A manual of psychological medicine : containing the history, nosology, description, statistics, diagnosis, pathology, and treatment of insanity, with an appendix of cases / by John Charles Bucknill and by Daniel H. Tuke.

John Charles Bucknill

Date:: 1858

Credit: A manual of psychological medicine : containing the history, nosology, description, statistics, diagnosis, pathology, and treatment of insanity, with an appendix of cases / by John Charles Bucknill and by Daniel H. Tuke. Source: Wellcome Collection.

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$Asylum, has been that which relates to the personal coercion or forci- ble restraint of the refractory patients. ... By a list of restraints appended to this report, it will be seen that the daily number in re- straint was in July so reduced, that there were sometimes only four and never more than fourteen, at one time [out of 800]; but, since the middle of August, there has not been one patient in restraint on the female side of the house; and since September 21, not one on either side. . . . For patients who take off or destroy their clothes, strong dresses are provided, secured round the waist by a leathern belt, fastened by a small lock. ... No form of strait waistcoat, no hand-straps, no leg-locks, nor any contrivance confining the trunk or limbs, or any of the muscles, is now in use. The coercion-chairs (40 in number) have been altogether removed from the walls. . . . Seve- ral patients formerly consigned to them, silent and stupid, and sink- ing into fatuity, may now be seen cheerfully moving about the walls or airing courts ; and there can be no question that they have been happily set free from a thraldom, of which one constant and lament- able consequence was the acquisition of uncleanly habits. In the Fifty-third Report (April 1840), the visiting justices report, that there has not been a single occurrence to weaken their confi- dence in the practicable nature of the system ; and that no in- creased destruction of clothing or other property is occasioned by the personal freedom which the patients enjoy. Indeed, so far as clothing is concerned, the amount of destruction is somewhat lessened, because of the general tranquillity of the patients under the adoption of the new system. In a later Report (October, 1844) Dr. Conolly ob- serves, It is to be ascribed to the want of opportunities of observa- tion, that such a simple exclusion of irritations from an irritable mind —an exclusion not found to be necessary in more than four or five instances in any one day in the year, among 1000 patients, and sel- • dom prolonged beyond four or five hours in any of those instances, during which time the patient's state is frequently ascertained by means of the inspection-plate in the door of his room, and all his reasonable wants and wishes attended to—should ever have been confounded with the idea of solitary confinement; the latter, in reality, comprehending a privation of almost all the stimuli upon which the integrity of intellectual and physical life depends. After five years' experience, I have no hesitation in recording my opinion, that, with a well-constituted governing body, animate*^! by philanthropy, directed by intelligence, and acting by means of proper$