American Notes

by Charles Dickens

As I rose to quit the room, a pretty little child of one of the attendants came running in to greet its father. For the moment, a child with eyes, among the sightless crowd, impressed me almost as painfully as the blind boy in the porch had done, two hours ago. Ah! how much brighter and more deeply blue, glowing and rich though it had been before, was the scene without, contrasting with the darkness of so many youthful lives within!

At South Boston, as it is called, in a situation excellently adapted for the purpose, several charitable institutions are clustered together. One of these, is the State Hospital for the insane; admirably conducted on those enlightened principles of conciliation and kindness, which twenty years ago would have been worse than heretical, and which have been acted upon with so much success in our own pauper Asylum at Hanwell. ‘Evince a desire to show some confidence, and repose some trust, even in mad people,’ said the resident physician, as we walked along the galleries, his patients flocking round us unrestrained. Of those who deny or doubt the wisdom of this maxim after witnessing its effects, if there be such people still alive, I can only say that I hope I may never be summoned as a Juryman on a Commission of Lunacy whereof they are the subjects; for I should certainly find them out of their senses, on such evidence alone.

Each ward in this institution is shaped like a long gallery or hall, with the dormitories of the patients opening from it on either hand. Here they work, read, play at skittles, and other games; and when the weather does not admit of their taking exercise out of doors, pass the day together. In one of these rooms, seated, calmly, and quite as a matter of course, among a throng of mad-women, black and white, were the physician’s wife and another lady, with a couple of children. These ladies were graceful and handsome; and it was not difficult to perceive at a glance that even their presence there, had a highly beneficial influence on the patients who were grouped about them.

Leaning her head against the chimney-piece, with a great assumption of dignity and refinement of manner, sat an elderly female, in as many scraps of finery as Madge Wildfire herself. Her head in particular was so strewn with scraps of gauze and cotton and bits of paper, and had so many queer odds and ends stuck all about it, that it looked like a bird’s-nest. She was radiant with imaginary jewels; wore a rich pair of undoubted gold spectacles; and gracefully dropped upon her lap, as we approached, a very old greasy newspaper, in which I dare say she had been reading an account of her own presentation at some Foreign Court.

I have been thus particular in describing her, because she will serve to exemplify the physician’s manner of acquiring and retaining the confidence of his patients.

‘This,’ he said aloud, taking me by the hand, and advancing to the fantastic figure with great politeness—not raising her suspicions by the slightest look or whisper, or any kind of aside, to me: ‘This lady is the hostess of this mansion, sir. It belongs to her. Nobody else has anything whatever to do with it. It is a large establishment, as you see, and requires a great number of attendants. She lives, you observe, in the very first style. She is kind enough to receive my visits, and to permit my wife and family to reside here; for which it is hardly necessary to say, we are much indebted to her. She is exceedingly courteous, you perceive,’ on this hint she bowed condescendingly, ‘and will permit me to have the pleasure of introducing you: a gentleman from England, Ma’am: newly arrived from England, after a very tempestuous passage: Mr. Dickens,—the lady of the house!’

We exchanged the most dignified salutations with profound gravity and respect, and so went on. The rest of the madwomen seemed to understand the joke perfectly (not only in this case, but in all the others, except their own), and be highly amused by it. The nature of their several kinds of insanity was made known to me in the same way, and we left each of them in high good humour. Not only is a thorough confidence established, by those means, between the physician and patient, in respect of the nature and extent of their hallucinations, but it is easy to understand that opportunities are afforded for seizing any moment of reason, to startle them by placing their own delusion before them in its most incongruous and ridiculous light.

Every patient in this asylum sits down to dinner every day with a knife and fork; and in the midst of them sits the gentleman, whose manner of dealing with his charges, I have just described. At every meal, moral influence alone restrains the more violent among them from cutting the throats of the rest; but the effect of that influence is reduced to an absolute certainty, and is found, even as a means of restraint, to say nothing of it as a means of cure, a hundred times more efficacious than all the strait-waistcoats, fetters, and handcuffs, that ignorance, prejudice, and cruelty have manufactured since the creation of the world.

In the labour department, every patient is as freely trusted with the tools of his trade as if he were a sane man. In the garden, and on the farm, they work with spades, rakes, and hoes. For amusement, they walk, run, fish, paint, read, and ride out to take the air in carriages provided for the purpose. They have among themselves a sewing society to make clothes for the poor, which holds meetings, passes resolutions, never comes to fisty-cuffs or bowie-knives as sane assemblies have been known to do elsewhere; and conducts all its proceedings with the greatest decorum. The irritability, which would otherwise be expended on their own flesh, clothes, and furniture, is dissipated in these pursuits. They are cheerful, tranquil, and healthy.

Once a week they have a ball, in which the Doctor and his family, with all the nurses and attendants, take an active part. Dances and marches are performed alternately, to the enlivening strains of a piano; and now and then some gentleman or lady (whose proficiency has been previously ascertained) obliges the company with a song: nor does it ever degenerate, at a tender crisis, into a screech or howl; wherein, I must confess, I should have thought the danger lay. At an early hour they all meet together for these festive purposes; at eight o’clock refreshments are served; and at nine they separate.