The Care and Cure of the Insane
331 REVIEWS.
- Author:
Mortimer Granville,
M.D., F.S.S. London: Hardvvicke & Bogue, Piccadilly.
The volumes before us are the result of a commission appointed by the Lancet to examine and report on the con- dition of asylums. As far as the appointment of this commission by the Lancet is concerned, we feel that we are only expressing the opinion of asylum proprietors and superintendents by stating that it was quite uncalled for. We have our Board of Commissioners, who sufficiently inspect our asylums and publish their reports thereon, and we are decidedly opposed to personal interference, even by a commission appointed by the Lancet. Notwithstanding this, we nevertheless welcome a most interest- ing and valuable work by Dr Mortimer Granville, on the Care and Cure of the Insane, founded as the result of this com- mission.
The presumed institution of the inquiry appears to be as follows:? 1st. To ascertain the general character and efficiency of the provisions made for the insane in asylums, and the condition of their daily life. 2nd. To discover the measures, and, as far as may be possible, to formulate the system of treatment adopted for the cure of remediable or recent cases, and the relief of incurable or chronic cases. 3rd. To collect and collate statistics of cases occurring “within the last ten years at the asylums visited, with a view to estimate the results. The first volume contains a list of the asylums visited, com- prising Brookwood, Hanwell, Colney Hatch, W andsworth, City of London, Caterham, Leavesden, Bethlehem, and St. Luke s. Dr Granville judiciously divides his report on each asylum as follows:? 1st. House and arrangements. 2nd. Treatment. 3rd. Eesults. 4th. Digest of official papers, reports, and general retrospect. It is not our intention to go fully into the description of each of these individual asylums, for it must be carefully perused to be properly understood. The account is a most complete one and carefully drawn up.
The new County Asylum at Brookwood is very highly spoken of. We read ” The visitor to Brookwood will be strongly impressed by its simple and homely characteristics. There is nothing prison-like or poor-law stricken in the exterior. No high walls, massive casements, gloomy iron bars, or other tokens of restraint, inspire repugnance.”
Again, ” The surrounding objects divert, as far as possible, the mind of the patient from that self-consciousness which con- stitutes one of the most formidable obstacles to recovery in curable cases, and is the severest sorrow of the confirmed lunatic’s dreary existence.” Some of the older asylums referred to, we are told, resemble gaols. We thus read of Hanwell: ” The Middlesex County Asylum, at Hanwell, offers a marked contrast to the edifice described in our last report in referring to Brookwood. It is a vast straggling building, in which the characteristics of a prison, a self-advertising charitable institution, and some am- bitious piece of pooi-law architecture, struggle for prominence.” Of course, asylums, like everything else, will improve as civilisation advances, and it is not to be supposed that an edifice that has existed for many years can compete in construction with one but lately erected. Stress is, however, laid upon one point connected with Hanwell?the uniform of the attendants. We agree with the opinion of the author that this should be changed simply for appearance sake. At present it resembles that of a warder of a gaoj. We read, “The Committee of Visitors are doing much to improve the conditions of life at Hanwell. It seems strange that so startling an error as the persistent use of this warder-like uniform has not long ago been remedied. e trust the Justices will take the matter into their serious consideration. It is one of grave moment regarded from a medical and cuiative, and not less from an economic, point of view. A suitable uniform might surely be devised which would be sufficiently distinctive and creditable, without reproducing the sombie coloui and buttoned-up appearance of the conven- tional prison warder.”
The treatment afforded to the patients mentioned in con- nection with the large asylums on the whole may be pronounced as admirable. They are all under the superintendence of men who have devoted a lifetime to the study and treatment of the insane; and when we mention such names as Dr Edgar Shep- pard, Dr Rayner, Dr Claye Shaw, Dr Rhys Williams, and Dr Brushfield, we can rest satisfied that the management of our public hospitals is in the hands of those who will use a judicious and skilful treatment over the unhappy inmates en- trusted to their care.
The second volume contains some valuable facts and data.
The asylums especially mentioned are the metropolitan licensed houses receiving paupers. Amongst these we may mention Camberwell House, Bethnal House, Peckham House, Hoxton House, and Grove House, Bow. The same descriptive arrange- ments are followed out as in that of the larger hospitals in the first volume. These houses receiving paupers are really private establishments undertaking work by contract for the State. They contain on an average from 400 to 500 inmates, and are subject to the same visitation as ordinary private houses. The charges are very moderate in these institutions, and the patients receive every care and treatment. From personal knowledge we can speak very highly of Camberwell House and Peckliam House, having frequently visited them. The latter asylum is under the able management of Dr Stocker and Mr. Brown, and the arrangements in both are excellent. Peckham House we have often visited ; the patients are ably treated, and the comfort of the inmates is considered in every respect. Several of the lecturers belonging to our London hospitals are allowed to bring their classes to these institutions to study mental disorder. We see no mention is made of this by Dr Orranville, though he specially refers to it when describing the larger hospitals^ as follows: ” Hospitals of all descriptions are improved by being used as schools of medicine; and, under proper restrictions for example, the obvious one of prohibiting students from entering the wards, or showing themselves to the patients, except when accompanied by one of the medical superintendents ??-the attendance of pupils at any asylum for lunatics is certain to elevate and improve it. The obligations of clinical research, and the emulation of success it implies, must go far to redeem asylums from the character of mere retreats and strongholds for the subjects of madness to drag out hopeless and unhelped lives, and finally die in.” We heartily coincide with these excellent remarks, and if this were generally the practice, and students availed themselves of the opportunity, mental disorder would be far better understood at the present day than it is by the majority of practitioners.
Dr Granville having fully described these institutions, passes on to consider the medical treatment of insanity generally, classification, and all pertaining to the care and cure of the insane. We cannot speak too highly of these two most excellent volumes, which are replete with valuable statistical and other information bearing on the subject at issue. _Ve canno , lc|w- ever, endorse the opinion as expressed by Dr Crianville, t latthe whole system of asylum treatment should be revised. It is rather a sweeping assertion, and, from a careful peiusal of his book, we must beg to differ from him. Nevertheless we are of opinion that the two volumes will form a most valuable addition to psychological medicine, and we heartily recommend it to our readers. It has been published, moreover, at a most opportune time, when the subject of lunacy legislation has caused so much discussion.
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