lunacy, mania, melancholia, and complex insanity. During the preceding century, distracted and lunatick was the term in the London registers; and in the last thirty years of that century, amounted in the funerals to 544; but in the present century, are quadruple. We must reflect, that two of the largest lunatick hospitals in Europe are erected in this metropolis, exclusive of several large private madhouses; all of which are of late years enlarged and multiplied in London and its suburbs. Into these publick and private receptacles many lunaticks, from sundry parts of the kingdom, are congregated; amounting in all, by the nearest calculation which I can form, to upwards of one thousand. Perhaps those whom nature originally, or disease branded as idiots, are also included in the lunatick catalogue of mortality. The coroner’s inquest generally returns suicides as lunaticks, after reciting the mode of their death; but the searcher’s reports in the bills of mortality, have invariably ranged lunatick and self-murder under two distinct heads. I have reason to believe that many lunatick deaths in London are not reported, from their being interred in dissenting and unregistered burying grounds, or in other places of interment without the verge of the bills; others intentionally suppressed, and a considerable remnant sunk amongst the suicides and drowned. It is probable, that in lunaticks and suicides, this island may challenge any other in Europe, whether in modern or in ancient times.
In illustrating this disease, above all others so little understood by the community, by the medical profession, or, in truth, by the greatest part of the authors on the subject, I shall rather trespass beyond the limits of a concise systematic survey of diseases. I had long since procured the printed annual reports of Bedlam during thirty years, from 1750 to 1780, wherein it appeared, that out of 6000 lunaticks, the deaths amounted to 1200, or 1 of 5. This information, so far as it went, was partly truth, but it was not the whole truth; and, in confirmation of the general proverb, I was compelled to search for it in a well. I was anxious to extend my inquiries to a vast variety of particulars, not one of which could be learned from the crowd of authors, good, bad, and indifferent, whom I perused for this purpose; from the remote era of the Greek and Roman Catholicon, the Hellebore, down to the present time.
Chagrined with this unprofitable research, I waited upon the learned and venerable physician of Bedlam, Dr. Monro; who, with his accustomed liberality and affability, recommended me to his son, upon whom the principal medical department of Bedlam now devolves; and in whom the hereditary virtue and exalted medical reputation of the father, are not likely to suffer any diminution. Dr. Monro, junior, introduced me to Mr. Gonza, the apothecary of Bedlam; whose curiosity and learning induced him to keep a private register of all the patients; and with all which Mr. Gonza most obligingly furnished me. It is from the records of this respectable and well-informed gentleman, especially on the subject of insanity, that I am enabled to form all the following Tables and data respecting a disease, wherein, except to the few high-priests of those temples, the rest of the Esculapian train are nearly as ignorant as the ancients; and the unenlightened mass of the community stare with superstitious amazement as the Israelites formerly on the epilepsy.
In penetrating this untrodden wilderness, and reconnoitering an unexplored host of morbid foes, I shall proceed with the cautious investigation of astronomers and natural philosophers; first to establish the facts and phenomena previous to any deduction or inference. From Bedlam, the largest palace and congregation of insane in any part of the globe; and from its valuable, but hitherto dormant archives, I shall attempt to settle all the leading and important data, by analyzing its internal history and transactions during fifteen years, or half a generation; which is sufficient to decide every ambiguity nearly as well as half a century. The materials are extracted from many volumes; they are condensed, classed, and arranged into a concise compendium, with no little trouble and fatigue to the author. In number, and consequently in magnitude of information, they must be as superior to any solitary individual observations on this subject, as the swelling flood of the Thames is to one of the thousand smaller rills which are swallowed up in its majestic stream. In this way we shall not be confounded with contradictory affirmation and negation, and the clash of oracles.
The following, therefore, are the general proportions which I shall endeavour to demonstrate, and upon them to found a multitude of others: the comparative proportion of insane males and females; their ages; the cured; incurable, and dead; the length of time they were insane before admission; the mischievous; those who attempted suicide; and the harmless; the relapses; the periods when recovery may be despaired of; the various remote causes. Mr. Gonza had distinguished the married and single; but in a treatise of this nature, these, and many other minutiæ, must be omitted.
The usual number, on a general average, of patients in Bedlam is 250; of which 110 are stationary incurables, male and female; and who remain there until they either die, or are discharged, for reasons hereafter to be explained. The remainder are a moving body, upwards of 200 of whom are annually admitted, and the same number annually discharged: the difference of males and females is very inconsiderable; in general the latter rather preponderate. During fifteen years, from 1772 to 1787, of 2829 insane males and females, their respective ages and numbers in each interval of life, when classed, were as follows:—Under 10 years of age, 1; from 10 to 20, 132; from 20 to 30, 813; from 30 to 40, 908; from 40 to 50, 632; from 50 to 60, 266; from 60 and upwards, 78. Of these the cured were, 934; the incurable, 1694; the dead, 230. Of these also, the mischievous were 743; attempted suicide, 323; not mischievous, 886; committed shocking murders, upwards of 20; relapsed, 535.
It seems necessary to be first mentioned, that I made memorandums of all the different periods, and time elapsed, from the invasion of the disease, or insane paroxism, to their admission into Bedlam, from one week to one year and upwards. I do not, however, think it important to form a distinct class, or table, of these, but merely to observe in the aggregate, that of the patients admitted into Bedlam, the majority were not above six months unremittingly deprived of reason; and those, in all the intervals, from one week to six months. The second great class were, in the intervals, from six to twelve months. After one year, and upwards, there are comparatively very few admissions, except on the incurable list.
The ages at which insanity predominates are obvious, and require no comment. During the first period under 20, the greatest part of this small group were between 15 and 20. The ages of about 300, as also of their cures, incurables, and deaths, are omitted in the records: fractional exactness cannot be expected: but for gross calculation there is abundant accuracy. With respect to the cured, incurable, and dead, I shall make a few remarks: amongst the discharged I found a considerable number reported as sick and weak; others, and amounting to some hundreds, as troubled with fits, or with paralytick strokes, and some with a complication of both the latter maladies; and also a small fragment of pregnant females; and none of these liberated from insanity. All these I threw into the incurable list, as I could discover very few of them ever to return back again. Many of the sick and weak may safely be added to the dead list; being on the confines of the grave when dismissed. The incurables likewise contain those admitted on the incurable list of Bedlam, as well as the great mass discharged from thence incurable, after one year’s trial.