Andrew Wynter

Horace Walpole, whose pen has graven so deeply the social characteristics of his age, in describing to his friend Mann the terrors excited by the Lord George Gordon mob, says “they threaten to let the lions out of the Tower, and the madmen out of Bedlam.” In this short sentence we have a clear view of the opinion which our forefathers entertained of lunatics—an opinion which the pictures of Hogarth’s Madhouse Cells have impressed on the popular mind even to this day. And in truth it is not fifty years since the state of things which now exists only in the imagination of the ignorant, was both general and approved. The interior of Bethlehem at that date could furnish pictures more terrible than Hogarth ever conceived. It is not our purpose, however, to dwell upon these horrors of former days. Through the instrumentality of the late Samuel Tuke, of York, Gardner Hill, Charlesworth, Winslow, and Conolly, of London, the old method of treatment, with its whips, chains, and manacles, has passed away for ever; and as a true emblem of the revolution which has taken place, we may mention that some years since a governor, in passing through the laundry of Bethlehem, perceived a wrist-manacle, which had been converted by one of the women into a stand for a flat iron!

In spite of the ameliorations in the condition of the insane, many among the higher, and nearly all among the lower classes, still look upon the County Asylum as the Bluebeard’s cupboard of the neighbourhood. These unfounded ideas act as a powerful drawback to the successful treatment of insanity, for as the vast majority of cures are effected within three months of the original attack, whatever deters the friends of the patient from bringing him under regimen at the earliest possible moment, probably ensures the perpetuation of the disease. We can well imagine the undefined awe and tribulation of spirit with which the unhappy creatures who are stricken in mind enter the gates of an abode in which they are supposed to be given over to a durance worse than death; but so mistaken is the impression, that the feelings of desperation are almost immediately succeeded by the inspiriting dawnings of hope. The furious maniac who arrives at Colney Hatch or Hanwell in a cart, or a hand-barrow, bound with ropes like a frantic animal, the terror of his friends and himself, is no sooner within the building which imagination invests with such terrors, than half his miseries cease. The ropes cut, he stands up once more free from restraint, kind words are spoken to him, he is soothed by a bath, and, if still violent, the padded room, which offers no aggravating mechanical or personal resistance, calms his fury, and sleep, which has so long been a stranger to him, visits him the first night which he spends in the dreaded asylum. An old lady—a relapsed patient—whose silver locks hung dishevelled on her shoulders, was, when we visited Hanwell, waiting in a cab in a state of the wildest excitement. Immediately she was admitted, and recognised the faces of the nurses who had formerly been kind to her, her whole countenance changed. “What, you Burke and you Thomson again!” she exclaimed, delighted at renewing former friendships; and settling herself down peaceably in the ward, she appeared as comfortable as at her own fireside.

Not only have the old methods of treatment been abandoned, but many changes have been made to render the houses for the insane less repulsive to the eye. Thousands of pounds have been spent in replacing the dungeon-like apertures (often without glass) with light-framed windows, undarkened by dismal bars; the gratings have been removed from the fireplaces; and that all the other associations may be in harmony with the improved appearance of the building, the harsh title of keeper has given place to that of attendant, and the madhouse has become the asylum. In the old plan, the entire treatment seemed to consist in secluding the patient from every sight which renders life sweet, and in wrenching him violently from all the conditions which formerly surrounded him; the new idea is to bring within the walls as much of the outside world as possible. Here the artisan finds employment in various handicrafts, the agricultural labourer renews his commerce with the soil, and the female plies her needle or pursues her accustomed occupations in the laundry or the kitchen. Amusement takes its turn, and those who travel by the Great Western train on winter evenings are surprised to see the lights streaming from the great hall of Hanwell, and to hear perchance the sounds of music. These issue from the ball-room of the establishment! In place of the dark dungeon, the bonds and the blows which once added outward to inward woe, the inmates are realising the poetic picture of Gray,—

“With antic Sport and blue-eyed Pleasures,
Frisking light in frolic measures;
Now pursuing, now retreating,
Now in circling troops they meet:
To brisk notes in cadence beating
Glance their many-twinkling feet.”

Mental aberration is not of necessity the bane of mental enjoyment. There are many sweets by which its bitterness may be diluted and diminished, though our ancestors were so ignorant of the fact, as to believe that the best thing to be done for a mind o’erthrown was to pour vinegar to gall.

Dr. Conolly, in his lately-published volume on “The Treatment of the Insane without Mechanical Restraint,” looks upon the banishment of the strait-waistcoat with a just pride, for to him we owe the abolition of the last mechanical means of coercing temporary violence; but we cannot participate in his fear that the selfishness and ignorance of human nature will ever be able to restore the gloomy reign which has at last been brought to a close. We can no more go back to the days of hobbles and handcuffs, chains and stripes, than we can go back to the days of the rack and thumbscrew. We may have, it is true, lamentable exposures, such as took place at Bethlehem in 1851, but the depth of the public outcry, and the promptness with which the irregularities were remedied, is of itself an evidence that general opinion will prove the corrective of occasional abuses. Nor can we, from a fancied apprehension of the return to obsolete practices, join in the fanaticism which forbids the use of the strait-jacket as a means of coercion under all circumstances. There can be no doubt that the treatment which requires its frequent use is a bad one; but to deny that there are cases which call for its restraints would be to deny the evidence of our senses. Mr. Wilkes, the late medical officer to the Stafford County Lunatic Asylum, and now Commissioner in Lunacy, in answer to a series of questions issued by the Commissioners on Lunacy upon the subject, makes the following remarks:—

“With every disposition to advocate the disuse of restraint to the utmost extent, I am compelled to admit that the result of my experience in this asylum, up to the present time, leads me to the conclusion that cases may occur in which its temporary employment may be both necessary and justifiable. Besides the occasional use of some means of confining the hands when feeding patients by means of the stomach-pump, a more prolonged use of restraint was necessary in two cases which occurred some years since. One of these was a man of so determined a suicidal disposition, that on more than one occasion he nearly effected his purpose by trying to beat his head and face against the walls, to throw himself from tables and chairs, and thrust spoons and other articles down his throat. When first admitted, he was not suspected of having any suicidal tendency, and for some weeks did not show any; as a matter of precaution he slept in a padded room, and one night he so battered his head with a tin vessel that he was found nearly dead from loss of blood, and his life was subsequently in much danger from extensive sloughing of the scalp. In this case it was absolutely necessary to confine the hands to keep any dressings on the head, and after the wounds had healed, and the confinement of the hands had been discontinued, he wore a thickly-padded cap for many months. Several years after this, he bit both his little fingers off; and though the suicidal disposition has in a great measure subsided, he is still at times much excited, but does not require any restraint. The second case was one of acute mania. A powerful young man refused all food under the impression that it was poisoned, and imagined that every one who went near him intended to murder him. Every inducement to get him to take food was in vain, and though a sufficient body of attendants, under my own inspection, attempted to do what was necessary for him, he became so much bruised in holding him in his struggles to assail the attendants, when it was urgently requisite that food should be administered into the stomach, that I decided upon confining his hands, and both food and medicine were then readily administered. The result certainly justified the means employed, as the excitement subsided, and he soon recovered.”

So much for the experience of the medical attendant of a public asylum; now let us hear the testimony of Dr. Forbes Winslow, whose experience in his private asylum, Sussex House, Hammersmith, has been as great perhaps as that of any man, since he has lived with his family for ten years in the very midst of his patients, and who is surpassed by no one in his enlightened and gentle treatment of the insane.

“Patients,” he says, in his Report to the Commissioners, “have often expressed a wish to be placed under mechanical restraint, should I, in my judgment, believe that they would, when much excited, commit overt acts of violence, and be dangerous to themselves and others. In cases like these, mechanical restraint may for a short period be applied, not only without detriment, but with positive advantage as a curative process. Several instances relative of this fact have come under my observation. I have seen cases where no food or medicine could be administered without subjecting the patient to restraint. In these cases, if all idea of cure had been abandoned, and I could have reconciled it to my conscience to allow the disease to take its uninterrupted course, and have permitted the patient to exist upon the minimum amount of nutriment, and take no medicine, all restraint might easily be dispensed with; but considering the cure of my patient paramount to every other consideration, I had no hesitation as to the humane and right mode of procedure.”

In a case which came under our knowledge, a patient imagined that the text, “If thine eye offend thee pluck it out,” was literally intended, and, after various attempts to comply with the command, he succeeded in destroying the sight of one orbit. Such instances are rare, but the medical man should at all times be prepared to meet them, instead of folding his arms and looking helplessly on whilst the mischief is being done, through a craven fear of the non-restraint cry. The strait-waistcoat is certainly liable to great abuse, but less than the padded room, which may be converted into a cruel means of coercion in the hands of unwatched attendants.

There yet remains a vast amount of restraint, which is almost as irritating, if not so strongly reprobated, as the implements which bind the limbs of the suicidal or violent. Restraint is only comparative. The strait-waistcoat is the narrowest zone of confinement, and the padded room but a little wider. Next to these comes the locked gallery for a class, then the encircling high wall for the entire lunatic community; and lastly, that aËrial barrier the parole, for those who can be trusted to go beyond the asylum. The efforts of philanthropists will not, we are convinced, cease, until all the methods of confinement, down to the parole, are removed; or at least so disguised as to hinder their present irritating action upon the inmates. As long as the chief idea in connection with these establishments is that they are receptacles for the detention of the insane, so long perhaps the means taken to prevent flight will obtain; but when they are simply regarded as hospitals for the cure of mental disease, we shall witness the abandonment of many arrangements which are as barbarous and ineffectual as the cruelties practised in the last century. The asylums where the restraint is greatest are precisely those from which the largest number of patients contrive to escape; whereas, when restrictions of all kinds are abolished, as at the insane pauper colony of Gheel, in Belgium, but few persons ever attempt to get away.

In former days the public were admitted to perambulate Bedlam on the payment of twopence. A writer in the World gives a narrative of a visit to it in Easter-week, 1753, when he found there a hundred holiday-makers, who “were suffered unattended to run rioting up and down the wards, making sport of the miserable inhabitants.” Richardson, the novelist, had, a few years earlier, depicted the scene in the assumed character of a young lady from the country, describing to her friends the sights of London.

“I have this afternoon been with my cousins to gratify the odd curiosity most people have to see Bethlehem, or Bedlam Hospital. A more affecting scene my eyes never beheld. I had the shock of seeing the late polite and ingenious Mr. —— in one of these woful chambers. No sooner did I put my face to the grate, but he leaped from his bed, and called me with frightful fervency to come into his room. The surprise affected me pretty much, and my confusion being observed by a crowd of strangers, I heard it presently whispered that I was his sweetheart and the cause of his misfortune. My cousin assured me that such fancies were frequent upon these occasions; but this accident drew so many eyes upon me as obliged me soon to quit the place. I was much at a loss to account for the behaviour of the generality of people who were looking at these miserable objects. Instead of the concern I think unavoidable at such a sight, a sort of mirth appeared on their countenances, and the distempered fancies of the miserable patients provoked mirth and loud laughter in the unthinking auditors; and the many hideous roarings and wild motions of others seemed equally entertaining to them. Nay, so shamefully inhuman were some, among whom, I am sorry to say it, were several of my own sex, as to endeavour to provoke the patients into rage to make them sport.”

Supposed to be degraded to the level of beasts, as wild beasts they were treated. Like them they were shut up in dens littered with straw, exhibited for money, and made to growl and roar for the diversion of the spectators who had paid their fee. No wonder that Bedlam should have become a word of fear; no wonder that in popular estimation the bad odour of centuries should still cling to its walls, and that the stranger, tempted by curiosity to pass beneath the shadow of its dome, should enter with sickening trepidation. But now, instead of the howling madhouse his imagination may have painted it, he sees prim galleries filled with orderly persons. Scenes of cheerfulness and content meet the eye of the visitor as he is conducted along well-lit corridors, from which the bars and gratings of old have vanished. He stops, surprised and delighted, to look at the engravings of Landseer’s pictures on the walls, or to admire the busts upon the brackets; he beholds tranquil persons walking around him, or watches them feeding the birds which abound in the aviaries fitted up in the depths of the ample windows. Indeed the pet animals, such as rabbits, squirrels, &c., with the verdant ferneries, render the convalescent wards of this hospital more cheerful than any we have seen in similar institutions. At intervals the monotony of the long-drawn corridors is broken by ample-sized rooms carpeted and furnished like the better class of dwellings. If we pass along the female side of the hospital, we find the apartments occupied by a score of busy workers, the majority of whom appear to be gentlewomen. Every conceivable kind of needlework is dividing their attention with the young lady who reads aloud “David Copperfield,” or “Dred;” while beside the fire, perhaps, an old lady with silver locks gives a touch of domesticity to the scene, which we should little have expected to meet within these walls. In traversing the male side, instead of the workroom we find a library, in which the patients, reclining upon the sofas or lolling in arm-chairs round the fire, beguile the hours with books or the Illustrated News. Many a scholar, the silver chord of whose brain jingles for the moment out of tune, here finds a congenial atmosphere, and such materials for study as he often could not obtain out-of-doors; and here many an artist, clergyman, officer, and broken-down gentleman, meets with social converse, which the world does not dream could exist in Bedlam.[14]

No cases of more than twelve months’ standing are admitted within the walls of Bedlam, and only ninety persons termed incurables are allowed to remain beyond that period. These regulations exclude the idiotic and epileptic patients, who form such distressing groups in other establishments, and the interest required to obtain admission into this amply endowed charity ensures at the same time a much higher class of inmates. Clergymen, barristers, governesses, literary men, artists, and military and naval officers make up the staple of the assembly. The representatives of the lower orders are also present, but the educated element prevails, and the tone of dress and manners is vastly above that to be found in the pauper-swarming county asylums. There is a ball on the first Monday in every month, and the company that gathers in the crystal chamber at the extreme end of the south wing would not disgrace in behaviour and appearance any sane and well-bred community. The polka, the waltz, and the mazurka, performed with grace and ease, declare the social standing of the assembly; and many a pedestrian who sees the dark silhouettes of the dancers as they whirl across the light, is astonished at the festivities of the inmates. In the summer evenings the spacious courts are crowded with the patients, not gloomily walking between four dismal walls in which the very air seemed placed under restraint, but enjoying themselves in the bowling-green or in the skittle alley. The garden is at hand for those who love the culture of flowers. When we contrast the condition of the Bethlehem of fifty years ago with the Bethlehem of to-day, we see at a glance what a gulf has been leaped in half a century—a gulf on one side of which we see man, like a demon, torturing his unfortunate fellows, on the other like a ministering angel carrying out the all-powerful law of love. Can this be the same Bethlehem where, in 1808, Mr. Westerton, Mr. Calvert, and Mr. Wakefield saw ten patients in the women’s gallery, each fastened by one arm or leg to the wall, with a length of chain that only allowed them to stand up by their bench, and dressed in a filthy blanket thrown poncho-like over their otherwise naked bodies? Can this be the same institution in which poor Norris, like a fierce hound in a kennel, was favoured with a long chain that passed through the wall into the next room, and which, while permitting him a little extra tether, enabled the keeper to haul him up to the side of the cell when it was necessary to approach him? But this indulgence did not last, and from the pages of Esquirol we learn the infernal torture which was finally put upon him.

“A stout iron ring was riveted round his neck, from which a short chain passed to a ring made to slide upwards or downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar, about two inches wide, was riveted; on each side of the bar was a circular projection, which, being fastened to and enclosing each of his arms, pinioned them close to his side.”

In this position, in which he could only stand upright or lie upon his back, he lived for twelve years! But in nothing, perhaps, is the contrast between the past and the present more apparent than in the two pictures presented by Dr. Hood, the resident physician, from the case book of the Bethlehem Hospital, which at once show the difference of treatment and the different results which attended it.

“A. F., admitted into the Hospital, February 6, 1808, aged 34. This woman was born at Derby. At the age of 20 she came to London to seek for service, but she soon lost her character. The natural violence of her disposition was increased by her intemperance. She was the most turbulent of all the females that disturb the night about Fleet Market, and has been repeatedly flogged at Bridewell for her extreme violence and disorder. She became at length the horror of the watchmen, for punishing and imprisonment had no effect in checking her career. She was known to her companions by the name of ‘Ginger.’ In one of her paroxysms of rage she attacked the windows of the Mansion House, and on her examination before the Lord Mayor, it appeared that her violent disposition had gradually passed into a state of complete madness. Under these circumstances she was sent, February 6th, 1808, to the Hospital, and placed on the curable establishment. At the expiration of twelve months, her lunacy continuing, she was admitted on the incurable list. There is no record of the manner in which she conducted herself during the first year, but it appears that she was chained to her bed of straw for eight years without any covering or apparel. So long as she continued thus coerced the violence continued. The last entry is ‘coercion still makes her ferocious, but when left at liberty she is not in the least degree dangerous.’”

“M. C., admitted into this Hospital, Sept. 30, 1853, in a state of violent raging excitement, depending upon acute mania. She had been in this state three days previous to her admission, and had wandered about the streets in a comparatively naked state, under the excitement of religious enthusiasm. She was a powerful, muscular woman; and to bring her to the Hospital it was necessary to impose upon her the restraint of a strait-jacket. She screamed violently all the way to the Hospital, and used the most threatening language, refusing to listen to anything that was said to her, but when tired of vociferating, contented herself with kicking and spitting at those within her reach. On admission, the mechanical restraint was removed; she was ordered a warm bath, and two grains of the acetate of morphia, and afterwards placed in a bed in a padded room. She continued noisy for an hour or two, and then became quieter; but the attendant, who looked at her every half-hour, always found her sleepless. The following day she continued tranquil, but when addressed, responded with an oath. She was ordered one grain and a half of acetate of morphia. The third day she continued quiet and sullen, but permitted the nurse to dress her and place her in a chair in the day-room with the other patients. The following day (the fourth) she continued tranquil and rational, rather shrinking from conversation; and being a little feverish, was ordered ‘henbane,’ with a saline. From that day she speedily became convalescent, and was discharged cured, November 11, 1853, having been a patient in the Hospital forty-two days.”

Thus diversely does disordered nature answer to an appeal according to the spirit in which it is made. There is a reverse, however, to every medal, and the skeleton cupboards of Bethlehem are the male criminal lunatic wards. These dens, for we can call them by no softer name, are the only remaining representatives of old Bedlam. They consist of dismal, arched corridors, feebly lit at either end by a single window in double irons, and divided in the middle by gratings more like those which enclose the fiercer carnivora at the Zoological Gardens than anything we have elsewhere seen employed for the detention of afflicted humanity. Here fifty male lunatics are herded together without regard to their previous social or moral condition. Thus the unfortunate clergyman, the Rev. Hugh Willoughby, who fired a pistol two years since at the judge at the Central Criminal Court, is herded with the plebeian perpetrator of some horrible murder. Side by side with the unfortunate Captain Johnson, of the ship “Tory,” who, in a fit of extraordinary excitement during a mutiny on board his vessel, cut down some of his crew, but is now perfectly sane, sits perhaps the ruffian who murdered the warder in cold blood at Coldbath Fields—a villain brought in mad by a tender-hearted jury who shrunk from the responsibility of hanging him. Here also poor Dad, the artist, who killed his father whilst labouring under a sudden paroxysm of insanity, is obliged to weave his fine fancies on the canvas amidst the most revolting conversation and the most brutal behaviour. Those who contend that all criminal lunatics should be treated alike, do not consider the vast difference between the tone of mind in an abandoned wretch who has lived a life of villany, and the gentleman who has committed a casual offence. As the former advances towards sanity the brutal disposition, which early training in vice and dissipation has engraved upon his nature, comes into strong relief, whilst the good breeding which is natural to the latter, and which was but temporarily eclipsed in him, resumes its sway. Nay, nothing is more certain than that the previous habits and manners of the lunatic are to a great extent unaffected by his unfortunate malady, even when it is at its height. The disgrace of thus caging up together the coarse and the gentle, the virtuous and the abandoned, rests wholly upon the shoulders of the Home Secretary. The governors of the hospitals, the medical officers, and the lunacy commissioners, have over and over again remonstrated against the enormity, and to our national shame have remonstrated in vain. It is proposed to build a special asylum for all the state lunatics who are now distributed among county asylums, hospitals, licensed houses, workhouses and jails, to the number of 591,[15] and it is a duty which we trust will not be longer delayed. There can be little doubt that the presence of these crime-tainted individuals is felt deeply by the innocent lunatics, and that their recovery is retarded by the indignation excited at their degrading companionship with the outcasts of society. The erection of a criminal asylum upon a large scale would both compel a better system of classification, and would necessitate some solution of the difficult question—What shall be done with criminal patients who have recovered? One class of cases at least, as Dr. Tyler Smith has pointed out, leaves no room for doubt. The females who have committed offences whilst under the influence of the delirium attendant upon puerperal fever, and who, having recovered, are past the age of child-bearing, should at once be released. They are no longer liable to a recurrence of mental aberration, and to keep them incarcerated for life, is to treat past misfortune as an inexpiable crime. Nothing can be more cruel, unjust, and motiveless.

It is proposed to remove Bethlehem Hospital into the country, on the plea that ground cannot be obtained in sufficient quantity for the use of the inmates. If by this is meant that agricultural pursuits cannot be carried on in St. George’s Fields, we rejoice in the fact. A sane man, accustomed to the busy scene of a large town, would be wretched if he was condemned to pass the remainder of his days amid the silence of the fields, and the lunatic remains for the most part under the same domination of former habits. The notion that his faculties are universally disordered, all his perceptions destroyed, all his tastes obliterated, and all his sympathies extinct, is one of the grossest errors which can prevail. Nor do the better class of patients (such as form the inmates of Bethlehem) require the hard exercise which is necessary for the maintenance of health with an agricultural pauper. They find far more recreation in strolling through the streets in the neighbourhood of the asylum, under the care of an attendant, than in wading through ploughed fields, or in taking a turn at spade husbandry. To this we must add, that insanity is often a sudden seizure, that individuals go raving mad in the streets; that, in short, there are frightful casualties of the mind, as of the body, which require the instant attention of the mental physician. For this reason alone every lunatic asylum should no more be removed into the country than every ordinary hospital. But, apart from this circumstance, we repeat that Bethlehem, within call of friends and within the hum of the busy world, glimpses of which can be caught by the patients from the loopholes of their retreat, and into which they are occasionally allowed to enter, is far better placed for purposes of cure than in any rural district, however well supplied with the means of pursuing agricultural labour. At present all the sights of the metropolis are from time to time enjoyed by the inmates. “The male patients last year,” says Dr. Hood, the resident physician, “who were not fit to be discharged, were allowed to spend a day at Kew; another day they went by steamboat to the Nore; and, conducting themselves well under the charge of careful attendants, visited many public exhibitions—the National Gallery, the Crystal Palace, Marlborough House, the Zoological Gardens, Smithfield Cattle-show, &c.” Who can doubt that people accustomed to such sights and sounds would infinitely prefer them to the delights of walking between hedge-rows, hoeing weeds, or digging potatoes? Who can doubt that these little excursions of the wall-bound inmates into the cheerful life of the outside world are a vast advantage to the slowly-recovering brain, and constitute just that desirable transitional training necessary to their safe restitution to unlimited freedom? In fact, under the old system, when convalescent patients, who had been confined for months in dungeon-like cells, bristling with bars, were taken to the gates and returned suddenly to unrestrained liberty, the effect of the contrast was often so great, that they set off running in a paroxysm of excitement, and were frequently brought back again in a few days, reduced by a too abrupt release to their old condition. It would not perhaps be undesirable to add to Bethlehem some small rural establishment, answering to the succursales of foreign lunatic asylums; but this should be strictly an appendage, to which patients should be sent for a short time, for change of air and scene, just as all the world now and then take a trip to the country to refresh the wearied eye with the sight of green trees and fields, and to cure that moral scurvy contracted by perpetually dwelling upon the dismal vistas of blackened bricks which constitute metropolitan prospects.

For the fullest development of the prevalent system of treating the insane we must go to Colney Hatch and Hanwell, the two great lunatic asylums for the county of Middlesex. The former, situated on the Great Northern Railway, only six miles from the metropolis, is the largest and perhaps the most imposing-looking non-metropolitan building of the kind in Europe. In this establishment, built within the last six years, we may study the merits and demerits of modern asylums. Containing within its walls a population, inclusive of officers and attendants, of 1,380 persons, which is equal to that of our largest villages, and presenting the appearance of a town, its wards and passages amounting in the aggregate to the length of six miles, it is here that we shall find the completest system of organization, and, if we may use the term, of official routine. The enormous sum of money expended upon Colney Hatch, which has reached already to £270,000, prepares us for the almost palatial character of its elevation. Its faÇade, of nearly a third of a mile, is broken at intervals by Italian campaniles and cupolas; and the whole aspect of the exterior leads the visitor to expect an interior of commensurate pretensions. He no sooner crosses the threshold, however, than the scene changes. As he passes along the corridor, which runs from end to end of the building, he is oppressed with the gloom; the little light admitted by the loop-holed windows is absorbed by the inky asphalte paving, and, coupled with the low vaulting of the ceiling, gives a stifling feeling and a sense of detention as in a prison. The staircases scarcely equal those of a workhouse; plaster there is none, and a coat of paint or whitewash does not even conceal the rugged surface of the brickwork. In the wards a similar state of things exists: airy and spacious they are, without doubt; but of human interest they possess nothing. Upwards of a quarter of a million has been squandered principally upon the exterior of this building; but not a sixpence can be spared to adorn the walls within with picture, bust, or even the commonest cottage decoration. This is the vice which pervades the majority of county asylums lately erected. The visiting justices doubtless believe that it would be a superfluous and even mischievous refinement to trouble themselves about pleasing the eye or amusing the brain of the lunatic; but this is a mighty error, as every person knows who understands how keenly sensitive are the minds of the majority of the insane.

“Stone walls do not a prison make,
Nor iron bars a cage,”

sings the graceful Lovelace; but it should be remembered that the lunatic has no divine Althea to muse upon in his house of detention, and the majority of the insane have no healthy wings by which their minds can leap beyond the dreariness of the present. To divert them from the demon in possession, all the ingenuity of philanthropy should be employed; but this truth has been overlooked both here and at Hanwell; and we are lost in astonishment when we reflect upon the folly of lavishing hundreds of thousands upon outward ornamentation, whilst the decorations common among the poorest labourers are denied to the inmates for whom all this expense has been incurred. There is no more touching sight at Colney Hatch than to notice the manner in which the female lunatics have endeavoured to diversify the monotonous appearance of their cell-like sleeping-rooms with rag dolls, bits of shell, porcelain, or bright cloth placed symmetrically in the light of the window-sill. The love of ornament seems to dwell with them when all other mental power is lost; and they strew gay colours about them with no more sense, but with as much enjoyment, as the bower-bird of the Zoological Gardens adorns his playing-bower.[16] The prison dress of the male patients is in keeping with the desolate walls. It is infinitely depressing, even to the visitor, to see nothing but dull grey garments; and the lunatics themselves feel degraded by a uniform dedicated to the gaol-bird. The medical officers of both this asylum and Hanwell are deeply impressed with its injurious effects, and they have long denounced it. Happily the system is confined to the men, not, however, from any benevolent feeling towards the females, but simply because gown-pieces of the same pattern cannot be procured in sufficient quantities to clothe the entire community. Among the sane, self-respect is increased by the possession of decent clothes, and the lunatic is often still more amenable to their influence. A refractory patient at Colney Hatch was in the habit of tearing his clothes into shreds. Mr. Tyerman, one of the medical officers, ordered him to be dressed in a bran-new suit. The poor man, a tailor by trade, either from a professional appreciation of the value of his new habiliments, or from being touched by this mark of attention, respected their integrity, and from that moment rapidly recovered. Before leaving the asylum he stated that he owed his cure to the good effect produced upon his mind by being intrusted with this new suit of clothes. At Hanwell, the patients who destroy their dresses are put into strong canvas garments, bound round with leather and fastened with padlocks. This plan is adopted at some other lunatic asylums; but it always looks repulsive.

It is only, we believe, in the metropolitan county asylums, which should be model establishments, that the grey prison dress is retained. In the majority of county asylums the smock-frock of the district is used, and the patient moves about undistinguished from the rest of the population by any repulsive badge. In France and Belgium they manage better still. Dr. Webster, in his notes on foreign lunatic asylums, published in the Psychological Journal of Medicine, speaks of the bright head-dresses and vivid shawls used in France, as giving a cheerful appearance to the assembled inmates. Nothing less could be expected from the known disposition of a people of whom it has been said, that if any man among them was thrown naked into the sea, he would rise up clothed from head to foot with a sword, bag-wig, and ruffles to boot. In the present matter they have been wiser in their generation than ourselves; and we can imagine with what surprise they would learn that at Hanwell, the most celebrated English establishment for the treatment of the insane, patients are rewarded for good conduct by allowing them to wear a fancy waistcoat. This fact of itself shows the aversion to the prison garb, and the necessity of discarding it. But the same visiting committee which inspects the county gaol governs the asylum, and we regret to say that they allow the organization of the former to be introduced into the latter.

In spite of these drawbacks, the progress made within the last twenty years has been immense. A walk through the wards and workshops of Colney Hatch will prove that the lunatic is at last treated as though he had human sympathy and desires, and was capable of behaving in many respects like a rational being. All large asylums possess an advantage over smaller ones in their greater ability to classify their inmates. The wards and corridors of Colney Hatch and Hanwell are so extensive that they may be likened to different streets inhabited by distinct classes. It is usual to name the compartments according to the mental condition of the patients contained in them. Thus in most asylums we have the refractory ward, the epileptic ward, the paralytic ward, the ward for dirty patients, and the convalescent ward. At Colney Hatch it is considered better to use numbers instead, as the patients soon become acquainted with the denomination of the class to which they belong, and often behave in conformity with it. Thus the lunatic, finding himself in a refractory ward, will sometimes act up to the part assigned to him, when he would otherwise be peaceable. The vice of classification is that it separates the population of an asylum into so many mental castes, which in some measure prevents that easy transition from lunacy to sanity, which it is desirable to maintain. In the choice of difficulties, however, there can be little doubt that these divisions in lunatic establishments, as at present constructed, present the most convenient as well as the best means of treating the insane, and the errors to which it is liable can at all times be obviated by the careful supervision of the medical officers.

Nothing strikes the visitor with greater admiration than the care taken of the paralytic and imbecile patients, who form so large a per-centage of the inmates of the county asylums. In most cases the sleeping apartments of these poor creatures at Colney Hatch and Hanwell are padded round breast-high, in order that they may not damage themselves against the walls whilst seized with convulsions in bed; and a pillow has been invented perfectly permeable to the air, on which they can lie with their faces downward during the paroxysm of a fit, without the risk of suffocation. In extreme cases even the floor is padded, lest the sufferer should unconsciously throw himself upon it. The bed-ridden paralytic reclines upon a water-bed, and is tended night and morning as sedulously as a helpless babe. The test of the care which prevails in an asylum is to be found in the condition of the persons who cannot help themselves. Where trouble begins, negligence begins also, in an ill-regulated establishment. Nowhere do the alleviations of humanity seem more required than with the idiots and paralytics. Of all the wards at Colney Hatch, these are the most depressing. It is impossible to contemplate a room full of creatures moving about on their seats with a monotonous action like a company of apes, or when paralyzed in their lower limbs, to see them dragging themselves like seals along the floor by the aid of their arms, without being oppressed by the sense of the dreadful condition to which man can be reduced when the mind is ruined and the nerve-power diseased. It is only in these wards and the refractory that on ordinary occasions the stranger would discover that he was among the mentally afflicted. It is reported that a lady, after she had been shown over a large asylum by the celebrated Esquirol, inquired, “But where are the mad people?” All the infinitely finely-shaded stages of lunacy which lie between mental health, wild fury, and chronic dementia are, in the popular idea, merged in the raving maniac. Yet it is rare for a casual visitor to witness scenes of violence in a lunatic asylum. Those who are mischievous are trained to concentrate their dislike upon the medical officers and attendants rather than upon their fellow-patients. The matron of Hanwell Asylum, in her report for 1856, thus speaks of one of the criminal lunatics who belongs to this refractory class:—

“She seldom interferes with any other patient, the officers and attendants being the special objects of her furious attempts, and her mode of attack is peculiar; there is not usually anything in her manner or appearance to indicate mischief, and she has perhaps previously spoken calmly to the person upon whom—having watched until she has turned her back; for as long as the face is towards her the individual is safe—she springs with the quickness and velocity of a tigress, fastening her hands in the hair, and bringing her victim to the ground in an instant. If not immediately rescued, the head of the unfortunate person is dashed repeatedly upon the floor; and it has been found impossible hitherto to detach the hand of this patient without a quantity of hair being torn by her from the head of the sufferer.”

The visiting magistrates are also highly obnoxious to the patients; and their passage through a ward generally leaves behind it a trail of excitement which often generates outbreaks that do not subside for some hours. On the whole, however, it is remarkable how small an amount of violence is attempted by the insane. In Colney Hatch, with its 1,250 patients, there are far fewer personal assaults in a year than would take place in any village containing half the number of inhabitants. Still precautions are always necessary; and the attendants, from long observation, are generally forewarned, and, consequently, forearmed. Special arrangements are made for those persons who have an unusual tendency to injure themselves or their companions. The suicidally inclined are always placed at night in dormitories with other patients, an arrangement which effectually prevents any attempts at self-destruction; while those who have a propensity to commit homicide are provided with separate cells. There is at the present moment a person at Colney Hatch who labours under the delusion that he can only recover his liberty by killing one of the keepers, and in accordance with this idea he has already made several attempts on their lives. A lamentable death took place at Hanwell the year before last, through the neglect on the part of an attendant to see a homicidal patient properly secured in his apartment for the night.

The utmost precaution will not always insure safety, for patients considered quite harmless will now and then commit the most horrible acts. A black man, a butcher, who had been many years in an American asylum, and had never shown any violence, one night secreted a knife, and induced another patient to enter his cell. When his companion had lain down, he cut his throat, divided him into joints, and arranged the pieces round his cell as he had been accustomed to arrange his meat in his shop. He then offered his horrible wares to his fellow-lunatics, carrying such parts as they desired to those who were chained. The keeper, hearing the uproar, examined the cells, and found one man missing; upon inquiring of the black butcher if he had seen him, he calmly replied, “He had sold the last joint!” Even those who have apparently harmless delusions, will sometimes, if thwarted, commit unlooked-for atrocities. Not many years since, an inquisition was held before Mr. Commissioner Winslow upon a young gentleman who would travel considerable distances to see a windmill, and sit watching it for days. His friends, to put an end to his absurd propensity, removed to a place where there were no mills. The youth, to counteract the design, murdered a child in a wood, mangling his limbs in a terrible manner, in the hope that he should be transferred, as a punishment, to a situation whence a mill could be seen.

Idleness is perhaps a greater curse to the majority of lunatics than to sane individuals. Occupation diverts the mind from its malady. Colney Hatch and Hanwell, from their populousness, and from the fact of their being filled principally by metropolitan lunatics, afford admirable examples of the new method of employing patients in the trades they have been accustomed to follow when in health. As the ranges of workshops at Colney Hatch are the most extensive, we will draw our description from that establishment. Of the male patients, only 245, out of an average of 514 in the house during the year 1855, were employed in labour at all, the remainder consisting of violent maniacs and those afflicted with paralysis, epilepsy, and idiocy, none of whom are capable of undertaking any work. Sixty-five persons were allotted to the gardens, grounds, and farms, leaving 180 to be distributed in the workshops and various offices of the asylum. The tailoring department is the most extensive. Upon the occasion of our visit, there were at least a score of cross-legged lunatics cutting out and making up grey dresses for the inmates, or repairing old clothing, their conduct being in no manner distinguishable from that of sane journeymen. The shoemakers numbered a dozen, every man handling his short knife. Those unaccustomed to lunatics will find it a nervous proceeding to thread their way among so many armed madmen, and will wish themselves well out of this apparently dangerous assembly. Yet, in truth, they are no more to be feared than any similar number of lucid workmen, as the homicidally inclined are carefully excluded. The carpenters planed away merrily among their chips in an adjoining apartment, using now and then chisel, gouge, and saw in perfect freedom. Many excitable patients have been placed in these shops without any bad result; and even those who are disposed to be mischievous when suspected, have become quiet when trusted with edge-tools of the most formidable description. The greater the confidence reposed in the majority of the insane, the more does it tend to insure good behaviour. Of the other artificers in different departments, we may mention painters, upholsterers, bakers, butchers, brewers, and coopers; whilst a still larger number are employed in the kitchen and dining-hall, or as helpers in the corridors and wards. The services of all these lunatic artisans and labourers were valued last year at 1,059l. 3s.

As far as possible, the men work at the trades they have previously followed; but there are many patients whose skilled labour cannot be utilized in this comparatively confined community; such, for instance, as rule-makers, jewellers, whale-bone-cutters, coach-painters, gold-beaters, buhl-cutters, wax-doll makers, and a score of other heterogeneous craftsmen, who are only to be found in a great metropolis. These persons engage in the employment most suited to them, and thus many of them leave the asylum skilled in two trades. Equally efficacious is the occupation on the farm, which contains seventy-six acres of pasture and arable land, principally dedicated to the rearing and maintenance of stock. On the 1st of January, 1856, there were 28 cows, 1 bull, 2 calves, 152 pigs, 40 sheep, 7 horses, &c. The tending of these animals, the culture of the fields and of the thirty-one acres of ornamental grounds, the milking the cows, the slaughtering of the meat, and the production of the butter, afford varied and healthy employment to the sixty-five agriculturists. Some persons who never handled a spade before, here set to work cheerfully and with a will, and a French polisher, a Wesleyan minister, a school teacher, or a law writer, may be seen digging away at a field of potatoes; or a ship-carpenter, saddler, cabman, coalheaver, and organ-player, diligently engaged in filling a manure-cart. They would, it is true, be better employed in occupations more in accordance with their previous habits; but these cannot be found for them, and labour of any kind is preferable to idleness. On the female side of the house industry is resorted to as a means of cure to a still larger extent. Of the 503 equal to labour, 270 work as needlewomen, 7 are employed in the kitchen, 72 wash, iron, and clearstarch in the laundry, 125 help in the wards, and 29 attend school, and are otherwise engaged. The total value of the female labour of the house is computed at 500l. per annum.

Colney Hatch is not so extensively embarked in industrial and agricultural pursuits as the North and East Riding Asylum, where the patients are received from a mixed manufacturing and agricultural population, and the produce of their fields and workshops is much greater than could be extracted from worn-out metropolitan patients. Not only do the lunatics rear the vegetables, but they take them to the asylum gates and dispose of them to the public. The result affords a proof of what we hold to be a settled principle, that chronic cases of insanity are greatly benefited by as much intercourse as possible with the saner part of the community.

In accordance with the opinion that pursuits of lunatics should be similar to their pursuits in former days, the south wing of Haslar Hospital is devoted to the officers, seamen, and marines of her Majesty’s fleet who are afflicted with insanity. Every window of the building commands a fine view of Spithead and the Isle of Wight, and here the old Salts can sit and watch the splendid panorama crowded with vessels, and active with that nautical life which recalls so many happy associations to their minds. They form fishing parties, make nets, and go on pleasure excursions in row and sailing craft. The “madman’s boat” of eight oars, manned by patients and steered by an attendant, is well known to the sailors on the Solent, and so harmless are they considered, that young ladies often accompany them on trips to the Isle of Wight, implicitly trusting in their seamanship and politeness.

Mental labour, as a means of cure, has not been adopted in England to any great extent; most asylums have their libraries, in which attentive readers are always to be found, but the inmates rarely attempt to produce amusement or instruction for their fellows. There is one signal exception to this rule in Murray’s Royal Asylum at Perth. This establishment, under the superintendence of Dr. Lauder Lindsay, appears to be the very focus of intellectual activity. The programme for the winter session of 1856-7 reads more like the prospectus of the AthenÆum of some large city than the bill of fare for a lunatic asylum. Famous professors reflect in its lecture-room the philosophy and science of the outer world, and their choice of subjects would not be disavowed by the committee of a London Scientific Institution.

These scientific and philosophic expositions are attended by all the better class patients. The paupers have a separate set of lectures and classes, the major part of which are delivered and conducted by the inmates themselves. Galvanism, the Blood, Time, Economic Botany, are among the subjects which the deranged brains of the Perth asylum are contented to hear elucidated. The activity of the place does not stop here: chamber concerts, in which the patients perform; grand concerts, in which artists from without supply the leading stars; and theatrical performances, in which the different characters are all taken by “resident actors,” are among the resources which were employed to amuse and interest the inmates during the winter months just past. A pit full of lunatics watching “Box and Cox” played by their fellows, is a curious subject for contemplation. Not content with these efforts, they seem to think that they are nothing unless critical, and accordingly they have set up a journal, in which they review their own performances. The first number of Excelsior is now before us, in which we find poetry, news, and criticisms on music, and contemporary literature; and he who reads with the idea of finding anything odd in this production, will most certainly be mistaken; for no one could divine that there was a “bee in the bonnet” of printer, publisher, and contributor. Balls and conversaziones form the staple of the lighter recreations of this singular community, whilst the more athletic games of running, leaping, hurdle-racing, Highland dancing, putting the stone, footing the bar, and lifting dead weights, are pursued with such success, that the lunatics boast with pride that they have beaten some of the prize-holders of the outer world.

It might be supposed that intellectual striving was not the medicine to offer to a diseased brain; but we are informed by Dr. Lindsay that in the vast majority of cases the best results flow from this method of treatment, and that a large percentage of cures is obtained. Such patients as would be injured by stimulating their faculties are debarred by the physician from their undue exercise, and others must be too far gone, or be too uninformed, to be capable of the pursuit. The surprise that lunatics should be susceptible of healthy mental exertion, arises from the common forgetfulness that many understandings are slightly affected, or are only deranged upon particular points. When Nat Lee was in Bedlam, he said that it was very difficult to write like a madman, and very easy to write like a fool. The works of the fools are more voluminous than the works of the madmen, because there are more fools than lunatics; but those who are completely mad are so far from experiencing a difficulty in writing in their own character, that they cannot write in any other. As many, however, who are not altogether right in their minds, are no more exclusively insane than people who are not absolutely wise are entirely foolish, it is easy to see that they may still be equal to much profitable mental exertion. In these days poor Christopher Smart would not be deprived of his pen and ink, and compelled to indent his long poem on “David” with a key on the panels of his cell; nor perhaps would the following epigram, which a woman in Bedlam wrote on Martin Madan’s argument in favour of polygamy, be handed about as a phenomenon to be wondered at:—

“If John marry Mary, and Mary alone,
It is a good match between Mary and John:
But if John marry more wives, what blows and what scratches!
’Tis no longer a match, but a bundle of matches.”

In France, and we believe in some other continental countries, it is the habit to employ lunatic labour in the private farms surrounding the asylum. This plan was in the olden time pursued in England; but it appears to have gone out with the ancient system of coercion. When radical revolutions are accomplished, good ideas sometimes perish with the bad; and we cannot help thinking that the abandonment of this method of exercising lunatics was an error, and that a return to the old practice, under proper regulations, would be of advantage both to employer and employed. Never must we lose sight of the wisdom of freeing the patient as much as practicable from the companionship of his fellows, and of placing him, to the utmost of our power, in the same free condition which he enjoyed in his days of sanity.

At Colney Hatch, as at Hanwell, and indeed all other public asylums, the sexes occupy separate portions of the building, and are only allowed to be present together on particular occasions. This unnatural arrangement undoubtedly arose from the introduction into asylums of prison and workhouse systems of management; for certainly nothing can tend to render the life of the patient more dreary than to find himself carefully excluded from the company of the other half of creation. It is stated by the advocates of separation that the mingling of the sexes among the insane would be productive of occasional misbehaviour; but nothing could be more unjust than to deprive the majority of the benefits which would arise from frequent social reunion, in consequence of the erotic tendencies of the few. It is with pleasure, therefore, we see the attempts which are being made to assimilate the intercourse of lunatics to that of the sane at Hanwell, Colney Hatch, and other asylums. The most interesting feature of the former establishment is the ball which takes place every Monday night. Shortly after six o’clock the handsome assembly-room, brilliantly lit with gas, becomes the central point of attraction to all the inmates, male and female, who are considered well enough to indulge their inclinations for festivity. On the occasion of our visit there were about 200 patients present, together with a few visitors and many of the attendants. In a raised orchestra five musicians, three of whom were lunatics, soon struck up a merry polka, and immediately the room was alive with dancers. In the progress of this amusement we could see nothing grotesque or odd. Had the men been differently dressed, it would have been impossible to have guessed that we were in the midst of a company of lunatics, the mere sweepings of the parish workhouses; but the prison uniform of sad-coloured grey presented a disadvantageous contrast to the gayer and more varied costumes at Bethlehem, and appeared like a jarring note amid the general harmony of the scene. In the corners of the room whist-players, consisting generally of the older inmates, were seen intent upon their game; not a word was uttered aloud, not a gesture took place that would have discredited any similar sane assembly; yet not a patient was free from some strange hallucination, or some morbid impulse. Among the merriest dancers in Sir Roger de Coverley was a man who believed himself to be our Saviour, and who wore in his hair a spike in imitation of the crown of thorns; and one of the keenest whist-players was an old lady, who, whilst her partner was dealing, privately assured us she had been dead these three years, and desired as a favour that we would use our influence with the surgeon to persuade him to cut off her head. In the midst of such strange delusions, it was curious to notice how rationally those who were their dupes enjoy themselves; and it is impossible to deny that such reunions are eminently calculated to hinder the mind from morbidly dwelling upon its own unhealthy creations. It is found that the too prolonged and frequent repetition of the balls somewhat diminishes their interest—an evil provided against at Hanwell by restricting the time allotted to them. At nine precisely, although in the midst of a dance, a shrill note is blown, and the entire assembly, like so many Cinderellas, breaks up at once, and the company hurry off to their dormitories. These hebdomadal balls have not yet been introduced at Colney Hatch. A movement has, however, been made latterly towards a limited association between the sexes by allowing them to dine together. Of the 500 patients who assemble in the ample dining-hall, 200 are females and 300 males. The scene when the women first made their appearance is described as something remarkable; the men rose in a body apparently delighted beyond measure, and the presence of the softer sex has not only tended to break the former monotony, but to keep the assembly in order and good humour. Before this happy meeting there were occasional outbreaks of some of the more excited patients; but now, when any of the men are inclined to be fractious or discontented, the women turn them into joke, and they are silenced immediately. As yet the two sexes are not allowed to sit at the same table, but are located on opposite sides of the room. By far the better plan would be to seat them on different sides of the long tables; but as many persons in authority, wanting confidence in human nature, object to this natural arrangement, the innovators must be satisfied for the moment with the present imperfect concession. When it was first proposed to introduce a billiard-table at Bethlehem, the scheme was rejected by a majority of two-thirds of the governors, on the score that the players would fight each other with the cues and balls, and bagatelle, as a kind of half measure, was permitted instead. As the patients confined the balls to their legitimate purpose, and the mace was not turned into an offensive weapon, the billiard-table was at last with reluctance established. The same thing will doubtless happen with respect to the dining arrangements at Colney Hatch; and before long we trust male and female lunatics will exchange courtesies across the table instead of across the room.

In the chapels of nearly all the larger lunatic asylums the quieter inmates are accustomed to meet at the daily morning and evening service. In the spacious chapels of Hanwell and Colney Hatch, the attendance on week days, as well as on the Sabbath, is far better than can be found among the same number of people out of doors, 250 on the average attending on week days, and 500 on Sundays. We do not suppose that the lunatic is more religious than the sane, but the ennui which, to a certain extent, still attaches to the asylum renders any form of reunion agreeable; and as the going to chapel is “something to do,” numbers of the inmates obey the summons who might stay at home if they were at large. The conduct, nevertheless, of this congregation is most exemplary. “The heartiness,” says the chaplain, in his report for 1856, “with which they join in the responses and the psalmody is very encouraging, while their quiet, orderly conduct—the prayer offered up by many on entering chapel, the regularity with which they all kneel or sit, according to the order of the service—would, I think, if generally witnessed, put to the blush many of our parochial congregations.” Now and then an epileptic patient will disturb the chapel by his heavy fall; but as those who are thus afflicted are located near the doors, the interruption is but momentary. The chaplain of Colney Hatch has trained twelve male and female patients to practise church music and psalmody. The choral service is well performed, and, in conjunction with the organ, has a visible effect in soothing the wilder patients, and in pleasing all. The sacrament is not denied to those who are fit to receive it, and no more touching scene can be witnessed than that which is presented in the chapel, when a score of communicants, disordered though their minds sometimes be, humbly kneel, and

“Drain the chalice of the grapes of God.”

The out-of-door games of the insane are very much regulated by the extent of ground attached to the asylum. Where this is ample, as at Colney Hatch, cricket is the favourite summer recreation; a skittle-alley, a bowling-green, and a fives-court, are found in most county asylums. In America, where women adopt more masculine habits than in England, female lunatics play matches on the bowling-green; and in France gymnastic exercises are employed for the exercise of both sexes, and may, we think, be introduced into the English asylums with advantage. The idiotic patients and those who are incapable of much exertion may be seen in the airing courts enjoying the monotonous swinging motion of the machine known in domestic life under the name of “the nursery yacht,” being nothing more than a rocking-horse with the horse left out by particular desire. In addition to these means of diverting the minds of the patients, walking parties, under the superintendence of officers of the establishment, are made up two or three times a week. During the haymaking season it is customary to allow the inmates of asylums to which farms are attached to go forth into the fields to assist with the rake and the pitchfork. This permission is always looked upon as a great treat, and its effect upon the patients is of the happiest kind, especially if the scene of their temporary labour admits no sight of the asylum and its wearisome walls. Here for a few hours they seem to realize the liberty and delight of younger days. The physician on such occasions may read in their “grateful eyes” that we are at present arrived only half way on the road of non-restraint. Individual patients, again, are suffered to leave the public asylums on a day’s visit to their friends, under the care of a nurse; and some who are nearly convalescent are permitted to go and return of their own accord. It is the custom of Colney Hatch and Hanwell, and we believe of most asylums in England, to grant the patients a certain period of probation among their friends, in order to test their fitness to be discharged as cured; to give them, in short, mental tickets-of-leave. This is an admirable plan, inasmuch as it secures to the patient the full enjoyment of liberty, at the same time that it enables him to keep himself well in hand, knowing that, as he is not unconditionally released, an immediate recall to the asylum would follow any sign of returning irrationality.

The dietary in public asylums is ample, and the quality excellent. Hanwell may, perhaps, be considered the model establishment in this respect. It is the joke of the other asylums, that one man has been regaled there daily for years with chicken and wine. Even the fancies of the patients are now and then gratified at some expense. There is an old lady in Hanwell who believes that the whole establishment is her private property; and, on one occasion, she complained to the medical superintendent that, notwithstanding all the expense she was at to keep up the grounds and forcing-houses, she never could get any grapes. The next day she was presented with a bunch, which had been purchased to appease her repinings. This humouring method of treatment, as it is called in other asylums, is much patronized by the matron, a person who seems to enjoy as much power as the medical officers. In her report for 1856 she thus speaks of a patient who died in the course of last year:—

In many asylums this method of treatment is thought calculated to feed the original delusion; but here, again, the judgment of the physician ought alone to determine the course to be taken in each individual case. In patients labouring under violent excitement, to oppose an hallucination, however absurd, would add fuel to the fire. Again, in a chronic case like that of the laundry-maid, the harmless fancy of the poor creature might not only be indulged in with impunity, but served to renew week by week her stock of cheerfulness.

The lunatic colony of Gheel, situated twelve miles south of Turnhont, in Belgium, amid a vast uncultivated plateau consisting of heath and sand, called the Campine, affords an extraordinary example of the pre-eminent advantages of the present mode of managing lunatics. Until the era of railroads this spot was so out of the ordinary track of the world, that but few persons even of those who were interested in the treatment of the insane were aware of its existence. Here we discover, like a fly in amber, a state of things which has lasted with little change for twelve hundred years. Here we see the last remnants of the priestly treatment of insanity, coupled with a system of non-restraint which certainly existed long before the term was ever heard of in England and France. Gheel owes its origin to a miracle. Saint Dympna, the daughter of an Irish king, suffered martyrdom in this place from the hand of her father in the sixth century. So great was her fame as the patron saint of lunatics, that her shrine, erected in the church dedicated to her, speedily became the resort of pilgrims, who journeyed hither in the hope of being cured of their madness or of preventing its advent. Her elegantly-sculptured tomb contains among other bassi-relievi one in which the devil is observed issuing from the head of a female lunatic, while prayers are being offered up by some priests and nuns, and close at hand another chained maniac seems anxiously awaiting his turn to be delivered from the demon. The idea carefully inculcated by the priests, that lunacy meant nothing more than a possession by the devil, has long been banished from other lands. Here, however, it has flourished for many centuries, and the ceremony of crawling beneath the tomb has existed so long, that the hands and knees of the devotees have worn away the pavement. The act is still occasionally performed amid a scene in which superstition and terror are combined in a manner calculated to cure any lunatic, if deep mental impressions were alone required to purge away his malady. But what is far more interesting and astonishing to those accustomed to the bolts and bars, the locks, wards, and high walls of crowded European asylums, is the almost entire liberty accorded to the lunatics resident in the town of Gheel and its neighbouring hamlets, to the number of 800, or one-tenth of the whole district. No palatial building, such as we encounter in nearly every county in England, is to be seen. The little army of pauper and other patients gathered from the whole superficies of Belgium, instead of being stowed away in one gigantic establishment, in which all ideas of life are merged in the iron routine of an enormous workhouse, are distributed over five hundred different dwellings, three hundred of which are cottages, or small farmhouses, in which the more violent and poorer classes are dispersed, and the remaining two hundred are situated in the town of Gheel, and are appropriated to quieter lunatics and those who are able to pay more liberally for their treatment. In these habitations the sufferers are placed under the care of the host and hostess; more than three persons never being domiciled under one roof, and generally not more than one. The lunatic shares in the usual life of the family; his occupations and employment are theirs, his little cares and enjoyments are the same as theirs. He goes forth to the fields to labour as in ordinary life; no stern walls perpetually imprison him, and make him desire to overleap them, as Rasselas desired to escape even from the Happy Valley. If it is not thought fit for him to labour with plough or spade, he remains at home, and takes care of the children, prunes the trees in the garden, and attends to the potage on the fire; or if a female, busies herself in the ordinary domestic duties of the house. The lunatics, as may be supposed, are not left to the discretionary mercies of the host and hostess. A strict system of supervision prevails, somewhat analogous to that of the lunacy commissioners and the visiting justices of England. The entire country is divided into four districts, each having a head guardian and a physician, to whom is entrusted the medical care of every inmate belonging to that section. There are, in addition, one consulting surgeon and one inspecting physician for the whole community. The general government of the colony is vested in the hands of eight persons, who dispense a code of laws especially devised for it. The burgomaster of Gheel presides over this managing committee, whose duties are to distribute the patients among the different dwellings, to watch over their treatment, and to admit or discharge them. A visiting commissioner is annually appointed, who inspects the dwellings of the different hosts, and sees that the patients are properly cared for. The oversight of the lunatics falls almost wholly upon the hostess, the man rarely interfering, unless called upon to control a disorderly patient. The people of Gheel, from having been engaged for ages in the treatment of the insane, are said to have acquired extraordinary tact in their management, which, Dr. Webster remarks, may be considered to exhibit a most judicious mixture of “mildness and force.” Although instruments of restraint, such as the strait-waistcoat, and the long leathern thong below the leg, to prevent patients from running away, are occasionally resorted to, the sectional physician must be instantly informed of their imposition, and their use cannot be continued without his sanction. So little are they required, that Dr. Webster found less restraint in this colony, unconfined by walls, than in the asylum at Mareville, in France, containing a similar number of lunatics. Yet there were fewer escapes than from the strictly-guarded restraint-abounding prison, only eleven persons having fled from Gheel in the course of last year, and nineteen from Mareville. Here also, it will be observed, there is no separation of the sexes. The lunatics live the life of the other inhabitants, and males and females associate in the same household. If we compare the effects of this simple treatment with that of the most expensive of our own asylums, we are compelled to admit that the balance is in favour of Gheel, where, notwithstanding the free admission of chronic cases, upwards of twenty-two per cent. of cures takes place annually, while at Hanwell and Colney Hatch the cures never exceed fifteen per cent. No fair comparison can be instituted between the expense per head at Gheel and in our English establishments, inasmuch as living is much cheaper in Belgium; but we may state, that the average cost of board and lodging for each pauper in the colony is 10l. per annum, or exactly the sum charged for lodging alone in our county asylums.[17]

A plan, towards which we have been slowly advancing during the last half-century, will speedily, we hope, be more closely followed. A trial is already, to some extent, being made of it in the neighbourhood of existing asylums, and might supplant, with immense advantage, the prevailing custom of building new wings, and over-populating old wards. The present system of enormous buildings, which destroys the individuality of the inmates, and suppresses all their old habits and modes of life, is evidently disapproved by the commissioners, as appears from the language they hold in their tenth annual report:—

It strikes us forcibly that the commissioners have tended to create the evil they deprecate in not protesting against the erection of gigantic asylums; but it is cheering to find that the idea of supplemental buildings possessing a “domestic character” has taken possession of their minds, and that they are now enforcing it on the minds of others with their well-known zeal and ability. The Devon Asylum, among others, has adopted the plan; and its accomplished physician, Dr. Bucknill, the editor of the Asylum Journal, bears important testimony to the great advantages to be derived from it.

“These cottages are much preferred to the wards by the patients themselves, and permission to reside in them is much coveted.” In these few lines we read the condemnation of huge structures like Colney Hatch, built externally on the model of a palace, and internally on that of a workhouse, in which the poor lunatic but rarely finds any object of human interest, where his free-will is reduced to the level of that of a convict, and the very air of heaven necessary to his health is doled out at intervals, when, with infinite lockings and unlockings, the attendants order a batch of persons into the stagnant and tiresome airing courts. Infinitely better for the lunatics would be the freedom and homeliness of the smallest cottage to the formal monotony of cheerless wards; better far that they should, as Dr. Bucknill suggests, cook and wash for themselves, than that the offices should be performed wholesale in the steam-laundry and the steam-kitchen. A patient would undoubtedly feel a far greater interest in peeling his own potatoes for the pot, and in cooking his own bit of bacon, than in receiving them ready cooked. It is the duty of the physician to interest the patient in his daily work, and no more effectual method of accomplishing this could be suggested than in putting him to work for himself.

Wherever large asylums are already erected, no better plan could perhaps be suggested than the building of satellite cottages, which would form a kind of supplementary Gheel to the central establishment; but we should like to see the experiment tried, in some new district, of reproducing in its integrity the Belgian system. The colony of Gheel was once a desert like the country which surrounds it; it is now, through the happy application of pauper lunatic labour, one of the most productive districts of the Low Countries. Have we no unoccupied Dartmoors on which we could erect cottages, and train the cottagers to receive the insane as members of the family? The performance of domestic offices, the society of the goodwife and goodman, and the influence of the children, would do far more to restore the disordered brain of the lunatic—pauper or otherwise—than all the organization of the asylum, with its daily routine, proceeding with the inexorable monotonous motion of a machine, and treating its inmates rather as senseless atoms than as sentient beings, capable, though mad, of taking an interest in things around them, and especially awake to the pleasure of being dealt with as individuals rather than as undistinguishable parts of a crowd. The children are of particular moment. Lunatics are singularly gentle to them, and are interested in all their actions. At Gheel it is customary to send the bairns into the fields to conduct the patients home from their labour in the evening; and we learn from Dr. Webster that a violent madman, who would not stir upon the command of his host, will suffer himself to be led, without a murmur, by an urchin scarcely higher than his knee. The presence of the young in the ward of an asylum seems to light it up like a sunbeam. The love of children does indeed lie at the very foundation of the human heart, and we cannot estimate too highly their beneficial influence upon the brain which is recovering from the horrors of insanity.

One of the most important points in reference to insane paupers, as we have already intimated, is the bringing them as speedily as possible under treatment. The reluctance of the lunatic himself to be removed is usually extreme, and it is marvellous what ingenuity he will often employ to thwart the design. Southey relates that a madman who was being conveyed from Rye to Bedlam slept in the Borough. He suspected whither he was going, and, having contrived by rising early to elude his attendant, he went to Bedlam, and told the keepers that he was about to bring them a patient. “But,” said he, “in order to lead him willingly, he has been persuaded that I am mad, and accordingly I shall come as the madman. He will be very outrageous when you seize him, but you must clap on a strait-waistcoat.” The device completely succeeded. The lunatic returned home, the sane man was shut up, and until he was exchanged at the end of four days, remained in his strait-waistcoat, having doubtless exhibited a violence which amply justified its use. The aversion of the sufferer himself to be taken away coincides with an equal aversion on the part of his relatives and friends to send him from home, nor do they take the step till the madness grows intolerable. Precious time is thus lost at the outset, and when the removal occurs it is mostly to the workhouse. Here the patient is usually kept during the remainder of the curable stage of his malady. The parochial authorities are generally guided by an immediate consideration for the pockets of the rate-payers, rather than by any care for the welfare of the lunatic; and, as they can maintain him in the “house” at three shillings a-week—when they would have to pay nine if they transferred him to the county asylum—in the workhouse he remains until he becomes so dirty or troublesome in his habits that the guardians are willing to pay the difference to get rid of him. The first few months of the disease, within the narrow limits of which full 60 per cent. of the recoveries take place, are thus allowed to run to waste. Months fly by, and the victim subsides into the class of incurables. This produces a second evil. As the drafts of incurables are perpetually flowing into the asylums, they become “blocked up” in the course of a few years, and are converted into houses for the detention of hopeless cases. To this condition three-fourths of the asylums are already reduced, and the efforts of philanthropic medicine are brought to a dead lock by the short-sightedness of the parish authorities, who do not consider that for the sake of saving a few shillings in the board of Betty Smith in the first weeks of her craziness, they are converting her into a chronic burthen, seeing that she will probably live on to a good old age in the asylum, and cause them an ultimate expenditure of hundreds of pounds. To the swifter removal after the outbreak of the disorder we must look for a permanent remedy; but in the mean time something must be done to disembarrass the public asylums of the dead-weight of hopeless cases, if we seriously intend to take advantage of the curative appliances we already possess. The commissioners seem inclined to favour the erection of separate asylums for those who are beyond the reach of medical art. To us it seems that the more economical plan would be to apportion certain wards in the various workhouses for the reception of chronic cases, and to draft off the idiots alone to special establishments. By this means our water-logged asylums would speedily right themselves, and again become what they should never have ceased to be—hospitals for the cure of the insane. At present we encourage an elaborate system for the manufacture of life-long lunatics. It is well known that the cures of early cases of insanity throughout England amount to 45 per cent., and at Bethlehem and St. Luke’s, where no others are received, the cures have amounted to 62 per cent. and 72 per cent. respectively; whereas at Colney Hatch, Hanwell, and the Surrey County Asylum, the three great receptacles for the weepings of the metropolitan workhouses, the average cures do not exceed 15 per cent. If we take the lowest averages of cures, there is still a difference of 30 per cent. of human creatures who sink down into the cheerless night of chronic dementia and idiotcy, or who dream away the remainder of their lives in hopeless childishness. Another ground of complaint is, that a degree of clerk’s work is imposed upon the medical superintendents of large asylums which is quite inconsistent with a proper discharge of their chief duty—the recovery of their patients. Irrespective of the routine-labour of making daily and quarterly and yearly reports, which is very considerable, they have far more to do in their strictly professional capacity than they can possibly accomplish. The three great asylums near the metropolis contain upwards of 3,000 patients, or the population of a good-sized country town; and their moral and physical training is confided to exactly six medical men, or as many as will be found in an hospital of a hundred beds! It is needless to observe how little attention can be paid to each individual, and that the more promising patients must be inevitably swamped in the sea of hopeless lunatics. As long as our asylums remain mere houses of detention, the want of medical superintendence is not so apparent; but immediately these establishments are restored to their proper functions, we predict that the evil will become too glaring to last.

In many boroughs the authorities have entirely evaded the requirements of the Act of Parliament relative to their insane pauper poor, and have not only neglected to erect proper asylums, but have resisted for years the attempts of the commissioners to compel them to do their duty. In all such cases the lunatics not only suffer the ills consequent upon insufficient care, but when too numerous for home accommodation are subjected to a system of transportation, which is not only disgraceful to the municipal authorities themselves, but to the age for permitting it. True to their economical instincts, the guardians of the poor often “farm out” their insane paupers to the proprietor of some private asylum, quite regardless of distance. The commissioners, justly indignant at this sordid practice, state in one of their Reports that—

“At present, large numbers of these patients are sent to licensed houses far from their homes, to distances (sometimes exceeding, and often scarcely less than, 100 miles) which their relations and friends are unable to travel. The savings of the labouring poor are quite insufficient, in most cases, to defray the expense of such journeys, and their time (constituting their means of existence) cannot be spared for that purpose. The consequence has been, that the poor borough lunatic has been left too often to pass a considerable portion of his life, and in some cases to die, far from his home, and without any of his nearest connexions having been able to comfort him by their occasional presence. The visits of his parish officers are necessarily cursory and unfrequent, and he is, in fact, cast upon the humanity of strangers, whose prosperity depends upon the profits which they derive from maintaining him and others of his class.”