Part 16

In spite of the ameliorations in the condition of the insane, many among the higher, and nearly all among the lower classes, still look upon the County Asylum as the Bluebeard's cupboard of the neighbourhood. These unfounded ideas act as a powerful drawback to the successful treatment of insanity, for as the vast majority of cures are effected within three months of the original attack, whatever deters the friends of the patient from bringing him under regimen at the earliest possible moment, probably ensures the perpetuation of the disease. We can well imagine the undefined awe and tribulation of spirit with which the unhappy creatures who are stricken in mind enter the gates of an abode in which they are supposed to be given over to a durance worse than death; but so mistaken is the impression, that the feelings of desperation are almost immediately succeeded by the inspiriting dawnings of hope. The furious maniac who arrives at Colney Hatch or Hanwell in a cart, or a hand-barrow, bound with ropes like a frantic animal, the terror of his friends and himself, is no sooner within the building which imagination invests with such terrors, than half his miseries cease. The ropes cut, he stands up once more free from restraint, kind words are spoken to him, he is soothed by a bath, and, if still violent, the padded room, which offers no aggravating mechanical or personal resistance, calms his fury, and sleep, which has so long been a stranger to him, visits him the first night which he spends in the dreaded asylum. An old lady--a relapsed patient--whose silver locks hung dishevelled on her shoulders, was, when we visited Hanwell, waiting in a cab in a state of the wildest excitement. Immediately she was admitted, and recognised the faces of the nurses who had formerly been kind to her, her whole countenance changed. "What, you Burke and you Thomson again!" she exclaimed, delighted at renewing former friendships; and settling herself down peaceably in the ward, she appeared as comfortable as at her own fireside.

Not only have the old methods of treatment been abandoned, but many changes have been made to render the houses for the insane less repulsive to the eye. Thousands of pounds have been spent in replacing the dungeon-like apertures (often without glass) with light-framed windows, undarkened by dismal bars; the gratings have been removed from the fireplaces; and that all the other associations may be in harmony with the improved appearance of the building, the harsh title of keeper has given place to that of attendant, and the madhouse has become the asylum. In the old plan, the entire treatment seemed to consist in secluding the patient from every sight which renders life sweet, and in wrenching him violently from all the conditions which formerly surrounded him; the new idea is to bring within the walls as much of the outside world as possible. Here the artisan finds employment in various handicrafts, the agricultural labourer renews his commerce with the soil, and the female plies her needle or pursues her accustomed occupations in the laundry or the kitchen. Amusement takes its turn, and those who travel by the Great Western train on winter evenings are surprised to see the lights streaming from the great hall of Hanwell, and to hear perchance the sounds of music. These issue from the ball-room of the establishment! In place of the dark dungeon, the bonds and the blows which once added outward to inward woe, the inmates are realising the poetic picture of Gray,--

"With antic Sport and blue-eyed Pleasures, Frisking light in frolic measures; Now pursuing, now retreating, Now in circling troops they meet: To brisk notes in cadence beating Glance their many-twinkling feet."

Mental aberration is not of necessity the bane of mental enjoyment. There are many sweets by which its bitterness may be diluted and diminished, though our ancestors were so ignorant of the fact, as to believe that the best thing to be done for a mind o'erthrown was to pour vinegar to gall.

Dr. Conolly, in his lately-published volume on "The Treatment of the Insane without Mechanical Restraint," looks upon the banishment of the strait-waistcoat with a just pride, for to him we owe the abolition of the last mechanical means of coercing temporary violence; but we cannot participate in his fear that the selfishness and ignorance of human nature will ever be able to restore the gloomy reign which has at last been brought to a close. We can no more go back to the days of hobbles and handcuffs, chains and stripes, than we can go back to the days of the rack and thumbscrew. We may have, it is true, lamentable exposures, such as took place at Bethlehem in 1851, but the depth of the public outcry, and the promptness with which the irregularities were remedied, is of itself an evidence that general opinion will prove the corrective of occasional abuses. Nor can we, from a fancied apprehension of the return to obsolete practices, join in the fanaticism which forbids the use of the strait-jacket as a means of coercion under all circumstances. There can be no doubt that the treatment which requires its frequent use is a bad one; but to deny that there are cases which call for its restraints would be to deny the evidence of our senses. Mr. Wilkes, the late medical officer to the Stafford County Lunatic Asylum, and now Commissioner in Lunacy, in answer to a series of questions issued by the Commissioners on Lunacy upon the subject, makes the following remarks:--

"With every disposition to advocate the disuse of restraint to the utmost extent, I am compelled to admit that the result of my experience in this asylum, up to the present time, leads me to the conclusion that cases may occur in which its temporary employment may be both necessary and justifiable. Besides the occasional use of some means of confining the hands when feeding patients by means of the stomach-pump, a more prolonged use of restraint was necessary in two cases which occurred some years since. One of these was a man of so determined a suicidal disposition, that on more than one occasion he nearly effected his purpose by trying to beat his head and face against the walls, to throw himself from tables and chairs, and thrust spoons and other articles down his throat. When first admitted, he was not suspected of having any suicidal tendency, and for some weeks did not show any; as a matter of precaution he slept in a padded room, and one night he so battered his head with a tin vessel that he was found nearly dead from loss of blood, and his life was subsequently in much danger from extensive sloughing of the scalp. In this case it was absolutely necessary to confine the hands to keep any dressings on the head, and after the wounds had healed, and the confinement of the hands had been discontinued, he wore a thickly-padded cap for many months. Several years after this, he bit both his little fingers off; and though the suicidal disposition has in a great measure subsided, he is still at times much excited, but does not require any restraint. The second case was one of acute mania. A powerful young man refused all food under the impression that it was poisoned, and imagined that every one who went near him intended to murder him. Every inducement to get him to take food was in vain, and though a sufficient body of attendants, under my own inspection, attempted to do what was necessary for him, he became so much bruised in holding him in his struggles to assail the attendants, when it was urgently requisite that food should be administered into the stomach, that I decided upon confining his hands, and both food and medicine were then readily administered. The result certainly justified the means employed, as the excitement subsided, and he soon recovered."

So much for the experience of the medical attendant of a public asylum; now let us hear the testimony of Dr. Forbes Winslow, whose experience in his private asylum, Sussex House, Hammersmith, has been as great perhaps as that of any man, since he has lived with his family for ten years in the very midst of his patients, and who is surpassed by no one in his enlightened and gentle treatment of the insane.

"Patients," he says, in his Report to the Commissioners, "have often expressed a wish to be placed under mechanical restraint, should I, in my judgment, believe that they would, when much excited, commit overt acts of violence, and be dangerous to themselves and others. In cases like these, mechanical restraint may for a short period be applied, not only without detriment, but with positive advantage as a curative process. Several instances relative of this fact have come under my observation. I have seen cases where no food or medicine could be administered without subjecting the patient to restraint. In these cases, if all idea of cure had been abandoned, and I could have reconciled it to my conscience to allow the disease to take its uninterrupted course, and have permitted the patient to exist upon the minimum amount of nutriment, and take no medicine, all restraint might easily be dispensed with; but considering the cure of my patient paramount to every other consideration, I had no hesitation as to the humane and right mode of procedure."

In a case which came under our knowledge, a patient imagined that the text, "If thine eye offend thee pluck it out," was literally intended, and, after various attempts to comply with the command, he succeeded in destroying the sight of one orbit. Such instances are rare, but the medical man should at all times be prepared to meet them, instead of folding his arms and looking helplessly on whilst the mischief is being done, through a craven fear of the non-restraint cry. The strait-waistcoat is certainly liable to great abuse, but less than the padded room, which may be converted into a cruel means of coercion in the hands of unwatched attendants.

There yet remains a vast amount of restraint, which is almost as irritating, if not so strongly reprobated, as the implements which bind the limbs of the suicidal or violent. Restraint is only comparative. The strait-waistcoat is the narrowest zone of confinement, and the padded room but a little wider. Next to these comes the locked gallery for a class, then the encircling high wall for the entire lunatic community; and lastly, that aërial barrier the parole, for those who can be trusted to go beyond the asylum. The efforts of philanthropists will not, we are convinced, cease, until all the methods of confinement, down to the parole, are removed; or at least so disguised as to hinder their present irritating action upon the inmates. As long as the chief idea in connection with these establishments is that they are receptacles for the _detention_ of the insane, so long perhaps the means taken to prevent flight will obtain; but when they are simply regarded as hospitals for the cure of mental disease, we shall witness the abandonment of many arrangements which are as barbarous and ineffectual as the cruelties practised in the last century. The asylums where the restraint is greatest are precisely those from which the largest number of patients contrive to escape; whereas, when restrictions of all kinds are abolished, as at the insane pauper colony of Gheel, in Belgium, but few persons ever attempt to get away.

In former days the public were admitted to perambulate Bedlam on the payment of twopence. A writer in the _World_ gives a narrative of a visit to it in Easter-week, 1753, when he found there a hundred holiday-makers, who "were suffered unattended to run rioting up and down the wards, making sport of the miserable inhabitants." Richardson, the novelist, had, a few years earlier, depicted the scene in the assumed character of a young lady from the country, describing to her friends the sights of London.

"I have this afternoon been with my cousins to gratify the odd curiosity most people have to see Bethlehem, or Bedlam Hospital. A more affecting scene my eyes never beheld. I had the shock of seeing the late polite and ingenious Mr. ---- in one of these woful chambers. No sooner did I put my face to the grate, but he leaped from his bed, and called me with frightful fervency to come into his room. The surprise affected me pretty much, and my confusion being observed by a crowd of strangers, I heard it presently whispered that I was his sweetheart and the cause of his misfortune. My cousin assured me that such fancies were frequent upon these occasions; but this accident drew so many eyes upon me as obliged me soon to quit the place. I was much at a loss to account for the behaviour of the generality of people who were looking at these miserable objects. Instead of the concern I think unavoidable at such a sight, a sort of mirth appeared on their countenances, and the distempered fancies of the miserable patients provoked mirth and loud laughter in the unthinking auditors; and the many hideous roarings and wild motions of others seemed equally entertaining to them. Nay, so shamefully inhuman were some, among whom, I am sorry to say it, were several of my own sex, as to endeavour to provoke the patients into rage to make them sport."

Supposed to be degraded to the level of beasts, as wild beasts they were treated. Like them they were shut up in dens littered with straw, exhibited for money, and made to growl and roar for the diversion of the spectators who had paid their fee. No wonder that Bedlam should have become a word of fear; no wonder that in popular estimation the bad odour of centuries should still cling to its walls, and that the stranger, tempted by curiosity to pass beneath the shadow of its dome, should enter with sickening trepidation. But now, instead of the howling madhouse his imagination may have painted it, he sees prim galleries filled with orderly persons. Scenes of cheerfulness and content meet the eye of the visitor as he is conducted along well-lit corridors, from which the bars and gratings of old have vanished. He stops, surprised and delighted, to look at the engravings of Landseer's pictures on the walls, or to admire the busts upon the brackets; he beholds tranquil persons walking around him, or watches them feeding the birds which abound in the aviaries fitted up in the depths of the ample windows. Indeed the pet animals, such as rabbits, squirrels, &c., with the verdant ferneries, render the convalescent wards of this hospital more cheerful than any we have seen in similar institutions. At intervals the monotony of the long-drawn corridors is broken by ample-sized rooms carpeted and furnished like the better class of dwellings. If we pass along the female side of the hospital, we find the apartments occupied by a score of busy workers, the majority of whom appear to be gentlewomen. Every conceivable kind of needlework is dividing their attention with the young lady who reads aloud "David Copperfield," or "Dred;" while beside the fire, perhaps, an old lady with silver locks gives a touch of domesticity to the scene, which we should little have expected to meet within these walls. In traversing the male side, instead of the workroom we find a library, in which the patients, reclining upon the sofas or lolling in arm-chairs round the fire, beguile the hours with books or the _Illustrated News_. Many a scholar, the silver chord of whose brain jingles for the moment out of tune, here finds a congenial atmosphere, and such materials for study as he often could not obtain out-of-doors; and here many an artist, clergyman, officer, and broken-down gentleman, meets with social converse, which the world does not dream could exist in Bedlam.[14]

No cases of more than twelve months' standing are admitted within the walls of Bedlam, and only ninety persons termed incurables are allowed to remain beyond that period. These regulations exclude the idiotic and epileptic patients, who form such distressing groups in other establishments, and the interest required to obtain admission into this amply endowed charity ensures at the same time a much higher class of inmates. Clergymen, barristers, governesses, literary men, artists, and military and naval officers make up the staple of the assembly. The representatives of the lower orders are also present, but the educated element prevails, and the tone of dress and manners is vastly above that to be found in the pauper-swarming county asylums. There is a ball on the first Monday in every month, and the company that gathers in the crystal chamber at the extreme end of the south wing would not disgrace in behaviour and appearance any sane and well-bred community. The polka, the waltz, and the mazurka, performed with grace and ease, declare the social standing of the assembly; and many a pedestrian who sees the dark silhouettes of the dancers as they whirl across the light, is astonished at the festivities of the inmates. In the summer evenings the spacious courts are crowded with the patients, not gloomily walking between four dismal walls in which the very air seemed placed under restraint, but enjoying themselves in the bowling-green or in the skittle alley. The garden is at hand for those who love the culture of flowers. When we contrast the condition of the Bethlehem of fifty years ago with the Bethlehem of to-day, we see at a glance what a gulf has been leaped in half a century--a gulf on one side of which we see man, like a demon, torturing his unfortunate fellows, on the other like a ministering angel carrying out the all-powerful law of love. Can this be the same Bethlehem where, in 1808, Mr. Westerton, Mr. Calvert, and Mr. Wakefield saw ten patients in the women's gallery, each fastened by one arm or leg to the wall, with a length of chain that only allowed them to stand up by their bench, and dressed in a filthy blanket thrown poncho-like over their otherwise naked bodies? Can this be the same institution in which poor Norris, like a fierce hound in a kennel, was favoured with a long chain that passed through the wall into the next room, and which, while permitting him a little extra tether, enabled the keeper to haul him up to the side of the cell when it was necessary to approach him? But this indulgence did not last, and from the pages of Esquirol we learn the infernal torture which was finally put upon him.

"A stout iron ring was riveted round his neck, from which a short chain passed to a ring made to slide upwards or downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar, about two inches wide, was riveted; on each side of the bar was a circular projection, which, being fastened to and enclosing each of his arms, pinioned them close to his side."

In this position, in which he could only stand upright or lie upon his back, he lived for twelve years! But in nothing, perhaps, is the contrast between the past and the present more apparent than in the two pictures presented by Dr. Hood, the resident physician, from the case book of the Bethlehem Hospital, which at once show the difference of treatment and the different results which attended it.

"A. F., admitted into the Hospital, February 6, 1808, aged 34. This woman was born at Derby. At the age of 20 she came to London to seek for service, but she soon lost her character. The natural violence of her disposition was increased by her intemperance. She was the most turbulent of all the females that disturb the night about Fleet Market, and has been repeatedly flogged at Bridewell for her extreme violence and disorder. She became at length the horror of the watchmen, for punishing and imprisonment had no effect in checking her career. She was known to her companions by the name of 'Ginger.' In one of her paroxysms of rage she attacked the windows of the Mansion House, and on her examination before the Lord Mayor, it appeared that her violent disposition had gradually passed into a state of complete madness. Under these circumstances she was sent, February 6th, 1808, to the Hospital, and placed on the curable establishment. At the expiration of twelve months, her lunacy continuing, she was admitted on the incurable list. There is no record of the manner in which she conducted herself during the first year, but it appears _that she was chained to her bed of straw for eight years without any covering or apparel_. So long as she continued thus coerced the violence continued. The last entry is '_coercion still makes her ferocious, but when left at liberty she is not in the least degree dangerous_.'"

"M. C., admitted into this Hospital, Sept. 30, 1853, in a state of violent raging excitement, depending upon acute mania. She had been in this state three days previous to her admission, and had wandered about the streets in a comparatively naked state, under the excitement of religious enthusiasm. She was a powerful, muscular woman; and to bring her to the Hospital it was necessary to impose upon her the restraint of a strait-jacket. She screamed violently all the way to the Hospital, and used the most threatening language, refusing to listen to anything that was said to her, but when tired of vociferating, contented herself with kicking and spitting at those within her reach. On admission, the mechanical restraint was removed; she was ordered a warm bath, and two grains of the acetate of morphia, and afterwards placed in a bed in a padded room. She continued noisy for an hour or two, and then became quieter; but the attendant, who looked at her every half-hour, always found her sleepless. The following day she continued tranquil, but when addressed, responded with an oath. She was ordered one grain and a half of acetate of morphia. The third day she continued quiet and sullen, but permitted the nurse to dress her and place her in a chair in the day-room with the other patients. The following day (the fourth) she continued tranquil and rational, rather shrinking from conversation; and being a little feverish, was ordered 'henbane,' with a saline. From that day she speedily became convalescent, and was discharged cured, November 11, 1853, having been a patient in the Hospital forty-two days."