"For Lunacy:1. Give decoction of agrimony four times a day.2. Or, rub the head several times a day with vinegar in which ground ivy leaves have been infused.3. Or, take daily an ounce of distilled vinegar.4. Or, boil juice of ground ivy with sweet oil and white wine into an ointment. Shave the head anointed therewith, and chafe it in, warm, every other day for three weeks; bruise also the leaves and bind them on the head, and give three spoonfuls of the juice warm every morning.☞This generally cures melancholy. The juice alone taken twice a day will cure.5. Or, electrify. Tried.For Raving Madness:1. It is a sure rule that all madmen are cowards, and may be conquered by binding only, without beating (Dr. Mead). He also observes that blistering the head does more harm than good. Keep the head close shaved, and frequently wash it with vinegar.2. Apply to the head clothes dipt in cold water.3. Or, set the patient with his head under a great waterfall, as long as his strength will bear; or pour water on his head out of a tea-kettle.4. Or, let him eat nothing but apples for a month.5. Or, nothing but bread and milk. Tried."
"For Lunacy:
1. Give decoction of agrimony four times a day.
2. Or, rub the head several times a day with vinegar in which ground ivy leaves have been infused.
3. Or, take daily an ounce of distilled vinegar.
4. Or, boil juice of ground ivy with sweet oil and white wine into an ointment. Shave the head anointed therewith, and chafe it in, warm, every other day for three weeks; bruise also the leaves and bind them on the head, and give three spoonfuls of the juice warm every morning.
☞This generally cures melancholy. The juice alone taken twice a day will cure.
5. Or, electrify. Tried.
For Raving Madness:
1. It is a sure rule that all madmen are cowards, and may be conquered by binding only, without beating (Dr. Mead). He also observes that blistering the head does more harm than good. Keep the head close shaved, and frequently wash it with vinegar.
2. Apply to the head clothes dipt in cold water.
3. Or, set the patient with his head under a great waterfall, as long as his strength will bear; or pour water on his head out of a tea-kettle.
4. Or, let him eat nothing but apples for a month.
5. Or, nothing but bread and milk. Tried."
In all hypochondriacal cases, and in obstinate madness, Wesley recommended the following, wherein we see a return to the almost inevitable hellebore: "Pour twelve ounces of rectified spirits of wine on four ounces of roots of black hellebore, and let it stand in a warm place twenty-four hours. Pour it off and take from thirty to forty drops in any liquid, fasting."
Lastly, for all nervous disorders, he recurs to what was his favourite remedy, and says, "But I am firmly persuaded that there is no remedy in nature for nervousdisorders of every kind, comparable to the proper and constant use of the electrical machine."
I would direct the reader's attention to the condition of some asylums at the latter end of the eighteenth century, as described by a prominent character and noble philanthropist of that period.
The celebrated John Howard did not confine his attention to prisons, but frequently took occasion to visit asylums in the course of his philanthropic travels; and in his "Accounts of the Principal Lazarettos in Europe, together with Further Observations on some Foreign Prisons and Hospitals, and Additional Remarks on the Present State of those in Great Britain and Ireland" (1789), he contrasts St. Luke's Hospital with a hospital for lunatics at Constantinople, to the advantage of the latter in some respects, although he states that there is very little regard paid to cleanliness or the patients, while the former was neat and clean. Of the Constantinople asylums, he says, "They are admirable structures.... The rooms are all on the ground floor, arched, and very lofty, having opposite windows, and opening under a corridor into a spacious area." In the midst of the neglect ofhumanbeings he was astonished to find so much attention paid tocats, an asylum having been provided for them near the Mosque of St. Sophia. Of St. Luke's he says, "The cells were very clean and not offensive. The boxes on which the beds of straw lie are on a declivity and have false bottoms. The cells open into galleries, fifteen feet wide, and on each gallery was a vault, which was not offensive.... Here are largeairing grounds for men and women; there is also a new but very inconvenient bath. Here are, very properly, two sitting-rooms in each gallery, one for the quiet, the other for the turbulent; but I could wish that the noisy and turbulent were in a separate part of the house by day and by night.... Several women were calm and quiet, and at needlework with the matron. A chapel would be proper here for the advantage of recovering patients, as I have seen in such houses abroad."
It would seem, then, that although Howard observes, "I greatly prefer the asylum at Constantinople," he must refer to the less important matter of the structure of the building. As also when mentioning St. Patrick's or Swift's Hospital at Dublin, he says he should prefer the Dol-huis at Amsterdam and the hospital at Constantinople, "where the rooms open into open corridors and gardens, which is far better than their opening into passages as here in England."[113]
In his previous work, 1784, Howard observes, speaking of English prisons, "I must add here that in some few gaols are confined idiots and lunatics. These serve for sport to idle visitors at assizes and other times of general resort. Many of the Bridewells are crowded and offensive, because the rooms which were designed for prisoners are occupied by the insane (by the Irish Act, 3 Geo. III., such persons are required to be kept separate). Where they are not kept separate, they disturb and terrify other prisoners. No care is taken of them, although it is probable that by medicines, and proper regimen,some of them might be restored to their senses and to usefulness in life."[114]
We shall see more clearly, as we proceed, what was the condition of the insane in England at the latter part of the eighteenth century.
A time then came—in the year 1792—fraught with an event as important as it was unexpected, the beginning, on a small scale, of the reform which ultimately took place in the condition of British asylums; a reform slowly brought about by means which might have seemed very inadequate for the purpose. But the poet warns us to
"Think naught a trifle, though it small appear;Small sands the mountain, moments make the year,And trifles life."
"Think naught a trifle, though it small appear;Small sands the mountain, moments make the year,And trifles life."
And does not Joseph de Maistre well say, "Aucune grande chose n'eut de grands commencements"—nothing great ever began great?
I should premise that there was at York an asylum founded some fifteen years before, on a charitable foundation, with it cannot be doubted, the best intentions on the part of its promoters, but, unfortunately, its management had been no better than the worst asylums of that day. It happened that, in 1791, the friends of a patient who was confined there, desiring to visit her, were refused admission, and suspicion was aroused as to the treatment to which she was subjected, with (as the event proved) only too much reason, and not,as sometimes happens at the present time, without just occasion, and, indeed, on the most frivolous and vexatious pretences. The knowledge that such is the case ought to make us very careful how we sit in judgment on our predecessors in regard to any charge brought against them. There is, however, undeniable evidence, proof which cannot be evaded, and ultimately admitted by all, that the asylum at York of which I speak was a frightful abode for lunatics. The time had not come for its public exposure, but instead of this it was proposed by a citizen of York—William Tuke—that an institution should be erected where there should be no concealment, and where the patients should be treated with all the kindness which their condition allowed. His mind, full of common sense, suggestive, and not seeing why the right thing should not be done—in fact, his creed being that it must be done—he set resolutely to work to effect his purpose. It became with him a question of humanity and right, and he resolved that if he could be the means of effecting it, there should be an asylum openly conducted and on humane principles. He talked over the project with his friends, and having at last formed a definite plan, he brought it forward before an assembly of the communion of which he was a member—the Society of Friends. I should have stated that the patient in the York Asylum to whom I have referred belonged to the same body. As was natural, difficulties were at first suggested; but, having an iron will, as well as a kind heart, he overcame them before long, and eventually succeeded in his object.His feeling that something should be done had been strengthened by a visit he had paid to St. Luke's Hospital, where he saw the patients lying on straw and in chains. He was distressed with the scene, and could not help believing that there was a more excellent way. He resolved that an attempt should be made to ameliorate their miserable condition. His proposition was made in the spring of 1792. Adopted, and the funds provided, steps were taken for erecting an institution in a healthy locality in the neighbourhood of York. "The ground was elevated, and the situation afforded excellent air and water, as well as a very extensive and diversified prospect." The illustration (Frontispiece) will convey a better idea than any verbal description of this unpretentious building. Its character as a labour of love and humanity was embodied in an inscription written at the time, which may be discovered whenever the foundation stone is disinterred:—
Hoc FecitAmicorum Caritas in HumanitatisArgumentumAnno dñi MDCCXCII.
Referring to the establishment of the Retreat, an American physician of celebrity in the department of Psychological Medicine says, "Merit of this kind is seldom duly appreciated by the world, for it does not strike the imagination like that of brilliant discoveries in the physical sciences, and the very reason that reforms like that in question are so obviously sanctioned and confirmed by common sense and the feelings ofcommon humanity is apt to detract from the merit of those who conceive them."[115]
There are several points to which I have devoted considerable labour among the archives of the Retreat, and on which I have had the advantage of frequently conversing with the author of the "Description of the Retreat" in former years. Among these I may refer to an interesting explanation of the origin of the now familiar term "Retreat" as applied to a lunatic asylum. One day the conversation in the family circle turned on the question, What name should be given to the proposed institution? when my grandmother, who was much interested in the establishment, quickly remarked that it should be called aRetreat. It was at once seen that feminine instinct had solved the question, and the name was adopted, "to convey the idea of what such an institution should be, namely, a place in which the unhappy might obtain a refuge; a quiet haven in which the shattered bark might find the means of reparation or of safety;"—a term which became the parent of numberless imitations, some of them, it must be confessed, only so called by a miserable irony. It need hardly be remarked that this term had been from an early period employed in the Church of Rome to indicate a place of resort for meditation and penance during certain periods of the year.
Family tradition says that the wife of the projector of the Retreat—a woman of great force of character—questioned at first his wisdom in proposing the foundationof such an institution. He had (with her full concurrence) already established a school for the higher education of girls, among other projects which sprang from his fertile brain, and she playfully told him that people would say he had had many children, and that his last was an idiot. Here for once the woman's instinct failed, and masculine sense succeeded. Some of his co-religionists also discouraged the undertaking. "Looking back to the year 1792, and considering the miserable condition of the insane in general at that period, it appears to us almost strange that the proposal should have met in the first instance with considerable opposition, and that the institution had to struggle through many difficulties into existence."[116]
The experiment began in earnest, on the opening of the establishment, four years after it was instituted, the projector residing at and superintending it, a short interval excepted, until the appointment of Jepson, who, as well as his wife, the matron, were admirably adapted for their posts. During this period, "the founder," says the historiographer of the Retreat, "superintended the management of the patients, and entered into their cases with great zeal, discrimination, and humanity."
Letters in my possession, written by him, attest this, and also the difficulties which he encountered; for in one of them he writes, "All men seem to desert me in matters essential." Happily, however, a like-minded man, in many respects, was at last found in Jepson, who became an excellent superintendent, and remained athis post until the death of the founder, who to an advanced age continued, to quote his grandson, "to pay very close attention to the institution, generally visiting it several times a week."
It was early seen that work in the open air would be an important help in the experiment, and enough land for a farm had been obtained. I observe that, among other things, the fact particularly struck a Swiss physician who visited the Retreat not long after it was opened. He remarks on its presenting the appearance of a large rural farm, and on its being surrounded by a garden. He was also struck by another important feature: "There is no bar or grating to the windows."
"Cette maison est située à un mille de York au mileau d'une campagne fertile et riante; ce n'est point l'idée d'une prison qu'elle fait naître, mais plutôt celle d'une grande ferme rustique; elle est entourée d'un jardin fermé. Point de barreau, point de grillages aux fenêtres, on y a supplée par un moyen dont je rendrai compte ci-après.
"Vous voyez, que dans le traitement moral on ne considere pas les fous comme absolument privés de raison, c'est-à-dire, comme inaccessibles aux motifs de crainte, d'espérance, de sentiment et d'honneur, on les considere plutôt, ce semble, comme des enfans qui ont un superflu de force et qui en faisoient un emploi dangereux."[117]
Pinel had now been at work five years, and for the first time heard of the management of the Retreat from the glowing account published by this Swiss physician Dr. Delarive. The conductors of the Retreat first became acquainted with Pinel's great work at the Bicêtre in Paris in 1806.
An incident related in honour of Jepson may fitly be introduced here. He "had found the doctrine of subduing the insane by fear maintained in St. Luke's Hospital, which was then esteemed, and probably justly, the best public establishment of the kind in Great Britain; and he could not but attach considerable value to its long and extensive experience. Soon after entering upon his office, a very violent patient came under his care. His friend and adviser (Tuke) was from home, and he determined for once, upon his own responsibility, to act upon the prevalent notion. In size he was not ill qualified to do the duty of a keeper upon the old system, but his feelings and all the habits of his mind were opposed to harsh methods. After the experiment he was so uneasy with himself, that on retiring to bed he slept but little, and he resolved that, if the course he had adopted was not in this case beneficial, he would entirely abandon the system. On visiting the patient his opinion was that the experiment had failed, and that it had left a painful and vindictive feeling on the mind of the subject of it." It is added that henceforth Jepson fully carried out, step by step, the views of the founder and his friends.[118]
The earnestness with which the officers who were appointed entered into the undertaking—the way in which they helped to make possible the success so much desired by the founder—deserves our grateful appreciation, and should preserve them from being in the least degree thrown into the shade. To enter heartily into the ideas and schemes of other people may be as meritorious as to originate them, and is often much more irksome. It is neither necessary nor generous to exalt one class of workers at the expense of the other. No doubt the originator of the Retreat was one who also worked hard himself at what he had initiated; but he could not have eventually succeeded if he had not been able to attract to himself men who would devote their powers to the new work in the same spirit as he did. Such men were Jepson and Fowler, the latter of whom, the first visiting physician,[119]died five years after his appointment. Such also was Dr. Cappe, his successor, who was cut off in his prime deeply regretted—"a man equally esteemed for the gentle urbanity of his manner, the excellence of his understanding and dispositions, and his professional attainments."[120]
It is not always that the insane are able to appreciate the efforts made to render them comfortable. It is all the more gratifying when it does occur. A patient was admitted who had nearly lost the use of his limbs from being chained, and for some time it was necessary tolead him about like an infant. He was found to require no restraint, and was, after a while, able to walk without assistance. When one of his friends visited him and asked him what he called the place, he replied, with great earnestness, "Eden, Eden, Eden!"
A man was admitted who had been for twenty years chained and naked; with the exception of the occasional use of arm-straps, no personal restraint was employed from the moment of his admission. He was soon induced to wear clothes and adopt orderly habits.
One day a man of Herculean size was brought to the institution, and the case is thus described by the author of the "Description": "He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrived to be taken off and put on by means of strings, without removing his manacles. They were, however, taken off when he entered the Retreat, and he was ushered into the apartment where the superintendent and matron were supping. He was calm. His attention appeared to be arrested by his new situation. He was desired to join in the repast, during which he behaved with tolerable propriety. After it was concluded, the superintendent conducted him to his apartment, and told him the circumstances on which his treatment would depend; that it was his anxious wish to make every inhabitant in the house as comfortable as possible, and that he sincerely hoped the patient's conduct would render it unnecessary for him to have recourse to coercion. The maniac was sensible of the kindness of his treatment.He promised to restrain himself, and he so completely succeeded, that, during his stay, no coercive means were ever employed towards him." When excited and vociferous, the superintendent went to his room and sat quietly beside him. After a period of increased irritation, the violent excitement subsided, and he would listen with attention to the persuasions and arguments of his friendly visitor. "Can it be doubted," asks Tuke, "that in this case the disease had been greatly exasperated by the mode of management, or that the subsequent kind treatment had a great tendency to promote his recovery?"
An architect, Mr. Stark, in visiting British asylums, when engaged in preparing plans for the Glasgow Asylum, came to the Retreat. He thus speaks in his "Remarks on the Construction and Management of Lunatic Asylums": "In some asylums which I have visited, chains are affixed to every table and to every bed-post; in others, they are not to be found within the walls.... At the Retreat they sometimes have patients brought to them frantic and in irons, whom they at once release, and by mild arguments and gentle arts reduce almost immediately to obedience and orderly behaviour. A great deal of delicacy appears in the attentions paid to the smaller feelings of the patients. The iron bars which guarded the windows have been avoided, and neat iron sashes, having all the appearance of wooden ones, have been substituted in their places; and when I visited them, the managers were occupied in contriving how to get rid of the bolts with which the patients are shut upat night, on account of their harsh, ungrateful sound, and of their communicating to the asylum somewhat of the air and character of a prison. The effects of such attentions, both on the happiness of the patients and the discipline of the institution, are more important than may at first view be imagined. Attachment to the place and to the managers, and an air of comfort and of contentment, rarely exhibited within the precincts of such establishments, are consequences easily discovered in the general demeanour of the patients." "It is a government," Stark also observes, "of humanity and of consummate skill, and requires no aid from the arm of violence and the exertions of brutal force."[121]But Stark himself, strange to say, is careful not to commit himself to the total abolition of chains, adopted at the Retreat.
Two more brief testimonies from competent visitors who inspected the institution may be permitted—one from Dr. Duncan of Edinburgh, when on a tour of inspection of asylums in Britain; the other from a foreigner, Dr. Naudi, then the "President of the Maltese Hospitals." The former wrote, after visiting the Retreat, of the demonstration, "beyond contradiction, of the very great advantage resulting from a mode of treatment in cases of insanity much more mild than was before introduced into almost any lunatic asylum, either at home or abroad. In the management of this institution they have set an example which claims the imitation, and deserves the thanks, of every sect and every nation. For, without much hazard of contradiction from thoseacquainted with the subject, it may be asserted that the Retreat at York is at this moment the best-regulated establishment in Europe, either for the recovery of the insane, or for their comfort when they are in an incurable state." And Dr. Naudi, in broken but effective English, observed, "This house or Retreat for the troubled in mind, I think, is one of the best things I saw in England on the same subject; and having observed many others on the Continent, I dare to say it is the best in all the world. The situation of the building out of the town, a large garden around it, the propriety of the rooms, the cleanliness of the patients, the way in which they are kept, as for dressing, as for feeding them, is very remarkable to be observed."
The institution had not been very long in full operation before the success of the more enlightened treatment pursued in it was so patent, that the same pleasure and astonishment which the Swiss doctor experienced became general, and it was decided, in the hope of inducing others to follow a like course, to publish an account of the means which had been adopted in the treatment of the patients. This "Description of the Retreat," by S. Tuke, containing "An Account of its Origin and Progress, the Modes of Treatment, and a Statement of Cases," appeared in 1813.[122]Sydney Smith helped to bringthe book into notice by his favourable review of it in theEdinburgh. In it he says of the Retreat:—
"The great principle on which it appears to be conducted is that of kindness to the patients. It does not appear to them (the managers), because a man ismad upon one particular subject, that he is to be considered in a state of complete mental degradation, or insensible to the feelings of kindness and gratitude. When a madman does not do what he is bid to do, the shortest method, to be sure, is to knock him down; and straps and chains are the species of prohibitions which are the least frequently disregarded. But the Society of Friends seems rather to consult the interest of the patient than the ease of his keeper, and to aim at the government of the insane by creating in them the kindest disposition towards those who have the command over them. Nor can anything be more wise, humane, or interesting than the strict attention to the feelings of their patients which seems to prevail in the institution.... To the effects of kindness in the Retreat are superadded those of constant employment. The female patients are employed as much as possible in sewing, knitting, and domestic affairs; and several of the convalescents assist the attendants. For the men are selected those species of bodily employment most agreeable to the patient, and most opposite to the illusions of his disease." He proceeds to say that in this instance, "an example has been set of courage, patience, and kindness which cannot be too highly commended or too widely diffused, and which, we are convinced, will gradually bring into repute a milder and better method of treating the insane."[123]
The author of the above work took an active part in the management of the Retreat for more than forty years, strenuously aided in exposing the abuses of the YorkAsylum, and exerted no inconsiderable influence upon the movement on behalf of the insane, not only by the work referred to, but by his writings on the construction of asylums.[124]
I find an entry in his journal, made in April, 1811, that he had begun an Essay on the state of the insane poor for a periodical called thePhilanthropist. His indignation had been aroused by witnessing the condition of pauper lunatics in a workhouse in the south of England. He was led into a small yard at a short distance from the principal building, in which were four cells. He found them large enough for one person. At the further end of each was a platform of wood attached to the wall, which was intended for the patient's bed. In two of the cells all the light and air which could be admitted passed through an iron grating in the door, so that the cold air could not be excluded without entirely darkening the apartment. In each of these cells a female was confined. "I cannot describe," he says, "my feelings and astonishment when I perceived that the poor women were absolutely without any clothes. The weather was intensely cold, and the evening previous to our visit, the thermometer had been sixteen degrees below freezing. One of these forlorn objects lay buried under a miserable cover of straw, without a blanket or even ahorse-cloth to defend her from the cold." So of the others, one of whom had the leg chained to the platform at the end of the cell. Bitter complaints were made of cold. Flannel dresses were at once sent to the workhouse for these poor wretches, which they wore, and invoked many blessings on the giver, who denounced the conduct of the guardians and writes, "Surely, a mind, actuated by the virtuous sympathies of our nature, would not have joined with comfort the warm social circle, or repose his head on a soft pillow, whilst he knew that any one was enduring so many privations, and so much misery which was not only in his power but was his duty to relieve."
It should be stated that a Select Committee had been appointed (moved for by Mr. Wynn) five years before (1806), to inquire into the state of pauper lunatics in England. This Committee proposed the erection of asylums in different parts of the kingdom, power being given to the magistrates of any county to charge the expense upon the county rate, all pauper lunatics within the district being conveyed thither and maintained at the expense of their respective parishes, and it was recommended that no asylum should contain more than 300 patients. At that time there were 1765 lunatics in workhouses, or houses of industry, 483 in private custody, 113 in houses of correction, and 27 in gaols; total, 2248.[125]Sir George Paul, who took an activeinterest in this Committee, stated, in a letter to the Secretary of State, that there was hardly a parish of any considerable extent in which there might not be found some unfortunate human creature, who, if his ill-treatment had made him "frenetic," was chained in the cellar or garret of a workhouse, fastened to the leg of a table, tied to a post in an outhouse, or perhaps shut up in an uninhabited ruin; or, if his lunacy were inoffensive, was left to ramble, half-naked and half-starved, through the streets and highways, teased by the rabble, and made the jest of the vulgar, ignorant, and unfeeling. "I have witnessed," he says, "instances of each of these modes of securing lunatics, under the Act 17 Geo. II., c. 5. Of all the lunatics in the kingdom, the one half are not under any kind of protection from ill-treatment, or placed in a situation to be relieved of their malady."
In the following year (1808) an Act (48 Geo. III., c. 96) was passed, providing that it should be lawful for justices in every county in England and Wales to take into consideration the propriety of providing a lunatic asylum for the reception of patients within the county. Referring to the Act 17 Geo. II. for the committal of vagrant lunatics, the new Act provided that in case there should be an asylum established for the county within which the lunatic belonged, then a warrant should be issued for the removal of such lunatic to the asylum, and not elsewhere; but if no asylum had been erected, then he was to be confined in any house duly licensed under the authority of the Act of 14 Geo. III. It will be seen that this legislation was not compulsory, and thereforeutterly failed in attaining the object of its promoters. It only authorized magistrates to act.
This Act was amended in some points of importance in 1811.[126]Overseers were obliged to produce a certificate of a medical man as to the state of the lunatic. Justices were to make returns to the quarter sessions of the cases brought before them, and medical superintendents returns of the state of persons intrusted to their care, at least once a year.
"The Description of the Retreat," then, of which Dr. Conolly writes in 1856, "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; in none are the details of management, economic, medical, and moral, to be found more convincingly set forth"—this work, happily, proved the means,[127]by the extraordinary interest it excited in the experiment, and the contrast it was but too well known to exhibit to the general condition of similar institutions, of arousing attention, first to the abuses of the old asylum at York, and then to others, until it was deemed desirable to appoint a Committeeof the House of Commons to investigate the subject thoroughly. To this we shall refer in more detail, but may here observe that the founder of the Retreat was one who gave evidence before it, and the members, says an eye-witness, were evidently interested in seeing the old man, then upwards of eighty, and hearing from his own lips some of the facts relating to the success of the experiment at York. He continued to devote himself to the interest of the institution, and died in 1822, thirty years after he had broached the idea of its establishment. It had, he said, some years before, succeeded far beyond his expectations, and he felt a wish to contribute such information as attentive observation had enabled him to make for the benefit of others. This he did in various ways, one being a Letter to the governors of the York Lunatic Asylum, in which he observes, "At the time of Lord Erskine's Chancellorship, I noticed with much satisfaction his remarks on the treatment of insane patients, especially in private mad-houses, which he found was so generally severe, that in case they were but a little deranged, it was sufficient to make them raving mad; and he delivered it as his judgment that kind and conciliating treatment was the best means to promote recovery. The latter part of this opinion I have the satisfaction of asserting has been evidently proved correct in the management of the Retreat, where coercion, though sometimes necessary for feeding the patients and preserving them from injury to themselves or others, is administered in the most gentle manner, and the use of chains is never resorted to."
"In person," wrote a contemporary, "William Tuke hardly reached the middle size, but was erect, portly, and of a firm step. He had a noble forehead, an eagle eye, a commanding voice, and his mien was dignified and patriarchal."
He was ninety when he died, and it may be added that Willan made a happy hit when he said, on being consulted by him many years before, "There is a pulse which will beat till ninety."
"Of no distemper, of no blast he died,But fell like autumn fruit that mellowed long:Even wondered at, because he dropt no sooner.Fate seemed to wind him up for fourscore years;Yet freshly ran he on ten winters more,Till like a clock worn out with eating time,The wheels of weary life at last stood still."Dryden,Œdipus, Act iii. sc. 1.
"Of no distemper, of no blast he died,But fell like autumn fruit that mellowed long:Even wondered at, because he dropt no sooner.Fate seemed to wind him up for fourscore years;Yet freshly ran he on ten winters more,Till like a clock worn out with eating time,The wheels of weary life at last stood still."Dryden,Œdipus, Act iii. sc. 1.
French physicians have done justice generously and ungrudgingly to the services rendered by the York reformers in the management of the insane. Parchappe, late Inspector-General of the "Service des Aliénés" in France, wrote: "La Retraite d'York, dont Samuel Tuke publia la description en 1813, fut considérée comme l'école où les aliénistes devaient s'instruire et comme le modèle auquel ils devaient se conformer. La création et l'organisation de cet établissement a eu la plus grande influence sur le développement des bonnes méthodes de traitement et sur le perfectionnement des asiles en Angleterre."[128]
Ferrus, physician to Napoleon I., visited the English asylums in 1826, in order to obtain some useful hints in the management of similar institutions in France, and commends, in a passage which I shall quote, the mild means of coercion resorted to at the Retreat. He speaks of it as the first asylum in England which arrested the attention of foreigners, and proceeds, "Mr. Tuke was a man for whom religion and morality were practical virtues, and in whose eyes neither riches nor poverty, imbecility nor genius, ought in the slightest degree to affect the bonds which unite all men together in common. He thought, with reason, that justice and force ought to be evinced, not by shouts and menaces, but by gentleness of character and calmness of mind, in order that the influence of these qualities might make themselves felt upon all, even when excited by anger, intoxication, and madness. The traditions of this friend of humanity are preserved in the house which he founded. Everything, even down to the patients, is silent and peaceful in this asylum, where some who are not members of the Society of Friends are also admitted. Those admitted, be their religion or social position what they may, whatever even their habits may have been, influenced by the tranquillity of the place and the force of example, find repose in this house, which much more resembles a convent of Trappists than a mad-house; and if one's heart is saddened at the sight of this terrible malady, we experience emotions of pleasure in witnessing all that an ingenious benevolence has been able to devise to cure or alleviate it.... The reputation of this institution is the best established ofany in England. We are assured that the number of cures is considerable, and we willingly believe this, because the general management of the house is favourable to the treatment of insanity."
Thirty years afterwards, when I paid a visit to Ferrus in Paris, he recalled, with great animation, the impressions he at this period received at the York Retreat.
Nor have the Americans been less grudging in their encomiums. Dr. Ray, one of their most distinguished physicians devoted to the treatment of the insane, whom I have already quoted, after visiting our asylums many years ago, bore witness to the results of the reform "so thoroughly effected at the York Retreat," and speaks of the founder as clear-headed and warm-hearted, one "who, true to his faith, conceived the idea that the insane, as well as the sane, could best be managed in the spirit of peace and good will." And Dr. Pliny Earle observes, "It is now very fully demonstrated that the idea of the amelioration of the condition of the insane was original with Pinel and Tuke, and that for some time they were actively pursuing their object, each uninformed of the action of the other. It is no new thing for inventions, discoveries, and innovations upon traditionary practices to originate almost simultaneously in more than one place, showing that they are called for by the times; that they are developments of science and humanity, necessary evolutions of the human mind in its progress towards the unattainable perfect, rather than what may be termed a gigantic or monstrous production of one intellectual genius. Each perceived thewretchedness, the misery, the sufferings of the insane around him; each was moved to compassion; each resolved to effect a reform in their treatment; each succeeded. The recognition of services to humanity is due to each. To each we freely accord it."[129]
Dr. Brown, the late physician of the Bloomingdale Asylum, New York, after visiting England in 1863, observes of the lunatic hospitals in England, "There is one possessing historical fame and interest, which yet retains its early popularity, as well as its excellent reputation among medical men. The York Retreat, founded by the Society of Friends at the close of the last century, and hallowed in the memory of every one who appreciates the spirit of beneficence which originated it and has ever since pervaded its halls, still pursues its sacred mission of removing and relieving mental diseases. Nowhere did I observe clearer evidence of intelligent and conscientious fulfilment of the humane purposes of all such institutions. The older sections of the building were being gradually replaced by new constructions, which conform interiorly to the present standard of advancement; and as for that personal devotion of the chief officers, on which the welfare of patients must mainly depend, it was sufficiently apparent that the genius and the earnestness of Tuke still abide among his successors."[130]
Returning now to what in the history of the rise and development of the modern treatment of the insane isof great importance, the guiding principles of the treatment pursued at the York Retreat, and its relation to what is understood as the non-restraint system, I would observe that the first principle of all was an active humanity—the highest form of it as embodied in the golden Christian rule. It has often been said that the members of the community by whose principles he was animated seem to think it necessary to act as well as to talk; to carry out their principles into actual practice, as if they were really intended to be applied to the ills of humanity. If some of his own friends discouraged Tuke's benevolent designs, it may have arisen from their not being convinced that a case had been made out for its exercise. An accident, as it were, brought the fact of the unsatisfactory condition of the asylums of his day forcibly before him. Accustomed to do as well as to talk about doing, when he knew the existence of an abuse, he set himself to work at once to prevent its recurrence so far as the area of his own influence could extend. Suspecting unkind treatment, he strove to have it replaced by kindness; convinced that abuses and cruelty ever tend to spring up when public surveillance is refused, he resolved to do away with all secresy in the management of the proposed institution. Further, he "had a strong faith in the dictates of an enlightened conscience and in the perfect wisdom and love which direct every law of human duty."[131]
This principle not only accounts for the successful commencement of the undertaking, but helps to explainthe individual treatment of the insane; for the patients were treated as human beings suffering under a terrible affliction, toward whom it was a duty to extend consolation, compassion, and kindness. This course necessarily led to the demonstration that when so treated they were calmer and required comparatively little restraint. The fact happily bore out the theory.
But a humane man may in the exercise of his humanity be injudicious, and by so doing inflict much actual suffering. The surgeon who to avoid inflicting pain should shrink from the complete removal of a malignant tumour, would fail to relieve the patient as he ought to have done. Therefore something more than humane feeling is required. Judgment must be exercised. Now, judgment and that common sense, or mother wit, which is so much better than mere routine practice, evidently characterized the early treatment of the Retreat. As benevolent feeling naturally led to the non-use of chains and the minimum resort to restraint which then seemed possible, so common sense led to the avoidance of the periodical bloodletting and emetics then in fashion. It is a remarkable fact that even then it was seen that insanity rarely calls for depressing remedies, and the observation was made and acted upon that excitement is often relieved by a directly opposite treatment. They allowed a liberal nourishing diet[132]in casesof violent mania; a free supply of meat, or bread and cheese, and porter, was found of the greatest service at supper in procuring sleep and reducing excitement. They had no faith in specifics and nostrums in the cure of insanity, but medical treatment was by no means despised, while a warm bath was found to be "of greater importance and efficacy, in most cases of melancholia, than all the other medical means which have been employed."[133]
With this, one cannot but contrast the old system, which was emphatically empirical and unscientific. It was continued without change from year to year, and it may truly be said that idleness and selfishness, still more than ignorance, constituted the vices of the old system. Those who treated the insane always encountered opposition by brute force, instead of by energy and patience, which surmount difficulties that to idleness are impassable mountains, and which selfishness would not, if it could, overcome. Again, from the commencement of the Retreat, the idea was entertained of making the institution a home; and with this view the arrangement and surroundings were made as cheerful and home-like as possible.
Another strong point was the employment of the patients; its vital importance was forcibly felt from the first. Dr. Delarive, who inspected the Retreat in 1798, particularly comments upon this novel feature of a mad-house. He found that an experiment recentlymade, that of inducing the patients to cultivate the land, giving to each a task proportionate to his strength, had answered well. It was found that they were fond of this exercise, and that they were much better after a day spent in this work than when they had remained in the house, or when they had taken an ordinary walk. Delarive went to see them at work, a sight so common now in our asylums that it seems strange it should have excited his surprise.
Of employment the author of the "Description" thus speaks: "The female patients in the Retreat are employed as much as possible in sewing, knitting, or domestic affairs; and several of the convalescents assist the attendants. Of all the modes by which the patients may beinduced to restrain themselves, regular employment is perhaps the most generally efficacious; and those kinds of employment are doubtless to be preferred, both on a moral and a physical account, which are accompanied by considerable bodily action, that are most agreeable to the patient, and which are most opposite to the illusions of his disease."[134]
We find it insisted upon by those who had the management of the Retreat that moral treatment is of the greatest importance; that gentleness must take the place of violence;[135]that it is erroneous to suppose itnecessary to commence an acquaintance with lunatics by an exhibition of physical strength; that every effort should be made to divert the mind of melancholiacs by bodily exercise, walks, conversation, reading, and other recreations; that the desire of esteem is a more powerful principle to appeal to than fear; that the best form of restraint is self-restraint; that patients should be treated as much as possible as rational beings, but that little or no advantage arises from reasoning with them on their particular delusions; that it is desirable to encourage the influence of healthy religious principle over the mind of the insane; that those who manage them should sedulously endeavour to gain their confidence and esteem, to arrest their attention and fix it on objects opposed to their delusions, to call into action every remaining power and principle of the mind, and to remember that in the wreck of the intellect the affections not unfrequently survive.
This recapitulation of the salient features of the practice of the Retreat renders it easy to understand the position taken by the managers of the institution in regard to mechanical restraints. When kindness failed to subdue maniacal excitement, when medical remedies exerted no calming influence, mild forms of restraint were reluctantly adopted, rather than maintain a conflict between patient and attendant. It appears from the Retreat archives that not more than five per cent., reckoning the night as well as the day, were restrained by strap or waistcoat.[136]It is notorious that, at the sameperiod, it was the custom in some asylums, probably many, to chain to the bedstocks, at night, every patient in the house. Ferrus, to whom I have referred, did not find camisoles in use at St. Luke's in 1826, but "strong chains were employed to hold the excited patients. These chains, fixed at different heights to the sides of stoves (chauffoirs), have iron rings at the end, by means of which the arms or the legs of the patient are rendered completely immovable.... Far from fearing that a painful impression will be produced on the patients by chains, they think, on the contrary, that this apparatus exerts a beneficial influence upon them; that it intimidates, humbles them, and removes all desire to attempt to get rid of their fastenings." Ferrus says that at the Retreat he found a belt was employed, softly padded, to which the arms were attached. "We do not employ it in France," he says, "although it might in hot weather be preferable to the camisole.... The Retreat offers all the resources of art and the comforts of life (douceurs de la vie) compatible with the condition of insane persons."
Coercion was regarded at the Retreat as an evil—that is to say, it was "thought abstractedly to have a tendency to retard the cure, by opposing the influence of the moral remedies employed"—but at the same time "a necessary evil," an unhappy alternative in certain cases. Practically, as we have seen, the amount of restraint was small; but noruleof practice was laid down that it should never be resorted to. The abstract principle of non-restraint adopted at Lincoln and Hanwell was notenunciated. "We greatly prefer," observes the author of the "Description," "to lay down no absolute rule of non-restraint, but to refer to our resident officers the exercise of a sound discretion in each individual case." But the managers of the Retreat did undoubtedly lay down as a fundamental principle that "coercion will diminish or increase as the moral treatment of the patient is more or less judicious;"[137]and therefore, although they did not anticipate that personal restraint would be superseded by any other mode of treatment, this principle is broad enough to embrace all that has since followed in the way of non-restraint. The result, in the long run, of honestly carrying out the doctrine to its legitimate consequences, will not very widely differ from that reached by those who adopt "non-restraint" as an abstract theory in the first instance.
Justice would scarcely be done to those who interested themselves in mental diseases during the latter half of the eighteenth and the commencement of the nineteenth century, if we did not give the titles of some of the works bearing on insanity which issued from the press during this period. A treatise on Madness was written in 1757 by Batty. Perfect wrote "Methods of Cure in some Particular Cases of Insanity" in 1778, and "Select Cases of Insanity" in 1787, and "Annals of Insanity" fourteen years later. Perfect's treatment of insanity mainly consisted in bleeding, setons, electricity, and the administration of emetics, digitalis, and antimony. Dr. T. Arnold published his "Observations on the Nature,etc., of Insanity," 1782. Harper published "A Treatise on the Real Cause and Cure of Insanity" in 1789—a work ridiculed by Pinel. Faulkner wrote his "Observations on the General and Improper Treatment of Insanity" in 1790; and Pargeter his "Observations on Maniacal Disorders" in 1792. What, if any, beneficial effect these works produced upon the condition of the insane in the British Isles, I am unable to say. Haslam wrote his "Observations on Madness" in 1798, and he was the author of several other works; but, whatever their value and interest, we know but too well the condition of the patients in the asylum of which he was the apothecary. Crichton published his "Inquiry into the Nature and Origin of Mental Derangement"—a work, certainly, of merit and the result of practical observation. In 1802 appeared "De intellectûs facultatum conditione in mentis Alienationis diversis generibus," by Campbell (Edinburgh). Cox published his "Practical Observations on Insanity" in 1804. (SeeAppendix B.)
Of Pinel, in relation to England, I must here say a few words.
TheEdinburgh Reviewof April, 1803, contains a review of Pinel's work, which deserves attention from the tone in which it is, for the most part, written. The Reviewer evidently thinks that England had very little to learn from France. The York Retreat had, indeed, been in active operation for some years, and the treatment pursued there might, no doubt, have borne comparison with that at the Bicêtre, but to speak of GreatBritain as a whole having a decided superiority over other countries in its moral treatment of maniacs was rather absurd. The Reviewer regards Pinel as the first author on the Continent who is fully sensible of the advantage of such moral treatment, and then observes, "To medical readers in this country many of our author's remarks will appear neither new nor profound, and to none will his work appear complete.... It may be considered as a sketch of what has already been done, with some notices of what the author intends to do; though he seems frequently to wonder, with a smile of self-approbation, at what he thinks his own discoveries." And again: "Dr. Pinel is desirous that France should have some claim to a judicious treatment of the disease of the mind, the honour of which has hitherto been exclusively confined to England."
It is curious to find the Reviewer observing that Dr. Pinel appears to display very little sagacity and precision in saying that in some cases the brain is not affected. And again: "He conceives that the result of the examination of the periods of life most subject to insanity is alone sufficient to show how seldom it is owing to any organic affection of the brain or the cranium. But in this opinion there is some inconsistency. For he soon after states that in thirty-six dissections he found nothing more remarkable than in the brain of apoplectic and epileptic patients, or of persons who died from furor or convulsions. Now, this is a confession that some deviations from the natural and healthy appearances were observed; and this is allthat is contended for, and all that the present limited state of our knowledge authorizes us to affirm." The Reviewer adds, no doubt with truth, "If no organic affections are said to have been discovered, in some few instances, we should not reason negatively from such dissections, perhaps cursorily and ignorantly made, and with instruments ill adapted to detect minute and apparently trivial deviations from the natural structure."
The following snarl is also noticeable:—"He informs us that he has studied with considerable attention the writings of Locke, Harris, Condillac, Smith, and Stewart; but the quotation of great names is not always the surest proof of an accurate acquaintance with their works, and we are inclined to think that there is some ground for doubt in the present instance."
The Reviewer is severe on Pinel's classification, which in the main has stood the test of all subsequent criticism to a remarkable degree. "It may," he says, "be entitled to the praise of ingenuity, but we doubt whether it is remarkable for its clearness and accuracy. Many of the distinctions seem absurd, and others not well founded. The several kinds of insanity are not distinct; they are only varieties of the same affection. All the symptoms mentioned under these five heads occur in the same patient. At different times he passes through all the gradations from furious phrenzy to complete fatuity." This criticism has, of course, great force as opposed to all symptomological classifications whatever, but not specially or mainly to Pinel's.
On the point whether madness can in certain cases becured, Pinel's utterances are dismissed with downright contempt: "Instead of any new light being thrown upon this important question, or any new rules of conduct pointed out, our author gives a minute detail of two cases, where any ancient female of ordinary capacity could have decided as well as himself, and relates with laboured minuteness the contrary opinions of some eminent physicians on a late memorable occasion in this country." Pinel an old woman! It will probably be new to most, if not all, of our readers that this illustrious man was regarded in this light by the leading Review of our country, when his writings first became known amongst us. The review ends, after crediting Pinel with some merit, and commending his work as containing some profitable instruction, with the exceedingly kind and patronizing observation that "we are therefore inclined to makean indulgent allowance(!) for the imperfect execution of many parts of Dr. Pinel's essay, and to entertain hopes of further information from his diligence and discernment" (!!).
Insular conceit could surely scarcely go further. However, the Edinburgh Reviewer is forgotten and his name unknown; Pinel's name covered with glory, although not a popular hero; for when I made a pilgrimage to his grave in the great Paris cemetery,Père la Chaise, in 1878, I was a solitary visitor, while crowds flocked to others, including that of Thiers, which is in close proximity to it. I am glad to see it announced that theSociété Médico-psychologiqueof Paris is about to erect—not too soon—a statue to his memory.
The bold proceeding, as it seemed in those days, of freeing the lunatics at the Bicêtre from their fetters, constitutes Pinel's title to honour—an honour of which no man will succeed in robbing him. He will be remembered when Dequin[138]is forgotten. Pinel, although his writings would have made him eminent as a physician had he never rendered his name illustrious in reference to the insane, did not, as a study of his life abundantly proves, liberate the patients at the Bicêtre from their chains in direct consequence of his medical knowledge of insanity, but mainly, if not entirely, from the compassion which he felt for their miserable condition. His knowledge, great before, was vastly increased after he had placed the patients in a more favourable state for medical observation; in fact, it is obvious that the opportunities of scientific research, and specially of observing the satisfactory progress of those labouring under the disease, were greatly augmented from the moment he introduced a humane system of treatment.
Had my sketch comprised France as well as England, I should have attempted to give a description of the work he performed in Paris. But I must not be tempted to go beyond my subject, and as a matter of fact the course of French and English reform in the treatment of the insane was entirely distinct and independent.[139]