LUNATIC ASYLUMS.

New Zealand Mail, Issue 38, 14 October 1871, Page 15

LUNATIC ASYLUMS.

[lndependent, October 12.] Reverting to the subject of public lunatic asylums, we proceed to remark that it has been made a subject of complaint against them, that they do not adequately promote the recovery of their inmates, or attain to curative results at all commensurate with the cost which they entail. Anyone looking over a file of English asylum reports would notice that the average rate of recovery recorded is only 40 per cent of the admissions—ranging from 19 per cent in some asylums, in which the house steward is the presiding genius and major-domo, up to 55 per cent in others, in which paramount medical authority is maintained. This discovery might at first seem to justify the complaint, and to be of a highly discouraging description. To find that, of every hundred lunatics received into public asylums only forty are restored to reason and liberty, might well be regarded as a painful revelation, if considered apart from various qualifying circumstances. If the admissions into the public asylums consisted altogether of cases of mental, derangement of recent origin, it would certainly be discreditable to the management of these asylums to fail in securing recovery in 60 per cent of such admissions. The fact is, however, that recent cases as they are termed constitute in every public asylum a comparatively small proportion of the admissions, the bulk of which consist of chronic and hopelessly incurable lunatics, or of patients in whom the mental aberration has existed for a considerable time, and survived ordinary treatment. There appears to be a conspiracy to prevent asylums from receiving curable lunatics, and to prevent curable lunatics from receiving appropriate treatment until they have become incurable. A sojourn in an asylum, leaves behind it a ban and disqualification which the relatives of the insane are unwilling to incur. A fear is entertained that the incarcerated insane are not kindly treated; a belief is cherished that restoration to reason may be obtained by home treatment, and hence the insane are not sent to asylums until hope and patience are exhausted, or until some overt act has been committed. Many cases of insanity in which the symptoms are of a mild kind, and in which therefore remedial measures would be especially influential, are detained until violent or troublesome propensities are developed—until the best chance of recovery is irretrievably lost. Thus it comes about that asylums receive only the elite of lunacy, and begin treatment, where it ought to have been left off. The general practitioner has tried his hand : the local panacea has had its turn; spiritual advice or quackery has done its worst, the healing power of time has been invoked ; all these have failed, and then the asylum is resorted to as a desperate expedient, a forlorn hope. But, besides the chronic and confirmed character of many of the patients admitted into asylums, there are other conditions which limit the operation of any curative influences which they may exert. Flesh is heir to many ills and infirmities which we pronounce fatal and irremediable, but which are not therefore f opprobria’ to medicine or surgery. There are many bodily deformities and diseases which we can never hope to rectify or control until our science has made inconceivable advances upon its present position—and so it is with mental defects and disorders. Until we have devised some means of expanding “ the narrow forehead of the fool,” idiots will still be idiots. Until we have discovered the

•elixir of perpetual youth, old men and women will sink irrecoverably into second childishness. Until we can mitigate the primal curse, and obviate the return of dust to dust, we shall still have human folly and vice resulting in irreparable organic disease.. Large numbers of the patients admitted into public asylums are included in the categories of incurables thus indicated. We must recollect that asylums are bound to accommodate all lunatics sent to them. They give no preference to pet maladies, and reject none because of their intractability. They receive the doomed and the dying as well as the recoverable.

The following analysis of 500 consecutive cases admitted into a country asylum in England enables us to estimate the proportion of incurable cases admitted into such institutions, and throws much cheering light upon the practical results of the system of treatment at the present time pursued. Of 500 lunatics admitted in a period short of two years, 195 were found, when admitted, totally incurable, and beyond the reach of anything but palliative treatment, for the following cogent reasons: —14 were congenital idiots ; 15 were above 70 years of age; 42 were in various stages of the euthanasia of general paralysis ; 24 labouied under organic disease of brain ; 52 were epileptics of more than five years standing; 26 were recognised lunatics of more than five years standing ; 22 were affected by well-developed consumption. Of the 305 not included in any of these classes, many were close upon seventy years of age; many were epileptics of less than five years’ duration, while others were affected by constitutional, diseases which would have been pronounced necessarily mortal, but which could not be taken into account in the general summary given above. We find, thus, that of 500 lunatics received into an asylum, fewer than 300, or under 60 per cent., could, on the most liberal construction, be counted as curable or amenable to treatment. The analysis also shows the results of the treatment of the same 500 patients up to the time at which the analysis was made, that is to say, within two years of the admission of the first of the 500. We find that 212 had been discharged recovered ; 14 had been discharged relieved ; that 100 had died; that 51 remained under treatment in an improved state; and that 123 had become worse, and were declining towards dementia or death. Bearing in mind that less thau 300 of the patients involved in the analysis could, even in the most sanguine calculation, be deemed amenable to treatment, we must regard these results as very satisfactory. Of these 300, about 70 per cent, had been cured, and 5 per cent, relieved ; while 17 per cent, were reported as improving. All the 212 patients discharged recovered had been submitted to careful medical treatment, so that the credit of their cure cannot fairly be ascribed to moral influences or a fortuitous combination of events. Besults such as these can, of course, only be attained in well-regulated asylums, in which all, from the sur-geon-superintendent downwards, are thoroughly trained for their work, and have at their disposal means which at present are unknown in most or all of the asylums in this colony.