INSANITY. 



Insanity is not limited to any particular age ; it 

 may begin as early as two years of age, but does 

 not become common until fifteen. Georget has 

 collected, from the admissions in France and Eng- 

 land, from the age of ten to seventy, 4409 patients, 

 and the average of admissions for every ten years: 



From 10 years to 20 



70 and upwards 



356 

 1106 

 1416 

 861 

 461 

 174 

 35 



4409 



There is one leading feature in the management 

 of the insane in which all writers seem to agree 

 seclusion. Pinel dwells on it as the most rational, 

 mode of cure, and considers the separation from 

 friends as indispensable. Willis changed all the 

 servants of George III. Confinement is also ne- 

 cessary ; but there is still aonsiderable difference 

 of opinion how far it should be carried. 



A system of treatment is adopted at Gheel in 

 Belgium, which, if acted on in other countries, 

 would doubtless be productive of great advantages. 

 Gheel is a small village, where 500 or 600 lunatics 

 are spread among the cottages of the peasants. 

 Each patient is to labour in the fields or gardens 

 for a certain number of hours every day. When 

 not employed they are allowed to walk about 

 without restraint, and are summoned to their 

 homes by a village bell. The peasants are bound 

 to treat them with kindness, and are rewarded 

 according to the care they take of them. 



A farmer once obtained in Scotland a great re- 

 putation for curing insanity. He fastened his 

 patients to his plough, and made them work his 

 grounds, and by degrees brought the most intem- 

 perate to reason. Music has been employed with 

 variable success in the treatment of the insane. 

 There are two states in which it may be useful; 

 first, when the invalid himself plays, his attention 

 is for a time agreeably occupied; and next, when 

 another person plays, pleasing sensations are thus 

 commonly excited. Frank employed it largely, 

 and found it of great advantage in mania, while 

 Esquirol states, that he found it in similar states 

 to produce raving fits. There is an impression 

 with the majority of the profession, that in mania 

 it is too exciting, but in states of lethargy or 

 apathy it may be used with benefit. Dr Cox em- 

 ployed it largely in his establishment, but his suc- 

 cessor, Dr Bompas, has altogether discontinued it. 

 The Quakers, in the Retreat at York, were the 

 first who discontinued the use of chains ; and the 

 only restraint used there is, seclusion, a straight- 

 waistcoat, shower-bath, and a few occasional pri- 

 vations. 



With respect to the frequency of insanity in the 

 different states and conditions of life, Esquirol has 

 supplied some interesting returns : For the three 

 years, 18261828, there were admitted into Cha- 

 renton 619 patients; of these, 282 were married, 

 293 never married, and 44 widowed. The number of 

 men was 386, women 253. Of the men 206 were 

 unmarried, and 87 of the women, which shows 

 celibacy to be a fruitful source of insanity. Ano- 

 ther large class, composing the inmates of this es- 

 tablishment, is made up of officers and soldiers. 

 For the three years above mentioned, there were 

 forty-nine officers and forty-seven soldiers admitted, 

 a proportion exorbitantly great, considering the 

 relative number of each class. Hereditary insanity 



is here estimated at one-seventh of the admit, 

 sions. 



From the review which we have now taken of 

 the statistics of insanity, we do not think that the 

 opinion advanced by some writers, of a positive 

 and permanent increase in that painful and dis- 

 tressing affection, is at all supported by facts. 

 That there is an apparent increase in the number 

 returned of late, as compared with older records, 

 is quite clear, but this is only what is manifest in 

 every other department of inquiry, when attention 

 is particularly directed to a subject previously 

 much neglected. The question of insanity was 

 hitherto surrounded with so many delicate and 

 distressing associations, that many cases have alto- 

 gether escaped notice. And when we consider 

 the system of treatment which then universally 

 obtained, we cannot wonder that the insane were 

 allowed to drag out a miserable existence in the 

 society of friends, rather than be consigned to the 

 hopeless alternative of chains and a dungeon. 

 The improvements which a mild but decisive sys- 

 tem of treatment, first adopted by those quiet 

 unobtrusive men, the Quakers, in the Retreat at 

 York, have at length forced themselves on general 

 attention. It is now the prevailing system 

 throughout Europe, and in all our own institutions. 

 Those asylums are now so much improved in their 

 internal economy and comforts, and the chance of 

 cure so great, when attention is early directed to 

 it, that cases are instantly sent thither, which, 

 under the former bad arrangements, would never 

 have reached them. In this way the apparent 

 increase may be accounted for; besides which, 

 slight shades of mental aberration are now classed 

 under one or other form of madness, which proba- 

 bly, at a period when the subject was not so well 

 understood, would not be classed at all under any 

 form of insanity. These, with other temporary 

 causes, will occasionally give a slight increase in 

 the returns, which is often mistaken for a progres- 

 sive augmentation in this painful disease. 



Asylums for the insane are of modern origin. 

 In fact, all public hospitals for the sick and poor 

 may be so considered, as they originated with the 

 Christians of the third or fourth century. But 

 long after those suffering from other diseases were 

 received into hospitals and provided with medical 

 assistance, lunatics were neglected, and perished 

 in great numbers. Some of the most furious were 

 confined in small cells, or shut up in convents and 

 dungeons, while others were burned as sorcerers, 

 or as possessed of demons. Those that were tran- 

 quil were permitted their liberty, abandoned how- 

 ever to neglect, to the abuse and laughter, or to 

 the ridiculous veneration of their fellow-creatures. 

 But about the commencement of the seventeenth 

 century, lunatics began to be received into the 

 I general hospitals, where they were confined in the 

 1 most obscure corners of the buildings, and received 

 no medical aid. Soon after this, in some of the 

 large towns of France, a few separate but poorly 

 conducted hospitals were provided for the insane, 

 though the greater part still remained at liberty, 

 or were confined in the general hospitals. It was 

 not until 1792, when M. Pinel was appointed phy- 

 sician in chief to the Bicetre at Paris, that correct 

 views respecting the treatment of the insane began 

 to prevail, and to be reduced to practice. At this 

 institution, when M. Pinel took charge of it, were 

 a large number of lunatics considered incurable. 

 Many of them being very furious, were kept 





