commissioned by different foreign governments to visit Great Britain, to inspect and take plans of the most approved asylums it contains, give fair promise that a system as near perfection as possible will soon every where prevail.

The capital of the Austrian empire, in which the science of medicine and all its auxiliary branches are so highly esteemed and cultivated, it is to be hoped will not long defer that improvement in the care of the insane which, in contiguous states, is so conspicuous.*

At

the room, when he unexpectedly falls into the bath, the sides of which are well guarded with cushions. The practice of putting the patient into a hot bath, and applying cold to the head, has not long been employed, although now it is a very common remedy.

"The patients are almost entirely without classification, as the size of the hospital does not admit of this arrangement. In general they seemed comfortable, and I only saw four or five with their arms confined. They have numerous methods of amusing the patients. There is a theatre, many musical instruments, billiard-table, &c. All the patients who are not outrageous attend the church twice every day. I saw about eighty sit down to supper in perfect order and quietness. Dr. Salvador Catania, the very intelligent assistant physician, told me that they had commenced a medical report of the hospital this year, which they intended to continue annually."

I may add to this account, that, in the same spirit of improving lunatic establishments which seems to pervade almost all foreign states, Dr. Vulpes has lately visited Great Britain and Ireland, and other countries, in order to inspect all that were most worthy of notice. He appears to possess great acuteness of observation, zeal, and benevolence; and I have no doubt that, with so much information, he will render the Aversa Asylum as perfect as its capabilities admit.—B.

* The subjoined account of the Lunatic Asylum of Sonnenstein at Pirna, in Saxony, is from the same source as those of the Italian establishments. It is altogether on so excellent a plan, that I cannot omit the description of it.

"June 12, 1828.-This lunatic establishment was formerly the castle of Sonnenstein, and is situated on an almost perpendicular rock, two hundred feet above the river Elbe, over which it projects. The ascent has now been rendered less abrupt; and the castle, gardens, courts,

present, the lunatic establishment at Vienna is a disgrace to the capital and the era of the nineteenth century.

Contrasting the proportion of cures before the year and out-buildings, have been converted into the best lunatic asylum I have seen out of England. The building is too irregular to give any description of it. The number of patients it contains is about 120, and twenty more are in the private house of Dr. Pienetz, the head physician. We first visited a court-yard, where numbers of patients were employed in sawing and chopping wood, others drawing water from a deep well, and in fact, almost all were occupied. The bath-room is of a good size, containing eight metal baths, in which the patient may be fixed if necessary. There is an excellent apparatus for directing a powerful stream of cold water upon any part of the bath-room. In the adjoining room is the bath of surprise. Here the patient is seated in a metal slipper-bath sunk in the ground, the attendant then comes to a window about fourteen feet above the patient, and throws a large bucket-full of water upon the head. This is often made use of both as a remedy and as a punishment, and the patients complain of pain as if the lateral lobes of the cerebrum were split asunder. We next went into a large billiard-room, to which the patients have constant access of an evening, particularly during winter. In an adjoining room was all the apparatus for giving electrical shocks; but the apparatus is almost laid aside, as no benefit has been found from the most powerful application of it. They here shewed me a very well contrived tin machine, made to fit the hollow of the thigh, with straps, for those patients who could not retain their urine. The evening winter-room is extremely well fitted up with piano-fortes, violins, flutes, three or four backgammon and draft-boards, and a very good book-case, which is at all times open to the patients. They are allowed to remain here until ten o'clock, and music and these games are encouraged as much as possible. The patients, in respect to their living, are divided into three classes, according to the money that is paid for their maintenance. The first class have two small rooms for two patients, with one attendant, and they eat their meals separate from the others. The second class have also two rooms for two patients, with one attendant, but their accommodations and fare are not so good. The third class dine altogether, and are six, seven, and eight, in one room. Every six months a set of rooms is completely cleaned out, white-washed, and painted. They shewed me a very good little instrument for forcing open the mouths of patients that would not eat. The revolving bed and chair are frequently made use of both as remedies and as punishments, and the time a patient remains in them is from five minutes to a quarter of an hour.

1817 with that a century and a half ago in Bethlem Hospital, it is not a little perplexing to account for the ratio having actually retrograded. The earliest records of that institution offer evidence, which, if accurate, prove that the interproportion of cures originally exceeded that at any vening period between 1748 and 1817. Stow informs us,* on the authority of Dr. Tyson, who was physician to Bethlem, that from 1684 to 1703, 1294 patients were admitted, of whom 890 were cured: this is a proportion of two in three. From 1784 to 1794, 1664 patients were admitted, of whom 574, or rather more than one in three, were cured. And it appears from the aggregate, that the cures and discharges from 1684 to 1707, were seven and twenty per cent more than the cures and discharges from 1799 to 1814. The cause of this retrogression may be worthy of inquiry. That so large a number should have been cured,

There is also a species of tread-mill, something like a revolving squirrel's cage, in which patients are compelled to take some exercise. They have a strong room, but no dark room, for furious maniacs. There is a Protestant church and clergyman in the building, and they find that the most noisy patients are quiet during divine service. The women's house is quite separate from the men's, and is conducted upon the same plan. The gardens around the building are immense, and are almost entirely cultivated by the patients. There are various summer amusements in the gardens. At present they contain forty women and eighty men, Separate from these who appear clean, orderly, and comfortable. houses is a new house, calculated for sixteen patients and the clergyman, situated upon a beautiful slope, with an excellent garden, and most delightful prospects. This is the convalescent house, and here the ladies and gentlemen dine with the clergyman altogether. They are allowed to take walks in the environs, and divert themselves as they please. The whole establishment is well conducted."

I presume that under Dr. Pienetz's superintendence, the Sonnenstein establishment has greatly improved since 1816; for, on reference to the comparative table, it will be seen that the cures in recent cases were then only twenty-four per cent; and in complicated cases, only twelve per cent.-B.

*Survey of London, &c. &c. book i. vol. i.

M M

though, according to Dr. Tyson, most of them had been under treatment before they were admitted, and when the exceptions were not so numerous nor so strict as at present, is remarkable. This information is the more important, since it is half a century anterior to any before published regarding the cures in this or any other lunatic institution. Surely, therefore, had not this statement escaped observation, it might have been accepted as a proof, that mental derangement was more responsive to curative treatment than has been supposed; and likewise, that the recoveries were in a ratio, considering the then state of medical knowledge, surpassing, probably, that of most other dis

eases.

Enough perhaps has been advanced to decide that insanity is a malady susceptible of cure, and that a very large proportion of lunatics, under a proper system of management, actually recover.

Did mental derangement experience the same prompt attention as most other complaints, it is impossible to judge how much more favourable the results might prove. The reverse almost always obtains; and therefore insanity more frequently degenerates into a chronic or continuous type before remedies are applied. All practitioners have remarked how difficult it is of cure when it has taken the latter form, comparatively with acute or recent cases. In this disposition it but assimilates to other diseases. For, be the disease what it may, whenever remedies are neglected long after its first access, there is great danger of its assuming an obstinate, if not a permanent, cha

racter.

Unfortunately, the approach of insanity, though generally perceptible to strangers, is rarely remarked by relations. We are all apt to shun that which is painful or displeasing. So the insidious approaches of mental derangement are rather construed into nervous irritability, or eccentricity, or any thing rather than the truth; and

are suffered to proceed till some terrible exacerbation of delirious fury or despondency ensues. A malady is thus often confirmed in one whom we most value, and whose intellects very probably might have been preserved, had timely aid been administered.

How frequently do we witness the bitterness of self-accusation, and the unceasing regrets of the near connexions of lunatics, because they have persevered in this wilful blindness till the calamity they deprecated has occurred! Assuredly, the approach of intellectual disorder sometimes escapes the most intelligent observer; while bodily ailments, from the derangement of some ordinary function, or from acknowledged pain, are at once visible: consequently, the remedy in the one case is unsought, which in the other is immediately applied. Thus the chances of cure in mental and corporeal complaints are, in a variety of ways, rendered unequal.

Even under these and many other disadvantages, incontrovertible proofs have been adduced of how great a proportion recover. And were it not that when evidence militates against preconceived notions it is always pertinaciously rejected, we might have been convinced, years ago, that insanity was cured in a ratio equivalent probably to what is experienced in most disorders. Thus, a celebrated physician was discredited when he stated, that nine out of ten cases of insanity would recover if medically treated within three months from the attack.* Doubts of his veracity were implied; but we now see, that, in situations perhaps less promising, eight in ten, and even six in seven recent cases, are credibly reported to have actually recovered!

The difference of the result between recent and old cases, and the superior success of early and active medical treatment, is indeed astonishing, and fully confirms

* Parl. Report, 1789.