The 2.4.1842 Edition of The Albion, published in New York, contained a lengthy report about the Hanwell Pauper Lunatic Asylum (London). A copy was offered on ebay in July 2005 and successfully bought by Brad Edmondson of Ithaca, New York, who is researching the development of the asylum system in New York state. Brad supplied a copy to Andrew O'Brien in England, who sent a copy to me. So here it is.

The Albion

New York, Saturday, April 2 1842

Very recently we had the satisfaction to give our readers a description of a New Year's fete to the female pauper lunatics at the celebrated asylum at Hanwell, near London. We are able today to lay before them some reports and statistics relative to that institution, more formal in their nature, and more important in the reflections they suggest, than have hitherto been made public upon this very interesting subject.

It has always been matter of regret, and not unfrequently, of dismay, to survey the harsh treatment, and the shocking restraints to which those in whom the light of reason was obscured, and whose passions were therefore left without internal restraint; nor were the regret or the dismay at all lessened by the belief that such stringent measures were necessary for the welfare of the patients and for carrying out the duties of those who had them in charge.

This belief has existed so long, and has been so general, that it is with difficulty mankind can adopt the notion of milder treatment, even with such demonstrations of the efficacy of the latter as are given in reports like those to which this paragraph alludes. Yet gratifying as these are, they are the results of measures carried on long enough to dissipate all fears that they may be chimerical. They are formed on a regular, firm, judicious, and benevolent course of three years, an ample time to establish the efficacy or the fallacy of the practice and the goodness of the system is made manifest both positively and negatively.

Yet excellent as the plan is, it is less easy to carry it through in reality, than to indulge in speculations on its utility, and too much praise can hardly be bestowed upon Dr Conolly who so ably has attended to all the intricate ramifications of the system of treatment.

When we look at the class of patients with whom a resident physician and manager of such an establishment has to deal, it will be evident that the task is a severe one. They are not only persons deprived for the present of reason, but belonging chiefly to that grade of society in whom passion has always a greater sway over reason than it exerts in more educated persons, and in whom passion is now more likely to be developed.

He must be able to judge much by his eye, to see almost intuitively the general disposition, to remember well the varieties of dispositions and degrees of his several patients, to be always cool, and determined, to know well all his assistants and their modes of proceeding, to attract the love and respect rather than the fears of his patients, and secure their docility by kindness rather than by the open exercise of authority ; to mix up their employments, amusements, and exercises, so as to retain their minds in tranquillity, their bodies in health, and the current of their thoughts within bounds, to induce to regularity of action, cleanliness of person, and order in every pursuit. It is indeed a life of labor to such a man, and one which no man can duly perform unless it be truly a " labor of love."

There is one point in the report which ought to weigh well on all reflecting persons, and should give additional stimulus to all who are in authority or who possess influence. It is the immense proportion of Lunacy which is attributable to intemperance. Lectures and essays on this subject abound everywhere in our days, but we know not any which apply more strongly than statistic accounts like these : they supply facts and induce comments, in a manner which should arrest the progress of the most insensate and reckless ; showing how the intemperate person not only ruins estate and constitution, but that the vice even drives from the human being that peculiar attribute which distinguishes him most strongly from the brute creation, and which alone qualifies him to be their ruler and controller.

HANWELL LUNATIC ASYLUM

The Fifty-ninth Report of the Visiting Justices of the Lunatic Asylum of Hunwell. The Resident Physician's Report, and the Report of the Chaplain, 1841.

The Hanwell Lunatic Asylum has been the theatre of an experiment which will not improbably produce an entire change in the treatment of insanity. The Report before us gives the results of a total abandonment of all personal restraints, except by occasional seclusion, in the treatment of above 900 lunatics of every degree and character of disease.

Chastisement and coercion, till within the last few years the habitual mode of treating the insane, exist no longer in the largest lunatic asylum in the empire:- one moreover where the class of patients being exclusively from the poorer orders of society, bodily restraints might be deemed most of all requisite, and mental or moral influences the least hopeful. Nevertheless, sleeves, coercive chairs, leg-locks and straitwaistcoats have been superseded for above two years, by the appliances of skill and kindness.

Hanwell is neither the only nor the first experiment of the disuse of restraints, but it has there been made in the most unqualified manner and on the largest scale: and as the new system has been the subject of much controversy, the results of another year's experience are of great interest.

The Visiting Justices, in a brief preliminary Report, very ably drawn up, state that the question whether the non-coercive system had been too rashly pursued, underwent prolonged discussion before the Court, at the Michaelmas Quarter Sessions of last year, when it was resolved to defer decision until the Court should have the benefit of the more lengthened experience and matured judgment of the Visiting Justices.

Danger, both to the insane and to their attendants, appears to have been the objection mainly raised to the new system. The decision of the Visiting Justices is now given in the following words :-

"But do the means which are now adopted at Hanwell offer an equal security against the dangers to which every institution, and especially every large institution for the insane is liable? Are they sufficient to guard, not with absolute certainty, but with reasonable hope, against danger, equal at least to the mode of management for which it has been substituted? The Visiting Justices beg to answer distinctly in the affirmative: and to state, as the result of their experience, that notwithstanding the many obstacles with which the non-restraint system has had to struggle, notwithstanding the difficulties which have unavoidably attended the transition from one system to another, notwithstanding all these, and even more than these obstacles by which the means have been materially weakened that were relied on for complete success, that success has fully equalled their hopes, and has presented advantages, which in their opinion more than compensate the imperfections to which every human contrivance is liable."

The Resident Physician's Report enters into further detail, and it constitutes one of the best comparative accounts of the old and new systems we have yet seen.

As respects the old mode of treatment, it is difficult to rise from the perusal of the Report, without a strong conviction that coercive appliances are inefficient as a means of preventing accidents ; whilst their irritating effects on the violent, the alarm they occasion to timid, and their tendency to debase those to whom they are applied, creating incurable habits of uncleanliness, are evil from which the use of restraints have been found inseparable.

One of the strongest objections to instrumental restraints appears to be the liability of the attendants to abuse the use of them.

On this point, Dr. Conolly says-

" As at that time no reports were ever made, or records kept, by the attendants of the patients in restraint; whilst closets full of instruments of restrain were at their command - it was impossible for the resident physician ever to know, by night or by day, how many of the patients whom it was his duty to protect, were in actual bondage. It was curiously indicative of the perversion 'of feeling engendered by long familiarity with restraint, that there was no par of the asylum in which they were more freely employed than in the female infirmary."

" A young woman, (E.D.), in a state of chronic dementia, following attacks of mania which had occurred six or seven years previously, was found on the resident physician's first visit to the wards after this appointment, fastened in her bed by a strap round her neck, by a strap round her waist, and by straps to her feet. She also had on the sleeves, which enveloped her hands in hard leather cases, and her hands were also fastened by short straps connected with the strap round her waist. She was extremely feeble and emaciated ; her skin was in a very irritable state. She could not get out of bed, or raise herself up, or turn, or lift her hand to her mouth. In this state she had been kept for some weeks. No cause was assigned, except that she was troublesome - that she would undress herself - that she was always in mischief. Day by day, with all the caution assumed to be necessary, one after another of her galling restraints was removed. For a short time she proved to be mischievous and troublesome in her powerless way. She delighted in taking off the clothes from her irritable skin, and she preferred standing up to lying down upon the irritating straw of her bed. She one day broke a pane of glass (being still locked up in her room), and squeezed part of her superfluous wardrobe through it. This habit was discontinued when she was permitted to come into the gallery ; but, as she was fond of taking any unappropriated bread, tea, or beer that she found in the ward, the infirmary nurse, who had highly disapproved of all the proceedings .u the patient's favour, contented herself with the milder means of fastening a long strap to the waist-strap of the patient's dress, and securing her by it to an iron bar, or a bench, or a heavy restraint-chair. This thraldom being also forbidden, the patient gradually became less troublesome, and being removed to another ward, slowly recovered strength, and even became fat The poor girl had been a music-mistress, and in a few weeks after her restraints were taken off, she was led to the organ in the chapel by the matron, and induced to play. This patient is yet in the asylum, imbecile, and incapable of employment, but seldom mischievous or troublesome."

The extreme liability to abuse, which the restraint system labours under, arises from the saving of trouble which it offers to the attendant:

" A prolonged maniacal attack is not unfrequently characterized by a continual activity and a most ingenious disposition to mischief. When restraints were employed, these restless and troublesome patients were very frequent subjects of it. It prevented the necessity for the almost continual watching required, and which was too irksome to be borne by an attendant who could at once be relieved from his care by putting the patient's hands in a leather muff, or locking his ankles together. The inconvenience then created fell chiefly on the patient; and many such patients were by degrees allowed to be either in constant or in very frequent restraint; always greatly to their detriment, and sometimes to their entire ruin. The patients now alluded to are seldom violent; they are easily amused, and when amused are as playful as children : but they are irritable, and become uncertain in their temper under the annoyance of mechanical restraints."

Cases in which extreme severity has been used in other asylums are of constant and, we regret to find, of recent occurrence.

" In the course of the year, several patients have been admitted in restraints, and many more marked with restraints imposed before admission. The management of all these cases has proved perfectly practicable without restraints."

Dr. Conolly states no stronger fact than the following, to prove how great a tendency habitual employment of restraint has to harden the feelings of the attendants, and blunt their humanity, of which, under other circumstances, they are by no means destitute :

"The resident physician cannot forget having more than once discovered that dying patients were not released from restraints. Even in the restlessness of death their feet were strapped or chained to the bedstead, and an order to liberate them seemed to occasion surprise."

To the Physician's Report succeeds one from the Chaplain. That it is nearly barren of information is to be excused by the shortness of the chaplain's experience, he having been appointed to the office within the last few months. If, however, he has had no time to cull fruits, he has had sufficient at least to become abundantly impressed with the difficulties of his task, to which he refers no less than six times in as many pages. The facts stated are, that

"the far greater number of the patients appear to him to have fallen victims to the disease whilst uninstructed in the truths of revelation, or at least uninfluenced by them"

The Church Service shortened to an hour's duration is used on Sunday morning, and sermon is preached in the afternoon.

"The path of the religious teacher of the insane, (the chaplain thinks,) must lie in the mean, between excitement and irritation."

We should be disposed to think that it ought to avoid both, and that unless the teacher be able to convey, and the patient to receive consolation and soothing influences from religion, there must either be incapacity in the one or unfitness in the other.

"That a degree of excitement is unavoidable in every case,"

The doctrine that

"excitement may, if judiciously directed, be beneficial in its effects,"

is one which, applied to lunatics, requires much explanation ; for it certainly appears irreconcilable with the system of soothing and calming, which is the rule of the establishment in every other respect. The rule not to excite, is certainly one of which the violation can alone be vindicated by lengthened experience, or the soundest and strongest reasons. In the absence of either, he chaplain says

"This course [of judicious excitement] always intricate when the mind is sane, becomes doubly difficult when its faculties are in derangement, It is your chaplain's anxious endeavour to discover and scrupulously to follow it."

We frankly confess that it is with the greatest satisfaction we learn that a course, doubly more difficult than one which is always intricate, will not be allowed until the chaplain has discovered it. In the interim, we would venture to suggest the strictest adherence on his part to such instruction as he finds soothes and quiets the mind of his flock, and which shall be wholly divested of the undiscovered benefits of excitement. He surely needs not to be reminded that the pure precepts and principles of the Gospel afford abundance of consolation and peace applicable to minds diseased as well as sane. He has undertaken an office of unlimited responsibility, and hitherto unfathomed interest and scope. It strikes us forcibly that his course must be one of investigation, rather than of experiment. It is not as though his trust were one of which the character and most fitting mode of discharging it were known and established. The system of treating lunatics otherwise than as brutes, is of present origin; the substitution of moral and mental remedy for the instruments of mere physical coercion, are of today. The mental physician has even newer ground to tread than the bodily one. The one has changed his mode of treatment; the office of the other is now called into being. The records of cure by chains and fetters, afford no clue to the administration of spiritual appliances. In a work so novel and a path as yet so little trodden, it seems that a thorough comprehension of the disease is primarily essential to the choice of the mode of cure. To probe the phenomena of lunacy, to trace the seat of the disease in the mind, to distinguish its peculiarities, classify its different descriptions and characters, to define their attributes, measure their comparative strength, and ascertain their degree of connexion with bodily infirmity, appear to us to be desiderata preliminary to the discovery or application of the spiritual and mental treatment of insanity.

These then will be the legitimate duties of the chaplain. He is aided, not merely by the discretion and observation of the resident physician ; but by a variety of moral and physical statistics, in great measure demarcating the distinctions, as far as they be historically traced, among the patients. These may serve as aids to his own judgment in the pursuit of the more elaborate portion of his investigation. But in the daily and hourly offices of his ministry among the sorely afflicted minds of his flock, we apprehend that our Saviour has superseded the necessity of any discovery in the fields of excitement, by the simple invitation,

" Come unto me all ye that labour and are heavy laden, and I will give ye rest."

The statistics of the Hanwell Asylum are very interesting. The number of patients in September last was 918, of whom 387 were males, and 531 females. This large preponderance of females over males, has not existed during the whole period of the establishment of the asylum, viz. since May 1831 ; for the total number of male patients admitted has been 1109, and of female patients, 1133, up to this time. From 1831 to 1833 inclusive, the number of females admitted considerably preponderated over the males ; but from 1834 to 1837, fewer females than males were admitted.

For the last four years the admissions have been as follows :

	1838	1839	1840	1841	Total
Males	120	111	125	96	452
Females	152	86	88	117	443
Males and Females	274	197	213	213	895

It thus appears, that the number of males and females admitted has not materially differed, either during the last ten years, or during the last four years ; but the number of females remaining in the asylum exceeds the number of males by thirty-seven per cent. This results from the singular fact that more males than females have been relieved, cured, and have died.

The numbers are as follows since the Asylum was opened :

	Relieved	Cured	Died
Males	53	254	417
Females	33	245	324
	86	499	739

The disease appears to be of a less fatal, but of a more enduring character, in females than in males. Of those who have been above seven years in the asylum. 180 are female, and only 116 males. Of the fifty patients discharged cured last year, thirty-one were males, and nineteen only females.

Of the forms of disease in the patients admitted during the last two years, the following is a summary :

	Males	Females	Total
Mania	112	93	205
Melancholia	28	47	75
Hypochondriasis	2		2
Incoherence	35	26	61
Imbecility	25	29	54
Dementia	13	7	20
Idiotcy	6	3	9
	221	205	426

Cases of mania are therefore twenty per cent, more frequent among men than women. Melancholia, on the contrary, prevails sixty-seven per cent, more in females than in males.

In the Retreat at York* the preponderance of females admitted is about five to four in proportion to males, but the duration of disease is greatest amongst males, and the probabilities of recovery are the greatest amongst females. Mania equally exists in both sexes. Melancholia is 10 per cent, more frequent in females : and Dementia, as at Hanwell, twice as frequent in males as in the other sex. The Retreat is inhabited chiefly by persons in the middle classes of life.

We now approach one of the most interesting of the many branches of the subject, namely, the causes of disease. At Hanwell, out of 201 males and 171 females admitted since September 1839, it appears that insanity is attributed to moral causes in 75 males and 96 females, to physical causes in 136 males and 83 females, and to hereditary causes, in conjunction with the other causes, in 27 males and 12 females. It thus appears, that no less than 56.1 per cent, of the female cases, and only 373 per cent, of (he male cases of insanity arise from moral causes. Whilst on the other hand, 67 6 per cent, of the male cases arise from physical causes, and 48.5 only of the female cases.

The following are among the chief of the immediate or exciting causes of disease among the above named 201 male and 171 female patients

Moral Causes
Poverty, M. 22, F. 21;
Reverses, M. 15, F. 5;
Disappointed Affections, M. 4, F. 11;
Domestic Unhappiness, M. 8, F. 19;
Religious Enthusiasm, M. 5, F. 10;
Fright, M. 6, F. 9 ;
Grief, M. 4, F. 11;
Mental Anxiety, M. 1, F. 7.

Physical Causes
Intemperance, M. 60, F. 9;
Epilepsy, M. 24, F. 19;
Injury of Head, M. 17, F. 3;
Paralysis, M. 12, F. 9.

The total number of cases arising from physical causes, out of the whole 372 cases, was 219, or 58.8 per cent of the whole. At the Retreat, out of 415 cases, 232 was attributed to physical causes, being 55.9 per cent. This shows that the poorer classes are not much less liable to be affected by moral causes than the easy classes. In hereditary madness there seems to be a very marked difference.

In the Retreat at York, hereditary causes are no less than 34.2 per cent, of the whole,; whilst at Hanwell they form but 10.4 per cent. The fact is commented on in the Report on the Retreat, and the number of hereditary lunatics is admitted to be large, as

"compared with results obtained at the large pauper institutions where so much less in known of the history of the cases, but by no means so as compared with other observations."

The cures form another highly interesting branch of both Reports. At the Retreat, the total cures have been 47.3 per cent. The cures at the Hanwell Lunatic Asylum have been 22.2 per cent. The large comparative amount of cures at the Retreat must be in great measure attributed to the milder forms of the disease, which prevail among the class admitted at that asylum. With a view of ascertaining the effect, if any, upon the cures of patients produced by the new system at Hanwell, we have deduced the following table of deaths and cures from the elaborate but somewhat undigested statistics, with which, the Report before us abounds :

	Average number of patients	Number of deaths	Number of cures	No, cured admitted in the same year	Number Relieved
1836	609	66	36	8	4
1837	609	48	29	8	4
1838	617	74	35	7	6
1839	798	92	73	32	9
1840	835	69	68	22	9
1841	883	83	50	17	20

The new system came into operation in 1839, and it is very gratifying to find that so marked an increase both in cures and in the number of the relieved patients dates from about the same period. The cures during the first three years of the above six years, and previous to the new system, were 16.2 per cent, upon the total average number of patients. During the last three years, since the new system, the cures were 22.7 per cent., showing that, under the absence of restraints, the cures have been nearly a third greater than during an equal period when restraints were used.

It is a singular circumstance that this increase of cures is almost wholly amongst the males. Prior to 1838 the number of females cured preponderated over the number of males, but since then the reverse has been the case each year ; and though the total number of females has been greater, there have been only 97 women cured, and 129 men, during the last four years.

The duration of insanity among the total number of the patients varies greatly : the great bulk of the patients have been insane between two and thirteen years. Out of the whole number (918) in the asylum in Sept. 1841, no less than 296, or nearly a third, have been inmates of it for above seven years ; 44 have been insane from birth. The age of attack is, chiefly, in males from 15 to 45, and in females chiefly from 15 to 50. One of the tables gives the degree of education possessed by the patients ; and since they belong to the poorer class, in a county where that class are avowedly ill-educated, it is surprising to find so large a number as 137 out of 193 patients among whom the test was made, able to read and write ; 27 more could read only ; and 26 alone were totally ignorant. The females are less educated than the males.

The number of married women in the asylum is 35, whilst there are no less than 66 single women, and 16 widows. The bachelors do not appear to be in equal preponderance over the married men ; they are but slightly more numerous. The married state does not protect men from insanity, therefore, nearly so effectually as it does with the females. That marriage is a preservative from insanity, in females^appears to be a fact, of which Hanwell affords additional evidence.

A table of the trades and occupations of the patients is given yearly. During the last two years there have been admitted, among 205 women, 68 female servants, 11 Dress-makers, 8 Laundresses, 6 Carpenters' wives, 7 Labourers' wives, 10 Needlewomen ; and among 221 men, 22 Labourers, 12 Shoemakers, 9 Sailors. 10 Soldiers, 9 Carpenters, 9 Porters, 8 Tailors, &c.

Employment was given in Sept. 1831 to 104 of the male lunatics in the garden and grounds, and 50 were occupied in trades and domestic offices ; 216 were unemployed, and 17 were sick. Of the females, 210 are employed in needlework, 181 in the kitchen, laundry, garden, and in picking coir: 123 were unemployed, and 17 were sick.

The total expenses of the establishment were last year £20,410 9s. 9d., being at the rate of 9s. 9.5d. per week for each patient. Of the above total amount, salaries to officers and wages of servants amount to 3,537 16s. 4d. The average expense per head in the preceding year was only 8s. 7d. weekly The contract price paid for all the provisions [word/s missing] nevertheless, fallen, excepting cheese and sugar. Notwithstanding this, it appears, that, in 1840, when their cost was dearer, the item of provisions was 4s. 8.75d. for each patient weekly ; and this year, when provisions are cheaper, it is 4s. 10.25d. The diet of the patients has been much increased, and we may fairly take this as an evidence of the increased appetites and health of the patients. If the system at Hanwell were to be weighed merely in the scale of economy, it would probably rank below many other asylums. A higher and better principle of judgment actuates the enlightened opinion of the times ; and however rigidly it may be desired to minimize public burthens, there are few persons who would grudge the means of insuring/the comfort and hastening the cure of that most helpless and pitiable of all human beings - the pauper lunatic.

The importance of an improved treatment of insanity is enhanced by its rapid and alarming increase. That the Hanwell mode of treating is the best and most perfect remedial system which could be devised, we are not perhaps warranted in affirming ; we may, however, safely indulge in no slight measure of satisfaction at the degree of success which has so far attended an experiment which supplants severity by kindness towards those whose helplessness renders the rigour of their ordinary treatment repulsive to every feeling of humanity.

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