Writing in the Nineteenth Century of 1889, in an article entitled, “Lunatics as Patients, not Prisoners,” Sir John Batty Tuke drew attention to the steadily increasing incubus of pauper lunacy, and raised the whole question of lunacy administration in England and Wales. In this paper he asked whether, commensurately with the increasing expenditure on the care and treatment of lunatics, even at that time enormous, there had been achieved an understanding of the hidden processes which underlie the insanities, and some means of arresting their occurrence, such as the ratepaying citizen might reasonably expect in return for the vast sums expended. These questions Sir John Tuke answered by a decided negative, and he adduced as his main reasons for this unsatisfactory state of affairs that, in the first place, asylums were merely asylums in the classic sense of the term, places of refuge, “model lodging-houses for the insane,” not great hospitals for the cure of disease; and, in the second place, that the medical men who had the direction of these establishments were occupied with administrative and economic duties to the practical exclusion of scientific investigation and their proper function of healers of the sick. He even staged that it was quite an open question whether, in a certain number of cases, asylum treatment did not tend to aggravate the disease and render it chronic. That a certain number recovered in consequence of it, that a certain number recovered in spite of it, and that a certain number became demented because of it, were, he believed, each and all equally true statements. “A man merged in a crowd of irresponsible beings, all under the influence of a common discipline, and under the control of common keepers, must lose his individuality, and cannot possibly receive that anxious care and attention at the hands of one physician which is necessary from the nature of the case. What every case of insanity demands as the primary condition for recovery is, separate and individual treatment and consideration.”
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