up, their little furniture sold, their children sent to the workhouse, and want and misery left them as their only portion." What a picture is this! The Report sensibly adds: "to overcome such difficulties often requires an energy their weakened minds no longer possess; and after a short struggle with their calamities, they again relapse into disordered intellect, and often become worse than when first admitted."

If the poor peasant or workman have the ordinary feelings of human nature, what must be his sensations when, full of gratitude and thankfulness to a beneficent Providence for his recent recovery, he prepares to return to his home and the bosom of his family, and finds that home and that dear family no longer offering him shelter and solace? Is a relapse under such afflictions wonderful?*

The probability of relapse is always in a ratio with the suddenness of recovery, and therefore is commonest in mania. The melancholic temperament is more permanent, and is slower in being provoked into action than the maniacal. The moral causes likely to depress the spirits are much more numerous than those calculated to raise them, and therefore favour the frequent occurrence of melancholia. But recurrences are most frequent in the latter, and, as well as relapses, are very apt to occur when tinctured with religious fears.

At certain seasons, persons of the melancholic cast, when their minds are seriously turned to religious duties, fasts, and humiliations, are inclined to experience mental

In a spirit of true philanthropy, funds have been raised to afford clothes and provide means of support to discharged criminals, to prevent, from the pressure of actual want, the temptation to sin again, ere employment can be found. Does not a more worthy object for compassion present in the recovered discharged pauper lunatic, with a mind honest and willing, but enfeebled by a visitation of Providence, and perhaps as utterly destitute as the criminal?

aberration. The lady whose case forms Example 1, Commentary II., became insane thrice at Easter, after the preparation for and the observances of Lent; and is an instance of recurring melancholia from religious feeling. At such periods pious Catholics are said frequently to become melancholics.

It has been observed, that the brain which has sustained the maniacal action, like every other organ once morbidly affected, is more liable to experience the renewal of that action than a brain which has never been so affected. This maxim, in relation to the danger of relapse, should never be forgotten by those who have been insane, or by their friends who know that fact.

The danger of a relapse or recurrence is announced by a train of nearly the same corporeal symptoms as preceded the first access of insanity, only perhaps in a less degree. Every one who has experienced insanity must know whether he has been exposed to causes sufficiently exciting, and whether he feels that symptoms have succeeded which have a strong analogy to those which were precursory to a former attack. If he esteem the possession of his intellectual faculties and personal liberty as blessings, he will adopt preventive measures, and consult his physician.

I will repeat that, if there be obtuse pain in the head, a sense of weight, confusion of ideas, disturbed sleep, with rushing of blood to the head, or throbbing of the cerebral vessels, and great heat of the scalp, suspicion ought to awaken. Moderate bleeding in this case, or cupping or leeches to the head, is indicated: purging, vomiting, pediluvium, an issue or seton, or producing an artificial eruption on the skin by the application of the tartarised antimonial ointment, are prophylactic remedies. If the menses be diminished in quantity, or obstructed, the loss of a little blood is particularly advisable. Cupping on the sacrum in such case relieves the uterine vessels.

The French, as usual, recommend in the case of a female leeches to the vulva, and in the male sex leeches to the anus, as a derivant.

Whether from ignorance of the possibility of preventing the return of insanity by prophylactic remedies, or whether from an insurmountable repugnance to confess the apprehension of an affliction which is most absurdly considered as a degradation, it is impossible to tell; but the truth is, that nothing is more rare than a person who has been insane applying for advice how it may be prevented, although well-known symptoms announce the danger. I fear no arguments that I can adduce will eradicate this repugnance. I shall not, therefore, attempt so useless a task.

I have thus endeavoured to explain the nature of a relapse, as well as the difference which exists between it and a recurrence of insanity. Ignorance on this point has led to many unhappy consequences, which better information will, I trust, in future avert.

Re-admissions under the head of Relapses, are entered in the registers of some British public asylums; but the intervals between the dismission as cured, and the readmission as relapsed, are omitted in their annual reports. Consequently, it is impossible to determine how many, according to the distinction I propose, ought to be considered as relapses, and how many as recurrences. Referring again to the Wakefield Report (1826), twenty-six of one hundred and twenty-two admitted, or one in six, had experienced previous attacks; and it is observed, that "fewer from relapse have been sent in this year in pro→ portion to the general number admitted, than in any preceding one."

The Paris Register* records very particularly the readmissions of those discharged positively, and those pre

Compte Rendu, Tab. No. 11.

sumed, cured. This table is divided; one compartment shews the number re-admitted from natural consequences of the primitive attack; the other, from fresh accidents or causes after the patients have been in society for perhaps years.

AVERAGE OF RE-ADMISSIONS IN 1822, 1823, AND 1824.

Relapses from fresh Accidents or Causes, at various remote periods.

In the last division the cases are all decided recurrences; and in the first, except those re-admitted within three months, I rank them under the same class.

Comparatively to the annual admissions, the proportion of relapses from the natural consequences of the primitive attack, says the reporter, is no more for the men than an eighteenth; for the women a thirty-fourth; the medium for both sexes being a twenty-sixth; and if the number of the relapses be compared with that of the annual cures, the proportion for the men is a fifth, and for the women a tenth; the medium of both sexes being a seventh and a half.* The proportion of re-admissions or recurrences from fresh accidents or causes is, of men a

twenty-second; of women a fourteenth; of the two sexes the medium is an eighteenth.

The reader cannot fail of being struck at the immense disproportion in the number of relapses of the two sexes. The reason is satisfactorily explained.* It solely arises from the much longer detention of the women in the asylums than of the men after they are pronounced cured. The medium residence of each man discharged cured is four months and fifteen days; that of each woman cured nine months and twenty-five days; the medium sojourn of both sexes being seven months and fourteen days.

This fact forcibly exemplifies the utility of a long detention after the cure of insanity is actually accomplished; and the means of so doing gives a great superiority to the French over British asylums in this respect. Thus, in the French asylums, the proportion of relapses to the admissions is in both sexes only a twenty-sixth part; while in the Wakefield, which perhaps is the best public asylum in England, the proportion of relapses to the admissions is as high as a sixth.

So long a detention of lunatics in our public asylums after recovery as is permitted in the French, would be contrary to the principles of English jurisprudence and to English prejudices; neither could the funds, perhaps, to support them during this space of probation be supplied from eleemosynary sources. But there can be no doubt that a great saving would eventually result, whatever fund furnished the means of supporting lunatics in public asylums, if, instead of being discharged so soon as they are pronounced cured, the term of residence were prolonged to confirm their recovery. The humanity of such a regulation is too faithfully represented in the Wakefield Report, to which I have just referred, to require further