Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

The institution had not been very long in full operation before the success of the more enlightened treatment pursued in it was so patent, that the same pleasure and astonishment which the Swiss doctor experienced became general, and it was decided, in the hope of inducing others to follow a like course, to publish an account of the means which had been adopted in the treatment of the patients. This "Description of the Retreat," by S. Tuke, containing "An Account of its Origin and Progress, the Modes of Treatment, and a Statement of Cases," appeared in 1813.[122] Sydney Smith helped to bring the book into notice by his favourable review of it in the Edinburgh. In it he says of the Retreat:—

"The great principle on which it appears to be conducted is that of kindness to the patients. It does not appear to them (the managers), because a man is mad upon one particular subject, that he is to be considered in a state of complete mental degradation, or insensible to the feelings of kindness and gratitude. When a madman does not do what he is bid to do, the shortest method, to be sure, is to knock him down; and straps and chains are the species of prohibitions which are the least frequently disregarded. But the Society of Friends seems rather to consult the interest of the patient than the ease of his keeper, and to aim at the government of the insane by creating in them the kindest disposition towards those who have the command over them. Nor can anything be more wise, humane, or interesting than the strict attention to the feelings of their patients which seems to prevail in the institution.... To the effects of kindness in the Retreat are superadded those of constant employment. The female patients are employed as much as possible in sewing, knitting, and domestic affairs; and several of the convalescents assist the attendants. For the men are selected those species of bodily employment most agreeable to the patient, and most opposite to the illusions of his disease." He proceeds to say that in this instance, "an example has been set of courage, patience, and kindness which cannot be too highly commended or too widely diffused, and which, we are convinced, will gradually bring into repute a milder and better method of treating the insane."[123]

The author of the above work took an active part in the management of the Retreat for more than forty years, strenuously aided in exposing the abuses of the York Asylum, and exerted no inconsiderable influence upon the movement on behalf of the insane, not only by the work referred to, but by his writings on the construction of asylums.[124]

I find an entry in his journal, made in April, 1811, that he had begun an Essay on the state of the insane poor for a periodical called the Philanthropist. His indignation had been aroused by witnessing the condition of pauper lunatics in a workhouse in the south of England. He was led into a small yard at a short distance from the principal building, in which were four cells. He found them large enough for one person. At the further end of each was a platform of wood attached to the wall, which was intended for the patient's bed. In two of the cells all the light and air which could be admitted passed through an iron grating in the door, so that the cold air could not be excluded without entirely darkening the apartment. In each of these cells a female was confined. "I cannot describe," he says, "my feelings and astonishment when I perceived that the poor women were absolutely without any clothes. The weather was intensely cold, and the evening previous to our visit, the thermometer had been sixteen degrees below freezing. One of these forlorn objects lay buried under a miserable cover of straw, without a blanket or even a horse-cloth to defend her from the cold." So of the others, one of whom had the leg chained to the platform at the end of the cell. Bitter complaints were made of cold. Flannel dresses were at once sent to the workhouse for these poor wretches, which they wore, and invoked many blessings on the giver, who denounced the conduct of the guardians and writes, "Surely, a mind, actuated by the virtuous sympathies of our nature, would not have joined with comfort the warm social circle, or repose his head on a soft pillow, whilst he knew that any one was enduring so many privations, and so much misery which was not only in his power but was his duty to relieve."

It should be stated that a Select Committee had been appointed (moved for by Mr. Wynn) five years before (1806), to inquire into the state of pauper lunatics in England. This Committee proposed the erection of asylums in different parts of the kingdom, power being given to the magistrates of any county to charge the expense upon the county rate, all pauper lunatics within the district being conveyed thither and maintained at the expense of their respective parishes, and it was recommended that no asylum should contain more than 300 patients. At that time there were 1765 lunatics in workhouses, or houses of industry, 483 in private custody, 113 in houses of correction, and 27 in gaols; total, 2248.[125] Sir George Paul, who took an active interest in this Committee, stated, in a letter to the Secretary of State, that there was hardly a parish of any considerable extent in which there might not be found some unfortunate human creature, who, if his ill-treatment had made him "frenetic," was chained in the cellar or garret of a workhouse, fastened to the leg of a table, tied to a post in an outhouse, or perhaps shut up in an uninhabited ruin; or, if his lunacy were inoffensive, was left to ramble, half-naked and half-starved, through the streets and highways, teased by the rabble, and made the jest of the vulgar, ignorant, and unfeeling. "I have witnessed," he says, "instances of each of these modes of securing lunatics, under the Act 17 Geo. II., c. 5. Of all the lunatics in the kingdom, the one half are not under any kind of protection from ill-treatment, or placed in a situation to be relieved of their malady."

In the following year (1808) an Act (48 Geo. III., c. 96) was passed, providing that it should be lawful for justices in every county in England and Wales to take into consideration the propriety of providing a lunatic asylum for the reception of patients within the county. Referring to the Act 17 Geo. II. for the committal of vagrant lunatics, the new Act provided that in case there should be an asylum established for the county within which the lunatic belonged, then a warrant should be issued for the removal of such lunatic to the asylum, and not elsewhere; but if no asylum had been erected, then he was to be confined in any house duly licensed under the authority of the Act of 14 Geo. III. It will be seen that this legislation was not compulsory, and therefore utterly failed in attaining the object of its promoters. It only authorized magistrates to act.

This Act was amended in some points of importance in 1811.[126] Overseers were obliged to produce a certificate of a medical man as to the state of the lunatic. Justices were to make returns to the quarter sessions of the cases brought before them, and medical superintendents returns of the state of persons intrusted to their care, at least once a year.

"The Description of the Retreat," then, of which Dr. Conolly writes in 1856, "For readers desirous to know the views which ought to prevail in all lunatic asylums, I could not even now refer to any work in which they are more perspicuously explained; in none are the details of management, economic, medical, and moral, to be found more convincingly set forth"—this work, happily, proved the means,[127] by the extraordinary interest it excited in the experiment, and the contrast it was but too well known to exhibit to the general condition of similar institutions, of arousing attention, first to the abuses of the old asylum at York, and then to others, until it was deemed desirable to appoint a Committee of the House of Commons to investigate the subject thoroughly. To this we shall refer in more detail, but may here observe that the founder of the Retreat was one who gave evidence before it, and the members, says an eye-witness, were evidently interested in seeing the old man, then upwards of eighty, and hearing from his own lips some of the facts relating to the success of the experiment at York. He continued to devote himself to the interest of the institution, and died in 1822, thirty years after he had broached the idea of its establishment. It had, he said, some years before, succeeded far beyond his expectations, and he felt a wish to contribute such information as attentive observation had enabled him to make for the benefit of others. This he did in various ways, one being a Letter to the governors of the York Lunatic Asylum, in which he observes, "At the time of Lord Erskine's Chancellorship, I noticed with much satisfaction his remarks on the treatment of insane patients, especially in private mad-houses, which he found was so generally severe, that in case they were but a little deranged, it was sufficient to make them raving mad; and he delivered it as his judgment that kind and conciliating treatment was the best means to promote recovery. The latter part of this opinion I have the satisfaction of asserting has been evidently proved correct in the management of the Retreat, where coercion, though sometimes necessary for feeding the patients and preserving them from injury to themselves or others, is administered in the most gentle manner, and the use of chains is never resorted to."

"In person," wrote a contemporary, "William Tuke hardly reached the middle size, but was erect, portly, and of a firm step. He had a noble forehead, an eagle eye, a commanding voice, and his mien was dignified and patriarchal."