“A stout iron ring was riveted round his neck, from which a short chain passed to a ring made to slide upwards or downwards on an upright massive iron bar, more than six feet high, inserted into the wall. Round his body a strong iron bar, about two inches wide, was riveted; on each side of the bar was a circular projection, which, being fastened to and enclosing each of his arms, pinioned them close to his side.”
In this position, in which he could only stand upright or lie upon his back, he lived for twelve years! But in nothing, perhaps, is the contrast between the past and the present more apparent than in the two pictures presented by Dr. Hood, the resident physician, from the case book of the Bethlehem Hospital, which at once show the difference of treatment and the different results which attended it.
Thus diversely does disordered nature answer to an appeal according to the spirit in which it is made. There is a reverse, however, to every medal, and the skeleton cupboards of Bethlehem are the male criminal lunatic wards. These dens, for we can call them by no softer name, are the only remaining representatives of old Bedlam. They consist of dismal, arched corridors, feebly lit at either end by a single window in double irons, and divided in the middle by gratings more like those which enclose the fiercer carnivora at the Zoological Gardens than anything we have elsewhere seen employed for the detention of afflicted humanity. Here fifty male lunatics are herded together without regard to their previous social or moral condition. Thus the unfortunate clergyman, the Rev. Hugh Willoughby, who fired a pistol two years since at the judge at the Central Criminal Court, is herded with the plebeian perpetrator of some horrible murder. Side by side with the unfortunate Captain Johnson, of the ship “Tory,” who, in a fit of extraordinary excitement during a mutiny on board his vessel, cut down some of his crew, but is now perfectly sane, sits perhaps the ruffian who murdered the warder in cold blood at Coldbath Fields—a villain brought in mad by a tender-hearted jury who shrunk from the responsibility of hanging him. Here also poor Dad, the artist, who killed his father whilst labouring under a sudden paroxysm of insanity, is obliged to weave his fine fancies on the canvas amidst the most revolting conversation and the most brutal behaviour. Those who contend that all criminal lunatics should be treated alike, do not consider the vast difference between the tone of mind in an abandoned wretch who has lived a life of villany, and the gentleman who has committed a casual offence. As the former advances towards sanity the brutal disposition, which early training in vice and dissipation has engraved upon his nature, comes into strong relief, whilst the good breeding which is natural to the latter, and which was but temporarily eclipsed in him, resumes its sway. Nay, nothing is more certain than that the previous habits and manners of the lunatic are to a great extent unaffected by his unfortunate malady, even when it is at its height. The disgrace of thus caging up together the coarse and the gentle, the virtuous and the abandoned, rests wholly upon the shoulders of the Home Secretary. The governors of the hospitals, the medical officers, and the lunacy commissioners, have over and over again remonstrated against the enormity, and to our national shame have remonstrated in vain. It is proposed to build a special asylum for all the state lunatics who are now distributed among county asylums, hospitals, licensed houses, workhouses and jails, to the number of 591,[15] and it is a duty which we trust will not be longer delayed. There can be little doubt that the presence of these crime-tainted individuals is felt deeply by the innocent lunatics, and that their recovery is retarded by the indignation excited at their degrading companionship with the outcasts of society. The erection of a criminal asylum upon a large scale would both compel a better system of classification, and would necessitate some solution of the difficult question—What shall be done with criminal patients who have recovered? One class of cases at least, as Dr. Tyler Smith has pointed out, leaves no room for doubt. The females who have committed offences whilst under the influence of the delirium attendant upon puerperal fever, and who, having recovered, are past the age of child-bearing, should at once be released. They are no longer liable to a recurrence of mental aberration, and to keep them incarcerated for life, is to treat past misfortune as an inexpiable crime. Nothing can be more cruel, unjust, and motiveless.
It is proposed to remove Bethlehem Hospital into the country, on the plea that ground cannot be obtained in sufficient quantity for the use of the inmates. If by this is meant that agricultural pursuits cannot be carried on in St. George’s Fields, we rejoice in the fact. A sane man, accustomed to the busy scene of a large town, would be wretched if he was condemned to pass the remainder of his days amid the silence of the fields, and the lunatic remains for the most part under the same domination of former habits. The notion that his faculties are universally disordered, all his perceptions destroyed, all his tastes obliterated, and all his sympathies extinct, is one of the grossest errors which can prevail. Nor do the better class of patients (such as form the inmates of Bethlehem) require the hard exercise which is necessary for the maintenance of health with an agricultural pauper. They find far more recreation in strolling through the streets in the neighbourhood of the asylum, under the care of an attendant, than in wading through ploughed fields, or in taking a turn at spade husbandry. To this we must add, that insanity is often a sudden seizure, that individuals go raving mad in the streets; that, in short, there are frightful casualties of the mind, as of the body, which require the instant attention of the mental physician. For this reason alone every lunatic asylum should no more be removed into the country than every ordinary hospital. But, apart from this circumstance, we repeat that Bethlehem, within call of friends and within the hum of the busy world, glimpses of which can be caught by the patients from the loopholes of their retreat, and into which they are occasionally allowed to enter, is far better placed for purposes of cure than in any rural district, however well supplied with the means of pursuing agricultural labour. At present all the sights of the metropolis are from time to time enjoyed by the inmates. “The male patients last year,” says Dr. Hood, the resident physician, “who were not fit to be discharged, were allowed to spend a day at Kew; another day they went by steamboat to the Nore; and, conducting themselves well under the charge of careful attendants, visited many public exhibitions—the National Gallery, the Crystal Palace, Marlborough House, the Zoological Gardens, Smithfield Cattle-show, &c.” Who can doubt that people accustomed to such sights and sounds would infinitely prefer them to the delights of walking between hedge-rows, hoeing weeds, or digging potatoes? Who can doubt that these little excursions of the wall-bound inmates into the cheerful life of the outside world are a vast advantage to the slowly-recovering brain, and constitute just that desirable transitional training necessary to their safe restitution to unlimited freedom? In fact, under the old system, when convalescent patients, who had been confined for months in dungeon-like cells, bristling with bars, were taken to the gates and returned suddenly to unrestrained liberty, the effect of the contrast was often so great, that they set off running in a paroxysm of excitement, and were frequently brought back again in a few days, reduced by a too abrupt release to their old condition. It would not perhaps be undesirable to add to Bethlehem some small rural establishment, answering to the succursales of foreign lunatic asylums; but this should be strictly an appendage, to which patients should be sent for a short time, for change of air and scene, just as all the world now and then take a trip to the country to refresh the wearied eye with the sight of green trees and fields, and to cure that moral scurvy contracted by perpetually dwelling upon the dismal vistas of blackened bricks which constitute metropolitan prospects.
For the fullest development of the prevalent system of treating the insane we must go to Colney Hatch and Hanwell, the two great lunatic asylums for the county of Middlesex. The former, situated on the Great Northern Railway, only six miles from the metropolis, is the largest and perhaps the most imposing-looking non-metropolitan building of the kind in Europe. In this establishment, built within the last six years, we may study the merits and demerits of modern asylums. Containing within its walls a population, inclusive of officers and attendants, of 1,380 persons, which is equal to that of our largest villages, and presenting the appearance of a town, its wards and passages amounting in the aggregate to the length of six miles, it is here that we shall find the completest system of organization, and, if we may use the term, of official routine. The enormous sum of money expended upon Colney Hatch, which has reached already to £270,000, prepares us for the almost palatial character of its elevation. Its façade, of nearly a third of a mile, is broken at intervals by Italian campaniles and cupolas; and the whole aspect of the exterior leads the visitor to expect an interior of commensurate pretensions. He no sooner crosses the threshold, however, than the scene changes. As he passes along the corridor, which runs from end to end of the building, he is oppressed with the gloom; the little light admitted by the loop-holed windows is absorbed by the inky asphalte paving, and, coupled with the low vaulting of the ceiling, gives a stifling feeling and a sense of detention as in a prison. The staircases scarcely equal those of a workhouse; plaster there is none, and a coat of paint or whitewash does not even conceal the rugged surface of the brickwork. In the wards a similar state of things exists: airy and spacious they are, without doubt; but of human interest they possess nothing. Upwards of a quarter of a million has been squandered principally upon the exterior of this building; but not a sixpence can be spared to adorn the walls within with picture, bust, or even the commonest cottage decoration. This is the vice which pervades the majority of county asylums lately erected. The visiting justices doubtless believe that it would be a superfluous and even mischievous refinement to trouble themselves about pleasing the eye or amusing the brain of the lunatic; but this is a mighty error, as every person knows who understands how keenly sensitive are the minds of the majority of the insane.
“Stone walls do not a prison make,
Nor iron bars a cage,”
sings the graceful Lovelace; but it should be remembered that the lunatic has no divine Althea to muse upon in his house of detention, and the majority of the insane have no healthy wings by which their minds can leap beyond the dreariness of the present. To divert them from the demon in possession, all the ingenuity of philanthropy should be employed; but this truth has been overlooked both here and at Hanwell; and we are lost in astonishment when we reflect upon the folly of lavishing hundreds of thousands upon outward ornamentation, whilst the decorations common among the poorest labourers are denied to the inmates for whom all this expense has been incurred. There is no more touching sight at Colney Hatch than to notice the manner in which the female lunatics have endeavoured to diversify the monotonous appearance of their cell-like sleeping-rooms with rag dolls, bits of shell, porcelain, or bright cloth placed symmetrically in the light of the window-sill. The love of ornament seems to dwell with them when all other mental power is lost; and they strew gay colours about them with no more sense, but with as much enjoyment, as the bower-bird of the Zoological Gardens adorns his playing-bower.[16] The prison dress of the male patients is in keeping with the desolate walls. It is infinitely depressing, even to the visitor, to see nothing but dull grey garments; and the lunatics themselves feel degraded by a uniform dedicated to the gaol-bird. The medical officers of both this asylum and Hanwell are deeply impressed with its injurious effects, and they have long denounced it. Happily the system is confined to the men, not, however, from any benevolent feeling towards the females, but simply because gown-pieces of the same pattern cannot be procured in sufficient quantities to clothe the entire community. Among the sane, self-respect is increased by the possession of decent clothes, and the lunatic is often still more amenable to their influence. A refractory patient at Colney Hatch was in the habit of tearing his clothes into shreds. Mr. Tyerman, one of the medical officers, ordered him to be dressed in a bran-new suit. The poor man, a tailor by trade, either from a professional appreciation of the value of his new habiliments, or from being touched by this mark of attention, respected their integrity, and from that moment rapidly recovered. Before leaving the asylum he stated that he owed his cure to the good effect produced upon his mind by being intrusted with this new suit of clothes. At Hanwell, the patients who destroy their dresses are put into strong canvas garments, bound round with leather and fastened with padlocks. This plan is adopted at some other lunatic asylums; but it always looks repulsive.
It is only, we believe, in the metropolitan county asylums, which should be model establishments, that the grey prison dress is retained. In the majority of county asylums the smock-frock of the district is used, and the patient moves about undistinguished from the rest of the population by any repulsive badge. In France and Belgium they manage better still. Dr. Webster, in his notes on foreign lunatic asylums, published in the Psychological Journal of Medicine, speaks of the bright head-dresses and vivid shawls used in France, as giving a cheerful appearance to the assembled inmates. Nothing less could be expected from the known disposition of a people of whom it has been said, that if any man among them was thrown naked into the sea, he would rise up clothed from head to foot with a sword, bag-wig, and ruffles to boot. In the present matter they have been wiser in their generation than ourselves; and we can imagine with what surprise they would learn that at Hanwell, the most celebrated English establishment for the treatment of the insane, patients are rewarded for good conduct by allowing them to wear a fancy waistcoat. This fact of itself shows the aversion to the prison garb, and the necessity of discarding it. But the same visiting committee which inspects the county gaol governs the asylum, and we regret to say that they allow the organization of the former to be introduced into the latter.
In spite of these drawbacks, the progress made within the last twenty years has been immense. A walk through the wards and workshops of Colney Hatch will prove that the lunatic is at last treated as though he had human sympathy and desires, and was capable of behaving in many respects like a rational being. All large asylums possess an advantage over smaller ones in their greater ability to classify their inmates. The wards and corridors of Colney Hatch and Hanwell are so extensive that they may be likened to different streets inhabited by distinct classes. It is usual to name the compartments according to the mental condition of the patients contained in them. Thus in most asylums we have the refractory ward, the epileptic ward, the paralytic ward, the ward for dirty patients, and the convalescent ward. At Colney Hatch it is considered better to use numbers instead, as the patients soon become acquainted with the denomination of the class to which they belong, and often behave in conformity with it. Thus the lunatic, finding himself in a refractory ward, will sometimes act up to the part assigned to him, when he would otherwise be peaceable. The vice of classification is that it separates the population of an asylum into so many mental castes, which in some measure prevents that easy transition from lunacy to sanity, which it is desirable to maintain. In the choice of difficulties, however, there can be little doubt that these divisions in lunatic establishments, as at present constructed, present the most convenient as well as the best means of treating the insane, and the errors to which it is liable can at all times be obviated by the careful supervision of the medical officers.