Читать книгу Chapters in the History of the Insane in the British Isles - Daniel Hack Tuke - Страница 13

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There were in England, at the beginning of the eighteenth century, private asylums for the insane, the beneficial treatment pursued in which was loudly vaunted in the public ear; but I am afraid the success was not equal to the promise or the boast. Thus, there was in London an old manor house in Clerkenwell, previously the residence of the Northampton family, which was converted into a private asylum by Dr. Newton the herbalist. His work, "The Herbal," was published by his son some years afterwards. There appeared in the Post Boy (No. 741) in the year 1700 an advertisement from Dr. Newton, which runs as follows:—"In Clerkenwell Close, where the figures of Mad People are over the Gate, liveth one who by the blessing of God cures all Lunatick, distracted, or mad people; he seldom exceeds three months in the cure of the Maddest person that comes in his house; several have been cured in a fortnight and some in less time; he has cured several from Bedlam, and other mad-houses in and about the city, and has conveniency for people of what quality soever. No cure—No money."

A certain Dr. Fallowes published a work on insanity which attracted some attention at this period, having for its title, "The Best Method for the Cure of Lunatics, with some Accounts of the Incomparable Oleum Cephalicum used in the same, prepared and administered."[100] The author observes in his preface that "as this Kingdom perhaps most abounds with lunaticks, so the greatest variety of distractions are to be seen among us; for the spleen to which it has been observed this nation is extremely subject, often rises up to very enormous degrees, and what we call Hypo often issues in Melancholy, and sometimes in Raving Madness." The proper seat of madness, he adds, appears to be the brain, "which is disturbed by black vapours which clog the finer vessels thro' which the animal spirits ought freely to pass, and the whole mass of blood, being disordered, either overloads the small veins of the brain, or by too quick a motion, causes a hurry and confusion of the mind, from which ensues a giddiness and at length a fury. The abundance of bile, which is rarely found to have any tolerable secretion in such patients, both begets and carries on the disorder." Again, it will be seen that there is nothing more than the fashionable classic humoral pathology, without any original observations, and, in fact, the book is little more than a puff of his incomparable oleum cephalicum, "a noble medicine," which he professes to have discovered; "a composition so very curious, which I have known the use and benefit of in so many instances, that I can venture to assure it to be the best medicine in the world in all the kinds of lunacy I have met with. It is of an excellent and most pleasant smell, and by raising small pustules upon the head, which I always anoint with it, opens the parts which are condensed and made almost insensible by the black vapours fixed upon the brain; it confirms its texture, strengthens the vessels, and gives a freedom to the blood and spirit enclosing them.... When applied after the greatest fury and passion, it never fails to allay the orgasm of the animal spirits, and sweetly compose 'em.... The distemper will be soon discharged, and I have known it frequently to produce a cure in the space of one month." He tells the reader he has had £10 a quart for it, but in compassion for the poor he has prepared a quantity to be sold at £4 a quart at his house. He also boasts of his kind treatment, and says, "The rough and cruel treatment which is said to be the method of most of the pretenders to this cure, is not only to be abhorred, but, on the contrary, all the gentleness and kindness in the world is absolutely necessary, even in all the cases I have seen." He says that not only has he never used violence, but that his patients have good and wholesome food in every variety, and maintains that such entertainments as are fit for persons of any degree or quality will be found in his house in Lambeth Marsh, "where the air is neither too settled and thin, nor too gross." As chalybeate waters and cold bathing are useful, they can be had near, at the Lambeth waters and in the Southwark Park; and he closes his book by declaring that he is "always ready to serve mankind upon such terms as shall be acknowledged reasonable and proportioned to the character and condition of every patient."

Whether the patients placed under his care were treated as scientifically and kindly as at the well-known asylum now in Lambeth Road does not admit of question, although the latter has not much to say of the "black vapours fixed upon the brain," nor can it, I am afraid, boast of such a panacea as the oleum cephalicum!

I may add that, contemporary with Dr. Fallowes, an anonymous physician in London published "A Discourse of the Nature, Cause, and Cure of Melancholy and Vapours," in which he prescribes for the former, among other remedies, not only "salt armoniac" (sic), steel filings, red coral, zedoary, xyloalics, but, strangest of all, toasted silk!

Had we no other means of knowing the treatment to which some at least of the insane were subjected in the early part of the eighteenth century, we might infer it from a single passage in Swift's "Tale of a Tub," in which the author says, in a "Digression concerning Madness," that original people, like Diogenes, would, had they lived in his day, be treated like madmen, that is, would incur the danger of "phlebotomy, and whips, and chains, and dark chambers, and straw."

This was written in 1704.

Another well-known writer of that period, Smollett, did not distinguish himself for generous views in regard to the insane, and forms a complete contrast to his contemporary, Defoe, in his ideas of what the legislature ought to do for the insane—a contrast greatly to the credit of the latter. Smollett thought it would be neither absurd nor unreasonable for the legislature to divest all lunatics of the privilege of insanity in cases of enormity—by which he evidently means violent or homicidal acts—to subject them "to the common penalties of the law." He maintains that the consequences of murder by a maniac may be as pernicious to society as those of the most criminal and deliberate assassination. The entire inability indicated by this sentiment to distinguish between voluntary and involuntary acts, the result of disease—between motives and consequences—is singularly well shown. Unfortunately it was not peculiar to Smollett.

Eloquently did Daniel Defoe protest against the abuses of asylums in his day.[101] The "True-Born Englishman" reprobates the practice of men sending their wives to mad-houses at every whim or dislike, in order that they might be undisturbed in their evil ways. He asserts that this custom had got to such a head that the private mad-houses were greatly on the increase in and near London. He might well characterize this system as "the height of barbarity and injustice," and worse than "a clandestine inquisition," and say that these houses, if not suppressed, should at least be subjected to examination. "Is it not enough," he asks, "to make any one mad to be suddenly clapped up, stripped, whipped, ill fed, and worse used?" He says, "If this tyrannical inquisition, joined with the reasonable reflections a woman of any common understanding must necessarily make, be not sufficient to drive any soul stark-staring mad, though before they were never so much in their right senses, I have no more to say." He asks the reader to indulge for once the doting of an old man while he lays down his remedy, and not to charge him with the ambition to be a lawgiver. Defoe goes at once to the point, and says that it should be no less than felony to confine any person, under pretence of madness, without due authority. He calls upon Queen Caroline to begin her auspicious reign with an action worthy of herself. Addressing the ladies, he says, "Who can deny when you become suitors? and who knows but at your request a Bill may be brought into the House to regulate these abuses?" Defoe little knew the prejudice any reasonable measure would arouse when he added, "I am sure no honest member in either honourable House will be against so reasonable a Bill; the business is for some public-spirited patriot to break the ice by bringing it into the House, and I dare lay my life it passes." He would have infallibly lost it.

This naturally brings us to the question of what has been done by legislation, both for protecting the subject from being unjustly incarcerated on the plea of insanity, and for the protection of lunatics when confined in asylums. The only Act of Parliament, up to the year 1808, which bore upon the care and protection of the lunatic poor was that passed in the year 1744, in the seventeenth year of George II. (17 Geo. II., c. 5). This authorizes any two justices to apprehend them, and have them securely locked up and, as might be expected, chained. The contrast between the spirit and the provisions of such an Act, and that passed a century later, under the auspices of Lord Shaftesbury, brings into strong relief the solid advance which has been made in a century, in the face of constant opposition from interested persons, as well as that which arises out of the mere apathy and lethargy of a large class of the community.

It should be added, in justice to the framers of the Act of 1744, that it refers to those who "are so far disordered in their senses that they may be too dangerous to be permitted to go abroad." It is rather for the protection of society than the care of the lunatic.

A Committee of the House of Commons was appointed in 1763, to inquire into the state of the private mad-houses of the kingdom. On this Committee sat Pitt and Fox,[102] Wilkes, Lord North, Mr. Grenville, and Mr. T. Townshend—names which alone serve to secure one's interest, and also to raise the expectation that something would be done. Their Report, while evidently drawn up in a cautious manner, shows, as had been insisted upon by Daniel Defoe, with what alarming facility the liberty of the subject could be taken away on the plea of insanity, and how frequently persons availed themselves of this facility in order to get rid of a troublesome wife or daughter, or to obtain some selfish object equally improper. Dr. Battie[103] gave it as his opinion that sane persons were frequently confined in asylums, and mentioned a case in which a gentleman, who had had his wife immured in one, justified himself by saying that he understood the house to be a sort of Bridewell, or place of correction. The same witness found one patient in an asylum, who had been there for years, chained to his bed, without ever having had the assistance of any physician before. He never heard anything more of him, until he was told some time after that he had died of fever, without having had further medical advice.

The Committee resolved, "That it is the opinion of this Committee that the present state of the private mad-houses in this Kingdom requires the interposition of the legislature."

The Resolution was agreed to by the House, and leave was given to bring in a Bill for the Regulation of Private Mad-houses, its preparation being left to Mr. Townshend and six other members of the House.

Unfortunately, no legislation followed the Report of this Committee; in fact, no further action was taken for ten long years.

Two years after this Committee sat, a melancholy picture of the condition of private asylums in England is given in the Gentleman's Magazine, and we can well believe that it was not over-coloured when we consider the evidence which had been given before the Committee.

The writer asserts that persons may be and are taken forcibly to these houses without any authority, instantly seized by a set of inhuman ruffians trained up to this barbarous profession, stripped naked, and conveyed to a dark room. If the patient complains, the attendant brutishly orders him not to rave, calls for assistants, and ties him down to a bed, from which he is not released till he submits to their pleasure. Next morning a doctor is gravely introduced, who, taking the report of the keeper, pronounces the unfortunate person a lunatic, and declares he must be reduced by physic. He is deprived of all communication with the outer world, and denied the use of pen and paper. Such usage, the writer goes on to say, without a formal warrant, is too much even for the Inquisition in Spain or Portugal, and cries aloud for redress in a land of liberty. One circumstance brought forcibly out is similar to that which, occurring at York some years afterwards (1791), led, as we shall see, to the foundation of an institution in which a directly opposite course was pursued. "Patients," he says, "often cannot be found out, because the master lets them bear some fictitious names in the house; and if fortunately discovered by a friend, the master, or his servants, will endeavour to elude his search and defeat his humane intentions by saying they have strict orders to permit no person to see the patient."

At an earlier period a lady was sent by her husband to a private asylum simply because she was extravagant and dissipated. The account of this affair is in manuscript, dated 1746, but the substance of it is given by a gentleman in Notes and Queries, May 5, 1866. Two or three girls were placed in the same house, in order to break off love affairs disapproved by their friends.

Again, I observe the following entry in the Gentleman's Magazine under date Sunday, August 6, 1769:—"A gentleman near Whitehall, by the assistance of four ruffians, forced his lady into a hackney coach, and ordered the coachman to drive to a private mad-house, and there to be confined."

The Gentleman's Magazine writer's remedy for "a condition compared with which none is so deeply calamitous; no distress so truly miserable; no object so deserving of compassion, and none so worthy of redress," was a really effective Bill for the regulation of private mad-houses.

At last, in 1773, a Bill passed the Commons for the "Regulation of Private Mad-houses," the Report of 1763 having been first read. But again disappointment awaited this honest attempt to protect the insane and those alleged to be insane. The Bill was thrown out, as too many good Bills have been thrown out, by the House of Lords. One is reminded of the saying of Daniel O'Connell, "If it took twenty years to do nothing, how long would it take to do anything?" In the House of Commons, Mr. Townshend said in the debate that facts had come to his knowledge which would awaken the compassion of the most callous heart. Mr. Mackworth said that the scenes of distress lay hid indeed in obscure corners, but he was convinced that if gentlemen were once to see them, they would not rest a day until a Bill for their relief was passed, and protested that he would mind neither time nor trouble, but employ every hour until some relief should be obtained. He asserted, as also did Mr. Townshend, that it was the "gentlemen of the long robe" who prevented any action being taken. Be this as it may, the Bill, as I have said, was thrown out, while another,[104] which proved almost a dead letter, was passed in the following year. It was required by this Act that licences should be granted "to all persons who shall desire the same." Reports of abuses were to be made to the College of Physicians, to be suspended in the College for perusal "by whosoever should apply for that purpose;" but the College had no power to punish delinquents. This Act is characterized by the Commissioners in Lunacy as "utterly useless in regard to private patients, though in terms directing visitations to be made to lunatics," and as they observe, its provisions "did not even apply to the lunatic poor, who were sent to asylums without any authority except that of their parish officers." Its scope did not extend beyond private mad-houses. For admission into these an order and medical certificate were necessary. They were sent to the secretary of the Commissioners, that is, five Fellows of the College appointed in accordance with the Act. They did not license or inspect the provincial private asylums, but these were directed to send copies of the order and certificate to the Fellows.

It is not surprising, perhaps, that nothing was done all these years, considering how many questions engrossed the public mind. These comprised the exciting debates and the popular tumults connected with Wilkes and Horne Tooke, the heated discussions on the question of the freedom of reporting debates in Parliament, and the "Royal Marriage Bill." Lord Clive and Warren Hastings were engaged in deeds in India which were about to bring down upon them the philippics of Burke and Sir Philip Francis—much more attractive than the carrying of a Lunatic Bill through Parliament. And, above all, the struggle had commenced, though blood had not been spilt, between this country and her American colonies. Then again, there was the distraction caused by the remarkable mental affection of the Earl of Chatham, on which it will be fitting, and I think interesting, to dwell for a moment. He had become Prime Minister in 1766, and the following year was attacked by his remorseless enemy, the gout. Partially recovered, he returned to Parliament—so partially, indeed, that he was "scarce able to move hand or foot." Engaged in making certain changes in the ministry, he began (to employ the descriptive language of Trevelyan[105]) "to be afflicted by a strange and mysterious malady. His nerves failed him. He became wholly unequal to the transaction of any public affairs, and secluding himself in his own house, he would admit no visitors and open no papers on business. In vain did his most trusted colleagues sue to him for one hour's conversation. As the spring advanced, he retired to a house at Hampstead, and was able at intervals to take the air upon the heath, but was still at all times inaccessible to all his friends." His brother-in-law, Mr. Grenville, wrote:[106] "Lord Chatham's state of health is certainly the lowest dejection and debility that mind or body can be in. He sits all the day leaning on his hands, which he supports on the table; does not permit any person to remain in the room; knocks when he wants anything; and, having made his wants known, gives a signal without speaking to the person who answered his call to retire."

"Other accounts of a rather later period," says Lord Mahon, "state that the very few who ever had access to him found him sedate and calm, and almost cheerful, until any mention was made of politics, when he started, trembled violently from head to foot, and abruptly broke off the conversation. During many months there is no trace in his correspondence of any letter from him, beyond a few lines at rare intervals and on pressing occasions, which he dictated to his wife. Even his own small affairs grew a burden too heavy for his enfeebled mind to bear. He desired Mr. Nuthall, as his legal adviser, to make ready for his signature a general power of attorney, drawn up in the fullest terms, and enabling Lady Chatham to transact all business for him (Chatham Correspondence, vol. iii. p. 282, August 17, 1767). At the close of the summer he was removed from Hampstead to Burton Pynsent, and thence to Bath, some benefit to his health being looked for from the change. But all his own thoughts and wishes at this time were centred in the purchase of Hayes. In that air he had enjoyed good health; in that air he might enjoy it again. There, in former years, he had made improvements which his memory fondly recalled—plantations, for example, pursued with so much ardour and eagerness that they were not even interrupted at nightfall, but were continued by torchlight and with relays of labourers. To Hayes, again become his property, Lord Chatham was removed in December, 1767. But there, during many months ensuing, he continued to languish in utter seclusion, and with no improvement to his health.

"It is scarcely to be wondered at that a malady thus mysterious and thus long protracted should have given rise to a suspicion in some quarters that it was feigned or simulated, with a view to escape the vexations or avoid the responsibilities of office. This idea, however natural, was certainly quite unfounded. But, on the other hand, we may not less decisively discard the allegation of gout.... In truth, it was not gout, but the absence of gout, which at this period weighed upon Lord Chatham. On the 2nd of March he had arrived in London from Marlborough, still lame, and no more than half recovered. There his new physician, Dr. Addington, eager, no doubt, to restore him to his public duties with the least delay, had rashly administered some strong remedies, which did indeed dispel the gout from his limbs, but only to scatter it about his body, and especially upon his nerves. This fact was discovered, and has been recorded by two separate and equally shrewd observers at the time (Lord Chesterfield to his son, December 19, 1767; Lord Orford, 'Memoirs,' ii. p. 451[107]). Hence arose the dismal and complete eclipse which for upwards of a year his mental powers suffered. There was no morbid illusion of the fancy, but there was utter prostration of the intellect.... In September, 1767, Junius spoke of Lord Chatham as 'a lunatic brandishing a crutch.'"[108]

"In the autumn Lord Chatham's health grew stronger. Judging from the event, we may conclude that the morbid humours had begun to leave his nerves, and to concentrate for a fit—so long intermitted and so much needed—of his hereditary gout. He was still entirely shut out from his friends, and still unable to transact any business, but he could bear to hear it mentioned, and could form some judgment of its tenor. In this situation his mind, not yet restored to its full vigour, brooded over suspicions and discontents, for which the behaviour of his colleagues afforded him no just foundation."[109]

Lord Chatham now resigned the Privy Seal (October, 1768), which he had held since July, 1766. "Until towards the middle of March, 1767, he had been truly and in effect Prime Minister; since that time he had been—nothing."

Lord Chatham's derangement was, however, at last dispelled. We find that "a few weeks only after Lord Chatham's resignation, his gout, so long interrupted, but for some time past giving symptoms of approach, returned. Bowed down as he was by a far more grievous malady, it proved to him a healing visitation. It raised his drooping spirits and strung his feeble nerves. The clouds which had obscured that great intellect wholly passed away. Never indeed did his splendid eloquence or his wise and resolute counsels shine forth more brightly than during the next following years."

It was in the year 1775 (November 29) that, on the American war question, Lord Chatham emerged from his retirement—a year after the Lunacy Act had passed.

Thirteen years later, his Sovereign fell a victim to the same disorder, and it is probable that the attention thus drawn to the malady exerted a beneficial influence upon public feeling, in the interests of those labouring under the same affliction. The clerical and medical doctor, Willis, who was at that time seventy years of age, was called in to attend George III. in 1788. The King had had, as early as 1765, a slight attack, but the fact was carefully concealed. Willis's treatment consisted in bark, blistering, and an occasional dose of calomel.[110] It is not necessary to enter here into the differences of opinion which arose as to the conduct of the case, between himself and his colleagues, Warren, Reynolds, and others. In February, 1789, the royal patient had progressed so favourably that he was able to write a sensible letter to Pitt, and on April 23rd of the same year he went to St. Paul's to offer thanks for his recovery, amid a vast and enthusiastic multitude, thereby running a great risk of a relapse. However, he had no return of the complaint till 1801, when he recovered rapidly. In 1804 he again became insane, and again recovered, the death of the Princess Amelia in 1810 causing the attack from which he never recovered. The subject of insanity was therefore brought before the public again and again, for some thirty years—longer, indeed, if we include Lord Chatham's derangement—and brought before them in a way which excited their commiseration in a marked degree.

It is worthy of notice that mechanical restraint was applied by Willis to the King. "Nothing," observes the late Dr. Ray, "can more strikingly indicate the change that has occurred since that time in respect to the means of managing the insane, than the fact that for two or three months the King was frequently subjected to mechanical restraint. There was nothing in his condition which could be considered at the present time a sufficient reason for its application."[111]

It may be observed here that John Wesley prescribed at this period for madness, as well as for irreligion.[112] One of his remedies was that the patient should be exclusively fed on apples for a month—a regimen which recalls the starving treatment of epilepsy prescribed, at a recent date, by Dr. Jackson, of Boston. Wesley's prescriptions for "lunacy" and "raving madness" are given with almost as much confidence of success as those we have cited from the Saxon leech-book.