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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![iM a pair of toft gloves •without division! for tho flnjoro end dMimb; |io as to prevent llic penclralion of llic teetti, and the mJichief of prehensile inovpnii'Ot!>. All such cnsc?, however, are rare, an^l where tliey exist nre rntlier the product of miserahle oomfincnient, monotony, and nepleet, than nf the disease. The propensities, nlso, are seldom of loii j continiianco, and are gene- rally checked or removed hv sonic sedative medicine and warm baths. When the proper medic:il reli'-f nf such c.i.se.s is neftlected, and the cause of those nervous lricl<s unregarded, the patient is condemned to some wretched form of restraint, and often for months ; n harhariiy excusable in ignornnt persons having the charge of them, hut dispraceftil in a medical siiperinti iident. I In the older .iccnunts of madness, von will find descriptions of ' tbe dirt-cRlinp propen.sities of lunatics; and among the evils] threatened, or asserted to he incidental to leavinp ofl'restrainis at 1 Hanwell, this w«s one. It ^v,^s asserted that several patients 1 ■would devour excrement and drink urine. Shocked by reports i of such thinps, we investifrated them with anxiety, found tliem | partly exaggerated, and partly founded on circumstances capable | of remedy. This miserahle propensity seems to exist in some eases, ns an effect of all discrimination of substances being lost, and in olhers it i.s the result of an insatiable voracity. The oldest ward-attendants assured us that tlie propensity was not baffled by the old restraints ; and we have found that it can be prevented by removing every opporninity for its gratification. A full supply of food by day, and of bread by the patient's liedside at night, has been efficacious in some instances; and the jiariicular form of dress which I now show you, consisting of trousers :ind ■waistcoat uniti-d, put on at night, and fastened behind, so that the patient cannot take it off, is extremely convenient. I need scarcely mention the necessity of insisting on constant cleanliness of the dresses, rooms, and utensils being maintained by the attendants', on their vigilant superintendence of tlie few patients addicted to such habits, and on the instant removal of all offensive matters. Vet no e of these things received due atten- tion so long as restraints were permitted to lie used; restraints being n subsdiule for all allentioiis by which the habits of the patients could be Improved. Very often from this neglect, and from having restraints put on nt night, or iliiring the day, patients become wholly regardless of personal cleanliness, and consei^uently offensive; and where many of tbem are collected together, the rooms, passages, and airing-courts become disagreeable, and abound with bacl smells. Uncleanliness is nlso a frei|uenl and miserable circumstance inci- dental to the malady itself: a sort of jK'rverse pleasure seems to be taken in it, even among insane patients who have been accustomed to neatness or to luxury. Their apartments are strewed with torn books and jiaper-, broken snuff-boxes or ornaments, ragged clothing disposed wilh a kind of art, tobacco, snuff, fragments of bread, orange-jieel, and all kinds of litter. Often from paralysis of the sphincters the palienis' clothes are eontinnally soiled ; and often from mere inntlentinn or imbecility of mind ; in which oeie great improvement may be effected hy a careful attendant, and by attention to the general health of the [latient. Kven in tome cases of paralysis, the want of proper retention of the con- tents of the bladder depends on mental iiiHrmily. and not on any affection of the sphincters ; and, as in the case of V. I, , in male ward No. 4, who is ali'ected with general paralysis, and was what is called a dirty patient, on admission a f w nKuiths ago, is capable of remedy. I hope yini have found our wards atl'ording a proof of what can Ih' done by cleanliness to prevent llie obtru- sion of anything offensive to sight or smell, both in the galleries and in the bed-rooms. Tins is effected by great activity on the part of the attendants, by changing the clothes of some of the patients frequently, by someiiuies removing the patients ftom room to room, and by the freipient use of warm baths. No Mcuse is ever admitted for the prevalence of a bad smell; and how often soever the clothes of a patient re(|uire to Ik- changed, we expect it to ha done. We do not permit anything of this kind to he spoken of as a trouble-, it is ii part of the attention re- quired bv the peculiar malady for the relief of which asylums are bnilt W e entirely disemmtenauce its evasion by the wretclutl means formerly employed, when dirty patients weit either left to lie all the day, as well as night, mi damp and dirty straw, or removed every morning from tbeu beds only to be fixed in a rentraint-chair —a sort of wntch box, pierced as a close stool—on which they tale in a stale of abaiulonuienl deslruelne of all delicacy, and which soon made any rcturu to decency scarcely possible. If yon feel any doubt of ihe possibility of preserving cleanliness in a few recent cases of malady, or in cases of recurrent excite- ment when neglect of cleanliues.s recurs as part of ibe attack, let me beg of you lo (Icvoie h ilf on hour to a niinnte inspi-rtion of our male ward No. 1, containing titty patients, all incurable, most of (hem imbecile, aud the greater jiurt of them alwavs la need of all the care required by children. You will not find one of them, kcjit in bed, nor on straw, nor fastened to bench or ring; not m corner filled with rcotraint-chairs, on a sloping and'gatterM rtoor, like a stable, as in as)lums where restraints are U8<^^ such cases ; hut every patient up, and out of doors in fine wcaihtr^ in clean clothing, and accuttumcd to sit down to cosnfortabli meals. This is effected by the care of four attendants; and b my own opinion, no ward does more lionour to Uanwel! th> this. It is in this ward that our new attendants learn some o? their most important duties, and receive their most valuaW. instruction. In recent cases, inattention to cleanliness shouUUihf ays be looked upon as temporary and curable. W'e do a grievuus iniury to a patient if we forget this, and allow the infirmity lo become in- veterate. The iiaticnt should be reminded of i-.tteulion to tb« bowels and bladder at proper intervals; and esyitciallv before going to bed. A good attendant will generally succeed in im, proving his patient in this respect, by encouragement, exhortation, remonstrance, and care. I remember a male [lalient admitted here after being in som* other asylum, with a written report of being dirtj and violent. Overhearing this read by somebody, he said iu me, .A uiun may well be dirty and violent who is fastened down in a trough-btd day and night, and struck hy the keepers, as 1 have been u He often repeao.^ this remark, and assured me of it» truth. I assured him he should never be fastened here, and that he should not lie in a trough, and that no one was ever permitted to strike a blow in this asylum. This man proved to be cleanly in all his habits. He was for a time maniacal, but was not long before he began to work in the shoemaker's shop; he gra- dually got cpiite well, and in a few months left the asylum. I doubt if he would have gfit well in his trough. Whilst uncleanly habits remain, the dress already spoken of may he worn with advantage, made of materials most suitable to the condition of the patient. It is necessary to enter into »U these humble particulars ; for if they are tlunight below regard, the neglect will entail lamentable consequences as respects the- resioraii(m of habits of mure dignity and value. N'o rank of life is exempt from the degradatioi.s of mental iiit^-niity, and it de- pends on attention to many small particulars whether life shall be preserved in comfort, and iniud restored, or all that is valo- able iu man or woman be irretrievably lost. In ordinary CSMI, and ill private houses, and where the evil of uncleanliness is oolj; temporary or occasional, the bedding may be preserved bv» .Alackinlosh covering, or a thick painted cloth, or an uil-cloth, placed under the sheet and blanket. .Among the poorer patienta different arrangements prevail; all -vhoweie in this state ■ireTB' accustomed, in this asylum, to sleep on loose straw, laid ui a crilv the bottom of which was lined with lead, sloping to a central per- foration. This was the most convenient loini of bed, and the straw being renewed fieipiently, and laid loosely and lengthwise, and a blanket and sheet laid over it, was not particiihirly obj€C-< tionable in itself; but when ]i.ilients were fjstened to the crib, and their cleanliness not rigidly attended ti', the hack or parB pressed upim became inflamed and ulcerated, and life was cer- tainlv sometimes shortened by these accidents. Much dirt and litter was also introduced with the straw, and it was very difficult to avoid bad smells. The model before you represents a frame- bed now used for dirty patients throughout this asylum. I believe it was first used in the (iloueester .\sylum, and afterward in the asylums •f Statford and Nottingham. Our adoption of it ha5 been attended with [Kjrtectly satisfactory results. It consists, yoo observe, of a frame of wood, which fits the crib, and supports a canvas stretcher, on which the blankets and sheets are placed. Two such frames are made for every crib so required, aud thusa fresh and dry one is put in every morning, oi ojieiier if necessary, the other being carefully scoured, scrubbed, and dried, ioo have, no doubt, remarked that scarcely any of our patients keep their beds in the day-time ; but if a patient is compelled to do SO bv illness or debility, and is aKo uncleanly, these frame-beds ITt highlv serviceable ; and it is now a most rare thing to h.iTe » patient in the bouse wilh an ulcerated back. Patients are ocfS- sionally admitted in such a slate, but the ulcers are soon healed when their cause vonfineinent to a horizontal position on wet straw—is discontinued. Among those to w hom I address these observations, there rosy he som-^ whose task it may hereafter be to endeavour to abousB the use of restraints in other asylums, either at home, or in on/ numerous colonies, of some of which the asylums will be foiwo to represent the exact state of such wretched phices in this '^^ try a century ago. To pri-vceed safely and successfully in sucO attempt, it will be advisable to inquire into tlie cause of the re- straint being resorted to iii each case. When walking round one I of the ainiig-conrts this morning, you were .it a lo-s to accouB I for a few iron rings atuched to some of the walls. UDderueaia](https://iiif.wellcomecollection.org/image/b21292140_0055.jp2/full/800%2C/0/default.jpg)
