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nature's institutions, and to more perfect enjoyment of life, I might now perhaps leave the farther application of the doctrines to the consideration of the reader. But the reception which the first edition of this volume met with, gives me fresh confidence in the practical importance of the principles which I have been unfolding, and encourages me to add in the present edition a few remarks on the condition of the insane, –a class of sufferers who have the strongest claims on our sympathy, and in regard to whom, notwithstanding the numerous channels in which public benevolence has of late been so generously flowing, an apathy is still displayed which is not less hurtful than melancholy, and which can proceed only from the real state and wants of the insane being too imperfectly known.
“ It is certaiu indeed, that the secluded life which most of the insane are obliged to lead, separated from kindred and from society, and the disgraceful prejudices against them which have descended to us almost unimpaired from amidst the superstitions of the darker ages in which they originated, have contributed, in no small degree, to perpetuate the obscurity in which the subject has long been involved, and to render insanity one of the few evils which mankind has never ventured to look fairly in the face, with a view to discover its nature, and the means of its prevention and cure. The consequences are, that its roots have been allowed to extend more and more widely, while scarcely any thing has been done to arrest its growth, or to remove it when formed; and, as little improvement can be effected until the public shall become heartily interested in the cause, it becomes an imperative duty to allow no opportunity to escape of spreading abroad such information as may help to dissipate the prevailing indifference, and rouse attention to the magnitude of the existing evils.
“ If the state and management of public and private asylums for the reception of this class of patients be examined with reference to the conditions of health already explained in treating of the respiratory, muscular, and nervous systems, it cannot fail to strike the reflecting observer, that while in many institutions the most laudable zeal has been shewn for the physical health and comfort of the patients, comparatively little has been accomplished, or even attempted, with the direct purpose of correcting the morbid action of the brain, and restoring the mental functions. We have now, in most asylums, clean and well ventilated apartments, baths of various deseriptions, abundant supplies of nourishing food, and a better system of classification ; the furious and the depressed being no longer subjected to each other's influence and society: and the result has been, that in so far as these important conditions are favourable to the general health, and to that of the nervous system in particular, recovery has
been promoted, and personal comfort secured. But in so far as regards the systematic employment of what is called active moral treatment, and its adaptation to particular cases, a great deal more remains to be done than has hitherto been considered necessary. This will be apparent on reflecting how extremely influential the regular employment of the various feelings, affections, and intellectual powers is on the health of the brain, and how few asylums possess any adequate provision for effecting this most desirable object: If want of occupation, and the absence of objects of interest, be, as we have seen, sufficient to destroy the health of a sound organ, the same causes must be not less influential in retarding the recovery of one already diseased. Hence it becomes an object of extreme importance in establishments for the insane, to provide the necessary means for encouraging the healthy and regular, exercise of the various bodily and mental powers and for drawing out, as it were, and directing, the various affections, feelings, and intellectual faculties to their proper objects this being a condition essential, in a higher degree than any other, to the success of our curative measures.
" Those who have not attended to the subject, way be disposed to think that the importance attached to mental and bodily occupation in cases of insanity is here exaggerated.- But the physiologist who looks to the established law of the animal economy, which decrees regular action of every organic part to be essential to its health, no matter whether that part be bone, muscle, bloodvessel, nerve, or brain, will not fail to bear testimony to the truth of my remarks. The pathological observer, also, whose attention is daily called to the miseries and bad health resulting from the total absence of mental cccupation in those whom fortune has condemned to a life of idleness, without having imparted to them that activity of constitution which seeks out objects of interest and makes occupation for itself, will at once acknowledge that a command of the means of healthy mental and bodily exercise would add more to his power over nervous and mental diseases, than any other remedy, which art has yet discovered. And yet, in the majority of our asylums, the patients are still inerely placed in security and humanely treated, without the least effort being made to afford them occupation of mind or body, or any of the more cheering comforts of sympathy and social intercourse; and this being the case, can we be surprised that only one-third or one-half recover their reason, or shall we rest contented in imagining that human means can go no farther to alleviate their calamities?
“ It is in the treatment of this unhappy class of patients, who are deprived of their dearest enjoyments and of the soothing intercourse and consolations of social and domestic life, that an ac
quaintance with the laws of health, and the structure and functions of the human body, becomes pre-eminently useful. When, for example, we contemplate the number of the muscles, the importance of their functions, and their influence on the circulation and on the general system, and understand the laws or conditions of their healthy action; -we cannot fail to perceive that any mode of treatment which does not provide for their exercise in the insane, must be radically defective, however kindly and judiciously it may be administered in other respects; and we have thus an unerring standard by which the efficacy of every contrivance used to rouse the lunatic from contemplative inaction to useful exertion, may be at all times determined. Hence we can have no hesitatioa in denouncing, as imperfect, every asylum which does not provide for the regular active employment of its inmates, either in their former trades or in some kind of bodily, and, if possible, useful and imperative exertion. When we know the structure, uses, and relations of the skin, and are at the same time aware that in insanity its exhalations and nervous functions are almost always disordered, so much so as often to be accompanied with a smell peculiar to mental invalids, it becomes impossible for us longer to overlook the necessity of devoting 'attention to its condition, and taking steps for its restoration to health as a means of promoting the recovery of the brain. When we become acquainted, in like manner, with the functions of the lungs, and the nature of respiration, we can scarcely fail to to use every exertion to secure free ventilation, and such ample accommodation as shall prevent several lunatics from being placed together in a small apartment. And, lastly, when we become impressed with the fact, that the human mind is endowed with affections, moral feelings, and intellectual powers, operating through the medium of bodily organs, and requiring for their health regular and free exercise on their respective objects, and that without this gratified activity they fall into debility and disease, we can no longer rest contented until every possible means of affording occupation to the intellect, interest to the feelings, and employment to the body, shall have been exhausted. In fact, till adequate arrangements shall have been made in every public and private asylum for effecting these purposes, it will be only deceiving ourselves and shutting our eyes to the truth, to suppose that we have accomplished all that can be done for the recovery and relief of the insane ; and too much pains cannot be taken to enforce attention to the defects which still impair the usefulness of many of our best institutions.
“ In making these comments. I have no wish either to blame any one, or to overlook the difficulties which stand in the way of such improvements as science and humanity will one day consider indispensable. Adequately trained and qualified moral agents will not be easily obtained in such numbers as will be required ; nor will money be easily procured to meet the necessary expense. Still, however slow our progress may be, it will begin the sooner, and proceed the faster, if attention be now called to the urgency of the case, and to the leading principles by which farther ameliorations are to be effected.
“ It is a common but most deplorable mistake, to suppose, that because a person is insane, he is insensible to the ordinary feelings and affections of humanity, that bis reason is blind to the ordinary relations of life and of external nature, and that consequently it matters little in what language he is addressed, or what demonstrations of feeling are offered to him ; for, in the great majority of instances, the mind is only partially disordered, and is as much alive as ever to the perception of insult, kindness, common sense, and drivelling. And even in those rare instances in which all the faculties seem to be deranged, and in which much irritation and violence frequently exist, kindness, truth, and reason, although at the moment they may seem without effect, rarely fail, when calmly persevered in, to produce a salutary impression, and to sooth the patient. It therefore becomes of the utmost conceivable importance, in erecting asylums for the insane, to make also special provision for that systematic moral treatment, which is to the brain and mind what medicine and dietetic regimen are to the stomach, the liver, and the bowels. It has been said, and I believe not without reason, that keepers of asylums, who live, without any variety of intercourse and occupation, exclusively in the company of the insane, are themselves apt to become of unsound mind; and that of those who escape insanity there are comparatively few who do not ultimately acquire the peculiar expression of eye which is observable in lunatics. If, then, constant exposure to the society of lunatics be in any case sufficient to give rise to madness in a previously healthy mind, it is as clear as the light of day, that the same influence must greatly retard the recovery of those whose minds are already deranged, and that, on the same principle, it must be of importance to subject the lunatic continually to the restorative influence of the society of healthy and well regulated minds. Every day brings fresh conviction with it, that the more nearly we can approximate our treatment of the insane to that of reusonable beings, the more successful shall we be in effecting cures, and the more delightfud will the duty become of ministering to the mind diseased.
" It is hardly necessary to remark, that in these observations on the importance of regulating the moral treatment of the insane, I have chiefly in view that numerous class of patients in whom the acute stage has been subdued, either by medical aid or by the mere lapse of time. At the very commencement of the disease, a cure may frequently be accomplished by the removal of the exciting causes, active medical treatment, and careful superintendence at home. But after this period, much more will be accomplished by judiciously regulating the exercise of the mental and , bodily functions, than by strictly medical remedies ; and it is consequently chiefly to this stage that I now refer.
“ To secure regular and animating exercise of all the mental and bodily functions, as conducive equally to the preservation and restoration of mental health, ought then to be our grand aim in the construction and management of public and private asylums.
" In planning the means of mental and bodily occupation for the insane, we should follow, as far as possible, the same rules and principles which are applicable to persons of sound mind. Thus, daily muscular exercise in the open air is essential equal. ly to bodily health and to mental soundness, and is therefore indispensable to both sane and insane. It is more pleasant, more easily persevered in, and also more salubrious to the individual, when it is combined with an object calculated to occupy but not to strain the mind. Mere walking or riding, for the sake of exercise, generally becomes irksome, and is consequently either speedily given up or pursued with a languid inactivity, which deprives it of its utility. On this account, mechanical and agricultural pursuits, which interest attention and elicit aclivity, ought to be provided for in choosing a situation : for experience has demonstrated that, as remedies, such employments cannot be too highly estimated ; and that, wherever the rank of the patient does not preclude bim from engaging in them, they produce the happiest results in promoting quiet and sleep, subduing irritation, disposing to perfect subordination, and, above all, hastening the progress of recovery.
“ Ample extent of ground for the purposes of agriculture and gardening, ought therefore never to be forgotten; and for those who either are fond of mechanics or have been trained to some manual employment, workshops become equally necessary, and have the advantage of contributing to the general expenses of the house. In several establishments where field labour, gardening, and workshops, have been tried on an extensive scale, the results have been highly satisfactory, not only in the improved habits and comfort of the patients, and in their more speedy and numerous recoveries, but also in the important advantage of economy : as the labour of the patients has in some asylumis gone far to defray their current expenses,—while scarcely' a single accident is op record, as having arisen from an imVOL. IX.-NO. XLI.