Karl Marx in the New-York Tribune 1857

The Increase of Lunacy in Great Britain

Source: New-York Daily Tribune, August 20, 1858;
Transcribed: by Tony Brown.

There is, perhaps, no better established fact in British society than that of the corresponding growth of modern wealth and pauperism. Curiously enough, the same law seems to hold good with respect to lunacy. The increase of lunacy in Great Britain has kept pace with the increase of exports, and has outstripped the increase of population. Its rapid progress in England and Wales during the period extending from 1852 to 1857, a period of unprecedented commercial prosperity, will become evident from the following tabular comparison of the annual returns of paupers, lunatics and idiots for the years 1852, 1854 and 1857 :

Date.Population.Patients in County or Borough Asylums. In licensed houses.In Work houses.With friends or elsewhere.Total of Lunatics and Idiots.Proportion to population.
Jan. 1, 185217,927,6099,4122,5845,0554,10721,1581 in 847
Jan. 1, 185418,649,84911,9561,8785,7134,94024,4871 in 762
Jan. 1, 185719,408,46413,4881,9086,8005,49727,6931 in 701

The proportion of acute and curable cases to those of a chronic and apparently incurable kind was, on the last day of 1856, estimated to be somewhat less than 1 in 5, according to the following summary of official returns:

 Patients of all classes in Asylums.Deemed curable.
In County and Borough Asylums14,3932,070
In Hospitals1,742340
In Metropolitan licensed Houses2,578390
In Provincial licensed Houses2,598527
 Deemed curable3,327 
 Deemed incurable17,984 

There exist in England and Wales, for the accommodation of lunatics and idiots of all sorts and of all classes, 37 public asylums, of which 33 are county and 4 borough asylums; 15 hospitals; 116 private licensed houses, of which 37 are metropolitan and 79 provincial; and lastly, the workhouses. The public asylums, or lunatic asylums properly so called, were, by law, exclusively destined for the reception of the lunatic poor, to be used as hospitals for the medical treatment, not as safe places for the mere custody of the insane. On the whole, in the counties at least, they may be considered well regulated establishments, although of too extensive a construction to be properly superintended, overcrowded, lacking the careful separation of the different classes of patients, and yet inadequate to the accommodation of somewhat more than one-half of the lunatic poor. After all, the space afforded by these 37 establishments, spreading over the whole country, suffices for the housing of over 15,690 inmates. The pressure upon these costly asylums on the part of the lunatic population may be illustrated by one case. When, in 1831, Hanwell (in Middlesex) was built for 500 patients, it was supposed to be large enough to meet all the wants of the county. But, two years later, it was full; after another two years, it had to be enlarged for 300 more; and at this time (Colney Hatch having been meanwhile constructed for the reception of 1,200 lunatic paupers belonging to the same county) Hanwell contains upward of 1,000 patients. Colney Hatch was opened in 1851; within a period of less than five years, it became necessary to appeal to the rate-payers for further accommodation; and the latest returns show that at the close of 1856 there were more than 1,100 pauper lunatics belonging to the county unprovided for in either of its asylums. While the existing asylums are too large to be properly conducted, their number is too small to meet rapid spread of mental disorders. Above all, the asylums ought to be separated into two distinct categories: asylums for the incurable, hospitals for the curable. By huddling both classes together, neither receives its proper treatment and cure.

The private licensed houses are, on the whole, reserved for the more affluent portion of the insane. Against these “snug retreats,” as they like to call themselves, public indignation has been lately raised by the kidnapping of Lady Bulwer into Wyke House, and the atrocious outrages committed on Mrs. Turner in Acomb House, York. A Parliamentary inquiry into the secrets of the trade in British lunacy being imminent, we may refer to that part of the subject hereafter. For the present let us call attention only to the treatment of the 2,000 lunatic poor, whom, by way of contract, the Boards of Guardians and other local authorities let out to managers of private licensed houses. The weekly consideration per head for maintenance, treatment and clothing, allotted to these private contractors, varies from five to twelve shillings, but the average allowance may be estimated from 5s. to 8s. 4d. The whole study of the contractors consists, of course, in the one single point of making large profits out of these small receipts, and consequently of keeping the patient at the lowest possible expense. In their latest report the Commissioners of Lunacy state that even where the means of accommodation in these licensed houses are large and ample, the actual accommodation afforded is a mere sham, and the treatment of the inmates a disgrace.

It is true that a power is vested in the Lord Chancellor of revoking a license or preventing its renewal, on the advice of the Commissioners in Lunacy; but, in many instances, where there exists no public asylum in the neighborhood, or where the existing asylum is already overcrowded, no alternative was left the Commissioners but to prevent the license to continue, or to throw large masses of the insane poor into their several workhouses. Yet, the same Commissioners add that great as are the evils of the licensed houses, they are not so great as the danger and evil combined of leaving those paupers almost uncared for in workhouses. In the latter about 7,000 lunatics are at present confined. At first the lunatic wards in workhouses were restricted to the reception of such pauper lunatics as required little more than ordinary accommodation, and were capable of associating with the other inmates. What with the difficulty of obtaining admission for their insane poor into properly regulated asylums, what with motives of parsimony, the parochial boards are more and more transforming the workhouses into lunatic asylums, but into asylums wanting in the attendance, the treatment and the supervision which form the principal safeguard of patients detained in asylums regularly constituted. Many of the larger workhouses have lunatic wards containing from 40 to 120 inmates. The wards are gloomy and unprovided with any means for occupation, exercise or amusement. The attendants for the most part are pauper inmates totally unfitted for the charge imposed upon them. The diet, essential above everything else to the unhappy objects of mental disease, rarely exceeds in any case that allowed for the healthy and able-bodied inmates. Hence, it is a natural result that detention in workhouses not only deteriorates the cases of harmless imbecility for which it was originally intended, but has the tendency to render chronic and permanent cases that might have yielded to early care. The decisive principle for the Boards of Guardians is economy.

According to law, the insane pauper should come at first under the care of the district parish surgeon, who is bound to give notice to the relieving officers, by whom communication is to be made to the magistrate, upon whose order they are to be conveyed to the asylum. In fact, these provisions are disregarded altogether. The pauper lunatics are in the first instance hurried into the workhouses, there to be permanently detained, if found to be manageable. The recommendation of the Commissioners in Lunacy, during their visits to the workhouses, of removing to the asylums all inmates considered to be curable, or to be exposed to treatment unsuited to their state, is generally outweighed by the report of the medical officer of the Union, to the effect that the patient is “harmless.” What the workhouse accommodation is, may be understood from the following illustrations — described in the last Lunacy Report as “faithfully exhibiting the general characteristics of workhouse accommodation.”

In the Infirmary Asylum of Norwich the beds of even the sick and feeble patients were of straw. The floors of thirteen small rooms were of stone. There were no water-closets. The nightwatch on the male side had been discontinued. There was a great deficiency of blankets, of toweling, of flannels, of waistcoats, of washing basins, of chairs, of plates, of spoons and of dining accommodation. The ventilation was bad. We quote:

“Neither was there any faith to be put in what, to outward appearance, might have been taken for improvement. It was discovered, for example, that in reference to a considerable number of beds occupied by dirty patients, the practice exists of removing them in the morning and of substituting, merely for show during the day, clean beds of a better appearance, by means of sheets and blankets placed on the bedsteads, which were regularly taken away at night and the inferior beds replaced.”

Take, as another example, the Blackburn Workhouse:

“The day rooms on the ground floor, occupied by the men, are small, low, gloomy and dirty, and the space containing 11 patients is much taken up by several heavy chairs, in which the patients are confined by means of straps, and a large, projecting fire-guard. Those of the women, on the upper floor, are also much crowded, and one, which is used also as a bedroom has a large portion boarded off as a privy; and the beds are placed close together, without any space between them. A bedroom containing 16 male patients was close and offensive. The room is 29 feet long, 17 feet 10 inches wide, and 7 feet 5 inches high, thus allowing 2,39 cubic feet for each patient. The beds throughout are of straw, and no other description is provided for sick or bed-ridden patients. The cases were generally much soiled and marked by the rusty iron laths of the bedsteads. The care of the beds seems to be chiefly left to the patients. A large number of the patients are dirty in their habits, which is mainly to be attributed to the want of proper care and attention. Very few chamber utensils are provided, and a tub is stated to be placed in the center of the large dormitory for the use of the male patients. The graveled yards in which the patients walk are two for each sex, surrounded by high walls, and without seats. The largest of these is 74 feet long, by 30 feet 7 inches wide, and the smallest 32 feet by 17 feet 6 inches. A cell in one of the yards is occasionally used for secluding excited patients. It is entirely built of stone, and has a small, square opening for the admission of light, with iron bars let in to prevent the escape of the patient, but without either shutter or casement. A large straw bed was on the floor, and a heavy chair in one corner of the room. Complete control of the department is in the hands of an attendant and the nurse: the master seldom interferes with them, nor does he inspect this as closely as he does the other parts of the workhouse.”

It would be too loathsome even to give extracts from the Commissioners’ report on the St. Pancras Workhouse at London, a sort of low Pandemonium. Generally speaking, there are few English stables which, at the side of the lunatic wards in the workhouses, would not appear boudoirs, and where the treatment received by the quadrupeds may not be called sentimental when compared to that of the poor insane.