any nearer approach to liberty, and with whom the safety of a closer acquaintance was considered problematical. A few were in straight waistcoats. It is well to have personally visited these poor creatures, as one can hardly gather from a statistical report, the exact kind or degree of the various treatments employed; otherwise Dr. Bulckens gives a very fair table of the patients subjected to restraint of different kinds, during 1856. From this tabular statement, it appears that 47 men and 18 women, had their feet chained; 5 men and 3 women had the confining girdle in addition to the chained feet; 7 men and 5 women had their arms confined by "handcuffs" attached to a confining girdle, and 3 men and 5 women were secured in straight waistcoats (camisoles), in all 93 persons subjected, to what Englishmen are wont to consider tolerably severe means of coercion. . Apropos of the argument held in favour of Gheel, viz., that the patients are enamoured of the plan, that they love their quiet, rustic, Baotian retreat, it may be mentioned that Dr. Bulckens, with some naiveté, remarks that two-thirds of the 93 patients spoken of above, were merely confined to prevent their running away! It would really seem from what has been stated above, and which may be verified by any one, (for there is no lack of courtesy or politeness to be complained of in visiting this and similar institutions on the continent-though, regret to say, that I have heard some of our obstructiveness deplored by foreigners more than once)-that little or nothing can be gained to the patient by the plan of the Gheel or "free air" treatment, over and above that experienced in our well regulated county asylums—that is, where the asylum is of such reasonable size as to render its proper supervision possible. The great drawback at Gheel, and to any similar plan is, and must be, want of proper supervision-the worst plan of treating the pauper insane, practised or known in this country at the present day, is the workhouse treatment. Even this, with only a moderately gifted and tolerably vigilant medical officer, cannot be liable to the gross abuses that either escape observation at Gheel, or if observed must be tolerated. Enough may be seen in a cursory visit to show the impropriety, the wickedness, of allowing patients known to have bad habits of all kinds, to go away from their houses without any one to look after them; and indeed, where the children of the colony, of both sexes, are used as watchers and companions, the proceeding is certaninly not less culpable. The bulk of the population is composed of those patients who can be easily ill-used, either the plodding worker, the semimechanical drudge, or the being but little removed from vegetable life. Let any one look through our county asylums and say, whether or not, such patients are unhappy therelet statistics show the percentage cured there, and let any one who likes to take the trouble, see the means of treating, medically and morally-the dieting, the forced alimentation when necessary, the warmth and airiness, the nursing and attention, and above all, the systematic supervision and constant care, exercised by those who are responsible for the treatment as a means-to-cure, not as a means-to-keep, and that carelessly and cheaply. The history of Gheel's importance at the present time is purely accidental, and it has a tendency to be mischievous as most accidents have. It was founded as an insane colony by accident; it is ruled by priests as every institution that might otherwise be valuable, unfortunately is, in every Roman Catholic country; the patients were treated by priests until very lately, and probably if the truth were accurately known, are now. A patient had been subjected to the exorcising process, within fifteen days of the visit that induced these remarks; this operation consists in chaining the patient down hand and foot to iron rings fixed in the wall of an ante-room to the church, for the space of nine days, with little or no food during this time, while a priest, having opened the window of the apartment, endeavours by exhortation and threats to induce the evil spirit to take his or her departure thereat. All this took place without the consent or connivance of the medical authority. In fact, though Dr. Bulckens seeemed anxious to give free vent to his opinion on each matter, medical and economical, when asked, why he as a physician, allowed his patients to be treated in a way that he knew to be exceedingly hurtful, or highly dangerous-likely rather to destroy life than restore reason, he candidly admitted that he had no control, and that if he had, he did not think that it would be advisable to put a stop to the practice, as reverence for Dymphna the presiding saint, and no faith in Medicine, ruled the colony, and he thought that Dymphna once ignored or slighted, but little of Gheel, as a means of harbouring the insane, would remain. Well, Gheel thus accidentally founded, and thus governed, would have continued to be little thought of, it being really but little removed from our old iniquitous cottage system; but, that the improvements that have taken place in the treatment of the insane in almost all countries, have shewn that kindness, humanity, and fellow feeling will do more than means of coercion towards the relief of the lunatic. This having become an established fact and almost a general practice, there has been a healthy emulation between divers countries and even between different psychologists in the same country, to endeavour to arrive at the highest point of excellence in this respect. On this account Gheel has been visited, commented on, and recommended as an example, but not by those most competent to judge of the real merit of its working. Many casual visitors, many medical men, even those engaged in psychology, might form a very erroneous opinion of the merits of such an establishment, if they had not had experience in asylum management such as can only be obtained by residence in one, and that for some continuance; these visitors have seized upon the idea, that here was to be found the best example of domestic home treatment-the apotheosis of all that modern education and civilisation could produce in the way of psychiatry. Judges differ, doctors disagree, how difficult the search for truth! Little has been said of medicine or medical treatment, there was an apothecary's shop; there may have been more than one; but Dr. Bulckens freely confessed that medicine was not made use of as a means of treatment, except in so far as the colonial bowels required moving, or the chance exhibition of expectorants or demulcents when fogs prevailed in that uncomfortable looking plain. To conclude, it may be stated that Dr. Bulckens has been loud in his demand for increased means of treating his patients; he has felt the necessity of a hospital with all its appliances and means of insuring proper attention and kindness; and that at last the government has voted 50,000 francs for the purpose of erecting an infirmary; the sum seems very small, but it is a beginning. This will enable the medical staff to exercise a tolerable surveillance over the more active cases, and may lead to the amelioration of the others, with respect to which and as a significant commentary on the whole scheme, it would be well to bear in mind what the head physician himself says of the trustworthiness of his "Nourriciers," to whom in such a system the patients are wholly confided. "La confiance dans les habitants de la localité était telle, que toute surveillance semblait inutile. Hélas! les temps et les mœurs ont imprimé aux sentiments des hommes des modifications bien déplorables! Gheel a aussi subi l'in fluence de ces modifications. L'abandon dans lequel les familles laissaient d'habitude les aliénés, y a engendré des abus. Le devoir fut impunément sacrifié a l'intérêt personnel, ce qui amena un trafic honteux, et d'autant plus lucratif qu'il s'exerçait sur des aliénés aisés. Il y avait alors à Gheel, comme aujourd'hui, des cœurs nobles et dévoués, qui déploraient ces tendances fâcheuses et préjudiciables á la colonie, dont le discrédit et la décadence étaient inévitables. Mais leurs efforts, leurs conseils et leur exemple demeurèrent impuissants, en présence de l'esprit de spéculation et de lucre qui avait pris la place de l'esprit de charité.' 1 Spicelegia Epileptica, by J. H. Epilepsy, says Aræteus, "is an illness of various shapes, and horrible;" and Hippocrates, who existed five hundred years before him, in one of his terse aphorisms, states that those fits "which come on after twenty-five years of age, for the most part terminate in death."" Lucretius, who lived in an age intervening between these two distinguished physicians, has with marvellous power pourtrayed the fearful symptoms of this apalling malady. Although a poet, and not a physician, his lines are equal in accuracy of delineation to those of the greatest pathologist: "Quin etiam, subito vi morbi sæpe coactus Ante oculos aliquis nostros, ut fulminis ictu, De Rerum Natura, p. 379. Valpy. More than two thousand years have rolled by, since the father of medicine penned his gloomy prognosis of this disease; more than two hundred writers have described its symptoms, and their views respecting it; but, alas! we rise from the perusal of the philosophic pages of our contemporary Marshall Hall, and the recent practical observations of Dr. Sieveking, with the same mournful regret as we do from the writings of Hippocrates and Arœtus, and murmur with the last sage, ἀλλόκοτον κακόν ἡ ἐριληψη. ʼn It merits the startling names, with which it has been designated, "Morbus scelestus," "morbus dæmoniacus," and even "morbus sacer," pourtray the awe and mystery with which it has in all ages been regarded. That it was even one of the diseases, which was characterised by the fearful sentence, "he hath a devil," will probably be admitted by all who are familiar with ancient medical writings, and whose ideas have not been biassed by early theological training. This opinion is held by Dr. Adams, of Banchory, Ireland, than, whom no one is more critically familiar with the writings of Hippocrates, and the early Greek authors; and who, moreover, informs us, that Leo (350 years B.C.) says expressly when treating of epilepsy," that the vulgar call the disease the demon and lunacy." This subject resting for proof, as it does, upon the precise meaning of certain Greek words, is rather a philological than a pathological one, and is alike beyond my scholarship and my purpose. Moreover, in the Psychological Journal it has been treated in a profoundly religious spirit, and with great scholarship and eloquence by the Rev. J. Sowter, the talented Chaplain of the Essex County Asylum. The philosophic view taken by Mr. Sowter gathers force from the fact, that all eastern nations speak of bodily diseases as entities, and the pagan world generally regard them as such, and seek relief by charms, incantations, and other rites, by which they imagine the evil spirit, the Saquóv can be appeased. A very able writer in the Dublin University Magazine, September, 1848, on "Pythonic and Demoniac Possessions in India and Judæa,' contends that the words δαίμων δαιμόνιον and the participle SaíuoviLóuevos whenever they occur in the New Testament, ought not to have a moral significance given to them; but that they express some physical infirmity, or mean, when used to individuals, the possession of an exorcist power, or an agency inferior to the Diabolus of Scripture. The latter word he states, occurs fifteen times in the evangelical narratives, while the former, or its derivatives, occurs no less. than sixty-three times, but on no occasion in a purely moral sense; from analogy with the word "daimon," with the Mahratta word "pishachin," and the effects manifested in all the persons to whom it is applied, in both languages, he concludes that lunacy, epilepsy, and convulsive fits, are typified by both, and they refer no further to Satanic agency, than as all diseases are the result of sin, and thus indirectly are the manifestations of the workings of the spirit of evil, the "Diabolos" of Scripture. How profoundly significant do the scriptural expressions upon this subject become, when contemplated in this sense! How truly may it be said of some forms of moral insanity, that the man is daimonized! |