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WHAT ASYLUMS WERE, ARE, AND OUGHT TO BE: 
 
 BEING THE SUBSTANCE OF 
 
 FIVE LECTURES 
 
 DELIVERED BEFORE 
 
 THE MANAGERS 
 
 OF THI. 
 
 -MONTROSE ROYAL LUNATIC ASYLUM. 
 
 / " 
 W. A. F. BROWNE, Surge.. 
 
 MEDICAL SUPERINTENDENT OF THE MONTROSE ASYLUM, FORMERLY 
 PRESIDENT OF THE ROYAL MEDICAL SOCIETY, EDINBURGH, &fe 
 
 < . 
 
 EDINBURGH : 
 ADAM AND CHARLES BLACK, 
 
 AND LONGMAN, REKS, ORME, BROWN, GREEN, AND LONGMAN, 
 LONDON. 
 
 MDCCCXXXVII. 
 .11 
 
a 
 
 
 
 
 EDINBURGH : PRINTED BY BALFOUR AND JACK, NIDDRY STREET. 
 
THIS WORK 
 
 IS DEDICATED, 3 ^ 
 
 WITH SINCERE RESPECT AND GRATITUDE, 
 TO 
 
 ANDREW COMBE, M.D., 
 
 PHYSICIAN TO THEIR MAJESTIES THE KING AND QUEEN OF THE BELGIANS ; 
 
 AUTHOR OF " OBSERVATIONS ON MENTAL DERANGEMENT j" 
 
 " PRINCIPLES OF PHYSIOLOGY, AS APPLIED TO HEALTH 
 
 AND EDUCATION," &.C. 
 
 AS AN ACKNOWLEDGMENT 
 
 OF THE BENEFITS CONFERRED ON SOCIETY, 
 
 BY 
 
 HIS EXPOSITION OF THE APPLICATION OF PHRENOLOGY IN THE 
 
 TREATMENT OF INSANITY AND NERVOUS DISEASE9 ; 
 
 AND 
 
 OF PRIVATE BENEFITS CONFERRED, 
 
 AS 
 
 THE MOST ENLIGHTENED PRECEPTOR, THE MOST DISINTERESTED 
 
 ADVISER, AND THE KINDEST FRIEND, 
 
 OF THE 
 
 AUTHOR. 
 

TO THE MANAGERS OF THE MONTROSE ROYAL 
 LUNATIC ASYLUM. 
 
 My Lord and Gentlemen, 
 
 To the many obligations -which you have 
 already conferred upon me, is now to be added the permission 
 to publish the following pages under your sanction and 
 patronage. In offering them for your acceptance, as a very 
 imperfect proof of the importance which I attach to the office 
 to which you appointed me, and as an equally imperfect 
 acknowledgment of my gratitude for the uniform kindness 
 and support which I have received from you, I have to express 
 the deep respect and admiration which I entertain for tin- 
 anxiety which you have ever manifested, and the exertions 
 which you have made, and are now making, to promote the 
 happiness and cure of those lunatics whose interests are more 
 immediately confided to your care. 
 
 I have the honour to be, 
 
 My Lord and Gentlemen, 
 
 Very much your obedient servant.. 
 
 W. A. F. BROWNE. 
 
 Montrose, May 1837- 
 
PREFACE. 
 
 My object in publishing the following Lectures, was to draw 
 the attention of the public, and especially of those who are by 
 profession engaged in, or who by philanthropy are prompted 
 to, works of mercy, to the consideration of what has been 
 done, and what remains to be done, for the relief of the 
 most unfortunate of our fellow-men : of those who may be 
 almost literally said to r * sit in darkness, and in the shadow 
 of death : being fast bound in misery and iron." My in- 
 ducements to publish were, first, the countenance and en- 
 couragement which I received from the Directors of the 
 establishment under my charge, to whom my observations 
 were in the first instance addressed ; and, secondly, the 
 hope that a plain and clear statement of facts by a practical 
 man might reach and influence those who administer either 
 by their opinion or by their power to the necessities of the 
 " poor in spirit." If my appeal should, even to a limited 
 extent, excite the sympathy of those who are blessed with a 
 sane, a benevolent, and a cultivated mind, and engage them 
 as cordially in the attempt to ameliorate the condition of the 
 lunatic, as similar, and even less clamant appeals have done 
 in behalf of the slave, the oppressed, the destitute; little 
 difficulty will be found in removing the evils, and in carrying 
 into effect the improvements which I have suggested, and an 
 amount of happiness will be secured to the objects of my so- 
 licitude which has hitherto been denied to them, but to which 
 
Vlll PREFACE. 
 
 they are as clearly entitled as the slave to freedom, or the 
 poor to pity and relief. 
 
 I have no claim to originality, either in the design or the 
 execution of the present production. A large portion of the 
 volume refers to the past, and is necessarily occupied with 
 historical details : that portion which refers to the future I 
 have as scrupulously as was practicable collected and collated 
 from the writings and opinions of others : and when present- 
 ing a synoptical view of the different forms under which 
 mental disease may appear, I was indebted rather to the 
 science upon the principles of which that arrangement was 
 founded, than to any peculiar views or philosophical analysis 
 of my own. To those who are acquainted with the doctrines 
 of Phrenology, the extent of my obligations in this particular 
 case, and throughout the work, will be readily recognized ; 
 and to those who are still ignorant of these doctrines, I have 
 to offer the assurance that Insanity can neither be understood, 
 nor described, nor treated by the aid of any other philosophy. 
 I have long entertained this opinion : I have for many years 
 put it to the test of experiment, and I now wish to record it 
 as my deliberate conviction. While, however, I have con- 
 stantly availed myself of the principles, I have avoided the 
 phraseology of the science, first, because my original auditors 
 were not, and my readers may not be phrenologists ; and, se- 
 condly, and chiefly, because my object was not to advocate or 
 promote particular truths, but to employ and apply these in 
 the elucidation of the object in view> and thereby to place in 
 as clear, and conclusive, and acceptable a manner as possible, 
 the noble cause which I have undertaken. 
 
3 
 
 CONTENTS. 
 
 LECTURE I. 
 
 WHAT IS INSANITY? 
 
 Page 
 Erroneous views on the Subject — Propensities, Sentiments, Re- 
 flective and Perceptive powers — The dependence of these on 
 Organization. — Derangement a disease of the Brain — The 
 changes which occur in the structure of the Brain — Evidence 
 that such changes take place — Extent of diseased action which 
 constitutes Insanity — Description preferable to definition of the 
 disease where the regulation of the internal economy of Asylums 
 is concerned — Nosological classification of the varieties of the 
 Disease — Arrangements of Arnold, Heinroth, and Author — 
 Idiocy — Its four gradations — Fatuity, partial, complete — Mo- 
 nomania, erotic, homicidal and destructive, proud, vain, timid, 
 suspicious, religious and superstitious, desponding and suicidal, 
 ; maginative, avaricious, benevolent, and affectionate — Incapabi- 
 lity of perceiving the relations of ideas — Incapability of perceiv- 
 ing the relations of external objects — Incapability of perceiving 
 the qualities of external objects — Mania, with and without in- 
 creased activity — Conclusion .... I 
 
 LECTURE II. 
 
 WHAT ARE THE STATISTICS OF INSANITY? 
 
 The numbers and distribution of Lunatics in Britain — Is insanity 
 increased by civilization — Does it increase in a greater ratio than 
 the population — Does it attack men of particular professions, or 
 of particular ranks — Does it prevail chiefly under free, or under 
 
 J 
 
CONTENTS. 
 
 Page, 
 despotic forms of Government — What period of life does it prin- 
 cipally attack — Does marriage diminish the liability to the dis- 
 ease — Are Males or Females most exposed — What is the pro- 
 portion of cures — Rate of Mortality — Does Insanity prolong or 
 shorten life — Influence of season on Mortality — Diseases affect- 
 ing Lunatics — Proportion of Furious, Paralytic and Epileptic, 
 Fatuous and Idiotic, Dirty, Noisy and Suicidal Madmen — Lucid 
 Intervals — Relapses — Complete isolation — Early confinement — 
 Employment as a means of cure — Proportion of Lunatics that 
 may be employed — Does it promote the cure? — The kind of 
 occupation — Is it safe ? . . . . 51 
 
 LECTURE III. 
 
 WHAT ASYLUMS WERE. 
 
 Character of System pursued previous to 1815 — St. Vincent de 
 Paul — Insane consigned to Monks — Lunatics set at large to beg 
 — Lunatics in Gaols, in Cages, in Caves, in Dungeons — Asso- 
 ciating of Lunatics with criminals — Modes of quieting Lunatics 
 — "Muffing" — Modes of feeding Lunatics — * Forcing" — Death 
 from this process — Lunatics in Hospitals — Four or five sleep 
 in one bed — Confined in Venereal Wards — Lunatics in Work- 
 houses — Want of Medical attendance, classification, comfort, 
 and cleanliness in these establishments — Sale of Idiot children — 
 Madhouses at Venice, Nantes — Confinement of sane indivi- 
 duals — Carelessness of Medical men in granting certificates — 
 Unusual modes of coercing the Insane — Coercion required for 
 the poor, but not for the rich — ^Coercion resorted to as economi- 
 cal — Lunatics exhibited for a sum of money ; excited and induced 
 to gorge themselves with food, or filth, for the amusement of 
 visitors — Gangrene of extremities from cold — Insufficient supply 
 of food, of clothing — No medical or moral treatment — Superin- 
 tendence confided to ignorant and dissolute keepers — Terror as 
 a remedy — Cruelty and immorality of servants — No separation 
 of sexes — Unhealthy cells — Concealment of mortality — Deaths 
 from fury of keepers and patients — Records burned to frustrate 
 inquiry, &c— A visit to Asylums as they were* . 98 
 
CONTENTS. XI 
 
 LECTURE IV. 
 
 WHAT ASYLU3JS ARE. 
 
 Page. 
 The old system not altogether exploded — Commencement of the 
 
 present system — Liberation of Lunatics at Bicetre by Pinel — 
 The adoption of enlightened principles partial, but a desire for 
 improvement prevalent — First recognition of humanity and occu- 
 pation as means of treatment in remote times, in Egypt and 
 Belgium — Present mode of treatment characterized by want of 
 classification, want of employment, want of bodily exercise — 
 Asylums insufficiently heated — Error of supposing Lunatics 
 impregnable to cold — Inattention to personal comfort of Luna- 
 tics — Corporal punishment professedly abandoned ; but cruelty 
 in various forms still committed — Patients confined to bed to 
 accommodate servants — Inadequate number of keepers — Coer- 
 cion as a means of cure, of protection — Character and qualifica- 
 tions of attendants on Insane — Evils of indiscriminate associa- 
 tion of insane — No wards for convalescents exists — Grounds 
 for separating Lunatics — Erroneous views of moral treatment — 
 Night visits — Mental anxiety and disturbance produced by the 
 oppressive, harsh, indelicate or derisive conduct of keepers- 
 Substitution of convalescent patients for keepers — Important 
 duties imposed on this class of servants — Difficulty of procuring 
 well-educated persons to undertake such responsibility — Exclu- 
 sion, desertion of friends of Lunatics — Asylums ill-adapted 
 for reception of rich — Luxurious diet — Indiscriminate diet — 
 Solitary meals — Prejudices of public present obstacles to im- 
 provement — Examples — How are these to be removed ? . 134 
 
 LECTURE V. 
 
 WHAT ASYLUMS OUGHT TO BE. 
 
 A perfect Asylum a Utopia — Belief of the inadequate provisions 
 for the cure of the insane in asylums, general — Character of the 
 physician — Benevolence, conscientiousness, courage — Intellec- 
 
 J 
 
Xil CONTENTS. 
 
 Page 
 ttral qualifications— Site of an asylum — It may contribute to the 
 cure of the inmates— Construction of the building — Size of 
 apartments — Night-classification — Houses of one story — Dor- 
 mitories — Night-keepers — Portion of asylum fire-proof — Pad- 
 ding of walls — Heating the apartments by the circulation of 
 hot water— Clothing — Airing-grounds — Shrubberies — Gardens 
 —Farm-employment of patients— Payment for labour — Classi- 
 fication—Religious worship and instruction — Fallacies in moral 
 treatment — Dancing— Voisin's and Esquirol's establishments — 
 Asylum at Sonnenstein — Library — Asylums at Naples, at Hart- 
 ^ ford, United States— Visit to an asylum as it ought to be. 176 
 
LECTURE I. 
 
 WHAT IS INSANITY ? 
 
 Erroneous views on the Subject — Propensities, Sentiments, Reflec- 
 tive and Perceptive powers — The dependence of these on Organi- 
 zation — Derangement a disease of the Brain — The changes which 
 occur in the Structure of the Brain — Evidence that such changes 
 take place — Extent of diseased action which constitutes Insanity — 
 Description preferable to definition of the disease where the regu- 
 lation of the internal economy of Asylums is concerned — Nosologi- 
 cal classification of the varieties of the Disease — Arrangements of 
 Arnold, Heinroth, and Author — Idiocy — Its four gradations — Fa- 
 tuity, partial, complete — Monomania, erotic, homicidal and de- 
 structive, proud, vain, timid, suspicious, religious and eupersti- 
 tious, desponding and suicidal, imaginative, avaricious, benevolent, 
 and affectionate — Incapability of perceiving the relations of ideas — 
 Incapability of perceiving the relations of external objects — Incapa- 
 bility of perceiving the qualities of external objects — Mania, with 
 and without increased activity — Conclusion. 
 
 Gentlemen, — The pages which I am about to submit 
 to you, and subsequently to the public, possess one quality 
 which many regard as a merit, but which I am inclined to 
 think is a misfortune. It is that of originality. No attempt, 
 so far as I know, has yet been made to condense, in a plain, 
 practical, and still popular form, the results of observation 
 in the treatment of insanity, for the specific and avowed 
 purpose of demanding from the public an amelioration of 
 the condition of the insane. The motives which have ac- 
 tuated me in bestowing a very careful, and, I humbly trust, 
 a candid examination on the subject, have been a profound 
 sympathy for the misfortunes of the insane, and a keen feel- 
 
 B 
 
z WHAT IS INSANITY. 
 
 ing of indignation that these misfortunes should often be 
 multiplied through the apathy, or ignorance, or cruelty of 
 those who have it in their power to become benefactors, in 
 the noblest sense of the term, and in the noblest cause which 
 can arouse virtuous ambition. Should this attempt to en- 
 list in that eause the feelings of justice and mercy in every 
 bosom, in any degree succeed, as by the blessing of a just 
 and merciful God I trust it may, and should the cry for im- 
 provement in public Asylums be raised where hitherto the 
 silence of indifference has reigned, the only reward which I 
 covet will have been obtained. 
 
 What is insanity ? The question may be put and answer- 
 ed in two senses ; either philosophically or practically ; ei- 
 ther as directed to ascertain the actual condition of the 
 mind which constitutes disease, or to determine that amount 
 of diseased action which compromises the safety of the suffer- 
 er, -and justifies legal interference. Our chief concern is 
 with the aspect which the disease presents, after the law has 
 interfered. In order to arrive at just conclusions on such a 
 subject, it is incumbent to understand something of the na- 
 ture, the powers, and the laws of the mind while in posses- 
 sion of health and vigour. This is generally overlooked in 
 the investigation, and the verdict of the public and of a jury 
 is as recklessly and ignorantly pronounced respecting men- 
 tal strength, as if the points at issue were the discovery of 
 the perpetual motion or the utility of a comet. It is not to 
 be expected that either of these tribunals should be com- 
 posed of metaphysicians; but it is highly desirable that 
 every man, qualified by his station in society to judge or 
 legislate in such matters, should be competent by education 
 to found and form his judgments on a knowledge of what 
 consciousness and observation shew to be the laws of our 
 spiritual nature. So vague are the ideas generally enter- 
 tained, or, rather, so destitute is the great majority of even 
 educated men of any ideas or definite opinions as to mental 
 
WHAT IS INSANITY. & 
 
 philosophy, that very recently the capability of repeating 
 the Multiplication Table was gravely propounded in an 
 English court of law as a test of sanity. This looks like 
 satire on the reputed money-making propensities of this na- 
 tion, but the proposal had no such origin. And to prove 
 how momentous the interests are which hinge upon a clear 
 comprehension of what insanity is, it may be mentioned 
 that in the very case where this arithmetical crux was sug- 
 gested, immense property and the reputation and affections 
 of many individuals were at stake. 
 
 So far as our present purpose is concerned it may be suffi- 
 cient to know, that the mind consists of four classes of 
 powers. The first of these are mere instincts or impulses, 
 manifested by us in common with the lower animals, capa- 
 ble of being directed by reason, or the moral feeling, to 
 great and noble ends, but in themselves prompting merely 
 to love, to combat, to acquire, and so forth. The second 
 class comprehends the sentiments where there is a vivid 
 emotion superadded to a propensity to act ; among these are 
 feelings of pride, vanity, veneration, hope, &c. The purely 
 intellectual powers constitute the third class. By them we 
 recognise the relations of ideas, of the impressions of the 
 mind itself; we are enabled to trace effects to their causes, 
 to ascertain the difference or agreement of propositions, and 
 to conduct what is commonly called a process of reasoning. 
 In the fourth class are the observing powers, those by which 
 we perceive the qualities and relations of external objects. 
 
 Now it appears that all these feelings and faculties are 
 gradually developed and that they gradually decline ; that 
 they are weak in infancy, strong at maturity, and again 
 weak in old age ; that their evolution and decay correspond 
 with the changes in organization. Farther, it has been as- 
 certained, that the condition and intensity of these powers 
 is influenced by^the state of the body, by external and in- 
 ternal stimuli; that in certain affections of the nervous sys- 
 
^ WHAT IS INSANITY. 
 
 tern, as intoxication, their energy is impaired ; and that in 
 certain other affections, as phrenitis and ramollissement, 
 their operation is altogether destroyed. Lastly it is proved, 
 that the integrity and health of these powers depend upon 
 the structure of the brain and its coverings ; that if this 
 organ be prevented from attaining a certain size, no mental 
 manifestations appear; that if by accident or disease, the 
 nervous mass should be directly or indirectly injured, these 
 manifestations are diminished in number, impaired in 
 strength, or annihilated. In what manner this connexion 
 between mind and matter is effected, is not here inquired 
 into. The link will, perhaps, ever escape human research. 
 Enough has been disclosed to teach us the importance of 
 recognising the connexion, and of making it the foundation 
 of all inquiries into the nature of mental alienation, and of 
 all attempts to improve the condition of the insane. From 
 lha admission of this principle, derangement is no longer 
 considered a disease of the understanding, but of the 
 centre of the nervous system, upon the unimpaired con- 
 dition of which the exercise of the understanding de- 
 pends. The brain is at fault and not the mind. The 
 brain is oppressed by blood ; it is irritated ; it is softened ; 
 and the ideas are confused, the feelings exalted, because 
 that part of the system with which their healthy manifesta- 
 tion has been associated in this world, has undergone an al- 
 teration. But let this oppression be relieved, this irritation be 
 removed, and the mind rises in its native strength, clear and 
 calm, uninjured, immutable, immortal. In all cases where 
 disorder of the mind is detectable, from the faintest pecu- 
 liarity to the widest deviation from health, it must and can 
 only be traced directly or indirectly to. the brain. The 
 change may exist in its own structure, or in distant organs 
 which influence its condition, but that which renders it im- 
 possible that the mental operation should be continued with 
 regularity, or equanimity, is to be referred to the brain. For 
 
WHAT IS INSANITY. O 
 
 example, if a blow is received on the forehead, the skull is de- 
 pressed, the brain is lacerated or contused, and the individual 
 passes at once from the possession of a sound and powerful rea- 
 son, from a clear and correct perception of the position which 
 he occupies, the plans he has formed, and of the knowledge 
 and energies he can put forth, into a dark fatuity, a bewil- 
 derment of thought, an ignorance of all he has done, can do, 
 or is required to do. Here the two facts of cerebral mutila- 
 tion, and of deprivation of intellect stand so distinctly in the 
 relation of cause and effect, that all men are accustomed to 
 regard them, and are warranted in regarding them in this 
 light. Again, if the dissolute and reckless debauchee per- 
 severe for long years in the practice of gratifying his palate, 
 and destroying his digestive powers, and keeping his ner- 
 vous and circulating systems in a state of excitement, alike 
 inimical to virtue and to health, the first indication of the in- 
 terruption to his enjoyments, and of the incursion of disease 
 may be in the stomach. Uneasy sensations, pain, disorga- 
 nization will attract his attention ; his reason will in vain 
 attempt steadily to contemplate his situation, his fears are 
 up in arms, the whole mind totters and ultimately falls. 
 After a few years of raving madness, or helpless idiocy, he 
 dies. On dissection, the stomach may exhibit traces of 
 deep-seated, long-continued morbid action, the obvious con- 
 sequences of frequent exposure to stimulants. But will this 
 be the only lesion discoverable ? Can such changes, which 
 are found to follow other causes without disturbing the 
 functions of the brain, in this particular case produce insa- 
 nity ? — Experience proves the reverse of this. In, or 
 around the brain will be detected some obvious alteration 
 of structure, with the existence of which health was incom- 
 patible. The incessant determination of an accelerated or 
 vitiated current of blood to the head, or the condition of 
 the nervous system consequent on repeated intoxication, 
 accounts for the production of this alteration. Occasion- 
 
6 WHAT IS INSANITY, 
 
 ally, cases occur where the lesions are very slight, have 
 been overlooked, or, according to some authors, have not 
 existed. The disease, in the latter case, is called functional, 
 or is supposed to depend upon some change in the propor- 
 tion or qualities of the elements of which the brain is com- 
 posed, not appreciable by our senses, nor detectable by che- 
 mical agents. Neither of these explanations is satisfactory. 
 The prevailing opinion at present is, that no cases do occur 
 where no pathological condition can be observed : that those 
 recorded owe this feature to the negligence or ignorance of 
 the narrator, and that, should such cases really exist, the 
 brain must be affected similarly to the rest of the body in 
 fever, where the alterations are evanescent, disappearing on 
 the extinction of life. But what does history contribute to 
 the settlement of the question. Greding noticed thickening 
 of the skull in one hundred and sixty-seven out of two hun- 
 dred and sixteen cases, besides other organic disease. It 
 ought to be observed, that Greding was in search of a par- 
 ticular morbid appearance. Davidson, of Lancaster Asy- 
 lum, in the examination of two hundred cases, scarcely ever 
 met a single instance in which evident traces of diseased 
 action were not found. Dr. Wright, Bethlem, dissected one 
 hundred cases, and saw disorganization of the brain, &c. in 
 all. Dr. Haslam, St. Lukes, says, insanity is always con- 
 nected with organic changes. Georget, Falret, Voisin, Cox, 
 Crighton, Crowther, Burrows, &c. entertain the same opi- 
 nion. 
 
 Insanity, then, is inordinate or irregular, or impaired ac- 
 tion of the mind, of the instincts, sentiments, intellectual, or 
 perceptive powers, depending upon and produced by an or- 
 ganic change in the brain ; the extent of the disease corres- 
 ponding to the extent of the destruction or injury of the 
 nervous structure.* It is here particularly worthy of notice/ 
 
 * " A great error has arisen," says Newnham, " and has been per- 
 petuated even to the present day, in considering cerebral disorder as 
 
WHAT IS INSANITY. 
 
 that being strictly a bodily disease, the nature, intensity 
 and aggravations of insanity must be regulated, in a great 
 measure, by the relation of the brain to the other organs of 
 the body, and the relation of both of these to external 
 agents : and that if such a dependence exists, an equally 
 intimate connexion must be concluded to obtain between 
 the means of cure and the state of these organs and external 
 agents. 
 
 But, in determining what treatment ought to be adopted 
 in cases of lunacy, how is the degree of diseased action to 
 be estimated, or rather, what departure from the healthy 
 standard is to be recognised and treated as disease ? There 
 appears to be a necessity for some estimate of this kind, 
 however vague, and upon whatever principles founded, in 
 every case where confinement is advised, or resorted to. 
 But, first, is there a healthy standard, or if there be, how is 
 it to be ascertained ? 
 
 In the well known trial relating to the lunacy of Miss 
 Bagster in 1832, Dr. Haslam gave two rather startling an- 
 swers when urged by Mr., now Sir F. Pollock. He is re- 
 ported to have said, " I never saw any human being who 
 was of sound mind ;" and subsequently, on being pressed 
 hard for a more explicit statement, he concluded, " I pre- 
 sume the Deity is of sound mind, and he alone." This is 
 
 mental; requiring, and indeed admitting, only of moral remedies, in- 
 stead of these forming only one class of curative agents ; whereas the 
 brain is the mere organ of the mind, not the mind itself: and its dis- 
 order of function arises from its ceasing to be a proper medium for the 
 manifestation of the varied action and passion of the presiding spirit. 
 And strange as it may seem, this error has been consecrated by a de- 
 sire to escape from the fallacies of materialism. Yet it is manifest 
 that they alone are guilty of the charge of attachment to materialism, 
 who consider the disorder of the cerebral functions as mental, for then, 
 indeed, the brain must be mind itself, and not simply its organ." — 
 Christian Observer, vol. xxix. p. 266. 
 
8 WHAT IS INSANITY. 
 
 next to asserting that no palpable distinction exists, no 
 line of demarcation can be traced between the sane and the 
 insane. It must be confessed, that the line is either ideal 
 or purely geometrical. If the two most widely separated 
 conditions of mind, its greatest strength and serenity, and 
 its most abject imbecility or fury be contrasted, the distance 
 appears enormous and impassable ; but if we gradually re- 
 cede from these extreme points towards the medium, it will 
 be found, so imperceptibly do the distinctive marks disap- 
 pear, and so insensibly do eccentricity on the one hand, 
 and enthusiasm on the other, blend together, that the task 
 of declaring this to be reason and that insanity is exceed- 
 ingly embarrassing, and, to a great degree, arbitrary. 
 People have puzzled themselves to discover this line, a terra 
 incognita, in fact, which does not exist ; the mind being sus- 
 ceptible of as many shades of difference in the strength and 
 relations of its powers as the body ; and the attempt being 
 as feasible to define the precise health-point in the one as 
 in the other. Another enigma has been propounded of 
 somewhat similar import. An enigma which GEdipus could 
 not have solved. It is to establish a definition of insanity. 
 That is, to discover one form of words expressive of the na- 
 ture of a hundred different things. I humbly think, that 
 however interesting and edifying these investigations may 
 be to mere philosophers, the philosophical practitioner ought 
 to make the inquiry invariably bear reference to the ques- 
 tion, whether isolation would be for the benefit of the pa- 
 tient. The criteria, however, in forming a judgment are 
 supposed to be various and adequate. Is a man able to 
 manage his own affairs, is he violent, virulent, extravagant 
 or troublesome? are the questions addressed to medical 
 witnesses. It is rarely demanded, whether confinement will 
 conduce to the restoration of health. That incompetency 
 for business, or irritability, do occasionally require the in- 
 terference of the law, may be true. Property and the 
 
WHAT IS INSANITY. 9 
 
 public peace of society must be protected. And where 
 either the one or the other is threatened, or disturbed, no 
 difficulty can be experienced as to the propriety of coercing 
 the violator. Insanity is evidently the cause of such out- 
 rages, and insanity of a kind that cannot be efficiently treated 
 without isolation. But even in such cases, the offender 
 sometimes proves to be a delinquent : a criminal rather than 
 a lunatic, and an Asylum becomes more of a penitentiary 
 than an hospital. This is a minor evil. A much greater 
 results from the universal application of such tests leaving 
 lunatics at liberty, and incarcerating sane, or comparatively 
 sane, individuals. This will be better understood from the 
 following illustrations. The cunning vindictive maniac, for 
 example, may be perfectly competent to conduct mercantile, 
 or even more complicated affairs, with ability, he may even 
 prosper in his enterprises ; and yet his treatment of those 
 dependant upon him, of all who may have offended him, of 
 all whom he suspects, may be marked by the maliciousness of 
 the demon, and the indiscriminate ferocity of the maniac. 
 He, if subjected to such tests, may never be suspected, un- 
 til some out-burst of fury, when he is deserted by his habi- 
 tual caution, consigns those around to death or misery. 
 This man ought to be confined, but escapes, until the evil 
 is done. Again, the man who from natural inaptitude to de- 
 tails of business is incapable of conducting his affairs ad- 
 vantageously, may be in all other matters rational and praise- 
 worthy : he may be a good mechanician, an artist, a man of 
 strong affections and irreproachable manners. This man 
 ought to be free, but being subjected to the same tests, is 
 confined, until his whole mind is as much enfeebled as his 
 business powers. All chances ought certainly to be in fa- 
 vour of the lunatic ; for a greater injury is done by the sa- 
 crifice of one sane individual, than by the freedom of many 
 lunatics. The test ought to be as general as possible, and 
 to have reference not to the abstract question of what insani- 
 
10 what is insanity. 
 
 ty is, but to the probable consequences which may accrue 
 from the declaration that it exists in every given case. 
 
 Entertaining these opinions then, in place of endeavour- 
 ing to define, I have described the different forms which 
 insanity assumes, believing that by such a course the inte- 
 rests of science and of humanity will be better served, than 
 by straining after what the failure of all previous writers 
 nearly proves to be a nonentity. 
 
 As an enlightened system of classifying lunatics must 
 depend on the accuracy of the classification of the varieties 
 of the disease with which they are affected, I have here pre- 
 sented three : the most ancient, at least the most ancient 
 which has any pretensions to be complete, the most recent, 
 and the best. We shall adhere to the latter. 
 
 I. Arnold's Table of the Species of Insanity. 
 
 I. Ideal. i. 
 
 Phrenitic. 
 
 IX. 
 
 Incoherent. 
 
 III. 
 
 Maniacal. 
 
 IV. 
 
 Sensitive. 
 
 II. Notional, v. 
 
 Delusive. 
 
 VI. 
 
 Fanciful. 
 
 VII. 
 
 Whimsical. 
 
 VIII 
 
 , Impulsive. 
 
 IX. 
 
 Scheming. 
 
 X. 
 
 Vain or Self-important. 
 
 XI. 
 
 Hypochondriacal. 
 
 XII 
 
 Pathetic. 
 
 
 1. Amorous. 
 
 
 2. Jealous. 
 
 
 3. Avaricious. 
 
 
 4. Misanthropic 
 
 
 5. Arrogant. 
 
 
 6. Irascible. 
 
 
 7. Abhorrent. 
 
 
 8. Suspicious. 
 
WHAT IS INSANITY. 1 L 
 
 II. Notional continued. 
 
 9. Bashful. 
 
 10. Timid. 
 
 11. Sorrowful. 
 
 12. Distressful. 
 
 13. Nostalgic. 
 
 14. Superstitious. 
 
 15. Fanatical. 
 
 16. Desponding. 
 xiii. Appetitive. 
 
 II. Heinroth's Division of Insanity. 
 
 I. Disorders of the Moral Dispositions. 
 
 1. Exaltation, or excessive intensity. 
 
 Undue vehemence of feelings, morbid violence of passions 
 and emotions. 
 
 2. Depression. 
 
 Simple melancholy, dejection without illusion of the un- 
 derstanding. 
 
 II. Disorders of the Understanding, or intellectual faculties. 
 
 1. Exaltation. 
 
 Undue intensity of the imagination, producing mental illu- 
 sions and all the varieties of monomania. 
 
 2. Depression. 
 
 Feebleness of conception ; of ideas. 
 Imbecility of the understanding. 
 
 III. Disorders of voluntary powers, or of propensities, or of will. 
 
 1. Exaltation. 
 
 Violence of will and of propensities ; madness without le- 
 sion of the understanding. 
 
 2. Depression. 
 
 Weakness, or incapacity of willing. 
 Moral imbecility. 
 
 Note.— To these unmixed forms others are added under e&ch division, 
 displaying combinations of several simple varieties. 
 
 
 .i 
 
12 WHAT IS INSANITY. 
 
 III. The Author's Arrangement. 
 
 I. Idiocy. Non-development of faculties. 
 
 ] . Gradation. Non-development of all the powers. 
 2- ~~~ External senses developed. 
 
 3. ~~~ A propensity or affection developed. 
 
 4. An intellectual power developed. 
 
 II. Fatuity. Obliteration of Faculties. 
 
 1. Partial. 
 
 2. Complete. 
 
 III. Monomania. Derangement of one or more faculties. 
 
 1. Satyriasis. 
 
 2. Homicidal and destructive. 
 
 3. Proud. 
 
 4. Vain. 
 
 5. Timid. 
 
 6. Cunning and suspicious. 
 
 7. Religious and superstitious. 
 
 8. Desponding and suicidal. 
 
 9. Imaginative. 
 
 10. Avaricious. 
 
 11. Benevolent or affectionate. 
 
 SECTION II. 
 
 12. Incapability of perceiving relations of ideas. 
 
 13. Incapability of perceiving relations of external things* 
 
 14. Incapability of perceiving qualities of external objects. 
 IV. Mania. Derangement of all the faculties. 
 
 1 . Mania with increased activity. 
 
 2. Mania with diminished activity. 
 
 I. Idiocy. The first of these classes comprehends the 
 manifestations of all those unfortunate beings, who, dead 
 to sensation, or, with the external senses perfectly faithful 
 and active, appear to possess no mind to which the impres- 
 
 I 
 
WHAT IS INSANITY. 13 
 
 sions thus received can be communicated, or one so closely 
 assimilated to that of the lowest gradations of animal exist- 
 ence, that the impressions pass away without becoming 
 objects of thought, or causality, and without calling forth a 
 single propensity or sentiment. The mind may not be, nay 
 rarely is, so utterly undeveloped as this description would 
 convey, but, while there may remain an attachment to some 
 favourite place or person, or a delight in harmonious sounds, 
 or constructive powers, or the irritability of anger, every 
 other faculty is blotted out : no appeal can be made to rea- 
 son, no progress can be made in education, there is, in fact, 
 nothing to educate. So great, occasionally, are these pri- 
 vations, that the individuals cannot articulate, nor acquire 
 language, and literally do not differ, we repeat, from the lower 
 animals, with which they delight to associate.* Hitherto 
 these helpless creatures have been permitted to remain at 
 liberty, the sport of fortune or of their own imperfect in- 
 stincts and ill-regulated passions, the prey of the designing, 
 the butt of the idle, or the cruel. According to a public 
 print,t two individuals of this neglected class who had long 
 roamed through llosshire, quarrelled, fought, one died of the 
 wounds received in the struggle, and the other was, of course, 
 consigned to prison. This took place in January 1835. 
 
 Rational and true humanity would have suggested their 
 protection from these sources of pain and annoyance by 
 seclusion, where their humble and limited wants might be 
 supplied, their wishes, so far as might be compatible with 
 their safety gratified, and all the vegetative happiness of 
 which they are susceptible, secured. 
 
 There are, however, gradations in the scale of idiocy. 
 Certain individuals advance farther towards the maturi- 
 
 *Art. " Idiotisme," by Esquirol, Diet, des Sciences Med., vol. xxiii. 
 — Pinel on Insanity, Eng. Trans., p. 126 — 169. — Voisin, Journal de 
 la Socie'te Phrenologique de Paris, April 1835. 
 
 f Scotsman, January 1835. 
 
14 WHAT IS INSANITY. 
 
 ty of mind than others, and yet fall infinitely short of what 
 our intellectual nature is intended to be, and even what the 
 most neglected and degraded sane individual actually is. 
 The lowest state in which humanity appears, is when neither 
 reason nor sensation has been bestowed. Where the im- 
 perfect being does not appear to be conscious of light, or 
 sound, or hunger, and where sleep and a swaying motion of 
 the body alternate, during the long protracted lifetime which 
 many of these unfortunates are required to endure. The 
 next gradation is where the external senses exist, but with- 
 out the co-existence of any faculty by which the sensations 
 thus obtained can become objects of reflection. The indi- 
 viduals of this class prefer light to darkness, experience great 
 pleasure from odours, and occupy a great part of their time 
 in moving their hands along smooth surfaces, an act which 
 in the child is supposed to contribute to the idea of exten- 
 sion*. The third gradation consists of patients, who, besides 
 exercising their senses, contract affections, display desires, 
 and feel the first throbs of ambition. The last gradation is, 
 where in addition to these feelings, there is a certain, but very 
 contracted power of ratiocination, a facility in acquiring a 
 mechanical art, or an aptitude for arithmetical or mathema- 
 cal studies, without any corresponding evolution of the 
 other powers of mind. 
 
 II. Fatuity is generally the effect of apoplexy, chronic 
 inflammation of the membranes of the brain, or of some sig- 
 nal alteration in the texture of the nervous substance. The 
 extent to which such deviations from the healthy condition 
 of structure may be borne with impunity, has not been as- 
 certained. But whenever both hemispheres are implicated, 
 and the parts affected are actually disorganized, the annihi- 
 lation, or, to avoid any mistake as to our meaning, the sus- 
 pension of mind inevitably follows. It should be understood 
 that these alterations are general and not local, or are at 
 
WHAT IS INSANITY. 15 
 
 least of such a nature as to affect the whole of the contents 
 of the encephalon. 
 
 The progress of the malady is often slow, always insidious. 
 Haifa lifetime may elapse, marked by gradually increasing 
 inconsistencies and imbecility, which are kindly attributed 
 to humour or eccentricity, before the understanding is sus- 
 pected to be undermined, or the glaring approach of a se- 
 cond childishness be more than surmised. When the keen 
 and easily awakened sensibility of affection is struck by some 
 unusual petulance, loss of attention, or inability to exercise 
 judgment, the source may be conjectured, but some momen- 
 tary gleam of returning reason, or the occurrence of circum- 
 stances where, from there being no demand for intelligence 
 the mental weakness may not be betrayed, will lull the fears 
 to sleep, and not until after repeated follies and irregularities, 
 does the truth, that an utter obliteration of the faculties is 
 on the eve of taking place, become manifest. Even when 
 succeeding another form of derangement, which very fre- 
 quently happens, the decay steals on as insensibly as the 
 approach of old age. The amount of deprivation can only 
 be measured by comparing distant periods. Furious mania 
 is probably more exposed than other varieties to this termi- 
 nation. The change in this case is indeed astounding : 
 when the outrageous, ungovernable desperado loses his attri- 
 butes one by one — suffers first the extinction of the memory 
 of his grievances, then of the inclination to hate or injure, 
 and ultimately sinks into complete tranquillity and reverieism. 
 Men of genius often share a similar fate, and from a similar, 
 though, in their case, a voluntarily incurred affliction. They 
 overtax, exhaust, and destroy their powers. And the con- 
 trast here is still more distressing. The brilliant wit, the 
 impassioned orator, even the calm philosopher become dot- 
 ards, imbeciles, puling children, and by their own act, by 
 their own ignorance of the mind, which they pretended to 
 improve and ennoble. 
 
16 WHAT IS INSANITY. 
 
 Fatuity may be partial or complete. It may comprehend 
 one or all of the intellectual energies, and enfeeble all or de- 
 stroy all. The powers may remain, but their strength, and 
 especially the strength acquired by cultivation, is gone. 
 They no longer act in concert ; and the indistinct descrip- 
 tion of a discovery in mechanics, or a transaction in busi- 
 ness, is associated with a prayer, or a passionate ejaculation. 
 Some solitary power, or accomplishment, or favourite train 
 of thought occasionally lingers behind the rest, or survives 
 their destruction. Imbecile weavers are sometimes met 
 with, who occupy themselves with the trade in which they 
 have been originally trained. Musical imbeciles, and affec- 
 tionate but one-ideaed imbeciles might be mentioned, who 
 diffused a happiness around them which they did not feel, 
 and from their peculiarities created a bustling and merry 
 activity among their companions in which they could not 
 participate. But as great infirmity of frame, in the majority 
 of instances, accompanies fatuity, a more insurmountable 
 obstacle is opposed to such manifestations than even the in- 
 trinsic decrepitude of the mind itself. Dementia and gene- 
 ral paralysis go hand in hand, and patients borne down by 
 such complicated misfortunes, are seldom able to leave their 
 beds or chairs.* From this circumstance, and from being 
 at once harmless and independent of society from the extinc- 
 tion of their social powers, a separate ward is appropriated 
 to their use in many hospitals, where their existence glides 
 on towards its peaceful but humiliating close, undisturbed by 
 cold, or hunger, or darkness, or pain, or any of the few 
 strictly animal irritations of which they are susceptible. 
 Notwithstanding the apparently hopeless condition of pa- 
 tients labouring under fatuity, cures occasionally take place. 
 Their rarity may be gathered from the fact, that of 518 cures 
 effected at Charenton, only four of those restored had been 
 Fatuous. 
 
 * De la Paralysie considered chez les Alienes par L. F. Calmeil. 
 
WHAT IS INSANITY. 17 
 
 III. Monomania. The attempt to. reduce the tints, and 
 shadings, and combinations of tints which meet the eye, to 
 the rudimentary colours, must appear to the unscientific 
 impossible. In the same way to a stranger who examines a 
 populous asylum, and perceives the thousand modifications 
 of disease of the moral sentiments and feelings which are 
 there presented, a classification of these under some ten or 
 twelve primitive powers or states of mind, must appear suffi- 
 ciently daring. Yet by the aid of a careful analysis this 
 may be readily done. You will not find the delusions of 
 two madmen alike, is a common remark. True, the particu- 
 lar succession of ideas will not and cannot be the same, for 
 that is determined in each case by education, pursuit, and 
 extraneous circumstances ; but the source, the emotion, by 
 which these ideas are suggested, and in consequence of the 
 derangement of which they are morbid, will frequently be 
 found to be identical. One man conceives himself to be our 
 Saviour, another that he is Louis XIV. ; the first rails 
 against his imaginary persecutors, his fellow-patients, whom 
 he designates unbelieving Jews ; the second pays court to 
 the chambermaid as Madam de Maintenon, or mourns over 
 his defeat at Blenheim ; the one walks about without shoes 
 or stockings ; the other has turned his coat inside out as a 
 fitting vestment for royalty. Two cases can scarcely be 
 imagined more remote in their characteristics ; but if the 
 deportment of each be traced back — if the assumption of 
 elevated rank, the mock dignity, the hauteur, be analyzed, 
 excessive activity of the feeling of self-esteem, accompanied 
 by an inability to perceive the relations subsisting between 
 the impressions in the mind and real circumstances, will be 
 discovered to be the ultimate cause, and adequate to account 
 for all the phenomena. Pride acting in the one case, on 
 dispositions originally religious, and strengthened by culti- 
 vation ; and pride, acting in the other, on the ambitious 
 longings of an enthusiastic spirit. If all cases of insanity be 
 
18 
 
 WHAT IS INSANITY. 
 
 dealt with in a similar manner, the specific distinctions 
 shrink within a very small compass. 
 
 Before proceeding to sketch a few of the distinctive marks 
 of the varieties of monomania, it is expedient to warn you that 
 this term is generally understood in a sense altogether unphi- 
 losophical. It is applied to cases where there exists only one 
 delusion. And it is intended to imply the disease of only one 
 power. Should a man declare himself to be Julius Caesar, 
 and be clear, and consistent, and cogent on all other points, 
 he is called a monomaniac, and is concluded to possess all 
 his powers sane and sound, except the feeling of pride. The 
 conclusion is erroneous. Pride communicates nothing more 
 than a vivacious, an intense feeling of haughtiness and dis- 
 dain, a desire for exaltation ; but the delusion whereby this 
 desire is gratified, on a supposed metempsychosis into the 
 body of the Roman emperor, must result from the diseased 
 a"ction of the intellectual powers, — from an incapability, in 
 fact, of perceiving the relations of ideas. A feeling cannot 
 give an idea that a man is a different person from what he 
 actually is. The word, then, is not here restricted to one 
 delusion, but means the disease of certain classes of men- 
 tal powers, in contradistinction to mania or disease of the 
 whole. 
 
 1 Sect. I. — 1. Satyriasis. The first form of Monomania, to which 
 it is necessary to advert, is Satyriasis, or inordinate sexual desire 
 uncontroled and incontrolable by any governing power within, 
 or by admonitions, threats, punishment or coercion. This 
 loathsome and most humiliating spectacle is fortunately rare, 
 and occurs in consequence either of organic alteration in the 
 brain, or of a long course of debauchery. We forge the bolt 
 that is to destroy us. The history of mental disease reveals 
 awful truths. And one^f these is, that the mind may be train- 
 ed to i nsan ity, to destroy itself. And by the wise and ever just 
 arrangements of Providence the punishment is proportioned 
 
WHAT IS INSANITY. 19 
 
 to the offence, the effect corresponds in nature and in de- 
 gree to the source from which it originated, the awards of 
 justice are inflicted on the criminal by means of the very- 
 weapon with which his offence was committed : he cultivat- 
 ed his passions and propensities, and these, on arriving at 
 the maximum of their energy, destroy him. Nay more, it 
 would appear that the lower the propensity to the gratifica- 
 tion of which his other powers have been but ministers, that 
 the more gross and injurious the violations committed against 
 the powers which regulate his own being, or connect him 
 with his fellow-men, the more signal and striking is the ter- 
 mination to such a career, the more grovelling and disgust- 
 ing the condition to which the offender is reduced. Has 
 sexual appetite polluted and paralyzed his mind ? He be- 
 comes the victim of a loathsome species of mania, to charac- 
 terize which we have been obliged to borrow the name of a 
 fabulous monster from the Roman mythology. 
 
 The erotomaniac is generally furious and inaccessible to 
 any moral influence ; the mind is concentrated upon one 
 point, and, as is always the case when profoundly affected, 
 is blind and deaf, and closed against every less powerful 
 motive. Sometimes there is mere sallacity attended by 
 shame at the degradation of such an enslavement, — a con- 
 viction of the diseased condition of the feelings, — a struggle 
 to resist the incursion of the attack, and long intervals of 
 health. All objects which address, excite the propensity ; 
 all alterations in the functions of the system which tend to 
 produce plethora or irritation, and all associations which 
 divert the mind from occupations purely intellectual, are 
 calculated to give force to the disease. Conceive, then, the 
 situation of a maniac of this description in an institution 
 where there was no separation of the sexes, little attention 
 to the connection of the nervous system with the other 
 functions, and no employment. Instances of pure mono- 
 mania of this kind are certainly rare ; but the inordinate 
 
20 WHAT IS INSANITY. 
 
 desire is often exhibited where other morbid feelings have 
 the predominance and give a name to the disease. Here 
 the regulating faculties are extinct, or suspended, and the 
 passions assume the sway as the only, or most energetic 
 mental impulses remaining, in the same way as a craving 
 for food, or pleasurable sensations, rise above the general 
 wreck in imbecility. Certain powers only, however, may 
 suffer obscuration. The suggestions of these, although un- 
 diseased, become vitiated by the over-ruling propensity ; 
 they become instruments at the disposal of a mightier ener- 
 gy ; they are bent from their natural course and directed to 
 objects, and visions, and hopes, and fears, which sympathize 
 with the impulse. Recollections, in themselves pure and 
 connected with periods or events long antecedent to the 
 commencement of the disease, are inextricably mingled 
 with the existing gross conceptions. Trains of associations 
 wliich originate in subjects the most remote from lascivious- 
 ness, and appear to tend towards an elevation of sentiment, 
 are found actually to terminate in and to inflame the feel- 
 ing. The dreams are voluptuous. Even the automatic 
 movements of the body are indelicate or indecent. The 
 terminations of this form are three. The victims are either 
 cured, sink into fatuity, or exhibit symptoms of another and 
 more benign species of insanity.* 
 
 2. Homicidal, or destructive mania, is asserted to be more 
 prevalent in this country than elsewhere. Were we inclin- 
 ed to form our opinion on the revolting descriptions con- 
 tained in a book, once too popular, we might conclude 
 every second or third madman to be ferocious, sanguinar}', 
 a maimer, a murderer, or a parricide.f But this is not a 
 correct exposition of the case. The Asylum from which 
 
 * Dictionnaire de Me'decine, Art. " Satyriasis," " Folie," vols. xix. 
 and viii. BufFon, vol. i. p. 222. Smellie's translation. Heckar, 
 Epidemics of the Middle Ages, p. 105. 
 
 •j- Sketches of Bedlam. 
 
WHAT IS INSANITY. 21 
 
 these sketches were drawn was a receptacle for criminal 
 lunatics, and, to a certain extent, adhered to the old regime 
 of manacles and punishment which render men furious and 
 dangerous. Our national character may render us more 
 prone to this than to other forms of alienation ; and the pre- 
 sent demoralised habits of certain sections of the population, 
 their dog-fights, bull-baitings, pugilistic contests, and so 
 forth, may assuredly predispose to the excitement of the 
 very lowest passions; but my own experience would lead 
 me to believe that homicidal mania is as frequent in France 
 at least as in Britain. The lowest and least formidable de- 
 gree of this malady is an irresistible inclination to destroy 
 clothes, furniture, every article that will tear or break. This 
 instinct attends the acute stage of many species of mania, 
 but I here speak of it as idiopathic and permanent. A man 
 who was otherwise tolerably well, once told me that the 
 only words he liked to use, and the only things he liked to 
 do, were " crush, smash." The second variety is where the 
 patient is incorrigibly quarrelsome ; where he seeks grounds 
 of dispute and antagonists ; throws all around into turmoil 
 and confusion, and will fight with his shadow rather than 
 allow his aggressive powers to continue dormant. The 
 third variety combines with these qualities an indomitable 
 hatred to human life; the thirst for blood is insatiable, arid 
 every other feeling seems subdued by the desire for victims. 
 In many countries and codes of law the majority of those 
 horrible atrocities which place man below the level of the 
 tiger are attributed to madness, and their perpetrators are 
 committed to the charge of the physician instead of the exe- 
 cutioner. For a long period the Romans had no law against 
 parricide. They thought the crime impossible. That the 
 insane have been immolated as criminals there exists too me- 
 lancholy proof; and whenever an adequate motive is want- 
 ing to explain the commission of such an act, or where the 
 act is opposed to the generally prevailing motives of the 
 
22 WHAT IS INSANITY. 
 
 actor, it is certainly humane and just to consider him as 
 irresponsible.* Without entering into the legal question, it 
 is necessary to observe that there exist very marked dif- 
 ferences in the mental condition of individuals instigated by 
 this blind impulse. There is the intense desire to kill ; but 
 at the same moment a sympathy for, a wish to save, and an 
 effort to warn the intended victim. There is this desire 
 without any such sympathy, but attended with a violent in- 
 ternal struggle to resist the temptation. And again, there 
 is the desire unmitigated either by sympathy or struggle, 
 burning for gratification, pausing, it may be from fear, but 
 ever watching for opportunities. Examples of these dis- 
 tinctions occur every day. Dr. Otho of Copenhagen relates 
 that Peter Nielson, the father of seven children, was seized 
 with a desire which he felt he could not resist to destroy 
 four of his children, whom, nevertheless, he tenderly loved. 
 Me took them to a turf pit, and after passionately embracing 
 them, pushed them into the water and remained until he 
 saw them drowned. Esquirol had a patient who acknow- 
 ledged that he experienced a desire to shed blood, and espe- 
 cially that of his own friends, to whom he was, notwithstand- 
 ing, much attached. He deplored the tendency ; but could 
 only frustrate his own designs by crying, when the fit re- 
 turned, " Mother, save yourself, or I will cut your throat." 
 The third degree may be illustrated by the history of a 
 man given by Dr. Caldwell. He had been guilty of nine 
 murders, the whole of which he acknowledged he had com- 
 mitted from an inherent love of slaughter. The flowing of 
 blood he declared to be " delightful to him." To such desola- 
 tors, or rather to the absence of any attempt to distinguish 
 and separate them from their less blood-thirsty or vindic- 
 
 * Simpson on Homicidal Insanity : Appendix to Necessity of Po- 
 pular Education. Archives de Medecine, vol. viii.p. 177. Georget's 
 various Medico-legal works. Annales d'Hygiene Publique et de Me'- 
 decine Legale, vol. xv. p. 128, and vol. xvi. p. 122. 
 
WHAT IS INSANITY. 23 
 
 tive associates, is the loss of life in asylums to be referred. 
 Within the last twenty years, two medical men and many 
 keepers and patients have been sacrificed from this cause. 
 
 The secondary incentives to, or reasons for such desires, 
 are very numerous. One deadly blow is inflicted to save 
 the soul of the sufferer, another is given to rid the world of 
 a monster, and a third that a sacrifice may be offered up for 
 the sins of all concerned. The effect which companions 
 entertaining, and known to entertain such designs, must 
 produce upon those labouring under the mania of fear or 
 despondency, must be most distressing. To have the keen, 
 cruel, blood-thirsty gaze of the glaring eye : the grinding 
 teeth, the clenched hand, and the threats of vengeance of 
 such a being constantly obtruded on the attention, might 
 excite madness. It may be supposed that patients of this 
 disposition are beyond the pale of humanity — beyond the 
 reach of art, or of alleviation. It is not so. They may be, 
 and often have been, humanized. By aiding the sympathy, 
 the virtuous resolves and sane convictions during the 
 struggle — by binding the mind to a certain routine of 
 purely intellectual or mechanical tasks, and thus excluding 
 the operation of the propensities, these unfortunates have 
 been reclaimed, have been intrusted with instruments which 
 might have served to wreak their fury, and finally have been 
 replaced in that position in society from which they had 
 fallen.* 
 
 3. Monomania of Pride, &c. There may be in this variety 
 either the exaltation of the emotion of self-conceit — the deep 
 and impregnable notion of superiority, and indifference or 
 contempt of all that is beneath, or that does not minister to 
 egotism, or to the affairs of the egotist, — or there may be 
 these feelings, coupled with delusions as to the character, 
 
 * Medecine Legale relative aux Alienes et aux Sourds-Muets 
 par J. C. Hoff bauer, p. 135. — Note sur la Monomanie Homicide par 
 M. le Docteur Esquirol. 
 
24 
 
 WHAT IS INSANITY. 
 
 circumstances, rank and claims, upon which this pride i 
 based. The self-satisfaction may be felt, the inattention t 
 business, the squandering of property, and other irratiom 
 acts, may be resolved upon by the lunatic in his own prope 
 person, or as a king or a conqueror. The latter is the mos 
 frequent form. There is, however, in the most pertinaciou 
 contenders for imaginary rank, no loss of the consciousnes 
 of personal identity. The individual may conceive himse; 
 to be Socrates or Sappho, a prince or a philosopher. H 
 may conduct himself with all the dignity, and speak an 
 think, as far as his abilities admit, in keeping with the as 
 sumed character, and spurn the slightest insinuation tha 
 Socrates is dead, that he himself is A. B., or that there is n 
 real ground for his pretensions. But should his friends b 
 presented to him, they are recognized and received as such 
 or should old scenes and former associations be recalled, h 
 will uniformly place himself in the same relation to these a 
 when they were previously before his mind. He will, fo 
 example, readily describe how Socrates sold a sheep t 
 CD., or took a dose of medicine at a certain time, and ii 
 a certain place, but will never dream of referring the sale c 
 the sheep to the pastures of Mount Hymettus, or the swal 
 lowing of the drug to the prison of the Acropolis. I hav 
 under my care a female, who declares herself to be the wif 
 of George III. ; but then it is as Queen Elspeth, born in tfo 
 parish of Benholm, that she ascended the throne. Thi 
 proud maniac, where his peculiar reveries or hallucination 
 are not combined with other feelings, is generally silent, am 
 is regarded as sullen. He is wrapped up in the magnificent 
 of his own importance and authority, or in the contempla 
 tion of his own attributes. He is independent of the world' 
 humility or kindness : he feels himself immeasurably remov 
 ed from its approaches, and despises the trifles which engag< 
 its inhabitants. But he is not unapproachable. Regulat< 
 your advances by the prevailing feeling of his mind, whicl 
 
WHAT IS INSANITY. 25 
 
 must be the foundation of all intercourse ; put into your 
 addresses that respect and deference which he demands ; 
 appear by the tone and style of your remarks to admit the 
 point at issue between him and the sane part of the com- 
 munity, and you will perhaps find him a condescending 
 patron, an adviser, or a protector. His happiness resides in 
 thoughts of personal magnificence : he is, therefore, con- 
 cluded to be selfish. But it is not the selfishness of aggran- 
 dizement or monopoly. His most marked symptom indeed 
 is, that within himself centre so many excellencies, that he 
 can dispense with all the ordinary objects cf man's desire 
 and ambition. He neglects his dress, he is solitary, he 
 seeks no kindness ; for what avails the foreign aid of orna- 
 ment, or companionship, or attention, to one who possesses 
 unbounded wealth, a descent of twenty quarterings, the 
 wisdom or the eloquence of all antiquity, everything, m 
 short, which nature or fortune could bestow. Such are his 
 delusions : they may, nay, must be varied, by the constitu- 
 tion and cultivation of his mind ; but they will be found to 
 revolve without deviation round one point, the feeling of 
 pride. The ease with which such patients are bent from 
 their own purposes towards those of others, by persons who 
 understand the human mind, and can use their knowledge 
 practically, is beautifully shewn in a statement of Pinel's. 
 He had no less than three Louis Sixteenth's in Bicetre at 
 one time. Their majesties unfortunately met in the court- 
 yard : a dispute ensued as to the right that each respective- 
 ly had to the title which they all assumed : and as a scuffle 
 appeared likely to take place, the matron interposed, took 
 one of the disputants aside, and said with great gravity, 
 " How happens it that you should think of arguing with 
 such fellows as these, who are evidently out of their minds ? 
 we all know well enough that your majesty alone is Louis 
 Sixteenth." The appeal produced the desired effect on each 
 
26 
 
 WHAT IS INSANITY. 
 
 real sovereign in succession, each retiring triumphant and 
 supreme.* 
 
 As a cause of insanity, wounded self-love, under the dif- 
 ferent aspects of disappointed ambition, jealousy, and insult, 
 is prolific. Of 492 cases given by Esquirol, sixty-one, or 
 about one-eighth, were attributable to these states of feel- 
 ing.f 
 
 4. Monomania of Vanity. Consists in an irrepressible 
 craving for praise, homage, and admiration. This is the 
 original germ ; but from this there spring a thousand gro- 
 tesque manifestations of the appetite and the modes by which 
 it shall be gratified. The actions of the great are imitated, 
 their manners travestied, and there is an affectation of all ac- 
 complishments and virtues, with the view of extorting ap- 
 probation. The courteous bow, the rakish swagger, the 
 ostentatious display of a scrap of old ribbon, are all intended 
 to' excite astonishment and admiration. The mind's errors 
 all tend towards what is called eclat : they bear reference 
 to the judgment of the world. The vain lunatic often suffers 
 a moral metamorphosis as well as the proud ; but when 
 imagination has suggested the delusion of being some very 
 important personage, it is not enough : the qualities upon 
 which this importance depends must be exhibited in order 
 to attract notice. If the idea of a celebrated singer has 
 predominated, the harshest notes will be screamed out in 
 the hope of an encore : if the maniac be converted into a 
 Demosthenes, you are assailed with the most incoherent, 
 but probably the most impassioned harangue that ever fell 
 from the lips of the most enthusiastic and successful orator: 
 if a person of fashion be imitated, rags are arranged in their 
 
 * Pinel on Insanity, p. 96 Davies' Trans. 
 
 •f Observations on the Nature, Kinds, Causes, and Prevention of 
 Insanity, &e. By Thomas Arnold, M.D-, vol. i. p. 251. 
 
WHAT IS INSANITY. 27 
 
 most elegant folds — ribbons, and stars, and orders, load the 
 breast — there is the mincing step, the stoop, the lisp — all 
 the frivolity of the character: if kingship be personated, it 
 will be popular kingship ; for although legitimacy may suf- 
 fice the proud, popularity, or living in the hearts of the 
 people, will alone satisfy the vain maniac. He is a cringing 
 beggar for the smallest mite of respect. 
 
 Females are more subject to this description of derange- 
 ment than males : and the French hospitals are crowded 
 with examples. These facts are accounted for by the 
 strength of the feeling of vanity in the female sex, and by 
 the injudicious encouragement which it receives from the 
 present state of society. The misery of this class of lunatics 
 is often extreme. They demand a tribute which is never 
 paid, and which it might prove injurious to pay. Their dis- 
 appointment is acute. They are discomfited to find that 
 their loathsome rags are not regarded as cloth of gold, their 
 croaking voice as melody. This discomfiture may be turn- 
 ed as a weapon against the disease.* 
 
 5. Monomania of Fear. The agitation of fear and anxiety 
 frequently produces the monomania of fear ; but the designa- 
 tion here used refers to the nature, and not to the origin of 
 the complaint. Its essence is vague, exquisite terror. It 
 may be definite, and have an object, real or imaginary, 
 frightful or not; or it may be an irrepressible apprehension 
 of present or prospective evil, without any conception of 
 what is feared, or why it is feared. The object dreaded, 
 v/hen there is one, is external and connected with certain 
 persons, events, or influences ; or it is internal, a part, a 
 condition of the diseased mind itself. Hence, there is the 
 fear of some persecutor, plot, or awful calamity ; or the 
 mind quails at its own resolves, at what it is, at what it may 
 
 6 Pinel. Quoted by Dr. A. Combe. — Observations on Mental 
 Derangement, p. 174. 
 
28 WHAT IS INSANITY. 
 
 become. Haunted by self-created torments, the lunatic 
 spends his days in seeking protection, in attempts to escape 
 from the incubus of ever-present danger — his nights in the 
 anguish of abandonment and despair. The wailings which 
 are heard in asylums, are oftener the petitions of the terror- 
 stricken for succour, or inarticulate cries of consternation at 
 what is seen, heard, or felt — than shouts of defiance, or ex- 
 pressions of sorrow. The timid are likewise the most sleep- 
 less inmates ; the night comes to them with its awe-inspiring 
 darkness and silence, but not with its repose. The furious 
 exhaust their muscular powers by their struggles during the 
 day, and obtain the deep sleep of fatigue ; but the timid 
 know no remission of misery, even during their disturbed 
 slumbers — for their terrors rise up before them as vividly in 
 dream as in their waking thoughts. The things dreaded 
 are proteiform. Occasionally, the same delusion, be it a 
 spectre, or the deep laid plan of a conspiracy, will remain 
 for months or years. More generally, every circumstance 
 is successively construed into a source of alarm, until no 
 impression reaches the mind, save through this distorted 
 medium. 
 
 Fear is well known to render the system defenceless in 
 the case of contagious diseases ; and while it actually causes 
 many attacks of insanity, it predisposes to a still greater 
 number. What I mean is, that the suspense, the apprehen- 
 sion, the actual terror incidental to many situations of life, 
 sap the foundations of mental strength, and leave the ner- 
 vous system a prey to the exciting causes of mania. It ap- 
 pears that of nearly five hundred cases of insanity depending 
 on a moral cause, forty-six or one-eleventh proceeded from 
 terror. A fact not less illustrative of the influence of fear, 
 is drawn from the history of the French revolution. Fe- 
 males, although they did not share so prominently in the 
 dangers of that period, could not escape from the panic and 
 misery which it created. They heard the howling of the 
 
WHAT IS INSANITY. 29 
 
 tempest, though they felt not its fury. They had husbands, 
 children to be guillotined, property to be confiscated, ties, 
 and hopes, and happiness to be sacrificed. The consequence 
 was, that an infinitely greater number of those who were 
 pregnant at the time, gave birth to idiots, or children who 
 afterwards became lunatic, than during times of order and 
 tranquillity. The year 1793, in which the most frightful 
 events of this convulsion took place, was likewise remark- 
 able for the number of suicides. Fear is known, by those 
 who have studied the feelings under which self-destruction 
 is attempted, to be one of its most frequent causes. Strange 
 to say, the apprehension of death itself leads to this act. 
 " It would seem," says Reid, " as if they rushed into the > 
 arms of death in order to shield themselves from the terror 
 of his countenance."* Now, in Versailles, a town, the po- 
 pulation of which even now does not exceed £0,000, and 
 where the Revolution may be said to have commenced, and 
 upon which it repeatedly recoiled from the capital, not less 
 than 1300 suicides occurred during the year mentioned.f 
 Public events, or private misfortunes often determine the 
 character of the object feared. Dr. Voisin affirms, that in 
 France, those who formerly would have trembled at ghosts, 
 the guillotine or Robespiere, now fear the police. The 
 timid maniac is little susceptible of cure ; but his sorrows 
 may be soothed ; his desire for society and protection may 
 be opposed to his imaginary horrors ; and the distraction of 
 having something to do may be made to counteract the de- 
 lusion of having something to fear.J 
 
 6. Monomania of Cunning and Suspicion. Wonder is 
 often expressed that madmen should say such shrewd, and 
 
 " Reid's Essays on Hypochondriasis. 
 
 t Art. Suicide, Diet, des Sciences Med. Burrow's Commentaries, 
 p. 438. 
 
 £ Perfect — Annals of Insanity, p. 243. Guislain, Traite sur les 
 Phrenopathies, &c. p. 122. 
 
30 WHAT IS INSANITY. 
 
 do such cunning things. Those who have felt any surprise 
 at a circumstance so common, are ignorant, first, that the 
 powers which give shrewdness may remain uninjured while 
 all the others are extinct ; and, secondly, that cunning, the 
 wish to mystify, deceive, or conceal, and likewise the sus- 
 picion that deceit is practised or designed, is itself a modifi- 
 cation of madness. We believe the terms cunning and sus- 
 picious to be convertible ; for in mania, as in the healthy 
 discharge of the mental functions, he who is disposed to 
 over-reach is jealous of the intentions of others, and while 
 shrouding his own feelings and projects, makes every effort 
 to penetrate those which he suspects. The cunning maniac 
 places no confidence in any one friend. He sees a sinister 
 meaning in every act ; he gathers insinuations from every 
 word ; he is the victim of some plot, the meshes of which 
 surround him, but which he will break through and baffle. 
 He will outwit all machinations. If a smile appears on the 
 face of a companion, it is held to be a secret sign. If a let- 
 ter is delivered in his presence, he is certain that it impli- 
 cates him in some mysterious transaction. He glories in 
 circumventing, in assuming an aspect different from the true 
 expression of his feelings — in concealment and insincerity. 
 His friends are his dupes ; and while he writhes under the 
 idea of their falsehood and connivance, his delusions revert 
 to schemes by which they may be deceived in retaliation. 
 If in confinement, he may disturb the concord of a whole 
 asylum, by disclosing conspiracies and schemes, and snares 
 which have no existence but in his own suspicion. He will 
 bend every energy to escape, and will display a great deal 
 of ingenuity in devising the means. An old spoon will 
 assume the office of a key to open the door ; a few stray 
 threads will be converted into a rope to scale the walls, and 
 some propitious moment will be chosen for the enterprise. The 
 apartment, bed and wearing apparel of such aMephistopheles 
 will afford ample proofs of his dominant propensity. Every 
 
WHAT IS INSANITY. 31 
 
 thing will be hidden. Whatever he does will be attempted 
 in secrecy, and the success of a stratagem will prove the 
 maximum of enjoyment. Although men so actuated can- 
 not well understand open dealing, candour and disinterested 
 kindness — all marks of which they will believe to be the 
 mask of a selfish purpose — yet they are accessible in many 
 ways. Flattery, humanity, honour, command, may all, in 
 different cases, find a responsive feeling in their breast. 
 They may even be cajoled, deceived into an exercise of rea- 
 son, although this should be the last resource. When cun- 
 ning is associated with malicious or suicidal intentions, the 
 case is distressing. A lunatic affected in this manner, known 
 to cherish a design to destroy himself, and deprived of all 
 ordinary means of executing his purpose, triumphed overall 
 these obstacles in the following manner. He complained of 
 a total want of sleep, restlessness, and headache. An opiate 
 was prescribed. He every evening received about a grain 
 of opium, and after a show of reluctance, put it into his 
 mouth. He did not, however, swallow it. By retaining it 
 in the mouth until his attendants left the room, he at last 
 accumulated nearly a scruple, swallowed the whole, and 
 died* 
 
 7. Monomania of Religion and Superstition. The engross- 
 ing sentiment in this variety is a blind devotion and awe ; 
 the delusions rest upon the relation which the patient holds 
 to Deity, his laws and providence, and to other supernatural 
 beings. Acts of worship, really solemn, extravagant or hor- 
 rible, according to the extent of the disease or the character 
 of the other predominating feelings, are often attendant on 
 the paroxysm. Vision seeing, miracle working, claims to the 
 possession of the divine afflatus, are among the symptoms. 
 The belief that as a missionary, a preacher, or a prophet, he 
 is to achieve the conversion and regeneration of mankind, 
 
 * Esquirol, Des Illusions chez les Alienes, p. 16. Guislain, p. 194. 
 
32 WHAT IS INSANITY. 
 
 is ever before the philanthropic, while his personal interests 
 and salvation are the cherished hope of the selfish maniac. 
 The vagaries of the vacillating powers often lead the indivi- 
 dual back to some far distant period in the progress of reli- 
 gion ; and standing on a heap of rubbish, he imagines him- 
 self a heroic Hebrew fighting for his faith on the crumbling 
 battlements of Jerusalem ; or, transported to the palmy days 
 of Rome, he declares himself to be the head of the church. 
 In the majority of instances the delusion bears a resemblance 
 to any recent demonstration of enthusiasm, or to any de- 
 scription of fanaticism which may be current. When I stu- 
 died at Salpetriere, the Jesuits were in deep disgrace ; the 
 St. Simonians were popular and fashionable ; and almost all 
 the religious maniacs admitted, laboured under the impres- 
 sion that they were Jesuits or St. Simonians.* The minor 
 features of this kind of derangement differ in different coun- 
 tries, and as it occurs in different sects : the insane Catholic 
 enfeebles his body with stripes and penance ; the insane 
 Protestant is more contemplative, but in essential points the 
 disease is the same in both. When complicated with the 
 belief in the visitation, or interference of spiritual existences, 
 fear may or may not be experienced. This is determined 
 by the courage of the party, or the attributes of the being 
 conjured up. The demon may be met by execrations, or 
 shouts of joy, this matters not ; the deviation from health con- 
 sists in the firm conviction that the eye sees what is the sha- 
 dowy creation of a distempered fancy, and that the heart 
 feels the inspiration and strength of divinity when it is agi- 
 tated by its own erring suggestions. Lunatics affected in 
 this manner appear to be supremely happy. The very in- 
 tensity of their feelings protects them against anxiety or de- 
 pression. They believe that their constant humility and 
 adoration will be rewarded ; that they are favoured more than 
 
 1832. 
 
WHAT IS INSANITY. 06 
 
 other men, and that their communication with higher intel- 
 ligences is proof and foretaste of this. This fine spun tissue 
 of error cannot but yield joy and security. There are, ac- 
 cordingly, few suicides from religious Monomania. Occa- 
 sionally they do occur, and under circumstances which cor- 
 respond to the peculiarity of the individual or of his situa- 
 tion. A Venetian shoemaker conceived that he was destined 
 to be a sacrifice for the human race. He prepared and 
 planted a cross, procured a sponge, nails, spear, and in fact 
 imitated the representations of the death of our Saviour so 
 often seen in Catholic countries. He wounded his side, 
 transfixed his feet and hands, and then raised himself up to 
 the cross by some mechanical contrivance, and hung impaled 
 for upwards of twenty-four hours before he was discovered. 
 Wherever lunatics are collected together, a great many 
 cases are always designated religious, and supposed to be 
 attributable to enthusiasm. This partly proceeds from the 
 difficulty of obtaining correct information as to the history 
 of each case, and partly from the philosophical blunder of 
 concluding that in insanity the cause is invariably of the 
 same nature as the effect. We are the more anxious to ex- 
 pose this error as it seems to set limits to religious instruc- 
 tion, to the cultivation of pious dispositions, and to cast a 
 doubt on the propriety of the promulgation of certain high 
 and holy principles of our faith. Now all men must, and 
 practically do, admit that the kind and degree of religious 
 training should be adapted to the capacity and the education 
 of the proselyte. By forgetting this principle, this " tem- 
 pering the wind to the shorn lamb ;" and by treating the 
 desponding and presumptuous, the weak and the strong un- 
 derstanding alike, madness may have been produced. Yet 
 even after allowing this system all the evil influence it can 
 possibly possess, and adding to it the injurious effect of the 
 theological speculation in which the ignorant engage, the 
 cases of insanity produced by these means are comparatively 
 
34 WHAT IS INSANITY. 
 
 few. Burrows states that no case of mania resulting from a 
 religious source ever fell under his notice which could not 
 be referred to the conflict accompanying a change of opinion 
 in religion.* To every one who can analyze this proposi- 
 tion, it must be clear that the tendency to insanity is given 
 by the change, by the overthrow of long established princi- 
 ples, and not by the nature of the thing from or to which the 
 change is effected. A change in politics or fortune would 
 be equally prejudicial. Scepticism produces a greater num- 
 ber of maniacs than enthusiasm. The authority just quoted 
 appears to coincide in this view, as he affirms that the cases 
 of which he speaks were developed during the interval of 
 doubt occurring between the relinquishment of old, and the 
 adoption of new principles. But to appeal to facts. Es- 
 quirol states, that of 492 patients insane from moral causes, 
 in nine only could the alienation be traced to religious fana- 
 ticism. This calculation was made in France at a period, it 
 is true, when a moral pestilence had swept the feelings and 
 symbols of Christianity from the land. Previous to this 
 period, that is, during the desecrations of the revolutionists, 
 the proportion was greater, Pinel attributes 25 in 113 cases 
 to fanaticism. But now, when the ordinary tone and cha- 
 racter of society and its institutions have been, to a certain 
 extent re-established, that proportion has scarcely at all in- 
 creased. Of 528 cases admitted to Charenton, from 1826 
 to 1832, produced by moral causes, only 24 arose from 
 " exalted devotion." In Hoist's tables, only 28 of 384 cases 
 are traced to this cause. In this country, statistics are very 
 deficient. Of 40 cases in a neighbouring institution, not 
 one is referred to this origin. But I am convinced from 
 observation, that although this cause does not operate more 
 powerfully, the number of religious maniacs is greater in 
 Britain than elsewhere. The explanation is obvious. Re- 
 
 * Barrow's Commentaries, p. 88. 
 
WHAT IS INSANITY. §J 
 
 Jigion has here its due exercise and awful importance ; the 
 inind is trained, thinks and feels under its influence ; and 
 when from misfortune or ambition, or physical injury, the 
 place of reason is usurped, it may always be predicated, 
 first that the delusions which succeed will correspond to the 
 natural disposition, and secondly to those impressions which 
 have been most powerful and permanent ; and hence there 
 are not a greater number of maniacs ; but there are a greater 
 number of maniacs exhibiting a certain class of delusions, 
 because our countrymen are, whatever may be their errors, 
 naturally and habitually devout." 
 
 8. Monomania of Despondency and Suicide. This form is 
 often classed with religious mania upon the very inadequate 
 ground that the patient may accuse himself of inexpiable 
 guilt, of having offended God, and therefore despond. But 
 the derangement consists in the depression and prostration 
 of energy ; the delusion of criminality, &c. follow, and are 
 adduced but cannot be received as reasons for the disquiet- 
 ude. The simplest form in which morbid despondency is 
 manifested, is as a want of confidence in the talents and pro- 
 spects which previously had been regarded with satisfaction ; 
 an utter abandonment of hope, a miserable lethargic despair. 
 There is no delusion or incoherence present; there is a set- 
 tled and horrible conviction of the approach of ruin and de- 
 solation, to which the mind gives itself up, against which it 
 can make no effort, but for which no cause, not even an im- 
 aginary one, can be assigned. This, when an individual has 
 the fortitude to control, or the cunning to conceal the ex- 
 pression of the full extent of his sufferings, or when they do 
 not interfere with the common affairs of life, is called lowness 
 of spirits. It ought to be regarded and treated as insanity, 
 and not dreaded as its forerunner. For it is at this stage 
 that suicide is resorted to. Should this not be the case, 
 
 * Perfect, Annals of Insanity, p. 87. Arnold's Observations, p. 2*28. 
 
36 WHAT IS INSANITY. 
 
 specific hallucinations may speedily appear, and the agony 
 of mind will be indured as a consequence of bankruptcy, the 
 unfaithfulness of a friend, the persecutions of enemies, or the 
 ravages of an incurable disease. No demonstration of the 
 untenableness of such grounds, no picture of brighter and 
 happier circumstances will avail to refute or encourage. The 
 sufferer clings to his hoarded misery. There is generally 
 great loss of physical strength in cases of this kind ; and the 
 pale, emaciated countenance, dull and sunken eye, and list- 
 less dejected form, tell as plainly as the querulous complaint, 
 or the long intricate description of sorrows and anticipated 
 evils, to what class the patient belongs. These unfortunate 
 beings are often persecuted by their fellow- maniacs, and have 
 real added to imaginary sources of uneasiness. I have con- 
 joined the cognomen of "suicidal" with this species of mad- 
 ness, because the propensity to self-destruction appears more 
 frequently in the desponding than in the religious, the sus- 
 picious, or even the homicidal maniac. In a table given by 
 Professor Casper of Berlin, 103 cases of suicide are attribu- 
 ted to mental affections ; 30 of these may be classed under 
 this head, and 32 under that of fear and despondency com- 
 bined. In the same table, containing in all 412 cases, the 
 causes of which were known, a corroboration of the opinion 
 that suicide is rare among religious maniacs is found, one 
 case only having followed religious excitement." In Paris 
 where there have been 3185 suicides in ten years, and the 
 annual mortality from this cause now amounts to 477, M. 
 Guerry, the eminent and accurate writer on the statistics of 
 
 * A somewhat different result appears to have been recently arrived 
 at by Dr. Sc. Pinel. He has published a table in which 11 of 125 
 cases of suicide depended upon religious excitement- His conclusions 
 are, however, much less valuable and satisfactory from his having taken 
 a particular class of suicides, that in which the attempt was unsuccessful, 
 as the ground of his observations. But even waiving such an objection, 
 the proportion is still small. 
 
WHAT IS INSANITY. 37 
 
 crime, says that gambling, and of necessity the defeated 
 hopes and dejection which it entails, produces a greater num- 
 ber of self-inflicted deaths than any other cause. He ha- 
 zards the opinion that it is almost the sole cause.* Next to 
 despondency, offended honour and domestic disappointments 
 appear as the most fertile source of suicide. But such rea- 
 sonable causes do not always exist ; a mere disgust at life, 
 an uneasy sensation, a disturbed digestion may be conceived 
 by the unhinged mind sufficient to justify the act. Such 
 reasons have been acknowledged by those who retained in- 
 telligence to know and describe their intentions ; and it 
 should be recollected that in proportion to the impairment of 
 intelligence, the danger increases, for to him who cannot dis- 
 tinguish the real position in which he stands, who cannot 
 estimate either the present or future consequences of the act, 
 and who is wholly delivered up to one series of ideas, or to 
 two, pleasure and pain, the most insignificant event, the most 
 ridiculous and incongruous motive, may precipitate the at- 
 tempt. The desponding maniac consequently requires un- 
 remitting attention. No ordinary precaution will frustrate 
 the success of his designs, for every object may by ingenui- 
 ty be turned into a means of destruction ; and the moment, 
 apparently the most inauspicious, and from that reason the 
 least suspected, will be chosen for the purpose. For years 
 will such a design be cherished in silence, until the fears and 
 care of those around are lulled to sleep, and then executed. 
 
 I have noticed a very interesting fact connected with the 
 utility of isolation and superintendence in this variety. We 
 learn from Guerry that suicides are annually effected in Paris 
 in the proportion of one to every 3000 inhabitants. This takes I 
 place among individuals accredited sane, and in possession 
 of many of the things which endear the continuance of life. 
 
 * Essai sur la Statistique Morale de la France. The statements of 
 M. Broue, Annales d'Hygiene Publique, vol. xvi. p. 243, do not 
 countenance this view. 
 
■■ 
 
 38 
 
 WHAT IS INSANITY. 
 
 Esquirol states, on the other hand, that among 12,000 luna- 
 tics confined at Salpetriere, during a series of years, and ex- 
 posed by their malady to constant temptations to escape from 
 suffering by death, only four suicides took place ; that is, one 
 in 3000. The proportion is apparently the same; but the ad- 
 vantages of restraint, and the actually low rate in asylums 
 must become manifest, when the circumstances of the cases 
 and the conditions of the persons compared are considered.* 
 9. Monomania of Imagination. This may be denned the 
 mania of accomplishments. It is displayed in attempts to do 
 every thing, and a pleased conviction that every thing is 
 done perfectly. The maniac is a poet, a painter, a mathe- 
 matician, as the case may happen, he pants after excellence,- 
 and struggles indefatigably to attain it; he writes verses 
 which would disgrace a valentine ; he scratches hideous 
 figures on the wall, his calculations cover every slip of paper ; 
 these efforts of his genius do not satisfy his longing after im- 
 mortality, but he is resolved to improve. He lives in an at- 
 mosphere where the distorted objects appear to him of gigan- 
 tic size, sublime magnificence, and surpassing beauty. Every 
 thing with him is superlative. This is the madness of Don 
 Quixote. He does all odd and eccentric things to satisfy his 
 humour, and if reprimanded for his extravagances, he will, 
 in all probability, reply in some impassioned strain to the 
 lady of his love, or to the keeper, as Shakspeare or the Em- 
 peror of Morocco. He literally 
 
 " Finds tongues in trees, sermons in stones." 
 
 He is, to use a word in a new sense, a transcendentalist. His 
 reasonings are so subtile as to escape the ordinary power of 
 the mind's eye ; and his refinements upon excellence would 
 astonish an optimist. His plans for human improvement are 
 original, and on the grandest scale. Whatever is new he 
 
 * Burrow's Commentaries, p. 412.— Perfect's Annals, p. 26 — 297. 
 Falret du Suicide et de l'Hypochondrie. 
 
WHAT IS INSANITY. 39 
 
 prizes, and, in fact, his grand desire and delusion is to act 
 differently from the common herd, in order to do it well and 
 with eclat. This, in less marked outline constitutes the od- 
 dities and eccentricities of society. A Frenchman passed 
 twenty years in cogitating a plan whereby the whole human 
 race could be accommodated under one roof in one sumptu- 
 ous building. The rulers were to reside in the centre, and 
 the nations over which they presided were to radiate in their 
 various interminable abodes from this point. His calcula- 
 tions and arrangements for this vast pantisocracy were re- 
 peated again and again, but on his pulling down his house in 
 order to apply these practically, his splendid visions were 
 dissipated by confinement. The disease evidently consists 
 in the inordinate activity of those feelings called romantic 
 which aim at an unreal, a perfect state of existence, without 
 any counterpoise on the part of reason. Poets and novel 
 writers have certainly done, or attempted to do much to- 
 wards the elevation of the human race ; but over the unpre- 
 pared, ill-balanced and sanguine mind, their works exercise 
 a pernicious dominion, and sometimes cause the madness 
 now delineated. In the Charenton table, thirteen cases are 
 traced to novel reading.* 
 
 10. Monomania of Avarice. This is not simply the vice of 
 the miser in excess. There is the propensity to acquire, by 
 any means, legitimate or otherwise, as well as the propensity 
 to hoard. The day-dreams of avaricious lunatics are all di- 
 rected towards wealth, property, or aggrandizement in some 
 shape. Their air castles are built of gold. But although 
 panting after riches, they may be styled omnivorous : they 
 will derive pleasure from receiving or taking any article 
 without reference to its nature or value. The only condi- 
 tion necessary to secure this gratification being, that the 
 
 * Tuke, Description of the Retreat at York, p. 182. — Perfect, An- 
 nuls, p. 47. — Guislain snr les Phrenopathies, p. 204. 
 

 40 WHAT IS INSANITY. 
 
 coveted possession is not theirs, but is about to become theirs. 
 They only, of all men, have discovered the philosopher's 
 stone ; every straw and rag and pebble becomes precious, is 
 transmuted into gold, or silver, or gem, when it passes into 
 their hands. Did they actually possess this flux, their be* 
 lief would be justifiable, that they are owners of half the 
 land in the kingdom: that the occupants are appointed by 
 them as agents ; that their food is served on plate and china ; 
 and their straw pillow filled with rubies. The rooms they 
 inhabit are littered, their clothes are loaded with collections 
 of indescribable trumpery, which they hold to be of incal- 
 culable importance. If possible these treasures are con- 
 cealed, and the hiding places would puzzle a French police 
 agent. The point of the shoe, the lining of the coat, the 
 sleeve, the mouth, even the stomach, are made depositaries 
 of these ill-gotten gains. They, of course, make no use 
 whatever of such acquisitions ; it is the act of accumulating 
 which constitutes their happiness. The pocket-handker- 
 chiefs of every one who visited a large Asylum disappeared, 
 no one could imagine how or where. At last they were 
 discovered bound round the waist of an avaricious maniac, 
 who had abstracted them so dexterously as to have eluded 
 suspicion, and who, though from his notorious character he 
 was searched every night, had outwitted the inquisitors by 
 placing the stolen goods next his skin. Stealing is delight- 
 ful to these men ; they rob their fellow-patients, seize upon 
 everything within their reach, and boldly justify their con- 
 duct on the ground that all they have taken is theirs de 
 jure. In the supposed plenitude of an ample fortune, such 
 men are sometimes generous. They offer to pay the board 
 of all the patients, and the wages of all the servants in an 
 asylum ; or present you with bills for an enormous amount, 
 sometimes for your own behoof, more frequently for their 
 own. For the last five or six years a patient has regularly, 
 every week, presented the physician at Charenton with 
 
WHAT IS INSANITY. 41 
 
 scraps of paper, designed to meet all the disbursements of 
 that vast institution. It is almost needless to say, that this 
 class of patients may be bribed to do any thing.* 
 
 11. Monomania of Benevolence and Affection. — Even the un- 
 restrained exercise of the powers giving a name to this variety 
 must be classed with madness. It may be described as an 
 over anxiety for the welfare of the whole human race, or for 
 that of the narrower circle of friends and acquaintances. A 
 visionary who neglects his own duties and concerns in order 
 to eradicate poverty, and sickness, and sorrow from the world, 
 or gives up his soul to anguish, because the attempt has failed, 
 and the mother who, distracted for the safety of her children 
 and acquaintances, can neither act, nor think, nor sleep, 
 because she cannot relieve them from some evil or misery 
 of which they do not complain, and by which they are sub- 
 jected to no annoyance, are both instigated by similar morbid 
 feelings. The affectionate maniac is a melancholy spectacle. 
 There is a nobleness and magnanimity in his phrenzy ; he •" 
 strips himself of his clothes ; he starves for days in order to ' 
 relieve the supposed wants of his associates ; his mind teems 
 with projects to alleviate their condition, to render them 
 happy ; or he wanders about declaring that his whole kin- 
 dred is destroyed, or in misfortune, and searches for their 
 mangled bodies in every hole and crevice. They often look 
 upon themselves as physicians, nurses, or overseers of the 
 poor, and the asylum, or their place of abode whatever it 
 may be, as an hospital, or house of refuge, where they are 
 commissioned to diffuse comfort and contentment. Such 
 ministrations are often highly beneficial ; but so far as the 
 kind ministrants are concerned, the labour never ends, for 
 they never fail to detect new wants and require to devise 
 new methods to relieve them. Men of this stamp often 
 
 * Guislain, Traitd sur les Pbrenopathies, p. 209. Esquirol, Des 
 
 Illusions chez les Alienes, p. 18- 
 
■^^^■■■■■■■■■i 
 
 42 WHAT IS INSANITY. 
 
 squander a noble fortune before confinement is resorted to. 
 As it is they who see the want and not the objects who feel 
 it, the charities which they bestow must be indiscriminate. 
 " To endow a college or a cat," affords to them nearly the 
 same satisfaction. This, however, is the most pleasing 
 view of the case. They are generally rendered unhappy by 
 the delusions of wretchedness which are ever before them, 
 but which they have no means to alleviate, and bemoan the 
 hard fate of being unable to execute the munificent and mer- 
 ciful behest for which they were sent upon earth. Or, torn 
 by apprehensions for the misfortunes of friends, by disap- 
 pointment from their want of affection, and by grief from 
 their ingratitude, they commit suicide.* 
 
 Sect. II. — 12. Incapability of perceiving the Relations of 
 Ideas, — The second section relates to disturbance of the re- 
 flecting and perceptive powers, and the first division of it to 
 the incapability of perceiving the relations of ideas. This 
 disorder of the thinking, may be consentaneous with the 
 perfect health of the emotive or feeling part of our nature. 
 The man who cannot recognise the relevancy of the most 
 obvious argument, or the agreement or disagreement of 
 two of the simplest propositions, may experience no exalta- 
 tion or depression of his sentiments ; may act with the same 
 integrity, love with the same fervor, and hope and fear as 
 intensely as if no change had taken place. Popularly it is 
 named confusion of ideas. The diseased process seems to 
 consist of the following steps. The mind receives percep- 
 tions accurately. The senses convey their reports with the 
 customary clearness and fidelity, and. the representations of 
 the external world are accordingly exact, and known and 
 acted upon as exact. The suggestions of the propensities 
 are neither exaggerated nor irregular, and they impel to cer- 
 
 * Perfect's Annals, p. 54. 
 
WHAT IS INSANITY. 43 
 
 tain actions, become objects of thought and memory, with- 
 out any interruption to the laws by which such conditions 
 are regulated. But at the point where the mind seeks to 
 arrange, contrast, compare, or analyze the ideas thus ac- 
 quired, the error which constitutes derangement occurs. 
 The qualities which associate or separate ideas are no longer 
 appreciable, and reasoning is at an end. For example, vi- 
 sion has at some period made an individual acquainted with 
 the effects of galvanism upon others, the image conveyed to 
 the mind was at the time distinct and correct, and the re- 
 collection preserved of it is equally so. At the same, or 
 some subsequent period, misfortunes have assailed this per- 
 son and produced all the pain of disappointed hopes and 
 aggrieved self-love. Now the calamities were real ; the 
 melancholy and wounded pride were no more than propor- 
 tioned to the circumstances which called them forth, and 
 the impressions of these states received and retained were 
 true indices of the existing feelings. But when the maniac 
 thinks of galvanism, there is probably suggested some por- 
 tion of his own distressing history ; he does not and cannot 
 see that these events have no possible connexion ; they im- 
 mediately become objects of reflection, finding them asso- 
 ciated, he believes them to be connected, and the issue may 
 be, I shall assume that it is, a conviction that the galvanism 
 was the cause of his ruin ; that the contortions which he 
 witnessed in the subjects of this experiment, upon which his 
 attempt at ratiocination is founded, were proofs that the 
 process of destruction was going on in them ; that the un- 
 easiness which he experienced on recalling the past is the 
 thrilling and tingling sensations communicated by this agent; 
 that every man in pain and poverty is galvanized ; that the 
 nation is on the eve of bankruptcy, and that galvanism is at 
 the bottom of it. The total absence of concord, connexion, 
 or sequence in these thoughts, the inability to assort, if such 
 a vague expression be admissable, the classes of ideas before 
 
44" WHAT IS INSANITY. 
 
 the mind according to their qualities and natural order, is 
 the principal feature of this form of insanity. The incohe- 
 rence of maniacs often depends on this cause; it is that 
 plausible incoherence, however, which seems to have a mean- 
 ing could it but be discovered. Men so affected may con- 
 tinue to mingle with society and to be useful citizens; when 
 confined, so much of the mind remains vigorous and sound 
 that they may, with perfect prudence, be intrusted with even 
 responsible situations in the management. 
 
 But the disease is occasionally more limited in its scope 
 than what I have described it. The incapability to perceive 
 relations being apparent only when certain classes of ideas 
 are presented to the mind, Such is the case of Matthews, 
 who imagined that he was the victim of what he learnedly 
 called " pneumatic chemistry." By means of this tremen- 
 dous agent, mercenary blood-hounds employed to torment 
 him, though residing at a distance, introduced notions into 
 his brain, intercepted the communication between his brain 
 and heart, distended his nerves with gas, and so forth.* Of 
 the same kind is the case of the clergyman who believed 
 that he had lost his rational soul, refused to join in worship 
 as an act of impiety for a being destitute of a spirit, and who, 
 in dedicating a book of great merit to the sovereign of the 
 time, subscribes himself as one " who was once a man, and 
 of some little name, but whose thinking substance wasted for 
 seventeen years, and is now utterly come to nothing/'f 
 Both of these men retained sufficient intelligence to per- 
 ceive the relations of other ideas, or were, to vary the ex- 
 pression, rational upon all other subjects. J 
 
 13. Incapability of perceiving the relations of external ob- 
 jects. A man cannot divest himself of the belief that the 
 house which he has inhabited for years has changed its po- 
 
 * Haslam's Illustrations of Madness. 
 
 T Conolly's Inquiry concerning the Indications of Insanity. 
 
 $ Burrow's Commentaries, p. 299. Guislain, 310. 
 
WHAT IS INSANITY. 45 
 
 sition, that the windows are diminished or increased in 
 number to a frightful extent, that the trees planted by his own 
 hands, and firmly rooted and flourishing for years in the 
 same spot, move off suddenly in various directions, crowd 
 together, or circle round him in the mazes of a dance. He 
 hears the most ravishing melody, or the harshest discord 
 emanating from every object around ; voices address him, 
 and counsel, or threaten him, where there is no tongue to 
 speak. But during all this the mind may be very sceptical 
 of the reality of the appearances presented to it, and is only 
 startled into an unwilling and conditional belief by the diffi- 
 culty of answering the question, can 1 doubt the evidence of 
 my own senses. But there is more than the senses at fault. 
 The powers which take cognizance of their reports must be 
 diseased. For we are well assured that, from the nature of 
 vision, the retina must receive the picture of the errant house 
 as it is, that the actual number of windows must be depicted, 
 and that the impressions corresponding to sounds which 
 reach the mind do not reach the ear. It is in the combin- 
 ing these, the faithful communications of sense, that the in- 
 fidelity is committed. The idea of a house maybe well de- 
 fined; but the idea of the relation which the house bears to 
 the surrounding trees, &c. is vague, indistinct, or erroneous ; 
 the idea of windows may be clear, but the interminable mul- 
 tiplication of these is the result of the diseased conception of 
 that idea. There is no fear, or superstition, consequent on 
 such extraordinary visions as that described, the patient 
 supposes them to be the real, everyday working of nature, 
 and neither looks for, nor detects in them magic, nor divine 
 interposition. The delusions of the superstitious maniac 
 conjure up objects which do not exist, the present class see 
 real objects through a false medium. The individual men- 
 tioned may be found to reason sensibly on all subjects ab- 
 stracted from external objects, and to act as if his house 
 were a fixture, and the trees budded and blossomed in their 
 
46 WHAT IS INSANITY. 
 
 original soil. The man who saw in his own house the In- 
 quisition, and in his chairs the instruments of torture, but 
 acted as if he never had heard of St. Dominic or the rack, 
 was a complete exemplification of this malady.^ 
 
 14. Incapability of perceiving the qualities of external ob- 
 jects. The mind, otherwise unimpa: \m hunting field,. 
 for instance, the horses, the dogs., and the sportsmen, i 
 gantic or microscopical size : they resemble mammoths or 
 ants at full speed : the colouring of the scene is uniform, a 
 brilliant scarlet, perhaps, or it is infinitely varied. The in- 
 dividual thus affected either cannot perceive the quality of 
 an object at all. there is a suspension of the power to do so, 
 here no impression is communicated to the mind by 
 seven! colours; or the quality is perceived in an imperfect 
 and erroneous manner, as when objects appear larger or 
 smaller than their actual size : and grotesque shapes occupy 
 the place of familiar pieces of furniture.- A great inapti- 
 tude is likewise felt to arrange all the visual impressions in- 
 to one whole, they start up contrary to the will, in irregular 
 succession, and as isolated sensations, so that the hallu- 
 cination, besides being a hallucination, is a thing of shreds 
 and patches. When this species of madness is accompanied 
 by bodily une: tese morbid perceptions are extended 
 to the personal condition and feelings of the lunatic, and he 
 declares his head to be a lantern, his b:>dy red-hot, or made 
 of glass. A royal maniac conceived himself to be a tea-pot. 
 believed that he had increased to so enormous a 
 size, thai he could not pass out of the door of his apartment, 
 and caused the partition to be taken down in consequence. 
 I have under my care a sturdy soldier, metamorphosed by 
 his own disordered perceptions into a louse ; and Zimmerman 
 
 * E- 7 £= Illusions chez les Alie'nes, passim. 
 
 - Phrenological Journal, voL viii.. p. 44. Phrenological Transac- 
 tions, p. 209. 
 
 
WHAT IS INSANITY. 47 
 
 mentions a lunatic who, supposing himself a barley-corn, 
 was terrified to venture into the open air lest he should be 
 picked up by the sparrows.* 
 
 IV. Mania may be defined the irregular action of all the 
 mental powers. Its ravages are not confined to certain 
 groups of feelings or perceptions, to associations more or 
 less extensive, but spread to all. They may not be all 
 equally injured ; but so deeply rooted is the perversion as 
 to enfeeble that which it does not overthrow. The ideas are 
 chaotic, but amid the confusion there may be observed the 
 struggle of maddened propensities and extravagant feelings, 
 and the jarring of the elements of memory and perception. 
 The recollection of some scene long past is mistaken for a 
 present impression, there is a want of discrimination between 
 what is reflected and what is felt ; the passions are involun- 
 tary ; anger bursts forth without provocation ; sorrow arises 
 the next moment, terror succeeds without a single cause for 
 alarm, and the whole terminates with the loud hollow laugh 
 of brutal merriment. There are three things to be consi- 
 dered here. First, the want of power to control or direct 
 the mental operations. Secondly, the absence of all harmony 
 or sequence between these operations. And, thirdly, the 
 incessant activity with which these operations are carried on. 
 To this last consideration have all the other phenomena been 
 referred. In whatever way induced, whether by wine, emo- 
 tion, or disease, excessive activity is known to affect the pro- 
 pensities and feelings by increasing their excitability and by 
 rendering their suggestions intense, irresistible, and involun- 
 tary, and, in some cases, if the cause continues to exist, 
 permanent. Upon the reflective and perceptive faculties 
 the effect of hyperactivity is altogether different. Carried 
 
 * Esquirol, Des Illusions cbez les Alienes, passim. Perfect, 
 Annals, p. 333, &c. 
 
48 WHAT IS INSANITY. 
 
 beyond a certain point, it disturbs, impedes, or arrests the 
 healthy operation of the understanding. The excited judg- 
 ment may attempt to compare two facts, but the laws under 
 which such a step can be made are abrogated. The whole 
 of the intellectual powers are simultaneously active, and, in 
 place of two, there are twenty propositions to be examined, 
 each of these being distorted by the medium through which 
 it arrived, and withal, neither the power to exclude what is 
 extraneous, nor the power to perceive what is essential to 
 the examination, remain. The violent excitement of the 
 propensities must materially contribute to this disturbance. 
 The process of intoxication amply illustrates the explanation 
 given of the psychological cause of mania, the excessive 
 simultaneous activity of all the mental powers. The drunk- 
 ard, as he swallows repeated draughts of some exciting 
 liquor, under its influence waxes valiant, or vain, or gene- 
 rous, according to his character. His wrath is fierce, his 
 mirth boisterous, his kindness overpowering. Every senti- 
 ment is extreme. This is clearly a description of the irre- 
 pressible activity of the propensities. Gradually, and in pro- 
 portion to the augmenting intensity of the emotions speci- 
 fied, the ability to perceive the merits of an opinion is affect- 
 ed ; then the perceptive powers fail, and double vision and 
 erroneous impressions of all kinds follow. The total con- 
 fusion of mania closes the scene. What tends not a little to 
 give force to the comparison here instituted, and to shew 
 that the states compared are to a certain extent identical, 
 differing only in duration, is the great development of phy- 
 sical strength and insensibility to pain which occur in both. 
 The maniac is in most cases furious as well as incoherent. 
 His strength is tremendous, and cannot be restrained or sub- 
 dued by ordinary means. It is not, however, necessarily 
 exerted for malicious purposes, otherwise death and desola- 
 tion must follow his track, and the coercive measures so long 
 recommended might appear to be justified. Passive as well 
 
WHAT IS INSANITY. 49 
 
 as active strength appears to exist in maniacs. Many bruise 
 and lacerate their bodies, either with a stoical indifference, or 
 with an expression of delight. A sect of insane fanatics at 
 one time occupied much attention in France, who endured 
 all kinds of torture without a murmur, and among other inge- 
 nious contrivances for immolation, they received blows on the 
 back, limbs, &c, from sledge-hammers, which, so their histo- 
 rians tell, would have crushed a stone wall to powder. These 
 symptoms all bespeak increased activity ; but there is also a 
 species of mania with diminished activity. Under this de- 
 nomination are included cases where the propensities are in 
 abeyance or extinct, while the powers purely intellectual are 
 diseased with increased activity. The combination of fatui- 
 ty of the propensities with incapability of perceiving the re- 
 lations of ideas or things will convey a notion of this form of 
 disease. There is the same incoherence, preposterous group- 
 ing of recollections and actual impressions, as in the preced- 
 ing variety, but there is neither wildness, nor vehemence, 
 nor irritability, nor terror. The incongruous imaginings 
 which the maniac conceives to be opinions, or observations 
 on what is presented to his mind, are poured forth volubly, 
 but he has neither pride, nor vanity, nor irritability to be 
 aroused, either by external or internal impressions.* 
 
 The subject is not exhausted. For these varieties of insanity 
 are found in every possible state of combination, exhibiting 
 new and characteristic symptoms. Proud monomania may 
 thus be found conjoined with that of vanity ; or both these 
 states of feeling may exist in the same mind which has been 
 deprived of the power to judge of its own operations, or of the 
 impressions which it receives from without. But although 
 it would require a voluminous treatise on the philosophy of 
 insanity to comprehend a description of these combinations, 
 
 * Calmeil de la Paralysie consideree chez les Alit'nes, p. 56, No. 
 *r. Art. Folie, Diet, de Med. torn. ix. p. 237. 
 
 D 
 
50 WHAT IS INSANITY. 
 
 my present object is gained if the sketch here submitted has 
 served to indicate the most striking distinctions between the 
 different varieties, and how readily and humanely, and pro- 
 fitably a separation of the inmates of asylums founded on 
 such broad distinctions could be carried into effect 
 
 I have mentioned that until this evening, no attempt has 
 been made to address an unprofessional, but well educated 
 audience, on the subject of Insanity. Until very recently 
 the care of the insane was monopolized by medical and other 
 adventurers : a ridiculous stigma, created by the character 
 and proceedings of the very persons engaged in this mono- 
 poly, deterred regular and well educated practitioners from 
 attempting to compete, and even from qualifying themselves 
 to do so. Indeed, it has only been since the voice of the 
 public has been raised against this monopoly and its conse- 
 quences, and the philanthropic of every profession interfered 
 in behalf of those who most required their protection, that 
 :e and mercy have, in any degree, dictated the treat- 
 ment which these unfortunate beings received. Until then, 
 a thick and almost impenetrable veil was cast over the work- 
 rnind diseased :" a species of awe and sacred- 
 m attached to the person of the maniac, as one on 
 whom the hand of his Creator had visibly, and fearfully, and 
 in a peculiar manner, fallen: the precincts of Lis pri 
 
 x were regarded as holy and peculiar ground, and the 
 secrets of that mysterious dwelling remained untold, or only 
 whispered in accents of horror and reverence. Eut u the 
 day-spring from on high" of knowledge which is beginning 
 to diffuse its cheering light on every the most distant land, 
 Las visited even the benighted sky of a madhouse, and fallen 
 rike healing on the hearts of those, whose doom, in other 
 days, must have been imprisonment, solitude, and despair, 
 
LECTURE II. 
 
 M'HAT ARE THE STATISTICS OF INSANITY? 
 
 The numbers and distribution of Lunatics in Britain — Is insanity in- 
 creased by civilization — Does it increase in a greater ratio than the 
 population — Does it attack men of particular professions, or of par- 
 ticular ranks — Does it prevail chiefly under free, or under despotic- 
 forms of Government — What period of life does it principally attack 
 — Does Marriage diminish the liability to the Disease — Are Males 01 
 Females most exposed — What is the proportion of cures — Rate of 
 Mortality — Does Insanity prolong or shorten life — Influence of sea- 
 son on Mortality — Diseases affecting Lunatics — Proportion of Fu- 
 rious, Paralytic and Epileptic, Fatuous and Idiotic, Dirty, > 
 and Suicidal Madmen — Lucid Intervals — Relapses — Complete isola- 
 tion — Early confinement — Employment as a means of cure — Propor- 
 tion of Lunatics that may be employed — Does it promote the cure? 
 — The kind of occupation — Is it safe ? 
 
 What are the statistics of insanity ? What are the num- 
 bers, the rank, the occupations, the ages of those who dis- 
 play the varieties of disease enumerated, and are committed 
 to the care of the physician ; and in what proportion are the y 
 susceptible of cure, alleviation or employment? 
 
 In England there are probably not less than 10,000 luna- 
 tics ; while in Scotland the numbers are certainly not below 
 4000. Of the latter, 1338 are confined in private asylums, 
 or licensed houses, unworthy the name of asylum, 21 linger 
 out their miserable existence in the jails of some of the re- 
 mote counties, 500 are in public establishments, and the 
 
£2 WHAT ARE THE STATISTICS OF INSANITY. 
 
 remainder, about 1500, are at liberty, subsisting upon cha- 
 rity, but in general exposed to the greatest privations.* 
 
 By the calculations of Sir A. Halliday, which, although 
 perhaps merely approximations to the truth, have the merit 
 of being the only data we possess, it appears that the pro- 
 portion of the insane to the sane population of Europe, is I 
 to 1000. In Wales the proportion is 1 to 800, in Scotland 
 1 to 574. The Americans, so closely allied to us by descent, 
 language, national character and customs, it is computed by 
 Dr. Brigham, present 1 lunatic in every 262 inhabitants.f 
 This disparity probably depends upon the rapid acquisition 
 of wealth, and the luxurious social habits to which the good 
 fortune of our transatlantic brethren has exposed them. With 
 luxury, indeed, insanity appears to keep equal pace. Nay, 
 the opinion has been hazarded, that as we recede, step by 
 step, from the simple, that is, the savage manners of our an- 
 cestors, and advance in industry and knowledge and happi- 
 ness,*this malignant persecutor strides onward, signalizing 
 every era in the social progress by an increase, a new heca- 
 tomb, of victims. Is insanity an inseparable adjunct to 
 civilization ? I spurn the supposition. The truth seems to 
 be, that the barbarian escapes this scourge because he is 
 exempt from many of the physical, and almost all the moral 
 sources of mental excitement ; and that the members of 
 civilized communities are subjected to it, because the enjoy- 
 ments and blessings of augmented power are abused ; because 
 the mind is roused to exertion without being disciplined, it is 
 stimulated without being strengthened ; because our selfish 
 propensities are cultivated while our moral nature is left 
 barren, our pleasures becoming poisonous ; and because in 
 
 * A general view of the present state of lunatics and lunatic asylums 
 in Great Britain and Ireland, &c, by Sir Andrew Halliday, M.D., pp. 
 16 and 27. 
 
 f Remarks on the Influence of Mental Cultivation and Mental ex- 
 citement upon health, by A. Brigbam, M.D., p. 52. 
 
WHAT ARE THE STATISTICS OF INSANITY. 53 
 
 the midst of a blaze of scientific light, and in the presence of 
 a thousand temptations to multiply our immediate by a sa- 
 crifice of our ultimate gratifications, we remain in the darkest 
 ignorance of our own mind, its true relations, its danger and 
 its destiny. With civilization then come sudden and agitat- 
 ing changes and vicissitudes of fortune ; vicious effeminacy 
 of manners; complicated transactions; misdirected views of 
 the objects of life ; ambition, and hopes, and fears, which 
 man in his primitive state does not and cannot know. But 
 these neither constitute, nor are they necessarily connected 
 with, civilization. They are defects, obstacles which retard 
 the advancement of that amelioration of condition towards 
 which every discovery in art, or ethics, must ultimately tend. 
 To these defects, and not to the amount of improvement, or 
 refinement of a people is insanity to be traced. Statistics, 
 the best guide in such an inquiry, support this view. Esqui- 
 rol's Tables of the moral causes of insanity clearly show that 
 a great majority of these are identical with the vices, pas- 
 sions, corruptions, and weaknesses of our nature, or with de- 
 viations from what all good or great men understand to be 
 the objects of civilization. Few cases can be traced, except 
 where hereditary predisposition exists, to the well-regulated 
 efforts, the virtuous contentment, or the settled principles of 
 a highly educated mind, or to the afHucncp, the enterprise, 
 the information, or the polish by which these may be ac- 
 companied ; and these, it is conceived, are the legitimate 
 products of civilization. And even when a hereditary taint 
 creates danger where it would not otherwise exist, it must 
 be remembered that it may have been originally contracted 
 through the ignorance or error of some individuals, in che- 
 rishing some predominating passion, or by intermarriage 
 with an impure stock. Vicious as the effect unquestionably 
 is of over exertion of the intellectual powers, or of giving an 
 undue preponderance to any faculty, and much as the pre- 
 vailing systems of education tend to encourage such a prac- 
 
54 VTBAY ASS THE STATISTICS OF IXSAXITV. 
 
 tiee, I find that out of a total of 47S .irol, 
 
 13 only are referred to an excess of study, while about 100 
 are the fruit of the excess of the propensities, and 90 resnk 
 from an uneducated and ill regulated state of the sentiments.* 
 Georget's lists afford similar evidence. He enumerates 25 
 victims of mental labour, 20 of an ill-conducted education, 
 106 drunkards, and 470 affected from other moral ca 
 out of about 1000 cases.f 
 
 Oneofthe most inte uestions to be decided by 
 
 the statistics of insanity is, does the disease increase, is the 
 poisoned stream larger, and wider, and deeper than former- 
 ly ? Does it like other streams deepen the channel as it 
 flows ? As population is doubled in certain periods, so will 
 be the number of cases of disease. But this is not exactly 
 the question at issue. Has insanity, like some other dis- 
 eases, a greater number of victims in proportion to the po- 
 pulation at present existing, than at former periods ? The 
 qufttion has been answered in the affirmative. Dr. Powell 
 entertains this opinion, and shows that while, in the lustrum be- 
 tween 1775 and 1776, the number of registered lunatics was 
 17 S3, in that between 1805 and 1809 it amounted to 2271 J 
 It must be confessed, however, that his investigations tend 
 rather to point out the fallacies which enter into all such cal- 
 culations, than to support his own views, or to determine the 
 question. Sir A. Haliiday asserts, that the number of lunatics 
 has been tripled within the last twenty years : and Esquirol 
 plates, that while the patients in the public hospitals in Paris 
 in 1801 were only 1070, in 1821 they amounted to 2145. 
 These startling facts, on the other hand, have been declared 
 to be inconclusive, and those who have adduced them d 
 nated alarmists. More careful examination is, without doubt, 
 
 • Diet, des Sciences Med., art- " Folic" Deb Folie. 
 
 J Observations upon the Comparative Prevalence of Insanity at dif- 
 ferent Periods. Medical Transactions of the College of Phvsician% 
 London, vol. iv. p. 130. 
 
WHAT ARE THE STATISTICS OF INSANITY. OO 
 
 required to establish the proposition : but this, at least, is 
 proved, that a much greater number of cases is known t:> 
 exist, and to require treatment, than formerly, whatever 
 may be the relative proportion of any given periods. But 
 there are many presumptions in favour of Sir A. Halliday's 
 opinion. We do not speak of the additional asylums build- 
 ing, or recently built, in almost every county in England. 
 The majority of those were required and ought to have 
 been erected fifty years ago. Nor do I allude to the ac- 
 knowledged increase of other nervous diseases: but to the too 
 palpable multiplication of the causes which produce mania 
 itself. The occupations, amusements, follies, and above all, 
 the vices of the present race, are infinitely more favourable 
 for the development of the disease then at any previous 
 period. We live under the dominion of the propensities 
 and must pay the penalty for so doing : and madness is one 
 of these. There is one feature which has often struck me 
 in examining tables of the causes of insanity in reference to 
 the matter under discussion. One half of these is resolvable 
 into crime, follies, and ignorance. If we consult Esquirol's 
 Table, published in J 835, comprehending 1.557 cases, and 
 exclude 337 instances of hereditary taint, as the exciting 
 circumstances under which this burst forth are not noted, 
 it will appear that 579 are attributable to the excess or 
 abuse of the passions, or to the weakness of the uneducated 
 intellect.* The writings of the recent statistical authorities, 
 Guerry and Quetelet, strongly corroborate this opinion. 
 The latter, in quoting from M. Pierquin the observation, 
 " Ies crimes sont toujours, par rapport aux populations dans 
 une proportion en rapport avec cette de la folie," says, " En 
 general je pense effectivement chez lui, que les causes qui 
 tendent a produire V alienation mentale, inrluent aussi sur le 
 nombre des crimes et sur le nombre des crimes contre les 
 
 * Annales d'Hygiene Publique, Janvier, 1S35. 
 
56 
 
 WHAT ARE THE STATISTICS OF INSANITY. 
 
 personnes surtout, mais sans qu'il y ait un rapport direct et 
 necessaireentrelenombredesfous etcelui des criminels,parce« 
 que tous les crimes ne prennent point necessairement leur 
 source dans l'alienation mentale."* 
 
 In the table formerly given by this author of the causes 
 of alienation, the abuse of intoxicating liquors is scarcely 
 mentioned ; in the present 134 are attributed to it.f Are 
 these indications of progressive demoralization ? From this 
 calculation are excluded 278 cases proceeding from family 
 affliction, although in these, vicious dispositions, ill-temper 
 or indiscretions must frequently have produced the evils 
 from which afflictions arises. In Hoist's tables, the obser- 
 vation is still better illustrated. Of 469 cases, the origin of 
 which had been ascertained, 323 may be shown to depend 
 upon ill-constituted or ill-regulated dispositions.^ 
 
 Such then is the general extent of the malady, upon what 
 classes do its ravages fall ? Are there any proscribed or 
 privileged orders recognized in the invasion of madness, or 
 are there any circumstances over which we possess control 
 that appear to promote or prevent that invasion ? There 
 are both. And it conveys an impressive truth that the pro- 
 fessions which are most intimately connected with temporal 
 and selfish interests, and the dispositions which are vicious 
 cr lead to vice, are precisely those upon which the infliction 
 falls most heavily. It may fall as a punishment ; I must re- 
 gard it simply as a consequence, — and believe that certain 
 classes of society, and certain courses of life, are exposed to 
 insanity, not because they are worldly or wicked, but be- 
 cause they expose to excitement and tend to the formation 
 of habits of thought and action inimical to the preservation 
 of mental serenity and health. Rank, riches, and education, 
 
 * Quetelet, sur l'Homme, p. 126. 
 t Diet, des Sciences M^d., Art. " Folic" 
 
 X Official Report of the State of Lunatics in Norway in the year 
 1825— quoted in the British and Foreign Medical Review, ISo. I. 
 
WHAT ARE THE STATISTICS OF INSANITY. 57 
 
 afford no protection against this disease as they do against 
 others ; nor do they increase the danger otherwise than by 
 giving rise to hopes and fears, and exertions and vicissitudes 
 which the humble and illiterate escape. Statistics must de- 
 cide this question likewise. And so for as our information 
 extends, the privileged orders, to continue this mode of ex- 
 pression, are merely those who, from the nature of their 
 employments, or their station in life, are farthest removed 
 from the causes of the disease. The proscribed orders live in 
 and by moral agitation. There is no preservative virtue in 
 particular professions, as has been imagined. Mathematical 
 study is not an antidote. The science may become as fatal 
 a poison to certain intellects as the gaming table or ambi- 
 tion. The cultivators of the earth are not so liable to de- 
 rangement as the cultivators of the mind itself; but it is not 
 because there is anything peculiar or injurious in the latter, 
 but because, from accessary circumstances, it is more calcu- 
 lated to destroy that tranquillity and equilibrium of the 
 powers which is favoured in the former. An eminent wri- 
 ter on this subject has made the startling assertion, that 
 among the educated classes of patients admitted into Bicette-, 
 no instances of insane geometricians, physicians, naturalists, 
 or chemists are to be found, while priests, poets, painters, 
 and musicians, occur in great numbers.* This can be prov- 
 ed to be an error. Bicetre is an asylum for the poor; and, 
 from its records, no legitimate conclusions can be drawn as 
 to the liability of the educated classes, or professions. Ig- 
 norance of the fact may have led to the error; but from 
 whatever cause proceeding, the reasoning which has been 
 founded upon it, and the obloquy thereby cast on some of the 
 noblest pursuits, is triumphantly exposed by a comparison of 
 the tables published by different authorities, and especially by 
 consulting one given by Esquirol, the most accurate ob- 
 server and the most cautious philosopher who has written 
 
 • Conclly. 
 
58 WHAT ARE THE STATISTICS OF INSANITY. 
 
 upon the subject.* It comprehends 164 cases treated in 
 his private asylum, which is appropriated to the wealthy 
 and educated, exclusively. Among these we find neither 
 priests nor poets. There are, however, two engineers, four 
 physicians, four chemists, and several others whose investiga- 
 tions had been directed to the observation of the qualities 
 and relations of external objects. Although, however, the 
 assertion, here combated be inaccurate it is perfectly true 
 that priests and poets are more frequently attacked by, or 
 are more exposed to, insanity, than either physicians or na- 
 turalists. And this for three reasons. First, the study and 
 exercise of religion, and the indulgence of the imagination,, 
 arouse all our most energetic emotions, keep them in con- 
 stant activity, and in this way, tend towards the condition 
 most favourable to the appearance of the disease. Second- 
 ly, those who from choice adopt and prosecute such sub- 
 jects, are naturally and constitutionally more liable to ex- 
 citement. And thirdly, the nature of the subjects them- 
 selves affords greater provocations to excitement than the 
 description of a butterfly, the solution of an arithmetical 
 problem, or the diagnosis of a loathsome disease. In speak- 
 ing of men of certain professions being naturally more liable 
 to excitement, I mean that they are so in consequence of 
 the nature of the powers by which they are led to adopt 
 these professions, and of the temperament by which these 
 powers are influenced. 
 
 If these observations be kept in view, and applied to the 
 moral relations and numerical proportions of the remaining 
 elements of the same table, the characteristics of the privi- 
 leged and proscribed classes, of which we have spoken, may 
 be understood. The most numerous classes are, students 
 25, military men 33, merchants 50. An ascending series 
 indicating the degree of excitement and the source of men- 
 tal disturbance to which the members have been subjected, 
 
 * Diet, des Sciences Me'd-, art. " Folie." 
 
WHAT ARE THE STATISTICS OF INSANITY. 59 
 
 Then follow public functionaries 21, advocates 11, artists 
 8, and so on, illustrating the same proposition. The same 
 author gives the professions of 500 patients admitted into the 
 Asylum at Charenton. Of these 96 belonged to the army, 
 63 had been engaged in trade, 60 were proprietors, 31 were 
 farmers or gardeners, 15 were students, 6 ecclesiastics, 6 phy- 
 sicians, and 2 chemists.* A table in my possession, con- 
 taining the admissions to Dr. Duncan's asylum, Ireland, for 
 eighteen years, confirms this view.-j- The number amounts 
 to 130. Of these, 1 is a schoolmaster, 5 are physicians or 
 surgeons, 7 are farmers, 11 are collegians, 11 are lawyers, 
 14 are men of property, 14 are clergymen, 29 belong to the 
 army or navy, and 37 are merchants, or connected with 
 mercantile affairs. 
 
 We do not possess sufficient data to determine the relative 
 proportions of the insane rich and the insane poor. The in- 
 formation which has been obtained tends to show that the 
 former are most numerous. Esquirol and Georget have adopt- 
 ed this opinion. At the first stage in the inquiry, it must 
 be apparent, that while the poor and the wealthy classes arc 
 equally exposed, or rather expose themselves equally, to 
 the physical causes; the situation, education and habits of 
 the latter are all more favourable to the development of the 
 moral causes of insanity, than can be affirmed of the condi- 
 tion of the poor. Poverty enjoins a compulsory temperance ; 
 it shuts out the longings of ambition ; it acquaints with the 
 realities of life, and excludes the effects of sentimentalism ; 
 it often trains the body to vigour, and in all these respects 
 may be styled prophylactic. The agricultural population, 
 which presents poverty in its most attractive forms and en- 
 joys its best privileges, is to a great degree exempt from in- 
 sanitj'. The returns published by Halliday show, that in 
 twelve of the agricultural counties of England, the propor- 
 
 * Annales d' Hygiene Publique, torn. i. p. 119. 
 t Statistics of Insanity by Mr. Duncan. Paper read before the 
 Royal Medical Society, Edinburgh, 1835. 
 
60 WHAT ARE THE STATISTICS OP INSANITY. 
 
 tion of lunatics to the whole population is as 1 to 2245, while 
 in twelve non-agricultural counties the proportion was 1 to 
 1965. Tables given by Esquirol and Duncan establish the 
 same relation. The former states the profession in 164 cases, 
 only three of these were cultivators of the soil. The latter 
 has met with only seven farmers in ISO patients. This ex- 
 emption has been explained by a reference to the active ha- 
 bits and out-of-door occupations of this class. But this is 
 only one cause. The deportment of a great majority of the 
 individuals belonging to it is virtuous, their amusements are 
 not of an exciting character; they are abstemious, and the 
 amount of their wages seldom fluctuates. All these circum- 
 stances are favourable to the continuance of sanity. 
 
 Another consideration is equally clear, — the affluent and 
 exclusive classes pant after the preservation of caste ; they 
 intermarry for this purpose, and thus transmit through an 
 endless succession of channels the predisposition to insanity 
 wherever it may arise. The state o£ our own peerage amply 
 confirms this statement. Hereditary taint is the most fre- 
 quent cause of this disease, and it is here established to a 
 vast extent in that very position of society which abounds 
 with those sources of mental disturbance which are calcu- 
 lated to rouse such a taint into activity. The ancient nobi- 
 lity of all lands are said to inherit this along with, and in as 
 regular succession as, their patents. But it is not to the 
 ordeal of the ordinary moral causes alone that the higher 
 orders are subjected. Besides wounded pride, jealousy, spe- 
 culation, they have to meet, and indeed court, the excitement 
 of public affairs. And it needs not to be told that the tem- 
 pest of political strife, or civil dissension, which passes over 
 the peasant and the artisan unheeded and almost unnoticed, 
 shakes and desolates the breasts of those who have honours 
 or property to lose or gain, with all its fury. For example, 
 the years 1880 and 1831 were marked in Paris for producing 
 a greater number of cases of insanity than had occurred dur- 
 ing the live previous years. Of the 387 admissions at Charen- 
 
WHAT ARE THE STATISTICS OP INSANITY. 61 
 
 ton, during these two years, twenty-eight cases were traced 
 to political events.* The very great number of Retreats, &c, 
 in this country, which are mere speculations, and have been 
 intended for the reception of those who can afford to pay for 
 such an investment of capital, has been assumed as a good 
 reason for believing that the rich are most liable to madness ; 
 and, in the absence of better grounds for forming a correct 
 judgment, the fact may be interpreted in this manner. From 
 the impossibility of obtaining accurate accounts of the state 
 of private establishments, and from the fact that vast numbers 
 of lunatics are at large, or under the care of their friends, 
 nothing more than an approximation to truth can be expected 
 from such an inquirjr. A very imperfect mode of estimating 
 the respective numbers of the two classes, is by comparing 
 the cases admitted into private asylums, where board is paid, 
 with those entering public establishments, supported by go- 
 vernment or by subscription, within a given period. This 
 can be done only in respect to Paris. But as it is a metro- 
 polis, having in its bosom all the good and evil of other 
 densely inhabited and highly artificial communities, and pre- 
 senting nearly the same distribution of property as elsewhere, 
 the results of the comparison may be received as evidence 
 of the condition of all other places similarly situated. Thus, 
 during eight years, from 1804 to 1818, there were 2749 ad- 
 missions to Salpetriere, a pauper female asylum. During the 
 same period, there were about 1883 admissions to Bieetre, a 
 pauper male asylum, making a total of 4632 lunatics sup- 
 ported by charity, and, of course, belonging to the most in- 
 digent classes. M. Esquirol treated about 300, and M. Du- 
 buisson about 240 in three institutions appropriated to the 
 rich. Into Charenton, during the eight years from 1826 to 
 1S34, 1557 cases were received. t These, with very few ex- 
 ceptions, belonged to the better ranks, paying an annual 
 
 * Charenton is a large and excellent asylum in the vicinity of Paris, 
 under the superintendence of M. Esqirrol. 
 t Burrow's Commentaries, p 512. 
 
62 WHAT ARE THE STATISTICS OF INSANITY. 
 
 board, varying from £35 to £65. These are not all the pri- 
 vate asylums in Paris; but they are all to the records of which 
 I have any access. A total of 2090 is thus given. If it be 
 borne in mind that the poor generally constitute nine-tenths 
 of every community, it must be very evident that the pres- 
 sure of the disease falls upon such classes at least as are re- 
 moved from absolute poverty. 
 
 Another mode of inquiry may be resorted to. Several 
 years ago, and before the erection of Haawell, it was com- 
 puted that there were residing in confinement in and around 
 London the enormous number of 7000 lunatics. Now, sup- 
 posing each of the large public asylums capable of containing 
 500, which they are not; and supposing further that the de- 
 pendencies at Hoxton, Bethnal Green, &c. contained another 
 thousand, or even fifteen hundred, there will still remain4500 
 who cannot be ranked with paupers, and accordingly must 
 be concluded to pay for their maintenance, and in a great 
 majority of instances to belong to the wealthier classes. 
 
 Leveille has recorded a very curious observation on this 
 subject. In examining the French hospitals in 1803, he 
 found that, of the lunatics rendered insane by the events of 
 the revolution, the males belonged to the aristocracy, the 
 females to the democracy. Disappointed and successful am- 
 bition had thus produced a similar result; and that equality 
 which pulled the one down, and raised the other up, had 
 proved fatal in the same way.* 
 
 Esquirol supposes that the rich are less exposed to relapses 
 than the poor, as they have it in their power to distract and 
 give tone to the mind, and to avoid the exciting causes. 
 
 The assertion of the greater prevalence of mental disease 
 under free than under despotic forms of government, may be 
 treated in the same spirit as that displayed in examining the 
 alleged connexion of insanity with civilization. I admit the 
 
 * Rapport fait au Conseil General des Hospices par un de ses mem- 
 bres, sur l'etat des Hopitaux des Hospices, &c, depuis le l er Janvier, 
 1.804, jusqu'au l er Janvier, 1814.. Paris, 1816. 
 
 ^■M 
 
WHAT ARE THE STATISTICS OF INSANITY. 63 
 
 fact, but deny the inference. Tyranny has no protective in- t 
 fluence — liberty is not the foe of mental health. Consump- 
 tion has doubled its ravages since the use of tea prevailed, 
 and cholera has invaded the country since the passing of the 
 Reform Bill; and these facts have nearly the same connex- 
 ion that the prevalence of insanity has with the nature of the 
 constitution under which a people lives. But although the 
 form of government which, it will be observed, is generally 
 the result and representation, and not the cause of the exist- 
 ing state of feeling, exercises no influence in the production 
 of insanity, the mode in which it is administered, the social 
 relations, the tranquillity or the fluctuations in the habits, 
 value of property and rank, the degree of prosperity, and the 
 moral and religious condition which arise out of it, must ob- 
 viously do so. In that state, then, be it monarchical or repub- 
 lican, in which the sources of moral agitation and excitement 
 are most abundant, will the proportion of insanity be the highest. 
 Panics in the commercial classes, civil commotions, war, 
 rapid influx and reflux of wealth, and ambitious projects, 
 which are the most fertile and frequent moral causes of the 
 disease, may occur, and have occurred, under every form of 
 government, and affect mankind, not because they are slaves 
 or citizens, but because their bodies are weak and vitiated, 
 their minds excitable and ill-balanced. A state in which 
 wide-spreading changes did not and could not take place, 
 would afford, to a certain and great extent, a guarantee against 
 madness. Were despotism another word for tranquillity, and 
 freedom for turmoil, the line of exemption would be clearly 
 defined. But public order and disorganization, although 
 undoubtedly favoured by political relations, flow more from 
 the character than the actual condition of a people, and ac- 
 cordingly affect indiscriminately the bond and the free. Thus 
 the free American is comparatively more liable to derange- 
 ment than the free Swiss ; — cretinism is, of course, excluded 
 from the comparison. The enslaved Turk is exempt; the 
 conquered Hindoo liable. The act of liberation, however, is 
 
64 WHAT ARE THE STATISTICS OF INSANITY. 
 
 certainly inimical to mental peace. It operates, like all other 
 great political movements, by powerfully affecting the inte- 
 rests of the mass, by calling forth the deepest sympathies, the 
 most ungovernable passions of the human breast. The French 
 Revolution is said to have filled the asylums to overflowing. 
 The immediate effects of the Crusades, the Reformation, and 
 the retreat from Moscow, were similar. These statements, 
 from the remoteness or the peculiar character of the periods 
 to which they refer, are necessarily vague and unsupported 
 by proof. But on turning to the Irish rebellion, the traces 
 and history of which are still fresh and before us, we find from 
 Kalloran that of 693 cases, 108, or nearly one-seventh, were 
 produced by the terror, the hostility, and the hopes then pre- 
 vailing.* From Esquirol we learn that of 492 cases, forty- 
 five resulted from public events; and that of the same num- 
 ber, ninety-one were occasioned by reverse of fortune, an 
 event often dependent on the current of political affairs, and 
 ranking next to them in its detrimental influence on the 
 mind. Georget shews that of 1079 cases, 116 were attribut- 
 able to political changes, and that these are among the most 
 fertile of the moral causes. This is not the general opinion, 
 nor is it countenanced by experience. Esquirol's observa- 
 tions., we have said, go to shew that while of 492 cases, only 
 forty-five could be traced to popular commotion, not less than 
 136 were caused by domestic affliction, and the enormous 
 number of 178 originated in the predominance, or non- 
 gratification of such passions as self-love, ambition, anger, 
 jealousy, and sensual desire. This is as good a commentary, 
 and probably contains a more impressive lesson on the ne- 
 cessity for a virtuous and well-regulated mind, than a homily, 
 or a treatise on ethics. 
 
 The number of lunatics is said to be much greater in America 
 than in any European country. Can this be the effect, it has 
 been asked, of the acquisition of independence, or of the opera- 
 tion of the constitution under which the people live ? I am 
 
 * BalToran on the Causes and Cure of Insanity- 
 
WHAT ARE THE STATISTICS OF INSANITY. 65 
 
 disposed to believe that a concurrence of causes may have 
 produced this result. First, the abuse of ardent spirits, and 
 especially dram-drinking, is reported to prevail to an awful 
 and destructive extent. Secondly, money is gained easily 
 and rapidly, and the abject and tiie ignorant become sudden- 
 ly rich, without becoming better or wiser ; the means of en- 
 joyment thus increase more quickly than the means of moral 
 training, and there are the effects of unexpected prosperity, 
 and the gross and unrestrained gratifications of an ill-regu- 
 lated mind to contend with. Thirdly, without wishing to 
 repeat the heartless sneer that the Adam and Eve of the 
 United States were born in Newgate, the fact cannot be 
 overlooked that the sources of the tide of population, which 
 has been flowing for so many years uninterruptedly towards 
 America, have been impure and poisoned. The refuse of 
 other nations has been poured forth. I do not wish to speak 
 disparagingly, nor do I allude merely to the criminal out- 
 casts of the old communities, but to the ruined, the unfor- 
 tunate, the disappointed, the adventurous, all those, in fact, 
 whose minds are predisposed by previous circumstances to 
 excitement and disease. Fourthly, the intensencss of politi- 
 cal feeling, and the agitating nature of the civil contests in 
 which the inhabitants generally are from time to time engaged, 
 must decidedly contribute to the development of the disease. 
 The most useful and active period of life is that most ex- 
 posed to the incursion of mania. Its activity is the cause. 
 All the mental energies are then excited, the affections find 
 objects, the passions are roused, and if there be a weak or 
 imperfect part of our nature, it is then shaken and may be 
 cast down in the struggle for subsistence, or wealth, or pow- 
 er ; or by the anxieties which will arise in the even tenor of 
 the most humble and unambitious career. Sources of dis- 
 quietude, altogether unconnected with the constitution of the 
 mind, are then most abundant. Man emerges from the moral 
 nonage of youth into the awful responsibility of indepen- 
 
65 WHAT ARE THE STATISTICS OF INSANITT. 
 
 dence, and new scenes, new situations, new feelings are the 
 consequence: and changes, and misfortunes, and sorrow, in- 
 evitably come. If the mind has been originally vigorous and 
 consolidated by a good education it withstands the shock, 
 but if there exists a hereditary predisposition or debility, a 
 proneness to excitement, an exalted state of feelings at the 
 expence of the intellect, that is, the absence of a well adjust- 
 ed balance between the emotive and reflective powers, it 
 totters and falls. The body is, at the same time, more sub- 
 jected to the physical causes of the malady. The accidents 
 of an active profession, the pernicious customs of society, the 
 diseases of mature age, all come into operation, and contri- 
 bute to swell the amount of attacks in adults. Extensive 
 observation shews that the greatest number of cases of 
 lunacy occur between thirty and forty. No age is exempt, 
 for even infants and octogenarians become insane : but the 
 frequency of the disease during the deeade mentioned is 
 evinced by the fact that of 2507, 572, or more than one-fifth, 
 occurred within its limits. Nearly the same proportion is 
 observed in Hoist's tables, where, of 1909 lunatics, 887 became 
 deranged between thirty and forty. If it be recollected that 
 not only is society liable to be deprived of the services of its 
 citizens at the precise moment when they are most valuable, 
 but that at this period a vast proportion of the population of 
 a country become parents, and transmit to their lineage what- 
 ever is good or evil, strong or weak in themselves: a still 
 more urgent reason is perceived, were the awful character 
 of the disease itself insufficient for guarding against the attack, 
 and for providing means the most ample and adequate for the 
 removal of the disease. The fact is worth recording, and is 
 connected with this part of the subject, that marriage, and the 
 peace and happiness which it secures, afford a protection from 
 insanity. This conclusion cannot, at least, be held to be un- 
 justifiable, or the grounds from which it is drawn accidental, 
 when in tables framed in various countries the unmarried or 
 
WHAT ARE THE STATISTICS OF INSANITY. 67 
 
 widowed lunatics always preponderate. Two tables shew 
 the following relations. The first refers to the admissions at 
 Charenton.* 
 
 Unmarried or widowed 859 
 
 Married 698 
 
 Difference 161 
 
 The second is extracted from Mr. Duncan's manuscript Es- 
 say on the Statistics of Insanity. He does not mention his 
 authority. 
 
 Unmarried 1779 
 
 Married 578 
 
 Difference 1201 
 
 Marriage may diminish the tendency to mental alienation 
 in various ways, either by removing individuals from the in- 
 fluence of many of the exciting causes, or by the formation 
 of regular habits, and the cultivation of virtuous impulses, 
 rendering that influence innocuous. To woman it generally 
 is or ought to be the point towards which all her wishes have 
 formerly converged, and from which all her future hopes and 
 happiness are to emanate. To man it is the shield against 
 himself and his passions ; he seeks and finds in it joy, solace, 
 and support, when his own thoughts, avocations, or the world 
 fail to furnish either. If founded on harmony of disposition, 
 not only does it create the capabilities of enjoyment, but of 
 enduring pain ; and on this account, and because it neutral- 
 izes selfish feelings and pleasures, because it prevents the 
 mind from retiring on itself, acts as a barrier against hidden 
 sorrows, gives employment to our noblest qualities, and while 
 chequered by the ordinary vicissitudes of life, because it 
 yields no strong or sudden or permanent excitement, it is an 
 antidote to insanity. 
 
 Of the parties to this engagement females are perhaps most 
 * Annales d' Hygiene Publique. Janvier, 1835. 
 
68 
 
 WHAT ARE THE STATISTICS OF INSANITY. 
 
 subject to insanity, both before and after its consummation. 
 This has been attributed to the peculiarities of their consti- 
 tution, the delicacy of frame and susceptibility of mind by 
 which the sex is distinguished. That these act powerfully 
 in producing insanity cannot be questioned. But if this set 
 of causes be confined in their operation to women, so are a 
 large proportion of the physical causes and the influence of 
 ambition, speculation, and dissipation, confined in their ope- 
 ration to men ; so that upon these grounds no explanation of 
 the inequality can be received or attempted. The education 
 of females is, however, more imperfect and vicious than that 
 of men ; it tends to arrest the development of the body ; it 
 overtasks certain mental powers, it leaves others untouched 
 and untaught ; so far as it is moral it is directed to sordid and 
 selfish feelings, and substitutes a vapid sentimentalism for a 
 knowledge of the realities and duties of life. From such a 
 perversion of the means of training, what can be expected to 
 flow but sickly refinement, weak insipidity, or absolute dis- 
 ease. That which is intended to impart, and is incapable of 
 imparting strength and stability, becomes the source of de- 
 bility and decay; that which is created as a bulwark of de- 
 fence, is converted into the open and easy road by which the 
 enemy may enter. Before any reasoning on this point can 
 be considered definitive, it will be necessary to know the pro- 
 portion of the causes affecting the two sexes. This depart- 
 ment of statistics is still uncultivated, almost unknown. 
 
 The facts are as follow : in one table of lunatics, Duncan's, 
 there are 752 males, 1625 females: in another of 2507 in- 
 sane in the Parisian hospitals, 1095 are men, 1412 women. 
 This great disparity is not uniformly observed in France or 
 even in Paris, but from the moral condition of that country 
 it would not have excited our surprise had it been so. For 
 example, one-twentieth of the patients at Saltpetriere are sup- 
 posed to be insane from prostitution.* Esquirol has calcu- 
 * Esquirol — Parent Duchatelet. Dela Prostitution dans la Vine de Paris. 
 
WHAT ARE THE STATISTICS OF INSANITY. 69 
 
 lated that of 25,083 persons ascertained to be insane in 
 France, 1 1,119 are males, 13,964 females. In Milan the num- 
 bers are 2699 men, 3207 women. Some other countries 
 present an equal proportion of lunatics in both sexes. In 
 Norway there appears to be a greater number of male than 
 female lunatics.* Scotland, in 1818, had 2311 men and 
 3339 women insane. In some other instances the males are 
 most numerous ; but a general census would, it is believed, 
 substantiate the view given above. 
 
 Medical men long acted as if nothing could be done with 
 any chance of success in insanity. They believed that were 
 the bowels regulated and the organic functions attended to, 
 their duty was discharged, and the vaunted powers of medi- 
 cine sufficiently vindicated. The suspicion even arose that 
 the disease could not be removed, that it did not come under 
 the ordinary rules of art. Drs. Munro, Burrows, and Ellis, 
 declare, however, that they cure ninety out of every hun- 
 dred cases. Such a result proves, so far as the practice of 
 these observers is concerned, that instead of being the most 
 intractable it is the most curable of all diseases. The declar- 
 ation, however, applies only to recent cases, which have not 
 existed for more than three months, and which have been 
 treated under the most favourable circumstances ; as the pa- 
 tients either belonged to the independent classes or were in- 
 mates of one of the most deservedly celebrated institutions in 
 England, Wakefield, under the care of one of the most en- 
 lightened physicians in Europe. But even where poverty, 
 popular prejudice, indifference, or other obstacles, have de- 
 prived the insane of many of those means which it is in the 
 power of benevolence and art to bestow, the proportion of 
 cures issuch as to dispel the disheartening and unworthy con- 
 viction that this affliction must continue to baffle human skill* 
 
 Quetelet sur l'Horame, tome ii. p. 127. 
 
70 WHAT ARE THE STATISTICS OF INSANITY. 
 
 and to open up a vista of delightful anticipations of what 
 might be effected by a coalition between the philanthropists 
 and the philosophers. That proportion, be it observed, in- 
 variably corresponds to the degree in which the treatment is 
 in unison with the laws of the human mind. It does not de- 
 pend upon, or vary with, local circumstances; it is the same 
 in Italy as in England ; it bears little relation to the occupa- 
 tion, sex, or age of the patient, and less to the cause of the 
 malady, unless that be organic ; it cannot even be attributed 
 to the talents of the physician, save where these are dedicat- 
 ed solemnly and enthusiastically to the task, and made the 
 instruments by which it is to be accomplished. If all asy- 
 lums had advanced to that stage of improvement to which 
 they will ultimately be forced by the irresistible impetus of 
 public opinion ; and were patients placed under treatment on 
 the very first and slightest indication, the oddity or eccen- 
 tricity which ushers in the disease, I have no hesitation in 
 affirming, that the proportion given by Ellis would become 
 universal. Even now, contending, as physicians to the in- 
 sane have almost everjavhere to do, with errors and difficul- 
 ties which none can appreciate save those who have tried to 
 put the moral machinery of an asylum into operation ; and 
 taking all cases as they are presented, of long or short dura- 
 tion, simple or complicated with malformation of thchead or or- 
 ganicdisease, the average number cured isabout one-half. Put 
 out of view the drawbacks mentioned, and consider only the 
 numbers cured of other diseases, cast up the recoveries from 
 consumption which is said to destroy all its victims, from 
 cholera which destroys one half, from pneumonia which de- 
 stroys about irbejity- nine per cent., or from less fatal ailments; 
 and having found that not two-thirds escape at all, and not 
 one-twentieth without some injury to the constitution, which 
 embitters, if it do not shorten life ; and the vast benefit con- 
 ferred on society by that treatment of the insane will be per- 
 ceived, which restores to the affections of their friends, and 
 
WHAT ARE THE STATISTICS OF INSANITY* 71 
 
 the duties of active life, and the glorious prerogative of serv- 
 ing God with the eye of reason clear, and the pulse of feel- 
 ing calm, one half of those who would otherwise be lost to 
 themselves and to the world, and lapse into fury or loathsome 
 futurity. We will here introduce a table of the proportions 
 recovered in different establishments. 
 
 Number of years 
 
 on which the aver- Hospital. Proportion of cures, 
 
 age is taken. 
 
 25 Senavra, Milan 58 in 100 3 
 
 2 Charenton, Paris 40... — b 
 
 12 Salpetritre and Bicetre 34 ... — c 
 
 12 Ivry, Paris 51... — d 
 
 13 Retreat, York 50 ... — e 
 
 16 Lancaster 40... — f 
 
 8 Gloucester 48 ... — s 
 
 York, (county asylum). .49 ... — h 
 
 5 Bethlem, 1748-1794 28 J 
 
 1 Bethlem, 1813 49... — . i 
 
 15 Bethlem, 1819-1833 50 ... — * 
 
 5 Wakefield 42 - l 
 
 10 Stafford 43... — m 
 
 2 Dundee 50... — " 
 
 5 Perth 46 ... — ° 
 
 Hartford, United States 91 j% — p 
 
 This table has been constructed and is given to the public 
 merely to convey some idea of what has been effected under 
 
 a Burrow's Commentaries, p. 522. b Diet, des Sciences Med. 
 
 art. "Folie." c Ibid. d Ibid. e Pritchard's Treatise 
 
 on Insanity. f Ibid. e Ibid. h Ibid, and Esquirol, Mem. 
 
 de l'Acad. Roy. de Med. > Ibid. 1 Ibid. k Ibid. ! Burrows. 
 m Ibid. h Annual Reports of Dundee. ° Annual Reports 
 
 of Murray's Asylum, Perth. v Combe on Mental Derangement, 
 
 p. 923. 
 
72 WHAT ARE THS STATISTICS OF INSANITY. 
 
 different circumstances, but has no pretensions either to rigid 
 exactitude or to be considered as affording a complete view 
 of the subject. The calculations proceeded on the number 
 of admissions and cures annually, and not upon the actual 
 number of patients in the asylums at one, or within any given 
 period. 
 
 The success at Hartford, which is probably the most per- 
 fect example of an asylum conducted on sound principles, is 
 highly encouraging. The proportion is exactly that which 
 Ellis and Burrows have met with in recent cases and in pri- 
 vate practice, and affords the most irrefragable proof of how 
 much may be accomplished by employing all the means 
 within our reach. The table now given refers chiefly to the 
 results of the current century. No one conversant with the 
 details of the subject can doubt that the proportion of cures 
 corresponds to the improvement of each establishment, and 
 that the gross amount of cures is much greater within the 
 last twenty years than during any previous period of the same 
 length, that is, since the recognition of humanity and em- 
 ployment as means of treatment. In the foregoing synopsis 
 those only are included whose reason was completely re-es- 
 tablished. But there are two other classes not noticed which 
 swell the amount of good: those who, retaining some visi- 
 onary project or harmless delusion, are dismissed so materi- 
 ally improved as to be capable of engaging in the pursuits 
 and tasting the pleasures of life, with great additional happi- 
 ness to themselves and perfect safety to others : and, second- 
 ly, those who. although requiring to be protected from them- 
 selves and displaying some untameable appetite which would 
 render liberty a curse, pass, under proper guidance, long in- 
 tervals of contentment, who are soothed: when unruly, cheer- 
 ed when depressed, advised when capricious, and are at all 
 times and in every mood surrounded by friends. 
 
 Mental disease has been imagined to confer longevity. 
 To bolster up this imagination, for it is nothing more, in- 
 
WHAT ARE THE STATISTICS OF INSANITY. 73 
 
 stances have been cited of lunatics reaching a great age : the 
 same thing has been said and done with respect to gout, but 
 without weakening the principle that any serious structural 
 change, or impairment of function, renders the system more 
 susceptible of disease, and less able to resist its effects. It 
 would be matter for regret, were it true, that life was pro- 
 longed by such means ; but the truth is that life is shortened. 
 To understand this statement, it ought to be premised, that 
 it is not my intention to assert that disorder of reason, which 
 is merely a symptom, shortens life, but that the affections of 
 the nervous system, upon which it depends, tend to do so. In 
 this sense it is no paradox to say that no one ever dies of in- 
 sanity. The bills of mortality announce the contrary ; but 
 it is well known that these are utterly worthless as scientific 
 documents, and that they are the compilation of churchwar- 
 dens and old women.* The bill for 1834 has the absurd 
 calculation that 170 persons died from this disease.f The 
 meaning of this, or the interpretation which a medical man 
 acquainted with the subject would give to it, is, that 171) 
 persons died while insane. But if you proceed to examine the 
 reports of the asylums in which these 170 were confined, or 
 even listen to the descriptions of their friends, you will dis- 
 cover that they suffered and succumbed under consumption, 
 dropsy, or more frequently apoplexy, epilepsy, or some other 
 malady of definite character, to which all men are liable. 
 All those who have actually practised among the insane, 
 know, and have cause to grieve, that besides derangement, 
 they are required to treat disease in all its forms. There are 
 then two evils to be combated, and hence arises the greater 
 mortality of the insane. There is the irritation, or organic 
 change, existing in the centre of the nervous system, the 
 cause of the insanity, lessening the general tone of the sys- 
 tem, and producing great disturbance as a secondary conse- 
 
 * Blizard. Remarks on Public Hospitals, p. 71. 
 t Companion to the Almanac, p. 37. 1836. 
 
 E 
 
74 WHAT ARE THE STATISTICS OF INSANITY/ 
 
 quence, and there is some other affection rendered more 
 intense and more intractable from that lessened tone and 
 general disturbance. But if the presence of the cause of in- 
 sanity militates so much against the restorative efforts of na- 
 ture and the remedial means employed, may it not predispose 
 to disease, and promote the frequency of its incursion as well 
 a&its violence. I believe that it may. That it directly induces 
 apoplexy, ramolissement, congestion, and so forth, there is 
 not the slightest doubt; and there is every probability that 
 it influences the condition of organs remote from, although, 
 of course, not independent of the nervous system, But 
 other considerations are mixed up with this question. In 
 General the situation of lunatics is unfavourable for the resis- 
 tance of disease. The confession of a person intrusted with 
 two private asylums, that from want of suitable protection- 
 from the weather, nourishing diet, cleanliness, &c. a hundred 
 of his patients perished in one season from typhus fever, will 
 explain the meaning of this observation."" Even when no 
 such maladministration exists, the patients in asylums often 
 take little exercise, — they are allowed to eat immoderately, 
 — their habits are uncleanly,— they pass their days in close 
 heated rooms, and their nights in rooms equally close, but of 
 a low temperature ; they are, in short, placed under enervat- 
 ing and depressing circumstances. Again, when attacked by 
 disease, unless the symptoms be of such a nature as to come 
 within reach of the senses, or of those modes of exploration 
 which are intended to aid or correct the senses, the powers 
 of medicine are, in a great number of cases, sadly trammelled. 
 All the information derivable from the patient's own sensa- 
 tions is denied ; for he may undervalue or exaggerate the pain 
 which he suffers, or he may refer it to a healthy region : the 
 origin and progress of the disease remain a blank from his 
 inability or unwillingness to disclose them. The duty of a 
 
 * First Report of Minutes of Evidence from Committee on Mad- 
 houses, 1816, p. 9. 
 
WHAT ARE THE STATISTICS OF INSANITY. 75 
 
 physician is, in such a situation, a very painful one : he sees 
 a fellow-creature writhing in agony, which may be that of a 
 troubled spirit or result from bodily suffering : he sees the 
 ravages of a deep-seated malady, but the exact seat of which 
 he can at best only conjecture : he hears supplications for aid 
 which he cannot afford : he is obliged to grope his way in 
 the darkness of empiricism, altering the direction of his steps 
 every hour, and at last finds that all his efforts have not only 
 been vain, but injurious. Such situations cannot always be 
 avoided ; but the frequency of their occurrence may be les- 
 sened by increasing the chances of recovery among the in- 
 sane, and by placing them in circumstances more conducive 
 to health. The rate of mortality will vary somewhat in dif- 
 ferent asylums according to the locality, the classes admitted, 
 and the treatment pursued ; but the following table may be 
 presented, as exhibiting these differences, and their influence. 
 There die in 
 
 Wakefield Asylum, 24 in 100 patients, or lin4 
 
 Lancaster, 24^ 1 ... 4 
 
 French Hospitals, 22 1...4£ 
 
 Senaora, Italy, 42^ 1...2J 
 
 Cork, 30 1...3J 
 
 Retreat, at York, 20 1...5 
 
 Charenton, 25 1...4 
 
 Glasgow, .10 1.10 
 
 Burrow's Private Asylum, ... 6^ 1 ..1 5 
 
 Now, if these statements be compared with the results of 
 the practice in any common hospitals, the proposition which 
 has been advanced will be readily admitted. From the re- 
 ports of eight of the principal hospitals in London, it appears 
 that the deaths per cent, of all patients received, vary from 
 seven to ten, while in ten provincial institutions, the mortal- 
 ity ranges from three to seven per cent.* In the Hotel 
 
 • British Medical Almanack, 1836. 
 
76 WHAT ARE THE STATISTICS OF INSANITY. 
 
 Dieu at Paris, the deaths amount to seven per cent ; and in 
 La Charite at Berlin alone, of all the continental hospitals to 
 the statistics of which we have access, do they reach so high 
 as 25 per cent. 
 
 By far the most fatal seasons to lunatics are autumn and 
 winter. A fact which shews the necessity, should humanity 
 require the lesson, of protecting them effectually against the 
 influence of the atmosphere and its sudden alternations. Of 
 798 deaths at Salpetriere, 175 took place during the spring, 
 and 174 during the summer quarter, while in autumn there 
 occurred 234, and in winter 207. At Charenton the dis- 
 parity is equally marked ; 119 deaths took' place in summer, 
 160 in winter. 
 
 The diseases which destroy lunatics afford cumulative evi- 
 dence of the positions that the mortality among them is great, 
 and that it is affected by the nature of the circumstances in 
 which they are placed. We learn from a table, embracing 
 nearly 3G0 cases, that the diseases most prevalent among 
 lunatics, attack them in the following order, — colliquative 
 diarrhoea, scurvy, affections of the liver, apoplexy, typhoid 
 fevers, nervous tevers, phthisis. With two exceptions, these 
 are the results of debility. In another table, including 995 
 deaths, which took place in a number of the principal asy- 
 lums in England, the proportions from the following diseases 
 are, exhaustion and old age, 227 ; apoplexy and paralysis, 
 152 ; diarrhoea and dysentery, 132 ; consumption, 119 ; epi- 
 lepsy and convulsions, 104.* Apart from the affections of 
 the chest, abdomen, and fibrous tissues, directly produced 
 by changes of temperature, the cold of winter has a depress- 
 ing effect upon the system, which indirectly causes ulcers on 
 the legs, loss of motion, and when the clothing is inadequate, 
 frost- biting. 
 
 Besides being distributed into the curable and incurable, 
 
 * Parliamentary Returns from County Asylums, 1836. 
 
WHAT ARE THE STATISTICS OF INSANITY. 77 
 
 the inmates of an asylum are subdivided into other groups, 
 the precise numbers of which it is of some importance to as- 
 certain, in order to make arrangements suited to their respec- 
 tive wants and habits. The sections of the curable are very- 
 obvious, and are considered elsewhere. The incurable may 
 be arranged into various classes. There is, first, the furious 
 madman, thirsting for blood, glorying in the destruction oi 
 every thing around, and requiring, for his self-preservation, 
 and the enjoyment of those transitory throbs of happiness of 
 which his soul is still susceptible, to be coerced, leniently, 
 and as rarely as possible, but to be completely deprived of 
 the power of doing injury. Such cases do certainly occur, 
 although not so frequently, nor of such a frightfully irre- 
 claimable nature as the supporters of the old system would 
 have us to believe.* Were we to be guided by a work which 
 appeared about twenty years ago, our conclusions would be 
 widely different.f From this source we learn, that of 1649 
 maniacs admitted in Bedlam, 743 were mischievous, and 20 
 had committed murder. There are only three ways of recon- 
 ciling the discrepancy thus created with the experience of 
 recent observers. Either the inmates of Bedlam must at that 
 time have been chosen on the ground of their turbulence or 
 treachery ; or an epidemic of mischief must have lurked 
 within its walls ; or, lastly, our national character must have 
 undergone a change. Whatever alternative we may adopt, 
 the change itself is matter for congratulation. Tor now the 
 largest establishments boast of having only one or two irre- 
 claimable patients, and of having discarded strait-waist- 
 coats as well as stripes. There is clearly a homicidal and 
 destructive mania, in which no kindness, no moral tie what- 
 ever, avails aught in preventing the sacrifice of life and pro- 
 perty. You will hear of institutions conducted upon princi- 
 ples of freedom and humanity, where there are neither chains 
 
 * Brierre de Boismont, Annales d' Hygiene, Juillet 1836, p. 56. 
 f Black's Dissertation on Insanity. 
 
78 WHAT ARE THE STATISTICS OF INSANITY. 
 
 nor chastisement ; but even under such mild government as 
 this, the furious maniac will be furious still, strew death and 
 desolation around, immolate his friends and protectors, and 
 exult in his deeds of vengeance. The boast of the reformed 
 treatment is, that these unfortunate beings are at once de- 
 tected, that no one is restrained on suspicion, that the periods 
 of exacerbation are known and provided for, that the precau- 
 tions adopted are compatible with many pleasures, and often 
 with the personal liberty of the patient. The proportion of 
 such a dangerous species of derangement is not well known : 
 indeed it must vary with the country, the race, class and oc- 
 cupation of the individuals diseased ; but it is estimated, that 
 of a hundred admissions not more than three will remain, un- 
 der proper management, permanently and immitigably fu- 
 rious.* The number of furious, or rather unmanageable 
 females, is greater than that of males. 
 
 Nor is such an inquiry unimportant for practical purposes. 
 Formerly asylums were constructed upon the principle that 
 ninety-five required to be restrained, that five only could be 
 intrusted with freedom. The considerations submitted above 
 shew, that now arrangements must be made in order to afford 
 freedom to the ninety-five, and adequate restraint to the five. 
 
 The second group is that of the paralytic and epileptic 
 incurables. They probably amount to one-tenth of the 
 whole. Hoist states that of 1422 cases, 245 were epileptics. 
 From the tables of Leveille we learn, that of 3662 cases ad- 
 mitted at Bicetre, 1292 were epileptics, that is, nearly one- 
 third of the whole. The proportion is not so large in this 
 country. Of 734 deaths which occurred in nine of the prin- 
 cipal county asylums in England, 104, or one-seventh, were 
 from epilepsy. The demands of this class on the affectionate 
 care of those around are constant and imperative. There is 
 the helplessness, without the hopes of childhood, to excite 
 
 * First Report from Committee on Madhouses, p. 51. 
 
WHAT ARE THE STATISTICS OF INSANITY. 79 
 
 pity. Instead of expanding, their minds contract under your 
 care; their wants diminish, and are at last reduced to the 
 desire for food, and a claim upon some friendly arm to sup- 
 port their tottering steps. 
 
 The third is a very numerous class. The imbecile, fatu- 
 ous, and idiotic constitute in this and some other countries 
 more than one-fifth of all the cases submitted to treatment. 
 In Norway, however, they are more than one-half, the num- 
 bers being 682 to 1229. Although placed beyond the reach 
 of all alleviation from medicine, this form of alienation ad- 
 mits of great alleviation from external circumstances. These 
 individuals have many joys, and the circle may be greatly 
 widened. They may be roused to exertion and industry ! 
 some last lingering gleam of intelligence may be brought to 
 bear on the pleasing parts of their condition — some half-ex- 
 tinguished habit may be encouraged ; the power of tasting 
 the physical enjoyments of existence may be gratified in such 
 a manner that their life may be passed in a succession of 
 useful employments and agreeable sensations. This is, more 
 than all besides, the boast of modern physicians. If they 
 cannot cure the imbecile and fatuous, they can render them 
 happy. 
 
 There is a fourth group. It brings us in contact with the 
 humiliating spectacle of the body living and breathing, but 
 no longer animated by the slightest spark of reason, where 
 even the senses are benumbed or annihilated, and, saving the 
 human form, man becomes as the clod of the valley. In this 
 situation patients are insensible to the calls of nature, and 
 put to a severe test the kindness and forbearance of those to 
 whom they are intrusted. A practical man has estimated 
 that of every hundred lunatics, there are ten who have lost 
 all power over the sphincter muscles. But this is probably 
 erroneous. The same authority calculates that every third 
 lunatic, whether curable or not, contracts dirty habits. I 
 believe that this is likewise an exaggerated estimate. To 
 
80 WHAT ARE THE STATISTICS OF INSANITY. 
 
 those who are accustomed to regard with pride the charac- 
 teristic cleanliness of a portion, at least, of our countrymen, 
 but have not traced this quality to a national mental consti- 
 tution, such a statement will appear ridiculous. But the love 
 of order and neatness share in the common ruin, and may be 
 extinguished, as well as the love of wealth or of friends, and 
 the consequence is, although not to the extent, of the kind 
 described. The slovenliness, the loathsome and disgusting 
 peculiarities, and utter disregard to decency or propriety 
 which follow in the train of madness, are astonishing, almost 
 incredible. The state of abstraction in which many indivi- 
 duals are plunged, and their corporeal weakness, contribute 
 as much as the disease of the perceptive powers, to this re- 
 sult. With proper care, however, and training — for the in- 
 sane must be taught their habits anew — this evil may be 
 greatly modified, and in one-half of the cases where it appears 
 altogether eradicated. There are some cases where, from a 
 wish to offend the delicacy of others, or from absolutely glory- 
 ing in shame, no persuasion or precaution can prevent the 
 insane from going about in a state of nudity. Clothe them 
 twenty times a-day, and twenty times will they appear naked. 
 This generally takes place where lunacy has been engrafted 
 on vicious and abandoned habits. Some restraint must be 
 resorted to, but fortunately incurable cases of this kind do not 
 occur oftenerthan 1 in 100. Occasionally idiots and epilep- 
 tics strip themselves from no worse motive than idleness, or 
 to enjoy a cold air bath. 
 
 In every hundred patients there will be five noisy ones : 
 riotous, not from the desperation of anger or fear, but from 
 the truly Irish love of fun and mischief, or from irrepressible 
 garrulity, which is itself a form of madness. This feature, ac- 
 cording to Guislain, presents itself in every ninth lunatic* 
 Such inmates may be easily tolerated, and soothed into quiet- 
 
 * Sur les Phrenopathies, p. 199. 
 
WHAT ARE THE STATISTICS OF INSANITY. 81 
 
 ness during the day, but during the night their cries and lo- 
 quacity, for they are sleepless, are altogether inconsistent 
 with that stillness which to the troubled mind is the best 
 anodyne I know of. Every patient is thus aroused — the fu- 
 rious maddened, the desponding and timid horrified ; and the 
 hours of rest become hours of turmoil and excitement. To 
 meet such a state of things, a part of every asylum should 
 be deafened ; and so effectually deafened, that all who are 
 able to obtain sleep may do so undisturbed. Or what is still 
 better, the noisy and refractory should inhabit distinct build- 
 ings. Then their melancholy orgies may proceed without 
 interruption. 
 
 With the furious may be classed those who are dangerous 
 to themselves, who have attempted, or are suspected of che- 
 rishing a design to attempt, suicide. Dr. Black represents 
 the proportion of suicidal to other maniacs as enormous. Of 
 1972 patients admitted to Bedlam from 1772 to 1787, 323, 
 or about one-sixth, are described as having attempted suicide. 
 It is both a sound and a safe doctrine to regard all who have 
 meditated or attempted to perpetrate this crime as insane. 
 Accordingly, many of those here rated as maniacs unques- 
 tionably owed their designation and their confinement to 
 harbouring such an intention, and to no other overt act of 
 folly or frenzy. The motives to destroy life vary with the 
 pains and sorrows to which it is exposed, the capability of 
 bearing these, and the general constitution with which each 
 individual mind is endowed. But the resolution is often 
 taken suddenly, and the hand is raised to accomplish the 
 deadly purpose, while the mind is blinded by intoxication, 
 tortured by bodily suffering, cast down by disappointment, 
 maddened by momentary passion. When the poignancy of 
 such disordered feelings has ceased, with it in a great number 
 of cases will cease every inclination and temptation to com- 
 mit suicide, and the mind will remain calm and undiseased ; 
 so that of the 323 persons consigned to Bedlam because they 
 
82 WHAT ARE THE STATISTICS OF INSANITY, 
 
 Lad yielded to the suggestions of a selfish and unholy cow- 
 ardice,, probably not one- half would continue under the influ- 
 ence of these feelings after the original impulse had been 
 checked, a result which was very likely to flow from the act 
 of isolation. This is a distinction of some importance, as 
 such patients may be treated with confidence corresponding 
 to what their dispositions are when relieved from the irrita- 
 tation by which they were disturbed. To hold an opposite 
 opinion will lead to the enforcement of all those galling pre- 
 cautions, which offer little or no obstacle to the determined, 
 provoke the vacillating, and harass the innocent. 
 
 The number of suicides ma}' be estimated in one of two 
 ways : either in proportion to the number of patients actually 
 sent to and inhabiting asylums, or in proportion to the popu- 
 lation of a country. The latter calculation affords some in- 
 formation as to the average that may be expected to be 
 committed to such institutions. There is only one link 
 wanting to render the chain complete. We would require 
 to know, but have no data from which to deduce, the propor- 
 tion of suicides effected to suicides attempted, and the pro- 
 portion of both to that of suicides meditated. I do not dis- 
 pute the accuracy of Dr. Black's statement, nor deny that in 
 a certain period the suicidal amounted to one-sixth of the 
 whole of the lunatics confined in Bedlam; but I protest 
 against the impression which such a statement is calculated 
 to convey. I deny that such a proportion will be found in 
 any other asylum. That the crime of suicide increases, that 
 every year adds to the number of victims cannot be doubted. 
 But the holocaust has not yet reached the appalling amount 
 here announced. My own experience leads me to think that 
 suicidal maniacs bear a proportion of about one-tenth to the 
 other inmates of asylums. In a table of patients who have 
 been under my own care, I find exactly this proportion. Of 
 1032 deaths in the English asylums, only seventeen were 
 brought about by self-destruction ; a fact which proves one 
 
WHAT ARE THE STATISTICS OF INSANITY. 83 
 
 of two things, either the rarity of this species of derangement, 
 or the excellence of the means adopted to prevent the fatal 
 consequences which so frequently flow from it. 
 
 One reason has already been given for separating suicides 
 into classes — into those who may be trusted, and those who 
 must be watched; another exists. It likewise proceeds from 
 a consideration of the cause. Suicidal mania, like many other 
 forms, is hereditary, whole families, generation after genera- 
 tion, perish by their own act, the different members often 
 selecting the same age and the same weapon for carrying 
 their design into execution. When such a propensity has 
 been transmitted, and is hence identified with the powers of 
 mind, our watchfulness must be tenfold more strict and search- 
 ing than when the incitement has consisted in an attack of 
 the reflective or perceptive powers, which may be controlled, 
 and which cannot recur without very marked premonitory 
 symptoms. 
 
 How easily lunatics may be diverted from their purpose 
 by presence of mind, an intimacy with their character, and 
 the tact to employ the destructive feeling by which they 
 are actuated as the means of protection, is well exemplified 
 in an anecdote related of Dr. Fox. He had accompanied a 
 suicidal and furious maniac, who was at the time calm, to the 
 upper story of his asylum, to enjoy the prospect beyond the 
 walls. In returning the spiral staircase struck the eye of the 
 patient, the opportunity roused the half-slumbering propen- 
 sity, and a paroxysm of frenzy ensued. His eye glared, his 
 teeth ground against each other, he panted like the blood- 
 hound for his prey, and clutching the doctor by the collar, 
 howled into his ear, " Now, I'll cast you down, and leap after 
 you." Standing on the brink of what seemed inevitable de- 
 struction, the doctor's reply was instantaneous, " Bah, any 
 child could do that ; come down and I'll throw you up." 
 " You cannot," was the rejoinder; but the artifice prevailed, 
 and they both hurried down to put the boast to the proof; 
 
84 WHAT ARE THE STATISTICS OF INSANITY. 
 
 and the sanguinary threat was forgotten before they reached 
 the lobby. 
 
 The proportion of suicides to the rest of the population is 
 strikingly different in countries where the condition of the 
 inhabitants is nearly similar. In Denmark it is higher than 
 in Britain ; and in some of the German states it is a hundred 
 times greater than in Copenhagen. In London the propor- 
 tion is one in 5000 ; in Paris it is said to be one in 2040.* 
 A very patriotic controversy has been waged by these cities 
 as to which the stigma shall attach of presenting the largest 
 catalogue of suicides. The contest is virtuous though idle ; 
 and has brought to light facts which impugn even the accu- 
 racy of the statements on which it has proceeded, and render 
 it highly probable that no definite conclusion can be drawn. 
 In Paris, it appears every person found dead, and whose death 
 cannot be otherwise accounted for, is ranked as a self-mur- 
 derer; whereas, in London, the want of evidence, and the 
 complaisance of juries, often screen the suicide under the 
 verdict of " died by the visitation of God." 
 
 It is stated that in the departments of France, the number 
 of deaths from suicide is comparatively small ; and, what may 
 appear strange, the more primitive and illiterate the district, 
 the smaller the proportion. We will accordingly find that 
 the darker the ignorance the less the predilection to suicide. 
 Thus, while in Finestre, which appears to be in the most de- 
 plorable state as to education, only twelve in a hundred in- 
 habitants being able to read or write, few suicides occur, at 
 least only in the proportion of one in 25,000. Paris, that 
 focus of all that is brilliant and imposing in science and liter- 
 ature, and where gratuitous elementary instruction is acces- 
 sible to all, gives a suicide for every 3000. Coreze, where 
 only twelve in the hundred can read or write, presents one 
 suicide in 47,000 ; and the High Loire one in 163,000. On the 
 
 * Quetelet, Sur 1' Homme, t. ii. p. 147. 
 
WHAT ARE THE STATISTICS OP INSANITY. 85 
 
 other hand, in Oise and Lower Seine, both places in possession 
 of the highest degree of general instruction, and of the means 
 of advancing in improvement, suicides occur in every 5000 or 
 9000 inhabitants.* This is an appalling picture of demoral- 
 ization, or of disease, but no hesitation can be felt in deter- 
 mining the causes. It is not because these unfortunates can 
 read or write, or live in a particular geographical position, 
 that they commit suicide. But, first, because they are mem- 
 bers of communities where the excitements to insanity, and 
 the temptations to crime abound ; secondly, because the in- 
 struction communicated is addressed solely to the reflective 
 and perceptive faculties ; thirdly, because there exists no 
 provision for the cultivation of the sentiments, by the aid of 
 which man, as a citizen, is not only preserved negatively in- 
 nocent, but is rendered positively virtuous ; there is no do- 
 mestic tuition in France; there are none of the restraints 
 which a prevailing morality imposes; there are in the semin- 
 aries and public institutions the means of corruption; fourthly, 
 because, as a nation, the doctrines of religion have been aban- 
 doned. I speak not of a particular creed or form. That 
 which the bulk of the people, and especially the well-inform- 
 ed, have rejected, was sufficiently objectionable ; but the 
 evil consists in this, that none other, or better, has been sub- 
 stituted. With the superstitions and ritual of Catholicism, 
 they appear to have cast aside all reverence for things sacred, 
 and, in great part, the duties which such a reverence imposes. 
 Connected with this inquiry is the fact that in the north of 
 France, Catholicism has been nearly extirpated, and there 
 suicide and crime predominate ; south of the Loire, on the 
 contrary, it still retains a strong hold on the affections of the 
 people, and there suicide, and its sister crimes or maladies, 
 are comparatively rare. This affords a noble proof that the 
 
 * Guerry, Essai but la Statistique Morale de la France. Buhver, 
 France, Social and Literary. 
 
86 WHAT ARE THE STATISTICS OF INSANITY. 
 
 effects of Christianity, in whatever form and under whatever 
 circumstances, are peace and joy. 
 
 There is still another consideration connected with this 
 subject, as affording some hints, not how far, but with what 
 a suicidal lunatic may be trusted. M. Guerry attempts to 
 shew that every age has its favourite means of destruction ; 
 that in youth and old age suspension is resorted to, in mid- 
 dle age fire-arms. The pistol has its maximum, to use his 
 mode of expression, between thirty and forty, while the rope 
 rises progressively, and does not reach its maximum till from 
 fifty to sixty.* Professor Casper's tables prove that in Ger- 
 many, hanging is the most common mode adopted. Of 525, 
 234, nearly one-half, died in this manner, while not more 
 than nineteen effected their purpose by throwing themselves 
 from the window.-j- These two expedients are in conse- 
 quence of the present construction of our asylums, and of the 
 furniture they contain, by far too accessible to lunatics, 
 seeing that by building that part of the house destined for the 
 reception of this class of one story, and by making the bed- 
 pole incapable of supporting more than a few pounds weight, 
 all danger might be avoided. Esquirol corroborates the 
 conclusions of the authorities previously quoted. Of 198 
 female suicides, he states that forty-nine employed hanging 
 or strangulation, forty-five precipitation, and forly-eight ab- 
 stinence. This table presents still another mode by which 
 lunatics may baffle the wisest and most affectionate precau- 
 tions. Fortunately, however, in an asylum death from vo- 
 luntary starvation can rarely happen. The darker pages of 
 medical history exhibit horrible scenes of forcing food into 
 the throat, where teeth were broken, and. sometimes disloca- 
 tion of the jaw took place. Modern sagacity has discovered 
 
 * Guerry, Essai sur la Statistique Morale de la France. Quetelet, 
 Sur 1' Homme, t. ii. p. 1.55. 
 
 t Burrow's Commentaries, p. 447. 
 
WHAT ARE THE STATISTICS OF INSANITY. 87 
 
 many ways of overcoming such stern obstinacy of purpose, 
 few of which bear even the semblance of compulsion. M. 
 Guislain dissents from the opinion now given, and declares 
 that determined abstinence occurs in one-ninth of the insane, 
 and that in more than a thirtieth part of these it is insur- 
 mountable.* It is impossible to explain this fact, contra- 
 dicted as it is by the experience of every British practitioner, 
 otherwise than by referring it to some local peculiarity, to 
 the prevalence of an epidemic of religious monomania, or, 
 candidly, to some circumstance of which we are completely 
 ignorant. In order to obtain the best and most recent infor- 
 mation on a subject so important, I applied to the medical 
 officers of two institutions where the most enlightened treat- 
 ment prevails, and where regular records of the history of 
 every case are preserved. From Mr. Mackintosh of Dun- 
 dee Asylum, I learn, that among 650 patients admitted since 
 the commencement of that establishment, there does not ap- 
 pear to have been a single case of obstinate refusal to eat, 
 followed by gangrene ; or, to use the gentleman's own ex- 
 pressions, "any thing at all corroborative of what M. Guis- 
 lain has advanced." Sir W. Ellis writes me, that in Han- 
 well Asylum, where the daily average of patients is 611, 
 there have not occurred above twelve cases in the last six 
 years ; but that at Wakefield the proportion was about one 
 in forty. 
 
 Common observers passing through the parlours or work- 
 shops of a properly conducted asylum, astonished by the 
 decorum and business-like air of the scene, often make such 
 remarks as, these people cannot be deranged, why are they 
 not sent home ? Even those who ought to have been ac- 
 quainted with the real state of matters, have clamoured in a 
 similar strain, and arraigned the detention of individuals 
 whose deportment might appear to elicit such indiscriminat- 
 
 * Gazette Me'dicalc de Paris. Janvier, 1836. 
 
88 WHAT ARE THE STATISTICS OF INSANITY. 
 
 ing interference, as an act of gross oppression and barbarity. 
 The perspicacity of that mind must be very questionable 
 which cannot penetrate the thin veil of correct demeanour 
 which disguises the wandering thought, or wild passions of 
 the maniac. The tranquillity which reigns among the insane 
 is not deceptious, it is not the silence of fear, nor the specious 
 blandness of affectation ; but yet it must not be received as 
 revealing the healthy serenity of those hearts from which it 
 springs. Its sources are three : the} r are all pure and heal- 
 ing. It may flow from the incapacity of the mind to expe- 
 rience any other than present or animal enjoyment; from the 
 subsidence of the maniacal paroxysm, in other words, the 
 presence of a lucid interval ; and, lastly, from that calmness 
 which occupation and other modes of abstraction are intended 
 to produce, and which, when permanently established, ren- 
 ders all subsequent measures comparatively easy. But to 
 release patients in any of these states, would be to place them 
 in the very circumstances calculated above all others to 
 destroy this superficial peace, and agitate the mind in its 
 deepest recesses. There may be some difficulty in deciding 
 what shall be called a lucid interval, and how it shall be dis- 
 tinguished from the stage of convalescence. The experience 
 of all practical men is, that much more is lost than can pos- 
 sibly be gained by an early restoration to society, and their 
 advice accordingly is to subject a patient to as long a period 
 of trial and observation as may be consistent with justice. 
 The only guide to a correct judgment is the fact of the com- 
 plete disappearance of every symptom of nervous disease. 
 During a lucid interval there generally linger some aberra- 
 tion of thought, some bodily disturbance. During conva- 
 lescence, no irregularity of function can be detected. Re- 
 lapses have been separated from recurrences of insanity : the 
 former being limited to all new attacks which occur within 
 three months after recovery ; the latter including all at more 
 distant periods. The distinction maybe scientifically just; 
 
 
WHAT ARE THE STATISTICS OF INSANITY. 89 
 
 but it is not practically useful. For, if whenever a patient 
 is brought into contact with the world, and the rude shocks 
 which the current of its affairs inflicts upon delicate and re- 
 tiring natures, an overthrow of reason ensues, it is of very 
 little importance what the duration of the interval may have 
 been ; as, whether of three or twelve months, the re-appear- 
 ance of the insanity in the same form, and from a similar 
 cause, cannot be regarded in any other light than as a re- 
 lapse. I have known patients continue perfectly sane for 
 ten or twelve months, and then fall into the most ungovern- 
 able paroxysm of mania on certain emotions being called 
 up, and whose sanity thus depended upon the discretion of 
 those around. There are indeed many individuals who are 
 comparatively or entirely sane when under the guardianship 
 of an asylum, who would become furious or melancholic if 
 compelled to mingle in a busier and more exciting scene, and 
 to bear the burden of an active life. 
 
 The Parisian registers furnish some very interesting facts 
 on this subject. From them it appears that the relapses are 
 to the admissions as four to one hundred, and that the re- 
 lapses to the cures in both sexes are as twelve to one hun- 
 dred. But on examining the proportion in the sexes sepa- 
 rately it is found to be twenty per cent, in males, and only 
 ten per cent, in females. What is the cause of such a dis- 
 parity ? it may be asked. The explanation seems to strength- 
 en the views I have adopted. " The medium residence," I 
 quote Burrows, " of each man discharged cured is four 
 months and fifteen days : that of each woman discharged 
 cured nine months and twenty-five days." Now this proves 
 most incontestibly either that the removal of the disease is 
 more difficult in women than in men, which is preposterous, 
 or that the longer the influence of good treatment is continu- 
 ed the greater will be the security of the individual. Assur- 
 edly it is purchasing an immunity from madness at a cheap 
 rate to reside for a short time with friends whose reputation 
 
90 WHAT ARE THE STATISTICS OF INSANITY. 
 
 is, to a certain degree, interwoven with the health of their 
 charge, and under a roof which, while it may remind of the 
 childishness or frenzy of alienation, cannot fail to be endear- 
 ed by recollections of the return of intelligence and feeling, 
 of the rising and renewed glory of the sun of reason from the 
 darkness of despair. To give any practicability or usefulness 
 to this suggestion, steps must first be taken to assimilate asy- 
 lums to the homes to which patients are desirous and are 
 destined to return. They must have within themselves temp- 
 tations to induce a protracted residence which it might be 
 hurtful to extort. They must become boarding houses of the 
 best description, where medical attendance and moral train- 
 ing shall be as unremitting as during the acute stage of the 
 disease ; and where there shall exist certain outlets, channels 
 of communication with the external world, through which 
 old impressions may be gradually revived ; old friends reun- 
 ited, and the resumption of former habits and pursuits safely 
 accomplished. 
 
 Complete isolation is as pernicious to the curable insane 
 as to the sane. The experience derived from the American 
 prisons and penitentiaries proves that the mind, when totally 
 deprived of the stimulus afforded by social intercourse and 
 occupation, gives way, and fury and fatuity succeed. Is this 
 result at all allied, or more closely than by analogy, to the 
 breaking up of the constitution, observed in the suddenly 
 reclaimed drunkard ? I have tried the experiment of com- 
 plete isolation. The effect was tremendous. A noisy and 
 ferocious maniac was in the course of a few weeks altogether 
 subdued, even his diseased energies seemed to be prostrated 
 by their own unrestrained violence ; but at the same time 
 the mind was enfeebled by the deprivation of every impres- 
 sion from without, and I for some time trembled lest the cure 
 of furious mania should prove to be fatuity. To the incur- 
 able and dangerous insane, whose alienation admits of no al- 
 teration from companionship or external nature, who live 
 
WHAT ARE THE STATISTICS OF INSANITY. 91 
 
 within themselves, solitary confinement is neither injurious 
 nor irksome. 
 
 The number of cases is very small which would not be 
 benefited by modified isolation, or rather by separation from 
 the places, and persons, and impressions, causing or connect- 
 ed with the origin of the disease. Were all asylums proper- 
 ly conducted ; were they what they ought to be, and pretend 
 to be, hospitals adapted for all forms of mental alienation ; 
 then all forms would be alleviated by this mode of treatment. 
 
 From mistaken kindness or an erroneous estimate of the 
 soothing and curative powers of friendship and affection, a 
 trial is frequently recommended to be made at home. Seve- 
 ral months after the incursion of the complaint are thus 
 spent in an experiment, in hoping, in grieving over the gra- 
 dual extinction of the noblest attributes of mind, but in doing 
 nothing. The man who would recommend a patient labouring 
 under inflammation of the lungs to try the effects of the kind 
 attentions of his relations, water-gruel, and the nurse's phar- 
 macopoeia, would be reprobated as an ignorant fool. The 
 man who gives similar advice to a patient labouring under 
 inflammation of the brain, or diseased action closely resem- 
 bling it, scarcely deserves to escape from similar reprobation. 
 From this advice being followed, it is comparatively rare for 
 the superintendents of public asylums to have recent cases 
 submitted to their care. Of one hundred and forty-nine pa- 
 tients admitted to the Retreat, at York, in the course of fif- 
 teen years, only sixty-one were recent cases.* 
 
 The chances of cure are consequently diminished, unjust 
 conclusions are drawn as to the curability of the disease, and 
 the real advantages of judicious treatment rendered abortive. 
 The reasons why we are more successful in cases of short 
 standing are very obvious. After the agitation consequent 
 on a sudden separation from society has subsided, or the 
 acute stage of mania has been mitigated, there are the for- 
 
 * Tuke's Description of Retreat, p. 201. 
 
y^ WHAT ARE THE STATISTICS OP INSANITY. 
 
 mer habits of the patient still imprinted vividly on the mind, 
 and arising more naturally to recollection than new combi- 
 nations of thought ; there is the languor of idleness, the crav- 
 ing for variety ; there is the instructive desire to escape from 
 self, and the equally instructive suggestions of making the 
 hands work instead of the head to effect this escape : there 
 are all these and many more conditions to be worked upon 
 which do not exist, or do not exist to the same extent at any 
 subsequent period. The mind is then more alive to the sti- 
 mulus of emulation, rewards, punishments, and threats. I 
 have not alluded to the paramount, that is, the physiological 
 reasons for early treatment. 
 
 In the application of labour as a remedy, it is of impor- 
 tance to know what number of patients may be expected to 
 co-operate, and should it be suited to their condition, to work 
 out their own cure. By using the proper incentives ninety 
 out of every hundred recent cases may be induced to do this, 
 provided there exist no physical disability, such as palsy, to 
 prevent the attempt. Even in old cases where the mind and the 
 muscles have been allowed to slumber, or to struggle in the 
 restlessness of pain for twenty years, wonderful transforma- 
 tions may be accomplished ; and so potent and infectious is 
 imitation, so exquisite is the pleasure of being roused to ac- 
 tivity, and of being tranquillized by having a specific objecl 
 to action presented, that two-thirds of those affected may be 
 employed, and the hoary headed lunatic who has dreamed 
 away a quarter of a century may be converted into a busy ; 
 bustling, and highly useful personage. It appears from the 
 report of Sir W. Ellis, that of 610 patients in the asylum al 
 Hanwellduring 1836,431 were constantly employed. In Dun- 
 dee asylum, during the year 1834-35, ninety-two of ninety-sis 
 paupers Were engaged in various branches of industry, from 
 picking oakum and mending shoes up to flowering muslin and 
 upholstery work. The Richmond asylum has one half, or 13C 
 out of 377 constantly contributing to the support of the in- 
 
WHAT ARE THE STATISTICS OF INSANITY. 93 
 
 stitution and to their own restoration. In that establish- 
 ment another principle, that of tuition, is directed against 
 insanity. Twelve of the 130 were learning to read, This 
 noble and most philosophical attempt to build the mind anew 
 on the ruins of outraged feeling, or enfeebled judgment, or 
 whatever may be the form of the injury sustained, by con- 
 veying new ideas to the perceptive powers, and by calling 
 up, by means of education, faculties which were previously 
 unknown or dormant, and which may prove to be healthy 
 or antagonist to those diseased — has been made elsewhere ; 
 and on a more extended scale, patients have been instructed 
 in the rudiments of science, in drawing, music, have been 
 taught weaving, shoe-mending, and other common arts, and 
 have been even tempted to participate in the representation 
 of comedies.* The fact is so evident that the mind must be 
 relieved from sorrow or any other painful impression by dis- 
 traction that the humanity of resorting to occupation for this 
 purpose is universally admitted. But it may not follow that 
 because the mind is relieved from pain it is consequently 
 placed in the best condition to recover ; in other words, does 
 employment promote cure ? The presumption that it is 
 capable of doing so is founded upon a very familiar precau- 
 tion. We do not use a leg or an arm that has been bruised 
 or wounded or is inflamed ; we endeavour to save it from 
 exertion, and allow it rest by employing the other. In pre- 
 scribing occupation then to the insane, it is proposed to en- 
 gage the healthy, the unwounded powers and thereby to save 
 those which are pained or diseased, and would be injured by 
 exertion. If a man, who imagines himself an outcast from 
 society, the object of contempt and scorn, be placed at a 
 loom., and induced to produce ten or fifteen yards of cloth per 
 day, it is quite clear, that during the execution of his task, if 
 
 * Wendt's Account of Asylums in North of Europe ; quoted in 
 Pritchard. Annales d'Hygiene ; Juillet, 1836. 
 
94 WHAT ARE THE STATISTICS OF INSANITT. 
 
 it be done well, he is forced to exert his whole attention and 
 no little ingenuity and manual dexterity upon the manag- 
 ment of the shuttle, beam, &c., that while his mind is so di- 
 rected, it cannot be under the dominion of its morbid sor- 
 rows ; that just in proportion to the degree and duration of 
 the occupation will be the freedom from disease and the 
 nearer approach to health. 
 
 But there are other objects than abstraction gained by this 
 system. It gives a regularity to the mental operations, than 
 which nothing can be more conducive to tranquillity : it 
 imposes the necessity of self-command and attention, it 
 communicates new series of impressions, and if judiciously 
 managed, it may be made, by giving tone and vigour to the 
 body, to react on the mind, in the same manner that eva- 
 cuants, opiates, or tonics do. It cannot then be immaterial 
 what the nature of the employment is which may be recom- 
 mended. In the selection, let the object be to combine as 
 many of the objects here specified as possible. It is not 
 enough to have the insane playing the part of busy automa- 
 tons, or to wear out their muscular energies vicariously, in 
 order to relieve the drooping heart of its load. There must 
 be an active, and, if possible, an intelligent and willing par- 
 ticipation on the part of the labourer, and such a portion of 
 interest, amusement, and mental exertion associated with the 
 labour, that neither lassitude nor fatigue may follow. The 
 more elevated, the more useful the description of occupation 
 provided then, the better. It ought not to be complicated, 
 for that would discourage : it ought not to be purely me- 
 chanical, for that frustrates the end in view : it ought not to 
 be useless and evidently for the purpose of acting as a 
 means of abstraction, for the artifice is often detected, and 
 the patient is disgusted. The utility of every thing ordered 
 should be palpable ; and this argument holds out another in- 
 ducement to engage every individual in the pursuits to which 
 he has been accustomed. Pinel mentions the case of a mad 
 
WHAT ARE THE STATISTICS OF INSANITY. 95 
 
 watchmaker, who spent many months in experiments on the 
 perpetual motion. He, of course, failed to solve the problem, 
 but regained his reason in the attempt. With a view to se- 
 cure the benefit of exercise in the open air, as well as mental 
 concentration, field-labour has been much resorted to, and 
 asylums have been surrounded by farms, and parks, and gar- 
 dens. The plan is unexceptionable, and whereverit can be car- 
 ried into effect, will promote the restoration of those engaged. 
 But however excellent in certain circumstances, it is quite 
 clear that its application must be partial, that it can only take 
 place during particular seasons of the year, and can include 
 a very small class of lunatics admitted into urban asylums. 
 Military exercise has been substituted in some countries; and 
 however ridiculous it may at first appear, that a battalion of 
 lunatics should perform the evolutions of a well-disciplined 
 corps, the moral result has justified the expedient. I confess 
 to have seen the drill-sergeant work miracles. But even 
 here fine weather is required for the daily drill ; and what 
 we are in search of is some employment which shall be ac- 
 cessible and in constant operation, altogether independently 
 of climate, or any accessory circumstance. The best rule is 
 to have all descriptions of occupation at command ; and 
 where a sedentary one is chosen, or preferable, to suggest 
 walking or swinging as a recreation and interruption, or to 
 devise means that the necessary amount of exercise be taken. 
 Wherever people of education are confined, a thousand ex- 
 pedients may be adopted to occupy and amuse. But as ar- 
 tisans and tradesmen furnish, and must always furnish, the 
 greatest proportion of the insane poor, all, or at least the 
 principal arrangements should be adapted to their wants, 
 and for their benefit. Whatever the staple trade of the dis- 
 trict, its implements, or the means by which it is carried on, 
 should be found in the asylum ; and not only this, but every 
 reasonable provision for engaging those workmen, who must 
 lie members of every community, and be found in every dis- 
 
96 WHAT ARE THE STATISTICS OP INSANITY. 
 
 trict. Weavers, shoemakers, tailors, gardeners, carpenters, 
 watchmakers, have all been tried for years, and found to 
 work as diligently, and to produce as good articles when 
 confined as when at liberty. I cannot indeed see, nor admit, 
 any limit to the application of the principle. 
 
 But conceding its practicability, it may be demanded, is 
 it safe ? Can the maniac be intrusted with instruments of 
 the most dangerous, and, if he should so incline, deadly kind ; 
 which, wielded by the tremendous force that he is well known 
 occasionally to possess, would enable him to sacrifice all 
 around, and then destroy himself? If there be any superiority 
 in the modern mode of studying the dispositions of the in- 
 sane, it consists in the power of discriminating those who 
 may be allowed to be set free from those who would abuse 
 liberty, and those who may be allowed with impunity to use 
 .knives, hatchets, &c. in their ordinary calling, from those 
 who may not. No man, unless mad, would place a knife in 
 the hands of a patient of whose character he was ignorant, 
 or whose character for revenge and cruelty he knew. But 
 nine-tenths of madmen are neither habitually malicious nor 
 furious ; and if they satisfactorily pass the ordeal of such ex- 
 amination as it is in the power of every man acquainted with 
 the human mind to institute, it would be egregious folly to 
 debar them from a privilege which may contribute to their 
 happiness, and cannot, in ninety cases out of a hundred, in- 
 terfere with the happiness or safety of others. In the Rich- 
 mond Hospital, where 130 individuals are constantly pos- 
 sessed of cutting instruments and other objects which could 
 be readily converted into weapons of destruction, no acci- 
 dent has ever occurred. Murders are sometimes perpetrated 
 in asylums ; but far more rarely than among the sane in- 
 habitants of the world ; and in almost all cases where such 
 misfortunes happened, they have been traced to one of two 
 causes, either to the intemperate language and brutal con- 
 duct of a keeper, or to the improper classification of the pa- 
 
WHAT ARE THE STATISTICS OF INSAITY. 97 
 
 patients. At Sonnenstein no accident is recorded. Sir W. 
 Ellis has pursued this plan first at Wakefield, latterly at Han- 
 well, in the treatment of several thousand patients, and his 
 courage, confidence, and discernment, have been justified 
 throughout. With the limitations mentioned, indeed, there 
 is no respectable establishment where employment, in its 
 widest sense, is not considered the grand specific, and every 
 successive improvement grounded upon its extension. 
 
 Possessed then, of such accurate knowledge of all that is 
 to be dreaded and all that is to be hoped in the treatment of 
 the insane, it remains to be inquired, have the arrangements 
 made to effect the great end in view been founded upon this 
 knowledge ? have they been in accordance with the laws of 
 the human mind, and the precepts "love mercy, do justly ?" 
 or have they sprung from the less noble sources, ignorance, 
 indifference, selfish interests ? To this inquiry the next lec- 
 ture is devoted. 
 
LECTURE III. 
 
 WHAT ASYLUMS WERE. 
 
 Character of System pursued previous to 1815 — St. Vincent de Paul — . 
 Insane consigned to Monks — Lunatics set at large to beg — Lunatics 
 in Gaols, in Cages, in Caves, in Dungeons. — Associating of Lunatics 
 with Criminals — Modes of quieting Lunatics — "Muffling" — Modes 
 of feeding Lunatics — "Forcing" — Death from this process — Lunatics 
 in Hospitals — Four or five sleep in one bed — Confined in Venereal 
 Wards — Lunatics in Workhouses — Want of Medical attendance, 
 classification, comfort, and cleanliness in these establishments — Sale 
 of Idiot children — Madhouses at Venice, Nantes — Confinement of 
 sane individuals — Carelessness of Medical men in granting certifi- 
 cates^ULJnusual modes of coercing the Insane — Coercion required for 
 the poor, but not for the rich — Coercion resorted to as economical — 
 Lunatics exhibited for a sum of money ; excited and induced to gorge 
 themselves with food, or filth, for the amusement of visitors — Gan- 
 grene of extremities from cold — Insufficient supply of food, of cloth- 
 ing — No medical or moral treatment — Superintendence confided to 
 ignorant and dissolute keepers — Terror as a remedy — Cruelty and im- 
 morality of servants — No separation of sexes — Unhealthy cells — Con- 
 cealment of mortality — Deaths from fury of keepers and patients — 
 Records burned to frustrate inquiry, &c. — A visit to Asylums as they 
 were. 
 
 There exists no wish in my mind, as ma^^ be supposed 
 from the details contained in this lecture, to produce a false 
 impression in order to excite a strong feeling of sympathy in 
 the fate and fortunes of those whom I regard as my clients. 
 Their sufferings are, unfortunately, so numerous and so cla- 
 mant as scarcely to admit of exaggeration. But it is my 
 wish to tell the whole truth, and to expedite the cause of 
 
WHAT Ao^UMS \F£RE. »» 
 
 humanity, although the sensitive may be shocked, or the 
 fastidious disgusted by the recital, although even the real 
 philanthropist should be conscience-stricken that his energies 
 have been expended on miseries less poignant and pressing, 
 and on objects of compassion less worthy. 
 
 What then were formerly the provisions for the cure of 
 the varieties of lunacy, and for the various classes of luna- 
 tics which have been considered ? u Nos peres n'ont pas ren- 
 verse," says a French writer in 1833, " toutes les Bastilles." 
 The atrocities which have been perpetrated within these bas- 
 tiles, deridingly called asylums, under the pretence, and, in 
 some cases, it is possible, at the dictation of benevolence, and 
 under the sanction of science, are too little known to the pub- 
 lic. Although belonging to the past, and generally repudi- 
 ated at the time by those who from ignorance, or some less 
 excusable cause, tolerated their continuance, they require to 
 be exposed in order to accelerate as much as possible the 
 progressive improvement, which shall destroy every lingering 
 remnant of the system from which they sprung, every trace 
 of their existence and influence. 
 
 It may appear presumptuous that I should volunteer to 
 preach a crusade in this cause : but he who moved and led 
 the whole Christian world in the first crusade, was nearly as 
 humble an individual as your lecturer, and certainly not more 
 sincere. My only justification, if any be required, is, that 
 my professional studies and pursuits have rendered me fa- 
 miliar with the principles upon which institutions for the 
 cure or reception of the insane have been, in contradistinc- 
 tion to those on which they ought to have been conducted. 
 I am likewise actuated by the desire to show, that practi- 
 cal men have been unjustly regarded as inimical to the 
 changes which the theoretical have proposed. At present 
 reference shall be made only to some of the errors, absurdi- 
 ties, and atrocities of the old system, as they obtained pre- 
 vious to the year 1815. Buried in those valuable though 
 
100 WHAT ASYLUMS WERE. 
 
 little valued monuments of legislative industry and wisdom? 
 Parliamentary Reports, or scattered through periodicals or 
 other works nearly as ephemeral, the facts upon which this 
 exposition will proceed, rarely if ever meet the eye of the 
 general observer or philosopher. As an indication of the 
 better spirit which now prevails they will appear scarcely 
 credible. But though the characters be written in blood, 
 the accuracy of the tale they tell cannot be questioned. 
 
 Until the noble efforts of St. Vincent de Paul were crowned 
 with success, the madman was, on the continent of Europe, 
 either expelled from society as an outcast unworthy of 
 care or compassion, or burnt as a sorcerer unworthy even 
 of those rude forms of justice which then prevailed. This 
 pious man was a divine, and is now a saint of the Catholic 
 church. If canonization ever was justifiable or excusable, 
 it Was in this instance. St. Vincent sacrificed every thing 
 for these outcasts : he journeyed from land to land to preach 
 and propagate the cause of charity : his mission was to 
 bring back the sympathies of our nature to their proper 
 channels, to proclaim that the darkened mind was as much 
 the visitation of God as the darkened vision, and that Chris- 
 tianity demanded of the humane and virtuous and powerful 
 to protect, and the skilful to relieve, the one as well as the 
 other. The hearts of nations responded to his call. He 
 became the emancipator of the diseased, the reviled and per- 
 secuted, during all succeeding ages. Of the same type and 
 mould as La Rochefoucauld and Howard, he worthily obtain- 
 ed the glorious epitaph, " The father of the poor, the stew- 
 ard of Providence." May the spirit and enthusiasm which 
 actuated, him be ever present to those who are now intrust- 
 ed with the good work which he commenced ! He was at 
 the time of his labours a monk, and from this circumstance 
 perhaps, or because these recluses were then the principal 
 depositaries of all knowledge, scientific as well as religious, 
 in the countries to which his exertions were confined, to 
 
WHAT ASYLUMS WERE. 101 
 
 monks was the care of the insane confided. For nearly two 
 centuries they discharged this trust ; — how ignorantly and 
 barbarously, may be judged from the treatment stated to have 
 been pursued in a monastic establishment in the south of 
 France. There every lunatic regularly received ten lashes 
 per day. To ascetics, however, who, themselves, shrunk 
 from neither lash nor torture, this regimen might appear 
 both beneficial and reasonable. Convents were, until the 
 Revolution, the only receptacles for the insane in France : 
 in Britain asylums existed at an earlier period. But of what 
 kind? 
 
 The reign of humanity in Bedlam commenced only about 
 twenty years ago. Before that period the lunatic might be 
 truly said to live under a reign of terror. Immured in a 
 wretched and comfortless prison-house, and left to linger 
 out a lifetime of misery, without any rational attempt at 
 treatment, without employment, without a glimpse of happi- 
 ness, or a hope of liberation, he was terrified or starved into 
 submission, lashed, laughed at, despised, forgotten. The 
 great objects were — confine, conceal. Protect society from 
 his ferocity : protect his sensitive friends from the humiliat- 
 ing spectacle of such a connexion. Regarded as wild beasts, 
 all maniacs indiscriminately were treated as such ; nay, the 
 imprisoned tiger enjoys a milder fate, for his keepers have 
 an interest in his health and preservation. That this is a 
 mitigated rather than an exaggerated summary of horrors, 
 will presently appear. Until very recently, such lunatics as 
 could not with safety be suffered to roam at large, were con- 
 fined in common prisons. Parliamentary returns prove, that 
 a few years ago, there were in Scotland, at least a thousand 
 lunatics at large, and consequently denied all provision for 
 their recovery. It is not a little illustrative of the utter in- 
 adequacy of the establishments formerly appropriated to the 
 insane to the end proposed, and of the crude, or cruel views 
 which were entertained of the nature of their disease, that 
 
102 WHAT ASYLUMS WERE. 
 
 it was either necessary or customary to discharge from Beth- 
 lem a number of lunatics, who, with a dress and manners as 
 grotesque as their delusions, wandered from house to house 
 and town to town, a sort of privileged paupers, long known 
 as Tom o' Bedlams, living no one cared how, and dying no 
 one cared where.* This hospital-delivery occurred, of 
 course, at a remote period, and was resorted to for the pur- 
 pose of relieving the institution of the burden of maintain- 
 ing a set of incurable madmen. 
 
 If those who were east into gaols were docile and inoffen- 
 sive, they were permitted to mingle with their fellow-cap- 
 tives and become their butt : if noisy or furious, they were, 
 of course, condemned to the deepest and darkest dungeon 
 which the house afforded, and never visited by a medical 
 man except when afflicted with some disease superadded to 
 their alienation, if even then. In Ghent the intractable 
 were inclosed in wooden boxes or cages. Strange to say, 
 at Eberbach, where considerable advancement seems to 
 have been made in classifying patients, a large iron cage is 
 still constantly used for confining the refractory and dan- 
 gerous.f At Strasburg these dens were only four feet wide 
 and six feet in height. Through the spars was tossed the 
 litter upon which the half naked maniac reposed : food was 
 conveyed to him in the same manner ; and from the ribald 
 jest, or harsh commands of the attendants, he had no pro- 
 tection ; he was indulged in neither darkness nor solitude ; 
 his tormentors were ever before him. But even here misery 
 had not reached its maximum. At Mareville the cages 
 containing the patients were placed in cellars : at Lille they 
 were confined in what are styled subterranean holes : at 
 Saumur they inhabited cells without windows, and were 
 
 * D'Israeli. Curiosities of Literature. First series. Vol. iii. p. 354. 
 t Bubbles from the Brunnens of Nassau, p. 290. 
 
WHAT ASYLUMS WERE. 103 
 
 provided with wooden troughs filled with oak bark as beds.* 
 Revolting as these disclosures are, 1 feel myself bound to 
 make them, in order to show from what a degrading state of 
 ignorance and brutality we have escaped, and from what 
 complicated misfortunes the objects of our care have been 
 rescued by the diffusion of knowledge. These examples 
 were not peculiar to any country. They have been select- 
 ed merely because they are the best authenticated. But to 
 what place and to what period would you conclude the fol- 
 lowing description to apply. "On visiting the gaol of , 
 
 a high legal functionary found that the gaoler was absent at 
 work, and being sent for, declined to attend. There was a 
 vault in the gaol in which a maniac was kept, who, twenty 
 years ago, had been sentenced to imprisonment for life for 
 killing a man. The individual who attended broke the key 
 in attempting to open the door of this vault ; but enough 
 was seen to show, that the place in which the miserable man 
 was kept, was of the most wretched description."-]- This 
 memorable visit was paid in 1834 : the prison is in our own 
 free and enlightened land, the legal officer was the Solicitor 
 General, and my authority is Mr. A. E. Menteith, univer- 
 sally known for his probity and piety. Now, who will dare 
 to assert, that this miserable creature, this homicidal maniac, 
 who, in some paroxysm of frenzy, perhaps unconsciously, 
 had imbrued his hands in blood, retained, during the long 
 period of his confinement, the same sanguinary ferocity 
 which had prompted to the crime : who dare assert, that if, 
 in place of being chained in a subterranean dungeon for half 
 a lifetime, he had been placed in favourable circumstances, 
 a period of tranquillity and serenity, and even of sanity, 
 
 • Esquirol. Diet, des Sciences Med. art. " Maisons des Alienes." 
 Sc. Pinel. Traite Complet du Regime Sanitaire des Alienes, p. 64. 
 
 •f- Speech delivered by Alex. E. Menteith, Esq. advocate, at the 
 First Annual Meeting of the Prison Discipline Society of Scotland, 
 Edin. 1836. 
 
- 
 
 ] 04 WHAT ASYLUMS WERE. 
 
 might not have arrived, when a feeling of responsibility and 
 repentance might have given at once strength and humility to 
 the mind, and formed the commencement of a life of useful 
 industry and virtuous contentment. None of these antici- 
 pated results might have followed a more lenient and rational 
 treatment in this case ; but the gravamen of the charge, the 
 .matter for deep regret is, that any human being, labouring 
 under mental disease, should be abandoned, without an 
 attempt at cure or alleviation, to the custody of a coarse and 
 negligent turnkey, and condemned to endure privations to 
 which the household dog is never exposed. " The accom- 
 modation for the insane," says Mr. Rice, " in the Limerick 
 Asylum, appears to be such, as we should not appropriate 
 for our dog-kennels."* The civil authorities had formerly 
 no alternative but to confine the pauper lunatics of the dis- 
 trict in the nearest gaol, or lock-up house. The evils of such 
 a procedure were even greater than that which has been dis- 
 cussed. There then existed, as there now, I believe, exists, 
 no classification among the prisoners ; and the lunatics, if 
 calm and obedient, were forced to associate with all who 
 might be placed in the common room. The unfeeling taunts 
 of the heartless and debased criminals were the least promi- 
 nent of these evils : such callous persecution could inflict but 
 momentary pain, could but aggravate the disease ; but to 
 minds naturally weak, enfeebled by excitement, or recover- 
 ing from derangement, the constant and friendly intercourse 
 of such polluted companions must have proved doubly de- 
 trimental, by corrupting every virtuous disposition and over- 
 throwing every principle of religion. The man who was 
 cast into prison a moping fool, ran the risk of being dis- 
 charged a reckless villain. But in these moral lazar-houses 
 the witless noise of the maniac was often found to be inimi- 
 cal to the repose of the other inmates, and how, will it be 
 
 * Report from the Select Committee on the Lunatic Poor in Ire- 
 land, &c. 1817, p. 14. 
 
WHAT ASYLUMS WERE. 105 
 
 supposed, were they soothed to sleep and silence ? Intimi- 
 dation is not, it was discovered, an infallible remedy in 
 mental medicine ; it will occasionally defeat its own object 
 and convert irritation and discontent into absolute fury and 
 despair. But cruelty is ingenious, and these practitioners 
 adopted the alternative of bleeding their patients to debility, 
 or drugging them with opiates. A less refined mode of 
 obtaining tranquillity was sometimes resorted to in mad- 
 houses, designated, in the revolting slang of its inventors, 
 " muffling" — which consisted in binding a cloth tightly over 
 the mouth and nostrils, or, as a person who had witnessed 
 its application graphically describes it, " tying a bit of sheet 
 or something round the nose to stun the noise, to see if it 
 would quiet them.""' Connected with this infamous custom 
 was another called " forcing." Patients often refuse to take 
 food. They suspect it to be poisoned : they imagine it to be 
 unwholesome, or to be human flesh : they conceive that 
 they are commanded by an angel to refrain from gratifying 
 their appetite ; or, finally, from obstinacy and perversity of 
 character, they resist all solicitations to eat. They were, in 
 times gone by, believed to be inaccessible to reasoning or 
 persuasion, and no such means were adopted to overcome 
 their resolution. Strength of arm was then the remedy for 
 all difficulties. And the struggling victim was bound down 
 on a bed, the teeth forced asunder, and the dreaded sub- 
 stance pushed or poured down the throat. Occasionally 
 teeth were broken or pulled from their sockets, and we hear 
 of the handle of a spoon — this was the instrument generally 
 selected for the operation — being forced through the palate 
 during the contest ; but these consequences were looked 
 upon as trifles.f They were in reality so when compared 
 
 • First Report of Minutes of Evidence from Committee on Mad- 
 houses, 1816, p. 30. 
 
 f First Report of Minutes of Evidence from Committee on Mad- 
 houses, 1816, p. 2, and 80. 
 
106 WHAT ASYLUMS WERE. 
 
 with what frequently ensued. To facilitate the descent of 
 the food, the head was unavoidably bent backwards and 
 placed in so unnatural and dangerous a position, that any 
 sudden or powerful movement on the part of the patient 
 rendered dislocation of the vertebrae almost unavoidable. 
 When the throat was strongly grasped in this attempt, suffo- 
 cation may have taken place, but the instantaneous death of 
 some of the victims, whose history is recorded, would lead 
 to the belief, that pressure on the spinal marrow had been 
 the cause. What adds to the horror with which we must 
 regard the practice, adopted although it may have been from 
 a mistaken compassion, is, that it was not resorted to in 
 desperate cases only, when long continued fasting, debility, 
 and the prospect of death from inanition might justify or 
 palliate such violence, but whenever a single meal was re- 
 fused. The tyrants would permit neither the stomach nor 
 the mind to be refractory. A female in a private Asylum 
 expressed her unwillingness to eat : she was immediately 
 forced, and is said to have died under the hands of the keeper. 
 Four or five times a-day would the same practice be had re- 
 course to, and if any disaster occurred, there appears to have 
 been no troublesome friends or coroner's inquest to tell the 
 tale. The following event is said to have taken place in the 
 same establishment, and will exemplify both the cruelty and 
 indifference displayed by all concerned in such proceedings. 
 A gentleman refused his food : the keeper forces, from no 
 revengeful inhumanity perhaps, but still he forces him to 
 take it, the patient calls for assistance in the piteous words, 
 
 " For God's sake, Mr. , come and help me, or I shall 
 
 be killed by this man." No entreaties either on the part of 
 
 the sufferer, or the other servants, could induce Mr. , 
 
 who was seated in an adjoining room and within hearing of 
 the scuffle, to interfere. All becomes suddenly still : the 
 
 keeper quietly reports to Mr. , that the gentleman 
 
 went off in a fit during the act of forcing, and no further 
 
WHAT ASYLUMS WERE. 107 
 
 notice is taken of the matter.* The truth of these state- 
 ments was denied at the time by the persons implicated. 
 Could it be otherwise ? I cannot say, strongly as I desire 
 to disbelieve such a charge, that the evidence adduced of the 
 inaccuracy of the details, or of the vindictive bias of the ac- 
 cusers, is by any means satisfactory or conclusive. But my 
 accusation is not levelled against these or any other parties, 
 but against the practice. Exonerating those in whose hands 
 such distressing accidents happened, from all cool, deliber- 
 ate cruelty, or even disregard for the lives of those committ- 
 ed to their care : and even admitting that the particular 
 instances cited may have been exaggerated : yet, is it no 
 less true, that interference of the nature here described is 
 generally an uncalled-for exercise of authority, is always 
 attended with severe suffering and some danger, and cannot 
 be regarded in any other aspect than as the most cruel alter- 
 native which the duty of a curator of the insane can force 
 him to adopt. Nor is it to be concealed, that such means of 
 administering food were in many respectable asylums con- 
 ceived to be indispensable, and that injuries were inflicted 
 where no blame was attachable except to the abominable 
 custom itself. " It is the general practice in all houses I have 
 visited," says a medical witness before the Committee of the 
 House of Commons.f 
 
 Hospitals were sometimes preferred to prisons abroad, and 
 that at a time when they deserved to be regarded rather as 
 places for the concentration and aggravation, than for the 
 relief of disease : when four, five, or more individuals slept in 
 the same bed, and cleanliness and ventilation were treated 
 as vain mockeries. J In the Hotel Dieu of Paris, previous 
 to the conversion of a part of Salpetriere into an hospital for 
 the reception of the curable insane, lunatics in whatever 
 
 * First Report of Committee, &c. 1816, p. 86. 
 •f First Report of Committee, &c. 1816, p. 5. 
 ± Diet, des Sciences Med. art. " Maisons des Alienes." 
 
108 WHAT ASYLUMS WERE. 
 
 stage, and presenting whatever features of mental derange- 
 ment, were confined in a hall adjoining the fever-ward, which 
 contained beds for four persons, and two small beds ; this 
 accommodation being intended for forty-two patients. In- 
 dividuals affected with hydrophobia were classed with the 
 insane and placed in the same apartment.* A similar disre- 
 gard to personal cleanliness and comfort, and to those laws 
 which regulate both the preservation of health and the pro- 
 gress of disease, appears to have crept into some of the es- 
 tablishments in this country at a comparatively recent period. 
 The Inspector of Naval Hospitals found, in one house where 
 insane officers and seamen are received, " in a ninth bed- 
 room three officers, one of whom was totally insensible to 
 the calls of nature, and slept in a double cradle with an offi- 
 cer who was cleanly in his habits. I found three officers in 
 a tenth apartment, containing pauper patients : a private 
 seaman slept in a double cradle with one of these officers."f 
 I believe that a partition of some kind divided these cradles 
 into two resting places. Again, the Commissioners for re- 
 gulating Madhouses affirm, that in one place they found 
 «.' not less than twenty persons ill of fever : a young girl 
 was in the same bed with a woman who was dying : some 
 women were lying on the floor, and others at different ends 
 of the same bed.";); Even one of the Commissioners of 
 Madhouses makes this singular admission. " It is a wrong 
 thing, but it cannot be expected that a man who pays only 
 ten shillings a-week should have a separate bed." So re- 
 cently as 1788, Iberti conceived it necessary to justify the 
 propriety of separating lunatics from the other patients in a 
 public hospital, and of placing them in distinct wards; he did 
 not venture to propose to place them in distinct buildings. 
 Asylums existed in England at the time he wrote, and ap- 
 
 * Tenon. Memoires sur les Hopitaux de Paris, p. 214>. 
 
 •»• First Report of Committee, &c. 1816, p. 25. 
 
 | Fourth Report of Committee, &c, 1815, p. 191. 
 
WHAT ASYLUMS WERE. 
 
 J09 
 
 pear, as may be supposed, to have been much more success- 
 ful in alleviating insanity than the continental receptacles* 
 Iberti modestly suggests that this success can easily be ex- 
 plained by attending to the eccentricity which distinguishes 
 the manners of Englishmen ; and, of course, by drawing the 
 obvious inference, that there exists but little difference be- 
 tween the sanity of those who are confined in asylums and of 
 those who are left at large.* Until the erection of a separ- 
 ate building, lunatics were placed in the Edinburgh Infir- 
 mary, where twelve cells were set apart for their exclusive 
 use, a measure which placed the sick at the mercy of the 
 insensate, and exposed the insensate to all the dangers of 
 contagion ; and which rendered all attempts to cure mental 
 disease ridiculous and impracticable, or if practicable, alto- 
 gether nugatory .f In 1818, the same practice wa3 pursued 
 at Lyons, and on principles still more objectionable. There 
 the lunatic was not permitted to associate with all the in- 
 mates indiscriminately ; he was condemned to the society of 
 those who were at once loathsome from disease and debased 
 by crime. The most wretched and infamous refuse of the 
 community mingled with, and, can we avoid supposing, taint- 
 ed those who, from their situation, could neither recognize 
 nor repel their friendship. 
 
 Previous to 1828, only twelve of the fifty-two counties of 
 England possessed public establishments for the insane : 
 and, until 1808, there was only one asylum in Ireland, all 
 pauper lunatics requiring restraint being necessarily placed 
 in the prison or work-house, with the indigent and idle, the 
 robber and the murderer.^ And so lax were the laws, that 
 serious doubts have arisen whether many of those treated in 
 this manner were not altogether free from mental disease, 
 
 * Iberti. Observations Generates sur les Hopitaux, p. 41, 42. 
 f History of Infirmary, p. 9. 
 
 X Halliday. General View of the Present State of Lunatics and 
 Lunatic Asylums, &c. 1828, p. 13. 
 
110 WHAT ASYLUMS WERE. 
 
 and sacrificed by malice, revenge, or avarice. The inquiry 
 is somewhat foreign to my present purpose : but even the 
 suspicion that such an injustice could have been perpetrated, 
 illustrates the amount of care and solicitude displayed re- 
 specting the subject of insanity. It is, however, necessary 
 to make some observations on the distribution and treatment 
 of lunatics in such places of detention. In 1807 the gaols in 
 England were proved to contain 37, the houses of correc- 
 tion 113, and the poorhouses, and houses of industry or 
 workhouses, 1765 lunatics.* Even at the present moment, 
 127 of the insane poor belonging to the county of Middlesex 
 are confined in workhouses.-!- It would be ridiculous to ima- 
 gine, that in such receptacles any attempt was, or could be 
 made to correct the delusions under which they laboured, 
 or even to the physical causes from which these proceeded. 
 If an ulcer appeared upon the leg, I shall admit that the 
 parish surgeon would exert his experience to heal it, but 
 into the mental ulcer he was not called upon to penetrate ; 
 nor, had charity or a perfect knowledge of his art prompted 
 him to do so, would interference, under such circumstances, 
 have been of the slightest avail. No kindness, no ingenuity 
 could have triumphed over the series of irritations insepara- 
 ble from such a situation. But, although destitute of all the 
 means necessary for the subjugation of their disease, there 
 is reason to believe, or rather to hope, that so far as food 
 and clothing and the comforts which many, even of the most 
 degraded lunatics, desire and value, were concerned, they 
 were as carefully and plentifully provided for as the other 
 inmates. There are, however, some known and appalling 
 exceptions to this charitable supposition. Naked patients 
 were found chained to the ground night and day, and this 
 for a long lapse of years : all water for ablution was denied 
 
 * Report from Select Committee, &c 1807, p. 12. 
 •f Sixth Report of the Physician and Treasurer of the Middlesex 
 Pauper Lunatic Asylum, 1837. 
 
WHAT ASYLUMS WERE. Ill 
 
 them : others passed the whole night in cells, where so 
 pestilential was the atmosphere, that the inquisitors who de- 
 tected these facts could not remain in them for a few minutes, 
 " Both of them," avers one of these gentlemen, speaking of two 
 lunatics, "were chained down to the damp stone floor, and one 
 of them had only a little dirty straw, which appeared to have 
 been there for many weeks, — the chain was a long one and 
 fastened to the centre, and admitted of her just coming out- 
 side where she sat, — she was perfectly quiet and harmless, — 
 she was not allowed water to wash herself."* Another witness 
 states, u that in a workhouse in his neighbourhood, there is 
 a cell which opens outwardly into the yard, but has no com- 
 munication internally with the house, and where they have 
 no comfort of a fire, — his father knew a person who was 
 chained naked, lying on straw for fifty years in a work- 
 house."f Still further doubt has been excited as to the 
 spirit in which certain workhouses were conducted, by the 
 discovery of a traffic of so detestable and revolting charac- 
 ter, that the soul sickens at the very name. " In a debate 
 in 1815, Mr. Horner, after stating that a gang of factory 
 children had been exposed to sale as part of a bankrupt's 
 effects, said, " Another case more horrible came to my 
 knowledge while on a committee up stairs : that not many 
 years ago, an agreement had been made between a London 
 parish and a Lancashire manufacturer, by which it was sti- 
 pulated, that with every twenty sound children one idiot 
 should be taken "% Here, then, in this free and glorious 
 land was the foundling idiot sold into servitude : here, in 
 this Christian land, and under the pretext of charity, were 
 the purposes of benevolence prostituted by the most unwar- 
 
 • First Report of Committee, &c. 1815, p. 55, evidence of Henry 
 Alexander, Esq. 
 
 f First Report of Committee, &c p. 124, evidence of Mr. Thomas 
 Bakewell. 
 
 X Quarterly Review. Vol. lvii. p. 402. 
 
H2 WHAT ASYLUMS WERE, 
 
 rantable measures for removing a parish burden, or, I ought 
 rather to say, by the most cruel, callous, and systematized 
 indifference to human suffering and infirmity, ever recorded. 
 Common sense has so far triumphed, that with the excep- 
 tion of some poor and remote districts, the grotesque classi- 
 fication of the insane with the criminal and the pauper has 
 been altogether abandoned in this country. But in some 
 parts of the continent, as Hesse and Hanover, the insane still 
 are, or very recently were, mixed with criminals, shut up in 
 damp cells, the windows of which are unglazed, furnished 
 with beds of dirty straw, but perfectly naked. One of the 
 most primitive and rude houses of detention exists in the 
 vicinity of Venice. On a flat, slimy, and solitary island in 
 one of the lagoons, there is a ruin, which, although de- 
 serted by rational men as uninhabitable, is conceived to be 
 sufficiently good for the degraded maniac. The requisite 
 qualities of strength of wall, bars in the loop-holes which ad- 
 mit light, and solitude, are certainly not wanting. In the 
 lower apartments of this building, which are unfurnished, 
 never cleaned, and exposed, from the want of windows, to the 
 extremes of temperature, are confined a few madmen nearly 
 naked, shockingly filthy ; haggard and half-starved in aspect* 
 these men seem to realise the ideas formerly entertained of 
 their condition. They are fed once a-day, the food being 
 thrown to them through the bars, as carrion is tossed to a 
 wolf. The continuance of such barbarity on the very con- 
 fines of civilization, may be pardoned ; but how awful the 
 responsibility of that government which permitted misman- 
 agement nearly as gross to exist at Nantes so late as 1818, 
 in the very centre of civilization.* Or what shall we think 
 of the following narration? Sir G. O. Paul states, in 1807, 
 that he was acquainted with the case of a maniac, who was 
 shut up and chained in an uninhabited ruin. His friends 
 
 * Diet, des Sciences Me'd. art. " Maisons des Alienes." 
 
WHAT ASYLUMS WERE. 113 
 
 resided at some distance, but brought him a daily allowance 
 of food.* The darkest chapter in the history of the human 
 heart might be compiled from the recorded sufferings of the 
 insane. 
 
 Now, I have spoken of prisons being used as asylums; but 
 the converse is likewise true, asylums having been used as 
 prisons, with this important difference, however, that in the 
 latter case the prisoner was guiltless, not even guilty of being 
 diseased. In fact, the popular belief that asylums have been 
 employed to gratify the cupidity or malice of interested or 
 indifferent friends, appears not to be without foundation. 
 Men who were sane, or who scarcely displayed a shade of 
 eccentricity in their conduct, have been entrapped, impri- 
 soned, and confined, in defiance of the most active interfer- 
 ence made in their favour. The spirit which gives a clemency 
 to the most rigid legal scrutinies, was suppressed ; and the 
 presumption, instead of being that the accused should be re- 
 garded as sane until he was proved to be deranged, was in- 
 variably, that the individual must be treated as mad until he \ 
 was proved to be sane. The provisions of the enactment for 
 the protection of the rights of those suspected of lunacy, are, 
 notwithstanding, ample and adequate. Confinement ought 
 not, according to the intention of the original framers of the 
 statute, to be resorted to, nor can it be held to be authorized, 
 until subsequent to the repeated visits of two medical men 
 to the person under suspicion, and until they have given an 
 affidavit that such a course is necessary. Practitioners have 
 been found so ignorant, or so regardless of their duties to 
 their fellow-men, imposed by the exercise of their profession, 
 as to sign this solemn attestation, which condemns to depri- 
 vation of freedom, and of the rights and privileges of citi- 
 zenship, and to separation from home and friends, without I 
 having seen the individual against whom such designs are 
 
 * Report of Committee, 1807, p. 21, 
 
114 WHAT ASYLUMS WERE. 
 
 meditated ; without knowing, except on hearsay evidence, 
 whether insanity exists, or insanity to such a degree as to 
 justify restraint. The poor are protected from such injustice 
 by their very poverty. No one is interested in secluding 
 them ; in fact, should selfish feelings predominate, it is the 
 interest of the parish upon which they are dependent, and 
 by the charities of which they must be supported during 
 confinement, to deprive them, when afflicted with insanity, of 
 the superintendence of medical men as long as possible. And 
 is not this hard-hearted parsimonious policy frequently 
 adopted ? Upon the rich falls the violation of this law. The 
 act of stealing a man of property, and immuring him for life 
 in a dungeon, in this country, appears, at first sight imprac- 
 ticable. But there exist strong grounds for believing that 
 such a species of kidnapping has been successfully carried 
 into effect.* Of the facility with which agents in such a 
 scheme may be found, I have personal experience. I was 
 employed to obtain medical evidence of the lunacy of a per- 
 son who retained reason and cunning sufficient to suspect my 
 designs, and had address and means to have eluded them. 
 He was attended by a physician of great eminence, who, 
 although convinced that his patient was insane, from the 
 dread of being dragged into a court of law, refused to parti- 
 cipate in the necessary legal steps. To have introduced 
 another medical attendant would have excited suspicion, and 
 precipitated either the retreat or the suicide of the object of 
 my solicitude. From this dilemma, a friend of the patient's 
 kindly offered to extricate me, by procuring the signature of 
 an individual whom he characterized as of great respectabi- 
 lity, and as possessing a reputation for intimate knowledge 
 of mental disease. On stating that it would be impossible to 
 bring about an interview between the parties, my adviser 
 assured me that this form was not necessary, that his friend 
 
 * Pigott on Suicide and its Antidotes, p. 107. Report of Com- 
 mittee, &c, 1807, p. 10, 14, 19. Ibid. 1815, p. 124. 
 
WHAT ASYLUMS WEEK. 115 
 
 would grant the requisite certificate of lunacy without any- 
 preliminary investigation, and that he was frequently called 
 upon to act in the same manner. That such cases of ab- 
 duction and inhumation have taken place, is pretty well esta- 
 blished ; that they still occur, is more than suspected. The 
 opportunities for confining and concealing sane persons in 
 asylums, whether public or private, are very great; and 
 while there exist relatives so inhuman as to consign those 
 who obstruct their selfish interests or thwart some cherished 
 project to such a fate, instruments sufficiently base and in- 
 famous will be found to carry their purpose into execution. 
 The only safeguard — it does not amount to prevention— 
 against such abuses, will be in making all asylums patent, 
 not only to the occasional visits and very imperfect scrutiny 
 of the legal authorities, but to the constant surveillance of 
 humane and trustworthy persons, competent by education 
 and character for the duty. 
 
 Some adequate remedy should be provided ; for even to 
 the partially unhinged mind there is scarcely within the range 
 of human misery an affliction more cruel than such a fate ; I 
 to the sane it can scarcely fail to prove the cause of derange- 
 ment. There is the uprooting of every affection, — the dis- 
 appointment of every hope ; there is the anticipated eternal 
 separation from the world, and all its enjoyments and inha- 
 bitants, the degradation of caste, and the conviction that all j 
 these varieties of bitterness are inflicted by those in whom 
 confidence was reposed, who were objects of love, and who 
 with the right and power to cherish and protect, have be- , 
 trayed their trust by deserting and oppressing. Besides this 
 there is to be endured a life of solitude and silence, spent 
 amid furious and raving maniacs, without object or pursuit ; 
 there is the deprivation of all sympathy ; the being ranked 
 and treated as a proud or perverse lunatic, or as a drivelling 
 imbecile ; and ultimately there must be endured a death 
 which may be solaced by the common charities of humanity, 
 
U6 WHAT ASYLUMS WERE. 
 
 but which no friend will know of or weep for. Such ideas 
 must be suggested to the sane, even to the partially sane 
 mind, when the first agitation and terror consequent on con- 
 finement have subsided ; and are calculated, as 1 have said, 
 to accomplish all that the conspirators desire. 
 
 The victims of persecution in the middle ages were committed 
 to oubliettes. Built into the recess of a dungeon, with sufficient 
 air and food to protract life, but not to allay suffering, they 
 were abandoned to linger on for da}*s and weeks, and, as the 
 name implied, were forgotten. I know not on which of these 
 demoniac destroyers of their kind, those who eutombed the 
 body, or those who entombed the soul, the deepest execra- 
 tions should be poured. Human law has no punishment for 
 such barbarities ; the Christian heart cannot trust itself in 
 condemning their perpetration, in awarding justice to the 
 perpetrators. I have spoken at length on this abuse, because 
 it is the most awful in its consequences, and because it is the 
 most difficult of detection. I have likewise spoken strongly, 
 but I trust it has been with a voice of virtuous indignation. 
 
 Closely as the asylums originally erected were assimilated 
 to prisons ; the whole array of bolts, bars, chains, muffs, 
 collars, and strait-jackets, were deemed some years back in- 
 sufficient to afford protection to keepers, and a machine was 
 invented, so perfect in its construction and satisfactory in 
 its application that it deserves description. I shall convey 
 the history of this extraordinary apparatus, and of the oc- 
 casion which was conceived to justify such unusual restraint, 
 nearly in the words of a witness before the parliamentary 
 committee : " William Norris had been confined fourteen 
 years ; in consequence of attempting to defend himself from 
 what he conceived to be the improper treatment of his keep- 
 er, who was a habitual drunkard, and at the time intoxicat- 
 ed : he was fastened by a long chain, which, passing through 
 a partition, enabled the keeper, by going into the next cell, 
 to draw him close to the wall at pleasure : to prevent this, 
 
WHAT ASYLUMS WERE. 117 
 
 Norris muffled the chain with straw so as to hinder its pass- 
 ing through the wall : he was afterwards confined by a stout 
 ring rivetted round the neck, from which a short chain pass- 
 ed to a ring made to slide upwards or downwards on an up- 
 right massive iron bar, more than six feet high, inserted into 
 the wall. Round his body a strong iron bar about two inches 
 wide was rivetted ; on each side the bar was a circular pro- 
 jection, which, being fashioned to, and enclosing each of his 
 arms, pinioned them close to his sides. This waist bar was 
 secured by two similar bars, which, passing over his shoulders, 
 were rivetted to the bars on his shoulders by a double link 
 to the waist-bar both before and behind. The iron ring 
 round his neck was connected to the bars on his shoulders 
 by a double link. From each of these bars another short 
 chain passed to the ring on the upright iron bar. He could 
 raise himself so as to stand against the wall, or in the pillow 
 of his bed in the trough in which he lay ; but it was impos- 
 sible for him to advance from the wall on which the iron bar 
 was soldered, on account of the shortness of his chains, which 
 were only twelve inches long. He could not repose in any 
 other position than on his back. His right leg was chained 
 to the trough, on which he had remained thus encaged and 
 chained for twelve years."* The unfortunate being thus em- 
 paled was of great muscular power ; his wrists were formed 
 in so peculiar a manner as to render all manacles useless, and 
 his disposition is described as blood-thirsty. I presume he 
 was affected with homicidal monomania. Notwithstanding 
 these very formidable qualities, when we learn that at one 
 time he was so docile as to be useful to the servants, that dur- 
 ing his incasement in iron he spoke rationally, seemed to 
 understand all that was addressed to him, and to recollect all 
 that he had suffered : that he occupied his time in reading, 
 and that when partially liberated he conducted himself with 
 
 * First Report of Committee, &c. 1S15, p. 12. Evidence of Mr. 
 E. Wakefield. 
 
118 WHAT ASYLUMS WERE. 
 
 propriety; the amount and nature of the precautions adopt- 
 ed appears to have been unnecessary and oppressive.* They 
 afforded, it is true, adequate protection to all around ; but on 
 a mind in such a condition, in a condition so favourable 
 for treatment, moral impressions might have been made 
 to become, as in cases of a precisely similar kind they 
 have become, a source of protection as powerful and as 
 permanent ; or, if the patient's nature was really so ferocious 
 and irreclaimable as to render all such efforts fruitless ; why 
 w r as complete isolation not attempted ? Why, during the 
 periods of intelligence and tranquillity, the periods in fact 
 when he was no longer dangerous, was there no intermission, 
 no diminution of these laboured precautions ? I know no- 
 thing at all parallel to this contrivance except a mode of re- 
 straint very recently employed at Rome for the turbulent and 
 furious. Two iron rings are fixed in the wall of the cell, one 
 of these serves as a collar and embraces the neck, the other 
 passes round the ankle ; thus united action compels the 
 prisoner to stand upright, or, should fatigue and exhaustion 
 render that impossible, to hang suspended. t The race of men 
 who could thus see no safety but in chains, drew a line of dis- 
 tinction as to whom they were to be applied. Patricians, we 
 would be led to believe, were calm and tranquil in their 
 frenzy, for Dr. Monro states, that under his superintendence 
 " gentlemen " were never chained, but that such measures 
 were necessary for the poor in public establishments.^ This 
 was clearly an error in judgment ; a pernicious mistake, it is 
 true., arising out of the opinions prevalent as to the nature. of 
 mental disease, and as to the inefficacy of moral treatment : 
 
 * First Report of Minutes, &c., 1816, p. 41. Evidence of Mr. James 
 Simmonds. Second Report from Committee, &c, 1815, p. 151. 
 Evidence of William Smith, Esq. 
 
 + Brierre de Boismont. Memoire pour l'Etablissement d'un Hos- 
 pice d'Aliene's, Annales d' Hygiene Publique, vol. xvi. p. 104- 
 
 J First Report of Committee, &c, 1 8 15, p. 93. 
 
WHAT ASYLUMS WERE. 119 
 
 but on advancing one step farther into the inquiry, the same 
 timid measures are discovered to have been taken as part of 
 a system, not of cure but of economy. To avoid the lavish 
 outlay that would be incurred by employing additional keep- 
 ers, " It was stated," says Dr. Fowler, " when the keepers 
 were asked the reason for putting them in irons, that it would 
 require a larger expense than they could afford to keep ser- » 
 vants to take care of them if they were not ironed."* 
 
 I have rashly, it may be conceived, compared the former 
 treatment of lunatics to that of the animals in a menagerie. 
 From motives precisely similar to those which actuate Polito 
 or Wombwell, the patients in Bedlam used to be exhibited to 
 any one paying four shillings. And that callous and unen- 
 lightened curiosity which draws crowds to the one exhibition 
 drew crowds to the other. So strong was this feeling that, 
 until about sixty years since, a large sum, amounting to about 
 L.400 per annum, was raised by this tax.f Throughout 
 France, one or two large towns excepted, this detestable prac- 
 tice is still persevered in, or, if nominally discontinued, the 
 purse always contains a talisman which removes all difficul- 
 ties. Esquirol adds that the guardians spare neither menaces 
 nor sarcasms in order to rouse the passions of the patients 
 for the amusement of the visitors. It is difficult to say who 
 shall be admitted and who excluded ; but no rule of admis- 
 sion, of whatever latitude, should include visitors for amuse- 
 ment. Open to the intelligent and humane as a means of 
 preventing or removing those abuses which I denounce, asy- 
 lums ought to be closed to the public, and as sacred from 
 vulgar unsympathizing eyes as the secrets they so often re- 
 veal. Conceive the feelings of a family whose sister, or father, 
 or friend, had been made the sport or even the gazing-stock 
 of what is, surely in derision, called a party of pleasure ; or, 
 
 * First Report of Committee, &c, 1815, p. 46. 
 f Highmore. An account of the various Public Charities in or near 
 London, p, 19. 
 
120 WHAT ASYLUMS WERtf. 
 
 conceive again the feelings of that sister, or father, or friend, 
 on returning to the world and encountering those to whom 
 their ravings and folly had afforded matter for wonder or 
 merriment. The evil consequences of such treatment in a 
 medical point of view are glaring, but here it is only neces- 
 sary to expose its barbarity and brutality. But we have not 
 yet arrived at the climax. It has been insinuated that imbe- 
 ciles have been deprived for some time of food, in order to 
 astonish the spectators by their voracity when it was given 
 to them. This at least is certain, that a miserable creature 
 who was in the habit of eating his own excrement, earth and 
 filth of every description, was furnished with weeds and grass 
 to devour to gratify the curiosity of visitors.* It would be 
 •absurd to suppose that this custom of swallowing noxious and 
 indigestible substances was in general encouraged for the 
 reason here alleged, or for any other. But, in proof of how 
 much lunatics have been neglected, it may be mentioned, 
 that, in the dissection of the bodies of those known as earth- 
 eaters, the colon is sometimes found to be distended with 
 earth and clay, and in such enormous quantities that it must 
 have been the accumulation of months or even years. This 
 I have seen. The gross inattention of governors of asylums 
 to the comfort, and of keepers to the helpless condition, of 
 those committed to their custody, it cannot be called care, is 
 seen in the fact mentioned by Esquirol, that idiots and imbe- 
 ciles often lose their limbs from grangrene produced by cold, 
 and, shocking to relate, from the attacks of rats. Similar 
 accidents used to occur at Bedlam, and Sir A. Halliday states 
 that he saw, in this country, a rat devouring the extremities 
 of a maniac, who was lying naked on some straw, in the 
 agonies of death. f Although inappropriate food is often given 
 to lunatics, so far as I know, there is no instance on record 
 
 * Carter. A Short Account of some of the Principal Hospitals of 
 Fiance, Italy, Switzerland, &c. p. 42. 
 ■f Letter in the Courant Newspaper, September 1836. 
 
WHAT ASYLUMS WERE. 121 
 
 of the supply of food being inadequate in this country. 
 The case is different in France. During the sway of the 
 revolutionary government, the allowance to the lunatics in 
 the public asylums was reduced to the smallest possible 
 amount which could sustain life. The most marked and me- 
 lancholy results followed. The convalescents relapsed, the 
 furious became still more frantic from hunger ; and the 
 mortality increased to a frightful degree. Fifty-six patients 
 died in one month in Salpetriere ; and in the space of two 
 months, the mortality in Bicetre exceeded that of the whole 
 previous year, when the rations were liberal. 
 
 In smaller institutions, the evils arising from negligence 
 or parsimony are probably still more aggravated. The 
 dread of detection is there comparatively slight. Proprietor, 
 servants, all may enter into an execrable league to gorge on 
 the spoils of the poor and defenceless ; and by whom can the 
 conspiracy be traced or defeated ? The lunatic who suffers, 
 is not listened to ; the barbarian who oppresses, is at once 
 witness and jury. We hear of the wine and spirits which 
 the exhausted maniac may be advised to take, being diluted 
 or adulterated ; we hear of patients being confined in out- 
 houses which were formerly pig-sties, sleeping in cribs so 
 small, as to cause permanent contraction of the limbs ; we 
 can scarcely picture to the mind three miserable, emaciated 
 beings, huddled together in a bed intended for one person, 
 without any straw or covering, save a single rug, or coarse 
 hop sack : we can scarcely believe, that, in a climate such 
 as this, a number of weak and diseased men should be 
 compelled to sleep in a damp cellar containing a well. But 
 if we once admit and believe these atrocities as possible, we 
 can then understand the details of suffering and death from 
 mortification and typhus fever, which are given as the con- 
 sequence, and the peculation and fraud which are given as 
 the cause. This applies chiefly to the want of proper cloth- 
 ing. An expose of the system pursued, adds another and 
 
 G 
 
122 
 
 WHAT ASYLUMS WERE, 
 
 darker shade to the picture I have drawn. The patients are 
 represented as furious and destructive, to their friends and 
 guardians. It is declared to be impossible to restrain them 
 from tearing their clothes, and new supplies are frequently- 
 demanded : and the articles thus accumulated are sold, while 
 those for whom they were intended sit naked and shivering 
 in the cold, without even the solace of heat to mitigate 
 their melancholy.* 
 
 The nature of the medical treatment which prevailed in 
 this disease previous to 1815, which may he styled the era 
 of the reformation, may be judged of from the following 
 statements. In a large asylum in England, the superintend- 
 ent, who was intrusted with the moral management, as well 
 as the direction of the internal economy, sometimes absent- 
 ed himself for two months ; in another, containing about 
 four hundred patients, no attempt whatever was at any time 
 made to restore mental health ; in a third, and that a me- 
 tropolitan one, where an immense number of individuals are 
 confined, and where the character of the various species of 
 lunacy, is as different as the dispositions and temperament 
 of these patients, and where every case may be accompanied 
 with a different bodily disease, it was an established rule, 
 that all, without any reservation, should be bled in June, 
 and receive four emetics per annum. -f When the physician 
 paid his regular visits, which were " few and far between," 
 the patients were arranged in two rows, between which he 
 passed rapidly, receiving reports of their complaints at se- 
 cond-hand from the apothecary ; prescribing, guided clearly 
 by some intuitive knowledge, in this fashion. — " Number one, 
 a purge ; number two, an emetic ; number ten, bleeding." 
 We are assured by certain high authorities, that insanity is 
 
 * First Report of Minutes, 1816, passim. 
 
 + First Report of Minutes, &c, 1816; and First Report by Com- 
 mittee, 1815, p. 37. 
 
WHAT ASYLUMS WERE. 123 
 
 the most easily cured of all serious maladies ; and I have at- 
 tempted to show, that, under favourable circumstances, it is 
 much more easily cured than what was formerly supposed ; 
 but such conduct as that now described would force us to 
 conclude that the cures are spontaneous, and that Nature, 
 in her prodigality of power and affection, rejects altogether 
 the assistance of art. In those days, even experienced and 
 humane physicians gave their sanction to such an opinion, 
 by declaring that medicine was of little importance ; and 
 in compliance with these views, there were no baths, no de- 
 pletion, no regulation of diet, no interference in fact, further 
 than what was demanded for the ailments which sprung 
 from this neglect. 
 
 Moral treatment there was none. The mind was left to 
 recover its native strength and buoyancy spontaneously. 
 All classes of patients were crowded together without occu- 
 pation, ec without means," remarks one of their benefactors 
 and champions, " being thought of to lead their attention 
 from the disturbed objects with which a diseased mind is 
 pervaded ; indeed, it struck me that the hospital was much 
 more like a lock-up house to confine persons in, than an 
 hospital for the cure of disease."* 
 
 Classification was never thought of: criminals, lunatics, 
 the furious and the gentle were compelled to live promiscu- 
 ously ; nay, the doctrine was gravely promulgated, that it 
 ought to be refrained from on principle : the principle being, 
 so far as I can understand it, to convince one set of lunatics 
 of their insanity, by exposing before them the fury and 
 follies of another set. The following quotation may serve as 
 a commentary on this text : " In one of these rooms I found 
 four and twenty individuals lying, seme old, some infirm, 
 one or two dying, some insane, and in the centre of the 
 
 * Evidence of Mr. Ed. Wakefield, First Report, 1816. 
 
- 
 
 124 WHAT ASYLUMS WERE. 
 
 room was left the corpse of one who died a few hours 
 before."* 
 
 If the burden of disease was removed, it was not through 
 the instrumentality of any process instituted for the purpose ; 
 if it remained, and the mind sunk debilitated and worn out 
 under the pressure, no active interference could be blamed 
 for accelerating the event. In many instances there existed 
 an obvious interest and unequivocal design to protract 
 the duration of the disease. The curability of cases at 
 that time depended, in many instances, less on the nature 
 of the derangement, than the amount of board. Accordingly, 
 we find, that where patients were not literally abandoned to 
 their fate, whatever curative measures were adopted, have 
 more the appearance of being obstacles and impediments to 
 the restoration of reason, than of being dictated by common 
 humanity, or common sense. The whole superintendence 
 was committed to keepers, uneducated, coarse in manners, 
 dissolute in morals, often cruel, and always irresponsible. 
 It was their duty to administer, nay more, to prescribe baths, 
 medicines, restraint, punishment. That which they might 
 have done with safety and benefit, and without much in- 
 struction, bathing, they neglected ; that, punishment, which, 
 if resorted to, requires the nicest discrimination and the 
 calmest judgment to prescribe, and to apportion to the of- 
 fence, and which almost all men now agree can be entirely 
 dispensed with, they inflicted constantly, ignorantly, indis- 
 criminately, and in retaliation. The lash, they conceived, 
 was ever ready, of easy application, and of instantaneous effi- 
 cacy. It is curious, that even the humane Pinel, biassed by 
 the opinions and timidity of his coadjutors, and by the spirit 
 of the age in which he lived, seemed inclined to admit the 
 
 * Report, Lunatic Poor in Ireland, p. 15. Evidence of Thomaa 
 Rice, Esq. 
 
WHAT ASYLUMS WERE. 
 
 125 
 
 propriety of trying the " excitement of terror " as a remedy. 
 You must have heard of individuals being frightened out of 
 their senses ; but will not readily credit the statement, that 
 attempts have been gravely made to frighten a man into his 
 senses. This was evidently the principle and object of those 
 who covered the walls of the lunatic's cell with sketches in 
 phosphorus, of hobgoblins and hideous figures, so that his 
 eye might be arrested by the glare whenever he awoke. But 
 in justice to the memory of those who suggested or advo- 
 cated this practice, I am bound to state, that it is still per- 
 severed in, even by men whose motives cannot be suspected, 
 and who declare that benefit has accrued from the applica- 
 tion of what is obviously but a modification of the same 
 principle. It appears that in the Senavretta at Milan, they 
 have constructed an apartment, which can be placed in 
 darkness or light, into which the rain can be made to de 
 scend, and around which the thunder can be made to peal 
 at pleasure.* These sources of terror are directed against 
 furious mania. I cannot conceive that much benefit should 
 accrue from such a plan. That insanity has been cured by 
 means of sudden, and powerful, and sometimes by depressing 
 impressions produced by external circumstances, may be ad- 
 mitted. But instances of this kind are of rare occurrence, 
 have generally been accidental, and of so dubious a charac- 
 ter, that it is difficult to determine, whether the joy, or sor- 
 row, or other vivid emotion excited, be the cause of the sub- 
 sequent recovery, or merely an indication of returning health 
 and the last of a series of stages of improvement. If such a 
 measure succeed in rousing the fear or superstition of the 
 patient, as it fairly may be expected to do, but fail in remov- 
 ing the disease, it is highly probable that the mind may be 
 totally unhinged, or so deeply injured, as to sink into fatuity, 
 
 * Brierre de Boismont — Annales de Hygiene, torn. xvi. p. 56. 
 
L26 Wll \T ASYI.IUUS \vi CM . 
 
 orto bailie nil other treatment. This risk is confessedly so 
 imminent) that even the surprise bath, the mildest and mosl 
 justifiable mode iii which sudden and disagreeable Impres* 
 lions could be oommiinioated} has fallen into disrepute, and 
 has been in many plaoes altogether abandoned. From these 
 statements it is clear, that although this practice may be 
 condemned is baiardous and unphilosophical, it cannot, 
 
 in every case, he si i^iual i/ed as cruel. 
 
 Thai you may not imagine that I have made assert ions of 
 
 ihe prevalence of oorpoval punishment rashly, or thai l have 
 
 merely eonelmleil thai such a result was likely to follow eon 
 duet, so irreconcilable wit h justice and humanity, two brief 
 
 but striking narratives may be presented to you. A surgeon 
 
 stated in evidence before a ( 'oiimiil lee of I he I louse of ( 'om- 
 inous, (hat in \ isiliii", a private asylum, he saw a keeper beat 
 Iflg in a most bridal manner a eaplain in the navy, who WSJ 
 Confined by means of ft chain on his legS, and hand-cull's, so 
 
 that he could neither escape aor defend himself. Mark the 
 
 import of Ihe concluding sentence : " He died shortly after- 
 wards." The same keeper beat another patient, so violently 
 with a pair of boots (hat, mark again tin- conse(|uence, lt he 
 died shortly afterwards." Now, I most fervently hope thai 
 although death untjuesl ionably followed the infliction of 
 this horrible cruelly, it was rather in the order of lime than 
 of causation. Yet what limits can be assigned, or can e\isl, 
 to passion which would give rise to such an accusation as 
 the Following : '* 1 have seen her, a keeper, lock her, a 
 harmless maniac, down in her crib with wrist-locks and || •<■;- 
 locks, and horse-whi|> her: I have seen the blood follow the 
 strokes."* This occurred in L81S, and was Ihe result neither 
 
 of in difference nor inhumanity on ihe part of the oonduotor 
 
 Ofthe establishment, but. ol'lhe vicious system then prevalent, 
 and especially of thai. most, reprehensible pari of it, which 
 
 * fust Report of Minutes, && i*u>, pp, 2, and 64. 
 
WHAT ASYLUMS WERE. 127 
 
 consigned the care of the insane to the uneducated and bru- 
 tal, to deputies and servants whose chief recommendation 
 
 was a want of delicacy and refinement, and whose onty ob- 
 ject was aggrandisement. 
 
 I would be loath, indeed it would be unfair, to take the 
 following relation, for the truth of which I can vouch, as il- 
 lustrative of the moral treatment formerly pursut d in public 
 institutions. A patient affected with satyriasis wasenaM- d, 
 either from the relaxed state of morality or discipline i 
 ing in the asylum in which he was confined, to gratify his 
 desires when he pleased. I lis gallantries were again and 
 again discovered, and punished by blows and lasftM so effi- 
 cacious, that he was obliged to return to chastity, in order to 
 preserve his life. This fact, although not adduced to prove 
 that a universal corruption of morals pervaded our asylums, 
 does prove two things, first, that the constitution of these was 
 so utterly inefficient, so faulty, that smell corruption might 
 existed ; and secondly, that the means taken to correct 
 this corruption, while characteristic of the time and mode of 
 thinking on the subject, were as much worthy the ti 
 moral treatment as the whipping of negroes to promote sub- 
 ordination and industry. But while I have every disposi- 
 tion to avoid establishing the above case as a standard, it 
 cannot be denied that gross immorality of a similar descrip- 
 tion existed, or rather was sanctioned by the absence of all 
 enlightened management, by the selection of improper 
 keepers, and by that secrecy and irresponsibility which cha- 
 racterised every proceeding within the walls of a madhouse. 
 Thus, for example, a female of unimpeachable character be- 
 came insane, and exposed, by the nature of her malady, to 
 the designs of all around, whether they aimed at the destruc- 
 tion of her body or of her virtue, fell a victim to the demo- 
 niac passion of one of the keepers to whom she was intrusted 
 for protection. In the asylum where this occurred the male 
 servants had keys which admitted them to the sleeping rooms 
 
128 WHAT ASYLUMS WERE. 
 
 of the female patients.* This is unfortunately not a solitary 
 instance.f 
 
 Some individuals carry their horror of innovation so far as 
 to contemplate with suspicion even the partial overthrow of 
 the ancient usages of madhouses. Yet, within the space of 
 a few years, and under the very eyes of these persons, so to- 
 tal was the disregard of decency, that in some institutions 
 every thing was conducted as if there had been no distinction 
 of sex. Perhaps the sapient rulers of these imagined that 
 the lunatic, in consequence of his or her affliction, lost all 
 knowledge of such distinction, or all the shame, or modesty, 
 or delicacy which attends such a knowledge. Be this as it 
 may, the male and female patients were allowed to mingle 
 indiscriminately, and to sleep in the same division of the 
 house : indeed, it is somewhat doubtful that even now a se- 
 paration has every where been carried into effect, for in 1818 
 no attempt of this kind had been made at Montpellier. J The 
 unscrupulous liberality which saw no impropriety in such an 
 arrangement could scarcely be expected to regulate the tone 
 or scrutinize narrowly the decorum and purity of the inter- 
 course which ensued. If it be remembered that the beings 
 thus having uninterrupted access to each other were irra- 
 tional, acting under the impulse of ungovernable passions, 
 and unrestrained, perhaps, by the sacred obligations of reli- 
 gion, and certainly unmindful of the conventional check of 
 public opinion, the extent of the corruption of morals, at all 
 events of the deterioration of manners, must have been appall- 
 ing. In an asylum, with the private history of which I am 
 somewhat acquainted, long after parlours and sleeping wards 
 had been provided, a woman continued to sleep in the divi- 
 sion of the house appropriated to the men, and to be attended 
 
 * First Report from Committee, &c. 1815, p. 2. 
 f First Report of Minutes, &c. 1816, p. 28. 
 } Diet, des Sciences Med. art. " Maison d'Alienes." First Report 
 of Committee, &c 1815, p. 46. 
 
WHAT ASYLUMS WERE. 129 
 
 by the male keepers at all times and under all circumstances." 
 The pretext for conduct so revolting was, that the individual 
 was so violent and powerful as to be unmanageable by- 
 females. But the pretext was utterly false, and a betrayal 
 of the ignorance and brutality under which those who dared 
 to urge it acted. The customs of the present day prove its 
 falsity and folly. I have examined many thousands of ma- 
 niacs, but I have yet to see one who could not be governed 
 or guided by one of her own sex. 
 
 Perhaps the most appalling example of negligence on the 
 part of the proprietors of asylums, I do not affirm which has 
 occurred, but which has been made public, was detected at 
 Fonthill in Wiltshire, by the Parliamentary Commissioners. 
 On opening the cells in which the patients lived, they were 
 found to be so dirty, and the smell so offensive, as to prevent 
 further inspection. Disgusting as I feel the task to be, duty 
 compels me to extract the description of one of the victims of 
 this savage tyranny : — (i He was confined in one of the ob- 
 long troughs, chained down ; he had evidently not been in 
 the open air for a considerable time, for when I made them 
 bring him out, the man could not endure the light ; he was i 
 like an Albino blinking; and they acknowledged that he had / 
 not. Upon asking him how often he had been allowed to get / 
 out of the trough, he said, ' perhaps once in a week, and / 
 sometimes not for a fortnight.' He was not in the least v'io-1 
 lent, — he was perfectly calm, and answered the questions 
 put to him rationally ; his breathing was so difficult that I 
 thought his life likely to be affected by it."f This man was 
 confined in an unwholesome cell, measuring nine feet by five. 
 Some idea may be formed of the mental capacity, if not of 
 the humanity, of the former governors of asylums in this 
 
 * Report from Committee, &c. 1815, p. 93, contains a case some- 
 what similar. 
 
 t First Report from Committee, &c, 1815, p. 46. Evidence of Dr. 
 Richard Fowler. 
 
130 WHAT ASYLUMS WERE. 
 
 country, from the statement made by one of them to a Par- 
 liamentary Committee, that sleeping cells of 8 feet by 7 are 
 as good as those measuring 10 feet 6 inches bj' 8. 
 
 But it is not merely accusations of unjustifiable confine- 
 ment, unhealthy cells or arrangements, which threaten life, 
 or deprive it of even physical enjoyment, of which I have to 
 speak ; charges are on record of systematic cruelty so ex- 
 treme, that death was the consequence. The Inquisition 
 never told the names or numbers of those who sunk under 
 its tortures, or died exhausted under the pestilential atmos- 
 phere of its dungeons. The policy of certain asylums appears 
 to have been the same. In the report given to the public by 
 the superintendents of the York institution, it at one time 
 appeared that 221 patients had died. On investigation, the 
 actual number was discovered to be 365. What possible 
 motive, or rather, what good motive, could suggest such a 
 falsification ? Or to put the question in a different form : In 
 what way can the deaths of 144 persons thus, for some inte- 
 rested purpose, consigned to oblivion, be explained ? But 
 this is not all,— .the accusation was more explicit; to quote 
 the words of Mr. Higgins : — f( A patient disappears, and is 
 never more heard of; he is said to be removed. A patient 
 is killed, the body is hurried away, to prevent a coroner's 
 inquest."* The human sacrifices of old served as the augur- 
 ies of succeeding generations, and from the blood of the un- 
 fortunate man here alluded to may be traced that generous 
 movement which was made by men of all creeds and parties 
 simultaneously, by all those who acknowledged a sympathy 
 in the sufferings of their fellow-men, for the purpose of de- 
 stroying every remnant of this judicial torture, this legalised 
 murder, and of extending protection and aid to the most 
 helpless and miserable members of our race. It is not here 
 insinuated that all the individuals whose deaths were con- 
 
 * First Report from Committee,[&c, 1815, p. 4. 
 
WHAT ASYLUMS WERE. 131 
 
 cealed, perished by unfair means, or in any way discreditable 
 to their ordinary or medical attendants ; but even after mak- 
 ing this admission, and after supposing that this investigation 
 was prompted by malicious motives, of which there is not a 
 shadow of evidence, will it be believed that grounds could 
 exist for accusing the responsible officers of a long established 
 asylum, of such crimes as the following ? First, That patients 
 were killed by the fury of the keepers, and then reported to 
 have died ; secondly, That the real amount of mortality was 
 concealed ; thirdly, That no less than 144 deaths took place, 
 which were not recorded; fourthly, That in order effectually 
 to bur}' these and other malpractices in oblivion, the books 
 of the establishment were burned, and false registers substi- 
 tuted ; and, lastly, That this attempt failing, the house was 
 set fire to and nearly consumed, to the imminent danger of 
 all its miserable inmates, and the destruction of at least 
 four.* For the honour of our country I would willingly 
 believe, that these atrocities may have been too deeply 
 coloured, too strongly stated. The charge, however, was 
 made by a respectable and benevolent magistrate of the 
 county where the circumstances are said to have occurred, 
 and is supported by proofs of so clear and convincing a 
 kind, that any doubt of the guilt of the parties accused can- 
 not be entertained for a moment. 
 
 I have said, that a sweeping charge against all institu- 
 tions, as scenes of impurity, profligacy, and cruelty, would 
 be unjust. The indictment is sufficiently grave, if it include 
 among its counts, total absence of all attempts to secure 
 moral, or any other treatment, a callous indifference to the 
 comforts, wants, and reasonable wishes of the patients, and 
 bigoted perseverance in a system at variance with common 
 sense and justice. 
 
 Experiment has shewn in America, that isolation, com- 
 
 * First Report of Committee, &c., 1815. Evidence of Godfrey 
 Higgins, Esq., passim. 
 
132 WHAT ASYLT7MS WERE. 
 
 plete solitary confinement, reduces the convict to madness. 
 Had it been designed to secure the continuance of this dis- 
 ease in all those afflicted, no better mode could have been 
 devised than that formerly pursued towards lunatics. The 
 vulgar have an opinion, that those keepers and medical men, 
 who have been long associated with lunatics ultimately sink 
 under the same disease. So horrible was the system of 
 which these persons were the agents, or spectators ; so 
 distressing the sufferings which they were condemned to 
 witness, or inflict, and so incessant must have been the ex- 
 citement of their own passions, that this opinion may have 
 been founded in truth. Let us pass a few minutes in an 
 asylum as formerly regulated, and from the impression 
 made by so brief a visit, let us judge of the effects which 
 years, or a life-time spent amid such scenes,, was calculated 
 to produce. The building was gloomy, placed in some low, 
 confined situation, without windows to the front, every 
 chink barred and grated — a perfect gaol. As you enter, 
 the creak of bolts, and the clank of chains are scarcely dis- 
 tinguishable amid the wild chorus of shrieks and sobs which 
 issue from every apartment. The passages are narrow, 
 dark, damp, exhale a noxious effluvia, and are provided with 
 a door at every two or three yards. Your conductor has 
 the head and visage of a Charib ; carries, fit accompaniment, 
 a whip and a bunch of keys, and speaks in harsh monosylla- 
 bles. The first common room you examine, measuring twelve 
 feet long, by seven wide, with a window which does not 
 open, is perhaps for females. Ten of them, with no other 
 covering than a rag round the waist, are chained to the wall, 
 loathsome and hideous ; but, when addressed, evidently re- 
 taining some of the intelligence, and much of the feeling 
 which in other days ennobled their nature.* In shame or 
 sorrow, one of them perhaps utters a cry ; a blow which 
 
 * Report from Committee, &c-, 1815, p. 11. 
 
WHAT ASYLUMS WERE. 133 
 
 brings the blood from the temple, the tear from the eye, an 
 additional chain, a gag, an indecent or contemptuous ex- 
 pression, produces silence. And if you ask where these 
 creatures sleep, you are led to a kennel eight feet square, 
 with an unglazed air-hole eight inches in diameter; in this, 
 you are told, five women sleep. The floor is covered, the 
 walls bedaubed with filth and excrement; no bedding but wet 
 decayed straw is allowed, and the stench is so insupportable, 
 that you turn away and hasten from the scene. Each of 
 the sombre colours of this picture is a fact. And those facts 
 are but a fraction of the evils which have been brought home 
 to asylums as they were. 
 
 Doubtless, although the result of these proceedings was 
 in every instance inhumanity, they cannot all be traced to 
 sheer, gratuitous cruelty — the Moloch propensity to enjoy 
 suffering. The motives must have been various. There 
 would be the indifference arising from a false hypothesis, 
 from the conclusion, that neither benefit nor injury could 
 accrue from whatever was done ; the ignorant belief that the 
 insane do not and cannot feel the evils heaped upon them ; 
 the timid carefulness to prevent escape, destruction of clothes, 
 &c. ; the careless sacrifice of the interests and comfort of the 
 patient to the temporary accommodation of his attendant ; 
 nay, there might even be, for such folly is possible, an ex- 
 pectation that bolts and bars, terror and stripes, arc neces- 
 sary, and endowed with remedial virtues. The evil of such 
 measures was not, however, the less grave, that the views 
 upon which they were founded, would not have consigned 
 the proposer to the common hangman, or to the milder fate 
 of becoming the companion of his victims. No arraign- 
 ment, I repeat, is made of the intentions of the curators of 
 the insane, but I do arraign the whole system of error which 
 they have sanctioned ; I call for a verdict of guilty, and a 
 sentence of total subversion, on the pernicious absurdities 
 which continue to be practised in their name and authority. 
 
LECTURE IV. 
 
 WHAT ASYLUMS ARE. 
 
 The old system not altogether exploded — Commencement of the pre- 
 sent system — Liberation of lunatics at Bicetre by Pin el — The adop- 
 tion of enlightened principles partial, but a desire for improvement 
 prevalent— First recognition of humanity and occupation as means of 
 treatment in remote times, in Egypt and Belgium — Present mode of 
 treatment characterized by want of classification, want of employ- 
 ment, want of bodily exercise — Asylums insufficiently heated — Error 
 of supposing lunatics impregnable to cold — Inattention to personal 
 comfort of lunatics — Corporal punishment professedly abandoned ; 
 but cruelty in various forms still committed — Patients confined to 
 bed to accommodate servants— Inadequate number of keepers — 
 Coercion as a means of cure, of protection — Character and qualifica- 
 tions of attendants on Insane — Evils of indiscriminate association of 
 insane — No wards for convalescents exist — Grounds for separating 
 lunatics— Erroneous views of moral treatment — Night visits — Mental 
 anxiety and disturbance produced by the oppressive, harsh, indelicate 
 or derisive conduct of keepers — Substitution of convalescent patients 
 for keepers — Important duties imposed on this class of servants — 
 Difficulty of procuring well-educated persons to undertake such re- 
 sponsibility — Exclusion, desertion of friends of lunatics — Asylums 
 ill-adapted for reception of rich — Luxurious diet — Indiscriminate 
 diet — Solitary meals — Prejudices of public present obstacles to im- 
 provement — Examples— How are these to be removed? 
 
 Great improvements have, undoubtedly^ been effected in 
 the internal economy of asylums. This result has proceeded 
 partly from selfish motives, partly from the prevalence of 
 sounder views of the nature and treatment of mental disease, 
 and chiefly, so far as the metropolitan establishments are 
 
WHAT ASYLUMS ARE. 135 
 
 concerned, from the dread of Parliamentary investigations, 
 and the surveillance and remonstrances of the medical com- 
 missioners. But that we have not altogether escaped from 
 the evils characteristic of what asylums were, appears from 
 the fact that, so recently as 1828, the Lunatic Hospital at 
 Vienna was, according to Burrows, a disgrace to that capital 
 and to the era of the nineteenth century ; and from the fol- 
 lowing recital, which inpinges more closely on our national 
 honour : " In a close room," says Dr. Bright, " in the yard 
 two men were shut by an external bolt, and the room was 
 remarkably close and offensive. In an outhouse at the bot- 
 tom of the yard, ventilated only by cracks in the wall, were 
 enclosed three females — the door was padlocked ; upon an 
 open rail-bottomed crib herein, without straw, was chained 
 a female by the wrists, arms, and legs, and fixed also by 
 chains to the crib — her wrists were blistered by the hand- 
 cuffs : she was covered only by a rug. The only attendant 
 upon all the lunatics appeared to be one female servant, who 
 stated she was helped by the patients." n The windows of 
 the bedrooms in which the patients pass the night without 
 any attendants, are not defended by bars, and the only 
 entrance to the men's bedroom is through that occupied by 
 the women ; the commissioners went up a staircase said to 
 be stopt, and found at the end of it a ruinous room prepared 
 with staples for the confinement of any violent patient, &c, 
 — an establishment which the commissioners regret they 
 have not the power to suppress."* Glad, however, to escape 
 from the disgraceful details which occupied the preceding 
 Lecture, my present purpose is to describe what is peculiar, 
 and especially what is objectionable, in the existing arrange- 
 ments, omitting, as much as possible, every thing that appears 
 to be and ought to be more characteristic of the system which 
 has been unanimously condemned, than of that benevolent 
 and rational policy which is now pursued. 
 
 * Report, Pauper Lunatics in Middlesex, &c. 1827, pp. 155-7. 
 
13*3 WHAT A5YLU5IS ARE. 
 
 Exaggerations have unquestionably crept in, and become 
 amalgamated with the rigid bare truth of many of the state 
 ments which have been advanced, both as to the past anc 
 present condition of the insane. But has the apocryphal nc 
 parallel in the accredited history ? Ignorance, — ignoranc< 
 alike of all that could and of all that did befall within ar 
 asylum lent its aid. Fear, inspired by the unlimited anc 
 irresponsible power either conferred by the law, orexercisec 
 in defiance of the law by interested friends : inspired by th< 
 jealous secrecy of every proceeding which took place subse 
 quent to incarceration, by the little that was disclosed, 01 
 rather that could not be concealed, of the mysteries of th< 
 prison-house, tended powerfully to aggravate the sugi 
 of that ignorance. And superstition entered as an ingredien 
 into the compound feeling of awe and detestation with whicl 
 all that related to the treatment of the insane was regardec 
 and interpreted. A similar combination of ill-directed cu 
 
 and suspicion has converted the apothecary 
 into a den of mercenary murder, and the medicine then 
 vended into the exuviae, the pharmaceutically 6. 
 
 of humanity. 
 The cry of the lunatic uttered in the exuberance of hii 
 
 rlf-inflicted anguish, or while writhing under the terror* 
 me self-created misfortune, may often have been con 
 5trued into expressions of bodily pain proceeding fron 
 castigation, or from some other device of that gratuitou; 
 cruelty which takes a delight in suffering. In like manner 
 as many lunatics, the cunning and suspicious for example 
 are as capable of telling, and are as much disposed to tell 
 falsehoods as their more responsible fellow-men, and as thej 
 are certainly more strongly tempted to make out as favour 
 able a case in their own behalf as possible, many 
 complaints of hard 1 -tripes, and chains, and starva 
 
 tion, which have reached and been received by the world 
 merit no other title than that of sheer fabrications. Butaftei 
 
WHAT ASYLUMS ARE. 137 
 
 ample allowance has been made for such cases, after deduct- 
 ing for the credulity of mankind, and for the fictions which 
 an occasional discovery of actual inhumanity might give 
 rise to, the question still remains to be answered, is there 
 any case which ignorance, or fear, or superstition has con- 
 jured up or blackened with their own sombre colouring, 
 one-half so gross and revolting as those which have been 
 proved by evidence which cannot be disputed ? Is there any 
 fiction, cunningly devised in the mind of the insane prisoner 
 panting for liberation, at all to be compared with those facts 
 which have been seen and recorded by men who had no 
 motive but mercy, no objects in view but justice? 
 
 An affecting picture has been drawn of the exhumation, — 
 it deserves no other name, of the prisoners from the Bastile, 
 and of the liberation of the condemned from the Abbaye on 
 the death of Robespierre. But the moral interest of these 
 events is equalled by the scene which signalized the appoint- 
 ment of Pinel as physician to Bicetre. The gaols used to be 
 thrown open on the accession of a new sovereign ; the assump- 
 tion of office by this friend to human nature was attended by 
 a similar triumph. It was a jubilee initiative of the reign of 
 mercy. Eighty lunatics who had long been galled by chains 
 were set at liberty. And it is mentioned that the very act 
 of liberation, affecting the mind as other powerful impres- 
 sions, restored many of them to tranquillity, if not to sanity. 
 " The first man on whom the experiment was to be tried," 
 says the narrator of the scene, " was an English captain, 
 whose history no one knows, as he had been in chains forty 
 years. He was thought to be one of the most furious 
 amongst 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 
 
138 WHAT ASYLUMS ARE. 
 
 you will promise me to behave well and injure no one.' 
 * Yes,' I promise you/ said the maniac ; * but you are laugh- 
 ing at me ; you are all too much afraid of me.' ' I have six 
 men/ answered Pinel, ' ready to enforce my commands if 
 necessary. 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 of his cell 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, walking up and 
 down the stair-cases, and uttering short exclamations of de- 
 light. 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 in the Bicetre, he had 
 no return of his previous paroxysms, but even rendered 
 himself useful by exercising a kind of authority over the in- 
 sane patients whom he ruled in his own fashion."* 
 
 From this period, 1792, may be dated a total revolution 
 in the opinions of medical men and legislators, respecting 
 the insane, and in the principles upon which houses of de- 
 tention are professed to be conducted. The application of 
 these views has been tardy ; but, from aiming merely at safe 
 custody, the ambition of the humane and philosophic, at 
 least, has extended to the employment of means which pro- 
 mise to restore a proportion of those confined, to their places 
 and duties in society, and to reconcile the remainder to their 
 captivity. From a blind and hard-hearted policy, which 
 
 * The British and Foreign Medical Review, No. I. p. 286. Traits' 
 Complet du Regime Sanitaire des Alienes, p. 57. 
 
WHAT ASYLUMS ARE. 139 
 
 embraced only the prevention of one evil by the infliction 
 of another, and which, to accomplish this end— amounting 
 in plain terms, to nothing more than the preservation of the 
 public peace — sacrificed every tie of justice, charity, and 
 human fellowship ; a sudden transition was made to a sys- 
 tem, professing to be based on a knowledge of the human 
 mind, and on the common sympathies of our nature, and 
 to have for its object the eradication, or if that appeared 
 Utopian, the amelioration of the evil. From darkness they 
 passed into light — from savage ferocity into Christian bene- 
 volence. These terms are energetic ; but the change which 
 they commemorate was so momentous, as to deserve to be 
 so characterized. Yet no one must conclude that the views 
 from which it proceeded, or the consequences to which it 
 led, either realized what subsequent experience has proved 
 to be sound and necessary, or completely harmonized with 
 what judgment and conscientiousness would dictate. The 
 promised land was in sight ; it was not reached. Vast and 
 manifest improvements even now require to be made on the 
 very soil of which Pinel was the cultivator; and although a 
 kindred spirit has succeeded to rear if not to reap the har- 
 vest, many years must roll on, and many changes intervene, 
 before it arrive at maturity. Unfortunately, every country 
 has not possessed a Pinel. The impulse of the reformation 
 which he began has been felt, it is true, less or more, in 
 every civilized country ; but it has succeeded at certain 
 points only, in shaking the strongholds of prejudice and 
 ignorance. The change is still one of degree ; for no where 
 has it been radical and complete. Even in those favoured 
 spots where the greatest care, and the greatest treasure have 
 been lavished, there exist organic evils, which nothing but 
 a more extended acquaintance with the moral constitution 
 of man can remedy. It will not readily be believed, that 
 in the country which has produced such men as Guislain, a 
 man, supposed to be labouring under hydrophobia, should 
 

 140 WHAT ASYLUMS ARE. 
 
 be confined for two days in a cell,, without assistance or treat- 
 ment, and ultimately should be allowed, in the presence of 
 the whole medical staff of the hospital, to beat out his brains 
 by running against the stove apparently urged to such a 
 desperate act, rather by the mania of fear, than by the ago- 
 nies of canine madness. It may be said that the cause of 
 the lunatic has been eloquently pleaded at the bar of public 
 opinion, but that the court has not yet pronounced judg- 
 ment. 
 
 There is this characteristic feature in the present condition 
 of asylums : — Those to whose care they are entrusted, are 
 completely aware of the errors formerly committed, and of 
 the grievous injustice which they or their predecessors may 
 have been unwittingly perpetrating. Universally a decided 
 change is contemplated and desired, and the din of prepara- 
 tion is heard wherever isolation is attempted. Good must 
 accrue from the opinions that prevail ; and the only ground 
 for apprehension which exists, is, that from the want of a 
 just estimate of the healthy and diseased states of the mind, 
 all the good may not be secured which in other circum- 
 stances would be perfectly practicable. For example, in 
 many modern institutions, where every anxiety is displayed 
 to promote the happiness and comfort of the inmates, the 
 same plan of moral treatment, the same enjoyments, the 
 same diet, are prescribed for all indiscriminately. It would 
 be as rational to treat common cold and consumption by 
 the same means, because they both attack the same organ. 
 The intention in this instance, is unquestionably to pro- 
 duce pleasure ; but it is benevolence acting without the 
 guidance of reason, which, for a momentary gratification, 
 forfeits the chances of recovery. Notwithstanding this, and 
 many similar inconsistencies and errors, which future phi- 
 losophers will perceive and correct, the movement which 
 commenced at the era alluded to, has produced incalculable 
 benefit, and tends towards still greater improvement. 
 
WHAT ASYLUMS ARE. l4l 
 
 The present system is imperfect, and falls short of a stand- 
 ard which is evidently attainable, chiefly because it is not 
 founded on, or regulated by any broad or practical philoso- 
 phical principle. Glimpses of truth occasionally break in 
 upon the minds of those who are the guardians of the lunatic, 
 and changes are effected in accordance with the discovery. 
 But no grand attempt has been made to place every part of 
 the treatment in harmony with his condition. We must not 
 quarrel, however, with great ameliorations, although they 
 flow from sources less exalted than what the sanguine might 
 desire. 
 
 Two of the earliest and most striking departures from the 
 time-sanctified system of force, are to be traced to the sub- 
 stitution of a system of imposture. So much evil has been 
 inflicted on man by superstition, that it is difficult to sup- 
 pose it contributing to his happiness. The same principle 
 which struggles to keep the mind in ignorance, seems, in 
 these instances, to have desired to keep it in peace, and to 
 restore to it intelligence. The first example of the com- 
 patibility of these objects is found in Egypt, where the most 
 enlightened views of modern science are recorded to have 
 been engrafted upon the darkest and most degrading forms 
 of ancient superstition. The temples dedicated to Saturn 
 were literally asylums of the best description. The inten- 
 tion of the priest was to enhance the popularity of the deity 
 of whom he. was the servant ; and his mode of effecting this 
 was founded upon a profound insight into the mechanism of 
 the being he designed to repair. He knew the boundless 
 credulity of his patients ; and to gratify this feeling, while 
 he used it as a powerful agent in giving efficacy to all sub- 
 sequent treatment, he declared that the cure about to be 
 performed was miraculous, and by the direct intervention 
 of his tutelar god. Having established this belief, recourse 
 was next had to all those means which a knowledge of mind 
 has shewn to be most conducive to restore its originaj tone 
 
142 WHAT ASYLUMS ARE. 
 
 and strength. Every new moral prescription was not, how- 
 ever, exhibited as a medicine, but as a formula of worship, 
 revealed by the benevolent member of the polytheism who 
 directed his energies to renovate the melancholic and the mad- 
 man. Under this guise, the crowds which frequented these 
 shrines were engaged in every healthful and amusing exer- 
 cise ; they were required to walk in the beautiful gardens 
 which surrounded the temples, or to row on the majestic 
 Nile. Delightful excursions were planned for them under 
 the plea of pilgrimages. Dances, concerts, and comic re- 
 presentations, occupied a part of the day, as constituting 
 the symbolical worship of some divinity. In short, a series 
 of powerful, yet pleasing impressions were communicated at 
 a time, and under circumstances, when the feelings were in- 
 spired with the most extravagant hope, and with perfect reliance 
 upon the power whose pity every act was intended to pro- 
 pitiate. The priests triumphed, and deserved to triumph. 
 The disease was subdued, and their reputation rose in pro- 
 portion. We cannot determine whether they trusted chiefly 
 to the mere will of Saturn, or to the discipline he had the 
 credit of suggesting ; or whether they believed at all in the 
 delusion which they propagated ; nor is it material to know. 
 The simple fact of the employment of such means is suf- 
 ficient to shew that exercise, occupation, and feelings of 
 enjoyment, were considered essentially contributive to the 
 efficacy of the miraculous interposition, if such was believed 
 to exist.* 
 
 The second example is drawn from a more recent period, 
 and is even more open to the suspicion of deception. The 
 village of Gheel, now attached to the asylum in Antwerp, 
 has long been celebrated as a retreat for lunatics. The 
 patients are boarded with the peasants, who employ them 
 in their gardens or fields. When unengaged, they are 
 
 * Voisin, Des Causes Morales et Physiques des Maladies Mentales, 
 p. 411. 
 
WHAT ASYLUMS ARE. 143 
 
 permitted to roam about at perfect liberty, and neither 
 accidents nor escapes are ever heard of. The labour is 
 compulsory, but is regulated according to the strength and 
 condition of the workman. The benefits which generally 
 accrue from air, exercise, and occupation, are considered as 
 of little avail in removing the disease, unless the patients 
 regularly once a-day pass under the tomb of a certain St. 
 Dymph, to whose sanctity, relics, and good offices, the re- 
 storation is solely attributable.* The ashes of this holy 
 personage constitute the riches of the place. The physi- 
 cians of Belgium may be sceptical of the virtue of these 
 relics, but they appear still to avail themselves of the respect 
 and confidence with which they are regarded by the lower 
 orders. Such a combination of work and penance is ad- 
 mirably suited to the character of a people in whom the 
 religious are the predominating feelings, and with whose 
 most ordinary and trivial transactions the ritual of the 
 Romish church is constantly interwoven. The cause which 
 produced these changes in a remote age, has led to the im- 
 provements which we claim as peculiar to the present. 
 
 From the absence of any common design in the alterations 
 which have taken place in the mode of conducting asylums, 
 and from the want of similarity in the alterations themselves, 
 no description can be attempted which would prove gene- 
 rally applicable ; so that my remarks must be classified into 
 statements of the excellencies and of the evils which attach to 
 the present condition of such establishments, particularizing 
 such countries or individual asylums as afford illustrations of 
 the one or of the other, but excluding from the investigation 
 those cases in which a maximum degree of improvement has 
 been attained, as properly belonging to the view of what 
 asylums ought to be. 
 
 Much of the present system may be described by nega- 
 
 * Diet, des Sciences Me'd. Carter, Short Account of Principal 
 Hospitals, &c. p. 191. 
 
144 WHAT ASYLUMS ARE. 
 
 tives. There is no classification, no employment, no exercise. 
 If you pass through an establishment, all may be tranquil, 
 orderly, and humane, but the inmates are lethargically 
 slumbering on chairs, or endeavouring to devise occupation 
 by tormenting their fellows, or circumventing their keeper. 
 Men have been proved to have remained seated in the same 
 spot, during the day, for a dozen years, without an attempt 
 being made to rouse their muscular or mental energies. 
 This species of negligence is often presented in a more 
 hideous form. Patients who at first are perfectly able to 
 walk, are allowed to remain in bed ; their limbs waste, con- 
 tract, are partially anchylosed, and they ultimately become 
 unable to rise. A contagious disease broke out in a small 
 asylum ; one-half of the patients died ; the bodies having 
 been carried to a public hospital, were inspected. In doing 
 this, numbers were found to have contracted limbs — a de- 
 formity which was traced to the practice to which I have 
 alluded ; the position being, in all probability, originally as- 
 sumed and retained in order to obtain as great a degree of 
 warmth as possible. 
 
 Where peculation no longer exists, and where the lunatic 
 is comfortably lodged and sufficiently clothed, there is still 
 great inattention to the mode in which the building where 
 he sleeps is heated. In winter he is compelled to pass, as if 
 in imitation of a Russian bath, from the temperature of a 
 crowded and probably over- heated common hall, to that of 
 a damp cell which has been cooled down by the indispensable 
 process of ventilation, to the freezing point. The cruel fallacy 
 that lunatics are insensible to cold and to other modifications 
 of pain, has long been acted upon. This error is counte- 
 nanced by three circumstances. First, In cases of acute 
 mania, from the state of the circulation there actually is 
 much heat developed at the surface ; secondly, In another 
 class of cases there does exist a degree of insensibility to 
 external circumstances ; and, thirdly, Lunatics rarely tell 
 
WHAT ASYLUMS ARE. 145 
 
 their sufferings. But in these as in all other cases the de- 
 pressing influence of cold must and does produce its usual 
 consequences. 
 
 Although we have passed the period when cruelty was 
 avowed and defended, if not actually prescribed, the spirit 
 characteristic of that period has, in some cases, been perpe- 
 tuated by avarice. Acts of oppression have been perpetrated 
 in defiance of a parliamentary commission, expressly ap- 
 pointed to detect and report such offences., which are worthy 
 of a darker age. One of these will suffice. In 1820, the 
 Commissioners found a patient in a private institution alone 
 in an out-house, without a fire — the visit was paid in winter 
 — the windows were broken, probably by his own act. He 
 was without shoes, but was in other respects sufficiently 
 clothed. After much prevarication and deception, it was 
 proved that this patient did not sleep in the apartment said 
 to be his, but in a miserable room up a private stair, con- 
 cealed by a door, which was discovered with considerable 
 difficulty. It was a single room, small and offensive, con- 
 taining only a wet and dirty piece of sacking filled with 
 straw, with one rug and a blanket. For this treatment the 
 patient paid L.50 per annum.* 
 
 One great revolution has been consummated, as a conces- 
 sion to public opinion ; slowly and reluctantly, but univer- 
 sally : one which every man can appreciate and applaud who 
 has a spark of benevolence in his composition, and whether 
 he understands the detrimental tendency of the former prac- 
 tice or not. Corporeal punishment has been professedly 
 abandoned. The lash is not openly seen, or recommended 
 as a medical instrument. That no cruelty is inflicted under 
 the ridiculous name of punishment, or the more specious 
 pretext of preserving order, it would be vain to expect ; but 
 the infliction is no longer acknowledged. The perpetrators 
 
 * Report, Pauper Lunatics in Middlesex, p. 158, 1827. 
 
 H 
 
^ 
 
 ? 
 
 146 WHAT ASYLUMS ARE. 
 
 shrink from, repudiate and conceal those deeds, in which a 
 few years back, if they did not absolutely glory, they at least 
 perceived no evil. The first object, then, is gained ; cruelty 
 is denounced as iniquitous and unnecessary. The next step 
 is' to shew that it is inconsistent with the personal interest of 
 those who are empowered to care for and cure the insane. 
 Were men generally actuated by pure and exalted motives, 
 it would be superfluous to advance further than an exposi- 
 tion of the anti-christian spirit of the system : but seeing 
 that they are not so actuated, the conviction must be im- 
 pressed upon their minds, that it is inefficacious in eradica- 
 ting or alleviating mental disease, and that it is inimical, 
 even fatal, to the reputation of all institutious where it is 
 sttpposed to be resorted to. That acts of cruelty are still 
 committed does not admit of doubt. They are less frequent 
 and less severe, but they have not ceased. But although 
 physical suffering be no longer inflicted, or inflicted to the 
 same extent, there are other species of harshness, nay, of 
 positive inhumanity, as repugnant to common sense and 
 common benevolence. Coercion is employed unnecessarily. 
 Either from the savage philosophy of terrifying into obe- 
 dience, and, it is to be presumed, into the possession of rea- 
 son, or from the despicable economy of employing a small 
 corps of keepers ; chains, muffs, manacles, are in many places 
 the substitutes for mildness and prudence, or suitable attend- 
 ance. Not only the violent and the destructive but the 
 perverse, even the restless and noisy maniac must be secured, 
 I presume for the preservation of order ; but that the keeper 
 may have more time to dispose of for his own amusement, 
 the same horrible practice is adopted. In fact, that he may 
 have freedom, they must be deprived of it. " I once," says 
 Tuke, " visited a house for insane persons, in which security 
 was a primary object. Here I saw three of the keepers, in 
 the middle of the day earnestly employed in — playing cards."* 
 
 * Description of the Retreat at York, &c-, p. 107. 
 
WHAT ASYLUMS ARE. 147 
 
 A refinement upon the old mode of economizing the labours 
 of keepers has been brought to light by the investigations of 
 the Commissioners. The patients were compelled to remain 
 in bed, or, as the terms of the justification run, were allowed 
 to remain in bed during the whole of Sunday, in order that 
 the servants of the establishment might visit their friends.* 
 It is possible that the wishes of the patients themselves sug- 
 gested this practice ; but the gratifications of such desires 
 would convert every day into one of rest and sleep, and 
 sacrifice the interests of ultimate restoration to lethargy or 
 whim. One of the excuses for resorting to such expedients, 
 and for keeping a number of miserable creatures in chains, 
 darkness, and filth, for thirty-six hours, was the small num- 
 ber of keepers employed. The reason was, in one point of 
 view, valid. Servants so engaged are often timid, although 
 otherwise well-disposed, and seek for protection : or they 
 become depressed and gloomy, contaminated by the atmo- 
 sphere in which they move, and seek for intervals of liberty 
 as a relief. And unless actuated by a high sense of duty, 
 they will not hesitate to obtain these objects, if the attain- 
 ment does not lead to a glaring dereliction of duty. They, 
 more than any other class of servants, undoubtedly require 
 periods of relaxation ; and the way to remove all temptation to 
 obtain these by compromising the interests of the patients, is to 
 have a large body employed. It appears that in one instance 
 three keepers were expected to guide, govern and soothe 
 250 patients. In another asylum, 164 patients were intrusted 
 to two keepers. In a third, each servant was appointed to 
 take charge of 50 patients. The proportion usually is one 
 keeper for 30 lunatics. This means that one man or woman 
 is to attend to all the wants and wishes, regulate the employ- 
 ments and amusements, counsel, tranquillize, walk and con- 
 verse with, feed, clothe, and put to bed thirty persons, every 
 
 * Report, Pauper Lunatics in Middlesex, &c-, pp. 22, 30, 37, 90, 
 1C9, &c. 1837. 
 
148 WHAT ASYLUMS ARE. 
 
 one of whom displays a different form of insanity, is furious 
 or fatuous, malicious or melancholy. The proposal is alto- 
 gether preposterous. Formerly every female keeper in 
 Bethlem had sixty patients under her care. This state of 
 things is strongly contrasted with the law on the subject in 
 France, which accords one keeper for every ten lunatics. 
 
 To return to the subject of restraint. That there are some 
 lunatics so completely stript of the attributes of intelligence 
 and moral feeling, as neither to perceive nor to suffer from 
 the galling thongs with which they are bound, is true. Such 
 are the fatuous and imbecile, in whom every power more 
 elevated than the impressions of hunger and thirst is oblite- 
 rated, and where no restraint is demanded. But such cases, 
 eVen when including those of furious maniacs, who are so 
 pre-occupied by some engrossing emotion as to be insensible 
 to every external circumstance, are rare, when compared 
 with the numbers of timid maniacs whose energies are for 
 ever paralyzed ; of irascible maniacs whose feelings of anger 
 and opposition are roused to a whirlwind of passion ; and of 
 proud maniacs, whose innocent arrogance is needlessly 
 wounded by the badges of moral slavery. There is now no 
 ground for retaining this practice as a means of cure. As a 
 source of protection it is sometimes indispensable : on all 
 other pretexts it is cruel and oppressive. Even when una- 
 voidable it may be deprived of some of its horrors : the 
 appearance of force may be concealed : the apparatus may 
 be of the least repulsive description, and for bodily coercion, 
 confinement to a private room, classification, or permanent 
 isolation may be substituted. The best and most humane 
 judge of the mutual rights and relations of madmen and 
 their keepers, Esquirol, has said that the only estimate which 
 can be formed of the character of a house of detention, must 
 be founded on the number of individuals actually coerced. 
 And this estimate applies not merely to the general gentle- 
 ness, but to the efficacy of the treatment pursued. Bu$ 
 
WHAT ASYLUMS ARE. 149 
 
 although coercion is less resorted to, the adoption of the 
 opposite method is slow, reluctant and partial. Not many- 
 years have elapsed since in one hall of an asylum, of very 
 recent erection, not fewer than eighteen out of twenty-seven 
 male patients were chained, muffed, or strapped to their 
 seats. A keeper, when first intrusted with these men, was 
 cautioned that his life would not be safe for an instant unless 
 he adhered to the plan then existing. A brighter destiny lias 
 dawned upon these unfortunate beings. In the very same 
 hall, containing the same number of persons and many of 
 the same individuals, there is not now more than one requir- 
 ing restraint. 
 
 The mere conviction that surveillance exists, that they are 
 watched and distrusted, is sufficiently painful to the self- re- 
 spect and sense of honour which many lunatics cherish, 
 without the degradation, — for to minds so constituted it must 
 appear degradation, — of personal thraldom. When violence 
 or disobedience is displayed, it is never supposed that there 
 are any other modes of controlling these than by brute 
 force. A common axiom inculcates, that to obtain confidence 
 it is necessary to confide. But all common axioms are set 
 at nought in an asylum. Xo effort is made to act upon the 
 sentiments of probity, or love of approbation, which are as 
 strong, cet. par. in the insane as in the sane mind ; and what 
 might be obtained by a promise, by an appeal to honour, or 
 by some well-chosen expression of admiration, is extorted by 
 a command or a chain. 
 
 The frequency with which restraint is even justifiably im- 
 posed, depends, in a great measure, upon the immediate 
 attendants of the insane. And, unfortunately, this tremen- 
 dous power is too often confided to men altogether unworthy 
 of the trust. The labours of such a situation are great, 
 varied, and of the most delicate nature. They are not, or 
 ought not to be limited to the administration of food, atten- 
 tion to cleanliness, or the prevention of escape, but should 
 
150 WHAT ASYLUMS ARE. 
 
 extend to the task of arousing and engaging such of the 
 faculties of the patients as still remain healthy, of amusing 
 or occupying all who are susceptible of such impressions — 
 of soothing the irritable and captious— of inspiring the des- 
 ponding with hope — of presenting to all, such objects as are 
 calculated to communicate present enjoyment, and to re- 
 store the current of thought to its ordinary channels. Such 
 ministrations comprise a moral treatment of the most ex- 
 tended and exquisite form. Yet to carry this into execution, 
 to set this complicated machinery in motion, who are the 
 persons, and what their standing and acquirements who are 
 employed? Do they possess natural talents or education 
 sufficient to perceive and to adapt their own behaviour to 
 the dispositions of those whom they are appointed to attend ? 
 Have they any knowledge of the human mind in its strength 
 or in its decay ; or are they even instructed in the routine 
 of duties which devolve upon those who have to superintend 
 the personal comforts of twenty or thirty men ? Are they 
 in general distinguished for patience, kindness, or those 
 conciliating manners which secure the affections, and through 
 them the obedience or friendly co-operation of all who come 
 within their influence. To not one of these qualifications 
 has the great majority of servants in asylums the slightest 
 pretension. To shew the ideas entertained by such person- 
 ages of insanity, one fact may suffice. The superintendent of 
 a public asylum, on paying his forenoon visit, found one of the 
 patients, and one subject to frequent fits of excitement, poised 
 upon his head. The keeper was seated by the fire, reading ; 
 and on being questioned as to the meaning of the scene, re- 
 plied, " O, Mr. D. is perfectly quiet ; he has been standing 
 on his head for the last half hour !" From the lowness of 
 the wages, and the difficult and sometimes dangerous duties 
 exacted, such servants are often of the very worst caste ; I 
 mean, of course, the worst adapted for such an office. They 
 are hired for the express purpose of acting as spies or watch- 
 
WHAT ASYLUMS ARE. 151 
 
 men, and they aspire to no higher sphere of utility. Coarse 
 and uneducated, their presence is offensive to all individuals, 
 either of polished mind or manners, or who have been ac- 
 customed to attendants of a better grade ; and their society 
 can be of no use, even if it be agreeable, to those who might 
 be soothed by compassion and affability, or improved by 
 intercourse with a person who could understand, and couU 
 direct to better objects, the distempered fancies under which 
 they labour. Keepers are the unemployed of other profes- 
 sions. If they possess physical strength, and a tolerable 
 reputation for sobriety, it is enough; and the latter quality 
 is frequently dispensed with. They enter upon their duties 
 altogether ignorant of what insanity is, fully impressed with 
 the idea that the creatures committed to their charge are no 
 longer men, that they are incapable of reasoning or feeling, 
 and that in order to rule or manage, it is necessary to terrify 
 and coerce them. They may not be devoid of good temper, or 
 active kindness ; but from their inability to employ these 
 agents, and often from a belief that it is contrary to rule to 
 employ them, they will be found to punish, domineer, and 
 restrain, to the same degree as if actually cruel and tyran- .. 
 nical. The physician who has trained his powers for a life 
 time, in penetrating into the depths of the diseased mind, 
 and who, with all the assistance derived from such experi- 
 ence, from the views and observations of others, and from 
 the tranquillity and benevolence of manner which he has 
 learned to assume, should it not originally be his own ; 
 often — how often, let the candid say — fails signally in de- 
 tecting the prevailing sentiments, in pacifying, in bending 
 to or from a certain purpose, in rendering happy. Yet, in 
 modern asylums, a similar course devolves upon the class of 
 persons of whom we have spoken ; and who, if they do not 
 shrink from the responsibility which they incur, ought to 
 pursue it unflinchingly and unceasingly. From the indi- 
 viduals who, at present, occupy such situations, it would be 
 
152 WHAT ASYLUMS ARE. 
 
 absurd to expect any co-operation of this kind. Until man- 
 kind perceive that it is as necessary that he who undertakes 
 to assist in improving the condition of the insane, should be 
 instructed in the mode of doing so, as he who professes to 
 improve the condition of the soil — all that can be expected 
 is a capability of securing the affections of the patients, and 
 a docility in promoting the plans suggested by others. 
 i( Your first attempt," I was once told, iC ought to be to cure 
 your keepers ; you need not proceed to your patients until 
 you have done so." Apart from the necessity of preserving 
 order, there is a necessity for the presence of a number of 
 this class of servants, arising out of the obvious evil of con- 
 lining a lunatic among lunatics. This evil, which is, of 
 course, unavoidable, may be materially mitigated, first, by 
 the introduction of keepers of strong, healthy, well-con- 
 stituted minds: secondly, by possessing ample means of 
 classification ; and, thirdly, by the exercise of sound discre- 
 tion in the selection of those who are to associate together. 
 The disposition, rather than the rate of board, should be the 
 principle of this choice. The magnitude of the error com- 
 mitted, in banding together a crowd of lunatics in the same 
 hall, without any reference to the extent or form of their 
 malady, may be gathered from the feelings of horror and 
 distraction excited in a perfectly unimpaired mind, on com- 
 ing into abrupt contact with the heterogeneous inmates of an 
 asylum ; or it may be more strikingly illustrated by the 
 pernicious consequences arising from the indiscriminate 
 intercourse permitted in prisons. How can the already 
 insecure and tottering intellect fail to be shaken by the 
 ribaldries, the ravings, the delusions which assail it from all 
 sides ? Or how can healthy impressions be received in such 
 an infected region ? Besides the constant excitement, the 
 trepidation, the sentiment of disgrace or disgust which must 
 be produced, positively new delusions may be suggested by 
 this intercommunion, and so successfully engrafted, as to 
 
WHAT ASYLUMS ARE. 153 
 
 supplant those originally characteristic of the disease. An 
 example of this was recently under my care. A woman 
 believed herself to be our Saviour ; and so excellent a prose- 
 lytizer was she, that she completely convinced one of her 
 fellow-patients of the truth of her pretensions, and so far 
 staggered another by relations of miracles, visions, and so 
 forth, as to induce her, occasionally, to acknowledge the 
 divinity claimed. Intercourse with healthy minds is, in fact, 
 indispensable ; and at such stages of the disease as permit 
 of the experiment, the greater the extent to which it is tried 
 the better. The visits even of strangers is often beneficial, 
 by interrupting the chain of morbid fancies, by arousing 
 feelings long dead or dormant, and by re-establishing that 
 bond of connection with the external world and its affairs, 
 which lunatics often conceive, and often conceive with rea- 
 son, is dissevered. Were a regular system, founded on such 
 views, instituted and carried into operation by persons pro- 
 perly qualified, the benefit might be expected to be great 
 and permanent. A practice somewhat similar to that here 
 recommended, at one time received the sanction of the di- 
 rectors of the Retreat at York, but it does not appear to have 
 been pursued to its legitimate extent.* Indeed, with its full 
 application the timidity and prejudices of the public, from 
 whom, under such circumstances, must arise the voluntary 
 moral physicians, will, for a long period, it is to be feared, 
 interfere with such outpourings of humanity, or direct them 
 into channels widely different. Various expedients may be 
 had recourse to in order to supply the deficiency. One of 
 these is to take advantage of the different forms and degrees 
 of alienation, and to employ him who is gentle and good- 
 tempered to take charge of him who is habitually irritable 
 and unruly, or to induce the partially insane, he who is 
 irrational ten degrees, to associate with, and teach him who 
 
 * Tuke. Description of the Retreat, &c. 
 
154 What asylums are. 
 
 is irrational twenty degrees. I have been informed that this 
 principle is acted upon in the excellent asylum at Perth. To 
 apply such a plan upon a grand scale would require great 
 delicacy in the anatysis of character : but if this be stated as 
 an objection it equally attacks the very foundation of mental 
 medicine. 
 
 If it be true that the lunatic at the incursion of the disease 
 maybe injured, his cure retarded or prevented, by injudici- 
 ously consigning him to the society of those whose deportment 
 must disturb or confuse, it will still less admit of question that 
 at the period of convalescence, the same danger must exist 
 and be felt in tenfold measure. The ease with which relapses 
 may be induced, the trifles which induce them are known to 
 all : but the knowledge has but in few instances led to any 
 provision by which the exciting causes, existing in hospitals, 
 may be removed. No separation takes place of those who 
 are recovering from those who are lapsing, or have already 
 fallen into a state of confirmed insanity. Even subsequent to 
 the complete restoration to health, and during the interval of 
 probation, which is generally allowed to elapse between that 
 period and the dismissal of the patient, no new arrangement 
 is made. No one perceives the cruelty of thus compelling the 
 sane to mingle with, and to run all the risks of mingling with, 
 the insane. We remove the man recovering from fever from 
 the effects of the presence of individuals similarly affected, 
 and assist the progress of his convalescence by a change of 
 scene or society, cheerful occupations and moderate exercise; 
 butno such indulgence, no such precautions against a renewal 
 of the disease is extended to the lunatic ; he is left exposed 
 to the same influence as before. In France convalescent 
 wards exist in almost every asylum, and in our own country 
 the propriety of such an arrangement is generally admitted. 
 Where any efforts have been made to group lunatics together, 
 the principle adopted, that is the classification into noisy, 
 tranquil and convalescent, is too vague and too contracted. 
 
WHAT ASYLUMS ARE. 155 
 
 It is not even enough that the idle shall be separated from 
 the industrious, that the depressed and desponding be pro- 
 tected from the riotous bacchanal, the tyrannical and the 
 deceitful. The slightest differences of disposition, and sym- 
 pathies in pursuit or taste must be taken advantage of, and 
 made the basis of separation and association. Dr. Abercrombie 
 quotes a case from Pinel, exhibiting the evils of ignorance or 
 negligence of such indications of treatment. A musician, 
 confined at Bicetre, as one of the first symptoms of returning 
 reason, made some slight allusion to his favourite instrument. 
 It was immediately procured for him : he occupied himself 
 with music for several hours every day and his convalescence 
 seemed to be advancing rapidly ; but unfortuuately he was 
 then allowed to come frequently into contact with a furious 
 maniac, by meeting him in the gardens. The musician's 
 mind Mas unhinged — his violin was destroyed, and he fell 
 back into a state of insanity which was considered as confirm- 
 ed and hopeless.* Had his companions been selected from 
 musicians, or those who delight in music, or even from the 
 calm and amiable, his reason might have been saved. 
 
 There are certain glaring incompatabilities of character 
 among lunatics which must strike, and ought to guide, the 
 least observant physician in his practice. 
 
 1. Some lunatics enjoy a quarrel; one as a promoter, 
 another as a spectator, a third as a participator. 
 
 ± The language of one is a mixed jargon of oaths, blas- 
 phemies and maledictions : the distempered fancy of another 
 receives these as oracles from Heaven. 
 
 3. An oppressor soon discovers a slave ; a sovereign, a 
 subject ; a fanatic, some self-deified maniac to worship. 
 
 4. The confiding are betrayed by the falsehoods and chi- 
 canery of the cunning: the timid are terrified by brutality 
 and arrogance ; the unsuspecting and unprotected are cheat- 
 ed and plundered. 
 
 * Inquiries concerning the Intellectual Powers, &.c. p. 353. 
 
156 WHAT ASYLUMS ARE. 
 
 All recent writers on insanity have spoken loudly in praise 
 of moral treatment. But they have spoken vaguely of its 
 nature. Each of them attaches a different meaning to the 
 word. Employment is the panacea of one ; amusement is 
 the specific of another; classification is advocated by a third. 
 Now, were every lunatic busily engaged in a suitable occu- 
 pation : were recreations adapted to the dispositions or 
 previous predilections of all provided : was classification, even 
 on the broad basis which I would assign, universally adopted; 
 moral treatment, if confined to one or all of these, excellent 
 though they be, would be imperfect and comparatively inef- 
 ficatious. The authors to whom I have alluded have mistaken 
 parts, unexceptionable, it is true, but still merely parts of the 
 system for the whole. Every arrangement, beyond these for 
 the regulation of the animal functions, from the situation, the 
 architecture and furniture of the buildings intended for the 
 insane to the direct appeals made to the affections by means 
 of kindness, discipline, and social intercourse, ought to be 
 embraced by an effective system of moral treatment. Even 
 many of the details which affect personal comfort alone are 
 of greater importance, as moral, than as physical agents. 
 The denial of an article of dress, or an unanswered bell, has 
 produced aparoxysm of fury. It is not prudent nor conducive 
 to health to comply invariably with the frivolous demands or 
 unreasonable desires of lunatics ; neither is it prudent, nor 
 will it conduce to health, to act invariably upon the principle 
 of resisting these demands and desires, because they are 
 frivolous and unreasonable. Both of these errors are detect- 
 able in the existing system. The resistance or compliance 
 should be regulated not by the nature of the demand but by 
 the state of mind of the individual by whom it is urged. 
 Great use may be made of self-created wants. The partiality 
 for a piece of dress, or a cup of tea, is often found to be a 
 more powerful lever in acting upon the intractable, than sage 
 counsel or religious impressions. The rule formerly was, 
 
WHAT ASYLUMS ARE. 157 
 
 and I suspect still is, to render an asylum as unlike the home 
 of which the patients had been deprived as possible. In 
 application, this was a partial and one-sided rule, however 
 specious and judicious it may appear. If the patient's home, 
 for instance, had been miserable, no attempt was seriously 
 and systematically made to reconcile him to the change by 
 increasing his comfort and happiness. The grand object was, 
 and perhaps is, to multiply impressions which would inspire 
 awe, submission, quiet, a wish to conceal, if not to correct, 
 the sallies of inordinate passion ormisdirected intellect, andan 
 anxiety to escape from such restraint. This might be calcu- 
 lated to subdue the refractory and to weary out the perverse. 
 But while, in all probability, it would fail to cure even these, 
 what must its effects have been on the much more numerous 
 classes, the desponding, the suspicious, the timid, the vain ? 
 Placing out of consideration the pernicious influence of such 
 a plan in relation to the particular feelings diseased, it obvi- 
 ously and unnecessarily diminishes the amount of enjoyment 
 in which persons so affected, could, without injury, partici- 
 pate. 
 
 In a bill recently submitted to Parliament as to the regula- 
 tion of asylums, it was proposed to invest the commissioners, 
 to be appointed under it, with the power of visiting all houses 
 of the kind during the night.* The proposal was, I believe, 
 negatived in consequence of the almost unanimous opposi- 
 tion of the medical men consulted on the subject : but it 
 indicates two things, — First, a total want of confidence in 
 the probity and competency of the managers of such institu- 
 tions, and upon this ground it was approved of by some 
 medical men ; and, secondly, as total a want of knowledge 
 of the interests of the insane on the part of the legislator. 
 Such visits might disclose some of the evils which it is desir- 
 
 * Minutes of Evidence taken before the Select Committee, 1S28, 
 passim. 
 
J 58 WHAT ASYLUMS ARE. 
 
 able were corrected, but it would undo all that which quiet 
 and care had effected, by rousing every inmate to fear or 
 fury, and thus realizing the delusions which sleep so often 
 weakens or eradicates. 
 
 There exist a class of injuries connected with that discussed 
 above, which are as cruel and destructive of peace as the 
 laceration of the lash, or the deep degrading ulcer excavated 
 by the fetter, but which no medical or other commission, 
 however probing and penetrating its inquiries, could reach. 
 The inquisitors might be actuated by the best motives and 
 by the clearest views of the great duty which they had under- 
 taken, and their visits might have been often repeated, 
 .unannounced and inopportune, and yet nothing but the 
 most glaring errors and inconsistencies of the system which 
 they desired to investigate could be detected. They could 
 see the physical misery which it inflicted, the disease and 
 death which ensued, and they might believe that the sum of 
 its iniquities were numbered. But they could not see the 
 thousand moral impressions of pain and anxiety and offended 
 delicacy which daily and hourly embittered the existence of 
 the lunatic. They could not separate the suffering which 
 was the result of insanity, from that which arose out of the 
 situation in which the lunatic was placed, or from the various 
 sources of annoyance to which he was exposed. The inter- 
 ested and offending party would be the last to reveal the 
 insults, the ridicule, the disgusting expressions, or, where 
 no intentional culpability could be charged, the offensive or 
 irritating conversation with which he assailed his victim : 
 and, unfortunately, the testimony of that victim is not re- 
 cognized as admissable. I hold this disqualification to be 
 not merely unfortunate but unjust. A wide distinction 
 ought to be drawn between the evidence of an insane per- 
 son as to what he believes and as to what he feels. His 
 opinions may be delusions, his feelings cannot. Under a 
 system, the grand principle of which was fear, he might, if 
 
WHAT ASYLUMS ARE. 159 
 
 unconscientious and desirous to deceive, complain of greater 
 injuries than what he actually received: but still there would 
 exist ground for his appeal. Under a rule of love, there is 
 nothing real or imaginary of which to complain. From this 
 distinction never having been acknowledged, and from con- 
 stantly rejecting every statement made by a lunatic as 
 unworthy of credit, the information on this part of the 
 subject is necessarily defective. Enough, however, has 
 been ascertained, and enough even now remains of that 
 disregard to the feelings of insane patients, that some idea 
 may be formed of the nature, although not of the extent of 
 the moral torture to which the}' were necessarily subjected. 
 It is to be hoped that this callous indifference proceeded, 
 and is still manifested, in many cases at least, from the pre- 
 posterous assumption that lunatics had no feelings, that they 
 did not feel as other men. Their bodies were said to be 
 unaffected by cold, and it was concluded to be analagous 
 reasoning to hold that their minds could not be stung by 
 shame, or dishonour, or injustice. But our business is less 
 with the cause in which such conduct originated, than with 
 its disgraceful inhumanity and its evil consequences. The 
 exploded system has been well characterized as one in which 
 "madmen were employed to torment madmen," and the 
 following relations, applying although they do to the re- 
 mains only of that system, appear to justify the force of the 
 accusation. Keepers, the tormentors alluded to, rarely at- 
 tempt to soothe or persuade : in addressing their charges 
 they employ at best heartless or harsh terms, and often 
 oaths and blasphemies, upon the principle of terrifying into 
 obedience. I do not doubt the success of such an expedi- 
 ent. But if it be recollected what effect such expressions 
 will produce on a well-constituted mind : upon the timid, 
 or the virtuous : if it be recollected, that in the irritable and 
 the passionate they will excite propensities corresponding to 
 those from which they emanate, it may be imagined, that 
 
160 WHAT ASYLUMS ARE. 
 
 they fall with tenfold force upon minds impaired and ener- 
 vated by disease, labouring under the monomania of fear, 
 viciously disposed, and, at the same time, furiously mad : 
 upon all, in fact, and there are ninety such in every hun- 
 dred, retaining a sufficient degree of intelligence to under- 
 stand the import, and a sufficient degree of feeling to be 
 disturbed and disgusted by the ribaldry and cruelty of what 
 is addressed to them. The mind in many cases of mania, 
 in place of becoming obtund or deadened, is endowed with 
 an unnatural sensitiveness, with an acuteness of perception, 
 upon which the insults and insinuations of the rude or the 
 indelicate, or the positively cruel must act in the same raan- 
 •ner, and must produce pain upon the same principle that 
 harsh sounds and bright light grate upon the eye and ear 
 when excited by fever. 
 
 To females, whom nature has wisely made more keenly 
 alive to propriety of external deportment, and to the refine- 
 ment and purity of language, it has been proved, that the 
 most gross obscenities have been addressed, the most offen- 
 sive gesticulations exhibited, and this by individuals of their 
 own sex, by those very persons to whose tender mercies 
 they were intrusted. The maniacs may or may not have 
 been sensible of the treatment which they received, its bru- 
 tality will not, however, be abated one jot by supposing that 
 it was expended in vain. Females who, from their original 
 situation in life, had been accustomed to all the luxuries of 
 dress, have been allowed to expose themselves in a state 
 bordering upon nudity, and then derided for the exposure. 
 If the unfortunate sufferers were at any time conscious of 
 their condition, how bitter the taunt : if reason ever return- 
 ed, how bitter the recollection. The observation has often 
 been made by those who have paid but transient visits to 
 institutions for the insane, and is perfectly familiar to those 
 who have been domesticated in such abodes, that the impre- 
 cations, profane and indecent expressions, which are heard 
 
WHAT ASYLUMS ARE. 161 
 
 even from the lips of those who, previous to the incursion of 
 the disease, it is certain were respectable, chaste and virtu- 
 ous, are horrible and altogether unaccountable. On making 
 this remark to a physician who has spent a long lifetime in 
 philanthropical attempts to uproot the prejudices and in- 
 justice which obtain wherever the insane are concerned ; and 
 adding my surprize as to where patients of superior rank 
 and unblemished reputation could have learned such words, 
 the rejoinder was emphatic and humiliating, — " Sir, they 
 have been taught here : the wages of our servants are ex- 
 tremely low : we are accordingly compelled to receive what- 
 ever applicants may present themselves without much scru- 
 tiny as to character or previous conduct, and consequently 
 the vile and abandoned flock to us because they will not be 
 admitted elsewhere, and because we must have keepers. 
 They inevitably bring with them their vices, and although 
 under a certain degree of moral restraint, they cannot be 
 prevented from propagating them, and thus corrupt all 
 around, debasing still further those whom it is their duty to 
 elevate." This happened in a country which boasts, and 
 perhaps truly, of having taken the lead in the race of im- 
 provement, where paupers live in palaces, and a certain 
 class of pensioners are served off plate. The blindness of 
 Humanity is often singularly contrasted with that of Justice. 
 The assertion, quoted above, must not be admitted without 
 certain limitations, in as much as there are certain forms of 
 mania which predispose, independently altogether of the in- 
 fluence of servants or any other secondary cause, to the use 
 of the most gross and revolting language. 
 
 The practice of ill-disciplined school-boys has often been 
 transferred to those places of refuge, where the imbecile or 
 lunatic seeks, or at least ought to find protection from ag- 
 gression ; and the very helplessness or delusion which it is the 
 object of such places to remove, has been made the subject of 
 merriment or derision. Conceive the poor idiot serving as 
 
162 
 
 WHAT ASYLUMS ARE. 
 
 the butt for his protector or physician. Certain animals 
 destroy or persecute the weak and defenceless of their own 
 species ; man, without the guidance of the higher sentiments, 
 acts similarly. Sane and insane acts from the same im- 
 pulses, and in the latter, as well as in the former, there exist 
 sore points, jarring strings, which, if touched, the whole soul 
 is roused under the infliction of pain to incontrollable fury, 
 or to that degree of excitement when its peculiarities be- 
 come visible. This experiment was frequently tried, and 
 for a very obvious reason, especially when visitors were pre- 
 sent. The very flame which it was essential to smother, 
 was thus fanned and kept perpetually burning. The proud 
 maniac was told that he was not a king, in order to witness 
 the extent of his royal rage : the desponding maniac was 
 confirmed in his forebodings and fears, that the wildness of 
 despair might be embodied; and the incoherence of the 
 idiot was encouraged, that a laugh or a jest might not be 
 wanting. A still more systematic mode of aggravating 
 disease is on record, where two lunatics were induced to 
 quarrel — were inspired with mutual dislike and distrust — 
 where the strong was allowed to tyrannize over the weak, 
 or the fool set to mock the fool. It is somewhat difficult to 
 estimate either the motives or the effects of such conduct. 
 But this much may be affirmed, that as neither cure nor 
 alleviation could possibly be the object, neither could they 
 possibly be the result. Pinel acknowledges, that in his own 
 experience, lunatics, who were perfectly composed, and in 
 a fair way of recovery, have, in consequence of the silly 
 raillery and rude brutality of their attendants, relapsed into 
 the opposite condition of violent agitation and fury.* Tuke 
 gives an instance of the same kind.f These statements 
 may, and I hope will be received with loathing ; but it is 
 necessary for the accomplishment of the object now in view, 
 
 * Pinel. Treatise on Insanity, p. 67. 
 •Y Description of Retreat, &c. p. 144. 
 
WHAT ASYLUMS ARE. 163 
 
 that the whole truth should be known. There is a diffi- 
 culty in determining the amount of misery the human heart 
 can bear : there is equally a difficulty in determining the 
 amount it will inflict. The following description, however, 
 which is quoted verbatim, lest a particle of the effect should 
 be diminished or increased by a change of expression, ap- 
 proaches as nearly to the climax of human suffering and 
 human ferocity as can be imagined. " Another case which 
 
 I laid before the governors, was that of the Rev. Mr. 
 
 He was a clergyman reduced to indigence, I believe, in 
 consequence of his mental complaint. He had at times, and 
 for considerable periods, intervals of reason. In these in- 
 tervals, when he was perfectly capable of understanding 
 every thing that was said or done to him, repeatedly in the 
 presence of his wife, he was exposed to personal indignity ; 
 and on one occasion, he was inhumanly kicked down stairs 
 by the keepers, and told, in the presence of his wife, that 
 he was looked upon as no better than a dog. His person 
 swarmed with vermin ; and to complete this poor man's 
 misery, the keepers insulted his wife with indecent ribaldry, 
 in order to deter her from visiting him in his unfortunate 
 situation. He had a gold watch which was lost there, and 
 which his wife could never recover."* This description be- 
 longs to the past ; but unfortunately, all the features of which 
 it is composed, with the exception, perhaps, of personal vio- 
 lence, might be used to characterize the evils of the system 
 still prevailing. Within a very short period, an instance has 
 fallen under my own observation, of a superintendent re- 
 fusing to sit down at table with a lady, one of his own 
 patients, and a person of good birth, education and man- 
 ners, because, and the reason was used in her presence, she 
 was a « mad creature." Surely it is a matter for regret, 
 that to men so ignorant and brutal, should be committed 
 
 * First Report from Committee on Madhouses, 1815. Evidence of 
 Godfrey Higgins, Esq. 
 
164 WHAT ASYLUMS ARE. 
 
 the care of the " mind diseased." For weeks, and some- 
 times for months, they have the sole and irresponsible 
 control of hundreds of patients ; they constitute at once the 
 legislative and the executive ; they decree, and with their 
 own hands inflict punishment ; or, should they feel disposed 
 to diminish their labours, they subsidize convalescent pa- 
 tients to perform the more menial duties, reserving for 
 themselves all the higher privileges of office.* The indis- 
 criminate employment of lunatics who are partially recovered, 
 to wait upon their less rational companions, is certainly to 
 be condemned. Under proper regulation, the attachment 
 of one patient to another, either as a friend or a servant, 
 proves highly beneficial to both parties ; but what is least 
 justifiable in the custom to which I have adverted, is the 
 substitution of patients for keepers, endowed with all the 
 tremendous power of coercing, confining, punishing, and 
 further, the detention of these useful convalescents, in order 
 to diminish the number of regular attendants. 
 
 The necessity for employing only well educated servants 
 in the care of the insane, has been so strongly felt in France, 
 that in many establishments the keepers are required to have 
 undergone a system of training previous to their appoint- 
 ment. They serve a sort of apprenticeship, if the expression 
 be allowable, attending some of the large public asylums as 
 assistants, where they have ample opportunities for observa- 
 tion, but are not intrusted with the charge of patients. This 
 laudable example has, in some few cases, been followed in 
 our own country. Tuke states, " several persons about to 
 engage in the superintendence of similar establishments, 
 have made a temporary residence at York, and have been 
 permitted to observe daily the economy of the house, and 
 the mode of managing the patients."f This is the true way 
 of grappling with the evils of the old system. We require 
 
 * Report Pauper Lunatics in Middlesex, pp. 171, 33, &c. 1827. 
 
 t Description of Retreat. Preface, p. 12. 
 
WHAT ASYLUMS ARE. 165 
 
 certificates of character from cooks and coachmen ; we ex- 
 pect from them previous experience, probity, a knowledge 
 of the duties they have to perform. It is never dreamed, 
 that the rude hewer of wood, and drawer of water, can at 
 once be transformed into the compounder of the delicacies 
 of the table, or the guardian and guide of animals " of price." 
 A greater transformation, however, has hitherto been ex- 
 pected to take place, in those promoted from wielding the 
 shuttle, or erecting a dwelling-house, to wield the happiness 
 of men, and in great measure reconstruct the shattered mind. 
 It has never been considered that the keeper is the principal 
 agent in leading the mind back to its original condition. 
 Many difficulties exist in this country, which must be over- 
 come before such training as that instituted in some parts 
 of France could ever be proposed. Our asylums are shut 
 against the medical student who pants and would pay ex- 
 orbitantly for the instruction to be gathered within ; and 
 it would be vain to hope that in this age of speculation 
 they will be opened to the domestic, whose only plea for 
 admission is poverty. But although it be highly desirable 
 that those undertaking so delicate and difficult a task should 
 be suitably prepared, sound objections may be urged against 
 the conversion of asylums into normal schools for this pur- 
 pose. Unless such a suggestion could be carried into effect 
 in some of the large metropolitan institutions appropriated 
 exclusively to paupers, its success must be despaired of. 
 The reservation " exclusively to paupers" is used advisedly. 
 Wherever the rich lunatic is confined, a veto will at present 
 be placed upon such a plan. But on the same principle, 
 and I regard it as dictated by the most exalted humanity, 
 that the poor, labouring under disease of the body, when 
 admitted to an hospital, partly remunerate that public by 
 whose charity they are supported and treated, by contribut- 
 ing to the instruction of the surgeon and physician, in like 
 manner might nervous disease be studied, and the treatment. 
 
■166 WHAT ASYLUMS ARE. 
 
 moral and medical, of such of its victims as are placed in 
 public asylums, be observed by those who are ultimately to 
 be engaged in attempting to mitigate similar cases. In place 
 of the patients being injured by the admission of students, 
 they would in many cases be decidedly benefited: and 
 wherever the consequences of such a visitation would be 
 either dangerous or doubtful, no judicious physician would 
 allow it to take place. At Salpetriere this system of tuition 
 has been long in operation. Until this view be taken, or 
 until it be practicable, there is still another expedient by 
 which respectable and well-informed men might be se- 
 cured as attendants. As these must be selected from the 
 mass of the community, their qualifications will, of course, 
 he more general and characteristic of the class to which 
 they belong. We must be content with kindness of heart 
 and intelligence. To these there need be no limit. But 
 how, it may be inquired, can individuals so endowed, be 
 drawn from their ordinary occupations ? The answer is, 
 by raising the status in society assigned to them, and by 
 very largely increasing the remuneration they receive. 
 The cooks and coachmen, whose case has been before 
 quoted, are paid by enormous, but it may be adequate, 
 salaries ; larger, or, at least, in many instances as large 
 as those given in situations requiring the exercise of talent 
 and a long preliminary education. To those, again, whose 
 care is the human mind, — for in no other light can the 
 office of an attendant upon the insane be viewed, — a pit- 
 tance is given, not only far below the allowance to cooks 
 and coachmen, but which is even less than can be realized 
 by the common artizan, by thousands engaged in the most 
 servile employments. And if it be recollected, that the 
 labour of the conscientious keeper never terminates, that he 
 has neither nights nor days of rest, that anxieties, provoca- 
 tions, disappointments, and disgusts, follow each other in 
 constant succession, that his only respite is, or ought to be, 
 
WHAT ASYLUMS ARE. 167 
 
 in the recoveiy of his patients, it will become matter for sur- 
 prize that any one, however humble may be his pretensions, 
 can be induced to submit to such bondage. There do exist 
 exceptions to the rate of payment now condemned, but they 
 are few and far between. 
 
 From the peculiar situation of a keeper, he is invested with 
 great and but ill defined power, and, as is ever the case, is 
 prone to abuse it. If his disposition be kind, he is inclined 
 to favouritism : he grants unwarrantable indulgences ; he 
 deviates from the rules of the dietary, should there be one, 
 in order to gratify some capricious appetite : he commiserates 
 where he ought to repel, and soothes where he ought to 
 command. If, as is more frequently the ease, his temper be 
 irritable, malicious, or his conduct regulated by the current 
 opinions respecting madness, he will prove a despot, anxious 
 to exercise his functions, brooking no opposition or remon- 
 strance, encouraging no confidence or affection : he will 
 annoy by petty grievances, excite by oppression or absolute 
 cruelty : he will employ restraint, prohibit ail intercourse 
 among the patients, or between these and their friends ; he 
 will intercept and destroy all letters, petitions, &c., and be as 
 unscrupulous in his conversation as in his conduct. TheM 
 an; vices springing out of false views or bad management, 
 which are still uncorrected. It is evident that they could 
 not exist were the servants of a more elevated and a better 
 educated class, or were the superintendents, by whom they 
 are directed and instructed, and under the sanction of whose 
 authority they at all times nominally act, either less assimi- 
 lated to them in character and condition, or more rigidly 
 conscientious in the performance of their own duties. 
 
 Complaints are often made against the cruel separation of 
 relations consequent on the isolation of lunatics, and especi- 
 ally of the obstacles thrown in the way of subsequent com- 
 munication to which I have referred. The necessity for 
 
168 WHAT ASYLUMS ARE. 
 
 excluding friends has unquestionably been exaggerated ; and 
 the rule founded upon it, by being made applicable to all 
 cases, has become injurious and oppressive. The presence 
 of relatives, and the emotions they excite, are occasionally 
 highly salutary. But although the accusation against super- 
 intendents and servants of asylums of estranging those who 
 might safely be allowed to meet, be perfectly just, a much 
 graver and more startling accusation may be urged against 
 the vast majority of the friends of the insane themselves. It 
 is that of utterly forgetting or abandoning those to whom they 
 are bound by ties of kindred and long companionship, if not 
 of affection, and who might be improved, and who could not 
 possibly be injured by their presence and counsel.* The 
 difficulty of inducing friends to visit the insane is generally 
 felt by superintendents to be much greater than that of pre- 
 ventingorregulating their visits. I have known the mother of a 
 family, the members of which were moving in a respectable 
 grade of society, remain in an asylum for thirty years, who was 
 neither visited nor sought to be visited, save once, by husband, 
 children, or friend. Children are consigned to this moral obli- 
 vion by their parents; parents by their children. Remonstran- 
 ces from medical advisers are often of no avail : the stroke of 
 disease seems to have enfeebled affection in the one, because it 
 has obliterated reason in the other : and the death- bed is the 
 only point at which reunion takes place, if even then. I have 
 seen many individuals in the French asylums, Whose name, 
 origin, and country, are now altogether unknown, or conjec- 
 tural. This has arisen partly from the imperfect manner in 
 which the entries were formerly made in the books, but 
 chiefly from these deserted beings having outlived the me- 
 mories or the kindness of their friends. This humiliating 
 description is particularly applicable to the condition of lu- 
 natics supported by public charity. The rich cannot forget 
 
 * Report. Pauper Lunatics in Middlesex, 1827, p. 155. 
 
WHAT ASYLUMS ARE. 169 
 
 their insane connexions, even when most disposed to do so, 
 as they must dole out a yearly pittance for their support. 
 
 The very affluent, however, do not place their relations 
 in asylums simply because there are no suitable provisions 
 for their reception. And they act wisely. To strip a man 
 suddenly, and for no reason that he can comprehend, of all 
 the luxuries and elegancies to which he has been accus- 
 tomed, and expose him to the bald simplicity or meagreness 
 observed in establishments for the insane, would overthrow 
 a tottering mind, and totally crush one that has been already 
 weakened. Upon all men the transfer from a palace to a cell 
 in Bedlam, would be a dangerous experiment, and upon such 
 as are bowed down with misery, or rabid with passion, the 
 effect cannot be salutary. More enlightened views are now 
 adopted, and fitting preparations are made which will tempt 
 the rich to have recourse to those measures from choice, 
 which the poor have long pursued from necessity. In ar- 
 ranging and adorning suites of apartments, however, in lay- 
 ing out gardens and pleasure grounds, in providing sources 
 of amusement, instruction and occupation, aud in increasing 
 the liberty, convenience and comfort of the patient of rank, 
 it ought to be kept in view that no mere appetite is to be pam- 
 pered, no idle whim humoured, that the only object in view 
 is to avoid giving pain, where pain could be of no service. 
 Occasionally a hermit's dinner and a dark room may be ne- 
 cessary to convince a lord that he is human, or to convince 
 a commoner that he is no lord : but these deprivations are 
 then employed upon the same principle as the shower-bath, 
 not from any foolish notion that either the want of comfort, 
 or the cold water will actually convince the distempered rea- 
 son, but that they will act medicinally, quiet the excitemen 
 upon which the delusion depends, and permit the functions 
 of the nervous system to remain undisturbed by the process 
 of digestion, or impressions from the external senses. No 
 possible evil can accrue from a patient being clothed in the 
 
 i 
 
170 WHAT ASYLUMS ARE. 
 
 same dress, surrounded by similar articles of furniture, or 
 in the enjoj^ment of the same pursuits, as when mingling 
 with the world., provided these are neither inimical to health, 
 nor inconsistent with virtue. Disadvantages do flow, how- 
 ever, from granting indulgences, to which the patient is 
 neither entitled nor accustomed. This occurs chiefly with 
 regard to diet. The irritable temper is soothed, the way- 
 ward disposition is coaxed, and the sickly or capricious 
 appetite is tempted by a profusion of delicacies which, while 
 they effect the object immediately in view, and restore order, 
 and subordination, and cheerfulness, poison the source of 
 future peace and ultimate recovery, by encouraging a re- 
 newal of irritability and waywardness, and by vitiating the 
 jfrocesses of digestion and nutrition. This practice of ena- 
 bling patients to live well, as it is termed, can often boast 
 of no better origin than a desire to bestow kindness, to 
 afford a gratification of which all men are supposed to be 
 fond, and which is as generally supposed to be innocent. 
 This lamentable ignorance of the laws of the economy, has 
 given origin to another practice more generally adopted, and 
 even more pernicious. All the inmates of an asylum, al- 
 though they may amount to many hundreds, will be found 
 to have the same diet prescribed for them ; and not only 
 will their allowance consist of the same description of food, 
 but of the same quantity. The old, the young, the robust, 
 and the debilitated — those who are free from, and those who 
 are affected with bodily disease — the furious and the fatuous 
 —the confirmed and the convalescent lunatic, are one and 
 all condemned to the same regimen, which may be adminis- 
 tered by a lavish hand, and dictated by a compassionating 
 heart, but which must be incompatible with the condition 
 of one half of those who receive it, precisely because it is 
 adapted to the condition of the other half. It would be as 
 reasonable to expect that five hundred men, all of them less 
 or more diseased should approach the same meal with the 
 
WHAT ASYLUMS ARE. 171 
 
 same degree of appetite, as that they should all be endowed 
 with the same powers of digestion. I am perfectly aware 
 that certain difficulties exist in carrying a dietary, founded 
 upon sound physiological principles, and upon a considera- 
 tion of every individual case, into execution. But no diffi- 
 culties of whatever amount, should prevent the attempt 
 being made ; and I am fully convinced, that under proper 
 management it will be completely successful. In many 
 asylums it is the custom to serve up the meals to the patients 
 belonging to the higher grades, in their own apartments, and 
 in solitude. This is to be condemned. The repast, pre- 
 sented in such a manner, is cheerless ; it brings with it none 
 of the ideas of comfort and contentment which should in- 
 variably be superadded to the gratification of appetite. It 
 is eaten with a rapidity and voracity which put the powers 
 of deglutition and digestion to a severe test. It is so pre- 
 pared as to do away with the necessity of sending in knives 
 and forks. Every circumstance bears the impress of degra- 
 dation and suspicion. The patient has no inducement to 
 retain the observances of civilized life. There exists no 
 check to the substitution of negligent or filthy habits. All 
 which results, as they depend on the dominion of the in- 
 stinctive, or the extinction of the intellectual powers, are 
 obstacles to improvement. Convenience and economy will 
 most fortunately prove allies to humanity, in bringing about 
 a change in this respect. It is easier for the domestics, and 
 cheaper for the establishment, that the patients, when not 
 prevented by the nature of their malady, should eat in 
 society, and if practicable, at the same table with the super- 
 intendent or matron ; or when paupers or poor, under the 
 eye of a keeper. The presence of those whom they re- 
 spect, or of strangers whose applause they desire, will act as 
 a restraining force ; ebullitions of passion or folly will be 
 controlled ; the usages of society adhered to, and the resto- 
 ration of sanity promoted. 
 
172 WHAT ASYLUMS ARE. 
 
 Passing from these objections, it will long be difficult to 
 convince the rich, who can purchase other, and, as they 
 imagine, better modes of isolation, that the vicious condition 
 brought home to certain asylums no longer continues, or to 
 allay the horror inspired by the prospect of being exposed 
 to the system supposed to be prevalent in all, because cer- 
 tainly prevailing in many. How deeply this opinion is 
 rooted, is shewn by an application made a few years ago, to 
 Dr. Fox of Brislington. A gentleman who was about to 
 place his brother under Dr. Fox's care, said, " I hope you 
 will be as gentle to my brother as you possibly can." 
 " Certainly," said the Doctor. " I know/' resumed the 
 ^applicant, ' f It is very necessary you should exercise some 
 severity on him ; but I hope it will be as gentle as possible." 
 Dr. Fox asked him what he meant. " Sir," said the gentle- 
 man, " I understand it is necessary that you should let him 
 go through a considerable degree of flagellation." " Sir," 
 was Fox's indignant rejoinder, ** You have brought him to 
 the wrong place. I would never carry on a concern of the 
 sort were I obliged to resort to such measures."* While 
 the greatest proportion of the evils and errors chargeable 
 against asylums as they are, can be proved to be inseparable 
 from the plan upon which they are conducted ; many of the 
 most praise-worthy attempts to enlarge the sphere of the 
 lunatic's joys, and to increase the chances of his recovery, 
 are frustrated or impeded by the prejudices and timidity of 
 the public. We are told that in America a man's Chris- 
 tian privileges are abridged on account of the colour of his 
 skin, and that the proscribed African cannot be permitted to 
 worship in the same pew with the favoured pale-face, that 
 God who is no respecter of persons. An objection which 
 must have sprung from the same root, excluded the conval- 
 
 * Minutes of Evidence taken before the Select Committee, &e 
 1828. p. 22. 
 
WHAT ASYLUMS ARE. 173 
 
 escents belonging to the Harwell Middlesex Asylum, from 
 the parish church. The knowledge of the fact, that certain 
 of their fellow- worshippers had at one time suffered under a 
 grievous malady, for a deliverance from which they had 
 come to testify their gratitude, disturbed the tranquillity 
 and devotion of these exclusive pietists. They would not 
 kneel down with those who had been stricken in spirit ; 
 they would not mingle their voices in the thanksgivings of 
 those whose hearts overflowed with love and adoration ; 
 they could not commune with their God in such society. 
 And yet may we not, are we not bound to hope that these 
 Pariahs in religion shall crowd the ranks, and swell the 
 hallelujahs around the throne of mercy? Here was the 
 promulgation of a ban against moral leprosy. The fiat was 
 respected, and the offending outcasts withdrawn. But the 
 persecution did not rest here ; and although the next blow 
 was comparatively innocuous, it serves to show how steadily 
 and surely the spirit of improvement is met by the spirit of 
 resistance. A pony chaise had been procured by the su- 
 perintendent of the same asylum, in order to present a 
 temptation to many of the patients to prolong their excur- 
 sions to a distance, and to enable the weak or indolent to 
 diversify their walks within the grounds, by drives through 
 the neighbourhood.* But the inhabitants protested against 
 such an invasion of their rights, such a destruction of their 
 comfort. They could not, forsooth, so delicate was their 
 sensibility, bear the sight of mad people. The remonstrance- 
 was again attended to, and the lunatic is again deprived of 
 his transient glimpses of happiness, of his visits to what is 
 literally to him another world. 
 
 There is little hope that any legislative interference could 
 finally arrest these abuses or eradicate these prejudices. It 
 
 * The Hamvell Lunatic Asylum, by Miss H. Martineau. Tait' 
 Edinburgh M<i£az ; ne. June 1834. p. 309- 
 
174 WHAT ASYLUMS ARE. 
 
 could do much ; but the removal of ignorance is somewhat 
 beyond its power. So far, however, as an act of government 
 can be instrumental in offering a premium for knowledge, and 
 in discouraging quackery and speculation, some benefit might 
 result. Were men of enlightened minds, liberal education, 
 and kind dispositions, alone appointed or permitted to attend 
 the insane : in other words, were those who pretend to cure 
 required to understand the human mind, these abuses would 
 disappear. To accomplish this, it would become necessary 
 that all asylums should be public and under the control of 
 government, or of parties incorporated by charter for the 
 purpose. The great objects in such a change would be that 
 all the proceedings of those immediately intrusted with the 
 insane should be patent to the public and to the legal authori- 
 ties, and under the management of a body whose sympathies 
 are all engaged in favour of the patient rather than of his 
 attendants. To bring about such a revolution as would place 
 all asylums in the class of public hospitals, there would be 
 required no act of suppression, no bill of pains and penalties 
 against private asylums, houses of detention, &c. Render 
 county asylums perfect, elevate all to the rank which afewnow 
 occupy, give them the means and the reputation of curing 
 ninety in place of forty-two in a hundred, and increase their 
 opportunities of affording protection and happiness to those 
 who cannot be further benefited, and the number of private 
 institutions would speedily decrease, and if improvement was 
 pushed sufficiently far, they would, in all probability, cease 
 to exist : or, should this result not ensue, they must, in self- 
 defence, adopt the system pursued by their rivals, a step 
 which would effect all that is desired or desirable. The 
 difference between the interests of the proprietor of a private, 
 and the superintendent of a public establishment is very 
 obvious. It is the interest of the former to detain as long, 
 while it is the interest of the latter to dismiss patients as soon, 
 as possible. The man who is the servant of, and is paid by, 
 
WHAT ASYLUMS ARE. 175 
 
 the public, is anxious for, and knows that his prosperity 
 depends upon, cures ; whereas, the man who is paid by the 
 patients or their friends, knows, or thinks that his prosperity 
 depends upon admissions and the duration of the complaint. 
 This may be a short-sighted but it is a common policy. I 
 do not mean to insinuate that such motives generally actuate 
 the proprietors of such establishments. Many of these are 
 models of the system which is here advocated. But such 
 principles of action may be, as it is known that they have 
 been, the cause of protracting the cure of the convalescent 
 and of perpetuating the imprisonment of the sane. The merit 
 of the change now proposed would consist in preventing any 
 act to which a humane and intelligent body of the community 
 were not parties, and of divesting the care of the insane of 
 every occasion for the exercise of selfish and unworthy 
 motives. 
 
176 
 
 LECTURE V. 
 
 WHAT ASYLUMS OUGHT TO BE. 
 
 A perfect asylum a Utopia — Belief of the inadequate provisions for the 
 cure of the insane in asylums, general — Character of the physician 
 — Benevolence, conscientiousness, courage — Intellectual qualifica- 
 tions — Site of an asylum — It may contribute to the cure of the 
 inmates— Construction of the building — Size of apartments — Night- 
 classification — Houses of one story — Dormitories — Night-keepers — 
 • Portion of asylum fireproof— Padding of walls— Heating the apart- 
 ments by the circulation of hot water — Clothing — Airing-grounds — 
 Shrubberies — Gardens — Farm-employment of patients — Payment for 
 labour — Classification — Religious worship and instruction — Fallacies 
 in moral treatment — Dancing — Voisin's and Esquirol's establish- 
 ments — Asylum at Sonnenstein — Library — Asylums at Naples, at 
 Hartford, United States — Visit to an asylum as it ought to be. 
 
 A perfect asylum may appear to be a Utopia ; " a sight to 
 dream of, not to see." It would be miserable policy to gratify 
 the ambition of the heart so far, or to pall the keen appetite 
 for doing good by admitting that any attempt had succeeded 
 in placing such retreats in complete accordance with the 
 necessities of the diseased mind. It would, in fact, be to 
 return to the old rule of " letting well alone." Unfortunately, 
 and, what is more to the purpose, it would be untrue. But 
 near approaches have been made to what reason and human- 
 ity point out as the standard of excellence. From these, and 
 from that standard itself, materials may be obtained for the 
 construction of a model which may serve to show how far 
 distant we still are from what must be the object of every 
 enlightened mind, and by what means that object is to be 
 arrived at. 
 
WHAT ASYLUMS OUGHT TO BE. 177 
 
 The whole secret of the new system and of that moral 
 treatment by which the number of cures has been doubled 
 may be summed up in two words, kindness and occupation. To 
 carry this system into effect, the first requisite is a mind which 
 understands the wide meaning of these words. I have shewn 
 that the grand objection to the present mode of conducting 
 madhouses is rather that there is no system than that there 
 is a bad one. The gross indecorums and neglect and inhu- 
 manity are abandoned, and the regulations which rendered 
 mismanagement obligatory are cancelled, but there have been 
 substituted no measures which shall render the recurrence 
 of such errors impossible; at the same time securing the 
 observance of those attempts at alleviation, of which every 
 case of lunacy admits, and the application of those principles 
 upon which the cure of so many depends. The opinion was, 
 and perhaps still is, prevalent, that if a building of suitable 
 dimensions and security was provided, and if medical advis- 
 ers occasionally saw the inmates, all was done for the insane 
 that could be expected or that could be useful. Every day, 
 however, shews that these provisions are utterly inadequate 
 to the end proposed, if that end be the recovery and not the 
 confinement of the insane ; that they form the first but the 
 smallest and most insignificant link of a mighty chain of 
 merciful measures, which must lengthen with our increased 
 acquaintance with the laws of the human mind and the pri- 
 vations of that mind, and can only terminate when the insane 
 are out of the land. So indifferent is even now the repute 
 of public asylums, that the physician in many instances re- 
 commends change of scene or of occupation, travelling, 
 anything in fact rather than mere incarceration. And he 
 gives this advice not from any preference of the step suggest- 
 ed, but from a conviction that mere isolation can do no- 
 thing, and that isolation, combined with treatment founded 
 upon mistaken views of our moral nature, can do little to 
 promote his object. Even when to isolation is added the 
 
178 WHAT ASYLUMS OUGHT TO BE. 
 
 best treatment which the science of medicine indicates, 
 very little additional confidence is inspired, as however 
 useful the established routine of bleedings, blisters and 
 baths may prove to be as auxiliaries, the experience of a 
 thousand years has exposed their worthlessness when trusted 
 to alone. A want of power or inclination to discriminate 
 between the inutility of medicine from its being inapplicable, 
 and from its being injudiciously applied, has led to the adop- 
 tion of the absurd opinion that the insane ought not to be 
 committed to the charge of medical men. A manager of a 
 large and excellent institution, entertaining this view, has 
 declared that the exhibition of medicine in insanity was 
 useless, and that the disease was to be cured by moral treat- 
 ment only. To the mere drug exhibiter, to the man who 
 conceives that he can combat mania by the lancet and tartar 
 emetic alone, or who believes that he can exorcise melan- 
 cholia by a purge, it would certainly be unpardonable folly 
 to commit the insane ; although an authority of equal weight 
 to that quoted above has expressed the opinion, " that apo- 
 thecaries must know much more about the practice of 
 medicine than physicians, because they are so much more 
 among drugs."* But to whom, rather than the well-educated 
 physician, is such a sacred and momentous trust to be con- 
 signed. The word well-educated is employed advisedly and 
 in its most comprehensive sense. The combination of quali- 
 fications which it represents is assuredly rare, but it is as 
 assuredly indispensable. The basis of such a character must 
 be dispositions truly Christian and catholic. Coleridge hassaid 
 with great acumen, that, "in the treatment of nervous disease, 
 he is the best physician who is the most ingenious inspirer 
 ofhope."f There must exist a benevolent kindness which 
 shall be so deep and expansive as to feel sympathy for the 
 
 * Crowther, Observations respecting the Management of the Pau- 
 per Lunatic Asylum at Wakefield, p. 13. ]830- 
 ■t Table- Talk, p. 99. 
 
WHAT ASYLUMS OUGHT TO BE. 179 
 
 lunatic, not merely because he is an alien to his kind, be- 
 cause he is visited with the heaviest and hardest affliction 
 which humanity can bear and live ; but will feel an interest 
 in those unreal and artificial and self-created miseries with 
 which the distracted spirit is oppressed, and which will be 
 as solicitous to alleviate suffering, where it is absurd and 
 the result of violence and perversity of temper, as where it 
 flows from misfortune. There must be a benevolence which 
 will be prepared to make the lunatic a companion and a 
 friend in all the essential qualities of reciprocal confidence, 
 mutual forbearance, fellow-feeling, and rational counsel, 
 which will in all cases forget that an awful but not an 
 unpassable gulf of obliterated acquirements, numbed or le- 
 thargic emotions, and darkened reason can separate two 
 beings born of one family ; and only hold before the mind's 
 eye the things that still remain in common. There must be 
 that benevolence, which will, at an immeasurable distance, 
 imitate the mercy of Him, who, in curing the broken and be- 
 wildered spirit of demonomania, " took him by the hand and 
 lifted him up." But this gentleness must be controlled ; it 
 must be graduated. It may sink into a barren sympathy, 
 or, more fatally for the welfare of those towards whom it is 
 directed, it may be active in soothing momentary pangs at 
 the sacrifice of permanent peace; it may indulge vicious 
 propensities, it may give way to unreasonable demands, it 
 may rather than inflict uneasiness foster those very delusions 
 and irritability which are the root of the disease. The 
 purely benevolent physician can never be a good practi- 
 tioner. There must be mingled with such a sentiment that 
 highly refined sense of duty, that keen perception of right 
 which guides even kindness and affection in their ministra- 
 tions, and which holds the balance as scrupulously in de- 
 ciding on the moral rights of lunatics as on the civil rights 
 of our fellow-citizens. That this quality is required, in 
 order to secure the discharge of the ordinary obligations of 
 
180 WHAT ASYLUMS OUGHT TO BE. 
 
 regular attendance and the exertion of every means pre- 
 scribed for the alleviation of insanity, every one must see 
 and admit. But it appears to be even more essential and 
 more important in indicating what the conduct of the phy- 
 sician and his subordinates ought to be towards their charges, 
 in enabling the former to feel what are the real interests of 
 the latter, and, aided by judgment, in distinguishing the 
 degree of responsibility attachable to each action ; but above 
 all, in conferring that impress of high integrity and honour 
 which is appreciated and reverenced and confided in almost as 
 generally among the insane as among the most shrewd and 
 intelligent of mankind. In this light, a disingenuous and 
 unconscientious, in other terms, a bad man, cannot be a good 
 physician. But even these noble attributes would be of 
 little avail in the trying situations in which the curator of 
 the insane is placed, without that moral and physical courage 
 and firmness which confer calmness and decision in the 
 midst of danger, and in dealing with the most furious and 
 unlistening madness, and imbues the whole character with 
 that controlling influence, which, tempered with mercy and 
 justice, governs the turbulent while it appears to guide, and 
 commands the most wild and ferocious by the sternness and 
 at the same time by the serenity of its orders, — by the absence 
 alike of timidity and anger. The intellectual qualifications 
 for such a trust are high and varied, but cannot easily be 
 specified. They must comprehend a familiarity with the 
 true and practical philosophy of the human mind, in order 
 that its diseases may be understood and controlled ; as ge- 
 neral an acquaintance as is practicable with the usages and 
 workings of society, with the habits, the pursuits, and the 
 opinions and prejudices of different classes, with literature 
 and science so far as they contribute to the instruction, 
 happiness, or amusement of these classes, with every thing, 
 in short, which is or can be rendered influential in what 
 may be called adult education, in the management or modi- 
 
WHAT ASYLUMS OUGHT TO BE. 181 
 
 fication of character, in order that as great a number of 
 moral means of cure, of restraining, persuading, engaging, 
 teaching the darkened and disordered mind may be created 
 as possible ; and finally, as liberal a professional education 
 as long preliminary study and equally long practical observ- 
 ation can accomplish, in order that the causes of alienation, 
 the physiological conditions by which its duration and 
 intensity may be increased or diminished, and the operation 
 of medicines or external agents in removing or modifying 
 either the one or the other, may be thoroughly mastered. 
 To acquire and apply this amount of knowledge and discri- 
 mination, it is not only necessary that he who devotes him- 
 self to the care of the insane should pass his noviciate in an 
 asylum ; or, in the active discharge of his duties, see his 
 patients, as has been recommended, once or twice a-week; 
 he must live among them ; he must be their domestic asso- 
 ciate ; he ought to join in their pursuits and pastimes ; he 
 ought to engage them in converse during the day, and listen 
 to their soliloquies in the retirement of their cells ; he must 
 watch, analyze, grapple with insanity among the insane, and 
 seek for his weapons of aggression in the constitution and 
 dispositions of each individual, and not in general rules or 
 universal specifics. 
 
 The next requisite is an establishment properly placed 
 and constructed. The site of an asylum is rarely considered 
 as of importance ; or, if any care be bestowed on the selec- 
 tion, it is in reference to salubrity. It certainly is indispen- 
 sable that the situation chosen should be healthy, that it 
 should possess the advantage of a dry cultivated soil and 
 an ample supply of water, that it should be so far in the 
 country as to have an unpolluted atmosphere, a retired and 
 peaceful neighbourhood, and yet be so near to a town as to 
 enjoy all the comforts and privileges and intercourse which 
 can only be attained in large communities. The evils 
 arising from inattention to these and even to less obvious 
 
182 WHAT ASYLUMS OUGHT TO BE. 
 
 considerations can scarcely escape observation, and have 
 occasionally been proved by painful experience. The 
 physicians in Paris have been forced to refuse baths, when 
 clearly indicated, in consequence of the want of water. I 
 am acquainted with asylums placed on ground so sandy and 
 unproductive that common garden vegetables could not be 
 raised from it, and the bare rock would have more liberally 
 repaid the labours of the flower-gardener. I have likewise 
 seen these institutions so surrounded by squares and streets 
 and filthy densely inhabited lanes, that roofs and stone walls 
 were the only objects visible from the windows, and all ex- 
 tension of gardens or airing grounds was out of the question. 
 But the locality in which the building is erected may be 
 made to contribute to the cure of insanity, and to the en- 
 joyment of those under treatment. If it occupy a dead 
 insipid flat, the view is either bounded by walls, and if the 
 structure be of one story only, according to the most ap- 
 proved plan, it must always be so, or should the longing 
 eye be permitted to catch a glimpse beyond, the horizon is 
 limited and the scenery tame. Patients are not, in such a 
 situation, so easily induced to take exercise, nor so much 
 benefited by it, as when the surface is irregular, the land- 
 scape varied, and the necessity for exertion and the exhi- 
 laration which attends it are greater. If the building be 
 placed upon the summit or the slope of a rising ground, the 
 advantages are incalculable. To many of those whose in- 
 tellectual avenues to pleasure are for ever closed, the mere 
 extent of country affords delight; to. some the beauty of 
 wood and water, hill and dale, convey grateful impressions ; 
 to some the inanimate objects, the changes of season, the 
 activity of industry, the living and moving things which pass 
 across the scene, form a strong and imperishable tie with 
 the world and the friends to which the heart still clings ; to 
 others the same objects may remind of freedom, its value, 
 and the price by which it may be purchased ; to all a sue- 
 
WHAT ASYLUMS OUGHT TO BE. 
 
 183 
 
 cession of new and varied and healthy impressions must be 
 imparted. 
 
 Wherever the institution is situate, it ought to be con- 
 structed with a direct reference to the comfort and the cure 
 of the inmates. It would be preposterous to lay down rules 
 as to the precise plan to be adopted in the erection of an 
 asylum. But there are certain principles applicable to every 
 case, which cannot properly be omitted. Economy in space 
 is a sad extravagance in medicine and medical attendance 
 and human life. It is not enough that the public rooms 
 should be large and lofty, the sleeping apartments should be 
 proportionally larger. If it be desirable that the lunatic should 
 enjoy a quiet and refreshing sleep, it is indispensable that his 
 breathing be not disturbed by foul confined air, or by the 
 effluvia which is concentrated, as it were, in small ill-ven- 
 tilated cells. And putting out of view the classification 
 which ought to obtain in the daily pursuits and pleasures of 
 the inmates, there exist urgent reasons for building a retreat 
 for the insane in such a manner as to allow an extensive 
 system of night classification to be put in operation. The 
 peculiarities and necessities of the furious, suicidal, and 
 fatuous must be provided for as carefully during the one 
 season as the other ; so that, although the external beauty of 
 the whole edifice ought not and need not to be sacrificed, it 
 is absolutely necessary that a large portion of it should be 
 built of one story only. In this are to be placed all those 
 who might be injured or who might injure themselves, if 
 lodged in a house constructed in the ordinary way. The 
 paralytic will not then be endangered in ascending or de- 
 scending stairs, the furious will have fewer opportunities of 
 wreaking their reckless violence or vengeance, and the 
 suicidal will be debarred from one of the most easily acces- 
 sible means of gratifying their ruling propensity. In the 
 older establishments, where stairs could not be dispensed 
 with, accidents were guarded against by the use of iron 
 
184 WHAT ASYLUMS OUGHT TO BE. 
 
 screens or cages surrounding the exposed part of the ascent, 
 which answered the purpose in view very imperfectly, and 
 suggested the most gloomy and painful thoughts, alike in 
 those who meditated evil and in those who were innocent 
 of such designs. By placing individuals who cannot be 
 trusted elsewhere in a cottage, the windows of which are 
 only a few feet from the ground, all danger is obviated, the 
 presence of attendants and the employment of mechanical 
 precautions rendered unnecessary, while free egress to the 
 open air, to the grounds or gardens is enjoyed by the 
 patient. 
 
 While it is very clear that the arrangements for the diffe- 
 rent sexes must be varied according to their respective 
 wants, occupations, and recreations, it is likewise necessary 
 to be borne in mind, that in the case of a public asylum, a 
 larger portion of the building should be allotted to females, 
 as their numbers almost always preponderate. The conti- 
 nental establishments are all constructed on this principle. 
 " Mais," says Brierre de Boismont, in writing on the subject, 
 " au lieu de construire les sections pour vingt malades, on 
 les ferait pour trente, a cause du plus grand nombre des folles 
 alienes." On the minute details of the internal economy, it 
 is not my purpose to enter : but two provisions for the 
 health and comfort of the inmates must be adverted to. The 
 first of these is an ample supply of baths. At certain seasons 
 they should be employed to secure the cleanliness of all the 
 patients : and during the whole year they are absolutely 
 required, in the treatment of particular cases. Leaving the 
 question of the propriety of using the plunge-bath, open for 
 discussion, I would strongly recommend, that in addition to 
 the customary complement of hot, and cold, and shower-baths, 
 every asylum should possess the means of directing a quan- 
 tity of cold water upon the head, while the body is immersed 
 in a warm-bath. When moral treatment cannot, and bleed- 
 ing and tartar emetic ought not to be resorted to, I have seen 
 
WHAT ASYLUMS OUGHT TO BE. 
 
 185 
 
 the most frantic and ferocious maniac restored to tranquillity, 
 by the discipline suggested. The second provision is the 
 erection of what may be styled self-acting, or cleansing wa- 
 ter-closets, in all convenient parts of the house and grounds. 
 The water may be introduced in various ways, either by 
 the valve being raised by the opening of the door, by the 
 pressure of the feet on the floor, or of the hands on the seat ; 
 but by whatever arrangement effected, the principle and the 
 object are the same, to render the process of purification alto- 
 gether independent of the habits or inclinations of the 
 patient.* 
 
 It contributes greatly to the quiet of an asylum during 
 the night, and to the remedial effects of sleep, if the noisy 
 and furious can be placed at a distance from the other 
 classes of patients. This is the first, and perhaps the most 
 important step in classification. In the immense barracks 
 which it was the fashion formerly to construct, it can only 
 be accomplished by removing the turbulent patients to some 
 remote and unoccupied wing, or by erecting cells distinct 
 from the main body of the house. Modern establishments, 
 instead of presenting an almost interminable succession of 
 wards and corridors under one roof, generally consist of a 
 number of separate houses, in which the patients are distri- 
 buted according to their dispositions and the features and 
 stage of their disease, and one of which is of course appro- 
 priated to that class of which we have spoken. This excel- 
 lent arrangement exists at Ivry, at Mr. Warburton's asylum 
 
 " It is almost needless to add, that all suitable expedients should be 
 had recourse to for the purpose of sufficiently ventilating every chamber, 
 corridor, and corner of such an establishment. For copious directions 
 of the best means of effecting this, I would recommend the perusal of 
 Sylvester's Philosophy of Domestic Economy, and Dr. D. B. Reid's 
 Brief Outlines Illustrative of the Alterations in the House of Com- 
 mons. 
 
186 WHAT ASYLUMS OUGHT TO BE. 
 
 near to London, and at Burlington asylum, under the super- 
 intendence of Dr. Fox.* 
 
 When the patients sleep in separate apartments, it appears 
 to be a great improvement on the old plan that these should 
 open into a long and spacious gallery. This, besides sub- 
 serving to ventilation, may be used as a common hall, as a 
 work-room, as the place where the night keeper or nurse 
 may watch, and for various other purposes equally useful. 
 But where the interests of paupers, or of such individuals 
 as cannot afford to provide a servant, are to be considered, 
 dormitories appear to be in many respects preferable to cells. 
 In giving this preference, it is, of course, supposed that the 
 rooms set apart as common sleeping places are large, cheer- 
 ful, well aired, that classification is rigidly attended to, that 
 the beds of the patients are wide apart, and that a keeper 
 either watches or sleeps beside them. The presence of this 
 person is even of greater consequence than an unvitiated 
 atmosphere, as it yields the pleasure of society and protection, 
 as it prolongs the influence of moral training into the silent 
 watches of the night, To many the step, the admonition, even 
 the presence of such an attendant acts as a powerful restraint; 
 some ebullition of ill temper, some wild fancy or horrible 
 delusion is arrested : the timid and superstitious are inspired 
 with confidence and courage, and sleep in peace, while the 
 docile and affectionate derive absolute delight from the 
 attentions of such a friend. The real or imaginary wants 
 of all are thus supplied. How often may the bitter cry or 
 earnest supplication, which is heard echoing through the 
 corridors of an asylum during the night, be for a drop of 
 water to appease the burning thirst of passion, or for some 
 friendly voice to dispel the self-created horrors of a distem- 
 
 * Combe, Physiology applied to Health, &c, fifth edition, p. 427. 
 Minutes of Evidence taken before the Select Committee, &c , 1828, 
 p. 5. 
 
WHAT ASYLUMS OUGHT TO BE. 187 
 
 pered or remorseful conscience. More than this, a paroxysm 
 of insanity or of some other disease is often developed during 
 the night, which, raging unnoticed and unresisted for hours, 
 either destroys life, or renders all previous and subsequent 
 treatment unavailing ; whereas had a keeper been present, 
 which, unless dormitories exist, he cannot be expected to 
 be, these evils might have been prevented or mitigated 
 These wards, or at least such of them as are inhabited by 
 those who from their malice and recklessness are most likely 
 to attempt fire-raising, and who from their imbecility are 
 most likely to suffer from it, ought to be fire-proof. This 
 plan has been adopted in Mr. Drury's excellent asylum, 
 Glasgow, and at once secures valuable property, and, what 
 is of infinitely more value, the lives of the patients from 
 danger. The French asylums are now principally built of 
 one story ; and this is done, as I have stated, to avoid the 
 possibility of accidents, or attempts at suicide being sug- 
 gested by the height from the ground, and to prevent the 
 success of the attempt should it be made. In these cases 
 the windows are likewise of the cottage fashion, and formed 
 of iron, which prevent escape without appearing to do so. 
 Among other precautions, and especially where solitary 
 cells are used for the furious, and no personal restraint is 
 resorted to, the walls should invariably be padded with 
 wool or cotton or some soft material, an expedient which 
 precludes the possibility of any injuries being inflicted by 
 running the head against the walls, which is a common 
 mode of mutilation. 
 
 Many of the old institutions were either wholly or in part 
 constructed without fire places, stoves, chimneys, or any means 
 of affording warmth to their inmates. This proceeded from 
 a fear for the safety of the building. The lunatic who could 
 scarcely be trusted with a fire during the day in the presence 
 of his companions and keeper, and even when guarded by an 
 ample grating, could not expect such a luxury in his cell or 
 
188 WHAT ASYLUMS OUGHT TO BE. 
 
 bedroom during the night. It is not, however, to be regarded 
 merely as a luxury. In consequence of a great fall in the 
 temperature, aided probably by the lethargic habits and 
 condition of the nervous system in lunatics, limbs and lives 
 have been lost. The fear of conflagration has so far subsid- 
 ed, and the public halls and parlours are in almost every case 
 sufficiently warmed. But the sleeping apartments are still 
 as cold and injurious to health as ever. And the lunatic 
 now passes suddenly from the common hall, where he has 
 enjoyed a heat as high as 70° or 80° during the whole day, 
 to his cell, where the thermometer indicates the freezing 
 point. This partly explains the great mortality in some 
 asylums, and is eminently unfavourable to the recovery of 
 the tone of the nervous system. How is it to be remedied? 
 It is quite clear that although it may be preposterous to 
 conclude, as was formerly done, that any great number of 
 lunatics are so destructive, suicidal, or idiotic, as to set fire 
 to the house in which they live, their custodiers must act as 
 if they were, and devise a plan which shall yield them suffi- 
 cient warmth, and be compatible with the safety of all around. 
 There are three modes of doing this : by heated air, by steam, 
 and by the circulation of boiling water. Without comment- 
 ing on the advantages of the two first it is enough to say that 
 the third mode appears to be preferable. The apparatus by 
 which this is effected consists of a furnace connected with a 
 boiler or coil of pipes in which the water is heated, and two 
 series of pipes, by one of which the hot water is conveyed to 
 all parts of the building, whatever may be its dimensions, 
 imparting its heat as it flows along : by the other the water 
 is returned to the boiler to be again heated and again circu- 
 lated. These pipes may be carried along passages, introduced 
 into sitting and sleeping rooms, and in such a manner as 
 neither to be seen nor to be accessible to the patients. This 
 plan is completely adequate to the end in view. The degree 
 of heat produced can be regulated, is equable, and does not 
 
WHAT ASYLUMS OUGHT TO BE. 189 
 
 alter the qualities of the air. The plan is likewise economi- 
 cal for, after deducting the first outlay for pipes, which, 
 although considerable, must greatly increase the value of the 
 house as property, the current expense of heating a large 
 building, capable of accommodating several hundred patients, 
 is said not to exceed that of a common fire. It is, further, 
 perfectly safe, and affords a genial warmth to the body of 
 the lunatic without afflicting or irritating his mind by the 
 distrust implied by the iron-grating, and other provisions 
 employed to keep him at a distance from the fire-place. 
 
 As a means of attaining the same object, the clothing of 
 lunatics should be rigidly attended to. One great difficulty 
 has generally to be contended with in arranging the details 
 of this part of the domestic economy of an asylum. Whether 
 we have to act for the poor or the rich the supply of clothes 
 is inadequate : in the one case from the poverty or parsimony 
 of the parishes, public bodies or individuals by whose charity 
 they are supported : and in the other, from the supposition 
 very frequently entertained, even by compassionating friends, 
 that anything is good enough for a madman, who cares not 
 for cold, and attends neither to comfort nor decency. I have 
 shewn that this supposition is directly at variance with the 
 truth. There must accordingly be an attempt made to pro- 
 vide, not only warm and clean clothes, but changes of these 
 adapted to the different seasons and variations of temperature 
 and weather, and resembling, as closely as possible, those to 
 which the individual had been accustomed; and, if practi- 
 cable, there should be no uniformity of costume. It may 
 have advantages, but it reminds of the workhouse, the prison, 
 the galley-slave. 
 
 Let us pass to the exterior. We must not rest content with 
 airing-grounds. However extensive the area of these may 
 be, and in certain establishments they are as ample as can 
 be expected, they are, in reality, nothing more than narrow 
 strips of sward or gravel surrounded by high walls. They 
 present all the characteristics of imprisonment without one 
 
190 WHAT ASYLUMS OUGHT TO BE. 
 
 of its alleviations. Within them a patient may walk his 
 weary round for half a century without obtaining a glimpse 
 of the world he has left, with no other objects to gaze upon 
 save his miserable companions in misfortune below, and the 
 interminable blue sky above. The expedients to relieve the 
 monotony of such a scene are interesting. A patient under 
 my own charge walked fifteen miles per day for a consider- 
 able length of time in making the circuit of one of these 
 courts ; another counts the stones in the wall ; a third watches 
 the appearance of faces at the windows by which the court is 
 overlooked. These places should be planted, have a foun- 
 tain ; a portion of ground prepared as a bowling green ; they 
 should be stocked with sheep, hares, a monkey, or some other 
 domestic or social animals. In the spirit of a bygone period, 
 it may be objected that the trees will be uprooted or used 
 for gallows, that the bowling-green will be destroyed, the 
 pets killed. But in any institution where such arrangements 
 exist the principles of classification would likewise be recog- 
 nised, and no lunatics, whose dispositions or delusions prompt 
 them to commit such acts, would be admitted to this part of 
 the establishment, or, if admitted, would be under the eye 
 and guidance of the attendant : one of the most useful duties 
 of a keeper being to render many enjoyments accessible and 
 innocent by his presence and superintendence, which in his 
 absence might be dangerous. The courts and promenades 
 in Salpetriere, containing a thousand lunatics, have been 
 planted for twenty years, and no suicide by suspension has 
 taken place. The grounds at Charenton, Rouen, Sonnen- 
 stein, &c., are laid out in the same style, and have neither 
 been destroyed, nor have they proved inconsistent with the 
 safety of the patients. But, besides, or in default of these 
 minor attempts to enliven the aspect of these prison-yards, 
 the centre should be raised as a mound or terrace, so high 
 only as will give a wide and animated horizon but so low 
 as will prevent any intercourse taking place with the inhabi- 
 tants in the immediate neighbourhood. The patients are 
 
WHAT ASYLUMS OUGHT TO BE. 191 
 
 thus, in a certain sense, restored to the world while reaping 
 all the benefits of seclusion. They have an immense num- 
 ber of new and pleasing and yet unexciting impressions 
 conveyed to their minds, all calculated to suggest healthy 
 trains of thought, all foreign to their morbid feelings, and 
 furnishing some materials for reflection more allied to sanity 
 than the ravings of their fellow -prisoners, or the glare of a 
 dead wall. All these changes might be wrought without 
 expense and with great moral benefit by the lunatics them- 
 selves. What lunatics can accomplish by mere manual 
 exertion may be learned from the following quotation : " The 
 supply of water for the establishment, Hanwell, having been 
 principally derived from the canal, inconvenience was often 
 experienced in dry weather from its insufficiency : a very 
 powerful spring had been found upon the premises by boring 
 to the depth of nearly three hundred feet. A large reservoir, 
 to contain the daily overflow, which was sufficient for the 
 consumption, was found to be the cheapest mode of render- 
 ing this spring available to the institution. At the sessions 
 held last April, the court granted L.650 for that purpose, the 
 sum at which the cost of it was estimated. Your committee 
 have to state that it is now finished. The excavation is thirty 
 feet deep, and forty-five feet in circumference. This work 
 having in a great measure been accomplished by the labour 
 of the patients, the cost has fallen considerably below the 
 estimate, so that instead of L.650, the sum voted by the court, 
 your committee have only to call upon the treasurer for the 
 county for L 318, 2s. lOd. for that purpose."* There are la- 
 bourers and gardeners and masons in every asylum, or should 
 there not, there will always be found men with sinews sufficiently 
 strong to carry earth and lay turf, and this is all that is wanted. 
 And why, under such circumstances, should not lunatics be 
 taught to do these and many other things ? There is besides 
 
 * Sixth Report of the resident Physician and Treasurer of the 
 Hanwell Pauper Middlesex Asylum. 1837. ?. 4. 
 
192 WHAT ASYLUMS OUGHT TO BE. 
 
 in such an undertaking a definite object in view, and this 
 invariably facilitates all operations in which lunatics are 
 concerned. Intrust the most irreflective with a frivolous 
 commission, or with some piece of work which is evidently 
 prescribed as an occupation, and of no utility either to him- 
 self or others, his pride is offended, the task is performed 
 reluctantly and without interest, and the moral effect is lost. 
 But in employment, the object and the utility of which is 
 explained and understood, the great majority of patients 
 will, at a certain stage of the disease, cheerfully engage. 
 This is a strong argument for enabling each to pursue his 
 own profession, so far as is practicable. But care should be 
 taken in the selection of the kind of occupation, for an 
 egregious and irremediable error may be committed in 
 allowing madmen to engage in an employment about which 
 their mind is deranged.* 
 
 It must be confessed, however, that the airing grounds, 
 as at present laid out, are great improvements upon the 
 dark ill-ventilated halls which used to be the only places for 
 recreation and exercise. Light and air are no longer con- 
 traband, although they are still severely taxed. But in 
 addition to the changes of which mention has been made, 
 there ought to run along the walls of these courts, or through 
 their centre, covered galleries, which, while they in the 
 former case prevent escape, protect from heat or rain, and 
 allow of exercise being taken in defiance of either. Where 
 the situation of the asylum affords a commanding view, such 
 as at Charenton, these alleys are favourite places of resort, 
 and during summer are frequented not only by the idle 
 saunterer or sentimental gazer, but are crowded with read- 
 ing-desks and drawing and work tables, and by all those 
 who have the wisdom, or are instructed, to associate the 
 pleasures which the beauty of nature affords with the ordi- 
 nary and obligatory occupations of life. But even were 
 
 * Spurzheim. Physiognomical System, p. 568. 
 
WHAT ASYLUMS OUGHT TO BE. 193 
 
 these yards modified in the manner proposed, we must not 
 rest content. A wider sphere for physical exertion and 
 means for multiplying pleasureable sensations must be pro- 
 cured. Gardens, grounds, farms must be attached to each 
 establishment, and must be cultivated by or under the 
 direction of the lunatics. Many of the existing establish- 
 ments have from thirty to forty acres in their own hands ; 
 and at Bicetre the least productive part of the farm has been 
 converted into a bleaching-green. In the same institution, 
 now under the able superintendence of Ferrus, there are 
 150 patients constantly employed in levelling, masonry, 
 digging, joiner's, blacksmith's, and even carpenter's work. 
 I have before adverted to the benefits of engaging every 
 patient in some suitable occupation, and shall now only 
 allude to the principles which ought to regulate all attempts 
 to induce them to take such a step. In many respects an 
 asylum should be assimilated to an infant school. The 
 mind has been reduced by disease to the state of childhood ; 
 it displays the same waywardness, the same impatience of 
 control and of compulsory labour, the same capricious desire 
 for the gratification of the most urgent motive, and some- 
 times the same stubbornness and ill-temper. But while 
 there exist similar difficulties, other characteristics of youth 
 are present, which may be employed in this instance as well 
 as in education to communicate strength, or to awaken 
 powers that perhaps require only a proper stimulus to 
 assume their legitimate exercise. There is often docility, 
 the gratitude inspired by habitual affection, the sense of 
 justice which fair dealing will enlist on the side of health, 
 and too frequently that simplicity, depending on diminished 
 intelligence, which permits the patient to be cheated by 
 amusement or active employment into health and serenity 
 of mind, as the learner is cheated into a knowledge of im- 
 portant truths or practical facts by means of a game at 
 
 K 
 
194 WHAT ASYLUMS OUGHT TO EE. 
 
 romps, or some merry carol. Place the undertaking of 
 acquisition, in the one case of health, in the other of infor- 
 mation, before the parties as a duty, a task, and as a duty 
 ■which must be performed, a task which must be learned or 
 punishment and disgrace will follow, and the probability is, 
 that in a majority of cases the proposal would be spurned, 
 or would excite disgust or insubordination, which even the 
 infliction of the threatened punishment would fail to remove. 
 Nor need we wonder at this result ; it is children of different 
 ages that we treat. Certain individuals might be awed, or 
 coaxed, or bribed into compliance : that is, the point is 
 carried by an appeal to the sense of fear, to vanity, or to 
 the wish to possess some desirable object, and not in virtue 
 of the reasonableness of the request, or the convinced under- 
 standing of the party. These modes of carrying our plans 
 extensively into operation are occasionally unavoidable. 
 But let those who have tried to teach children by these 
 methods, and who, departing from such a vicious discipline, 
 have endeavoured to make what is valuable attractive, and 
 what is attractive valuable, declare the comparative results, 
 and their experience will be found to coincide exactly with 
 the recorded effects of compelling the insane to do what is 
 necessary and proper, and of inducing them voluntarily to 
 do the same things, by connecting them with their comfort 
 and happiness. No argument against the system pursued 
 in infant schools is valid, because in some instances it fails 
 to unfold the embryo mind ; nor should an objection to the 
 proposition advanced be founded on the inapplicability of 
 persuasion and moral training to certain lunatics, inasmuch 
 as in the great majority of cases they bring peace and plea- 
 sure. If the infant school teacher be efficient, he discri- 
 minates not only the talents but the dispositions of his 
 pupils, and metes out instruction of a nature and a quantity 
 and in a manner suited to both : and if the superintendent 
 
WHAT ASYLUMS OUGHT TO BE. 195 
 
 of the insane knows his duty, he likewise adapts the impres- 
 sions he is desirous of conveying to the condition of the 
 mind which he is solicitous to restore. No superintendent 
 or keeper would be so grossly ignorant as to force a man to 
 dig who was disposed to weave, and none ought to be so 
 ignorant as to overtax the weakened or already burdened 
 mind by long sustained attention to either. The comparison 
 between the enlightened treatment of lunatics and the prin- 
 ciples of infant teaching proceeds no farther. In the infant 
 school one invariable mode of tuition is applied to all, whe- 
 ther judicious or not is not here the question ; in an asylum, 
 while general principles are held in view, a different plan 
 must be pursued in leading every individual, or at least 
 every class of individuals, to the point at which we desire 
 to arrive. We may be justified in giving the stern tones 
 of command to our voice, when it is necessary to govern 
 the proud or venerative maniac, but it would be absurd and 
 cruel to do so in order to guide the timid, the affectionate, 
 or the irascible. 
 
 The deception is virtuous, when by an imagined pursuit 
 of pleasure we lead on the mind unwittingly in the pursuit 
 of sanity ; but if a higher motive can be used, if reason can 
 be made to assist in its own restoration, no deception, how- 
 ever pure and praiseworthy the intention, should be resorted 
 to. Even in intercourse with the insane, honesty is the best 
 policy. 
 
 There is a rule in many asylums, that when we have 
 succeeded, when the pauper lunatic, in obedience to our 
 injunctions, has engaged in some useful occupation, he shall 
 receive no wages for his labour. I think the rule in every 
 way a bad one. It says, in other words, he shall have no 
 interest in what he does. " Mais," says a kind and judicious 
 friend to the lunatic, "nous le repetons, il faut remunerer 
 l'activite par une recompense quelconque, par un leger 
 salaire, une plus grande liberie, de plus beaux habits. La 
 
196 WHAT ASYLUMS OUGHT TO BE. 
 
 plupart des alienes aiment le tabac. On f'era ce besoin an 
 profit du travail."* There can exist no doubt but that an 
 establishment is fully entitled to the proceeds of the labour 
 of all those supported upon charity, and even of those who 
 pay board. In many places these proceeds are considerable, 
 and constitute a part of the annual income of the house, 
 one of the means, in fact, whereby its beneficence is main- 
 tained, and its benefits extended. In 1886, the proceeds of 
 work done by lunatics amounted in the Dundee Asylum to 
 L.200, and in that at Armagh to L.250. It would be indis- 
 creet to sacrifice this, it may be argued, and preposterous 
 to stipendize those who can want for nothing, and who very 
 often neither know the value of money, nor how it can be 
 'converted into gratification. But this is not the principle at 
 stake, this is not the bearing of the question upon which we 
 would stamp the stigma of error. Every one will admit 
 that the lunatic has no claim on the asylum, where he is 
 cherished and supported, to a compensation for his earnings ; 
 that the amount of these are as nothing in liquidation of the 
 debt he owes for the peace and protection and chance of 
 recovery which he enjoys ; and that it would be ridiculous, 
 and might be dangerous, to inculcate upon him that he has 
 any such claim. The gravamen lies in the declaration, 
 that he has, and can have, no interest in, or reward for, his 
 daily occupations. To tell the madman, as an encourage- 
 ment, that although he can expect no reward or indulgence 
 for what he does, still the inducement of being improved by 
 labour ought to be to him a consideration paramount to all 
 others, is to describe colours to the blind, sounds to the deaf. 
 He cannot appreciate the temptation, for he will not ac- 
 knowledge that he is ill, or stands in need of improvement. 
 It will scarcely be denied that a man will do that best and 
 most cheerfully, in which he has some real or fancied in^ 
 
 * Briere de Boismor.t, A?;miles d'Hygiene,[tcm. xvi. 
 
WHAT ASYLUMS OUGHT TO BE. 197 
 
 terest ; that if he expect honour, or ease, or remuneration, 
 or the satisfaction of any desire, he will exert his powers 
 more continuously and energetically than if he expects no 
 results whatever. It is because the enforcement of such a 
 rule divests labour of all those attractions, that I conceive 
 it to be bad. Could we act upon all lunatics through higher 
 motives than by wages or bribes or commands, it would be 
 well, but the great majority of the worst cases, at least, are 
 ceasing to be lunatics, becoming convalescent, before you 
 can do so. As the minds of the lower orders are at present 
 constituted, the most powerful stimulus is gain, and if by 
 addressing ourselves to the propensity to acquire, we can 
 subdue more violent propensities, or still the agitation of 
 disease, it would be imprudent and unphilosophical to reject 
 the aid of such an agent. Payments in money are not ad- 
 vocated, although in certain cases they are found to be. 
 strongly desired, and more desired and more irresistible 
 than any other temptation ; but it is generally more conve- 
 nient, and equally acceptable to the other contracting party, 
 to pay in another manner. First, either better diet and 
 clothing are given, certain coveted luxuries are awarded to 
 the industrious patient, to which as a pauper he has no right, 
 and which his board, if in a higher class, could not purchase ; 
 or secondly, a portion of his earnings is set apart for his 
 behoof, to be accumulated until restoration of reason take 
 place, and to be then delivered to him to meet the exigencies 
 of his dismissal. The first of these plans is chiefly appli- 
 cable to the incurable and the most debased lunatics ; the 
 second to those who are curable, or who retain sufficient 
 intelligence and feeling to cherish the hope of reunion with 
 their friends, who are gladdened by the sympathies and 
 cheerful prospects which such a hope creates, and will 
 struggle to co-operate in your designs for their welfare in 
 order to gratify that hope. In both cases it would be wise 
 to allow so much per cent, on all labour, the rate to increase 
 
198 WHAT ASYLUMS OUGHT TO BE. 
 
 both according to the amount of work done and the spirit 
 in which it is executed. Certain tasks and working hours 
 should be appointed, otherwise the anxiety to win may frus- 
 trate the whole scheme, by first exciting and then fatiguing 
 all the powers. The patient must, of course, be acquainted 
 with the conditions upon which he is solicited to engage in 
 active employment, and a certain degree of choice permitted 
 as to the kind of compensation most acceptable, and the 
 period at which it shall be made. The discretion of the 
 employer must decide whether compliance is justifiable, but 
 after the bargain is concluded, the terms, although they 
 refer to nothing more than an ounce of tobacco or a cup of 
 tea, should be observed as sacred. Violations of such 
 'agreements have often led to serious consequences. 
 
 The kindness and expediency of the proposal to accumu- 
 late part of the earnings of the curable insane, until their 
 health be completely restored, can best be understood by 
 considering the situation of such individuals when liberated. 
 Supported by their parishes or by public benevolence while 
 insane and confined, they lose all claim upon such resources 
 by their dismissal, they pass from a quiet home, are thrown 
 upon society pennyless, it may be without friends or a single 
 being who will shelter or sustain them, incapable of engaging 
 in their ordinary trade, and unable to obtain employment 
 were they capable of undertaking it. This cannot fail to 
 inflict misery, to threaten the still delicate tenure of health, 
 and undoing all that care and kindness had accomplished 
 to bring about a relapse. The remedy is self-evident. Let 
 all institutions, where occupation is extensively carried on, 
 tax the revenue derived from the articles manufactured, or 
 saved by the services performed ; the amount of the tax to 
 be expended in providing for the safety and support of 
 patients after they have left the house ; the funds to be con- 
 fided to themselves if trustworthy, or, what would be better, 
 to responsible guardians. This is just continuing the sur- 
 
WHAT ASYLUMS OUGHT, TO BE. 199 
 
 veillance and treatment for a longer time, and spreading the 
 benefits of such institutions over a period and scenes more 
 critical as to the permanence of health, than even the first 
 weeks of convalescence. These suggestions are founded 
 upon experience, and are sufficiently justified by what has 
 long been the practice at Salpetriere, although there the 
 distinct right of the lunatic to wages is recognized. The 
 " Samaritan" societies proposed by Sir W. Blizard and, I 
 believe, organized in London about forty years ago, had a 
 similar object in view. The benevolent intentions of their 
 founders were, however, confined to the support of the poor 
 when discharged from the public hospitals. The necessity 
 for such a provision is very urgent, and obvious to all fami- 
 liar with the class of individuals received into these esta- 
 blishments, or with their fate subsequent to their recovery 
 and dismissal. But the case of the recovered but destitute 
 lunatic is ten times more clamant ; he is not only without 
 work, but the malady from which he has been relieved 
 proves all but an insurmountable obstacle to his obtaining 
 any, however well established his character for honesty and 
 industry may be. 
 
 Classification may proceed on various principles. There 
 is first the very obvious ground for separation, the rates of 
 board. The accommodation, the fare, the attendance re- 
 quired for the rich, caunot be extended to the poor, nor is it 
 necessary that it should. The pauper could not appreciate, 
 nor prize, nor derive benefit from the refinement and delica- 
 cies essential to the comfort, and instrumental in the recovery 
 of the affluent. Most fortunately this arrangement, which is 
 called for by the usages of society, is found to correspond 
 with those higher and less artificial distinctions which are 
 dictated by philosophy. The second principle to be recog- 
 nised, is the stage of the disease. Common sense would 
 indicate ; but common sense has not yet effected a separation 
 of the curable from the incurable, and both of these from the 
 
200 WHAT ASYLUMS OUGHT TO BE. 
 
 convalescent, that class of patients who may be said to havfi 
 recommenced their existence, and to require the gentle and 
 strengthening treatment bestowed on infancy. For the incur- 
 able, little active interference is required : but much may be 
 done to render them happy and contented, to reconcile them 
 with captivity, and to enable them to pass the close of their 
 dreamy existence in tranquillity. As a class, they are iso- 
 lated for the behoof of others, that they may not prove 
 injurious to those who are still capable of being influenced 
 by moral impressions, and liable according to the nature of 
 these impressions, to be confirmed in their alienation, to be 
 afflicted with a still more intense form of mental disease, or 
 to be restored to health. That evil has been done, and this 
 is the principal point at issue, by ignorance of this fact may 
 be gathered from Pinel. To the curable and convalescent, 
 then, our greatest care ought to be consecrated. The object 
 is to place them in the most favourable circumstances for 
 the re-development of impaired, impoverished, or imperfect 
 power. Unless classification be pushed farther than has 
 hitherto been suggested, this object can never be attained. 
 The third principle, and that next in importance, is, that 
 these classes should be subdivided according to the character 
 of the malady and of the dispositions of each individual. It 
 is not enough that the furious should be separated from the 
 docile, or the imaginative from the fatuous ; the mind of 
 every individual should be carefully studied, its healthy as 
 well as its insane bearings analyzed, and the relations which 
 these may have with, or the influence they may acquire upon 
 the. minds of others calculated, and groups formed in refer- 
 ence to the result. The violent or malicious may often be 
 confided with perfect safety to the acquisitive, or vain, or 
 religious monomaniac. The affectionate and happy may be 
 associated with the desponding and despairing, and the help- 
 less idiot may become the adopted child of some mother 
 whose only delusion is weeping for infants which she never 
 
WHAT ASYLUMS OUGHT TO BE. 201 
 
 bore. A system somewhat similar to that here described is, 
 I believe, pursued in the excellent asylum at Perth. But 
 it may be carried farther ; and whole families may be formed. 
 A vain idler may be intrusted to the tutelage or example of 
 three or four industrious knitters or oakum teasers ; and be- 
 ing encircled by temptations to exertion, and stimulated by 
 the desire of rivalry, abstraction from the dominant idea is 
 often the consequence. A contented, self-satisfied, and ac- 
 tive minded maniac is joined to a timid, a lethargic, and a 
 gloomy maniac, and seldom fails to communicate some portion 
 of those qualities which it is our object to infuse. Ln a great 
 majority of cases, the members of these small communities 
 contract lasting attachments. The first step in giving efficacy 
 to the principle under discussion, is a short and an easy one. 
 The great affinities of gentleness, of docility, of despondency, 
 of vehemence, &c, are readily perceived. But the nearer 
 approaches to the complete working of the plan are more 
 difficult, because generally impeded by the structure of asy- 
 lums, the small number of attendants, and the inefficient 
 assistance afforded by them, and above all, by the prevailing 
 ignorance of the laws of the human mind, and consequently 
 of those differences of disposition, upon a knowledge of which 
 the successful application of such a principle must depend. 
 Notwithstanding these obstacles, a little tact and manage- 
 ment will bring together those who are fitted for each other's 
 society. The fourth principle is a corollary to the last. It 
 is based, however, rather upon the amount of cultivation 
 which the mental powers and dispositions have received, 
 than upon their nature. Our confederacies must often be 
 constructed with a reference to the degree of education, the 
 tastes, and pursuits, and manners of the parties. The unhap- 
 piness which would flow from bringing the ignorant and 
 brutal into constant and compulsory contact with the en- 
 lightened and refined may be imagined. In acting upon 
 this principle we are sometimes forced to violate a rule pre- 
 
202 WHAT ASYLUMS OUGHT TO BE. 
 
 viously laid down. Wherever the poor lunatic has been 
 veil educated, accustomed to the courtesies and amenities 
 of good society, and retains amid his hallucinations, the feel- 
 ings and tastes which characterize that condition, he should 
 be raised from the grade of paupers, and placed among those 
 who still cherish similar feelings and tastes. His degradation, 
 his loss of caste may be fatal, while his elevation may prove 
 curative, and is in perfect conformity with the spirit and aim 
 of the principle now insisted. Wherever practicable, that is 
 wherever the acquirements and deportment of the superin- 
 tendent admits of such an arrangement, the well-educated 
 and well-bred convalescent lunatic should reside and asso- 
 ciate with their physician and governor. The advantages 
 •of this have been before adverted to ; but it may be stated 
 here, that besides many examples of the partial success of 
 the plan, which might be quoted from the reports of asylums 
 in this country, there is at present an excellent private esta- 
 blishment in Paris, where about thirty patients take all their 
 meals, spend their time, and pursue their occupations and 
 pleasures in the company of their medical attendant. 
 
 Much may be done in certain classes by an appeal to 
 honour, to that conventional integrity and faithfulness which 
 is more frequently the offspring of a dread of the world's 
 censure, than a dread of the culpability of disingenuousness. 
 yieu. who have long lived and acted under such a motive, 
 may often, even during the access of frenzy, be guided by 
 it. To a man of the world with confused notions of duty 
 and virtue, but with a clear conception of the code of chi- 
 valry, and an elevated opinion of the character which it 
 becomes him to support, all doubt, all suspicion of the pos- 
 sibility* of his breaking his word, of his doing that which he 
 has promised not to do, will communicate intense pain, de- 
 stroy all reciprocity of sentiment, confirm his delusions, and 
 increase his malady. Whatever the supposed intentions of 
 such a patient, personal restraint would be improper. Es- 
 
WHAT ASYLUMS OUGHT TO BE. 203 
 
 quirol acting on this rule, trusted a military man who was 
 determined on suicide with the means of destruction on his 
 pledging his honour that he would make no attempt to use 
 thein. He passed through the ordeal in safety, but not with- 
 out a struggle. This was venturing far, perhaps too far, but 
 when well assured of the strength and influence of this feel- 
 ing, it would be wise and prudent to appeal to it in preference 
 to resorting to harsh or compulsory measures. It may be 
 turned to good account in classifying patients of the higher 
 ranks, but the dangerous error should be carefully avoided 
 of attributing a greater strength and influence to this feeling 
 in lunatics than in sane individuals. 
 
 The association of lunatics requires to be skilfully man- 
 aged. But when classes have been formed in conformance 
 to the mutual wants, and wishes, and dispositions of the 
 parties, the system is at once beautiful and self-operating. 
 There is no need of keepers to direct, and chide, and caution. 
 Their presence is required to regulate the machine, but its 
 motions are spontaneous. The little kindnesses of co-opera- 
 tion and assistance go forward, the weaver plies his shuttle 
 as vigorously, and the dance and song conclude the day as 
 regularly as if a whip or a comfit were displayed. It is a 
 mistake to suppose that, as a general rule, these bands should 
 consist of patients of similar dispositions. 
 - When once associated, there ought to be as much liberty 
 as is consistent with the safety of the whole community, and 
 just as much restraint as is consistent with the happiness and 
 recovery of each of the members. By liberty I do not 
 mean independence of authority, idleness, or even a mere 
 exemption from strait jackets and fetters. There must be 
 laws vigorously enforced, and industry, and rewards, and 
 punishments, in an asylum, as in every other body. I 
 would here, however, make a distinction, confining punish- 
 ments to moral delinquencies exclusively, exonerating the 
 offender from all penal consequences where the offence is 
 
I 
 
 204 WHAT ASYLUMS OUGHT TO BE. 
 
 clearly the result, the manifestation of his derangement. 
 But by liberty I mean the power of gratifying every inno- 
 cent propensity, every justifiable desire, of pursuing every 
 object which is calculated to inspire present pleasure, or 
 conduce to the ultimate re-establishment of reason. Be nig- 
 gard of mere indulgence ; but you cannot be too extrava- 
 gant of enlightened humanity. Many establishments have 
 been condemned and ruined, by the occurrence of a case of 
 suicide within their walls, or an attempt to escape proving 
 successful. I never heard of one suffering any penalty for 
 undue severity or restraint, if these fell short of absolute 
 cruelty. Self-destruction under such circumstances, is pe- 
 culiarly distressing ; but it cannot be construed as a proof of 
 laxity of discipline, or of too great indulgence in the par- 
 ticular case, nor as an argument against general lenity and 
 humanity. The lunatic turns some of the very means 
 employed to protect him against himself, to his own de- 
 struction. This, however, cannot be prevented under the 
 best management, unless chains and unfurnished cells be 
 resorted to; and even then the security is not complete. 
 Every object may be converted into a deadly weapon. 
 Pieces of glass, rusted nails, worsted thread taken from the 
 carpet, medicine, the very walls, may be so employed. 
 Escapes, while every precaution should be taken to prevent 
 them, in general prove nothing more than that great free- 
 dom is enjoyed by the inmates of the asylum — greater by 
 one degree only, than what they ought to enjoy. There 
 sometimes, however, arises danger from patients being too 
 kindly treated. From being obliging, useful, amusing, and it 
 may happen from the very nature of their malady, individuals 
 become favourites. Out of this favouritism grow indulgen- 
 ces, exemptions from medicines, duties, or punishments, and 
 the encouragement of delusions, lest contradiction should 
 annoy or render refractory. It is certainly very difficult to 
 avoid forming and practically shewing a stronger attachment 
 
WHAT ASYLUMS OUGHT TO BE. 205 
 
 for those who trust, serve, and it may be, love you, than for 
 those who bend every thought to irritate or destroy you, or 
 circumvent your plans. The preventive or remedy for such 
 partialities, is to be found in the judicious selection of ser- 
 vants — in the employment of those only who perceive and 
 feel, that the fewer the endearing qualities of the patient, 
 and the farther he is removed from participating in the sym- 
 pathies of the healthy mind, the greater are his claims upon 
 those around ; or who in the administration of justice, or 
 the distribution of favours, recognize a perfect equality be- 
 tween the patient with one sound feeling, and the patient 
 with many. An easier, and perhaps safer mode of inter- 
 rupting such ties, is the frequent change of servants from 
 ward to ward. This is practicable in large establishments 
 only. The same expedient is strongly recommended in 
 cases of relapse. Celebrated authors go so far as to say, 
 that patients should never be attended during two attacks, 
 by the same servant. No vestige, it is argued, of their 
 former illness, should be allowed to appear; and accord- 
 ingly, every object calculated to recall the impressions 
 existing during its continuance should be excluded. Almost 
 every one has heard of the unfortunate victim of the blue 
 devils, who was first hunted from London, and ultimately 
 from his native country, by the reappearance of these per- 
 secutors, whenever he was surrounded by certain pieces of 
 furniture. The visual deception was here associated with, 
 and constantly excited by a real visual impression. Upon 
 a similar principle is the change of attendants proposed. 
 But it is doubtful how far it ought to b*e pushed, as the re- 
 collections of the state of convalescence which took place 
 under the care of the servant, must be more vivid than the 
 recollections of the state of insanity, and in proportion to 
 the vividness and agreeableness of an impression, will it prove 
 beneficial or injurious. But this change is advocated upon 
 still another ground ; that of the dislike which is supposed to 
 
206 WHAT ASYLUMS OUGHT TO BE. 
 
 arise in the mind of those who have recovered from insanity, 
 towards those who have been instrumental in the cure. This 
 supposition is altogether erroneous and libellous to human 
 nature. When the hand of the curator of the insane was 
 armed with the lash, and when insult and the bastinado were 
 prescribed as specifics, it is highly probable that the re- 
 covered lunatic did regard his oppressors with loathing and 
 detestation. But now when the insane are treated as human 
 beings, there exists evidence that gratitude and esteem as 
 frequently reward the kindness and care of their attend- 
 ants, as in any other of the relations of life where such 
 sentiments are likely to be called forth. Upon this ground 
 then, a change of attendants cannot be justified. Indeed 
 where kindly feelings are known to exist, or to have existed, 
 they should be received as indications of the propriety of 
 resorting to the original attendant. 
 
 Many profound sophisms have been delivered as to the 
 introduction of religious worship among lunatics. It has 
 been argued that such exercises are addressed to the highest 
 feelings of our nature, and bring before the attention the 
 most awful truths — that they are eminently exciting, and 
 consequently prejudicial ; and the aphorism has been quot- 
 ed, that it is necessary to avoid all excitement ; that as no 
 opportunity should be given for the irritation of the furious, 
 or for the intimidation of the timid, neither should any plan 
 be adopted which may tend to foster religious impressions 
 in the superstitious. This opinion has been controverted by 
 the assertion, that such an appeal is tranquillizing and con- 
 solatory, and leads the enfeebled mind to the only source of 
 strength and succour. One authority adduces examples of 
 the efficacy, another of the evils of such an attempt. It is 
 prohibited, because it sometimes causes insanity, or aggra- 
 vates a predisposition to the disease : it is recommended, 
 because it brings hope and peace to those who, although 
 sane, are miserable. I regard the grounds of opposition 
 
WHAT ASYLUMS OUGHT TO BE. 207 
 
 and advocacy as equally invalid. Upon certain forms of 
 mental disease, religious teaching or ceremonies would act 
 as a direct irritant ; upon others they would fall powerless ; 
 upon a third class, such ministrations would operate as any 
 otlaer novel scene or occupation which assisted in relieving 
 the monotony of their mode of life ; while upon a fourth, 
 their influence would be altogether benign, affording a le- 
 gitimate gratification to healthy feelings, directing the mind 
 from depressing, or agitating, to soothing associations, and 
 tending to inspire with brighter and nobler hopes, which 
 disease can neither darken nor quench, which will beam in 
 on the troubled spirit amidst its gloomiest delusions, as clear 
 and certain points of guidance, like shore-lights to the storm- 
 bound sailor. Upon the discrimination of the patients to 
 whom religious instruction is adapted, the whole question of 
 its utility rests. To prescribe it as applicable to all cases, 
 would be as wise as to seek for the elixir vita? ; and to ex* 
 elude it because sometimes injurious, betrays a deplorable 
 ignorance of the constitution and the wants of the human 
 mind. I may, with all reverence, compare the employment 
 to that of any other medicine. It must be regulated by 
 the idiosvneracies of the patients, by the symptoms, the 
 duration and the complications of the disease. No man 
 entertaining this view, will establish public worship as an 
 hospital routine duty, in which all must or may participate. 
 It should be reserved for the few who can understand its 
 meaning, who may be quieted by its solemnity, cheered by 
 the prospects which it affords, attracted by the beauty of 
 the service, or roused by the recollections which it calls up 
 — the condition of each of these classes having been previ- 
 ously examined and tested as to the extent to which such 
 impressions may be borne, and may prove beneficial. It 
 will be observed, that many are here proposed to be admit- 
 ted to these rites, who cannot be expected to regard them, 
 or be influenced by them as religious duty. The imagina- 
 
208 WHAT ASYLU3IS OUGHT TO BE. 
 
 tive, the musical, the lethargic lunatic, are thus all included, 
 because pleasure would be communicated, and a new and 
 healthly direction may be given to their thoughts by the 
 aspect and accessory circumstances of the assembly, in- 
 dependently altogether of its sacred character. Many 
 exceptions, however, must be made, and the pleasure de- 
 rivable must not be chosen as the ground of admission. 
 Those, in fact, who most ardently desire to join such meet- 
 ings, and who pant for spiritual communion, are often those 
 who are least fitted for it. They doubt or despair of their 
 salvation, or their whole soul is in wild exultation at the 
 prospect of the bliss which awaits them : or they have seen 
 visions, or they prostrate every power before the conviction 
 that they are incarnations of Deity, or of the angelic host. 
 In such states as these, any act connected with religion, 
 must generally contribute to promote and perpetuate the 
 activity of the diseased feeling. I say generally, for where 
 the reason remains intact, and the dominant emotions are 
 terror, despondency, penitence for imaginary crimes, and so 
 forth, a clear exposition of the promises of Christianity made 
 to the understanding, in a clear and conciliating manner, 
 sometimes acts as if miraculously. Such cases must be select- 
 ed, and not experimented on. Under such circumstances, 
 private religious instruction would be infinitely preferable 
 to any public devotional service. It is somewhat singular, 
 that this mode of conveying powerful impressions is scarcely 
 at all resorted to in our establishments. Apart from all 
 other considerations, it enables the clergyman to study and 
 probe the wound he desires to heal, to know the dispositions 
 he has to contend with, and to frame his exhortations, and 
 to regulate his intercourse accordingly. In a promiscuous 
 congregation this cannot be attempted. The propriety of 
 such a mode of communication is strongly insisted upon by 
 the English physicians, and even by some of those who 
 express doubts as to the salutariness of public worship, or 
 
WHAT ASYLUMS OUGHT TO BE. 209 
 
 entertain a decided opinion against its employment. This 
 practice was at a very remote period, 1677, introduced at 
 Betblcm, but for reasons which cannot now be ascertained, 
 has fallen into disuetude. In order to take advantage of 
 every impression which public worship is calculated to 
 excite, it appears to be highly expedient that it should be 
 performed on Sunday, in the manner to which the patients 
 have been accustomed in health, and in some apartment 
 consecrated to the purpose. Many objects are hereby gain- 
 ed : the regular passage of time is marked, I have two 
 patients under my care, who lost all conception of this, ap- 
 parently from the want of a calendar : the nature of the in- 
 stitution is recalled, and with that fact many of the thoughts 
 of other years, which, as connected with an unimpaired 
 state of mind, and the performance of a sacred duty, are 
 generally serene and salutary ; sentiments of reverence and 
 humility are engendered, and the hope of the return of the 
 day is excited, and an anticipation of the same calm thoughts 
 and recollections. " They all look forward to it with plea- 
 sure," says Dr. Fox. I am disposed to urge the propriety 
 of Sunday being observed in the same manner within as 
 without an asylum for another, and what may be condemned 
 as too much of a secular, reason. It is there a day of idle- 
 ness and lethargy ; it is shortened as much as possible by 
 indulgence in sleep, or prolonged by the uninterrupted 
 sufferings of self-tormenting spirits: in short, all moral 
 treatment is suspended. This monotony is very hurtful. 
 To continue that regimen by which occupation is provided, 
 and by which unhappiness is combated, by calling healthy feel- 
 ings into play, some act of public worship would be essential. 
 There are certain descriptions of madness in the treat- 
 ment of which religion is indispensable. But in the employ- 
 ment of such an agent, great difficulties occur, so great 
 indeed, as to discourage the most zealous of its advocates. 
 These consist in determining the modes in which its effects 
 
210 WHAT ASYLUMS OUGHT TO BE. 
 
 may be best obtained. If its doctrines are taught to weak 
 or perverted intellects, they may add to the confusion already 
 existing; if its mysteries are brought prominently forwards 
 they are apt to mingle with superstitious fears and delusions ; 
 if its duties alone are commented on, the doubting and igno- 
 rant may be left unsatisfied ; if preaching is the vehicle, the 
 attention may be fatigued and exhausted ; if prayer, the sen- 
 timents may be strongly affected. These suppositions are 
 all obviously founded upon the injudicious use of such an 
 agent. Men are surely to be found with discretion sufficient 
 to avoid the extremes here indicated, and to select these really 
 catholic truths upon which men of all sects and shades of 
 opinion, and even men of all degrees of intellectual enlight- 
 * enment and moral excitement, may agree, and from which 
 the insane as well as the sane may derive comfort. Prayer 
 and praise certainly appear to be the least susceptible of 
 abuse. They are placed by their nature beyond the control 
 of the pastor. Either as if dubious how far even an educated 
 mind can be trusted in dealing with these for the behoof of 
 lunatics, or in the spirit of their peculiar views, the philoso- 
 phical and humane governors of the Retreat at York, have 
 confined the religious service performed there to the reading 
 of certain portions of Scripture. But that, under proper 
 management, this department of mental medicine may be 
 carried much farther, is proved by the statements contained 
 in the Annual Reports of various asylums. " When they do 
 attend," says Mr. Ricketts, " they are attentive generally, 
 and well conducted ; so much so, that I have known when 
 a paroxysm was likely to come on ; five or six minutes before 
 prayers, the patient has been brought in, and he has had such 
 command over himself, that the paroxysm has been check- 
 ed."* " It was only about the beginning of 1833," I quote 
 now the experience of the medical officers of the Dundee 
 
 * Minutes of Evidence taken before the Select Committee, &c. 
 1828, p. 45. 
 
WHAT ASYLUMS OUGHT TO BE. 211 
 
 Asylum on the subject, " that a regular chaplain was ap- 
 pointed ; and who ever has witnessed the preparation made 
 by the patients for their appearance at chapel — the solemn 
 demeanour and strict decorum observed during the whole of 
 the service — the close attention paid to the words of the 
 preacher — and one of the patients occasionally officiating as 
 precentor with becoming propriety and tasteful execution — 
 will contemplate the picture with feelings of the deepest in- 
 terest,, and fondly hope that the swelling notes that delight 
 the ear have proceeded from lips which God has touched : 
 and the words listened to with such attention, have been 
 embraced by those whose heart has felt the power of divine 
 truth." " No class is excluded : and though there must ne- 
 cessarily be some whose state of health does not admit of 
 attendance, and some who are without the inclination — and, 
 in this case compulsion is out of the question — yet upwards 
 of three-fourths of the whole number regularly assemble in 
 chapel ; and it is found that, in regard to those whose tem- 
 per is the most restless, and who are the most easily excited, 
 the solemn nature of the religious service has a wonderful 
 effect in subduing their irritation, in calming their minds 
 and composing their spirits, not only during the time of the 
 service, but during the remaining hours of the day of rest."* 
 The following is the result of my own observations : — " The 
 effects in each individual are probably as different as in the 
 members of an ordinary congregation, but the general impres- 
 sion produced is that of reverence and order. In whatever 
 spirit the simple truths announced to them may be received, 
 the meeting is almost invariably distinguished by perfect 
 decorum and propriety. The stocking and book are laid aside 
 — the involuntary and incoherent exclamation is no longer 
 uttered, or subdued into a whisper, and one of those who 
 usually spurns the authority and rejects the entreaties of 
 
 * Fourteenth Report of the Directors of the Dundee Lunatic Asy- 
 lum, 1834, p. 7. 
 
212 WHAT ASYLUMS OUGHT TO BE. 
 
 those around, kneels calmly and reverently down as if 
 perfectly conscious of the majesty of the Being whom her 
 more rational companions are uniting to worship. Where 
 convalescence has advanced to a certain stage, or where 
 observation has shown that a patient is trust-worthy, per- 
 mission is given to attend church, of course under proper 
 superintendence. This is done partly that the idea of im- 
 prisonment may be eradicated, partly that reunion with 
 society may be gradual, but chiefly that the mind may be 
 strongly directed to those principles and duties, a knowledge 
 of which renders mental exertion and the cultivation of in- 
 ternal peace and harmony alike an obligation, a reward, and 
 a blessing. No violation of the promises given previous to 
 the grant of such permission as to the deportment and return 
 has occurred. One individual, after a seclusion of thirteen 
 years, during which she had never been permitted to go to 
 church, was deeply affected, and wept on again joining in 
 the service, but otherwise her behaviour was irreproachable. 
 It would have been extraordinary and unnatural had no 
 feeling been manifested, and this conduct was accordingly 
 regarded rather as an indication of sound mind than of alie- 
 nation.'** The practice of allowing patients to attend the 
 parish church has, I perceive, been adopted in other places. 
 " Prayers," says Mr. Ricketts," are read in my establish- 
 ment every Sunday, to every patient capable of receiving 
 religious instruction. The convalescents go to church ; some 
 of the highest classes with my own family." " But in other 
 cases," is the statement of Dr. Finch, " I have been so con- 
 vinced of the utility of religious services, that many of my 
 patients go regularly to the village church, &c."f 
 
 * Report of the Directors of the Montrose Lunatic Asylum, &c. 
 1835, p. 16. 
 
 f Minutes of Evidence, &c. 1828. Evidence of Mr. W. H. Rick- 
 etts of Droitwitch, Worcestershire, and of Dr. W. Finch of Salisbury, 
 pp. 42-49. 
 
WHAT ASYLUMS OUGHT TO BE. 213 
 
 Similar efforts have been made at Sonnenstein and other 
 places on the Continent, and have been attended with similar 
 success. But these attempts to administer consolation by 
 means of religious ordinances, have been pushed much farther, 
 and the results have been supposed to be proportionally great. 
 Patients have been permitted to participate in the sacrament 
 of the Lord's Supper, and have been recommended to direct 
 their thoughts constantly to the contemplation of their moral 
 condition as the only course by which health and happiness 
 can be secured. How far any physician is justified in counte- 
 nancing such measures as these, appear to be very doubtful. 
 The first of them presupposes, I presume, a state of convales- 
 cence in the communicant, such a state at least as admits of 
 a clear conception of the nature of the rite and of the obli- 
 gations which its celebration imposes. The great objection 
 to which it appears open, is the excitement to which the 
 mind is exposed by the imposing aspect and duration of the 
 ceremony, and the mingled feelings of awe, and penitence, 
 and hope to which it gives rise. The determination of the 
 question whether the probable amount of good to be obtained 
 counterbalances the certain amount of danger to be encoun- 
 tered, must rest in each case on the discretion and judgment 
 of the medical adviser : for to establish a general rule on the 
 subject would be most unphilosophical and pernicious. I 
 am, however, inclined to think that when patients have ad- 
 vanced so far towards restoration as to be intrusted with such 
 high and holy privileges, that they should not longer be de- 
 tained in an asylum, but should be reinstated in society, and 
 in the possession of rights, and the discharge of duties of an 
 important but less exciting character. The second measure, 
 although sanctioned by a few practical observers, is in direct 
 opposition to every rule laid down for the regulation and 
 tranquillization of the unhealthy mind. To occupy the at- 
 tention in a sustained manner, with any powerfully affecting 
 topic, is prejudicial ; but when the object is the. ultimate des- 
 
214 WHAT ASYLUMS OUGHT TO BE. 
 
 tiny of the troubled soul itself, the disturbance, the despond- 
 ency, the exultation necessarily ensuing from the particular 
 view taken by the unstable intellect, or waiving this position, 
 even the anxiety, the tumultuous struggle of hope and fear, 
 roused in the coolest, and strongest, and purest mind by such 
 a train of thought, must inevitably overthrow that equani- 
 mity which it is the aim of all rational treatment to establish ; 
 and create that internal conflict, and agitation, and intense 
 feeling which it is equally the aim of all rational treatment 
 to prevent or remove. Many, if not all the cases where in- 
 dividuals incurably lunatic have expressed apparently clear 
 ideas on religious subjects, and satisfaction that they had 
 been led to the consideration of these, have terminated 
 almost immediately afterwards in death, and cannot accord- 
 ingly be admitted as evidence, either of the permanency or 
 of the remedial efficacy of the impressions produced. If 
 great caution ought to be exercised in dealing with the insane 
 mind, still greater care is required in drawing conclusions as 
 to the effects of such interference. 
 
 It would be foreign to my present object to delineate the 
 detailed application of the principles of moral treatment in a 
 well conducted asylum ; but it is of some importance to 
 point out certain fallacies which have misled the public as to 
 the nature of the system pursued, and give to it an appear- 
 ance of empiricism which it actually does not possess. They 
 farther countenance the prejudice that the management of 
 the insane depends upon a peculiar and mysterious tact, and 
 is not founded upon a knowledge of human character. Thus, 
 for example, the idea that an unanswerable argument or piece 
 of pleasantry can eradicate a delusion, is altogether errone- 
 ous. The most plausible case of this kind is that of the 
 mechanician mentioned by Pinel. This person was haunted 
 by the imagination that he was one of the victims of the Re- 
 volution ; that he had been guillotined ; but the sentence 
 having been reversed just at the moment the execution had 
 
 
WHAT ASYLUMS OUGHT TO BE. 215 
 
 been completed, the judges in order to remedy, so far as 
 possible, what had been done, commanded that the heads 
 should be replaced on the respective bodies. In the confu- 
 sion, two heads were transposed: the mechanician lost his own, 
 but was provided with another, which he very much disliked, 
 and which he attempted to prove was not his own property by 
 saying, " look at these teeth ; mine were exceedingly hand- 
 some, these are rotten and decayed. What a difference between 
 this hair and that of my own head !" He likewise ima- 
 gined that he had discovered the perpetual motion, and 
 worked night and day in the construction of a machine on 
 this principle. He often quarrelled with his companions on 
 the subject of his head ; and one of them being instructed 
 how to act, led the conversation to the miracle of St. Denis, 
 who, it is said, walked about with his head under his arm, 
 and kissed his own lips. The mechanician maintained the 
 possibility of this : his opponent retorted, " madman that 
 thou art, how could St. Denis kiss his own head — was it 
 with his heels ?" This discomfiture is said to have restored 
 him to reason. But here it is quite evident, that the six 
 months' course of vigorous application to his business was 
 more instrumental in the cure than the biting repartee. 
 Equally undeserving of confidence is the belief in the effi- 
 cacy of an acquiescence in the whim of the maniac, and the 
 institution of some process to remove the evil complained of, 
 it being acknowledged to be real. Esquirol advises this to 
 be tried as a last resource. It is especially applicable to 
 hypochondriacal maniacs, who imagine that they labour 
 under disease, are devoured by animals, &c. The following 
 examples are not intended to justify the practice, but will 
 show to what cases it is applicable, and in what cases it has 
 been supposed to prove successful. A woman suffered 
 from pain on the top of the head, and believed that it was 
 caused by an animal burrowing beneath the skin. She was 
 for a time restored to sanity by an incision made in the 
 
216 
 
 WHAT ASYLUMS OUGKT TO RE- 
 
 spot, and the pretended extraction of an earth worm. A 
 hypochondriac who believed that he had frogs in his stomach, 
 is said to have been cured by a purgative, and the introduc- 
 tion of one or two frogs in the night stool. But admitting 
 that such instances are worthy of consideration, is it not 
 more likely that the incision and the purgative were the 
 remedial agents than the deception practised ? But without 
 insisting upon such a construction, the plan is objectionable 
 from its tending to foster the delusion, by suggesting, as 
 often happens, under somewhat similar circumstances, that 
 although one worm had been removed, others more deeply 
 imbedded remained behind : and in the case of the hypo- 
 chondriac, that before the expulsion of his full-grown enemies 
 they had spawned, and that his malady was renewed by their 
 growing progeny. 
 
 Quackeries of a more marked character, and of a less 
 innocent description, have at all periods in the history of 
 mental medicine, obtained celebrity, shrunk from the test of 
 experience, and ultimately been rejected. Any mode which 
 is reputed to cure insanity instantaneously, or in the course 
 of a few hours, may be looked upon with suspicion, when 
 the nature of the remedy is concealed, and the mystery thus 
 created employed as a means of enriching the discoverer. 
 In our own country, in former times, lunatics were supposed 
 to be cured in a single night, by sleeping in churches of 
 great sanctity, or by a bath in particular springs. A Mil- 
 anese physician cured all cases of mania in a given time, by 
 chaining his patients in a well. The water was allowed 
 gradually to ascend to the mouth, and when the maniac was 
 in terror of being drowned his disease ceased. He was thus 
 terrified into his senses. In our own country, and in our 
 own day, a medical man has declared, that he has in his 
 possession a remedy, which, when properly administered, 
 will cure the most incurable maniac, and that in a few days. 
 Mr. Lucett's method has received high sanction. In one 
 
WHAT ASYLUMS OUGHT TO BE. 217 
 
 instance he received L.200 from the Board of Treasury, for 
 the cure of a servant of the Duke of Kent. He professes to 
 perform the cures attributed to him — miracles they deserve 
 to be named — by the aid of kindness, a lotion applied to the 
 head and the secret nostrum, before alluded to. A com- 
 mittee of medical men was appointed to enquire into the 
 facts of the case ; and their report shows, that mitigation of 
 symptoms, and not cure, was the amount of Mr. Lucett's 
 success— a mitigation which is within the reach of every 
 practitioner, if he chooses to push the exhibition of a power- 
 ful and unmanageable drug to a great extent — a mitigation 
 which, although occasionally desirable, has not been proved 
 to facilitate the cure of the patient, while it places his life 
 in jeopardy. Mr. Lucett's success may be contrasted with 
 his pretensions, as narrated by one of his patrons. " The 
 third experiment was upon an idiot, without the powers of 
 speech, or the use of his limbs, and blind from pressure on 
 the optic nerve. Within seven weeks he was restored to 
 reason, speech, sight, and the use of his limbs." The only 
 commentary which such a relation requires, is that all other 
 physicians would find it nearly as easy a task to imbue the 
 dead with life, as to raise such a being as that described to 
 intelligence. 
 
 It may be laid down as a general rule, that all mystery 
 is foolish and hurtful. It creates a suspicion that there is 
 something which requires to be concealed. It inspires dread 
 — the very opposite of the feeling which it is desirable should 
 be entertained both by the public and the patients. It is 
 allied to quackery, as founded upon the pretence of superior 
 or secret knowledge, or upon the existence of proceedings, 
 the nature of which it would be unsafe or imprudent to dis- 
 close. For a long period English practitioners arrogated to 
 themselves the possession of some specific which enabled 
 them to cure a greater number of lunatics than their con- 
 tinental rivals. This secret and all powerful remedy, in 
 
 L 
 
218 WHAT ASYLUMS OUGHT TO BE. 
 
 order to bolster up their own reputation they had the sel- 
 fishness and cruelty to conceal. There was in fact nothing 
 to reveal. Pinel exposes this compound fraud and folly by 
 detailing his own benevolent views as to the moral treat- 
 ment of the insane, and by proving that the boasted secret 
 consisted in nothing more than the judicious application of 
 these. 
 
 On the continent, a very powerful movement has been 
 made to place the treatment of lunatics upon a true basis ; 
 and were we to believe some of our periodical writers, the 
 improvements already effected, infinitely exceed any thing 
 which has been attempted or thought of in this country. 
 For instance, a writer in the Medical Gazette favours the 
 Ipublic with the following relation and remarks : " The 
 French certainly carry their treatment of the insane to a far 
 higher pitch of refinement than we do. The idea of giving 
 a ball in a lunatic asylum, may startle some of our mad 
 doctors ; but what think they of the following precedent. 
 On the 7th instant, May 1835, the females of Salpetriere 
 were treated to a grand ball. The insane ladies themselves 
 were entrusted with the getting up of the entertainment. 
 They adorned the ball-room with festoons, garlands, and 
 devices ; and in the midst they crowned with immortelles, 
 the bust of Pinel, the liberator of the insane from the old 
 system of cruelty and terror. The dancing, it is said, went 
 off with charming effect ; the students, intern and extern, 
 did the honours ; and the festivity was kept up to an hour 
 sufficiently advanced to satisfy all parties, who, to do them 
 justice, were indefatigable in their efforts to please and to be 
 pleased. It should be added, that the gay scene, (which 
 was appointed and arranged with the most serious object) 
 has been generally attended with good results : it served 
 admirably to fix and amuse the minds of the patients ; and 
 several who laboured under melancholia were much divert- 
 ed for the time from their imaginary woes. M. Esquirol 
 
WHAT ASYLUMS OUGHT TO BE. 219 
 
 some years ago tried this method with success ; but it is to 
 M. Pariset, the physician to Salpetriere, that the credit is 
 due of having so happily ventured on its repetition in the 
 present instance."* Now, in place of this statement creating 
 any astonishment in the minds of those intrusted with the 
 care of the insane in Britain, they will experience regret and 
 surprise, that what they have done for the behoof of their 
 charges should be so little known even to their professional 
 brethren. Dancing, both as a physical exercise, and a6 a 
 recreation, has been introduced, and with excellent effects, 
 into many well-regulated British asylums ; and to speak 
 from personal experience, were the foregoing account di- 
 vested of some of the embellishments — the festoons and 
 immortelles — it would very correctly describe what takes 
 place, and has for years taken place, once every week in the 
 establishment under my care. So that while I would speak 
 with veneration and gratitude of all that Esquirol and 
 Pariset have advised or accomplished, it is but justice to 
 our national discernment to say, that we have already 
 reduced to a system what they have only tried as an experi- 
 ment. I cannot speak so decidedly as to the introduction 
 of dramatic representations as a means of cure. The attempt 
 has been made at Charenton unsuccessfully, at Copenhagen 
 without injury ; but the inhabitants of this country mani- 
 fest during health so little taste for such spectacles, and 
 depend so little upon them as sources of amusement, that it 
 would be injudicious to resort to them in order to arouse, 
 or attract, or amuse the insane, while we have so many bet- 
 ter modes of abstraction at our disposal. 
 
 In front of the philanthropical enterprize in favour of the 
 insane in France, may be placed, Drs. Falret and Voisin. 
 They have long studied mental disease in the best school ; 
 they have long cherished the desire of putting the prin- 
 
 * London Medical Gazette, May 23, 1835. p. 288. 
 
220 WHAT ASYLUMS OUGHT TO BE. 
 
 ciples dictated by humanity and philosophy to the treatment 
 of the insane, to a fair and full test, and they have now em- 
 barked their whole fortune and hopes of prosperity in the 
 experiment. They possess a large domain of about sixty 
 acres, partly farm, party ornamental garden, situate in one 
 of the many picturesque villages in the vicinity of Paris. 
 From many points in their enclosure, the whole of the 
 surrounding country is visible, while the bustle and annoy- 
 ances of the metropolis are shut out. The banks of the 
 Seine being undulated, every walk and turn presents a new 
 aspect of the natural panorama. Fertility and beauty are 
 constantly before the eye ; the luxuriance of a rich soil, the 
 products of human skill. Within, the resources are equally 
 great. The extensive grounds afford constant employment 
 in the open air. Detached buildings render a scientific and 
 rigid classification easy ; spacious apartments contain all the 
 ordinary means of amusement, music, billiards, &c, and no 
 appendage of which reminds the inmate that he is mad or 
 not trust-worthy. In addition to these excellent arrange- 
 ments, there is the constant superintendence of two humane 
 and enlightened physicians, the society of their families, 
 accommodation for the patients' friends, should their pre- 
 sence be deemed expedient, the active administration of 
 every moral agent, and the main spring of all, gentleness and 
 affection. 
 
 As an additional instance of the progress of sound princi- 
 ples in France, and as an example of what an asylum for the 
 upper ranks ought to be, I make the following quotation 
 from the valuable work of Dr. Combe on " Physiology 
 applied to Health and Education." " The celebrated and 
 benevolent Esquirol has been loud and eloquent in enforcing 
 regard to the feelings, and attention to the real welfare of 
 the insane ; and in his private establishment at Ivry, near 
 Paris, which I had the gratification of visiting along with 
 him in September 1881, he exemplifies almost every prin- 
 
WHAT ASYLUMS OUGHT TO BE. 221 
 
 ciple upon which an asylum ought to be conducted. The 
 asylum is placed in a beautiful and airy situation, with a 
 pleasant exposure ; and its general aspect is that of an in- 
 habited and well kept villa. Four distinct buildings, of 
 ample size and elegant appearance, are conveniently distri- 
 buted through a well laid out and ornamented park of twenty- 
 five acres, part in garden, part in grass, and part in planta- 
 tion, with neat walks bordered with flowers, running in every 
 direction ; which, it will be observed, is a very handsome pro- 
 vision for thirty or thirty-five patients, to which number he 
 restricts himself. For the troublesome or excited patients, 
 there are two neat one-story buildings, one for males, and the 
 other for females, separate from each other, and far removed 
 from those appropriated to the convalescent and tranquil. 
 These one-story tenements open upon, and look into spa- 
 cious grass plots, surrounded on two sides by high walls, 
 along which covered galleries are made for shelter from the 
 rain and sun ; so that the height of the walls seems as if 
 intended to admit of galleries being made, rather than for 
 the purpose of preventing escape. The third side is occu- 
 pied by a plain., neat, high railing, like that of Tuilleries 
 Garden. To these plots and galleries the patients have ac- 
 cess at pleasure ; and most of them prefer coming out at the 
 window, from which they can easily step, no restraint being 
 visible, and nothing of the prison being apparent. This 
 degree of harmless freedom tranquillizes them amazingly. 
 Each room (neatly and plainly furnished) has beside it a 
 room for a servant, each patient having one, so that ample 
 surveillance is exercised. When a little confirmed in tran- 
 quillity, they are allowed to go out by a back door to a 
 large ornamental walk, shrubbery and garden, with a fine 
 view over a lower wall, apparently opening upon the public 
 fields, but in reality perfectly retired. The attendants are 
 more refined and gentle in their manners, and better edu- 
 cated., as well as naturally more humane and intelligent, 
 
222 WHAT ASYLUMS OUGHT TO BE. 
 
 than the corresponding class of persons in this country. 
 Their number, intelligence, and amiable dispositions, are a 
 great advantage both to themselves and to the patients. 
 Being less exclusively confined to the society of the insane, 
 they have not that peculiar expression of eye, and general 
 appearance, which our keepers so often acquire, and which 
 indicate a state in some degree allied to insanity. Esquirol 
 says that his English visitors complain of the difficulty of get- 
 ting any but coarse and ignorant men for keepers, and wonder 
 how he succeeds ; but the French, of all classes, are natural- 
 ly more observant of the kindnesses of ordinary intercourse, 
 especially with their inferiors, than we are, and are habitu- 
 ally more tolerant of the caprices and weaknesses of others. 
 The different classes of society thus stand at all times in a 
 more favourable position than with us for acquiring an in- 
 terest in each other, and for becoming friends, or, in other 
 words, for effecting a cure. The importance of this confi- 
 dence was well illustrated by an expression of Esquirol's, in 
 speaking of a patient. * At last,' he said, < I succeeded in 
 gaining his confidence, and after that,' he added with a sig- 
 nificant look, < on va vite a la guerison/ This, of course, 
 must be received as a general proposition only, but it shows 
 the force of the principle. When tranquillity is secured, the 
 patient is removed to another building, and from that to a 
 third, each bringing him nearer and nearer to ordinary life, 
 till, in a third, convalescents meet, in the character of ladies 
 and gentlemen, at meals, music, billiards, reading, &c, along 
 with the family of Dr. Metivier, a nephew of Esquirol, who 
 resides there with his wife and children. There the patients 
 receive their friends, and with them make excursions to the 
 environs, or to go to the theatre, — or if from the provinces, 
 they go and see the wonders of the capital. They are thus 
 gradually prepared to resume their station in society, and 
 from being treated throughout with most considerate kind- 
 ness, they become attached to the family, and cease to repine 
 
WHAT ASYLUMS OUGHT TO BE. 223 
 
 at their temporary separation from friends and home. But 
 not to dwell too long on this most interesting subject, I shall 
 conclude at once by remarking, that it is necessary only to 
 see the different appearance and conduct of the patients in a 
 well contrived and properly regulated asylum, as contrasted 
 with one of an opposite character, to perceive at once how 
 influential active moral treatment is in promoting recovery, 
 and how necessary it is to devote more attention than hitherto 
 to this and the other conditions of health in our treatment 
 of the insane."* 
 
 In some parts of America, there appears to be a complete 
 realization of all that I have wished to inculcate as necessary 
 to place the lunatic in that condition which is most conducive 
 to his happiness and recovery. " In respect to the moral 
 and intellectual treatment," remark the Visiting Physicians 
 of the Retreat at Hartford, " the first business of the physi- 
 cian, on the admission of a patient, is to gain his entire 
 confidence. With this view he is treated with the greatest 
 kindness, however violent his conduct may be — is allowed 
 all the liberty which his case admits of, and is made to un- 
 derstand, if he is still capable of reflection, that so far from 
 having arrived at a madhouse, where he is to be confined, 
 he has come to a pleasant and cheerful residence, where all 
 kindness and attention will be shown him, and where every 
 means will be employed for the recovery of his health. In 
 case coercion and confinement become necessary, it is im- 
 pressed upon his mind, that this is not done for the purpose 
 of punishment, but for his own safetj' and that of the keepers. 
 In no case is deception on the patient employed or allowed : 
 
 * The Principles of Physiology applied to the preservation of health, 
 and to the improvement of Physical and Mental Education. By An- 
 drew Combe, M.D. Fifth Edition, pp. 425—428. 
 
 A very interesting account of this institution has just appeared in 
 the New Monthly Magazine. May 1837. 
 
224 WHAT ASYLUMS OUGHT TO BE. 
 
 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 be- 
 come necessary."* A plan commenced on principles so 
 rational and benign, could not fail to effect all that is in the 
 power of art : we accordingly find towards the conclusion of 
 the Report, that in one year there had been admitted 
 twenty-three recent cases, of which twenty-one recovered, a 
 number equivalent to 91^ per cent. 
 
 Dr. Burrows gives the following description of a justly 
 celebrated asylum at Pirna in Saxony. To some of the ar- 
 rangements, however, I entertain strong objections. " This 
 lunatic establishment was formerly the castle of Sonnenstein, 
 and is situated on an almost perpendicular rock, two hun- 
 dred feet above the river Elbe, over which it projects. The 
 ascent has now been rendered less abrupt ; and the castle, 
 gardens, courts, and out-buildings, have been converted into 
 the best lunatic asylum I have seen out of England. The 
 number of patients which it contains is about 120, and 
 twenty more in the private house of Dr. Pienetz, the head 
 physician. We first visited a court-yard, where numbers of 
 patients were employed in sawing and chopping wood, others 
 drawing water from a deep well, and in fact all were occu- 
 pied. The bath-room is of a good size, containing eight 
 metal baths, in which the patient may be fixed if necessary. 
 There is an excellent apparatus for directing a powerful 
 stream of water upon any part of the bath-room. In an ad- 
 joining room is the bath of surprise. Here the patient is 
 seated in a metal slipper bath, sunk in the ground, the at- 
 tendant then comes to a window about fourteen feet above 
 the patient, and throws a large bucketfull of water upon the 
 head. This is often made use of both as a remedy and as a 
 
 * Hall's Travels in North America, vol. ii. p. 195. 
 
WHAT ASYLUMS OUGHT TO BE. 225 
 
 punishment, and the patients complain of pain as if the late- 
 ral lobes of the cerebrum were split asunder. We next went 
 into a large billiard room, to which the patients have con- 
 stant access of an evening, especially during winter. The 
 evening winter-room is extremely well-fitted up with piano- 
 fortes, violins, flutes, three or four backgammon and draft- 
 boards, and a very good book-case, which is at all times 
 open to the patients. They are allowed to remain here until 
 ten o'clock, and music and these games are encouraged as 
 much as possible. The patients, in respect to their living, 
 are divided into three classes, according to the money that 
 is paid for their maintenance. The first class have two small 
 rooms for two patients, with one attendant, and they eat their 
 meals separate from the others. The second class have also 
 two rooms for two patients, with one attendant, but their 
 accommodations and fare are not so good. The third class 
 dine together, and are six, seven, or eight in one room. 
 There is a Protestant church and clergyman in the building, 
 and they find that the most noisy patients are quiet during 
 divine service. The women's house is quite separate from 
 the men's, and is conducted upon the same plan. The gar- 
 dens around the building are immense, and are almost 
 entirely cultivated by the patients. There are various sum- 
 mer amusements in the gardens. Separate from these houses 
 is a new house, calculated for sixteen patients and the cler- 
 gyman, situated upon a beautiful slope, with an excellent 
 garden, and most delightful prospects. This is the conva- 
 lescent house, and here the ladies and gentlemen dine with 
 the clergyman altogether. They are allowed to take walks 
 in the environs, and divert themselves as they please."* 
 
 It is here stated that books are placed within the reach of 
 the patients. Dr. Abercrombie recommends a regular course 
 of historical reading as a part of the moral discipline in cer- 
 
 * Burrow's Commentaries, pp. 528, 529. 
 
226 WHAT ASYLUMS OUGHT TO BE: 
 
 tain species of derangement.* I am inclined to think that a 
 course of reading of any kind adapted to the powers, previous 
 tastes and acquirements regularly pursued, will prove bene- 
 ficial. But it is not enough that there should be a well 
 selected and easily accessible library in an asylum ; nor that 
 books, and maps, and attractive drawings be placed before 
 the convalescent patient ; there must be inducements to read 
 and examine. And these must be suggested and supplied, 
 principally by a study of the dispositions of those whom it 
 is our object to interest. We may inflict punishment where 
 it is our wish to communicate pleasure, by condemning a 
 man who abhors fiction to the perusal of the last new novel ; 
 and disgust for every description of reading may be inspired 
 by the injudicious choice of such works as offend a prejudice 
 or reanimate a delusion. Religious authors are most fre- 
 quently resorted to. No error can be more natural or more 
 pernicious. It is a noble and beautiful conception that the 
 reinvigorated mind should turn in adoration and gratitude 
 to the power from whence these new-born energies have 
 been derived ; but the effort often proves fatal to the wor- 
 shipper by whom it is made. The attempt is akin to that which 
 is made by the weak, worn-out, partially restored victim of 
 bodily disease to try his strength, that is, to task his nerves 
 and muscles, as if they were endowed with their original 
 power and activity, and no longer predisposed to lapse into 
 that condition from which they have so recently recovered. 
 The general practice is alone condemned. For that cases 
 every day occur where it is not only safe but expedient, that 
 religious impressions should be encouraged by reading as 
 well as by preaching, is as evident as that in a country where 
 so large a number of persons become insane, either from the 
 inherent intensity, or the cultivation of religious feelings, or, 
 rendered insane by some other cause, are affected with reli- 
 
 * Inquiries concerning the Intellectual Powers, &c. p. 355. 
 
WHAT ASYLUMS OUGHT TO BE. 227 
 
 gious mania, it would be eminently hazardous to place works 
 on religious subjects within the reach of all those who have 
 scarcely yet ceased to bs lunatics. But not only are such 
 works objectionable because they are religious, but because, 
 in common with every matter which is of great importance, 
 and involves our interest and happiness, they are powerfully 
 exciting. When the lungs, or heart, or stomach, have been 
 diseased, we avoid stimuli, whether they are ardent spirits 
 or violent passions, whether they affect the weakened part 
 merely, or the whole system. The brain is not exempt from 
 the necessity of this precaution. And the instances must be 
 extremely rare in which fears or intense desires can be made 
 instruments of cure. Indeed, the selection of books, as every 
 other arrangement for the behoof of the insane, should be 
 regulated by the maxim, dictated as evidently by prudence 
 as by philosophy, that the mind should be led back to its 
 original and healthy condition, by appealing to those powers, 
 the exercise of which is attended with the least possible de- 
 gree of excitement. 
 
 The most recent accounts of the Italian asylums which have 
 reached this country, are contained in Willis' "Pencillings by 
 the Way." This author has been said to eulogize where he ought 
 to describe, and to give hyperbole, where statistics are requir- 
 ed. There are, it is true, some men of so happy a tempera- 
 ment, as to see every thing as through a kaleidoscope. The 
 most trivial and hideous objects arrange themselves to such 
 minds in forms of beauty and novelty, and the medium by 
 means of which the images are created is forgotten. But 
 so far as the very interesting picture of the visit to the 
 asylum is concerned, this remark does not apply to it. It 
 bears truth and fidelity in every line, and although the 
 announcement, that in Naples exist " two of the best con- 
 ducted asylums in the world," may startle those who are 
 accustomed to look upon the distant south as the land of 
 
228 
 
 WHAT ASYLUMS OUGHT TO BE. 
 
 sunshine and mental darkness : this opinion is fully borne 
 out by the facts adduced. When we are informed, that 
 "the secret of his, the governor's, whole system, was employ- 
 ment and constant kindness," we can readily credit all the 
 marvels which ensue. An eccentric old nobleman is the 
 wizard who performed these, or, as he is pleased to style 
 himself, " the first fool." In moving through a kitchen 
 where culinary preparations, extensive enough to occupy 
 eight or ten people, are going on, and on encountering 
 peaceful and cheerful individuals engaged in painting or 
 reading, it is with considerable difficulty that Mr. Willis 
 could be convinced that they were all mad. And his 
 scepticism must have been still more excited, when he in- 
 spected curiously paved courts ornamented with Chinese 
 grottoes, trees, artificial rocks, &c, the walls painted as the 
 perspective of such a scene, with fountains gushing up in 
 the centre, the whole opening upon a large and lovely garden, 
 and is told that every thing around is the work of the 
 patients. The great charm, the spell which gives the colour- 
 ing of happiness to the whole community is, that its members 
 are ruled by love, that their sympathies, and not their fears, 
 are employed as the ground work of subordination and cure. 
 Several exacerbations of fury took place during Mr. Willis' 
 visit : they were all, save one, hushed, and tranquillity 
 immediately restored by the voice of kind expostulation or 
 commiseration. In the stubborn case, which occurred in a 
 female, — and I may mention, that the governor has arrived 
 at the conclusion, that his most rebellious subjects are 
 females, a swing in a hammock was prescribed with the 
 desired effect. Had punishment or restraint been substituted, 
 the paroxj'sm would in all probability have been exasper- 
 ated, and continued until sleep or exhaustion soothed the 
 passion or obliterated the insult. This system has been 
 suitably rewarded. Two thirds of the patients are stated 
 
WHAT ASYLUMS OUGHT TO BE. 229 
 
 to be discharged cured. This proposition refers, I presume, 
 although the information is not supplied, to the recent cases. 
 If it does not, it is the most signal success on record. 
 
 In place of multiplying individual examples of excellence, 
 let me conclude by describing the aspect of an asylum as it 
 ought to be. Conceive a spacious building resembling the 
 palace of a peer, airy, and elevated, and elegant, surrounded 
 by extensive and swelling grounds and gardens. The inte- 
 rior is fitted up with galleries, and workshops, and music- 
 rooms. The sun and the air are allowed to enter at every 
 window, the view of the shrubberies and fields, and groups 
 of labourers, is unobstructed by shutters or bars ; all is clean, 
 quiet, and attractive. The inmates all seem to be actuated 
 by the common impulse of enjoyment, all are busy, and de- 
 lighted by being so. The house and all around appears a hive 
 of industry. When you pass the lodge, it is as if you had en- 
 tered the precincts of some vast emporium of manufacture ; 
 labour is divided, so that it may be easy and well performed, 
 and so apportioned, that it may suit the tastes and powers 
 of each labourer. You meet the gardener, the common 
 agriculturist, the mower, the weeder, all intent on their 
 several occupations, and loud in their merriment. The 
 flowers are tended, and trained, and watered by one, the 
 humbler task of preparing the vegetables for table, is com- 
 mitted to another. Some of the inhabitants act as domestic 
 servants, some as artizans, some rise to the rank of overseers. 
 The bakehouse, the laundry, the kitchen, are all well sup- 
 plied with indefatigable workers. In one part of the edifice 
 are companies of straw-plaiters, basket-makers, knitters, 
 spinners, among the women; in another, weavers, tailors, 
 saddlers, and shoemakers, among the men. For those who 
 are ignorant of these gentle crafts, but are strong and steady, 
 there are loads to carry, water to draw, wood to cut, and 
 for those who are both ignorant and weakly, there is oakum 
 to tease and yarn to wind. The curious thing is, that all 
 
 M 
 
230 WHAT ASYLUMS OUGHT TO BE. 
 
 are anxious to be engaged, toil incessantly, and in general 
 without any other recompense than being kept from dis- 
 agreeable thoughts and the pains of illness. They literally 
 work in order to please themselves, and having once expe- 
 rienced the possibility of doing this, and of earning peace, 
 self-applause, and the approbation of all around, sound sleep, 
 and it may be some small remuneration, a difficulty is found 
 in restraining their eagerness, and moderating their exertions. 
 There is in this community no compulsion, no chains, no 
 whips, no corporal chastisement, simply because these are 
 proved to be less effectual means of carrying any point than 
 persuasion, emulation, and the desire of obtaining gratifica- 
 tion. But there are gradations of employment. You may 
 I visit rooms where there are ladies reading, or at the harp or 
 piano, or flowering muslin, or engaged in some of those thou- 
 sand ornamental productions in which female taste and inge- 
 nuity are displayed. You will encounterthem going to church 
 or to market, or returning from walking, riding, and driving 
 in the country. You will see them ministering at the bed- 
 side of some sick companion. Another wing contains those 
 gentlemen who can engage in intellectual pursuits, or in the 
 amusements and accomplishments of the station to which 
 they belong. The billiard-room will, in all probability, 
 present an animated scene. Adjoining apartments are used 
 as news-rooms, the politicians will be there. You will pass 
 those who are fond of reading, drawing, music, scattered 
 through handsome suits of rooms, furnished chastely, but 
 beautifully, and looking down upon such fair and fertile 
 scenes as harmonize with the tranquillity which reigns within, 
 and tend to conjure up images of beauty and serenity in the 
 mind which are akin to happiness. But these persons have 
 pursuits, their time is not wholly occupied in the agreeable 
 trifling of conning a debate, or gaining so many points. 
 One acts as an amanuensis, another is engaged in landscape 
 
 painting, a third devolves to himself a course of historical 
 
 1 •*> 
 
WHAT ASYLUMS OUGHT TO BE. 231 
 
 reading, and submits to examination on the subject of his 
 studies, a fourth seeks consolation from binding the books 
 which he does not read.* In short, all are so busy as to 
 overlook, or all are so contented as to forget their misery. 
 
 Such is a faithful picture of what may be seen in many 
 institutions, and of what might be seen in all, were asylums 
 conducted as they ought to be. 
 
 * To exemplify the various modes of engaging the attention of 
 lunatics, it may be mentioned that the manuscripts of these pages were 
 transcribed, and the proofs corrected by individuals in the asylum under 
 my charge. 
 
 Edinburgh : Balfour & Jack, Printers, Niddry Street. 
 

INDEX. 
 
 Abercrombie's, Dr., opinion of a course of reading as a means of cure 
 
 in insanity, 225. 
 Advantages of permitting those persons intended to take charge of 
 
 lunatics to study insanity in public asylums, 165. 
 Age, what, most exposed to insanity, 67 — influence of, on suicidal 
 
 monomania, 86. 
 Airing-grounds, 189 — at Ivry, 221. 
 Amusements in interior of asylums, 220. 
 Animals in airing-grounds, 1 90. 
 Appearances, morbid, following insanity, 5. 
 Arnold's classification of varieties of insanity, 10. 
 Assault upon a lunatic, 163. 
 
 Association of lunatics with superintendent and matron, 202. 
 Asylums not open to medical men, 165. 
 Asylum, a perfect, 176. 
 
 Author's classification of varieties of insanity, 12. 
 Avarice, monomonia of, 39. 
 
 Ball at Salpetriere, 218. 
 Baths, 184, 224. 
 Benevolence of physician, 178. 
 Benevolence and affection, monomania of, 41. 
 Bethlem, introduction of religious worship, 208. 
 Beauty, external, ought to be regarded in the choice of a site for an 
 asylum, 220. 
 
 N 
 
224 
 
 INDEX. 
 
 Bicetre. employment of lunatics at, 193. 
 Billiard-room, 225. 
 
 Board, rate of, as a principle of classification, 199. 
 Books, selection of, for lunatics, 226. 
 Buildings, separate, in an asylum, 221, 224. 
 Burrow's description of Sonnenstein, 224. 
 
 Cages, lunatics confined in, 102. 
 
 Cases, recent, 91. 
 
 Cellars, lunatics confined in, 102. 
 
 Charenton, dramatic representations at, 219 — grounds at, 190. 
 
 Church in asylum at Pirna, 225 — in Dundee, 210. 
 
 Classification, principles of, 199 — according to rate of board, 225 — to 
 state of disease, 199 — to degree of education, 201 — form of derange- 
 ment, 200 — at one time not attempted, 123. 
 .Clothing of lunatics, 189 — supply of, inadequate, 122. 
 
 Coleridge, opinion of, as to the conduct of a physician, 178. 
 
 Combe's description of Ivry, 220. 
 
 Complaints of lunatics disregarded, 158. 
 
 Comforts in the interior of an asylum, 220. 
 
 Confidence of lunatics important to obtain, 222. 
 
 Confinement unnecessary, 116 — resorted to for economy, 119 — substi- 
 tuted for coercion, 148. 
 
 Convalescents, number of, provision for, 154. 
 
 Conventual treatment of lunatics, 101. 
 
 Conscientiousness of physician, 179. 
 
 Coercion, unnecessary, 146. 
 
 Copenhagen, dramatic representations at, 219. 
 
 Course of reading as a remedy, 226. 
 
 Courage of physician, 1 80. 
 
 Cruelties perpetrated in asylums, 116, 126. 
 
 Cunning and suspicion, monomania of, 29. 
 
 Cures, proportion of, in insanity, 69. 
 
 Dangerous maniacs, proportions of, 81. 
 Dancing, as a remedy, 219. 
 Debaucheries, committed in asylums, 127. 
 Deception in the treatment of lunatics, 195, 223. 
 Derangement, form of, as a principle of classification, 200 — a disease 
 of the brain, 4. 
 
INDEX. 235 
 
 Despondency and suicide, monomania of, 35. 
 
 Diet, 170. 
 
 Difficulty of treating diseases of insane, 74. 
 
 Disease, stage of, as a principle of classification, 199 — aggravation of, 
 
 by brutality of keepers, 162. 
 Diseases most prevalent among insane, 76. 
 Dormitories, 185 — should be fire-proof, 187. 
 Dramatic representations, 219. 
 Dairy's asylum, Glasgow, 187. 
 Dundee asylum, introduction of worship at, 211. 
 
 Education, amount of, as a principle of classification, 201 — influence 
 
 of, on suicidal mania, 85. 
 Egypt affords an early example of the rational treatment of insanity, 141. 
 Employment of patients, 228. 
 Epileptic patients, proportion of, 78. 
 Errors of present system of treatment, 140, 144. 
 Esquirol employs the sense of honour as a means of moral treatment, 
 
 203 — his opinion as to the employment of coercion, 1 48. 
 Exaggerations of the evils of the old system of treatment, 136. 
 Excitement of terror as a remedy, 125. 
 Exhibition of lunatics to public, 119. 
 Exclusion of patients from church, 173. 
 
 Extremities of patients destroyed by cold, gangrene, rats, &c, 120. 
 Evils of confining lunatics among lunatics, 152. 
 
 Fallacy of supposing lunatics to be insensible to cold, 144. 
 
 Fatuity, 14 — partial or complete, 16. 
 
 Fatuous maniacs, proportion of, 79. 
 
 Favoritism, evils of, 204. 
 
 Fear, monomania of, 27. 
 
 Females chiefly exposed to insanity, 68. 
 
 Ferrus of Bicetre, recommends labour, 1 93. 
 
 Fire-proof, parts of an asylum ought to be, 77. 
 
 Fonthill asylum, abuses in, 129. 
 
 Food, inadequate supply of, 121. 
 
 Forcing, 105 — injuries from, 105. 
 
 Fox's, Dr. establishment, 185 — opinion as to religious worship on 
 
 Sunday, 209 — as to harsh treatment, 172. 
 Friends of lunatics, exclusion of, 167— estrangement of, 168. 
 
236 INDEX. 
 
 Fund for support of lunatics subsequent to their discharge, 198. 
 Furious maniacs, proportions of, 77. 
 
 Galleries, 186. 
 
 Gaols, confined in, 102~evils of such an arrangement, 104. 
 
 Gentlemen less furious than paupers, 118. 
 
 Gheel, village of, long celebrated for the cure of the insane, 142. 
 
 Hammock, swinging in, as a remedy, 228. 
 Hartford, United States, asylum at, 223. 
 Heating, provisions for, 1 88. 
 Heinroth's classification of varieties of insanity, 1 1 . 
 Homicidal or destructive monomania, 20. 
 Honour, appeal to, in moral treatment, 202. 
 Hospitals, lunatics confined in, 107. 
 Houses for friends of patients, 222. 
 
 Idiocy, 12. 
 
 Improvements in present system, 134. 
 
 Imagination, monomania of, 38. 
 
 Indulgence of patients, 170. 
 
 Industry of lunatics, 229. 
 
 Incapability of perceiving the relations of ideas, 42— the relations of 
 external objects, 44 — the qualities of external objects, 46. 
 
 Incompatibilities of character which should be attended to in classify- 
 ing lunatics, 1 55. 
 
 Infant school, an asylum should resemble, 193. 
 
 Insanity, definition of, 7 — an adjunct to civilization, 52 — increase of, 
 54 — ranks of life chiefly affected by, 59 — cure of by an argument, 
 214 — by a jest, 214 — example of such cure, 214 — cure of by a 
 pretended operation, 215 — instantaneous cure of, 216. 
 
 Intellectual qualifications of physician, 180. 
 
 Intercourse of sane with insane, 153. 
 
 Interests of superintendents of public and private asylums, 174. 
 
 Isolation, complete, 90. 
 
 Italy, asylums in, 227. 
 
 jvry, Esquirol's establishment at, 220 — separate houses at, 185. 
 
 Keepers, duties and responsibility of, 160 — properly educated in 
 France, 164 — qualifications of, 221 — one for each patient, 221 — 
 
INDEX. 237 
 
 numbers of, 222 — proportions of to patients, 147 — ought to be 
 frequently changed, 205 — disadvantages of such a step, 206 — care 
 of lunatics confided entirely to, 124. 
 Kitchen, patients employed in, 228. 
 
 Labour, 229 — division of, 229 — as a remedy, 92 — ought to have an 
 
 object, 192. 
 Language, profane and obscene, heard in asylums, 161. 
 Legislative interference, 173. 
 Liberation of prisoners from Bastile, 137 — of patients from cells of 
 
 Bicetre, 137. 
 Liberty, what is meant by, in an asylum, 204. 
 Longevity, is it increased by insanity ? 73. 
 Lucett's method of treatment, 216. 
 Lucid intervals, 88. 
 Lunatics, proportion of, that may be employed, 93 — employed as 
 
 keepers, advantages and evils of, 164-201 — supposed to be callous 
 
 to insults, 159. 
 
 Males least subject to insanity, 68. 
 
 Mania, 47 — active or passive, 48. 
 
 Marriage, influence of, on insanity, 67. 
 
 Meals> solitary, 171. 
 
 Medical treatment at one time supposed to be fruitless, 123. 
 
 Mental powers, division of, 3. 
 
 Mental manifestation, connexion of with brain, 3. 
 
 Menteith, Mr. A. E., speech of, at meeting of Prison Discipline So- 
 ciety, 103. 
 
 Metivier, resident physician at Ivry, 222. 
 
 Milanese physician cured insanity by chaining in a well, 216. 
 
 Minds of patients corrupted by keepers, 161. 
 
 Monomania, definition of, 17. 
 
 Montrose, introduction of worship at, 211. 
 
 Moral treatment, 156— at one time not attempted, 123— fallacies as 
 to, 214 — quackeries in, 216. 
 
 Mortality, rate of among insane, 75. 
 
 Mound in centre of airing-grounds, 189. 
 
 Muffling, 105. 
 
 Music -rooms, 229. 
 
238 
 
 INDEX. 
 
 Mystery foolish and hurtful, 216. 
 
 Nantes, asylum at, 112* 
 
 Negligence in some small asylums, 121. 
 
 Night-keeper, 186 — advantages of, 186. 
 
 Night visits of commissioners, 157 — objections to, 157. 
 
 Number of lunatics in England, 51 — in Scotland, 51. 
 
 Occupation, 177 — should be real, 230 — for higher classes of patients, 
 
 230. 
 Oppression, acts of, in asylums, 145. 
 Oubliettes, asylums served as such, 1 16- 
 
 Paralytic maniacs, proportion of, 78 — provisions for, in the construc- 
 tion of asylums, 183. 
 
 Pariset sanctions dancing, 219. 
 
 .Park at Ivry, 221. 
 
 Patients, noisy, placed in separate houses, 185 — proportion of, 80. 
 
 Patients irritated for amusement of visitors, 162. 
 
 Physician, qualifications of, 178- 
 
 Pinel's exposure of the " tact" of the English physicians, 218 — intro- 
 duction of a system of treatment founded on humanity, 138. 
 
 Pirna in Saxony, asylum at, 224. 
 
 Prejudices as to the necessity for harsh treatment, 172 — as to the ef- 
 fects of medicine, 178. 
 
 Prevalence of insanity under free or despotic governments, 62 — in 
 America, 64 — causes of, 64. 
 
 Pride, monomania of, 23. 
 
 Professions particularly affected by insanity, 56. 
 
 Propensities, definition of, 3. 
 
 Proportion of sane to insane population, 52. 
 
 Punishment, corporeal, generally abandoned, 145 — when admissi- 
 ble, 203. 
 
 Recoveries, proportion of, 224, 228. 
 Reflective and perceptive powers, definition of, 3. 
 Religion and superstition, monomania of, 31. 
 Religious feelings, cultivation of, 213. 
 
 Religious worship in asylums, error as to, 206 — discrimination of cases 
 fitted for, 207 — should be regulated by idiosyncracies of patients, 
 
INDEX. 239 
 
 207 — classes of patients to be admitted, 207 — classes to be excluded 
 from, 208 — indispensable in some forms of madness, 210 — mode in 
 which it should be performed, 210 — effects of, 210. 
 
 Reluctance of friends to confine insane, 91. 
 
 Remuneration, in money, for labour of lunatics, 197. 
 
 Rich, provision for in asylums, 169. 
 
 Rickett's, Mr., opinion as to religious worship, 210, 212. 
 
 Rouen, grounds at, 1 90. 
 
 Sacrament, patients admitted to, 213 — objections to such a step, 213. 
 
 Salpetriere, ball at, 218. 
 
 Samaritan Societies, 199. 
 
 Satyriasis, 18. 
 
 Season, influence of, on mortality of insane, 70. 
 
 Seclusion of sane in asylums, 1 13. 
 
 Sense of injury sometimes preternaturally acute, 1G0. 
 
 Sentiments, definitions of, 3. 
 
 Services, religious, private, 208 — should be regulated by idiosyncracies 
 of patients, 207 ; — sex, no distinction of, in some asylums, 128. 
 
 Sexes, provisions for different proportions of, 184. 
 
 Site of an asylum, 181 — external beauty of, 220, 229 — effects of on 
 health, 182. 
 
 Sonnenstein, grounds at, 190 — religious worship at, 213. 
 
 St. Vincent de Paul, efforts of, 100. 
 
 Students admitted at Salpetriere, 166. 
 
 Suicidal maniacs, proportions of, 82. 
 
 Suicides in France, 84. 
 
 Sunday should be selected as the day for religious worship in an asy- 
 lum, 209 — reasons for, and advantages of this choice, 209. 
 
 Superstition blended with rational treatment in Egypt and at Gheel, 
 141. 
 
 System pursued previous to 1815, 99. 
 
 Tasks appointed for lunatics, 198. 
 Tenements of one story, 221. 
 Terraces at Cbarenton, 192. 
 Terror, excitement of as a remedy, 125. 
 Tom o' Bedlams, origin of, 101. 
 Travelling, substitute for isolation, 178. 
 Trees in airing grounds, 189. "^ 
 
J - 
 
 240 INDEX, 
 
 Vanity, monomania of, 26. 
 
 Varieties of insanity, arrangement of, 10. 
 
 Venice, asylum at, 1 1 2. 
 
 Visit to an asylum as it ought to be, 228. 
 
 Visit to asylums as they were, 132. 
 
 Voisin and Falret's establishment, 219. 
 
 Wages for labour of lunatics, 195 — advantage of, 196 — withheld in 
 
 some institutions, 195. 
 Wages of keepers should be increased, 166. 
 Warburton's establishment, 185. 
 Water-closets, 185. 
 Willis's Pencillings by the Way, 227. 
 Workhouses, lunatics confined in, 107, 110. 
 Working-houses for lunatics, 198. 
 Workshops, 229. 
 Worship, religious, errors as to, 206 — discrimination of cases fitted 
 
 for, 207. 
 
 York asylum, abuses in, 130. 
 
 

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