Great advantages may fairly be anti cipated from the restrictions imposed by these acts ; and they may probably only be considered as steps towards the highly desirable result of making all insane persons immediately the care of the State. The duties of the commissioners have, until the last few years, been very imper fectly performed, and the utmost secrecy as to their names and movements was preserved. The management of private asylums must vary considerably, as such houses are rarely built for the purpose, and are frequently under the direction of persons unfitted by their want of education for such an important charge; but these circumstances can by no means be ad mitted as excuses for the scandalous in stances of cruelty and mismanagement which have gone on under the eyes of the commissioners, and in houses which have received their praise; especially in those large private asylums, where an im mense number of paupers are taken at low rates ; the temptation held out in such cases to economy at the expense of the care and comfort of the patients ought to call forth an especial watchfulness on the part of the commissioners.
The patients who are confined in prisons, hospitals, workhouses, or in the houses of their relatives, are exposed perhaps more than any others to great neglect and mismanagement ; and not nnfrequently are treated with great cruelty, even when the intentions of the parties who have charge of them are good, through their entire ignorance of the na ture and proper treatment of the disorder. Management of PublicAsylums. —There is considerable diversity in the internal regulations of different public asylums as to the power and position of the medi cal and non-medical officers. In some there is a resident physician who holds the supreme authority, and is also stew ard and general manager ; in others the physician only presides in his own de partment ; and in others the chief officer is not medical, and the physician is non resident. The Norfolk asylum is the only large one in England without a resident medical officer ; and this fact is severely commented on by the commis sioners in their report. Under the new act a resident medical officer must be appointed ; but we understand that the chief authority will still remain with the non-medical superintendent. In the 70th Report of the visiting justices of Hanwell (April, 1844), it is stated that they have appointed an officer in the army to super intend the institution, with a view to the preservation of greater order and disci pline than had been maintained under medical rule ; in the 72nd Report (Octo ber, 1844) the resignation of the go vernor is mentioned, and we cannot learn from the reports that any steps have been taken to appoint a successor, nor whether the advantages derived from his appointment equalled the expectation of tile justices.
In all asylums the position of the matron is one which requires to be settled in some uniform manner; owing to the matron having been in many cases the wife of the superintendent, on undue im portance has been given to her position; the appointment of the female attendants, and even the classification of the female patients, has sometimes been left in her hands. When we consider that the matron cannot possibly have had a medi cal education, and that in very few cases those who hold the situation possess any previous knowledge of insanity, or are even persons of good general information, it is manifestly improper to allow her too high an authority. In the French asy lums, and we believe also in some of those in the United States, there is no matron: a few of the most experienced female at tendants act as heads of departments, and receive the orders of the medical officers; and this arrangement, which is found to work exceedingly well at the Salpetriere, where there are 1500 female patients, seems on the whole to be the best. The effect of placing the matron in a higher position is almost certainly to bring about interference on her part with the duties of the medical officers, which cannot fail to be injurious to the welfare of the patients. At Hanwell the salary of the matron is higher than that of the resident medical officers, or than that of any officer ex cepting the physician.
In the appointment of a chaplain, steward, secretary, accountant, and any other officers, the most important point is to confine their duties within certain proper limits, and to prevent their inter ference with the patients without the con currence of the medical officers.
If the government should at any time take the entire superiision of asylums for the insane into its own hands, we trust that the mode of proceeding will be to appoint to each asylum one resident me dical officer, who shall be responsible for the entire conduct of the asylum ; and to whom, therefore, the power of appointing and dismissing all the subordinate officers shall be given. Uniformity of system, the want of which has been a great evil iu many asylums, would thus be secured; and careful selection of a competent principal officer responsible for every in stance of negligence or cruelty in the asylum under his care, could not fail to improve the general management of these institutions. At Glasgow the whole au thority has for some years been in the hands of the resident physician, with the most satisfactory results ; and an approxi mation is made to this plan in the Irish district asylums, where the non-resident physician is the principal officer.