« 前へ次へ »
cannot into the courses in wade peak of curing
tonics of others. This practitioner prescribes warm, that, coldbathing. Some say little is to be done by any curative means, others, with even greater confidence, assert that insanity is the most remedial of all the maladies to which man is heir..
The fact is, we believe, that a great deal of this diversity of sentiment and opinion, has arisen in consequence of regarding the subject in too empirical a manner. Medical men talk of curing lunacy, as the vulgar speak of curing a cough. Indeed, while a generic term is made to include so many varieties, in relation to the causes upon which derangement depends, it. cannot in strict propriety be made a question, whether insanity is, or is not curable. When a man receives a sabrewound on his skull, and consequently loses his senses, we are in the habit of considering the case without cure, from a general feeling founded upon obvious truth, that as an organic lesion' has here been the occasion of the deranged state of the intellect, it cannot be set to rights, because it is not within the compass of medicine or management to re-organize. Again, if part of the brain is annihilated by accident or disease, we cannot restore, the lost material, nor by consequence its particular functions ; or if a tumour grow in the interior of the encephalon, the des rangement of functions to which it gives rise, is irremediable, inasmuch as the cause of the derangement is itself untangible. Now, our knowledge of sentient and intellectual faculties, as connected with structure, is so extremely limited ; the knife of the anatomist does so very little in clearing away the obscurities which hang over sentient organization, that we may conceive of alterations quite as effective, and quite as permavent, as those just supposed, although they may not, even by any artificial means, be capable of being detected by our sepses; and, in that case, the mental malady might be quite as hopeless, in respect to any prospect of recovery, as in instances where it has been dependent upon such palpable causes as obviously to place it out of the possibility of cure. Disordered intellect, therefore, having in its display to do with the sen tient system, of which our knowledge is so confined, cannot be calculated upon, either in respect to its essential nature, or any probability of advantage to be derived from treatment, with any thing like the accuracy with which we predicate the remedial nature or fatal tendency of mere bodily ailment. "
Although it is not within the scope or intention of the present paper, to pursue the subject of insanity in the way of reguar dissertation, we shall, we trust, be excused for adverting to one particular feature in the phenomena of deranged intellect, which We conceive has not been sufficiently recognized or dwelt upon, in investigations relative to the rationale of mental alienations. We allude to the alternate, and, as it were vicarious manner, in
which diseases of the body and of the mind oftentimes succeed to, and take place of each other. In a pamphlet which Mr. Tuke some time since published, there is one remarkable example of this kind, which, from its very interesting nature, deserves recital.
• A young woman, who was employed as a domestic servant by the father of the relater, when he was a boy, became insane, and at length sunk into a state of perfect idiocy. In this condition she remained for many years, when she was attacked by a typhus fever, and my friend, having then practised for some time, attended her. He was surprized to observe as the fever advanced, a development of the mental powers. During that period of the fever when others were delirious, this patient was entirely rational. She recoga nized in the face of her medical attendant the son of her old master, whom she had known so many years before'; and she related many circumstances respecting his family, and others, which had happened to herself in her earlier days. But alas! it was only the gleam of reason; as the fever abated, clouds again enveloped her mind. She sunk into her former deplorable state, and remained in it till her death, which happened a few years afterwards.'
Although this case must be considered as very extraordinary, the records of medicine are not wanting in instances of that kind of succession and alternation of mental and bodily disorder Ho which we have above referred, and of which the example just narrated, is but a remarkable and forcible illustration. Dropsical and pulmonary affections have been seen to yield, in order to make way, in a manner, for the introduction of insanity ; while this last has been expelled, in its turn, by the supervention and return of the original complaint. There is another circumstance, also, which is common to mental alienations, and which, indeed, is of so frequent occurrence, as to have been often noticed by many persons who were not professional observers ; we allude to that sudden and transient restoration of the intellectual faculties, which not unfrequently immediately precedes bodily dissolution. After the mind has, to all appearance, been for years extinct, it bursts out from its corporal confinement, and casts a parting glance at the surrounding scene.
These facts demonstrate a frequent connexion between ailments of the body, and of the mind, as intimate as it is inscrutar ble; and serve to shew that the human frame may be subject to such varieties of condition as to be productive of mental hallucination, although the precise nature of such state shall elude every research of the pathologist. As we are ignorant, then, of the nature, we must also be ignorant of the extent and probable duration of the morbid change. When, therefore, we find, as in some of the publications before us, individuals asserting with confidence the curable pature of insanity, and hinting,
that had this and that patient been under their care, the hallucinations would have disappeared, we cannot avoid regarding their assertions and intimations, as partaking in a large measure of empirical presumption. Which among them could have anticipated the circumstances and temporary cure of the idiotic girl above referred to ? and who is there that could unravel the intricacies of the case by any ascertained physiological principle?
But there is another consideration, and it is one of a very momentous and i:nperative nature, which has still more to do with the late investigation, it is this whether, even in cases of incurable lunacy, it be not possible to effect by cone; ciliation and kindness, what has hitherto been oftert essayed to be done by coercion and restraint ? - Is a madman out of the pale of humanity? --- Is he, on account of the suspension of reason, to be treated as if the rational faculty were not obscured, hut extinct ? To these most important queries such replies have been made as to implicate in their tendency, the conduct and character of several receptacles for the insane; it appeared, therefore, to be the duty, of an enlightened legislature to interfere further in behalf of this most afflicted portion of the hu-, man race That interference, as we have above observed, has been candidly, rationally, and humanely made, and the publications before us are some of its consequences.
The Legislature has bad, however, a still further object in view, than that of securing an appropriate treatment, and as much comfort as is consistent with their situations, to those who are already and properly confined in consequence of mental disorder. Its aim has been directed towards placing a' more effectual barrier, than the act already in force has been found to provide, against the commission of the enormous crime of unnecessary confinement; a crime which, to the eternal disgrace of human nature, has not only been in many instances conceived, but actually committed.
We shall not detain our readers with any very copious extracts from the published reports of the Committee of investigation, especially as they have already been before the public in the prints of the day. We shall therefore confine ourselves to the selection of one or two examinations, which will serve to shew to those who may not hitherto have had their attention drawn to the subject, the great good that has already been effected by the business having been brought before the cope sideration of Parliament. The Honorable Henry Grey Bennet, himself a member of the Committee, presents to it the following: evidence:
I visited Bethlem some years ago, and was then very much struck with the condition in which the patients were; there appeared Vol. V. N. S.
to me to be the greatest coercion in general use; numbers were gonfined to the wall, fastened to benches and tables, and many of the patients were almost in a state of nudity: I visited it again lagt year in company with Mr. Wakefield, Mr. Lambton, and one or two other gentlemen ; I found not so many patients in the same state of nakedness and restraint as at my last visit, but in the women's wards upstairs, there were many of those unfortunate people chained to the wall in a small room, some of whom had been so chained for years during the day; the smell and dirt of the room were in the highest degree offensive; amongst those persons was a roman of the name of Stone, who was formerly a governess in a respectable family, evidently a person of some accomplishments, who was chained to the wall, though she did not appear to be at that time or was stated ever to have been a furious maniac. There was also a woman confined in a cell, chained to the wall at the end of the gallery; she had been so confined for several years, was, in a state of furious agitation, and her voice and cries could be heard in all that part of the hospital. I saw also Norris; the iron apparatus in which he had been confined was then removed; but the chains which fas... tened the neck of the patient to the iron' stanchion as well as the leg-lock, were still used.
Norris stated, that he was fully aware he was a dangerous person ; that he should be sorry to be permitted to walk unmanacted in the gallery ; but if he could be prevented from doing others any misChief, which, if he was not provoked he should not attempt to do, he should consider the permission of taking that exercise a great indulgence; he added also, that he had made repeated complaints against the mode of confinement in which he bad been for so many years; but that he was now treated like an Christian, and that has felt himself quite comfortable. He particularly alluded to the plos sure he felt in being able to sit down on the edge of his bed; he was employed in reading the news paper, and he asked me many ques tions on the subject of politics, in which he appeared to take the greatest interest. I visited Bethlem, on the 27th of May last, in company with other members of the House of Commons, Lord Las. oelles, Mr. William Smith, Mr. Duncombe, Mr. Frankland Lewis, and Mr. Sturges Bourne. The change that had taken place in the appearance of the patients in the Hospital was most striking; on the, men's side, no man was chained to the wall: only one was in bed, and he was ill; the patients were mostly walking about in the gallery, and the whole Hospital was clean and sweet. On the women's side, two only, when we entered the Hospital, were chained by the hand. Miss Stone, who had been confined in the hospital for several years, three of which, she had been chained during day-time to the wall, wrapped up in a flannel gown, was sitting by the fire dressed like a woman, employed in needle-work, and tolerably rational; she appeared chcarful, and contented, and most grateful to the Matronig, who accompanied us during our visit, for the change which had taken place in her situation.'
"The woman who was confined at the end of the gallery the year before, in that violent state of irritation above mentioned, was now
teiensed, and was walking about the gallery, apparently tranquil ; she repeatedly thanked the Matron for her kindness, and said it was owing to that kindness that she was in the composed and comfortable state in which we found her. I have no doubt that the change which is so visible in the condition of the hospital, and in the mental improvement of the patients, has arisen from the different treatmeñt that they have received from the new Steward, Mr. Wallett, and the new Matron, Mrs. Forbes. To any one who remembered the apparent neglect with which, the preceding year, these unfortunate persons were treated, this change in their condition was most consolatory
In aóswer to a further question from the Committee, whether be did not consider the iron apparatus worn by Norris to be unnecessarily heavy, Mr. Bennet replies,
• From what I have seen of furious maniacs in other hospitals and places of confinement, I should have no hesitation in saying that it was a mode of restraint unnecessary and unwarranted. It has always appeared to me (he adds) from what I have seën of Bethlem, that the restraint was used there more from feelings of revenge than for purposes of medical cure.
The above evidence is a document of too unequivocala nature, which establishes the fact that much abuse has existed ; it serves at the same time to prove, beyond the possibility of dispute, that much may be done, with safety to the attendant and advantage to the patient, by kindness and conciliatory treatment. The only remaining inquiries, then, at issue, are, by what means this treatment can be best secured to the unhappy sufferers under mental dérangement; and what are the best measures to which the Legislature can have recourse in order to prevent the practice of confining individuals upon groundless and false pretences.
It was a natural order of proceeding, in reference to the first particular, to establish an inquisition into the condition and usages of those several receptacles for the insané, that were already in existence; and by collating and contrasting their respective advantages and disadvantages, to come to such conelusions as should serve for a guide to future proceed.. ings. Accordingly, the printed reports exhibit the interior of a great number of lunatic asylums, in some of which, as in the larger and more public establishments, were unveiled the most shocking mismanagement and the most culpable neglect. It is, however, gratifying to learn, from the accounts of others, that a conscientious skill and persevering humanity, were employed, to effect one of the most momentous objects that can engage the energies of man. An account of a well-regulated establishment, called the Retreat, near York, instituted and conducted by the Society of Friends, has already beep pub