Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly.
- John Conolly
- Date:
- 1845
Licence: Public Domain Mark
Credit: Clinical lectures on the principal forms of insanity : delivered at the Middlesex Lunatic-asylum at Hanwell / by John Conolly. Source: Wellcome Collection.
Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.
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![in wcll-ventilated rooms, are matter* of importance. •aeatnicD'' roofincmcut to IxhI or to a cell, and the use tIu ki'wl* of restraints, ajfpravAte such cases, induce dis f habits of ancleauhnes*. ai\d make tlie patient's state „ t»<ry respect worse, '■'g^^ncernipp these and aU the varieties of acute mania, I ^.^observ'cJ youtliat tl'.e adiiuuisiratioii of medicines, and •^Sowinil Ut any settled p!an ul' treatment, is attended with ■ul)4r'iiitliL>ilties. arismi; Ironi tlie irregularity or vliJence ^ii-li beloii>.'S to the malady; and whilst J am discoursiiif; of _ niedicin.il means, you arc naturally anxiou.s to ask, as all iilors W nn asvUini ilo when such thinus are nH'iitiooe<l, how paliciit IS maiia^red who so furioiL'; tliat he will strike his j^jj j^T^inst the walls, or tear his Hesh, or put out his eyes, or pillow any kin ! of dirt, or make ferocious attacks on every (t^v who couics near luni. You liave now twice visited the ^pjijy-.ioven war^ls, in which nearly one thou.sand patients j-tplaciHl in this asylum, and will, tlureforc. Ik- less inclined ■iin you otlierw ise mi<;lit be to distrust me when 1 say, in •V first pl.n'c, that sucli Jijrpravated cases are rare. We lOi on the outside ot an asylum with a painful belief that iifkntss. nakedness, howliiij;, and fnry make up the scene t.lhiD. but tliese features of aiyliun.s belonijed to a system jhich ciists no loniter. When tliekee|KTS. as they were then ^-nicd, ilreaded approaching; the violent iiatients, anil nikcil jfiy sucli parts of tlie dirty straw ol their cells as they could Mch. a'' tinnded lood to them on a long shovi l, and washed •ten) with a long mop, tliK )>atieDts were in cages resembling •jkneof a iiienagfrie, and cliaiueil to the wall, unclothid, for itfks, for m.jntlis, lor years, and the keeper was as surely i.Tiic<i witli a will]) as is tlie liunljman who visits his kennel. Midness, under such a systi m, and under a lictter system, is K'jrccly the same dist'ase. m those dreadl'ul place s it was the (tmpound product of disi aw.' and neglect, ami the traces of ijnuniiy were almost obliterated. We now see it as a jiurc lUeisc. and are supnted to find its pheiioniena less terrible ;Mn vrc expected. You have bei'U to-day in eight w ards as- t.p(d to our worst cases. In some you have w itnesscil great iialenicnt, loml talking and activity. in others, have heiird Kurctly a sound. (.)iily two or three of the iiatieiiis were locked jpn their rooms; only one was in a jiadded room; and even :vic were, with one exception, riot noisy when in se< lusioii, L'.houch too niiieli excited to fK.' safely at large. Such is the jffltral state, even of the rel'rac tory w arils, hut liable, ot course, l^f^■^^ucnt, sudden, and sometimes dangerous interruptions; :'«f whatever tystcin is pursued in an .isylimi, cases of excessive ntJence, caleiilatcd to produce great .inxiet), niusi present touelves, (and the quietest of the jialients are subject tu ftro-iysms.) and tliese, doubtless, call hir all the resources of pfJClical ninnagcment, but arc all iiianageable, if proper activity ^combined with a humanity bo resolute that no dillicnlty can ^ivc It to the adoption ot cruel expedients. 'I'htTc is no more ffilnecCMity lor abaiidoiung the [iriiic iples of our healing and 'amine art III the trcatmeni ol insanity than in the treatniciit '■'funpk' bodily disease. Our great rule at llaiiweU is, even in the ease of a violent Wtfnt, not to interl'ere unnecessarily. The su[ierintendenee is wuuuit, the interference only occasional, yet always prompt '•agh to prevent nuscluef, instc.id of [.lermitting and p.inisli * It The word puiiieli, indeed, is not permitted to U'pro ^Dccd in the asylum. When the brain is much excited, the i.,itc gesticulation, the veliemeut exercise, and the loud voice tllhe patient, arc natural results of the excitement, and relieve ■' If any of the.se actions are excessively indulged, they P<Mibly cause a re-aetioii on the brain, and, for tiial reason, udilao bo ;iuse they are often incompatible with the ronifort '■Mhers, wc interfere, and try to moderate tlieni; bnt our in- 'fcrenu is chiefly dirt-eted to removing the i ause. If w( ^J'jrfere witJi the etfect.s, we are careful to do so in a manner •^^^ not counteract ;mr ende.ivours by adding strength to ■^caage itsell. Thus, although we neither fasten a manuu al to hi^ bed, nor put on restrain's for liun t<i walk alHiut (a spectacle always unwt Iconic to the other p.uicnts,) o '^Ptoy attendants to hold his arm.s, as re|>resi nted by tht ad ^'*itis of nii-chanical restraints, we very vigil.uitly w.'.tcf 11c IB alloweil to w alk abuut, unbound, from the hour ol ^ inival, but all un.ins of m!>e!iief are n ino>.i.d from liis <Jur windows and doors arr .secure, without the air of ^Prifonnitnt; and our atteinlants a.'-e a.-ciLStomed to lo<ik it! '^''^'s without vexing tl.cui iiy appi aring to do so. ^■'Ortujiatcly, descrifitions (aiinol eniivev ;.j you .a just im- J^-Mton ct ti,,. et!, ^t.s ; ri^hiced on a violent mania, by ;i gwyl- ^fn.-.i :ij;j„; y,,;, how..ver. Sc.'; l!ic rn dluctraud in »ard«. You will fii.d uc'.-y, rcstl..*-, vio!' nl p.itienl.', who, Wrtiui^. ;be r-il:' of ervlinary tr'arbi^; x.i.aid b pkia; up in the dark, or wearing the sleeves or strait-waistcoat, or fastened in bod by the handp and fi'ct, and waist and neck, here permitteil to walk up and down ottr long palleries, or up anil down the airmp-courts, or ridinp, if they choose, on the largo and secure rockinp-horsos placed there for exercise and amusement, and which often seem to give aa much pleasure to the attendants ns to the patients. Hut all the time these p.-iticnts arc diligently watched hy those attendants who have no other business, or duty of any kind, but to pay attention to them, and make themselves companions to the patients, and to become their protectors and friends; exacting from them only that limited and cheerful obodionco which is usually soon yieldeit. No excuse is admitted for rcmi-^STiess in this im- [Kirtant duty by the attendants; for on it^ just performnnce the safety of the p.aticnt, and of other patients, inul even their iwn, de])ends. The patient is in continual action,ever changing his place, and undertaking something new; and a-s long n.s he IS out of diHirs, or out of his riHiui, he must not Ix' left for a iiioiiicnt; and our attendants know that they arc engape<l tor the es]iceial purpose of protecting the patients in all circmn- stances, and they find that this trouble saves them much greater trouble, and of longer eontiminnee, and prc\ents many inconveniences and dangers. It is not often that violent and noisy patients, thus treated, continue constantly noisy and violent throughout the dny; it they do, the attendants must relieve each other in the duty ot looking after them. ('immionly, the jratient has intervals ol iniet, or of sleep; or he is eager for food, and ))U*ased when it is brought to him; and if he cannot be trustisl with a knife and fork, it is cut up for him, and it is generally taken with manifest contentment. Not only an' there (piiet hours, but |iiirt days, in cases of acute mania, otten suggi'sting, in an isylum, :i reniovi'l from a ri'fr.ai-tory to a fpiiet ward; but this trani|iiillity is often interrupted by fresh outbreaks, sudden, and ill.my times rcjieated. Such calm intervals are precious to the practitioner, bnt lost it the patient is treated with dis- trust and kept in restraint. A female patient in ward No. 8 (.\. K ), exemplifies these circamistances strongly. I li'r de- ineanoiir to-day is mild, her manner iierfectly trani|iiil, her gentle, and her eonntenance pleasing; to-ninrroiv, she may Ix' walking raimlly aliout, talking violently, hiding hersell in corners, and all gi-ntli-ness banished, for a tinii-, from her face, but even in this state, a tew words addres.sed to her l>y those whose kindness she recollects will suspend this excite- ment for a lew minutes, although they cannot all at once remove it. Still, thiTc are i ases in wli , li it is not praeticahlo at all times to let the patient Ik' in the galleries; for he is sometiniet irritated bv the sight of other patients, or cannot 1k' ]iroveiileii Iroin interfering with or striiiing them, mistaking them loi some supposed enemies: or the patient maybe furious, un- appeased by kindness, and deaf to all persuasion. In such ii ease, it is not only bitter for the other iiatients and the iit- teriilants tliat he should he put into his own room, hut mncti iR ttcr for the jiaticnt himself We, therefore, s<'eludc liim. ile IS simply jiut into his bed-room, and the door is locked, and he is left to himself, sometimes, hut not always, the window- shutter is closed, and, as it is locked, thgpatient cannot oin n it, 11 the patient is very much agitated, or destructive, the i-ei lu- sioii IS effected in one of the paddeil rmims. It is often easy ti. IMTsnade him to go quietly into the riKim; but if this eaniiol Ik-done, the attendant blows a whistle always woni by him and is imiiieiliately aiilcd by the pri seni-e of Hve or six attend ants from other wards. This is done to prevent a struggle ii which either the attendant or the patient wouhl bo hurt. j\ violent patient will resist two or thre<' attendants; but whei he sees five or six be gives up the point When this is done furtlier attempts are made to jwrsuade the patient to go into hi; room and he (|uict; and if he resists all entreaty, the attemlanli surround him, and sei iiring him as quickly as they can, earri him into the rwjm, place him on his tn-d, and n tn at. Mud dept nds upon this U'lng ilone dexti rously and rapidly, am witbont any injury being receiTcd or given. If any mstaiiei of this kind of seclusion takf-s place when you are in the wards I beg you to pay especial attention to the necessity for it ii the particular ca.se, to the manner in which it is effected, .un to Its immi diate effects on the patient. After the door i Itxked, if you quietly observe the patient through the iiispe. lion-plate, you will see that m almost every ease be seeiin a if surprised to find himself so siuldenly alone, and lies down or walks at)Out like a man recovering from a tit of passion Sonietim(~ be lontinues violent and noisy, but not olten o Icng. Th'- ocebision is ininvdiately rcfortdl, ami a daily rc fiorl is made of each cciusMHl. k is eonunurd according t. '.•ir<-um.-{aiM:'s Irvm ow- bo«r to several twure, seldom fur lb](https://iiif.wellcomecollection.org/image/b21292140_0027.jp2/full/800%2C/0/default.jpg)
