poreal faculties, possessing in advanced age less recuperative powers. Thus the disproportion just referred to may be fairly accounted for.

According to a synopsis of the general social condition of patients, it appeared that the unmarried predominated to a very large extent, there being 354 single or unmarried, and 105 married-majority of unmarried, 249; in the two preceding years it was 253 and 241 respectively, thus showing a uniformity of scale on this head.

With regard to occupations, professions, &c., there is no material alteration, on the whole, since the date of our last public Report in 1853.

It may be worthy of mention, however, in reference to particular professions, that the number of insane persons belonging to the army and navy is about the same now as in 1843; being in 1843-army, 23; navy, 3. In 1854-army, 25; navy, 3; while the number belonging to the church has increased over threefold, viz., from 6 to 19; to the law, twofold-from 9 to 18 (being an average of 1 insane person in every 220 of these two professions, respectively, that of the general population being estimated at about 1 in every 750); of the medical profession, during the same period, from 4 to 6; students of all classes, 6 to 15. Those under the heading "No Occupation" are mainly comprised of females and persons of independent fortune.

During the two years there were 94 patients discharged cured, which reaches 34 per cent. on the admissions; relieved, 55; incurable, 13; died, 45.

Among the deaths, we regret to report the occurrence of one case by suicide, that of an unmarried lady, Miss J, aged 43, who was admitted into the asylum on the 31st May, labouring under a violent attack of mania. From the evidence given on the inquest, held by the coroner for the county, it appeared that injunctions had been given to the servant in whose charge the lunatic was placed, not to leave her for a moment until she was relieved by some other nurse or attendant. Four days after admission, she having, as she stated in her evidence, other duties to perform, left the lunatic alone, trusting to a strait waistcoat which she put on (without the knowledge of the superintendent) for security. Returning shortly after, she found Miss J- suspended from the rail of her bed by the cord or lace of the strait waistcoat, of which she had, by some means not accounted for, managed to divest herself. Life at the time was quite extinct. A minute inquiry took place at the inquest, in presence of the brothers of the deceased lady, who felt satisfied that no blame lay with the proprietor; as, had the attendant strictly adhered to the instructions which she admitted had been issued, the unfortunate occurrence could not have taken place. A verdict in accordance with the facts was found by the jury.

Under all the circumstances connected with the foregoing accident, the only course that presented itself, and which was immediately acted upon by direc tions from this office, was to dismiss the attendant, and impress upon the others, from the example before them, the great responsibility under which they lie, to pay implicit obedience to the instructions they receive, and the serious consequences that may, at any moment, follow a neglect of duty.

Having occasion to animadvert, in the year 1853, on the state of a private asylum, we recommended the magistrates at quarter sessions in the October of that year to give a conditional licence only. At the last October sessions, one of the inspectors attended at the request of the justices, when the chairman intimated to the various proprietors their determination not to grant a licence for any private asylum in future, without the full approbation of the inspectors as to its management in every detail.

The licences, orders for admission, and medical certificates, notices of discharges, and deaths, &c., with two exceptions, have been generally correct, save in some minor points, not necessary to notice in a report to your Excellency, but which points we have not omitted to observe upon to the parties them

selves a strict adherence both to the spirit and letter of the Act of Parliament being required by us.

The first exception occurred in an establishment in the County Limerick, the proprietor having failed to apply for a renewal of his licence. We felt it our duty immediately to notify the fact to the Clerk of the Peace, for the information of the magistrates at quarter sessions: subsequently, however, being assured that the omission was not intended as an evasion of the law, and on the party undertaking to lodge an application for a fresh licence, to be taken into consideration at the quarter sessions next ensuing, and paying the full amount of fees for which he was liable in the first instance, we did not deem it necessary to interfere further.

The second case was that of a medical gentleman, under whose care we discovered three idiotic patients. Having satisfied us that he acted from ignorance of the law in receiving them without due authority, we forebore to institute those legal proceedings which otherwise it would have been our duty to follow up. Finding his house, however, on inspection, to be well suited for the reception of ten patients, we directed him to take out the necessary licence, to which he at once acceded. We think, with due care and some improvements that have been suggested to him, this establishment will ultimately become a very useful one for the reception and treatment of incurables and idiotic patients.

We shall not unnecessarily trouble your Excellency by references to individual cases, which have been officially brought under our observation, and on which we have duly reported; or to lunatics confined singly in unlicensed houses, many instances of which we have become acquainted with during the past year, and in whose regard we have either personally or by letter communicated with their family or friends, for the purpose of bettering their condition, either by a change of residence, or by additonal means of support.

The returns of single lunatics under the Act 5 & 6 Vic., c. 123, sec. 36, are by no means regular. The law is easily evaded, so much so that unless the party in charge of the individual sends a voluntary intimation to the Inspector's office, we may say we can have none but accidental information on the subject. Patients, for example, are removed from asylums uncured, and we have not the means of tracing their subsequent abode, or even an authority to make inquiries thereon. Lunatics under the Lord Chancellor's protection are, no doubt, safe; but as to the others, it is impossible for us to say what treatment they ultimately receive. We are strongly inclined to think that all insane persons, whether placed on pension or otherwise, should be inspected from time to time, and individual reports made to the Lord Chancellor in each

case.

RELIGIOUS CONSOLATION TO THE INSANE.

BY THE REV. JOS. SOUTER,

Chaplain to the Essex County Lunatic Asylum,

As might be expected in an asylum for the insane, a considerable number of the inmates are not capable, in any degree perceptible to us, of being influenced by religious or any other teaching. I speak of those who from birth have been insane, and of those whom disease has reduced to a state of dementia. But there are others upon whose minds the ministrations of religion produce a strong and marked impression. I cannot forbear here to refer to one or two examples. One is that of a male patient who was restored to sanity. Dr. Campbell informed him that he would recommend his discharge. He was

most grateful for the kind intention, but begged to be permitted to remain, as he felt that he had not many weeks to live. He said he knew that if he left the asylum he could not enjoy the advantage of medical advice, and of other kindnesses that he received here; but more than all, he should regret to be taken away from the daily services of the chapel, which had been so great a comfort and blessing to him. Dr. Campbell was moved by the man's entreaties, and with great kindness permitted him to remain, though he knew that by so doing it would only add to the number of deaths. The religion which that man so highly prized supported him through the brief remainder of his days. He looked forward to his end with calmness, and met it with the faith and resignation of a Christian. A rapid consumption, in a few weeks, carried him beyond the reach of all earthly sorrows and trouble, we trust, "to another and a better world."

A second example is that of a female patient, who has now left the asylum in a state of convalescence. She was upwards of sixty years of age, but had never partaken of the Holy Communion till she received it in the asylum chapel. From her manner of speaking on this subject, I should judge that she was strongly impressed with religious feeling. She, too, had found the services of the church to be a blessing to her. I trust she has carried with her to her home that principle of piety which shall be a strength and consolation to her for the remaining years of her life, and which shall enable her, when death comes, to triumph over it, through faith in Him who "has opened to all believers the gate of everlasting life.

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There are not a few patients who, from mistaken notions of religion, refuse the consolations which it offers them, and cling with a strange tenacity to the belief that, though there may be forgiveness for all others, there is none for them. You may quiet their terrors of conscience one day, and on the next you shall find they have returned again to their old and cherished despair. But even of cases such as these I have seen some, not able indeed totally to subdue their melancholy, but strengthened to bear it through confidence in God. I have seen many whose despondency has vanished entirely, and all the gloomy fancies that had haunted them night and day for years have been dispelled; but that change has been the precursor of death. One especially I remember, who died at the commencement of the year. Her dread of death, when first she felt its advances, her ravings of despair, her firm persuasion that she had committed the "unpardonable sin," were sometimes fearful to witness. But a few days before she died all was changed, and happily changed, not in a return to those high delusions which she had once been taught to call religion, but changed to a calm, humble, and penitent belief in the atonement. There was no ecstasy, no unbounded rapture, but there was repentance, resignation, faith. It is not at all unusual in certain similar cases to see them, a few days before death, lighted up with new hopes. The mind is freed from its terrors and its delusions. The sunshine of earlier days revisits the soul. Allow me, however, here to guard against an impression that this is always the case. Many of the insane die as they have lived. Their minds are not lighted up with even a momentary flash of returning intelligence. I have had the most abundant opportunity afforded me for forming this judgment, for I have visited the sick daily. I have gone to the bedside of the dying, in every case, thinking it possible that even in the most bewildered and lost there might occur some moment before death, in which the mind would be prepared to receive the comfort and instruction of religious truth. Even during the prevalence of cholera, feeling it to be my duty to keep up this practice, I went every morning to the bedside of the patients upon whom the scourge of that mysterious disease had fallen. And I rejoice to say, that terrible as it was to witness so many smitten as it were by an invisible hand,-cold and dead in a few hours, my visits were sometimes

attended also with circumstances of a most affecting and not unpleasing nature. The majority, indeed, sunk at once into total unconsciousness or apathy. But there were some actively alive to their danger, and anxious to receive the last consolations of religion. I cannot omit to notice one in particular. He was an old sailor; he lived several days after his first attack. Each day as I entered the ward he lifted up his hands, and placed them together in an attitude of devotion, as if to signify to me a request to pray with him. I asked him if that were his wish, and he murmured, as well as he was able, "Yes." I then read a few verses from the Bible, and knelt down at his bedside to pray for pardon and strength, and to commend his soul to God; and never have I heard a more earnest and devout amen than that which was whispered so faintly, but so fervently, by that dying man. I have not often witnessed a scene more touching. In that one room were the beds of four other dying men. The eyes of more than one there were filled with tears. Let us trust that He, "who despiseth not the sighing of a contrite heart, nor the desire of such as be sorrowful," would mercifully regard those tears, and hear those prayers, and receive those afflicted men into everlasting rest.—From the recent Official Report of the Asylum.

ON THE CAUSES AND TREATMENT OF INSANITY.

BY D. C. CAMPBELL, M.D.,

Physician to the Essex Lunatic Asylum.

RELIGIOUS excitement forms no small number of the assigned causes; and, in accordance with the humane purpose of the institution, I feel it a duty to mention any cause, against the operation of which it may be possible, in some degree, to guard. I do not believe that true religion is ever a cause of insanity, though fanaticism or erroneous theological views undoubtedly may. Mental derangement never can be produced by just views of the essential truths of the Gospel; but intense and long protracted meditation on abstruse points of religious doctrine, or on prophetic mystery, remorse in highly sensitive minds on account of supposed unpardonable sins, and above all, innovation in established religious belief, have been fruitful causes of insanity.

An eminent physician, of great experience in the treatment of mental derangement, in his writings remarked, "Were I to allege one cause which I thought was operating with more force than another to increase the victims of insanity, I should pronounce that it was the overweening zeal with which it is attempted to impress on youth the subtle distinctions of theology and an unrelenting devotion to a dubious doctrine. This practice is an alarming error. It is growing to an excess fatal to the preservation of intellectual sanity, and in a manner especially dangerous to the rising generation." I would recommend to parents to use their best efforts against the influence of new and questionable religious doctrines. The mental distress occasioned by the conflict between such doctrines and earlier religious impressions ends often in confirmed maniacal melancholy; or, as there is a tendency to reaction in our moral as well as in our physical nature, I have seen a sudden transition from the deepest self-abasement to triumphant confidence, with belief in supernatural communications, miraculous gifts, and all the phantasies of an insane mind. Such madness is lamentable in itself; but, in some instances, doubly lamentable, when the patient awakes from his delusion. His religious opinions are then unsettled, and it would be well if he could return to the consolations of that quiet and soothing faith which has given peace to christians in all ages.

Employment in the open air not only improves bodily health, but also

powerfully co-operates, with other means of regulating the mind, in promoting the cure of lunacy. Many of the male patients have laboured most assiduously on the farm and in the garden, from which no small saving to the county has arisen; four large airing courts have been laid out by them, which are now finished, and a large garden has been brought into cultivation, now supplying sufficient vegetables for the establishment. Two of the patients are daily employed as carpenters, four as shoemakers, and two assist the engineer and smith. It will be seen by the tables that a considerable quantity of profitable work has also been done by the females, who in addition to that necessary for the establishment, have made a number of shirts for the Springfield prison, and also for a house in London. The females are principally employed in washing, dressing, sewing, and knitting, and a large number of males and females give their assistance in the wards and at domestic work. In several instances I have remarked that the cases were retrograde or progressive, according as the patients were idle or employed. Among those patients who laboured daily, not a few proceeded with a steady pace to recovery, until soundness of mind was perfectly restored.

It requires no proficiency in the study of mind, nor any experience in the treatment of the insane, to comprehend the utility of labour in promoting the cure of lunacy. Any occupation which serves to arrest the attention of the lunatic necessarily arouses him from his waking dream; and the repose induced by toil no less effectually excludes the visions of the night.

The great object is to make the necessary arrangements of the institution available for the treatment of the patients, to secure as much occupation as possible for them consistent with their health, and to render their services as far as possible advantageous to the institution. The amusements consist of bagatelle, cards, draughts, and dominoes; and books are provided for those who are disposed to read. Several derive much enjoyment from variety of scene, and are permitted to make little excursions into the country, and entertainments with dancing and vocal and instrumental music have been found very serviceable.

The treatment of insanity in all its forms consists less in the administration of medicine than in surrounding the patients with influences, each of which may apparently be very trifling, nay, unfelt and unseen, but the combination of the whole of which produces the most powerful effect; thus they are permitted to enjoy the greatest possible degree of liberty, consistent with their safety, and furnished with the means of such suitable employment, amusements, and recreations, as serve both to relieve the irksomeness of confinement and to promote the cure of the malady. I cannot omit this opportunity of pressing upon public attention the importance of early medical treatment, and the unhappy consequences which arise from the delay so frequently prompted by mistaken affection and shortsighted economy. It is at the commencement of the disease that medical treatment is most obviously demanded and most likely to be efficacious; for notwithstanding the most violent symptoms, if the disorder is of recent occurrence, it generally yields to proper treatment. This important truth, which prejudice, ignorance, and false delicacy are too apt to overlook, is forcibly illustrated in the experience of every asylum. Nothing is more imprudent of the friends of such individuals in trusting, for any period, an unfortunate relative to their own inexperienced, and too often injudicious management, for it is one of the most melancholy attendants on this disease, that it frequently destroys and disregards the ties of nature, and that a patient never can be more unhappily placed than in the circle of his own dearest friends and relatives. From the last Report of the Asylum.