The Sun.
London, England, 1841-09-02 00:00:00

EVENING SUN.

ON THE MANAGEIVIENi OF TB

INSANE.
(From the Medical Gazette.)
We have just received, with very: great pleasure, a
translation of Dr. Maximilian Jacobi's work " On the
Constructioa and Management of ll(*pitals for the In-
sane." and we desire to recommend it strongly to our
readers, not merely because the arrangements of the in-
stitution at Siegburg, to which it especially relates, a
pear to us to be in general excellent, but becmise the'
whole work is composed with a Aare practical know-
ledge of the subject, and with a regard for science,-
which,have seldom marked the recent publications all
th 3 same class.

The management of the insane in this country is al
present, it must be confessed, in a most disordered state;
it is altogether systemless and inefficient. Considering
that insanity is a disease which it is scarcely possible to
treat at the patient's home, and in which, therefore, all
ranks are reduced to the condition of hospital patients,
it is obvious that the most perfect scheme would be that
in which, with such a diligent surveillance as would
prevent oppression, all lunatics who are not manageable
at home should be confided to persons authorized for
their fitness' sake to their exciusiVe care. But what
is now the ease ? Of the lunatics.. among the
poor, and even of some of those. from among the
middle classes, the great inajoti:y are commit-
ted to almost pauper asylums. where the effi-
cacy of treatment, and the titness of manage-
ment, are, with few exceptions, marred by the
necessity for economy. Excluded by. the iery nature of
their disorder from hospitals whose :amPle: funds might
provide them all that they need, hnutfics from these
classes are consigned to asylums supported not by the
liberal hand of private charity, but by the slowly-open-
ing public purse. And they live the lives of paupers :
in most cases, the buildings provided for them, and all
their domestic arrangements (in which arc, in a great
measure, involved their therapeutic management), are ill
appointed, and for want, or for economy of funds, cannot
be mended.

Yet it may be questioned whether, on the whole, the
condition of the lunatics from among the poor is not
better than that of patients of the same kind in a higher
class. In the public asylums there areat least the advan-
tages of experienced attendants, of generally appropriate
diet and medical treatment, and still more of the regular
superintendence of licensed and competent meiical prac-
titioners, inclading, in some instances, a physician, a
surgeon, and a resident apothecary. But the lunatics
from the class whose friends can afford to pay for at-
tendance by no means generally fare so well ; and
in this consists the greatest anomaly of our sytem.
There are around the metropolis, and, in general,
in the neighbourhood of each large town, lunatic asy-
lums superintended, or, more properly speaking., kept
by medical practitioners, who, devoting the greatest part,
or the whole of their attention, to this departmen't of
their profession, must be regarded as competent to the
charge of the insane; and some of them are undoubtedly
eminently fitted for the office. But, the proportion of
lunatics who are thus provided for is unhappily ex-
tremely small; the terms of maintenance in such institu-
tions as these are either absolutely more than the friends
of patients can afford, or they are more than they regard
as equivalent to the difference of the advantages between
such an establishment and one of a lower grade in value
and price ; and so, the comfort, or, it may be, the health
and sanity of the patient, is made to wait upon the eco-
nomy of his friends ' • and that, though the monoy they
expend upon him be his own.
In these minor and cheap establishtlents, the superin-
tendent has rarely any knowledge at all of the proper
medical, or even of the moral, management of the insane.
Some of them are kept by gentlemen, whom we suppose
we may call amateurs, and who take this mode of earning,
an income through an accidental preference for it befor 6
the pursuit of some profession or trade to which thy
would be better suited. Others of these asylums are pia-
naged by ladies, who of course cannot be expected to be
qualified for more than the duties of matrons or nurses un-
der proper government. Others, again, are superintem ded
by retired keepers, who, having raised some money iutheir
subordidate offices, lay it out to good interest in an esta-
blishment of this kind, the low terms of which, seldom
fail to bring them patients. And, in addition to all these,
a number more of lunatics are committed singly to the
charge of keepers, who, for various
.reasons (their own
profit, misconduct, or any other), have left authorized
lunatic asylums, and taken up business on th air own ac-
count. Now surely in all these cases there is grievous
error. Till the condition of a lunatic is absolutely hope-
less he ought never to he removed from the charge of
one who, by some test of his knowledge, has been
proved competent to treat his case and; :even when the
incurable state is really set in, surely it is not too much
to require that the guardians of those ~.tho cannot have
safe charge of themselves should have some proved judg-
ment to guide them in the management of their patients'
health and comfort. Such a condition must he demanded,
unless it is to be admitted that the life of a lunatic is not
worth prolonging.
We have no intention of entering at large into the
details of a measure by which these evils might be re-
medied. We will only express the opinion that the main
feature in it should be, that no lunatic should be lodged
in an establishment kept by any but a licensed medical

practitioner, till, on sufficient testimony, he can be re-
garded as positively incurable. Unless it can be proved
that there is no hope of applying the knowledge of me-
dicine beneficially in the treatment °fins:pity, nothing
can be more flagrantly wrong than that
.it Atoold pass
into unauthorized hands.

It has happened unfortunately for lunn tics that of late
they have become too much objects for public curiosity;
for, mistaking the softness of their feelings for the
strength of their intellects, too many from among the
public have lately interfered in this matter. Newspaper
discussions, anonymous letters, magisterial sugge,rtions,
and books by authors of all grades but the right, hove
abounded far too much fir the adTantagc of the patients.
A certain amount of openness to the public 1.; un-
doubtedly a necessary safeguard for the inmates of asy-
lums ; but Nueb u safeguard is amply provided by
the visits of authorized persons to see that no oppres-
sion is exercised ; and it is altogether beyond the right
of the public to three their opinions on any part of the
therapeutic management. lie profession has been de-
graded by this recent clamour
_about a non-restraint

stern : if, as w•e have said onee before, it be

. . . _
the best adapted for the patients' good (aid,
on the whole, we - belive that it generally-
is), let it be proved so by the honest evidence of facts ;
but let not medical men competent to judge have the
system forced upon them by a mere popular cry—by
anonymous and senseless appeals to feelkgs—by pathe-
tic books by ladies—or even by the sanKuous solemni-
ties of magistrates. No good can come of these : to
every one who would study and practice his profession
as a science, a scheme thus supported must appear, prima
.facie, a bad one ; and no one can, without danger to
his professional character, embark in n common cause
with those that will sail with the wind of popularexpres-
sions of this kind. Next to its falling. into the hands of
designing quacks, nothing is more dangerous to the pro-
gress of a science than its becoming a subject of popular
curiosity.
It is this interference of the public in the manage-
ment of lunatics which has led to the degenerate charac-
ter of modern publications on the subject ; 43 ut we hope
that Dr. Jacobi's work will assist in calling medical prac-
titioners to better thoughts. Much time and muvh
energy are being now squandered in the discussion of a
matter of detail, on which, if there he any doubt, it is
only because at present the facts necessary either to
establish or to overthrow the supposed -value of the new
method are insufficient. But in the midst of'• this dis-
cussion, the spirit of which is maintained only because it
is carried on in the view of the public, the much more
important general questions of the construction of asy-
lums, and the competency of their superintendents—of
medical treatment—of morbid anatomy, and, in a word,
of all the real science of insanity, are almost utterly
lost sight of. Yet on these, much morn than on the kind
and quantity of restraint to be employed, • does the
patients' welfare depend. Nor is his alone concerned ;
for while these things aro publicly discussed, the medical
man is being gradually more and more supplantsd from
that for which he is alone fit, and which should, there-
fore, be his exclusive privilege—the charge of cases of
curable insanity.
rWe have given this article rather as a proof of the
self-sufficiency of medical men than of its excellence.
But for the Press, mad-houses would be the most hor-
rible places in the universe.]
* Translated by John Kitching, with Introductory
Observations by Samuel Tuke, Treasurer of the " Re
treat." London, 1841. Churchill.

Do NYBRObK FAIR.-61—Prfi-trsday,
day (26th August), the proprietors took measures
whotci
ascertain an average of the number f
4). P°"(liilrs of
entered the town of Donnybrook, balz,k,ol
.the.
*.
t ie ponce
nine, A.M. and six P.m., the period specified bY 1
the fair
almost incredible number of 7.1,792, rip..eni!? rzillsi.:(
was
very
conso..rattl__Tihsewutmber
regulations. The result of this calculation
iras the
pro-
portion of the adult population of Ipi..bli,whithl
entered
tits of cows, heifers, sheeps, pi;i.so ''',`,.e.
the "custom gap"
of horses present was supposed t(1
ei,(°_'__°,7B,!__',,rli 2,500.,.
They were mostly adapted for tz
_"_"4,'". 1:14-_..1.1-t1.,ht of
the lighter description. .
‘I'"; k"iaiiitrimvi:lrlu
0,1(4.c.,., prices.
which might ire!! startle " 0 '
st , k. . • . 'I hein
purea..o horsestor the cavalry
were agents present who
B.ritain cr Ireland.. having
Gtoras. This fair is-one of the most
the 4th Dragoon • . .
to the nunibsr of twenty-six ;-of. these eleven were for
been
instituted by King John, i (the year 1205, when he em,
Fitz Henrythen Justvce of Irelonde")
ancient either in Great
powered Myles .
to institute "tine fair at John's Well, and the other at
Donny Bourne. This, if it proves nothing else, proves
" :
at least the antiatut -3'
of this locality.—Snumler's News
Letter.
JUNCTION OF THE ATLANTIC AND PACIrIC
OCEANS.-The great natural advantage of Guatenia!a
is the all but ready-made connection Of the Atlantic and
Pacific Oceans. The great lake of Nicaragua. having
an average depth of fifteen fathoms, is within sixteen
miles of the Pacific. The only known outlet of this
inland sea is the river San Juan, navigable for craft,
drawing four feet water, to the Atlantic Ocean, in de-
spite of rapids, and capable of being impri`ived for the
passage of ships. At preseht TM coiumeree is carried en
upon this line of navigation ; it might almost be said
that nothing floats upon it. As soon; however, as a
settled country and stable Government can give security
to commerce and capitalists, it is easy to see that this
water-line will be the scat of an extensive transit trade ;
whether it will ever answer the full expectations of sun •
guine men, and supersede Cape Horn, is very question-
able, as regards coarse and bulky commodities.
A Goon EXAMPLE,— We heard Mr. Clay
in a debate, a day or two since, upon the Loan Bill, re-
mark, that for 20 or 30 years, neither he no his wife
had owed any man a dollar. kith of therh. alany years
gone by, had come to the con ' shin that tile best prin-
ple of economy was thiS;----" Neverfit,o*et it
to debt:. To
indulge your wants when you werviable 6, 0 Kt, and to
r_epress them when you are.not able.to indulge them."—
' Xelt, York Express,