of Mental Science, published by authority
of the association of medical officers of
Asylums and Hospitals for the Insane," a
considerable part is devoted to a review, by
Doctor Bucknill of the reports of English,
Scotch, Irish, and East Indian Lunatic
Asylums published during the last two years,
with citation of the most important facts
contained in each. There are added notes on the
reports of the Irish Lunacy Commission, and
a review of the last published report of
our commissioners in lunacy. Fresh from
the reading of these notes we write what
follows.

Taking for granted the first principle of
the treatment of insane persons, without
harsh restraint, a principle which is now
recognised almost universally in England,
we pass to two main facts which have been
more recently established, and which should
have as general a recognition. One is, that
insanity is a disease of bodily weakness, not
of strength,—a disease commonly arising from
defect of nourishment and physical depression.
The other is, that in its first stages,
insanity is generally curable; that on its
appearance help against it should be sought
without even a putting off until to-morrow,
since every day's delay adds to the difficulty of
cure, and after the delay of two or three
months, relief—perhaps a long relief—may
indeed be obtained, but cure has become
nearly impossible.

Most important is it that a proper
understanding of these facts should be impressed
on all who are concerned in the administration
of our workhouse system. Throughout
the curable stage of their disease insane
paupers very frequently indeed are retained
in workhouses to save the expense of their
maintenance in the county asylum. While
so detained they are receiving neither the
right medical treatment nor the right supply
of nourishment. Rightly to treat a pauper
lunatic in a workhouse would, for want of
the organised system and all the appliances
belonging to an establishment built and
maintained with the sole view to such a purpose,
cost more than the charge payable to a
county asylum for the care of him. Patients
retained thus in the workhouse during the
first weeks of lunacy do not recover, but
becoming worse, are sent when the possibility
of perfect cure is at an end, to the
asylum, and become for the rest of their lives
a permanent or an occasional charge upon
the rates.

A discussion has been lately carried on
between the commissioners in lunacy and the
visitors of the Middlesex Lunatic Asylums.
The visitors have gained their point, but the
commissioners were surely in the right. They
had opposed the enlargement of the two
great Middlesex asylums—Hanwell and
Colney Hatch—first, because over-grown
asylums have proved disproportionately
costly, through the waste and loss occasioned
by the multiplication of servants, and the
impossibility of subjecting them to the
individual and constant oversight of a single
responsible head; secondly, because a medical
officer, let him work as he will, cannot do his
duty thoroughly in the case and treatment
of patients, unless there is reasonable limit
to their number; thirdly, because, at
Hanwell and Colney Hatch, there is not
ground enough fairly to admit of the proposed
increase of the number of patients by whom
it is to be used. The commissioners
recommended, therefore, that the fresh expenditure
for building should go to the erection on
some simple and inexpensive plan of a third
asylum for the incurable idiotic and demented
patients, so that there might be more room at
Colney Hatch and Hanwell, for those recent
and curable cases for which it is especially
important that the doors of an asylum should
be open their widest. The suggestion seems
to have been beyond all question right and
wise.

The opposing argument raised by the
visiting justices of Colney Hatch, did not join
issue upon any general principle, but argued
as a fact that it would be of no use to
make much room for curable cases in a
Middlesex asylum, because "the occurring
cases of insanity among the pauper population
of the metropolis are of a most unfavourable
description," and curious facts are given to
illustrate the particular incurability of
pauper lunatics in the county of Middlesex.
We certainly do not believe that there is
any special malignancy in the incipient
madness of a London pauper as compared
with that of a pauper in the crowd of
Birmingham, where, as Doctor Bucknill points
out, the per centage of cases is rather above
the average. Evidently the truth must be
that in London the fresh cases are not
brought to the asylum door. Many perhaps
are overlooked in the defective practical operation
of the workhouse system, others may be
allowed to pass into the incurable state by
guardians and union surgeons who have paid
little attention to the subject of insanity,
who are not sufficiently aware of the
emergency of every lunacy case at its outset, and
who in such matters cannot distinguish
between curable and incurable affliction.
Cases of lunacy will be multiplied five fold
throughout the country whenever the whole
public has been made alive to the necessity
of seeking instant remedy. In the last report
of the Derbyshire Asylum there is mention
of an interesting case. A young woman,
liable to returns of insanity, and living fourteen
miles away, left her home at four
o'clock one wet morning, and taking the
railway as her guide, hurried to the asylum;
she passed through several tunnels on her
road, and arrived wet and exhausted. She
said, "she dreaded being ill at home, for they
treated her badly when mad. She knew the
asylum was her best place, and she came as