Billeder på siden

my opinion, I have to state, that one was discovered elevation. The attitude of the figure is natural and by myself to have been at twelve o'clock last night in full of character, and from whatever quarter viewed the grounds of the asylum with another female atten- the features are a striking resemblance. The material dant in company with two male servants of the asy-is most suitable to the peculiarity of our variable clilum; at the same time, I also discovered the sleeping mate, the sculptor (T. Milnes, Esq.) having selected rooms of two female patients unlocked, one of whom Sicilian marble, the statue being worked from a block was not in bed, and the other walking about her room weighing upwards of six tons. It is of the finest texnot undressed, neither of which circumstances was ture, a beautiful colour, and will long retain its freshknown to the female night attendant who accom-ness. panied me. I further found that the approach to the female patients was quite free to the male attendants, and even from the road by scaling the wall, and there was nothing to prevent either of these patients escaping. The master and matron were in bed, but were called up to witness the ingress of the attendants who were out.

I am quite certain that no man of mind, and integrity of purpose, will long hold the situation of medical officer in this institution, if the superintendent can insult him as he thinks proper, and oppose him in the treatment of his patients; and if he has not entire control over the superintendent, matron, and servants of the asylum.

It must appear to any one of proper feeling, that a female sick ward should be one of strict privacy, and not be entered by male persons; and certainly not when the medical officer considers that such entrance may place in jeopardy the lives of his patients, or in the slightest degree retard their recovery.

I have omitted to state, that I have repeatedly objected to the seclusion of this patient, E. P., when the matron has importunately desired it, as I have seen the sad effects produced upon her by it, and as she was so easily managed by the nurse to whom she belonged.


I propose in a future letter to give you a statement of the condition of the asylum when I entered, and the changes which have been effected during my residence.

I am, Gentlemen, your obedient servant,
Medical Officer of the Norfolk County Asylum.

20th July, 1854.

Inauguration of the Statue of the late

The following inscription is on the pedestal:


His disinterested and persevering benevolence, "his original and enlightened views, now happily "influence the treatment of the insane through all "civilised nations."

The effect altogether of the appearance of the statue on a site, not only exceedingly appropriate, but so well adapted for a work of art, is most happy.

Eloquent and affecting speeches were made by the Rev. the Precentor, the Hon. A. L. Melville, and others. But the interest of the occasion was centred in the following address of Dr. Conolly's.

Dr. Conolly said, I have been most anxious to attend on the present occasion, not only that I might assist in the performance of a public duty, but because I have always acknowledged how large a debt of gratitude I personally owe to Dr. Charlesworth, whose services in the cause of the insane you are now met to commemorate. To those services I must confess myself chiefly indebted for the determination to do what afterward I had opportunities of effecting in the same direction. There had been great benefactors to the insane before Dr. Charlesworth, and he willingly bore testimony to what they had done. Pinel, in the stormy time of the first French revolution, had liberated many lunatics from chains and dungeons. The Society of Friends had established the Retreat at York, where every humane principle was carried into practical effect. Still, the state of most of the asylums of this country remained very defective, and the condition of the insane very miserable. The York County The ceremony of the inauguration of the statue of Asylum, and the great Asylum of Bethlem, presented the late lamented Dr. Charlesworth, senior physician deplorable examples of neglect and cruelty at that of the Lincoln Lunatic Asylum, took place on the time: and in every asylum there were to be found 12th of July last, in presence of a large assembly. patients who had been chained and fettered for years; When the statue, which stands in an area at the ill fed, ill clothed, and ill treated in every possible south-east corner of the asylum grounds, visible manner. The records of the Lincoln Asylum shew, both to the patients and the public, was exposed that as early as the year 1821, two years after to view, all present uncovered; and, after a moment's the opening of the institution, Dr. Charlesworth's atsilence, a burst of applause followed. It consists tention was strongly directed to the improvement of of a full-length figure of the doctor, in a position in the treatment of insane persons. Step by step may be which he frequently appeared, having his right hand traced in those records the mitigation of the condition advanced a little, grasping a small scroll, and his of the patients; the substitution of various means of left resting on his hip; his head is reclining to the security, without the necessity of resorting to severe left, and the expression of the countenance is exceed- mechanical restraints. Increased liberty was given to ingly faithful, expressing that studious habit and de-them, their superintendence was rendered more efficision of character for which he was so remarkable. cient, and one by one the terrible inventions for fastenThe statue is 6 feet 6 inches in height, and stands ing them up became unnecessary and were destroyed. upon a pedestal of Yorkshire granite of the same It appears to me that it was Dr. Charlesworth's peculiar

merit, and that it constitutes his peculiar claim to our grateful remembrance, that he persevered in this great work, year after year, regardless of opposition, and undaunted by difficulties; and that he so animated the resident officers of the asylum that at length, with his superintendence, they accomplished that which perhaps he had scarcely been sanguine enough to expect, and found that the total abolition of mechanical restraints was possible; and actually effected it. This had taken place a short time before I visited the Lincoln Asylum, in May, 1839. I was then about to take the direction of the Hanwell Asylum; and I visited several such institutions, to observe what was done in them. I found improvements going on in most of them; but restraints still used in them all: strait-waistcoats, hand-cuffs, leg-locks, various coarse devices of leather and iron, including gags and horrible screws to force open the mouths of unhappy patients who were unwilling or even unable to take food. At Lincoln alone, I found none of these things. I do not mean to say that I found a perfect system; but I found watching and care substituted for mechanical restraints. From Dr. Charlesworth's lips I afterwards heard an exposition of his views and principles; and I certainly left Lincoln with a hope, almost with a determination, of carrying out those principles which were, I knew, the real principles of Pinel and Samuel Tuke more fully developed. It was my privilege, and has been the happiness of my life, to effect this at Hanwell: and whilst I live I shall always be proud to acknowledge my debt to Lincoln. From September, 1839, to the present time, no hand or foot has been bound at Hanwell, by night or by day. In my first printed Report of Hanwell, and on numerous subsequent occasions, my acknowledgements to Lincoln have been fully and gratefully expressed, and I repeat them now before the statue of Dr. Charlesworth, because but for what I saw at Lincoln, I might never have thought of what it was afterwards in my power to effect on a larger scale at Hanwell. The system of non-restraint has yet its opponents. There is a tendency in too many places to adhere to or return to the indolent system of mechanical coercion. The French and German and American physicians still maintain that restraints are in some cases necessary. But yet, in England, in Scotland, and in Ireland, mechanical restraints are unknown in almost all the large asylums. No physician who has tried to do without them has failed; and those who defend such means have never attempted to abolish them. Within the last few years new county asylums have been opened in many parts of England, and in these there is not to be found one instrument of mechanical restraint. If we take the instance of the asylum at Colney Hatch alone, we find an asylum for the reception of twelve hundred insane persons; and this great asylum, with its farm, its gardens, its workshops, its entertainment room, its chapel, and all the means of amelioration and cure, is opened without any instrument of mechanical restraint being admitted within its walls; so confident are physicians now that they can manage and cure insane people better without such instruments than with them. Such examples are more forcible than any arguments: they are unanswerable. For all these great results, I believe

we are largely indebted to that great physician before whose statue I address you. I rejoice, therefore, to see this beautiful work of art raised to his memory. The sculptor has given a noble embodiment to the feelings you would express; and I trust the contemplation of it will animate many a young medical man who sees it when he visits the asylum, the scene of Dr. Charlesworth's labours, to emulate them elsewhere. We raise statues in memory of the dead, to whom all our warmest tributes are no longer matters of consideration or importance; but such memorials reflect good upon the living, and this, raised this day, will, I trust, for many years to come, give rise to a determination in many connected with asylums, that in those abodes of suffering, severity shall exist no more.

Suicide of DR. GRAHAMSLEY, Medical Superintendent of the Worcester County and City Pauper Lunatic Asylum.

Our readers will learn with deep grief the melancholy end of this promising physician. The following brief summary we condense from the Worcester Herald. Dr. Grahamsley had disagreed with the former attendants of the asylum, and with one of the officials. The single officer above referred to, the Matron of the asylum, made an application to the Visitors for an increase to her salary. This application was referred to Dr. Grahamsley, who refused to recommend it, and informed the Visitors that he had privately advised the matron not to present the application. He had carefully examined the statistics of such institutions, and found that her salary (£60 a year, with board and lodging) was rather above than below the average of the emoluments of such officials. Some time ago the attendants objected to sign the body of rules drawn up by the Visitors for the government of the asylum, and they "struck,”—i. e., they resigned their situations in a body,- -no doubt intending thereby to frighten the medical superintendent into compliance with their terms; but he accepted their resignations, and at the expiry of the usual notice they nearly all left, there having been less difficulty in filling up the vacancies than they imagined. The matron did not resign; and the discharged servants, whose conduct in leaving simultaneously had been so evidently based upon anything rather than consideration for the convenience and welfare of the asylum, clubbed together, purchased a silver salver, and presented it to the matron with a suitable inscription.

It may easily be conceived that a sore feeling between Dr. Grahamsley and the matron was created by his conscientious refusal to sanction an addition to her wages. The state of their relations has, in short, been greatly disturbed ever since, and Dr. Grahamsley has frequently made complaints upon the subject to the Committee of Visitors.

An investigation was demanded by Dr. Grahamsley on the subject that the matron had accepted a present of a piece of plate from a body of servants discharged from the asylum under the circumstances above stated, whereby that harmony and confidence which ought to exist between himself and so important a subsidiary officer had been greatly impaired.

It appears that the matron was the sister-in-law of Dr. Grahamsley, and that the Doctor had not stated that fact to the Committee of Visitors.

face with the contents of the chloroform bottle, for the purpose of mitigating the agony arising from imbibition of prussic acid.

The above facts were stated at the Coroner's inquest, which was held at the asylum, on Tuesday the 8th instant. Coomber also stated that the Doctor had told

We think it probable that to his sensitive mind the feeling that at all events he had been deficient in candour, if not in concealing, at least in not making known this fact to the Committee of Visitors, had become un-him that the attendants had been putting down the supportable But the conclusion we arrive at is this, that there has not been stated, and that there does not exist, any one single fact in the brief career of the deceased, sufficient of itself to have caused aberration of intellect; but that there are enough of irritating circumstances in his unhappy history, when collected, by their continual irritation, to have unseated reason and driven this amiable and accomplished man to seek for peace in the grave.


hour he had passed through the wards, and the number of times. The attendants had told them that the Matron had given them orders to take this notice. Another witness, Dr. Turley, deposed that "the deceased was a man of very sensitive mind. About three weeks ago I was with him, and he then appeared very low-spirited, and in the course of conversation he told me there was one person in the establishment who I would break his heart. He said the person he meant was the Matron. Mr. Curtler, the Clerk to the Committee of Visitors, stated at the inquest that he had been requested by the Committee to attend, for the purpose of stating that the Visitors had always been highly satisfied with the conduct of Dr. Grahamsley, and to express their deep regret at his untimely end.

The jury, without hesitation, found a verdict that the deceased destroyed himself in a fit of temporary derangement.

At the time of his decease Dr. Grahamsley was in his 30th year. He was a native of Northumberland, and was formerly Assistant Physician to the Morningside asylum at Edinburgh. He leaves a widow (a most amiable lady, now enceinte) with one child, about two years old, to lament their irreparable loss.

So far as can be traced, Dr. Grahamsley was last seen alive by Thomas Coomber, who usually attended to the deceased's pony, at twenty minutes to nine o'clock on Sunday evening last, August the 6th: Coomber was coming out of the stable door after 'supping up" the pony. On approaching Coomber, the deceased directed his attention towards the asylum and said to him, "Tom, whose carriage is that at the front door?" Coomber replied, that he thought it was Lawyer Elgie's, who had come to see the matron; whereupon the deceased put up his hands to his face and said, “Oh! I shall be a ruined man,” and at the same time tears burst from his eyes. Deceased then took from his pocket a shilling, which he gave to Coomber, and further said, "Perhaps I shan't see you again just yet, and you may want some money." As a public officer, the deceased was well known Coomber then put the coin into his pocket and went and greatly respected throughout the county, the news towards the asylum, whilst deceased took an opposite of his death was received with incredulity, amazement, direction leading to the gas house. As the deceased and deep regret. Dr. Grahamsley was elected to the was not at home by ten o'clock, Mrs. Grahamsley be- office which he held in the asylum, two years and a came anxious about her husband, and sent a servant half ago, and it is not too much to say, that no public to the residence of the house steward, Mr. Hume appointment was ever made more completely upon (which is located on the estate though distant from the public grounds-upon the force of recommendations asylum), to enquire if he was there. A negative an- and testimonials of the highest order; and the corswer was returned to Mrs. Grahamsley; but as the rectness of the choice has been amply testified. The deceased had not arrived at half-past eleven o'clock, Committee of Visitors have repeatedly felicitated the her anxiety became intense, and a second messen-county upon having secured the services of a gentleger, in the person of Passmore, the head attendant man so capable of performing the responsible duties was dispatched to Mr. Hume. Immediately upon entrusted to him. this Mr. Hume and Passmore set about an earnest search of the premises, and at five minutes past two o'clock found the Doctor lying dead in the retort room of the gas-works belonging to the asylum. His body was extended on the floor and his face covered with a white handkerchief. He wore the whole of his clothing except his hat, which lay near his left foot. This awful and distressing occurence is but one of Underneath his head was carefully placed a napkin. several which have taken place within a recent period, On his left hand side, within reachable distance, sup- proving the injurious mental tension caused by poor posing the body in a sitting posture on the floor, was Dr. Grahamsley's occupations. "I am at length rea small-sized barrel, on which was placed an empty warded" says Müller "since after twenty-six years inpurple phial with the following label upon it:-tercourse with the insane, I have not become insane "Hydrocyanic acid, of Scheele's strength-minimum dose, one drop." This bottle had evidently contained prussic acid, and close to it was an empty gallipot. In a window near was found a second empty bottle which had contained chloroform, and it is conjectured that previous to taking the fatal draught he imbued the handkerchief which was found upon his

How profoundly ought we not to be affected by the sad spectacle of the cunning physician, who could detect at a glance the most disguised approaches of insanity in others, falling himself a victim to that mental disease, which it was the pride and great object of his life to detect and cure.

myself." In a letter to Pinel it is observed, "the labourer in lead works is thankful if he escape lameness, and the medical attendant of a mad-house, if he does not there leave his reason, a more deliberate sacrifice to the mightiest good of mankind is not conceivable."

* Dr. Winslow's Lectures.


Observations on Sanguineous Tumours of the External
Ear, by DR. FRANCIS FISCHER, Physician to the
Asylum of Illenau, Baden. (From the Allgemeine
Zeitschrift für Psychiatrie.) Translated with Notes,
&c., by J. T. ARLIDGE, A.B. and M.B., Lond., L.R.C.P.,
late Resident Medical Officer, St. Luke's Hospital.
(Continued from p. 48.)

viscid, fluid. Not rarely, indeed, the cartilage undergoes actual loss of substance, and then in a moderately capacious cavity only a portion may remain adherent to the perichondrium, presenting a dusky, grey, ap


The cartilage, moreover, exhibits as a rule, less lustre. In some few cases it is only rather swollen, and its perichondrium looser than usual.

Dr. Fischer feels convinced that from these conditions the sanguineous tumour is developed as an after phenomenon. Nature seems to make an attempt at repair, which ends in thickening and induration of the part. The process is for the most part chronic; in one case only did Dr. F. witness a rapid course, where both ears became the seat of a tumour, the size of an almond, with a detachment of the perichondrium and subsequent sanguineous effusion. An opportunity rarely offers to discover the early condition in the living subject by the eye; yet it is readily detected by careful handling of the ear. Under the circumstances detailed, where the cartilage and its coverings are torn, an effusion of blood occurs in the ready formed cavity, accompanied by a high degree of inflammation. In almost all cases there is a greater or less diseased condition (dyscrasia) which exerts some influence in the production of the sanguineous tumour; and Dr. Fischer thinks that the antecedent inflammation of the cartilage and of its coverings stands in some direct relation with the depraved habit of body originating in the serious lesion of the nervous centres, and pre

Causes. Opinions are divided respecting the causes of this condition of the external ear. The one most in vogue refers it to mechanical injuries, such as blows, bruises, and the effects of pulling or of rubbing the ear. F. Bird has not recognized the operation of external violence, and when such has happened he has regarded it as only an accelerating cause; for he considers necessary a peculiar condition consisting in persistent congestion about the head and enlargement of the vessels. Flemming, on the contrary, believes an external hurt to be always the cause, mostly self-inflicted by the patient, who, from severe and painful feelings about the head, strikes it against hard objects. He would, however, not deny the existence of a predisposition to the morbid condition resulting from a cachectic state. Ferrus discovers the cause in the long continued pressure and rubbing, &c., to which the ear is submitted. Friedreich concurs with Bird, and adduces in illustration two cases of dementia in which an inflammatory swelling of the ear manifested itself along with evident signs of congestion, occurring after maniacal paroxysms. Belhomme believes it to spontaneously originate from the feeble, retarded, cir-eminently of the brain. culation, the consequence of paralysis, and from the It is a well known fact that the condition of the proneness to stagnation in extreme parts. Again, Wallis, Leubuscher, and Schmalz, assume the presence of cachexia as necessary to the production of the swollen ear; whilst Riedel and Rupp are of opinion that external violence is in itself a sufficient cause.

nervous centres is not without influence on the quality of the blood. Engel remarks, that "in acute diseases of the brain and of its membranes, in inflammation of those parts, the blood becomes so altered in quality that it is not easily distinguished from that in typhus." In demented paralytic patients indeed, some such abnormal condition is manifested both by physical and chemical signs, particularly by the great tendency to arrest of circulation, to petechia, to ulcers, to gangrenous destruction of parts, &c. According to Thore, the venous blood of paralytic dementia has an excess of serum, and forms a loose diffluent clot. Also the blood in the heart is found imperfectly coagulated, and

red colour; whilst that in the aorta is more watery. The fibrin is deficient in quantity, and if there be any clot formed, it is small and generally pale, or of an unnaturally red or yellowish colour. The living membrane of the heart and of the great vessels is saturated with this abnormal blood, and assumes a foul, brownish red colour.

Dr. Fischer expresses his belief, that without a peculiar predisposition swollen ear is never developed among the insane. He has often seen patients strike, bruise, and scratch their ears most severely, without producing any swelling. As a predisposing cause of most moment he regards chronic inflammation of the cartilages of the ears and their coverings. On examining the ears of many more or less cachectic patients, which do not exhibit a swollen state, excava-presenting a thick, unctuous, viscid liquid, of a dark tions of greater or less size, may very often be seen, either in the cartilage itself, or between it and the perichondrium. Those in the cartilaginous lamellæ commence by a breaking up of the tissue into irregular plates or granular fragments; their walls are of unequal thickness, and frequently at spots constituted alone of perichondrium. On the other hand, the cavities between the cartilage and perichondrium arise from a gradual detachment of the latter from the former, and generally become evident on the outer aspect of the ear. Both sorts of cavities enlarge gradually as time elapses; but in the former variety this does not often happen from increasing divergence of the cartilaginous plates, but by separation of the perichrondrium from the margin of the excavations. The cavities vary in diameter from one to six or more lines; are seldom empty, but more commonly contain a few drops of a greyish or yellowish, and at times

Such blood, after long standing, as for twenty or thirty hours, forms a spongy clot, the upper layers of which gradually assume a pale red hue. The serum, both by boiling, and by the addition of nitric acid, precipitates a great quantity of albuminous matters. An accurate analysis of the blood obtained from two bodies, shewed that in a hundred parts there were:


[ocr errors]
[ocr errors]

1st Case. 79.100

2nd Case. 80.619





[merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors]

1.105 The salts met with consisted of chloride of sodium, and sulphate of soda, and some phosphate of lime. In the first example a little lactate of soda existed, but in the second this was absent, and some magnesia pre


a rupture takes place there is only a simple extravasation of blood into the meshes of areolar tissue, but never the formation of the characteristic sanguineous tumour, when no cavity has been previously prepared to receive the effused blood.

The application of the slightest mechanical force is sufficient to determine the production of the tumour on the ear. The varieties of injuries commonly operating, are blows, pressure, friction, scratching, and pulling, and such are frequently self-inflicted owing to The small proportion of fibrin and the large quan- painful and unpleasant sensations about the head, tity of albumen and casein are remarkable facts. It is and occasionally to general irritability. The helpalmost unnecessary to remark that the amount of lessness of the patients further exposes them to harm these ingredients in the blood varies according to the and to rough treatment on the part of others, which degree to which the morbid state of system has ar- they are able neither to resent nor to appeal against. rived; and that in paralysis not far advanced, in the Without the operation of the causes alleged, sanslighter grades of dementia, and where proper treat-guineous tumours of the ear are not produced, though ment is pursued, the decomposition of the blood does the evidence of external violence may not always be not occur, or does not proceed so far or so readily, and | attainable. consequently more fibrin is discoverable than in the cases above referred to. Possibly this quantitative, possibly also the qualitative deterioration of fibrin, may be the reason of the rarity of tuberculosis in paralytic-dementia. It must moreover be mentioned, that the actual quantity of blood in the body under-extravasation of blood under the skin of the ear. goes diminution. After concussions and traumatic injuries of the brain, Rokitansky has noticed a considerable consumption of blood.

As this depraved habit of body is essentially associated with the diseased nervous centres, the sources of it are especially to be sought in an impure atmosphere, in crowded habitations, in improper or scanty diet, in want, in anxiety, and the like.

Wherein the specific nature of the dyscrasia conists, and why it attacks the outer ear, and in a few cases probably the outer table of the skull also, and the intimately adherent pericranium, are problems difficult of solution.

Nature of the lesion. This was considered by Bird to consist in inflammation of the cartilage of the ear with effusion of blood beneath the integuments. Neumann presumed it to be erysipelatous, and most recent writers content themselves with describing it as an

Schmalz regards it as a chronic asthenic inflammation
of the cartilage, and of the aerolar tissue lying be-
tween it and the skin, with an effusion of blood or of
bloody serum. Dr. Fischer says, the dyscrasia called
forth by the lesion of the nervous centres localizes
itself in the inflammation of the cartilages of the ear,
and of their integuments; the inflammation runs a
very chronic course, the perichondrium loosens itself,
and eventually, from some mechanical injury of the
ear, becomes detached from the cartilage and more or
less torn, the cartilage itself more frequently also par-
taking in the laceration. This mischief is accom-
panied by the rupture of the vessels which are dilated
in parts by congestion, and which pour out their blood
between the cartilages and perichondrium.
The in-
flammation lighted up will always vary in intensity
according to the strength of the exciting cause and to
the reaction of the system; and besides invading the

No doubt the greater fluidity of the diseased blood favors its escape from the vessels; and the sometimes concurring congestion of the head, causing necessarily a dilatation and thinning of the blood vessels, must be regarded as secondary or predisposing causes of the sanguineous effusion into the ear. Bird and Fried-cartilages and perichondrium, it may also seize on the reich are certainly wrong in assigning this state of areolar tissue and the skin. The effused blood coaguactive congestion as the only cause of these tumours, lates, and in process of time becomes absorbed. It is for they are certainly more frequently seen without only when the injury to the ear has acted for a longer any trace of active determination of blood to the head time, or an improper treatment has been pursued, and than with any. Even where vascular activity and ful-particularly if the cartilage has been laid bare, that an ness have been present in the earlier phases of mental unhealthy watery pus takes the place of the blood, acdisease, they are as a rule extinguished in those ad-companied probably by a partial exfoliation or erosion vanced stages, in which we meet with the condition of the ear in question.

of the cartilage. Either upon or between the layers of the perichondrium and on the cartilages of the ear Venous congestion indeed is more common, being new cartilage substance is developed, which, if the due to defective nervous influence, to functional dis- disease continue, leads to patches of induration, and turbances of the circulation and of respiration, to may itself become the seat of ossific deposit. The pressure from exudation within the brain, and pro- walls of the cavity become covered by firm, fibrous bably also to a contraction of the cranial orifices from tissue, which eventually fills up the space. These new ossific deposits. It is readily conceivable that, as in structures are nothing else than inflammatory prosuch subjects the veins are found enlarged and dis-ducts, and in general, are more abundant in proportion tended with black blood, or as sometimes happens to the duration of the inflammation. with those in the vascular membranes of the brain, are ruptured, the vessels of contiguous organs, as the ears, may be similarly distended and burst. Only when such

The resemblance between these tumours of the ear

and the sanguineous tumours seen on the heads of newly born children is very remarkable. The latter

« ForrigeFortsæt »