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same time aware of the difference between mere bodily disease, and disease of the understanding, and who is not himself so organically mad as to deny the subordination of matter to mental impulse and motive.
But it is time to attend to the author, whose treatise has been the immediate cause of our suggestions.
That Dr. Burrows estimates duly the limits by which those researches must ever be bounded which involve the connexion between organization and intellect, we have great pleasure in offering the following quotation as evidence.
'None dispute that the brain is the seat of the understanding. The structure of this grand organ has been minutely dissected, in order to discover the specific instrument of each intellectual function, by the synthetical operation of which that effect is produced which we call mind. But notwithstanding the industry and research exercised, or the pretensions lately advanced, the futility of every attempt is no less exemplified than the presumption to explain that attribute which the CREATOR, in his inscrutable wisdom, has conferred on him alone whom he made after his own image.
'The persuasion that the integrity of the brainular mass was essential to the manifestation of the mental faculties was long a favourite theorem; but like other errors has yielded to observation. For there is no part within the cranium supposed to exercise an intellectual function, that has not been læsed or even destroyed, and yet the understanding has remained clear and undisturbed.
In reference also to the question respecting the connexion of mental aberration with bodily ailment, he introduces the following remarks, the spirit and tenour of which we fully approve.
No impression, perhaps, has been more detrimental than the scholastic dogma, that the mind, being independent of the body, can simulate all its functions and actions; can sicken, be administered to, recover and relapse; and that consequently all but moral remedies must be secondary, if not nearly useless, every other being incompatible with an immaterial essence like mind.
To discuss the validity of this or that hypothesis would be plunging into an inextricable labyrinth, and is quite foreign to my present purpose. But we may bazard the predicate, that he who relies singly on moral means will be as surely disappointed as he who resorts to the art of medicine only for the cure of insanity.'
The leading opinions to which Dr. Burrows summons the attention of the public, are these: 1st, Insanity is conceived so very difficult of cure, that few afflicted with it recover; 2dly, It is thought to be an increasing evil; and, 3dly, It is supposed a very prevalent malady:' and to prove that these opinions have no foundation in fact, but have originated in erroneous views of the dis
order, is the main motive by which he professes to have been instigated in drawing up the treatise before us.
It is an extraordinary and lamentable fact, that no writer on insanity, prior to Dr. Burrows, has favoured the public with a statement of the relative proportion of cures to the cases which have come under his immediate cognizance and treatment. This omission is the more to be regretted, since the reports from public and eleemosynary institutions cannot fail, from several causes, to be widely different from those of a private nature. To remedy this defect, Dr. Burrows calls upon all who give particular attention to mental maladies, to register and report in future their cases and cures; and he presents the following synoptic view of his own experience.
242 221 54 19 22 26
This offers a proportion of cures on the aggregate of all cases of 81 in 100; on recent cases of 91 in 100; and on old cases of 35 in 100. A proportion, (particularly that of the cures in recent cases,) we venture to affirm, far different from that which the majority of our readers have supposed to obtain as the result of any practice however prompt and judicious. This statement must for the present stand upon the credit of a single individual; but when he has given prior evidence of respectability, and moreover invites investigation, and solicits comparative trials, the scepticism which refuses to listen to his statement, on the ground that it opposes preconceived opinion, must be deemed unjustifiably captious.*
The late Dr. Willis, in his evidence before a Committee of Parliament, in 1789, averred that nine out of ten cases of insanity recovered, if placed under his care within three months from the attack--an assertion which was discredited generally at the time it was made, both by physicians and the public but Dr. Burrows's table, allowing its correctness, fully justifies the allegation as far as the remediable nature of the malady is involved; and we are happily furnished with evidence which will prove to some still more corroborative of Dr. Willis's position; for it appears that in La Salpetriere, at Paris, one of the best conducted
At the end of the present article will be found A Comparative View of the Cures of Insane Cases, in different Institutions for Lunatics.' This is an exceedingly curious and interesting document, and we should be wanting in a due appreciation of the author's industry did we neglect to point it out, as deserving every praise.
lunatic institutions in Europe, the proportion of cures of recent cases, exclusive of the fatuous, idiotic, and epileptic, was in 180G and 1807, according to Dr. Carter, almost as high as that of Dr. Willis; and even in other public institutions, in which the remedies have been applied early, the success has not been much under this
In an Article on insanity and mad houses,' given about three years since in this journal, some of our readers may recollect to have found the economy and general regulations of an asylum at York spoken of with much approbation. The institution alluded to is named the Retreat; it is conducted by an individual of the Society of Friends, and is devoted, we believe, exclusively to insane persons belonging to that body. Now it is a remarkable fact, that in spite of the most judicious and humane treatment on the part of the superintendents of this establishment, the number of patients restored to their senses and society is greatly inferior, not only to the proportions stated above, but even to that of several other institutions in which there is confessedly still much room for improvement, with regard both to moral and medical management. How is this to be accounted for? Dr. Burrows presents the following solution of the difficulty, and from a happy combination of compliment and censure upon the conductors of the Retreat, deduces an inference, as he conceives, with the force almost of demonstrative evidence, in favour of medical treatment in cases of mental disease.
The York Retreat (says Dr. Burrows) excels every other asylum for lunatics in moral qualities. But in the number of absolute cures it is not on a par either with the London or Paris hospitals, and in this respect has much about the same relation to the cures in the former, as Charenton has to those in the latter; and possibly for a similar reason, viz. that physical remedies are too lightly regarded, and therefore too little employed. In the Retreat, it is true, patients are admitted who are excluded from Bethlem and St. Lukes; therefore the proportions of cures ought to be greatly in favour of those hospitals. But if the number cured in the Retreat be compared with that in the Newcastle asylum, which receives the same description of cases, and where medical means are more fully tried, the ratio of success will be seen to be inferior in the former. Having the fullest conviction of the great efficacy of medicine in the majority of cases of insanity, I have ever viewed with regret the little confidence professed by the benevolent conductors of the Retreat in its powers; and have always considered that the exercise of a more energetic remedial plan of treatment was the only thing required to render the system they pursue perfect.'
Should the manager of the institution to which we now advert, be induced, from the suggestions of Dr. Burrows and others, to make the required alteration in his plan, and the result prove favourable, there could then exist no reasonable doubt that Mr.
Tuke has not hitherto duly appreciated the efficacy of medicine: as the matter now stands, it must be admitted that the circumstances of individuals received into his and other asylums, may not be sufficiently similar to warrant these comparative inferences. A census made of the proportion of Quakers who are the victims of mental malady to the numbers of their whole body, would, we believe, prove that these awful visitations are with them much less frequent than with society at large; and it is exceedingly probable that when madness does occur among individuals, marked as these are by steadiness of character and sobriety of habit, it is more frequently the result of constitutional bias, and therefore less likely to be beneficially influenced by remedial agents. We remark too (without meaning to convey any thing like a reflection on other reports), that Mr. Tuke must be expected to be more than ordinarily careful not to declare patients cured till he believes them actually and permanently restored.*
We are apprehensive that reports of cures both in cases of mental, and more positively physical complaints, are often made too precipitately, and that relapse or death in a short time gives the lie to announcements of radical recovery. It ought indeed further to be stated, in justice both to Mr. Tuke and Dr. Burrows, that in the copy of the work which is in our hands a manuscript note is inserted, stating that the proportion of cures to total of cases in the Retreat up to 1811 was 36 in 100,' and in a subsequent part of the volume is found likewise the following Postscript.
From delay in replying to my inquiries, for which Mr. Samuel Tuke most obligingly and satisfactorily accounts, I was not enabled to avail myself of the information he has since favoured me with (dated April the 4th) at the proper place, in the text. It was in time, however, to insert the results in the Comparative table, No. 1.
Mr. Tuke being also engaged in an inquiry, connected with those points on which I solicited intelligence, preparatory to a second edition of his interesting Description of the Retreat,' has furnished me with the following statement, which I deem too valuable to be omitted. How fully it corroborates many of my observations and inferences, cannot escape notice.
A STATEMENT of the CASES admitted into the RETREAT; exhibiting the RATIO of CURES from its opening in 1796, to the end of 1819. Total of Admissions-253.
Cases 45 Cases 34 Cases 48 Cases 79 Cases of
not exceeding not exceeding not exceeding not exceeding more than two
Dead........... 5 Dead........... 7 Dead........... 3 Dead...........11 Dead............ 27
much in- improved... 4 improved... 9 proved.......... 8
It should be observed, that both Dr. Willis and our author lay the utmost stress upon the probability of success, in the ratio given above, depending on early medicinal applications, and we deem it our duty to point out this fact to the particular attention of the reader, convinced as we are that the insidious approaches of mental derangement are too often suffered to proceed, till some terrible exacerbation of delirious fury or despondency ensues; and a malady is thus confirmed in one whom we most value, and whose intellects very probably might have been preserved, had timely aid been administered."'
Upon the whole we may remark, that although our author is perhaps somewhat too sanguine, when he infers that recoveries from insanity would exceed those from corporeal diseases, were the same chances of cure given in both cases; yet we feel no hesi tation in allowing, that his statements and reasonings, on the mo mentous question of the remediable nature of mental sickness, have produced in our minds something at least approaching to convic tion, that we had, with others, indulged too much doubt on this score; at any rate, we regard it as imperative on the part of those who undertake the management of the insane, either to confirm the rectitude, or prove the fallacy of Dr. Burrows's assumptions and conclusions, by a series of attentive and systematic investiga tions, directed especially to the elucidation of these most essential points. We may add, also, that Dr. Burrows, on his part, is called upon to exhibit the details of those plans and practices which he reports to have been so eminently successful; and we feel assured that his notions are too correct and honourable to permit his entertaining for a moment the desire of concealment.
The next question which our author discusses (and on which he maintains that much error likewise prevails), is, whether madness be on the increase? Insanity being an evil almost confined to the social state, it would seem a very natural supposition, that with the progress of refinement and the multiplication of artificial excitants, mental derangement and disease would increase in an equal proportion; and to a certain extent this is indisputably the case: but that up to the present period there has been a regular increase of those disorders, is probably one among the many notions which we receive as axiomatic truths, without having duly examined the data upon I which they are founded. We recollect some time since receiving much gratification from a little work of
N. B. Of the five deaths in the most recent class, three took place so soon after admission, as not to allow the experiment of curative means: one indeed was, at the time of admission, in the delirium of fever, and died within three days. The other two were in an almost hopeless state of health at the time of admission. Such cases to be excluded in estimating the probability of recovery from Insanity. S. T.'