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 INSANE

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INSANE

come under observation sooner; they are more willing to go to such hospitals and their friends are more ready to send them. Serious developments are often thus prevented. In this sjstem of psycho- pathic wards in general hospitals the Middle Ages anticipated our modern views. In another phase of the care of the insane there is a similar anticipation. At Gheel in Belgium the harmless insane are cared for by the people of the village and the neighbouring country who provide them with board, and treat them as members of the family. This system has attracted much attention in recent years, and articles on Ciheel have appeared in every language. It has its defects, but these are probably not so great as those that are likel}' to occur in the institutional care of such pa- tients. This method of caring for the insane has been practised at Gheel for over a thousand years. Orig- inally the patients were brought to tlie shrine of St. Dj-mpna, where, according to tradition, they were often liealed. The custom of leaving chronic sufferers near the shrine, under the care of the vil- lagers, gradually arose and has continued ever since. Nearly every country in Europe had such shrines where the insane were cured; we have records of them in Ireland, Scotland, England, and Germany, and it is evident that this must be considered an important portion of the provision for these patients. In France the shrines of Sts. Menou, or Menulphe, and Dizier were visited from very early times by the insane in search of relief. The shrine of St. Menou at Mailly- sur-Rose was especially well-known and a house was erected for the accommodation of the mentally dis- eased. At St-Dizier a state of affairs very like that at Gheel developed, and the patients were cared for by the families of the neighbourhood. All of this inter- esting and valuable provision for the care of the insane, as well as the monastic establishments in which they were received, disappeared with the Reformation.

Spain, though not the first country to organize special institutions for the insane, did more for them than perhaps any other country. The asylum at Valencia already mentioned was founded in 1409 by a monk named Joffre, out of pity for the lunatics whom he found hooted by the crowds. The movement thus begun spread tlu'oughout Spain, and asylums were founded at Saragossa in 1425, at Seville in 1435, at Valladolid in 1436, and at Toledo before the end of the century. This movement was not due, as has been claimed, to Mohammedanism, for Mohamme- dans in other parts of the world took no special care of the insane. Lecky, in his " History of European Morals", has rejected the assertion of Desmaisons in this matter, which is entirely without proof. Spain continued to be the country in which hmatics were best cared for in Europe down to the Ijeginning of the nineteenth century. Pinel, the great French psychi- atrist, who took the manacles from the insane of France, declared Spain to be the country in which lunatics were treated with most wisdom and most humanity. He has described an asylum at Saragossa "open to the diseased in mind of all nations, govern- ments, and religions, with this simj)lc iiiscrijition: Urbis el Orbis" (Trait(^> Mod.-jjiilos. sur I'alirnation mentale, Paris, 1809). He givfs some details of the treatment, which show a very modern recognition of the need to be gentle and careful with the insane rather than harsh and forceful.

The puzzarcUa at Rome already mentioned was foundcci during the sixteenth century by Ferrantez Ruiz and the Bruni, father and son, all three Navar- rese. This hospital for the in.sane "received crazed persons of whatever nation they be, and care is taken to restore them to their right mind ; but if the madness prove incurable, they are kept during life, have food and raiment necessary to the condition they are in. A Venetian lady was moved to such great pity of these poor creatures upon sight of them that on her

death she left them heirs to her whole estate." This enabled the management, with the approbation of Pope Pius IV, to open a new house, in 1561, in the Via Lata. In France and Italy the custom continued during the seventeenth and eighteenth centuries of placing lunatics, particularly tho.se of the better class — though also of other classes when they had patrons who asked the privilege — in male or female monas- teries according to their sex. This practice also pre- vailed in Russia. In 1641 the Charenton Asylum was founded in one of the suburl)S of Paris, near the Park of ^'inccnncs, and was placed under monastic rule. After the foundation of the Sisters of Charity of St. Vincent de Paul, the charge of this institution was given to them. During this century the French estabhshed a system of colonies by which the insane were transferreil to country places for work during intermissions in their condition, and were returned to the central asylum whenever they were restless.

During the eighteenth century there was an awak- ening of humanitarian purpose with regard to the insane in nearly every coimtry of Europe. St. Peter's Hospital, at Bristol, England, was opened in 1696; the Manchester Royal Lunatic Hospital in 1706; Bethel Hospital at Norwich in 1713; Dean Swift's Dublin hospital in 1745; while the Pennsylvania Hos- pital of Philadelphia (1751) and the New York Hos- pital (1771) each contained wards for lunatics. In 1773 the first asylum exclasively for the care of the insane in the United States was opened at Williams- burg, Va. After tliis, asylums for the insane multi- plied, though the system under which the inmates were cared for involved many abuses. Burdett's third chapter is entitled "The Period of Brutal Sup)- pression in Treatment and Cruelty: 1750 to 1850".

In 1792 what has been called the humane period in the treatment of the insane began, when Pinel, against the advice of all those in authority and with the disapprobation of his medical colleagues, removed the chains and manacles and other severer forms of restraint at the gi-eat asylum of Bicetre, near Paris, and gave the inmates all the liberty compatible with reasonable safety for themselves and others. At the same time William Tuke was engaged in establishing the retreat near York, which came into full operation in 1795. In this institution very enliglitene<l prin- ciples of treatment ^\ere carried into effect. Early in the nineteenth century. Dr. Charles Worth and Mr. Gardner Hill, in the Lincoln Asylum, did away with all forms of mechanical restraint. The non-restraint system was fully developed by Dr. John Conolly in the Miildlesex County Asylum at Hanwell. In the mean time, at the second institution solely for the insane in the United States, the Friends' -\syl\mi at Frankfort, Pennsylvania (1817), the principles of gentle, intelligent care for the insane were being thor- oughly applied and developed. The treatment of the insane was first systematized by Dr. S. B. Woodward, at Worcester, Massachusetts. Dr. Kirkbride of Phila- delphia did much to remote the evils of restraint. Miss Dix must ever bear an honoured name for her successful philanthropy in doing away with many abuses in England and her native .\merica. In recent years the care of the insane has to a great extent come entirely under the control of the State. 'This was apparently renilcri'd necessary by the abuses that crept into private institutions for tlie insane. Even in the State institutions, however, until the last twenty-five .years, there were many customs to be deprecated. Mechanical restraints "of all kinds were usetl very commonly in America; within a genera- tion patients were fastened to chairs, or to their beds, or secured by means of chains. The " open tloor" is, however, now becoming the policy of most institu- tions. Modes of restraint are very limited and used only with proper safeguard.

Most American institutions are overcrowded, be-