Posted April 25, This is my first visit to your blog!
If someone with one lunatic boarding received another see John Jacksonthe house needed a licence. If a licensed house with two insane boarders, lost one, the house would cease to be licensed. The houses with more than one lunatic needed to be licensed, but the kind of care might not differ from that in a single house.
In the nineteenth century and earlier some people provided services relating to this whole range of provision. For example, a physician see Morison and Seymour for example might visit at home were a person was confined by relatives.
The same physician might recommend a paid attendant keeper, nurse who would keep guard over the patient. Alternatively the physician might recommend someone who would arrange single care in lodgings or might recommend a madhouse.
In the case of attendants, single houses and madhouses, there would be a variation of financial arrangements between the physician and the attendants and the house.
Often, the physician would receive a regular retainer for making recommendations. Other words used for paid attendants in the early nineteenth century were keeper and nurse.
Nurse was only used for a female attendant or keeper. It should be noted that there were many non-paupers received at similar charges to paupers, and maintained in similar conditions. Paupers were poor but non-paupers were not necessarily rich!
In the midth century all workhouse asylums and most county asylums were exclusively occupied by paupers, although a few county asylums made some provision for others.
Most licensed houses did not take paupers. Only a minority the pauper houses took both or exceptionally only paupers. The pauper houses, however, included the very largest, and as a result over half the lunatics in licensed houses were paupers. Hospitals received relatively few paupers.
Who could be a pauper? In relation to lunacy or illness the potential for being maintained out of public funds was greater than in relation to straightforward poverty. By section 18 a JP would sign a lunatic as a pauper who was "either in receipt of relief, or in such circumstances as to require relief for his proper care" and "for the purposes of this section" "a person who is visited by a medical officer of the union, at the expense of the union" was counted as in receipt of relief.
The legal process that made someone a chancery lunatic was expensive and generally invoked in connection with the preservation of property.
Single houses were one of the most expensive forms of confinement. Although there is no logical reason why the term single lunatic should not be applied to insane relatives of the poor confined, or just living, at home; in most of the material I have read the text tends to suggest affluence when this term is used.
The Report does speak of paupers being confined in single houses see quote. As the context suggests they are received for a fee, I suspect that some sort of farming out as in Wales is being thought of.
Having used the concept of single house broadly, the Report distinguishes the affluent class by calling them private patients.Increasing reliance on hospitalists in the United States entails a number of risks and costs for everyone involved in the health care system — most critically, for the patients that the system.
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