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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![64$ these riii,?s was a bench ; and it used, I suppose, to be considered iKj-^ntnCi'oui wher, troublesome patients were taken out of doors, to-place them on these benches, and to fjsten tliem to the rinfrs. The sanie patients, when within doors, sat at a table covered with ffflr. whie!; '■'''e employed in picking, and their feet were fastened to the K'gsnf the table. Siicli a practice would doui)tless r^w seem shockin;: to you, depriving; nur pi»r people of the pleasure of ruunin j about or lying dow n in fine weather on the •yw^ grass, or ino-. inp about liie galleries. But far worse scenes rsre forme, ly always to be witnessed within doors in the older 3.<Tlamf. in sonif r.f which pa'.ienls passed years chained to the vt'.'ii : ;'.nil if you exercise your profession in distant colonies, or, I fear, even in distant provinces of oiir own country, you will Im'c still to contend with these primitive barbarities. If vo'.i find a patient in a sirait-waisicoat, or wearing the leather Ijntf. because his clothes will be torn, take care that outside clothing ofstrong materials be prepared for him. and if he undresses him- self as fast as it is put on, let the dress be fastened at the waist, prists, and neck, with these small locks instead of buttons. Let hini wear boots similarly secured, Examine also the state of his sVin for any explanation of his wish to be without clothing; pianiine the clothing also. A wnmi bath and a supply of per- fectly clean under clothing will sometimes remove all the dilfi- cultv. If patients still contrive to expose themselves improperly, let tbem have the dress consisting of trousers or drawers and iriislcoat united. If the ordinary bed-clothes are torn, substitute far them bl.inkets sewed up in a licking case. The patterns of all these contrivances are laid before ycu, and a little ingenuity will eaabie you to adapt them to patients of ditTerent classes. These Jresses and contrivances render it quite unnecessary to confine i!W muscle of the arms or hands, or feet or 'egs, or body ; and even the habit which n. de them necessary usually soon ceases, and we thus avoid having recourse to restraints which fret and heat the body, and irritate and mortify the mind ; and which, if resorted to in every trifling difficulty, have an unhappy trodency to become peniianently applied, as was actually the owe even in this asylum not many years ago. I coirld show you both men and women who formerly wore leg-looks for a great length of lime, — for motjths or years,—and who have been harni- leis ever since they were liberateil from thein ; others, who were seldom without the muff or str^it-waistcoat ; and others.who were tlirays in restraint-chairs in the day-time, and fastened at night; all of whom have improved in habits and cliaracter since their entire and unconditional liberation. I have already described to you how we manage such patients as are disposed to make attacks on nil who approach them. These patients are, in fact, not so inconvenient to us as some are who bave a frequent and sudden propensity to strike those about them. It must be confessed, that at first sight one would pro- BOUDce that some limitation of the free motion of the anus was ia these instances a desideratum But no one would expect this kind of restraint to cure an impulse S|iriiiging from an irritable train. The restraint must therefore be perpetual, and iii order really to prevent the patient from hurting his neightKuirs, it must be very severe. Watching the patient, and occupying liim, if possi'dc, or, at least, -ultivating his goo-i humour, is far more likely to make him discontinue the practice ; and after much experience of recent cases treated without restraints, and chronic oases tre.itid with restraints, I am convinced that the habit of strikii.g and kicking, of which we had once so many, and now have so few, examples, was generally the product of restraints, »nd was aggravated by their continuance. I douht our haviug one instance of such a propensity being uiveterate m any case of which »e hav.^ had the management before the patient had been roughlv treated elsewhere. In such a case as that of J. M , now in male ward Nu. 4, restraints would probably have fostered every vioUnl propensity. The patient is thirty-nine years of age, las >K-' 11 .1 sold er, of intemperate habits, and was sent here by a »aiTant of the .Secretary of State, on account of some violence wimmittid. For six months he has been in a state of restless Jrtivity, exhi>iiling all the clu.ract'rictics of acute mania; but you !iive sirn that he is on the most friendly ;,tiiis with the attendants, rto, he savs. are very nood fellows, and very kind to him; and lie is most friendly with the medical officers. M'e observe a gradual but very slow amendmeiit in him, and have sanguine •xjpes of L.s recovery. It is an undeniab'c fact, that blows and injuries, and casualties everv kind, have become less frequent since restraiuts were •bohshJd . fewer windows are broken ', they are not even guarded ^ the day-rooms of t« 'i out of f..ur of the male refractory wards; there i.> less cloiliing and bedding desiroyed. What is also ery curio :s and interesting is, that the house-surgeons have from tiinr- to tim.; had to manage some tlifficult and delicate sur- CIS. ;, and have contrived to conduei them to a success- ^ termiMtion nithout lastcuint; the patient lu any way. In I one or two instances tbU course h&s bean ueceuariiy departid I from, but only on the same principle which would be acted upon in I certain cases among sane, but highly irritable and restlesa patients. I As regards all the dreadful accidents often represented u ' resulting from the absence of restraints, such as patients putting out their own eye.s, putting their heads on the fire, guafring , their arms, killing one another with hatchets, &c., 1 gball only I remai k, ilmi these accidents seem to have occurred exclosively I in asylums where restraints were very frc-ely resorted to ; and if 1 not the product of restraints, were signs of that negligent 6>ip«r- ; intendence which is not permitted when restraints are no longer trusted to. Sudden accidents may and will happen in every ] asylum ; sudden blows will be struck, and a single blow may be filial. The only general protection against such things is careful superintendence, and a uniform and tiuiversal adherence lo • system of treatment wliich tends to keep the whole asylum in co-iiifort and good humour. I have seJdom iuquired into the particulars of any accident without finding that it was to be ascribed lo some negligence. If the wards are left withoat attendants, if the fire-guards are left open, if mops and brushM and pas-keys are left about the galleries, if excited patients *re left ut large, and not properly superintended, if patients are allowed to (juarrel uutil blows succeed, if doors are left open, ii the shutters are not secure, or the windows, accidents of ail Itinda mnr'. be expected ; but these negligences are entirely up|>osed to the spirit of the non-restraint system. There must be constant kindness and constant care, abundaut exercise, suitable occupa- tion when practicable, and the absence of all that can vex and hara,ss the patients. These are all remedies, even in acute cases of mania, and aid the practitioner in producing the effects he looks for from medicc.i iieatment, baths, and occasional secluMon and sedative medicines. I'he patients are quite sensible of thia treatment, 11 , a patient now iu female ward No. 15, was here in a former attack, from which she soon recovered; she canie from an asylum in which there was reason to suspect that at that time (1842) every patient was fastened to the bed by leg- locks every night. Ol that treatment she retained an angiy recollection, as well as of the rough way in which they were summoned to bed, and their clothes rudely taken olT, the patients being left, withoutany regard to delicacy, lyingon straw, chained, and lialf covered with a horse-cloth. Her mind was strongly impressed, on admission, with the entire absence of day or night restraints, the general attention to cleanlinesH, and Ine regard shown to the feelings of our patients. When she was lately ad- mitted again, having become insane after confinement, she reco- gnised us with evident pleasure, and she is now again convaiesoenU Depend upon it, gentlemen, that wherever restraints are p«r- mitted to be used, the attendants will put them on wantonly, sod frequently unnecessarily, and will become regardless of all the minor offices of humanity towards their patients. Not only in pauper asylums, but m asylums for the rich, if you permit the att.;ndants to have a strait-waistcoat at their command, yoa abandon your unprotected patients to very variety of abuse and secret outrage. I shall conclude my remarks on acute mania, by making an observation, which, although it may not be very satisfactory, you will find to b<; very well founded—namely, that whilst some cases have a tendency to spontaneous ciue, all disturbing agents beiDK removed, others will jiresent the phenomena of restlessness and I violence for many months; the attack not appearing to be shortened by any mcxle of treatment that we can adopt. In such cases, mediciruR and all the auxiliary means that can be employed scarcely exercise even a modifying intiuence on the malady, and night and day the patient continues excited and apparently irra- tional. But during all this time, we shall find, if amendment at length takes place, that the patient has appreciated our conduct, ami been sensihl of our kindness or our irritability , and that if we have been unilornily considerate, not only has luuch danger 1 been averted during the course of the malady, but the resulting content and good humour of the patient have laid the best foundation for a steady, progressive, and happy recovery. When a gardener wishes to etiolate,—that is, to bUrich, soften a vegetable, such as lettuce, celery, &c.,—he binds the leaves to- geth.T, .so that the light may have as little access as possible to their surfaces. In like niaiiner, if »e wish to etiolate meu and I women, we have only to congregate them in cities, w here they are 1 pretty securely kept out of the sun, and where they become as ' white and tender as the finest celery. For the more exquisite s|)ecimens of this human eliolaiion, we must survey the inhabitants of mines, dungeons, and other sulilerraneous abodes ; lind fior complete contrjsts to these, we have only lo exajaine the com- I plexions of stage roachnien, shepherds, and the sailor.—-X'r. i i/a/nev Juhnson on (Jliauijz of Air,](https://iiif.wellcomecollection.org/image/b21292140_0057.jp2/full/800%2C/0/default.jpg)
