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 hesitation 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 his 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 reasonable beings, the more successful shall we be in effecting cures, and the more delightful 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. (17

"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.

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"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 equally 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 activity, 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 him 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 mechanies 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 asylums gone far to defray their current expenses,-while scarcely a single accident is on record, as having arisen from an im

VOL. IX.-NO. XLI.

F

proper use of the liberty allowed them, or of the edged tools put into their hands.

"Man is so much of a social being, and depends so much on the sympathy, esteem, and co-operation of his fellows, that, as one of a body, he will submit cheerfully to tasks and duties, against which, if proposed to him as an individual or as one of a few, he would unhesitatingly rebel. Disease may modify this tendency of the mind, but cannot destroy it; and the practical physician does not fail to avail himself of its power in the management of the insane. Many will at first refuse to work in the fields or in the garden, particularly if unaccustomed to manual labour, who, seeing others do so with cordiality and pleasure, will gradually allow their resolution to give way, and ere long become as zealous as they were previously backward. One of the chief advantages of large establishments, is the great facility they afford of turning out numbers to every kind of employment, so as to subject an individual who refuses to exert himself to all the disadvantages of singularity, which the insane dislike even more than persons of sound mind.

"Where there is any difficulty in engaging patients of a higher class in bodily labour, much good may still be done by engaging them as much as possible in the employments to which they were formerly accustomed. Billiards, bowls, walking, reading, writing, and music, are then valuable resources, and may be made to constitute the business of the day; care being always taken to turn the talents of the patient to a useful account, whenever an opportunity occurs, so as to give him as frequently as possible the consciousness of filling his place as a member of society.

"In the smaller, and especially in private asylums, dedicated to the middle and higher classes of society, the presence of a

NUMEROUS BODY OF INTELLIGENT AND EDUCATED ATTEND

ANTS, is a great desideratum. The patients are too few in number to operate on each other by example, and their habits are not in harmony with any manual employments. By placing numerous attendants among them, who would act systematically in endeavouring to engage them in useful labour, at first of a very light description, and to rouse them by example and cheerful encouragement, a good deal might be done; but as in such retreats, the patients are generally persons of a more intelligent and refined description than in the larger asylums, the attendants, to be on a par with them, would require to possess proportionally higher moral and intellectual qualifications, so as to fit them for being companions and friends, as well as guardians, of the inmates. The expense of providing a sufficient number of qualified persons will long be an obstacle to their being obtained; but if the importance of the provision were once fully ap

preciated, and its success demonstrated, it can scarcely be doubted that this difficulty would be surmounted. Every year, we hear of large legacies being left to Lunatic Asylums by the benevolent, and if one of these were bequeathed to the first public institution that should introduce such a system, we should not have to wait long to see the example generally followed. The wealthier classes are, indeed, directly interested in the experiment, as their ranks afford proportionally the greatest number of victims; and if the disease were once treated on such principles, there would be much less reluctance to seek early advice, and consequently much more success in combating its attacks.

"Pinel has said that thirty years' experience had taught him that a striking analogy subsists between the art of educating and training the young and that of managing the insane, as the same principles are applicable to both. Natural activity, unwearied kindness, tact and firmness, are eminently useful in both situations; but they are productive of their fullest advantages only when reinforced by an accurate acquaintance with the laws which regulate the mutual influence of mind and body, with the nature and sphere of the primitive mental powers, and with the methods and objects by which each may be soothed into repose or stimulated to activity-in other words, by an intimate knowledge of human nature and of the philosophy of mind.

But it will be asked, What fortunate establishment possesses attendants endowed with such excellent qualifications, and where are such persons to be found by any one who wishes to procure their assistance? The answer must be, Nowhere; but as a necessary consequence, it may with equal truth be affirmed, that nowhere is the treatment of insanity so successful as it would be, were such assistants provided in sufficient numbers to mix with and exert a constant and active influence on the patients. In some retreats, an approximation to this desideratum is made in the frequent admission of visitors, who, actuated by kindness and intelligence, seek the society of the insane, devote themselves to their relief and comfort, and, by gaining their confidence and shewing a sympathy with their situation, succeed in dispelling morbid associations and restoring health and tone to the disordered mind. In these asylums, the proportion of cures is proportionally greater than in others apparently as well regulated, but in which no effort is bestowed in active moral treatment. In the Connecticut Retreat, this system has been carried as far as the present state of knowledge will permit, and with the best effects; the proportion of cures in recent cases being nine out of ten of all admitted. At present, indeed, no amount of funds could command the services of a sufficient number of properly qualified assistants; but, nevertheless, it is important that the