English asylums, Dr. Ray states, have a naked, cheerless, prison-like appearance; but he adds, "It would be a misplaced kindness to furnish poor patients with accommodations very much better than they ever knew before, and with which their own poverty-stricken abode, when they return to it, would present a painful contrast. Wisely, therefore, have cleanliness and suitable comfort been regarded as the only essential requisites in these rooms." The directors of the different European establishments entertain very different opinions upon the expediency of large associated dormitories. In England, these seldom contain more than a dozen beds, and often a much less number; while, in France, they sometimes have 50 placed in them. A very much larger proportion of the patients sleep in dormitories in the latter country than in England. The dormitory system has been much disapproved of by some as calculated to allow of annoyance by noisy or filthy patients; but those who have most employed them maintain that one of their chief advantages consists in the greater quietude which many excited patients assume when placed in them. This testimony was afforded the author in France and Scotland, and at Siegburg. In America, where every patient has his room which he may call his own both by day and night, the general introduction of such dormitories would be impossible. Moreover, the much larger proportion of excited patients would prevent this. Still the author is convinced, that in certain cases they would prove very useful. "There is a class of timid, nervous patients, who would be far more comfortable in an associated dormitory, especially when they first enter the institution. A poor, nervous female, startled by every sound, and apprehending every possible evil, who finds herself, perhaps for the first time for years, shut up in a room by herself, with no companion but her own agitated thoughts, unable to sleep, afraid to speak, is thrown into a state of disquietude, sometimes amounting to agony, not very favorable to recovery. Here the difficulty would be completely met by an associated dormitory. They are far better also for those suicidal cases which we now manage by having an attendant sleep in their rooms by the side of the bed. To be obliged to sleep on the floor in a room barely large enough for one, has no tendency to improve the humour of the attendant, and the consciousness of being specially watched is not likely to exert a salutary effect upon the mind of the patient. Nothing in the management of an asylum is a source of so much embarrassment as that class of patients in whom we suspect the existence of a suicidal disposition, but which is so feeble, or so successfully concealed, that we hesitate to place an attendant in their room at night, from the fear of unnecessarily exciting displeasure, and even suggesting suicidal thoughts where they did not previously exist. Thus, the patient goes unwatched, until he is found some morning ingeniously strangled by his pockethandkerchief, or a strip of his sheet. The liability of such deplorable events is much diminished by the use of dormitories. I do not mean to say that suicide would never occur in a dormitory, for the disposition is sometimes so strong that nothing short of unremitting vigilance can prevent it. What I do mean is, that it would be effectually prevented in that large class of the suicidal in which the propensity is not so strong as to lead to its gratification in the presence of others, whether asleep or awake. Many filthy patients, too, when tranquil, are, no doubt, better managed in dormitories, because the supervision there exercised is sufficient to improve their habits by exciting their self-control, and also secures that attention to their wants which they cannot receive so effectually when sleeping alone. * The dormitory itself, when tastefully * * * * * * * 1846.] VENTILATION, Attendants, &c. 399 fitted up, presents a more cheerful and pleasing appearance than rows of small solitary rooms, which necessarily have a somewhat prison-like appearance. Few features in the foreign asylums left a more pleasing impression upon my mind than some of their dormitories. Those of the Northampton asylum were the very embodiment of good taste, neatness, and propriety-temples to the somniferous god in which it would seem he must be delighted to dwell. In walking over the Salpetrière I could not help stopping repeatedly to admire the coup d'œil which one obtained by standing in the door-way of one of its dormitories, and looking towards its opposite side." 6. Day Rooms.-Little or nothing has as yet been done, either in America or Europe, to relieve the nakedness of the walls of these by the suspension of maps, pictures, &c.; although they should be rendered as attractive as possible in order to induce the patients to resort to them, and prevent the baneful practice of remaining alone. The substitution of long, narrow, half-lighted galleries for cheerful day-rooms is a great error. The windows of the rooms in the British asylums too often have a very prisonlike appearance. They are also superfluously guarded, and in a far greater degree than prevails in France. In Edinburgh and Glasgow a very convenient shutter is employed for the windows of excited patients, which, out of sight at other times, may be made very conveniently when required to cover any portion of the window desired. The doors of European asylums are also closed, and locked with far more clatter and noise than in America, owing to the ponderous nature of the instruments employed. The small tubular key described by Jacobi is in universal use in the States. 7. Padded Rooms.-These much excited the author's curiosity, as he felt convinced, from the description he had heard of their utility, either that insanity is a different thing in England from what it is in America, or that he had not been rightly informed of the nature of the cases in which they are employed. Subsequent enquiry confirmed these opinions. In England even, however, opinions are divided as to the utility of these chambers, but the author is disposed to believe they may be of much more service in this country than in America, where the violence in cases of excitement is so much greater. 8. Warming and Ventilation. The author was much surprised not only at the want of system of ventilation in the English asylums, but at the little importance their directors seemed to attach to its absence. They, for the most part, seemed content to rely upon the simple expedient of opening the windows, an imperfect one at all times, and impracticable in cold and wet weather. The infected state of the large dormitories was generally complained of, and stated erroneously as one of their inherent defects. Dr. Ray is a great admirer of Dr. Reid's system of ventilation, but with our present experience of its inefficiency it is not very likely to be introduced into any new establishment in which the preservation of health is an object in view. 9. Attendants.-In America, owing to the ease with which more agreeable employment may be obtained elsewhere, attendants will not remain more than a year or two in the establishments, while in England they are too often found therein after they have lost all their efficiency. In France, an excellent classification of the attendants prevails. One class performs the menial services, another acts as companions to the insane, and executes the orders of the remaining or superintending and responsible class, the organs of communication between the patients and the officers. It is obvious that much of the efficiency of the asylum depends upon the qualifications of the immediate attendants, and we fear the remuneration offered by most of our asylums is not sufficient to ensure these being of a high order. 10. "Quiet of the European Asylums.-With no feature of the foreign asylums was I so forcibly struck as the extraordinary quiet of the patients, as contrasted with the uneasiness and agitation of ours. Not a single instance of vociferation did I witness, and cries, and shrieks, and shouting, I rarely heard. That peculiar kind of vituperation joined with inexhaustible volubility, so familiar to those who have had charge of the insane on this side of the Atlantic, seemed to be unknown there; and even in the refractory wards, instead of the agitation and disorderly movements that characterise that class with us, there was a degree of stillness and quiet that would lead one to suspect, at first thought, that he was among the tranquil or convalescent. A visitor in passing through one of our asylums is besieged by persons who fill his ears with the bitterest complaints, representing themselves as the victims of the grossest injustice, and importuning him to procure their discharge. He is almost disposed to believe that there is really something wrong; that such feelings must have some other foundation than mere fancy; and he needs a hint or two on the subject, before he is made aware, that these persons believing themselves to be perfectly sane, cannot help regarding the deprivation of their liberty as an act of high-handed injustice, and the allegation of insanity as a bitter insult added to the injury. Twice only, once in England, and once in France, was I importuned for my assistance in 'getting them out.' I was allowed to pass along, seldom addressed, and exciting a look only of the faintest curiosity. The causes of such a singular phenomenon, I was naturally led to investigate, and, although I may have overlooked some of them, yet I believe, that the principal ones met my attention." We wish we were able to extract Dr. Ray's exposition of these causes, which is a very interesting one, but our limits forbid us to do more than enumerate them. 1. The proportion of old, incurable, and therefore quieter, cases is far greater in the British and French Asylums than in the American. 2. In these countries, too, insanity seems to far less frequently assume the form of intense and uncontrollable excitement. Common as such cases are in America, Dr. R. did not meet with one in Europe. "The continuance of furious, maniacal excitement for months together, which is so common a circumstance with us, is seldom witnessed in England or France; and nothing which I communicated concerning the disease in this country, excited so much surprise and interest as this trait." Dr. Hutchinson of Glasgow, expressed his belief that cases of intense excitement were much more frequent some years since than at present. 3. The physical condition of the patients in the British Asylums is much less vigorous than is that of the Americans. Want of food is not unfrequently described among the causes of the disease in the Reports. 3. The peculiar moral and social condition of the mass of British patients, they being in a state of pauperism, in which they are but too contented with the, to 1846.] RESTRAINT-LABOUR-RECREATIONS. 401 them, luxurious arrangements of an asylum. The American, on the contrary, has been cut short in the course of some hopeful career. 5. The manners existing in European society, and which inculcate so deferential a submission upon the part of the humbler orders, continue to exert their effect upon them with almost the force of an instinct, even when under the influence of their calamities. 6. There is a much smaller proportion of cases of moral insanity, (in which there is a complete perversion of some of the moral sentiments and affections,) in the European than in the American hospitals, where they exist in the proportion of 6 in 50, and become foci of discontent and confusion among those in whose company they may chance to be placed. 11. Restraint and non-restraint.—The subject of the disuse of restraint naturally excited much of the author's attention; but the information he was enabled to acquire concerning it was of a very conflicting and unsatisfactory character; and, as with regard to the padded rooms, he arrives at the conclusion that the non-restraint system has been regarded with undeserved favor in Britain, and that insanity is a very different thing here and in America. The directors of the various establishments furnished very discrepant opinions as to the possibility of entirely doing without restraint, especially in the violent description of cases seen in America, and for which none of the substitutes which he has here met with would prove effectual. We entirely agree with him that cases every now and then occur even in this country, for which restraint, not too long continued, affords the most humane as well as the most effectual mode of management. Dr. Ray is disposed to think a disproportionate share of attention has been given to this question. "When we consider, on the one hand, how slight a thing restraint is in the European institutions, and how seldom it is applied at all; and, on the other, how many points there are in the management of the insane, involving their comfort and curability in a far greater degree, I cannot help concluding that this question has received a degree of attention altogether disproportionate to its intrinsic merits. I do not mean to sanction the idea that the imposition of restraint is an unimportant matter. On the contrary, I would have it regarded as, in most cases, a necessary evil, used only for the prevention of a greater. When insane manifestations are to be resisted, as they sometimes must, the precise form in which it is to be done, whether by mechanical restraint, by seclusion in a room, or by the hands, arms, or legs of attendants, is a question that must be determined by the circumstances of the individual case, not by theoretical considerations." 12. Labour. This the author found actively pursued, and with unanimous testimony in its favour, in most of the European asylums he visited. The very different social position of the patients in America prior to the attack of insanity, already adverted to, prevents this engine of improve ment being there so much resorted to. Their independent spirit quite rejects all idea of labouring gratuitously in an institution in which they are detained against their will and at their cost. 13. Amusements and Recreations.-The same amusements are observed in the European as in the American asylums. Reading, however, by reason of the frequent illiterate character of the patients, is much less common; and even among the better classes of patients, books, and especially newspapers, are much seldomer seen. Walking and driving out into the country, so frequently practised in America, is seldom permitted in England, where paupers, as a general rule, never go outside the walls. "There seems to be in the English community, an undue apprehension from the insane when at large. The safety of the lieges is thought to require their constant detention within the asylum walls, and the utmost jealousy is manifested of any attempt to relax the rigour of their confinement. One of the Superintendents informed me that on one occasion he permitted a few of his tranquil or convalescent patients, accompanied by attendants, to witness the exhibition of a circus or some dramatic entertainment. The next day to his surprise he was severely censured in the newspapers of the place, for unwarrantably trifling with the safety of the community, by letting loose a band of lunatics. The gratification experienced by these unfortunate fellow-men, and the safeguard provided against any harm were not thought worth taking into account." The author also severely and justly comments upon the state of public Opinion among the wealthier classes in England, which, regarding the ocCurrence of insanity among any of their members with morbid sensitiveness, as if it were a reflection upon themselves, induces the immuring of these unfortunate beings to a degree not only unrequired by their symptoms, but prejudicial to their recovery. He also observes upon the care with which such persons were removed from his observation when he visited asylums, however deliberately he might be allowed to examine into the condition of the pauper class. While protesting against any desire to exhibit these or any other unfortunate beings to the gaze of heartless curiosity, he is certain the almost monastic seclusion practised is no less injurious. Many of the Superintendents deplored this state of things, but stated that any attempt at its amendment would be followed by the removal of the patients from the establishment. "It cannot be denied that in every asylum there are some patients who could be made happier and better by occasionally seeing and conversing with their more rational fellow-men. The only consideration that should influence our conduct in this matter should be the welfare of the patient, not the selfish feeling of his friends. Intercourse with the world should be regarded in the light of a moral remedy of no insignificant power, which it is as much our right and duty to use where it is evidently beneficial, as to withhold when there is reason to believe its effects would be pernicious. Its management should be left to the Superintendent, who is most able to form a correct opinion on the subject, and his decision ought not to be affected by the squeamishness of friends who would convert an asylum into a prison, nor by the vulgar curiosity of the public who would turn it into a show-house for the exhibition of the saddest infirmities of our nature." 13. Schools. Dr. Ray did not see any schools in operation in the British Asylums, although some were said to exist. In France and America they seem to be in advance of us in this particular, especially in the former country. At the Surrey and Wakefield Asylums much pains have been taken in the instruction of idiots. Dr. Corsellis, of the latter institution has found that, although by perseverance many of their mischievous propensities may be cured, and some simple employment taught them, any attempt to excite intellectual.exertion brings on paroxysms of ex |