The modern realisation of the association of mental with physical health, the annexation to the sphere of biology of the phenomena of mind, and the concurrent comprehension of the true attitude of the physician towards mental diseases, have doubtless put into the shade achievements less than a century old, and some of them dating from only fifty years ago. Yet the simple discontinuance of the system of restraint practised from time immemorial on almost all lunatics was perhaps a greater practical revolution than the biological one just referred to; and England stands in the forefront of this revolution.
The old lunatic asylums of this country were objects of dread and repulsion. Severity was considered to be an absolute necessity in their management. “The affrighted visitors,” says Conolly,[17] “saw that many were furious ... and it never occurred to them that habitual severity was the real cause of the habitual fury.” New Bethlem in Moorfields two centuries ago was a place of chains, manacles, and stocks. Down to 1770 the inmates were exhibited to the public at a charge of twopence, afterwards reduced to one penny.
The medical profession had become accustomed to neglect mental diseases, and to acquiesce in severe treatment. Cruelty became developed in ingenious forms. In some Continental asylums patients were terrified by the gradual ascent of water in a well in which they were chained. Machines were imagined by which a newly arrived lunatic could suddenly be raised to the top of a tower, and as suddenly lowered into a deep dark cavern; “if the patient could be made to alight among snakes and serpents, it would be better still.” A revolving chair was invented, in which the victim could be strapped and made to gyrate at the rate of one hundred revolutions per minute. This was eulogised as a potent means of quieting the unmanageable, and was supposed to induce the melancholy to take “a natural interest in the affairs of life.” We can only make this passing allusion to the way in which ingenuity was exhausted in devising methods of restraint and torture.
Nothing could have been worse than the condition of the Bicêtre and the Salpêtrière, the two large asylums of Paris, when Pinel was in 1793 appointed to the former by Cousin, Thouret, and Cabanis, then newly appointed administrators of the Parisian hospitals. Damp, dark cells, infested by rats, contained dirt-coated beings whose only comfort was a little straw, chained, brutally ill-treated, and attended by brutal criminals. For nearly ten years previously Pinel’s attention had been directed to the treatment of the insane, and now, in spite of difficulties which officials threw in his way, he succeeded in loosening the chains and ameliorating the treatment of the majority of the patients. Yet his reforms nearly cost him his life. Rumours were spread accusing him of some evil motive in unchaining dangerous lunatics, and a mob one day seized him, and uttered the well-known terrible cry “à la lanterne!” An old soldier of the French Guard, once a lunatic, whom he had released from chains, cured, and employed in his own service, was appropriately the means of his rescue. Thus was philanthropy once more justified of her children.
At this very period English public opinion had been excited by revelations of cruelty and consequent deaths in the old York Asylum. In 1791 a lady belonging to the Society of Friends was placed in this asylum; her friends were refused admission to visit her, and in a few weeks she died. Inquiries that were made showed great grounds for suspicion, although full details could not be obtained.[18] But with great promptitude William Tuke, a prominent Friend at York, whose family has continued famous for attention to the affairs of the insane, proposed early in 1792 the establishment of a “Retreat” at York for insane patients, in which sympathy should be substituted for unkindness, severity, and stripes. The account given by Samuel Tuke in 1813 of its management is still a model in many respects.[19]
Neither Pinel nor the Tukes were however bold enough entirely to dispense with mechanical coercion. In 1818 Esquirol, the true successor of Pinel in France, found maltreatment still generally prevalent in the provincial asylums of France. In England mechanical restraint continued to be largely employed till Conolly’s time, and survives in some private asylums to the present day. We cannot give further details on this head, but hasten to mention the names of two men, Dr. Charlesworth and Mr. Gardiner Hill, who must ever be remembered as the first to give up mechanical coercion entirely in the small asylum of Lincoln. Dr. Charlesworth, physician to the asylum, had for many years diligently watched the effects of mechanical coercion, and gradually lessened the number of instruments of restraint in the asylum. Finally, the total disuse of mechanical restraints was decided on, and put in practice by Mr. Gardiner Hill in 1836 in concert with Dr. Charlesworth, with the most gratifying results.
We now come to the man who more than any other in England may be said to have established the non-restraint system so firmly that it will never be upset. John Conolly was born at Market Rasen in Lincolnshire, in 1794. His father, a member of a good Irish family, died young, and the care of a young family fell on his widow, whose maiden name was Tennyson, and whose patience and self-sacrifice her son ever affectionately acknowledged as the main influence which led to his own success. When his mother ultimately married a French gentleman, a political emigré, the latter taught his stepson French, and imbued him with a genuine taste for and knowledge of the language. Condillac’s essay “On the Origin of Human Knowledge” influenced his mental life. While in his teens his attention was first called to the subject of lunacy by an inspection of the Glasgow Asylum, and he never afterwards ceased to take the deepest interest in it.
At eighteen young Conolly became an officer in a militia regiment, in which capacity he served several years. While still young, he married in 1816 the daughter of Sir John Collins and went to reside in France, on the banks of the Loire. A year later he had decided to enter the medical profession, and in 1817 became a student at Edinburgh University. After a diligent career, in the course of which he was one of the presidents of the Royal Medical Society, he graduated M.D., and settled in practice as a physician at Chichester. Here he became intimately acquainted with Dr. (afterwards Sir John) Forbes, with whom he was afterwards much connected in literary matters.
Dr. Conolly did not remain very long at Chichester, but removed in 1823 to Stratford-on-Avon, where he wrote many contributions to and took part in editing the “Cyclopædia of Practical Medicine,” and the British and Foreign Medical Review. At Stratford he became alderman and mayor, established a public dispensary, and studied Shakespeare with enthusiasm. This occasioned him afterwards, while practising at Warwick in 1835, to take an active part as chairman of the committee formed for securing the preservation of Shakespeare’s tomb, and the restoration of the chancel of the church.