A great economy
Ashley presented the Bills to the House of Commons as a series of
"amendments" to the existing laws. "An attentive perusal" of which, the
Lancet said:
"will show that a provision is made for the treatment and preservation
of all lunatics whose resources are inadequate ... and ... at the
same time, every rational precaution is made to reduce, as far as
possible the cost to the public"
(Lancet 14?.6.1845 p.20)
What Ashley presented to the Commons appeared, in fact, to be a magnificent
scheme for the care of pauper lunatics that would be both humane and
economic.
The central provision was that every county and borough in England and
Wales would be required to provide County asylum accommodation for all its
pauper lunatics
(5S.1.7
+
5S.4). The belief that
underpinned this proposal
was that insanity was in most cases curable if it was treated in an asylum
early enough:
"The system we propose to substitute for the present one will effect a
cure in seventy cases out of every hundred" (Ashley, Hansard 6.6.1845
col.193) [A little earlier he said 60%]
He explained to the House of Commons that the expense of constructing a
national network of County Asylums was, in fact, an economy.
"The financial part of our project ... a most dry and uninviting topic
... is of the most essential importance, and hon. Members will allow
that without some explanation on this head I shall have little hope for
any Bill." (Ashley, Hansard 6.6.1845 col.190)
The usual complaint about tardy admission of pauper lunatics to asylums was
(as Ashley put it) that the parish authorities were indolent, indifferent
or sought to avoid the expense. (See above ###) Another impediment was a
recent Queens Bench ruling that in counties with a County Asylum the JPs
could not authorize a pauper's admission into a licensed house when the
County Asylum was full. But Ashley argued that the greatest impediment was
the lack of asylum accommodation due to "the fear of the enormous cost"
supposed to be necessary to construct a County Asylum.
Massive savings, however, were possible. The cost of existing asylums, he
said, was excessive and was increased because chronic patients were not
separated from the curable. But the greatest saving of all was that once
the system had been put into order the costs of building asylums would be
recovered through reduced poor law maintenance. Ashley's County Asylum
scheme was the bargain of the 19th century!
Eleven existing asylums had cost, on average, £170 a patient. The
commission thought that £80 a head would be "ample" for buildings
providing
for the "enlightened curative system ... recommended by the best
authorities. This would make the cost of an adequate 300 bed County Asylum
for recent cases only £24,000 rather than the £51,000 derived
from the
average cost of existing asylums.
"The greatest error", however, had been to assume that all patients
required such facilities: "We look at the matter in a totally different
way. Chronic lunatics, Ashley said, did not require the "minute care",
"precautions", "careful supervision" or "the same medical attention" as
recent cases "undergoing the whole of the curative process". Chronic
lunatics, therefore, should be kept in separate departments or asylums,
which could be constructed for as little as £50 a head.
At this rate, if 60% of patients were chronic, the cost of a 300 bed asylum
could be reduced to £16,740 if divided into recent and chronic
departments.
But this was going too far, because all epileptic and violent patients
would require special care in the recent case hospital - which would
inflate the cost to £20,030, or about £67 per head.
From the finances of his model asylum Ashley turned to the finances of the
whole scheme. The number of pauper lunatics not in asylums was 12,500 (See
4.17). At the established rate of £170 a head it would cost
£2,125,000
throughout England and Wales to accommodate them in asylums. "Whilst under
our plan it would be £813,750 ... a difference of
£1,311,250".
He then argued that counties should set this expenditure against the cost
of maintaining their pauper lunatics for life if asylums were not provided
for their early treatment and cure. He proceeded to calculate this and to
show that it was more expensive not to provide adequate asylums than to
provide them. Actually he only appears to calculate it. He seems to have
been confused by the figures, so I have re-worked them below as I think he
intended to present them.
In his calculations he said that 60% of the chronic pauper lunatics in
asylums and workhouses would have been cured if treated early enough. There
were, perhaps, 13,600 of these (5,600 in asylums, 8,000 in workhouses) of
whom 8,160 could have been cured.
Conolly had calculated a lunatics average life at ten years. So, at a fixed
rate per head, it would cost ten times as much not to cure someone as it
would to cure them. If the maintenance of the pauper cost £20 a year
the
saving on 8,160 would be (8,160 x 60% = 4,896) x (£20 x 9 years =
180) =
£881,280. Which is more than the £813,750 that the Commission
estimated the
cost of additional asylums.
On a different basis of calculation, but with the same conclusion, he
argued that in Middlesex £30,000 a year could be saved by providing
an asylum:
"This is a saving which, in the course of ten years will more than cover
the whole additional outlay for the construction of a new asylum"
These were conservative estimates of the total savings because, Ashley
said, Conolly's estimate of ten years was "a very low average" and, Ashley
was persuaded "far too low a basis to calculate upon. Dr Hitch, of
Gloucester, says that insanity by no means shortens life, and he gives
tables to show this." [The future for county finances looked very rosy!]
4.11.3 Perceval and Duncombe's opposition
Opposition to the Bills was mainly on Civil Liberties grounds. It also
contained clear, if not always coherent, protests against the increase in
executrive power, against a movement of power from the courts to the
executive and against the further centralization of government.
The main opposition was from Thomas
Slingsby Duncombe, Wakley's
fellow radical MP for Finsbury. Duncombe presented petitions from
John
Perceval
and other ex-patients, asking for a Select Committee of the House of
Commons to inquire:
"into the treatment of Lunatic and other patients and ... the laws
affecting their seizure, detention and release"
before the Lunacy Bill became law.
If that was not possible Perceval
wanted specified amendments be made to the bill to provide greater security
of civil liberties.
(Perceval's petition: JHC
1.7.1845)
Duncombe wished the Bill to be postponed to the next session:
"in order that an inquiry might be made as to the manner in which the
Commissioners had discharged their duty ... He would divide the House
on every stage, if the noble Lord persisted in pressing on the Bill this
Session." (Hansard
2.7.1845
col.1417)
He was supported by Sharman Crawford and Viscount Duncan and on one
occasion secured 15 votes (to 117) for postponement (Hansard
2.7.1845)
John Perceval's Petition
Perceval's petition was directed only against the
Lunacy Bill. It claimed that:
"the said Bill is very defective, and may prove very injurious, and that
it falls very far short of the objects for which it was intended; that
the Board of the Metropolitan Commissioners in Lunacy is, in practice,
contrary (as the Petitioner believes) to the intentions of and without
the real knowledge of Parliament, a closed and secret court, where
persons confined in asylums, without the knowledge of the charges
brought against them, and without even any one specific charge amounting
to a proof of insanity, have their cases inquired into behind their
backs, without notice being given to them of the day on which such
inquiry is to take place; without the power of being present by
attorney, or of sending a friend to watch the proceedings; without any
knowledge of the evidence against them; and consequently without power
to cross-examine, refute, or answer the same; that the delays necessary
to such a course of proceedings are very great, but that they are
cruelly aggravated by the long intervals of time that elapse between
each inquiry, that the present Bill tends to continue and sanction this
system, which is foreign to and hateful to the constitution of these
realms and furthermore tends to erect another Committee within their
Commission still more secret, for inquiry into the cases of persons
confined as of unsound mind in private houses; that it is the opinion of
the Petitioner, from the reports he has heard of the manner in which the
Commissioners conduct their inquiry into a patient's case, of such
patient himself, that they are influenced by prejudice, and that they
frequently conduct their examination in an unfeeling and negligent
manner and that they are not worthy of so much confidence as they demand
from the House ... "
(Perceval's petition: JHC 1.7.1845)
Ashley protested against the allegations of prejudice and
insensitivity, but neither he nor anyone else was recorded as responding to
the picture of
the Commission as an executive court, not following due process of law
and without consideration for the rules of justice; or to Perceval's
assertion that:
"the present Bill tends to continue and sanction this system, which is
foreign to and hateful to the constitution of these realms"
4.12 Like a thief in the night
Part of the Lunacy achievement of the Inquiry years (1842-1845) was a
massive increase
in centralisation
(see 5.3.4), comparable to that achieved by
the Poor Law Commission from 1834.
The 1845 Acts finished the process off and turned the new
machinery from one of inspection and information gathering into an engine
of national transformation: the agency under whose auspices asylums for the
lunatic poor would rise on green fields from
Denbigh in
North Wales to
Warley
in Essex and from
Hampshire
in the south of England to
Northumberland
in the far north.
As we turn to look more closely at the process of transformation it is as
well to remember that tiny minority of MPs who condemned the process as un-
English and un-constitutional. Notice how lost and how unreasonable their
voices sound. What had they to hold on to? What evidence had they of this
new tyrant that had stolen in on the autonomy of local government in
England and Wales? When had anyone said "we are going to create a new
government department to control the affairs of the Justice of the Peace
with respect to the lunatic poor."? The Commission had come like a thief
in the night. In 1841 it was not there, in 1845 it was there and all that
Ashley and Graham sought to do was to extend its powers. "It is not the
same
commission!" Ashley called out to Duncombe.
And he was right.
© Andrew Roberts 1981-
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