It must not be understood, that the medical officers of lunatic asylums have overlooked the importance of these institutions as the true school of mental pathology in this country, or their own responsibilities as workers, if not as teachers in this field of science. that of the recording faculty. The rector of a populous parish conscientiously discharging the duties of his cure, has seldom either time or taste for polemical divinity. If the polemics of psychiatric medicine were of no greater value, than those which render the simple questions of loving one's God and one's The establishment of the Association of neighbour subjects of recondite disputation, Medical Officers of Asylums and Hospitals it might, perhaps, be well to imitate the silent for the Insane in the year 1841, was a practeaching of those who adopt the short road of tical announcement of opinion on this subject. example, rather than the long one of precept. The periodical meetings for the interchange But this cannot for one moment be admitted. of experience and opinion, and the discussion The All-wise Ruler Who has not left the paths of disputed points, which formed one main of godliness uncertain, even to the most simple object of the Association, have fallen into disenquirer, has enveloped the nature of cerebro-use. The exigeant duties of the members, mental disease in so much obscurity, that and the system which prevails in this country through all past ages it has been completely of vesting in the medical superintendent the misunderstood; and not until a recent period | entire management of an asylum and the has the gloom been penetrated by some beams treatment of the patients, have rendered it of truth from the lamp of science. impossible that any large proportion of these officers should ever leave home at the same time. The nature of insanity is a subject of abstruse enquiry; and upon the proper answer to this enquiry, depends the application of a right and wrong method of treatment. The Canons of the Church of England recognized the priestly exorcism of devils from the insane; if the evil spirits would not come out, can we be surprised at any amount of hard usage to which a body possessed by the enemy of mankind should have been subjected? These theories are now practically exploded, and their terrible results are in this country unknown. Perhaps another efficient reason for the literary inactivity of asylum superintendents is to be found in the fact that they are beneficed. Our position is for the most part taken, and our ambition lies within the boundaries of the particular institutions over which we preside. Our rivalry with each other depends upon the comparative degrees of excellence to which these institutions can be brought. Having no private asylums to fill, and no private fees to attract, we have no personal motives to obtrude ourselves on the notice of the public by any literary announcement for the purposes of individual gain. Such briefly appear to be the most obvious of the impediments to the advancement of psychiatric literature by the official psychiatrists of this country. In other countries, where it is not the custom strictly to debar the medical officers of public institutions for the insane from private practice, these impediments are not found to exist. In France and America, where it is the custom to attach several physicians to one asylum, and not unfrequently to restrict their duties to the medical treatment of the patients, similar associations have maintained their periodical meetings, simply because the members find that occasional absence from their duties is neither difficult nor disad vantageous. Soon after the English Association was founded, the publication of papers written by the members was commenced, and the establishment of a Journal was strongly advocated, and only postponed because at that time no one could be induced to assume the responsibilities of editor. This proposition has from time to time been. again mooted; because the necessity of an organ of opinion could not fail to impress itself upon the minds of all who were desirous of seeing the Association something more than a list of members, and of feeling that to belong to it was something more than a nominal affair without honour and without usefulness. A scientific association, the members of which are precluded by their duties from periodical meetings at any reasonable intervals, has but one mode of activity left open to it, namely, that of the pen. Opinions and discussions which cannot be spoken, may be printed and circulated with this advantage, that at such discussion all the members will be present. We do not stop to enquire into the relative In associations where personal meetings of merits of the different arrangements for the the members are possible, knowledge may be medical care and treatment of the insane, but communicated and science advanced by dismerely indicate the influence of the one pre-cussion alone; though even under such cirvailing in England in the advancement of cumstances the publication of transactions is mental pathology. not the least useful and important result of combination. But when the members of an dence of those engaged in overcoming these association cannot meet, if no attempt is made difficulties far from each other, the impedito substitute the power of the printing press ments of personal intercourse arising from for that of the assembly, such an association their duties, the peculiarity of those duties, cannot even claim an existence of decrepitude, and of their professional experience, all made it must be in a state of complete and absolute painfully evident the want of a medium of palsy; if it continues to hold together, it will intercommunication, and a means of record do so from very want of the powers of decom- for matters of practical importance in their position. department of science. Dr. Conolly added the weight of his great authority, and spoke with much emphasis of the treasures hitherto hidden in asylum case books, likely to become known and useful to mankind through the intervention of such a Journal. Several of the most earnest friends of the Asylum Medical Association, who were impressed with the above views, corresponded with many of the members during the spring and summer of last year, on the absolute necessity of establishing an Asylum Journal, not only as being in itself a most desirable The Association came to an affirmative object, but as affording the only chance of res- decision nemine contradicente, not only on the cuing the association from complete inanition. | main question of establishing an Asylum JourBy such correspondence it was ascertained nal, but also on the secondary one of confiding that the great majority of asylum medical the editorial labors and responsibilities to Dr. officers earnestly desired the establishment of Bucknill. such a Journal, and that two of them were The intervention of other duties postponed willing to undertake the duties of editor. the immediate commencement of the enterprize, and in the meantime some doubts were felt, respecting the amount of literary support which could reasonably be expected from men so preoccupied as the medical officers of asylums. These communications and enquiries of course took place before the meeting at Oxford we apprehend that such preliminaries are not only usual, but essential to the discharge of business at all public meetings. They have since been objected to by the editor of a Journal, of whom we desire to speak with all possible respect, and whose experience and calmer judgment must inform him, that the unremunerated labors of an editor are not of a nature to be hastily and without forethought undertaken at a public meeting, or indeed at any time without serious deliberation and self-sacrifice. At the Oxford Meeting, owing to the combined attraction of the Provincial Medical Association, and the public spirit of W. Ley, Esq., the Superintendent of the Oxfordshire Asylum, (who not only exerted himself to bring the members together, but entertained them most hospitably afterwards,) the attendance of asylum officers was numerous and influential. To resolve these doubts, and to ascertain as accurately as possible the feeling of all the superintendents of asylums, on the propriety of carrying out the resolutions of the Association meeting, the Editor addressed to them during the past summer, a circular letter of enquiry, "for the purpose of ascertaining as accurately as possible, the amount of support likely to be rendered by the members of the Association." The following paragraphs are extracted from the replies received from the medical superintendents of county asylums, and from the physicians and medical officers of hospitals for the insane. 1. "The proposed Journal has my best wishes for its success." The following members of the association 2. "No one can more ardently desire success were present: Drs. Conolly, Davy, Dymond, to such an object than myself. I should have Hitchman, Kirkman, Thurnham, Winslow, much pleasure in being an occasional volunWilliams, Wintle, Wood, and Bucknill; teer in the good cause, though I could not Messrs. Ley, Caleb Williams, Metcalfe, and undertake to be a regular and punctual corRice. respondent." A long and interesting discussion on the 3. "I should be very glad to see the Journal best mode of establishing an Asylum Journal you refer to started, and if in my power I would took place. One member alone thought that most willingly aid in the undertaking." some portion of an existing journal might be 4. "I wish the Journal success that I may made subservient to the wants of the Asso-profit by it. Should I find myself in a posiciation. The other members expressed their tion to become an occasional contributor, I conviction that a special Asylum Journal was should be, most happy and should feel bound urgently needed; that the magnitude of the to do so." interests at stake, the difficulties of asylum management and lunacy treatment, the resi 5. "With ardent wishes for the success of such an undertaking, and with a strong in clination to participate in its efforts, I have not the leisure, &c. Should the work proceed you will find me, if no a fellow labourer, a cordial well wisher." 19. "If I can be of any service in assisting you I shall be most happy. I am convinced of the very great want of such a Journal." 20. "Your plan of it (the Journal) seems ex6. "I think it would be the means of dif- cellent, and I should certainly rejoice to see an fusing much valuable information, which, for independent Journal devoted to psychology." the want of such a medium, is now locked up 21. "I approve most cordially of the estabin the minds of individual superintendents. Ilishment of the Journal. I shall be most shall be most happy to subscribe to the Jour- happy to send any papers I may have for nal, which I sincerely hope may be estab-publication." lished." 7. "I am glad to find that you have undertaken the duties of Editor to the Journal; I wish you every success, and shall be glad to become a subscriber." 8. " Although I most cordially wish you success in the undertaking which you are about to embark, I fear it will not be in my power to offer you any efficient aid; nevertheless I am so much interested in the success of the Journal, that I will try to do a little towards promoting it." 9. That a Journal would be useful I have no doubt, I wish one could be founded. It is many years since I submitted the subject to a gentleman, who has always taken a warm interest in the advancement of science as applied to the insane." 10. "Should any practical or interesting case arise here, I shall be only too happy to place you in possession of the same." 11. I quite agree with you that such a Journal is much required by this particular branch of the profession. If I can in any way assist you, either by the contribution of occasional cases of interest, or by any other means, I shall be very happy to do so." 12. "I shall most gladly do what may lay in my power, to promote so desirable an object as that which you have in view." 13. "I will most readily cooperate in the working of the proposed Journal, and will contribute as much as I can. I sincerely wish you success.'" 14. "I shall be most happy to do my best in promoting the usefulness of the proposed Journal, which to be useful must be practical. When you want a page or two let me know." 15. "I should be glad not only to see the existence of a Journal such as that you mention, but also to contribute to the same." 16. "If found practicable, I am satisfied that the Journal would prove the remedy of the Association. From the anxieties I have had, I feel sure that the juniors of the profession would derive great benefit (from the Journal), and would probably return enthusiastic support. 17. "I will do all I can to help you, and I enclose an article." 18. "I wish you every success." 22. "I should not withhold my humble support from any periodical of which you were the Editor." 23. "I most cordially wish that it (the Journal) may be established and may succeed. In regard to my ability to contribute to it, I should be glad occasionally to send a short communication." 24. "I am very much pleased that the Society of Superintendents wish to establish a Journal. I hope the matter will not drop, as I think a great deal of useful knowledge may be brought forward on the treatment of insanity, by men more experienced on that subject than others possibly can be. I shall be most happy to forward cases, and to do all in my power towards the success of the work." 25. “I have always thought that a Journal of contributions from medical superintendents of county and other asylums should be attempted, and am glad to hear that you are willing to undertake the duties of Editor." 26. "If time and opportunity allow, I shall be happy to give my mite in aid.” 27. "I trust that the proposed Journal may succeed." 28. "In reply to your circular I beg to say, that I fully intended to prepare a paper for your proposed Journal, and had already commenced one." 29. "I shall have much pleasure in contributing to your proposed Journal." Three superintendents who did not send written replies to the circular, have given the Editor verbal promises of support; and four others whose appointments were very recent, were unfortunately overlooked in sending the circular. The above passages-with one exception from the superintendent of a large private asylum-are extracted from the letters of men who have distinguished themselves as the superintendents and physicians of our county asylums and of the largest public hospitals for the insane. With the exception of one or two gentlemen exclusively engaged in private practice, they were received "from all the members of any influence or status in the Association." With this double call to the work, first at Oxford, and next in the replies to the circular, we cordially undertake the establishment and conduct of the Journal, feeling assured that These allegations are indeed only true of the enterprise possesses the best wishes of our a certain number of our governing bodies; psychiatric brethren, and that we may safely we readily admit that, for the most part, they depend upon them for an amount of literary discharge their duties in a spirit of benevoassistance amply sufficient to maintain the use-lence, justice, and sound discretion; and that ful and practical character of this publication. they repose much confidence in, and are much The aims and objects of the Asylum Jour-guided by, their medical officers. The excepnal will be, to afford a medium of inter- tions, however, are sufficiently numerous; and communication between men engaged in the even in the most favoured instances, the opinconstruction and management of asylums, in ions of a single superintendent expressed in the treatment of the insane, and in all sub- the Board-room must possess much less weight sidiary operations; it will therefore embrace than after having been communicated in a topics, not only interesting to medical men, publication like the Asylum Journal, and but to visiting justices, asylum architects, and tested by the examinations of his professional chaplains; nothing will be excluded which is brethren in other counties. not foreign to the modern system of the care An object of the Journal of much utility, and treatment of the insane. It will be a though of minor importance to those above record of improvements and experiments in stated, will be that of making known throughpsychotherapeutics; whether in medicine, hy-out all asylums the want of any one of them; giene, diet, employment, and recreation; or of supplying a medium for asylum advertisein the construction, fittings, organization, and ments. management of asylums. It will notice new opinions in the physiology of the nervous system, and the neurological observations and discoveries of every kind. It will be conducted with a studious regard to the principles of justice and fair play, in assigning to every labourer in its pages the credit due to his work. "Palmam qui meruit ferat.” For this purpose, and for the satisfaction of the reader, all papers, except when an especial wish is expressed to the contrary, will have the names of the authors attached to them. By this warranty all statements of fact will be authenticated, and opinions be estimated. It is hoped that it will afford a means of conveying to Visiting Justices and others, in whose hands is vested the ultimate authority in the government of asylums, much valuable information respecting their own duties, which has not hitherto reached them through any other channel. That the governing bodies of lunatic asylums and hospitals are much in need of some instruction respecting the principles on which their duties should be discharged, is sufficiently evident, from the imperfect arrangements both of accommodation and management still to be found in many asylums; from the excessive expenditure which has often been permitted in the architectural department, and the contrasting, but not counteracting, parsimony in matters more immediately affecting the welfare of the patients; from their not unfrequently converting that which should be a hospital, even for patients incapable of perfect cure, into a great almshouse; from their forgetfulness that insanity is a disease, and their consequent want of the due appreciation of medical science in its treatment. The want of such an advertising medium has been pointed out to the Editor by several superintendents, by whom it has been much felt. The advertisements referred to were not those which are inserted as a matter of course in the weekly medical periodicals, but were those for fittings, clothing, servants, and the thousand little matters, in which the information of one superintendent may be of great economical service to others. The Editor hopes that the superintendents of asylums will make use of the Journal for this purpose to the fullest extent in their power. He also trusts they will feel no disappointment at the unassuming garb in which the work is introduced to them. That it will not provoke the remark Institui, currente rotâ, cur urceus exit?" The Editor, remembering that amphoric resonance is often symptomatic of decay, has indeed thought it right in the commencement of his undertaking to begin almost from the gallipot; he however begs to remind his readers, not only that real utility dignifies all things, but also that should occasion require, and prosperity justify the use of a more pretentious vessel, such a change can always readily be made. The issue of the Journal will at first take place once in six weeks, or at the semiquarterly periods; a less frequent issue having been thought incompatible with its mission as a means of intercommunication between asylum officers. Should it be found upon trial that this interval is too great, it will readily be shortened. The Journal will be supplied to members of the Association through their booksellers, or on the receipt of sixteen pence in stamps for postage it will be supplied to them for one two of the number (15 and 28, Leicester and Suffolk) year by post; to other persons each number at all exceeded it. will be charged sixpence, or by post eightpence. We have now only to beg the kind support of our brother officers; to promise a conscientious discharge of the responsible duties we have undertaken, and to begin. The converse however obtains with thirteen asylums established since 1847, the date of this report of the Commissioners. In seven of these (Nos. 7, 16, 19, 26, 30, 31, and 33,) the proportion of land is higher, in six (Nos. 7, 16, 26, 31, 32, and 33,) very much higher, than that prescribed; in five (Nos. 3, 6, 13, 14, and 25,) is about that recommended; and in two instances only (Nos. 2 and 17,) falls below the required amount. There can Statistics of Land attached to the County Asylums of be no doubt that it is to the judicious exercise of their England, by JOHN THURNAM, M.D., Medical intendent of the Wiltshire County Asylum. Super-functions by the Commissioners in Lunacy, that we owe the general recognition, which is here apparent, of the necessity for a sufficient amount of land being Having had occasion to enquire into the amount provided in connection with every pauper asylum. and appropriation of the land attached to the several The inadequacy of the original provision in the case of County Asylums of England, and having, during the many of the older asylums is the more to be regretted, course of the past summer, had "Returns" from nearly as, in the majority of such instances, it appears hardly the whole of these institutions obligingly communi- possible to remedy this defect, in consequence of the cated to me, I have been induced to throw them into land in the immediate neighbourhood not being pura tabular form, and communicate the whole to the chaseable; or if so, only at the most extravagant prices. Asylum Journal of Insanity, in the pages of which | The superintendent of one asylum complains, that he they may perhaps prove useful to the committees of visitors and superintendents of such establishments. A few remarks are perhaps called for in illustration of the table. has space only for a few piggeries; another, that he has but just garden ground enough to find the establishment in vegetables; and several lament the utter inadequacy of their farms for the proper development of the industrial system among the patients. In all cases it appears desirable, in an economicpoint of view, that the ground should be sufficient for the production of all the vegetables (including that most important vegetable, the potato), milk, and at least part of the butter, which would be required for the use of the establishment; for it is assumed, that it can hardly ever be other than more costly to purchase these necessary articles of consumption, than to produce them; to say nothing of the advantage and satisfact of securing the supply of fresh vegetables and unadulterated milk. It will hardly be contested, that with regard to the quantity of land, which it is desirable to attach to asylums for the insane, in different localities and for different classess of society, we are not in a position to insist on any fixed or determinate standard. This, indeed, should vary with the varying circumstances of districts and communities; and a diversity of provisions must itself be deemed useful, as promotive of experiment and enquiry, as to the development of agricultural as well as of other modes of employment. In this, as in all other respects, may the public asylums of this country be long spared the infliction of the dicta of an assumed optimism, which must be destructive of all individual efforts at advance, and must tend to reduce all to the common level of a self-satisfied | least in agricultural districts, where some profit should mediocrity. But the labour which an asylum can command from the male patients, ought to provide more than this, at be derived from the sale of farm produce, not required for the use of the establishment. Whether it is expedient that corn should be grown for the consumption of the inmates, or for sale, must be regarded as an open question; and it is one which will probably divide the opinions both of experienced economists and farmers on the one hand, and of medical superintendents on the other. To be carried If we confine our attention to the circumstances of county asylums for the insane poor, it would be rash to assume any certain proportion of land as alike suitable in every instance. In their report for 1847, the Commissioners in Lunacy recommend that, in pauper asylums the proportion of land “should, as far as possible, be in the ratio of at least one acre to ten patients." This, it may be presumed, is a mini-out advantageously, a much larger farm is of course mum quantity; for in agricultural districts, there can be no doubt that a much larger proportion is really desirable. implied, than that hitherto recommended by the Commissioners: but I am not prepared to say, that where opportunities exist for it, the plan is not worthy of a I will now turn to the table itself, which comprises fair trial. One can hardly see why a profit should not thirty-four asylums in England and Wales, being all be made; and I am sure, that by affording opportuthe county asylums, together with the Borough Asy-nities for agricultural pursuits on a more varied and lum for Birmingham, and the General Asylum at extended scale, it would be beneficial and gratifying Northampton, which seem naturally to fall under the to many of the patients. When the tillage is not consame head. fined to spade labour, and when the plough and the harrow are brought into requisition, there is more scope for drawing out the capabilities of individual patients, and the pleasure connected with these various operations, and those of the stack-yard and barn-floor, is not to be slighted as a beneficial agent. With the Of the nineteen asylums in existence, when the Commission of Lunacy assumed its functions, about two-thirds of the number fell below, and some very much below, the standard recommended: and only * Commissioners' Report, p. 323. |