1870.] On Insanity. 183 



niciously. The want of definite work, of exercise which interests, of 

 relief from miserable sights, and of those happinesses of home which 

 cannot be replaced by any luxurious comforts, together with the effects 

 of the dismal companionship of fellow-sufferers, during the periods of 

 temporary sanity, are constantly producing depressing results. Dr. 

 Boyd, writing in 1869, states that in his experience the tubercular 

 class of diseases produces very fatal results in the chronically insane. 

 He remarks, that " However we regard the fact, whether from the 

 numbers collected, or from insanity being more prevalent amongst 

 phthisical (consumptive) patients than others, or from both causes, 

 the mortality from tubercular disease was about double amongst 

 chronic cases of insanity in both sexes to that of the adult male and 

 female population of England in 1866." The longer the duration 

 of the residence in the asylum, the greater was the mortality from 

 consumption.* 



In ordinary medical practice the consumptive are not more fre- 

 quently transferred to the alienist physician on account of mental 

 derangement, than those suffering from other diseases, and of course 

 less frequently than those with disease of the nervous system. It is 

 the depressing effect of association and of the want of physical labour 

 that adds to the list of the consumptive in our great asylums. 



Here, then, is one of the most prominent causes of the incura- 

 bility of the insane brought into definite relation with the asylum 

 system. Even if it were admitted, which it cannot be, that the 

 majority of the insane are afflicted with tubercular diseases before 

 they enter asylums, the peculiar arrangements of the establishments 

 are not those which would benefit the constitution or retard the issue. 



Consider another point. The miseries and the excitements of 

 one age were pretty well equalled in all others; but it is by no 

 means clear that education, however trivial, does not add to the 

 wretchedness of the pauperized, and of those who, whilst they wit- 

 ness the splendid luxury and waste of their fellow-men, are dragged 

 down by circumstances into a hopeless condition of semi-starvation 

 and drudgery whose only termination is in a long vista of want, 

 with the poorhouse and grave hi the distance. The want of mental 

 and physical resiliency amongst the poorest of our urban and agri- 

 cultural populations is evident to those who care to mix with them. 

 The well-disposed and honest are in constant fear about the sus- 

 tentation of their families, and the careless are, as a rule, steady 

 drinkers and unsteady workers. The wants of the primitive con- 

 dition of mankind are superadded to the miseries of our social state ; 

 and the poverty, which is hardly ever to be cast off, prevents that 

 healthy direction of the mind and senses which the early hunters 

 enjoyed, but which appears to be incompatible with the present 

 state of things. There is nothing wonderful, then, in the state- 



* 'Journal of Mental Science,' 1809, pp. 200-2. 



o 2 



