2. Dutch Retrospect
Authors: Pietersen J. F. G. 
Published: August 2008

Dr. F. M. Cowan, the senior physician, gives in a pamphlet of 112 pages the annual report of this institution for the insane, and includes in his publication a detailed account of the administration, as well as an elaborate résumé of the mental condition of the patients admitted and the post-mortem examinations conducted during the past year. He makes the same complaint to which we have constantly been treated in most of our own asylum reports, want of space and the difficulty in finding accommodation for the ever rapidly increasing insane population. The provision for 1,800 lunatics, out of a population of 911,534, for Southern Holland he regards as wholly inadequate. “It would,” he says, “be worth our earnest consideration whether these old and decayed members of asylums, who require nought but good and careful supervision, could not be established in separate localities or habitations, such as almshouses, etc.;” acute cases and recent admissions, he holds, would thereby greatly be benefited, both with regard to accommodation and treatment. He next makes allusion to a series of weekly nursing lectures which, since October, 1888, he has introduced into this asylum, and already, at the date of his report, he speaks highly of the admirable results he has obtained by such a course. His asylum attendants have by his efforts been enabled to become thoroughly acquainted with the contents of Billroth's “Die Krankenpflege im Hause und Hospital,” Florence Nightingale's “Notes on Nursing,” and the “Handbook for the Instruction of Attendants on the Insane,” prepared by a subcommittee of the Medico-Psychological Association, text books which have formed the basis of his lectures. Massage has also largely been used, and he dwells on the possible employment of this means in the future as a method of cure; already has he found massage of the abdominal walls of value in the intractable constipation met with among the insane. The number of admissions for the year was 36—26 males and 10 females. The number of patients resident in the asylum was 200. The deaths were 13 (or a percentage of 6·5 of the number of inmates), and were mainly due to phthisis pulmonalis. He gives an elaborate series of tables dealing with the social status, religion, occupation, age, education, causation of mental affections and relapses of the admissions for the year, and a like list with regard to the deaths and discharges. Electricity, in the ordinary method, and as electric baths for suicidal cases, has been employed with varying result; and regarding Franklinisation, he gives as the results of his experiments “that while various patients experience an agreeable feeling of relief and improvement when under a positive current, the reversion of such induces a feeling of oppression and aggravation of their symptoms.” In one case included in his clinical list, the galvanic current, both positive and negative, induced a return of aural hallucinations which had been absent for some time. Bronchitis appears to have been especially prevalent, ten per cent. of the inmates classified in his table of incidental affections having been subject thereto during the year. A successful’ operation for the removal of a large lipoma and a fractured radius were the only noteworthy surgical occurrences. With regard to the weight and weighing of patients, he makes some valuable observations, which our own asylum superintendents might with advantage take into consideration. The simple periodical weighing of patients can serve only one good end, namely, the insight it gives us as to the proportionate decrease or increase in weight of each individual patient. To establish a true proportionate relation between individuals when taking into consideration their body weight, we must, as was pointed out by Dr. Stephenson in the Lancet (Vol. ii., No. 12, 1883), take into account the height and rate of growth in man. Now, this co-efficient of weight, as he calls it, is expressed by the formula (where l= height, and G= weight), and the formula was obtained by observing that during growth the weight increases in direct proportion to the square of the body length. This co-efficient of weight would be a far more valuable comparative quantity than the mere body weight minus any note of the body length. The number of recoveries was 12 (or 6 per cent. of the total number of inmates), those discharged not recovered nine (or 4·5 per cent.). The rest of the report deals with the detailed account of the mental and physical condition of the admissions, and the post-mortem examinations. Among the former the most interesting case was that of a young woman (æt. 23) suffering from delusional mania, with hallucinations of sight and hearing, who was subjected to hypnotism about one month after her admission. To quote Dr. Cowan's own account of the case: “She was brought into the hypnotic state for the first time on August 3rd, and within twelve minutes she was in a fit condition for suggestion, by which it was intimated to her that the following night her sleep (which had been broken and disturbed) would last no less than nine hours, and that she would be freed from her nightly visual hallucinations. Success attended this first experiment, for her sleep was deep and refreshing, but during the half-hour preceding it she was still subject to the visual hallucinations. Encouraged by this favourable result, the hypnotic state was re-induced, and the absence and disappearance of her hallucinations were suggested; it was only, however, on August 12th, after eight experiments, that she communicated to us the fact that she no longer saw visions, etc., in the dark, and that the voices were becoming indistinct, but on the other hand there was an increase in the ‘unintelligible mumbling and whispering’ she was subject to. From that date she was hypnotized thrice a week, and suggestion employed. Up to August 30th the ‘whispering’ continued, but on that day it also disappeared; and so territied was the patient that these ‘nasty voices' would return, that she begged for a continuation of the experiments. From the 2nd of September to the 30th of that month she was hypnotized for suggestion twice a week, after which latter date they were wholly discontinued. The total number of experiments was twenty-eight, and to test the value of this method no other medicament of any kind was employed.” Sulphonal, employed in a case of acute mania, was unsuccessful in inducing sleep after the first night; no other experiments appear to have been made with this drug. The most noteworthy of the post-mortem examinations was that of a girl (æt. 20), who for fifteen years had been subject to attacks of hystero-epilepsy. Here there was found sclerosis and diminution in size of the left pes-hippocampi, some oedema cerebri, diminution and anæmia of grey matter of the cortex, gyri atrophied. Sommer's theory of the association of sensitive aura with sclerosis of the cornua ammonis was not verified in this case, but the fact that the patient died of pulmonary phthisis gives support to the opinion urged by Grasset (v. “Brain,” Vol. vii., “The Relations of Hysteria with the Scrofulous and Tubercular Diathesis,” and his “Traité pratique des maladies du systéme nerveux,” Ed. troisme., p. 977) as to the connection between nervous affections generally, and especially hysteria and tuberculosis. In commenting on the religious instruction of the insane, he urges the necessity of care and tact on the part of ministers attached to or visiting asylums, and the knowledge they should possess of individualizing their instruction. “Religion,” he says, “deals not entirely with threats and punishments, but gives also a due promise of reward for those brave of spirit. Who could be so lacking in knowledge of his fellow-man—nay, more, who could be so barbarous as to demonstrate to some self-accusing melancholiac the gloomy and severe aspects of religion, and to debar from his gaze the bright and hopeful lights thereof?” How many ministers of the Gospel have we in our own asylums who can with truth aver that they study the mental condition of those under their care? They deal out, it is true, weekly or daily instruction in their services and visitations, but they generalize such instruction; they speak to a body of hearers who oftentimes, as we ourselves have witnessed, obtain anything but consolation from the doctrines impressed on them. The patients appear to have been well employed and well amused, and consequently isolation and restraint have seldom been resorted to. According to the tables, 55 per cent. of the inmates were employed on an average daily in various forms of work, a result that speaks volumes for the admirable administration of this institution. We miss from this report any statement as to the expenditure per patient, an item which would have been of much value for comparison with our own asylums. The number of attendants (15 male attendants to 105 patients, and 13 female to 95 patients) appears small, but we suppose in cases of urgency drafts are made from the number of artisans, etc., employed, which is, for so small an institution, exceptionally large (21 in all of various callings). We cannot close this review without complimenting Dr. Cowan not only on his admirable and systematic report, but also on the evidently satisfactory condition into which he has brought the working of his asylum.