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                       TO


 THIRTEEN ASYLUIWS  FOR THE INSANE




                 EUROPE;

           TO WHICH ARE ADDED

                A BRIEF NOTICE

                       OP

SIMILAR INSTITUTIONS IN TRANSATLANTIC  COUNTRIES

                    AND IN THE

               UNITED STATES,

                       AND


                AN  ESSAY

                      ON THE

  f'AOHS. DURATION* TERMINATION AND MORAL TREATMENT

                        OK                   r,

                 INSANITY.       iqUL,

       WITH  COPIOUS  STATISTICS.  ■- 0>■$
A&1
            BY PLINY fE ABLE, M. D.         *
Ka dent Physician of Friends' Asylum for tBeJwane, Franftord, near Huladelphia, Pa.; Honorary .Member of the
   Philadelphia Medical Society; Member of the Bolanical Society of Edinburgh, anil Corresponding
             Member of the Medical Society of Athens, Greece.
       PHILADELPHIA:

J. DOBSON, 108 CHESTNUT STREET.
            1841. 
ytA
E. G. Dorsey, Printer,
  Library Street. 
PREFACE.
  During a recent tour in Great Britain and on the European
continent, I visited several Asylums  for the Insane, situated
either  upon my route or in its immediate vicinity.  When
the visits were made I had  no intention of presenting what
might  be gleaned by them to the public; and I now regret my
inability, from a want of more copious data, to do that ample
justice to the Asylums  mentioned, as well  as to  the general
subject itself, which they both deserve, and which the pro-
gress of our knowledge of insanity, and of the most judicious
method of treating it, seems imperiously  to demand.

  Imperfect, however, as  may be these descriptions, it  is be-
lieved  that, in connection  with the succeeding essay, they may
be the means of extending the information of those who have
heretofore devoted but little attention to the subject.  I would
direct  the attention of those who are interested in the question
of the  utility of Lunatic Asylums, to the results of treatment as
exhibited in  the tables of both recent and  chronic cases, and
request them  to compare the condition  even of the "incura-
bles" with that of  hundreds, may it not be said, thousands, in
our country,  who  are pining,  famishing, dying in garrets, cel-
lars and dungeons, clothed in rags, and, in too many instances,
confined by chains.
    Frankford, Pa., 1841. 
# 
A   VISIT,  &c.
         THE MIDDLESEX COUNTY LUNATIC ASYLUM.

   The Lunatic Asylum for the paupers of the county of Mid-
dlesex, Eng., is  the  largest institution of the  kind in Great
Britain.  It is located at Hanwell, a few  miles from London.
It went into operation in 1831.   The very extensive building
is erected upon three sides of a square, or rather of an oblong
space, which, being handsomely planted in the style of English
gardens, forms a front yard of attractive beauty.  The princi-
pal part, or longest portion of the edifice, runs parallel to the
road, which is, perhaps, one-eighth of a mile distant.  The
other two portions, as may be inferred from what is said above,
run towards the road from the two extremities of the principal
one.  The  three are of equal height and  width.  The central
part of the principal one is expanded to a greater width,  and
is hexagonal  in  form.   Within this are  the offices  and  the
apartments of the superintendents.   A similar hexagonal por-
tion exists  in  each of  the other two, not, however, near  the
centre, but removed  a  short  distance  from their extremities.
Large as was this edifice, it had proved inadequate to the ne-
cessities of the county, and, at  the time  when I was there,
extensive additions were in progress.  These consisted of  two
wings,  one near the extremity of each of the two portions
running from the principal building, towards the road, attached
to these portions on the external side, or that opposite the ob-
long yard,  and running  at right angles to them.  Hence they
are parallel to  the road and to the principal part of the build-
ing.  The  stairs  are in  the hexagonal enlargements.   The
wards  are  divided into small  rooms  for dormitories, upon
       1 * 
6
one side of a narrow gallery which runs from one extremity
to the other.   The cooking and  the  heating  of the  apart-
ments, throughout the whole establishment, are  performed by
steam.  The length of pipes for the last purpose is upwards of
one and  a half  miles.  The house is  lighted  by gas.   The
hours of meals are 8 o'clock, A. M. and 1 and 7  P. M.  A
quart of strong beer, per diem, is allowed  to such of the  pa-
tients as labour, and a pint to the others.
  One of  the most  prominent characteristics  in the internal
economy of this  institution, is the amount of labour performed
by the inmates.  But few Asylums of the kind  can furnish so
great  a per centage of patients devoted  to  useful occupations.
Of the six hundred who were there in  1837,  more than four
hundred were thus employed.   Most of these were incurables.
The cooking for all the residents at the Asylum, the brewing,
washing, tailoring, shoemaking,  and  gasmaking, are all per-
formed by the patients,  there being, in  each  department, a
sane  person who  acts as  overseer.   Carpentering, cabinet-
making, the manufacture of straw hats  and bonnets, the spin-
ning of twine, basket-making, and picking, carding, and spin-
ning wool for  mops are also carried  on to no  inconsiderable
extent.   Many of the patients are employed in horticulture
and other labour in the open air.  In one  year  six of the  pa-
tients were taught the art  of shoemaking.  No accident  has
hitherto  occurred from trusting edged and other dangerous
tools  in the hands of the employed.
  "On entering  the gate," says Harriet Martineau, in describ-
ing her visit to  this Asylum, "I met  a patient going  to  his
garden work, with his tools in his  hand; and passed three
others breaking clods  with their  forks,  and keeping near each
other for the sake of being sociable.   Further  on were three
women rolling the grass in company;  one of whom, a merry
creature, who clapped her hands at the sight of visitors,  had
been chained to her bed for seven years before she was brought
hither, but is likely to give little further  trouble  henceforth,
than that of finding enough for her to do.   A very little suffices
for  the happiness of one on whom seven years of gratuitous
misery have been  inflicted:—a  promise   from  Mrs. Ellis to 
7
shake hands with her, when she  has  washed  her hands; a
summons to assist in carrying dinner; a permission to help to
beautify the garden, are enough.  Further on, is another in a
quieter state of content, always calling to mind  the strawber-
ries and cream Mrs. Ellis set before the  inmates on the lawn
last year, and persuading herself that the strawberries  could
not grow, nor the garden get on, without her, and fiddle-fad-
dling in the sunshine to her  own satisfaction, and that of her
guardians.   This woman had been  in a strait waistcoat for
ten years before she went to Hanwell.   In a shed in the gar-
den, sit three or four patients cutting potatoes for seed, singing
and  amusing  each  other;  while  Thomas, a mild, contented
looking  patient, passes by with Mrs. Ellis's clogs, which he
stoops to tie on with all possible politeness; finding  it  much
pleasanter, as Dr. Ellis says,  'to wait on a lady than be chained
in a  cell.'   In  the bakehouse, meanwhile, are  a company of
patients  kneading their dough;  and in  the wash-house and
laundry  many more equally busy, who would be tearing their
clothes to pieces if there was not the  mangle to be turned, and
a prodigious array of linen in the drying closet  to  be ironed.
A story higher are coteries of straw-plaiters, and basket-makers,
and knitters among the women, and saddlers, shoemakers and
tailors among the men."*
   A  chapel is connected with the institution, where a portion
of the patients assemble at a weekly service, and at  morning
and evening prayers.  Those patients who  leave the Asylum
destitute of pecuniary means  are, by a beneficent provision of
the government of the institution, so far assisted as to enable
them to supply their  wants, until they can obtain  a  situation
wherein to  gain a subsistence.
   Sir W. C. Ellis, who, in 1837,  and for  several years pre-
viously, had fulfilled  the  duties  of superintendent of this
Asylum, has published a work upon  insanity, from  which
the  following anecdote is extracted.  It proves  that  he is
gifted with  a  presence of mind, and  a sagacity adapted to any
emergency, and worthy of the man who has received the dis-

  * Miscellanies, by Harriet Martineau.  Boston edition. Vol. i. p. 231, 232. 
8
tinguished honour of knighthood, in consideration of his skill
in the management of the insane.
   A workman at the Wakefield Lunatic Asylum left a  chisel
more than three feet long in one of the wards; a furious pa-
tient seized it and threatened to kill any one who approached
him.  Every one then in the ward immediately retreated from
it.  "At length," says the author referred to, "I opened the
door, and, balancing the key of the ward on my  hand, walked
slowly towards him, looking intently at it.   His attention was
immediately attracted; he  came  towards  me,  and  inquired
what I was doing.   I told  him I was  trying to balance  the
key, and said, at the same time, that he could not balance the
chisel in the same way on the  back of his  hand.  He imme-
diately placed it there, and extending his hand with the  chisel
on it, I took it off very quietly, and without making  any com-
ment upon it.   Though he seemed a little chagrined at having
lost his weapon, he  made no  attempt  to regain it,  and, in  a
short time,  the irritation passed away."
  This accomplished physician, (Sir William C.  Ellis) is now
(1840) deceased, and the Asylum is under the superintendence
of Dr. Conolly, the author of a valuable treatise upon insanity.
The new wings have been completed, making, in  all, accommo-
dations for 850 patients.
  For the opposite engraving of the ground plan of  the Asy-
lum, I am indebted to Frederick A. Packard, Esq. 
9
i   /"
a Bake-house.
  Brew-house.
  Gas-house.
  Steam-boilers, &c.
b Kitchen and Scullery.
c Coal sheds.
d Cart-house, stable and shed.
e Superintendent's stable.
/ Gardener's house.
g Cow-house.
h Wash-house, drying-rooms,  laun-
    dries.
i Engine-house, and Engineer's shop.
j Superintendent's garden.
k Garden.
I Airing Court.
m Well.
n Carriage road.
o Cultivated grounds.
p Burial ground.
q Canal.
r River.
s Road.
t Lodge.
u Entrance.
v Farm yard.
w Dock.
x Male side.
y Female side. 
10
THE PAUPER LUNATIC ASYLUM FOR THE WEST RIDING OF YORK,
                     AT WAKEFIELD.

  This, like the Asylum just treated  upon, is one of a great
number of establishments erected in various counties through-
out England, for the reception  and treatment of those unfor-
tunate people who, drinking  a  twofold  portion of the cup of
affliction, are  suffering under both abject poverty and mental
alienation.  It was  established  in the year 1816, and opened
in Nov. 1818.   Its whole original cost, including a farm  of
twenty-five acres, was eleven thousand pounds sterling.   Ex-
tensive additions have since been made.   It is  pleasantly situ-
ated,  about a mile  from the  town of  Wakefield,  and, when
approaching it, is nearly hidden from view by the shrubbery
and trees with which it is environed.   The original  form of
the ground plan of the building was that of the letter H.   At
either of the two  points  represented  by the junction  of the
horizontal with the  upright portions of the letter, there is an
expansion of a circular form, constituting a kind of tower.
Within these,and leading to the uppermost story, are spiral stair-
cases, at the side of which there are windows communicating
with the wards.   Hence two persons, one upon each flight of
stairs, can, with very little  labour,  oversee all the patients
while they are  in  the  wards.   The  wards, unlike  those  of
some of the American  Asylums, have dormitories upon but
one side,  the remaining space  being occupied by a gallery.
The bedsteads, like those of most public institutions in Eng-
land and France, are composed of iron.  The establishment
is lighted  throughout by gas, which,  as well as  the beer,
bread, shoes, clothes,  and cloth  for external garments con-
sumed by  the patients, are manufactured upon the premises,
and,  principally, by the insane  themselves.  The  medical
superintendent, to  whom  all  other persons  in the house  are
subordinate, acts as  secretary, treasurer,  steward,  surgeon and
apothecary, and, in concert with the  matron, has the general
direction of the treatment of the  patients, the domestic arrange-
ments, &c. &c.   In the medical department, however, he is 
11
subject  to the visiting physician.   Besides  other records, he
keeps a diary of casualties, or remarkable circumstances, and a
medical journal, in which  he  places a history of every case
admitted to the Asylum.   He is obliged to visit all the wards
and see every patient at least once every day, and oftener if
necessary.   He carries a master-key to the wards  and outer
doors, and these are secured every night by himself, personally.
   The matron, who has a salary of 100/. sterling per annum,
is  subject to the director or medical superintendent, and, so far
as their duties are similar in the two departments, is governed
by the same rules and regulations.  Aside from her duties to
the patients, she has charge of the kitchen and of the neatness
and  propriety of  the whole house.  She is  required to  see
every room and every female  patient as  often  as  once each
day, and to secure all the doors in the female department at 9
o'clock, P.  M., from the 1st of October to the 1st of April,
and at 10 o'clock during the remainder of the year.
   As many of the  patients as possible are employed as servants,
and the hiring and dismissal of other domestics is entrusted to
the director.  The cause of dismissal, when such cases occur,
is always  registered.   The following extracts  are from  the
"Rules and regulations for the  management" of the Asylum.
   "Any officer or servant found  making a perquisite of any
kind  whatever,  will be instantly dismissed."
   "Any servant striking a patient, will be instantly dismissed."
   "It is now known, by actual experiment,  both at the Retreat
and  the Asylum at  York, that much work of  various kinds
may be done by patients,  not only to the  great profit of the
institution, but also to their very great advantage, both in body
and mind; therefore, the director and matron will consider that
they  will  not give  satisfaction  unless they  have considerable
success in this department of their duty."
   Furthermore, in respect to officers  and servants,  if any one
of them take any  present, or gratuity, from any  tradesman
dealing with the Asylum, or from any patient or visitor, he is
discharged.  Anv servant found intoxicated, or  who has been
known to sell anything  to one  of the patients, without  the
knowledge  of the director, is reprimanded for the first offence
and  dismissed for the second. 
12
   The number of patients in the Asylum during the summer
 of 1S37, was  334, of whom a small  minority were women.
 Fifty or sixty of the men labour, regularly, either in the manu-
 facture of the  articles above mentioned, in gardening, or  in
 some mechanical trade.   All the utensils used by the patients
 at their meals, unless  necessarily metallic, are  made of wood.
 The working patients are furnished, besides their regular meals,
 with two "drinkings" during the day, each of them consisting
 of three-fourths of a  pint of beer and four ounces of bread.
 Nearly two  hundred  dollars per annum is paid for tobacco,
 which is also divided among the labourers, each being entitled
 to a weekly ration of one ounce.  Many of the patients, as we
 passed through  the wards, begged us for tobacco, or for money
 to purchase  it with.   One of them, after having thus played
 the mendicant,  put into our hands a piece of cloth, upon one
 side of which he had  written, in large letters, "Millennium.
 Green, blue  and yellow united."   And upon the other, " Vic-
 toria 1st, July 2Sth, 1S37.   Virgin Queen of Peace.  Amen.
 JLquila."   It will be  perceived from the date, that  this was
 but a short time subsequent to the accession of Victoria to the
 throne of Great Britain.  The universal popularity which the
 youthful queen  enjoyed, at that  time, among her sane subjects,
 seems to have  been  participated also by some of those who
were  insane.   And this poor, infatuated  maniac beheld the
"green, blue and yellow," the insignia of the different political
parties of the realm, united through her means, and hence the
"consummation devoutly to be wished," the immediate advent
of the millennium!  "Eh, eh," said he, after I had read the
above, and, as  he spoke, he looked up  into my face  with a
piercing glance  and  a most  significant smile, "do you know
what Aquila signifies  in English?"  Being answered in the
affirmative, "Well, sir," he continued, "/ am the eagle," and
he placed a most emphatic stress upon  the  pronoun, in order
to give us  an adequate idea of the dignity of his person.
   Food.—The food is furnished by contracts, of three months
each,  which  are made between the visiting justices  and the
contractors on  the first Monday in January, April, July and
October.   The contractors for meat, bread, &c, at the  time  of 
13
the delivery of one parcel, take an order for the next.   The
meat and  bread  are  delivered twice a week, on Wednesdays
and Saturdays.   For breakfast and  supper the  patients are
furnished  with a kind of pudding, made of  the following ma-
terials, and in the proportions annexed,  viz.—Milk, 1 gallon;
water, 2 gallons; oatmeal,  2f lbs.; wheat flour, \ lb.   For din-
ner, "Yeast dumplings with treacle  sauce, and  boiled beef or
mutton with vegetables, on Sundays, Tuesdays and Thursdays;
6 ounces of meat, free from bone, allowed to each patient."  On
Mondays, Wednesdays and Fridays, a soup made from the meat
boiled on the previous days, and on Saturdays, beef-pie or Irish
stew.  Fifteen ounces of bread per day is allowed to each person,
and milk is furnished them, "as required," not exceeding one
pint each per diem.  The  hours of meals are 8^ o'clock, A. M.,
and 1 and 7 o'clock, P. M., throughout the year.
   The women were supping when we went through their de-
partment, each eating her ration from  a small wooden dish,
similar to a  pail.  That  air of neatness and  comfort  which
reigns throughout the establishment is particularly conspicuous
in the section for the females.  One of  the women, who had
been refractory, had her arms confined.  We  had  previously
observed, in the men's department, that confinement by straps
in chairs and beds, is also  resorted to in  cases of violent mania.
   "Who  are you?" inquired one  of the  women  who were
eating, after having  scrutinized me with the wild and search-
ing gaze of a maniac, "are you a Methodist  minister?" "No,"
said I, "I am an American."   This  answer was perfectly
satisfactory, and no sooner was  it uttered  than  half a dozen
patients suddenly rose, "0, you are  from America; then you
know my brother," said one.   "Do you know J. F.?" in-
quired a second.  "Have you ever seen---------?" asked a
 third;  "he is my husband's brother."  "I have  a sister  in
America," remarked a young woman, looking up with a smile
 so gentle and an expression of countenance so calm and sub-
 dued, that one beheld in  it  more of the attractive  innocence
 and beauty of sane and healthy childhood,  than the fierceness
 and wildness of confirmed lunacy.
    The number  of patients admitted  to  treatment in this Asy- 
14
lum, from the time it commenced operation, Nov. 23d, 1818,
to January 1st,  1837, was 2242, viz.
                           Males.   Females.    Total.
                            1150  .  .  1092   .  .  2242
   Of whom there have died,   420  .  .   289   .  .   709
     "   "   been discharged, 560  .  .   664   .  .  1224
     "   "   are remaining,   170  .  .   139   .  .   309
The total number of cures was 991, equivalent to 44-i per cent.
The number  relieved, but not cured, was 233.   The deaths
are equivalent  to 31t6q- per cent.  The admissions have ave-
raged, for a few years past, between 140 and  150 per year.
   The following table exhibits the ages  at which all the pa-
tients were admitted:—
	d o a o fa	© o © a o	d o © CO a o fa .	d o o a o I-fa	d o o © a o fa	d o o a o fa	d 00 o © a o It fa	d as o © 00 a o fa	15 o
Males,	56	282	303	285	127	74	18	5	1150
Females,	51	232	324	270	128	71	13	3	1092
Total,	107	514	627	555 255|145			31	8 ) 2242	
  By this, it will be perceived  that the number received  be-
tween 20 and 30 years of age is less than that of those between
30 and 40, or even those between 40  and  50.   The  number
between 30 and 40 is considerably larger  than  either of  the
others.  It is greatly to be regretted that the ages of the at-
tacks, instead of those of entrance to  the Asylum, could  not
have been preserved.  Had this been the case, the number of
those between 20 and 30, and 30 and 40, would probably both
have been larger, the former  certainly  so, while all those of a
greater age would have been  reduced.
  The annexed table exhibits the results of treatment in  refer-
ence to the stage of the disease, or its term  of duration. 
15
382
212
1631
149
1st. Within 3 months of the first
       attack,      .       .     682
2d.   "    12    "    "        409
3d. Between 1 and 30 years from
       the first attack,  .     .     516   58   265
4th. Those who  had previously^
       been insane and confined v 288
       in this Asylum,         3
5th. Those who  had previously
       been insane but not treat- y 347
       ed  in this Asylum,
73 „j
i5§
>339   132 J>233
>309
                        Total, 2242  991   709  233  309
Of the 1st division there were cured, 56.01 per cent., and 22.9
per cent, died;  of the 2d division 51.83 per cent, were cured,
and 36.43 per cent, died; of the 3d, 11.2 per cent, were cured,
and 51.35 per cent, died; of the 4th and 5th included together,
53.38 per cent, were cured, and 20.79 per cent. died.
  By an examination of these  results, we have another  evi-
dence of the utility of treatment during the acute stage of in-
sanity.

                 THE RETREAT NEAR YORK.
  Perhaps the remarks to be  made upon this Asylum cannot
be given more suitably than in an extract from a letter, written
to a correspondent while I was in York, in  1837.
  "Soon after dinner, on the  day of my arrival in this city, a
son of Samuel Tuke called at the hotel, with an invitation from
his father for me to make a home at his house during my stay
in York.  This politely proffered hospitality was  accepted,
and I shall  ever  remember with  pleasure  the hours which I
have spent beneath this  roof,  in the society of an intellectual
and intelligent family.   S. Tuke is well known in this country,
as well as  in the  United States, by those interested in the
treatment of lunatics, for the  attention which he has devoted 
16
to the subject, and the essays connected with  it which  have
emanated  from his pen.  It is  probable  that  no other man
living, without the pale of the medical  profession,  is so well
acquainted with the proper management of the insane, and the
most suitable construction, arrangement and discipline of luna-
tic asylums.   His father was the projector of the Retreat, an
institution of the kind near York, which, under the  auspices of
the son, and others, has attained a high reputation.  This Asylum
was one of the pioneers in  that great and important  revolution
which has taken place in  the moral treatment of the insane.
'The Retreat near York' has long been quoted  in the  United
States, as  approaching nearer to  perfection in its management,
and as giving a higher per  centage of  cures  than  any other
public establishment in England.   It was established by mem-
bers  of the  society of Friends,  the funds being obtained by
annuities,  donations and annual  subscriptions.   The  original
cost was 5970 pounds, 18 shillings, 10 pence, sterling, includ-
ing the expense of eleven acres of ground, which constitutes the
farm.   The  receipts from  patients  were inadequate  to defray
the current expenses, for several years after the institution went
into  operation.  Our  countryman, Lindley Murray,  was  an
early and  active promoter of the  interests of this establishment.
  "I  breakfasted yesterday with  Dr. W-------, and, subse-
quently,  he accompanied  me to the  Asylum.   The  superin-
tendent conducted us  through the  several departments.  The
buildings  are,  perhaps, less convenient than those of  some
other similar institutions,  inasmuch  as, having been  at first
small, they  have been several times altered  and  enlarged, ac-
cording to the increasing necessity for additional accommoda-
tion.   To the  wings, hitherto but two stories in  height,  an
additional story is now in  progress of erection.   Originally
intended for but thirty, the  buildings, after the completion of
the present  improvements, will  furnish ample room for one
hundred and twenty patients.  The classification of the insane
is founded,  principally, upon their ability or  willingness to
pay for the  accommodations afforded.   There are four classes,
in the lowest of which the price is  fixed at four shillings,
sterling, per week, while in  the highest it varies from about 
17
twenty to  eighty shillings.   Those who pay the price last
mentioned  have two rooms, elegantly furnished, and a special
attendant.   System and  neatness  prevail  in  every depart-
ment,  and  elegance is  added to that of the class  last  men-
tioned.  The  courts, or yards, occupied by the  patients  when
out  of doors,  correspond  with the  rooms within.   That
belonging to the highest class of men is a lawn,  gently sloping
southwardly, surrounded  by trees and hedges, and  bordered
with a diversity of flowers, the  profuse  blossoms of the rose
predominating at the present time.   In this court there were
several patients, either reading in the shade or amusing them-
selves with the flowers.   In cooking, steam is used to a con-
siderable extent; and, as we passed  through the kitchen, we
perceived that  instrument of olden days, a smoke-jack, turning
no less than four spits, liberally  supplied with meat.
  "It  appears to have been the aim of those who have had the
direction of this institution, to make the place a home to each
patient.  Hence the expense devoted in improving the grounds
and the apartments, and hence, also, the introduction of amuse-
ments, judiciously selected, and  the encouragement of reading
and  of labour.  S. Tuke believes that labour, properly pursued,
is the  most efficient auxiliary in effecting a cure, and acknow-
ledges the  superiority of the treatment at the Asylum at Sieg-
berg, on the banks of the Rhine, over all others, principally
from their having succeeded in inducing, not compelling, the
wealthy patients to labour.  In England, as  in the United
States, the officers of the  Lunatic Asylums co'mplain of  negli-
gence on the part of the friends of insane persons, in omitting
to place them under their care until  the disorder  has assumed
a  chronic  character, and, consequently, the probability of a
cure exceedingly diminished.  In order, if possible, to remedy
this evil, fraught, as it is, with consequences of so fearful a
nature to the unfortunate  sufferers, the directors of the Retreat
have  ordered  that an abatement  of four shillings per week
during the first year of the patient's residence in the Asylum,
be  made from the expenses of those who enter  within six
months of the first decisive symptoms of the dreadful malady."
   From the  report of the Retreat for  1S37,  we learn that, 
18
since its foundation, 508  insane persons have partaken of its
benefits.  Of this number 245 were men, and 263 women: 85
of the former and 95 of the latter had been married, but some
of them were widowers and widows.
  The following table exhibits the  result of the treatment of
the whole number, down to the time of making the report:—
-a > O s-a	Q	a o	to '3 'rt s Pi
4	12		1
6	20	4	23
6	15	6	14
18	66	13	48
         Total,              508 236 16   34 113  23  86
  Besides the results immediately evident by the table, it will
be found, by calculation, that  the cures of those in the  upper-
most line, or those of the  first  attack and  admitted  within
three months of its  commencement, are equal to 79.7 per
cent.;  of those  between 3 and 12 months, 43.9 per cent.; of
those of the second attack, and whose disease was of less than
12 months duration, 59.4 per cent.; and of those of more than
12 months duration, 25.8  per cent.  The cures of thewhole
equal 46.5 per cent., and the deaths 22.2 per cent.
  The  following table, showing the ages of those who died,
may be useful in ascertaining the comparative length of life in
maniacs and the sane.
		tio	©	©	©	©	©		
	*- fr*i	§■*	in	©	i-	00	OS	©	
Died.	P© CO	£ a id * rn © ^■eo	©	a a ©' m	a © ©	a © 1^	a cti © oo	© © C5	73 o h
Males,	5	8	5	15	10	6	6	1	56
Females;	, 6	4	10	8	16	8	4	1	57
Total,  11   12    15   23   26    14   10     2  113
Of 1st attack, and less than?
  three months duration,    3
Of 1st attack, and from three 5
  to twelve months duration, 5
Less than 12 months duraO
  tion, but not the 1st attack, 5
More than  twelve  months 5
 H3    -g   £
 •H    >   M
      So   o
 <    Pi   S
 89   71  1

107   47  7

111   66  4

201   52  4 
19
  The next table  gives the ages at which 89 of the  patients
were first attacked with the malady for which they were con-
fined.  As such it is very  valuable; and  it is to be regretted
that the same  data could not have  been ascertained and pre-
served in regard to a greater number.
SI'S
B   —
co   —
    8   17  18   13'  12  4   5  2  3  2   4  0   1   89
  It has already  been remarked  that amusements and labour
have been  introduced  into this institution, as curative means.
Of the  former, however, there is not so great a variety as in
some other Asylums, and a  difficulty  exists in applying the
latter to so great an extent as  would be  desirable, from the fact
that there is a large proportion of the patients, who, from their
previous station in society are unaccustomed to manual labour,
and consequently indisposed to it.

                  YORK LUNATIC ASYLUM.

  In  the suburbs of the city of York, in  a direction nearly
opposite to that of the Retreat, and not  far from Bootham Gate,
stands the  York  Lunatic Asylum.   It is approached  through
an avenue, nearly a quarter of a mile  in length, and thickly
shadowed by lime trees.
  This  institution was established in 1777, the necessary funds
having been raised by voluntary subscription. It was intended
for the  insane, both paupers  and others, within the limits of
the county in which it is situated.  In some instances, however,
when peculiar circumstances render it desirable, those from
other counties are received.   From the nature of this institu-
tion  all  patients are obliged to pay for their accommodation.
The  expenses of the paupers, of whom there is  a  considera-
ble number, are defrayed by  the parishes to which  they seve-
rally belong.  The price varies from 6 shillings to 2/. sterling
per week.  Parish  paupers  of the county  of York pay  6
shillings, those of other counties, 7 shillings.  Other indigent
persons pay according to their circumstances.   By paying  3 
20
 guineas per week, a patient is  permitted to bring his own ser-
 vant to the Asylum.  In this case the board of the servant is
 an extra expense.
   The principal edifice is of brick, consisting of a central por-
 tion  and two wings.   Another building, affording  additional
 accommodations, stands adjacent to this and nearly in the-rear
 of its westerly wing.   The courts or yards are all spacious,
 and  those  occupied by  the  highest  classes  of patients  are
 well  cultivated, being handsomely planted with  shrubbery
 and flowers.   The number of insane in the  Asylum,  in  the
 summer  of  1837,  was 170.   There are  accommodations  for
 200.  The patients are divided,  as in the Retreat, into four
 classes, the principle forming the  basis of classification being
 the same as at that Asylum.   Among  the amusements per-
 mitted are cards  and  billiards.   Several  groups of patients
 were engaged in playing with the  former, at the time I  passed
 through the wards.  The strait jacket, the "refractory  chair"
—(into  which a patient may be  fastened by a strap passing
around his body)—and muffs, for the confinement of the  hands,
are among the resources for punishment or coercion.
  The number of patients admitted into this Asylum, from  the
time of its  going into  operation, in November, 1777, to Octo-
ber 10th, 1S14, was 2635. Of these  there were  discharged,
either cured, improved, or at the request of friends  and guar-
dians, 2133.  Of the remainder, 399 died, and 103  remained
in the Asylum at the latter  date.   The  deaths  during this
period were equal to 16.8 per cent.   Again, from October
10th,  1814, to June 1st, 1837, a period of 22 years 4^ months,
there were  1131 admissions, which, together with the 103  re-
maining at the former date, makes a total of 1234.   Of these
there were  387 cured, 224 improved, 247 removed by their
friends,  and 217  deceased.  There were remaining  in  the
Asylum, at the date last mentioned, 83 men and 76 women, a
total of  159.   Excluding this 159, as being still under treat-
ment, we have for the cures 36  per cent, and for the  deaths 20
per cent.
  The officers of the York Asylum are a physician, a chaplain,
a treasurer, an apothecary, a steward, a house steward,  and a 
21
matron.  The steward acts as secretary, keeps the minutes of
the courts or meetings of the governors, the lists of admissions,
removals, deaths, &c, and  an  inventory of the  property in
possession of the patients when admitted.  He sees to supply-
ing clothes,  pays the bills for goods used in the house, and for
the special use of patients.  The institution is under the care of
a number of officers, called governors.  They consist of all the
benefactors  of the Asylum to the amount of 201. and upwards,
besides the Lord Mayor of York and one or two other ex-ojjicio
members.   The governors hold five meetings, or, as they are
technically  termed, "courts," during each year.  Special meet-
ings may also be called.  A committee  appointed  by the go-
vernors  hold monthly sessions for the purpose  of auditing
accounts, contracting  for supplies, &c. &c.  No officer resident
at the Asylum is eligible to a place in this committee.  There
are two  visiting governors for each month in  the year, and
three ladies, having similar duties, and  appointed  by the go-
vernors,  for each quarter.
   The physician,  who  does  not  reside at the  Asylum,  is
required to visit the  patients,  regularly, three times a week,
independently  of those times in  which  some  special  case
requires  his attention.   Divine service is  performed  every
Sabbath, by the chaplain; and  if those patients whose state of
health does  not  admit of their attendance, should desire it, the
chaplain  is required to visit them in their wards at least twice
a week, provided they are in a suitable state of mind.   The
apothecary  resides  in the house.   It is his duty to oversee the
attendants,  to visit every patient  twice during  each day, to
keep a history of all the cases admitted, to decide when and in
what manner coercion shall be used, together with such other
duties  as generally  belong to an officer of this kind.
   Any servant  who strikes or  otherwise maltreats a patient is
dismissed.   If a patient escape, the expense of retaking him is
defrayed, either wholly or in part,  at  the  discretion of the
committee,  by the servant having  charge of him.   No officer
or servant is allowed  to receive any fee or gratuity, other than
the regular  salary.
   The friends and  medical attendant of each patient admitted 
22
to the York Asylum receive the following questions, to which
they are requested to give as correct answers as possible:—""Is
this the first attack?  If not, how many previous ones, and at
what distance of time from each other?   How long  since the
commencement of the present one?  Has any, and what change
taken place in  the symptoms?   Is there, or has there appeared,
a disposition to self-destruction? or to injure others?  or to de-
stroy clothes?  What defect, impropriety, or false notion marks
the disease?  What  circumstance appears  to have  been the
exciting cause?  Was there any previous singularity or weak-
ness?   Is  it known  that any  of the patient's relations  have
been in any degree deranged?   What was the patient's natural
temper?   Favourite  pursuits?   Habits  as to temperance?  Of
what  religious profession?  Have  any, and what,  medical
means been employed?   Is the patient  subject to  fits? or  la-
bouring under  any bodily disease?  Has the patient had the
small-pox? or the vaccine disease?"

                 ASYLUM  AT  AMSTERDAM.

   The  city of Amsterdam, famous for its large  number of
charitable institutions, is supplied  with two extensive  civil
hospitals,  one of them in a central part of the town, the other,
half a mile distant from its southern limits.   Connected with
the latter, or rather  constituting a  portion  of it,  there  is an
Asylum for the  insane.   A  gentleman to  whom  I carried
letters of  introduction,  having  obtained,   from  the  proper
authorities, permission  to visit  that institution, accompanied
me to it.   The resident physician, a young man  of enlarged
intelligence and of great enthusiasm in the profession of which
he is a member, conducted  us through the  several  depart-
ments.  The building is of somewhat  antique  construction.
Each ward, like those of most hospitals for the sick, is without
subdividing partitions,  the beds being  arranged upon either
side, and, in this instance,  rather too compactly.  The wards
are, moreover, like  those in the hospitals for the sick in Am-
sterdam, in that they are two stories in  height, a platform, or
gallery, running around, above the beds, between the first and 
23
the second  story.  This is used as a place of promenade for
the patients.  There  are  seven  wards,  four for women and
three for men.  The courts devoted to the use of the patients,
and of which there is but one for each sex, are very small, and
being without shrubbery, flowers, or even green-sward,  have
the naked and forbidding aspect of a prison-yard.   Natives of
the city of Amsterdam, alone, are admitted into this Asylum.
The patients are mostly paupers, or subjects of charity. Thei;e
are six beds, in small, decently furnished rooms, which are
intended for pay patients.   The number of patients, in July,
1838, was 157.   Of these  69 were men, and 8S women.  A
large majority of them were incurable.   No  less than 45 of
the women  were epileptics.   One of the men has been in the
Asylum ever since the year 1793.   During the two years and
eight months ending in July,  1838, there had been admitted
85 men and 78 women, or a total of 163.  In the same period,
27 men  and 29 women  had  been cured, and 40 men and  37
women had died.  As means of coercion and  punishment, the
hands and  feet of patients are sometimes fastened, and the
camisole, the strait-jacket and imprisonment are resorted to.
For the last mentioned purpose there are six dungeons, con-
structed three upon either side of a small apartment.  One of
these was occupied, at the time of my visit, by a woman, who
was naked,  raving and filthy.
   But little, indeed nothing, can be said in commendation of
this Asylum.  Time, perhaps, has been, in  which it ranked
among the most comfortable, and the most judiciously manag-
ed institutions of the  kind in the  world; but  it has so long
remained stationary, that others have far outstripped it in  the
rapid march of improvement which  has  characterized the last
half century.  The resident  physician  of the  place  is fully
aware of its deficiencies, and is endeavouring to effect a change.
In fact, the city government has  already promised radical
reform.  The most glaring defects, at present, are, an insuffi-
ciency of room within doors, as  well as without; a want of
cleanliness, particularly  in  the  men's wards, and an almost
entire absence of either labour or amusements.  A few of  the
women were either knitting or sewing,  but the men, without 
24
exception, were unoccupied, lying on the floor, the ground, or
the beds, standing in the stupidity of dementia and idiocy, or
walking to and fro,  raving with  the unbridled fury of mad-
men.   There was about the place an air of most indescribable
melancholy.  How different from many a scene which I had
witnessed in similar institutions in Great Britain, France, and
the United  States—institutions in which commodious apart-
ments, thorough ventilation, and a scrupulous regard  to per-
sonal cleanliness, conduce to the physical health of the patients,
in which judicious amusements win the wandering mind to its
wonted path, and appropriate labour tends to calm the disturb-
ed and agitated intellect.

                  ASYLUM AT UTRECHT.

  I had a letter of introduction to Professor Vander Hoik, of
the University at Utrecht, the principal physician of this hos-
pital;  but he was  absent in the  country. ,  M.  J. J. Vander
Hagen Vander Heuvel, one of the agents, had  the kindness,
however, to accompany me to the  Asylum and through  its
several departments.   From the  specimen  of Dutch  institu-
tions of the kind which I had  seen  in Amsterdam, I  confess
that my expectations in regard to  this  were  not very exalted.
Besides, while we were on our way  to it, M. Vander Heuvel
took the opportunity to  speak  of  its defects, saying that not
much  had been done  by  way of improvement, that  much  re-
mained to be done, and that, to one who had  seen the Asy-
lums of other countries, this could  present nothing of inter-
est.  Thus prepared,  thus prejudiced, we entered the Asylum
and gave it a pretty thorough examination.  And it is but jus-
tice to say,  that in no other institution have I seen  greater
neatness, more apparent order,  or the evidence of a more en-
lightened and rational mode of treatment.
  This Asylum was formerly a private establishment, founded
in the 15th century.   It  continued in  existence, still pur-
suing  the old method of treatment and  of discipline, until the
year 1830.   In that memorable year of  revolutions the spirit
of reform crept into this institution,  effected a radical change, 
25
and is still continuing the march of improvement.  The build-
ing, though still comparatively small,  has been  enlarged; the
courts have  been planted with trees and flowers, and, at the
time of my visit, in July, 1838, their size was being much in-
creased by extending  their limits over the  sites of some an-
cient buildings, purchased by the "Regents"  of the Asylum,
and demolished by their order.   The building is  shaped like
the letter L.   The room of the superintendent is in the angle,
in the second story, so situated that he can see every patient
who is  out  of doors.  The  wards have dormitories on but
one  side, the remaining space being a gallery,  which is used
as a place  of promenade in bad weather.  The  bedsteads
for the most maniacal patients,  and such as are not the most
cleanly,  are somewhat  different  from any  others  which  I
recollect to have seen.  They are made of boards, in the form
of a child's crib, though deeper, and the bottom is concave  or
descends in every direction  to  the centre, where there is  an
aperture for the escape of water.  There is a common sitting
room for each class of the inmates.  The number of patients,
at the date just mentioned, was  94, that of the two sexes being
about equal.   They are divided into three classes, the basis of
division being the sum paid  for entertainment.   Those of the
first class pay 812  florins, equal to  about  125  dollars, per
annum;  those of the second, 412 florins  or 165 dollars; and
those of the third, 100  and  150 florins.   The third class is
composed of paupers. Their clothing is included in the sum
mentioned.  Those who  pay but  100 florins  are  natives  of
Utrecht; those  who  pay  150 come from  other places.  The
rooms of the first class are furnished handsomely,  but not with
that elegance  which is seen  in  those of the  similar classes in
some Asylums.
   When necessary, the camisole or the strait-jacket,  fetters,
the douche and the dungeon  are put in requisition as means of
 punishment.  The stream of water forming  the douche is but
 one-fourth of an inch in  diameter, while  those of Salpetriere
 and Bicetre,  at Paris, are  about seven-eighths  of an inch.
 The quantity of water flowing from  the  latter  must, conse-
 quently, be nearly twelve times as great  as  from the former.
        3 
26
There is but one bathing tub belonging to the  establishment,
but the accommodations in this  respect  are about to be in-
creased.  The patients resort  to reading, writing, drawing,
music,  cards, billiards, chequers  or draughts, and some other
games, for amusement.  There is a library intended for their
use.  The billiard table, a large and handsome  one, was made
by two of the former  patients.  In one of the men's rooms
several patients were occupied in drawing and reading;  and,
had it not been for the wildness of the eye, and the character-
istic traits of countenance, which cannot be mistaken,  in  one
or two others who were present, I could hardly have believed
myself to be  in a mad-house.   Most  of the  men in the first
class were in  the court devoted to their use.  Among them
was  a  physician.  He conversed  freely upon his situation,
gave an  account of his commencement of practice,  and the
success which attended his efforts, until his friends thought  it
best  for him to take  lodgings in  the  lunatic  Asylum.   At
length he asked me if I thought him deranged.  He had talked
so rationally, and  this question  was put  so directly  and so
earnestly, that to avoid answerjng it was almost impossible.
An evasive reply, if any,  must be given.  "It is difficult to
define derangement,"  said I;  "and, if we should accept the
definition  given  by some  authors,  we  should  include almost
the majority  of mankind."  He appeared satisfied  with the
answer, and only remarked, with a melancholy tone, "Je crois
bien que le plupart des gens sont des alienis."   Poor man!
although reason was dethroned, it was evident, from his con-
versation, that the affections retained their empire.
  Some of the women were employed in sewing, knitting and
house-work;  some of the  men in carpentry, shoemaking  and
tilling  the garden.   No accident has  hitherto  occurred from
the use of edge tools by the patients.
  The following are  the statistics of the entrances, cures,
deaths, &c. from 1832 to 1837, inclusive: — 
27
                           Disch'd not Per cent.    Per cent.
Date.   Entered.  Cured.   Died,  improved,  of cures.    of deaths.
1832     22     10      3            45.45     13.63
1833     44     14      6     2      31.81     13.63
1834     41     16     13     7      39.02     31.70
1835     53     18     11     6      33.96     20.75
1836     57     25     10    11      43.50     17.54
1837     38     21     12    11      55.26     31.57
  Total,    255   104     55    37      40.07     21.56

As the cures  and deaths were not among those patients alone
who entered in each several  year, but among all those in the
Asylum at the time, data of which  I  am not possessed, it is
impossible  to ascertain  their exact  per centage.  On the sup-
position,  however, that as many remained in the Asylum at
the close of  the year 1837  as there were  in it  at  the com-
mencement of 1832, and  rejecting both those numbers, we
shall find that there was 40.07 per cent, of cures and  21.56 per
cent, of deaths.  This is the manner  in which the similar sta-
tistics of most other Asylums are  calculated.  The result in
this instance cannot be very  remote from the truth, and I am
the more inclined to believe  in its very approximate accuracy
from the following table given me by M. Vander Heuvel.  It
includes  the  admissions and the cures during five successive
years.
                  Received.       Cured.         Per cent.
     Men,   ...  142   ...   74  ..  .   52.11
     Women,  .   .    75   .  .  .   14  .   .  .   1S.66
         Total,      217          SS           40.55

  This Asylum is under the care of a body of directors, called
"Regents."   They are elected, annually, by the city officers.
Endued with the spirit of improvement,  they appear to be
determined that the institution shall be made as nearly perfect
as means  and circumstances will admit.  In order the more
completely to effect this object, they have made, among them-
selves, a division of labour, thus being  able to work with more
efficiency  than if they acted conjointly.  One of their number 
28
has charge of the  finances; another,  of clothing;  a third, of
the building;  a fourth, of the food; and the others, of other
departments.
  Before closing these remarks,  I may observe that I was as
agreeably surprised  in this Asylum as I had previously been
sadly disappointed in that  at  Amsterdam; and  perhaps  the
assertion of Halliday, that "nowhere are more comfortable
hospitals to be found than in the Netherlands," may prove as
correct in the present day as it  was years since, at the time in
which that author wrote.  Other countries may possess larger,
more convenient, and more elegantly  furnished buildings,  but
none in which the end appears to be much more effectually
accomplished than in that at Utrecht.

                  ASYLUM AT ANTWERP.

  Being in Antwerp without letters of introduction, I went to
the Asylum, in hopes of being  allowed to see its several apart-
ments without any special assistance  of the  kind alluded to.
A man-servant in a blue frock met me at the door, and, upon
being informed of  what I wished, requested me to wait a  few
minutes, in the drawing-room,  until the "Pere" should come.
This officer soon arrived; but, what with his ignorance of both
English and  French,  and mine  of Dutch, not a word could
pass between  us, mutually understood.  The servant, however,
speaking French, acted  as interpreter;  and, through  him,  I
learned  that it was  impossible  for me to go through the esta-
blishment without permission from  one  of the  "Regents."
This difficulty was overcome,  as  at  Utrecht, by despatching
the servant with me to the house  of one of those officers.  H.
Willaert, the gentleman to whom I thus became  introduced,
appears  to be  much occupied  in objects of benevolence, having
been many years a member of  the "Administration des Hos-
pices" of the  city in which he  resides.   This "Administra-
tion" consists in a body of men, each called "Regent," to
whom is entrusted  the general superintendence  of the City
Hospital, the  Lunatic Asylum, the Foundling Hospital,  and
two Orphan Asylums, one for  boys and the  other for girls. 
29
They are the trustees of a large amount of property belonging
to the city,  the  interest of which is devoted  to these several
institutions.  They  are elected by the  burgomaster,  for the
term  of five years.   In order to  economise both  time and
labour,  as well as to  make the arrangements and regulations of
all the  institutions as nearly perfect as  possible, by enabling
each individual to obtain a more complete knowledge of one of
them than  he could of the whole, and to  concentrate  his efforts
thereupon, the several members have divided  their trust, each
taking  the  principal direction of one of the establishments.
The total  number of persons under the care  of the Adminis-
tration  is  upwards  of three  thousand.   H. Willsert  has the
charge  of the Lunatic Asylum.
   After having  spent an hour in conversation, during which  I
obtained much information in regard to the state of  society in
Antwerp,  as well as in relation to the management of its seve-
ral charitable institutions, M. Willsert  offered  to accompany
me to as many of these institutions as I  might feel desirous of
seeing.   Accordingly, we went to the  City Hospital, the
Foundling  Hospital, and  the Lunatic  Asylum.   Passing by
the first two, as irrelevant to  the present subject, I proceed to
 a notice of the last.
   Arrived  at the Asylum, we were conducted  through it by
the "Pere," the French servant carrying the keys.  The build-
ing, composed  of brick,  is very old.   It is but two stories in
height, and encloses several  small courts, which, like almost
everything connected with lunatic Asylums in  general, have,
within the last few years, been made "to blossom as the rose."
They had  never been cultivated until since the commencement
of the  administration of M.  Willsert.   The internal construc-
tion  of the building, the  arrangement  of apartments, &c,  is
such as mio-ht be  expected in an edifice of this kin.d erected a
 century since,  at a  time  in which the comfort of the patient
 was sacrificed to a paltry economy, in which their proper treat-
 ment was  unknown, and the unfortunate maniac was placed, in
 public  estimation, upon a  level with the criminal who has fla-
 grantly violated the laws  of both God and man.  The doors  of
 the dormitories,  throughout the establishment, still  bear the 
30
relics of those days, in  the huge bolts with which, at both top
and bottom, they are fastened.  I spoke of them, in passing,
and the gentleman accompanying me remarked that they were
soon to be  taken off.   The rooms referred to are arranged on
both sides of very narrow passages leading through each ward.
There are 24 cells for the raving maniacs, 12 for those of each
sex.   These are small;  the wainscoting is of wood, in order to
diminish the danger of the patients injuring themselves  against
the walls; and each contains  no  other furniture than  a bed.
These beds are low, made of plank,  and fastened to the walls.
The  mattrasses, throughout the building,  are mostly of straw;
those of the convalescent  and of the pay patients are, however,
of better materials.  In the infirmary the beds are very good.
The  corpse of a patient, just deceased, was lying upon one of
them when we passed.  There are special wards for the idiots,
epileptics and incurables.  A few years since, the proportion of
incurables was very large; but the Grippe, which prevailed so
generally, in an epidemic  form, throughout the west of Europe,
during the  winter of 1836-7, carried off many of them, and,
subsequently, most of  those who had been attacked by it and
recovered,  became victims to phthisis pulmonalis.   Each class
of patients has a court and a common hall, in which they spend
most of their time.  The halls are warmed by stoves, which
are surrounded,  at a few  feet distant, by a strong reticulated
wire  fender.   The dormitories,  or  private  rooms  of  the
patients, as well as the  cells for the furious, are not furnished
with  the means  of being warmed.    At the suggestion of
Ramon de la  Sagra,  the celebrated political economist of Spain,
who visited this  institution but a few days before I was there,
the defect is about to be remedied by the introduction of a hot-
air furnace.
   The number of patients in the  summer of 1838 was  130, of
whom 60 were men and 70  women.  The Asylum is suffi-
ciently large  to accommodate a much greater number.  A few
pay for their  entertainment; those who are natives of Amster-
dam, 280 florins, or 112 dollars; and  others, 300 florins, or 120
dollars, per annum.
   Regimen.—Breakfast; tea, bread and butter.   The bread 
31
is  made  of  equal proportions  of wheat and  rye.  Dinner;
meat and bread four days in the week; soup and vegetables,
with bread,  the remaining three.   Supper; bread and butter,
with beer, if wanted.   The beer, which  is not very strong,
but sufficiently so to be palatable, is at the command of the
patients at all times.
  Labour and amusements have not, as yet, been extensively
introduced.   A few of the men work at  small jobs, such as
some parts of domestic labour, whitewashing, &c, and  there
is one room in which the convalescent and some of the quiet
incurable women were spinning tow  and making lace with
bobbins.   Both men and  women  are  remunerated for  what-
ever labour they perform, it having been found "difficult, or
nearly impossible," to  induce  them to work, except by the
stimulus of pecuniary  reward.   Connected with, the  building
is an elegant Catholic chapel, in which mass is regularly said.
Such patients as can be admitted with propriety are allowed to
attend.   There is an apartment for the men, and another for
the women, so arranged that they may all witness the ceremo-
nies before the altar, without the ability to see each other  or the
rest of the congregation.  Attendance upon the services is con-
sidered a privilege, as such  is dispensed, and  as such is much
sought.  Thus here, as in other places, religious worship  has
been found, to a certain extent, an efficient means in the moral
treatment of the  insane.

                    LA SALTPETR1ERE.

   This vast Asylum for the poor, this pauper-village,  if the
term be  admissible, was established by Louis XIV. in the year
1656.   It is situated on the southern  shore of the Seine, in a
remote part of Paris,  and  in the vicinity of  the Jardin des
Plantes.  It is devoted exclusively to females, for whom  it
contains about 4500 beds.   It is in the hospital of this  exten-
sive establishment, that the celebrated Cruveilhier has collected
most of the materials for his elaborate and beautiful works upon
pathological anatomy.   The department devoted to the  insane
is, perhaps, the  most  extensive in the world, the number of 
32
 lunatics being from 1000 to 1200, and  that of epileptics and
 idiots, from 700 to 800.  The approximate number of admis-
 sions, per annum, is 500, that  of discharges 300, and of deaths
 200.  The cures are equal to 33^ per cent, of the whole num-
 ber admitted.  "This  proportion," says' a French author, "is
 sufficiently large,  when we consider that many of the maniacs
 do not enter the Salpetriere until after they have been treated,
 and pronounced   incurable, at other hospitals  [maisons-de-
 sante)."  Drs. Pariset and Mitivie have charge of the depart-
 ment for  lunatics.  The medical visit was made  by the latter
 on the morning that I  was there.  He seems admirably quali-
 fied, by his gentleness and kindness of manners, and his firm-
 ness of character, for the situation which he fills.  It is a fact,
 too generally known to require repetition, that this establish-
 ment and the Bicetre  were the chief  theatres  of  action of the
 benevolent Pinel; that,  by him,  the Augean stables of their
 misery, degradation and torture were cleansed; that, at his
 suggestion,  the great  amelioration  in the condition  of  the
 inmates, wrought both during his life and since,  have been
 effected.   France  owes a debt  of  gratitude to this benefactor
 of a portion of her citizens, which the giving of his name to  a
 ward in  the  Salpetriere but inadequately repays.   Pope, in
 allusion to the broadly contrasted characters of the Roman
 emperors, Caesar and Titus, exclaims—
        "And which more blest, who chained his country, say,
         Or him whose virtue sighed to lose a day!"
 In like manner, may we not ask which is "more blest," Na-
 poleon, wading through the blood  of six millions of his fellow
 beings to  a transient throne of despotism, or Pinel,  severing
 the manacles and chains of those who had been laden with them
 merely because they were suffering under a disease to which all
 are liable, breaking up the strong holds of misery, and  carrying
light, cheerfulness and content into the  abodes of darkness,
 wretchedness and  woe.   The ameliorations prospectively made
by this distinguished philanthropist, and subsequently insisted
upon by his  brother in benevolence,  M. Esquirol, have not,
hitherto, been fully accomplished.  A few years, however  will
suffice  for their completion.   The  buildings  recently con- 
33
structed for the patients are but one story in height, surround-
ing  spacious  courts.*   Upon  three sides there  are  wards,
and, on the fourth, two  bathing  rooms, communicating with
each  other, and with  the  wards, by an  extensive  corridor,
similar to the  markets of Philadelphia,  if deprived of their
benches.   The wards  have two  rows of windows, the upper
ones, which are small and near the ceiling, being kept  open at
all proper seasons, for the purpose of ventilation.  In one large
enclosure, belonging to  the establishment, there are several,
perhaps 14 or 15, small buildings for the  furious, each  adapted
to the accommodation  of one alone.  They are  heated by an
apparatus beneath  the floor.  In one  of them there was a girl,
of interesting appearance, who begged the physician  that he
would order a camisole to be placed  upon her, lest she should
do herself some injury.   In reference to the  treatment at this
Asylum,  M.  Milne Edwards says:—"In the  treatment of  the
insane no  violent means are  ever employed.  The  greatest
mildness, kindness and care are  constantly enjoined upon  the
attendants, and the physicians set a good example  in these re-
spects.   Baths, the  douche, exutories,  mild  purgatives, and
medicines intended to restore  suppressed evacuations  are  the
principal remedial agents  resorted  to.   Isolation  and  moral
means form the basis of treatment."!

                         LE BICETRE.

   The  "hospice,"  or pauper  Asylum  of  Bicetre,  is in  a
 southerly direction from Paris, about two miles  from the walls
 at the barriere de Fontainebleau.   It  is  for  men  alone.   Its
 extent is less than  that  of La Salpetriere, the  number of
 inmates  being about 3000.   The department for the insane is

  * In regard to buildings of this kind, Esquirol observes, "During the  last
 twentv-five years 1 have often exposed the inconveniences of buildings several
 stories in "height.  I have so loudly proclaimed the advantages of a ground
 floor as the dwelling place for the insane, that I shall abstain from remarking
 upon them here, particularly as in France, as well as in foreign countries, my
 principles  have been received and put in practice in the construction ot lunatic
 Asvlums.                                        , .   „   ..   ,
  t Sotice  sur les Hbpitaux de Paris, in the Xouveau Formulairc Pratique des
 Hbpitaux,  by Milne Edwards and P. Vavasseur. 
34
proportionally smaller.   The  number of patients  in  May,
1838, was 760.  Besides these there  were about 200 idiots.
The average number of admissions, annually, is, for the insane,
360; the imbecile, 40; that of discharges of  the former, per
month, 12 to  15; the deaths about the same, and the cures from
7 to 8.  The proportion  of deaths to  the whole number ad-
mitted is  as  1  to  6, or  16.66  per  cent.  The medical care
of the patients is confided to Drs. Ferrus and Pinel.   The work
quoted at the close of the remarks upon La Salpetriere  says,
in reference to this Asylum:—"Every thing disapproved of
by Pinel  has been destroyed; all that he required has  been
executed.  The lodges have disappeared, large promenades have
been made, and the number of attendants is increased.  There
is a farm upon which sixty of the patients labour daily.   It is
impossible to describe all the  good resulting  from these  mea-
sures.   Formerly, if the department  of the  insane bore the
least resemblance to any other place, it  was to a hell;—now, all
is calm, and it  is  not rare for  whole  nights  to  pass without
hearing the slightest noise."
  The whole number of insane who labour is about two hun-
dred.   The  establishment is  supplied  with water from  large
and deep  wells, whence it is  pumped  into reservoirs by the
patients.
  Admission to the department for the insane can be obtained
only  by a special permission from the  "Directeur" of the
establishment.  An English physician  accompanied  me to the
place, and having  obtained a  permit, we entered.   Dr. Pinel
made the medical visit  for the day, and we  accompanied him
through all the wards.  He, too, like  his illustrious predecessor
of the same name, appears to take a lively interest in the un-
fortunate class of persons with whose treatment he is  entrusted,
and seems well qualified, by both nature and education, for the
important and responsible station which  he occupies.   Many
of the patients greeted him  with a "bon jour;" those who
were not confined  to their beds thronged around him, to con-
verse, some seizing his hand  and saying, "Vous etes un bien
brave  homme," or some other compliment of a similar  kind,
he, the while, treating them as his friends and  companions, and 
35
adapting his conversation to each, according to his particular
hallucination.   In one of the wards which we  first entered, a
merry patient, seeing us approach, took his violin for the pur-
pose of  giving his physician a musical  entertainment.  He
followed us through the ward,, playing several lively airs, and
when we were about to leave, insisted upon accompanying us.
The doctor permitted him so to do, and he followed us, con-
stantly playing upon his fiddle, through most of the remaining
wards.
   The recently constructed  buildings of the Bicetre are upon
the same plan as those of La Salpetriere, though not so spacious.
The courts are planted with  trees, and supplied with permanent
seats beneath the shade.  After  the visit was completed, we
went to  the bathing-room, which is  furnished with  perhaps a
dozen tubs.  Over each of  several of them, at the  height of
about  five feet from its top, is a douche, the diameter of  the
stream of  which is a little  more than three-fourths  or about
seven-eighths of an inch.   There were patients in two of  the
tubs, each being confined in his  place by a board passing around
the neck, as in a pillory.  One of them was a robust man, of a
nervo-sanguineous temperament, who, during the course of his
alienation, had been subject to  several hallucinations.   At one
time he talked so long and so constantly as to produce aphony.
At  another time he was rich as Crcesus, and 25,000 francs of
his  annual income accrued from  a  pinch  of  snuff.   He  now
believed himself to be the husband  of the Duchess de Berri,
and a favourite friend of the ex-king, Charles X., and of his
son, the Duke de Bordeaux;  that these  persons had recom-
mended him to Louis Philippe, who showed him particular
attention and was about to load him with honours.   On  the
previous day, he had requested to be furnished with materials
for writing.  These were given to  him on condition  that he
should write something reasonable,  and  not the wild vagaries
with which his mind was haunted.   He wrote a letter to M.
Dupin, president of the Chamber of Deputies, desiring that gen-
tleman to  give his compliments to Louis Philippe, with many
 thanks for the  kindness which he had received, and should re-
 ceive, in future, from  his royal highness.   Pinel approached 
36
 the patient with this document in his hand, reminded him of
 the conditions upon which he was permitted to write, read to
 him the letter, an amusing tissue of absurdities, and then asked
 him if he still believed himself to be a favourite of the'royal
 family. "Oui, Monsieur," was the instantaneous reply. "Give
 him the  douche," said Pinel.  A servant who  stood waiting
 orders, turned the water-cock and the stream fell directly upon
 the vertex of the patient's head.  He struggled, writhed  and
 screamed under the shock, and begged that it should be stopped.
 This  request was complied with in a  few seconds.   Pinel.
 "Do you still entertain the foolish idea that you are an intimate
 friend of Charles X." Patient. "I think I do." Pinel. "Let
 him have the douche."   This  was no sooner  ordered than
 obeyed.  The patient floundered, hallooed, and begged as be-
 fore.  The douche was stopped. Pinel.  "Are you an intimate
 friend of Charles X.  and  the Duke de Bordeaux?"   Patient.
 "I  presume so."  Pinel. "Give him  the douche."   It  was
 given  with all the previous results.  The doctor  again read
 some portions of the letter, attempted to  convince the man of
 the absurdity of  his notions, and concluded  by asking  him
what marks of attention he had ever  received from  the "Roi
 d6chu."  Patient. "You are aware, Monsieur  Pinel, of the
 important works of  which  I am   author, and which were
 written long since.  I presume, sir, that Charles  X. takes a
 great interest in those, and  consequently in me;  besides, he
has given me a letter of  recommendation to Louis  Philippe,
from whom I have received so man-y  proofs of friendship."
Pinel. "It  is impossible  that Charles  X. should have given
you a letter of that description to Louis Philippe, since they
and their families are at enmity with each other." The patient
muttered something about Henry V. and an umbrella.  Pinel.
"France knows no such person as Henry V.; when you speak
 of the gentleman referred  to, call him Duke de Bordeaux."  In
 this  manner nearly half  an  hour was  occupied, the douche
 being administered whenever the patient insisted upon the truth
 of his fantastical ideas.  At length, what with the arguments
 of the doctor, and what with the still  more cool and cogent
 logic of cold  water to the head, the patient yielded his points, 
37
deeply regretting, however, to be thus shorn of his splendour,
and so unceremoniously brought down from his "high estate."
Pinel then gave him a lesson  to commit to memory for the
following day.
  The other patient was meagre and of a bilious temperament.
Throughout the scene which we have partially described, he
remained perfectly quiet in his bath.   On the day previous a
task of manual labour had been given him, and he had  left it
untouched.   Pinel  approached  and  asked him  why he had
done so.  He looked up with a smile, and a most ludicrous
leer of the eye, as he said, "To speak candidly, sir, I felt no
particular desire to work."   The doctor himself could  hardly
refrain  from  laughter.  "Well," said he, "will you  work
hereafter, when you are ordered to?"  The patient reflected a
moment, then looked up with the  same expression of counte-
nance as before, and  said, "I  will  not  work,  my word of
honour for it."   "Give him the douche," said the doctor, and
the stream of water instantly  fell  upon the patient's head.
 The effect was even greater upon him than it had been upon
 the other, insomuch that, in a moment, like a child smarting
 under castigation, he exclaimed, "I will, I will."  The douche
 was stopped, and the task left unfinished on the previous day
 was ordered to be completed before  night.
    That the douche employed as in  the two cases above men-
 tioned is not only destitute of  utility, but absolutely and de-
 cidedly injurious, does not,  in my opinion, admit a doubt.
 The real frenzy to which the former patient was driven by the
 combined effects of a positive and determined contradiction of
 his hallucination, and the agitation produced by his knowledge
 of the fact that the douche was used as a means of compulsion,
 caused a rush of blood to the brain, the deleterious influence of
 which could not be overcome by the  sedative effects of the
 cold water.   Nor can we believe that the immediate object in
 view in the case  in  question, that of dispelling the  illusion
 under which the unfortunate maniac was labouring, was either
 gained  or even approximated, for the dread of the  douche
 compelled the man to  sacrifice truth on the altar of fear, and
         4 
38
 made his tongue belie his still persistent belief.   It is with the
 insane as with the sane,
                "Who is convinced against his will,
                 Is of the same opinion still."
   During the past year (1840) we have made  a  very free use
 of the cold douche in the Frankford Asylum, but in no instance
 has it been employed as a means of coercion or of punishment.
 It is of decided advantage in all cases in which there  exists a
 determination  of  blood  to the brain, indicated by flushings of
 the face, and excessive heat, either constant or variable, of the
 integuments of the cranium.  A majority of the patients who
 have been submitted to  its influence, have  preferred to use it,
 on  account  of the refreshment and  relief  thereby produced.
 Several of them have been accustomed to  applying it  to their
 heads, from day to day, voluntarily.   The douche in this in-
 stitution is the only one I have seen in this country, and I am
 not aware that it has been resorted to  as a  curative means in
 any other Asylum for the Insane in the United States.   It is
so constructed  as to  make the stream of water of variable size,
from one-fourth to three-fourths of an inch  in diameter.   The
water falls from two to four feet, according  to the situation of
the head of the patient.
  The Bicetre is  hallowed as being the scene of the  boldest
and noblest  achievement recorded in the  annals of insanity.
Here, morning first dispelled the  midnight gloom of  lunacy,
and the guiltless maniac was released from the thraldom which
associated  him  with  criminals and  brutes, taken  by the hand
as a brother, and acknowledged to be worthy  of the  kindest
attention, commiseration and sympathy.
  The following brief  account of the commencement  of the
labours of Pinel, extracted from a paper read by his son, before
the Royal Academy of Sciences, commends itself to the atten-
tion of every reader:
  "Towards the end of 1792, Pinel, after having many times
urged the  government to allow him  to unchain the maniacs of
 the Bicetre, but in vain, went himself to the authorities  and
 with much earnestness  and warmth,  advocated the removal of
this monstrous abuse.   Couthon, a member of the commune 
39
gave way to M.  Pinel's arguments, and agreed to meet him
at the Bicetre.  Couthon then interrogated those who were
chained,  but the abuse he received, and the confused sounds of
cries, vociferations  and clanking  of chains, in the filthy and
damp cells,  made him recoil from Pinel's proposition.  'You
may do what you will with them,' said  he,  'but I fear  you
will become their  victim.'  Pinel instantly commenced  his
undertaking.  There were about fifty whom he considered
might, without  danger to  the others, be unchained, and he
began by releasing  twelve, with the sole  precaution of having
previously prepared  the same number of strong waistcoats,
with long sleeves, which could be tied behind the back if ne-
cessary.   The first man on whom  the experiment was to be
tried was an English captain,  whose history no one knew, as
he had been in chains for forty years.   He was thought to be
one of the most furious among them.   His keepers approached
him with caution, as he had in a fit of fury, killed one of them
on the spot with a  blow from  his manacles.   He  was chained
more rigorously than any of the others.   Pinel  entered his
 cell unattended, and calmly said to him,  'Captain, I will order
 your chains to be taken off, and give you liberty to walk in
 the court if you will promise  me  to behave  well, and injure
 no one.'   'Yes, I promise you,' said the maniac, 'but you are
 lauo-hing at me—you are all too much  afraid of me.'  'I  have
 six men,' said Pinel, 'ready to enforce my commands, if neces-
 sary.  Believe me then,  on  my word,  I will  give you  your
 liberty if you will put on this waistcoat.'
    "He  submitted to this  willingly,  without  a word.   His
 chains were  removed, and the  keepers retired, leaving the
 door open.  He raised himself many times from his seat, but
 fell again on it, for he had been in a  sitting posture so  long,
 that he  had lost the use of his legs.  In  a quarter of an hour
 he succeeded in maintaining  his  balance, and with tottering
 steps came to the door of  his dark cell.   His first look was at
 the sky, and he  cried out enthusiastically, 'How beautiful!'
 During the rest of the day he was constantly in motion, walk-
 ing up°and down  the staircases,  and  uttering  short exclama-
 tions of delight.   In the evening he  returned of  his  own
 accord  into his cell, where  a better bed than he had been 
40
 accustomed to had been prepared for him, and he slept tranquil-
 ly.  During the two succeeding years which he spent in the
 Bicetre, he had no return of his previous paroxysms, but even
 rendered himself useful by exercising a kind of authority over
 the insane patients, whom he ruled  in his own fashion.
    "The next unfortunate being whom Pinel visited was a sol-
 dier of the French guards, whose only fault was drunkenness;
 when  once he  lost  his  self-command  by  drink,  he became
 quarrelsome and violent, and  the  more dangerous  from his
 great bodily strength.
   "From his  frequent excesses, he had been discharged from
 his  corps,  and he had speedily dissipated  his scanty means.
 Disgrace and misery so depressed him that he became insane;
 in his paroxysms he believed  himself a General,  and  fought
 those who  would not acknowledge his rank.  After a furious
 struggle of this sort, he was brought to  the Bicetre in a state
 of great excitement.   He had now been chained for ten years,
 and with  greater care than the others, from his  frequently
 having broken his chains with his  hands  only.  Once when
 he broke loose, he defied all his keepers to enter his cell, until
 they had each  passed under his  legs; and he compelled  eight
 men to obey this strange command.  Pinel, on his  previous
 visits to him, regarded him as a man of original good nature,
 but under excitement incessantly kept up by cruel  treatment;
 and  he  had promised  speedily  to  ameliorate his  condition,
 which promise alone had made him  more calm.  Now he  an-
 nounced to him that he should  be chained no longer, and, to
 prove that he had confidence in him,  and  believed him to be
 a man capable  of better things,  he called upon him  to assist in
 releasing those others  who had  not reason like himself,  and
 promised, if he conducted himself well, to  take him into  his
 own service.  The change was sudden and  complete.   No
 sooner was he  liberated than he became attentive, following
 with his eye every motion of Pinel, and executing his orders
 with as much address  as promptness.   He spoke kindly and
 reasonably to the other patients; and  during the rest of his
 life was entirely devoted to his deliverer.   And 'I can never
hear without emotion,' says Pinel's son,  'the name of this
man, who some  years  after this occurrence shared with me 
41
the games of my childhood, and to whom I shall always feel
attached.'
   "In the next cell  were three Prussian soldiers, who had
been in chains for many  years, but on what  account  no one
knew.  They were, in general, calm and  inoffensive,  becom-
ing animated only when conversing together  in  their own
language, which  was unintelligible to  others.   They  were
allowed the only consolation  of which they appeared sensible
—to live together.  The preparations taken  to release  them
alarmed  them, as  they imagined the keepers were come to
inflict new severities;  and they opposed them violently when
removing their irons.   When released, they were not willing
to leave their prison, and remained  in their habitual posture.
Either grief or loss of intellect had rendered them  indifferent
to liberty.
   "Near them was an old priest, who was possessed with the
idea that he was Christ;  his  appearance indicated  the vanity
of his belief;  he was grave and solemn;  his smile  soft, and at
the same time severe, repelling all familiarity; his hair was
long,  and hung on each side  of his face, which was  pale,  intel-
ligent, and resigned.  On his being once taunted with a ques-
tion,  that  'if he was  Christ he  could break his chains,' he
solemnly replied,  'Frustra tentaris Dominum  tuum.'   His
whole life was a romance of religious excitement.   He under-
took,  on foot, pilgrimages to  Cologne  and  Rome, and  made a
voyage to America for the purpose of converting the Indians;
his dominant idea became changed into  an actual  mania, and
on his return to France he announced  himself as the Saviour.
He was taken by the Police before  the  Archbishop of Paris,
by whose orders he was  confined in the Bicetre  as  either im-
pious  or insane. '  His hands and feet were loaded with heavy
chains,  and  during twelve  years  he bore with  exemplary
patience, martyrdom and constant sarcasms.
   "Pinel did not  attempt to reason  with him, but ordered
him to  be unchained  in  silence, directing, at the same time,
that every one should imitate the old man's reserve, and never
speak to  him.   This order  was  rigorously observed,  and
produced  on  the patient a  more decided effect  than either
      4# 
42
chains or the dungeon; he became humiliated by this unusual
isolation, and introduced himself to the society of the other
patients.  From this time his  notions became more  just and
sensible, and in less  than  a year he acknowledged the  ab-
surdity of his previous prepossessions, and was dismissed from
the Bicetre.
   "In the course of a few days,  Pinel released fifty-three
maniacs from their chains; among them were men of all condi-
tions and countries; workmen, merchants, soldiers,  lawyers,
&c.  The result was beyond his hopes.  Tranquillity and har-
mony succeeded to tumult and disorder; and the whole disci-
pline  was marked with a regularity and kindness,  which had
the most favourable effect on the insane themselves; rendering
even the most furious  more tractable."

                 ASYLUM AT  CHARENTON.

  Dr. Louis favoured  me with  a letter of introduction  to M.
Esquirol, the midecin en chef of the Asylum at Charenton,
and the distinguished  veteran  in the treatment of the insane.
With this I went to the Asylum, where  I had the pleasure of
meeting him to whom it was addressed, in the  scene  of his
present labours, among the unfortunate  people who  love and
honour him as a father, and in whose welfare his interest con-
tinues unrepressed by  the weight of accumulated  years.   After
his visit to the patients was completed, I sat an hour with him
in the  parlour of the  institution,  during which  time he con-
versed chiefly upon the subjects of lunacy and of Lunatic Asy-
lums.   After speaking of the comparative merits of the various
establishments of the kind in Europe, and giving the preference
to that at Reggio, in  Italy, over  all others that he  had ever
visited, he  made many inquiries with regard to those of  the
United States, and expressed much  interest in the progress of
improvement in the treatment of the insane, upon this side of
the Atlantic.
   The Asylum of Charenton,  in a village of the same  name,
is about five  miles eastwardly from  the city of  Paris.   It is
situated upon the southern declivity of  a hill, which runs 
43
parallel to the river Marne,  near  its shores, and but a short
distance from its junction with the Seine.   It was originally a
hospital, under the care of the Brothers of  Charity.  About
the beginning of the 18th century, a department was, for the
first time, devoted to the reception  of those labouring  under
mental  alienation.   In 1795 the hospital was suppressed, but in
1797 it was re-established  and  devoted  exclusively  to the
treatment of the  insane.  It is  now called, in common with
some other establishments of the kind in other parts of France,
"Maison Royale d'Alienes."  It includes many edifices, which
have been erected  at various periods, and extensive gardens
and promenades, which extend to  the summit of the hill upon
the declivity of which it is located.   The following description
is translated  from the recent elaborate work of M'. Esquirol, to
which we are also indebted for most of the subject matter for
our remarks upon  this  Asylum.'*   "The  section  for  men  is
composed of four courts, of which three  are  planted; three
infirmaries;  one ward  for patients  of a  suicidal  propensity;
one dormitory;  one  gallery and  six  corridors,  into  which
open the doors of the  several rooms; one bathing room, and
six rooms where the patients assemble.  These last mentioned
can be heated.   The  section for  women  has  a garden, four
planted courts, two infirmaries, one  ward  for women disposed
to commit suicide, two bathing  rooms, seven dormitories, six
galleries and corridors into which  open the doors of the apart-
ments, and five rooms in common, which  may be heated."
   An extensive additional department for females, combining
most of the  modern improvements, was erected about twelve
years  since, and  first  occupied  in 1829.   This is  one of the
best arranged and most neatly-kept  establishments of the kind
that I have had occasion  to examine.  The  furniture is good
and sufficiently handsome, without being extravagant.   The
beds of the  dormitories  are hung with white  curtains.  No
corresponding  department  for  the men  has hitherto been
erected.  There  is  a  parlour in the Asylum, in which  those

  * Des maladies men tales, considered sous les rapports medical, hygienique
et medico-legal, par E. Esquirol. Paris, 1838. 
44
 patients  the state of whose disease renders them admissible,
 assemble every evening for social intercourse.  This  contains
 many  arm-chairs,  several  card-tables and a piano-forte.  A
 room having tables for billiards, is devoted to that amusement.
 The bathing room of the new department for females  contains
 ten copper tubs, separated from  each  other by curtains, and
 each supplied with  a cover which may be  used in case of ne-
 cessity.  A chapel, or oratory, is devoted to religious worship;
 the exercises  being conducted in the  Catholic  form.   The
 priest (aumonier) resides at the Asylum.   Ministers of other
 sects are, at the request of  patients, permitted to visit them in
 their wards.
   There are three grades of prices  for  entertainment at  this
 institution: the 1st, 1300; the 2d,  1000; and the 3d, 720 francs
 per annum.   The regimen  of  the patients varies according to
 the grade, and  is of a quality proportionate to the prices of
 those grades.   The rules of the establishment require that there
 shall be one attendant to every tenth patient, but this number,
 according to M. Esquirol, is not sufficient.  There are 73 in
 all, two of whom remain in the garden  to  oversee those  who
 are walking.  Several others have charge of but  one or two
patients each.   The number of persons employed  at the Asy-
lum, including, on the one hand,  the visiting physician,  and,
 on the  other, the gardeners, gate-keeper and hostlers, is 170.
  The number of admissions, from the establishment of the
institution exclusively for lunatics, in 1797, to  the end of the
year 1833, is 5972.  The following list exhibits the same num-
ber divided in the proportion that the patients were  received
 in several different epochs.
From 1797 to 1802 .	. . 202
1802 " 1805 .	. . 435
1805 " 1810 .	. . 1007
1810 " 1815 .	. . 722
1815 " 1825 .	. . 2049
1S25 " 1834 .	. . 1557
Total,   .  .  .  5972 
45
Previously to  1815, the number of each  sex  was not desig-
nated, but  from  that year to 1825 there were 1245 men and
804  women;  and from  1825  to  1834,  932  men and 625
women.
  The following table, compiled, with some  additions, from
several of those in the work above quoted, exhibits the number
of admissions  for each of the  years between  1825 and 1834,
the condition in  society (etat civil) of the patients, and the re-
sults of their treatment.
				m				"3 '	0				l				0 10
1*	B V	CD bD S3	13 .2	CD 0 -a >	-6 3 O	.a a 5 §	-6 a	3 is 3h ' u	s . 0 -c ■- es <D D Ok -3	c 0) s 0	J5 "5b S3 S3	■a .2 a	-3' s 5;u		si	5	3 .' 3 x ^ X 1 CJ .~ 2h c, |2h -3
1826121		68	49	4	34	39	59	28.09	48.76	89	34	49	6 41		35	28	46.05' 31.57
1827 123		72	41	10	51	34 42		41.46	34.14	82	26	48	8	24	29	17	29.26 20.73
1828 122		66	51	ft	34	34	54	27.86	44.26	82	27	44	11	25	23	21	30.48J 25.60
1829121		59	55	7	40	38	58	33.05	47.10	71	19	47	5	28	27	15	39.43j21.12
1830112		54	52	6	34	52	44	30.35	39.28	74	18	49	7, 29		19	21	39.18 28.37
1831 109		64	49	3	22	31	51	20.18	46.60	82	27	44	ll! 29		44	14	35.36! 17.07
1832118		60	56	9	36	40	38	30.50	32.20	79 24		4'J	12 29		24	17	49.35121.51
1833106		62 505	41 387	3 40	33 284	33 301	60 406	31.13	56.60	66 18		39 363	9j ay		25 7		43.93 10.60
	'932									625	193		fio'234		226	140	
The proportion of single men, as calculated from this table,
equals 54.18 per cent.; of single women, 30.8S  per  cent.; of
married men, 41.52 per cent.; of married women, 5S.08 per
cent.; of widowers, 4.29 per cent.; and of widows, 11.04 per
cent.   It is a singular fact that the proportion of married men
is  but about two-thirds as  great as that  of married women,
while that of single men is nearly twice as great as that of
single women.
  The total number of cures  is 518, equal to 64.7+ per an-
num; that of deaths 546, or  68.3+  per  annum.  It will be
perceived, by the table, that the greatest proportion of the an-
nual cures of men was in 1827, = 41.46 per cent, and that of
women, in 1832,  = 49.35 per cent; also, that  the least pro-
portion of the cures of men was in 1831, = 20.18 per cent, and
that of women, in 1827, = 29.26 per cent.  The proportion
of the deaths of men was largest in 1833, = 56.60 per cent;
that of women, in 1826, = 31.57 per cent; the proportion was 
46
least, for men, in 1832, = 32.20  per cent; and, for women,
in 1833, == 10.60 per cent
  The average number of cures, per annum, was,  for  men,
30.32 per cent; for women, 39.13  per cent; and for both
sexes, inclusive,  34.72 per cent.   The average of deaths was,
for men, 43.61 per cent.; for women, 22.07 per cent.; and for
both, 32.84 per cent.
  In  regard to the ratio of cures, M. Esquirol says that  there
were 355 epileptics, paralytics and  idiots among those admitted,
all of whom were considered, at the time of their entrance, as
incurable.   Deducting this number from 1557, the total of
admissions, there will remain but 1205 as under curative  treat-
ment.   The proportion of cures, in this case, will be as 1 to
2.33 or equal  to 42.14 per cent.   The mortality, as  exhibited
by the table, is very great; but, in making out the per centage,
the 492  patients who were in the Asylum at the commence-
ment of the year 1826, and among whom, according to Esqui-
rol, death made its greatest ravages, were not  taken  into con-
sideration.  If these be  added  to the number admitted, we
have a total of 2049,  to which the deaths, 546, are in the pro-
portion of 1 to 3.75 + , or 26.64 per  cent   It is proper to remark
that the insane of all descriptions are  admitted, irrespective of
age, grade of disease or its duration, or of the many other ma-
ladies with which  it may be complicated.   Again, very few
persons  attacked by "those acute  diseases of  the encephalon,
which, as people say, are always cured, and which increase
the  number  of cures of some  similar  establishments," are
brought to this institution.  From these facts we cannot expect
the  ratio of  cures  to  be very large.  The mortality  of men
considerably exceeded that of women. ^ That of the latter was
much less in the last than in the first years of the period; and,
at the same time, there was a corresponding increase of cures.
These facts are very plausibly accounted for, in that the women
occupied the new and commodious building, before mentioned,
during the last five years.
  We now present a table exhibiting the admissions and the
results of treatment, in reference to the different seasons of the
year. 
47
 Season.  Admitted.  Cured.   Died. Per ct. of cures. Per ct. of deaths.
Winter,    341
Spring,    406
Summer,   445
Autumn,   365
92	160	26.97	46.92
123	139	30.29	34.23
145	119	32.80	26.74
158	128	43.28	35.06
518	546		
  Total,    1557
The average of admissions was  194 per annum.   The maxi-
mum  number in any series of the same month was in that of
July,  and of seasons, as will be  seen above, in summer.   The
minimum of men, and of both sexes inclusive, was in winter;
but that of women was in  spring.   The proportion of cures
was greatest in autumn, and least in winter;  that of deaths,
greatest in winter and least in summer.
   The  next table shows the ages of the patients at the time of
admission.
Men      82 119 135 130 106 105  83  68  37  35  25  4  2  1
Women,   42 55  72  77 102  90  65  46  36  22  10 J2 jt ^1 J^
 Total,  124 174 207 207 208 195  148 114  73  57  35  6  6  2   1
Hence it appears that the greatest number of men during any
period of  five years was 135, and that between the ages of 25
and 30; the maximum of women was 102, between the ages
of 35 and 40; and that of both sexes inclusive 20S, between
the a^es of 35 and 40.  The number second in rank is found,
for men,  between the ages of 30 and 35,  and for women, be-
tween 40 and 45.   The number under 20 years  occupies, for
the men, the third rank, for the women, the sixth rank.  From
these results, Esquirol is led to infer that insanity generally
occurs at  an earlier period of life in men than in women   It
will be seen that more men  than women  enter this Asylum:
the former are to the latter nearly as 3 to 2.   This difference
arises from the number of soldiers and  marines who resort
here to be cured.   Esquirol has ascertained by his researches
 that  of 76,000 lunatics, in various countries, the proportion  of
 men to women is as 37 to 38.  The ratio differs in  different 
48
nations, according to climate, habits and other modifying  in-
fluences.
  The number of patients in each variety of insanity, together
with the results of treatment upon them, respectively,  will be
seen in the following table.
	Men.	Cures.	Percent	^Women.	Cures.	Per cent. 1	lemarl
Monomania,	372	123	33.06	343	128	37.31	*
Mania,	334	160	47.93	211	103	48.81	o a
Dementia, Idiocy,	219 8	1	.45	62 7	3	4.83	ct 3 so &
	——	'		^—^_	——		e-s."
      Total,   933    284            623*   234            P-S

   The cures in monomania of both sexes, inclusive, were equal
 to 35.10 per cent; those in mania, 48.25 per cent, and those
 in dementia, 1.42 per cent.  The number of patients affected
 with monomania exceeded that of any other variety; but the
 per  centage of cures has its maximum in mania.
   Of the 1557 cases, the  causes are assigned to 1375; they are
 as follows.  "Hereditary, 337; domestic chagrins, 278;  liber-
 tinage,  excesses of all kinds, 146; abuse of spirituous liquors,
 134; suppression  of  habitual evacuations,  54;  onanism,  52;
 reverse of fortune, 49;  abuse of mercury,  44;  disappointed
 love, 37;  fright, 35;  political causes, 32; parturition, 28;  ex-
 alted devotion, 24; blows  on the head, 20;  jealousy, IS;  cere-
 bral affections,  17;  excess of study and  night waking, 16;
 wounded  self-love, 16; reading of romances, 13;  insolation,'
 12; love of play,  5;  suppression of habitual suppuration,  3;
 cholera morbus,  3; excess of joy, 2."   Total 1375.
  Esquirol thinks that the proportion of cases  arising  from
 hereditary predisposition  is usually greater than in this in-
 stance.  In relation to those arising from political causes, we
 may remark that none occurred  previously to 1830.   In that
 year, the year of the  last revolution, there were 13 cases  of
 this nature, and 15 in  1831.
  The following is a list of the several trades and professions
previously pursued by the patients, with the exception of a few
in which there was but one each.  "Proprietors (landlords) 307
tillers of the ground 99, masons 7, locksmiths 5, cabinet-makers
 16, bakers 19, butchers 10, sellers of hog's flesh (charcutiers) 4 
49
grocers 31, wine-merchants 26,tunnelers 3, tavern-keepers and
cooks 24, jewellers 13, tailors and shoemakers 17, cap makers
and hosiers 5, hatters 5, modistes and cutters 35, merchants and
clerks 81, tobacco dealers 7, military officers 103, soldiers 124,
conductors of public coaches and  couriers 11, teachers  30,
students 46, priests 11, "seminarists" 4, nuns 5, physicians 15,
apothecaries  9, advocates 9, notaries 6, clerks (commis  de
bureau) 83,  "clercs d'avoue" 10, ushers or door-keepers 6,
literary men 3, painters 8, musicians 4, printers and booksel-
lers 15, domestics 35."
•   In the years  1826,  1830, and 1831, a much larger number
of proprietors  entered the  Asylum  than at any other time.
This is explained  by the difficulties, in the first of those years,
arising from the order for the reimbursement of rents; and, in
the last two, by the pecuniary losses necessarily augmented by
the revolution.

                     ASYLUM AT MILAN.

   Saint John's Hospital, at Milan, is one of the most exten-
 sive  institutions of the kind in the world.  It is probably
 exceeded by none.   The principal  edifice appertaining to it
 is within the  city,  but the  department  for  the  insane is
 without the  walls, about a  mile distant  from the Porta Tosa.
 This building, "formerly a convent of the Jesuits, was enlarged
 and  converted into a Lunatic Asylum, about 55 years since.
 It encloses  large courts, but those which are  devoted to  the
 use of the patients are chiefly external to it.   The wards are
 very large, some of them consisting of a hall, of ample width,
 running the whole length, and, beside it, two or three dormi-
 tories, each  containing numerous beds.  In others, there are
 dormitories upon both sides of a  narrow passage.  The rooms
 are all lofty and well ventilated.   In those where a fire is re-
 quired, the  stove is  placed in the middle of the room  and
 covered on all sides  with  bricks, and surrounded by strong
 wooden frames or fenders.  The beds for the furious have con-
 fining rings and straps at the foot and the sides, like  those in
 many other Asylums. The mattrasses are made, some of straw,
         5 
50
 some of wool, and  some of hair; and the beds and linen are
 as neat, though not so elegant, as those in any institution  I
 have ever visited.   In some of the dormitories  metallic pots-
 de-chambre are fastened by straps to the bedsteads.  In the third
 story of the department for women, there is a ward consisting
 of a suite of small rooms, each opening from a narrow gallery.
 The bed in each of these is beneath the window, at the extre-
 mity opposite the door.  Beside it, in the corner,  is a stool of
 convenience, communicating with a balcony on  the  outside
 of the building, where a servant can attend to it without enter-
 ing  the  room.   The infirmary  contains many beds, four of
 which alone were occupied.   The patient in one of these was
 labouring under pelagra, a disease which is endemic in some
 parts of the north of Italy.  Many of the  patients who were
 not confined in  the infirmary have the goitre, the swellings
 being of various dimensions.  I  had  previously  seen  many
 cases of this disease in Savoy and the  canton  of Vallais, in
 Switzerland.  In one case which I saw at Sion, a town  among
 the Alps and upon the road over the Simplon, the left  lobe of
 the thyriod gland  equalled in dimensions the head  of the
 woman who was afflicted with it.  One ward  in  the depart-
 ment of  each sex, in the Asylum under notice, is devoted to
 convalescent patients.  In these they remain forty days, pre-
 viously to leaving the Asylum, for the purpose of confirming
 a cure.   The bathing room contains four baths, three of them
 for one person each, the other sufficiently large to accommodate
 2S at the same time.  Each of the three former is cut  from a
 single stone.  They are for the most violent patients, and con-
 sequently have fixtures for the purpose of fastening  the feet and
 the body.  The large bath is also constructed of stone.   The
 streams  of the douches are  very small,  but they fall from a
 height of 12 or 15 feet.   A horizontal  jet, in which the water
 is thrown, with considerable force, completely across the room,
 is intended for a similar purpose as the douche.  Being thus
arranged" it may be more easily applied to the various parts of
 the body.
  Three physicians, two resident and one  "attending," do
the medical service of the Asylum.  The number of patients 
51
in November, 1S38, was 420, of whom  215 were men and
205  women.   The  accommodations are  sufficient  for  500.
The  number of wards for either sex is six, and the patients are
divided into three classes, the furious,  the tranquil, and the
incurable.
  Regimen.—Breakfast; bread and cheese.  Dinner;  meat,
five  days in the week,  and polenta—a  pudding made of the
meal of Indian corn—the remaining two days.  Wine is  a
constant drink at this  meal.   Supper;  bread, cheese, and
wine.
  Manual  labour is  pursued to a considerable  extent by the
patients.   A large garden belonging to the Asylum furnishes
employment to nearly  100 of them during the  warm season.
In one room  through  which we passed,  between  40 and 50
men were engaged  in braiding paglia di Spagna—Spanish
straw—for carpets.  They worked  as steadily,  and appeared
as orderly, as  if they had not been lunatics.   In  another apart-
ment  several  men were employed in  making  shoes, and as
many more in tailoring.  One of the latter was cutting clothes.
Soon after we entered, he commenced talking to me, and con-
versed so  rationally that I supposed him  to be a sane person,
acting as overseer to  the others.   Under this  supposition,  I
inquired of him  if all those under his care  were  insane, to
which he  answered in the  affirmative.   Perceiving that he
conversed  in  French,  I asked  him  if  he was  a Frenchman.
He  replied that he was not, and added,  "Je suppose que vous
etes Anglais."  "No," said I, "I am  an American."  "Ah!
vraiment," he responded, dropping his shears and lifting both
bands, as if agreeably surprised,  "vous etes Americain.  Eh
bien, vous etes tres  heureux, vous etes carbonaro.  Tous les
Americains sont des carbonari; Je voudrais bien etre dans ce
pays la."  Knowing the subject of the carbonari to be rather
a delicate  one in Italy, these remarks,  together with  some
others, subsequently made, induced me to suspect him insane,
and  this  suspicion,  upon inquiry of the "direttore" of the
Asylum, who accompanied me, proved correct.  An artist, in
the  same apartment  with the above mentioned, was occupied
in cutting designs in paper.  He showed  me  a  representation 
52
of Bonaparte  at  St. Helena, and another of the  garden of
Eden.   They were, indisputably, the most elegant workman-
ship of the  kind  that I have ever examined.   I attempted to
purchase the latter, but he  informed me  that it was already
disposed of.
  Many of the women  were making lint, or charpie, for the
use of  the hospital in the city; and, in one apartment, there
were about 90 sewing and spinning tow upon throstles whirl-
ed in the hand.  For coercion and  punishment, the douche,
confinement in bed, the restraint of limbs,  &c. are effectual
means.  I  observed one patient manacled  with irons,  and
strong  leather  mittens  upon his hands.   He tears  off his
clothes whenever  his arms are unrestrained.   Several others
had on strong leathern belts, to which their arms were fasten-
ed.   In the same ward with these men there was another,
very gentleman-like in appearance, who was exceedingly anx-
ious lest I should go away without being aware of his dignity,
or of the distinguished honour I had received in being admit-
ted into his presence.   Accordingly, he approached me,  and
repeated, with the utmost volubility, a long list of titles which
he graced, such as "Prince" of one place; "King" of another;
"Emperor" of a  third; and, finally,  "Ruler of the World."
In his anxiety to furnish me with this important information,
he followed us far out of the ward.
  The only means of  amusement which I saw were a swing
and a giustra,  if I rightly understood the word.  The latter
is so constructed that four, or, indeed, eight persons may turn
horizontally in a  circle, being situated  at the extremities of
two beams which  cross each  other at right angles, in the cen-
tre.  These are in the  principal court occupied by the men.
The court is shaded by two  parallel rows  of  sycamore trees,
beneath which are many seats for the patients,  permanently
fastened to the ground.

                    ASYLUM AT VENICE.

  Pertaining to the civil hospital at Venice,  there is  a large
edifice exclusively devoted to the insane.   It  is situated upon 
53
the eastern  limits of the city, beside the celebrated church of
San Giorgio e Paolo,  and in the corner, at the confluence of
one of the lagunes with the Adriatic.   It is three stories in
height, and  entirely surrounds a court about 100 feet square.
A corridor  passes around this court, furnishing shelter from
both sun and rain.  In  November,  1838,  this Asylum con-
tained  230 patients, all  of  whom were women.  Upon the
island of San Cervilio there is another establishment,  for the
men, of whom the number  varies but little from that of the
women.  The patients  at the Asylum for the women are di-
vided into  six classes, according to the species  of insanity.
These  classes are not kept exclusively separate;  on the con-
trary, some individuals belonging to every one of them may
be found in the  same ward.   The colour of a strip of cloth
attached, as an epaulette, to the shoulder of each patient, is  a
mark by which those belonging to the several classes may be
identified.   The classes are,  1st, mania,  distinguished by  a
red colour;  2d, monomania, distinguished by deep blue;  3d,
melanconico, by green; 4th, idiotismo, by orange; 5th, stu-
pidita, by light blue; 6th,  demenga, by yellow.
   As I was  unable to  procure all  the data which would have
been desirable, I shall speak of the apartments through which
we passed,  introducing,  as appropriate  opportunity offers, the
other information which I possess.
   15/  Story.— Bathing-room, dining-room, kitchen, a dormi-
tory containing many beds,  and  a  room  in which about 70
patients were spinning tow  upon a hand throstle, as at Milan,
and several others  knitting and sewing.   I noticed several,
among these, who had the goitre.   The room in which these
 were at work is warmed by a stove, which is entirely  enclosed
 with bricks  and mortar, and surrounded, three or four feet dis-
 dant, by a strong wooden railing.   The women were at dinner
 when  we went into the dining-room.  Their regimen is as
 follows, viz.—Breakfast;  bread  and  soup;—dinner; meat,
 bread, rice,  and wine every day, with the addition of potatoes
 or cheese, the two being given alternately.  Suspended under
 the corridor, near the door of the  dining-room, there was a
 table of the  appropriation of time.  It is as follows:-
        5* 
54
   Week days.         A. M.         Sabbath and Feast days.
Rise and dress,   .  .  .  6^ to 7£ o'cl.           The same.
Breakfast,.....7£ to 8              . The same.
Doctor's visit,  .  .  .  .  8 to 9               The same.
Labour,......9 to 12   10 to 11 o'cl., atttend mass.
                     P. M.    11 to 12  "  receive visits of friends.
Dinner,......12£ to 2               The same.
Study of numbers for pi ay, 2 to 3               Recreation.
Labour,......3 to 4    Play at Tomboli and religious exercise.
Supper.......4 to 5               The same.
Walk,   ......5 to 6               The same.
Recreation, .....  6 to 7               The same.

  2d Story.—The study of the physician, the infirmary, three
large dormitories, like the wards of hospitals for the sick, and
two or three small rooms for the accommodation of pay pa-
tients.   The bedsteads are of wood throughout the establish-
ment.   The  beds are without   curtains.   The infirmary  is
large, containing about 30 beds,  most of which were occupied.
It is one of the most complete and  elegant apartments of the
kind that I have seen.   The floor is of Mosaic.
  3c? Story.—A suite of three rooms called " Sicurezza," and
intended for the most violent patients.   They contain about 50
beds, all of which were occupied.  The bedsteads are made  of
plank, similar in form to those at the Asylum  at Utrecht, but
differing from them, in that the bottom is a rack, thus permit-
ting water to  escape in all parts.   A large box or trough  is
placed beneath each, to preserve the  cleanliness of the floor.
The patients in this  department mostly lie  upon loose straw,
which is covered by a blanket.   Many of them were confined
by having their arms fastened to the sides and their feet to the
foot of the bedsteads.   The rooms in question  overlook a por-
tion of the Adriatic, the Lido and the cemetery of Santo Cris-
tofero.   There is another department in the third story called
"Osservazione."   It is intended  for the  convalescent patients
and such as  have recently been  admitted.   The latter remain
here until the nature of their disease is satisfactorily ascertained.
This department contains about 30 beds. 
55
ASYLUM AT MALTA.
  The island of Malta, the rendezvous of vessels traversing
the Mediterranean, is said to be more populous, in proportion
to its size, than any other portion of Europe, or, perhaps, of
the whole world.  The number of inhabitants to a square mile
is five times as great as that of England.   Its population, to-
gether with that of the small island of Gozo, in its immediate
vicinity, is about 120,000.  Of this number there are at pre-
sent, as nearly as has been ascertained,  130 lunatics, or about
1 in 900.  The only  Asylum for the reception and treatment
of  them is at Floriana, in the suburbs of Valetta, the port of
Malta.   It is  one of the several benevolent institutions for the
poor which are under the direction and  support of the go-
vernment.  For an  introduction  to this Asylum, as well as
to  the hospitals and charitable institutions  of the island, I am
indebted to Dr. Gouder, who accompanied me to them, seve-
rally, and afforded me every assistance  in  his power to obtain
 such information  as  was desired.   The Asylum is old, and,
 as an almost necessary consequence, very incommodious for
 the present method of treatment.   Additions, however, have
 recently been  made,  and others are  in progress;  so that,
 eventually, and at  a  period not  very remote, the  defects
  will in  a great measure be overcome.  Baths  have recently
  been constructed, the Asylum never previously having been
  supplied with them.   The mattrasses of the beds are of straw,
  the  most  comfortable as well as wholesome  material,  in a
  climate like  that  of Malta,  even for  such patients  as other-
  wise might be permitted to lie upon feathers.   The bedsteads
  consist of two movable iron  stands acting as supports to the
  boards upon  which the mattrass is laid.   In the morning, these
  stands  are placed beside the walls of  the dormitory,  and the
  direction of the boards changed so as to be parallel with the walls
  instead of at right angles with them.  Each  mattrass  is then
  doubled, or folded once upon itself, and the bed-clothes, folded
  also, laid  upon it.  This gives a  neat aspect to the rooms, and
  leaves a much greater portion of the floor unencumbered than 
56
is the case with bedsteads of the ordinary kind.   Adjacent to
the building, and partially enclosed by it, are three courts, or
yards, for the use of the  patients.  These are  not large, but
they are well cultivated.   One of them is planted with orange
trees, which are  large, and, when I was there, were in  full
bearing.   Another of the courts is used  as a kitchen-garden.
It is well planted with a variety  of vegetables, the labour re-
quired in its cultivation being performed by the patients.  The
regimen, which has been  recently  improved,  is as follows:—
Breakfast;  coffee and  bread; dinner, which  is eaten at mid-
day, soup, meat and fruit*;  supper,  soup and fruit.
   The number of patients in February, 1839, was 90, of whom
40 were  men and 50 women.  There are, at all  times, more
female than  male  patients.  The superintendent informed me
that  he  believes  the proportionate number of the former to
the latter to be as 3 to 2.  The same ratio,  agreeably to his
opinion,  is equally applicable to all the cases of insanity in the
two islands.
   A very large proportion of the patients perform some manual
labour.   The principal employments  are gardening, sewing,
knitting, spinning, and domestic affairs.   Thus far, however,
there has not been sufficient employment to keep  the patients
so constantly occupied as  might be  best for their own content-
ment, or most beneficial in promoting a cure.  Amusements
have not, hitherto, been introduced; and the same  remark is
equally applicable to reading and writing.  When punishment
is necessary, close confinement is the principal resource.  For
this purpose there are several small cells, supplied with no
furniture, having a grating to the doors, and, for the admission
of light,  a small aperture  in the outside wall,  so high as to be
inaccessible  to the patient.
  The principles  of reform began  to enter this institution in
the year  1812.   The use  of chains, those  implements of con-
finement and of torture, fit only for criminals  and  wild beasts,
was  then entirely abolished.  Whenever bodily restraint is
necessary,  the camisole or strait-jacket is called in  requisi-
tion.  The  pattern of this garment of coercion, used  in this
Asylum, is, in my opinion, an improvement  upon all others 
57
which have come under  my observation.   Its principal pecu-
liarity consists in two bands, one upon either side, attached to
its lower border and  passing around the legs.  The whole
garment is thus kept more effectually in its proper place.  The
patients have ever been,  and still are, mingled together, irre-
spective of stage or intensity of disease.  A division into two
classes, 1st, the imbecile and the incurable; and 2d, the cura-
ble,  is about to be made.   Most of the patients were  remark-
ably quiet.  There were, however, two exceptions.  The first
of these was a man at  work in the court of orange trees.  He
talked with superlative volubility  as  long as we would listen,
the principal burthen of his conversation being a desire to get
out of the Asylum for the  purpose of taking a wife; and, inas-
much as fifty-four winters  had qegun to shed  their frosts upon
his brow, he feared that the time  would soon arrive  in which
 to him, as to Omar, the  son of Hassan, it would  no longer be
 possible to  "marry a wife  as beautiful as the Houries  and wise
 as  Zobiede."   The other  was  a  Frenchman, a  member of a
 respectable family in  France.  He assumes to himself the title
 of Prince de  Valois; says he  has millions  of property, and
 can afford to keep a numerous suite of valets.   His clothes were
 in tatters.  The superintendent informed me that, but a short
 time previously, he had received  a good suit from his friends,
 but will not deign to  wear them, because, forsooth, they were
 not made by the lailleur  du roi—ihe king's tailor.
    Many of the inmates of this  Asylum died  of the Asiatic
 cholera, during the ravages of that fatal epidemic in  Malta, in
 the summer of 1837.   The superintendent could not tell me
 the precise proportion of cures effected here, but thinks that it
 exceeds 50 per cent.

                 ASYLUM AT CONSTANTINOPLE.

    Connected with some of the mosques in Constantinople, there
  are buildings  for the  reception of the sick-a kind of hospital,
  in which the  poor who are suffering  under  disease  may have
  their wants ministered  to  by the  hand of charity.   That which
  is adjacent to Sulimanyo,or the mosque of Suhman, is devoted 
58
exclusively to the insane.   There, none but men are admitted;
the women, according  to  the Turkish custom, as  well as in
conformity with the precepts of the religion of Mahomet, being
kept in private seclusion.   The building is but one story in
height, and, like the cloisters of many gothic  cathedrals,  and
the khans or caravanseras of Turkey and Natolia, completely
surrounds a central court.   The entrances to all the rooms are
beneath the corridor  at which the court,  upon all sides, is
limited.
  I visited this Asylum during the feast of the Bairam, near
the close of the year 1838, in  company with  two  American
gentlemen, residents at Constantinople.   We entered the court,
passing several miserably  clad people, "sitting at  the  gate,"
not "to ask  alms," but to receive  it, if  voluntarily offered.
Within the court were many people, mostly young men  and
boys, who had come, either for the gratification of curiosity,
or to administer to the  wants of the afflicted.  We  passed
along the  corridor to the  first  window.   From between  the
bars of the iron grating with which this was defended, a heavy
chain, ominous of  the  sad  reality within,  protruded, and  was
fastened to the external surface of the wall.  It was about six
feet in length.  The opposite extremity was attached to a heavy
iron ring, surrounding the  neck of a patient who was sitting,
within the grating, upon the window-seat  We entered  the
room and  found two other patients, similarly fastened, at  the
two windows upon the opposite side of the room.   It was a
most  cheerless apartment   A jug to contain  water, and, for
each of the patients, a few  boards  laid upon  the floor, or  ele-
vated three or four inches, at most, and covered with a couple
of blankets, were all the articles of comfort or convenience
with which, aside from their clothing, these miserable creatures
were supplied.   Although in the latter part of December, they
had no fire;  nor were the windows  glazed, but close shutters
attached to each, rendered  it possible measurably to shield the
inmates from severe weather whenever it  might occur.   The
length of the chain of each patient is barely sufficient to enable
him to lie down upon his comfortless bed of boards and blan-
kets.  Leaving this apartment, we proceeded successively to the 
59
others, twelve or fifteen in number, in all of which we found
the patients in a very similar condition to those whom we had
first seen.  There  was but one who was not chained.   He was
an elderly man, though still retaining  much of the vivacity of
earlier years.  His long and profuse hair and beard were nearly
white, and his complexion very delicate.   He was formerly a
priest of the Islam faith.   He has been deranged and confined
in  this  place nearly fifteen  years, during which time  he has
thrice  broken the chain with which he was  secured.  He  is
now alone in his apartment, within which no one is permitted
to enter.   He talked and raved incessantly, threatening to kill
those who were making  him their gazing stock.  Like those
in  the  apartment  first mentioned, all the patients, with one
exception, were without  fire.  The person forming this ex-
ception was one of  the  most hideous of undeformed  human
beings.  He has  been in the Timar-hane, as this Asylum is
called by  the Turks, more  than  forty years.   His  hair and
beard, both naturally abundant,  curly, and black  as  ebony,
 appeared as if they  had  not been cut  or combed  since  his en-
 trance.  They nearly concealed his face, and the former hung
 in a profusion of literally "dishevelled locks" about his neck
 and shoulders.  His head would  have been a nonpareil for an
 original to the figure of Cain, in  David's  celebrated picture of
 "Cain meditating  the death of Abel."  He lay crouched upon
 all-fours, resting upon his knees and  elbows, and  holding his
 head and hands over a manghale of living embers.   Whatso-
 ever was said, whether addressed to  him or  otherwise, could
 only induce him slowly to turn his huge head, and present his
 hideous face more directly to view.   His case was a  striking
 example of dementia.
    The  patients,  generally, appeared  to enjoy pretty good
 health, aside from the lesion producing  insanity.   I  was  in-
 formed that a physician  attends  them regularly.  There is a
 person who has the charge of supplying  them with food  and
 they receive considerable attention from those who visit them
 While we were  there,  many visiters were  conversing with
 them,  giving them  articles  of food, money and tobacco and
 doing  them a  kind office  by filling and lighting  their "che- 
60
 bouks."   These patients presented a diversity of species of
 insanity, and a variety of  hallucinations.   One of them was
 seated against the bars of his window, cross-legged, and with
 arms folded upon his breast, in all the counterfeited dignity of
 a sovereign, and the imperturbable gravity of a saint.   It was
 evident by his demeanour that he esteemed himself one of the
 rulers of the earth—a Mahmoud, a Mahomet, or a Great Mo-
 gul.   Upon being informed that I was an American, "Please,"
 said  he, turning towards me slowly, and without  the  slightest
 change of countenance, "please, effendi, to give my respects to
 the Sultan of America."  This  said, he assumed his former
 position, and maintained it with the most scrupulous exactitude.
  There was another, one of the finest looking Mussulmen that
 ever worshipped  before the altars  of Stamboul.  His beard
 might acknowledge no rival  in beauty, excepting that of Mah-
 moud the Second, and his eye  possessed all  the mingled fire
 and softness of the Orient  He was occupied in sewing.  He
 was  surrounded  by several  young  Turks, but continued  his
 labour regardless of any of those who were present.  The
 gentleman of our party who  speaks the Turkish language ad-
 dressed him, and at length won him, although with  consider-
 able  reluctance on  his part,  into  conversation.  I  have never
 witnessed a greater blandness and suavity of manners than in
 him.  Upon being asked the cause for which he  had come to
 that  place, "Please, gentlemen,"  said he, "to be seated, and I
 will  relate the whole  history."  Inasmuch  as the uncovered
stone floor presented an aspect  rather uninviting, as a seat,  we
excused ourselves,  and he was  requested to proceed.   There-
upon he placed himself in an attitude worthy of the orators of
antiquity, and  related a long  story, in  a  most amusing but
graceful manner.   The whole substance of it was, that people
began by calling him a fool;  and, going from bad to worse, at
length ended by bringing him to the Timar-hane of Suliman-ye.
  Such, then, is the gloomy picture with which these sketches
of some of the Asylums for suffering  humanity are brought to
a conclusion.  It presents  us  with  an additional  motive for
hoping that the stream of knowledge, which, taking its rise in
Chaldea, has flowed to us, constantly augmented in its course 
61
through  Egypt,  Greece,  Rome, and the nations  of  western
Europe, may reverse its course, or release a branch, once more
to fertilize the desolate regions of intellect throughout the East.
It is  a  proposition, the truth  of  which cannot, perhaps, be
questioned, that, in proportion as a nation advances in intel-
lectual cultivation, its  practical  benevolence assumes a loftier
standard.   When,  then, the light  of  science shall gild with
brighter rays the empire of the Ottoman, we doubt not that the
chains of the  maniac will be broken, and his condition  ren-
dered such as to leave a hope, that alienated  reason may reas-
sume her proper throne.
   It is difficult to reconcile the treatment of the patients in the
"Timar-hane" with the testimony of physicians in regard to
the attention paid to unconfined lunatics in Turkey, and with
the prevalent opinion  among the followers of Mahomet, that
the insane are the  especial  favourites of Heaven—that their
"discord" is
                    ''harmony not understood;"

 that their language appears to us to be incoherent and unmean-
ing merely because the minds of the  sane are not sufficiently
 spiritualized to comprehend  it.  Dr.  Millengen, an English
 physician who had practised nearly twenty  years in Constan-
 tinople, informed me that he had known the wandering lunatic
 to be received by  strangers, and, for weeks  in  succession, re-
 ceive all the kindness of the most cordial hospitality.
6 
62
              ASYLUMS IN ENGLAND.

  In the year 1815, the British Parliament passed a law, by
which each of the several counties of England was authorized
to erect an Asylum for the insane.   As the provisions of this
act were not compulsory, the counties have been slow in com-
plying with them.  At the  present  time, sixteen institutions,
constructed in conformity  with  this law, are in operation.
They are in the counties of  Middlesex, Bedford, Chester, Lei-
cester,  Gloucester, Stafford, Norfolk, York (West  Riding),
Nottingham, Lancaster, Oxford, Lincoln, Kent, Suffolk, Dorset
and Cornwall.  There is one in progress  in  the  county of
Surry.   Of the above mentioned Asylums, an account of that
of Middlesex, at  Hanwell,  and that of  the  West  Riding of
York, at Wakefield, have already been given.  Our informa-
tion in regard to the remainder is neither extensive nor minute.
It is comprised in the following notices.

                    BEDFORD ASYLUM.

  This Asylum, opened in  1812, accommodates 52 patients, of
whom  the convalescents assist in gardening during the warm
season.   The original expense was more than 10,000 pounds.

                  GLOUCESTER ASYLUM.

  Subscriptions were raised, more than  forty years  since,  for
the establishment of  a charitable institution for the insane in
Gloucester, but after the act was passed authorizing  the con-
struction of  county  Asylums, the  amount thus raised was
added  to the  public fund, and the present building erected.  It
cost, with  the grounds, 44,457 pounds, 6 shillings, and was
opened in  July, 1823.  It  accommodates 120 patients.  The
patients  assist in  gardening, farming and  household labour,
which, according to  one of the reports, "is found not only
most useful  to themselves, but, also, most beneficial  to  the
establishment." 
63
                    STAFFORD ASYLUM.

  The Asylum at Stafford was opened in October, 1818.  It is
said  to be a well conducted establishment.  The number of
patients in 1826 was 155.  A report at that  time says, "The
cultivation  of thirty acres of pasturage, pleasure and  garden
ground, is performed entirely by the patients, assisted  by two
of the keepers; and  all the making of linen, and mending of
clothes, is  done by the  females."   The weekly expense of
each patient is about 9 shillings sterling.

                     NORFOLK ASYLUM.

   This institution can accommodate about 120 patients.   The
 cost of the establishment was  35,221 pounds.

                   NOTTINGHAM ASYLUM.

   This Asylum, situated at Nottingham, was constructed at an
 expense of 20,350 pounds, and opened in February, 1812.  It
 accommodates eighty patients, of  whom the labouring portion
 among the males are employed in gardening.

                    LANCASTER ASVLUM.

   This Asylum is situated about a mile from the town of Lan-
 caster.  It was opened  for  the reception of patients on the
 28th  of July, 1816.  It has  accommodations for 360.  The
 cost was 59,833 pounds.  The original tract of land belonging
 to the establishment was fifteen acres, but,  I believe  the farm
 has been considerably increased.   Some of the patients labour,
 the women at sewing, knitting and domestic duties;  the men
 at gardening and husbandry.

                      LINCOLN ASYLUM.

    This Asylum is at Lincoln.  It was opened in April, 1820.
  It was originally  intended  for about  fifty patients, and  was 
64
 completed at an expense of  12,405 pounds sterling.  Some of
 the patients are employed in household work and gardening.
 I know not that the buildings have been enlarged.

                    CORNWALL ASYLUM.

   This institution is pleasantly situated, and the airing grounds
 are said to be extensive.  It was opened in October, 1820, with
 accommodations  for  102 patients.  The  original cost was
 15,724 pounds, 14 shillings and 8 pence.   In speaking of the
 inmates,  a report says, "They work in the garden, and raise
 water  for the use of  the  house by means of a wheel  pump.
 The female patients also  work in  the garden and assist the
 laundress."

  Besides  the  County Asylums, there are many institutions
 established by subscriptions and donations.  Of these, the "Re-
 treat," at York, has already passed under observation;  of the
 others, we proceed to notice those of which we possess any
 information.

               BETHLEHEM ASYLUM, LONDON.

  The Bethlehem Asylum, generally called  "Bedlam," in
 England, and referred to by Pope, in the line
               "All Bedlam or Parnassus is let out,"

 is one  of the oldest institutions for the insane in Great  Bri-
 tain.  The original  building was  in Finsbury, on the north
 side of the Thames; but new edifices, imposing in their exter-
 nal appearance, were erected in 1812 on the south side  of the
 river.
  When  in London, I went to this Asylum, and was  disap-
 pointed in learning that no one is admitted, as a visitor,  except
by special permission  from one of the directors.  An  almost
immediate departure from the city prevented me from obtain-
ing such permission.
  Sir Andrew  Halliday,  in speaking of  this institution, in 
65
1828, says,  it "is now well conducted, and the  patients  are
humanely and judiciously treated; but it has still too much of
the leaven of the dark ages in its constitution, and too  rigid a
system  of quackery is maintained, in regard to its being seen
and visited  by  respectable strangers, and there  is too little
space for exercise and employment, for it  ever  to prove an
efficient hospital."
   A more recent writer observes,  "Little has been  done for
the purpose of employing the patients,  and diverting their
minds from the subjects  of morbid thought.  We do not re-
member to  have seen either work-shops for manual labour, or
a  reading-room,  or  games of amusement.   The grounds,
though large for an institution  located in a  city,  are too con-
tracted for so great a number of patients."*
   This Asylum has a permanent income of about 90,000  dol-
lars per annum, and receives, from government,  an additional
 sum  of 13,000 dollars,  for the support of  criminal  lunatics.
 These  patients are  kept in wards, devoted  exclusively to
 themselves.  The number of patients, at Bethlehem, in 1840,
 was 429.

                  saint  luke's hospital.

    This Asylum  is  in  the northerly part of London.  It was
 founded by subscription, and  has been in  operation  nearly a
 century.   During the last eighty  years, the number of admis-
 sions was 16,589.  Of these,  5S  per  cent,  were cured.   The
 average expense of the  patients is S2,50 per week.   Epilep-
 tics, paralytics,  idiots,  those  who have  been  deranged more
 than one year, those who are under twelve years or over se-
 venty  years of age,  and  those who are able to support them-
 selves, are  not admitted.   It is said that this Asylum  is better
 conducted  than the one last  noticed, although useful labour
 and judicious amusements have  not entered so fully into the
 plan of treatment as is desirable.
    * Review of Ferrus on the Insane. Am. Journal of the Medical Sciences.
 Mav, 1837.
         6* 
66
                ASYLUM AT NORTHAMPTON.

  The cost of this establishment,  including twenty-four acres
of ground, was 24,000 pounds.  Parish paupers are maintain-
ed here at an expense of 9 shillings sterling per week—others
pay from 3 dollars to 5  dollars.—"Eighty-three  per cent,  of
all the patients are employed, and  ninety-four per cent, of the
male patients.  The non-resisting  principle is applied here  in
its ultra form.  In one instance, the day I was there, the bed
and bed-clothes  of a patient were completely changed, four
times, between eight and twelve o'clock, a warm bath prepar-
ed each time, and the patient washed, and her clothes changed
throughout, rather than use severe measures for correcting  or
counteracting  her  propensities.—The superintendent  of this
institution, (Dr.  Pritchard,) is passionately  devoted  to his
duty."*

              ASYLUMS  IN SCOTLAND.

                  ASYLUM  AT MONTROSE.

  This Asylum  has been in operation many years.   I have
not obtained the statistics of the institution, nor am-1 aware  of
the extent of its accommodations.  The  superintendent, Dr.
Poole, in his report  for 1840,  approves of the  abolition of  all
bodily restraints, in the treatment of the insane, in those insti-
tutions which are provided with the "essential requisites"  to
such a mode of  treatment.  "But in the  absence of some  of
them," says he, in speaking of the Montrose Asylum, "and at
variance with my own creed, I must tolerate the occasional
imposition of hand-cuffs,  to prevent greater evils  than they
inflict.  Mr. H.,t I am persuaded, would not blame me, under
circumstances, for departing from the true faith,  inasmuch  as,
e. g., I pinioned one man because, having an ulcerated leg,

 •* "Memorandum of a late Visit, &c." by  F. A. Packard.
  t Gardiner Hill, of Lincoln, an  advocate for the abolition of all physical
restraint. 
67
which  needed poultices and  ointment, he repeatedly tore off
and actually swallowed them; or that, with a latitudinarianism
not deemed heretical in a pure physician, I had another tucked
down to bed till the turbulence of delirium tremens yielded to
a potent opiate;  or even that, with only one female attendant
to twenty of her sex, I permit the temporary confinement of a
couple of arms, which would both reduce their possessor to nu-
dity and dispense  merciless blows to all around."

            ROYAL LUNATIC ASYLUM AT GLASGOW.

   This is  an institution of very high standing, but we  have
 but little information in regard to it.   The wings of the build-
 ing are three  stories in height: the pauper patients being in
 the first, the  lowest  class of pay patients in the  second, and
 the highest in the third.

                   ASYLUM AT EDINBURGH.

    This was founded by voluntary subscription, and  no patient
 is received under a guinea a week.

                   ASYLUM  AT ABERDEEN.

    This institution was  erected by subscription.  It will ac-
 commodate about 100 patients.  It is said to be well conducted.
    There are also  Asylums  at Perth, Dundee, and  Dumfries.

                ASYLUMS IN IRELAND.

    An act of parliament, in 1817, authorized the lord-lieutenant
 of Ireland to direct the "magistrates of any county  or district
 to erect  an  asylum for the  accommodation  of  their insane
 poor  "  These asylums are  under  the general  superintendence
 of two individuals, called inspectors general, who are obliged
 to report, annually, to parliament.  They  are empowered to
 inspect private as well as public asylums. 
68
               RICHMOND ASYLUM AT DUBLIN.

   This asylum is calculated for about 300  patients.   It was
 begun in 1S10, and cost £77,809 5s. 9\d. sterling.  In 1827
 it contained 277 patients, of whom 130 were usefully employed
 in  gardening,  needlework,  washing  and  other  housework,
 weaving, tailoring, &c.   Twelve  were  learning to read.
 During the year "3188 hanks of yarn were spun;  406 pairs of
 men's*and 349 pairs  of women's stockings knitted:  and,  of
 linen woven in the establishment, there were made, by the
 female  patients, for the  use of the inmates, 140  shirts, 180
 shifts, 115 bolster-cases, 56 pairs  of sheets, 53 rollers, 83 bo-
 dices, 80 nightcaps, besides keeping in repair the whole cloth-
 ing of the male and female patients."

               WORKHOUSE  ASYLUM, DUBLIN.

   A department of the workhouse, at Dublin, is  devoted  to
 insane paupers.  It generally contains from 500  to 600 pa-
 tients.  I visited this in the summer of  1837,  but  took no
 notes.   The patients  appeared  to  have very comfortable ac-
 commodations.

                 ASYLUM AT WATERFORD.

   This is connected with the house of industry.   In 1827 it
 contained 48 idiots and 57 lunatics.  The report of the inspec-
tors states that "the patients  are treated with lenity, and there
was but one patient coerced,  a male lunatic, on whom a strait-
waistcoat was placed."

                ARMAGH DISTRICT ASYLUM.

   This establishment has 13  acres of land, and accommodates
 106 patients.   The original cost was £20,900 4s. 5d.   It was
opened in 1825.   The patients are employed in gardening and 
69
other manual labour.  They weave all the linen for the use of
the house, and make the clotfting for themselves.
ASYLUM AT CORK.
  This is a well conducted institution, having accommodations
for more than 300 patients.
ASYLUM AT LIMERICK.
  This was opened in 1827, having been erected at an expense
of £29,511 105. Sd., inclusive of the cost of 12 acres of land.
It is calculated for 150 patients, and "is one of the best arranged
public asylums that has ever been built."
ASYLUM AT LONDONDERRY.
  This institution can accommodate 106 patients.
  There are public  asylums at  Belfast, Kilkenny and  Wex-
ford, and several smaller ones in  other places.   There are also
four private establishments in the vicinity of Dublin.

     ASYLUMS  IN HOLLAND AND BELGIUM.

  To the notices already given of Asylums in the Netherlands,
we shall only add the following:

               COMMUNITY ASYLUM AT GHEIL.

   Gheil, a  commune containing nearly 7,000  inhabitants, is
situated about twenty-seven miles from Antwerp.   According
to a local tradition, an English lady of rank and beauty, being
"driven to  madness by  the  treachery of a  lover, and  the
cruelty of friends, wandered  from her home  and from  her
country, and found refuge in this secluded  spot, where  she
recovered her reason, built a church,  and  devoted a long life
to curing the insane, having received from Heaven the power
of performing such cures."  From that time until the present
the village of Gheil has been  the place of resort for thou-
sands  of the insane, and, although the English lady no longer 
70
lives, to  minister to the afflicted, yet she has been canonized
under the title of Saint Nymphrw, and still is made the presi-
ding saint of the village and the commune.  Some stones, said
to be the remains of her sarcophagus, are  preserved, being
placed upon pillars adjacent to the church which she caused to
be erected.   For a long period, every new patient was confin-
ed nine days, in  a solitary room, and, at three times during
each day, joined  a procession which marched several times
around the  church, at each time passing under the relics of the
sarcophagus, repeating a prayer  to  the saint, that she  would
condescend to  effect  his  restoration.  This  custom is now
nearly or entirely abolished.
  The number of lunatics in this commune, in 1789, was 400;
in 1803,  600; in 1812, 500;  and in 1821, 400.  No resident
is permitted to have more  than five  patients, at one  time, in
his house.  Those patients whose  condition  will admit,  are
obliged  to  work a certain number of  hours during  the day,
and then are permitted to ramble at their pleasure, being sum-
moned home  by the ringing of the bell of the village church.
Of the 400  patients who were there  in  1821, about 100 were
of this class, and 50 of them worked at agriculture.   It is said
that escapes have been frequent.   The patients,  when quiet,
are treated kindly, but if mischievous  or  furious,  they  are
chained at the wrists and ancles.   In every house, there is  a
ring beside the chimney, or  attached to the beds,  to which
they may be  chained.   Esquirol  says he saw one man, from
whose legs the skin had been abraded by the iron  surrounding
them.
   While the  superstitious belief  in the supernatural powers of
Saint Nymphna remained unshaken,  the proportion of cures
at Gheil  was  said to be very great, many of them being effect-
ed during the preliminary nine  days of  probation and  devo-
tion. But since this faith  has been lost, the charm is broken,
the number of cures is but small, and the place  has become
rather an  asylum for incurables, than a place for  judicious
curative treatment.  The  mortality among the  insane  is  said
to be a little greater than among the residents  of  the com-
mune. 
71
               ASYLUMS IN FRANCE.

  Nearly all the insane, in France, are  placed in public in-
stitutions;  some of them being in special Asylums,  others
in hospitals,  alms-houses, houses  of correction, and prisons.
Their condition has been very much ameliorated  since the
commencement of the present century.
  In 1818, there were  but eight establishments, throughout
the whole  kingdom,  exclusively devoted to the  reception of
persons labouring under mental disorders.   But, between that
period and 1837,  the number was augmented to thirty-four.
In a few of these,  however, some  other persons are received.
  Three of the largest and most  important of these institu-
tions,  La  Salpetriere, Le Bicetre, and the  Maison Royale
d'Alienes,  at Charenton,  have already  received  a  somewhat
elaborate notice.   Of the others,  the  following are the most
important.

                   ASYLUM AT AVIGNON.

   This Asylum has been in operation many years.   Since the
 commencement of the present century, it has  been  greatly
 enlarged  and improved.  It is said to be well conducted  and
 remarkable for its neatness,  but  the relics of by-gone time
 still remain, in the bolts upon the doors of the patients' rooms.

               SAINT-YON ASYLUM, AT ROUEN.

   This is one of the best institutions of the kind in France.
 It  was opened in July, 1825.  The buildings are constructed
 according to the plan of Esquirol,  being but  one story  in
 height.  The number of patients, on the 31st Dec. 1834, was
 455, of whom 221 were men, and 234 women.   From 1S25
 to 1S34, inclusive, 1438 patients were admitted.   Of these,
 737 were  men and 701 women.  In 1S32, two men and eleven
 women died of the Asiatic cholera.  The price of board, &c.
 for patients, varies from  350  to 1500 francs, per annum. 
72
         COUVENT DE FORCE ASYLUM, AT BORDEAUX.

   This Asylum is pleasantly situated,  in  the vicinity of the
 city of Bordeaux.   It was formerly a  prison, with  a depart-
 ment for the insane;  but, since the year 1803, it  has been de-
 voted exclusively to the latter.  The rooms are large, and the
 buildings  but  one  story  in height,  enclosing  courts.   The
 institution is under the "immediate surveillance of the Sisters
 of Charity," who make mildness, benevolence,  and humanity
 reign throughout.  " The medical department is under the care
 of a physician, assistant physician,  and two surgeons.   The
 pay patients have wine,  daily.   Their  dishes are of earthen,
 while those  of the indigent are of tin and block-tin.   In 1817,
 the number  of patients was 125; of whom 47 were men, and
 78 women.
  At Cadilhac, about 15  miles from  Bordeaux, there  is  an
 inferior Asylum, where, in 1835, there were 209  patients.

                 ASYLUM AT MONTPELIER.

  This was  opened for men, in 1822, and for women, in 1824.
 Since that time, it has been very much enlarged and improved.
 In December,  1835,  it contained 138  patients,  75 of whom
 were men, and 63 women.

                 ASYLUM AT MARSEILLES.

  This establishment was formerly a general hospital.  It was
much enlarged in  1816, and at  subsequent periods. The recent
buildings are three stories in height, with  dormitories on each
side of a central gallery.   From 1797 to 1818, there entered
 345 men, and  351 women: total 696.   In 1819, the number
of patients in the Asylum was 119.
  A large and commodious establishment, with  accommoda-
tions for  300 patients, has recently been  erected, near Mar-
seilles. 
73
                     ASYLUM AT AIX.

  This is an inferior establishment connected with the alms-
house.  The furious patients are chained, by the legs, to the
walls of the cells.

                    ASYLUM AT LYONS.

  A part of this establishment was formerly a convent.  It is
situated upon the declivity of a hill, in the vicinity of the city.
Drs.  Martin and Bottex have  charge of the medical  depart-
ment, the latter of  whom delivers clinical lectures on  mental
disorders.   The regimen of the patients is as follows:  At 8
o'clock,  A. M., bread  and cheese; at  12 o'clock, M., soup,
meat and bread; 4  o'clock, P. M., vegetables, fruit and bread.
Each patient  is allowed  one and a half pounds of bread per
diem; each of the pay-patients, four ounces of meat, and each
of the paupers, two ounces.  On  four  days in  the year  the
rations are doubled.

           HOSPICE DE LA PROVIDENCE, AT SAUMUR.

   This  singular Alms-house is situated on the declivity of a
rocky hill.  The following description  of it is  abridged from
Esquirol.  After ascending a staircase  and  a rocky acclivity,
the visiter comes to a place where a great number of small cells,
or lodges, are excavated in the rock.   Some of these are large
enough to contain several beds—the bedsteads, in some instan-
ces, being the rock itself. In these cells are maniacs, quiet luna-
 tics, and some  superannuated men who pay their board.  At
 some distance from these cells  is  a large cavern, 260 feet in
 length, 26 in width, and 16 in height, also cut in the rock, as is
 the°vestibule at its entrance, which is  occupied as a  working
 room.   This large cave is furnished with three ranges of beds,
 occupied by  more than sixty imbecile, demented, epileptic and
 paralytic women.   Light is admitted through a large circular
 aperture in the middle of the roof of the cavern.  Adjacent to
        7 
74
 this large room are numerous  smaller ones, occupied by such
 patients as require to be isolated.   Farther on are two  more,
 even larger than  the largest  heretofore described.   These
 unique halls for the insane are said to be dry, and the patients,
 having exercise and a good regimen, are said to enjoy as good
 general health as at other asylums.  The number of insane is,
 generally, from 70 to 80; the whole number of inmates, about
 300.  Dr. Gaulay has the medical charge of the  institution.

                ASYLUM AT ARMENTIERES.

  This is a large  establishment; the  buildings, which  were
 erected before the French revolution, being constructed around
an oblong court.  It is for men  alone.

             BON-SAUVEUR ASYLUM, AT CAEN.

  This was a convent, founded in 1720.  It was enlarged  in
 1805, and in 1818 it was first opened for the insane.  It is an
extensive establishment, having three distinct departments for
the insane men.  1st, for the quiet;  2d, for the  idiots, epilep-
tics and the demented; 3d, for the furious.  The department
for women is about 600 feet long, and three stories in height.
  In each section, there is  a room supplied  with baths and
douches, several common  halls, and rooms for  the working
patients.   There  is  a  chapel, a  library and a  billiard-room.
The patients work in the garden.  The number of patients, in
July, 1833, was 300; from  that time to January  1st,  1835,
there were 122  admissions.   Of these 422 patients, 199 were
men and 223 women.

                   ASYLUM AT RENNES.

  This was, formerly, the  Saint-Maen  hospital.  It has  been
devoted to the insane but a few years; the nurses are Sisters of
Charity.   Cider is given to the paupers, and wine to the pay-
patients. 
75
                  ASYLUM AT TOULOUSE.

  This is an old establishment, in which both lunatics and pri-
soners were formerly confined.  In 1819, the prisoners were
removed, the dungeons  destroyed, and large rooms erected;
and, in 1826, an ancient convent was added to the establish-
ment.  Although the condition of the patients has been much
improved, yet great ameliorations remain to be effected.  The
number of patients, in 1836, was 293.

                   ASYLUM AT NANTES.

   This is attached  to the Hospice de Saint Jacques.  It was
built in 1832.   "The first thought," says Esquirol, "of the
physician,  Dr.  Bouchet, who has so admirably organized the
service of  this house, and that which governs all his views of
treatment,  has  been to subject the patients to order and disci-
pline, and  to furnish  them with all  kinds  of labour of which
they are capable.  For their encouragement  he  allows them a
recompense. Hence, there are few Asylums in which a greater
proportion of the inmates work, or where they appear to enjoy
greater liberty."  In 1835 there were 207 patients, of whom
 172 were employed in manual labour. The number of patients
at the commencement of 1835, together with the  admissions
during that year, was 277, of  whom 123  were  men, and 154
 women.

                   ASYLUM AT AURILLAC

   This Asylum is attached to the Civil Hospital.  It was founded
 in 1836.  It is a  fine  establishment, built  upon the  plan of
 Esquirol.   There are eight series  of buildings, one story in
 height, each series enclosing a square court.  Four series are
 devoted to the men, and four to the women; and between these
 two departments is a building containing parlours, bath-rooms.
 and an office for the physician.  There are accommodations for
 200 patients.  The service, in the wards, is performed by the 
76
 Sisters of Charity.  In front of the establishment is a beautiful
 lawn,  ornamented with a fountain, and planted with five thou-
 sand mulberry trees.

                   ASYLUM AT LAFOND.

   This Asylum was opened  in December, 1829.   It is well
 constructed, with parlours, rooms for labour, and covered pro-
 menades.   In each  court there is a fountain.   There are ac-
 commodations  for 200 patients, of whom each class may be
 kept entirely distinct from the others.

                   ASYLUM AT POICTIERS.

   This was opened in  1821; it is  under the  care of Dr. La-
 marque.  In 1S26 it contained 56  patients.  The pay-patients
 are furnished with wine.

   M.  Esquirol has an admirably conducted  private Asylum
 at Paris.

   In Bavaria and Saxony, the  asylums are said to be well ap-
 pointed, and conducted in an  enlightened manner.   "One of
 the most perfect establishments in Europe is  at Wurtzburg."
 In Prussia, also, these institutions are of a superior order.  In
 Sweden, the asylums have been much improved;  but it is said
 that little is attempted towards curing the mental  disease of
 the patients.   Denmark is incompletely  furnished  with  asy-
 lums, but those of Copenhagen are well  conducted.   One of
 the best asylums in the world is  at Seigburg, on the Rhine.
 It is under the care of Dr. Jacobi.   We  have seen  no notice
 of any institution for lunatics  in Spain, excepting one at Sa-
 ragossa, and  of a large one at Madrid;  and that of Lisbon
 is the  only one which we know to exist in  Portugal.   The
 asylums of Hesse are very inferior.   In that of  Hanover
 "the madman  and the idiot are shut  up with the  thief and
 the murderer;" and in that of Celle "may be found every
 gradation of human wickedness and of human infirmity, with
only this difference, that the depraved and the  criminal part of
its inmates are treated with some kindness and attention, while 
t i
the diseased and  afflicted  are left in utter wretchedness and
neglect."   An asylum at Geneva, which was opened in 1837
or 1838, is the only one we know of in Switzerland.   There
are large asylums at Vienna and  Munich, and one at  Pirna,
near Dresden.

                 ASYLUMS IN ITALY.

   The  most important establishments for the reception and
treatment of the  insane, in Italy, are  those of Turin, Genoa,
Milan,  Reggio, Florence, Bologna, Venice, Aversa and Paler-
mo.  Two of them have already been  noticed, in detail; and
of that  at  Reggio, it has  been remarked that Esquirol  consi-
ders it  the best of the many institutions which he has visited.

                     ASYLUM AT TURIN.

   This is an extensive establishment, under  the  medical care
 of Drs. Bertolini and Bonacossa.  The number of patients,
 January 1st, 1837, was 361.   During the six and a half years
 next preceding  that  date, the  number admitted was 1066, of
 whom  650 were males, and 416 females.  The  species of in-
 sanity  of 1048 of these was  as follows, viz.: mania, 206; de-
 mentia, 238;  monomania, 238;  lipemania, (tristimania of Rush)
 •266; idiocy, 56: acute delirium, 44.
    Ages at the time of admission.
_ >, Z o — a P3m	©' ct c d 8	6 c © CO	©' in -a a a ©	©' c © in	P--d a ©	© 00 -a a ci © I-	T3 2 O S	
49	272	342	222	104	41	7	29	1065
Number in six semi-decades.
c£	in	©		!?)	S
	a	C C3	c ci	r3 C ©	s CJ in
ll	© CO	in	©	CN	—
1S3	159	151	127	121	95.
rr*					
 
78
  Of 945 patients, the disease of 646 is attributable to physical,
and 299 to moral causes.
  Specific physical causes.—Hereditary  133; diseases  and
injuries of the head and brain, 85; intemperate drinking, 76;
epileptic,  35; abuse of mercury, 2S;  diseases of the abdominal
viscera, 27; insolation, 19; syphilis,  18; suppression of anor-
mal  discharges,  15; excessive venery and  masturbation, 14;
diseases of the chest,  12;  excessive fatigue, 12;   disordered
menstruation, diseases of the uterus, pregnancy and parturi-
tion, 54.
  Specific moral causes.—Poverty  and distress,   124;  love,
35; domestic trouble, 22; religion, 21; jealousy, 19; reverses
of fortune, and disgrace, 18;  terror and fright, 17;  protracted
study,  7.
  Total of cures, discharged, 466;  total of deaths, 328.
  Wine is used, as a drink, by all the classes of patients in this
asylum.

                   ASYLUM AT AVERSA.

  This institution  is  situated- about ten miles from Naples.
Our  knowledge of its arrangement, organization and success is
very imperfect.  The physician, Dr.  G.  Lostritto, has pub-
lished  a summary of 1725 patients, who were admitted during
the interval of ten  years, from 1814 to 1824.   Of these, 783
were monomaniacs.   A greater number of patients were re-
ceived in 1822  and  1823  than in any other equal period of
time, owing to the revolution and the popular commotions of
the time.   Dr. L.  concludes, from his  observations, that there
are more  attacks of insanity in summer than in winter,—that
there are  a greater number between the ages of 20 and  30 than
during any other period of equal duration  in  life,—that the
disease frequently arises from fevers, particularly intermittents,
but "generally from moral  causes,"—that mania is  more easily
cured  than any other form of insanity,—that more recoveries
take place in April than  in  any other  month,—that in  the
Neapolitan vicinity,  as well  as throughout Italy  and Spain,
there are more insane men than insane women. 
79
  The mortality during the  period  mentioned was about one
in four, or 25 per centum; and  the  principal diseases causing
death were  febrile  exanthematae, dry gangrene, and cachectic
diseases.

             ASYLUM AT GRAND CAIRO, EGYPT.

  The following interesting account of a visit to this Asylum
is from Dr.  Madden's "Travels in Turkey."
   "I believe  that  no  eye hath witnessed,  elsewhere,  such  a
melancholy spectacle as this place affords.   The keeper made
many objections to my admission;  he said  no Frank was suf-
fered  to go in, but the name of the hakkim of the English
Consul, and the sight of half-a-dozen piastres to boot, removed
 his scruples.
   "I was led from one passage to another, door after door was
 unbarred, the keeper  armed himself with a courbash, a whip
 made of one solid thong of  the hippopotamus, and we at length
 o-ot into an open court, round which the dungeons of the luna-
 tics were situated.  Some who were not violent were walking,
 unfettered; but the poor wretches in the cells were chained, by
 the neck, to the bars of the grated windows. The keeper went
  round, as he would in a menagerie of wild beasts, rattling the
  chain at the window, to rouse the  inmates,  and dragging them
  by it when they were tardy in approaching.   One madman,
  who spat at me as I passed his cell, I  saw the keeper pull  by
  his chain, and knock his  head against the bars till the blood
  issued from his nose.  I forced him to desist.  Each of them,
  as we passed, called out for food.   I  enquired about their  al-
  lowance, and, to my horror, I heard that there was none except
  what charitable people were pleased to afford, from day to day.
  It was now noon, and they had had no food from the prece-
  ding mornino-.  Two well dressed Turkish women brought in,
  while I was "there, a large  water-melon and two cakes of bread;
  this was broken in pieces and thrown to the famished creatures
  I never saw nature subdued to such lowliness. They devoured
  what they got like hungry tigers, some of them thrusting their
  tongues through the  bars,  others screaming for more bread.  I 
80
 sent for a few piastres worth of bread, dates and sour milk;  its
 arrival was hailed with a yell of extasy that pierced the very
 soul.   I thought that they would have torn down the iron bars
 to get at the provisions; and in spite of the courbash, their
 eagerness to get their portions rendered it a difficult matter to
 get our hands out  of their clutches.  It was humiliating to
 humanity to see these poor wretches tearing their  food  with
 their  filthy fingers.   Some of their  nails were so long as to
 resemble the  talons  of a hawk.
   "And can such be the condition of 'man, so noble in reason,
 so infinite in  faculties, in form and movement so express and
 amiable!'  Vain boast!   Go, paint the faculties of this 'paragon
 of animals' in the dungeons I have described; and when you
 have  studied  the institutions of the Turk,  sit down, if you
 can, with an exalted opinion of human nature.
  "There was one thing that  I could not help remarking; the
 ruling passion of the Mahometan, as preserved even in insanity.
 One man, who begged  me to give him  bread, spat upon  me
 when he got it; another, with all the eagerness of famine, ab-
 stained from eating  it; hungry as he was, he  preferred flinging
 the portion of melon he had just received at a christian's head,
 rather than  satisfy  his  craving  stomach.  He  concealed  his
 missile for nearly a  quarter of an hour, till I was opposite  his
 window,  he  then  thrust his naked arm  through the bars and
 took deliberate aim  at me.  In  spite of  my entreaties he got
 the courbash around his  uncovered shoulders.  But  there was
 one old man who  moved not  while the food was distributing;
 and as I  looked into  his  cell, destitute of every thing, with
 neither straw nor rug, I  could barely distinguish an emaciated
form lying on the bare earth, with hardly a rag upon his body.
He could not lie down altogether, for he was chained by the
neck to the window. He was worn to a skeleton; and whether
it was the pressure of the  chain that impeded respiration,  or
 not, I cannot  say,  but his stentorious  breathing resembled that
of a person in the last convulsions; and, on enquiry, I found
this wretched  creature to be actually dying.  The  smell of the
 apartment was horrible.   I had some difficulty to prevail on
 the keeper to take off his chain;  I gave some piastres to  buy 
                            81

straw, and some days afterwards sent the janizary to enquire
after the poor wretch:—he was dead, and there was no straw
to be seen in his dungeon.
  "I observed a very decent looking Turk, in one of the cells,
who had been an officer in the pasha's troops. He complained
bitterly of hard usage, and said  he was famished; some days
he had only five para's worth of bread, or a half-penny's worth,
and he talked altogether so  rationally of his condition, that  I
expressed my wonder to the  keeper that he was not permitted
to go abroad.  The keeper laughed at my ignorance.  -You
don't know,' said he, 'that when mad people appear most.
quiet they are always plotting mischief.'   He  illu.strated his
assertion by a story  which,  if credible, certainly shewed  the
necessity of confining lunatics, however mild in their appear-
ance, to the cells at night.
   "A  black man,  who followed the trade of a butcher,  had
been confined there many years ago; he had been allowed the
range of the house, with two or three  others whose derange-
 ment was attended with no violence.   One night the black
 butcher secreted a  knife: he induced another man to enter his
 cell, prevailed on  him to  lie down, and  then cut his throat;
 he calmly cut him  in quarters, and distributed the joints around
 his cell, as he was in the  habit of arranging his meat  in his
 shop.   He solicited the custom of his  comrades, and to those
 who were  chained, he carried such portions as they desired.
 The keeper was disturbed by the cannibal  rejoicings; it was the
 first full meal  they had had for many a long day.  On examin-
 ing the cells, he found one man missing.   He asked the black
 butcher if he  had seen him, and  he replied that he  had  sold
 the last joint of him.  'Since that time,' said the keeper, 'we
 look out better, otherwise they would  eat one every day
    «I endeavoured to ascertain the cause of the madness of the
 present inmates.   They were thirteen in number, and all males.
 Four of them had gone mad from smoking hachs,*n in oxi-
 catin. drug, composed of the small pistils of the flax plant;
 five of them had had poison administered to them; three  were
  religious  monomaniac fanatics,  and one  had gone mad  after
  being  bastinadoed. 
82
         ASYLUMS IN THE EAST INDIES.

  It appears that previous to ISIS there were hospitals for the
insane  in the British East Indies, but they were very badly
conducted.   In  the  year mentioned, an improvement was
made, by placing at the head of each  an  experienced  British
physician.  These asylums are under  the general supervision
of the judges of the circuit courts; but the immediate govern-
ment of each is confined to the  magistrates of  the district  in
which it is situated.   The asylums are all built at the expense
of government   The following are in Bengal:

                  ASYLUM AT CALCUTTA.

  The  average number of patients in this establishment is 170.
During the year 1820, the number of admissions  was 110,
cures 73, deaths 21.

                    ASYLUM AT DACCA.

  The average number of  patients at this asylum is 36.  The
admissions, in 1S20, were 32,  cures 11, deaths 8.

                ASYLUM AT MOORSHEDABAD.

  In 1820, the number of admissions was 68, that of discharges
6S.  The average number of patients  is 55, the average annual
number of deaths 9.

                    ASYLUM AT PATNA.

  There were 11 admissions,  12 discharges, and 2  deaths at
this institution in 1820.   The average number of inmates is 45.

                   ASYLUM AT BENARES.

   The number admitted to this asylum  in 1820 was  31, that
of discharges 9, of deaths 12.   Average number of patients 75. 
83
ASYLUM AT BAREILLY.
  In 1820, 48 patients were admitted, 29 discharged, and 10
died.   The average number of patients is 100.

  Within the government of the presidency of Fort George,
there are, at least, four asylums for the insane.  These are at
Madras, Chittoor, Trichonoply, and Masulipatam.   Of these
we have  no  statistics; but that at Madras,  it is  said,  "sur-
passes many of the  European establishments that have  long
been  considered as the most perfect of their kind."  Within
the government of Bombay, but one asylum is mentioned.  It
is at Colabah.

ASYLUMS IN THE UNITED STATES OF AMERICA.

   The institutions for the insane in this country may properly
be arranged  in four  several classes.  1st.  State Asylums.  2d.
City Asylums.   3d.  Institutions founded by subscriptions, and
under the care of a board of managers.  These may be  desig-
nated Corporate  Asylums.   4th. Private Asylums, or  those
belonging each to one or two persons.   These institutions will
be designated here by the name by which  they are generally
 known.

                     STATE ASYLUMS.

            MAINE INSANE HOSPITAL AT AUGUSTA.
           Cyrus Knapp, M. D., Superintendent.
           Chauncey Booth, Jun., M. D., Assistant Physician.
    This Asylum  was but  recently completed.  It went into
  operation October  14th, 1840.  The farm contains seventy
  acres   The edifice consists of a central building and wings,
  and will accommodate 120 patients.   It is  pleasantly situated,
  upon the eastern shore of the Kennebeck river.  Although a
  state institution, two benevolent individuals contributed ten
  thousand dollars each towards its foundation. 
84
   The first annual report of the directors of this Asylum has
very recently  been published.  From this, it  appears that,
from the time of opening to the close of the year 1840, a period
of two and a  half months, 30 patients were  admitted.   Of
these,22 were  men and 8 women;  22 were old cases, or those
of more than one year in  duration, and 8 were  recent, or of
less  than one year in duration.
  Religious Worship.—Evening prayers are held  regularly,
and  attended by most of the patients.  Weekly religious exer-
cises, on the Sabbath, are about to be introduced.
  Labour.—Many of the men cut  wood, and work at carpen-
try and other kinds of labour.  A portion of the women are
engaged in domestic occupations.
  Amusements.—Nothing is said,  in  the report, in regard to
these, excepting the remark that many of the patients are fond
of reading.

  NEWHAMPSHIRE STATE LUNATIC ASYLUM AT PORTSMOUTH.

  An appropriation for this institution has been  made by the
legislature  of  the state, and its location determined  upon.
Measures have  been taken  for the prosecution of  the enter-
prise; and George Chandler, M.  D., assistant physician to the
Massachusetts  State  Lunatic Hospital, has been invited  to
superintend the erection of the buildings, with a prospect of
taking charge of the institution when it shall go into operation.


   VERMONT ASYLUM FOR THE INSANE AT BRATTLEBORO.

          William H. Rockwell, M. B., Superintendent.
          Chauncey Booth, Jan., M. D., Assistant Physician.

  This  Asylum  can  accommodate about 100  patients.  Its
fourth annual report, that for 1840, has recently appeared.
  During the year ending October 1st,  1840, 73 patients were

  * In the report, for 1840, of both this Asylum and that at Augusta, Maine,
the name of this gentleman appears as assistant physician. 
85
admitted and 61 discharged, including deaths.  Of this number,
33 were  cured and 6 died.   Remaining in the Asylum, at the
close of the year, 80.
  During the year ending October 1st, 1839, the  number dis-
charged was 38, cured 25.   The whole number of admissions,
from the time of opening to October  1st,  1S40, is  239; the
number of deaths 11.

The recoveries, in  1840,  of  all cases dis-}  54      cent
     charged, equalled                      S
charged, equalled
     a       a        i
than one year's standing,
of less £ SS2

ofmore 128.5
than one year's standing,
     "       of all cases discharged since 7  56  3
the commencement,                    5
     "       "        "       of less ">  gg
than one year's standing,               S
     a       «        "       ofmore"
than one year's standing,
28.2
  Religious  Worship.— Religious  exercises are  regularly
performed, and have been found beneficial.
  Labour.—Those of the  men  patients whose condition will
admit are employed "in the garden, on the farm, and about the
premises."   The women are engaged  in needlework and do-
mestic duties.
  Amusements.—The patients are furnished with the means
.of diversion  and relaxation in walking, riding, fishing, reading,
writing, drawing, painting, playing on the  piano, and at the
games  of  ball,  quoits, cards, chess, backgammon, draughts,
dominoes, battledoor and graces.

 ' MASSACHUSETTS STATE LUNATIC HOSPITAL AT WORCESTER.

             Samuel B. Woodward, M. D., Superintendent.
             George Chandler, M. D., Assistant Physician.
  The buildings of this institution are situated upon the sum-
mit of an  eminence commanding a beautiful view of the vil-
lage of Worcester,  and of the surrounding country.   The
8 
86
principal edifice originally consisted of a centre building, 76
by 40 feet, and four stories in height, and two wings, each 90
feet long in front and 100 in the rear, 36 feet wide and three
stories high.  "The front of the centre building  projects 22
feet forward of the wings.   The wings, being  36 feet wide,
half their width, or 18 feet, joins upon the centre building;
the other half falls in its rear."  By this arrangement, light is
freely admitted, and the means of thorough ventilation secured
to the  central galleries of the wings.   This edifice furnished
accommodations for 120 patients.  Being found inadequate to
the demands, two additional wings have been  erected, one at
either extremity of the original wings, touching the rear corners
of the latter and receding at right angles  from them.   The
squares thus left at the adjoining  extremities of  the old and
the new  wings is  occupied  by verandahs, of equal height
with the wings, which are used  as promenades by  the patients
of the  several wards.  The accommodations are thus rendered
sufficient for from 230  to 240 patients.  The first admission
into  this Asylum was on the 19th of January, 1833.   From
that time to the 30th November, 1840, the  number of admis-
sions  was 1196; of which  637 were men  and  559 women.
The number of discharges was 960,  being  515 men and 445
women.   The results of their treatment may be learned from
the following table:

                V
                t-
                V
                >
                o
                CJ
                V
                Pi
       Men,    247
       Women, 259
Q
54
36
w
Total,    506    175     185     90    4     960 
87
	<	Q	tf	P
Men,	75	68	28	6
Women,	87	87	54	9
  The statistics for the year ending November 30th, 1840, are
as follows:
                                      p      5     <u JE
                                                   122
                                                   114

  Total,    162    155     82   15     29     29     236

  The average number in the Asylum during the year was
229; the greatest number 245.   Of the 155 cases discharged,
70 were recent, or of a duration less than one year.   Of these,
64 recovered, 2 improved and 4 died.  The remaining 85 were
of longer duration than one year.  Of these, 18 recovered, 26
improved, 14 were harmless, and  15 were sent to places of
security for want of room.

Of all the recent cases which have been discharged
   from this Asylum,  the average of recoveries is  87.25 p. ct.
Of the same, discharged last year,    "       "    91.25
Of all the old cases,                "       "    19-50   "
Of those discharged last year,       "       "    22.50
Of all the cases, both recent and old, "       "    52.00   "
The same during last year,         "       "   53-00
Of all the cases discharged, the average of deaths is   7.50
The same during last year,                 "    3-'5
445 patients were married,    -     -     -       37-50
751  do   including widowers and widows, were
    .     '                     ...    -  62.50  "
   single,     -
   We are indebted, for the above  statistics, to the intelligent
and accomplished superintendent of the hospital under notice.
 His eighth report, from which these are extracted, is now in
 press, and will soon be published.
   The following statistics are condensed from  his seventh
 annual report, made  for the year ending ISov. 30th, 1839  at
 which time  1034 patients had been admitted into the  hospital.
 and S05 discharged therefrom. 
88
  Species of Insanity.—Mania, 533; melancholia,  304; de-
mentia, 146; idiots, 8; unclassified, 43.  Total, 1034.
Age of patients when admitted.
03 JO	„ d gco o o ti —	d o	d o o	d o	d o	d oc o	3
I—1 <N		o CO	o	o	o to	o	H
62	260	298	210	104	73	29	1026
  Civil State.—Single, 558; married, 374; widows, 63; wi-
dowers, 39.
  Causes of Insanity.—Intemperance,—men, 151;  women,
20; total,  171:  ill-health,  154;  masturbation, 97;  domestic
afflictions,  107;  religious,  78;  loss  of property,  fear of po-
verty,  &c, 68; disappointed affection,  47; disappointed ambi-
tion, 27; epilepsy,  34; puerperal, 24; injuries  of the head,
12; abuse of snuff and  tobacco,  6.
  Arising from physical causes, 498; from moral causes, 324.
  Hereditary, or having insane ancestors or near kindred, 311.
  Periodical, 188; homicidal, 18; actual homicides, 13.
  Suicidal,  or having  a strong propensity to self-destruction,
125; actual suicides, 5.
  Of 544 cases examined,  275 have dark complexions, hair
and eyes, and 262 light complexions, hair and eyes.
  Of 165 periodical cases, 103 were  caused by intemperance.
  Profession and Occupation.—Farmers, 124; labourers, 97;
shoemakers, 42;  seamen, 40; merchants, 33;  carpenters, 27;
manufacturers, 26;  teachers, 23;  blacksmiths,  13; printers,
13; students, 11; tailors, 9; machinists, 8; clothiers, 6;  pain-
ters, 4; millers,  4;  coopers, 4; paper-makers, 3;  calico-prin-
ters, 3; cabinet-makers, 3;  clergymen, 4;  sail-makers, 3; tan-
ners,  3; bakers,  3; inn-keepers,  2;  stevedores, 2; stone-cut-
ters, 2; comb-makers,  3; musicians, 3;  turners, 3;  harness-
makers,  3; pedlars, 4; physicians, 2;  broom-makers, 2; cop-
persmiths, 2;  coachmen, 3;  butchers, 2;  currier, 1;  brick-
layers, 3; lawyer, 1; jewellers, 2; watchmen, 2;  drovers, 2;
news-collector, 1; rope-maker, 1; engineer, 1; hatter, 1; gar-
dener,  1;  idiots, 9;  vagrants, 28. 
89
  Women unaccustomed to labour, 92; women accustomed to
sedentary employments that  are  laborious,  and to factory
labour,  72;  women accustomed to active  employment,  the
wives and daughters of farmers, mechanics, &.c, 128.  Many
not classified.
  Religious Worship.—A  chaplain  is connected  with  the
hospital, and services are  regularly performed, twice every
Sabbath, in a  neat and commodious chapel erected for the
purpose.
  The meetings are generally attended by from two-thirds to
three-fourths of  all the patients.   The seventh report says
"four-fifths of the patients who  have been in the hospital
during the last year, have attended—and most  of them  very
regularly.   The  congregation  varies from 175 to 200  and
upwards.   The experience of each  day,  strongly  impresses
us  with the benefit of these religious services."
   Labour.—In no institution for the  insane has manual labour
 been more  extensively introduced as a part of Ihe moral treat-
 ment, and  in  no  one has its utility  been  more satisfactorily
 demonstrated.   The men are employed in almost every de-
 partment of gardening and farming, and some of them work at
 shoemaking.   The women are engaged in sewing, knitting,
 and domestic duties.
    The following  list exhibits the number employed in 1839,
 together with  their occupations.

                 Men.
    Agriculture and horticulture, 40
    Shoemakers,                  8
    In the kitchen,                5
    Washer,
    Woodsawyers,               16
    Mason-tenders,               3

                                73
      Women.
Knitters,          60
Seamstresses,      32
Washers,           4
In the kitchen,      4
In the laundry,     6

                 106
                  73
Engaged in manual labour during the year,
    8*
179 
90
  Amusements.—Walking, riding,  the swing, draughts, and
some other games, afford amusement and recreation. A library
of nearly  two hundred  volumes belongs to the  institution,
and is much used  by the patients.   Tea-parties  are given by
the matron, weekly or semi-monthly, and  a  large  dancing
party assembles three or four times a year.   Many of the men
are permitted to walk  where they please, generally going  in
companies  of from five to twenty.   In 1839, no less  than 93
were indulged abroad without an attendant.

   NEW YORK STATE ASYLUM FOR THE INSANE, AT UTICA.

  This  Asylum is now  in progress  of  erection.  It is "to
consist of four buildings, of three stories and a  basement, the
principal front to  have the main building carried up an addi-
tional story, to be located at right angles to each other, facing
outwards, and to be connected, at the angles, by verandahs of
open  lattice-work, the whole  enclosing  an octagonal area."
Each of the four  buildings is  to be 446 feet in length, by 48
in width.  That  which  forms the principal front is nearly
completed.   When finished, this institution will be by far the
most extensive in the United States.   The estimated  cost  of
the buildings, is $431,636.

   MARYLAND HOSPITAL FOR THE INSANE, AT BALTIMORE.

           William Fisher, M. D., Medical Superintendent.

  This  Asylum  is situated about half a mile eastwardly from
the city of  Baltimore, upon an eminence which commands  a
beautiful view of the city and the surrounding country, inclu-
ding the Patapsco river and Chesapeake Bay.
  Originally a general hospital, it was first exclusively  devoted
to the insane in 1839.  It has been recently enlarged,  making
its accommodations  sufficient  for  150 patients.   It  has ten
acres of land.
  The present number of  patients is 56.  The whole  number 
91
under care from January 1st, 1835, to January 1st, 1841, was
393.
  Results of  treatment.
T3 CD CJ		lb is		.3 &• « O	
O	o s>		■d		2
	3 o <5 p-	Q «	QJ Q		o
135	75	106	34	43	393
  A large majority of the cases were of more than one year's
duration.
  The female department of this  institution is under the im-
mediate care of the "Sisters of Charity."
  Divine worship on the Sabbath has been introduced "with
good effect."
  Labour.—Gardening, carpenter's work, and various domes-
tic employments.
  Amusements.—Walking, riding,  fishing, reading, and  play-
ing at quoits, chess, backgammon and draughts.

       WESTERN LUNATIC ASYLUM, AT STAUNTON, VA.
             Francis T. Stribling, M. D., Superintendent.

  This is a  state institution.  The building, which possesses no
inconsiderable architectural beauty, is situated upon an emi-
nence, commanding a view of the surrounding country.   The
farm contains 65 acres.  The Asylum went into operation July
lst, 1828.   From that time to July 1st, 1836, a period of eight
years, there were 79 admissions and 13 cures. From July 1st,
1836, to November 1st, 1839, the  number admitted was 7S;
cured  34.   Of the 78 admissions, but 30 were recent cases,  or
those of less than one year in duration.  Of the recent cases 25
were cured, which, exclusive of deaths and  removals, is equi-
valent to 83 per cent.
  Religious worship, at  regular periods, has not been  intro-
duced.
  Labour.— The men patients are employed in tillage, fencing,
cutting wood, excavating earth, &c.  The work thus performed
bv  them, in 1839, would have cost, if paid for at the current 
92
prices  of labour, about  $600.   The females knit, sew,  and
engage, to some extent, in domestic duties.
  Amusements.—A library of 300  volumes, horses and  car-
riage, a piano, violins, flutes, cards, balls, backgammon, draughts,
graces  and battledoor furnish means for amusement and recrea-
tion.

       ASYLUM FOR THE INSANE AT WILLIAMSBURG, VA.

             Philip J. Barziza, Esq., Superintendent.

  This Asylum is also under the care of the state.  It is one
of the  oldest institutions of the kind in the country, having
been established before the revolution.  When the British and
American armies were near Yorktown, the buildings, having
been temporarily vacated by the insane, were used as barracks
and a hospital for the sick and  wounded.  We have seen  no
report  and  no  statistics of this establishment, excepting the
statement that,  in 1838, the number  of patients was about 80.

            OHIO LUNATIC ASYLUM AT COLUMBUS.

            William M. Awl, M. D., Superintendent.
            Samuel M. Smith, M. D., Assistant Physician.

  This Asylum was opened November 30th, 1838. It is con-
structed on  the  plan of the original edifice of the Massachu-
setts State Lunatic Hospital; it cost about $40,000.   Thirty
acres of land, which constitutes the  farm, were  purchased at
the additional expense of 1980 dollars.
  The  number  of admissions, from  the time of opening to
November 13th, 1840,  was 258.   Of these, 140  were males
and 118 females; S8 were recent cases, or those of less dura-
tion than one year, and  170  were old cases.   Of the  patients,
135 were single, 100 married, 17 widows and 6 widowers.
  During the  same period  120 have been  discharged, 69 of
them being  recent, and 51 old  cases.  The average  number,
during the last year, was 131, and  138 remained in the house
at the expiration of that year.
  Species of Insanity.—Mania 170, melancholia  38, epileptic 
93
mania 20, homicidial mania 4, moral insanity 11, dementia 12,
idiocy  or imbecility 3.   Total, 258.
   Profession and occupation.—Labourers 24, millwrights 2,
wagon-makers 2, miller 1, surveyor 1, mason 1, carpenters 8,
students 3, tailors 4, merchants 2, cooper 1, collier 1, potter 1,
engineer 1, farmers 47, blacksmiths 6, tobacconist 1, printers
3, teachers 4, brewers 2, shoemakers 5, lawyers 3, saddlers 1,
weaver 1, clerks 4,  preachers 8, musicians 1, sea captain 1.
   Causes of Insanity.—Intemperance 18, domestic  affliction
10, puerperal 22, ill health 23, loss of friends 5, matrimonial
perplexities  10, indulgence of temper 1, fright 3, political ex-
citement 1, seduction  1, intense application 4, jealousy 2, dis-
appointed love 10, epilepsy 17, excessive joy  1, injuries of the
head 5, excessive use  of snuff 1, constitutional 15, disappoint-
ment and mortification 16, masturbation 17, fear of  want and
loss of property 7,  ill treatment from parents or guardians 6,
religious 29, unknown 34.
   Religious worship.—Evening  exercises of family worship
 are regularly performed, at which from 30 to 40 patients usually
 attend.  A  sermon is read on the Sabbath.
   Labour.—The men patients labour in "clearing up the pre-
 mises," grading and levelling the grounds, gardening, preparing
 fuel and taking care of the stock.   The making and mending
 of the clothing of the indigent patients, and the washing and
 ironing for  all the inmates of the  house are mostly  performed
 by the women.
   Amusements.— The patients walk in  parties accompanied
 by an attendant; a tea-party is made weekly; dancing parties
 more rarely; books and stationary are  distributed to such as
 wish, and  some  of the usual games, both  within  doors and
 without, are resorted  to.  "The  4th  of  July" is  duly cele-
 brated, and the annual election, for the choice of state officers.
 is held with scrupulous regularity.

          KENTUCKY LUNATIC ASYLUM AT  LEXINGTON.

                      John Catherwood, Keeper.
This institution  has  been in  operation about si 
94
It has no resident physician.  From the time of opening to the
close of the year  1838, the number of admissions was 690,
discharges  301, deaths, 297.   Remaining  January  1st, 1839,
122, of whom 54 were men and  118 women.   At the time of
the prevalence of the Asiatic cholera, 43 of the patients died
of that disease.
  The statistics of the first fourteen years of the operations of
this Asylum are as follows:
                                     Per cent.    Per cent.
           Admitted. Discharged.  Died, of discharges,  of deaths.
     Men     420    218    155    51.90      36.90
     Women,  207      58      83    28.01      40.09

      Total,   627    276    238    44.10      37.95
  The number of  cures is not stated in the reports.   Of the
627 patients included in the table, 118  were idiots and epilep-
tics, all of  whom have died.  Deducting this number from the
admissions and  the  deaths, the  per centage of  deaths will  be
23.57, or 1 in 4.24, and that of discharges 54.22, or 1 in 1.84.
                                Men.     Women.  Both sexes.
P.ct. of deaths, 1838, of old cases  12.50    16.36     14.56
               "    recent "     9.52    21.42     14.22
P. ct. of discharges, of old  "    10.41      1.81      5.82
              "      recent "    71.42    28.57     54.28
   The reports  give  no  information  in regard  to religious
worship, labour and amusements.

   Active exertions are being made for the establishment of
State Asylums for the insane in  Connecticut, New Jersey and
Pennsylvania; and during the present session  of Congress,  a
bill has been passed  for the foundation of one  in the District
of Columbia.

           SOUTH CAROLINA ASYLUM AT COLUMBIA.

   The state has appropriated 100,000 dollars to this institution.
Nothing further than this can be said in regard to it, from want
of data. 
95
            TENNESSEE ASYLUM AT NASHVILLE.
              James Overton, M. D., Superintendent.
  No information has been received from this institution since
it  went  into operation.   In  1838, the central building was
completed and the wings in progress.

                     CITY ASYLUMS.

                BOSTON LUNATIC HOSPITAL.
               John S. Butler, M. D., Superintendent.
   This institution is for the insane poor of the city of Boston,
 Massachusetts.   It is  situated in  South  Boston, on a spot
 which commands a prospect of the city and its beautiful har-
 bour.   The  edifice consists of a central building and wings,
 the whole being 160 feet in length.   The expense of construc-
 tion was about  32,000  dollars.
   This Asylum was opened for patients December 11th, 1839,
 and in the first  report, which appeared a few months since, the
 statistics are made out to July 1st, 1840.   During the period
 included between these  dates, 104 patients were admitted, of
 whom  57 were men, and  47 women.  Ten of  them were of
 less duration than one  year, and 94 were  of longer duration.
 Of the 10 recent  cases, 4  were discharged, well, and 1 died.
 Of the 94 old cases, 10 were discharged stationary, 1 recovered,
 and 1  died.  On the 1st of July,  1840, S7 patients remained in
 the Asylum.
    A large  proportion  of the  cases  herein  reported were of
 maay years standing, the patients enjoying very good general

   ^ReKo-ious 0Wh>.-Family worship has been introduced,
  and continued  every evening, and religious  services are gene-
  rally performed  on the afternoon of the Sabbath.  The average
  number of patients who attend is more than forty
     Labour -"Our male patients," says the report, "assist much
  in the out-door work of the hospital, though we have to regret 
96
that we have so little opportunity of giving them constant and
regular employment."
  Amusements.—The report says  nothing upon this subject,
except acknowledging the receipt of several donations of books
and tracts, and remarking that they are received "with eager-
ness" by the patients.

                NEW YORK PAUPER ASYLUM.

  This institution, founded by the city of New York, is situated
upon Blackwell's island.  It is  intended, when  complete, to
accommodate about 400 patients.
  That portion which was finished was opened for the recep-
tion  of patients about a year and a half since.   On the 1st of
February 1840, the number of patients was, men 100, women
110—total 210.  Nearly all of these were removed  from the
almshouse at Bellevue.

                 CORPORATE ASYLUMS.

      M'LEAN ASYLUM,  CHARLESTOWN, MASSACHUSETTS.
              Luther V. Bell, M. D., Superintendent.
  This institution is connected with the Massachusetts General
Hospital, and was opened more  than twenty years since.  It
is one of the most complete, handsomely furnished  and suc-
cessful asylums in the country.  It can accommodate about 120
patients.   We regret not to be able to present its full statistics.
From the report for 1839 we glean the following:
  Remaining at the commencement of the year,    .     93.
  Admitted during the year,.....132.
  Total enjoying the benefits of the Asylum, in 1839, 225.
  Discharged during the year,    .    .     .     .117.
Remaining at the close of the year,
Recovered,     ....
Improved,     ....
Stationary,     ....
Died,.....
108.
 90.
 22.
 16.
 10. 
97
  The per cent, of deaths of all the inmates was, in 1835, 6.1;
in 1S36, 5.5; in 1837,4.2; in 1838, 5.4; in 1839, 4.4.
  The number admitted, during sixteen successive years, was,
of men  652, women 443—total 1095.
   Religious  Worship.—Daily devotional  exercises  are per-
formed in the evening, and such of the patients as are suitable
are permitted to attend the neighbouring churches on the Sab-
bath.   From one half to  three-fourths of  the  patients  attend
the former, and of those who avail themselves of the  latter,
the average number is about 30.
   Labour.—The men work in  the garden, on the farm, and
in a large carpenter's shop.   During the year 1836, 50 "worked
in the carpenter's shop, six hours per  day, and were employed
 151 days;" they made 7236 boxes, which sold for $907 06 cts.
Several years since, a sewing society was established among the
women, which is, undoubtedly, still continued. The avails of
their labour, during the  first eighteen months, was $112 96 cts.
   Amusements.—The  usual  games  are introduced; dancing
 and tea-parties are  occasionally  made, and a library of a few
 hundred volumes is devoted to the use of the patients.
          CONNECTICUT RETREAT FOR THE INSANE.

             Amariah Brigham, M. D., Superintendent.

  This Asylum is pleasantly situated, about one mile from the
city of Hartford.   It is upon a gentle elevation of ground, and
commands a fine prospect of the cultivated  country by which
it is surrounded.   It was opened  in April 1S24, with accom-
modations for 60 patients.  In 1831, it was sufficiently enlarged
to accommodate  100.
  This  institution  has enjoyed a high reputation, which, we
doubt not, will be fully maintained by the present accomplished
superintendent, who has but recently entered upon his duties.
  From the sixteenth report,  not long since published, we
extract  the following  table, exhibiting the annual number of
       9 
98
admissions, recoveries and  deaths, from  the  opening of the
Retreat.
                             Recent cases Recent cases
Years.	Admitted.	Cured.	admitted.	cured.	Deaths.
1824-5	44	10	12	6	1
1825-6	33	16	16	13	1
1826-7	37	24	23	22	0
1827-8	40	27	25	22	4
1828-9	42	26	20	19	2
1829-30	51	28	25	23	0
1830-1	53	32	25	23	1
1831-2	80	46	42	38	6
1832-3	68	37	30	28	4
1833-4	72	43	33	32	3
1834-5	72	36	36	28	6
1835-6	73	42	35	29	6
1836-7	91	55	60	48	6
1837-8	67	42	41	35	10
1838-9	94	49	61	45	8
1839	84	50	53	40	2
    Total,    1001      563      537       451        60

  Religious Worship.—At  this Asylum they have prayers
every evening, and religious service on the Sabbath, conducted
by a regular chaplain.
  Labour and Amusements.—The reports before us contain
nothing upon these subjects.

                 BLOOMINGDALE ASYLUM.

            William Wilson, M. D., Resident Physician.

  The Bloomingdale Asylum is one of the  finest institutions
of the kind in the United States.   It is beautifully  situated, a
few miles from New York city, and has extensive and well
cultivated grounds.  It commenced operations in 1821.
  From the reports of 1S31, 1832, 1834, 1835 and 1838, we
have obtained the following statistics.  During those five years,
there were 631 patients admitted, of whom 405 were men and
266 women.   The number of recent  cases was, of men, 213;
women, 111; total, 324: that of old cases, men, 192; women,
115; total, 307. 
99
The results of treatment were as follows:
	-a				>->	«-• C/i		
		a	Ct)					
	<u	'" *d	>		> JG	>■*?	T3	
	>	rP CU	O		o-e	O ,n	cu	
	o u	P o	cx,	-d		ss	o	rt
	cu	§ pL		Q	0< ■ -*	m —	s	£
Recent cases,	260	10	17	18	21		3	329
Old cases,	42	4	66	64	74	37	9	296
      Total,      302   14  83  82   95  37  12   625

  During the year 1839, the whole number in the asylum was,
men 154, women 97, total 251.  The number  admitted was,
men 69, women  44, total 133.   Of the admissions, the number
of cases of less duration than one year was, men  44, women
20, total 64;  that of cases of longer  duration than one year,
men 25, women 24, total 49.   Remaining, Jan.  1st,  1840,
men 74, women  52, total 126.
                        Recent cases.
               Recovered. Improved. Stationary. Died.   Total.
       Men,        37       2       0      4       43
       Women,     15       2       0      2       19
         Total,     52       4      0      6       62
                        Chronic cases.
                Recovered. Improved. Stationary. Died.   Total.
       Men,        13     13       6      5       37
       Women,      3     15       5      3       ^>

         Total,     16      28     11      8       63

   Whole number discharged, 125.
   Species of Insanity.-Of the 126 patients remaining at the
 close of the year in question, there were suffering under mania
 39, monomania  32, dementia 51, idiocy 4.
   Profession and Occupation.--Merchants  14, farmers 11,
 seamen 9, clerks 8, servants 6, milliners and dress-makers 5,
 lawyers 3, physicians 3, cabinet-makers  3, tailors  2, watch-
 makers 2, students 2, carpenters 2, teachers 2, saddler 1, cur-
 rier 1, inn-keeper 1, shoemaker 1, butcher 1, blacksmith 1, no
 occupation, chiefly females, 48. 
100
   Causes of Insanity.—Hereditary 20, intemperance 12, do-
 mestic trouble 10, pecuniary embarrassments 9, puerperal 8,
 fevers and  other  diseases 8,  disappointed affection 6, mental
 exertion 6, religious excitement 5, congenital 4, cerebral disease
 4, uterine disorders 3, masturbation 3, constitutional 3, injuries
 of the head 2, isolation 1, mortified pride 1,  remorse 1, anti-
 masonic excitement 1,  sudden wealth  1, unknown 20.
   Religious  Worship.—There is  one religious  service  each
 Sabbath, at which such of the patients as are  suitable, attend.
   Labour and Amusements.—The reports before us are silent
 upon these  subjects, but from the  character and reputation of
the institution, we presume it is not "behind  the age"  in re-
gard to the introduction of these among the patients.

                 PENNSYLVANIA HOSPITAL.

   A department of this extensive and useful  institution,  the
oldest of the  kind in the United  States, has always been  de-
voted to the insane.  The following table exhibits the number
of admissions, and  the results of treatment,  from  February
11th, 1752, to April 28th, 1832, a period of more than eighty
years.
-6 Si a <	■d 3 u	H3 CD S> CD co oi	> « o.S	T3 CO O W	73 CO 5	bu a ]3 '3 S cu Pi
2509	905	488	499	188	359	66
1209	384	292	264	42	171	60
3718	1289	780	763	230	530	126
  From April 28th, 1832, to April  28th, 1840, the number
admitted was 584; cured 191; died 72.
  Previous to the year 1823, the cases of mania a potu were
included with those of insanity.   Since that year they are not
included.
  Of 394 consecutive admissions, the ages of the patients was
as follows:— 
101
° 2
En m
   25   59  66  77  44   45  30  16  14   10  3  3  2

  Civil State.—Of 284 men, 170 were single, 97 married, and
17 widowers; and of 202  women, 70 were single, 97 married,
and 35 widows.
  The patients of this institution,  of whom there are  about
one hundred,  are  now being removed  to  the new Asylum,
west of the Schuylkill.

           ASYLUM AT FRANKFORD, PENNSYLVANIA.
             John C. Redmond, Superintendent.
             Charles Evans, M. D., Attending Physician.
             Pliny Earle, M. D., Resident Physician.
   This institution, generally called, in the reports, "The Asy-
 lum for the Relief of Persons  deprived of  the use of their
 Reason," is pleasantly situated, about six miles northerly from
 the city of Philadelphia.   The principal  edifice consists of a
 central building and wings, and, at the extremity of the latter,
 other buildings, called "lodges," intended for such patients as
 may be so noisy as to disturb the others.   The front formed
 by "these several portions is 322 feet S inches  in length.   The
 farm contains sixty-one  acres, which  is divided  into airing
 courts, and garden, tillage and woodland.   The airing courts
 and the grounds in front of the building are well shaded with
 large and  beautiful trees.
   This Asylum was opened in Fifth-month, (May,)  1817,
 and, for many years, was restricted exclusively to members of
 the Society of Friends.   In 1834, however,  it was opened to
 others, who still continue to be admitted.
   The number of admissions, from the time of opening to the
 close of the year 1838, a period of nearly 22 years, was 634.
 Of these,  331  were men, and 303 women.
    Civil State.-There  were, single, 326; married, 234; wi-
 dowers, 17;  widows, 57.
         9* 
102
Ages at the time of admission.
in	£>	©	d	d	©	©	d	© ©	
2 >>	- CO	«#	>n	o	t-	00	C5		
	is	o	o	o	O	o	o	o	o
&8	Ekoj	©	©	© in	© CO	i	© 00	o Ol	H
28	187	141	126	83	48	15	5	1	634
  Of the 634 patients, 507 were never readmitted.   The fol-
lowing table exhibits the results of their treatment:
Duration.		73 d	-6 CD o	CD >	■d CJ > o	c	'3 '3	
		a T3 <	Cfl CD		Ol a	02	a CD	■d CD s
Less than 1 year,		261	152	26	27	18	4	34
From 1 to 2 years,		57	18	8	8	9	7	7
" 2 " 3	i<	36	17	3	3	4	5	4
" 3 " 5	a	45	14	7	6	9	3	6
" 5 " 10	a	47	13	7	3	8	11	5
Over 10	(i	61	0	7	5	22	13	14
Total,		507	214	52	52	70	43	70
  During the year ending 1st of 3d month, (March,) 1840, the
number of admissions  was 54, that of discharges, including
deaths, 60.   Of the latter, 25 were restored, 5 much improved,
9 improved, 17 stationary, and 4 died.
  Religious Worship.—Those patients whose condition will
admit, assemble on Sabbath afternoons to hear a portion of
the Scriptures.   Some of them attend  meeting in the village
of Frankford.
  Labour.—During the warm season, many of the patients are
employed in gardening  and farming.  In winter, they work in
two shops, one devoted to basket-making, the other to carpen-
try.  They keep the reservoirs  in  the Asylum supplied with
water, throughout the  year.   It  is driven up  by a forcing
pump, operated by a crank.
  Amusements.—A grove of about twenty acres, at  one  ex-
tremity of which an enclosure of two acres  contains several
deer, and,  at the other,  a summer-house is erected amid 
103
romantic scenery, forms a pleasant place for rambling in sum-
mer.   Horses and a carriage are devoted to the use of the
patients, and the means are furnished for many of the games
mentioned in the notices of  other Asylums.   Tea-parties are
given occasionally, and lectures upon Natural Philosophy and
Chemistry are delivered, weekly,  during the  winter.  But the
sources of diversion most resorted to are, 1st, a circular rail-
way upon the lawn in front of the house, in a small  car upon
which two persons may  drive themselves, with great rapidity,
by means of a crank; and, 2d, a library.   A small building, at
the extremity of the garden, opposite the house, is devoted to
this purpose.  Externally, it is surrounded  with a corridor,
the pillars of which are  overgrown with honeysuckle.  With-
in, it is carpeted, and otherwise well furnished; upon the walls
are framed engravings;  two series of shelves  are supplied with
about 300 volumes of useful books; the whole  of one side of the
room  is occupied by a  cabinet of minerals,  shells, corals and
stuffed birds and  quadrupeds, while lemon and orange trees,
with a variety of flowers, give a delightful fragrance to the
air.  This retreat is much resorted to  by the patients,—the
women having the use of it during the forenoon, and the men
in the afternoon.

          PENNSYLVANIA HOSPITAL FOR THE  INSANE.

             Thomas S. Kirkbride, M. D., Superintendent.

   This Asylum is situated about two miles westwardly from
 the city of Philadelphia.  It is a splendid  establishment, no
 expense that would contribute to  the suitable accommodation
 of the patients  having been  spared in its erection.  A large
 farm is connected with it, about forty-two  acres of  which is
 surrounded  by a high stone wall.
   It is but about six weeks since the Asylum was opened.
 Nearly fifty of the patients formerly at the Pennsylvania Hos-
 pital, in the city of Philadelphia, have  been removed to this
 place, and  the  remainder will soon be  transferred.  The ac-
 commodations, when complete, will be sufficient for more than 
104
200.  Under the care of its intelligent and assiduous Superin-
tendent, this will, undoubtedly, become  one of the best insti-
tutions in the country.

                  PRIVATE ASYLUMS.

                HUDSON LUNATIC HOSPITAL.

  This institution was established by Drs. S. and G. H. White,
and is still continued under their supervision.  The following
are the statistics for 1838 and 1840.
  The whole number under care in 1838 was 98; of which 30
were recent cases, 65 chronic, and 3 intemperate.   The whole
number in 1840 was 84; of which 25 were recent, 54 chronic,
and 5 intemperate.
  Results of treatment in the cases discharged.

                       Recent cases.
1838,
1840,
     15
     14

Chronic cases.
s 5
S o
P
 1
 2
Intemperate.
1838,
1840,
27
10
£    02
15
 5
10
 2
Pi
 2
  Remaining, January 1st, 1839, 43; January 1st, 1841, 36.
  The whole number admitted from the opening of the insti-
tution to January 1st, 1841, is 503.
  Family worship  is continued  daily, and  with beneficial
effects upon the patients.   We have no information in regard
to labour and amusements. 
105
  There is a private Asylum  at Pepperell,  Massachusetts,
under the care of  Dr. Cutter, and another at  Cambridgeport,
in the same state, established by Dr. Chaplin, and continued,
since his decease, under the superintendence of his widow.

           ASYLUM AT MILLEDGEVILLE, GEORGIA.

   We know not under which of the above classes to place this
 institution; nor can we say anything in regard to its extent,
 organization or  success. 
 
OF THE
CAUSES, DURATION, TERMINATION AND MORAL
             TREATMENT OF INSANITY.
  The object in this essay is not to enter into an elaborate dis-
cussion of the subject of mental derangement, but to adduce
propositions heretofore  stated in regard to that  disease, and
subject them, as far as possible, to  the test of statistics, with a
view to the demonstration of their truth or falsity.   Besides
this, we wish  to illustrate  the  modern  mode  of  moral  treat-
ment, by examples adduced from various asylums, and to de-
monstrate the utility of that treatment, in its results, combined
with other remedial agents, upon the patients  subjected to  its
influence.
  Causes of Insanity.—These have, with evident propriety,
been divided into, first, those which predispose to the disease,
and secondly, those which excite it.
   1. Predisposing Causes.—Under this head we shall consider
the constitution, temperament and  complexion, age,  sex, civil
state and education.
  a The  state of the constitution is undoubtedly, in  many
instances, a most powerfully predisposing cause of some of the
forms  of  insanity.  A  peculiar organization  of  the cerebro-
spinal system, and, according to Dr. Rush, of the blood-vessels
also, an organization molecular in its nature, and consequently,
particularly in relation to the nervous system, inappreciable
by the senses, favours the  encroachment of the disease.   This
condition may be  hereditary, or may arise, de novo,\n a family 
108
 entirely free from the maniacal  taint.   The progress recently
 made and still making in transcendental anatomy, together
 with the great improvements in microscopes, may encourage
 us in the belief that we shall eventually be enabled to ascertain
 the nature of this, if we may use the  term, congenital lesion.
 We have abundant proofs that  this cause is  hereditary.   At
 the Pennsylvania Hospital, Philadelphia, application was made
 for the simultaneous  admission of three  lunatics, members of
 the same family.   One of the patients of the  Retreat for the
 Insane in Hartford, Connecticut, was the eleventh individual
 of his family who had suffered under an attack of mania.   M.
 Esquirol  says that hereditary transmission is more frequent
 among  the opulent than  in  other  classes of society.  Such
 children of maniacs as are born  before their parents become
 deranged, are less liable to inherit the predisposition than those
 who are born subsequently.   Children  whose parents are both
 maniacal, are more liable to the  disease  than  those of whom
 but one parent  is so.   According to Dr.  Barton, the children
 of persons in the decline of life are less subject to insanity than
 those whose parents are young.
  The following table exhibits the  proportion of patients, of
some of the asylums, in whom the disease was hereditary.
Asylums. No. of patients.	No. hereditary
Charenton, 1264	337
Richmond, Dublin, 608	13
Under care of W. C. Ellis, 1380	214
Massachusetts State, 1034	311
Ohio State, 311	15
  With regard to those under the care of Sir  W.  C. Ellis,
that author remarks, "If we had more complete information, I
have no doubt that the insanity would be found to have been
hereditary in a much greater number."   According  to Ellis,
"relatives by blood  intermarrying with each other, have a
progeny prone to insanity.  Why it is  so, I do  not  presume
to give an opinion; but of the fact I have no  doubt, not only
from what has come within my own knowledge, but from its 
109
having been particularly noticed by Dr. Spurzheim and others,
who have paid great attention to the subject: it cannot be too
generally known and guarded against."
   In many instances  the disease  manifests itself in several
individuals of the same family  at  nearly the  same age.  Dr.
Rush says that among the patients  in the Pennsylvania Hos-
pital, were a father and two sons, all of whom became deranged
between the ages of 60 and 70 years.   Two sons of a  merchant
in Switzerland died insane at the age of 19 years.  Dr. Prichard
mentions three other cases of a similar kind.  M. Esquirol be-
lieves that fright in the mother, during pregnancy, may excite
a strong predisposition to insanity in  the infant with which she
is pregnant.   Although there are  probably but few who will
concur with him in the opinion, it is  a point which, as being
thus spoken of by an individual  of so extensive observation, at
least merits attention.
   Discovered in early life,  the constitutional predisposition,
 whether inherent  or  not, may be  very  much checked in its
 progress, if not  entirely eradicated, by proper treatment.
   b Temperament and Complexion.—People of choleric and
 nervous temperaments are said  to be more liable  to the inva-
 sion of insanity than others; a predisposition which  is greatly
 fostered  in  those  who give a loose rein to their  passions.
 Haslam, Rush and some  others, believe dark-coloured  hair to
 be  indicative of a  maniacal  predisposition.  In Bethlehem
 Hospital, London, according to the former gentleman,  of 265
 patients, 205 had hair of  this colour;  and in the Pennsylvania
 Hospital, in 1S12, according to the latter, of 79 insane inmates,
 73 were of a similar description.  Of 544 patients  examined
 at the Massachusetts State Hospital, 275 had dark complexions,
 hair and eyes, and 269 light complexions, hair and eyes.  The
 per centage with regard  to  Bethlehem Hospital is  somewhat
 remarkable when we take into  consideration the large propor-
 tion of people  with light-coloured hair in England.   It would
 not be remarkable in France.   Dr. Prichard  can  trace a pre-
 disposition to no particular complexion.
   c Age.—The middle period of life is by far the most  prolific
 in cases of mental alienation; and this from the evident reason
         10 
110
that  both  males  and females are more  exposed, during that
portion of their existence, to the various exciting causes, than
they are in either early or advanced life.   Attacks in very
early life are extremely rare.   Dr. Rush mentions  four  cases
of the  kind which  came within his knowledge;  and in St.
Luke's Hospital, England,  there was an insane child of but
two years of age.   Dolseus, Greding and Rush mention in-
stances of attacks in very advanced life; the last mentioned
having observed  one which occurred in a person more than
80 years of age.
  The British and the European continental writers upon the
subject, generally, if not invariably, assert that more persons
are attacked between the ages of 3P and 40 years, than during
any other  interval of ten years in life.   This appears to  be
sustained by the  following  table of M.  Georget and Dr.  Bur-
rows.
      Hospitals.      £   t3   -0   t3   t3   Ti-d^g
                    °   S    £    a    B   SS5r:5
                   i2©©   ©   ©   ©    ©   x; >5
French & English, 4409 356  106 1416 361 461  174  35
French,           2507 140  465  572 521 350  265 189  6
           Total,  6916 496  571 1988  882 811 439 224

  The results exhibited by the following table, however, tend
to disprove the truth of the assertion.

                    _ ©  ©    ©   ©   d    d  z^  d
                    g c*  co    ■*   in   «o    p  »  ©    ^
fcin  ©   ©   ©   ©    ©  ©   ©
  rid   CO   ■*   iO    C£>l-00
65 329  380 236 130  53        1193
Bicetre, from 1784
  to 1793,

SaWUtol8M?  ]     3°6  259 144 205 115 66  23 "IS
Esquirol's private,      150   78  30   46  15   5   3  327
Total,       65 785  717 410 381  183 71  26 2638 
Ill
  Whether it be true or not in  regard to Europe, we believe
it to be untrue if applied to the United States.   This belief is
induced by the statistics of the table which follows.
	|S§		©		©	s	© ©		©	
			CO	-f	o to		L- X			
Asylums.	Time. | 2 o		o	o	o | o		o . o	2 P		rt
			©	©	© 1 ©		© p	© ©		c H 1036
			<N	CO	"*	in 104	73 29	X 1 CI		
Mass. State,	1833 to 1839; 62		260	298	210					
Virginia, at Staunton,	1 year,	8	25	33	24	10	3 1			104
Ohio State,	1839 & 1840,	11	108	66	41	26	5 1			258
Kentucky State,	1 vear,	8	39	24	10	5	2 1			89
M'Lean, Mass.,	15 years,	70	352	264	191	91	38j 9			1015
Retreat, Conn.	7 years,	19	107	73	54	20	6! 4			28b
Bloomingdale, N. Y.,	in 1839,	3	30	37	22	19	7i 1			12b
Frankford, Pa.,	1816 to 1838, 28		187	141	126	83	4815	5 1		b34
Pennsylvania,	1832, | 3		32 1140	29 965	27	33	12.12 194|73	2		138 4484
Total,	j 1212				705|391			7	1	
  By this it appears that a considerably larger number become
insane in the United States between the ages of 20 and 30, than
during any other period of equal length.   But the evidence of
this table is, to a certain extent, deceptive; the ages reckoned
are, in most of the cases, those of the patients at the time they
were  admitted into the several hospitals, and, in many others,
at a time when  they had been in  the hospitals  several years.
Now, could these be so  corrected as to state the age at the time
of the attack, the table would be of more value, and we should
have  more striking evidence of the fact in question.  But there
was no means by which that correction could in all instances
be made.   Wherever  the  means  did  exist, advantage was
taken of it, and the result'is as follows:
       Hospitals.

Retreat, Connecticut,
M'Lean, Massachusetts,
Massachusetts State,
£  2
2 11
1  7
36
30
*   S
22
21
22  11
11   8
Frankford, Pennsylvania, 4   9   32   16
- 35  127   99  70  33  15
Totals,
104
 80
384
 ?0
62  225  15S 112  59  24   8  643 
112
    The change effected by this correction is remarkably exem-
 plified in the cases at the Frankford Asylum.   As they were
 before alteration, the proportion of those  between 20 and 30
 years to those between 30 and 40 was as 9  to 7;  whereas, after
 being corrected, it is as 2 to 1.  In the total numbers previous
 to correction, those between the ages of 20  and 30 are to those
 between 30 and 40 nearly as 11 to  9; while in the same, after
 correction, the ratio is as 11 to 7.
   d Sex.—It was asserted by ancient  writers  that, in  their
 time, more males than females suffered under the various forms
 of mental derangement.   The reverse appears to be true in
 modern Europe.   Pinel  estimates that in France, in 1802, the
 ratio of insane females to males  was as 2 to 1.  In England it
 is far less.   At Bethlehem Hospital, agreeably to Dr. Haslam,
 of 8S74 patients, 4042 were males, and 4832 females.   At St.
 Luke's there were one-third more females than males.   M.
 Esquirol, from statistics  derived from several countries, con-
 cludes that the proportion "does not, in fact, greatly exceed
 the difference which exists between the  sexes in the ordinary
 state of population."  Judging of the proportionate number of
 the sexes insane in the United States from those confined  in
 the several hospitals, we  must conclude that there are  more
 men than women.   See the following table.

       Asylums.               Time.       Men.  Women. Total.
 Maine State,           2£ months, 1840,     22       8      30
 Massachusetts State,      1833 to 1840,     637    559   1196
 Va. State, Staunton,         in  1839,        56     48    104
 Ohio State,             1839 and 1840,    140    118    258
 Kentucky State,         1824 to 1838,     420    207    627
M'Lean, Massachusetts,    in 16 years,      652    443   1095
 Retreat, Connecticut,      "  9  "        183    199    382
Bloomingdale, N. Y.,                      607    302    909
Pennsylvania Hospital,     1752 to 1832,    2509   1209   3718
Frankford, Pa.,           1817  to 1838,     331    303    634

                               Total,   5557   3396   8953
  This makes the number of men to that of women as 5 is
3.   It can hardly be believed that  there would be  so  great 
113
predominance of men in the asylums, if there were not, in
reality, a greater  number of them  in the  country  who  are
insane.   There are reasons, however, for inducing the  belief
that the disproportion between the two sexes is not so great as
is represented by this table.  Yet it is thought that the evi-
dence  is  sufficiently  conclusive  in  warranting the assertion
that, in the United States, there are more  men  than women
suffering under mental alienation.  Should future observations
demonstrate the truth  of this proposition  in regard to  our
country, and its converse in  regard  to  continental Europe, to
what shall be attributed this  difference in the  two countries?
We believe the  causes of that difference will be chiefly found
in the difference of condition, of the men,  with regard to pe-
cuniary affairs, and that of women in  society.  But  it would
be  untimely to  enter into a discussion of this subject  before
the proposition in question be satisfactorily  demonstrated.
   Dr. Rush  believed that the number of insane women  is
 greater than that of insane men, from the fact that the former
 are exposed to several  exciting causes from which  the latter
 are exempt; such  are  the derangements  of the catamenia,
 utero-gestation, parturition, and the peculiar situation of their
 sex in society.  But, on the other hand, it will be found that a
 very large proportion of male lunatics are brought to that un-
 happy situation by causes from the influence of which females
 are either partially or wholly removed.   Among these  are in-
 temperance and pecuniary embarrassments.
   e Civil State.—Georget believes  celibacy to be a predis-
 posing cause of insanity.  S. Tuke,  also, considers it as among
 those which are the  most prominent  of this  class.   There is
 much plausibility in this opinion, even admitting it not to have
 been founded upon direct observation.   Unmarried people are
 more liable than others to some of  the exciting  causes of the
 malady;  and unmarried females, particularly, are more subject
 than those who are married to other nervous affections.   Yet,
 admittina; that  there are a  greater number of single than of
 married persons among the insane,  it  is still difficult to ascer-
 tain  positively whether this  is to  be ascribed  solely  to  the
 influence of celibacy.   M. Desportes states, that of 1668 insane
        10* 
114
females, 980 were single, 291 widows, and 397 married; and
of 764 insane  males, 492 were single, 59 widowers, and 201
married.
  The following table, compiled from the reports of several
of the hospitals in  the United States, goes to confirm the
opinion of M. Georget.
		MEN.				WOMEN.			
		GC	3	3	•-3	Ul	3	£	H
ASYLUMS.	TIME.	3	5" a.	ol o CO w	E.	'3.	»" a.	o CO	w
Maine State,	2^ months 1840,	15	7		22	4	3	1	8;
Massachusetts State,	1833 to 1835,	135	68	19	222	83	50	24	157i
Va. State, Staunton,	in 1839,	38	11	3	52	21	18	6	45
Kentucky State,	in 1838,	65	13	8	86	47	21	22	90
M'Lean, Mass.,	1 year,	27	18	3	48	16	12	4	32
Retreat, Connecticut,		119	80	4	203	80	86	12	178
Bloomingdale, N. Y.,	in 1839,	36	29	2	67	15	24	7	46
Frankford, Pa.,	1 year,	27	18	3	48	22	6	5	33
Penn. Hospital,		170	97	17	284	70	97	35	202
Total,		632	341	59	1032	358	317	116	791
  Of the 1S23 cases herein reported, 990 had never been mar-
ried, 658 were married, and 175 were widowed.   The pro-
portion, in men, of the single to the married is nearly as 2 to 1,
while that in women  is as 1.12  to 1; and that in both sexes is
as 1.5 to 1.  The number of widows is  very nearly twice as
great as that of widowers, a result which might have been  an-
ticipated, from a knowledge of the greater susceptibility of the
female mind to the influence of grief. 
115
  In the following table, no distinction is made between the
sexes, excepting in the case of widowers and widows.
				<7>	3	£	£	1-3
				3	S»			
				aq		a.	Cl.	w |
ASYLUMS.	TIME.			n	a.	o CD	o CO	
								
						CO		
Massachusetts State,	1833	to	1839,	558	374	39	63	1034J
Ohio State,	1839	&	1840,	135	100	6	17	258!
Frankford, Pa.,	1817	to	1838,	326	234	17	57	634
M'Lean, Mass.,				556	532 1240	3	4 141	1095
Total,				1575		65		3021
  The statistics of the Massachusetts State, the Frankford,
and the M'Lean Asylums which are in the former table, are
included in those of the same institutions  in the latter table.
In regard to the  cases of the M'Lean Asylum, it is believed
that, with the exception of one year, the  widowers and wi-
dows are included with the married.  Notwithstanding this,
the proportion of the single  to  the  married is as 3 to 2, or
as 1.5 to 1, a result almost precisely corresponding with  that
of the former table: its similar correspondence is also perceived
in the ratio of widowers to widows.
  Finally, rejecting, in  the former table, those numbers which
are included in both, we have a total of 4304 cases, of which
2255 were  married, 1726  single,  99 widowers, and 224 wi-
dows.  The proportion of the single to the  married is as 1.283
is to  1, and that of widowers to widows as 1 to 2.26.
  / Education.—An injudicious education is believed by Dr.
Prichard to  predispose  to  mental  derangement.  "It may be
erroneous," says he, "in  two  ways:" (we abridge from the
author) 1st, by too lenient a government, allowing the passions
to act uncontrolled and unsubdued, and never exercising that
wholesome moral restraint which seems necessary to promote
the  happiness, as well as to  conduce to the integrity of the
health of the individual; and 2d, by over exertion of the men-
tal faculties, and a neglect of the cultivation of the physical
powers and the moral feelings. 
116
  It is well that so prominent an individual as Dr. Prichard
has raised his voice  against the great error in modern educa-
tion included  under the second head.   It is an evil which, in
our country, exists to too great  an  extent,  and calls loudly
for  reform—complete, unsparing, radical reform.   And  inas-
much as it involves the health and happiness of so great a por-
tion of our countrymen, may we not hope that the subject will
obtain an increased attention among those who have the power
to effect a change?
  Sir W. C. Ellis, also, alludes to the errors of education as
contributing to increase the number of lunatics, and deprecates
the  modern institutions termed "infant schools," as being pro-
ductive of injury, by requiring a mental effort too severe for
the  brain  to  bear, with  impunity, during  the early years of
childhood.
  Apoplexy, epilepsy and paralysis are  considered  among the
predisposing causes of insanity, inasmuch as they induce a pe-
culiar state of the encephalon, upon which this malady may
easily supervene; but the most potent of all causes of this kind
is a previous attack of mania.
  2. Exciting Causes.—The exciting causes of insanity, like
those  which predispose to the disease,  are divided into two
classes,physical and moral.   The number of causes in either
of these classes is so great, and  some  of  them, at the same
time, of so little comparative importance, that it would be of
little utility to enter into a special discussion of each.
  a Physical Causes.—Intemperance,  the hydra of modern
days,  appears  to be the most prolific of mental disease of all
the  causes belonging to this class.  Attesting  to the truth of
this, we have the authority of Esquirol,  in  regard  to France,
of Ellis and Prichard, in regard to Great Britain, and of Rush,
Woodward, and others, in regard to the United States.  Du-
ring the residence of Dr. Waters in the Pennsylvania Hospi-
tal,  one-third  of the cases of insanity admitted  arose from
intemperance.
  The following statistics  of  four Asylums will exhibit the
influence of intoxicating liquors,  in the production  of  the
disease: 
117
Produced	by	
intemperance.		Per cent.
76		7.12 +
134		8.60 +
171		16.53 +
18		6.97 +
    Asylums.        Admissions.
Turin,                1066
Charenton,            1557
Massachusetts State,   1034
Ohio State,             258
  At Charenton, besides the 134 attributed solely to intoxica-
tion, there are 146 stated to have been produced by "excesses
of all kinds," which may be supposed to include intemperance
in drinking.
  Masturbation.—Nearly  all recent  writers  upon insanity,
unite in  acknowledging that this  is a  much more  prolific
source of the disease than has heretofore been supposed. They
also coincide in the opinion, that the cases produced by it are
among the most incurable, and a great proportion of them sink
into imbecility, fatuity or dementia.  Among the best autho-
rities upon this subject  are, Sir W. C.  Ellis  on  Insanity,
Esquirol on Mental Diseases, the Reports of the Massachusetts
State Lunatic  Hospital, and  two treatises,  the  one entitled
"Hints for the Young, in relation to the Health  of Body and
Mind," and the other, "An hour's Conference with Fathers
and Sons, in relation to a common and fatal Indulgence  of
Youth."  These treatises, although published anonymously,
were written by Physicians  who  have  had extensive  experi-
ence in the treatment of the insane.
  Climate, season, and profession, are included, by some  wri-
ters, among the predisposing causes of insanity.  We prefer,
for what we think to be obvious reasons, to place them with
the exciting causes.
   Climate.__It will be found  that the  number of lunatics  is
greatest in those countries which, being situated in the tempe-
rate zone, are subject to  the extremes of heat and cold, and  to
sudden vicissitudes in the weather.
  Season.— The proposition  whether any one of the  seasons
predisposes, in  a greater degree than either of the others,  to
insanity, is not yet fully demonstrated. 
118
  The following  table exhibits the number  of admissions to
three large Asylums, in each of the respective seasons:

  Asylums.        Time.      Winter.   Spring.  Summer.  Autumn.
Salpetriere,   1S06—1S14    531     626    755    592
Charenton,    1825—1834    341     406    445    365
Mass. State,   1833—1839    211     306    269    235
                 Total,    1083   1338   1469   1192

  By the evidence of these few statistics, it appears that there
are more admissions to  asylums in summer than in any other
of the four  seasons; but,  inasmuch as patients are, in but a
comparatively small proportion  of cases,  carried  to the asy-
lums immediately upon  the invasion of the disease, it cannot
be considered as satisfactory in regard to attacks.
  Profession and Occupation.—It is  very difficult to deter-
mine in what particular profession or art,  man  is  most liable
to mental disease.   Could we ascertain the precise ratio of the
number in each profession to that of the whole population, the
statistics of the  asylums,  for a  series  of  years, would throw
much  light upon the  subject.   Such  occupation  as  requires
intense mental exercise, or exposes one to sudden changes of
atmosphere, or to any of the active exciting causes of insanity,
would, of course, be the most productive of that disease.
   Of 1135 cases treated in American asylums, previously to
1836, those attributed to physical causes were as follows:
   Intemperance, 146;  various bodily diseases,  103; constitu-
tional, 57; masturbation,  55;  hereditary, 40; puerperal, 36;
typhus fever, 10; repelled eruptions, 9; blows on the head, 7;
parturition,  6;   structural  lesion of the brain,  5; excessive
physical exertion, 4; injuries,  3;  epilepsy, 3; insolation, 2;
injury of nervous centre by falls, 2; inflammation of the brain,
2; "change from ordinary to vegetable and abstemious diet,"
2; erythema of the brain, 1; malformation, 1; menorrhagia,
1; suppressed menses,  1;  total, 496.
   Hydrocephalus,  vertigo, headache,  metallic fumes,  inani-
tion,  inordinate  sexual gratification, severe pain,  extremes in 
119
heat and cold, worms, dropsy, consumption, and the suppres-
sion of  any natural or habitual discharge  may be included in
this class of causes.
   b Moral Causes.—Religious  excitement and anxiety,  re-
verses of fortune, and other pecuniary embarrassments, grief
for  the  loss of friends, domestic difficulties, intense  mental
exertion, and disappointed affection and ambition, are the most
prominent of the exciting moral causes of insanity.
   It is a fact worthy of notice, that of the 1557 cases admitted
at the Asylum at Charenton,  and of which the causes of 1375
are assigned, not one is attributed to religious doubt,  anxiety
 or perplexity.   On the other hand, of 678 cases treated at the
 Massachusetts State Lunatic Hospital, no less than 53, equal
 to 7.81 per cent, are stated to have arisen from those causes.
    Ellis, in  speaking of the  general paucity of cases  arising
 from these causes, in continental Europe, accounts for the fact
 by the  prevalence of  "infidelity among  the higher orders,"
 and "ignorance and  blind  superstitious obedience to  the  dic-
 tum of the  priests, among the lower classes," together with
 the fact that religious discussion is prohibited  in some of the
 continental  countries.
    The predominating cause  of the disease in  the  patients  of
 the Asylums  at Wakefield and  Hanwell,  in England, is po-
 verty and pecuniary difficulty;  and, what is a lamentable fea-
 ture  in regard to these cases, they  are mostly  among the
 honest and  industrious.  These institutions  being  devoted
 especially to the indigent, it is not remarkable that this cause
 should bear a greater relative proportion, than in asylums of a
  different  character.
     In  1S27  it was estimated that of 14,000 lunatics in England
  and Wales, 11,000  of them  were  in  indigent circumstances.
  In the state of New York, in 1825, of 967 lunatics, 382 were
  supported by charity, 312 possessed the means of  subsistence,
  and 273  were unclassified in this respect; and of 1484 idiots,
  514  were  supported by  charity,  549 supported  themselves,
  and  421 were unclassified.   In the same state,  in  1837,  no
  less than 652 lunatics were either relieved or  supported  by
   charity. 
120
   Grief for the loss  of friends is much more productive of
 mental  derangement in women  than in men; and, in them, the
 origin of the grief is  most frequently the loss of children.
   Of the  1135 cases  mentioned  under the head of physical
 causes, the moral  causes, so far as known, were as follows:—
 Religious 70, domestic trouble 60, reverse in fortune and other
 pecuniary difficulties 56, loss  of friends 46, mental application
 34, disappointed affection  2S, disappointed  ambition  11, "dis-
 appointment" 11, indulgence  of temper 8, care and anxiety 7,
jealousy 5, austere parental government 4, fright 2, mortified
 pride 1, "agitation on the  approach of matrimony" 1, "meta-
 physical hair-splitting" 1, "predisposition excited by novel-
 reading" 1.  Total 346.
   Thus it appears  that of the 1135 cases, 496 were produced
 by physical causes, 346 by moral  causes, and in 220 cases the
 origin was  unknown.
   In  Europe, it is generally believed that a greater number of
 people become  insane  from moral than from physical causes*
 The truth  of this, if applied  to the  United States, is doubted,
 although our statistics are not sufficiently complete for a satis-
 factory  demonstration.  It is  extremely difficult for the physi-
 cians of lunatic asylums to ascertain either the proximate  or
 the immediate causes of the disease, in many of their patients.
 In some cases it is unknown by the friends of the  individual;
 while, in others, although known, a concealment is  induced by
 motives of friendship.  We submit  that, for the facility of the
 physician in obtaining that accurate knowledge of the disease
 upon  which, alone, he can  establish a rational treatment,  as
 well as for  the  advancement of  our  knowledge in  relation  to
 the disease  in general, such motives ought to be entirely waived.
   Among the  moral causes unenumerated, but mentioned by
 several  authors, are avarice,  joy, terror, anger, shame, guilt,
 defamation, calumny,  ridicule,  absence from  native country,
 loss of liberty, loss of beauty,  love of praise, gaming, and "the
 complete gratification  of every wish of the heart."
   Dr. Rush believed that the  study of the mechanic and other
 arts is more liable to induce insanity than that of the sciences.
 Among those  who  have suffered from similar studies, have 
121
been many who have followed, with a zeal worthy of a better
cause, that "shadow of a shade," the Utopian perpetual-motion.
It is said that instances of insane priests, artists, sculptors,
poets and musicians are numerous, whereas no case is known
to have occurred among naturalists, geometricans and chemists.
Further investigations are  required before the latter clause of
this  proposition can be received as an  established truth.   In
regard to a part of the former clause, it may be mentioned that
an acquaintance of ours asserts that in order to write poetry a
person "must be a little crazy."
   Fear has  driven  people to  madness; it has  blanched the
darkest hair  in the course of a few hours, and it  has proved
fatal to existence. Ellis relates a painfully interesting case of the
effect last mentioned, which, as a useful warning, is worthy of
being known. "A melancholy instance," says he, "of the effect
of terror happened a few years ago, in the north of England.
A lady  had gone out to pay an  evening visit, at which she was
expected to  stay late.   The  servants took advantage of the
absence of the family to have a party at  the house.  The nurse-
maid, in order to have enjoyment without being disturbed by
a little  girl who was entrusted  to her care, and who would not
remain in bed by herself, determined to frighten her into being
quiet   For  this purpose, she dressed up a figure and placed it
at the foot of the bed, and told the  child if she moved or cried
it would get her.   In the  course of the evening the mother's
mind became so forcibly impressed that something was wrong
at home, that she could not remain without going to ascertain
if any  thing extraordinary had occurred.   She  found all the
servants dancing and in great  glee; and, on enquiring for the
child, was told that  she  was  in bed.   She ran up stairs and
found the figure at the foot of  the bed,  where it was placed by
the servant,  and her child  with its eyes intently fixed upon it,
but, to her inexpressible horror, quite dead."
   It has been  denied that political excitement and changes
have given rise to insanity.   Without  reference to  other au-
thority upon the subject,  I would adduce the 28 cases  men-
 tioned  by Esquirol among those who, in 1830 and 1831, were
 admitted into the asylum at Charenton.   There had not been
        11 
122
an individual case of the kind during the four years previous
to 1830.  Even admitting political causes,  abstractly con-
sidered, to possess  no direct  tendency to the production of
insanity, still the consequences which but too often result from
them, must  inevitably exercise a powerful influence  to  that
effect.   Such are mental anxiety, the loss of  property and of
friends.  Who can for a moment doubt that, at the time when
France was  menaced by powerful foes upon every hand; torn
by dissensions, and bleeding under a civil war; when hundreds
of princely  estates  were confiscated, and all the rich  were
compelled to relinquish, not  only a tithe, but a  third part of
their wealth, to  support political movements to  which they
were opposed;  when the country was  filled with guillotines,
and whole cities were doomed to destruction; that there was a
greater tendency to mental alienation than in the time of peace
and political quietude?  The following is an interesting case of
derangement which occurred during the difficulties alluded to
in France.  It is related  by the Viscountess Beauharnais, after-
wards the Empress Josephine.
  The Abbe Capdeville became  interested  in  an  English
orphan, eight years of age, and took him to educate.  The boy,
who, in the account, is called  Tommy,  was so kindly treated,
that he conceived a  strong attachment for his benefactor.  At
length, the Abbe was imprisoned in the Carmelites, and Tommy
obtained permission to be shut up with him.    One day, when
the Abb6 and other priests, his fellow prisoners, were at prayers
in the  chapel connected with the building, a mob of revolu-
tionists broke into  the place.   Tommy took  a station  beside
the kneeling Abbe,  and would not remove.   "The ruffians
having forced open the doors, and broken the windows, pene-
trated by several points  at once;  the pavement of the chapel,
and the steps of  the  sanctuary, were speedily inundated with
blood.   Capdeville, struck immediately after the bishop, fell
at his feet, and, extending a mangled hand to  Tommy, expired
as he looked upon him.   That look was a last blessing.
  "Already the poor youth, or rather child—for he is not yet
sixteen—exhibited  unequivocal  symptoms of alienation of
mind: on  the death  of his friend, a fixed insanity appeared. 
123
The unfortunate Abbe, who had  knelt apart from his compa-
nions  in martyrdom, having been engaged in  officiating, had
fallen with his head supported on the upper step of the altar,
and his body extended across the others; the left hand  was
pressed against the heart, and the right, as I have already said,
extended towards his pupil.   The blow which  had finally de-
prived him of life, had been  so rapid in its  operation,  that
death had not effaced the habitual expression  of benevolence
which lighted his  placid countenance.  He seemed to smile
and slumber.   By some sudden changes in the reasoning facul-
ties, Tommy became convinced that his friend slept. Instantly,
as if by enchantment,  the scene  of slaughter disappeared from
before his  vision;  he knelt down by the  side of the bleeding
corpse, waiting its awaking.  After three hours of watching,
and as the sun  sank down below the horizon, Tommy went to
seek  his  harp, and again sat down beside the remains of his
friend, playing melancholy airs in order to hasten his awaking,
which appeared to him long in taking place.  While thus em-
ployed, sleep  stole  over his  own  frame, and the charitable
hands that removed  from the  despoilers the bodies  of  the
martyrs,  carried  away Tommy, and laid him on  his  bed.
There he remained eight and forty hours in a kind of lethargy,
whence, however, he awoke with all the appearances of sound-
ness  of body and mind.   But, if health had been restored,
reason had fled forever.
   "In commemoration of his pious madness, a free asylum has
been granted to him in this house, where he passes the day in
silence till each afternoon at three o'clock.  The moment that
hour strikes, Tommy, who ordinarily walks  slowly, runs to
seek  his  harp, upon  which, leaning against the ruins of the
altar still remaining in the chapel, he plays his friend's favour-
ite airs.   The expression  of his countenance, on these occa-
sions, announces hope; he seems to expect a word of approba-
tion from  him whose remembrance he cherishes: this hope and
 this employment continue until  six o'clock, when he leaves off
 abruptly, say fog 'Not yet, but to-morrow he will speak to his
 child.'  He then  kneels down, prays fervently, rises  with a
 sigh, and  retires  softly, upon tiptoe, that he may not  disturb 
124
the imaginary  repose of his  benefactor.  The same affecting
scene takes place day after day; and, during the intervals, the
poor boy's faculties seem completely  absorbed, till the fatal
hour calls forth the same hopes, detined forever to be chilled
by the same disappointment"*
  It is a fact worthy of notice that, as  a general rule, insanity
is but little known in those countries the inhabitants of  which
are either in a savage or a barbarous state of society; whereas
it prevails to the  greatest extent  in  nations occupying the
highest rank in civilization.   The celebrated traveller, Baron
Von Humboldt, found but few cases among the aborigines of
America.   It is rare, also, among the negroes of the West In-
dies.   The peasantry of Wales, the natives of the Hebrides,
and of the most secluded parts of Ireland, are almost entirely
free from it  It is comparatively infrequent in Spain and Por-
tugal, although  idiocy is very common  in those countries.   In
Russia and in China, it is said that  it but seldom occurs; but,
in  regard to the British East Indies, Sir  Andrew Halliday
says, "Insanity is a frequent disease among the natives of every
caste.  The attacks are generally sudden and often  violent;
but, under proper medical treatment, they are easily removed."
  In the hospital at Cairo, Egypt, a city of 300,000  inhabi-
tants, Desgenettes  found but fourteen persons afflicted wifn
disorders of the brain and the nervous  system.  In Greece, at
the present day, there are very few  who are insane.  There is
no asylum for their  treatment  in that country, and there were
no patients of the kind  in the hospitals of Athens in  the au-
tumn of 1838.   In Turkey, also, the number of the insane is,
undoubtedly, very  small, although we  have no accurate data
upon the subject.  The people of that  country are, however,
to a greater or less extent, exempt from the influence of some
of the  most potent causes of  the disease in  the United States
and the nations of the west of Europe.   1st. The Turks are a
pre-eminently temperate people.  2d.  They avoid the  sallies
of uncontrolled passion, and preserve a remarkable degree of

  * Vide Memoirs of the Empress Josephine,  by John S. Menres  LL. D.
Harpers' edition, p. 88 to 93. 
125
equanimity of temper.   3d.  Reverses of fortune operate less
powerfully upon them than upon some other people: both be-
cause a misfortune of that kind  is considered as a decree of
Allah, and because, with a loss of fortune, a person does  not
lose his station in society.  4th. They probably are less affected
by religious anxiety, doubt and perplexity.   The practical
religion of Mahomet  chiefly consists in the observance of cer-
tain ceremonies, having fulfilled which, the Turk rests satisfied
that he has performed  his duty.  It will  be  perceived that,
under these  four  heads, are included  three, at least, of the
most powerful causes of mental derangement.
   We possess but very  little accurate knowledge in reference
to the number of lunatics in different nations.   The following
table, compiled from various authorities, exhibits, in a condensed
form, the principal data upon the subject.  It is extracted from
a  review of Esquirol on Mental Diseases in the American
Journal of the Medical Sciences.
	Population.	No. of Insane.	Proportion.
England,	12,700,000	16,222	1 in 793
Scotland,	2,093,503	3*652	" " 563
France,	32,000,000	32,000	" " 1,000
Norway,	1,051,300	1,909	" " 551
Belgium,	3,816,000	3,763	" « 1,014
Holland,	2,302,000	2,300	" " 1,046
Italy,	16,789,000	1,441	" " 4,879
Spain,	4,OS5,000	569	" " 7,181
United States,	12,866,020	16,000	" •< 800
Westphalia,	.		" " 846
Saxony,	.		" " 968
  The following, from the same  source, exhibits the similar
statistics of several large cities.

                    Population.  No. of Insane.    Proportion.  ,
     London,        1,400,000     7,000    1 in    200
     Paris,            S90,000     4,000    " "    222
     Petersburg,       377,000       120    ""  3,133
       11" 
126
	Population.	No. of Insane.	Proportion.
Naples,	370,000	479	1 in 759
Cairo,	330,000	14	" " 30,714
Madrid,	204,000	60	" " 3,350
Rome,	154,000	320	" " 421
Milan,	151,000	618	" " 242
Turin,	114,000	331	" " 344
Florence,	80,000	236	« " 338
Dresden,	70,000	150	tt tt 466
  In a recent work by Professor Vander Kolk, of the Univer-
sity at Utrecht, it is asserted that  there are 1828 lunatics in
the several provinces of Holland.   The population of the same
territory is 2,253,796;  which gives 1233 inhabitants to  1  lu-
natic.  The proportion of insane is small;  if it be correct, the
comparative exemption from the disease may, in part, be attri-
buted to the general sobriety of the people, and their somewhat
phlegmatic temperament.
  The population of the islands of Malta and Gozo is 120,000.
Of this number, 130, or 1 in 920, are insane.   In most of the
New England States, the proportion was formerly believed to
be about  1 in 1000.   More recent  investigations have proved
this estimate to be too low.  In the following table are includ-
ed, with  others, the most recent and accurate estimates that
have been published in regard to several of the States of the
American Union.
	Population.	No. of Insane.	Proportion.
Holland,	2,253,794	1,828	1 in 1,233
Malta and Gozo,	120,000	130	a tt 920
New Hampshire,	280,000	600	" " 466
Massachusetts,	612,000	1,000	" " 612
Connecticut,	298,000	700	" " 425
New York,	•	. .	" " 887
Pennsylvania,	1,348,233	2,000	" " 674
Virginia,	1,200,000	800	" " 1,500
 
127
  In some of these estimates, idiots are included with the  in-
sane;  in others they are excluded.
  In Scotland the greatest proportion of insane and idiots is in
the counties  of Perth, Aberdeen,  Lanark, Inverness, Nairn,
Banff, Fife and Kinross, and in  the  mainland of Argyle and
the island of Bute.
  In England, the disease is more  prevalent in the counties of
York, Wilts, Stafford, Durham, Rutland and Gloucester, than
in any other parts of the country.  The greatest proportionate
number of lunatics  and idiots is in Rutland, where there is  1
for every 497 persons; and the smallest number in Lancashire,
where there  is but 1 for every 1960 persons.   In Wales  the
number  of insane,  relative  to the whole population, is very-
small.   The  remark is also  applicable to the Celtic tribes in
other parts of  Great Britain;  and, where there is a union of
Celtic with Saxon and Norman blood, the disease is scarcely
known, except in cases of anormal structure, or malformation
of the cranium.  In these instances the individuals are idiotic.
We have a remarkable  example of endemic idiotism in the
cretins of some of the cantons of Switzerland.  Esquirol asserts
that, in the southern provinces of France, the number of insane
men exceeds that of insane women, while the reverse obtains
in the provinces of the north.
   Duration.—The duration tof insanity varies from  a  few
days, in one extreme, to forty,  fifty, and even  sixty years  in
the other.   The average time is said to be about thirteen and
a half years, but it cannot fail of being materially diminished
by the modern enlightened  mode  of treatment.   Individual
 cases may, perchance,  be even prolonged; not, however, by
any injury arising from  the treatment, but from a mitigation
in  the  severity of the  disease by which the day of death  is
postponed.  In a memoir  presented  to the French Institute,
 M. Pinel states that more are cured  during the first month  of
 the disease than in  any one of the  succeeding, and that the
 average duration of those that  are  cured is from five to six
 months.   M. Esquirol and S. Tuke give a longer  period  as
 the mean time of continuation.   The former says, that of 2,005
 females admitted at the  Salpetriere,  Paris, the greatest number 
128
 of cures was  effected in the first two years, and that the ave-
 rage was "somewhat short of a year."  The probability of a
 recovery after the third year, is considered as  about  one to
 thirty.  "I  have constantly observed," says Dr.  Prichard,
 "that in the course of  the first month, a very marked  remis-
 sion  takes place" in the disease.   He  supposes that  at  this
 time the acute form of the disease is exchanged for the chronic.
   From these statements we may infer that, if uncomplicated
 with any other functional disease, and unaccompanied by an
 organic lesion of the brain, the natural period of acute mania
 is brief.
   Termination.—Insanity  terminates  in   a  restoration  to
 health, in fatuity, or in death.
   Curability.—The proportion of cures varies  according to
 the age and sex of the patients,  the cause of the disease, the
 disorders with which it may be complicated, the treatment, &c.
 &c.  The probability of recovery is greater in young than in old
 people.  According to  M. Esquirol, few recover who are more
 than sixty years of age.  The same author asserts that the  pro-
 portion of cures is  greater in France than in England.   To
 demonstrate the truth of this, he collects the statistics of  four
 asylums in England and compares them with those of his  own
 practice in three asylums of Paris.
                         No. of patients.   Recovered.   Percent.
 Four Asylums in England,   16,516      5918       35.7
 Three   "    in Paris,       5,360      2691      50.2

  Dr. Burrows denies  the truth of the assertion  which these
 statistics are intended to prove.
  The proportion of recoveries in various institutions, in both
the United  States and other countries, may be seen in the  fol-
lowing table.

     French Asylums
Charenton,
    a
Salpetriere,
Esquirol's private,
                   No. of  Recover-
        Time.       patients,  ed.   Perct.
From 1798 to 1803   596    194  32.55
  "  1826 to 1834  1205    516  42.82
  "  1801 to 1813  3007   1625  54.04
     unknown.       335    173  51.64 
129
•No. of Recover-
British Asylums.		Time. ]	patients.	ed.	Perct.
Bethlehem, F;	rom	1684 to 1703	1294	890	69.77
u	u	1748 to 1794	8874	2557	28.81
ii	((	in 1813	422	204	48.34
tt	i(	1819 to 1833	2445	1124	45.56
Saint Luke's,	it	1751 to 1801	6458	2811	43.52
Wakefield,	a	1819 to 1836	2242	991	44.20
Lancaster,	it	1817 to 1832	1750	697	39.82
Stafford,		unknown	1000	429	42.90
Retreat, near York,	a	1796 to 1835	508	236	46.43
York, at York,	a	1815 to 1837	1131	387	34.21
Cork, Ireland,		20 years	1431	751	52.48
Other European Asyli	ims.				
Amsterdam, Holland,		2£ years	163	56	34.35
Utrecht, "	(<	1832 to 1837	255	104	40.78
Turin, Italy,	u	1827 to 1836	1066	466	45.59
Aversa, "	u	1813 to 1833	3897	1514	38.85
American Asylums.					
Pennsylvania Hospital,	a	1752 to 1836	4116	1349	32.77
Frankford, Pennsylvania	a >	1817 to 1838	507	214	42.21
$U^*~^t<?C±/^u		1838 to 1839	235	141	60.00
Bloomingdale, N. Y.,	u	1821 to 1835	1915	828	43.23
Bellevue, "	a	1791 to 1821	1553	704	45.33
M'Lean, Mass.,	a	1818 to 1834	1015	362	35.66
Retreat, Conn.,	ti	1824 to 1839	1001	563	56.24
Massachusetts state,	(C	1833 to 1840	1196	506	42.30
Maryland, "	a	1835 to 1840	393	135	34.35
Virginia state, Staunton,	a	1828 to 1836	79	13	16.45
U . it ii	ti	1836 to 1839	78	34	43.59
Ohio, state,	ti	1839 to 1840	258	80	31.00
  The average per cent, as exhibited by this table, is, for the
French Asylums, 45.26;  for  the  British, 45.01; the  other
European, 39.S9; and for the American, 40.26.
  The difference  in the proportion of cures, at the several
asylums is, in reality, less than appears by this table; for the
number of patients given is, in some instances, that of all ad-
mitted; while, in  others, it is  that of the  discharges  alone.
Again, the difference actually existing, is  owing, in no incon- 
130
 siderable degree, to the  diversity of character in the institu-
 tions themselves.   While some of them  are  intended exclu-
 sively for paupers,  and are  consequently  compelled to admit
 every applicant of  that class, of what age, grade or condition
 soever he may be; others  have the power of rejecting such
 cases as they please, and  restricting their admissions to those of
 a certain character.  This difference exists in both Europe and
 America.  St. Luke's and Bethlehem Hospitals, in London,
 reject all persons "who have been insane more than a year,
 those  affected  by paralysis and  epilepsy, and  the  aged  and
 feeble."
   It is probable that there is an error in the statistics of Beth-
 lehem Hospital,  from 1684 to 1703.  If there be not, the
 patients must have recovered in spite of their treatment, or the
 institution must have been far superior to what it was a century
 later.
   Those asylums which have but recently commenced opera-
 tions, suffer much by a comparison with the others, if  the per
 cent,  of cures is reckoned upon the whole number  admitted.
 The Ohio State Lunatic Asylum furnishes an example of this
 kind.  The number (258) in the table, iArfe?<^frtr»-p*teMs
 admitted.   The per  cent,  of cures, upon these, is only  31;
 while, if calculated upon the  discharges, it would have been
 66.66.
  It was left for the physicians of the present age to demon-
 strate, that as great a proportion  of patients suffering under
 acute mania  may  be cured as of those of any other acute
 disease. This  has been satisfactorily proved.  A great remiss-
 ness,  however, exists upon the part  of the  friends of this
 unfortunate class of the community, in neglecting to place them
 in  a hospital during the earliest stages of the malady.  "It fre-
quently happens," says the eighteenth report of the Asylum at
Frankford, Pennsylvania, "that applications for admission into
our asylum are not made  until  after the most promising period
for recovery has elapsed."   Similar  complaints are urged in
the reports of other hospitals. 
131
The following	tab]	le exhibits thi	2 advantage	of early treat-
ment.			Per ct. of cures	Per ct. of cures
Asylums.		Time,	in recent cases.	in chronic cases.
Dr. Burrows',			91.32	35.18
Vermont State,		3 years	89.	28.02
a tt		1840	8S.20	28.05
Massachusetts State,		1833 to 1840	87.25	19.05
a a		in 1840	91.25	22.05
Ohio State,		1839 & 1840	85.50	41.17
Bloomingdale,		in 1839	S3.S7	25.39
Retreat, Conn.,		6 years	75.95	
n u		4 years	91.60	25.83
  The average per  cent, of the recent cases is 87.10, while
that of the chronic cases is but 28.28.   The term  "recent" is
generally applied to  all cases of less than one year induration,
and "chronic" to  all others.  This  signification of the terms
is recognised  in all  the  above mentioned  asylums, excepting
the Connecticut Retreat.  In that institution I think the term
"recent" is restricted to  cases of less than  three months dura-
tion.
  A large  majority of recoveries are complete and permanent,
others are  apparently complete, but the patient remains in a
qondition from which he may very easily relapse, if exposed
to exciting causes.   In  many cases of perfect restoration to
physical health and  energy, the persons are incapable of sus-
taining their former  intellectual rank.  Diseases of the nervous
system are peculiarly liable to relapses.   When the integrity
of  this dynamic  apparatus has been destroyed, it is restored
with more difficulty than is that of any of the other systems
of organs in the human  economy.   Pinel and Desportes state
the proportion of  relapses at one-sixth the number of original
cases; at the Salpetriere it was one-seventh.
   Fatuity.__The state of patients whose  disease has had  this
unfortunate termination, is different from that of  idiots, or of
those who are in the imbecility sometimes attendant upon old
age.   Dr.  Prichard  divides fatuity  into two  grades, 1st,  De-
mentia,  and 2d, Amentia. 
132
  1st.  Dementia.  This is the "dtmence" of M. Esquirol and
Georget, and is  that state in which  the  physical and mental
powers have  become overpowered or exhausted by the force
of the disease.  From an intense excitement the patient relaxes
into a state of quietude, ominous of a decay of mental vigour;
memory is obliterated, the patient  becomes inactive, thought-
less, unobserving, and perhaps utters
              "A hollow laugh or melancholy song,"—
the former a painful evidence of mental vacuity and imbecility,
the latter, as it were, a requiem over the departed powers of
that spirit which alone elevates man above "the brutes that
perish."  Some appear to recollect their  friends, but all affec-
tion for them is annihilated.   Some are capable of performing
light manual labour, others are not.   Physical health is  gene-
rally good, digestion and  assimilation being unimpaired.  A
few instances of recovery  are on record.
  2nd. Amentia.  We have  here  arrived at the most abject
state of mental  imbecility.   Reason, entirely  dethroned, has
left no trace of her once having occupied  the palace  which she
has deserted.  Man,  "the lord of the universe," entirely di-
vested of his mental and moral energies,  becomes a  mere vital
automaton, moving by the force of its organic life, and directed
by the capricious impulse of the moment.  Many patients in
this state remain  motionless,  perchance, during the  day, their
eyes fixed upon  the ground, as if unconscious of the things or
persons around them, or even of their own existence.   They
would not retire to bed nor rise were they not forced to  do it
by their attendants.
  3d.  Death.  "Madness," says Prichard, "cannot  be reckon-
ed among the diseases  which  are very dangerous to  life." But
if, as he declares in  another place, "lunatics are subject, in  a
much  greater proportion than other people, to  apoplexy,
paralysis, epilepsy, and all the train of symptoms  depending
on different degrees of cerebral congestion;" if, as is the fact,
acute  insanity produces  great exhaustion  and prostration  of
physical energy, and if "diseases of the thoracic and abdominal
viscera, and a cachectic or scorbutic state  of the system" be its 
133
sequelae, then  must he, and every other person, acknowledge
that if not "very," it is somewhat "dangerous to life."  The
following table exhibits  the ratio of deaths to  the number of
patients in several asylums.

    Asylums.                 Time.   No. of patients. Deaths. Perct.
Hanwell, England,       From 1832 to 1837    3327     418    12.56
Lancaster,   "            "  1832 to 1837    2148     522    24.29
Wakefield,   "            "  1818 to 1836    2242     709    31.64
York,       "            "  1777 to 1814    2635     399    16.80
  »         »            "  1815 to 1837    1131     217    19.27
Retreat, York,"            "  1796 to 1836     508     113    22.22
Charenton, France,         "  1826 to 1833    2049     546    26.64
Salpetriere,   "            "  1801 to 1804    1002     250     4.95
    «       "            »  1805 to 1813    2804     790    28.17
Bicetre,      "            "  1784 to 1794    1405     685    48.75
Aversa, Italy,              "  in 20 years     3897     1222    31.35
Amsterdam, Holland,       "  1832 to 1837     255      55    21.56
Penna. Hospital, U. States,  "  1752 to 1836    4116     548    13.31
Bellevue, N. Y.    "      "  1791 to 1821    1553     154     9.91
Bloomingdale, "     "      "  1821 to 1835    1915     146     7.62
Frankford, Pa.       "      "  1817 to 1838     634      90    14.19
Maryland State,      "      "  1835 to 1839     393      34     8.65
Retreat, Connecticut, "      "  1824 to 1839    1001      60     5.99
Massachusetts State,  "      "  1833 to 1840    1196      90     7.50
Ohio State,          "      "  1839 to 1810     258      22     8.52
Kentucky State,     "      "  1824 to 1838     627     238    37.95

   The  average of the deaths  in the British Asylums is 21.13
per cent;  in  the French  32.12 per cent; in the American
12.62 per cent; in the American, rejecting the  Kentucky State
Asylum, 9.33 percent.
   Among the immediate causes of death  other than insanity
itself, the  following  diseases  are reported as  being  the most
numerous, viz:—Apoplexy, paralysis, epilepsy, phrenitis, con-
vulsions, tumour  of the brain, phthisis pulmonalis, pleurisy,
pneumonia, hydrothorax, organic affection of the heart, hydrops
pericardii,  gastritis, schirrus of the pylorus, organic  lesions of
the liver, diarrhoea, typhus fever and marasmus.   It is evident
that the insane are equally liable with others to the invasion of
most of the diseases which afflict mankind.
        12 
134
   Treatment.—The treatment of insanity is divided into, 1st,
medical, and 2d, moral.  Of the former nothing will here be
introduced;  the latter alone will receive attention.
  Among the many benevolent institutions which have origi-
nated as almost legitimate consequences of superior civilization,
more extensive and  widely diffused  knowledge, and a more
enlightened philanthropy,  not the least beneficial in their re-
sults are those which have for their object the amelioration of
the condition of the  insane.   Formerly, the unfortunate indi-
vidual subject to maniacal  hallucination was  supposed to have
violated the laws of heaven, and thus incurred the displeasure of
a Creator, the phials of whose wrath were consequently poured
out, in this form, upon the offender.   But the sentiments of
the community have changed.  The lunatic  is no  longer "a
reproach and a bye-word," his family are no longer shunned as
being partially implicated  in  his unknown offence; but, as a
sufferer  under one of the most afflicting maladies to which our
race is subject, the former  receives that kindness and attention
which the human  heart, alive to the sufferings of our fellows,
so well knows how to bestow,  while the latter partakes of the
fountain of sympathy gushing from a  thousand bosoms.  The
sufferings to which maniacs were formerly, and, in  too many
instances, still  are, subjected, sufferings which place recovery
beyond  hope, their imprisonment and confinement in dungeons,
their tortures under manacles and chains, their  deprivation of
food, of clothing,  and of all the comforts of life,  are such that
we are almost struck with  horror at their  recital.  The noble
philanthropist, M. Pinel, to whose untiring exertions the luna-
tics of France are indebted for an amelioration of their condi-
tion, has given a thrilling description of the vast accumulation
of misery, which, during his investigations, was presented to
his view.  In England and Scotland, although some hospitals
existed, the  wretchedness  and inhumanity, were, according to
Halliday, previously to 1S15, equally  great.   In "Bedlam,"
or Bethlehem Hospital, in London, at  that time, the patients,
"as wild beasts, were shown for  sixpence  for each person ad-
mitted."
   A  fundamental error formerly existed  with  regard  to the 
135
nature of insanity;  it was believed that the mind is  itself dis-
eased,  instead of the organ through  which it is  manifested.
But disease is the minister of death, and the mind, a scintilla-
tion from the fire of Heaven, being free from the power of the
latter,  is consequently exempted from the encroachments of
the former.  It is, therefore, now acknowledged that insanity
is produced by a cerebral lesion, and  that, too, generally of a
functional  nature;  it necessarily  follows  that the  disease  is
within the  reach of remedial agents.   But chains and a dun-
geon are miserable prescriptions to  a  pathological state of the
most  delicate organ of the human frame, an organ which  is
called constantly into action by an invisible, but powerful and
controlling agency.  Experience  has fully attested the truth
of this assertion.   It has also proved  that mild and gentle
means, pleasing amusements, light  labour,  and affectionate
treatment,  by those around the patient, are powerful  auxiliaries
in promoting a cure.  Since this has been demonstrated, the
number of Lunatic Asylums has greatly increased, for, in those
institutions,  the system of  treatment can be more completely
adopted than in most  private families.   England, Scotland,
Ireland, and most of the countries of continental Europe are
supplied to a greater or less extent with these institutions, and
there  are several of the kind  in Southern Asia.  Our  country
has caught the spirit, and is imitating the good example of her
transatlantic sisters.  Already we have no less than seventeen
Lunatic Asylums in operation. In these,  or  in such  of them
as are of the most approved construction, the  patients  are clas-
sified  according to  the degree of their mental alienation, thus
making three divisions;  1st, those in whom the disease is vio-
lent and unabated; 2d, the milder  and  the convalescing; and
 3d the convalescent.  The individuals of each class occupy a
 suit of rooms communicating with  each other by  a  common
 hall,  and also with a yard in which  they are  permitted to ex-
 ercise at suitable hours.  The different classes have  no  com-
 munication  with each other.   The patients are treated  medi-
 cally  whenever such treatment is   necessary;  but, as in the
 European asylums, the  management of all cases, indiscrimi-
 nately, in this manner,  has  been  abolished.   The physician 
136
now endeavours "to combine moral and  medical  treatment,
founded  on the principles of mental philosophy and physi-
ology."  Hence, in many cases, a simple, but wholesome and
nutritious diet has supplanted the  long  category of medicines
which have sometimes been employed.
  It is now conceded by all who are best acquainted with the
management of the insane, that the first element in their mo-
ral treatment is their removal from acquaintances and former
associations.  One prominent advantage in such removal is the
promotion of the second element of treatment, that of with-
drawing  the  mind from its  hallucinations,  and attracting  it
into  a new  current of  thought.  For the full accomplishment,
however, of this latter object, after the  removal to a suitable
place has been made, the almost unremitting  attention of judi-
cious caretakers is required.  New objects must be presented
to the view, new incentives  to the mind, and  no expedient
which would be likely  to attract the attention and divert the
thoughts  must be left untried.   Hence, in those institutions for
the treatment of this disease which have recently been estab-
lished, as well as those older establishments  which have kept
pace with the progress  of knowledge, manual labour, in many
of its forms, amusements, and sources  of  literary and scien-
tific entertainment and instruction,  have been introduced among
the patients.   In short, instead of being  degraded to  a level
not only  with criminals, but with the brute creation, and con-
sequently shut out from association with mankind, and placed
beyond the influence of kindness and of sympathy, the insane
are now; treated as  intelligent and immortal  beings, the affec-
tions and sympathies of whose hearts are still alive to the in-
fluences which operate  upon those of mankind in general.
  Labour.—"We have seen," says one of the reports of the
M'Lean  Asylum, Massachusetts, "the very best results from
labour.   Patients who,  without it, were noisy and  trouble-
some, have  become quiet  with it.  One patient, who was
brought to the institution in irons, and  who, until employed,
was  constantly raving and excited, when furnished with occu-
pation became quiet."   At the Massachusetts State  Lunatic
Hospital, in 1839, no less than one hundred  and seventy-nine 
137
patients were employed in manual labour.  The superinten-
dent of that institution says, in his seventh report:  "Of the
benefit of labour, both for the curable and incurable insane, we
have been long impressed.   It promotes health, induces sleep,
favours self-control, satisfies the individual of the confidence
reposed in him by the officers of the institution,  and produces
quiet and contentment."
   At the Pennsylvania  Hospital, the Asylums  at  Frankford,
New York and Hartford, and at the state institutions of Maine,
Vermont, Maryland,  Virginia and Ohio, the patients are in-
duced to labour; and  testimonies in favour of the utility of the
practice might be adduced from nearly all of them.
   In Europe similar  sentiments prevail.   "As employment,"
says Sir Andrew Halliday, speaking of the patients of the Ar-
magh Asylum, Ireland, "is now generally allowed to be the
best restorative, every  means  has been used to promote  it.
Such as are at  all capable  among  the females  are constantly
employed  in  plain work, spinning,  &c; and the division in
which  this is  going  on is  remarkable for  its  regularity and
cheerfulness."   At the Middlesex County Lunatic Asylum, at
Hanwell, England, in 1837, of 600 patients, more  than 400
were constantly engaged in some useful occupation.
   In  reference to this element of moral treatment, Samuel
Tuke remarks, "The employment should, as far as it is prac-
ticable,  be adapted to their (the patients') previous habits, in-
clinations and capacities."   He prefers that in which the indi-
viduals  will excel, and the useful rather  than amusing, as
 affording to the patient "a calm feeling of satisfaction."  "It
 is related," says the  same author,  "of  an institution  in Spain,
 which accommodated all ranks, and in which the lower classes
 were usually employed, that a great proportion of these reco-
 vered, while the number of grandees (that recovered) was ex-
 ceedingly small."
   M. Brierre de Boismont, in a recent work, speaking of the
 patients at the Bicetre, Paris, says, "The convalescent maniacs
 have this year excavated large quantities of earth: they have
 engaged with pleasure in farming, and have  kept a laundry in
 operation.   More than one  hundred and fifty of  them  are
         12* 
138
employed in throwing up terraces, in masonry, gardening, the
manufacture of locks, making plaster, cabinet-making and car-
pentry."   Dr.  Ferrus, who has long had  the medical  charge
of the patients  in the Bicetre, in speaking of labour, says, "I
have made, myself, on a large scale, a happy experiment of its
efficacy as a means of both discipline and cure.   The recove-
ries  have been  more  rapid, and  the  relapses  more  rare."
Similar testimony might be adduced from the Asylum of Son-
nenstein in Prussia; from those of  Turin and Milan, in Italy,
and from various institutions of the kind in France and Great
Britain.
  It is a remarkable fact that, although farming implements
and edged tools have, for many years, been entrusted to  the
insane, there is not a single instance on record of any serious
injury having arisen therefrom.
  Religious Worship.—Some  of the asylums of  both Europe
and America have a  regular chaplain  connected with them;
while, in others, religious services are performed under  the
direction of clergymen who  volunteer their services.  There
are but four institutions, in this country, in which there is not
some  religious  devotional exercise; and, wherever this duty
has been observed, it  has been accompanied by beneficial re-
sults.   "Regular religious teaching," says Dr. Woodward,  "is
as necessary and beneficial  to  the insane  as to  the rational
mind:  in a large proportion of the cases it will have  equal in-
fluence.  They as well know their imperfections, if they will
not  admit their delusions; and they feel  the  importance of
good  conduct, to  secure the confidence and esteem of those
whose good opinion they value."
  Dr.  Bell, of  the  M'Lean Asylum, says, "The regulated,
discriminating and cautious attention to the exercises of reli-
gion, is so valuable an auxiliary to the moral means of treating
diseased mind, not less from  its specific influences on the heart
and feelings, than of its administering to the self-control of the
individual, that we have rejoiced to see the experience of this
institution adopted into others."
 i Dr.  Rockwell, of the Vermont State  Asylum, remarks that
"much of the good effect of religious worship depends upon 
139
the prudence and discretion with which it is managed.  We
consider the judicious employment of religious exercises  an
important part of our  moral treatment.   They serve to pro-
mote order, revive former gvateful habits  and associations, and
recall into exercise that self-control which tends to their reco-
very.   That religion which breathes peace on earth and good-
will to  men, and whose cheering influences extend beyond the
grave, affords solace and consolation to the insane, as well as
comfort to the rational mind."
   Dr. Awl, of the Ohio State Asylum,  observes,  "We are
fully prepared to add  our  testimony to  the importance and
value of religious exercises, with the insane, as a special means
of grace, well calculated to  bring  light  and wisdom  to the
mind, relief and peace to the heart and conscience."
   Amusements.—It is universally acknowledged that suitable
amusements are efficacious adjuvants in restoring  the  excited
and deluded minds of the  insane to their healthy standard of
calmness and accuracy of perception.  Hence, in nearly every
asylum, whether foreign or domestic, the means are furnished
by which the patients may engage in a  diversity  of  games.
Entertainment is afforded by an occasional  tea-party or dancing-
party, and the means of intellectual gratification and instruc-
tion are supplied by books, newspapers and magazines.  Those
patients who have a particular taste or  predilection for any
special science, or in whom such taste can be awakened, ought
to be supplied with the means of pursuing it.  At the Frank-
ford Asylum, during the past year, a gentleman who had been
 several  months under medical  treatment, became, by an inci-
 dental  circumstance, interested  in botany.  He immediately
 commenced the study of  it, devoting himself with the most
 untiring assiduity to the pursuit.  Books, and a microscope to
 facilitate in the analysis of flowers, were furnished him, and
 he  was  permitted  to  ramble alone through the woods and
 fields,  for the purpose of collecting specimens.  He improved
 very'rapidly  in both  physical  and mental health, and soon
 returned to his home perfectly restored.
    Music has been  tried as a curative means in many Asylums.
 We should suppose, a priori, that it might be attended with 
140
 beneficial results.  In order, however, that this should obtain,
 it must be managed with a most discriminating judgment.  It
 must be adapted to each patient, according as he is depressed
 or exalted; otherwise, the melancholy in the former case might
 be augmented, and the  exaltation, in  the latter, increased to
 fury. Esquirol, whose experience in this respect is undoubtedly
 greater than that of any other person now living, remarks, "I
 have tried it (music) in every manner, and under circumstances
 the most favourable to success.  Sometimes it has irritated the
patient even to fury; often it has tended to divert the atten-
 tion, but / cannot say that it has contributed to a cure.  It
 has been advantageous to the convalescent"     *    *     *
  "Having made so many partial applications of music, I was
 desirous  of attempting it upon many persons, simultaneously.
 My  experiments were made during the summer of 1824, and
 that  of 1825.   Many distinguished musicians of the capital,
 seconded by the students of the  Conservatory of Music, as-
 sembled  at our Asylum  (La Salpetriere) many Sabbath-days in
 succession.  The harp, the piano, the violin, some wind instru-
 ments, and some excellent voices, combined to render our con-
 certs as agreeable as interesting.
  "Eighty insane  women, chosen by me from the  convales-
 cents, the maniacs, the tranquil monomaniacs, and some lype-
 maniacs, were commodiously seated, facing the  musicians, in
 the dormitory of the convalescents.  *   *  *  *  Airs of all
 kinds,  of all metres, and upon all keys,  were played and sung,
 varying the number and the nature of the instruments.  Some
 great pieces of music  were  also executed.  My patients were
 very attentive, their countenances became animated, the eyes
 of many beamed with additional brilliancy, but all  remained
 tranquil.  Some tears were shed.   Two of the patients asked
 permission to sing an  air, and to  be accompanied: the request
 was  granted.
  "This novel spectacle was not  without influence upon our
 unhappy patients, but we obtained no cure, not even an ame-
 lioration of their mental condition.   After these concerts
 each of which lasted two hours,  the musicians went into the
 apartment among the patients and executed, upon wind instru- 
141
ments, various well-known popular airs, of a martial or senti-
mental  character.   A  great  number of the women  became
excited, exalted  at  the  sound of the instruments, and many,
among  the furious, formed circles in  order  to dance.  This
excitement was transient, and passed off almost as soon as the
music ceased."
  After some further observations, the author finally concludes,
"If music does not cure, it diverts, and consequently  soothes.
It produces some alleviation, both physical  and moral; it is
evidently useful  to the convalescent, and consequently  it is not
necessary to discontinue its use."
  The human mind is prone to extremes, as the musical chord,
which, if deviated from the line of tension, recoils to nearly
the same extent  upon the  opposite side.   And, to pursue  the
simile, the  harmony of  the former, like  that of the latter, is
the most agreeable when those extremes are least.  The most
intimate friend,  if once estranged,  is liable to become the most
implacable  enemy.   Some physicians,  discarding the antiphlo-
gistic, adopt the ever  stimulant  method of  treatment;  and
others,  once  accustomed to drugging their patients to a most
liberal extent, reject this practice and adopt the infinitessimal
principles of homoeopathy.  Governments fall from despotism
into anarchy, and from anarchy return to despotism.   In the
modern laudable crusade  against distilled spirits, some of the
leaders in  the  cause, the hermit-Peters  of  the warfare, have
banished not only spirits, wine and fermented liquors, but tea,
coffee, meat and condiments, by their code  of dietetics.  In
all these instances, perhaps, there  is a  "golden mean," which
is better and wiser than either extreme.  In the moral treat-
ment of insanity care is required, lest, in the recoil from the
barbarity of  former times, the opposite error be  not avoided.
  These remarks have been suggested  by the account given by
Esquirol of the introduction of theatrical  entertainments at
Charenton.  This was done about the year 1805, and continued
until 1811.  A  theatre was constructed, comedies, operas and
dramas were enacted, and, occasionally, fire-works were  dis-
played.  "Every body was pleased  with it; great and  small,
wise and ignorant, were  desirous of being at the exhibition 
142
given by the lunatics of Charenton.   All Paris  flocked there
for several years; some from curiosity, others to judge of the
prodigious effects of this admirable means of curing the insane.
The truth  is, this means effected no  cure.   *  *  *  Those
who were  to witness the exhibition were selected by favour.
This  excited jealousies, quarrels, and bitterness  of feeling.
Hence occurred sudden explosions of delirium and returns of
mania and  of fury.   *  #   *   That  which passed at Charen-
ton teaches us sufficiently upon this subject.   How many were
the relapses, how numerous  the paroxysms of fury, provoked
by these theatrical representations!   Never have we seen pa-
tients cured by  this mode of treatment."
  Since the foregoing  remarks were  written, a  treatise upon
Insanity has appeared in Paris,  the  object of  which is  "to
establish the truth of the following three  propositions:—
  1. If it  be true that insanity depends on an  alteration, or
morbid condition of the encephalon, we  are completely igno-
rant in what this alteration consists.
  2. The moral treatment of the insane,  as  usually practised,
is considered only as an auxiliary of the physical treatment.
  3. In the insane, the intellect and passions cannot be brought
back  to their healthy type, or standard, without the aid of
moral treatment; and this mode of treatment is the only
ONE WHICH HAS A DIRECT INFLUENCE ON THE  SYMPTOMS OF
INSANITY."*
  The author of this work is a highly intellectual and scienti-
fic physician, and his experience in the treatment of the insane
has been very extensive: hence, his  opinions merit  attention
and respect.  Those best acquainted with mental diseases,  and
with  their present  mode of treatment, will  acknowledge  an
affirmative  to the first two propositions, even without an inves-
tigation of  the arguments adduced in the  demonstration of the
truth  of them.   But, it is believed that the same assent cannot
be granted  to the sentiment of the  latter clause of the third
proposition.  Insanity is far from being an invariably idiopathic
disease  of  the  encephalon;  it is frequently symptomatic of

     * Du Traitement Morale de la Folie. Par F. Leuret, Paris, 1840. 
143
affections of the other viscera.  Now, we would ask, what is
that moral treatment, so potent in its influence as to correct the
morbid conditions of the portal circle, or restore the dyspeptic
stomach to its normal state?  It is to be feared that this author
has fallen into the extreme alluded to above.
  Attendants.—How perfect soever may be an asylum  in its
organization and administration, how complete soever it may
be in all the physical comforts which wealth may purchase or
ingenuity invent, how diverse soever may  be the  means of
recreation and amusement—the great object for which  these
have been furnished, that of  effecting a cure in the patients,
will be tardily,  if indeed it  be ever accomplished, unless the
attendants, those who have  the immediate  care of those pa-
tients, are of  a  suitable character.   Complete dominion over
the passions,  a well cultivated mind,  unyielding firmness, un-
tiring  energy,  and an  ever-watchful vigilance, united  with
 mildness, gentleness, an affable and respectful deportment, and
 a benevolent, sympathising, christian mind, are necessary to
 constitute the perfect attendant.  The nearer this standard be
 approached, the better will  be the care extended to the pa-
 tients, and the more rapid will be the cures.   "We will not,"
 says one of the reports of the M'Lean Asylum, "continue any
 male or female attendant, whom we cannot invite into our
 family and seat at our table; and  with whom  we could not
 confidently place our wives, sisters and brothers."   The rule
 that immediate dismissal shall be the penalty of striking a pa-
 tient, is adopted in most asylums, and should be in all.   Could
 the standard  which we have mentioned be reached, perhaps no
 such rule would be necessary.
    Coercion and Punishment.-The strait-jacket manacles and
 chains have nearly been abandoned in the best institutions of the
 treatment of lunatic, The first, however  is still u^«;
 ally in some of the British Asylums, and is not entnely aban
 did in some  of those of the United States.   A change, of  ca
                  .    c    •„;iom  the. shower-bath, ana omer
 Hon, the deprivation of a privilege, the snoue     ,
       .              *•   i„m;iH are often sufficiently effective.
 nunishments comparatively mild, are one.          ^
 P                   ,  •  ■>,    1 ™;i<5 and muffs, are still em-
 The "tranquillizing chair," and mits ana mu  ,
  ine      4       ©     o,1„_1i osvlums.   In the Connecticut
  ployed occasionally in nearly all asyiuma. 
144
 Retreat, as says one of the reports of that institution, "in case
 coercion and confinement become  necessary, it is impressed
 upon his (the patient's)  mind, that this is not done for the
 purpose of punishment, but for his own safety and that of his
 keepers."   "In no case," says the same report, "is deception
 of the  patient employed or allowed;  on the contrary, the
 greatest frankness as  well as kindness,  forms a part of the
 moral  treatment.  His case  is explained to him,  and  he  is
 made to understand, as far  as  possible, the  reasons why the
 treatment to which he is  subjected has become necessary.  By
 this course of intellectual management, it has been found, as a
 matter of experience, at our institution, that  patients who had
 always been raving when confined without being told the rea-
 son,  and refractory when commanded, instead of being en-
 treated, soon became peaceful and  docile."  Sir A. Halliday
 insists  upon the necessity of honourable and candid dealing
 with the insane, and urges the importance of the fact, that they
 are generally, if not universally, affected by kindness, while
 they never  forget injuries,  insults, duplicity or imposition.
 An appeal  to  the  sympathies of the most  maniacal patients,
 while, at the same time, a negative assent is  given to their
particular hallucination, is sometimes more  effective than pun-
ishment.  An interesting instance of this  kind is related by
the late Dr. Rush,  of a lunatic in the Pennsylvania Hospital.
This patient having frequently attempted  to set  fire to the
building, was expostulated with by one of the managers, who
endeavoured to impress upon his mind the effects of a confla-
 gration, such as he had attempted.   "But I am a salamander,"
said he.  '-Recollect, however," answered the  gentleman ex-
postulating with him, "'that all the patients in the hospital are
 not salamanders."   This  sagacious reply had the desired effect;
the patient desisted from  his incendiary attempts. 
 
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