the Celsean axiom, quò vetustior est longus autem, quò recentior eò facilius curatur.

Irrefragable as the testimony uniformly is of the great success attending the treatment of insanity, yet I shall venture to declare my belief, that the utmost success hitherto recorded falls short of that which is attainable.

In my former publication* I stated, that on the aggregate of all the cases I had had under my care, including patients in a state of fatuity, idiocy, and epilepsy, the proportion of recoveries was 81 in 100; of recent cases, 91 in 100; of old cases, 35 in 100.

These proportions, when stated eight years ago, though not disputed, appeared by some to be doubted. But the testimony of other authorities to which I have referred, and the subsequent annual reports of various public lunatic institutions, fully establish them. And further experience in a wider field of observation confirms my former statements.

Extraordinary as it may appear, yet it is a fact, that no detailed or even general result of private practice in the treatment of insanity has ever been published by any British practical author. I do not recollect one who has attempted to elucidate the subject by a candid statement of the relative proportion of cures to the cases occurring within his personal experience.

A defect so remarkable almost justifies the reproach of foreigners, that the many learned English writers who have written on mental affections, have displayed greater fondness for speculative disquisition than practical induction. And hence another reason for that general scepticism common in this country on every matter connected with insanity or insane people.

It is obvious, that the study of mental derangement

* Inquiry, p. 48.

partakes of all the incidences attaching to a disease, the proximate cause of which is a mystery, and the mode of treatment unsettled; therefore, any conjecture on the degree of improvement which may be attained would be presumptuous. However, we certainly have not arrived at the maximum. The obstacles to that consummation are indeed numerous. Nevertheless, they are not to be imputed to a defect in knowledge or enterprise in the faculty; for although possessing every physical and medical qualification, and evincing the most ardent zeal, yet the necessary resources are rarely at command. Indeed, few physicians possess the pecuniary means requisite for undertaking the charge of the insane, and treating the malady agreeably to such plan as their experience might dictate. Even the outfit of such an asylum for the reception of insane patients as a philosophic mind would plan and like to conduct, is beyond the ordinary resources of professional men.

Were equal confidence evinced in his physician by the friends of a patient in cases of insanity as in ordinary chronic and surgical diseases, the success would be commensurate. But success much depends on unconstrained volition in directing the means; this being denied, a proportionable limit is imposed on exertion. This has been a cause obnoxious to the improving of the medical treatment of insanity, but not of other diseases.

There must be a revolution of public opinion in England respecting insanity as a human malady, and also in respect to those who professionally attend or superintend the care of lunatics, before that point of excellence will be attained which I am persuaded is within reach.

A most laudable emulation has been elicited throughout Great Britain. The spirit of improvement has gone forth, and if properly encouraged and regulated, will leave nothing for humanity to desire contributory to the comfort or recovery of the insane.

If so much have been accomplished through means which, I will venture to assert, however much desired or sought, have been scarcely ever adequate, and often notoriously deficient; and notwithstanding the visionary speculations of some, and the ignorance of others, which are eternally counteracting the wisest ordinances,-who can refrain from contemplating without a prescient hope, what might be achieved, were the requisites at command, and were more enlightened views to predominate ?*

* What will foreigners say, who yearly, in admiration of our lunatic establishments, visit Great Britain for the purpose of inspecting them, and acquiring a more perfect knowledge in the treatment of the insane, if they should chance to peruse a Bill "To regulate the Care and Treatment of Insane Persons," which passed a British House of Commons without dissent in the year 1828? or what will posterity think? Will the former credit their senses, or the latter the records of the time, when they compare the descriptions of these lunatic institutions, and the annual reports of the number of recoveries effected in them, with the proposed enactments? Will they believe, that at an epoch esteemed enlightened, when any member of a family is visited with a paroxysm of insanity, the sacredness of private affliction must be intruded upon and violated by an examiner when a Secretary of State chooses? Or, that if a physician have advised for such patient that he or she should be removed from home to a private lodging, that it cannot be done without the examination and certificate of two other medical men? that the name and connexions of the patient are also to be set forth and registered, and a return of such removal and circumstances, and of all subsequent changes of lodging, are to be made to the said Secretary of State? It was also enacted, that even physicians who have devoted themselves to the treatment and care of the insane-gentlemen, in fact, of the highest education and character-should be subject, in the strict performance of their professional duties, to prosecution for innumerable misdemeanours, and liable to the infliction of penalties, and the pains of imprisonment and hard labour, that is, the tread-mill, in a common gaol! Besides, their property, and—what to a professional man is dearer than all-his reputation, was placed at the mercy of discarded servants and others, who were not only invited, but rewarded for becoming informers, although participators in the very offences for which they had laid the information! Such are a few of the provisions by which improvement was to be accomplished! Certainly no measure introduced into parlia

ment ever betrayed greater want of information, and consequent misconception of a subject.

How presumptuous to imagine, that without any practical knowledge or information, minute legislative enactments can be framed for improving the treatment of the insane!

If any thing is to be feared that may check the progress of improving the treatment, moral and medical, of the insane, it is these absurd attempts to effect it by legislation. The inevitable consequence is to disgust honourable and well-educated men, and to deter them from pursuing a branch of the medical art, in the exercise of which they cannot be free agents, and which marks them as degraded and unworthy of public confidence.

Had such an act passed as was originally proposed, the charge of the insane would thenceforward have been consigned to those whose sole object is pecuniary advantage.

Let those who feel an interest in the question examine and compare the printed evidence in support of the Bill before a Select Committee of the House of Commons in 1827, and that before a Select Committee of the House of Peers in 1828; and they will then be able to appreciate some portion of the mischief which would have ensued.

Truly has Montesquieu said, "C'est une expérience éternelle, que tout homme qui a du pouvoir est porté à en abuser; il va jusqu'à ce qu'il trouve des limites. Qui le diroit? La vertu même a besoin des limites!"

Happily, the wisdom of the House of Peers has interposed, and saved the afflicted lunatic and the public from the injurious consequences of such a measure, and also those who had devoted themselves to the charge of the insane, from a great part of the odium attaching to it.

The Act is an experimental one for three years. In the course of that time the argumentum ad hominem may be severely felt, and prove the gross outrage it commits on domestic as well as on professional rights and feelings.

COMMENTARY II.

RELAPSES AND RECURRENCES OF INSANITY.

THE interpretation of relapse, as applied to mental derangement, has given rise to much misconception. Its real signification, in reference to any disease, is, I apprehend, regress from a state of convalescence to the original malady. But in the sense it is generally used in relation to insanity, it is extended to a mere iteration of the malady, whatever interval of health may have passed since recovery. This is a manifest error. In the one sense it is plainly a relapse, in the other only a recur

rence.

Many have argued, that it is useless attempting the cure of insanity, because relapses are so common, and therefore have declined medical aid.

If every recurrence of this disease be considered a relapse, it will certainly be found to happen very frequently; but if we assign to each phrase its real meaning, and look to what occurs in other diseases, we shall conclude that, comparatively, a relapse is more rare than has been imagined.

A relapse, then, is only when a malady returns, from the effect of which a patient has scarcely or very recently recovered. It may take place a few weeks, or two or three months, after an attack of insanity, provided that certain symptoms, the sequelæ of that affection, have not entirely ceased.

The precise time when a cure may be pronounced to be solid, it is impossible to fix. Most, for weeks, nay months, after they have recovered, experience, uneasy