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[HOSPITAL TREATMENT
INSANITY

visited by the Chancery Visitors. There are three Chancery Visitors, two medical and one legal (a barrister of at least five years’ standing at the date of his appointment), who are appointed and removable by the Lord Chancellor. The Chancery Visitors (together with the Master in Lunacy) form a Board, and have offices in the Royal Courts of Justice. In addition to these two classes of visitors, every asylum has a Visiting Committee of not less than seven members, appointed by the local authority; and the justices of every county and quarter-sessions borough not within the immediate jurisdiction of the Commissioners in Lunacy annually appoint three or more of their number as visitors of licensed houses.

Provision is made for the discharge of lunatics from asylums, &c., on recovery, or by habeas corpus, or by the various visiting authorities. Any person who considers himself to have been unjustly detained is entitled on discharge to obtain, free of expense, from the secretary to the Lunacy Commissioners a copy of the documents under which he was confined.

The Irish [Lunacy Acts 1821-1890; Lunacy (Ireland) Act 1901] and Scottish [Lunacy Acts 1857 (20 & 21 Vict. c. 71), 1887 (50 & 51 Vict. c. 39)] asylum systems present no feature sufficiently different from the English to require separate notice, except that in Scotland “boarding out” is a regular, and not merely an incidental, part of asylum administration. The “boarding out” principle has, however, received its most extended and most successful application in the Gheel colony in Belgium. The patients, after a few days’ preliminary observation, are placed in families, and, except that they are under ultimate control by a superior commission, composed of the governor of the province, the Procureur du Roi and others, enjoy complete liberty indoors as well as out of doors. The patients are visited by nurses from the infirmary, to which they may be sent if they become seriously ill or unmanageable. They are encouraged to work. The accommodation provided for them is prescribed, and is to be of the same quality as that of the household in which they live. Clothing is provided by the administration.

In the French (see laws of 30th June 1838 and 18th December 1839) and German (see Journal of Comparative Legislation, n.s. vol. i. at pp. 271, 272) asylum systems the main features of English administration are also reproduced.

The lunacy laws of the British colonies have also closely followed English legislation (cf. Ontario, R.S. 1897, cc. 317, 318; Manitoba, R.S. 1902, c. 80; Victoria (No. 1113, 1890); New Zealand (No. 34 of 1882 and Amending Acts); Mauritius (No. 37 of 1858).

In America the different states of the Union have each their own lunacy legislation. The national government provides only for the insane of the army and navy, and for those residing in the District of Columbia and in Alaska. The various laws as to the reception, &c., of the insane into asylums closely resemble English procedure. But in several states the verdict of a jury finding lunacy is a necessary preliminary to the commitment of private patients (Kentucky, Act of 1883, c. 900, § 14; Maryland, R.S. 1878, c. 53, § 21; Illinois, R.S. 1874, c. 85, § 22).

Authorities.—The following works may be consulted: Collinson on the Law of Lunatics and Idiots (2 vols., London, 1812); Shelford on the Law of Lunatics and Idiots (London, 1847). On all points relating to the history and development of the law these two treatises are invaluable. Pope on Lunacy (2nd ed., London, 1890); Archbold’s Lunacy (4th ed., London, 1895); Elmer on Lunacy (7th ed., London, 1892); Wood Renton on Lunacy (London and Edinburgh, 1896); Fry’s Lunacy Laws (3rd ed., London, 1890); Pitt-Lewis, Smith and Hawke, The Insane and the Law (London, 1895); Hack-Tuke, Dictionary of Psychological Medicine (London, 1892), and the bibliographies attached to the various legal articles in that work; Clevenger, Medical Jurisprudence of Insanity (2 vols., New York, 1899); Semelaigne, Les Aliénistes français (Paris 1849); Bertrand, Loi sur les aliénés (Paris, 1872), presents a comparative view of English and foreign legislations. In forensic medicine the works of Taylor, Medical Jurisprudence (5th ed., London, 1905); Dixon Mann, Foreign Medicine and Toxicology (3rd ed., London, 1902); and Wharton and Stillé, A Treatise on Medical Jurisprudence (Philadelphia, 1873); Hamilton and Godkin, System of Legal Medicine (New York, 1895); are probably the English authorities in most common use. See also Casper and Liman, Praktisches Handbuch der gerichtlichen Medicin (Berlin, 6th ed., 1876); Tardieu, Étude médico-légale sur la folie (Paris, 1872); Legrand du Saulle, La Folie devant les tribunaux (Paris, 1864); Dubrac, Traité de jurisprudence médicale (Paris, 1894); Tourdes, Traité de médecine légale (Paris, 1897); and especially Krafft-Ebing, Lehrbuch der gerichtlichen Psychopathologie (Stuttgart, 1899).

(A. W. R.)

III. Hospital Treatment

The era of real hospitals for the insane began in the 19th century. There had been established here and there in different parts of the world, it is true, certain asylums or places of restraint before the beginning of the 19th century. We find mention in history of such a place established by monks at Jerusalem in the latter part of the 5th century. There is evidence that even earlier than this in Egypt and Greece the insane were treated as individuals suffering from disease. Egyptian priests employed not only music and the beautiful in nature and art as remedial agents in insanity, but recreation and occupation as well. A Greek physician protested against mechanical restraint in the care of the insane, and advocated kindly treatment, the use of music, and of some sorts of manual labour. But these ancient beneficent teachings were lost sight of during succeeding centuries. The prevailing idea of the pathology of insanity in Europe during the middle ages was that of demoniacal possession. The insane were not sick, but possessed of devils, and these devils were only to be exorcised by moral or spiritual agencies. Medieval therapeutics in insanity adapted itself to the etiology indicated. Torture and the cruellest forms of punishment were employed. The insane were regarded with abhorrence, and were frequently cast into chains and dungeons. Milder forms of mental disease were treated by other spiritual means—such as pilgrimages to the shrines of certain saints who were reputed to have particular skill and success in the exorcism of evil spirits. The shrine of St Dymphna at Gheel, in Belgium, was one of these, and seems to have originated in the 7th century, a shrine so famed that lunatics from all over Europe were brought thither for miraculous healing. The little town became a resort for hundreds of insane persons, and as long ago as the 17th century acquired the reputation, which still exists to this day, of a unique colony for the insane. At the present time the village of Gheel and its adjacent farming hamlets (with a population of some 13,000 souls) provides homes, board and care for nearly 2000 insane persons under medical and government supervision. Numerous other shrines and holy wells in various parts of Europe were resorted to by the mentally afflicted—such as Glen-na-Galt in Ireland, the well of St Winifred, St Nun’s Pool, St Fillans, &c. At St Nun’s the treatment consisted of plunging the patient backwards into the water and dragging him to and fro until mental excitement abated. Not only throughout the middle ages, but far down into the 17th century, demonology and witchcraft were regarded as the chief causes of insanity. And the insane were frequently tortured, scourged, and even burned to death.

Until as late as the middle of the 18th century, mildly insane persons were cared for at shrines, or wandered homeless about the country. Such as were deemed a menace to the community were sent to ordinary prisons or chained in dungeons. Thus large numbers of lunatics accumulated in the prisons, and slowly there grew up a sort of distinction between them and criminals, which at length resulted in a separation of the two classes. In time many of the insane were sent to cloisters and monasteries, especially after these began to be abandoned by their former occupants. Thus “Bedlam” (Bethlehem Royal Hospital) was originally founded in 1247 as a priory for the brethren and sisters of the Order of the Star of Bethlehem. It is not known exactly when lunatics were first received into Bedlam, but some were there in 1403. Bedlam was rebuilt as an asylum for the insane in 1676. In 1815 a committee of the House of Commons, upon investigation, found it in a disgraceful condition, the medical treatment being of the most antiquated sort, and actual inhumanity practised upon the patients. Similarly the Charenton Asylum, just outside Paris, near the park of Vincennes, was an old monastery which had been given over to the insane. Numerous