1870.] On Insanity, 181 



with straps ; and that the whole asylum system is uselessly ex- 

 pensive and detrimental to the majority of the insane and unphilo- 

 sophical, especially as no means have been adopted by the State 

 to prevent the occurrence of that misery and pauperdom which 

 develops lunacy. 



Many independent thinkers, whilst they admit the sedulous care 

 that is taken of the insane in asylums, and believe that cruel 

 treatment is very exceptional, are by no means satisfied that much 

 progress has been made by medical science in the cure of the 

 alienated. The inmates of asylums are well taken care of, and 

 they are as comfortable as they can be; but with all this there 

 is a doubt whether the cures increase year by year with the expe- 

 rience of the psychological gentlemen. There is even a doubt 

 expressed about the applicability of the asylum system to many 

 cases of chronic insanity, and the Commissioners hint at a want 

 of individual attention to demented patients. Certainly the Com- 

 missioners have forced the present system of shutting up all lunatics 

 upon the nation, and have necessitated an enormous expenditure ; 

 but it becomes a serious question whether the whole of the insane 

 who are not affected with the disease in its acute form, and who 

 are not dangerous to themselves and others, would not be better off 

 under very different circumstances than those of the model asylums. 

 The heavy expense of the present system is admitted, and the 

 anxiety of the physicians to do their best also. Now let us consider 

 some results. 



Prichard, writing thirty-five years since, notices the remarkable 

 results of Dr. Burrows' treatment. He writes : — " Dr. Burrows has 

 reported from his own experience 240 cures in an aggregate of 

 296 cases of various descriptions; 221 cures from recent cases ; 19 

 cases from 64 old cases; affording a proportion of 81 in 100 of all 

 cases." He acknowledges the general surprise that this high per- 

 centage of recoveries has excited, but notices that it coincides nearly 

 with the statements of Dr. Willis. Dr. Jacobi, of Siegburg, in 

 Westphalia (1830), cured 40 in 100 cases, and kept his patients 

 sufficiently long under his eye to render any doubt about their per- 

 fect cure impossible. Esquirol collected the results of 5360 cases, 

 and found 2691 recoveries, and this was between a.d. 1798 and 

 1813. This is at the rate of nearly 50 per cent. In a report 

 made officially in Paris in 1825 of the state of the hospitals for 

 lunatics during the three preceding years, and which was con- 

 sidered by Dr. Burrows, the recoveries were proved to be 34 in 

 100. Esquirol tabulated the returns from English lunatic hos- 

 pitals from 1748 to 1814, and found that the percentage of cases 

 was about 33 against the 50 per cent, in France. The cures at 

 Bethlehem Hospital from 1819 to 1833 amounted to rather more 

 than 50 per cent. In the Stafford Asylum, from 1818 to 1828, 



VOL. VII. O 



