Inspection of County Lunatic Asylums

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Inspection of County Lunatic AsylumsAuthor(s): Adam HunterSource: Provincial Medical Journal and Retrospect of the Medical Sciences, Vol. 4, No. 5 (May7, 1842), pp. 89-94Published by: BMJStable URL: http://www.jstor.org/stable/25491158 .

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INSPECTION OF COUNTY LUNATIC ASYLUMS. 89

perfecting a process which-it would be contrary to all experience to believe-had started at once from infancy to manhood, from the first glimpses of truth to its perfect development. I must also most dis tinctly deny his assertion at page 12, that vacciniation " now stands convicted, in the judgment of the whole canldid and experienced members of the medical pro fession, of being unworthy of further confidence." So far from it, I would assert that, howeNer prejudices

may have been created in the minds of many, yet that, in the real judgment of those who have not suf

fered themselves to be led astray by a few facts wllich only invalidate the perfectionl of the process, or by the erroneous reasonings of partial observers, the value of vaccination stands unimpeached, not as a prophylactic against small-pox, but as the best security

which can be obtained against the malignity of its effects.

I will not trespass longer upon your time in the present letter; but, if you think the subject worthy of

more extended consideration, I will, if my engage ments permit, follow Mr. Brown through his volume for a few successive weeks; and, with best wishes for

your success, I remain,

Yours faithfully, W. NEWNHAM.

Parnham, April, 1842.

INSPECTION OF COUNTY LUNATIC ASYLUMS.

TO THE EDITORS OF THE PROVINCIAL MEDICAL JOURNAL.

GENTLEMEN,-On tlle 17th of March last, Lord

Granville Somerset brought forward a motion in the House of Commons relativ-e to the inspectioll of lunatic asylumns in England and Wales, in which, duriig his speech, and in that of Lord Ashley, as re

ported in the " Times" of the following day, ex

pressionis were contained, and principles attempted to be established, no less derogatory to the medical pro fession than they are undoubtedly and palpably in

correct. Not being anxious at any time, and par ticularly in my present state, to appear before the

public in suclh matters, I have waited with some im

patience in the hope of seeing the subject taken up by your Journal,* the " Lancet," or the " Medical

Gazette," which I am accustomed, in your various

walks, to consider the three weekly organis or guardirns

of the public medical weal-but as you have not

hitherto done so, I shall endeavour, with as much

brevity as the subject will admit, to bring it before your readers, and particularly the council of tile Pro vincial Medical Association, and the officers of other public medical institutions, that measures may be

adopted to support the character and defend the in terests of the profession. For whatever may be the expectations entertained by some of medical reform -of which, judginig from other reforms, I have very limited hopes-it would be bad policy to neglect the present rights of the profession, to lose the substanice for the shadow, and tacitly to submit to encroach

The subject was taken up in our Number for April 10, which had not reached Dr. Hunter.

ments no less unjust than injurious, under the flatter

ing prospect of ultimate though indefinite redress.

It is known to every medical practitioner that there

are several acts of Parliament relating to lunatic

asylums and the care of their unfortunate inmates;

and to improve, amend, or extend one of these acts,

passed in 1828, is the ostensible object of Lord G.

Somerset in his proposed new bill. To guard myself

from, or rather to deprecate, any real or apparent

inaccuracy, I think it proper at this stage to lay be

fore you the limited sources of information which are

at present in my power. Having been recommended

to this remote quarter to regain my health, which

gave way early last winter, and being forbidden the

use of much or severe study, my reading is mainly

confined to the " Times " paper, and the three medical

journals already referred to. My authorities, there

fore, are limited,

1. To the report in the " Times" of March 18, the

speakers being Lord G. Somerset, Mr. WVakley, Mr.

Hawes, and Lord Ashley, with a few brief remarks

from Mr. C. Wynin.

2. A few days afterwards the following useful

paragraph, which I shall here copy entire, appeared

in the " Times," headed,

"Metropolitan Commissioners of Lunacy.-From

the official returns ordered to be printed by the

House of Commons, on the 3rd of February last, it

appears that there were under their direct charge or

inspection 36 houses, of which 4 were devoted to

pauper and private patients, and 32 to private patients

only, these being independent of the different county

lunatic asylums. Of these 32 houses, there were

5 kept by resident medical proprietors, 4 by physicians

resident in London, ]6 by resident proprietors not

being medical men, and 7 by non-resident proprietors

of the saige class. Of the counties under the joint

jurisdiction of the commissioners and the courts of

quarter sessions, there are 14 which contain no

licensed houses, and the remaining 26 contain 87,

which did not, in the course of five years, include an

average of above 2,500 patients. Within the period

there was oniy one license suspended, which was in

Dorsetshire. In the last five years the expenses

of the commissioners have been no less than

?13,583 17s. 6d., of which there was paid, as fees

to two barristers, ?2,920; to five physicians, ?6,498;

the salary of the secretary, ?2,000; and chaise hire

and other incidental expenses, ?2,165 17s. 10d. The

average annual charge of inspecting each house was

?388 !"

3. In tlle "Lancet" of April 3, under the head

"British Medical Association," at a half-yearly meet

ing held March 29, tlle subject, among other matters,

is introduced by Dr. Granlville in a spirited manner,

and a resolution passed, on which a petition is to be

founded, and presented against the bill.

4. On the 8th of April there appeared in the

"Times " an able anid argumenitative letter under the

signature Ignatus, which, had it been also inserted in

the medical journals, or even an epitome of its con

tents given, my present attempt w%~ould have been

superseded. Besides clearing myself, I wish to put

your readers in possession of these data, which are

easily attainable. Wlhatever may have been done or

published in other quarters, I havc no means of ascer



90 INSPECTION OF COUNTY LUNATIC ASYLUMS.

taining, situated, as I am, inl the extreme cornier of

this remote Patmos.

Lord G. Somerset, then, after some preliminary

observations, proceeds to state the great object of the

bill of 1828, which has already undergone several

amendments, to have " proper houses of a proper

character licensed for the reception of insane people, to be conducted on proper principles, so as to conduce

to the comfort and inisure proper treatment to the

inmates; to prevent persons not in a state of insanity being confined; and, lastly, to prevent persons when

recovered being detained in such asylums." By the

same act it appears " that all licensed houses were

brought under two separate and distinct authorities." A certain number, about one half, under the authority

of the metropolitan commissioners, consisting of twenty individuals, including five physicians, two bar

risters, the rest gentlemen who dedicated their time and trouble to this object. This commission super

intends all the licensed asylums in Middlesex, Surrey,

Kent, and Essex, of course including London, and is

the object of the noble lord's unqualified panegyric. " The remainder of the houses licensed," in the

noble lord's words, " throughout the rest of England were placed under a different jurisdiction; they were

licensed by the magistrates at quarter-sessions, and

placed under the superintendence of physicians and

magistrates then appointed to visit them; and in

addition to these gentlemen were others, who devoted their time to this work of humanity. There were also

individuals whose particular business it was to pay

more especial attention to the conducting of these

houses." WVhile Dr. Granville, in the speech already

referred to, states, " the latter bodies are to make

reports to the metropolitan commissioners, and these

again are to make annual reports to the government."

We have here apparently plenty of machinery, and on

nlo antique model either, provided it were well wrought. This is the question as regards the public. Lord G. Somerset thinks it is not, and to amend it proposes his present bill, which, as I understand it, has this amount and no more-to appoinit the two luIIatic bar risters already in the metropolitan commission, who

are now only paid for the time they devote to the

London district, to superintend all the asylums in the

country. They are to relinquish all their legal pursuits,

anld to receive a suitable salary.

But I anticipate-before, however, quoting more of

the noble lord's speech, or attempting to analyse it, or

that of the other speakers, let it be distinctly under

stood that I no more wish or intend to impugn the

noble lord's motives than I wish my own integrity in

thlis matter to be questioined. With Dr. Granville

anid I notus, I believe him and Lord Ashley, whose

speech I shall also have to comment upon, to be two

most estimable noblemeni, ornamenits to their own

order anld an honour to the British senate. I think,

however, that in this instance they are both grievously

mistaken, and, as regards the medical profession,

severely unljust. Lord G. Somerset, then, to show cause for his bill,

proceeds to poilnt out the defects of the present pro

vincial system, the gqravamen of which is, the inatten

tion of those wvho ought to visit or iinspect these asy lums. This I am not prepared either to affirm or

deniy, havinig no appointment of the kinid, thouglh I

think it can scarcely apply to the magistracy of the

county of York, among which there are both clergy

mlen, physicians, and barristers. After paying his

brotlier magistrates some left-hanlded compliments for

their negligence or apathy in the discharge of this im

portant duty, the noble lord returns to his favourite

metropolitan commission. " He believed that no sys

tem could work better; the medical, legal, and other

gentlemen of that commission had vied with each other

in their exertions to render their superintendence as

efficient as possible-they had not only done a great

deal of good by their exertions, but prevented much

harm." Ignotus coolly hints upoIl this that seven of

them were pretty well paid for these exertions, but

that I think is all fair-the labourer, in his proper

place, is worthy of his hire. I come now to what I

must term the puff preliminary, preparatory to the

introduction of, and assigning the reasons for, the sin

gular machinery by which the noble lord proposes to

work the new bill, wherein he not only gives the pro

vincial magistracy a regnlar summerset, but, which is

our point, in the same breath deals heavy blows and

great discouragement to the medical profession-a profession which, whatcvcr the noble lords may thiink

or aver, I feel confident to assert, and competent to

prove, has not only fewer favours from the government

than any of the other learned professions, but does

more in its different branches for the poor and helpless

than all the lawyers and law-makers in the empire.

At the risk of encroaching upon your limits, I must

here state his lordship's views at some length, and

make my subsequent remarks the shorter, as it is

highly desirable that the ipsissima verba should appear

in a more permanent form, particularly in a medical

journal, than in the fleeting columns of a daily paper. " Nothing could be more valuable than the services

of the barristers whlo had been appointed on the

commission during the whole period of their appoint ment. This object w as, by the bill he wished to intro duce, to appoint that some of the commissionlers acting

in London should immake circuiits of inspection to the

asylums in the country districts. Ile had not the

slightest doubt but that the habits of business which

these gentlemen would have acquired would be foujnd

most valuable, and their being also a part of the Lon

don commission would act as a clheck on their pro

ceedings in the country, and the advice of their fellow

commissioners in Lonidon would be very useful to

them in the discharge of their duties. lie had now to

consider whether it would be desirable to have medi

cal or legal gentlemen, as paid commnissioners, to make

circuits through the country. Ile was of opinion that

it was not so desirable to appoint medical men, as

genierally, though there were some brilliant exceptions, they were not distinguished by the habits of exactniess

which legal men acquired from their education, and

also, because it would be difficult to get any medical

gentlemen of first rate-ability-and others he would

be sorry to see appointed-to givc up theirpractice, and

dedicate the whole of their time to the duties of the

situation, more especially as it was not in his (Lord G.

Somerset's) power, for various reasons, to move that

the bill should be more than of a temporary duration.

What he proposed to do was this, that, instead of the

commissioners being appoimited as they niow were,

allowed to practise, and only paid for tlhe hours they




devoted to this duty, that they should dedicate the whole of their time to the duties of the situation, and

be paid by such a salary as should insure the appoint

ment of proper individuals of high tegal attainments, and which at tlle same time should not be so large a

salary as to enicroach on that fair economy which was

proper to be observed. He proposed, therefore, that legal gentlemnen should be appointed with a fixed

salary, that so long as they continued on the commis

sion they should devote the whole of their time to the

duities of the situation, and to their duties on the London

commission. He proposed that these commissioners should, once at least in every four months, visit every licensed asylum for the reception of insane persons ill the country. It appeared from returns made, that there

were somewhere about 60 or 70 houses licensed for the

reception of insane persons in the country. It was rather curious to observe that in about 25 counities

-in all the counties in Wales and some others in

England-tlhere was not a sinigle asylum for the recep tion of insane persons, coilsequently, without allowing

more thlani fair time for relaxation for healtlh, he con ceived the barrister commissioner, would have proper time to visit regularly every asylum in tllc metropolitan

district four times, anld in the country district three

times a year. It was not his initention to do away withl the visits of the magistrates in tlae country district

as established by law. He thought that the barristers, from their experience acquired ini London, anid from their kniowledge of the law, would make the local

magistrates more active in the discharge of their duties, and that the result would be a very regular superin

tendence on the part of the magistrates, as well as by the commissioners. Eyery licensed asylum in the

country would thereby be visited six times each year; and he thought also, from the greater degree of exer

tion which would be caused amongst the country gen tlemen, that they would be induced to be more fre

quent in their attendance thani the lawi, required. Oin tlle visits made by these individuals, he proposed that their attention should be specifically directed to vari ous matters-first, to the state and descriptionl of the licensed house; next to the treatment of the patients; then to ani examination of the certificates, and more

especially how far the patients were fitting or other wise for removal to a lunatic asylum. Such were

some of the principal duties hie meanlt to devolve on the barrister commissioners."

It would be highly desirable, for a proper uniider

stailding of this extraordinary passage, to have a little insight into the private history of this bill, and by

whom it was concocted. Iqnotus boldly mentions that it was done " with the full knowledge of the

commission, wlho are known to entertain a strong desire to extend their own power over the whole coun

try." If so, where were the five physicians ?-were

they out-voted? Or being themselves safely seated at the commission board, and not finding it pleasant or profitable to make " circuits," did they forget the

thousands of their brethren who are able, and might be willing to do so ? I cannot believe that five

gentlemen, holding the ranik and station which they miiUst do, could so far forget themselves. Will nionle of them in pity unlock the secret ? However it was, let thenii beware ! or, like the unfledged younig of the

poor hedge-sparrow, they will soonl be edged out of

the niest by the surreptitious offspring of the bird

(cuckoo), whose voraciouis habits and gormandizing

propensities lead them first to join in ejecting the rightful owners, and then to wrestle with each other, to the death, for sole possession. There is another

pertinent question-with a secretary at ?500 per

annum (I know both physicians and barristers who have made less for the first seven years), what was the object of introducing paid barristers into the com

mission at all ? It appears they were not there at

first. I trust, that in the next number of your Jour

nal, you will at least favour us with the names and

designations of the twenty commissioners as well as

of the secretary. I must now refer to Lord G. Somerset's speech, and

in drawing " a bow at a venture," neither intend to af

fect him personally or the other nineteenr, who are all at present equally unknown to me. The tenor of the

noble lord's observations, particularly in the last quo

tation, seems to me as if he had, in somne unfortunate

moment, been committed to make the worse appear the better side. In the first sentence we have the

two barristers, like Minerva springing from the head of

Jupiter, fully equipped; nothing could be more valuable

thani their services from the day they entered the com

mission; then the habits which they would acquire would be found most valuable; and lastly, their

brethren of the commission in London would be a check to their proceedings in the country.

Passing over the evidently foregone conclusion, that barristers, anid the two barristers only in the London

commission, are to be appointed, the manner in which it is supported shows the tact of the advocate, orator, and statesmani. An assertion is boldly made in favour of the superior habits of business and of exactness, not of the two barristers over the five physicians

such a thing is possible, though not very probable but of the legal over the whole medical profession. Now, can this be met by a medical man by an assertion equally bold, but far more correct, to the contrary ?

Oh, no; I am an initerested party; my evidence,

therefore, is suspiciouIs. Granting it otherwise, how can I or aniy professional man, endowed with a scin tilla of delicacy of feeling, avow himself as a man of

"superior habits of businiess," of "exactness," of

"brilliant character," of "first-rate abilities ?" The Lord Chancellor, Lord Brougham, Sir Robert Peel, Mr. Macauley, and some others, whom all acknow

ledge as first-rate orators, could not, under any almost

conceivable circumstances, be induced to say so in totidem verbis of themselves. Even the noble lord

would slhun to avow that he is the most useful mem ber of the twenty commissioners, paid or unpaid, though I may believe him to be so, and doubt iot

many others know it. The noble lord may have met

with medical characters who, for the sake of eccen

tricity, notoriety, or other motives, may have boasted of a total disregard of regularity and ignorance of

business habits; these are the real exceptions. I have met with several, but I never yet knew one of them take a distinguished or pernmanent place in the pro

fession. Whom have we to rebut this? Mr. Wakley, himself attached to the profession. Where were or are the hundreds on both sides of the houise who owe the preservation of their owin lives, under God, or that

of members of their fleiunilies, to the skill and atten




tion of our profession, who grumble if we are five minutes behind our time, even thouglh arranged forty eight hours before-who wait our arrival, and watch our motions, sayings, and doings, with the utmost anxiety-who pour out blessings upon our heads, little less fervent than the lower Irish, and, alas ! appa rently not more sincere, who, even ill general business and private intercourse, know our punctuality-where

was one of theem in that house, no matter how lie voted, to utter a word in our defence ? And echo

answers-Where? Or where the members for the different universities, whose peculiar province it is to defend the rights, maintain the privileges, and, if

required, support the character of the learned pro fessions, or, at least, discriminate between them when

unjustly assailed ? " Have the sons of Zeruiah," as Oliver Cromwell termed them, been too strong for us

in that question also ?

Tied to the stake as we are, my professional brethren will appreciate the motive, and forgive me, if I attempt a brief sketch of what I know to be com

mon to nearly all in my situation. Well, to be " accurate," I left my father's home on the 9th of October, 1810, to enter upon the study of medicine; withont keeping any regular diary, which many do, but from data and memoranda chiefly connected with

my studies or profession, I will pledge myself to tell within ?E5i what I have received and paid, with dates, &c., from that day to this. I will point out not oilly where I was every day, but how employed; and in almost innumerable instances, what I was doing each hour, even dowYn to miniutes. Now this is no way re

markable, because it is part and parcel of our pro fession. During the last twenty-two years, I have attended, gratuitously, upwards of 30,000 pauper pa tients in the charitable institutions of Leeds,* of these, I shall give day and date of admission; of examina tion and subsequent visits; name, age, sex; in most instances, employment, disease, and result; with, in

many instances, an extended history of the whole case. Now, I have this also in common, be the num ber of patients more or less, witlh every physician and surgeon attached to a medical hospital, in common

with every medical officer of the army or navy, and in common with almost every respectable practitioner unattached to any public institution, but who must carry the same order into the range of his private practice. I have also giveIl what is termed gratis advice to some thousands at my house, whose names,

with a few particulars, I also retaini. I need scarcely add, that few of Us would be less " accurate " in the cases of our private patients.

The late Mr. Hey, of Leeds, who had the most ex tensive general practice in Yorkshire, a magistrate, and twice mayor of that borough, so arrranged his time, that for forty years he did not more than twice

miss morning service at church, and onlly five or six times in the eveniig ; and without alluding more

particularly to his family, the same " business habits "

are common to the other practitioners of Leeds, and of the West Riding.

I say nothing of the accuracy iequired in prescrib

4 This enables me to explain a preceding passage as to the gratuitous services of the two professions of law and

physic to the public. Upon an under average, a physician receives five guineas for each case he attends throughout

attack-30,'J00 cases would thus give 150,goo guineas.

ing; a single error of a few grains or drops, might prove fatal; how rarely, how very rarely, does such a

thing occur. Ignotus has touched upon this so ably,

as to preclude the necessity of further remark. I shall

make no inroads upon the legal profession; I claim no

reprisals from the noble lord; but unitil it can be

shown not by mere assertion, but stern irrefragable proof, that the education, and habits, and practice of

the lawyer, compel equal, nay greater, accuracy, the

allegation falls to the ground.

As to the supposed difficulty of obtaining medical

men every way qualified for this, or any similar office, it is painfully cruel. There are many of my profes

sional brethren, amiable, talented, and experienced

men, who wanit the mioral courage to make such a

claim; there are a vast nlumber more, equally capa ble, who, if it were known that they had offered, and

were not appointed, it would certainly injure their

presenit situationi and prospects. But that the in

terests of huimanity and the rights of the profession

may not suffer, I shall engage to procure one or more

able practitioners, which no board could fairly refuse on account of their qualifications or experience.

Thus the noble lord is relieved of all difficulty on this

point. Are the two pet barristers such brilliant characters,

and of such firstrate abilities ? If they are, I hope

the noble lord will consider well what he is doing. It

would be a thousand pities to withdraw men of such

transcendant abilities from the gleaming prospects of

the woolsack, or the lustrous ermine of the lord chief

justiceship-though I do wish their present posstssors

may long continue to enjoy them. Wliat! to send

such rising Solons, in the words of the poet, " to skelp

through dirt and mire "-to superinitend among other

things, the " medical treatment " in lunatic asylums? No, let Lord G. Somerset leave this more humble but

important duty to the entire experience and perse

vering industry of the medical practitionier, who un

derstands its requirements and will fulfil them; and,

above all, to wlhom it justly, and in mercy to the poor

unfor'tunates, oughlt, and by the laws of the realm, can only properly belong. If barristers are required to explain the law which they have framed, that

law cannot surely require expounding at all times. It

is much more consonant, then, to reason and commonl

sense, that the medical inspector should submit such

points to the lawyer when they arise, than that he, inl his various and constant duties, should be put under

the others' control. Where is the difference between the unlicensed

quack who is prosecuted, and the unlicensed barrister who may interfere with the " treatment," or even

prescribe a nostrum of Iis owII ?

Mr. Wakley returned Iris thanks to the noble lord

for having given his attention to the subject. He

soon proceeds, however, in a much less compli

mentary manner. He expresses the disappointment he felt at tIre measure, that it was a " small measure indeed"-" too insignificant to admit of any disquiisi tion at all." True to this centralisation principle and

one faculty scheme, lie wishes to have one great mea sure for England, Scotland, anid Ireland, to stretch the poor lunatics of these kingdoms on the sanme bed without regard to the difference which he must

know to exist even in the habitudes of madmen




in these countries. The hon. gentleman then asks " What were licensed lunatic asylums.?- They were hospitals, houses of reception for the treatment of persons afflicted with the most grievous disease to

which humanity could be subject. And what did the noble lord propose ? To appoinit two barristers as

medical visitors to the hospitals. He did not suppose that the noble lord intended this proposition as an insult to the medical profession, but if it had been so intended, one of a more marked character could scarcely have been offered." Now this is excellent both in spirit and in manner, and differing as I do in

many points from the hon. gentleman (the execution of his official duties as coroner are I believe above all praise), he has my best thanlks, and I might venture to add those of the profession, for his prompt and chastened reply to the noble mover. Mr. Wakley then proceeds to notice other parts of the subject, entreating the noble lord to postpone the second read ing to a distant day, and that he (Mr. Wakley) would

bring the whole subject before the house, and he trusted with such success as to induce the governiment to appoint a commission to investigate the whole

matter in the three kingdoms, previous to legislating upon the subject. Here I differ toto coelo from the hon. gentleman, for all but the commissioners them selves and their immediate partisans have an utter abhorrence to these visitations in the country, nor is this feelilng new, as in Henry the Eighth

" There have been commissions Sent down among them, which have flaw'd the heart Of all their loyalties."

Besides, there is abundant information oIn hanid, or which can readily be procured, for every legislative purpose, provided it is put into proper hands.

In the short speech of Mr. Hawes there are only two points which I need refer to. " He thought the inea sure so small as hardly to be worth producing. The appointment of barristers to judge whether a lunatic should or should not be detained in anl asylum was absurd."-" If there must be a legal inspector at all a medical man should be joined with him." Obsta principiis is a sound maxim in medicine as well as in

legislation. Of course, I agree with the hon. gentle man in the great absurdity of the barristers being appointed; one only lessens the evil, and does not

remove it, besides forming a bad precedent. If there is a gentlemani in the House of Commons

personally uniknown to me, whom I have been accus

tomed to venerate and esteem more than another, it

is Lord Ashley. I had fondly hoped, and do still trust, that the mantle, so to speak, of my lamented

friend, the late Michael Thomas Sadler, had fallen

upon his shoulders, in regard to various matters con

nected with the coinfort and well-being of the poorer working class. In the present instance, however, the

noble lord has followed in the wake of the other noble lord, and advainced propositions which I feel certain I am not alone in considering untenable. The

noble lord refers more to the nature and treatment of

insanity than the former speakers. Upon some of

these points I shouild be happy to meet him, did my limits permit. After eulogisinig the metropolitan system in terms little inferior to Lord G. Somerset, and blaming the provincial one in the same ratio, he

remarks, that "the former had not the power of.

tracing lunatics through the provincial houses, and,

therefore, could not tell what was done with them.

That power it was desirable they should have," Here

is a desire for power, indeed ! They have not the

power of tracing the lunatics of France or America

through their respective houses. But, if they really

want information, by writing in a proper manner to

the heads of the various establishments, I do not

think they would be refused in a single instance. My

experience at least goes to prove that every facility,

nay, an anxious desire, is sometimes shown, both by

the heads of public and private asylums, to give and

show every information in their power. There is only

one small private asylum near Leeds, kept by Mr.

Hare, a respectable surgeon there. He has often

pressed me to go through it, and to examine and give

him my opinion of everything connected with it. I

have been, for several years, in the habit of giving the

senior students of the Leeds Medical School a prac

tical lecture on insaility annually, at the large asylum

at Wakefield, where Dr. Corsellis has always received

us most courteously, has shown us the whole house,

from the convalescents down to those in the very

lowest state of idiotcy, and has replied, with the

greatest good nature, to the various questions of my

twenty-five or thirty inquisitive followers. I have

met the same kind reception at York, where there

are several; at Perth, where I happened to be last

year; nor in these or all the other houses of a similar

description which I have visited in the north of

England and in Scotland, have I ever remarked (and

I would have observed it) the least attempt at con

cealment. While the noble lord, however, is so

anxious to extend the powers of the London commis

sionl, he twits Mr. Wakley upon the impracticability

of establishing a uniform system for all the asylums

in the country. There is another and a deeper point

connected with this desire to "trace" them through

different houses, which I am rather surprised that

Lord Ashley has overlooked-the mental feelings of

the friends of the patients, and of the patients them

selves, when restored to health anid serenity. This

disease-for disease, in one form or another, it is, and

onie which I shall have a few words to address to his

lordship presently-arising from the most varied,

numerous, and opposite causes, and beiing often here

ditary, apparently from no cause whatever, or these

the most innocent, is yet, unfortunately, by all classes

of society, as scrofula, &c., held to convey a degree

of disgrace or reproach to the individual or to the

family in which it occurs. Let not the noble lord,

which I am sure lie does not, or any one else, suppose

for a momeint that the middle and lower classes do

not feel this most acutely; and, though limited cir

cumstances may compel thenm to take their relatives

to the public or licensed asylum, they always wislh it

done as quietly and privately as possible, and, where

it can be afforded, uniformly to some distant one.

This is my experience, at least; and further, I have

known them removed again and again, to prevent

them being recognised by neighbours or others, and

this from no other or bad motive whatever. What,

then, is the object or intention of all this "tracing

through the different provincial houses ?" Surely not

to blazon in full length their names, the disease, the

cure, the relapses, and the various houses they have




occupied, to figure in tile columns of a bulky report drawn up by the two barristers. If it be this, or aiiy

tlhing approaching to this, I pity thie concoctors, and

Eiiglishmen vill not submit to it long. If it is the

mere " lust of power" in tho twenty commissioners, irrespective of the barristers, it may be passed anid

laughed at.

But the most grave part of his lordship's speech is

the following :-" With respect to the question of legal inspectors, he must say, speaking from the expe

rience he had had in visiting these houses, that,

although so far as health was concerned, the opinion of a medical man was of the greatest importance, yet,

it having been once established that the insanity of a

patient did not arise from the state of his bodily

health, a manl of common sense could give as good an

opinion as any medical man he ever knew." 1 rejoice

to hear of his lordship's experience; and further, that

he considers a mnedical man useful when the health is

concernied. This, indeed, gives us the whole question;

for it never has been and never can be established that the insanity of a patient did not arise from or

depend upon the state of his bodily health. Even in

cases of idiotcy from infanicy, wlhere the general health

may be apparently good, original malformation and

many otlher causes, as known to every one wvho has

studied the subject, may and undoubtedly have pre

vented the regular and proper developmestt of the

mnental faculties. The mysterious conbection between mind and body has hitherto been, and will probably

always continue, inexplicable; but it is as clear as

any problem in Euclid, or that barristers are not phy.

sicians, that such a connection does exist, and thal

they mutually act and react upon each other, to the

extent of not only producing diseases. of which in

sanity is one of the most remarkable, but in man,

cases to their amelioration and cuie. In some case

of insanity there may have been no apparent cansz

sufficiently evident for its production, even to the

most experienced practitioner, much less to Lord

Ashley; but disease may, and in too many instances

does, exist, even when its charbcter is not fully de

veloped. Again, insanity arising from such an obscure

cause reacts on the body apparently in health, and too

frequently leads to other and more serious disease, or

develops the original cause more distiinctly; in either

case, then, the insane person is in an abnormal state,

or, in other words, in a state of disease, which, ac

cording to his lordship's oAwn shlowing, requires the

attention of the physician. As to the latter clause of

the sentence, it is one of those heedless, though en

tirely groundless, assertions which any public speaker

might make, and which can only provoke a smile,

though I should scarcely havc expected it on such a

subject from Lord Ashley. If he does persist coolly

to maintain it, I must, with all deference, take the

liberty to state, and shall presently prove, that he

never was more mistaken. Did the noble lord never

see or hear of monomaniacs? Some country people

are so ill-bred as sometimes to say there are a few in

the house. I did myself think that there were many

such, both in the house and out of it, some ten or

eleven years ago, but consider there are fewer niow.

Be that as it may, the most ingenious men livinig, with

all the common sense of all "the Commons," are

unable to detect tllemii iithout a clue to the particular

point on which they are insane. They imay appear in

good health, talk ratiolnally, make out an excellent

case for their confinement-what would the common

senise manl do in such a case? Blame the keeper,

perhaps write out his discharge in a lawyer's best

hand, and most accurately dated, &c., wlhen the man

would return home, and perpetrate the murder of one

or more of his family, or some other atrocious crime,

for the intention or attempt to do which he had been

originally confined. Twenty instances of a similar

kind rush upon my mind; our medical writings are

full of them. But I must hasten to a conclusion. In

cases of monomania, then, his lordship and all his

people of common sense would not ascertain the

cause or the state of the patient without information

from the keeper or medical attendant. Take another

and the last instance. I shall allow his lordship to

select five persons of common sense, and add the two

barristers to them, and I shall place five or seven

persons labouring under insanity, with an equal num

ber suffering from other diseases, as delirium tremens

(temporary derangement from drinking, not requiring

removal to an asylum), inflaznmation of the brain

in certain stages, hysterics, and simulated insanity

(not a disease, certainly, but extremely difficult and

sometimes very important to detect); in one ward with

the others, can the noble lord believe that the com

mon sense party could distinguish these cases accu

rately, and give as "good an opinion," in regard to

detention, admission, or treatment, as the five phy

sicians of the commission, or any one of them, couild

do ? Or does his lordship put the opinions of such

men as Sir James Clark, Drs. Copland, C. B. Wil

liams, Bright, Chambers, Holland, Marshall Hall,

Elliotson, and hundreds of others, in town and coun

try, on a level in a critical case of this obscure and

protean form of disease, or of any other, with the un

tauiisht man of common sense? No, my lord, the

thing is impossible; as the finest acre upon your lord

ship's estate will not grow a crop of wheat without

cultivation and seed, so ineither will your lordship

aild the chosen two become physicians wvithout both

study and practice. In regard to the signing of cer

tificates, also, an alleged grievance in his lordship's

address, 1 have never seen or heard of any difficulty

in the North; but if this delicate and important duty

is put into the hands of those who know nothing of

the matter, doubtless there will soon be plenty.

Having thus, gentlemen, at greater length than I

intended, but with muchi more difficulty to suppress

than enlarge, attempted to do my duty to the profes.

sion, ald to the poor sufferilng objects of this bill, at

some sacrifice to my personal feelings, I leave the

subject to other and more able hands.

I am, Gentlemen,

Your very obedient servant,

ADA!oi HUNTER, M.D.

Undercliff, Isle of \Vight, April 23, 18412.

*** From the great interest and importance of this

sutbject, we have been induced to devote a consider

able space to Dr. Hunter's communication.-EDS.



Documents

Inspection of County Lunatic Asylums