as such take part in proceedings, in every respect, as ordinary governors. We consider this position quite inconsistent with that of an Inspector, whose duty it is to report on the state and condition of institutions in the government of which he thus personally shares the responsibility.218
The commission noted the existence of regulations permitting the formation of ‘rules and regulations for the good conduct and management of district asylums in general, or any asylum in particular’ but ‘this most important measure for securing the good government of these institutions appears to have been imperfectly carried out for several years’:219
The principal defect in the rules, as regards the existing state of things in the asylums, is that the ‘duties’ assigned to the manager have been drawn up in contemplation of that officer not being a member of the medical profession. Fully concurring in the propriety of the asylums being in charge of professional persons, as our subsequent suggestions for their improvement will indicate, we regard a total alternation of that portion of the rules which affects the manager and physician as absolutely requisite.220
More specifically, the commission was unanimously ‘of opinion that the resident physician should have charge of the asylum, and be responsible for the treatment of the inmates as regards their insanity’:221
We think the resident physician should be relieved from all duties of a civil character connected with the management of the institution, which might interfere with the devotion of his time to his more proper duty, the care and treatment of the inmates. Leaving him the chief officer of the asylum, with authority over all the other officers, except the consulting physician, we propose that his civil duties should be transferred to the officer to be called the clerk.222
The commission also made several other recommendations, including better record keeping,223 changes relating to the appointment and conduct of governors,224 and review of the wages paid to asylum workers:
Another point, to which we desire to draw attention, is the small amount of wages given to the attendants in some of the asylums. The duty of the persons so employed is at all times disagreeable and irksome – frequently dangerous and disgusting. It requires intelligence, temper, and kindness, on the part of those discharging it, or the conduct of the attendant may undo all the judicious treatment of the manager. A higher class of servants, therefore, should be sought, and care should be taken, in their selection, not alone that they are possessed of the qualities above described, but that they are sufficiently educated to be enabled to contribute to the recreation of the patients by reading for their amusement. Such occupations will beguile the wearisomeness of their watching in the wards, and, helping to cheer and tranquilize the patients, will render their attendance a more grateful task.225
The commission lamented variations in admission practices across asylums and recommended that ‘there should be one rule, rigidly enforced, for regulating admissions’ and that ‘idiots, as well as epileptics, where the fits produce imbecility of mind as well as of body, should be admissible’.226 The commission felt that the ‘Resident Medical Manager’ should have authority to admit patients between meeting of the Board because ‘it is of the utmost importance that cases of insanity should as speedily as possible be removed to an asylum’.227
As regards ‘paying patients’, the commission noted that ‘there is no fixed rule in district asylums’ as ‘some boards decline to receive them; others receive them at a charge equal to the cost of maintenance; and in others the annual payment demanded is regulated at the discretion of the Board of Governors’:228
We are of the opinion that the admission of paying patients should be distinctly recognised, but that it should be subject to such restrictions as the Central Board, which we shall propose to establish, may lay down, both as to the class of patients and the proportion of such cases to be admitted into the asylums, so as at the same time to protect the ratepayers from undue taxation, and the lunatic poor of the lowest class from unfair encroachment upon the accommodation intended more especially for them.
The class of patients to be admitted ought not to comprise those who, from the means which they possess, should be maintained in a private asylum.229
After considering the various laws and regulations governing asylums, the commission then turned its attention to the ‘general condition of the asylums’, and found plenty of causes for concern including, inter alia, ‘cold and cheerless’ airing courts;230 ‘imperfect or ill-planned’ sewage arrangements; ‘defective’ water supplies; ‘inattention to cleanliness’; ‘privies … so offensive as to be absolutely injurious to the health of the inmates’; ‘improper occupation of inmates’; poor heating and ventilation; bedsteads ‘of bad and objectionable construction’;231 ‘neglect of school instruction’;232 misuse of restraint in certain asylums;233 and a ‘general want of’ recreation and amusement for patients:
At present, whatever attempts have been made in a few instances, and especially at Richmond and Sligo, in the way of evening entertainments, & c.,234 nothing has been done to mitigate the bare and cheerless character of the apartments usually occupied by the inmates. In corridor or day-room, the lunatic sees nothing but the one undiversified white wall – giving to these hospitals, intended for the restoration of the alienated mind, an air of blankness and desolation more calculated to fix than to remove the awful disease under which it labours.
It cannot be denied, notwithstanding the care and attention which appear generally to be given by the managers and visiting physicians to the patients under their charge, that, on the whole, the lunatic asylums of Ireland wear more the aspect of places merely for the secure detention of lunatics than of curative hospitals for the insane.235
After this rather damning consideration of district asylums, the commission next examined the position of the mentally ill in workhouses, and concluded that ‘there can be no more unsuitable place for the detention of insane persons than the ordinary lunatic wards of the union workhouses’.236 On this basis, the commission outlined a proposal ‘to appropriate unused workhouse accommodation for certain classes of insane’:
It should be competent to the Board of Governors of any asylum to direct the admission of any lunatic of the above class237 belonging to the district into the workhouse asylum; and, on the recommendation of the resident physician of the asylum, to admit directly to such workhouse asylum any such lunatic then in gaol or workhouse, or for whom admission to the district asylum may be sought. The governors should also have power to transfer patients, when necessary, from these auxiliaries to the district asylums.238
Notwithstanding its approval of ‘workhouse asylums’, the commission did not approve of the idea of ‘provincial asylums’, recommending instead that ‘as far as possible, all cases should be treated in the district asylum’.239 The commission advised clarity on the role of the Central Criminal Asylum and, specifically, that ‘a law should explicitly define who is to be detained in the criminal asylum; and as cure is not the only object with which such an institution has been founded by the state, the incurable inmate should not, because his case is hopeless, and he may himself be harmless, be again remitted to association with lunatics who are not criminal’.240 Other recommendations included establishment of a ‘central board’ to control and direct asylums;241 various changes to the establishment and conduct of ‘private asylums’242 and the role of chaplains;243 and the ‘desirableness of benevolent institutions for the insane’;244 and various other suggestions.245
Many of the commission’s conclusions were not new: it recommended expansion of the asylum system (e.g. through ‘workhouse asylums’) and strongly endorsed the idea of permanent segregation as a key element in management.246 More progressively, however, it drew attention to the importance of the asylums ‘as educational establishments, for the purpose of extending a knowledge of the nature and treatment of insanity’:247
We feel confident that, if the lunatic
