Village hospitals for the sick sane poor have proved very successful in the south of England, and they are consequently being there multiplied in all directions. It is one of the chief aims of the Board of State Charities in Massachusetts

"To show that the system of providing large public institutions for the permanent dwelling of special classes of the dependent is unsound in principle; that such establishments are only tolerated as a choice of evils; and consequently that they should not be multiplied, and those existing should not be enlarged, without pressing necessity. ..... It is better to separate and diffuse the dependent classes than to congregate them" (Second Report, 1866).

If, as we have endeavoured to show, the "Family system" of treatment is a natural one, applicable alike to certain classes of the sane and insane poor; if it has existed in some form in all countries and ages; if even without proper regulation or supervision it has been wonderfully free from abuse; if, when properly organized, it is so successful on a large scale at Gheel, both as regards economy to the ratepayer and advantage to the patient; if it is in accordance with the genius of the age to break up hospitals for the sick, and to board out pauper children and adults; if diffusion, not aggregation, of the dependent classes be the order of the day; if individualisation, not what the Germans call "Casernirung,"-" Barracking"-be prominent features in our modern hospital system, how comes it, our readers may naturally inquire, that Gheel has never found an imitation in other countries? Our answer is, shortly and simply, the old, old one that has had to be urged in many other similar cases, viz. the too common obstacle to progress or reform, which embraces public or professional prejudice, ignorance, apathy, or inertia !

It is not a little curious that in all civilised countries which possess a well-developed "asylum system" the prevalent feeling of alienists has been adverse to any imitation of Gheel. There are, however, certain signal exceptions. Thus, Professor Parigot, of Brussels, who was for some time Physician-in-chief of Gheel, after visiting England and Scotland and inspecting their asylum systems, specially in order to a consideration of the question how far the Gheel system might fittingly be introduced into these countries, gave it as his deliberate opinion in 1863 " that a Gheel-a pure colony even-could be very easily instituted in Scotland:" while he had "not the slightest doubt about the practicability of erecting the best possible Gheel in England." Nor have we, as regards either Scotland or England! Again, Baron Mundy, than whom no living authority has a more thorough knowledge of European asylums and asylum-systems, and

who spent several months at Gheel, leisurely studying all its features-its defects as well as its advantages-visiting it, moreover, at different times, is most enthusiastic and sanguine regarding the adaptation of the Gheel system to the requirements of the insane in all civilised countries. Those who visited the Paris Exhibition of 1867 might have seen, as we did, in the Austrian section, a model of a "village asylum," with a complete scheme for a new Gheel colony-on too magnificent a scale, however-suited, we fear, only for the very affluent insane! In Scotland the adoption of the Gheel system, as part of the state policy in providing for the insane poor, has been for a long series of years persistently and temperately advocated by Dr. Lindsay, the physician to the Murray Royal Institution [for the Insane], near Perth, both in his annual reports, and in various articles in the public journals. Thus, in 1858 he writes:

"Justice has not been done, as regards treatment, to the incurable but industrious, well-behaved, and harmless insane of Scotland. We have over and over again, and long prior to recent agitations regarding Gheel, advocated the advantages of the cottage or home principle of treatment as applicable to them. . . . We would introduce all that is admirable in the Gheel system, while we would avoid all that is to be condemned in it. Suitable occupation, amusement, and open air exercise at home; the advantage of homely surroundings; the society of kind relatives or friends; the possession of all the social ties that make life a pleasure instead of a burdenthese we would place at the command of the classes of the insane we have indicated. The principles we advocate are not altogether new to Scotland; they have been, to a certain extent, already acted upon. Hitherto many fatuous and idiotic harmless patients have been allowed by the Board of Supervision" (there was then no Lunacy Board)" to be kept at home by their own relatives; or they have been boarded with attentive peasants or cottars, and in many of these cases the patients have been altogether better placed than in asylums. Doubtless there have been cases of abuse, but these have arisen from negligence on the part of the authorities, and ignorance of the proper treatment of the insane. These exceptional cases, however, must not be allowed to invalidate all we wish at present to urge-the principle of home treatment. . . . But though long recognised, and hitherto acted on to a considerable extent, its advantages have never been fully recognised by the public, without whose sympathy and assistance little on the great scale can be achieved. The subject is of special interest at a time when Scotland is exerting herself to erect establishments for the proper treatment of her whole insane population on a scale commensurate with her necessities, and, we trust, with her liberality and enlightenment. . . . . If Scotland would agree to establish a Central National Institution for all her incurable, harmless, but industrious insane, we are convinced the industrial or colony plan might be carried out with signal success.

There is abundance of unreclaimed land in Scotland to work

upon. . . . . It is a pity, at so favorable a juncture, that Scotland is indisposed to deviate from the beaten track in regard to the construction of her asylums and the treatment of her insane, and that the golden opportunity should hence be allowed to pass!"

In 1861, reverting to the subject, he remarks:

"Nearly seven years ago, when we were first charged with the responsibilities of the management of this institution, our attention was attracted to the home treatment of insanity. It was still more closely directed to the same subject by the investigations of the Royal Lunacy Commission for Scotland in 1855, and by particulars which we learned about the same time as to the chief features of the Gheel settlement in Belgium. Our deliberations led us to adopt and publish views, in which, so far as we are aware, we were at the time comparatively unsupported, but which, we are glad to find, are now being generally advocated by most of the competent authorities on such a subject throughout England and Scotland. We recommended essentially the restriction of hospitals or asylums proper to a limited class of cases, and advocated home treatment in cottage-like buildings for another class. . . . . Our suggestions are intended more immediately for the parochial authorities of our own county" (Perthshire), "but we believe they are equally applicable to, as they are assuredly equally at the service of, every parish in Scotland which has any of its population insane."

In 1869 he writes (on this occasion in the Blue Book of the Board of Lunacy):

"Experience has proved that to separate the present generation of the insane poor from their hovel-like, theoretically unhealthy, homes, massing them in palatial buildings superabundant in light, air, and all so-called 'sanitary' advantages, increases, and may even double their mortality; and produces a degree of discomfort or disease which may be safely measured by this mortality. In other words, there are many insane patients who can be much better treated, if domestic contentment and freedom from physical disease are the indices of success, in ordinary private houses, even of the humblest cottage class. . For the poor insane there is no good ground, of a medical character, why the Gheel system should not be, with proper modifications, adopted in Scotland."

Now, what is possible in this direction in Scotland may be estimated by what has been already accomplished. It is an evidence of the vitality and ready applicability of the family system to existing requirements, that while certain forms of colonisation of the insane poor, which flourished under the Board of Supervision, were broken up by the Board of Lunacy, certain other equivalent forms have taken their place. We have already mentioned that in at least four different localities in Scotland

there are rudimentary colonies of insane paupers, numbering at each of two points twenty-four persons. Of these embryo colonies the best known is that of Kennoway, Fifeshire, which we lately took the trouble of visiting.

We were fortunate in securing as guide the intelligent Inspector of Poor, Mr. Smith, who evidently takes a warm interest in the welfare of all the insane boarders in the village, though most of them are not in his special (parochial) jurisdiction. The patients are boarded in groups of two to four in the houses of the villagers, only persons of one sex being resident in each house. The dwellings are of a much better class than those, probably, to which the patients had been accustomed in their own homes; the bedroom accommodation is superior to that of the hosts, who are sometimes married couples, sometimes widows or elderly single women. The diet is ample, though simply of the character of that generally used by the cottar class in Scotland. We saw some of the patients at dinner, which consisted mainly of abundance of wholesome Scotch "kail," well thickened with barley, potatoes, and greens. The hosts struck us as being most kindly and attentive, taking quite as much interest in their charges as if they had been relatives. In every cottage visited there was perfect liberty of action on the part of the patients, though only a few were able or disposed to take advantage thereof to any extent. So far from being subject to annoyance from the children of the village, the patients are universal favorites, and go freely about without attracting notice. Testimony was unanimous among the hosts that the patients give no trouble, unless in the same way that children do-requiring looking after as to washing and dressing. Accidents of any kind are seldom heard of, either to or from patients. The only contretemps reported to us was an outburst of temporary furiosity in a woman, during which she broke several panes of glass; she was, however, at once, and perhaps unnecessarily, transferred to the district asylum, and this is the procedure adopted with all who prove unsuitable for this free-air or domestic treatment. Practically, such transfers rarely occur, a circumstance that argues a wise discrimination in the selection, on the one hand, of the patients boarded out, and on the other, of their custodiers. There are circumstances connected with this family treatment, however, to which cavillers will probably take objection; but we may venture to remark that that scheme to which objection cannot be taken by cavillers must have a more than human perfectness! Persons of prurient imagination will probably look aghast at and reprobate the fact, that the bathing of adult males is occasionally in the hands of adult females! This arrangement, if really or seri

ously objectionable, could easily be altered in favour of male bath attendants; but it is questionable how far such a change would be a benefit. Indubitably women are far kindlier and more efficient nurses than men; nor should greater objection be taken to this department of a nurse's duties than to the similar labours of female nurses or friends not only in all hospitals, but in private homes, where woman ministers, and has always in all countries ministered, to all the requirements of the male sick, dying, and dead! Indeed, one of the chief advantages of the family or Gheel system is that the patient is consigned mainly to the care of kindly woman.

The general impressions produced by our inspection of the Kennoway insane colony were decidedly favorable, and yet the experiment is a most unambitious one, and on quite a trivial scale. The theory of the treatment at Kennoway is thus expressed by one of the Commissioners in Lunacy (Dr. Mitchell):

"If we get kindly and sensible people as guardians, belonging to the grade to which the patient belongs, and living as respectable people of their class generally do; and if the patient be treated as the other members of the family are, and be incurable and harmless, then we may be satisfied that we have made a reasonable provision for his care and comfort."

There can be no doubt that the accommodation and guardianship provided come fully up to this very moderate standard of requirements-a standard which is, however, markedly at variance with that set up by the Scottish Board of Lunacy for the treatment of the same classes of pauper lunatics in poorhouses! The paltriness of the scale on which this phase of the Gheel experiment has been adopted in Scotland is evident when we contrast with the 1000 boarders of the Belgian Gheel the fact that in all Scotland there are only about 100 insane paupers distributed in licensed private houses!

The origin of the Kennoway colony was this. Some years ago an Assistant-Inspector of Poor of the City Parish of Edinburgh was spending a holiday at this out-of-the-way, somewhat decayed and deserted, village. The subject of "boarding out" insane, as well as other classes of, paupers, had been occupying the attention of the City Parochial Board of Edinburgh, and its officers were on the outlook for guardians to their charges. It occurred, then, to this assistant-inspector on his holiday to put the question to his brother inspector in Kennoway whether any of the villagers would take imbecile boarders. Inquiry was made: several of the villagers expressed their willingness to make the experiment; this fact was reported to the Board of Lunacy; the cottagers and their dwellings were visited and approved of by the Commissioners, and their official