CHAPTER III.

EIGHTEENTH-CENTURY ASYLUMS--FOUNDATION OF THE YORK RETREAT.

There were in England, at the beginning of the eighteenth century,

private asylums for the insane, the beneficial treatment pursued in

which was loudly vaunted in the public ear; but I am afraid the success

was not equal to the promise or the boast. Thus, there was in London an

old manor house in Clerkenwell, previously the residence of the

Northampton family, which was converted into a private asylum by Dr.

Newton the herbalist. His work, "The Herbal," was published by his son

some years afterwards. There appeared in the _Post Boy_ (No. 741) in the

year 1700 an advertisement from Dr. Newton, which runs as follows:--"In

Clerkenwell Close, where the figures of Mad People are over the Gate,

liveth one who by the blessing of God cures all Lunatick, distracted, or

mad people; he seldom exceeds three months in the cure of the Maddest

person that comes in his house; several have been cured in a fortnight

and some in less time; he has cured several from Bedlam, and other

mad-houses in and about the city, and has conveniency for people of

what quality soever. No cure--No money."

A certain Dr. Fallowes published a work on insanity which attracted some

attention at this period, having for its title, "The Best Method for the

Cure of Lunatics, with some Accounts of the Incomparable Oleum

Cephalicum used in the same, prepared and administered."[100] The author

observes in his preface that "as this Kingdom perhaps most abounds with

lunaticks, so the greatest variety of distractions are to be seen among

us; for the spleen to which it has been observed this nation is

extremely subject, often rises up to very enormous degrees, and what we

call _Hypo_ often issues in Melancholy, and sometimes in Raving

Madness." The proper seat of madness, he adds, appears to be the brain,

"which is disturbed by black vapours which clog the finer vessels thro'

which the animal spirits ought freely to pass, and the whole mass of

blood, being disordered, either overloads the small veins of the brain,

or by too quick a motion, causes a hurry and confusion of the mind, from

which ensues a giddiness and at length a fury. The abundance of bile,

which is rarely found to have any tolerable secretion in such patients,

both begets and carries on the disorder." Again, it will be seen that

there is nothing more than the fashionable classic humoral pathology,

without any original observations, and, in fact, the book is little more

than a puff of his incomparable oleum cephalicum, "a noble medicine,"

which he professes to have discovered; "a composition so very curious,

which I have known the use and benefit of in so many instances, that I

can venture to assure it to be the best medicine in the world in all the

kinds of lunacy I have met with. It is of an excellent and most pleasant

smell, and by raising small pustules upon the head, which I always

anoint with it, opens the parts which are condensed and made almost

insensible by the black vapours fixed upon the brain; it confirms its

texture, strengthens the vessels, and gives a freedom to the blood and

spirit enclosing them.... When applied after the greatest fury and

passion, it never fails to allay the orgasm of the animal spirits, and

sweetly compose 'em.... The distemper will be soon discharged, and I

have known it frequently to produce a cure in the space of one month."

He tells the reader he has had L10 a quart for it, but in compassion for

the poor he has prepared a quantity to be sold at L4 a quart at his

house. He also boasts of his kind treatment, and says, "The rough and

cruel treatment which is said to be the method of most of the pretenders

to this cure, is not only to be abhorred, but, on the contrary, all the

gentleness and kindness in the world is absolutely necessary, even in

all the cases I have seen." He says that not only has he never used

violence, but that his patients have good and wholesome food in every

variety, and maintains that such entertainments as are fit for persons

of any degree or quality will be found in his house in Lambeth Marsh,

"where the air is neither too settled and thin, nor too gross." As

chalybeate waters and cold bathing are useful, they can be had near, at

the Lambeth waters and in the Southwark Park; and he closes his book by

declaring that he is "always ready to serve mankind upon such terms as

shall be acknowledged reasonable and proportioned to the character and

condition of every patient."

Whether the patients placed under his care were treated as

scientifically and kindly as at the well-known asylum now in Lambeth

Road does not admit of question, although the latter has not much to say

of the "black vapours fixed upon the brain," nor can it, I am afraid,

boast of such a panacea as the oleum cephalicum!

I may add that, contemporary with Dr. Fallowes, an anonymous physician

in London published "A Discourse of the Nature, Cause, and Cure of

Melancholy and Vapours," in which he prescribes for the former, among

other remedies, not only "salt armoniac" (_sic_), steel filings, red

coral, zedoary, xyloalics, but, strangest of all, _toasted silk_!

Had we no other means of knowing the treatment to which some at least of

the insane were subjected in the early part of the eighteenth century,

we might infer it from a single passage in Swift's "Tale of a Tub," in

which the author says, in a "Digression concerning Madness," that

original people, like Diogenes, would, had they lived in his day, be

treated like madmen, that is, would incur the danger of "phlebotomy, and

whips, and chains, and dark chambers, and straw."

This was written in 1704.

Another well-known writer of that period, Smollett, did not distinguish

himself for generous views in regard to the insane, and forms a complete

contrast to his contemporary, Defoe, in his ideas of what the

legislature ought to do for the insane--a contrast greatly to the credit

of the latter. Smollett thought it would be neither absurd nor

unreasonable for the legislature to divest all lunatics of the privilege

of insanity in cases of enormity--by which he evidently means violent or

homicidal acts--to subject them "to the common penalties of the law." He

maintains that the consequences of murder by a maniac may be as

pernicious to society as those of the most criminal and deliberate

assassination. The entire inability indicated by this sentiment to

distinguish between voluntary and involuntary acts, the result of

disease--between motives and consequences--is singularly well shown.

Unfortunately it was not peculiar to Smollett.

Eloquently did Daniel Defoe protest against the abuses of asylums in his

day.[101] The "True-Born Englishman" reprobates the practice of men

sending their wives to mad-houses at every whim or dislike, in order

that they might be undisturbed in their evil ways. He asserts that this

custom had got to such a head that the private mad-houses were greatly

on the increase in and near London. He might well characterize this

system as "the height of barbarity and injustice," and worse than "a

clandestine inquisition," and say that these houses, if not suppressed,

should at least be subjected to examination. "Is it not enough," he

asks, "to make any one mad to be suddenly clapped up, stripped, whipped,

ill fed, and worse used?" He says, "If this tyrannical inquisition,

joined with the reasonable reflections a woman of any common

understanding must necessarily make, be not sufficient to drive any soul

stark-staring mad, though before they were never so much in their right

senses, I have no more to say." He asks the reader to indulge for once

the doting of an old man while he lays down his remedy, and not to

charge him with the ambition to be a lawgiver. Defoe goes at once to the

point, and says that it should be no less than felony to confine any

person, under pretence of madness, without due authority. He calls upon

Queen Caroline to begin her auspicious reign with an action worthy of

herself. Addressing the ladies, he says, "Who can deny when you become

suitors? and who knows but at your request a Bill may be brought into

the House to regulate these abuses?" Defoe little knew the prejudice any

reasonable measure would arouse when he added, "I am sure no honest

member in either honourable House will be against so reasonable a Bill;

the business is for some public-spirited patriot to break the ice by

bringing it into the House, and I dare lay my life it passes." He would

have infallibly lost it.

This naturally brings us to the question of what has been done by

legislation, both for protecting the subject from being unjustly

incarcerated on the plea of insanity, and for the protection of lunatics

when confined in asylums. The only Act of Parliament, up to the year

1808, which bore upon the care and protection of the lunatic poor was

that passed in the year 1744, in the seventeenth year of George II. (17

Geo. II., c. 5). This authorizes any two justices to apprehend them, and

have them securely locked up and, as might be expected, chained. The

contrast between the spirit and the provisions of such an Act, and that

passed a century later, under the auspices of Lord Shaftesbury, brings

into strong relief the solid advance which has been made in a century,

in the face of constant opposition from interested persons, as well as

that which arises out of the mere apathy and lethargy of a large class

of the community.

It should be added, in justice to the framers of the Act of 1744, that

it refers to those who "are so far disordered in their senses that they

may be too dangerous to be permitted to go abroad." It is rather for the

protection of society than the care of the lunatic.

A Committee of the House of Commons was appointed in 1763, to inquire

into the state of the private mad-houses of the kingdom. On this

Committee sat Pitt and Fox,[102] Wilkes, Lord North, Mr. Grenville, and

Mr. T. Townshend--names which alone serve to secure one's interest, and

also to raise the expectation that something would be done. Their

Report, while evidently drawn up in a cautious manner, shows, as had

been insisted upon by Daniel Defoe, with what alarming facility the

liberty of the subject could be taken away on the plea of insanity, and

how frequently persons availed themselves of this facility in order to

get rid of a troublesome wife or daughter, or to obtain some selfish

object equally improper. Dr. Battie[103] gave it as his opinion that

sane persons were frequently confined in asylums, and mentioned a case

in which a gentleman, who had had his wife immured in one, justified

himself by saying that he understood the house to be a sort of

Bridewell, or place of correction. The same witness found one patient in

an asylum, who had been there for years, chained to his bed, without

ever having had the assistance of any physician before. He never heard

anything more of him, until he was told some time after that he had died

of fever, without having had further medical advice.

The Committee resolved, "That it is the opinion of this Committee that

the present state of the private mad-houses in this Kingdom requires the

interposition of the legislature."

The Resolution was agreed to by the House, and leave was given to bring

in a Bill for the Regulation of Private Mad-houses, its preparation

being left to Mr. Townshend and six other members of the House.

Unfortunately, no legislation followed the Report of this Committee; in

fact, no further action was taken for ten long years.

Two years after this Committee sat, a melancholy picture of the

condition of private asylums in England is given in the _Gentleman's

Magazine_, and we can well believe that it was not over-coloured when we

consider the evidence which had been given before the Committee.

The writer asserts that persons may be and are taken forcibly to these

houses without any authority, instantly seized by a set of inhuman

ruffians trained up to this barbarous profession, stripped naked, and

conveyed to a dark room. If the patient complains, the attendant

brutishly orders him not to rave, calls for assistants, and ties him

down to a bed, from which he is not released till he submits to their

pleasure. Next morning a doctor is gravely introduced, who, taking the

report of the keeper, pronounces the unfortunate person a lunatic, and

declares he must be reduced by physic. He is deprived of all

communication with the outer world, and denied the use of pen and paper.

Such usage, the writer goes on to say, without a formal warrant, is too

much even for the Inquisition in Spain or Portugal, and cries aloud for

redress in a land of liberty. One circumstance brought forcibly out is

similar to that which, occurring at York some years afterwards (1791),

led, as we shall see, to the foundation of an institution in which a

directly opposite course was pursued. "Patients," he says, "often cannot

be found out, because the master lets them bear some fictitious names in

the house; and if fortunately discovered by a friend, the master, or his

servants, will endeavour to elude his search and defeat his humane

intentions by saying _they have strict orders to permit no person to see

the patient_."

At an earlier period a lady was sent by her husband to a private asylum

simply because she was extravagant and dissipated. The account of this

affair is in manuscript, dated 1746, but the substance of it is given

by a gentleman in _Notes and Queries_, May 5, 1866. Two or three girls

were placed in the same house, in order to break off love affairs

disapproved by their friends.

Again, I observe the following entry in the _Gentleman's Magazine_ under

date Sunday, August 6, 1769:--"A gentleman near Whitehall, by the

assistance of four ruffians, forced his lady into a hackney coach, and

ordered the coachman to drive to a private mad-house, and there to be

confined."

The _Gentleman's Magazine_ writer's remedy for "a condition compared

with which none is so deeply calamitous; no distress so truly miserable;

no object so deserving of compassion, and none so worthy of redress,"

was a really effective Bill for the regulation of private mad-houses.

At last, in 1773, a Bill passed the Commons for the "Regulation of

Private Mad-houses," the Report of 1763 having been first read. But

again disappointment awaited this honest attempt to protect the insane

and those alleged to be insane. The Bill was thrown out, as too many

good Bills have been thrown out, by the House of Lords. One is reminded

of the saying of Daniel O'Connell, "If it took twenty years to do

nothing, how long would it take to do anything?" In the House of

Commons, Mr. Townshend said in the debate that facts had come to his

knowledge which would awaken the compassion of the most callous heart.

Mr. Mackworth said that the scenes of distress lay hid indeed in obscure

corners, but he was convinced that if gentlemen were once to see them,

they would not rest a day until a Bill for their relief was passed, and

protested that he would mind neither time nor trouble, but employ every

hour until some relief should be obtained. He asserted, as also did Mr.

Townshend, that it was the "gentlemen of the long robe" who prevented

any action being taken. Be this as it may, the Bill, as I have said, was

thrown out, while another,[104] which proved almost a dead letter, was

passed in the following year. It was required by this Act that licences

should be granted "to all persons who shall desire the same." Reports of

abuses were to be made to the College of Physicians, to be suspended in

the College for perusal "by whosoever should apply for that purpose;"

but the College had no power to punish delinquents. This Act is

characterized by the Commissioners in Lunacy as "utterly useless in

regard to private patients, though in terms directing visitations to be

made to lunatics," and as they observe, its provisions "did not even

apply to the lunatic poor, who were sent to asylums without any

authority except that of their parish officers." Its scope did not

extend beyond private mad-houses. For admission into these an order and

medical certificate were necessary. They were sent to the secretary of

the Commissioners, that is, five Fellows of the College appointed in

accordance with the Act. They did not license or inspect the provincial

private asylums, but these were directed to send copies of the order and

certificate to the Fellows.

It is not surprising, perhaps, that nothing was done all these years,

considering how many questions engrossed the public mind. These

comprised the exciting debates and the popular tumults connected with

Wilkes and Horne Tooke, the heated discussions on the question of the

freedom of reporting debates in Parliament, and the "Royal Marriage

Bill." Lord Clive and Warren Hastings were engaged in deeds in India

which were about to bring down upon them the philippics of Burke and Sir

Philip Francis--much more attractive than the carrying of a Lunatic Bill

through Parliament. And, above all, the struggle had commenced, though

blood had not been spilt, between this country and her American

colonies. Then again, there was the distraction caused by the remarkable

mental affection of the Earl of Chatham, on which it will be fitting,

and I think interesting, to dwell for a moment. He had become Prime

Minister in 1766, and the following year was attacked by his remorseless

enemy, the gout. Partially recovered, he returned to Parliament--so

partially, indeed, that he was "scarce able to move hand or foot."

Engaged in making certain changes in the ministry, he began (to employ

the descriptive language of Trevelyan[105]) "to be afflicted by a

strange and mysterious malady. His nerves failed him. He became wholly

unequal to the transaction of any public affairs, and secluding himself

in his own house, he would admit no visitors and open no papers on

business. In vain did his most trusted colleagues sue to him for one

hour's conversation. As the spring advanced, he retired to a house at

Hampstead, and was able at intervals to take the air upon the heath,

but was still at all times inaccessible to all his friends." His

brother-in-law, Mr. Grenville, wrote:[106] "Lord Chatham's state of

health is certainly the lowest dejection and debility that mind or body

can be in. He sits all the day leaning on his hands, which he supports

on the table; does not permit any person to remain in the room; knocks

when he wants anything; and, having made his wants known, gives a signal

without speaking to the person who answered his call to retire."

"Other accounts of a rather later period," says Lord Mahon, "state that

the very few who ever had access to him found him sedate and calm, and

almost cheerful, until any mention was made of politics, when he

started, trembled violently from head to foot, and abruptly broke off

the conversation. During many months there is no trace in his

correspondence of any letter from him, beyond a few lines at rare

intervals and on pressing occasions, which he dictated to his wife. Even

his own small affairs grew a burden too heavy for his enfeebled mind to

bear. He desired Mr. Nuthall, as his legal adviser, to make ready for

his signature a general power of attorney, drawn up in the fullest

terms, and enabling Lady Chatham to transact all business for him

(Chatham Correspondence, vol. iii. p. 282, August 17, 1767). At the

close of the summer he was removed from Hampstead to Burton Pynsent, and

thence to Bath, some benefit to his health being looked for from the

change. But all his own thoughts and wishes at this time were centred

in the purchase of Hayes. In that air he had enjoyed good health; in

that air he might enjoy it again. There, in former years, he had made

improvements which his memory fondly recalled--plantations, for example,

pursued with so much ardour and eagerness that they were not even

interrupted at nightfall, but were continued by torchlight and with

relays of labourers. To Hayes, again become his property, Lord Chatham

was removed in December, 1767. But there, during many months ensuing, he

continued to languish in utter seclusion, and with no improvement to his

health.

"It is scarcely to be wondered at that a malady thus mysterious and thus

long protracted should have given rise to a suspicion in some quarters

that it was feigned or simulated, with a view to escape the vexations or

avoid the responsibilities of office. This idea, however natural, was

certainly quite unfounded. But, on the other hand, we may not less

decisively discard the allegation of gout.... In truth, it was not gout,

but the absence of gout, which at this period weighed upon Lord Chatham.

On the 2nd of March he had arrived in London from Marlborough, still

lame, and no more than half recovered. There his new physician, Dr.

Addington, eager, no doubt, to restore him to his public duties with the

least delay, had rashly administered some strong remedies, which did

indeed dispel the gout from his limbs, but only to scatter it about his

body, and especially upon his nerves. This fact was discovered, and has

been recorded by two separate and equally shrewd observers at the time

(Lord Chesterfield to his son, December 19, 1767; Lord Orford,

'Memoirs,' ii. p. 451[107]). Hence arose the dismal and complete eclipse

which for upwards of a year his mental powers suffered. There was no

morbid illusion of the fancy, but there was utter prostration of the

intellect.... In September, 1767, Junius spoke of Lord Chatham as 'a

_lunatic_ brandishing a crutch.'"[108]

"In the autumn Lord Chatham's health grew stronger. Judging from the

event, we may conclude that the morbid humours had begun to leave his

nerves, and to concentrate for a fit--so long intermitted and so much

needed--of his hereditary gout. He was still entirely shut out from his

friends, and still unable to transact any business, but he could bear to

hear it mentioned, and could form some judgment of its tenor. In this

situation his mind, not yet restored to its full vigour, brooded over

suspicions and discontents, for which the behaviour of his colleagues

afforded him no just foundation."[109]

Lord Chatham now resigned the Privy Seal (October, 1768), which he had

held since July, 1766. "Until towards the middle of March, 1767, he had

been truly and in effect Prime Minister; since that time he had

been--_nothing_."

Lord Chatham's derangement was, however, at last dispelled. We find

that "a few weeks only after Lord Chatham's resignation, his gout, so

long interrupted, but for some time past giving symptoms of approach,

returned. Bowed down as he was by a far more grievous malady, it proved

to him a healing visitation. It raised his drooping spirits and strung

his feeble nerves. The clouds which had obscured that great intellect

wholly passed away. Never indeed did his splendid eloquence or his wise

and resolute counsels shine forth more brightly than during the next

following years."

It was in the year 1775 (November 29) that, on the American war

question, Lord Chatham emerged from his retirement--a year after the

Lunacy Act had passed.

Thirteen years later, his Sovereign fell a victim to the same disorder,

and it is probable that the attention thus drawn to the malady exerted a

beneficial influence upon public feeling, in the interests of those

labouring under the same affliction. The clerical and medical doctor,

Willis, who was at that time seventy years of age, was called in to

attend George III. in 1788. The King had had, as early as 1765, a slight

attack, but the fact was carefully concealed. Willis's treatment

consisted in bark, blistering, and an occasional dose of calomel.[110]

It is not necessary to enter here into the differences of opinion which

arose as to the conduct of the case, between himself and his colleagues,

Warren, Reynolds, and others. In February, 1789, the royal patient had

progressed so favourably that he was able to write a sensible letter to

Pitt, and on April 23rd of the same year he went to St. Paul's to offer

thanks for his recovery, amid a vast and enthusiastic multitude, thereby

running a great risk of a relapse. However, he had no return of the

complaint till 1801, when he recovered rapidly. In 1804 he again became

insane, and again recovered, the death of the Princess Amelia in 1810

causing the attack from which he never recovered. The subject of

insanity was therefore brought before the public again and again, for

some thirty years--longer, indeed, if we include Lord Chatham's

derangement--and brought before them in a way which excited their

commiseration in a marked degree.

It is worthy of notice that mechanical restraint was applied by Willis

to the King. "Nothing," observes the late Dr. Ray, "can more strikingly

indicate the change that has occurred since that time in respect to the

means of managing the insane, than the fact that for two or three months

the King was frequently subjected to mechanical restraint. There was

nothing in his condition which could be considered at the present time a

sufficient reason for its application."[111]

It may be observed here that John Wesley prescribed at this period for

madness, as well as for irreligion.[112] One of his remedies was that

the patient should be exclusively fed on apples for a month--a regimen

which recalls the starving treatment of epilepsy prescribed, at a

recent date, by Dr. Jackson, of Boston. Wesley's prescriptions for

"lunacy" and "raving madness" are given with almost as much confidence

of success as those we have cited from the Saxon leech-book.

"For Lunacy:

1. Give decoction of agrimony four times a day.

2. Or, rub the head several times a day with vinegar in which

ground ivy leaves have been infused.

3. Or, take daily an ounce of distilled vinegar.

4. Or, boil juice of ground ivy with sweet oil and white wine

into an ointment. Shave the head anointed therewith, and

chafe it in, warm, every other day for three weeks; bruise

also the leaves and bind them on the head, and give three

spoonfuls of the juice warm every morning.

This generally cures melancholy. The juice alone taken twice

a day will cure.

5. Or, electrify. Tried.

For Raving Madness:

1. It is a sure rule that all madmen are cowards, and may be

conquered by binding only, without beating (Dr. Mead). He

also observes that blistering the head does more harm than

good. Keep the head close shaved, and frequently wash it with

vinegar.

2. Apply to the head clothes dipt in cold water.

3. Or, set the patient with his head under a great waterfall,

as long as his strength will bear; or pour water on his head

out of a tea-kettle.

4. Or, let him eat nothing but apples for a month.

5. Or, nothing but bread and milk. Tried."

In all hypochondriacal cases, and in obstinate madness, Wesley

recommended the following, wherein we see a return to the almost

inevitable hellebore: "Pour twelve ounces of rectified spirits of wine

on four ounces of roots of black hellebore, and let it stand in a warm

place twenty-four hours. Pour it off and take from thirty to forty drops

in any liquid, fasting."

Lastly, for all nervous disorders, he recurs to what was his favourite

remedy, and says, "But I am firmly persuaded that there is no remedy in

nature for nervous disorders of every kind, comparable to the proper

and constant use of the electrical machine."

I would direct the reader's attention to the condition of some asylums

at the latter end of the eighteenth century, as described by a prominent

character and noble philanthropist of that period.

The celebrated John Howard did not confine his attention to prisons, but

frequently took occasion to visit asylums in the course of his

philanthropic travels; and in his "Accounts of the Principal Lazarettos

in Europe, together with Further Observations on some Foreign Prisons

and Hospitals, and Additional Remarks on the Present State of those in

Great Britain and Ireland" (1789), he contrasts St. Luke's Hospital with

a hospital for lunatics at Constantinople, to the advantage of the

latter in some respects, although he states that there is very little

regard paid to cleanliness or the patients, while the former was neat

and clean. Of the Constantinople asylums, he says, "They are admirable

structures.... The rooms are all on the ground floor, arched, and very

lofty, having opposite windows, and opening under a corridor into a

spacious area." In the midst of the neglect of _human_ beings he was

astonished to find so much attention paid to _cats_, an asylum having

been provided for them near the Mosque of St. Sophia. Of St. Luke's he

says, "The cells were very clean and not offensive. The boxes on which

the beds of straw lie are on a declivity and have false bottoms. The

cells open into galleries, fifteen feet wide, and on each gallery was a

vault, which was not offensive.... Here are large airing grounds for

men and women; there is also a new but very inconvenient bath. Here are,

very properly, two sitting-rooms in each gallery, one for the quiet, the

other for the turbulent; but I could wish that the noisy and turbulent

were in a separate part of the house by day and by night.... Several

women were calm and quiet, and at needlework with the matron. A chapel

would be proper here for the advantage of recovering patients, as I have

seen in such houses abroad."

It would seem, then, that although Howard observes, "I greatly prefer

the asylum at Constantinople," he must refer to the less important

matter of the structure of the building. As also when mentioning St.

Patrick's or Swift's Hospital at Dublin, he says he should prefer the

Dol-huis at Amsterdam and the hospital at Constantinople, "where the

rooms open into open corridors and gardens, which is far better than

their opening into passages as here in England."[113]

In his previous work, 1784, Howard observes, speaking of English

prisons, "I must add here that in some few gaols are confined idiots and

lunatics. These serve for sport to idle visitors at assizes and other

times of general resort. Many of the Bridewells are crowded and

offensive, because the rooms which were designed for prisoners are

occupied by the insane (by the Irish Act, 3 Geo. III., such persons are

required to be kept separate). Where they are not kept separate, they

disturb and terrify other prisoners. No care is taken of them, although

it is probable that by medicines, and proper regimen, some of them

might be restored to their senses and to usefulness in life."[114]

We shall see more clearly, as we proceed, what was the condition of the

insane in England at the latter part of the eighteenth century.

A time then came--in the year 1792--fraught with an event as important

as it was unexpected, the beginning, on a small scale, of the reform

which ultimately took place in the condition of British asylums; a

reform slowly brought about by means which might have seemed very

inadequate for the purpose. But the poet warns us to

"Think naught a trifle, though it small appear;

Small sands the mountain, moments make the year,

And trifles life."

And does not Joseph de Maistre well say, "Aucune grande chose n'eut de

grands commencements"--nothing great ever began great?

I should premise that there was at York an asylum founded some fifteen

years before, on a charitable foundation, with it cannot be doubted, the

best intentions on the part of its promoters, but, unfortunately, its

management had been no better than the worst asylums of that day. It

happened that, in 1791, the friends of a patient who was confined there,

desiring to visit her, were refused admission, and suspicion was aroused

as to the treatment to which she was subjected, with (as the event

proved) only too much reason, and not, as sometimes happens at the

present time, without just occasion, and, indeed, on the most frivolous

and vexatious pretences. The knowledge that such is the case ought to

make us very careful how we sit in judgment on our predecessors in

regard to any charge brought against them. There is, however, undeniable

evidence, proof which cannot be evaded, and ultimately admitted by all,

that the asylum at York of which I speak was a frightful abode for

lunatics. The time had not come for its public exposure, but instead of

this it was proposed by a citizen of York--William Tuke--that an

institution should be erected where there should be no concealment, and

where the patients should be treated with all the kindness which their

condition allowed. His mind, full of common sense, suggestive, and not

seeing why the right thing should not be done--in fact, his creed being

that it must be done--he set resolutely to work to effect his purpose.

It became with him a question of humanity and right, and he resolved

that if he could be the means of effecting it, there should be an asylum

openly conducted and on humane principles. He talked over the project

with his friends, and having at last formed a definite plan, he brought

it forward before an assembly of the communion of which he was a

member--the Society of Friends. I should have stated that the patient in

the York Asylum to whom I have referred belonged to the same body. As

was natural, difficulties were at first suggested; but, having an iron

will, as well as a kind heart, he overcame them before long, and

eventually succeeded in his object. His feeling that something should

be done had been strengthened by a visit he had paid to St. Luke's

Hospital, where he saw the patients lying on straw and in chains. He was

distressed with the scene, and could not help believing that there was a

more excellent way. He resolved that an attempt should be made to

ameliorate their miserable condition. His proposition was made in the

spring of 1792. Adopted, and the funds provided, steps were taken for

erecting an institution in a healthy locality in the neighbourhood of

York. "The ground was elevated, and the situation afforded excellent air

and water, as well as a very extensive and diversified prospect." The

illustration (Frontispiece) will convey a better idea than any verbal

description of this unpretentious building. Its character as a labour of

love and humanity was embodied in an inscription written at the time,

which may be discovered whenever the foundation stone is disinterred:--

HOC FECIT

AMICORUM CARITAS IN HUMANITATIS

ARGUMENTUM

ANNO DNI MDCCXCII.

Referring to the establishment of the Retreat, an American physician of

celebrity in the department of Psychological Medicine says, "Merit of

this kind is seldom duly appreciated by the world, for it does not

strike the imagination like that of brilliant discoveries in the

physical sciences, and the very reason that reforms like that in

question are so obviously sanctioned and confirmed by common sense and

the feelings of common humanity is apt to detract from the merit of

those who conceive them."[115]

There are several points to which I have devoted considerable labour

among the archives of the Retreat, and on which I have had the advantage

of frequently conversing with the author of the "Description of the

Retreat" in former years. Among these I may refer to an interesting

explanation of the origin of the now familiar term "Retreat" as applied

to a lunatic asylum. One day the conversation in the family circle

turned on the question, What name should be given to the proposed

institution? when my grandmother, who was much interested in the

establishment, quickly remarked that it should be called a _Retreat_. It

was at once seen that feminine instinct had solved the question, and the

name was adopted, "to convey the idea of what such an institution should

be, namely, a place in which the unhappy might obtain a refuge; a quiet

haven in which the shattered bark might find the means of reparation or

of safety;"--a term which became the parent of numberless imitations,

some of them, it must be confessed, only so called by a miserable irony.

It need hardly be remarked that this term had been from an early period

employed in the Church of Rome to indicate a place of resort for

meditation and penance during certain periods of the year.

Family tradition says that the wife of the projector of the Retreat--a

woman of great force of character--questioned at first his wisdom in

proposing the foundation of such an institution. He had (with her full

concurrence) already established a school for the higher education of

girls, among other projects which sprang from his fertile brain, and she

playfully told him that people would say he had had many children, and

that his last was an idiot. Here for once the woman's instinct failed,

and masculine sense succeeded. Some of his co-religionists also

discouraged the undertaking. "Looking back to the year 1792, and

considering the miserable condition of the insane in general at that

period, it appears to us almost strange that the proposal should have

met in the first instance with considerable opposition, and that the

institution had to struggle through many difficulties into

existence."[116]

The experiment began in earnest, on the opening of the establishment,

four years after it was instituted, the projector residing at and

superintending it, a short interval excepted, until the appointment of

Jepson, who, as well as his wife, the matron, were admirably adapted for

their posts. During this period, "the founder," says the historiographer

of the Retreat, "superintended the management of the patients, and

entered into their cases with great zeal, discrimination, and humanity."

Letters in my possession, written by him, attest this, and also the

difficulties which he encountered; for in one of them he writes, "All

men seem to desert me in matters essential." Happily, however, a

like-minded man, in many respects, was at last found in Jepson, who

became an excellent superintendent, and remained at his post until the

death of the founder, who to an advanced age continued, to quote his

grandson, "to pay very close attention to the institution, generally

visiting it several times a week."

It was early seen that work in the open air would be an important help

in the experiment, and enough land for a farm had been obtained. I

observe that, among other things, the fact particularly struck a Swiss

physician who visited the Retreat not long after it was opened. He

remarks on its presenting the appearance of a large rural farm, and on

its being surrounded by a garden. He was also struck by another

important feature: "There is no bar or grating to the windows."

"Cette maison est situee a un mille de York au mileau d'une campagne

fertile et riante; ce n'est point l'idee d'une prison qu'elle fait

naitre, mais plutot celle d'une grande ferme rustique; elle est entouree

d'un jardin ferme. Point de barreau, point de grillages aux fenetres, on

y a supplee par un moyen dont je rendrai compte ci-apres.

"Vous voyez, que dans le traitement moral on ne considere pas les fous

comme absolument prives de raison, c'est-a-dire, comme inaccessibles aux

motifs de crainte, d'esperance, de sentiment et d'honneur, on les

considere plutot, ce semble, comme des enfans qui ont un superflu de

force et qui en faisoient un emploi dangereux."[117]

Pinel had now been at work five years, and for the first time heard of

the management of the Retreat from the glowing account published by this

Swiss physician Dr. Delarive. The conductors of the Retreat first became

acquainted with Pinel's great work at the Bicetre in Paris in 1806.

An incident related in honour of Jepson may fitly be introduced here. He

"had found the doctrine of subduing the insane by fear maintained in St.

Luke's Hospital, which was then esteemed, and probably justly, the best

public establishment of the kind in Great Britain; and he could not but

attach considerable value to its long and extensive experience. Soon

after entering upon his office, a very violent patient came under his

care. His friend and adviser (Tuke) was from home, and he determined for

once, upon his own responsibility, to act upon the prevalent notion. In

size he was not ill qualified to do the duty of a keeper upon the old

system, but his feelings and all the habits of his mind were opposed to

harsh methods. After the experiment he was so uneasy with himself, that

on retiring to bed he slept but little, and he resolved that, if the

course he had adopted was not in this case beneficial, he would entirely

abandon the system. On visiting the patient his opinion was that the

experiment had failed, and that it had left a painful and vindictive

feeling on the mind of the subject of it." It is added that henceforth

Jepson fully carried out, step by step, the views of the founder and his

friends.[118]

The earnestness with which the officers who were appointed entered into

the undertaking--the way in which they helped to make possible the

success so much desired by the founder--deserves our grateful

appreciation, and should preserve them from being in the least degree

thrown into the shade. To enter heartily into the ideas and schemes of

other people may be as meritorious as to originate them, and is often

much more irksome. It is neither necessary nor generous to exalt one

class of workers at the expense of the other. No doubt the originator of

the Retreat was one who also worked hard himself at what he had

initiated; but he could not have eventually succeeded if he had not been

able to attract to himself men who would devote their powers to the new

work in the same spirit as he did. Such men were Jepson and Fowler, the

latter of whom, the first visiting physician,[119] died five years after

his appointment. Such also was Dr. Cappe, his successor, who was cut off

in his prime deeply regretted--"a man equally esteemed for the gentle

urbanity of his manner, the excellence of his understanding and

dispositions, and his professional attainments."[120]

It is not always that the insane are able to appreciate the efforts made

to render them comfortable. It is all the more gratifying when it does

occur. A patient was admitted who had nearly lost the use of his limbs

from being chained, and for some time it was necessary to lead him

about like an infant. He was found to require no restraint, and was,

after a while, able to walk without assistance. When one of his friends

visited him and asked him what he called the place, he replied, with

great earnestness, "Eden, Eden, Eden!"

A man was admitted who had been for twenty years chained and naked; with

the exception of the occasional use of arm-straps, no personal restraint

was employed from the moment of his admission. He was soon induced to

wear clothes and adopt orderly habits.

One day a man of Herculean size was brought to the institution, and the

case is thus described by the author of the "Description": "He had been

afflicted several times before; and so constantly, during the present

attack, had he been kept chained, that his clothes were contrived to be

taken off and put on by means of strings, without removing his manacles.

They were, however, taken off when he entered the Retreat, and he was

ushered into the apartment where the superintendent and matron were

supping. He was calm. His attention appeared to be arrested by his new

situation. He was desired to join in the repast, during which he behaved

with tolerable propriety. After it was concluded, the superintendent

conducted him to his apartment, and told him the circumstances on which

his treatment would depend; that it was his anxious wish to make every

inhabitant in the house as comfortable as possible, and that he

sincerely hoped the patient's conduct would render it unnecessary for

him to have recourse to coercion. The maniac was sensible of the

kindness of his treatment. He promised to restrain himself, and he so

completely succeeded, that, during his stay, no coercive means were ever

employed towards him." When excited and vociferous, the superintendent

went to his room and sat quietly beside him. After a period of increased

irritation, the violent excitement subsided, and he would listen with

attention to the persuasions and arguments of his friendly visitor. "Can

it be doubted," asks Tuke, "that in this case the disease had been

greatly exasperated by the mode of management, or that the subsequent

kind treatment had a great tendency to promote his recovery?"

An architect, Mr. Stark, in visiting British asylums, when engaged in

preparing plans for the Glasgow Asylum, came to the Retreat. He thus

speaks in his "Remarks on the Construction and Management of Lunatic

Asylums": "In some asylums which I have visited, chains are affixed to

every table and to every bed-post; in others, they are not to be found

within the walls.... At the Retreat they sometimes have patients brought

to them frantic and in irons, whom they at once release, and by mild

arguments and gentle arts reduce almost immediately to obedience and

orderly behaviour. A great deal of delicacy appears in the attentions

paid to the smaller feelings of the patients. The iron bars which

guarded the windows have been avoided, and neat iron sashes, having all

the appearance of wooden ones, have been substituted in their places;

and when I visited them, the managers were occupied in contriving how to

get rid of the bolts with which the patients are shut up at night, on

account of their harsh, ungrateful sound, and of their communicating to

the asylum somewhat of the air and character of a prison. The effects of

such attentions, both on the happiness of the patients and the

discipline of the institution, are more important than may at first view

be imagined. Attachment to the place and to the managers, and an air of

comfort and of contentment, rarely exhibited within the precincts of

such establishments, are consequences easily discovered in the general

demeanour of the patients." "It is a government," Stark also observes,

"of humanity and of consummate skill, and requires no aid from the arm

of violence and the exertions of brutal force."[121] But Stark himself,

strange to say, is careful not to commit himself to the total abolition

of chains, adopted at the Retreat.

Two more brief testimonies from competent visitors who inspected the

institution may be permitted--one from Dr. Duncan of Edinburgh, when on

a tour of inspection of asylums in Britain; the other from a foreigner,

Dr. Naudi, then the "President of the Maltese Hospitals." The former

wrote, after visiting the Retreat, of the demonstration, "beyond

contradiction, of the very great advantage resulting from a mode of

treatment in cases of insanity much more mild than was before introduced

into almost any lunatic asylum, either at home or abroad. In the

management of this institution they have set an example which claims the

imitation, and deserves the thanks, of every sect and every nation. For,

without much hazard of contradiction from those acquainted with the

subject, it may be asserted that the Retreat at York is at this moment

the best-regulated establishment in Europe, either for the recovery of

the insane, or for their comfort when they are in an incurable state."

And Dr. Naudi, in broken but effective English, observed, "This house or

Retreat for the troubled in mind, I think, is one of the best things I

saw in England on the same subject; and having observed many others on

the Continent, I dare to say it is the best in all the world. The

situation of the building out of the town, a large garden around it, the

propriety of the rooms, the cleanliness of the patients, the way in

which they are kept, as for dressing, as for feeding them, is very

remarkable to be observed."

The institution had not been very long in full operation before the

success of the more enlightened treatment pursued in it was so patent,

that the same pleasure and astonishment which the Swiss doctor

experienced became general, and it was decided, in the hope of inducing

others to follow a like course, to publish an account of the means which

had been adopted in the treatment of the patients. This "Description of

the Retreat," by S. Tuke, containing "An Account of its Origin and

Progress, the Modes of Treatment, and a Statement of Cases," appeared in

1813.[122] Sydney Smith helped to bring the book into notice by his

favourable review of it in the _Edinburgh_. In it he says of the

Retreat:--

"The great principle on which it appears to be conducted is that of

kindness to the patients. It does not appear to them (the managers),

because a man is mad upon one particular subject, that he is to be

considered in a state of complete mental degradation, or insensible to

the feelings of kindness and gratitude. When a madman does not do what

he is bid to do, the shortest method, to be sure, is to knock him down;

and straps and chains are the species of prohibitions which are the

least frequently disregarded. But the Society of Friends seems rather to

consult the interest of the patient than the ease of his keeper, and to

aim at the government of the insane by creating in them the kindest

disposition towards those who have the command over them. Nor can

anything be more wise, humane, or interesting than the strict attention

to the feelings of their patients which seems to prevail in the

institution.... To the effects of kindness in the Retreat are superadded

those of constant employment. The female patients are employed as much

as possible in sewing, knitting, and domestic affairs; and several of

the convalescents assist the attendants. For the men are selected those

species of bodily employment most agreeable to the patient, and most

opposite to the illusions of his disease." He proceeds to say that in

this instance, "an example has been set of courage, patience, and

kindness which cannot be too highly commended or too widely diffused,

and which, we are convinced, will gradually bring into repute a milder

and better method of treating the insane."[123]

The author of the above work took an active part in the management of

the Retreat for more than forty years, strenuously aided in exposing the

abuses of the York Asylum, and exerted no inconsiderable influence upon

the movement on behalf of the insane, not only by the work referred to,

but by his writings on the construction of asylums.[124]

I find an entry in his journal, made in April, 1811, that he had begun

an Essay on the state of the insane poor for a periodical called the

_Philanthropist_. His indignation had been aroused by witnessing the

condition of pauper lunatics in a workhouse in the south of England. He

was led into a small yard at a short distance from the principal

building, in which were four cells. He found them large enough for one

person. At the further end of each was a platform of wood attached to

the wall, which was intended for the patient's bed. In two of the cells

all the light and air which could be admitted passed through an iron

grating in the door, so that the cold air could not be excluded without

entirely darkening the apartment. In each of these cells a female was

confined. "I cannot describe," he says, "my feelings and astonishment

when I perceived that the poor women were absolutely without any

clothes. The weather was intensely cold, and the evening previous to our

visit, the thermometer had been sixteen degrees below freezing. One of

these forlorn objects lay buried under a miserable cover of straw,

without a blanket or even a horse-cloth to defend her from the cold."

So of the others, one of whom had the leg chained to the platform at the

end of the cell. Bitter complaints were made of cold. Flannel dresses

were at once sent to the workhouse for these poor wretches, which they

wore, and invoked many blessings on the giver, who denounced the conduct

of the guardians and writes, "Surely, a mind, actuated by the virtuous

sympathies of our nature, would not have joined with comfort the warm

social circle, or repose his head on a soft pillow, whilst he knew that

any one was enduring so many privations, and so much misery which was

not only in his power but was his duty to relieve."

It should be stated that a Select Committee had been appointed (moved

for by Mr. Wynn) five years before (1806), to inquire into the state of

pauper lunatics in England. This Committee proposed the erection of

asylums in different parts of the kingdom, power being given to the

magistrates of any county to charge the expense upon the county rate,

all pauper lunatics within the district being conveyed thither and

maintained at the expense of their respective parishes, and it was

recommended that no asylum should contain more than 300 patients. At

that time there were 1765 lunatics in workhouses, or houses of industry,

483 in private custody, 113 in houses of correction, and 27 in gaols;

total, 2248.[125] Sir George Paul, who took an active interest in this

Committee, stated, in a letter to the Secretary of State, that there was

hardly a parish of any considerable extent in which there might not be

found some unfortunate human creature, who, if his ill-treatment had

made him "frenetic," was chained in the cellar or garret of a workhouse,

fastened to the leg of a table, tied to a post in an outhouse, or

perhaps shut up in an uninhabited ruin; or, if his lunacy were

inoffensive, was left to ramble, half-naked and half-starved, through

the streets and highways, teased by the rabble, and made the jest of the

vulgar, ignorant, and unfeeling. "I have witnessed," he says, "instances

of each of these modes of securing lunatics, under the Act 17 Geo. II.,

c. 5. Of all the lunatics in the kingdom, the one half are not under any

kind of protection from ill-treatment, or placed in a situation to be

relieved of their malady."

In the following year (1808) an Act (48 Geo. III., c. 96) was passed,

providing that it should be lawful for justices in every county in

England and Wales to take into consideration the propriety of providing

a lunatic asylum for the reception of patients within the county.

Referring to the Act 17 Geo. II. for the committal of vagrant lunatics,

the new Act provided that in case there should be an asylum established

for the county within which the lunatic belonged, then a warrant should

be issued for the removal of such lunatic to the asylum, and not

elsewhere; but if no asylum had been erected, then he was to be confined

in any house duly licensed under the authority of the Act of 14 Geo.

III. It will be seen that this legislation was not compulsory, and

therefore utterly failed in attaining the object of its promoters. It

only authorized magistrates to act.

This Act was amended in some points of importance in 1811.[126]

Overseers were obliged to produce a certificate of a medical man as to

the state of the lunatic. Justices were to make returns to the quarter

sessions of the cases brought before them, and medical superintendents

returns of the state of persons intrusted to their care, at least once a

year.

"The Description of the Retreat," then, of which Dr. Conolly writes in

1856, "For readers desirous to know the views which ought to prevail in

all lunatic asylums, I could not even now refer to any work in which

they are more perspicuously explained; in none are the details of

management, economic, medical, and moral, to be found more convincingly

set forth"--this work, happily, proved the means,[127] by the

extraordinary interest it excited in the experiment, and the contrast it

was but too well known to exhibit to the general condition of similar

institutions, of arousing attention, first to the abuses of the old

asylum at York, and then to others, until it was deemed desirable to

appoint a Committee of the House of Commons to investigate the subject

thoroughly. To this we shall refer in more detail, but may here observe

that the founder of the Retreat was one who gave evidence before it, and

the members, says an eye-witness, were evidently interested in seeing

the old man, then upwards of eighty, and hearing from his own lips some

of the facts relating to the success of the experiment at York. He

continued to devote himself to the interest of the institution, and died

in 1822, thirty years after he had broached the idea of its

establishment. It had, he said, some years before, succeeded far beyond

his expectations, and he felt a wish to contribute such information as

attentive observation had enabled him to make for the benefit of others.

This he did in various ways, one being a Letter to the governors of the

York Lunatic Asylum, in which he observes, "At the time of Lord

Erskine's Chancellorship, I noticed with much satisfaction his remarks

on the treatment of insane patients, especially in private mad-houses,

which he found was so generally severe, that in case they were but a

little deranged, it was sufficient to make them raving mad; and he

delivered it as his judgment that kind and conciliating treatment was

the best means to promote recovery. The latter part of this opinion I

have the satisfaction of asserting has been evidently proved correct in

the management of the Retreat, where coercion, though sometimes

necessary for feeding the patients and preserving them from injury to

themselves or others, is administered in the most gentle manner, and the

use of chains is never resorted to."

"In person," wrote a contemporary, "William Tuke hardly reached the

middle size, but was erect, portly, and of a firm step. He had a noble

forehead, an eagle eye, a commanding voice, and his mien was dignified

and patriarchal."

He was ninety when he died, and it may be added that Willan made a happy

hit when he said, on being consulted by him many years before, "There is

a pulse which will beat till ninety."

"Of no distemper, of no blast he died,

But fell like autumn fruit that mellowed long:

Even wondered at, because he dropt no sooner.

Fate seemed to wind him up for fourscore years;

Yet freshly ran he on ten winters more,

Till like a clock worn out with eating time,

The wheels of weary life at last stood still."

DRYDEN, _OEdipus_, Act iii. sc. 1.

French physicians have done justice generously and ungrudgingly to the

services rendered by the York reformers in the management of the insane.

Parchappe, late Inspector-General of the "Service des Alienes" in

France, wrote: "La Retraite d'York, dont Samuel Tuke publia la

description en 1813, fut consideree comme l'ecole ou les alienistes

devaient s'instruire et comme le modele auquel ils devaient se

conformer. La creation et l'organisation de cet etablissement a eu la

plus grande influence sur le developpement des bonnes methodes de

traitement et sur le perfectionnement des asiles en Angleterre."[128]

Ferrus, physician to Napoleon I., visited the English asylums in 1826,

in order to obtain some useful hints in the management of similar

institutions in France, and commends, in a passage which I shall quote,

the mild means of coercion resorted to at the Retreat. He speaks of it

as the first asylum in England which arrested the attention of

foreigners, and proceeds, "Mr. Tuke was a man for whom religion and

morality were practical virtues, and in whose eyes neither riches nor

poverty, imbecility nor genius, ought in the slightest degree to affect

the bonds which unite all men together in common. He thought, with

reason, that justice and force ought to be evinced, not by shouts and

menaces, but by gentleness of character and calmness of mind, in order

that the influence of these qualities might make themselves felt upon

all, even when excited by anger, intoxication, and madness. The

traditions of this friend of humanity are preserved in the house which

he founded. Everything, even down to the patients, is silent and

peaceful in this asylum, where some who are not members of the Society

of Friends are also admitted. Those admitted, be their religion or

social position what they may, whatever even their habits may have been,

influenced by the tranquillity of the place and the force of example,

find repose in this house, which much more resembles a convent of

Trappists than a mad-house; and if one's heart is saddened at the sight

of this terrible malady, we experience emotions of pleasure in

witnessing all that an ingenious benevolence has been able to devise to

cure or alleviate it.... The reputation of this institution is the best

established of any in England. We are assured that the number of cures

is considerable, and we willingly believe this, because the general

management of the house is favourable to the treatment of insanity."

Thirty years afterwards, when I paid a visit to Ferrus in Paris, he

recalled, with great animation, the impressions he at this period

received at the York Retreat.

Nor have the Americans been less grudging in their encomiums. Dr. Ray,

one of their most distinguished physicians devoted to the treatment of

the insane, whom I have already quoted, after visiting our asylums many

years ago, bore witness to the results of the reform "so thoroughly

effected at the York Retreat," and speaks of the founder as clear-headed

and warm-hearted, one "who, true to his faith, conceived the idea that

the insane, as well as the sane, could best be managed in the spirit of

peace and good will." And Dr. Pliny Earle observes, "It is now very

fully demonstrated that the idea of the amelioration of the condition of

the insane was original with Pinel and Tuke, and that for some time they

were actively pursuing their object, each uninformed of the action of

the other. It is no new thing for inventions, discoveries, and

innovations upon traditionary practices to originate almost

simultaneously in more than one place, showing that they are called for

by the times; that they are developments of science and humanity,

necessary evolutions of the human mind in its progress towards the

unattainable perfect, rather than what may be termed a gigantic or

monstrous production of one intellectual genius. Each perceived the

wretchedness, the misery, the sufferings of the insane around him; each

was moved to compassion; each resolved to effect a reform in their

treatment; each succeeded. The recognition of services to humanity is

due to each. To each we freely accord it."[129]

Dr. Brown, the late physician of the Bloomingdale Asylum, New York,

after visiting England in 1863, observes of the lunatic hospitals in

England, "There is one possessing historical fame and interest, which

yet retains its early popularity, as well as its excellent reputation

among medical men. The York Retreat, founded by the Society of Friends

at the close of the last century, and hallowed in the memory of every

one who appreciates the spirit of beneficence which originated it and

has ever since pervaded its halls, still pursues its sacred mission of

removing and relieving mental diseases. Nowhere did I observe clearer

evidence of intelligent and conscientious fulfilment of the humane

purposes of all such institutions. The older sections of the building

were being gradually replaced by new constructions, which conform

interiorly to the present standard of advancement; and as for that

personal devotion of the chief officers, on which the welfare of

patients must mainly depend, it was sufficiently apparent that the

genius and the earnestness of Tuke still abide among his

successors."[130]

Returning now to what in the history of the rise and development of the

modern treatment of the insane is of great importance, the guiding

principles of the treatment pursued at the York Retreat, and its

relation to what is understood as the non-restraint system, I would

observe that the first principle of all was an active humanity--the

highest form of it as embodied in the golden Christian rule. It has

often been said that the members of the community by whose principles he

was animated seem to think it necessary to act as well as to talk; to

carry out their principles into actual practice, as if they were really

intended to be applied to the ills of humanity. If some of his own

friends discouraged Tuke's benevolent designs, it may have arisen from

their not being convinced that a case had been made out for its

exercise. An accident, as it were, brought the fact of the

unsatisfactory condition of the asylums of his day forcibly before him.

Accustomed to do as well as to talk about doing, when he knew the

existence of an abuse, he set himself to work at once to prevent its

recurrence so far as the area of his own influence could extend.

Suspecting unkind treatment, he strove to have it replaced by kindness;

convinced that abuses and cruelty ever tend to spring up when public

surveillance is refused, he resolved to do away with all secresy in the

management of the proposed institution. Further, he "had a strong faith

in the dictates of an enlightened conscience and in the perfect wisdom

and love which direct every law of human duty."[131]

This principle not only accounts for the successful commencement of the

undertaking, but helps to explain the individual treatment of the

insane; for the patients were treated as human beings suffering under a

terrible affliction, toward whom it was a duty to extend consolation,

compassion, and kindness. This course necessarily led to the

demonstration that when so treated they were calmer and required

comparatively little restraint. The fact happily bore out the theory.

But a humane man may in the exercise of his humanity be injudicious, and

by so doing inflict much actual suffering. The surgeon who to avoid

inflicting pain should shrink from the complete removal of a malignant

tumour, would fail to relieve the patient as he ought to have done.

Therefore something more than humane feeling is required. Judgment must

be exercised. Now, judgment and that common sense, or mother wit, which

is so much better than mere routine practice, evidently characterized

the early treatment of the Retreat. As benevolent feeling naturally led

to the non-use of chains and the minimum resort to restraint which then

seemed possible, so common sense led to the avoidance of the periodical

bloodletting and emetics then in fashion. It is a remarkable fact that

even then it was seen that insanity rarely calls for depressing

remedies, and the observation was made and acted upon that excitement is

often relieved by a directly opposite treatment. They allowed a liberal

nourishing diet[132] in cases of violent mania; a free supply of meat,

or bread and cheese, and porter, was found of the greatest service at

supper in procuring sleep and reducing excitement. They had no faith in

specifics and nostrums in the cure of insanity, but medical treatment

was by no means despised, while a warm bath was found to be "of greater

importance and efficacy, in most cases of melancholia, than all the

other medical means which have been employed."[133]

With this, one cannot but contrast the old system, which was

emphatically empirical and unscientific. It was continued without change

from year to year, and it may truly be said that idleness and

selfishness, still more than ignorance, constituted the vices of the old

system. Those who treated the insane always encountered opposition by

brute force, instead of by energy and patience, which surmount

difficulties that to idleness are impassable mountains, and which

selfishness would not, if it could, overcome. Again, from the

commencement of the Retreat, the idea was entertained of making the

institution a home; and with this view the arrangement and surroundings

were made as cheerful and home-like as possible.

Another strong point was the employment of the patients; its vital

importance was forcibly felt from the first. Dr. Delarive, who inspected

the Retreat in 1798, particularly comments upon this novel feature of a

mad-house. He found that an experiment recently made, that of inducing

the patients to cultivate the land, giving to each a task proportionate

to his strength, had answered well. It was found that they were fond of

this exercise, and that they were much better after a day spent in this

work than when they had remained in the house, or when they had taken an

ordinary walk. Delarive went to see them at work, a sight so common now

in our asylums that it seems strange it should have excited his

surprise.

Of employment the author of the "Description" thus speaks: "The female

patients in the Retreat are employed as much as possible in sewing,

knitting, or domestic affairs; and several of the convalescents assist

the attendants. Of all the modes by which the patients may be _induced

to restrain themselves, regular employment is perhaps the most generally

efficacious_; and those kinds of employment are doubtless to be

preferred, both on a moral and a physical account, which are accompanied

by considerable bodily action, that are most agreeable to the patient,

and which are most opposite to the illusions of his disease."[134]

We find it insisted upon by those who had the management of the Retreat

that moral treatment is of the greatest importance; that gentleness must

take the place of violence;[135] that it is erroneous to suppose it

necessary to commence an acquaintance with lunatics by an exhibition of

physical strength; that every effort should be made to divert the mind

of melancholiacs by bodily exercise, walks, conversation, reading, and

other recreations; that the desire of esteem is a more powerful

principle to appeal to than fear; that the best form of restraint is

self-restraint; that patients should be treated as much as possible as

rational beings, but that little or no advantage arises from reasoning

with them on their particular delusions; that it is desirable to

encourage the influence of healthy religious principle over the mind of

the insane; that those who manage them should sedulously endeavour to

gain their confidence and esteem, to arrest their attention and fix it

on objects opposed to their delusions, to call into action every

remaining power and principle of the mind, and to remember that in the

wreck of the intellect the affections not unfrequently survive.

This recapitulation of the salient features of the practice of the

Retreat renders it easy to understand the position taken by the managers

of the institution in regard to mechanical restraints. When kindness

failed to subdue maniacal excitement, when medical remedies exerted no

calming influence, mild forms of restraint were reluctantly adopted,

rather than maintain a conflict between patient and attendant. It

appears from the Retreat archives that not more than five per cent.,

reckoning the night as well as the day, were restrained by strap or

waistcoat.[136] It is notorious that, at the same period, it was the

custom in some asylums, probably many, to chain to the bedstocks, at

night, every patient in the house. Ferrus, to whom I have referred, did

not find camisoles in use at St. Luke's in 1826, but "strong chains were

employed to hold the excited patients. These chains, fixed at different

heights to the sides of stoves (_chauffoirs_), have iron rings at the

end, by means of which the arms or the legs of the patient are rendered

completely immovable.... Far from fearing that a painful impression will

be produced on the patients by chains, they think, on the contrary, that

this apparatus exerts a beneficial influence upon them; that it

intimidates, humbles them, and removes all desire to attempt to get rid

of their fastenings." Ferrus says that at the Retreat he found a belt

was employed, softly padded, to which the arms were attached. "We do not

employ it in France," he says, "although it might in hot weather be

preferable to the camisole.... The Retreat offers all the resources of

art and the comforts of life (_douceurs de la vie_) compatible with the

condition of insane persons."

Coercion was regarded at the Retreat as an evil--that is to say, it was

"thought abstractedly to have a tendency to retard the cure, by opposing

the influence of the moral remedies employed"--but at the same time "a

necessary evil," an unhappy alternative in certain cases. Practically,

as we have seen, the amount of restraint was small; but no _rule_ of

practice was laid down that it should never be resorted to. The abstract

principle of non-restraint adopted at Lincoln and Hanwell was not

enunciated. "We greatly prefer," observes the author of the

"Description," "to lay down no absolute rule of non-restraint, but to

refer to our resident officers the exercise of a sound discretion in

each individual case." But the managers of the Retreat did undoubtedly

lay down as a fundamental principle that "_coercion will diminish or

increase as the moral treatment of the patient is more or less

judicious_;"[137] and therefore, although they did not anticipate that

personal restraint would be superseded by any other mode of treatment,

this principle is broad enough to embrace all that has since followed in

the way of non-restraint. The result, in the long run, of honestly

carrying out the doctrine to its legitimate consequences, will not very

widely differ from that reached by those who adopt "non-restraint" as an

abstract theory in the first instance.

Justice would scarcely be done to those who interested themselves in

mental diseases during the latter half of the eighteenth and the

commencement of the nineteenth century, if we did not give the titles of

some of the works bearing on insanity which issued from the press during

this period. A treatise on Madness was written in 1757 by Batty. Perfect

wrote "Methods of Cure in some Particular Cases of Insanity" in 1778,

and "Select Cases of Insanity" in 1787, and "Annals of Insanity"

fourteen years later. Perfect's treatment of insanity mainly consisted

in bleeding, setons, electricity, and the administration of emetics,

digitalis, and antimony. Dr. T. Arnold published his "Observations on

the Nature, etc., of Insanity," 1782. Harper published "A Treatise on

the Real Cause and Cure of Insanity" in 1789--a work ridiculed by Pinel.

Faulkner wrote his "Observations on the General and Improper Treatment

of Insanity" in 1790; and Pargeter his "Observations on Maniacal

Disorders" in 1792. What, if any, beneficial effect these works produced

upon the condition of the insane in the British Isles, I am unable to

say. Haslam wrote his "Observations on Madness" in 1798, and he was the

author of several other works; but, whatever their value and interest,

we know but too well the condition of the patients in the asylum of

which he was the apothecary. Crichton published his "Inquiry into the

Nature and Origin of Mental Derangement"--a work, certainly, of merit

and the result of practical observation. In 1802 appeared "De

intellectus facultatum conditione in mentis Alienationis diversis

generibus," by Campbell (Edinburgh). Cox published his "Practical

Observations on Insanity" in 1804. (See Appendix B.)

* * * * *

Of Pinel, in relation to England, I must here say a few words.

The _Edinburgh Review_ of April, 1803, contains a review of Pinel's

work, which deserves attention from the tone in which it is, for the

most part, written. The Reviewer evidently thinks that England had very

little to learn from France. The York Retreat had, indeed, been in

active operation for some years, and the treatment pursued there might,

no doubt, have borne comparison with that at the Bicetre, but to speak

of Great Britain as a whole having a decided superiority over other

countries in its moral treatment of maniacs was rather absurd. The

Reviewer regards Pinel as the first author on the Continent who is fully

sensible of the advantage of such moral treatment, and then observes,

"To medical readers in this country many of our author's remarks will

appear neither new nor profound, and to none will his work appear

complete.... It may be considered as a sketch of what has already been

done, with some notices of what the author intends to do; though he

seems frequently to wonder, with a smile of self-approbation, at what he

thinks his own discoveries." And again: "Dr. Pinel is desirous that

France should have some claim to a judicious treatment of the disease of

the mind, the honour of which has hitherto been exclusively confined to

England."

It is curious to find the Reviewer observing that Dr. Pinel appears to

display very little sagacity and precision in saying that in some cases

the brain is not affected. And again: "He conceives that the result of

the examination of the periods of life most subject to insanity is alone

sufficient to show how seldom it is owing to any organic affection of

the brain or the cranium. But in this opinion there is some

inconsistency. For he soon after states that in thirty-six dissections

he found nothing more remarkable than in the brain of apoplectic and

epileptic patients, or of persons who died from furor or convulsions.

Now, this is a confession that some deviations from the natural and

healthy appearances were observed; and this is all that is contended

for, and all that the present limited state of our knowledge authorizes

us to affirm." The Reviewer adds, no doubt with truth, "If no organic

affections are said to have been discovered, in some few instances, we

should not reason negatively from such dissections, perhaps cursorily

and ignorantly made, and with instruments ill adapted to detect minute

and apparently trivial deviations from the natural structure."

The following snarl is also noticeable:--"He informs us that he has

studied with considerable attention the writings of Locke, Harris,

Condillac, Smith, and Stewart; but the quotation of great names is not

always the surest proof of an accurate acquaintance with their works,

and we are inclined to think that there is some ground for doubt in the

present instance."

The Reviewer is severe on Pinel's classification, which in the main has

stood the test of all subsequent criticism to a remarkable degree. "It

may," he says, "be entitled to the praise of ingenuity, but we doubt

whether it is remarkable for its clearness and accuracy. Many of the

distinctions seem absurd, and others not well founded. The several kinds

of insanity are not distinct; they are only varieties of the same

affection. All the symptoms mentioned under these five heads occur in

the same patient. At different times he passes through all the

gradations from furious phrenzy to complete fatuity." This criticism

has, of course, great force as opposed to all symptomological

classifications whatever, but not specially or mainly to Pinel's.

On the point whether madness can in certain cases be cured, Pinel's

utterances are dismissed with downright contempt: "Instead of any new

light being thrown upon this important question, or any new rules of

conduct pointed out, our author gives a minute detail of two cases,

where any ancient female of ordinary capacity could have decided as well

as himself, and relates with laboured minuteness the contrary opinions

of some eminent physicians on a late memorable occasion in this

country." Pinel an old woman! It will probably be new to most, if not

all, of our readers that this illustrious man was regarded in this light

by the leading Review of our country, when his writings first became

known amongst us. The review ends, after crediting Pinel with some

merit, and commending his work as containing some profitable

instruction, with the exceedingly kind and patronizing observation that

"we are therefore inclined to make _an indulgent allowance_ (!) for the

imperfect execution of many parts of Dr. Pinel's essay, and to entertain

hopes of further information from his diligence and discernment" (!!).

Insular conceit could surely scarcely go further. However, the Edinburgh

Reviewer is forgotten and his name unknown; Pinel's name covered with

glory, although not a popular hero; for when I made a pilgrimage to his

grave in the great Paris cemetery, _Pere la Chaise_, in 1878, I was a

solitary visitor, while crowds flocked to others, including that of

Thiers, which is in close proximity to it. I am glad to see it announced

that the _Societe Medico-psychologique_ of Paris is about to erect--not

too soon--a statue to his memory.

The bold proceeding, as it seemed in those days, of freeing the

lunatics at the Bicetre from their fetters, constitutes Pinel's title to

honour--an honour of which no man will succeed in robbing him. He will

be remembered when Dequin[138] is forgotten. Pinel, although his

writings would have made him eminent as a physician had he never

rendered his name illustrious in reference to the insane, did not, as a

study of his life abundantly proves, liberate the patients at the

Bicetre from their chains in direct consequence of his medical knowledge

of insanity, but mainly, if not entirely, from the compassion which he

felt for their miserable condition. His knowledge, great before, was

vastly increased after he had placed the patients in a more favourable

state for medical observation; in fact, it is obvious that the

opportunities of scientific research, and specially of observing the

satisfactory progress of those labouring under the disease, were greatly

augmented from the moment he introduced a humane system of treatment.

Had my sketch comprised France as well as England, I should have

attempted to give a description of the work he performed in Paris. But I

must not be tempted to go beyond my subject, and as a matter of fact the

course of French and English reform in the treatment of the insane was

entirely distinct and independent.[139]

FOOTNOTES:

[100] "By Tho. Fallowes, M.D., at his House in Lambeth-Marsh, and to be

had there, or at Mr. Jones's Haberdasher in Hats, over against the

_Pump_ in _Chancery_ Lane, and nowhere else," 1705. A second edition

appeared in 1814.

[101] In his Review for 1706 there is a "Scheme for the Management of

Mad-houses," with a case of abuse.

[102] As will be seen by the date, the elder Pitt and Fox.

[103] The physician referred to at p. 87.

[104] 14 Geo. III., c. 49 (1774).

[105] "The Early History of Charles James Fox," by G. O. Trevelyan,

1880.

[106] Letter written July 30, 1767.

[107] "Lady Chatham also, when writing confidentially to Lord Shelburne

in the autumn of 1767, observes, 'I wish I could say there was any

material change in the state of my Lord's health, but we are forbid to

expect that, until he can have a fit of gout.'"

[108] "History of England from the Peace of Utrecht," vol. v. pp. 166,

188 (edit. 1853).

[109] Page 203.

[110] See "Evidence before the House of Commons." See also "Debates on

the Regency," Hansard, vol. xxvii.

[111] "American Journal of Insanity," July, 1855.

[112] See the last edition, corrected by himself (1780), of his

"Primitive Physic, or an Easy and Natural Method of curing most

Diseases."

[113] Page 82.

[114] "The State of the Prisons in England and Wales, with Preliminary

Observations," by John Howard, F.R.S., 3rd edit., 1784.

[115] Ray, _American Journal of Insanity_, vol. iv. p. 112.

[116] "Review of the Early History of the Retreat," by S. Tuke. 1846.

[117] "Lettre addressee aux Redacteurs de la Bibliotheque Britannique

sur un nouvel etablissement pour la guerison des Alienes" (1798). Par

Dr. Delarive, p. 29.

[118] "Review of the Early History of the Retreat," p. 14.

[119] The physician who gave his name to the well-known solution of

arsenic. Author of a treatise on Arsenic, 1786, and one on Rheumatism in

1795. Jepson resigned in 1822, and died in 1836.

[120] "Description of the Retreat," by S. Tuke, p. 62.

[121] Pages 11, 12.

[122] The _British Review_ (vol. vi. No. xii.), in reviewing this book,

observed: "In 1813 Mr. Samuel Tuke published his 'Description of the

Retreat,' the celebrated work, the title of which we have placed among

others at the head of our article.... The Retreat has been conducted

from the beginning upon the principle that the utmost practicable degree

of gentleness, tenderness, and attention to the comforts and feelings of

the patients was in the first place due to them as human beings; and in

the next place was infinitely the most promising means of effecting

their recovery. The object of this work of Mr. Tuke was to describe the

system of management which had been pursued in the Retreat; to make

known the success which had attended it; and to point out more

distinctly than had ever yet been done, the principle upon which that

management was founded (the principle of gentleness, and of regard to

the feelings of the patients) as the grand principle which ought to

regulate the management of every establishment of the kind. The service

which Mr. Tuke professed to render to the public by his book was

assuredly of importance, and his book has performed it well.... In

having pointed out this as the governing principle, he has rendered a

service to humanity of the greatest importance. It is this

characteristic circumstance which will render the publication of his

book an era in the history of the treatment of this calamity. The book

has already met with great and almost universal attention. It has by the

nation been much more than approved; it has been applauded and admired."

The reviewer continues: "One thing we may venture to say, that it was

hardly possible for a book to be written in a manner less calculated to

give offence to anybody.... Yet this book gave prodigious offence. It

has been regarded as a libel upon the York Asylum, and an attack upon it

has appeared in the newspapers." This was a letter signed "Evigilator,"

who was in reality the superintendent of the above institution. This led

to a long and heated correspondence. About the same time a charge of ill

treatment of a patient in the York Asylum was made by a magistrate (Mr.

Godfrey Higgins of Doncaster), whose persistent endeavours to bring this

and other cases to the light of day were beyond praise, and happily

proved successful at last.

The writer has in his possession a mass of private letters which passed

between his father and Mr. Higgins on these cases, which indicate their

combined endeavours, made (under the fiercest opposition) to reform the

horrible abuses which had converted a well-intentioned charity into a

hell upon earth. Mr. Higgins was the author of a book on Mahomet, the

remarkable work on the Celtic Druids (1827), and of "Anacalypsis"

(1836).

[123] April, 1814, pp. 190, 194, 198.

[124] (1) "Practical Hints on the Construction and Economy of Pauper

Lunatic Asylums; including Instructions to the Architects who offered

Plans for the Wakefield Asylum, and a Sketch of the most approved

Design." York, 1815. (2) "On the Construction and Management of

Hospitals for the Insane," by Dr. Jacobi, with Introduction by Samuel

Tuke, 1841. Born 1784; died 1857. An Honorary Member of the

Medico-Psychological Association.

[125] The incompleteness of this Parliamentary return was shown by the

fact that, a few weeks afterwards, Sir Andrew Halliday found that in

Norfolk there were 112 instead of 42.

[126] 51 Geo. III., c. 74; also in 1815, May 2 (55 Geo. III., c. 46),

independently of the Report of the Select Committee. Overseers were to

make returns of all lunatics and idiots within their parishes. These

Acts do not touch "Private mad-houses"--only paupers.

[127] "What strenuous efforts fruitlessly combined to accomplish, a

little volume has at once achieved. I hardly need name Mr. Samuel Tuke's

account of the Retreat. Mr. Tuke's work, operating on a suspicious and

irritable mind, produced the letters signed 'Evigilator;' the public

attention became aroused, doubts and surmises were started. Either

confident in right, or daring in wrong, a general challenge was given;

that challenge was answered, with what results it is needless to add"

(_vide_ "Papers respecting the York Lunatic Asylum," by S. W. Nicoll,

Esq., 1816).

[128] "Les Principes a suivre dans la Fondation et la Construction des

Asiles d'Alienes," Paris, 1853, p. 226.

[129] _American Journal of Insanity_, April, 1856.

[130] _Ibid._, October, 1863, p. 205.

[131] "Review of the Early History of the Retreat," by S. Tuke, 1846.

[132] Referring to the practice at the Retreat as given in the

"Description," the editor of the _Medical Repository_, 1817, after

observing, "We are told that in violent maniacal paroxysms, depletion

having failed to procure quiescence, a full meal of meat and good porter

for supper produced the desired effect, and that this mode has since

been very frequently and successfully employed," adds that if this be

true, the general system of well-known physicians, that of pursuing

depletion through "paroxysm and remission," cannot be right.

[133] Tuke's "Description," p. 113.

[134] Page 156.

[135] "If it be true that oppression makes a _wise_ man mad, is it to be

supposed that stripes and insults and injuries, for which the receiver

knows no cause, are calculated to make a _mad_ man wise? or would they

not exasperate his disease and excite his resentment" ("Description of

the Retreat," 1813, p. 144).

[136] Including cases in seclusion.

[137] "Description of the Retreat," S. Tuke.

[138] A Savoy physician who dedicated the second edition of his "La

Philosophie de la Folie," published in 1804, to Pinel. M. Brierre de

Boismont thinks the latter guilty of "the conspiracy of silence" in not

mentioning him in his work, but I do not think the conspiracy is proved.

[139] See Appendix C.