1851] A Visit to Gheel. 67 ARTICLE V By Pliny Earle, M. D. G H E E L. No objects of contrast, no extremes or opposites are much more dissimilar than the different sections of coun- try traversed by the Rhine, between Johannesberg and the sea. From the upper extremity of the Rhinegajf to " The Castled Crag of Drachenfels," the river is almost uninterruptedly hemmed in by precipitous mountains, while the largest portion of the district farther down, ex- tending through the Netherlands, is an undiversified, mo- notonous level. The former of these divisions is the re- gion, par execellence, of legendary tales. But, although these compositions of mingled fact and fable are mostly concentrated among the mountains, a country best adapt- ed to their romantic spirit, yet even the low lands of Flan- ders are not wholly destitute of them. The outlines of one of these are as follows. 68 .Journal of Insanity. [July, Sometime in the seventh century there lived, in Ireland, a girl named Dympna, who was no less remarkable for beauty than for piety and chastity. But her loveliness excited the mostunholy passions and desires of her father, who, instigated by the devil, determined to gratify them, even though he should accomplish the ruin of his own daughter. Maintaining her virtue, but shocked at the un- natural conduct of her parent, she resolved to fly beyond the possible reach of his power. Accordingly, having obtained the companionship of a priest, named Geburnus, she escaped from her native country, and found a place of supposed security in a secluded district of the Nether- lands. The father was greatly angered when he received in- telligence of the departure of his lovely daughter. Still incited by the devil, who constantly followed him, whis- pering evil in his ears, he determined to find her place of refuge, though at the uttermost ends of the earth. He prosecuted enquiries until he discovered the course she had taken, and followed her, the evil one still at his ear. The winds did not dismast his vessel, the waters did not overwhelm it. He landed upon the continent, found his daughter, and immediately caused her to be beheaded. She died and became a Saint. She was buried, and her bones-the bones of Saint Dympna were worshipped.- But, even after her death, the good and benevolent Saint devoted herself to the afflicted of the human race ; to the restoration of those whose reason had become alienated. Geburnus also died, and was buried beside the mar- tyred girl whom, in her flight from an incestuous father, he had protected. A chapel was erected near the graves, and hither came the insane from all quarters of the land, to intercede with the blessed Saint, and to be healed by her health-restoring power. In process of time, as the 1851] A Visit to Ghcel. 69 fame and influence of the Saint became more and more extended, the people erected a new church, some half- mile distant from the graves of Dympna and Geburnus. It is a massive structure, about two hundred and fifty feet in length, and otherwise correspondingly proportioned.- Nor is it an unimportant testimony to the zeal and devotion of its builders, that the stone of which this laraje edifice is composed, was drawn more than thirty miles, over a heavy sandy road. They were prodigal of toil until this, the principal church of the commune of Gheel* was com- pleted. At length some Germans came to Gheel, for the pur- pose of exhuming the remains of Saint Dympna, and re- moving them to their own country. They excavated the wrong grave and obtained the bones of the priest Gebur- nus. The Gheelans, excited at the intended outrage, attacked the Germans, but were repulsed. The latter, discovering their mistake in regard to the remains, again went to work, and dug to the coffin of Saint Dympna. But, with all the power which could be applied, they could not remove it-could not stir it a hair-breadth. The Gheelans, reinforced, returned, re-attacked the Ger- mans, conquered and drove them from the country.- Thus rid of their enemy, they attempted to remove the coffin of the Saint, but, for a long time, were equally un- successful with the Germans. It appeared as if no hu- man power were able to stir the bones of Dympna. When all imaginable devices had failed, and the attempt was about to be relinquished, a deaf and dumb boy, as if by chance, came by. "If you would succeed," said he, "you must take yonder horse." The people gazed with astonishment. The boy had never spoken before. He never spoke again. These were the only words he ever * Pronounced Hkale. 70 Journal of Insanity. [July, uttered. The particular horse which he had designated was attached to the coffin, and the remains of the Saint were thus removed, without farther difficulty, to the new church, where they are still preserved in a shrine of sil- ver. The stones of the coffin were deposited in an ele- gant case, which was placed in the chancel, elevated upon pillars, at a height sufficient for a person to kneel beneath it. Meanwhile, a knowledge of the miraculously curative power of Saint Dympna circulated more widely, and the insane from all the surrounding provinces were brought to Ghcel for the purpose of obtaining her assistance.- Arrived there, the ceremonies performed, were as fol- lows :- "The relatives of the patient cause a nine days' offer- ing (unc neuvainc) to be madejn the church of St. Amans.* During the nine days the patient is placed in a house at- tached to the church. He is shut up alone, or with other companions of misfortune, under the surveillance of two old women. A priest comes every day to say mass, and to read prayers. The patients who are tranquil, accompanied by some children of the country, by some devotees, make, during the nine days, the circuit of the church, three times on the outside, and three times within. When the patients are in the chancel, where stands the case en- closing the stones of the Saint's coffin, they kneel and pass under this case three times, that is, at each circuit which they make of the interior. If the patient be furious, a per- son of the country and some children are paid for making the processions for him. " While the patient makes the three circuits, his rela- tives arc in the interior, praying to the Saint to effect a * This was called, the Church of St. Dympna, by the gentleman who con- ducted me through it.-P. E. 1851] A Visit to Gheel. 71 restoration. Mass is said on the ninth day, the patient is exorcised, and sometimes a second offering (neuvaine) is commenced."* Such is the legend of Gheel. It commences, perhaps, in fable, but terminates in the authentic history of recent years. The place has been, for centuries, known as a resort for persons suffering under mental disorders, and the ceremonies for securing the favor of Saint Dympna, are accurately described. The principal information in regard to this unique Commune, which has hitherto been received upon this side of the Atlantic, is contained in the description by Esquirol, who visited it in 1821, and published an account of it it in 1822, which was afterwards embodied in his large work upon mental diseases. No American has described it, and probably, previous to LS49, no one had visited it. Being in Belgium, in the summer of that year, I determined to obtain a knowledge of it by personal ob- servation. A diligence runs daily between Antwerp and Gheel, the distance being about twenty-live miles. Upon a beautiful afternoon in July, I took a seat in this convey- ance. For several miles we passed through a fertile and highly cultivated district, teeming with a luxuriant vege- tation; the road bordered upon both sides with almost uninterrupted rows of trees. Soon after leaving the old town of Sierre, the soil became light and sandy, and vege- tation less abundant. Trees no longer bordered the road, but small pines were scattered over the country, and, at length, we traversed an almost sterile plain. As the horses slowly dragged the burdened wheels through the sand, the idea was suggested that this desolation of na- * Des Maladies Mentales,Tar E. Esquirol. Vol. 2d, p. 713-14. 72 Journal oj' Insanity. [July, lure comported well with the mental desolation which I was about to witness ; that the change in the face of the earth, during this short journey, was typical of the alter- ation in a vigorous mind when, by disease, it is trans- formed into a dreary intellectual waste. As we ap- proached Ghcel, however, the landscape again assumed a more cheerful aspect, and rich fields, laden with grass and grain, stretched far and wide around us. Nature re- sumed her smiles, and the strong mind which had been made a desert was again restored to reason. We entered the town or city, and stopped at the Hotel de la Campine. The Commune of Ghecl is about twelve miles square, and contains a population often thousand persons, exclu- sive of the insane. The city of Gheel has but about three thousand, the remainder being distributed upon farms, and in eighteen small villages, or hamlets, in different sections of the commune. The country is level, the soil in some parts good, and highly cultivated and productive; in others, light and sandy. Agriculture, the care of the insane, and the manufacture of lace, are the principal occupations and sources of revenue of the inhabitants. The city of Gheel, like most other small towns upon the continent, is as completely built as if it were a por- tion of one of the larger capitals. The houses are con- structed of stone or brick, and but few of them are more than two stories in height. The principal church, the public offices, and the houses for the entertainment of travelers, are upon the limits of a large, open square, near the centre of the city. The accommodations of the Hotel de la Campine are quite as comfortable as could be expected in a place so secluded, and ol so little trade. Within the square is a public well, with a large pump, the creaking of whose heavy iron handle, as it is moved by the village maids,-city maids they must be 1851] A Visit to Ghecl. 73 called, since they are under the government of a Burgo- master-coming, one after another, from various direc- tions, to procure water for domestic use, is almost the only sound which, of a summer afternoon, disturbs the silence of the place. The house in which patients were formerly kept, while performing the ncuvaiw, is so connected with the church as apparently to form a part of it. Upon cither side of its immense fire-place an iron ring is fixed to the wall, and a chair attached. These were used for the confine- ment of the excited and violent. At the opposite extrem- ity of the church is the case containing the stones of the coffin of Saint Dympna. The floor beneath it, although of stone, is very perceptibly worn away by the persons who have knelt there, in their intercessions to the Saint. In near proximity to the case, there is a small side-chapel. Suspended upon its walls'therc still exists a well-pre- served series of ancient oaken tablets, representing, by figures carved in alto relievo, nine scenes in the history of the Saint. The subjects of these may be understood by the following translation of the Latin inscriptions upon the several tablets :- 1. Here Dympna* is born of Christ. 2. She is given to an angel to be guarded. 3. She refuses incest with her father. 4. Being virtuous, she leaves her ancient country. 5. Being found, she is given up to her father. 6. She is slain, a victim to chastity. 7. They collect the remains of the angel. 8. They worship the bones of the martyr. 9. She ministers unto many sick people. ' Esquirol invariably writes this " Nymphna," but I only heard it spoken, at Gheel, as Dympna. Upon the tablet it is Dimpna. 74 Journal of Insanity. [July, The carving is pretty well executed. Wherever the wicked father of the Saint is introduced, the image of the "unwearied adversary," with an infernal grin, is at his ear. In the last tablet the Saint is represented curing the insane, from the top of the head of one of whom a "devil" is making his egress. The number of insane in the Commune of Gheel, in the latter part of the last century, was about four hundred. In 1803 it had increased to six hundred. In 1812 there were but five hundred, and, in 1821, four hundred. In 1849, according to Mons. Vygen, the Commissaire de Police, there were about one thousand, making the whole popu- lation of the Commune eleven thousand, of which the proportion of the insane to the sane, was, of course, as one to ten. There are but three hundred patients in the city of Gheel. The remainder arc distributed among the farmers, and in sixteen of the eighteen hamlets. .The number of patients in the houses where they are taken is variable, but no person is permitted to have more than five. M. Vygen thinks that, in the city, there arc not more than one hun- dred families which do not receive them. The accommodations are of various grades. At some houses which I visited, the apartments were very agree- able and commodious, but in none were they furnished in a style nearly so elegant, as that of many of the private institutions for the insane in Belgium, France, England and America. But, at Gheel, much the greater propor- tion of the patients are supported at the expense of the public, and but about fifty cents a week is paid for the board and care of each of these. No very great extent of luxury, either in furniture or food, can be supplied at the rate of seven cents a day.- Consequently many of these arc placed in garrets, lofts, out-houses and other out-of-the-way nooks and corners 1851 A Visit to Ghcel. 75 where their accommodations can hardly be accurately described by that expressive word-"comfortable."- They appear, however, to be decently clothed and suffi- ciently well fed, and of all that I saw, in the numerous houses which I visited in Gheel and the surrounding country, I have no recollection of hearing a word of com- plaint in these respects. On the contrary, one woman, at a large farm-house a mile or two out of the town, was sorely troubled because there was too much food, too much clothing, in short, too much of every thing in the world. A considerable number, though not a large proportion of the patients are permitted to go at large, unaccompa- nied. A stranger in Gheel, without a knowledge of the fact that he is surrounded by a large number of insane, might, perhaps, pass a day or two before he would suspect it, as those who are abroad are mostly such as betray no very prominent eccentricities of conduct.- Several with whom I conversed in the, streets said they were brought to the place because they were thought to be insane. One of them declared himself to be the Em - peror of Austria, and another, a woman, claimed to be the daughter of the same sovereign. Within the town, I saw but one patient in the streets upon whom there was any restraining apparatus. His waist was encircled with an iron belt to which his hands were secured by wristlets. In the suburbs and around the farm-houses, however, there were several who were fettered with iron, the chain be- tween the ancles being about eight inches in length. In some cases the rings around the ancles had abraded the skin'and occasioned bad ulcers. The climate of Gheel is said to be favorable to longe- vity. Mons. Vygcn said that many of the patients were over eighty years of age, that a considerable number have died at nearly one hundred, and one, about the yeat 184-5, 76 Journal of Insanity. [J uly, at one hundred and four. The Asiatic cholera has never visited the place, although it has ravaged some of the surrounding communes. On the second evening after my arrival in Gheel I at- tended a meeting of the Socictc cP Harmonic, a musical as- sociation founded by one of the patients resident in the place. He remained a member for several years, and before his decease, saw it a flourishing society, composed of many members, playing upon nearly all kinds of mu- sical instruments and furnished with a spacious hall for the accommodation of themselves and their audiences. All the insane in the Commune are under the general supervision of a Board of Commissioners consisting of the Burgomaster, four physicians, two surgeons, and three citizens. Until recently the sick were all attended by the physicians of Gheel. The city of Brussels, how- ever, having no less than three hundred and sixty patients here, has sent a physician, Dr. J. Parigot, formerly Pro- fessor in the University of Brussels, to have the special oversight of them. To him, as to M. Vygen, I am much indebted, not for verbal information alone, but for their company in visiting the houses in which patients are en- tertained. The question whether the welfare of the insane is as much promoted in this Commune as it would be in Asy- lums or Hospitals has recently been much discussed in Belgium, particularly by medical men and the public authorities of the cities which now send their patients to Gheel. The Gheelans, citizens, medical men and public officers, espouse the opposite side of the question. They maintain that the patients under their care enjoy greater liberty and suffer less coercive restraints, that they breatho a purer air and take more exercise, arc more constantly under supervision, and by being so widely distributed, a few in each family, arc less subject to disturbance and 1851J A Visit to Gheel. 77 annoyance from other patients than is possible in large institutions. 1 saw nothing, farther than what is herein mentioned, tending to excite a doubt that the patients are kindly treated by their immediate protectors. The Physicians, the Commissaire de Police and the other officers whose duties involve a supervision of the insane, have an ardu- ous task, but it is apparently faithfully performed. Not- withstanding all this I believe the system is liable to greater abuses than can possibly occur in well ordered institu- tions, and that the interests of the patients now at Ghcel would be advanced if they could be placed in public Asylums, such as have recently been established in America, England, and several of the continental coun- tries. The work of Mons. Appert, a Frenchman, who recently traveled in Belgium, contains a notice of Gheel fiom which the following paragraph is translated. " The greater part of the insane work in the fields with the persons who board them; they sometimes, also, take care of very young children, and, what is very remarka- ble, there is no instance of any injury (cxces) committed by them upon these little creatures."* M. Appert, according to the dates in his journal, re- mained but part of a day in Gheel, and, consequently, had not an opportunity of collecting all the information upon the subject of the insane which the place affords.- I was told, by two or three persons, at different times, that, about two years previous to my visit, one of the pa- tients became strongly attached to a child in the family with which he boarded. Another patient was subse- quently received, and, as he also became interested in the child, the jealousy of the former was aroused to * Voyage en Belgique. Par B. Appert, 1819. 78 Journal of Insanity. [July, such an extent that he murdered the little object of his affection. The modern annals of Ghecl furnish another tragedy, no less melancholy in its termination. About four years before my visit, one of the insane men was in the prac- tice of collecting herbs, making infusions of them in beer, and selling this liquid, as medicine, at a high price. He had acquired a somewhat extensive reputation among the people of the vicinity, for his skill as a Physician, and was consequently consulted by many who were suffering from disease. The Burgomaster of Ghecl, at that time, was a chemist and druggist, and, as his business was thus interfered with, he became perhaps imprudent in his opposition to the proceedings of the patient. The insane man frequented the beer-shops, where, as in similar places in other countries, political subjects were frequently discussed. He heard much said against the Burgomaster, and hence probably at length believed that officer to be a very general object of dislike. He obtained an old bayonet, sharpened it, met the Burgomaster upon a some- what secluded cross-path, by which he was accustomed to pass between his house and store, and killed him by repeated stabs. These occurrences are not related as arguments against the system at Ghecl. Incidents equally unfortu- nate, equally melancholy and fatal have occurred, more than once, in Asylums. Assertions, however, so errone ous as that of M. Appert, although made, undoubtedly, under a conviction of their truth, ought not to be permit- ted to give a false impression to the public mind. I( should be known that at Ghecl, as al every other place where there is a large congregation of the insane, there is liability to serious accidents, and that these have not always been avoided. 1851] On the Construction of Asylums. 79 ARTICLE VI. REPORT on the Construction of Hospitals for the Insane, made by the Standing Committee of the Association of Medical Superintendents of American Institutions for the Insane, at its Meeting in Philadelphia, May, 21, 1851. At the meeting held at Boston, June 18th, 1850, the Standing Committee on the Construction of Hospitals for the Insane, was instructed to report to the next meeting, a scries of propositions relative to the structure and ar- rangements of American Institutions for the Insane, that would embody the well ascertained views of the body in reference to many points in regard to which there was no difference of opinion. The twenty-six now reported arc of that character, entire unanimity in reference to them was expressed, and they arc importantas embodying the views of those who have a practical knowledge of the subject. Many other points might have been introduced, but from a conviction that some diversity of sentiment still existed in reference to them. I. Every Hospital for the Insane should be in the country, not within less than two miles of a large town, and easily accessible at all seasons. II. No Hospital for the Insane, however limited its capacity, should have less than fifty acres of land, devoted to gardens and pleasure grounds for its patients. At least one hundred acres should be possessed by every State Hospital, or other Institution for 200 patients, to which number these propositions apply, unless otherwise mentioned. III. Means should be provided to raise ten thousand gallons of water, daily, to reservoirs that will supply the highest parts of the building. IV. No Hospital for the Insane should be built, without the plan having been first submitted to some Physician or Physicians, who have had 80 Journal of Insanity. [July, charge of a similar establishment, or are practically acquainted with all the details of their arrangements, and received his or their full approba- tion. V. The highest number that can with propriety be treated in one building is two hundred and fifty, while two hundred is a preferable maximum. VI. All such buildings should be constructed of stone or brick, have slate or metallic roofs, and as far as possible be made secure from acci- dents by fire. VII. Every Hospital, having provision for two hundred or more pa- tients, should have in it at least eight distinct wards for each sex,-making sixteen classes in the entire establishment. VIII. Each ward should have in it a parlour, a corridor, single lodging- rooms for patients, an associated dormitory, communicating with a cham- ber for two attendants; a clothes room, a bath room, a water closet, a dining room, a dumb waiter and a speaking tube leading to the kitchen .or other central part of the building. IX. No apartments should ever bo provided for the confinement of patients, or as their lodging rooms, that are not entirely above ground. X. No class of rooms should ever be constructed, without some kind of window in each, communicating directly with the external atmosphere. XI. No chamber for the use of a single patient should ever be less Ilian eight by ten feet, nor should the ceiling of any story occupied by patients be less than twelve feet in height. XIL The floors of patients' apartments should always be of wood. XIII. The stairways should always be of iron, stone, or other inde- structible material, ample in size and number, and easy of ascent, to afford convenient egress in case of accident from fire. XIV. A large Hospital should consist of a main central building with, wings. XV. The main central building should contain the offices, receiving rooms for company, and apartments entirely private, for the Superin - tending Physician and his family, in case that officer resides in the Hos- pital building. XVI. The wings should be so arranged, that if rooms arc placed on both sides of a corridor, the corridors should be furnished at both ends with movable glazed sashes for the free admission of both light and air. XVII. The lighting should be by gas, on account of its convenience, cleanliness, safety and economy.