Stafford Asylum-from 1818 to 1828, admissions 1000-Cured 429,

or about 43 in 100.

Lancaster County ditto_from 1817 to 1825, admissions 812-Cured

322, or about 39 in 100.

Wakefield County ditto-from 1819 to 1826, admissions 917-Cured 384, or about 42 in 100.

Lunatic asylums have, since 1820, been built in Cornwall, Lincolnshire, Gloucestershire, Oxfordshire, and Suffolk.

Not content with reports only, and desirous of extending my information by personal observation, I have visited, within the last six years, the following asylums, public and private: - Bedford, Nottingham, Wakefield, York, Quaker's Retreat at York, Newcastle and Durham, Lancaster, Liverpool, Manchester, Stafford, Gloucester, the Military Asylum at Rochester, Oxford (before it was occupied), Glasgow, Edinburgh (Morning Side), St. Luke's, Bethlem and Guy's Hospitals; and likewise Droitwich (Mr. Rickett's), Laverstock (Dr. Finch's), Brislington (Dr. Fox's), and several other private establishments.

From this extensive survey I drew two very satisfactory conclusions: first, that among all the provincial asylums, excepting one, there was much to commend, and nothing to condemn but what arose from locality or faults in the designs of the buildings; and second, that a most laudable emulation prevailed to improve the system of treatment to the uttermost the means each respectively afforded.

The remarkable discrepancy displayed in the proportions of cures in different institutions, cannot escape notice, and requires some comment. Reasoning à priori, we may naturally infer that the results will always correspond with the means adopted for the treatment of lunatics, and that these must be greatly influenced by the rules for the admission and duration of patients in asylums. The objects, economy, and regulation, indeed,

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of public asylums often differ as much from each other as they necessarily do from those of private asylums; and nearly the same diversity prevails among the latter as among the former. Again, even under the most judicious management, much difference in the degree of success must obtain from local circumstances. Nobody will expect the same results in Bethlem and St. Luke's as in the Quaker's Retreat, or in the asylums of Nottingham, Stafford, Exeter, Gloucester, or Glasgow, or in the Military Asylum, or in those of Wakefield and Lancaster. Even the very site and construction of such edifices must produce different effects on the curative system.

Besides, the objects for which these establishments are intended differ. I shall briefly detail the essential distinctions in British public lunatic asylums. They may be divided into three classes:-1. Those which are entirely eleemosynary, or are supported partly by an income, funded or landed, but arising from benevolence, and partly by voluntary contributions. 2. Those which are supported partly by voluntary contributions and partly by pensionary patients, paying according to a certain gradation of rank. 3. Pauper lunatic asylums, founded under Mr. Wynne's Act, at the expense of the county, and wherein the patients are supported by their parishes. In all these, except where there are patients taken on profitable allowances, or any officer of the establishment is remunerated according to the number or ability of such pensioners, at least a common interest prevails, if no better feeling operate, to facilitate the cure, and consequently the discharge, of every patient.

Private asylums are also of different descriptions. In some, nothing more is professed, unless especially required, than kind usage and safe custody; while, in others, the means of cure are not only professed, but sometimes very efficaciously employed: the first are

commonly under the superintendence of unprofessional persons; the second are generally under that of a member of the faculty.

The destination of these institutions being as dissimilar in England as they are in France, it might be wise to imitate the French custom, and to both kinds attach a characteristic name: the former the French call Maisons de Détention; the latter, Maisons de Santé, or Pensionnats.

In Willis's time (1685), hospitals for the insane were clearly viewed in the character of the former; for he expressly says, that inveterate mania was rarely subjected to medical treatment, and that insane persons were merely placed in them to be under discipline, either to recover, or prevent their doing injury to others or themselves.

In Great Britain and Ireland, imitating France, public institutions for lunatics should be called Hospitals, (Asylum is not appropriate); and private ones be contradistinguished as Houses for the Cure, and Houses for the Care, of Lunatics. The license for the former should be entrusted to medical men only; and for the latter be granted to any person proving that he has sufficient means, and an unimpeachable character.

I have observed, that lunatic hospitals and asylums vary exceedingly in their regulations. For instance, the two metropolitan lunatic hospitals, Bethlem and St. Luke's, impose certain exclusions unknown in any other British asylum, public or private. They reject all patients who have been above twelve months insane; those affected by paralysis, however slight; epilepsy or convulsive fits; idiots; the aged and weak; those discharged uncured from other hospitals; the venereal and the pregnant: besides, every patient who is seized by any acute or chronic disease likely to be fatal; and all who have not recovered at the expiration of one year's trial, are dismissed. Each hospital has two classes of

patients, incurables and curables: the one considered hopeless cases, and the number always continuing the same; the other receiving the aids of medicine and regimen, and varying in number with the applications for admission. Upon this latter class only the calculation of cures in the table is made.

There are no other hospitals in Europe that exercise this system of selection and rejection of cases; consequently, the number of cures ought to be greater, and of deaths less, in Bethlem and St. Luke's than in any other. Since 1817, when an improved arrangement was made in Bethlem Hospital, it appears, from its annual returns, that a much larger proportion is discharged cured than formerly. Considering the superior advantages this rigid selection of curable cases affords, its results should correspond; but comparing them with those of other institutions, where no selections or exclusions exist, and all kinds of cases, and in every stage of the disorder, are admitted, the proportion of cures is not so large as might be expected.

From the length of time these two hospitals have been founded, and their capaciousness, had their registers been properly arranged and well kept ab initio, satisfactory evidence might have been obtained of the exact relation the cures had, at different periods, borne to the curables admitted; and thence we might have been better able to judge whether any and what progress had been made towards improvement.

Most eleemosynary lunatic asylums, either for want of sufficient funds, or of room to accommodate all the lunatics who apply, exclude epilepsy and idiocy; making occasional exceptions, where the friends of the patient can afford to pay the expense of maintenance.

County pauper-lunatic asylums are compelled to receive both these classes of patients, if considered dangerous; but not otherwise.