WESTMINSTER REVIEW. 1842.

399

NON-RESTRAINT.-Three distinct opinions now govern treatment of insane. 1. Old system; from horrid brutality of Constantinople, to the much modified coercion of Bethlem and St. Luke's. 2. Degree of bodily restraint limited and checked by superintendent: occurs in five per cent. of all the patients; in this class York Retreat, and many private as well as minor asylums. 3. In which all personal restraints are entirely abandoned in all cases. Palermo, Ilanwell, Lincoln, Northampton, arid Lancaster, among the most noted instances of this. At Palermo, executive management of the establishment conducted entirely by the patients themselves. Admirably laid out gardens, which they cultivate and keep in order; and a theatre. in which they perform plays, and which was built by themselves. Regular balls once a week, which they frequent. Only means of restraint, secluding them in their rooms. Such means effectual for their preservation arid that of those around them. Asylum contains 100 patients. At the Lancaster asylum, magic lantern in winter months, source of much enjoyment. Although such means of keeping up attention more necessary and useful in particular cases, yet in all have a beneficial influence. Music and dancing, so far from causing over-excitement and restlessness, seem to be followed by increased quiet and more natural repose. Most festival days, occasions for a general assemblage of the inmates in their respective department, who dance to the music of one of the patients, dressed in gala costume, on the violin. These things, though trifles, are at all times important in treatment, and still more so where the patients are undergoing a change from a system of coercion to one of comparative freedom. Much of the excitement liable to arise in patients who have been subjected to restraint has been averted by these means. A daily and several weekly newspapers taken in, and everything is done to divert the mind from diseased thoughts. At Hanwell, above 900 lunatics of every grade and degree of insanity wholly exempt from personal coercion. Solitary and occasional seclusions, the resort in cases of extreme paroxysm. The one principle, avoidance of irritation, arid the unwearying appliance of every soothing influence. Mrs. Bowden, the matron. states that previous to September, 1839, there were 41 cases under constant restraint, leg-locks, muff's, restraint-chairs, &c. All liberated before end of month, and not one in restraint since. Thirty-seven yet in asylum, and not one but an instance of improvement of the mental faculties or habits. Some considered dangerous at all times, now occasionally seen at the work-table, smiling and pointing out what they have done. Some sinking into dementia or imbecility, now lively arid talkative. Observed in the Lancaster report, that in every instance of being freed from restraint, considerable improvement resulted. In some cases, so striking a change had taken place in habits and general appearance, that in a little while they were with difficulty recognised. Substitute 400 for coercion at the asylums which disuse restraint, seclusion. Mode at Hanwell thus enjoined : must be strongly enforced upon attendants, that it is their business to prevent mischief, and not to punish it. Must be habituated when persuasion fails to act steadily and systematically together, without words and prolonged struggle. Whenever required to collect, to seclude a dangerous patient must assemble quickly and quietly, no controversy or useless contradiction, and the purpose being accomplished, must disperse quietly. These are directions continually acted upon: and the effect is considerable on the patients, who are satisfied that they will not be unnecessarily- interfered with; but when interference is necessary, it is sure to be effectual. Seclusion similarly adopted at the Lancaster asylum. In all cases of violent excitement, if gentle persuasion fails in subduing irritability, removed as carefully and mildly as possible to his own room, where he is left alone, or, if circumstances require it., to a room into which is admitted a subdued light, and prepared so that he cannot injure himself. Being short as practicable, patients in general admit its justice, evincing such admission by their future good conduct. At Lincoln, the still milder remedy, of merely holding the patient quietly, but powerfully. Bodily power of attendant employed solely to prevent direct mischief, the patient being permitted otherwise to indulge his whims and dispose of his accumulated irritability. Peculiar benefit, that the attendant, for his own convenience, will cease from interference, the first moment that it can be dispensed with. When a patient has been held by the hand ten minutes, a report is made to the house surgeon, who orders and makes a minute of any farther detention he thinks necessary. Mr. W. Smith, the house surgeon, writes, Jan. 7th, 1842,-Practice of non-restraint firmly established at Lincoln. Some months ago commenced experiment of abolishing seclusion or solitary confinement, and it is gratifying to report that not a single instance of seclusion has occurred since 14th September last. Altered condition of patients, and absence of irritation and violence, so frequent in the wards when seclusion was largely employed, has been repeatedly commented on by persons visiting galleries. Patients now entertained by music and dancing once a month, and the most violent usually allowed to be present. Visiters of both sexes, to a limited extent, also admitted, and confidence so great, that young and delicate females freely join in the dance with some of the occasionally most violent patients without the slightest apprehension. Mr. Tuke rather against the nonrestraint system. Dr. Conolly observes, that he has not yet met with one related case, with one imaginary combination of danger and difficulty of which he does not know, from actual observation, that the management is practicable and the evils avoidable, without recourse to such measures. Retreat Report observes, to treat them, in fine, as much as possible, as though they were sane, and as responsible beings; the basis of moral treatment.