Various, then, are the functions of our a.s.sociation. But what, asks the late Sir James Stephen, the eloquent writer in the _Edinburgh_ is a party, political or religious, without a Review? and he replies, "A bell without a clapper." Such a bell would this a.s.sociation have been without its _Journal_, and it must gratefully attribute much of its success to the ability with which in the first instance Dr. Bucknill, and subsequently Drs. Robertson, Maudsley, Sibbald, and Clouston, have helped to make an otherwise clapperless bell articulate.

Through this organ of the a.s.sociation, for which, speaking for my colleague and myself, I would venture to ask your loyal co-operation, much scientific work can be brought before the profession, many questions can be systematically discussed, and the invaluable experience of the superintendents of asylums on practical points be presented to its readers and permanently preserved.

The objects I have mentioned as calling for further attention, and many more, belong to the future of Psychological Medicine, and as I began my address with proposing to review the period bounded by the years 1841 and 1881, I will close it with expressing the hope that when a successor of mine in this office reviews the then vanished period between 1881 and 1921, he will be able to report an accelerated ratio of progress compared with that of the time I have attempted, so inadequately, to survey.

And may the Medico-Psychological a.s.sociation, which I trust will always be identified with this progress, be about to enter, after its wanderings, "forty years long," a land flowing with milk and honey, won by conquests over ignorance, superst.i.tion, and cruelty--the triumphs of the application of humanity and medical science to the relief of mental weakness and suffering.

FOOTNOTES:

[292] Presidential Address, delivered at the Annual Meeting of the Medico-Psychological a.s.sociation, held at University College, London, August 2, 1881.

[293] I here do homage to the dead. Calmeil, Baillarger, and Brierre de Boismont still live, at an advanced age. (Since this address was given, the last named has died. See eloquent tribute to his memory by M. Motet, in _Journal of Mental Science_, April, 1882.)

[294] As will be seen by the history of lunacy reform contained in this volume, Lord Shaftesbury's interest in the movement extends back as far as 1828.

[295] _American Journal of Insanity_, April, 1855.

[296] 9 Geo. IV., c. 40.

[297] Amended by 18 and 19 Vict., c. 105 (1855). Acts referring to Lunacy Commissions and Chancery Patients, 16 and 17 Vict., c. 70; 25 and 26 Vict., c. 86 (1862).

[298] If parts of workhouses, etc., be included, 166. See p. 211.

[299] I should find it difficult to point to a more striking ill.u.s.tration of these remarks than the good work being done at the Lenzie Asylum by Dr. Rutherford.

[300] "On the Construction, Organization, etc., of Hospitals for the Insane," by Thomas S. Kirkbride, M.D., LL.D. (Philadelphia, 1880), p.

300.

[301] On the large degree to which patients, as shown by the experience of the Chancery Visitors, can be treated satisfactorily outside asylums, see pp. 261 and 286; also Dr. Bucknill's trenchant little book, "Care of the Insane and their Legal Control," 1880.

[302] "Ideal Characters of the Officers of a Hospital for the Insane,"

by I. Ray, M.D. Philadelphia, 1873.

[303] See Dr. Baker's Annual Reports of the York Retreat, and Dr. Rees Philipps's last Report of the Wonford Asylum, Exeter, etc., etc.

[304] "A Treatise on the Nervous Diseases of Women," by Thomas Layc.o.c.k, M.D., 1840, chapter ix. p. 107.

[305] _British and Foreign Medical Review_, January, 1845, p. 311.

[306] "Remarks on Insanity, its Nature and Treatment," p. 14.

[307] "I agree with Mr. Martineau in repudiating the materialistic hypothesis as utterly futile."--Herbert Spencer, _Contemporary Review_, June, 1872.

[308] "Die Freiheit der Wissenschaft im Modernen Staat," by Rudolf Virchow. Berlin, 1877.

[309] Preface to his work on Mental Alienation, p. 20.

[310] "General Paralysis of the Insane," by Wm. Julius Mickle, M.D., M.R.C.P. London, 1880.

[311] Among the groups of cases in which they were more decidedly present is that comprising many due to syphilis; that in which degenerative changes follow upon haemorrhagic softening, and another in which they succeed to occlusion of vessels and its immediate results. In another, degeneration and atrophy follow, the brain state conditioning acute insanity; and in another they are secondary to brain injury, not to mention many other groups.

[312] In the same department the services of another American alienist, Dr. Edward Jarvis, ought not to be forgotten. Among other works, his Report on the Idiotic and Insane in Ma.s.sachusetts, 1854, was of great value.

[313] It is a remarkable fact, showing the ma.s.s of incurable cases which have acc.u.mulated, that the number of curable cases now is only about 1000 more than it was in 1844 (2519).

CONCLUSION.

In completing the task which the author has attempted in the foregoing chapters in the History of the Insane in the British Isles, he is only too conscious that, in the endeavour to be concise as well as comprehensive, he has made many omissions. With every desire to be fair to all who have been engaged either in originating or in advancing the improved treatment of those who, suffering cruelly from a malady involving their very nature and being, have also been treated cruelly by their fellows, the writer fears that some names which ought to have been recorded and some inst.i.tutions which ought to have been honourably mentioned, have been pa.s.sed over in silence. Apart from unintentional oversight, it is not always easy to find in the Temple of Fame the precise niche in which to place the figure that would rightfully fill it, and the consequence is that the pedestal, as in some of our great public edifices, remains unoccupied. It may be said, however, in extenuation of any such omission, that it did not fall within the scope of this book to chronicle all the establishments which, in more humane methods of treatment, have been in advance of others, still less to complete the history up to the present day of those which have been mentioned. As it proceeded, the work has entered more into detail than was originally designed; thus, in the chapter on Scotland the sketch is filled in with particulars somewhat out of proportion to that attempted in the earlier chapters.

Again, in crediting various asylums, as Lincoln, Hanwell, and Lancaster, with introducing non-restraint, the author has not found s.p.a.ce for more than a reference to the meritorious course pursued at an early period at the Suffolk Asylum, the Gloucester Asylum, and at Northampton from its opening (1838), and at the Haslar Hospital.[314]

The writer would have been glad, had the proposed limits of the book admitted of it, to describe much more fully the rise and growth of those charitable inst.i.tutions, the endowed or registered hospitals for the insane, which have in England formed so important, and, on the whole, so successful, an experiment in providing care and treatment for the insane of the poor but non-pauper cla.s.s, supplemented as they have been by the payments of the rich. At the present moment, the principle and the method by which these inst.i.tutions are governed attract much earnest attention, and appear to not a few to afford the best alternative provision for the middle and upper cla.s.ses, as against asylums carried on by private enterprise. It may be so. Abuses which in former days were possible, could not occur under the legislative restrictions of our time; but it must not be overlooked that their annals have disclosed, in some instances, abuses as great and inhumanities as shocking as any that have disgraced the history of private houses. How abominably even such inst.i.tutions have been managed, has already been depicted in a notorious example; how admirably, might have been shown, had s.p.a.ce allowed, as regards the same inst.i.tution in the hands of men who, like Dr. Needham, have maintained the reforms previously introduced within its once dishonoured walls, and carried forward that humane system of treatment which, Phnix-like, arose from its ashes. The author would have liked to do justice to other hospitals--as that at Northampton, which under Dr. Bayley's remarkable power of organization has proved so great a success; that at Cheadle, which under Mr. Mould's exhaustless energy has shown how the various needs of different phases of mental disorder may be met by various modifications in the provision made for their care outside the walls of the asylum, thus combining cottage treatment with the control of the central establishment; and, lastly, that at Coton Hill, Stafford, which now and for many years has been superintended by Dr. Hewitson--an inst.i.tution due to a wave of public feeling in favour of an inst.i.tution for those in reduced circ.u.mstances, which bore this practical fruit after some temporary discouragement.

Of the work done by county asylum superintendents it is impossible to speak too highly; in fact, it would be difficult to know when to stop, were one to be mentioned. Superintendents of the vast asylums of Middles.e.x, Lancashire, and Yorkshire deserve the recognition of services performed day by day with faithful diligence, not always sufficiently appreciated, and not always without peril, as instanced in the case of the late superintendent of Brookwood, Dr. Brushfield.[315]

As of those whose hourly labour is performed in these and other inst.i.tutions, so of those who were labourers, however humble, in the early days of asylum reform at the close of the last and the beginning of the present century, it must never be forgotten that work un.o.bserved by the public eye, but conscientiously performed for the unfortunate cla.s.s which, to a large extent, is unable to appreciate or thank the kindly hand which shields them from cruelty or saves them from neglect, will find its reward in the conscience; and also in the increased happiness of those whom it benefits, though it may not set the worker on any pinnacle of fame. It is to such that the author of "Romola" refers when speaking of the "valiant workers whose names are not registered where every day we turn the leaf to read them, but whose labours make a part, though an unrecognized part, of our inheritance, like the ploughing and the sowing of past generations."

FOOTNOTES:

[314] See Report of the Metropolitan Commissioners. 1844.

[315] Since the above was in type, another example has occurred in the case of Dr. Orange, who has been a.s.saulted by a criminal lunatic, and narrowly escaped serious injury.

APPENDIX A.

(Page 61.)

In addition to the maps of Ralf Agas (cir. 1560?) and Braun and Hogenberg (1572), there is an earlier view of London and Westminster by Anthony van der Wyngrede, 1543, in the Bodleian Library, Oxford, but it is worthless for the purpose of tracing the outline of Bethlem. No additional light is thrown on the buildings by the view of London and Westminster in Norden's "Speculum Brittanniae," engraved by Pieter van dem Keere, 1593. It appears to be agreed that, whatever the date or designer of the so-called "Agas" may be, it is "the earliest reliable survey of London." Virtue's reprint is dated 1737. Mr. Overall's "Facsimile from the original in the possession of the Corporation of the City of London" was published in 1874. It is, however, only by a careful study of the original with a magnifying gla.s.s and a good light, that the outline of the Bethlem buildings can be made out.

Smith, in his "Topography of London" (1816), p. 36, says that the only plan of London showing the first Bethlem which he had been able to meet with is that by Hollar. This map showed Moorfields divided into quarters, with trees surrounding each division, the site of the second Bethlem being then an uninterrupted s.p.a.ce, and a cl.u.s.ter of five windmills standing on the site of the north side of Finsbury, a part of which in Mr. Smith's memory was called Mill Hill. Hollar's rare map (1666 or 1667) is so much later than Agas, that we have not followed its distribution of the buildings. In Faithorne's map, published a few years earlier (1658), from a survey in 1640, "Bedlame" is represented as a quadrangle, with a gate in the wall on the south side. There is a very clear outline of the first Bethlem in Lee and Glynne's map of London (in Mr. Gardner's collection), published at the Atlas and Hercules, Fleet Street, without date. This map is also in the British Museum. Mr. Coote, of the Map Department, fixes the date at about 1705. Rocque's map of London (1746) shows Bethlem distinctly. This map, and Ogilby's, formed the basis of Mr. Newton's "London in the Olden Time," 1855.

With regard to the story of the skeleton in irons and Sir T. Rowe's burying-ground, mentioned at p. 49, it is not disputed that he was concerned in the burying-ground of Bethlem; but the skeleton appears to have been found some distance from this spot. What is stated in Strype's "Stow" (Bk. ii. p. 96, edit. 1720), is that in 1569 "Sir Thomas Rowe caused to be enclosed with a wall about one acre, being part of the said hospital of Bethlem, to wit, on the west, on the bank of Deep Ditch, parting the hospital from Moorfields. This he did for burial in case of such parishes of London as wanted ground convenient within their parishes. This was called New Churchyard near Bethlem."

There are some very fine prints of the _second_ Bethlem Hospital in the Print Room of the British Museum. Of these (to which Mr. Crace's collection is a recent valuable addition), and the prints in Mr.

Gardner's private collection and the Guildhall Library, the following list has been prepared. I have again to thank Mr. Gardner and Mr. Coote for their a.s.sistance. I have also to thank Mr. Crace for allowing me to see his prints before they were removed to the British Museum.

VIEWS OF BETHLEM HOSPITAL.