LUNATIC ASYLUMS. COMMIS SIONERS IN LUNACY. STATIS TICS, CONSTRUCTION, and MA NAGEMENT OF ASYLUMS. The subject of insanity and asylums for the insane has of late years occupied a very large share of public attention ; parti cularly as an opinion has prevailed that insanity is on the increase in this king dom beyond the ratio of population. The want of accurate information renders this point doubtful ; but it is certain that more than 20,000 insane persons are in confinement in the public asylums and licensed houses in England and Wales, of whom 16,000 are paupers. But as a great number of patients are confined se parately, or in the care of their relatives, of whom no public returns are made, this number is probably much underrated.
Two acts passed in 1845 (8 & 9 Viet. caps. 100 and 126) have placed the powers vested in the Commissioners in Lunacy on an entirely new footing, and have in many respects modified the constitution of asylums. The first act repeals 2 & 3 W. IV. 0. 107; 3 & 4 W. IV. c. 64 ; 5 & 6 W. IV. c. 22; 1 & 2 Vict. C. 73; 5 Vict. c. 4; & 5 & 6 Vict. c. 87. This first act appoints six commissioners, three of whom are physicians, and three barristers, with salaries ; and five other commissioners who act gratuitously. The rule that none of these shall be connected with any asylum is continued. No person can act as a commissioner who within two years has been directly or indirectly connected with any asylum. Licences are granted by these commissioners at each of their quarterly meetings. Any person who wishes to open a house for the reception of patients is required to send a plan upon a scale of one-eighth of an inch to a foot of every part of the premises at least fourteen days previously to his application. No additions to or alterations in a licensed house can be made without the consent of the commissioners. No licence is to remain in force more than thirteen months, and the notice of a wish to renew must give the number of patients then confined. The jurisdiction of the commissioners extends to the whole of London and Middlesex, and Southwark : and to all places within seven miles of London, Westminster, and Southwark : in the country the licences are to be granted by the justices of the peace in quarter-ses sion, who are bound to appoint three of their number, together with one physi cian, surgeon, or apothecary, as visitors of the asylums licensed by them. Strict regulations are enforced for the recep tion of patients; it is required that every person not being a pauper, received as insane, shall be certified to be so by two physicians or surgeons, who shall visit such patient separately, and shall have no interest in the asylum in which such patient is to be confined ; and certain entries of these particulars are to be kept at each asylum. For a pauper, the cer
tificate of one medical man and the order of two justices is required.
Penalties are fixed for neglecting these rules, or those which direct notice to be given of every admission, death, dis charge, or escape. Houses having 100 or more patients are to have a resident medical attendant, and those of smaller size are to be visited by a medical attend ant at defined periods, according to their size. Every house within the immediate jurisdiction of the commissioners shall be visited by them at least four times in the year, and every other house at least twice in every year ; these visits may be made at any hour, even by night, and it is penal to conceal any part of a house from them. Similar powers are given to the visitors in the country.
The commissioners are to present an annual report to the lord chanCellor of the state of the different asylums visited by them, which Report shall be laid before parliament.
An important alteration is made in the law concerning the care of single patients. Orders and medical certificates must in future be procured for the care of one patient similar to those used for the ad mission of patients into licensed houses ; and copies of these documents are to be privately sent to and registered by the secretary to the commissioners. This act only extends to England and Wales, and it does not affect Bethlem Hospital, London. The persons appointed to hold commissions "De lunatico inquirendo," heretofore styled commissioners, are in future to be termed " Masters in Lunacy." The second act, which repeals 9 Geo. IV., c. 40, relates to the regulation of lunatic asylums for counties and bo roughs, and the maintenance and care of pauper lunatics ; and gives to the com missioners a greater power over these institutions, which had previously been entirely under the control of justices of the peace. The justices of every county and borough are uow to be compelled to erect or to join in the erection of an asylum when none such already exists ; and all proposals, agreements, and plans, and the rules and regulations of each asylum, are to be submitted to the commissioners, and all contracts and estimates approved by the secretary of state. Contracts for the care of insane persons in licensed houses do not exempt any county or borough from the obligation of providing an asylum. Power is given to committees to grant retiring allowances to the officers of asylums ; and a medical officer must be resident in every asylum which contains more than 100 patients. Lists of all the patients are to be sent twice in every year to the commissioners by the medical officer. This act extends only to Eng land and Wales, and does not apply to Bethlem Hospital.