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Judging by the reports of Dr. Gray, referred to, it may be said that the somewhat elaborate means of moral treatment adopted by Dr. Brigham have been gradually given up, or rather, given place to general remedial means. The theory is, that at the basis of most cases of insanity is an anaemic condition of the system, and that the especial organic or functional disease, upon which the derangement primarily depends, originates in this.

"The great indications for treatment, therefore, are nutrition, sleep, rest. The medication is mainly directed to secure these, by sustaining, stimulating, and invigorating the nutritive functions, in order that the system may be able to receive and assimilate the requisite amount of aliment for building-up and renewing the tissues, and to calming agitation, allaying irritability, and controlling the inordinate cerebral action, that due rest and sleep may be obtained."

"The average per cent. under medical treatment during the year 1865 was 43 per cent." (I name this year because full statistics are given in the report for that year.) "The greater portion of the feeble and broken-down, represented as under regular medical treatment, are on remedies administered with a view to building up the general health, and but a small number (7 per cent.) on soporifics alone. The prescriptions daily made, independent of those for patients on the list of the above table, average 14. per day." In other words, 2 1/2 per cent. of the patients have a special medical treatment.

Dr. Alexander Robertson, of England, in describing his visit to the Utica Asylum, and the treatment there, says, quoting Dr. Gray: "Persons suffering from chronic melancholia are permitted to do very much what they choose, within the bounds, of course, of their own safety, and that of others, for a long time, at first -- six months or a year, perhaps -- attention being directed principally to the promotion of their nutrition. When their physical state improves, then, and not till then, they are asked to occupy their attention in work," etc. (or other forms of moral treatment).

There is a free use of malt and spirituous liquors, the vegetable tonics, phosphoric acid, with nightly soporifics when needed. It is, in short, class treatment; instead of individual and special treatment.

Such is the treatment that prevails at Utica, as one reads it in the annual reports of that institution for the last dozen years. It is the natural outcome of the "physical-basis" theory of insanity and of that view of causation that rules in its management.

Twenty years ago, the superintendents of American asylums for the insane, in one of their annual conventions, adopted unanimously a resolution that the highest number of patients that could be treated with propriety in one institution was two hundred and fifty, while two hundred was the preferable maximum. And also that for the former number of patients one medical superintendent and two medical assistants were needed. This was in the days of a belief in moral causes and mental disease, and a faith in moral treatment, either alone or in conjunction with appropriate hygienic and medical means. This embodied the experience and wisdom of a generation of alienists. A supposed necessity or expediency induced this same association, at a later day, to modify its views upon these points, and we now find all over the land institutions, two or three times as large as was then proposed. As a consequence, with the limited number of medical officers, it has been almost impossible to make a study of individual cases in their medical and psychical aspects. At all events, it has been very much easier for those in charge to permit their patients to do very much what they chose for six months or a year, attention being directed principally to the promotion of their nutrition, till their physical state improved.

Think what a variety of conditions complicate the problem of cure in the case of every insane man or woman; and then multiply this by the number of cases to be regarded possibly curable in an asylum like that at Utica, with six hundred or more patients! And remember that, practically, these are under the charge of two physicians; for the superintendent's general duties, at the head of a community so large, responsible for the care of the building and supplies, and the general conduct of the assistants of every name, his occasional absences in attendance upon the courts, leave him little time for the medical supervision of the institution. For the third medical assistant there are the multifarious duties of the supernumerary in such a case; the record of cases, the statistics, the pathological investigations, etc., etc.

It will be seen from this -- and Utica is but the type of many another asylum for the insane -- how naturally alienists may have drifted into this "physical-basis" theory of insanity; have lapsed into the condition of mere doctors of medicine in the narrow sense. In this connection let me quote from Maudsley's chapter on the treatment of insanity, which is full of admirable suggestions: