Chapter 8

â€œShe seldom interferes with any other patient, the officers and attendants being the special objects of her furious attempts, and her mode of attack is peculiar; there is not usually anything in her manner or appearance to indicate mischief, and she has perhaps previously spoken calmly to the person upon whomâ€”having watched until she has turned her back; for as long as the face is towards her the individual is safeâ€”she springs with the quickness and velocity of a tigress, fastening her hands in the hair, and bringing her victim to the ground in an instant. If not immediately rescued, the head of the unfortunate person is dashed repeatedly upon the floor; and it has been found impossible hitherto to detach the hand of this patient without a quantity of hair being torn by her from the head of the sufferer.â€

The visiting magistrates are also highly obnoxious to the patients; and their passage through a ward generally leaves behind it a trail of excitement which often generates outbreaks that do not subside for some hours. On the whole, however, it is remarkable how small an amount of violence is attempted by the insane. In Colney Hatch, with its 1,250 patients, there are far fewer personal assaults in a year than would take place in any village containing half the number of inhabitants. Still precautions are always necessary; and the attendants, from long observation, are generally forewarned, and, consequently, forearmed. Special arrangements are made for those persons who have an unusual tendency to injure themselves or their companions. The suicidally inclined are always placed at night in dormitories with other patients, an arrangement which effectually prevents any attempts at self-destruction; while those who have a propensity to commit homicide are provided with separate cells. There is at the present moment a person at Colney Hatch who labours under the delusion that he can only recover his liberty by killing one of the keepers, and in accordance with this idea he has already made several attempts on their lives. A lamentable death took place at Hanwell the year before last, throughthe neglect on the part of an attendant to see a homicidal patient properly secured in his apartment for the night.

â€œOn the 12th of April, the patients of No. 7 ward (twenty-five in number) having had their supper, were going to bed at a quarter before eight oâ€™clockâ€”all of them, being more or less refractory, have a single bedroom each. The attendant, in seeing them to bed, inadvertently locked up two (B. and W.) in one room; he stated that, observing the day-clothing of all outside their doors, he supposed that the patients were in their rooms, and, therefore, did not take the precaution to look into them. The room No. 19 was the one usually occupied by W., a man of exceedingly clean habits, of a mild expression of countenance, but very violent, prone to strike suddenly and without provocation any person within reach of him; so frequently had he done this, that he was not allowed to sit near other patients, even at meals, but took his food apart from them at a side-table. B., whose room was No. 10, directly opposite to No. 19, was occasionally violent, always dirty in his habits, and destructive of clothing. It is supposed that this man entered No. 19 room by mistake, and that his presence there excited the homicidal tendency of the other into action. What is known is, that the night-attendant, when he visited the ward at half-past ten oâ€™clock, and went as usual to the room No. 10, found it unoccupied, and the patientâ€™s clothes outside the door; then hearing a noise in the room 19, he opened the door, and saw B. extended at full length on his back on the floor, naked and quite dead. W. came out of the room in his shirt immediately the door was opened, and, pointing to B., said, â€˜That fellow will not allow me to sleep.â€™ There was a mark round B.â€™s neck as if caused by a cord, which had produced strangulation, and a mark of a severe blow on the top of the nose, and of a bruise on the chest: the bedclothes were in great disorder; amongst them were found the shirt and flannel of B.; one sleeve of the former was twisted like a rope, as if W. had strangled B. with it.â€

The utmost precaution will not always insure safety, for patients considered quite harmless will now and then commit the most horrible acts. A black man, a butcher, who had been many years in an American asylum, and had never shown any violence, one night secreted a knife, and induced another patient to enter his cell. When his companion had lain down, he cut his throat, divided him into joints, and arranged the pieces round his cell as he had been accustomed to arrange his meat in his shop. He then offered his horrible wares to his fellow-lunatics, carrying such parts as they desired to those who were chained. The keeper, hearing the uproar, examined the cells, and found one man missing; upon inquiring of the black butcher if he had seen him, he calmly replied, â€œHe had sold the last joint!â€ Even those who have apparently harmless delusions, will sometimes, if thwarted, commit unlooked-foratrocities. Not many years since, an inquisition was held before Mr. Commissioner Winslow upon a young gentleman who would travel considerable distances to see a windmill, and sit watching it for days. His friends, to put an end to his absurd propensity, removed to a place where there were no mills. The youth, to counteract the design, murdered a child in a wood, mangling his limbs in a terrible manner, in the hope that he should be transferred, as a punishment, to a situation whence a mill could be seen.

Idleness is perhaps a greater curse to the majority of lunatics than to sane individuals. Occupation diverts the mind from its malady. Colney Hatch and Hanwell, from their populousness, and from the fact of their being filled principally by metropolitan lunatics, afford admirable examples of the new method of employing patients in the trades they have been accustomed to follow when in health. As the ranges of workshops at Colney Hatch are the most extensive, we will draw our description from that establishment. Of the male patients, only 245, out of an average of 514 in the house during the year 1855, were employed in labour at all, the remainder consisting of violent maniacs and those afflicted with paralysis, epilepsy, and idiocy, none of whom are capable of undertaking any work. Sixty-five persons were allotted to the gardens, grounds, and farms, leaving 180 to be distributed in the workshops and various offices of the asylum. The tailoring department is the most extensive. Upon the occasion of our visit, there were at least a score of cross-legged lunatics cutting out and making up grey dresses for the inmates, or repairing old clothing, their conduct being in no manner distinguishable from that of sane journeymen. The shoemakers numbered a dozen, every man handling his short knife. Those unaccustomed to lunatics will find it a nervous proceeding to thread their way among so many armed madmen, and will wish themselves well out of this apparently dangerous assembly. Yet, in truth, they are no more to be feared than any similar number of lucid workmen, as the homicidally inclined are carefully excluded. The carpenters planed away merrily among their chips in an adjoining apartment,using now and then chisel, gouge, and saw in perfect freedom. Many excitable patients have been placed in these shops without any bad result; and even those who are disposed to be mischievous when suspected, have become quiet when trusted with edge-tools of the most formidable description. The greater the confidence reposed in the majority of the insane, the more does it tend to insure good behaviour. Of the other artificers in different departments, we may mention painters, upholsterers, bakers, butchers, brewers, and coopers; whilst a still larger number are employed in the kitchen and dining-hall, or as helpers in the corridors and wards. The services of all these lunatic artisans and labourers were valued last year at 1,059l.3s.

As far as possible, the men work at the trades they have previously followed; but there are many patients whose skilled labour cannot be utilized in this comparatively confined community; such, for instance, as rule-makers, jewellers, whale-bone-cutters, coach-painters, gold-beaters, buhl-cutters, wax-doll makers, and a score of other heterogeneous craftsmen, who are only to be found in a great metropolis. These persons engage in the employment most suited to them, and thus many of them leave the asylum skilled in two trades. Equally efficacious is the occupation on the farm, which contains seventy-six acres of pasture and arable land, principally dedicated to the rearing and maintenance of stock. On the 1st of January, 1856, there were 28 cows, 1 bull, 2 calves, 152 pigs, 40 sheep, 7 horses, &c. The tending of these animals, the culture of the fields and of the thirty-one acres of ornamental grounds, the milking the cows, the slaughtering of the meat, and the production of the butter, afford varied and healthy employment to the sixty-five agriculturists. Some persons who never handled a spade before, here set to work cheerfully and with a will, and a French polisher, a Wesleyan minister, a school teacher, or a law writer, may be seen digging away at a field of potatoes; or a ship-carpenter, saddler, cabman, coalheaver, and organ-player, diligently engaged in filling a manure-cart. They would, it is true, be better employed in occupations more in accordancewith their previous habits; but these cannot be found for them, and labour of any kind is preferable to idleness. On the female side of the house industry is resorted to as a means of cure to a still larger extent. Of the 503 equal to labour, 270 work as needlewomen, 7 are employed in the kitchen, 72 wash, iron, and clearstarch in the laundry, 125 help in the wards, and 29 attend school, and are otherwise engaged. The total value of the female labour of the house is computed at 500l.per annum.

Colney Hatch is not so extensively embarked in industrial and agricultural pursuits as the North and East Riding Asylum, where the patients are received from a mixed manufacturing and agricultural population, and the produce of their fields and workshops is much greater than could be extracted from worn-out metropolitan patients. Not only do the lunatics rear the vegetables, but they take them to the asylum gates and dispose of them to the public. The result affords a proof of what we hold to be a settled principle, that chronic cases of insanity are greatly benefited by as much intercourse as possible with the saner part of the community.

In accordance with the opinion that pursuits of lunatics should be similar to their pursuits in former days, the south wing of Haslar Hospital is devoted to the officers, seamen, and marines of her Majestyâ€™s fleet who are afflicted with insanity. Every window of the building commands a fine view of Spithead and the Isle of Wight, and here the old Salts can sit and watch the splendid panorama crowded with vessels, and active with that nautical life which recalls so many happy associations to their minds. They form fishing parties, make nets, and go on pleasure excursions in row and sailing craft. The â€œmadmanâ€™s boatâ€ of eight oars, manned by patients and steered by an attendant, is well known to the sailors on the Solent, and so harmless are they considered, that young ladies often accompany them on trips to the Isle of Wight, implicitly trusting in their seamanship and politeness.

Mental labour, as a means of cure, has not been adopted in England to any great extent; most asylums have their libraries,in which attentive readers are always to be found, but the inmates rarely attempt to produce amusement or instruction for their fellows. There is one signal exception to this rule in Murrayâ€™s Royal Asylum at Perth. This establishment, under the superintendence of Dr. Lauder Lindsay, appears to be the very focus of intellectual activity. The programme for the winter session of 1856-7 reads more like the prospectus of the AthenÃ¦um of some large city than the bill of fare for a lunatic asylum. Famous professors reflect in its lecture-room the philosophy and science of the outer world, and their choice of subjects would not be disavowed by the committee of a London Scientific Institution.

These scientific and philosophic expositions are attended by all the better class patients. The paupers have a separate set of lectures and classes, the major part of which are delivered and conducted by the inmates themselves. Galvanism, the Blood, Time, Economic Botany, are among the subjects which the deranged brains of the Perth asylum are contented tohear elucidated. The activity of the place does not stop here: chamber concerts, in which the patients perform; grand concerts, in which artists from without supply the leading stars; and theatrical performances, in which the different characters are all taken by â€œresident actors,â€ are among the resources which were employed to amuse and interest the inmates during the winter months just past. A pit full of lunatics watching â€œBox and Coxâ€ played by their fellows, is a curious subject for contemplation. Not content with these efforts, they seem to think that they are nothing unless critical, and accordingly they have set up a journal, in which they review their own performances. The first number ofExcelsioris now before us, in which we find poetry, news, and criticisms on music, and contemporary literature; and he who reads with the idea of finding anything odd in this production, will most certainly be mistaken; for no one could divine that there was a â€œbee in the bonnetâ€ of printer, publisher, and contributor. Balls and conversaziones form the staple of the lighter recreations of this singular community, whilst the more athletic games of running, leaping, hurdle-racing, Highland dancing, putting the stone, footing the bar, and lifting dead weights, are pursued with such success, that the lunatics boast with pride that they have beaten some of the prize-holders of the outer world.

It might be supposed that intellectual striving was not the medicine to offer to a diseased brain; but we are informed by Dr. Lindsay that in the vast majority of cases the best results flow from this method of treatment, and that a large percentage of cures is obtained. Such patients as would be injured by stimulating their faculties are debarred by the physician from their undue exercise, and others must be too far gone, or be too uninformed, to be capable of the pursuit. The surprise that lunatics should be susceptible of healthy mental exertion, arises from the common forgetfulness that many understandings are slightly affected, or are only deranged upon particular points. When Nat Lee was in Bedlam, he said that it was very difficult to write like a madman, and very easy towrite like a fool. The works of the fools are more voluminous than the works of the madmen, because there are more fools than lunatics; but those who are completely mad are so far from experiencing a difficulty in writing in their own character, that they cannot write in any other. As many, however, who are not altogether right in their minds, are no more exclusively insane than people who are not absolutely wise are entirely foolish, it is easy to see that they may still be equal to much profitable mental exertion. In these days poor Christopher Smart would not be deprived of his pen and ink, and compelled to indent his long poem on â€œDavidâ€ with a key on the panels of his cell; nor perhaps would the following epigram, which a woman in Bedlam wrote on Martin Madanâ€™s argument in favour of polygamy, be handed about as a phenomenon to be wondered at:â€”

â€œIf John marry Mary, and Mary alone,It is a good match between Mary and John:But if John marry more wives, what blows and what scratches!â€™Tis no longer a match, but a bundle of matches.â€

In France, and we believe in some other continental countries, it is the habit to employ lunatic labour in the private farms surrounding the asylum. This plan was in the olden time pursued in England; but it appears to have gone out with the ancient system of coercion. When radical revolutions are accomplished, good ideas sometimes perish with the bad; and we cannot help thinking that the abandonment of this method of exercising lunatics was an error, and that a return to the old practice, under proper regulations, would be of advantage both to employer and employed. Never must we lose sight of the wisdom of freeing the patient as much as practicable from the companionship of his fellows, and of placing him, to the utmost of our power, in the same free condition which he enjoyed in his days of sanity.

At Colney Hatch, as at Hanwell, and indeed all other public asylums, the sexes occupy separate portions of the building, and are only allowed to be present together on particular occasions. This unnatural arrangement undoubtedly arose from theintroduction into asylums of prison and workhouse systems of management; for certainly nothing can tend to render the life of the patient more dreary than to find himself carefully excluded from the company of the other half of creation. It is stated by the advocates of separation that the mingling of the sexes among the insane would be productive of occasional misbehaviour; but nothing could be more unjust than to deprive the majority of the benefits which would arise from frequent social reunion, in consequence of the erotic tendencies of the few. It is with pleasure, therefore, we see the attempts which are being made to assimilate the intercourse of lunatics to that of the sane at Hanwell, Colney Hatch, and other asylums. The most interesting feature of the former establishment is the ball which takes place every Monday night. Shortly after six oâ€™clock the handsome assembly-room, brilliantly lit with gas, becomes the central point of attraction to all the inmates, male and female, who are considered well enough to indulge their inclinations for festivity. On the occasion of our visit there were about 200 patients present, together with a few visitors and many of the attendants. In a raised orchestra five musicians, three of whom were lunatics, soon struck up a merry polka, and immediately the room was alive with dancers. In the progress of this amusement we could see nothing grotesque or odd. Had the men been differently dressed, it would have been impossible to have guessed that we were in the midst of a company of lunatics, the mere sweepings of the parish workhouses; but the prison uniform of sad-coloured grey presented a disadvantageous contrast to the gayer and more varied costumes at Bethlehem, and appeared like a jarring note amid the general harmony of the scene. In the corners of the room whist-players, consisting generally of the older inmates, were seen intent upon their game; not a word was uttered aloud, not a gesture took place that would have discredited any similar sane assembly; yet not a patient was free from some strange hallucination, or some morbid impulse. Among the merriest dancers in Sir Roger de Coverley was a man who believed himself to be our Saviour, and who wore in his hair aspike in imitation of the crown of thorns; and one of the keenest whist-players was an old lady, who, whilst her partner was dealing, privately assured us she had been dead these three years, and desired as a favour that we would use our influence with the surgeon to persuade him to cut off her head. In the midst of such strange delusions, it was curious to notice how rationally those who were their dupes enjoy themselves; and it is impossible to deny that such reunions are eminently calculated to hinder the mind from morbidly dwelling upon its own unhealthy creations. It is found that the too prolonged and frequent repetition of the balls somewhat diminishes their interestâ€”an evil provided against at Hanwell by restricting the time allotted to them. At nine precisely, although in the midst of a dance, a shrill note is blown, and the entire assembly, like so many Cinderellas, breaks up at once, and the company hurry off to their dormitories. These hebdomadal balls have not yet been introduced at Colney Hatch. A movement has, however, been made latterly towards a limited association between the sexes by allowing them to dine together. Of the 500 patients who assemble in the ample dining-hall, 200 are females and 300 males. The scene when the women first made their appearance is described as something remarkable; the men rose in a body apparently delighted beyond measure, and the presence of the softer sex has not only tended to break the former monotony, but to keep the assembly in order and good humour. Before this happy meeting there were occasional outbreaks of some of the more excited patients; but now, when any of the men are inclined to be fractious or discontented, the women turn them into joke, and they are silenced immediately. As yet the two sexes are not allowed to sit at the same table, but are located on opposite sides of the room. By far the better plan would be to seat them on different sides of the long tables; but as many persons in authority, wanting confidence in human nature, object to this natural arrangement, the innovators must be satisfied for the moment with the present imperfect concession. When it was first proposed to introduce a billiard-table at Bethlehem, the schemewas rejected by a majority of two-thirds of the governors, on the score that the players would fight each other with the cues and balls, and bagatelle, as a kind of half measure, was permitted instead. As the patients confined the balls to their legitimate purpose, and the mace was not turned into an offensive weapon, the billiard-table was at last with reluctance established. The same thing will doubtless happen with respect to the dining arrangements at Colney Hatch; and before long we trust male and female lunatics will exchange courtesies across the table instead of across the room.

In the chapels of nearly all the larger lunatic asylums the quieter inmates are accustomed to meet at the daily morning and evening service. In the spacious chapels of Hanwell and Colney Hatch, the attendance on week days, as well as on the Sabbath, is far better than can be found among the same number of people out of doors, 250 on the average attending on week days, and 500 on Sundays. We do not suppose that the lunatic is more religious than the sane, but theennuiwhich, to a certain extent, still attaches to the asylum renders any form of reunion agreeable; and as the going to chapel is â€œsomething to do,â€ numbers of the inmates obey the summons who might stay at home if they were at large. The conduct, nevertheless, of this congregation is most exemplary. â€œThe heartiness,â€ says the chaplain, in his report for 1856, â€œwith which they join in the responses and the psalmody is very encouraging, while their quiet, orderly conductâ€”the prayer offered up by many on entering chapel, the regularity with which they all kneel or sit, according to the order of the serviceâ€”would, I think, if generally witnessed, put to the blush many of our parochial congregations.â€ Now and then an epileptic patient will disturb the chapel by his heavy fall; but as those who are thus afflicted are located near the doors, the interruption is but momentary. The chaplain of Colney Hatch has trained twelve male and female patients to practise church music and psalmody. The choral service is well performed, and, in conjunction with the organ, has a visible effect in soothing the wilder patients, and in pleasing all. The sacrament is not denied to those whoare fit to receive it, and no more touching scene can be witnessed than that which is presented in the chapel, when a score of communicants, disordered though their minds sometimes be, humbly kneel, and

â€œDrain the chalice of the grapes of God.â€

The out-of-door games of the insane are very much regulated by the extent of ground attached to the asylum. Where this is ample, as at Colney Hatch, cricket is the favourite summer recreation; a skittle-alley, a bowling-green, and a fives-court, are found in most county asylums. In America, where women adopt more masculine habits than in England, female lunatics play matches on the bowling-green; and in France gymnastic exercises are employed for the exercise of both sexes, and may, we think, be introduced into the English asylums with advantage. The idiotic patients and those who are incapable of much exertion may be seen in the airing courts enjoying the monotonous swinging motion of the machine known in domestic life under the name of â€œthe nursery yacht,â€ being nothing more than a rocking-horse with the horse left out by particular desire. In addition to these means of diverting the minds of the patients, walking parties, under the superintendence of officers of the establishment, are made up two or three times a week. During the haymaking season it is customary to allow the inmates of asylums to which farms are attached to go forth into the fields to assist with the rake and the pitchfork. This permission is always looked upon as a great treat, and its effect upon the patients is of the happiest kind, especiallyif the scene of their temporary labour admits no sight of the asylum and its wearisome walls. Here for a few hours they seem to realize the liberty and delight of younger days. The physician on such occasions may read in their â€œgrateful eyesâ€ that we are at present arrived only half way on the road of non-restraint. Individual patients, again, are suffered to leave the public asylums on a dayâ€™s visit to their friends, under the care of a nurse; and some who are nearly convalescent are permitted to go and return of their own accord. It is the custom of ColneyHatch and Hanwell, and we believe of most asylums in England, to grant the patients a certain period of probation among their friends, in order to test their fitness to be discharged as cured; to give them, in short, mental tickets-of-leave. This is an admirable plan, inasmuch as it secures to the patient the full enjoyment of liberty, at the same time that it enables him to keep himself well in hand, knowing that, as he is not unconditionally released, an immediate recall to the asylum would follow any sign of returning irrationality.

The dietary in public asylums is ample, and the quality excellent. Hanwell may, perhaps, be considered the model establishment in this respect. It is the joke of the other asylums, that one man has been regaled there daily for years with chicken and wine. Even the fancies of the patients are now and then gratified at some expense. There is an old lady in Hanwell who believes that the whole establishment is her private property; and, on one occasion, she complained to the medical superintendent that, notwithstanding all the expense she was at to keep up the grounds and forcing-houses, she never could get any grapes. The next day she was presented with a bunch, which had been purchased to appease her repinings. This humouring method of treatment, as it is called in other asylums, is much patronized by the matron, a person who seems to enjoy as much power as the medical officers. In her report for 1856 she thus speaks of a patient who died in the course of last year:â€”

â€œShe had been employed many years in the laundry, and always imagined she was to be removed elsewhereâ€”that on Monday morning a waggon would call at the gate for herself and her property. Accordingly, every Monday morning throughout the year, at 10 oâ€™clock, she was accompanied to the gate, dressed with a coloured handkerchief pinned fancifully over her cap instead of a bonnet, and carrying a small parcel (her property) of the most heterogeneous contentsâ€”thimbles, ends of tape, polished bones, pebbles, pieces of smooth coal, &c. The waggon was never found to be in waiting, and Mary, without evincing any disappointment, walked cheerfully back to the laundry, telling the superintendent that â€˜The waggon would be sure to come next Monday, but that she need not lose time, so she would work all this week.â€™â€

In many asylums this method of treatment is thought calculated to feed the original delusion; but here, again, the judgmentof the physician ought alone to determine the course to be taken in each individual case. In patients labouring under violent excitement, to oppose an hallucination, however absurd, would add fuel to the fire. Again, in a chronic case like that of the laundry-maid, the harmless fancy of the poor creature might not only be indulged in with impunity, but served to renew week by week her stock of cheerfulness.

The lunatic colony of Gheel, situated twelve miles south of Turnhont, in Belgium, amid a vast uncultivated plateau consisting of heath and sand, called the Campine, affords an extraordinary example of the pre-eminent advantages of the present mode of managing lunatics. Until the era of railroads this spot was so out of the ordinary track of the world, that but few persons even of those who were interested in the treatment of the insane were aware of its existence. Here we discover, like a fly in amber, a state of things which has lasted with little change for twelve hundred years. Here we see the last remnants of the priestly treatment of insanity, coupled with a system of non-restraint which certainly existed long before the term was ever heard of in England and France. Gheel owes its origin to a miracle. Saint Dympna, the daughter of an Irish king, suffered martyrdom in this place from the hand of her father in the sixth century. So great was her fame as the patron saint of lunatics, that her shrine, erected in the church dedicated to her, speedily became the resort of pilgrims, who journeyed hither in the hope of being cured of their madness or of preventing its advent. Her elegantly-sculptured tomb contains among other bassi-relievi one in which the devil is observed issuing from the head of a female lunatic, while prayers are being offered up by some priests and nuns, and close at hand another chained maniac seems anxiously awaiting his turn to be delivered from the demon. The idea carefully inculcated by the priests, that lunacy meant nothing more than a possession by the devil, has long been banished from other lands. Here, however, it has flourished for many centuries, and the ceremony of crawling beneath the tomb has existed so long, that the hands and knees of the devotees have worn away the pavement.The act is still occasionally performed amid a scene in which superstition and terror are combined in a manner calculated to cure any lunatic, if deep mental impressions were alone required to purge away his malady. But what is far more interesting and astonishing to those accustomed to the bolts and bars, the locks, wards, and high walls of crowded European asylums, is the almost entire liberty accorded to the lunatics resident in the town of Gheel and its neighbouring hamlets, to the number of 800, or one-tenth of the whole district. No palatial building, such as we encounter in nearly every county in England, is to be seen. The little army of pauper and other patients gathered from the whole superficies of Belgium, instead of being stowed away in one gigantic establishment, in which all ideas of life are merged in the iron routine of an enormous workhouse, are distributed over five hundred different dwellings, three hundred of which are cottages, or small farmhouses, in which the more violent and poorer classes are dispersed, and the remaining two hundred are situated in the town of Gheel, and are appropriated to quieter lunatics and those who are able to pay more liberally for their treatment. In these habitations the sufferers are placed under the care of the host and hostess; more than three persons never being domiciled under one roof, and generally not more than one. The lunatic shares in the usual life of the family; his occupations and employment are theirs, his little cares and enjoyments are the same as theirs. He goes forth to the fields to labour as in ordinary life; no stern walls perpetually imprison him, and make him desire to overleap them, as Rasselas desired to escape even from the Happy Valley. If it is not thought fit for him to labour with plough or spade, he remains at home, and takes care of the children, prunes the trees in the garden, and attends to the potage on the fire; or if a female, busies herself in the ordinary domestic duties of the house. The lunatics, as may be supposed, are not left to the discretionary mercies of the host and hostess. A strict system of supervision prevails, somewhat analogous to that of the lunacy commissioners and the visiting justices of England. The entire country is divided into four districts, each having a headguardian and a physician, to whom is entrusted the medical care of every inmate belonging to that section. There are, in addition, one consulting surgeon and one inspecting physician for the whole community. The general government of the colony is vested in the hands of eight persons, who dispense a code of laws especially devised for it. The burgomaster of Gheel presides over this managing committee, whose duties are to distribute the patients among the different dwellings, to watch over their treatment, and to admit or discharge them. A visiting commissioner is annually appointed, who inspects the dwellings of the different hosts, and sees that the patients are properly cared for. The oversight of the lunatics falls almost wholly upon the hostess, the man rarely interfering, unless called upon to control a disorderly patient. The people of Gheel, from having been engaged for ages in the treatment of the insane, are said to have acquired extraordinary tact in their management, which, Dr. Webster remarks, may be considered to exhibit a most judicious mixture of â€œmildness and force.â€ Although instruments of restraint, such as the strait-waistcoat, and the long leathern thong below the leg, to prevent patients from running away, are occasionally resorted to, the sectional physician must be instantly informed of their imposition, and their use cannot be continued without his sanction. So little are they required, that Dr. Webster found less restraint in this colony, unconfined by walls, than in the asylum at Mareville, in France, containing a similar number of lunatics. Yet there were fewer escapes than from the strictly-guarded restraint-abounding prison, only eleven persons having fled from Gheel in the course of last year, and nineteen from Mareville. Here also, it will be observed, there is no separation of the sexes. The lunatics live the life of the other inhabitants, and males and females associate in the same household. If we compare the effects of this simple treatment with that of the most expensive of our own asylums, we are compelled to admit that the balance is in favour of Gheel, where, notwithstanding the free admission of chronic cases, upwards of twenty-two per cent. of cures takes place annually, while at Hanwell and ColneyHatch the cures never exceed fifteen per cent. No fair comparison can be instituted between the expense per head at Gheel and in our English establishments, inasmuch as living is much cheaper in Belgium; but we may state, that the average cost of board and lodging for each pauper in the colony is 10l.per annum, or exactly the sum charged for lodging alone in our county asylums.[17]

A plan, towards which we have been slowly advancing during the last half-century, will speedily, we hope, be more closely followed. A trial is already, to some extent, being made of it in the neighbourhood of existing asylums, and might supplant, with immense advantage, the prevailing custom of building new wings, and over-populating old wards. The present system of enormous buildings, which destroys the individuality of the inmates, and suppresses all their old habits and modes of life, is evidently disapproved by the commissioners, as appears from the language they hold in their tenth annual report:â€”

â€œWe have the best reason for believing that the patients derive a direct benefit, in many ways, from residing in cheerful, airy apartments detached from the main building, and associated with officials engaged in conducting industrial pursuits. A consciousness that he is useful, and thought worthy of confidence, is necessarily induced in the mind of every patient, by removal from the ordinary wards where certain restrictions are enforced, into a department where he enjoys a comparative degree of freedom; and this necessarily promotes self-respect and self-control, and proves highly salutary in forwarding the patientâ€™s restoration. As a means of treatment, we consider this species of separate residence of the utmost importance, constituting in fact a probationary system forpatients who are convalescing; giving them greater liberty of action, extended exercise, with facilities for occupation; and thus generating self-confidence, and becoming not only excellent tests of the sanity of the patient, but operating powerfully to promote a satisfactory cure. The want of such an intermediate place of residence is always much felt; and it often happens that a patient just recovered from an attack of insanity, and sent into the world direct from a large asylum, is found so unprepared to meet the trials he has to undergo, by any previous use of his mental faculties, that he soon relapses, and is under the necessity of being again returned within its walls. Commodious rooms contiguous to the farm-buildings are now in the course of construction at the Somerset County Asylum; and there is every reason to believe that the patients will derive benefit by residing in these apartments, which at once possess a domestic character, and afford every facility to carry on agricultural pursuits.â€

It strikes us forcibly that the commissioners have tended to create the evil they deprecate in not protesting against the erection of gigantic asylums; but it is cheering to find that the idea of supplemental buildings possessing a â€œdomestic characterâ€ has taken possession of their minds, and that they are now enforcing it on the minds of others with their well-known zeal and ability. The Devon Asylum, among others, has adopted the plan; and its accomplished physician, Dr. Bucknill, the editor of theAsylum Journal, bears important testimony to the great advantages to be derived from it.

â€œI have recommended the erection of an inexpensive building, detached from, but within the grounds of the present asylum, in preference to an extension of the asylum itself. My reasons for this recommendation are, that such a building will afford a useful and important change for patients for whom a change from the wards is desirable. The system of placing patients in detached buildings, resembling in their construction and arrangements an ordinary English house, has been found to afford beneficial results in the so-called cottages which this institution at present possesses.These cottages are much preferred to the wards by the patients themselves, and permission to reside in them is much coveted.I am also convinced that such auxiliary buildings can be erected at much less expense than would be incurred by the enlargement and alteration of the asylum itself. I propose that in the new building the patients shall cook and wash for themselves.â€

â€œThese cottages are much preferred to the wards by the patients themselves, and permission to reside in them is much coveted.â€ In these few lines we read the condemnation of huge structures like Colney Hatch, built externally on the model of a palace, and internally on that of a workhouse, in which the poor lunatic but rarely finds any object of human interest, wherehis free-will is reduced to the level of that of a convict, and the very air of heaven necessary to his health is doled out at intervals, when, with infinite lockings and unlockings, the attendants order a batch of persons into the stagnant and tiresome airing courts. Infinitely better for the lunatics would be the freedom and homeliness of the smallest cottage to the formal monotony of cheerless wards; better far that they should, as Dr. Bucknill suggests, cook and wash for themselves, than that the offices should be performed wholesale in the steam-laundry and the steam-kitchen. A patient would undoubtedly feel a far greater interest in peeling his own potatoes for the pot, and in cooking his own bit of bacon, than in receiving them ready cooked. It is the duty of the physician to interest the patient in his daily work, and no more effectual method of accomplishing this could be suggested than in putting him to work for himself.

Wherever large asylums are already erected, no better plan could perhaps be suggested than the building of satellite cottages, which would form a kind of supplementary Gheel to the central establishment; but we should like to see the experiment tried, in some new district, of reproducing in its integrity the Belgian system. The colony of Gheel was once a desert like the country which surrounds it; it is now, through the happy application of pauper lunatic labour, one of the most productive districts of the Low Countries. Have we no unoccupied Dartmoors on which we could erect cottages, and train the cottagers to receive the insane as members of the family? The performance of domestic offices, the society of the goodwife and goodman, and the influence of the children, would do far more to restore the disordered brain of the lunaticâ€”pauper or otherwiseâ€”than all the organization of the asylum, with its daily routine, proceeding with the inexorable monotonous motion of a machine, and treating its inmates rather as senseless atoms than as sentient beings, capable, though mad, of taking an interest in things around them, and especially awake to the pleasure of being dealt with as individuals rather than as undistinguishable parts of a crowd. The children are ofparticular moment. Lunatics are singularly gentle to them, and are interested in all their actions. At Gheel it is customary to send the bairns into the fields to conduct the patients home from their labour in the evening; and we learn from Dr. Webster that a violent madman, who would not stir upon the command of his host, will suffer himself to be led, without a murmur, by an urchin scarcely higher than his knee. The presence of the young in the ward of an asylum seems to light it up like a sunbeam. The love of children does indeed lie at the very foundation of the human heart, and we cannot estimate too highly their beneficial influence upon the brain which is recovering from the horrors of insanity.

One of the most important points in reference to insane paupers, as we have already intimated, is the bringing them as speedily as possible under treatment. The reluctance of the lunatic himself to be removed is usually extreme, and it is marvellous what ingenuity he will often employ to thwart the design. Southey relates that a madman who was being conveyed from Rye to Bedlam slept in the Borough. He suspected whither he was going, and, having contrived by rising early to elude his attendant, he went to Bedlam, and told the keepers that he was about to bring them a patient. â€œBut,â€ said he, â€œin order to lead him willingly, he has been persuaded that I am mad, and accordingly I shall come as the madman. He will be very outrageous when you seize him, but you must clap on a strait-waistcoat.â€ The device completely succeeded. The lunatic returned home, the sane man was shut up, and until he was exchanged at the end of four days, remained in his strait-waistcoat, having doubtless exhibited a violence which amply justified its use. The aversion of the sufferer himself to be taken away coincides with an equal aversion on the part of his relatives and friends to send him from home, nor do they take the step till the madness grows intolerable. Precious time is thus lost at the outset, and when the removal occurs it is mostly to the workhouse. Here the patient is usually kept during the remainder of the curable stage of his malady. The parochial authorities are generally guided by an immediate considerationfor the pockets of the rate-payers, rather than by any care for the welfare of the lunatic; and, as they can maintain him in the â€œhouseâ€ at three shillings a-weekâ€”when they would have to pay nine if they transferred him to the county asylumâ€”in the workhouse he remains until he becomes so dirty or troublesome in his habits that the guardians are willing to pay the difference to get rid of him. The first few months of the disease, within the narrow limits of which full 60 per cent. of the recoveries take place, are thus allowed to run to waste. Months fly by, and the victim subsides into the class of incurables. This produces a second evil. As the drafts of incurables are perpetually flowing into the asylums, they become â€œblocked upâ€ in the course of a few years, and are converted into houses for the detention of hopeless cases. To this condition three-fourths of the asylums are already reduced, and the efforts of philanthropic medicine are brought to a dead lock by the short-sightedness of the parish authorities, who do not consider that for the sake of saving a few shillings in the board of Betty Smith in the first weeks of her craziness, they are converting her into a chronic burthen, seeing that she will probably live on to a good old age in the asylum, and cause them an ultimate expenditure of hundreds of pounds. To the swifter removal after the outbreak of the disorder we must look for a permanent remedy; but in the mean time something must be done to disembarrass the public asylums of the dead-weight of hopeless cases, if we seriously intend to take advantage of the curative appliances we already possess. The commissioners seem inclined to favour the erection of separate asylums for those who are beyond the reach of medical art. To us it seems that the more economical plan would be to apportion certain wards in the various workhouses for the reception of chronic cases, and to draft off the idiots alone to special establishments. By this means our water-logged asylums would speedily right themselves, and again become what they should never have ceased to beâ€”hospitals for thecureof the insane. At present we encourage an elaborate system for the manufacture of life-long lunatics. It is well known that the cures of early cases of insanitythroughout England amount to 45 per cent., and at Bethlehem and St. Lukeâ€™s, where no others are received, the cures have amounted to 62 per cent. and 72 per cent. respectively; whereas at Colney Hatch, Hanwell, and the Surrey County Asylum, the three great receptacles for the weepings of the metropolitan workhouses, the average cures do not exceed 15 per cent. If we take the lowest averages of cures, there is still a difference of 30 per cent. of human creatures who sink down into the cheerless night of chronic dementia and idiotcy, or who dream away the remainder of their lives in hopeless childishness. Another ground of complaint is, that a degree of clerkâ€™s work is imposed upon the medical superintendents of large asylums which is quite inconsistent with a proper discharge of their chief dutyâ€”the recovery of their patients. Irrespective of the routine-labour of making daily and quarterly and yearly reports, which is very considerable, they have far more to do in their strictly professional capacity than they can possibly accomplish. The three great asylums near the metropolis contain upwards of 3,000 patients, or the population of a good-sized country town; and their moral and physical training is confided to exactly six medical men, or as many as will be found in an hospital of a hundred beds! It is needless to observe how little attention can be paid to each individual, and that the more promising patients must be inevitably swamped in the sea of hopeless lunatics. As long as our asylums remain mere houses of detention, the want of medical superintendence is not so apparent; but immediately these establishments are restored to their proper functions, we predict that the evil will become too glaring to last.

In many boroughs the authorities have entirely evaded the requirements of the Act of Parliament relative to their insane pauper poor, and have not only neglected to erect proper asylums, but have resisted for years the attempts of the commissioners to compel them to do their duty. In all such cases the lunatics not only suffer the ills consequent upon insufficient care, but when too numerous for home accommodation are subjected to a system oftransportation, which is notonly disgraceful to the municipal authorities themselves, but to the age for permitting it. True to their economical instincts, the guardians of the poor often â€œfarm outâ€ their insane paupers to the proprietor of some private asylum, quite regardless of distance. The commissioners, justly indignant at this sordid practice, state in one of their Reports thatâ€”

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