Слике страница
PDF
ePub

reported, from his own experience, 221 cures out of 242 recent cases, affording a proportion of 91 in 100. Dr. Ellis, director of the York West Riding Lunatic Asylum in England, stated in 1827, that of 312 patients, admitted within three months after the commencement of the insanity, 216 recovered.

Mr. Tuke, of the Retreat near York, observes, "According to the result of our experience, I should say the probability of recovery from uncombined insanity, in recent cases, is somewhat greater than nine to one. Several other hospitals for lunatics in England, established within a few years, have been equally successful in curing recent cases of insanity.

Some of the asylums of this country are not behind those of England in this respect. By the Report of the Bloomingdale Asylum, near New York, it appears, that of 125 recent cases, received during the last two years, 93 were cured. At the Connecticut Retreat at Hartford, previous to the 1st of April, 1836, there had been received 328 recent cases, of which 274 recovered. The last Report of the superintendent of the McLean Asylum at Charlestown, Massachusetts, states, that from May 1st to December 31st, 39 recent cases were received, of which number 32 had been cured. So large a proportion of recoveries has surprised many, especially medical men on the continent of Europe; and some have believed it could be explained only by supposing that patients were discharged at a very early period after apparent recovery, or during an intermission of the insanity which occasionally occurs. We are inclined to believe that this is sometimes the case, as we have known cases, reported cured, in a short time relapse, and others pronounced well that were but improved. It is much to be regretted that any institution of this kind, from anxiety to report a great number of recoveries, or from any other motive, should dismiss as cured, any who are not so, or any who have not remained a considerable time after apparent recovery.

Again; in some institutions many are received, whose insanity is caused by the immoderate use of intoxicating drinks. Such cases, as Dr. Prichard remarks, "are in general to be reckoned among the cases most easily cured, for although this is not uniformly the fact, it often happens that when the exciting cause is removed, the effect begins to lessen, and eventually ceases. When these patients are prevented from

obtaining stimulating liquors, and are treated with sedative. remedies, they quickly show signs of amelioration and of the subsidence of the disease." This may perhaps explain why, in some of the institutions of England and of this country, the cures of recent cases of insanity have been more numerous than in the institutions on the continent of Europe. Intemperance, in this country and in England, is reported to be a very frequent cause of insanity; but, according to M. Esquirol, it is not so in France, even among the lower classes. Among 336 lunatics in his establishment, there were only three who appeared to have lost their reason through the habit of intoxication. Still the uniform testimony of all lunatic hospitals is, that a large majority of the recent cases of insanity are cured; and in contrast with this, is the fact, that those of long standing are exceedingly difficult to cure.

According to an official statement to Parliament, by Doctor Vietch, out of 152 old cases, only 5 were cured. Dr. Ellis says, that at the York West Riding Asylum, of 318 cases that had existed from one to thirty years, only 26 were restored to their reason. M. Esquirol, who from his vast experience is great authority on this subject, observes, that after the insanity has existed three years, the probability of cure is scarcely one in thirty. Of 173 old cases in the Bloomingdale Asylum, New York, in 1835, only 16 were cured. The reason of the incurability of chronic cases appears, from the researches of modern pathologists, to be, that the longer the disease has existed, the more profound the alterations of the brain become. But though the probability of curing old cases is small, compared with those that are recent, yet we ought never to despair of recovery; as many, after having passed eight or ten years in a state of lunacy, have been restored to their reason, and some after having been insane twenty and even forty years.

But there is reason to hope that hereafter, few of the insane will be suffered to remain month after month, and year after year, without measures being adopted for their restoration. Just views respecting the disease now more generally prevail than formerly. It is no longer regarded as a disgrace, or as a disease resulting from some criminal offence. It is now considered a physical disorder, a disease of the brain, and one which can be as readily cured as disease of other organs of the body. But, in order to effect a cure, it

is often necessary to remove the patient from his home, and separate him from his relatives and former associates. We say it is often necessary, for undoubtedly there are cases that would not be benefited by this course, and some that would be aggravated by it. Quite recent cases may frequently be cured without seclusion. Broussais refers to a great number of cures effected by active treatment alone in the commencement of the disease. On the necessity of seclusion, M. Esquirol remarks, in a late publication; "Confinement should not be prescribed for all insane persons; for, if the delirium is partial or transitory; if it relates only to objects of indifference, and is unaccompanied with violent passion; if the patient has no aversion to his home, nor to the persons with whom he lives, and his delirium is independent of domestic habits; if his real or imaginary causes of excitement are not to be found in the bosom of his family; if the fortune or life of the patient, by retaining a large proportion of his friends, is not compromised, and he submits to the proper means of cure; in all these cases confinement may be useful, but it is not indispensable. But if the patient, retaining a large portion of his intellect, has a great attachment to his relations, it is to be feared that confinement might aggravate the disease." But such cases are much less frequent than those that require seclusion and separation from friends and home. This renders hospitals for the insane necessary, and we rejoice to find they are rapidly multiplying in this and all civilized countries.

Asylums for the insane are of modern origin. In fact, all public hospitals for the sick and poor may be so considered, as they originated with the Christians of the third or fourth century. But long after those suffering from other diseases were received into hospitals and provided with medical assistance, lunatics were neglected, and perished in great numbers. Some of the most furious were confined in small cells, or shut up in convents and dungeons, while others were burned as sorcerers, or as possessed of demons. Those that were tranquil were permitted their liberty, abandoned however to neglect, to the abuse and the laughter, or to the ridiculous veneration of their fellow creatures.

But about the commencement of the seventeenth century, lunatics began to be received into the general hospitals, where they were confined in the most obscure corners of the buildings, and received no medical aid. Soon after this, in some

of the large towns of France, a few separate but poorly conducted hospitals were provided for the insane, though the greater part still remained at liberty, or were confined in the general hospitals. It was not until 1792, when M. Pinel was appointed physician in chief to the Bicêtre at Paris, that correct views respecting the treatment of the insane began to prevail, and to be reduced to practice. At this institution, when M. Pinel took charge of it, were a large number of lunatics considered incurable. Many of them being very furious, were kept constantly chained. This illustrious physician, after having in vain solicited the government to allow him to unchain these maniacs, finally went in person to the authorities, and advocating, with much warmth and earnestness, the removal of this monstrous abuse, obtained permission to do as he pleased respecting them. Great fears were entertained for the personal safety of M. Pinel, should he undertake to unchain them. This, however, he resolved to do. The first man on whom he tried the experiment was one of the most furious, who had been in chains forty years, and had already killed one keeper by a blow with his manacles. Pinel entered his cell unattended, and offered to remove his chains and permit him to walk in the court, if he would promise to behave well and injure no one. "Yes, I promise you," said the maniac. His chains were then removed, and the keepers retired leaving the door of his cell open. "He raised himself," says the son of the celebrated Pinel, in a paper read at the Academy of Sciences, "many times from his seat, but fell again on it, for he had been in a sitting posture so long that he had lost the use of his legs. In a quarter of an hour he succeeded in maintaining his balance, and with tottering steps came to the door of his dark cell. His first look was at the sky, and he cried out enthusiastically, How beautiful!' During the rest of the day he was constantly in motion, walking up and down the staircases, and uttering short exclamations of delight. In the evening he returned of his own accord into his cell, where a better bed than he had been accustomed to had been prepared for him, and he slept tranquilly. During the two succeeding years which he spent at the Bicêtre, he had no return of his furious paroxysms, but even rendered himself useful, by exercising a kind of authority over the insane patients, whom he ruled in his own fashion.

[ocr errors]

In the course of a few days, Pinel released fifty-three maniacs from their chains. The result was happy beyond his hopes. Tranquillity and harmony succeeded to tumult and disorder; and, by the aid of continued mild and judicious treatment, the most furious became calmer and more tractable, and many were restored to perfect health of body and mind. This transaction caused much sensation, not only in France, but throughout the civilized world, and created a revolution in the treatment of this unfortunate but hitherto neglected portion of our fellow creatures. To M. Pinel is unquestionably due the great credit of first employing judicious, systematic, moral means in the cure of the insane.

At present there are in France many large institutions for the reception and cure of lunatics. Among the most celebrated are the Salpêtrière and the Bicêtre, and the Maison Royale de Charenton. The former, at the southeastern extremity of Paris, is composed of several buildings, enclosing spacious gardens and grounds for exercise. This is for the accommodation of females only. It usually contains about 1000 lunatics. These are divided into three classes, the curable, incurable, and idiotic. M. Pariset has the medical superintendence of the curable class. The Bicêtre, about two leagues from Paris, receives only males. It usually has from 350 to 400 patients. Here are also spacious grounds for exercise, and a farm where many of the patients are employed much of the time. The Maison Royale de Charenton, a short distance from Paris, is exclusively appropriated to the reception of the insane of both sexes, and contains 600 beds. Besides these, there are others. in the vicinity of Paris and in many of the large towns of France, some public and some private, but all under good regulations and well conducted.

In London, so early as 1553, lunatics were received into the Bethlem Hospital, a Royal foundation for lunatics, incorporated by Henry VIII. This hospital has been rebuilt several times, and enlarged. It is now a noble brick building, 580 feet in length, with accommodations for 400 patients. It cost about £100,000, and has an annual income of £18,000. St. Luke's Hospital, another institution in London for the reception of lunatics, originated in 1732. The present building, though commenced in 1751, was not completed until 1786, at an expense of £55,000. It is a solid

« ПретходнаНастави »