ANNUAL REPORT ON LUNATIC ASYLUMS.
17
One death occurred this year of a patient—health on admission not recorded—
the having been thirty-one years and ten months an inmate of the asylum. She
died of general debility at the age of 78. No less than 13 of the deaths this year
curred in aged persons of 50 and upwards, and 14 more were over 40 years of age;
while in natives may be looked on as much past the prime. I append this
statement and analysis of deaths to the usual report on account of the high
mortality of this season, which without it might appear to detract from the
satisfactory condition of the asylum. On the other hand, the high percentage of
cures, elsewhere given in detail, more than compensate for the large number of
eaths, and must be regarded as of supreme importance, lunatic asylums being as
ably expressed by Dr. Wynter, " hospitals for the cure of the insane and not houses
of detention for hopeless cases."
9. In writing of the treatment of insanity, we must take into consideration the
two-fold nature of the disease: first, as a malady of the mind, whether from injury
to the cerebral substance, or from a vitiated condition of the blood affecting the
brain directly, or from exhaustion of the mental powers through worry, grief or
excessive strain of any kind; secondly, as a physical disease of the nerve centres
thereby the mental functions become deranged. In the one case we may conceive
of the mind as acting on the body, in the other we see the reaction of the body
in the mind. There are those who would explain mind as a mere attribute of the
brain, and Maudsley defines insanity " as a disorder of the supreme nerve centres
of the brain, the special organs of mind producing derangement of thought,
feeling and action, together or separately." This being so, the treatment must also
be of a double character, and whilst we may rely on medicinal agents to improve the
bodily health, regulate the secretions, give tone to the system or soothe excited or
irritated conditions of the nerves, we must endeavor by careful hygienic measures,
attention to dietetics and the moral influence of gentle discipline, firmness united
with kindness, exercise, interesting occupation, to restore the mental capacity, and,
where a complete cure cannot be effected, to alleviate the symptoms, divert the
thoughts from brooding on their own sad condition, and render life endurable to
whose thus afflicted. On the so-called moral treatment Dr. Bucknell observes, " the
emotional repose and intellectual diversion which are now sought to be obtained
well-conducted establishments for the treatment of the insane are not, strictly
speaking, moral agencies ; they constitute physiological measures taken to procure
functional repose for an irritated and diseased organ."
Of the medicinal remedies we may mention morphia used hypodermically and
hydrate of chloral as hypnotics and sedatives, and bromide of potassium in
epilepsy, now looked upon as a remedy of established value. Mild counter-irritation
is often attended with most marked benefit.
Of hygienic measures cold douche, warm baths, tepid sponging to the weak
and feeble, and shower baths for those who are violent and troublesome. These
are valuable aids when judiciously administered, care being taken that they should
never assume a punitive character. The above must, however, be regarded as
there accessories and the greatest attention paid to diet, which should be light and
nutritious, to exercise in the open air, which should be sufficient to induce
epose, without causing over-fatigue to a quiet routine of occupation varied with
amusement. The non-restraint system is rigidly adhered to in this asylum, and
no patient restricted to his ward without my sanction, nor is it often found
necessary to resort even to this mild form of restraint, A kind word and a little
encouragement is generally sufficient to induce most of the inmates to engage in
any work to which they are suited, and when a patient is noisy and troublesome
adopt the plan of having him taken for a long walk or removed to another portion
of the asylum, when they usually quiet down without the need of more stringent
measures.
Before leaving this subject, I must allude to the boarding-out system which, it
now thought, will be so important an element in the future treatment of lunacy.
The results of the trial at Gheel are most satisfactory and cannot be overlooked in a
consideration of the proper treatment of the insane, advocated as it is by the authority
of Dr. Maudsley, who has expressed an opinion " that the true treatment of the
insane lies in a still further increase of their liberty." The application of this
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