BROWNE S ASYLUMS FOR THE INSANE.
THE substance of this work was originally delivered in the shape of lectures to the Managers of the Montrose Lunatic Asylum, of' which establishment Mr. BROWNE was Medical Superintendent ;
and so much both of the form and manner of discourses are still retained, as to warrant their arrangement under that class of pro- ductions. The Lectures are five in number ; the first treating on the nature and varieties of insanity ; the second on its statistics ; the third describes what lunatic asylums were formerly ; the fourth what they are now'; and the fifth throws out a variety of sugges- tions as to what they ought to be, as regards their site, structure, officers, and general management. The book only professes to be a compilation, with such addi- tional matter as the professional experience and reflections of the author have enabled him to supply. In the execution of this task be displays a considerable acquaintance with the works of other writers on insanity ; he selects their facts and their views with . judgment ; his own additional remarks are sensible and useful, and both his style and arrangement clear. There is, however, a want of that spirit which original conceptions for the most part give to a production: the reader must have an interest in the subject before lie will take much interest in the work.
The most exciting lecture of the five, is that which relates to the past conditions of Lunatic Asylums in this and other coun- tries; though the horrors are of that debasing and physical nature which rather revolts than interests. The most curious is that on the statistics of madness ; from which we will glean a few facts. The proportion of the insane to the sane population throughout Europe is I to 1,000; in Wales, I to 800; in Scotland, 1 to 574;
in the United States, 1 to 262: which facts support the opinion that madness advances with the excitements of civilization,— commercial speculation, cheap spirits, and other social circum- stances being expressly assigned by BRIGHAM as the causes of American madness. Study, by itself, does not seem to be so injurious as is commonly supposed. Out of 472 cases, ESQUIROL
refers only 13 to the excess of study ; whilst 100 result from "the excess of the propensities, and 90 from an uneducated and ill-
regulated state of the sentiments." GEORGET'S lists affords Similar evidence. Out of about 1,000 cases, he enumerates " 25 victims of mental labour, 20 of an ill-conducted education, 106 drunkards, and 470 affected from other moral causes." On a wide
examination of statistical tables of insanity, one half of the cases are resolvable into (tales, follies, and ignorance.
It appears that in one instance three keepers were expected to guide, govern, and soothe :230 patients. In another asylum, HA patients wine mutt misted u two Lein rs. lis a third, each servant was appointed to take charge of ,e patkuts. The proportion usually is one keeper for 30 lunatic, This meals that one knurl Or woman is to attend to all the wants and wishus, regulate the eursloynieuts and amusements, counsel, tiampiillize, walk and 01n% ern with, clothe, and put to lest thirty per.00s, every (Inc of whom ili•plays a dif. ii rut form of insanity, is furious or fatuous, malicious or melancholy. The pruposal is altogether preposterous. rointrrly every female keeper in bethlem bad sixty patients under her care. This state of things is strongly contrasted wills the law on the subject in France, which accords one keeper for every tea lunatics.
But the character of the keepers is a greater evil. Owing te the scanty pay, and the risk, the anxiety, and the labour of the employment, no one engages in it but as a matter of necessity. As a body, the attendants on lunatics are said to be the refuse of other callings. "If' they possess physical strength, and a tole- sable reputation for sobriety, it is enough; and the latter quality is frequently dispensed with." Coarseness of manners, and an absence of all delicacy of feeling, is an inevitable result. If of brutal disposition, they are very liable to insult and tyrannise over their victims; and though a rigid supervision might prevent positive coercion, it cannot check the mockery of tongue or gesture. It is however to be suspected, that restraint not only takes place from ignorance and temper, but even from idleness. "I once" says TUKE, "visited a house for insane persons, in which security was a primary object. Here I saw three of the keepers, in the middle of the day earnestly employed—in playing at cards." Bat even if zealous and good-natured, such a class are obviously un- fitted for the delicate task of managing the insane. Impressed with vulgar notions of the disease, they often think it neeessaryto terrify or domineer ; and even their good-nature, if actively shown, frequently takes the shape of thvouritism or improper indulgence, "To show the ideas entertained by such personages of insanity, one fact may suffice. The superintendent of a public asylum, on paying his forenoon visit, found one of the patients, and one sub- ject to frequent fits of excitement, poised upon his head. The keeper was seated by the fire reading; and on being questioned ai 10 the meaning of the scene, replied, 'Oh, Mr. D. is perfectlf quiet ; he has been standing on his head for the last half hour. In establishments where females are confined, moral results of distressing nature take place, at least so far as ideas and language are concerned; and similar effects no doubt follow in male asylums, • if the patients are not beyond corruption of this kind. It may comfort the sentimental to mention, that statistics els not support CosroseY's assertion that geometricians, physicians, naturalists, and painters, are rarely insane, whilst mad poets, painters, priests, and musicians are rife. There are not sufficient filets to decide whether rich madmen proportionately exceed peer. nor, if more complete, would they be of much use, unless the respective numbers of the sane in each class were also ascertained, States of high political excitement, such as revolutions, add greatly, it is well known, to the number of insane; so do conn mercial convulsions. No age is secure from madness; infants and octogenarians become insane ; but the prime of MI:, as might be supposed from its exertions and excitements, is the period most - liable to attack. Out of tables whose aggregate gives nearly -1,500 patients, more than one-fifth became deranged between the ages of thirty and forty. As regards the sexes, mad women are upon the whole more numerous than mad men,—though there is a national exception in the case of Norway, and the proportions fluctuate in other countries. Let our bachelor readers note that the single are more obnoxious to madness than the married. At Charenton, out of 1337 patients, only 698 were yoked, whilst 859 were unmarried or widowed; and Dr. DUNCAN gives only 373 married out of 2,357: the proportion of the whole being more than three to one in favour of the conjugal state.
The chapter on " W hat Asylums Are," is useful for its calm exposition of the evils at present existing in establishments for the insane. A few of these may be traced to lurking prejudices and misconceptions as regards the treatment of the malady; but the greater part arise from the grand want, the want of means. The buildings are for the most part situated in confined or unpleasant or unwholesome spots ; their internal arrangement is often ill adapted to the objects for which they are used; still less do they admit of a proper classification of patients; and their grounds, if they have any, are insufficient, or not laid out to the best ad- vantage. But the great evil is the paucity of the attendants, and, looking to the nature of their task, their inferior character, In one public establishment, the patients, not long since, were irs duced or compelled to remain in bed on Sundays, that the keepers might visit their friends. In many others, unnecessary coercion tukes place, because the attendants are too few to employ the means that would enable it to be dispensed with. In most, if nut in all cases, the attendance seems to be insufficient even for the personal comfort of the patients, much less for the requisite attention their malady requires.
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