The Press. — London, England, 1856-08-30 00:00:00

AUGUST 30, 1856. Nitcraturt. The resubmit of the Insane without Mechanical Restraints. By John Conolly, M.D., Edin., Consulting Physician to - the Middlesex Lunatic Asylum at Hanwell. London : Smith and Elder. THE greatest revolutions in society are often accomplished without noise or violence of any kind. They seem to progress by natural agencies, and to realise that fine image in Burke's " Reflections " where he compares the orderly progress of States to the changes of Nature, for ever repairing what is decayed and renewing what is old, by almost imper ceptible gradations. In a note to Hume's reign of Elizabeth there is a passage which always struck us as one of the most remark able in the history. It is that in which he says that in her reign the last traces of vil lenage ceased. But by what means the change was effected, or how it was that the great body of the English people grew from serfhood into freedom, no express record exists. In this age of historical research the inquiry would not be without interest, as the change is the greatest that can possibly be made in the con dition of a people, and it is doubtful whether any social revolution has ever been so noise less, so beneficial, and so complete. In modern day, when all arrangements of society are precise, and the Legislature or executive pOwer is so vigilant, it is not possible for any great social change to progress un marked ; yet perhaps the most important changes are those which are accomplished without statutes, or without more important aid • from them than is required to legalise arrangements society has itself originated Indeed, a little reflection is sufficient to show that considerable social changes, of whatever kind they be, must proceed from society itself. The reformation of juvenile offenders is an instance in point. Little more is asked of' the Legislature than to sanction the exertions of voluntary effort. The attention of Christian people cannot be fixed too earnestly on all such movements. Very often—most usually, indeed—they spring from the humblest com mencements; and it is when they are strug gling with prejudice or indifference, when both patronage and funds are wanting, that the earnest support of one or two individuals is sufficient to turn the scale, and to convert what was but a philanthropic thought into a vital and beneficent institution. When the French Revolution was beginning to convulse the world, and turbulence and cruelty without parallel broke loose from all restraint, a social reform had its birth iu France which humanity can now contemplate with sentiments of the purest satisfaction M. Pinel, a physician in Paris, was struck with horror at the state of insane patients in the hospitals of that city ; and in the year of the September massacres, when M arat , Robes pierre, and Denton commenced their reign of terror, Pinel became physician of the Bicetre, the lunatic asylum in Paris for males, and with him entered, says his biographer, " pity, good ness, and justice." The state in which those lunatics who were reported to be incurable were kept would seem incredible, if we did not know how easily use deadens the moral sense to the perception of enormities. The incurable, says' Dr. Couolly,— Were lodged at the Bicitre and the Salpktiere ; and, in both places, in cells either attached on one side to higher terraces, or formed below the level of the surrounding earth; and in both cases damp and dreadful. These cells (at the Bicetre) were only six feet square. Air and light were admitted by the door alone. Food was intro duced through a sort of wicket: The only furniture con sisted of narrow planks fastened into the moist walla, and covered with straw. At the Salpetriere, where the cells were below the surface, and. level with the drains, large rats found their way into them, often attached and severely wounded the unhappylunatics, and sometimes occasioned their death.• Of the two large asylums of Paris, the Bicetre (for men) was still the worst. • In an Eloge of the famous Pinel, Dr. Pariset-paints its character with his usual eloquence. The insane, the, vieions, and the criminal, were mingled together, and treated alike. Wretched beings, covered with'dirt, were seen crouched down in the narrow, cold, and damp cells ; where scarcely air or light found way, and where the-s was neither table nor chair nor bench to tat upon, but only a bed of straw, very rarely renewed. THE PRESS. The attendants on these unhappy lunatics were male. factors, selected, not for any of the gentler virtues, from the prison. The patients were bailed with chains, and defenceless against the brutality of their keepers ; and the building resounded, day and night, with cries and yells, and the clanking of chains and fetters. We cannot wonder that the keepers were sometimes murdered : that the maniac, more maddened by pain and insult, often learned to dissemble his revenge, and waited to effect it. During the revolutionary period Pinel con tinued his humane and enlightened efforts for the amelioration of the insane, and he had the good fortune to be seconded and succeeded by men scarcely inferior to himself. The lunatic asylums in France have been con tinually improving since 1792, yet the best of them, we infer from Dr. Conolly's book, are now much below the best in our own land. Attention was' accidentally directed to the cruel treat ment of the insane in this country about the time that the reformation commenced in Paris. We are old enough to recollect the day when the very first indications of insanity were met with a strait waistcoat, and when every form of mechanical restraint, with chains, manacles, and scourges, were thought to be so indispensable for the treatment of the insane as to excite no surprise. In all the public lunatic asylums were some cells, ex hibited as a curiosity to visitors, where maniacs, chained to walls, with a litter of straw, were kept in a loathsome state of filth. Dr. Conolly remarks : It would almost seem as if, at the period from the middle to near the end of the last century, the superinten dents of the insane had become frantic in cruelty, from the impunity with which their despotism was attended. Some of the German physicians meditated even romantic modes of alarm and torture ; wished for machinery by which a patient, just arriving at an asylum, and after being drawn with frightful clangour over a metal bridge across a moat, could be suddenly raised to the top of a tower, and as suddenly lowered into a dark and subterra nean cavern ; and they avowed that if the patient could be made to alight among snakes and serpents it would be better still. People not naturally cruel became habituated to severity until all feelings of humanity were forgotten. used to be astonished, even seventeen years ago, to see humane physicians going daily round the wards of asylums, mere spectators of every form of distressing coercion, without a word of sympathy, or any order for its mitigation. But men's hearts had on this subject become gradually hardened. In medical works of authority the first prin ciple in the treatment of lunatics was laid down to be fear, and the best means of producing fear was said to be punishment, and the best mode of punishment wasdefined to be stripes. The great authority of Dr. Cullen, certainly one of the most enlightened physicians of his time, was given to this practice,!although his theory of madness was that it depended upon an increased excitement of the brain. The author then proceeds to give particular instances of the kind of tortures invented for tho restraint of the insane : By degrees, restraints became more and more severe, and torture more and more ingenious. Among many cruel devices, an unsuspecting patient was sometimes induced to walk across a treacherous floor ; it gave way, and the patient fell into a bath of surprise, and was there half drowned and half frightened to death. We read with almost as much amusement as wcnder the respectful acknowledgment of Dr. Hallaran, that Dr. Cox made known to the profession the " safe and effectual remedy " of the circulating swing, the invention of which Dr. Cox " generously gives the credit of " to Dr. Darwin ; this invention being one by means of which the maniacal or melancholic patient, fast bound on a sort of couch, or in a chair, was rotated at various rates up to one hundred gyrations in a minute. The effect of this last diabolical contrivance was to make the patient frightfully giddy and sick, and the author supposes that it was only through fatal consequences frequently result-. ing from its use, that the recommendation of Dr. Hallaran, that no " well-regulated institu " tion intended for the relief and reception of " insane persons should be unprovided " with one of these machines, came to be disregarded. The ingenuity of some members of the faculty was exercised to improve this barbarous in vention:— 1)r. Cox had advised its being used in some " hopeless " cases, in the dark ; with the addition of unusual noises, smells, &c.; that every sense might be assailed; but I do not think this advice was ever acted upon. Mechanical restraints of a thousand different kinds were in univeral use : The simplest and cheapest means was by the use of chains, to which. as more lenient, succeeded strong waist coats confining the arms to the trunk, the legs being secured by hobbles. Handcuffs, and leather muffs and straps, have been much relied upon, with complications, in difficult cases, investing the patient with a kind of heavy circular collar and harness. Patients were seen standing by a wall to which their hands were chained, or sitting on a bench, to which they were strongly secured. Others 831 were fastened in a sort of chair resembling the ancient watchman's box, and many were chained or strapped down in bed. The methods of restraint varied acconling to the ingenuity of the superintendents ; but the object of all the methods was the same—to restrain the movements of the patient. The vagrant action of the limbs was suppressed, but the source of irritation in the brain left out of °onside• ration. The condition of the patients in these asylums was infinitely worse than when such " poor Toms " as Edgar personated in King Lear, were left to roam about the country at will. Wretched as they were, and exposed to cold and hunger, they yet had their liberty, and were less dangerous than when chained in the asylums intended for their refuge. The York Lunatic Asylum seems to have been one of the worst in the kingdom : So early as 1791 it happened that a female patient, of the Society of Friends, was placed in this institution. As her family lived at a distance from York, they requested some of their acquaintances to visit her. These ac quaintances were denied admission; and in a . few weeks the unhappy patient died. This circumstance gave rise to uncomfortable suspicions ; or rather it confirmed bus picions which had for some time existed. The Society of Friends, abstaining from any direct reflection on the asylum, acted with their characteristic benevolence and promptness, and, although scarcely able •to • command sufficiently ample resources, resolved to institute an asylum of their own. The result was the foundation of the Retreat at York; which was opened a few years afterward. Of this ad mirable asylum, the first in Europe in which every en lightened principle of treatment was carried into' effect, the chief promoter was the late William Tuke, of York. His worthy grandson, Samuel Tuke. who is still living, has continued, up to a very advanced period of- life, to be a frequent visitor' and most active governor of 'that ad mirable•establishment ; and for readers desirous to know the views which ought to prevail in all lunatic asylums, I could not even now refer to any work in which they are more perspicuously explained than in Samuel Take's ac count of the Retreat at York, published in 1813. The substitution of sympathy for gross unkindness, severity, and " stripes ; " the diversion of the mind from its excite ments and griefs by various occupations ; and a wise con fidence in the patients when they promised to control themselves, led to the prevalence of order and neatness, and nearly banished furious mania from this wisely devised place of recovery. With the opening of the Retreat the refor mation in„England commenced ; but down to 1815, and even to a later period, every form of cruelty was exercised in lunatic asylums. Dr. Conolly collects some details from a re port of the committee of the House of Com mons in 1815: In the women's galleries in Bethlem they found in one of the side rooms " about ten patients, each chained by one arm or leg to the wall ; the chain allowing them merely to stand up by the bench or form fixed to the wall, or to sit down on it." Fora dress, each had only a sort of blanket gown, made like a dressing-gown, but with nothing to fasten it round the body. The feet were without shoes or stockings. Some of these patients were lost in imbecility, dirty, and offensive ; associated with them were others capable of coherent conversation, and sensible and accomplished. Many women were locked up in their cells, chained, without clothing, and with only one blanket for a covering. In the men's wing, six patients in the side room were chained close to the wall, five were handcuffed, and one was locked to the wall by the right arm, as well as by the right leg. Except the blanket-gown, these men had no clothing; the room had the appearance of a dog-kennel. Chains were universally substituted for the strait-waistcoat. Those who were not cleanly, and all who were disinclined to get up, were allowed to lie in bed; in what state may be imagined. In one cell they found a patient, a representation of whose condition is preserved in a plate published in Esquirol's work, not much to the honour of our English treatment. This patient's name was Norris. He had been a powerful and violent man. Having on one occasion resented what he considered some improper treatment by his keeper, he was fastened by a long chain, which was ingeniously passed through a wall into the next room, where the victorious keeper, out of the patient's reach, could drag the unfortu nate man close to the wall whenever he pleased. To pre vent this sort of outrage, poor Norris muffled the chain with straw; but the savage inclinations of the keeper were either checked by no superintending eye, or the officers of the asylum partook of his cruelty and his fears ; for now a new and refined torture for the patient was invented, in the shape of an ingenious apparatus of iron. " A stout iron ring was rivetted round his neck, from which a sheet chain passed to a ring made to slide upwards or downwards on an upright massive iron bar, more . thaneix feet high , inserted into the walL Round his body a strong iron bar, about two inches wide, was rivetted ; on each aids of the bar was a circular projection which, being fastened to, and inclosing each of his arms, pinioned them dose to his sides." The effect of this apparatus was, that the patient could indeed raise himself up so as to stand against the wall, bat could not stir one foot from it, could not walk one step, and could not even lie down, except on his back ; and in this thraldom he bad lived for twelve years. Duringintich of that time he is reported to have been rational in his conversation. 'But' for him, in all those twelve years, there had 'been no variety of any kind, no refreshing change, no relief : no fresh air ; no exercise ; no sight of fields or gardens, or earth or hum. Each atiserabia jig "' 1, .'„