Chapters in the History of the Insane in the British Isles Part 32

Has not Belgium her Guislain, Holland her Schroeder van der Kolk, and Italy her Chiaruggi?

And when I pa.s.s from Europe to the American continent, many well-known names arise, at whose head stands the celebrated Dr. Rush. Woodward, Bell, Brigham, and Howe (whose many-sided labour included the idiot) will be long remembered, and now, alas! I have to include among the dead an honoured name, over whom the grave has recently closed. Saints.h.i.+p is not the exclusive property of the Church. Medicine has also her calendar. Not a few physicians of the mind have deserved to be canonized; and to our psychological Hagiology, I would now add the name of Isaac Ray. With his fellow-workers in the same field, among whom are men not less honoured, I would venture to express the sympathy of this a.s.sociation in the loss they have sustained. Nor can I pa.s.s from these names, although departing from my intention of mentioning only the dead, without paying a tribute of respect to that remarkable woman, Miss Dix, who has a claim to the grat.i.tude of mankind for having consecrated the best years of her varied life to the fearless advocacy of the cause of the insane, and to whose exertions not a few of the inst.i.tutions for their care and treatment in the States owe their origin.

Abroad, psychological journalism has been in advance of ours.

The French alienists established in 1843 their _Annales Medico-Psychologiques_ (one of whose editors, M. Foville, is with us to-day), five years before Dr. Winslow issued his Journal, the first devoted to medical psychology in this country, and ten years before our own _Journal_ appeared, in 1853.

The Germans and Americans began their Journals in the following year--1844; the former, the _Allgemeine Zeitschrift fur Psychiatrie_, and the latter the _American Journal of Insanity_.

I believe that our a.s.sociation has precedence of any other devoted to Medical Psychology, and it is an interesting fact that its establishment led to that of the corresponding a.s.sociation in France--a society whose secretary, M. Motet, I am glad to see among my auditors. The a.s.sociation of Medical Superintendents of American Inst.i.tutions for the Insane was inst.i.tuted in 1844; that of Germany in 1864, the subject of Psychology having previously formed a section of a Medical a.s.sociation.

Returning to our own country, I may observe that when Dr. Hitch, of the Gloucester Asylum, issued the circular which led to the formation of this a.s.sociation in 1841, almost half a century had elapsed since the epoch (1792) which I may call the renaissance of the humane treatment of the insane, when the Bicetre in France, and the York Retreat in England, originated by their example an impulse still unspent, destined in the course of years to triumph, as we witness to-day. This triumph was secured, in large measure, by the efforts of two men who, forty years ago, shortly after the well-known experiment at Lincoln, by the late Mr. Robert Gardiner Hill, were actively engaged in ameliorating the condition of the insane. Need I say that I refer to Lord Shaftesbury and Dr. Conolly? The n.o.bleman and the physician (alike forward to recognize the services of the pioneers of 1792), each in his own sphere having a common end in view, and animated by the same spirit, gave an impetus to the movement, the value and far-reaching extent of which it is almost impossible to exaggerate. Lord Shaftesbury,[294] celebrating his eightieth birthday this year, still lives to witness the fruits of his labours, of which the success of the well-known Acts with which his name is a.s.sociated, will form an enduring memorial. Dr. Conolly was in his prime. He had been two years at Hanwell, and was contending against great difficulties with the courageous determination which characterized him. I do not hold the memory of Conolly in respect, merely or princ.i.p.ally because he was the apostle of non-restraint, but because, although doubtless fallible (and indiscriminate eulogy would defeat its object), he infused into the treatment of the insane a contagious earnestness possessing a value far beyond any mere system or dogma. His real merit, his true glory, is to have leavened the opinions and stimulated the best energies of many of his contemporaries, to have stirred their enthusiasm and inflamed their zeal, to have not only transmitted but to have rendered brighter the torch which he seized from the hands of his predecessors. He desired to be remembered after his death by asylum superintendents as one who sincerely wished to place the insane in better hands than those in which he too generally found them; and I hold that, whatever may be our views on what we have chosen to call non-restraint, we may cordially unite in fulfilling his desire.

As the non-restraint system--a term, it must be confessed, which cannot boast of scientific precision, but is well understood--has been the leading, and often engrossing, topic of discussion during the period now under review, I must not omit a brief reference to it. No one will call in question the statement as an historical fact that the Commissioners in Lunacy and the medical superintendents of asylums in this country are, with few exceptions, in favour of non-restraint. Dr. Lauder Lindsay--for whose death, as well as that of Dr. Sherlock and of Dr.

White Williams, during the last year, the tribute of sorrowful regret ought, in pa.s.sing, to be paid--Dr. Lindsay, I say, had only a small following in Great Britain. In Germany, on the other hand, although Griesinger looked favourably upon the system, and Westphal has advocated it, and Brosius has translated Conolly's standard work into German, there has not been a general conversion, as may be seen by the discussion which took place in 1879, at meetings of the Psychological Society in Berlin and Heidelberg. In France, again, although Morel gave it the sanction of his name, and Magnan has practised it recently, there has been within the last twelve months a striking proof of anti-non-restraint opinion among the French physicians, in an interesting discussion at the Societe Medico-Psychologique. I wish here only to chronicle the fact, and would urge the necessity of not confounding honest differences of opinion with differences of humane feeling. The non-restrainer is within his right when he practises the system carried to its extremest lengths. He is within his right when he preaches its advantages to others. But he is not within his right if he denounces those physicians, equally humane as himself, who differ from him in opinion and practice. I therefore unite with the observation of Dr. Ray, by whom, as well as by the majority of his fellow-psychologists, the non-restraint system as a doctrine was not accepted, when he wrote thus in 1855, "Here, as well as everywhere else, the privilege of free and independent inquiry cannot be invaded without ultimate injury to the cause."[295]

The arguments in favour of mechanical restraint are clearly set forth by Dr. John Gray, of the Utica Asylum, in his annual report of the present year.

Leaving this subject let me recall to your recollection that when this a.s.sociation was formed, the care of the insane in England and Wales was regulated by the Gordon-Ashley Act of 1828,[296] which, among other reforms, had subst.i.tuted for the authority of five Fellows of the College of Physicians, who performed their duties in the most slovenly manner, fifteen metropolitan Commissioners in Lunacy. I find, on examining the Annual Report of these Commissioners issued in 1841, that it does not extend over more than one page and a half! It is signed by Ashley, Gordon, Turner, Southey, and Proctor. They report the number confined in the thirty-three asylums within their jurisdiction as 2490.

Their verdict on inspecting them is expressed in half a dozen words, namely, that the "result is upon the whole satisfactory."

"The business of this Commission," they say, "has very much increased, partly by more frequent communications with the provinces (over which, however, they have no direct legal control), and partly by the more minute attention directed by the Commissioners to individual cases with a view to the liberation of convalescent patients upon trial ... and the consequence has been that many persons have been liberated who otherwise would have remained in confinement."

That a state of things in which such an occurrence was possible should be described as on the whole satisfactory, is somewhat remarkable, and in reading this paragraph we cannot but contrast with it the very different result of the investigation made by the Committee of the House of Commons in 1877.

Again, nothing more strikingly marks the change which has taken place in the inspection of asylums than the contrast between the last Report of the Lunacy Commissioners, consisting of a bulky volume of more than four hundred pages, and that of 1841, of a page and a half. In fact, the Reports of the Commissioners form the best evidence to which I can refer of the progress made from year to year in the provision for the insane, and the gradual but uninterrupted amelioration of their condition.

An important advance was made in 1842 by the Act 5 and 6 Vict., c. 87, which provided that provincial houses were to be visited by the Metropolitan Commissioners, as well as those in their own district. They were also to report whether restraint was practised in any asylum, and whether the patients were properly amused and occupied. Not only was a great step forward made by thus extending the inspecting power of these Commissioners to the provinces, but their memorable Report on the state of the asylums in England and Wales in 1844 led to the highly important legislation of the following year (introduced by Lord Ashley)--the Act 8 and 9 Vict., c. 100, which along with the Acts of 1853 (16 and 17 Vict., cc. 96, 97)[297] and 1862 (25 and 26 Vict., c. 111) form, as you are well aware, the Code of Lunacy Law under which, for the most part, the care of the insane is determined and their protection secured.

I should like to have been able to state the number of recognized lunatics in England and Wales forty years ago, but no return exists which shows it. The nearest approach is to be found in the Report just referred to of the Metropolitan Commissioners (1844), in which the number of ascertained lunatics in England and Wales is stated to be about 20,000, of whom only 11,272 were confined in asylums, whereas now there are nearly 55,000. It is difficult to realize that there were then only some 4000 patients in county asylums, these being 15 in number, and that there were 21 counties in England and Wales in which there were no asylums of any kind, public or private. At the present time, instead of 20,000 ascertained lunatics and idiots, we have 73,113--an increase represented by the population of the City of York--instead of 15 county asylums we have 51, with scarcely less than 40,000 patients, instead of 4000; while the provincial licensed houses have decreased from 99 to 59, and the metropolitan increased by 2. The total number of asylums in England and Wales in 1844 was 158,[298] now it is 175--excluding those (3) erected under Hardy's Act. I need not say that these figures do not necessarily point to an increase of lunacy, but may merely represent the increased accommodation which ought to have been provided long before.

Into the general question of the spread of insanity I feel that it would be impossible to enter satisfactorily now.

Recurring to the Metropolitan Commissioners' Report, I must observe that while an immense advance took place between 1828, when they were appointed, and 1844, the subsequent advance between the latter date and now is such that we cannot but recognize the extremely beneficial operation of the legislation which has marked this period. It must also be gratifying to Scotch asylum superintendents, knowing as they do the satisfactory condition of the insane in their country in 1881, to be able to measure the progress made since Lord Ashley, in his speech in 1844, moved for an address to the Crown, praying her Majesty to take into consideration the Commissioners' Report, for he there observes, "I believe that not in any country in Europe, nor in any part of America, is there any place in which pauper lunatics are in such a suffering and degraded state as those in her Majesty's kingdom of Scotland." I need not do more than chronicle the fact, in pa.s.sing, that the reform in Scotland dates, to a large extent, from the appointment of a Royal Commission in 1855, and the action of the Board of Lunacy Commissioners which was established in consequence. Legislation for Ireland and the appointment of inspectors have likewise proved very beneficial in that country. But restricting my remarks to England and Wales, I would observe that the establishment by the Act of 1845 of the Lunacy Board as at present const.i.tuted, and the rendering it compulsory upon counties to provide asylums for pauper lunatics, are the chief causes of the improvement to which I have referred, so far, at least, as it has been brought about by legislation.

I will not dwell in detail on the lunacy legislation of these years. To have said less would have been to overlook the salient and most important facts of the period. To have said more would have been to travel over the ground so ably occupied by Dr. Blandford in his Presidential Address three years ago. He, by-the-by, complained of the ever-increasing difficulty each President finds in selecting a subject for his discourse, and then immediately proceeded to effectually lessen the chances of his successors. What the last occupant of this Chair will be able to discover new for his address I do not know. I can only think of the funeral oration over this a.s.sociation at its obsequies--when its "dying eyes are closed," its "decent limbs composed," and its "humble grave adorn'd,"

"By strangers honour'd, by survivors mourn'd."

On the Board of the Commissioners in Lunacy have sat two members of our profession (one still living), to whose services I wish more especially to refer. I allude to Dr. Prichard and Mr. Gaskell.

Apart from his official work, the former will always be remembered in the republic of letters by his learned contributions to anthropology and the literature of mental diseases, in which he is more especially identified with the doctrine of Moral Insanity. Chronicler of the period in which he enunciated or rather developed it, I cannot avoid a brief reference to a theme which has caused so much heated discussion. As an impartial historian I am bound to admit that his views are still by no means unanimously adopted, and that I am only expressing my own sentiments when I avow that what Latham says of Prichard's "Researches into the Physical History of Mankind"--"Let those who doubt its value, try to do without it"--applies to the teaching contained in the remarkable treatise ent.i.tled "Different Forms of Insanity in relation to Jurisprudence," published in 1842. We may well be dissatisfied with some of the ill.u.s.trations of the doctrine it supports. We may express in different terms the generalization he has made as to the relation of intellect and emotion; but I am greatly mistaken if we shall not from time to time be confronted by facts which instantly raise the question which presented itself with so much force to his acute mind, and which does not appear to me to be successfully met by those who controvert the conclusions at which Prichard arrived. The necessity of admitting in some form or other the mental facts in dispute, is well ill.u.s.trated by the recent work by Krafft-Ebing on mental disorders. For what does this practised mental expert do? He, although the supporter of mental solidarity and the integrity of the Ego--adverse, therefore, to the psychology in which the theory has been enshrined--feels that he must admit into his cla.s.sification some term which describes certain emotional or volitional disorders, and can discover none better than "moral insanity"--a practical, though reluctant, admission of the value of Prichard's views after their discussion for forty years. I might also refer as an indication of opinion to a most excellent article in the last number of the _Journal_ by Dr. Savage, who, while recognizing the abstract metaphysical difficulty of conceiving moral as distinct from intellectual insanity, fully admits as a clinical fact the form of mental disease for which Prichard contended, and had he been living he would doubtless have claimed this article as a striking proof of the vitality of his opinions.

One is certainly disposed to exclaim, if observation on the one hand compels us to admit certain mental facts, and the metaphysician on the other declares them to be unmetaphysical, so much the worse for metaphysics!

Mr. Gaskell, in addition to his good work as a reformer at the Lancaster Asylum, where may yet be seen preserved quite a museum of articles of restraint formerly in use in that inst.i.tution, and his efficient labours as a Commissioner, was also, it may not be generally known, the real cause of the practical steps taken in this country to educate the idiot.

It was in 1847 that he wrote some articles in _Chamber's Journal_, giving an account of Seguin's Idiot School at the Bicetre, which he had visited and been greatly interested in. These articles had the effect of inducing Dr. Andrew Reed to interest himself in the establishment of a school for idiots in England. The Highgate and Colchester Asylums for idiots were inst.i.tuted--the origin, as it proved, of the great establishment at Earlswood. All, therefore, that has been done for this pitiable cla.s.s has been effected during the last forty years. The indefatigable Seguin has pa.s.sed away during the last twelve months. He pursued to the last, with unabated zeal, a study possessing attractions for only a limited number, and advocated the claims of idiots and imbeciles with unceasing energy in the Old World and the New.

Fortunately his mantle has descended upon a worthy successor in the person of his son, Dr. E. Seguin, of New York.

It has necessarily happened that the direction of public attention to the larger and better provision for the insane in all civilized lands has led to much consideration, and inevitably some difference of opinion as regards the form and arrangement of asylums. But all will admit that their construction has undergone a vast improvement in forty years. The tendency at the present moment is to attach less importance to bricks and mortar, and the security of the patient within a walled enclosure, than to grant the largest possible amount of freedom, in asylums, compatible with safety. The more this is carried out, the easier, it is to be hoped, will it be to induce the friends of patients to allow them to go in the earliest stage of the disorder to an asylum, as readily as they would to a hydropathic establishment or an ordinary hospital, to which end medical men may do much by ignoring the stupid stigma still attaching to having been in an asylum. The treatment of the insane ought to be such that we should be able to regard the asylums of the land as one vast Temple of Health, in which the priests of Esculapius, rivalling the Egyptians and Greeks of old, are constantly ministering, and are sacrificing their time and talents on the altar of Psyche.[299]

Most heartily do I agree with Dr. Kirkbride when he says that "Asylums can never be dispensed with--no matter how persistently ignorance, prejudice, or sophistry may declare to the contrary--without retrograding to a greater or less extent to the conditions of a past period with all the inhumanity and barbarity connected with it. To understand what would be the situation of a people without hospitals for their insane, it is only necessary to learn what their condition was when there were none."[300]

In advocating the prompt and facile recourse to an asylum, I include, of course, the cottage treatment of the insane so long ago resorted to by Dr. Bucknill, and extended in so admirable a manner by my immediate predecessor in this chair, whose practical observations last year on the villas and cottages at Cheadle rendered his address one of the most valuable that has been delivered. Moreover, I would not say a word in disparagement of the placing of suitable cases in the houses of medical men, or in lodgings, under frequent medical visitation.[301] I also recognize the value of intermediate or border-land inst.i.tutions, so long as they are conducted with the sanction of the Commissioners and open to their inspection.

The modern advocacy of the open-door system has been recently brought under the notice of the a.s.sociation by Dr. Needham, with the view of obtaining a general expression of opinion on a practice, to the wisdom of which he is disposed to demur.

But a less regard for mere bricks and mortar, the removal of high boundary walls and contracted airing-courts, or the introduction of the open-door system, do not lessen the importance of properly constructed asylums. The works of Jacobi in Germany, Kirkbride in America, Parchappe in France, and Conolly in England, must retain their value as cla.s.sical productions on this subject; while the contributions recently made by Dr. Clouston present not only the general principles of asylum construction, but the minute details of building, in the light of the knowledge and experience of the present day.

I was fortunate in being able to render M. Parchappe some service when he visited England to examine the construction of our asylums. Those who formed his acquaintance on the occasion of this visit may remember his mixed feelings on visiting them, how he demurred on the one hand to what he regarded as too costly and ornamental, while, on the other hand, he liked the English arrangement of the buildings better than the Esquirol-Desportes system. I need not point out that those who have had the planning of the county asylums in England have objected, as well as Parchappe, to the distribution of isolated pavilions upon parallel lines. Parchappe, while far from believing it to be indispensable to make asylums monuments fitted to excite admiration for the richness of their architecture, and indisposed to emulate our asylums, which, he says, only belong to princely mansions, turns nevertheless from the square courts and the isolated pavilions of Esquirol to apostrophize the former in these glowing terms:--

"How much more suited to reanimate torpid intelligence and feeling, or to distract and console melancholy among the unfortunate insane, these edifices majestic in their general effect and comfortable in their details, these grandiose parks, with luxuriant plantations and verdant flowery lawns, whose harmonious a.s.sociation impresses upon English asylums an exceptional character of calm and powerful beauty!"

Whether a stranger, having read this florid description of our asylums, would not, on visiting them, be a little disappointed, I will not stop to inquire. Probably during this or the following week, some of Parchappe's compatriots may answer the question for themselves.

The fundamental question of the separation of the curable and incurable cla.s.ses has in different countries been earnestly discussed during the last forty years. Kirkbride has entered his "special and earnest protest" against this separation; his own countryman, Dr. Stearns, on the other hand, has lately advocated it. In Germany, where, following the lead of Langermann and Reil, complete separation of the curable in one building was first realized under Jacobi at Siegburg, there has been a complete reversion to the system of combining the two cla.s.ses in one inst.i.tution. Parchappe, who opposed the separation of these cla.s.ses, as illusory if justice is done to the incurable in the construction of the building provided for them, and mischievous if this is denied them, was constrained to admit, however, in view of the enormous number of lunatics in the Department of the Seine, that it was the least of two evils to separate the epileptic and the idiotic from the curable.

In England the separation principle has been recognized in Hardy's Act (30 Vict., c. 6) for the establishment in the metropolis of asylums for the sick, insane, and other cla.s.ses of the poor, 1867; and, again, in the erection of such an asylum as Banstead for Middles.e.x--and I am informed by Dr. Claye Shaw, who, from holding the office of superintendent there, and formerly superintending the Metropolitan District Asylum of Leavesden, is well calculated to judge, that the experiment has proved successful, that the patients do not suffer, and that the office of superintendent is not rendered unendurable. Regarded from an economic point of view, it has been found practicable to provide buildings at a cost of between 80 and 90 per bed, which, though not aesthetic, are carefully planned for the care and oversight of the inmates. This includes not only the land, but furnis.h.i.+ng the asylum.

Five years ago this a.s.sociation unanimously adopted a resolution, expressing satisfaction that the Charity Organization Society had taken up the subject of the better provision, in the provinces, for idiots, imbeciles, and harmless lunatics, and the following year carried a resolution, also unanimous, that the arrangement made for these cla.s.ses in the metropolitan district is applicable in its main principles to the rest of England. But it does not follow that the separation of these cla.s.ses from the county asylums should be so complete, either as respects locality or the governing board, as in the metropolitan district; and, further, the a.s.sociation expressed a strong opinion that the boarding-out system, although impracticable in the urban districts, should be attempted wherever possible in the country; the greatest care being taken to select suitable cases, unless we wish to witness the evils which Dr. Fraser has so graphically depicted in his report for 1877 of the Fife and Kinross Asylum. If pauper asylums can, without injury to families, be relieved by harmless cases being sent home to the extent Dr. Duckworth Williams has succeeded in doing in Suss.e.x, and if, as he proposes, they were periodically visited, their names being retained on the asylum books, the enlargement of some asylums might be rendered unnecessary.

But what, gentlemen, would be the best-contrived separation of cases, what would the best-constructed asylum avail, unless the presiding authority were equal to his responsible duties? Now, it is one of the happy circ.u.mstances connected with the great movement which has taken place in this and other countries, that men have arisen in large numbers who have proved themselves equal to the task. We witness the creation of an almost new character--the asylum superintendent.

One Sunday afternoon, some years ago, Dr. Ray fell asleep in his chair while reading old Fuller's portraits of the Good Merchant, the Good Judge, the Good Soldier, etc., in his work ent.i.tled "The Holy and Profane State," and, so sleeping, dreamed he read a ma.n.u.script, the first chapter of which was headed, "The Good Superintendent." Awakening from his nap by the tongs falling on the hearth, the doctor determined to reproduce from memory as much of his dream as possible for the benefit of his brethren. One of these recovered fragments runs thus:--"The Good Superintendent hath considered well his qualifications for the office he hath a.s.sumed, and been governed not more by a regard for his fortunes than by a hearty desire to benefit his fellow-men....

To fix his hold on the confidence and goodwill of his patients he spareth no effort, though it may consume his time and tax his patience, or encroach seemingly on the dignity of his office. A formal walk through the wards, and the ordering of a few drugs, compriseth but a small part of his means for restoring the troubled mind. To prepare for this work, and to make other means effectual, he carefully studieth the mental movements of his patients. He never grudges the moments spent in quiet, familiar intercourse with them, for thereby he gaineth many glimpses of their inner life that may help him in their treatment.... He maketh himself the centre of their system around which they all revolve, being held in their places by the attraction of respect and confidence."[302]

And much more so admirable that it is difficult to stay one's hand. You will, I think, agree with me that what Dr. Ray dreamed is better than what many write when they are wide awake, and those familiar with Dr.

Ray's career, and his character, will be of the opinion of another Transatlantic worthy (Dr. John Gray, of Utica) that in this act of unconscious cerebration the dreamer unwittingly described himself--

"'The Good Superintendent!' Who is he?

The master asked again and again; But answered himself, unconsciously, And wrote his own life without a stain."

In what a strange land of shadows the superintendent lives! But for his familiarity with it, its strangeness would oftener strike him. It becomes a matter of course that those with whom he mixes in daily life are of imperial or royal blood--nay, more, possess divine attributes--and that some who are maintained for half a guinea a week possess millions and quadrillions of gold. He lives, in truth, in a world inhabited by the creatures of the imagination of those by whom he is constantly surrounded--a domain in which _his_ views of life and things in general are in a miserable minority--a phantom world of ideal forms and unearthly voices and mysterious sounds, incessantly disputing his authority, and commanding his patients in terms claiming supernatural force to do those things which he orders them to leave undone, and to leave undone those things which he orders them to do; commanding them to be silent, to starve themselves, to kill, to mutilate or hang themselves; in short, there is in this remarkable country, peopled by so many thousand inhabitants, an _imperium in imperio_ which renders the contest continuous between the rival authorities struggling for supremacy, sometimes, it must be confessed, ending in the triumph of the ideal forms, and the phantom voices, and the visionary sights, which may be smiled at in our studies, and curiously a.n.a.lyzed in our scientific alembics, but cannot be ignored in practice without the occurrence of dire catastrophes, and the unpleasant realization of the truth that idealism, phantasy, and vision may be transformed into dangerous forms of force. It may be said, indeed, that the appropriate motto of the medical superintendent is--"_Insanitas insanitatum, omnia insanitas._"

With such an _entourage_ it is not surprising if the first residence in an asylum as its responsible head--especially an asylum in the olden days--should disconcert even a physician. A German psychologist once declared, after pa.s.sing his first night in an inst.i.tution as superintendent, that he could not remain there; he felt overwhelmed with his position. Yet this physician remained not only over the next night, but for thirty-five years, to live honoured and venerated as Maximilian Jacobi, and departing to leave behind him "footprints on the sands of time," from seeing which, others, in a similar hour of discouragement, may again take heart.

I cannot pa.s.s from this subject without enforcing, as a practical comment, the necessity of asylum physicians having a very liberal supply of holidays, so as to insure a complete change of thought from not only the objective but the subjective world in which they live, and this before the time comes when they are unable to throw off their work from their minds, as happened to a hard-working friend of mine, who, even during his holiday among the Alps, must needs dream one night that he was making a post-mortem upon himself, and on another night rose from his bed in a state of somnambulism to perform certain aberrant and disorderly acts, not unlike what his patients would have performed in the day.

I have heard it suggested that superintendents should have six weeks'

extra holiday every third year, five of them to be spent in visiting asylums. Whether this is the best way of acquiring an interchange of experience or not, I will not decide, but no doubt the feeling, how desirable it is men should compare notes with their fellow-workers, prompted the founders of our a.s.sociation (which was expected to be more peripatetic than has proved to be the case) to determine that its members should at its annual meetings carefully examine some inst.i.tution for the insane.

It is not too much to say that only second in importance to a good superintendent is a good attendant, and of him also Dr. Ray dreamed in his Sunday afternoon vision, and his description is equally excellent.

I am sure that it will be admitted that the last forty years have seen a vast improvement in the character of attendants, and among them are to be found many conscientious, trustworthy men and women, forbearing to their charge and loyal to their superintendent. It is not the less true that for asylums for the middle and higher cla.s.ses the addition of companions.h.i.+p of a more educated character is desirable, and it is satisfactory to observe that there is an increasing recognition of its importance, as evidenced by the Reports of our asylums.[303]