5
which might lead us to suppose that tobacco alone can become a cause of
insanity, still it cannot be denied that in many individuals, with weak and
disturbed mental functions, it may co-operate to this end.
In this country, where malarious fever prevails to so great extent, sta-
tistics of its relation to mental disease would be highly desirable, and
information as to whether, in localities where intermittent fever is endemic
instead of the ordinary ague, any individuals have been attacked by an
intermittent cerebral affection, and if any such have passed into cases of chro-
nic mental disease.
The treatment has been rather hygienic and moral than medical.
Mechanical restraint has been had recourse to only in one instance, mentioned
in the remarks upon the Colaba Asylum. The advantages of the total banish-
ment of all means of mechanical restraint from the treatment of insanity have
been both praised and disputed. The principal argument in favour of this
system is its greater humanity and its easier quieting of the patient, who is
often rendered more irritable by mechanical coercion.
There is no doubt that the modern treatment of insanity is much more
successful than the old system. Yet even now the true state of things is
sufficiently discouraging. Dr. Edgar Sheppard, quoting Dr. Thurnam, who
is great in the statistics of mental disease, says that, " of ten persons attacked
by insanity, five recover, and five die sooner or later during the attack. Of
the five who recover not more than two remain well during the rest of their
lives; the other throe sustain subsequent attacks during which, at least, two
of them die." All recoveries cannot, therefore, be regarded as permanent
or stable ; and the broad rule may be laid down, that when insanity has once
exhibited itself, there is ever afterwards a tendency to relapse; and of the
insane in public asylums for the reception of all classes, about 70 per cent.
may be reckoned as incurable.
A primary consideration, and indeed the most important as regards the
question of curability, is the form of the insanity and the period of the disease
All the Superintendents agree in the great value of outdoor employ-
ment as a curative means. This will be more particularly alluded to in the
remarks upon the individual asylums.
A celebrated German Physician, Griesinger, from whose work on mental
diseases I have already quoted, writes : "No asylum is complete which has
not space sufficient to admit of prolonged outdoor exercise for all classes of
its inmates, in gardens, airing courts, &c. In many chronic cases it is
highly beneficial to prescribe gymnastic exercises and cheerful games which
necessitate exercise, where, in the harmloss excitement of the game, the
patient for a time forgets self and the thoughts which harass him. " When
will all our asylums, instead of being as they are at prosent chiefly houses of
refugo for the insane, bo converted into hospitals for the cure of insanity.
By far the largest number of recoveries take place within a few months,
thus showing the value of early treatment. Dr. Niven places these as high
as 90 per cent. within the first year, and, although this appears to me to be
over-estimated, there can be no doubt that treatment to bo of any real use
should bo had recourse to as soon as the patient manifests the slightest sign
of mental alienation.