for females, under the constant supervision of a lady of high character for fidelity and intelligence; and no visitors allowed, not even the officers of the institution, without her permission and attendance. Idiots should be wholly excluded from hospitals for the insane. It is painful to behold patients, partially insane, who have received good education and been accustomed to intelligent associates, confined in the same place, and in fact classed, with idiots totally destitute of mind. It cannot fail of having an injurious effect upon the former, and can be of no service whatever to the latter. The incurably insane should also be perpetually separated from the curable, and the latter never know of the former.

The best Asylums for the insane are those that receive but 30 or 40 patients, only those of the same sex; and to which are attached extensive gardens and grounds for exercise. Public establishments ought always to have considerable land and workshops connected with them. Labor is often quite an essential aid in the cure of those, who have previously been accustomed to it. Patients belonging to the wealthier class, who have never been used to manual labor, require pleasure-grounds, carriages, and horses, for exercise and amusement.

Too much attention cannot be given by the proper authorities to the prevention of abuses in lunatic hospitals. There are no institutions where abuses are more likely to arise; none where they are more difficult to detect. This the history of such institutions, in England and other countries, but too painfully testifies. Some patients are frequently so violent and vindictive, that it requires great command of temper in their overseers not to retaliate sometimes; while others, instigated by appetite and passion, increased by their insanity, are perpetually on the watch to seduce those appointed to guard them, from their duty. Attendants of the most unblemished moral character, and remarkable for kind disposition, for calmness and intelligence, should be procured, and well instructed in their responsible duties; and be induced by proper compensation to devote themselves perpetually to the care of the insane.

Notwithstanding the attention hitherto given to the subject of insanity, much still remains to be learned. The medical superintendents of the institutions for the insane will have it in their power to add essentially to our knowledge of this important disease. Much, we have no doubt, is yet to be learned by autopsical examinations, made with the carefulness and minute

ness which distinguish modern researches in pathology. It is already rendered probable, that in all cases of insanity there are specific alterations of the brain. These, with the symptoms of the disease, should be accurately ascertained and described. At the same time, the treatment adopted, and its effects, should be faithfully recorded, and occasionally made public. It is gratifying, to be sure, to learn from the Reports of Lunatic Asylums, that many of the insane are cured; but surely it would be more gratifying, and of far greater utility to the public, to be informed what were the means which produced such results. Is separation from home, from relatives and acquaintance, all that is required for the cure? If so, this should be known. Many would prefer, and in many cases it would be better, to accomplish this without sending insane patients to large lunatic establishments. If medicines are serviceable, these should be made known, and the cases in which they are necessary described. In this way, such information might be imparted, as would enable many to be restored, at home, at the onset of the disease. We are of the opinion, that in a majority of cases of insanity, proper treatment in the commencement of the disease would remove it; and it will be very unfortunate for the community, if the impression becomes general, that insanity cannot be cured except at Lunatic Asylums. Cases of relapse, and we fear they are not few, should be ascertained as far as possible; and, together with the apparent cause, made known. The public desire the whole truth; and not merely to be informed that a large number of patients were considered cured, and discharged after a short residence in the Hospital. They wish to know how many of these were original cases, how many of them readmissions, what were the means of their restoration, and every particular calculated to throw additional light on the nature and cure of this mysterious disease. In this way, public Asylums, in addition to their present utility, will become valuable schools of instruction for all medical men, and be of incalculable benefit to the country and mankind.

But is the cure of insanity all that can be done to prevent its extension in this country? Cannot the causes of this disease frequently be ascertained and avoided? We believe they may. According to most writers on insanity, moral causes are far more operative than physical ones in producing the disease. "The observations," says M. Georget, "which

I have had it in my power to make, the more numerous ones which I have compared in authors, have convinced me, that among one hundred lunatics, ninety-five at least have become such from the influence of affections and moral commotions. It is an observation become almost proverbial in the Hospital, (the Salpêtrière,) 'qu'on perd la tête par les revolutions d'esprit.' The first question that M. Pinel puts to a new patient, who still preserves some remains of intelligence, is, 'Have you undergone any vexation or disappointment? Seldom is the reply in the negative." This opinion derives support from the fact, that the disease mostly occurs at that period of life, when the passions are excited by the strongest interests, and is chiefly confined to the civilized and intellectual communities. Insanity is a disease of the material organ of the mind, the brain; and never occurs unless this organ is affected. It is, therefore, theoretically probable, that moral commotions, mental anxiety, and the excitement of the feelings and passions, which disturb the natural action of the brain, should most frequently produce this disease.

It is, however, extremely difficult to determine with accuracy the cause of insanity in many cases. In examining the records of Lunatic Asylums in this country, we find intemperance in the use of intoxicating drinks mentioned, as a very frequent cause. No doubt it sometimes is; but we are not without suspicion that there is some other primary and predisposing cause, that is essential to the production of insanity in the intemperate. Intemperance has long been, and is now, very prevalent in some countries where there is but little insanity; and the instances are so very numerous of long and habitual intoxication without any tendency to this disease, that our suspicion is strengthened that some other cause predisposes the brain to the disease we call insanity. Intemperance is very common among the negroes and the Indians of this country, yet insanity is rare among them. The few cases of which we have heard among the former, appeared to arise from excitement of mind. Besides, the excessive use of intoxicating drink is not unfrequently the consequence, not the cause, of the mental derangement, and among the first symptoms of the disease. This fact has been often noticed. Still we do not doubt, that some cases are correctly attributed to intemperance; and still less do we doubt, that, as a secondary cause, it is of quite frequent operation, and has much increased this disease of late,

among the laboring classes in this country and England. When there is an hereditary tendency to insanity, or when the brain has been much disturbed by anxiety and mental excitement, then the use of intoxicating drinks unquestionably tends to develope it; and we have no doubt that very many thus circumstanced would escape the disease, if they would entirely abstain from stimulating drinks.

But altogether the most frequent cause of insanity is hereditary predisposition. Even if one sane generation has intervened, there is not, then, a certainty the next will continue so. It is much to be feared, that if marriages are contracted in disregard of this fact, the numerous cures effected of late will but serve to increase the number of the insane in another generation. In those born of insane parents, much may be done towards preventing the developement of the disease, by attention to their education, both physical and mental. "Predisposition to insanity," says M. Esquirol, "may be traced from the age of infancy; it furnishes the explanation of a multitude of caprices, irregularities, and anomalies, which, at a very early period, ought to put parents on their guard against the approach of insanity. It may furnish useful admonitions to those who preside over the education of children. It is advisable, in such cases, to give them an education tending to render the body robust, and to harden it against the ordinary causes of madness; and particularly to place them under different circumstances, from those with which their parents were environed. It is thus we ought to put in practice the aphorism of Hippocrates, who advises to change the constitution of individuals, in order to prevent the diseases with which they are threatened, by the hereditary predisposition of their family."

Next to hereditary predisposition, mental disturbance, care, anxiety, and faulty education are the most common causes of insanity. In no country, we presume, are these more operative, if as much so, as in this. As has been hinted, the very freedom of our institutions, by creating universal strife, and increasing the mental activity of all classes, causes much insanity. "Great mental activity among all classes, and both sexes, was the most striking characteristic of the people of the United States," noticed by Spurzheim. All are excited, and almost constantly; either on politics, religion, or, more generally, by speculations and projects to acquire wealth. This is not true merely of brokers, dealers in stocks, and merchants, neither is it

confined to the inhabitants of cities; but into whatever part of the country we go, or with whatever class we mix, we find excitement, speculation, and strife. Our thousands of newspapers, circulating in all parts of the Union, and their exciting articles read by all classes, create and perpetuate mental agitation. Then, their details of crimes, murders, and suicides add to the excitement, and, we are not without strong suspicion, often lead others to the commission of similar acts. We hope, however, that some of these evils, which are perhaps but consequences of our freedom, will correct themselves, and cease to be injurious; that the public mind, like the palate of certain epicures, will cease to be affected by ordinary stimulants.

But we hope more from the proper education of children and females. They are placed, in a good degree, without the vortex of speculation and political strife; and if educated properly, we trust a generation will arise, not liable to be affected by causes that hitherto have deranged and destroyed many. To effect this, however, the utmost pains should be taken to develope the physical powers of children. Premature cultivation of the mind should be avoided. Early excitation of the brain is as dangerous to that organ, as stimulating drink is to the stomach; and of itself is calculated to produce a tendency to nervous diseases, and often to insanity. Females should be educated in such a manner, as to make them robust and healthy. At present, especially in cities, in the large towns and villages of this country, they labor but little, exercise but little, and have become too generally delicate and nervous. This can be remedied only by accustoming them to much exercise in the open air, especially when young; with their bodies untrammelled by ridiculous and constrained dress, and their minds unoccupied, some of the time at least, by tasks and lessons.

Erroneous education is reckoned by many writers among the predisposing causes of insanity. On this subject Dr. Prichard observes,

"There are two different points of view under which the injurious effects of wrong education may be considered. By too great indulgence, and a want of moral discipline, the passions acquire greater power, and a character is formed subject to caprice and to violent emotions; a predisposition to insanity is thus laid in the temper and moral affections of the individual. The exciting causes of madness have greater influence on per