THE

INSANE.

THIRD PAPER.

THE Insane Institutions of Germany are very numerous, and of course of every degree of merit. In many cases they occupy the old monastery buildings, and are endowed with the funds which on their suppression accrued to the government. In others, where the Roman Catholic religion is still the religion of the state, they are under the control of some of the religious fraternities, and the Sisters of Charity are the attendants upon the patients. Under both circumstances, although much has been done to alter and modify the buildings for their present use, there is necessarily a want of those more recent improvements, of warmth, ventilation, and comfort which are to be found in the more recently constructed edifices for the care of the insane. In a few instances new and convenient buildings have been erected, replete with all those arrangements which can conduce to the health, comfort, and rapid recovery of the patients. It should be remarked that in all the continental institutions physical labor is regarded as one of the best curative measures in the treatment of the insane. The hands are kept busy where it is profitable, and, so far as may be, the mind also.

Among the best conducted of the German institutions are that at Berlin, under the care of Dr. Ideler; at Siegburg, under Dr. M. Jacobi; at Sachsenberg, under Dr. Flemming; at Halle, under Dr. Damerow; at Sonnenstein, in Saxony, under Dr. Lessing; at Leubus, under Dr. Martini; the Asylum for Incurables at Zurefalten, under the care of Dr. Schaeffer; at Hildesheim, an immense establishment, under Dr. Bergmann; Illenau, in the Grand Duchy of Baden, under Dr. Roller; Eichberg, in the Duchy of Nassau, under Dr. Snell; Frankfort-on-the-Main, under Dr. Hoffman; and the private institutions of Dr. Jessen, at Hornheim, near Kiel, and Dr. F. Engelken, at Obervenland, near Bremen.

Some of these are deserving of special notice; the Insane Hospital at Seigburg has been, perhaps, better known abroad than any other in Germany, Dr. Jacobi having been at its head since its foundation in 1825, and having contributed as much as any man in that country to the promotion VOL. XII.-3

insane. The buildings were originally erected and occupied as a Benedictine monastery as early as A.D. 1051. Though many alterations and improvements have been made in them, they are still not well adapted to the present purpose, but the genius and skill of Dr. Jacobi have triumphed over all obstacles, and the hospital is one of the best conducted in Germany. The patients mostly labor, and tobacco and snuff are given them as a recompense for their work. Dr. Jacobi has also provided for recreation both out of doors and within the hospital. Shooting with the crossbow at a mark, cultivating flowers, etc., form the principal out-door amusements, while within there is a library, theatrical exhibitions, the occasional presentation of gifts, musical entertainments, and instruction in music, drawing, and literature. The scenery in the vicinity of the hospital is exceedingly picturesque.

The Institution for the Insane at Halle, under the care of Professor Damerow, the accomplished editor of the Journal of Psychiatry, was erected under his supervision and opened in 1843. It has two departments, one for curable and the other for incurable patients, and is intended to furnish accommodations for four hundred. Dr. Earle, who visited it in 1849, commends its arrangements and the ability with which it is conducted.

The asylum for incurables at Zurefalten is said to be the best establishment of its kind in Germany. It has apartments for one hundred and fifty patients. It was organized in 1839.

The Illenau Hospital, in the Grand Duchy of Baden, was opened in 1842. No pains or expense was spared in the construction of the buildings, which form a vast pile resembling, at a little distance, a village compactly built. Dr. Roller, the present director, superintended its construction. The arrangements for the comfort of the patients are very perfect. Labor is practiced, but considered only as a curative means, not an end. There is more variety of labor than in most of the other German institutions; in addition to agricultural pursuits, there are workshops for tailors, shoemakers, saddlers, bookbinders, turners, joiners, wagon-makers, coopers, locksmiths, blacksmiths, and mattress makers. Schools have also been established, and are under the charge of

the chaplains and one of the female supervisors. In these the elementary branches are taught. Botany is also taught to such patients as desire it, by one of the assistant physicians, and music, both on the piano and organ, by a special music teacher hired for the purpose. Concerts and festive parties are frequently given. The corridors and rooms are hung with pictures. A gymnasium and bowling alleys are among the provisions for the recreation of the patients. The Christmas holiday is as fully observed at Illenau as anywhere in Germany.

The institution at Leubus, near the confines of Poland, is one of great interest to the traveler, from the extent of its buildings, originally erected for a monastery by Casimir the First, the beautiful scenery by which they are surrounded, and the genial and attractive manners of the accomplished superintendent, Dr. Moritz Martini. The household economy of this institution is represented by Dr. Earle as admirable. Its general system of treatment and its arrangements for labor and recreation do not differ materially from those of the other institutions already described.

The great hospital La Salpetriere contains a population of five thousand three hundred and fifty, all of whom, except the physicians and internés, are females. Of these, sixteen hundred are insane, epileptic, or idiotic. The Bicetre is a similar institution for male patients, but its total number of inmates is somewhat less, and of this number about twelve hundred are insane, epileptic, idiotic, or paralytic. Both are intended in all these departments exclusively for paupers. A very large proportion of the insane rank as incurables.

Where a number so very large are assembled together, we cannot reasonably expect that the treatment will be as skillful or the success as great as in smaller institutions. There is, too, a general feeling in the Parisian hospitals that the canaille are fit subjects on which to make those experiments which, however hazardous they may prove to life and limb, are so congenial to the tastes of French physicians and savans. The present physicians of both of these great hospitals are men of eminent attainments, both in the general literature and science of the profession, and in the special walk (insanity) to which they have devoted themselves. Dr. Baillarger in particular has devoted to the investigation of mental disease all the powers of a very superior intellect and the extraordinary facilities which attach to his position. There are also many eminent psychologists in Paris who have charge of private institutions for the insane. M. Brierre de Boismont is perhaps the best known of these, from his able work on suicide, as well as from his other valuable communications to the Annales Medico-Psycholo

sane.

The Hospice de Bon Sauveur, at Caen, has accommodations for deaf mutes and the infirm as well as the insane. It has twelve hundred and forty-three resident inmates, of whom two hundred and thirtyseven are the choir and lay sisters of the

boarders; one hundred and fifty-five deaf mutes; one hundred and twenty-eight resident domestics, and six hundred and ninety-two lunatics, of whom three hundred and two are men and three hundred and ninety women. There are also attached to the establishment, but non-resident, two physicians and eighty workpeople. It is largely endowed. The celebrated Beau Brummell, the companion

of George IV., and so long the Napoleon of the realms of fashion, passed the last year of his life here, and died in one of the apartments which is pointed out to the visitor. The institution is in no respect up to the demands of the time as a hospital for the insane. The Sœurs Religieuses, though deserving of admiration for their earnest zeal in the care of the sick and insane, and the courage with which they control the violent and wayward, are somewhat too conservative for the adoption of those improvements which would elevate the condition of their establishment. The order have two other similar institutions of a similar character with this at Caen, one of them (in the south of France) fully as large as the one we have described.

The Nantes asylum, like Bon Sauveur, is only a department of a general hospital, intended for the reception of infirm paupers, deaf mutes, orphans, and lunatics. The whole number of persons connected with the establishment is eleven hundred and ninety-six, of whom three hundred and ninety-one are insane. The buildings were constructed expressly for lunatics, and are very conveniently arranged, and every department of the institution is well conducted. The patients are quiet, contented, and generally very well behaved. The milder forms of restraint are in quite general use in most of the French insane hospitals.

Charenton has always maintained a high reputation for the skill and tenderness with which the insane have been treated within its walls; and under its present accomplished, able physicians, Drs. Calmeil and Foville, it seems likely to lose nothing of its past high character. It is intended only for pay patients, and is well adapted to facilitate their recovery.

But the model insane institution of France, and, indeed, of the continent, is that of Stephansfeld, near Strasbourg. In the construction of its buildings, adapting them to their designed purpose, giving an air of cheerfulness even to those intended for the most violent; in the management of its household economy, combining a plentiful supply with careful economy and strict accountability for everything in use in the establishment; in its system of labor, in which almost all of the mechanic arts and agricultural pursuits are followed, and the ambition, industry, and energy of the patient encouraged by

the incentive of a small reward; in its wellconsidered system of recreation, as adapted to call into action the dormant powers of the intellect, and to call off attention from the delusions and hallucinations to which they are subject; and especially in its schools for the instruction of such of the insane as are disposed to study, schools which were the first in the world to demonstrate the possibility and advantage of the instruction of the insane; in all these respects we must pronounce the Insane Hospital at Stephansfeld as equal to any on the continent. Dr. Ræderer, its able director, has been at the head of the institution since 1842, and it is owing almost entirely to his skill and tact that it has attained its present high position.

We have only given examples of the three classes of insane hospitals in France, as any extended account of them would far transcend the limits we have proposed to ourselves. By a decree of government every department, of which there are eighty-six in France, is required to provide at least one establishment for the treatment of the insane, and as in addition to this there are a very considerable number supported by religious orders, and also many private maisons de santè, as these hospitals are called, the whole number of asylums in France must considerably exceed one hundred.

The hospitals for the insane in the United States, though not as numerous in proportion to the population as those of Great Britain, are of more uniform capacity, and are not so generally filled with incurable patients. The pauper class is much less numerous and formidable here than there, and the great mass of incurable patients, if quiet and harmless, are received by their friends, and do not cumber the wards of the hospital. There is, besides, less dread of the reputation of insanity in families here than there, and consequently not the necessity for mystery and concealment which is supposed to exist there.

There are in the United States between fifty and sixty insane hospitals, including several private establishments, averaging, as nearly as can be estimated, two hundred patients each; thus furnishing provision for between ten thousand and eleven thousand of the insane. Besides these, there are county or other receptacles in the nature of alms-houses, which provide

separate though inadequate and very objectionable accommodations for perhaps three thousand more. The total number of the insane in the United States, according to the most recent and reliable data, is not less than twenty-seven or twenty-eight thousand. The provision as yet made is of course entirely inadequate for the accommodation of those deprived of reason. Public attention has, however, been so thoroughly aroused to the necessity of making provision for this class, both in the hope of their restoration and for the protection of community, that there is little reason to doubt that hereafter the proportion of hospital accommodations to the whole number of the insane will be greatly increased.

The first chartered institution for the treatment of the insane in this country was the Pennsylvania Hospital at Philadelphia. It was opened in 1752, and though intended as a general hospital, yet special provision was made in its charter for the reception of insane patients. In the ninety years previous to 1841, when the insane patients were removed to the new hospital for the insane, which had been erected for their special accommodation, it had received four thousand three hundred and sixty-six patients, of whom thirty-four per cent. had been discharged cured. The new hospital completed in 1841 is replete with every convenience for the comfort and successful treatment of the insane, and in the perfection of its arrangements is not surpassed by any institution of this country or Europe. The grounds belonging to the hospital comprise one hundred and ten acres, and on a portion of them at some distance from the present buildings the corporation are now erecting another hospital, of equal capacity with the present, at an expense of two hundred and fifty thousand dollars on the completion of which it is intended to devote one edifice to male and the other to female patients. The two establishments will furnish accommodations for about five hundred patients.

A portion of the ample grounds is laid out as a lawn, and the grapery, greenhouse, and gardens of the hospital not only add much to the beauty of the premises, and conduce to its healthfulness and comfort, but also add materially to its revenues; the sums thus received, however, being, for the most part, expended in pro

curing books for the ward libraries, apparatus for illustrating the lectures, materials for games of recreation, etc.

Dr. Kirkbride, the accomplished superintendent of this hospital, combines in an extraordinary degree the qualifications required for a post so important and arduous. An accomplished scholar, a thoroughly educated physician, endowed with a genial and sympathizing spirit, he possesses also great tact and executive ability, and a remarkable capacity for details as well as for the general management of the establishment. His able treatise on the " Construction and Organization of Hospitals for the Insane," as well as his numerous valuable contributions to the Journal of Insanity, give evidence of his zeal in the cause to which he has devoted his life as well as his abilities as a writer.

The New York State Lunatic Asylum, recently the scene of a disastrous conflagration, was planned and constructed at a period when erroneous views prevailed relative to the extent of such institutions. It is too large to be properly and efficiently superintended by a single physician. The very able and eminent physicians who have preceded the present incumbent have proved by their own experience the evil of placing so heavy a burden of care and responsibility on the shoulders of one

man.

Dr. Brigham fell a victim to his overexertion. Dr. Benedict was compelled by nervous prostration to seek a milder climate and relaxation from the severity of his professional duties, which he soon found must be permanent instead of temporary. We can only hope that the present superintendent may long be spared their painful experience. The asylum was intended to accommodate from four hundred and fifty to five hundred patients, and is always full. The central portion of the building having recently been destroyed by fire, it is presumable that in its rebuilding every improvement which experience has sanctioned will be introduced. The state is suffering from the want of two or three more insane hospitals, and the preliminary steps have already been taken for deciding upon suitable localities for two at least. The Insane Hospital at Blackwell's Island and the Bloomingdale Asylum, a branch of the New York Hospital, are both well conducted, but offer no special characteristics deserving of notice.