Notes on Belgian Lunatic Asylums, Including the Insane Colony of Gheel

50 r Art. IV.? :Author: John Webster, M.D., F.Il.S., Fellow of the Royal College of Physicians, a Governor of Bcthlem Hospital, &c. Preface.

Having communicated in former numbers of the Psychological Journal various observations collected during several recent visits made to French and Scottish Lunatic Asylums, I am induced, by the notice they then received, again to resume a traveller’s pen, in order to describe cursorily the present condition of different Belgian institutions inspected during last autumn ; including particularly, the insane colony of Glieel, which seems not only the most remarkable, but is actually the oldest existing establishment for maniacs throughout Europe. Previous how- ever to entering upon such tasks, one or two general remarks respecting the lunacy laws of the country just named, it is hoped may not prove inappropriate, or be thought altogether super- fluous.

Like England and France, considerable alterations have been made, of late years, in the laws affecting lunatics, as also regard- ing the administration of Asylums in Belgium. The most important measure recently passed being the Legislative Act, dated 18th June, 1850 ; according to which, questions connected with lunacy institutions, and the management of patients attacked by mental disease, are now regulated. That enactment was fol- lowed, 011 the 1st of May, 1851, by an ordonnance of King Leopold, containing general and organic rules to explain more fully the previous law, and its practical application. In order to give British readers some idea of these new regulations, it may be briefly stated that, no person can either open, or at present direct, any institution in Belgium destined for the treatment ot lunatics, without first obtaining the authorization of Government; whilst a similar permission must also be procured, for the con- tinuance of all hitherto existing insane establishments. Every house in which, not only several, but even one lunatic re- sides not being a relative of the individual under whoso care such person is placed, or unless with the curator, tutor, or provi- sional administrator?is considered an insane institution. Before granting a licence to receive lunatic patients into any building, it is required ?lurst, that the situation be salubrious, the locality well aired, ot sufficient extent, and have convenient interior arrangements. Second, that the sexes are separately lodged, and classified according to the nature or requirements of their respective mental maladies. Third, that medical and sanatory officers be attached to each establishment, with sufficient accom- modation for the wants and condition of the inmates; and, Fourth, that the permanent deputation, appointed for such purposes, must renew, every three years, their approval of every professional attendant. This body, or ” College,” as it is now denominated, may also modify the medical staff, order the dismissal of any official, in cases of grave negligence ; or should he have omitted to perforin duties legally required. An appeal may, however, be made to the King against such sentence.

According to other regulations also in force, no insane person can be at present received into an asylum, excepting as follows : ?First, upon the written petition of the tutor of an interdicted party, accompanied by a resolution passed in the ” Conseil de Farnille” for that purpose; but in cases where interdiction has not yet been pronounced, the provisional administrator must petition. Second, on the demand of a local authority empowered to grant domiciliary assistance to pauper lunatics. Third, in virtue of the decision by a local judge, according to the 95th article of the communal law Fourth, in execution of an order at the suit of a public ministerial officer. Fifth, upon petition of any person interested in the patient; but specifying the nature of their intimacy, the particulars of the alleged case, and any degree of relationship, or affinity, which exists betwixt the applicant and lunatic. All these documents being further countersigned by the commune Burgomaster, where such insane persons are found, or reside. Lastly, upon a decision of the per- manent deputation appointed by the Provincial Council. In urgent cases, however, this order may, nevertheless, be made by the Governor alone ; but, in all such examples, every fact must be reported to the Council, at their meeting next ensuing. In each of the preceding modes, excepting that first named, a medical certificate must be likewise produced, describing the party’s mental condition, whom it is proposed to place under treatment, as also every particular symptom characterizing the actual disease. This document should neither bear an older date than fifteen days, nor be signed by any medical officer of the establishment, to which the patient is consigned. However, in very urgent cases, the usual medical certificate may be dispensed with at the moment of admission ; but its delivery is imperatively required within twenty-four hours subsequently.

Not later than one day after the patient’s reception into an asylum, the chief officer must notify every such admission?- !? To the provincial governor. 2. The King’s procureur of t e arrondissement. 3. The cantonal judge of the peace. 4*. I he burgomaster of the commune ; and, 5. To the committee o in spection. Besides these necessary formalities, the same official authority should intimate to the Procureur of the arrondissement, where the patient previously resided, the individual’s admission ; so that, through the local officers, he may inform the relatives or friends of that circumstance. A similar procedure being also adopted in cases of sequestration.

^No lunatic can he sequestrated in his own domicile, neither in the house of a relative, nor of any person who may occupy that responsible position, unless the mental condition of such insane patient be certified by two medical practitioners, legally qualified. One being appointed by the party’s family, or the persons most interested, the other by a cantonal judge of the peace, who must satisfy himself, through personal examination, respecting the lunatic s actual condition. Besides which, he is required to renew his visits at least every three months. Independent of these periodical inspections, that magistrate ought further to leceive, every quarter, a fresh certificate from the family physi- cian, reporting the patient’s state, during the whole term of sequestration. Moreover, he may also order at any time another practitioner to visit the lunatic, whenever that proceeding seems necessary, or is considered expedient.

Every lunatic establishment, or temporary asylum, is visited by official persons specially delegated by Government for that pur- pose ; or by the permanent committees of inspection appointed to carry into eftect the recent regulations respecting lunacy. Each asylum, and the patients they contain, must bo inspected at east once, as follows : ? 1. Every half-year by the Burgomaster o t le commune. 2. Every three months by the Procureur of the arrondissement; and 3. Annually by the provincial Governor, or by one member of the permanent deputation of the provincial couna named by the governor. Temporary asylums, or pro- mnnfV . ei^0tfi n 8’ aro a,so inspected onco evory three Rif7 i i? liro0II)astc*r of the commune in which it is offi ? 1 !e cantonal judge of the peace, besides the official persons previously specified sex renl|tation8, when the aggregato inmates of each mUents^vi-f ? * only two divisions of of the simo Unf* 1 agitated lunatics. Should the number four sections <ii ?,nount to “J01”0 than fifty, there must then bo idiots, including dirty^Sntf- ;.,a8itated; and f”rious: Whenovpr oi?lw r llents, and, fourth, convalescents. then all dean and moro than hundred patients, from the d^yT^M idiolf ? T ?? Pkce<l categories. For every ten nation* constitute two distinct- indispensable, unless undJr ,1 r’ T? 8e?lu8,on 0(3,1 ,H deemed particular circumstances; whilst INCLUDING THE INSANE COLONY OF GHEEL. 53 private patients ought always to be kept apart from pauper inmates. Lastly, neither class must ever be mixed with boarders, not insane. Each asylum should have a medical officer; and “where two or more are attached, one is denominated the chief physician. If the house contains beyond one hundred patients, there ought to be an assistant physician, or one medical pupil, resident within the institution, or in its vicinity; by either of whom, all the patients should be visited daily. The medical staff, their emolu- ments, and attributes, are submitted every three years, during the month of November, to the permanent committee of the pro- vincial council for consideration and approval; who may also make whatever changes they deem requisite. When the director of an asylum, whether public or private, undertakes to support the inmates, as also to superintend such an establishment, he must first obtain a special authority from the permanent deputation. Again, for every ten patients, there ought to be one attendant. Lastly. 110 person can erect a new asylum without the sanction of Government, or even make important changes in an old establish- ment, unless under a similar authority; and then only after plans of the proposed alterations have been forwarded for examination and approval. With reference to medical certificates required, prior to the admission of patients into an asylum, it is expressly enacted that the parties signing such documents shall specify when the disease commenced, its nature, duration, and essential characteristic symptoms; whether the patient had undergone any previous treatment, and, generally, every other circumstance with which the medical officer should be made cognizant. In addition to this report, the certifying practitioner is expected to forward a sealed communication indicating the cause, known or presumed, of the inmate’s malady, and if any relative has ever been affected with mental disease. When these certificates refer to indigent persons, they must be granted gratuitously, by the medical officers of the poor belonging to the particular locality, where such insane patients may reside, even casually.

Numerous other points, besides those now mentioned, are also specifically alluded to, in the legislative enactments just quoted ; but, being of secondary importance, the subject need not be pur- sued further. My object, at present, being only to speak gene- rally of the system which prevails in Belgium with reference to lunatics, and the organization of asylums, not certainly to tire readers by any lengthened legal disquisition ; believing that pro- ceeding would seem both misplaced and supererogatory to t ie chief purpose proposed for discussion in this communication.

Nevertheless, before adverting particularly to the institutions recently visited, it is important as a preliminary to remark that the special inspection of every lunatic asylum?whether provi- sional or permanent, as also temporary depots lor the insane, during their transference from one district to another is contii e< in each arrondissement to a committee, consisting of five, seven, or nine members, including the district Commissary, who si s officially. All are nominated by the King, while the ha is renewed every two years ; but retiring members may >e re appointed immediately. These Committees select their own secretary, the Commissary being always chairman, and having a casting vote in cases of equality. That officer alone summons t le committee, names the hour, their place ot meeting, and, in case he cannot attend himself, appoints a substitute to preside. n short, the above government official is the moving power o this local board of inspection. It corresponds diieet y wit t 10 Minister of Justice at Brussels; and the united committee is required to visit, at least once yearly, every lunatic asylum situated within their own particular jurisdiction. Besides these annua visits of the entire local committee, individual members ni.us arrange a rota amongst themselves, so that each insane establis 1- ment shall be officially inspected, not seldomer than eveiy two months. Such inspections must not be mere formalities, as they embrace many important questions of inquiry and examination, which are specifically enumerated in the new code ot lunacy regulations already quoted.

Finally, but independent of these local committees of exami- nation, and in conformity with the Legislative Act, dated 18th June, 1850, a general commission has been instituted, whose duty is to inspect every asylum in Belgium, and report respect- ing their actual condition. These Commissioners are appointed by royal decree, and receive instructions from the Minister of Justice, to whom each are responsible ; their salaries and all expenses incurred being included in the budget ot that depart- ment rlhe present commission comprises three members viz., M. liid. Ducpetiaux, also Inspector of prisons; Dr Joseph Guislain, well known throughout Europe for his great reputa- tion ; and M. D. Sauveur, also medical Inspector at the liome Office ; with M. N. Oudant, as secretary. In addition to visitng officially asylums, and taking special cognizance ot everything connected with lunacy, it is also one of the chief functions of these gentlemen to present, annually, a detailed statement regard- ing the insane establishments placed under their surveillance, which is first communicated to the Legislative Chambers by the Minister of Justice, and afterwards printed. The last Report issued is that for 1855, which amply merits perusal, as au ablo and instructive public document.

According to that ministerial paper, the total number of recep- tacles tor lunatics, whether public or private, amounted to fifty- one last December. Of thesi, seventeen were appropriated to patients of both sexes; fifteen to male, and nineteen to female inmates, exclusively. Again, thirty-two of the above admitted both pauper and private patients ; five only indigents; and fourteen received none but members of the middle, or those be- longing to the upper classes of society. Many of the above enumerated institutions are of limited ex- tent : since only eighr. contain from 1U0 to 150 inmates; whilst the population of not more than six actually exceed 200 patients. The largest establishment at present is JSt. Julien, in Bruges?if the insane colony of Gheel be excluded ; which latter locality can- not be classified comparatively,?seeing, the lunatics congre- gated in that district are distributed both in numerous private houses of the town, and amongst neighbouring villages, as 1 shall ‘ O O more particularly notice in the subsequent part of this com- munication.

Speaking generally, Belgium does not possess asylums placed upon the same footing as in France, and in many other European countries?where the direction, and also the management, are con- fided to agents appointed and paid by Government. In this part of the Continent, the institutions for lunatics, at present open, be- long either to hospitals, private individuals, or religious associa- tions ; who adminster them at their own risk and expense. These peculiar circumstances have created difficulties in carrying out some of the Commissioners’ late recommendations, made with a view to improvements ; and may in part explain why several old institutions still remain nearly in the same ‘ deplorable condi- tion” they exhibited, when the Commissioners, about three years ago, made their first official inspection, after being appointed by Government.

Throughout Belgium, whose present population verges on 4,520,000 inhabitants, there were very recently 4907 recognised lunatics, ?which hence gives a ratio of one insane patient to every 1)20 persons ; the proportion being, however, greatest in urban, and least in rural communes. The latest statistical cal- culation made, with reference to this point, shows that in most towns, the amount reached to one lunatic for every 470 residents, whereas, only one insane person was found amongst so many as 1368 inhabitants of rural districts. In regard to sex, thejnales preponderated ; their number being 2Go0?whilst only 22/ 7 were females : thus giving a difference of 1.3’50 per cent., or nearly one- seventh more male than female lunatics. This fact is interesting, since it proves, notwithstanding the greater tendency consideied to prevail, in most countries, of females to mental diseases, m Belgium, generally, the predisposition seems strongest^ amongst the?male part of its population. Of the 4,907 lunatics a >oe enumerated, 1,220 were classed as private patients, or pensioners , the rest being indigents, About one-third were deemed cura e cases ; the remainder comprised incurables.

By way of giving an outline of ‘the general movement w lie l characterized the insane population under treatment, during one year, in all the asylums of Belgium, that ot 1854 may be quo ec as instructive. During the period above named, 1309 new pa len s are reported to have been then admitted, ot whom 402 were c is charged cured, being exactly 30 per cent, on the admissions, whilst 421 died; which, therefore, makes the mortality ainoun to more than 32 per cent., and greater than the actual recoveries, when similarly calculated. This result cannot be reckoner as y any means satisfactory, and it also becomes certainly ( i cu o explanation. Amongst the 1309 new patients receivec in o ie different establishments, 1142 were cases who had never een previously insane, whilst 1G7 were reported relapses, mB making nearly one-eighth of the entire number.

Although impartial observers acknowledge that numerous ame liorations still require to be accomplished, in various e gian ,nb tutions for the insane,?both private and public, it is no ie e. . true, many important and useful improvements have )cen e ec ec since the permanent commission ol inspection wastiist appoin^ ci. These public authorities state in their last Repoit, amours o lcr facts which are gratifying, that “‘1 hanks to the changes mac e m the insane establishment of the Cellito I1 re res at Antweip , h’ospice at Duffel; the asylum for males in Louvain ; that ot i cnin , St. Nicolas, in East Flanders; Strop, near Ghent; as also it institution of Uccle and Evere, in the environs ot Brussels, u. number of inmates have increased in a proportion moie ot ess remarkable. On the contrary, those receptacles for lunatics which do not yet supply all desirable guarantees ot their gooc condition, will be inevitably abandoned.” The parties hero alluded to must soon comprehend their real interest; so that, in accordance with the dictates of humanity, beside future mate- rial prosperity, they will bo compelled to introduce those reforms the new laws prescribe, and which are likewise imperatively re- quired for the physical comfort of many afflicted inmates, now confined in several unlicensed establishments.

Unlike most other European capitals, Brussels possesses no public asylum for the permanent reception of lunatics; there be- ing only a small provisional depot attached to the civil hospital ot St. John, which is more like a prison than an insane receptacle, and where mad patients are temporarily confined, previous to their transference to other establishments; generally to Qheel or Bruges. When I visited this temporary domicile, it contained only ten inmates; some of whom had been merely placed within its precincts, prior to removal elsewhere. Indeed, only a few days afterwards, I recognised two of these identical patients at the provisional infirmary of Gheel, where they had been sent, preparatory to being placed with some authorized resident in that commune.

Indubitably, ample accommodation may be found, for insane members of the middle and upper classes, in the private ” maisons de sante,” near Brussels. For instance, in that of . penaeyer-Dupont, at Evere, containing, on an average, fifty- six inmates; or at the larger institution belonging to M. Vander- kindere, having upwards of eighty patients, which occupies an elevated, salubrious position, not far from the capital. Here, the general aspect, means of treating insane patients, and also various modern appliances, seemed very satisfactory when I visited the establishment. Again, should parties feel desirous of send- ing their relatives to new scenes or more distant localities, then, the excellent ” inaison de santd,” at Ans et Glain, near Li&ge, the property of M. Abry, and whose son-in-law is the resident physician, may be selected. The latter institution now specified occupies an admirable position, possesses an extensive yet beautiful prospect over the neighbouring city, as also the fertile valley of the Aleuse; and having personally examined this precinct and buildings?then containing sixty-five patients?I can speak favourably of its several capabilities. Notwithstanding such varied means for treating demented persons?not victims of poverty in addition to their mental diseases?still, the absolute want of n large public asylum for indigent lunatics, in such a populous locality as the metropolitan district, is remarkable ; particularly when readers remember that in the arrondissement of Brussels, con- taming a population of about 415,000, there are nearly GOO insane persons reputed natives, most ot whom now occupy asylums in other provinces. So great a desideratum requires some speedy remedy, for the sake of humanity, altogether irre- spective of other equally potent considerations.

Although the superior Administrative Board of existing Brus- sels Charitable Institutions have not yet come to any determina- tion respecting this deficient accommodation for lunatics within their own jurisdiction, that question has not been overlookec.

Indeed, various members of Council, the Inspectors of lunatics, and also the Provincial Governor, it is said, seem fully impresse with the great importance of constructing an asylum of t le rs rank, for receiving indigent patients, which shall in future o via ? any necessity of sending their insane poor elsewhere. ie ca^? urgent; anil however great might be the preliminary cxp^n which such an establishment must entail upon the Biussels hospital administration, it ultimately would prove mos >ene ficial, and relieve the city from all opprobrium of icing now obliged to solicit admission for their necessitous insane pa len s into the asylums of other districts. This deficiency oug i o be supplied, whereby the metropolitan province of la an shall no longer remain without having a public asylum, supp y ing adequate accommodation for the insane pool born on is soil; and who, therefore, possess the strongest claims o par ticipate in the benefits which such an establishment wou c disseminate. . , Considering the limited extent of Belgium, the aggrt ga c asylums for the insane it contains are much ?0,e. numerous than in almost any other European country, l he insti u ions are, however, generally of small size ; nay, many have on y rom ten to thirty inmates. The largest numbers are locatei in as and West Flanders ; the chief places being Ghent and luges, or in the immediate vicinity of these towns. Ot course, this re mar does not apply to the insane colony ot Gheel, which is si ua c in the eastern part of the province of Antwerp, not tar rom i s frontier towards the Rhine, and contains more lunatic pa ion s than any other district; but the inmates are there vuy’ i 1 er ently placed, being lodged with cottagers, peasants, am o lers not congregated together in a confined public asylum.

The above facts, and recent investigations respecting 10 nini her of lunatics under treatment in ^ different insane os a > is ments, besides those which still remain with relatives, piove la mental diseases are by no means of un frequent occurrence throughout Belgium; and, if compared with neighbouring king- doms, they appear even more numerous, ‘lhe ratio, as alieai y stated, amounts to one lunatic in every 920 inhabitants ; w nc 1, therefore, constitutes a higher proportion than in France, Ger- many, or England. The causes of this marked frequency ot insanity amongst Belgians, not being one of the objects proposed in these notes, 1 consequently only allude to the question, tiom considering it of much interest, and deserving farther discussion. Nevertheless, hereditary tendency to mental disease, the preva- lence of scrofula amongst the lower classes, their poor innutritious diet, frequently more vegetable than animal, weakened physical frames?too often caused by hard work, and privations in the labouring population?with the mixed or mongrel races which seem to characterize many natives of this country, must exert considerable influence, unquestionably. These peculiar features certainly attracted my special observation, when recently travel- ling through Belgium. In its large prisons?many of which wore inspected, in mendicity, or poor-houses, lunatic asylums, the churches?where crowded congregations then often assembled,?

at railway stations, and in market-places this occurred. Indeed, wherever numerous bodies of spectators got collected together, even casual observers could not avoid noticing the diversity of race, and outward physical aspect, which the populace around then supplied for ethnological meditation. The dark hair and swarthy features of Spain ; the blue eyes, light auburn locks, and true Saxon countenances ; the complexion, gait, and manner of genuine natives of France; and, lastly, the more staid, phlegmatic mental and bodily characteristics of Dutchmen, might be everywhere easily distinguished. In short, throughout 110 country of Europe, which I have ever visited, was the same difference of peoples so peculiarly observable, as seemed to prevail in the places under discussion.

Before describing the several public asylums which form the subject of subsequent remarks, it may be premised, with reference generally to Belgian establishments for the insane that, amongst the fifty-one asylums now open, three-fourths are situated in towns, or their immediate environs; while only about one-fourth occupy rural communes. From this cause, their precincts are often of very limited extent; and, consequently, such institutions become badly adapted for the treatment of lunatics. This remark particularly applies to Ghent, and likewise to Bruges; although to the latter city, less strongly. However, as in these districts the largest public asylums are situated, they therefore will form the chief subject of future observations. To notice small establish- ments, which contain very few inmates, would prove superfluous; consequently, I will at once proceed to describe the two rather extensive institutions for lunatics, located in the ancient and once powerful capital of West Flanders?namely, Bruges.

Preliminary, however, to commencing that undertaking, it seems desirable to give some outline of the features which most Belgian asylums exhibited very recently, in order to contrast their former state with the present No authority in reference to such matters can be considered so truly unexceptionable, and less liable to express exaggerated or unjust condemnation of the public asylums in Belgium, than a native of that kingdom; since his feelings would be naturally inclined to take an opposite direc- tion. A more trustworthy and also impartial judge cannot there- fore be found, or one better able to speak upon tfie subject with weight, than AL Guislain, who says, in his first lecture, ” Sur les Phonopathies,” published 18-32, “Lunatics in Belgium remain forgotten in sombre prisons. They resemble merchandize amongst speculators, who make them an object of infamous traffic, like animals from the farm-yard, fit only to be bought and sold, as horses or swine. Much talk has certainly taken place during the last thirty years ; but so little has yet been accomplished that our afflicted maniacs have been only turned round in a icious circle of selfish and fatal administrative influences. To show that asylums are now improved, I commence with those a Bruges.

In this formerly opulent city, and, several centuries ago, a great emporium of trade, with upwards of 150,000 in ><i >1 an but now reduced to less than one-third of that num jer, w 1 . its commerce is almost annihilated?there are at prcsen extensive institutions for treating lunatics namely, ? 11 > and St. Dominick. Having visited botli asylums early as k p tember, I therefore propose giving a brief account ot t le insp tion then undertaken. c , mnct

1. St. Julien Asylum.?This institution is one ot the most ancient establishments for receiving lunatics, thioug ion gium. It is situated in a wide, airy street, neai tierai 1 j station, close to the Porta Santa?one of the gates o rug and closely adjoining its ramparts. Being originally a com en , buildings are old, and some appeared not well adaptet or l present purpose. Still, considerable improvements in ie in i arrangements having been since effected, it is muc i ‘csor e ,. by patients of both sexes. According to tradition, us y formed a hostelry for pilgrims, so early as the seven i c y ? but it was not till about A.P. 1500, that insane pusons received within its precincts for protection anil ti catmen . taclied to the present lunatic institution ol St. Julien, am the same superintendence, two other?although muc i srn.i ?establishments, are also opened tor the treatment o perso afflicted with mental disease. One is that ot St. Anne, si ua t i in a healthy and agreeable district near Court ray ; the o lei being the Convent of Cortenbergh, lyiug between Brusse s am Louvain, in a very picturesque locality, celebrated for salu >n y. This house has been recently rebuilt, according to the appiovt < principles of modern architecture; but, being intended sole for the accommodation of female patients ot tho upper and middle classes, the number received is therefore very limited. Having thus three separate establishments?all under the same superior direction?the relatives of private patients may there- fore secure, if considered advisable, a change of residence, so that those who wish can then pass the winter ill town, and summer in the country.

When I visited St Julien?early last September, the total population of the chief institution, situated in Bruges, amounted to 310 lunatics; of whom 166 were male and 144 female inmates. Of these, half were tranquil patients, seventy-live agitated, thirty-eight epileptics, thirty idiots, and twelve wero then con- sidered convalescents. Amongst the whole, thirty were classified as dirty persons ; the sexes being nearly equal, in reference to that, particular feature. No female lunatic appeared in camisole, or undergoing any kind of bodily restraint whatever. However, one male patient was temporarily confined by a strait-waistcoat, whilst two men and one woman were in seclusion cells; all three being much agitated and very violent. The general population seemed tranquil, considering the number of inmates congregated in different divisions. Many females occupied themselves in lace- making, domestic employments, and in preparing or mending clothes for residents. A large number of male patients were engaged in agricultural work on the adjoining farm, which amounts to twenty acres, belonging to this institution ; as like- wise in the garden attached to the building for private male pensioners. These pay a larger sum for board than the indigent residents, and varies from 500 to 2500 francs annually ; whereas, the allowance received from communes, for pauper patients, amounts to only 75 centimes per diem?that is, 273 francs, or 11Z. annually ; which truly seems a very low remuneration for such inmates?feeding, lodging, and clothing included. Being in most parts an ancient structure, this asylum is not conveniently arranged. Theapartments are too crowded in several instances, and its buildings being sometimes very close together, there seemed not sufficient separation of several wards occupied by the different sexes. Nevertheless, much has been done to remedy existing defects; and considerable improvements are also in contemplation. The patients’ court-yards are four in number, some being, however, rather limited ; and there are, besides, three small gardens for inmates taking open-air exercise, with another of greater magnitude for pensioners, whose number amounted to forty-eight, comprising twenty-two females, and twenty-six male lunatics. Of these, several were, I understood, natives of Great Britain. Indeed, one was pointed out who had only recently arrived from the north of England.

Two physicians and one surgeon are attached to the St Julien Asylum, one of whom pays daily visits, or oftener, if necessary ; but there is no resident medical ofhcer. The chief authority and director is M. le Canon Maes, who has a lease of his pre- sent premises from the Mendicity Depot of Bruges. That reverend gentleman may be therefore considered the pioprietor. Ho is principal manager, takes all pecuniary risk upon himself, and must be at whatever expenses either improvements or alter- ations may entail. Those now essential are certainly considerable, in order to meet the requirements of constituted public authori- ties ; and, consequently, to render the interior more in unison with the present ideas entertained, regarding what seems proper treat- ment for lunatics.

Having been only provisionally licensed until the 1st of last April, on condition that various important changes, admitted by impartial parties as urgently required, were effected in its in- ternal arrangements, this institution remains at present without legal sanction ; and will continue, till the Committee of Inspec- tion’s suggestions are completed. Different propositions were made to arrive at a satisfactory solution, but, hitherto, every effort has proved unsuccessful. As the Communal Council of Bruges have not yet sanctioned any of the plans proposed, and as the admi- nistrators of hospital property, the Inspectors of lunatics, besides the parties interested pecuniarily in this establishment, all enter- tain very different opinions with reference to the questions in dispute, some time may yet elapse ere matters shall be arranged satisfactorily. This dilemma is much to be regretted, since the hospital of St. Julien has long been known as a useful institu- tion ; and if properly reorganized, whilst various admitted defects were removed, it would doubtless confer most useful benefits upon those unfortunate persons, for whose individual advan- tage it is destined. The anomalous position, in which this insti- tution is now placed, forms the subject of a special notice in the Committee of Inspection’s last Report, who think it cannot much longer exist as at present. The ameliorations demanded must be carried out efficiently, or the establishment will be shut up and suppressed. During the past year fifty-two new patients were admitted, thirty-two being male, and twenty female lunatics; twenty- seven left the asylum cured, of whom nine were male and eigh- teen female inmates, and thirty-three died ; the male patients in that category being twenty-one in number, with only twelve females. These figures hence show that insanity oftener affected male persons applying for relief at this institution, and fewer were discharged cured; whilst the proportion of deaths ranged higher amongst that sex, than those recorded in female patients. Such results, however, become less remarkable when it is known that two-thirds of the inmates were classed as incurable lunatics ; and in about one-third only was a slight hope entertained of ever doing much good, still less gave any prospect of recovery. In fact, the mental diseases of many being of long standing, their favourable termination consequently appeared utterly hopeless.

2. St. Dominiclc Asylum?This institution?like the former, also an ancient convent is situated in one of the streets of Bruges, and has been now appropriated for the treatment of insane patients upwards of half a century. Since 18Ml, the asylum has received considerable augmentations, in reference to accom- modation ; and, at the same time, various ameliorations have been effected m its interior arrangements. Nevertheless, from the buildings being defective?some of which appeared rather an- cient?and although several new constructions have been recently erected, this establishment is not considered well adapted as a resi- dence for private patients. Hence, the proprietors, who are five in number, have lately leased a chateau named ” St. Michel,” with a garden and farm of about 100 acres attached. This ” maison de sant^” is nearly two miles from Bruges, on the Court-ray road, and had, when 1 visited it, twenty-nine male pensioners, as also twenty convalescent patients of the indigent class, sent from the town establishment to labour in the fields; which work often materially promotes their ultimate recovery. The central asylum likewise receives, according to an arrangement with the Depart- ment of Justice, lunatics accused of crimes, and those who have been convicted by ordinary courts of law, or sent from various prisons. This criminal category forms a separate section, and quite distinct from other inmates ; whilst such parties are placed in courts or cells specially constructed, to prevent escape.

When I inspected St. Dominick, the population comprised 330 persons, consisting of J 82 male, and 118 female lunatics; amongst the latter sex eighteen being pensioner patients, belonging to the upper and middle classes. Besides these numbers, twenty-nine insane men, paying from oOO up to 3000 francs annually, with twenty indigent lunatics, occupied in agricultural labour, as pre- viously stated, were then lodged at St. Michel’s ; so that the total inmates of the united establishments under discussion, amounted to 37!) individuals. In the town department, the patients are divided into live categories; viz., 1st, convalescent; 2nd, tranquil lunatics; 3rd, agitated; 4th, turbulent; and 5th, idiots, with dirty inmates. The same classification being adopted in both sexes throughout.

Again in reference to the nature of their mental maladies, ac- cording to information supplied to my inquiries, it appears twenty- one were epileptics, ten being mules and ten females; twenty- eight men and twenty-six women were classed as dirty patients ; thirty males and twenty-eight females as agitated ; whilst only two male and one female inmates were said to be paralytic. I he remainder being all reported tranquil lunatics ; a large propor- tion of whom consisted, as elsewhere, of chronic cases, aud con- sidered incurable. The buildings comprised twelve court-yards, six being appropriated for male, and six for female residents , the agitated, and those requiring more surveillance than the rest, occupying very properly the central portion.

Some dormitories contained forty beds, others only fifteen, but all appeared clean, and also comfortable: particularly, when it is remembered the inmates were chiefly of the pauper class. The sleeping chambers for dirty patients were uniformly single-bedded, well ventilated, entirely free from any offensive odour, and seemed really much better than I have occasionally observed in other countries, for that class of lunatics. The general aspect of the asylum appeared most satisfactory : both male and female residents being also neatly and properly clothed; whilst the physical health of all was reported particularly good. No female amongst the entire population being sick or in bed ; and only one male invalid, slightly indisposed from bodily disease, occupied the infirmary, along with a soldier, almost convalescent, from an attack of intermittent fever he had caught when in garrison at Newport; where that malady proved, as usual, very prevalent during the recent summer, and of which he had become the victim, besides labouring under severe mental disease. Five female patients were confined in camisoles?but free, and walking about in the agitated court-yard ; another being in temporary seclusion. No male lunatic was in anyway physically restrained, although two ex- cited maniacs occupied seclusion cells, having become very excited and violent. However, this proceeding would not likely be of long continuance, and merely till they got more tranquil. If not entirely abolished, restraint is now as little employed as possible ; the general opinions respecting camisoles, and their utility, beiug much the same in this country as in France. Further, in the cases now mentioned, the strait-waiscoat was not tightly, but loosely put on : a.great object being, apparently, to prevent the patient from injuring either others or themselves; and chiefly to confine such parties’ hands, so as thus to disable them from tearing their clothes, or so forth. Notwithstanding the number of agitated patients, the appearance of the entire population seemed that of quietude. The females everywhere were certainly more noisy and talkative, than the male inmates. But comparing this estab- lishment with analogous collections of insane residents through- out France, there prevailed much less violence and excitement than I have often observed in that country, when visiting similar institutions.

Occupying and amusing the lunatics always constitute a prin- cipal object in the treatment pursued. Many male patients are consequently employed as tailors, weavers, spinners, and in other employments; besides numbers also in tho gardens, or at agricul- tural labour. One interesting and peculiar feature deserves how- ever special notice?namely, the numerous former patients who have now become assistants, or ” aides infirmiers,” in the different wards: of whom, not less than thirty male lunatics of this description are so inscribed, according to a recent statement.

Amongst female patients, the same system is pursued ; henco, not less than sixteen were also registered as assistants, on their own side of the institution. INCLUDING THE INSANE COLONY OF GHEIiL. Go Numbers were likewise engaged in the laundry, knitting stockings, making clothes, for other patients, as also in the kitchen; whilst all the bread consumed in this large establish- ment being made on the premises, the bakehouse therefore forms no inconsiderable means of employment to inmates. According to present opinions entertained by the executive authorities of this asylum, physical labour, as a means of distraction, exercises often most beneficial influences upon the mental condition of lunatics; , consequently, it is always very zealously promoted. Neverthe- less, no person is ever forced to labour, either through moral or physical restraint; that object being always attempted by the aid of example, or the desire of gain in those who are induced to work, and by granting small favours, with additional indulgences to the most industrious. Amusements and recreations are likewise assi- duously promoted. Card-playing, draughts, dominoes, billiards, and gymnastics being very often resorted to as favourite sources of enjoyment.

The medical staff of this asylum consists of a chief physician, Dr Van Hecke?well known as an experienced practitioner, resident in Bruges,?with two’ assistant physicians, and one con- sulting surgeon ; while the lay officials comprise a director and secretary, besides an almoner. By way of conveying some defi- nite idea of the number of persons employed, and hence actually required in- managing such an extensive establishment as that of St. Dominick?containing always upwards of 300 lunatic inmates?it may be interesting to mention that, on the male side, besides the chief overseer, there are constantly twelve attendants, of whom nine superintend the workshops and garden, with six as- sistants,and six sub-assistants; irrespective of various convalescent patients, who also give their services in different departments. On the female side, in addition to the lady-superior, who over- looks all the others, there are thirteen religious sisters of the order of St. Dominick. These superintend the different wards, one in each, as also the clothing department, the kitchen, the laundry, the work-rooms, and dining-hall. The above sisters have, besides four head domestics, an unlimited number of female servants, taken from convalescent patients, upon a similar plan to that pursued in the male department. Not being permitted, by superior authority, to have ” sceurs and fr^res rcligieux ” in the same institution, all the attendants on indigent male patients consist of laymen. However, at the succursal asylum of St. Michel, where only male inmates are admitted, six religious brothers, with four lay-domestics, placed under the superintendence of a clergj’man, manage the establishment; whilst a physician?Dr. Beckman?living in the neighbourhood, takes charge of all medical treatment and professional surveillance.

In order to obtain well qualified lay-attendants, and in suffi- cient number, when convalescent patients exhibit an aptitude, or express any wish to become regular domestics in this asylum, rather than leave, such parties are first placed on the list of can- didates ; when they obtain a particular dress, assigned by way of distinction. After fully proving their fitness for office, and so soon as a vacancy occurs, they are then installed as effective attendants. The above system has hitherto answered admirably; most of the present male servants employed at St. Dominick having been formerly patients. It is hence specially mentioned as worthy of trial, and if approved, for adoption elsewhere; since nothing is confessedly more difficult than to obtain good attendants oil the insane; whereas, the result here has proved quite otherwise. One feature at this institution also deserves special mention, ?namely, the excellent medical register at present kept of all cases admitted. Such proceeding, certainly, is only in accordance with the recent law; but as similar documents seemed not inva- riably forthcoming elsewhere, and, I fear, do not always even exist in the form required, more credit is therefore due to Dr. Van Hecke, for the manner in which these valuable memoranda are officially preserved. I looked over several, and found records of symptoms, and treatmeht; besides post-mortem, reports, which were most interesting. This repertorium of facts is already large: and doubtless will every year become more valuable to the prac- tical physician, as likewise to zealous psychological pathologists. Although not of much apparent significance, nevertheless, as it shows the great attention paid, even to minute matters of detail, a very recent improvement, or rather an important addition, which has been made to the male wards of St. Dominick, deserves being specially mentioned. Spittoons are now placed in such apartments, particularly those occupied by dirty patients. In this country, where almost every man and boy, nay, even women, seem slaves to that degrading, filthy custom, and health-destroying ?both of body and mind?abomination, Tobacco-smohiny, these appendages become absolutely essential throughout any inhabited dwelling, whether for sane people or maniacs. There- fore, irrespective of sanatory considerations, as most lunatics, by thus placing such saliva recipients within easy reach, may be taught to usm them, instead of soiling floors or walls with their offensive spittings, internal discipline thereby becomes materially promoted. I am no advocate of smoking; on the contrary, would strongly condemn such an unseemly habit?or vice, more correctly speaking?from believing it proves both injurious to the mental faculties, and inimical to the physical powers of many votaries. Nevertheless, if mankind will obstinately use this dele- terious weed, assuredly the most excusable proselytes are lunatics. Therefore, spittoons ought always to he placed in every similar institution where smoking is permitted.

During the past year, 100 new patients were admitted into both establishments ; sixty-one being male, and thirty-nine fe- male lunatics. The total cures amounted to forty-four cases, of whom thirty-three were male, and eleven female inmates; while thirty-six deaths were recorded, twenty-three being of male, and thirteen female residents. It thus appears that the ratio of recoveries wasforty-four, and the deaths thirty-six per cent.; when both results be calculated, according to actual admissions. > More fatal cases occurred during June, October, and February, than throughout any other months of last year; whereas, the fewest happened in May, August, and December. The total number of persons who passed through the infirmary in the course of twelve months, from being attacked by bodily disease, was seventy-nine, of whom thirty-six died, as already stated, and thirty-eight reco- vered; thereby leaving five patients inmates of that department on the 1st of January; thus showing that physical disease pre- vailed here much more frequently throughout the former, than during the present season.

Having stated in a previous paragraph that the strait-waistcoat and personal restraint are not yet entirely laid aside at the St. Dominick Asylum, it may be now mentioned as instructive, and also further to illustrate the above important question, bearing upon the treatment of lunatics, that in this institution, where usually about fourteen to every 100 inmates appear agitated patients, the cases are but rare for which the medical officer feels obliged to institute coercive measures; seeing, cellular isolation generally proves sufficient. When bodily restraint is actually used, the camisole, or leathern bracelet, are the only means em- ployed ; and then chiefly in suicidal persons, and excited eroto- maniacs. With reference to the application of physical coercion, such as those just mentioned, it was reported by Dr Van Hecke, that amongst 377 lunatics under treatment, during the entire year, eighteen male and twenty-four female patients were subjected to cellular repression ; which, therefore, represents a totality of fifty-four days. Further, eight men and ten women were confined by strait-waistcoats; whilst twelve male and sixteen female lunatics temporarily wore leathern bracelets. Lastly, eleven pa- tients had been put in camisole, during two to four days con- secutively, besides seven others for a much longer period. These authentic and official reports, showing the actual employment of personal restraint at this asylum, would be considered excessive in England, or altogether unnecessary, if not reprehensible. Still, it should be remembered that, throughout various con- tinental countries, the application of camisoles, in furious or dangerous maniacs, becomes not only justified by several con- scientious and experienced practitioners, but then even strongly defended from being, according to their opinion, both beneficial in repressive results under the above circumstances, and likewise proves often humane in its judicious application.

Ghent.

Another district where numerous lunatics are at present con- gregated, in different asylums, is the ancient city whose name has been given above. Within this populous locality?now designated the modern Manchester of Belgium?having upwards of 100,000 inhabitants, but formerly nearly double that amount, and de- serving special notice by travellers on account of its historical reminiscences, valuable pictures, and venerable buildings, there are, besides two large public establishments for lunatics of each sex, the Hospice of “St. Jean de Dieu”?although actually of very limited extent; next, two small asylums attached to the great and little Bdguinage; then, the ” Maison de Santd” for females in Rue d’Assaut; and, lastly, that known as the ” Strop,” which is situated 011 a rising ground, not very far from one of the gates of Ghent, but where only male patients belonging to the middle and upper classes are received. These seven establishments generally con- tain about (130 insane residents, upon an average; the majority being female lunatics. Before adverting to different institutions in Ghent, besides the fact that, a greater number of female compared with male lunatics are enumerated, it is important to add as an authentic observa- tion that, mental diseases seem exceedingly common amongst its general population. Thus, M. Guislain says, there is one lunatic to every 302 inhabitants, which constitutes, therefore, an enormous ?proportion ; indeed,much greater than in either Germany, France, or England, and altogether unique. Without attempting now to explain this remarkable circumstance, however singular it appears, I at once proceed to consider?

1. The Asylum for Males.?This public institution is situated almost in the centre of Ghent, having a sluggish canal on one side and adjoining a broad street of considerable traffic on the other. It is quite close to the ” Hotel de Flandre,” where I happened to take up my quarters. As the principal entrance can be only approached by a narrow lane, visitors may hence easily pass its antique gateway unobserved ; which actually happened to myself, when first endeavouring to find the venerable-looking porta! whereby I gained admittance. The building now appropriated for receiving male indigent lunatics was an ancient Alexieu convent, constructed some centuries ago. This seems proved by its very old chapel, where the insane residents still assemble for divine worship, and which really deserves inspection by anti- quarians, or any curious archa3ological amateur.

This entire property belongs to the city: and in everything appertaining to its administration, is represented by a Commis- sion of the Civil Hospitals. Having been condemned by com- petent authorities, and likewise by public opinion, as wholly unfit for the reception of lunatics, any opinion in reference to many defects seems, therefore, supererogatory. However, I would only further remark, after quoting an observation of one of its own able officers, who says in a recent publication, ” The whole structure offers an accumulation of arrangements the most deplorable/’ that whenever the truly magnificent institution for male patients, now erecting near the Bruges gate, in one of the city faubourgs, is completed, this antiquated building will be closed as a lunatic asylum, and appropriated for other purposes ; one of which, report states, being a barrack for lodging the local fire brigade. But happen what may, the sooner every insane resident now confined within the precincts of this venerable convent gets removed to the new asylum, so much the better ; as, then, all sombre recollections of this melancholy abode will at least have become matters of history, if they be not forgotten, by the present generation. Being only kept open as an asylum until the new institu- tion is ready to receive its present inmates, to make any remarks regarding the accommodation now supplied appears out of place and superfluous; therefore, without adverting to such questions, I would observe that, at the period of my visit to this receptacle, the total insane male lunatics amounted to 260 ; amongst whom 30 were epileptics, 21 agitated, and 16 dirty patients. All were in- digents, excepting 45, who paid a moderate board; but even these did not, however, belong to the superior classes of society; every ‘ inmate of that category being now placed at the ” Maison de Santd” of Strop, which is, although separate, still under the same management. The general health of residents was reported, on the whole, as satisfactory. Not more than twelve patients were sick in bed, whose physical diseases seemed of a mild description, and none suffered from any serious malady. One lunatic was in camisole, while another wore leather gloves, to prevent him tear- ing his own clothes. These were the only persons under bodily restraint; hence, speaking generally, the whole establishment ex- hibited a tranquil aspect, including the quarter appropriated to agitated and furious patients.

.Respecting the causes of insanity in patients recently admitted, moral influences were reported the most frequent. Drunken- ness being likewise often assigned. Dissipation, with misconduct, produced madness in several instances; and lastly, hereditary predisposition seemed to have existed in about one-third the total admissions. This transmissibility of mental diseases was, however, proved to prevail, in a greater ratio, from father to son, than from mother to her male offspring; thereby showing that, here as elsewhere, insanity oftener descended through the same sex than the opposite. Indeed, it was confidently said, grand- fathers more likely transmit mental complaints than the grand- mother to descendants.

In one of the court-yards visited, about twenty idiot boys were assembled, who seemed, on our entering, going through mili- tary evolutions, under the directions of a fugle-man. This occu- pation was encouraged both for physical exercise, as also to endeavour, if possible, to excite their mental faculties by making them keep the step when marching, and further to awaken atten- tion, during various bodily manoeuvres. Afterwards, the poor little fellows cheerfully sung a hymn, then performed some gymnastic exercises: and, notwithstanding the darkened state of their intel- lects, besides being confined in this small area, which constituted almost the sole outer world they knew, they appeared healthy, looked contented, and even happy, in spite of many mental, as likewise material, privations.

Another commendable feature should likewise be here men- tioned?namely, that music, both vocal and instrumental, is much cultivated in this abode of affliction. The reverend almoner zealously promotes such sources of gratification, in which he is greatly aided by the assistant physician; besides various frh’es belonging to the establishment, who are often performers. These musical reunions are, however, encouraged more as recreations than like any scholastic instruction. A worthy frbre plays on the piano, another on a bass fiddle, the clarionet, and so forth, whilst others, and patients, join in chorus. The evening previous to my visit, one of these much-appreciated musical parties had assembled, whereof ample evidence appeared in the large hall, into which I was shown next morning, prior to visiting the various dormitories; since various musical instruments, and other appurtenances used, during the fete, were still remaining in that apartment.

During the past year, sixty-two new patients were admitted, nineteen discharged cured, and twenty-eight died : which results show that, the proportion of deaths was even more numerous than actual recoveries. Amongst the cases terminating fatally, fifteen were reported as labouring under dementia, six had general paralysis, four were examples of mania, and the remaining threo died from less defined varieties of mental disease. With regard to seasons, in reference to admissions, cures, and deaths, according to the experience of past years, it appears that, more patients were usually admitted during warm weather; as, for instance, in the months of May, June, and July. The largest number of cures being reported within six months after the patients’ admission ; whilst the deaths proved most numerous during the cold, or first months of each year. Again, respecting suicides, it may be men- tioned as highly interesting that, from 1816 to 1852 inclusive, only eight cases of self-murder occurred among the whole male lunatics of this establishment. Such results may be partly explained by the fact that, great vigilance is constantly exercised, on the at- tendants’ part, towards suspected suicidal patients, who are never left alone, but always associate with the other inmates. During day-time, that class of maniacs remain constantly under surveil- lance ; and at night they sleep always in a dormitory surrounded by other lunatics, capable of watching over their conduct. Lastly, in the worst cases of that description, one religious brother belong- ing to this establishment occupies a bed adjoining the suspected individual, so as to notice every suspicious movement, and thus be ready for any emergency which may supervene.

The medical staff consists of one physician?the eminent M. Guislain?a consulting surgeon, and an assistant physician; but none of these officers reside on the premises. However, when the patients are removed to the new Asylum, a resident physician will be installed. The whole attendants are male persons ; and consist of twenty-two religious brothers, four domestics, with four assistants : thus making, altogether, thirty individuals to super- intend 2(50 lunatics?viz., one to every nine patients. Over these, a resident director presides, who is a clergyman, and takes the chief management. There is, besides, an almoner; the entire establishment being administered under the supreme direction of the City Hospital Commission. That body has constantly endeavoured, it is only just to observe on the present occasion, to do everything in their power to diminish the admitted insalu- brity of this locality; and have, further, seldom been deterred from making any reasonable sacrifice to attain that result, or to promote the comfort of residents; whilst the zeal and talent of M. Guislain appear constantly exerted towards promoting other objects equally benevolent.

2. Asylum for Females.?The establishment which now comes under review is situated not far from the ancient Asylum for male patients just described. It lies in the same quarter of Ghent, being close to the street and canal already mentioned? having only intervening the large buildings, at present occupied as the College of Jesuits. According to an inscription still visible on a stone placed over the antiquated gateway, the year 1605 is stated to be the date of its foundation. The present structure was erected by the magistracy of Ghent, upon ground formerly consti- tuting part of the ancient ramparts, but which now forms almost the centre of the modern city, Being surrounded by streets, many private houses, besides public buildings, and Laving a large factory close to its very ontrance?the noise of whose revolving machinery never ceases during day-time?the outward condition of this Asylum seems by no means favourable. In the interior, with reference to the actual number of its inmates, sufficient space appears wanting for the existing population. Hence, it is only through various ingenious combinations, carried forward by the constant zeal of managing au- thorities, that this institution has been made convenient, or able to contain comfortably its numerous residents under treatment.

Like the establishment for males, it receives lunatics of the in- digent classes belonging to Ghent; and likewise, by special per- mission, patients from other districts. The property belongs to the Civil Hospitals’ Commission, and is managed under their administration. Although greatly superior to the male depart- ment in many attributes, nevertheless, impartial observers can- not but agree in the expressed opinion of several officials, that a time not distant must arrive, when some new locality will have to be chosen, and another structure erected, for the reception ot indigent females; much of the same description as the building now in course of construction for pauper male lunatics. In the meantime, however, this institution continues to render impor- tant services to suffering humanity, being distinguished by the order, as also cleanliness everywhere prevalent, besides the caro and attention exhibited towards patients, lo carry out these important objects more effectually, the administration propose to add an adjoining house to the present accommodation ; so that several further ameliorations may be accomplished, which cannot be now fully realized, in consequence oi the limited space pos- sessed, and from other existing inconveniences.

When perambulating the different dormitories, court-yards, and other appurtenances of this Asylum, although some appeared rather of a limited extent?owing to the nature ot its ancient buildings, and confined interior precincts?the cleanliness, excel- lent ventilation, general tranquillity, and good order which pre- vailed throughout, were very gratifying to behold. Much atten- tion appeared given to keep the various wards always thoroughly ventilated. This becamo the moro necessary, although it was attended with greater difficulty in effecting, seeing apparatus hail to be applied to an anciently constructed domicile like the present. ^1. Guislain has especially undertaken this very responsible task; and, judging from various effects already produced, by tho machinery employed for that purpose, as likewise the absenco oi all unpleasant odours, when passing through different apartments at an early hour, visitors might conclude on such evidence that these hygienic operations have proved successful. Consequently, critics may fairly say tliat one step in advance had been rr.ade towards solving the much disputed problem?Can efficient ven- tilation be ever really accomplished ?

Throughout, the wards looked very clean, the inmates tranquil, well clothed, and apparently contented. In one apartment I saw about 120 patients at work, many being then engaged in lace-making, which seemed to me of much better quality, if not finer, than that made by ordinary sane persons. Indeed, report states, the article manufactured in this establishment is highly esteemed, from its unusual cleanness and beautiful texture; these qualities being particularly noticed in a lace veil lately presented to H.11.H. the Duchess of Brabant. Subsequently, a large party were noticed at dinner, who then conducted themselves quietly, the same as ordinary persons, and really behaved very like rational creatures. In another apartment, upwards of a dozen young females?all idiots or imbeciles?were assembled at their singing-lesson, under the tuition of a zealous “sister.” These poor girls sung delightfully, accompanied by their teacher on the piano, which made quite a musical treat; and as several juvenile performers were blind or dumb, while their execution hence seemed more surprising, this unexpected performance by intellectually bedimmed and unfortunate fellow-creatures caused us greater gratification. Many inmates seemed helpless from physical infirmities; but, considering their previous position in the external world, they now lived comparatively more comfortable. The number of resident lunatics under treatment, on the day of my visit, amounted to 26i) altogether, of whom 201 were considered incurables, and twenty-five as doubtful, in reference to any prospect of ultimate recovery ; the remainder being classed as curable or recent cases. The agitated patients were reported at fifty; the epileptics comprised forty-seven examples ; whilst the dirty furnished thirty instances. No person was under restraint of any kind whatever, nor in seclusion. Indeed, it may be added that, physical coercion in any form is very seldom employed at this establishment; the great objects con- stantly kept in view being to amuse and occupy the inmates, whereby tranquillity becomes promoted, at the same time that such means tend to improve their mental condition.

About half the entire population are usually engaged in some kind of employment Many zealously spend hours in lace- making?the common occupation of females in this part of Flan- ders. Numbers work as mantua-makers; others in the laundry, and at wool-picking; besides a large proportion who attend to household and domestic duties; as, also, knitting stockings, or in making and mending clothes ; of which the amount annually accomplished is considerable. It must however be added, that M. Guislain does not consider the quantity of work done as always an unerring criterion of its utility. He even objects to any excessive development of physical labour in confined apartments, or close workshops, as thus imparting to the establishment an aspect of being a factory, a prison, or like ordinary depots of men- dicity. Further, M. Guislain thinks, unless the occupation chosen is carried out with discernment and caution, it may aggravate a lunatic’s malady ; whilst bodily labour which is severe, fatiguing, or too long continued, may do much harm; nay, even render the mental disease incurable.

During the past year seventy-seven new patieuts were ad- mitted, and sixteen discharged cured, the deaths reported being thirty-two ; thereby showing that recoveries were few, and fatal cases numerous. Amongst the latter, nine were cases of demen- tia, seven melancholia, and four general paralysis ; the rest being mania and other varieties. Viewed with reference to the chief pathological phenomena observed, chest diseases were most numerous, affections of the abdominal viscera followed next, whilst the cerebral and nervous system supplied the fewest fatal illustrations.

Somewhat analogous to the experience observed amongst male patients, in reference to particular causes producing insanity, it may be also said that, moral influences were frequently reported, of which anxiety, chagrin, family misfortunes, devotion, and reli- gious exaltation, seemed the most common ; whereas the abuse of intoxicating liquors was very rarely observed. On the other hand, affections of the sexual organs, and disordered catamenia, not unfrequently appeared to have been a marked exciting cause of mental disease amongst female inmates.

Similar to the asylum for males, the medical staff at this insti- tution consists of one attending physician, M. Guislain?its pre- siding genius?one consulting surgeon, and Dr Vermeulen, the assistant physician ; all being non-resident. Besides tho ” Sceur Supdrieure ” there are also thirty-one Sisters of Charity ; of whom one is secretary, another music-mistress, while others are teachers of various departments, and chief superintendents; as also in other capacities, throughout different wards. To these, ten lay-female servants, with seven assistants, must be added ; thus making altogether forty-eight actual attendants for 261) patients, or one to every six lunatic inmates.

Irrespective of tho ordinary officials now enumerated, usually three male domestics belong to this establishment, who act as porters, messengers, and in out-door employments. Such appen- dages become absolutely necessary, when readers are informed, Ao “sceur religieuse” attached to the institution ever goes beyond its threshold; that being contrary to her sacred vows.

To these estimable females external society is closed for ever. Niglit and day must be wholly spent in assisting afflicted fellow- creatures. They sleep constantly on straw, and are devoid of all toilet luxuries; frequently fast, and pass much time in prayer, both late and early, at all seasons; yea, even when others are sound asleep. In truth, their whole existence seems a life of devotion and virtual self-sacrifice, which they here dedicate entirely to alleviate the sufferings of those insane persons who have come under surveillance. With reference to such sisters, one important feature should be further stated?viz., all rise regu- larly at 3”o0 A.M., notwithstanding they were previously out of bed to assist at early religious duties in chapel, and although perhaps called up during night-time, to visit patients on emer- gencies. Many of the above enthusiastically unselfish ladies are persons of family, who have retired from the outer world with its varied allurements, so as to employ their mental energies and physical strength in attending upon the sick and unfortunate, without any prospect of fee or reward, on this side the grave. Nay, ” scours” of the class described will frequently undergo pri- vations, in order to assist others when required; and some will also contentedly injure present health, or peril life, in the great cause of benevolence, while aiding frail humanity.

Adjoining this establishment, but quite distinct in respect of all domestic arrangements, yet still under the same board of management, a ” Maison de Sante” is attached, which has an entrance in the adjacent ” Rue d’Assaut.” This female precinct is exclusively appropriated for the reception of private insane patients, who pay from GOO to 3000 francs annually. The house in which they lodge is a large, commodious, and well-furnished mansion, having in front one small, although rather pretty garden. When I visited this department the number of inmates amounted to sixty lunatics, with fourteen Sisters of Charity, seven female servants, and two assistants. Thus making, altogether, eighty-two persons living within its enclosure; and hence, giving the propor- tion of one sane to nearly every three insane residents. M. Guis- lain is superintending physician, while the same assistant also officiates who is attached to the asylum for indigents. 3. The Strop ” Maison de Saute.”?Another establishment must likewise be noticed, although briefly, in connexion with the institutions for insane patients, located in or near Ghent, and to which M. Guislain is the attending physician, besides being further under the same directing management as the preceding. This asylum occupies an elevation not far from one of the city gates, is well ventilated, and has been constructed in an apparently salu- brious locality. When I visited the institution, various build- ings were in course of construction, including a new kitchen, and dormitory for dirty patients, in order thereby to afford additional accommodation. There is also a rather pretty garden attached.

Still, to my apprehension, the whole enclosure then seemed too limited in extent for its present large population. Fifty patients were under treatment, all being of the upper and middle classes of society. The payments for board vary from GOO to 3000 francs annually; but sometimes beyond that sum, and even up to 6000 is paid, when any inmate requires a “fr&re” as his exclu- sive attendant, with also one or two apartments.

The head authority, or chief manager of this establishment is a clergyman, designated ” Le ph*e supfrieur.” Besides having several lay-servants, for menial occupations, he has also under his direction twenty “frh’cs religieux,” attached to an order whose denomination has escaped my remembrance. These offi- cials overlook the various departments, and perform different assigned duties. In fact, they constitute the only attendants upon the patients ; no female being ever permitted to remain within the forbidden precincts?to them?of this ” sanctum insanoram.”

Moreover, unless in reference to medical treatment, with its chief direction, the whole internal management and discipline of this in- stitution remains specially subjected to clerical superintendence. During the past year, sixteen new patients were admitted, and seven discharged cured, while six deaths were reported. Hence, here as elsewhere, the ratio of recoveries proved small, and that ol deaths large; when their several proportions are calculated according to the number of admissions.

4. The New Asylum.?Before taking leave of Ghent, and its insane establishments, some brief remarks respecting the largo public asylum now constructing for indigent male lunatics, will neither seem out of place nor uninteresting. The locality chosen is situated at a short distance beyond the Bruges-gate, and occupies an agreeable, open position, not overlooked by any other buildings ; while otherwise it appears well selected for the pur- pose proposed. The structure is palatial-looking, has the form ot a horse-shoe, rises two stories high, with various collateral appen- dages; and lastly, an elegant chapel will occupy its centre. The original plan and general programme was traced by M. Ouislain ; wholesales being an eminent physician and zealous cultivator o science, is likewise an excellent practical engineer and archi- tect. Hie execution and final completion of the entire building las been entrusted to M. Pauli, well known in Belgium as a man ot talent; and may be, it is confidently expected, ready for the ^?V0l? l^ien^s about eighteen months hence, or early in o , w len t leie will exist altogether accommodation for 300 insane residents.

Ihe erection of this public institution virtually constitutes a new era in Belgium, witli reference to the management of luna- tics; being the first receptacle of the kind in this country ex- pressly constructed for their reception. It is likewise an eloquent manifestation of the great progress which has recently taken place in public opinion, respecting the objects to be kept constantly in view, wherever insane persons are brought together, for the pur- pose of treatment and protection. The new building, when finished, must further serve as a model for other establishments of the same description, which cannot fail to be constructed, before any long period elapses, in various Belgian provinces, now wholly devoid of such accommodation. Lastly, it is likely to become one of the most remarkable institutions throughout Europe, appropriated solely as an asylum for the insane.

The hospital administration of Ghent and general Government have both contributed towards the expenses incurred, which must amount to nearly a million of francs, before the whole structure is finished. But the money will be well expended, although hyper- critics may likely say that too much has been laid out on its external embellishments, ^ornamented turret-looking chimneys, and minutely indented cornices. Such parties ought, however, to recollect that, being the first public asylum erected under government sanction, if it attracts more attention and discussion, even upon similar points, so much the better. Nay, should de- tractors object” to place paupers in palaces,” which might be most justly said, occurs in the present instance, other provinces can avoid committing a similar error, in regard to future analogous establishments, by attending chiefly to internal arrangements. Judging from the portion already finished, the entire construc- tion will certainly prove very fine and imposing. The dormito- ries are not too large, or intended to contain so many inmates, as numerous similar apartments often seen on the Continent. They are lofty, spacious, and properly ventilated; having win- dows of greater magnitude than ordinary. Nowhere, unless at the new asylum of Auxerre, in France, have the sleeping rooms pleased me so much as those I noticed at this institution. Indeed, altogether, they appeared of a very superior description.

Amongst many excellences which characterize its general features, in my opinion, the court intended for agitated patients is an exception, from not seeming well adapted for the purpose proposed. Being placed outside the round portion of this horse- shoe-figured building, it wilt thus be more difficult to exercise constant surveillance over numerous excited inmates, than in square enclosures. A greater number of attendants will hence be required ; while one, at least, must always station himself near the central concave part of the outer encircling wall, in order to overlook, at the same time, as large a portion as possible of this really extensive enclosure. Still, that arrangement cannot re- move the above objection; consequently, either more assistants will become necessary, or the space now intended for one must ultimately form two divisions.

Irrespective, however, of so very minor a fault in detail, and, perhaps, some other objections equally unimportant, there is yet no question regarding the undoubted superiority of this new construction, in every essential feature, over all previous asylums, appropriated for receiving lunatic patients, throughout Belgium. It cannot otherwise prove than of inestimable value to the afflicted insane poor of that country, and reflects great credit on the Government who promoted, as also those provinces con- tributing towards raising such an elegant structure. But to no person whatever will honour be more deservedly due than to M. Guislain?the original projector, who continues most zealous in his endeavours to ensure its perfectand final completicn. Hjnce, the edifice should be named L’Asile Guislain.” (To be conti med.)

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