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sleeping in rooms heated by stoves in which anthracite coal is burned. These stoves have no chimney, and the coal being smokeless, leads the people to suppose that nothing injurious passes from the fire, but of course a large amount of carbonic acid and carbonic oxide is generated, and injuriously affects those exposed to it, causing severe headache, stupefaction, and fever. Many persons have been brought to me semicomatose, who in the cold weather had lighted the stove and
gone to bed, but were afterwards found by their friends to be insensible. Such a state, often repeated, must give rise to cerebral disease sooner or later, and I am sure it does so in many instances.
“ Amaurosis is also very common, the consequence of unremitting application to reading, and also of dissipation and excess. Many of the Buddhist and other priests are subject to this malady.
“ Insanity.—Many cases of insanity and idiocy were seen, but they were for the most part quiet and easily controlled. In one case of acute mania, the young woman had been tightly bound with cords by the wrists till mortification set in, which, spreading up the arms, caused her death. The condition of the insane in a country like China, where there are no asylums, is truly pitiable. The unfortunate sufferers are usually bound fast, sadly neglected, and subject to hard and cruel treatment, in order to precipitate their death, which is urgently desired by their friends and relatives.
“Many epileptics were seen, and deaf mutes are from time to time brought to the Hospital.”
It is quite evident that no satisfactory conclusions can be drawn from the statistical method as applied to these returns, which, in most cases, are rather a simple record of the rough and ready treatment of a general hospital, by men engaged in private practice, than a careful analysis and classification of cases for scientific purposes. But it will be remarked that, whereas the proportion of nervous diseases to general maladies varies thus :-1 to 235, 1 to 297, 1 to 302, 1 to 345, 1 to 316, 1 to 319,1 to 246, 1 to 103, 1 to 90; it is stated to be so rare in one hospital as 1 to 1607, and so frequent in others as 1 in 59, 1 in 58, 1 in 48, 1 in 42, and even 1 in 35. This enormous divergence can only be attributed to the greater nicety of diagnosis practised at some hospitals than others.
Still it may be interesting to compare with these returns of the native hospitals a few which I have by me of the maladies prevalent amongst foreign communities in China, from which it will be seen that the percentage of nervous disorders is much greater, though, as a rule, the residents in our foreign settlements are young, hale and hearty-in fact, generally speaking, people in the prime of life. For this excess of nervous affections the climate is generally blamed. Dr. Scott, of Swatow, for 1870, reports upon 361 cases of general disease amongst the foreign population, of which 12 belong to the nervous class, or 1 in 30.
Dr. Somerville, of Foochow, returns a total of 496 cases for 1872, of which 19 were classed under the neuroses, or 1 in 26, as follows:–Heat apoplexy, 1; sun malaise, 13; tetanus, 1; sciatica, 1; neuralgia, 3.
Dr. Wong, of Canton, makes a return of 204 cases of disease amongst foreigners during 1872, of which 12 were nervous cases, or 1 in 17, thus :-Sunstroke, 2; neuralgia, 6; paraplegia, 1; cerebral exhaustion, 2 ; hysteria, 1.
Amongst the foreign community of Shanghai, numbering between 2000 and 3000 souls, during the half-year ending September, 1872, there took place in all 63 deaths, 16 of which, or nearly one-fourth, were from affections of the nervous system, as follows :-Disease of the brain, 1; heat apoplexy, 10; spinal arachnitis, 1 ; delirium tremens, 1 ; infantile convulsions, 3.
During the succeeding half-year (cool winter season), 50 deaths occurred, of which only 6, or fth were from affections of the mind and brain, thus:-Suicide, 1; brain disease, 4; epilepsy, 1.
On the Family Care of the Insane in Scotland. By PROFESSOR
FRIEDRICH JOLLY, of Strasburg.* The treatment of the insane in families, and the system pursued at Gheel, are generally regarded as identical. The experiment which has been going on for centuries in the little Belgian town appears to satisfy all the requirements of a crucial experiment; and it is supposed that it furnishes in its results a demonstration of the worth or worthlessness of the family system of treatment. Friends and foes have long 1875.] On the Family Care of the Insane in Scotland.
* It seldom happens that any portion of our lunacy, administration is dis. cussed in detail by foreign writers. As such discussions when they do take place ought to be specially valuable to the readers of this Journal, it has been thought a translation in full of this interesting paper would prove acceptable, The original appeared in the Archiv. für Psychiatrie, V Bd., 1 Heft, 1874. -TR.
been accustomed to investigate the matter at Gheel, and to found their respective verdicts on the system which they may have observed there.
As one glances over the copious literature which is devoted to the subject, it almost appears as if there was an ever increasing conviction in regard to at least one point, that the Gheelese system is suitable or desirable only in the country of its origin; and that there can be any considerable development of it in other places, which have not been prepared for it by centuries of usage, appears to be inconceivable.
Indeed, the imitations of the system which have been attempted in various parts of England and Germany have nowhere had any special success. In England these attempts have generally been given up, and the family treatment of the insane has neither there, nor with ourselves, been adopted to any great extent. The general belief has been that the experiment made in Scotland for carrying out the family system had no greater significance than the others; and it was prophesied that its fate also was to fall rapidly into oblivion. Even among the English members of the profession, though nearer than we are to the locality, the Scottish experiment is generally looked upon as nothing more than a personal whim of the Scottish Commissioners, and as having already within it the seeds of dissolution. An illustration in point will be found in the ironical remarks which the reviewer in the “ Journal of Mental Science” makes on the Fourteenth Scottish Report when dealing with this question. (January, 1873, Vol. xviii., p. 549.)
In the summer of last year (1873), after a short visit previously made to Gheel, I arrived at Edinburgh, holding views very similar to these; but while there I found occasion to modify my ideas essentially. By the friendly services of Sir James Coxe, one of the Commissioners in Lunacy, I made an excursion, in company with an Inspector of Poor, to one of the lunatic colonies. This visit, and the information furnished by these gentlemen, as well as a more careful study of the Scottish Reports and their appendices, convinced me that it is no “Gheel in the North" with which we have to do, but an organisation which rests on a quite different and much sounder basis.
I may now give a short description of the “colony" which I visited. It was the village of Kennoway, situated in the upland which stretches to the north of the Firth of Forth, and easily reached from Edinburgh. It lies in a pleasant neighbourhood, is of considerable size, and presents a moderately well-to-do appearance. Round about there are a number of scattered farm-houses, in which some of the patients are boarded, so that one has to make a tour of considerable extent to see them all. On the whole, however, the number, if regarded by the standard of Gheel, is but small. There are at present not more than 47 boarded in the whole village and neighbourhood. Of these there were 27 to whom we directed special attention; the others we saw only in passing and imperfectly. The 27 belong to the parish of Edinburgh, are boarded here at its expense, and are visited at least every quarter of a year by the inspector of the poor of that parish. Opportunities also occur for incidental visits, such as that in which I took part. It has also to be noted that, in addition to these inspections, there are also visits specially paid for and regularly made by a medical practitioner resident in the neighbourhood; and that at least one yearly visit must be made to the colony by a Commissioner in Lunacy, who has to make a detailed report upon it. A book is placed in every house for the purpose of recording in it the visits paid, and the observations made, A second book, containing the state of the account between the inspector of the poor and the guardian, gives information regarding the payments for board and other expenses which are incurred on behalf of the patients.
Most of the houses that we visited consisted merely of a ground floor and attics; a few only had a first story. On the ground floor there were, besides the kitchen, one or two other apartments, which were generally used both as sitting-rooms and bedrooms. In some houses there was a bed in the kitchen also. The beds, which were everywhere carefully inspected by my conductor, consisted invariably of palliasse, mattress, and bedclothes, and were, without exception, clean. There appeared to be no real difference between the bedding of the sane and the insane. I received the impression throughout that the patients enjoyed the same attentions and comfort as the families of their guardians. They eat at the same table, sleep, in many instances, in the same rooms, and move about with complete freedom in the houses and neighbourhood.
It is precisely the same impression as was produced at Gheel in such houses as contained quiet and cleanly patients, and have there furnished so much cause for enthusiasm to the advocates of the family system. Some further information in regard to the Kennoway patients
will give an indication of the Scottish manner of selecting patients suited for family treatment.
Of the 27 patients only four were men. This preponderance of the female sex is also found, though not so markedly, in looking at the total number of patients under family care. There were, for instance, 645 men and 847 women, among 1,492 pauper lunatics who, according to the last Report, were so placed on 1st January, 1872. The male portion of these by no means belonged to the class of lunatics whose labour might be made profitable. Those, at least, whom I saw in Kennoway, were physically helpless imbeciles, who might, indeed, be got to do a little work, but more for the sake of providing them with occupation than to make them really useful. Generally the same state of matters exists in the other “colonies.” The women whom we visited were sometimes engaged in knitting or sewing, or assisting in the house work; but very few gave the impression of being able to earn by their work any appreciable part of their mainten
Another circumstance which struck me as remarkable and different from what is seen at Gheel, was the absence among the women of those belonging to the earlier periods of life. Only one was but of the age of 25 years; the next youngest was 34; the next 39; all the rest were over 40, and the greater number over 50 years of age. And this is not accidental but the result of a principle, which seems to be generally adopted in the selection of the patients. Females of child-bearing age are entrusted only to families who can furnish special guarantee of suitability. And there can be no doubt that in this manner a well-known danger connected with the system is, to a great extent, if not altogether, obviated. We shall, however, return to the discussion of this point.
The maximum number of patients that may be placed in one family has hitherto been fixed at four, though this number is only rarely reached. But the experience which has now been gained leads to the conviction that it is not desirable to board more than two patients in one family. In his last report on this subject, Dr. Sibbald expresses himself as follows—“What should be aimed at is, if possible, to merge the life of the insane inmates in that of the household. But when there are more than two such members, they overwhelm and destroy, instead of contributing to, the family life.” And I received the same impression in the two houses in Kennoway, in which four female patients were boarded. The other