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THE 
 
 CURABILITY OF INSANITY 
 
 AND THE 
 
 Individualized Treatment of the Insane 
 
 BY 
 
 JOHN S. BUTLER, M.D. 
 
 HARTFORD, CONN. 
 
 LATE PHYSICIAN AND SUPERINTENDENT OF THE CONNECTICUT RETREAT FOR THE 
 
 INSANE ; MEMBER OF THE CONNECTICUT STATE BOARD OF HEALTH ; 
 
 HONORARY MEMBER OF THE MEDICO-PSVCHOLOGICAL 
 
 ASSOCIATION OF GREAT BRITAIN 
 
 NEW YORK AND LONDON 
 
 G. P. PUTNAM'S SONS 
 
 S;^e Knickerbocker ^rcss 
 
 1887 
 

 / r 
 
 COPYRIGHT BY 
 
 JOHN S. BUTLER 
 
 Press of 
 
 G. P. Putnam's Sons 
 
 New York 
 

 I 
 
 Insanity is a disease of the brain, including a departure from 
 ordinary modes of thoiight and states of feeling in health. — Dr. Ray. 
 
 Insanity is a calamity incident alike to tender sensibility, to grand 
 enthusiasm, to sublime genius, and to intense exertion of the intel- 
 lect. — Sir James Alacintosh. 
 
 Whoever has brought himself to consider a disease of the brain as 
 differing only in a degree from a disease of the lung, has robbed 
 insanity of that mysterious horror which forms its chief malignity. 
 — Sir y antes Macintosh — Life of Robert Hall. 
 
 The physician, confident in the assurance that patient and careful 
 observation of insanity, with the earnest desire to understand its 
 nature, does fit him to express with authority the results of his ex- 
 perience, must not shrink from pronouncing his opinion sincerely and 
 fearlessly, however unpopular it may be. — Maudesley on Responsi- 
 bility in Mental Disease. 
 
 lU 
 
THE CURABILITY OF INSANITY AND THE 
 INDIVIDUALIZED TREATMENT OF 
 
 THE INSANE. 
 
 IN the comparisons of the provisons made for the in- 
 sane in the United States, in 1844, with those of the 
 present day, we find the best measure of progress to be in 
 the larger recognition of their necessities, in remedial 
 treatment, custodial provision, and acceptance of the 
 power of prevention as applicable to insanity as to other 
 physical diseases. 
 
 In October, 1844, thirteen gentlemen met in Philadel- 
 phia and organized the " Association of Medical Super- 
 intendents of Institutions for the Insane." Their object 
 was, by a comparison of views and careful study, "■ to 
 secure for the future a higher standard for hospitals, 
 and a more liberal and enlightened treatment for all suf- 
 fering from mental diseases." The causes which led to 
 this result are stated in the Secretary's history of the 
 Association. At that time, 1844, there were in the United 
 States twenty-five lunatic hospitals of all classes, contain- 
 ing less than twenty-six hundred or twenty-seven hundred 
 inmates. The largest number in a distinct hospital was 
 two hundred and sixty-three, in that of Worcester, al- 
 though there were three hundred and fifty in the Recep- 
 
2 THE CURABILITY OF INSANITY. 
 
 tacle on Blackwell's Island. According to the report of 
 the Board of the State Charities in Pennsylvania, in Sep- 
 tember, 1883, there were in the United States one hun- 
 dred and foTty-seven lunatic asylums, containing fifty- 
 one thousand eight hundred and seventeen patients ; the 
 total number of insane in the United Sates being esti- 
 mated to be ninety-two thousand, or one in five hundred 
 and forty-five of the population, the lowest rate of insanity 
 being found in the more recently settled States. The 
 Association at this time embraces all North American 
 institutions, and now records one hundred and twenty- 
 two active and retired members. Well may the excellent 
 and most efficient Secretary say of the Association that, 
 " Formed in the interest and for the promotion of the 
 welfare of the insane, it has been steadily growing in 
 numbers, in influence and power, until it covers with 
 its protecting shield a large proportion of the insane 
 throughout the length and breadth of the land." In the 
 eventful history of the Association for the past forty years 
 there has been, for the most part, a singular and cordial 
 unanimity of action as to the best means of attaining the 
 desired end — the highest good of the insane. The " Propo- 
 sitions " adopted by the Association show not only 
 a large wisdom, but a foresight of the necessities of this 
 comparatively new and unexplored field of philanthropy. 
 The unexpectedly large and continually increasing 
 number demanding either hospital treatment, or simply 
 hospital supervision and care, has naturally led to a diver- 
 sity of opinion as to the number of patients that can be 
 most profitably treated in one institution. That the causes 
 of this diversity may l^e better understood, and my own 
 
THE CURABILITY OF INSANITY. 3 
 
 position more clearly defined, I may here quote some of 
 these propositions, and my reasons for objecting, not 
 only to the one accepted by a close vote, but to the 
 others subsequently passed in accordance with it. 
 
 At the meeting in Philadelphia, in 1851, among other 
 propositions, the following was unanimously adopted : 
 
 The highest number that can, with propriety, be treated in one 
 building is 250, while 200 is a preferable maximum.' 
 
 At the meeting in Washington, in" 1866, the following 
 propositions were adopted : 
 
 Insane persons considered incurable, and those supposed curable, 
 should not be provided for in separate establishments. 
 
 ****** 
 
 The large States should be divided into geographical districts of 
 such size that a hospital, situated at or near the centre of the district, 
 shall be practically accessible to all people living within its bounda- 
 ries, . . . and available for their benefit in cases of mental 
 disorder. 
 
 All State, county, and city hospitals for the insane should receive 
 all persons belonging to the vicinage designed to be accommodated 
 by such hospitals, who are afflicted with insanity, whatever may be 
 the form of the bodily disease accompanying the mental disorder. 
 
 The enlargement of any such specified institution may be properly 
 carried, as required, to the extent of accommodating six hundred pa- 
 tients, embracing the usual proportion of curable and incurable in a 
 particular community. 
 
 ' The International Record for April, 1887, gives the number of 
 inmates in each of eighty-eight of our lunatic hospitals. Of these 
 eighty-eight hospitals only sixteen contain not more than 250 patients, 
 — that " highestnumber " accepted by the Association in 1851 ; 
 thirty-eight contain from 250 to 600 ; twenty-four from 600 to 1,000 ; 
 and ten from 1. 000 to 1,818. 
 
 The complaint of the continued over-crowding for admission 
 seems unabated. 
 
4 THE CURABILITY OF INSANITY. 
 
 While the other i^ropositions were quite unanimously 
 accepted, this was passed, near the close of the meeting, 
 by a vote of eight to six. Under the increasing pressure 
 of necessary admissions, this proposition has seemed 
 practically to annul any official limitation of number. 
 
 At the meeting at Toronto, in 187 1, the Association 
 reaffirmed, in the most emphatic manner, all the former 
 declarations in regard to hospital organization, manage- 
 ment, etc., and also. 
 
 Resolved, That neither humanity, economy, nor expediency can 
 make it desirable that the care of the recent and chronic insane 
 should be in separate institutions. 
 
 My own position upon this point of numbers was early 
 taken, and I have seen no good reason to change. At 
 the meeting in Pittsburg, in 1865, I stated to the Asso- 
 ciation that the admission into the Retreat of a large 
 number of incurable State patients had greatly embar- 
 rassed the remedial treatment of the recent and hopefully 
 curable. And I was, consequently, led to suggest the 
 consideration by the meeting of some kind of distinct 
 and efficient provision to be adopted by the State for 
 these unfortunates. I did this simply, without any dis- 
 tinctly formed plan of my own, but only to find the best 
 effectual way of escaping from such possibly avoidable 
 interference with hopefully curable treatment. Most 
 unexpectedly to me, this proposition led, as was reported, 
 to the " most excitable debate of the session," as unex- 
 pectedly, to its almost unanimous disapproval, only one 
 member (Dr. Hills, of Ohio) voting with me in favor of 
 it. I then offered the following motion : 
 
thp: curability of imsamity. 5 
 
 Resolved, That a committee of three be appointed to take into 
 consideration the condition of the chronic and supposed incuiable in- 
 sane, and the possible arrangement for their treatment and custody, 
 and to report at the next meeting of the Association. 
 
 The motion was, in due courtesy, passed, and Drs. 
 Butler, Walker, and Curwen were appointed the com- 
 mittee. 
 
 A long vacation, made necessary by illness, prevented 
 both my preparation of a report and my attendance at 
 the next meeting. 
 
 At the meeting in 1866, propositions favorable to my 
 views were presented by Dr. Walker, and rejected ; 
 while others of an opposite import, by Dr. Chipley, were 
 accepted. The unanimous reaffirmation of all the propo- 
 sitions heretofore adopted, clearly defined the decision of 
 the Association on those points. 
 
 I hold that these later propositions fail to anticipate 
 the large increase of the number of the insane, the larger 
 hospital accommodations they demand, and, especially, 
 the changes so rapidly coming over the different classes. 
 Neither the original thirteen, in 1844, nor the members 
 who in 1 85 1 voted that, " two hundred were a preferable 
 maximum of inmates to be treated in one building," 
 could have imagined the present number of insane, in 
 and out of hospitals, or that its rapid increase would, in 
 a single year (1884) add more than two hundred to their 
 number in the single State of Massachusetts. 
 
 My proposition at the Pittsburg meeting in 1865 
 seemed to fall lifeless from the animated discussion which 
 it had excited ; but the radical principle it contained, 
 like good seed sown by more than one hand and in good 
 
6 THE CURABILITY OF INSANITY. 
 
 ground, has, after twenty years of gradual and persistent 
 development, come forward with better promise of ac- 
 ceptance in the future. 
 
 Here, fairly to myself, I may recall some of those 
 events in my earlier professional life, which led me to 
 determined opinions in regard to the necessities of the 
 insane. 
 
 Early in 1833, shortly after I had commenced the 
 practice of medicine in Worcester, Mass., I made a call 
 simply of professional courtesy on Dr. Woodward, who 
 had been lately appointed superintendent of the newly 
 erected State Lunatic Hospital. While standing with 
 him in the entrance hall, a party of his patients, " crazy 
 men " (then a sadly strange sight to me), passed in from 
 a walk. The Doctor stopped them to give an order to 
 their attendant, and my attention was especially drawn 
 to the pitiable appearance of the laggard of the group. 
 Feeble and emaciated, he seemed to be a hopeless re- 
 mainder of a man. The Doctor told me he was a young 
 Welshman, Llewellyn by name, as I well remember, who 
 had come to this country " to pick up gold in our streets." 
 Unable to find work or wages, hearing sad news from his 
 home in Wales, through homesickness he had sunk into 
 the deepest melancholy. " Poor fellow," I said, " his is 
 an utterly hopeless case." " By no means," answered 
 Dr. Woodward. " But I mean him,'' pointing to Llewel- 
 lyn, "he cannot recover!" "I confidently expect he 
 will," replied Dr. W. " May I see your treatment ? " I 
 asked. " Every day, if you wish," was the Doctor's re- 
 ply. For weeks following I saw him, if not every day, 
 very frequently. On my return home I said to a friend : 
 
THE CURABILITY OF INSANITY. / 
 
 " In my course of lectures in the Harvard Medical 
 School, in my graduate and post-graduate courses in 
 Philadelphia, I heard no such case described. In a li- 
 brary fairly well stocked for that day and faithfully con- 
 sulted, no such case and treatment were given. If 
 Llewellyn can be cured it will be next to a revelation in 
 medicine to me." In a few weeks he came down to my 
 office to bid me a grateful good-bye, etc., there present- 
 ing himself, in contrast with my first interview, a rarely 
 good specimen of a healthy, vigorous, and intelligent 
 young man. This case shaped the future of my profes- 
 sional life. For years afterwards I was a frequent visi- 
 tor to the hospital and a somewhat careful observer in 
 the wards, to all of which Dr. Woodward gave me free 
 access. In those wards I saw frequent illustrations of 
 the marvellous results of the moral treatment of the in- 
 sane — that individualized power, which the healthy, in- 
 telligent, enthusiastic mind holds over the " untuned and 
 jarring senses " of the lunatic. Then a young practition- 
 er, striving to win public confidence and position, I found 
 that I gave to my cases of typhus fever, etc., no more 
 frequent, sharp, and kindly treatment than Dr. Wood- 
 ward gave to his cases of recent insanity. This, espe- 
 cially, was before the first enlargement of the Hospital by 
 the addition of two new wings, which Dr. Woodward 
 greatly regretted, being confident it would cripple his 
 system of treatment. He earnestly advised that it should 
 be as an "annex" erected on the adjacent farm land of 
 the Hospital. 
 
 In 1839 I was elected Resident Medical Officer of the 
 Penal, Charitable, and Reformatory Institutions, and 
 
8 THE CURABILITY OF INSANITY. 
 
 superintendent of the newly erected Lunatic Hospital, of 
 the city of Boston. Those three years' superintendency 
 of the Lunatic Hospital gave me the desired opportunity 
 of applying to my own cases of insanity those principles 
 of treatment which I had seen applied with such eminent 
 success in Dr. Woodward's wards, a success which I have 
 never seen surpassed, if equalled ; a fascinating illustra- 
 tion to me, of the merciful advances in these later days 
 from the ignorance and cruel barbarism in the " mad 
 houses " of " ye olden times," when, in the language of 
 an old Scotch writer : " The better sort of ye mad people 
 were given to the care of the chirurgeon, the baser sort, 
 to the taming of the scourge ! " See Appendix (i). 
 
 The North American Revieiv^ for January, 1843, has an 
 article on " Insanity in Massachusetts." The writer says : 
 " We select for description the Boston Lunatic Hospital in 
 1842. Its patients are wholly of the pauper class. Its in- 
 mates are of the worst and most hopeless class of cases. 
 They are the raving madman and the gibbering idiot, 
 whom, in the language of the inspectors of prisons, hos- 
 pitals, etc., for Suffolk County, we had formerly seen 
 tearing their clothes amid cold, lacerating their bodies, 
 contracting most filthy habits, without self-control, unable 
 to restrain the worst feelings, endeavoring to injure those 
 who approached them, giving vent to their irritation in the 
 most passionate, profane, and filthy language, fearing and 
 feared, hating and almost hated. Now they are all neatly 
 clad by day and comfortably lodged in separate rooms 
 by night. They walk quietly with self-respect along their 
 spacious and airy halls, or sit in listening groups around 
 the daily paper, or they dig in the garden, or handle 
 
THE CURABILITY OF INSANITY. 9 
 
 edged tools, or stroll around the neighborhood with kind 
 and careful attendants. They attend daily and rever- 
 ently upon religious exercises and make glad music with 
 their united voices. Such is the condition of the insane 
 of the city of Boston ; and although but twenty-eight out 
 of one hundred and seventy-one have been cured, and 
 the rest will probably wear out their lives in hopeless in- 
 sanity, yet there is a melancholy pleasure in witnessing 
 the great amount of animal happiness they enjoy, in see- 
 ing the kind regard paid to prostrate humanity, the re- 
 spect shown to the deserted temple of reason. It is only 
 as it were twining fresh flowers on the graves of the dead ; 
 still it is a grateful sight to the humane, and a more cer- 
 tain indication of high civilization, than the most refined 
 taste in literature and the arts, or the most fastidious of 
 social etiquette." 
 
 One of these patients came into the hospital out of an 
 iron cage, which I was told she had inhabited more than 
 a year, and several others out of veritable Barnum's me- 
 nagerie wooden cages. All these were females. Freed 
 from restraint and seclusion, soon after admission, they 
 were all readily won over to decent and orderly lives. 
 Before long all of them were occasional visitors in our 
 own family parlor.^ I trust these details will not be con- 
 
 ' Among the pauper lunatics admitted late in the autumn of 1839 
 into the recently organized Boston Lunatic Hospital, and whose con- 
 dition was so graphically and truthfully described in the N'orth 
 American Review for January, 1843, in the article on " Insanity in 
 Massachusetts," was a Scotch-Irish girl named Mary. She was a 
 fair specimen of the repulsive and difficult class which first occupied 
 those wards. 
 
 Mary was unusually athletic, naturally good-natured, but trained to 
 the necessity of fighting her own way, and yielding only to brute 
 
lO THE CURABILITY OF INSANITY. 
 
 sidered outside of good taste, as they seem to me to be 
 but fairly descriptive of the natural outgrowth of due 
 sympathy with the insane, as instructed and fortified by 
 the teachings and examples of Dr. Woodward and others. 
 On my election, early in 1843, to the superintendency 
 of the Connecticut Retreat for the Insane, I found that 
 the directors had most charitably voted to admit, and at 
 very low rates, many of the pauper and chronic insane 
 from the almshouses of the State. In these, the earlier 
 days of my Retreat life, when our crowded wards crip- 
 
 force. Her untamed and belligerent state was the natural result of 
 her sadly neglected mental condition. 
 
 One day, passing by the outer door of her ward, my attention was 
 attracted by the unusual brightness of a dandelion flower which on 
 that cold autumn day had crowded its unseasonable (but as it proved 
 its timely) way up through the lately graded ground. As I picked it 
 up I was startled by a wild uproar within the ward. Hastening in, 
 I met the frightened and then utterly inexperienced nurse, and, ap- 
 prehending some serious trouble, sent her to hurry up an assistant of- 
 ficer to my possibly needed aid. I have never imagined a more strik- 
 ing illustration of an old time mad-house than that crowded hall 
 then presented to me. Mary, her stout arms akimbo, was marching 
 down the hall, her voice at the highest pitch, profanely denouncing 
 everj'body and every thing ; the other patients highly excited, some 
 running for shelter, others joining the wild uproar. I announced my 
 advent by a decided stamp on the floor, with an equally decided 
 voice, saying : " I will not have such a tumult here." " The h — 1 you 
 won't ! we '11 see to that," I very distinctly remember was her prompt 
 answer, as, suddenly wheeling, she advanced to the decision of that 
 question by " force of arms," — arms to which mine would be but 
 feeble impediments ! How heartily did I then wish myself Ijack in 
 general practice, out among the sick and wounded Irish 7ne7i on the 
 railroads ! But seemingly the supremacy of the week-old superin- 
 tendent was then and there to be fought out on the instant ! Re- 
 calling the experience of my boyhood when, wrestling with the stouter 
 farmer boys, I learned that a sudden catch at the collar and as quick 
 a rap at the heels gave me the right relative position in the downfall, 
 I waited, silently and quietly watching her ferociously maddened ap- 
 proach ! When just within reach suddenly her whole aspect changed 
 
7'HE CURABILITY OF INSANITY. II 
 
 pled my means of classification, a quiet and apparently 
 inoffensive case of dementia was necessarily located in 
 one of the better wards ; the poor man would sit silent 
 all day in a dreamy, stupid state, his only token of active 
 life, the constant twirling of his thumbs. A refined and 
 intelligent gentleman on the same hall, who was recover- 
 ing from the results of an overworked brain, came to me 
 one day, exclaiming with no little agitation, " Doctor, I 
 nmst go home ! " I remonstrated, urging his rarely good 
 prospects of a speedy recovery. " Why should you go ? " 
 
 and wonderfully softened. Naturally following her eye, and looking 
 downward, for the ally who had so suddenly come to my relief, I 
 found my hand, unconsciously upraised for the encounter, held that 
 dandelion ! I offered it to her in a few low-toned words, and she 
 accepted it with a very humble courtesy. The sudden and wonder- 
 ful change of aspect was only surpassed by the touching pathos with 
 which the subdued maniac exclaimed: "Oh! beautiful! can j^m 
 mane to give that to the loikes of me ? " The battle was fought and 
 won. Taking my offered arm, she went quietly to her room. 
 
 There was another chapter in the history of poor Mary, which 
 may well be recorded. A few days after my instructive experience 
 with the dandelion, she tore up the new dress given her on admis- 
 sion. After due reproof and persuasion, her promise of future good 
 behavior was accepted, and another dress ordered. " Why, sir, she 
 will certainly tear it up ! " said the nurse. " Then give her an- 
 other, and, if need be, another," was my answer. Much to my dis- 
 appointment, one or two more soon followed the first. My repeated 
 expressions of surprise and sorrow, with kindly remonstrance against 
 such unprovoked bad behavior, followed by seclusion in her room, 
 and withdrawal of my daily and kindly personal attentions, soon 
 produced the desired effect, namely, more self-control and a better 
 mind. I then gave her a pretty dress pattern, — " good enough for a 
 lady," she said, — and allowed her to help make it up. We all gave 
 her a somewhat formal reception on her " coming out " in it ; and 
 our comments were cordially, and Avith no little self-complacency, 
 received. From that time she became quiet and industrious, an 
 orderly attendant on chapel services, and at our little social parties. 
 
 Hopelessly insane, she remained in an orderly, submissive, and 
 seemingly happy condition while under my protective care, 
 
12 THE CURABILITY OF INSANITY. 
 
 I asked. " Because," said he, " this continued rainy 
 weather has kept me in-doors for a fortnight. I am in 
 your way, in your business rooms. I have worn out the 
 hospitality of Mrs. Butler — up there, seeing that poor old 
 fellow twirling his thumbs hour after hour ! day after 
 day ! I can't stand it ! D — n it, I shall be just like 
 him ! " My continued experience ever afterwards 
 strengthened my convictions of the expediency and in- 
 deed humanity of the segregation of the chronic insane 
 from the recent and hopefully curable cases. I was 
 compelled by this conviction to present this question to 
 the consideration of the Association at the meeting at 
 Pittsburg, in 1865. 
 
 Individualized treatment is called for in insanity as 
 imperatively as in the case of acute forms of other physi- 
 cal disease. The form of treatment is different according 
 as the practitioner is hopefully working for a cure in an 
 acute case, or as in some chronic case of long standing, 
 he is simply administering palliation and general care. 
 The first requires his personal and persistent attention, 
 the second may be treated in a general way and may be 
 committed to others. 
 
 I believe strictly recent insanity in very many cases, is 
 radically curable under the prompt, persistent, and united 
 use of medical and moral means. These, to be efficient? 
 demand individualized application, /. <?., that same im- 
 mediate, close, and sharp personal service which the gen- 
 eral practitioner necessarily gives to the early stages of 
 typhus, diphtheria, cholera, etc. This power, essential to 
 the largest success, is limited, as in all individual efforts, 
 by number. Applicable to the few, it cannot be extended 
 
THE CURABILITY OF INSANITY, 1 3 
 
 to the many. While here and there it may reach one in 
 a crowd, the general result proves the limitation. In ad- 
 dition to professional skill the largest success of individ- 
 ualism demands that combination of those innate, inher- 
 ent qualities of " courage, kindness, and patience " which 
 the Edmbui'gJi Review^ in April, 18 14, attributed to Wil- 
 liam Tuke as the secret of his success in the Retreat for 
 the Insane in York, a " success " which remains to this 
 day our highest instruction ! As no two cases of insanity 
 or physical disease are, in all causes and effects, precisely 
 alike,' the peculiarities of each will of course demand 
 special consideration. 
 
 Dr. Conolly, in his admirable essay on the " Indica- 
 tions of Insanity," speaking of the duties of medical men, 
 says (page 428) : 
 
 To- superintend with care and without offending ; to control with- 
 out severity, and to indulge without weakness ; to attract without 
 fatiguing the attention ; to revive the memory without reviving memo- 
 rials of affliction ; to touch the imagination but not too sensibly ; to 
 encourage at favorable moments to such comparisons as may triumph 
 over retreating delusions, is a task too delicate, too sacred, I might 
 say, to be entrusted to common hands. It is a power which cannot 
 be delegated.^ 
 
 ^ Esquirol relates that an old nun, formerly employed in the tuition 
 of the young, was brought to the hospital in a state of profound 
 melancholy. During six months all the methods which we had re- 
 course to were without effect. Her notions always remained the 
 same, and she continually repeated to the superintendent that he 
 was wrong not to treat her as the most guilty of women, and that he 
 ought to impose on her the severest punishments. 
 
 One day she met him in the interior of the hospital, and renewed 
 the same kind of conversation. She received from him a sharp reply, 
 with an express declaration that he would listen to her no more, 
 since she always persisted in the same notions, and showed him no 
 sort of confidence. The patient retired in silence to her apartment, re- 
 
14 THE CURABILITY OF INSANITY. 
 
 The best definition of the alleged power of individual- 
 ism to charm down insanity, is that given by Emerson as 
 " The power b e /mid th.Q eye." 
 
 fleeted deeply on the reproof she had experienced, and did justice in 
 her own mind to the upright and irreproachable character of the super- 
 intendent, and his sincere desire to assist in the re-establishment of the 
 unhappy persons about him. Was not all he had said dictated by 
 the most humane intentions ? She experienced great perplexity that 
 night, and a sort of interior conflict between the thought of her 
 imaginary crimes and the friendly remonstrance of a man who could 
 have no personal interest in what he said. These vacillations, and 
 this interior conflict, going on for some time in the form of cool dis- 
 cussion in her own mind, produced the most favorable change in her, 
 and she ended by being fully convinced that her scruples were chi- 
 merical, and she at once entered eagerly upon the proper means for 
 the perfect re-establishment of her health by the proper physical 
 treatment. 
 
 The preceding case reminds me of one of my old patients whose 
 history on admission told of long time duration of persistent antago- 
 nism in the varied relations of her life. She was a widow of middle 
 age, without living children ; of superior natural intellectuality and 
 refinement, and a quick pleasant manner. Neglect in childhood, and 
 defective training in later life led to the natural consequences of the 
 undue indulgence of a strong will. These, added to unhappy domestic 
 relations and ill health, readily induced insanity, though not of a 
 marked salient character. In due time and manner I kindly and 
 frankly discussed with her the whole sad story of these unhappy 
 causes and effects, explaining their direct action upon her nervous 
 system. I urged my hearty desire for her cordial acceptance of my 
 professional opinions, and her cooperation in what my every-day ex- 
 perience taught me was her only way of escape. The result of thus 
 winning her confidence and sympathy, was a gradual but decided 
 gain in general health and better self-control. Her " fallings from 
 grace " became less frequent and marked. Some time afterward to 
 my great surprise and annoyance she came to me one day during a 
 temporary disturbance of her health, abruptly demanding an entire 
 change in my medical prescriptions. I declined, pleasantly explain- 
 ing the good working of the present remedy, and the peril of the ex- 
 treme one she proposed. She persisted in demanding the change. I 
 sought to avoid the discussion, but in vain ; the difference of opinion 
 finally culminating in her saying with marked emphasis : " I know 
 my own case, sir, and I will have it " ; and in my answering with all the 
 then possible courtesy : " Madam, you compel me to say you shall 
 
THE CURABILITY OF INSANITY. 1 5 
 
 The chapel/ the amusement hall, the social circle in- 
 side and the social circle outside of hospital wards have, 
 in my experience, proved potent remedial agencies. Un- 
 
 not have it." She left the room with a defiant expression, which, 
 shadowing my good hopes of her improvement, made me much soHci- 
 tude. I found next morning a letter from her on my desk. I opened 
 it with no little anxiety and reluctance, knov/ing the peremptory 
 power of her pen. I expected a sharp continuance of her argument ; 
 but I gladly accepted her conclusion when I read, 
 
 " My dear, dear — Emperor Nicholas : — Forgive me — forgive me 
 — I will try never to be so naughty again." 
 
 A young lady between sixteen and seventeen years of age, of good 
 physical development, but apparently of a decidedly ner\'ous tempera- 
 ment, lady-like in her present manners, was some time ago placed 
 under my care. Her parents told me that she had been in pretty good 
 health until within a year or two, when without any apparent cause 
 she had become dyspeptic, oftentimes sleepless, generally unwell, and 
 gradually growing worse and more nervous and excitable. She had 
 of late become so uncontrollable that they were compelled to bring 
 her to the Retreat, fearing she was drifting into insanity. As she was 
 their only child, they now feared that they had been unwisely indul- 
 gent to her. 
 
 Her heartless indifference to the separation from her parents 
 plainly indicated the " spoiled child." 
 
 A careful investigation of her case enabled me readily to detect 
 the disordered condition of various organs, a condition easily pre- 
 ventible in its primary stages, and now as easily remedied by suita- 
 
 ' ' ' Though it is the first time for years that many of our inmates had 
 been thus recognized as members of the human family, their fixed at- 
 tention and serious deportment is a pleasant illustration of the adapta- 
 tion of the Gospel to ' all sorts and conditions of men.' The utility 
 of its influences should be undoubted. No one can look upon our 
 household assembled for the instruction of the Sabbath, or for the 
 family worship of the evening, and see them there as one family rise 
 up silently and reverently to pray to ' Our Father in Heaven,' with- 
 out realizing that some feel the solemnity of the act, without being 
 convinced that a clford may be struck, whose ultimate vibration may 
 awaken some recollection of early life and bring back upon the ex- 
 cited and bewildered mind some calm and solemn influences, and give 
 that one moment of self-control in which the first link in the chain 
 of diseased associations may be broken." — Boston Lunatic Hospital 
 Report, 1840. 
 
1 6 THE CURABILITY OF INSANITY. 
 
 der such influences I have frequently detected the first 
 indications of recovery. It seems self-evident to me that 
 these details of moral treatment can be most successfully 
 applied only in a hospital of the originally assumed "best 
 number " of two hundred inmates. Here can be most 
 easily developed those social influences which have such 
 special power over diseases of the brain and nervous 
 system. In such comparatively secluded lives, the nat- 
 ural cravings for sympathy and companionship most 
 readily attract those genial affinities which lead to the 
 formation of little homelike circles of newly found 
 friends. The happiest results can often be traced from 
 such circles. The reaction of mind upon mind, compari- 
 son and discussion, with criticisms, sometimes happily 
 sharp they may be, but ever kindly, have here their 
 
 ble remedial agencies, — another of the familiar and sad old stories of 
 neglected cause and effect. 
 
 As she appeared pleasant and lady-like, and quietly accepted her 
 novel position, I located her with others of my lady patients, natu- 
 rally expecting that the regaining of self-control would be aided by 
 the influence of such refined and genial surroundings. 
 
 For a few days all went so well with her that I was beginning to 
 think her parents had been needlessly alarmed. But the little stock 
 of self-control was soon exhausted, even under the soothing influence 
 of the new surroundings, when I was summoned hastily, the nurse 
 reporting a violent outbreak of temper on slight provocation, and the 
 free use of language " too bad to be repeated to you." On reaching 
 the hall, assuming the appearance of great regret and mortification, 
 I told the ladies that I came up to apologize for the sad blunder I 
 had made in associating that ' ' unfortunate young woman " with them. 
 From the social position of her j^arents I had unfortunately taken it 
 for granted that their daughter was a young lady,* asking them to ex- 
 cuse my mistake, and directing "the young woman " to follow me. 
 I immediately took her down to a lower department, occupied by a 
 sadly repulsive class, whom the charity of our Board, before the 
 erection of the State hospital, had temporarily received from the alms- 
 houses of the State. Bidding the nurse to be very patient with 
 
THE CURABILITY OF INSANITY. 1 7 
 
 place. The desponding are comforted and made hope- 
 ful, and the excited are repressed and instructed by the 
 cordial and kindly comments of the convalescent and ex- 
 perienced. If all these desired good effects do not /;;/- 
 mediately YQ^\i\t, they certainly remove at once that greatest 
 evil of lunatic hospitals — monotony. Dr. Tuke, in his 
 admirable " Illustrations of the Influence of the Mind 
 upon the Body," speaking of the importance of this 
 power as a practical remedy in disease, quotes John 
 Hunter, as follows : 
 
 There is not a natural action in the body, whether voluntary or 
 involuntary, that may not be influenced by the special state of the 
 mind at the time. 
 
 The variety of ways by which one may promote the 
 interest of the insane, happily illustrates the many-sided- 
 ness of truth. 
 
 this sad addition to her burdensome family, to shut her up in a room 
 if her language became intolerable, I left her with no little anxiety 
 as to the result of this " moral treatment." 
 
 In a brief time I was earnestly recalled, the nurse reporting that 
 the young lady, in a paroxysm of tears, repentant of her folly, ad- 
 mitting my just decision, was begging the privilege of my forgive- 
 ness. Accepting her sincere repentance with great delight, and 
 bidding the nurse to readjust her dress, and to remedy the flushed 
 and tearful face with a little cold water, I gave the girl my arm and 
 returned to the hall.. Entering the room with much assumed formali- 
 ty, I introduced my companion as " a charming young lady friend of 
 mine, who had just come up to us from the country." The ladies 
 readily appreciating our position, gave their returned associate a 
 right merry and hearty reception. From that time forth her progress 
 toward recovery Avas satisfactory. Her physical ailments gave way 
 to simple remedies. The power of self-control without a.Tiy serious 
 interruptions returned, and under its carefully persistent cultivation 
 advanced to its natural and sufflcient development. On leaving us she 
 said, " lam well, and shall keep so ; thanks, you have taught me the 
 necessity of self-denial. For the first time in my life I have been 
 made to obey." 
 
1 8 THE CURABILITY OF INSANITY. __ 
 
 The same appliances that tend to make life in a well- 
 ordered house beautiful and happy, may be brought to 
 bear upon- the disordered mind ; and its wanderings and 
 vagaries be arrested by putting it as nearly as possible in 
 relations like those of private secluded home-life. The 
 great caravansaries we call hotels are not homes, neither 
 do the immense structures we build as hospitals, however 
 well kept, tend to promote the home content, and to 
 awaken those sweet and restorative feelings that belong 
 to home itself.' 
 
 ^ Some years ago, a young lady of about seventeen years of age, 
 of delicate organization, sensitive and nervous, and in frail general 
 health, was brought from a distant city to our care by her only and 
 older sister. 
 
 They had been left motherless at an early age. The neglect of 
 rightful early training, the varying impulses of a wayward will, some 
 sad hygienic mistakes — the result of educational neglect, — made her 
 committal to the Retreat a discreet and timely measure. 
 
 After the formalities of admission, the sister, after giving the out- 
 line of her case, besought me to give some little extra attention to 
 my new patient. " It is a terrible thing, sir," she said, " to leave this 
 poor, sick, dear child, hundreds of miles from home, all alone among 
 strangers." I was ready to promise what she wished, hopingin some 
 way to allay the not unnatural nervous excitement of both. 
 
 After expediting their separation, I told the young lady that, being 
 now under my professional care, she could better tell me all about 
 her troubles somewhere out on the lawn. There, surrounded by 
 those soothing influences which I have so often found efficient aids 
 to professional treatment, I at first led her attention to our beautiful 
 surroundings rather than to the details of her ailments, calling her 
 attention to the varied scenery, the pleasant changes of light and 
 shade, and to the flowers of which she seemed so fond ; occasionally 
 alluding to the events of her long journey, and casually asking lead- 
 ing questions aljout her health, — all this with the pleasant result of 
 gradually substituting self-control and smiles for nervous agitation 
 and tears. The songs of the birds attracted her attention. " I am 
 so fond of music," she said. This I was glad to hear, as we had so 
 many musical parties. Disclaiming the rare musical merit I had 
 heard she f)Ossessed, as I called for evidence, it came first in sad, 
 and ]jy and by in merrier, notes. The noon-day bell put an end to 
 
THE CURABILITY OF INSANITY. 19 
 
 " How clean and nice this room is," said a director to 
 me, one day, in one of the old, rigidly plain halls, long 
 before the reconstruction. " Yes," I answered, " the 
 floor, the bed, the walls are white — if not white as snow 
 — white enough to chill the heart of the delicate, refined 
 young mother who is to occupy it to-day." "Why, what 
 better would you have ? " he asked. " All possible home- 
 like ornamentation, neutral tints, pictures, flowers, etc., 
 etc. ; every thing to give the room an inviting aspect, and 
 not painfully to remind her of that refined and home-felt 
 
 our pleasant out-of-door visit. " What is'that for ? " she asked. " It 
 is noon, and we must go in to get ready for dinner," I told her. 
 " Noon ! " she exclaimed, " how strange, how really absurd ! why, 
 a little while ago to be left here all alone, was to break my heart, and 
 now I have been singing and laughing with you." Then came my 
 sought opportunity. " No, this is nothing absurd ; all this is hope- 
 ful to me ; you have given me the keynote to the history of your 
 illness ; this gives good promise of your restoration to health and 
 a happy future, if you will only trust yourself to my guidance 
 and accept my teachings." " Why ! " she promptly answered, " of 
 course 1 shall do so." After this I held the case easily in hand. 
 Right heartily did she hold to the faith so cheerfully professed. Her 
 vivacity and kind-heartedness made her a favorite member of our 
 family. In due time, after she had left us as recovered, the evidence 
 of her permanent restoration to health and to new purposes of life 
 coming to us through the echoes of marriage bells, was accepted as 
 the natural sequence of that morning on the lawfi. 
 
 I shall ever remain grateful to those liberal friends on record in the 
 Report of the Retreat for 1S61, who gave to my personal solicitation 
 the ample means of developing the natural beauties of the lawn, the 
 erection of the museum, the Ives amusement hall, with many orna- 
 mentations which have since been found to be such efficient thera- 
 peutic remedies. 
 
 Medicine is justly divided into " Prophylactic, or the art of pre- 
 serving health," and " Therapeutic, or the art of restoring it." 
 Moral Therapeutics have a wide range ; they are so effectual in al- 
 laying the undue excitability of the disordered mind, and in diverting 
 the current of morbid thought back into the natural channels of 
 health. 
 
 After the correction of those physical disorders (so generally ac- 
 
20 THE CURABILITY OF INSANITY. 
 
 room in which she has left her infant child." Bearing 
 this in mind, when Mr. Vaiix, the architect, came up from 
 New York to examine the Retreat as to its reconstruc- 
 tion, he asked me, " What would you have me do with 
 this old building ? " " Reconstruct the ' Lunatic Hospi- 
 tal ' thoroughly, and develop the * Home ' for the nervous 
 and insane," was my answer. The result was a success. 
 In one of my earlier reports of the Retreat I stated 
 that of one hundred and eighty-seven female patients 
 last admitted, thirty-four per cent, were wives of farmers 
 
 cepted as "the punctum saliens," or starting-point, of insanity), I 
 have often turned successfully to this department of Therapeutics for 
 that " Medicamentum gratia probatum " of quaint old Paracelsus, 
 the " remedy approved by grace," for restoring the sufferer from in- 
 sanity to a right mind. 
 
 The whole forenoon I gave this young lady was not wasted. I 
 know not how it could have been more profitably, humanely, or sci- 
 entifically employed, I met her afterwards more or less frequently 
 every day, keeping quiet but careful watch over her progress. 
 
 In my regular morning visits to the various departments of the 
 House, it was my custom to have itsimmates, who were well enough 
 to leave their rooms, meet me in the parlor attached to their respec- 
 tive halls. Of course private and confidential interviews were fre- 
 quently required. These every-day family-like gatherings proved 
 far more than formal visits to each room. Such informal meetings, 
 like many of my old-time visits in general practice, were so homelike 
 and natural that their influence readily drew out those genial and 
 social elements of the heart which, in the most extreme developments 
 of insanity, I have rarely, if ever, found beyond our reach. For here 
 was possible " that intangible permeation of a household not too 
 large for the personality at the head of it," The conversations were 
 easy and natural, often bringing out the mental peculiarities of one 
 and another ; these in turn leading to timely criticisms, and then to 
 frank and general discussions. 
 
 The best results depended upon the discreet association of varied 
 elements. Judicious antagonisms worked better than similarities ; 
 the excited and melancholic amended each other, while the appeal 
 to the judgment of the majority, confirming the best decision, bene- 
 fited both, I have again and again traced the final results of suc- 
 cessful treatment to such persuasive agencies, by which doubts were 
 
THE CURABILITY OF INSANITY. 21 
 
 and mechanics — an undue proportion of these classes in 
 the State. Many were young women, leaving nursing 
 children at home. In these cases it had naturally fol- 
 lowed from the sequences of child-bearing and child- 
 nursing ; the too frequent entire absence of all or of only 
 the brief week's service of the "monthly nurse"; the 
 accumulation of household duties and drudgeries ; nar- 
 row and near-sighted economies, and absence of needed 
 relief of change and recreation ; that the exhausted wife 
 lost, in due time and course, her appetitite, sleep, and 
 
 resolved, darkness lightened, excitemer^t subdued, and the better 
 mind restored. Pleasant as were my visits to such associations, I 
 often found that I could much more readily decide upon the best 
 remedy for the excited maniac, than meet to their satisfaction or my 
 own the sharp questions presented by their ready wit. 
 
 The personal influence of the superintendent is naturally trans- 
 mitted to the assistant physicians, and, by their concurrence, to all 
 other employes. The best results in such a singularly complicated 
 household can only be obtained when its various officials act in unity. 
 Emerson says: "The institution is the shadow of the man." He 
 must be such a one that the shadow, to be protective, must not be 
 too thin ! 
 
 They are greatly in error who think that an attack of insanity 
 necessarily eclipses all the faculties of the mind. This extremity of 
 disorder is rarely seen. Frequently the. one delusion (sometimes the 
 many) are kept out of sight so ingeniously as to elude the unskilful 
 observer. The history of legal investigations, and the experience of 
 experts in insanity, are full of such curious instances, and not the 
 least are the illustrations of the ease with which judge and jury are 
 sometimes misled. 
 
 I record one of many cases illustrating that mania in the highest 
 state of excitement is rarely if ever lost to the power of partial self- 
 control. A lady once under my care, a person of superior intelligence 
 and mental ability, belonging to the highest circle of society, became 
 so furiously insane that she was destructive and dangerous to ap- 
 proach, and obliged to be placed in a room without movable furni- 
 ture. A member of my family in the habit of making frequent visits 
 to her, came to the ward to see her. The attendant said : " It is 
 impossible for you to go to her room this morning ; it is dangerous." 
 (The lady had a beautiful bright scarlet shawl around her.) "She 
 
22 THE CURABILITY OF INSANITY. 
 
 general strength, and consequently her self-control, and 
 was compelled to seek the recovery of all in the Retreat. 
 The very large majority of these cases were returned to 
 their families in good physical and mental health ; the 
 avoidable causes of their insanity frankly and plainly ex- 
 plained to them and to their friends, with instructions 
 for their future avoidance. While remedying the marked 
 physical disorders and debilities which, almost without 
 exception, were found to exist, I patiently sought to gain 
 the confidence of each one by the persistent use of indi- 
 vidualized moral as well as remedial treatment, gradu- 
 ally winning their sincere trust by sympathy with their 
 condition, seeking to relieve it by pleasant and varied 
 occupation, recreation, and amusement, all evidently for 
 the one result of promoting their restoration to health 
 and home duties.^ From this confidence there naturally 
 
 will tear your shawl to atoms." " Well," she said, " I will risk it." 
 Slfe opened the door and met the patient very cordially, who at once 
 exclaimed, " Oh ! what a lovely shawl ! " She caught it off, and 
 wrapping it around herself, sat down on the floor with her visitor, 
 and had a long, pleasant, and amusing conversation. The visitor 
 was most reluctantly parted with ; the shawl replaced kindly and 
 carefully by the patient. After her recovery the lady often referred 
 to this visit. " That shawl was so attractive," she said. 
 
 September, 184-. 
 ' It is with much pleasure that I take my pen to address you in 
 respect to my dear wife. She stood the journey remarkably well, 
 and glad indeed was she once more to hail her home and friends, es- 
 pecially her little danghter. My wife appears as well as she ever 
 did ; she has a good appetite, sleeps well, and gains flesh every day. 
 Were it not for the deep trouble and anxiety through which we have 
 passed, we should not, from any thing on her part, know any thing of 
 the painful affliction through which she has passed. We are all now 
 gathered in our little circle, and wliile I write she is singing like a 
 lark. Happy are we, indeed, to have once more so dear a one to 
 make her home happy, and to banish the desolation and loneliness 
 
THE CURABILITY OF INSANITY. 23 
 
 came out to me the simply told stories of home — cause 
 and effect — stories that were of lives more patient, unsel- 
 fish, devoted, and oftentimes tragic than any novelist, but 
 one,^ has ever portrayed. I could fill page after page 
 with these pathetic illustrations of the causes of insanity. 
 I often found that the instructions given to these patients, 
 when discharged, and to their friends, prevented the re- 
 currence of their insanity. The experience of both 
 parties, together with the earnestness with which they 
 urged others similarly afflicted to trust themselves to its 
 curative influences, with the frequent tokens of their 
 grateful remembrance of benefits conferred, did much to 
 dispel the too common, yet causeless, dread of the Re- 
 treat. See Appendix (2). 
 
 If circumstances, in despite of experience and instruc- 
 tion, compelled them to be again exposed to the same 
 malignant influences, would the consequent relapse and 
 re-admission to the Retreat invalidate the first record of 
 " Discharged Recovered " P'"* 
 
 that rested like an incubus on all our spirits in her absence. Much 
 cause have we to be thankful to the God of all our mercies for the 
 restoration to health of one of the best of wives, the kindliest and 
 loveliest of mothers, the choicest and most valued of friends. Nor 
 shall we soon cease to remember you, and the rest of those kind 
 friends who have been instrumental, through the mercies of Israel's 
 King, in bringing about so important and desirable a change. May 
 Heaven shine propitiously on your arduous labors, and crown your 
 efforts in behalf of suffering humanity with success. We have all 
 been at my father's to spend the day, and it was a real old-fashioned 
 gathering I can assure you. There was no sighing, and anxious, 
 painful longing for the dearest of our flock. 
 
 ' Rose Terry Cooke, 
 
 '■^ More than all other physical diseases, insanity requires a pro- 
 tracted period of carefully guarded convalescence. The thorough 
 restoration of the fractured limb needs the curative help of the splin- 
 ter or the crutch. The successful physician keeps a sharp watch 
 
24 THE CURABILITY OF INSANITY. 
 
 A healthy young fisherman, by needless and repeated 
 exposures in the Cove, inducing an attack of acute rheu- 
 matism, " hereditary " in his family, is admitted to the 
 Hartford Hospital. He is successfully treated, and in 
 due time discharged recovered. If, in two or three years 
 afterwards, disregarding experience and professional ad- 
 vice, he repeats the exposures, induces a return of rheu- 
 
 over his convalescing cases of typhus, pneumonia, and diphtheria. 
 The military commander guards sharply against the possible midnight 
 attack of his apparently defeated enemy. The prolonged residence 
 at the Retreat has often proved its practical wisdom by the results 
 of confirmed convalescence. I recall one of many illustrations. 
 
 A farmer, fairly well to do, in middle life, of a nervous tempera- 
 ment, hardly up to the standard of general health, was brought to 
 the Retreat in a state of high nervous excitement. The death of his 
 father had left a considerable property to be divided between himself 
 and other heirs. An acceptable division had been agreed upon, ex- 
 cepting the right to an outlying piece of land, on which was a valua- 
 ble bam. The quarrel about this upset the reason of this poor man, 
 and brought him to the Retreat. In reasonable time his debilitated 
 system yielded to treatment, the effect of unwise discussions and 
 needless excitement giving way to quiet, genial influences and pleas- 
 ant surroundings ; all which, with the aid of good digestion and suf- 
 ficient sleep, led him to accept the evidences of his mistake regarding 
 the disputed property. This had been fully explained to me, for my 
 possibly timely application. In this state of early convalescence, his 
 brother came to see him, finding him out-of-doors, quite at liberty, 
 cheerful and reasonable, and apparently " as well as ever." The 
 brother insisted upon taking him home, where he said he was greatly 
 needed. My advice was overlooked, as my apprehension was 
 deemed unfounded. The result confirmed my judgment. The man 
 was brought liack the next day in a highly excited condition. The 
 brother reported that he seemed as well as ever while they were re- 
 turning home, till, unluckily, to shorten distance, they took a cross- 
 road that brought them suddenly up to the old barn, " when he 
 jumped right up in the wagon, as crazy as ever." He seemed glad 
 to be back at the Retreat, remained willingly, and finally recovered. 
 On his next departure, bidding him a hopeful good-by, I jocosely 
 told him not to take that shorter road home. " Never you fear, 
 doctor," he replied, "it will be a long time before I go near that 
 confounded old Vjarn again." As he was never re-admitted I am 
 sure he found that the longer way round proved the safer way home ! 
 
THE CURABILITY OF INSANITY. 25 
 
 matism, is again admitted, and again discharged recov- 
 ered, does the last record annul the primary one of 
 recovery ? and if not, why should not the same law of re- 
 ported results, valid at the Hospital, obtain across the 
 street, at the Retreat for the insane ? 
 
 An eminent writer (Huxley) points out that — 
 
 In the present rapid growth of the minutest branches of most of 
 the sciences, and the consequent tendency to narrowness which this 
 diminishing scale of research seems likely to invoke, all men of sci- 
 ence should be primarily so educated as to secure breadth of scien- 
 tific education without superficiality of knowledge, as the best secur- 
 ity against the natural danger of drifting into narrow specialties. 
 
 In view of the largely increasing varieties of disorders 
 from which insanity may originate, and of the many new 
 remedies, in addition to the better knowledge of the old, 
 which come to the aid of medicine in the progressing art 
 of preserving and restoring health — the broader reach- 
 ings of prophylactic and therapeutic agencies — the prac- 
 tical alienist should possess not only a readily available 
 knowledge of all this, but keep a careful watch over the 
 possibilities of the future. The comparison of the Dis- 
 pensary (or " Bigelow's Sequel ") at the date of my grad- 
 uation, in 1828, with that of to-day, naturally suggests the 
 possible future of some of the one hundred thousand 
 weeds " whose virtues," Emerson says, " are yet to be dis- 
 covered." Certainly most, if not all, the original thirteen 
 members of the Association had a large experience in 
 general practice before assuming special charge of the 
 insane. 
 
 Dr. Parkes says : '' Hygiene aims at rendering growth 
 more perfect, decay less rapid, life more vigorous, deatli 
 
26 THE CURABILITY OF INSANITY. 
 
 more remote." The acceptance of this art or science of 
 preserving health has within the past thirty years added 
 nearly four years to the average life of the men and 
 women in England. The humane and scientific re- 
 searches of Dr. Bowditch, of Boston, have largely limited 
 the ravages of consumption in New England. The es- 
 tablishment of thirty-one State Boards of health, in the 
 United States, since that of Masschusetts, in 1869, and 
 the increasing acceptance of the vital necessities of sani- 
 tary reform, all lead us to hope that erelong consump- 
 tion, malaria, and insanity, with many other formidable 
 enemies of health and life, may be met by some new an- 
 tagonistic power. 
 
 In measuring our means of arresting insanity we must 
 accept the science of prevention as a higher power than 
 the science of remedy, a power to be looked for outside 
 the wards of a hospital. '' True medicine," says Dr. 
 Richardson, " now stands boldly forth to declare the 
 higher philosopliy — the prevention of disease." "Our 
 art," says Dr. Bowditch, "looks still higher, to the pre- 
 vention as well as the cure of disease." Prevention 
 justly takes precedence. Very many of the ordinary 
 causes of insanity may be easily avoided, and, if need- 
 lessly induced, may be readily overcome. They are the 
 natural outgrowth of heedless or ignorant violation of 
 well-established laws of hygiene — laws that should be in- 
 telligently taught in every common school in the land. 
 There are other causes of far graver import than they at 
 first suggest, where prevention demands that the earliest 
 symptoms should be promi)tly recognized and efficiently 
 treated. Dr. Tuke says : 
 
THE CURABILITY OF INSANITY. 2/ 
 
 The prevention of disease is the first and most earnest intention of 
 medical science in all its departments. The prevention of mental 
 disease is clearly within the scope of the physician's highest aim. 
 
 He further says : 
 
 No medical forethought can prevent the occurrence of insanity 
 from accidental causes, but a vast proportion of the insane become so 
 in consequence of physical conditions of life and modes of living, 
 which lead to the result as certainly as unsanitary conditions of physi- 
 cal life lead to typhoid fever or tuberculosis. It is in such cases that 
 a prophylaxis can sometimes be established. Moral treatment is the 
 true prophylaxis. If the most favorable instances of these ailing 
 minds are brought under the influence of strong and healthy minds, 
 the fearful heritage may oftentimes be avoided. 
 
 Dr. Conolly dwells at length upon the effects he has 
 witnessed from the "individualized treatment " — the in- 
 fluence of a sane, addressed to an insane mind." 
 
 ' Universally in zymotic disease, and generally in all others, the 
 practitioner finds a law of rise, progress, and limitation. This ac- 
 cepted, it remains to watch over the course of the disease, antagoniz- 
 ing the deviations and the often perilous complications. No such 
 law is found in insanity ; its origin is more obscure, its range is 
 wider, its development is more varied, unexpected, and seemingly 
 unreasonable. Sometimes in its formative stage, a specific delusion 
 originating in a doubt or question develops gradually, growing witli 
 the growth, and strengthening with the strength of the disorder, 
 until it becomes a fixed habit ; the mind running in a rut influences 
 every motive and thought of the daily life. This will sometimes re- 
 main painfully dominant after every other symptom has yielded. 
 Few conditions of a patient under treatment are more painfully em- 
 barrassing ; the apprehension naturally arises that some one portion 
 of the brain, and a very limited one it may be, is seriously, perhaps 
 hopelessly disordered. Mere the natural hopefulness of trained in- 
 dividuality leads to persevering eff^ort, vm the hope that some sharp, 
 unexpected impulse may shake o[{ this incubus, which like Sindbad's 
 " Old Man of the Sea" threatens to hold on to the end. 
 
 Some years ago a gentleman about thirty years of age was brought 
 to the Retreat in a truly deplorable condition. He was an officer in 
 
28 THE CURABILITY OF INSANITY. 
 
 Ill the application of moral treatment it is of vital im- 
 portance so carefully to scrutinize the environment of 
 each patient as to avoid as far as possible all depressing 
 or exciting influences. All accept the axiom that cheer- 
 fulness and sympathy in any sick-room promote the best 
 working of remedies ; in the wards of a lunatic hospital, 
 remedies avail little without their cooperation. I have 
 found few things more depressing and harmful to the re- 
 cent and hopefully curable cases of insanity, than even 
 the sight, and, much more, the association with the de- 
 mented and hopeless. To such cases (excluding the few 
 the severity of whose disorder prevents any realization 
 of their condition), finding themselves in the bewilder- 
 ment of such surroundings, their natural conclusion is : 
 " I am one of a hopeless crowd ; what better chance can 
 
 active service under the national government. His duties, invoh'- 
 ing large responsibilities, under harassing circumstances, in a tropi- 
 cal climate, were prolonged without change until he broke down 
 both in body and mind, A rigid sense of duty had led him without 
 complaint or request for relief to this possibly fatal overwork. His 
 case presented on admission an unusual combination of discouraging 
 symptoms. Happily his one overruling delusion disposed him cheer- 
 fully to accept his position with us. After some months of careful 
 watching, patient care, and that due medication which the condition 
 of nearly every physical organ demanded, his general health seemed 
 fairly restored. He had a good digestion, and plenty of that " best 
 food of the brain," sleep. Notwithstanding all this one great anxi- 
 ety remained to me in his delusion, the vividness and tenacity of 
 which I have rarely, if ever, seen equalled under similar conditions 
 of general health. No belief whatever was more firmly held by him 
 than that for a neglect of official duty his life was forfeited ; the De- 
 partment having resolved to order his execution in a signal and im- 
 pressive manner. He confessed the offence was a trifling matter, — 
 in truth the oversight of a Htbordinate. But its frequent repetition, 
 in contem);t of repeatefl orders, had compelled the Secretary to make 
 an example. All reasoning with my jialient seemed worse than use- 
 less ; the only comfort J gave him was the assertion that no g(wern- 
 ment, State or General, could take him from the Retreat against my 
 
THE CURABILITY OF INSANITY. 29 
 
 I have of recovery ? " The number of patients in some 
 of our State hospitals exceeds the population of more 
 than each one of forty of the towns of the State of Con- 
 necticut. In several the recent case on admission be- 
 comes the legally committed citizen of a community 
 whose annual official report records more discharges by 
 death than by recovery from insanity. Classified, how- 
 ever carefully, as the multitude may be, the different in- 
 dividuals must come frequently in contact in the chapel, 
 and in the means of their recreation and amusement. 
 With such immediate surroundings the recent case can 
 hardly look from his window or step out of his door with- 
 out seeing or hearing some hopeless victim of a disease 
 from which he has fainting hopes of his own recovery. 
 Reason as you may with him, for the present time, at 
 
 record of " not recovered." Afterwards, avoiding the discussion, 
 I continued every effort to strengthen his general health, and to 
 amuse and occupy his mind, awaiting my opportunity, and this in 
 time came. One morning, when he seemed more bright and genial 
 than usual, I referred jocosely to our old difference of opinion, and 
 confessing that discussions were useless with one who clung to a de- 
 lusion with the obstinacy of Tam O'Shanter's wife, who "hugged 
 her wrath to keep it warm," T told him that I was sure that in good 
 time his large stock of common-sense would come to the front, and 
 added most seriously and earnestly : " If I were now to give you the 
 endorsed testimony of your Department of your deserved high stand- 
 ing as an officer, and that your official record was without fault or re- 
 proach, I really fear you would reject it." "Oh! no indeed, I 
 would not ! if you would only show me that," he replied. Drawing 
 from my pocket the formal official document, I answered : " I re- 
 joice that I can do so. Here, in reply to my letter of inquiry, is the 
 prompt and cordial answer of the Department, a flattering certifica- 
 tion of your high position in the service." He received it with 
 much emotion. The effect was electrical. He seemed to awake, as 
 it were, from an oppressive dream. When he came down next 
 morning to make arrangements for his return home, he was a very 
 happy and sane man. 
 
30 THE CURABILITY OF INSANITY. 
 
 least, the " twirling thumbs " will beat down your sani- 
 tary arguments. 
 
 We believe that absolute segregation is possible, and is 
 consistent with a large economy in construction and in 
 current expenses. The telegraph, the telephone, and the 
 tramway may bring the annex of the main hospital suffi- 
 ciently near, so that out of sight and out of hearing, at the 
 distance, more or less, of a mile, these apparently sepa- 
 rate institutions are within easy reach of the sharp super- 
 vision of the chief superintendent. Again, the query 
 may be raised whether, in the continued growth of very 
 large institutions, there may not be developed in the 
 future a school of hospital specialists, simply executive 
 officers, skilled in economic management and training, 
 instead of broad, earnestly sympathetic, and versatile 
 physicians of large experience, through study of individ- 
 ual cases. 
 
 Our position is amply confirmed by authorities who 
 have the right to speak and to be heard. At the meeting 
 of the International Medical Congress in Philadelphia, 
 in 1876, Dr. Ray said : 
 
 As the result of my own observation and experience I am con- 
 vinced that four hospitals of three hundred patients each can be both 
 built and maintained at a less cost than one of twelve hundred pa- 
 tients, equal provision being made in both cases for the kind of care 
 to which the insane, even in the lowest grades of the disease, are 
 entitled. 
 
 Again he says : 
 
 I doubt whether it is possible to have in these mammoth establish- 
 ments certain qualities of administration indispensable to their high- 
 est purposes. The animating spirit, the close, thorough supervision, 
 
THE CURABILITY OF INSANITY. 3 1 
 
 inspiring, guiding, correcting every movement, and essential to our 
 highest ideas of hospital management, will be but feebly maintained 
 under such conditions. The patient is but an atom in the great mass 
 around him, losing the attributes of humanity, sane and insane, in 
 the technical character of patients. 
 
 At the same meeting Dr. Kirkbride said : 
 
 It is fully shown by reliable statistics, as I believe, that the people 
 of the State will derive more benefit from several small hospitals in 
 different parts of the State than from one large one at a central point. 
 And I think it will also be found that the former can be provided 
 with quite as small an expenditure of money, and could be carried on 
 at no greater cost per patient. . . , There is one advantage in 
 these smaller hospitals I cannot avoid referring to, and that is the 
 personal intercourse which a superintendent is able to give to his pa- 
 tients when their number is not so great as to prevent his paying 
 daily, or very nearly daily, visits to eacli. I believe this to be one of 
 the most important of all his duties, and one which, certainly, if he is 
 rightly constituted for his position, no one can do for him. 
 
 Dr. E. C. Seguin, of New York, in a letter to a mem- 
 ber of our Legislature, 1880, says : 
 
 The vast majority of the insane are afflicted with chronic and in- 
 curable disease. They need only humane treatment, the largest pos- 
 sible amount of personal liberty, plenty of occupation, some amuse- 
 ment, the plainest quarters, and the simplest diet consistent with the 
 demands of modern hygiene. They do not require the attention of as 
 high a grade of medical talent or as numerous and skilled attendants 
 as do acute cases. They can, I believe, be well taken care of at a 
 comparatively small cost. It seems a reckless waste of money to 
 build palatial hospitals to be filled with incurables. . . . The 
 curable insane need the highest medical skill which a large salary can 
 attract ; a much larger number proportionately of assistant physicians 
 selected by severe examination ; many real nurses, not mere attend- 
 ants or guardians. They require the best food, with the liberal use 
 
32 THE CURABILITY OF INSANITY. 
 
 of costly medicine, etc. It is economical and humane to spend 
 money freely in order to facilitate recovery. 
 
 An intimate knowledge of the condition of the insane 
 for more than half a century has given me an increasing 
 sympathy for them as the most grievously afflicted of the 
 human family. Both my experience and observation 
 since the meeting of the Association in 1844 have con- 
 vinced me that the great and unexpected changes in their 
 numbers and relative condition demand some modifica- 
 tion of the original propositions. That which gave two 
 hundred as the preferable maximum of patients to be 
 treated in one building, may again be as wisely accepted 
 in connection with a new classification. See Appendix 
 
 (3). 
 
 In conclusion, let me quote from Dr. Ray, one known 
 to us all, and best esteemed and honored by those who 
 knew him best, and who, in his description of the " Good 
 Superintendent," has given us a most happy photograph 
 of his own hospital life : 
 
 The " Good Superintendent " constantly striveth to learn what is 
 passing in the mind of his patient, by conversation and inquiry of 
 those who see him in his unguarded moments. He also maketh dili- 
 gent inquiry respecting the bodily and mental traits of his kindred, 
 knowing full well that the sufferer is generally more beholden to 
 them than to himself, for the evil that has fallen upon him. He en- 
 deavoreth so to limit the number committed to his care as to obtain a 
 personal knowledge of every wandering spirit in his keeping. He 
 boasteth not of the multitudes borne on his register, but rather, if he 
 boasteth at all, of the many whose experience he has discovered, 
 whose needs he has striven to supply, whose moods, fancies, and im- 
 pulses he has steadily watched. To fix his hold on the confidence 
 and good-will of his patients he spareth no effort, though it may con- 
 
THE CUkABlLITV OF INSAMtTV. 33 
 
 sume his time and tax his patience or encroach seemingly on the dig- 
 nity of his office. A formal walk through the wards and the ordering 
 of a few drugs compriseth but a small part of his means of restoring 
 the troubled mind. To prepare for this work and to make other 
 work effectual, he carefully studieth the mental movements of his pa- 
 tients. He never grudgeth the moments spent in quiet, familiar in- 
 tercourse with them, for thereby he gaineth many glimpses of their 
 inner life that may help him in their treatment. Among them are 
 many sensible to manifestations of interest and good-will, and the 
 good physician esteemeth it one of the felicities of his lot that he is 
 able to witness their healing influence. He maketh himself the cen- 
 tre of their system, around which they all revolve, being held in their 
 places by the attraction of respect and confidence. To promote the 
 great purpose of his calling he availeth himself of all his stores of 
 knowledge, that he may converse with his patients on matters most 
 interesting to them, and thereby establish with them a friendly rela- 
 tion. The unwelcome communication he ever tempereth with soft 
 and pleasant words, thereby verifying in himself that saying respect- 
 ing a worthy of old, that he made a flat refusal more agreeable than 
 others did the most thorough compliance. 
 
 In my report of the Retreat for i860, I remarked that 
 over three thousand cases of insanity have now come un- 
 der my direct care and observation. In a large propor- 
 tion of those cases whose history I could obtain, I have 
 found that the remote and predisposing causes of insan- 
 ity could be plainly traced to the malign influences of 
 childhood. 
 
 In this connection I quoted the following from Gen- 
 eral Oliver's report to the Massachusetts Board of Edu- 
 cation : 
 
 While we abundantly provide for the thorough training of the 
 mind, we almost wholly neglect the training of the body, and the ef- 
 fect of this pressure upon the intellect without corresponding pres- 
 sure of the body is that the latter suffers, and by degrees the feeble- 
 
 / 
 
34 THE CURABILITY OF INSANITY. 
 
 ness which is generated by this want of proper physical exercise of 
 the body extends to the mind ; for the twain are in incomprehensible 
 mystery of connection, and each is participant of the other's strength 
 or weakness. So then the mind becomes less vigorous by reason of 
 the fading vigor of the body, as the body is always weakened by the 
 fading powers of the mind, and each gradually participating in a grad- 
 ual antasionism to the efforts of educators and the efforts of self-edu- 
 cation. This is especially true of our girls. Our boys indulge more 
 in vigorous and active exercises. Athletic sports are full of interest 
 to them, and into them they go with a rush and a relish and a hearti- 
 ness of fun most cheering to behold, and most excellent in its influ- 
 ence upon their bodily health. But of how little physical exercise do 
 our girls partake, and how quick are we to check any propensity to 
 activity in play and to any romping gambols or vigorous recreation 
 on their part. ... I venture to say that not more than one girl 
 in ten nowadays enjoys real sound, rugged health, and surely that is 
 a very unwelcome statement about those who are expected hereafter 
 to be helpmates to husbands and mothers of children. 
 
 In an admirable article upon Insanity and Hospitals 
 for the Insane, prepared for the National Almanac, Dr. 
 Earle remarks : 
 
 That it is not the regular employments of mankind which are the 
 most prolific causes of insanity. It is rather those habits, customs, 
 and other influences which minister to his appetites, stimulate his 
 passions, and most powerfully operate upon his sentiments. 
 
 Intemperance of all kinds, debauchery, self-abuse, all high popu- 
 lar excitements whatever maybe the subject, these excite and exhaust 
 the nervous energy ; and grief, anxiety, troubles, difficulties, and dis- 
 appointments greatly depress it. To these influences then we may 
 rightfully look as among the most powerfully exciting causes of the 
 disorder in question. 
 
 In the thirty-ninth of the Retreat's reports it will be 
 seen that of nine thousand four hnndred and seventy- 
 three cases, as given by Dr. Earle, being the total of all 
 
THE CURABILITY OF INSANITY. 35 
 
 cases admitted in four prominent hospitals wherein the 
 causes of insanity were given, seven thousand five hun- 
 dred and ninety-one, or four fifths of the whole, were the 
 results of some one of ten causes, all of which were such 
 as exhaust, debilitate, or depress the vital or nervous en- 
 ergies. A sensual and selfish, or idle and aimless life, 
 must inevitably act as a predisposing cause to the devel- 
 opment of one or more of these causes. In a large pro- 
 portion of the cases which have come into my care 
 insanity might have been prevented by the use of well- 
 known measures, or natural and right development of 
 body and mind, wise aims in life, and a reasonable exer- 
 cise of self-control. The power of the will to control the ' ^ 
 insane impulse is great, but its power to effect this result 
 must be trained and be made conscious of its supremacy. 
 The question, therefore, how shall I escape insanity ? is 
 one capable of a more direct and explicit answer than 
 many parents and educators of youth seem to imagine. ) 
 See Appendix (4). 
 
 It follows, as a necessary consequence, that whatever 
 makes us better or wiser, gives us more correct views of 
 our duties to God and our neighbor, and at the same 
 time gives us more courage, strength, and willingness to 
 do that duty, places us so much more beyond the reach 
 of these causes of insanity, and gives us also the greater 
 ability to resist successfully the attacks of this disease 
 when induced by causes beyond our control. 
 
 Insanity, as a strictly physical disease, comes emi- 
 nently within the range of preventive medicine. When 
 our proposed and thorough system of State sanitary regis- 
 tration in Connecticut is carried out (if ever), and each 
 
36 THE CURABILITY OF INSANITY. 
 
 case is reported in its earlier stages, we may hope to at- 
 tain a more accurate knowledge of the predisposing and 
 exciting causes of this malady, which is filling our luna- 
 tic hospitals faster than we do or can build them. We 
 can also more efficiently apply the means of prevention 
 and remedy, when we can better measure its various 
 causes : erroneous educational and social influences, neg- 
 lect of family training to reverence and obedience, sen- 
 sational reading, evil habits of body and mind, idle, aim- 
 less, or sensual life, and learn more exactly, as we shall 
 learn, how very early in life the predisposing causes of 
 insanity are implanted in the child. 
 
 During the present century, no greater progress has 
 been made in any department of philanthropy and sci- 
 ence than in the direction of the better care and treat- 
 ment of the insane. A greater work remains to be done, 
 a work greater than cure or kindly care — that of preven- 
 tion ; a work which, in order to be of the highest suc- 
 cess, must reach back often to the early life, the family, 
 the nursery, and the school. 
 
 The question before us to-day is not only, what can 
 the State do for the chronic insane ? but the wiser and 
 more timely question, how can we prevent insanity ? 
 
 The neglect of physical training, and the imperfect 
 physical development which follows from this neglect, 
 were strikingly evident in many of my female patients. 
 The various causes which were reported to me as the 
 sources of disease, and which are classified in the tables 
 under the head of " ill-health," " undue mental effort," 
 " grief," " domestic unhappiness," etc., could very fre- 
 quently be traced, in their primary influences, to the one 
 
r//^ CURABILITY OF INSANITY. -i,"/ 
 
 cause of a want of physical stamina. We press the train- 
 ing of the mind, by all possible hours of study in and 
 out of school, and by the added stimulus of emulation, 
 while we neglect the training of the body, in disregard 
 of that mysterious but absolute law of. sympathy, which 
 compels the debility of the latter to cripple the action of 
 the former. In the same line, is the prevention of ex- 
 citement so happily illustrated in the Northampton Hos- 
 pital by Dr. Earle, where the busy day on his thoroughly 
 cultivated farm, followed by a quiet night, illustrates, 
 happily, the sanitary results of wisely directed occupa- 
 tion. 
 
 Life has been compared to a line — that of birth, the 
 point of origin, that of death, the point of termination, 
 the length of the line between being an uncertain quan- 
 tity under a supposed secret and inexorable law, over 
 which we were ignorantly believed to have no control. 
 The history of the human race has ever testified to the 
 incessant craving of the heart that " our days may be 
 prolonged in the land." The Science of Preventive 
 Medicine justifies this innate desire by demonstrating 
 that it possesses the power to give a longer extension and 
 a more definite and certain quantity to this "line of life." 
 We are told that the days of our years are threescore 
 years and ten, and that if we are deprived of the " resi- 
 due of our years," and do so generally fall far short of 
 that attainment, it will be well for us more carefully to 
 regard that wonderfully true and perfect sanitary code 
 given to the Jewish nation, and recorded for our instruc- 
 tion and guidance in the Holy Scriptures, and remember 
 through their obedience to those hygienic laws *' He in- 
 
3S THE CURABILITY OF INSANITY, 
 
 creased the people greatly, and made them stronger than 
 their enemies," and when he brought them forth out of 
 the land of Egypt, " there was not one feeble person 
 among their tribes." Nor one insane ! 
 
 In many of the insane the power of observation is ac- 
 tive and the understanding has a considerable range of 
 exercise, while the affections exist as warmly and the 
 sensibility is as acute as in a state of perfect mental 
 health. The utmost care therefore, should be taken to 
 act on what remains of intellect, wisely to direct the im- 
 paired faculties of the understanding, and at the same 
 time to cherish and govern the affections by all the re- 
 sources of compassionate protection. 
 
 To suppose that the inmates of a lunatic asylum must 
 necessarily be in a state of continual unhappiness, is as 
 erroneous as to suppose the asylum itself a place only 
 for confinement and suffering. There is a wonderful 
 diversity in the manifestations of this disease, each case 
 having its peculiar character : the melancholic, who sup- 
 poses God has forsaken him for time and eternity ; 
 the excitable, defying all law but his own sovereign will ; 
 and those who, less gravely affected, are yet unfitted for 
 the duties of life, and are waiting, with more or less of 
 patience and resignation, the time of their recovery." 
 
 ' The history of one of my patients in the Retreat made such an im- 
 pression that I cannot refrain from describing it in some detail. She 
 was a married lady, under middle age, well developed physically, 
 with a genial and easily impressible temperament, which, with her 
 happy manner, made her a universal favorite. On admission to the 
 Retreat she left an intelligent and devoted husband, several charm- 
 ing children, and ample means in a pleasant home. The history of 
 the case, as given to me, showed that the gradually widening scope of 
 maternal duties and household cares had unconsciously led her to a 
 devoted but really reckless draft upon her physical energies, which 
 
THE CURABILITY OF INSANITY. 39 
 
 Now, as amusement and recreation are essential to the 
 preservation of the health of body and mind, and as their 
 genial influence is fully appreciated by us during the 
 convalescence from an ordinary illness, how much more 
 sensitive to their effect must be those who are suffering 
 under this graver disorder. 
 
 in due course brought on a disorder of the widest range of the diges- 
 tive apparatus, and consequently and most naturally of other equally 
 vital organs sympathizing with it. The derangement of the nervous 
 system was the common and natural sequence of loss of appetite, 
 loss of sleep, and loss of both physical and nervous power. 
 
 I found her emaciated, enfeebled, and dejected ; the whole system 
 "fagged" (I can find no better word for its best description). 
 The case was one of functional disorder, primarily induced by readily 
 preventible causes ; easily remedied in its early stages by simple 
 means. But the system had literally drifted into a condition where 
 there was, at first sight, some apparent reason to fear disease of the 
 brain, or change of cerebral structure. 
 
 A close scrutiny into the case revealed its simple character. The 
 suicidal tendency which at first I had reason to fear (but which was 
 never discussed between us) soon ceased to worry me. The general 
 treatment required for its ultimate and entire succcess some months 
 of uninterrupted residence at the Retreat ; in the earlier stages the 
 use of ordinary alteratives, sub-tonics, and milder sedatives, etc. ; 
 throughout all, persistent rest both of mind and body ; relief from 
 all duties and worries, with all possible cheerful surroundings and 
 heart-cheering influences ; diversions, in-doors and out-of-doors ; in 
 brief, those social and genial remedies which I have elsewhere more 
 minutely described, and in which my prolonged experience has in- 
 creased my confidence. My acquaintance with this interesting pa- 
 tient ceased with my record of " Discharged recovered." Of this I 
 am confident : with a reasonable regard to prophylactics in her future 
 life, and fair play given to her naturally large power of self-control, 
 and in all a common-sense profiting from the sad lesson she had 
 learned by heart, there would not be a relapse in the record of her case. 
 
 If the love of God, faith in Christ, and the hope of heaven give 
 way under the delusions of insanity to hopeless despair and the cer- 
 tainty of endless doom, suicide seems a natural and logical sequence. 
 
 The peril which lurks beneath such cases demands unwearied 
 vigilance. This was fairly illustrated by another patient who was 
 one of a class before described. She was a woman of more than 
 ordinary intelligence and self-control ; she was broken down by the 
 
40 THE CURABILITY OF INSANITY. 
 
 While, to the insane, all their delusions are as real as 
 they are, in truth, imaginary, none but those who are in 
 constant converse with them can realize how material is 
 the result of an intimate personal intercourse. I daily 
 saw some cloud brightened, some terror banished, some 
 wearisome burden lightened, by a few words of advice, 
 
 " accumulations of household duties and drudgeries, of narrow and 
 near-sighted economies," and was brought to the Retreat by friends 
 in the faint hope of her recovery. It was an extreme case of melan- 
 choly, demanding constant watchfulness. In due time the apparent 
 improvement in all her symptoms gave me comforting promise of 
 her speedy recovery and return to her home, where she was greatly 
 needed. My family residence was on the lawn at a little distance 
 from the Institution. Parties of our convalescent patients were our 
 frequent social visitors. She joined the party one evening, and this 
 her first visit appeared to be greatly enjoyed ; no one of all seemed 
 more truly convalescent. As the party was about returning to the 
 Retreat, her hostess, learning that a storm had suddenly come up, 
 and seeing her need of warmer wraps, sent up for a shawl, and 
 wrapped it carefully round her, adding some brief words. Her 
 health was soon confirmed, and she returned home. A year or two 
 afterwards, meeting her hostess in the city, she ran up to her with 
 many expressions of grateful remembrance. " Excuse me, I do not 
 remember you," was the answer. " Oh ! I don't wonder at that ; I 
 am so changed since I saw you. Don't you remember inviting me 
 to your house one evening, and, as we were about to return to the 
 Retreat, being told that a heavy storm had come up, you brought 
 down a beautiful shawl and wrapped it carefully round nie. I can 
 never forget it ; let me tell you — before coming over to your house I 
 had made up my mind to commit suicide that very night. I had for 
 a long time believed that God had blotted me out of the book of his 
 remembrance, and the quicker I met my fate the better ; that my 
 husband would be happier with another wife ; my children with an- 
 other mother. I knew I was watched pretty closely all the time, but 
 I had fixed it so that I should certainly have succeeded. After I had 
 gone back to the Retreat, thinking over what a nice time I had had 
 at your house, all at once it came over me. ' What cati all this 
 mean? this lady to invite me, treat me so kindly, and then wrap her 
 beautiful shawl so carefully about me, lest I should catch cold and be 
 sick, why God cannot have forsaken me ; I can't be such a sinner ; 
 how foolish, how really crazy I must have been to think so ! ' From 
 that moment I was right. And now ! I am so happy ! " 
 
THE CURABILITY OF INSANITY. 4 1 
 
 of cheer, of consolation, or of sympathy. That asylum 
 for the insane is poorly cared for where the wants of the 
 body are alone abundantly supplied, while the cravings 
 of the heart are left unappeased. Far better, in my view, 
 to banish all other remedies from the wards of such an 
 asylum, than to leave them destitute of that practical. 
 
 In connection with the two preceding cases, I here may well intro- 
 duce the partial history of one more — another vivid ilkistration of this, 
 the saddest of all forms of mental disease — melancholia. Unfortu- 
 nately, the writer of the following letter, immediately after its recep- 
 tion, was placed outside of my aid, but never outside of my deepest 
 sympathy : 
 
 " Dr. Butler : — Will you allow yourself to be interested in a 
 stranger who has been attracted towards you by some remarks in an 
 article on the treatment of insanity ? Long years ago (nearly twenty) 
 a deep dark cloud settled on my spirit. I cannot find the daylight ; 
 midnight envelopes me ; a weight of suffering oppresses me. The 
 sense of being is pain. I can conceive of no circumstance that could 
 make existence precious, an habitual blessing, I seem to be in a 
 dreary dream, from which I cannot awake. I move about among 
 men, but not of them ; nothing makes a deep, abiding impression, 
 becoming part of my nature, and arousing all my soul. Things 
 come and go, and almost every thing is intangible, I am not a young 
 romantic girl ; I am over thirty years of age, but alas ! I know no^ 
 hozv to live ; I die a living death. What can furnish interest, mo- 
 tion, object, to fill the abyss of the human soul? 
 
 "What am I? 
 An infant crying in the night, 
 An infant crying for the light, 
 And with no language but a or)-.' 
 
 " It seems sometimes as if I was almost beside myself. I have such a 
 profound sense of want of adaptation to any thing. I am a stranger in 
 a strange land ; I cannot do life's work ; my sinews are cut ; my hands 
 drop at my side. I am a poor crushed spirit, staggering sometimes under 
 the load of life. Of course I have not sufferecl this without looking up- 
 ward ; but all in that direction is total darkness. The whole realm of 
 Christianity is a terra incognita to me ; my knowledge of the system is 
 simply historical. Sermons, reading, the instructions of Christians, 
 are all unavailing. My deepest prayer is an agonized cry for help to 
 the 'Unknown God.' My religious consciousness has never in my 
 
42 THE CURABILITY OF INSANITY, 
 
 personal sympathy, whose hearty sincerity so directly 
 tends to the larger development of hopefulness and self- 
 control. 
 
 In some varieties of this physical disease (insanity) 
 some articles of the 7nateria viedica are, in my opinion, 
 essential to speedy or to permanent cure ; in many more, 
 
 life been awakened. I have not the slightest realization of the re- 
 lation between the finite spirit and the Infinite, — my soul and its 
 Creator. When I say : ' Is there a great Being who knows all I suf- 
 fer, who cares forme, and who is deterred by adequate reasons from 
 coming to my aid ? ' and receive this reply : ' There is a great Being 
 who is deterred from helping you, till you come to Christ' I feel 
 utterly powerless. I can utter a cry of vague, undefined want ; but 
 when I am bidden to 'believe' which means to exercise towards 
 Christ adoring, trusting affection, I know nothing about the matter ; 
 I can see nothing, do nothing. If you put a stone on the head of a 
 plant looking up for the free air and sunlight, if you do not crush it 
 out of existence do you not make it a living tomb ? Is there vitality 
 for the human soul ? Is there a world of life and activity and pleas- 
 urable existence? Shall I ever breathe its atmosphere? Must to 
 'suffer and be still 'be my life's work? Must I go on, crushed, 
 paralyzed, benumbed, till body and spirit separate ? If God ' is not 
 willing that any should perish,' must I die to gain my first conception 
 of happiness? Professionally, is not this an abnormal condition? 
 ^What is the matter with me? Is there any hope for me? Am I not 
 the victim of mental disease ? Do I not speak simple truth when I say 
 I have no power to rise, throw off this nightmare, enter into life's 
 labor, respond to its relations, meet its obligations, and enjoy 
 existence ? 
 
 " I am not well ; my back is not strong ; my system wants healthful 
 tone and vigor ; I have habitual dyspepsia ; it is an uneasiness and 
 lack of vitality of the stomach and want of digestive power, but not 
 habitually attended with constipation. I remember that some such 
 derangements of health were felt soon after my soul sunk down op- 
 pressed Ijy this inner suffering. 
 
 "And now, have I touched your sympathy for a deeply tried fellow- 
 being ? Can you do any thing for me in the way of suggestion ? Is it 
 at all probable that I shall ever Ijc, do, enjoy, any thing as others may ? 
 Will I live on and on in the darkness and pain, do you suppo>-e, and 
 when from old age or disease ' the weary wheels of life stand still,' 
 must I fear that I will close my eyes on this dreary ante-chamber of 
 being, and ' take a leap in the dark ' ? " 
 
THE CURABILITY OF INSANITY. 43 
 
 they are useful, soothing, pleasant adjuvants ; but these 
 moral means are so pleasant in the using, they so soothe 
 the heart weary with long waiting for health and home, 
 banishing, for a time at least, those delusions which 
 make the worse appear the better reason. I claim that 
 
 A lady, the daughter of a merchant, married, and a connection in 
 business was formed between the father and the husband. 
 
 In a short time the embarrassment of the former involved the 
 whole fortune of the latter ; and in about a year the young couple 
 were left without any provision, with one child and the expectation of 
 another. What added to her affliction was, the trouble of her pa- 
 rents and the other children, for all of whom she had the tenderest 
 affection. I knew this lady from her childhood, She never had a 
 good constitution, but had always been subject to severe headaches 
 and other corporeal ailments. A near and dear relative with whom 
 she corresponded, in the attempt to console, very vehemently ex- 
 horted her to seek consolation in religion, which advice she enforced 
 by such spiritual arguments as she thought necessary. Unfortunately, 
 these arguments were intermixed with many abstract doctrinal points 
 which were new to the sufferer. In the adaptation of them to her 
 own case she felt great perplexity. Instead, therefore, of deriving 
 consolation, she at last adopted, without due examination, the most 
 dangerous sophisms for truths. It was soon perceived that her rea- 
 son was w^avering ; shortly complete insanity was developed. In 
 this state she was brought to London, and consigned to my direction. 
 She was then only twenty-four years of age. There was evidently 
 great constitutional as well as mental disorder. In a few months I 
 had the satisfaction to see her health much improved, and every il- 
 lusion by degrees vanish. In a few wrecks she returned to the bosom 
 of her family. 
 
 Never, probably, has any one who had been insane been exposed 
 to greater risk of relapse ; yet after the first struggle, and experien- 
 cing some threatening symptoms, she rallied. 
 
 Then it was she experienced real consolation from religion. Her 
 recent spiritual delusions had passed away. If she remembered the 
 new lights which had so fatally misled her, and finally absorbed her 
 reasoning faculties, she was aware of their dangerous effect ; and re- 
 lying solely on those principles from which she had formerly always 
 derived satisfaction and support, she was enabled to preserve her 
 reason and attain a state of comparative happiness. 
 
 The above is given by Dr. Burrows of London, in Barlow's " On 
 Man's Power over Himself to Prevent or Control Insanity," page 92. 
 
44 THE CURABILITY OF INSANITY. 
 
 both of these remedies are essential to the best curative 
 
 treatment. 
 
 Amid the weary hours of sad or fearful imagining, 
 
 music, games, all social or intellectural gatherings and 
 
 recreations, excursions, changes of scene and localities, 
 
 art, in its various forms of beauty, pictures, engravings, 
 
 statuary, and, above all other things, flowers — they are 
 
 ever most welcome. 
 
 Dr. Poole, of the Montrose Asylum, says : 
 
 After the obliteration of reason, many of the highest feelings of 
 our nature remain, to which a successful appeal may be made, and 
 those by which we are connected with a higher sphere of existence, 
 admit as readily of being awakened, on the proper object being pre- 
 sented to them, as the ordinary passions under which the lunatic acts. 
 Their influence is, in the highest degree, consoling, and congenial to 
 the return to mental strength and serenity ; the effects in each indi- 
 vidual are probably as different as in the members of an ordinary 
 congregation. 
 
 I cannot forbear quoting the testimony of the Rev. 
 Dr. Gallaudet, for many years chaplain of the Retreat : 
 
 How many torpid sensibilities have I seen awakened to respond to 
 the impressions of the fair, the beautiful, and the good ; how many 
 consciences aroused to a sense of the right and the wrong, so as to 
 produce the power of self-control and of proper conduct ; how many 
 slumbering domestic and social affections kindled up into their for- 
 mer activity ; how many religious despondencies, sometimes deepen- 
 ing into despair, changed into the serenity of Christian hope ; how 
 many suicidal designs forever abandoned, because life had become a 
 pleasure, instead of a burden too heavy to be borne ; how many pray- 
 ers revived at the altars of private and public devotion ; how many 
 kindly charities of the soul breathing forth, once more, in deeds of 
 self-denying benevolence ! 
 
 Amid the vestiges of reason, the affections and sen- 
 
THE CURABILITY OF INSANITY. 45 
 
 sibilities sometimes exist as warmly and as acute as ever, 
 and, in many cases, the same high and ennobling results 
 may be attained as from the operation of similar causes 
 upon individuals under ordinary circumstances. Leaving 
 out of the estimate all other results, my fifty years' ex- 
 perience, thirty-three as superintendent, have confirmed 
 the opmion, early expressed, of the benefits of these in- 
 fluences as remedial agents. Any deviation from good 
 order and propriety, during chapel service, has been no 
 more frequent than interruptions from impatient and 
 undisciplined children during '' meeting " in the country.' 
 
 ^ During the Rev. Mr. Gallaudet's services as our chaplain, a very 
 insane woman was admitted. She was the wife of a well-to-do far- 
 mer, and was of more than usual intelligence, of kindly, cheerful, tem- 
 perament, and naturally of large self-control. She had broken down 
 under the too common influences of monotonous overwork and worry. 
 I found her general health seriously impaired. She was excitable, 
 impulsive, indeed utterly out of reach of control. Her language was 
 profane and obscene beyond all precedent in the somewhat large ob- 
 servation which my varied fields of practice had given me. I placed 
 her in rigid seclusion, not allowing the matron or the nurses in my 
 visit to be exposed to such foulness of words. In due time her gen- 
 eral physical health decidedly improved. She had a good appetite, 
 and slept well ; but neither persuasion nor reproof could tame that 
 unruly member, the tongue. My hopes of speedy recovery were 
 fading, when one afternoon, just before the chapel service, her nur.-e, 
 passing through my office, remarked — not as a request to be heeded, 
 but as something strange : " Mrs. B. wants to go to prayers." Re- 
 calling her as she passed out, I asked : " Was the request made with- 
 out any suggestion ? Does she really want to go ? If so, take her up 
 with you. Sit near the door, and watch her sharply. If she says a 
 word, hurry her out." A few minutes' reflection convinced me that 
 this time at least the first conclusion was not a wise one. A few evil 
 words from the poor insane woman would disgust many with the 
 chapel services ever after. But as the bell was ringing it was too 
 late to revoke the order. On going to the chapel I found her seated 
 near the door. She gave quiet attention to the whole service, and 
 peaceably retired. Telling her the next morning that I was pleased 
 to see how quiet she was in the chapel, she answered : " The nurse 
 was afraid to have me go." " Do you wonder," I said, " talking so 
 
46 THE CURABILITY OF INSANITY. 
 
 (I must remark that it is self-evident that the chaplain 
 should be like the assistant physician, the direct ap- 
 pointee of the superintendent). 
 
 We are largely indebted to Dr. Dewey, of Kankakee, 
 111., for a most timely article in the Alie7iist and Neurol- 
 ogist of January, 1884, giving an exposition of the rise 
 and progress of the separate systems of " Congregate " 
 and '' Segregate " buildings for the insane, /. ^., the con- 
 nection or separation of the different classes. In a brief 
 recapitulation of the lines of thought in general, he says : 
 
 1. Institutions for the insane were at first only founded for public 
 relief, and without the idea of benefit to the insane. 
 
 2. It has always been a too general impression that the insane are 
 essentially different from the sane in every thing, instead of the fact 
 being recognized that they possess natural traits and activities, which 
 are, however, modified through the agency of disease, wrongly di- 
 rected or held in abeyance ; and this mistake has been very mischiev- 
 ous in its effects upon the provision for them, preventing a supply of 
 a natural and domestic abode, adapted to the varying severity of dif- 
 ferent degrees and kinds of insanity. 
 
 badly as you have done ? " "Oh! doctor," she said, "you never 
 need fear that. I know better than to use unholy words in God's holy 
 house." I " improved the occasion " by leading her thoughts back : 
 " What would your good friends at home think of you," I said, " to 
 hear you talk as you do — your good minister's wife, and the deacons, 
 your husband, your own children, and all the good folks who, you 
 say, think so much of you ? " This appeal subdued her, hopefully ! 
 "Now," I added, " if you behave like a lady in God's house, you 
 can do so everywhere else. You can do so with those good folks up- 
 stairs who long to have you with them, and in a nicer room than 
 this, and away from these poor unhappy people whom you can't 
 like ! " Asking it also as a great favor to myself, I won the promise 
 of better behavior, and only good words. Bating some few inci- 
 dental and brief relapses, her promises were faithfully kept. After 
 a few weeks of pleasant and uninterrupted association with quiet and 
 convalescing patients, her restoration to health, and her return home 
 was a cheering illustration of the principle we are advocating. 
 
THE CURABILITY OF INSANITY. 47 
 
 3. The essential difference between an institution for the insane 
 and all other institutions, in confining and controlling those who are 
 held as prisoners without being guilty of any offence, and who are 
 entitled to the utmost privileges and consideration of their wants, 
 without possessing in the eye of the law or in the exercise of reason 
 the ability to enforce their claims, was long overlooked, but has 
 come to be more fully appreciated. 
 
 4. Gradually insanity has come to be recognized as a disease, 
 hospitals have been founded, mainly for curative treatment, and the 
 congregate asylum has been developed, admirable for its purpose, 
 but not adapted for universal application to the entire body of the 
 insane. 
 
 5. Finally, the infinite variations among the insane, in the mani- 
 fold forms of the disease ; in the degree of reason and self-control 
 possessed by different individuals or characterizing different groups 
 of the insane as a whole ; in the various classes of private and pau- 
 per, criminal and innocent, epileptic, inebriate, etc., are beginning 
 to be more fully understood by the public and the medical profession, 
 and a variety is being introduced in the erection of buildings, as to 
 location and internal arrangement, by which an appropriate environ- 
 ment for each and all is sought to be attained, while at the same 
 time, the opinion gains ground that the domestic or "segregate," as 
 contrasted with the " congregate " or institution idea, should prevail 
 for a large portion, in providing for them economical and substantial 
 buildings, with as much of the house-like and home-like character as 
 in each instance the fact of insanity would permit. 
 
 We have here one of the many good evidences that 
 from the first of the organization of the Association, its 
 members have accepted the teachings of Dr. Arnold, 
 that " Nothing is so wrong as the strain to keep things 
 fixed when the whole organization of law and order is 
 one of eternal progress." 
 
 Originally the congregate system was naturally adopted 
 in the State lunatic hospitals, as promising to be adequate 
 to all necessities then known. The pressure for admis- 
 
48 THE CURABILITY OF INSANITY. 
 
 sion bevond the original estimates was as unexpected as 
 it was irresistible. The suffering applicants would not 
 and could not be denied. Experience alone can measure 
 the painful perplexities attending the management of a 
 lunatic hospital, and the positive evils resulting from an 
 overcrowded condition. In this connection I cannot 
 forbear recording my admiration of those my justly 
 honored fellow-members of the Association of Super- 
 intendents, whose administration under their embar- 
 rassments, often with narrow means, has met with such 
 grand success. 
 
 Among the thousands of the varied classes of the in- 
 sane whom the broad charities of the States have so 
 mercifully sheltered, there are many old and hopeless 
 cases, without friends or kindred, the daily care of whose 
 lives has hitherto been often calculated with a rigid 
 economy and scant sympathy, who have a right to claim 
 from their fellow-men a quiet and kindly resting-place 
 on their way to the grave. Some of them are truly good 
 men and women, though the moral accountability of 
 their lives is at an end. '' Possible angels in another 
 life " (as some one aptly termed them), they are waiting, 
 sometimes in tumult, sometimes in fear, rarely in peace, 
 that conclusion of life which may be to them the prelude 
 of a better existence. 1 never looked upon this class 
 without hearty interest. As we scatter flowers over the 
 graves of our friends, and keep their resting-places in 
 decency and order, so should we care for those ever 
 worthy of our love, who were never more in need of our 
 thoughtful and practical sympathy. 
 
 « John S. Butler, 
 
APPENDIX. 
 
 (i.) Page S. In 1845, that enlightened and persevering philanthro- 
 pist, Lord Ashley, to whom the poor of England are greatly indebted 
 for his able advocacy of their interest, submitted to the House of Com- 
 mons two bills " for the better care of the insane." On presenting 
 them for consideration he made an able speech replete with valuable 
 information (Editor, yournal of Insanity'). " It seems unnecessary," 
 he said, " that I should weary the House further, to enforce upon an 
 assembly of educated, humane, and liberal-minded men the necessity 
 for making provisions for those unhappy and destitute beings, who, 
 by a wise though inscrutable dispensation of Providence, have been 
 made subject to this awful calamity, and whose suffering and helpless 
 condition demands that they should receive an unusual share of sym- 
 pathy from every one of us. But it is remarkable how slow and 
 tedious has been the process whereby we have arrived at the rational 
 and kind mode of treatment which now appears to be recommended 
 to all of us, not only by the dictates of humanity, but also by com- 
 mon-sense. Until the period of the Reformation there is not a single 
 instance of a lunatic asylum being established. Persons of station 
 and wealth were confined in their own houses ; and whips, chains, 
 darkness, and solitude were the approved remedies. That practice 
 has indeed descended to our own times ; and Ur. Conolly states that 
 he has formerly witnessed ' humane English phy>icians daily con- 
 templating helpless insane patients bound hand and foot, and neck 
 and waist, in illness, in pain, and in the agonies of death, without 
 one single touch of compunction, or the slightest approach to feeling 
 of acting either cruelly or unwisely ; they thought it impossible to 
 manage insane people any other way.' " It belonged to the French 
 
 49 
 
50 THE CURABILITY OF INSANITY. 
 
 nation, to the genius of French professors, first to make this mighty 
 advance in the cause of humanity. It was reserved for M. Pinel, the 
 great physician, to achieve this great work. 
 
 He undertook what appeared to be the rash enterprise of liberating 
 the dangerous lunatics of the Bicetre.' He made application to 
 the Commune for permission. Couthon offered to accompany him 
 to the great Bedlam of France. They were received by a confused 
 noise. The yells and angry vociferations of three hundred maniacs 
 mixing their sounds with the echo of clanking chains and fetters 
 through the dark and dreary vaults of the prison. Couthon turned 
 away with horror, but permitted the physician to incur the risk of 
 his undertaking. 
 
 There were fifty who, he (Pinel) considered, might without danger 
 to the others be unchained ; and he began by releasing twelve, with 
 the sole precaution of having previously prepared the same number of 
 strong waistcoats with long sleeves, which could be tied behind the 
 back if necessary. The first man on whom the experiment was to 
 be tried was an English captain, whose history no one knew, as he 
 had been in chains forty years. He was thought to be one of the 
 most furious among them. The keepers approached him with cau- 
 tion, as he had, in a fit of fury, killed one of them on the spot, with 
 a blow of his manacles. He was chained more rigorously than any 
 of the others, Pinel entered his cell unattended, and calmly said to 
 him : " Captain, I will order your chains to be taken off, and give 
 you liberty to walk in the court, if you will promise me to behave 
 well, and injure no one." "Yes, I promise you," said the maniac, 
 " but you are laughing at me ; you are all too much afraid of me." 
 "I have six men," answered Pinel, "ready to enforce my com- 
 mands, if necessary. Believe me, then, on my word, I will give you 
 your liberty if you will put on this waistcoat." He submitted to this 
 willingly, without a word. His chains were removed, and the keep- 
 ers retired, leaving the door of the cell open. He raised himself 
 many times from his seat, but fell again on it, for he had been in a 
 sitting posture so long that he had lost the use of his limbs. In a 
 
 * In " Pinel, a Biographical Study," read before the Academy of Sciences, by 
 Casimer Pinel (his nephew), we find this thrilling relation. 
 
THE CURABILITY OF INSANITY. 5 I 
 
 quarter of an hour he succeeded in maintaining his balance, and, 
 with tottering steps, came to the door of his dark cell. His first 
 look was at the sky, and he cried out enthusiastically : " How beau- 
 tiful ! " During the rest of the day he was constantly in motion, 
 walking up and down the staircases, and uttering short exclamations 
 of delight. In the evening he returned of his own accord to his cell, 
 where a better bed than he had been accustomed to had been pre- 
 pared for him, and he slept tranquilly. During the two succeeding 
 years, which he spent in the Bicetre, he had no return of his previous 
 paroxysms, but even rendered himself useful by exercising a kind of 
 authority over the insane patients, whom he ruled in his own fashion. 
 
 It was spread abroad that Pinel had released the lunatics from 
 their fetters with bad intentions, and under this pretext a furious 
 mob one day brought him ^^ a la lanterned Chevinge, an old soldier 
 of the French Guards, rescued him out of their hands, and thus saved 
 his life. This man was one of those lunatics liberated by Pinel, 
 afterwards cured, and ultimately taken into his service. 
 
 It is elsewhere recorded that for months after his rescue of Pinel, 
 he procured all the needed supplies of the Bicetre, under the direc- 
 tion of the doctor, who did not dare to be seen in the street. 
 
 In his comprehensive and interesting history of the insane, Dr. 
 Hack Tuke quotes from Dr. Pliny Earle {^American yourtial of 
 Insanity, April, 1856), who says: "It is now very fully demon- 
 strated that the idea of the amelioration of the condition of the 
 insane was original with Pinel and Tuke, and that for some time 
 they were actively pursuing their object, each uninformed of the 
 action of the other. It is no new thing for inventions, discoveries, 
 and innovations upon traditionary practices to originate almost sim- 
 ultaneously in more than one place, showing that they are called for 
 by the times, that they are developments of science and humanity, 
 necessary evolutions of the human mind in its progress towards the 
 unattainable perfect, rather than what may be termed a gigantic or 
 monstrous production of one intellectual genius. Each perceived 
 the wretchedness, the misery, the suffering of the insane around 
 him ; each was moved to compassion ; each resolved to effect a 
 reform in their treatment ; each succeeded. The recognition of 
 services to humanity is due to each. To each we freely accord it." 
 
52 THE CURABILITY OF INSANITY. 
 
 Dr. Ray, in the same journal, speaks of the founder of the Retreat 
 as "clear-headed and warm-hearted, one who, true to his faith, con- 
 ceived the idea that the insane as well as the sane could be best 
 managed in the spirit of peace and good-will." 
 
 (2.) Page 23. In describing the Retreat for the Insane in the 
 yournal of Ifisaniiy for July, 1845, page 67, Dr, Bingham says : 
 
 " From the report of the Chaplain we make the following extracts : 
 
 " ' To guard against relapse also, it ought never to be forgotten, is 
 a prominent feature of complete success in the care of the insane. 
 Self-control, prudence in observing the rules of health, watchfulness 
 in avoiding those kinds and degrees of excitement which tend to pro- 
 duce a relapse, calm and equable feelings, just views of life, a con- 
 scientious performance of duty, regular, useful, and encouraging 
 employment, cheerful resolution and hope, and, above all, moral and 
 religious principles, — these should be cultivated with the most assid- 
 uous care, as they constitute the strongest security against the return 
 of the distressing malady. That institution which can best succeed 
 in furnishing its cured and discharged patients with these elements of 
 security has attained one of the highest ends, if not the very highest, 
 to be allied at in this department of benevolent effort. To do this 
 the whole man must be put right, or as near right as can be. Not 
 only medical but also moral and religious influences must be brought 
 to bear upon him, or else he will be healed but in part, and subse- 
 quent irregularity, or even deficiency, in the working of one portion 
 of his system may again derange other portions, and the old, or som.e 
 new form, perhaps, of mental aberration be the result.' 
 
 " These we consider valuable suggestions. We have long felt and 
 tauglit that ' we had not done a patient all the good we ought by 
 curing him of one attack, but that we should endeavor so to instruct 
 him that he may prevent another ; that we believed in man's power 
 over himself to prevent and control insanity in many instances.' 
 
 " But to accomplish this men need instruction, especially those pre- 
 disposed to insanity, and we know of no one better calculated to aid 
 in enlightening all such on this important subject than the dis- 
 tinguished Chaplain to the Retreat, and we indulge the hope that he 
 will prepare a work on the topics to which he has alluded, embracing 
 also those errors in education and in the moral training of children 
 
THE CURABILITY OF IMSAIS^ITY. 53 
 
 and youth likely to dispose them to violent emotions, and ultimately 
 to insanity. Such a work is much needed, and would, we believe, be 
 of great utility." 
 
 These are wise and timely words. This application, ever needed, 
 seems of late less efficiently enforced. The ultimate results of 
 typhus, pneumonia, and especially scarlet-fever and diphtheria, in 
 children, would be far less favorable if the danger from relapses of 
 these insidious diseases were not explained and vigilantly watched. 
 The marked change in the convalescence from insanity increases the 
 inability of the non-experts to measure the danger which may remain. 
 The naturally earnest desire of both friends and patients to hasten 
 the return home, with the frequent sharp economies or the really 
 narrow pecuniary means, combines to defeat the cautions of the 
 physician. It has again and again occurred that patients thus un- 
 wisely removed have been brought back within a few weeks or 
 months, in most cases not as insane as on the first admission. Gen- 
 erally their experience had made them wiser. Some frankly con- 
 fessing their mistake, were ready to give the institution another and 
 fairer trial. In equity two such admissions should count but one. 
 Such lessons, if not as promptly efficient as that taught by the " old 
 barn " (see page 24), often proved as effectual. 
 
 The more the aspect of home was given to the Retreat, the greater 
 was the readiness of convalescents to remain, in the good hopes of 
 securing a more thorough and permanent recovery. Sometimes 
 when this had been secured, the patients, finding themselves after 
 leaving us giving way under the oppressions and unavoidable 
 influences of their own home lives, have come back for some 
 possible relief, and have found it to their present content in 
 being admitted not formally, but as visitors for a few days or 
 weeks. This was one of the minor but happy influences of the 
 Retreat. 
 
 Insanity is confessedly a most formidable disease. The great 
 question now pressing upon us comes from the masses of incurables 
 overcrowding many of our capacious State hospitals, crippling the 
 means of remedial treatment, as well as that of comfort. How shall 
 this multitude be cared for, and how shall we check their rapid in- 
 crease ? In my belief this mass of human beings, hopeless of cure. 
 
54 THE CURABILITY OF INSANITY. 
 
 rightly demanding kindly care, come far more frequently from the 
 ignorance or neglect of scientifically well-known and preventible 
 causes than from the often accepted one of heredity. Passing by the 
 discussion of the due proportion of these fruitful causes, we must 
 look for our best relief in the future to the higher power of preven- 
 tion, that best means of averting insanity. To this, better than to 
 the science of remedy, we may confidently look for the instrument to 
 root out its subtle heritage. 
 
 (3.) Page 32. In his introduction to Dr. Jacobi's ' ' Hospitals for the 
 insane," 1841, Samuel Tuke says : " The reasons which Dr. Jacobi 
 assigns for restricting establishments for the insane to two hundred 
 patients appear to us very satisfactory — this number being considered 
 as being mainly of the curable class." 
 
 Dr. Jacobi strongly condemns the practice of admitting or retain- 
 ing in such a hospital those incurable lunatics who are affected with 
 such forms of insanity as may render them highly distressing or in- 
 jurious to those who are yet considered curable. 
 
 Mr. Tuke says : "I had many years ago an opportunity of seeing 
 the change from large to small classes, and was confirmed by it in the 
 opinion which I had previously formed on comparing the condition 
 of the large companies of patients in one institution with the smaller 
 divisions in another. 
 
 " In the one thirty patients were frequently found in one division, 
 in the other the number in each room rarely if ever exceeded ten. 
 Here I generally found more of the patients engaged in some useful 
 or amusing employment. Every class seemed to form a little family. 
 They observed each other's eccentricities with amusement or pity ; 
 they were interested in some degree in each other's welfare, and con- 
 tracted attachments or aversions. 
 
 " In the large society the difference of character was very striking. 
 I could perceive no attachments, and very little observation of each 
 other. In the midst of society every one seemed in solitude ; con- 
 versation or amusement was rarely to be observed — employment 
 never. Each individual was pursuing his own busy cogitations, pa- 
 cing with restless step from one end of the enclosure to the other, or 
 lolling in slothful apathy upon the benches. It was evident that 
 society could not exist in such a crowd." 
 
THE CURABILITY OF INSANITY.. 55 
 
 Some may be interested in the explanation which Dr. Tuke gives 
 of the origin of the familiar term " Retreat " as applied to a lunatic 
 asylum. He states that ' ' one day the conversation in the family cir- 
 cle turned on the question what name should be given to the proposed 
 institution, when my grandmother, who was very much interested in 
 the establishment, quickly remarked that it should be called a Re- 
 treat. It was at once seen that feminine instinct had solved the 
 question, and the name was adopted to convey the idea of what such 
 an institution should be, namely, — a place in which the unhappy 
 might find a refuge, a quiet haven in which the shattered bark might 
 find the means of reparation or of safety." 
 
 (4.) Page 35. Dr. John Brown, the well-known author of " Rab 
 and His Friends, " in the memoirs of his father, says : ' ' From his ner- 
 vous system and his brain predominating steadily over the rest of his 
 body, he was habitually excessive in his professional work. Thus it 
 was, and thus it ever must be, if the laws of our bodily constitution, 
 laid down by Him who knows our frame, and from whom our substance 
 is not hid, are set at naught, knowingly or not — if knowingly, the 
 act is so much more spiritually bad ; but if not, it is still punished 
 with the same unerring nicety, the same commensurate meting out of 
 the penalty, and paying ' in full tale.' It is a pitiful and sad thing 
 to say, but if my father had not been a prodigal in a true, but very 
 different meaning, if he had not spent his substance, the portion of 
 goods that fell to him, the capital of life given him by God, in what 
 we must believe to have been needless, and therefore preventable ex- 
 cess of effort, we might have had him still with us, shining more and 
 more, and he and they who were with him would have been spared 
 those two years of the valley of the shadow, with its sharp and steady 
 pain, its fallings away of life, its longing for the grave, its sleepless 
 nights and days of weariness and languor, the full expressions of 
 which you will find nowhere but in the Psalms and in Job." 
 
 " I have often found that the more the nervous centres are em- 
 ployed in those offices of thought and feeling the most removed from 
 material objects, — the more the nervous energy of the entire nature 
 is concentrated, engrossed, and used up in such offices, so much 
 the more, therefore, are those organs of the body which preside over 
 that organic life common to ourselves and the lowest worm de- 
 
56 
 
 THE CURABILITY OF INSANITY. 
 
 frauded of their necessary nervous food ; and being in the organic 
 and not in the animal department, and having no voice to tell of their 
 wants or wrongs till they wake up and annoy their neighbors who 
 have a voice, that is, who are sensitive to pain, they may have been 
 long ill before they come into the sphere of consciousness. This is 
 the true reason, along with want of purity and change of air, want 
 of exercise, want of shifting the work of the body, why clergymen, 
 men of letters, and all men of intense mental application are so lia- 
 ble to be affected with indigestion, constipation, lumbago, and low- 
 ness of spirits, black bile, melancholia. The brain may not give 
 way for long, because for a time the law of exercise strengthens it ; 
 it is fed high, gets the best of every thing, of blood and nervous 
 pabulum, and then men have a joy in the victorious work of their 
 brains, and it has a joy of its own, too, which deludes and misleads. 
 All this happened to my father. He had no formal disease when he 
 died, no structural change ; the mechanism was entire, but the mo- 
 tive power was gone, it was expended. The silver cord was not so 
 much loosed as relaxed. The golden bowl, the pitcher at the 
 fountain, the wheel at the cistern, were not so much broken as emp- 
 tied and stayed. The clock had run down before its time, and there 
 was no one but Him who first wound it up and set it who could 
 wind it up again ; and this He does not do, because it is His law — an 
 express injunction from Him — that having measured out to His 
 creatures each his measure of life, and left him to the freedom of his 
 own will and the regulations of his reason. He also leaves him to 
 reap as he sows. . . . 
 
 " Hugh Miller, that remarkable man — who stands alongside of 
 Burns and Scott, Chalmers and Carlyle, the foremost Scotchmen of 
 their time — in his life a noble example of what our breed can pro- 
 duce, of what energy, honesty, intensity, and genius can achieve ; 
 and in his death (' by suicide ')• a terrible example of that revenge 
 which the body takes upon the soul when l^rought to bay by its inex- 
 orable taskmaster. I need say no more. His story is more tragic 
 than any tragedy. Would to God it may warn those who come after 
 to be wise in time, to take the same — I ask no more — care of their 
 body, which is their servant, their beast of burden, as they would of 
 their horse. . . . Most men have, and almost every man should 
 
THE CURABILITY OF INSAXJTY. 57 
 
 have, a hobby ; it is exercise in a mild way, and does not take him 
 away from home : it diverts him ; and by having a double line of 
 rails, he can manage to keep the permanent way in good condition. 
 A man who has only one object in life, only one line of rails, who 
 exercises only one set of faculties, and these only in one way, will 
 wear himself out much sooner than a man who shunts himself every 
 now and then, and who has trains coming as well as going ; who 
 takes in as well as gives out," 
 
 In this connection the following extract from a lecture delivered 
 some years ago before the Young Men's Association of Utica on the 
 physiology of the brain, by Prof. Coventry, seems to be in good and 
 timely order : 
 
 " Vague and indistinct notions were long entertained as to the in- 
 strumentality of the brain in mental operation. This is well illus- 
 trated by the following q^uotation from Burton's ' Anatomy of 
 Melancholy.' It is from the original writings of Marrilium Fier- 
 nus : ' Other men look to their tools : a painter will wash his pen- 
 cils ; a smith will look well to his anvils, hammers, and forge ; an 
 husbandman will mend his plow iron, and grind his hatchet if it be 
 dull ; a falconer or huntsman will have an especial care of his hawks, 
 hounds, horses, and dogs ; a musician will string and unstring his 
 lute. Only scholars neglect that instrument (their brain and spirit I 
 mean) which they daily use, and by which they range all over the 
 world, and which by much study is consumed. This (he says) dries 
 the brain, extinguishes natural heat, and whilst the spirits are intent 
 on meditation above, in the head, the stomach and liver are left des- 
 titute, and thence comes black blood, crudities, and melancholy ; so 
 that sedentary and diligent men, for the most part, spend their for- 
 tunes, lose their wits, and often their lives also, and all through im- 
 moderate pains and extraordinary studies." 
 
 We may smile at his physiology, but so far as he represents the 
 effects of intense application of the mind and sedentary habits, he is 
 undoubtedly correct, and shows the close observer of nature. The 
 following, taken from a recent number of the London Quarterly Re- 
 view, exhibits the modern view of the same subject. Speaking of 
 the education of Lord Dudley, the writer observes : ' ' The irritable 
 susceptibility of the brain was stimulated at the expense of bodily 
 
58 THE CURABILITY OF INSANITY. 
 
 power and health. His foolish teachers took a pride in his preco- 
 cious progress which they ought to have kept back. They watered 
 the forced plant with the blood of life. They encouraged the viola- 
 tion of nature's laws, which are not to be broken in vain. They in- 
 fringed the condition of conjoint moral and physical existence. 
 They imprisoned him in a vicious circle, where the overworked brain 
 injured the stomach, which reacted to the injury of the brain. They 
 watched the slightest deviation from the rules of logic, and neglected 
 those of dietetics, to which the former are a farce. They taught him 
 no exercises but those of Latin ; they gave him a Gradus instead of 
 a cricket bat, and his mind became too keen for its mortal coil, and 
 the foundation was laid for ill-health, derangement of stomach, 
 moral pusillanimity, irresolution, lowness of spirits, and all the pro- 
 tean miseries of nervous disorders by which his afterlife was haunted. 
 
 " The picture drawn of Lord Dudley's education has its counter- 
 part in every day's experience. . . . The overwrought and over- 
 stimulated intellect is literally nourished with the blood of life. The 
 brain is inordinately excited at the expense of every other part of 
 the system, and life or permanent ill-health is too often the penalty 
 paid for this violation of nature's laws." 
 
 Some years ago there was published in London, a valuable series 
 of * ' Small Books on Great Subjects, Edited by a Few Well- Wishers 
 to Knowledge." 
 
 Among them was one by the Rev. John Barlow, of London, en- 
 titled " Man's Power over Himself to Control Insanity." 
 
 To the 3rd edition of this valuable essay I am greatly indebted, not 
 only for the timely suggestions, but for several pertinent quotations 
 from foreign authorities. 
 
 Mr. Barlow quotes' with hearty commendation Mr. Gallaudet's 
 testimony to the beneficial influence of the religious services of the 
 patients as follows : 
 
 " In estimating their value there are many things to be taken into 
 account in addition to their spiritual benefit to the patient. . . . 
 Such are the following : the necessary preparations to be made for 
 attending the religious exercises in a becoming manner, and which 
 
 ^ Report of the Retreat for 1846. 
 
THE CURABILITY OF INSANITY. 59 
 
 fill up a portion of time agreeably and profitably ; the regular return 
 of the stated hour for doing this, and the pleasant anticipations con- 
 nected with it ; the change of scene from the apartments and halls to 
 a commodious, cheerful, and tasteful chapel, there to unite in the 
 worship of God ; the social feelings induced and gratified, the wak- 
 ing up of formerly cherished associations and habits ; the soothing, 
 consoling, and elevating influence of sacred music ; the listening in- 
 telligently to the interesting truths of the word of God, and uniting 
 with the heart in rendering him that homage which is his just due, as 
 is, beyond doubt, the case with not a few of the patients ; the success- 
 ful exercise of self-control, so strikingly and constantly exhibited by 
 those who need to exercise it ; . . . the habits of punctuality, 
 order, and decorum which they acquire in going to and retiring from 
 the accustomed place of their devotions; . . . the feeling that in 
 all this they are treated like other folks, and act as other folks do ; 
 and the subsequent satisfaction, a part of our common nature, which 
 many of them experience in the reflection that they have performed 
 an important duty. . . . All this is frequently and abundantly 
 confirmed by statements on the part of restored patients before 
 leaving the Retreat, who speak with gratitude of the interest they 
 have felt in the religious exercises, and of the comfort and benefit 
 they have derived from them, and from the other means of religious 
 counsel and consolation which they have enjoyed." 
 
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 Curability of insanity^ 
 
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 1887