argument. It is undeniable, however, as a medical conclusion, and applicable to all cases of insanity, that precipitancy in removing the recently restored patient from proper supervision and regimen is highly dangerous, and a principal cause of so many relapses. The detention of the patients, especially the women, for so considerable a space after they have recovered, not only very much diminishes the probability of relapse, but renders it likely that almost all who are re-admitted into the French asylums ought rather to be considered as recurrences than relapses. In either case, from a review of the above table, it is clear, that whether proceeding from the natural effects of the malady, or from fresh causes, one half of the re-admissions occur in the first three months after being reputed and discharged cured. In the second quarter the number is reduced more than half, and in the third and fourth it successively decreases. I am therefore, from these results and my own observations, led to conclude, that real relapses occur only in the first three months after recovery; and that all cases and re-admissions into asylums after that period are positive recurrences of insanity, from the effect of fresh exciting causes. COMMENTARY III. INCURABILITY. THE proportion of the recoveries from insanity when the proper means are adopted, satisfactory as it is, leaves the painful conviction, that too many, under the best and most skilful management, pass from an active and curable to a chronic and incurable state of mental derangement or incapacity. In all such cases it is to be presumed that the brain, like other organs long exposed to diseased action, undergoes some structural change, which renders it unfit to exercise its proper functions; hence certain, or all the intellectual faculties remain permanently deranged. Georget conceives that in the three terminations of incurable insanity, according to his anatomical researches, the brain is affected by-1. general atony; 2. acute or chronic paralysis; 3. chronic irritation.* It is highly probable that the brain in every form of fatuity, as in every form of active insanity, is differently affected, or such distinct effects would not be produced; at least, as far as our pathological knowledge of the organ of the mind extends, the morbid conditions presumed by this author to exist may be correct. A large proportion of those who fall into this miserable condition are the victims of want, neglect, or mismanagement, and many, I fear, of mal-practice. * De la Folie, p. 438. Incurability, therefore, is probably as often the consequence of some moral cause as of insanity itself. Incurable lunatics have been thus divided:-1. Lunatics sunk into a complete state of fatuity, so as to be incapable of any intellectual operation, upon which state paralysis is often consequent or combined with.-2. Lunatics whose fatuity is less advanced, and whose intellectual powers are still capable of some exercise.-3. Lunatics restored to a certain degree of reason, but whose judgment being deteriorated, can only be trusted to a limited extent.-4. Lunatics whose delirium intermits, and who, during the interval, think and act rationally.— 5. Lunatics, the character of whose delirium, whether furious, melancholic, or monomaniac, has continued undiminished and unchanged till death closes their wretched existence. Notwithstanding the sentence of incurable, some so considered recover. Such recoveries, however, must rather be ascribed to the spontaneous operations of nature, than those of art. We have seen (Part I. Comm. VI.) that it is possible in long-standing cases for the brain to reassume sufficient energy to exercise the intellectual functions, when, according to experience, the mental derangement might be pronounced permanent; and we meet with instances of persons insane, ten, twenty, and even more years, regaining their mental powers without any apparent previous cause. These, however, must be considered. almost as miracles, being beyond human comprehension. Conformably with the regulations for admissions and discharges, so of course will be the proportion of incurables in lunatic asylums. In the Paris hospitals, the proportion cured of those deemed incurable is, in men, 1 in 5-13; in women, 1 in 6-48; the medium is 1 in 5.84.* In the Glasgow Asylum, from 1822 to 1827 inclusive (six years), there were 161 old cases admitted, which were considered incurable; of these seven recovered, which is only 1 in 23. In Bethlem Hospital, two or three out of about sixty incurables are annually discharged as being recovered. The selected curable patients discharged as uncured, both from Bethlem and St. Luke's Hospitals, after a year's trial, (the period of probation allowed,) are usually consigned to cheap private houses for the reception of lunatics, where they are treated in a manner inferior to that which they have received in those hospitals, and no further attempt is made at recovery. The number thus allotted to permanent lunacy must be very great, but cannot be ascertained. It appears, that from 1751 to 1826 five thousand and sixty-eight out of 14,050 selected curable patients admitted into St. Luke's had been discharged uncured. Judging from the number who actually recover, both in foreign and British asylums after the first year, we may form some calculation of the number plunged into irremediable insanity by a regulation which expels every patient at the expiration of a year's trial. Although cases which have existed several years may be generally considered incurable, as far as medical treatment goes; yet as nature in her own way often refutes all human calculations, the chance of their spontaneous recovery will be very much augmented or diminished, according to the care old lunatics receive. If they are well lodged, clothed, and fed, and are kindly used, some will recover in despite of a condemnatory prognosis. This fact has been happily established by experience in all the newly erected county pauper lunatic asylums. A great number of the pauper lunatics imported from parish workhouses, &c., where they had been for years |