56

THE LANCET.

LONDON: SATURDAY, JULY 21, 1855.

THE PUBLIC LUNATIC ASYLUMS IN NORFOLK.

THE magistrates of Norfolk and the city of Norwich seembent upon achieving for themselves an unenviable distinctionin the treatment of lunacy. In most parts of the country the

public asylums present examples for imitation by the privateinstitutions. In Norfolk the order is reversed. Public asylumsare maintained out of public funds, and governed by gentlemensupposed to be unbiassed by any personal interest, who areconspicuous by their social station, and who, if not necessarilyconspicuous for virtue and intelligence, at least arrogate tothemselves the quality of benevolence, and a certain talent foradministration, or they could not with decency assume func-tions which imperatively demand the possession of those quali-ties. Institutions seamaintained and governed may reasonablybe expected to keep pace with the humane spirit and scientific

improvements of the age; they should certainly be free fromthe reproach of obstinate adhesion to exploded barbarities. Dothe magistrates of Norfolk and Norwich ever visit the asylums’of other counties-the Lincoln asylum is not very distant--inorder to enlarge their knowledge through the precious mediumof comparison ? Or do they look upon the asylums they them-selves conduct as such perfect models of what asylums ought tobe, that they have nothing to learn ? We fear they stay toomuch at home. But if the magistrates are insensible to theteachings of experience and comparison, there is another bodyof men whose peculiar duty it is to compare, and to deduce

maxims for general improvement out of the enlarged observa-tion of the merits and defects of all the asylums in the kingdom.What the Norfolk and Norwich magistrates are too remiss ortoo obtuse to do for themselves, the Commissioners in Lunacydo for them. The Commissioners having visited the asylums,observed what to them appear defects, and pointed out fittingremedies, annually report the result of their observations andsuggestions. From these Reports we find that there are

asylums such as those which have had the good fortune to beorganized or directed by such men as CHARLESWORTH andCONOLLY, which constitute the highest standard of excellence.These the Commissioners see and admire; there is no scope forcensure. There is another order of asylums, less perfectperhaps, but whose governors, animated by a praiseworthyambition not to suffer their institutions to lay under the impu-tation of inferiority, are ever ready to recognise defects, andanxious to carry out useful reforms. And there is yet another

class, happily now small in number, governed by men upon whomexperience is without fruit, who are insensible alike to thevoice of admonition and to the shame of being last in the noblerace of emulative justice, benevolence, and science. Those

who read the Reports of the Lunacy Commissioners need notbe told that the public asylums of Norfolk and Norwich hold abad pre-eminence in the last category. And the magistrateswho are responsible for the government of those asylums seemdetermined that they shall continue to hold that unenviableposition. Even Bethlehem has been reformed; but to theseasylums the most disgraceful abuses still cling with the tenacityof ignorance and prejudice.

In the Report just published by order of the House of

Commons, we find the following passages, which we reproduce,in the hope that they may furnish matter for wholesome reflec-tion in those whose opinions may in turn influence or coercethose to whom is entrusted the immediate control of theasylums condemned.

" The staff of officers in the Norfolk County Asylum hasalways differed in some degree from those of other similarestablishments.

" It may be remembered that in the Report made to theLord Chancellor by the Commissioners in Lunacy, in the year1844, the want of a resident medical officer in this institutionwas noted as a most serious defect.’ The superintendent nothaving any knowledge or experience, medical or surgical,’ itwas ascertained that, in cases of apoplexy or suspended anima-tion from strangling, it would be necessary to send to Norwich(three miles distant) for one of the medical visitors. The defi-

ciency of land provided for the Asylum was also adverted to inthe same Report.

" Since that time a large and sufficient quantity of land hasbeen purchased for the use of the institution, and a residentmedical officer has been appointed in pursuance of the requi-sitions of the Act 8 and 9 Vict., c. 126. But inasmuch asunder the 55th section of the Lunatic Asylums Act, 1853, anyperson other than a resident medical officer, who was thesuperintendent of any asylum on the 10th day of February,1853, may continue to be such superintendent, unless the Com-mittee of Visitors otherwise direct, the superintendent of theNorfolk Asylum has continued to be a non-medical man ; andhe has been invested with powers, some of which materiallycircumscribed the power of the resident medical officer to

manage lunatic patients according to the modern improvedmode of treatment.

" Upon the occasion of the proposed rules for the governmentof the Norfolk Asylum being submitted to us by ViscountPalmerston in September last, we suggested various alterationstherein, some of which had for their object the increase of themedical officer’s power. The Committee of Visitors, however,although yielding their assent to many of our suggestions, ad-hered to the system which has so long governed the NorfolkAsylum. The superintendent has still the general control overthe male attendants and servants, and the matron the control,in common with him, over the female attendants and servants,and each of them is invested with authority to order any patientto be placed under mechanical restraint, or in seclusion, oncondition of their reporting the circumstance forthwith to themedical officer. This authority, of course, prevents the medicalofficer from carrying into effect any system of complete non-restraint. The superintendent has also the exclusive power ofpermitting patients to go out for exercise beyond the limits ofthe grounds, and to direct the employment of all male patients,except such as the resident medical officer shall certify as beingaltogether unfit to be employed. The effect of these powers isto enable the superintendent to interfere very materially withthe powers and duties of the resident medical officer, underwhom we think everything bearing upon the general treat-ment (moral or otherwise) of the patients ought to be placed.

" In the month of July last we received a statement fromDr. R. F. Foote, at that time resident medical officer in theNorfolk County Asylum, in reference to that establishment.As this statement has some bearing upon the foregoing remarks,it may be expedient to notice it more particularly.

"Dr. Foote complained that a female patient had beenharshly treated by the matron, and three of the attendants ;that male persons had been admitted into the Female Infirmaryat improper times, in opposition to his directions, and that onthe subject being brought before the visiting justices, thosegentlemen had upheld the authority of the matron, and haddecided in favour of the treatment which had been adoptedtowards the patients.

" Without entering into the merits of this dispute betweenthe officers of this institution, we are disposed to attribute anyevil attending it to the rules of the Asylum, which deprive themedical officer of powers which ought properly to belong tohim, and give them to non-professional persons, who, neces-sarily, cannot be fully competent to exercise them.

" It appears to us to be of the greatest importance to thewell-being of these large public institutions, not only that theresident medical officer should have paramount authoritytherein, but also that he should be liberally remunerated.

"Without meaning to question the qualifications of theseveral gentlemen who have during the last few years filled

57

THE THAMES AS A SOURCE OF DISEASE.

the situation of resident medical officer in the Norfolk Asylum,we think that the remuneration has hitherto been very inade-quate, the salary ranging from £80 to X100 per annum-a sumquite insufficient under ordinary circumstances to induce me-dical gentlemen of much experience and skill to accept such anoffice."

There must be few persons out of the board-room of the

Norfolk Asylum who will not coincide in the justice of theabove remarks. But it may be surmised that the superintendentin whom such trust is reposed, whose authority overrides thatof the medical officer, must be at any rate a man gifted withremarkable discretion-a man of education and refinement.

Perhaps the superintendent may be a man of this kind, anddeserving the implicit confidence of the magistrates. It maybe so; but it certainly is, not usual to look for the education,the accomplishments, the temper, and the gentle feelings thatshould distinguish the superintendent of a lunatic asylum,amongst those who had failed to achieve success in the voca-tions of an ordinary keeper, of a policeman, of a turnkey in agaol, and of a master to a workhouse!The Norfolk magistrates, however, see no incongruity in

making the resident medical officer subordinate to a man whosefitness for his present position rests upon the urbanity, theadministrative capacity, and the scientific knowledge which hemay chance to have acquired or preserved, whilst filling theexalted and ennobling offices we have specified. The choice of

a superintendent in truth supplies the surest test of the viewsentertained by the magistrates as to the proper managementof insane persons. The Thorpe Asylum is governed in strictconformity with the qualifications that may be supposed to beunited in their superintendent. There is a happy union of thediscipline of the gaol with the parsimony of the workhouse, andmedical treatment is kept in judicious subordination. The

result of this theory and practice are exemplified in a catas-trophe which led to a coroner’s inquest, to a special inquirybefore two of the Lunacy Commissioners, and which excitedthe general indignation and animadversion of the press. We

have on a former occasion related the circumstances under

which the unfortunate lunatic, WILLIAM SiZEB, met with hisdeath. We may recall attention to the fact that eight of hisribs and his breast-bone were broken; that an attempt wasmade to prove that Sizer had inflicted these injuries on him-

self; and that grave suspicion rested upon some of the attend-ants. The Commissioners, not satisfied with the result of theirown investigation, recommended the magistrates to inquirefurther into the case, with the assistance of counsel. The

magistrates replied that they had already, " to the best of

their judgment," used every means to elicit the truth, and

they declined to probe too closely into the working of theirfavourite system. Three of the attendants were dismissed, the

superintendent was retained, the system was not changed, andtheir Asylum was preserved in the same condition as before.How long this is to continue-how long a set of men who

have exhibited incompetency so flagrant, and ignorance sogross, are to be permitted to outrage decency, and to violatethe plainest dictates of humanity and science, is a questionwhich it remains for public opinion, or the direct interventionof Parliament, to decide. It would be a more rational proceed-ing to refer the matter to the judgment of the inmates of theAsylum than to persist in aimless and hopeless appeals to thegood sense and humanity of their governors.

IT was last week, and must be again, our duty, as overseersof the public hygiene, to allude to a picture of very repulsiveaspect-a picture scarcely less repugnant to our taste thanthat we placed before the reader a few months back, (videTHE LANCET, vol. ii. 1854, p. 425,) which exhibited the

fastidious as well as plebeian denizens of the Chaussee

d’Antin and Belgravia, the Fauxbourgs and Grub-street,compounding their eau sucrée and lemonade, their ginger.beer and gin-and-water, with a diluent into whose chief reser-voirs (the Thames and the Seine respectively) the sewageand excremental matter of the surrounding inhabitants werehourly being poured. However, as " time-honoured custoni

"

and taste (for, as regards the latter, we all know, de gU8tibu8non est disputandum) seem not only to sanction, but evento foster, the to its revolting anomaly, it may be thought weare venturing a little too far in thus turning up our noses S(]very determinately at the daily employment of a fluid, which,to the poorer inhabitants, at least, of our metropolis, mustseem thick and substantial enough to be " meat as well a,s

drink." But we are still unconvinced and obstinate; and wecannot say that, in returning—as we intend for a few minutes- to the subject, it is to sing an 10 pcean to the praises of theThames. We wish, indeed, we could join PoPE in saying----

"Hail, sacred Peace! hail, long-expected daysThat Thames’s glory to the stars shall raise!Though Tiber’s streams immortal Rome behold-Though foaming Hermus swells with tides of gold-

* * * *

The time shall come when, free as seas or wind,Unbounded Thames shall flow for all mankind."

For, until it flows- a little more translucent than it is now

doing, we shall still reiterate our objections, not only to anaugmented, but to its present use as a daily food. When we pre-viously hinted our dislike, (loc. cit.,) we had just passed throughthe ordeal of a fearful pestilence, which had decimated themetropolis to the extent of nearly 11,000 persons above theordinary mortality in the space of three months. We had

passed through a pestilence, too, whose greatest ravages wereproved to have been exhibited in those localities which werenearest to the banks of a filthy river, and amongst those

persons who employed the filthier portion of its waters. We

may possibly be again, for ought we know to the contrary, onthe verge of another visitation, and as we closed our account ofthe past one by a picture of the Thames, so may it be left for usto open the present with a representation of the same locality.Steamboat captains and men of science-plain Jogrt SMITHand Professor FARADAY-are alike calling us to account. The

Thames, (as we last week pointed out to our readers,) andit is useless to disguise it, is, if it be possible, daily gettingmore abominably disgusting in its state; it is a worse fer-

menting excremental cesspool than ever-a greater sink offilth and putridity-a thicker Alexandrine puddle of effete sew-age, absolutely unbearable, from its nauseating emanations, bythe stomachs both of bargaman and philosopher. Beneath a Julysun, in the centre of a city containing nearly two millions and ahalf of people, ready to become the prey of a fearful and painfulmalady, slowly move the turbid, dirty waters of a stream, thereceptacle of the sinks, sewers, and water-closets of the peopledwelling near it. As sure as is the truthfulness of this melan-

choly and repulsive statement, so surely will the fatality of thecholera, if it appear, be augmented in a ratio with the exagge-rated filthiness of the river. Near the bridges, according to Pro-

58

THE UNIVERSITY OF LONDON AND THE LICENCE TO PRACTISE.

fessor FARADAY, the feculence rolls up in clouds so dense as tobe visible at the surface, and the smell and filthiness of the

"opaque pale-brown fluid" are such, that a row down theFleet-ditch might be comparatively a blessing to a trip " be-tween bridges" in a " Citizen" steam-boat. Well, indeed, maythe Thames be called "a putrescent pond"-. "fermentingsewer;" but to think that its possessors seem rather to aim at

augmenting its revolting noxiousness, than in arresting or

diminishing it, is a paradox fearful in the extreme. Is

there no power, we would seriously and once more

ask, in so huge a municipal system as our own-no voicein any branch of our administrative or legislative govern-ment which will at least attempt to arrest the self-immolationof perhaps 12,000 persons ere the year shall have run its

course ? Surely the climax is attained, and the Thames musthenceforth be purified; or is the stream that passes through ourtown so apotheosed by the Palace that overhangs its banks atWestminster, that, like the " holy Ganges," nur Brahminshaving sanctified, now venerate their elongated cesspool of deadcats and putrescence, as those of India do their reservoirs ofcrocodiles and mud ? Is there no voice which will speak in unisonwith that of the illustrious chemist, whose letter we lately pub-lished-no CARLYLE in hygiene who will exhibit to us anotherof our great shams, in thus wallowing, like the pig, in our ownordure at home, whilst a mile or so distant we scream at ourvoices’ summit for fountains, palm-trees, and crystal palaces!Disgusting indeed is this fact, as deeply so in truth as is ourvery river. But the inhabitants of this great town may be satis-fied that if like pigeons they mean to live dirty at home, andbe in fine feather only on the house-top, not all the springs ofSydenham, the palm-trees of Kew, or the fresh air of Hamptonand Bushy, will avert for one moment-nay, diminish oneiota of the strokes of the plague-sword which hangs abovetheir heads. It may be all very well to talk about half.holidays for enjoying the artistic adornments of the CrystalPalace, of opening the grounds of Gore House to enjoy somefresh air in, and of planning cheap Sunday excursions to Mar-

gate and Brighton; but if this is alone to be the style of socialimprovement we are going to rest contented with, we say againthat the people, both plebeian and patrician, of our great townsmay feel assured that such things will prove to be useless in miti-gating the ravages of disease, both ordinary and pestilential, solong as the conditions we have hinted at in respect to theThames are allowed to exist, flourish—nay, rapidly increasearound our ordinary dwellings. Let them be alarmed ere it be

worse. It is now most imperative on us to give the hint. The

time for pestilence approaches; there is already somethingpeculiar about the atmosphere, and even those, " to the man-ner born," say the gully-holes are vomiting forth miasmata

peculiarly faint and nauseating in character. The Thames,our great hot-bed of miasmatic poison, is hourly getting worse,our city is getting denser, provisions are dear, war continues,and taxes do not diminish, -all circumstances tending to increasethe difficulties of living and supporting the agrémens of life, andwith these consequently rendering us a more easy prey to thevirulence of a fearful devastation, by the blast of whose onsetwe know not how soon we may be awoke.We urge, then, upon the authorities, and upon the people,

no longer to shut their eyes to the seriously destructiveagents they permit to be engendered all around them.

THE course adopted by the Senate of the University ofLondon in preparing a diploma, purporting to confer on theDoctors of Medicine a licence to practise, and withholding asimilar document from the Bachelor of Medicine, has calledforth the just animadversion of " A London Graduate," whoseletter we published last week. The terms of the Act of last

session for extending to the medical graduates of the Universityof London the privileges enjoyed by those of Oxford and Cam-bridge are so precise as to leave no room for doubt in the constru-ing. No difference whatever is made between the Bachelor andDoctor. They stand on an equal footing; and it is certainly acircumstance requiring explanation, why the Senate, with theAct in hand, should make a distinction totally at variance withthe title and spirit of that Act. But for certain passages in the

past history of the University, we should have concluded thatthe Senate had committed a mere oversight, which only re-quired to be pointed out to meet with instant rectification.But we greatly fear that this proceeding is the result of deli-

beration. It is quite clear from the terms of the Act that nodistinct authority from the Senate is required in order to con-vey to the medical graduates the licence to practise. The

taking of the degree is their full and sufficient licence. A

separate diploma, setting forth that the Senate, "by the

authority conferred" on it, "grants him (the M.D.) licence to

practise in medicine," is mere surplusage, unless indeed it beintended, by confining the issue of such a document to theM.D., to imply that the M.B. is not entitled to a similar

licence. Is that the meaning of the Senate? We shall becurious to learn. In the meantime the Bachelors will be apt tolook with some not unnatural suspicion upon the fact that theSenate at one time enunciated the doctrine that the M.D. was,

par excellence, a physician, and the M. B. a general practitioner.Is that still the opinion of the Senate ? It is certainly not the

opinion of the graduates; it is certainly not the opinion of thosewho drew up the Medical Graduates Act. At the very com-

mencement of the organization of the graduates, this arbitrarytheory was repudiated. Before the Committee on Medical

Registration, which sat in 1848, Dr. BARNES, who appeared asSecretary of the Graduates, thus clearly defined the relativepositions of the Doctor and Bachelor of Medicine:-

"I think it is an academical difference, rather than a medical’

one-a difference in degree, not in kind. The Doctor of! Medicine holds a higher academical position in the University,

not that he is more a physician than the Bachelor of Medicine."

This definition. has been consistently adhered to in all the! subsequent proceedings of the graduates, it rules the wording

of the Act of last Session, and it is beyond the function andthe power of the Senate to establish any other. It would be

just as reasonable to lay down the dictum that a Bachelor ofLaws is an Attorney, and a Doctor of Laws a Barrister.The case. then, at present stands thus: An Act exists, con.

ferring upon all Graduates in Medicine of the University ofLondon the licence to practise medicine throughout the same

L area as the Licentiates of Oxford and Cambridge. The Senate

has resolved to issue a distinct diploma, professing to convey; the licence to practise to each M.D. The Senate has not yet

determined to issue a like diploma to the M. B. Whether the

, Senate shall hereafter determine to issue such a diploma to theBachelor is a matter of no importance, as the Bachelors possessthe licence to practise in virtue of an Act of Parliament.

59

"THE LANCET" AND THE ANALYTICAL SANITARY COMMISSION.

INHUMANITY in a member of the medical profession is for-tunately rare; for not only is it a disgrace to the individualpractising it, but to a certain extent it reflects discredit onthe profession generally. When proved to exist, either in

a private or public practitioner, it deserves to be visited withcondemnation and punishment. No one can therefore be sur-

prised at the sentence lately passed by a court martial uponMr. J. W. ELLIOTT, a surgeon of the Royal Albert, attachedto the Brigade of Marines, at Balaklava. It was shown uponhis trial that he had habitually behaved in a most cruel man-ner towards the sick men under his charge, had called them" rotten," a "rotten set," or words to that effect, and hadrefused or neglected to attend to them in their greatest need.Found guilty, he was sentenced " to be mulcted of the pay"due to him, to be dismissed her Majesty’s service, and to be

"imprisoned for two years in one of her Majesty’s gaols." Helives at present in a screened berth of the main deck of theRoyal Albeot, and will be sent home in her Majesty’s ship-Tnflexible. "

Now, if Mr. ELLIOTT be really responsible for his actions-if, in fact, he be not labouring under hallucination-we say thesentence is a just one. For the sake of humanity, for the sakeof the profession, we could almost have wished that the pleaof insanity could have been established. There appeared, how-ever, to be no grounds for such a plea, and the verdict mustbe regarded as righteous and the sentence as just. The

culprit stands out from the ranks of his profession as unworthyto associate with his brethren.

During the campaign in the Crimea, members of the medicalprofession, true to the noble instincts of a calling in whichcourage and humanity have always been foremost, have shedimperishable honour upon medicine. Earnest, faithful, and

untiring in their labours, they performed their duties in a

manner which, if it did not call for special mention in a

despatch, has shed a lustre on the medical profession.Let the cavillers against the surgeons in the Crimea

remember for a moment the devotion and heroism of thelamented THOMSON. Prominent as were these, we believe

sincerely that they were only a type of the general conduct ofhis colleagues. Let it be remembered, too, that these dutieswere performed, not in the heat of battle nor in the excitementof action, but after the bloody work was done, and the true

courage of manhood was called forth; not, too, be it recol-

lected, with the expectation of posthumous honours, for theState has never yet done justice to our profession. No, theyknew full well that the

" Storied urn or animated bust"

was not likely to be the reward of their heroic actions, if theyperished in their performance. We call upon the authorities,then, to do justice to such men as these. Punish the offender,we say-aye, and with severity too, if it be shown that he isneglectful or cruel; but equally we demand that honoursshould not be withheld from those who nobly and courageouslyperform their duty.

THE petition of the Metropolitan Counties Branch of theProvincial Medical and Surgical Association, praying fot

reform in the Army and Navy Medical Departments, whichwas drawn up by Dr. BIRD for the Medical Services Committeeof the branch of which Dr. GEORGE WEBSTER is Chairman, has

just been printed by the House of Commons. It was presented

to the House, on the 18th of June, by Mr. ROEBUCK; and onThursday, the 12th of July, a deputation of the Committee,consisting of the Chairman, Dr. WEBSTER, Dr. BIRD, Mr.ANCELL, and Dr. RICHARDSON, had an interview, by specialinvitation, with the Minister of War, at the War-Office, forthe purpose of presenting him with the petition, which wassigned by seventeen members of the Metropolitan CountiesBranch. The petition was read to Lord PANMURE, who

signified his assent to the propriety and necessity of most ofthe changes prayed for, and said, moreover, that the re-

commendations, in the fifth and sixth paragraphs, for theoriginal selection of army medical officers to be made on thegrounds of merit and fitness, ascertained by examination, andthat in any improved system of military medical organiza-tion the administrative affairs of the department should beseparated from those of purely professional duties, met withhis entire concurrence, and were about to be carried out.

There were difficulties in the way, at present, as to carryinginto effect some other changes recommended, but to which,however, he promised to give his best and earliest attention.

THE institution, by the Editor of this Journal, of the Ana-

lytical Sanitary Commission, and the publication of the Re-ports of that Commission in our columns, have already led toone of the most important of their legitimate results-namely,the interference of the legislature on the subject. The appoint.ment of a Committee of Inquiry by the House of Commons,on the motion of Mr. SCHOLEFIELD, will, in all probability,give rise to the enactment of some legislative measure whichwill be productive of great public benefit. Evidence has

already been taken at two sittings of the committee. It

would be useless to give that testimony at length in this place,because all the main facts have been already recorded in our

pages, in the elaborate reports which we have published withinthe last four years, of which the evidence hitherto adduced is

only a repetition. A summary of any additional facts that

may be elicited will be placed before our readers at a futureperiod.The subject is one of immense importance, as it strictly

relates to the health of the community, and to those principlesof integrity which ought to be characteristic of all commercialtransactions. The attention of Parliament could scarcely bedirected to more important questions than are involved in thisinvestigation.

THE pressure upon our space compels us to postpone till nextweek the important letters of Dr. ANDREW SMITH to the variousauthorities and the medical staff relating to the sanitary careof the army in the East. The intimate connexion of these to

each other, and the complete vindication of the medical fore-sight and administrative capacity displayed by the MedicalDirector-General, when taken together, renders us anxious topublish the entire series in one number. We are the more

inclined to this course because we are convinced that, whilstthis publication is an act of justice to an able public servant,who has been assailed in a most dastardly manner, these letterswill be read with the greatest professional interest, as contain-ing valuable and complete information as to the organizationand means required for the medical care of armies about totake the field.