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Lincoln And Hanwell Progress Of Reform In The Treatment Of The Insane From 1844 To The Present Time





Before presenting official evidence of the gradual progress in the
condition of the insane in England, we must interpose in our history a
brief reference to the development of what every one knows as the
non-restraint system of treating the insane. It is, no doubt, true that
restraint begins the moment a patient enters an asylum, under whatever
name it may be disguised, but by this term is technically meant the
non-use of mechanical restraint of the limbs by the strait waistcoat,
leg-locks, etc. If, as indeed it may be granted, it had its real origin
in the humane system of treatment introduced into England long
previously, it was in the first instance at Lincoln, and subsequently at
Hanwell, adopted as a universal method, and as a rule having almost the
sanctity of a vow.

The following table shows, in the clearest manner, by what gradual steps
the experiment was tried and carried on at the former asylum. Dr.
Charlesworth was the visiting physician and Mr. R. Gardiner Hill the
house surgeon.

------+--------+-------------+---------------+-----------------
Year. Total Total Total number Total number of
number number of instances hours under
in the restrained. of restraint. restraint.
house.
------+--------+-------------+---------------+-----------------
1829 72 39 1727 20,424
1830 92 54 2364 27,113-3/4
1831 70 40 1004 10,830
1832 81 55 1401 15,671-1/2
1833 87 44 1109 12,003-1/2
1834 109 45 647 6,597
1835 108 28 323 2,874
1836 115 12 39 334
1837 130 2 3 28
------+--------+-------------+---------------+-----------------

Here we observe that in 1829 more than half the number of the inmates
were subjected to mechanical restraint, while in 1836, out of 115
patients, only twelve were so confined, and in 1837 there were only two
out of 130.[178] The total disuse of mechanical restraints followed.
They were, however, resorted to on one or two occasions subsequently.

In connection with the foregoing, it must be mentioned that the entries
of the visitors and the reports of the physicians alike agree in
describing the condition of the patients as much improved, the quiet of
the house increased, and the number of accidents and suicides as
materially reduced in number.

It would appear that the mitigation of restraint, as evidenced by these
minutes (which commence with 1819), "was ever the principle," to use Mr.
Hill's own words, "pressed upon the attention of the Boards of the
Lincoln Asylum by its able and humane physician, Dr. Charlesworth, at
whose suggestion many of the more cruel instruments of restraint were
long since destroyed, very many valuable improvements and facilities
gradually adopted, and machinery set in motion which has led to the
unhoped-for result of actual abolition, under a firm determination to
work out the system to its utmost applicable limits." Mr. Hill became
house surgeon in 1835; and it will be seen, by the table already given,
that the amount of restraint (which, in consequence of Dr.
Charlesworth's exertions, had already remarkably decreased) became less
and less under the united efforts of these gentlemen, until the close of
the year 1837, when restraint was entirely abolished; and while, on the
one hand, as Mr. Hill frankly acknowledges, "to his [Dr. Charlesworth's]
steady support, under many difficulties, I owe chiefly the success which
has attended my plans and labours," while Dr. Charlesworth's great
merit, both before and after Mr. Hill's appointment, must never be
overlooked, it is due to the latter gentleman to admit that he was the
first to assert the principle of the entire abolition of mechanical
restraint, as is stated in the "Fourteenth Annual Report of the Lincoln
Asylum," which report is signed by Dr. Charlesworth himself.

For a time there were, certainly, some drawbacks to the success of the
Lincoln experiment, from the serious physical effects (such as broken
ribs, etc.), which occasionally resulted from the struggles between
attendants and patients; and it is probable that, had not the experiment
been carried out on a much larger scale at Hanwell by Dr. Conolly, with
far greater success, a reaction would have ensued, of infinite injury
to the cause of the insane.

Dr. Conolly went to Hanwell in 1839; and in the first of an admirable
series of reports written by him, we read, "The article of treatment in
which the resident physician has thought it expedient to depart the most
widely from the previous practice of the asylum, has been that which
relates to the personal coercion, or forcible restraint, of the
refractory patients.... By a list of restraints appended to this report,
it will be seen that the daily number in restraint was in July so
reduced, that there were sometimes only four, and never more than
fourteen, at one time [out of eight hundred]; but, since the middle of
August, there has not been one patient in restraint on the female side
of the house; and since September 21st, not one on either side.... For
patients who take off or destroy their clothes, strong dresses are
provided, secured round the waist by a leathern belt, fastened by a
small lock.... No form of waistcoat, no hand-straps, no leg-locks, nor
any contrivance confining the trunk or limbs or any of the muscles, is
now in use. The coercion-chairs (forty in number) have been altogether
removed from the walls.... Several patients formerly consigned to them,
silent and stupid, and sinking into fatuity, may now be seen cheerfully
moving about the walls or airing-courts; and there can be no question
that they have been happily set free from a thraldom, of which one
constant and lamentable consequence was the acquisition of uncleanly
habits."

In a later report (October, 1844) Dr. Conolly observes, "After five
years' experience, I have no hesitation in recording my opinion that,
with a well-constituted governing body, animated by philanthropy,
directed by intelligence, and acting by means of proper officers
(entrusted with a due degree of authority over attendants properly
selected, and capable of exercising an efficient superintendence over
the patients), there is no asylum in the world in which all mechanical
restraints may not be abolished, not only with perfect safety, but with
incalculable advantage."

Four years ago when I visited the Lancaster Asylum, I was shown a room
containing the dire instruments of coercion formerly in use, and a most
instructive exhibition it was. At my request the superintendent, Dr.
Cassidy, has kindly provided me with the following list of these
articles: 1 cap with straps; 4 stocks to prevent biting; 2 muzzles
(leather) to cover face and fasten at the back of the head; 10 leather
gloves, of various forms, perforated with holes, and cuffs of leather or
iron; 14 double ditto, with irons for wrists; 1 kicking shoe; 11 leather
muffs with straps; 4 stout arm leathers (long sleeves with closed ends)
with cross-belt and chains; 8 heavy body straps, with shoulder-pieces,
waist-belts, cross-belts, and pairs of handcuffs attached by short
chains; 5 ditto of somewhat different make; 30 ditto, but with leather
cuffs; 2 waist straps with leather cuffs attached; 9 pairs of leather
cuffs padded; 11 pairs of leg-locks; a quantity of foot and hand cuffs
(iron), with chains and catches to fasten to a staple in the wall or
bedstead; 21-1/2 pairs of padded leather handcuffs; a larger quantity
of handcuffs, single and double, of iron; 22 sets of strong body
fastenings, very heavy chains covered with leather and iron handcuffs; a
large quantity of broad leather straps; a bag of padlocks; keys for
handcuffs, etc.

Truly the iron must have entered into the soul of many a poor lunatic in
those days. Mr. Gaskell began at once to remove handcuffs, etc., on his
appointment as superintendent, February, 1840. The disuse of restraint
is chronicled in the annual report, dated June, 1841. He resigned,
January 16, 1849, to become a Commissioner in Lunacy.

The Metropolitan Commissioners in Lunacy, as we have seen in the
previous chapter, issued a Report which forms an epoch in the history of
the care and provision for the insane in England and Wales. It should be
stated that, previous to the date of its preparation in 1844, the
following asylums had been erected under the Acts 48 Geo. III., c. 96,
and 9 Geo. IV., c. 40.

------------------+--------------------------+-----------------
County. Town. Date of opening.
------------------+--------------------------+-----------------
Beds Bedford 1812
Chester Chester 1829
Cornwall Bodmin 1820
Dorset Forston, near Dorchester 1832
Gloucester Gloucester 1823
Kent Barming Heath, Maidstone 1833
Lancaster Lancaster Moor 1816
Leicester Leicester 1837
Middlesex Hanwell 1831
Norfolk Thorpe, near Norwich 1814
Nottingham Nottingham 1812
Stafford Stafford 1818
Suffolk Melton, near Woodbridge 1829
Surrey Springfield, Wandsworth 1841
York, West Riding Wakefield 1818
------------------+--------------------------+--