18
ANNUAL REPORT ON LUNATIC ASYLUMS.
cure. Mild counter-irritation is frequently of marked benefit, and a blister on the
nape of the neck has, in many cases, transformed a violent and maniacal patient
into a mild and rational inmate; but care is always taken that remedies of this
class should not assume a punitive character. The same may be said of the shower.
bath, douche warm bath, and tepid sponging, from which great benefit is experi
enced. The non-restraint system is the rule of the institution, and its salutary
effects are often markedly observable in new admissions brought in under the
custody of several men, and often bound or hand-cuffed with a character for much
violence, who on being set at liberty and treated according to the rules of the asylum,
frequently behave quietly and well. At the same time it is imperative that
discipline be maintained, and the system of non-restraint must not be permitted to
become one of terrorism of the strong and violent over the feeble and timid. If a
patient becomes dangerous or annoying to others, he is at once removed to a separate
room, or to another ward, and sometimes it is found sufficient to take him for a
brisk walk, after which he quiets down. This is usually effectual with noisy patients
who sing or shout and disturb the others at night : the warders are required to
walk them up and down till they become composed, after which they usually sleep,
and this often proves the best hypnotic. Exercise in the open air must be regarded
as an important point of treatment, exercising as it does a salutary effect on the
general health, and affording, as it were, a safety-valve, by means of which restless-
ness and excess of energy may be dissipated. I have established the custom,
which I find highly profitable, that all patients who do not join in some active
employment through the day should walk morning and evening round the grounds,
which are extensive and well planted with avenues of fine trees.
I find these walks conducive of quiet by day and of healthy natural sleep by
night. The women also, whose chief occupation, sewing, is of a sedentary nature,
extend their walk in the evenings beyond the limits of the enclosure allotted to
them, and the change of scene is cheerful and refreshing to them. It is much to be
wished that the benefit of sea air could be added to this, but the distance from the
shore, about 4 miles, and want of any means of conveying them thither, precludes
all but a few of the richer patients from enjoying this advantage. With those
whose friends can afford a conveyance, I make a point of the evening drive to the
beach, which I find very beneficial.
Under treatment must not be omitted work and recreation, both most neces-
sary to divert the mind from painful introspection and imaginary troubles. On
both these points more will be said, but as a remedial measure their importance
cannot be over-estimated. It is pleasant to see one native employed in winding
thread : he runs backwards and forwards, spindle in hand, cheerful and happy and
absorbed in his work, walking miles in the course of the day, and is a notable
instance of the cheering and enlivening effects of occupation. Out-door work has
the further advantage of being most healthful. The Madras Asylum with its large
grounds dotted with detached cottages, the patients employed in gardening,
weaving, carrying water, and other homely occupations, assisted by their warders
who work with them, more nearly approaches the spirit of the Gheel community
in many respects, and has few points of resemblance to the prison-like and crowded
asylums we too frequently see.
10. The subject of occupation is one of great importance in the treatment of
the insane; for if idleness is productive of evil amongst the sane, much more so
in those whose minds have lost the balance, which would enable them to regulate
their actions and thoughts aright, whose idle broodings would turn on delusions
and fancies dependent on their malady. To provide constant, interesting, and
cheerful occupation must be the aim of those engaged in the care of the insane,
and that this should be rational and useful, and this appeal to their sense of the
practical is an additional advantage. These requirements are amply met by the
weaving operations, which have been successfully established. The work requires
a certain amount of care and attention sufficient to abstract the worker from his
own thoughts and direct them on the work in hand. It interests him to see the
material growing beneath his hand, and most of the weavers are able to appreciate