These reports ought to be circulated extensively and read by every person capable of thought on subjects of every day interest. Unhappily, this is a subject of every day interest in this country, where insanity is not only a prevalent, but an increasingly prevalent form of disease. And the exciting causes also being on the increase, great wisdom as to prevention, no less than cure, is demanded to preserve our people from a permanent condition of semi-mania.
Every one should read on this subject, and we would point the attention of all readers to what is said by Dr. Earle of the great importance of having recourse as soon as possible to scientific treatment. It is too usual to tamper with such cases till the true remedies come too late.
“When the insane are placed under proper curative treatment in the early stages of the disease, from 75 to 90 per cent. recover. “On the contrary, if they be not put under treatment before the disease has continued a year or more, from 15 to 20 per cent. only are cured.”
Let all fix in their minds a statement which may become so important to them in the guardianship of those they hold most dear.
The chapter on Moral Treatment is of deep interest, and shows the enlightened mind, gentleness and dignity that have given the physician such power to benefit the objects of his care.
“Burns, in expounding the principles of ‘Justice,’ asserts that ‘any man may justify confining and beating his friend, being mad.’ It might be asked, which of the two, the maniac or his ‘friend,’ would, under such circumstances, be the most truly mad.
“For centuries, however, this system was pursued in the treatment of the insane, and, even at the present time, is not abolished in some places. In the most enlightened communities, there is still an impression that persons of disordered mind can be governed only through fear. But few ideas are more erroneous than this. It is not intended that fear shall enter, as a principle, into the system of management pursued at this institution, and all measures calculated to inspire the patients with awe, are as far as possible avoided.
“Show the insane man that you feel an interest in his ease, that you really consult his welfare; that you will even submit to some self-denial or self-sacrifice to promote his interests, and, in nineteen cases out of twenty, you have secured a friend who will be the foremost to protect you from injury. There are but very few persons laboring under mental derangement who cannot be approached as a brother would meet a brother. There is no place in all the earth where the infant can be more safely entrusted than in most of the halls of a well-regulated asylum for the insane; and none where the little child is more petted and caressed.
“It is a fact which probably will not be questioned, that, in what point of view soever the subject be considered, the true policy in an institution like this, is to make it, as far as the circumstances and condition of the patients will admit, an agreeable home. Render the insane comfortable and a great point is gained, not only in preserving quiet in the house, but in hastening a cure, if a cure be possible. It is believed to be the honest endeavor, not only of the Committee, but of the officers and others concerned in the management of the Asylum, to effect the object mentioned.
“The apartments of the patients are well furnished, their tables mostly set with cloths and all the furniture used in private families, and well supplied, in both quantity and quality, with a sufficient variety of meats, vegetables, pastry and fruit. They have access to a variety of means of instruction and amusement, a more particular account of some of which may not be devoid of interest.” In reference to what is said of entrusting an infant to the Insane, we must relate a little tale which touched the heart in childhood from the eloquent lips of a mother. The “minister” of the village had a son of such uncommon powers that the slender means on which the large family lived were strained to the utmost to send him to college. The boy prized the means of study as only those under such circumstances know how to prize them, indeed far beyond their real worth, since by excessive study, prolonged often at the expense of sleep, he made himself insane.
All may conceive the feelings of the family when their star turned to them again shorn of its beams, their pride, their hard earned hope, sunk to a thing so hopeless, so helpless, that there could be none so poor as to do him reverence. But they loved him and did what the ignorance of the time permitted. There was little provision, then, for the treatment of such cases, and what there was of a kind that they shrunk from resorting to, if it could be avoided.—They kept him at home, giving him, during the first months, the freedom of the house, but on his making an attempt to kill his father, and confessing afterwards that his old veneration had, as is so often the case in these affections, reacted morbidly by its opposite, so thus he never saw a once loved parent turn his back without thinking how he could rush upon him and do him an injury, they felt obliged to use harsher measures, and chained him to a post in one room of the house.
There, so restrained, without exercise or proper medicine, the fever of insanity came upon him in its wildest form. He raved, shrieked, struck about him, and tore off all raiment that was put upon him.
One of his sisters, named Lucy, whom he had most loved while well, had now power to soothe him. He would listen to her voice, and give way to a milder mood, while she talked or sang. But this favorite sister married, went to her new home, and the maniac became wilder and more violent than ever.
After two or three years she returned, bringing with her an infant. She went into the room where the naked, blaspheming, raging object was confined. He knew her instantly and felt joy at seeing her.
“But, Lucy,” said he suddenly, “is that your baby you have in your arms? Give it to me; I want to hold it.”
A pang of dread and suspicion shot through the young mother’s heart; she turned pale and faint.—Her brother was not so mad that he could not understand her fears.
“Lucy,” said he, “do you suppose I would hurt your child?”
His sister had strength of mind and of heart. She could not resist the appeal and hastily placed the baby in his arms. Poor fellow!—he held it awhile, stroked its little face, and melted into tears, the first he had shed since his insanity.
For some time after that he was better, and probably had he been under such intelligent care as may be had at present, the crisis might have been followed up and a favorable direction given to his disease. But the subject was not understood then, and having once fallen mad he was doomed to live and die a madman.
The account of the religious services, school, lectures and amusements provided for the use of the Insane and the effects produced, will be read with delight by every good man. The Committee, by the apparatus provided, have shown a truly wise and generous spirit, and the effects of the Orrery and Magic lantern may be traced in the section of Restraints, which we give entire.
“RESTRAINTS.—No subject connected with the management of institutions for the insane, has received more attention, or awakened more discussion, during the last few years, both in Great Britain and the United States, than that of corporeal restraints. Although, in some instances, this may have resulted in an ultraism of sentiment, yet much good has been effected. The important fact has been learned, that the insane can be as easily and better managed with a comparatively rare resort to mechanical appliances for the confinement of the limbs, as by a constant or very frequent use of them; while much is gained on the score of humanity.
“It is now one year and eight months since the ‘tranquilizing chairs,’ so called, were taken from the halls, and neither of them has since been used. It is more than thirteen months since the muffs, mittens, wristbands, straps, and all other leathern apparatus were removed, and during that period not one of them has been carried into the men’s department.
“During the cold weather of last January, one of the men-patients, who was dangerously ill and in the delirium of a typhoid condition, threw off the clothing of his bed, and exposed himself to the air to such an extent that it was thought expedient to confine his hands.—This was accordingly done, for three days, with the camisole.
“Some time in the Summer the hands of another man were similarly restrained, a few hours, while a blister was ‘drawing.’ These are the only instances during the afore-mentioned thirteen months in which the limbs of any of the men have been confined by any means whatever. During that period the average number of men has been about sixty five. Of those who have been admitted, no less than five were brought to the Asylum in irons, and several others with their limbs bound with ropes, leathern thongs, or other implements.
“Probably not one in ten of those admitted, has seen, while in the Asylum, any apparatus for confining either the hands or the feet. Many of them have left, and whatever other recollections soever they may have of the institution, they certainly have none of the means of corporeal restraint. There is no hesitation in asserting the belief that the patients have been more quiet and orderly, under this general disuse of the means in question, than they could have been with their constant use. Moreover, the amount of damage to clothing, windows and furniture, has not increased.
“In the female department there has not been so general an exemption from restraints, yet their use has been greatly diminished, and the camisole* has almost invariably been sufficient.”
Who does not see that all observed here applies with the same force to the mode of governing prisons? Now that the late atrocious offence perpetrated against humanity in Auburn has brought the subject before the public, we hope that some will think on the above remarks in that relation, and be led to see that the same methods would be effectual with the morally as with the mentally insane. The important remarks that follow on the subject of Attendants, would also apply to the qualifications for office in the case of the prisoners.
“ATTENDANTS.—The character of the persons employed to take the immediate care of the insane has very important influence in determining the extent to which confinement of the limbs is expedient. There is this difference in attendants; that, with a given class of patients, while one would find it necessary to ask a resort to restraints, perhaps daily, and even then be in the midst of continual disorder, another would preserve a satisfactory degree of tranquillity without ever having recourse to those means of confinement. The latter would also have an easier task than the former and perform it with generally milder measures. Nature, to some extent, qualifies men for all the departments of duty in life. A peculiar talent and a peculiar tact are requisite to the good government of persons whose reason is disordered.
“It is highly essential that the qualifications of attendants should be such that they will be regarded by the patients as friends and companions. The advantages thus derived are greater than can easily be conceived by one unacquainted with the subject. In reference to this end, there has been an endeavor to procure persons of intelligence, education, and disciplined passions. Five of the attendants in the men’s department, at the present time, have been successful school-teachers.
“It is to be hoped that the time will come when persons will be specially educated for attendants, as teachers are educated in the Normal schools, or as nurses are taught in France. During the past few years the subject has received much attention in England, and in 1842 a society was formed in London, with the Earl of Shaftsbury at its head, the object of which is—
“‘The advancement of the moral, intellectual and professional education of the immediate attendants on insane patients.’
“The same subject presents an uncultured field to the philanthropists of the United States.”
The slightest touch upon this subject suggests far more than we have time to write down, but we shall be satisfied if we turn the attention of some persons to perusal of the Report.*
* If the sleeve of the ordinary female dress be made of twice the length of the arm, they answer the purpose of the camisole. The arms of the patient being folded across the breast, the sleeves are carried around the body and tied behind. There is thus no pressure upon the hands or wrists. [Earle’s note]