. I need not say that these figures do not necessarily point to an increase of lunacy, but may merely represent the increased accommodation which ought to have been provided long before. Into the general question of the spread of insanity I feel that it would be impossible to enter satisfactorily now.

Recurring to the Metropolitan Commissioners' Report, I must observe that while an immense advance took place between 1828, when they were appointed, and 1844, the subsequent advance between the latter date and now is such that we cannot but recognize the extremely beneficial operation of the legislation which has marked this period. It must also be gratifying to Scotch asylum superintendents, knowing as they do the satisfactory condition of the insane in their country in 1881, to be able to measure the progress made since Lord Ashley, in his speech in 1844, moved for an address to the Crown, praying her Majesty to take into consideration the Commissioners' Report, for he there observes, "I believe that not in any country in Europe, nor in any part of America, is there any place in which pauper lunatics are in such a suffering and degraded state as those in her Majesty's kingdom of Scotland." I need not do more than chronicle the fact, in passing, that the reform in Scotland dates, to a large extent, from the appointment of a Royal Commission in 1855, and the action of the Board of Lunacy Commissioners which was established in consequence. Legislation for Ireland and the appointment of inspectors have likewise proved very beneficial in that country. But restricting my remarks to England and Wales, I would observe that the establishment by the Act of 1845 of the Lunacy Board as at present constituted, and the rendering it compulsory upon counties to provide asylums for pauper lunatics, are the chief causes of the improvement to which I have referred, so far, at least, as it has been brought about by legislation.

I will not dwell in detail on the lunacy legislation of these years. To have said less would have been to overlook the salient and most important facts of the period. To have said more would have been to travel over the ground so ably occupied by Dr. Blandford in his Presidential Address three years ago. He, by-the-by, complained of the ever-increasing difficulty each President finds in selecting a subject for his discourse, and then immediately proceeded to effectually lessen the chances of his successors. What the last occupant of this Chair will be able to discover new for his address I do not know. I can only think of the funeral oration over this Association at its obsequies—when its "dying eyes are closed," its "decent limbs composed," and its "humble grave adorn'd,"

"By strangers honour'd, by survivors mourn'd."

On the Board of the Commissioners in Lunacy have sat two members of our profession (one still living), to whose services I wish more especially to refer. I allude to Dr. Prichard and Mr. Gaskell.

Apart from his official work, the former will always be remembered in the republic of letters by his learned contributions to anthropology and the literature of mental diseases, in which he is more especially identified with the doctrine of Moral Insanity. Chronicler of the period in which he enunciated or rather developed it, I cannot avoid a brief reference to a theme which has caused so much heated discussion. As an impartial historian I am bound to admit that his views are still by no means unanimously adopted, and that I am only expressing my own sentiments when I avow that what Latham says of Prichard's "Researches into the Physical History of Mankind"—"Let those who doubt its value, try to do without it"—applies to the teaching contained in the remarkable treatise entitled "Different Forms of Insanity in relation to Jurisprudence," published in 1842. We may well be dissatisfied with some of the illustrations of the doctrine it supports. We may express in different terms the generalization he has made as to the relation of intellect and emotion; but I am greatly mistaken if we shall not from time to time be confronted by facts which instantly raise the question which presented itself with so much force to his acute mind, and which does not appear to me to be successfully met by those who controvert the conclusions at which Prichard arrived. The necessity of admitting in some form or other the mental facts in dispute, is well illustrated by the recent work by Krafft-Ebing on mental disorders. For what does this practised mental expert do? He, although the supporter of mental solidarity and the integrity of the Ego—adverse, therefore, to the psychology in which the theory has been enshrined—feels that he must admit into his classification some term which describes certain emotional or volitional disorders, and can discover none better than "moral insanity"—a practical, though reluctant, admission of the value of Prichard's views after their discussion for forty years. I might also refer as an indication of opinion to a most excellent article in the last number of the Journal by Dr. Savage, who, while recognizing the abstract metaphysical difficulty of conceiving moral as distinct from intellectual insanity, fully admits as a clinical fact the form of mental disease for which Prichard contended, and had he been living he would doubtless have claimed this article as a striking proof of the vitality of his opinions.

One is certainly disposed to exclaim, if observation on the one hand compels us to admit certain mental facts, and the metaphysician on the other declares them to be unmetaphysical, so much the worse for metaphysics!

Mr. Gaskell, in addition to his good work as a reformer at the Lancaster Asylum, where may yet be seen preserved quite a museum of articles of restraint formerly in use in that institution, and his efficient labours as a Commissioner, was also, it may not be generally known, the real cause of the practical steps taken in this country to educate the idiot. It was in 1847 that he wrote some articles in Chamber's Journal, giving an account of Seguin's Idiot School at the Bicetre, which he had visited and been greatly interested in. These articles had the effect of inducing Dr. Andrew Reed to interest himself in the establishment of a school for idiots in England. The Highgate and Colchester Asylums for idiots were instituted—the origin, as it proved, of the great establishment at Earlswood. All, therefore, that has been done for this pitiable class has been effected during the last forty years. The indefatigable Seguin has passed away during the last twelve months. He pursued to the last, with unabated zeal, a study possessing attractions for only a limited number, and advocated the claims of idiots and imbeciles with unceasing energy in the Old World and the New. Fortunately his mantle has descended upon a worthy successor in the person of his son, Dr. E. Seguin, of New York.

* * * * *

It has necessarily happened that the direction of public attention to the larger and better provision for the insane in all civilized lands has led to much consideration, and inevitably some difference of opinion as regards the form and arrangement of asylums. But all will admit that their construction has undergone a vast improvement in forty years. The tendency at the present moment is to attach less importance to bricks and mortar, and the security of the patient within a walled enclosure, than to grant the largest possible amount of freedom, in asylums, compatible with safety. The more this is carried out, the easier, it is to be hoped, will it be to induce the friends of patients to allow them to go in the earliest stage of the disorder to an asylum, as readily as they would to a hydropathic establishment or an ordinary hospital, to which end medical men may do much by ignoring the stupid stigma still attaching to having been in an asylum. The treatment of the insane ought to be such that we should be able to regard the asylums of the land as one vast Temple of Health, in which the priests of Esculapius, rivalling the Egyptians and Greeks of old, are constantly ministering, and are sacrificing their time and talents on the altar of Psyche.[299]

Most heartily do I agree with Dr. Kirkbride when he says that "Asylums can never be dispensed with—no matter how persistently ignorance, prejudice, or sophistry may declare to the contrary—without retrograding to a greater or less extent to the conditions of a past period with all the inhumanity and barbarity connected with it. To understand what would be the situation of a people without hospitals for their insane, it is only necessary to learn what their condition was when there were none."[300]