Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

Pinel had now been at work five years, and for the first time heard of the management of the Retreat from the glowing account published by this Swiss physician Dr. Delarive. The conductors of the Retreat first became acquainted with Pinel's great work at the Bicêtre in Paris in 1806.

An incident related in honour of Jepson may fitly be introduced here. He "had found the doctrine of subduing the insane by fear maintained in St. Luke's Hospital, which was then esteemed, and probably justly, the best public establishment of the kind in Great Britain; and he could not but attach considerable value to its long and extensive experience. Soon after entering upon his office, a very violent patient came under his care. His friend and adviser (Tuke) was from home, and he determined for once, upon his own responsibility, to act upon the prevalent notion. In size he was not ill qualified to do the duty of a keeper upon the old system, but his feelings and all the habits of his mind were opposed to harsh methods. After the experiment he was so uneasy with himself, that on retiring to bed he slept but little, and he resolved that, if the course he had adopted was not in this case beneficial, he would entirely abandon the system. On visiting the patient his opinion was that the experiment had failed, and that it had left a painful and vindictive feeling on the mind of the subject of it." It is added that henceforth Jepson fully carried out, step by step, the views of the founder and his friends.[118]

The earnestness with which the officers who were appointed entered into the undertaking—the way in which they helped to make possible the success so much desired by the founder—deserves our grateful appreciation, and should preserve them from being in the least degree thrown into the shade. To enter heartily into the ideas and schemes of other people may be as meritorious as to originate them, and is often much more irksome. It is neither necessary nor generous to exalt one class of workers at the expense of the other. No doubt the originator of the Retreat was one who also worked hard himself at what he had initiated; but he could not have eventually succeeded if he had not been able to attract to himself men who would devote their powers to the new work in the same spirit as he did. Such men were Jepson and Fowler, the latter of whom, the first visiting physician,[119] died five years after his appointment. Such also was Dr. Cappe, his successor, who was cut off in his prime deeply regretted—"a man equally esteemed for the gentle urbanity of his manner, the excellence of his understanding and dispositions, and his professional attainments."[120]

It is not always that the insane are able to appreciate the efforts made to render them comfortable. It is all the more gratifying when it does occur. A patient was admitted who had nearly lost the use of his limbs from being chained, and for some time it was necessary to lead him about like an infant. He was found to require no restraint, and was, after a while, able to walk without assistance. When one of his friends visited him and asked him what he called the place, he replied, with great earnestness, "Eden, Eden, Eden!"

A man was admitted who had been for twenty years chained and naked; with the exception of the occasional use of arm-straps, no personal restraint was employed from the moment of his admission. He was soon induced to wear clothes and adopt orderly habits.

One day a man of Herculean size was brought to the institution, and the case is thus described by the author of the "Description": "He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrived to be taken off and put on by means of strings, without removing his manacles. They were, however, taken off when he entered the Retreat, and he was ushered into the apartment where the superintendent and matron were supping. He was calm. His attention appeared to be arrested by his new situation. He was desired to join in the repast, during which he behaved with tolerable propriety. After it was concluded, the superintendent conducted him to his apartment, and told him the circumstances on which his treatment would depend; that it was his anxious wish to make every inhabitant in the house as comfortable as possible, and that he sincerely hoped the patient's conduct would render it unnecessary for him to have recourse to coercion. The maniac was sensible of the kindness of his treatment. He promised to restrain himself, and he so completely succeeded, that, during his stay, no coercive means were ever employed towards him." When excited and vociferous, the superintendent went to his room and sat quietly beside him. After a period of increased irritation, the violent excitement subsided, and he would listen with attention to the persuasions and arguments of his friendly visitor. "Can it be doubted," asks Tuke, "that in this case the disease had been greatly exasperated by the mode of management, or that the subsequent kind treatment had a great tendency to promote his recovery?"

An architect, Mr. Stark, in visiting British asylums, when engaged in preparing plans for the Glasgow Asylum, came to the Retreat. He thus speaks in his "Remarks on the Construction and Management of Lunatic Asylums": "In some asylums which I have visited, chains are affixed to every table and to every bed-post; in others, they are not to be found within the walls.... At the Retreat they sometimes have patients brought to them frantic and in irons, whom they at once release, and by mild arguments and gentle arts reduce almost immediately to obedience and orderly behaviour. A great deal of delicacy appears in the attentions paid to the smaller feelings of the patients. The iron bars which guarded the windows have been avoided, and neat iron sashes, having all the appearance of wooden ones, have been substituted in their places; and when I visited them, the managers were occupied in contriving how to get rid of the bolts with which the patients are shut up at night, on account of their harsh, ungrateful sound, and of their communicating to the asylum somewhat of the air and character of a prison. The effects of such attentions, both on the happiness of the patients and the discipline of the institution, are more important than may at first view be imagined. Attachment to the place and to the managers, and an air of comfort and of contentment, rarely exhibited within the precincts of such establishments, are consequences easily discovered in the general demeanour of the patients." "It is a government," Stark also observes, "of humanity and of consummate skill, and requires no aid from the arm of violence and the exertions of brutal force."[121] But Stark himself, strange to say, is careful not to commit himself to the total abolition of chains, adopted at the Retreat.

Two more brief testimonies from competent visitors who inspected the institution may be permitted—one from Dr. Duncan of Edinburgh, when on a tour of inspection of asylums in Britain; the other from a foreigner, Dr. Naudi, then the "President of the Maltese Hospitals." The former wrote, after visiting the Retreat, of the demonstration, "beyond contradiction, of the very great advantage resulting from a mode of treatment in cases of insanity much more mild than was before introduced into almost any lunatic asylum, either at home or abroad. In the management of this institution they have set an example which claims the imitation, and deserves the thanks, of every sect and every nation. For, without much hazard of contradiction from those acquainted with the subject, it may be asserted that the Retreat at York is at this moment the best-regulated establishment in Europe, either for the recovery of the insane, or for their comfort when they are in an incurable state." And Dr. Naudi, in broken but effective English, observed, "This house or Retreat for the troubled in mind, I think, is one of the best things I saw in England on the same subject; and having observed many others on the Continent, I dare to say it is the best in all the world. The situation of the building out of the town, a large garden around it, the propriety of the rooms, the cleanliness of the patients, the way in which they are kept, as for dressing, as for feeding them, is very remarkable to be observed."