Annual Report of the Board of Managers of the Prison Discipline Society

physician is dissuading or promising restraint, his hand unconsciously returns to its wonted act, -to place the hands in a muff of leather, at once simple, free from pain, and effective, or to trust to the vigilance or the eventually annoying and irritating remindings or restraints of an assistant? Who can doubt as to the comparative advantage of personal restraint from the hands of attendants, or of apparatus, in those cases of delirium-like fury, where the sufferer is constantly endeavoring to rise from his bed, and where the presence of faces around him is associated in his blind frenzy with enemies to be contended with, regardless of their numbers? The mind may be in that state where the most soothing attentions are met only with fury and suspicion. How valuable, in such a case, is the beautiful and simple apparatus, constructed, I believe, by my distinguished predecessor, Dr. Wyman, which holds the sufferer gently in his position on his bed, allowing him almost every natural and proper movement, yet prevents his wearing himself out by constant efforts to rise, and allows every person to leave his immediate apartment, (for his disordered fancy makes cruel enemies of all,) with a certainty that he is safe and comfortable!

Again, in some highly-active forms of the suicidal propensity, where no human vigilance can prevent the consummation of the dreadful act, except accompanied by the ceaseless application of the force of several persons, a proper restraining means, such as the leathern muff, at once allays the violence of the propensity, by showing the patient that he need not be on the watch to elude his attendants, and that attempts are vain to accomplish his design by force. The best proof of the value of the occasional use of this and other means of vigilance, is manifested in the extraordinary fact, that of the more than 650 patients admitted within the last five years, amounting to more than one third of all the inmates during the 23 years of the existence of this institution, a single individual only has committed suicide! I cannot here forbear to refer to this remarkable result, as one redounding to the honor of the male and female supervisors, and entitling them in the highest degree to the obligations of the community; for to them necessarily appertains, to a great extent, the merit of a prompt detection, often no easy matter, and a successful prevention, of this sad accident. This result will be duly appreciated when it is considered that the number of those evincing this propensity has sometimes amounted to a dozen, and I have never known the period when no instance existed. I recall also from memory no less than three instances within as many years, where patients have returned home, upon partial convalescence, or from other motives, and resorted almost immediately to the fatal act successfully, although the friends and relatives were forewarned to exert their utmost vigilance by our experience."

Dr. Woodward, of the Worcester Asylum, says,

"The British institutions are at present making an effort to surpass each other in the success of managing the insane without restraints. Some of them have abolished them almost entirely, while others have noted the hours, in the course of the year, that they have applied them. The restraints here considered are the strait waistcoat, muffs, mittens, and confining chains; solitary rooms are not included.

"In this Hospital, strait waistcoats and muffs are never used, and confining chains but rarely. Mittens and wristbands are all the restraints which are here applied, and those only when absolutely necessary to the comfort of the individual, or the safety of the patients who occupy the same apartment. These restraints are made use of for two purposes for the individuals themselves, viz., to keep clothes upon them when they are disposed to take them off, and as a safeguard in case of suicidal propensity. For the more violent, such as strike, tear clothes and bedding, break furniture, &c., they are sometimes applied for a short period, but never continued for a great length of time.

"While restraints should be applied as rarely as possible, and never for the benefit of the attendant, but only for the good of the patient or the safety of those with whom he associates, yet I cannot but consider them as important auxiliaries in the treatment of the insane. It is undoubtedly true, that, with corporeal restraints judiciously applied, patients will sooner be made tranquil than by the presence of one or more attendants, who they know will watch all their movements and interfere with their mischievous designs. Their presence will often be a source of irritation which will serve to keep up the excitement ; and, in most cases, restraints that are not painful are far less disagreeable to both the furious and suicidal patients, than that unceasing surveillance which is necessary as a substitute.

"Whenever a patient is under restraint, we frequently propose a release, on condition of a pledge to avoid the irregular conduct for which it was imposed. These pledges we require to be given in a solemn manner, stating to the patient the condition he will be in, if, by a forfeiture of his word, it should be necessary to re-apply them. Both his self-respect and desire of liberty are here called in requisition, to prevent him from further violation of decorum, and afterwards, in many cases, restraints cease to be necessary.

Pledges. We think much of pledges with the insane, and often avoid restraints, by taking the word of a violent patient to be quiet and peaceable. Even the suicidal, who have been detected in making preparation for self-destruction, or in secreting instruments for future use, will generally, and with me have never failed to, adhere strictly to a pledge given in good faith, with feelings of solemnity.

"With most patients, ever so violent, there are times when they will make promises, which will have no inconsiderable influence. Those who are desirous to labor, are easily induced to give a pledge to be orderly and industrious, and make no effort to escape. A more quiet and regular class of patients, of which we always have more or less, are permitted to go abroad unattended, on a pledge to return with punctuality; and few, indeed, ever forfeit it.

"Advancement to a better gallery, permission to ride or walk, admission to the matron's parties, liberty to attend chapel on the Sabbath, are obtained on a pledge given or implied, and well understood, that every propriety suitable to be observed in the place is absolutely binding on them. It is sufficient, in most cases, for patients to know that privation of privileges will follow violation of a pledge, to induce them strictly and punctually to adhere to whatever is expected of them. "Having adopted this course with respect to pledges, and the inculcation of self-respect and self-control, we have very little need of per

sonal restraints; and, while this sheet is being written, but one individual in the Hospital has any restraint upon his person, and this only to prevent his destroying his clothes and bed; he is quiet, and entirely harmless.

"Courts or Yards. By relying upon the pledges of our patients, and inculcating self-respect, we have been able to dispense with the use of courts. They have a Prison-like appearance, and, while in them, our patients were constantly rolling in the dirt, or sleeping upon the ground, thus soiling their clothes and becoming sunburnt. We find that one attendant can take charge of the same number of patients while walking or at labor, as he could formerly in the courts, and they are more pleasantly and usefully employed. Escapes were more common while these were used, for, the wall being considered a protection, less vigilance was used by the attendants. We now dispense with them entirely, and find that not only the personal appearance of our patients is improved, but they are also more quiet, and have more self-respect."

CAUSES OF INSANITY.

The The most frequent causes of predisposition to insanity are, unrestrained indulgence, unbridled appetites and desires, pernicious mechanical restraint upon the free movement of organs essential to life, improprieties of dress, excessive effeminacy, or ill-directed education, by which the individual is not prepared to meet the vicissitudes and trials which must be encountered in the journey of life; and particularly from that intensity of the mind and feelings, which is too often encouraged, but which overtaxes the young brain, and excites it to morbid irritation and actual disease. If this is not counteracted, it will, most assuredly, result in that perversion of the faculties which is exhibited in mental alienation, or in organic lesion, which will sooner or later prove fatal.

"Let this subject receive the attention it should do, and insanity will lose half its victims, and hereditary predisposition be divested of most of its terrors." - Dr. Woodward; Eighth Annual Report.

The per cent. of cases, from the same author, from the most prominent causes, is as follows:- From intemperate drinking, 12 per cent.; from ill health, 25 per cent.; from the affections, such as domestic afflictions, disappointed affection, &c., 16} per cent.; concerning property, 43 per cent.; religious, 43 per cent.; masturbation, 63 per cent.

In the Ohio Asylum, at Columbus, Dr. William M. Awl assigns the following as the causes of insanity in the 258, the whole number of cases admitted: