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Un des symboles suivants apparattra sur la dernidre image de cheque microfiche, selon le cas: le symbole — •► signifie "A SUIVRE", le symbole V signifie "FIN". IMnps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dire fiim6s ^ des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seui cliche, il est filmd A partir de Tangle supdrieur gauche, de gauche d droite. et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes suivants lllustrent la m6thode. 1 2 3 1 2 3 4 S 8 h INSANITY, ^-. V / &-\o REMARKS ON AND THE MANAGEMENT or INSANE PERSONS. BY J. F. LEHMANN. PRINTED BY JOHN LOVELL, ST. NICHOLAS STREET. 1840. i^ i^' '^'OXTb^ (fir I 1 331 AY 17 1935 I !k REMARKS ON INSANITY, AND THE MANAGEMENT or INSANE PERSONS. BY J. F. LEHMANN. PRINTED BY JOHN LOVELL, AT. NICHOLAS STREET. 1840. .V PREFACE. T It MAy be a mailer oljust surprise, that a person unacquainted with the study and practice of medicine should have the boldness to com- municate his opinions and observations to the world, on the nature of insanity and the treatment of insane persons. But whilst the author begs ihe courteous r«ader to bear in mind the class of persons this work is intended for, he also appeals to the declarations of the most celebrated moral physicians, " that the communication with these "■ patients requires so many and various exercises, faculties and at- " tainments, that they cannot possibly be expected from, or afforded " by, a graduate in medicine." It is, therefore, his sincere wish not to have a comparison made between the remarks contained in the following pages and those emanating from the pen of any metrical authort If the humble efforts of the author prove at all instrumental In ameliorating the condition of these unfortunate beings, his wishes have been fully realized* I , PREFACE TO THE TRANSLATION. Some celebrated German physicians, passing sentence on this pam- phlet, expressed their satisfaction of its utility. This encouraged me to present it, translated, to a nation whose physicians arc the most celebrated for the treatment of mental diseases. But they will please recollect that a translaUon can never have the value of the Original. 1 am much indebted, and must express my most sincere thanks, to Dr. Edwd. Van Cortlandt, for the valuable assistance he rendered mc in imprOYins my translation. J. F. LEHMANN. Bytown, U. C, Ms^isty 1840. /V REMARKS ON iHfSAlVITY, AND THE MANAGEMENT OF f his patn- ! raged mc the most they will lue of the thanks, to ndered mc ANN. INSANE PERSONS. Whoever has had the opportunity of communicating with insane persons, or the misfortune to have such amoiigst tlie members of his family, v^^ill at once understand the (^' " * ■ -^ss arising out of such a conference, and the infinite J, , A self-possession required for enduring their d^ obstinacy, refractoriness and the various othv na of their d-sordered minds ; supposing that in their Uauucinations any traces of the existence and activity of mind is perceivable. Nevertheless, tolerating their caprices and humourB can- not and ought not to be aimed at, but the end ought ratfier to be that of opposing their capricious inclinations ; and the patients should be made to understand that they are wholly dependant upon, and must obey those to whose keeping the- are entrusted ; in other words, that they must make a virtue of necessity. The treatment of such patients, therefore, bears a great resemblance to the education of children, who, by habit, become peculiarly accustomed to obedience and attention, as well as a just use and reason- able application of their faculties (bo.h mental and cor- poreal) to a life of regularity and order. But the charge of the mental pliysician is far more dif- ficult, and his labour meets with a worse reward than that of a pedagogue ; inasmuch as the former, unli''c the latter, has not to form and unfold new ideas, but has to rectify confused and to dispel false ones ; or, to speak figuratively, has not to give direction t a sapling, but to straighten an older tree that has become crippled and crooked. Children, notwithstanding any difference in their respec- tive mental attainments, or the rank of their parents, may all be placed upon the same footing, as far as regards their general cultivation ; and can, consequently, all be instruct- ed in community, after a method answering and adapted to them, both individually and collectively. But what endless varieties and modifications do we discover in the ideas, sentiments, and propensities of persons of riper years in the case of insane persons. A specific plan must, there- fore, be entered upon for each individual, in order to lead him to consciou3ne8s,reflection and attention ; consequently, a particular method of moml mpnagement is required ; for, abstractedly, from that point every individual stands upon a different degree of cultivation, to which all his conver- sation and communiiiations ought to be adapted^ The causes of insanity are nearly as numerous as the subjects of it. These may all, however, be more or less brought under general rules, to wit : — Grief, fright, unre- quit-ed affection, jealousy, immoderate ambition, pride, ibss of property, religious fanaticism, excessive applica- tion, inflammatory and other diseases, &c. Besides tliis, the same patient may assume an entirely different chain of symptoms at the beginning, during the progress, and in the end of his disease. A change may also be effected in the md cor- lore dit- han thai le latter, y rectify ratively, hten an r respec- nts, may rds their instruct- iapted to it endless 16 ideas, years in St, there- r to lead 3quently, ired ; for, ads upon conver- ts as the re or less ;ht, unre- m, pride, applica- sides tliis, t chain of md in the ;ted in tiie ^.Jf' nature of the symptoms by occupati .n, exertion, and diversions j and on this head, a treatment of insane persons in community is r. ore applicable than any other, inasmuch as properly regulated exertion, by gynmastic, and various other healthy exercises and pastimes, in the open air, in- cites a spirit of emulation, and affords nourishment for the contemplative imagination. From the foregoing remarks, the reader will at once dis- cover that they are intended to prove the advantaoes atlbrded to ins?:,- persons by Lunatic Asylums, wherein tliey are subj ic^ced to proper management and treatment : for should it happen that a family, either from regard to- wards any one of its members so imfortunately afflicted, or from any dread of harsh treatment in such an institution, should object to his removal, nevertheless it is known from experience tliat the place and surrounding company where am' amongst whom the patient has lost his reason, are, of all others, the least calculated for effecting its restoration. On the one hand, the arrangements and materials are wanting to protect the patient from mockery, and the gratifying of vexatious and mischievous curiosity; as he cannot be so placed as to prevent the intrusion of strangers. On the other hand, it is absolutely necessary that his friends and those about him be secured from the effects of his vio- lence, and that the patient be removed to a situation where he can in no way prove dangerous either to them or to himself. The removal of nich a persoii from the bosom of his family, amongst whom he has become insane, (whether from neglected education, or arising out of anger, or the indulging of an arrogant and capricious behaviour,) and where he was more accustomed to order and command than to endure submission, and the transferring him to an asylum wherein lie discovers at his first entrance unknown h r |:n faces and the systematic discipline of the establishment, as well as the spirit of determination exercised by those in charge of it, and who at once compel him to obedience, must, inevitably, be attended with advantageous results.— How and in what manner he may there obtain the desired recovery, and how such an establishment is to be condi- tioned and regulated, will form the subject of our future consideration ; for the present suffice it to say that I do not agree unconditionally in the opinion of many physicians, that an establishment founded and supported by the vigour of government, is to be preferred to a private institution, from the fact that there are private establishments which command all the means and resources ol the larger ones, but in which it is not so often necessary to resort to them ; since, from the smaller numlx?r of patients they contain, greater vigilance can be observed, and the inmates more easily occupied and attended to, and thereby tiie paroxysm of rage can be more effectually prevented. It is true, in- • deed,°that the proportionate expenses of a private asylum are greater than in a public one ; owing to the disparity between the number of the patients, and the nurses and attendants ; but thi* is more than counterbalanced by the continual observation and attentions afforded to the msaue, and the stricter and more proper separation of them. When from seven to nine lunntics are living and sleep- ing together in the same room, it is evident there must be more or less hazard: inasmuch as, amon^the minor evils attendant thereon, the convalescent, at the sight of one of his companions in a state of fury, ordinarily relapses into his own previous aUenation ; a circumstance which clear- ly ought to be guarded against as mudi as possible ; and this objection applies to private institutions as well as pub- lic ones, where the former are overstocked with patients. i ft' hmcnt, r those dience, ults. — desired condi- future '. do not sicians, 3 vigour titutioii, which 3r ones, > tliem ; Dontain, »s more iroxysin true, in- asyhnn lisparity 'ses and I by the 5 insaue, sm. id sleep- must be nor evils t of one pses into ch clear- ^le ; and 1 as pub- patients. Nay, more, we may even excuse the objection in some measure, in a public asylum, where poor and indigCTit per- sons meet with shelter and protection, and for whom there is either no emolument at all, or at best something very ti'ifling ; a circumstance which would preclude them from a private institution. It may be inferred from these observations, that we con- ftider it advisable for the insane of opulent families to be conveyed to private institutions, unless, indeed, the objec- tions alluded to could be overcome by an extension of the public ones, for it is evident that such persons, both from previous education and refined habits, are not proper as- sociates for the illiterate and vulgar, nor can the desired recovery be expected where such persons are compelled to mingle at all times, both night and day, with plebeian associates, amongst whom are many of the worst outcasts of society. It is of little consequence, however, that any esta- blishment, whether public or private, possesses all the requisite measures and expedients, if it be wanting in the " genius loci^^ viz, in the inspecting, directing and admi- nistering department, and in well formed and strictly and conscientiously executed arrangements — such an institu- tion would bear no unapt resemblance to a goodly apple, which, although it might present every possible appearance of promise on its exterior, was, withal, internally a prey to the destructive ravages of the canker and the worm. Perhaps there is no situation in life where a reasonable application of our minds could be more necessarily and usefully exercised than in conversing with, and overlook- ing irrational beings, whom it is our duty not only to lead, divert and govern, but whom we ought to remove from darkness, and inspire, so far as may be, with the healthy 10 \i\ I iJ : light of a sound mind, nnd reinstate in their original posi- tion amongst their rational brethren. The times, certainly, are happily past when the unfor- tunate creatures were considered to labour under demoniac influence, and treated like wild beasts, being confined in cages, and there excited and provoked into fury to gratify the curiosity of spectators. By such treatment, and for similar ends, those in charge of them were wont to cloak their indolence, cruelty and insensibility. Notwithstand- ing, however; that these times are indeed past, we still occasionally find such a perservity of remedies, and so many conspicuous instances of want of reason in the manacrement and treatment of insanity, that it does not seem "superfluous to submit that often discussed subject to a new examination. Say, worthy and philanthropic reader, is it an instance of the " mens sana'' to confine a lunatic for five or six hours to an empty room, the doors and windows of which are closed and fastened, with nothing but religious books of a gloomy character to divert him ; by reading which it was supposed he could look into the recesses of his soul, dispel his sins and recover. Such was the ostensible intention, whilst the true motive con- sisted in the nurse's services beiiK^ turned to a more profi- table account in the household economy ; but, Exemph sunt odiosa! How can we hope for the recovery of a patient if we see him daily undergoing abuse and punishment, in the absence of his friends and relatives, but enjoying the kind- est and best treatment when they are allowed to visit him ; or how, when from seven to ten persons are compressed in a small and confined apartment night and day during the winter season, to save the consumption of fuel, and where, if the patients are occupied at all, it is not in ac- 11 \\ posi- 1 unfor- moniac ined in I gratify and for ;o cloak ihstand- we still and so ; in the :loes not ibject to z reader, I lunatic )ors and . nothing ;rt him ; into the ', Such tive con- Dre profi- Exempla ent if we t, in the the kind- k'isithim ; »nipresscd ay during fuel, and not in ac- cordance with their individual faculties, abihties and wants, or wilh a view towards effecting their recover}'-, but only to the utility and advancement of the institution ? These are phc omena which may be discovered even at tlie pre,?ent day, notwitstanding the vigilance and atten- tive inspection of the police, which, especially in Prussia, aims at preventing abuses and the misemployment of proper measures in this regard. But how can the spirit of benevolence be impelled into an institution, when the semblance of it only was assumed at the time of applica- tion for permission to found an establishment, where " They raise the word of promise to the ear, but break it to the sense.'* Learning and knowledge are not of themselves suffi- cient for the entire control and establishment of a Lunatic asylum, or, otherwise, the most learned medical practi- tioner, or he who has studied the various branches of me- dicine, and consequently of the physical sciences, would, of course, be the best moral physician. But he who arrives at conclusions from the analogy of human diseases only, and who knows, simply, that de- pression is effected by the administration of large doses of Belladona, Hellebore and Camphor, and by continued cold effusion ; and that excitement is brought on by a stimulating dist, Wine, Beer, Ardent Spirits, &c., is, clearly not the person to be entrusted with the treatment of such patients. For what would be his demeanour if in the presence of a lunatic patient, providing he had no previous opportunity of observing the nature of the disease ; or^ in other words, what would be the plan of treatment adopted by such a person wanting experience in such a case. Suppose he were in entire possession of the nosological Table of the gifted Heinroih, (wherein this latter has, with the most marked acuteness andtalent,disposed of the various modifications of 4^! r^ li m: (1' h m disordered intellect) notwitstanding that he might form new genera, yet withal would he return to the primitive causes to he enabled to discover the more distinct and clearer phenomena of the disorder. And yet it is decidedly ad- visable that he should not defer the medical treatment of his patient, lest by so doing, the disease should take root ; for the Methode Exptciante of Pinel, cannot be resorted to until after all other measures have been tried in vain. But it is not immediately with the physician, who is most aptly styled the soul of such an institution, that I have reference on the present occasion, since he has studied, and is fully aware of all that is required, and by proper control and correct reports from his subordinates, knows what measures to adopt for effecting the cure of his patients. I, here, only intend to address myself to the subordinate officers of such an institution, whereby I comprise the surveyors, superintendants, keepers and nurses. In accordance with Prussia's enlightened laws at the Charity Hospital of Berlin, under the direction of pro- fessors Kluge, Dieffenbach and Gedicke, the nurses are properly instructed, and gi'eat care is taken to secure a diligent superintendance of their education in this im- portant service. Therein they are perfected in every thing belonging to the attendance and support of the sick, and in whatever can afford them assistance and protec- tion, and, what is of paramount importance, they have an opportunity of becoming practically acquainted with the nature of diseases at the bedside of the patient. Notwith- standing all the advantages thus afforded, yet, as the treat- ment of insane persons, and the intercourse with them, is something sui generis, I trust that these remarks may be instrumental in affording some information to those into 1 •m new causes clearer tdly ad- ment of te root ; resorted i vain, who is , that I he has and by rdinates, cure of lyself to lereby I ers and ^s at the of pro- jTses are secure a this im- in every the sick, d protec- f have an with the Notwith- the treat- li them, is :s may be those into 13 whose hands they may chance to fall. In this, however, I do not mean to apply myself immediately to any person of office or dignity, but wish to be understood as making the remarks generally, and that my observations are in- tended for all those who are engaged, and whose calling it is to be occupied with such patients, especially such as are so circumstanced as to influence the patients, more or less, from the nature of their situations, to wit ; the direc- tors of private establishments and the superintendants of public lunatic asylums. The objects to be kept in view by such persons, in order to effect the restoration of reason with insane persons by those who are entrusted with them, are : I. TO OBTAIN THE CONFIDENCE OF THE PATIENTS. This may be effected, 1. By the superintendants or keepers possessing some knowledge of the diiferent forms of insanity. It is not, of course, to be expected that they can judge and act in strict accordance with the rules of art and science, or the etiology, symptomatology or diagnosis of their patients, for such would require a thorough acquaintance with patho- logy and therapeuticks ; but a knowledge of the more im- portant parts of these different sciences is indispensably necessary. For supposing, of course, that the directing (we say directing physician, because the keeper must necessarily assume the oflice of physician on various occa- sions,) physician be not always at hand, what is lo be done during his absence, when a patient is suddenly seized with a paroxysm of fury ; or when he that is lying in chains and fetters appears to have returned to conscious- ness and implores his release ; or what steps are to be pursued when a sudden vomiting or bleeding from the nose I jii r- ■I'l 14 «,me9 on, or an eruption is making it. appearance ; or X mea ures have to bo adopted, when a chan^ m tho Torbid phenomena themselves takes place; when, for ^Inee! a patient, until now depressed by gnef, becomes rrmy wM and furious ; or, on the contrary, when an exid and frenzied patient sinks into apathy and glooml S pe,.on who woxid allow such all important pheno- , rls by unnoticed and unattended to, would be Iwe oiyTo an ignomnt and inexperienced tra- :rr w ented upon 'a wrong path simply because e !w nit read the words written upon the direction post. I suchtalr hints thrown out by nature are disregarded Id not Ltan ly a.^nded to, it will be found very diffi- cuJ nav often impossible to return to the right track and t^: "h ;M. i-noiLce and inattention, the patient .s al- red o relate into his unfortunate condition out of XcU we have fruitlessly endeavoured to draw h.m, and It wXl failed, by not acting in harmony with nature, when she extended her hand to our assistance. It is not my intention to explain here, specifically, the diLnt phenomena of disordei^d mind, or the correspon- SureaLent, although it isagreatdosideratumthas^^^ a work had a place in our literature, (or, as la as I know, amo gst the m' ny works published on insanity there is Tany detailing separately the ''" ^^^J^^ sures to be adopted in the various forms of the disease s"ch a work Im serve as a useful guide to many, not even CKceuting the experienced physician, who, notvvith- ZL his p ofound knowledge of the disease, mjght stiU have ciualties to contend with in his practice of a des- cription which before he was a stranger to, and knew not ho vto manage. If there be such an mnmiierable ho* of corporeal ills, to how many gradations and mod.fica- M' 15 :e ; or in tho 311, for icomes len an gloom 1 pheno- Duld be jed tra- ause he 3n post, regarded ;ry diffi- ack, and ent is al- 1, out of him, and ti nature, cally, the ^orrespon- that such Ls I know, r, there is itive mea- le disease, many, not 0, notvvith- |^ , might still [ , of a des- [ knew not lerable hoirt d modifiea- ions of disorder is the human mind subjected, in various individuals, and how important would such a production be, if written with due circumspection and evidenced and illustrated by suitable cases. But it is not enough for the superintendant or keepers of an asylum to know the forms of insanity only, thef should be thoroughly acquainted with the entire individu- ality of their patients, and this should, if possible, be ac- quired before their reception into the institution. Although from his versed eye, the superintendant, at the first glance of his patient, will commonly know how such a person is to be treated and managed, whether with severity or mild- ness ; yet it happens on some occasions that he is but too easily deceived, since, from the cunning peculiar to insane persons; a deceitful character may be assumed by them which will throw him off his guard, and induce him to adopt wrong measures ; a circumstance of the greatest importance, inasmuch as the first impression ordinarily remains indelibly stamped upon the recollection of the patient. As it is absolutely necessary that a proper tone and bearing should be evinced towards the patient from the beginning, both by the physician and superintendant, they ought, therefore, to be made acquainted with all the circumstances connected with him, in detail, viz. his cha- racter, temperament, communications, education, cultiva- tion, his peculiarities, propensities and faults, as well as the causes and phenomena of his disorder. There are some gestures, words and phrases which of themselves often serve to bring on a paroxysm of rage, when evinced or uttered before an insane person j the disagreeable discovery of which might have been avoided by a timely notification. It may appear that these are trifles, but they are in fact of the very greatest importance, b2 r^ ,i„ce the regard or aversion of such a patient to his keep- ers or others surrounding him, hinges upon it. It is 2Z of no less imoortance to regulate the society of m- "lons, since "they either part.Ue of the syniptonis of their companions, or out-general their nurses. To confine r Jh idiots' on,y, or to assign the .aine a^a— entirely to meianchoiics or frantic p« .^d^h rlearlv erroneous : and yet 1 cannoi aunu a ;ln depressed by unfortunate circumstances .vith another in a state of absolute fatuity, lest, by such a ^P, the former may sink into the more piteable and unfortu nate condition of the latter. • „» ;„ ,he The same caution should be exercised m the appottment of nurses, especially in P^"'-— ™ : where the patients are almost perpetually either convers Tn. :'ith them in the house or walking with them out o : To a person of advanced age and oprvessed by in firmity. a mirthful, buoyant, but not ^ooy<^^^-^_ -" ^^ -"^rs/rii: 'T^z:::::^-^^ iLI'r.ltf^lsimagin.^ natient in mechanical operations. A visional y lu HTnot be associated with a silent - -served aU^nd- ant, who can very easily be =^ J-^J^'-^rlr: because he possesses all the resignav.o i -p .-^ their endless b-'le and tormenting questions. Egotists "n self sufficient persons, fond of publishing their own inments, and persons of an argumentative or d.sputa- Tus Za ter, as' well as indolent adventurers, whocan- rotherwise btain a livelihood, are utterly useless fo^ notomerwib u .wrfore becomes necessary this important service. " '■'« 1 I i 17 is keep- It is a :y of in- ptoms of 3 confine partment vould be ssocialing ices with h a step, [ unfortu- l in the istitutions, : convers- em out of ;ed by in- hful nurse be attach- ; and to a ih abstract ind conver- iteresttohis ary lunatic ved attend- illy patient, •ed*o endure s. Esotistjj I or their own I 3 or disputa- | jrs, who can- i [ useless for | les necessary j that we should possess a knowledge of the patient ah initio^ in order that a proper plan of treatment may be en- tered upon, and a suitable sphere chosen for him at once, to save a subsequent change of society, a proceed- ing often advisable and sometimes absolutely necessary. 2. To the due attainment and custody of his patient, it is also necessary that the superintendant should be an en- tirely and thoroughly educated and well instructed person, and one who is able to enter into all the ideas of the patient, as well as to converse with him unhesitatingly on all his more interesting topics, without, of course, expect- ing that he should possess the knowledge of everything " in succo et sanguine,''^ By shewing the patient that he is thus conversant with the different branches of his favourite studies, he acquires the power of gaining his con- fidence. I need hardly here state the necessity there ia for always agreeing^ with the patient in his favourite no- tions, since anything like contradiction or refutation could Berve no other end than that of making the patient more headstrong and pertinacious in his opinion. But for the superintendant, en the other hand, to maintain absolute silence towards his patient, v/ould be to place him on a level with his nurses and keepers, who are certainly cor- rect in general in keeping up no protracted convei*sation with those entrusted to their care and protection. The mistaking or not comprehending of a single word, renders the patient irritable and angry, whilst, by the aid of addi- tions and explanations to his ideas, we please his imagi- nation, and acquire his esteem and confidence, and that to such an extent as on some occasions (but which are to be closely and carefully observed) to admit of his being contradicted, and at thi« period of his disorder, the patient becomes persuaded that although we do not possess tlje IB full force of his knowledge, we can, nevertheless, duly appreciate it. Amongst other insane persons in my establishment were three, one of whom liked to converse continually about warfare-he had been an officer. The second chose philo- sophy as his topic ; whilst the third, a well accomplished young man, (a tailor by trade and ignorant only of his caU- inOif he could procure paper and pencil,amused himself m composing poetry, and then reading his effusions to me. The two lat'ter have recovered, and have continued m sound mind ever since, now five years. To the philoso- pher, I shewed that I was at least partially acquainted with the different systems and not altogether ignorant of its history. For the tailor, I composed some poetry in return for his, but in which he discovered some errors. Yet, nevertheless, he began to esteem me for the attention I paid him by my production. On his poems I never ventured to mss censure, nor did I extend to them either my assent or dissent, being in fact simply and only an attentive hearer, and notwithstanding that I afterwards altccether deprived him of the opportunity of versifying, considering it in general as pernicious to his health and as the cause ef his malady, he was withal satisfied with my decision. ^ m •„ ^r Dacquin's opinion, « Ilfaut Strefou avec eux, is oi some use, but in its exercise we should take especial care that we do not lose our own authority, or forfeit the pa- tient's respect. Another proof of the advantage to be derived from entering into the ideas of our pa- tients, is shewn in the case of a Turkish Grand Vizier, who fancied that he had an insect perched upon bis somewhat prominent nose, and which was a source of perpetual annoyance to him. Some of his physician* 1 ,•1 I J, duly ntwere \f about e philo- iplished his call- mselfin to me. nued in philoso- quainted orant of loetry in e errors, attention I never jm either I only an fterwards ersifying, ith and as with my ta?," is of lecial care it the pa- lage to be our pa- sh Grand jhed upon IS a source physicians 19 tried to convince him of his error by placing a mirror be- fore him and other such methods, but, as was to be ex- pected, all in vain, for His Excellency considered them all to bo blind. As the recovery of this important person was of great importance to the State, they sent for a prac- titioner from Vienna, a person celebrated in this descrip- tion of diseases, and who, on entering the chamber of the Vizier, suddenly exclaimed, " for what purpose has your Excellency got such a large insect on your nose ?" at last, replied the delighted and astonished Vizier, there comes a reasonable man, and willingly submitted himself to the preliminary steps of an operation — the plan succeeded, and they shewed him an insect pretending to have taken it from his nose, and effected the recovery of the august patient. This procedure is not new, and is often adopted and attended with beneficial results— It shews us how far it is profitable to enter into the ideas of the patients, to ac- quire their confidence, and thus to pave the way to a po- sitive and lasting influence over their minds. 3. The superintendant should moreover be always prudent, cautious, temperate and vigilant. He should never be lost in absence, nor absorbed in reverie — in one word, he should be a person of sound mind. But as an absolutely healthy state of mind is not to be expected, since cares and sorrows can instantaneously depress tiio spirits, in the same way that joy and agreeable emotions can exalt them he ought to have -nuired by practice, and e^cercise as much self control as will keep him from exposing his weak points, at least in the presence of his patients. He should especially exercise caution and cir- cumspection, inasmuch as whoever would lead and govern others, should previously have learnt to govern if 20 himself. If ihe superintendant is very loquacious, and likes to hear himself talk, he will, were he ever so well educated, often utter absurd things, which cannot fail to be prejudicial to his ptient, and have, moreover, fre- quent occasion to repent bitterly many of the words and expressions which escape from his unbridled tongue. If he does not possess sufficient strength of mind to behold the most absurd deeds and obscure actions, committed without betraying any change of countenance, he will either injure himself by sinking into apathy, or his patient, by acting inconsiderately and thoughtlessly, and under the first transports of anger resort to measures, which on re- flection and in cool blood, he will readily detect to be most perverse. That under such circumstances, he should sometimes grow angry, scold, and evince great determination, is quite natural and generally suitable, provided that he always maintains his reason, since, amongst other good effects, it causes him 1o be feared by his patient. The superintendant who considers the poet's remarks to be correct, viz. " That he who does not, on some occasions, lose his mind, has none to lose," is most certainly not adapted for the important office he assumes. That the superintendant should accustom him- Belf to such scenes is quite correct, but it is likewise ab- solutelv necessarv that his license does not extend so far as to give rise to positive indiOerence. A uniform pro- priety of conduct, tranquillity and calmness, may be ac- quired by sobriety and temperance in his enjoyments, especially the former— at all events, the use of stimulating beverages, which give rise to excitement and anger, are to be avoided ; since, when under their ebullitions, we see objects with distorted vision, and are unjust in the application of the means placed at our disposal. Trifle/j> I )us, and so well )t fail to )ver, fre* ords and igue. If o behold ammitted , he will IS patient, under the ;h on re- tect to be mces, he nee great suitable, jn, since, feared by iders the who does 3 to lose," office he stom hiin- ewise ab- 3nd so far iform pro- [lay be ac- njoyrnents, stimulating anger, are litions, we just in the 1. Trifles^ 1 I under such circumstances, are apt to ruffle our tempers , and give rise to action^?, which, in our sober senses, we would not have thought of; besides the great impropriety of committing them before our patients, and by whom it is too dear they should not be seen. If the patients dis- cover that the superintendant has been drinking ardent spirits, (which they easily may detect by smell,) they will most certainly make their animadversions thereon, and this in an increased ratio to the efforts made to con- ceal it. As any infirmity, of whatever nature, is at once detected by the patients, it follows that the superintendant should not onlv be attentive to them, but be especially circumspect as' regards himself. He will moreover de- rive great benefit for the establishment of his character and his disposition by such a line of conduct. As in many instances fathers and tutors are led to self consciousness by the questions of their children and pupils, and discover thereby how incorrectly they have reasoned on some subjects, and how entirely they have overlooked others, so, in like manner, do we become trans- ferred, by the questions of insane persons, to regions, where, in order to satisfy them, the very greatest versa- tility and circumspect" ^n are required. As has been before remarked, the treatment of such patients bears a great resemblance to that of the education of children ; in like manner both^afford similar results: they make us more attentive to our faults and errors of judgment, and infuse into us a greater love of order Tutors and fathers who were before not so precise in the regulation of their houses, are now obliged to accustom themselves to a regular and strict diet and regimen, if they desire (as ought to be the case,) to set a good example. Discip- line and manner in language and action, are more strictly f^-^ ^ 22 observed and involuntarily, and almost imperceptibly, they become more diligent, steady and circumspect. The prayers and other religious exercises are fulfilled with greater accuracy and consciousness, as they are required herein also, to set a good example to those who are allotted to them by Providence. In this way they be- come more pious and better, and more agreeable to the eye of God: advantages, all of which may be appreciated by the superintendant of a lunatic asylum, if he only reflects on the circumstance that the unfortunate beings confided to his care by the special allotment of Divine Providence, are to be protected and saved, not only from a bodily, but as well from a moral death ; unquestionably such a person devoting his time and attention to worldly pleasures, is acting in opposition to his noble calling and entirely at variance with the nature of his situation. Such conduct would be like erecting a solid edifice upon an unfirm foundation ; and which would no sooner be constructed, than it would fall assunder, owing to the yielding nature of the soil. Amongst other evils arising out of such an irregular life, on the part of the superin- tendant, will be distress for want of money, uneasiness of mind, reproach, weariness of life and indolence or entire negligence of his duties : which disagreeable attend- ants he will in vain attempt to dispel, by resorting to new dissipations and diversions and from which no good can possibly accrue. " Love engenders love, and esteem begets esteem," If, in accordance with the above, the superintendant bears in mind that his life and services are to be entirely devoted to the welfare of his patients ; if he remembers that as well as himself, these unfortunate beings are also made after the image of his Creator, and, as our brethren, worthy of our compassion and love ; and I I ceptibly, ct. The led with required who are they ba- le to the preciated ' he only te beings )f Divine :)nly from jstionably ) worldly illing and situation, ifice upon sooner be ng to the ils arising J superin- jneasiness lolence or )le attend- ing to new good can rid esteem above, the id services J patients ; in fortunate !ator, and, love ; and i ■s i 23 if, moreover, he reflects that they have often fallen guilt- less into their pitiful and dismal situation, whether from neglected education, organic diseases, reverses of fortune, or some unaccountable dispensation of Providence, he will try, by every means in his power, to effect for his unfortunate sufferers, the restoration of their lost reason. It is an object of pre-requisite importance, that the superintendant should exercise humanity; not in its common and accepted sense j to wit, a polite, kind, and pleasing behaviour, such as is evinced in our conversa- tion with strangers, and by which we recommend our- selves to their notice ; but by it be it understood, what- ever is qualified to raise man to that level for which he was originally destined by his Divine Creator above all the other creatures of the earth, and where he is sup- ported and retained by the agency of his reason and free will. He should exercise it with that Christian senti- ment which comprehends love, forbearance and trau- . quility ; and thus, by the united influence of his reason and his understanding, he will effect complete self-domi- nion, without which he never should aspire to control or govern others. For should it so happen that he cannot control his own feelings, or entirely suppress his anger in certain cases, he will, as already remarked, expose him- self to the railleries of his patients. It, therefore, be- comes a matter of great difficulty to participate in any of their p^f^asures, unless we are rewarded, in doing so, by clearing up and breaking the tormenting hallucinations of the patients, even for a short time, A certain degree of resignation is always to be observed and exercised. Thus, I played at billiards with one of my patients every second day, and although I played better than him, I took care that he should win at least as many games as I I I )rnc in mind, Jing he may conversation with rational nily ; to one Lirs, we may s inclination, lose who arc ing, we may n dishes, and ons, whether &c. we may mens in the y a degree of 3 patient, and ;lt towards us ppy position considerately? )ns have pro- not see liis jmoui ? And 'olent feeling not been hi- 3 expected in his assertion, began to be- Qportioned to iring the first different rout ledid not like followed j on rection oppo- 33 isite to the one I had made choice of, this circumstance arose from giving way to any whim or caprice which might casually occur, and to which he was greatly predis- posed, an event which could not fail to be very disagree- able to me, inasmuch as it thereby became necessary either that I should follow him, and absolutely renounce all influence I had over him, or that I should expose my- 1 self to a conflict, which chance or force of circumstances would decide, for I had often heard that he was an adept at pugilism ; what was I to do under such circumstances ] I If I had the worst of it, I might depend upon my patient laughing at me ; however I risked the undertaking, and fixing my eyes sharply upon him, at the same time seiz*^ ing his hands, I ordered him with an authoritative voice to follow me immediately ; as he had not been accustom- ed to this style of language from me, this being the first and luckily the only occasion on which I had resorted to it, he was quite terrified, nevertheless he made some steps backwards with a view of eluding me, when I seized him again, and although he resisted me greatly, I grasped him so firmly, and held him with such determination, that he at once discovered he was too weak for me ; he therefore tried an expedient he had formerly found effectual with other conductors, throwing himself on the ground. In this situation I procured the assistance of some persons pass- ing at the moment, I had him tied and placed in a wagon. After his arrival at the institution I caused him to be punished, and he never repeated the experiment. I re- gretted greatly that it was necessary to have recourse to such a severe measure, fearing i might thereby alienate him from me for a long time ; fortunately it was attended with beneficial results, since from this time he feared me, and knew fully how to appreciate my strength when he n ill' ■t f 1 1 I'.' ji 1 i'i i i 34. contended with me, a most important circumstance on the negative side. In his own house and surrounded with nurses, of course, a superinterdant will not degrade him- self by putting on the straight jacket, or inflicting any punishment with his own hands, he must cause this to be done by keepers or other subordinates— all he ought to do is to order and instruct. It ought to be generally underetood that the patient should seldom be allowed to make any appeal for a mitigation of the sentence, and when the punishment has been ordered by any superior officer, it should be considered absolute and irrefutable. Patients are unceasing in their complaints and invariably resist more or less performing any duties required of them, be- ing always to a greater or less degree at variance with the nurses, and others by whom they are surrounded. As they very seldom like to take medecine and still less to be blis- tered or bathed, they are, consequently, always prepossess- ed against the physician, whom they in like manner dread more than any other person. As he is less frequently amongst them, he does not suffer much in the loss of their affection ; the main point is to have established fear, and this is soon effected when the patient discovers that his orders are executed most punctually ; and the conscious- ness of his being the most authoritative person connected with an institution, is sufficient to keep the dread requir- ed, and this knowledge further leads them to excuse the measures of the superintendants, since they can enter on no arbitrary step, without the order or sanction of the physician. In like manner the nurses are subject to the control and authority of the superintendants, and great care should be observed that harmony and concord exist between all the officers and subordinates of such an insti- tution, and that all orders emanating from superiors are matance on ounded with 3grade him- iflicting any se this to be ' ought to do ' underetood make any i when the or officer, it )* Patients 'iably resist f them, be- ice with the ed. As they s to be blis- prepossess- anner dread 3 frequently OSS of their d fear, and ers that his conscious- connected ead requir- excuse the n enter on tion of the >ject to the and great cord exist h. an insti- )eriors are 35 punctualb^ and faithfully obeyed by those in office under them. The patients at once detect any undue exerc se of at the m^scamage of any project or experiment in another The supenntendant of a lunatic asylum, as well a th. nurses and keepers, should be engrossJd entVely "^^^^^^^^^^^^^ patients, and he, who whilst managing or insnecZ . . k persons, enters on the performance^'anT othe;^! h.s attention diverted and cannot observe he fa^'^ folhes committed by them, and if a keeper, nstt^^^^^^^ tending solely to a patient, sits down t'o ead a bool affords the patient not only an onnortunitv nf . they may occasionally follow it, inasmuch a ff prove of service ho'h »,, ,1. 1 ""**'""«" a» it may growang^ and excited, if asked fo'l^oi^tt^t management of critical ca«P, . ■ ^ " "'^ natelv bn„.„ ,:.:, '*'"!' =" «="-<="mstance vnfortu- • .uivl^ lu occur Irequently. /^ u ll ; ! f i:1 n I ;i 1 ¥ 36 It is certainly proper that he should keep pace with the improvements of the age, write down all that is of import- ance, become acquainted with the daily discoveries and inventions which tend towards effecting an easier and na- tural, surer and more suitable treatment of insane persons, and as far as may be, exercising them for the benefit of his patients ; he will find, however, sufficient time to prosecute these enquiries either early in the morning or after the patients have retired to rest in the evening, since the visiting physician will have too much to engage him, and connected purely with the patients in the institution, to admit of his imparting a knowledge of all the recent in- ventions ; but he may easily arrive at this end himself by the combined efforts of his experience, observation and application, provided always that he has an earnest love for his noble calling, and possesses the requisite cultivation and versatility, to use and apply correctly the suggestions afforded him by the medical practitioner, and has the fa- culty of noticing the patients closely, as well as valuing their expressions, language and gestures, from all which he will be enabled to impart a sure and correct method for the moral manngoment of insanity, and perhaps he would be the best qimiified to lay down rules and regulations on the communication with such patients ; as he acts only morally whilst his medical adviser officiates in a material on somatical wav. Physicians have of course various opinions on insanity, as is sufficiently manifested in the different asylums where the plans of treatment are entirely at variance with each other, but it is not now my intention to examine into the respective merits of either, whether he who lays most stress upon the somatical, or he who approves most of the moral plan of treatment is most correct, although I cannot ) pace with the lat is of import- iiscoveries and easier and na- insane persons, le benefit of his ne to prosecute ig or after the ing, since the igage him, and institution, to the recent in- 3nd himself by )servation and m earnest love site cultivation he suggestions ind has the fa- ell as valuing om all which ect method for :iaps he would regulations on he acts only in a material is on insanity, sylums where nee with each imine into the ho lays most es most of the ough I cannot 37 find so wide a diflercnce between them as some pretend does ex.t, masmuch as the bodily practitioner infl" he mmd ^algre lui, and the moral physician exercTeH correspondent power over the body in like manner as mtd and body ai-e so mtimately connected that one cann^be affected vvithout sympathetically affecting the X j' general, I think however the best plan a m'edica man ca^ adopt, . after having examined the symptoms and cause of the disease, to confine his treatment i articularlv to T body provided that he knows the patient vX pW ^^^^ .tuat.on wl.re he is only required to convey st^t^^^^^^^^ concen.ng the moral treatment, and has the com Z that the communication, attendance and guidance o a " cumspectwel educated and kind superint:3ndant, ^ p " severe w.h and finish effectually what he hascomrence , If even the disease is dependant entirely upon maS causes, if there should exist pain in the bowerd^er^ nation of blood to the head, and other ^^2l'^ wlu^therthe disease is deenda^:;^^^^ owing to suppression either of the menses !h 7 n . wldch the physician will have to^~;^2^^ removal of the excitmg cause, but will only recover healthy tone gradually , the instances are unfoLre ! V numerous vvhere the functions of the body CLm^ pletely restored, and yet the infirmJh^ .f • , very long after ; but the rel noS™ H™" 7""-' wrong moral measures, chiefly denenrlnn. 7^^'^^^'^" ^^ -lection of ■^r.,,.^^.o:'l!Xtt!l5:, T '" occupation., can spare time to walk out with (he nntient .! to .0 constantly .vitl. hi. as i. nece.a,y tt oXtj ' n mt 38 divert his attention, and fix new and correct ideas in his disordered brain. It is in his absence, consequently, that the moral manager can lead the patient to consciousness, by alternately convincing and instrucliiig, warning and threatening, rewarding and punishing, and thus by perpe- tually exciting him, dispel his hallucinations and restore him to reason, whilst i is always to be the task of the physician to assist the infirm patient somatically, to restore his shattered nervous system, as well as to remove all su- perabundant excitement. As I before remarked that every patient should be treat- ed according to a different method, so would I give it as my opinion that no patient should be committed to a pub- lic asylum, al least for some time, if there w^ere means for supporting him in a private one, unless indeed he was of so corrupt and abandoned a character as to render it dan- gerous that he should have any communication either with his equals or even with persons more corrupt than him- self. There are occasionally cases met with where the pa- tients wish to become pensioners on public asylums where- in they are committed, but the intercourse they there have with other persons cannot fail to be attended with prejudi- cial results from the influenc<^ they exercise over their companions, the intrigues and plots hatched by them, and in which they assume the leading character, withal pos- sessing sufficient adroitness and art to elude the vigilance of the attendants, and thereby obtaining much advantage. This wayward sort of life has a charm in it for such a vil- lain who knows full well that if dismissed from the insti- tution, he has nothiri'^ to look forward to but an existence replete with pains aiid sorrows, and that he must provide for a starvmg family. If the humane physician thinks it his duty to act upon such a person in a moral and religious I ect ideas in hia nsequently, that consciousness, g, warning and 1 thus by perpe- ons and restore the task of the ically, to restore D remove all su- should be treat- uld I give it as mitted to a pub- were means for leed he was of render it dan- ition either with rupt than him- 1 where the pa- asylums where- tliey there have }d with prejudi- cise over their d by them, and er, withal pos- le the vigilance uch advantage, it for such a vil- L from the insti- ut an existence le must provide sician thinks it 'al and religious 39 way and with a view to change his character, the patient knows well how to dissemble and for a time to deceive hm • he confesses his sins, he evinces signs of repentance, and makes fair promises of improving his way of life, but shoula any particular transgression be subsequently discovered, he is not only puni.hed for it, but likcvvise de- dared unrecovered, and it is unfortunately not to be ex- pected that such an institution should alter the wiiole cha- racter of such an individual, and change him from a vil- lam to an honest, upright and virtuous min. Such a per- son should, when detected, be removed a. once fromTe institution, but not conveyed to any situation where he can have free intercourse with rational beings; the fittest abode would be a house of correction conducted on he American principle, where he would be kept in solitary confinement, and at constant hard labour There are many physicians, and amongst them some cdebrated ones, who are of opinion that mental disease a e the offspring of sins, especially of pride and sensuali- y. I have, in the introduction, named what I considered the chief causes of insanity, but although I do not here venture upon adenial of these two passions being very of! ten the cause, at the same time I consider that a greaLle- ion, in general. The idea of sin is very relative, no ml being without sin, according to the scriptures. 4oT^i have smned and come short of the glory of God "and ogam^^the imagination of man's ,eL i evil t^t ' but^it'f tT '"^ ""'""' '^ '^" itself beyond this isnothing, but It IS the views taken of sin by different individual ;nce one may consider a casual tiLgression a r ,' • sin, which another may look upon as a mere tri/e. He ^Pf= m h fj.^i I, i i t! i who feels more acutely and with a refined degree of sen- sibility, will detect an action to be criminal, which to an- other may appear comparatively harmless. The first, we say, has increased nervous developenient, or fine nerves, and the latter blunted, coarse, or obtuse feelinjrs. 2, Experience entirely subverts the assertion that the more sinners (^^ e. the more malefactors, with design) the more lunatics. Horn the celebrated physician of Ber- lin, affirms something to the same effect, viz. that moral corruption, by leading to reflection and self communion, predisposes us for committing crime, at the same time that it induces the perpetrator to conceal them as far as possible. Such a state of tension in the powers of mind, let their ends be ever so corrupted and criminate, is by no means calculated to favour the evolution of these diseases, but much rather to prevent them. In another section he continues, were this the case there would be a larger num- of houses required for lunc "cs than for criminals, since the majority of prostitutes in the large towns, and who are exposed to so many virulent diseases, would become sub- jects for lunatic asylums. On the contrary, however, we find females of spotless character and unl^lemished reputa- tions are infinitely more frequently the inmates of such institutions than their more currupt sisters ; persons, quiet- ly engaged in domestic afiairs, females of honest demea- nour, and the purest morals somewhat however advanced in life, or if they be young, 'tis when they have become widows, or when they have been shutout from intercourse with the world, as nuns, &c. and are placed under circum- stances which debar them from gratifying sexual desires, but yet without any co-operation of guilt or sin. As an instance in favour of this assertion, I will here relate the case of a girl twenty-four years of age, of good repute, and degree of sen- I which to an- The first, we >r fine nerves, ings. ertion that the ith design) the sician of Ber- '\z, that moral f communion, [le same time them as far as wcrs of mind, inate, is by no these diseases, ler section he a larger niim- iminals, since s, and who are 1 become sub- hou-ever, we iiished reputa- mates of such )ersons, quiet- onest demea- ?ver advanced have become m intercourse inder circum- ?xual desires, sin. As an >re relate the )d repute, and 41 who supported her poor motlier, brothers and sisters by sewing and embroidering, whom a frivolous and corrupt iad pretended to love ; he promised to marry her, but only with a view that she would consent to his gratifying hi. lust. He however though failing in his bad intention, never- theless secured the girl's affections ; she loved him most ardently and hoped to alter and amend his life and conduct. Finding himself thwarted in his design, he relinquished his object, and exposed her to the scandal of a small country town. Her sedentary occupation and removal from the con- versation of other men gave rise to some derangement in he stomach and bowels ; a predisposition to insanity was here set up and it only required some powerful emotion of the mind, that existing in a loving and finally disdain- ed, abandoned and perhaps Insulted girl, todevelope it fully. f that g,rl had sinned, no bodily malady (at least at t) e beginning, would have been developed, and frivolousnes, would have enabled her to support the consequences of her fault with an undisturbed mind. This girl was cor- veyed to a public establishment, and had she been th ^e reated in the same moral way as the con-upt and disorder- ly prostiutes, how great and striking would have been the mistake? and how unhappy the consequences to her on the restoration of reason, to find what a degree of injury has been inflicted on her unblemished reputation. It IS as before stated, indispensably necessary that the superintendant should become acquainted with the „di! viduahty of his patients, in order to adapt his san tar measures .hereto, for if we arrive a. c/nclusiorf he appearances presented by the disease in its JZ ag s as to the character of the patient, we ar^^ cfe - "tdu-ging in error; persons of the best educa ion !n. connected with the highest families, are oftSllt /w^ 42 the condition of beasts, and make use of such language and expressions as is not to be equalled by persons fre- quenting the lowest haunts of vice and iniquity. These should always be overlooked and forgotten by the super- intendant, as they are by the patient, who would blush and evince tokens of the greatest shame., when reminded either by his own cruel memory, or when represented to him by another patient under the workings of malicious rage. On this account it has often proved a source of sorrow and surprise to me, to find a number of patients compressed together in the same apartments. I do not pretend to deny that the more various the description of the surrounding company, conversation, &c. in order to contrast more widely with the lunatic's former situation, the better for the patient, and the more likely to be attended with beneficial results ; for whoever has hereto- fore lived secluded and for a selfish end, and who is con- tinued in the same situation, has but a small chance of being restored to reason ; or if a man of influence, for ex- ample, and who has been accustomed to order and com- mand, cannot be expected to recover if marks of honour and expressions of submission are paid to him whilst he is insane ; such persons, therefore, can rarely be cured, except in the lunatic asylum. Conse- quently Horn may be correct whc.i he remarks that a lunatic asylum must be so conditioned, that a healthy person residing in it would become foolish, or as Reil en- thusiastically observes : "The reception of a patient into a lunatic asylum may be attended with the thunders of artillery, he may be carried during the night over a drav^^- bridge, he may be received by negroes, subsequently led into a subterraneous dungeon and placed in a bath teem- ing with disgusting reptiles and fishes." If such scenes f 1 language ersons fre- Ly. These the super- ould blush I reminded 'esented to f malicious I source of of patients I do not icription of in order to r situation, kely to be has hereto- dio is con- chance of < nee, for ex- • and coni' f marks of 3 paid to refore, can 1. Conse- irks that a a healthy as Reil en - patient into ihunders of i&t a draw- quently led bath teem- uch scenes 43 .10 not recall his senses, then I do not know what else is calculated to excite attention and to effect their restora- But what steps are to be taken when light Hrst begins to dawn on the patient's mind, and lie perceives the ob- jects by which he is surrounded. Ought he to be con- tmued m the same sphere ? In an earlier portion of this work I hav^ sa,d that the patient should be treated dif- ferently at the beginning, during the progress, and at the termmataon of h.s disease; sttch a patient must therefore be transferred to a different situation ; but unfortunately it » m th,s pomt mamly, that all public institutions are wanting, and by which a progressive convalescence of he patient is impossible. For usually by the word lunatic asylum, we comprehend a large building, with appartenances, garden, yard, arrangements for bithin. swingmg, &c. ; but to render such an establishment com" P lete, there ought to be a variety of buildings, and if nos- ^b^, a farm adjoining to it, or still better, as is the case in Holland, an entire village. For patients during the first stage of the malady, tliere should be an isolated building, strongly f„rtfijd .^th only a single entrance, to pre,5lude any patients within it .rom coming in contact with those in d flerent compart of the patients is to be the main consideration ; it is there- fore to be firmly secured vvitli iron barred window and subterraneous dark apartments, which are moreov« to'e furnished with .he necessary measures for effecting con! pu sion and surety, viz. ring-bolts, chains, &c. a°nd the walls are to be duly padded with some soft substan e ,„ prevent the patient from inflicting any injury on hl^lf If the patient evinces any symptoms of recovery, we f^^!^ 44 may cautiously and gradually try the effect of liberty on him ; he will evince so small a degree of liking for his late abode, as to take great pains to effect his release therefrom ; consequently, if sufficiently restored, he may safely be transferred to another apartment, but where he is still to be kept under strict control. Here the com- mencement of a more moral plan of treatment is to be entered on, (in opposition to the first, which merely con- sisted in bodily incarceration,) viz : regular, active bodily exercise, strict observance of the rules of the institution, exercises of the intellectual powers by conversation and instruction, by di3coursing5reading,arithmetical calculations, recitations, &c. li the patient conducts himself properly in this, the second stage of his recovery, (and he will as far as possible avoid being sent back to his first abode,) he should be still more at his liberty and freed from the molestations and the restraint imposed upon him by the attendants, and he should be looked upon as a pensioner of the third and last stage where he may think himself free, but where never- theless a system of espionage can be exercised on him unobserved ; occasional leave may even be granted him to make short excursions, and a trifling sum may be given him for pocket money, which may be further augmented by the fruits of his own industry, and he may be looked upon in all respects as convalescent. The advantages afforded by an institution modelled after the above plan, and the preferences it claims before ordin- ary asylums are very striking : three of which will an- swer our present ends, and which I shall here relate. \stly, A better state of discipline is exercised, the inflic- tion of bodily punishment is less frequently had recourse to, the nurses and attendants cannot exercise any arbitrary i^i 3l of liberty on f liking for his fleet his release 3stored, he may t, but where he Here the com- tment is to be ch merely con- ar, active bodily ' the institution, )nversation and cal calculations, rly in this, the IS far as possible e should be still nolestations and 3ndants, and he le third and last It where never- ercised on him J granted him to 1 may be given ;her augmented may be looked 1 modelled after ns before ordin- vhich will an- lere relate. :ised, the inflic- y had recourse se any arbitrary 45 therci since any disobedience, laziness or malig- . causes its own punishment along with it, from the ne- I cuhar constitution of the establishment. 2^/y. The patients do not continue as inmates of such an mstmition for so long a period as in the ordinary os abhshmcnts:, especially as in the third stage (that of con- v^Iescence) it can be better proved whether the patients, a terhavmg attained their pohtical hberty, will m'alj ^le of n reasonably, and to a proper end. For the physician can now more safely grant a certificate, having less to fear A-om a relapse. As such establishments are common y conducted, no person can reasonably blame a physician for postponing such a testimonial as long as possible since" when a patient has been dismissed from such an insti ution supposed to be recovered, and is again replaced therein^ a recurrence of his symptoms, all tl obligation and lum , pi,eed on his shoulders, and yet the patient can- not be expected to have recovered so very rapidly if he has loeen kept in such constant community with other ^ toSteS::::;t::fh^ natirnt'^. mi„ 1 1, , ^ '"^P' '"asmuch as the pa. cntsmmJ has gamed increased vigour, and his body as become accustomed to activity. He has shewn by the rreedom of h,s actions (which have been chosen y h,mseir,) and in the selection of his companions, whC .her he ,s fated to return to his forme avocations • he .s now satisfied that the punishment which ws fl.cted upon h,m was not arbitrary, but natural, and a:,- hcaUe to h,s condition, and he evinces gratitude towars the msutufon, and I believe would prefer remainir „ .nmate thereto returning ,o that more unquiet life,^n- '" ^'"•^'^ ^^«"™- ^° !»'-g^ly enters. A circumspect, hu i il F^ X 11^! I 46 mans and benevolent superintendant has consequently many opportunities of conferring benefits, and he can but prove these by shewing esteem for his patients. Institutions have of late years been founded, which are well directed und circumspectly conducted by persons who have no connection or communication, either directly or indirectly, with medical men, and which moreover ha\ e been productive of many blessings. Rust Junior, * men- tions the existence of one in Frankfort under the inspec- tion of Anionic and of another in Palermo conducted by Baron Pisani, to neither of which was any physician ap- pointed. To the largest and most celebrated institution of this description, however, that viz. at Jlversa, near Na- ples, and which contains six hundred patients, Dr. Vulpes is appointed director, but the management is entirely of the moral description, as may be seen by the following do- cument, extracted from the work mentioned below,t and which is here introduced from its curiosity. A spectacle exclusive in its kind and in more than one respect remarkable took place durinpr the last days of the carnival, (1823) in the to^^'n of Aversa near Naples ; it consisted in the performance of a comedy, entitled " The disorderly improved," at the lunatic asylum there. The characters were supported by thirty insane patients, and there were upwards of five hundred other insane persons present as spectators, as well as all the chief au- thorities of the town, with many other persons in rank, some of the staff from Naples, and a numerous assemblage of Austrian officers. We were surprised immediately on * Ueber eimige Irrenanstalten von Rust Jun. Berlin 1832. t Beitraege zur Erieichterung des Geljngcns der practifohen Po« liaey, von Werker. Berlin 1832. IL I as consequently , and he can but tients. mded, which are cted by persons Dn, either directly :h moreover ha\ e ',st Junior, « men- Lipder the inspec- 10 conducted by ny physician ap- ated institution of Iversa, near Na- ientsj Dr. V^dpes ent is entirely of the following do- ned below,t ^"^^ in more than one last days of the near Naples ; it iy, entitled " The urn there. The me patients, and ;d other insane all the chief au- persons in rank, erous assemblage I immediately on Berlin 1832. der practifohen Po« ( 47 entering the theatre, at the great propriety, order and quiet- ude that re.gned throughout ; bt.t we scarcely knew what to th,nk, and with great difficulty .uppresse.l our heartfelt emot,ons on w,tnes«ing, at the drawing up of the curtain, tie precision and understanding wherewith these dement- 1 ed beings, now changed into rational actors, played the parts allolted to them ; the attention with which their un- fortunate fellow patients listened to them, the judgment and dehght they evinced, by clappmg their hands -"appro. which the performers received their reiterated applause, and the zeal and exertions whereby they strove to deserve t lem ; indeed, we believed ourselves ti-ansported into a theatre which was occupied entirely by persons of the soundest understanding. However, some of the spectators present on this occasion expressed their doubts to the de- servedly esteemed director of the institution, as to whether such an occupation for people referable to the most unfortunate description of human beings, should be allow- ed without the sanction of medical men, and whether the excitement of their minds, such an exaltation of their 'magmatmns, an It ' i. J In 1 j i 11 L ces and if care is taken to allot to every perfoinier a cha- racter entirely opposite in its nature and tendency to his own fixed and prevailing opinions, then theatrical performances cease to be to them a source of mere diversion and grant- ed only for amusement, and prove rather excellent an- tidote to insanity itself, and after fifteen v : s meditation and no less experience, they were pronounced by him as the most efficacious of all remedies. Inbanity, he ob- serves, is nothing else than an invincible passion which fixes our minds constantly and immoveably upon certain objects, and the surest means of conjuring such passion is to attack the patient on his vanity, and that is a stimu- lus whose irresistible influence could be perceived as well over the sublimest geniuses, as in the most ordinary com- prehension. The insane performers at Aversa did not go on tne stage voluntarily and for the purpose of gaining applause, but forced themselves there by an eflbrt ; and just such an ir- resistible measure as this is required in order to conquer and forget the favourite ideas which the melancholy are a prey to ; their attentions must be directed to oiher ob- jects, and whoever succeeds in eflecting this has gained an important step tov/ards the recovery of his patient. Linguiti had often observed the great zeal and desire evinced by various insane comedians to acquit themselves with eclat in the parts which had been selected for them, and where, from the applause awarded them by the au- dience, they had renewed and doubled their exertions by entering more deeply into the spirit of the characters, and had in some cases acquired such a liking for them u3 to become at once freed from the hallucinations which ;> to this time had taken entire possession of their minds ; contraria contrariis curarJur, were Mr. Linguiti's last foinier a cha- ncy to his own Ml performances ion and grant- excellent an- 3 meditation !ed by him as anity, he ob- assion which upon certain such passion at is a stimu- ;eived as well •rdinary coni- 5 on tiie stag-e ipplause, but st such an ir- 1 to conquer lancholy are to oiher ob- s has gained ' his patient. I and desire it themselves ted for them, I by the au- exertions by aracters, and r them u:: to IS which •> their minds ; linguiti's last 49 words, And that ail insane persons in the world, both m lunatic asylums and out of them, may enjoy such a rea- sonable and circumspect di .ctor is our prayer In smaller institutions it i, of course impossible to cele- brate a festival with such pomp ; but declamations, per- formed m presence of other inmates of the house, and the rectaiions of particular scenes are good surrogates, as well as diversions and recreations, either in community or otherwise. Among the best are leaping, swinging, ;l.gg.ng, practising music, swimming, riding and danc- ing, all of which may be tried »vith advantage, and the more .f many formalities are observed, and their exer- cse attended with great solemnity. Nobody could be- !!.!;.' r, ""' ''? "' ''"" '"«'">• ^°'"^ P«"«"« feel flattered and honoured, if they have in any way distin- 'al e all ,mag,„able precautions not to abuse the confidence extended to them. The morning and evening praye . nnd a psalm or hymn, or edifying poet,,-, should be read by each, every alternate week provided hia mind and edr:at,on ,s of such a description as to admit of it I . ex raordmary how pleasingly the patient looks fortvm the penod when his turn for reading comes round ad what pams he takes to secure the attendance of a 1 his hearers, and the anxiety he evinces that they should all hsten to him with attention ; and it is remarkable to ob- serve the extreme vigilance evinced by convalescent over any of his fellow patients, who have been C mitted to his protection and snperintendance, and the CivTs! '""" " ^'■^^^"' "'^'" '■" -^ ^-y "-^"^ From the foregoing remarks we are led to infer that communication with insane persons is not the E gn a 50 burthen as it is generally considered, but the procedure must nevertheless be entered on with benevolence, incli- nation and love. But not so honourably is he requited who is entrusted with the care of fatuous and incurable patients only, but which, properly speaking, ought not to be assigned to an asylum for curing them, but to an institution for guarding and sheltering them, and where all due regard should be paid to their cleanliness, corporeal nourishment and suitable exercise. They should moreover be treated, in every instance, with humanity and esteem, and which they are entitled and lay claim to, as frail fellow mortals. m the procedure evolence, incli- ho is entrusted tients only, but assigned to an on for guarding gard should be urishment and be treated, in ;m, and which fellow mortals.