It is desirable to have window-shutters to most or all of the bedrooms.
They are indispensable in the bedrooms of refractory wards, and should be
made to shut easily, and to fasten with a small spring-lock, or in some way
which occasions no delay, and so as not to be unfastened by the patients.
Sufficient light should be admitted through perforations in the shutter to
make the inspection of a patient secluded in the daytime practicable.
Seclusion in total darkness is seldom, perhaps never, necessary ; and it
would often be a dreadful punishment, either much aggravating the patient's
agitation, or exciting frightful [p.29] thoughts. In visiting patients in
private houses, I generally find the rooms made totally dark, but filled
with anxious relatives, attendants, and half the servants of the house. All
these things are unfriendly to the patient's tranquillity, and produce
suspicion, fear, and increased violence. The locks of the bedroom doors
should not be spring-locks, but simple locks, of a strong construction.
There is great danger of injuring a patient who tries to come out of his
room against the will of the attendant if the door fastens with a
spring-lock; and the doors would, of course, be locked whenever closed,
which would be highly inconvenient both to patients and attendants. The
doors of the galleries should have spring-locks, without which they will
seldom be locked at all. All the locks in the house should be so made, and
so kept in order, as to open and close with the least possible noise. The
jingling of keys, the clang of the locks, and the violent opening or
shutting of the doors of bedrooms and galleries, are generally considered
of no consequence by the attendants ; but they produce the most
uncomfortable feelings in the patients. The gallery doors should have large
handles, enabling those who pass through to shut the door quietly. The
state of a whole ward may immediately be altered by persons hastily and
noisily passing through. There is, however, no point so little attended to
by the generality of attendants, servants, workpeople, officers, and even
by the official visitors of all asylums. The physician's caution is
generally despised, and his example disregarded. Doors are thrown suddenly
open; attendants are loudly or fiercely called for; unexplained intimations
are given of something being wrong somewhere ; the ward is hastily passed
through ; the hindering patients are put aside; the door is violently shut;
the next ward and the next are similarly invaded ; and the whole of the
inmates, attendants as well as patients, are left in a state of agitation,
or even of alarm. I have often, in former times, discerned the impression
of these impetuous visits so distinctly left as to make me inquire into its
cause ; and have had deep reason to lament that it should be so much
forgotten that the [p.30] manner, the voice, the words, the very step of
those who pass through a house full of insane people ought to be calm and
tranquillizing. Those most conversant with the insane will the most readily
acquit me of exaggerating the importance of these matters. Being desirous,
whenever I suggest arrangements which appear at first sight to be but
remotely connected with medical treatment, to append the reason to the
suggestion, my remarks on all points of building and construction become
unavoidably mingled with some details of treatment; for the only standard I
acknowledge in all the arrangements, is that of their bearing on the
patients. There is no other test of their goodness or badness.
No part of the subject of the construction of asylums is more difficult to
give a satisfactory opinion upon than that which relates to the proper
method of warming and ventilating such buildings. Different plans are in
use in different asylums, and yet ventilation is generally found to be
imperfect, and the temperature of different parts of the building in winter
very unequal, varying in different wards as much, sometimes, as twenty
degrees of Fahrenheit. If story is piled upon story, and basement wards and
dormitories are excavated, I believe no system of ventilation will prevent
the air of the asylum from being generally unwholesome, and often highly
offensive. From subterranean dormitories insidious streams of
corrupted air
are for ever rising, pervading every room above ground, ascending every
staircase, and infecting every corner. Visitors go round such buildings in
the middle of the day, and do not perceive this, although in certain states
of the weather it is very perceptible; but those who live in asylums, and
who have to return to them after breathing the fresh air of the evening, or
who visit the wards, and occasionally enter the bedrooms at night, or who
even pass the head of staircases leading to basement dormitories, in which
the patients have been sleeping two or three hours, know too well that the
air becomes so impure as sometimes to occasion immediate sickness; and
although the governing bodies may persist in accumulating [p.31]
beds wherever they can be placed, so close to each other as almost to
touch, and subservient officers will permit these un-salutary practices,
nothing is more certain than that all this is done at the expense of the
general health of the whole establishment. In such asylums some of the
attendants are always sick; febrile attacks, attended with great debility,
are very common among them; what is called influenza becomes, as it were,
domiciled and perpetual among them; and no one living under the roof of the
asylum has the appearance of being in perfectly good health. Impaired
health induces impaired spirits, and the efficiency of the attendants, and
even of the officers, becomes manifestly diminished. They are too soon
fatigued, and too easily dispirited; they are less comfortable, and less
forbearing; and the final result of all these faults, and their
consequences, is, that the patients suffer.
At
Hanwell the ventilation is merely effected by the ordinary doors
and
windows, aided in some parts of the building by openings in the walls, or
openings communicating with the roof. These openings, and some additional
doors and windows in the basement story, have much improved the general
ventilation of the building within the last few years, and it is seldom now
that the heavy and peculiar atmosphere which used to pervade the wards is
perceptible. The circular portions of the building, and the large
dormitories in the basement, present the greatest difficulties in respect
to efficient ventilation. Nearly the whole of the asylum is warmed by means
of steam admitted into iron pipes, placed, in the older wards, about seven
feet from the floor of the galleries, and in the newer parts, beneath the
floor, and in some of the sleeping-rooms a little above the floor, inclosed
in perforated wooden cases.
The chief objection to warming an asylum by steam is, that the warmth thus
produced is very unequal in different parts of the building; oppressive in
the wards nearest the boilers, and not sufficient in wards more remote; and
that it also varies at different heights of the building. Generally
speaking, the newest portions of the asylum, in which the steam-pipes are
[p.32] beneath the floor, are the most comfortable in cold weather, and the
temperature appears to be more equally kept up in them. The general
coldness of the bedrooms is a great evil; they never attain the warmth of
the galleries, except when steam-pipes are introduced into them. At night,
except in very severe weather, the steam is turned off, and the coldness of
some of the wards then, and in the morning when the patients are expected
to get up, is extreme.
It is difficult to keep up the proper heat all night for the production of
steam; and this particular inconvenience may be avoided, by adopting the
plan of warming an asylum by means of hot-water pipes, in which the water
will circulate if its temperature is kept at 120" Fahr. But this mode of
warming is only applicable to small buildings, and a general preference
seems now given to providing for the general warmth of a building by the
admission, to all parts of the building, of air warmed by passing over
pipes containing hot water, provision being also made for the passing out
of foul air, either through simple openings in the galleries and rooms, or
through shafts containing fires, so as to draw or pump out the used or foul
air, and all the steam and effluvia from the kitchen and other offices.
This plan of "air-drainage" is adopted in the plan for the
Derby asylum;
and it is stated by
Mr Duesbury, that the areas of the flues, and the rate
of motion of the withdrawn and supplied air, will be such as to secure a
change of air of from sixty to one hundred feet per minute for each
individual, the supply depending on the variations of the general
temperature. The
model prison at Pentonville, the prison at Derby, and
other buildings, are already warmed and ventilated in this manner, which
seems peculiarly adapted to such buildings, as the prisoners pass the
greater part of the day, as well as the night, in their cells. It is
possible that the complete ventilation of a well-constructed and not
over-crowded asylum may be effected with a less elaborate apparatus, or, at
least, without the shafts.
But whatever mode of ventilating and warming an asylum [p.33]
is adopted, it should be compatible with having the fresh air admitted
unwarmed, and by open windows, in all temperate weather, and with having
open fireplaces in every day-room, or, if there are no day-rooms, in every
gallery, and in many of the work-rooms. Our windows at
Hanwell
do not admit
air enough in the summer time; and advantage is gained in some asylums, as
at
Stafford, from having the glass of a part of the gallery or
bedroom
window set in wooden frames, corresponding in size and situation to iron
frames placed exterior to them, so that the whole wooden frame can be
opened without leaving the danger of an open window, and yet closed without
any appearance of iron bars. When the wards are warmed by artificial means,
there is too frequent a tendency to economize such means, by excluding the
fresh air, and thus substituting warm, foul, and expired air, for fresh air
warmed. This is one of the many faults which a specious economy too readily
covers.
All my observation of the habits and condition of the insane at
Hanwell
has
led me to be especially of opinion that whatever mode of warming is
adopted, there is both utility and comfort in having fireplaces accessible
to all patients, properly protected by a light iron guard, fastened with a
small spring-lock. The inequality of temperature in different wards, and on
different days, is a source of complaint all the winter; and in many
autumnal days, as well as in the early spring, when the steam-warming or
hot-air warming is discontinued, because it is no longer winter, or is not
commenced because the winter has not yet come, the patients suffer
excessively; and the feeble, elderly, paralytic, and epileptic are
occasionally brought into a state of danger, only averted by removing them
to a ward in which there is a comfortable fire. It is impossible to witness
a party of lunatics sitting round a cheerful fire in winter, without
wishing to see a fireplace in every ward. There is no comfort more missed
by the poorest lunatic than that of an open fire, and many incidental
conveniences are secured where this comfort is enjoyed. The visiting
magistrates of
Hanwell have lately authorized the introduction of
[p.34] fireplaces into most of the day-rooms, to the evident satisfaction
of the patients. It would appear that the mere keeping of the general
temperature of the galleries at 60° is not sufficient for comfort, and that
much gratification arises from greater warmth being applied to the surface
than is absolutely necessary for health. Our patients try to obtain this,
even in the wards most efficiently warmed by steam, by lying down close to
the gratings which admit the warmth ; only imitating in this respect the
general pleasure enjoyed by sane persons when they gather round a
fireplace, although in warm apartments. The point becomes of more
importance in relation to persons shut up in one place, and for whom the
mere sight of a fire helps to break a daily monotony with difficulty
imagined by those who are at liberty to go every day where they pi ease.
I have mentioned fire-guards, although I know that they are disused in some
asylums. I do not recommend their disuse in public asylums. Some patients
are mischievous, and play with the fire dangerously; many are imbecile, and
apprehend no danger from touching it; many are feeble, and may fall or be
pushed into the fire ; and some, debarred from other modes of
self-destruction, may wilfully try to destroy themselves by burning. The
guard should inclose the whole fireplace, but there should be a large
opening in front, of which the lock should close of itself when the open
part, or gate, is shut. If it requires to be locked by an attendant, this
duty will often be forgotten. In the older asylums I have seen iron
handcuffs hanging to the fire-guards, and to these, poor shivering
wretches, half clothed and half starved, were fastened, if they came near
the fire at all; being thus deprived of much of the comfort of being near
the fire, and in some cases exposed to the danger of being half roasted. I
even now occasionally see fire-guards in houses for the reception of insane
gentlemen and ladies, of a form so clumsy, and so dismal, as to present a
strong contrast to the light guards found efficient in asylums for the
poor; and I observe that they are secured by a common padlock,[p.35]
which is objectionable both as regards appearance and convenience.
The manner in which the admission of light and air by the windows is made
compatible with perfect security is illustrated in all asylums of recent
construction. It is only in the older ones that windows are seen placed so
high that no one can look out of them; windows of small and scarcely
transparent panes of glass, set in thick and heavy frames of wood, and
guarded on the outside by massive bars of iron, precautions which may have
been necessary in asylums where violence and neglect reigned uncontrolled,
but which are utterly superfluous under existing modes of treatment. A very
thick window-glass has recently been adopted in the bedrooms of some
asylums, admitting a modified light, but which cannot be seen through : no.
invention can be more abominable. Our windows in the galleries and
day-rooms at
Hanwell are wide and cheerful, allowing the patients to look
out as they sit at work. The panes are of good size, varying in different
parts of the building from 10 inches by 6, to 8 inches by 5^ ; and they are
set in a light frame of cast iron, which is painted white. Towards the
upper part of each window there is a circular portion with two sets of
frames, one turning on the other, so as to leave open spaces, the glass
being set in alternate spaces in each of the circles. In parts of the
building in which there are small square windows, as in the rooms in the
third story, the frame containing the upper row of panes turns on a swivel,
so as to be partially opened ; but this kind of window is far from secure
without the protection of wire-guards. Even the ordinary large windows,
with a complete qircle of panes capable of being opened, are not quite safe
in bedrooms, unless there are shutters or wire-guards. The windows of the
galleries of our refractory wards, and of some others, are guarded; the
rest without guards; and on the male side, the experiment of having no
window-guards in the day-rooms of two out of four of the refractory wards
has been tried, without inconvenient results. In the
Surrey Asylum I
believe none of the windows [p.36] are guarded; but if light honeycomb
wire-guards are placed interiorly to the windows, so as to permit plants
and birds to be put between the windows and the guards, the guards being
painted white, and having a green frame, nothing unpleasant is offered to
the eye. For the mere protection of the windows the guards should be about
a foot from the glass. When restraints were first discontinued at
Hanwell,
the destruction of windows was said to be ruinous. I believe it was often
most negligently permitted by attendants partial to the old means of
securing the patients: now it has become quite trifling, having diminished
with the decrease of all other kinds of violence and irregularity.
Window-frames of cast iron may be broken by a sharp and heavy blow with any
hard instrument; and we had, some years agov a patient who was very expert
in doing this, and making his escape from the asylum; but such accidents
can only happen where the attendants are negligent, and perhaps they are
only likely to happen where patients arc made unhappy by restraints. The
patient alluded to was once or twice brought back to us. The period of
emancipation from muffs and strait-waistcoats arrived in his time: he
sometimes tried to provoke us to make him an exception, and to put
restraints on him again ; but he was treated differently, began to mend,
got well, and was discharged cured. Since restraints were discontinued, I
remember no instance of escape being effected by breaking the
window-frames.
When these and worse accidents occurred at
Hanwell, there was not an
efficient window-shutter in the house. All kind of security had rested on
fastening the arms and legs and bodies of refractory patients to bedsteads
or to heavy chairs; and there was an interval between the removal of these
fastenings and the supply of required shutters and other means, which
interval was signalized by untoward occurrences, now seldom heard of in the
asylum, and when occurring, attributable to some negligence of the same
kind. Dr. Jucobi thinks that iron window-frames are attended with mam ether
[p.37] inconveniences, and seems much to prefer the old iron bars; but his
objections do not seem to be well founded. We do not find, at Hanwell, that
the expansion or contraction of the iron ever breaks the panes, nor that
they admit the air inconveniently, nor the rain generally ; nor do they
darken the rooms, or open of necessity in a dangerous manner; nor do they
stain and streak the glass in wet weather. The chief inconvenience, that of
rendering it difficult to admit sufficient air through them in hot weather,
has been already spoken of. The insertion of one pane of zinc in some of
the windows, perforated for the admission of air, and making openings over
the fireplaces, with a valve, permitting air to pass out of the ward also,
as practised in some of the habitations of the poor in London, might
perhaps remedy this fault.
The best method of lighting the galleries and day-rooms, as well as the
chapel and larger apartments, in the winter evenings, is by coal-gas. If
well prepared, it is the least offensive, and the cheapest kind of light.
There should be several lights in each gallery and day-room, so
placed as to enable the patients easily to read, write, work, or amuse
themselves with cards, draughts, dominoes, &c.; and one moderate light
should be maintained in each gallery all night. There is a refinement
of economy practised in some private asylums which grievously
interferes with the comfort of educated patients, and which consists
of allowing a long interval to elapse between the departure of daylight and
the introduction of lamps and candles. A great amount of suffering is
entailed on the patients by this ingenious neglect. This is generally
allied with an equal anxiety to save in the article of fuel; and servants
are permitted to forget to mend the fires with entire impunity. The same
principle creeps sometimes into public asylums; and to save the
expenditure of a few shillings in a week, the patients are allowed to grope
their way about the wards, and find their way to bed as they can, when the
days are shortening, and when the patients are also cold and comfortless
and irritable, in consequence of passing many hours in too low a
temperature.
[p.38]
In whatever manner light and air are admitted into the wards, and warmth is
diffused over the asylum, perfect cleanliness is indispensable. Nothing
offensive to sight or smell should be permitted in any part of the asylum.
Warmth must not be, obtained by excluding the air, nor light by means
corrupting the atmosphere. No excuse should be admitted for a bad smell in
any room or corner. If perfect cleanliness cannot remove it from any one
part of the building, there must be something wrong in the drainage or
ventilation of that part, which ought to be rectified at any cost. But
instances of this kind are few in comparison with the origin of such bad
smells in neglect. Attendants who have not been well instructed in their
duty, or who are not well affected to the non-restraint system, will
stoutly maintain that this or that bedroom cannot be freed from a bad
smell, do what they will; but such is scarcely ever the case, and for a
proof that it is not the case, I would refer every visitor to
Hanwell to
the male ward No. 1. It is a ward in which every inconvenience has to be
contended with ; it is in the basement story ; it has small windows ; it
has bed-rooms on both sides of the gallery, from one end to the other ; it
is the longest ward in the asylum, and it contains fifty patients, all of
whom are imbecile or idiotic, many paralysed or helpless, and three fourths
what are called
dirty patients, requiring all the care of children. Four
male attendants keep this ward so scrupulously clean that there is scarcely
ever the least smell in any part of the gallery, or in any bedroom. The
admirable cleanliness and general state of this particular ward are
favoured by each patient having a single sleeping-room. If they slept in
large dormitories, the air of the ward, and of all the wards above it,
would become noxious to health. Dormitories in which only four or five
dirty patients sleep are seldom free, even after being empty for many
hours, from an odour offensive to a person who has a delicate sense of
smell.
The provisions necessary for cleanliness are humble things to dwell upon,
but they are the auxiliaries of health, and deserve the most vigilant
attention of the physician, who ought [p.39] to remember, when he detects a
bad smell in passing any door in a gallery or passage, that some of the
inmates of the asylum are exposed to that offensive air all the day long,
and all the night, and that some of them never go out beyond the boundaries
of the asylum grounds, so as to recruit, by change of air and scene, their
constitutional power of resisting the influence of
local malaria. And
whoever pays much attention to the habits of human beings, must know how
much the irritability of the mind is increased by habitual ill health, in
whatever way produced; and it is with this irritability, on a large scale,
that we have to deal, and which it is our business to remedy or prevent in
asylums for the insane. It well illustrates the importance of everything in
an asylum being regulated by the physician, when we find that even this
point of cleanliness, so essential to health of body and mind, cannot be
secured without well-chosen attendants. Their selection is allowed to rest
at
Hanwell, and in a few other asylums, with those who either do
not
understand or do not appreciate the comprehensive nature of the duties
required by attendants, and the physician is compelled to work with
inefficient instruments, and liable, any day in the week, and every week in
the year, to find a great number of his patients deprived of the attentions
of an efficient attendant, and placed at the command of those in whom it is
impossible for him to place any confidence. But the subject of the
selection, government, and duties of the ward-attendants will be
subsequently treated of, with the fullness which its importance demands;
and as I consider that I am addressing the public on subjects of more than
ephemeral interest, I shall not abstain from condemning what is wrong
merely because it happens to be practised in the asylum to which I am
myself the physician, and which I would fain see a model for general
imitation.
The sources of bad smells in an asylum are chiefly the large dormitories
already alluded to; the water-closets, sinks, and urinals, and also the
neglected persons, and clothing or bedding of the patients. Until lately,
the sinks in most asylums [p.40] were at once sinks, and watering-places,
and washing-places. The sinks should be used as sinks alone, and the door
leading to them should be locked by the attendants. There should be in
every ward a lavatory or washing-room, containing half-a-dozen
enamelled-iron washing basins, sunk in a leaden table, and each basin
supplied with a watercock, and having a movable plug. There should also be
one or two large round towels in each room. Among the late additions to the
wards at
Hanwell, none has been more productive of comfort to the
patients
than this, and the washing-rooms are the perfection of neatness. These
rooms are open to the patients of quiet wards at all hours of the day ; and
the means of having a clean face and hands, and the refreshment of washing
when fatigued, or after various occupations, is very much enjoyed. An
additional means of personal cleanliness is also afforded by each patient
having a warm bath once a week. Where these regulations prevail, the skin
of insane patients loses its most repulsive and unwholesome aspect; general
health is promoted, and with health, comfort, and cheerfulness ; and the
peculiar odour of the insane, so often described, does not permeate every
ward, and is, indeed, seldom perceived. There are private asylums, on the
old plan, which I could recognize as such, if taken blindfolded into them;
and where this terrible and peculiar smell tells the visitor, as plainly as
any impression on the sense can tell, that the rooms are not thoroughly
clean, that the bed and body linen are not sufficiently often changed, and
that washing and bathing are very little attended to.
Every ward of an asylum should have one room in it appropriated to keeping
the clothing and linen required for the immediate use of the ward ; and
although certain general rules for the supply of clean linen must be
observed, these rules must have many exceptions in favour of the patients.
In or near every ward there should be a bath-room, containing one or two
baths, raised above the floor, and of moderate depth. When many patients
are required to take baths at the same time, the baths may even be shallow;
their depth at Siegburg [p.41] is one foot five inches, their length five
and a half feet, and their width two feet. The best material for the bath
is stone, painted, and the edges rounded. There should be a matting, or
rug, or carpet at the side of the bath when it is used. It is convenient to
have the head of the bath towards a wall, and the two sides and the foot of
the bath free, so that, when required, the attendants can stand round the
patient. The best method of supplying the water is by a single opening at
the bottom of the bath, admitting hot and cold water at the same time. The
handles to turn the water off or on should be out of the patient's reach.
To avoid the difficulty and pain attending the removal of feeble and
bedridden patients to the bathroom, we had some slipper-baths at
Hanwell placed on wheels, but they were not often employed. In
the hospital of St.
Louis, at Turin, (for incurable maladies,) there is a door behind each bed,
and each bed is on wheels, so as to be moved, if required, to the
bath-room. Shower-baths of moderate force are so often useful, that I
should always prefer having an apparatus for one fixed over each bath. To
be effective, they should be supplied from a large cistern, or reservoir.
The ordinary shower-baths, only containing from seven to ten gallons of
water, and which are filled slowly and with difficulty, are very
troublesome, and are more fitted for refreshment or gentle excitement, than
for subduing violent symptoms. As it is extremely difficult to keep a
refractory patient under the shower, it is useful to have a few
shower-baths made of a square shape, and inclosed; the upper half of the
door being made of wirework, and the whole of the top of the bath
perforated. Some of our bath-rooms at
Hanwell
are fitted up with a leaden
pipe, to which a hose-pipe can be affixed, for the purpose of administering
the douche-bath ; but I have long ceased to employ this form of bath, which
occasions much more distress to the patient than the shower-bath, without
any corresponding advantage.
No care can be too great to keep the water-closets within the building, and
the outside privies, and the urinals, free [p.42] from offensive
accumulations and bad smells. All urinals are invariably offensive unless
there is a small stream of water continually running over their surface.
Privies out of doors are required in courts where very maniacal patients,
or imbecile patients, take exercise ; but in the airing-courts for the more
comfortable patients they are superfluous. If there is a deep fall, there
should be the security of a grating, to prevent the patients from leaping
down; and if there is very little depth under the seat, the accumulation
becomes highly inconvenient. All privies become sources of trouble and
annoyance, unless made on the principle of a water-closet, or, at least,
unless a powerful stream of water can be commanded, to carry away all
accumulations. An abundant, never-failing supply of water is the great
requisite for cleanliness, and to secure it no expense should be spared. It
creates a benefit for ever. The
asylum at Siegburg
is for 200 patients, and
it is computed by Dr. Jacobi that 4014 gallons of water are required
daily. For the use of the
Hanwell asylum, containing 1000 patients, we
require 40,000 gallons of water per diem, or about double the proportion
allowed at Siegburg; and at the cost of lO00l. a deep well has been formed,
which supplies 100 gallons per minute at the surface, and about 20 gallons
per minute 26 feet above the surface. When there is this abundant supply of
water, I prefer, to all others, the plan of water-closet by which a current
of water is carried through it whenever the door is opened and shut. The
supply then depends on no one's attention, and no one's caprice, but there
may possibly be some waste of water. When the current of water depends on
the pressing down of the seat, and the subsequent removal of the pressure,
various accumulations of an offensive kind may occur, from things poured
into the closet without any pressure of the seat being made. The dependence
of the current of water on the pulling of a string, or lifting up and
depressing a handle by an attendant, is sure to lead to neglect. Even in
private houses, it is well known that without constant care the
water-closets infect the whole house.
[p.43]
All arrangements in an asylum for the insane, I would once more observe,
and particularly those relative to doors, windows, and window-shutters,
fire-guards, ventilators, baths, and water-closets, should be as simple and
uncomplicated as possible. If much trouble is occasioned by opening and
closing the window-shutters, or fire-guards, or ventilators, the trouble
will be as often as possible avoided. Even when a fire-guard shuts with a
spring-lock, the attendants will not take the trouble to close it, because
in an hour or two they may have to employ a key to open it. Officers of
asylums are sometimes prone to overload the attendants with minute duties,
and the consequence is a neglect of some that are more important.
The observations included in the present chapter have reference principally
to County Asylums for Pauper Lunatics. In asylums for the classes above
them, many modifications of the architect's plan are necessary. Several
private sitting-rooms are required; and these may be on the ground-floor,
and open into gardens, or into a gallery or corridor ; the bedrooms must
almost all be single rooms, opening into a gallery above-stairs. Various
other arrangements become obviously requisite, according to the rank of the
patients, and their habits of living, and the extent of accommodation
required by them. But the general principles of arrangement must be the
same : there must be the same general attention to the health of the
intended inmates ; and there must be apartments for the refractory, the
noisy, and the
dirty, although the furniture may be of different materials
from those used in a pauper asylum. Where such arrangements are not
adopted, restraint is the general substitute for them; and the richer
patient is more unfavourably situated than the poorer lunatic, and is,
indeed, not unfrequently treated with excessive cruelty.
Many of Dr. Jacobi's remarks on the construction of asylums contemplate
providing in the same asylum for patients of different ranks, or of all
ranks. But asylums built for the [p.45] reception of both rich and poor
patients can never be free from many objections ; and the uncomfortable
suspicion is inseparable from them-that the humbler patients have the
refuse of the provisions, and the most indifferent attendance. If such a
mixture of classes in one asylum should be unavoidable, the establishments
for the different classes ought to be virtually distinct, although in
immediate contiguity, as in the
new asylum near Glasgow
.
The buildings and arrangements in the greater number of private asylums
continue to be very defective. Gloom and confinement seem to be inseparable
from an ordinary private dwelling when made into an asylum ; and the
cheerless aspect, the faded furniture, the want of fresh air, and of proper
warmth and light, and of free egress to the courts or gardens, and even,
too often, of proper attention to cleanliness, are oppressively
conspicuous. Some assimilation in these respects, and in others, to the
plan and arrangements of public asylums,- due attention being given to the
requirements of patients who have been accustomed to enjoy every kind of
comfort, and to the feelings of their friends on these points,-would
greatly improve many of them.