Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

H. Houses of relatives and strangers.

I. Schools for idiots. Baldovan, near Dundee; and Gayfield Square, Edinburgh.

This Commission did not report until 1857, and unhappily the evidence more than justified the necessity of the appointment of the Committee, and of a sweeping measure of reform. The difficulty in selecting passages from the Report is to know where to stop. We shall restrict ourselves within moderate bounds; and first let us cite the reference to the condition of the insane and idiotic not in asylums. "It is obvious," says the Report, "that an appalling amount of misery prevails throughout Scotland in this respect. When estimating the condition of the insane not in establishments, it should be remembered that the details furnished by us give only an imperfect representation of the true state of matters. They form only a part of the picture of misery; and, had we been able to extend our investigations, it would, we are convinced, have assumed a much darker shade.

"A practice prevails in some workhouses, as in a few of the licensed asylums, of fastening the hands behind the back, by which much unnecessary pain is inflicted on the patient."

Of the methods employed in asylums to repress violence, etc., the Report thus speaks:—

"Instrumental Restraint and Seclusion.—Personal restraint by the application of the strait waistcoat, or of the straps or muffs, is almost entirely banished from the chartered asylums; but we have reason to think that seclusion for long periods is frequently used. This remark applies more especially to the asylums of Montrose, Glasgow, Aberdeen, and Edinburgh. In Montrose we found, on one occasion, eleven patients in seclusion out of a population of 174, several of them having been so secluded for considerable periods, and one woman for several months; and it is to be observed that the seclusion rooms in this asylum are mere cells, with stone floors and darkened windows, and that the patients who are placed in them are frequently allowed no other covering than blankets, and no other bedding than loose straw cast on the floor."

Here is a picture of the way in which one asylum was conducted: "We have grounds for fearing that the patients suffered from cold. The house is carelessly conducted and the state of the patients very unsatisfactory. The bed-frames, which are about the ordinary size with only spars of wood at the lower part, were dilapidated and saturated with filth; and the quantity of straw in them was very scanty and mixed with refuse; it was wet, offensive, and broken into small portions, and had clearly not been renewed for a considerable time. A certain number of the patients, males as well as females, were stripped naked at night, and in some cases two, and in one case even three, of them were placed to sleep in the same bed-frame, on loose straw, in a state of perfect nudity." The proprietor in his evidence says, "I never go into the rooms at night. The floor is constantly soaked with wet. There is an epileptic lad who is frequently fastened to the rings in the wall. The nurses keep the muffs in their custody. I dare say half of the dirty patients would sleep naked; seven would, therefore, sleep with others, I cannot say that more did not sleep together in a state of nudity. I consider the treatment is proper for them."

Again: "The bad treatment of the patients, and the very unsatisfactory treatment of the patients, are not fully known to the official inspectors. Indeed, it would appear that in some houses the instruments of restraint are systematically removed from the persons of the patients after the arrival of the sheriff at the asylum, for we find in Dr. Renton's evidence that, speaking of L—— Asylum, in which two male patients are kept constantly in restraint by means of handcuffs, he says, 'There are not many patients under restraint at L——.' And, further, in reference to Mrs. B——'s house at N——, he states, 'In Mrs. B——'s house I don't think there are many cases of restraint. There is a Miss W—— lately come, and a Miss M——. I don't think restraint is used to them.' We have ascertained, however, that these two patients were frequently restrained. These instances might be multiplied.

"Rent is saved by placing patients in small houses, making them use the same rooms both as day and sleeping accommodation; they are also crowded into small airing-courts, inadequate to afford proper exercise and a proper separation of the sexes. The inmates during the winter months pass the greater part of each twenty-four hours in their bed, whereby candle-light is saved. In L—— Asylum, the patients are not allowed candle-light at any season.

"We cannot doubt that in many instances practices obviously wrong, and detrimental to the patients, have been adopted in licensed houses, because an increased profit would thereby be obtained by the proprietor."