Various instruments have been devised, and some good practical hints offered by different authors, how food is best to be got down. I have seen liquid nutriment introduced into the stomach most readily by means of the stomach-pump: passing its hollow elastic tube through a nostril is a more ready mode than forcibly separating the jaws.

Much nourishment may also be conveyed by the medium of glysters.

Whenever any means are made use of to convey food by force into the stomach, it ought never to be left to the sole execution of an ignorant person. Patients have been choked in the attempt; and even with the utmost care, some injury is often inflicted. Consequently, it is obvious that such operations should never be executed except in the presence of a superior and responsible

person.

Practice gives to some attendants on the insane a wonderful dexterity in getting down food. They should be especially resorted to, when it is possible, for this particular purpose.

I shall add one admonition -never to intermix medicines with the food of an insane person. This naturally strengthens the suspicion of poison, or mere disgust of nutriment, and his resolution to resist taking any.

COMMENTARY IV.

MORAL TREATMENT.

Ir the moderns have any claims to pre-eminence in the cure of insanity, it is certainly from studying those means which have been denominated moral, with more attention, and applying them with most effect.

The tact of the physician, however, is, in this particular, the pivot on which every thing moves. It is an art, in fact, that cannot be taught. The qualifications are intuitive, not acquired: they may be elicited by accident, and then can only be perfected by experience.

To Pinel, among the moderns, is due the great praise of first adopting that moral system of treating the insane, which has contributed most essentially to the amelioration of their condition, and consequently to the increase of the number of recoveries. This celebrated physician's suggestions have been successfully practised, not only by his immediate pupils, Esquirol, Georget, and other eminent French physicians, but by those of Europe generally.

Although specific rules cannot be laid down for the moral management of the insane, yet a few general principles are recognised,* which embrace almost the essence of this department of the curative treatment, and which, if adhered to, must be conducive to that object. These

are:

First, Never to exercise the mind of an insane person in the sense of his delirium.

* Georget, p. 280.

Second, Never to openly oppose the morbid ideas, affections, or inclinations of the insane.

Third, which is a consequence of the two preceding, to give rise, by diversity of impressions, to new ideas and feelings; and thus, by exciting fresh moral emotions, revive the dormant faculties.

Fourth, Never to commit one's self to an insane person by a promise; but if inadvertently a promise be given, faithfully to adhere to it, unless certain that the fulfilment will be attended with worse consequences than the breach of it.

These principles are not for the government solely of the physician, but of every one who has the charge, or is attending on, or visits casually, a lunatic.

There is no stage of insanity where moral treatment has so beneficial an influence as in that of convalescence.

The approach to convalescence from every species of insanity, is an event of no less delicacy than interest to a philosophic and humane mind. No stage of the malady requires so much judgment, whether it be in detecting the first signs of dawning reason, or in encouraging the efforts of a mind struggling to enfranchise itself from thraldom.

The first indications of convalescence in most diseases are obscure, and none but the experienced perceive them. But, when perceived, frequently little else is requisite than to assist the efforts of nature. In many cases, however, much higher qualifications, and much greater caution, are required to conduct a convalescent mind to a completely sane state. A common mind demands but common care and patience; but a naturally fine and wellcultivated mind requires tact, delicacy, and discrimination, to lead it from the chaos and darkness of insanity to the order and light of intelligence. The first glimmer of returning reason, when unfolded, will be cherished and encouraged by the feeling and judicious. These are too

often neglected, or perhaps heedlessly checked, by the indifferent and ignorant. Hence, recovery is procrastinated, if the chance which such sign presents be not altogether destroyed.

The qualifications of the physician are infinitely more severely tried in conducting convalescence to perfect health, than in the curative treatment of active insanity. He has not only to exercise a sound judgment, to encourage every dawning sign of returning sense, and to reason with his patient, (for reasoning now is highly useful in removing weakened and decaying illusions,) but he must add the soothing voice of friendship to calm the agony which reminiscence often generates. He must also have to repress the patient's impatience to be freed from restraint; to contend with and remove the suspicion and want of confidence, which his cautious course usually produces in the relations and friends, and which, if not steadily resisted, endanger the approaching recovery of his patient, for whom he has thus far and most anxiously employed his skill, time, and attention.

"There is a stage," says an eloquent writer,* “ approaching convalescence, in which the bodily disease is loosening its hold over the mental faculties, and in which the latter are capable of being drawn out of the former by judicious appeals to the mind.”

No sooner is this bodily disease seen to be loosening its attachments by an evident amendment in the physical condition of a lunatic, than the most careful scrutiny should follow, to detect a ray of returning reason. The one generally follows the other as the effect the cause. If, with the improvement of bodily health none be discovered in the mind, it is a bad omen, and the probability of recovery proportionably diminishes.

At this critical point it is, that the art and judgment

* Dr. Gooch.

of the physician and his assistants are especially called for. And at this critical point it is, that the ignorant and the rash fail, and too often replunge the hapless convalescent into irremediable insanity.

The return to health, however, like the access of insanity, may be sudden, or it may be as gradual as the development of the symptoms which preceded it. When sanity is suddenly restored, its stability is more doubtful than when gradually attained.

In the worst cases, where the patient has been lost to every object that would naturally engage the attention of a sane mind, the symptom first indicative of returning reason is, perhaps, some sense of the decencies of life, or the dropping, as it were by chance, of some apposite remark, or the asking of some pertinent question, though with the hesitation of one in doubt, in respect to his own situation, or that of his family. Any particular delusion that has been cherished becomes less prominent, and is not so obstinately defended. Reasoning then begins to have greater effect. Sometimes the approaching convalescence is announced by the gradual revival of the moral affections, and associated with these recollections, the feelings are often moved to tears. No augury is more favourable than when such emotions are evinced. All these motions of the mind and of the moral affection, are at first feeble, and perhaps transitory. They should be encouraged; but these efforts of returning reflection and reason must be guided with a gentle and imperceptible hand. No errors which the patient may commit of memory or speech ought to be noticed, lest, if exposed too suddenly, they shock and discourage him. If, in reasoning with him on any remaining delusion, a painful recollection is revived, the subject should be changed, and resumed at another time.

So in respect to returning moral affections. The inquiries to which this happy condition leads must be