men.

19. Insanity is more difficult of cure in women than

20. After the seventh month the ratio of recoveries rapidly decline, and after the third year recovery is rare.

21. Men are more liable to relapses than women. One half of all relapses happen in the first three months after recovery.

22. Insanity, comparatively, is a hazardous disease. Melancholia more so than mania; and demency most of all. The mortality on the aggregate of all lunatics in British public asylums is about 24 in 100.

PART V.

COMMENTARY I.

CURATIVE TREATMENT.

Preliminary Observations.

THE writer in a celebrated Review, in the favourable notice he took of my "Inquiry into Certain Errors relative to Insanity,"* exhorts those who have the management of the insane, either to confirm the rectitude, or prove the fallacy, of my assumptions and conclusions on the success which has attended the attempts to cure insanity; and he particularly calls on me" to exhibit the details of those plans and practices which I have found so eminently successful; adding, that he believes me too correct to permit his entertaining a suspicion that I have a desire of concealment." Other reviewers, as well as some medical practitioners, have obliquely hinted their doubts, if not of my veracity, at least of my accuracy.

Perhaps I had some reason to complain of want of candour in querying statements when I had honestly referred to so many authorities, both in public and private practice, in confirmation of my own individual experience and conclusions. I could not mean to claim any superiority in the cure of insanity, when, at the same time, I shewed that others had obtained nearly the same results,

* Quarterly Review, No. XLVIII. p. 176.

and under circumstances less favourable than those which I avowed I had possessed.*

I must congratulate myself for abstaining so many years from noticing these sceptical observations. Time, which confirms or refutes all evidence, has vindicated me. The proportions of recoveries which are exhibited in Commentary I. (Part III.), and in the Minutes of Evidence taken before a Select Committee of the House of Peers in the present Session of Parliament, testify beyond doubt, that wherever curative means and judicious management are employed, there the ratio of cures of insane persons will correspond and increase. Not only is the proportion of cures proved to be what I before stated, and consequently the number of lunatics thereby diminished, but the number who relapse and return into the general mass of the insane is also considerably lessened; for although nature may cure insanity, yet that cure which is effected through the medium of medical treatment always proves most permanent.

I profess no knowledge of an antimaniacal remedy, nor can I even offer the charm of novelty in my "plans and practices." My practice has been directed by those pathological views of the causes, nature, forms, and complications of insanity, which I have so extensively described. And I conceive that those descriptions will be found better guides to practice than the most minute details of cases. I have before observed, that every case of insanity should be considered as an insulated one, and so it must be treated. Remedies, therefore, must vary with the constitution and peculiar features of each case; consequently I hold that no fixed rules or formulæ can be given, or, if prescribed, be adhered to.

Hence my observations on the curative treatment will be very general. They are intended for medical

rather than popular reading; and I must assume, that medical practitioners having perused my preliminary views of the pathology of insanity, and being from their education competent to appreciate the value due to them, cannot be greatly at a loss in applying appropriate remedies.

They who have never read the ancient authors, especially Aretæus, Celsus, Cælius Aurelianus, Galen, &c., and the Greek and Arabian writers of the middle ages, will be astonished to find that the remedial plan of treatment which they recommend, although founded on a different pathology, yet is in most points well adapted to the pathology founded on the anatomical discoveries of modern investigations.

If we give credit to the success of the ancients in the treatment of other diseases, we cannot deny belief to their success also in curing insanity. Yet, and it is a remarkable fact, their remedial treatment of insanity seems to have been nearly lost sight of in the revolutions of theories which have since had birth and died away.

Abundant hints, and a few effective ones, have been suggested by contemporary authors, but these suggestions have not generally shone as lights; for as they have oftener emanated from theoretical rather than pathological inductions, they have soon been extinguished. Indeed, they have proved mere coruscations, which flash but for a moment, though, perhaps, they have contributed in some degree to shew the shoals and quicksands which beset the course on which others have stranded.

Celsus remarks, "Oportet autem neque recentiores viros in his fraudare, quæ vel repererunt, vel rectè secuti sunt; et tamen ea, quæ apud antiquiores aliquos posita sunt, auctoribus suis reddere." I have not attempted to defraud the moderns of what is owing to them in developing the causes, or improving the treatment, of insanity; but I will acknowledge it as due to the ancients, that the practice they pursued appears to me to be generally judicious,

and that I feel more indebted to them than the moderns have attended my efforts.

for what success may

Inductive evidence, therefore, aided by experience and reflection, and exemption from preconceived theories, form the basis of my views and practice.

As to the methodus medendi which I pursue, much may be collected from the preceding Commentaries; especially those on Delirium Tremens, Puerperal Insanity, Suicide, Hypochondriasis, and Demency.

An idle opinion still exists, and even pervades the understanding of those whom it might be expected were more enlightened, that insanity is a mental disease independent of corporeal disease, and that there are remedies specifically applicable to mental disorder; and hence the inquiry so often recurring in parliamentary investigations, whether medicines are prescribed suitable to the mental complaints of the patient? My answer is, that no mental disorder can originate except through corporeal disorder; and that the only remedies for a mind deranged are those which apply to the corporeal derangement that influences mental derangement. The physic for the mind is moral discipline: this is requisite throughout insanity : medicine is no longer so than the hope of cure is entertained.

The curative treatment, like the causes of insanity, is usually divided into medical and moral. I shall proceed

in that order.