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Morison's account of his visit to the Salpêtrière, Paris (22 March 1818)

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Morison wrote about his visit to the Salpêtrière, Paris in his diary entry for 22 March 1818. The diary is now held at the Royal College of Physicians, Edinburgh.

Extract

Went to Dr. Esquirol’s and from thence to the Salpêtrière where I found him between 30 and 40 I think, an intelligent man who for 10 years has paid great attention to the subject of madness and has written and collected much upon the subject of hospitals and private receptacles for the insane. He has near 200 plaster of Paris casts of the faces of insane persons and 600 skulls.

He is of opinion that insanity is in general the effect of another disease to which our attention must be directed with a view to a cure, as - Parturition - repelled diseases of the skin, suppressed discharges, derangement of the abdominal viscera in particular, he has by a great number of dissections observed that the transverse colon instead of being transverse has been perpendicular which first lead him to the use of emetics which he employs very much - He also employs the tepid bath (25 or 26 Reaumur) and has a considerable number of these. Two are kept apart for the use of those with cutaneous diseases.

He showed me various plans of madhouses, condemning the plan of Bedlam [Bethlem] as having part a sunk floor and too much sacrificed to outward show; approves of that offered for the West Riding of York [Wakefield] - showed me his own plan which is somewhat of this nature - a centre-piece for the residence of physician and surgeon, infirmary for patients having other diseases etc., two side pieces, one for men on one side and [one] for women on the opposite - also one for convalescents and one for furious maniacs on each side with separate exercise grounds attached to each, and the whole except the middle piece to be on the ground (no second storey).

He recommends in private receptacles that there should be two kinds, one for the treatment of the disease in a recent state in which they might be limited to one or two years residence, and another description of houses for the abode of those discharged not cured from the first. He supposed six of the first kind and 40 of the permanent kind which would require a more frequent inspection than the former, which indeed ought to be left very much to the honour of the medical practitioner.

The mode of managing the inspection of rival madhouses in France is when the lunatic person is brought to the asylum, the superintendent gives notice to the police who send an officer with a medical attendant in the course of ten days to examine the patient and ascertain his insanity and this visit may be repeated at short intervals. There is an order that every patient must be certified insane before he is sent to the madhouse but this is not acted up to.

The Salpêtrière contains 1100 lunatics all women - the Bicêtre above half that number men - and the Charenton where they pay a salary with each patient about 400. There are about 400 or more in the Salpêtrière, epileptics and idiots, who have a separate building allotted to them. There is one female attendant to about every ten patients (no male attendants). Much assistance is rendered by the religious sœurs [nuns]. Little use is made of the straight waistcoat or camisole and none of chains or by fasteners. The whole number of insane persons in France does not exceed 7000 (in Paris about 2000).

In England he says we have above 12000. The chambers in the Salpêtrière are large enough but in some originally intended for one, two are placed for want of room. The beds are clean and the general appearance favourable except that they must suffer much from cold, the floors being of stone and there being no fire-places, nor are the apartments warmed by heated air or steam. One ward is appropriated to those called melancholic…