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" De Lunatico."
Some two or three years ago a few medical men who stood at the head of their branch of the profession met together with the generous purpose of providing for a want recognised by all, but which it seemed nobody's business to satisfy. As the Government would have answered their request with the usual assertion that it had no funds at its command for the purpose, these medical men resolved to make a direct appeal to the public, which, thanks to English men and women, hardly fails when a valid reason is submitted. But, in spite of the powerful support of Charles Dickens on this occasion, the appeal proved unsuccessful; for the subject was painful, and of a nature people are ever disposed to forget. The medical men to whom I have referred were those who have taken lunacy under their peculiar care, and the subject of their anxiety was the provision of a home and refuge for those afflicted members of the middle classes who must either accept parochial relief or become a heavy burden on their family and friends. The former was only too often the alternative accepted, and wisely accepted; but, as I said, such men as Drs. Hood, Conolly, and others of equal reputation, believed that they had a fair case to lay before the public, and resolved to make the effort. That it should fail was not surprising. Now and then the nation is aroused by some glaring instance to turn its attention to the subject of lunacy ; but when the
; nine days' wonder has died out, we tacitly shelve the subject again. There are few among us, I fancy, who would care to visit an asylum; for there is something essentially depressing in the contemplation of man bereft of his senses; while, on the other hand, the patients are completely out of the world, and even if they suffered wrong (which is very improbable) any protest they might venture to make would be met in limine by the objection that it was the prompting of a diseased imagination. Still, the subject is not one that should be overlooked ; for it is a matter in which every one of us may say that we know what we are, but knotv not what we may be, and therefore an investigation into the present treatment of lunacy may not be labour thrown away. In order, then, to lay before my readers what it is and what it may become, I will describe to them, as cursorily as I can, the refuges which public charity or the parochial system offers to a hapless class of beings, whom savage nations have ever treated with peculiar tenderness, but whom civilisation prefers to keep out of sight.
I assume all my readers are aware that lunacy is gradually on the increase, and that there is a growing complaint throughout the country of a want of space to provide for patients of this class. It would carry me too far were I to attempt to account for this fact; but fact it is, and even the Middlesex portion of the metropolis, although it has two asylums, holding an aggregate of four thousand patients, is awaiting with dread
the moment when these buildings must be enlarged. It is equally known that with the increase of lunacy the treatment of the patients has undergone an entire change. Time was when they were chained up to make an English holiday, and people thought they had expended their time and their twopence profitably in paying a visit to the poor wretches confined in Bethlehem. It is only necessary to examine a certain picture by Hogarth to feel convinced that the change was not made one moment sooner than was imperative. To Dr. Conolly, I believe, is owing this wondrous alteration, as well as the introduction of the non-restraint system on a large scale. Having thus cleared the ground, I will ask my readers to accompany me to Colney Hatch, and inspect the working of the new treatment.
Colney Hatch Asylum is probably the largest in the world : for, although the Salpetrière may cover more ground, it includes a hospital, a reformatory, and other buildings unconnected with lunacy. The first thing that strikes the visitor is the remarkable quietude: he has, doubtless, preconceived notions about lunacy generally, and has not yet resigned the feeling of dread with which he has invested the subject. After he has looked about him sufficiently long to convince himself that no patients are lurking round corners in order to pounce on him, or perform any of those playful tricks which novelists of the Lorrequer school have described (I pity their taste) as occurring in private asylums, the visitor cannot help noticing the beautiful cleanliness and order every where prevailing. Ere I visited Colney Hatch I had believed that a man-o'-war was the beau-ideal of order; but I may safely affirm that the system prevailing at Colney Hatch is not surpassed on board the most crack vessel in her Majesty's Channel fleet, although the latter is far more expensive to produce. The next stage the visitor passes into is one of bewilderment; for he is led along interminable passages, all precisely alike, and he helplessly resigns himself to the kindly offices of his guide.
The asylum stands in its own grounds, which are well shut in, although no obtrusive stone wall is visible: in these grounds the patients roam about in perfect freedom, and the parterres are as well kept up as in a gentleman's private park. We might reasonably suppose that such patients would take a delight in planting trees root upwards, breaking off branches, and picking all the flowers; but destructiveness is no longer the rule with the mentally afflicted. It is true that here and there instances are still found of patients who have a fancy for tearing up their books and clothes, but it is remarkable how soon they are cured of such propensities. Slight confinement, or privation of small comforts, regarded as great by these childish intellects, is in most cases found sufficient to enforce an obedience to the regulations.
The facade of the asylum, which is of enormous length, is divided into two equal wings by a gateway and dome in the centre. On entering the hall the visitor has the male wards on his left, the female on his right, hand; the neutral ground between them being occupied by the chapel,
official rooms, and dining-halls. On entering a ward, say on the female side,for, although both are much alike, I presume that the visitor will feel more comfortable among the gentler sex,-he will probably have his preconceived ideas as to lunacy at once and for ever overthrown. He finds himself in a very long, well-ventilated, and cheerful gallery, with doors opening out of it to the sleeping-cells. In the centre is a species of bay, in which are the fire-places and a pleasant out-look on the exercising grounds, while down the gallery are covered tables, bearing chess- and draught-boards, gay flowers, and other social amenities. The walls are hung with engravings, among which the coloured pictures of the Illustrated London News occupy a prominent place, while in the majority of the wards there is an excellent pianoforte. An inspection of the sleeping. rooms is equally satisfactory; they are beautifully clean and comfortable, and there is about their arrangements a thoughtfulness which does the heart good when we reflect on the class for which they are provided. Among them are a lavatory, a species of pantry, and the padded and half-padded rooms. The latter, however, are principally kept up in terrorem, or a patient may be placed in them, whom recurrent illness induces to disturb the rest of her companions; for, with all their quietude, the patients have this in common with the denizens of the Zoological Gardens, that when one begins to make an uproar, all the others grow excited.
The guard of such wards, which contain an average of seventy to eighty patients, is confided to two young women, whose sole weapon of defence is a whistle, which may be heard for a long distance, I grant, but would be powerless in the event of a combined attack, such as we read of in Mr. Whitty's Friends of Bohemia. These nurses are in no way selected for their strength, but they are as safe as the traditional lady who, as Moore tells us, used to walk about Ireland covered with jewelry, before car-drivers were introduced. In the first place, there is always a certain number of patients who will help the nurses, either through selfinterest or a feeling of affection; and secondly, the medical superintendent knows, as it were intuitively, when a patient is inclined to grow dangerous, and has her removed. I need not say that classification goes for a great deal in the prevention of émeutes.
The wards are nearly all alike, of course with this difference, that epileptic and dirty patients are kept apart, and small luxuries would be thrown away on them. The house-work of the asylum is performed by the patients, who appear to take a pride in keeping the wards and cells clean; and a visit to the laundry is worth a day's journey. In a word
, regarding Colney Hatch as a pauper asylum, that is to say, a building maintained by the metropolitan ratepayers,—where the expenditure of every extra shilling is jealously watched by some friend of the people or popularity-hunting county magistrate, who is nothing if not critical, and
* In every asylum and hospital I have visited, I have seen the well-known print of the “Great Eastern" occupying the post of honour.
not very much even then, the management reflects great credit on all parties concerned. When I look at Colney Hatch as a pauper asylum, and remember the way in which paupers as a rule are treated, I take off my hat to the Middlesex magistrates, for recognising progress so far as they have done. They have so long been an object of ridicule, and perhaps justly so, that I have resolved to do all I can to rehabilitate them, though never forgetting that, while Plato is my friend, truth is my sister.
. Colney Hatch Asylum is recruited from the northern and eastern parts of the metropolis, while Hanwell offers an asylum to patients from the west and south-west. Although pauper patients, I regret to say, represent nearly every class of the community, the majority come from the lower strata of society, in the shape of small tradesmen, costermongers, and their wives and families. The causes of mania are, in the first place, a propensity for drinking ; secondly, religion; and lastly, mental depression, produced by a hard and incessant struggle for the means of existence. Among the latter, poor needlewomen figure to a large extent. With a small portion there is an hereditary predisposition to mania; but as I am treating my subject generally, I may omit them. The facilis descensus by which patients reach the asylum can be easily described : they display traces of an undeveloped mania, and their friends, with that laudable desire of Englishmen to keep aloof from the parish as long as possible, conceal the fact, and endure much suffering in consequence. At length the patient grows worse, or the family funds are exhausted, and no resource is left; the parochial doctor is called in; he very speedily decides the question of sanity--for no Windham examination takes place with the utterly poor; the circumstances of the family are investigated, and if nothing can be contributed by them to the patient's support, the parish authorities hand him over to the county asylum, and undertake to pay fourteen shillings a week till he is cured, which is doubtful, or till he dies, which is certain.
And now let me look at the reverse of the medal. It has been stated over and over again that the maximum of patients an asylum should hold is five hundred, if any hope of permanent cure is entertained. Several of the commissioners, when examined before a committee of the House, reduced this maximum to three hundred. Now, at Colney Hatch there are over two thousand patients, in all stages; and the medical staff, though numerous enough to attend to the physical wants of the patients, have no time to devote to curative processes. It is also certain that such an aggregate of patients must have a deleterious effect on each other, and that those who have a remnant of sanity left gradually drift, through constant association, into the same hopeless state as the rest. Virtually we may say, therefore, that a patient who has once entered Colney Hatch has little chance of ultimate recovery. But I have a worse objection to offer : the system prevailing at Colney Hatch is an amalgamation of those existing in prisons and workhouses, and the effect is most depressing. All the patients who addressed me, and they were numerous, wanted to know what crime they had committed to be shut up in prison. An idée fixe, if you will, but the incessant locking and unlocking, and the clang of keys, are apt to make the visitor much of the same opinion. Then again, in their desire for order, the magistrates appear to have gone to the opposite extreme, and employed a Prussian bureaucrat to draw up the regulations. A dull uniformity offends the eye: the warders resemble continental policemen minus the sabre; the nurses wear dresses all alike; and the patients represent a regiment in the uniformity of their clothing. Another fault I find with Colney Hatch is the great number of idiots mixed up with the patients proper : were they placed in a building of their own, as common sense dictates they should be, the number of patients at Colney Hatch would be greatly reduced, and I feel assured that great advantage would accrue. Altogether, then, beyond the cleanliness and order, I cannot bestow any great praise on Colney Hatch; for it has been allowed to become a refuge for incurables, instead of fulfilling its higher mission as a place of cure. Far be it from me to attach any blame to the medical department for this lâche : they work with an energy and perseverance beyond all praise; but I regret that the county magistrates should have allowed the evil to grow above their heads, and the result is, that a building destined for the simply unfortunate has gradually assumed the aspect of a prison.
The next large pauper asylum I will select as a type is the Surrey, pleasantly situated on Wandsworth Common. It is a very handsome building in the Elizabethan style, and intended for one thousand patients
. Although many of the faults I have mentioned in connexion with Colney Hatch exist here, I am bound to confess that it is in every respect a more cheerful place, and I noticed a more hopeful look among the patients, instead of the prevailing sullenness at Colney Hatch. I am glad to say, too, that they made considerably more noise, which struck me as a recog. nition of their existence. If I may venture the comparison, Colney Hatch resembles a huge schoolroom, with the master seated at his desk and toying with his cane, and the Surrey Asylum the same schoolroom when the master's back is turned. One great point is, that there is not a single uniform throughout the building, and the patients do not suffer from the presence of self-obtruding authority. As a class they are much the same as at Colney Hatch, and in both establishments it is a gratifying thing to notice the tolerance granted to all religious creeds. I was specially struck at Colney Hatch by the sleeping-room of an old Catholic dame, in which she had arranged a small altar, while the walls were covered with pictures of saints and holy women. In one respect the Surrey Asylum possesses a marked superiority over Colney Hatch, and that is in the farm ; which, through the intelligent care of Mr. Bridgelands
, is not only self-supporting, but at the same time allows the male patients to be employed in a way that causes a great saving in the medical stores.
The Essex County Asylum at Brentwood may be regarded as the model of pauper buildings of this class. The Asylum, which is a very