The lunacy law : its defects, and a scheme of reform / by William R. Huggard.
- Huggard, William R. (William Richard), -1911.
- Date:
- [1885]
Licence: Public Domain Mark
Credit: The lunacy law : its defects, and a scheme of reform / by William R. Huggard. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![factory in regard to private patients ia licensed houses, in single care, and uniler the protection of the Court of Chancery. Under the pro- posed scheme, these classes will all be included. That the proprietor of a private asylum should have the discre- tionary custody of the insane is, as we have seen, utterly inde- fensible in principle. The remedy for this evil, however, is, not to abolish private asylums, but to do away with the anomalous com- bination of antagonistic functions—to separate the duties of paid host from the duties of discretionary custodian. The proprietor of an asylum should be entrusted simply with providing for the safety and for the well-being of the patients ; and the State should undertake, in a much more immediate manner, than at present, the discretion of continued detention. The immediate responsibility for a patient's detention should rest with a government official, or Medical Visitor in Lunacy. Almost all the duties, in fact, that now fall on the proprietor or .superintendent of a private asylum, in virtue of his office as dis- cretionary custodian, should be transferred to the Medical Visitor ; such, for example, as the duty of reporting (or supervising the report- ing) of the mental and bodily health of the patients at weekly, monthly, or quarterly intervals, according to the nature of the case ; and it should be in his power, subject to the control of the Commis- sioners, to authorise a discharge, or a transfer, should he think fit. Let us now see the number of medical visitors that would be re- quired, and whence the money would come to pay them. There are, roughly, about eight thousand private lunatics in England and Wales. Of these, more than half are in registered hospitals, or other public asylums, and need not, therefore, occupy us further. Of the remainder, upwards of three thousand are in private asylums, and less than a thousand are either lunatics by inquisition, under the imme- diate supervision of their committees, or patients in single care. It is with the custody of these four thousand patients (in private asylums, etc.) that we are concerned, and for whom it is suggested that Medical Visitors be appointed. To determine the number of Visitors, let us see the requirements. The proportion of recent cases of insanity (cases under one year's standing), to chronic cases, is ahout one in four. Out of four thousand cases, about one thousand would be recent cases. This proportion is, more or less, permanent; the admissions being nearly balanced by the discharges and deaths. Visits by the Medical Visitor should, for the first month, be made once a week; for the next three months, once a fortnight; for the remainder of tlie first year, once a month ; and, in chronic cases, once every throe months. Calcu- lating as closely as I can, I think one Visitor would be able to super- vise, in this manner, about two hundred patients. This number would, on the average, include about fifty recent cases. On this basis of ciilculation, twenty Medical Visitors of Private Asylums would be re- quired in all. In forming districts, hovvever, other considerations, besides the mere number of patients, would have to bo borne in mind. The payment of the.se officials stands on a somewhat different foot- ing from tlio payment of the Medical Examiners in Lunacy. To pay the Medical Examiners, no fresh outlay is incurred, no new burden is iiiipofed ; the expenditure is merely turned into a dilferent channel. The Medical Visitors, however, vvoidd be an altogether new creation. They have no counterpart under the present system : and the ques- tion is, on whom should the burden ol paynioiit. be thrown, and how should tbe money be raised ? Now I do not think it would be unfair to say tliat those who can alford to pay for tlio greater luxury, privacy, and comfort of a private asylum or of ])rivate care, .should bo re(iuired to pay also for increa.sed security against unjust delentlDU. It hap- ]iens, too, as is shown by putting together the facts scattered tlirougli- out the Commissioners' Report for 1882, that private patients in private](https://iiif.wellcomecollection.org/image/b22301306_0009.jp2/full/800%2C/0/default.jpg)
