FOOTNOTES:

[316] Seventeenth Report of Commissioners in Lunacy, 1863.

APPENDIX H.

(Page 205.)

Extract from the _British and Foreign Medical Review_, January, 1840:--

"In this particular there is apparently no asylum in England which presents so remarkable a model as that of Lincoln. Of all the works that have appeared on the subject of lunatic houses since the publication of Mr. Tuke's account of the Retreat, there is none which contains matter more deserving of attention than that recently published by Mr. Hill.

His lecture is little more than a simple commentary on the resolutions of the board of management of the Lincoln Asylum for twenty years past; during which period, under the superintendence of Dr. Charlesworth, and latterly with the vigilant co-operation of Mr. Hill himself, as house surgeon, almost every kind of bodily restraint is stated to have gradually fallen into disuse as superfluous, a mere subst.i.tute for want of watchful care.... If the Lincoln Asylum can present a model of this kind, which all may visit and examine, the services of Dr. Charlesworth to the cause of humanity and in behalf of the insane, already considerable, will only be second to that of him who first released them from their chains."

On this Mr. Hill observes, July 8, 1840:--

"At last the first Medical Review in Europe took up the subject, and placed most deservingly Dr. Charlesworth in a striking position as to the non-restraint system, and also honoured myself with approbation."

The following extracts from the Orders in the Lincoln Asylum books[317]

are essential to the right understanding of the introduction of non-restraint there. Dr. Charlesworth was visiting physician from its opening in 1821; Mr. Hill was appointed house surgeon in 1835.

"1828. _Ordered_--That the use of the strait waistcoat be discontinued in this inst.i.tution except under the special written order of the physician of the month.

"1828, October 13. Ordered and resolved--That the physicians be requested to consider whether it be possible to make any improvement in the means of restraint now in use, and especially for obviating the use of the strait waistcoat."

Extract from the Fifth Report of the Lincoln Lunatic Asylum, 1829, April:--

"The governors have particularly directed their views to the subject of coercion and restraint, well aware of their injurious consequences to the patients.... The construction of the instruments in use having also been carefully examined, they have destroyed a considerable proportion of those that were not of the most improved and least irritating description, and hope hereafter to introduce still further amelioration into this department."

Extract from the House Visitor's Report, 1829, August 17:--

"Every attention seems to be paid to the patients, whose general state has, I understand, for some time past, been so generally good that it is gratifying to say that the strait waistcoat has almost become useless."

Extract from the Seventh Annual Report, 1831, March 28:--

"Heretofore it was conceived that the only intention of a receptacle for the insane was the safe custody of the unhappy objects, by any means, however harsh and severe. These views are now pa.s.sing away, and the fair measure of a superintendent's ability, in the treatment of such patients, will be found in the small number of restraints which are imposed. The new director has answered this test in a very satisfactory manner."

The new director here referred to was Mr. Henry Marston. The following note is appended to this report:--

"As early as the 24th day of November last (viz. Nov., 1830, five years before Mr. Hill's appointment), there was not any patient in the house under restraint, unless one wearing a collar, which leaves all the limbs quite at liberty, can be so considered. This gratifying occurrence has taken place more than once since that time."

Extract from the Ninth Annual Report, 1833, April:--

"It is unceasingly an object in this inst.i.tution, and should form a prominent point in the annual reports, to dispense with or improve as much as possible the instruments of restraint."

Extract from the House Visitor's Report, 1834, August 4th to 10th inclusive:--

"I have much satisfaction in being able to state that not a single male patient has been under restraint since the 16th of July, and not one female patient since the 1st of August, and then only for a few hours."

At this time Mr. Hadwen held the appointment of house surgeon.

Extract from the Governor's Memorandum Book, 1835, July 8th:--

"Resolved,--That this Board, in acknowledging the services of Mr. Hadwen during the period of fifteen months that he held the situation of house surgeon of this inst.i.tution, feel called upon to express their high approbation of the very small proportion of instances of restraint which have occurred amongst the patients under his care."

Extract from _Edinburgh Review_, April, 1870:--

"But to Conolly belongs a still higher crown, not merely for his courage in carrying out a beneficent conception on a large scale and on a conspicuous theatre, but for his genius in expanding it. To him, hobbles and chains, handcuffs and m.u.f.fs, were but material impediments that merely confined the limbs; to get rid of these he spent the best years of his life; but beyond these mechanical fetters he saw there were a hundred fetters to the spirit, which human sympathy, courage, and time only could remove.

"Perfect as was the experiment carried out at Lincoln Asylum, the remoteness of that inst.i.tution from the great centre of life, and the want of authority in its author, would no doubt have prevented its acceptance for years by the physicians of the great county asylums so long wedded to old habits. It was for some time treated as the freak of an enthusiastic mind, that would speedily go the way of all such new-fangled notions; and no doubt it would, had not an irresistible impulse been given to it by the installation of Dr. Conolly at Hanwell, where, with a n.o.ble ardour, he at once set to work to carry out in the then largest asylum in the kingdom the lesson he had learned at Lincoln."

Dr. Conolly's works bearing on mental disorders, in addition to his "Lectures on Insanity," were as follows:--

1. "An Inquiry concerning the Indications of Insanity, with Suggestions for the better Protection and Care of the Insane." 1830.

2. "The Construction and Government of Lunatic Asylums and Hospitals for the Insane." 1847.

3. "The Treatment of the Insane without Mechanical Restraints." 1856.

See "Memoir of Dr. Conolly." By Sir James Clark. 1869.

FOOTNOTES:

[317] As given in the _Journal of Mental Science_, July, 1870.

APPENDIX I.

(Page 236.)

The Commissioners give, in their Report for 1857, a table in support of the statement at p. 236, but it is not borne out by the _average_ of the six largest and six smallest county asylums.

--------------+---------------------+--------------------- | Daily average | Average weekly cost Asylum. | number of patients. | per head.

--------------+---------------------+--------------------- | | s. d.

Colney Hatch | 1257 | 9 10 Hanwell | 1020 | 10 5 Surrey | 934 | 8 8 Wakefield | 803 | 7 4 Lancaster | 710 | 8 1 Prestwich | 509 | 7 10 +---------------------+--------------------- | Average} 872 | Average} 8 8 | number} | cost } | | Dorset | 155 | 8 1 Denbigh | 189 | 9 8 Bucks | 192 | 10 8 Notts | 216 | 10 5 Cornwall | 238 | 8 3 Chester | 278 | 8 6 +---------------------+--------------------- | Average} 211 | Average} 9 3 | number} | cost} --------------+---------------------+---------------------

APPENDIX K I.