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three or five years that he requires of them ?There is a vague but atrue saying, that thereare but two ways of doing a thing; that is,doing it well and half doing it. The latterof these the great adviser of the poor-lawcommissioners seems to have adopted ; forif he wished that one particular part ofthe Act should be carried into force, whynot have requested the commissioners not toenforce it until the next election of medicalofficers; for no doubt numbers of gentlemenhave engaged assistants at the last election,many of them having undergone the greaterpart of their study in town, and are now com-pelled to part with them at a great inconve-nience to both.Mr. G. again states, that in his official

capacity as president to the college, thatmany gentlemen have made a merit withhim that they have attended the poor fortwo or three years without any previousknowledge of anatomy, surgery, &c.: buthe does not state whether these were moreproficient than those who had not performedthat office. This is the great point for con-sideration, whether those who have neverseen any country practice previous to their

coming up for examination, are more profi-cient than those whose lot it has been to haveexperienced it. If Mr. G. would set thispoint of the question at rest, there might besome grounds for his assertion. I remain,Sir, your ever attentive reader,


Wincanton, Somersetshire,April 15, 1842.




To the Editor of THE LANCET.

SIR,—The battle of humanity is foughtand won, and little now remains for the0 Looker-on" but to register the number ofadherents to the new dynasty. He has thisweek the unqualified gratification of addingto the list the name of Mr. Hitch, of Glou-cester, who, with a judicious mixture of en-terprise and caution, has gradually carriedout the new system in his admirably regu-lated asylum, and has now presented to the Ipublic a valuable report of his proceedings.Twelve months ago Mr. Hitch was a disbe-liever in the practicability of the entire aboli-tion of restraint: he honestly said as muchin his report, and his asylum exhibited afew, though but few, unfortunates, whom hedeemed it necessary to coerce; but the spec-tacle was so inconsistent with every other re-gulation of the establishment, and so opposedto the judicious and enlightened views ofMr. Hitch, that the " Looker-on" venturedat that time to prognosticate that the civic

crown would be awarded to him, as the firstsuperintendent who had abolished restraintagainst his own preconceived opinion. Hearthe following extract from the report of thevisiting committee just published, and ac-

knowledge the fulfilment of the prediction :-" The visitors have likewise during this

year sanctioned-in fact, but not as a uni-versal regulation-the total disuse of all me-chanical restrictions on the persons of theinsane. It has ever been the practice of themedical officers to use as little restraint aswas deemed compatible with the safety ofthe patient, or the protection of those abouthim; but they admit with the visitors, that,up to this time, all the patients are as securelymanaged, and are governed with much lessdifficulty and disturbance, WITHOUT than WITHmechanical assistance." From the causes above-named, and, per-

haps, from others not at once cognisable, theasylum has during the past year exhibited avast increase of good order and comfort.The exercising grounds, formerly scenes ofoccasional riot and confusion, with indica-tions of mischief and destruction scatteredon all sides, are now laid out as vegetableand flower gardens, and planted with fruittrees. To these, all the patients of eachclass and sex respectively have constant ac-cess, and yet the productions of each arepermitted to flourish, and their fruits to attainmaturity."When to this candid and manly avowal

the gratifying fact is added, that the humanesystem is now in full operation under its

newly-appointed superintendent at the RoyalHospital at Portsmouth, it may be well saidthat the battle of humanity is fought andwon.

But there are other parts of this valuablereport to which I would call the attention ofyour readers. 1st. The Gloucester Asylumis not confined to pauper patients : it affords,therefore, an opportunity of practically testingthe success of the humane system amongstpatients of the middle and higher classes ofsociety, which is wanting in pauper asylums.The number of admissions of these patientsin 1841 was forty-eight; the number of curesthirty, or upwards of sixty-two per cent.,being a much larger average than the curesat Bethlem, although the admissions are notlimited as in that hospital to recent cases.

2ndly. It brings prominently forward thefundamental principles of the new system ofmanagement, that is to say, the treatment ofthe sufferers as beings not wholly deprivedof moral and intellectual qualities, the en-couragement in them of habits of self-respectand self-control, the provision for their enjoy-ment of the beauties of the all-glorious crea-tion, and the privilege to mingle and associatewith their fellow-men.

« Musical entertainments within the walls,and attendance on public amusements, areof so frequent occurrence, that they consti-

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tute the practice rather than form the occa-sional source of astonishment in this asylum.Indeed, to so great an extent does our super-intendent endeavour to make his patientsfeel that they belong to the great communityof mankind, and are only temporarily sepa-rated for their health’s sake, that he en-

courages a great proportion to attend to theirreligious duties, on Sundays, in the placesof worship in the city and neighbourhood;and induces all who can or will separatethemselves from the asylum, to take theirexercise in the surrounding country; whilst,to give encouragement to those who are in-clined to be industrious, he employs all hecan, without the walls, in various ways, andcultivates nearly twenty acres with the spade

.:-in the fields adjoining and belonging to theasylum, with scarcely any other check upontheir escape beyond the good feeling subsist-ing between himself and them."

_ Srdly. It informs us that the committeeare sensible of the public necessities, and areendeavouring to supply the lamentable defi-ciency in medical instruction, by the forma-tion of schools for the training of superintend-ents and matrons for public asylums, and of

guardians of the more wealthy victims of thisdreadful malady.

« During the past year the visitors havemade a great addition to the comforts of thepatients,-and they trust a grand step to-wards a public benefit,-by commencing asystem of receiving into the asylum a limitednumber of officers of both sexes, in thedouble capacity of assistants and students,who do not entail any expense upon the esta-

blishment, whilst they devote the whole oftheir time and energies to its business.Those of the male to be medical gentlemenwho have completed their professional edu-cation ; and those of the female, youngladies of good education and manners, andboth required to remain twelve months inthe asylum. They reside constantly withthe patients-head their tables-join in their

. excursions-promote their amusements-ar-range their difficulties-and act in all thingsas their friends and advisers."

And, lastly. It boldly avows the importanttruth of the superiority of the public over theprivate asylum ; a truth yet partially ob-scured by the mist of prejudice, but whichere -long will be universally acknowledged,and may God grant universally acted upon.


14 The visitors being powerfully impressed, with the conviction that the sole objects of

this establishment are the cure of the patients,and the- kind - treatment of those who are in-

curable; and with the palpable fact everbefore them, that the interests of the officersconsist alone in these, whereby their respon-sibilities are diminished, their benevolent

- feelings and professional pride are gratified_ _-cannot- refrain from urging upon thosewhose relatives are afflicted with insanity,-to -seek rather the public than the private

asylum. They urge still more the takingthis step in the early stage, when the diseasehas not been tampered with by inexperience,nor rendered hopeless by delay—for it is

amongst the few regrets which the retrospectof past years affords, that the most paitifalcases have ever been those in which otte orother of these misfortunes has befallen.While it is an acknowledged fact, tltat-ofthose who are sent within two or threeweeks of the commencement of the maladynine-tenths are cured."

Let us now for a while turn our attentionfrom this gratifying report to that, Colossusof riches and sloth, the Royal Hospital ofBethlem, with its two physicians, its con.sulting surgeon, its resident apothecary andmatron, its two hundred and sixty patientsupon pauper diet, and its 20,0001. per annum,and compare it in some essential points withthe unpretending establishment at Glouces-ter :-First. As to the management of its funds.The expenditure of the Gloucester Asylum(repairs and tradesmen’s bills inclusive) doesnot exceed 70001. per annum ; its number ofpatients averages two hundred and thirty,being within thirty of the average numberin Bethlem, and of these upwards of one-fourth enjoy the superior dietary, attendance,and accommodation awarded to patientspaying liberally for their board ! If Bethlemwas conducted with similar prudence, theestablishment might be increased nearlyone-half, and the dietary placed upon aliberal footing. Secondly. As to its effortsfor the diffusion of knowledge and the in-struction of the young practitioner. Uponthese points the returns of Bethlem are all

entire blank. It may be that, incumberedwith their heavy machinery, they feel theycannot keep pace with the zealous managersof Hanwell, and are content to occupy thesecond place in public opinion. But are

they prepared to bow to every provincialasylum, and be the last to start in the raceof improvement? Let us hope that ere an. ,other year shall have elapsed, some effortwill be made to follow the examples of Han-well and Gloucester, and some symptomsexhibited of the establishment of lectures andschools of instruction. Thirdly. As to theirannual reports. When may we hope to see .

a report of equal merit with the Gloucesterreport which we are now discussing, or Ishould rather say any report at all? InJanuary last the quarterly court directed the

publication of the reports of Sir A. Mpxisonand Dr. Munro then presented to them, andthe profession expected that those -eminentphysicians would have redeemed the failureof the former year, and produced eomposi.tions worthy of their high reputatiO11.’ Butit is a well-known fact,that the committee towhom the superintendence of the publicationwas referred, have deemed itprudeht to with-hold them from the public eye; and if the in-formation they would- give be as meagre, and



the statements as cpntradictory as those con-Wp4,, in the reports sQ, -unfortunately pub-lished in 1841, the committee ha. ve judgedwisely. But how long is this state of thingsto continue? How long will the physiciansendure this opprobripm from the committee,or the committee submit to this apathy ofthe physicians? I am, Sir, your obedientservant,, A LOOKER-ON.May 7, 1842.



London, Saturday, May 14, 1842.


" Iris said that a series of conversazioni

are to be given at Lincoln’s-Inn-fields."

We are happy to hear it. It is so long sincethe members of the College of Surgeonshad an opportunity of holding any kind of

conversation-excepting that for which theypaid twenty guineas-with the great men ofthe Council (which condescends to treat themlike wards in Chancery, and to manage theiraffairs, as well as spend their money, for

them,) that the bare announcement is refresh-ing. For a conversazione there is such a

variety of topics immediately connected withthe interests of the members, and the con-duct of the Council, that after the thing has

been mentionecl one can scarcely help feel-ing that the Council of the College is aboutone of the last societies in London that

might have thought of it. The Council

must be so glad to see the members ! The

Twenty-one must have so many things to sayto them, at the first meetings; after a separa-tion protracted by adverse fates to so late a

day, that it would be unkind to disturb theindulgence of their natural emotions, and thetrains of thought suggested by Mr. OWEN’Santediluvian researches, by any prematurediscussion.

Leisure will, nevertheless, be found in thecourse of time for a few topics which maybe very conveniently treated in the series ofcouversations, or "talks," as our red brethrenin America would call these deliberative in-

terviews. Two views, we know, may be

taken of the meetings. They may be lightFrench " soirées" or, Italian " conver-sazioni," for the discussion of buns, bavar-dage, and coffee ; or they may become thescenes of serious interesting English confer-ences, the commencement of a medical par-liament, in which the voice of an, injuredprofession may make itself heard. -Whichof these classes of assemblies the meetingsshall be, must depend on the good sense, thesagacity, and the energy of the members.Nothing should be done rashly ; everythingshould be done deliberately, and in concert.The members, of the College have not yetachieved the electoral system ; they haveno representatives within the walls whichthey have raised ; the meetings must, ’there-fore, be made ’primary assemblies" of, theconstituency, to decide at once these ques-

tions :-

(1.) Are the members of the College ofSurgeons in London, of all the members ofthe scientific societies of this country, alone

incapable of managing their own-affccirs ?

(2.) Are they alone unworthy of beinggoverned by a representative council ? Arethey alone disqualified ,as electors, on the

ground of deficiency of good breeding, ofeducation, of sound discrimination, and ofhonest principles ?

(S.) If their qualification be admitted,upon what principle are they excluded,fromtheir rights? For whose advantage dotwenty-one self-appointed, self-perpetuatinggentlemen expend 12,ûOOl a-year, without

consulting their fellow-members, lettingthem into the secret of their deliberations,or rendering any satisfactory account of

their stewardship ?(4.) What has the Council of Twenty-one,

in its corporate capacity, ever done _to pro-mote in the slightest degree the interests ofthe members at large, in any question ofimportance,-the poor-law, for ill.stapce, orthe affair of the barrister-commissioners in

lunacy? ...

And are these questions of no moment?Are they matters to be set’aside for tea andcollbe, and gossip, or even for Mr. OWEN’S