Appendix D.

(Page 173.)

9 GEO. IV., C. 40 (1828).

The fifteen persons appointed Commissioners in Lunacy for the metropolitan district, five of whom were physicians, were paid L1 an hour, and were appointed for one year. They were to meet quarterly for the purpose of granting licences, those in the provinces being granted by justices at quarter sessions, where three or more justices were to be elected to visit the provincial licensed houses, together with at least one medical Visitor.

Three of the Commissioners were to visit licensed houses in the metropolitan district four times a year.

Two justices to visit licensed houses in the provinces, accompanied by the medical Visitor, four times a year.

An annual report was to be prepared and presented to the Secretary of State for the Home Department.

Private patients were not to be admitted to asylums without the certificates of two medical men and an order; the certificates being in force fourteen days before admission.

Pauper patients were not to be admitted without one medical certificate and the order of two justices, or an overseer and clergyman.

The proprietor of an asylum had to transmit a copy of documents to the Commissioners or justices, as the case might be.

Single patients to be received on like order and certificates. No regular visitation of this class instituted.

It should be stated that among the previous Acts, now repealed, there was a small Act passed May 2, 1815, notwithstanding the failure of Mr. Rose to induce Parliament to undertake legislation based on the evidence given before the Committee of that year. This was the Act 55 Geo. III., c. 46, entitled, "An Act to amend an Act 48 Geo. III., c. 96 (1808), being an Act for the better Care and Maintenance of Lunatics being Paupers or Criminals in England."

The committee of visiting justices of lunatic asylums were to be elected annually.

Subscribers to lunatic asylums erected by voluntary contributions, who should unite with any county, might elect a committee of governors to act with committee of visiting justices.

Justices to fix sums to be expended in purchase of lands, houses, etc., or in erecting buildings.

Overseers of the poor to return lists of all lunatics and idiots within their parishes, verified on oath and accompanied with a medical certificate.

When any asylum could accommodate more lunatics, magistrate might order an addition under certain regulations.

APPENDIX E.

(Page 188.)

8 AND 9 VICT., C. 100 (1845).

The following are the clauses of the Act which provide for the expense of carrying out its provisions.

By this statute it was enacted, after repealing 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV., c. 64; 5 and 6 Will. IV., c. 22; 1 and 2 Vict., c. 73; 3 Vict., c. 4; 5 and 6 Vict., c. 87, that the Commissioners in Lunacy under 5 and 6 Vict., c. 84, should be henceforth called "the Masters in Lunacy," and that new Commissioners in Lunacy should be appointed. The Commissioners were to grant licences for the reception of lunatics within a certain jurisdiction of the metropolis; justices of the peace in general or quarter sessions licensing houses for the reception of lunatics and appointing Visitors in all other parts of England and Wales, including a medical man. For every licence granted a sum to be paid of ten shillings for every private patient and two shillings and sixpence for every pauper, or so much more as shall make up the sum of fifteen pounds, these moneys being applied towards the payment of the expenses of the Commissioners or any charge incurred by their authority. The secretary of the Commissioners to make out an annual account of moneys received and paid by him in the execution of the Act, to be laid before the Lords Commissioners of the Treasury, the balance (if any) to be paid into the Exchequer to the account of the Consolidated Fund, such accounts being laid before Parliament every year, the Treasury being empowered to pay out of the Consolidated Fund any balance of payments over receipts which may be necessary. With regard to the application of moneys received by the clerk of the peace for provincial licences, they were to be applied towards the payment of the clerk to the Visitors for the county, and the remuneration of the medical Visitors, and other expenses incurred in the execution of the Act, the accounts being laid before the justices at the general or quarter sessions, who shall direct the balance (if any) to be paid into the hands of the treasurer of the county or borough in aid of the rate; any balance of payment over receipts being paid out of the county or borough funds.

There was paid into the Exchequer in the year ending March 31, 1880, L1376 for licences in the metropolitan district, besides L18 stamps. Lunacy Board expenses, L15,064.

I have not any accurate returns of the amounts received from the provincial houses, but on a rough estimate these licences produce to the counties in the aggregate L1452, and L30 to the Imperial Exchequer, per annum.

In the following year, August 26, 1846, an Act was passed "to amend the Law concerning Lunatic Asylums and the Care of Pauper Lunatics in England," and was to be construed with 8 and 9 Vict., c. 126. There were only twelve sections. It was passed to clear up doubts which had been entertained as to the meaning of certain clauses in the above Act. It was repealed by 16 and 17 Vict., c. 97.

APPENDIX F.

(Page 190.)

After the legislation of 1853, the Acts referred to at p. 190 and p. 188 constituted, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and the Acts relative to criminal lunatics, the then code of Lunacy Law.

Lord St. Leonards' first Act, p. 188 (16 and 17 Vict., c. 70), enacts that when the Commissioners shall report to the Lord Chancellor that they are of opinion that the property of any lunatic, not so found by inquisition, is not duly protected, or the income thereof not duly applied for his benefit, such report shall be deemed tantamount to any order or petition for inquiry supported by evidence, and the case shall proceed as nearly as may be in all respects as therein directed upon the presentation of a petition for inquiry.

The next Act (16 and 17 Vict., c. 96) prescribes amended forms of orders and certificates, notices of admission, and of the medical visitation book.

The requirements on the part of the medical man signing the certificate are laid down.

Empowers proprietors or superintendents of licensed houses (with consent of Commissioners) to entertain as a boarder any patient desiring to remain after his discharge, or any relation or friend of a patient.

Authorizes amendment of any order or certificate within fourteen days after admission of patient.

Permits the Commissioners to allow medical visitation of single patients less frequently than once a fortnight.

Empowers one or more Visitors to visit single patients at request of Commissioners, and report to them their condition.

Directs that the medical man who visits a single patient shall make an annual report to the Commissioners of the mental and bodily health of such patient.

Empowers the Lord Chancellor to discharge single patients.

Directs that notice of the recovery of every patient shall be sent to his friends, or in case of a pauper to his parish officers, and in case of death of a patient in any hospital or licensed house, a statement of the cause, etc., to the coroner.

Authorizes transfer of a private patient (with consent of two Commissioners) from one asylum, hospital, or licensed house to another, without any fresh order or certificate, and similarly as to single patients.

Empowers the Lord Chancellor, on the representation of the Commissioners, to require a statement of the property and application of the income of any person detained as a lunatic under an order and certificates.

Extends to the Commissioners the powers vested in the private committee, as to single patients, by the Act 8 and 9 Vict., c. 100, s. 111.

Repeals s. 27 of 8 and 9 Vict., c. 100, as to the visitation of workhouses; and enacts that one or more Commissioners shall visit such workhouses as the Board shall direct.

Authorizes the Commissioners in urgent cases to employ any competent person to visit any lunatic and to report to them.

Directs committee of every hospital to submit regulations to the Secretary of State for approval, and to send a copy to Commissioners.

Empowers Commissioners, with sanction of the Secretary of State, to make regulations for the government of licensed houses.

Enacts that Bethlem Hospital shall be subject to the provisions of Act 8 and 9 Vict., c. 100.

The third Act (16 and 17 Vict., c. 97) repeals the several Acts then in force respecting county and borough lunatic asylums, and re-enacts most of the provisions therein contained, with certain additions and improvements.

It authorizes justices of boroughs, instead of providing asylums for their own use, or in arranging with counties, etc., to contract with the Visitors of any asylum for the reception of their pauper lunatics, in consideration of certain payments.

The powers of the Visitors were enlarged in many ways.

When a county or borough asylum can accommodate more than its own pauper lunatics, the Visitors are empowered to permit the admission of the pauper lunatics of any other county or borough, or lunatics who are not paupers, but proper objects to be admitted into a public asylum, such non-pauper patients to have the same accommodation, in all respects, as the pauper lunatics.

The Visitors are directed to appoint a medical officer to be superintendent of the asylum.

They are empowered to grant superannuation annuities to the officers and servants.

They are directed to make an annual report to the general or quarter sessions of the state of the asylum.

Every pauper lunatic, not in an asylum, hospital, or licensed house, is to be visited every quarter by the medical officer of the parish or union, who is to make return thereof; and the medical officer is to be paid two shillings and sixpence for every visit.

The forms of orders, statements, and medical certificates are amended, and the medical officers of unions are permitted to sign certificates.

The medical man certifying is required to state his qualification, when and where the patient was examined, and to specify facts indicating insanity; distinguishing facts observed by himself from those communicated to him by others.

Visitors are empowered to order the removal of pauper patients to and from asylums, and also to discharge or permit the absence on trial of any patient. The Commissioners are empowered to direct the removal of any lunatic from any asylum, hospital, or licensed house to any other.

The person signing the order for admission of a private patient into an asylum may discharge such patient, subject, in the case of dangerous lunatics, to the consent of the visiting justices. Any person having authority to discharge a private patient is empowered (with consent of two Commissioners) to transfer him to another asylum or to the care of any person.

Orders and certificates, if defective, may be amended within fourteen days.

Patients escaping may be retaken within fourteen days.

This statute did not re-enact the clause contained in the Act it repealed respecting workhouses.

18 AND 19 VICT., C. 105 (1855).

In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth Years of Her Majesty, for the Regulation of the Care and Treatment of Lunatics."

By this statute it was enacted that any single county or borough might unite with the subscribers to a registered hospital, and that the proportion of expenses between any county and borough might be fixed with reference to accommodation likely to be required.

Other sections provide in detail for the maintenance of county and borough asylums, and other matters which it is unnecessary to enumerate.

APPENDIX G.

(Page 195.)

A short summary is added of the provisions in force at the time of the Select Committee of 1859-60, for the protection of private patients. They remain essentially the same.

In the metropolis, the power of licensing is exclusively in the hands of the Metropolitan Commissioners. In the provincial districts it rests with the justices at quarter sessions. These licenses are annually renewed, and they may be revoked by the Lord Chancellor. The patients are admitted upon an order signed by some relative or friend, with a statement of all the particulars of the case. This statement must be supported by the certificates of two medical practitioners, who, having examined the patient separately within seven days previous to the reception, state that he is a person of unsound mind, and a proper person to be detained under care and treatment. It must also specify the grounds upon which their opinion has been formed, viz. the facts observed by themselves or communicated by others. After two and before the expiration of seven clear days, the proprietor or superintendent of the licensed house must transmit to the Commissioners, and also to the visiting justices, if the licensed house is within their jurisdiction, a copy of the order and certificates. The licensed house must be visited by two of the Commissioners, four times at least every year, if it lies within their immediate jurisdiction; and if beyond, it must be visited four times at least by Visitors appointed by the justices, one of whom shall be a medical man, and twice at least by two of the Commissioners. In the course of such visits, inquiries are directed to be made as to the occupation, amusement, classification, condition, and dietary of the different patients, and also whether a system of non-coercion has been adopted or not; and where it shall appear, either to the Commissioners or to the visiting justices, that a patient is detained without sufficient cause, they have the power, under certain conditions, of ordering his discharge. When a patient recovers, the proprietor or superintendent is required to send notice of such recovery to the person who signed the order for his reception; and if such patient is not discharged or removed within fourteen days, the proprietor is required immediately to transmit a similar notice to the Commissioners or visiting justices, as the case may be. When a patient dies, the medical practitioner who attended such patient during his illness is to cause a statement to be entered in the case-book, setting forth the time and cause of death, and the duration of the disease of which the patient died, and a copy of such statement, within two days, must be transmitted to the coroner. In addition to these specific provisions, the Commissioners have power from time to time to make regulations for the government of any of these licensed houses, and they must report annually to the Lord Chancellor the number of visits they have made, the number of patients they have seen, the state and condition of the house, the care of the patients therein, and such other particulars as they may think deserving of notice (p. vi.).

25 AND 26 VICT., C. 111, "THE LUNACY ACTS AMENDMENT ACT, 1862."

In consequence of the importance of the Act of 1862, the Commissioners issued the following circular noting its chief provisions:--

Private Patients.

Sec. 23.--The order must be dated within one month prior to reception; the person signing the order must himself have seen the patient within one month prior to its date; and a statement of the time and place when the patient was so seen must be appended to the order.

Sec. 25.--When possible, every order must contain the name and address of one or more relations of the lunatic, to whom notice of the death of a lunatic must be sent.

Sec. 24.--Besides the persons hitherto prohibited from signing certificates and orders, the following also are now disqualified:--Any person receiving any percentage on or otherwise interested in the payments for patients, and the medical attendant as defined in the Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.

Sec. 26.--Where a patient received as a pauper is made a private patient, no fresh order or certificate is required, and vice versa.

Sec 28.--With the exception of the statement by the medical officer as to a patient's mental and bodily condition, all the documents heretofore required to be sent to the Commissioners after two or before seven clear days from the reception of the patient, must in future be sent within one clear day from such reception. The medical officer's statement is, as heretofore, not to be sent until after two and before seven clear days.

Letters of Patients.

Sec 40.--Without special directions to the contrary, letters addressed to the Commissioners, committees of Visitors, committees of a hospital, and the Visitors of licensed houses, must be forwarded unopened. Other letters must also be forwarded, unless, by an endorsement thereon, the superintendent or other person having charge of patients should prohibit their transmission. Letters so endorsed to be laid before Commissioners, committees, or Visitors at next visit.

Sec. 38.--Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.

Sec. 43.--In the absence of any person qualified to discharge, a discharge or removal may be ordered by the Commissioners.

Pauper Patients.

Sec. 25.--The order must contain the name and address of one or more relations of the lunatic, and notice of the death of the lunatic must be sent to such relation.

Sec. 38.--A pauper permitted to be absent on trial from a licensed house or hospital may have such an allowance made to him by order of the Commissioners, Visitors, or committees as would be charged for him were he in the house or hospital.

Licensed Houses and Hospitals.

Secs. 14 and 15.--No fresh licence can be granted by justices without inspection and report by the Commissioners. Notices of alterations in houses licensed by justices must be given to Commissioners. Their report must be considered by the justices before licence is granted or alterations are consented to.

Sec. 16.--The physician, surgeon, or apothecary not being a licensee, where any such is by law required to reside in or visit a licensed house, must in the metropolitan district be approved of by the Commissioners, and in the provincial district by the visiting justices.

A penalty is imposed on any person infringing the terms of his licence as to numbers, sex, or class.

Sec. 18.--With consent of two of the Commissioners, or, in the case of the provincial licensed houses, of two of the Visitors, a person who may have been a patient within five years immediately preceding, may be received as a boarder into a licensed house (extension of c. 96, s. 6).

Sec. 29.--Licensed houses may be visited at any time by one or more of the Commissioners or Visitors, but in the metropolitan district they must be so visited twice in the year, in addition to the present visits by two Commissioners, and in the provincial districts similarly by Visitors. Commissioners and Visitors visiting singly have substantially the same powers of inspection and inquiry as when visiting together. To these the sixty-second section of the Act does not apply.

Sec. 39.--A penalty is now imposed on any officer or servant conniving at an escape.

Sec. 43.--In the absence of any person qualified under ss. 72, 73, c. 100, the Commissioners may order discharge or removal of a patient.

Sec. 38.--Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.

Medical Certificates.

Sec 27.--Where medical certificates have been returned with a written direction of the Commissioners for amendment, and such amendment shall not have been made within fourteen days, the Commissioners may order the patient's discharge.

Sec. 22.--Lunatics so found by inquisition may be received without certificate on an order of the committee, accompanied by an official copy of the order appointing such Committee.

Workhouses.

The Poor Law Board issued a circular at the same time. The only paragraph which it is of interest to cite here is the following:--"The eighth section empowers the Visitors of any asylum and the guardians of any parish or union within the district for which the asylum has been provided, if they shall see fit, to make arrangements, subject to the approval of the Commissioners in Lunacy and the President of the Poor Law Board, for the reception and care of a limited number of chronic lunatics in the workhouse of such parish or union, to be selected by the superintendent of the asylum and certified by him to be fit and proper so to be removed. The Board are at present not aware of any workhouse in which any such arrangement could conveniently be made; but they will be ready to consider any such proposals on the subject when the Visitors of the Board of Guardians of any union shall find it convenient or practicable to act upon this clause."

FOOTNOTES:

Seventeenth Report of Commissioners in Lunacy, 1863.

APPENDIX H.

(Page 205.)

Extract from the British and Foreign Medical Review, January, 1840:--

"In this particular there is apparently no asylum in England which presents so remarkable a model as that of Lincoln. Of all the works that have appeared on the subject of lunatic houses since the publication of Mr. Tuke's account of the Retreat, there is none which contains matter more deserving of attention than that recently published by Mr. Hill. His lecture is little more than a simple commentary on the resolutions of the board of management of the Lincoln Asylum for twenty years past; during which period, under the superintendence of Dr. Charlesworth, and latterly with the vigilant co-operation of Mr. Hill himself, as house surgeon, almost every kind of bodily restraint is stated to have gradually fallen into disuse as superfluous, a mere substitute for want of watchful care.... If the Lincoln Asylum can present a model of this kind, which all may visit and examine, the services of Dr. Charlesworth to the cause of humanity and in behalf of the insane, already considerable, will only be second to that of him who first released them from their chains."

On this Mr. Hill observes, July 8, 1840:--

"At last the first Medical Review in Europe took up the subject, and placed most deservingly Dr. Charlesworth in a striking position as to the non-restraint system, and also honoured myself with approbation."

The following extracts from the Orders in the Lincoln Asylum books are essential to the right understanding of the introduction of non-restraint there. Dr. Charlesworth was visiting physician from its opening in 1821; Mr. Hill was appointed house surgeon in 1835.

"1828. Ordered--That the use of the strait waistcoat be discontinued in this institution except under the special written order of the physician of the month.

"1828, October 13. Ordered and resolved--That the physicians be requested to consider whether it be possible to make any improvement in the means of restraint now in use, and especially for obviating the use of the strait waistcoat."

Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829, April:--

"The governors have particularly directed their views to the subject of coercion and restraint, well aware of their injurious consequences to the patients.... The construction of the instruments in use having also been carefully examined, they have destroyed a considerable proportion of those that were not of the most improved and least irritating description, and hope hereafter to introduce still further amelioration into this department."

Extract from the House Visitor's Report, 1829, August 17:--

"Every attention seems to be paid to the patients, whose general state has, I understand, for some time past, been so generally good that it is gratifying to say that the strait waistcoat has almost become useless."

Extract from the Seventh Annual Report, 1831, March 28:--

"Heretofore it was conceived that the only intention of a receptacle for the insane was the safe custody of the unhappy objects, by any means, however harsh and severe. These views are now passing away, and the fair measure of a superintendent's ability, in the treatment of such patients, will be found in the small number of restraints which are imposed. The new director has answered this test in a very satisfactory manner."

The new director here referred to was Mr. Henry Marston. The following note is appended to this report:--

"As early as the 24th day of November last (viz. Nov., 1830, five years before Mr. Hill's appointment), there was not any patient in the house under restraint, unless one wearing a collar, which leaves all the limbs quite at liberty, can be so considered. This gratifying occurrence has taken place more than once since that time."

Extract from the Ninth Annual Report, 1833, April:--

"It is unceasingly an object in this institution, and should form a prominent point in the annual reports, to dispense with or improve as much as possible the instruments of restraint."

Extract from the House Visitor's Report, 1834, August 4th to 10th inclusive:--

"I have much satisfaction in being able to state that not a single male patient has been under restraint since the 16th of July, and not one female patient since the 1st of August, and then only for a few hours."

At this time Mr. Hadwen held the appointment of house surgeon.

Extract from the Governor's Memorandum Book, 1835, July 8th:--

"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen during the period of fifteen months that he held the situation of house surgeon of this institution, feel called upon to express their high approbation of the very small proportion of instances of restraint which have occurred amongst the patients under his care."

Extract from Edinburgh Review, April, 1870:--

"But to Conolly belongs a still higher crown, not merely for his courage in carrying out a beneficent conception on a large scale and on a conspicuous theatre, but for his genius in expanding it. To him, hobbles and chains, handcuffs and muffs, were but material impediments that merely confined the limbs; to get rid of these he spent the best years of his life; but beyond these mechanical fetters he saw there were a hundred fetters to the spirit, which human sympathy, courage, and time only could remove.

"Perfect as was the experiment carried out at Lincoln Asylum, the remoteness of that institution from the great centre of life, and the want of authority in its author, would no doubt have prevented its acceptance for years by the physicians of the great county asylums so long wedded to old habits. It was for some time treated as the freak of an enthusiastic mind, that would speedily go the way of all such new-fangled notions; and no doubt it would, had not an irresistible impulse been given to it by the installation of Dr. Conolly at Hanwell, where, with a noble ardour, he at once set to work to carry out in the then largest asylum in the kingdom the lesson he had learned at Lincoln."

Dr. Conolly's works bearing on mental disorders, in addition to his "Lectures on Insanity," were as follows:--

1. "An Inquiry concerning the Indications of Insanity, with Suggestions for the better Protection and Care of the Insane." 1830.

2. "The Construction and Government of Lunatic Asylums and Hospitals for the Insane." 1847.

3. "The Treatment of the Insane without Mechanical Restraints." 1856.

See "Memoir of Dr. Conolly." By Sir James Clark. 1869.

FOOTNOTES:

As given in the Journal of Mental Science, July, 1870.