301
Art. XI.?LUNACY IN SCOTLAND.
The Nineteenth Annual Eeport of the General Board of Commissioners in Lunacy for Scotland, addressed to the Principal Secretary of State for the Home Department, has been presented to both Houses of Parliament in due course, and is In its general character the Eeport is now before us. precisely We have the usual subjects similar to those of past years. again discussed, namely, the number and distribution of the insane, and their proportion to population, etc., indicating, in the manner of distribution, the changes that have occurred in the royal and district asylums, private and parochial asylums, the lunatic wards of poorhouses, the lunatic department of the Central Prison of Perth, the training schools for imbeciles, and in private dwellings. On the 1st of January 1877, it appears that from official cognisance there were 1,566 insane persons in Scotland, maintained from private sources, 7,239 by parochial rates, and 57 at the expense of the State. As in the report for last year, we again observe a large number of tables showing the pauper lunatics chargeable to each county, the number of private and pauper patients in each establishment in Scotland, and the counties from which the paupers came, also, the relations of the population and pauperism to pauper lunacy. Under the heading "Patients in Establishments," the number of admissions of patients either voluntary, by transfer, or otherwise, the discharges of the recovered and unrecovered,
on probation, deaths, escapes, accidents, changes of treatment in, and the condition among attendants, the results of, the different establishments, are at length discussed. In reference to the royal and district asylums, we are glad to hear that the extension of the Aberdeen Asylum is in prowill be ready for occupation gress, and that the new buildings that in this asylum there is informed are we since next spring, still considerable overcrowding, especially upon the male side. A large number of patients have been removed from the Argyll and Bute district asylums to the new parochial asylums at Eiccartsbar, near Paisley, and at Woodilee, near Lenzie, and this' proceeding has not only relieved the overcrowding, but even afforded vacant accommodation. The condition of the wards and patients, and the general management of the Banff District Asylum at Ladybridge, are
discharges
noticed very favourably.
302
LUNACY IN SCOTLAND.
At the Edinburgh Royal Asylum, a considerable increase in the number both of male and female patients is reported. The new wings of the east division are now ready for occupation, and although the establishment has been destitute of walled airing-courts, due to extensive structural changes, still there has been no apparent increase in the number of escapes and accidents. It is gratifying to find that not a few unfortunate inmates of the educated classes who, if not actual paupers, are only capable of contributing a pauper rate of board, are nevertheless treated as private patients, and are enabled to hold communion with those of their own sphere in life. It is sincerely to be hoped that a larger number may be permitted to enjoy so great a privilege through the liberality of a charitable public. We read with satisfaction that the want of a large amusement-hall and dmmg-hall is dwelt upon in the reports on the Montrose Royal Asylum, and that regret is expressed concerning the delay in carrying out these improvements, for there cannot be the slightest doubt of the immense importance of these accessories m the treatment of many cases of unsound mind. In the Stirling District Asylum reference is again made to the overcrowding. The mortality has been high, and cases of erysipelas have frequently occurred. The apparent cause of this appears to be damp, partly due to the soil and climate and partly to frequent wet scrubbing of the floors. Measures are in progress for heating the asylum with steam, and suggestions are made that the corridors should be furnished with linoleum or matting, the wood on each side being varnished or painted. It is announced that Dr. Skae has resigned his appointment, having gone as the Government inspector of asylums to New Zealand; and Dr. JIaclaren, for some time assistant to Dr. Clouston at the Royal Edinburgh Asylum, has been appointed to the vacant omce. The reports upon parochial asylums point to an overcrowded condition of wards m the Abbey Parochial Asylum, and special attention is drawn to the want of a general dining and recreation hall. Much credit is given to the Parochial Board and the Asylum Committee for the excellent arrangements and general management of the new asylum at Riccartsbar, and the Woodilee Asylum 01 J3aiony Parochial Asylum near Lenzie is hi^hlv & spoken of. In reference to private asylums, the reports are highly favourable, and in no case is there any complaint of any kind. The lunatic wards of poorhouses are also said to be in a highly satisfactory condition. During 1876, nine patients were
LUNACY
IN
SCOTLAND.
303
admitted into the establishments for State or criminal lunatics, and for the following offences: assault, to serious injury of person; murder; theft and previous conviction; theft by housebreaking and previous conviction of theft; rape; assault, with intent to rob ; and assault, to severe injury of person and danger of life. In reference to patients in private dwellings, the words of the Report are as follows: " The mortality continues to be low, being 6'0 per cent, of the average number on our registers for the year 1875, and "We accept this fact as evidence 5*8 per cent, for the year 1876. that the circumstances in which pauper patients in private dwellings are placed, are not adverse to health, and that they include some influences which prove a compensation for the loss of orderliness, discipline, and better food, which are secured in establishments. " The number of private lunatics who were provided for in private dwellings with the sanction of the Board on the 1st of January 1877 was 104. Fifty of these were patients under curatory, and 54 were ordinary private patients. Of the whole number of private patients in private dwellings, 33 were in houses which had a special licence. It is obvious, however, from the large number of private patients removed from asylums as unrecovered, that these figures represent only a fraction of those disposed of in private dwellings. Private patients not kept for profit do not, as a rule, come under our cognisance." Special attention is drawn by Dr. Paterson to the varied circumstances in which pauper lunatics are found in private dwellings, and he says it would be both unreasonable and impossible to judge of their condition by one common standard applicable to all Scotland. Writing of Aberdeenshire, he says : " The guardians, as a rule, are faithful and intelligent, and are often found to devote themselves to the discharge of duties of all comexceptionally burdensome in a way that is worthy " There are few mendation." Speaking of Caithness, he says: counties in which the improving character of the visitation reports from year to year bear more unequivocal testimony to the good done through the intervention of the Board of Lunacy in raising the condition of patients who were at first reported on
unfavourably."
two cases are given illustrating the tendency to lunatics persons of merely weak mind, which has apparently arisen through the operation of the Government grant towards the maintenance of pauper lunatics; and Dr. Sibbald, referring to this subject, says that " by the introduction of a class of patients whose insanity is but slightly marked,
One estimate
or as
304
LUNACY IN
SCOTLAND,
their supervision may be attended with difficulties and risks of which we have hitherto had little or no experience." This remark is followed by a case in illustration, that ordinary mental enfeeblement is more frequently certified as now than lunacy " was formerly done, and such a case," he adds, " only requires to be mentioned to prove how great a change has taken place of late in the views of the community as well as of medical men in regard to the kind and degree of mental unsoundness that constitute lunacy." We cannot refrain from expressing a somewhat contrary opinion to the above, for we believe that medical men are far more careful in their estimation of soundness and unsoundness of mind than was the case in past years; and in reference to the statement that ordinary mental enfeeblement is more frequently certified as lunacy now than was formerly done," we think that the profession are very loth to confine as a lunatic any person who can by any possibility be allowed to remain at
large.
Dr. Sibbald's report concludes with some highly interestingobservations on the efficient training of idiots in private dwellunder the care either of relatives or ings strangers. He says " It should always be borne in mind as follows : that the amount of mental culture or development that can be attained by any treatment m the lower class of imbeciles is small exceedingly No amount of education will ever make them self-supportinono work they can be taught to do will ever be equal in commercial value to the supervision they will require in the doing of it. Indeed, we obtain almost all that we can hope for, if they acquire cleanly and orderly habits, so as to be innoxious to themselves and others; if they become attached to those with whom they are associated, and if they acquire an interest in the ordinary events of their daily life. The difference between the condition of those m whose cases these objects have been fairly attained, and those in whose cases no efforts for their attainment have been made, is m many cases all the difference between happiness and extreme misery. But I incline to believe that efforts m the direction of higher culture are generally fruitless and sometimes even hurtful. I therefore strongly recommend that such patients should, where suitable guardians can be got, be placed undei private care, as the best opportunity affording for the development of such faculties as they possess, and the attainment of such happiness as they can feel. In all cases it is most important that an effort should be made as life as possible to tram them, like infants, to cleanly habits. If this be successfully accomplished, the chief difficulty and discomfort which threatened their future years will have been overcome. ?
early'in
LUNACY
IN
SCOTLAND.
305
I submit these observations, because it is not sufficiently recognised by some of those interested in the improvement of idiots how much may, in favourable circumstances, be done for them without removing them from their natural surroundings." In connection with this important subject we would refer our readers to the interesting and instructive pamphlet of Dr. J. Langdon Down, " On the Education and Training of the Feeble in Mind." The expenditure for pauper lunatics in Scotland has been steadily on the increase, year by year, as we observe by Table XVII.; and we find that in 1858 the total expenditure was ?80,652, whilst in 1875-76 it amounted to ?165,261 ; the difference therefore gives ?84,609, or, in fact, more than double the amount of that of eight years previous; of this increase ?82,002 were devoted to patients in establishments, and ?3,109 to
in
private dwellings. opinion of the Commissioners that it would be a public advantage if the friends of the pauper inmates were called on and obliged to contribute more frequently to their support, since contributions from such source, even though of patients
It is the
small amount, would lead to a more careful consideration of the need of continued detention. We observe that 363 lunatics, under Judicial Factors, are reported by the accountant of the Court of Session; all these patients are seen by the Medical Commissioners at least twice a " year, and we are told that, in some instances, though deprived of the'management of their property, exhibit an unsoundness of mind so slight in degree as not to justify the granting of the medical certificates which are needed for placing them on our as lunatics." Attention is again called to the necessity of some economical procedure for administering the property of lunatics when only of small amounts ; and gratification is expressed concerning the suggestion of the Scotch Law Commission, that in those cases where the funds are less than ?1,000, the authority to appoint a cuTator should be extended to the sheriff. A similar change of the law has been recommended in the Eeport on the Criminal and Judicial Statistics of Ireland, for 1875. The Report concludes with a large number of appendices, the chief of these being devoted to the entries of the Commissioners in the patients' book, and the reports of Drs. Paterson and Sibbald. This portion of the Eeport contains the usual details, and calls for little comment or remark at our hands, but we must congratulate the compilers of the work upon their excellent and laborious efforts.
registers
Art. XI.?LUNACY IN SCOTLAND.
The Nineteenth Annual Eeport of the General Board of Commissioners in Lunacy for Scotland, addressed to the Principal Secretary of State for the Home Department, has been presented to both Houses of Parliament in due course, and is In its general character the Eeport is now before us. precisely We have the usual subjects similar to those of past years. again discussed, namely, the number and distribution of the insane, and their proportion to population, etc., indicating, in the manner of distribution, the changes that have occurred in the royal and district asylums, private and parochial asylums, the lunatic wards of poorhouses, the lunatic department of the Central Prison of Perth, the training schools for imbeciles, and in private dwellings. On the 1st of January 1877, it appears that from official cognisance there were 1,566 insane persons in Scotland, maintained from private sources, 7,239 by parochial rates, and 57 at the expense of the State. As in the report for last year, we again observe a large number of tables showing the pauper lunatics chargeable to each county, the number of private and pauper patients in each establishment in Scotland, and the counties from which the paupers came, also, the relations of the population and pauperism to pauper lunacy. Under the heading "Patients in Establishments," the number of admissions of patients either voluntary, by transfer, or otherwise, the discharges of the recovered and unrecovered,
on probation, deaths, escapes, accidents, changes of treatment in, and the condition among attendants, the results of, the different establishments, are at length discussed. In reference to the royal and district asylums, we are glad to hear that the extension of the Aberdeen Asylum is in prowill be ready for occupation gress, and that the new buildings that in this asylum there is informed are we since next spring, still considerable overcrowding, especially upon the male side. A large number of patients have been removed from the Argyll and Bute district asylums to the new parochial asylums at Eiccartsbar, near Paisley, and at Woodilee, near Lenzie, and this' proceeding has not only relieved the overcrowding, but even afforded vacant accommodation. The condition of the wards and patients, and the general management of the Banff District Asylum at Ladybridge, are
discharges
noticed very favourably.
302
LUNACY IN SCOTLAND.
At the Edinburgh Royal Asylum, a considerable increase in the number both of male and female patients is reported. The new wings of the east division are now ready for occupation, and although the establishment has been destitute of walled airing-courts, due to extensive structural changes, still there has been no apparent increase in the number of escapes and accidents. It is gratifying to find that not a few unfortunate inmates of the educated classes who, if not actual paupers, are only capable of contributing a pauper rate of board, are nevertheless treated as private patients, and are enabled to hold communion with those of their own sphere in life. It is sincerely to be hoped that a larger number may be permitted to enjoy so great a privilege through the liberality of a charitable public. We read with satisfaction that the want of a large amusement-hall and dmmg-hall is dwelt upon in the reports on the Montrose Royal Asylum, and that regret is expressed concerning the delay in carrying out these improvements, for there cannot be the slightest doubt of the immense importance of these accessories m the treatment of many cases of unsound mind. In the Stirling District Asylum reference is again made to the overcrowding. The mortality has been high, and cases of erysipelas have frequently occurred. The apparent cause of this appears to be damp, partly due to the soil and climate and partly to frequent wet scrubbing of the floors. Measures are in progress for heating the asylum with steam, and suggestions are made that the corridors should be furnished with linoleum or matting, the wood on each side being varnished or painted. It is announced that Dr. Skae has resigned his appointment, having gone as the Government inspector of asylums to New Zealand; and Dr. JIaclaren, for some time assistant to Dr. Clouston at the Royal Edinburgh Asylum, has been appointed to the vacant omce. The reports upon parochial asylums point to an overcrowded condition of wards m the Abbey Parochial Asylum, and special attention is drawn to the want of a general dining and recreation hall. Much credit is given to the Parochial Board and the Asylum Committee for the excellent arrangements and general management of the new asylum at Riccartsbar, and the Woodilee Asylum 01 J3aiony Parochial Asylum near Lenzie is hi^hlv & spoken of. In reference to private asylums, the reports are highly favourable, and in no case is there any complaint of any kind. The lunatic wards of poorhouses are also said to be in a highly satisfactory condition. During 1876, nine patients were
LUNACY
IN
SCOTLAND.
303
admitted into the establishments for State or criminal lunatics, and for the following offences: assault, to serious injury of person; murder; theft and previous conviction; theft by housebreaking and previous conviction of theft; rape; assault, with intent to rob ; and assault, to severe injury of person and danger of life. In reference to patients in private dwellings, the words of the Report are as follows: " The mortality continues to be low, being 6'0 per cent, of the average number on our registers for the year 1875, and "We accept this fact as evidence 5*8 per cent, for the year 1876. that the circumstances in which pauper patients in private dwellings are placed, are not adverse to health, and that they include some influences which prove a compensation for the loss of orderliness, discipline, and better food, which are secured in establishments. " The number of private lunatics who were provided for in private dwellings with the sanction of the Board on the 1st of January 1877 was 104. Fifty of these were patients under curatory, and 54 were ordinary private patients. Of the whole number of private patients in private dwellings, 33 were in houses which had a special licence. It is obvious, however, from the large number of private patients removed from asylums as unrecovered, that these figures represent only a fraction of those disposed of in private dwellings. Private patients not kept for profit do not, as a rule, come under our cognisance." Special attention is drawn by Dr. Paterson to the varied circumstances in which pauper lunatics are found in private dwellings, and he says it would be both unreasonable and impossible to judge of their condition by one common standard applicable to all Scotland. Writing of Aberdeenshire, he says : " The guardians, as a rule, are faithful and intelligent, and are often found to devote themselves to the discharge of duties of all comexceptionally burdensome in a way that is worthy " There are few mendation." Speaking of Caithness, he says: counties in which the improving character of the visitation reports from year to year bear more unequivocal testimony to the good done through the intervention of the Board of Lunacy in raising the condition of patients who were at first reported on
unfavourably."
two cases are given illustrating the tendency to lunatics persons of merely weak mind, which has apparently arisen through the operation of the Government grant towards the maintenance of pauper lunatics; and Dr. Sibbald, referring to this subject, says that " by the introduction of a class of patients whose insanity is but slightly marked,
One estimate
or as
304
LUNACY IN
SCOTLAND,
their supervision may be attended with difficulties and risks of which we have hitherto had little or no experience." This remark is followed by a case in illustration, that ordinary mental enfeeblement is more frequently certified as now than lunacy " was formerly done, and such a case," he adds, " only requires to be mentioned to prove how great a change has taken place of late in the views of the community as well as of medical men in regard to the kind and degree of mental unsoundness that constitute lunacy." We cannot refrain from expressing a somewhat contrary opinion to the above, for we believe that medical men are far more careful in their estimation of soundness and unsoundness of mind than was the case in past years; and in reference to the statement that ordinary mental enfeeblement is more frequently certified as lunacy now than was formerly done," we think that the profession are very loth to confine as a lunatic any person who can by any possibility be allowed to remain at
large.
Dr. Sibbald's report concludes with some highly interestingobservations on the efficient training of idiots in private dwellunder the care either of relatives or ings strangers. He says " It should always be borne in mind as follows : that the amount of mental culture or development that can be attained by any treatment m the lower class of imbeciles is small exceedingly No amount of education will ever make them self-supportinono work they can be taught to do will ever be equal in commercial value to the supervision they will require in the doing of it. Indeed, we obtain almost all that we can hope for, if they acquire cleanly and orderly habits, so as to be innoxious to themselves and others; if they become attached to those with whom they are associated, and if they acquire an interest in the ordinary events of their daily life. The difference between the condition of those m whose cases these objects have been fairly attained, and those in whose cases no efforts for their attainment have been made, is m many cases all the difference between happiness and extreme misery. But I incline to believe that efforts m the direction of higher culture are generally fruitless and sometimes even hurtful. I therefore strongly recommend that such patients should, where suitable guardians can be got, be placed undei private care, as the best opportunity affording for the development of such faculties as they possess, and the attainment of such happiness as they can feel. In all cases it is most important that an effort should be made as life as possible to tram them, like infants, to cleanly habits. If this be successfully accomplished, the chief difficulty and discomfort which threatened their future years will have been overcome. ?
early'in
LUNACY
IN
SCOTLAND.
305
I submit these observations, because it is not sufficiently recognised by some of those interested in the improvement of idiots how much may, in favourable circumstances, be done for them without removing them from their natural surroundings." In connection with this important subject we would refer our readers to the interesting and instructive pamphlet of Dr. J. Langdon Down, " On the Education and Training of the Feeble in Mind." The expenditure for pauper lunatics in Scotland has been steadily on the increase, year by year, as we observe by Table XVII.; and we find that in 1858 the total expenditure was ?80,652, whilst in 1875-76 it amounted to ?165,261 ; the difference therefore gives ?84,609, or, in fact, more than double the amount of that of eight years previous; of this increase ?82,002 were devoted to patients in establishments, and ?3,109 to
in
private dwellings. opinion of the Commissioners that it would be a public advantage if the friends of the pauper inmates were called on and obliged to contribute more frequently to their support, since contributions from such source, even though of patients
It is the
small amount, would lead to a more careful consideration of the need of continued detention. We observe that 363 lunatics, under Judicial Factors, are reported by the accountant of the Court of Session; all these patients are seen by the Medical Commissioners at least twice a " year, and we are told that, in some instances, though deprived of the'management of their property, exhibit an unsoundness of mind so slight in degree as not to justify the granting of the medical certificates which are needed for placing them on our as lunatics." Attention is again called to the necessity of some economical procedure for administering the property of lunatics when only of small amounts ; and gratification is expressed concerning the suggestion of the Scotch Law Commission, that in those cases where the funds are less than ?1,000, the authority to appoint a cuTator should be extended to the sheriff. A similar change of the law has been recommended in the Eeport on the Criminal and Judicial Statistics of Ireland, for 1875. The Report concludes with a large number of appendices, the chief of these being devoted to the entries of the Commissioners in the patients' book, and the reports of Drs. Paterson and Sibbald. This portion of the Eeport contains the usual details, and calls for little comment or remark at our hands, but we must congratulate the compilers of the work upon their excellent and laborious efforts.
registers
