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 LUNACY: 
 
 1T8 PAST AND ITS PRESENT. 
 
 '^
 
 LUNACY: 
 
 ITS PAST AND ITS PRESENT. 
 
 BY 
 
 ROBERT GARDINER HILL, F.S.A., 
 
 Licentiate of the Royal College of Physicians, Edinburgh; Member of tlie Royal 
 
 College of Surgeons, England; Fdloio of the London Medical Society ; 
 
 Author of the Non-restraint System of Treatment in Lmiaq/; late Medical 
 
 Superintendent of the Lincoln Lunatic Asylum ; and late 
 
 one of the Visiting Justices of the Lincolnshire 
 
 County Lunatic Asylum, dc. 
 
 WITH 
 
 APPENDIX. 
 
 ' The evil that men do lives after them ; 
 The frood is oft interred with their bones." 
 
 LONDON: 
 LONGMANS, GREEN, HEADER, AND DYER. 
 
 1870.
 
 LONDON : 
 
 PRINTED BY C. W. REYNELL, LITTLE PULTENEY STREET, 
 
 HAVMARKET, W.
 
 WM 
 
 PREFACE. 
 
 THE writer of the following pages addresses 
 himself to those who think, but emphati- 
 cally to those whom the accidents of life have 
 familiarized with the painful phenomena of 
 mental alienation. If he does not profess to 
 furnish a scientific treatise on the subject, his 
 hesitation must be attributed to its right cause 
 — to the fact, in other words — that the so- called 
 science of psychology is still in its earliest 
 infancy, and that however great have been our 
 advances in all that is material in the world 
 around us, we are far removed from even pene- 
 trating the crust of that which is mental. 
 WhUst to man is given the faculty of plumbing 
 the depths of the ocean, and of bringing conti- 
 nents in proximity through the subtle agencies 
 of electricity, he is prostrated in any attempt to 
 analyse the recesses of thought. They are
 
 vi Preface. 
 
 amenable to no delicacy of instrument, and how- 
 ever much we may generalise, we ultimately 
 arrive at nothing beyond obscure and uncertain 
 guesses — their spirituality rebuking us at every 
 step we take. The writer, therefore, eschews such 
 debatable ground, and contents himself in the 
 humbler sphere of propounding the results of 
 a large and extensive practice that has given a 
 zest to the labours of the greater part of a life- 
 time. The experience so acquired he thinks 
 should be utihsed for the benefit of those who are 
 treading in his footsteps, and it is in this spirit 
 he ventures again to come before the public. 
 What insanity is would furnish speculation for 
 the materials of a lexicon. What the writer 
 aims at elucidating are some of those particular 
 forms of the disease falling under the head of 
 legal insanity, wherein the application of the 
 Lunacy Laws is brought into operation. Be- 
 yond such an arena he does not desire to travel ; 
 his starting point is a legal document framed in 
 accordance with the Act of Parliament, which 
 limits the freedom of one for the benefit of 
 many. 
 
 If we cannot be said to live in the maturity
 
 Preface. vli 
 
 of time, we can at any rate bring home to 
 our senses that we do not live in a non-pro- 
 gressive era, the magnificent strides in every de- 
 partment of research meeting us at every turn in 
 the journey of Hfe. In none has our progress 
 been more conspicuous than in the recognition 
 of our moral obligations, when we substituted a 
 law of kindness for the practice of cruelty in the 
 treatment of the insane. The conception of 
 abolishing all mechanical restraint ushered in the 
 dawn of a new day — its practical success is the 
 crowning of the edifice. 
 
 To have been an instrument in this great 
 achievement ought to satisfy the ambition of any 
 ordinary mortal, and so undoubtedly it would in 
 the present case had not some unjust and un- 
 generous criticisms lately appeared, the effect of 
 which was not only to deprive the author of his 
 laurels in the long-sustained fight, not only to 
 discredit the institution of which he was the re- 
 presentative, but actually to pervert the current 
 facts of history. Under such circumstances 
 silence would have been culpable. He is neces- 
 sarily obliged, therefore, to assume the part of the 
 historian by placing before the public the grava-
 
 viii Preface. 
 
 mina of the case, with all the materials of dates 
 and figures, as they appear in the records of that 
 institution — everything that can enable them to 
 form a just judgment as to whom the palm of 
 merit should be awarded. The details may ap- 
 peal* to be disproportionally tedious, but as they 
 are essential to the clearing up of the controversy, 
 the reader is requested to extend his indulgence 
 by kindly remembering that the stake at issue 
 is whether others shall be permitted to share 
 in the triumph which he emphatically proclaims 
 is /iw, and Ms alone. " Divide et impera " may 
 be a safe political maxim, but it is no rule in his 
 code ; he would rather exclaim on such a vital 
 and historical point, *' Aut Caesar, aut nullus." 
 
 Earl's Court House, 
 
 Old Brompton, S.W., 
 
 Janvuary 3, 1870.
 
 LUNACY: 
 
 ITS PAST AND ITS PRESENT. 
 
 IN the early part of the present century, 
 lunatics were kept constantly chained to 
 walls in dark cells, and had nothing to he upon 
 but straw. Some were chained in dungeons, and 
 were gagged, outraged and abused. The keepers 
 visited them whip in hand, and lashed them 
 into obedience ; they were also half-drowned 
 in baths of surprise, and in some cases semi- 
 strangulation was resorted to as a means of neces- 
 sity or the result of accident. The bath of surprise 
 was so constructed that the patients, in passing 
 over a trap-door, fell in ; some patients were 
 chained in wells, and the water made to rise 
 until it reached the patient's chin. One hor- 
 rible contrivance was a rotatory chair, in which 
 patients were made to sit, and were revolved at a 
 frightful speed. The chair was in common 
 use. Patients in a state of nudity, women as 
 well as men, were flogged at particular periods, 
 
 B
 
 2 Lunacy ; its Past and its Present. 
 
 chained, strapped and fastened to iron bars, and 
 even confined in iron cages. At Inverness, 
 between the second and third arches of the old 
 bridge, built in 1685, there is a dismal vault, 
 used first as a jail and afterwards as a mad- 
 house, the air-hole or grating of which is still 
 exhibited. This appalling place of durance, 
 where the inmates were between the constant 
 hoarse sound of the stream beneath, and the 
 occasional trampling of feet and rattling of 
 wheels overhead, existed so late as 55 years 
 ago, and is said not to have been abandoned till 
 its last miserable inmate, a maniac, had been 
 devoured by rats. 
 
 One of the most notable instances of mecha- 
 nical restraint on record is that of the man 
 Norris at Bethlem Hospital, who, for striking 
 the apothecary, was encaged and kept in irons 
 for twelve years. The nature of the restraint 
 was such that he could not stand upright. The 
 restraint is thus described : — 
 
 "A stout iron ring was riveted round his 
 neck, from which a short chain passed to a ring 
 made to slide upwards or downwards on an up- 
 right massive iron bar, more than six feet high, 
 inserted into the wall. Round his body a strong 
 iron bar, about two inches wide, was riveted ; 
 on each side the bar was a cii'cular projection, 
 which, being fastened to and enclosing each of 
 the arms, pinioned them close to his sides ! 
 The waist-bar was secured by two similar bars, 
 which, passing over his shoulders, were riveted
 
 Lunacy ; its Past and its Present. 3 
 
 to the waist-bar, both before and behind. The 
 iron ring round his neck was connected to his 
 shoulders by a double link. From each of these 
 bars another chain passed to the ring on the 
 upright iron bar. His right leg was chained to 
 the trough." This, be it remembered, was in 
 the year 1815. 
 
 The atrocities committed at the York Asylum 
 are almost too horrible to be believed. " A 
 man who had been sent to the York Asylum, 
 apparently in health, was returned in a state, 
 weak and emaciated ; he could with difficulty 
 support himself, having mortification in one of 
 his legs, being filthy, having the itch very bad, 
 and his body covered with bruises and marks, 
 which could be attributed to nothing but the 
 lash of a whip." " A female patient declared 
 that she had been flogged." " Another woman 
 came home with marks of wounds upon her 
 head, and her hip dislocated — she was dirty 
 and in rags, and swarming with vermin." " A 
 clergyman, w^ho had been inhumanly kicked 
 down-stairs, was swarming with vermin." " The 
 cells were in a state dreadful beyond descrip- 
 tion; some miserable bedding was lying on 
 straw, which was daubed and wet with excre- 
 ment and urine: the boarded floors perfectly 
 saturated with filth ; the walls also besmeared 
 with excrement ; the round air-holes, about 
 eight inches in diameter, partly filled with it — 
 the stench intolerable." Another patient, also 
 at York, was found in the washhouse, standing 
 B 2
 
 4 Lunacy ; its Past and its Present. 
 
 on a stone floor, apparently in the last stage of 
 decay ; he was a mere skeleton, his thighs 
 were covered with excrement in a dry state, 
 and those parts which were not so, appeared 
 excoriated, as did also some parts of his waist." 
 In those days " patients were starved for want 
 of food," and the irons with which they were 
 fastened were allowed to remain until they had 
 eaten into the flesh, causing large sores and 
 abscesses, and sometimes mortification. Patients 
 were found chained to stone floors, wallowing in 
 their own excrement and filth. There are many 
 instances on record of the female patients being 
 with child by the keepers and male patients. 
 The atrocities at the York Asylum became so 
 notorious that an inquiry was instituted. 
 Scarcely had the inquiry terminated when the 
 wing of the asylum which contained the worst 
 cases, was purposely set on fire, and several of 
 the patients burnt to death. The statistics of 
 the asylum were found to be falsified; 221 
 patients w^ere advertised as dead, whereas the 
 number ought to have been 365. 
 
 The Parliamentary Inquiry of 1815 brought 
 out numerous instances of very gross cruelty. 
 
 The Retreat at York was, I beheve, the only 
 establishment in which the condition of the 
 Lunatic was amehorated ; it was an Asylum for 
 a peculiar sect of Christians, was founded by 
 Mr Tuke, and was under humane, liberal, and 
 benevolent management.
 
 Lunacy ; its Fast and its Present. 5 
 
 I will now proceed to describe the condition of 
 the Lunatic, and the state of our public and private 
 Asylums immediately prior to the introduction of 
 the non-restraint system at Lincoln, and during 
 the period the system was upon its trial. I 
 think it will be admitted that the treatment of 
 Lunacy was not greatly advanced, and that 
 reform was very urgently needed. As late as 
 1844 patients were very much neglected, and in 
 many instances as brutally treated as before the 
 Parhamentary Inquiry of 1815. 
 
 Shortly after my connection with the Lincoln 
 Asylum, I visited several large asylums — Beth- 
 lem, St Luke's, Hanwell, Leicester, Nottingham, 
 Glasgow, York County, and the Retreat, Wake- 
 field, Exeter, Bodmin, the Bethel Asylum at 
 Norwich, &c. At all these places, except at the 
 Retreat near York, restraint was extensively em- 
 ployed ; at Hanwell I saw patients strapped down 
 to their bedsteads in complete sets of harness. 
 At Bethlem all kinds of instrum.ents were in use, 
 and some of the patients were chained (tethered 
 like beasts) to the seats in the airing courts. 
 Some foreigners appeared to be fastened behind 
 iron gates or in cages — jabbering and making an 
 unearthly noise. Many of the patients were very 
 ferocious, the hubbub and noise being almost 
 deafening. At St Luke's Hospital the same 
 state of things existed. At that asylum I was 
 shown a bath of surprise. At Leicester and 
 many other asylums 1 found patients in a semi- 
 nude state sitting upon and fastened by straps to
 
 6 Lunacy ; its Past and its Present. 
 
 ponderous arm-chairs, which answered the double 
 purpose of seats and commodes. These seats 
 were placed upon inclined planes, so that the ex- 
 crement might more readily pass away. Some 
 friends who accompanied me over the Leicester 
 Asylum were seized with faintness, and had to 
 make a precipitate retreat. The odour was most 
 offensive. 
 
 At Glasgow the patients were mostly without 
 shoes and stockings. There also restraint was 
 the rule. Several of the patients were strapped 
 down on straw beds. 
 
 One of the most disgusting places I visited 
 was an asylum near Lichfield, the master of 
 which boasted of having the patronage of the 
 authorities at Lichfield and neighbouring parishes. 
 The house was in a state of filth, and the build- 
 ings generally unfit for occupation. The patients 
 were barely clothed, fastened and manacled as 
 was usual at that time. Bethel House at Nor- 
 wich was in a similar condition. 
 
 At a private asylum in Kent it was a constant 
 practice to restrain the patients ; some of them 
 by spring body-belts and handcuffs, others by 
 iron leg hobbles, and some were fastened to 
 staples fixed in the floor. Other patients, in 
 addition to the iron belt, had gloves attached to 
 straps, by which the hands were fastened to the 
 sides. Some of the patients when in bed w^ere 
 also secured by leg-hobbles, which were strapped 
 to the bedstead. Ladies were fastened to their 
 bedsteads by means of iion k^g-locks. The pro-
 
 Lunacy ; its Past and its Present. 7 
 
 prietor of this asylum was afterwards prosecuted 
 for making false entries in the Medical Visitation 
 Book. 
 
 At some of the asylums when patients had 
 become filthy in their habits from being mana- 
 cled at night, it was customary to take them 
 from their beds to an out-house to be washed. 
 This was sometimes done by means of a mop 
 and some cold water out of a common bucket. 
 At an asylum in Lincolnshire I was shown a 
 small yard paved with sharp- pointed coggles, in 
 which dirty patients were taken naked at all 
 seasons to be mopped. This process took place 
 in a small shed in one corner of the yard, where 
 there was a wooden apparatus for wTinging. 
 
 This method of washing patients was, I fear, 
 frequently practised. I saw it done at Lincoln 
 only a few days after being installed in office. 
 I had risen very early, and was looking out of an 
 upper window, when I noticed a male patient 
 walk out of the disorderly patients' gallery into 
 the open yard and there mopped, '"'secundum 
 artemr Of course the practice was at once 
 put a stop to. Here is a case in point. "At a 
 coroner's inquisition, held on the body of a 
 pauper lunatic at Southampton it was stated by 
 two witnesses that the patient was washed in a 
 very indecent manner. She was stripped naked, 
 and scrubbed with a broom in the open yard. 
 It might be for half-an-hour — she was naked all 
 the time — she had been struck with a heavy 
 crutch stick, and was frequently beaten by the
 
 8 Lunacy ; its Past and its Present. 
 
 nurses, and sometimes even when she was naked. 
 The instrument used was a knotted stick of the 
 thickness of witness's finger. Water was after- 
 wards thrown upon the patient, and she was 
 then driven into the straw-house, which seems 
 to have been a receptacle for the most 
 outrageous of patients." 
 
 In 1842 (December) Carisbrooke Asylum, at 
 Newport, Isle of Wight, was described in " The 
 Times " as the most unmitigated remnant of 
 the old system then existing. " It is a narrow 
 parallelogram, about 60 feet long and 30 broad, 
 divided at the centre into two compartments for 
 males and females. The court-yards are paved, 
 and the sleeping cells open into them upon the 
 principle of dog-kennels. In each department 
 there is a room called the settle-room, containing 
 from six to eight strong chairs with handcuffs 
 and leg-locks (whose brightness shows their 
 frequent use) attached to them, and also a small 
 dismal day-room. There is not, and there can- 
 not be, either amusement or occupation, and the 
 only object in nature which gladdens the sight of 
 the unfortunate inmates is the noonday sun as it 
 passes over their prison. In this horrible place 
 there is, or recently was, a male patient confined, 
 who for upwards of ten years had been pinioned 
 like a felon before execution, his hands being 
 tightly handcuffed across his chest, and his 
 elbows fastened by leathern thongs across his 
 back, whilst his ankles were chained together so 
 that he could scarcely shuffle forwards; and
 
 Lunacy ; its Past and its Present. g 
 
 there were also, when I saw the place, in addi- 
 tion to the settle-chairs, two yoimg females lying 
 on their backs, fastened to their beds ; their arms, 
 which were black with bruises, passed through 
 iron rings affixed to the bed-frames, and their 
 wrists handcuffed across their bodies like figures 
 on an ancient monument." 
 
 The following anecdotes are of an indisput- 
 able nature, derived from the inspection of a 
 private licensed Asylum in Devonshire, in the 
 year 1837 :— 
 
 Who is that helpless paralytic female, stretched 
 on her rude bed of straw, " cribbed^ cabined, and 
 confined" in yonder dark recess, that almost seems 
 to begrudge the tiny space allotted to this miser- 
 able remnant of humanity ? Whence those 
 several apertures in the walls of her dismal cell ? 
 She speaks, and this is the burden of her story : 
 that she can obtain neither sleep by night nor 
 rest by day, that vermin (rats) approach her so 
 as to compel her to drive them away with her 
 hand, which they often succeed in injuring ; that 
 her complaints are unheeded, and that she is 
 miserable. And w'hat pity does she obtain from 
 her inhuman janitor? He rebuked her for a 
 falsehood, and seriously asked the eye-witnesses 
 if a mad woman was worthy of credit, and this, 
 too, in the very teeth of the evidence which the 
 apertures afforded of the poor woman's veracity. 
 At last, finding himself hardly pressed, he ad- 
 mitted that he was unable to keep them away ! ! 
 Here was the case of a helpless lunatic, sent to a
 
 lO Lunacy ; its Past and its Present. 
 
 legally licensed private establishment, maintained 
 there by wages wrung from the produce of the 
 industrious, and who was thus — treated shall we 
 call it ? — aye, rather say shamefully neglected and 
 slowly destroyed. 
 
 But yonder cell exhibits what is more revolt- 
 ing still — a maniac in Nature's state of nudity, 
 chained down and confined, like a dog in a 
 kennel, in a large open puncheon, partially filled 
 with straw, which the wretched being, during 
 the intervals of almost ceaseless, unintelligible 
 raving, is reducing to the smallest fragments. 
 The scene is almost too great for humanity to 
 contemplate with composure — the spectator is 
 as firmly riveted to the spot as is the semi- 
 human object whom he went there to visit. 
 Not so impressed, however, was he whose special 
 and natural duty it was to provide the necessaries 
 to cover his nakedness, and to administer the 
 comforts of existence. With an apathy and 
 grossness which nothing but familiarity could 
 create, this unfeeling individual was contented 
 with the explanation that it was useless to provide 
 clothing for one who, as soon as it was furnished, 
 would proceed to destroy it ! This sad case had 
 not even the mask of pauperism to sustain it ; 
 the relatives were both respectable and inde- 
 pendent, and great would have been their morti- 
 fication if they could have conjectured such a 
 discipline for him. 
 
 One more illustration will close this sad 
 catalogue of wrongs inflicted in this terrible
 
 Lunacy ; its Past and its Present. 1 1 
 
 pandemonium : — Wandering into an adjacent 
 court-yard, rendered somewhat more attractive 
 with the view of captivating the unwary friends 
 of the patients, the visitor is pleased to see that 
 if the walls are high, the space is cultivated and 
 adequate for exercising purposes — in other words, 
 this was the show-place. Here was a veteran, 
 one of the hardiest of the sons of Neptune — a 
 tall, well-made muscular subject : he was in the 
 full possession of his liberty, at least as far as the 
 four corners of the yard would admit of it. He 
 was the most orderly and rational of the inmates. 
 Was his lot as happy as his residence in such an 
 institution could render it ? Listen, and he will 
 tell you that he is starved: the whole of his 
 grievances are summed up in one dreadful and 
 comprehensive word — Starvation ! Suiting the 
 action to the word, he doffs his blue jacket, and, 
 baring his arm, exclaims, Feel that. It was not 
 the quahty of the food that made him murmur, 
 but it was that at the termination of a meal he 
 was as keen set as when he sat down. The 
 result of this complaint elicited the extraordinary 
 fact that the diet was regulated by a scale derived 
 from one of the Poor Law Union establishments. 
 Here, then, for once, was a system extensively 
 acted upon, avowed, and maintained, that what 
 was deemed adequate for an able-bodied pauper 
 should be the measure of allowance for an active 
 and healthy lunatic — in other words, that to the 
 victim of mental alienation should be doled out
 
 1 2 Lunacy ; its Past and its Present. 
 
 the same amount of food as sliould be given to 
 the idle tramp of the workhouse. 
 
 Here are some instances of restraint as re- 
 ported by the Commissioners in Lunacy in 
 1844:— 
 
 West Auckland Asylum, — " In a small, 
 cheerless day room, with only one nnglazed 
 window, five men were restrained by leg-locks, 
 called hobbles, and two were wearing in addition 
 iron handcuffs and fetters from the wrist to the 
 ankle. One powerful young man, who had 
 broken his fetters, was heavily ironed ; and 
 another was leg-locked and handcuffed, who was 
 under medical treatment and in a weak state. 
 One woman was leg-locked by day, and chained 
 to her bed at night. Chains were fastened to 
 the floors in many places, and to many of the 
 bedsteads. The males throughout the house 
 slept two in a bed." 
 
 Plympton Asylum, Devonshire. — "Ten per- 
 sons were found under restraint. One of them 
 had been restrained for two months merely for 
 breaking windows. In a day-room, in a state of 
 furious mania, was a young woman, who had 
 been delivered of a child five or six weeks pre- 
 viously, confined by a strait-waistcoat and chained 
 by the arm and leg to a bench. Another woman 
 in this ward, in a strait-waistcoat, was lying in a 
 hole in the middle of the airing court, without 
 covering to her head, or anything to shelter her 
 from the broiling sun. Ten curable patients 
 and two idiots were under the charge of a
 
 Lunacy ; its Past and its Present. 1 3 
 
 lunatic, who was himself confined by a chain 
 from the wrist to the ankle." At another visit 
 to this house, October 2, 1843, " three women 
 were found chained by their legs to the benches. 
 One of them, mentioned in the previous report, 
 had, besides the chain to her leg, another chain 
 passing round her w'aist, to which were fixed, by 
 an iron ring, two hand -locks, in which both her 
 hands were confined. Besides this restraint, 
 there were twenty-one patients who were chained 
 to their beds at night." 
 
 The state of the Plympton Asylum is thus 
 described by the Commissioners : — Extracts from 
 Report. — "One room, in which seventeen patients 
 lived during the day, measured only sixteen feet 
 six inches by twelve feet. There was no table 
 in it, and there was sitting-room for no more 
 than ten patients. Several of the bed-rooms 
 w^ere cheerless and wet, from the damp or rain, 
 and the walls were besmeared with filth. Close 
 to some small crib -rooms, in which some girls 
 (violent patients) slept, there w-as a bed-room 
 for a male patient, who, it appeared, had access 
 to the room in which the girls slept." 
 
 " The day -room of this ward was extremely 
 small, with an unglazed window, and no table. 
 A series of sleeping cells for dirty patients, 
 connected with this ward, were dark, damp, and 
 offensive ; they were occupied at night by four 
 males, two in one cell, and two in single cells. 
 The dirty male paupers slept in a room, for- 
 merly the dairy, in which were six beds ; it was
 
 14 Lunacy ; its Past and its Present. 
 
 damp, ill- ventilated, and offensive. There was 
 only one small window, unglazed, which was 
 closed with a shutter at night. There were 
 chains and wrist-locks attached to nine of the 
 beds on the male side, which were constantly 
 used at night, partly to prevent violence, and 
 partly to guard against escape. Four of the 
 female paupers, represented to be subject to 
 violent paroxysms after epilepsy, were ordinarily 
 confined to their beds by chains and wrist- 
 locks." 
 
 " The three sleeping rooms in the women's 
 cottage could not, in the judgment of the Com- 
 missioners, have been cleaned for some days; 
 the wooden cribs were filthy, the floor was in 
 holes, and soaked with urine, and in parts 
 covered with straw and excrement. We can 
 give no other general description of it than that 
 it was most disgusting and offensive." 
 
 " In one of the cells in the upper court for 
 the women, the dimensions of which were eight 
 feet by four, and in which there was no table, 
 and only two wooden seats, fastened to the wall, 
 we found three females confined. There was 
 no glazing in the window, and the floor of this 
 place was perfectly wet with urine. The two 
 dark cells, which adjoin the cell used for a day- 
 room, are the sleeping-places for these three 
 unfortunate beings. Two of them sleep in two 
 cribs in one cell. The floor of the cell in which 
 the two cribs were was actually reeking wet 
 with urine, and covered with straw and filth, and
 
 Lunacy ; its Past and its Present. 1 5 
 
 one crib had a piece of old carpet by way of 
 bedding, besides the straw, but the other ap- 
 peared to have had nothing but straw without any 
 other bedding. In the other cell, the patient 
 who slept in it had broken the crib to pieces, 
 and a part of it was remaining in the cell, but 
 the straw was heaped up in one corner, and as 
 far as we could rely upon what was said, she 
 had slept upon the straw, upon the ground, at 
 least one night. The straw itself was most 
 filthy, the floor was perfectly wet with urine, 
 and part of the straw had been stuck to the wall 
 in patches with excrement. It must be added 
 that these two cells, and one other adjoining it, 
 have no window, and no place for light or air, 
 except a grate over the doors, which open into a 
 passage. The persons of these three unfortunate 
 women were extremely dirty, and the condition 
 in which we found them and their cells, was 
 truly sickening and shocking. Adjoining to the 
 two sleeping-cells of these women, and opening 
 into the same passage, was a third cell which 
 was occupied as a sleeping- place by a male 
 criminal of verv dangerous habits, and an idiotic 
 boy." 
 
 "This cell was dirty and offensive, and the 
 floor of it wet with urine, but it was not in so 
 filthy a state as the other two. The criminal 
 was fastened at night to his bed with a chain. 
 We strongly objected to these men being con- 
 fined in a cell closely adjoining to the females. 
 The whole of these cells were as damp and as
 
 i6 Lunacy ; its Past and its Present. 
 
 dark as an underground cellar, and were in such 
 a foul and disgusting state that it was scarcely 
 possible to endure the offensive smell. We sent 
 for a candle and lantern to enable us to examine 
 them." 
 
 Passing from these private abodes of misery, 
 let us glance once more at the state of the 
 lunatics in our great public establishments. The 
 survey only tends to show that whether in or 
 out of an asylum, the lunatic appears to be 
 hardly recognised as belonging to the great 
 family of man. In proof of this take Mr 
 Gilbert's Commissioners' Poor Law Report 
 for 1831. " At Bideford, two lunatics, a male 
 and a female, are confined in dens exactly like 
 those used for wild beasts, and equally offensive. 
 These I had immediately released. The female 
 was sent to an asylum, and is expected to re- 
 cover. The male is now at work in the house, 
 quite sensible of the benefit conferred on him by 
 the change." 
 
 " At Tiverton there was a female lunatic who 
 had been 28 years in the workhouse ; she was 
 confined in a small room, having neither furni- 
 ture, fire-place, nor bed ; there was nothing in 
 the room but a bundle of straw ; she was with- 
 out a single piece of clothing, perfectly nakecl^ 
 and had been confined in that state, during 
 winter and summer, for 28 years." 
 
 A physician, in visiting the Wakefield Asy- 
 lum about the year 1838, found from seven 
 to nine male patients strapped down in bed in
 
 Lunacy ; its Past and its Present. 17 
 
 strait-waistcoats. The reason assigned for such 
 treatment was that they could not in any other 
 way be prevented from tearing their clothes. 
 Another patient was in the habit of spitting at 
 persons who approached him, and for that offence 
 was strapped to the bedstead. At the same 
 asylum seven of the female patients were found 
 seated in restraint chairs, the wrists of each being 
 fastened to the arms of the apparatus. 
 
 The superintendent of the Wakefield County 
 Asylum was greatly offended when a more 
 humane system of treatment was proposed, and 
 some time after, in consequence of a report having 
 got into circulation that some of his patients were 
 strapped to their bedsteads for tearing their 
 clothes, he came forward, supported by the visit- 
 ing justices, to vindicate the system as then 
 practised. These gentlemen had a number of 
 questions put to their medical officers, and these 
 interrogatories and the answers were published 
 and circulated throughout the county of York. 
 The questions and answers were signed by 
 four medical men — viz., two physicians and two 
 surgeons, and were as follow : — 
 
 " Q. Is it your opinion that restraint can be 
 dispensed with in all cases of high maniacal ex- 
 citement ? 
 
 " A. Decidedly not. 
 
 " Q. Does restraint in any cases tend to pro- 
 mote recovery when judiciously applied, and may 
 it be considered a remedial measure in the cure 
 of insanity ? 
 C
 
 1 8 Lunacy ; its Past and its Present. 
 
 "J.. Certainly. 
 
 " Q. Are the instruments of restraint used in 
 this institution of the most approved kind, or are 
 there any others which in your opinion could be 
 used in preference ? 
 
 " ^. I do not think any improvement can be 
 made in the instruments of restraint. 
 
 " ^. Do you ever remember any patients 
 being confined in strait-waistcoats for tearing 
 their clothes ? 
 
 "^ A. It is necessary that some patients should 
 be put under restraint who are addicted to cer- 
 tain outrages, but we never remember any in- 
 stance of a patient being fastened in bed for 
 merely tearing his clothes. 
 
 " Q. Were there ever seven or any other 
 number of female patients fastened by their 
 wrists in arm-chairs ? 
 
 "^. We have seen some patients in arm- 
 chairs ; there is a bar across the chairs, and a 
 slight strap or belt round the patients, fixed to 
 the back of the chair to keep them in. We have 
 seldom known more than four patients in chairs, 
 and less than four lately. We think the above 
 system of restraint is much milder than per- 
 sonal coercion on the part of the keepers, and in 
 certain cases ought not to be dispensed with." 
 
 The restraint chair which is here described 
 by the medical officers of the Wakefield Asylum 
 as a mild form of restraint, is well known to 
 have been productive of the worst consequences 
 to the patient. The occupant of course became
 
 Lunacy ; its Past and its Present. 1 9 
 
 helpless, contracted filthy and disgusting habits, 
 and soon lapsed into imbecility, and in many 
 instances exhaustion and death were the con- 
 sequences. 
 
 It was customary in the early days of non- 
 restraint for the supporters of the opposite 
 system to describe all restraint as then existing 
 as mild restraint. Mr Serjeant Adams, at a 
 meeting of Middlesex magistrates (October 29, 
 1840), in detailing some instances, stated that 
 within the last fourteen days he had seen a man 
 in an Asylum in heavy manacles. Within the 
 last month, in another Asylum, he had seen 
 three young women who were bound fast down 
 to their beds with their hands passed through 
 rings, so that they were utterly incapable of 
 moving ; and yet such treatment was called 
 mild restraint. He had seen, too, a man who 
 was manacled by the legs so tightly as only to 
 be able to shuffle along the floor, in which state 
 he had been for no fewer than ten years. The 
 arms of the young women were black and blue 
 from the chains which had been placed around 
 and upon them. He had seen at the Maidstone 
 County Asylum, said to be an Asylum in which 
 the system of mild restraint was practised, two 
 men who had been chained to their beds for 
 four years and a half. In the same Asylum he 
 saw a female fastened into what was termed a 
 coercive chair, with a large cuirass of thick 
 leather so tightly compressing her body that it 
 creaked upon the slightest motion. Her hands 
 c 2
 
 20 Lunacy ; its Past and its Present. 
 
 were pinioned before her. There were also 
 twenty or thirty others in different sorts of 
 manacles for reputed acts of nnischief. 
 
 The following account of the state and con- 
 dition of the inmates of the Lancaster Asylum 
 is extracted from Mr. Gaskell's Report of that 
 Asylum for 1841 : — 
 
 " From the opening of this Asylum, in the 
 year 1816, mechanical restraint appears to have 
 been extensively employed ; and at the time 
 your officers took charge they found twenty- 
 nine persons wearing either handcuffs, leg-locks, 
 or strait-waistcoats, exclusive of between thirty 
 and forty patients who were chained down 
 during the day-time on seats so constructed 
 as to answer all the purposes of water-closets, 
 in rooms known by the appellation of ' the 
 warm rooms;' moreover, during the night-time, 
 all the epileptic and violent patients were chained 
 or otherwise secured in bed. It was also an 
 established custom to place every case on admis- 
 sion under restraint during the night-time, for a 
 longer or a shorter period, as might appear most 
 expedient. Before proceeding any further, it 
 may be advisable, more especially as some 
 erroneous statements have already appeared 
 about these ' warm rooms,' to give a general 
 idea of their construction and situation. They 
 are two in number, one for the females and the 
 other for the males, situated in the centre of the 
 building in juxtaposition, and obtain their de- 
 signation from the circumstance of the floors,
 
 Lunacy ; its Past and its Present. 1 1 
 
 which are of stone, being heated by flues. 
 They are thirty-four feet long by eighteen 
 broad, and fourteen feet high, and although 
 they are dark and gloomy in appearance, they 
 are tolerably well ventilated. Along the inner 
 wall of these rooms were placed fourteen stalls 
 or boxed seats, answering the double purpose, 
 as stated above, of seats and water-closets ; and, 
 at the end of each room, three similar seats, not 
 answering the purpose of water-closets, were 
 affixed. Idiotic and violent patients, and those 
 of filthy habits, were chained in these seats 
 from early in the morning until bed-time. 
 The men were clothed in a short petticoat ; 
 and, owing to the floor being warmed, neither 
 the men nor women were usually allowed, shoes 
 or stockings. A long leaden trough, imme- 
 diately below these seats and communicating 
 with a common drain or sewer, was repeatedly 
 washed out during the day by turning on a tap 
 of water at the upper part." 
 
 Upwards of two hundred patients at the 
 Lancaster Asylum slept upon straw. 
 
 At the Bedford Asylum, since disused, the 
 rooms were furnished with iron rods, which 
 were fixed to the walls. To these rods the 
 violent patients were chained, and by means of 
 a sliding ring could walk backwards and for- 
 wards to the extent of the rod, but no further. 
 The early reports of the Northampton Asylum 
 contain some horrible details of patients who were 
 removed from Bedford Asylum to Northampton.
 
 22 Lunacy ; its Past and its Present. 
 
 Here we have a case of home treatment. In 
 May, 1840, a male patient, with extensive swell- 
 ing of both arms from the use of the strait- 
 waistcoat and straps, was admitted into the 
 Lincoln Asylum. The left arm was four times 
 its original size. There was emphysema, ex- 
 tensive destruction of the skin, and complete 
 loss of sensation. The man was in a very 
 critical state. Ten days after there was still 
 considerable swelling and emphysema, and 
 several superficial sloughs. There was also 
 inflammation of the membrane of the bone 
 where the strap went round the arm. It was 
 the opinion of the surgeon in attendance that if 
 the pressure had been made a short time longer, 
 he would have lost the use of his arm, as the 
 circulation was intercepted and the artery com- 
 pressed. 
 
 Thus, then, under whatever aspect we view 
 the condition of the lunatic thirty years since — 
 whether in or out of an asylum — we find him 
 doomed to neglect, privation, and cruelty. 
 
 I shall now proceed to describe the state of 
 the Lincoln Asylum, the birth-place of non- 
 restraint : — 
 
 The Lincoln Asylum was opened, March, 
 1820. For nine years the instruments of 
 restraint were unfortunately under the control 
 of the inferior keepers. During that period 
 there is the strongest evidence to show that the 
 patients were terribly neglected. No record
 
 Lunacy ; its Past and its Present. 23 
 
 was kept of the several instances of restraint. 
 While the patients were undergoing the torture 
 of the iron handcuff, the keepers were enjoying 
 themselves ; " they were guttling and guzzhng 
 all day long, eating five meals a-day, and getting 
 drunk," and the result was that the superin- 
 tendent had frequently to put the keepers into 
 strait- waistcoats themselves. This was stated 
 as a fact by the then superintendent. During 
 this period a patient was found strangled in a 
 strait-waistcoat, but it was never satisfactorily 
 made out whether he committed suicide, or 
 whether he was strangled by the keepers or by 
 the visitation of God. There is no mention of 
 the case in the Annual Report. The discovery 
 of marks of strangulation on his throat by Dr 
 Cookson, one of the visiting physicians of the 
 asylum, led to an order being made by the 
 Board that the use of the strait-waistcoat be 
 interdicted, except under special circumstances. 
 
 The period I shall now notice is that between 
 March, 1829, and the time of my appointment 
 as medical superinteiident (house-surgeon), July, 
 1835. A daily record was from that time kept 
 of every instance of mechanical restraint. Dur- 
 ing that period there were three changes in the 
 ofBce of medical superintendent. These persons 
 were all advocates of the restraint system. The 
 first used restraint indiscriminately, the second 
 very largely, the latter said it could not be 
 dispensed with, and hinted, in a local paper, 
 that if dispensed with, " surreptitious flagella-
 
 24 Lunacy ; its Past and its Present. 
 
 tion" must have been substituted for it. The 
 amount of restraint increased under this gentle- 
 man's superintendence. My immediate pre- 
 decessor in office declared himself strongly in 
 favour of restraint. In a letter to the ' Lancet ' 
 he stated that " restraint forms the very basis 
 and principle on which the sound treatment of 
 lunatics is founded. The judicious and appro- 
 priate adaptation of the various modifications 
 of this powerful means to the peculiarities of 
 each case of insanity, comprises a large portion 
 of the curative regimen of the scientific and 
 rational practitioner ; in his hands it is a reme- 
 dial measure of the very first importance, and 
 it appears to me that it is about as likely to be 
 dispensed with, in the cure of mental diseases, 
 as that the various articles of the Materia 
 Medica will be altogether dispensed with in the 
 cure of the bodily," He further stated, that 
 " j\Lr HilVs curious and heterodox opinion 
 that restraint is never necessary, never justifiable, 
 but always injurious in all cases of lunacy what- 
 ever, is more remarkable for its rashness even 
 than its boldness " 
 
 Up to July, 1835, there had been seven cases 
 of suicide besides the case mentioned as having 
 been strangled in a strait- waistcoat. One of 
 these suicides used the belt with which she had 
 been restrained, to hang herself. The use of 
 the belt was not interdicted by the Board, as 
 in the case of the strait-waistcoat, although it 
 must have been patent to every governor that
 
 Lunacy ; its Past and its Present. 2^ 
 
 the one instrument was equally as mischievous 
 as the other. 
 
 Of the deaths prior to 1829, as connected 
 with or affected by restraint, I am unable to 
 speak, but from March, 1829, to July, 1835, 
 there were seventeen patients who from violence 
 or maniacal excitement were subjected to re- 
 straint of a most frightful kind and to an 
 excessive degree. Each patient averaged 135 
 days and nights of restraint, and while under 
 restraint had to sleep upon straw and in his 
 own ordure. The result was that only two of 
 these patients recovered, whilst ten died, three 
 committed suicide, one escaped, and one was 
 removed by friends. 
 
 The following particulars are extracted fi'om 
 the Case Book, and will illustrate the condition 
 of the lunatic, at the Lincoln Asylum, a short 
 time prior to, and at the time of, my appoint- 
 ment : — 
 
 Case 309. Time from June 21, 1832, to 
 April 19, 1833. 
 
 The patient is very mischievous ; he undresses 
 himself, tears his clothes, occasionally breaks a 
 pane of glass, is noisy, violent, wild, and inco- 
 herent, and will not take food voluntarily. He 
 is forcibly fed for many days in succession, is 
 frequently in seclusion, and is almost always 
 under restraint. At night being fastened to a 
 tub-bedstead by the hands and feet. 
 
 July 11. — Fastened in restraint chair by
 
 26 Lunacy ; its Past and its Present. 
 
 the feet, hands, and body — shouting and 
 singing. 
 
 July 22. — Confined all the morning in a 
 chair in noisy cell : the handcuffs were removed 
 at dinner, one of them having become twisted, 
 so as to make pressure on the hand ; at night 
 violent — elbow and forearm much inflamed and 
 swollen. Apply 18 leeches and poultices. 
 
 July 23. — Refuses his diet. Arm greatly 
 swollen and soft to the touch. 
 
 July 24. — Arm well — forcibly fed every day 
 until the 31st. 
 
 Aug. 22. — Forcibly fed since the 13th — 
 fastened to his bedstead at night — under restraint 
 during the day — has become dirty in his habits. 
 
 Aug. 25. — The Boot Hobbles invented 
 BY Dr Charlesworth for confining the 
 
 FEET TO THE BEDSTEAD WERE APPLIED THIS 
 EVENING. 
 
 Sep. 3. — Becoming violent, struck his keeper : 
 two or three attendants were required to secure 
 him. 
 
 Sep. 8. — Mischievous and tearing his clothes, 
 muttering to himself — cannot be trusted without 
 restraint. 
 
 Sep. 11. — Bruised his right ear by throwing 
 himself against his bedstead. 
 
 Sep. 12. — Has a carbuncle forming on his 
 back. Fiat incisio cruciformis tumori. App, : 
 Cataplasm : 
 
 Sep. 14. — Abscess on scalp opened. 
 
 Oct. 15. — Has a small swelling on his occi-
 
 Lunacy ; its Past and its Present. 27 
 
 put, with unhealthy inflammation surrounding 
 it, which is tender on being touched. Apply 
 Linseed Cataplasm. 
 
 Oct. 19. — Keeper requires assistance — • 
 patient almost always under restraint. 
 
 Oct. 22. — So violent as to require three of 
 the keepers to dress him. Is becoming dirty 
 in his habits. 
 
 Oct. 23. — To have his allowance of meat 
 withdrawn, and pudding substituted in its 
 place. The same difficulty occurred in dressing 
 him this morning. 
 
 Oct. 24. — Continues violent, and bruising 
 his feet by kicking against his chair. 
 
 Oct. 25. — Violent, and constantly kicking 
 his heels against the chair in which he is 
 fastened. To prevent further injury to his 
 heels he was placed in bed untU a cushion can 
 be made for the front of his chair. 11 p.m. — 
 More violent, and chafing his arms against 
 the sides of his bedstead so as to erode the skin. 
 The waistcoat has been put on, as the 
 mildest and most efficient mode of re- 
 straint in these particular cases. 
 
 Oct. 26. — Had the waistcoat on last night 
 and the whole of to-day. This evening he is 
 throwing his head about in a violent manner. 
 No disposition to sleep ; pupils rather dilated ; 
 cannot be left for a minute. 
 
 Oct. 27. — By constantly throwing up his 
 arms during the night, loosened the waistcoat 
 sufficiently to get it off. The keeper in attend-
 
 28 Lunacy ; its Past and its Present. 
 
 ance had to call up another to assist him in 
 replacing the waistcoat. He has been throw- 
 ing his head about the most of the night. 
 
 Oct. 31. — Restrained to prevent him tearing 
 his clothes. 
 
 Nov. 1. — Ear very much enlarged, poultice 
 applied to it ; he is constantly under restraint, 
 from his disposition to mischief. 
 
 Nov. 2. — Cov^ered himself from head to foot 
 with foeces. Ear still much enlarged ; poul- 
 ticed. Some papulee about the lower ex- 
 tremities. 
 
 Nov. 3. — Requires restraint to prevent him 
 tearing his clothes. 
 
 Nov. 4. — The ear, which was emptied of a 
 large quantity of pus and serum, has filled again 
 since last night. 
 
 Nov, 5, — Ear again filled with sero-purulent 
 fluid. Continue poultices. 
 
 Nov. 6. — Abscess filled with pus. 
 
 Nov. 7. — No change in state of mind ; ear 
 distended with pus. 
 
 Nov. 8. — Covered himself with fcEces during 
 the night ; ear as yesterday. 
 
 Nov. 9. — Covered himself with foeculent 
 matter. 
 
 Nov. 10. — Ear continues to discharge a con- 
 siderable quantity of pus when opened. Con- 
 tinues to require restraint. 
 
 Nov. 11. — Has several sores upon his lower 
 extremities ; becoming dirty in the day as well 
 as at night.
 
 Lunacy ; its Past and its Present. ig 
 
 Nov. 16. — Several of the sores are healing; 
 has a sore on his right heel to which a poultice 
 is applied. It was brought on by his habit of 
 kicking the chair, to which a cushion has since 
 been fitted. 
 
 Nov. 17. — Abscess of the ear is beginning 
 to contract ; there is still considerable thicken- 
 ing of the parts, and some discharge, but not to 
 any great extent. General health better ; sores 
 healing fast. 
 
 Nov. 18. — Has had a trial made of a petti- 
 coat, on account of his constantly wetting him- 
 self, causing excoriation. 
 
 Nov. 20. — Dirty and wet in his habits. 
 
 Nov. 23. — Was eating his foeces this morn- 
 ing when the keeper entered his room. 
 
 Nov. 27. — Sores healing. 
 
 Nov. 29. — Abscess in the ear discharges 
 again to a considerable extent. 
 
 Dec. 2. — Violent and unmanageable ; could 
 not be dressed until two additional keepers came 
 to assist his own attendant. 
 
 Dec. 6. — Sores on his legs nearly well. 
 
 Dec. 7. — Abscess of the ear nearly well, in 
 other respects no change. 
 
 Dec. 13. — Is calmer and more easily managed 
 than he has been of late — is led about by the 
 keeper every day. Most of the sores healed. 
 
 Dec. 14. — More manageable, and walking in 
 the gallery. He is not able to be trusted with- 
 out restraint. 
 
 Dec. 16. — Quieter, able to wear his trousers.
 
 30 Lunacy ; its Past and its Present. 
 
 Dec. 17. — Not so calm, and cannot be trusted 
 without restraint. 
 
 Dec. 19. — Becoming dirty again, and re- 
 quires the petticoat to prevent excoriation. 
 
 Dec. 20. — Cannot be trusted at liberty. 
 
 Dec. 21.. — No improvement; dirty and can- 
 not wear his trousers. Seldom speaks to any- 
 one. 
 
 Dec. 22. — Still wet and dirty — does not con- 
 verse at all. 
 
 Dec. 23. — Very dirty — suUen. 
 
 Dec. 24. — Sullen, and does not answer ques- 
 tions ; very dirty in his person. 
 
 Dec. 27. — Much more excited, and requiring 
 the belt. 
 
 Dec. 30. — ^Was not fastened last night, as 'a 
 trial, but contrived to cover himself with foeces 
 before morning. The walls of his room were 
 also in a filthy state, 
 
 Jan. 1, 1833. — Has a wound on the lower 
 part of his body, which appears to have been in- 
 flicted with a sharp body. On examining his per- 
 son nothing has been discovered upon him, nor 
 on any of those patients about him. His straw 
 bed has also been examined without anything 
 being found by which the patient could have in- 
 jured himself. 
 
 Jan. 2. — Very dirty in his bedroom. Wound 
 going on well. He is quite imbecile, and takes 
 no cognizance of what passes around him. 
 
 Jan. 5. — The keeper is leading this patient 
 about the gallery. 
 
 I
 
 Lunacy ; its Past and its Present. 3 1 
 
 Jan. 8. — Wet and dirty in his habits. 
 
 Jan. 9. — Again becoming more dirty. He is 
 not at all violent, but sits the whole day in a 
 state of childishness, without opening his lips to 
 speak to anyone. 
 
 Jan. 11. — In a dirty state, requiring the petti- 
 coat. 
 
 From Jan. 11 to Feb. 28. — He has been in 
 a childish state, seldom speaking to anyone ; has 
 continued wet and dirty in his habits, and to 
 wear the petticoat — still very mischievous. Has 
 a sore on his left leg, which he is in the habit 
 of scratching. — Still requires restraint. 
 
 March 16. — Made so much noise in his 
 room last night that it will be necessary to 
 secure him again by his hands and feet to pre- 
 vent him getting out of bed. 
 
 April 19. — Does not vary. He has been 
 calm for a considerable period, but is as dirty as 
 ever. 
 
 Now, this case describes a state of things 
 which, for the amount of cruelty and mis- 
 management, it is difficult to conceive could be 
 surpassed. Here was a man suffering from 
 a disease arising from debility, with sores on 
 almost every part of his person — from his head 
 to his heels, with a carbuncle on his back, and 
 with papulae on his legs, deprived of animal 
 food, and, of course, all stimulants (stimulants 
 not being allowed in the Lincoln Asylum), 
 and subjected to treatment of the most brutal
 
 3 2 Lunacy ; its Past and its Present. 
 
 and horrible kind. No attempt was made to 
 support the patient, although it must have been 
 evident from the poisoned condition of his 
 blood, that he was in extremis. Had he been 
 subjected to the rational treatment of the 
 present day — had he been allowed plenty of 
 nourishment, with good food, wine and other 
 stimulants, and abundance of fresh air, in all 
 human probability the degrading and shocking 
 spectacle of a man in petticoats, in a state of 
 mental and physical debility, would have been 
 avoided. For nearly twelve long months was 
 this poor creature under this restraint and 
 torture. The case does not say much for the 
 improved condition of the Lincoln Asylum under 
 my immediate predecessors, nor does it bear 
 out the statement made by some anonymous 
 writers (perverters of history) that in dispensing 
 with restraint altogether I had merely knocked 
 off the last instrument. 
 
 The case really proves that the condition of 
 the lunatic at Lincoln was very little, if at all, 
 ameliorated. Imagine a patient reduced to 
 imbecility fastened to his bedstead by his hands 
 and feet simply because he was noisy. 
 
 The Report of the Lincoln Asylum for 1838 
 states that " during the period when restraints 
 were so freely resorted to in this and other 
 asylums, it could be little imagined by strangers 
 permitted to see the condition of only a selected 
 portion of the patients, exercising or engaged in 
 the beautiful foregrounds, or in some of the
 
 Lunacy ; its Past and its Present. 1,7, 
 
 cheerful galleries in front, that behind this scene 
 were lingering under restraints such a large 
 proportion of the patients." 
 
 In the Report for 1839 we have a description 
 of the asylum in its earlier years. It states : " Of 
 the great extent to which the general condition 
 of the patients has been ameliorated some 
 judgment may be formed from a review of its 
 early state. Then might be seen (amidst the 
 quiet and convalescent patients) some in strait- 
 waistcoats, or wearing padded iron collars, heavy 
 cumbrous leathern muffs, belts with manacles, 
 solid iron wrist-locks, jointed iron leg-locks, or 
 hobbles ; — or in dresses inappropriate to their 
 sex, to accommodate habits, which the use of 
 instruments confining the fingers had too often 
 induced ; while others were sitting locked in 
 massive chairs with lime strewed underneath, or 
 were secluded in solitary cells ; — and these cruel 
 substitutes for a steady system of watchfulness, 
 but a prelude to the still greater miseries of 
 nights to be spent under the same wretched 
 system of restraints, painfully sacrificing the 
 freedom and ease of the patients to the leisure 
 or mis-employment, or inadequate number of 
 the attendants." 
 
 Now, in July, 1835, I was appointed Medical 
 Superintendent of the Lincoln Lunatic Asylum. 
 
 On entering upon my duties I found every 
 necessary and unnecessaryinstrument of restraint. 
 I found iron handcuffs, anklets, chains, straps, 
 tub-bedsteads, with fastening locks, boot hobbles 
 
 D
 
 34 Lunacy ; its Past and its Present. 
 
 called quarter boots, invented by Dr Charles- 
 worth for securing the feet to the foot- board, 
 leathern hobbles, strait- waistcoats, and round 
 towels. I abolished, annihilated them — not one 
 of these instruments, but the whole of them. 
 
 The per-centage of patients restrained for the 
 six years preceding my appointment was as 
 follows : — 
 
 1829—54-16 1832—67-90 
 
 1830—58-69 1833-50-57 
 
 1831—57-14 1834—41-28 
 
 From Jan. 21 to June 30, 1835-41-36. 
 I commenced non-restraint as a point of 
 departure, and as a distinct system, and, labour- 
 ing under every disadvantage, succeeded so 
 rapidly that the reports for the last six months 
 of 1835, and for the years 1836, 1837, and 
 1838, were as follow : — 
 
 Per-centage of patients restrained 
 From July 1 to December 31, 1835-19-54 
 1836—10-43 I 1837—1-53 
 1838—0-00 
 But in order that the public may more tho- 
 roughly appreciate the onerous responsibilities of 
 my position in carrying out the system I had 
 devised, it is necessary to enlighten them as to 
 the nature of the restrictions imposed on me by 
 the Board of Governors, and they can then 
 judge of the impediments standing in my way. 
 
 1832. July 16.—" Ordered, that buckskin 
 and round-cornered buckles be used for the 
 hobbles.
 
 Lunacy ; its Past and its Present. 3 5 
 
 That a leathern belt, for temporary security of 
 patients becoming suddenly violent, be kept in 
 the attendants' rooms." 
 
 1832. July 23.—" Resolved, that a pair of 
 quarter boots (suggested by Dr Charlesworth), 
 with rings fixed to the soles, be procured as a 
 night restraint for patients requiring the same." 
 
 1834. Aug. 18.— "The Visitor's Report 
 having been read : — Ordered, that the Fur- 
 nishing Committee do take measures for 
 procuring improved wrist-locks for day and 
 night use." 
 
 About three months after my appointment 
 these wrist-locks (iron handcuffs), four dozen in 
 number, arrived from Birmingham. 
 
 1834. Dec. 29. — " Ordered, that one pair of 
 night shoes (Dr Charlesworth's quarter boots 
 for confining the feet) for male patients, and two 
 for females, be procured." 
 
 The Eleventh Annual Report, pubhshed April, 
 1835, states that "a further review of the 
 instruments of restraint has reduced them to four 
 simple methods, viz. : — 
 
 " Day 1. — The wrists secured by a flexible 
 connection with a belt round the waist." 
 
 " Day 2. — The ankles secured by a flexible 
 connection with each other, so as to allow of 
 walking exercise." 
 
 " Night 3. — One or both wrists attached by 
 a flexible connection to the sides of the bed." 
 
 '^ Night 4. — The feet placed in night shoes 
 similarly attached to the foot of the bed." 
 D 2
 
 ^6 Lunacy ; its Past and its Present. 
 
 The four simple methods here mentioned 
 were in plain English, — 
 
 1. — Iron handcuffs connected by chains to a 
 leathern waist-belt. 
 
 2. — Leathern hobbles, locked round the ankles, 
 which permitted the patient to shuffle his feet, 
 and impeding his movements, but not fo walk. 
 
 3. — Iron handcuffs with chains, which passed 
 through fastening locks at the sides of heavy 
 tub-bedsteads filled with straw. 
 
 4. — Boots made of ticking, with rings and 
 chains, which passed through fastening locks at 
 the bottom of bedstead. 
 
 The Report further states that " the object of 
 restraint is not punishment but security." 
 
 The foregoing orders of the Board, and the 
 Reports of the Lincoln Asylum prior to my 
 connection with it, prove that there was an at- 
 tempt on the part of the Governors and the 
 medical authorities, and especially by Dr Charles- 
 worth, one of the Visiting Physicians, to miti- 
 gate the evil, but nothing more.* Everything in 
 
 * Physician's Case Book, July 31, 1832.— Extract.— 
 " It should be a fixed principle in the construction of all 
 instruments of lestraint, to prevent, as much as possible, 
 the capability of the patients to effect any injurious change 
 of their positions, or otherwise to increase their severity. . 
 . . With regard to the ' fixing on ' of the instruments of 
 restraint, nothing can prevent the dangers of negligence on 
 the part of the attendants in securing the locks, or, what is 
 much more common, the distressing severity of over-caution 
 in tightening the straps, &c., except minute and continually- 
 repeated personal examination by the superior officers in 
 each individual instance, and especially of the cases left 
 for the night." — (Signed) " E. P. Charlesworth."
 
 Lunacy ; its Past and its Present. 37 
 
 the shape of restraint is described as simple, 
 whereas, to my knowledge, the instruments in 
 use at Lincoln were quite as injurious and mis- 
 chievous in their effects as any other description 
 of instrument could possibly be. For proof of 
 this I refer my readers to the details of Case 
 309. Animal force was said to be the substitute 
 for mechanical restraint, but a greater amount of 
 animal force was used to impose the instrument 
 than was ever required after the instruments had 
 ceased to be employed. It was the struggle and 
 the force used to put on the instruments that 
 Jirst suggested to my mind the injurious and 
 fatal effects of such treatment, leading me to 
 abolish restraint. I can well remember visiting 
 the wards of the Lincoln Asylum for the first 
 time. My attention was arrested by a poor old 
 crippled imbecile sitting in a large arm-chair, his 
 hands and wrists being enveloped in poultices. 
 He had been wearing the handcuffs, and the iron 
 had eaten into his wrists, causing inflammation, 
 sloughs, and abscesses. He was dressed in a 
 suit of canvas, and was the very picture of 
 wretchedness. His condition was enough to 
 move a heart of stone. The poor old man was 
 mischievous: at the time I saw him he made 
 many attempts to remove the poultices and eat 
 them, but was otherwise harmless. An atten- 
 dant was at hand watching him. I felt disgusted. 
 It then occurred to me that if the patient could 
 be managed by surveillance only, after the injury 
 had been inflicted, why not before ? My whole
 
 3 8 Lunacy ; its Past and its Present. 
 
 and sole aim from that time was to abolish 
 mechanical restraint, and I never ceased to 
 exert myself until that great object was accom- 
 plished. From the Reports of the Lincoln 
 Asylum, and other documents connected there- 
 with, I shall give the history ; — 
 
 Report for 1836, signed R. Pretyman, Chair- 
 man and Vice-President.— Extract — " Three 
 successive months (excepting one day) have now 
 elapsed without the occurrence of a single in- 
 stance of restraint in this establishment ; and 
 out of thirty-six weeks that the house-surgeon 
 has held his present situation, twenty-five whole 
 weeks (excepting two days) have been passed 
 without any recourse to such means, and even 
 without an instance of confinement to a separate 
 room." 
 
 Report for 1837, signed W. M. Pierce, 
 Chairman. — Extract : " The present house sur- 
 geon, Mr Gardiner Hill, has expressed his own 
 belief, founded on experience in this house, that 
 it may he possible to conduct an institution for 
 the insane without having recourse to the 
 employment of any instruments of restraint 
 whatsoever. He has certainly made a striking 
 advance towards verifying this opinion, by con- 
 ducting the male (the completed) side of the 
 house, with but a solitary instance of such re- 
 straint, either by day or by night, during the course 
 of the sixteen last months, and that applied only 
 for two hours during his absence. Nor is it 
 impossible, when the buildings can be finished,
 
 Lunacy ; its Past and its Present. 39 
 
 that an example may be offered of an asylum, 
 in which undivided personal attention shall be 
 altogether substituted for the use of instru- 
 ments." 
 
 Minute Book, April 12, 1837.— "That the 
 thanks of this Board be offered to Dr Charles- 
 worth for the Report read this day, and that the 
 same be adopted." 
 
 Report for 1838, signed by E. P. Charles- 
 worth, Chairman. — Extract: "There is now an 
 increased confidence that the anticipations of 
 the last year may be fulfilled, and that ' an ex- 
 ample may be offered of a public asylum, in which 
 undivided personal attention towards the patients 
 shall be altogether substituted for the use of in- 
 struments of restraint.' ' The bold conception^ 
 of pushing the mitigation of restraint to the 
 extent of actually and formally abolishing the 
 practice mentioned in the last Report as due to 
 Mr HiU, the house-surgeon, seems to be justified 
 by the following abstract of a Statistical Table, 
 showing the rapid advance of the abatement of 
 restraint in this Asylum under an improved con- 
 struction of the building, night watching, and 
 attentive supervision. We may venture to ajirm 
 thai this is the first frank statement of the com- 
 mon practice of restraints hitherto laid before 
 a British public" 
 
 "Number of the patients restrained, and of 
 the instances and hours of restraint, in eight 
 successive years and nine months, as extracted 
 from the Register of Restraints, established
 
 40 Lunacy ; its Past and its Present. 
 
 March 16, 1829, on the plan required by law 
 in Scotland: — 
 
 
 Total number 
 
 Total number 
 
 Total number 
 
 Totiil number 
 of Hours 
 
 passed under 
 Restraint. 
 
 Year. 
 
 of Patients 
 
 of Patients 
 
 of Instances 
 
 
 in the House. 
 
 Kestrained. 
 
 of Restraint. 
 
 1829 
 
 72 
 
 89 
 
 1,727 
 
 20,423 
 
 1830 
 
 92 
 
 54 
 
 2,364 
 
 27,1131 
 
 1831 
 
 70 
 
 40 
 
 1,004 
 
 10,830 
 
 1832 
 
 81 
 
 55 
 
 1,401 
 
 15,67H 
 
 1833 
 
 87 
 
 44 
 
 1,109 
 
 11,0031 
 
 1834 
 
 100 
 
 45 
 
 647 
 
 6,597 
 
 1835 
 
 108 
 
 28 
 
 323 
 
 2,874 
 
 1836 
 
 115 
 
 12 
 
 39 
 
 384 
 
 1837 
 
 130 
 
 2 
 
 3 
 
 28 
 
 1838 
 
 158 
 
 
 
 
 
 
 
 " This striking progress of a melioration affords 
 good encouragement for persevering in a system 
 so successfully commenced, and the more so, 
 as a corresponding decrease of violence^ ac- 
 cidents, and revolting habits has accompanied 
 the change.'' 
 
 Minute Book, March 19, 1838.— "That the 
 thanks of this Board be offered to Dr Charles- 
 worth for the Report read this day, and that the 
 same be adopted." 
 
 Report for 1839, signed by R. Elmhirst, 
 M.D., Chairman : '■''At last severity of every kind 
 has disappeartd through the zealous co-ojieration 
 0/ the present house-surgeon, who, by an honest
 
 Lunacy ; its Past and its Present. 41 
 
 and determined application of ike means placed 
 at his disposal, has carried out the system of 
 mitigation to the unhoped-for result of an actual 
 abolition* of the practice of personal restraint, 
 not any instance of which has now occurred for 
 a period of more than twenty-three successive 
 months." 
 
 Minute Book, April 10, 1839.— "That the 
 thanks of this Board be offered to Dr Charles- 
 worth for the Report read this day, and that the 
 same be adopted." 
 
 Report for 1849, signed E. Ff. Bromhead, 
 Bart., Vice-President. — Extract. — "The cases 
 diminished with unexpected rapidity, and some- 
 times weeks or months elapsed without any case 
 at all. At last, under these circumstances, the 
 idea occurred to Mr HiU, that no case of the 
 hind whatsoever need exist ; and, in the practice, 
 he was determinedly supported by the Boards, 
 throughout every species of ojiposition^ exag- 
 geration, a7id misrepresentation, within the 
 Asylum and without'' 
 
 In July, 1838, I delivered my Lecture on the 
 non-restraint system of treatment in Lunacy. 
 Upon that occasion I asserted in plain and dis- 
 
 * " lu order to become personally assured of tlie eflfect 
 produced upon the disorderly patients by the substitution 
 of a system of watchfulness instead of restraints, the 
 house-surgeon spent tkree hours daily for 38 out of 40 
 successive days iu the months of March and April of the 
 present year among these particular patients and their 
 attendants, and had the satisfaction to witness good order 
 preserved, without either violence or intimidation on the 
 part of the latter, throughout the whole period."
 
 42 Lunacy ; its Past and its Present. 
 
 tinct terms, " that in a properly-constructed 
 building, with a sufficient number of suitable at- 
 tendants, restraint is never necessary, never justi- 
 fiable, and always injurious in all cases of lunacy 
 whatsoever." I gave, as the substitute for coercion, 
 classification and watchfulness, and vigilant 
 and unceasing attendance by day and night. I 
 enjoined kindness, occupation, and attention to 
 health, cleanliness and comfort, together with 
 cessation of all occupation that did not tend to 
 the immediate benefit of the patients. 
 
 1 showed the practicability of the system, and 
 offered to carry it out in any asylum in the king- 
 dom ; and, in concluding the Lecture, expressed 
 a hope that the Legislature would not deem the 
 subject unworthy of its consideration. The sys- 
 tem was quite new ; it had never been broached 
 before. Pinel, although he had released some 
 of the inmates of the Bicetre from chains and 
 dungeons, had taken the precaution to substitute 
 camisoles (strait- waistcoats ) for iron manacles.* 
 
 The reports of the Lincoln Lunatic Asylum 
 state that " Mr Hill was supported in his practice 
 by the Boards through every species of opposi> 
 tion, exaggeration, and misrepresentation, within 
 
 * " Pinel did not venture on unrestrained liberty ; yet 
 it was a grand step in advance to substitute a linen jacket 
 for a yoke of iron. It was reserved for England to be the 
 first to attempt the total abolition of physical resti^aint. 
 
 " I believe the Lunatic Asylum of Lincoln was the first 
 to discard its use altogether." — ' Notes on Lunatic Asylums 
 in Germany and other parts of Europe,' by W. F. Gumming, 
 M.D. 
 
 I
 
 Lunacy ; its Past and its Present. 43 
 
 the asylum and without." Within the walls I 
 had the whole staff of attendants against me. 
 I prevailed over the attendants by going amongst 
 them and personally superintending the refractory 
 patients. I spent several hours daily in the dis- 
 orderly patients' wards for weeks in succession — 
 in fact, I watched the attendants and the patients 
 until I felt satisfied that restraint was simply a 
 pretext for idleness, and nothing more. When 
 restraint was abolished, then ceased the reign 
 of " guttling, guzzling, and getting drunk by the 
 attendants," as had been the case under former 
 management. 
 
 Outside the asylum I had the whole medical 
 
 world against me. The superintendents of 
 
 several of our largest asylums opened a regular 
 
 battery upon me. I was assailed right and left. 
 
 The " Hillite system," as they pleased to term 
 
 it, was denounced as " Utopian." By one it was 
 
 called " an absurd dogma," — by another, " a 
 
 gross and palpable absurdity." Some fulminated 
 
 against it as " the wild scheme of a philanthropic 
 
 visionary, unscientific and impossible ; " by others, 
 
 as the ra\nng of a theoretic philosopher, involving 
 
 the unnecessary exposure of the lives of the 
 
 attendants — in fact, a practical breaking of the 
 
 Sixth Commanclment. Others, more moderate 
 
 in their views, denounced it as speculative, pecu- 
 
 lative, etc., etc. Dr Clutterbuck rhetorically 
 
 condemned it as " empirical and highly dangerous 
 
 to the patient and to those around him." Dr 
 
 James Johnson said " it indicated insanity on the
 
 44 Lunacy ; its Past and its Present. 
 
 part of its supporters; it was a mania, which, 
 like others, would have its day ": and Monsieur 
 Moreau de Tours said that " the idea was en- 
 tirely Britannic ; that it was an impossibility in 
 most cases, an illusion always, and the expres- 
 sion itself a lie" 
 
 Now it is well known that I had for a long 
 time to bear the whole odium of the attack : 
 not a soul came to my assistance, — not even Dr 
 Charlesvvorth, who has been brought forward by 
 some anonymous scribblers as the originator of 
 non-restraint. If Dr Charlesvvorth had been 
 the moving cause, could he have remained a 
 silent spectator throughout ?— would he not have 
 claimed the original idea ? He never did ; and 
 he never, although my warm adherent in the 
 earlier days of non-restraint, hoisted me above, 
 by penning a single line to any one of the 
 numerous medical periodicals of the day. If it 
 had not been for the encouraging remarks made 
 by the Editor of the Lancet from time to time, 
 I must have i-etired from the scene of my labours 
 altogether. At length Mr Serjeant Adams came 
 to the rescue as my advocate, and by his power- 
 ful aid and the letters he wrote to the Lancet, 
 as " Looker-on," the system was no longer a 
 dream but a success. It was this gentleman 
 who induced Dr Conolly to visit the Lincoln 
 Asylum, and it was he who carried Dr Conolly 
 through all his difficulties at Hanwell. About 
 the time that Dr Conolly was prosecuting the 
 system at Hanwell, Mr Gaskell introduced it at
 
 Lunacy ; its Past and its Present. 4 5 
 
 the Lancaster County Asylum with 600 patients, 
 although prior to its introduction at either of 
 those institutions it had been adopted by Dr O. 
 Pritchard at Northampton. As a proof of its 
 immediate results, it is only necessary to observe 
 that, after its introduction at Lancaster, no less 
 than nineteen tons weight of iron bars, gates, 
 and paraphernalia connected with restraints were 
 completely removed from the building. 
 
 This abolition of mechanical restraint has 
 ])een productive of incalculable good ; the num- 
 ber of recoveries has increased, whilst the deaths 
 and cases of injury, whether homicidal or sui- 
 cidal, have considerably decreased. At Lincoln 
 not a single instance of suicide occurred during 
 the five years of my official residence. Acute 
 mania has since become as manageable and 
 curable as before it was irresistible and fatal. It 
 was stated at an inquest at Bethlehem Hospital, 
 after the non-restraint system came into play, 
 that suicides had decreased by 80 per cent. 
 During the restraint period patients were fre- 
 quently strangled in strait- waistcoats and other 
 instruments ; whilst of two patients restrained at 
 York Asylum, one was murdered by the other. 
 
 Accidents from violence will occur occasionally 
 in Lunatic Asylums, as elsewhere ; but I do not 
 believe that any accident has arisen from the 
 absence of mechanical restraint. When restraint 
 was employed, it was generally before or during 
 the time of its application that injuries were 
 inflicted. The largest number and the most
 
 46 Lunacy ; its Past and its Present. 
 
 serious cases of violence which have occurred 
 lately have been in the larger asylums. It is not 
 to be expected but that in vast wards, with a 
 great number of patients, these wUl occur in 
 spite of all precautions ; but this must be re- 
 garded as being in the order of things. Let any 
 one stand on London Bridge for one hour of 
 every day and count the number of black eyes 
 that pass over it, he would cease to be dismayed 
 by the occasional exhibition of such marks of 
 violence in a Lunatic Asylum. If liberty gene- 
 rates such trifles, who is the man so thin-skinned 
 as to shudder at its occasional manifestation 
 among the insane ? The proportion of attend- 
 ants in large asylums is much less than in the 
 small, and the medical supervision necessarily 
 less complete, and, in many instances, in- 
 sufficient. Asylums are quite large enough 
 if they contain from three to four hundred 
 patients. There are no lunatics so well attended 
 to as those in the moderate or small-sized 
 establishments. 
 
 At page 47 of Dr ConoUy's work on the 
 ' Construction and Government of Lunatic Asy- 
 lums/ published in 1847, a case is described so 
 very similar to the one which induced me to 
 abolish restraint at Lincoln, that I shall extract 
 it verbatim. 
 
 Dr Conolly says, " Perhaps if I had never 
 seen such a case, I should have been less earnest 
 to adopt the system which I knew had been 
 tried at Lincoln, and slower to try to manage
 
 Lunacy ; its Past and its Present. 47 
 
 the patients of this great asylum entirely without 
 restraints." 
 
 Case. — " In the female infirmary at Hanwell, 
 exactly seven years ago, I found, among other 
 examples of the forgetfulness of what was due 
 either to the sick or insane, a young woman 
 lying in a crib, bound to the middle of it by a 
 strap round the waist, to the sides of it by the 
 hands, to the foot of it by the ankles, and to 
 the head of it by the neck. She also had her 
 hands in the hard leather terminations of canvas- 
 sleeves ; she could not turn, nor lie on her side, 
 nor lift her hand to her face ; and her appear- 
 ance was miserable beyond the power of words 
 to describe. How long she had been in this 
 state it is not material to record. That she w^as 
 almost always wet and dirty, it is scarcely neces- 
 sary to say. But the principal point I wish to 
 illustrate by mentioning this case is, that it was 
 a feeble and sick woman who was thus treated. 
 At that very time her whole skin was covered 
 with neglected scabies, and she was suffering all 
 the torture of a large and deep-seated abscess of 
 the breast. Let it be considered what must be 
 the effect on the attendants of having customary 
 recourse to the imposition of restraints, when 
 such complicated suffering as this became com- 
 paratively disregarded by medical men, in 
 consequence of the spectacle presented to them 
 being, at each visit, not that of a sick person 
 requiring aid, but of a dangerous lunatic cruelly 
 fastened and bound. But this patient was
 
 48 Lunacy ; its Past and its Present. 
 
 neither dangerous to herself nor to others. The 
 excuse alleged for this mode of treatment was, 
 that she would eat the poultices employed, and 
 which contained lead, and that she was very 
 mischievous : that was all. However, she was 
 liberated ; no bad consequences followed ; and 
 in a few weeks I saw the poor creature at the 
 chapel, and even heard her play the organ, 
 which she had been accustomed to do in the 
 church of a village in Middlesex before her 
 admission." 
 
 An anonymous attack having lately been made 
 upon me in one of the daily papers, I shall take 
 this opportunity of making some observations in 
 reply. I have never meant by the term " non- 
 restraint " a mere substitution of bodily strength 
 as an alternative of manacles and strait-waist- 
 coats, nor is it any business of mine to do more 
 than to protest against its existence. So far 
 from wishing to " hoodwink " the public on the 
 point, or conceal the fact that broken ribs and 
 even loss of life are still the frequent consequences 
 of restraint, I would desire that the public should 
 know every such case, and to agree with me in 
 opinion that every such case is unwarrantable. 
 
 I have never claimed more than the anony- 
 mous writer gave me credit for, viz., that the 
 mechanical instruments, et id genus omne, were 
 annihilated by me in my treatment of the insane, 
 a firm and gentle control being the substitute ; 
 and T do not think any man can expect to reap 
 a o-reater reward in his generation. There was
 
 Lunacy ; its Past and its Present. 49 
 
 a time when strait-waistcoats, manacles, and other 
 instruments of restraint and torture, together with 
 bodily strength, were recognised as a distinct 
 and acknowledged refuge. 1 smote it with a 
 rod of iron, and established treatment by the 
 means of gentleness and kindness. These were 
 my weapons. This has led to change in every 
 detail in asylums : — in fact, the present system 
 of management, when compared with the old 
 system, is as different as railway travelling is 
 from the four-horse coach mode of olden times. 
 Perhaps, however, my anonymous opponent 
 would not admit that Stephenson introduced 
 any new system of locomotion, because he did 
 not introduce travelling itself. I think he 
 did. 
 
 As to Dr Charlesworth, I think it necessary 
 to state that he never made any experiment on 
 any patient for the aboliiion of mechanical re- 
 straint. He never suggested the possibility 
 of doing without it, he never, more than any 
 other governor or physician, seconded the 
 slightest approach to any experiment of mine ; 
 he never eulogised me, except if saying what is 
 simply true be eulogy. The report in which he 
 accords to me " the bold conception " was not, 
 indeed, his report alone, but that of a whole 
 Board over which he occasionally presided. The 
 fact that he signed a report, recognising the 
 originaHty and success of my work, is sufficient 
 evidence that he was conscious of my claims, and 
 that the Board recognised them at the time. In
 
 5C Lunacy ; its Past and its Present. 
 
 short, the reports of the Board in reference to 
 me were acts of shnple truth and duty. Here 
 lies the strength of my case. The reports spon- 
 taneously written, recording matters of current 
 history, cannot be corrupted, nor can the most 
 cunning sophistry distort the facts declared in 
 relation to me. 
 
 I must repeat that I was not subordinate in 
 any sense to Dr Charlesworth, that all instru- 
 ments of restraint and moral management were 
 in my hands, and that between Dr Charlesworth 
 and myself there was the same relationship as 
 between myself and every other visiting phy- 
 sician of the Institution — no more, no less. I 
 affirm that I have never done Dr Charlesworth 
 any wrong in thought, word, or deed, that 
 every time when I have asserted my true 
 position, I have kept absolutely to facts, and 
 that what the anonymous writer calls my inter- 
 mittent and excited exclamations have never 
 occurred at my instance, but have invariably 
 been the simple replies to " the intermittent and 
 excited exclamations " which a few jealous con- 
 temporaries, generally under the cover of the 
 anonymous, have fulminated against me. 
 
 The statement of the anonymous writer that 
 my part of the reform in the treatment of the 
 insane consisted in abolishing the few remaining 
 instruments of restraint which Dr Charlesworth's 
 reforming zeal had left is such embittered per- 
 versity of fact it requires a man to be a 
 psychologist to understand the order of mind
 
 Lunacy ; its Past and its Present. 5 1 
 
 that could write it. When I entered on my 
 duties at the Lincoln Lunatic Asylum, I found 
 the several instruments of restraint as before 
 enumerated. I think my readers will agree 
 with me that these instruments were at all 
 events quite sufficient to mark a system of 
 treating the insane founded on the firm belief 
 of the necessity of mechanical restraint. * 
 
 Previous to my effort, no Superintendent, 
 Physician, or Governor, ever before, as far as 
 we have records of asylums, ventured to live, 
 move, and sleep in an institution charged with 
 insane persons, every inmate being always equally 
 as free as himself from all mechanical impedi- 
 ment. Now, I voluntarily, nay, in direct 
 opposition to the act, accepted all the risk of that 
 experiment. I withstood the superstitions, the 
 fears, the threats of the attendants, who thought 
 themselves endangered. I accepted the further 
 risk, with my eyes wide open to it, that if any 
 accident had followed the experiment, if any 
 patient set free had committed suicide, if any 
 patient set free had committed homicide, not 
 Dr Charlesworth, not any physician, nor any 
 
 * It is admitted in the Report of the Lincoln Lunatic 
 Asyhim for 1869 that, pi'ior to the abolition of restraint 
 by Mr R. Gardiner Hill, the amount of restraint at that 
 Asylum was " enormous." In my work on the Non- 
 restraint System of Treatment in Lunacy, I mentioned 
 that the condition of the Lincoln Asylum had retrograded, 
 owing to its being under the superintendence of a worth- 
 less, drunken reprobate ; but I am happy to state since 
 his removal, and now for a great many years past, the 
 management, under the able superintendence of Mr F. D. 
 Walshe, has been all that could be desired. 
 E 2
 
 5 2 Lunacy ; its Past and its Present. 
 
 governor, would have borne the responsibility ; 
 it would have been borne exclusively by the 
 house-surgeon, and that house-surgeon was 
 myself. 
 
 And here, in plain language, lies the mere 
 point of credit I ask for: that, in fact, I did 
 not think of modifying restraint or lessening its 
 evils, but that I did away with it altogether. 
 Previous to my time, in the colonies for the 
 insane all over the world, the chain and the 
 slavery accompanying it w'ere considered neces- 
 sary principles of government. They might be 
 humanised, but they were absolutely required. 
 In one of the colonies I ventured to introduce 
 perfect emancipation. When the proceeding 
 was small, when it was in its first days, I was 
 the recognised author of it, and anathematised 
 for being so. When it began to extend from 
 one colony to another, I was recognised and 
 complimented. When, as now, the results of 
 the change have flowed like a sea, and set free 
 from the chain and the slavery of it hundreds of 
 thousands of our most unfortunate fellow- 
 creatures, whose afflictions are their own, but 
 not of their own seeking, the attempt is made to 
 deprive me of the honour and glory of my 
 labours. 
 
 I should not have made these observations 
 but for the fact that my reply to the anonymous 
 writer in a daily paper was refused admission — 
 a very unfair proceeding, considering the attack 
 had been admitted.
 
 Lunacy ; its Past and its Present. c^i^ 
 
 But who has been the main cause of this and 
 other attacks ? I unhesitatingly answer, the late 
 Dr ConoUy. He it was who associated Dr 
 Charlesworth's name with mine without any 
 authority from me for doing so. He was, I 
 know, a friend of Dr Charlesworth, but friend- 
 ship ought not, particularly in matters of history, 
 to over-ride truth, Dr ConoUy, in reviewing 
 my book on non-restraint, spoke of my praise- 
 worthy plans — plans which, if they were even to 
 fail, it would have been no dishonour to have 
 tried. Yet Dr Conolly, in after years, in face of 
 all history, designates Dr Charlesworth " the 
 father of non-restraint." 
 
 I shall here give some extracts from the late Dr 
 Conolly's works, and the first will be from his 
 review in the ' British and Foreign Medical 
 Review ' for January, 1840. 
 
 " We are perfectly aware that Mr Hill's 
 statements will be received in many lunatic 
 asylums with surprise, and even with incre- 
 dulity." (Page 155). 
 
 " If Mr Hill's cases lose any portion of their 
 persuasive effect in consequence of his own 
 zealous and successful efforts (a most unjust 
 but not uncommon consequence), the testimony 
 of those is not wanting who, without being 
 committed to the abolition of restraint, are well 
 known to have endeavoured to improve the 
 management of lunatics. The excellent man- 
 agement of the Nottingham Asylum, under its 
 able and humane Superintendent, Mr Powell,
 
 54 Lunacy ; its Past and its Present. 
 
 is so well known, that we cannot but regret to 
 see the somewhat offensive term Utopian 
 applied in the Nottingham report to Mr Hill's 
 praiseworthy plans ; plans which, if they were 
 even to fail, it would be no dishonour to have 
 tried." (Page 165.) 
 
 The next extract is taken from the article 
 " Lunatic Asylums " in the supplement to the 
 ' Penny Cyclopsedia,' and reprinted in Dr 
 ConoUy's work on " The Construction and 
 Government of Lunatic Asylums." 
 
 " Mr Hill's lecture, which contains much that 
 is exceedingly interesting upon this subject, has 
 the following sentence, which has been the text 
 on which all the controversy on the abolition of 
 restraint has been founded : ' In a properly- 
 constructed building, with a sufficient number 
 of suitable attendants, restraint is never neces- 
 sary, never justifiable, and always injurious in 
 all cases of lunacy whatever.' This sentence, 
 when published in 1838, was declared, even by 
 those most inclined to the new system, to be too 
 decided, and likely to produce a bad effect ; but 
 fortunately the lapse of eight years has proved 
 '\i^ perfect truth, by its adoption as a principle 
 in all the most important asylums in the king- 
 dom. But the upholders of the old system 
 received the announcement of a doctrine so 
 startling as if there were something atrocious in 
 proposing to liberate those who were unfortunate 
 enough to be insane ; and for years after re- 
 straint had been actually abolished, the non-
 
 Lunacy ; its Past and its Present. 5 5 
 
 restraint system was declared ' Utopian ' and 
 impracticable ; then declared to be practicable, 
 but not desirable ; and at length, when every 
 other argument has failed, those who have so 
 strenuously opposed it come forward and claim 
 it as their own system, which they have been 
 practising for years, except that it was carried a 
 little further." (Page 171). 
 
 The next and last extracts are from Dr 
 ConoUy's work, ' The Treatment of the Insane 
 without Mechanical Restraints.' 
 
 " At last^ in 1837, Mr Hill expressed his 
 confident opinion that mechanical restraints 
 might he altogetlier abolished. And thus the 
 non-restraint system became established^'' 
 (Page 178). 
 
 " In various asylums, some attention had 
 been drawn to the subject of Mr Hill's lecture ; 
 but I had observed that his vien'S were received 
 unfavourably, and sometimes in a spirit of 
 hostility, or even of ridicule ; and I found them 
 by no means favourably regarded by the Medical 
 Officers at Han well." (Page 178). 
 
 " Neither the successive Superintendents who 
 adopted it, nor myself, ventured to say, with Mr 
 Gardiner Hill, that a case might not possibly 
 occur in which the rule of non-restraint must be 
 departed from ; but they and I equally well 
 knew, or gradually learned, that in a well-con- 
 structed and well-governed asylum, wuth proper 
 attendants, such a concession need scarcely be 
 made. The experience of the years which have
 
 ^6 Lunacy ; its Past and its Present. 
 
 passed over since the experiment began, 
 has fully confirmed this confidence." (Page 
 291). 
 
 " It is also to be observed that whilst the 
 opponents of the non-restraint system have 
 always been non-resident officers, the great 
 measure of the abolition of restraints was only 
 at first ventured upon by resident officers, whose 
 constant observation gave them ftill assurance 
 that it was safe." (Page 299).* 
 
 I may also quote from Dr Conolly's fourth 
 Report of the Hanwell Asylum (1842), wherein 
 he says that the management of a large asylum 
 is not only practicable without the application 
 of bodily coercion to the patients, but that after 
 the total disuse of such a method of control, the 
 whole character of an asylum undergoes a 
 gradual and beneficial change. I may supple- 
 ment his statement by his own admission " that 
 lie had adopted the plan from the Lincoln 
 Asylum." 
 
 It is clearly stated in these extracts that the 
 plans for abohshing restraint were mine, and 
 that they were both '' novel and startling." This 
 being so, Dr Conolly could have no ground for 
 associating Dr Charlesworth's name with mine 
 beyond Dr Charlesworth's own ipse dixit. I 
 
 * Here Dr Conolly admits that the abolition pf restraint 
 could only have been ventured on by a resident officer. 
 Neither I)r Conolly, nor Sir James Clark in his memoir 
 of Dr Conolly, give any evidence whatever for assuming 
 Dr Charlesworth to have been in any way instrumental to 
 its abolition.
 
 Lunacy ; its Past and its Present. 57 
 
 have always repudiated the association, and I 
 always shall do so. 
 
 Sir James Clark, in his memoir of the late 
 Dr Conolly, seems to have appHed to and obtained 
 his information from parties who could not have 
 been personally cognisant of the facts as con- 
 nected with the origin and early carrying-out of 
 the non-restraint system. In truth the parties 
 who could have supplied him with correct infor- 
 mation on the subject were not sought after. 
 Sir James Clark in that memoir states that Dr 
 Conolly lived to see his system, ^the non- 
 restraint system) approved and^'^^ited by all 
 whose approval was worth having throughout 
 England. Now, as Sir James Clark has 
 acknowledged in other parts of the memoir that 
 Dr Conolly adopted the system from Lincoln, 
 Dr Conolly should have been recognised as one 
 of those who approved and imitated the system 
 and not as the author of it. The authorities of 
 the Lincoln Asylum seem to be aware that Sir 
 James Clark has done the Lincoln Asylum an 
 injustice, for they state in their report for the 
 last year that he has described that estab- 
 lishment as " a small one," whereas they say 
 " the asylum contained 130 patients, and was 
 quite large enough to develope the system which 
 Dr Conolly afterwards introduced at Hanwell."* 
 
 * The observation of Sir James Clark, that " no one 
 who reads the accounts of Dr ConoUy's labours at Hanwell 
 can doubt that he would have introduced non-restraint 
 into that institution if he had never heard of what had 
 been done at Lincoln," is, as I think Sir James on re-
 
 5 8 Lunacy ; its Past and its Present. 
 
 Great merit is due to Dr. ConoUy for having 
 adopted the system of another, and for having 
 carried it out on a large scale ; but equal merit 
 is due to Mr. Gaskell, a retired Lunacy Com- 
 missioner, for having introduced it at Lancaster, 
 that asylum being almost as large as Hanwell. 
 From that time the system became gradually 
 adopted ; but it was the Commissioners in 
 Lunacy who put it on a firmer basis by re- 
 moving patients subjected to severe restraint to 
 asylums where restraints were not employed. I 
 remember a case being sent from Bethlem 
 Hospital to Lincoln. The patient at Bethlem 
 was always under restraint, whereas at Lincoln 
 she was perfectly free to go about the house and 
 grounds, and was, almost from the commence- 
 ment of her sojourn there, entrusted with a 
 key. 
 
 Now, let us turn from this subject, and from 
 
 flection will himself see, the earnestness of friendship 
 carried to forgetfulness of history. On such a suj^jjosition 
 the claim of j^riority may be accorded, in direct opposition 
 to facts, to anyone who niny follow those who originate 
 and demonstrate new systems. I need not press this point 
 further, but I cannot avoid making one other remark. Dr 
 Conolly was many years older than myself, and was 
 engaged in the study of lunacy earlier than I was. But it 
 is the fact that he never in his practice, although he must 
 have had ample opportunities at Warwick, made a single 
 step towards the system of non-restraint until September, 
 1839, that is, nearly three years after I had proved and 
 established the practice. Indeed, the first article on non- 
 restraint by Dr Conolly was a review of my work, " On 
 the Total Abolition of Mechanical Kestraiut in the Treat- 
 ment of the Insane," in the ' British and Foreign Medical 
 Review.' " — (Letter from myself, ' Standard,' August 31, 
 1869).
 
 Lunacy ; its Past and its Present. 59 
 
 the dreary theme of wrongs inflicted and endured 
 through successions of generations to that 
 brighter era when the day-star from on high, 
 as it were, visited us, and when juster views, 
 under the providence of God, lirst taught the 
 greater lessons of humanity in our treatment of 
 our fellow-man. That era may be unquestion- 
 ably assigned to that period when we proclaimed, 
 as it were, with one voice, the abolition of 
 mechanical restraint. It was then, and then 
 only, that we can be said to regard the sufferer 
 as a part and parcel of ourselves. We may have 
 in the past acted according to the light that was 
 in us ; but alas ! that light was all but a 
 Cimmerian darkness. We thought we had 
 done our duty when we had given a little addi- 
 tional security to the leg locks, or imposed 
 tighter manacles on voluntary motion. The 
 darkened cell and the strait- waistcoat were ever 
 ready to our hands, and rough-and-ready keepers 
 always at command. The natural consequence 
 of such a system, independent of its direct cruelty, 
 was to beget a spirit of inditferentism in the 
 minds of the sane, of hopelessness and dread on 
 those of the insane. All were alike smitten by 
 one demon or another until the old Adam was 
 thrown off. and the reign of hberty for all sorts 
 and conditions of the insane installed in its 
 place. This great triumph of light over dark- 
 ness, of knowledge over prejudice and ignorance, 
 was not consummated without encountering 
 sturdy and uncompromising opponents. Now
 
 6o Lunacy ; its Past and its Present. 
 
 that the fiat has gone forth, and that there can 
 be no return to the revolting and desolating past, 
 it may not be uninteresting to sketch what is 
 really comprised in all that appertains to the 
 non-restraint system. 
 
 It is necessary to premise that the glory of 
 having emancipated man from a degrading 
 thraldom is not precisely and exclusively limited 
 to the abolition of mechanical restraint. Non- 
 restraint signifies means to an end, and that end 
 must always be the cure or the amelioration of 
 the patient. We have lived to see restraint 
 emphatically extinguished ; but we must not 
 take a narrow view of our duty in supposing 
 that nothing more remains to be done. The 
 wise physician on putting on his harness has the 
 highest duties to perform that can be committed 
 to him by his fellow -man. He it is who is to 
 supply eyes to the blind and feet to the lame. 
 His is the mind that is to administer to the lost 
 sheep — to console, cheer, and identify himself 
 with him, even in his vagaries. In his hands is 
 deposited the balm of Gilead, and from the just 
 application of it he will derive his great reward. 
 To feed the hungry, to clothe the naked, and to 
 visit the sick, becomes, in a supreme degree, the 
 province of him who, it is to be hoped, from pure 
 love of the vocation consecrates his life to the 
 enterprise. 
 
 The wants of the insane can, with difficulty, 
 be placed in any well-defined category ; they re- 
 semble the wants of the outside world, with
 
 Lunacy ; its Past and its Present. 6 1 
 
 sundry and varied additions. Warmed by the 
 same heat and chilled by the same cold, they 
 nevertheless present their peculiar phases. The 
 peculiarities arise from states of feeling or pro- 
 cesses of thought. They ought always to be 
 respected, even if they cannot be gratified. To 
 turn a deaf ear to their complaints, to exhibit 
 either a churlish or indifferent demeanour, may 
 often prove an outrage not readily forgotten. 
 The wise physician, with eyes and ears open, 
 ought to be the trusted friend of the patient. 
 How much is to be accomplished by kindness 
 of manner none know but those who have had 
 charge of a lunatic asylum ! 
 
 But whilst the rule of kindness must consti- 
 tute the key to the proper government of the 
 insane, it must not be forgotten that tact is a 
 most invaluable auxiliary, as the following case 
 will exemplify : — A physician labouring under 
 confirmed mental imbecility, and under ordinary 
 circumstances tranquil and harmless, conceived 
 the idea that he had received a commission from 
 above to wag:e war against the windows of his 
 apartments, and, accordingly, in obedience to the 
 charmer, he very soon commenced the work of 
 demolition ; no sooner was one pane replaced 
 than it was made to follow its predecessor. The 
 glazier was in constant request, and the nuisance 
 became an aggravating one. It was necessary to 
 adopt some decisive step to arrest it. Under the 
 old system a shower-bath and a strait-waistcoat 
 would in all probability have been brought into
 
 62 Lunacy ; its Past and its Present. 
 
 play, but a much more judicious expedient was 
 resorted to. The Superintendent kindly inti- 
 mated to the patient that he was very desirous of 
 having a little chat with him in his own private 
 room — a ready response came, and, after a con- 
 versation de omnibus rebus the broken panes 
 were referred to. Then came the admission 
 why and wherefore he had so acted, whereupon 
 the Superintendent assured him, rising for the 
 nonce from his chair and putting the key into 
 his drawer, that whilst he, not disputing the 
 patient's commission, nevertheless held a supe- 
 rior one, duly signed and sealed, of a much older 
 date, forbidding such excesses. " Have you, 
 indeed ? " was his ejaculation. On its being 
 offered to be produced, he at once said, I will 
 not trouble you — 1 believe all you state, and 1 
 give you my word that I will never break another 
 pane of glass wilfully — a promise, be it said, 
 that he religiously observed. 
 
 As another instance of tact, I will give the 
 particulars of a case as they were narrated to me 
 by a physician. A gentleman conceived that the 
 boundaries of the asylum grounds, covering over 
 forty acres, were insufficient for his liberty of 
 action, and served to remind him that he was 
 under restraint. What would you say, said the 
 Superintendent, if you had the whole county 
 added to your domains with the understanding 
 always that you observe the hours of meals, and 
 return before dark ? 1 should be delighted, was 
 the reply. This additional privilege satisfied him
 
 Lunacy ; its Past and its Present. 6 2 
 
 for several montlis, and before it was necessary 
 to add another county the improvement was 
 such that he was able to return to his friends in 
 all respects an altered and wiser man. Promises 
 of this kind may often be advantageously made, 
 and, by a careful study of the character of your 
 patient, may in numerous instances be beneficially 
 exercised. But it would be doing only scant 
 justice to him who afforded the materials for this 
 anecdote thus cursorily to part company with him. 
 He, be it known, has greater merits, and if, as Dr 
 Johnson has said, " all merit has a right to be 
 recorded," I may be pardoned for dwelling a 
 little longer on his case. He was a man of 
 studious and reserved habits, with a peculiar 
 aptitude and proneness for what may be termed 
 philosophical speculation. His friends were iron- 
 masters, residing in what is familiarly known as 
 the Black Country, where indeed he had himself 
 passed some years of his life. The bent of his 
 mind led him, on being introduced into his new 
 home, to ponder on its geological strata. It was 
 during his solitary peregrinations in the neigh- 
 bourhood that he arrived from one process of 
 thought to another to the conclusion that the 
 stone that met him everywhere contained a 
 large per-centage of iron. Thoroughly impreg- 
 nated with this belief, he never missed his op- 
 portunity equally to indoctrinate the minds of 
 others. The ball was soon thus set roUing. 
 Resolutions to smelt the stone were quietly 
 adopted — with the happy result of demonstrating
 
 64 Lunacy ; its Past and its Present. 
 
 his conception to be, not a theory but a fact. A 
 brilliant success has flown from this apparently 
 insignificant origin — a new industry has been 
 developed, whilst some eighty square miles of 
 country previously devoted to agriculture were 
 now added to the mineral wealth of the king- 
 dom, enriching not only the fortunate owners of 
 the soil, but throwing broadcast its showers of 
 benefits on hundreds and thousands of labourers. 
 If thrice happy are they that give, doubly blessed 
 are they who now receive from the genius of a 
 man smitten by the direst of calamities such in- 
 estimable advantages — destined henceforth to be 
 a legacy for future generations. If he never 
 lived to reap a Parliamentary reward, the world 
 should, nevertheless, know to whom it is indebted 
 — to a mind temporarily eclipsed and secluded 
 under the mild system of non-restraint. To all 
 exercising this vocation of the healing art, this 
 case ought to be hio-hlv encouragino-. The 
 moral teaches us that we should leave no means 
 untried for the creation of even unexplored 
 sources of interest. He is the wise physician who, 
 in dealing with the " mind diseased," is the 
 swiftest to appreciate the hidden springs of 
 strength and weakness, and to supply the fitting 
 aliment. If he cannot always raise up an ideal 
 standard by supposing that he is harbouring a 
 Newton in disguise, he may from this recorded 
 anecdote take courage and perhaps be able to 
 realize that within his own domain there dwells 
 one able to extract bread from out of a stone —
 
 Lunacy ; its Past and its Present. 65 
 
 the true discoverer of that better secret which 
 rebuked the philosophers of old. 
 
 The establishment of asylums throughout the 
 kingdom for all classes of the community has 
 been attended with the happiest results. If 
 abuses have been discovered, they have been 
 discovered only to be corrected. Placed under 
 a rigid inspection, the public have now a 
 guarantee against wanton and improper con- 
 finement — perhaps, indeed, in our natural dread 
 of this possibility we have erred in the other 
 extreme by the needless multiplication of safe- 
 guards — injurious to the patient and more or 
 less harassing to his friends. Not without 
 reason, be it said that the latter will often shirk 
 their duty rather than have recourse to the 
 extreme course of proper custody, from a belief 
 that they are possibly bringing down upon their 
 heads the risk of an action-at-law. I am myself 
 so far cognisant of this state of feeling as to be 
 able to aver that there are persons at large who 
 should be under control, both for their own good 
 and that of the community, and who would be 
 so but for that apprehension. To dissipate it, 
 all that is necessary is to recognise the legal 
 validity of the documents upon which a patient 
 is received after they have passed the ordeal of 
 the Commissioners, and that, ii[)so facto, no 
 legal action should lie. 
 
 I am aware, of course, that this legal enact- 
 ment is intended as a shield against possible 
 criminal acts ; but when we fully consider how 
 
 F
 
 66 Lunacy ; its Past and its Present. 
 
 greatly jeopardised would be not only the 
 physician of a licensed asylum, but also the 
 outside members of the profession, we may 
 surely get rid of it. " Ce ne vaut pas la 
 chandelle." 
 
 Let it not be supposed that the inconveniences 
 thus referred to are imaginary ; they really have 
 deep ramifications, and smite, without partiality, 
 all who are signitaries to the proceeding. Hence 
 it happens that some medical men absolutely 
 refuse to sign such certificates on the ground 
 that they are thereby not safe from future pro- 
 ceedings in a law court to vindicate their acts ; 
 whilst the friends of the patient govern 
 themselves on the same principle, preferring to 
 " bear the ills they have rather than fly to others 
 that they know not of." Meanwhile, what is 
 the fate of the invahd ? Left necessarily thus to 
 his own devices, his hand against every man 
 and every man's hand against him, his future 
 career is too often but a continuous lapse from 
 degradation to ruin. Some relaxation in this 
 part of our lunacy law has always appeared to 
 me to especially recommend itself. 
 
 Once landed in an asylum, a new life opens 
 upon him, which, as a rule, he takes kindly to, 
 because he sees the law of kindness in the full 
 swing of its operation. An atmosphere of 
 association surrounds him, and now free from 
 the carking cares of the outside world, he 
 begins to feel that he is in a new home with 
 new surroundings. Discipline and order,
 
 Lunacy ; its Past and its Present, 67 
 
 " Heaven's first law," reign everywhere. What 
 is designated as care and treatment may now be 
 said to commence, the treatment resolving itself 
 under two heads — medical and moral. His gene- 
 ral health may be so good as not to require the aid 
 of drugs, but rather the eyes of vigilance, for it 
 would be as yet premature to fathom all that is 
 passing in that disturbed brain. In this, as 
 indeed in all other cases, we are permitted to 
 trust to the hopeful influence of time. Change 
 of air, change of scene, change of surroundings, 
 may be expected to produce much ; change of 
 habits, together with change by scintillation, as 
 it were, with other minds, will produce more, 
 until the novice is gradually moulded into new 
 impressions, however dimly and darkly he may 
 scan the past or the present. The step which 
 has detached him from home and other injurious 
 influences is now fairly put upon its trial — that 
 trial which is probably destined to bring " heal- 
 ing on its wings." True the process may be 
 tardy, but it dates from his entrance on the new 
 life ; true, also, it may never be complete, but 
 the foundation is at any rate laid that culminates 
 in the comfort of himself and his belongings, 
 for it may be safely said that that home knows 
 no peace which nurses within its walls the 
 suff'erer from mental disease. And could we 
 only realise the fact that our mistaken kindness 
 in keeping him there is fraught with the chances 
 of putting an extinguisher on his ultimate reco- 
 very, we should not now have to deplore the 
 F 2
 
 68 Lunacy ; its Past and its Present. 
 
 number of lifelong cases so made by following a 
 false, fatal, and obstructive policy. 
 
 I would by no means have it inferred, how- 
 ever, that I attach but little importance to 
 medicine in the treatment of the insane. At 
 one time I thought it useless, but I do not 
 now. I fully recognise its necessity when that 
 necessity arises ; but I own to a liking for other 
 agencies, on the principle that, as there is no 
 royal road to learning, neither is there any 
 specific road by which we can gain access to a 
 disturbed brain. I give a preference to generous 
 diet, with or without stimulants, according to 
 circumstances, pure air, exercise, and occupa- 
 tion. " These be your gods ! " enumerated 
 very much in the order of their importance — 
 the rest, physic included, is by comparison, 
 very much like " leather and prunella." 
 
 It is worth while to devote a little considera- 
 tion to these different headings, for though it 
 may be supposed that all the world knows what 
 they mean, all the world outside an asylum does 
 not know how comprehensive they are. 
 
 1. Generous diet implies a daily supply of 
 animal food with different vegetables, varied as 
 much as possible, and supplemented from time 
 to time with fish, fruit, and farinaceous com- 
 pounds — well cooked and well served, and in 
 sufficient and adequate proportions, so that no 
 one at the conclusion of the repast shall be able 
 to say that he has not had enough. The great 
 meal of the day being thus despatched, the three
 
 Lunacy ; its Past and its Present. 69 
 
 other and lighter meals need not detain us ; all 
 making their appearance with scrupulous regard 
 to cleanliness and punctuality. 
 
 But it sometimes happens that with the best 
 of catering we find some unable to appreciate 
 the provided cheer. If this arises from sickness 
 it has, of course, to be specially treated by appro- 
 priate diet — if from other causes it marks a phase 
 that demands our gravest attention. As an illus- 
 tration, I will give the two following cases : — 
 A clergyman, thirty-two years of age, who had 
 recently recovered from an acute attack of mania, 
 became impressed with the illusion that he had 
 no stomach — -that it was therefore useless to eat, 
 because he had no receptacle for his food. With 
 this conviction he persistently refused all aliment. 
 No coaxing could shake his resolution, and thus, 
 calmly talking of his condition, he wandered to 
 and fro, the picture of misery, with daily dimi- 
 nishing bulk and power. It was patent that his 
 inflexibihty must be energetically combated, for 
 there seemed no alternative between artificial 
 feeding or slow death. Before, how^ever, re-^ 
 sorting to what may not be inaptly described in 
 the healing art as the ultima ratio regum^ a 
 doubtful experiment was projected. There was 
 in the house a lady well known to him, in a 
 state of convalescence after long illness, who was 
 in the habit of cooking her own mutton chop, 
 and the cue having been given to her for his re- 
 ception he was invited into her room to see how 
 she ate ; he readily consented, witnessing the
 
 yo Lunacy ; its Past and its Present. 
 
 whole process of cooking, and whether from the 
 ascending aroma of the meat or other causes he 
 never left that room until he had followed that 
 lady's example — consuming his full share of the 
 meal with an avidity and relish truly surprising. 
 From that time forth the stomach was proved to 
 have an existence — his scruples about eating 
 vanished, and such are the changes in this 
 changeable world, that from being a man of 
 moderate appetite, he now became absolutely 
 voracious. He lived two years afterwards, being 
 then carried off by an explosion of epilepsy. 
 
 The other case was that of a young female 
 with many similar phenomena, but terminating 
 in a very different issue. Under some religious 
 delusion she had made a vow not to eat for forty 
 days and forty nights. Undaunted by all per- 
 suasion, and proof against every ordinary device, 
 procrastination in the use of the sole remaining 
 remedy became dangerous. For three successive 
 weeks did she tranquilly submit to the intro- 
 duction of the instrument, of her own accord 
 presenting herself night and morning to the 
 manipulator, until at last her resolution yielded. 
 The food introduced was three quarters of a pint 
 of beef tea thickened with flour, an egg, and 
 half an ounce of brandy, night and morning. 
 
 This exceptional treatment may sometimes be 
 averted even in these exceptional cases — by such 
 devices as variety of food, of depositing it in the 
 bedroom of the patient, or in other places which 
 may attract his attention. He will thus occa-
 
 Lunacy ; its Past and its Present. 7 1 
 
 sionally appropriate it, particularly if he thinks 
 it belongs to another — thus establishing, as it 
 were, the existence of such a disease as " klepto- 
 mania " — or an innate propensity to confound 
 the distinctions between mewn and tuum. 
 
 2. Pure Air. — By this term I do not pro- 
 pose to limit my observations to the mere che- 
 mical elements of oxygen and nitrogen that 
 enter into its composition. A prison or a her- 
 mitage could boast of these. Our vision is 
 more comprehensive, because it embraces an 
 acreage of green fields, shaded walks, " with a 
 brotherhood of spreading elms," and all that the 
 poetry of life can furnish in a well-cultivated 
 garden. The mind that can muse on such ob- 
 jects can never be said to be wholly alone or out 
 of the world. A celebrated rustic poet who came 
 under my particular observation some years since, 
 and who spent the last twenty-five years of his 
 life most happily in an asylum, graphically de- 
 scribed his state of feeling in this expressive 
 line : 
 
 "Where flowers are, God is, and I am free." 
 
 The pure air imbibed in such contemplations 
 affords the patient much mental tranquillity, if 
 it merely reconciles him to his lot. The freedom 
 of the outside world is here displayed in minia- 
 ture : he feels himself a guest and the physician 
 to be his host. 
 
 But let me not be misunderstood by appearing 
 to put the cart before the horse. Great as are
 
 72 Lunacy ; its Past and its Present. 
 
 the advantages we have been enumerating, we 
 must never forget that as by far the larger por- 
 tion of our existence is spent in the house, the 
 preservation of pure air is here to us invaluable. 
 That preservation is impossible unless it be by 
 courting the breeze from without — all artificial 
 systems of ventilation are nugatory in comparison 
 with what we derive from doors and windows. 
 The health, comfort, and well-being of all the 
 inmates is comprised in the comprehensive word 
 — fresh air. Smells that war against the olfac- 
 tory nerves must find no existing place here. 
 
 3. Exercise. — This is one of our sheet- 
 anchors in the treatment of insanity, and as 
 such its daily encouragement should constitute 
 one of the canons of the establishment, as the 
 two following cases will exemplify : — A clergy- 
 man, both erudite and exemplary in all the 
 relations of life, was smitten with an attack of 
 acute mania, and for eighteen months was an 
 inmate of a metropolitan licensed house. His 
 case was then pronounced to be without the 
 pale of recovery by several of the most eminent 
 members of the faculty in London. His in- 
 sanity assumed that type which may be described 
 as violent and abusive, and arrangements_^were 
 at once concluded to transfer him to another 
 institution. His treatment had consisted in 
 giving him a handsome sitting room and in 
 supplying him with the literature of the day, 
 with occasional daily walks in a small contracted 
 garden in company with an attendant. Asso-
 
 Lunacy ; its Past and its Present. j^ 
 
 elation with kindred minds was not put in 
 practice. Hence, in his new abode, an opposite 
 poHcy was determined on. He was, even in 
 his madness, penetrated with a high sense of 
 conscientiousness, and if he gave a promise, he 
 would, as a clergyman, observe it. Under these 
 circumstances it w^as not difficult to come to 
 terms — those terms being that he should have 
 the privilege of exit and entrance, upon the con- 
 dition that he would not depart from the 
 boundaries of the place. But though it was a 
 great relief to be able to make such an arrange- 
 ment, it must not be supposed that the Physician 
 had an easy berth of it. He conceived the idea 
 that his medical friend was as deeply involved 
 in the conspiracy against him as those he had 
 left behind, and hence, in his daily inter- 
 views, it was more or less desirable either to 
 shirk or curtail them ; if he thought you were 
 manoeuvring to get clear of him, he would in a 
 stentorian voice shout out and foUow you with 
 some scriptural phrase, such as " The wicked 
 fleeth when no man pursueth," or it might be 
 if you contented yourself with a simple good 
 morning and passed on, " Great is Diana of the 
 Ephesians." Thus time rolled on — he con- 
 tinuing his exercise of five or six miles a-day, 
 whilst everyone was rejoicing to be spared the 
 noise of his presence. In eight months after- 
 wards a more tranquil frame of mind supervened 
 — he became more sociable, and was prevailed 
 on to write some poetical effusions which pos-
 
 74 Lunacy ; its Past and its Present. 
 
 sessed sufficient merit to be printed ; having the 
 pen of a ready-writer, his versification was con- 
 siderable, the upshot of it all being to restore 
 him to the performance of his clerical duties 
 that had thus been so grievously interfered with. 
 This happy termination has never been inter- 
 rupted ; he is now, 1870, fulfilling all the duties 
 of a country clergyman in the most eff'ective 
 manner, esteemed and appreciated by all who 
 know him. After this, may I not say. Nil 
 desiperandum. 
 
 The details of this case would be but imper- 
 fectly narrated if I omitted all allusion to a 
 remarkable phenomenon that this faculty for 
 versification developed in the minds of other 
 inmates — a mania for rhyming met you at 
 various corners most unexpectedly — pen, ink, 
 and paper then reigned at the top of their bent ; 
 everything was so epitomised in this demand 
 that I am not sure whether the ejaculation of 
 Juvenal, " Quam miserum est cum tot ubique 
 vatibus occurras," was not put by the spiritual 
 pastor and master of the place to whose eyes 
 these eflfusions were submitted. This imitative 
 propensity was, however, only a nine days' 
 wonder ; it was as readily laid aside as it had 
 been adopted for a newer fashion — " a rattle or 
 a straw " — having served its purpose meantime 
 by the creation of a new occupation, for novelty, 
 be it remembered, is as acceptable inside as out- 
 side the walls of an asylum. 
 
 But how, it was asked one day of a genuine
 
 Lunacy ; its Past and its Present. 7 5 
 
 veteran poet, do you contrive to embody your 
 thoughts in such choice and correct imagery? He, 
 poor fellow, believed that he had written the works 
 of Byron and Scott, and had so far lost his own 
 identity as to announce himself to be either one 
 or both these celebrities. His reply was charac- 
 teristic of his simplicity : " I am sure I don't 
 know, but I suppose I kick it up as I am kick- 
 ing up the clods in my walks." 
 
 Descending from the regions of fancy to the 
 prosaic one of facts, in corroboration of the 
 value of muscular exercise, I will give another 
 illustration. He, too, was a beneficed clergyman, 
 and had been a passionate lover of field-sports. 
 No cry to him had been so enchanting as the 
 crack of the huntsman's whip, or the music of 
 the pack in full chase after Mr Reynard. But 
 he was suddenly smitten with a sense of remorse 
 — a visitation of God prostrated him by an 
 attack of profound melancholy madness, under 
 which his agonies were extreme. His conscience 
 smote him with opportunities that he had lost, 
 and of duties that he had neglected. It was not 
 that fox-hunting was of itself a reprehensible or 
 wicked sport, but he had pursued it as a clergy- 
 man, and as a clergyman he had sinned against 
 the Holy Ghost, knowing fall well all the time 
 that it was wrong. This was the burden of his 
 song, and here was the opportunity of testing the 
 value of the five-mile course. The over-charged 
 brain gradually found relief in the exercise that a 
 Scotchman would designate as " shaking the
 
 76 Lunacy ; its Past and its Present. 
 
 shanks." Many months, it is true, thus rolled 
 away, but the issue was again so far fortunate 
 that he was able to resume his clerical duties, 
 without relapse, and for fifteen years has con- 
 tinued to do so. 
 
 Without pretending to give a scientific ana- 
 lysis of the process of recovery, I think I may 
 hazard this — that reasonable and regularly ap- 
 pointed bodily exercise acts very much in the 
 same way as a safety valve of a steam boiler 
 working under high pressure — it carries off the 
 superfluous steam, and generates that equable 
 condition that conduces to a healthy play of aU 
 the organs. 
 
 4. Occupation. — All our praises are not, 
 however, to be engrossed under the preceding 
 heads to the exclusion of this, the last and 
 latest offshoot of the non-restraint system. Oc- 
 cupation is the fruit of that now forbidden tree, 
 which men in manacles and chains could not 
 indulge in. It has been the growth and natural 
 inheritance of the extinct system, the new super- 
 structure upon which our foundations are laid. 
 Its value is priceless, as the annals of every in- 
 stitution in the kingdom that opens its doors for 
 the insane proclaim in no uncertain utterances. 
 There is a Turkish proverb so much to my pre- 
 sent purpose, that I cannot refrain to give it. 
 It is " that the devil tempts all other men, but 
 that idle men tempt the devil." The due ob- 
 servance of it should constitute the headstone or 
 cardinal creed in every asylum, and his will be the
 
 Lunacy ; its Past and its Present. 77 
 
 victory who most assiduously reduces it into prac- 
 tice. It will be, as it were, the triumph of Laertes 
 over the Tyro — of the veteran over the recruit. 
 What the nature, kind, or degree may be, must 
 depend on an infinite variety of circumstances, 
 even as there are different kinds and degrees 
 among men — tastes, habits, and education will 
 more or less determine it : at all events, how- 
 ever, an inexorable warfare must be maintained 
 against idle hands. There are few so lost as not 
 to know how to wheel a barrow — few to whom 
 the exercise would not be beneficial, supposing 
 they cannot achieve anything higher. The farm 
 and garden will always yield its volunteers, 
 whilst the more tranquil occupation of the 
 needle will ever find its votaries. In times of 
 yore our ancestors' recommendations of the 
 qualifications of a wife were 
 
 That she should bake and brew, 
 And shape and shoe. 
 
 Apply this distich in all its practicable latitude, 
 and you may perchance find as your reward that 
 they who came to curse will live to bless. In 
 thus dealing with every damaged specimen of 
 humanity, you must not travel from Dan to 
 Beersheba and say it's all barren. It is barren, 
 perhaps, but it is your special province to culti- 
 vate it. " All discord's harmony not understood." 
 Underlying all this barrenness is a convertible 
 something waiting your appropriation. This is 
 very much like an Utilitarian view of the ques- 
 tion ; abutting somewhat on its undefined terri-
 
 7 8 Lunacy ; its Past and its Present. 
 
 tory lies however another kingdom — the kingdom 
 of occupation still, but divested of its more special 
 recommendation of obvious utility — the occu- 
 pation that borders on amusement. Our earliest 
 associations are identified with what all work and 
 no play means. We must not disregard it in an 
 asylum, endeavouring so to dovetail the two 
 systems as to obtain an harmonious whole. What 
 amusements are to the occupant of the outside 
 world, they are to the inmate in seclusion. They 
 are generally as much sought after and appre- 
 ciated. There can be no difficulty in a suitable 
 selection with the changeable features that ever 
 present themselves either in novelty or fashion. 
 Let it be understood that the greater the air of 
 freedom, the less is the appearance of restraint — 
 in proportion as you assimilate your arrange- 
 ments to the world in which you live, the nearer 
 you attain to perfection, and that perfection to 
 be attained is no trifle. 
 
 So far with regard to the ordinary and chronic 
 treatment of the ordinary and chronic invalid. 
 Now, then, as respects the treatment of acute 
 mania : That this is an active or sthenic disease is 
 founded in error ; it is as a rule a result of de- 
 bility consequent upon an abnormal condition of 
 the blood, or some disease affecting the circula- 
 tion. The brain in either case is imperfectly 
 nourished. The disease is highly amenable to 
 treatment unless it arises from organic causes. 
 It is frequently occasioned by tubercular deposit 
 in the lungs, and this will account for the large
 
 Lunacy ; its Past and its Present. 79 
 
 number of deaths from phthisis in om' lunatic 
 asylums. Formerly it was supposed that the 
 insane were predisposed to consumption, but I 
 came to the conclusion long ago that insanity 
 was consequent upon phthisis — not phthisis upon 
 insanity. In acute mania there is always a ten- 
 dency to purpura. In the treatment, therefore, 
 all depletives must be avoided, or exhaustion 
 would be the result. I disapprove of mecha- 
 nical restraint on account of its debihtating 
 effects. I equally condemn all lowering agents, 
 such as tartar emetic, ipecacuanha, digitahs, and 
 all drastic purgatives — also the hot, Turkish, and 
 mustard baths — the douche, and particularly 
 the wet sheet. I look upon the latter as a mere 
 substitute for mechanical restraint, and, as such, 
 productive of great irritation and consequent 
 diminution of the vital powers. The first object 
 in treatment is to relieve the patient of his ex- 
 citability, and, whilst doing so, to give him 
 abundance of nourishment — good beef tea be- 
 tween meals, wine, malt liquor or brandy, and 
 diffusible stimulants, such as ammonia, chloric 
 ether, and compound spirit of lavender, with de- 
 coction of bark or infusion of quassia. I find 
 the nitro- muriatic acid very useful, but it has to 
 be taken for a long time. If the patient be 
 restless at night, a stimulating draught or a full 
 dose of whisky is generally effective. Opiates 
 in acute mania are, as a rule, pernicious, more 
 frequently aggravating than alleviating the symp- 
 toms. But whatever may be the advantages of
 
 8o Lunacy ; its Past and its Present. 
 
 these remedies, they are comparatively insignifi- 
 cant by the side of a new compound which I 
 have recently most successfully employed under 
 the designation of the hydrate of chloral. This 
 invaluable compound recently introduced to our 
 notice under the auspices of that distinguished 
 physician, Dr B. W. Richardson, I am able to 
 speak from experience of, as one of the most 
 striking and effectual additions that has ever 
 been added to hygienic medicine. 
 
 If of other remedies I have to speak, be it 
 known that that splendid medicine from America, 
 designated under the name of Podophyllin, is 
 capable of producing most energetic action on 
 the functions of the liver, and as a cholologue 
 its virtues are not to be surpassed. This espe- 
 cially applies to cases of melancholia. It may 
 be used most successfully either |;er se or in 
 combination with small doses of phosphorus. 
 Nor would I disguise from my readers the fact 
 that atropine can be successfully brought into 
 action in cases of mania arising from uterine 
 irritation — more particularly of those of an inter- 
 mittent character. As to epilepsy, that oppro- 
 brium medicorum, I do not hesitate to affirm 
 that most material assistance may be derived 
 from the use of ozonic ether. As to bromide 
 of potassium, although I have heard that it has 
 been very efficacious in the hands of others, yet 
 in my own experience I wish I could confirm 
 the opinion of the outside world. I would also 
 enumerate amongst other remedies the advan-
 
 Lunacy ; its Past and its Present. 8i 
 
 tages that may be derived from the salts of iron 
 in combination with strychnine. A word to the 
 wise : those only half know their lesson who 
 cannot appreciate the benefits of the last-named 
 alkaloid. 
 
 By these various agencies, and with proper 
 moral control, I have had no difficulty in en- 
 countering all cases of acute disease. I have 
 had patients who have been under treatment at 
 other asylums even for long periods, and with 
 them the treatment, continuous and prolonged 
 though it be, has generally been successful. It 
 is necessary, in acute mania, to find occupation 
 for the patient, and however unfitted for ordi- 
 nary amusements, he must be allowed the 
 creative faculty after his own fashion, even if, in 
 doing so, he plunges into some mischief If 
 destructive to furniture, remove the loose 
 articles ; if to wall papers, sweep them away, 
 and let prints occupy their places. For this 
 latter purpose I use engravings or woodcuts 
 from the " Illustrated London News " and other 
 periodicals. Destructive patients will find re- 
 sources for themselves in pulling them off, or by 
 painting over them in their own particular 
 fashion. These, when so destroyed or defaced, 
 are immediately replaced by others. Walls 
 appropriately decorated afford no inconsiderable 
 amusement even to those suffering from chronic 
 disease. It is sometimes no easy task to supply 
 occupation or amusement for maniacal patients, 
 especially as safe toys are very readily broken ; 
 
 G
 
 8 2 Lunacy ; its Past and its Present. 
 
 whilst others, more or less unsafe, may be used 
 as weapons of offence. There is a very harm- 
 less pictorial toy, consisting of a number of 
 square wooden blocks which, when properly put 
 together, form a picture. These can be turned 
 over and over, so as to form six different repre- 
 sentations. I have found this a very nice 
 puzzle for maniacal patients. I have known 
 them amuse themselves with these blocks for 
 hours at a time. The squares are too large to 
 be swallowed, and not large enough to inflict 
 injury on others. Wooden bricks for building 
 model houses are also very entertaining. Domi- 
 noes must conspicuously figure in the category if 
 the patient be trustworthy. There are many 
 maniacal patients who indiscriminately eat any- 
 thing that comes in their way, such as cinders, 
 &c. ; when this is the case, they require very 
 prompt and watchful care, and especially a 
 guarded fire-place. It may be necessary, in 
 these instances, to secure the blankets in strong 
 ticking cases, as a safeguard against these 
 injurious practices. This apphes to the down 
 of the blanket. The padded room, used now 
 but rarely for seclusion, is most useful for them 
 at night. Mine is provided with a mattress 
 fixed in a frame to the floor, easily removable, 
 and with every convenience for wet, dirty, or 
 suicidal patients, or those destructive to clothes 
 and bedding. It is generally regarded as very 
 comfortable by all who use it, and if I only say 
 a word in favour of it, it is the expression of
 
 Lunacy ; its Past and its Present. 83 
 
 reluctance to surrender it for other quarters. 
 Strong clothes, with a proper fastening, should 
 be provided for those who destroy either their 
 bedding or garments, or who have a propensity 
 to denude themselves. As some with acute 
 symptoms will sometimes show tendencies to 
 precipitate themselves from great heights, and 
 even to go through glass windows, it is necessary 
 to keep all such on the ground floor. These 
 patients require to be tenderly and warmly clad, 
 and kept as much in the open air as possible in 
 all available seasons. In cases of a disposition 
 to refuse food, early nutrition is necessary. 
 Compulsory feeding is very rarely necessary ; 
 but, when so, it can generally be managed with 
 proper assistance without the aid of any instru- 
 ment. In any extreme case, I have found that 
 the passing of the food through the nostril, by 
 means of a funnel, preferable to the stomach- 
 pump or the Bakewell can. The best food is 
 strong beef tea, thickened with Ridge's patent 
 food or corn flour, a glass of good port wine 
 being subsequently added. Avoid holding a 
 patient, because the small vessels, being in a 
 weak state, are easily broken, and by your grasp 
 you may bruise his arms without being aware of 
 it. It cannot be too much impressed on the 
 public that cases of acute mania can never be 
 properly treated at their own homes. Home 
 treatment is pernicious and always productive of 
 great irritation, the invariable source of annoy- 
 ance to friends or neighbours. My personal 
 g2
 
 84 Lunacy ; its Past and its Present. 
 
 experience teaches me the rule that persons 
 affected with insanity, either in the acute or 
 chronic stages, eat and require more food than 
 others. To prevent chronic cases deteriorating, 
 a Hberal diet is absolutely necessary. It is 
 owing to the present humane method that cases 
 of lunacy have gone on steadily increasing in 
 our asylums of late years. Formerly these poor 
 creatures fell victims to the brutal treatment of 
 those who had them under charge. With the 
 great change inaugurated with the abolition of 
 restraint came prolongation of life, and this will 
 account, in a great measure, for the alleged, 
 increase of insanity in this country. 
 
 With the full and free explanation thus given, 
 we can endorse emphatically the following 
 statement derived from the " Journal of Mental 
 Science " for the last year, to the eifect that 
 there are 30,000 patients in the public asylums 
 of England, all of whom have been treated for 
 the last fifteen years without the use of any 
 mechanical restraint whatsoever. 
 
 The reader who has been my travelling com- 
 panion thus far, may, perhaps, take exception to 
 the multiplied proofs I have in self-defence been 
 obliged to submit to his candid judgment. In 
 truth, there was no other alternative open to me 
 but to declare broadly, and in the teeth of all 
 usurpers, that whatever may be the crowning 
 merits of the system of non-restraint as embodied 
 in the abolition of all mechanical appliances in 
 the treatment of the insane, those merits un-
 
 Lunacy ; its Past and its Present. 8 5 
 
 equivocally belong to me as the first pioneer to 
 demonstrate the practicability and safety of its 
 universal application. I should be untrue to 
 myself, untrue to those who succeed me, did I 
 abate one jot of my pretensions on this head. 
 My case is parallel with that of the captain of a 
 ship of war who suddenly finds himself in front 
 of a hostile fleet, securely anchored, it may be, 
 in the Bay of Restraint. My mission, according 
 to my views, was not to flinch, but to break the 
 centre of that force. And so it was, that though 
 I w^as afterwards joined by many consorts bear- 
 ing friendly colours, my flag hoisted on board 
 the good ship " City of Lincoln," was the first to 
 proclaim the success of the achievement. Another 
 seeks to deprive me of the honour of the victory, 
 either by claiming it for himself, or sharing it 
 with me. I can assent to neither course. I 
 was the responsible captain in command, and 
 lived on board. The sleeping partner. Dr. 
 Charlesworth, an ornament in his way, lived 
 ashore, and could only give a sanction to my 
 proceedings. 
 
 Whilst we applaud and reward the eff'orts of 
 those who successfully pierce Alpine passes, who 
 gauge the depths of the ocean and connect 
 distant continents by the hidden mysteries of 
 electricity, be it borne in mind that other 
 ag-encies were at work, — that work which was 
 brought to its triumphant issue when the last 
 link of the chain was removed from the body of 
 the down-trodden and neglected lunatic-
 
 APPENDIX. 
 
 HISTORY OF THE NON-RESTRAINT 
 SYSTEM. 
 
 By B. W. RICHARDSON, M.A., M.D., 
 
 As extracted from the 'Medical Times and Gazette,'' Oct. 22, 
 and Nov. 12, 1864. 
 
 THE MEDICAL HISTORY OF LINCOLN. 
 
 The old city of Lincoln, if it present not, to 
 the purely medical reader, so many features of 
 practical interest as Birmingham, Wolverhamp- 
 ton, or the Potteries, has one point of great 
 historical value in its favour; in fact, it is 
 probable there is no town or city in this king- 
 dom in which, during the present century, so 
 important an event has taken place in the 
 treatment of one form of disease as in Lincoln. 
 I allude to the introduction, into one of the 
 charities of the city, of that system of the 
 treatment of the insane, known as the system of 
 non-restraint. I, for one, feel that, excepting 
 the discovery of Jenner, no such advance has 
 been made in practical scientific medicine as 
 this non-restraint method, the very greatness 
 and simplicity of which almost enshrouds its 
 meaning and reality. In traversing our modern
 
 88 Appendix. 
 
 asylums with the young, I have found It difficult 
 to make them understand what the improvement, 
 that within one generation has been effected, is 
 at all like. It hardly appears possibly true to the 
 mind charged with the sentiments of to-day, 
 and with so much more of that perfect love 
 which casteth out fear, that there has ever been 
 a time when every insane person who may be met 
 in the corridor, the play-room, or the walking- 
 ground, of the asylum, might once have been 
 seen, in the period of current memory, a miser- 
 able, manacled, tortured specimen of humanity — 
 a specimen such as the gaol would not now 
 present, and lodged in a prison over which even 
 the modern workhouse offers numerous advan- 
 tages. And yet all this is true, and the picture 
 of the past cannot be forgotten in the picture of 
 the present by those whose recollections can 
 carry them back some quarter of a century : 
 neither should it, nor shall it, be forgotten that 
 here, in Lincoln, the great reform which has 
 made the two pictures so definite quietly oc- 
 curred — a reform which marked an entire revo- 
 lution in psychological medicine ; a reform 
 which the man who led it, and who, I think, I 
 might almost say completed it, has lived to see 
 carried out to this day without reserve and in 
 all parts of the world. More of this subject in 
 the sequel, and in due time and place: I have 
 touched on it thus early to recall the fact that 
 Lincoln has a Medical claim worthy of conside- 
 ration ; like Schlegel's historical prophet, with
 
 Appendix. 89 
 
 his head turned backwards, I see the Medical 
 scholar of a century hence climbing the steep 
 hill that leads to the City Asylum to visit the 
 place as a spot that must be seen, like the 
 birth-place of Shakespeare, or the Egyptian tomb 
 in the Holy Island whence Osiris rose again. — 
 (Oct. 22, 1864, page 440). 
 
 The City of Lincoln Lunatic Asylum or Hos- 
 pital is situated, as I have once before said, on 
 the upper part of the city, overlooking a wide 
 extent of country. It is a plain building from 
 the exterior, but light and cheerful within. The 
 construction is of the old architectural type: a 
 plain front, wings, and galleries. As it was in 
 this building that the system of non-restraint for 
 the insane was carried out, it is well for me to 
 be rather minute in the description of the place 
 and of the event it covers. 
 
 The asylum was opened for the reception of 
 lunatics in the year 1820. Prior to the erection 
 the lunatics of the city had been placed in asylums 
 in the neighbourhood of London, or in their own 
 homes ; not unfrequently in outhouses and sheds. 
 The idea of building an asylum originated with 
 a Mr P. Parnell, who left a sum of one hundred 
 pounds, conditionally, towards the expenses, 
 many years before anything was done. At first 
 the asylum was not able to receive more than 
 forty or fifty inmates, and these were intended 
 to be persons who had seen better days : it soon, 
 however, changed in its practical working, and
 
 90 Appendix, 
 
 was occupied by paupers mainly. In the course 
 of a few years it underwent enlargement, and in 
 1835 it was capable of containing from sixty to 
 seventy inmates. The first Honorary Medical 
 Officers were Dr Ambrose Cookson, Dr Charles- 
 worth, Dr Hett, and Mr James Snow. The first 
 resident medical officer or superintendent was 
 Mr Thomas Fisher, who resigned his office on 
 October 14, 1830. He was succeeded by Mr 
 Henry Marston, who resigned on April 9, 1834. 
 Mr Marston's successor was Mr Samuel Had- 
 wen, who held office until July 8, 1835. The 
 next election of a superintendent brought for- 
 ward Mr R. Gardiner Hill, then a young man of 
 twenty-four years of age, to whose exertions, 
 courage, and observation the world is indebted 
 for the introduction of non-restraint in the treat- 
 ment of the insane. Mr Hill, up to the time 
 of his election, was Medical Officer or House- 
 surgeon of the General Dispensary of Lincoln. 
 He was persuaded to compete for the office at 
 the asylum by Dr Charlesworth. Upon entering 
 on his duties the condition of the asylum was as 
 follows : — 
 
 The moral and social management of the in- 
 mates was under the direct and sole control of 
 the resident medical officer; the honorary phy- 
 sicians and surgeon took part only in the treat- 
 ment of the symptoms of physical disease. The pa- 
 tients were classified in three groups, the orderly, 
 disorderly^ and convalescent, and these were 
 again divided into three ranks according to the
 
 A-pfendix. 9 1 
 
 sums paid for them. The patients who were 
 considered orderly and convalescent were allowed 
 to have the best rooms and the use of front 
 grounds. They were also allowed to intermingle 
 amongst themselves, and so long as they re- 
 mained in the class in which they were grouped 
 they were subject to no restraint. The majority 
 of these were imbeciles, monomaniacs, and me- 
 lancholies. The disorderly patients were placed 
 in the back wards or galleries on the north side 
 of the building, and they had ouly the use of a 
 court-yard. They were subjected to the most 
 strict system of restraint, but the methods of re- 
 straint adopted varied somewhat from those com- 
 mon at that time to asylums in general. Most 
 of the modifications in the way of restraint had 
 been introduced on the suggestion of Dr Charles- 
 worth, and were simply these. The strait-waist- 
 coat had been laid aside, and in place of it iron 
 handcuffs were used, attaciied to leathern belts 
 going round the body. The reason for this 
 change was not based on the idea that the re- 
 straint of the handcuffs was less than that of the 
 waistcoat, but on the circumstance that a patient 
 had been found dead, apparently strangled by one 
 of the waistcoats. The handcuffs, consequently, 
 were thought to be safer and equally effectual. 
 A second modification consisted in the use of 
 what were called the " boot hobbles " of Dr 
 Charlesworth. To explain what this invention 
 was, it is necessary to state that previously to 
 the invention the legs of the patients at night were
 
 92 Appendix. 
 
 confined to the foot-board of their tub bedsteads 
 by means of iron leg-locks. The " boot hobbles " 
 of Dr Charlesworth were boots made of bed-tick 
 and leather, and were locked by the soles to the 
 foot of the bedstead. The reason for the adop- 
 tion of these boots was to avoid the great chafing 
 and the irritation of skin produced by the iron 
 fillet or lock ; it was not intended that the patients 
 should not be restrained, but that they should 
 be well restrained, without suff'ering injury. The 
 idea, as far as it went, was humane, but very un- 
 successful in its working. The boots did not 
 hold the patients so securely as the " leg lock," 
 and the chafing was so great that abrasion of skin 
 and even abscess followed their employment. 
 Handcuffs and chains were also used at nifjht for 
 confining the upper limbs, and every patient who 
 exhibited violence, or who was insensible to the 
 ordinary calls of nature, was bedded on straw. 
 
 From all I can learn from reports of English 
 asylums prior to 1835, these systems of restraint 
 w^ere universal. The picture we see at Lincoln 
 had nevertheless this one redeeming quality, that 
 it aimed to be more merciful in its details. The 
 evidence is satisfactory to the eff'ect that the phy- 
 sician to the asylum who invented the " boot 
 hobbles," Dr Charlesworth, was awake to the 
 fact that from the rudeness of restraint injury 
 was often inflicted on life and limb, and it is due 
 to him to say that he tried to alleviate the suf- 
 fering arising from what he, and all others with 
 him, considered a necessary evil. But Dr
 
 Appendix. 93 
 
 Charlesworth went no further than this : he had 
 no word against restraint per se, but disputed 
 the methods by which it was carried out. His 
 improvements were analogous to those which 
 might follow if some tender-hearted philanthro- 
 pist, w^io thought capital punishment necessary, 
 should get an Act passed for culprits to be de- 
 stroyed by inhahng chloroform instead of by the 
 more brutal method of hanging them up by the 
 neck ; such a man would be a modifier of a sys- 
 tem, but he would have nothing to do with the 
 abolition of the system or the stamping of it out. 
 
 We come then to the year 1835, and to Mr 
 Hill's election. A significant fact followed him 
 into office. After he was comfortably installed 
 there arrived at the asylum " an order " of hand- 
 cuffs from Birmingham ; four dozen " wrist- 
 locks " for the use of the institution. During 
 his first year Mr Hill, naturally, to a large extent 
 accepted things as they were, but not without 
 distrust and disgust. A patient whose wrists 
 had been rendered sore by the handcuffs had a 
 penchant for eating his poultices ; and this ex- 
 cited Mr Hill's feeling against restraint alto- 
 gether. He began therefore gradually to feel his 
 way towards removing it, once and for all, and 
 he soon commenced to discover that success was 
 certain in its course. 
 
 It is commonly assumed — I know not on what 
 data — that the non-restraint method came into 
 existence in the asylum at one step — as though 
 some one had said openly and tersely. Every fetter
 
 94 
 
 Appendix. 
 
 shall be at once removed. There is no ground 
 whatever for such an assumption. The facts are 
 clear on the reports of the asylum that Mr Hill 
 went to work leisurely, and, as we may say, case 
 by case, in removing the manacles from the 
 patients under his care. But true it is also that 
 as he progressed he was astounded to see how 
 readily the restraint system succumbed when its 
 gradual removal was put to the test. In a very 
 few months restraint became the exception in- 
 stead of the rule, and in March, 1837, the very 
 last case in which restraint was resorted to was 
 entered upon the books of the City of Lincoln 
 Asylum. It is most interesting to note from the 
 reports the course of the facts. The following 
 short table will give at a glance the correct 
 data : — 
 
 
 
 Per Cent 
 
 In 1829 {^^--r;- 
 
 mder restraint 
 Asylum 
 
 1 5416 
 
 1830 
 
 jj 
 
 58-69 
 
 1831 
 
 ;j 
 
 57-14 
 
 1832 
 
 5> 
 
 67-90 
 
 1833 
 
 » 
 
 50-57 
 
 1834 
 
 » 
 
 41-28 
 
 1835) 
 
 from L 
 
 Jan. to( 
 
 July ) 
 
 
 
 
 41-36 
 
 
 
 
 
 1835) 
 
 
 
 from C. ^^ 
 
 
 19-54 
 
 July to I 
 
 
 
 Decern.-' 
 
 
 
 1836 
 
 » 
 
 10-48 
 
 1837 
 
 j> 
 
 153 
 
 1838 
 
 JJ 
 
 •0
 
 appendix. 95 
 
 The success of the system of non-restraint, 
 so clear, so sharp, so decisive, was not accom- 
 plished without considerable and obstinate 
 opposition. The attendants in the asylum were 
 the first who raised their voices against the 
 innovation. To them the theory was surrounded 
 with imaginary personal dangers ; in addition, 
 they were compelled to perform more work. 
 When, under the old system in which they 
 had been bred up, they had pinioned their un- 
 fortunate patients, they themselves were free and, 
 as they held it, "jolly." Then the card-table 
 and beer jug and good fare invited them to ease, 
 and non-restraint was the order of their day, or 
 rather their night. Mr Hill's new-fangled 
 notions put this merry time of it out of joint. 
 Non-restraint to the insane carried with it as the 
 essential of success restraint of the attendant, 
 more watching, more care, more kindness. It 
 was a hard task to overcome the difficulties 
 imposed, but at last they were met, and atten- 
 dants such as we now see everywhere were part 
 and parcel of the asylum at Lincoln. 
 
 Another source of difficulty lay with the 
 Board of Directors of the asylum. These gen- 
 tlemen were divided in opinion ; some were 
 opposed to Hill tooth and nail — thought his 
 idea chimerical, and stamped his practice as 
 eminently dangerous. It was even suggested 
 that he himself was insane, that he had gone 
 mad on his " hobby," and with it was galloping 
 headlong to destruction. Nor was this all; it
 
 ^6 Appendix. 
 
 was alleged that in his course he had no respect 
 for others, but was ready at any moment to 
 expose the lives of the nurses and attendants not 
 less than his own to the wild fury of the maniac, 
 and all in order that his wonderful conceptions 
 should be fully realised. 
 
 Lastly, there was opposition outside of the 
 asylum ; with few exceptions, the superinten- 
 dents of other asylums received the method with 
 more than distrust, and, indeed, it required the 
 generation of superintendents then extant to go 
 out altogether, and make room for younger and 
 less prejudiced men, before the whole truth was 
 sufficiently approved. Precisely as in the case 
 of the discovery of the circulation of the ])lood, 
 few over forty fully believed. Not until Dr 
 Pritchard followed out the plan at Northampton, 
 and Dr Conolly afterwards placed it on the 
 most extended basis of proof at Hanwell, was 
 its soundness, not less than its humanity, placed 
 beyond dispute. In the actual working out of 
 his design Mr Hill was fortunate and unfortu- 
 nate in the circumstance that he was supported 
 by the steady friendship and sympathy of Dr 
 Chariesworth. He was fortunate in that by 
 having in Dr Chariesworth one on whom he 
 could rely whenever he made a new and untried 
 experiment. He was unfortunate in that from 
 the very fact of having such powerful aid an 
 excuse was afterwards found for trying to de- 
 prive him of credit which success had rendered 
 unusually valuable, and for endeavouring to
 
 Appendix. 9*7 
 
 divide his dearly -bought honours with his senior 
 ofRcer and former friend. On this attempt 
 there arose some years ago a paper war signahsed 
 by two peculiar traits — a rancour against Mr 
 Hill which it is hard to see surpassed, and a 
 quiet, staid, unassuming defence, on his part, 
 which it would be difficult to imitate. Lookina: 
 over all the documentary evidence that is pro- 
 curable, with the determination to be the simple 
 and faithful historian, I must say that a more 
 pitiable spectacle than the endeavour to rob Mr 
 Hill of the value and respect due to his labours 
 was never before witnessed in such a contro- 
 versy. The evidence is conclusive that for years 
 Dr Charlesworth himself gave to Mr Hill the 
 full credit of the introduction of the non-restraint 
 system, and, what is more, he lived and died 
 without leaving a line claiming the introduction. 
 For this and for his support rendered to Mr 
 Hill we may thank him heartily, and, indeed, he 
 might have placed himself by the merest touch 
 of generosity in one of the most enviable posi- 
 tions in the history of physic. Had he, when 
 his injudicious friends claimed for him that 
 which he never did — had he then and there 
 possessed the courage to repeat the words he 
 used at the meeting of the Provincial Medical 
 Association at Hull — had he said what was just 
 true, that he was the first and earnest abettor of 
 a system which he did not invent, it would have 
 been the happiness of the commentator to have 
 placed him in the first rank of those men who 
 
 H
 
 98 Appendix. 
 
 have been made great by their own resignation 
 of imputed fame and their sacrifice of self to the 
 dictates of conscience. Unfortunately Dr Charles- 
 worth had not the courage to speak out : he 
 could not actually claim what he knew belonged 
 to his friend ; but he died letting his friends 
 claim for him that which he would not claim 
 for himself. 
 
 I have entered rather largely into this ques- 
 tion of the origin of the system of non-restraint 
 in lunacy, because it is a question that in the 
 future will be of profound interest to the 
 historian, and because the said historian will of 
 necessity turn to what is written in this day for 
 his evidences and convictions. I am bound, 
 therefore, to give what seems to be the simple 
 and actual truth ; and the truth is, that the 
 whole credit of introducing the system of non- 
 restraint is due to Mr Hill. There had been 
 perhaps before him some vague or feeble humani- 
 tarian ideas on the subject ; there had been an 
 impression, which, in fact, could not fail to 
 arise, that restraint was cruel ; but it was Mr 
 Hill who dared to show that it was as un- 
 necessary as it was cruel. 
 
 In that act of daring he won the prize, as 
 Columbus, by the same act, won a new world. 
 Had Mr Hill failed in his efforts; had some 
 maniac, who previously was held in mechanical 
 restraint, committed a murder in the early days 
 of his system, the failure — the crime almost — 
 would, clearly enough, have been saddled on Mr
 
 Appendix. ^g 
 
 Hill ; while those who were opposing him 
 would not have failed to have beaten him with 
 his own weapon. Had he failed in those first 
 efforts, there is not the slightest reason to 
 suppose that even now restraint would have 
 been abolished. These negatives are so clear 
 that those who run may read them ; and why 
 the affirmative should ever have been doubted I 
 cannot, for my part, decipher, except by assum- 
 ing that it is the most difficult of all concessions 
 to recognise the successful labourer in his own 
 day and generation. Away with the thought ! 
 Let us give Gardiner Hill his just due, if no 
 more, and be proud to feel that we have lived 
 with him, and have bound up such works as we 
 have done in the same volume of the time. — 
 (Nov. 12, 1864, page 521.) 
 
 Further evidence corroborating the import- 
 ance of the application of the system of non- 
 restraint in connection with my practice at the 
 Lincoln Lunatic Asylum : — 
 
 From Dr Charlesworth's letter-testimonial, 
 Nov. 26, 1838.— "He (Mr Hill) has dili- 
 gently applied all the means of amelioration 
 placed at his disposal, and in so doing has 
 conceived and effected results honourable to 
 himself, and beyond the hopes of the Board. 
 The practice of restfmnt and coercion has dis- 
 appeared under his management. — (Signed) 
 H 2
 
 loo Appendix. 
 
 E. P. Charlesworth, M.D., Senior Physician 
 of the Asylum." 
 
 From Dr Cookson's letter-testimonial, Nov. 
 27, 1838.—" He (Mr HiU) has, during his stay 
 with us, so completely substituted a system of 
 strict supemsion for the old system of restraint, 
 that the latter has in our establishment become 
 entirely obsolete. — (Signed) W. D. Cookson, 
 M.D., Physician to the Lincoln Lunatic 
 Asylum." 
 
 Review of Mr Hill's Lecture in the * Lincoln 
 Standard,' by Sir E. Ff Bromhead, Bart,, re- 
 vised by Dr Charlesworth, May 15, 1839: — 
 
 "It is not often that a provincial town has 
 produced a work of this description — a work 
 which may fairly lay claim to an European 
 character, as forming a most marked era in the 
 interesting subject on which it treats. Mr Hill 
 had for some time successfully carried into 
 operation at our asylum the total abolition of aU 
 restraint and all severity, before he presented 
 himself to the public as the deliverer of a lecture 
 on the subject. In this lecture, Mr Hill ex- 
 hibits a frightful picture of the ancient abuses 
 universally inflicted on the insane, until the 
 benevolent Pinel made an inroad on this 
 domain of cruelty. He began what Mr Hill 
 has completed. The graphic description of some 
 of Pinel's cases might touch the coldest heart ; 
 and some of the cases brought forward by Mr
 
 Appendix. loi 
 
 Hill, from the store of his own experience, are 
 also of a very touching and affecting character. 
 The receptacles for the insane were formerly 
 deemed places of safe-keeping for wild beasts, 
 in which cure was never dreamt of, except as 
 the result of accident, and in which the most 
 horrid%nd painful modes of confinement, amidst 
 loathsome dirt, cold, and hunger, and frequent 
 blows, was systematically practised ; that the 
 keepers (as the attendants were termed) might 
 riot in debauchery, free from all concern and 
 trouble about their victims. The public will 
 bear this no longer ; the atrocities at Bethlem, 
 York, and Warburton's have awakened indignant 
 sympathy, so that kindness is now universally 
 professed, while the public eye is excluded with 
 a kind of jealous dismay, lest, forsooth, the 
 lunatic should be distressed by it. At Lincoln, 
 the Boards resolutely set about to ameliorate the 
 treatment, and have confirmed the remark, 
 ' were every one to see the whole effects, mediate 
 and immediate, present and remote, even of 
 trifling acts of good or evil, his mind would, 
 on many occasions, be filled with delight or 
 remorse.' The Governors never expressed a 
 loish for the extinction of restraint ; they never 
 expected it, not one of them deemed it possible. 
 They did all the good they could in a proper 
 direction, they mitigated evil. . . . He (Mr 
 Hill) had much to struggle with — the character 
 of visionary humanity, the underplot of reluctant 
 servants, who found every step in his progress a
 
 I02 * Appendix. 
 
 trespass on their repose ; and it may be con- 
 sidered most fortunate for mankind that no un- 
 lucky a iwopos accident blasted the plan for 
 ever." 
 
 From the Governor's Memorandum Book, 
 Lincoln Asylum, Oct. 9, 1839.— " The 'entire 
 absence of restraint still continues, to the high 
 honour of the house-surgeon." — (Signed) " Edw. 
 Ff. Bromhead, W. M. Pierce, E. P. Charles- 
 worth." 
 
 Sir Edw. Ff Bromhead's letter-testimonial, 
 addressed to the Chairman of the Lunatic Asy- 
 lum., Bodmin, — " Thurlby Hall, Newark, Nov. 
 6, 1840. — Sir, I have great pleasure in certifying 
 my opinion of the probity, zeal, good temper, 
 and solid judgment of Mr R. G. Hill, shown for 
 several years as house-surgeon of the Lincoln 
 Asylum. Having myself, for a very long period, 
 paid much attention to this asylum, the County 
 Prison, and other public institutions, I can de- 
 clare that I have not yet met with any officer so 
 little disposed to content himself with formal 
 duty, nor any who seemed more to take a deep 
 personal interest in his duty. It is most honour- 
 able to him, that when I was in the chair on 
 Mr Hill's retiring from office, the vote of regret 
 for his loss, and thanks for his services, passed 
 the Board unanimously, though the opponents 
 of his system of throwing aside the strait- 
 waistcoat and chains were then present. Most
 
 Appendix. 103 
 
 unhappily, this great improvement has been 
 deemed a rebuke to the practice of Mr Hill's 
 predecessors, and the practice of other houses, 
 and has drawn much acrimonious exaggeration 
 and even misstatement against the practice, and, 
 finally, as might be expected, some hostility to 
 the author from the party favourable to instru- 
 mental restraint and their friends. — I have the 
 honour to be, Sir, your very obedient servant, 
 Edw. Ff. Bromhead." 
 
 From the Physician's Case Book, January 3, 
 1841. — "The bold position taken by Mr Hill 
 in his publication on the non-restraint system, 
 assuming the practicability of a total abolition of 
 instrumental restraint, was not less sensible than 
 sound. The present house-surgeon has taken a 
 similar position as regards the abolition of soli- 
 tary confinement, and I trust he will succeed in 
 his object, as Mr Hill has done in his own'' 
 — (Signed) " E. P. Charlesworth." 
 
 From the ' Stamford Mercury,' May 3, 1839. 
 — " Lecture on the Management of Lunatic 
 Asylums, by Robt. Gardiner Hill, house-surgeon 
 of the Lincoln Lunatic Asylum. — The author of 
 this volume has distinguished himself as being 
 the first individual in this country to emancipate 
 the sufferers under the bereavement of reason 
 from the cruel and ill-judged punishments and 
 restraints to which they were so long subject. 
 The total abolition of personal restraint in the
 
 1 04 Appendix. 
 
 treatment of the insane, be it remembered, dis- 
 tinguishes our County Asylum alone; and Mr 
 Hill is the praiseworthy individual who alone has 
 had the benevolence and courage to attempt this 
 great moral reform, in spite, too, of numerous 
 sneers thrown at him by the managers of the 
 Nottingham and other asylums." 
 
 From the * Stamford Mercury,' May 31, 
 1839.—" J. Conolly, Esq., M.D.,' Physician of 
 the Hanwell Lunatic Asylum, and his brother, 
 W. Conolly, Esq., M.D., last week inspected the 
 institution at Lincoln. These gentlemen regis- 
 tered in the visitors' book a strong testimonial of 
 the effects produced by the humane system of 
 Mr Hill. Mr H. was the first to break through 
 the prejudice of medical men, and to commence 
 a course of treatment diametrically opposite to 
 the barbarous system of his predecessors. Its 
 result has been success to an unprecedented ex- 
 tent ; and we doubt not that ere long the plan 
 of conciliatory treatment will be universally 
 adopted. Coercion might have deprived the 
 world of the mine of intellectual wealth stored 
 in the clouded mind of the poet Cowper ; kind- 
 ness, and an opportune effort to lead him into his 
 former pursuits, restored him." 
 
 From the ' Athenseum,' Sept. 28, 1839.— 
 " A Lecture on the Management of Lunatic 
 Asylums, &c,, by Robert Gardiner Hill. — ' The 
 object of this lecture,' we are told in the preface,
 
 Appendix. 105 
 
 *is simply to advocate the total abolition of 
 severity of every species and degree in our asy- 
 lums for the insane ; and, with this view, to 
 show, first, that such abolition is in theory 
 highly desirable ; and secondly, that it is practi- 
 cable.' Mr Hill, who is house-surgeon of the 
 Lincoln Lunatic Asylum, has apparently designed 
 this lecture, in the first instance, as a compte 
 rendu to the subscribers to that institution ; but 
 he has done wisely in giving it a more extended 
 circulation. The main proposition he has un- 
 dertaken to establish, — that in a properly con- 
 structed building, with a sufficient number of 
 suitable attendants, restraint is never necessary, 
 never justijiable, and always injurious in all 
 cases of lunacy whatever (page 21) — we be- 
 lieve to be substantially correct ; and it is a fact 
 no less consolatory than true. . . . The 
 impediments in the way of a general adoption 
 of the Lincoln plan are all summed up under 
 the two heads of trouble and expense; and 
 these, in fact, resolve themselves into the one 
 consideration of money. . . . In a case of 
 this kind, however, expense is a consideration 
 scarcely to be entertained ; and we trust that this 
 appeal of Mr Hill will find its way throughout 
 the kingdom, and that humanity will not be 
 suffered to sleep over his statements. The 
 fundamental revolution in the treatment of the 
 insane which this author recommends, if sanc- 
 tioned by ulterior experience, will be one of the 
 greatest and most glorious triumphs of civili-
 
 1 o6 Appendix. 
 
 sation over prejudice and ignorance, of which 
 modern times can boast. Most heartily do we 
 desire its immediate success." 
 
 From the 'Penny Magazine,' January 16, 
 1841. — "But with respect to the important 
 matter of restraint, we cannot avoid noticing 
 that Mr Hill was the first to contend that no 
 personal restraint, such as that implied by the 
 use of bands, belts, &c., was necessary; and, 
 startling as the opinion was, he unquestionably 
 reduced his theory to practice in the Lincoln 
 Asylum for the space of two or three years 
 without a single accident." 
 
 From the ' Asylum Journal,' January 1, 1855. 
 — " The measure of desert of Mr Hill and Dr 
 Charlesworth has been the subject of acrimonious 
 discussion, the more painful because, all the facts 
 being known, it was perfectly unnecessary. It 
 is not denied that the whole proceedings at 
 Lincoln were animated by Dr Charlesworth, and 
 that, being first in command there, he was the 
 systematic promoter of all efforts to improve the 
 condition of the lunatic. Nor is it possible to 
 doubt that with Mr Hill originated the concep- 
 tion of the total abolition of restraint, and that 
 he first put it into practice ; that he was not 
 only the first man to think the thing possible, 
 and to express that belief, but the first man also 
 to make it an accomplished fact. On what sub- 
 stantial point, therefore, is dispute possible ? "
 
 Appendix. 1 07 
 
 (Signed) " J. C. Bucknill, Editor of Journal, 
 and now one of the Chancery Lunacy Visitors." 
 
 From the ' Asylum Journal,' Feb. 15, 1855. 
 Third Notice of the Eighth Report of the Com- 
 missioners in Lunacy, by John Conolly, M.D. — 
 " The Lincoln Asylum must always occupy an 
 important place in the history of asylums, as 
 having been the first in which the idea of wholly 
 abolishing mechanical restraints was adopted in 
 the most unqualified manner, and acted upon 
 with success, I wish on this occasion, as on 
 many former ones, to express my grateful recol- 
 lection of the advantage I derived from a visit 
 to that asylum in May, 1839, with Mr Gardiner 
 Hill ; and to an interview, on the same occasion, 
 with the late Dr Charlesworth. Although, when 
 a student, I had been familiar with the admirable 
 principles of treatment, as regarded the insane, 
 in Mr. Samuel Tuke's account of the Retreat at 
 York, and with the writings of Pinel, it is pro- 
 bable that I might never have conceived the idea 
 of entirely excluding restraints from an asylum if 
 I had not seen that it was practicable at Lincoln." 
 
 From the 'Asylum Journal,' April 2, 1855. 
 — Fourth Notice of the Eighth Report of the 
 Commissioners in Lunacy, by John Conolly, 
 M.D. — " But one reference more I must make, 
 and with it I shall conclude. It is pleasant to 
 cite the latest testimony of Mr Gardiner Hill, 
 who, after his experience in the Lincoln Asylum,
 
 io8 Appendix. 
 
 has now for some years put the non-restraint 
 system equally to the test in his private esta- 
 blishment of Eastgate House in that city. Mr 
 Gardiner Hill may have employed a few un- 
 guarded expressions in his celebrated lecture in 
 1838 ; but that lecture excited universal atten- 
 tion in asylums. 
 
 " Mr Gardiner Hill says : ' As I had occasion 
 to remark some years ago, does restraint prevent 
 accidents? Experience proves the contrary. 
 Does restraint prevent suicide? Experience 
 proves the contrary. Can a patient, insensible 
 to the calls of nature, be restored to habits of 
 cleanliness while under restraint ? He cannot. 
 Does restraint contribute to the recovery of a 
 patient ? Experience proves the contrary. It 
 exasperates the sufferer, excites in him a spirit 
 of revenge against the attendants, and thus is 
 the fertile cause of accidents or injuries in an 
 asylum. 
 
 " ' I further observe, non-restraint is practi- 
 cable, for it has been well tested ; it is humane, 
 as all must acknowledge ; it contributes to the 
 comfort, the cheerfulness, and the recovery of the 
 insane. It is also safe, for no serious or fatal 
 accident has occurred in consequence of it. Con- 
 stant surveillance has prevented this. It soothes 
 the patient, keeps his angry and revengeful pas- 
 sions at rest, gives him the power to assist 
 himself, and thereby prevents his falling 
 into habits of hopeless filth and misery ; and 
 I venture to pronounce of it that it is the
 
 Appendix. 109 
 
 system which must and will ultimately prevail 
 in every asylum.' 
 
 " These are words of great weight and value. 
 They proceed from one who has lived in an 
 asylum ; has watched the effects of different 
 treatment in very numerous cases from the hour 
 of their admission to the end ; and who knows 
 all the details of the anxious but most instructive 
 nights and days of those medical officers who, 
 resident under the same roof with many lunatics, 
 are zealous and vigilant, and depend more upon 
 their own observation than on the vague reports 
 of uneducated or slothful subordinates."
 
 POSTSCRIPT. 
 
 QINCE this work was in type, certain non-medical journals 
 have been industriously ventilating the question of the pro- 
 priety of returning to the use of the strait-waistcoat, in conse- 
 quence of some painful disclosures in one or two of our large 
 public asylums during the past year. This suggestion, stripped 
 of its plausible recommendations, is neither more nor less than a 
 recognition of restraint in disguise. The sanction of the strait- 
 waistcoat would only be the stepping-stone to the revival of tlie 
 abominations of the practices of the old system, and with that 
 old system there must be no parleying. Non-restraint may be 
 compared to the indestructible pillar of Smeaton that is founded 
 on a rock ; the passions, the prejudices, the winds and waves of 
 current doctrine may assail it, but only to prove that it can hold 
 its own against all comers. " Vestigia nulla retrorsum " must 
 be our motto. As well expect to re enact the Heptarchy, or 
 revivify Gattou and Old Sarum, because occasional failures cross 
 our path. 
 
 It must be borne in mind that non-restraint was never 
 brought forward as an absolute unimpeachable remedy that 
 would under all imaginable circumstances anticipate every pos- 
 •sible strain that might be put on it. Like all other human dis- 
 coveries, it was not pei'fect, because it required other human 
 agencies to carry out its behests, and in this way it was liable to 
 occasional failure ; but, nevertheless, where lives the man who is 
 not prepared to endorse the statement that it was a gigantic
 
 ii Postscript. 
 
 stride in advance of the system it superseded ? Look at sub- 
 sidiary contributions that have made the triumphs of art con- 
 spicuous. Is vaccination an invariable prophylactic against the 
 scourges of small pox, and do we find that the invaluable boon 
 that chloroform has conferred is not sometimes marred by 
 disastrous and fatal results ? Good and evil under the pro- 
 vidence of God are so permitted to exist as if to rebuke 
 our pride by showing us that there is only One that is per- 
 fect. Failure, then, being admitted to accompany us in all our 
 advances, it is important that we should accurately weigh their 
 value by the test of exiierience, — to balance, in so many words, 
 the state of the account. That occasional casualties have taken 
 place in our large asylums, under the non -restraint system, and 
 that their recuri-ence is to be prevented by falling back on the 
 old expedient of strait- waistcoats involves something like a,petitio 
 principii, as if no such accidents ever occurred under the ancient 
 system. If the oracles could ever disclose their terrible secrets, 
 a difierent tale would be told. The notion of the easy application 
 of the strait- waistcoat somewhat resembles the "belling of the 
 cat," and involves a brutal struggle between two opposing forces, 
 in which ribs may be broken and other injuries inflicted. Un- 
 doubtedly, it is eminently unsatisfactory that these misadventures 
 should occur, and still more so that they should be shrouded 
 in such imjjenetrable mystery. With proper supervision 
 and care they ought not to happen. Absolutely to prevent 
 them may be a difficulty, but to minimise their occurrence 
 is quite within the range of possibility. With that view, 
 it should be recognised as an axiom in an Asylum, that if 
 it be necessary to subdue maniacal excitement by force, that 
 force should not be employed without the presence of the 
 educated intelligence of the house, so that responsibility should 
 be fixed where it properly belongs. I think the process now 
 resorted to in Asylums of " Club Law," when it is necessary to 
 interfere with the restricted liberty of the patient, should never 
 be left as it is to the impulsive energies of the attendants, who
 
 Postscript. iii 
 
 are acquainted with nothing beyond brute force. "We do not in 
 the outside world, when a capital operation is to be performed, 
 rely on our individual skill ; we are glad to avail oui'selves of the 
 presence of neighbours and friends. Consider the act which 
 deprives a man of his limited liberty in an Asylum as one that is 
 to be classed with lithotomy, and you will from that date 
 inaugurate a purer and safer system of control. 
 
 But whilst every human agency should be called into play to 
 avert such evils, we must not be so exacting as to seek upon 
 every failure to revolutionise the system of non-restraint. 
 Official returns show us that, highly as we prize the safety of the 
 traveller, something like 300 individuals are annually killed in 
 the streets of London by horses and vehicles. Do we conse- 
 quently lay an embai'go on locomotion, or do we multiply our 
 means of safety by widening narrow thoroughfares, rounding 
 sharp corners, by supra or subways, or by diminishing the perils 
 of great crossings by adding to the strength of the police-force ? 
 It is to be hoped that we do one and all of these things. So in 
 the treatment of the insane — let vigilance be the motto, and 
 increase, if necessary, even the eyes of Argus. 
 
 That the public may thoroughly comprehend the nature of the 
 strait- waistcoat, so fatal in its use in former times, and realise 
 its application, I introduce the following most recent report 
 Extracted from the " Eevue des deux Mondes " of the present 
 month, as given from the pen of M. Maxime du Camp. 
 
 "It is not without difficulty (says M. du Camp) that the turn- 
 keys get a prisoner into the strait-waistcoat, and the struggles 
 and despair of most men at this aggravation of their punishment 
 cannot be witnessed without a feeling of pity, whatever their 
 crimes may be. As soon as they are strapped and buckled in, 
 most prisoners lean back panting against the wall and exclaim, 
 * This thing prevents my breathing ! ' The wearing of this gar- 
 ment is the real punishment the convict has to endure ; it 
 paralyses every motion and every gesture, and, sleeping or 
 waking, reminds him of his inevitable death."
 
 IV 
 
 Postscript. 
 
 I also introduce a statement from the " Eecords of Parlia- 
 ment," recently made by Mr Blake, M.P. In calling the attention 
 of the House to the case of Edmund Fliun, of the Clonmel 
 Lunatic Asylum, the hon. gentleman observed " that the unfor- 
 tunate lunatic had been confined in a strait-waistcoat for a 
 month, and that the treatment had terminated in mortification 
 of the hands, wrists, and arms. He was in a dreadful condition, 
 and it became necessary to send him to the hospital, where he 
 remained for some months. On coming out he was found to be 
 incaj^acitated for work. The wounds on his arms, wrists, and 
 hands were healed, but the cicatrices left were deep and most 
 pitiable." 
 
 Whatever may be the drawbacks, the shortcomings, or the 
 failures of the non-restraint system, and whatever may be the 
 responsibility of him who first inaugurated it, I adhere to it with 
 no faltering pen ; if I have erred, I must err still, and if the 
 world chooses to visit me with condemnation, I shall not shrink 
 from the consequences— prepared to exclaim in the language of 
 Euryalus : — "Me, me, adsum qui feci, in me convertite ferrum." 
 
 PRINTED BY C. V. EEYNELL, IG LITTLE PULTENET STREET, W. 
 
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