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It has sometimes occurred that a delay in the admission arose from the want of sufficient accommodation in the asylum; much more frequently, however, from neglect of timely application. The friends of patients often dislike their being placed in an asylum so long as they are manageable at home, and in consequence, that period of the disease is too frequently allowed to pass over when proper medical treatment is most likely to be efficacious.

The results of treatment are next adverted to.

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From the recoveries, forty-two must be deducted on account of re-admissions in consequence of relapses; thus reducing the number of permanent recoveries to 224, so far as the event is known. But on the other hand, credit is to be taken for at least one-half of those discharged as relieved, who are known ultimately to have recovered; the removal of a patient from the asylum who is tranquil and easily managed, having often a salutary effect. Again, of those remaining, a very considerable number are likely to recover, which circumstance must be considered in forming any calculation of the curability of the disease.

Dr. Mollan adverts to the pathology of insanity, but so cursorily that we do not think it necessary to notice this part of his report. We may simply observe, that many more males died from head-affections than females, a circumstance corroborative of the greater prevalence of the physical causes of insanity in the former.

The tendency of insanity to shorten life is a subject of importance, were it only in reference to life-assurance. Dr. Mollan subjoins the ages at which death occurred, as a contribution to the stock of data.

DIED.

Between 20 25 30 35 40 45 50 55 60 65 70
and 25 years. and and and and and and and and and and 85

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55 60 65 70 75

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In our last notice of the work of Esquirol, we gave at full length the results of his observations on the value of laborious employment in the treatment of insanity. The following observations so strongly confirm the opinions and statements of that distinguished physician, that we give them at full length. The subject is one of the first importance.

"The advantages of laborious employment in the treatment of insanity have long been known, but its systematic adoption in public asylums is of recent date. I have already mentioned the extent of ground attached to the asylum; the part of this lately acquired, is now being converted into a market garden for the growth of vegetables for sale. An average number of sixty men are constantly employed in the cultivation of the grounds; and although entrusted with the use of spades, shovels, and other implements, no serious accidents have ever occurred. They are of course at all times under proper superintendance. About fifteen men find employment in various trades, as weavers, tailors, shoemakers, and carpenters. A few are occasionally engaged in breaking stones, and making mats, others in the performance of various domestic offices in the house. The female occupations consist of spinning, knitting, and the various branches of needle-work, and they assist in washing, and in all the offices of house-maids. All the clothing for both males and females is made up by the patients, with the exception of hats and shoes. During the last year, 2088 yards of linen and calico were woven in the establishment, the yarn for the linen having been spun by the females, and 524 pairs of stockings were made by them. Small rewards are generally given for the articles manufactured, which here as elsewhere operate powerfully as a stimulus to exertion. Of the advantages of this system of employment, I can speak in very decided terms; persons who, when unemployed, are noisy, violent in their demeanor, quarrelsome, and discontented, very generally become, under the influence of suitable occupation, tranquil, orderly, and easily managed; and to its salutary effects I mainly attribute the recovery of numerous cases, some of which were at first most unpromising. Difficulties will no doubt occur in its individual application, requiring perseverance and address, and of course, it is not suitable to every case, nor to every stage of the disease; but I can confidently say, that at least eight out of every ten lunatics will be found in a fit state for some useful pursuit; and it is often a subject of regret that our means of employment are inadequate. The advantages, in an economical point of view, of employing the patients in a pauper establishment, are so obvious as to require no comment.

I shall give a brief sketch of a few cases in illustration of these observations. A farmer about twenty-seven years of age was admitted into the asylum, after having been nearly four years in a state of dementia, in consequence, as was reported, of the improper use of mercury. He was listless and taciturn, and would only reply to questions about himself, by telling his name and place of abode; his general health was unimpaired, and his appetite was good, but before commencing his meals he always required the assurance of some of the attendants that the food was good, and proper for him to eat. At first, he refused to engage in any occupation, but being otherwise amenable, and shewing no vicious propensity, a wheel-barrow was placed before him, and a man at

either side took him each by a hand, and fixing them on the handles of the barrow, he was gently urged to the use of it; finding this plan persevered in, he soon consented to work by himself; and afterwards taking to the use of the spade he proved himself an excellent workman. In a short time an improvement was apparent in his mental state, he became gradually more intelligent and communicative; his recovery proceeded without interruption, and he was discharged quite well after a residence of eleven months in the asylum.—A tailor, aged thirty-six years, was admitted in a state of melancholy of six months' duration; he was remarkably timid and reserved, and when questioned about himself he seemed disposed to give the required information, but his sentences were always unfinished from failure of memory, and want of words to express himself; his general health was impaired, and his appetite poor. After having been for some time under medical treatment, it was determined to try if he could be induced to work at his business, another tailor being constantly employed in the same division with him. Some difficulty occurred in persuading him to make the effort; but by encouraging language, and holding out the hope to him that he should be enlarged as soon as he shewed that he was able to resume his trade, he was led to begin. At first his progress was slow, and frequently interrupted by fits of abstraction: but he gradually became more collected, and capable of longer continued application, and by steady perseverance in this course he recovered perfectly, and was discharged nine months after his admission.-A man, aged twenty-eight, who had served for some years in the East India Company's Artillery, was invalided in the island of St. Helena, and discharged as unfit for service in consequence of insanity, which had commenced with delirium tremens. He was admitted into the asylum about twelve months after being first attacked, when he was incapable of giving any correct account of himself; he was melancholic, and in general silent; when he did speak, his conversation was an incoherent jumble of the recollection of past events; his general health was a good deal impaired. For nearly three months after his admission there was very little change in his situation, he then began to shew more intelligence, and to take more notice of what was passing around him. It was discovered that he had been accustomed to the care of horses, and was fond of them; advantage was taken of this circumstance, and he was employed about the manager's horse, which in a short time was entrusted entirely to his care. From this period he steadily improved, and his recovery was complete in twelve months from the time of his admission. After being discharged as a patient, this man was employed as a keeper in the asylum; the duties of which situation he has now performed in a very satisfactory manner for the last two years. I may here mention, that one of the best nurses at present in the establishment is a woman who first entered it as a patient many years ago, and was then in a state of violent excitement.

The example of others employed around them greatly assists in overcoming the disinclination to every kind of exertion which many patients evince; and although the results of employment will not be always as satisfactory as in the examples I have adduced, still in every case more or less advantage will be derived from it. The general health is promoted, discipline is maintained, and active exertion in the open air is found more advantageous in producing quiet sleep than opiates. Many of our most industrious patients are persons whose cases are likely to prove incurable, but who are made as happy as their several states admit of; some, by their labours, are fully requiting, others materially lessening, the expense of their maintenance to the public."

TWENTIETH REPORT OF THE DIRECTOR OF THE WEST RIDING OF YORK PAUPER LUNATIC ASYLUM.

We have lately devoted some space to the consideration of insanity, and of the questions that hang by it. The utility of a periodical journal of medicine consists, we imagine, in bringing important subjects prominently, and in succession, before the public eye, and in directing particular attention to the main practical points connected with them. We would fain believe that by pursuing such a plan, we are contributing, and not meanly, to the diffusion of science, if not to the advancement of it.

The Report before us, brief at the best, is peculiarly so in reference to the medical history and management of insanity. But we are vaguely promised, at some future period, the information we may reasonably ask for.

The number of patients in the house appears to range between 317 and 366. The average number during the year was 346. Of these, rather more than one half were males. All cases of insanity, favourable or unfavourable, are admitted, a circumstance that must tell, of course, on the mortality.

808 1406

Statement of the Admissions, Discharges, and Deaths of all the Patients in the
Asylum, since its Opening, on the 23rd of November, 1818.

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We think the following Table of Re-admissions both curious and likely to be profitable. Some perhaps may feel surprise at the preponderating number of re-admissions, after a considerable period.

Statement of Patients re-admitted.

Patients re-admitted who had not been discharged three months

Patients re-admitted who had been discharged between three and six months.

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Patients re-admitted who had been discharged between three and ten years

Patients re-admitted who had been discharged between two and three years

Patients re-admitted who had been discharged between
six and nine months..
Patients re-admitted who had been discharged between
nine and twelve months
Patients re-admitted who had been discharged between
one and two years

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Of 183 admitted in 1838, 45 are the subjects of insanity, the result of intemperance; 38 with propensity to suicide, having made actual attempts on their lives; 16 are epileptic, and 8 idiots from birth.

There are one or two points on which we shall touch.

1. Bad Effects of great Reduction in Mania. "It is satisfactory to find, that notwithstanding the great increase in the number of patients, (the average throughout the year being 346,) the mortality has diminished. Thirty-seven have died, some within a short period of admission. Amongst this number was a patient who had been insane seven days before being sent here; he had been bled from the arm three times, to syncope; the quantity abstracted was 96oz. in less than four days; from this, and severe purgation,' the system was so reduced, that the patient, as may be expected, never rallied. Another was received in a sinking state, with the hands and arms enormously swollen, of a blackish colour, approaching to mortification, and a deep indentation in the upper arm, produced by a cart-rope, which had been used for the purpose of binding him down in bed; he had been highly excited, but on his admission all restraint was removed; he became calm, answered every question rationally, and continued in that state up to the period of his death, which took place in twelve hours."

2. Sketch of the Economy of the Asylum. The patients are all paupers, their respective parishes paying for each 6s. per week. This sum defrays every expense. They are fed, lodged, and clad alike, wearing a dress of grey woollen cloth, which is woven and made up by themselves; they rise at six A. M. in the Summer, and seven in the Winter, and all who are in a fit state, (of whom there are a great number,) attend with such servants as can be spared at morning prayers precisely at eight o'clock. They breakfast on milk pottage and bread at half-past eight. At nine o'clock the gardener, farmer, laundry woman, &c., select those patients, who by previous arrangement with the Director have been fixed on, for their several occupations, and commence work.

At eleven, the workers have a luncheon of bread, and three-quarters of a pint of table-beer. They dine at one. Their dinners are one day, meat, yeast dump

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