F — Persons of Unsound Mind
It is difficult to discover what was the policy of the Central Authority during this period with regard to lunatics, idiots, and the mentally defective. Lunacy had always been, and remained, a ground of exception from the prohibition to grant outdoor relief. The provision of a lodging for a lunatic was, moreover, an exception to the prohibition of the payment of rent for a pauper. As a result of these exceptions, there were on 1st January 1852, 4107 lunatics and idiots on outdoor relief,398 and this number had increased by 1859 to 4892399 and by 1870 to 6199.400 The Central Authority took no steps to require or persuade boards of guardians not to grant outdoor relief to lunatics, nor yet to get any appropriate provision made for them in the great general workhouses on which it had insisted. Parliament in 1862 (in order to relieve the pressure on lunatic asylums) expressly authorised arrangements to be made for chronic lunatics to be permanently maintained in workhouses, under elaborate provisions for their proper care.401 These arrangements would have amounted, in fact, to the creation, within the workhouse, of wards which were to be in every respect as well equipped, as highly staffed, and as liberally supplied as a regular lunatic asylum.402 The Central Authority transmitted the Act to the boards of guardians, observing, with what almost seems like sarcasm, that it was not “aware of any workhouse in which any such arrangements could conveniently be made”;403 and the provisions of this Act were, we believe, never acted upon. Whilst consistently objecting to the retention in workhouses of lunatics who were dangerous, or who were deemed curable, we do not find that the Central Authority ever insisted on there being a proper lunatic ward for the persons of unsound mind who were necessarily received, for a longer or shorter period, in every workhouse.404 Moreover, the Central Authority took no steps to get such persons removed to lunatic asylums. In 1845 it had agreed with the Manchester Board of Guardians (who did not want to make any more use of the county asylum than they could help) that they were justified in retaining in the workhouse any lunatics whom their own medical officer did not consider “proper to be confined” in a lunatic asylum.405 In 1849 it expressly laid it down that a weak-minded pauper or, as we now say, a mentally defective, must either be a lunatic, and be certified and treated as such, or not a lunatic, in which case no special treatment could be provided for him or her in the one general workhouse to which the Central Authority still adhered.406 We can find no indication of policy as to whether it was recommended that such mentally defectives should be granted outdoor relief, or (as one can scarcely believe) required to inhabit a workhouse which made no provision for them.407
The explanation of this paralysis of the Central Authority, as regards the policy to be pursued with persons of unsound mind, is to be found, we believe, in the existence and growth during this period of the rival authority of the Lunacy Commissioners, who had authority over all persons of unsound mind, whether paupers or not. The Lunacy Commissioners had not habitually in their minds the principle of “less eligibility”; and they were already, between 1848 and 1871, making requirements with regard to the accommodation and treatment of pauper lunatics that the Poor Law authorities regarded as preposterously extravagant. The records of the boards of guardians show visits of the inspectors of the Lunacy Commissioners, and their perpetual complaints of the presence of lunatics and idiots in the workhouses without proper accommodation; mixed up with the sane inmates to the great discomfort of both;408 living in rooms which the Lunacy Commissioners considered too low and unventilated, with yards too small and depressing, amid too much confusion and disorder, for the section of the paupers for whom they were responsible.409 Such reports, officially communicated to the Poor Law Board, seem to have been merely forwarded for the consideration of the board of guardians concerned. But other action was not altogether wanting. Under pressure from the Lunacy Commissioners, the Central Authority asked, in 1857, for more care in the conveyance of lunatics;410 urged, in 1863, a more liberal dietary for lunatics in workhouses;411 in 1867 it reminded the boards of guardians that lunatics required much food, especially milk and meat;412 it was thought “very desirable that the insane inmates... should have the opportunity of taking exercise”;413 it concurred “with the Visiting Commissioner in deeming it desirable that a competent paid nurse should be appointed for the lunatic ward,” in a certain workhouse;414 it suggested the provision of leaning chairs in another workhouse;415 and, in yet another, the desirability of not excluding the persons of unsound mind from religious services.416 In 1870 it issued a circular, transmitting the rules made by the Lunacy Commissioners as to the method of bathing lunatics, for the careful consideration of the boards of guardians.417 But we do not find that the Central Authority issued any Order amending the General Consolidated Order of 1847, which, it will be remembered, did not include among its categories for classification either lunatics, idiots, or the mentally defective; and the Central Authority did not require any special provision to be made for them.
The policy of the Lunacy Commissioners was to get provision made in every county for all the persons of unsound mind, whatever their means, in specially organised lunatic asylums in which the best possible arrangements should be made for their treatment and cure irrespective of cost, and altogether regardless of making the condition of the pauper lunatic less eligible than that of the poorest independent labourer. Unlike the provision for education, and that for infectious disease, the cost of this national (and as we may say communistic) provision for lunatics was a charge upon the poor rate. Under the older statutes, the expense of maintaining the inmates of the county lunatic asylums was charged to the Poor Law authorities of the parishes in which they were respectively settled; and the boards of guardians were entitled to recover it, or part of it, from any relatives liable to maintain such paupers, even in cases in which the removal to the asylum was compulsory and insisted on in the public interest.418 The great cost to the poor rate of lunatics sent to the county lunatic asylums, and the difficulty of recovering the amount from their relatives, prevented the whole-hearted adoption, either by the boards of guardians, or the Central Authority, of the policy of insisting on the removal of persons of unsound mind to the county asylums. For the imbeciles and idiots of the Metropolitan Unions, provision was made after 1867 in the asylums of the Metropolitan Asylums Board.419 But no analogous provision for those of other unions was made. The result was that, amid a great increase of pauper lunacy, the proportion of the paupers of unsound mind who were in lunatic asylums did not increase.420 On the other hand the indisposition of the Central Authority to so amend the General Consolidated Order of 1847 as to put lunatics in a separate category, and require suitable accommodation and treatment for them—an indisposition perhaps strengthened by the very high requirements on which the Lunacy Commissioners would have insisted—stood in the way of any candid recognition of the fact that for thousands of lunatics, idiots, and mentally defectives, the workhouse had, without suitable provision for them, and often to the unspeakable discomfort of the other inmates, become a permanent home.