Lunacy administration22nd June 2016
Extract from an article in The British Medical Journal, June 2, 1906.
Turning from the legal situation to the actual administration of the law and the provision made for the insane, we find that here again Guernsey affords an illustration of the perpetuation in modern times of antiquated forms. In all countries the earliest measures taken with regard to the insane, after it had become recognized that the maintenance of the indigent insane devolved upon the State or the community, were disciplinary, and the treatment accorded to these unfortunates little if any better than that meted out to common malefactors. Following this came the second stage, when the barbarous usages which obtained in madhouses gave place to simple detention, with no eye to curative treatment and no complete separation of the insane from the vagrant, idle, or vicious poor. Lastly came the modern asylum under expert guidance, under a separate administration, and with as adjuncts, in many countries, special mental hospitals for curable and acute cases, and for the chronic inoffensive cases, the family colonies.
As will appear, Guernsey, whose administration is happily undergoing revolution, is as yet in the second stage. The earliest legislation we have been able to trace is [a] provisional ordinance of 1889. Prior to this time there must have been some provision made for the insane poor under Poor-law Boards and for private cases under the regulations governing legal guardianship, but we have been unable to discover documentary evidence of any such cases in the volumes of the Recueil d'Ordonnances, which date back as far as 1533. We have heard it stated that in times past mad people were confined in small towers with bricked-up doors in the parish of Torteval, and had their food thrown in through small, high windows, but have been unable to obtain any confirmation of this. Possibly the old building called Colombier, near the church of S. Pierre-du-Bois, whose origin and purpose still puzzle archaeologists, may have been used for this purpose, or even Victor Hugo's ‘haunted house’ at Pleinmont. Probably, also, many of the seventy-eight wretched people burnt for witchcraft and heresy during the reigns of Elizabeth, James I, and Charles I were only the victims of insane delusions. However that may be, the fact remains that the earliest provision made for the relief of the necessitous or sick poor was the establishment in 1751 of the Country Hospital at Câtel for the country parishes and in 1742 of the Town Hospital for St. Peter Port and that to this day the two Poor-law Boards, those of the country and the town parishes, have under their care in the same institutions, the ordinary sick, the vagrant, vicious, and prostitute classes and the insane both pauper and private.
These two institutions, the Country Hospital and the Town Hospital with its annexe, the Town Asylum, are the only establishments for the reception of lunatics, either pauper or private, in the island. They were not erected as the result of State legislation, but were established voluntarily by the parishes concerned; they have remained, not only with regard to the ordinary and sick poor, but also as regards both rate-paid and private insane, under the same management. Naturally such an arrangement, with its confusion of Poor-law and lunacy administration, could not give satisfactory results. Reforms have been carried, as one of the speakers of the States said ‘at the point of the bayonet,’ and so far as the insane are concerned remedial effort has been, and still is, conspicuous by its absence. The Poor-law Board of St. Peter Port consists of a president, a vice-president, the rector of the parish, the two constables, the churchwarden of the parish, and the procureur of the poor with three other members, and ten overseers. The superintendence of the hospital and asylum is in the hands of a House Board composed of six members of the Poor-law Board and the vice-president as chairman and treasurer of the House Board. At the Country Hospital, in the same way, the relief of the poor and the sick, and the care of pauper and private insane, is carried on by a Board of Directors composed of various parochial and Crown officials, and popularly-elected representatives of the parishes. The medical officers to the hospitals and to the Town Asylum are visiting medical men, and in no sense medical superintendents, the superintendence being, as said above, vested in the House Board. They thus correspond in the main to the visiting medical officers of our workhouses in England and Wales, but, in respect to the insane, have no possibility of appeal beyond their respective Poor-law Boards, there being no Commissioner in Lunacy in Guernsey. This fact, that the whole superintendence of the asylum is in the hands of the House Board, is one chief cause of the dispute which has arisen in the case of the Town Asylum; but, faulty as this arrangement may be, it is clearly laid down in the regulations of the asylum, and was the condition under which the medical officer accepted office.
I was unfortunately refused permission to visit the Town Asylum, but through the courtesy of Dr Gibson, the Medical Officer of the Country Hospital, I was able to make a thorough inspection of this institution. It consists of a main building of simple but pleasing design, with side wings prolonged some distance in front and behind, the whole being roughly the form of the letter H. The main building is of three stories, the ground floor being given up to administrative offices, refectories and day rooms for male and female inmates, kitchens, etc.
The first floor, forming the hospital for the poor of the country parishes, is divided into male and female sides, each under the charge of a head nurse with a staff of assistant nurses; it is comfortable, scrupulously clean and neat, and from the medical point of view well provided.
The second floor is for able-bodied paupers, and though clean is strikingly bare and uncomfortable, with utterly inadequate provision for ventilation and warming; it is moreover decidedly crowded. The lunatic wing, the left front limb of the letter H, is a small long one-story building, divided into male and female halves by a median wall running from end to end of the building, which is fenced off from the rest of the hospital by iron railings, enclosing a very small exercise yard or airing-court for each half. There is on each side one small day-room, rudely furnished, for both pauper and private cases, and the sleeping accommodation consists of cells which resemble, but are very much inferior to, the cells of our large convict prisons. They are, of course, except in cases of illness, merely sleeping cells, but are practically devoid of daylight, and are only warmed by means of a row of hot-water pipes separated from them by the width of the corridor. There is no bathroom on either side, but merely a dark cell, containing movable hand basins and a portable metal bath. The accommodation for all classes of patients is alike, and there appear to be no facilities for the amusement or recreation of the inmates. Notwithstanding the obvious structural defects, the whole place, asylum, workhouse, and hospital wards, was exceedingly neat and clean, the patients in good physical condition, comfortably clothed and apparently contented, reflecting great credit on its energetic master, Mr Ferbrache, who obligingly conducted us over the establishment, and on Mrs Ferbrache the matron.
The orphan and destitute children are cared for in a separate building, at one time an isolation hospital, removed by the width of the extensive farm belonging to the hospital from the main building.
As we have said, we were denied entrance to the Town Asylum, but, from what we have heard, this differs in no essential particular from the Country Hospital in its provision for the insane, and we think that enough has been said to support the strictures of the medical officer to the Town Asylum on Guernsey lunacy administration.
Fortunately, action is being taken. The whole matter of lunacy and Poor-law administration has been engaging the attention of the States since it was raised in the beginning of 1904. At a meeting of the States, at which the Bailiff said that 'he would be a bold man who would stand up in the House that day and say that their sick, infirm, poor, and needy were efficiently looked after,' and that scenes were to be witnessed which were 'quite sufficient to cause sleepless nights;' a Committee was appointed to inquire into the matter and formulate a better scheme than that now in force. The report, or rather the reports—for the Committee were divided, and there is both a majority report and a minority report—were presented to the States in June, 1905. Both the majority and the minority were agreed that there should be established one central asylum, under a separate administration, for the whole Island in place of the existing institution, but were divided as to the wisdom of establishing a single central Poor-law authority. On the point, however, which immediately concerns us the States have accepted in principle the responsibility of establishing one central Lunatic Asylum for the whole Island, and we see from a recent billet-d’état that a site for the new asylum has already been selected at Montville, which visitors to Guernsey will remember as beyond and not far distant from Hauteville House, the old residence of Victor Hugo.
Some points which to us the committee revising the lunacy laws will be well advised to take into consideration have already been indicated, and the further opinion might be expressed that the interests of Guernsey will be best served in this matter by the appointment of a resident Medical Superintendent to the new asylum with powers similar to those of the Medical Superintendent of asylums elsewhere. A wholesale revolution of lunacy administration in a small self-governing Commonwealth like this offers a favourable opportunity of putting into effect reforms, such, for instance, as the treatment of incipient insanity and the family-care system, which can only be effected after prolonged deliberation in larger states where millions instead of thousands would be affected.
In conclusion, I wish to tender grateful thanks to Mr E C Ozanne, the Attorney-General for Guernsey, and to Mr J Linwood Pitts, the Librarian to the Guilles-Allès Library, for much assistance in making this inquiry.
NOTE: Since writing the above we see from reports of the subsequent deliberations of the States that the purchase of Montville has been abandoned, and the acquirement of a more suitable site at Oberland is under consideration.
For the complete article, see the Library's Hospitals file. For a history of the Hospitals as lunatic asylums and an explanation of the background to this article, see Crossan, R-M, Poverty and welfare in Guernsey, 1520-2015, The Boydell Press: Woodbridge, 2015, pp. 160-176, esp. p. 173, and 100 Years of Health, Chapter 5, Adrian Gaggs, 'Mental Health Service,' pp. 57 ff., in the Library.