Eminent doctors: Their lives and their work; Vol. 2 of 2

by G. T. Bettany

In 1827 Dr. Conolly was appointed Professor of the Practice of Medicine in London University, which appointment he only held four years, finding life as a London physician unsuitable to his tastes. In 1831 he again resorted to the country, establishing himself in Warwick.

The subject of insanity had long engaged Dr. Conolly’s attention. He had studied the question both abroad and at home, and had been for five years, (while residing at Stratford) inspecting physician to the Lunatic Houses for the County of Warwick, an office which he resumed when he settled in Warwick. He had unsuccessfully proposed to the council of the University that he should give his pupils clinical instruction on insanity in one of the lunatic asylums in London. “Thus,” says Sir James Clark,[20] “clinical instruction in mental diseases was thrown back for thirty years in this country.”

In 1830 Conolly published his valuable work, “An Inquiry concerning the Indications of Insanity, with Suggestions for the better Protection and Care of the Insane.” His objects were to render the recognition of insanity less difficult, by showing in what it differed from those varieties of mind which approached nearest to it; and to point out those circumstances which, even in persons decidedly insane, could alone justify various degrees of restraint. He lamented that during a student’s career he only saw cases of insanity by some rare accident. Every lunatic asylum was closed to him, and yet when qualified he might any day have to decide on a patient’s insanity. In view of some recent revelations a quotation from the introduction to this work (p. 3) is not inappropriate. “The timidity or ignorance, or it may be, a dishonest motive, of relatives, leads to exaggerated representations; and the great profit accruing from a part of practice almost separated from general medicine, cannot but now and then operate against proper caution in admitting such representations. When men’s interests depend upon an opinion, it is too much to expect that opinion always to be cautiously formed, or even in all cases honestly given. The most respectable practitioners in this department openly justify the authorising of restraint before the patient is seen, and on the mere report of others; and it seems that depositions to the insanity of individuals have been received in courts of law, concerning persons with whom the deponents have never had an interview; and that on these depositions proceedings have been partly founded, of which the results were the imprisonment of lunatics, and restraint over their property. When the affair is conducted with more formality, and the suspected person is visited before being imprisoned, those who visit him are often very little acquainted with mental disorders, and come rather to find proofs of his insanity, which, to minds pre-possessed, are seldom wanting, than cautiously to examine the state of his mind.”

“If a person of sound mind were so visited, and knew of the visit beforehand, it would not be quite easy for him to comport himself, so as to avoid conviction that he was not of sound mind. His indignation would pass for raving; his moderation for the proverbial cunning of a lunatic.”

After describing the condition of asylums and lunatics at that time, the author considers the constitution of the human understanding and the inequalities, weaknesses, and peculiarities of mind which do not amount to understanding, and the influence of stimuli, of age, and of disease on the mind, and then discusses the phenomena of insanity and the questions of treatment and protection. He insists on the necessity of the most scrutinising watchfulness over the servants employed in their care. In cases where patients would do themselves or others an injury he insists on watching, instead of mechanical means of restraint. He proposes a complete scheme for the care of all lunatics by the State, providing for perfect publicity of procedure. He finally points out the increasing liability of the nervous system to disorganisation owing to the increased pressure and more varied anxieties of modern life, an observation most fully justified by what has been established since his day.

This work, a most readable and interesting one, both to medical men and to general readers, was not received with nearly sufficient warmth. Too many were wedded to the old systems of treatment; too many knew nothing about the diseases of the mind, and their sympathy could not be aroused in favour of lunatics. So Conolly was left to his country work at Warwick, varied by one year’s residence at Birmingham, till 1839, when he was appointed Resident Physician to the Middlesex County Asylum at Hanwell, at that time the largest in England. He had taken the opportunity of visiting the Lincoln Asylum and gaining all the advantages possible from its experience. He was now satisfied that mechanical restraint was not only unnecessary, but possibly injurious. On few others had the non-restraint system gained a hold. Hanwell had the reputation of being one of the best-managed asylums in England, many patients being occupied in agricultural and other pursuits. Yet one year after Sir William Ellis’s resignation, when Conolly took office, “instruments of mechanical restraint of one kind or other were so abundant in the wards as to amount, when collected together, to about six hundred, about half of them being handcuffs and leg-locks.”

Conolly entered upon his duties on the 1st June 1839. The asylum then contained 800 patients, and he found forty under continuous mechanical restraint. In his first report to the Quarter Sessions, he informed the Justices that since the 21st of September not one patient had been under restraint. “No form of strait waistcoat, no handcuffs, no leg-locks, nor any contrivance confining the trunk, or limbs, or any of the muscles, is now in use. The coercion chairs, about forty in number, have been altogether removed from the wards.” In fact, they had been cut up to make a floor for the carpenter’s shop.

This was not accomplished without some trouble and anxiety. It took time to indoctrinate the officers and attendants with the principles of the new system, in which they were deprived of their old prop. The aid which he received from Miss Powell the matron was most valuable. In ten years not one case was admitted to Hanwell in which mechanical restraint was deemed necessary, although many suicidal patients were among them. In fact, the removal of restraint tended directly and powerfully to promote the recovery of these, by taking away the sense of degradation occasioned by such restraint, by bringing them within the sphere of medical remedial agents and of cheerful influences. The only substitutes allowed were in some cases seclusion of a patient in an ordinary sleeping apartment, and, in extreme cases, in a padded room in which the floor was a bed; such seclusion being immediately reported to the medical officers, and recorded, even when continued only for a few minutes. This was found sufficient to protect the other patients, to calm the refractory one, and act as a tonic and remedial influence. The shower-bath was rarely resorted to except for medical reasons; window-guards, clothing, and bedding of strong materials to prevent tearing, were only required in a few cases. “The great and only real substitute for restraint is invariable kindness,” says Dr. Conolly. “This feeling must animate every person employed in every duty to be performed.”

Dr. Conolly published the main results of his experience in his Clinical Lectures in the Lancet in 1846, and in a work on the Construction and Government of Asylums, in 1847. His annual reports to the Justices detailed the progress of his system, and he afterwards summarised them and published them collectively. At the end of ten years, finding the non-restraint system in no danger of being abandoned at Hanwell, Dr. Conolly ceased to be resident physician, and became visiting physician, attending at the asylum twice a week, and spending the greater portion of the day there. His interest in the patients, says Dr. Hitchman, seemed never to flag. He would always look out for something to commend in a patient, the hair better kept, clothes more neatly worn, &c., and addressing the patients in the most gentle, affectionate tones, he made his visits always a matter of longing. The old attendants at the hospital in after years spoke of Dr. Conolly’s untiring watchfulness in the first years of his experiment. He would visit the wards at all hours of the night to see that his orders were being obeyed, walking noiselessly along the corridors. He was kept up in his arduous duties by an elevated religious principle. “I feel grateful to God,” he wrote, “who has intrusted duties to me which angels might stoop to perform.” He suffered greatly from an affection of the skin, which kept him awake at night and ill at ease during the day; and hence was liable to fits of depression and irritability which sometimes made him appear impatient.

In 1852, on his resignation of the appointment of visiting physician, Conolly’s connection with Hanwell practically ceased, and a piece of plate and his own portrait by Sir W. Gordon were presented to him at a public meeting by Lord Shaftesbury. In his reply on this occasion Dr. Conolly said: “Those who know me well will believe me when I say there never was an occasion when the sense of merit was less reflected from the breast of the recipient of a public honour, than it is from me at this moment.” He further stated that when he had first heard of the establishment of Hanwell Asylum, he was seized with a restless desire to become one day its head.