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from uncombined insanity, in recent cases, is somewhat greater than nine to one." Several other hospitals for lunatics in England, established within a few years, have been equally successful in curing recent cases of insanity.
In these institutions, many no doubt are received whose madness has been caused by the immoderate use of intoxicating drinks. Such cases are in general to be reckoned among the cases most easily cured, for although this is not uniformly the fact, it often happens that when the exciting cause is removed, the effect begins to lessen, and eventually ceases. When these patients are prevented from obtaining stimulating liquors, and are treated with sedative remedies, they quickly show signs of amelioration and of the subsidence of the disease. This may perhaps explain why, in some of the lunatic asylums of this country, the cures of recent cases of insanity have been more numerous than in the institutions on the continent. Intemperance, in this country, is reported to be a frequent cause of insanity; but, according to M. Esquirol, it is not so in France, even among the lower classes. Among 336 lunatics in his establishment, there were but three who appeared to have lost their reason through the habit of intoxication.
More just views respecting this disease prevail than formerly: it is no longer regarded as a disgrace, or as a disease resulting from some criminal offence. It is now considered a physical disorder, a disease of the brain, and one which can be as readily cured as disease of other organs of the body. But, in order to effect a cure, it is often necessary to remove the patient from his home, and separate him from his relatives and former associates; we say it is often necessary, for undoubtedly there are cases that would not be benefited by this course, and some that would be aggravated by it. Quite recent cases may frequently be cured without seclusion. Broussais refers to a great number of cures effected by active treatment alone in the commencement of the disease. On the necessity of seclusion, M. Esquirol remarks, in a late publication, "Confinement should not be prescribed for all insane persons; for if the delirium is partial or transitory; if it relates only to objects of indifference, and is unaccompanied with violent passion; if the patient has no aversion to his home, nor to the persons with whom he lives, and his delirium is independent of domestic habits; if his real or imaginary causes of excitement are not to be found in the bosom of his family; if the fortune or life of the patient, by retaining a large proportion of his friends, is not compromised, and he submits to the proper means of cure ;-in all these cases confinement may be useful, but it is not indispensable. But if the patient, retaining a large portion of his intellect, has a great attachment to his relations, it is to be feared that confinement might aggravate the disease." But such cases are much less frequent than those that require seclusion and separation from friends and home. This renders hospitals for
the insane necessary, and we rejoice to find they are rapidly multiplying in this and all civilized countries.
Asylums for the insane are of modern origin. In fact, all public hospitals for the sick and poor may be so considered, as they originated with the Christians of the third or fourth century. But long after those suffering from other diseases were received into hospitals and provided with medical assistance, lunatics were neglected, and perished in great numbers. Some of the most furious were confined in small cells, or shut up in convents and dungeons, while others were burned as sorcerers, or as possessed of demons. Those that were tranquil were permitted their liberty, abandoned however to neglect, to the abuse and the laughter, or to the ridiculous veneration of their fellow creatures.
But about the commencement of the seventeenth century, lunatics began to be received into the general hospitals, where they were confined in the most obscure corners of the buildings, and received no medical aid. Soon after this, in some of the large towns of France, a few separate but poorly conducted hospitals were provided for the insane, though the greater part still remained at liberty, or were confined in the general hospitals. It was not until 1792, when M. Pinel was appointed physician in chief to the Bicêtre at Paris, that correct views respecting the treatment of the insane began to prevail, and to be reduced to practice. At this institution, when M. Pinel took charge of it, were a large number of lunatics considered incurable. Many of them being very furious, were kept constantly chained. This illustrious physician, after having in vain solicited the government to allow him to unchain these maniacs, finally went in person to the authorities, and advocating with much warmth and earnestness the removal of this monstrous abuse, obtained permission to do as he pleased respecting them. Great fears were entertained for the personal safety of M. Pinel, should he undertake to unchain them. This, however, he resolved to do. The first man on whom he tried the experiment was one of the most furious, who had been in chains forty years, and had already killed one keeper by a blow with his manacles. Pinel entered his cell unattended, and offered to remove his chains and permit him to walk in the court, if he would promise to behave well and injure no one. "Yes, I promise you," said the maniac. His chains were then removed, and the keepers retired leaving the door of his cell open. "He raised himself," says the son of the celebrated Pinel, in a paper read at the Academy of Sciences, " 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, walking up and down the staircases, and uttering short
exclamations of delight. In the evening he returned of his own accord into his cell, where a better bed than he had been accustomed to had been prepared for him, and he slept tranquilly. During the two succeeding years which he spent at the Bicêtre, he had no return of his furious paroxysms, but even rendered himself useful, by exercising a kind of authority over the insane patients, whom he ruled in his own fashion."
In the course of a few days, Pinel released fifty-three maniacs from their chains. The result was happy beyond his hopes. Tranquillity and harmony succeeded to tumult and disorder; and, by the aid of continued mild and judicious treatment, the most furious became calmer and more tractable, and many were restored to perfect health of body and mind. This transaction caused much sensation, not only in France, but throughout the civilized world, and created a revolution in the treatment of this unfortunate but hitherto neglected portion of our fellow creatures. To M. Pinel is unquestionably due the great credit of first employing judicious, systematic, and moral means in the cure of the insane.
At present there are in France large institutions for the reception and cure of lunatics. Among the most celebrated are the Salpétriere and the Bicêtre, and the Maison Royale de Charenton. The former, at the south-eastern extremity of Paris, is composed of several buildings, enclosing spacious gardens and grounds for exercise. This is for the accommodation of females only. It usually contains about 1000 lunatics. These are divided into three classes, the curable, incurable, and idiotic. M. Pariset has the medical superintendence of the curable class. The Bicêtre, about two leagues from Paris, receives only males. It usually has from 350 to 400 patients. Here are also spacious grounds for exercise, and a farm where many of the patients are employed much of the time. The Maison Royale de Charenton, a short distance from Paris, is exclusively appropriated to the reception of the insane of both sexes, and contains 600 beds. Besides these, there are others in the vicinity of Paris and in many of the large towns of France, some public and some private, but all under good regulations and well conducted.
In London, so early as 1553, lunatics were received into the Bethlem Hospital, a Royal foundation for lunatics, incorporated by Henry VIII. This hospital has been rebuilt several times, and enlarged. It is now a noble brick building, 580 feet in length, with accommodations for 400 patients. It cost about 100,000l., and has an annual income of 18,000l. St. Luke's Hospital, another institution in London for the reception of lunatics, originated in 1732. The present building, though commenced in 1751, was not completed until 1786, at an expense of 55,000l. It is a solid brick edifice, 500 feet in length, and accommodates 300 patients. This hospital has an annual income of 9,000.
Both these old establishments are quite defective, as they are without the useful appendage of spacious grounds and workshops, for the exercise and employment of the patients. In other parts of England, in Ireland, and Scotland there are many well-arranged and well-conducted lunatic establishments. Among the most celebrated, are the Wakefield Asylum for the West-Riding of York, and the Lancaster Asylum, in England; the Richmond Asylum at Dublin ; and the Glasgow Lunatic Asylum in Scotland. But there are several others, more recently established, equally well conducted. Most of these institutions can accommodate from two hundred to three hundred patients. Workshops are generally attached to them, and twenty or thirty acres of land, where the patients are much of the time employed at their trades, or in agriculture. In addition to such public institutions, private ones, for the accommodation of a limited number of lunatics, are numerous. Often one such receives only those of the same sex. Some of them are fitted up with great elegance, with every thing desirable for the safety and welfare of the patients, affording to them all the advantages of a secluded private residence, with large, airy, and commodious apartments, beautiful gardens and grounds for exercise and amusement, together with experienced and careful medical superintendence.
In many of the states of the Continent, hospitals for the insane have been provided. Some of them are well, and others badly conducted. In the Netherlands, according to Halliday, much attention has been paid to the relief and comfort of the insane. At Ghent are several public establishments, and one private, for their accomodation. At Antwerp there is an excellent hospital for lunatics. It was built about thirty years since, and usually has between two hundred and three hundred patients. With this is connected the celebrated and singular establishment at Gheil, which, with perhaps some modifications, might be adopted with advantage in this country. It consists of a village, or a number of detached cottages, far removed from other habitations. These buildings are occupied by peasants of good character, who receive lunatics,-mostly those that are convalescent,-treat them with great kindness, and employ them in the cultivation of the land. Each patient is obliged to labour a certain number of hours every day when able; and when not so employed is allowed to walk about without restraint. Scarcely any accident occurs, and very few attempt to escape. The recoveries here have been so numerous and rapid, that the fame of the institution has extended far, and many persons of distinction have been sent to it for recovery.
In Bavaria and Saxony, much has been done by government for the welfare of the insane. In Denmark and Sweden there are several lunatic hospitals. Those in the former, and especially the one at Copenhagen, merit high commendation. Many of the large
towns of Italy have one or more Asylums for lunatics. At Milan there is a well-conducted lunatic hospital, containing near five hundred patients, most of whom are employed in gardening and in manufacturing clothing. At Genoa, part of the Hospitals of Incurables is given up to the insane. About two hundred and fifty are kept here in a wretched condition. A recent writer has the following remarks on them :-"When we visited this establishment in 1829, though the sexes were in different wards, all varieties and degrees of insanity were congregated together. From fifty to one hundred were in one room, most of them chained to their beds by their wrists and ankles. When we entered the women's ward, the inmates were eating; and, perhaps excited by the entrance of strangers, their fury exceeded any thing of the kind we ever witnessed. Mingled with the clashing of chains, were groans, and curses, and prayers, and shouts of laughter. Every individual appeared excited. Some came the length of the chains, and strained every muscle to break them; others threw at us with their utmost strength, the little pittance they were eating; while others, a little less furious, beckoned to us, and besought us to look at some coarse pictures they had drawn on the wall, or at some rags they had fantastically put together. Throughout this vast Pandemonium, we saw not one that appeared tranquil, or in the way of recovery. We were told they received but little medical treatment, and were not allowed to leave their wards until death released them."
At Florence, the average number of the insane in the Spedale di Bonifacio, the hospital appropriated to them, is about three hundred. The patients are clothed alike, in white woollen dresses, and have their apartments kept very neat. When it becomes necessary to confine a patient, his hands are placed in a wooden case, and bound to the abdomen by a strap around his body. Furious patients are confined in dark rooms with well-padded walls. The darkness is thought to be very serviceable in rendering them more tranquil. The management of this institution appears to be good. Many of the male patients are employed in gardening, or at their trades, and the women in knitting and spinning. At Rome, the hospital for lunatics consists of two separate buildings, one for each sex. The number of patients is about 400. The most furious are confined by chains. All varieties of insanity are mixed together, and no moral measures are resorted to in their treatment. At Naples is the celebrated Aversa, an hospital for lunatics. The sexes are here in different buildings, above 200 in each. Great regularity prevails throughout the institution. On ringing a bell, the patients rise, breakfast with decorum, and the more quiet are present at religious worship. Though the advantages of this institution are said to have been exaggerated, it is the most extensive and best regulated hospital for the insane in Italy.