_CONOLLY, MAUDSLEY, AND MENTAL DISEASES._
The modern realisation of the association of mental with physical
health, the annexation to the sphere of biology of the phenomena of
mind, and the concurrent comprehension of the true attitude of the
physician towards mental diseases, have doubtless put into the shade
achievements less than a century old, and some of them dating from
only fifty years ago. Yet the simple discontinuance of the system of
restraint practised from time immemorial on almost all lunatics was
perhaps a greater practical revolution than the biological one just
referred to; and England stands in the forefront of this revolution.
The old lunatic asylums of this country were objects of dread and
repulsion. Severity was considered to be an absolute necessity in
their management. “The affrighted visitors,” says Conolly,[17]
“saw that many were furious ... and it never occurred to them that
habitual severity was the real cause of the habitual fury.” New
Bethlem in Moorfields two centuries ago was a place of chains,
manacles, and stocks. Down to 1770 the inmates were exhibited to the
public at a charge of twopence, afterwards reduced to one penny.
The medical profession had become accustomed to neglect mental
diseases, and to acquiesce in severe treatment. Cruelty became
developed in ingenious forms. In some Continental asylums patients
were terrified by the gradual ascent of water in a well in which
they were chained. Machines were imagined by which a newly arrived
lunatic could suddenly be raised to the top of a tower, and as
suddenly lowered into a deep dark cavern; “if the patient could be
made to alight among snakes and serpents, it would be better still.”
A revolving chair was invented, in which the victim could be strapped
and made to gyrate at the rate of one hundred revolutions per minute.
This was eulogised as a potent means of quieting the unmanageable,
and was supposed to induce the melancholy to take “a natural interest
in the affairs of life.” We can only make this passing allusion to
the way in which ingenuity was exhausted in devising methods of
restraint and torture.
Nothing could have been worse than the condition of the Bicêtre and
the Salpêtrière, the two large asylums of Paris, when Pinel was in
1793 appointed to the former by Cousin, Thouret, and Cabanis, then
newly appointed administrators of the Parisian hospitals. Damp,
dark cells, infested by rats, contained dirt-coated beings whose
only comfort was a little straw, chained, brutally ill-treated,
and attended by brutal criminals. For nearly ten years previously
Pinel’s attention had been directed to the treatment of the insane,
and now, in spite of difficulties which officials threw in his way,
he succeeded in loosening the chains and ameliorating the treatment
of the majority of the patients. Yet his reforms nearly cost him
his life. Rumours were spread accusing him of some evil motive in
unchaining dangerous lunatics, and a mob one day seized him, and
uttered the well-known terrible cry “_à la lanterne!_” An old soldier
of the French Guard, once a lunatic, whom he had released from
chains, cured, and employed in his own service, was appropriately the
means of his rescue. Thus was philanthropy once more justified of her
children.
At this very period English public opinion had been excited by
revelations of cruelty and consequent deaths in the old York Asylum.
In 1791 a lady belonging to the Society of Friends was placed in
this asylum; her friends were refused admission to visit her, and in
a few weeks she died. Inquiries that were made showed great grounds
for suspicion, although full details could not be obtained.[18] But
with great promptitude William Tuke, a prominent Friend at York,
whose family has continued famous for attention to the affairs of the
insane, proposed early in 1792 the establishment of a “Retreat” at
York for insane patients, in which sympathy should be substituted
for unkindness, severity, and stripes. The account given by Samuel
Tuke in 1813 of its management is still a model in many respects.[19]
Neither Pinel nor the Tukes were however bold enough entirely to
dispense with mechanical coercion. In 1818 Esquirol, the true
successor of Pinel in France, found maltreatment still generally
prevalent in the provincial asylums of France. In England mechanical
restraint continued to be largely employed till Conolly’s time,
and survives in some private asylums to the present day. We cannot
give further details on this head, but hasten to mention the names
of two men, Dr. Charlesworth and Mr. Gardiner Hill, who must ever
be remembered as the first to give up mechanical coercion entirely
in the small asylum of Lincoln. Dr. Charlesworth, physician to
the asylum, had for many years diligently watched the effects of
mechanical coercion, and gradually lessened the number of instruments
of restraint in the asylum. Finally, the total disuse of mechanical
restraints was decided on, and put in practice by Mr. Gardiner Hill
in 1836 in concert with Dr. Charlesworth, with the most gratifying
results.
* * * * *
We now come to the man who more than any other in England may be
said to have established the non-restraint system so firmly that
it will never be upset. JOHN CONOLLY was born at Market Rasen in
Lincolnshire, in 1794. His father, a member of a good Irish family,
died young, and the care of a young family fell on his widow, whose
maiden name was Tennyson, and whose patience and self-sacrifice
her son ever affectionately acknowledged as the main influence
which led to his own success. When his mother ultimately married a
French gentleman, a political emigré, the latter taught his stepson
French, and imbued him with a genuine taste for and knowledge of
the language. Condillac’s essay “On the Origin of Human Knowledge”
influenced his mental life. While in his teens his attention was
first called to the subject of lunacy by an inspection of the Glasgow
Asylum, and he never afterwards ceased to take the deepest interest
in it.
At eighteen young Conolly became an officer in a militia regiment,
in which capacity he served several years. While still young, he
married in 1816 the daughter of Sir John Collins and went to reside
in France, on the banks of the Loire. A year later he had decided
to enter the medical profession, and in 1817 became a student at
Edinburgh University. After a diligent career, in the course of
which he was one of the presidents of the Royal Medical Society, he
graduated M.D., and settled in practice as a physician at Chichester.
Here he became intimately acquainted with Dr. (afterwards Sir John)
Forbes, with whom he was afterwards much connected in literary
matters.
Dr. Conolly did not remain very long at Chichester, but removed in
1823 to Stratford-on-Avon, where he wrote many contributions to and
took part in editing the “Cyclopædia of Practical Medicine,” and the
_British and Foreign Medical Review_. At Stratford he became alderman
and mayor, established a public dispensary, and studied Shakespeare
with enthusiasm. This occasioned him afterwards, while practising at
Warwick in 1835, to take an active part as chairman of the committee
formed for securing the preservation of Shakespeare’s tomb, and the
restoration of the chancel of the church.
In 1827 Dr. Conolly was appointed Professor of the Practice of
Medicine in London University, which appointment he only held four
years, finding life as a London physician unsuitable to his tastes.
In 1831 he again resorted to the country, establishing himself in
Warwick.
The subject of insanity had long engaged Dr. Conolly’s attention. He
had studied the question both abroad and at home, and had been for
five years, (while residing at Stratford) inspecting physician to the
Lunatic Houses for the County of Warwick, an office which he resumed
when he settled in Warwick. He had unsuccessfully proposed to the
council of the University that he should give his pupils clinical
instruction on insanity in one of the lunatic asylums in London.
“Thus,” says Sir James Clark,[20] “clinical instruction in mental
diseases was thrown back for thirty years in this country.”
In 1830 Conolly published his valuable work, “An Inquiry concerning
the Indications of Insanity, with Suggestions for the better
Protection and Care of the Insane.” His objects were to render
the recognition of insanity less difficult, by showing in what it
differed from those varieties of mind which approached nearest to it;
and to point out those circumstances which, even in persons decidedly
insane, could alone justify various degrees of restraint. He lamented
that during a student’s career he only saw cases of insanity by
some rare accident. Every lunatic asylum was closed to him, and
yet when qualified he might any day have to decide on a patient’s
insanity. In view of some recent revelations a quotation from the
introduction to this work (p. 3) is not inappropriate. “The timidity
or ignorance, or it may be, a dishonest motive, of relatives, leads
to exaggerated representations; and the great profit accruing from
a part of practice almost separated from general medicine, cannot
but now and then operate against proper caution in admitting such
representations. When men’s interests depend upon an opinion, it is
too much to expect that opinion always to be cautiously formed, or
even in all cases honestly given. The most respectable practitioners
in this department openly justify the authorising of restraint before
the patient is seen, and on the mere report of others; and it seems
that depositions to the insanity of individuals have been received
in courts of law, concerning persons with whom the deponents have
never had an interview; and that on these depositions proceedings
have been partly founded, of which the results were the imprisonment
of lunatics, and restraint over their property. When the affair is
conducted with more formality, and the suspected person is visited
before being imprisoned, those who visit him are often very little
acquainted with mental disorders, and come rather to find proofs of
his insanity, which, to minds pre-possessed, are seldom wanting, than
cautiously to examine the state of his mind.”
“If a person of sound mind were so visited, and knew of the visit
beforehand, it would not be quite easy for him to comport himself,
so as to avoid _conviction_ that he was _not_ of sound mind. His
indignation would pass for raving; his moderation for the proverbial
cunning of a lunatic.”
After describing the condition of asylums and lunatics at that time,
the author considers the constitution of the human understanding and
the inequalities, weaknesses, and peculiarities of mind which do not
amount to understanding, and the influence of stimuli, of age, and
of disease on the mind, and then discusses the phenomena of insanity
and the questions of treatment and protection. He insists on the
necessity of the most scrutinising watchfulness over the servants
employed in their care. In cases where patients would do themselves
or others an injury he insists on watching, instead of mechanical
means of restraint. He proposes a complete scheme for the care of all
lunatics by the State, providing for perfect publicity of procedure.
He finally points out the increasing liability of the nervous system
to disorganisation owing to the increased pressure and more varied
anxieties of modern life, an observation most fully justified by what
has been established since his day.
This work, a most readable and interesting one, both to medical men
and to general readers, was not received with nearly sufficient
warmth. Too many were wedded to the old systems of treatment; too
many knew nothing about the diseases of the mind, and their sympathy
could not be aroused in favour of lunatics. So Conolly was left
to his country work at Warwick, varied by one year’s residence at
Birmingham, till 1839, when he was appointed Resident Physician to
the Middlesex County Asylum at Hanwell, at that time the largest in
England. He had taken the opportunity of visiting the Lincoln Asylum
and gaining all the advantages possible from its experience. He was
now satisfied that mechanical restraint was not only unnecessary, but
possibly injurious. On few others had the non-restraint system gained
a hold. Hanwell had the reputation of being one of the best-managed
asylums in England, many patients being occupied in agricultural and
other pursuits. Yet one year after Sir William Ellis’s resignation,
when Conolly took office, “instruments of mechanical restraint of
one kind or other were so abundant in the wards as to amount, when
collected together, to about six hundred, about half of them being
handcuffs and leg-locks.”
Conolly entered upon his duties on the 1st June 1839. The asylum
then contained 800 patients, and he found forty under continuous
mechanical restraint. In his first report to the Quarter Sessions,
he informed the Justices that since the 21st of September not one
patient had been under restraint. “No form of strait waistcoat, no
handcuffs, no leg-locks, nor any contrivance confining the trunk, or
limbs, or any of the muscles, is now in use. The coercion chairs,
about forty in number, have been altogether removed from the wards.”
In fact, they had been cut up to make a floor for the carpenter’s
shop.
This was not accomplished without some trouble and anxiety. It took
time to indoctrinate the officers and attendants with the principles
of the new system, in which they were deprived of their old prop. The
aid which he received from Miss Powell the matron was most valuable.
In ten years not one case was admitted to Hanwell in which mechanical
restraint was deemed necessary, although many suicidal patients were
among them. In fact, the removal of restraint tended directly and
powerfully to promote the recovery of these, by taking away the sense
of degradation occasioned by such restraint, by bringing them within
the sphere of medical remedial agents and of cheerful influences. The
only substitutes allowed were in some cases seclusion of a patient in
an ordinary sleeping apartment, and, in extreme cases, in a padded
room in which the floor was a bed; such seclusion being immediately
reported to the medical officers, and recorded, even when continued
only for a few minutes. This was found sufficient to protect the
other patients, to calm the refractory one, and act as a tonic and
remedial influence. The shower-bath was rarely resorted to except
for medical reasons; window-guards, clothing, and bedding of strong
materials to prevent tearing, were only required in a few cases. “The
great and only real substitute for restraint is invariable kindness,”
says Dr. Conolly. “This feeling must animate every person employed in
every duty to be performed.”
Dr. Conolly published the main results of his experience in his
Clinical Lectures in the _Lancet_ in 1846, and in a work on the
Construction and Government of Asylums, in 1847. His annual reports
to the Justices detailed the progress of his system, and he
afterwards summarised them and published them collectively. At the
end of ten years, finding the non-restraint system in no danger
of being abandoned at Hanwell, Dr. Conolly ceased to be resident
physician, and became visiting physician, attending at the asylum
twice a week, and spending the greater portion of the day there. His
interest in the patients, says Dr. Hitchman, seemed never to flag.
He would always look out for something to commend in a patient, the
hair better kept, clothes more neatly worn, &c., and addressing the
patients in the most gentle, affectionate tones, he made his visits
always a matter of longing. The old attendants at the hospital in
after years spoke of Dr. Conolly’s untiring watchfulness in the first
years of his experiment. He would visit the wards at all hours of the
night to see that his orders were being obeyed, walking noiselessly
along the corridors. He was kept up in his arduous duties by an
elevated religious principle. “I feel grateful to God,” he wrote,
“who has intrusted duties to me which angels might stoop to perform.”
He suffered greatly from an affection of the skin, which kept him
awake at night and ill at ease during the day; and hence was liable
to fits of depression and irritability which sometimes made him
appear impatient.
In 1852, on his resignation of the appointment of visiting physician,
Conolly’s connection with Hanwell practically ceased, and a piece
of plate and his own portrait by Sir W. Gordon were presented to
him at a public meeting by Lord Shaftesbury. In his reply on this
occasion Dr. Conolly said: “Those who know me well will believe me
when I say there never was an occasion when the sense of merit was
less reflected from the breast of the recipient of a public honour,
than it is from me at this moment.” He further stated that when he
had first heard of the establishment of Hanwell Asylum, he was seized
with a restless desire to become one day its head.
Many objects of philanthropy had Dr. Conolly’s untiring advocacy,
both before and after his retirement from Hanwell. Public
middle-class lunatic asylums, the education of medical men in mental
diseases, the establishment of idiot asylums, especially that at
Earlswood, were among these. He was the first doctor applied to
by Mrs. Plumbe in regard to the foundation of Earlswood, and his
co-operation with Dr. Andrew Reed was of the most essential service
to the enterprise.
Dr. Langdon Down, formerly Medical Superintendent at Earlswood, wrote
in regard to Conolly: “His visits were the most refreshing incident
of my recollection in connection with the asylum. Entering on my
work (in 1858) as an untried man, and finding myself allied to an
institution which had become unpopular at the Lunacy Board, I was
mainly decided on holding a position which had so much to overwhelm
one by the influence of Dr. Conolly. That influence was magical. The
humility of his character was only equalled by the real love he
manifested for the mentally afflicted.
“At the visits of the Board of Management, he would steal away from
his colleagues, and was to be found holding loving intercourse
with the little members of my charge in a way that one has never
seen before or since. Moreover, he so encouraged every official
in his or her work, that the savour of his visit lasted till
he again returned.... For myself, I have often had to seek his
counsel, and never without being struck with his judgment and the
fascination of his influence, the high resolve he inspired in one,
and what willingness he exhibited to maintain, co-equally with the
responsibility, the power of the Medical Superintendent, and thus
to prevent a repetition of those evils which he had so bitterly to
lament in his own experience.”
The years after Conolly left Hanwell were busily occupied with a
large practice, especially in mental cases. In a few years his
unceasing labour told on him, and he suffered much from chronic
rheumatism and neuralgia. Finally he was compelled to retire from
practice, when he took up his residence at Lawn House, Hanwell,
whence he could see the asylum in which he had spent so many
anxious hours. He finally lost mental energy, and was unable to
complete several treatises and records of experience which he
was contemplating. He, however, left an enduring memorial of his
life-work in “The Treatment of the Insane without Mechanical
Restraints,” 1856, written in a most readable style. We must not
omit to mention his courses of lectures on Insanity at the College
of Physicians and at the Royal Institution, his papers on Infantile
Insanity, and finally “A Study of Hamlet,” in which he brings the
most skilfully marshalled arguments to prove that Hamlet’s was a
real and not a feigned madness. As to Hamlet’s treatment of Ophelia
in Act II., Scene 1, and more especially in the scene where Hamlet
and Laertes met over her grave, he remarked; “The picture of madness
here is too minutely true, its lights and shades are too close to
nature to have been painted as a mere illustration of feigning,
and of feigning without intelligible purpose.” Both Sir Theodore
and Lady Martin (Miss Helen Faucit) considered his exposition most
satisfactory, and that it settled the question finally.
Conolly was carried off, after years of weakness, by an attack of
paralysis with convulsions, which was fatal in a few hours, on March
5, 1867. Few have left behind them a brighter record as physician and
philanthropist.
* * * * *
Improvement in the treatment of the insane and the knowledge of
mental diseases has progressed rapidly in late years, owing to the
efforts and studies of many workers, among whom Drs. Bucknill,
Tuke, Hood, Lockhart Robinson, and Forbes Winslow are conspicuous.
The record of their work would lead us into too wide a field.
But the life-work of one of the sons-in-law of Dr. Conolly, HENRY
MAUDSLEY, is of a character which for good or ill has exerted, and is
exerting, a powerful influence on younger minds. We come here into
a region of work influenced by the philosophy of Darwin and Herbert
Spencer, applied to the physiology and pathology of mind, and to the
relationship between body and mind. The time is not yet come for
an impartial estimate of the striking works which Dr. Maudsley has
brought forth in fertile succession, in addition to his extensive
labours as one of the editors of the _Journal of Mental Science_. But
it is certain that every one who would place himself in a position
to estimate the strength of the so-called “materialistic” school,
whether he be a metaphysician, a doctor, or a person of average
culture, must read Dr. Maudsley’s works. They are written fearlessly,
and for the most part with admirable lucidity, displaying a knowledge
of literature and philosophy not often met with, combined with great
practical experience in mental phenomena.
Henry Maudsley was born near Giggleswick, in Yorkshire, on February
5, 1835. After receiving his early education at Giggleswick School,
he proceeded to University College, London, and took the M.B. degree
at London University in 1856, with the distinction of University
Scholar in Medicine. He proceeded to the M.D. degree in 1857. During
the years 1859-1862 he was Resident Physician to the Manchester
Royal Lunatic Hospital. Returning later to London he became for a
time Professor of Medical Jurisprudence at his old college, and later
Consulting Physician to the West London Hospital.
In an article on “The Theory of Vitality,” which Dr. Maudsley
published in the _British and Foreign Medico-Chirurgical Review_ in
1863 (republished in “Body and Mind,” 1870), he showed remarkable
power for a young man of twenty-eight. His conclusion was that
the conscious mind of man blends in unity of development with the
unconscious life of nature. He looked for the harmonisation of the
idealism of Plato and the realism of Bacon as the expressions of the
same truths.
In 1867 Dr. Maudsley published an important work on the Physiology
and Pathology of Mind. It was intended to treat of mental phenomena
from a physiological rather than from a metaphysical point of view
and secondly, to bring the manifold instructive instances presented
by the unsound mind to bear upon the interpretation of the obscure
problems of mental science, and to do what he could to put an end to
the inauspicious divorce between the two branches of his subject.
He energetically exposed the shortcomings of psychologists and
metaphysicians, and naturally encountered severe criticism, and it
may be allowed that some of his expressions were those of youthful
enthusiasm rather than of matured wisdom. But the book had such
merits, that a second edition was called for in the next year, and
before long exhausted, after which the book was out of print for some
years.
At length Dr. Maudsley republished in a modified form the “Physiology
of Mind” in a separate volume of 550 pages (1876), putting it
forward as a disquisition, by the light of existing knowledge,
concerning the nervous structures and functions which are the
probable physical foundations of those natural phenomena, which
appear in consciousness, or feelings, and thoughts. In this work he
says (p. 47) “that the subjective method—the method of interrogating
self-consciousness—is not adequate to the construction of a true
mental science has now seemingly been sufficiently established. That
is not to say that it is worthless; for when not strained beyond its
capabilities, its results must, in the hands of competent men, be as
useful as they are indispensable.... That which a just reflection
teaches incontestably, the present state of physiology illustrates
practically. Though very imperfect as a science, physiology has made
sufficient progress to prove that no psychology can endure except it
be based upon its investigations.”
Meanwhile Dr. Maudsley had been called upon in 1870 to deliver the
Gulstonian Lectures at the College of Physicians, and these were
published in a small book under the title “Body and Mind: an Inquiry
into their Connection and Mutual Influence, specially in Reference
to Mental Disorders.” The first lecture expounded the physical
conditions of mental function in health; the second described some
forms of mental degeneracy which showed prominently the operation of
physical causes from generation to generation, and the relationship
of mental disorders to other diseases of the nervous system. The
third included a general survey of the pathology of the mind, and the
relations of morbid states of body to disordered mental function.
Meanwhile some important medico-legal cases had brought into
prominence Dr. Maudsley’s belief that there are many forms of
mental disease in which a patient ought not to be held criminally
responsible for his actions, although he might be fully cognisant of
their nature. This was definitely expressed as far back as 1864 in a
pamphlet entitled “Insanity and Crime,” a medico-legal commentary on
the case of George Victor Townley, by the editors of the _Journal of
Mental Science_. It was in 1872 more fully developed by Dr. Maudsley
in his “Responsibility in Mental Disease,” which has gone through
numerous editions.
In 1879 the “Pathology of Mind” appeared in a separate and enlarged
form, and contains a systematic exposition of the subject, introduced
by an account of sleep, dreaming, somnambulism, and allied states.
He then proceeds to deal with the causation of insanity, both social
and material, and then further expounds the symptoms of insanity,
treating it as one disease with varied manifestations, and then
delineating the clinical groups of mental disorders met with in
practice and which the physician has to deal with. One great merit
of the book is, that the clinical pictures it contains are drawn from
life. An extract from chapter iv., dealing with the influence of
conditions of life on the production of insanity, will show how at
every step Dr. Maudsley introduces considerations bearing on morality.
“The maxims of morality which were proclaimed by holy men of old as
lessons of religion indispensable to the well-being and stability of
families and nations, are not really wild dreams of inspired fancy,
nor the empty words which preachers make them; founded on a sincere
recognition of the laws of nature working in human events, they
were visions of eternal truths of human evolution. Assuredly the
‘everlasting arms’ are beneath the upright man who dealeth uprightly,
but they are the everlasting laws of nature which sustain him who,
doing that which is lawful and right, leads a life that is in
faithful harmony with the laws of nature’s progress; the destruction
which falls upon him who dealeth treacherously and doeth iniquity,
‘observing not the commandments of the Lord to obey them,’ are the
avenging consequences of broken natural laws. How long will it be
before men perceive and acknowledge the eternity of action, good
or ill, and feel the keen sense of responsibility, and the strong
sentiment of duty which so awful a reflection is fitted to engender?
How long before they realise vividly that under the reign of law on
earth sin or error is inexorably avenged, as virtue is indicated,
in its consequences, and take to heart the lesson that they are
determining in their generation what shall be predetermined in the
constitution of the generation after them?”
A later important work is “Body and Will,” 1883. “Its justification
from my standpoint,” says Dr. Maudsley, “is, that I have been engaged
all my life in dealing with mind in its concrete human embodiments,
and that in order to find out why individuals feel, think, and do
differently, and in what way best to deal with them so as to do one’s
duty to oneself and to them, I have had no choice but to leave the
barren heights of speculation for the plains on which men live and
move and have their being. It is not enough to think and talk about
abstract minds and their qualities when you have to do with concrete
minds that must be observed, and studied, and managed.”
This work deals with questions too vast to be summarily discussed;
but one aspect of Dr. Maudsley’s mind is well expounded in the
following extract:—
“In nature, as we see it, we seem to see a conflict of warring
opposites; gravitation opposed, or rather indeed complemented, by
repulsion; chemical affinities by chemical repulsions; magnetic
attraction by electric repulsion; evolution by dissolution;
conservation by revolution, quiet or catastrophic; love by hate;
self-love by love of kind; heaven by hell. Certain it is that hate
and destruction are just as necessary agents as love and production
in nature, which could no more be, or be conceived to be, without
the one than without the other; and to call the one good more than
the other, however necessary from the standpoint of human egoism,
is just as if one were to call gravitation good and repulsion bad,
as gravitation, had it self-consciousness, would no doubt do. In
order to have a theory of cosmogony that shall cover all the facts,
it has always been necessary to supplement a good principle by a
bad principle, a God of love and creation by a God of hate and
destruction. And it must always be so. We may, agreeably to the logic
of our wishes, comfort ourselves in our pilgrimage by entertaining
the hope and belief of the working out of good through evil and of
the permanence of good after the disappearance of evil, just as, if
it were useful and pleasing to us to cherish the illusion, we might
persuade ourselves that repulsion will one day be annihilated and
gravitation endure, or that evolution will continue and dissolution
cease to be; but if we look at the matter in the cold spirit of
strictly rational inquiry we shall always find abundant reason to
believe that the sum of the respective energies of good and evil
remains a constant quantity, the respective distribution only
varying, and that we might as well try to increase the height of the
mountain without increasing the depth of the valley, as to increase
the good in the world by purging it of its so-called evil.”
Dr. Maudsley became a Fellow of the College of Physicians in 1869,
has been President of the Medico-Psychological Association, and
received the LL.D. degree from Edinburgh University in 1884.
FOOTNOTES:
[17] “Treatment of the Insane without Mechanical Restraints,” 1856.
[18] For details of the exposure of 1813 and 1814, see “A History of
the York Asylum,” York, 1815.
[19] For a description of the state of Bethlem Hospital in 1815, see
Conolly’s work above cited, pp. 26-29. In making this record Conolly
says, “Nothing can more forcibly illustrate the hardening effect of
being habitual witnesses of cruelty, and the process which the heart
of man undergoes when allowed to exercise irresponsible power. Partly
from custom, and partly from indifference, and partly from fear, even
physicians not particularly chargeable with inhumanity used formerly
to see patients in every form of irritating restraint, and leave them
as they found them. _Such facts justify the extremest jealousy of
admitting the slightest occasional appliance of mechanical restraints
in any asylum. Once admitted, under whatever pretext, and every abuse
will follow in time._”
[20] Memoir of John Conolly, M.D., D.C.L., by Sir James Clark,
Bart., 1869; very ill-arranged.