The capacity to do profitable work varies among the different classes of patients. Idiots, according to Dr. Peeters, make efficient laborers, unless their disease is too far advanced. To prevent abuse, it is stipulated that the nourricier shall not decide on his own responsibility whether his patient shall work or not; that is determined by medical permission or prescription. The patients are apt to work too much. They become interested in the occupations of the family and follow them to the fields, unless they are prohibited by the physician, and are in this way often tempted to do the full day's work of a strong man-sometimes, possibly, to their harm. The compensation they receive depends, of course, upon the work they do. Sometimes they receive a small sum at the end of the week; sometimes they are paid in tobacco, eggs, beer, or articles of clothing. But the administration takes care that they get something, either in the form of a present or as regular pay.

The regulations of internal discipline imposed on the patients are very simple. They can go out between eight o'clock in the morning and four o'clock in the afternoon in the winter, and between six and six in the summer, and at other hours by special permission. Only quiet patients can resort to the inns, and it is forbidden to give spirituous liquors to any of them. If the patient does not desire to work, he can indulge his taste for reading or art; in pleasant weather he can go to Gheel or walk in the country, alone or with a friend; but he is not allowed to travel on the railroad or to go away.

The question is in order of the effect of this liberty upon the personal security and the health and morality of the population of Gheel.

Suicides are very rare; there has been only one since 1879; there were three between 1875 and 1879, and others in 1850 and 1851. No act of violence has been recorded since 1878. But such things have occurred, as when, in 1844, the burgomaster, who was also a druggist, was assassinated by an insane herbalist, who imagined him his rival in trade. Dr. Peeters can recall only three cases of crime in a very long time. The personal security of the lunatics is sometimes compromised by the dealers selling them liquors. The fact is always a grave one, for it implies a deficiency in the surveillance. We have already said that four guards of section are not enough. More are needed, to watch those who have their senses, as well as those who have lost them. In this way only can some of the objectionable features inherent in the mode of life carried out at Gheel be eliminated. Escapes are by no means rare. Sixty-six cases occurred in the six years, 1876-1881, or an average of about nine a year. Whenever a patient betrays an inclination to run away, instead of being subjected to measures of coercion, he is usually sent to a close asylum. fact worthy of remark that, in nine cases out of ten, attempts at escape take place on Sunday. This is usually because the nourriciers go off and amuse themselves on that day, and leave their patient to take care

It is a

量

of himself; when, with nothing to do, or with which to occupy his mind, and in his timidity and strangeness, the idea of escape is apt to take possession of him. The remedy for this is simple: the patient has shared the occupations of the family during the week, now let him share their diversions. Although Gheel is not a place of dissipation, there is no lack of diversions there; and there is no reason why the lunatic, being invited to participate in them along with the others, should not be made to feel at home in the colony, and become attached to it.

A doctor of laws, who had had several attacks of insanity, and had passed sixteen months in a close asylum, came to Gheel in 1871. His host took pains to procure diversions for him, and frequently engaged him to assist in the concerts of the musical circle of the town. He took great pleasure in this recreation, so that, in 1872, when he was cured and at liberty to go away, he chose to stay in Gheel with his musical circle; and nothing but an official appointment in another city could induce him to leave the place where he had had so much enjoyment. The Harmonic Society was founded near the beginning of this century by a lunatic named Colbert, a musical artist, with another insane musician and a friendly amateur, and has Colbert's portrait in its hall.

A few unpleasant features, from the moral point of view, are produced through the constant intermingling of the insane with the normal-minded population. There have been half a dozen cases of pregnancy among the insane within fifty years; two of them since 1880. Some of the patients also will occasionally manifest their passions in an obscene manner; but, whenever they do so, they are sent to a close establishment as soon as possible, and are in the mean time confined in the infirmary. Generally, however, so careful discrimination is exercised in sending patients to Gheel, that it is rare to find among them any who are dangerous to public morality. It has long been usual for persons to come to Gheel for a temporary sojourn; and these are mostly deranged. They are not under the control of the administration, which has no right to interfere with them, except in case of scandal or danger; and they come and go without surveillance. Many of them, according to Dr. Peeters, may be regarded as dangerous, and likely to abuse their liberty; and the doctor cites some particular instances to prove his position. These are the persons who commit most of the immoral acts, and it would be wrong to hold the colony responsible for their misdeeds. The value of the system pursued at Gheel can not be justly estimated by the proportion of cures obtained. The colony makes no pretense to be a substitute for the close asylums. The administration, agreeing with alienist experts, recognizes that there are some forms of insanity for which the close asylum is the only possible resort. Therefore, only certain classes can be sent to Gheel, and among these the number regarded as curable

is very limited. In fact, the Belgian asylums send their incurables here so far as they can; and of the whole number of patients cared for, seventy-eight per cent are classed as incurable. The system works unfavorably for the colony relatively in a double way-by diminishing the number of failures to cure in the close asylums, and by correspondingly increasing the number at Gheel. Undoubtedly, the régime at Gheel is favorable even to incurables, but it is more so to curable cases, and it is to be regretted that the colony is not put in a position to make a more obvious proof of it. The proportion of deaths is raised in appearance by the same cause. From 1860 to 1875, the proportion of deaths varied from five to ten per cent, rising to the latter figure only twice. Such proportions are not, however, exaggerated, and, if we consider the hopeless character of the disease of the majority of the patients, we shall find that Gheel, if it can not heal incurables, keeps them in life and health for many years.

The insane population has recently increased very fast. In 1840 there were 717 patients; in 1855, 778; in 1866, 1,035; in 1872, 1,118; in 1879, 1,383; in 1883, 1,663. The increase is partly owing to the growing willingness of the people to receive patients, and partly to the improved administrative and medical service, which makes it more obvious that, with their liberty, persons sent there will not be uncared for. As to nationality, most of the patients are Belgians; after whom come Dutch, a few French, and fewer Germans and English. Among the cases are some who have passed most of their lives at Gheel. One is recorded as having died after a residence of fifty years; another stayed there fifty-two years; and residences of from forty to fifty years are not rare.

In what does this family treatment consist? The lunatic is taken from his habitual environment, from the society of those among whom he fell ill. They exist for him only in memory; they are not there to remind him continually of a melancholy subject, and to keep up the current of ideas in which he is involved. A new life is opened before him, with new faces, in a new country; everything is a subject of distraction to him; and, on the other hand, he has not the continual feeling that he is in a close asylum, with a door he can not pass through, and a wall over which he can not look. He is not in perpetual contact with lunatics, and is not subjected to a depressing influence. He enjoys the privilege of physical activity, and of life in the open air with sound-minded people, who are all the time diverting him from his preoccupations. He has even little children asking him to amuse them, and winning his attention, in spite of himself, perhaps, from himself. He is part of the family; they become attached to him, and he becomes attached to them. No one laughs at him, no one mocks him, he is never the object of any kind of demonstration, but all take him for what he is, an innocent. That is the family treatment at Gheel-isolation without solitude.

We add a few notes of our own visit to Gheel, which we made on two days in the spring of 1883. We arrived there, by railway, in the same train with a mother who was bringing her idiot son-a lusty youth, twenty years old-to leave him there. We found a town with wide streets, not entirely regular, and poorly paved, with few people out. The houses, two or three stories high, appeared well kept, with glistening window-panes and brightly polished door-knobs. Passing the grand square, near the church, we met a man about sixty years old, walking slowly along, with a baby in his arms which he was trying to entertain with a most discordant song. He was a patient, taking care for an hour or two of his host's child. He performed his duty faithfully and diligently, bidding good-morning to such persons as he knew, and exchanging a few words with them.

A few steps more brought us to the wide, tree-bordered avenue on which the infirmary is situated. The building is a handsome structure of brick and stone. We sought out Dr. Peeters, and after a few moments of conversation were authorized to visit the institution, and then, in company with a guard of section, to inspect the city and some of the houses where insane are entertained. The infirmary was throughout a model of Flemish neatness, with well-scoured floors and flagging, bright kitchens, and abundance of air and light. The sick-wards are in front. We paid a rapid visit to the women's quarter. Some were in the dormitory, some walking in the halls. Among the former, some of the more seriously affected ones were plaintively muttering words that we could not catch, others were grieving over the persecutions of which they imagined themselves the objects; another, of pleasant appearance, and fluent in conversation, answered all of our questions with suavity. She was delighted to receive our visit; the only thing about it that troubled her was to see our head some sixty feet above our body, and she could not but be surprised at it. She was well treated, and desired nothing better than her present condition. Thence we went into the garden, where we found two sisters, both hysteric, waiting their transfer to a close asylum. One had a dangerous propensity to homicide, and the other was subject to a depravity of manners that made it improper for her to be at large.

Our first visit, in company with a guard, to the boarding-houses, was at the comfortable dwelling of a well-bred lady, who was entertaining an Englishman and a Pole. We found the Englishman in his room, a bright and spacious apartment, sitting on a sofa, with his head between his hands. Our efforts to engage him in conversation, even in his own language, were vain. He answered sulkily, and ended by muttering that he was tired of us. Just as we were going out, the other patient came in, returning from a visit to a friend. He was a Polish prince, bearing a great historical name, but suffering from weakness of mind and occasional delirious fancies that he was an object of persecution. He was a man of excellent education, with the experi

VOL. XXVIII.-5

ence and manners of a man of the world, of fine build and well dressed. He paid the honors of the house to us with the greatest politeness, and declared that he was well satisfied to be at Gheel, saying, "I am a little deranged, and the quiet of the place does me a great deal of good." He had not the least desire in the world to go away. His

wife had been there a short time before to take him to the sea-shore for a little while, but he would not go. It was not still enough there, and the life of the world would worry him.

On the road we met another lunatic, whose monomania was to go every day to the railway-station for a case of wine that he was expecting. It had never come, but the porter would always answer his questions hopefully, and he would go away satisfied, to repeat his errand the next day. Walking is one of the man's principal diversions.

We next visited the home of a peasant who had the care of two indigent insane women. One of them was sitting near the stove, much depressed, and silently weeping. The children of her hostess were playing at her feet, while the mother was attending to her household duties. The other woman was assisting the mistress of the house. Going out, we met a portly, dignified gentleman, who imagined himself to be a general. He entered into conversation with us. "Don't you know, Gheel is a very pleasant place? There is plenty of society here, and very enjoyable. Yes, it is good to be here. The air is pure and the life is quiet. I love it! This man was sent here, several years ago, alone and unattended. The story goes that on reaching some city on the way, the police asked to see his papers. The "general" showed the certificate of insanity, which the physician who sent him to Gheel had given him, and the order for his admission to the colony. The gend'arme was not satisfied with these papers, which did not correspond with his routine, and asked for others. The "general" answered, with dignity: "I am mad; you see that from my papers. They have sent me to Gheel; let me alone, and I will go on!" He was at last allowed to proceed. He looks upon Gheel as a town where numbers of people come to take board to calm their nerves, and declares that the idea is an excellent one. Farther on we met two French lunatics. One, from Saint-Brieuc, had found things so comfortable at Gheel, that, having been restored to his family after getting better, he became discontented, and came back all alone, to join the colony again. The other one was a musical amateur who regularly attended all the concerts. The next case was a little woman about forty years old, a fluent and proper conversationist, who lived in constant expectation of her lover, who was to marry her as soon as he came, but that would not be till a railroad was built direct from his village to Gheel. She seemed to bear herself very cheerfully in her waiting. She had been discarded by her lover.

We next saw an English architect and water-color painter, who had been ruined by American whisky. He complained of being