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ASYLUMS FOR THE INSANE - Lil
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EUROPE;
To w H IG H A R E A D DE D
A BRIEF NoTICE g -
- OF
similar INSTITUTIONS IN TRANSATLANTIC countries
. AND m m. t -
us it eo states, - - . º
“;
AND
A N E S S A Y
- j oN THE - . . .
CAUSES, buRATION, TERMINATION AND MORAL TREATMENT , -
- - of - . .
I N S A N I T Y.
with coPIo Us s TAT Is T1c s.
BY, PLINY EARLE, M. D.
Resident Physician of Friends' Asylum for the Insane, Frankford, near Philadelphia, Pa.; Honorary Member of the
Philadelphia Medical Society; Member of the Botanical Society of Edinburgh, and Corresponding
Member of the Medical Society of Athens, Greece. . -
K
PHILADELPHIA: .
J. DOBson, 108 CHESTNUT STREET.
1841. -





A W I S I T
TO
THIRTEEN ASYLUMS FOR THE INSANE
IN
...” ~~
* - EUROPE :
... . - . . .
- º, º R& 5
* 3. "...º. *
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× -ºº O W H I C H A R E A D DE D
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ºf A BRIEF NoTICE
. . . . . . . .';"
• ‘s s ! 2 , , , - P’.”
S.; < * : , , - .3
*~~~~~ OF

SIMILAR INSTITUTIONS IN TRANSATLANTIC COUNTRIES
AND IN THE
UNITED STATES,
AND
A N E S S A. Y.
ON THE
CAUSES, DURATION, TERMINATION AND MORAL TREATMENT
OF
I N S A N I T Y.
W IT H C O PIO U S S T A T IS TI C S.
BY PLINY EARLE, M. D.
Resident Physician of Friends’ Asylum for the Insane, Frankford, near Philadelphia, Pa.; Honorary Member of the
Philadelphia Medical Society; Member of the Botanical Society of Edinburgh, and Corresponding
Member of the Medical Society of Athens, Greece.
PHILADELPHIA :
J. DOBSON, 108 CHESTNUT STREET.
1841.
P. R. E. F. A. C. E. .
DURING a recent tour in Great Britain and on the European
continent, I visited several Asylums for the Insane, situated
either upon my route or in its immediate vicinity. When
the visits were made I had no intention of presenting what
s might be gleaned by them to the public; and I now regret my
s inability, from a want of more copious data, to do that ample
justice to the Asylums mentioned, as well as to the general
subject itself, which they both deserve, and which the pro-
gress of our knowledge of insanity, and of the most judicious
method of treating it, seems imperiously to demand.
º, Imperfect, however, as may be these descriptions, it is be-
liced that, in connection with the succeeding essay, they may
be the means of extending the information of those who have
heretofore devoted but little attention to the subject. I would
direct the attention of those who are interested in the question
of the utility of Lunatic Asylums, to the results of treatment as
exhibited in the tables of both recent and chronic cases, and
request them to compare the condition even of the “incura-
bles” with that of hundreds, may it not be said, thousands, in
our country, who are pining, famishing, dying in garrets, cel-
lars and dungeons, clothed in rags, and, in too many instances,
confined by chains.
Frankford, Pa., 1841.
A VISIT, &c.
THE MIDID LESEX COUNTY LIJN ATIC ASYLUM.
The Lunatic Asylum for the paupers of the county of Mid-
dlesex, Eng., is the largest institution of the kind in Great
Britain. It is located at Hanwell, a few miles from London.
It went into operation in 1831. The very extensive building
is erected upon three sides of a square, or rather of an oblong
space, which, being handsomely planted in the style of English
gardens, forms a front yard of attractive beauty. The princi-
pal part, or longest portion of the edifice, runs parallel to the
road, which is, perhaps, one-eighth of a mile distant. The
other two portions, as may be inferred from what is said above,
run towards the road from the two extremities of the principal
one. The three are of equal height and width. The central
part of the principal one is expanded to a greater width, and
is hexagonal in form. Within this are the offices and the
apartments of the superintendents. A similar hexagonal por-
tion exists in each of the other two, not, however, near the
centre, but removed a short distance from their extremities.
Large as was this edifice, it had proved inadequate to the ne-
cessities of the county, and, at the time when I was there,
extensive additions were in progress. These consisted of two
wings, one near the extremity of each of the two portions
running from the principal building, towards the road, attached
to these portions on the external side, or that opposite the ob-
long yard, and running at right angles to them. Hence they
are parallel to the road and to the principal part of the build-
ing. The stairs are in the hexagonal enlargements. The
wards are divided into small rooms for dormitories, upon
1 *
6
one side of a narrow gallery which runs from one extremity
to the other. The cooking and the heating of the apart-
ments, throughout the whole establishment, are performed by
steam. The length of pipes for the last purpose is upwards of
one and a half miles. The house is lighted by gas. The
hours of meals are 8 o’clock, A. M. and 1 and 7 P. M. A
quart of strong beer, per diem, is allowed to such of the pa-
tients as labour, and a pint to the others.
One of the most prominent characteristics in the internal
economy of this institution, is the amount of labour performed
by the inmates. But few Asylums of the kind can furnish so
great a per centage of patients devoted to useful occupations.
Of the six hundred who were there in 1837, more than four
hundred were thus employed. Most of these were incurables.
The cooking for all the residents at the Asylum, the brewing,
washing, tailoring, shoemaking, and gasmaking, are all per-
formed by the patients, there being, in each department, a
sane person who acts as overseer. Carpentering, cabinet-
making, the manufacture of straw hats and bonnets, the spin-
ning of twine, basket-making, and picking, carding, and spin-
ning wool for mops are also carried on to no inconsiderable
extent. Many of the patients are employed in horticulture
and other labour in the open air. In one year six of the pa-
tients were taught the art of shoemaking. No accident has
hitherto occurred from trusting edged and other dangerous
tools in the hands of the employed.
“On entering the gate,” says Harriet Martineau, in describ-
ing her visit to this Asylum, “I met a patient going to his
garden work, with his tools in his hand; and passed three
others breaking clods with their forks, and keeping near each
other for the sake of being sociable. Further on were three
women rolling the grass in company; one of whom, a merry
creature, who clapped her hands at the sight of visitors, had
been chained to her bed for seven years before she was brought
hither, but is likely to give little further trouble henceforth,
than that of finding enough for her to do. A very little suffices
for the happiness of one on whom seven years of gratuitous
misery have been inflicted:—a promise from Mrs. Ellis to
7
shake hands with her, when she has washed her hands; a
summons to assist in carrying dinner; a permission to help to
beautify the garden, are enough. Further on, is another in a
quieter state of content, always calling to mind the strawber-
ries and cream Mrs. Ellis set before the inmates on the lawn
last year, and persuading herself that the strawberries could
not grow, nor the garden get on, without her, and fiddle-fad-
dling in the sunshine to her own satisfaction, and that of her
guardians. This woman had been in a strait waistcoat for
ten years before she went to Hanwell. In a shed in the gar-
den, sit three or four patients cutting potatoes for seed, singing
and amusing each other; while Thomas, a mild, contented
looking patient, passes by with Mrs. Ellis's clogs, which he
stoops to tie on with all possible politeness; finding it much
pleasanter, as Dr. Ellis says, “to wait on a lady than be chained
in a cell.” In the bakehouse, meanwhile, are a company of
patients kneading their dough; and in the wash-house and
laundry many more equally busy, who would be tearing their
clothes to pieces if there was not the mangle to be turned, and
a prodigious array of linen in the drying closet to be ironed.
A story higher are coteries of straw-plaiters, and basket-makers,
and knitters among the women, and saddlers, shoemakers and
tailors among the men.”
A chapel is connected with the institution, where a portion
of the patients assemble at a weekly service, and at morning
and evening prayers. Those patients who leave the Asylum
destitute of pecuniary means are, by a beneficent provision of
the government of the institution, so far assisted as to enable
them to supply their wants, until they can obtain a situation
wherein to gain a subsistence.
Sir W. C. Ellis, who, in 1837, and for several years pre-
viously, had fulfilled the duties of superintendent of this
Asylum, has published a work upon insanity, from which
the following anecdote is extracted. It proves that he is
gifted with a presence of mind, and a sagacity adapted to any
emergency, and worthy of the man who has received the dis-
* Miscellanies, by Harriet Martineau. Boston edition. Vol. i. p. 231, 232.
8
tinguished honour of knighthood, in consideration of his skill
in the management of the insane.
A workman at the Wakefield Lunatic Asylum left a chisel
more than three feet long in one of the wards; a furious pa-
tient seized it and threatened to kill any one who approached
him. Every one then in the ward immediately retreated from
it. “At length,” says the author referred to, “I opened the
door, and, balancing the key of the ward on my hand, walked
slowly towards him, looking intently at it. His attention was
immediately attracted; he came towards me, and inquired
what I was doing. I told him I was trying to balance the
key, and said, at the same time, that he could not balance the
chisel in the same way on the back of his hand. He imme-
diately placed it there, and extending his hand with the chisel
on it, I took it off very quietly, and without making any com-
ment upon it. Though he seemed a little chagrined at having
lost his weapon, he made no attempt to regain it, and, in a
short time, the irritation passed away.”
This accomplished physician, (Sir William C. Ellis) is now
(1840) deceased, and the Asylum is under the superintendence
of Dr. Conolly, the author of a valuable treatise upon insanity.
The new wings have been completed, making, in all, accommo-
dations for 850 patients.
For the opposite engraving of the ground plan of the Asy-
lum, I am indebted to Frederick A. Packard, Esq.
|
|
|
a Bake-house.
Brew-house.
Gas-house.
Steam-boilers, &c.
b Kitchen and Scullery.
c Coal sheds.
d Cart-house, stable and shed.
e Superintendent's stable.
f Gardener's house.
g Cow-house.
h Wash-house, drying-rooms, laun-
dries.
i Engine-house, and Engineer's shop.
j Superintendent's garden.
k Garden.
l Airing Court:
m. Well.
n Carriage road.
o Cultivated grounds,
p Burial ground.
q Canal.
'r River.
s Road.
t Lodge.
w Entrance.
v Farm yard.
to Dock.
ac Male side.
ºf Female side.

10
THE PAUPER LUNATIC ASYLUM FOR THE west RIDING of York,
AT WAXEFIELD.
This, like the Asylum just treated upon, is one of a great
number of establishments erected in various counties through-
out England, for the reception and treatment of those unfor-
tunate people who, drinking a twofold portion of the cup of
affliction, are suffering under both abject poverty and mental
alienation. It was established in the year 1816, and opened
in Nov. 1818. Its whole original cost, including a farm of
twenty-five acres, was eleven thousand pounds sterling. Ex-
tensive additions have since been made. It is pleasantly situ-
ated, about a mile from the town of Wakefield, and, when
approaching it, is nearly hidden from view by the shrubbery
and trees with which it is environed. The original form of
the ground plan of the building was that of the letter H. At
either of the two points represented by the junction of the
horizontal with the upright portions of the letter, there is an
expansion of a circular form, constituting a kind of tower.
Within these, and leading to the uppermost story, are spiral stair-
cases, at the side of which there are windows communicating
with the wards. Hence two persons, one upon each flight of
stairs, can, with very little labour, oversee all the patients
while they are in the wards. The wards, unlike those of
some of the American Asylums, have dormitories upon but
one side, the remaining space being occupied by a gallery.
The bedsteads, like those of most public institutions in Eng-
land and France, are composed of iron. The establishment
is lighted throughout by gas, which, as well as the beer,
bread, shoes, clothes, and cloth for external garments con-
sumed by the patients, are manufactured upon the premises,
and, principally, by the insane themselves. The medical
superintendent, to whom all other persons in the house are
subordinate, acts as secretary, treasurer, steward, surgeon and
apothecary, and, in concert with the matron, has the general
direction of the treatment of the patients, the domestic arrange-
ments, &c. &c. In the medical department, however, he is
II
subject to the visiting physician. Besides other records, he
keeps a diary of casualties, or remarkable circumstances, and a
medical journal, in which he places a history of every case
admitted to the Asylum. He is obliged to visit all the wards
and see every patient at least once every day, and oftener if
necessary. He carries a master-key to the wards and outer
doors, and these are secured every night by himself, personally.
The matron, who has a salary of 100l. sterling per annum,
is subject to the director or medical superintendent, and, so far
as their duties are similar in the two departments, is governed
by the same rules and regulations. Aside from her duties to
the patients, she has charge of the kitchen and of the neatness
and propriety of the whole house. She is required to see
every room and every female patient as often as once each
day, and to secure all the doors in the female department at 9
o'clock, P. M., from the 1st of October to the 1st of April,
and at 10 o’clock during the remainder of the year.
As many of the patients as possible are employed as servants,
and the hiring and dismissal of other domestics is entrusted to
the director. The cause of dismissal, when such cases occur,
is always registered. The following extracts are from the
“Rules and regulations for the management” of the Asylum.
“Any officer or servant found making a perquisite of any
kind whatever, will be instantly dismissed.”
“Any servant striking a patient, will be instantly dismissed.”
“It is now known, by actual experiment, both at the Retreat
and the Asylum at York, that much work of various kinds
may be done by patients, not only to the great profit of the
institution, but also to their very great advantage, both in body
and mind; therefore, the director and matron will consider that
they will not give satisfaction unless they have considerable
success in this department of their duty.”
Furthermore, in respect to officers and servants, if any one
of them take any present, or gratuity, from any tradesman
dealing with the Asylum, or from any patient or visitor, he is
discharged. Any servant found intoxicated, or who has been
known to sell anything to one of the patients, without the
knowledge of the director, is reprimanded for the first offence
and dismissed for the second.
12
The number of patients in the Asylum during the summer
of 1837, was 334, of whom a small minority were women.
Fifty or sixty of the men labour, regularly, either in the manu-
facture of the articles above mentioned, in gardening, or in
some mechanical trade. All the utensils used by the patients
at their meals, unless necessarily metallic, are made of wood.
The working patients are furnished, besides their regular meals,
with two “drinkings” during the day, each of them consisting
of three-fourths of a pint of beer and four ounces of bread.
Nearly two hundred dollars per annum is paid for tobacco,
which is also divided among the labourers, each being entitled
to a weekly ration of one ounce. Many of the patients, as we
passed through the wards, begged us for tobacco, or for money
to purchase it with. One of them, after having thus played
the mendicant, put into our hands a piece of cloth, upon one
side of which he had written, in large letters, “Millennium.
Green, blue and yellow united.” And upon the other, “Pic-
toria 1st, July 28th, 1837. Pirgin Queen of Peace. Amen.
.#quila.” It will be perceived from the date, that this was
but a short time subsequent to the accession of Victoria to the
throne of Great Britain. The universal popularity which the
youthful queen enjoyed, at that time, among her sane subjects,
seems to have been participated also by some of those who
were insane. And this poor, infatuated maniac beheld the
“green, blue and yellow,” the insignia of the different political
parties of the realm, united through her means, and hence the
“consummation devoutly to be wished,” the immediate advent
of the millennium! “Eh, eh,” said he, after I had read the
above, and, as he spoke, he looked up into my face with a
piercing glance and a most significant smile, “do you know
what Aquila signifies in English?” Being answered in the
affirmative, “Well, sir,” he continued, “I am the eagle,” and
he placed a most emphatic stress upon the pronoun, in order
to give us an adequate idea of the dignity of his person.
Food.—The food is furnished by contracts, of three months
each, which are made between the visiting justices and the
contractors on the first Monday in January, April, July and
October. The contractors for meat, bread, &c., at the time of
13
the delivery of one parcel, take an order for the next. The
meat and bread are delivered twice a week, on Wednesdays
and Saturdays. For breakfast and supper the patients are
furnished with a kind of pudding, made of the following ma-
terials, and in the proportions annexed, viz. –Milk, 1 gallon;.
water, 2 gallons; oatmeal, 23 lbs. ; wheat flour, 3 lb. For din-
ner, “Yeast dumplings with treacle sauce, and boiled beef or
mutton with vegetables, on Sundays, Tuesdays and Thursdays;
6 ounces of meat, free from bone, allowed to each patient.” On
Mondays, Wednesdays and Fridays, a soup made from the meat
boiled on the previous days, and on Saturdays, beef-pie or Irish
stew. Fifteen ounces of bread per day is allowed to each person,
and milk is furnished them, “as required,” not exceeding one
pint each per diem. The hours of meals are 8% o’clock, A. M.,
and 1 and 7 o’clock, P. M., throughout the year.
The women were supping when we went through their de-
partment, each eating her ration from a small wooden dish,
similar to a pail. That air of neatness and comfort which
reigns throughout the establishment is particularly conspicuous
in the section for the females. One of the women, who had
been refractory, had her arms confined. We had previously
observed, in the men’s department, that confinement by straps
in chairs and beds, is also resorted to in cases of violent mania.
“Who are you?” inquired one of the women who were
eating, after having scrutinized me with the wild and search-
ing gaze of a maniac, “are you a Methodist minister?” “No,”
said I, “I am an American.” This answer was perfectly
satisfactory, and no sooner was it uttered than half a dozen
patients suddenly rose, “O, you are from America; then you
know my brother,” said one. “Do you know J. F.?” in-
quired a second. “Have you ever seen ?” asked a
third; “he is my husband’s brother.” “I have a sister in
America,” remarked a young woman, looking up with a smile
so gentle and an expression of countenance so calm and sub-
dued, that one beheld in it more of the attractive innocence
and beauty of sane and healthy childhood, than the fierceness
and wildness of confirmed lunacy.
The number of patients admitted to treatment in this Asy-
2
I4
lum, from the time it commenced operation, Nov. 23d, 1818,
to January 1st, 1837, was 2242, viz.
– - Males. Females. Total.
1150 . . 1092 . . 2242
Of whom there have died, 420 . . 289 . . 709
“ “ been discharged, 560 . . 664 . . 1224
“ “ are remaining, 170 . . 139 . . .309
The total number of cures was 991, equivalent to 444 per cent.
The number relieved, but not cured, was 233. The deaths
are equivalent to 31% per cent. The admissions have ave-
raged, for a few years past, between 140 and 150 per year.
The following table exhibits the ages at which all the pa-
tients were admitted:—

es | < | < | < | < | < | < | c.
S | S S | S | S | S | S S.
e - c | < | c. c | c | < | c.
- GN QYS | SH AG | SC i- | CO º
P- | H | H | Pº H | H | H | * | H
Males, 56|2s2308|285 197 74 18 || 5 || 1150
Females, 51339|224|970 iss|7||18 || 3 |1992
Total, 107514|627|555 |255] 145|31 || 8 ||2242
By this, it will be perceived that the number received be-
tween 20 and 30 years of age is less than that of those between
30 and 40, or even those between 40 and 50. The number
between 30 and 40 is considerably larger than either of the
others. It is greatly to be regretted that the ages of the at-
tacks, instead of those of entrance to the Asylum, could not
have been preserved. Had this been the case, the number of
those between 20 and 30, and 30 and 40, would probably both
have been larger, the former certainly so, while all those of a
greater age would have been reduced. •.
The annexed table exhibits the results of treatment in refer-
ence to the stage of the disease, or its term of duration.
15
re: §: §
# - *:: * =
# # 3 #5 #
3 5 § 53 &
1st. Within 3 months of the first
attack, e o 682 382 163) \
2d. &é. 12 & & & 4 409 212 149
3d. Between 1 and 30 years from -
the first attack, . 516 58 265
4th. Those who had previously
been insane and confined X-288)
in this Asylum,
5th. Those who had previously
(*
339 132 #233 }so
| |
Total, 2242 991 709 233 309
been insane but not treat-
ed in this Asylum,
Of the 1st division there were cured, 56.01 per cent., and 22.9
per cent. died; of the 2d division 51.83 per cent. were cured,
and 36.43 per cent. died; of the 3d, 11.2 per cent. were cured,
and 51.35 per cent. died; of the 4th and 5th included together,
53.38 per cent. were cured, and 20.79 per cent. died.
By an examination of these results, we have another evi-
dence of the utility of treatment during the acute stage of in-
sanity.
THE RETREAT NEAR YORK.
Perhaps the remarks to be made upon this Asylum cannot
be given more suitably than in an extract from a letter, written
to a correspondent while I was in York, in 1837. -
“Soon after dinner, on the day of my arrival in this city, a
son of Samuel Tuke called at the hotel, with an invitation from
his father for me to make a home at his house during my stay
in York. This politely proffered hospitality was accepted,
and I shall ever remember with pleasure the hours which I
have spent beneath this roof, in the society of an intellectual
and intelligent family. S. Tuke is well known in this country,
as well as in the United States, by those interested in the
treatment of lunatics, for the attention which he has devoted
16
to the subject, and the essays connected with it which have
emanated from his pen. It is probable that no other man
living, without the pale of the medical profession, is so well
acquainted with the proper management of the insane, and the
most suitable construction, arrangement and discipline of luna-
tic asylums. His father was the projector of the Retreat, an
institution of the kind near York, which, under the auspices of
the son, and others, has attained a high reputation. This Asylum
was one of the pioneers in that great and important revolution
which has taken place in the moral treatment of the insane.
“The Retreat near York’ has long been quoted in the United
States, as approaching nearer to perfection in its management,
and as giving a higher per centage of cures than any other
public establishment in England. It was established by mem-
bers of the society of Friends, the funds being obtained by
annuities, donations and annual subscriptions. The original
cost was 5970 pounds, 18 shillings, 10 pence, sterling, includ-
ing the expense of eleven acres of ground, which constitutes the
farm. The receipts from patients were inadequate to defray
the current expenses, for several years after the institution went
into operation. Our countryman, Lindley Murray, was an
early and active promoter of the interests of this establishment.
“I breakfasted yesterday with Dr. W , and, Subse-
quently, he accompanied me to the Asylum. The superin-
tendent conducted us through the several departments. The
buildings are, perhaps, less convenient than those of some
other similar institutions, inasmuch as, having been at first
small, they have been several times altered and enlarged, ac-
cording to the increasing necessity for additional accommoda-
tion. To the wings, hitherto but two stories in height, an
additional story is now in progress of erection. Originally
intended for but thirty, the buildings, after the completion of
the present improvements, will furnish ample room for one
hundred and twenty patients. The classification of the insane
is founded, principally, upon their ability or willingness to
pay for the accommodations afforded. There are four classes,
in the lowest of which the price is fixed at four shillings,
sterling, per week, while in the highest it varies from about
17
twenty to eighty shillings. Those who pay the price last
mentioned have two rooms, elegantly furnished, and a special
attendant. System and neatness prevail in every depart-
ment, and elegance is added to that of the class last men-
tioned. The courts, or yards, occupied by the patients when
out of doors, correspond with the rooms within. That
belonging to the highest class of men is a lawn, gently sloping
southwardly, surrounded by trees and hedges, and bordered
with a diversity of flowers, the profuse blossoms of the rose
predominating at the present time. In this court there were
several patients, either reading in the shade or amusing them-
selves with the flowers. In cooking, steam is used to a con-
siderable extent; and, as we passed through the kitchen, we
perceived that instrument of olden days, a smoke-jack, turning
no less than four spits, liberally supplied with meat.
“It appears to have been the aim of those who have had the
direction of this institution, to make the place a home to each
patient. Hence the expense devoted in improving the grounds
and the apartments, and hence, also, the introduction of amuse-
ments, judiciously selected, and the encouragement of reading
and of labour. S. Tuke believes that labour, properly pursued,
is the most efficient auxiliary in effecting a cure, and acknow-
ledges the superiority of the treatment at the Asylum at Sieg-
berg, on the banks of the Rhine, over all others, principally
from their having succeeded in inducing, not compelling, the
wealthy patients to labour. In England, as in the United
States, the officers of the Lunatic Asylums complain of negli-
gence on the part of the friends of insane persons, in omitting
to place them under their care until the disorder has assumed
a chronic character, and, consequently, the probability of a
cure exceedingly diminished. In order, if possible, to remedy
this evil, fraught, as it is, with consequences of so fearful a
nature to the unfortunate sufferers, the directors of the Retreat
have ordered that an abatement of four shillings per week
during the first year of the patient’s residence in the Asylum,
be made from the expenses of those who enter within six
months of the first decisive symptoms of the dreadful malady.”
From the report of the Retreat for IS37, we learn that,
2
18
since its foundation, 508 insane persons have partaken of its
benefits. Of this number 245 were men, and 263 women: 85
of the former and 95 of the latter had been married, but some
of them were widowers and widows. f
The following table exhibits the result of the treatment of
the whole number, down to the time of making the report:-
re;
g f
- ſº 9 * bo
* re; Q- sº >
of it stuck and less ºn : * * * * *
St attack, and leSS than
three months duration, ; S9 71 1 4 12 I
Of 1st attack, and from three 107 47 7 6 20 4 23
to twelve months duration,
Less than 12 months dura-
tion, but not the 1st *:::: 1 11 66 4 6 15 6 14
More than twelve months 201 52 4 18 66 13 48
duration, - &
Total, 508 236 16 34 113 23 86
Besides the results immediately evident by the table, it will
be found, by calculation, that the cures of those in the upper-
most line, or those of the first attack and admitted within
three months of its commencement, are equal to 79.7 per
cent.; of those between 3 and 12 months, 43.9 per cent.; of
those of the second attack, and whose disease was of less than
12 months duration, 59.4 per cent,; and of those of more than
12 months duration, 25.8 per cent. The cures of the whole
equal 46.5 per cent, and the deaths 22.2 per cent.
The following table, showing the ages of those who died,
may be useful in ascertaining the comparative length of life in
maniacs and the sane. -
Died. # # H H H H # 5 #
160. 55 35 cº CS 5. cº : 5 cº §
T & Paş S: 3 3 £ 3 5. F.
Males, 5 8 5 15 10 6 6 1 56.
Females, 6 4 10 8 16 8 4 1 57
1 12 15 23 26 14 10 2 113
Total, 1
19
The next table gives the ages at which 89 of the patients
were first attacked with the malady for which they were con-
fined. As such it is very valuable; and it is to be regretted
that the same data could not have been ascertained and pre-
served in regard to a greater number.
Afy Gº . AGº Gº Yº Gº Yº Gº
#3 & 3 # 5 § 3 # 3 3 & 2 3
# E E E E E H E E E E E = E =
: 5 º Cº CŞ cº cº cº Cº º º : § : É
ſº tº 5 # 3 :3 S ºff 3 # 3 g E G B-
8 17 18 13 12 4 5 2 3 2 4 0 1 89
It has already been remarked that amusements and labour
have been introduced into this institution, as curative means.
Of the former, however, there is not so great a variety as in
some other Asylums, and a difficulty exists in applying the
latter to so great an extent as would be desirable, from the fact
that there is a large proportion of the patients, who, from their
previous station in society are unaccustomed to manual labour,
and consequently indisposed to it.
York LUNATIC ASYLUM.
In the suburbs of the city of York, in a direction nearly
opposite to that of the Retreat, and not far from Bootham Gate,
stands the York Lunatic Asylum. It is approached through
an avenue, nearly a quarter of a mile in length, and thickly
shadowed by lime trees.
This institution was established in 1777, the necessary funds
having been raised by voluntary subscription. It was intended
for the insane, both paupers and others, within the limits of
the county in which it is situated. In some instances, however,
when peculiar circumstances render it desirable, those from
other counties are received. From the nature of this institu-
tion all patients are obliged to pay for their accommodation.
The expenses of the paupers, of whom there is a considera-
ble number, are defrayed by the parishes to which they seve-
rally belong. The price varies from 6 shillings to 21. Sterling
per week. Parish paupers of the county of York pay 6
shillings, those of other counties, 7 shillings. Other indigent
persons pay according to their circumstances. By paying 3
20
guineas per week, a patient is permitted to bring his own ser-
vant to the Asylum. In this case the board of the servant is
an extra expense. - — ,
The principal edifice is of brick, consisting of a central por-
tion and two wings. Another building, affording additional
accommodations, stands adjacent to this and nearly in the rear
of its westerly wing. The courts or yards are all spacious,
and those occupied by the highest classes of patients are
well cultivated, being handsomely planted with shrubbery
and flowers. The number of insane in the Asylum, in the
summer of 1837, was 170. There are accommodations for
200. The patients are divided, as in the Retreat, into four
classes, the principle forming the basis of classification being
the same as at that Asylum. Among the amusements per-
mitted are cards and billiards. Several groups of patients
were engaged in playing with the former, at the time I passed
through the wards. The straitjacket, the “refractory chair”
—(into which a patient may be fastened by a strap passing
around his body)—and muffs, for the confinement of the hands,
are among the resources for punishment or coercion.
The number of patients admitted into this Asylum, from the
time of its going into operation, in November, 1777, to Octo-
ber 10th, 1814, was 2635. Of these there were discharged,
either cured, improved, or at the request of friends and guar-
dians, 2133. Of the remainder, 399 died, and 103 remained
in the Asylum at the latter date. The deaths during this
period were equal to 16.8 per cent. Again, from October
10th, 1814, to June 1st, 1837, a period of 22 years 43 months,
there were 1131 admissions, which, together with the 103 re-
maining at the former date, makes a total of 1234. Of these
there were 387 cured, 224 improved, 247 removed by their
friends, and 217 deceased. There were remaining in the
Asylum, at the date last mentioned, 83 men and 76 women, a
total of 159. Excluding this 159, as being still under treat-
ment, we have for the cures 36 per cent, and for the deaths 20
per cent. -
The officers of the York Asylum are a physician, a chaplain,
a treasurer, an apothecary, a steward, a house steward, and a
21
matron. The steward acts as secretary, keeps the minutes of
the courts or meetings of the governors, the lists of admissions,
removals, deaths, &c., and an inventory of the property in
possession of the patients when admitted. He sees to supply-
ing clothes, pays the bills for goods used in the house, and for
the special use of patients. The institution is under the care of
3. number of officers, called governors. They consist of all the
benefactors of the Asylum to the amount of 20l. and upwards,
besides the Lord Mayor of York and one or two other ex-officio
members. The governors hold five meetings, or, as they are
technically termed, “courts,” during each year. Special meet-
ings may also be called. A committee appointed by the go-
vernors hold monthly sessions for the purpose of auditing
accounts, contracting for supplies, &c. &c. No officer resident
at the Asylum is eligible to a place in this committee. There
are two visiting governors for each month in the year, and
three ladies, having similar duties, and appointed by the go-
vernors, for each quarter.
The physician, who does not reside at the Asylum, is
required to visit the patients, regularly, three times a week,
independently of those times in which some special case
requires his attention. Divine service is performed every
Sabbath, by the chaplain; and if those patients whose state of
health does not admit of their attendance, should desire it, the
chaplain is required to visit them in their wards at least twice
a week, provided they are in a suitable state of mind. The
apothecary resides in the house. It is his duty to oversee the
attendants, to visit every patient twice during each day, to
keep a history of all the cases admitted, to decide when and in
what manner coercion shall be used, together with such other
duties as generally belong to an officer of this kind.
Any servant who strikes or otherwise maltreats a patient is
dismissed. If a patient escape, the expense of retaking him is
defrayed, either wholly or in part, at the discretion of the
committee, by the servant having charge of him. No officer
or servant is allowed to receive any fee or gratuity, other than
the regular salary.
The friends and medical attendant of each patient admitted
22
to the York Asylum receive the following questions, to which
they are requested to give as correct answers as possible:—“Is
this the first attack? If not, how many previous ones, and at
what distance of time from each other? How long since the
commencement of the present one? Has any, and what change
taken place in the symptoms? Is there, or has there appeared,
a disposition to self-destruction? or to injure others? or to de-
stroy clothes? What defect, impropriety, or false notion marks
the disease! What circumstance appears to have been the
exciting cause? Was there any previous singularity or weak-
ness? Is it known that any of the patient’s relations have
been in any degree deranged? What was the patient’s natural
temper? Favourite pursuits? Habits as to temperance? Of
what religious profession? Have any, and what, medical
means been employed? Is the patient subject to fits? or la-
bouring under any bodily disease? Has the patient had the
small-pox" or the vaccine disease?” . . .
– - ASYLUM AT AMSTERDAM.
The city of Amsterdam, famous for its large number of
- charitable institutions, is supplied with two extensive civil
hospitals, one of them in a central part of the town, the other,
half a mile distant from its southern limits. Connected with
the latter, or rather constituting a portion of it, there is an
Asylum for the insane. A gentleman to whom I carried
letters of introduction, having obtained, from the proper
authorities, permission to visit that institution, accompanied
me to it. The resident physician, a young man of enlarged
intelligence and of great enthusiasm in the profession of which
he is a member, conducted us through the several depart-
ments. . The building is of somewhat antique construction.
Each ward, like those of most hospitals for the sick, is without
subdividing partitions, the beds being arranged upon either
side, and, in this instance, rather too compactly. The wards
are, moreover, like those in the hospitals for the sick in Am-
sterdam, in that they are two stories in height, a platform, or
gallery, running around, above the beds, between the first and
23
the second story. This is used as a place of promenade for
the patients. There are seven wards, four for women and
three for men. The courts devoted to the use of the patients,
and of which there is but one for each sex, are very small, and
being without shrubbery, flowers, or even green-sward, have
the naked and forbidding aspect of a prison-yard. Natives of
the city of Amsterdam, alone, are admitted into this Asylum.
The patients are mostly paupers, or subjects of charity. There
are six beds, in small, decently furnished rooms, which are
intended for pay patients. The number of patients, in July,
1838, was 157. Of these 69 were men, and 88 women. A
large majority of them were incurable. No less than 45 of
the women were epileptics. One of the men has been in the
Asylum ever since the year 1793. During the two years and
eight months ending in July, 1838, there had been admitted
85 men and 78 women, or a total of 163. In the same period,
27 men and 29 women had been cured, and 40 men and 37
women had died. As means of coercion and punishment, the
hands and feet of patients are sometimes fastened, and the
camisole, the strait-jacket and imprisonment are resorted to.
For the last mentioned purpose there are six dungeons, con-
structed three upon either side of a small apartment. One of
these was occupied, at the time of my visit, by a woman, who
was naked, raving and filthy.
But little, indeed nothing, can be said in commendation of
this Asylum. Time, perhaps, has been, in which it ranked
among the most comfortable, and the most judiciously manag-
ed institutions of the kind in the world; but it has so long
remained stationary, that others have far outstripped it in the
rapid march of improvement which has characterized the last
half century. The resident physician of the place is fully
aware of its deficiencies, and is endeavouring to effect a change.
In fact, the city government has already promised radical
reform. The most glaring defects, at present, are, an insuffi-
ciency of room within doors, as well as without; a want of
cleanliness, particularly in the men’s wards, and an almost
entire absence of either labour or amusements. A few of the
women were either knitting or sewing, but the men, without
24
exception, were unoccupied, lying on the floor, the ground, or
the beds, standing in the stupidity of dementia and idiocy, or
walking to and fro, raving with the unbridled fury of mad-
men. There was about the place an air of most indescribable
melancholy. How different from many a scene which I had
witnessed in similar institutions in Great Britain, France, and
the United States—institutions in which commodious apart-
ments, thorough ventilation, and a scrupulous regard to per-
sonal cleanliness, conduce to the physical health of the patients,
in which judicious amusements win the wandering mind to its
wonted path, and appropriate labour tends to calm the disturb-
ed and agitated intellect.
ASYLUM AT UTRECHT.
I had a letter of introduction to Professor Vander Holk, of
the University at Utrecht, the principal physician of this hos-
pital; but he was absent in the country. M. J. J. Vander
Hagen Vander Heuvel, one of the agents, had the kindness,
however, to accompany me to the Asylum and through its
several departments. From the specimen of Dutch institu-
tions of the kind which I had seen in Amsterdam, I confess
that my expectations in regard to this were not very exalted.
Besides, while we were on our way to it, M. Vander Heuvel
took the opportunity to speak of its defects, saying that not
much had been done by way of improvement, that much re-
mained to be done, and that, to one who had seen the Asy-
lums of other countries, this could present nothing of inter-
est. Thus prepared, thus prejudiced, we entered the Asylum
and gave it a pretty thorough examination. And it is but jus-
tice to say, that in no other institution have I seen greater
neatness, more apparent order, or the evidence of a more en-
lightened and rational mode of treatment.
This Asylum was formerly a private establishment, founded
in the 15th century. It continued in existence, still pur-
suing the old method of treatment and of discipline, until the
year 1830. In that memorable year of revolutions the spirit
of reform crept into this institution, effected a radical change,
25
and is still continuing the march of improvement. The build-
ing, though still comparatively small, has been enlarged; the
courts have been planted with trees and flowers, and, at the
time of my visit, in July, 1838, their size was being much in-
creased by extending their limits over the sites of some an-
cient buildings, purchased by the “Regents” of the Asylum,
and demolished by their order. The building is shaped like
the letter L. The room of the superintendent is in the angle,
in the second story, so situated that he can see every patient
who is out of doors. The wards have dormitories on but
one side, the remaining space being a gallery, which is used
as a place of promenade in bad weather. The bedsteads
for the most maniacal patients, and such as are not the most
cleanly, are somewhat different from any others which I
recollect to have seen. They are made of boards, in the form
of a child’s crib, though deeper, and the bottom is concave or
descends in every direction to the centre, where there is an
aperture for the escape of water. There is a common sitting
room for each class of the inmates. The number of patients,
at the date just mentioned, was 94, that of the two sexes being
about equal. They are divided into three classes, the basis of
division being the sum paid for entertainment. Those of the
first class pay 812 florins, equal to about 125 dollars, per
annum; those of the second, 412 florins or 165 dollars; and
those of the third, 100 and 150 florins. The third class is
composed of paupers. Their clothing is included in the sum
mentioned. Those who pay but 100 florins are natives of
Utrecht; those who pay 150 come from other places. The
rooms of the first class are furnished handsomely, but not with
that elegance which is seen in those of the similar classes in
some Asylums.
When necessary, the camisole or the strait-jacket, fetters,
the douche and the dungeon are put in requisition as means of
punishment. The stream of water forming the douche is but
one-fourth of an inch in diameter, while those of Salpêtrière
and Bicêtre, at Paris, are about seven-eighths of an inch.
The quantity of water flowing from the latter must, conse-
quently, be nearly twelve times as great as from the former.
3
26
There is but one bathing tub belonging to the establishment,
but the accommodations in this respect are about to be in-
creased. The patients resort to reading, writing, drawing,
music, cards, billiards, chequers or draughts, and some other
games, for amusement. There is a library intended for their
use. The billiard table, a large and handsome one, was made
by two of the former patients. In one of the men's rooms
several patients were occupied in drawing and reading; and,
had it not been for the wildness of the eye, and the character-
istic traits of countenance, which cannot be mistaken, in one
or two others who were present, I could hardly have believed
myself to be in a mad-house. Most of the men in the first
class were in the court devoted to their use. Among them
was a physician. He conversed freely upon his situation,
gave an account of his commencement of practice, and the
success which attended his efforts, until his friends thought it
best for him to take lodgings in the lunatic Asylum. At
length he asked me if I thought him deranged. He had talked
so rationally, and this question was put so directly and so
earnestly, that to avoid answering it was almost impossible.
An evasive reply, if any, must be given. “It is difficult to
define derangement,” said I; “and, if we should accept the
definition given by some authors, we should include almost
the majority of mankind.” He appeared satisfied with the
answer, and only remarked, with a melancholy tone, “Je crois
bien que le plupart des gens sont des aliénés.” Poor man!
although reason was dethroned, it was evident, from his con-
versation, that the affections retained their empire. f
Some of the women were employed in sewing, knitting and
house-work; some of the men in carpentry, shoemaking and
tilling the garden. No accident has hitherto occurred fro
the use of edge tools by the patients.
The following are the statistics of the entrances, cures,
deaths, &c. from 1832 to 1837, inclusive:–
f
27
* ~. . Disch'd not Per cent. Per cent.
Date. Entered. Cured. Died. improved. of cures. of deaths.
1832 22 10 3 45.45 13.63
1833 44 14 6 2 31.81 13.63
1834 41 16 13 7 39.02 31.70
1835 53 18 11 6 33.96 - 20.75
1836 57 25 10 11 43.50 17.54'
1837 38 21 12 11 55.26 31.57
gººmsºmºsºm. ºmºsº - tºº ams sºmmammammº
Total, 255 104 55 37 40.07 21.56
As the cures and deaths were not among those patients alone
who entered in each several year, but among all those in the
Asylum at the time, data of which I am not possessed, it is
impossible to ascertain their exact per centage. On the sup-
position, however, that as many remained in the Asylum at
the close of the year 1837 as there were in it at the com-
mencement of 1832, and rejecting both those numbers, we
shall find that there was 40.07 per cent. of cures and 21.56 per
cent. of deaths. This is the manner in which the similar sta-
tistics of most other Asylums are calculated. The result in
this instance cannot be very remote from the truth, and I am
the more inclined to believe in its very approximate accuracy
from the following table given me by M. Vander Heuvel. It
includes the admissions and the cures during five successive
years. -
Received. Cured. Per cent.
Men, . . . 142 . . . 74 . . . . 52.11
Women, . . . 75 . . . . 14 . . . 18.66
cºsmºme
Total, 217 SS 40.55.
This Asylum is under the care of a body of directors, called
“Regents.” They are elected, annually, by the city officers.
Endued with the spirit of improvement, they appear to be
determined that the institution shall be made as nearly perfect
as means and circumstances will admit. In order the more
completely to effect this object, they have made, among them-
selves, a division of labour, thus being able to work with more
efficiency than if they acted conjointly. One of their number
28
has charge of the finances; another, of clothing; a third, of
the building; a fourth, of the food; and the others, of other
departments. - -
Before closing these remarks, I may observe that I was as
agreeably surprised in this Asylum as I had previously been
sadly disappointed in that at Amsterdam; and perhaps the
assertion of Halliday, that “nowhere are more comfortable
hospitals to be found than in the Netherlands,” may prove as
correct in the present day as it was years since, at the time in
which that author wrote. Other countries may possess larger,
more convenient, and more elegantly furnished buildings, but
none in which the end appears to be much more effectually
accomplished than in that at Utrecht.
ASYLUM AT ANTwerP.
Being in Antwerp without letters of introduction, I went to
the Asylum, in hopes of being allowed to see its several apart-
ments without any special assistance of the kind alluded to.
A man-servant in a blue frock met me at the door, and, upon
being informed of what I wished, requested me to wait a few
minutes, in the drawing-room, until the “Père” should come.
This officer soon arrived; but, what with his ignorance of both
English and French, and mine of Dutch, not a word could
pass between us, mutually understood. The servant, however,
speaking French, acted as interpreter; and, through him, I
learned that it was impossible for me to go through the esta-
blishment without permission from one of the “Regents.”
This difficulty was overcome, as at Utrecht, by despatching
the servant with me to the house of one of those officers. H.
Willaert, the gentleman to whom I thus became introduced,
appears to be much occupied in objects of benevolence, having
been many years a member of the “Administration des Hos-
pices” of the city in which he resides. This “Administra-
tion” consists in a body of men, each called “Regent,” to
whom is entrusted the general superintendence of the City
Hospital, the Lunatic Asylum, the Foundling Hospital, and
two Orphan Asylums, one for boys and the other for girls.
29
They are the trustees of a large amount of property belonging
to the city, the interest of which is devoted to these several
institutions. They are elected by the burgomaster, for the
term of five years. In order to economise both time and
labour, as well as to make the arrangements and regulations of
all the institutions as nearly perfect as possible, by enabling
each individual to obtain a more complete knowledge of one of
them than he could of the whole, and to concentrate his efforts
thereupon, the several members have divided their trust, each
taking the principal direction of one of the establishments.
The total number of persons under the care of the Adminis-
tration is upwards of three thousand. H. Willaert has the
charge of the Lunatic Asylum.
After having spent an hour in conversation, during which I
obtained much information in regard to the state of society in
Antwerp, as well as in relation to the management of its seve-
ral charitable institutions, M. Willaert offered to accompany
me to as many of these institutions as I might feel desirous of
seeing. Accordingly, we went to the City Hospital, the
Foundling Hospital, and the Lunatic Asylum. Passing by
the first two, as irrelevant to the present subject, I proceed to
a notice of the last.
Arrived at the Asylum, we were conducted through it by
the “Père,” the French servant carrying the keys. The build-
ing, composed of brick, is very old. It is but two stories in
height, and encloses several small courts, which, like almost
everything connected with lunatic Asylums in general, have,
within the last few years, been made “to blossom as the rose.”
They had never been cultivated until since the commencement
of the administration of M. Willaert. The internal construc-
tion of the building, the arrangement of apartments, &c., is
such as might be expected in an edifice of this kind erected a
century since, at a time in which the comfort of the patient
was sacrificed to a paltry economy, in which their proper treat-
ment was unknown, and the unfortunate maniac was placed, in
public estimation, upon a level with the criminal who has fla-
grantly violated the laws of both God and man. The doors of
the dormitories, throughout the establishment, still bear the
3%
30
relics of those days, in the huge bolts with which, at both top
and bottom, they are fastened. I spoke of them, in passing,
and the gentleman accompanying me remarked that they were
soon to be taken off. The rooms referred to are arranged on
both sides of very narrow passages leading through each ward.
There are 24 cells for the raving maniacs, 12 for those of each
sex. These are small; the wainscoting is of wood, in order to
diminish the danger of the patients injuring themselves against
the walls; and each contains no other furniture than a bed.
These beds are low, made of plank, and fastened to the walls.
The mattrasses, throughout the building, are mostly of straw;
those of the convalescent and of the pay patients are, however,
of better materials. In the infirmary the beds are very good.
The corpse of a patient, just deceased, was lying upon one of
them when we passed. There are special wards for the idiots,
epileptics and incurables. A few years since, the proportion of
incurables was very large; but the Grippe, which prevailed so
generally, in an epidemic form, throughout the west of Europe,
during the winter of 1836–7, carried off many of them, and,
subsequently, most of those who had been attacked by it and
recovered, became victims to phthisis pulmonalis. Each class
of patients has a court and a common hall, in which they spend
most of their time. The halls are warmed by stoves, which
are surrounded, at a few feet distant, by a strong reticulated
wire fender. The dormitories, or private rooms of the
patients, as well as the cells for the furious, are not furnished
with the means of being warmed. At the suggestion of
Ramon de la Sagra, the celebrated political economist of Spain,
who visited this institution but a few days before I was there,
the defect is about to be remedied by the introduction of a hot-
air furnace. - º . *: t
The number of patients in the summer of 1838 was 130, of
whom 60 were men and 70 women. The Asylum is suffi-
ciently large to accommodate a much greater number. A few
pay for their entertainment; those who are natives of Amster-
dam, 280 florins, or 112 dollars; and others, 300 florins, or 120
dollars, per annum. .
Regimen.—Breakfast; tea, bread and butter. The bread
31
is made of equal proportions of wheat and rye. Dinner;
meat and bread four days in the week; soup and vegetables,
with bread, the remaining three. Supper; bread and butter,
with beer, if wanted. The beer, which is not very strong,
but sufficiently so to be palatable, is at the command of the
patients at all times.
Labour and amusements have not, as yet, been extensively
introduced. A few of the men work at small jobs, such as
some parts of domestic labour, whitewashing, &c., and there
is one room in which the convalescent and some of the quiet
incurable women were spinning tow and making lace with
bobbins. Both men and women are remunerated for what-
ever labour they perform, it having been found “difficult, or
nearly impossible,” to induce them to work, except by the
stimulus of pecuniary reward. Connected with the building
is an elegant Catholic chapel, in which mass is regularly said.
Such patients as can be admitted with propriety are allowed to
attend. There is an apartment for the men, and another for
the women, so arranged that they may all witness the ceremo-
nies before the altar, without the ability to see each other or the
rest of the congregation. Attendance upon the services is con-
sidered a privilege, as such is dispensed, and as such is much
sought. Thus here, as in other places, religious worship has
been found, to a certain extent, an efficient means in the moral
treatment of the insane.
LA SALTPETRIERE.
This vast Asylum for the poor, this pauper-village, if the
term be admissible, was established by Louis XIV. in the year
1656. It is situated on the southern shore of the Seine, in a
remote part of Paris, and in the vicinity of the Jardin des
Plantes. It is devoted exclusively to females, for whom it
contains about 4500 beds. It is in the hospital of this exten-
sive establishment, that the celebrated Cruveilhier has collected
most of the materials for his elaborate and beautiful works upon
pathological anatomy. The department devoted to the insane
is, perhaps, the most extensive in the world, the number of
32
lunatics being from 1000 to 1200, and that of epileptics and
idiots, from 700 to 800. The approximate number of admis-
sions, per annum, is 500, that of discharges 300, and of deaths
200. The cures are equal to 33% per cent. of the whole num-
ber admitted. “This proportion,” says a French author, “is
sufficiently large, when we consider that many of the maniacs
do not enter the Salpêtrière until after they have been treated,
and pronounced incurable, at other hospitals (maisons-de-
santé).” Drs. Pariset and Mitivié have charge of the depart-
ment for lunatics. The medical visit was made by the latter
on the morning that I was there. He seems admirably quali-
fied, by his gentleness and kindness of manners, and his firm-
ness of character, for the situation which he fills. It is a fact,
too generally known to require repetition, that this establish-
ment and the Bicêtre were the chief theatres of action of the
benevolent Pinel; that, by him, the Augean stables of their
misery, degradation and torture were cleansed; that, at his
suggestion, the great amelioration in the condition of the
inmates, wrought both during his life and since, have been
effected. France owes a debt of gratitude to this benefactor
of a portion of her citizens, which the giving of his name to a
ward in the Salpêtrière but inadequately repays. Pope, in
allusion to the broadly contrasted characters of the Roman
emperors, Caesar and Titus, exclaims— . . .
“And which more blest, who chained his country, say,
Or him whose virtue sighed to lose a day?” .
In like manner, may we not ask which is “more blest,” Na-
poleon, wading through the blood of six millions of his fellow
beings to a transient throne, of despotism, or Pinel, severing
the manacles and chains of those who had been laden with them
merely because they were suffering under a disease to which all
are liable, breaking up the strong holds of misery, and carrying
light, cheerfulness and content into the abodes of darkness,
wretchedness and woe. The ameliorations prospectively made
by this distinguished philanthropist, and subsequently insisted
upon by his brother in benevolence, M. Esquirol, have not,
hitherto, been fully accomplished. A few years, however, will
suffice for their completion. The buildings recently con-
33
structed for the patients are but one story in height, surround-
ing spacious courts.” Upon three sides there are wards,
and, on the fourth, two bathing rooms, communicating with
each other, and with the wards, by an extensive corridor,
similar to the markets of Philadelphia, if deprived of their
benches. The wards have two rows of windows, the upper
ones, which are small and near the ceiling, being kept open at
all proper seasons, for the purpose of ventilation. In one large
enclosure, belonging to the establishment, there are several,
perhaps 14 or 15, small buildings for the furious, each adapted
to the accommodation of one alone. They are heated by an
apparatus beneath the floor. In one of them there was a girl,
of interesting appearance, who begged the physician that he
would order a camisole to be placed upon her, lest she should
do herself some injury. In reference to the treatment at this
Asylum, M. Milne Edwards says:—“In the treatment of the
insane no violent means are ever employed. The greatest
mildness, kindness and care are constantly enjoined upon the
attendants, and the physicians set a good example in these re-
spects. Baths, the douche, exutories, mild purgatives, and
medicines intended to restore suppressed evacuations are the
principal remedial agents resorted to. Isolation and moral
means form the basis of treatment.”f
LE BICE TRE.
The “hospice,” or pauper Asylum of Bicêtre, is in a
southerly direction from Paris, about two miles from the walls
at the barrière de Fontainebleau. It is for men alone. Its
extent is less than that of La Salpêtrière, the number of
inmates being about 3000. The department for the insane is
* In regard to buildings of this kind, Esquirol observes, “During the last
twenty-five years I have often exposed the inconveniences of buildings several
stories in height.' I have so loudly proclaimed the advantages of a ground
floor as the dwelling place for the insane, that I shall abstain from remarking
upon them here, particularly as in France, as well as in foreign countries, my
º have been received and put in practice in the construction of lunatic
sylums. . . * , - :
f Notice sur les Hôpitauá de Paris, in the Nouveau Formulaire Pratique des
Hôpitawa, by Milne Edwards and P. Vavasseur. - .
34
proportionally smaller. The number of patients in May,
1838, was 760. Besides these there were about 200 idiots.
The average number of admissions, annually, is, for the insane,
360; the imbecile, 40; that of discharges of the former, per
month, 12 to 15; the deaths about the same, and the cures from
7 to 8. The proportion of deaths to the whole number ad-
mitted is as 1 to 6, or 16.66 per cent. The medical care
of the patients is confided to Drs. Ferrus and Pinel. The work
quoted at the close of the remarks upon La Salpêtrière says,
in reference to this Asylum:-“Every thing disapproved of
by Pinel has been destroyed; all that he required has been
executed. The lodges have disappeared, large promenades have
been made, and the number of attendants is increased. There
is a farm upon which sixty of the patients labour daily. It is
impossible to describe all the good resulting from these mea-
sures. Formerly, if the department of the 'insane bore the
least resemblance to any other place, it was to a hell;-now, all
is calm, and it is not rare for whole nights to pass without
hearing the slightest noise.” -
The whole number of insane who labour is about two hun-
dred. The establishment is supplied with water from large
and deep wells, whence it is pumped into reservoirs by the
patients. - - . . . . .
Admission to the department for the insane can be obtained
only by a special permission from the “Directeur” of the
establishment. An English physician accompanied me to the
place, and having obtained a permit, we entered. Dr. Pinel
made the medical visit for the day, and we accompanied him
through all the wards. He, too, like his illustrious predecessor
of the same name, appears to take a lively interest in the un-
fortunate class of persons with whose treatment he is entrusted,
and seems well qualified, by both nature and education, for the
important and responsible station which he occupies. Many
of the patients greeted him with a “bon jour;” those who
were not confined to their beds thronged around him, to con-
verse, some seizing his hand and saying, “Vous étes un bien
brave homme,” or some other compliment of a similar kind,
he, the while, treating them as his friends and companions, and
35
adapting his conversation to each, according to his particular
hallucination. In one of the wards which we first entered, a
merry patient, seeing us approach, took his violin for the pur-
pose of giving his physician a musical entertainment. He
followed us through the ward, playing several lively airs, and
when we were about to leave, insisted upon accompanying us.
The doctor permitted him so to do, and he followed us, con-
stantly playing upon his fiddle, through most of the remaining
wards. -
The recently constructed buildings of the Bicêtre are upon
the same plan as those of La Salpêtrière, though not so spacious.
The courts are planted with trees, and supplied with permanent
seats beneath the shade. After the visit was completed, we
went to the bathing-room, which is furnished with perhaps a
dozen tubs. Over each of several of them, at the height of
about five feet from its top, is a douche, the diameter of the
stream of which is a little more than three-fourths or about
seven-eighths of an inch. There were patients in two of the
tubs, each being confined in his place by a board passing around
the neck, as in a pillory. One of them was a robust man, of a
nervo-sanguineous temperament, who, during the course of his
alienation, had been subject to several hallucinations. At one
time he talked so long and so constantly as to produce aphony.
At another time he was rich as Croesus, and 25,000 francs of
his annual income accrued from a pinch of snuff. He now
believed himself to be the husband of the Duchess de Berri,
and a favourite friend of the ex-king, Charles X, and of his
son, the Duke de Bordeaux; that these persons had recom-
mended him to Louis Philippe, who showed him particular
attention and was about to load him with honours. On the
previous day, he had requested to be furnished with materials
for writing. These were given to him on condition that he
should write something reasonable, and not the wild vagaries
with which his mind was haunted. He wrote a letter to M.
Dupin, president of the Chamber of Deputies, desiring that gen-
tleman to give his compliments to Louis Philippe, with many
thanks for the kindness which he had received, and should re-
ceive, in future, from his royal highness. Pinel approached
36
the patient with this document in his hand, reminded him of
the conditions upon which he was permitted to write, read to
him the letter, an amusing tissue of absurdities, and then asked
him if he still believed himself to be a favourite of the royal
family. “Oui, Monsieur,” was the instantaneous reply. “Give
him the douche,” said Pinel. A servant who stood waiting
orders, turned the water-cock and the stream fell directly upon
the vertex of the patient’s head. He struggled, writhed and
screamed under the shock, and begged that it should be stopped.
This request was complied with in a few seconds. Pinel.
“Do you still entertain the foolish idea that you are an intimate
friend of Charles X.” Patient. “I think I do.” Pinel. “Let
him have the douche.” This was no sooner ordered than
obeyed. The patient floundered, hallooed, and begged as be-
fore. The douche was stopped. Pinel. “Are you an intimate
friend of Charles X. and the Duke de Bordeaux?” Patient.
“I presume so.” Pinel. “Give him the douche.” It was
given with all the previous results. The doctor again read
some portions of the letter, attempted to convince the man of
the absurdity of his notions, and concluded by asking him
what marks of attention he had ever received from the “Roi
déchu.” Patient. “You are aware, Monsieur Pinel, of the
important works of which I am author, and which were
written long since. I presume, sir, that Charles X. takes a
great interest in those, and consequently in me; besides, he
has given me a letter of recommendation to Louis Philippe,
from whom I have received so many proofs of friendship.”
Pinel. “It is impossible that Charles X. should have given
you a letter of that description to Louis Philippe, since they.
and their families are at enmity with each other.” The patient
muttered something about Henry V. and an umbrella. Pinel.
“France knows no such person as Henry V.; when you speak
of the gentleman referred to, call him Duke de Bordeaux.” In
this manner nearly half an hour was occupied, the douche
being administered whenever the patient insisted upon the truth
of his fantastical ideas. At length, what with the arguments
of the doctor, and what with the still more cool and cogent
logic of cold water to the head, the patient yielded his points,
37
deeply regretting, however, to be thus shorn of his splendour,
and so unceremoniously brought down from his “high estate.”
Pinel then gave him a lesson to commit to memory for the
following day.
The other patient was meagre and of a bilious temperament.
Throughout the scene which we have partially described, he
remained perfectly quiet in his bath. On the day previous a
task of manual labour had been given him, and he had left it
untouched. Pinel approached and asked him why he had
done so. He looked up with a smile, and a most ludicrous
leer of the eye, as he said, “To speak candidly, sir, I felt no
particular desire to work.” . The doctor himself could hardly
refrain from laughter. “Well,” said he, “will you work
hereafter, when you are ordered to?” The patient reflected a
moment, then looked up with the same expression of counte-
nance as before, and said, “I will not work, my word of
honour for it.” “Give him the douche,” said the doctor, and
the stream of water instantly fell upon the patient’s head.
The effect was even greater upon him than it had been upon
the other, insomuch that, in a moment, like a child smarting
under castigation, he exclaimed, “I will, I will.” The douche
was stopped, and the task left unfinished on the previous day
was ordered to be completed before night.
That the douche employed as in the two cases above men-
tioned is not only destitute of utility, but absolutely and de-
cidedly injurious, does not, in my opinion, admit a doubt.
The real frenzy to which the former patient was driven by the
combined effects of a positive and determined contradiction of
his hallucination, and the agitation produced by his knowledge
of the fact that the douche was used as a means of compulsion,
caused a rush of blood to the brain, the deleterious influence of
which could not be overcome by the sedative effects of the
cold water. Nor can we believe that the immediate object in
view in the case in question, that of dispelling the illusion
under which the unfortunate maniac was labouring, was either
gained or even approximated, for the dread of the douche
compelled the man to sacrifice truth on the altar of fear, and
4.
38
made his tongue belie his still persistent belief. It is with the
insane as with the sane, -
“Who is convinced against his will,
Is of the same opinion still.”
During the past year (1840) we have made a very free use
of the cold douche in the Frankford Asylum, but in no instance
has it been employed as a means of coercion or of punishment.
It is of decided advantage in all cases in which there exists a
determination of blood to the brain, indicated by flushings of
the face, and excessive heat, either constant or variable, of the
integuments of the cranium. A majority of the patients who
have been submitted to its influence, have preferred to use it,
on account of the refreshment and relief thereby produced.
Several of them have been accustomed to applying it to their
heads, from day to day, voluntarily. The douche in this in-
stitution is the only one I have seen in this country, and I am
not aware that it has been resorted to as a curative means in
any other Asylum for the Insane in the United States. It is
so constructed as to make the stream of water of variable size,
from one-fourth to three-fourths of an inch in diameter. The
water falls from two to four feet, according to the situation of
the head of the patient. - - -
The Bicêtre is hallowed as being the scene of the boldest
and noblest achievement recorded in the annals of insanity.
Here, morning first dispelled the midnight gloom of lunacy,
and the guiltless maniac was released from the thraldom which
associated him with criminals and brutes, taken by the hand,
as a brother, and acknowledged to be worthy of the kindest
attention, commiseration and sympathy. -
The following brief account of the commencement of the
labours of Pinel, extracted from a paper read by his son, before
the Royal Academy of Sciences, commends itself to the atten-
tion of every reader: - -
“Towards the end of 1792, Pinel, after having many times
urged the government to allow him to unchain the maniacs of
the Bicêtre, but in vain, went himself to the authorities, and
with much earnestness and warmth, advocated the removal of
this monstrous abuse. Couthon, a member of the commune,
39
gave way to M. Pinel’s arguments, and agreed to meet him
at the Bicêtre. Couthon then interrogated those who were
chained, but the abuse he received, and the confused sounds of
cries, vociferations and clanking of chains, in the filthy and
damp cells, made him recoil from Pinel’s proposition. “You
may do what you will with them,” said he, but I fear you
will become their victim.” Pinel instantly commenced his
undertaking. There were about fifty whom he considered
might, without danger to the others, be unchained, and he
began by releasing twelve, with the sole precaution of having
previously prepared the same number of strong waistcoats,
with long sleeves, which could be tied behind the back if ne-
cessary. The first man on whom the experiment was to be
tried was an English captain, whose history no one knew, as
he had been in chains for forty years. He was thought to be
one of the most furious among them. His keepers approached
him with caution, as he had in a fit of fury, killed one of them
on the spot with a blow from his manacles. He was chained
more rigorously than any of the others. Pinel entered his
cell unattended, and calmly said to him, “Captain, I will order
your chains to be taken off, and give you liberty to walk in
the court if you will promise me to behave well, and injure
no one.’ ‘Yes, I promise you,” said the maniac, “but you are
laughing at me—you are all too much afraid of me.” “I have
six men,” said Pinel, ‘ready to enforce my commands, if neces-
sary. Believe me then, on my word, I will give you your
liberty if you will put on this waistcoat.”
“He submitted to this willingly, without a word. His
chains were removed, and the keepers retired, leaving the
door open. He raised himself many times from his seat, but
fell again on it, for he had been in a sitting posture so long,
that he had lost the use of his legs. In a quarter of an hour
he succeeded in maintaining his balance, and with tottering
steps came to the door of his dark cell. His first look was at
the sky, and he cried out enthusiastically, “How beautiful!’
During the rest of the day he was constantly in motion, walk-
ing up and down the staircases, and uttering short exclama-
tions of delight. In the evening he returned of his own
accord into his cell, where a better bed than he had been
40
accustomed to had been prepared for him, and he slept tranquil-
ly. During the two succeeding years which he spent in the
Bicêtre, he had no return of his previous paroxysms, but even
rendered himself useful by exercising a kind of authority over
the insane patients, whom he ruled in his own fashion.
“The next unfortunate being whom Pinel visited was a sol-
dier of the French guards, whose only fault was drunkenness;
when once he lost his self-command by drink, he became
quarrelsome and violent, and the more dangerous from his
great bodily strength. :
“From his frequent excesses, he had been discharged from
his corps, and he had speedily dissipated his scanty means.
Disgrace and misery so depressed him that he became insane;
in his paroxysms he believed himself a General, and fought
those who would not acknowledge his rank. . After a furious
struggle of this sort, he was brought to the Bicêtre in a state
of great excitement. He had now been chained for ten years,
and with greater care than the others, from his frequently
having broken his chains with his hands only. Once when
he broke loose, he defied all his keepers to enter his cell, until
they had each passed under his legs; and he compelled eight
men to obey this strange command. Pinel, on his previous
visits to him, regarded him as a man of original good nature,
but under excitement incessantly kept up by cruel treatment;
and he had promised speedily to ameliorate his condition,
which promise alone had made him more calm. Now he an-
nounced to him that he should be chained no longer, and, to
prove that he had confidence in him, and believed him to be
a man capable of better things, he called upon him to assist in
releasing those others who had not reason like himself, and
promised, if he conducted himself well, to take him into his
own service. The change was sudden and complete. No
sooner was he liberated than he became attentive, following
with his eye every motion of Pinel, and executing his orders
with as much address as promptness. He spoke kindly and
reasonably to the other patients; and during the rest of his
life was entirely devoted to his deliverer. And ‘I can never
hear without emotion,’ says Pinel’s son, “the name of this
man, who some years after this occurrence shared with me
41
the games of my childhood, and to whom I shall always feel
attached.” . * --
“In the next cell were three Prussian soldiers, who had
been in chains for many years, but on what account no one
knew. They were, in general, calm and inoffensive, becom-
ing animated only when conversing together in their own
language, which was unintelligible to others. They were
allowed the only consolation of which they appeared sensible
—to live together. The preparations taken to release them
alarmed them, as they imagined the keepers were come to
inflict new severities; and they opposed them violently when
removing their irons. When released, they were not willing
to leave their prison, and remained in their habitual posture.
Either grief or loss of intellect had rendered them indifferent
to liberty. e
“Near them was an old priest, who was possessed with the
idea that he was Christ; his appearance indicated the vanity
of his belief; he was grave and solemn; his smile soft, and at
the same time severe, repelling all familiarity; his hair was
long, and hung on each side of his face, which was pale, intel-
ligent, and resigned. On his being once taunted with a ques-
tion, that “if he was Christ he could break his chains,” he
solemnly replied, “Frustra tentaris Dominum tuum.” His
whole life was a romance of religious excitement. He under-
took, on foot, pilgrimages to Cologne and Rome, and made a
voyage to America for the purpose of converting the Indians;
his dominant idea became changed into an actual mania, and
on his return to France he announced himself as the Saviour.
He was taken by the Police before the Archbishop of Paris,
by whose orders he was confined in the Bicêtre as either im-
pious or insane. His hands and feet were loaded with heavy
chains, and during twelve years he bore with exemplary
patience, martyrdom and constant sarcasms.
“Pinel did not attempt to reason with him, but ordered
him to be unchained in silence, directing, at the same time,
that every one should imitate the old man’s reserve, and never
speak to him. This order was rigorously observed, and
produced on the patient a more decided effect than either
4%
42
chains or the dungeon; he became humiliated by this unusual
isolation, and introduced himself to the society of the other
patients. From this time his notions became more just and
sensible, and in less than a year he acknowledged the ab-
surdity of his previous prepossessions, and was dismissed from
the Bicêtre. - - - •
“In the course of a few days, Pinel released fifty-three
maniacs from their chains; among them were men of all condi-
tions and countries; workmen, merchants, soldiers, lawyers,
&c. The result was beyond his hopes. Tranquillity and har-
mony succeeded to tumult and disorder; and the whole disci-
pline was marked with a regularity and kindness, which had
the most favourable effect on the insane themselves; rendering
even the most furious more tractable.”
ASYLUM AT CHARENToN.
Dr. Louis favoured me with a letter of introduction to M.
Esquirol, the médecin en chef of the Asylum at Charenton,
and the distinguished veteran in the treatment of the insane.
With this I went to the Asylum, where I had the pleasure of
meeting him to whom it was addressed, in the scene of his
present labours, among the unfortunate people who love and
honour him as a father, and in whose welfare his interest con-
tinues unrepressed by the weight of accumulated years. After
his visit to the patients was completed, I sat an hour with him
in the parlour of the institution, during which time he con-
versed chiefly upon the subjects of lunacy and of Lunatic Asy-
lums. After speaking of the comparative merits of the various
establishments of the kind in Europe, and giving the preference
to that at Reggio, in Italy, over all others that he had ever
visited, he made many inquiries with regard to those of the
United States, and expressed much interest in the progress of
improvement in the treatment of the insane, upon this side of
the Atlantic.
The Asylum of Charenton, in a village of the same name,
is about five miles eastwardly from the city of Paris. It is
situated upon the southern declivity of a hill, which runs
*
43
parallel to the river Marne, near its shores, and but a short
distance from its junction with the Seine. It was originally a
hospital, under the care of the Brothers of Charity. About
the beginning of the 18th century, a department was, for the
first time, devoted to the reception of those labouring under
mental alienation. In 1795 the hospital was suppressed, but in
1797 it was re-established and devoted exclusively to the
treatment of the insane. It is now called, in common with
some other establishments of the kind in other parts of France,
“Maison Royale d'Aliénés.” It includes many edifices, which
have been erected at various periods, and extensive gardens
and promenades, which extend to the summit of the hill upon
the declivity of which it is located. The following description
is translated from the recent elaborate work of M. Esquirol, to
which we are also indebted for most of the subject matter for
our remarks upon this Asylum.* “The section for men is
composed of four courts, of which three are planted; three
infirmaries; one ward for patients of a suicidal propensity;
one dormitory; one gallery and six corridors, into which
open the doors of the several rooms; one bathing room, and
six rooms where the patients assemble. These last mentioned
can be heated. The section for women has a garden, four
planted courts, two infirmaries, one ward for women disposed
to commit suicide, two bathing rooms, seven dormitories, six
galleries and corridors into which open the doors of the apart-
ments, and five rooms in common, which may be heated.”
An extensive additional department for females, combining
most of the modern improvements, was erected about twelve
years since, and first occupied in 1829. This is one of the
best arranged and most neatly-kept establishments of the kind
that I have had occasion to examine. The furniture is good
and sufficiently handsome, without being extravagant. The
beds of the dormitories are hung with white curtains. No
corresponding department for the men has hitherto been
erected. There is a parlour in the Asylum, in which those
* Des maladies mentales, considérées sous les rapports médical, hygiènique
et médico-légal, par E. Esquirol. Paris, 1838.
44
patients the state of whose disease renders them admissible,
assemble every evening for social intercourse. This contains
many arm-chairs, several card-tables and a piano-forte. A
room having tables for billiards, is devoted to that amusement.
The bathing room of the new department for females contains
ten copper tubs, separated from each other by curtains, and
each supplied with a cover which may be used in case of ne-
cessity. A chapel, or oratory, is devoted to religious worship;
the exercises being conducted in the Catholic form. The
priest (auménier) resides at the Asylum. Ministers of other
sects are, at the request of patients, permitted to visit them in
their wards. -
There are three grades of prices for entertainment at this
institution: the 1st, 1300; the 2d, 1000; and the 3d, 720 francs
per annum. The regimen of the patients varies according to
the grade, and is of a quality proportionate to the prices of
those grades. The rules of the establishment require that there
shall be one attendant to every tenth patient, but this number,
according to M. Esquirol, is not sufficient. There are 73 in
all, two of whom remain in the garden to oversee those who
are walking. Several others have charge of but one or two
patients each. The number of persons employed at the Asy-
lum, including, on the one hand, the visiting physician, and,
on the other, the gardeners, gate-keeper and hostlers, is 170.
The number of admissions, from the establishment of the
institution exclusively for lunatics, in 1797, to the end of the
year 1833, is 5972. The following list exhibits the same num-
ber divided in the proportion that the patients were received
in several different epochs.
From 1797 to 1802 . . . 202
1802 “ 1805 . . . 435
1805 “ 1810 . . . . 1007
1810 “ 1815 . . . 722
1815 “ 1825 . . . 2049
1825 “ 1834 . . . 1557
Total, . . . 5972
45
Previously to 1815, the number of each sex was not desig-
nated, but from that year to 1825 there were 1245 men and
804 women; and from 1825 to 1834, 932 men and 625
women. - l . ~ * -
The following table, compiled, with some additions, from
several of those in the work above quoted, exhibits the number
of admissions for each of the years between 1825 and 1834,
the condition in society (état civil) of the patients, and the re-
sults of their treatment.

g; ‘s |3 ‘s is
* |g| . || | | |# | # , || 3 | . || || 3 | . |+ ..] ||= |# .
Gº || > , , $ºes tºº ö | 3 | – | #'s wº
§ $ | 3 || 3 |#|F |##| 3 |5 = 5 § || 3 || 3 || 3 |#| 3 ||3: ; 5 #|3.3
:- 3 ||3: = |*|5|##|ā |& 3|& 3 > || 3 || 3 |> || 3 |##| 3 || 3 |& 3
1826|121| 68 49| 4 34 39 5928.09|48.76|| 89. 34: 49| 6’ 41| 35 28|46.0531.57
1827|123| 72] 41|10| 51| 34 4241.46||34.14|| 82 26|| 48 8| 24, 29| 17|29.2620.73
1828,122 66 51|5| 34 34 5427.86|44.26|| 82 27|44|11 25 23, 2130.4825.60
1829,121| 59 55 7| 40 38 58.33.05|47.10|| 71, 19 47 5 28 27| 1539.4321.12
1830;112 54 52 6 34 52. 4430.35|39.28|| 74; 18|49. 7. 29||19| 21|39.1828.37
1831||109| 64 42 3 22 31|| 5120.1846,60|| 82 27| 44|11 29 44 1435.36||17.07
1832|118 60 55] 2 36 40 38.30.5032.20 79 24|43|12| 29 24 1749.35|21.51
1833|106| 62 41|3| 33 33 6031.1356.60||66, 18| 39| 9, 29 25 743.93|10,60
1932505.387A0284301406|| 625 19336369234.226.140
The proportion of single men, as calculated from this table,
equals 54.18 per cent. ; of single women, 30.88 per cent.; of
married men, 41.52 per cent. ; of married women, 58.08 per
cent.; of widowers, 4.29 per cent. ; and of widows, 11.04 per
cent. It is a singular fact that the proportion of married men
is but about two-thirds as great as that of married women,
while that of single men is nearly twice as great as that of
single women. * * -
The total number of cures is 518, equal to 64.7+ per an-
num; that of deaths 546, or 68.3+ per annum. It will be
perceived, by the table, that the greatest proportion of the an-
nual cures of men was in 1827, - 41.46 per cent., and that of
women, in 1832, - 49.35 per cent.; also, that the least pro-
portion of the cures of men was in 1831, = 20.18 per cent, and
that of women, in 1827, − 29.26 per cent. The proportion
of the deaths of men was largest in 1833, - 56.60 per cent.;
that of women, in 1826, = 31.57 per cent.; the proportion was
46
least, for men, in 1832, - 32.20 per cent.; and, for women,
in 1833, − 10.60 per cent. * , -
The average number of cures, per annum, was, for men,
30.32 per cent.; for women, 39.13 per cent.; and for both
sexes, inclusive, 34.72 per cent. The average of deaths was,
for men, 43.61 per cent. ; for women, 22.07 per cent. ; and for
both, 32.84 per cent. .
In regard to the ratio of cures, M. Esquirol says that there
were 355 epileptics, paralytics and idiots among those admitted,
all of whom were considered, at the time of their entrance, as
incurable. Deducting this number from 1557, the total of
admissions, there will remain but 1205 as under curative treat-
ment. The proportion of cures, in this ease, will be as 1 to
2.33 or equal to 42.14 per cent. The mortality, as exhibited
by the table, is very great; but, in making out the per centage,
the 492 patients who were in the Asylum at the commence-
ment of the year 1826, and among whom, according to Esqui-
rol, death made its greatest ravages, were not taken into con-
sideration. If these be added to the number admitted, we
have a total of 2049, to which the deaths, 546, are in the pro-
portion of 1 to 3.75+, or 26.64 per cent. It is proper to remark
that the insane of all descriptions are admitted, irrespective of
age, grade of disease or its duration, or of the many other ma-
ladies with which it may be complicated. Again, very few
persons attacked by “those acute diseases of the encephalon,
which, as people say, are always cured, and which increase
the number of cures of some similar establishments,” are
brought to this institution. From these facts we cannot expect
the ratio of cures to be very large. The mortality of men
considerably exceeded that of women. That of the latter was
much less in the last than in the first years of the period; and,
at the same time, there was a corresponding increase of cures.
These facts are very plausibly accounted for, in that the women
occupied the new and commodious building, before mentioned,
during the last five years. - - . -
We now present a table exhibiting the admissions and the
results of treatment, in reference to the different seasons of the
year. #
47
Season. Admitted. Cured. Died. Per ct, of cures. Per ct. of deaths,
Winter, 341 92 160 26.97 46.92
Spring, 406 123 139 30.29 34.23
Summer, 445 145 119 32.80 26.74
Autumn, 365 158 128 43.28 35.06
Total, 1557 518 546
The average of admissions was 194 per annum. The maxi-
mum number in any series of the same month was in that of
July, and of seasons, as will be seen above, in summer. The
minimum of men, and of both sexes inclusive, was in winter;
but that of women was in spring. The proportion of cures
WaS greatest in autumn, and least in winter; that of deaths,
greatest in winter and least in summer.
The next table shows the ages of the patients at the time of
admission. - -
c - -
§ 3 ; ; ; ; ; # 3 3 & #2 & 3 &
# 9 s 2 g g g g g g g g g g g
gº -
5 § 3; 3 ; S. $ 3 tº 3 3 e º 3 #3
Men, 82 119 135 130 106 105 83 68 37 35 25 4 2 1
Women, 42 55 72 77 102 90 65 46 36 22 10 2 4 1 1
Total, 124 174 207 207 208 195 148 114 73 57 35 6 6 2 1
Hence it appears that the greatest number of men during any
period of five years was 135, and that between the ages of 25
and 30; the maximum of women was 102, between the ages
of 35 and 40; and that of both sexes inclusive 208, between
the ages of 35 and 40. The number second in rank is found,
for men, between the ages of 30 and 35, and for women, be-
tween 40 and 45. The number under 20 years occupies, for
the men, the third rank, for the women, the sixth rank. From
these results, Esquirol is led to infer that insanity generally
occurs at an earlier period of life in men than in women. It
will be seen that more men than women enter this Asylum:
the former are to the latter nearly as 3 to 2. This difference
arises from the number of soldiers and marines who resort
here to be cured. Esquirol has ascertained by his researches,
that of 76,000 lunatics, in various countries, the proportion of
men to women is as 37 to 38. The ratio differs in different
48 *
nations, according to climate, habits and other modifying in-
fluences. - - - -
The number of patients in each variety of insanity, together
with the results of treatment upon them, respectively, will be
seen in the following table.
A
Men. Cures. Per cent. Women. Cures. Per cent. Remark.
Monomania, 372 123 33.06 343 128 37.31 *
Mania, 334 160 47.93 211 103 48.81 5. 3
Dementia, 219 1 .45 62 3 4.83 # 3
Idiocy, 8 - 7 f £8.
Total, 933 284 623%. 234 *ś,
The cures in monomania of both sexes, inclusive, were equal
to 35.10 per cent.; those in mania, 48.25 per cent, and those
in dementia, 1.42 per cent. The number of patients affected
with monomania exceeded that of any other variety; but the
per centage of cures has its maximum in mania.
Of the 1557 cases, the causes are assigned to 1375; they are
as follows. “Hereditary, 337; domestic chagrins, 278; liber-
tinage, excesses of all kinds, 146; abuse of spirituous liquors,
134; suppression of habitual evacuations, 54; onanism, 52;
reverse of fortune, 49; abuse of mercury, 44; disappointed
love, 37; fright, 35; political causes, 32; parturition, 28; ex-
alted devotion, 24; blows on the head, 20; jealousy, 18; cere-
bral affections, 17; excess of study and night waking, 16;
wounded self-love, 16; reading of romances, 13; insolation,
12; love of play, 5; suppression of habitual suppuration, 3;
cholera morbus, 3; excess of joy, 2.” Total, 1375.
Esquirol thinks that the proportion of cases arising from
hereditary predisposition is usually greater than in this in-
stance. In relation to those arising from political causes, we
may remark that none occurred previously to 1830. In that
year, the year of the last revolution, there were 13 cases of
this nature, and 15 in 1831. - -
The following is a list of the several trades and professions
previously pursued by the patients, with the exception of a few,
in which there was but one each. “Proprietors (landlords) 307,
tillers of the ground 99, masons 7, locksmiths. 5, cabinet-makers
16, bakers 19, butchers 10, sellers of hog's flesh (charcutiers) 4,
49
grocers 31, wine-merchants 26, tunnelers 3, tavern-keepers and
cooks 24, jewellers 13, tailors and shoemakers 17, cap makers
and hosiers 5, hatters 5, modistes and cutters 35, merchants and
clerks 81, tobacco dealers 7, military officers 103, soldiers 124,
conductors of public coaches and couriers 11, teachers 30,
students 46, priests 11, “seminarists”.4, nuns 5, physicians 15,
apothecaries 9, advocates 9, notaries 6, clerks (commis de
bureau) 83, “clercs d’avoué” 10, ushers or door-keepers 6,
literary men 3, painters 8, musicians 4, printers and booksel-
lers 15, domestics 35.” - -
In the years 1826, 1830, and 1831, a much larger number
of proprietors entered the Asylum than at any other time.
This is explained by the difficulties, in the first of those years,
arising from the order for the reimbursement of rents; and, in
the last two, by the pecuniary losses necessarily augmented by
the revolution.
ASYLUM AT MILAN.
Saint John’s Hospital, at Milan, is one of the most exten-
sive institutions of the kind in the world. It is probably
exceeded by none. The principal edifice appertaining to it
is within the city, but the department for the insane is
without the walls, about a mile distant from the Porta Tosa.
This building, formerly a convent of the Jesuits, was enlarged
and converted into a Lunatic Asylum, about 55 years since.
It encloses large courts, but those which are devoted to the
use of the patients are chiefly external to it. The wards are
very large, some of them consisting of a hall, of ample width,
running the whole length, and, beside it, two or three dormi-
tories, each containing numerous beds. In others, there are
dormitories upon both sides of a narrow passage. The rooms
are all lofty and well ventilated. In those where a fire is re-
quired, the stove is placed in the middle of the room and
covered on all sides with bricks, and surrounded by strong
wooden frames or fenders. The beds for the furious have con-
fining rings and straps at the foot and the sides, like those in
many other Asylums. The mattrasses are made, some of straw,
5
50
some of wool, and some of hair; and the beds and linen are
as neat, though not so elegant, as those in any institution I
have ever visited. In some of the dormitories metallic póts-
de-chambre are fastened by straps to the bedsteads. In the third
story of the department for women, there is a ward consisting
of a suite of small rooms, each opening from a narrow gallery.
The bed in each of these is beneath the window, at the extre-
mity opposite the door. Beside it, in the corner, is a stool of
convenience, communicating with a balcony on the outside
of the building, where a servant can attend to it without enter-
ing the room. The infirmary contains many beds, four of
which alone were occupied. The patient in one of these was
labouring under pelagra, a disease which is endemic in some
parts of the north of Italy. Many of the patients who were
not confined in the infirmary have the goitre, the swellings
being of various dimensions. I had previously seen many
cases of this disease in Savoy and the canton of Vallais, in
Switzerland. In one case which I saw at Sion, a town among
the Alps and upon the road over the Simplon, the left lobe of
the thyriod gland equalled in dimensions the head of the
woman who was afflicted with it. One ward in the depart-
ment of each sex, in the Asylum under notice, is devoted to
convalescent patients. In these they remain forty days, pre-
viously to leaving the Asylum, for the purpose of confirming
a cure. The bathing room contains four baths, three of them
for one person each, the other sufficiently large to accommodate
2S at the same time. Each of the three former is cut from a
single stone. They are for the most violent patients, and con-
sequently have fixtures for the purpose of fastening the feet and
the body. The large bath is also constructed of stone. The
streams of the douches are very small, but they fall from a
height of 12 or 15 feet. A horizontal jet, in which the water
is thrown, with considerable force, completely across the room,
is intended for a similar purpose as the douche. Being thus
arranged” it may be more easily applied to the various parts of
the body.
Three physicians, two resident and one “attending,” do .
the medical service of the Asylum. The number of patients,
51
sº
in November, 1838, was 420, of whom 215 were men and
205 women. The accommodations are sufficient for 500.
The number of wards for either sex is six, and the patients are
divided into three classes, the furious, the tranquil, and the
incurable. . * -
Regimen.—Breakfast; bread and cheese. Dinner; meat,
five days in the week, and polenta—a pudding made of the
meal of Indian corn—the remaining two days. Wine is a
constant drink at this meal. Supper; bread, cheese, and
wine. - - - -
Manual labour is pursued to a considerable extent by the
patients. A large garden belonging to the Asylum furnishes
employment to nearly 100 of them during the warm season.
In one room through which we passed, between 40 and 50
men were engaged in braiding paglia di Spagna—Spanish
straw—for carpets. They worked as steadily, and appeared
as orderly, as if they had not been lunatics. In another apart-
ment several men were employed in making shoes, and as
many more in tailoring. One of the latter was cutting clothes.
Soon after we entered, he commenced talking to me, and con-
versed so rationally that I supposed him to be a sane person,
acting as overseer to the others. Under this supposition, I
inquired of him if all those under his care were insane, to
which he answered in the affirmative. Perceiving that he
conversed in French, I asked him if he was a Frenchman.
He replied that he was not, and added, “Je suppose que vous
ëtes Anglais.” “No,” said I, “I am an American.” “Ah!
vraiment,” he responded, dropping his shears and lifting both
hands, as if agreeably surprised, “vous étes Americain. Eh
bien, vous étes très heureux, vous étes carbonaro. Tous les
Americains sont des carbonari; Je voudrais bien étre dans ce
pays lä.” . Knowing the subject of the carbonari to be rather
a delicate one in Italy, these remarks, together with some
others, subsequently made, induced me to suspect him insane,
and this suspicion, upon inquiry of the “direttore” of the
Asylum, who accompanied me, proved correct. An artist, in
the same apartment with the above mentioned, was occupied
in cutting designs in paper. He showed me a representation
52
of Bonaparte at St. Helena, and another of the garden of
Eden. They were, indisputably, the most elegant workman-
ship of the kind that I have ever examined. I attempted to
purchase the latter, but he informed me that it was already
disposed of. - -
Many of the women were making lint, or charpie, for the
use of the hospital in the city; and, in one apartment, there
were about 90 sewing and spinning tow upon throstles whirl-
ed in the hand. For coercion and punishment, the douche,
confinement in bed, the restraint of limbs, &c. are effectual
means. I observed one patient manached with irons, and
strong leather mittens upon his hands. He tears off his
clothes whenever his arms are unrestrained. Several others
had on strong leathern belts, to which their arms were fasten-
ed. In the same ward with these men there was another,
very gentleman-like in appearance, who was exceedingly anx-
ious lest I should go away without being aware of his dignity,
or of the distinguished honour I had received in being admit-
ted into his presence. Accordingly, he approached me, and
repeated, with the utmost volubility, a long list of titles which
he graced, such as “Prince” of one place; “King” of another;
“Emperor” of a third; and, finally, “Ruler of the World.”
In his anxiety to furnish me with this important information,
he followed us far out of the ward. - . . .
The only means of amusement which I saw were a swing
and a giustra, if I rightly understood the word. The latter
is so constructed that four, or, indeed, eight persons may turn
horizontally in a circle, being situated at the extremities of
two beams which cross each other at right angles, in the cen-
tre. These are in the principal court occupied by the men.
The court is shaded by two parallel rows of sycamore trees,
beneath which are many seats for the patients, permanently
fastened to the ground. • * -
ASYLUM AT vBNICE.
Pertaining to the civil hospital at Venice, there is a large
edifice exclusively devoted to the insane. It is situated upon
53
the eastern limits of the city, beside the celebrated church of
San Giorgio e Paolo, and in the corner, at the confluence of
one of the lagunes with the Adriatic. It is three stories in
height, and entirely surrounds a court about 100 feet square.
A corridor passes around this court, furnishing shelter from
both sun and rain. In November, 1838, this Asylum con-
tained 230 patients, all of whom were women. Upon the
island of San Cervilio there is another establishment, for the
men, of whom the number varies but little from that of the
women. The patients at the Asylum for the women are di-
vided into six classes, according to the species of insanity.
These classes are not kept exclusively separate; on the con-
trary, some individuals belonging to every one of them may
be found in the same ward. The colour of a strip of cloth
attached, as an epaulette, to the shoulder of each patient, is a
mark by which those belonging to the several classes may be
identified. The classes are, 1st, mania, distinguished by a
red colour; 2d, monomania, distinguished by deep blue; 3d,
'melanconico, by green; 4th, idiotismo, by orange; 5th, stu-
pidita, by light blue; 6th, demenga, by yellow.
As I was unable to procure all the data which would have
been desirable, I shall speak of the apartments through which
we passed, introducing, as appropriate opportunity offers, the
other information which I possess.
1st Story.—Bathing-room, dining-room, kitchen, a dormi-
tory containing many beds, and a room in which about 70
patients were spinning tow upon a hand throstle; as at Milan,
and several others knitting and sewing, I noticed several,
among these, who had the goitre. The room in which these
were at work is warmed by a stove, which is entirely enclosed
with bricks and mortar, and surrounded, three or four feet dis-
dant, by a strong wooden railing. The women were at dinner
when we went into the dining-room. Their regimen is as
follows, viz. – Breakfast; bread and soup;-dinner; meat,
bread, rice, and wine every day, with the addition of potatoes
or cheese, the two being given alternately. Suspended under
the corridor, near the door of the dining-room, there was a
table of the appropriation of time. It is as follows:—
5*
54
Week days. A. M. Sabbath and Feast days.
Rise and dress, . . . 6; to 73 o'cl. The same.
Breakfast, . . . . . 73 to 8 The same.
Doctor's visit, . . . . 8 to 9 ° The same.
Labour, . . . . . . 9 to 12 10 to 11 o'cl., atttend mass. +
- P. M. 11 to 12 “ receive visits of friends.
Dinner, . . . . . . 12% to 2 - The same.
Study of numbers for play, 2 to 3 Recreation.
Labour, . º . 3 to 4 Play at Tomboliandreligious exercise.
Supper, . . . . . . 4 to 5 - The same.
Walk, . . . . . . 5 to 6 The same.
Recreation, . . . . . 6 to 7 The same.
2d Story.—The study of the physician, the infirmary, three
large dormitories, like the wards of hospitals for the sick, and
two or three small rooms for the accommodation of pay pa-
tients. The bedsteads are of wood throughout the establish-
ment. The beds are without curtains. The infirmary is
large, containing about 30 beds, most of which were occupied.
It is one of the most complete and elegant apartments of the
kind that I have seen. The floor is of Mosaic. “ -
3d Story.—A suite of three rooms called “Sicurezza,” and
intended for the most violent patients. They contain about 50
beds, all of which were occupied. The bedsteads are made of
plank, similar in form to those at the Asylum at Utrecht, but
differing from them, in that the bottom is a rack, thus permit-
ting water to escape in all parts. A large box or trough is
placed beneath each, to preserve the cleanliness of the floor.
The patients in this department mostly lie upon loose straw,
which is covered by a blanket. Many of them were confined
by having their arms fastened to the sides and their feet to the
foot of the bedsteads. The rooms in question overlook a por-
tion of the Adriatic, the Lido and the cemetery of Santo Cris-
tofero. There is another department in the third story called
“Osservazione.” It is intended for the convalescent patients
and such as have recently been admitted. The latter remain
here until the nature of their disease is satisfactorily ascertained.
This department contains about 30 beds.
55
ASYLUM AT MALTA.
The island of Malta, the rendezvous of vessels traversing
the Mediterranean, is said to be more populous, in proportion
to its size, than any other portion of Europe, or, perhaps, of
the whole world. The number of inhabitants to a square mile
is five times as great as that of England. Its population, to-
gether with that of the small island of Gozo, in its immediate
vicinity, is about 120,000. Of this number there are at pre-
sent, as nearly as has been ascertained, 130 lunatics, or about
1 in 900. The only Asylum for the reception and treatment
of them is at Floriana, in the suburbs of Valetta, the port of
Malta. It is one of the several benevolent institutions for the
poor which are under the direction and support of the go-
vernment. For an introduction to this Asylum, as well as
to the hospitals and charitable institutions of the island, I am
indebted to Dr. Gouder, who accompanied me to them, seve-
rally, and afforded me every assistance in his power to obtain
such information as was desired. The Asylum is old, and,
as an almost necessary consequence, very incommodious for
the present method of treatment. Additions, however, have
recently been made, and others are in progress; so that,
eventually, and at a period not very remote, the defects
will in a great measure be overcome. Baths have recently
been constructed, the Asylum never previously having been
supplied with them. The mattrasses of the beds are of straw,
the most comfortable as well as wholesome material, in a
climate like that of Malta, even for such patients as other-
wise might be permitted to lie upon feathers. The bedsteads
consist of two movable iron stands acting as supports to the
boards upon which the mattrass is laid. In the morning, these
stands are placed beside the walls of the dormitory, and the
direction of the boards changed so as to be parallel with the walls
instead of at right angles with them. Each mattrass is then
doubled, or folded once upon itself, and the bed-clothes, folded
also, laid upon it. This gives a neat aspect to the rooms, and
leaves a much greater portion of the floor unencumbered than
56
is the case with bedsteads of the ordinary kind. Adjacent to
the building, and partially enclosed by it, are three courts, or
yards, for the use of the patients. These are not large, but
they are well cultivated. One of them is planted with orange -
trees, which are large, and, when I was there, were in full
bearing. Another of the courts is used as a kitchen-garden.
It is well planted with a variety of vegetables, the labour re-
quired in its cultivation being performed by the patients. The
regimen, which has been recently improved, is as follows:—
Breakfast; coffee and bread; dinner, which is eaten at mid-
day, Soup, meat and fruit; supper, soup and fruit. --
The number of patients in February, 1839, was 90, of whom
40 were men and 50 women. There are, at all times, more
female than male patients. The superintendent informed me
that he believes the proportionate number of the former to
the latter to be as 3 to 2. The same ratio, agreeably to his
opinion, is equally applicable to all the cases of insanity in the
two islands. - ;
A very large proportion of the patients perform some manual
labour. The principal employments are gardening, sewing,
knitting, spinning, and domestic affairs. Thus far, however,
there has not been sufficient employment to keep the patients
so constantly occupied as might be best for their own content-
ment, or most beneficial in promoting a cure. Amusements
have not, hitherto, been introduced; and the same remark is
equally applicable to reading and writing. When punishment
is necessary, close confinement is the principal resource. For
this purpose there are several small cells, supplied with no
furniture, having a grating to the doors, and, for the admission
of light, a small aperture in the outside wall, so high as to be
inaccessible to the patient. -
The principles of reform began to enter this institution in
the year 1812. The use of chains, those implements of con-
finement and of torture, fit only for criminals and wild beasts,
was then entirely abolished. Whenever bodily restraint is
necessary, the camisole or strait-jacket is called in requisi-
tion. The pattern of this garment of coercion, used in this
Asylum, is, in my opinion, an improvement upon all others
57
which have come under my observation. Its principal pecu-
liarity consists in two bands, one upon either side, attached to
its lower border and passing around the legs. The whole
garment is thus kept more effectually in its proper place. The
patients have ever been, and still are, mingled together, irre-
spective of stage or intensity of disease. A division into two
classes, 1st, the imbecile and the incurable; and 2d, the cura-
ble, is about to be made. Most of the patients were remark-
ably quiet. There were, however, two exceptions. The first
of these was a man at work in the court of orange trees. He
talked with superlative volubility as long as we would listen,
the principal burthen of his conversation being a desire to get
out of the Asylum for the purpose of taking a wife; and, inas-
much as fifty-four winters had begun to shed their frosts upon
his brow, he feared that the time would soon arrive in which
to him, as to Omar, the son of Hassan, it would no longer be
possible to “marry a wife as beautiful as the Houries and wise
as Zobiede.” The other was a Frenchman, a member of a
respectable family in France. He assumes to himself the title
of Prince de Valois; says he has millions of property, and
can afford to keep a numerous suite of valets. His clothes were
in tatters. The superintendent informed me that, but a short
time previously, he had received a good suit from his friends,
but will not deign to wear them, because, forsooth, they were
not made by the tailleur du roi—the king’s tailor.
Many of the inmates of this Asylum died of the Asiatic
cholera, during the ravages of that fatal epidemic in Malta, in
the summer of 1837. The superintendent could not tell me
the precise proportion of cures effected here, but thinks that it
exceeds 50 per cent.
ASYLUM AT CONSTANTINOPLE.
Connected with some of the mosques in Constantinople, there
are buildings for the reception of the sick—a kind of hospital,
in which the poor who are suffering under disease may have
their wants ministered to by the hand of charity. That which
is adjacent to Sulimanyé, or the mosque of Suliman, is devoted
58
exclusively to the insane. There, none but men are admitted;
the women, according to the Turkish custom, as well as in
conformity with the precepts of the religion of Mahomet, being
kept in private seclusion. The building is but one story in
height, and, like the cloisters of many gothic cathedrals, and
the khans or caravanseras of Turkey and Natolia, completely
surrounds a central court. The entrances to all the rooms are
beneath the corridor at which the court, upon all sides, is
limited.
I visited this Asylum during the feast of the Bairam, near
the close of the year 1838, in company with two American
gentlemen, residents at Constantinople. We entered the court,
passing several miserably clad people, “sitting at the gate,”
not “to ask alms,” but to receive it, if voluntarily offered.
Within the court were many people, mostly young men and
boys, who had come, either for the gratification of curiosity, -
or to administer to the wants of the afflicted. We passed
along the corridor to the first window. From between the
bars of the iron grating with which this was defended, a heavy
chain, ominous of the sad reality within, protruded, and was
fastened to the external surface of the wall. It was about six
feet in length. The opposite extremity was attached to a heavy
iron ring, surrounding the neck of a patient who was sitting,
within the grating, upon the window-seat. We entered the
room and found two other patients, similarly fastened, at the
two windows upon the opposite side of the room. It was a
most cheerless apartment. A jug to contain water, and, for
each of the patients, a few boards laid upon the floor, or ele-
vated three or four inches, at most, and covered with a couple
of blankets, were all the articles of comfort or convenience
with which, aside from their clothing, these miserable creatures .
were supplied. Although in the latter part of December, they
had no fire; nor were the windows glazed, but close shutters
attached to each, rendered it possible measurably to shield the
inmates from severe weather whenever it might occur. The
length of the chain of each patient is barely sufficient to enable
him to lie down upon his comfortless bed of boards and blan-
kets. Leaving this apartment, we proceeded successively to the
59 .
others, twelve or fifteen in number, in all of which we found
the patients in a very similar condition to those whom we had
first seen. There was but one who was not chained. He was
an elderly man, though still retaining much of the vivacity of
earlier years. His long and profuse hair and beard were nearly
white, and his complexion very delicate. He was formerly a
priest of the Islam faith. He has been deranged and confined
in this place nearly fifteen years, during which time he has
thrice broken the chain with which he was secured. He is
now alone in his apartment, within which no one is permitted
to enter. He talked and raved incessantly, threatening to kill
those who were making him their gazing stock. Like those
in the apartment first mentioned, all the patients, with one
exception, were without fire. The person forming this ex-
ception was one of the most hideous of undeformed human
beings. He has been in the Timar-hané, as this Asylum is
called by the Turks, more than forty years. His hair and
beard, both naturally abundant, curly, and black as ebony,
appeared as if they had not been cut or combed since his en-
trance. They nearly concealed his face, and the former hung
in a profusion of literally “dishevelled locks” about his neck
and shoulders. His head would have been a nonpareil for an
original to the figure of Cain, in David’s celebrated picture of
“Cain meditating the death of Abel.” He lay crouched upon
all-fours, resting upon his knees and elbows, and holding his
head and hands over a manghale of living embers. Whatso-
ever was said, whether addressed to him or otherwise, could
only induce him slowly to turn his huge head, and present his
hideous face more directly to view. His case was a striking
example of dementia.
The patients, generally, appeared to enjoy pretty good
health, aside from the lesion producing insanity. I was in-
formed that a physician attends them regularly. There is a
person who has the charge of supplying them with food, and
they receive considerable attention from those who visit them.
While we were there, many visiters were conversing with
them, giving them articles of food, money and tobacco, and
doing them a kind office by filling and lighting their “che-
60
bouks.” These patients presented a diversity of species of
insanity, and a variety of hallucinations. One of them was
seated against the bars of his window, cross-legged, and with
arms folded upon his breast, in all the counterfeited dignity of
a sovereign, and the imperturbable gravity of a saint. It was
evident by his demeanour that he esteemed himself one of the
rulers of the earth—a Mahmoud, a Mahomet, or a Great Mo-
gul. Upon being informed that I was an American, “Please,”
said he, turning towards me slowly, and without the slightest
change of countenance, “please, effendi, to give my respects to
the Sultan of America.” This said, he assumed his former
position, and maintained it with the most scrupulous exactitude.
There was another, one of the finest looking Mussulmen that
ever worshipped before the altars of Stamboul. His beard
might acknowledge no rival in beauty, excepting that of Mah-
moud the Second, and his eye possessed all the mingled fire
and softness of the Orient. He was occupied in sewing. He
was surrounded by several young Turks, but continued his
labour regardless of any of those who were present. The
gentleman of our party who speaks the Turkish language ad-
dressed him, and at length won him, although with consider-
able reluctance on his part, into conversation. I have never
witnessed a greater blandness and suavity of manners than in
him. Upon being asked the cause for which he had come to
that place, “Please, gentlemen,” said he, “to be seated, and I
will relate the whole history.” Inasmuch as the uncovered
stone floor presented an aspect rather uninviting, as a seat, we
excused ourselves, and he was requested to proceed. There-
upon he placed himself in an attitude worthy of the orators of
antiquity, and related a long story, in a most amusing but
graceful manner. The whole substance of it was, that people
began by calling him a fool; and, going from bad to worse, at
length ended by bringing him to the Timar-hané of Suliman-yé.
Such, then, is the gloomy picture with which these sketches
of some of the Asylums for suffering humanity are brought to
a conclusion. It presents us with an additional motive for
hoping that the stream of knowledge, which, taking its rise in
Chaldea, has flowed to us, constantly augmented in its course,
*.
61
through Egypt, Greece, Rome, and the nations of western
Europe, may reverse its course, or release a branch, once more
to fertilize the desolate regions of intellect throughout the East.
It is a proposition, the truth of which cannot, perhaps, be
questioned, that, in proportion as a nation advances in intel-
lectual cultivation, its practical benevolence assumes a loftier
standard. When, then, the light of science shall gild with
brighter rays the empire of the Ottoman, we doubt not that the
chains of the maniac will be broken, and his condition ren-
dered such as to leave a hope, that alienated reason may reas-
sume her proper throne.
It is difficult to reconcile the treatment of the patients in the
“Timar-hané” with the testimony of physicians in regard to
the attention paid to unconfined lunatics in Turkey, and with
the prevalent opinion among the followers of Mahomet, that
the insane are the especial favourites of Heaven—that their
“discord” is .
“harmony not understood;”
that their language appears to us to be incoherent and unmean-
ing, merely because the minds of the sane are not sufficiently
spiritualized to comprehend it. Dr. Millengen, an English
physician who had practised nearly twenty years in Constan-
tinople, informed me that he had known the wandering lunatic
to be received by strangers, and, for weeks in succession, re-
ceive all the kindness of the most cordial hospitality.
62
Asylums IN ENGLAND.
In the year 1815, the British Parliament passed a law, by
which each of the several counties of England was authorized
to erect an Asylum for the insane. As the provisions of this
act were not compulsory, the counties have been slow in com-
plying with them. At the present time, sixteen institutions,
constructed in conformity with this law, are in operation.
They are in the counties of Middlesex, Bedford, Chester, Lei-
cester, Gloucester, Stafford, Norfolk, York (West Riding),
Nottingham, Lancaster, Oxford, Lincoln, Kent, Suffolk, Dorset
and Cornwall. There is one in progress in the county of
Surry. Of the above mentioned Asylums, an account of that
of Middlesex, at Hanwell, and that of the West Riding of
York, at Wakefield, have already been given. Our informa-
tion in regard to the remainder is neither extensive nor minute.
It is comprised in the following notices.
BEDFord ASYLUM.
This Asylum, opened in 1812, accommodates 52 patients, of
whom the convalescents assist in gardening during the warm
season. The original expense was more than 10,000 pounds.
GLOUCESTER ASYLUM.
Subscriptions were raised, more than forty years since, for
the establishment of a charitable institution for the insane in
Gloucester, but after the act was passed authorizing the con-
struction of county Asylums, the amount thus raised was
added to the public fund, and the present building erected. It
cost, with the grounds, 44,457 pounds, 6 shillings, and was
opened in July, 1823. It accommodates 120 patients. The
patients assist in gardening, farming and household labour,
which, according to one of the reports, “is found not only
most useful to themselves, but, also, most beneficial to the
establishment.”
63
st AfroRD ASYLUM.
The Asylum at Stafford was opened in October, 1818. It is
said to be a well conducted establishment. The number of
patients in 1826 was 155. A report at that time says, “The
cultivation of thirty acres of pasturage, pleasure and garden
ground, is performed entirely by the patients, assisted by two
of the keepers; and all the making of linen, and mending of
clothes, is done by the females.” The weekly expense of
each patient is about 9 shillings sterling. -
NoFFOLK ASYLUM.
This institution can accommodate about 120 patients. The
cost of the establishment was 35,221 pounds.
Not TINGHAM ASYLUM.
This Asylum, situated at Nottingham, was constructed at an
expense of 20,350 pounds, and opened in February, 1812. It
accommodates eighty patients, of whom the labouring portion
among the males are employed in gardening.
LANCASTER ASYLUM.
This Asylum is situated about a mile from the town of Lan-
caster. It was opened for the reception of patients on the
28th of July, 1816. It has accommodations for 360. The
cost was 59,833 pounds. The original tract of land belonging
to the establishment was fifteen acres, but, I believe the farm
has been considerably increased. Some of the patients labour,
the women at sewing, knitting and domestic duties; the men
at gardening and husbandry. - -
LIN colN ASYLUM.
* This Asylum is at Lincoln. It was opened in April, 1820.
It was originally intended for about fifty patients, and was
64
completed at an expense of 12,405 pounds sterling. Some of
the patients are employed in household work and gardening.
I know not that the buildings have been enlarged.
CoRNWALL ASYLUM.
This institution is pleasantly situated, and the airing grounds
are said to be extensive. It was opened in October, 1820, with
accommodations for 102 patients. The original cost was
15,724 pounds, 14 shillings and 8 pence. In speaking of the
inmates, a report says, “They work in the garden, and raise
water for the use of the house by means of a wheel pump.
The female patients also work in the garden and assist the
laundress.” s *
Besides the County Asylums, there are many institutions
established by subscriptions and donations. Of these, the “Re-
treat,” at York, has already passed under observation; of the
others, we proceed to notice those of which we possess any
information. - •
BETHLEHEM ASYLUM, LoNDoN.
The Bethlehem Asylum, generally called “Bedlam,” in
England, and referred to by Pope, in the line
“All Bedlam or Parnassus is let out,”
is one of the oldest institutions for the insane in Great Bri-
tain. The original building was in Finsbury, on the north
side of the Thames; but new edifices, imposing in their exter-
nal appearance, were erected in 1812 on the south side of the
river. f : - -
When in London, I went to this Asylum, and was disap-
pointed in learning that no one is admitted, as a visitor, except
by special permission from one of the directors. An almost
immediate departure from the city prevented me from obtain-
ing such permission. - ºf
Sir Andrew Halliday, in speaking of this institution, in
65
1828, says, it “is now well conducted, and the patients are
humanely and judiciously treated; but it has still too much of
the leaven of the dark ages in its constitution, and too rigid a
system of quackery is maintained, in regard to its being seen
and visited by respectable strangers, and there is too little
space for exercise and employment, for it ever to prove an
efficient hospital.” -
A more recent writer observes, “Little has been done for
the purpose of employing the patients, and diverting their
minds from the subjects of morbid thought. We do not re-
member to have seen either work-shops for manual labour, or
a reading-room, or games of amusement. The grounds,
though large for an institution located in a city, are too con-
tracted for so great a number of patients.” - -
This Asylum has a permanent income of about 90,000 dol-
lars per annum, and receives, from government, an additional
sum of 13,000 dollars, for the support of criminal lunatics.
These patients are kept in wards, devoted exclusively to
themselves. The number of patients, at Bethlehem, in 1840,
was 429. #
SAINT LUKE’s Hospit AL.
This Asylum is in the northerly part of London. It was
founded by subscription, and has been in operation nearly a
century. During the last eighty years, the number of admis-
sions was 16,589. Of these, 58 per cent. were cured. The
average expense of the patients is $2,50 per week. Epilep-
tics, paralytics, idiots, those who have been deranged more
than one year, those who are under twelve years or over se-
venty years of age, and those who are able to support them-
selves, are not admitted. It is said that this Asylum is better
conducted than the one last noticed, although useful labour
and judicious amusements have not entered so fully into the
plan of treatment as is desirable. .
.# Review of Ferrus on the Insane. Am. Journal of the Medical Sciences.
May, 1837.
-- 6%
66
Asylum. At NorthAMPtoN.
The cost of this establishment, including twenty-four acres
of ground, was 24,000 pounds. Parish paupers are maintain-
ed here at an expense of 9. shillings sterling per week—others
pay from 3 dollars to 5 dollars.-‘Eighty-three per cent. of
all the patients are employed, and ninety-four per cent of the
male patients. The non-resisting principle is applied here in
its ultra form. In one instance, the day I was there, the bed
and bed-clothes of a patient were completely changed, four
times, between eight and twelve o’clock, a warm bath prepar-
ed each time, and the patient washed, and her clothes changed
throughout, rather than use severe measures for correcting or
counteracting her propensities.—The superintendent of this
institution, (Dr. Pritchard,) is passionately devoted to his
duty.” -
ASYLUMS IN SCOTLAND.
ASYLUM AT MONTROSE.
This Asylum has been in operation many years. I have
not obtained the statistics of the institution, nor am I aware of
the extent of its accommodations. The superintendent, Dr.
Poole, in his report for 1840, approves of the abolition of all
bodily restraints, in the treatment of the insane, in those insti-
tutions which are provided with the “essential requisites” to
such a mode of treatment. “But in the absence of some of
them,” says he, in speaking of the Montrose Asylum, “and at
variance with my own creed, I must tolerate the occasional
imposition of hand-cuffs, to prevent greater evils than they
inflict. Mr. H.,t I am persuaded, would not blame me, under
circumstances, for departing from the true faith, inasmuch as,
e.g., I pinioned one man because, having an ulcerated leg,
* “Memorandum of a late Visit, &c.” by F. A. Packard.
t Gardiner Hill, of Lincoln, an advocate for the abolition of all physical
restraint. - -
67
which needed poultices and ointment, he repeatedly tore off
and actually swallowed them; or that, with a latitudinarianism
not deemed heretical in a pure physician, I had another tucked
down to bed till the turbulence of delirium tremens yielded to
a potent opiate; or even that, with only one female attendant
to twenty of her sex, I permit the temporary confinement of a
couple of arms, which would both reduce their possessor to nu-
dity and dispense merciless blows to all around.”
ROYAL LUNATIC ASYLUM AT GLASGow.
This is an institution of very high standing, but we have
but little information in regard to it. The wings of the build-
ing are three stories in height: the pauper patients being in
the first, the lowest class of pay patients in the second, and
the highest in the third. -
ASYLUTM AT IFIDINBURGH.
This was founded by voluntary subscription, and no patient
is received under a guinea a week.
ASYLUM AT ABERDEEN.
This institution was erected by subscription. It will ac-
commodate about 100 patients. It is said to be well conducted.
There are also Asylums at Perth, Dundee, and Dumfries.
ASYLUMS IN IRELAND.
An act of parliament, in 1817, authorized the lord-lieutenant
of Ireland to direct the “magistrates of any county or district
to erect an asylum for the accommodation of their insane
poor.” These asylums are under the general superintendence
of two individuals, called inspectors general, who are obliged
to report, annually, to parliament. They are empowered to
inspect private as well as public asylums. -
68
RICHMOND ASYLUM AT DUBLIN.
This asylum is calculated for about 300 patients. It was
begun in 1810, and cost £77,809 58.9%d. sterling. In 1827
it contained 277 patients, of whom 130 were usefully employed
in gardening, needlework, washing and other housework,
weaving, tailoring, &c. Twelve were learning to read.
During the year “3188 hanks of yarn were spun; 406 pairs of
men’s and 349 pairs of women’s stockings knitted: and, of
linen woven in the establishment, there were made, by the
female patients, for the use of the inmates, 140 shirts, 180
shifts, 115 bolster-cases, 56 pairs of sheets, 53 rollers, 83 bo-
dices, 80 nightcaps, besides keeping in repair the whole cloth-
ing of the male and female patients.” * - *
work Hous E ASYLUM, DUBLIN.
A department of the workhouse, at Dublin, is devoted to
insane paupers. It generally contains from 500 to 600 pa-
tients. I visited this in the summer of 1837, but took no
notes. The patients appeared to have very comfortable ac-
commodations.
Asylum AT water Ford.
This is connected with the house of industry. In 1827 it
contained 48 idiots and 57 lunatics. The report of the inspec-
tors states that “the patients are treated with lenity, and there
was but one patient coerced, a male lunatic, on whom a strait-
waistcoat was placed.” .
ARMAGH DISTRICT ASYLUM.
This establishment has 18 acres of land, and accommodates
106 patients. The original cost was £20,900 48. 5d. It was
opened in 1825. The patients are employed in gardening and
69
other manual labour. They weave all the linen for the use of
the house, and make the clothing for themselves.
ASYLUM AT CORK.
This is a well conducted institution, having accommodations
for more than 300 patients.
ASYI:UM AT LIMERICK.
This was opened in 1827, having been erected at an expense
of £29,511 10s. Sq., inclusive of the cost of 12 acres of land.
It is calculated for 150 patients, and “is one of the best arranged
public asylums that has ever been built.” .
ASYLUM AT LONDON DERRY.
This institution can accommodate 106 patients.
There are public asylums at Belfast, Kilkenny and Wex-
ford, and several smaller ones in other places. There are also
four private establishments in the vicinity of Dublin.
ASYLUMS IN HOLLAND AND BELGIUM.
To the notices already given of Asylums in the Netherlands,
we shall only add the following:
COMMUNITY ASYLUM AT GHEIL.
Gheil, a commune containing nearly 7,000 inhabitants, is
situated about twenty-seven miles from Antwerp. According
to a local tradition, an English lady of rank and beauty, being
“driven to madness by the treachery of a lover, and the
cruelty of friends, wandered from her home and from her
country, and found refuge in this secluded spot, where she
recovered her reason, built a church, and devoted a long life
to curing the insane, having received from Heaven the power
of performing such cures.” From that time until the present
the village of Gheil has been the place of resort for thou-
sands of the insane, and, although the English lady no longer
70
lives, to minister to the afflicted, yet she has been canonized
under the title of Saint Nymphna, and still is made the presi-
ding saint of the village and the commune. Some stones, said
to be the remains of her sarcophagus, are preserved, being
placed upon pillars adjacent to the church which she caused to
be erected. For a long period, every new patient was confin-
ed nine days, in a solitary room, and, at three times during
each day, joined a procession which marched several times
around the church, at each time passing under the relics of the
sarcophagus, repeating a prayer to the saint, that she would
condescend to effect his restoration. This custom is now
nearly or entirely abolished. -
The number of lunatics in this commune, in 1789, was 400;
in 1803, 600; in 1812, 500; and in 1821, 400. No resident
is permitted to have more than five patients, at one time, in
his house. Those patients whose condition will admit, are
obliged to work a certain number of hours during the day,
and then are permitted to ramble at their pleasure, being sum-
moned home by the ringing of the bell of the village church.
Of the 400 patients who were there in 1821, about 100 were
of this class, and 50 of them worked at agriculture. It is said
that escapes have been frequent. The patients, when quiet,
are treated kindly, but if mischievous or furious, they are
chained at the wrists and ancles. In every house, there is a
ring beside the chimney, or attached to the beds, to which
they may be chained. Esquirol says he saw one man, from
whose legs the skin had been abraded by the iron surrounding
them. • . -
While the superstitious belief in the supernatural powers of
Saint Nymphna remained unshaken, the proportion of cures
at Gheil was said to be very great, many of them being effect-
ed during the preliminary nine days of probation and devo-
tion. But since this faith has been lost, the charm is broken,
the number of cures is but small, and the place has become
rather an asylum for incurables, than a place for judicious
curative treatment. The mortality among the insane is said
to be a little greater than among the residents of the com-
IIll! Il 6, i -
71
ASYLUMS IN FRANCE.
Nearly all the insane, in France, are placed in public in-
stitutions; some of them being in special Asylums, others
in hospitals, alms-houses, houses of correction, and prisons.
Their condition has been very much ameliorated since the
commencement of the present century.
In 1818, there were but eight establishments, throughout
the whole kingdom, exclusively devoted to the reception of
persons labouring under mental disorders. But, between that
period and 1837, the number was augmented to thirty-four.
In a few of these, however, some other persons are received.
Three of the largest and most important of these institu-
tions, La Salpêtrieré, Le Bicêtre, and the Maison Royale
d'Aliénés, at Charenton, have already received a somewhat
elaborate notice. Of the others, the following are the most
important. - -- -
ASYLUM AT AVIGNON.
This Asylum has been in operation many years. Since the
commencement of the present century, it has been greatly
enlarged and improved. It is said to be well conducted and
remarkable for its neatness, but the relics of by-gone time
still remain, in the bolts upon the doors of the patients’ rooms.
SAINT-Yon ASYLUM, AT RouBN.
This is one of the best institutions of the kind in France.
It was opened in July, 1825. The buildings are constructed
according to the plan of Esquirol, being but one story in
height. The number of patients, on the 31st Dec. 1834, was
455, of whom 221 were men, and 234 women. From 1825
to 1834, inclusive, 1438 patients were admitted. Of these,
737 were men and 701 women. In 1832, two men and eleven
women died of the Asiatic cholera. The price of board, &c.
for patients, varies from 350 to 1500 francs, per annum.
. . . . * * * : -
72
couvBNT DE FoRCE ASYLUM, AT Boad EAUx.
This Asylum is pleasantly situated, in the vicinity of the
city of Bordeaux. It was formerly a prison, with a depart-
ment for the insane; but, since the year 1803, it has been de-
voted exclusively to the latter. The rooms are large, and the
buildings but one story in height, enclosing courts. The
institution is under the “immediate surveillance of the Sisters
of Charity,” who make mildness, benevolence, and humanity
reign throughout. The medical department is under the care
of a physician, assistant physician, and two surgeons. The
pay patients have wine, daily. Their dishes are of earthen,
while those of the indigent are of tin and block-tin. In 1817,
the number of patients was 125; of whom 47 were men, and
78 women. - -
At Cadilhac, about 15 miles from Bordeaux, there is an
inferior Asylum, where, in 1835, there were 209 patients.
ASYLUM AT MONTIPELIER.
This was opened for men, in 1822, and for women, in 1824.
Since that time, it has been very much enlarged and improved.
In December, 1835, it contained 138 patients, 75 of whom
were men, and 63 women. - -
ASYLUM AT MARSEILLES.
This establishment was formerly a general hospital. It was
much enlarged in 1816, and at subsequent periods. The recent
buildings are three stories in height, with dormitories on each
side of a central gallery. From 1797 to 1818, there entered
345 men, and 351 women: total 696. In 1819, the number
of patients in the Asylum was 119. -
A large and commodious establishment, with accommoda-
tions for 300 patients, has recently been erected, near Mar-
seilles. - * . ſº
73
ASYLUM AT AIX.
This is an inferior establishment connected with the alms-
house. The furious patients are chained, by the legs, to the
walls of the cells.
ASYLUM AT LYONS.
A part of this establishment was formerly a convent. It is
situated upon the declivity of a hill, in the vicinity of the city.
Drs. Martin and Bottex have charge of the medical depart-
ment, the latter of whom delivers clinical lectures on mental
disorders. The regimen of the patients is as follows: At 8
o'clock, A. M., bread and cheese; at 12 o’clock, M., soup,
meat and bread; 4 o’clock, P. M., vegetables, fruit and bread.
Each patient is allowed one and a half pounds of bread per
diem; each of the pay-patients, four ounces of meat, and each
of the paupers, two ounces. On four days in the year the
rations are doubled.
HOSPICE DE LA PROVIDENCE, AT SAUMUR.
This singular Alms-house is situated on the declivity of a
rocky hill. The following description of it is abridged from
Esquirol. After ascending a staircase and a rocky acclivity,
the visiter comes to a place where a great number of small cells,
or lodges, are excavated in the rock. Some of these are large
enough to contain several beds—the bedsteads, in some instan-
ces, being the rock itself. In these cells are maniacs, quiet luna-
tics, and some superannuated men who pay their board. At
some distance from these cells is a large cavern, 260 feet in
length, 26 in width, and 16 in height, also cut in the rock, as is
the vestibule at its entrance, which is occupied as a working
room. This large cave is furnished with three ranges of beds,
occupied by more than sixty imbecile, demented, epileptic and
paralytic women. Light is admitted through a large circular
aperture in the middle of the roof of the cavern. Adjacent to
7.
74
this large room are numerous smaller ones, occupied by such
patients as require to be isolated. Farther on are two more,
even larger than the largest heretofore described. These
unique halls for the insane are said to be dry, and the patients,
having exercise and a good regimen, are said to enjoy as good
general health as at other asylums. The number of insane is,
generally, from 70 to 80; the whole number of inmates, about
300. Dr. Gaulay has the medical charge of the institution.
ASYLUM AT ARMENTIEREs.
This is a large establishment; the buildings, which were
erected before the French revolution, being constructed around
an oblong court. It is for men alone.
Bon-SAUVEUR ASYLUM, AT CAEN.
This was a convent, founded in 1720. It was enlarged in
1805, and in 1818 it was first opened for the insane. It is an
extensive establishment, having three distinct departments for
the insane men. 1st, for the quiet; 2d, for the idiots, epilep-
tics and the demented; 3d, for the furious. The department
for women is about 600 feet long, and three stories in height.
In each section, there is a room supplied with baths and
douches, several common halls, and rooms for the working
patients. There is a chapel, a library and a billiard-room.
The patients work in the garden. The number of patients, in
July, 1833, was 300; from that time to January 1st, 1835,
there were 122 admissions. Of these 422 patients, 199 were
men and 223 women. -
ASYLUM AT RENNIES.
This was, formerly, the Saint-Maen hospital. It has been
devoted to the insane but a few years; the nurses are Sisters of
Charity. Cider is given to the paupers, and wine to the pay-
patients. - - -
75
ASYLUM AT TOULOUSE.
This is an old establishment, in which both lunatics and pri-
soners were formerly confined. In 1819, the prisoners were
removed, the dungeons destroyed, and large rooms erected;
and, in 1826, an ancient convent was added to the establish-
ment. Although the condition of the patients has been much
improved, yet great ameliorations remain to be effected. The
number of patients, in 1836, was 293. e
ASYLUM AT NANTES.
|
This is attached to the Hospice de Saint Jacques. It was
built in 1832. “The first thought,” says Esquirol, “of the
physician, Dr. Bouchet, who has so admirably organized the
service of this house, and that which governs all his views of
treatment, has been to subject the patients to order and disci-
pline, and to furnish them with all kinds of labour of which
they are capable. For their encouragement he allows them a
recompense. Hence, there are few Asylums in which a greater
proportion of the inmates work, or where they appear to enjoy
greater liberty.” In 1835 there were 207 patients, of whom
172 were employed in manual labour. The number of patients
at the commencement of 1835, together with the admissions
during that year, was 277, of whom 123 were men, and 154
WOmen. - -
ASYLUM AT ALJRILLAC.
This Asylum is attached to the Civil Hospital. It was founded
in 1836. It is a fine establishment, built upon the plan of
Esquirol. There are eight series of buildings, one story in .
height, each series enclosing a square court. Four series are
devoted to the men, and four to the women; and between these
two departments is a building containing parlours, bath-rooms,
and an office for the physician. There are accommodations for
200 patients. The service, in the wards, is performed by the
76
Sisters of Charity. In front of the establishment is a beautiful
lawn, ornamented with a fountain, and planted with five thou-
sand mulberry trees.
ASYLUM AT LAFOND.
This Asylum was opened in December, 1829. It is well
constructed, with parlours, rooms for labour, and covered pro-
menades. In each court there is a fountain. There are ac-
commodations for 200 patients, of whom each class may be
kept entirely distinct from the others. •,•
ASYLUM AT POICTIERs.
This was opened in 1821; it is under the care of Dr. La-
marque. In 1826 it contained 56 patients. The pay-patients
are furnished with wine. -
M. Esquirol has an admirably conducted private Asylum
at Paris. -
In Bavaria and Saxony, the asylums are said to be well ap-
pointed, and conducted in an enlightened manner. “One of
the most perfect establishments in Europe, is at Wurtzburg.”
In Prussia, also, these institutions are of a superior order. In
Sweden, the asylums have been much improved; but it is said
that little is attempted towards curing the mental disease of
the patients. Denmark is incompletely furnished with asy-
lums, but those of Copenhagen are well conducted. One of
the best asylums in the world is at Seigburg, on the Rhine.
It is under the care of Dr. Jacobi. We have seen no notice
of any institution for lunatics in Spain, excepting one at Sa-
ragossa, and of a large one at Madrid; and that of Lisbon
is the only one which we know to exist in Portugal. The
asylums of Hesse are very inferior. In that of Hanover,
“the madman and the idiot are shut up with the thief and
the murderer;” and in that of Celle “may be found every
gradation of human wickedness and of human infirmity, with
only this difference, that the depraved and the criminal part of
its inmates are treated with some kindness and attention, while
77
the diseased and afflicted are left in utter wretchedness and
neglect.” An asylum at Geneva, which was opened in 1837
or 1838, is the only one we know of in Switzerland. There
are large asylums at Vienna and Munich, and one at Pirna,
near Dresden.
ASYLUMS IN ITALY.
The most important establishments for the reception and
treatment of the insane, in Italy, are those of Turin, Genoa,
Milan, Reggio, Florence, Bologna, Venice, Aversa and Paler-
mo. Two of them have already been noticed, in detail; and
of that at Reggio, it has been remarked that Esquirol consi-
ders it the best of the many institutions which he has visited.
ASYLUM AT TURIN.
This is an extensive establishment, under the medical care
of Drs. Bertolini and Bonacossa. The number of patients,
January 1st, 1837, was 361. During the six and a half years
next preceding that date, the number admitted was 1066, of
whom 650 were males, and 416 females. The species of in-
sanity of 1048 of these was as follows, viz.: mania, 206; de-
mentia, 238; monomania, 238; lipemania, (tristimania of Rush)
266; idiocy, 56; acute delirium, 44.
Ages at the time of admission.
o,
$— g * º º º tº * *
s: 3 & # 3 £ 3 ;
old CN: rº rt; T. Tº: º: "º S *
É .5 5 & & : : º É
tº 3 $3 3. § 3 £ 3 H
49 272 342 222 104 41 7 29 1065
Number in six semi-decades.
aś :3 3 § § $2
3 re T. 'g Tº T. º:
# : Cr; Cº cº cº as
- \º
pā;3 $2 § Sº 3 •eft
183 159 151 127 121 95
7
*:
78
Of 945 patients, the disease of 646 is attributable to physical,
and 299 to moral causes. -- -
Specific physical causes.—Hereditary 133; diseases and
injuries of the head and brain, 85; intemperate drinking, 76;
epileptic, 35; abuse of mercury, 28; diseases of the abdominal
viscera, 27; insolation, 19; syphilis, 18; suppression of anor-
mal discharges, 15; excessive venery and masturbation, 14;
diseases of the chest, 12; excessive fatigue, 12; disordered
menstruation, diseases of the uterus, pregnancy and parturi-
tion, 54. -
Specific moral causes.—Poverty and distress, 124; love,
35; domestic trouble, 22; religion, 21; jealousy, 19; reverses
of fortune, and disgrace, 18; terror and fright, 17; protracted
study, 7. . - . -
Total of cures, discharged, 466; total of deaths, 328.
Wine is used, as a drink, by all the classes of patients in this
asylum.
ASYLUM AT AVERSA.
This institution is situated about ten miles from Naples.
Our knowledge of its arrangement, organization and success is
very imperfect. The physician, Dr. G. Lostritto, has pub-
lished a summary of 1725 patients, who were admitted during
the interval of ten years, from 1814 to 1824. Of these, 783
were monomaniacs. A greater number of patients were re-
ceived in 1822 and 1823 than in any other equal period of
time, owing to the revolution and the popular commotions of
the time. Dr. L. concludes, from his observations, that there
are more attacks of insanity in summer than in winter,-that
there are a greater number between the ages of 20 and 30 than
during any other period of equal duration in life,—that the
disease frequently arises from fevers, particularly intermittents,
but “generally from moral causes,”—that mania is more easily
cured than any other form of insanity,+that more recoveries
take place in April than in any other month, that in the
Neapolitan vicinity, as well as throughout Italy and Spain,
there are more insane men than insane women.
79
The mortality during the period mentioned was about one
in four, or 25 per centum; and the principal diseases causing
death were febrile exanthematae, dry gangrene, and cachectic
diseases. -
ASYLUM AT GRAND CAIRO, EGYPT.
The following interesting account of a visit to this Asylum
is from Dr. Madden’s “Travels in Turkey.”
“I believe that no eye hath witnessed, elsewhere, such a
melancholy spectacle as this place affords. The keeper made
many objections to my admission; he said no Frank was suf-
fered to go in, but the name of the hakkim of the English
Consul, and the sight of half-a-dozen piastres to boot, removed
his scruples.
“I was led from one passage to another, door after door was
unbarred, the keeper armed himself with a courbash, a whip
made of one solid thong of the hippopotamus, and we at length
got into an open court, round which the dungeons of the luna-
tics were situated. Some who were not violent were walking,
unfettered; but the poor wretches in the cells were chained, by
the neck, to the bars of the grated windows. The keeper went
round, as he would in a menagerie of wild beasts, rattling the
chain at the window, to rouse the inmates, and dragging them
by it when they were tardy in approaching. One madman,
who spat at me as I passed his cell, I saw the keeper pull by
his chain, and knock his head against the bars till the blood
issued from his nose. I forced him to desist. Each of them,
as we passed, called out for food. I enquired about their al-
lowance, and, to my horror, I heard that there was none except
what charitable people were pleased to afford, from day to day.
It was now noon, and they had had no food from the prece-
ding morning. Two well dressed Turkish women brought in,
while I was there, a large water-melon and two cakes of bread;
this was broken in pieces and thrown to the famished creatures.
I never saw nature subdued to such lowliness. They devoured
what they got like hungry tigers, some of them thrusting their
tongues through the bars, others screaming for more bread. I
80
sent for a few piastres worth of bread, dates and sour milk; its
arrival was hailed with a yell of extasy that pierced the very
soul. I thought that they would have torn down the iron bars
to get at the provisions; and in spite of the courbash, their
eagerness to get their portions rendered it a difficult matter to
get our hands out of their clutches. It was humiliating to
humanity to see these poor wretches tearing their food with
their filthy fingers. Some of their nails were so long as to
resemble the talons of a hawk.
“And can such be the condition of ‘man, so noble in reason,
so infinite in faculties, in form and movement so express and
amiable!” Vain boast! Go, paint the faculties of this paragon
of animals’ in the dungeons I have described; and when you
have studied the institutions of the Turk, sit down, if you
can, with an exalted opinion of human nature. -
“There was one thing that I could not help remarking; the
ruling passion of the Mahometan, as preserved even in insanity.
One man, who begged me to give him bread, spat upon me
when he got it; another, with all the eagerness of famine, ab-
stained from eating it; hungry as he was, he preferred flinging
the portion of melon he had just received at a christian's head,
rather than satisfy his craving stomach. He concealed his
missile for nearly a quarter of an hour, till I was opposite his
window, he then thrust his naked arm through the bars and
took deliberate aim at me. In spite of my entreaties he got
the courbash around his uncovered shoulders. But there was
one old man who moved not while the food was distributing;
and as I looked into his cell, destitute of every thing, with
neither straw nor rug, I could barely distinguish an emaciated
form lying on the bare earth, with hardly a rag upon his body.
He could not lie down altogether, for he was chained by the
neck to the window. He was worn to a skeleton; and whether
it was the pressure of the chain that impeded respiration, or
not, I cannot say, but his stentorious breathing resembled that
of a person in the last convulsions; and, on enquiry, I found
this wretched creature to be actually dying. The smell of the
apartment was horrible. I had some difficulty to prevail on
the keeper to take off his chain; I gave some piastres to buy
81
straw, and some days afterwards sent the janizary to enquire
after the poor wretch:-he was dead, and there was no straw
to be seen in his dungeon. -
“I observed a very decent looking Turk, in one of the cells,
who had been an officer in the pasha’s troops. He complained
bitterly of hard usage, and said he was famished; some days
he had only five para’s worth of bread, or a half-penny’s worth,
and he talked altogether so rationally of his condition, that I
expressed my wonder to the keeper that he was not permitted
to go abroad. The keeper laughed at my ignorance. “You
don’t know,” said he, “that when mad people appear most
quiet they are always plotting mischief.” He illustrated his
assertion by a story which, if credible, certainly shewed the
necessity of confining lunatics, however mild in their appear-
ance, to the cells at night.
“A black man, who followed the trade of a butcher, had
been confined there many years ago; he had been allowed the
range of the house, with two or three others whose derange-
ment was attended with no violence. One night the black
butcher secreted a knife: he induced another man to enter his
cell, prevailed on him to lie down, and then cut his throat;
he calmly cut him in quarters, and distributed the joints around
his cell, as he was in the habit of arranging his meat in his
shop. He solicited the custom of his comrades, and to those
who were chained, he carried such portions as they desired.
The keeper was disturbed by the cannibal rejoicings; it was the
first full meal they had had for many a long day. On examin-
ing the cells, he found one man missing. He asked the black
butcher if he had seen him, and he replied that he had sold
the last joint of him. “Since that time,” said the keeper, “we
look out better, otherwise they would eat one every day.”
“I endeavoured to ascertain the cause of the madness of the
present inmates. They were thirteen in number, and all males.
Four of them had gone mad from smoking hachis, an intoxi-
cating drug, composed of the small pistils of the flax plant;
five of them had had poison administered to them; three were
religious monomaniac fanatics, and one had gone mad after
being bastinadoed.
82
Asylums IN THE EAST INDIES.
It appears that previous to 1818 there were hospitals for the
insane in the British East Indies, but they were very badly
conducted. In the year mentioned, an improvement was
made, by placing at the head of each an experienced British
physician. These asylums are under the general supervision
of the judges of the circuit courts; but the immediate govern-
ment of each is confined to the magistrates of the district in
which it is situated. The asylums are all built at the expense
of government. The following are in Bengal:
ASYLUM AT CAL CUT.T A.
The average number of patients in this establishment is 170.
During the year 1820, the number of admissions was 110,
cures 73, deaths 21.
ASYLUM AT DACCA.
The average number of patients at this asylum is 35. The
admissions, in 1820, were 32, cures 11, deaths 8.
ASYLUM AT MOORSHEDABAD.
In 1820, the number of admissions was 68, that of discharges
68. The average number of patients is 55, the average annual
number of deaths 9. -
- ASYLUM AT PATNA.
There were 11 admissions, 12 discharges, and 2 deaths at
this institution in 1820. The average number of inmates is 45.
ASYLUM AT BENARES.
The number admitted to this asylum in 1820 was 31, that
of discharges 9, of deaths 12, Average number of patients 75.
83
ASYLUM AT BAREILLY.
In 1820, 48 patients were admitted, 29 discharged, and 10
died. The average number of patients is 100.
Within the government of the presidency of Fort George,
there are, at least, four asylums for the insane. These are at
Madras, Chittoor, Trichonoply, and Masulipatam. Of these
we have no statistics; but that at Madras, it is said, “sur-
passes many of the European establishments that have long
been considered as the most perfect of their kind.” Within
the government of Bombay, but one asylum is mentioned. It -
is at Colabah. ... 3
ASYLUMS IN THE UNITED STATES OF AMERICA.
The institutions for the insane in this country may properly
be arranged in four several classes. 1st. State Asylums. 2d.
City Asylums. 3d. Institutions founded by subscriptions, and
under the care of a board of managers. These may be desig-
nated Corporate Asylums. 4th. Private Asylums, or those
belonging each to one or two persons. These institutions will
be designated here by the name by which they are generally
known.
STATE ASYLUMS,
MAINE IN SANE FIOSPITAL AT ALJ G LISTA.
- Cyrus Knapp, M. D., Superintendent.
Chauncey Booth, Jun., M. D., Assistant Physician.
This Asylum was but recently completed. It went into
operation October 14th, 1840. The farm contains seventy
acres. The edifice consists of a central building and wings,
and will accommodate 120 patients. It is pleasantly situated,
upon the eastern shore of the Kennebeck river. Although a
state institution, two benevolent individuals contributed ten
thousand dollars each towards its foundation.
84
The first annual report of the directors of this Asylum has
very recently been published. From this, it appears that,
from the time of opening to the close of the year 1840, a period
of two and a half months, 30 patients were admitted. Of
these, 22 were men and 8 women; 22 were old cases, or those
of more than one year in duration, and 8 were recent, or of
less than one year in duration, -
Religious Worship.–Evening prayers are held regularly,
and attended by most of the patients. Weekly religious exer-
cises, on the Sabbath, are about to be introduced. -
Labour.—Many of the men cut wood, and work at carpen-
try and other kinds of labour. A portion of the women are
engaged in domestic occupations. º: #
.#musements.—Nothing is said, in the report, in regard to
these, excepting the remark that many of the patients are fond
of reading.
NEW HAMPSHIRE STATE LUNATIC ASYLUM AT PORTSMOUTH.
An appropriation for this institution has been made by the
legislature of the state, and its location determined upon.
Measures have been taken for the prosecution of the enter-
prise; and George Chandler, M. D., assistant physician to the
Massachusetts State Lunatic Hospital, has been invited to
superintend the erection of the buildings, with a prospect of
taking charge of the institution when it shall go into operation.
VERMONT ASYLUM FOR THE INSANE AT BRATTLEBORO.
William H. Rockwell, M. D., Superintendent.
Chauncey Booth, Jun., M. D., Assistant Physician.
This Asylum can accommodate about 100 patients. Its
fourth annual report, that for 1840, has recently appeared.
During the year ending October 1st, 1840, 73 patients were
• In the report, for 1840, of both this Asylum and that at Augusta, Maine,
the name of this gentleman appears as assistant physician. .
85
admitted and 61 discharged, including deaths. Of this number,
33 were cured and 6 died. Remaining in the Asylum, at the
close of the year, 80.
During the year ending October 1st, 1839, the number dis-
charged was 38, cured 25. The whole number of admissions,
from the time of opening to October 1st, 1840, is 239; the
number of deaths 11.
The recoveries, in 1840, of all cases dis-
charged, equalled 54 per cent.
& 4 & 6
9 “ of less }ss.2. 66
than one year’s standing, - - |
6 & é & 6 & of more 28. 5 &é
than one year’s standing, : . . .
66 of all cases discharged since 56.3 &é
the commencement, ; • * ,
“ & 4 << . of less 89 “
than one year’s standing, }
6 6. & 4 - & 6 of more 28.2 66
than one year’s standing, * : * ; ſº
Religious Worship. —Beligious exercises are regularly
performed, and have been found beneficial. -
Labour.—Those of the men patients whose condition will
admit are employed “in the garden, on the farm, and about the
premises.” The women are engaged in needlework and do-
mestic duties. -
•Amusements.—The patients are furnished with the means
of diversion and relaxation in walking, riding, fishing, reading,
writing, drawing, painting, playing on the piano, and at the
games of ball, quoits, cards, chess, backgammon, draughts,
dominoes, battledoor and graces.
MASSACHUSETTS STATE LUNATIC HOSPITAL AT WORCESTER.
Samuel B. Woodward, M. D., Superintendent.
George Chandler, M. D., Assistant Physician.
The buildings of this institution are situated upon the sum-
mit of an eminence commanding a beautiful view of the vil-
lage of Worcester, and of the surrounding country. The
8
86
principal edifice originally consisted of a centre building, 76
by 40 feet, and four stories in height, and two wings, each 90
feet long in front and 100 in the rear, 36 feet wide and three
stories high. “The front of the centre building projects 22
feet forward of the wings. The wings, being 36 feet wide,
half their width, or 18 feet, joins upon the centre building;
the other half falls in its rear.” By this arrangement, light is
freely admitted, and the means of thorough ventilation secured
to the central galleries of the wings. This edifice furnished
accommodations for 120 patients. Being found inadequate to
the demands, two additional wings have been erected, one at
either extremity of the original wings, touching the rear corners
of the latter and receding at right angles from them. The
squares thus left at the adjoining extremities of the old and
the new wings is occupied by verandahs, of equal height
with the wings, which are used as promenades by the patients
of the several wards. The accommodations are thus rendered
sufficient for from 230 to 240 patients. The first admission
into this Asylum was on the 19th of January, 1833. From
that time to the 30th November, 1840, the number of admis-
sions was 1196; of which 637 were men and 559 women.
The number of discharges was 960, being 515 men and 445
women. The results of their treatment may be learned from
the following table:
º res : ..?
$–1 Q & .2
§ ă ă s à 53
§ ă 3 .92 * 5 §
p3 ºf CD ſº fiº H 5
Men, 247 54 -
Women, 259. 36.
Total, 506 175 185 90 4 960
87
The statistics for the year ending November 30th, 1840, are
as follows: :
sº s:
re; # re; : #:
$2 § 5 g § .#sº
º -- P- & O C & Co
8 Q_) 3 Tº 3. J 3 s
rc .93 Q} • * 8 § q} O
<! ſº p3 ſº H-4 {ſ} p32.
Men, 75 68 28 6 122
Women, 87 87 54 9 114
Total, 162 155 82 15 29 29 236
The average number in the Asylum during the year was
229; the greatest number 245. Of the 155 cases discharged,
70 were recent, or of a duration less than one year. Of these,
64 recovered, 2 improved and 4 died. The remaining 85 were
of longer duration than one year. Of these, 18 recovered, 26
improved, 14 were harmless, and 15 were sent to places of
security for want of room.
Of all the recent cases which have been discharged
from this Asylum, the average of recoveries is 87.25 p. ct.
Of the same, discharged last year, “ << 91.25 ¢ &
Of all the old cases, & 6 << 19.50 <<
Of those discharged last year, 6 & << 22.50 <<
Of all the cases, both recent and old, “ “ 52.00 “
The same during last year, & 6 << 53.00 & 4
Of all the cases discharged, the average of deaths is 7.50 “
The same during last year, é & & 6 3.75 ¢ &
445 patients were married, º $º ſº- - 37.50 <<
751 do. including widowers and widows, were
single, gº tº a Eºs tº tº- iº – 62.50 66
We are indebted, for the above statistics, to the intelligent
and accomplished superintendent of the hospital under notice.
His eighth report, from which these are extracted, is now in
press, and will soon be published.
The following statistics are condensed from his seventh
annual report, made for the year ending Nov. 30th, 1839, at
which time 1034 patients had been admitted into the hospital,
and 805 discharged therefrom.
88
Species of Insanity.—Mania, 533; melancholia, 304; de-
mentia, 146; idiots, 8; unclassified, 43. Total, 1034.
Age of patients when admitted.
3 # a & Sº § 3 £ 3 –
£ 3, 3 S S S Sº S S :
35 ºr 3 s 3 & 2 &
62 260 298 210 104 73 29 1026
Civil State.—Single, 558; married, 374; widows, 63; wi-
dowers, 39.
Causes of Insanity. —Intemperance,—men, 151; women,
20; total, 171: ill-health, 154; masturbation, 97; domestic
afflictions, 107; religious, 78; loss of property, fear of po-
verty, &c., 68; disappointed affection, 47; disappointed ambi-
tion, 27; epilepsy, 34; puerperal, 24; injuries of the head,
12; abuse of snuff and tobacco, 6.
Arising from physical causes, 498; from moral causes, 324.
Hereditary, or having insane ancestors or near kindred, 311.
Periodical, 188; homicidal, 18; actual homicides, 13.
Suicidal, or having a strong propensity to self-destruction,
125; actual suicides, 5. * - -
Of 544 cases examined, 275 have dark complexions, hair
and eyes, and 262 light complexions, hair and eyes.
Of 165 periodical cases, 103 were caused by intemperance.
Profession and Occupation.—Farmers, 124; labourers, 97;
shoemakers, 42; seamen, 40; merchants, 33; carpenters, 27;
manufacturers, 26; teachers, 23; blacksmiths, 13; printers,
13; students, 11; tailors, 9; machinists, 8; clothiers, 6; pain-
ters, 4; millers, 4; coopers, 4; paper-makers, 3; calico-prin-
ters, 3; cabinet-makers, 3; clergymen, 4; sail-makers, 3; tan-
ners, 3; bakers, 3; inn-keepers, 2; stevedores, 2; stone-cut-
ters, 2; comb-makers, 3; musicians, 3; turners, 3; harness-
makers, 3; pedlars, 4; physicians, 2; broom-makers, 2; cop-
persmiths, 2; coachmen, 3; butchers, 2; currier, l; brick-
layers, 3; lawyer, l; jewellers, 2; watchmen, 2; drovers, 2;
news-collector, 1; rope-maker, 1; engineer, l; hatter, l; gar-
dener, l; idiots, 9; vagrants, 28.
89
Women unaccustomed to labour, 92; women accustomed to
sedentary employments that are laborious, and to factory
labour, 72; women accustomed to active employment, the
wives and daughters of farmers, mechanics, &c., 128. Many
not classified. - *x
Religious Worship.–A chaplain is connected with the
hospital, and services are regularly performed, twice every
Sabbath, in a neat and commodious chapel erected for the
purpose. %. . . .
The meetings are generally attended by from two-thirds to
three-fourths of all the patients. The seventh report says
“four-fifths of the patients who have been in the hospital
during the last year, have attended—and most of them very
regularly. The congregation varies from 175 to 200 and
upwards. The experience of each day, strongly impresses
us with the benefit of these religious services.” .
Labour.—In no institution for the insane has manual labour
been more extensively introduced as a part of the moral treat-
ment, and in no one has its utility been more satisfactorily
demonstrated. The men are employed in almost every de-
partment of gardening and farming, and some of them work at
shoemaking. The women are engaged in sewing, knitting,
and domestic duties.
The following list exhibits the number employed in 1839,
together with their occupations. -
Men. Women.
Agriculture and horticulture, 40 Knitters, 60
Shoemakers, - 8 Seamstresses, 32
In the kitchen, 5 Washers, 4
Washer, 1 In the kitchen, 4
Woodsawyers, - 16 In the laundry, 6
Mason-tenders, 3 —
— I06
73 73
Engaged in manual labour during the year, 179
8%
90
•Amusements.-Walking, riding, the swing, draughts, and
some other games, afford amusement and recreation. A library
of nearly two hundred volumes belongs to the institution,
and is much used by the patients. Tea-parties are given by
the matron, weekly or semi-monthly, and a large dancing
party assembles three or four times a year. Many of the men
are permitted to walk where they please, generally going in
companies of from five to twenty. In 1839, no less than 93
were indulged abroad without an attendant. - 5
NEw York st'ATE As YLUM FOR THE INSANE, AT UTICA.
This Asylum is now in progress of erection. It is “to
consist of four buildings, of three stories and a basement, the
principal front to have the main building carried up an addi-
tional story, to be located at right angles to each other, facing
outwards, and to be connected, at the angles, by verandahs of
open lattice-work, the whole enclosing an octagonal area.”
Each of the four buildings is to be 446 feet in length, by 48
in width. That which forms the principal front is nearly
completed. When finished, this institution will be by far the
most extensive in the United States. The estimated cost of
the buildings, is $431,636. ."
MARYLAND HOSPITAL FOR THE INSANE, AT BALTIMORE.
William Fisher, M. D., Medical Superintendent.
This Asylum is situated about half a mile eastwardly from
the city of Baltimore, upon an eminence which commands a
beautiful view of the city and the surrounding country, inclu-
ding the Patapsco river and Chesapeake Bay.
Originally a general hospital, it was first exclusively devoted
to the insane in 1839. It has been recently enlarged, making
its accommodations sufficient for 150 patients. It has ten
acres of land. - - -
The present number of patients is 56. The whole number
91
under care from January 1st, 1835, to January 1st, 1841, was
393. 3.
Results of treatment.
# # §5. ãº
5 ** +3 § 3 5 § sº
à ‘5 § -53 -3 § 9 Tº:
3 E. S. .93 ± .9 ă ă. 3
p: > 3. ſº º ſº 3.5 H
135 75 106 34 43 393
A large majority of the cases were of more than one year’s
* duration. .
The female department of this institution is under the im-
mediate care of the “Sisters of Charity.”
Divine worship on the Sabbath has been introduced “with
good effect.”
Labour.—Gardening, carpenter’s work, and various domes-
tic employments. . -
Jāmusements.-Walking, riding, fishing, reading, and play-
ing at quoits, chess, backgammon and draughts.
westERN LUNATIC ASYLUM, AT STAUNTON, VA.
Francis T. Stribling, M. D., Superintendent.
This is a state institution. The building, which possesses no
inconsiderable architectural beauty, is situated upon an emi-
nence, commanding a view of the surrounding country. The
farm contains 65 acres. The Asylum went into operation July
1st, 1828. From that time to July 1st, 1836, a period of eight
years, there were 79 admissions and 13 cures. From July 1st,
1836, to November 1st, 1839, the number admitted was 78;
cured 34. Of the 78 admissions, but 30 were recent cases, or
those of less than one year in duration. Of the recent cases 25
were cured, which, exclusive of deaths and removals, is equi-
valent to 83 per cent. i
Religious worship, at regular periods, has not been intro-
duced. . -
Labour.—The men patients are employed in tillage, fencing,
cutting wood, excavating earth, &c. The work thus performed
by them, in 1839, would have cost, if paid for at the current
92
prices of labour, about $600. The females knit, sew, and
engage, to some extent, in domestic duties.
.4musements.-A library of 300 volumes, horses and car-
riage, a piano, violins, flutes, cards, balls, backgammon, draughts,
graces and battledoor furnish means for amusement and recrea-
tion. - A
ASYLUM For THE INSANE AT will IAMSBURG, VA.
Philip J. Barziza, Esq., Superintendent.
This Asylum is also under the care of the state. It is one
of the oldest institutions of the kind in the country, having
been established before the revolution. When the British and
American armies were near Yorktown, the buildings, having
been temporarily vacated by the insane, were used as barracks
and a hospital for the sick and wounded. We have seen no
report and no statistics of this establishment, excepting the
statement that, in 1838, the number of patients was about 80.
OEIIO L'UN ATIC ASYLUM AT COLUMBUS.
William M. Awl, M. D., Superintendent.
Samuel M. Smith, M. D., Assistant Physician.
This Asylum was opened November 30th, 1838. It is con-
structed on the plan of the original edifice of the Massachu-
setts State Lunatic Hospital; it cost about $40,000. Thirty
acres of land, which constitutes the farm, were purchased at
the additional expense of 1980 dollars. -
The number of admissions, from the time of opening to
November 13th, 1840, was 258. Of these, 140 were males
and 118 females; 88 were recent cases, or those of less dura-
tion than one year, and 170 were old, cases. Of the patients,
135 were single, 100 married, 17 widows and 6 widowers.
During the same period 120 have been discharged, 69 of
them being recent, and 51 old cases. The average number,
during the last year, was 131, and 138 remained in the house
at the expiration of that year. -
Species of Insanity.—Mania 170, melancholia 38, epileptic
93
mania 20, homicidial mania 4, moral insanity 11, dementia 12,
idiocy or imbecility 3. Total, 258.
Profession and occupation.—Labourers 24, millwrights 2,
wagon-makers 2, miller 1, surveyor 1, mason 1, carpenters 8,
students 3, tailors 4, merchants 2, cooper 1, collier 1, potter 1,
engineer 1, farmers 47, blacksmiths 6, tobacconist 1, printers
3, teachers 4, brewers 2, shoemakers 5, lawyers 3, saddlers 1,
weaver 1, clerks 4, preachers 8, musicians 1, sea captain 1.
Causes of Insanity.—Intemperance 18, domestic affliction
10, puerperal 22, ill health 23, loss of friends 5, matrimonial
perplexities 10, indulgence of temper 1, fright 3, political ex-
citement 1, seduction 1, intense application 4, jealousy 2, dis-
appointed love 10, epilepsy 17, excessive joy 1, injuries of the
head 5, excessive use of snuff 1, constitutional 15, disappoint-
ment and mortification 16, masturbation 17, fear of want and
loss of property 7, ill treatment from parents or guardians 6,
religious 29, unknown 34. -
Religious worship.–Evening exercises of family worship
are regularly performed, at which from 30 to 40 patients usually
attend. A sermon is read on the Sabbath. -
Labour.—The men patients labour in “clearing up the pre-
mises,” grading and levelling the grounds, gardening, preparing
fuel and taking care of the stock. The making and mending
of the clothing of the indigent patients, and the washing and
ironing for all the inmates of the house are mostly performed
by the women. .
./?musements.-The patients walk in parties accompanied
by an attendant; a tea-party is made weekly; dancing parties
more rarely; books and stationary are distributed to such as
wish, and some of the usual games, both within doors and
without, are resorted to. “The 4th of July” is duly cele-
brated, and the annual election, for the choice of state officers,
is held with scrupulous regularity.
KENTUCKY LUNATIC ASYLUM AT LExENGTON.
John Catherwood, Keeper.
This institution has been in operation about sixteen years.
94
It has no resident physician. From the time of opening to the
close of the year 1838, the number of admissions was 690,
discharges 301, deaths, 297. Remaining January 1st, 1839,
122, of whom 54 were men and 118 women. At the time of
the prevalence of the Asiatic cholera, 43 of the patients died
of that disease. - -
The statistics of the first fourteen years of the operations of
this Asylum are as follows: -
- Per cent. Per cent.
Admitted. Discharged. Died. of discharges. of deaths.
Men 420 218 155 51.90 36.90
Women, 207 58 83 28.01 40.09
Total, 627 276 238 44.10 37.95
The number of cures is not stated in the reports. Of the
627 patients included in the table, 118 were idiots and epilep-
tics, all of whom have died. Deducting this number from the
admissions and the deaths, the per centage of deaths will be
23.57, or 1 in 4.24, and that of discharges 54.22, or 1 in 1.84.
Men. women. Both sexes.
P. ct. of deaths, 1838, of old cases 12.50 16.36 14.56
- - << recent “ 9.52 21.42 14.22
P. ct. of discharges, of old “ 10.41 1.81 5.82
- - << recent “ 71.42 28.57 54.28
The reports give no information in regard to religious
worship, labour and amusements. . . + - ‘.
Active exertions are being made for the establishment of
State Asylums for the insane in Connecticut, New Jersey and
Pennsylvania; and during the present session of Congress, a
bill has been passed for the foundation of one in the District
of Columbia. . -
souTH CAROLINA Asy LUM AT COLUMBIA.
The state has appropriated 100,000 dollars to this institution.
Nothing further than this can be said in regard to it, from want
of data. - -
95
TENNIESSEE ASYLUM AT, NASHVII, LE.
James Overton, M. D., Superintendent.
© | e * © {} tº e e
No information has been received from this institution since
it went into operation. In 1838, the central building was
completed and the wings in progress.
CITY ASYLUMS.
BosTon LUNATIC HospitaL.
John S. Butler, M. D., Superintendent. .
This institution is for the insane poor of the city of Boston,
Massachusetts. It is situated in South Boston, on a spot
which commands a prospect of the city and its beautiful har-
bour. The edifice consists of a central building and wings,
the whole being 160 feet in length. The expense of construc-
tion was about 32,000 dollars. -
This Asylum was opened for patients December 11th, 1839,
and in the first report, which appeared a few months since, the
statistics are made out to July 1st, 1840. During the period
included between these dates, 104 patients were admitted, of
whom 57 were men, and 47 women. Ten of them were of
less duration than one year, and 94 were of longer duration.
Of the 10 recent cases, 4 were discharged, well, and 1 died.
Of the 94 old cases, 10 were discharged stationary, 1 recovered,
and 1 died. On the 1st of July, 1840, 87 patients remained in
the Asylum. -
A large proportion of the cases herein reported were of
many years standing, the patients enjoying very good general
health. -
Religious Worship.—Family worship has been introduced,
and continued every evening, and religious services are gene-
rally performed on the afternoon of the Sabbath. The average
number of patients who attend is more than forty.
Labour.—“Our male patients,” says the report, “assist much
in the out-door work of the hospital, though we have to regret
96
that we have so little opportunity of giving them constant and
regular employment.”
Jāmusements.—The report says nothing upon this subject,
except acknowledging the receipt of several donations of books
and tracts, and remarking that they are received “with eager-
ness” by the patients. -
NEW YORK PAUPER ASYLUM.
This institution, founded by the city of New York, is situated
upon Blackwell's island. It is intended, when complete, to
accommodate about 400 patients.
That portion which was finished was opened for the recep-
tion of patients about a year and a half since. On the 1st of
February 1840, the number of patients was, men 100, women
110—total 210. Nearly all of these were removed from the
almshouse at Bellevue.
CORPORATE ASYLUMS.
M“LEAN Asy LUM, CHARLESTOWN, MASSACHUSETTS,
Luther V. Bell, M. D., Superintendent.
This institution is connected with the Massachusetts General
Hospital, and was opened more than twenty years since. It
is one of the most complete, handsomely furnished and suc-
cessful asylums in the country. It can accommodate about 120
patients. We regret not to be able to present its full statistics.
From the report for 1839 we glean the following:
Remaining at the commencement of the year, . 93.
Admitted during the year, . º º . . . 132.
Total enjoying the benefits of the Asylum, in 1839, 225.
Discharged during the year, • ſº . I 17.
Remaining at the close of the year, . . . . 108.
Recovered, {º & & ſº * te gº 90.
Improved, = 6; * * tº e * e 22.
Stationary, ge e e * e º tº 16.
Died, ſº * > tº wº e Qe º g 10.
97
The per cent. of deaths of all the inmates was, in 1835, 6.1;
in 1836, 5.5; in 1837, 4.2; in 1838, 5.4; in 1839, 4.4.
The number admitted, during sixteen successive years, was,
of men 652, women 443—total 1095. -
Religious Worship.–Daily devotional exercises are per-
formed in the evening, and such of the patients as are suitable
are permitted to attend the neighbouring churches on the Sab-
bath. From one half to three-fourths of the patients attend
the former, and of those who avail themselves of the latter,
the average number is about 30.
Labour. —The men work in the garden, on the farm, and
in a large carpenter’s shop. During the year 1836, 50 “worked
in the carpenter’s shop, six hours per day, and were employed
151 days;” they made 7236 boxes, which sold for $907 06 cts.
Several years since, a sewing society was established among the
women, which is, undoubtedly, still continued. The avails of
their labour, during the first eighteen months, was $112 96 cts.
Jāmusements.-The usual games are introduced; dancing
and tea-parties are occasionally made, and a library of a few
hundred volumes is devoted to the use of the patients.
CONNECTICUT RET REAT FOR THE INS ANE.
.Amariah Brigham, M. D., Superintendent.
This Asylum is pleasantly situated, about one mile from the
city of Hartford. It is upon a gentle elevation of ground, and
commands a fine prospect of the cultivated country by which
it is surrounded. It was opened in April 1824, with accom-
modations for 60 patients. In 1831, it was sufficiently enlarged
to accommodate 100.
This institution has enjoyed a high reputation, which, we
doubt not, will be fully maintained by the present accomplished
superintendent, who has but recently entered upon his duties.
From the sixteenth report, not long since published, we
extract the following table, exhibiting the annual number of
9
98
admissions, recoveries and deaths, from the opening of the
Retreat. :
Recent cases Recent cases
Years. Admitted. Cured. admitted. cured. Deaths,
1824–5 44 10 12 6 I
1825–6 33 16 16 13 1
I826–7 37 24 23 22 0
1827-8 40 27 25 22 4
1828–9 42 26 20 19 2
1829–30 51 28 25 23 0
1830–1 53 32 25 23 I
1831–2 80 46 42 38 6
1832–3 68 37 30 28 4
1833–4 72 43 33 32 3
1834–5 72 36 36 28 6
1835–6 73 42 35 29 6
1836–7 91 55 60 48 6
1837–8 67 42 41 35 10
1838–9 94 49 61 45 8
1839 84 50 53 40 2
Total, 1001 563 537 451 60
Religious Worship.–At this Asylum they have prayers
every evening, and religious service on the Sabbath, conducted
by a regular chaplain. 's
Labour and Amusements.-The reports before us contain
nothing upon these subjects. .
BLooMINGDALE ASYLUM.
William Wilson, M. D., Resident Physician.
The Bloomingdale Asylum is one of the finest institutions
of the kind in the United States. It is beautifully situated, a
few miles from New York city, and has extensive and well
cultivated grounds. It commenced operations in 1821.
From the reports of 1831, 1832, 1834, 1835 and 1838, we
have obtained the following statistics. During those five years,
there were 631 patients admitted, of whom 405 were men and
266 women. The number of recent cases was, of men, 213;
women, 111; total, 324: that of old cases, men, 192; women,
115; total, 307. -
99
The results of treatment were as follows:
e ** o as
-5 ..? e º --> ºn
§ 3 ; 'E # 3
Qi.) • * * :- > z > -ſ; -e;
§ 5%; g is 3; 37; # 7.
ă ă ă ă ă ă ă ă ă ă ă
tº E s. E 6 p.33 ±3 fiP.
Recent cases, 260 10 17 18 21 3 329
Old cases, 42 4 66 64 74 37 9 296
Total, 302 14 83 82 95 37 12 625
During the year 1839, the whole number in the asylum was,
men 154, women 97, total 251. The number admitted was,
men 69, women 44, total 133. Of the admissions, the number
of cases of less duration than one year was, men 44, women
20, total 64; that of cases of longer duration than one year,
men 25, women 24, total 49. Remaining, Jan. 1st, 1840,
men 74, women 52, total 126. -
Recent cases.
Recovered. Improved. Stationary. Died. Total.
Men, 37 2 0 4 43
Women, 15 2 0 2 19
Total, 52 4 0 6 62
Chronic cases.
Recovered. Improved. Stationary. Died. Total.
Men, 13 13 6 5 37
Women, 3 15 5 3 26
Total, 16 28 11 8 63
Whole number discharged, 125.
Species of Insanity.—Of the 126 patients remaining at the
close of the year in question, there were suffering under mania
39, monomania 32, dementia 51, idiocy 4.
Profession and Occupation.—Merchants 14, farmers 11,
seamen 9, clerks 8, servants 6, milliners and dress-makers 5,
lawyers 3, physicians 3, cabinet-makers 3, tailors 2, watch-
makers 2, students 2, carpenters 2, teachers 2, saddler 1, cur-
rier 1, inn-keeper 1, shoemaker 1, butcher 1, blacksmith 1, no
occupation, chiefly females, 48.
I00
Causes of Insanity.—Hereditary 20, intemperance 12, do-
mestic trouble 10, pecuniary embarrassments 9, puerperal 8,
fevers and other diseases 8, disappointed affection 6, mental
exertion 6, religious excitement 5, congenital 4, cerebral disease
4, uterine disorders 3, masturbation 3, constitutional 3, injuries
of the head 2, isolation 1, mortified pride 1, remorse 1, anti-
masonic excitement 1, sudden wealth 1, unknown 20.
Religious Worship.–There is one religious service each
Sabbath, at which such of the patients as are suitable, attend.
Labour and Amusements.-The reports before us are silent
upon these subjects, but from the character and reputation of
the institution, we presume it is not “behind the age” in re-
gard to the introduction of these among the patients.
PENINSYLVANIA HOSPITAL.
A department of this extensive and useful institution, the
oldest of the kind in the United States, has always been de-
voted to the insane. The following table exhibits the number
of admissions, and the results of treatment, from February
11th, 1752, to April 28th, 1832, a period of more than eighty
years. -
º * §
re: tº red Łº * *
# , ; ; ; ; , ;
s g .# 8 : Ø- rt; s
re: t; Q) $3 -, .8 .92 Qi.)
<! . O p3 p3.25 º ſº pd
Men, 2509 905 488 499 188 359 66
Women, 1209 384 292 264 42 1.71 60
530 126
Total, 3718 1289 780 763 230
From April 28th, 1832, to April 28th, 1840, the number
admitted was 584; cured 191; died 72.
Previous to the year 1823, the cases of mania a potu were
included with those of insanity. Since that year they are not
included. -
Of 394 consecutive admissions, the ages of the patients was
as follows:– - .
101
- \º dº Mºb
25 § 3 ; G 3 & # 3 3 £ 3 &
5 S S S S S S S S 9 S S S 9
- hº) º Mſ)
* E & 3 & 3 s. 5. 3 # 3 3 Fe 3
25 59 66 77 44 45 30 16 14 10 3 3 2
Civil State.—Of 284 men, 170 were single, 97 married, and
17 widowers; and of 202 women, 70 were single, 97 married,
and 35 widows. e
The patients of this institution, of whom there are about
one hundred, are now being removed to the new Asylum,
west of the Schuylkill. -
ASYLUM AT FRANKFORD, PENNSYLVANIA.
John C. Redmond, Superintendent.
Charles Evans, M. D., Attending Physician.
Pliny Earle, M. D., Resident Physician.
This institution, generally called, in the reports, “The Asy-
lum for the Relief of Persons deprived of the use of their
Reason,” is pleasantly situated, about six miles northerly from
the city of Philadelphia. The principal edifice consists of a
central building and wings, and, at the extremity of the latter,
other buildings, called “lodges,” intended for such patients as
may be so noisy as to disturb the others. The front formed
by these several portions is 322 feet 8 inches in length. The
farm contains sixty-one acres, which is divided into airing
courts, and garden, tillage and woodland. The airing courts
and the grounds in front of the building are well shaded with
large and beautiful trees.
This Asylum was opened in Fifth-month, (May,) 1817,
and, for many years, was restricted exclusively to members of
the Society of Friends. In 1834, however, it was opened to
others, who still continue to be admitted.
The number of admissions, from the time of opening to the
close of the year 1838, a period of nearly 22 years, was 634.
Of these, 331 were men, and 303 women.
Civil State.—There were, single, 326; married, 234; wi-
dowers, 17; widows, 57.
9*
102
Ages at the time of admission.
3 *, 5 & 3 3 & 2 & 3 & #
$5 fºr 3 Sº § 3 ºr 3 3 H
2s 187 141 126 83 48 15 5 1 634
Of the 634 patients, 507 were never readmitted. The fol-
lowing table exhibits the results of their treatment:
sº * e s, ºf
"E TE iſ § 3 ;
Duration. §: # = 5 5 5 : &
5 § 3 ; ; ; ; ;
<! 3 - 5 5 § 3 &
Less than 1 year, 261 152 26 27 18 4 34
From 1 to 2 years, 57 18 8 8 9 7 7
“ 2 “ 3 “ 36 17 3 3 4 5 4
<< 3 4 5 “ 45 14 7 6 9 3 6
<< 5 & 10 “ 47 13 7 3 8 11 5
Over 10 ( & 61 0 7 , 5 22 13 14
Total, 507 214 52 52 70 43 70
During the year ending 1st of 3d month, (March,) 1840, the
number of admissions was 54, that of discharges, including
deaths, 60. Of the latter, 25 were restored, 5 much improved,
9 improved, 17 stationary, and 4 died. -
Religious Worship.–Those patients whose condition will
admit, assemble on Sabbath afternoons to hear a portion of
the Scriptures. Some of them attend meeting in the village
of Frankford. -
Labour.—During the warm season, many of the patients are
employed in gardening and farming. In winter, they work in
two shops, one devoted to basket-making, the other to carpen-
try. They keep the reservoirs in the Asylum supplied with
water, throughout the year. It is driven up by a forcing
pump, operated by a crank. • *
Jāmusements.—A grove of about twenty acres, at one ex-
tremity of which an enclosure of two acres contains several
deer, and, at the other, a summer-house is erected amid
103
romantic scenery, forms a pleasant place for rambling in sum-
mer. Horses and a carriage are devoted to the use of the
patients, and the means are furnished for many of the games
mentioned in the notices of other Asylums. Tea-parties are
given occasionally, and lectures upon Natural Philosophy and
Chemistry are delivered, weekly, during the winter. But the
sources of diversion most resorted to are, 1st, a circular rail-
way upon the lawn in front of the house, in a small car upon
which two persons may drive themselves, with great rapidity,
by means of a crank; and, 2d, a library. A small building, at
the extremity of the garden, opposite the house, is devoted to
this purpose. Externally, it is surrounded with a corridor,
the pillars of which are overgrown with honeysuckle. With-
in, it is carpeted, and otherwise well furnished; upon the walls
are framed engravings; two series of shelves are supplied with
about 300 volumes of useful books; the whole of one side of the
room is occupied by a cabinet of minerals, shells, corals and
stuffed birds and quadrupeds, while lemon and orange trees,
with a variety of flowers, give a delightful fragrance to the
air. This retreat is much resorted to by the patients, the
women having the use of it during the forenoon, and the men
in the afternoon.
PEN NSYLVANIA HOSPITAL FOR THE INSANE.
Thomas S. Kirkbride, M. D., Superintendent.
This Asylum is situated about two miles westwardly from
the city of Philadelphia. It is a splendid establishment, no
expense that would contribute to the suitable accommodation
of the patients having been spared in its erection. A large
farm is connected with it, about forty-two acres of which is
surrounded by a high stone wall.
It is but about six weeks since the Asylum was opened.
Nearly fifty of the patients formerly at the Pennsylvania Hos-
pital, in the city of Philadelphia, have been removed to this
place, and the remainder will soon be transferred. The ac-
commodations, when complete, will be sufficient for more than
104
200. Under the care of its intelligent and assiduous Superin-
tendent, this will, undoubtedly, become one of the best insti-
tutions in the country. -
PRIVATE ASYLUMS.
HUDSON LUNATIC HOSPITAL.
This institution was established by Drs. S. and G. H. White,
and is still continued under their supervision. The following
are the statistics for 1838 and 1840. -
The whole number under care in 1838 was 98; of which 30
were recent cases, 65 chronic, and 3 intemperate. The whole
number in 1840 was 84; of which 25 were recent, 54 chronic,
and 5 intemperate. -
Results of treatment in the cases discharged.
Recent cases.
# º É
Q) • * > c;
* .e : O o •
3 © tº 3. ": rº,
Q) E > 3 § ..?
p3 > Q- }= Uſ) ſº
1838, 15 5 5 l 1
1840, 14 2 2
Chronic cases. - Intemperate.
re; tº, wº '.
§ 5% # 3 is ; :
§ 3 ; # 3 # § =
- p: ; S. E tº º p3 P
1838, 9 27 15 10 4 2 l
1840, 7 10 5 2 3 -
Remaining, January 1st, 1839, 43; January 1st, 1841, 36.
The whole number admitted from the opening of the insti-
tution to January 1st, 1841, is 503. -
Family worship is continued daily, and with beneficial
effects upon the patients. We have no information in regard
to labour and amusements. -
I05.
There is a private Asylum at Pepperell, Massachusetts,
under the care of Dr. Cutter, and another at Cambridgeport,
in the same state, established by Dr. Chaplin, and continued,
since his decease, under the superintendence of his widow.
ASYLUM AT MILLEDGEVILLE, GEORGIA.
We know not under which of the above classes to place this
institution; nor can we say anything in regard to its extent,
organization or success.
































OF THE
CAUSES, DURATION, TERMINATION AND MORAL
TREATMENT OF INSANITY.
The object in this essay is not to enter into an elaborate dis-
cussion of the subject of mental derangement, but to adduce
propositions heretofore stated in regard to that disease, and
subject them, as far as possible, to the test of statistics, with a
view to the demonstration of their truth or falsity. Besides
this, we wish to illustrate the modern mode of moral treat-
ment, by examples adduced from various asylums, and to de-
monstrate the utility of that treatment, in its results, combined
with other remedial agents, upon the patients subjected to its
influence.
CAUSEs of INSANITY.—These have, with evident propriety,
been divided into, first, those which predispose to the disease,
and secondly, those which earcite it.
1. Predisposing Causes.—Under this head we shall consider
the constitution, temperament and complexion, age, sex, civil
state and education.
a The state of the constitution is undoubtedly, in many
instances, a most powerfully predisposing cause of some of the
forms of insanity. A peculiar organization of the cerebro-
spinal system, and, according to Dr. Rush, of the blood-vessels
also, an organization molecular in its nature, and consequently,
particularly in relation to the nervous system, inappreciable
by the senses, favours the encroachment of the disease. This
condition may be hereditary, or may arise, de novo, in a family
108
entirely free from the maniacal taint. The progress recently
made and still making in transcendental anatomy, together
with the great improvements in microscopes, may encourage
us in the belief that we shall eventually be enabled to ascertain
the nature of this, if we may use the term, congenital lesion.
We have abundant proofs that this cause is hereditary. At
the Pennsylvania Hospital, Philadelphia, application was made
for the simultaneous admission of three lunatics, members of
the same family. One of the patients of the Retreat for the
Insane in Hartford, Connecticut, was the eleventh individual
of his family who had suffered under an attack of mania. M.
Esquirol says that hereditary transmission is more frequent
among the opulent than in other classes of society. Such
children of maniacs as are born before their parents become
deranged, are less liable to inherit the predisposition than those
who are born subsequently. Children whose parents are both
maniacal, are more liable to the disease than those of whom
but one parent is so. According to Dr. Barton, the children
of persons in the decline of life are less subject to insanity than
those whose parents are young.
The following table exhibits the proportion of patients, of
some of the asylums, in whom the disease was hereditary.
Asylums. No. of patients. No. hereditary.
Charenton, - 1264 337
Richmond, Dublin, - 608 13
Under care of W. C. Ellis, 1380 214
Massachusetts State, 1034 311
Ohio State, 3.11 - 15
With regard to those under the care of Sir W. C. Ellis,
that author remarks, “If we had more complete information, I
have no doubt that the insanity would be found to have been
hereditary in a much greater number.” According to Ellis,
“relatives by blood intermarrying with each other, have a
progeny prone to insanity. Why it is so, I do not presume
to give an opinion; but of the fact I have no doubt, not only
from what has come within my own knowledge, but from its
109
having been particularly noticed by Dr. Spurzheim and others,
who have paid great attention to the subject: it cannot be too
generally known and guarded against.”
In many instances the disease manifests itself in several
individuals of the same family at nearly the same age. Dr.
Rush says that among the patients in the Pennsylvania Hos-
pital, were a father and two sons, all of whom became deranged
between the ages of 60 and 70 years. Two sons of a merchant
in Switzerland died insane at the age of 19 years. Dr. Prichard
mentions three other cases of a similar kind. M. Esquirol be-
lieves that fright in the mother, during pregnancy, may excite
a strong predisposition to insanity in the infant with which she
is pregnant. Although there are probably but few who will
concur with him in the opinion, it is a point which, as being
thus spoken of by an individual of so extensive observation, at
least merits attention.
Discovered in early life, the constitutional predisposition,
whether inherent or not, may be very much checked in its
progress, if not entirely eradicated, by proper treatment.
b Temperament and Compleasion.—People of choleric and
nervous temperaments are said to be more liable to the inva-
sion of insanity than others; a predisposition which is greatly
fostered in those who give a loose rein to their passions.
Haslam, Rush and some others, believe dark-coloured hair to
be indicative of a maniacal predisposition. In Bethlehem
Hospital, London, according to the former gentleman, of 265
patients, 205 had hair of this colour; and in the Pennsylvania
Hospital, in 1812, according to the latter, of 79 insane inmates,
73 were of a similar description. Of 544 patients examined
at the Massachusetts State Hospital, 275 had dark complexions,
hair and eyes, and 269 light complexions, hair and eyes. The
per centage with regard to Bethlehem Hospital is somewhat
remarkable when we take into consideration the large propor-
tion of people with light-coloured hair in England. It would
not be remarkable in France. Dr. Prichard can trace a pre-
disposition to no particular complexion.
c Age.—The middle period of life is by far the most prolific
in cases of mental alienation; and this from the evident reason
10
110
that both males and females are more exposed, during that
portion of their existence, to the various exciting causes, than
they are in either early or advanced life. Attacks in very
early life are extremely rare. Dr. Rush mentions four cases
of the kind which came within his knowledge; and in St.
Luke's Hospital, England, there was an insane child of but
two years of age. Dolaeus, Greding and Rush mention in-
stances of attacks in very advanced life; the last mentioned
having observed one which occurred in a person more than
80 years of age. .
The British and the European continental writers upon the
subject, generally, if not invariably, assert that more persons
are attacked between the ages of 30 and 40 years, than during
any other interval of ten years in life. This appears to be
sustained by the following table of M. Georget and Dr. Bur-
I’OWS.
Hospitals. Č ºf ro rt; rºs rº- E 3
º ; : 5 ă ă ă ş º
Z = 5 & 3 s 3 & 5
French & English, 4409. 356 106 1416 361 461 174 35
French, 2507 140 465 572 521 350 265 189 6
Total, 69.16 496 571 1988 882 811 439 224
The results exhibited by the following table, however, tend
to disprove the truth of the assertion. : -
sº sä $2 s: § 3 £ 3 g : —5
S. S S S S S 9 S 9 º'
*2 & 3 s = 3 & 2 #
to 1793, > - --
Salpêtrière, from } - 144 205 115 . .
1811 to 1814, 306 2.59 144 205 115 66 23 1118
Esquirol's private, 150 78 30 46 15 5 & 327
Total, 65 785 717 410 881 183 71 26 2638
111
Whether it be true or not in regard to Europe, we believe
it to be untrue if applied to the United States. This belief is
induced by the statistics of the table which follows.


g;| 3 |s|3|3|s ###|_
Asylums. Time. ÉÉ S | S S 3 || S |S|S|8 || 3
- . - ; jº O
T=| 3 ||3|s|3|s #23 F
Mass. State, 1833 to 1839, 62 260298.210,104| 7329 1036
Virginia, at Staunton, 1 year, 8 25| 33 24; 10| 3| 1 104
Ohio State, 1839 & 1840, 11 || 108 66 41| 26 5| 1 258
Kentucky State, 1 year, 8| 39| 24; 10 5 2. 1 89
M“Lean, Mass., 15 years, 70 || 352,264|191|91|38|9 1015
Retreat, Conn. 7 years, 19 || 107 73| 54 20 6| 4 286
Bloomingdale, N. Y., in 1839, 3| 30 37 22, 19| 7 || | | 126
Frankford, Pa., 1816 to 1838, 28 187|141|126 83 4815 5|1| 634
Pennsylvania, 1832, 3 32 29| 27 33 12|12| 2 | 138
Total, | 212||1140965705391|19473| 7 || |4484
By this it appears that a considerably larger number become
insane in the United States between the ages of 20 and 30, than
during any other period of equal length. But the evidence of
this table is, to a certain extent, deceptive; the ages reckoned
are, in most of the cases, those of the patients at the time they
were admitted into the several hospitals, and, in many others,
at a time when they had been in the hospitals several years.
Now, could these be so corrected as to state the age at the time
of the attack, the table would be of more value, and we should
have more striking evidence of the fact in question. But there
was no means by which that correction could in all instances
be made. Wherever the means did exist, advantage was
taken of it, and the result is as follows:
Hospitals. : § # § § ă ; § É
> 3 & 3 S 3 3 #2 H
Retreat, Connecticut, 2 11 36 22 22 11 2 – 104
M“Lean, Massachusetts, 1 7 30 21 11 8 2 1 80
Massachusetts State, – 35 127 99 70 33 15 5 384
Frankford, Pennsylvania, 4 9 32 16 7 5 2 80
59 24 8 648
Totals, 62 225 158 112
112
The change effected by this correction is remarkably exem-
plified in the cases at the Frankford Asylum. As they were
before alteration, the proportion of those between 20 and 30
years to those between 30 and 40 was as 9 to 7; whereas, after
being corrected, it is as 2 to 1. In the total numbers previous
to correction, those between the ages of 20 and 30 are to those
between 30 and 40 nearly as 11 to 9; while in the same, after
correction, the ratio is as 11 to 7. -
d Sea.—It was asserted by ancient writers that, in their
time, more males than females suffered under the various forms
of mental derangement. The reverse appears to be true in
modern Europe. Pinel estimates that in France, in 1802, the
ratio of insane females to males was as 2 to 1. In England it
is far less. At Bethlehem Hospital, agreeably to Dr. Haslam,
of 8874 patients, 4042 were males, and 4832 females. At St.
Luke’s there were one-third more females than males. M.
Esquirol, from statistics derived from several countries, con-
cludes that the proportion “does not, in fact, greatly exceed
the difference which exists between the sexes in the ordinary
state of population.” Judging of the proportionate number of
the sexes insane in the United States from those confined in
the several hospitals, we must conclude that there are more
men than women. See the following table. -
Asylums. Time, Men. Women. Total.
Maine State, - 2# months, 1840, 22 8 30
Massachusetts State, 1833 to 1840, 637 559 1196
Va. State, Staunton, in 1839, 56 48 104
Ohio State, . 1839 and 1840, 140 118 258
Kentucky State, 1824 to 1838, 420 207 627
M“Lean, Massachusetts, in 16 years, 652 443 1095
Retreat, Connecticut, “ 9 “ I83 199 382
Bloomingdale, N. Y., 607 302 909
Pennsylvania Hospital, 1752 to 1832, 2509 1209 3718
Frankford, Pa., 1817 to 1838, 331 303 634
*-ºs = sºmeºme
Total, 5557 3396 895.3
This makes the number of men to that of women as 5 is to
3. It can hardly be believed that there would be so great a
I 13
predominance of men in the asylums, if there were not, in
reality, a greater number of them in the country who are
insane. There are reasons, however, for inducing the belief
that the disproportion between the two sexes is not so great as
is represented by this table. Yet it is thought that the evi-
dence is sufficiently conclusive in warranting the assertion
that, in the United States, there are more men than women
suffering under mental alienation. Should future observations
demonstrate the truth of this proposition in regard to our
country, and its converse in regard to continental Europe, to
what shall be attributed this difference in the two countries?
We believe the causes of that difference will be chiefly found
in the difference of condition, of the men, with regard to pe-
cuniary affairs, and that of women in society. But it would
be untimely to enter into a discussion of this subject before
the proposition in question be satisfactorily demonstrated.
Dr. Rush believed that the number of insane women is
greater than that of insane men, from the fact that the former
are exposed to several exciting causes from which the latter
are exempt; such are the derangements of the catamenia,
utero-gestation, parturition, and the peculiar situation of their
sex in society. But, on the other hand, it will be found that a
very large proportion of male lunatics are brought to that un-
happy situation by causes from the influence of which females
are either partially or wholly removed. Among these are in-
temperance and pecuniary embarrassments. -
e Civil State.—Georget believes celibacy to be a predis-
posing cause of insanity. S. Tuke, also, considers it as among
those which are the most prominent of this class. There is
much plausibility in this opinion, even admitting it not to have
been founded upon direct observation. Unmarried people are
more liable than others to some of the exciting causes of the
malady; and unmarried females, particularly, are more subject
than those who are married to other nervous affections. Yet,
admitting that there are a greater number of single than of
married persons among the insane, it is still difficult to ascer-
tain positively whether this is to be ascribed solely to the
influence of celibacy. M. Desportes states, that of 1668 insane
10*
114
females, 980 were single, 291 widows, and 397 married; and
of 764 insane males, 492 were single, 59 widowers, and 201
married. - -
The following table, compiled from the reports of several
of the hospitals in the United States, goes to confirm the
opinion of M. Georget.

MIEN woMEN
(/) CZ) … . . *
ASYLUMS. TIME, E ; : ; E 5 : 5.
"3. E. 5: 5 || 3 | E. 5 5.
* |3|#| ||*|| 3 || 3 |"
§ | ?
|Maine State, 24 months 1840, 15| 7 || 22|| 4 || 3 |1| 8
Massachusetts State, 1833 to 1835, 135 68||19| 222|| 83 50 24|157
Wa. State, Staunton, in 1839, 38 11 3| 52|| 21, 18 6 45
Kentucky State, in 1838, 65. 13| 8 86|| 47; 21 22 90
M“Lean, Mass., 1 year, 27, 18 3 48|| 16 12 4 32
Retreat, Connecticut, 3. 119 80 4 203|| 80 86 12|178
Bloomingdale, N.Y., in 1839, 36 29| 2 67|| 15 24 7| 46
Frankford, Pa., 1 year, 27| 18| 3| 48|| 22 6|| 5 || 33
Penn. Hospital, 170. 97.17 284|| 70 97| 35|202
Total, 632|34159.1032.358317.116791
Of the 1823 cases herein reported, 990 had never been mar-
ried, 658 were married, and 175 were widowed. The pro-
portion, in men, of the single to the married is nearly as 2 to 1,
while that in women is as 1.12 to 1; and that in both sexes is
as 1.5 to 1. The number of widows is very nearly twice as
great as that of widowers, a result which might have been all-
ticipated, from a knowledge of the greater susceptibility of the
female mind to the influence of grief. .
115
In the following table, no distinction is made between the
sexes, excepting in the case of widowers and widows.

C/X tº- -
# || 5 || 3 || 3 || 3:
U.S. E. 2 F- || >.
ASYLUMS. TIME, F | #. 3 3 | *
* > g | Jº
ºn
Massachusetts State, 1833 to 1839, 558 374 39 || 63 |1034
Ohio State, 1839 & 1840, 135 100 6 || 17 258
Frankford, Pa., 1817 to 1838, 326|| 234 17 | 57 634
M“Lean, Mass., 556 532| 3 || 4 ||1095|
Total, - 15751240 65 |1413021
The statistics of the Massachusetts State, the Frankford,
and the M*Lean Asylums which are in the former table, are
included in those of the same institutions in the latter table.
In regard to the cases of the M'Lean Asylum, it is believed
that, with the exception of one year, the widowers and wi-
dows are included with the married. Notwithstanding this,
the proportion of the single to the married is as 3 to 2, or
as 1.5 to 1, a result almost precisely corresponding with that
of the former table: its similar correspondence is also perceived
in the ratio of widowers to widows.
Finally, rejecting, in the former table, those numbers which
are included in both, we have a total of 4304 cases, of which
2255 were married, 1726 single, 99 widowers, and 224 wi-
dows. The proportion of the single to the married is as 1.283
is to 1, and that of widowers to widows as 1 to 2.26.
f Education.—An injudicious education is believed by Dr.
Prichard to predispose to mental derangement. “It may be
erroneous,” says he, “in two ways:” (we abridge from the
author) 1st, by too lenient a government, allowing the passions
to act uncontrolled and unsubdued, and never exercising that
wholesome moral restraint which seems necessary to promote
the happiness, as well as to conduce to the integrity of the
health of the individual; and 2d, by over exertion of the men-
tal faculties, and a neglect of the cultivation of the physical
powers and the moral feelings.
116
It is well that so prominent an individual as Dr. Prichard
has raised his voice against the great error in modern educa-
tion included under the second head. It is an evil which, in
our country, exists to too great an extent, and calls loudly
for reform—complete, unsparing, radical reform. And inas-
much as it involves the health and happiness of so great a por-
tion of our countrymen, may we not hope that the subject will
obtain an increased attention among those who have the power
to effect a change?
Sir W. C. Ellis, also, alludes to the errors of education as
contributing to increase the number of lunatics, and deprecates
the modern institutions termed “infant schools,” as being pro-
ductive of injury, by requiring a mental effort too severe for
the brain to bear, with impunity, during the early years of
childhood.
Apoplexy, epilepsy and paralysis are considered among the
predisposing causes of insanity, inasmuch as they induce a pe-
culiar state of the encephalon, upon which this malady may
easily supervene; but the most potent of all causes of this kind
is a previous attack of mania.
2. Eacciting Causes.—The exciting causes of insanity, like
those which predispose to the disease, are divided into two
classes, physical and moral. The number of causes in either
of these classes is so great, and some of them, at the same
time, of so little comparative importance, that it would be of
little utility to enter into a special discussion of each.
a Physical Causes.—Intemperance, the hydra of modern
days, appears to be the most prolific of mental disease of all
the causes belonging to this class. Attesting to the truth of
this, we have the authority of Esquirol, in regard to France,
of Ellis and Prichard, in regard to Great Britain, and of Rush,
Woodward, and others, in regard to the United States. Du-
ring the residence of Dr. Waters in the Pennsylvania Hospi-
tal, one-third of the cases of insanity admitted arose from
intemperance. -
The following statistics of four Asylums will exhibit the
influence of intoxicating liquors, in the production of the
disease:
I17
f Produced by
Asylums. Admissions. intemperance. Per cent.
Turin, 1066 76 7.12–H
Charenton, 1557 134 8.60–H
Massachusetts State, 1034 171 16.53–H
Ohio State, 258 18 6.97+
W.
At Charenton, besides the 134 attributed solely to intoxica-
tion, there are 146 stated to have been produced by “excesses
of all kinds,” which may be supposed to include intemperance
in drinking. --
Masturbation.—Nearly all recent writers upon insanity,
unite in acknowledging that this is a much more prolific
source of the disease than has heretofore been supposed. They
also coincide in the opinion, that the cases produced by it are
among the most incurable, and a great proportion of them sink
into imbecility, fatuity or dementia. Among the best autho-
rities upon this subject are, Sir W. C. Ellis on Insanity,
Esquirol on Mental Diseases, the Reports of the Massachusetts
State Lunatic Hospital, and two treatises, the one entitled
“Hints for the Young, in relation to the Health of Body and
Mind,” and the other, “An hour’s Conference with Fathers
and Sons, in relation to a common and fatal Indulgence of
Youth.” These treatises, although published anonymously,
were written by Physicians who have had extensive experi-
ence in the treatment of the insane.
Climate, season, and profession, are included, by some wri-
ters, among the predisposing causes of insanity. We prefer,
for what we think to be obvious reasons, to place them with
the exciting causes. -
Climate.—It will be found that the number of lunatics is
greatest in those countries which, being situated in the tempe-
rate zone, are subject to the extremes of heat and cold, and to
sudden vicissitudes in the weather.
Season.—The proposition whether any one of the seasons
predisposes, in a greater degree than either of the others, to
insanity, is not yet fully demonstrated.
118
The following table exhibits the number of admissions to
three large Asylums, in each of the respective seasons:
Asylums. Time. Winter. Spring. Summer. Autumn.
Salpêtrière, 1806–1814 531 626 755 592
Charenton, 1825–1834 341 406 445 365
Mass. State, 1833–1839 2 11 306 269 235
Total, 1083 1338 1469 1192
By the evidence of these few statistics, it appears that there
are more admissions to asylums in summer than in any other
of the four seasons; but, inasmuch as patients are, in but a
comparatively small proportion of cases, carried to the asy-
lums immediately upon the invasion of the disease, it cannot
be considered as satisfactory in regard to attacks.
Profession and Occupation.—It is very difficult to deter-
mine in what particular profession or art, man is most liable
to mental disease. Could we ascertain the precise ratio of the
number in each profession to that of the whole population, the
statistics of the asylums, for a series of years, would throw
much light upon the subject. Such occupation as requires
intense mental exercise, or exposes one to sudden changes of
atmosphere, or to any of the active exciting causes of insanity,
would, of course, be the most productive of that disease.
Of 1135 cases treated in American asylums, previously to
1836, those attributed to physical causes were as follows:
Intemperance, 146; various bodily diseases, 103; constitu-
tional, 57; masturbation, 55; hereditary, 40; puerperal, 36;
typhus fever, 10; repelled eruptions, 9; blows on the head, 7;
parturition, 6; structural lesion of the brain, 5; excessive
physical exertion, 4; injuries, 3; epilepsy, 3; insolation, 2;
injury of nervous centre by falls, 2; inflammation of the brain,
2; “change from ordinary to vegetable and abstemious diet,”
2; erythema of the brain, l; malformation, 1; menorrhagia,
1; suppressed menses, l; total, 496. -
Hydrocephalus, vertigo, headache, metallic fumes, inani-
tion, inordinate sexual gratification, severe pain, extremes in
119
heat and cold, worms, dropsy, consumption, and the suppres-
sion of any natural or habitual discharge may be included in
this class of causes.
6 Moral Causes.—Religious excitement and anxiety, re-
verses of fortune, and other pecuniary embarrassments, grief
for the loss of friends, domestic difficulties, intense mental,
exertion, and disappointed affection and ambition, are the most
prominent of the exciting moral causes of insanity.
It is a fact worthy of notice, that of the 1557 cases admitted
at the Asylum at Charenton, and of which the causes of 1375
are assigned, not one is attributed to religious doubt, anxiety
or perplexity. On the other hand, of 678 cases treated at the
Massachusetts State Lunatic Hospital, no less than 53, equal
to 7.81 per cent, are stated to have arisen from those causes.
Ellis, in speaking of the general paucity of cases arising
from these causes, in continental Europe, accounts for the fact
by the prevalence of “infidelity among the higher orders,”
and “ignorance and blind superstitious obedience to the dic-
tum of the priests, among the lower classes,” together with
the fact that religious discussion is prohibited in some of the
continental countries.
The predominating cause of the disease in the patients of
the Asylums at Wakefield and Hanwell, in England, is po-
verty and pecuniary difficulty; and, what is a lamentable fea-
ture in regard to these cases, they are mostly among the
honest and industrious. These institutions being devoted
especially to the indigent, it is not remarkable that this cause
should bear a greater relative proportion, than in asylums of a
different character. *
In 1827 it was estimated that of 14,000 lunatics in England
and Wales, 11,000 of them were in indigent circumstances.
In the state of New York, in 1825, of 967 lunatics, 382 were
supported by charity, 312 possessed the means of subsistence,
and 273 were unclassified in this respect; and of 1484 idiots,
514 were supported by charity, 549 supported themselves,
and 421 were unclassified. In the same state, in 1837, no
less than 652 lunatics were either relieved or supported by
charity. -
120
Grief for the loss of friends is much more productive of
mental derangement in women than in men; and, in them, the
origin of the grief is most frequently the loss of children.
Of the 1135 cases mentioned under the head of physical
causes, the moral causes, so far as known, were as follows:—
Religious 70, domestic trouble 60, reverse in fortune and other
pecuniary difficulties 56, loss of friends 46, mental application
34, disappointed affection 28, disappointed ambition 11, “dis-
appointment” 11, indulgence of temper 8, care and anxiety 7,
jealousy 5, austere parental government 4, fright 2, mortified
pride 1, “agitation on the approach of matrimony” 1, “meta-
physical hair-splitting” 1, “predisposition excited by novel-
reading” 1. Total 346. %
Thus it appears that of the 1135 cases, 496 were produced
by physical causes, 346 by moral causes, and in 220 cases the
origin was unknown.
In Europe, it is generally believed that a greater number of
people become insane from moral than from physical causes.
The truth of this, if applied to the United States, is doubted,
although our statistics are not sufficiently complete for a satis-
factory demonstration. It is extremely difficult for the physi-
cians of lunatic asylums to ascertain either the proximate or
the immediate causes of the disease, in many of their patients.
In some cases it is unknown by the friends of the individual;
while, in others, although known, a concealment is induced by
motives of friendship. We submit that, for the facility of the
physician in obtaining that accurate knowledge of the disease
upon which, alone, he can establish a rational treatment, as
well as for the advancement of our knowledge in relation to
the disease in general, such motives ought to be entirely waived.
Among the moral causes unenumerated, but mentioned by
several authors, are avarice, joy, terror, anger, shame, guilt,
defamation, calumny, ridicule, absence from native country,
loss of liberty, loss of beauty, love of praise, gaming, and “the
complete gratification of every wish of the heart.”
Dr. Rush believed that the study of the mechanic and other
arts is more liable to induce insanity than that of the sciences.
Among those who have suffered from similar studies, have
121
been many who have followed, with a zeal worthy of a better
cause, that “shadow of a shade,” the Utopian perpetual-motion.
It is said that instances of insane priests, artists, sculptors,
poets and musicians are numerous, whereas no case is known
to have occurred among naturalists, geometricans and chemists.
Further investigations are required before the latter clause of
this proposition can be received as an established truth. In
regard to a part of the former clause, it may be mentioned that
an acquaintance of ours asserts that in order to write poetry a
person “must be a little crazy.” * - º
Fear has driven people to madness; it has blanched the
darkest hair in the course of a few hours, and it has proved
fatal to existence. Ellis relates a painfully interesting case of the
effect last mentioned, which, as a useful warning, is worthy of
being known. “A melancholy instance,” says he, “of the effect
of terror happened a few years ago, in the north of England.
A lady had gone out to pay an evening visit, at which she was
expected to stay late. The servants took advantage of the
absence of the family to have a party at the house. The nurse-
maid, in order to have enjoyment without being disturbed by
a little girl who was entrusted to her care, and who would not
remain in bed by herself, determined to frighten her into being
quiet. For this purpose, she dressed up a figure and placed it
at the foot of the bed, and told the child if she moved or cried
it would get her. In the course of the evening the mother’s
mind became so forcibly impressed that something was wrong
at home, that she could not remain without going to ascertain
if any thing extraordinary had occurred. She found all the
servants dancing and in great glee; and, on enquiring for the
child, was told that she was in bed. She ran up stairs and
found the figure at the foot of the bed, where it was placed by
the servant, and her child with its eyes intently fixed upon it,
but, to her inexpressible horror, quite dead.”
It has been denied that political excitement and changes
have given rise to insanity. Without reference to other au-
thority upon the subject, I would adduce the 28 cases men-
tioned by Esquirol among those who, in 1830 and 1831, were
admitted into the asylum at Charenton. There had not been
1 1
122
an individual case of the kind during the four years previous
to 1830. Even admitting political causes, abstractly con-
sidered, to possess no direct tendency to the production of
insanity, still the consequences which but too often result from
them, must inevitably exercise a powerful influence to that
effect. Such are mental anxiety, the loss of property and of
friends. Who can for a moment doubt that, at the time when
France was menaced by powerful foes upon every hand; torn
by dissensions, and bleeding under a civil war; when hundreds
of princely estates were confiscated, and all the rich were
compelled to relinquish, not only a tithe, but a third part of
their wealth, to support political movements to which they
were opposed; when the country was filled with guillotines,
and whole cities were doomed to destruction; that there was a
greater tendency to mental alienation than in the time of peace
and political quietude? The following is an interesting case of
derangement which occurred during the difficulties alluded to
in France. It is related by the Viscountess Beauharnais, after-
wards the Empress Josephine.
The Abbé Capdeville became interested in an English
orphan, eight years of age, and took him to educate. The boy,
who, in the account, is called Tommy, was so kindly treated,
that he conceived a strong attachment for his benefactor. At
length, the Abbé was imprisoned in the Carmelites, and Tommy
obtained permission to be shut up with him. One day, when
the Abbé and other priests, his fellow prisoners, were at prayers
in the chapel connected with the building, a mob of revolu-
tionists broke into the place. Tommy took a station beside
the kneeling Abbé, and would not remove. “The ruffians
having forced open the doors, and broken the windows, pene-
trated by several points at once; the pavement of the chapel,
and the steps of the sanctuary, were speedily inundated with
blood. Capdeville, struck immediately after the bishop, fell
at his feet, and, extending a mangled hand to Tommy, expired
as he looked upon him. That look was a last blessing.
“Already the poor youth, or rather child—for he is not yet
sixteen—exhibited unequivocal symptoms of alienation of
mind: on the death of his friend, a fixed insanity appeared.
*.
123
The unfortunate Abbé, who had knelt apart from his compa-
nions in martyrdom, having been engaged in officiating, had
fallen with his head supported on the upper step of the altar,
and his body extended across the others; the left hand was
pressed against the heart, and the right, as I have already said,
extended towards his pupil. The blow which had finally de-
prived him of life, had been so rapid in its operation, that
death had not effaced the habitual expression of benevolence
which lighted his placid countenance. He seemed to smile
and slumber. By some sudden changes in the reasoning facul-
ties, Tommy became convinced that his friend slept. Instantly,
as if by enchantment, the scene of slaughter disappeared from
before his vision; he knelt down by the side of the bleeding
corpse, waiting its awaking. After three hours of watching,
and as the sun sank down below the horizon, Tommy went to
seek his harp, and again sat down beside the remains of his
friend, playing melancholy airs in order to hasten his awaking,
which appeared to him long in taking place. While thus em-
ployed, sleep stole over his ºwn frame, and the charitable
hands that removed from the despoilers the bodies of the
martyrs, carried away Tommy, and laid him on his bed.
There he remained eight and forty hours in a kind of lethargy,
whence, however, he awoke with all the appearances of sound-
ness of body and mind. But, if health had been restored,
reason had fled forever.
“In commemoration of his pious madness, a free asylum has
been granted to him in this house, where he passes the day in
silence till each afternoon at three o’clock. The moment that
hour strikes, Tommy, who ordinarily walks slowly, runs to
seek his harp, upon which, leaning against the ruins of the
altar still remaining in the chapel, he plays his friend’s favour-
ite airs. The expression of his countenance, on these occa-
sions, announces hope; he seems to expect a word of approba-
tion from him whose remembrance he cherishes: this hope and
this employment continue until six o'clock, when he leaves off
abruptly, saying ‘Not yet, but to-morrow he will speak to his
child.” He then kneels down, prays fervently, rises with a
sigh, and retires softly, upon tiptoe, that he may not disturb
124
the imaginary repose of his benefactor. The same affecting
scene takes place day after day; and, during the intervals, the
poor boy’s faculties seem completely absorbed, till the fatal
hour calls forth the same hopes, detimed forever to be chilled
by the same disappointment.”* - -
It is a fact worthy of notice that, as a general rule, insanity
is but little known in those countries the inhabitants of which
are either in a savage or a barbarous state of society; whereas
it prevails to the greatest extent in nations occupying the
highest rank in civilization. The celebrated traveller, Baron
Von Humboldt, found but few cases among the aborigines of
America. It is rare, also, among the negroes of the West In-
dies. The peasantry of Wales, the natives of the Hebrides,
and of the most secluded parts of Ireland, are almost entirely
free from it. It is comparatively infrequent in Spain and Por-
tugal, although idiocy is very common in those countries. In
Russia and in China, it is said that it but seldom occurs; but,
in regard to the British East Indies, Sir Andrew Halliday
says, “Insanity is a frequent disease among the natives of every
caste. The attacks are generally sudden and often violent;
but, under proper medical treatment, they are easily removed.”
In the hospital at Cairo, Egypt, a city of 300,000 inhabi-
tants, Desgenettes found but fourteen persons afflicted with
disorders of the brain and the nervous system. In Greece, at
the present day, there are very few who are insane. There is
no asylum for their treatment in that country, and there were
no patients of the kind in the hospitals of Athens in the au-
tumn of 1838. In Turkey, also, the number of the insane is,
undoubtedly, very small, although we have no accurate data
upon the subject. The people of that country are, however,
to a greater or less extent, exempt from the influence of some
of the most potent causes of the disease in the United States
and the nations of the west of Europe. 1st. The Turks are a
pre-eminently temperate people, 2d. They avoid the sallies
of uncontrolled passion, and preserve a remarkable degree of
* Vide Memoirs of the Empress Josephine, by John S. Menres, LL. D.
Harpers' edition, p. 88 to 93. - -
I25
equanimity of temper. 3d. Reverses of fortune operate less
powerfully upon them than upon some other people; both be-
cause a misfortune of that kind is considered as a decree of
Allah, and because, with a loss of fortune, a person does not
lose his station in society. 4th. They probably are less affected
by religious anxiety, doubt and perplexity. The practical
religion of Małomet chiefly consists in the observance of cer-
tain ceremonies, having fulfilled which, the Turk rests satisfied
that he has performed his duty. It will be perceived that,
under these four heads, are included three, at least, of the
most powerful causes of mental derangement.
We possess but very little accurate knowledge in reference
to the number of lunatics in different nations. The following
table, compiled from various authorities, exhibits, in a condensed
form, the principal data upon the subject. It is extracted from
a review of Esquirol on Mental Diseases in the American
Journal of the Medical Sciences: -
Population. No. of Insane. Proportion.
England, 12,700,000 16,222 I in 793
Scotland, 2,093,503 3,652 < * 4 & 563
France, 32,000,000 32,000 “ “ 1,000
Norway, 1,051,300 1,909 << * , 551
Belgium, 3,816,000 3,763 “ “ 1,014
Holland, 2,302,000 2,300 “ “ 1,046
Italy, 16,789,000 1,441 “ “ 4,879
Spain, - 4,085,000 569 “ “ 7,181
United States, 12,866,020 16,000 * * * * SOO
Westphalia, . g º º º tº << * * 846
Saxony, © º o ſº & ... < * * * 968
The following, from the same source, exhibits the similar
statistics of several large cities.
- Population. No. of Insane. Proportion.
London, 1,400,000 7,000 1 in 200
Paris, 890,000 4,000 4 & 6 & 222
Petersburg, 377,000 120 “ “ 3,133
1.1%
126
Population. No. of Insane. Proportion.
Naples, 370,000 : 479 1 in 759
Cairo, 330,000 14 “ “ 30,714
Madrid, 204,000 60 “ “ 3,350
Rome, 154,000 320 << 3 & 421
Milan, 151,000 618 4 & 6 & 242
Turin, 114,000 331 & “ 344
Florence, 80,000 236 & 4 & 6 338
Dresden, 70,000 150 “ . . 466
In a recent work by Professor Vander Kolk, of the Univer-
sity at Utrecht, it is asserted that there are 1828 lunatics in
the several provinces of Holland. The population of the same
territory is 2,253,796; which gives 1233 inhabitants to 1 lu-
natic. The proportion of insane is small; if it be correct, the
comparative exemption from the disease may, in part, be attri-
buted to the general sobriety of the people, and their somewhat
phlegmatic temperament. - .
The population of the islands of Malta and Gozo is 120,000.
Of this number, 130, or 1 in 920, are insane. In most of the
New England States, the proportion was formerly believed to
be about 1 in 1000. More recent investigations have proved
this estimate to be too low. In the following table are includ-
ed, with others, the most recent and accurate estimates that
have been published in regard to several of the States of the
American Union. :
- Population. No. of Insane. Proportion.
Holland, 2,253,794 1,828 1 in 1,233
Malta and Gozo, 120,000 130 << & 920
New Hampshire, 280,000 600 “ “ 466
Massachusetts, 612,000 1,000 “ “ 612
Connecticut, 298,000 700 * << 425
New York, . tº º * > sº º “ & 887
Pennsylvania, 1,348,233 2,000 « & 674
Virginia,
1,200,000 800 “ “ 1,500
127
In some of these estimates, idiots are included with the in-
sane; in others they are excluded.
In Scotland the greatest proportion of insane and idiots is in
the counties of Perth, Aberdeen, Lanark, Inverness, Nairn,
Banff, Fife and Kinross, and in the mainland of Argyle and
the island of Bute.
In England, the disease is more prevalent in the counties of
York, Wilts, Stafford, Durham, Rutland and Gloucester, than
in any other parts of the country. The greatest proportionate
number of lunatics and idiots is in Rutland, where there is 1
for every 497 persons; and the smallest number in Lancashire,
where there is but 1 for every 1960 persons. In Wales the
number of insane, relative to the whole population, is very
small. The remark is also applicable to the Celtic tribes in t
other parts of Great Britain; and, where there is a union of
Celtic with Saxon and Norman blood, the disease is scarcely
known, except in cases of anormal structure, or malformation
of the cranium. In these instances the individuals are idiotic.
We have a remarkable example of endemic idiotism in the
cretins of some of the cantons of Switzerland. Esquirol asserts
that, in the southern provinces of France, the number of insane
men exceeds that of insane women, while the reverse obtains
in the provinces of the north.
Duration.—The duration of insanity varies from a few
days, in one extreme, to forty, fifty, and even sixty years in
the other. The average time is said to be about thirteen and
a half years, but it cannot fail of being materially diminished
by the modern enlightened mode of treatment. Individual
cases may, perchance, be even prolonged; not, however, by
any injury arising from the treatment, but from a mitigation
in the severity of the disease by which the day of death is
postponed. In a memoir presented to the French Institute,
M. Pinel states that more are cured during the first month of
the disease than in any one of the succeeding, and that the
average duration of those that are cured is from five to six
months. M. Esquirol and S. Tuke give a longer period as
the mean time of continuation. The former says, that of 2,005
females admitted at the Salpêtrière, Paris, the greatest number
I28
of cures was effected in the first two years, and that the ave-
rage was “somewhat short of a year.” The probability of a
recovery after the third year, is considered as about one to
thirty. “I have constantly observed,” says Dr. Prichard,
“that in the course of the first month, a very marked remis-
sion takes place” in the disease. He supposes that at this
time the acute form of the disease is exchanged for the chronic.
From these statements we may infer that, if uncomplicated
with any other functional disease, and unaccompanied by an
organic lesion of the brain, the natural period of acute mania
is brief. e
Termination.—Insanity terminates in a restoration to
health, in futuity, or in death. -
Curability.—The proportion of cures varies according to
the age and sex of the patients, the cause of the disease, the
disorders with which it may be complicated, the treatment, &c.
&c. The probability of recovery is greater in young than in old
people. According to M. Esquirol, few recover who are more
than sixty years of age. The same author asserts that the pro-
portion of cures is greater in France than in England. To
demonstrate the truth of this, he collects the statistics of four
asylums in England and compares them with those of his own
practice in three asylums of Paris.
No. of patients. Recovered. Per cent.
Four Asylums in England, 16,516 5918 35. 7
Three “ in Paris, 5,360 2691 50.2
* Dr. Burrows denies the truth of the assertion which these
statistics are intended to prove.
The proportion of recoveries in various institutions, in both
the United States and other countries, may be seen in the fol-
lowing table.
No. of Recover-
French Asylums. Time. patients, ed. Per ct.
Charenton, From 1798 to 1803 596 194 32.55
66 . . ** 1826 to 1834 1205 516 42.82
Salpêtrière, “ 1801 to 1813 3007 1625 54.04
Esquirol’s private, unknown. 335 173 51.64
129
British Asylums.
Bethlehem,
66
66
6 &
Saint Luke's,
Wakefield,
Lancaster,
Stafford,
Retreat, near York,
York, at York,
Cork, Ireland,
Time.
From 1684 to 1703
“ 1748 to 1794
66 in 1813
“ 1819 to 1833
<< 1751 to 1801
<< 1819 to 1836
<< 1817 to 1832
unknown
<< 1796 to 1835
<< 1815 to 1837
20 years
Other European Asylums.
Amsterdam, Holland,
Utrecht, & 6
Turin, Italy,
Aversa, “
23 years
<< 1832 t0 1837
<< 1827 to 1836
** 1813 to 1833
American Asylums.
Pennsylvania Hospital,
Frankford, Pennsylvania, “
& 4 § {
Bloomingdale, N. Y.,
Bellevue, 6 &
M“Lean, Mass.,
Retreat, Conn.,
Massachusetts state,
Maryland, & 6
Virginia state, Staunton, “
66 6 & & 4
Ohio, state,
The average per cent, as exhibited by this table, is,
<< 1752 to 1836
1817 to 1838
<< 1838 to 1839
<< 1821 to 1835
<< 1791 to 1821
<< 1818 to 1834
<< 1824 to 1839
<< . , 1833 to 1840
** 1835 to 1840
1828 to 1836
<< 1836 to 1839
<< 1839 to 1840
No. of Recover-
patients... ed.
1294 890
8874. 2557
422 204
2445 1124
6458 2811
2242 991
1750 697
1000 429
508 236
II 31 387
1431 751
163 56
255 104
1066 466
3897 1514
41.16 1349
507 214
235 141
1915 828
1553 704
1015 362
1001 563
1196 506
393 135
79 13
78 34
80
258
Per ct.
69.77
28.81
48.34
45.56
43.52
44.20
39.82
42.90
46.43
34.21
52.48.
34.35
40.78
45.59
38.85
32.77
42.21
60.00
43.23
45.33
35.66
56.24
42.30
34.35
16.45
43.59
31.00
for the
French Asylums, 45.26; for the British, 45.01; the other
European, 39.89; and for the American, 40.26.
The difference in the proportion of cures, at the several
asylums is, in reality, less than appears by this table; for the
number of patients given is, in some instances, that of all ad-
mitted; while, in others, it is that of the discharges alone.
Again, the difference actually existing, is owing, in no incon-
130
siderable degree, to the diversity of character in the institu-
tions themselves. While some of them are intended exclu-
sively for paupers, and are consequently compelled to admit
every applicant of that class, of what age, grade or condition
soever he may be; others have the power of rejecting such
cases as they please, and restricting their admissions to those of
a certain character. This difference exists in both Europe and
America. St. Luke’s and Bethlehem Hospitals, in London,
reject all persons “who have been insane more than a year,
those affected by paralysis and epilepsy, and the aged and
feeble.”
It is probable that there is an error in the statistics of Beth-
lehem Hospital, from 1684 to 1703. If there be not, the
patients must have recovered in spite of their treatment, or the
institution must have been far superior to what it was a century
later. - . -
Those asylums which have but recently commenced opera-
tions, suffer much by a comparison with the others, if the per
cent. of cures is reckoned upon the whole number admitted.
The Ohio State Lunatic Asylum furnishes an example of this
kind. The number (258) in the table, is that of all the patients
admitted. The per cent. of cures, upon these, is only 31;
while, if calculated upon the discharges, it would have been
66.66. & . *
It was left for the physicians of the present age to demon-
strate, that as great a proportion of patients suffering under
acute mania may be cured as of those of any other acute
disease. This has been satisfactorily proved. A great remiss-
ness, however, exists upon the part of the friends of this
unfortunate class of the community, in neglecting to place them
in a hospital during the earliest stages of the malady. “It fre-
quently happens,” says the eighteenth report of the Asylum at
Frankford, Pennsylvania, “that applications for admission into
our asylum are not made until after the most promising period
for recovery has elapsed.” Similar complaints are urged in
the reports of other hospitals.
131
The following table exhibits the advantage of early treat-
ment.
Per ct. of cures Per et. of cures
Asylums. Time. in recent cases. in chronic cases.
Dr. Burrows', 91.32 35.18
Vermont State, 3 years 89. 28.02
65 & 6 1840 8S.20 28.05
Massachusetts State, 1833 to 1840 87.25 19.05
& 6 66 in 1840 91.25 22.05
Ohio State, 1839 & 1840 85.50 41.17
Bloomingdale, in 1839 83.87 25, 39
Retreat, Conn., 6 years 75.95
& 6 6& 4 years 91.60 25.83
The average per cent. of the recent cases is 87.10, while
that of the chronic cases is but 28.28. The term “recent” is
generally applied to all cases of less than one year in duration,
and “chronic” to all others. This signification of the terms
is recognised in all the above mentioned asylums, excepting
the Connecticut Retreat. In that institution I think the term
“recent” is restricted to cases of less than three moriths dura-
tion. |
A large majority of recoveries are complete and permanent,
others are apparently complete, but the patient remains in a
condition from which he may very easily relapse, if exposed
to exciting causes. In many cases of perfect restoration to
physical health and energy, the persons are incapable of sus-
taining their former intellectual rank. Diseases of the nervous
system are peculiarly liable to relapses. When the integrity
of this dynamic apparatus has been destroyed, it is restored
with more difficulty than is that of any of the other systems
of organs in the human economy. Pinel and Desportes state
the proportion of relapses at one-sixth the number of original
cases; at the Salpêtrière it was one-seventh.
Fatuity.—The state of patients whose disease has had this
unfortunate termination, is different from that of idiots, or of
those who are in the imbecility sometimes attendant upon old
age. Dr. Prichard divides fatuity into two grades, 1st, De-
mentia, and 2d, Amentia.
132
1st. Dementia. This is the “démence” of M. Esquirol and
Georget, and is that state in which the physical and mental
powers have become overpowered or exhausted by the force
of the disease. From an intense excitement the patient relaxes
into a state of quietude, ominous of a decay of mental vigour;
memory is obliterated, the patient becomes inactive, thought-
less, unobserving, and perhaps utters
“A hollow laugh or melancholy song,”—
the former a painful evidence of mental vacuity and imbecility,
the latter, as it were, a requiem over the departed powers of
that spirit which alone elevates man above “the brutes that
perish.” Some appear to recollect their friends, but all affec-
tion for them is annihilated. Some are capable of performing
light manual labour, others are not. Physical health is gene-
rally good, digestion and assimilation being unimpaired. A
few instances of recovery are on record.
2nd. Amentia. We have here arrived at the most abject
state of mental imbecility. Reason, entirely dethroned, has
left no trace of her once having occupied the palace which she
has deserted. Man, “the lord of the universe,” entirely di-
vested of his mental and moral energies, becomes a mere vital
automaton, moving by the force of its organic life, and directed
by the capricious impulse of the moment. Many patients in
this state remain motionless, perchance, during the day, their
eyes fixed upon the ground, as if unconscious of the things or
persons around them, or even of their own existence. They
would not retire to bed nor rise were they not forced to do it
by their attendants. -
3d. Death. “Madness,” says Prichard, “cannot be reckon-
ed among the diseases which are very dangerous to life.” But
if, as he declares in another place, “lunatics are subject, in a
much greater proportion than other people, to apoplexy,
paralysis, epilepsy, and all the train of symptoms depending
on different degrees of cerebral congestion;” if, as is the fact,
acute insanity produces great exhaustion and prostration of
physical energy, and if “diseases of the thoracic and abdominal
viscera, and a cachectic or scorbutic state of the system” be its
133
sequelae, then must he, and every other person, acknowledge
that if not “very,” it is somewhat “dangerous to life.” The
following table exhibits the ratio of deaths to the number of
patients in several asylums. f
Asylums. Time. No. of patients. Deaths. Per ct.
Hanwell, England, From 1832 to 1837 3327 418 12.56
Lancaster, “ “ 1832 to 1837 2148 522 24.29
Wakefield, “ ** 1818 to 1836 2242 709 31.64
York, 66 ** 1777 to 1814 2635 399 16.80
66 - 66 ** 1815 to 1837 1131 217 19.27
Retreat, York, “ ** 1796 to 1836 508 113 22.22
Charenton, France, ** 1826 to 1833 2049 546 26.64
Salpêtrière, “ ** 1801 to 1804 1002 250 4.95
66 & 6 ** 1805 to 1813 2804 790 28.17
Bicêtre, 66 ** 1784 to 1794 1405 685 48.75
Aversa, Italy, - “ in 20 years 3897 1222 31.35
Amsterdam, Holland, ** 1832 to 1837 255 55 21.56
Penna. Hospital, U. States, “ 1752 to 1836 4116 548 13.31
Bellevue, N. Y. “ ** 1791 to 1821 1553 154 9.91
Bloomingdale, “ £6 ** 1821 to 1835 1915 146 7.62
Frankford, Pa. 66 ** 1817 to 1838 634 90 14.19
Maryland State, 66 ** 1835 to 1839 393 34 8.65
Retreat, Connecticut, “ ** 1824 to 1839 1001 60 5.99
Massachusetts State, “ ** 1833 to 1840 1196 90 7.50
Ohio State, 66 ** 1839 to 1840 258 22 8.52
Kentucky State, £ 6 ** 1824 to 1838 627 238 37.95
The average of the deaths in the British Asylums is 21.13
per cent.; in the French 32.12 per cent.; in the American
12.62 per cent.; in the American, rejecting the Kentucky State
Asylum, 9.33 per cent. .
Among the immediate causes of death other than insanity
itself, the following diseases are reported as being the most
numerous, viz:—Apoplexy, paralysis, epilepsy, phrenitis, con-
vulsions, tumour of the brain, phthisis pulmonalis, pleurisy,
pneumonia, hydrothorax, organic affection of the heart, hydrops
pericardii, gastritis, schirrus of the pylorus, organic lesions of
the liver, diarrhoea, typhus fever and marasmus. It is evident
that the insane are equally liable with others to the invasion of
most of the diseases which afflict mankind.
12 *
134
Treatment.—The treatment of insanity is divided into, 1st,
medical, and 2d, moral. Of the former nothing will here be
introduced; the latter alone will receive attention.
Among the many benevolent institutions which have origi-
nated as almost legitimate consequences of superior civilization,
more extensive and widely diffused knowledge, and a more
enlightened philanthropy, not the least beneficial in their re-
sults are those which have for their object the amelioration of
the condition of the insane. Formerly, the unfortunate indi-
vidual subject to maniacal hallucination was supposed to have
violated the laws of heaven, and thus incurred the displeasure of
a Creator, the phials of whose wrath were consequently poured
out, in this form, upon the offender. But the sentiments of
the community have changed. The lunatic is no longer “a
reproach and a bye-word,” his family are no longer shunned as
being partially implicated in his unknown offence; but, as a
sufferer under one of the most afflicting maladies to which our
race is subject, the former receives that kindness and attention
which the human heart, alive to the sufferings of our fellows,
so well knows how to bestow, while the latter partakes of the
fountain of sympathy gushing from a thousand bosoms. The
sufferings to which maniacs were formerly, and, in too many
instances, still are, subjected, sufferings which place recovery
beyond hope, their imprisonment and confinement in dungeons,
their tortures under manacles and chains, their deprivation of
food, of clothing, and of all the comforts of life, are such that
we are almost struck with horror at their recital. The noble
philanthropist, M. Pinel, to whose untiring exertions the luna-
tics of France are indebted for an amelioration of their condi-
tion, has given a thrilling description of the vast accumulation
of misery, which, during his investigations, was presented to
his view. In England and Scotland, although some hospitals
existed, the wretchedness and inhumanity, were, according to
Halliday, previously to 1815, equally great. In “Bedlam,”
or Bethlehem Hospital, in London, at that time, the patients,
“as wild beasts, were shown for sixpence for each person ad-
mitted.”
A fundamental error formerly existed with regard to the
135
nature of insanity; it was believed that the mind is itself dis-
eased, instead of the organ through which it is manifested.
But disease is the minister of death, and the mind, a scintilla-
tion from the fire of Heaven, being free from the power of the
latter, is consequently exempted from the encroachments of
the former. It is, therefore, now acknowledged that insanity
is produced by a cerebral lesion, and that, too, generally of a
functional nature; it necessarily follows that the disease is
within the reach of remedial agents. But chains and a dun-
geon are miserable prescriptions to a pathological state of the
most delicate organ of the human frame, an organ which is
called constantly into action by an invisible, but powerful and
controlling agency. Experience has fully attested the truth
of this assertion. It has also proved that mild and gentle
means, pleasing amusements, light labour, and affectionate
treatment, by those around the patient, are powerful auxiliaries
in promoting a cure. Since this has been demonstrated, the
number of Lunatic Asylums has greatly increased, for, in those
institutions, the system of treatment can be more completely
adopted than in most private families. England, Scotland,
Ireland, and most of the countries of continental Europe are
supplied to a greater or less extent with these institutions, and
there are several of the kind in Southern Asia. Our country
has caught the spirit, and is imitating the good example of her
transatlantic sisters. Already we have no less than seventeen
Lunatic Asylums in operation. In these, or in such of them
as are of the most approved construction, the patients are clas-
sified according to the degree of their mental alienation, thus
making three divisions; 1st, those in whom the disease is vio-
lent and unabated; 2d, the milder and the convalescing; and
3d, the convalescent. The individuals of each class occupy a
suit of rooms communicating with each other by a common
hall, and also with a yard in which they are permitted to ex-
ercise at suitable hours. The different classes have no com-
munication with each other. The patients are treated medi-
cally whenever such treatment is necessary; but, as in the
European asylums, the management of all cases, indiscrimi-
nately, in this manner, has been abolished. The physician
136
now endeavours “to combine moral and medical treatment,
founded on the principles of mental philosophy and physi-
ology.” Hence, in many cases, a simple, but wholesome and
nutritious diet has supplanted the long category of medicines
which have sometimes been employed.
It is now conceded by all who are best acquainted with the
management of the insane, that the first element in their mo-
ral treatment is their removal from acquaintances and former
associations. One prominent advantage in such removal is the
promotion of the second element of treatment, that of with-
drawing the mind from its hallucinations, and attracting it
into a new current of thought. For the full accomplishment,
however, of this latter object, after the removal to a suitable
place has been made, the almost unremitting attention of judi-
cious caretakers is required. New objects must be presented
to the view, new incentives to the mind, and no expedient
which would be likely to attract the attention and divert the
thoughts must be left untried. Hence, in those institutions for
the treatment of this disease which have recently been estab-
lished, as well as those older establishments which have kept
pace with the progress of knowledge, manual labour, in many
of its forms, amusements, and sources of literary and scien-
tific entertainment and instruction, have been introduced among
the patients. In short, instead of being degraded to a level
not only with criminals, but with the brute creation, and con-
sequently shut out from association with mankind, and placed
beyond the influence of kindness and of sympathy, the insane
are now treated as intelligent and immortal beings, the affec-
tions and sympathies of whose hearts are still alive to the in-
fluences which operate upon those of mankind in general.
Labour.—“We have seen,” says one of the reports of the
M“Lean Asylum, Massachusetts, “the very best results from
labour. Patients who, without it, were noisy and trouble-
some, have become quiet with it. One patient, who was
brought to the institution in irons, and who, until employed,
was constantly raving and excited, when furnished with occu-
pation became quiet.” At the Massachusetts State Lunatic
Hospital, in 1839, no less than one hundred and seventy-nine
137
patients were employed in manual labour. The superinten-
dent of that institution says, in his seventh report: “Of the
benefit of labour, both for the curable and incurable insane, we
have been long impressed. It promotes health, induces sleep,
favours self-control, satisfies the individual of the confidence
reposed in him by the officers of the institution, and produces
quiet and contentment.” -
At the Pennsylvania Hospital, the Asylums at Frankford,
New York and Hartford, and at the state institutions of Maine,
Vermont, Maryland, Virginia and Ohio, the patients are in-
duced to labour; and testimonies in favour of the utility of the
practice might be adduced from nearly all of them.
In Europe similar sentiments prevail. “As employment,”
says Sir Andrew Halliday, speaking of the patients of the Ar-
magh Asylum, Ireland, “is now generally allowed to be the
best restorative, every means has been used to promote it.
Such as are at all capable among the females are constantly
employed in plain work, spinning, &c.; and the division in
which this is going on is remarkable for its regularity and
cheerfulness.” At the Middlesex County Lunatic Asylum, at
Hanwell, England, in 1837, of 600 patients, more than 400
were constantly engaged in some useful occupation.
In reference to this element of moral treatment, Samuel
Tuke remarks, “The employment should, as far as it is prac-
ticable, be adapted to their (the patients’) previous habits, in-
clinations and capacities.” He prefers that in which the indi-
viduals will excel, and the useful rather than amusing, as
affording to the patient “a calm feeling of satisfaction.” “It
is related,” says the same author, “of an institution in Spain,
which accommodated all ranks, and in which the lower classes
were usually employed, that a great proportion of these reco-
vered, while the number of grandees (that recovered) was ex-
ceedingly small.”
M. Brierre de Boismont, in a recent work, speaking of the
patients at the Bicêtre, Paris, says, “The convalescent maniacs
have this year excavated large quantities of earth: they have
engaged with pleasure in farming, and have kept a laundry in
operation. More than one hundred and fifty of them are
12*
I38
employed in throwing up terraces, in masonry, gardening, the
manufacture of locks, making plaster, cabinet-making and car-
pentry.” Dr. Ferrus, who has long had the medical charge
of the patients in the Bicêtre, in speaking of labour, says, “I
have made, myself, on a large scale, a happy experiment of its
efficacy as a means of both discipline and cure. The recove-
ries have been more rapid, and the relapses more rare.”
Similar testimony might be adduced from the Asylum of Son-
nenstein in Prussia; from those of Turin and Milan, in Italy,
and from various institutions of the kind in France and Great
Britain. -
It is a remarkable fact that, although farming implements
and edged tools have, for many years, been entrusted to the
insane, there is not a single instance on record of any serious
injury having arisen therefrom.
Religious Worship.—Some of the asylums of both Europe
and America have a regular chaplain connected with them;
while, in others, religious services are performed under the
direction of clergymen who volunteer their services. There
are but four institutions, in this country, in which there is not
some religious devotional exercise; and, wherever this duty
has been observed, it has been accompanied by beneficial re-
sults. “Regular religious teaching,” says Dr. Woodward, “is
as necessary and beneficial to the insane as to the rational
mind: in a large proportion of the cases it will have equal in-
fluence. They as well know their imperfections, if they will
not admit their delusions; and they feel the importance of
good conduct, to secure the confidence and esteem of those
whose good opinion they value.”
Dr. Bell, of the M*Lean Asylum, says, “The regulated,
discriminating and cautious attention to the exercises of reli-
gion, is so valuable an auxiliary to the moral means of treating
diseased mind, not less from its specific influences on the heart
and feelings, than of its administering to the self-control of the
individual, that we have rejoiced to see the experience of this
institution adopted into others.”
" Dr. Rockwell, of the Vermont State Asylum, remarks, that
“much of the good effect of religious worship depends upon
139
the prudence and discretion with which it is managed. We
consider the judicious employment of religious exercises an
important part of our moral treatment. They serve to pro-
mote order, revive former grateful habits and associations, and
recall into exercise that self-control which tends to their reco-
very. That religion which breathes peace on earth and good-
will to men, and whose cheering influences extend beyond the
grave, affords solace and consolation to the insane, as well as
comfort to the rational mind.” -
Dr. Awl, of the Ohio State Asylum, observes, “We are
fully prepared to add our testimony to the importance and
value of religious exercises, with the insane, as a special means
of grace, well calculated to bring light and wisdom to the
mind, relief and peace to the heart and conscience.”
Jłmusements. –It is universally acknowledged that suitable
amusements are efficacious adjuvants in restoring the excited
and deluded minds of the insane to their healthy standard of
calmness and accuracy of perception. Hence, in nearly every
asylum, whether foreign or domestic, the means are furnished
by which the patients may engage in a diversity of games.
Entertainment is afforded by an occasional tea-party or dancing-
party, and the means of intellectual gratification and instruc-
tion are supplied by books, newspapers and magazines. Those
patients who have a particular taste or predilection for any
special science, or in whom such taste can be awakened, ought
to be supplied with the means of pursuing it. At the Frank-
ford Asylum, during the past year, a gentleman who had been
several months under medical treatment, became, by an inci-
dental circumstance, interested in botany. He immediately
commenced the study of it, devoting himself with the most
untiring assiduity to the pursuit. Books, and a microscope to
facilitate in the analysis of flowers, were furnished him, and
he was permitted to ramble alone through the woods and
fields, for the purpose of collecting specimens. He improved
very rapidly in both physical and mental health, and soon
returned to his home perfectly restored.
Music has been tried as a curative means in many Asylums.
We should suppose, a priori, that it might be attended with
140
beneficial results. In order, however, that this should obtain,
it must be managed with a most discriminating judgment. It
must be adapted to each patient, according as he is depressed
or exalted; otherwise, the melancholy in the former case might
be augmented, and the exaltation, in the latter, increased to
fury. Esquirol, whose experience in this respect is undoubtedly
greater than that of any other person now living, remarks, “I
have tried it (music) in every manner, and under circumstances
the most favourable to success. Sometimes it has irritated the
patient even to fury; often it has tended to divert the atten-
tion, but I cannot say that it has contributed to a cure. It
has been advantageous to the convalescent.” 3: # #
“Having made so many partial applications of music, I was
desirous of attempting it upon many persons, simultaneously.
My experiments were made during the summer of 1824, and
that of 1825. Many distinguished musicians of the capital,
seconded by the students of the Conservatory of Music, as-
sembled at our Asylum (La Salpêtrière) many Sabbath-days in
succession. The harp, the piano, the violin, some wind instru-
ments, and some excellent voices, combined to render our con-
certs as agreeable as interesting. -
“Eighty insane women, chosen by me from the convales-
cents, the maniacs, the tranquil monomaniacs, and some lype-
maniacs, were commodiously seated, facing the musicians, in
the dormitory of the convalescents. * * * * Airs of all
kinds, of all metres, and upon all keys, were played and sung,
varying the number and the nature of the instruments. Some
great pieces of music were also executed. My patients were
very attentive, their countenances became animated, the eyes
of many beamed with additional brilliancy, but all remained
tranquil. Some tears were shed. Two of the patients asked
permission to sing an air, and to be accompanied: the request
was granted. -
“This novel spectacle was not without influence upon our
unhappy patients, but we obtained no cure, not even an ame-
bioration of their mental condition. After these concerts,
each of which lasted two hours, the musicians went into the
apartment among the patients and executed, upon wind instru-
141
ments, various well-known popular airs, of a martial or senti-
mental character. A great number of the women became
excited, exalted at the sound of the instruments, and many,
among the furious, formed circles in order to dance. This
excitement was transient, and passed off almost as soon as the
music ceased.” :
After some further observations, the author finally concludes,
“If music does not cure, it diverts, and consequently soothes.
It produces some alleviation, both physical and moral; it is
evidently useful to the convalescent, and consequently it is not
necessary to discontinue its use.” § -
The human mind is prone to extremes, as the musical chord,
which, if deviated from the line of tension, recoils to nearly
the same extent upon the opposite side. And, to pursue the
simile, the harmony of the former, like that of the latter, is
the most agreeable when those extremies are least. The most
intimate friend, if once estranged, is liable to become the most
implacable enemy. Some physicians, discarding the antiphlo-
gistic, adopt the ever stimulant method of treatment; and
others, once accustomed to drugging their patients to a most
liberal extent, reject this practice and adopt the infinitessimal
principles of homoeopathy. Governments fall from despotism
into anarchy, and from anarchy return to despotism. In the
modern laudable crusade against distilled spirits, some of the
leaders in the cause, the hermit-Peters of the warfare, have
banished not only spirits, wine and fermented liquors, but tea,
coffee, meat and condiments, by their code of dietetics. In
all these instances, perhaps, there is a “golden mean,” which
is better and wiser than either extreme. In the moral treat-
ment of insanity care is required, lest, in the recoil from the
barbarity of former times, the opposite error be not avoided.
These remarks have been suggested by the account given by
Esquirol of the introduction of theatrical entertainments at
Charenton. This was done about the year 1805, and continued
until 1811. A theatre was constructed, comedies, operas and
dramas were enacted, and, occasionally, fire-works were dis-
played. “Every body was pleased with it; great and small,
wise and ignorant, were desirous of being at the exhibition
142
given by the lunatics of Charenton. All Paris flocked there
for several years; some from curiosity, others to judge of the
prodigious effects of this admirable means of curing the insane.
The truth is, this means effected no cure. * * * Those
who were to witness the exhibition were selected by favour.
This excited jealousies, quarrels, and bitterness of feeling,
Hence occurred sudden explosions of delirium and returns of
mania and of fury. * * * That which passed at Charen-
ton teaches us sufficiently upon this subject. How many were
the relapses, how numerous the paroxysms of fury, provoked
by these theatrical representations! Never have we seen pa-
tients cured by this mode of treatment.”
Since the foregoing remarks were written, a treatise upon
Insanity has appeared in Paris, the object of which is “to
establish the truth of the following three propositions:—
1. If it be true that insanity depends on an alteration, or
morbid condition of the encephalon, we are completely igno-
rant in what this alteration consists.
2. The moral treatment of the insane, as usually practised,
is considered only as an auxiliary of the physical treatment.
3. In the insane, the intellect and passions cannot be brought
back to their healthy type, or standard, without the aid of
moral treatment; and THIS MoDE of TREATMENT IS THE on LY
oNE which HAs A DIRECT INFLUENCE ON THE SYMPTOMs of
INSANITY.”
The author of this work is a highly intellectual and scienti-
fic physician, and his experience in the treatment of the insane
hº hence, his opinions merit attention
and respect. Those best acquainted with mental diseases, and
with their present mode of treatment, will acknowledge an
affirmative to the first two propositions, even without an inves-
tigation of the arguments adduced in the demonstration of the
truth of them. But, it is believed that the same assent cannot
be granted to the sentiment of the latter clause of the third
proposition. Insanity is far from being an invariably idiopathic
disease of the encephalon; it is frequently symptomatic of
* Du Traitement Morale de la Folie. Par F. Leuret, Paris, 1840.
143
affections of the other viscera. Now, we would ask, what is
that moral treatment, so potent in its influence as to correct the
morbid conditions of the portal circle, or restore the dyspeptic
stomach to its normal state? It is to be feared that this author
has fallen into the extreme alluded to above.
Jättendants.—How perfect soever may be an asylum in its
organization and administration, how complete soever it may
be in all the physical comforts which wealth may purchase or
ingenuity invent, how diverse soever may be the means of
recreation and amusement—the great object for which these
have been furnished, that of effecting a cure in the patients,
will be tardily, if indeed it be ever accomplished, unless the
attendants, those who have the immediate care of those pa-
tients, are of a suitable character. Complete dominion over
the passions, a well cultivated mind, unyielding firmness, un-
tiring energy, and an ever-watchful vigilance, united with
mildness, gentleness, an affable and respectful deportment, and
a benevolent, sympathising, christian mind, are necessary to
constitute the perfect attendant. The nearer this standard be
approached, the better will be the care extended to the pa-
tients, and the more rapid will be the cures. “We will not,”
says one of the reports of the M*Lean Asylum, “continue any
male or female attendant, whom we cannot invite into our
family and seat at our table; and with whom we could not
confidently place our wives, sisters and brothers.” The rule
that immediate dismissal shall be the penalty of striking a pa-
tient, is adopted in most asylums, and should be in all. Could
the standard which we have mentioned be reached; perhaps no
such rule would be necessary.
Coercion and Punishment.—The strait-jacket, manacles, and
chains have nearly been abandoned in the best institutions of the
treatment of lunatics. The first, however, is still used occasion-
ally in some of the British Asylums, and is not entirely aban-
doned in some of those of the United States. A change of loca-
tion, the deprivation of a privilege, the shower-bath, and other
punishments comparatively mild, are often sufficiently effective.
The “tranquillizing chair,” and mits and muffs, are still em-
ployed occasionally in nearly all asylums. In the Connecticut
144
Retreat, as says one of the reports of that institution, “in case
coercion and confinement become necessary, it is impressed
upon his (the patient’s) mind, that this is not done for the
purpose of punishment, but for his own safety and that of his
keepers.” “In no case,” says the same report, “is deception
of the patient employed or allowed; on the contrary, the
greatest frankness as well as kindness, forms a part of the
moral treatment. His case is explained to him, and he is
made to understand, as far as possible, the reasons why the
treatment to which he is subjected has become necessary. By
this course of intellectual management, it has been found, as a
matter of experience, at our institution, that patients who had
always been raving when confined without being told the rea-
son, and refractory when commanded, instead of being en-
treated, soon became peaceful and docile.” Sir A. Halliday
insists upon the necessity of honourable and candid dealing
with the insane, and urges the importance of the fact, that they
are generally, if not universally, affected by kindness, while
they never forget injuries, insults, duplicity or imposition.
An appeal to the sympathies of the most maniacal patients,
while, at the same time, a negative assent is given to their
particular hallucination, is sometimes more effective than pun-
ishment. An interesting instance of this kind is related by
the late Dr. Rush, of a lunatic in the Pennsylvania Hospital.
This patient having frequently attempted to set fire to the
building, was expostulated with by one of the managers, who
endeavoured to impress upon his mind the effects of a confla-
gration, such as he had attempted. “But I am a salamander,”
said he. “Recollect, however,” answered the gentleman ex-
postulating with him, “that all the patients in the hospital are
not salamanders.” This sagacious reply had the desired effect;
the patient desisted from his incendiary attempts.
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