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mistaken, than that the Superintendents of all the other public asylums in England, having under their charge nearly ten thousand patients, should have never met with such cases?

camisole de force, gilet de force,) and now some modification of it is called the spencer. An ordinary spencer is a great coat without tails, worn by old gentlemen who affect quaintness and comfort in their costume. It is generally observed in combination Besides, in logic one negative instance is worth a with gaiters and knee breeches, and its peculiarities | hundred positive ones; and, if Hanwell stood alone in will be brought to mind by recollecting Mawworm's managing patients without restraint, the use of restraint joke about it. Dr. Simpson unfortunately leaves us in ignorance of the exact construction of the binding up apparatus which he employs. We have no doubt it is very scientific, and possesses great advantages over the modes of restraint formerly employed at the asylum of which he is the Superintendent, for instance, over that instrument found there by Mr. Godfrey Higgins, which he describes as 66 a gyve." "It is a strong bar about two feet long, with a shackle at each end, intended to keep open the legs of a patieut; and has two chains to it, and handcuffs for the hands of the patient. I took it directly to the weighing scales, and that part of it which was there, for the chain was wanting, weighed twenty-four pounds."-See Parliamentary Committee on Mad Houses, 1815.

in all the other asylums in the world would not prove that it was necessary. Flogging Colonels asseverate, with all the force of passion and conviction, that regiments cannot be kept in order without the lash; that there are cases in which to withhold the lash would be the ruin of the army, the destruction of the constitution, and the dissolution of society. But other Colonels govern their regiments without flogging, and without finding that the bonds of discipline become relaxed by the omission.

Our observations have extended to some length, we trust they may not be barren of results, and that Dr. Simpson's opinions may be sufficiently shaken, to induce him personally to observe the practical working of the non-restraint system in any county asylum, except those above mentioned. We are convinced that such enquiries would change his opinions, and would conduce not less to his own comfort and happiness than to those of the patients entrusted to his charge. He must excuse us if out of consideration for the patience of our readers we do not attempt to refute the timeworn fallacies respecting the use of restraint in surgical cases, the use of manu-tension and the coercion required to place patients in seclusion. Does the imposition of restraint require no coercion ?

So between 1815 and 1854 the practise of the York Lunatic Asylum has advanced from the gyve to the spencer and the muff. But after all what is the difference? Dr. Monro being asked before the above Committee, "What are your objections to chains and fetters as a mode of restraint?" answered, "They are only fit for pauper lunatics. If a gentleman was put into irons he would not like it." So, perhaps, the change at the York asylum is but a matter of taste, a mere fashion. Our forefathers were hardier than we are. They wore heavy broad cloth great coats with a dozen capes to them; we invest ourselves in paletots and siphonias, and such like flimy wrapperings. So also the gyve has gone out of fashion and has been replaced by the muff and the spencer. But the asylum at Clifton is a new institution, bound by no pre-Dr. Simpson ought to have been explicit on this point. cedents, possessing no archives of restraint, and free to adopt whatever fashions or want of fashions its Superintendent may think fit. It is therefore the more to be regretted that it has fallen into the customs of the York asylum and not into those of Hanwell.

Are we to understand from Dr. Simpson's account of the transactions between himself and the Commissioners in Lunacy, that the Commissioners gave their sanction to his employment of mechanical restraints? They must either have done so, or not have done so:

Misgovernment of the Norfolk County Asylum.

The circumstances attending the dismissal of Dr. Foote from the post of medical officer to the Norfolk County Asylum afford a striking proof that an extended

But the existence of cases which cannot be managed without restraint is after all a matter of testi-publicity in matters affecting the welfare of the insane mony. Dr. Simpson says, "I do not hestitate to poor is much needed. A publicity which without delay affirm that there are cases in which to withhold may inform all who are entrusted with the care of the painless restraint would be as flagrant an act of insane, of the most recent ameliorations in their treatinhumanity,” etc., and accordingly he restrains two ment, and may thus remove from abuses the excuse of and a half per cent. of his patients. On the other ignorance: a publicity which may expose abuses as hand, Dr. Conolly states that, "From September, they arise, and prevent their growth and their con1839, no hand or foot has been bound at Hanwell, by tinuance: a publicity which can only be secured by a night or by day. In England, in Scotland, and in journal devoted to the purpose, and aided by the adIreland, mechanical restraints are unknown in almost herents of the new system throughout the kingdom all large asylums. No physician who has tried to do The new system of which non-restraint is the key without them has failed; and those who defend such stone, but only the key stone, and which comprises means have never attempted to abolish them."-(See kindly treatment, sufficient diet, decent clothing, cleanpage 105.) Has Dr. Simpson tried to do without them? | ly and wholesome lodging, and the skilful application That he, Mr. Hill, and the medical officers of the Bedfordshire Asylum, believe that, among the 700 patients they have collectively under treatment, they meet with cases of insanity which are only to be controlled by mechanical means, they have informed But is it not more probable that they have been

us.

of remedial agents; this system could not in every particular have been set at nought in the Norfolk County Asylum, had not its Visiting Justices been ignorant of the extent to which they betrayed the sacred duties they had accepted; nor could the abuses we shall describe have sheltered themselves under the igno

rance of the Visitors, had the public been aware of Justices to appoint a medical officer, but they have their existence. Before the new treatment of insan- retained the non-medical superintendent. They have ity was discovered or at least developed into common attempted to engraft the new system upon the old practice, the immediate care, or to speak more cor- one; to put a new piece into the old garment, and rectly, the immediate control of the insane was en- they have succeeded as such attempts always do suctrusted to persons distinguished by strength of body, ceed. After having appointed a purser to the comfirmness of nerve, and inflexibility of temper. The mand of the good ship Thorpe, they have given him a governors also of the places in which the insane were first lieutenant to discipline the crew to navigate the immured, were selected without reference to their pos- vessel; and to demean himself as becometh a subsession of any medical skill, or knowledge of mental ordinate officer. Such are the plans of Mr. Blofield diseases. They were, indeed, not unfrequently chosen and his colleagues, but unfortunately they do not anfrom the ranks of those who were then rightly called swer. They have indeed themselves acknowledged keepers, but who are now more properly called atten- the difficulty of separating power and honor 'from dants. Far be it from us to detract from the merits of responsibility and skill. The following is extracted any man who has raised himself by his own merits from a testimonial given by them to their stewardfrom a menial position to one of honor and responsi-superintendent on the occasion of his applying for the bility. If the Superintendent of the Norfolk Asylum appointment of Governor to the Birmingham Gaol. after having held the situation of attendant in the "We were unwilling to part with him, nor do we wards of Hanwell had studied medicine, and having now desire it, but having experienced the difficulty of so qualified himself to undertake the care and treat- a satisfactory division of management between the ment of some hundreds of insane persons, had then superintendent and the resident medical officer, we been appointed to his present office, we should have should be glad to see Mr. Owen placed in a situation admired and applauded his honorable ambition and more suitable to a person of so much ability, and who his success. His appointment in default of such qual- had moreover the entire management of our establishifications we refer to only as a proof that the Visiting ment." The opinion thus forcibly expressed, that their Justices of the Norfolk Asylum were under the in- superintendent is better suited for the peculiar duties fluence of opinions which are now recognized as of the GOVERNOR OF BIRMINGHAM GAOL than for erroneous, and which in other parts of the kingdom those of his present office we leave without comment. have become obsolete. In 1843, the Norfolk Asylum, In the early part of last year the Visiting Justices with those for Bedford and Pembroke, were the only appointed Dr. Foote, the assistant medical officer of county asylums in England Wales without a resident the Wilts County Asylum, to be their medical officer, medical officer. The following extract from the Re- and all who knew Dr. Foote's thorough adhesion to port of the Commissioners in Lunacy for 1844, will the most enlightened and humane principles in the shew the value which the Visiting Justices for the treatment of the insane, his activity in the discharge of Norfolk Asylum then placed upon medical skill in the his duties, and his earnestness of character, felt that in treatment of the unfortunate persons placed under this appointment the Visiting Justices had committed their jurisdiction. themselves, to the reform of their asylum.

"The most serious defect in this institution, and one When Dr. Foote took office in the early part of last which may be attended with the most mischievous year, he found the asylum in a disgraceful condition, if not fatal consequences, is the want of a resident the classification of the patients was most imperfect; medical officer. On this subject, we cannot but notice, all of them, even those suffering from age, infirmity, as a singular anomaly in the law, that whilst it is and disease, were lying upon straw mattresses, the required in every licensed house containing a hundred straw of which was frequently damp. The epileptics patients, that there shall be a resident physician, sur had no flannels and they suffered much from cold. geon, or apothecary, there is no similar provision as to There was only one laundress to superintend the county or subscription asylums, or public hospitals. washing of the linen of 320 patients, with that of the The liability to apoplexy, and the possible occurrence servants and attendants; and the supply of clean linen of cases of suspended animation from strangling, may to the patients was wretchedly defective. He found be mentioned as among the many reasons for the con- that the supply of clean stockings allowed for sixty stant attendance or immediate vicinity of a medical patients was ten pairs per week: consequently each man. We put some questions to the superintendent patient got a pair of clean stockings once in six weeks. as to what he would do in cases such as we have He with the Chairman examined the beds, and found described. His answer was, that he would not ven- that the supply of blankets was insufficient for warmth ture upon the responsibility of acting or applying or comfort; there was no clean clothing to change remedies, that he could not bleed, and had no know- fifty dirty male patients. The dirty clothes of the ledge or experience, medical or surgical. Upon ask-patients were washed on Sundays. ing, then, what steps he would take in such cases, we were told that he would immediately send to Norwich, the nearest place, three miles distant, for one of the medical visitors.

He was told by the steward superintendent and the matron, that he had no right to enquire respecting the supply of clean clothing to the patients.

With respect to the condition of the wards, he found "He subsequently directed our attention to a pony that some of them were very offensive; that the single on the lawn, which he informed us was constantly bedrooms were very damp; that there were neither ready to be saddled as occasion required." close stools nor water-closets in the wards, and that Subsequent legislation has compelled the Visiting all the patients, even those in bad health, had to go

into the open air to privies, whatever might be their own condition, or the state of the weather: they had thus to expose themselves even when they had recently taken warm baths; that the supply of hot and cold water was very deficient; that the helpless patients were turned out into the courtyards every morning, while the floors of the wards were washed; that the fires for heating the wards were left out by day in April, and that several cases of inflammation of the lungs occurred in consequence.

He found that patients were compelled to take their food by being held by the throat; he found that they suffered by remaining out of bed at night and standing with bare feet upon cold stone floors. He found that blows, bruises, and injuries to patients, were not reported to him, and that the attendants were repeatedly directed not to supply him with information respecting patients. The attendants treated the patients with harshness and severity.

He found great irregularities in the admission of male patients into the female wards, and of workmen into the same at improper times. He found that at meal times the patients were not supplied with the proper means of eating their food in decency and comfort; there were no table-cloths, or knives and forks, and they were allowed to seize and tear their victuals with fingers and teeth. There was no grace said before meals. There were no family prayers. These and many other faults of omission and commission did Dr. Foote find in the management of the Norfolk Asylum in the spring of 1853; he reported them from time to time to the Visiting Justices, and many of them owing to his importunities have been remedied; some of them and the source of them all remain to the present time.

One fact alone will be sufficient to prove the success of his efforts to improve the dietary. In the year preceding his appointment, the asylum, containing 360 patients, was supplied with 2214 stones of butcher's meat. In the year following his appointment the asylum contained 381 patients and consumed 3410 stones of butcher's meat. The increase in the number of patients was one-eighteenth, which would have been represented by an increase of 123 stones of butcher's meat. The dietary therefore was improved to the amount of 803 stones; and therefore each patient in 1853 was supplied with an addition of more than a third to his allowance of meat.

The above statements are for the most part verified by the Reports of the Commissioners in Lunacy. In their Report, dated May 10, 1853, they state, "We regret to observe that since the last visit of the Commissioners in October, 1851, the mortality has been very large; a considerable number of deaths are attributable to exhaustion.

"In looking over the records of death we find that five of the patients were found dead in their beds; having expired during the night: no attendant being present." 'We saw the patients at their dinner: the supply of meat appeared to be very small."

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"We recommend that water-closets be introduced; that grace be regularly said before dinner; and that the patients be induced to observe order and decorum at their meals."

It may perhaps excite surprise that the Commissioners in Lunacy should have permitted nineteen months to elapse between their visits to an institution so much in need of their vigilant inspection as the Norfolk Asylum. But when the amount of their necessary labors and the smallness of their number is borne in mind, it is obvious that they cannot afford to expend much of their valuable time in the inspection of institutions in which they have no power to enforce the reform of abuses, and where moreover the governing body and the Superintendent may be alike unwilling to adopt their most reasonable recommendations. In a subsequent report the Commissioners state: "Some of the flagged floors of the single sleeping rooms on the ground floor were damp, and most of the single sleeping rooms were deficient in satisfactory ventilation.

"We recommend, 1st, A system of night watching. "2nd, A better description of bedding.

"3rd, That greater care be taken to keep the straw in a dry state.

4th, That the wire-work and bars be removed from most of the windows.

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5th, That efforts be made to introduce in-door employments.

"6th, Six deaths having occurred from Pneumonia, we accordingly direct attention to all the means of preventing the recurrence of such disease, such as warm clothing, good diet, prevention of dampness both in the clothing and bedding," &c.

The above particulars will enable our readers to understand Dr. Foote's letter to the Magistrates of Norfolk, which we append. They will easily perceive that he has been too zealous in his attempts to reform the evils with which he was brought into contact, too zealous, at least, to please his employers; that perhaps he has not shewn a sufficient amount of deference to the person to whom they had confided the “entire management of their establishment"; an amount of deference which an educated physician would not find it easy to shew to a superior officer who had been raised from the position of a servant, and whom he believed to be incompetent to the duties he had undertaken.

Dr. Foote has been virtually dismissed from the Norfolk County Asylum, because he has resisted the attempts of the superintendent's wife the matron, to place his patients in seclusion, when in his judgment such seclusion was unnecessary and injurious, and because he has endeavoured to procure some respect for his female infirmary, and to establish there at least, a little of that "quiet and decorum," the want of which appears to have been so much felt in all parts of the establishment.

We write in no spirit of partizanship for Dr. Foote, and still less with any feeling of hostility towards Mr. Owen. The former has met with the common fate of reformers; he will, we trust, have little occasion to regret the loss of the paltry appointment which he is now leaving.

Mr. Owen has very probably done the best which his knowledge and his abilities enabled him to do; and not to him but to the Visiting Justices must be attributed the blame of his having been placed and

maintained in his present position. Were it not for the interests of the poor lunatics entrusted to his care, we could wish that for the tranquillity of himself and the establishment, the vacancy effected by Dr. Foote's resignation might be filled by some person of gentle manners, tranquil temperament, and a just appreciation of the dolce far niente; one who would confine his attention to the treatment of diseases, without busying himself about the causes of their production; who would readily leave the seclusion of the female patients in the hands of the matron, and who would be able to contemplate with placidity the irruption of strangers and objectionable persons into his female infirmary, and the consequences thereof, namely, one patient fainting, another much excited, and another in hysterics. We could inform Mr. Owen how such things have been managed with complete satisfaction to all parties, only excepting those whose strongest interests are for the welfare of the patients.

waste; and where there is waste, there can be no true economy.

Are the magistracy of the great county of Norfolk satisfied with the manner in which the duties delegated to their Visiting Justices have been discharged? The disinclination of influential justices to join the existing Board is a clear indication that they are not satisfied. In other counties the most influential and the most distinguished men in the magistracy feel it a pleasure and an honor to participate in the government of asylums, managed on the modern principles: men do this, who would have shrunk from all contact with the regime of the old mad-house, with its damp straw bedding, its filthy clothing, its scanty dietary, and its stinking wards. Among the large body of noblemen and gentlemen who form the magistracy, some may be found to whose dispositions the perpetuation of abuses is not uncongenial; others who are competent to effect reforms: but a much larger class is composed of those who are not partial to either of these employments, but who delight to lend their influence and their services to all works which are creditable, orderly, and humane. If the present Board of Visitors of the Norfolk Asylum could, by any possibility, render that institution a credit to the county, they would not need to persuade influential magistrates to join in their good work. A seat at their Board would no longer be shunned; it would be an object of desire, almost of ambition.

But we do not believe that a Board, which could tolerate the state of affairs above described, will ever obtain this amount of success; and, in our opinion, the

entirely new Board of Visiting Justices. We sincerely trust that this change may not be far distant. It is a matter in which the honor aud interest of the magistracy, not only of Norfolk, but of the whole kingdom, are interested. As a rule, the governing Boards of county asylums are distinguished by the most enlightened and disinterested humanity; but glaring exceptions ever strike the attention of the public with force.

But the blame of whatever has taken place that is wrong at the Norfolk Asylum cannot justly be laid upon Mr. Owen's shoulders. Both he and Dr. Foote have been placed in a false position; and the Justices who made that position are alone responsible for its consequences. Indeed, the Justices are responsible for all which is known to take place in this asylum. They have almost unlimited power in the institution; and responsibility and duty are the necessary equivalents of power. The Visiting Justices had a sacred duty entrusted to them by the magistracy of the county, being no less than to protect and to provide for the well-being of the most unfortunate and the most helpless of their fellow-creatures. How they have dis-only hope for the inmates of the Norfolk Asylum is an charged that duty may be gathered from the few details above given. The most charitable construction we can arrive at is that they have erred through ignorance; and that they have really not been aware of the nature of the "care and maintenance" which pauper lunatics require, which they have a right to receive, and which is provided for them in almost every other part of the kingdom. We believe, however, that they have been led into grave errors by a desire to appear economical in their management: a desire which, if not worthy of praise, may be deemed scarcely deserving of censure. True economy in public affairs is an absolute virtue; but the Visitors of the Norfolk Asylum took the wrong course to obtain it, and succeeded in presenting to their constituents the semblance only of a prosperous finance. They placed on the county rates charges which, by law and custom elsewhere, are borne by the maintenance fund; and in this manner they made it appear that the patients in their asylum were maintained at a very low cost; while, in truth, the actual cost of their maintenance was equal to that in some of the most liberally conducted asylums in the kingdom.

How could the Visiting Justices expect to obtain true economy, while their household was in disorder throughout? Economy, “house law,” primarily meant the good management of a household, and its secondary meaning, of financial saving, was taken to express the result of such management. Wherever there is disorder in management, however sordid and penurious that management may be, there will be

If the magistracy of Norfolk desire to maintain the high character of their order, as the protectors of the insane poor, let them not delay to appoint a new Board of Visiting Justices.

Appointment of Medical Superintendent to the
Bedfordshire County Asylum.

We are delighted to learn that, since the issue of our last number, the Visiting Justices of the Bedfordshire County Asylum have reconsidered the conditions of this appointment. They advertized for candidates, offering the paltry salary of £100 per annum. They have elected a gentleman at a salary of £300 per annum, with board, etc., for himself and his family. They have, moreover, elected the medical officer of an institution containing one thousand patients, and wherein "no hand or foot has been bound, by night or by day," for the last fifteen years. The election of Mr. Denne is honorable to the Visiting Justices, as a proof of the readiness with which they can retrace their steps when they discover they are not in the right path.

Letter of DR. FOOTE to the Magistrates of Norfolk.

Gentlemen,-On Tuesday last, the Committee of Visitors at their meeting, at which four only were present, called upon me to resign my appointment, in consequence of conclusions which they had formed in reference to my conduct; I having laid before them circumstances in which I considered that my directions, as to the treatment of patients, had been disobeyed, and myself grossly insulted.

As I feel it a duty which I owe to myself, and as I believe that the future treatment of the patients in this institution is greatly concerned, I feel bound to lay the facts before you.

I will state as briefly as possible the reasons which the committee assigned for such a demand; for I was,

entering the infirmary in opposition to my wishes, as I

had previously told her, that I wished her to keep out of the infirmary.

When the steward superintendent returned on Sunday evening, I informed him of what had taken place, and the excitement produced upon the patient P., by the presence of the male stranger and the female attendant C.

Notwithstanding this, on Monday, C. continued to enter the apartment, and stated in the sick wards publicly to attendants and patients, that she had orders from the superintendent and matron to go into the infirmary as often as she liked, and that the medical officer had no business to give any directions to the attendants.

The result of the perseverance of this person to

I consider, acting strictly up to my duties, and inter-enter the room (time after time) considerably excited fered with unnecessarily in the treatment of my pa- both patients, P. and B., on former occasions. At tients, by non-medical officers of the institution; and I 3 30, P.M., the nurse to whom E. P. belonged came to believe that the committee would not have arrived at report the state of P., &c., produced by the frequent the same conclusion had they acknowledged, that, as entrances of C. Whilst she was reporting to me the far as the treatment of patients is concerned, the medi-state of these patients, C. again entered, the matron cal officer should not be interfered with by the stew-standing outside the door, as she stated, for the purard-superintendent and matron.

The whole number of Visitors had not been summoned to consider the matter as I proposed; this was objected to; but those present stated, that the frequent disagreements between the superintendent and myself had alone led them to arrive at their conclusion. I asked the committee if ever I had in any way broken the laws of the institution, and whether I had not entirely fulfilled my duties, points which they did not attempt to deny.

of watching P. The irritation of the patient was now considerably increased, and P. insisted on leaving the room, but was prevented by the matron, who called immediately to her assistance two other attendants, who took this delicate woman to a room, where they locked her in. On receiving instructions from me the nurse returned. She found P. was removed; a patient had fainted; another much excited; and B., the sick attendant, in hysterics.

The infirmary nurse returned to me; I immediately

I will now state the circumstances under which the saw P., and ordered her a bath at 70° F. demand of resignation was made.

I have always objected to male persons being indiscriminately admitted into the female sick wards, where patients are in bed; for it occasionally happens that no one but females and the medical officers should enter.

On Sunday afternoon, one of the female attendants, named C., admitted, without my knowledge, and in the absence of the matron and superintendent, a male and female stranger into the female sick ward, where there was in bed a patient, E. P., who has lately been very ill with uterine disorder and much excitement; and also a female attendant, B., suffering from uterine hemorrhage for the previous fourteen days; whose life has been in great danger. I have on more than one occasion stated my objections to the sick attendant being disturbed by the intrusion of any one into the infirmary, except the matron, deputy matron, and the nurse who had charge of her. I have more particularly expressed my disapprobation as to the visits of C. On one interview which I had with the matron, I told her that C. had on the previous evening caused much excitement in the sick ward among the patients from the way she talked to attendant B., and desired that she might be kept away, as her conversation had considerably excited P., through talking with B. This order was known to the matron and all the female attendants.

It is not now necessary for me to say that I reproved attendant C., for disobeying my orders, by

Finding that I had entered the ward, the matron brought her husband, the steward-superintendent, and two female attendants-one C., who had been the cause of this excitement, and another P., who had on a former occasion caused much disturbance to the patient P.

I was told, in the presence of these two attendants, in the hearing of the infirmary attendant and some patients, that my conduct was not that of a gentleman, and that he, the superintendent, would not allow me to do as I thought proper.

The matron said she must have the patient kept in seclusion.

I then ordered the two attendants to open the door where my patient was secluded. Being refused admission, I obtained a key and opened the door myself, and remained until E. P. was taken to the bath. She was afterwards, by my orders, moved by the infirmary attendant to her bed in the infirmary, where she now remains quite manageable, so long as the cause of excitement is prevented.

In the presence of the two female attendants, and within their hearing, and in the hearing of patients, I was insulted by the remarks of the matron and superintendent; and by the latter I was called a "humbug." I was told by them that I had no right whatever to give any orders at all to the attendants, and that the committee would support them..

To shew further how far the committee should rely upon the evidence, and whether I was not justified in

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