During the third quarter of the 19th century it became clear that the problem of pauper lunacy was not being contained by the county asylums. Despite much new building, accommodation in asylums was over-crowded; the patient population had become increasingly heterogeneous and therapeutic optimism was waning. The proportion of curable patients in county asylums declined steadily—for example, from 1844 to 1870 the proportion fell from 15 per cent to 7 per cent. The prospect of large-scale institutional confinement, however, did not go unnoticed and alarm was expressed by many contemporary writers. J. T. Arlidge, formerly of St Luke's Hospital, for example, observed that: ‘Many asylums have grown to such a magnitude, that their general management is unwieldy, and their due medical and moral care and supervision an impossibility … in a colossal refuge for the insane, a patient may be said to lose his individuality, and to become a member of a machine … In all cases admitting of recovery, or a material amelioration, a gigantic asylum is a gigantic evil, and, figuratively speaking, a manufactory of chronic insanity.’
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