HISTORY OF PSYCHIATRY Workhouse or asylum: the nineteenth century battle for the care of the pauper insane E. D. Myers Throughout the 19thcentury some 20-25% of all known person or idiot was to be detained in any pauper lunatics in England and Wales were workhouse for longer than 14 days. This was accommodated in workhouses. Early on, the lunacy interpreted to mean, with doubtful legal validity, commissioners considered that all pauper lunatics that any non-dangerous lunatic, insane person should be admitted to asylums and were highly or idiot could, on the say-so of the master, critical ot the conditions under which they were kept guardians or medical officer, be kept in the in workhouses. As the century progressed the lunacy workhouse indefinitely. As a result, throughout commissioners were forced to compromise because of the 19th century, the number of insane inmates the lack of space in asylums and diminishing in the workhouses never fell much below 20 per confidence in the results of asylum treatment. By the cent of all known pauper lunatics in England and end of the century the lunacy commissioners were Wales (Table 1). reconciled to the accommodation of feeble-minded, imbecile, idiot, chronic psychotic and demented paupers in workhouses, but held to the view that the acute pauper insane should be admitted to Lunacy commissioners asylums. Lunacy commissioners were first appointed in 1774: they were fivein number, all Fellows of the Before the asylum era, pauper lunatics were Royal College of Physicians, and their duties confined in poorhouses, houses of correction or were to visit, report upon and license all private bridewells. Some were confined within their own asylums within the cities of London and West homes in circumstances varying from the most minster and within the County of Middlesex. humanitarian to the most cruel and some, the Outside the metropolitan area, these duties were harmless and inoffensive, were allowed to wan to be carried out by the justices at Quarter der at large. With the emergence of private Sessions. The Lunatics Act of 1845 replaced the asylums in the mid-17th century, a number Metropolitan Commission with a new Commis were admitted to these institutions where the sion which included five laymen, three medical parish was prepared to pay the required fee. The men and three lawyers whose remit was ex number requiring admission increased rapidly in tended to cover all asylums, both public and the early 19th century resulting in the building of private, throughout the whole of England and public asylums into which it was intended all the Wales (Jones, 1993). This lunacy commission pauper insane should be admitted as early as remained the body responsible for visiting and possible with a view to treatment. At the same reporting to the Lord Chancellor on all matters time, Parliament, concerned with the rising relating to the asylums until its replacement by number of able-bodied paupers receiving out the Board of Control in 1913. The lunacy door relief, passed the NewPoor LawAmendment commissioners were concerned that all pauper Act of 1834, enabling parishes to join together to lunatics (the word 'lunatic' at this time including build workhouses into which were to be received the imbeciles and idiots together with the insane) all able-bodied paupers who could not exist should be admitted to the newly provided public without relief; no more outdoor relief was to be asylums but the Poor Law Unions preferred the permitted for such persons. Conditions in the cheaper option of maintaining their lunatic workhouse were to be harsh and unattractive so members in workhouses (where in 1847 (Lunatic as to discourage all but the most desperate from Return of Stoke-on-Trent Union, Public Record wanting to be admitted. Office MH12 11463) it cost three shillings (15p) The New Poor Law Amendment Act made only per week compared with eight shillings (40p) per one reference to the pauper insane. This was to week in the asylum) and thus commenced the the effect that no dangerous lunatic, insane battle between the two authorities. Psychiatric Bulletin (1998). 22. 575-577 575 HISTORY OF PSYCHIATRY Table 1. Lunatics chargeable to Poor Law Unions in England and Wales 1842-1910' house/ relatives Year184218601865187018751880188518901895190019051910Asylum32741559520626260293049737815453925024159152708338285192587Workhouse23829hospital21881454162720611842133511301568145712431219626Withregistered lodgings457959806557708668565980589658115869584755625639Total313870329934016048433564306347071370770268337096865109100117120in (28)8219(25)9756 (24)11358(23)15376(27)16464(26)17282(24)17825(23)16898(20)17460(18)17806(16)18258(15)Licensed 1. Reports of Poor Law Board (1842-1870) and Local Government Board (1871-1910). 2. Numbers in brackets after workhouse figures are the per cent total in workhouses. 3. Includes up to 2000 paupers maintained by county/borough rates. Early on, the Poor Law Commissioners agreed obtained in the asylums; no record was kept of that: restraint or seclusion, both of which could be "with lunatics, the first object ought to be their carried out without the sanction of a medical cure, by means of proper medical treatment. This officer: there were no registers or records of can only be obtained in a well-regulated Asylum: accidental occurrences. The attendants were and therefore the detention of any curable lunatic unqualified, often themselves pauper inmates, in a Workhouse is highly objectionable, on the and there was no authoritative official visitation. score both of humanity and economy" (Metropolitan The rooms were gloomy and prison-like, there Commissioners in Lunacy. 1844). was little provision for occupation or amusement They went on. however, to say that they believed and little space for exercise. The law directing that "most of the persons of unsound mind that every person thought to be a lunatic should detained in Workhouses are incurable, harmless be taken before a Magistrate and then, if the idiots". The lunacy commissioners, while entirely latter agreed, admitted to an asylum, was 'almost universally' ignored and, instead, the pauper was concurring with the opinion that the detention of taken to the Union workhouse where, "if he any curable lunatic in a workhouse was highly appears to be quiet and harmless, he is suffered objectionable, considered that the Poor Law to remain". Such patients were often melan Authorities were nevertheless, cholies, urgently requiring treatment and receiv "under some misconception as to the condition of ing none. The motive of the parish authorities in lunatics in workhouses, when they represent them as detaining insane patients in workhouses, in being in general incurable harmless idiots, and their stead of placing them in county asylums "has detention not objectionable on the ground of defective undoubtedly been that of economy" (Commis medical treatment". sioners in Lunacy, 1859). In those workhouses that they had visited the lunacy commissioners had found "not only incurable harmless idiots but numerous mania cal and dangerous lunatics of every class" Policy changes (Metropolitan Commissioners in Lunacy, 1844). As the asylums became progressively over An increasing number of workhouses began to crowded the lunacy commissioners were forced provide separate lunatic wards for their insane to rethink their policy with the result that in inmates. The lunacy commissioners described 1862 an Act was passed making it legal for the this as 'mischievous'. In 1859 the commissioners visitors of any asylum to make arrangements produced a supplement to their Report, strongly with the guardians of the district for a limited critical of the condition, character and treatment number of chronic lunatics to be transferred of lunatics in workhouses, whether mixed with from the asylum to the workhouse; stringent other inmates or placed in distinct wards requirements for the care of such lunatics were (Commissioners in Lunacy, 1859). The latter, laid down and the patients remained on the they maintained, had none of the advantages for books of the asylum and subject to all the legal treatment or safeguards against abuse that protection that they would have had if they had 576 Myers HISTORY OF PSYCHIATRY remained in the asylum. It is, however, doubtful satisfactory" (Commissioners in Lunacy, 1891). whether many lunatics were transferred under The battle for the detention of all certifiable this provision. The same Act also granted the lunatics in asylums had been lost but that the commissioners the authority to transfer to the commissioners had still not given up the hope of asylum any lunatic in a workhouse whom they curing acute insanity in asylums is evident from thought was inappropriately placed there (Hodg- their comment in 1910 to the effect that they kinson, 1966). The existence of this power had were, the effect of preventing "any frequent necessity of resorting to it". Guardians and workhouse "well satisfied on the whole with the condition of the ordinary workhouses visited by us during the year medical officers not only acted readily on under review. Whatever views may be held as to the suggestions for removal of acute and curable cases but even anticipated them "by observing in advisability or propriety of detaining persons of unsound mind in workhouses, at the present time, this respect more carefully the requirements of apart from the lunatic institutions, there is no other the law" (Commissioners in Lunacy, 1864). kind of establishment in which insane paupers can In spite of its illegality, cases of certifiable be received: and we consider that in many of the insanity continued to be brought to and detained workhouses very suitable accommodation is pro vided, with obvious limitations, for patients who are in workhouses. The lunacy commissioners were not suffering from acute insanity" (Commissioners in in a difficult position. Much though they would Lunacy, 1910). have liked to insist on all such cases being admitted to asylums they were forced, because of The asylum had lost its role as the sole lack of space, to compromise. In addition, much accommodation for the non-recoverable insane.