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482 Mr. Tuke on the Cure of Lunacy.
establishment, issuperior to that of the Retreat; but whether the cure of the recent cases admitted into this establishment has been prevented by their mixture, in the same establishment, with the confirmed class. Of the probability of this, your readers shall judge for themselves from the following statement.
It appears from the tables published in
the year 1812, in the “Description of the Retreat,” that there had been admitted, from the commencement of the institution in 1796, one hundred and forty-nine patients, of whom eighty-eight were of that confirmed class which T. Bakewell admits, under his treatment, to be rarely susceptible of cure. Of these, sixteen have been discharged perfectly recovered, and six others in a state so much improved as not to require further confinement. Of the sixty-one cases in which the disease had not continued more than twelve months previous to admission, it appears that seven have died, ten remain in the house, four have been removed, either convalescent, or in so improved a state as not to require confinement, and forty have been discharged perfectly recovered. It appears from this statement, that out of the sixty-one recent cases, twentyone have either died, been removed, or remain in the house in an uncured state ; and it is highly deserving of enquiry, whether, under a different mode of treatment, this unhappy number might have been diminished. It may be seen in the tables above alluded to, that four out of the seven deaths took place within three months of admission ; and I find, on enquiry, that three of these deceased patients were in a dying state at the time of admission, and the fourth had had two apo
remain in the house, I find that three had been for years distinguished by great peculiarities; and though the disease might not have been so decidedly marked, for more than twelve months, as to justify a medical certificate for removal to a place of confinement; yet these cases could not be considered as recent, and were perhaps quite as hopeless as if a decided state of mania had continued for two years. Of the other seven uncured cases, remaining in the house, I have no observation to make, except that the disease, in five instances, had been of more than three months duration at the time of admission. Of the four cases removed, in an improved or convalescent state, one continued recovering, and, I have reason to believe, is perfectly well; I do not know that any of the remaining three are perfectly recovered, but they had been ill more than three months when they entered the house, and, it is to be observed, that Bakewell, in the statement of his cures, only considers such as recent, in which the disease had not been of more than three months duration at the time of their coming under his care. This difference between the application of the term recent to cases of twelve-months, as at the Retreat, or of only three months standing, as at Spring Vale, materially affects the probability of cure. H have enquired what number of cases have been admitted into the Retreat which come under this latter definition of recent, and I find it to be thirty-six. Of this number four have died, three of whom, as before mentioned, were in such a state of bodily disease, at the time of admission, as to afford no hope of recovery; the fourth was the elderly patient before described. Of the remaining thirty-two cases, thirty have been discharged perfectly recovered, and two out of thirty-six remain uncured, to justify the assertion of Thomas Bakewell, that the separation of curable and incurable cases is essential to recovery ; and that, at the Retreat, the eure, if not lost sight of, is a secondary object. As the tables, from which the preceding statement is chiefly derived, were published in the year 1812, I will beg leave to add here the following short extract from the
last report of the Retreat, which is dated the 29th of the 6th month, 1815:—“ It is worthy of remark, (say the Directors) as affording satisfactory evidence of the good management of the institution, and of the importance of early attention to cases of insanity, that, of the sixteen recent cases admitted in the last three years, fisteen have already been discharged recovered.” During these three years the proportion of old to recent cases in the Retreat has been at least five of the former to one of the latter. I am aware that the preceding statements do not decide the question, whether curable and incurable patients may be best provided for in the same establishment; but I think they will sufficiently prove, that as many cures, in curable cases, have been made in an establishment where this mixture has taken place, as in any asylum, not excepting Spring Vale, with whose reports we are at present acquainted. And I trust it will also satisfy those magistrates who are forming asylums with the two objects before mentioned, that their plan is not necessarily Calculated to increase the number of incurable lunatics. My friend Bakewell will doubtless urge the difference in time which the patients who have recovered at the Retreat and Spring Vale have.continued in their respective establishments; and it does appear from the published statements of each, that the process of cure has been much more rapid in the latter than the
Their different circumstances will,however, in great measure explain this difference. The expence of maintenance at Spring Vale will naturally induce the friends of patients to remove them as early as they can ; but this inducement does not exist at the Retreat, where a majority of the patients are supported at from four to eight shillings per week; and it happens that those who recover seldom remain less than three, often six or more, months in the house, after they are considered well. This is allowed by the committee, at the request of the friends of the patients, and with their consent, from the difficulty which very often arises in providing suitable situations for them on their recovery. The small number of
relapses which have taken place aster patients have left the Retreat, induces me to think that these detentions have been salutary. It has, however, frequently happened that relapses have taken place during the detention, which have, in several instances, materially protracted the ultimate recovery, and the first is not noticed in the tables from which Thomas Bakewell has drawn his inferences. Indeed in some of the cases, where the patients appear to have been several years in recovering, they have been, during that time, more than once discharged recovered, and have returned to the house. In several of these cases only the last discharge is noticed in the tables published in the “Description of the Retreat.” Perhaps a different mode might have been fairly adopted, which would, of course, have increased the proportion of recoveries, and diminished the time which they appear to have taken. I am, however, far from imagining that no improvements are to be made in the medical or moral treatment at the Retreat, or that it surpasses, in either of these respects, all other establishments. And, though it is desirable that the experience of this, and all similar institutions, should be fairly laid before the public, I should not have offered these observations and statements, if it had not been for the important inferences which Thos. Bakewell has attempted to draw from the proportion of cures which have occurred in the Retreat. The chief argument in favour of distinct establishments for recent cases of insanity, seems to be, the probability of their claiming more particular attention than where they are united with those cases which afford no prospect of successful treatment. Our own hospitals of Bethlem and St. Luke's are oecupied chiefly by recent cases; and the plan of separation is, I believe, adopted in the French asylums. The success of these establishments in the cure of lunatics is not much in favour of their plan. In favour of the union of old and recent cases in the same hospital, it is to be remembered that the former very often supply a most useful class of assistants, and the probability of recovery in old
cases is not so small as to consign them to that neglect which would probably prevail in asylums for what would be considered incurable patients. I do not mean, however, to assert, that there are very material objections to the plan of separation proposed by Thos. Bakewell, but I will confidently say, that his main objection to the plan now generally adopted in lunatic hospitals, is either chimerical or unfounded, and that the proper classification of patients, according to their state of mind, not the duration of the disease ; and such a limitation of the number of patients as to be well observed by the superintendant, are objects of much greater importance than the provision of distinct asylums for old and recent cases. SAMUEL TUKE. York ; 17th of 5th month, 1816. --To the Editor of the Monthly Magazine. SIR. NDER the article “ Observatory,” in Dr. Hutton's last edition of his Mathematical Dictionary, a compilation of considerable worth and merit, I have noticed two mistakes, which I will beg leave to correct, through the medium of your very extensively circulated Magazine. The first is, where the doctor asserts that the Hon. Charles Greville had an observatory, on a great scale, at Milford. The fact was, that just as the building, intended for an observatory, was nearly completed, the honourable gentleman died, and the instruments designed for the observatory, after having lain at Milford, in packing cases unopened, for about a twelve-month, were sent to Mr. Troughton's, in Fleet-street, for sale. In pointing out the second mistake feelings of interest will manifest themselves. Among the private observatories of the present day, Dr. H. adds an alphabetical list of the places where they are situate, with the names annexed of the astronomical amateurs to whom each belong. Annexed to the word “Woolwich,” how
ever, he inserts Royal Mil. Acad.* Now
the fact again is, that there is no observatory at this institution. The only obser
* Vide vol. xxxvi. of the Magazine, p. 100; or the number for Sept. 1813.
vatory at Woolwich is one built by myself, contiguous to my dwelling-house, on the common, which, it is presumed, although upon a small scale, is not exceeded, for the excellency of its instruments, its perfect convenience, and compactness, by any of the private ones mentioned in the list. And I crave permission here to dilate a little on its description.
It is furnished with one of Mr. Troughton's best transit circles,t supported by a large old cannon, having a thick cast iron circular cap, fastened to the face of the piece with strong screws, on which the instrument rests. The cannon is sunk into the ground, as far as the trunnions, and firmly secured by powerfully ramming in the surrounding materials. In order that the circle might be lifted up with facility, for alternating the pivots, an adjustment at first absolutely necessary, and afterwards occasionally, a crane, for this purpose, with rackwork, is attached to the east side of the observatory. The transit clock is of the best construction, having one of Mr. Troughton's improved compensating pendulums. The wires in the telescope of the circle are illuminated by a lamp fastened to the cannon below, instead of, as is usual, to the end of the perforated axis, which improvement precludes the communication of heat to any part of the instrument. The modes of shewing light to the clock and micrometers are most conveniently devised. Superadded to these might be named a variety of clocks, angular instruments, and reflecting and refracting telescopes, capable of high magnifying powers, which are occasionally applied to a substantial polar axis, and other stands, for readily viewing the heavenly bodies.
It is possible that Dr. H. might have supposed, that the observatory, with the whole of the appendant instruments now briefly described, belonged to the Hon. Board of Ordnance, and that they were placed under my superintendance, as constituting a part of my duty at the academy; but the very reverse is the case, the whole being my property, which, with truth it may be asserted, is
a source of the most rational amusement and inexpressible gratification to me during the intervals of professional engagements. L. Evans. Woolwich, May 6, 1816. -- To the Editor of the Monthly Magazine. SIR, Who men are impressed, and more particularly when they enter, they should not be sent immediately on a foreign station, until they visit the port to which they belong, which in ght be done by permitting them to find a proper substitute, or to give security to a certain amount. There are very few who will not be able to obtain one or the other. A certain time of liberty should then be allowed them. The impress service should be confided to very different persons from those to whom it is generally entrusted, and who are frequently the refuse of mankind; a seaman never forgives the out age of being seized upon by such miscreants. This abuse too often arises from the neglect of the Admiralty orders to officers commanding gangs, who leave it to men most improperly selected. A gang is seldom headed by a proper officer. The persons employed upon that service should possess a kilowledge of seamen, with a great share of prudence. When people are impressed from any ship, it should be the duty of the officer who performs that service to afford the ship immediate help, and to take her i.1to her destined port, and the wages of the men ought to be secured to them while on board, and they should be under the control of the officers of such ship. No impress should take place abroad, except under the most imperious necessity, and rules should be laid down for its proper regulation. No ship bound to a foreign station should be permitted to send on board of outward-bound vessels, and take, from them one or two men, as is often the case at present, contrary to the orders of government. It is also necessary that apprentices should be protected by some better rules; which, upon any officer presuming to transgress, he should be amenable to punishment,
Plans for removing the Impress. 485
When men have served a certain time in the navy, according to rank, situation. and trade, they should be free from the impress, agreeably to certain regulations, different situations, and tonnage of ships: making a difference between those who have entered, those who are impressed, and those who have left their country, during the time of war, to evade their services in the navy.
Perhaps the following propositions will be found to contain the outlines of the object in view :--
The East insia trade, as now conducted, is a waste of men ; instead-of raising them, having no apprentices as seamea, (except officers, servants, and midshipmen, are considered such, which I do not.) and whie they can navigate their ships with foregoers and Lascars, no chaage will take place. This trade ought to raise at least as many seamen as it now gives you, instead of drawing upon the navy, or other trades, to answer its purpose.” What advantage gover, meat can possibly deem they obtain from the present mode is beyond my comprehension. That it tends to impede the raising of seamen, is sufficient proof against it without advancing any thing further upon the subject. With respect to this trade I should propose, that, at the conmencement of a war, the first and second officers be exempt from the impress. either on board or on shore. It the third officer had served one year in the navy, prior to that time, he also should be exempt. The fourth officer two years. The fifth and sixth officers, of all ships above six hundred tons, three years. Boatswains, carpenters, and gunners, four years. Cooks, stewards. &c. six years. Seamen eight years. And if it should be necessary to retain them one year longer, in that case they should receive double wages. All those who fill such situations at the commencement of a war, not having served in the navy during war, provided they enter into that service, shall be discharg— ed at the ends of the periods abovemenned with British-born subjects, at least to
* It is an understood arrangement between government and the Fast India Company, or the owners of ships, that each ship shalf turn over in india a certain number of Brit sh seamen to thc mow, of war on the station. This is a negative made of maining the navy.
tioned : but if impressed, then two years more to be allowed for exemption. Every ship should carry one apprentice, during war, for every fifty tons of tonnage. , Half of whom should be indentured from seventeen years and upwards for three years. And no apprentice should be impressed under the age of twenty if he has not been five years at sea. All men who leave their country during time of war, and go into foreign service, or that are in foreign service, and do not return within a limited time, should be liable to double servitude if impressed. In the West India trade the first mate should be exempt as above; the second mate, at the expiration of three years, in ships of five hundred tons and upwards. Third mate four years. Boatswains and carpenters five years. Gunners, stewards, and cooks, seven years. Seamen eight years. And the same regulation should apply to all other vessels trading southward of the Canaries. The West India Dock system, at present, with respect to apprentices, causes the loss of at least one thousand seamen annually. In the American, Mediterranean, and Baltic trades, the first mate, if he has served one year in the navy, should be exempt from the impress. Second mate four years. Boatswains and carpenters six years. Gunners, stewards, and cooks, seven years. Seamen, eight years, &c. In the coal and coasting trades, first mate three years; second mate five years; other officers seven years; and seamen eight years, &c. No vessel under fifty tons should protect a master except he has served three years in the navy, unless such vessel have two apprentices belonging to her; one of whom shall be seventeen years of age or upwards when indentured. Ships employed in the Greenland trade and fisheries, should have regulations adapted for their purpose suitable to the above. Apprentices the same. All running ships and packets should carry four apprentices to every ten of their compliment of men; half of each class. All ships under the British flag, sailing to or from Europe, should be man
the extent of two-thirds of her complement, with their proportion of apprentices. A certain regulation should take place with respect to men in all other water employments; for whom I do not venture to offer regulations for want of proper information on the subject. Transports should have three apprentices to every one hundred tons, half of whom should be above seventeen when indentured. Apprentices should not be permitted to enter into the navy without the approbation of their masters, and in that case the unexpired term of apprenticeship should not be allowed as a part of the term of exemption, and the regular bounty should be granted to the masters. All men who have performed their services in the navy agreeable to these rules, should have a decided preference, as long as their conduct deserves it, during and after a war, in all shipping employments belonging to government, public docks, pilotage, &c. and the freedom of any town in the kingdom, where they might choose to settle or reside, after the war, should be theirs by right. It would be desirable to institute public schools, founded upon voluntary contributions, in or near sea ports, devoted to the education of children of persons actually serving in the navy. And when their service expires, the education might be continued ; but this must be regulated by the extent of the funds. At the conclusion of a war, or at the expiration of time of servitude, the men should be conveyed, free of expense, to their nearest place of residence. No ship should be allowed to sail outwards, at the commencement of a war, with more than one-third foreigners for the first two years ; one-fourth for the third year; one-sixth for the fifth year; one-seventh for the sixth year ; one-eighth for the seventh year, and the remaining period of war. This may be
governed as circumstances require. Four years actually employed in the
merchant service should be equal to two
years in the navy. A certain portion of lieutenants em