The earliest documentation concerning asylums were the minutes taken by Visiting Committees. These groups were formed to solve an emerging problem, which was usually overcrowding of existing facilities. The Committee would then visit a select list of other asylums, compare and contrast their experiences, working methods and organisation, and then propose recommendations for the problem’s solution.

If accepted, then the Visiting Committee morphed from its "think-tank" role into a body charged with the implementation of its own recommendations. Architects were selected, builders chosen, and the plan would be made real. The last concerns of the Visiting Committees were usually the employment of key medical roles, the overseeing the first influx of patients, and sorting out any snagging problems. The committee were then disbanded, although many key members would find themselves subsequently promoted to the board of the asylum’s governors.

This rare and insightful document is the Visiting Committee’s Recommendations for resolution of overcrowding at the Sussex County Asylum. Their proposal, formed after visiting several other asylums around the country, was to build an entirely new asylum at Hellingly. The document details the proposed size of the asylum, all the key buildings that would be required, and the organisation and classification of some patient types. In short, it explains why Hellingly was built, and why it was built the way it was.

Unfortunately some of the pages are missing but the majority of the document is still intact. Therefore the reproduction of the document here notes the missing pages.

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... think it may be judiciously extended in this county being indicated in the recommendations which we propose to offer.

At Lenzie we saw one cottage containing about eight trustworthy female patients, and were informed that there were one or two others on the estate which had been converted to a similar use.

RECOMMENDATIONS

In setting out a scheme for the erection of an asylum, it is essential to start with an estimate of the probable number of inmates to be provided for, both at once and in the future.

The number of E. Sussex patients now at Haywards Heath is about five hundred. We anticipate that by the time the new asylum is fit for habitation there will be about six hundred ready to come in. This number will undoubtedly be increased from year to year, and, in view of certain contingencies, we have taken 860 beds as the amount of the accommodation which should be put at once in course of provision. As will be seen, we shall put forward a scheme by which this number can be largely increased as necessity arises without entailing any great stress on the administrative accommodation provided at the outset.

The general idea of our proposals is a combination of a certain amount of centralization with the Village system. The relative proportion of the former to the latter should eventually be lessened by letting accommodation which may be required later on take the shape of the latter. The benefits of the Village system will be set out when that part of the scheme is considered; but we do not feel that in this County it can be adopted with safety and economy in its entirety. We believe that among patients, in addition to those who need continuous supervision, there are many to whom the residence outside the main building would make no sort of difference, and that, therefore, for the sake of these, undoubtedly good points should not be imperilled.

We advise, therefore, the disposition of the patients as follows:-

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The greater relative number of female admissions, together with a tendency to greater accumulation of females arising from a lower death rate, make it necessary to find room for females in a proportion of about four-sevenths of the total accommodation. It does not appear that this proportion will be lessened by separation from the Borough of Brighton.

We proceed to remark on these individual buildings, in the order in which they are placed above.

THE MAIN BUILDING

We do not propose to deal here with the Administration centre, the disposition of which must be settled after consultation with the Architect. We advise that the patients’ accommodation be broken up into units of seventy beds each, each of such units to be a separate self-contained block, connected with other units and with the Administrative centre by suitable covered passages. Each unit to be again subdivided into two wards, each self-contained to a certain extent. In some cases, such as wards for epileptics and the feeble, the day-rooms and dormitories will be on one floor, while in others the day-rooms will be below and the dormitories above. The latter arrangement appears to us to be the more desirable when it can be attained, since it allows of the very thorough ventilation during the day. It may, however, entail some of the blocks being of three floors, which is of no great disadvantage to patients of average robustness.

There will thus be on the female side four blocks of two wards each, making eight wards in all, and on the male side three blocks also of two wards each, or six wards in all. No ward will contain more than thirty-five patients. The amount of classification which will be rendered possible by these fourteen wards, together with separated buildings, will be very valuable from a medical and administrative point of view, while the blocks, being more or less open and detached on all sides, will admit of easy and efficient sanitary treatment. It is also contemplated that, by an appropriate disposition of the day-rooms and dormitories in each ward, a further parting off of patients will be made possible. We feel strongly that this is the most desirable as long as the subdivision is not carried so far as to render the supervision difficult and too costly. In going into the wards of the asylums visited no point struck us more than the influence in orderliness and comfort produced by small numbers. The addition of even a few patients to each ward at once impressed itself on us.

The question of baths can be conveniently dealt with here. In several asylums we saw general bath houses, in which the great bulk of the patients in the asylum are periodically bathed. The arrangements in many cases are most perfect, great pains being taken to give as much privacy as is desirable. In other asylums each department had its own bath-room. While there is something to be said for the former system, we consider the latter to be preferable. In any case the regulations of the Commissioners in Lunacy require at least one or two baths in each ward, and a moderate addition to those would not add much to the capital or working cost, while the extra cost of a large bathing establishment would be obviated. But our chief reasons of preference for sufficient bathing accommodation being supplied in each block are :- we think that it is more in accordance with custom, and indeed more comfortable for the patients, that they should not have to traverse long passages to and from the bath; we believe that the working of the wards will be easier if the strength of the staff is not reduced by the removal of one or more of the attendants away from the block at bathing hours; further, we think that centralisation even in this matter will to some extent militate against the idea of division of patients into independent and moderated sized groups, each with its own charge attendant as the responsible head, knowing all the habits and points of each individual patient. This idea is the real key to all our proposals. We think that in domestic matters the greatest benefit will arise from the formation of "families" so to speak, leading to the striving on the part of the head and his or her assistants to keep the particular department up to or above others in the matter of discipline and comfort. We hold that centralisation should be discouraged except for those purposes which bring sane people together – such as recreation, public worship, and industrial work as far as the latter may require it.

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Another important point is raised by these considerations. In old days patients had their meals in their respective wards. This was found to be unsatisfactory chiefly because the ideas and means of treating patients were but little developed. To secure more order and economy central dining halls have been established in which all but the sick or turbulent are congregated for meals. We saw several such halls which undoubtedly, from their cheerful decoration and size, are very taking to the eye. At first sight economy both in initial cost and daily use would seem to be increased. It has been also said that the general tone of the patients had been improved by coming together so many times each day. This idea has been pushed so far in one asylum (Hartwood) that, with few exceptions for special reasons, male and female patients sit side by side at the tables. This has been found to work well, and seems to use to afford the most powerful justification for a general dining hall. Having regard to the very general provision of such a hall we started with the idea that it would form part of our proposals. But doubts arose in our minds, and the inspection of two asylums in which the practice has been discontinued has served to lead us to the conclusion that our general idea of segregation and supervision by the responsible head of a group (most essential in the study of varying appetites and capacity to take fat or lean, &c) should not be departed from in this respect. As far as economy is concerned, we see no advantage in congregation – in fact, we were assured that breakages of crockery and general damage is less where the work of washing-up is done in ward sculleries. The preparation of food in the central kitchen has to be done in either case, and subdivision for tables or groups of tables in the hall has to be practised to the same extent as for the wards. The time consumed in preparing the tables, and bringing of the patients thereto is quite as much in one case as the other. Any moral improvement would be confined to few patients relatively, and might probably be said to be at the expense of the decent, orderly patients, who we believe are, in the enforced absence of the more turbulent patients, in the great majority. To the timid shrinking patients we fear that the taking of meals in a large assemblage of fellow patients must often be an ordeal. We were informed in some asylums that the patients themselves had expressed a most decided preference for dining in the wards.

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It has been pointed out to us that one disadvantage of dining in wards is that the smell of food, especially of vegetables, is likely to remain for some time. That this can be obviated by proper ventilating arrangements was conclusively proved to us at the Dorchester and Chichester Asylums, where no such smell could be detected by us immediately after dinner.

Taking all this into consideration we recommend that the hall, which will have to be provided for recreation, shall not be used for the purpose of general meals.

The general arrangements of heating, lighting and ventilation, concerning which we have ample details, have each a bearing on the disposition of the main building, but obviously these questions must be left for consultation with the architect. The only other questions connected with the main building which needs mention now, are the Recreation Hall, the Chapel, and Nurses and Attendants’ blocks.

The Recreation Hall should be able of seating about two-thirds of the patients and staff. As the population of the asylum is likely to increase, so an increase of the hall must be contemplated. It seems to us that a hall may now be built larger than present needs require, the surplus portion being shut off by a temporary screen, and used for some other purpose e.g., a library, school, extra visiting room, &c., which could be met by the erection in the future of further accommodation when the space is called for. The hall itself should be cheerful and reasonably decorated. It will be necessary to provide rooms for the deposit of cloaks and boots of patients coming to entertainments from the detached houses. It is needless to say that it should be in communication with all parts of the main buildings by covered passages.

The Chapel – The present accommodation would need to be rather less than in the Recreation Hall. The question whether it should be detached or not from the main building is a difficult one. On the one hand, the feeling of liking to leave the house and go to church is very general and is certainly proper. On the other hand, it will be difficult to ensure the attendance of many patients at daily prayers in it if the chapel is completely detached, and thus the use of the hall for such daily prayers will necessarily follow. The chapel at the West Sussex Asylum, designed by Sir A. Blomfield, and built at a reasonable cost, is a model of a detached building. At Lenzie we saw a beautiful chapel connected with the main buildings by conservatory passages, which had a very pleasing effect. If arrangements could be made on similar lines in our asylum we should recommend their adoption. But whether this is possible cannot be settled till the general relations of the Administrative block and the male and female departments have been fixed.

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The Attendants’ And Nurses’ Homes – In no respect has greater improvement taken place than in the study of the well-being of the staff, and this is undoubtedly right. In most if not all asylums separate mess-rooms, recreation-rooms, baths, &c., for attendants have been provided, and no attendant nowadays should be asked to sleep in the patients’ dormitories. Mostly each attendant has a bedroom in which when off duty he or she can sit. In some cases two junior attendants may share a room. Another great step has been taken in providing separate day and night services, instead of the old custom of attendants sleeping in the dormitories, while a single night-watch for each half of the institution was considered to be sufficient. Except in cases of emergency each attendant is considered to be off duty between a certain hour in the evening and a given hour next morning. At Hartwood the idea for removing attendants from the scene of their daily labour has been pushed so far as to lead to the erection of blocks, connected to the asylum by passages, wherein are found recreation and mess-rooms (the male attendants having a billiard-room) and excellent sleeping accommodation for a good proportion of the day attendants, and extra accommodation for the night attendants. It is a curious fact that in some asylums the attendants are said not to be in favour of such separate accommodation, preferring to retire to their own rooms in the wards when off duty. Some of the superior staff expressed their opinion that this would be the case with us. But even these, when the question was put from the other side, whether it would not be good for the staff, allowed that this would be so. Therefore we, seeing that the preservation of the health, mental and bodily, of the staff is certainly a question in which the County as employer has a large interest, recommend that such separated accommodation be provided. We further believe that as it comes to be recognised that benefits are thus conferred and that the County is in earnest in looking after the interests of the attendants a greater number of intelligent and sufficiently educated persons will apply for employment.

In his official report as a Lunacy Commissioner on the Hartwood Asylum, Dr. Sibbald says: "It was observed with approval that the accommodation that is provided for attendants and nurses in these houses is excellent. It does much to render the position of these officials desirable if due provision is made for their comfort during the time they are off duty, and the District Board have done wisely in recognising this in a liberal manner. Acting in the same wise and kindly spirit, twenty-five cottages have been erected on the estate for the accommodation of married employees and their families. In regard to the special blocks for male and female officials, Dr. Clark, who lived in the male block for six months before his own house was ready, says that he had during that time a sense of something distinctly different from anything he had previously known in his asylum life. Those living in them feel away from ordinary asylum influences. The houses are entirely independent of each other; they are nurses’ homes isolated in the administrative centre, and not inconveniently isolated as nurses’ homes usually are. I’ll never knew, he says, the female side of an asylum with so much privacy for the nurses before, or with facilities so great for raising their self-respect."

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... with a minimum of supervision, even if it is certainly known that a removal home or elsewhere will be followed by a relapse. Such patients should in justice to themselves have means found them for enjoying life apart from the average discipline, and from the discomforts of the asylum proper. This idea is the foundation of the Village system as practised at Alt Scherbitz and elsewhere, and the liberal spirit which has prompted it has met its reward in the improvement of the patients themselves, and in increased ease in managing the institution. A further advantage is the ready means supplied for testing the thoroughness of the apparent recovery. We believe also that work done by patients living under the freer circumstances implied by this system will be more natural and through, and therefore more remunerative. It requires a very advanced sense of duty in any patient to do a fair day’s work without remuneration, or without any further recognition than is accorded to the lazy and discounted. We attach but little weight to the statement which is so frequently made that patients’ work is of small value. In every asylum there are a few who do thoroughly good work even in the least happy circumstances. This number we are convinced can be largely increased if some simple inducements can be held out.

For the houses now recommended to the built we have purposely selected a smaller population (30) in each than the Edinburgh authorities contemplate (40). Our reasons are that it will be easier to find the smaller number of trustworthy patients. The inclusion of one or two doubtful cases would militate at once against the idea of less-restricted freedom. Further, the smaller number is more in accordance with the "family" or "group" idea. The larger the number, the less chance of the head of the house maintaining a satisfactory influence. Considerations of domestic details also are in favour of the number selected.

Where we have found any of these houses in occupation, we have been informed that residence in them is valued by the patients, and conversely, that removal to the main asylum is felt as a privation. We can well believe that this is so and that therefore a healthy stimulus to self-control is supplied.

Taking these houses into financial consideration, we are confident that pleasant, wholesome structures can be built for a sum per head considerably below the cost of a large mass of building. The latter, if it is to avoid the appearance of a gaol, must have architectural treatment of a more or less expensive kind, which will be wholly unnecessary in these less pretentious buildings. The sanitary arrangements can be simpler and therefore less costly.

In the direction of maintenance also we believe that these houses will bear favourable comparison with the larger portions. Especially in the matter of the staff the expense should be less. Matters have not progressed so far at Edinburgh as to allow for a definite statement, but we were informed that the impression there is that the Village system will at least not lead to expenditure above the average.

We wish here again to draw particular attention to a consideration which appears to us to be most important. We suggest that when a full trial has been given to the house-system, and when further necessity for accommodation arises, it will probably be found that such accommodation can be best supplied in this direction. If this is so, the advantages are obvious. Instead of a large capital expenditure being called for at one time, and instead of the whole asylum being upset by erecting large additions to the main buildings, the provision of accommodation can follow immediate needs and without any interference with the system. The selection of sites, instead of being compulsorily fixed, is almost unlimited. Further, any variation of principles which experience may suggest will then be easy of execution. It may be found advisable to have housed for a smaller or larger number of patients, for instance.

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We made special inquiry as to the effect of calls on the stores, kitchen, &c., made in respect of such houses built in excess of the number for which they were designed. At Glamorgan where blocks for 120, 56 and 30 were so erected, the effect was so inconsiderable as to be hardly noticeable.

But we believe that it will be found quite as advantageous financially and administratively to have some of these houses doing their own cooking, supplies being sent periodically from the central stores. This system was found at Lenzie, and, as far as they could be accurately gauged, the expenses were not above the average. We suggest therefore that two of the houses – one male and one female – should be on this principle, whilst the other two can be left dependant on the kitchen for prepared meals. There can thus be made a good test of which will be the best plan to adopt for any further houses which may be built thereafter. We have to point out that the telephone now renders it possible to work detached buildings with far greater ease and safety than would have been the case before its introduction.

Taking these houses in the order above given :-

The Laundry House – It may be an advantage, but it is not necessary that this should be close to the laundry. This question will depend much on the site chosen for the latter. We propose that thirty of the most trustworthy laundry patients should be settled under the care of a charge laundry attendant and a junior laundry attendant. The laundress herself might live in the house, but should not while in it have responsible charge of the patients, as her duties in the laundry would often prevent her leaving the latter at the same time as the patients. This house should be one of those relying on the kitchen for dinner at least.

The House for Female Working Patients may be quite away from the main building. It should be under the care of a charge attendant and a seamstress attendant. In it a very considerable amount of profitable work should be done, especially the cutting out and making of new garments, the mending being left to the other workers. A sufficient number of sewing machines for the various classes of work should be provided. A suitable work-room in addition to the ordinary day-room space will be requisite. We have been warned occasionally that this drawing of the best labour may seriously interfere with the general routine of the other female departments but, on the other hand, we have found many asylums with special sewing-rooms in which are congregated patients drawn from most of the other female wards, without causing any inconvenience. This house might do its own cooking, for which the services of one cook, with the help of patients, would be sufficient.

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The Farm-patients’ House. – Both at Lenzie and Hartwood, where the plan is in full operation, and at Chichester, where it is being prepared for, the cooking is done at home. The charge attendant’s wife is the cook-housekeeper, and has, at the former asylum, help from trustworthy female patients. The charge attendant and a junior should be sufficient for supervision by day, while at night, since the former would be in the domestic part of the house, a farm-hand could have a room off one of the dormitories, such lodging, and possibly board, being taken as part of his wages. The junior attendant would have his room off the other. It is not proposed that the bailiff should have responsible charge of the patients at all, since his duties might call him away at any time.

The house should be near the farm, and therefore at some distance from the central part.

The Tradesmen’s House. - This would be inhabited by picked men from each trade, and be under the charge of a married charge attendant and a single junior attendant. Here, too, one of the artisans might be found in board and lodging in order to assist in night supervision. This house should be served from the general kitchen.

The House For Idiot Children – We strongly advise that such a house be an essential part of the institution. The appearance of children of this type among adults in a ward is always a subject of regret on the part of Visitors. At Lichfield we saw a very pleasant little ward specially put apart for them. We wish to go further and imitate the example of the Hants County Asylum, where a self contained house, with its garden railed off for the special use of the children, is found to answer its purpose well. The advantages to be derived from such a separate house appear to be – the possibility of having a special staff who will be trained to afford such limited education as the patients are capable of receiving, and, more important, to correct or prevent bad habits and bad conduct. The house being separate can also partake more of the character of a kindergarten. Financially it may be hoped that the institution will partly pay its way by the reception of private idiot children, for whom the accommodation in the county is very scant though constantly in demand. We advise that this house should be designed with a view to enlargement if necessity arises.

REMARKS ON SUBSIDIARY MATTERS

A small Infectious Hospital situated at some distance from other buildings will be necessary.

The arrangements and position of the Medical Superintendent’s House will depend very much on considerations which much necessarily be somewhat vague at present.

A Lodge and Cottages for married attendants and artisans should be provided.

Pathological rooms and apparatus. – Liberal provision should be made for these, since not only will valuable aid be rendered to the medial service of the asylum itself, but the County will, as should be the case with all Asylum Authorities, be taking its fair share in the combined attempts that are being made towards solving the problems connected with the causation, prevention, and cure of insanity.

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The Cemetery. – One or two sites on the estate have suggested themselves to us; the final choice, however, should be delayed for the present.

Private Tramway. – Our observations elsewhere have led us to make a strong recommendation that the laying down of such a tramway be commenced as soon as possible; and that it be constructed with a view to its being permanent. We can give strong evidence in favour of its saving a very considerable amount of expenditure during the erection of the asylum, while in years to come the haulage of coal and other material will be simple and economical. We think that a suitable carriage running on the tramway might be provided later on for bringing patients and others from the station, thus saving road conveyance. The land between the station at Hellingly and the estate appears to us to lend itself readily to this proposal.

THE CAPITAL COST OF THE NEW ASYLUM

We regret that it is impossible to speak of this in any but very general terms. We have seen asylums that have been built for less than £200 per bed, while others have cost over £400. The difference between these two extremes is accounted for under several heads more or less unavoidable. For instance, the price of available land, its propinquity to a railway or other means of economical haulage, the nature of the materials available for the carcase, e.g. – stone or brick – the presence of absence of stone, sand, lime, &c., on the estate, the distance from centres of the iron industry, rates of wages, &c., all have a weighty influence on expenditure. In most of these respects the County stands in a favourable position. Beyond these of course are the views of each authority as to what amount of decoration in structure and fittings should be permitted. We see no reason for incurring any by moderate expense on those heads, since the architect can do much to produce a pleasant effect by simple means. But we cannot advise that economy should be practised so far as to secure a building that shall be sufficient for bare necessity and not more. In the matter of sanitary and administrative apparatus considerable, even heavy, expenditure may be justified, if after careful consideration it can be shown that the use of the apparatus is likely to be attended by less expense, by reason of increased initial cost.

We are confident that the general idea of decentralization as recommended by us is at least as economical, both in capital expenditure and maintenance, as any other system. We have before us the figures given to Dr. Sibbald by Dr. Paetz the superintendent of the Alt Scherbitz institution. These cannot be compared with the accounts of asylums in this country, both because of the variance of the amount of use and cost of different articles, and because capital and maintenance expenditure are divided from each other on different lines. But on comparing Alt Scherbitz with other German Asylums of a more concentrated type, both capital and maintenance are considerably cheaper in the former.

Our inquiries cause us to believe that the cost for equipment, including all matters usually found in an inventory, varies from £10 to £15 per patient provided for. A great deal may be saved by the judicious selection of articles required by those responsible.

We have now finished our report on those matters which formed the object of our tour of inspection. In our visit, however, we formed opinions on one or two other points bearing less on plans and arrangements than on the future management of the asylum. We think that it will not be out of place to state these opinions here, for the consideration of those on whom the management of the asylum will eventually devolve.

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In the newer asylum we found no such things as airing courts with brick walls, and we are convinced that they are neither necessary nor desirable. In place thereof we saw large plots of ground in one case as much as four acres in extent, laid out in gardens, surrounded by a light iron fence. At Lenzie, though a main line of railway runs in front of the institution, hardly any other means of confining the patients were visible than a similar railing along the boundary facing the railway. We have no reason to believe that escapes are more frequent under these circumstances, while we are sure that the increased sense of freedom which was at once recognised by us, must be of immense service to those who have most need of pleasant impressions. We think that the detached houses for females should have gardens with such railings, as much for keeping others out as keeping the inmates at home. Every enclosure should be planted suitably and provided with kiosks and sufficient garden seats.

The open door system. – There can be no doubt that nothing is more offensive both to visitors and to patients, than finding every door locked against all but the possessors of a key. The disuse of the key has of late years made great strides, and we saw it so disused in varying extent. At Lenzie we found that our party could go a considerable distance without finding a locked door. At Dorchester we passed almost everywhere without hindrance from locks. The patients have free ingress from their wards into the gardens and indeed from ward to ward. There was absolutely nothing structural or mechanical to prevent a patient passing out from the ward and making his escape over a low hedge into a public road. Proper supervision, especially of the untrustworthy patients, took the place of the usual precautions, and apparently with excellent effect. It is said that such supervision may be almost more galling to a patient than structural confinement. Even granting this point, which is a doubtful one, it is to be remembered that the patients who are content to remain where their comforts are properly attended to are in the great majority, and their convenience and pleasure should meet with chief consideration. Of course some doors should be closed against patients, such as those between the male and female side, or those leading to places where there may be a special source of danger. We should be well pleased if the management of the new asylum does not fall behind any other in the matter of freedom.

It will be observed that no mention is here made of accommodation for private, or paying patients. We contemplate that, as is the case in every asylum, there will be received, when there is room for them, a few patients whose friends, not wishing that they should come on the rates, are prepared to pay the ordinary maintenance rate, plus a small weekly sum to cover rent, &c., of the space taken up. These patients are treated in all respects like others. But in pursuance of another of the recommendations made, as above stated, by the Visiting Committee of the Haywards Heath Asylum, it is proposed sooner or later to provide accommodation for patients paying say, from £1.1s to 30s. per week. We strongly advise that such accommodation be not added to the present undertaking. A very suitable site, at the other end of the Hellingly estate has been provisionally designated for such a purpose. The question needs much and careful consideration, and we propose to leave it out of sight altogether for the present, though we are fully prepared to take it up on receiving instructions. We found an extensive and most suitable institution for such patients in the Isle Of Wight Asylum where the charge of 25s per week seemed to us to be most moderate, in view of the accommodation provided.

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We wish to express now, as we have done personally, our warm thanks for the courteous and ready manner in which advice and information was everywhere given to us, often at the expense of considerable trouble, by Dr. Sibbald and Mr. Spence, Messrs. Alexander Moffatt, Robert Stalker, Members of the Edinburgh District Lunacy Board, Mr. Andrew Ferrier, Clerk to the same Board; Dr. Yellowlees; Dr. Watson of Hawkhead; Dr. Cambell Clark of Hartwood, who, in his absence, arranged that should be accompanied by Dr. Bois, Dr. Murray, the Architect, and Mr. John Thomson, Clerk of the Works; Dr Oswald, in whose absence also, Dr. Parker showed us Gartloch Asylum; Dr. Kidd of Chichester; Dr. Harold Shaw of Whitecroft; Dr. Beveridge Spence of Lichfield; Dr. Blair of Lenzie; Dr. Pringle of Glamorgan; Dr. Macdonald of Dorchester; and finally to Messrs. Giles, Gough and Trollope, for permission to view Cheddleton – during the inspection of which the two latter gentlemen kindly accompanied us. We cannot refrain from expression also the intense interest and admiration which we felt in seeing the progressive steps which have been taken, and are being taken, in the recognition of the just claims of the insane poor to be treated in a reasonable and liberal manner. It has been especially interesting to us to note the success with which each Medical Superintendent has impressed his individual aims on the establishment under his control, and how, even in the older asylums, by skilful and kindly attention to the personal surroundings of patients, comfort, even of a homely nature, has been attained to an extent not to be exceeded in the newer. On some points of structure and management we found wide divergence of opinion; however, where we have found it impossible to harmonize such differences, we have been content to follow positive experiences rather than fears of failure. In making our recommendations we have not proposed anything which cannot be supported by instances of actual practice, and each point has been considered from every side, medical, practical, financial and otherwise.

Since completing our journey and after shaping out our recommendations, we have again visited the Hellingly estate, and on careful examination of sites, aspects and levels, we find no reason on these heads against our recommendations being fully carried out, as well in general plan as in details.

H. HAYES NEWINTON (Chairman)
W. HENRY CAMPION
H. R. KNIPE
J. J. LISTER
J. STEWART OXLEY

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SUMMARY OF RECOMMENDATIONS

That the accommodation to be at present provided in the new asylum be for 860 patients, with administrative accommodation so arranged as to admit of its economical extension to meet the requirements of 1250 patients, perhaps more.

That the buildings required for the first 860 patients be arranged as follows :-