Report of the Medical Superintendent of the Asylum for the Insane, Toronto
for the year ending September 30, 1877. By Daniel Clark, M.D.
On the 1st October 1876, there remained in this asylum 631 patients?321 men and 310 women; and during the past twelve months, 232?129 men and 103 women ?were admitted, making a total of 863 persons who received treatment and care during the year ending September 30, 1877, as against 956 in the previous year. As compared with the statistics of the preceding year, neither the number admitted nor the total number under treatment is so great, chiefly owing to the large number of chronic and incurable cases that were transferred in 1876 to the Hamilton Asylum, which left an unusually large number of vacant beds for new awards. During the latter part of the past year vacancies only occurred through deaths and discharges. Dr Clark speaks strongly against an ” enshrouded moral pestilence.” Owing to the delicate nature of the subject he appi’oaches it with diffidence; and it is only from a sense of duty after mature deliberation that he portrays a ” deplorable class who make up nearly one-half of the population of our asylums, and specimens of whom are seen in numberless homes in every part of the land.” He then draws a graphic picture of those degraded wretches who make self-abuse a habit, and who are so well known to alienist physicians everywhere. He quotes his predecessor, Dr Workman, who in 186.5 wrote touching this vice:?
” Its victims are not intemperate?nay, indeed, not unfre- quently very temperate?as to indulgence in alcoholic beverages; these are very modest, very shy, very (dare I say it?) pious?as sueh, at least, they often are sent here with sufficient creden- tials?very studious, very everything but what they really are. Would that one-tenth of all the zeal and intelligence and stirring eloquence which has been expended on other not unim- portant reforms could be enlisted in the exposition and ameliora- tion of this enshrouded pestilence! But who will venture on such a work ?
In the report of 18GG Dr Workman truthfully says : “The time has now come when, in my opinion, silence or inaction, not merely on the part of medical superintendents, but of every man in society who knows anything of the evil under consideration, or who can in any way contribute to its removal or mitigation, should be regarded as criminal. The responsibility of the medical profession and of the clergy, as well as that of the whole body of educationalists, is infinitely more weighty than they have ever yet regarded it. They well know that all I have written on the subject not only is true but it falls very far short of the whole truth, and yet it seems impossible to move them. What sort of account of the use made by them of the talents com- mitted and of the opportunities presented to them will they be able to present at the great day of reckoning ? It is, however, but just to the clergy to state that some of them are very im- perfectly informed in relation to the subject now treated of. I have known numerous instances in which clergymen have given to patients whose insanity was mainly ascribed to secret vice the highest testimonials of moral excellence and even of religious worth.
” The first rational step towards the removal of an evil is the recognition of its existence and the ascertainment of its magnitude. Many persons are, I believe, in the present instance, ignorant of these facts; yet such persons may be parents, or may have the guardianship of youth. How are they to protect those under their care against an evil the existence of which is unknown to them ? “
” These,” says Dr Clark, ” are weighty words from men of experienceand he calls on medical men and on clergymen to proclaim the enormity of the vice, and on parents to warn their children of its dire effects. Parents have been too modest, timid, and reticent; and in view of this fact Dr Clark speaks with energy : ” I would that the combined testimony of asylum officers were hung up in the sight of every family, and conned in the light of unimpeachable statistics of insanity and morality! If no other way to reach the public is likely to be adopted than through the press, then I would suggest that a pamphlet should be issued on the subject, and sent broadcast throughout the community. It might be objected that many who are ignorant of this habit might learn it in the suggestions thus promul- gated. In reply to this I may say it is my firm conviction that there are not two per cent, of the adult population who can be classed in this way, and ‘ the greatest good to the greatest number’ is a wise rule to go by.
” There is no doubt that the statements made concerning this secret vice will be vehemently denied by those who know nothing about its prevalency, except in a very limited degree. Let such visit asylums, and also read the reports presented by their officers from all parts of Britain and America year after year, especially the tables of ‘ Causes of Insanity,’ and if they have any ‘ bowels of compassion’ left, they will shudder at the record. Cutting irony, withering sarcasm, and unsparing invec- tive, are launched in power and profusion?and justly too? against flagrant vice and national sins. Let each of us con- tribute our mite and influence to excoriate a viper passion, which is silently doing a deadly work among our loved ones unheeded and unrebuked. The Hebrews took heroic measures to purge themselves of the ‘ uncleanness.’ The ancients and modern heathens record its evils, and the latter take vigorous steps to prevent it. If a Christian community fears for the modesty of it’s youth in expressing it and condemning it, not- withstanding its soul-destroying influence, I cannot help it; my duty has been performed, for ‘ I am in a place where I am demanded of conscience to speak the truth; the truth therefore speak I, impugn it whoso listeth.’ “
The question of mechanical restraint is also treated with much detail. In the Toronto Asylum, during the year the report deals with, ten months passed without a camisole having been used. ” Wristlets, mitts, and muffs were used in isolated cases, but always as the more humane treatment of the violent and dangerous. This sparing use of restraint was not adopted because I felt constrained to give way to the ultra hobbyists, but because few cases presented in which I thought it necessary.” Dr Clark quotes from a monograph on ” Mechanical Pro- tection for the Insane,” by Dr Grrissom, Superintendent of the Insane Asylum of North Carolina: ” Mechanical restraint is far better in many cases:?
” First.?Because of the absence of the personal antagonism between the attendant and the patient, sure to arouse evil passions stirring to excitement, and followed by proportionate depression.
” Second.?Because of the certainty and uniformity of its action, unaffected by momentary strength or weakness, by sudden access of feeling, or the impatient weariness of fatigue. ” Third.?Because it does not excite the passions of the patient, by the mere sight of disturbance in the over-wrought and worn-out attendant.
” Fourth.?Because, when recognised as irresistible, it may be said to establish an environment which the patient accepts, as there is no hope of suddenly overcoming it.
” Fifth.?Because it is far better for female patients, espe- cially the epileptic and hysterical, than the sight of long con- tinued struggles with attendants. On the other hand, if manual restraint is used only out of sight, then seclusion is added, with its evils.
” Sixth.?Because it may be applied uniformly at night, when necessary, to the suicidal, who could not otherwise be safely cared for, unless at enormous expense, and with the dis- advantage of the attendants keeping the patient awake by their presence.
” Seventh.?Because in the mild form it may be applied to the homicidal during the day, and still allow him outdoor exercise and air with safety.” The following cases illustrate some of the points emphasised in the foregoing quotation:?
” There is now in this asylum a powerful mulatto who has homicidal tendencies, and when these are about to manifest themselves, he begs to have wristlets on, or to be secluded, lest, as he says, ‘ he may kill somebody.’ He will spurn attendants from him, but will submit to mechanical restraint with the greatest docility. On the female side there is an estimable lady, who a few weeks ago made a desperate attempt to commit suicide, and immediately afterwards bitterly repented of it; when she feels the uncontrollable impulse coming on, she beo-s to have her hands enclosed in leather muffs. I have suggested to many such cases the choice of being watched by attendants, or having* mechanical restraint imposed, and with few excep- tions they have chosen the latter. There is a natural repug- nance to being forcibly restrained by friends or attendants. The feeling of being vanquished by them excites intuitive anta- gonism, and the knowledge of our kind being spectators of our sufferings, trials, and struggles is far from palatable to a much larger percentage of insane than the public suppose. At least this is the expressed experience of many of those who relate their retrospects of these periods of insane impulse.”
Amongst many other things bearing on this subject, Dr. Clark says, ” As a class, the servants in asylums are as kind as any other respectable class of the community. I can truthfully say they are more kind-hearted, because they are selected prin- cipally from being possessed of this trait of character, and not retained if found to be the reverse in the smallest degree. Not- withstanding this fact, I have yet to learn from the Bucknill School that two or three of the best nurses in any asylum can, by grips, grasps, seizures, or any manual method, do less harm to a maniacal patient than canvas or leather. The latter has no temper, but the former, after hours of struggling with a violent patient, may possess enough of Adam to lose the sweetness of patience, even if blessed with angelic dispositions. The reports of those asylums where manual restraint is only used, show records of casualties as frequent and as tragical as in those which lay no claim to the so-called humanitarian methods. Both plans have been adopted here; and after seeing the struggles of patients for hours to free themselves from the hands and arms of attendants, and often successfully, I confess that gentle mechanical restraint was a beneficial change. The patients often have the delusion that attendants are conspirators against them, and consequently enemies plotting to kill them. This being a reality to them, they will struggle frantically to free themselves from their supposed foes. They have no such intense and ever-present feeling against mild mechanical re- straint ; and after a few futile efforts, will often at once subside into quietude and repose, accepting the inevitable much more readily than they would from human hands, whose clutches they cunningly know they can often escape from, even at the risk of receiving bruises and scratches.”
One plan of treating troublesome patients is severely con- demned, the treatment by sedatives. Dr Clark thinks that such drugs, continuously given, produce hyperana3inia of the cerebro-spinal system, and hurry an acute stage into the chronic and incurable.
The whole report is characterised by thoughtfulness and by- hearty interest in the welfare of those that by reason of mental infirmity are thrown helpless on the clemency of the world. In the Annual Report of the Royal Edinburgh Asylum, Dr. Clouston remarks, in reference to the increasing number of patients:* ” About one thing the general public need be under no alarm whatever. It is not due to any great increase of lunacy. As one of the eight reasons I assigned in my last Iveport for the increase, one was, that ‘ cases of slighter mental disturbance, the result of old age, of paralytic attacks, of bodily diseases affecting the brain, and of general breaking down ot the bodily powers, that formerly would not have been reckoned insanity at all, are now sent here to be nursed and cared forand this reason has received such a powerful illustration within the past few weeks, that I cannot forbear alluding to it in passing. A woman who had attained the venerable age of 90 years was sent to us, declared not only to be a lunatic, but’ dangerous to others. This is, so far as I am aware, an unprecedented fact in the his- tory of lunacy. No person of that age was ever probably sent as a dangerous lunatic to an asylum before in the world. She was, it is true, mentally feeble from dotage, and had none of the outward appearances of having been well cared for. Since she came to us, and with proper care, food, and attention, she has simply exhibited want of memory and some confusion of mind, but is quiet, cleanly, and profoundly grateful for the care bestowed on her. Her case represents the highest point to which the cause I have alluded to has yet attained. Should it become a precedent, the managers of this institution will have at once to set about providing extensive accommodation suitable for aged persons whose mental faculties have become obtuse from old age. Within the past week another aged man, of 88, has been sent to us as dangerous too.f I find the mean age of the patients sent to us is steadily rising since 1874, it having been 38-2, 40*2, 40-9, and 41 years, in the four years ending with 1877.”
Annual Report of the Physician Superintendent, T. S. Clouston, M.l).f
F.R.C.P., Royal Edinburgh Asylum for Insano._ _ f Who lived for only twelve days aftor admission.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.