649

deceived, as she was this morning de- Ilivered of a healthy boy, her tenth child.Her other children are all living. In thiscase conception must have taken place atleast seven months after what I shouldhave considered to be the final cessationaf the menses. I am, Sir, your obedientservant,

JOHN PEARSON.Staleybridge, Dec. 31, 1839.

THE LANCET.

London, Saturday, January 25, 1840.

THE HANWELL LUNATIC ASYLUM.

As there is no disease more distressingthan madness, there is no subject more im.

portant than the treatment of the insane inAsylums. We have frequently called atten.tion to the abuses of management in those

abodes, as well as to the safeguards whichare required in them to protect the publicfrom extortion, and the patients from neglector cruelty; at present we merely wish tonotice a few facts contained in " The Fifty-« first Report of the Visiting Justices of thed° County Luuatic Asylum, at Hrcmvell," andin the 11 Rel)ort of the Resident Physician."The Report extends to three-quarters of a

year, and ends on the 30th September, 1839.The Asylum contained 321 males, and 470

females, on the 1st of Jan., and 329 males,and 462 females, on the 30th of September.The average number of patients in the Asy-lum was 804. In the 9 months 84 males, and48 females, were admitted ; 38 males, and 27females, were cured; 3 males and 5 females,were discharged, relieved and 35 males, and24 females, died. It will be evident, fromthis statement, that the Hanwell Lunatic

Asylum is one of the largest establishmentsof the kind in Great Britain ; and that con-siderable interest attaches to it both in an

economical and a scientific point of view.Much has been said of the expense of the

County Asylums under the care of the Visit-ing Justices. The accounts of the Hanwell

Asylum are now published, in a clear, in-telligible form. It appears from them that

the income was :e12)486; the expenditure,

in 9 months, £11,344 17s, of which latter sum£6,045 16s. were for provisions; 1:1,83912s.for house expenses, including coals, soapi,bedding, &c. ; t255 for medicine (£133 12s.for drugs and instruments); 1:128 for

clothing; f 1,465 for salaries ; £926 for

wages; and £85 for incidental expensesThe cost of each patient was, on an average,7s. 3d. a week; 3s. lOd. having been ex-

pended for provision, including Is. 1½d. formeat; and Is. 3d. for flour.

We are glad to perceive, from the Reportof the Resident Physician, that the diet has

been improved. The amount of solid food

has been increased. The nature of the

change will be seen in the subjoined state-ment of the amounts of solid and fluid food

in the old diet table and the new.

Weekly Proportion of Solid and Fluid Food.Old Diet Table, solid food per week, 160

ounces; fluid, 201 pints.New Diet Table, solid food per week

(men), 194 ounces ; fluid, 16 pints.Ditto, ditto (women), solid, 172 ounces,

fluid, 19 pints.Of the 34 ounces of increase in the solid

portion of the mens’ diet, 8! consist ofcooked meat, 6 of bread, and 14 of cheese.The substitution, for gruel, of a tea break..fast for the women, and a supper of bread,cheese, and beer for the men, is said to have

given much satisfaction.All this may, in the detail, seem very dry

and dull to some persons; but nothingcan be considered to be uninteresting thatrelates to the relief of many thousands of our

afflicted fellow-creatures; and their com-

forts and prospects of recovery will be foundto depend intimately on details of a very

vulgar description. Let the refined cavillers

who now " dwell at home at ease," reflectthat they may live to see the day whenthe addition of 8! ounces of cooked meat,the introduction of tea, and the banishmentof water.gruel, in an establishment will forman epoch in their existence.

It appears to be pretty well established,that fewer persons die, and that recovery is

TT

650 THE HANWELL LUNATIC ASYLUM.

more rapid in institutions where the patients geously applied, and that this would tend toenjoy a nutritious diet, than where they are secure the safest and the most efficient treat.

kept at the starving point. The water- ment. The proprietors may assure the livesgruel slop frequently gives rise to diarrhoea ; of the patients, and a premium on recoveryand it appears impossible to preserve the may be calcnlated on equitable principles,inmates of one large establishment in health, if the data, which the public asylumson a diet which sustains the life and strength would furnish, were collected, and properlyof the agricultural peasantry living in de- digested in tabular forms. Dr. CONOLLY’Stached cottages. Report contains several valuable contribu.

Every medical practitioner must agree tions to the statistics of insanity; and thein the sentiments expressed by Dr. CONoLLY registers which he has established, if car.in the following paragraph :- ried on with perseverance and accuracy,

« The general appearance of the patients will furnish data for these calculations, asat Hanwell, the striking improvement which well as for determining the laws whichtakes place in many of them in a month or

we as for determining the laws which

two after admission, and the entire absence regulate the progress of the disease, and theof epidemic sickness during the autumnal influence of different modes of treatment.quarter, in which those disorders of thestomach and bowels are most prevalent to Tha first return shows the number ad.

which lunatics have been considered parti- mitted in every year since 1831 ; and thecularly liable, may perhaps be looked upon numbers that died, were relieved, or wereas so many indications that the present diet

’ ’.and regimen are conducive to the general eured, year by year, down to 1839. Thishealth and comfort of the patients. By the return is excellently conceived ; but weresame means, it is hoped, that they may be none dischccrged that were neither relievedguarded from many forms of illness, arising

none discharged that were neither relieved

from the lowered condition of the circulation nor cured ? 1,846 were admitted, 381 wereand other functions which seems to belong cured, 57 relieved, 587 died, and 791 re-to every variety of insanity, and preserved

’ ,

from many bodily irritations and some mained in the Asylum.mental dissatisfaction unfavonrable to reco- The duration of the disorder was ascer.

very. These considerations cannot be lost tained, or assigned, in 780 cases; 28 were ofsight of in a lunatic asylum, and specialty tamed, or assigned, in 780 cases; 28 were of

in the regulation of the food of the patients. less than a year, 327 of less than 6 years,A lunatic asylum is an infirmary, of many of 432 of less than 7 years duration Of thethe inmates of which the hope of recovery ....is never abandoned ; whilst all are visited causes assigned, in 281 cases 37were intem.with severe affliction, of which their becom- perance, epilepsy 28, blows on the heading dependent on pauper allowance is only 14 (!) effects of lightning 2. Other Tablesone of the consequences. Their claim uponsociety is consequently different from that of show the numbers of married, single,the ordinary description of paupers." p. 34. widows, and widowers; the occupation, theThe character of the cases in the Hanwell religion, and the education of the patients.

Asylum is seen in the following classifica- The degree of education was ascertained intion:--Of 805 cases, examined in the au- 494 cases; 18 were well educated, 263

tumnal quarter, 148 were cases of mania, could read and write, 178 could read, and50 of melancholia, 4 of monomania, 4 of 35 could not read. Hence it would ap.

hypochondriasis, 277 of incoherency, 171 of pear that 43 per cent. could not write; and

imbecility, 137 of dementia, 14 of idiotcy. this is nearly the proportion in the entireOf the 805 cases, 108 were complicated with population that cannot write their names.epilepsy; 48 in 469 females ; 60 in 335 males. The lunatics appear, however, to have beenThis complication is more common in males better educated on the whole than ordinarythan in females, having occurred in the pro- paupers.

portion of 18 per cent. of the males, and We have dwelt upon these returns, in the12 per cent. of the females. hope that a uniform system of registration

It has been shown, that in private asylums may be adopted in all the County Lunatic

the principle of assurance might be advanta- Asylums.

651IMPROVED TREATMENT OF LUNATICS.

The most important article in the Re- Those who are in the habit of striking sud.port is that, perhaps, which relates to the dc-nly, tearing the bed-clothes, &c., some.’ times wear a dress of which the sleevesgreat reduction of personal coercion in the terminate in a stuffed glove without divisionsAsylum. No patient has been put in re- for the thumb and fingers. But no form of

straitit in the Lincoln Lunatic Asylum for strait-waistcoat, no hand-straps, no leg-straint in the Lincoln Lunatic Asylum for locks, nor any contrivance confining thenearly 3 years! The number of patients trunk or limbs, or any of the muscles, is

in that Asylum, in the year 1830, was 92 now in use. The coercion chairs, aboutforty in number, have been altogether re-

54 were restrained; the total number of forty from the wards ; no chair of thisinstances of restraint, was 2,364; and the kind has been used for the purpose of re-

total number of hours passed under re- straint since the middle of August.

earl ly to pro -It may be considered yet too early to pro-straint amounted to 27,114 ! In 1838 the nounce a positive opinion on the generaltotal number of patients in the house was effects of these measures. In so large an

Asylum, filled with pauper lunatics, the158; not one was restrained for a single means of mere mental pauper must alwayshour ! The change has been attended with be limited, and the discontinuance of cruel

the:happiest consequences. restraints may only slowly be appreciatedby the patients. But the Resident Physi-

The system has been tried in the Ban- cian is inclined to believe, after as carefulwell Asylum ; and the principle is of such observation at all hours as the space of a

few months has permitted, and notwitbstand-incalculable importance, that we shall ex- few months has permitted, and that the noisetract Dr. CONOLLY’s description of the and disorder prevalent in some of the wardsexperiment.- has already undergone diminution; that in-

.

stances of frantic behaviour and ferocity areBy a list of restraints appended to this becoming less frequent; that the paroxysms

Report, it will be seen that the daily num- of mania to which many of the patients areber in restraint was in July so reduced that subject, are passed over with less outragethere were sometimes only four, and never and difficulty ; and that, if cases are yet seenmore than fourteen, in restraint at one time ; which appear for a length of time to bafflebut that since the middle of August there all tranquillizing treatment, they chiefly, ifhas not been one patient in restraint on the not exclusively, occur in acute mania, thefemale side of the house, and since the 21st symptoms of which would be exasperatedof September not one on either side. by severe coercion, or among those who,"There have, however, been occasional and having been insane many years, have been

brief instances of restraint, unsanctioned, in repeatedly subjected to every variety of vio-some cases, by the physician, and which do lent restraint.not appear in this Table ; but it correctly re- " With respect to the discontinuance ofpresents the total absence of continued re- the restraint-chairs, he may speak more con-straint during the whole period since fidently. Several patients formerly consignedAugust 9th. For patients who take off or to them, silent and stupid, and sinking intodestroy their clothes, strong dresses are pro- fatuity, may now be seen cheerfully movingvided, secured round the waist by a leathern about the wards or airing-courts ; and therebelt, fastened by a small lock. For some can be no question that they have beenwho destroy the collar and cuffs of their happily set free from a thraldom of whichdresses with their teeth, a leather binding one constant and lamentable consequenceto those parts of the dress is found con- was the acquisition of uncleanly habits."venient. Varied contrivances are adopted, p. 48.with variable results, for keeping clothingon those who would otherwise expose them- The old, brutal system of the mad doc-selves to cold at night; and warm boots, . ’ ., .fastened round the ancles by a small lock tors, beginning with coercion and cruelty,instead of a button or buckle, are sometimes and ending with cruelty and coercion, ena-a means of protecting the feet of those who bled them to manage their establishments atwill not lie down. As it is now and then °

necessary to confine the hands when a blister less expense than is required by the milderis applied, to prevent its removal; and as and more efficient system which is nowthis, like all other temporary restraints ap- carried into successful operation. The Mid-plied with the justifiable plea of protection, ried into successful operation. The Mid-

is generally abused by being too much pro- dlesex Magistrates have fallen into Dr.longed, or unnecessarily severe, a kind of CONOLLY’S views, and have employed ninecape, as a covering for a blister, capable ofbeing secured over it, has been thought of, additional keepers, to substitute « vigilantand will no doubt be found practicable, superintendence for personal restraint:’

2U2

652 MR. FARR ON THE MORTALITY TABLES.

We recommend the view which they take

of the duties of nurses, to the Governors

of Hospitals :-" The duties of a nurse or of a keeper, if

well and conscientiously discharged, are

harassing and laborious, and require quali-ties of no ordinary kind, and yet their sala.ries have been hitherto, for the most part,below those usually given to common do-mestic servants. The consequences havebeen such as might be expected ; keepersand nurses have been engaged, not fromchoice, but from necessity, who, if in courseof time they became fitted for the office, asthey had not a sufficient inducement to re-main, have left the Asylum for situationsless irksome, or where they have been bet-ter paid. The plan adopted by your com-mittee is calculated to invite a superiordescription of persons, and to retain them inthe service of the Asylum ; persons of cha-racter and intelligence, and of well regu-lated minds, who are not likely to abuse theauthority with which they are invested ; anauthority, which, if not controlled by rightprinciples, they have, unfortunately, buttoo many opportunities and inducements toabtise.1’

We have but one recommendation to add,and that is, that the Asylum be renderedaccessible to medical students under liberal

regulations. It is of the highest importanceto the community that the nature of insanityshould be well understood. The certificates

of two medical practitioners will consignthe father of a family to confinement in alunatic asylum ; yet insanity is excluded

from the wards of clinical observation, thestudent is shut out of the lunatic asylum,and, during the period of his studies, has

absolutely no opportunity of making himselfacquainted with this most important andformidable disease. A certain number of

the wards may be visited, without any in-convenience. The Middlesex Asylumshould be useful to all classes of society, un-der regulations which would be advan-

tageous, rather than injurious, to the afflict.ed inmates.

Dr. MARC, Physician to the King of theFrench, has died suddenly of apoplexy.He has been succeeded by M. Fouquier, ofLa Charite.

ON THE

"TABLE OF MORTALITY" FOR THEMETROPOLIS.

PUBLISHED BY ORDER OF THE REGISTRAR-

GENERAL.

An Article for THE LANCET, by W. FARR. Esq.

I find, upon an average, that 14,000 persons dieannually in Paris. This is a fine battle. (C’estune belle bataile.)—NAPOLEON IN COUNtIL.

THE Table of mortality, for the Metropolis,came into operation on the 5th of January,1840 ; and presents an abstract of the deathsregistered in the first week of the year 1840.As it differs essentially from the Bills ofMortality, and is to be continued weekly, Ihave drawn up a few observations on thefacts which it embraces, that its nature andapplication may be more readily appre.hended by medical readers.The Table exhibits, by a very simple ar-

rangement, the state of public health, inconnection with atmospherical and otherchanges. Its principal indications will beas accurate as the results of meteorologicalobservation ; and it is calculated to lead tothe discovery of the sources of disease, ofthe laws of epidemical visitations, and of themeans of controlling their ravages. It willgive a timely intimation of the approachof epidemics, guide the practice of medicalmen, and impress upon the public mind, byfraquent reiteration, that diseases prevail toa great extent, and depend upon evidentcauses, which may, in many instances, beremoved.

I shall give, in the present article, a rapidaccount of this instrument of statistical in-vestigation ; and, at another time, reviewthe physical circumstances which appear toregulate the mortality and sickness, withthe view of ascertaining whether the healthof the inhabitants of the metropolis, and ofall the cities of the kingdom, is not suscep.tible of great amelioration.The Metropolitan Division extends from

Hammersmith and Chelsea, in the West, toWoolwich, in the East ; and from StokeNewington in the North, to Camberwell andDulwich, in the South. Its area is 70

square miles, nearly equal to a circle of 9miles in diameter. The population enume.rated in 1821 was 1,328,671, which, in 1831,had inereasedlto 1,594,890. The Metropolisis divided into 32 Superintendent Registrars’Districts,and subdivided into 125 Registrar;;’Districts. (First Report of the Registrar-General, 1839.) Each Registrar fills up thesubjoined Schedule, and forwards it bypost to the General Register Ollic!’ everyMonday morning. The Table is an abstractof the Registrars’ returns :-