Rate-built Private Asylums.

1061 took

place on Oct. 9th, when there was a distinguished gathering of lunacy and county council authorities and representatives of other public bodies. Colonel SPENCER STANHOPE, C.B., chairman of the General Asylums Committee, who has been so long and intimately associated with asylum work in the West Riding, spoke upon the objects of the new scheme, and Sir JAMES CRICHTON BROWNE reviewed the history of the events that had led np to its development and completion. If we are not sanguine as to Sir JAMES CRICHTON BROWNE’s dream that the ’’ wide-spreading Upas tree of madness will wither away" in time, we feel that a hopeful sentiment is to be encouraged and we gladly welcome this new asylum as a "blessing to the district"’

LONDON: SATURDAY, OCTOBER 18, 1902.

Rate-built Private

Asylums.

WE

congratulate Yorkshire, and more especially the West Riding, in continuing to maintain its traditional position in the forefront of public effort for the due recognition of the collective claims and requirements of the insane and for the In the searching advancement of asylum administration. criticism which the Metropolitan Commissioners in Lunacythe highest authority in that day-wrote upon the asylums of this country in their report in 1844, they referred to the West Riding Asylum as one of the best ; and, going back another half-century, the part played by York through the humane TUKE and the Society of Friends, in debrutalising the environments of the insane and in opening up for them the light of heaven and the influences of a dawning civilisation in the treatment of mental disease, is now universally acknowledged. Humane considerations, the progress of medical observation and skill, the accumulation of social and domestic experience, and the insistence of’

and as a valuable means of dealing with a group of cases which call for our deepest sympathy. The special kind of work that has thus been inaugurated in Wharfedale by the construction of a "private" asylum out of the rates

chiefly devolved upon registered hospitals origin mostly in endowments from and on this subject the Com-benevolence ; private missioners in Lunacy in their report recently published "once more express their regret that the urgent need which exists for the provision of additional accommodation Suit-

has

hitherto have

which

their

educated persons of small means who become continues to be apparently unrecognised by that, part of the public which is generally foremost in philan" thropic work." They go on to say that they "have constantly to deplore the presence in the ordinary wards of pauper asylums, and, of course, amid the most uncongenial surroundings, of professional men and other

able

for

insane

officials have together been the means of so focussing persons of culture and refinement to whom more appropriate information regarding the insane that their properaccommodation and associates would afford only the classification at all events has, with a view to advantageous! comfort and amenities to which their social position has

asylum

not

our

treatment, been gradually rendered possible by ture which has shown itself very matter.

a

unimpressionable

legislain the:

hitherto entitled unnecessary

them, but also freedom from avoidable and of friction and an increased prospect of

sources

"

These are all-important advantages which Ought the of of lunatics lost sight of. Not only will this removal from never to be Apart question management under the official control of and whose property is Chancery, pauper asylums prove of direct benefit to those most apart from the "cubic space" standard which enablesconcerned, but, indirectly, the paupers left behind will wholesome classification in asylums to be carried out, to some extent derive a levelling-up advantage by the authoritative segregation of the insane of differing occupying the vacated places, ofttimes of a somewhat mental and social types from each other has enabled the; better sort, which the medical superintendent is able tc, 110.700 notified lunatics of England and Wales to besqueeze out of his general accommodation to meet the

recovery.

from the

,

the Commissioners under the following eight special cases. Another big advantage which the new project heads so far as their location and maintenance are will bring is that it will enable relatives to exercise a concerned: (1) in county and borough asylums ; (2) ini wider selection as to the class of institution to which they registered hospitals ; (3) in licensed houses ; (4) in naval1 can send an afflicted member of their family. There is,

grouped by

and

asylums ;; unfortunately, room for all classes of well-regulated as-77,IMTP-. (6) metropolitan district asylums ;; We desire to say nothing against the value of purely private (7) private single patients ; and (8) outdoor paupers. Thiss asylums, for they do most excellent work and fulfil require-general classification has been the gradual outcome off ments which are demanded by a large section of the public. official experience during the past half-century or more, butt But it cannot be gainsaid that the atmosphere of suspicion not till 1890 were powers given to make provision out off and mistrust that attaches to the asylum detention of the the rates for the middle-class insane who are able to pay forr insane from a merely speculative and commercial standtheir own maintenance. And here it is that the West Riding point, although grossly and unjustly exaggerated, appeals county council has taken the initiative and built, in one off to the minds of many. It is an atmosphere from which the prettiest spots in Wharfedale (Scalebor), at a costt registered hospitals are not entirely free, although they of .6130,000, a private asylum for the accommodation have now very rightly come to be regarded with high, in the first instance of 210 patients. The opening of f favour by those who prefer a public institution as being this institution by Lady CATHERINE MILNES GASKELL Lat least likely enough to give the maximum of care and military hospitals ; (5)

in

workhouses

and

in criminal

lunatic

1062 trend of

public opinion

in

favour

treatment with the minimum risk of

of

fresh

air.

The

The opprobrium rests not on our healtk with difficulty. officers but on the public whose parental irresponsibility must be regarded as the real source of this scourge t. For the term infantile diarrhoea connotes infantile life.

unnecessarily prolonged

detention after convalescence. It has, however, to be borne in mind in this relation that public institutions are less likely than private ones to suffer in reputation in cases where a too early discharge has led to regrettable

maternal

ignorance. Improvements in

our

disposal, the sysdwellings apart from

methods of sewage

disaster. The experiment of rate-built objected to by those who for a

tematic house-to-house examination of

doubt the nearest

progress the extent of which Dr. SPOTTISWOODE CAMERON proceeded to measure by statistics. The death-rate of the

asylums, while it may be the existence of an already discovered nuisance, and espevariety of reasons are un- cially the enlightenment of public opinion on sanitary matters willing and unable to see the expediency of spending or and the consequent demand on the part of the people to investing large sums of money in this direction, is without have their towns made healthy, all have helped towards the to ideal treatment and management for the insane of the particular class for which such

institutions

are

reason

every with the best

approach

intended. It deserves to succeed and we have It has been started so.

five

quinquennia from 1851 to 1875, he said, averaged 22’3 Only in one of these five-year periods did the rate for the lustrum fall below 22. On the other hand, during the five similar periods beginning with 1876-80 and ending with

to think that it will do

per cent.

possible intentions under the most favourable auspices and, assuredly, no pains will be spared to see that it is carried out by a well-selected and skilled staff of 1896-1900 the average of the five death-rates had been 19 1. officials in a spirit of rectitude, common sense, and Only once in these five later periods had the rate been above independence. The minimum charge for maintenance is 25s. 20 and in each successive quinquennium the rate had been a week, but in course of time as the work becomes consolilower than in its predecessor. These figures, which he dated this charge will probably be reduced o as to bring quoted, were based on calculations made for him by Dr. it within the resources of a still larger area of the afflicted TATHAM, superintendent of statistics at the General Register The life table for the decade 1891-1900 not population. The county of Dorset is, we understand, making Office. similar provision for its insane and other counties will not being yet available he suggeted that, as had been done care to lag behind in their consideration for those of their on the chart he submitted, the survivorships at each age the who have broken down community mentally through period out of 1000 persons born according to the last pubstrain involved in the modern struggle for existence. lished life-table, which dealt with what was very nearly the middle portion of the quarter century under consideration, should be compared with the earlier life-table for the years Sanitary Progress During the Last 1838-54. At each five years of life up to the period 80-85 there

25 Years—and in the Next. AT the annual

meeting of

the

Incorporated Society

were

in

Dr. TATHAM’S table

persons surviving

ofI

Medical Officers of Health held on Oct. 10th at the Hotel Russell, London, the President, Dr. J. SPOTTISWOODE CAMERON, medical officer of health of Leeds, chose for his

out of the

same

a

greater

number of

number born than in Dr.

W. FARR’s table. Put in another way we now live a greater number of years during the most active period of life than did our predecessors, while measured by the death-rate, the

mortality during the concluding quarter of the nineteenth of address the subject Sanitary Progress during century showed an improvement of 14 per cent. on the rate inaugural the last 25 Years-and in the Next. He did justice to his of the preceding 25 years. In forecasting the improvement in the next similar period important theme by his able address. Speaking as a medical officer of 25 years’ standing he reviewed briefly some of Dr. CAMERON regarded as most important the fact that the principal changes which he had witnessed in health public opinion was with the medical profession. With In 1877 he was one of two greater care in the prevention of I return " cases and a freer matters during that period. medical officers in whose districts the notification of certain provision of isolation hospitals (there is no hospital so The notification and expensive as one too small for the requirements of the infectious diseases was compulsory. isolation of these diseases were now the rule. Briefly community), with freer use of this accommodation when proreferring to the subject of so-called "return" cases and vided, and with improved methods of disinfection, there is, the manner in which they might be in his opinion he pointed out, great hope for a still lessened death-rate. he with and disdealt the methods of prevented, We ought, however, urged Dr. CAMERON, to educate the apparatus infection and showed how these had been improved during to teach the teachers. Every teacher in an infant the last quarter of a century. He mentioned the prevention ought to be able to recognise the early symptoms of of the spread of typhoid fever by the immediate disinfection commoner infectious diseases and should have authority of the excreta and their collection in tubs and cremation in consult a medical man as to their real nature. The visit destructors where these were available, and alluded to the the medical man to the infant school ought to be a matter methods the examination of water of improved bacteriological of common routine. It should take place, as a matter of and the greater protection of the sources of supply. He course, soon after the assembly, and he should see those dealt at some length with infantile diarrhoea, the con- children whom the teacher had picked out at the roll-call. tinuance of which in our large towns he regarded as The prompt sending home of suspicious cases would improve an opprobrium. We are at one with Dr. SPOTTISWOODE rather than decrease the average attendance at the school. CAMERON in trusting that a terrible cause of mortality Of other conditions making for a lessening of the deathmay be removed from among us, but the subject bristles rate in the future Dr. CAMERON selected for notice the

as

educators, school the

to

of