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YALE MEDICAL LIBRARY 



HISTORICAL LIBRARY 



The Bequest of CLEMENTS COLLARD FRY 



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GEORGE, 

EARL OF EGLINTON & WINTON 




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Uatelu ^ublisftt*, 

BY HODGES AND SMITH, 104, GRAFTON-STKEET, DUBLIN; 

LONGMANS & CO. AND SIMPKINS & MAESHALL, LONDON; 

Price 3s. in boards. 

AN ESSAY 

ON THE 

USE AND ABUSE OF EESTEAINT IN THE MANAGEMENT 
OF THE INSANE : 

Br 

HAMILTON LABATT, A.B. T.C.D. 

FELLOW OF THE HOTAL COLLEGE OF SUHCEONS IN LHELAND, ETC. 

©pinions of tfic $rcss. 

Quarterly Journal of Psychological Medicine and Mental Pathology. 

' ' Among the various publications which have recently appeared, hearing 
upon so interesting a subject as the treatment of lunatics without restraint, 
we have selected the one whose title is placed at the head of this article. 
The volume, although of small dimensions, we have chosen from the cir- 
cumstance of its being an advocate of the doctrine of non-restraint, and one 
which deserves perusal. In the treatise before us there arc undoubtedly 
many interesting statements, illustrated by data both original and derived 
from other sources ; at the same time that several of the conclusions enun- 
ciated by the author are judicious, and fully borne out by the premises he 
has brought forward." 

British and Foreign Medico-Chirurgical Quarterly Review. 

" Showing a proper discrimination with regard to the true value of the 
non-restraint system." 

Dublin Medical Press. 

" The question discussed in Mr. Labatt's Essay is one of the most 
important connected with the management of the insane, and perhaps more 
intimately associated with the well-being of this unfortunate class, and has 



a greater influence upon the chances of recovery, than perhaps any other in 
the whole range of treatment. The author of the essay before us is a 
strenuous advocate for non-restraint in the treatment of the insane. The 
length of our extracts affords sufficient proof of the importance we attach 
to the subject. The author has adduced a number of important facts bear- 
ing on the superiority of the non-restraint system. The essay abounds in 
sentiments which do credit to the heart and feelings of the writer ; and the 
zeal and activity which it displays for the improvement of the condition of 
the unhappy lunatic are deserving of every praise." 

Monthly Journal and Retrospect of Medical Sciences. 
"We would remark that, with the admission incidentally made by Mr 
Labatt, that personal restraint may be admitted in some cases to facilitate 
treatment, few will be found who will combat with the rest of his essay." 

Dublin Evening Mail. 

" Mr. Labatt is a. zealous advocate of the non-restraint system in the 
treatment of the insane, and truly his views are fully justified. That the 
case of non-restraint versus restraint has been satisfactorily decided in favor 
of the former, is, we think, fully proved in his essay." 

Dublin Evening Packet. 

" This highly interesting and instructive essay, as peculiar for the vigour 
of its style as the clearness and perspicuity with which its views are put 
before the reader, will prove as acceptable to the legal as the medical pro- 
fession, comprehending as it does much useful information on the question 
of Insanity." 

Agriculturist's Gazette. 
" On the whole we consider the work before us of exceeding merit. The 
extensive research it displays, and the desire it evinces throughout to enlist 
a humane and philanthopic interest in behalf of the unfortunate creatures it 
refers to, must and will, we trust, succeed in giving'a stimulus to the reac- 
tion which is in progress for the furtherance of a most ennobling object— 
the relief of suffering humanity." 



AN ESSAY 



USE AND ABUSE OF RESTRAINT 



MANAGEMENT OF THE INSANE, 

INCLUDING 

SOME REMARKS ON THE ORIGIN AND NATURE OF THEIR 

DISEASE : 

WITH COPIOUS NOTES. 



HAMILTON LABATT, A.B. T.C.D. 

FELLOW OF THE ROYAL COLLEGE OF StTRGEONS, IRELAND; DE3IONSTRATOR OF ANATOMY AT THAT 

COLLEGE; AND MEDICAL OFFICER TO THE SOUTH EASTERN 

GENERAL DISPENSARY, DUBLIN. 



" Read not to contradict and confute, nor to believe and take fur granted, nor to find talk and 
discourse, -but to weigh and consider." — Bacon. 



HODGES AND SMITH, DUBLIN ; 

LONGMAN AND COMPANY, AND SIMPKINS AND MARSHALL, 

LONDON. 

1847. 







DUBLIN : PRINTED BY TTEBB AND CHArMAN, 
GIIEAT BRUNSWICK STREET. 



TO 

W I L L I A M L A W R E N C E , F . K . S . 

PRESIDENT OF THE ROYAL COLLEGE OF SURGEON'S, LONDON; 

SOTtGEON EXTRAORDINARY TO THE QUEEN ; SURGEON TO SAINT BARTHOLOMEW'S HOSPITAL ; 

SURGEON TO EETHLEM AND BRIDEWELL HOSPITALS, 

ETC. ETC. 



Dublin, 1, Uppei' Fitzwillkim-street. 
My Dear Mr. Laweence, 

The distinction you have so kindly conferred on tins Essay requires the warmest 
expression of gratitude on my part. 

In now presenting a very inadequate tribute to intellectual attainments of the highest order, 
permit me also to record my unalterable sense of the many personal kindnesses, as will as 
professional advantages, derived from you during my residence in London ; and for which I beg 
to tender my sincere and lasting acknowledgments. 



Believe me, 

My dear Mr. Lawrence, 
With every sentiment of respect and esteem, 

Tours ever faithfully, 

HAMILTON LACATT. 



PREFACE. 



In consequence of facts which transpired during 
the late important discussions at the College of Sur- 
geons in Ireland, both in council and at the last 
annual meeting, as to the validity of the adjudication 
of the Sugden Prize, the author has been induced, 
with the advice and concurrence of some professional 
friends, to submit the following pages to the public. 

The discussions referred to were consequent on a 
series of letters addressed by the author to the Presi- 
dent of the College, embodying certain objections of 
a serious character ; and vitally affecting, as was 
alleged, the eligibility, or " qualification" of the writer 
of the selected essay, " to be even considered by the 
committee" appointed to adjudicate the Prize. 

From the letters, which were moved for and 

a2 



VI 

granted at the annual meeting,* it appeared that the 
objections were founded, 

Firstly, on the fact of a section of the adjudicating 
committee not having voted ; thereby rendering the 
constitution of the final tribunal fractional or imper- 
fect, as appears from the printed Annual Report 
brought up by the Council to the College on the 7th 
of June last. 

Secondly, on the circumstance of the candidate 
whose essay was selected, having disclosed his name, 
by making " a communication"! to one of the adjudi- 
cating body, previous to the final decision ; which was 
also reported in the same official document, and fur- 
ther corroborated by a public reply J given to one of 
the Fellows to that effect, at the annual meeting, by 
the gentleman who received the " communication." 

Months have now elapsed since that meeting, and 
the circulation of the printed Annual Report ; yet no 
explanation touching this extraordinary affair lias 



* This meeting was attended by seventy-three Fellows. 

t Annual Report of Council. 

X The question that elicited this reply was put, as an act of justice to the 
other candidates ; as the Annual Report merely stated that the " communi- 
cation" was sent by " one of the candidates for the prize," the name being 
omitted, by some oversight we presume, from that official document. 



vn 



emanated, either in a public or official form, from 
the gentleman against whom the charge has been pre- 
ferred and substantiated before the assembled College ! 

In this simple statement of facts, which is only due 
to the other candidates, the author has but one mo- 
tive. He seeks to place in a clear and intelligible 
light, the precise position occupied by the writer of 
the selected Essay, previous to the final adjudication, 
in relation to his competitors ; who, in submitting their 
manuscripts with fictitious signatures, meditated no 
delusion ; but rather conceived they were giving the 
first or initiative guarantee, on their respective parts, 
for the honorable fulfilment of that mutual compact, 
enjoining secrecy as to authorship, which the spirit of 
the first advertisement from the College obviously 
dictated ; and with the intention, be it recollected, of 
rendering the final decision as pure, unalloyed, and 
unexceptionable as possible. 

But it would be unjust and ungenerous, to neglect 
so legitimate an opportunity to acknowledge the high 
and independent course pursued by those influential 
members of the Council, who, when the facts were 
clearly before them, did not hesitate to admit, in open 
College, the errors which had been committed ; and 



Vlll 

also explicitly to state, that such involved an absolute 
disqualification of the candidate. 

In this powerful demonstration (it cannot be desig- 
nated otherwise) consisted the highest vindication of 
justice that could possibly have been calculated on by 
the aggrieved parties ; and well may the College con- 
gratulate itself on the significant and vigorous mani- 
festation of spirit and determination which, to the ho- 
nour and credit of our body be it stated, has been 
evinced to discountenance such means of superseding 
fair and unimpeachable competition. 

The cause, then, for the publication of this Essay* 
is at once declared. Under other circumstances, it 
might probably have rested in that oblivion, to which 
the selected manuscript has been hitherto unfortu- 
nately consigned. And much, indeed, is it to be 
regretted, that the object originally contemplated by 
the learned founder of the Prize, should be frustrated 
by the non-appearance of that Essay ; — a production 
which, if published, would have afforded an opportu- 
nity for canvassing arguments designed to uphold 
physical restraint as a remedial agent in insane cases. 

* It must be borne in mind that the original manuscript was written in 
1846. 



IX 

And, on this account, the author entertains peculiar 
reasons for anxiety ; inasmuch as opinions directly at 
variance with the views put forward in that manu- 
script are advocated in the following pages. 

This duty being disposed of, the author has now to 
record his sincere acknowledgments for the very libe- 
ral and kind indulgence afforded by his esteemed 
friends, Dr. Mollan and the late lamented Surgeon 
Blood, in having given him free permission to accom- 
pany them during their visits to the institution 
committed to their charge,* where such ample oppor- 
tunities were presented for prosecuting the subject of 
the following investigations. 

* In consequence of the contiguity of this institution, as also the (then so 
called,) lunatic department or cells of the House of Industry, to the Richmond 
Surgical Hospital, where the author pursued his earliest professional studies 
for a period exceeding five years, he had abundant opportunities of visiting 
a large class of insane patients during his apprenticeship. 



CONTENTS 



Introductory Remarks 1 

Horrible atrocities under the old system — Evidence of Rogers 4 

Melancholy condition of the British and Continental Asylums at that 

period 8 

Humane exertions of Tuke in England 12 

. Pinel in France — his success 14 

Success in the York Retreat under Tuke 17 

System of non-restraint supported 19 

Views of M. Guislain — objections thereto 21 

Constant Medical Surveillance necessary 22 

Punishments ; opinions of Georget, Pritchard, and Copland — objections 

thereto 23 

Critical periods in Insanity. — views of Hippocrates, Celsus, Coclius, and 
Boerhaave, and the more recent ones of Pinel, Esquirol, Connolly, &c. 

with arguments in support of non-restraint founded thereon 24 

Separation of the Insane from their friends 27 

Experience of Esquirol, Georget, Willis, Ellis, Tuke, Finch, &c 29 

Mode of adopting it 31 

Non-restraint — Arguments in favor of, deducible from the nature and 

seat of Insanity ib. 

Opinions of Franck, Guislain, Nasse, Heinroth, Georget, Foville, Cox, 

Cullen, Haslam, Broussais, Maximilian Jacobi, &c. — Strictures thereon 32 
Digestive Organs — Influence of the condition of, in producing Insanity — 
Views of Dr. James Johnson — Disordered digestion terminating in In- 
sanity and death 35 

Non-restraint — Forbes Winslow's views— erroneous 38 

Evidence of Connolly in favour of 40 

Irish Institutions — Condition of— Richmond Lunatic Asylum, Swift's, 

Clonmel, Waterford, Armagh, Belfast, Maryborough, &c Progress 

of non-restraint treatment in each 41 



Xll 

Reports of the Metropolitan Commissioners for 1844— Shocking details of 

abuses still prevalent in various English Institutions 45 

Reports of the Inspectors-General of the Irish Asylums — Laudable efforts 
to correct existing abuses, and to encourage the universal adoption of 

the Nou-restraint System 4" 

Sir Edward Sugden, benevolent exertions of 48 

Solitary Seclusion further considered 49 

Bodily Restraint — further objections thereto — in a physical point of view 50 

moral 56 

Non-restraint — arguments in favour of, founded on certain peculiarities 

of the disease GO 

Important Abstract by M. Georget of the disquisition of Pineland Esquirol 03 

Mode of addressing the Insane 64 

Dr. Burrows — views of — Exceptions 65 

Further peculiarities considered in connexion with non-restraint 67 

Asylums — Architectural plan of, briefly considered — Shocking results 

from neglect of this— Bethlem— Bicetre 69 

Employment— mental and bodily — Bazaars— "Workshops— Choice of At- 
tendants — their responsibilities — Conclusion 71 



ESSAY. 



To the System of cruel and unmitigated Restraint, 
recorded as part of the treatment formerly adopted 
in Lunatic Asylums, we may attribute that reaction 
in public opinion, which has happily terminated in 
the very rapid, and almost universal revolution in 
the management of the insane. And when, on visit- 
inc one of our well-regulated Institutions for the 
reception of these poor creatures, so deserving of our 
sympathy and care ; and remarking the unwearied 
attention paid to their comforts and wants, — indeed, 
in many cases, the almost parental anxiety evinced 
towards them, by those privileged to dispense such 
invaluable offices,— we cannot, on noting the result, 
but entertain a feeling of incredulity and amazement, 
that a method so opposite in its character, and so 
revolting to humanity, should for a moment have 
been sanctioned, not only by the ignorant attendant 



and official, but by the weight and authority of the 
learning and experience of the day.* 

To enter on any lengthened detail of the barbari- 
ties alluded to, would lead us beyond the limits 
prescribed for this Essay. They are open for the 
perusal of him who would seek for melancholy in- 
stances of man, degraded — brutalized by his fellow- 
man ; of madness exasperated — confirmed by the 
lash, the chain,f and all manner of contrivances calcu- 
lated to harass and extinguish the remaining spark of 
our noblest attribute ; and, lastly, (for we must re- 
ceive what is authoritatively handed down to us, 

* Of the truth of this, the writings of Cullen, formerly Professor of 
Physic in the University of Edinburgh, and one of the most experienced 
and accomplished physicians of the day, afford us melancholy evidence. 
Alluding to the treatment of insanity, he states: — "In most cases it has 
appeared to be necessary to employ a very constant impression of fear ; and 
therefore to inspire them with the awe and dread of some particular persons, 
especially of those who are to he constantly near them. This awe and dread 
is therefore, by one means or other, to be acquired ; in the first place, by 
their being authors of all the restraints that may be occasionally pro- 
per ; but sometimes it may be necessary to acquire it even by stripes and 
blows. The former, although having the appearance of more severity, are 
much safer than strokes or blows about the head." — Works of William 
Cullen, edited by J. Thompson, p. 524, vol. 2. 

Delarive of Geneva, in a celebrated letter addressed to the editors of the 
British Library in 1798, alluding to the evils then existing in our asylums, 
observes, ' ' that one would think madmen were employed to torture 
madmen." 

f Mr. Rogers relates cases of the legs and wrists of patients being dread- 
fully lacerated from being improperly confined. And Mr. Tuke mentions a 
male patient, who was brought to the York Retreat, chained and in a state 
of frantic excitement, and in order that the chains might not be removed 
for a moment, it had been managed that his clothes could be taken off 
without interfering with them I On his admission, all restraint was instantly 
taken off, and under the mild system pursued in that institution, he was 
restored in a month. 



horrible as the consummation of wickedness may have 
been) of the violation of all that is most dear to the 
possessor ; and which the condition alone of the poor 
maniac ought to have rendered doubly sacred in the 
eyes of those around her* : but, without reference to, 
or consideration of the limits we must observe, such 
a detail would, we feel assured, be unnecessary ; as 
public opinion and the progressive march of know- 
ledge have already pronounced a verdict, which alone 
is sufficient to seal the condemnation of so monstrous 
a system, f 

At the same time, we must not dismiss this part of 
our subject without some further notice. Such a 
course would be unsatisfactory to ourselves, as well 
as calculated to expose us, in the estimation of those 
who are probably ignorant of the facts, to the impu- 
tation of undue exaggeration in what we have stated ; 
and naturally so, for who could credit that in a 
christian country, and within the present century, 
scenes so horrifying and fiendish in their character 



* "A Statement of the Cruelties, Abuses and Frauds which are 
practised in Madhouses," by J. S. Rogers, Surgeon, London, and dedicated 
to the Right Honorable George Rose (1815). 

f Dr. Connolly, in his admirable lectures published in last year's Lancet, 
thus speaks of the effects of the atrocities alluded to : — " The patient's state 
is made worse by what he feels to be an injury and an outrage ; and it was 
by patients thus fastened, that the cries and bowlings were uttered, which 
those who used to pass the walls of the ancient Bedlam have described as 
making night hideous. The patient can scarcely use his limbs, and lie 
therefore shouts or sings with all his might ; and he vents the bitterest ex- 
ecrations on all who come near him ; for he feels that they come as tormen- 
tors, not as friends.'' 

B 2 



could have taken place, had we not eye-witnesses to 
bear testimony to the atrocities which, it is sad to 
reflect, disgraced our land at so recent a period ? Some 
of these facts are so replete with moral turpitude, 
and so revolting to all delicacy, that we cannot allow 
ourselves to be accessory to the revival of them here, 
further than mentioning the author who has recorded 
them. There are, however, others which we shall 
bring forward, being anxious to elucidate the system 
of degradation from which we have been relieved, as 
well as to set forth the immeasurable debt which is 
due to those who achieved the revolution. 

In order to present a specimen of the description 
of persons sometimes engaged in the management of 
madhouses at that period, we cannot do better than 
relate a circumstance which came to the knowledge 
of Mr. Rogers, who was an eye-witness, and whose 
fortune it was " to be placed in a situation that gave 
an opportunity of ascertaining the cruelties" practised 
by " certain licensed ruffians," as he styles them: — 

A person, who had been long acting a conspicuous 
part in these scenes, began his career in life as a porter 
at the gate of a private madhouse, and soon after be- 
came keeper, when he was initiated into the pi'oceedings 
of this dark asylum. In due time he was admitted into 
a share in the concern, having previously married the 
housemaid. By means easily to be conceived, he 
engaged the master of a public institution to recom- 
mend patients to his house. The son and daughter 



of these two worthies intermarried, and the former 
having been brought up as an apothecary, added in 
no small degree to the gains of his family.* The 
salary of the master alluded to, together with that of 
his wife, amounted to about £150 per annum, and he 
has accumulated a fortune of at least thirty thousand 
pounds. It would be affronting common sense," 
adds Mr. Rogers, " to make this fact a subject of 
comment." 

From such and other evidence, it would appear to 
have been literally a system of the vilest and most 
abominable traffic in human miseries. We learn that 
it was customary for the friends of the insane at first 
to apply to the master of some public asylum, who, 
if his house happened to be full, as was too often the 
case, Avould recommend to them some private house, 
for which patronage he has been known to get a dou- 
ceur of £500 ! The fruitful resources for wholesale 
robbery and imposition were sufficiently productive, 
to allow of this voluntary tax on the part of the mas- 
ters of these private dens of wickedness ; for it ap 
pears that whatever stock of wine, and other expen- 
sive articles of diet, was ordered, was largely paid for, 
but seldom enjoyed by the patient ; and notwith- 
standing a most liberal supply of clothing, he was 



* "Medicine,"' says Mr. Rogers, "is always poured in by the apothecary 
in such quantity, that it commonly exceeds in charge the bill for board." 
Bad as this may have been, we shall presently see that it was very insigni- 
ficant indeed, compared with the atrocious cruelty of the medical attendant. 



generally kept in the barest state, except when visited 
by his friends, when he was reported to be "a great 
destroyer of his apparel." Another stock was then 
sent in, which, like the first, was given to those whom 
the master was paid for providing. In fact, to use 
the words of a writer already referred to, " so enor- 
mous was the expense incurred, that in the end the 
friends became tired, and the poor sufferer was re- 
moved to an underground cellar, where he ended his 
miserable existence."* Hence occurred heart-rending 
scenes, such as the following : — 

" One afternoon in November," writes Mr. Rogers, 
" a very severe day, at a very early hour, about three 
o'clock, I observed several wretched females lying 
three together, in a crib calculated for one person 
only, and actually in a state of nakedness, a piece of 
worn carpet being thrown over them. On enquiring 
into the cause of the cruelty, the female keeper told 
me that she was obliged to put them to bed so soon, 
because they had but one shift, which she must wash 
against the morning !" 

" Another time," he says, " I noticed a woman in a 
similar situation, and the following morning I saw 
her dead in her crib !" 

Such was the condition in which those wretched 
creatures often closed their sufferings, seldom per- 
haps breathing the open air ; except when whipped 

* Rogers' statement. 



out of bed, probably by some female accomplice, and 
forced to the pump to be mopped down * by the 
direction of a savage keeper ; to whose mercy an entire 
establishment has frequently been left for months, 
without once undergoing the inspection of the 
master. 

But whilst we shudder at the thought of this atro- 
cious system, and the blood runs cold on perusing its 
horrible records, must not our indignation be turned 
to other quarters also, where the most criminal apathy 
and neglect, amounting almost to connivance, must 
have existed, to have allowed of the continued perpe- 
tration of such abominable wickedness ? We can but 
too easily imagine how the friendless wanderer may 
travel through a long series of misery and wrongs, 
almost unseen and unhenrd of ; and when the sorrow- 
ful journey has at length been accomplished, every 
voice may still remain as silent on his sufferings as 
the grave which has received him. Unhappily, we 
fear, such is often so ; but when we read of " gentle- 
men" of high rank, who must have had friends, and, 
in another place, of " a lady," who must have had 
some relative or protector, tortured — persecuted abso- 
lutely to death ; we cannot but ask where were they 
whose duty it was to have watched and interfered, 
when they witnessed the awful devastation exhibited 
in, perhaps, a parent or a relative, whose shattered 

* Mr. Rogers has known this barbarous operation to be adopted at the 
harshest period of winter, when the snow was on the ground ! 



frame presented an appalling wreck of misery and 
ruin ? 

Before leaving these sad reflections, and passing to 
a more agreeable portion of our task, we shall transfer 
a few cases from Mr. Rogers' pamphlet, without offer- 
ing any further comment, which might only weaken 
the descriptions we are about to present: — 

" A young married lady was taken to a house in 
the vicinity of London, in good bodily health. After 
a time, her friends, dissatisfied with her appearance, 
removed her to another house. There, however, she 
deteriorated still more strikingly, and they again 
placed her in the former house, where she soon died in 
great misery. Her teeth were completely loosened by 
the brutal manner of forcing the food, and several 
were displaced ; her gums were putrid, and her whole 
appearance demonstrated extreme ill-treatment." 

" A gentleman, who was confined in a room by 
himself, refusing to take food, the keeper proceeded 
to force him, and in so doing used such violence that 
the patient called loudly for assistance, saying ' For 
God's sake, come and help me, or I shall be murdered ;' 
but this exclamation, though it was distinctly heard 
by both master and mistress, was not attended to. 
The noise ceased, and the keeper presently came to 
acquaint his master, that while forcing the gentleman, 
he went off in a fit !"* 

"In these cases," says Mr. Rogers, "a note is dispatched to the 
friends, and the body taken away without further enquiry 1" 



" I have seen gentlemen secured in a chair, their 
hands and feet manacled, in which situation, on a 
slight murmur, they have been struck with the 
clenched fist of a brawny villain, till the blood gushed 
from different parts of their faces. Another patient, 
under similar circumstances, was deprived of the 
sight of an eye by a blow !"* 

" I have known a gentleman who mixed in the first 
ranks of society, and who held high situations in the 
army and navy, kicked and beaten by his brutal keep- 
ers, and confined in a cell unfit for the habitation of 
any human being." 

" A patient, for some trifling refractory airs, was 
frequently lashed on the bare back with a knotted 
cord, by a keeper assisted by another ruffian similarly 
armed, in so merciless a manner, that it is impossible 
he should have escaped the most serious injury. The 
patient died shortly after, and no doubt can be enter- 
tained that his death was accelerated by ill-treatment." 

" A patient for whom a bath had been ordered, on 
his first emersion called out, ' Serve up dinner for 

Lord .' The keepers cried, ' Oh damn you ! 

Are jou at that sport ? we'll soon cure you.' He re- 
peated the exclamation several times, and was as often 
thrown in until he was nearly drowned !"f 

The frank tone of honesty with which the above 

* *' This," states the author, "was a daily and unreproved practice." 
f ' ' Upon my remonstrating in this case, " states Mr. Rogers, ' ' the medical 
attendant said it was ' good fun I' " 



10 

and other details are given, strengthen their authen- 
ticity in no slight degree. The author, naturally 
enough dreading the consequence which an exposure 
of names might bring on an humble private indivi- 
dual, and at the same time evidently hesitating as to 
the course of duty, thus reasons : " It behoved me 
to consider, whether my individual testimony would 
have sufficient weight with the pubbc mind, to turn 
the balance against the false witnesses which great 
wealth, unchecked by any sense of religious or moral 
obligation, would, I well knew, bring against me."* 

But this revolting system was not confined to our 
own country. Similar atrocities were committed on 
the Continent, where, it would appear, a species of 
public countenance and support was afforded to them, 
by those who could only be interested in perpetuating 
so melancholy a state of things, by the desire to gra- 
tify an appetite for all that was fiendish and inhuman. 
We have it, on authority not to be doubted, that in 
many of the continental institutions, the lunatics were 
confined in cages, through the bars of which food and 
straw were thrust in ; and, in this condition, they 
were publicly exhibited to visitors who paid a certain 
sum to see them as wild beasts !f 

Hitherto, our observations have been confined to 

* Although Mr. Rogers does not mention the houses where these atroci- 
ties took place, he distinctly states the following in liis work. " I will most 
gladly communicate with those who happily may have both the will and the 
power to aid effectually in putting a stop to the atrocities I shall expose." 

t Chambers' Edinburgh Journal, No. 307. 



11 

those barbarities which constitute the extreme abuse 
of bodily restraint and punishment. We have not 
made any allusion to that milder form of coercion 
which shall now occupy our attention, and which, at 
the present period, is practised and upheld by those 
whose high motives of humanity are beyond cavil or 
doubt. Nevertheless we entertain a sanguine hope, 
(and we are far from any desire to disparage the 
efforts of these distinguished individuals,) that even 
this system will yet be totally expunged from our 
treatment ; and will merely be recorded in the annals 
of a more enlightened period of that history which 
we have been dwelling on. 

Let it not be supposed that in thus candidly ex- 
pressing our views, we think lightly of the arguments 
adduced by the present supporters of bodily restraint. 
Far from it ; opinions emanating from such a source 
deserve the utmost attention and respect ; but we are 
to bear in mind that if such be found, on further 
enquiry, to be erroneous, it the more behoves us to 
expose their fallacy ; as the higher the authority may 
be from which any mistaken notions proceed, the 
more general will be their adoption, and conse- 
quently, the more extensive the evils resulting there- 
from. Bearing in mind, then, the magnitude of the 
subject proposed for discussion by the learned and 
enlightened oi'iginator* of this Essay, whose high and 

* Sir Edward Sugden. 



12 

benevolent purpose cannot be too highly commended, 
and fully impressed with the importance it assumes 
in connexion with the happiness or otherwise of so 
many of our fellow-creatures, we shall not hesitate to 
canvass freely the opinions of others ; whilst, at the 
same time, we shall give an unreserved statement of 
the conclusions which our own personal observation 
and research have led us to, " on the use and abuse 
of restraint in the management of the Insane." 

Before doing so, it may not be irrelevant briefly to 
glance at the labours of one, whose untiring energy 
and persevei'ance contributed so largely towards the 
reaction we have referred to. We allude to the 
late Mr. "William Tuke, who, in the year 1792, called 
the attention of the Society of Friends to the enor- 
mities then prevailing in the system of Lunatic 
Asylums,* urging at the same time the necessity of 
some speedy remedy. The sad occurrence which 
roused the attention of that distinguished philanthro- 
pist is peculiarly interesting ; not only in connexion 
with the history of our subject, but also as strongly 

* From the statistical information connected with this period, as given by 
the late M. Esquirol in the Dictionnaire des Sciences Medicates, we can 
collect the very unfavourable condition of the English Asylums, in which 
the proportion of cures appeared for the most part to be less than in the 
French Institutions ; although in some of the former, Bethlem and St. 
Luke's for example, patients who were more than twelve months insane, or 
who were subject to paralysis, epilepsy, or convulsions, were rejected. 
Whereas, since the system of treatment has been altered, the preponderance 
has been in favor of the English asylums. 



13 

corroborative of the fact that a pernicious system 
often cures itself. 

" A respectable female of the Society of Friends was 
placed at an establishment for the reception of insane 
persons near York, and her family residing at a 
considerable distance, requested some of their acquain- 
tance to visit her. This visit was refused on the 
grounds of the patient not being in a suitable state to 
be seen by strangers: in a few weeks she died !"* 

After the series of atrocities we have just related, 
we shrink from contemplating what may have been 
the particulars of this case, now sunk for ever in 
mysterious darkness ! But we have the melancholy 
satisfaction to know, that it was the forerunner of 
that bright era which subsequently led to the realiza- 
tion of the most benevolent designs. Still there 
were deep-rooted prejudices and conflicting interests 
to be contended with ; which, with limited resources, 
and the various other difficulties but too often opposed 
to great and useful undertakings, presented a most 
discouraging aspect. Notwithstanding all this, Mr. 
Tuke persevered : and, at the termination of the year 
1793, the committee was enabled to purchase a piece 
of ground about half a mile from York, on which 
the Eetreat was erected. 

On the 11th of May, 1796, the institution was 
opened, and early in the following month, three 

* Tuke's Description of the York Retreat. 



14 

patients were received. Afterwards, the building was 
gradually increased from time to time ; and in 1812 
accommodation was afforded to 66 inmates. Such 
is a brief history of that celebrated Retreat, in which 
many a poor frantic lunatic has found a refuge from 
the iron hand of restraint ; and the government of 
which was, to use the energetic language of an intelli- 
gent writer, " a government of humanity and consum- 
mate skill, and required no aid from the arm of 
violence or the exertion of brutal force."* 

In the same year, but subsequent to the period 
which marked the commencement of Mr. Tuke's 
exertions, a similar revolution originated in France, 
through the instrumentality of the celebrated Pinel. 
We are informed that this distinguished individual, 
" having many times urged the government to allow 
him to unchain the maniacs of the Bicetre, but in 
vain, went himself to the authorities, and with much 
earnestness and warmth advocated the removal of 
this monstrous abuse. Couthon, a member of the 
commune, gave way to M. Pinel's arguments, and 
agreed to meet him at the Bicetre. Couthon then 
interrogated those who were chained, but the abuse 
he received, and the confused sounds of cries, vocife- 
rations, and clanking of chains in the filthy and damp 
cells, made him recoil from Pinel's proposition. 
" You may do what you will with them," said he, 

* "Remarks on the construction of Asylums," by Mr. Starkie, Archi- 
tect, Glasgow. 



15 

" but I fear you will become their victim." Pinel 
instantly commenced his undertaking. There were 
about fifty whom he considered might, without danger 
to the others, be unchained; and he began by releasing 
twelve, with the sole precaution of having previously 
prepared the same number of strong waistcoats, with 
long sleeves, which could be tied behind the back if 
necessary. The first man on whom the experiment 
was to be tried was an English captain, whose history 
no one knew, as he had been in chains forty years. 
He was thought to be one of the most furious among 
them ; his keepers approached him with caution, as 
he had, in a fit of fury, killed one of them on the 
spot with a blow of his manacles. He was chained 
more rigorously than any of the others. Pinel en- 
tered his cell unattended, and calmly said to him, 
" Captain, I will order your chains to be taken off, 
and give you liberty to walk in the court, if you will 
promise me to behave well and injure no one." " Yes, 
I promise you," said the maniac, " but you are laugh- 
ing at me ; you are all too much afraid of me." " I 
have six men," answered Pinel, " ready to enforce my 
commands if necessary. Believe me then, on my 
word, I will give you your liberty, if you will put on 
this waistcoat." 

He submitted to this willingly, without a word ; 
his chains were removed, and the keepers retired, 
leaving the door of the cell open. He raised himself 
many times from his seat, but fell again on it, for he 



a 



1G 

had been in a sitting posture so long, that he had lost 
the use of his limbs. In a quarter of an hour he 
succeeded in maintaining his balance, and with totter- 
ing steps came to the door of his dark cell. His first 
look was at the sky, and he- cried out enthusiastically, 
How beautiful !" During the rest of the day he 
was constantly in motion, walking up and down the 
staircases, and uttering short exclamations of delight. 
In the evening he returned, of his own accord, to his 
cell, where a better bed than he had been accustomed 
to had been prepared for him, and he slept tranquilly. 
During the two succeeding years which he spent in 
the Bicetre, he had no return of his previous parox- 
ysms, but even rendered himself useful by exercising 
a kind of authority over the insane patients, whom he 
ruled in his own fashion.* 

But it is unnecessary to dwell further on such 
cases ; nor should we have presented the above, did 
it not offer a practical lesson, which cannot fail to 
bring conviction even to the most sceptical ; not only 
as to the pernicious results which restraint and ill- 
treatment entail, but also as to the beneficial effects 
which so speedily follow, even under the most un- 
favourable circumstances, a system of indulgence and 
kindness towards the patients. If the gentleman 
whose case has been so touchingly related above, had 
not possessed, notwithstanding years of persecution, 

* The British and Foreign Medical Keview, No. 1. 



17 

much of that which is estimable in our nature, what 
could have prevented his breaking forth in all the 
fire of natural resentment towards his cruel and 
merciless tormentors : instead of adhering so faith- 
fully to that pledge which he had given to his humane 
deliverer. 

The above details will afford a tolerable conception 
of the abuses that existed in both countries, when 
Mr. Tuke's grandson and successor published, in 
1813, his celebrated Description of the York Retreat, 
a work characterized by that genuine spirit of huma- 
nity and benevolence, which reflects unbounded credit 
on its excellent author ; and of pre-eminent import- 
ance at a period, when the horrible system we have 
referred to was still in operation, and had attracted 
so much attention as to call for the repeated interfer- 
ence of the legislature.* The facts to be collected 

* In July, 1807, a select Committee of the House of Commons, composed 
of Mr. W. Wynne, Mr. Wilberforce, Mr. Morton Pitt, Mr. Dickinson, Mr. 
Rose, Mr. C. Dundas, Sir W. W. Wynne, Mr. F. Burton, Mr. Bathurst, 
Mr. Whitbread, Mr. Shaw Lefevre, Sir H. Paulet, Mr. St. John Mildmay, 
Mr. Attorney-General, Mr. Solicitor-General, Mr. Sturges Bourne, Mr. 
Patten, and Mr. Fane, was appointed " to enquire into the state of the crimi- 
nal and pauper lunatics in England and Wales, and of the laws relating 
thereto, and to report to the House on the same, with their opinions and 
observations thereon." In the following year, on the 1st of June, a bill "for 
the better care of criminal and pauper lunatics" passed. In 1811 and 1815, 
amended bills were enacted, and we find by the parliamentary proceedings in 
1817, 1819, and 1824, further enactments were passed, and in March, 1826, 
an Act " for the establishment of asylums for the lunatic poor of Ireland," 
received the royal assent. Subsequent to this, the attention of the legisla- 
ture was almost yearly directed to this important subject, as will appear 
from the various proceedings of the House, in the years 1828-31-2-3-4-7-9-40, 
&c. — Vide Journals of the House of Commons. 



18 

from Mr. Tuke's remarks, which, to use the words of 
an eminent physician, " have doubtless led to the mi- 
tigation of the lot of many a restless lunatic,"* were 
so strong and convincing, as to excite the public mind 
to the amelioration of a system but too frequently 
calculated to depress and degrade, rather than to re- 
kindle the slumbering spark of reason, or correct its 
wild hallucinations ; and accordingly we find a general 
sympathy started up in favor of a plan, conducted 
with the utmost humanity, by which " patients brought 
frantic and in irons" were reduced " to obedience and 
orderly behaviour," and such was the success attending 
it, that " furious mania was almost unknown in the 
Retreat." Bodily restraint was not, however, entirely 
rejected ; it was still adopted, but under considerable 
restriction ; and we consequently observe a correspond- 
ing improvement in the condition of the poor patients, 
as also in the proportion of cures, compared with those 
in the other English asylums, or even in the conti- 
nental, which had previously presented such prepon- 
derating success. 

To the statistical information brought forward by 
Mr. Tuke, in connexion with this point, we would in- 
vite particular attention, as demonstrative of the 
encouraging results under the modified system then 
adopted in his institution. Of the 61 recent cases in 
the York Report, two-thirds were discharged cured, 

* Connolly's Lectures Lancet, 1845. 



19 

although one-half of the whole were cases of melan- 
cholia, which is allowedly more intractable than 
violent mania. From the 88 old cases mentioned in 
the same report, we can scarcely, with precision or 
fairness, draw any conclusions ; it being impossible to 
estimate how far the plan of treatment pursued in 
those institutions, where they had previously been, 
may have complicated or confirmed the mental dis- 
ease. Of these old cases, however, it appears that 
one-fifth terminated in death, whereas of the recent 
cases only one-ninth had such a termination. It is 
also to be remarked, that nearly one-fifth of the old 
cases were discharged cured. On the other hand, if 
we refer to the Bethlem report, of the 78 ill only 12 
months, not more than one is mentioned as cured ; 
and even she relapsed into an incurable state ; and of 
the whole number admitted, only one-third were 
cured. In St. Luke's, the proportion of cures amongst 
the average annual admissions would seem to be more 
favourable. Whilst at Salpetriere, according to Pinel, 
of the 1002 admitted, (473 of whom had been in 
other hospitals) one-half recovered. Such are some 
of the rough data which attracted our attention on 
perusing the statistical returns in the work referred 
to. 

We shall now proceed to examine the validity of 
the arguments adduced by the advocates of bodily re- 
straint in the treatment of the insane ; and to submit 
the grounds on which we have been led to entertain a 

c 2 



20 

total dissent from them. Notwithstanding the great 
weight of authority opposed to us, we have long been 
of opinion that it has been productive of the worst 
consequences ; that under it every influence of a 
moral tendency is endangered, if not destroyed ; and 
that its adoption has led, in many cases, to a forfeiture 
of that confidence so essentially necessary in our 
treatment ; and which, under different circumstances, 
the patient would have reposed in his attendant. Such 
is the position we would maintain ; and we entertain 
a sanguine hope of being able to prove, assisted in no 
slight degree by the statements of even the adopters 
of restraint, that whether we view its effects morally 
or physically, its use ought to be completely excluded 
from the precincts of a lunatic asylum. We shall 
never forget on one occasion, during our first inter- 
course with the insane, witnessing a middle-aged man 
labouring under high maniacal excitement, for which 
bodily restraint had been imposed ; the symptoms 
continued unabated, during which he used the most 
violent language to those around him. While in this 
state, the restraint was removed by order of the medi- 
cal officer, and he then gradually became calmer ; and 
shook hands with the author, (a perfect stranger) say- 
ing to him, " I will fight for you against any man ;" 
yet continued most indignant towards those who had 
imposed the coercion. This simple case made an in- 
delible impression on us ; affording, as it did, hints 
which, in our mind, constituted the key-stone of that 



21 

arch, on which alone could be built a rational and 
proper method of treating the insane ; as also sug- 
gesting the necessity of gaining an ascendancy in the 
confidence of the patient, and sympathizing with him 
in all his feelings. 

But the difficulty so obviously manifested in the 
above case, was evidently entertained and felt by the 
advocates of restraint ; and it is curious to observe 
into what fatal errors we may fall, whilst endeavour- 
ing to bolster up a system, the incalculable evil of which 
is admitted, and actually doubly increased, by the very 
precautions we may recommend. For instance, M. 
Guislain, in his Traite sur 1' Alienation Mentale, after 
most judiciously advising the physician to abstain 
from doing or saying any thing calculated to inspire 
fear or dread, or by which he might become an object 
of aversion, or lose the confidence of his patient, re- 
commends that some other person should be the agent 
in all restraints or punishments, and that the physi- 
cian should be regarded as the protector of the patient, 
and the dispenser of kindnesses and indulgence ! 

Were we required to describe a system at all likely 
to be tolerated in the present day, to which more than 
another we should offer our unqualified opposition, it 
would be the very one laid down by M. Guislain. If 
we are to have punishments and restraints, let the 
poor sufferer, at all events, have the advantage of a 
competent medical dispenser, before he be subjected 
to a treatment about which, it must at least be con- 



22 

fessed, there is some doubt. We mean not to object 
to as many moral superintendents as may be proposed ; 
such officers are most advantageous ; but we can 
never award perfection to any plan connected with 
the care of the insane, where a constant medical sur- 
veillance is not kept up. Let the power of imposing 
restraint, if it must be, emanate from the medical au- 
thority alone, and then the attendants will, for their 
own sakes, be the more anxious to cultivate that 
moral control over the patients, which it must be our 
primary object to establish.* We cannot be too par- 
ticular in the power we commit to ignorant or inex- 
perienced persons in those institutions. And well has 
M. Georget laid down, that active and incessant in- 
spection must be exercised, particularly in an asylum, 
over both patients and attendants. 

Moreover, M. Guislain appears to us to have too 
hastily calculated on the possibility of separating the 
respective responsibilities of the medical officer and 
proposed agent, in the mind of the patient. The phy- 
sician is well known to most of the inmates of an 
asylum ; he is looked on as the head and protector ; 



* In the 13th Annual Report of the Maryborough District Asylum, pub- 
lished in the Dublin Medical Press for the 8th of July, 1846, an observation 
is put forward by Dr. John Jacob regarding the result of non-restraint treat- 
ment, 'which may not be inapposite here, viz. : ' ' The beneficial influence on the 
demeanour of the attendants, which the total abolition of instrumental re- 
straint has exercised, cannot be over-estimated." 

"Wherever restraints arepermittedtobeused, the attendants will put them 
on wantonly, and frequently unnecessarily, and will become regardless of all 
minor offices of humanity towards the patient." — Connolly's Lectures. 



23 

and M. Guislain cannot have failed to remark what 
has often struck ourselves ; the poor lunatic, in a state 
of acute excitement, running across the court on see- 
ing the physician, and complaining to him, as the re- 
sponsible person and source of redress, of some petty 
or imaginary grievance. What, under M. Guislain's 
plan, would be the defence set up, in the case of a real 
grievance, by the " dispenser of kindnesses," for the 
cruelties of his agent ? 

But the above views, as put forward by M. Guislain, 
present another important feature which has attracted 
our attention ; and the same is observable in works of 
more recent date, emanating from individuals of the 
highest consideration, whose opinions occupy a promi- 
nent position in the writings of the day. We allude 
to the frequent mention of " punishment," in con- 
nexion with the treatment of the insane. It is true 
that we find considerable modification adopted by 
each, and that an evident degree of hesitation is 
evinced, proving that they themselves were apprehen- 
sive of its evil tendency. M. Georget, for instance, 
states that the only means of punishment that should 
be practised are the shower bath, strait-Avaistcoat, 
seclusion in a cell, and some occasional privation. 
Again, Dr. Pritchard, whose experience entitles him 
to the deepest attention, observes that all measures 
of punishment and intimidation should be used as 
sparingly as possible, and be of the most harmless de- 
scription. Lastly, Dr. Copland lays it down, that 



24 

when obstinate lunatics refuse to take food or medi- 
cine, persuasion should be first tried ; and if this fails, 
threats and harmless punishments may be adopted. 
The qualified tone in which the above opinions are 
put forward, corroborates our position in no slight 
degree, and we notice it the more particularly, con- 
nected as it is with that principle which, in our opi- 
nion, forms the pivot on which the entire moral* 
treatment turns. As long as it remains unsettled, so 
long must a doubt most dangerous to a successful plan 
of treatment exist ; and we cannot contemplate any 
thing more truly melancholy, than the reflection that, 
under erroneous views, we may have been impeding 
instead of favouring the returning light of reason in 
a fellow creature. Pre-eminent as is the privation 
amongst our numerous afflictions, we feel the greater 
responsibility in our task. And if we be correct in 
stating that the doctrine of crisesf is applicable to 



* " Toutce qui pourra agir sur le cerveau directement ou indirectement, et 
modifier notre etre pensant, tout ce qui pourra dominer et diriger les pas- 
sions, sera l'objet du traitment moral." — Esquirol, vol. 1, p. 119. 

Tuke divides moral treatment into three parts. " 1st. By what means 
the power of the patient to control the disorder is strengthened and assisted. 
2nd. What modes of coercion are employed when restraint is absolutely ne- 
cessary. 3rd. By what means the general comfort of the insane is promoted." 
We would suggest the omission of the second. 

t " Ces crises sont physiques ou morales, elles ne s'observent que dans la 
monornanie, la lypemanie, la manie, la demence aigut', elles ne sauraient 
avoir lieu dans l'imbecillete, la demence chronique, et la demence senile." — 
Esquirol, p. 82, vol. 1. 

Again : " J'ai constamment observe que dans l'espace du premier mois de 
la maladie, il se fait une remission tres marquee." — Ibid, p. 93. 

A case of acute mania, neither aggravated by neglect nor injudicious 



25 

certain forms of insanity, as was put forth by Pinel, 
Esquirol, and others, and long ago supported by Hip- 
pocrates, Celsus, Caalius, and Boerhaave, we can duly 
estimate the consequences likely to result, from any 
rash interference with the favorable progress the dis- 
ease may be disposed to take. It is by patient and 
humane perseverance alone, that we can achieve im- 
provement in our patient, watching when we can be 
of service, and not inconsiderately stepping forward 
with the expectation of effecting sudden changes : 
ever bearing in mind the sentiments of an eminent 
writer, whose views are entitled to the utmost atten- 
tion and respect. " Reason does not in general at 
once resume her lost empire over the mind ; her ap- 
proach resembles rather the gradual influx of the tide. 
She seems to struggle to advance, but again and again 
is compelled to recede. During this contest, the judi- 
cious attendant may be the most valuable ally, and 
render the most effectual assistance in the recovery of 
her lawful throne."* 

In this beautiful and impressive passage, we have a 
valuable lesson on the importance of " a judicious 
attendant." And we can legitimately derive from it 
the danger apprehended by the author, from that vio- 
lent system of treatment which it was the peculiar 



means, has a tendency to subside within a certain period. If that period 
passes by, marked by a mere remission, and followed by fresh excitement, 
our hope of an early cure is much diminished." — Connolly's Lectures. 
* Tuke's Description of the York Retreat. 



26 

object of his work to deprecate ; and which, by pro- 
longing the disease, was certain to diminish the chance 
of a favourable issue. It has been observed by a high 
authority, that the ultimate tendency of insanity is to 
pass into a state of mental decay, or obliteration of the 
intellectual faculties ;"* in other words, into a state of 
incoherence or dementia. And it is recorded, on the 
authority of Pinel, Esquirol, and others, that the 
greater number of cures are effected in the first month 
of the disease, and that the number of recoveries 
diminish comparatively as we go beyond that period.f 
From these and other data, we at once collect that 
certain changes do take place as the disease continues ; 
that it does not remain stationary or unaltered for any 
length of time ; and that, if not advancing to reco- 
very, it must be retrograding into a more unmanage- 
able form. Hence it is that in this disease, above 
many others, our treatment must be seasonable and 
judicious. At the same time we are never to despair, 
but, to use the words of a distinguished physician, 
" conduct the treatment on the principle that ameli- 
oration is attainable in every case."J Instances on 
record encourage this view. Pinel has given " a well 
authenticated case" of twenty-five years standing sud- 
denly cured. Escpuirol gives another of ten years 

* Pritchard. 
f Pinel and Esquirol have laid down certain average periods of duration ; 
the former stating the period to be between the fifth and sixth month, whilst 
the latter gives a greater extension, in which he is supported by Tuke. 
J Connolly's Lectures. 



27 

duration, which recovered in the same manner ; and 
he is of opinion, that there is always hope when there 
is physical derangement.* Neither are we to be en- 
tirely discouraged by the unfavourable form of the 
malady ; as the last mentioned writer has recorded 
two cases of maniacal dementia, in which the symp- 
toms subsided on the appearance of the catameniaj ; the 
patients having been insane since earliest youth. He 
also gives one of a Avoman who was insane since the 
the menstrual period commenced, and became sane at 
forty-two years old, when it terminated. An apparently 
hopeless case of dementia is recorded by Sir W. Ellis, 
as having been suddenly restored, f 

"We shall now proceed to the consideration of the 
first measure of restraint which is usually adopted, 
preparatory to the treatment of the insane, viz. the 
separation of the patient from his friends and rela- 
tives, and his removal to a suitable place of residence, 
where a new train of ideas will arise, and all former asso- 
ciations be removed from his mind as much as possible. J 
The necessity for this preliminary step has now be- 
come so obvious, that it is scarcely necessary to dwell 
on it. All the English, French, and German authori- 
ties are agreed respecting it ; and although M. Esquirol 

* Esquirol, page 95, vol. 1 . 

t Sir Wm. Ellis on Insanity, p. 138. 

X " The care bestowed on them in the bosom of their own families makes 

no good impression on them, while the attention they receive from strangers 

is appreciated from its being new, and their having no right to expect it." — 

Edinburgh Medical and Surgical Journal, January 1st, 1839. 



28 

expressed a doubt as to its being serviceable in every 
case, generally speaking he appears to have been a 
decided advocate for its adoption. The presence of 
strangers, he thinks, suspends the delirium of the 
insane, either by the influence of new impressions, 
which is always useful, or from a secret feeling of 
self-respect, that induces lunatics to correct their state 
of mind, " par un sentiment secret d'amour propre, 
ils veuillent cacher leur etat." This fact must have 
struck the most superficial observer ; we have seen 
patients, in the midst of the most violent excitement, 
suddenly become tranquil on the appearance of the 
physician and a stranger (the author). The principle 
of separation was strongly supported by the celebrated 
Willis, and we are told that, in the case of a late illus- 
trious sovereign * he dismissed all his former atten- 
dants, and substituted others, with the happiest 
effects on his first attack. 

On the condition calling for this, it is not our inten- 
tion to dwell. It is a matter of the deepest impor- 
tance, and if unnecessarily decided on, may be pro- 
ductive of the most lamentable consequences. The 
question involving the sanity or otherwise of an 
individual, requires the nicest discrimination and 
judgment, oftentimes presenting considerable difficulty. 
On more than one occasion have we witnessed an insane 
person baffle, for a long time, the most experienced ; 

* George III. 



29 

displaying a wonderful tact and cunning* to conceal 
his real state. Sir William Ellis says that, in order 
to justify confinement, there must be diseased action 
sufficient either to render the individual incapable of 
managing his own affairs, or to make his conduct 
injurious either to himself or to society. This is all 
very true ; but it, unfortunately, leaves the difficulty 
just as it was ; for what data has he afforded us to 
decide on such a state ? At all events, this is not the 
place for discussing the point ; we here take it for 
granted, that a separation from former associations is 
considered adviseable, and it is for us to point out the 
best mode of conducting it. 

The separation, to be effectual, must be absolute, and 
early in its adoption. Absolute, because even a single 
visit at an unseasonable period, is calculated to renew 
associations and ideas, in which probably the disease 
originated ; and, consequently, may be the cause of 
as much evil as one conducted at the proper and 
fitting period, and with discretion, may be productive 



• The cunning displayed by some lunatics in their arguments, as also on 
their mode of putting questions, whilst at the same time they conceal 
the object in view, is really surprising. The following example struck us 
forcibly. On the occasion of one of our visits to a neighbouring asylum, in 
company with the physician, we saw a respectable looking man who had 
been in the institution before, and had been re-admitted about two days 
previous to our visit, in consequence of a return of his malady. When we 
entered his apartment, he said to the doctor in rather a careless manner, 
"Canst thou minister to a, mind diseased?" " Why," replied the doctor, 
" lam here to be of use to you." " Then," said he, " you can have no business 
with me, as I am not mad ; and if I wanted further proof, it would be in 
the fact that I got no medicine since I came here." 



30 

of advantage. Of this, we have the strongest evidence 
adduced by Willis and Esquirol ; the former states 
that in England he found the treatment of foreigners, 
who had so few opportunities of seeing their friends, 
was much more successful than that of the English : 
and the latter authority experienced greater success 
amongst strangers coming to Paris for treatment. 
Indeed M. Georget objects to private asylums, on the 
distinct grounds, that the patient is more likely to see 
his friends in such institutions. Besides, we are to 
recollect that there is no class of persons more likely 
to be betrayed into injudicious observations, than 
those so deeply interested as relatives must naturally 
be ; and it is quite impossible they can possess that 
address which we shall hereafter see is of so much 
moment, and so difficult to be acquired. 

The adoption of separation we have stated must be 
early. This is of no less importance than its being 
absolute. Dr. Willis declared that nine out of ten 
recovered, of those put under his care, during the 
first three months. Dr. Finch stated that in his asy- 
lum the proportion was 61 out of every 69. Mr. 
Tuke of the York Retreat mentions 7 out of 8 ; and 
if we apply to the very interesting report lately pre- 
sented to the profession by Dr. John Jacob, already 
referred to, we shall find it distinctly stated that delays 
in admitting patients " have exercised a very preju- 
dicial effect on the results of practice." We have 
known the patients themselves apparently aware of 



31 

this, and we recollect two gentlemen, who were sub- 
ject to periodic fits of insanity, and used regularly, 
on the approach of the attack, which they were aware 
of, go to a private asylum. 

In adopting this necessary measure, the less formal- 
ity or mystery that is observed the better. It has 
been truly observed by Pritchard, that " some, when 
brought to a madhouse, are shocked, and experience 
a sense of degradation ;■" and we should therefore be 
careful in our manner of addressing the patient on 
the subject. Speak to him as if he were going to an 
hospital for the restoration of his health, and of the 
necessity of his giving up worldly engagements for 
an interval. By this system we have, on more than 
one occasion, seen patients completely reconciled to a 
separation from their friends ; and feel quite happy, 
as if a weight was taken off their minds, on receiving 
an assurance that an improvement in health would 
restore them to their friends. 

It would be quite impossible to obtain a clear and 
comprehensive view of the value of the arguments, 
for and against bodily restraint in the management of 
the insane, without taking into consideration the 
nature and seat of the disease under discussion. On 
this point considerable difference of opinion exists. 
Indeed it is better at once to confess the great diffi- 
culty it involves, hoping that future investigations 
may clear it up, rather than to attempt to gloss it 
over by any ingenious or plausible theory. Probably 



32 

the more general adoption of this principle would, in 
the end, better contribute to the progress of knowledge. 
According to Franck, Guislain, and Nasse of Bonn, 
with others, insanity is essentially a disease of the 
organic structure of the body ; whilst, on the other 
hand, there are many, (chiefly German authorities) 
who assert that madness is essentially a disease 
of the mind, and at the same time they adduce cases 
where no organic disease could be found. But, 
recollecting the utter impossibility of appreciating 
the first trace of organic disease, as also the very 
minute alteration in structure which may produce 
most serious symptoms, we ought certainly to be slow 
in acceding to such views. Professor Heinroth de- 
clares it to be a moral depravity ; this theory we have 
quite sufficient arguments to controvert, independent 
of the very interesting case of the wife of John Casper 
Lavater, of Zurich, as brought forward by Maximilian 
Jacobi, director of the asylum of Siegburg near 
Bonn.* 

* The following is Jacobi's account of this remarkable person, as given by 
Pritchard : — "The wife of John Casper Lavater, of Zurich, was a person 
regarded by all who knew her with respect and love. Her mind was en- 
dowed with the highest principles, sensible, and intelligent ; her disposition 
was cheerful, pious, and benevolent. She had been tried and proved by 
misfortunes and sorrows, was the friend, the counsellor, and comforter of 
many. She was induced, by the sole desire of doing good to her suffering 
fellow creatures, to undertake the chief care of some insane persons. It 
pleased Divine Providence that in an advanced period of her life, this excel- 
lent person should herself become insane, and continue for a long time to be 
a victim to the deepest melancholy. Towards the close of her life she re- 
covered from the disease, and her friends had the gratification of knowing 
that the last few months of her existence were passed in a state of mind 
resembling that of her earlier days, and in that state she died." 



33 

Amongst those who assert that insanity is a dis- 
ease of organic structure, there is also a variety of 
opinions. Some, as Georget, Foville, Cox, Cullen* and 
Haslam, assert that it is an idiopathic affection of the 
brain, and that the diseases found in other parts of the 
body are merely accidental, and consequent thereon. 
Others regard the primary disease to be in the stomach, 
as Broussais and his followers, who affirm that it 
always consists in irritation of the trisplanchnic appa- 
ratus. Pinel describes it as spreading from that organ 
as a centre, f Lastly, we may refer to the views, in 
some respects peculiar, of Maximilian Jacobi, as first 
brought forward in his " Collections for the Treatment 
of Disorders of the Mind," (Sammlungen fiir die Heil- 
kunde der Gemiithskrankheiten) and more fully en- 

* Cullen supposed that insanity depended on different portions of the 
brain being unequally excited. Sir William Ellis dwells on the frequency 
of diseased brain. Esquirol found in 168 melancholies, 2 with diseased 
liver, and 65 with diseased lungs. M. Georget found three-fourths of the 
cases he examined with lung affections. Foville found diseased heart fre- 
quent, chiefly hypertrophy, 5 out of 6 so. Pritchard says that perhaps the 
most frequent morbid phenomena found in the abdomen, is inflammation of 
mucous membrane of alimentary canal. 

t In Maximilian Jaeobi's last work published at Leipzig, in 1844, on the 
principal forms of insanity in relation to treatment, (Die Hauptformen der 
Seelenstorungen in ihren Beziehungen zur Heilkunde) we find it stated by 
the author, as the result of fifty cases examined after death, that there was 
little departure from the healthy condition of the gastric organs. At the 
same time, he states that the appetite was often excessive; and nutrition in 
a low state, but no constant disorder of the digestive system. This is rather 
remarkable as differing so widely from the experience of the French and 
English, who state that the secretions and mucous membrane of alimentary 
canal of maniacs are much disordered. 

We have ourselves been frequently attracted by the very foul condition of 
the tongue and foetor of breath amongst lunatic patients. 

D 



34 

larged on in his subsequent works. This distinguished 
author, altogether opposed to the doctrine that would 
refer insanity to causes purely mental or moral, asserts 
that in every instance it is the consequence of functional 
or organic disease in some part of the system. Fur- 
thermore, he insists that the brain is not the only 
organ for producing the phenomena ordinarily referred 
to the mind, but that the bones, ligaments, and mus- 
cles, in fact every part of the system, have an equal 
share in originating psychical action. He also affirms 
that disease of any part of the body acts at once and 
directly on the mind, and not through the medium of 
the brain. 

We have already alluded to the very great obscu- 
rity which must necessarily involve the question now 
under consideration, owing to the utter impossibility, 
in many cases, of appreciating the first or earliest 
stages of organic disease ; as also to the very minute 
alteration of structure which is capable of producing 
the most serious consequences. And these observa- 
tions are peculiarly applicable to the brain, inasmuch 
as the ultimate tissue of that organ, being so deli- 
cately arranged as to be beyond our detection, we are 
left no guide nor standard, as it were, by which to ap- 
preciate certain transitions from the healthy and 
natural organization. This difficulty we observe in 
lesions even of a fatal character. Severe concussion 
is suffered by that organ, death ensues, and although 
it is obvious that some extensive organic derangement 



must have occurred, to cause this total and permanent 
suspension of all the faculties, mental and bodily, yet 
the most searching examination may present no trace 
whatever of structural disturbance discernible by our 
senses.* And, with such facts before us, it is obvious 
that we are scarcely warranted in founding any defi- 
nite or sure conclusion on the mere denial of the 
existence of that which, because of the natural imper- 
fection of our senses, we cannot arrive at. Neither 
can we, unaided by visible proofs, argue on a bare 
gratuitous assumption of its positive presence. For 
our own part, in the absence of all theoretical bias, 
we cannot adhere exclusively to any of the views pro- 
posed respecting the cause of the disease in question. 
A very limited experience teaches us the influence of 
various organic changes, over the operations of the 
intellectual principle ; whereas, on the other hand, it 
is equally certain that cases of insanity do occur, 
where no lesion of internal organs can be discovered, 
and the disordered mind is presented as the sole and 
prominent malady. 

Of the marked influence exercised over the in- 
tellectual functions by disorders of the digestive 
organs, we must all be aware, as also how tedious 
affections of the former become, if the irritation of 

* We do not forget what has been stated by the late professor Colles, as 
the result of his dissections in these obscure cases, viz. . " That the brain 
did not appear to fill up the cranium completely." But we are not aware 
that such has been universally remarked by that accurate and faithful 
observer of disease. 

D 2 



36 

the latter be kept up. Every medical man is conver- 
sant with the horrors of those hypochondriacal symp- 
toms brought about by, and clearly traceable to, the 
cause we have laid down. " The great majority of 
these complaints," observes Dr. James Johnson, " which 
are considered as purely mental, such as irascibility, 
melancholy, timidity, and irresolution, might be 
greatly remedied, if not entirely removed, by a 
proper system of temperance, and with very little 
medicine. There is no accounting for the magic-like 
spell which annihilates for a time the whole energy 
of the mind, and renders the victim of dyspepsia 
afraid of his own shadow, or of things, if possible, 
more unsubstantial than shadows." And again he 
states, " many a happy thought has sprung from an 
empty stomach ; many a terrible and merciless edict 
has gone forth in consequence of an irritated gastric 
nerve. Thus health may make the same man a 
hero in the field, whom dyspepsia may render imbecile 
in the cabinet." That cases such as the above have gone 
on to absolute insanity there can be no doubt.* An 

* Considering the mass of evidence which can be arrayed in favour of this, 
it is rather extraordinary to remark the exclusive importance attached by some 
to moral treatment, whilst they totally pass over or deny the advantages to 
be derived from medical aid. Mr. Hill, for example, in his otherwise ad- 
mirable Lecture, delivered at the Mechanics' Institution, Lincoln, states 
that "in the treatment of the insane, medicine is of little avail, except of 
course when they are suffering also from other diseases, to which lunatics 
as well as sane persons are liable. Moral treatment, with a view to induce 
habits of self-control, is all and everything." — Something more than a mere 
ipse dixit is necessary, we apprehend, to settle this ; and we wish Mr. Hill 
had applied himself a little more to the causes of the disease. 



37 

irritation is kept up at a certain portion of the peri- 
phery of the nervous system, which, by a species of 
reflex influence, subsequently extends to the brain, 
and produces insanity.* The following case, which 
we were cognizant of some years ago, is so entirely 
in point we cannot omit it here : — 

A professional gentleman, whom we had the plea- 
sure of knowing, and who was respected by all 
acquainted with him, as well for his public worth as 
his private qualities, had been complaining for a con- 
siderable period of slight symptoms of indigestion. 
At that time his intellect was particularly active, and, 
in the most efficient manner, he discharged duties 
of a highly responsible character. In this condition 
he remained for many months ; occasionally obtaining 
medical advice, but rarely, we fear, observing it. 
During our frequent visits to his family, he often com- 
plained of his stomach, and the fcetor of his breath was 
peculiarly offensive. On many occasions we urged the 
absolute necessity of attention to regularity of meals, 
as he scarcely ever took breakfast, fasted during the 
day, and did not dine perhaps until 7 o'clock. After 

* Pinel gives two cases in point. The first was that of a young man who 
swallowed some cigars. Gastritis followed, which was relieved, but returned. 
Melancholia subsequently ensued, and suicide closed the scene. The other 
case was that of a soldier with ague, who took a glass of brandy with some gun- 
powder in it. Violent mania came on, which lasted for months. Mr. Forbes 
Winslow, in his work on " The Anatomy of Suicide,'' which contains a vast 
fund of interesting facts, states that " there is no more frequent cause of 
suicide'than visceral derangement, leading to melancholia and hypochon- 
driasis." In some rare cases, however, a3 observed by Tukc, the maniacal 
symptoms, instead of being aggravated, are suspended by bodily disorder. 



38 

some time, we observed a decided peculiarity in his 
manner of speaking ; his memory was evidently 
failing ; so much so, that we have frequently known 
him to relate the same occurrences twice or thrice 
during an evening. This attracted our attention ; we 
pointed out to. his friends the serious consequences 
which might result if he did not alter his system. 
All, however, was useless ; he would not be guided by 
any advice, or solicitation. The symptoms progressed ; 
he retired after some time to the country, and in 
about two years or more we met an intimate friend of 
his, who informed us his mind had become deranged. 
We subsequently learned that imbecility supervened, 
in which condition his life terminated. 

We have thus digressed from the immediate point 
at issue, in order that we may be the better able to 
grapple with the arguments opposed to us. What- 
ever may be the primary seat of the disease, or what- 
ever its cause, be it physical or moral, we are fully 
convinced as to the pernicious tendency of bodily re- 
straint, in the treatment of the insane. And such 
being our impression, we were rather surprised at an 
observation put forward with such entire confidence, 
in a work but recently published, to the following 
effect : — " Men who talk loudly of the effects of moral 
coercion, and who repudiate the idea of the strait- 
waistcoat, &c, have had but little practical experience 
of the treatment of the insane."* We shall not stop 

* Anatomy of Suicide, by Forbes Winslovr. 



39 

to consider the amount of " practical experience," the 
author of the above passage may consider necessary 
to decide the question ; but our own impression is, 
that it requires very little observation to appreciate 
the extraordinary influence which moral control, if 
properly exercised, can exert amongst the insane. On 
more than one occasion have we sat beside a lunatic, 
in the most frantic state of excitement, uttering the 
wildest cries, and using the most violent gesticulations 
towards those around him ; and yet, though perfectly 
free from all bodily restraint, he did not once attempt 
to injure those around him. This we witnessed in an 
institution* where the medical officers are exercising 
the most praiseworthy efforts, to inculcate the princi- 
ples we are advocating. It exemplifies that moral 
influence we have frequently witnessed the inward 
struggle of the patient himself to succumb to, and 
which, when unsuccessful, points out the necessity for 
solitary seclusion. The following case will elucidate 
what we mean. 

During the past summer, we visited a patient with 
Dr. Mollan, in the Richmond Lunatic Asylum. He 
had been in a high state of excitement, but, on our 
appearance, he became, comparatively speaking, tran- 
quil, and continued so as long as we remained with 
him. At the same time, we evidently saw, from the 
quivering expression of his features, that an inward 
struggle was going on to check an out-break. Shortly 

* Richmond Lunatic Asylum, Dublin. 



40 

after we left him, he became most violent, tore off his 
shoe, with which he broke the window-glass opposite 
his apartment, and was ultimately secluded in a sepa- 
rate room by order of the physician. 

If then, the patient be so violent as to endanger not 
only his own life, but the safety of others, it will be 
necessary to adopt a system of solitary seclusion, in 
an apartment so arranged and padded, as to prevent 
the possibility of bodily mischief. This, with a libe- 
ral supply* of qualified and conscientious! attendants 
will, we affirm, be all sufficient. In corroboration of 
this, we might adduce the valuable testimony of Dr. 
Connolly, physician to the Hanwell Asylum. In that 
institution there is accommodation for nearly one 
thousand patients. " All the means," says he, " calcu- 
lated to impose bodily restraint, we entirely and un- 
conditionally reject. Whatever restraint they are 
brought to Hanwell in, it is removed, and never put 
on again ; and yet, since the abolition of restraint in 
that institution, in Sept. 1839, not one patient died 
by suicide ; many have attempted it, and in different 
ways, but have been baffled by vigilance, until they 

* The laws of France assign one keeper to every ten patients. 

t Frightful indeed must, at one time, have been the condition of those 
attendants. Mr. Rogers, whilst referring to their atrocities, remarks, " but 
if such is the natural cruelty of these men, what must their lot be, who are 
exposed to it, when received, as it often is, with all the additional wantonness 
of intoxication." 

Mr. Tuke mentions having once visited an asylum where bodily restraint 
was carried to an extreme extent, and he found tlirec of the keepers playing 
cards ! 



41 

lost the propensity to do so." In that asylum there 
is, of course, an adequate supply of attendants, with- 
out which, we unhesitatingly affirm, there would be 
more humanity in having recourse to even an unqua- 
lified system of restraint, than to attempt, with insuffi- 
cient means, what might only lead to scenes of suicide 
and bloodshed. 

But if we turn to our own country, we shall have 
abundant evidence, deducible from the Irish asylums, 
which yield pre-eminence to none in that rapid march 
of improvement, so deeply interesting to us all. '' I 
am inclined to think," states Dr. Connolly, in his Let- 
ter on the Lunatic Asylums of Paris, " that both the 
continental and Irish asylums are better managed 
than the asylums of England, and that there is con- 
sequently a prospect of more permanent and steady 
improvement in them." Again, in the admirable and 
comprehensive Report of the Inspectors-general, for 
the year 1844, we find it stated of the District Insti- 
tutions, that " they continue to be kept in the best 
possible order, and they are conducted in a manner 
which reflects credit upon the zeal, efficiency, and 
humanity of the local governors and officers." The ac- 
counts given of the private asylums by the same gentle- 
men are also satisfactory. Lastly, if we peruse the statis- 
tical tables lately published by Dr. Thurnam, in con- 
nexion with his work on insanity, it will appear that 
the average number of cures in the District Asylums 
of Ireland, is somewhat greater than in the English 



42 

and Scotch Institutions for the insane. With such 
testimony as to efficiency before us, (which must be 
gratifying to all who have an honest desire to do jus- 
tice to the humane exertions of those to whom much, 
indeed, is due) we need not, surely, look elsewhere for 
facts to confirm or reject our views. In the metro- 
polis there are two hospitals for the insane, which 
afford the strongest evidence in favour of the position 
we have taken up. The first we shall notice is the 
Richmond Lunatic Asylum, capable of accommoda- 
ting nearly 300 patients, and of course calculated to 
present most valuable information on the question at 
issue ; and what has been the experience of the medi- 
cal officers on the use of restraint ? If we examine 
the Report of the Inspectors-general for 1843, we 
shall find the following statement of the medical offi- 
cers of that institution : — " Personal restraint, as a 
part of the discipline of this asylum, has very much 
diminished for several years past ; and it may now be 
said, as a general rule, that it is done away with. Ex- 
ceptions, however, must and do occur. A patient is 
now in the asylum, who in consequence of a rupture 
is obliged to wear a truss constantly, and in order to 
prevent his interfering with this instrument, which he 
is always disposed to do, it is necessary to restrain his 
hands. In cases Avhere blisters* or other counter- 



* " If necessary, "remarks Dr. Conolly, "we cover the blister and afterwards 

the dressing, with a ease made of ticking, which is made very much like a 
man's ordinary waistcoat, but is fastened with little round locks instead of 



43 

irritants are employed, it is frequently necessary to 
restrain the hands, to prevent the patient from remo- 
ving those remedies. Many insane persons are prone 
to the destruction of their bedding and clothes, and if 
left to themselves, would often be divested of all cover- 
ings. Such cases obviously require some organ of re- 
straint." Such were the observations put forward by 
the zealous and efficient officers of this asylum. The 
" exceptions" proposed by them scarcely deserve such 
an appellation, as they obviously do not interfere with 
the clear and comprehensive views manifestly enter- 
tained by them on the subject of restraint. To the 
Institution itself we should not be doing justice, if we 
omitted to notice the gratifying announcement, in the 
report of the Inspectors-general for 1845, just received, 
to the effect that " the statistical results as to recover- 
ies and deaths have been most favourable, and that 
upon the whole this asylum may be ranked amongst 
the foremost in this or any other country, as having 

buttons. An inspection of this vest or blister case will show you its advan- 
tages. But the curious circumstance is, that these blister cases are now 
very little in requisition. It would seem as if removing a blister, like many 
other inconvenient habits, grew up most strongly amidst the discontent pre- 
vailing in asylums where mechanical means of opposition are most relied 
upon. A cap of the same materials, and similarly fastened, is useful when 
the scalp is irritated, to prevent the great addition to the irritation that might 

be occasioned by the patient's hands." Again, if the patient 

be so frantic as to bite his flesh, a well-made, well padded, and well secured 
dress and a pair of soft gloves without divisions for the fingers and thumb. 
All such cases are rare, and such propensities generally checked by some 
sedative medicine and warm bath. Also, if patients expose themselves im- 
properly, a dress consisting of trousers and vest united, and if bed clothes be 
torn, substitute blankets sewed upon a ticking case. — Lancet, Nov. 1st, 1845. 



44 

fulfilled in every respect the humane and charitable 
intentions of the government and the public at large. 

The other institution to which we allude is St. 
Patrick's Asylum, endowed by the celebrated Dean 
Swift,* and established in 1751. It affords accommo- 
dation to about 180 patients. Some time has elapsed 
since we had the pleasure of visiting this excellent 
asylum, but the recollection of its comforts, and 
the excellence of its management, are full in our mind. 
According to the Report of the Inspectors-general for 
1844, " the non-coercion system is pursued with success 
throughout the entire establishment." 

Our limits must necessarily prevent us from enter- 
ing on the merits of our country district asylums in 
detail, and we would therefore refer the reader to the 
Reports of the Inspectors-general for 1844, where 
most satisfactory evidence is afforded in favor of the 

* According to the last will of the Dean, we find it directed, that after 
paying certain legacies, " the residue of Ins yearly income and interest of his 
said fortune shall be laid out in purchasing a pixe of land situate near Dr. 
Stevens's Hospital, or if it cannot be there had, somewhere in or near the 
city of Dublin, for the reception of as many idiots and lunatics as the an- 
nual income of the said lands and worldly substance shall be sufficient to 
maintain, and that the said Hospital may be called St. Patrick's Hospital." 
This benevolent disposition of his property is noticed as follows, by an inti- 
mate friend of the Dean : — 

"Unless I am misinformed, he (the Dean) died worth about £12,000, 
inclusive of specific legacies mentioned in his will, and which may be com- 
puted at the sum of £ 1 , 200, so that the remainder, nearly £11, 000, is entirely 
applicable to the Hospital for idiots and lunatics, a charitable foundation 
particularly beneficial in these kingdoms, where the epidemic distemper of 
lunacy is so prevalent." — Lord Orrery's " Account of the situation of Dean 
Swift's health and mind, from 1739 to his death, at the latter end of Oct. 
1745, with a Dissertation vn Lunacy and Idiotism." 



45 

system of non-restraint. In the Clonmel District 
Asylum, we observe, according to the report of Dr. 
Sheill, "that the non-restraint system is carried to 
its fullest extent." In the Londonderry District 
Asylum, " the non-coercion system is pursued, and 
fully justifies the general opinion in its favor." In 
the Armagh Institution, we find " total absence of all 
unnecessary restraint" announced. From AVaterford, 
Belfast, and other districts, the reports are also most 
gratifying. Lastly, if we apply to the report lately 
published by Dr. John Jacob, whose untiring zeal to 
carry out the fullest improvement is so commendable, 
we shall find it stated that in the Maryborough Asy- 
lum, " during the past year and a half, instrumental 
restraint has not been had recourse to in a single in- 
stance," and it is further added, " that several of the 
attendants have not even seen any apparatus for that 
purpose." 

But let us not be deceived by such encouraging 
facts, nor lulled by any feeling of false security, 
against the abuses which, we regret to state, still exist 
to a lamentable extent in the United Kingdom. It is 
indeed strange to reflect that, after all the exertions 
of private as well as public individuals, and all that 
has been written and said on this important subject, 
darkness and error are still abroad, and an apathetic 
indifference in many quarters so great as to their 
existence, that it recpiires fresh tales of misery and 
suffering to rouse their slumbering energies. But 



46 

that England should be the foremost with her black 
catalogue, is to us the most unaccountable fact of all ! 
If we examine the Report of the Metropolitan Com- 
missioners for 1844, (section 6th) we shall be pre- 
sented with scenes of wretchedness, which are scarcely 
to be conceived as existing in public Institutions 
visited by public functionaries. No classification of 
any description attempted in some of them ; all the 
patients crowded together in ill ventilated, filthy cells, 
without distinction ; males and females sleeping in 
rooms communicating with each other at all hours, 
and scarcely a shred of garment to cover their squalid 
and miserable forms ; handcuffs and handlocks of iron 
still in requisition ; and the wretched sufferer sink- 
ing under the chain encircling his exhausted frame ! 
yet there is some consolation mingled with these 
lamentable facts, when we reflect that they are not 
traceable to that wicked system of heartless selfish- 
ness and traffic which formerly disgraced our nature ; 
but rather to a melancholy deficiency of the means 
that such public Institutions ought to possess, of 
supplying, at all events, the common and necessary 
comforts of life. 

And from identically the same causes, our own 
country has sad announcements to make, calling for 
similar redress. But it is gratifying to know that they 
are few indeed, compared with those just referred to, 
and promise a speedy reform, under the zealous 
energy and perseverance of those who have brought 



47 

them to public light. In the last reports* of the 
Inspectors-general, " Neglect, mismanagement, and dis- 
comfort are complained of, and scenes described which 
" shocked and disgusted" those whose painful duty it 
was to witness them. The melancholy condition of 
two patients in one of these asylums is instanced, " to 
convey a pretty accurate description of the whole In- 
stitution." One was " a male patient, lying in a so- 
litary cell, (which had no window nor proper ven- 
tilation) on some loose straw, without a particle of 
clothing, except a filthy old blanket wrapped round 
him ; on raising which was found the poor creature 
convulsed with contracted limbs, and altogether in a 
state requiring the constant and judicious treatment 
of a physician." The other was "a female in a similar 
state of nudity and neglect." Such are the revolting- 
facts recorded in the Report of the county and city of 
Kilkenny Local Asylum* for 1844. Again, we find in 
the Report of the Inspectors-general for the same 
year, details of misery and destitution in the Wex- 
ford Local Asylum, which forcibly revive the recol- 
lection of that harrowing history of cruelty and woe 
we have endeavoured to depict elsewhere. The case 
of the unfortunate man Edwards we almost thought 
presented a striking parallel with one we have read in 
another place. The wretched condition in which he 
was found by the able reporter of his state, his final 
delivery and improvement, appear almost a repetition 

* Report for 1844. 



48 

of what we hoped had passed away for ever ! And 
when years shall have rolled on, and that bright 
consummation to which all humanity is so anxiously 
looking forward shall have been accomplished, every 
heart must beat with gratitude for the benevolent 
acts bestowed on that poor creature and his fellow- 
sufferers, by one* who, although a stranger to our 



* The following extracts from the report of the Inspector-general for 1844 
will sufficiently depict what is alluded to here. "On looking in, I saw the 
unfortunate man standing at his cell door, nearly in a state of nakedness, 
chained hy the wrist and ankle, and padlocked ; he wore an old torn jacket 
and short petticoat ; a trencher of potatoes lay on the floor, as also a por- 
ringer of milk. I had the door unlocked, and caused him to be let out, his 
chains to he struck off, and allowed to walk about the place. He was repre- 
sented as a very dangerous idiot ; however, I could perceive that he had 
intellect enough to convince me that he felt grateful so far, for having been 

allowed his liberty. This man's name was Edwards " The female division 

of this establishment was equally wretched and "filthy" — " bed and bed- 
ding very bad" — " neither shoes nor stockings allowed." " In fact there 

was a curtailment (from want of funds) of all the necessaries and comforts 

of life." " Supper was not allowed, &e Having reported to the Lord 

Chancellor, (Sir Edward Sugden) he directed me to communicate with the 
local authorities without further delay It was on the approach of Christ- 
mas, and fearing that any delay should take place in providing the necessary 
comforts, his lordship handed me a draft for £30 out of his private purse, with 
directions to have clothing, blankets, and sheeting, &c. purchased, and sent 
down with an experienced keeper to attend the institution ; and that a Christ- 
mas dinner in true English style should be provided on the occasion For 

the result, see page 47 of the Report. 

We find, by the Keport for 1845, which reached us when the manuscript 
of this Essay was arranged, that the Wexford Local Asylum will soon be 
abolished. But we regret to observe it stated in the same report, that the 
county and city of Kilkenny Local Asylum continues in the same state as 
reported by Dr. White last year." 

Before going to press, the Report for 184fi has been sent to us by our intelli- 
gent friend Dr. White, the Inspector-General of Lunatic Asylums in Ireland, 
from which it appears that the want of "suitable accommodation" is still 
complained of, "for the inmates of this wretched Institution." With ex- 
treme satisfaction, however, wc read in the same admirable Report, of the 



49 

country a few years back, made the influence of his 
high office subservient to the relief of the afflicted of 
our native land ! 

We have stated that the solitary seclusion of the 
more refractory is sometimes called for, in considera- 
tion of the condition of the other patients. This we 
insist on, not only for the sake of protecting them 
from bodily harm, but also to guard against their be- 
ing exposed to any scene of excitement, which would 
considerably militate against their ultimate recovery. 
And it is with this view that we recommend such a 
classification, as will keep the more violent apart from 
the convalescent ; although it sometimes will happen, 
notwithstanding all the care we may adopt, that we 
cannot anticipate an occasional interruption to the 
harmony we are desirous of preserving amongst the 
convalescent class. 

We recollect visiting an asylum, (and we know of 
no better managed one ) where several female patients 
were sitting, apparently in a state of the utmost tran- 
quillity. Many of them were employed at work. 
Suddenly, one, a young woman, rushed forward in a 
state of violent agitation, and uttered a most piercing 
cry. The general excitement produced on the occasion 
amongst the other patients was most marked, and the 

proposal intended to remedy so miserable a state of things. To those inter- 
ested in the welfare and comfort of the inmates of our asylums, it will be a 
source of much gratification to peruse the various improvements this volume 
announces, attributable in no slight degree to the energy, activity, and zeal 
of the able reporter, since his entrance on office. 

E 



50 

expression of each countenance was peculiarly indica- 
tive of the effect produced. We therefore, for such 
reasons, recommend solitary seclusion, which will sel- 
dom be necessary for more than an hour or so. During 
this retirement, we must be most careful to administer 
to all the wants and comforts of the patient. It will 
make a most favourable and salutary impression here- 
after, and pave the way to the best results. When 
the calm approaches, and the stage of excitement is 
dying away, we are anxiously to watch the opportu- 
nity for that period of repose, when the most invalu- 
able aid can be administered ; and, as has been beauti- 
fully expressed by a late eminent physician,* "if, at 
this auspicious moment, the intercourse of a discreet 
friend be permitted, it will cheer the patient's heart, 
while by kindness and attention the physician will 
easily get possession of his returning confidence ; and 
so induce him to unbosom himself of the disturbed 
notions which still continue to haunt him. These, 
although they be founded in palpable error, the phy- 
sician will not combat, although he will take proper 
opportunities of hinting his doubts of their reality." 

From the various facts and evidences presented for 
our consideration, we cannot avoid the conviction, that 
nothing but a paltry feeling of economy, (too fre- 
quently, we fear, the parent of restraint) or mistaken 
views of the nature of the malady, can reduce us to 
the necessity of even a modified form of bodily re- 
straint. To the former Ave are rather disposed to 

'* Sir Henry II;dford. 



51 

attribute it ; and certain Ave are that, if that difficulty 
were done away with, we should hear very little of 
those various contrivances for coercion, many of which 
are better suited for the brute inaccessible to reason, 
than the human being whose reason is but disordered. 
Let us reflect, for a moment, on the serious physical 
results that must accrue to the frame under such 
treatment. Place before you a poor lunatic labouring 
under a violent fit of excitement, moving about in 
every direction, scarcely a muscular fibre of his agi- 
tated system at rest ; and suppose him to be placed 
under the most strict influence of mechanical restric- 
tion: are there not muscular efforts still going on, 
(the result, recollect, of a now more excited mind) 
which, though scarcely perceptible to the eye, are 
more capable of wearing down the physical powers, 
than if the same efforts were left totally unrestrained 
and free ? Who has not remarked the excessive ex- 
haustion observable on the removal of restraint ? and 
when we consider all this, what must be its effects on 
the organic diseases that are probably going on in 
the system, and which may be destined to terminate 
the life of the poor sufferer ? must not the bodily 
struggles exasperate the physical lesion, which should 
be a chief object of our solicitude, and is probably 
only masked by the more prominent symptoms of the 
disordered mind ? 

The above objections to the use of bodily restraint 
occurred to us frequently during our reflections on 

e 2 



52 

the important question before us ; and in seeking for 
statistical information to bear out the views we enter- 
tained, we availed ourselves of the records of those 
institutions, where the abolition of restraint had been 
effected gradually, and where almost each successive 
year witnessed some substantial change, either in the 
multiplicity of the instruments employed, or in the 
severity of their application and mechanism, until at 
last an entire abandonment of their use was arrived 
at. The question that first suggested itself was, how 
far do the physical effects of coercion on the human 
frame tend to a fatal result? one of the authorities 
we consulted on this point, is presented in the very 
valuable appendix and statistical references attached 
to Mr. Hill's excellent Lecture, and a most satisfactory 
reply is there given to our question. If we examine 
the voluminous returns of the Lincoln Asylum for 
nine years, attached to that work, we cannot but ob- 
serve the great proportion of deaths from" exhaustion" 
which took place in the early part of that period, when 
restraint was carried to such a degree, that more than 
one half the inmates were reported " under restraint." 
In the year 1830, of the deaths, six out of eight are 
stated to have been the result of " gradual exhaustion ;" 
and in 1831, five were reported to have died in the 
same state out of nine, the total number of deaths. 
In 1834, it appears that some modifications in the 
instruments were adopted ; and these, with certain 
restrictions on the frequency of their application evi- 



5.3 

dently worked out an improvement, as not a single 
death from exhaustion is mentioned in the report for 
that year. After this, there were more decided altera- 
tions in the system of the institution, both as regards 
the nature of instruments adopted, and the number 
under restraint ; until, at last, a total abolition of all 
physical coercion was announced, with the most erati- 
fying results. 

And in order to estimate the full value of this 
example, of the diminution of deaths from exhaus- 
tion, in proportion to the relaxation adopted in 
the system of bodily restraint, we must not lose sight 
of the gradual increase in the number of patients 
which took place within the period referred to. In 
1830, for instance, the return appears to have been 
92 ; whereas in 1838 it amounted to 158 ; and yet 
the deaths from "exhaustion" in the former year 
were treble the number of those specified in the latter. 
In 1831, also, the proportion of deaths from the same 
cause appears to have been very considerable ; in fact, 
one fourteenth of the whole number in the asylum 
appear to have sunk under " gradual exhaustion," and 
in that year, 40 of 70 patients were reported " under 
restraint." 

But there is another remarkable feature in the same 
returns, that cannot fail to attract our most serious 
attention ; we allude to the total disappearance of 
suicide under the improved system. This would 
strengthen the opinion advanced by Mr. Hill, and 



54 

other authorities, as to the utter inefficiency of even 
the strictest system of restraint, in preventing such 
disastrous consequences.* Indeed, we are strongly 
inclined to think that it may have a directly opposite 
tendency. We have already appended, in form of a 
note, an instance where attendants, taking advantage 
of the unlimited power conferred on them, of restrain- 
ing patients, were found employed in some frivolous 
amusement, neglecting altogether the important 
charge committed to their care ; and we have read 
elsewhere of unfortunate sufferers being driven, in 
consequence of the horrid cruelties that were perpe- 
trated, to the desperate alternative which alone could 
save them from their ruthless tormentors. Such con- 
siderations are of infinite value, and must materially 
confirm the objections we have raised to a system of 
treatment, which would appear to have been as demo- 
ralizing to the attendant as it was injurious to the 
patient. 

In following up this part of our investigation, we 
naturally refer to those morbid appearances met with 
in the examination of lunatics after death, and en- 
quire how far they may be connected as cause and 
effect. Foville, for example, has recorded that in five 
out of six he found diseased heart, especially hyper- 

* In the report presented to the Inspectors-general of Asylums in Ireland, 
by Dr. J. Jacob, for the year 1844, the following statement appears, "lam 
impressed with the conviction that suicide is more to be apprehended 
amongst patients treated with mechanical restraint, the use of which is also 
strongly calculated to diminish the vigilance of the attendants." 



55 

trophy ; and we would suggest a similar form of 
evidence to that just adopted, with the view of ascer- 
taining if such cases have been less frequent under 
the system of non-restraint. We are all aware of the 
influence of fear and bodily exertion in producing 
cardiac disease,* and such facts afford us additional 
reasons for objecting to a plan of treatment, which 
would inevitably foster the tendency to such results. 

But there is another instance where coercion has 
been, physically speaking, prejudicial ; Ave allude to 
the case where the patient obstinately refuses all food, 
and will not be overcome in his determination by 
threats or persuasion. Formerly, the indiscriminate 
practice in such cases was, to force the wretched luna- 
tic, (whose disorder was probably connected with 
some gastric lesion) to swallow that which his sto- 
mach was unable to bear. The dictates of nature 
were construed into obstinacy arising from some 
purely mental delusion, and immediately the iron 
screwgag, or some such means, was put in requisition 
to force obedience.f Such was the system adopted in 
cases where, perhaps, rest, with the application of a few 
leeches and other remedies, would have restored the 
diseased organ, and rendered it fit and willing, if we 



* It is stated, we think by Corvisart, that during the French Revolution 
(that reign of terror) the frequency of heart-disease was frightful. 

f Mr. Rogers, in his statement, affirms " that numbers were suffocated in 
the act of forcing down food, and he gives a case of frightful laceration of 
the upper part of the mouth, from violence used with the handle of a 
spoon." 



50 

may use the expression, to undertake its accustomed 
functions. 

Let us not be understood to imply that the refusal 
to take food does not sometimes arise from other 
causes besides organic derangement. We know that 
it frequently originates, in some cases, in a premedi- 
tated desire of self-destruction, or some unaccountable 
delusion ; but even here we shall find that coercion is 
scarcely, if ever, necessary. We have ourselves 
known a patient declare that he would not take any 
food, as he was determined to destroy himself ; and 
notwithstanding the failure of every description of per- 
suasion, he voluntarily took it in a few hours after- 
wards, when it was left in the room with him alone. 
In other cases, we shall succeed by telling the patient 
that he must not have any food ; as was successfully 
adopted by Mr. Tuke, who has also succeeded, in very 
obstinate cases, by bringing the patient into a larder, 
and leaving him to select for himself And we have 
lately heard of a case where every means was resisted, 
until the food was taken away, and thrown under the 
grate. 

But the evil effects which bodily coercion has a ten- 
dency to produce, on the moral condition of the in- 
sane, is of much more importance ; and notwith- 
standing the authority* of an individual to whom we 
owe so much, and who mentions it as having '' a salu- 
tary moral tendency," we cannot acquiesce in a view 

* Tuke. 



57 

so entirely at variance with our own impressions. It 
is remarkable to observe the almost universal repug- 
nance evinced to it by the patient, True it is, there 
are some exceptions to this ; for instance, we have 
lately heard of a patient, who was so restless at night 
as actually to solicit the use of the waistcoat, in order 
to be kept quiet ; and in it he felt comfortable. Here 
there is no moral ill-effect ; the adoption of it has be- 
come a voluntary act on the part of the patient, who 
consequently cannot entertain that feeling of degrada- 
tion which physical restraint so generally entails. We 
also find various contrivances used, to give support to 
those labouring under epilepsy and paralysis, and pre- 
vent any injury from falls or such accidents ; but 
these cases do not interfere with the force of our 
argument, and therefore do not require further notice 
here.- 

Viewing the effects of restraint in a moral light, 
Ave object to it, in the first place, in consequence of 
that sense of self- degradation which it is so difficult 
to oblitei'ate from the mind of the patient ; who is, 
generally speaking, morbidly sensitive, and carries 
with him an extraordinary recollection of the most 
trivial occurrence.* Let us not suppose that the 

* " Les alienes, lorsqu'ils sont gue'ris, conservent le souvenir le plus parfait 
de leurs sensations vraies ou fausses ; ils se rappellent tres bien leurs raison- 
neraens et les determinations qui en ont €te la suite, et merne la memoire de 
tous les plus petits details aequiert d'autaut plus de force qu'ils avancent 
davantage vers le complement de la sante' done pendant le de'lire ils avaient 
le connaisanee et la faeulte de raisonner. " — Esquirol, vol. 1, p. 19. 

" Memory for the most part remains unimpaired through all the stages, 



58 

maniac, even under the most violent stage of madness, 
is insensible to each circumstance that passes before 
him. Fully aware of every word and action proceed- 
ing from those around him, all will remain fixed in 
that memory which becomes even more tenacious of 
the past as convalescence approaches. 

In the course of last year, a stout athletic man was 
brought to the Richmond Lunatic Asylum, labouring 
under acute mania. In his attempts to break through 
some windows in the neighbourhood of Kingstown, 
where he had been, he received two large gashes from 
the glass across the right forearm. One of the 
wounds divided a considerable part of the inner mass 
of muscles. On his admission, the parts were pro- 
perly adjusted with adhesive plaister, &c, which he 
managed to remove, soon after. At the second dress- 
ing, we happened to be present, and assisted ; several 
times he exclaimed, " There is no use, all the blood is 
out of it. I am determined to die, and I will die." 
On being asked to take food, he refused, saying, " I 
won't eat a bit ; I must — I am determined to die." 
He was then removed to a separate apartment, and 
food left with him, of which he partook soon after- 
wards. About a fortnight after this, Ave saw him ; 
he perfectly recollected us, and on our asking him if 
he felt grateful for the care taken of his wound, he 
replied, " Oh ! of course I do ; it was all right." 

ami during the highest intensity of the disease, the senses appear to acquire 
an unusual degree of acuteness and susceptibility." — Pritchard. 



59 

On our system of treatment, then, must depend 
whether we generate a feeling of gratitude and confi- 
dence,* or one of suspicion and disgust in the mind 
of the patient. The following case, which we were 
cognizant of, will elucidate the deep sense of obliga- 
tion which may be engendered by kind and sympa- 
thizing consideration on the part of the medical 
attendant. 

A young lady became insane, and was placed under 
the care of an eminent physician in this city. It was 
proposed by some of her friends, (and unfortunately 
she herself subsequently became aware of the fact) 
to have her removed to a private asylum. To this 
her medical adviser strongly objected, preferring to 
place her apart from her friends, in a private abode in 
the country. After the lapse of some time she re- 
covered, and was restored to her family, and we have 
frequently since heard her physician, (who from his 
successful career in practice must have experienced 
the fruits of many an impulse of gratitude) state that 
he never met with an instance where such intense 
and lasting confidence was reposed in him, as by that 

* It is very remarkable how trifling a circumstance (the result of medical 
treatment) will tend to produce confidence, and promote a rapid progress to 
recovery. A respectable, middle aged female was under the care of my 
friend Dr. Mollan, in the Richmond Lunatic Asylum, labouring under an 
obstinate form of melancholia. Amongst other symptoms, she was particu- 
larly annoyed by a spongy state of gums, for which some local applications 
were used. The state of the gums improved, and she at once became evi- 
dently better, and rapidly advanced to recovery from that period. 



GO 

young lady, in consequence of the delicate considera- 
tion he had evinced for her feelings during her malady. 

And if, as the above case proves, the humane and 
sympathising plan adopted is capable of producing 
such an outpouring of grateful recollection, we can 
well imagine how, in an equally sensitive mind, an 
opposite system would be productive of a state of 
moral degradation and distrust, most difficult to be 
effaced. What it is that causes the repugnance in 
some to return to society after convalescence, we do 
not pretend to say, but we can very well imagine how 
the recollection of scenes of harsh and degrading 
restraint would tend to that result.* 

Did our limits permit, we would dwell on some 
very striking peculiarities of the memory in cases of 
insanity. In some instances, circumstances of very 
distant date are recollected, when perhaps occurrences 
of the previous day are not retained. Some months 
ago, we saw a patient who perfectly recollected the exe- 
cution of the Sheares in 1798, but could not tell what 
he had taken for dinner the previous day ; nor how 
long he had been in the asylum. Again, we some- 
times find that faculty chiefly occupied in preserving 
a recollection of the merest trifles ; as in the following 
example. 

* Plusieurs a cause dn souvenir qu'ils en conservent, n'osent sc montrer 
en public, renouer leurs ancieus rapports, craignant, qu'en rentrant dans le 
roonde, ils ne soient un objet de curiosite, de commiseration, et de defiance, 
ce qui blesse leur amour propre, ct lcs humilie. — Esqnirol, page 97, vol. 1. 



Gl 

A young girl, who had been some time insane, was 
visited by her medical attendant, in company with 
myself and another, whom she immediately recog- 
nized with some indignation, in consequence of his 
having three months before told her, jokingly, that 
she had rather a long nose ! 

Our friend Dr. Mollan has given us a remarkable 
instance of retentive memory in an organist, who had 
been insane for fourteen years, after which period he 
was able to play the most beautiful airs without miss- 
ing a single note. In some, the memory would 
appear to be a mere blank ; but in no case ought we 
to act on this presumption, but, in the words of Mr. 
Tuke, " treat the patients as rational beings." 

Even in the most hopeless cases, there appear to 
be doubts entertained as to the fact of the intellectual 
faculties being totally annihilated ; and such being 
the fact, a common feeling of humanity ought to 
dictate a constant care on our part, to avoid any harsh 
act or expression, calculated to excite or irritate. 
Alluding to the state of fatuity, Dr. Pritchard re- 
marks that some in this condition " have compara- 
tively lucid intervals, in which nature seems to light 
up the mind, and recal lost impressions and ideas ;" 
and the same author relates a case, where the patient 
had been in a state of fatuity for years, " but occasion- 
ally appeared to rouse himself, and for a short time 
to recover an unusual degree of animation. At such 
periods he will sometimes read a chapter in the Bible, 



m 

with a clear voice, and a distinct and intelligible 
articulation. Such occasional variations in demen- 
ted persons are not," he adds, " unfrequent." "We have 
ourselves known a man in extreme fatuity answer, 
" yes," or " no" to questions put loudly and distinctly, 
but immediately afterwards he relapsed into his former 
condition. We also recollect another, (an epileptic) 
who, when asked a question, would turn round to the 
keeper, and attempt to articulate with a drawling tone 
of voice. A very extreme case is given by Tuke as 
related to him by a medical friend. " A girl became 
idiotic,* and remained so for years ; she contracted 
typhus fever, and was entirely rational. She knew 
her master and his son, who happened to be her 
medical adviser. She told many occurrences of 
her early days ; but when the fever abated, she re- 
lapsed into her former state of imbecility." This case 
was told to Mr. Tuke, to prove that even in idiotcy 
the mind may be rather suppressed, and not destroyed. 
At all events, whatever credence we may be disposed 
to give to such instances, we cannot be too cautious 
in avoiding every word or act of harshness, which, for 
aught we know, may be piercing as an arrow to the 
heart of the poor maniac. 

There is peculiarity, almost characteristic, amongst 
the insane, which we must not omit in weighing the 



♦ This case is improperly called idiotic, a term which ought strictly to be 
confined to congenital cases. It was rather an instance of extreme dementia 
verging on fatuity. 



63 

evil tendency of bodily restraint and punishment. 
We allude to that marked propensity to undue suspi- 
cion evinced by the patient — a distrustful feeling of 
apprehension and alarm, which it is most difficult to 
overcome. ''Cette alienation morale," observes M. 
Esquirol, on referring to it, " est si constante qu'elle 
me parait un caractere essentiel de l'alienation 
mentale;" and so strong is it in some instances, that 
we observe at times a desire to avoid even the nearest 
relatives. " Ce melancholique," writes the same 
author, " adore son epouse, mais il est sourd a ses 
avis, a ses prieres. Ce fils immolerait sa vie pour son 
pere; mais il ne fera rien par deference pour ses con- 
seils, des qu'ils auront son delire pour objet." And 
with such knowledge, so graphically laid down, we 
find the same authority has recorded his support to a 
system of bodily restraint, instead of giving the entire 
force of his powerful influence, to the encouragement 
of a plan calculated to do away with the above pecu- 
liarity ; or, as we may call it, symptom of the disease ; 
by the observance of a kind and humane sympathy, 
which Av r ould gain the confidence of the patient, and 
impress on him the sincerity of the motives of those 
around him. But what would appear to be the con- 
sequence of M. Esquirol's plan? The reply is but 
too manifest, from the following remarkable passage, 
translated by an eminent writer,* from an abstract 
given by M. Georget of the disquisitions of Pinel and 

* Pritchard. 



64 

Esquirol, viz. : — " As long as each person continues 
insane, he looks on the director and inspector of the 
establishment as accomplices in the power which has 
deprived him of his liberty, and upon the attendants 
as inhuman jailors. The directors, the inspectors, 
and the attendants will invariably be objects of pre- 
judice, suspicion, and hatred to the patients ; they 
will receive abuse, and often blows from them." In- 
dependent of the undoubted authority from whence 
this account proceeds, we can at once, considering the 
circumstances, fully imagine its accuracy. A re- 
markable instance has been recorded by Mr. Tuke, 
where " an inexperienced attendant was guilty of 
some severity towairls a patient in the Retreat, who 
beat him severely, and was more violent and vindic- 
tive afterwards." And although M. Esquirol put 
very stringent limits on his system of restraint,* still 
we are convinced that even a mitigation of the plan 
must lead to the state of things pictured above. If 
the attendant be in any manner accessory to the 
infliction of severity, he cannot obtain the confidence 
of the patient, he will be, as stated above, " an object 
of prejudice and suspicion," perhaps " of hatred." 

Considering this, as well as other peculiarities of 
the disease, it also becomes obvious that we cannot be 



* Esquirol advised that coercive means should not be resorted to until the 
maniac risked his own life, or the lives of others, and even then be only 
temporarily so, and laid aside as soon as possible. He also observed, that 
the more liberty that is granted, without compromising the safety of the 
patient, the fewer have been the cases of furious mania. 



65 

too guarded in our mode of conversing with the in- 
sane. * There is a kind and gentle manner of speaking 
to, and reasoning with, these poor creatures, that 
experience alone can teach ; and well has it been 
observed by a distinguished writer,f that "the address 
which is acquired by experience, and constant inter- 
course with the insane, cannot be communicated ; it 
may be learned, but it must perish with the possessor." 
A trifling species of familiarity is most offensive to the 
patient, who, oftentimes over sensitive on his condition, 
will imagine it to be intended as a species of ridicule. 
With respect to speaking to him on the subject of his 
illusions or hallucinations, considerable tact and judg- 
ment are required. The general impression is, that 
it ought to be avoided altogether ; and we accordingly 
find it laid down by Dr. Burrowes, that " to reason 
with a lunatic is folly ; to oppose or deny his hallu- 
cinations! is worse." At all times there is a natural 

* Amongst the extracts from the revised rules appended to Mr. Hill's Lec- 
ture we shall find an admirable order on this point, connected with the duties 
of the attendants, viz. — " The attendants shall not unnecessarily converse 
with the non-convalescent patients, and shall speak principally in reply only, 
and shall especially avoid the subject of their delusions. They shall not 
incautiously speak of any patients in their presence, nor on the subject of 
insanity, nor unnecessarily do any act the remembrance of which may be 
hurtful to any patient's feelings or convalescence." 

t Tuke. 

f With reference to those hallucinations or false notions, we may remark 
that it is urged on authority, hereafter to be stated, that the presence of one 
or more of them is not essential to madness. It has been laid down by Locke, 
that " madmen do not appear to have lost their faculty of reasoning, but 
having joined together some ideas very wrongly, they mistake them for 
truths ; and they err as men do, who argue right from wrong pre- 
mises." This definition, which infers some illusion as characteristic of 

F 



66 

and becoming disposition to rely on whatever may 
proceed from so high an authority ; nevertheless, we 
cannot avoid passing some stricture on this, as we 
conceive, too general rule. We certainly have known 
a simple mode of reasoning and conversing weaken, 
if not do away with delusive impressions. Many who 
would manifest considerable obstinacy, we have heard 
conclude their remarks by saying, " Well then, say no 
more about it ;" or, " You'll hear no more about it ;" 
or some such observation ; and we have witnessed 
others suddenly give up such impressions, and, on a 
promise being made, not recur to them. At the same 
time, much discretion is required here, to avoid the 

insanity, prevailed very generally until impugned by subsequent writers, 
amongst whom is Mr. Pritehard, who has described a form of insanity in 
which the intellectual faculties are little, if at all, involved ; but the disease 
is manifested principally or alone in the state of the feelings, temper, and 
habits, one or all of which appear to become depraved and perverted. Self- 
control is lost or impaired, and although an extraordinary quickness may 
appear in the power of reasoning, still the capability of conducting the rou- 
tine affairs of life with decency or propriety is lost ; and in fact a morbid 
change appears to have pervaded most or all of the better feelings, habits, 
affections, and inclinations. Such is the moral insanity of the distinguished 
author referred to. He adduces the support of the older nosologists, viz. 
Sauvages, Sagar, and Linnaeus, who formed a distinct division, styled, 
morosiiates or morbi pathetici, consisting of depraved appetites, feelings, &c. 
Pinel also gives support to this opinion, and terms the affection, " Emporte- 
ment maniaque sans delire," and the views of M. Esquirol are also brought 
forward to confirm it. The question involved in the above is most important 
and interesting i we shall find it amply discussed in Pritchard's celebrated 
work on Insanity. But whether the condition referred to really constitutes a 
distinct form of the disease, or, as M. Georgct has described it, merely the 
stage or period of incubation, admits of considerable doubts, which we do not 
as yet feel ourselves competent to discuss. Certain it is, that an alteration in 
the moral qualities is frequently the precursor of mental derangement. 



07 

mischief that might result from an injudicious con- 
tradiction. 

In concluding this part of our observations, we 
cannot but notice a condition which strengthens very 
considerably the position we have endeavoured to 
maintain. It unfortunately is the fact, that lunacy 
very generally entails a proneness to moral degrada- 
tion, and a falling off of those finer feelings, which 
were so inherent in the patient previous to the acces- 
sion of the malady. And not only in this respect do 
we observe an alteration, but also in the general 
personal appearance there is a change that cannot have 
escaped our notice. The individual who before, pro- 
bably, presented the demeanour and intelligence re- 
sulting from a refined and polished education, now 
affords a mean and slovenly aspect, oftentimes becom- 
ing filthy and disgusting in the extreme. More than 
once, on visiting these poor creatures, have we expe- 
rienced a feeling of astonishment, mingled with 
melancholy, on being informed that such a patient 
was the son of respectable parents, and had been 
afforded the fullest advantages which education and 
society could give ; and that another had been once 
accomplished, and possessed, all those finer feelings so 
characteristic of her sex. And this, recollect, does 
not proceed from any neglect or mismanagement, but 
is, as it were, an accompaniment of the disease.* 

* Such, however, is not always the case. Some time ago, we saw a 
patient in the Richmond Asylum, who had been insane for a long time, and 

F 2 



68 

With this also in recollection, and daily before our 
eyes, can Ave expect that so d ebased a condition is to 
be improved by a system of mechanical coercion and 
punishment ? Ought we not rather take advantage 
of those higher qualities, which may not yet have be- 
come extinct, availing ourselves of the valuable pre- 
cept laid down by the humane and enlightened Tuke, 
who cautions us " not to consider the insane as abso- 
lutely deprived of reason, or, in other words, as 
inaccessible to the motives of fear, hope, feeling, and 
honour ; but rather to look on them as children with 
too much strength, and who make a dangerous use of 
it." Of the existence of the motives of honour in a 
lunatic, Esquirol has given a remarkable example ; 
and we shall offer an abridged account of it here, as 
it affords a valuable hint in our treatment. 

A general officer, who had been in the French army, 
and served at "Waterloo, after the fall of Napoleon re- 
tired to the country, and married a young wife. Sub- 
sequently he became insane, and being naturally 
jealous in his disposition, this failing unfortunately 
increased with his malady. Suspecting the loyalty of 
his wife, he attempted suicide on several occasions. 
Various means were tried to dissuade him from his 
wicked purpose, but without effect. At last, on be- 
coming worse, he was put under the care of Esquirol, 

yet preserved all her former delicacy and demeanour. The sympathizing 
and kind manner evinced hy the medical officers of that establishment 
towards the patients may contribute in some degree to this. 



69 

who extracted from him a promise that he would not 
repeat his attempt. The promise was made and faith- 
fully observed, and he often afterwards informed M. 
Esquirol, that on more than twenty occasions he took 
his cravat to strangle himself, but was prevented by 
the recollection of having pledged his honour, which 
as a military man was so clear to him. 

In carrying out the principles we have endeavoured 
to advocate, it is of essential importance that the 
architectural plan and internal arrangements of insti- 
tutions for the reception of insane persons be attended 
to. And we consider an allusion to this matter by no 
means irrelevant to our subject, inasmuch as it cannot 
be denied, that the sense of restraint felt by the 
patient may be considerably modified and relieved, by 
the appearance of the place in which he resides. 
Indeed, on this very account, it has occupied a consi- 
derable portion of public attention, that has led to the 
greatest benefit ; and such have been the improvements 
of late, that we cannot now promise to offer anything 
additional or novel on this point.* In former times, 
it was usual to construct the buildings for the recep- 

* It is unnecessary to enumerate the writers who have applied themselves 
to this important subject. Information is given on it by all the leading 
authors of the day. But we would particularly point out Mr. Samuel 
Tuke's translation of Jacobi's work, " on the principles and directions for 
the erection of suitable buildings for an hospital for the insane." And in 
the Lectures published in this year's Lancet, by Dr. Connolly, " on the con- 
struction and government of Lunatic Asylums," we are furnished with most 
abundant and useful information as to the more modern improvements con. 
nected with this part of our inquiry, which we regret to state our limits 
oblige us to dwell on so briefly. 



70 

tion of the insane, similar, in every respect, to prisons 
for criminals ; and it is unnecessary to state the very 
prejudicial effects produced by such a plan on the 
minds of the unfortunate inmates. Instead of glazed 
windows, there were bars and shutters of iron ; so 
that when it was desired to avoid the inclemency of 
the weather, it was necessary to exclude the daylight 
altogether ; and when the daylight was sought, the 
wretched patient was exposed to perhaps the harsh 
winter's blast, whistling through his dismal cell. 
Hence followed the horrid results recorded. Mortifi- 
cation of the extremities, consequent on the cold and 
confinement in damp cells, was, according to Haslam, 
frequent at Bethlem ; and was also prevalent in the 
private asylums in England. Pinel confessed that 
scarcely a year passed without some fatal cases of the 
kind at Bicetre. Whereas, in the York Retreat, 
under the improved system subsequently adopted, we 
find, according to Take, that such results were hardly 
known, and never as connected with cold or want of 
exercise. To obviate these evils, we should combine 
every necessary provision for comfort with due secu- 
rity. For instance, in order to take away all appear- 
ance of a prison, we may adopt, instead of the clumsy 
iron bars crossing the window-glasses, either sashes of 
cast iron, or, as we have observed in some parts of the 
Richmond Lunatic Asylum in this city, metal sash- 
work external to the ordinary window frames, and 
corresponding to them. The deception is admirable, 



71 

and we must confess escaped our observation for some 
time. 

In selecting a position for an institution of the 
kind, we should endeavour to have it as cheerful as 
possible, airy and salubrious. Let the ground be laid 
out in such a manner as to provide every possible 
concealment from the mind of the patient, of its being 
a place of confinement ; and let it be as like that 
attached to a private residence as circumstances will 
allow. Here may be alloted employment* for the 
patients, that will not only improve their physical 
condition, but also assist in drawing them away from 
their delusions. Sir William Ellis gives a remarkable 
instance of a man bent on suicide, but who was 
averted from his purpose by the occupation his mind 
had in building a moss-house, and it appears there 
was no danger apprehended from entrusting him with 
tools, he being of course under proper surveillance. 
Patients even in the most hopeless state of dementia 
may, according to Pritchard, be usefully employed. 
We shall generally find the insane willing to work, 
although they are sometimes opposed to it. The 
benefit of mental occupation was well exemplified in 
an individual labouring under great depression of 
mind, whom Dr. Keid recommended to engage in the 
composition of a novel, and with the best results. 

* The abuse as well as the use of employment amongst the insane, has been 
very ably discussed by Dr. Connolly in his Lectures recently published.— 
Lancet, August 15th, 1846. 



72 

Workshops may also be instituted, for the purpose of 
mechanical labour, and we see no reason why bazaars 
should not be connected with every asylum for the 
sale of the articles manufactured, the proceeds to be 
applied either to the liquidation of the ordinary ex- 
penses of the house, or to the purchasing of suitable 
rewards for the more industrious patients. Such has 
been established at Hanwell, and Sir William Ellis 
states that at the end of the second ycer, the profits 
were sufficient to purchase an organ for the patients.* 
The interior of the building must be planned in 
the same design as the exterior — comfort, combined 
with due security, and the avoidance of everything 
denoting restraint as far as possible. Let us always 
endeavour to impress on the inmates, that they are 
in an ordinary hospital for the improvement of their 
health, and that their discharge is to follow the at- 
tainment of that object. Until that period shall have 
arrived, let us, by a kind and sympathizing treatment, 
smooth down the effects of those depressing recollections 
which might otherwise follow them on their dismissal, 
and let us strive to imprint in their place, the remem- 
brance of benefactors left behind. This is the animus 

* Although it happens that the great proportion of inmates in the District 
Asylums in Ireland consists of incurable cases, we find by the Reports of the 
Inspectors-general, that in the year 1843, of the total number of inmates, 
amounting to 1160, "considerably more than four-fifths have been employed 
industriously ;■" and that "the total net produce of their labour amounted to 
£1,609 6s. 4d.;" and in the following year, an increase of £271 18s. 8d. was 
announced by the same authorities, which has been attributed to the marked 
improvement in the general health, and the increased proportion of cures. 



73 

that ought to influence the medical superintendant of 
an hospital for the insane, and we have lately had 
many and most gratifying proofs of its excellent effects 
in a neighbouring institution,* we have been so often 
obliged to refer to as the source of much useful know- 
ledge. To dwell on the assiduous anxiety evinced by 
the gentlemen - ) - placed over that establishment, would 
be presumption in us ; and we therefore leave to 
them the high and noble gratification, which must 
result from the inward conviction of the good that 
has been achieved under their government. 

A library of well selected books will be a great 
acquisition to such an institution. It will assist ma- 
terially in that religious and moral instruction which 
ought never to be lost sight of. What is inculcated 
in the asylum may effect a lasting impression for 
good or for evil, on the mind of the patient, when he 
shall have passed its walls. Sir William Ellis gives a 
most striking case of a woman, aged 45 years, " who 
lived in one of the manufacturing towns, and kept a 
brothel ; her husband was a receiver of stolen goods. 
She was admitted into Wakefield Asylum in a 
state of furious mania, from drunkenness. After the 
violence of the paroxysm had abated, it was found 
that she was as grossly ignorant of the vital truths of 
Christianity, as she was depraved and abandoned in 
her conduct. As she began to recover, she was in- 

* The Richmond Lunatic Asylum. 
f Dr. Mollan and Surgeon Blood. 



74 

duced, in the first instance, probably as much from 
curiosity as from any other motive, to attend morn- 
ing and evening family prayers. Light by degrees 
broke in on her mind ; she saw the dreadful conse- 
quences that would inevitably result from the life 
she had been leading ; and determined, by the help 
of God, to amend it. She remained in the asylum 
until she was perfectly restored to sanity ; and was 
so confirmed in the views she had imbibed on reli- 
gious subjects, that, on her return home, she not 
only gave up all her vicious ways, but had sufficient 
influence to reform her husband." 

The selection of proper attendants cannot possibly 
engage us too much. We must recollect that they 
are to be the companions of our patients ; and it is 
necessary that they should possess a full measure of 
all those humane and benevolent feelings which can 
alone fit them for the office. The duties are indeed 
serious, and the responsibilities attached thereto can- 
not be too strongly impressed on those who undertake 
them. 

M. Esquirol recommended convalescents as keepers. 
To this we object, recollecting the various relapses 
that occur, in consequence of patients being left in 
the asylum after the period they are pronounced fit 
for discharge. Dr. Mollan relates two cases of relapse ; 
one was a male, the other a female. The latter had 
been declared cured, but she remained as an attendant 
for seventeen j'ears, discharging her duties remark- 



75 

ably well ; but at the termination of that period, she 
fell into a state of melancholia. The former was not 
so decided a case as to the cause, he having received 
some bodily injuries from the patients before he 
relapsed. 

In bringing to a conclusion the foregoing re- 
marks, we cannot conceal the difficulties we felt on 
undertaking the task. The points on which we enter- 
tained a doubt, we sought to clear up by personal 
observation from the book of nature. The results 
may be imperfect ; but, nevertheless, the fountain 
from whence they are derived must recommend them. 
An honourable encouragement was held out by a dis- 
tinguished individual* to the College of Surgeons in 
Ireland, to prosecute the investigation of the question 
involved in " the use and abuse of restraint in the 
management of the insane ;" and duly appreciat- 
ing the proposed distinction, we were induced to 
submit to the appointed tribunal the opinions we had 
arrived at, after the most careful examination of that 
important subject. And although it might, perhaps, 
have been more interesting to have followed up some 
ingenious and speculative theory, we could not but re- 
collect that if such had been done, the object origin- 
ally set out with must have been lost sight of. We 
therefore concluded that the fruits of experience, how- 
ever limited, would, considering the magnitude of the 

* Sir Edward Sugden. 



76 

question, be more acceptable, than that which, although 
at first novel and attractive, might in the end prove 
barren and unproductive of good. 

THE END. 

P. S. — The author has omitted three statistical 
tables, which were in the original M.S. ; but the con- 
clusions deducible therefrom are given in the text. 






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