Says Andrew Boorde in his strange Regyment of Health:[[669]] “I do advertyse every mā the which is mad or lunaticke or frenticke or demoniacke, to be kept in save garde in some close house or chambre where there is lytell lyght. And that he have a keper the which the mad man do feare.” The same idea we see expressed by Shakespeare:[[670]] “We’ll have him in a dark room and bound,” is the immediate cry towards the mad. Shut up and bound they were, in all manner of ways and places, by relatives, monks, and keepers. As we have seen, many were executed as witches or malefactors, and would be thrown into gatehouses and prisons,[[671]] where they might furnish horrible diversion for the other prisoners,[[672]] and where they were sometimes drugged to make them silent and to cease from raving.[[673]] Sometimes they were placed in such hospitals as there were,[[674]] along with fever and accident cases.[[675]]
In the course of time, as population spread and townships grew, the old resorts were found to be inadequate. The number of the lunatics was increasing, and the whole country was filling up and enclosing. Whipping from place to place became ineffective, and there had been no public institutions available but monasteries, gaols, and hospitals.[[676]] In the year 1247 was founded by Bishopsgate the Priory of St. Mary of Bethlem,[[677]] and here insane people were kept and tended, at any rate from 1403. Doubtless there came to be other places thus put to use, such as, for instance, one St. Katherine’s by the Tower,[[678]] where, we are told, “they used to keep the better sort of mad folks.” But it was not until about the middle of the eighteenth century[[679]] that grim and sombre circumvallate buildings began to be erected to intern the troublesome.[[680]] “They were,” says Dr. Conolly,[[681]] “but prisons of the worst description. Small openings in the walls, unglazed, or whether glazed or not, guarded with strong iron bars, narrow corridors, dark cells, desolate courts, where no tree nor shrub nor flower nor blade of grass grew.[[682]] Solitariness, or companionship so indiscriminate as to be worse than solitude; terrible attendants armed with whips ... and free to impose manacles and chains and stripes at their own brutal will; uncleanness, semi-starvation, the garrotte, and unpunished murders—these were the characteristics of such buildings throughout Europe.” What may be called the theoretical treatment was bad enough. Those who could not be cured must be subdued;[[683]] the teaching of Boerhaave and Cullen admitted this, and the latter wrote: “Fear being the passion that diminishes excitement, may therefore be opposed to the excess of it, and particularly to the angry and irascible excitement of maniacs; these being more susceptible of fear than might be expected, it appears to me to have been commonly useful.”[[684]]
It was desired “to acquire some awe over them,”[[685]] and he declares that “sometimes it may be necessary to acquire it even by stripes and blows.”[[686]] This was the therapeutic flogging already alluded to.[[687]] Shock, terror, blistering, bleeding, purging, the use of chains and all manner of manacles[[688]]—these were the means employed and set down in the textbooks to heal the disordered mechanism of the brain.[[689]]
In the Gentleman’s Magazine of 1765[[690]] we read of the private asylums that “persons were taken forcibly to these houses without any authority, instantly seized by a set of inhuman ruffians trained up to this barbarous profession, stripped naked, and conveyed to a dark room.” So ignorant were the doctors of those days as to the nature of insanity that the harsh cruelties practised on private patients were carried out even upon the king. Of the eighteenth-century practice Mr. Massie has written:[[691]] “Mental disease was at that time a branch of art little understood, and the specific treatment of lunatics was worthy of the barbarous age of medicine. The unhappy patient” (King George III.) “upon whom this most terrible visitation of Heaven had fallen, was no longer dealt with as a human being. His body was immediately enclosed in a machine, which left it no liberty of motion. He was sometimes chained to a staple. He was frequently beaten and starved, and at least he was kept in subjection by menacing and violent language.” That, like most lunatics, he was very annoying is certain; he once talked for nineteen hours unceasing. But all his troubles were intensified by ill-treatment;[[692]] they left him to be knocked about by a German servant,[[693]] and the first doctors kept him even from his own children, at which the poor old man complained “very heavily.”[[694]] Such, then, was the orthodox treatment applied against the highest in the land. But the worst deeds were done behind thick walls. “Sane people,” says Beach,[[695]] writing of private establishments, “were frequently confined in these asylums, for persons frequently availed themselves of the facilities[[696]] then in use in order to get rid of a troublesome relative or to obtain some selfish object.”
And what of the really mad?[[697]]—irritable, violent, irrational, helpless, often with as little control over the functions of the body as on the workings of the mind. We can imagine what their state became when left in the hands of ignorant practitioners and brutal attendants, with chains and instruments of restraint convenient and ready. Screened off from all kith and kin they writhed with sores and rotted in ordure.[[698]] Sometimes—mostly on Monday mornings after the Sabbath rest and accumulations—they might be carried out into a yard[[698]] to be mopped and soused from pails in the coldest weather.[[699]]
The condition of the living rooms and wards[[700]] was often such that visitors grew physically sick from going into them;[[701]] but they were rare within those private prisons,[[702]] strangers are never welcome behind the walls. At York Asylum[[703]]—an especial plague spot opened in 1777 and burnt,[[704]] it is said, to avoid disclosures that might hang its keepers,[[705]] in 1814—a rule was adopted in 1813 “that no person[[706]] shall be allowed to visit any of the patients without a special written order signed by the physitian.” Official visitors were generally harmless.[[707]] At York the worst rooms were not shown them.[[708]] For most of the small asylums there were none at all.[[709]]
Even the larger public asylums during the eighteenth, and also far into the nineteenth century, were horrible monuments of cruelty and neglect. The miserable patients lay upon straw in cells,[[710]] or upon wooden shelves to which they were fastened. Many were naked or decked over with one blanket.[[711]] In the wards they were frequently chained to the wall by wrist or ankle,[[712]] and occasionally by both. One patient at Bethlem,[[713]] a fierce, powerful man whose name was Norris, after a fracas with a drunken keeper, had his arms and shoulders encased in a frame of iron obtained from Newgate.[[714]] This instrument[[715]] was attached by a twelve-inch chain to a collar round his neck, from a ring round a vertical iron bar which had been built into the wall by the head of his bed.[[716]] His right leg was secured to the frame upon which he lay. The effect was that the patient could move up and down as far as the ring and short chain round the upright bar permitted, but he could not stir one foot from the wall, and could only rest lying upon his back. “In this thraldom,” says Dr. Conolly,[[717]] “he had lived for twelve years. During much of this time he is reported to have been rational in his conversation. At length relief came, which he only lived about a year to enjoy. It is painful to add that this long-continued punishment had the recorded approbation of all the authorities of the hospital. Nothing can more forcibly illustrate the hardening effect of being habitual witnesses of cruelty, and the process which the heart of man undergoes when allowed to exercise irresponsible power.”
The medical men were poorly paid and proportionately neglectful. At the time of which we are speaking—the end of the eighteenth and the beginning of the nineteenth century—the physician at Bedlam got only £100 a year.[[718]] However, he kept a private asylum, and sometimes left the public institution for months together.[[719]] One of the surgeons is described as having been “generally insane and mostly drunk,” in spite of which he was retained there for ten years.[[720]]
With such shameful neglect and callousness on the part of the doctors—there appear to have been no chaplains in those days[[721]]—it is not to be wondered that the unhappy patients fell entirely into the hands of their keepers and immediate attendants, and most of these were quite ignorant people, rendered impatient and brutal by the exasperating ways of the demented inmates, and by their boundless power over them. Instinctive and retaliative floggings (the third kind, alluded to on p. 149), assaults, and possibly even murders, were not uncommon, as well as the distressing and unlimited restraints already referred to.[[722]] One doctor invented and introduced a special instrument to prize open the patients’ mouths at compulsory feeding. He mentions that, by the usual process, teeth were apt to be broken, and some were left “without a front tooth in either jaw.”[[723]]
In the eighteenth century[[724]]—up to 1770—and in some places, doubtless, even to later times, the mad people were reckoned among the “sights.”[[725]] The public paid[[726]] to go round the asylums, as they do now to gaze upon wild beasts.[[727]] The baser and more mischievous among them would irritate and purposely enrage the secured patients, as their descendants tease caged animals to this day;[[728]] and thus reproduced for their ghastly diversion “exhibitions of madness which are no longer to be found, because they were not the simple product of malady, but of malady aggravated by mismanagement.”