Chapter 17

PROGRESS OF PSYCHOLOGICAL MEDICINE DURING THE LAST FORTY YEARS: 1841-1881.[292]

If, gentlemen, History be correctly defined as Philosophy teaching by examples, I do not know that I could take any subject for my Address more profitable or fitting than the Progress of Psychological Medicine during the forty years which, expiring to-day, mark the life of the Association over which, thanks to your suffrages, I have the honour to preside this year--an honour greatly enhanced by the special circumstances under which we assemble, arising out of the meeting in this metropolis of the International Medical Congress. To it I would accord a hearty welcome, speaking on behalf of this Association, which numbers amongst its honorary members so many distinguished alienists, American and European. Bounded by the limits of our four seas, we are in danger of overlooking the merits of those who live and work beyond them. I recall the observation of Arnold of Rugby, that if we were not a very active people, our disunion from the Continent would make us nearly as bad as the Chinese. "Foreigners say," he goes on to remark, "that our insular situation cramps and narrows our minds. And this is not mere nonsense either. What is wanted is a deep knowledge of, and sympathy with, the European character and institutions, and then there would be a hope that we might each impart to the other that in which we are superior."

Do we not owe to France the classic works of Pinel and of Esquirol--justly styled the Hippocrates of Psychological Medicine--works whose value time can never destroy; and have not these masters in Medical Psychology been followed by an array of brilliant names familiar to us as household words, Georget, Bayle, Ferrus, Foville, Leuret, Falret, Voisin, Trelat, Parchappe, Morel, Marce, who have passed away,[293] and by those now living who, either inheriting their name or worthy of their fame, will be inscribed on the long roll of celebrated psychologists of which that country can boast.

If Haslam may seem to have stumbled upon General Paralysis, we may well accord to French alienists the merit of having really discovered the disorder which, in our department, is the most fascinating, as it has formed the most prominent object of research, during the last forty years.

To mention Austria and Germany, is to recall Langermann, Feuchtersleben, Reil, Friedreich, Jacobi, Zeller, Griesinger, Roller, and Flemming, who, full of years and honours, has now passed away.

Has not Belgium her Guislain, Holland her Schroeder van der Kolk, and Italy her Chiaruggi?

And when I pass from Europe to the American continent, many well-known names arise, at whose head stands the celebrated Dr. Rush. Woodward, Bell, Brigham, and Howe (whose many-sided labour included the idiot) will be long remembered, and now, alas! I have to include among the dead an honoured name, over whom the grave has recently closed. Saintship is not the exclusive property of the Church. Medicine has also her calendar. Not a few physicians of the mind have deserved to be canonized; and to our psychological Hagiology, I would now add the name of Isaac Ray. With his fellow-workers in the same field, among whom are men not less honoured, I would venture to express the sympathy of this Association in the loss they have sustained. Nor can I pass from these names, although departing from my intention of mentioning only the dead, without paying a tribute of respect to that remarkable woman, Miss Dix, who has a claim to the gratitude of mankind for having consecrated the best years of her varied life to the fearless advocacy of the cause of the insane, and to whose exertions not a few of the institutions for their care and treatment in the States owe their origin.

Abroad, psychological journalism has been in advance of ours.

The French alienists established in 1843 their _Annales Medico-Psychologiques_ (one of whose editors, M. Foville, is with us to-day), five years before Dr. Winslow issued his Journal, the first devoted to medical psychology in this country, and ten years before our own _Journal_ appeared, in 1853.

The Germans and Americans began their Journals in the following year--1844; the former, the _Allgemeine Zeitschrift fuer Psychiatrie_, and the latter the _American Journal of Insanity_.

I believe that our Association has precedence of any other devoted to Medical Psychology, and it is an interesting fact that its establishment led to that of the corresponding Association in France--a society whose secretary, M. Motet, I am glad to see among my auditors. The Association of Medical Superintendents of American Institutions for the Insane was instituted in 1844; that of Germany in 1864, the subject of Psychology having previously formed a section of a Medical Association.

Returning to our own country, I may observe that when Dr. Hitch, of the Gloucester Asylum, issued the circular which led to the formation of this Association in 1841, almost half a century had elapsed since the epoch (1792) which I may call the renaissance of the humane treatment of the insane, when the Bicetre in France, and the York Retreat in England, originated by their example an impulse still unspent, destined in the course of years to triumph, as we witness to-day. This triumph was secured, in large measure, by the efforts of two men who, forty years ago, shortly after the well-known experiment at Lincoln, by the late Mr. Robert Gardiner Hill, were actively engaged in ameliorating the condition of the insane. Need I say that I refer to Lord Shaftesbury and Dr. Conolly? The nobleman and the physician (alike forward to recognize the services of the pioneers of 1792), each in his own sphere having a common end in view, and animated by the same spirit, gave an impetus to the movement, the value and far-reaching extent of which it is almost impossible to exaggerate. Lord Shaftesbury,[294] celebrating his eightieth birthday this year, still lives to witness the fruits of his labours, of which the success of the well-known Acts with which his name is associated, will form an enduring memorial. Dr. Conolly was in his prime. He had been two years at Hanwell, and was contending against great difficulties with the courageous determination which characterized him. I do not hold the memory of Conolly in respect, merely or principally because he was the apostle of non-restraint, but because, although doubtless fallible (and indiscriminate eulogy would defeat its object), he infused into the treatment of the insane a contagious earnestness possessing a value far beyond any mere system or dogma. His real merit, his true glory, is to have leavened the opinions and stimulated the best energies of many of his contemporaries, to have stirred their enthusiasm and inflamed their zeal, to have not only transmitted but to have rendered brighter the torch which he seized from the hands of his predecessors. He desired to be remembered after his death by asylum superintendents as one who sincerely wished to place the insane in better hands than those in which he too generally found them; and I hold that, whatever may be our views on what we have chosen to call non-restraint, we may cordially unite in fulfilling his desire.

As the non-restraint system--a term, it must be confessed, which cannot boast of scientific precision, but is well understood--has been the leading, and often engrossing, topic of discussion during the period now under review, I must not omit a brief reference to it. No one will call in question the statement as an historical fact that the Commissioners in Lunacy and the medical superintendents of asylums in this country are, with few exceptions, in favour of non-restraint. Dr. Lauder Lindsay--for whose death, as well as that of Dr. Sherlock and of Dr. White Williams, during the last year, the tribute of sorrowful regret ought, in passing, to be paid--Dr. Lindsay, I say, had only a small following in Great Britain. In Germany, on the other hand, although Griesinger looked favourably upon the system, and Westphal has advocated it, and Brosius has translated Conolly's standard work into German, there has not been a general conversion, as may be seen by the discussion which took place in 1879, at meetings of the Psychological Society in Berlin and Heidelberg. In France, again, although Morel gave it the sanction of his name, and Magnan has practised it recently, there has been within the last twelve months a striking proof of anti-non-restraint opinion among the French physicians, in an interesting discussion at the Societe Medico-Psychologique. I wish here only to chronicle the fact, and would urge the necessity of not confounding honest differences of opinion with differences of humane feeling. The non-restrainer is within his right when he practises the system carried to its extremest lengths. He is within his right when he preaches its advantages to others. But he is not within his right if he denounces those physicians, equally humane as himself, who differ from him in opinion and practice. I therefore unite with the observation of Dr. Ray, by whom, as well as by the majority of his fellow-psychologists, the non-restraint system as a doctrine was not accepted, when he wrote thus in 1855, "Here, as well as everywhere else, the privilege of free and independent inquiry cannot be invaded without ultimate injury to the cause."[295]

The arguments in favour of mechanical restraint are clearly set forth by Dr. John Gray, of the Utica Asylum, in his annual report of the present year.

Leaving this subject let me recall to your recollection that when this Association was formed, the care of the insane in England and Wales was regulated by the Gordon-Ashley Act of 1828,[296] which, among other reforms, had substituted for the authority of five Fellows of the College of Physicians, who performed their duties in the most slovenly manner, fifteen metropolitan Commissioners in Lunacy. I find, on examining the Annual Report of these Commissioners issued in 1841, that it does not extend over more than one page and a half! It is signed by Ashley, Gordon, Turner, Southey, and Proctor. They report the number confined in the thirty-three asylums within their jurisdiction as 2490. Their verdict on inspecting them is expressed in half a dozen words, namely, that the "result is upon the whole satisfactory."

"The business of this Commission," they say, "has very much increased, partly by more frequent communications with the provinces (over which, however, they have no direct legal control), and partly by the more minute attention directed by the Commissioners to individual cases with a view to the liberation of convalescent patients upon trial ... and the consequence has been that many persons have been liberated who otherwise would have remained in confinement."

That a state of things in which such an occurrence was possible should be described as on the whole satisfactory, is somewhat remarkable, and in reading this paragraph we cannot but contrast with it the very different result of the investigation made by the Committee of the House of Commons in 1877.

Again, nothing more strikingly marks the change which has taken place in the inspection of asylums than the contrast between the last Report of the Lunacy Commissioners, consisting of a bulky volume of more than four hundred pages, and that of 1841, of a page and a half. In fact, the Reports of the Commissioners form the best evidence to which I can refer of the progress made from year to year in the provision for the insane, and the gradual but uninterrupted amelioration of their condition.

An important advance was made in 1842 by the Act 5 and 6 Vict., c. 87, which provided that provincial houses were to be visited by the Metropolitan Commissioners, as well as those in their own district. They were also to report whether restraint was practised in any asylum, and whether the patients were properly amused and occupied. Not only was a great step forward made by thus extending the inspecting power of these Commissioners to the provinces, but their memorable Report on the state of the asylums in England and Wales in 1844 led to the highly important legislation of the following year (introduced by Lord Ashley)--the Act 8 and 9 Vict., c. 100, which along with the Acts of 1853 (16 and 17 Vict., cc. 96, 97)[297] and 1862 (25 and 26 Vict., c. 111) form, as you are well aware, the Code of Lunacy Law under which, for the most part, the care of the insane is determined and their protection secured.

I should like to have been able to state the number of recognized lunatics in England and Wales forty years ago, but no return exists which shows it. The nearest approach is to be found in the Report just referred to of the Metropolitan Commissioners (1844), in which the number of ascertained lunatics in England and Wales is stated to be about 20,000, of whom only 11,272 were confined in asylums, whereas now there are nearly 55,000. It is difficult to realize that there were then only some 4000 patients in county asylums, these being 15 in number, and that there were 21 counties in England and Wales in which there were no asylums of any kind, public or private. At the present time, instead of 20,000 ascertained lunatics and idiots, we have 73,113--an increase represented by the population of the City of York--instead of 15 county asylums we have 51, with scarcely less than 40,000 patients, instead of 4000; while the provincial licensed houses have decreased from 99 to 59, and the metropolitan increased by 2. The total number of asylums in England and Wales in 1844 was 158,[298] now it is 175--excluding those (3) erected under Hardy's Act. I need not say that these figures do not necessarily point to an increase of lunacy, but may merely represent the increased accommodation which ought to have been provided long before. Into the general question of the spread of insanity I feel that it would be impossible to enter satisfactorily now.

Recurring to the Metropolitan Commissioners' Report, I must observe that while an immense advance took place between 1828, when they were appointed, and 1844, the subsequent advance between the latter date and now is such that we cannot but recognize the extremely beneficial operation of the legislation which has marked this period. It must also be gratifying to Scotch asylum superintendents, knowing as they do the satisfactory condition of the insane in their country in 1881, to be able to measure the progress made since Lord Ashley, in his speech in 1844, moved for an address to the Crown, praying her Majesty to take into consideration the Commissioners' Report, for he there observes, "I believe that not in any country in Europe, nor in any part of America, is there any place in which pauper lunatics are in such a suffering and degraded state as those in her Majesty's kingdom of Scotland." I need not do more than chronicle the fact, in passing, that the reform in Scotland dates, to a large extent, from the appointment of a Royal Commission in 1855, and the action of the Board of Lunacy Commissioners which was established in consequence. Legislation for Ireland and the appointment of inspectors have likewise proved very beneficial in that country. But restricting my remarks to England and Wales, I would observe that the establishment by the Act of 1845 of the Lunacy Board as at present constituted, and the rendering it compulsory upon counties to provide asylums for pauper lunatics, are the chief causes of the improvement to which I have referred, so far, at least, as it has been brought about by legislation.

I will not dwell in detail on the lunacy legislation of these years. To have said less would have been to overlook the salient and most important facts of the period. To have said more would have been to travel over the ground so ably occupied by Dr. Blandford in his Presidential Address three years ago. He, by-the-by, complained of the ever-increasing difficulty each President finds in selecting a subject for his discourse, and then immediately proceeded to effectually lessen the chances of his successors. What the last occupant of this Chair will be able to discover new for his address I do not know. I can only think of the funeral oration over this Association at its obsequies--when its "dying eyes are closed," its "decent limbs composed," and its "humble grave adorn'd,"

"By strangers honour'd, by survivors mourn'd."

On the Board of the Commissioners in Lunacy have sat two members of our profession (one still living), to whose services I wish more especially to refer. I allude to Dr. Prichard and Mr. Gaskell.

Apart from his official work, the former will always be remembered in the republic of letters by his learned contributions to anthropology and the literature of mental diseases, in which he is more especially identified with the doctrine of Moral Insanity. Chronicler of the period in which he enunciated or rather developed it, I cannot avoid a brief reference to a theme which has caused so much heated discussion. As an impartial historian I am bound to admit that his views are still by no means unanimously adopted, and that I am only expressing my own sentiments when I avow that what Latham says of Prichard's "Researches into the Physical History of Mankind"--"Let those who doubt its value, try to do without it"--applies to the teaching contained in the remarkable treatise entitled "Different Forms of Insanity in relation to Jurisprudence," published in 1842. We may well be dissatisfied with some of the illustrations of the doctrine it supports. We may express in different terms the generalization he has made as to the relation of intellect and emotion; but I am greatly mistaken if we shall not from time to time be confronted by facts which instantly raise the question which presented itself with so much force to his acute mind, and which does not appear to me to be successfully met by those who controvert the conclusions at which Prichard arrived. The necessity of admitting in some form or other the mental facts in dispute, is well illustrated by the recent work by Krafft-Ebing on mental disorders. For what does this practised mental expert do? He, although the supporter of mental solidarity and the integrity of the Ego--adverse, therefore, to the psychology in which the theory has been enshrined--feels that he must admit into his classification some term which describes certain emotional or volitional disorders, and can discover none better than "moral insanity"--a practical, though reluctant, admission of the value of Prichard's views after their discussion for forty years. I might also refer as an indication of opinion to a most excellent article in the last number of the _Journal_ by Dr. Savage, who, while recognizing the abstract metaphysical difficulty of conceiving moral as distinct from intellectual insanity, fully admits as a clinical fact the form of mental disease for which Prichard contended, and had he been living he would doubtless have claimed this article as a striking proof of the vitality of his opinions.

One is certainly disposed to exclaim, if observation on the one hand compels us to admit certain mental facts, and the metaphysician on the other declares them to be unmetaphysical, so much the worse for metaphysics!

Mr. Gaskell, in addition to his good work as a reformer at the Lancaster Asylum, where may yet be seen preserved quite a museum of articles of restraint formerly in use in that institution, and his efficient labours as a Commissioner, was also, it may not be generally known, the real cause of the practical steps taken in this country to educate the idiot. It was in 1847 that he wrote some articles in _Chamber's Journal_, giving an account of Seguin's Idiot School at the Bicetre, which he had visited and been greatly interested in. These articles had the effect of inducing Dr. Andrew Reed to interest himself in the establishment of a school for idiots in England. The Highgate and Colchester Asylums for idiots were instituted--the origin, as it proved, of the great establishment at Earlswood. All, therefore, that has been done for this pitiable class has been effected during the last forty years. The indefatigable Seguin has passed away during the last twelve months. He pursued to the last, with unabated zeal, a study possessing attractions for only a limited number, and advocated the claims of idiots and imbeciles with unceasing energy in the Old World and the New. Fortunately his mantle has descended upon a worthy successor in the person of his son, Dr. E. Seguin, of New York.

* * * * *

It has necessarily happened that the direction of public attention to the larger and better provision for the insane in all civilized lands has led to much consideration, and inevitably some difference of opinion as regards the form and arrangement of asylums. But all will admit that their construction has undergone a vast improvement in forty years. The tendency at the present moment is to attach less importance to bricks and mortar, and the security of the patient within a walled enclosure, than to grant the largest possible amount of freedom, in asylums, compatible with safety. The more this is carried out, the easier, it is to be hoped, will it be to induce the friends of patients to allow them to go in the earliest stage of the disorder to an asylum, as readily as they would to a hydropathic establishment or an ordinary hospital, to which end medical men may do much by ignoring the stupid stigma still attaching to having been in an asylum. The treatment of the insane ought to be such that we should be able to regard the asylums of the land as one vast Temple of Health, in which the priests of Esculapius, rivalling the Egyptians and Greeks of old, are constantly ministering, and are sacrificing their time and talents on the altar of Psyche.[299]

Most heartily do I agree with Dr. Kirkbride when he says that "Asylums can never be dispensed with--no matter how persistently ignorance, prejudice, or sophistry may declare to the contrary--without retrograding to a greater or less extent to the conditions of a past period with all the inhumanity and barbarity connected with it. To understand what would be the situation of a people without hospitals for their insane, it is only necessary to learn what their condition was when there were none."[300]

In advocating the prompt and facile recourse to an asylum, I include, of course, the cottage treatment of the insane so long ago resorted to by Dr. Bucknill, and extended in so admirable a manner by my immediate predecessor in this chair, whose practical observations last year on the villas and cottages at Cheadle rendered his address one of the most valuable that has been delivered. Moreover, I would not say a word in disparagement of the placing of suitable cases in the houses of medical men, or in lodgings, under frequent medical visitation.[301] I also recognize the value of intermediate or border-land institutions, so long as they are conducted with the sanction of the Commissioners and open to their inspection.

The modern advocacy of the open-door system has been recently brought under the notice of the Association by Dr. Needham, with the view of obtaining a general expression of opinion on a practice, to the wisdom of which he is disposed to demur.

But a less regard for mere bricks and mortar, the removal of high boundary walls and contracted airing-courts, or the introduction of the open-door system, do not lessen the importance of properly constructed asylums. The works of Jacobi in Germany, Kirkbride in America, Parchappe in France, and Conolly in England, must retain their value as classical productions on this subject; while the contributions recently made by Dr. Clouston present not only the general principles of asylum construction, but the minute details of building, in the light of the knowledge and experience of the present day.

I was fortunate in being able to render M. Parchappe some service when he visited England to examine the construction of our asylums. Those who formed his acquaintance on the occasion of this visit may remember his mixed feelings on visiting them, how he demurred on the one hand to what he regarded as too costly and ornamental, while, on the other hand, he liked the English arrangement of the buildings better than the Esquirol-Desportes system. I need not point out that those who have had the planning of the county asylums in England have objected, as well as Parchappe, to the distribution of isolated pavilions upon parallel lines. Parchappe, while far from believing it to be indispensable to make asylums monuments fitted to excite admiration for the richness of their architecture, and indisposed to emulate our asylums, which, he says, only belong to princely mansions, turns nevertheless from the square courts and the isolated pavilions of Esquirol to apostrophize the former in these glowing terms:--

"How much more suited to reanimate torpid intelligence and feeling, or to distract and console melancholy among the unfortunate insane, these edifices majestic in their general effect and comfortable in their details, these grandiose parks, with luxuriant plantations and verdant flowery lawns, whose harmonious association impresses upon English asylums an exceptional character of calm and powerful beauty!"

Whether a stranger, having read this florid description of our asylums, would not, on visiting them, be a little disappointed, I will not stop to inquire. Probably during this or the following week, some of Parchappe's compatriots may answer the question for themselves.

The fundamental question of the separation of the curable and incurable classes has in different countries been earnestly discussed during the last forty years. Kirkbride has entered his "special and earnest protest" against this separation; his own countryman, Dr. Stearns, on the other hand, has lately advocated it. In Germany, where, following the lead of Langermann and Reil, complete separation of the curable in one building was first realized under Jacobi at Siegburg, there has been a complete reversion to the system of combining the two classes in one institution. Parchappe, who opposed the separation of these classes, as illusory if justice is done to the incurable in the construction of the building provided for them, and mischievous if this is denied them, was constrained to admit, however, in view of the enormous number of lunatics in the Department of the Seine, that it was the least of two evils to separate the epileptic and the idiotic from the curable.

In England the separation principle has been recognized in Hardy's Act (30 Vict., c. 6) for the establishment in the metropolis of asylums for the sick, insane, and other classes of the poor, 1867; and, again, in the erection of such an asylum as Banstead for Middlesex--and I am informed by Dr. Claye Shaw, who, from holding the office of superintendent there, and formerly superintending the Metropolitan District Asylum of Leavesden, is well calculated to judge, that the experiment has proved successful, that the patients do not suffer, and that the office of superintendent is not rendered unendurable. Regarded from an economic point of view, it has been found practicable to provide buildings at a cost of between L80 and L90 per bed, which, though not aesthetic, are carefully planned for the care and oversight of the inmates. This includes not only the land, but furnishing the asylum.

Five years ago this Association unanimously adopted a resolution, expressing satisfaction that the Charity Organization Society had taken up the subject of the better provision, in the provinces, for idiots, imbeciles, and harmless lunatics, and the following year carried a resolution, also unanimous, that the arrangement made for these classes in the metropolitan district is applicable in its main principles to the rest of England. But it does not follow that the separation of these classes from the county asylums should be so complete, either as respects locality or the governing board, as in the metropolitan district; and, further, the Association expressed a strong opinion that the boarding-out system, although impracticable in the urban districts, should be attempted wherever possible in the country; the greatest care being taken to select suitable cases, unless we wish to witness the evils which Dr. Fraser has so graphically depicted in his report for 1877 of the Fife and Kinross Asylum. If pauper asylums can, without injury to families, be relieved by harmless cases being sent home to the extent Dr. Duckworth Williams has succeeded in doing in Sussex, and if, as he proposes, they were periodically visited, their names being retained on the asylum books, the enlargement of some asylums might be rendered unnecessary.

But what, gentlemen, would be the best-contrived separation of cases, what would the best-constructed asylum avail, unless the presiding authority were equal to his responsible duties? Now, it is one of the happy circumstances connected with the great movement which has taken place in this and other countries, that men have arisen in large numbers who have proved themselves equal to the task. We witness the creation of an almost new character--the asylum superintendent.

One Sunday afternoon, some years ago, Dr. Ray fell asleep in his chair while reading old Fuller's portraits of the Good Merchant, the Good Judge, the Good Soldier, etc., in his work entitled "The Holy and Profane State," and, so sleeping, dreamed he read a manuscript, the first chapter of which was headed, "The Good Superintendent." Awakening from his nap by the tongs falling on the hearth, the doctor determined to reproduce from memory as much of his dream as possible for the benefit of his brethren. One of these recovered fragments runs thus:--"The Good Superintendent hath considered well his qualifications for the office he hath assumed, and been governed not more by a regard for his fortunes than by a hearty desire to benefit his fellow-men.... To fix his hold on the confidence and goodwill of his patients he spareth no effort, though it may consume his time and tax his patience, or encroach seemingly on the dignity of his office. A formal walk through the wards, and the ordering of a few drugs, compriseth but a small part of his means for restoring the troubled mind. To prepare for this work, and to make other means effectual, he carefully studieth the mental movements of his patients. He never grudges the moments spent in quiet, familiar intercourse with them, for thereby he gaineth many glimpses of their inner life that may help him in their treatment.... He maketh himself the centre of their system around which they all revolve, being held in their places by the attraction of respect and confidence."[302]

And much more so admirable that it is difficult to stay one's hand. You will, I think, agree with me that what Dr. Ray dreamed is better than what many write when they are wide awake, and those familiar with Dr. Ray's career, and his character, will be of the opinion of another Transatlantic worthy (Dr. John Gray, of Utica) that in this act of unconscious cerebration the dreamer unwittingly described himself--

"'The Good Superintendent!' Who is he? The master asked again and again; But answered himself, unconsciously, And wrote his own life without a stain."

In what a strange land of shadows the superintendent lives! But for his familiarity with it, its strangeness would oftener strike him. It becomes a matter of course that those with whom he mixes in daily life are of imperial or royal blood--nay, more, possess divine attributes--and that some who are maintained for half a guinea a week possess millions and quadrillions of gold. He lives, in truth, in a world inhabited by the creatures of the imagination of those by whom he is constantly surrounded--a domain in which _his_ views of life and things in general are in a miserable minority--a phantom world of ideal forms and unearthly voices and mysterious sounds, incessantly disputing his authority, and commanding his patients in terms claiming supernatural force to do those things which he orders them to leave undone, and to leave undone those things which he orders them to do; commanding them to be silent, to starve themselves, to kill, to mutilate or hang themselves; in short, there is in this remarkable country, peopled by so many thousand inhabitants, an _imperium in imperio_ which renders the contest continuous between the rival authorities struggling for supremacy, sometimes, it must be confessed, ending in the triumph of the ideal forms, and the phantom voices, and the visionary sights, which may be smiled at in our studies, and curiously analyzed in our scientific alembics, but cannot be ignored in practice without the occurrence of dire catastrophes, and the unpleasant realization of the truth that idealism, phantasy, and vision may be transformed into dangerous forms of force. It may be said, indeed, that the appropriate motto of the medical superintendent is--"_Insanitas insanitatum, omnia insanitas._"

With such an _entourage_ it is not surprising if the first residence in an asylum as its responsible head--especially an asylum in the olden days--should disconcert even a physician. A German psychologist once declared, after passing his first night in an institution as superintendent, that he could not remain there; he felt overwhelmed with his position. Yet this physician remained not only over the next night, but for thirty-five years, to live honoured and venerated as Maximilian Jacobi, and departing to leave behind him "footprints on the sands of time," from seeing which, others, in a similar hour of discouragement, may again take heart.

I cannot pass from this subject without enforcing, as a practical comment, the necessity of asylum physicians having a very liberal supply of holidays, so as to insure a complete change of thought from not only the objective but the subjective world in which they live, and this before the time comes when they are unable to throw off their work from their minds, as happened to a hard-working friend of mine, who, even during his holiday among the Alps, must needs dream one night that he was making a post-mortem upon himself, and on another night rose from his bed in a state of somnambulism to perform certain aberrant and disorderly acts, not unlike what his patients would have performed in the day.

I have heard it suggested that superintendents should have six weeks' extra holiday every third year, five of them to be spent in visiting asylums. Whether this is the best way of acquiring an interchange of experience or not, I will not decide, but no doubt the feeling, how desirable it is men should compare notes with their fellow-workers, prompted the founders of our Association (which was expected to be more peripatetic than has proved to be the case) to determine that its members should at its annual meetings carefully examine some institution for the insane.

It is not too much to say that only second in importance to a good superintendent is a good attendant, and of him also Dr. Ray dreamed in his Sunday afternoon vision, and his description is equally excellent.

I am sure that it will be admitted that the last forty years have seen a vast improvement in the character of attendants, and among them are to be found many conscientious, trustworthy men and women, forbearing to their charge and loyal to their superintendent. It is not the less true that for asylums for the middle and higher classes the addition of companionship of a more educated character is desirable, and it is satisfactory to observe that there is an increasing recognition of its importance, as evidenced by the Reports of our asylums.[303]

* * * * *

One word now in regard to the advance in our classification of mental disorders, though I hardly dare to even touch thus lightly upon so delicate a subject, for I have observed that it is one of those questions in our department of medicine--dry and unexciting as it may at first sight seem to be--which possess a peculiar polemical charm.

Few circumstances are more noteworthy than the attacks which have been made upon the citadel of the Pinel-Esquirol classification, the symptomatological expression of the disease--attacks not new forty years ago, but renewed with great force and spirit by Luther Bell in America, and subsequently by Schroeder van der Kolk in Holland, Morel in France, and Skae in Britain. When Dr. Bell asserted that this system of symptoms "would not bear the test of accuracy as regards the cause of the disease or the pathological condition of the sufferer;" that the forms in use "were merely the changing external symptoms, often having scarcely a diurnal continuance before passing from one to another," and constituting a division useless as regards moral or medical treatment--he expressed in a nutshell all the objections since urged against the orthodox classification by the other alienists I have mentioned. These, however, substituted a mixed aetiological or pathogenetic classification, which Bell did not, and this classification is, in its essential characters, on its trial to-day. The wave of thought which bore these attempts to the surface, was a wholesome indication of the desire to look beneath the mere symptom right down to the physical state which occasioned it, and upon which the somatic school of German alienists had long before laid so much stress. The movement has been useful, if for no other reason than that it has concentrated attention afresh and more definitely upon the conditions which may stand in causal relation with the mental disorder, nor has it been without its influence in affecting the terms generally employed in the nomenclature of insanity. At the same time it is very striking to observe how the great types of mental disorder adopted and in part introduced by the great French alienists have essentially held their ground, and if their citadel has had in some points to parley with a foeman worthy of their steel, and even treat with him as an honourable rival, they remain still in possession, and their classification of symptoms seems likely to remain there for long to come. As such, these types are partly founded upon clinical and, to some extent, pathological observation, and may well be allowed with a few additional forms to stand side by side with a somato-aetiological nomenclature, as it grows up slowly and cautiously, reared on scientific observation and research; and had Skae been living he would have rejoiced to hear Mr. Hutchinson assert the other day that in all diseases, "our future classification must be one of causes and not external symptoms, if we would desire to construct anything like a natural system, and trace the real relation of diseases to their origin."

* * * * *

In a sketch, however brief, of the progress of Psychological Medicine since the foundation of this Association in 1841, it would be a serious omission not to notice the important contributions of the late Professor Laycock shortly before as well as after that year. In 1840 he first promulgated the opinion that "the brain, although the organ of consciousness, is subject to the laws of reflex action, and in this respect does not differ from other ganglia of the nervous system."[304] And in a paper read before the British Association, September, 1844, he observed, "Insanity and dreaming present the best field for investigating the laws of that extension of action from one portion of the brain to the other, by which ideas follow each other in sequence, giving as an illustration the case of a patient at the York Retreat, whose will being suspended, he expressed ideas as they spontaneously arose in associated sequence, the combination being singularly varied, but traceable to a common root or centre of impulse." "Researches of this kind," Laycock continues, "whether instituted on the insane, the somnambulist, the dreamer, or the delirious, must be considered like researches in analytical chemistry. The re-agent is the impression made on the brain; the molecular changes following the applications of the re-agent are made known to us as ideas."[305]

Time will not allow me to cite other passages in these remarkable papers, or later ones; but these are sufficient to show the germ at that early period of the doctrine of cerebral reflex action, and the unconscious cerebration of Carpenter, the seeds having been already sown by Unzer and Prochaska, and arising out of it, that of automatic states occasioned or permitted by the abeyance of a higher restraining power--the Will, according to Laycock, in the case he employs as an illustration of his doctrine. His teaching in regard to mental and nervous disorders due to vaso-motor disturbance also deserves recognition.

Dr. Henry Monro, again, in a treatise published in 1851, put forward a theory of the pathology of insanity, the essence of which was that the cerebral masses having lost their static equilibrium exhibit in their functions two different degrees of deficient nervous action (coincidently), viz. irritable excess of action and partial paralysis. He maintained that these two states do not fall alike upon all the seats of mental operations, but that there is "a partial suspension of action" of "higher faculties, such as reason and will," while there is an irritable excess of action of the seats of the more elementary faculties, such as conception, etc., and hence delusions and the excessive rapidity of successive ideas. Dr. Monro compares this condition to a case of paralysis, combined with convulsions; and discusses the question whether the temporary and partial paralysis occurring as he supposes in insanity, "results directly and entirely from excessive depression of the nervous centres of those higher faculties, or partly in an _indirect_ manner from nervous energy being abstracted to other parts which are in more violent exercise at the time."[306]

This, it will be seen, is a still clearer statement of the doctrine that insanity is caused by the depression or paralysis of the higher nervous centres and excessive action of others.

As is well known, Dr. Hughlings Jackson, whose views regarding active states of nerve structures as liberations of energy or discharges, are familiar to us all, has adopted and extended Laycock's doctrine, which he designates as "one of inestimable value," and has urged the importance of Monro's doctrine of negative and positive states in cases of insanity, using the term "insanity" in an exceedingly wide sense. He has pointed out that Anstie and Thompson Dickson have also stated the doctrine that so-called "exaltation of faculties" in many morbid states is owing to "insubordination from loss of control," and that the same was said in effect by Symonds, of Bristol. Adopting the hypothesis of evolution as enunciated by Herbert Spencer, Dr. Hughlings Jackson thinks that cases of insanity, and indeed all other nervous diseases, may be considered as examples of Dissolution, this being, I need not say, the term Spencer uses for the process which is the reverse of Evolution. Insanity, then, according to this view, is dissolution beginning at the highest cerebral centres, which centres, according to Jackson, represent or re-represent the whole organism. There are distinguishable, he believes, cases of uniform dissolution, the process affecting the highest centres nearly uniformly, and cases of partial dissolution in which only some parts of these centres are affected. The dissolution, again, whether uniform or partial, varies in "depth;" the deeper it is, the more general are the manifestations remaining possible. The degree of "depth" of dissolution is, however, but one factor in this comparative study of insanity. Another is the rapidity with which it is effected. To this, Dr. Jackson attaches extreme importance, believing that degrees of it account for degrees of activity of those nervous arrangements next lower than those _hors de combat_ in the dissolution. Another factor is the kind of person to whom dissolution "comes." And the last factor is the influence of circumstances on the patient undergoing mental dissolution. All factors should, of course, be considered in each case, or, as Dr. Jackson characteristically puts it, "insanity is a function of four variables." I refer to these opinions to show the direction in which some modern speculation on the nature of insanity tends, that thus tracing the course of thought in recent years we may see how, step by step, certain views have been reached, some of them generally adopted, others regarded as still requiring proof before they can be accepted.

The negative and positive view of the nature of insanity receives support, I think, from the phenomena of Hypnotism which, about forty years ago, attracted, under the name of Mesmerism, so much attention in England in consequence of the proceedings of Dr. Elliotson in the hospital and college where we meet to-day. This was in 1838, and Braid's attention was arrested by what he witnessed in 1841. It is no reason because we have re-christened mesmerism that we should ignore the merit of those who, as to matters of fact, were in the right, however mistaken their interpretation may have been.

Elliotson recorded some striking examples of induced hallucinations and delusions, and in an article in the _Journal_ in 1866, I endeavoured to show how suggestive similar instances which I then reported are in relation to certain forms of insanity, and also in relation to sudden recovery from mental disease; the conclusion being forced upon us that there may be cases in which no change takes place in the brain which the ablest microscopist is likely to detect, but a dynamic change--one more or less temporary in the relative functional power of different cerebral centres, involving loss or excess of inhibition.

Nor can I, in connection with the reference to cerebral localization, allow to pass unrecorded the researches of Fritsch, Hitzig, and Ferrier, on account of the intimate, although only partial relation in which they stand to mental pathology--a relation promising to become more intelligible and therefore more important as the true meaning of the psycho-motor centres becomes better understood; for that we are only on the threshold of this inquiry must be evident, when men like Goltz, Munk, and other investigators call in question the conclusions which have been arrived at.

But be the final verdict what it may, when I look back to the time when "Solly on the Brain" was our standard work, and then turn to Ferrier's treatise on its functions, to the remarkable works of Luys, and to Dr. Bastian's valuable contribution to the International Series, I cannot but feel how unquestionable has been the advance made in the physiology of the brain, strangely bent as Nature is on keeping her secrets whenever the wonderful nexus which binds together, yet confounds not, mind and brain, is the subject of investigation.

* * * * *

The past forty years have witnessed a great change in the recognition of mental disease as an integral part of disorders of the nervous system, and medical psychology is less and less regarded as a fragment detached from the general domain of medicine. Contributions from all lands have conspired to produce this effect, the somatic school of psychologists in Germany having exerted, probably, the most influence. And we are proud to number in France among our roll of associates a physician who, not only by his pathological researches into diseases of the brain and cord, but by his clinical study of affections closely allied to mental derangement, has by the brilliant light he has thrown upon the whole range of diseases of the nervous system, advanced the recognition of which I have just spoken. I need not say that I refer to our distinguished honorary member, Professor Charcot.

No one will deny that the relations of mind and brain, physiologically and pathologically considered, have in our own country been ably handled by Dr. Maudsley. Those who most widely differ from some of his conclusions will acknowledge this ability, and that his works are expressed in language which, with this author, is certainly not employed to conceal his thoughts. To trace the influence of these writings, and those of Herbert Spencer, Bain, and others of the same school, on the current belief of psychologists would, however, carry me far beyond the legitimate limits of an address, but I may be allowed to observe that here, as elsewhere, we must not confound clearly ascertained facts in biology and mental evolution with the theories which are elaborated from them. The former will remain; the latter may prove perishable hay and stubble, and when we overlook or ignore this distinction, it must be admitted that we expose ourselves to the just rebuke of the celebrated Professor of Berlin when he protests against "the attempts that are made to proclaim the problems of research as actual facts, the opinion of scientists as established science, and thereby to put in a false light before the eyes of the less informed masses, not merely the methods of science, but also its whole position in regard to the intellectual life of men and nations." He is surely right when he insists that if we explain attraction and repulsion as exhibitions of mind, we simply throw Psyche out of the window and Psyche ceases to be Psyche;[307] and when, allowing that it is easy to say that a cell consists of minute particles, and these we call plastidules, that plastidules are composed of carbon and hydrogen, oxygen, nitrogen, and are endued with a special soul, which soul is the product of some of the forces which the chemical atom possesses, he affirms that this is one of those positions which is still unapproachable, adding, "I feel like a sailor who puts forth into an abyss, the extent of which he cannot see;" and, again, "I must enter my decided protest against the attempt to make a premature extension of our doctrine in this manner--never ceasing to repeat a hundred-fold a hundred times, 'Do not take this for established truth.'"[308]

We all believe in cerebral development according to what we call natural laws or causes, and in the parallel phenomena of mind; as also in the arrested and morbid action of brain-power by infractions of laws or by causes no less natural. In this sense we are all evolutionists. The differences of opinion arise when the ultimate relations of matter and mind are discussed, and when a designing force at the back of these laws is debated. But these questions in their relation to mental evolution, as to evolution in general, do not enter the domain of practical science, and are not affected by the degree of remoteness, according to our human reckoning, of this force or "Ultimate Power."

It will not be denied that at least the foundations of the pathology of insanity have been more securely laid in cerebral physiology during the last forty years, in spite of the fact that the relation of the minute structure of the brain to its functions, and the nature of the force in operation, still elude our grasp. The so-called disorders of the mind having been brought within the range of the pathologist, what can he tell us now of the post-mortem lesions of the insane? Can he give a satisfactory reply to the question asked by Pinel in his day, "Is it possible to establish any relation between the physical appearances manifested after death, and the lesions of intellectual function observed during life?"[309]

It is a little more than forty years since Lelut published his work entitled "The Value of Cerebral Alterations in Acute Delirium and Insanity," and Parchappe his "Recherches," to be followed by other works containing valuable contributions to the pathological anatomy of mental disease. To attempt to enumerate the contributions to this department abroad and at home would be simply impossible on the present occasion. I cannot, however, omit to notice how early Dr. Bucknill was in the field, as his laborious examination of a number of brains of the insane to determine the amount of cerebral atrophy and the specific gravity, bear witness, as also his demonstration of the changes which take place, not only in the brain and its membranes, but in the cord, in general paralysis; these observations, along with those of Dr. Boyd, having been fully confirmed by subsequent observers.

I recall here, with interest, a visit I paid eight and twenty years ago to Schroeder van der Kolk at Utrecht, whom I found full of enthusiasm (although racked at the time with neuralgia) in the midst of his microscopical sections. And this enthusiasm I cannot but suspect insensibly coloured what he saw in the brains and cords of the insane, or he would hardly have said, as he did say, that he had never failed during a quarter of a century to find a satisfactory explanation after death of the morbid mental phenomena observed during life.

It must not, however, be forgotten that Parchappe, just forty years ago, was able to speak as strongly in regard to the brains of general paralytics; and that of others he said that it would be nearer the truth to assert that you can, than that you cannot, distinguish between a sane and an insane brain.

Since that period microscopes of higher power have been sedulously employed by European and American histologists, and in our country the example set by Lockhart Clarke has been followed by many able and successful investigators. I had intended to enumerate in some detail the gains of pathological anatomy in cerebro-mental diseases, and to endeavour to apportion to those who have cultivated this field of research their respective merits; but I find it better to consider what is the practical result of these researches. I may, however, so far depart from this course as to mention the memoirs of Dr. J. B. Tuke in the _Edinburgh Medical Journal_ of 1868 and 1869, and elsewhere, on account of their importance in the history of the morbid histology of insanity.

Returning to the practical question of the knowledge now possessed by the cerebral pathologist, I will put into the witness box Professor Westphal and Dr. Herbert Major, as having enjoyed and utilized large opportunities for making microscopic and macroscopic examinations of the insane, and not being hasty--some think the former too slow--to admit the presence of distinctive lesions.

Now, Professor Westphal informs me that he is unable to trace, in the majority of post-mortems of the insane who have not suffered from general paralysis, any morbid appearance of the brain or its membranes, either with the naked eye or the microscope. He maintains that it would be impossible to designate amongst a hundred miscellaneous brains those which have belonged to insane persons, if the cases of general paralysis had been eliminated.

Dr. Major speaks guardedly; but inclines to think that, even putting aside general paralytics, the sane may be _generally_ distinguished from the insane brain. His experience at Wakefield shows that in only seventeen per cent. of the autopsies (excluding general paralysis) the brain showed no decided morbid change. "It must be always remembered," Dr. Major writes, "that the difficulty is not to distinguish between the insane brain on the one hand and a perfectly healthy and vigorous sane brain on the other--the difference between these two extremes is, in my own experience, most striking and startling. The difficulty is to distinguish between the insane brain and that of an individual sane, but in whom the brain is (as in time it may be) anaemic, wasted, or even with tracts of softening. Still," he adds, "I think, generally speaking, the sane organ may be distinguished from the insane, the decision turning largely on the _degree_ of the degenerative or other morbid change."

Again, taking only cases of general paralysis, Professor Westphal holds that in by far the greater number of brains of insane persons dying in an advanced stage, morbid appearances similar to those which he has described in Griesinger's "Archiv. I.," etc., can be traced; the morbid appearances of the cord occurring more constantly than those of the brain.

Dr. Major found that of the post-mortems of paralytics, all displayed appreciable morbid lesions, although in five per cent. of cases they were not typical of general paralysis.

Then coming definitely to the question whether these pathologists have, to any considerable extent, been able to connect the morbid appearances found in cases of insanity with the symptoms, including motor troubles, Dr. Major says that at present he cannot; and Professor Westphal says that he regards "the connection of morbid symptoms with the changes found after death as exceedingly uncertain and doubtful."

I should observe that Dr. Major grounds his statements upon his own recent experience and observation at Wakefield, and that he is not disputing the greater preference shown by certain lesions in general paralysis for particular localities; but only that he does not yet see his way to connect them with the abnormal symptoms present during life. The researches carried on by Dr. Mickle, contributed to our _Journal_ (January, 1876), and those of Dr. Crichton Browne, published with illustrations in the "West Riding Reports," must be regarded along with M. Voisin's large work and Hitzig's article in Ziemssen's "Cyclopaedia," as placing before us whatever evidence can be adduced on the relations between the pathology of general paralysis and cerebral physiology. Hitzig, who from his investigations into the cerebral motor centres, and his position in an asylum for the insane, ought to be qualified to judge, surmises that those localities of the brain by the electrical irritation of which in animals he produced epileptiform attacks bearing the closest resemblance to the attacks of paralytics, are affected in general paralysis. He thinks, moreover, that as destruction of these cortical spots causes disturbance of motion, resembling the symptoms pathognomonic of grey degeneration of the posterior columns observed in general paralysis, there is an added reason for assuming this connection.

Dr. Mickle in his recent excellent work on general paralysis has exercised much cautious discrimination in admitting the relation between the symptoms and the alleged psycho-motor centres, and while his researches in a rich field of observation at the Grove Hall Asylum lead him to find some cerebral lesion in every case, especially in the fronto-parietal region, he cautions against the "too ready indictment of motor centres in the cerebral cortex as answerable for the most frequent and characteristic motor impairment, that of the lips, tongue, face, and articulatory organs generally;" fully believing, however, that in the production of these symptoms the cortical lesion is at the very least an important factor. "Whether the principal mental symptoms can be entirely referred," he says, "to the organic changes in certain frontal (and parietal) convolutions--the motor to those of the so-called cortical motor zone--the sensory to those of certain portions of the temporo-sphenoidal and parietal--must remain a matter of question," while in regard to the convulsive attacks, Dr. Mickle has in some cases been "unable to trace a harmony between these and the results of physiological experiment; in other cases they have seemed to harmonize fairly."[310] Dr. Mickle informs me that in the insane other than general paralytics, he has in the majority found some lesion in the brain and membranes.[311]

These results of research in cerebro-mental pathological anatomy and physiology may not seem, when placed side by side with the sanguine opinions of Schroeder van der Kolk and Parchappe, to present so triumphant a proof of progress and solid gain as might be desired or expected, and much, we must admit, has to be done before Pinel's question can be answered with the fulness we should wish. Nevertheless the advance is very considerable, and the best proof of the accumulating knowledge of the morbid histology of the brain and cord in the insane will, I think, be given this week by the collection of microscopical preparations of Gudden, Holler, etc., brought together by the untiring energy of Dr. Savage, including his own at Bethlem Hospital. I have but to point out how impossible such an exhibition would have been forty years ago to give significance to the contrast between 1841 and 1881; thanks to those who, although they may still often see as "through a glass darkly," have so wonderfully advanced the application of microscopic examination to the tissue of the brain, and prepared such beautiful sections of diseased brain and cord.

Another proof of progress might have been given, had time allowed of a reference to what has been done in the study of the brains of idiots, both morphologically and histologically, by Mierzejewski, Luys, and others, these results being sufficient to prove, had we no other evidence, the fundamental truth of cerebro-mental pathology--the dependence of healthy mind on healthy brain.

We are surely justified in expecting that by a prolonged examination of every part of the brain structure, and the notation of the mental symptoms, we shall arrive in future at more definite results; that the locality of special disorders will be discovered, and that the correlation of morbid mental and diseased cerebral states will become more and more complete, that the scientific classification of mental maladies may be one day based upon pathological as well as clinical knowledge, and psychology be founded, in part at least, upon our acquaintance with the functions of the brain. Let us hope, also, even though it be a hope in the sense rather of desire than of expectation, that by these discoveries the successful treatment of mental disorders may be proportionately advanced.

* * * * *

I would now turn to the very important question whether the treatment of the insane has advanced since 1841?

Of course, so far as this includes moral treatment and management, it has advanced in all civilized countries in a manner calculated, all will admit, to cause the liveliest feelings of satisfaction. Putting aside _moral_ treatment, we cannot boast, it must be confessed, of the same unanimity of judgment. If, however, it must be admitted that as respects details, _Tot capita, tot sensus_, it will be allowed that, notwithstanding the so many heads, and the as many opinions, the general principles of treatment based upon a just view of the general pathology of insanity, are accepted by all. There were too many who, forty years ago, bled freely for mania, and I remember Conolly, at even a later period, complaining of the number of patients brought to him hopelessly demented in consequence of the heroic treatment to which, when maniacal, they had been subjected by men who, no doubt, still believed with Paracelsus when he said, "What avails in mania except opening a vein? Then the patient will recover. This is the arcanum. Not camphor, not sage and marjoram, not clysters, not this, not that, but phlebotomy." Well, this treatment by the Paracelsuses of 1841 has been supplanted by the more rational therapeutics which we witness in 1881.

Dr. Stokes, the highly respected superintendent of the Mount Hope Retreat, Baltimore, thus writes in his last annual report: "Forty years ago, when this institution was opened, large blood-lettings--in the standing, recumbent, or sitting posture, to the amount of thirty or forty ounces--were recommended in acute mania, followed up by local depletion, by leeches, to the number of twenty or thirty, to the temples. The moral treatment, hygienic measures, exercise, and suitable occupation were almost wholly ignored. Drastic purgatives, ... the shower bath, large and frequent doses of tartarized antimony, and mercury to the extent of producing ptyalism, were the most popular remedial agents in the treatment of insanity. This, in general terms, was the system advocated and practised when, forty years ago, this institution entered upon its godlike mission."

If the success of the treatment of insanity bore any considerable proportion to the number of the remedies which have been brought forward, it would be my easy and agreeable duty to record the triumphs of medicine in the distressing malady which they are employed to combat. But this, unhappily, is not the case. Hypodermic injections of morphia, the administration of the bromides, chloral hydrate, hyoscyamine, physostigma, cannabis indica, amyl nitrite, conium, digitalis, ergot, pilocarpine, the application of electricity, the use of the Turkish bath and the wet pack, and other remedies too numerous to mention, have had their strenuous advocates during late years. Each remedy, however, let us hope, leaves a certain residuum of usefulness behind it, though failing to fulfil all the hopes raised on its first trial.

Dr. Ramskill lately avowed his opinion in my hearing that the advent of the bromide has done infinite mischief. Others, attacking chloral, would maintain that while the bromide has slain its thousands, chloral hydrate has slain its tens of thousands. In spite of this, however, Dr. Ramskill, doubtless, continues to employ the bromide; and who would wish to be deprived of chloral, or any other drug, because of its abuse?

"For nought so vile that on the earth doth live, But to the earth some special good doth give; Nor aught so good, but strained from that fair use, Revolts from true birth, stumbling on abuse."

Employed without discrimination, regarded as a talisman in insomnia and excitement--petted, in short, when it ought to have been restrained--chloral became for a time the spoilt child of psychological medicine, and, like other spoilt children, it has disappointed the fond hopes of its parents.

When it is possible for a physician in asylum practice to write as Dr. Pritchard Davies has written this year in our _Journal_, "On Chemical Restraint," to the effect that chloral, the bromides, and other sedatives are unnecessary, or even injurious; when, on the other hand, we have Dr. Hills replying that his experience at the Norfolk Asylum leads him to an entirely opposite conclusion; and Dr. Stokes, in America, writing thus in his report, after 7425 patients have been under treatment in his asylum, "without wishing to undervalue the great importance of an efficient system of moral treatment, great results can only be expected from a patient and persevering administration of powerful remedial agencies"--I say when such contrary opinions can be expressed by practical men, one feels how impossible it is to dogmatize upon the good effected by pharmaceutical remedies in insanity, and how far we are yet from witnessing a consensus of opinion in regard to their value.

It must be frankly granted that Psychological Medicine can boast, as yet, of no specifics, nor is it likely, perhaps, that such a boast will ever be made. It may be difficult to suppress the hope, but we cannot entertain the expectation, that some future Sydenham will discover an anti-psychosis which will as safely and speedily cut short an attack of mania or melancholia as bark an attack of ague.

Rather must we rest satisfied with the general advance in treatment in a scientific direction. Most of us know asylums where, within forty years and much less, tartarized antimony was in daily use in large doses as a quietus, and where croton oil was administered in addition to black draughts to a surprising extent, all these remedies being now employed only on the rarest occasions. Take an actual example, one of many, in a particular asylum. A few years ago a patient, who had been much excited and very troublesome, was treated in season and out of season with strong purgatives and sedatives. It so happened that he then fell under a new _regime_, which consisted in knocking off all these medicines and placing him under one attendant's entire supervision. The result was that he became as quiet and docile, though not cured, as any of the inmates of the asylum, and has remained so to the present time. But we may go further, and say that some cases of insanity are cured now which a few years ago would have remained uncured. Indeed, in relation to the associated bodily state, it may be said that specific treatment has been adopted. Remedies, like iodide of potassium, in large doses, are employed in cases in which, from the increased attention directed in recent years to the somatic aetiology of insanity, a causal relation between the physical and mental condition has been recognized, and the mental symptoms have disappeared in the most marked manner; and so again in gouty melancholia, relief has been obtained by appropriate remedies and diet. These are illustrations of the directly scientific application of medicine to medical psychology, and it is in this direction we must hope for a really satisfactory advance.

On the other hand, there are the successes obtained by the employment of drugs without our being able to say why or how they have exerted a curative agency; and it is obvious that as the number of drugs has so much increased during the period over which my survey extends, the chances of hitting on the right remedy are proportionately increased. How often we see one, two, or three drugs exhibited in mania without any result, while a fourth acts like a charm. Only by studying in detail the special characteristics of each case, can we hope to find a clue which will serve as a guide to the treatment of a subsequent one.

In this country, Dr. Clouston has distinctly advanced our knowledge of the action and uses of narcotic remedies by experiments made to determine the effect on maniacal excitement of single doses of certain remedies, stimulants, and food; of, again, the effect on mania of prolonged courses of certain narcotic medicines, along with clinical observations on the effects of the same medicines in all kinds of insanity, and has determined the equivalent value of opium, bromide of potassium, and cannabis indica in the treatment of insanity.

Dr. Savage has experimented with one drug at a time on a number of patients, and has already given to the profession some valuable results in "Guy's Hospital Reports," and the _Journal of Mental Science_. "The West Riding Asylum Medical Reports" of Dr. Crichton Browne also contain some important experiments with drugs by himself and others; and in this connection I would notice the excellent clinical notes issued from time to time by Dr. Williams and other officers of the Haywards Heath Asylum, which are well worthy of more permanent record in the archives of the Association. I cannot, indeed, understand any one seriously maintaining that we are practically no better off in our medicinal resources now than we were forty years ago.

Whatever differences of opinion may exist in regard to the advantages gained by the introduction of new drugs, one thing is clear, that the employment and, let me add, the repose of patients, well-ordered arrangements, and the tact of the superintendent will oftentimes do more to reduce the amount of excitement and noise in an asylum than tons of chloral and bromide. For example, any one who has visited Hanwell knows that Dr. Rayner anticipates and prevents post-epileptic mania to a very large extent by the simple expedient of keeping patients in bed after their fits, just as he finds forced alimentation of patients rarely necessary when rest is resorted to. It is striking to see how, even in an over-grown asylum and an old building, the results of good management and treatment can be highly satisfactory, and worthy of an institution of such historic fame.

* * * * *

But, after all, the question faces us, are there or are there not more insane persons cured in 1881 than in 1841?

One's first impulse, of course, is to take the statistics of recovery for a certain number of the more recent, and compare them with those of the earlier years, or to take the recoveries of the past forty and place them side by side with those of the previous forty years. The attempt, however, is fraught with so many fallacies that it is dangerous to make such a comparison. In a report of Bethlem Hospital, issued in 1841, Sir Alexander Morison stated--not as anything exceptional--that seventy per cent. of the patients had been discharged cured; while an examination of the recoveries at this hospital for the last ten years shows a much smaller proportion per cent. But I cannot accept these comparisons as proving anything one way or the other, as various causes, quite apart from the comparative success of treatment at different periods, may explain the difference. Take a single asylum, like Hanwell, and compare the recoveries of a later with an earlier period. I find a population so fluctuating in character, in regard to curability, that the comparison becomes utterly worthless, and although it is true that during the last quinquennium 28.1 per cent. have recovered, as against 26.3 per cent. during the first quinquennium of the past forty years, in spite of there having been more incurables received during the later period, the result is not so satisfactory when we divide into certain periods the whole time during which Hanwell has been open (omitting the first four years). It then appears that during two previous periods the recoveries were higher than 28.1 per cent., viz. from 1840 to 1849 and from 1865 to 1874. Thus:--

1835-39 (inclusive) 25.3 1840-49 28.5 1850-54 25.2 1855-64 27.9 1865-74 30.4 1875-79 26.3

Or in quinquennial periods throughout:--

1835-39 (inclusive) 24.8 1840-44 26.3 1845-49 32.1 1850-54 25.2 1855-59 30.7 1860-64 27.0 1865-69 30.4 1870-74 30.5 1875-79 26.3

If to escape the fallacies connected with the comparison of different periods of the same asylum, we go to the Lunacy Blue Books, we do not get any reliable figures before 1870, on account of transfers having been previously included in the admissions, so that a fair comparison of recent and former recoveries worked on the admissions is impossible.

I have before me the statistics of the Siegburg Asylum, thanks to Dr. Ripping, from its opening to its close; and I find that the recoveries during the first twenty-five years amounted to forty-two per cent., and during the twenty-five years ending with the year 1877, they were forty-six per cent., thus showing an increase of four per cent. in the more recent period. As this asylum, now closed, has admitted curable cases only, these figures are among the few valuable statistics which I have been able to procure.

I have not succeeded in obtaining satisfactory comparative results by adopting, in the mixed asylums of England and Wales, the plan of working the recoveries, not on the total admissions, but on those only deemed curable; but to explain this fully would involve me in more detail than the occasion warrants.

I would add that in the United States, where reasons have been assigned why the statistics of asylums exhibit apparently fewer recoveries in the later than the earlier period of the last forty years, Dr. Pliny Earle has done good service by the remarkable contribution he has made to the question of the curability of insanity,[312] corroborating, at the same time, the somewhat unfavourable conclusion as to permanent recovery which Dr. Thurnam, in a work which will always be a Pharos to guide those who sail on waters where so many are shipwrecked, arrived at, after a laborious examination of the after history of cases discharged recovered from the York Retreat. It is likewise anything but reassuring to find that, out of the total number of lunatics under care in England and Wales, there are at this moment only 3592 who are deemed curable.[313]

* * * * *

Such, gentlemen, is my Retrospect of the Past. Meagre it has necessarily been, though occupying more of your time than I could have wished, but the number of subjects demanding reference must be my excuse.

We found, at the commencement of the period we have traversed, the accommodation provided for the insane scandalously insufficient, and the condition of many of the existing asylums calling loudly for a radical reform.

We witness to-day, throughout the kingdom, a large number of institutions in admirable working order, reflecting the greatest credit upon their superintendents and committees.

We found a wholly inadequate system of inspection.

We witness now a Board of Commissioners, which, without forfeiting the good will of the superintendents, carefully inspects the asylums throughout the provinces as well as the metropolis--as carefully and thoroughly, at any rate, as the same number of men originally appointed to examine into the condition of some 20,000 patients can fulfil a like duty for above 70,000.

We found a resolute attempt being made to carry out and extend the humane system of treatment inaugurated nearly half a century before in France and England.

To-day we witness its success.

And had I had time to sketch the progress in the provision made for criminal lunatics, we should have found that just forty years ago was the commencement of what Dr. Nicolson has named the "Reactionary Period"--during which this Association petitioned the Government (in 1851) to establish a criminal lunatic asylum--followed in 1860 by the "Period of Centralization" or that of Broadmoor--an institution to-day so efficiently superintended by Dr. Orange.

And in what consists the superiority of the new over the old system of treatment--the nineteenth over the eighteenth century?

The old system was mainly one of brute force--the child alike of ignorance and fear.

The new does not indeed dispense with force, but it is a maxim of the reformed school, from which no one, whose opinion carries weight in psychological medicine, whether in America or in Europe, would dissent, that it should be reduced to the lowest possible point, consistent with safety and the good of the patient, and that humanity should dictate the means of repressing, or rather guarding against, violence, both as regards their amount and character.

The old system subjected patients, who underwent any medical treatment at all, to a miserable routine, often determined by the season of the year and the phases of the moon, rather than the condition of the patient.

The new does not pretend to possess a universal formula, or to have discovered the psychologist's stone, but strives to treat each patient according to individual indications.

The old system desired secrecy; the new is not afraid of publicity.

The old system, in short, believed in harshness and darkness; the creed of the new is, "I believe in sweetness and light."

Such are the results achieved for Psychological Medicine.

* * * * *

If this be the Retrospect of the Past, what is the Prospect of the Future? Will the progress of the last forty or the last ninety years be maintained? I trust it will, but one need not be a pessimist to be sensible that the humane treatment of the insane may have its ebb as well as its flow; that so far from its being true that there is a constant and certain tendency to humanity, there is also a strange tendency to relapse into inhuman ways. Vigilance is and always will be required, for if it be allowed to slumber, we but too well know that there is only one direction in which things will go when left to themselves--and that is downhill.

The functions--the mission--of this Association may be regarded from a threefold point of view: first, in relation to insanity and the insane; secondly, in relation to its members; thirdly, in relation to the public.

I.--Under the first are comprised what in the original rules, drawn up by the founders of this Association forty years ago, were stated to be its objects, namely, "Improvement in the management of asylums and the treatment of the insane;" and further, "The acquirement of a more extensive and more correct knowledge of insanity."

Added to the improved management of asylums is the necessity now for making appropriate provision for idiots and imbeciles, and their education so far as practicable, grappling at the same time with the problem how best to provide for the mass of incurable pauper patients in the provinces, and the extension of middle-class asylums, and of cottages in connection with the central institution.

There are, of course, various ways in which the welfare of the patients in asylums can be promoted, by the attention directed by the Association to special points of importance. To instance only one, the occupation of patients, including systematic teaching which Dr. Lalor has so successfully developed in the Richmond Asylum, Dublin. Though very much has been done, there is, all, I think, will agree, room for more sustained effort in this direction. "There is one monster in the world--the idle man," are the words of one who has lately passed beyond the reach of praise or blame, which ought ever to be in the minds of those who direct our asylums. It may be that if more were done in future in the spirit of this apophthegm of the Sage, if not the Saint, of Chelsea, there would be less chance of patients chewing the cud of bitter reflection and dwelling upon the delusions by which they are haunted and harassed.

In proportion as we feel the inadequacy of our means of cure, we must recognize the necessity of studying the aetiology of insanity, including that _damnosa haereditas_, which is the cause of causes in so large a number of the cases coming under our treatment. But what induced the ancestral taint? It behoves us to pay more and more attention to those laws of inheritance in general to which Mr. Hutchinson has recently directed attention in his suggestive lectures at the College of Surgeons.

When M. Baillarger proposed that a similar association to this should be established in France, he gave, among other reasons, the advantage which would accrue from discussing this very question. "Every one," he said, "is assuredly decided upon the influence of heredity in the production of insanity (Mr. Buckle had not then written); but in this primary question, how many secondary ones there are which remain unsolved." Since he thus wrote, his own countrymen, Morel and Lucas, have, by their researches, advanced our knowledge, and rendered the task of their successors in the same field easier.

Intemperance also, as a cause as distinct from a symptom of insanity, requires to be more thoroughly examined into, and I am happy to say Dr. Hayes Newington, than whom no one could be better fitted for the task, has prepared a series of questions arranged in a tabular form, which has been before the Statistical Committee, and will appear in the _Journal_.

Again, there remains for the future the continued research into the causal connection between certain mental symptoms or disorders and accompanying lesions of the brain and cord. Dr. Spitzka, of New York, in the prize essay which he is about to publish, enters carefully into this inquiry, and I am hopeful that his industry and talent will be rewarded by marked success. These and kindred investigations might, no doubt, be pursued in a more methodical manner than is always the case in English asylums. To this end, the appointment of a pathologist, as at Wakefield in our own country, and at the Utica Asylum in America, ought to become general.

Clinical teaching in our asylums admits of much greater development, though they may not be able to meet the demands made upon them, should examinations be required in medical psychology by the examining bodies. To-day the student has fortunately a very different position from that which fell to his lot forty years ago. He has at his command means of research then unknown, as the ophthalmoscope and sphygmograph, and all the modern improvements in the microscope and in preparing sections; and can he not experiment on knee jerks, and a host of reflex and electric phenomena never dreamt of by his predecessors? He has, moreover, the stimulus begotten of the sense that enough has been discovered to indicate how much precious treasure lies hidden beneath the ground he now treads, like the gold-digger whose ardour is quickened and labour repaid by the discovery of the minutest particle of the metal of which he is in search.

II. The second relation in which this Association stands--to its members--suggests that we must needs be alive to legislation affecting the rights of those who are engaged in this department of medicine. This association is not a trades union, but there are various points bearing on their position which have to be considered, as in connection with a Bill like Mr. Dillwyn's, or the matters discussed two years ago at the annual meeting, when brought forward by Dr. Murray Lindsay. It is true that for him who has taken mental science, in its widest sense, as his mistress; for him who has wooed her for her own sake, knowing full well that for him she may hold no dowry in hand or pocket, there is the supreme pleasure arising from study and observation themselves--that recompense which is better than gold, and more precious than rubies. All this is true; but none the less the superintendents of asylums have a right to expect not only that their services shall be adequately remunerated when in harness, but that they may count with certainty upon a fair provision in the evening of life.

III. With regard, thirdly, to the influence of this Association on public opinion, we should be strangely faithless to our mission, if we were not the expositors of the principles in accordance with which the insane ought to be regarded; if we did not endeavour to enlighten the community in the doctrines of true psychological science, and in that philanthropy which is as far asunder as the poles from the fitful pseudo-philanthropy from which our country is unfortunately not free, the wild, ill-regulated, hysterical clamour with which we are epidemically visited, as injurious to the lunatic as it is to the interests of society at large.

This Association, further, ought to continue to bring before the lawyer what it regards as the just test of criminal responsibility; to entreat the educator not to defeat the object of his noble profession by exactions which transgress the limits by which Nature has bounded human capacity; and to warn parents, as Dr. Brigham did in his day with so much zeal, of the dangers to mental health arising from precocious forcing during the early growth of the brain, and with a tenfold greater necessity than when he wrote, in presence of the illimitable folly of examining boards, some of them medical, the members of which have not even the poor excuse of ignorance; and last, but not least, to counsel the teacher of religion against the peculiar dangers which attend his exalted mission, remembering that--

"Virtue itself turns vice, being misapplied."

Various, then, are the functions of our Association. But what, asks the late Sir James Stephen, the eloquent writer in the _Edinburgh_ is a party, political or religious, without a Review? and he replies, "A bell without a clapper." Such a bell would this Association have been without its _Journal_, and it must gratefully attribute much of its success to the ability with which in the first instance Dr. Bucknill, and subsequently Drs. Robertson, Maudsley, Sibbald, and Clouston, have helped to make an otherwise clapperless bell articulate.

Through this organ of the Association, for which, speaking for my colleague and myself, I would venture to ask your loyal co-operation, much scientific work can be brought before the profession, many questions can be systematically discussed, and the invaluable experience of the superintendents of asylums on practical points be presented to its readers and permanently preserved.

The objects I have mentioned as calling for further attention, and many more, belong to the future of Psychological Medicine, and as I began my address with proposing to review the period bounded by the years 1841 and 1881, I will close it with expressing the hope that when a successor of mine in this office reviews the then vanished period between 1881 and 1921, he will be able to report an accelerated ratio of progress compared with that of the time I have attempted, so inadequately, to survey.

And may the Medico-Psychological Association, which I trust will always be identified with this progress, be about to enter, after its wanderings, "forty years long," a land flowing with milk and honey, won by conquests over ignorance, superstition, and cruelty--the triumphs of the application of humanity and medical science to the relief of mental weakness and suffering.

FOOTNOTES:

[292] Presidential Address, delivered at the Annual Meeting of the Medico-Psychological Association, held at University College, London, August 2, 1881.

[293] I here do homage to the dead. Calmeil, Baillarger, and Brierre de Boismont still live, at an advanced age. (Since this address was given, the last named has died. See eloquent tribute to his memory by M. Motet, in _Journal of Mental Science_, April, 1882.)

[294] As will be seen by the history of lunacy reform contained in this volume, Lord Shaftesbury's interest in the movement extends back as far as 1828.

[295] _American Journal of Insanity_, April, 1855.

[296] 9 Geo. IV., c. 40.

[297] Amended by 18 and 19 Vict., c. 105 (1855). Acts referring to Lunacy Commissions and Chancery Patients, 16 and 17 Vict., c. 70; 25 and 26 Vict., c. 86 (1862).

[298] If parts of workhouses, etc., be included, 166. See p. 211.

[299] I should find it difficult to point to a more striking illustration of these remarks than the good work being done at the Lenzie Asylum by Dr. Rutherford.

[300] "On the Construction, Organization, etc., of Hospitals for the Insane," by Thomas S. Kirkbride, M.D., LL.D. (Philadelphia, 1880), p. 300.

[301] On the large degree to which patients, as shown by the experience of the Chancery Visitors, can be treated satisfactorily outside asylums, see pp. 261 and 286; also Dr. Bucknill's trenchant little book, "Care of the Insane and their Legal Control," 1880.

[302] "Ideal Characters of the Officers of a Hospital for the Insane," by I. Ray, M.D. Philadelphia, 1873.

[303] See Dr. Baker's Annual Reports of the York Retreat, and Dr. Rees Philipps's last Report of the Wonford Asylum, Exeter, etc., etc.

[304] "A Treatise on the Nervous Diseases of Women," by Thomas Laycock, M.D., 1840, chapter ix. p. 107.

[305] _British and Foreign Medical Review_, January, 1845, p. 311.

[306] "Remarks on Insanity, its Nature and Treatment," p. 14.

[307] "I agree with Mr. Martineau in repudiating the materialistic hypothesis as utterly futile."--Herbert Spencer, _Contemporary Review_, June, 1872.

[308] "Die Freiheit der Wissenschaft im Modernen Staat," by Rudolf Virchow. Berlin, 1877.

[309] Preface to his work on Mental Alienation, p. 20.

[310] "General Paralysis of the Insane," by Wm. Julius Mickle, M.D., M.R.C.P. London, 1880.

[311] Among the groups of cases in which they were more decidedly present is that comprising many due to syphilis; that in which degenerative changes follow upon haemorrhagic softening, and another in which they succeed to occlusion of vessels and its immediate results. In another, degeneration and atrophy follow, the brain state conditioning acute insanity; and in another they are secondary to brain injury, not to mention many other groups.

[312] In the same department the services of another American alienist, Dr. Edward Jarvis, ought not to be forgotten. Among other works, his Report on the Idiotic and Insane in Massachusetts, 1854, was of great value.

[313] It is a remarkable fact, showing the mass of incurable cases which have accumulated, that the number of curable cases now is only about 1000 more than it was in 1844 (2519).

CONCLUSION.

In completing the task which the author has attempted in the foregoing chapters in the History of the Insane in the British Isles, he is only too conscious that, in the endeavour to be concise as well as comprehensive, he has made many omissions. With every desire to be fair to all who have been engaged either in originating or in advancing the improved treatment of those who, suffering cruelly from a malady involving their very nature and being, have also been treated cruelly by their fellows, the writer fears that some names which ought to have been recorded and some institutions which ought to have been honourably mentioned, have been passed over in silence. Apart from unintentional oversight, it is not always easy to find in the Temple of Fame the precise niche in which to place the figure that would rightfully fill it, and the consequence is that the pedestal, as in some of our great public edifices, remains unoccupied. It may be said, however, in extenuation of any such omission, that it did not fall within the scope of this book to chronicle all the establishments which, in more humane methods of treatment, have been in advance of others, still less to complete the history up to the present day of those which have been mentioned. As it proceeded, the work has entered more into detail than was originally designed; thus, in the chapter on Scotland the sketch is filled in with particulars somewhat out of proportion to that attempted in the earlier chapters.

Again, in crediting various asylums, as Lincoln, Hanwell, and Lancaster, with introducing non-restraint, the author has not found space for more than a reference to the meritorious course pursued at an early period at the Suffolk Asylum, the Gloucester Asylum, and at Northampton from its opening (1838), and at the Haslar Hospital.[314]

The writer would have been glad, had the proposed limits of the book admitted of it, to describe much more fully the rise and growth of those charitable institutions, the endowed or registered hospitals for the insane, which have in England formed so important, and, on the whole, so successful, an experiment in providing care and treatment for the insane of the poor but non-pauper class, supplemented as they have been by the payments of the rich. At the present moment, the principle and the method by which these institutions are governed attract much earnest attention, and appear to not a few to afford the best alternative provision for the middle and upper classes, as against asylums carried on by private enterprise. It may be so. Abuses which in former days were possible, could not occur under the legislative restrictions of our time; but it must not be overlooked that their annals have disclosed, in some instances, abuses as great and inhumanities as shocking as any that have disgraced the history of private houses. How abominably even such institutions have been managed, has already been depicted in a notorious example; how admirably, might have been shown, had space allowed, as regards the same institution in the hands of men who, like Dr. Needham, have maintained the reforms previously introduced within its once dishonoured walls, and carried forward that humane system of treatment which, Phoenix-like, arose from its ashes. The author would have liked to do justice to other hospitals--as that at Northampton, which under Dr. Bayley's remarkable power of organization has proved so great a success; that at Cheadle, which under Mr. Mould's exhaustless energy has shown how the various needs of different phases of mental disorder may be met by various modifications in the provision made for their care outside the walls of the asylum, thus combining cottage treatment with the control of the central establishment; and, lastly, that at Coton Hill, Stafford, which now and for many years has been superintended by Dr. Hewitson--an institution due to a wave of public feeling in favour of an institution for those in reduced circumstances, which bore this practical fruit after some temporary discouragement.

Of the work done by county asylum superintendents it is impossible to speak too highly; in fact, it would be difficult to know when to stop, were one to be mentioned. Superintendents of the vast asylums of Middlesex, Lancashire, and Yorkshire deserve the recognition of services performed day by day with faithful diligence, not always sufficiently appreciated, and not always without peril, as instanced in the case of the late superintendent of Brookwood, Dr. Brushfield.[315]

As of those whose hourly labour is performed in these and other institutions, so of those who were labourers, however humble, in the early days of asylum reform at the close of the last and the beginning of the present century, it must never be forgotten that work unobserved by the public eye, but conscientiously performed for the unfortunate class which, to a large extent, is unable to appreciate or thank the kindly hand which shields them from cruelty or saves them from neglect, will find its reward in the conscience; and also in the increased happiness of those whom it benefits, though it may not set the worker on any pinnacle of fame. It is to such that the author of "Romola" refers when speaking of the "valiant workers whose names are not registered where every day we turn the leaf to read them, but whose labours make a part, though an unrecognized part, of our inheritance, like the ploughing and the sowing of past generations."

FOOTNOTES:

[314] See Report of the Metropolitan Commissioners. 1844.

[315] Since the above was in type, another example has occurred in the case of Dr. Orange, who has been assaulted by a criminal lunatic, and narrowly escaped serious injury.

APPENDIX A.

(Page 61.)

In addition to the maps of Ralf Agas (cir. 1560?) and Braun and Hogenberg (1572), there is an earlier view of London and Westminster by Anthony van der Wyngrede, 1543, in the Bodleian Library, Oxford, but it is worthless for the purpose of tracing the outline of Bethlem. No additional light is thrown on the buildings by the view of London and Westminster in Norden's "Speculum Brittanniae," engraved by Pieter van dem Keere, 1593. It appears to be agreed that, whatever the date or designer of the so-called "Agas" may be, it is "the earliest reliable survey of London." Virtue's reprint is dated 1737. Mr. Overall's "Facsimile from the original in the possession of the Corporation of the City of London" was published in 1874. It is, however, only by a careful study of the original with a magnifying glass and a good light, that the outline of the Bethlem buildings can be made out.

Smith, in his "Topography of London" (1816), p. 36, says that the only plan of London showing the first Bethlem which he had been able to meet with is that by Hollar. This map showed Moorfields divided into quarters, with trees surrounding each division, the site of the second Bethlem being then an uninterrupted space, and a cluster of five windmills standing on the site of the north side of Finsbury, a part of which in Mr. Smith's memory was called Mill Hill. Hollar's rare map (1666 or 1667) is so much later than Agas, that we have not followed its distribution of the buildings. In Faithorne's map, published a few years earlier (1658), from a survey in 1640, "Bedlame" is represented as a quadrangle, with a gate in the wall on the south side. There is a very clear outline of the first Bethlem in Lee and Glynne's map of London (in Mr. Gardner's collection), published at the Atlas and Hercules, Fleet Street, without date. This map is also in the British Museum. Mr. Coote, of the Map Department, fixes the date at about 1705. Rocque's map of London (1746) shows Bethlem distinctly. This map, and Ogilby's, formed the basis of Mr. Newton's "London in the Olden Time," 1855.

With regard to the story of the skeleton in irons and Sir T. Rowe's burying-ground, mentioned at p. 49, it is not disputed that he was concerned in the burying-ground of Bethlem; but the skeleton appears to have been found some distance from this spot. What is stated in Strype's "Stow" (Bk. ii. p. 96, edit. 1720), is that in 1569 "Sir Thomas Rowe caused to be enclosed with a wall about one acre, being part of the said hospital of Bethlem, to wit, on the west, on the bank of Deep Ditch, parting the hospital from Moorfields. This he did for burial in case of such parishes of London as wanted ground convenient within their parishes. This was called New Churchyard near Bethlem."

There are some very fine prints of the _second_ Bethlem Hospital in the Print Room of the British Museum. Of these (to which Mr. Crace's collection is a recent valuable addition), and the prints in Mr. Gardner's private collection and the Guildhall Library, the following list has been prepared. I have again to thank Mr. Gardner and Mr. Coote for their assistance. I have also to thank Mr. Crace for allowing me to see his prints before they were removed to the British Museum.

VIEWS OF BETHLEM HOSPITAL.

1. Inscribed "Hospitium Mente Captorum Londinense. Frontispicium Hospitii (vulgo Bedlam dicti) mente captis destinati, sub auspiciis colendissimi viri Gulielmi Turner Equitis aurati Senatoris non ita pridem Praetoris Londini Praesidis dignissimi nec non Beniamini Ducane Armigeri Thesaurarii fidelissimi; caeterorumque ejusdem Hospitii Gubernatorum A.D. MDCLXXV mense Aprili fundati, anno sequento mensi Juli consummati." R. White sculp. Printed by John Garrett, 1690. 47 in. by 22-1/2 in. Crace Collection, 26/3; Guildhall Library.

2. A New Prospect of y{e} North Side of y{e} City of London, with new Bedlam, and Moorefields (showing New St. Paul's). 1710. 58 in. by 22-1/2 in.

This print is a later edition of one by J. Nutting, 1689, in which old St. Paul's is shown. Crace Collection, 26/1.

3. On a scroll, "Hospitium mente captorum Londinense." New Bedlam in Moorefields. Soly fec. Sold by H. Overton, cir. 1730. 22-3/4 in. by 16-1/2 in. Gardner Collection; British Museum.

4. Painting of Bethlem Hospital (fresco) in one of the rooms of the Foundling Hospital, by Haytley. 1746.

5. The Hospital of Bethlem (L'Hospital de Fou). A view showing also Moorgate. J. Maurer del.; T. Bowles sculp. 1747. 16 in. by 10-1/2 in. Gardner Collection; Crace Collection, 26/6; Guildhall Library.

6. Hospital of Bedlam. Smaller copy of Bowles's print. Gardner Collection.

7. Interior of Bedlam, by Hogarth. 1735. Gardner Collection.

8. Bethlehem, a Poem, with a view of Bethlehem. By J. Clark. 1749.

9. Bethlehem in Moorfields. 1752. By B. Cole.

10. The Hospital called Bedlam. 1754. Gardner Collection.

11. View of Hospital of Bethlehem. 6 in. by 10 in. Robert Sayer, cir. 1760.

12. Visit to Bedlam. R. Newton. 1794.

13. Mezzotint of Bethlehem, by Malton. 1798. 11 in. by 9 in.

14. Bethlem Hospital as it appeared in 1811 (proof). Arnold del.; Watkins sculp. Guildhall Library.

15. London Wall and Bethlehem Hospital. Etching by J. T. Smith. 1812.

16. South-west View of Bethlem Hospital and London Wall, 1814. Smith del. et sculp. Guildhall Library.

17. Two clever water-colour drawings of Bethlem. Gardner Collection.

18. Water-colour drawing of gate with the recumbent figures by Cibber. Richardson. Gardner Collection.

19. The two figures on the pediment of the gate by Cibber. Stothard del.; Sharp sculp. 1783. Guildhall Library.

20. The same. Burell sculp. 1805. 6-1/2 in. by 4-1/2 in. Crace Collection.

21. The same engraved by Warren in Hughson's "London," vol. iii. p. 81. Gardner Collection.

22. A portrait of William Norris as confined in Bethlem Hospital. Arnold fec. 1814.

23. New Bedlam in Moorfields, 6-1/2 in. by 9-1/2 in., and another 5-1/2 in. by 6-1/2 in. No date or name of artist. Gardner Collection.

24. Das Narren Hospital Bethlehem. Dutch print. No date. Gardner Collection.

25. Plan of Moorfields and Bethlem Hospital. Gardner Collection.

26. New Bedlam in Moorfields. 10-1/2 in. by 7 in. Very early view. No date. Gardner Collection.

27. The New Prospect of Bedlam, Moorfields. By John King. 10 in. by 4 in. No date (costume cir. Will. III.).

28. The Hospital of Bethlehem. 9 in. by 14 in. No date. Gardner Collection.

29. Curious and quaint drawing of Moorfields and Bethlehem. 13 in. by 21 in. Gardner Collection.

30. Bethlehem Hospital, by Toms. 7-1/2 in. by 15. Gardner Collection.

31. Three views. Hospital de Bethlem; New Bedlam; Bethlehem. Gardner Collection.

32. Bethlehem in St. George's Fields. Ground Plan of New Bethlem Hospital. Basire sculp. 1819. This, with five other views by Shepherd, etc., are in the Guildhall Library.

VIEWS OF ST. LUKE'S.

1. "Enthusiasm displayed." The Rev. John Whitfield preaching under a tree in Upper Moorfields, with view of "St. Luke's Hospital for Lunaticks" in the background. J. Griffiths pinx.; R. Tranker sculp. 1750. 19-3/4 in. by 15 in. Gardner Collection; Crace Collection, 33/19.

2. Elevation of St. Luke's Hospital in a pamphlet entitled "Reasons for the Establishing, etc., of St. Luke's." 1765. Guildhall Library.

3. Another elevation. J. Dance arch. et sculp. 1784. 15 in. by 4-1/2 in. Gardner Collection; Crace Collection, 33/15.

4. Front view of the New St. Luke's Hospital, lately erected in the City Road. Deeble del. et sculp. 1785. Gardner Collection; Guildhall Library.

5. St. Luke's Hospital, Old Street Road. A coloured print from a drawing by F. A. Shepherd. 1814. 8 in. by 5-1/4 in. Original drawing in the Gardner Collection; Crace Collection, 33/16.

6. Lunatic Hospital of St. Luke's. Aquatint. Gardner Collection.

7. Front View of the New St. Luke's Hospital. No date. Gardner Collection.

8. Ditto. Ditto. 15 in. by 5 in. Gardner Collection.

9. Sepia drawing of St. Luke's. Gardner Collection.

10. Two original drawings by John Carter. Gardner Collection.

11. Lunatick Hospital of St. Luke, published by Ackermann. 1815. Gardner Collection; Guildhall Library.

12. St. Luke's Hospital, Old Street Road. Shepherd del.; Sands sculp. 1815. Gardner Collection; Guildhall Library.

13. St. Luke's Hospital. Higham del. et sculp. 1817. Guildhall Library.

14. Lunatic Hospital, St. Luke's. S.W. view. T. H. Shepherd del.; J. Gough sculp. 1837. 5-3/4 in. by 3-1/2 in. Gardner Collection; Crace Collection, 33/18.

15. Interior of St. Luke's. Rowlandson and Pugin del. et sculp.; Stahler aquat. 1809. Gardner Collection; Guildhall Library.

APPENDIX B.

(Page 142.)

In reference to the writers on insanity at the close of the eighteenth century, Dr. Pargeter, in the work referred to at p. 142, after dwelling slightly on the pathology, causation, and nature of insanity, becomes disheartened and exclaims, "Here our researches must stop, and we must declare that wonderful are the works of the Lord and His ways past finding out" (p. 15). Of asylums he says, "The conduct of public hospitals or institutions for the reception of lunatics needs no remark; the excellence in the management of them is its own encomium" (p. 123). Of private madhouses under the management of regular physicians, he ventured to say that "people might securely trust that in them the afflicted would be judiciously and tenderly treated, and also managed by servants selected and instructed with such judgment as will make them as zealous of their own character and reputation, as of the honour of their employers. In such hands we may place implicit confidence; and a perfect assurance that in such an abode dwells nothing offensive or obnoxious to humanity--here no greedy heir, no interested relations will be permitted to compute a time for the patient's fate to afford them an opportunity to pillage and to plunder. But such dwellings are the seats of honour, courtesy, kindness, gentleness, mercy, and whatsoever things are honest and of good report." Such was the comfortable satisfaction with which a worthy man in 1792 regarded the condition of the insane in English asylums in that year. He admits, however, that in private asylums kept by illiterate persons, compassion as well as integrity is oftentimes to be suspected, and quotes a passage from a paper written in 1791, which asserts that "if the gaolers of the mind do not find a patient mad, their oppressive tyranny soon makes him so."

The work written by Dr. Mason Cox (Fishponds, near Bristol) was the best medical treatise of the day on insanity. Unlike Cullen, he objects to "stripes" in the treatment of the insane. On the cold bath he says, "Even so late as Boerhaave we have the most vague directions for its employment; such as keeping the patient immersed till he is almost drowned, or while the attendants could repeat the Miserere.... The mode recommended and so successfully practised by Dr. Currie of Liverpool is certainly the best, that of suddenly immersing the maniac in the very acme of his paroxysm; and this may be easily accomplished if the patient, previously secured by a strait waistcoat, be fixed in a common Windsor chair by strong broad straps of leather or web girth" (p. 135, 3rd edit., 1813). The author observes that it is certainly worth trying whether keeping a patient for days in succession in a state of intoxication would be beneficial, where every other means has failed (p. 75).

APPENDIX C.

(Page 146.)

ASYLUMS IN OPERATION IN 1792.

Bethlem Hospital. Used for lunatics about 1400.

St. Luke's Hospital. Founded 1751.

Liverpool Royal Lunatic Hospital, associated with the Royal Infirmary. 1792.

Manchester Royal Lunatic Hospital, in connection with the Royal Infirmary. 1706. (Removed to Cheadle, 1849.)

Bethel Hospital, Norwich. 1713.

The Lunatic Ward of Guy's Hospital. 1728. (New building, 1797.)

The York Lunatic Hospital, Bootham. 1777.

St. Peter's Hospital, Bristol. Incorporated 1696.

Brooke House, Clapton (Dr. Monro's). 1759.

Hoxton Asylum. 1744.

Fonthill-Gifford, Hindon, Wilts. 1718.

Droitwich Asylum. 1791.

Belle Grove House, Newcastle-on-Tyne. 1766.

Lea Pale House, Stoke, near Guildford. 1744.

Ticehurst, Sussex. 1792.

The number of lunatics in London and in the country, returned under the Act of 1774 (14 Geo. III., c. 49), from that year to the projection of the York Retreat (1792), was 6405; and from 1792 to the Select Committee of 1815, 12,938.

In 1775 the number registered during the year was 406; and in 1791, after various rises and falls, it was also 406.

In 1792 the number rose to 491, and in 1815 to 850; the lowest being 414 in 1807, and the highest 700 in 1812.

The above list of asylums shows how scanty was the provision made for the care of the insane at the time of the foundation of the York Retreat. I may here add that, in addition to the notice taken of this experiment by the writers on the Continent mentioned in the text, the attention of the Germans was forcibly directed to it by Dr. Max. Jacobi, of Siegburg. He visited York, and, much struck by what he witnessed there, translated into German the greater part of the "Description of the Retreat." The late superintendent of the Retreat, Dr. Kitching, who filled that office for many years with much efficiency, spent a considerable time at the Siegburg Asylum, comparing notes with Dr. Jacobi.

APPENDIX D.

(Page 173.)

9 GEO. IV., C. 40 (1828).

The fifteen persons appointed Commissioners in Lunacy for the metropolitan district, five of whom were physicians, were paid L1 an hour, and were appointed for one year. They were to meet quarterly for the purpose of granting licences, those in the provinces being granted by justices at quarter sessions, where three or more justices were to be elected to visit the provincial licensed houses, together with at least one medical Visitor.

Three of the Commissioners were to visit licensed houses in the metropolitan district four times a year.

Two justices to visit licensed houses in the provinces, accompanied by the medical Visitor, four times a year.

An annual report was to be prepared and presented to the Secretary of State for the Home Department.

Private patients were not to be admitted to asylums without the certificates of two medical men and an order; the certificates being in force fourteen days before admission.

Pauper patients were not to be admitted without one medical certificate and the order of two justices, or an overseer and clergyman.

The proprietor of an asylum had to transmit a copy of documents to the Commissioners or justices, as the case might be.

Single patients to be received on like order and certificates. No regular visitation of this class instituted.

It should be stated that among the previous Acts, now repealed, there was a small Act passed May 2, 1815, notwithstanding the failure of Mr. Rose to induce Parliament to undertake legislation based on the evidence given before the Committee of that year. This was the Act 55 Geo. III., c. 46, entitled, "An Act to amend an Act 48 Geo. III., c. 96 (1808), being an Act for the better Care and Maintenance of Lunatics being Paupers or Criminals in England."

The committee of visiting justices of lunatic asylums were to be elected annually.

Subscribers to lunatic asylums erected by voluntary contributions, who should unite with any county, might elect a committee of governors to act with committee of visiting justices.

Justices to fix sums to be expended in purchase of lands, houses, etc., or in erecting buildings.

Overseers of the poor to return lists of all lunatics and idiots within their parishes, verified on oath and accompanied with a medical certificate.

When any asylum could accommodate more lunatics, magistrate might order an addition under certain regulations.

APPENDIX E.

(Page 188.)

8 AND 9 VICT., C. 100 (1845).

The following are the clauses of the Act which provide for the expense of carrying out its provisions.

By this statute it was enacted, after repealing 2 and 3 Will. IV., c. 107; 3 and 4 Will. IV., c. 64; 5 and 6 Will. IV., c. 22; 1 and 2 Vict., c. 73; 3 Vict., c. 4; 5 and 6 Vict., c. 87, that the Commissioners in Lunacy under 5 and 6 Vict., c. 84, should be henceforth called "the Masters in Lunacy," and that new Commissioners in Lunacy should be appointed. The Commissioners were to grant licences for the reception of lunatics within a certain jurisdiction of the metropolis; justices of the peace in general or quarter sessions licensing houses for the reception of lunatics and appointing Visitors in all other parts of England and Wales, including a medical man. For every licence granted a sum to be paid of ten shillings for every private patient and two shillings and sixpence for every pauper, or so much more as shall make up the sum of fifteen pounds, these moneys being applied towards the payment of the expenses of the Commissioners or any charge incurred by their authority. The secretary of the Commissioners to make out an annual account of moneys received and paid by him in the execution of the Act, to be laid before the Lords Commissioners of the Treasury, the balance (if any) to be paid into the Exchequer to the account of the Consolidated Fund, such accounts being laid before Parliament every year, the Treasury being empowered to pay out of the Consolidated Fund any balance of payments over receipts which may be necessary. With regard to the application of moneys received by the clerk of the peace for provincial licences, they were to be applied towards the payment of the clerk to the Visitors for the county, and the remuneration of the medical Visitors, and other expenses incurred in the execution of the Act, the accounts being laid before the justices at the general or quarter sessions, who shall direct the balance (if any) to be paid into the hands of the treasurer of the county or borough in aid of the rate; any balance of payment over receipts being paid out of the county or borough funds.

There was paid into the Exchequer in the year ending March 31, 1880, L1376 for licences in the metropolitan district, besides L18 stamps. Lunacy Board expenses, L15,064.

I have not any accurate returns of the amounts received from the provincial houses, but on a rough estimate these licences produce to the counties in the aggregate L1452, and L30 to the Imperial Exchequer, per annum.

In the following year, August 26, 1846, an Act was passed "to amend the Law concerning Lunatic Asylums and the Care of Pauper Lunatics in England," and was to be construed with 8 and 9 Vict., c. 126. There were only twelve sections. It was passed to clear up doubts which had been entertained as to the meaning of certain clauses in the above Act. It was repealed by 16 and 17 Vict., c. 97.

APPENDIX F.

(Page 190.)

After the legislation of 1853, the Acts referred to at p. 190 and p. 188 constituted, with 8 and 9 Vict., c. 100, and 15 and 16 Vict., c. 48, and the Acts relative to criminal lunatics, the then code of Lunacy Law.

Lord St. Leonards' first Act, p. 188 (16 and 17 Vict., c. 70), enacts that when the Commissioners shall report to the Lord Chancellor that they are of opinion that the property of any lunatic, not so found by inquisition, is not duly protected, or the income thereof not duly applied for his benefit, such report shall be deemed tantamount to any order or petition for inquiry supported by evidence, and the case shall proceed as nearly as may be in all respects as therein directed upon the presentation of a petition for inquiry.

The next Act (16 and 17 Vict., c. 96) prescribes amended forms of orders and certificates, notices of admission, and of the medical visitation book.

The requirements on the part of the medical man signing the certificate are laid down.

Empowers proprietors or superintendents of licensed houses (with consent of Commissioners) to entertain as a boarder any patient desiring to remain after his discharge, or any relation or friend of a patient.

Authorizes amendment of any order or certificate within fourteen days after admission of patient.

Permits the Commissioners to allow medical visitation of single patients less frequently than once a fortnight.

Empowers one or more Visitors to visit single patients at request of Commissioners, and report to them their condition.

Directs that the medical man who visits a single patient shall make an annual report to the Commissioners of the mental and bodily health of such patient.

Empowers the Lord Chancellor to discharge single patients.

Directs that notice of the recovery of every patient shall be sent to his friends, or in case of a pauper to his parish officers, and in case of death of a patient in any hospital or licensed house, a statement of the cause, etc., to the coroner.

Authorizes transfer of a private patient (with consent of two Commissioners) from one asylum, hospital, or licensed house to another, without any fresh order or certificate, and similarly as to single patients.

Empowers the Lord Chancellor, on the representation of the Commissioners, to require a statement of the property and application of the income of any person detained as a lunatic under an order and certificates.

Extends to the Commissioners the powers vested in the private committee, as to single patients, by the Act 8 and 9 Vict., c. 100, s. 111.

Repeals s. 27 of 8 and 9 Vict., c. 100, as to the visitation of workhouses; and enacts that one or more Commissioners shall visit such workhouses as the Board shall direct.

Authorizes the Commissioners in urgent cases to employ any competent person to visit any lunatic and to report to them.

Directs committee of every hospital to submit regulations to the Secretary of State for approval, and to send a copy to Commissioners.

Empowers Commissioners, with sanction of the Secretary of State, to make regulations for the government of licensed houses.

Enacts that Bethlem Hospital shall be subject to the provisions of Act 8 and 9 Vict., c. 100.

The third Act (16 and 17 Vict., c. 97) repeals the several Acts then in force respecting county and borough lunatic asylums, and re-enacts most of the provisions therein contained, with certain additions and improvements.

It authorizes justices of boroughs, instead of providing asylums for their own use, or in arranging with counties, etc., to contract with the Visitors of any asylum for the reception of their pauper lunatics, in consideration of certain payments.

The powers of the Visitors were enlarged in many ways.

When a county or borough asylum can accommodate more than its own pauper lunatics, the Visitors are empowered to permit the admission of the pauper lunatics of any other county or borough, or lunatics who are not paupers, but proper objects to be admitted into a public asylum, such non-pauper patients to have the same accommodation, in all respects, as the pauper lunatics.

The Visitors are directed to appoint a medical officer to be superintendent of the asylum.

They are empowered to grant superannuation annuities to the officers and servants.

They are directed to make an annual report to the general or quarter sessions of the state of the asylum.

Every pauper lunatic, not in an asylum, hospital, or licensed house, is to be visited every quarter by the medical officer of the parish or union, who is to make return thereof; and the medical officer is to be paid two shillings and sixpence for every visit.

The forms of orders, statements, and medical certificates are amended, and the medical officers of unions are permitted to sign certificates.

The medical man certifying is required to state his qualification, when and where the patient was examined, and to specify facts indicating insanity; distinguishing facts observed by himself from those communicated to him by others.

Visitors are empowered to order the removal of pauper patients to and from asylums, and also to discharge or permit the absence on trial of any patient. The Commissioners are empowered to direct the removal of any lunatic from any asylum, hospital, or licensed house to any other.

The person signing the order for admission of a private patient into an asylum may discharge such patient, subject, in the case of dangerous lunatics, to the consent of the visiting justices. Any person having authority to discharge a private patient is empowered (with consent of two Commissioners) to transfer him to another asylum or to the care of any person.

Orders and certificates, if defective, may be amended within fourteen days.

Patients escaping may be retaken within fourteen days.

This statute did not re-enact the clause contained in the Act it repealed respecting workhouses.

18 AND 19 VICT., C. 105 (1855).

In 1855 was passed the Act 18 and 19 Vict., c. 105, "to amend the Lunatic Asylum Acts and the Acts passed in the Ninth and Seventeenth Years of Her Majesty, for the Regulation of the Care and Treatment of Lunatics."

By this statute it was enacted that any single county or borough might unite with the subscribers to a registered hospital, and that the proportion of expenses between any county and borough might be fixed with reference to accommodation likely to be required.

Other sections provide in detail for the maintenance of county and borough asylums, and other matters which it is unnecessary to enumerate.

APPENDIX G.

(Page 195.)

A short summary is added of the provisions in force at the time of the Select Committee of 1859-60, for the protection of private patients. They remain essentially the same.

In the metropolis, the power of licensing is exclusively in the hands of the Metropolitan Commissioners. In the provincial districts it rests with the justices at quarter sessions. These licenses are annually renewed, and they may be revoked by the Lord Chancellor. The patients are admitted upon an order signed by some relative or friend, with a statement of all the particulars of the case. This statement must be supported by the certificates of two medical practitioners, who, having examined the patient separately within seven days previous to the reception, state that he is a person of unsound mind, and a proper person to be detained under care and treatment. It must also specify the grounds upon which their opinion has been formed, viz. the facts observed by themselves or communicated by others. After two and before the expiration of seven clear days, the proprietor or superintendent of the licensed house must transmit to the Commissioners, and also to the visiting justices, if the licensed house is within their jurisdiction, a copy of the order and certificates. The licensed house must be visited by two of the Commissioners, four times at least every year, if it lies within their immediate jurisdiction; and if beyond, it must be visited four times at least by Visitors appointed by the justices, one of whom shall be a medical man, and twice at least by two of the Commissioners. In the course of such visits, inquiries are directed to be made as to the occupation, amusement, classification, condition, and dietary of the different patients, and also whether a system of non-coercion has been adopted or not; and where it shall appear, either to the Commissioners or to the visiting justices, that a patient is detained without sufficient cause, they have the power, under certain conditions, of ordering his discharge. When a patient recovers, the proprietor or superintendent is required to send notice of such recovery to the person who signed the order for his reception; and if such patient is not discharged or removed within fourteen days, the proprietor is required immediately to transmit a similar notice to the Commissioners or visiting justices, as the case may be. When a patient dies, the medical practitioner who attended such patient during his illness is to cause a statement to be entered in the case-book, setting forth the time and cause of death, and the duration of the disease of which the patient died, and a copy of such statement, within two days, must be transmitted to the coroner. In addition to these specific provisions, the Commissioners have power from time to time to make regulations for the government of any of these licensed houses, and they must report annually to the Lord Chancellor the number of visits they have made, the number of patients they have seen, the state and condition of the house, the care of the patients therein, and such other particulars as they may think deserving of notice (p. vi.).

25 AND 26 VICT., C. 111, "THE LUNACY ACTS AMENDMENT ACT, 1862."

In consequence of the importance of the Act of 1862, the Commissioners issued the following circular noting its chief provisions:--

_Private Patients._

Sec. 23.--The order must be dated within one month prior to reception; the person signing the order must himself have seen the patient within one month prior to its date; and a statement of the time and place when the patient was so seen must be appended to the order.

Sec. 25.--When possible, every order must contain the name and address of one or more relations of the lunatic, to whom notice of the death of a lunatic must be sent.

Sec. 24.--Besides the persons hitherto prohibited from signing certificates and orders, the following also are now disqualified:--Any person receiving any percentage on or otherwise interested in the payments for patients, and the medical attendant as defined in the Lunacy Act, c. 100. Also 15 and 16 Vict., c. 96, s. 12; c. 97, s. 76.

Sec. 26.--Where a patient received as a pauper is made a private patient, no fresh order or certificate is required, and _vice versa_.

Sec 28.--With the exception of the statement by the medical officer as to a patient's mental and bodily condition, all the documents heretofore required to be sent to the Commissioners after two or before seven clear days from the reception of the patient, must in future be sent within one clear day from such reception. The medical officer's statement is, as heretofore, not to be sent until after two and before seven clear days.

_Letters of Patients._

Sec 40.--Without special directions to the contrary, letters addressed to the Commissioners, committees of Visitors, committees of a hospital, and the Visitors of licensed houses, must be forwarded unopened. Other letters must also be forwarded, unless, by an endorsement thereon, the superintendent or other person having charge of patients should prohibit their transmission. Letters so endorsed to be laid before Commissioners, committees, or Visitors at next visit.

Sec. 38.--Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.

Sec. 43.--In the absence of any person qualified to discharge, a discharge or removal may be ordered by the Commissioners.

_Pauper Patients._

Sec. 25.--The order must contain the name and address of one or more relations of the lunatic, and notice of the death of the lunatic must be sent to such relation.

Sec. 38.--A pauper permitted to be absent on trial from a licensed house or hospital may have such an allowance made to him by order of the Commissioners, Visitors, or committees as would be charged for him were he in the house or hospital.

_Licensed Houses and Hospitals._

Secs. 14 and 15.--No fresh licence can be granted by justices without inspection and report by the Commissioners. Notices of alterations in houses licensed by justices must be given to Commissioners. Their report must be considered by the justices before licence is granted or alterations are consented to.

Sec. 16.--The physician, surgeon, or apothecary not being a licensee, where any such is by law required to reside in or visit a licensed house, must in the metropolitan district be approved of by the Commissioners, and in the provincial district by the visiting justices.

A penalty is imposed on any person infringing the terms of his licence as to numbers, sex, or class.

Sec. 18.--With consent of two of the Commissioners, or, in the case of the provincial licensed houses, of two of the Visitors, a person who may have been a patient within five years immediately preceding, may be received as a boarder into a licensed house (extension of c. 96, s. 6).

Sec. 29.--Licensed houses may be visited at any time by one or more of the Commissioners or Visitors, but in the metropolitan district they must be so visited twice in the year, in addition to the present visits by two Commissioners, and in the provincial districts similarly by Visitors. Commissioners and Visitors visiting singly have substantially the same powers of inspection and inquiry as when visiting together. To these the sixty-second section of the Act does not apply.

Sec. 39.--A penalty is now imposed on any officer or servant conniving at an escape.

Sec. 43.--In the absence of any person qualified under ss. 72, 73, c. 100, the Commissioners may order discharge or removal of a patient.

Sec. 38.--Absence on trial may be permitted to patients, in the same way as leave of absence for the benefit of health is permitted under s. 86, c. 100.

_Medical Certificates._

Sec 27.--Where medical certificates have been returned with a written direction of the Commissioners for amendment, and such amendment shall not have been made within fourteen days, the Commissioners may order the patient's discharge.

Sec. 22.--Lunatics so found by inquisition may be received without certificate on an order of the committee, accompanied by an official copy of the order appointing such Committee.[316]

_Workhouses._

The Poor Law Board issued a circular at the same time. The only paragraph which it is of interest to cite here is the following:--"The eighth section empowers the Visitors of any asylum and the guardians of any parish or union within the district for which the asylum has been provided, if they shall see fit, to make arrangements, subject to the approval of the Commissioners in Lunacy and the President of the Poor Law Board, for the reception and care of a limited number of _chronic lunatics_ in the workhouse of such parish or union, to be selected by the superintendent of the asylum and certified by him to be fit and proper so to be removed. The Board are at present not aware of any workhouse in which any such arrangement could conveniently be made; but they will be ready to consider any such proposals on the subject when the Visitors of the Board of Guardians of any union shall find it convenient or practicable to act upon this clause."

FOOTNOTES:

[316] Seventeenth Report of Commissioners in Lunacy, 1863.

APPENDIX H.

(Page 205.)

Extract from the _British and Foreign Medical Review_, January, 1840:--

"In this particular there is apparently no asylum in England which presents so remarkable a model as that of Lincoln. Of all the works that have appeared on the subject of lunatic houses since the publication of Mr. Tuke's account of the Retreat, there is none which contains matter more deserving of attention than that recently published by Mr. Hill. His lecture is little more than a simple commentary on the resolutions of the board of management of the Lincoln Asylum for twenty years past; during which period, under the superintendence of Dr. Charlesworth, and latterly with the vigilant co-operation of Mr. Hill himself, as house surgeon, almost every kind of bodily restraint is stated to have gradually fallen into disuse as superfluous, a mere substitute for want of watchful care.... If the Lincoln Asylum can present a model of this kind, which all may visit and examine, the services of Dr. Charlesworth to the cause of humanity and in behalf of the insane, already considerable, will only be second to that of him who first released them from their chains."

On this Mr. Hill observes, July 8, 1840:--

"At last the first Medical Review in Europe took up the subject, and placed most deservingly Dr. Charlesworth in a striking position as to the non-restraint system, and also honoured myself with approbation."

The following extracts from the Orders in the Lincoln Asylum books[317] are essential to the right understanding of the introduction of non-restraint there. Dr. Charlesworth was visiting physician from its opening in 1821; Mr. Hill was appointed house surgeon in 1835.

"1828. _Ordered_--That the use of the strait waistcoat be discontinued in this institution except under the special written order of the physician of the month.

"1828, October 13. Ordered and resolved--That the physicians be requested to consider whether it be possible to make any improvement in the means of restraint now in use, and especially for obviating the use of the strait waistcoat."

Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829, April:--

"The governors have particularly directed their views to the subject of coercion and restraint, well aware of their injurious consequences to the patients.... The construction of the instruments in use having also been carefully examined, they have destroyed a considerable proportion of those that were not of the most improved and least irritating description, and hope hereafter to introduce still further amelioration into this department."

Extract from the House Visitor's Report, 1829, August 17:--

"Every attention seems to be paid to the patients, whose general state has, I understand, for some time past, been so generally good that it is gratifying to say that the strait waistcoat has almost become useless."

Extract from the Seventh Annual Report, 1831, March 28:--

"Heretofore it was conceived that the only intention of a receptacle for the insane was the safe custody of the unhappy objects, by any means, however harsh and severe. These views are now passing away, and the fair measure of a superintendent's ability, in the treatment of such patients, will be found in the small number of restraints which are imposed. The new director has answered this test in a very satisfactory manner."

The new director here referred to was Mr. Henry Marston. The following note is appended to this report:--

"As early as the 24th day of November last (viz. Nov., 1830, five years before Mr. Hill's appointment), there was not any patient in the house under restraint, unless one wearing a collar, which leaves all the limbs quite at liberty, can be so considered. This gratifying occurrence has taken place more than once since that time."

Extract from the Ninth Annual Report, 1833, April:--

"It is unceasingly an object in this institution, and should form a prominent point in the annual reports, to dispense with or improve as much as possible the instruments of restraint."

Extract from the House Visitor's Report, 1834, August 4th to 10th inclusive:--

"I have much satisfaction in being able to state that not a single male patient has been under restraint since the 16th of July, and not one female patient since the 1st of August, and then only for a few hours."

At this time Mr. Hadwen held the appointment of house surgeon.

Extract from the Governor's Memorandum Book, 1835, July 8th:--

"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen during the period of fifteen months that he held the situation of house surgeon of this institution, feel called upon to express their high approbation of the very small proportion of instances of restraint which have occurred amongst the patients under his care."

Extract from _Edinburgh Review_, April, 1870:--

"But to Conolly belongs a still higher crown, not merely for his courage in carrying out a beneficent conception on a large scale and on a conspicuous theatre, but for his genius in expanding it. To him, hobbles and chains, handcuffs and muffs, were but material impediments that merely confined the limbs; to get rid of these he spent the best years of his life; but beyond these mechanical fetters he saw there were a hundred fetters to the spirit, which human sympathy, courage, and time only could remove.

"Perfect as was the experiment carried out at Lincoln Asylum, the remoteness of that institution from the great centre of life, and the want of authority in its author, would no doubt have prevented its acceptance for years by the physicians of the great county asylums so long wedded to old habits. It was for some time treated as the freak of an enthusiastic mind, that would speedily go the way of all such new-fangled notions; and no doubt it would, had not an irresistible impulse been given to it by the installation of Dr. Conolly at Hanwell, where, with a noble ardour, he at once set to work to carry out in the then largest asylum in the kingdom the lesson he had learned at Lincoln."

Dr. Conolly's works bearing on mental disorders, in addition to his "Lectures on Insanity," were as follows:--

1. "An Inquiry concerning the Indications of Insanity, with Suggestions for the better Protection and Care of the Insane." 1830.

2. "The Construction and Government of Lunatic Asylums and Hospitals for the Insane." 1847.

3. "The Treatment of the Insane without Mechanical Restraints." 1856.

See "Memoir of Dr. Conolly." By Sir James Clark. 1869.

FOOTNOTES:

[317] As given in the _Journal of Mental Science_, July, 1870.

APPENDIX I.

(Page 236.)

The Commissioners give, in their Report for 1857, a table in support of the statement at p. 236, but it is not borne out by the _average_ of the six largest and six smallest county asylums.

--------------+---------------------+--------------------- | Daily average | Average weekly cost Asylum. | number of patients. | per head. --------------+---------------------+--------------------- | | s. d. Colney Hatch | 1257 | 9 10 Hanwell | 1020 | 10 5-3/4 Surrey | 934 | 8 8-3/4 Wakefield | 803 | 7 4 Lancaster | 710 | 8 1-1/2 Prestwich | 509 | 7 10 +---------------------+--------------------- | Average} 872 | Average} 8 8-1/2 | number} | cost } | | Dorset | 155 | 8 1 Denbigh | 189 | 9 8-3/4 Bucks | 192 | 10 8 Notts | 216 | 10 5 Cornwall | 238 | 8 3-3/4 Chester | 278 | 8 6 +---------------------+--------------------- | Average} 211 | Average} 9 3 | number} | cost} --------------+---------------------+---------------------

APPENDIX K I.

(Page 258.)

The sketch of the rise and growth of county asylums and registered hospitals would not be complete without giving the provision obtained, up to the present time, by means of rates on the one hand and private charity on the other. We are not concerned here with private asylums.

The following are the asylums and charitable hospitals in England and Wales, January 1st, 1881, with the number of patients.

_Counties._--Beds., Herts, and Hunts. (913); Berks (420), Bucks. (421), Cambridge (421); Carmarthen, Cardigan, and Pembroke (335); Chester--at Chester (521), ditto at Macclesfield (632); Cornwall (582); Cumberland and Westmoreland (447); Denbigh, Anglesea, Carnarvon, Flint, and Merioneth (427); Derby (404), Devon (800), Dorset (469), Durham (944), Essex (932), Glamorgan (581), Gloucester (662), Hants (792), Hereford (364), Kent--at Maidstone (1253), ditto at Canterbury (692); Lancaster--at Lancaster Moor (1118), ditto at Rainhill (675), ditto at Prestwich (1211), ditto at Whittingham (1260); Leicester and Rutland (463), Lincoln (600); Middlesex--at Banstead (1702), Colney Hatch (2173), Hanwell (1841); Monmouth, Brecon, and Radnor (537); Norfolk (619), Northampton (557), Northumberland (432), Notts (280), Oxford (471), Salop and Montgomery (50), Somerset (733); Stafford--at Stafford (645), ditto at Burntwood (529); Suffolk (401); Surrey--at Wandsworth (1028), ditto at Brookwood (1050); Sussex (802), Warwick (644), Wilts (586), Worcester (766); York--North Riding, York (525); ditto West Riding, Wakefield (1400); ditto West Riding, Sheffield (1125); ditto East Riding, Beverley (260).

_Boroughs._--Birmingham (676), Bristol (387), Hull (163), Ipswich (249), Leicester (392), City of London (380), Newcastle-on-Tyne (248), Norwich (171), Nottingham (262), Portsmouth (375).

_Metropolitan District Asylums._--Leavesden, Herts (1990); Darenth, Kent (687); Caterham, Surrey (2039).

_Hospitals._--Manchester Royal Lunatic Hospital, Cheadle (183); Wonford House, Exeter (93); Barnwood House, Gloucester (111); Lincoln Lunatic Hospital (56); St. Luke's Hospital (199); Bethel Hospital, Norwich (74); St. Andrew's Hospital, Northampton (314); Nottingham Lunatic Hospital (66); Warneford Asylum, Oxford (68); Coton Hill, Stafford (146); Bethlem Hospital (265); Bootham Asylum, York (187); The Retreat, York (151).

_Idiot Establishments._ See chapter viii., pp. 307-319.

_Naval and Military Hospitals and India Asylum._--Royal Military Hospital, Netley (34); Royal India Lunatic Asylum, Ealing (105); Royal Naval Hospital, Yarmouth (168).

_Criminal Asylum._--Broadmoor (491). See chapter vi.

The total number of ascertained lunatics and idiots in England and Wales, January 1st, was as follows:--

----------------+------------------+--------------------+-------------------- | Private. | Pauper. | Total. +-----+-----+------+------+------+------+------+------+------ Location. | M. | F. |Total.| M. | F. |Total.| M. | F. |Total. ----------------+-----+-----+------+------+------+------+------+------+------ 61 county and | | | | | | | | | borough | | | | | | | | | asylums | | | | | | | | | (51 and 10) | 230| 309| 539|18,427|22,389|40,816|18,657|22,698|41,355 | | | | | | | | | 16 registered | | | | | | | | | hospitals |1,454|1,346| 2,800| 92| 56| 148| 1,546| 1,402| 2,948 | | | | | | | | | Licensed houses:| | | | | | | | | 35 Metropolitan |1,030| 836| 1,866| 198| 447| 645| 1,228| 1,283| 2,511 59 Provincial | 738| 816| 1,554| 257| 304| 561| 995| 1,120| 2,115 | | | | | | | | | 3 naval and | | | | | | | | | military and | | | | | | | | | hospitals, | | | | | | | | | Royal India | | | | | | | | | Asylum | 288| 19| 307| -- | -- | -- | 288| 19| 307 | | | | | | | | | 1 criminal | | | | | | | | | lunatic asylum| | | | | | | | | (Broadmoor) | 172| 55| 227| 199| 65| 264| 371| 120| 491 | | | | | | | | | Workhouses: | | | | | | | | | Ordinary | | | | | | | | | workhouses | -- | -- | -- | 5,211| 6,882|12,093| 5,211| 6,882|12,093 | | | | | | | | | Metropolitan | | | | | | | | | district | | | | | | | | | asylums | -- | -- | -- | 2,144| 2,574| 4,718| 2,144| 2,574| 4,718 | | | | | | | | | Private single | | | | | | | | | patients | 175| 273| 448| -- | -- | -- | 175| 273| 448 | | | | | | | | | Outdoor paupers | -- | -- | -- | 2,358| 3,769| 6,127| 2,358| 3,769| 6,127 +-----+-----+------+------+------+------+------+------+------ --- | | | | | | | | |73,113 175 Total |4,087|3,654| 7,741|28,886|36,486|65,372|32,973|40,140|[318] ----------------+-----+-----+------+------+------+------+------+------+------

FOOTNOTES:

[318] Exclusive of 224 Chancery patients residing with their committees.

APPENDIX K II.

(Page 276.)

It should have been stated in the text that the ratio of the insane there given to the number of those tried, only refers to those tried for murder. I am indebted to Dr. Guy for the following additional figures, extracted from the last volume of the Judicial Statistics:--

------------------------------+-----+-----+-----+-----+-----+------ |1875.|1876.|1877.|1878.|1879.|1880. ------------------------------+-----+-----+-----+-----+-----+------ Sentenced to death | 33 | 32 | 34 | 20 | 34 | 28 Executed | 18 | 22 | 22 | 15 | 16 | 13 Subsequently certified as | | | | | | insane and sent to Broadmoor| 1 | 1 | 2 | 1 | 4 | 1 ------------------------------+-----+-----+-----+-----+-----+------

The following figures for 1878 are of interest:--

Removed by order of Secretary of State, acquitted as insane 33.2 Ditto, becoming insane after trial 22.2 Ditto, becoming insane after committal 23.5 Ditto, found or declared insane 20.9 Committed by justices--dangerous lunatics 0.2 ----- 100.0

The last figure is in striking contrast with the return from Ireland, where, on account of the peculiarity of the law, the justices committed 1276 as dangerous lunatics, out of 1393 sent to asylums in the same year.

APPENDIX L.

(Page 284.)

Since Broadmoor was opened, in 1863, to January 1, 1881, the number of persons admitted was 1322; the re-admissions were 27, making 1349 cases. The number discharged recovered was 108; the number recovered and sent back to prison to finish their sentences, 59; making a total of recoveries of 167, or 12.37 per cent. of the admissions. There were transferred to other asylums, being still insane, 452; and 234 died, or 2 per cent. on average number resident. Twenty-one patients escaped and were recaptured, 3 escaped and were not recaptured. The number remaining January 1, 1881, was 490.

Of these, 19 were affected with epilepsy; 13 with paralysis; and 4 with epilepsy and paralysis.

The principal crimes were as follows:--For murder, 220; attempt to murder, 122; arson, 28; larceny and petty theft, 25; insubordination as soldiers, 18; burglary and housebreaking, 16; manslaughter, 10.

With reference to the period at which insanity was recognized, 39 were certified to be insane whilst awaiting trial or judgment; 117 were found insane by jury on arraignment; 244 were acquitted on the ground of insanity; 13 were reprieved on the ground of insanity; and 77 were certified insane whilst undergoing sentence of penal servitude.

Of 230 who had committed homicide, 93 had killed their own children; 23 their wives; 8 women to whom engaged; 7 the mother, and 4 the father; while 18 had killed fellow patients in asylums.

APPENDIX M.

(Page 298.)

The following are some of the statistics of the duties performed in the office of the Masters in Lunacy during the year ending October 31, 1879:--

Orders for inquiry in Commissions of Lunacy executed by Masters in Lunacy 115

Reports made to the Lord Chancellor 248

Summonses for proceedings before the Masters 5739

REGISTRAR IN LUNACY.

Petitions presented for hearing 253

Ditto for orders for inquiry, and for orders under Lunacy Regulation Act, 1862 179

Orders made for inquiry (Commissioners in Lunacy) 119

Number of orders made in pursuance of the Lunacy Regulation Act, 1862, for the application of properties of small amounts for the maintenance of lunatics 51

CASH ACCOUNTS.

Amount of receipts included in accounts and affidavits of committees and receivers of lunatics' estates, taken and passed by the Masters L882,481

Amount of disbursements and allowances thereon 766,220

Percentage on lunatics' incomes under general order 21,140

Amount of stock directed to be transferred into court 144,439

Amount of stock directed to be sold or transferred out 325,925

Amount of stock directed by orders in lunacy to be transferred, or otherwise than into court 2,092,038

_Judicial Statistics_, 1880.

INDEX.

A.

Abendberg, the, 305

Aberdeen Asylum, 333, 334, 343

Abram men, 39, 40, 65

Accumulation of insane, 261, 362, 402, 429, 438, 493

Adam, Dr., 379

Admissions into asylums, 260

Aetius, 30

Agas's map, 60, 507

Agrippa, Cornelius, 36, 38

Ahagaltaun, 23

Airing-courts, 375

Ale, 2, 4, 5

Alkermes, 31

Allen, Dr. T., 80, 81

Altarnun, 11

America, 445

---- and idiots, 302

Amsterdam Hospital, 111

Amusements, 336

Apparition, treatment of, 4

Apples in insanity, 109

Apuleius, 2, 31

Argyll, Duke of, 340

Armagh, 403, 417

Armoric word for mania, 11

Arnold, Dr. T., 141

----, Dr. (Rugby), 442

Ashe, Dr., 431

Ashley, Lord, 170, 176, 177, 178, 180, 184, 339, 449, 451

Asylums in 1792, Appendix C; in 1844, pp. 209-212; in 1851, p. 225; in 1858, 238; in 1881, Appendix K I

Attendants, 233, 244, 466

Aubrey, 65

Austria, 444

Auxiliary asylums (Ireland), 426

Ayrshire petition against lunacy reform, 327

B.

Backus, Dr., 302

Bacon's restoration of Cibber's statues, 71

Baillarger, 444, 497

Bain, Mr., 474

Baker, Dr., 466

Baldovan Idiot School, 308

Ball, Professor, 284

Ballinasloe, 403, 417

Balsam of bats, 33

---- of earthworms, 33

Banstead, 460

Barking, asylum at, 55, 68

Barlow, Master, 191, 293, 294, 296

Bastian, Dr., 473

Bath, school for imbeciles, 304, 307, 320

Baths in insanity, 6, 12, 137, 485

Battie, Dr., 82, 86, 87

Batty, Dr., 141

Bayle, 444

Bayley, Mr., 504

Beach, Dr., 304, 308

Bedford Asylum, 165, 166, 180, 214

"Bedlam," synonymous with mad-house, 56; lines on, 75

---- Gate, 48, 49

Belfast Asylum, 417, 424

Belgium, 445

Belhomme, M., 302

Bell, Dr. Luther, 445, 467

----, St. Fillan's, 2, 15, 16

Benefits arising from the removal of restrictions, 379

Bennet, Hon. H. G., 149

Bethel Hospital, 210

Bethlem Hospital, 12, 45, 85, 152, 166, 400, 507

----, plates of, 60, 74; prints of, Appendix A

Bethnal Green Asylum, 155, 156, 167, 168, 174, 183

Bezoartick pastills, 33

Bicetre, the, 302, 446

Bile, 33, 43, 93

Bill of 1773, 101

Binning, Lord, 149, 326, 328

Bishopsgate Street, 45

Blackburn, Mr., 355

Blandford, Dr., 453

Blood-letting, 484

Board of Lunacy, 453, 493, 518

---- of Supervision (Scotland), 348, 349, 351, 352, 354, 355

---- of Works (Ireland), 404

Boarding out of lunatics, 387

Boase, Dr., 13

Boerhaave, 18

Boismont, Brierre de, 145, 444

Bootham Asylum (York Asylum), 210

Borage, 30

Borde, Dr., 26

Borlase, Mr. W. C., 13

----, Dr., 13

Bowen's Bethlem, 62

Bowling Green, the, 87

Bowssening lunatics, 11, 513

Boyd, Dr., 477

Braid, Mr. James, 472

Brank, the, 42

Braun's map, 60

Bread and milk in insanity, 109

Bridewell, 61

Bridle, scold's, 42

Brigham, Dr., 445, 500

Bright, Dr., 167

_British Review_, 123

British word for mania, 11

Broadmoor, 240, 252, 265, 494, Appendix L

Broadway, H., his medical certificate, 163

Brodie, Dr., 308

Brogden, Mr., 326

Brookwood Asylum, 42, 505

Brosius, 448

Brougham, Lord, 164, 175

Brown, Dr. (N. Y.), 134

Browne, Sir T., 31, 35

----, Dr. W. A. F., 335, 339, 368

----, Dr. Crichton, 480, 489

Bruce, Mr., 355

Brushfield, Dr., 42, 505

Buckland, Mr., 49

Bucknill, Dr., 191, 297, 458, 477, 500

Burt, Mr., 279

Burton, 29, 30, 31

Butt of St. Lewes, 16

C.

Cairns, Lord, 433

Calmeil, 444

Campbell, Lord, 245

Cappe, Dr., 118

Carlow Asylum, 403, 417

Carmarthen Asylum, 250

Carpenter, Dr., 469

Cassidy, Dr., 208

Castlebar Asylum, 423

Caterham Asylum, 240, 241, 262, 308, 319

Cath Finntraglia, 24

Census of insane, 1844, 179, 211, 451; 1847, 221; 1854, 230; 1858, 191; 1859, 259; 1864, 240; 1874, 252; 1879, 258; 1881, 259, 533

---- (Scotch), 1818, 330; 1855, 340; 1858, 360; 1874, 364; 1881, 367, 368, 373

---- (Ireland), 1827, 408; 1843, 414; 1881, 439, 441

Cerebral reflex action, 469

Certificate, illiterate, 163

Chains, 8, 40, 52, 64, 95, 154, 155

Chamber of Horrors at Lancaster, 208

Chancery lunatics, 199, 222, 285, 298, Appendix M ---- (Ireland), 434

Charcot, 474

Charing Cross, asylum at, 53, 68

Charity Commissioners' Report on Bethlem, 60, 79, 85

---- Organization Committee on idiots, 311, 313, 461

Charles I., 66

Charlesworth, Dr., 182, 204, 206, 527

Chatham, Earl of, 98, 103-7

Chaucer, 10, 53, 54

Cheadle Lunatic Hospital, 199, 243, 458, 504

Cheshire Asylum, 42, 165, 214, 250

Chiaruggi, 445

Christ's Hospital, 61

Christmas Rose, 30

Chronicles of Great Britain during Middle Ages, 8

Church-bell, 2, 15

Cibber, Caius Gabriel, 70, 78

City and Bethlem, 58, 61, 67, 82

Clapton. _See_ Darenth

Clark, J. Benwell, 61

Clarke, Lockhart, 478

----, Rev. E. M., 414

Classification of insanity, 467

Clerkenwell Close, 92

Cloghnagalt, 23

Clonmel Asylum, 394, 417

Clouston, Dr., 371, 488, 501

Cock, sacrifice of a, 20, 21

Code of rules (Irish) issued by Privy Council, 424

Coin paid to a Scotch loch, 20

Coke, 31, 32, 38

Colebrooke, Sir E., 352

College of Physicians, 102, 162, 170, 174, 449

Colney Hatch Asylum, 236, 249

Colquhoun, Mr., 324

Comfort of asylums, increased, 386

Commission, Lunacy Inquiry (Irish), 1877, 397

Commissioners in Lunacy, 187, 220, 235, 242, 246, 493

---- (Ireland), 403

Committee (House of Commons), 1763, 98; 1808, 127; 1814, 1815, 149, 157; 1816, 158, 159; 1827, 167; 1859, 191, Appendix G; 1877, 196, 294

---- (Ireland), 1804, 399; 1817, 394, 402; 1859, 402

---- (Scotch), 1848, 338, 339

---- House of Lords (Ireland), 1830, 409, 413; 1855, 417

Congress, International Medical, 284, 286

Connaught Asylum, 409

Conolly, Dr., 177, 180, 182, 191, 206, 207, 220, 414, 447, 448, 459, 484, Appendix H

Constantinople asylums, 110

Construction of asylums, 236

Coote, Mr., 508

Cork Asylum, 398, 407, 415, 420

Cornish word for mania, 11

Cornwall, treatment in, 11

---- Asylum, 165, 166, 199, 214, 215

Corrigan, Dr., 418

Corsellis, Dr., 182

Cost of asylums, 166, 180, 239, 241, 262, 461

---- of maintenance of lunatics, 222, 244, 269, 278, 366, Appendix I

---- of pauper lunatics transferred from parish to union, 239

Coton Hill Lunatic Hospital, 244, 504

Cottage treatment (Devon Asylum), 458

County asylums, 1844, 209, 211

Couper, Marable, 21

Course of Lunacy Legislation, 147

Cowan, Mr., 355

Cox, Dr., 142, 513

----, Mr. James (afterwards Sir James Coxe), 360

Crace, Mr., 508

Crichton, Dr. (Friars Carse), 335

----, Mrs., 335

----, Dr., 142

Criminal lunatics, 265

Crooke, Hilkiah, 64, 80

Cross, sign of the, 5

Crosses, lunatics bound to, 28

Cullen, Dr., prescribes stripes, 513

Currie, Dr., 513

D.

Daire Dornmhar, 24

Dalyell, 16, 21

Dangerous lunatics (Ireland), 423, 436, 534

Darenth Asylum, 241

---- Idiot Schools, 307, 319

Dark room, 29, 44

Darwin on idiots, 318

Davies, Dr. Pritchard, 486

Defoe, Daniel, 96

Dekker, 65

Delarive, Dr., 117, 137

Demoniacal possession, 1, 5, 9, 18, 27, 43

Demonology, 34

Denbigh Asylum, 253, 254

Denton, Robert, 55

Depeditch, 48, 49

Depletion in insanity, 136, 137, 484

Derby, Earl of, 269

"Description of the Retreat," 115, 123, 129, 400, 515

Desportes, 459

"Devil sickness," 2

Devon, Earl of, 306

Dickens on the Court of Chancery, 285

Dickson Thompson, Dr., 471

Diet in insanity, 136

Difficulties met with in carrying out improvements, 385

Dillwyn, Mr., 196, 200, 499

---- Committee, 196, 296, 450

Dioscorides, 2, 30

"Dissolution," 471

District asylums (Scotland), 358

Divination, 26

Dix, Miss, 338, 353, 445

"Dog and Duck," 84

Dorridge Grove Asylum, 306

Dorset Asylum, 214, 250

Down, Dr., 307

Downpatrick Asylum, 423

Drummond, Mr. H., 191, 332, 339, 351, 356

----, Alex., trial of, 21

Dublin Asylum. _See_ Richmond

Ducking stools, 34

Dumfries Asylum, 335, 368

Dunbar, Sir William, 356

Duncan, Dr., 122, 322

Dundas, Mr. W., 324

Dundee Asylum, 333

Dundrum Asylum, 180, 268, 431, 435

Dunlop, Mr., 356

Dunne, Col., 417

Dunstan, Mr., 89

Durham Asylum, 250

Dwellings, insane in private, 262

E.

Earle, Dr. Pliny, 492

Earlswood, 305, 319

_Edinburgh Review_ on Pinel, 142

Edinburgh Royal Asylum, 322, 323, 343, 371, 372

Edward VI., 61

Eldon, Lord, 162, 165

Electricity, 110

Elgin Asylum, 341

Ellice, Mr. E., 339, 348, 350, 352, 353, 355

Elliotson, Dr., 472

Elmes on St. Luke's, 88

Empiric, a Scotch, 21

Employment of patients, 137, 278, 333, 336, 489

Ennis Asylum, 423

Enniscorthy Asylum, 423

Epilepsy, 4, 20, 31-37, 489

Erskine, Lord, 130

Esquirol, 302, 448, 459, 467

Essex Hall, 305, 320

---- Asylum (Brentwood), 250

Evelyn's visit to Bethlem, 64, 68

"Evigilator" (Dr. Best), 124

Evolution, 471, 475

Exeter Lunatic Hospital, 214

Exorcism, 28

F.

Fallowes, Dr., 93

Falret, 302, 444

Farm labour, 138, 334, 382

Faulkner, Dr., 142

Fellows of College (Commissioners), 102, 167

Ferrier, Dr., 473

Ferrus, 132, 133, 444

Feuchtersleben, 445

Feverfew, 30

Fife and Kinross Asylum, 388, 391, 462

Fig poultices, 31

Finnmac-Cumhail, 24

Finsbury Circus, 67, 68

Fisherton House, 268

FitzMary, Simon, 45

Fletcher, Dr. Bell, 306

Fonthill-Gifford Asylum, 156, 212

Forfar, 42

Fort Clarence Hospital, 210

Foster, Mr. J. Leslie, 394, 400

Foville, 444

----, M. Achille, 284, 446

Fowler, Dr., 119

Fownes, Sir William, 396

Fox (Lord Holland), 98

----, Mr. John, on schools for the insane, 438

France, 142, 301, 444

Fraser, Dr., 387, 462

Friedreich, 445

Friends, Society of, 113, 125, 132, 134, 306

Fritsch, 473

Fry, Mrs., 329

Furness, 28

G.

Galen, 30

Gall, son of King of Ulster, a lunatic, 25

Galt, etymology of, 24

Gardner, Mr. J. E., 62, 74, Appendix A

Garth's Dispensary, 81

Gartnavel, 372

Gaskell, Mr., 191, 209, 214, 454, 456

Gay, 67

Gealach, etymology of, 24

_Gentleman's Magazine_, 99, 101

George III., insanity of, 107, 108

Georget, 444

Gerarde, 30

Germany, 304, 444

Gilchrist, Dr., 371

Giraldus of Wales, 8, 9

Glamorgan Asylum, 249, 250

Glasgow Asylum, 332, 334, 343

Glen-na-galt, 23, 25, 393

Gloucester Asylum, 165, 166, 179, 180, 214, 503

Godfrey, Bishop of Bethlehem, grant to, 47

Goltz, 473

Gordon, Mr. R., 166, 169, 171, 187, 202, 203, 332, 449

Grabham, Dr., 305, 319

Graham, Sir James, 184, 339

Grand Juries' presentments (Ireland), 404, 405

Grant, capitation, 196, 251, 364, 390

Gray, Dr. (Utica), 449, 463

Great Staughton, 41

Gregorian water, 18

Grenville, Mr., 98

Gresham, Sir J., 58, 61

Grey, Sir George, 191, 338, 351, 361

Griesinger, 448

Grove Hall Asylum, 481

Gudden, 482

Guislain, 445

Gurney, Mr. J. J., 329

Guy, Dr., 534

Guy's Hospital Lunatic Ward, 211

H.

Hale, 31, 32, 38

Hallaran, Dr., 398, 407

Halliday, Sir A., 127, 164, 165, 166, 167, 328

Hanwell Asylum, 177, 179, 180, 206, 207, 213, 228, 236, 489

Hardinge, Judge, on Dr. Battie, 86

Hardy's Act, 460

Harper, Dr., 142

Harvey, Mr., on Moorfields, 77

Haslam, Mr., 65, 80, 142, 152, 444

Haslar Hospital, 210, 213, 503

Hatchell, Dr., 423

Haverfordwest Asylum, 210, 253

Haywards Heath Asylum, 489

Hebrides, 19

Hellebore, 30, 31, 109

Henbane, 2

Henry VIII., portrait of, 73; treatment of insane in his reign, 27; grant of Bethlem, 58, 59

Herb treatment of insane, 1

Hereford Asylum, 183

Heron, Mr., 14

Higgins, Mr. G., 124, 150

Highgate Asylum, 305

Hill, Mr. R. Gardiner, 204, 205, 206, 447, Appendix H

Hills, Dr., 486

Hitch, Dr., 182, 446

Hitchcock, Professor, 284

Hitzig, 473, 480

Hogarth's Bethlem, 73, 74, 509

Hogenberg's map, 61

Hole in floor of cabin for lunatic, 395

Holidays, essential for superintendents, 465

Hollar's map, 65, 507

Holler, 482

Holy water, 2, 5

---- wells, 9, 11, 13, 14, 16, 19, 21

Hood, Dr., 191

Hop, 5

Hospitals, lunatic, 210, 263

Howard, John, 110-112

Howe, Dr. S. G., 303, 445

Humieres, Mrs., evidence of, 155

Humours, influence of, 9, 33, 34

Hutcheson, Dr., 334

Hutchinson, Mr. Jonathan, 468, 497

Hypnotism, 472

I.

Idiots, 286, 299, 309, 483

Imbeciles, 299

Inch Maree, 17, 18

Increase of lunacy, apparent, 232, 253, 260

Incubi, 36

Industrial system, 381, 382

Inspectors of the poor, action of, in boarding out, 385

International Medical Congress, 443

Invocation to periwinkle, 3

Ipswich Borough Asylum, 250

Ireland, 23, 393

----, Dr., 304, 308

Ireland's Hogarth, 74

Irish Lunacy Inquiry Commission, 1878, 424-431

Island Bridge Asylum, 410

Itard, M., 301

Ivy ointment, 109

J.

Jacke Napes, 56

Jackson, Dr. (Boston), 109

----, Dr. Hughlings, 471

Jacobi, Dr., 126, 333, 445, 459, 460, 465, 515

Jails, lunatics in (Ireland), 412

James I., 34

Jarvis, Dr. E., 492

Jepson, G., 116, 118

Jocelin, 28

Johnstone, Mr., 356

Junius on Chatham, 106

K.

Kekewich, Mr., 191

Kennoway, 391

Kent Asylum, 180, 214

Kerry, 393

Kilkenny Asylum, 410, 421

Killarney Asylum, 339

Kimbell, Mr., 306

Kinnaird, 352

Kirkbride, Dr., 457, 458, 459, 460

Kitching, Dr., 515

Knowle, idiot asylum at, 306, 320

Kolk, Schroeder van der, 445, 467, 477, 482

Krafft-Ebing, 455

L.

Lalor, Dr., 430, 438, 496

Lamb, Rt. Hon. W., 406

Lancaster Idiot Asylum, 306, 319

---- Asylum, 165, 166, 179, 208, 214, 245

Langermann, 460

Lansdowne, Marquis of, 162

Larbert Institution, 308

Latham, Dr., 454

Law, John, his servant, 22

Laycock, Professor, 468

Laying on of hands, 21

Leavesden Asylum, 240, 241, 262, 308, 319, 461

Leech, Saxon, 7

Leechdoms, Saxon, 1

Legislation, 97, 449, Appendices D-G

Leicester Asylum, 214, 250

Lelut, 477

Leonards, Lord St., 188, 518

Letterkenny Asylum, 423

Leuret, 444

Libcorns, 2

Liberton Institution, 308

Lifford Asylum, 410

Lilburne, John, 50

Limerick Asylum, 394, 398, 399, 410, 417

Lincoln County Asylum, 250

---- Lunatic Hospital, 165, 166, 179, 204, 206, 213, 250, 447, Appendix H

Lindsay, Dr. Lauder, 448

----, Dr. Murray, 499

Litton, Mr., 434, 437, 439, 441

Liverpool Asylum, 210, 214, 242

---- Street, 48, 50

Location of insane, 1844, 191, 211; 1847, 221; 1858, 1859, 191, etc.

Loch Maree, 17, 18

Lochmanur, scene at, in 1871, 20

London, City of, asylum, 250

_London Spy_, 75

Londonderry Asylum, 417

Lord Chancellor, 175, 257

---- Chancellor's Visitors, 285

Lotherwerd, 28

Lucas, M., 497

Luke's Hospital. _See_ Saint

Lunatics are God's minstrels, 10

"Lunatik lollares," 11

Luther on Idiots, 318

Lutwidge, Mr., 191, 257, 418

Luys, Dr., 473, 483

Lyndsay, Sir David, 28

Lyttleton, Hon. W. H., 149

M.

Macclesfield Asylum, 249

McCabe, Dr., 431

McIntosh, Dr., 334

Mackie, Mr., 356

McKinnons, Dr., 371

Mackworth, Mr., 101

McNeill, Sir John, 355

Madman's Glen, 24

---- Ford, 23

Madmen, cowards, 109

Madron Well, 13

Maelrubha, 17

Magnan, 448

Mahon, Lord, 104

Maistre, Joseph de, 112

Major, Dr. Herbert, 478, 479, 480

Malcolm, on Bethlem, 78

----, Dr., 334

Malmesbury, Lord, 170

Manchester Hospital, 210, 214

Mandrake, 3

Maniacs, how treated at the Retreat, 120, 121

Mapes, Walter, 8

Marce, 444

Maree, St., 17

Martin, Baron, 245

Maryborough Asylum, 408, 417

Masses sung, 2, 5, 6, 12

Masters in Lunacy, 291, Appendix M

Maudsley, Dr., 474, 501

Mayerne, Sir T., 32, 34

Mead, Dr., 109

_Medical Repository_, 136

Medico-psychological Association, functions of, 495

Melgund, Lord, 360

Melista, 19

Mesmerism, 472

Metropolitan Commissioners, 173-175, 177, 178 (Report), 187, 209, 220, (Report of 1841) 450, 515

---- Poor Act, 240, 241, 243

Meuynge after the mone, 11

Mewing of hawks, 54

Mewse, Royal, at Charing Cross, 54

Meyer, Dr., assault upon, 280

Mickle, Dr., 480, 481, 482

Mickley, Dr., 91

Middlesex Asylum, 165, 167

Mierzejewski, 483

Millard, Mr., 306, 319, 320

Millbank, 282

"Miller's Tale," 10

Mitchell, Dr. Arthur, 17, 18, 20, 21, 391, 392

Mitford, John, petition of, 164

Monks and the monastery in insanity, 8

Monro, Dr. Edward, 82

----, Dr. Henry, 470

----, Dr. James, 71, 81

----, Dr. John, 81, 86

----, Dr. Thomas, 68, 79, 82

Montrose Asylum, 343

Moon, 2, 4, 9, 11, 24, 31

Moir, Mr. G., 360

Monaghan Asylum, 423

Moorfields, 67, 68, 69, 86, 507

Moorgate, 67, 69

Moral insanity, 454

More, Sir T., 41, 56, 60

Morel, 444, 448, 467, 497

Motet, M., 284, 444, 446

Mould, Mr., 458, 503

Mount Hope Retreat, 484

Muggleton, Lodowick, 50

Mueller, Dr., 284

Mullingar Asylum, 421

Munk, 473

----, Dr., 64, 80, 81, 87

Murray Royal Institution, 329, 341

Musselburgh Asylums, 353

N.

Naudi, Dr., 122, 123

Needham, Dr., 458, 504

Newington, Dr. Hayes, 497

Newton, Mr., his map, 60, 61, 508

----, Dr., 92

Nicoll, Mr. S. W., 129

Nicolson, Dr., 494

Nider, 36

Night goblin visitors (nightmare), 5

Niolin, red, 4

Non-restraint, 139, 177, 182, 204, 205, 213, 216, 220, 221, 223, 226, 228, 240, 342, 360, 416, 448, 494

Norfolk Asylum, 165, 166, 214, 250

Norman Conquest, treatment before the, 1

Normansfield, 307

Norris, case of, 79

Northampton Lunatic Hospital, 210, 213, 244, 504

Northumberland Asylum, 250

Norwich Asylum, 235, 249

Nottingham Asylum, 165, 166, 214, 486

Nugent, Dr., 417, 423

O.

Occurring insanity, 260

O'Curry, Professor, 26

Ogilvie, Sir John, 308, 356

O'Hagan, Lord, 432, 434, 435, 437, 441

Oleum cephalicum, 93

Oliver Cromwell's porter, 71

Omagh Asylum, 421

Open-door system, 376-378

Orange, Dr. William, 273, 276, 494

Osborne, Dr., 407

Overall, Mr., 60, 507

P.

Palmerston house for idiots, 309, 439

Paracelsus, 484

Parchappe, 131, 444, 459, 460, 478, 482

Pargeter, 142, 512

Park House, Highgate, 305, 456

Parole, liberty on, 378

Pathology of insanity, 476

Paul, Sir George, 127

Pauper lunatics in private dwellings, 262, 392

Peerless Pool, 88

Pennant, 17, 88

Penny gates at Bethlem, 71, 73

Peony, its virtue in insanity, 2, 3

Pepys and Bethlem, 65

Percy Reliques, 39, 40

Perfect, Dr., 141

Periwinkle, 3

Perth Asylum, 333

---- Tolbooth, 329

Philanthropist, the, 126

Philip, Dr., his asylum, 216

Philipps, Dr. Rees, 466

Phlebotomy, 95, 484

Piers the Plowman, 10

Pillory, insane treated at, 27, 29

Pinel, 118, 133, 142-46, 186, 268, 467, 482

Pitt. _See_ Lord Chatham

Plastidules, 475

Poole, Dr., 304, 334

Pools, insane placed in, 12

Poor Law Act, 1874, 196

Pope, on Colley Cibber, 70

Possession, demoniacal, 1, 5, 9, 18, 43, 393

Posts, whipping, 41, 57

Poultices, 31

Power, Rev. John, 12

Preston Lodge, institution for imbeciles, 308

Prestwich Asylum, 226, 249

Prichard, Dr., 454

Priest employed in treatment, 2

Principles pursued at the Retreat, 135

Prison Act in Ireland, 399

Private asylums, 99, 193, 194, 199, 201, 211, 212, 223, 264

---- dwellings, 262, 286, 458

---- patients, how distributed, 263

Prochaska, 469

Proctor, Mr. (Barry Cornwall), 450

Progress of Psychological Medicine, 1841-81, 443

Properties, small, 295

Property, protection of, 286

Prospect of the future, 495

Psycho-motor centres, 481

Q.

Quarterly visitation of pauper lunatics, 189

Queen's pleasure men, 274

R.

Radish, a cure for female chatter, 4

Rainhill Asylum, 226

Rake's Progress, 73, 509

Ramskill, Dr., 485

Ray, Dr., 108, 133, 449, 462, 463, 466

Rayner, Dr., 489

Recent changes in mode of administering Scotch asylums, 374

Recoveries in county asylums, private asylums, and lunatic hospitals, 263, 264

Recovery, statistics of, 263, 490

Reed, Rev. Andrew, 305, 456

Reil, 444, 460

Religious services, 369

Renton, Dr., 344

Rest in bed 489, 490

Restraint, abuse of, in Ireland, 420

Retreat. _See_ York Retreat

Retrospect of the Past, 493

"Review of the Early History of the Retreat," 135

Reynolds, Dr., 107

Rice, Mr. T. Spring, 394, 398, 402, 406

Richart, accused, 22

Richmond Lunatic Asylum, Dublin, 400, 401, 406, 409, 417, 421, 438, 496

Ringmer Asylum, 224

Ripping, Dr., 492

Robert Evan, case of, 256

Robertson, Dr. Lockhart, 262, 263, 286, 296, 500

----, Dr. (Ireland), 424

Rome, treatment of a lunatic in, 27

Rose, Right Hon. G., 148, 149, 157, 159, 161, 202, 516

Roubiliac, 70

Rowe, Sir Thomas, 49, 508

Royal Commission (Ireland), 1856, 418

---- Asylums (Scotch), 341

---- Commission (Scotch) 1855, 340; report of, 342

Rural insanity, 362

Rush, Dr., 445

Rutherford, Dr., 372, 457

Rutherfurd, Lord, 338, 351, 352, 353

Rutter, J., his lines on Bethlem, 69

S.

Saegert, Herr, 304

Saints, Cornish, 13

Salpetriere, 302

Salt, 5, 21

Salve employed against the elfin race, 5; and for the "wood-heart," 6

Sandisone, Elspeth, 22

Savage, Dr., 74, 284, 455, 482, 489

Savage of the Aveyron, 301

Saxons, treatment of insane by the, 1

Saxony, Elector of, 319

Scarlet oak, 31

Schools for the insane, 438

Scone, Augustan canon of, 28

Scot, Reginald, 31, 33, 37, 38

Scotch Board of Lunacy, 325, 347, 354

---- Commissioners, Report of, 1858, 360; 1878, 366; 1881, 373

---- system, analyzed, 373

Scotland, 14, 185, 321, 453

Seclusion, 139, 250, 273, 342

Seguin, Dr., 302, 456

----, Dr. E., 456

Select Committee. _See_ Committee

Seymour, Lord R., 160, 165

Shaftesbury, Earl of, 173, 191, 202, 248, 267, 268, 447

Shakespeare, 29, 40, 54, 56, 60, 65, 84

Shaw, Dr. Claye, 461

Sheil, Mr., 203

Sherlock, Dr., 448

Shuttleworth, Dr., 306

Sibbald, Dr., 501

Siegburg Asylum, 460, 492, Appendix C

Silk, toasted, 95

Single patients, 186, 236, 262, 286

Skae, Dr., 371, 467

Skelton, 56

Skull of man executed, 33

Sligo Asylum, 421

Smart, Mr. T. L., 48

Smith, Mr., his notice of Bethlem, 65, 67, 69, 73, 507

----, Dr. C., 24

----, Mr. C. Roach, 50

----, Dr. John, 391

----, Sydney, 83, 123, 147, 151, 152

----, Mr. W., 149

Smollett, 96

Solly, 473

Somerset, Lord R., 175, 176, 177, 187, 202

Southey, Dr., 191, 450

Specifics in insanity, 486

Spencer, Herbert, 474, 475

Spitzka, Dr., 498

St. Agnes, 13

St. Bartholomew's Hospital, 58

St. Botolph, 45, 48

St. Fillan, 2, 14

St. George's Fields, 82, 84

St. Kea, 13

St. Kentigern, 14, 29

St. Levan, 13

St. Luke's Hospital, 86-91, 110, 113, 118, 166, 214, Appendix A

St. Mangose, 28

St. Maree, 17, 19

St. Martin's Lane, 53

St. Mary of Bethlem, 45

St. Molonah, 16

St. Nun, 11

St. Peter's Hospital, 210

St. Ronan, 16

St. Thomas' Asylum (Exeter), 210

St. Vincent de Paul, 301

St. Winifred, 9, 10

Stafford Asylum, 165, 214, 250

Stag's skull, 33

Star of Bethlem, 52

Starcraft (Saxon), 1

Starcross Institution, 306, 320

Stark, Mr., 121

Stearns, Dr., 460

Stewart, Dr. Henry, 309

----, Dr. Robert, 424

Stilliard's map, 61

Stocks, 43, 52

Stokes, Dr. (Baltimore), 484, 486

Stothard, 70

Stow, 53, 55, 88, 508

Strathfillan, 14

Struthill, 16

Submersion, 18, 19, 20, 513

Suffolk Asylum, 165, 214, 503

Sumner, George, 302

Superintendent of asylum, his strange mental environment, 464

----, the good, 460

Superstitions, Scotch, 14, 22

Surrey Asylum (Brookwood), 250, 505

----, (Wandsworth), 249

Swallows, stones from maw of, 5

Swift, Dean, 95

Swift's Asylum, 111, 396

Switzerland and idiots, 304

Symonds, Dr. J. Addington, 471

T.

"Tale of a Tub," 95

Tamburini, Professor, 284

Temple of St. Molonah, 16

Temptations of the fiend, 4

Thornbury's "London," 88

Thurnam, Dr., 492

Timbs' London, 84

Tober-na-galt, 23

Tokens (Bedlam), 48

Tom of Bedlam, 39, 40, 65, 66

Tooke, Horne, 103

Torture in Scotland, 42

Townshend, Mr. T., 98, 99, 101, 202

Treatment of insane, advance in, 484, 490

"Tree of truth," 41

Trelat, 444

Trevelyan, Sir Charles, 312

----, Mr., 103

Tuileries, Bethlem copied the, 70

Tuke, William, 113-116, 130, 131, 133, 134, 135

----, Samuel, 89, 121, 125, 126, 150, 182, 187, 220, 333, 400

----, J. Batty, 391, 478

Turkish bath, 485

Tyndale, 56, 60

Tyson, Dr., 80, 81

U.

University College, London, 443

Unzer, 468

Urban insanity, 362

V.

Vale of St. Fillan, 14

Valley of Lunatics, 22

Ventry, battle of, 24

Virchow, 475, 476

Visitation of Asylums, 188

Vitre, Dr. de, 182, 306

Voisin, 302, 444

----, M. Aug., 480

Voluntary patients, 374

---- restraint, 215

Votive offerings, 16

W.

Wakefield Asylum, 165, 166, 179, 180, 214, 250

Wakley, Mr., 176

Wales, 182, 253

Walpole, Mr., 191

Wandsworth Asylum, 249

Warburton, Dr., 164, 167, 168, 171, 183

Ward, Ned, 73, 75

Warneford Asylum, 210, 214

Warren, Dr., 107

Wastell cake, 53

Waterford Asylum, 399, 417

Weir, Dr., 156

Wells. _See_ Holy

Wemyss, General, 324

Wesley, John, 108, 109

Western, Mr., 149

Westminster play, lines on Bethlem, 70

Westphal, 448, 478, 479, 480

Wexford, cells for lunatics, 411

Whipping insane, 7, 41, 42, 43, 57, 95, 513

Whitbread, Mr., 191

White, Dr., 411

----, Misses, 304

White Hart Tavern, 48

Whitmer, Dr., 284

Whittier, on St. Maree, 19

Wiclif, 299

Wierus, 35, 37

Wilbur, Dr. H. B., 303, 304

Wild Murdoch, 19

Wilkes, Mr., 98, 103, 418

Willes, Mr. Justice, 245

Williams, Mr. (afterwards Dr.), visiting physician to the Retreat, 333

----, Dr. Duckworth, 462, 489

----, Dr. W., 448

----, Dr. W., (Denbigh Asylum), 253

----, Mr. R. L., 257

Willis, Dr., 107

Windmill Hill, 86

---- Inn, 84

Winslow, Dr. Forbes, 446

Witch's bridle, 42

Witchcraft, 26, 31, 32, 34, 43

Witley, 85

"Wodnes" and "Wodman," 6

Wolf's flesh, 4

Wolsey, 56

Wonford Asylum, 466

"Wood," 6, 10

Wooden statues at Bethlem, 72

Woods, Dr. Oscar, 23

Woodward, Dr., 302, 445

Wordsworth, 54

Work, physical importance of, for women, 384

Workhouses, 126, 192, 199, 234, 250

---- (Irish), 430, 441

Wortcunning (Saxon), 1

Wortley, Mr. Stuart, 339

"Wud," 6

Wynn, Mr., 127, 128, 160, 161, 162, 164, 202, 203

Y.

Yellowlees, Dr., 372

York Asylum, 112, 124, 150, 174, 210, 244

---- Retreat, 113-125, 135, 187, 214, 220, 231, 244, 268, 323, 446, 493, 515. _See_ Frontispiece

Young, Mr. G., 360

Z.

Ziemssen's "Cyclopaedia," 480

THE END.

PRINTED BY WILLIAM CLOWES AND SONS, LIMITED, LONDON AND BECCLES.

BY THE SAME AUTHOR.

I. ILLUSTRATIONS OF THE INFLUENCE OF THE MIND UPON THE BODY. Designed to Elucidate the Action of the Imagination. 8vo. 14s.

II. A MANUAL OF PSYCHOLOGICAL MEDICINE. Fourth Edition. 8vo. 25s. (Joint Author with DR. BUCKNILL, F.R.S.)

III. INSANITY IN ANCIENT AND MODERN LIFE, WITH CHAPTERS ON ITS PREVENTION. Second Edition. 12mo. 6s.

Transcriber's Note, continued:

Except when index entries did not match the body of the text, irregularities in capitalization and hyphenation have not been corrected. Alternate spellings (e.g. Ogilvy vs. Ogilvie), possible errors in quoted passages (e.g. remembraance), and mathematical errors have not been changed or corrected.

Minor punctuation errors (e.g. missing or extra quotation marks, extra commas) have been corrected without note.

Footnote markers have been changed from symbols to numbers. Tables spanning more than one page in the original book have been joined and the "Carried Forward" and "Brought Forward" rows removed.

The following corrections and changes were also made:

p. 211: moved footnote marker in table from before "Workhouses and elsewhere" to after

p. 263: mantenance to maintenance (the average weekly cost of maintenance)

p. 304: Etvy to Etoy

p. 308 and p. 537/538 (Index): Boldovan to Baldovan, and moved index entry to correct alphabetical order

p. 340: aslyums to asylums (lunatics and lunatic asylums)

p. 356: Kircudbrightshire to Kirkcudbrightshire

p. 394: Clonwell to Clonmel (Clonmel Asylum)

p. 444: pychologists to psychologists (celebrated psychologists)

p. 489: apostrophe removed from "Haywards" (Haywards Heath Asylum)

p. 494: igorance to ignorance (ignorance and fear)

p. 533: chapter v to chapter vi (See chapter vi.)

p. 538: 1858, 1859, 191, 259; to 1858, 191; 1859, 259; (Index entry for "Census of insane")

p. 539: Colebrook to Colebrooke (Index entry)

p. 541: Stoughton to Staughton (Index entry for "Great Staughton")

p. 543: 553 to 355 (Index entry for "McNeill, Sir John")

p. 544: Nicolin to Niolin, and moved to correct alphabetical order (Index entry for "Niolin, red")

p. 546: added C. (Index entry for "Smith, Mr. C. Roach")

p. 546: Thomas's to Thomas' (Index entry for "St. Thomas' Asylum")

p. 548: moved Index entry for "Willes, Mr. Justice" to correct alphabetical order (originally between "Willis, Dr." and "Windmill Hill")

Italics markup has not been included on the currency symbols "d." and "s." and, to save space, several em-dashes in tables have been changed to colons.