Table of Lunatics admitted, cured, and deceased, in the ... 151 145 296 80 ... 1822 143 186 329 73 91 164 116 196 1825 156 173 329|| 104 97 201 64 98 162 193 234 190 243 427 433 186 261 447 42 43 85 194 254 448 36 37 73 198 257 455 16 45 61 34 59 93 158 200 358 30 51 81 89 103 192 45 Totals 2799 3207 6006 1619 1897 3516 1124 1456 2580 4704 5378 10,082 The proportion of males to females admitted is as 87 to 100. The deductions from the Senavra table differ so much from those of all other lunatic institutions, that some further explanation seems requisite. The majority of the patients admitted into this hospital are of the poorest class, chiefly inhabitants of the low and swampy grounds in the neighbourhood of Milan, who, from the joint influence of marsh miasma, and the very worst species of food, become affected with the pelagra―a species of cachexy inducing mental derangement. Purer air, wholesome lodging, and a good diet, recover, with little or no medical aid, a very large proportion of these poor people. If they do not get well, they spend the remainder of their lives in the hospital; but from the extenuated condition of most of them when admitted, a greater number die than in any other equally well regulated hospital in Europe. There is, therefore, no alternative but to recover and be discharged from the hospital, or to continue and die in it.* * The accuracy of the table, and of the descriptions of the Italian institutions which follow, I can depend upon, as they are derived from my son, George Burrows, M.B., Fellow of Caius College, Cambridge, who, during a residence on the continent, has personally inspected all of them. The Senavra, an Hospital for Lunatics at Milan. "A few days before I left Milan I visited the lunatic asylum, which is a short distance from the walls, and situated in a very low part of the country, with a considerable quantity of swampy ground all around. The Senavra, as the hospital is called, is a large brick building, which was formerly a convent, and is calculated to hold about 400 patients. The present numbers (November 25th, 1827) are 220 men and 209 women. The general appearance of the interior is extreme neatness, and good order reigns throughout. The building is composed of three floors, and is divided into male and female sides, each side having two airing-grounds attached to it. The larger airing grounds are allotted to the convalescent and quiet patients; and the others, which are much smaller, to the noisy and furious. Each side of the building is divided into six sections of patients. The noisy patients are kept upon the ground floor, and the convalescent and imbecile upon the upper floors. It is a source of sincere gratification to find, that the hope I formerly expressed is realised; and that the examples of England and France are stimulating the rest of Each section on the female side has eight female attendants; those on the male side have only seven, as the men who are in a proper state contribute greatly to perform the part of domestics in cleansing the house, carrying the food, &c. Each of the attendants is allowed one day's holiday in seven. The new part of the building consists of some long, airy corridors, with cells on each side, and a day-room at the extremity, which is heated by a stove; but this room is much too small for the number of patients in the corridor. Each patient that is at all furious has a separate cell, with a window looking out into the gardens, and a door communicating with the corridor. It appears to me that these apartments must be most terribly cold in the winter season. Each of these cells has a sort of privy within it. The greater number of the patients are poor people, who have suffered from the endemic of this country, the pelagra. The convalescent women were generally employed in spinning; and the men, independent of the domestic work, labour, in fine weather, in a large kitchen-garden attached to the house, which completely supplies the establishment with vegetables. I never visited any lunatic hospital where there was less noise among so great a number. I was only troubled by some of the male patients for snuff; and I find that a certain quantity of this is allowed by the establishment, and distributed occasionally as a favour. There is a bath-room attached to both the male and female sides. The bath of surprise, which was formerly made use of here, is now given up, in consequence of the fright having proved fatal in two or three cases. Exercise in the airinggrounds, and labour in the garden, are the only means of employment. I made particular inquiries about the report of music having been greatly resorted to in this establishment; but the head physician, who is an intelligent gentleman, and who has visited the different establishments in Italy, assured me that music never had been resorted to, except as a means of diversion, in that establishment. They have a small handorgan, which, in the fine evenings of summer, is allowed to be taken to the airing-grounds, and there some of the patients amuse themselves with it. They also swing themselves occasionally in one of those turnabouts which are seen at our country fairs in England. There is one resident medical officer, and the physician makes a daily visit. Strangers are seldom admitted to see this establishment, and never without personal application to the Director-General of Hospitals. I observed malformation of the cranium very striking among many of the patients, and 1 Europe to emulate them in forming establishments for the reception and cure of the insane upon the principles of true philanthropy and science. The excellent asylums several of them with the goitrous throat. With respect to treatment, I could learn nothing particular; but the physician said, that after the first or second year, no very active measures were resorted to. The diet appears to be very good, and much more liberal than at the other establishments in Italy. Accurate accounts are kept of the previous history, of the commencement of the attack, of its continuance in the hospital, and of its termination. Examinations after death are almost always made, and registered. Previous to placing the patient in any particular section of the establishment, he is always lodged in a small room alone for two or three days, and there examined and watched, in order to determine the class of the disease." Villa Antonini, at Milan, for Lunatics. "The Villa Antonini, near the Porta St. Celso, in Milan, like the Senavra, was originally a convent; and although not built for a lunatic asylum, is nevertheless well adapted for that purpose, as the house is divided into a number of separate apartments, which were formerly occupied by the monks. The building is of an irregular form, and calculated, I should think, to contain about forty patients. At the present time there are thirty patients, male and female. The physician, Dr. Antonini, and his son, with the director, and male and female servants, make the establishment forty-one persons in all. The building stands at the end of a wide street, from which it is shut out by a high wall, and is bounded on one side by a large church, and on the other sides by the airing-grounds and large orchards, which extend from the house to the ramparts of the town. There are four separate gardens, one of which is exclusively for the females; another has a small mound in its centre, and is planted with shrubs; and there is, besides, a common swing, and also one of those swings which revolve in an horizontal direction. The physician said that he had found the swings of great utility as a diversion, and that the latter had answered the purpose of the rotatory chair, which is now interdicted by the medical commissioners. There is also a third small garden allotted to those patients who, by noise or dirty habits, would annoy the convalescent and quiet patients. The apartments in general were clean and comfortable, and in most of the doors there was a small opening, through which the director might observe the actions of the patient without opening the door. Much use seems to be made of baths, and there are two or three regular bath-rooms. They make their patients get into the now established in many of the German states, in Switzerland, and likewise in Italy, where improvement is generally commencing, and the number of physicians recently bath empty if they have any fear of the water, and then the water enters from the bottom. In one of the bath-rooms there was an apparatus for directing a steady and powerful stream of water upon any part of the patient's body, and the physician says that he has found great benefit to arise from this remedy. There is a room fitted up for music, but the only instrument in it is a piano-forte. Whenever there is a patient in the house that is musical, and that is generally the case, the patients are allowed occasionally to assemble in this room, and they make up as good a concert as they can; this has been found a most useful and advantageous means of diverting the patients. Dr. Antonini is upon the point of fitting up a billiard-room. He told me that he flattered himself the patients were in such order, that if he commanded one of them to retire to his chamber for bad conduct, he would do it without force being applied, and that this was the only manner of punishment he adopted. There was only one man with his hands confined in a muff, and he had the propensity of stripping himself naked when left at liberty. During his lucid intervals he is a most excellent musical performer: he had a most remarkable depression of the left eyebrow, and a considerable dilatation of the pupil of the same eye. A complete register is kept of all the cases, of their treatment, and of their results." The Royal Magdalen Hospital for Lunatics, at Aversa. "This hospital is at Aversa, a large village in a highly cultivated plain, about seven miles from Naples. The hospital stands about half a mile from the road, quite detached, with good gardens, which are cultivated by the patients. It is entirely devoted to men, and at present (July 1827) contains 230 patients of different classes of life. There are about forty who pay so much per day, and have each a separate establishment. This institution has only existed thirteen years; previous to which the insane were kept in the great poor-house, and were treated more like wild beasts than men. At that time a priest obtained permission of the government to form this establishment, and brought it into a state of order and cleanliness, and treated the inmates with great kindness, but with little medical assistance. Two years ago this priest died, and Dr. Vulpes was appointed the directing physician; and from that period medical treatment has commenced in a regular way. The baths of this hospital are good. The bath of surprise is in the floor of a moderate-sized room. The patient is blindfolded and led across |