> '» , > >• r > >J»>/ ^m>»2 3 >jf>u» ■j > >> _>'^ >»»2 >5>„ > > >:>J> 2> > >■> ) 'J • > >> > >? > >.» rt> > ■> >> > > }5 > > •>.> > >:> 2 >r> j<» 3 ---)) "SWCK> JO , ? >>*S3 ""3^ » > ,>^> > » "3 > > ^> » >5 > > ^ i>. > > > » > > ^ XI 3\> > >i_ > ■> > a ► 3 > > >» >: > > > ^ ^T • " - \ r " Y Surgeon Geucral's Office 1 i1 i$!isee» i 6" / K.US&?{f~ (.1 ✓ w ESSAYS y J>L. S "ST !_■ tj m JS PERSONS OP UNSOUND MIND. Second Serus. BI JTOME" Mo ©AliTj Mo B, » r • u* Superintendent and Physician of the*Eastern Lunatic Asylum of Virginia, at Williamsburg. % '"'' CO UichmonJr, ba. PRINTED BY R1TCHIES & DUNNAVANT. 1853. l?6"3 ^ ld-fS-1 PREFACE. The first of the two Essays contained in the following Pamphlet, was offered as a Report to the Association of Medical Superintendents of American Institutions for the Insane, at their meeting in May 1848—the topics discussed hav- ing been previously assigned the writer as a sub- ject of report. The article on the Lincoln Lu- natic Asylum was laid before the Association, at the annual session that occurred during the present year. Two productions, of analogous character to that of those now submitted to the public, were published by the writer in pamphlet form about three years s,ince. They were also subsequently inserted in full, in their respective Periodicals, by the learned and distinguished Editors of the American Journal of Insanity, and the Journal of Psycological Medicine, the latter of which is printed in London. The Essays forming the present brochure are hence denominated, on the title page, a " Second Series." Williamsburg, June 1st, 1853. ESSAYS. ON READING, RECREATION AND AMUSE- MENTS FOR THE INSANE. In accordance with my appointment at the last meeting of the Association, to report at the present session of this body on " Reading, Recreation and Amusements for the Insane," I beg leave to submit the following remarks : Here, as on most points of treatment, we are led into great error, if we entirely'abstract the insane from the sane; if we look upon the former class as altogether different in their psychological manifestations from the latter. Hence in making a just and proper basis upon which to originate alike our theoretical ideas and our practical operations, we must consider these two divi- sions, though evidently differing in many particulars, as in the main holding the same position objectively with regard to reading, amusements and recreation. There- fore it is, that if it be desirable to penetrate beneath the mere crust of the subject under consideration, it is re- quisite to take such a scope of enquiry as includes not only the insane, but also those who have the mind in an unimpaired condition. The same general remark applies to reading as to the two accompanying heads of our article, so far as regards the principle upon which it is employed as a moral means in the treatment of 6 insanity. We adopt it as a measure which serves to occupy the mind to the effacement of delusions and morbid feelings, at least for a transitory period ; it is, in other words, one of the great revulsive modes of acting upon the insane mind. Moreover, it serves as a plea- sant method of passing away time, and in this respect exerts a tranquilizing effect on the individual. To many patients it thus proves a source of agreeable feel- ings during time which would otherwise be full of the tedium of ennui, To the chronic insane, indeed, who have a taste in this direction, it is a source of comfort that beguiles many a lonely hour, in the long and mo- notonous track of life's drear journey, spent away from the friends of their youth in the cloistered retirement of an asylum. In the third place, in some instances, besides the mere effect of reading as a porlion of the treatment in mental alienation, instruction may also be acquired. It is moreover one of those means the very provision of which by the officers of an asylum exhibits in a clear light the kindly disposition thoroughly felt by them towards their afflicted charge; thus having a ten- dency to lull all suspicious feelings on the part of ihe latter, at the same time that they are also rendered more manageable by being contented and properly oc- cupied. Taking the sane mind as a point of departure in examining the utility and advantage of reading, we may proceed to divide the insane into several classes. In the first place, however, apart from the circumstance of insanity, we have some of these unfortunates who have never learned to read. These can be subject to this measure then only in two ways: first, they may be taught to do so, a consideration not within the scope of this report; and secondly, they may listen lo the read- 7 ing aloud of their fellow patients and others. This hi iter method in a pauper asylum, and particularly in the institutions of stales where education is not general, seems quite worthy of more attention than has been given it. Anecdotes in newspapers and interesting tales may thus confer as much pleasure upon those incapable of reading as upon those who possess this accomplishment. With a number of the insane who have been edu- cated, we take the broad ground of a nearly identical action from reading as occurs to the sane. For the dis- eased mind must not be considered as essentially morbid in all its faculties, but as in numerous instances having many of them, at least in a comparatively undiseased condition. When indeed we look to the faint outlines which mark the transition of sanity through what in common language is termed eccentricity, into positive and decided mental alienation, in other words a state of insanity recognized as such not only by the expert but by the mosi ordinary person, we cannot fail to arrive at the conclusion that if reading is a source of pleasure and comfort lo the sane and eccentric, then may it be inferred thai it is so too to many of the insane. And what a comfort is found in this resource to a multitude of persons in all civilized countries, serving not only for in- struetion and religious counsel, but as a mode of abstrac- tion from earth's cares and anxieties, as well as a plea- sant recreation in the monotonous routine of daily life. The moments are few in which most of us can hang en- tranced on the stirring words thai fall from the lips of genius, in conversation or from the oratorical tribune. Hut lo the educated, by means of books, ihe wise and great throughout all past time and in all lands, speak as- 80 8 though face to face. Books indeed constitute a precious treasure-house of thought, which is open to all; which in every community has been a comfort to the sick and afflicted; which has beguiled the voyager on the lonely sea and the denizen of the crowded city; which has softened the hard lot of the prisoner and added new charms to the life of the free in all its forms. Many of the insane then whose mental powers in this aspect are not strikingly different from those of the sane, turn with eagerness to so potent a solace of weary hours. But with these, as with the sane, it should be remem- bered, there are some who, although they have received an education, are not fond of reading. The class of readers amongst the insane, who understand and appre- ciate what they read, nearly or quite as well as persons of sound mind, may be considered to pass gradually into another, who appreciate what they peruse but to a limited extent. Yet the effect of revulsive occupation is perhaps almost equally as great here as in the former class. With regard to such, an American superinten- dent observes : " For some, one book answers a long time. One day, recently, as I passed through the hall, an excited patient was lamenting that he had lost his sermon. The next day he was happy; he had found it; he said he had nearly read it through before my visit, and had only failed to do so the day before when it was lost for a long time previous, he said it was a good ser- mon, and he intended to read it through every day." A fourth division of the mentally deranged, which may be conventionally established, consists in that class of patients whose minds are so much weakened and af- fected, that they not only take no interest in reading, but appear not to comprehend or appreciate, what they may 9 still possess, the power of articulating in print. Read- ing may be considered perhaps as wholly inappreciable to these; and in the same division may be included lunatics whose minds are reduced to a state of idiocy of greater or less completeness. To many patients, moreover, laboring under the acute or paroxysmal state of a maniacal attack, it is also manifestly inapplicable. Considered merely as a stimulus, it likewise demands some caution in particular instances where there is much excitement. As to conversation, change of scene and other par- ticulars in connection with the insane, so does the law laid down by Georget, apply to reading. This is as follows: " The ideas or passions of a patient should never be excited in the direction of his delusions." The application of the rule must be modified so as to suit each individual case. But, after all, the examples in which carefulness is necessary, cannot be considered as numerous. And on the whole, (apart from a rule of supervision hereafter mentioned,) I do not apprehend that there are many rules applying to the insane, with regard to reading, which differ essentially from those applicable to the sane. Thus, all publications of an im- moral tendency should be prohibited ; and a pernicious influence is likely to ensue from too great a proportion of works of fiction. We think that in general, the most suitable productions are such as combine interest with no great strain upon the attention or the reflective powers ; for the insane are many of them incapable of persistent reflection for a long period, at least with plea- sure ; and indeed this is also the case with sane persons taken en masse. We would not by this remark be un- derstood as being against the adoption of schools in, 2 10 asylums, but the consideration of these does not enter into the field of our present enquiry. It should be observed also, that where there is an acquaintance with any special art or science to a considerable extent, works of quite an abstruse character, and which to or- dinary patients might prove very uninteresting, become in such instances, just the contrary; and indeed the principle last enunciated is only modified here, inas- much as where there is a familiarity with and a love of any subject, works relative thereto, however abstruse, may be considered to give pleasure, and at the same time, not as an usual thing to demand an excessive degree of attention. Hence such individuals should be furnished with productions of the character in question. Every asylum ought to be provided with a library or collection of books. The principal portion of these should be, perhaps, travels, biography, history and the many miscellaneous works which form the charming, polite literature of the English language. In conso- nance with the character of the asylum, as to the num- ber of patients therein, who are acquainted with foreign languages, or who have been cultivators of the sciences, should be the amount of provision in this respect. And indeed in the library of every asylum, some few works of the kind are requisite. It being understood also that when a patient is received as to whose peculiar pur- suit or department of study, there are no books in the library of such an institution, as great care should be exercised in the procuration of such as we would em- ploy in purchasing an additional medicament to meet some rare physical symptom. European writers concur with those of America as to the advantages of reading in asylums. The British 11 commissioners in lunacy observe, for example: " No asylum should be without a library." And Dr. Jacobi remarks, " The collection of books belonging to the es- tablishment must be of sufficient magnitude to satisfy the requirements of every case that occurs." These views, we find, therefore, carried out to a considerable extent on the other side of the Atlantic, though not to so great an extent as in the United States. Nearly all the asylums in this country are furnished with a collec- tion of books; and as compared with foreign countries, a striking peculiarity in the reading matter is found in the large number of newspapers; although British physicians not unfrequently mention in favorable terms the employment of newspapers and magazines, as for example in the reports of the asylums at Dundee and Hanwell. The Saturday and penny magazines have been favorite publications in the British asylums. I cannot omit this opportunity of adding my mite of ad- miration to the generous sympathy evinced by editors of the periodical press in this country for the inmates of so many of our asylums. Year after year this noble fraternity, though not often blessed with fortune's goods, continue to send their winged messengers to bear com- fort to the hearts of the afflicted and despairing. The British commissioners complain of there being a defi- ciency of entertaining works in the asylums under their supervision as compared with the abundance of reli- gious productions, and they advise an alteration in this respect. The asylums in America vary in the number of books forming the library, from collections hardly entitled to such a name, to those institutions possessing several hundred volumes. And in one instance the number amounts to more than a thousand. The staple 12 of these collections consists in general of history, biogra- phy, travels, reviews and such standard writers of fic- tion as Sir Walter Scott, Miss Edgeworth and Mrs. Sherwood. Dr. Thurnam observes with regard to the York retreat in England: "A reading-room with a se- lect library, consisting of books of travels, natural his- tory, biography, history and moral and religious works, has been provided for the men, the most orderly of whom have access to it under certain regulations as to conduct and behavior. The books in this collection are also allowed to circulate among the women, and patients of more extensive acquirements and literary tastes have the opportunity of procuring the works of nearly all the standard authors from two excellent subscription libra- ries in the city." The last mentioned idea has also been adopted elsewhere in Great Britain, and doubtless, when practicable, answers a good purpose in certain cases, particularly where we meet with some " helluo librorum" who will read through a comparatively small collection of books in a short time. With regard to the perusal of the Bible by the insane, perhaps the following re- marks which we give from Dr. Chandler respecting the patients in the institution of which he has charge, em- bodies the general views and practice of the physicians in our asylums : " The Scriptures are placed in the hands of all whose disease does not lead them to make an improper use of them. Sometimes patients read and search the Bible to find passages to substantiate their delusions. Except in a few instances of this kind, the perusal of the Scriptures tends wholly to good, for therein is written the law of love and kindness, of justice and truth; and therein is taught nothing that vitiates the conscience, injures the health or deranges the mind." 13 In some institutions a yearly fund is appropriated to the purchase of books, and this appears a good arrange- ment. The assistant physician is usually the officer who has charge of the library, and a certain day in the week is sometimes selected for giving out books. In many in- stances, however, not much system is observed in this respect, and the patients have pretty free access to the library throughout the week. The writer is decidedly in favor of a systematic action in this department, be- lieving that analogous benefits are likely to result from such a course here, to those attending a similar proceed- ing as to other things. Dr. Awl remarks respecting the Ohio asylum : " The rules which govern the library are amongst the best in our whole system, and we know of no more gratifying exhibition in the institution than the orderly and interesting appearance of the different classes upon a Sabbath morning as parties from gallery after gallery arrive and depart with books of their own selection." The same physician elsewhere conveys the following significant hint to the friends of patients who send them newspapers: "Avoid all papers that are filled with horrible suicides and murders. There cer- tainly cannot be a greater mistake than to select articles of this character and mark them with a pencil in order to attract their notice." At the Western asylum of Vir- ginia, in order to guard against impressions of this cha- racter systematically, it is the business of one of the officers to look carefully over the newspapers before they fall into the hands of the patients. Although in most of our asylums a good deal of attention is given to the encouragement of reading, yet still perhaps we may not err in advising a systematic action in this respect—not contenting ourselves with 14 merely providing the means of this pursuit to those who are anxious at all times to receive books and news- papers, but also in cases where there is torpor and apathy towards them, using due exertions to conquer this indifference. Moreover there should be regulations tending to produce a proper degree of carefulness in the preservation of books ; in other words, we should seek here that arrangement by which there is the maxi- mum of reading, with as little attending wear and tear of material as possible, when conjoined with this para- mount endeavor. A comfortable, pleasant reading room, with soma officer or attendant especially dele- gated to take charge of it, is we think a very desirable accompaniment of other facilities. This room should be furnished with books, newspapers, prints, illustrated works, maps, globes, &c, and it might not be amiss to add also such philosophical toys as the prism, the mi- croscope, and the kaleidescope. A rule which we cannot but view as highly important, is that the super- intendent of an asylum should have a complete know- ledge of the reading in which each of his patients en- gages; it is similarly important that no part of the treatment here should escape his notice, as with regard to other means included under the head of moral management; there is sometimes a considerable degree of neglect in this respect. Perhaps also, with judicious oversight and selection, benefit might be derived from what is entitled a course of reading, as contradistin- guished from that of a desultory nature; this idea is rendered plausible when we contrast the important in- fluences of the one on the sane, when compared with that of the other. A similar mode of reasoning applies to the basis upon 15 which we originally adopt " Recreation and Amuse- ments for the Insane," to that whose existence we have endeavored to demonstrate as sufficient ground for the employment of reading as a means of treatment. In other words, from the similitude of the diseased to the undiseased mind in many attributes, apart from all ex- perience, we would be led, a priori, lo the introduction of " Recreation and Amusements" in the treatment of the insane, from the facts connected with their habitual existence amongst sane persons. Looking through the long line of ages, even up to the primeval mystery which entailed labor thenceforth upon the race of man, we find parallel with constant industrial pursuits the presence in every nation of modes of recreation and amusement. " Recreation," says Fuller, " is a second creation, when weariness hath almost annihilated one's spirit. It is the breathing of the soul, which otherwise would be stifled with continual business." The effect of a mistaken conscientiousness in endeavoring to inter- dict and abolish all means of recreation and amusement, only tends to disease of body and mind; and in order to restore the mental health of the insane, we discover by experience that the well established necessity of such measures for the sound mind, is not found in vain as applied to the former unfortunate class. The gene- ral theory conventionally recognized as to the utility of amusements and recreation, in the treatment of insanity, apart from the above considerations, is that by means of them we supplant the place of delusive ideas and feelings, tending by this disuse to their gradual en- feeblement or disappearance. The healthful influence of the hilarity attending such engagements, both upon the mind and upon the body, must also be allowed its 16 due weight, and the general contentment arising from a continuous occupation of pleasant character. And so far as respects active amusements, the exercise involved, it is scarcely necessary to observe must have a direct influence over the vital processes of the whole system. Moreover, for several reasons there is a disposition in the insane to have their attention withdrawn to their own mental operations, rather than to enter into any in- timate fellowship with each other ; amusements tend to break down this wall of separation, and, by arousing social feelings, they wean the morbid spirit from so hurtful an introspection. After Pinel and Tuke had substituted for the harshness of the old method of ma- naging the insane, the two great measures, kindness and occupation, we soon find, in addition to bodily labor, the further recommendation by many writers of recreation and amusements. These engagements had, it is true, been advised in hypochondriasis and melancholy by some of the older authors; but we can scarcely con- sider such counsel as of greater import than the loose suggestions and hints which upon the occurrence of any valued discovery are found upon examination to gleam faintly from the misty chaos of the past, but which usually have little practical merit in heralding or assist- ing the actual and permanent establishment of a great improvement. Means acting upon the imagination, but serving too as recreation, had also been employed in ancient Egypt, at Gheel and elsewhere in olden time; but the direct intention of these appears to have been simply to act as religious ceremonials. All the standard writers on insanity may be cited in favor of amusement and recreation as measures of treatment. And a variety is found in most of the asy- 17 lums both of Europe and of this continent. Those most often employed are cards, draughts, backgammon, baga- telle and chess. And with females, the battledores, graces and swinging are the usual methods. In the American asylums excursions in the neighborhood of the institution by walking and riding are amongst the most ordinary modes of recreation, especially in those of the South. This is not so much the case in Europe, public opinion being sometimes against it; still, occa- sionally, the reverse occurs, as for instance, according to Dr. Browne, at the Montrose and Crichton asylums in Scotland. In looking over the writers on insanity, and the reports of asvlums, we find there is scarcely an amusement in which the sane commonly engage, that has not been recommended or adopted in some one or other asylum ; and in point of fact, the proper mode of reasoning as lo the kind of amusement to be most ad- vantageously followed, does not differ in the two classes except as modified by circumstances, almost extrinsic of insanity- Thus in the first place, though there are some amusements not wrong in themselves, which may be engaged in by sane persons and still not prove suit- able; yet even here we will find conclusions apparently obvious, to be by no means without exception. For example, sailing by water, which at first view might seem too dangerous for the insane, is adopted at some asylums and with few or no accidents ensuing from it. Dr. Anderson speaks of the use of a boat in fishing ex- cursions, at the Haslar naval asylum, as being beyond all comparison the most valuable of remedial agents; and he states it his pleasing duty to report the complete success of a measure in the estimation of some fraught with so much danger to the lunatic, by affording him an 3 18 easy opportunity of carrying any suicidal propensity into effect. Dr. Kirkbride, it may also be mentioned, in the last report of the Pennsylvania hospital for the insane, alludes to excursions in steamboats by the pa- tients of that institution. As regards the examples which might be given of this character, however, it would be better, so far at least as the idea applies to masses of the insane, and not to those treated in pri- vate, to be on the safe side, and rather avoid than other- wise modes of recreation attended with some risk. In the second place, there are a few amusements which we may view as involving moral considerations, and which are employed as means of treatment in in- sanity. Cards we think unobjectionable as played by a large number of chronic cases ; with these no ulterior bad effects can result, as they are destined most usually to pass their lives within the confines of an asylum. But in institutions where there are large numbers of young persons in the recent stages of the disease, per- haps some caution may be necessary, lest a game be taught or encouraged which might lead to gambling when they become sane. A second recreation to which may be adduced some objections, is dancing. So far as regards persons of the same sex, we see no objection to this amusement: the mere active exercise in itself, we believe, will not be unsuitable, except in a few ex- cited cases. The author of a work on dancing ob- serves, that with most sorts of active amusement the muscles of particular portions of the body are exercised and strengthened, but that it is somewhat at the ex- pense of other parts, whilst in dancing the action is general and universally beneficial. Moreover, the pre- valence of dancing amongst all nations evinces an inhe- 19 rent desire for grace in movement, and the pleasure attending its fulfillment. But it is a question whether it is not a bad mode of recreation, if the male and female patients dance in company, as having a tendency to awaken sexual feelings. There is a speculative idea respecting the character of the pleasure in dancing, which deserves notice here ; and this is, that where the two sexes intermingle, a part of the pleasure seems to consist in a dim idea of the exclusive though temporary possession of the partner of the individual. We may remark that we are by no means in favor of an exclu- sive rigor in preventing the mere sight of the opposite sex ; we are satisfied, indeed, that the reverse of a good action will thus be created. By accustoming persons to see and meet the opposite sex continually, sexual feelings are rather lulled than the contrary, so that with the insane there is no objection, we think, to such occa- sional assemblages as will not be attended by any very direct intermingling, yet which, at the same time, ac- customs the sexes to the presence of each other. But so far as dancing is concerned, and perhaps anything in the nature of a mixed party, the intercourse between the two sections of patients becomes, we think, too free to prove advantageous. The experience and practice in different asylums as to the amusement under con- sideration, is variable; in general, however, it is in some form rather approved of than the reverse. Attendance on theatrical performances has been re- commended by some writers; and plays have been acted by the insane in a few instances, both on the con- tinent of Europe and in the United States. On this subject, opinion seems divided. One caution is evi- dently requisite here, that such scenes should be 20 avoided as tend to excite into action the sexual feelings. The effects on the insane performer would seem to be chiefly those of mental revulsion. It is also, however, a question of wide import, how far will prove benefi- cial or otherwise, the love of or the gratification of the love of display, the awakening of simulative feelings, the fear, the hope and other emotions attendant upon the exercises of the rostrum and the stage. The recre- ative effect on the insane as spectators, must be in gene- ral, simply the action of other public exhibitions, except that in the case of tragedy, or at a public theatre, the excitement of the emotions might be great. Farce and comedy would seein to be the most suitable perform- ances for such actors and spectators. The experience of Esquirol was decidedly against the institution of theatrical performances, this being the conclusion which he drew from the effects on the insane at Charenton, attendant on the exhibitions given by them for several years. Dr. Browne, on the other hand, so far as re- gards the consideration of this class of persons merely as spectators, observes respecting the patients of the Chrichton asylum in Scotland, that the theatre has been an object of great attraction to them, and that this mode of recreation was encouraged for many reasons; but chiefly because the drama conveys much amusement and some information, without imposing either sus- tained mental exertion or attention, supplying pastime without passion, and knowledge without study, suggest- ing truth by fiction, and appealing to the happy, to the cheerful and the mirthful parts of our nature. Amidst the numerous amusements which have been recommended or employed with the insane, it would be well we think to select those which refer themselves 21 rather to grown persons than those which are suitable for mere children. Means falling rather under the head of labor than amusement answer very well to recreate the minds of some patients who have a taste for such pursuits. Thus the mental occupation accompanying study acts in this way : gardening is also of this charac- ter; and with females ornamental needle work. A taste for the fine arts should be fostered by providing the necessary means of pursuing them. In a description of the asylum at Palermo in Sicily, a medical acquaintance of mine observes, that this estab- lishment is ornamented with paintings and statues, the work of the insane residents. Music we think deserves every encouragement, and indeed it constitutes a very common pastime in most of our asylums—whiling away the hours agreeably in individual instances, and serving to enliven routine assemblages of patients, or being em- ployed as a preparation for the Sabbath exercises of the choir. The directly curative effects of music, of which the older writers have spoken, do not appear to be borne out by experience. It may be doubted, however, whe- ther a sufficiently scientific and well arranged trial of this means has yet been made in the first place as to its direct action on the nervous system; and secondly, merely as a mode of occupation. Some of the older writers make particular mention of the kinds of instruments and airs which are most suitable in each variety of insanity; and they enter into considerable details on the subject. This seems however to have been of little consequence. Respecting the direct action of music on the nervous system, Esquirol says: " A small number of instru- ments should be selected ; the musicians should not be seen by the patient, and airs familiar to his infancy, 22 which were agreeable to him before his disease, should be executed." As being ready and pleasant means of obtaining musical sounds, we would recommend the employment in an asylum of a musical box, hand organ and iEolian harp. For singing in large numbers to- gether, perhaps temperance songs would answer a good purpose; inasmuch as with some persons there exists a religious dislike of any such vanities as ordinary songs. Most certainly no exertions made by the officers of an asylum can be deemed as in vain, which have for their end the cultivation of the mental faculty on which this art depends, in any patient where the least success is to be hoped. We would recommend therefore greater efforts in this particular. It may be observed also that the Mainzerian system of singing, as adopted in several British and continental asylums, deserves bein°- em- ployed in those of the United States. About every institution for the insane there should be as many objects as possible to interest and excite the attention. Thus the grounds should be extensive and adorned with flowers ; a fish pond and playing fountain are not amiss here in the way of ornament; there should also be woods wiib agreeable walks in them, and fitted up with summer-houses and convenient seats and swings; a deer park is sometimes found; arid we may have too a cottage furnished with books, maps and curiosities. A museum is also an interesting addition to an asylum, particularly if designed chiefly for the educated classes. Of a similar character is a green- house. In some of the British asylums, for the sake of the surrounding scenery, there is a mound placed in the centre of the court; terraces are also not unfrequently found. Walking and riding out to attractive spots, and 23 similar modes of recreation, it may be observed, are common in American asylums. Different exhibitions occurring in the vicinity of the asylum have too in some instances been visited by the patients. A requisite part of every good asylum is at least one large room of a square or other convenient form, by reason of the fact that assemblages of the patients for different purposes, now constitutes an engagement common in most of our asylums. Thus lectures are given in a few instances, and it is reported, with very beneficial effects. Again there are exhibitions with the magic lantern, dissolving views and other modes of amusing large numbers at a time; or such an apartment will prove useful for the recitations and other exercises connected with these asylums, in which schools form a means of treatment; or for the debating societies that have sometimes been adopted with advantage; and also for musical parties and other social reunions. Both in Great Britain and this country, moreover, it is sometimes a custom to cele- brate the public anniversaries after the manner of the sane; and the associations and cheerfulness thus aroused have often been alluded to with commendation; in this regard a large room is quite useful. Apart from the mere amusement in all these various gatherings, it may be observed that an important end is attained with the insane by increasing their self-control and their power over the will. I cannot but approve here of the ar- rangement adopted in some asylums, of alloting to each day of the week some particular mode of recreation or mental employment, thus preserving a continuous pleasing influence and keeping up an unbroken revul- sive action, whilst besides other good effects, the evils ensuing from ennui are entirely removed. 24 In addition to the modes of amusement previously mentioned, it ma}r not be amiss to run over a list of most of the remainder, which have been adopted in different asylums. These are dominoes, the mansion of happiness, Dr. Busby, the Pickwick cards, fox and geese, German tactics, Morris, the game of the mill, dissected maps, Chinese puzzles, summer ice, billiards, bowls, nine pins, and (its modification) one pin, the ring, marbles, coronella cups, tennis, different games pla3red with a ball, the see-saw, the spring board, the rocking boat, the rocking horse, the jumping rope, the giustra, flying horses, miniature railroad, and quoits ; fishing and similar excursions into the surrounding country are also not unfrequently allowed ; and even bathing in summer. Raising animals has been likewise deemed beneficial. In Great Britain cricket and foot-ball, amusements common with the sane, have been adopted at some of the asylums. In private practice, traveling is occa- sionally of benefit, and this has been recommended by many writers in cases of melancholy and hypochon- driasis, but there is not entire agreement on this head amongst those well acquainted with the phenomena of mental disease. There are other modes of passing time agreeably, which require no other provision for car- rying them on, or but very little, except the inclination of the parties concerned ; some of them will also be found suitable to the insane : narrating stories to them, for example, has been occasionally employed with ad- vantage. Such diversions as " What are my thoughts like," "How do you like it," and the game of "Defini- tions," might too be made lo serve as recreative means with some. 25 Proportionately as asylums differ in the number of their patients, the character of the inmates as to original disposition and taste, and other circumstances, so will there be greater or less advantage from the introduction of one or other particular kind of amusement: difference of management and national characteristics here exert an important bearing; thus an amusement which has failed in the asylum of one nation might succeed in that of another; nay, more, that which had proved useless in one gallery of an institution might be decidedly be- neficial in another, with different patients and different attendants. It well behooves a superintendent to study the relative position in this respect of the institution of which he has the supervision, and to adopt a corres- ponding action. The number of recent cases, for ex- ample, is an important item, connected as it is, when considerable, with a large body of convalescent patients. We may, indeed, suppose in this instance, a new element added to any of our calculations, consisting not so much of insane persons as of the sane, who may be expected to aid us in contriving and carrying into effect various modes of recreation designed for our inmates generally. Whatever be the character of the institution however, a second indication, which the superintendent should have in view, is to be ever on the watch to stimulate and encourage any innocent mode of recreation which patients may themselves devise, or which may be sug- gested by others ; and he should carefully seek to try every plausible means of adding to the comfort and welfare of his afflicted charge in the way of recreation, also directing his attention to borrow hints on the sub- ject from the pursuits of the sane. But moreover we should carefully avoid the error of using little effort ex- 4 26 cept merely providing the means of amusement. Many of the insane are indifferent as to any diversion, and in- deed to all other kinds of exertion, either mental or bo- dily. Hence we should use every mode of encourage- ment, both by example and persuasion, and by furnish- ing a variety of diversions in order to satisfy the taste of each one. As is the case with sane persons, we may anticipate that the insane will become tired of particu- lar kinds of amusement, and hence we should always have this in view, so as to supply the place of one by that of another. In fine, the most systematic efforts should be conti- nually made, by furnishing adequate means of amuse- ment and recreation, to prevent the insane from lapsing into the dull torpor of reverie and indolence into which it is the very nature of man to sink, if mind and body alike are left in a state of vacuity from the want of means to occupy them. All which is respectfully submitted. JOHN M. GALT. May 8th, 1848. 27 ON THE LINCOLN LUNATIC ASYLUM If there be aught which has tended most to advance the amelioration of the condition of the insane in the present century, and particularly of late 3'ears, it is the intercommunication of views by those having the management of establishments for this afflicted class. Americans, in spite of the great ocean which separates them from Europe, are much more cosmopolitan in their views and practice, than the Trans-Atlantic na- tions with regard to each other. Apart from other cir- cumstances which have led to this favorable result in the United States, I do not think it amiss to allude to the lies which bind us to European nations. In the first place, a common literature, a common language, a common descent, analogus institutions, connect us indis- solubly with the people of the British Isles, notwith- standing former dissentions between the governments of the two countries. In the second place, the assistance which we received from France iu the early struggle, can never be forgotten whilst gratitude has a resting place in human hearts. And thirdly, as to the third European territory of importance, the great German na- tion, the many useful citizens which we derive from that source, and the fact that so many of us can trace our ancestry to the "vaterhmd," must ever attach us in this direction, by ties of affectionate interest. In perusing the remarks of Trans-Atlantic writers, I have been struck with the surprising ignorance occa- sionally exhibited by them, respecting the condition or character of asylums in adjacent countries. Thus, M. 28 Scipion Pinel observes, concerning the treatment of in- sanity in England, that the English physicians exhibit a polypharmacie of the most marked character, in treat- ing nervous diseases, whilst they are also greatly go- verned by phrenological considerations. This sweep- ing and very erroneous conclusion, he deduces from some remarks of Sir William Ellis. Again, M. Brierre de Boismont, in speaking of the non-restraint system, adopts the most incredulous air, and observes that En- glish lunatics seem to be entirely different creatures from those of France. In accordance with our opinion of the good attaina- ble by the examination of foreign asylums, we have not deemed it amiss to submit to the association an attempt to analyze the novel views set forth at the Lincoln Luna- tic Asylum in England. We have done so with the more confidence, because we firmly believe, that with the exception of the writings of M. Leuret, no views so important or so original, have emanated from any other source as from the Lincoln Asylum, since the publica- tions of Pinel and Tuke. I have before me all of the reports of the Lincoln Lunatic Asylum, as likewise all documents of value, which have been derived from officers attached to that institution. I have, moreover, carefully examined the criticisms both in favor of the system there adopted, and those against it. The report of the year 1849,* contains a more detailed expression of the opinions and * The wjiole system in force adopted at Lincoln, with its direct and its indirect particulars alike, dates very far back in the history of the insti- tution, as is shown in a little pamphlet entitled " Minutes of the Pro- gressive Proceedings under which the Total Abolition of Instrumental Restraint was introduced and established in the Lincoln Lunatic Asy- lum;" but the report of 1849 exhibits it as complete. 29 arrangements existing at that asylum, than any other document. I shall proceed, therefore, to examine this at large, with incidental remarks as to points seeming to require such mode of mention. This report commences with a tabular view, in which are enumerated a number of arrangements and mea- sures, with regard to which it is observed that they are not found in that institution ; and further, that " these omissions are intentional; some of ihem are coeval with the building, and others are the results of practical ex- perience." The first particular in this " bill of excep- tions" is cold bath rooms. Now it is clear that this subject admits of consideration in more than one point of view. In the first place, it may be discussed as a medical measure. If it be useful, ought we not to have arrangements facilitating the administration of a bath— the shower, or simple immersion, or the douche? There is scarcely a writer on the treatment of insanity who has not a good deal in his work respecting baths; and whilst the warm bath is preferred by one, the cold will be the favorite of another; so differenl varieties of the disease will, in the author's estimation, require, as the case may be, either the warm or the cold bath. Thus, Dr. Seymour observes: " As the use of cold in various forms appears to be productive, under proper manage- ment, of the greatest advantage in cases of mania, a corresponding good effect has been said often to be ob- served in the employment of the warm bath in cases of melancholia." So too in the French asylums, what they entitle "irrigation" has been employed with ad- mirable effects, consisting of the patient being for hours in the warm bath, whilst a slight sprinkle of cold water falls gently on the head. I have derived the very best 30 results from this remedy in highly excited cases of mania. Now it will be observed, that these remarks are referable lo the consideration of baths in a medical sense. The conclusion prominently brought forward and supported at the Lincoln Asylum in this connec- tion, is tantamount to the doctrine that the excitement of insanity does not require objective influences to re- move it. Hence the opposition to the use of baths, opiates and other sedative agents. And moreover, this antagonism is conjoined with the philanthropic conside- ration of removing unpleasant efforts at repression by the use of baths and of restraint. Now, whilst we have always sought to avoid exclusiveness in treatment, and on lhat account do not range ourselves specially under the banners of any theory, yet, still we feel in the high- est degree the importance of the general tendency constituting the innate character of the principles of management adopted at Lincoln. The upholding the doctrine of patient forbearance towards the insane, and the steady adherence to a sort of moral expectation, instead of endeavoring to cut short the excitement or lo repress it by sedative action, deserves at least due at- tention from every lover of truth. Although perhaps remedies valuable in some cases are given up by so exclusive a management, yet, on the other hand, the zeal displayed in this ver}' action is expressive of the thorough devotion to the substitutes—a devotion which, being so much greater at an asylum thus managed, will, it may be, amply compensate for what is lost by the disuse of sedative agents. Here, as in other instances of reform, " il est le prime pas qui coute ;" and not only is the progress then much further than had been anticipated, but further in- 31 deed than the principle at first enunciated would have led per se. So that other ideas are the result, perhaps differing essentially from the original and central one. We think, however, the true merits of the reformatory process conducted at the Lincoln Asylum, as regards the present point, that is the administration of sedative agents, and in the progress of the discussion ensuing as to other remediate means, will be discovered to rest on the conclusion which we have given above. We will however proceed to trace some additional items of this character, and make a few remarks in relation to them. It is observed, for example, " nine-tenths of the erroneous treatment of insanity has arisen from con- founding insanity with phrenitis or inflammation of the brain, a disease requiring remedies usually contraindi- cated in the treatment of the insane; and the same re- marks may be applied to cases of delirium tremens: the former introducing, among other proposed remedies, blood-letting and shaving the head, and the latter the use of opiates. It is scarcely necessary to say that knives and forks are not used in this house, though by some this is considered an exaggerated precaution; neither are articles that could be dangerously used left habitually in sight. Some patients who have been disposed to kick have had list shoes substituted for their ordinary shoes." The commissioners of lunacy ob- serve in their report of visits on the 22d and 24th of September 1846, that of 130 patients no one was taking medicine. They also remark that malt liquor is pro- hibited, " contrary to the practice of almost every in- stitution for the cure of lunatics in England." They object too to a standing order of the governors, pro- 32 hibiting the use of opiates administered in order to pro- cure sleep. With respect to the employment of opiates, the prac- tice of asylums is still, we think, by no means decided. Most of us have seen in American institutions striking examples of the potency of narcotics, when kept up in continuous and considerable doses, in lulling excitement. But yet there are numerous other instances in which this treatment does not avail; and must not such medi- cation disorder the system exceedingly when it fails to do good ? Moreover, would not the expectant treat- ment answer as well? With regard however to the in- fluence of the continuous treatment by opiates, we are inclined to believe that there is a class of nervous cases in which undoubted good is effected; nay more, we think it likely that the idea might be profitably extend- ed to cases of other affections of a nervous character, though caution would be requisite lest there should be contraindicating symptoms. With regard to their be- ing an order by the board of governors on the subject, we think this objectionable, as improperly interferring with the observances of medical etiquette. The remark of the governors concerning the disuse of knives and forks and the employment of list shoes is very characteristic of the mode of management ensuin« on the relinquishment of restraint. In other words, an assimilation to the habits of the sane, if interfering with the great end in view, is to be surrendered, and all pos- sible modifications of dress are devised to carry out the same purpose. As respects the small number of pa- tients whom the commissioners found under treatment, we esteem this a good sign. Take the medical treat- ment of insanity as practiced in a vast variety of forms 33 and in a number of asylums, and how little is the ratio of cures affected by any difference here. Now, what logical conclusion can we derive from this circumstance? What conclusion would be drawn by a dispassionate judge under this state of things, especially when we dis- cover that all the asylums agree as to the efficacy of moral measures? Must not the deduction be plainly one adverse to the utility of medical means to a very great extent? The question concerning malt liquors, it may be remarked, is one of those which we find looked upon as very important, and producing a great amount of discussion which would be entirely saved by turning the attention from home; for this is a matter which American superintendents have deemed of little conse- quence ; and it certainly does not materially influence the question of restraint, as has been imagined at the Lincoln Asylum. The improvements which by their introduction for the first time at Lincoln, have given this institution its great and merited celebrity, are, first and by far the chief, the disuse of restraint, and secondly, the aban- donment of seclusion. Amongst the special circum- stances pointed out in the preface to the report for 1849 as existing elsewhere but not at the Lincoln Asylum, we go on to point out those that appear to relate directly to restraint and seclusion. These are as follows: Seclu- sion rooms, padded rooms, detached rooms, and rooms for the accumulation of stores and manufactories, bake- house, brew-house, beer-cellar, stable, cow-house, or- chard, burial ground, galleries with elbows, attendants' rooms with fire places. These exceptions have been instituted at the Lincoln Asylum, first, with the inten- tion of fully carrying out the disuse of personal restraint 5 34 and of seclusion ;* and secondly, in realizing this prin- ciple, all means have been scrupulously rejected, save an entire dependence on the watchfulness and action of suitable attendants—and hence the necessity of remov- ing all duties otherwise occupying this class and en- abling them to give their undivided attention to this one sole important end. These ideas are embodied in a statement in the governor's memorandum book for 1840: " One of the greatest principles of improvement hitherto introduced into the asylum has been the entire separa- tion of the personal care of the patients from all other duties whatsoever." To a similar feeling is due an or- der of the board of governors, passed May the 24th, 1847, to the effect—"that the house surgeon be em- powered to engage temporarily any number of extra attendants necessary for the care of any patientt perse- vering in acts of extraordinary violence." Hence, also, we find remarks or regulations against various provi- sions requiring extraneous exertion. Thus it is, proba- bly, in a measure, with this intention, that they remark, in as early a report as that for 1833, that no provision had been made for a class of patients paying a very high rate of board. So too in the report for 1837, it is observed that by the degree of approach to substituting entirely personal attention instead of restraint, the ex- cellence of every asylum should be tested, and conse- quently the governors should not let their attention be * We might also add to the list "cold bath rooms," although previously discussed. At the Middlesex County Asylum at Hanwell, both seclu- sion, padded rooms and the shower bath were employed as adjuvants in inaugurating the novelty of non-restraint. We believe that the principle may be enforced without adopting the precautions insisted on as neces- sary conditions, either at those asylums or elsewhere. t Tall attendants are especially desired. 35 drawn off from this important point b}r such operations as husbandry, the management of cattle and the like. The same principle may be traced in all the exceptions above enumerated. As to other asylums, this may be considered under two heads : first, then, apart from the question of restraint and seclusion, it may be observed that many of these exceptions deserve particular notice, as embodying the general principle that the care of the patients, and particularly the direct influence of the of- ficers and attendants upon them, is so important that the fewer adventitious matters we have to occupy our atten- tion, the better it will be for the main purposes of an institution. Moreover, much less is gained pecuniarily by an opposite course than has been sometimes repre- sented. And we believe that old notions as to economy from this source have been everywhere discarded by later experience. Hence the general principle applies to other asylums, though in all it may not prove suitable to limit the means of control to the hands of attendants, whilst doubtless in so doing, the Lincoln Asylum is ful- filling its mission. As concerns the condition and pro- gress of asylums generally, we think the move on the part of this reformatory institution is of inestimable value, for it has led to others in the same direction, so that however we may agree with the exclusiveness of a total rejection of restraint, we cannot but rejoice in the general tendency involved, and give due credit and ad- miration to the zeal displayed by the governors in car- rying out their peculiar views—a zeal so unusual with the corporate bodies of this character. The considerations advanced at Lincoln respecting classification are worthy of special examination. Even though we hold to the prominent features of classification, 36 those adopted for reasons very palpable, at least in their apparent character, yet it is not deemed amiss to call attention to circumstances certainly tending to modify the opinion of the unprejudiced. So also we may quote Esquirol, as approving a conclusion somewhat different from that usually entertained in this relation. As we treat persons, whether sane or insane, they will generally behave towards us in turn, and moreover will be apt to act accordingly to the character which we attribute to them. The influence of example too in placing an in- dividual in a ward where the patients are all disorderly, needs attentive consideration. By varying at least our exact classification, we would gain the advantages in- volved in any change on the insane mind. I have often thought, for instance, we might suitably thus locate for a time all patients of similar age in a division : take half its inmates from one ward and exchange them for half of those of another, and so on. Analogous modifica- tions might be varied ad infinitum. In the Eastern Asy- lum, by not keeping up too strictly the closing of doors, and other means of classification, we have observed very good effects produced, in warding off the con- straining air of confinement.* Included in the table of arrangements which we have previously referred to as containing a statement of their not being found at Lincoln, is the following item: "Apartments warmed with heated air;" and as far back as their report for 1836, we see that the governors reject warm air flues on account of the " original cost of fixing the apparatus, intricacy of arrangements, mis- takes of servants, extravagant consumption of fuel; and * The increased space of the airing courts under the new arrange- ment, was found very advantageous at Lincoln. 37 above all, a doubt of the wholesomeness of apartments warmed by means of heating the air respired." In the midst of the opposite practice, we still think that for a large majority of the insane open fire-places are prefer- able, as being more pleasant to the patient, and as pro- bably being more conducive to health. From the year of its being opened, 1773, until the present date, the major portion of the Eastern Lunatic Asylum of Virginia has been heated by open fire-places. Wherever the warm air flues were introduced, if there was an open fire-place anywhere in the same department, the in- mates have almost always preferred this, and forsaking the apartments under the action of the flues, have gone thither; and I think that open fire-places are to be pre- ferred for most of the insane, at least in a temperate clime. In the report of the Lincoln Asylum for the year 1844, it is observed—" There is, moreover, special pro- vision—apartments with a fire and night-watching—for unsettled patients, unwilling to compose themselves to rest, as well as infirmaries with fires for sick and feeble patients." They here speak likewise of the evils of ex- ercising galleries with a heated atmosphere, and quote from the commissioners of the Pentonville prison, a mo- del institution of the kind, to the same effect. Hence, too, amongst the particulars specified, as before detail- ed, to be exceptions, we have mention of "galleries with fire-places." The House Visitor observes in De- cember 1832, " I cannot but remark the contrast be- tween the rooms warmed by coal fires and those heated with air flues. In the latter apartment, the patients ne- ver appear so comfortable as they do in the others, and the atmosphere feels oppressed and unwholesome." In the report for 1842 the governors arrive at " the 38 conclusion that the attention of the patients should be drawn from internal reverie lo external impressions, by gentle and exhilarating measures, and not by forcible means, as the whirling-chair, the douche, stripes, chains, terror and violence." In this connection, they speak of the introduction of two female children to act as play- mates of the patients; of the inmates going to the ca- thedral, to the public institutions of the adjacent city, the union, mechanics' institution, public library, the cas- tle grounds, public concerts, the theatre, menageries and other shows at the fairs, a variety of games, the hunting of a pack of beagles presented by a gentleman in the neighborhood, parties and balls, attended too by ladies and gentlemen and children from without the demesnes of the establishment, and in turn the attendance of the inmates on private parties when they were invited by friends of the officers. To a high estimation of this train of external influences we most heartily give in our adhesion ; and also to an accompanying remark of Mr. Hill, the accomplished house surgeon at the time, a gen- tleman to whose courageous perseverance so much is due in ameliorating the condition of the unfortunate in- sane. He says, " There is much real or pretended false alarm about the danger of exciting the insane. The excitement arising from the development of the kindlier feelings of their nature, or the diversion of their atten- tion to external objects by the presence of strangers, &c, must be considered to exert a healthy action on the men- tal and corporeal system. The appearance of excite- ment also sometimes exists with but little of reality; and we must not be misled by the harmless bluster of the insane, " full of sound and fury, signifying nothing." Now, after the indulgence in so judicious an inter- 39 course with the public, and after remarks so striking and sensible, we are somewhat surprised at the lan- guage in the report (apparently endorsed by the gover- nors) for 1846, concerning visitors, that they " shall in all cases be accompanied by a physician or the house surgeon or matron ; and shall be cautioned not to ad- dress the patients or make any audible remarks in their presence without express permission." In our opinion, the most unrestricted social intercourse is admissible on the part of the public with a large majority of the in- sane. Nay, more, we believe first that there is less ex- citement than there would be under the opposite plan ; and that such a plan is beneficial to the inmates in a number of respects. Under the same mode of view, we think that but an inconsiderable expenditure is re- quired in establishing an asylum. We might have a comparatively small number of rooms, and allow the remainder of those sent to the care of a superintendent to receive full benefit from the action of " external im- pressions," by being boarded in the neighborhood of the asylum, though still under the treatment and super- vision of the superintendent. But we have now spun out this brochure to a far greater length than we had intended, certainly if " brevity be the soul of wit." With a few remarks then as to isolated ideas, all of which we deem worthy of attention when advanced as at Lincoln, alike from experience and due consideration, and with a few ob- servations as to the general tendency of the system of operations in force at that asylum, we shall conclude our paper. In the first mentioned connection, a remark as to a common and unmanageable disease of establish- ments for the insane is important. It is observed in 40 the report of the institution for 1848, " In cases of diarrhoea it is now the practice at once to give the aromatic chalk mixture, to discontinue the use of meats (on account of a red tongue) and potatoes, and place the patient on a rice diet. With a view to diminish the tendency to diarrhoea, the board has enlarged the allowance of green vegetables and fruit, on the sug- gestion of the house surgeon, who thinks, from his ex- perience in the navy and elsewhere, that this diet is often preventive of a tendency to this complaint." Another circumstance worthy of attention is the sup- position, that when we sometimes meet in the insane with apparently strange phenomena, and those ex- tremely difficult to grapple with, we find on examina- tion that these very manifestations have their counter- part in the sane, and are general symptoms common to the sane and the insane, only slightly modified in the latter. Hence, too, in a measure, they are to be met by simple, remediate means, instead of by labored contrivances. We are reminded here of remarks of the late Dr. Woodward concerning the medical treat- ment of insanity, by their analogous character. He says, " the excitement of the pulse, &c. are signs of the amazing excitement and not symptoms of the disease. A little cold water or ice applied to the head will afford greater and more immediate relief than the loss of a pound of blood." And he proceeds to mention a case in which he took twenty-eight pounds of blood in thirty days, and used Cox's circular swing almost daily, until it produced sickness and vomiting; and yet at the end of the month the patient was little or no better. A re- sort to remedies less hazardous and more composing was productive of a sudden amendment and speedy 41 recovery. In an analogous method, as referable to moral measures, the managers at the Lincoln Asylum describe a number of expedients of a mild nature to meet the difficulties of insanity, and advise those having in charge other institutions for the mentally afflicted to keep a record of similar means. We go on to describe a few of these, to the general principles of which we lend a most cordial acquiescence. As compared with a course frequently pursued by others, to these means may be fitly applied the words of the great bard, Milton : " With good Still overcoming evil, and by small Accomplishing great things, by things deemed weak Subverting worldly strong and worldly wise." In the relation here descanted on, as to insomlescence, the governors recommended exercise in the open air, so that it does not tend to feverishness, warm clothing, flannel; that before retiring, the patient be thoroughly warmed by a comfortable fire, &c. With regard to noisiness, the resemblance to similar tendencies in the sane, is forcibly pointed out in finding this propensity so common with children; and allusion is also made to " the artificially accelerated circulation of drunkenness, which exhibits itself in the same phenomena." And further, it is suggested that " It is possible, as in the case of pain, that nature may, in some cases, intend the phenomenon for some purpose of counteraction. From these data, it may be distinctly concluded that we must not, by any artificial process of repression, attempt to prevent noise, either by day or night; and even may distinctly conclude that an asylum, which exhibits the quiet of the grave, indicates intimidation or cruelty, though superficial persons may express their 6 42 admiration of an asylum in which it appear." The report then goes on to advise very free exercise in the open air; a remote situation of noisy patients at night, carpeted floors and other contrivances. We would that our limits would permit an entrance on other topics, discussed in a similar manner; but in the first place,* we have no room ; and moreover, justice could scarcely be done to ideas partaking so much of the subjective, by a mere discursive review. We will, therefore, sim- ply as a further remark, recommend with the utmost confidence, the perusal of this report for 1849, to all interested in the management of the insane. Various other important matters are considered very judiciously, and in an exactly analogous mode, under the heads Breakage, Homicide, Refusal of Food, Perverted In- stinct, Indecency of Action and Language, Depressing Habits, Irretention of the Bladder and Bowels, Fits, Suicide, Sickness. We cannot conclude this sketch without expressing our admiration, not for the system generally, to which we have given due credit, nor for particular measures adopted at Lincoln, many of which are of great practi- cal importance; not so much for these, as for a spirit of * For the same reason, we are prevented from discussing the interest- ing and instructive proceedings of which we have previously made mention, that took place between the governors of this asylum and the commissioners in lunacy, on the visits of the latter, according to legal provision. The commissioners write concerning the system at Lincoln, as though they ignorantly fancied the points of difference between this and other institutions, to arise from neglect, or being in the rear of ex- isting progress; whereas, the system is due to much thought and expe- rience, and is, as to many specialities touched on by the commissioners, far in advance of the times. Amongst other things, the governors very properly object to the expressions of the commissioners, " cells and keepers," as conveying derogatory and unpleasant ideas. 43 progress which lies as it were beyond them, at their basis—a spirit that constitutes the life and soul of the zeal and assiduity so marked in the governors of the Lincoln asylum—a disposition too so little felt compara- tively elsewhere. This tendency to progress as a gene- ral sentiment, doubtless pervades all our asylums to a partial extent. But the prominent position that seems to be apparently assumed at Lincoln, goes far beyond the feeling usually prevalent. The governors have not been content with the investigation of one or two points, but there is scarcely a single subject that they have not particularly enquired into. No matter how imposing the authority might be in favor of any especial mode of management, they are still ready to seek and to find some means of improvement. Now if this spirit was general in our asylums, there is no doubt that we would be far more likely to attain a greater degree of success and a greater degree of progress in the treatment of in- sanity.* We should not consider a single iota in this respect as a settled matter, but should always be ready to scrutinize every particular with minute attention, and should deem all measures, views and arrangements as constantly open to discussion and improvement. If this position was steadfastly and continuously adopted in all asylums, then truly might the philanthropist rejoice in a • By accustoming ourselves to a firm and unvarying adherence to the principle, never to consider as fixed and decided, any conclusion whatso- ever, whether held by the public generally, or by a few eminent persons; whether relative to theory, or as concerning the practical, we have be- fore us a boundless field of invention and discovery. By basely surren- dering the radiant lights of reason and experience, and taking as a guide the dim taper of authority, the progress of mankind has been retarded for centuries. And in the antagonistic principle, before whose might and excellence we are proud to bow down, lies the soul of all that is grand and glorious in the future destinies of the world. 44 future, at once of success to those having the manage- ment of the insane, and productive of the largest possi- ble amount of benefit to those laboring under the dire and awful calamity of mental alienation. All which is respectfully submitted. JOHN M. GALT. May 11, 1853. ESSAY S m&i ■ I H ^1 :<~, * ■ « tfS**.? W Wi * i PERSONS OF UNS0ITND MIND, 1 ■ V * ■ Second QtvitB Superintendent and Physician of the East era Lunatic Asylum of Virginia, at Williamsburg '49**- Hi c b m 0 n fr Do PRINTED BV RlTCHlErf & BUNNAVAUT. 1353- «~ *£st NATIONAL LIBRARY OF MEDICINE r«rc C£C j c c ccjc cc cr ^ <«LC <• cc ■ ' ^ «r ' c «rr«(K