52 
PATHOLOGY. 
their cells. The others, intermixed with paupers, are 
without any of the care which their ftate requires. Dr. 
Elquirol fpecifies twelve places where lunatics are received 
into the depots de mendicite. In feven towns, lunatics are 
even confined in prifons, and chained by the fide of the 
moft abandoned criminals. The latter can work, and 
the produce of their labour enables them to procure many 
comforts: the infane are deprived of this refource, and 
expofed to the jefts of the moft abandoned wretches. 
How humiliating muft their ftate be, if a lucid interval 
reveal to them their fituation; and if, in fpite of fo many 
obftacles, a cure ftiould be effected, how dreadful muft 
the recollection be of fuch fcenes ! 
Our author now proceeds to give, in a general way, 
the refult of his obfervations. The buildings devoted to 
the infane in France are bad: for they are always con¬ 
fined, damp, and generally in a ruinous ftate; and even 
in the depots de mendicite, and fome hofpitals where new 
buildings have been erefted for the infane, they have 
been conftrudted without reference to the objedt for which 
they are intended. The cells are dreadful: without air 
or light, narrow and damp. They are paved like the 
ftreets, are often under ground, and fometitnes in caves. 
They have feldom any other aperture than the door, and 
a finall fquare hole oppolite to it ; and very often, even 
this aperture is wanting. There is, confequently no cir¬ 
culation of air, and the fmell is almoft fuffocating. Al- 
moft all the inlane, not only the indigent, but thofe who 
pay, are naked, or only clothed in rags. They receive 
the tattered garments which have been thrown off by the 
poor, or the prifoners. Straw is all they have to protedt 
them from the humidity of the ground, and the coldnefs 
of the air; andftraw is fometimes wanting ! “J’ai vu un 
inalheureux imbecile, tout nu et fans paille, couche fur le 
pave. Exprimant mon etonnement d’un pared abandon, 
le concierge me repondit que l’adminiftration ne lui paf- 
fait, pour chaque individu, qu’une botte de paille tous 
les quinze jours. Je fis remarquer a ce barbare que le 
chien qui veillait a la porte des alienes etait loge plus 
fainement, et qu’il avait de la paille fraiche et en abon- 
dance ; cette remarque me valut un fourire de pitie. 
Etj’etais dans une des grandes villes de France!” 
In no inftitution is there room enough for the patients 
to take air and exercife. The fpace allotted for that pur- 
pofe is promifcuoufly devoted to both fexes ; and, in fome 
houfes, the patients are brought out and “chained to the 
walls of the court, by way of taking the air.” 
The attendants are infufficient, and ignorant; and, 
indeed, in moft houfes the patients have no fervants. In 
prifons, the jailor, who has fifty or lixty criminals to look 
after, has alio to attend to beings who have not the power 
of expreffmg their wants. 
Chains are every-where employed: i. On account of 
the wretched ftate of the buildings : 2. From the infuf- 
ficiency of attendance : 3. From the ignorance of the 
keepers: 4. From the expenfe of waiftcoats. “J’ai 
envoye des gilets pour fervir de modele dans plufieurs 
villes; on ne s’en fert point par economie ; il eft certain 
que les chaines coutent moins d’entretien.” The chains 
employed confift of iron collars, girdles, and fetters. In 
one inftitution, the patients were confined by means of 
an iron collar attached to a chain, a foot and a half in 
length. A whip is in the hands of the fervants, and the 
bunch of keys is made a common inftrument of correc¬ 
tion. In all the eftablifhments of Paris, containing 2000 
individuals, corporal punilhment has been long abolilhed. 
The medical men in the different towns have made 
many efforts to remedy thefe abufes ; but, difappointed 
in their attempts, they have become difgufted, and only 
vifit the infane who labour under illnefs, but never with 
a view to cure the infanity. The fervants of the hofpital 
order the means which they judge neceffary. At Tou- 
loufe, from time immemorial, it has been the cuftom for 
the medical men to vifit the indigent in the general hof¬ 
pital, but they never go into the quarter where the infane are 
confined. 
The magiftrates, deceived by falfe reports, and fright¬ 
ened at the tales with which interefted keepers awaken 
their fears, never vifit the lunatics; reconciling their 
confciences to this adt of negledl, by viewing the patients 
in the light of incurables, and thinking they have done 
enough when they have put them out of a ftate to do 
harm, and given them bread and water fufficient to keep 
them from ftarvation. 
Having detailed the abufes which exift, our author 
next proceeds to confider the belt method of remedying 
them. The outline of his plan is fomething like what 
has been propol’ed in England ; to build afylums in various 
parts of the kingdom, which fhould be appropriated to 
lunatics only. Dr. Efquirol is of opinion, that about 
twenty of thefe buildings would be required for the whole 
kingdom of France; and, as there are already three at 
Paris and eight in the provinces, he would retain thefe for 
the fake of economy; and, after radically reforming 
them, built nine others ; all which he would place un¬ 
der the direction of a managing committee, to confift of 
the prefects of different departments, fubfcribers, ma¬ 
nager, phyfician, &c. The diredtors and phyficians to be 
in conftant correfpondence with a central committee, im¬ 
mediately under the fuperintendance of the minifter of 
the interior. In conclufion, Dr. Efquirol announces his 
intention to publilh an extenfive work on infanity, which 
may perhaps afford us an opportunity of refuming this 
intereftingfubjedl. 
In Italy, the madhoufes are in a ftate equally lamen¬ 
table, or more fo. Dr. James Clark (Medical Notes on 
the Hofpitals of France, Italy, &c. 1820.) has given us 
fome fhocking inftances at Turin and Genoa; and the 
temper of the Sardinian government does not lead us to 
expedt any prompt amendment, as reformation is not the 
order'of the day in that unhappy country. Dr. Clark fays, 
“The part of the hofpital (Cafa de’Pazzi) we were firft 
taken to, confifted of fmall rooms fimilar to thofe gene¬ 
rally met with in fuch inftitutions ; but I was difappointed 
to find thefe were not for the poor patients, but for thofe 
who paid a certain fum for being kept. The firft of thefe 
that was opened prefented to us the wretched prifoner, 
perfectly naked, and chained down to his bed by both 
wrilfcs. He had raifed himfelf in his bed as far as his 
chains admitted, by which movement he had call off 
the fingle coverlet that had been thrown over him. He 
had no Hurt; his legs (apparently red and fwollen from 
cold) were drawn up under the corner of the bed-cover, 
which lay over a fmall part of his body ; he was pale and 
emaciated ; he uttered not a word. In Ihort, a human 
being in fo wretched a ftate I had never before feen ; but 
I was foon to witnefs others in a ftate ftill more horrible. 
We were next condudted into a ward where thirty beds 
were huddled together, on moft of which lay a poor 
wretch chained by one or more limbs to the bedftead ; 
for to each corner of thefe was attached a maffy iron 
chain, with a clafp of the fame materials and ftrength at 
the extremity, for admitting the wrift and ankle; and, 
according as the keeper judged neceffary, one or more 
of thefe were applied. Some were polilhed and bright as 
filver, from conftant ufe. I imagined that thefe were the 
moft unruly patients, but was told that this was by no 
means the cafe. To thefe we were next led ; and, on 
unbolting the door of a large cell, the fcene that prefented 
itfelf almoft exceeds belief. The fpedlacle of the poor 
wretches, naked, or covered only by fome ftraw, chained 
down hand and foot to their bedfteads ; the clanking of 
their chains ; the dreadful vociferation they fet up at the 
fight of him who had rivetted thefe chains; the ftill 
more horror excited by fuch a fpedlacle; no terms 
are ftrong enough to depidt! I had read and heard of 
chains and other means of torture for fubduing (irritat¬ 
ing) the unfortunate maniac; I had even feen fuch, 
1 fngly 
