In the thirteenth number of this Journal, May, 1855, we published an article on the accumulation of chronic lunatics in asylums, in which we recommended that further accommodation should be provided when needful, not by enlarging the existing buildings, but by the erection of distinct houses built on a simple plan, retaining as much as possible the ordinary arrangements of English homes. We recommended this arrangement on the experience derived from the occupation by patients of two small houses originally built for offices; these small houses or cottages, as they are called, are cheerful and homelike, and patients much prefer residing in them to the wards; their efficiency for the accommodation of tranquil patients and the simplicity of their construction, led us to advise on the score of economy, that further accommodation for chronic patients should be provided by establishing lunatic colonies, the cost of which we calculated “at the rate of 48 for each patient, or from one-fourth to one-seventh part of the relative cost per head, at which county asylums have been erected.”∗

Macbeth, the most awful creation of the poetic mind, is a study every way worthy of those to whom the storms of passion present the frequent cause of mental disease. The historian studies the temper of the mind in its most ardent heats, that he may gain a clue to the causation of human events; the statesman, that he may obtain foreknowledge of tendencies to human action; and the psychologist, for the more beneficent purpose of acquiring that knowledge as the means of alleviating the most terrible of calamities, and of doing that which the terrified physician in this tragedy dared not attempt, of “ministering to the mind diseased.” The philosopher studies the laws of storms, that he may teach the mariner to avoid the destructive circle of their influence; and the physician, whose noble object of study is the human mind, seizes every opportunity of making himself acquainted with the direction and events of its hurricane movements, that he may perchance lead some into a port of safety, or at least that he may assist in the restoration of the torn and shattered bark. But to stand on one side and calmly contemplate the phenomena of human passion, like the chorus in the old Greek drama, is the lot of few. When the elements of human passion are in fierce strife, there is no near standing-place for the foot of science, like the deck of the great steamer which allowed Scoresby to measure the force and speed of the wild Atlantic wave. The vortex of passion tends to draw in all who float near; and tranquil observation of its turmoil can only be made from a standing point more or less remote. On all actual occasions, indeed, it behoves the man whose object of study and of care is the human mind, to observe accurately its phenomena, and to test its springs and sources of action; but it behoves him to accept the testimony of those who have weathered the storm, and also gratefully to appreciate any assistance he may obtain from others who contemplate the same phenomena from different points of view to his own: and there is no one from whom he will derive help of such inestimable value, as from him whose high faculties enables him to contemplate human nature, as it were, from within. The Poet or maker, the same intrinsically with the Seer or gifted observer, is the best guide and helpmate with whom the psychologist can ally himself. He is like the native of a country to whom mountain and stream and every living thing are known, acting as instructor and guide to the naturalist, whose systems and classifications he may hold in slight esteem, but with whom he has a common love and a more personal knowledge for all their objects. Compared with the assistance which the psychologist derives from the true poet, that which he obtains from the metaphysician is as sketchy and indistinct as the theoretical description of a new country might be, given by one who had never been therein, as the description of Australia might be, drawn from the parallel of its climate and latitude with South America or China.

Every practical alienist will admit the great importance of the application to his specialty of the principles of Surgery, inasmuch as those corporeal defects and casualties, which are often connected with, and are prone to result from disturbance of the mind, the “noble guest of the flesh,” must have forced themselves upon his attention in a multitude of his cases.

It has been unfortunate for the cause of cerebral pathology, that those writers who have devoted much care and attention to the observation of cerebral changes presented in post-mortem examinations, have either lacked the desire or the opportunity to make themselves acquainted with the mental phenomena which had preceded death. The careful and minute detail of appearances observed in the brains of persons supposed to have died insane, disconnected from any account of the symptoms which existed during life, are of comparatively little value in the present imperfect state of pathological science. A few fossil teeth and bones enable Professor Owen to reconstruct the probable similitude of an extinct animal; but the science of pathological anatomy has attained far less certitude than that of comparative anatomy; and even the able descriptions of the post-mortem examinations made in Bethlem by Dr. Webster, have their practical value diminished from the want of some account of the symptoms which in each case preceded death. The descriptions of the older anatomists, Morgagni, Bonetus, and others, have the same defect; a defect, indeed, of which Morgagni was fully sensible, and of which he offers an explanation, or rather an excuse, in the fact that the medical men who had observed the cases during life frequently did not know whether to call the patients melancholics or maniacs; and that, indeed, “melancholia is so nearly allied to mania that the diseases frequently alternate, and pass into one another, so that you frequently see physicians in doubt whether they should call a patient a melancholic or a maniac, taciturnity and fear alternating with audacity in the same patient; on which account, when I have asked under what kind of delirium the insane people have laboured whose heads I was about to dissect, I have had the more patience in receiving answers which were frequently ambiguous, and sometimes antagonistic to each other, yet which were, perhaps, true in the long course of the insanity.” (De Sedibus et Causis Morborum, Epist. VIII.)

Among not a few less agreeable influences pervading lunatic asylums, there is one under whose effect every person concerned in the general management of those institutions is sure to come, viz., the architectural. No asylum superintendent is to be found, who has not various plans of renovation and improvement for his own institution, who does not see precisely the constructional arrangements which the insane require, and who has not, very generally, floating before his mental vision, asleep or awake, some grand scheme for a model asylum. Nor is this to be wondered at, when it is considered that the asylum building is the machine through and by which the superintendent is to work out and develope his system of moral management; that, in short, it is an instrument of cure, of the adequacy, utility, and perfectness of which he must be the best judge.

Insanity, together with many other forms of disease affecting the brain, are doubtless upon the increase. Our statistical tables and periodical registers all clearly and unmistakeably tell us this. It is no advantage either to society at large, or to individuals composing that society, to try to beg the question. We cannot disprove the fact. Better, therefore, let us try to search out its causes, that, if possible, they may be removed. By taking this course, we shall sooner find our-selves in a more hopeful position for arresting the onward march of a formidable enemy to our national peace and prosperity.

In the former part of this essay, I have dwelt at some length on the various causes that may induce a patient suffering under mental derangement to refuse food; and I imagine it is not difficult to gather, from what I have already said as to the treatment of such a case, that my opinion is strongly in favor of “Forced Alimentation.” As a general rule I consider that less harm can accrue from even too early mechanical interference, than must happen if the patient be left unaided till the vital powers have become enfeebled, and symptoms of dangerous exhaustion have set in. At the same time, I trust I have made it clear that I look upon the forcible administration of food to be the last resource, and only to be used when all persuasion has failed, and everything that experienced tact can suggest has been tried in vain.

The employment of warm and cold bathing in the treatment of the insane is of the highest antiquity. Three thousand years ago, long before Pindar had sung his famous αϱιστον μεν υδωϱ, or that Hippocrates, arid after him Celsus, Aretæus, and Galen, had given their testimony to the value of its application in head affections, and in nervous disorders; Melampus the Pylian, the first “alienist,” and indeed the first physician of whom we have any record, is said to have cured mania and melancholia by the administration of hellebore and the use of the warm bath. It may be mythical, that by the last prescription he restored the health of a princess, and gained a wife; but it is not the less true that his practice, as recorded or alluded to by Homer, Herodotus, and Ovid, was rational and successful; and that the first specialist appears to have well understood the efficacy of purgation, and the beneficial effects of bathing, in the treatment of mental disease.

Mr. President,—I need not tell you, Sir, nor the Fellows of this Society, that the study of the human mind is a subject which has occupied the attention of the greatest philosophers of every age; nor need I remind you how long that study was enveloped in the shades of mysticism, bewildered in the mazes of metaphysical subtilty, amid the dogmata of conflicting systems. It is to Locke that we are so much indebted for dispelling the mysticism of the schoolmen. Unshackled from the tyranny of ancient names, and regardless alike of Aristotle and his categories, Locke discarded the syllogism, and instituted a searching analysis of the phenomena of thought.

This question may conveniently be regarded from two different points of view. Apart from the information to be derived from actual observation or statistical inquiry, it is manifestly very important also to inquire, whether the most frequent causes of insanity are to be found in greater force in civilized countries than in those which are not civilized.

Of all the available resources of the Materia Medica, opium, in its beneficial efficacy, is probably surpassed by none. It calms irritability, it soothes pain, it assuages spasm, and restores sleep. And when, in the course of disease, these indications have to be fulfilled, there is no drug like opium upon which we can place such uniform reliance. It is no wonder, then, that its advantages have been solicited, and realised, in the practice of psychological medicine.

Before proceeding to give a slight description of a most interesting visit which I paid last September to the Asylum for the Insane, on the Isola di S. Servolo, Venice, conducted by the Padri Ospitalieri di san Giovanni di Dio, I am tempted to extract, from Dickens' Pictures from Italy, an account of his arrival by night at Venice, as it so prettily tells the story of my first impressions there, as leaving the railway station I embarked on board one of the black gondolas,* just as the bright harvest moon rose in all its glory on the broad waters of the Grand Canal.

Pursuing the consideration of those mechanical and surgical difficulties which beset the path of the practitioner in his treatment of insanity, I will again more particularly allude to those which result from the voracity, or unnatural appetites of classes of the insane, impelling them to swallow substances absolutely indigestible, or large portions of unmasticated food; and from paralysis of the nerves supplying the muscles of deglutition. A portion of this subject belongs equally to the sane world, as the remains of corroded knives, and other metallic substances in the museums of Guy's and other hospitals, and the works of authors on morbid appetite, sufficiently testify.

The object of the present paper is to illustrate some of the forms of Epilepsy met with in Asylums, and to point out their characteristics.