ANNUAL REPORT

OF THE

COURT OF DIRECTORS

OF THE

EASTERN LUNATIC ASYLUM,

FOR THE YEAR 1846.

The board of directors of the Eastern asylum, for the maintenance and cure of insane persons, in the City of Williamsburg, respectfully report to the general assembly of Virginia:

That nothing worthy of being specially mentioned has occurred in the affairs of the asylum during the past year.

The success of the institution in promoting all the objects of its establishment, the directors do not hesitate to class with that of the first asylums of this country.

As evidence of this they refer the general assembly to the detailed report of the superintendent, which accompanies this report, and to which the attention of the general assembly is respectfully requested.

That report is herewith filed, together with a tabular view of the inmates of the asylum, and marked A. The treasurer's account of receipts and disbursements for the year 1846 accompanies this report, and is marked B.

By this it appears that the amount received from the treasury of the commonwealth during the year was twenty-four thousand three hundred and nine dollars and fifteen cents; and from all other sources, five hundred and ninety-one dollars and sixty cents. The total amount of receipts being therefore twenty-four thousand nine hundred dollars and seventy-five cents, ($24,900 75.)

The disbursements for the year 1846 and up to the 9th day of the present month, are twenty-one thousand three hundred and sixty dollars and twenty-three cents, ($21,360 23,) leaving a balance of three thousand five hundred and forty dollars and fifty-two cents, ($3540 52,) due the asylum. This balance, however, is subject to a deduction of about one thousand dollars on account of claims against the institution yet outstanding, and about six hundred dollars yet to be expended for pork, (the whole supply being not yet obtained,) so that the real balance falls short of two thousand dollars. The amount which may be received from pay patients during the present year is perhaps one thousand dollars. This, however, is entirely contingent.

In view of this condition of things, the board are of opinion that twenty-five thousand dollars will be necessary for the support of the asylum during the present year, taking into consideration that several important and extensive improvements are highly necessary, which have been hitherto delayed for want of funds. This sum they therefore respectfully suggest shall be appropriated by law for that purpose.

The directors have to report that several slaves have been received into the asylum during the past year, under the act of the general assembly of the last session.

They also report that in obedience to an act of the general assembly of that session, declaring that purchases of the articles of prime consumption in the asylum, should be made by wholesale, in the best market in the United States, they decided, after due deliberation upon the difficulty of ascertaining that best market, that this was the best market, provided the articles could be had here as cheap as they could be purchased by agents in the large cities. Accordingly they ascertained by a competition among the merchants of this place, that the articles could be furnished to the asylum here at 7 per centum upon the prime cost in New York, and they contracted with a merchant here to that effect; considering that 7 per centum would not exceed the commission which an agent would charge for purchasing, together with carriage, insurance, &c., to say nothing of the advantage of inspecting the articles before purchasing, and receiving them in such quantities, and at such times as are convenient; the articles being stored at the risk of the merchant instead of at that of the asylum.

All of which is respectfully submitted.

[A.]

PHYSICIAN AND SUPERINTENDENT'S REPORT.

The number of patients who have been inmates of the Eastern asylum for the maintenance and cure of insane persons, since the 1st of January 1846, is one hundred and sixty. Of these, ninety-two were males and sixty-eight females.

The number of patients on the 1st of January was one hundred and twenty-eight, viz: seventy-one males and fifty-seven females.

During the year thirty-two have been received, twenty-one of these were males and eleven females.

The number of discharges is thirteen, viz: seven males and six females. All except one of these were in the usual form of recoveries.

The number of deaths is seven, viz: three males and four females. Two of these occurred in females who had been mentally sane for some time, one of them, indeed, for several months. I did not, however, think proper to recommend them for discharge, as labouring under bodily maladies which appeared to be incurable. One of them died of pulmonary consumption, and the other of cancer of the stomach. A male patient unfortunately eloped, and died whilst away from the institution, apparently from an accidental cause, which constitutes the third of the three deaths amongst the inmates of this sex, as given above.

The number of patients at present is one hundred and forty, viz: eighty-two males and fifty-eight females.

Ages of Patients in the Asylum, at the time when their Insanity commenced.

The above table comprises patients in the asylum during the last several years, in whose cases the data as to when insanity first commenced, could be satisfactorily ascertained. Where more than one attack had occurred, reference is made to the first of them. In a French production on the statistics of insanity, it is observed: "In conclusion, after the results which we have given, and the tables and works of authors which we cite, it seems established that mental alienation, rare at an early period of life, becomes very common after 20 years, is at its maximum between 30 and 40 years, and gradually ceases as we approach senility." In his valuable work on the statistics of insanity, published last year, Dr. Thurman arrives at a similar result. He observes, "there can be little or no doubt that the period of life most liable to insanity, is that of maturity, or from 20 to 50 or 60 years of age. From 30 to 40 years, the liability is usually the greatest; and it decreases with each succeeding decennial period." With regard to the maximum, this is verified by the records of the Middlesex county asylum in England. Thus the number of patients received therein during four years, whose disease commenced between the ages of 20 and 30, was 145, whilst that of those between 30 and 40 years of age, was 188; there being a difference between the two classes, of ten at least, in each year. It will be seen from our table, that this order is here reversed, and the same takes place, we think, in all American asylums. Thus, according to the tables relative to this point, found in the reports for last year, of six American institutions, the collective number of patients whose insanity commenced between the ages of 20 and 30, was 1108; whilst that of those becoming deranged between 30 and 40 years, was but 663. This difference between the old and the new world, has been attributed to the circumstance of an earlier entrance into the cares and responsibilities of life in the latter, than takes place in the former. Insanity is of very rare occurrence in childhood; it is a disease belonging to adolescence and mature life; whilst idiocy is the brainular affection of infancy and childhood.

Civil condition of the Patients in the Asylum during the year 1846.

Most of the cases of insanity, which are not produced directly by some variety of ill-health, seem traceable to a want of self-control. Yielding to any one feeling in excess tends to produce this disease. Disappointments in life for example, must occur to every one; and if this great lesson of the world's experience be not early taken to heart, when misfortunes come reason easily gives way before their influence. So too it is made evident from an acquaintance with mental disease, that it is wrong to exercise any one power of the mind excessively, to the exclusion of the rest. He who does so, will be likely to prove a dreamer through life, or that which is worse, to

become insane. In consonance with this principle it is, that, apart from the information acquired, the mind is usually strengthened and improved by the exercise of its several faculties, which the study of various branches of knowledge confers, instead of confining the attention solely to one or two subjects. But excessive devotion to any course of study, however well chosen, is as similarly to be reprehended as excess in other modes: doubtless books on education have sometimes done harm, by encouraging this tendency-perhaps usually met with in those least fit to indulge in it, that is, those with a physical constitution not robust either by nature or by cultivation. Burning the "midnight lamp" is an idea better honoured in the breach than in the observance.

A curious case was once brought to the asylum, in which the mental disease appeared to have been produced by the imagination exerted unduly in a single direction. This was an individual who had conceived an affection for a young person of the opposite sex; and she seemed to have been so much in his thoughts, that he at last took imagination for reality, and fancied that he was already married to her. This solitary delusion vanished by the time he reached the asylum, and he was refused admittance, as being an unfit subject.

There is, as has been often observed by the physicians of asylums, much doubt, as to their cause, in numerous cases of insanity; oftentimes it is far from being such as is assigned by the friends of a patient; and even when we are minutely acquainted with the history of a case, its origin escapes our investigation. Nevertheless, we cannot but think that all, or nearly all, the items comprised in the tabular views of hospital reports, certainly act as causative circumstances. So that, if we fail in particular cases, in assigning as such, the chief agent amongst several causative circumstances, yet still taken as a mass, the tabular records accurately denote the usual causes of insanity; and this is all which is here desirable in a practical point of view.

A case illustrating the doubtful influence of two causative circumstances of a moral character, was one on the list of patients several years ago. The individual in question, had emigrated from Virginia to the north, and had been engaged in business there for several years. During the political difficulties that occurred in Rhode Island, at which time he lived in that state, he belonged to the party which was ultimately defeated when matters were brought to a crisis. And at the last mentioned period, he was one of those who left the state; after remaining a few days in Connecticut and New York, he ultimately determined to return to his friends in Virginia. The anxiety of mind which he experienced from passing through these misfortunes, was sufficient to account for the subsequent attack of insanity. But on his arrival in his native county, there happened to be a protracted religious meeting going on; and whilst attending this he professed conversion. Shortly after, an attack of mania burst forth; of which the papers affirmed, "the first evidences were praying and singing without intermission." The cause assigned by all the witnesses was simply "religion." But this case, as we have previously said, is an example of those, in which we cannot ascertain positively what was the most prominent causative circumstance; from what he stated on his recovery, I attributed his disease mainly to the anxiety of mind attending his flight from Rhode Island.

Two causative circumstances which seem to me, to be far more frequently instrumental in the production of insanity than has been generally supposed, are injuries of the head and the loss of sleep. In a number of patients received at the Eastern asylum, I have observed the marks of former wounds of the head, probably it is true, made long before the apparent inception of their insanity; but which in some of these and in similar instances, there is reason to believe, tended to implant a predisposition to mental disease, which it only required slight causes to bring into action. The loss of sleep, though not much spoken of in works on insanity, is made a subject of caution by Course, Neville, and several other standard writers. The following cases appear directly traceable to this source. The first of them was a carpenter by trade, and became deranged from sitting up many nights in succession to kiln-dry plank, without taking rest in the day time to compensate for that so lost; his mind was also much employed at the time in reference to draughting. The second case, which like the first, was that of a very young person, arose from indulging in hunting and other amusements during nearly the whole night, through a long period of time, with a similar neglect of rest in the day. It may be observed that both of these patients appeared to recover, and in a surprisingly short time, from the opiate or anodyne treatment; they, through this medication, slept a great deal for a few weeks; and on the cessation of the means, their mental powers seemed completely restored, both of them possessing good natural abilities.

A particular order of cases, directly referable to the "sexual function," seems much less numerous in this institution than occurs in some of the northern asylums. Those to all appearance so assignable, are not included in the tabular view. The physician to au institution for the insane, meets with mournful revelations on this subject, both from without as well as from within the confines of the asylum.

In the table above given, the first term applies to those cases in which the mind is deranged on a number of subjects, as exhibited by delusions upon them, without any very great impairment in power. The second is that in which there is a greater degree of rationality on many topics, whilst there are delusions on some one or more. The third includes those in whom there is a marked enfeeblement of mind. And the fourth term is applied to cases in which the most prominent morbid symptoms are rather those of the feelings, than of the intellectual faculties. Moral insanity implies, strictly speaking, the absence of delusions; we here include however, under this term, cases also possessing them, but where the morbid condition of the feelings is evidently the most striking characteristic. In other words, the varieties of insanity may be classed, as many delusions, few delusions, weakness of intellect, morbid feelings.

A not unfrequent form of development which the varieties of insanity tend to assume, is periodicity. Some of the patients brought to all asylums are found on investigation to have had attacks of insanity previous to that under which they are labouring when received. And of the incurables in an institution as permanent residents, most appear worse at certain times than at others, this condition, entitled excitement, being sometimes quite regular in its phases. The tendency to periodicity, insanity shares with many other diseases; and the nature of what are called lucid intervals, finds an analogy in other maladies possessing intermission as to duration. Thus in intermittent fever, in some cases during the interval of the paroxysmal disturbance, the patient appears nearly or quite well, in others some palpable symptoms of disease remain; and there is, when the disease ceases, an evident tendency to return on particular days. Perhaps in such instances, mental or bodily, it accords better with facts, to consider the apparently undiseased interval, as being strictly but a diminution and not a removal of the morbid state. In insanity, some cases in which the disease returns are probably instances of periodicity, and a portion merely of recurrence. Or in other words, there is in some cases often an interval longer or shorter in duration, of apparent mental health, so great a tendency to a renewal of the malady, that no degree of care seems to avail in preventing its return. In other cases, as in various physical diseases of the different bodily organs, the brain by a first attack is simply rendered more liable to again succumb to any of the causes of insanity; but through the avoidance of these all danger of renewal is removed; and it is only by undue exposure to them, that the disease is made to recur. There is too often on the part of recovered patients, and of their friends, an entire absence of carefulness in avoiding an exposure to circumstances calculated to produce alienation of mind. A few patients relapse on their return home from asylums, and have to be re-admitted. Besides a case of periodical moral insanity, during the last five years, but four such have occurred amongst our discharges. Three of them subsequently recovered and were discharged. The fourth occurred during the past year, and the individual is still an inmate. Being rather a striking case in some of its characteristics, it may not be amiss to relate a portion of its history. The patient in question was received in 1840. During most of his stay here, he was in a strangely depressed condition. He would not move out of one position throughout many hours, unless urged to do so; his skin was very sallow; his features relaxed, and his eyes dull and glassy; the circulation was at all times feeble, varying from 47 to 57 pulsations in a minute; when induced to walk at all, his motions would be exceedingly slow; at times he would refuse sustenance unless fed by some one. The most peculiar trait exhibited, was the complete silence which he kept; having an aspect of vacancy and astonishment in his countenance when asked the simplest question, taking a very long time to answer, and then in the fewest possible words. He remained in this condition more or less for about five years, or until October 1845. During this period efforts were made to engage him in household, garden or other work, and these seemed to better his condition slightly, but there was no permanent improvement of a substantial character. The idea finally occurred to me, that he might receive benefit from being occupied at the carpenter's shop daily and steadily: I also found upon questioning him, that although he came from the agricultural population, yet he had been something of a carpenter. At first he did little or nothing in the way of work. But he succeeded better and better as he went on; and by the end of the year he had become a very useful workman, would converse freely, and had lost most of the torpor previously besetting both mind and body. He continued to improve during the next month or two; ultimately in the summer, he took walks in the surrounding country, went fishing and engaged in other pursuits; he became very cheerful, gained flesh, and was nearly sane in all respects. Indeed the only remaining trace of mental disease was merely, that he thought himself much older than was in reality the case. He continued in this state for six months or more, eventually giving up the delusion as to his age. He was discharged, returned home, and three days after his return thither, the mental disease reappeared; he became violent towards his family, and was committed to jail preparatory to being brought to the asylum again. On his reception about a fortnight subsequently, he was very much reduced and weakened, his skin looked shrivelled and sallow, and he presented in fact much the same symptoms formerly exhibited by him; having also a very wild aspect, and seeming to be agitated by great fear. From his tendency to refuse nourishment, he had taken for some days an exceedingly small quantity, and he had now therefore to be fed very carefully. After taking liberal doses of brandy and quinine three times a day for some time, he was able to walk about, and the worst symptoms disappeared. He then went to work in the shop once more; the torpor about him has now nearly disappeared, and he seems quite rational.

Cases of readmission after relapse, are not included in the summary of discharges and admissions, given at the commencement of the present and previous reports.