By A. M. SHEW, M. D., 
Superintendent Connecticut Hospital for the Insane. 
[From the American Journal of Insanity, for April, 1879.] MECHANICAL RESTRAINT.* 
BY A. M. SHEW, M. D., 
Superintendent Connecticut Hospital for the Insane. 
I believe I am correct in saying that the chief aim 
and study of Medical Superintendents during the past 
quarter of a century has been to reduce to the mini- 
mum the amount of restraint required in asylums, 
and to substitute labor, exercise and amusement in its 
stead. It is absurd to assert that all restraint is un- 
necessary and must be abolished. If it were a fact, 
where would be the necessity for building hospitals? 
Should not the patients be at home and at liberty ? 
An experience of fifteen (15) years in the care of 
more than three thousand (3,000) insane persons, to- 
gether with considerable observation in this and foreign 
countries, and a careful study of the literature relating 
to the insane, convinces me that one of the most efficient 
elements in the treatment and restoration of insane per- 
sons may be found in the regularity of hospital life, 
and the moral restraint therein exercised. Nearly all 
deranged persons lack will force to balance, correct and 
control perverted mental action. Unless their abnor- 
mal thoughts are directed and corrected, morbid habits 
of thought will become fixed and permanent. No one 
doubts the efficacy of properly directing the growth 
and development of the mental faculties in healthy 
childhood; of exercising suitable control over wayward 
youth; and but few will question the wisdom of similar 
supervision over those who, from disease, are unable to- 
reason correctly and act properly. Admitting then, 
that removal from home influences and the substitution 
* Remarks extracted from the Thirteenth Report of the Connecticut Hos- 
pital for the Insane. 2 
of properly directed control at a hospital, is advan- 
tageous and necessary m a majority of cases, (not all), 
let us for a moment inquire how far this supervision 
can be confined to purely moral means. In other words 
is it ever necessary to resort to mechanical restraints in 
the treatment of the insane ? 
This is one of those questions which can not be 
answered by a simple affirmative or negative. A few 
years ago, (not now), the English alienist would ufi- 
hesitatingly have answered, mechanical methods of 
control are unnecessary. At the same date the Ameri- 
can alienist conscientiously believed that some forms of 
mechanical protection were absolutely required in hos- 
pital practice. 
Paradoxical as it may seem, both of these positions 
were untenable. Here, as in other debatable questions, 
the extremes were not correct. Experience has shown, 
on the one hand, that asylums can be conducted with- 
out mechanical appliances; and, on the other, that there 
are some insane patients wdio are more humanely re- 
strained, who make quicker and better recoveries, at 
less expense and trouble, when controlled by mild 
mechanical appliances, than when subjected to the 
seclusion of padded* rooms or personal holding by at- 
tendants, under the so-called “Non-Restraint” system 
introduced by Hill or Connolly into the English asy- 
lums. The result has been a modification of views on 
both sides, and the thoughtful, conscientious alienist of 
to-dav exercises a more healthy supervision over his 
patient by following neither the one extreme or the 
other, but a happy mean. It is a fact easily .substan- 
tiated by statistics, that during the past ten (10) years 
American superintendents have steadily lessened the 
amount of mechanical restraint in hospital use, until 
now ninety (90) of every one hundred (100) patients 3 
sent to the hospitals return to their homes restored, or re- 
main at the institution in a condition of chronic insanity, 
without having been subjected to any form of mechani- 
cal restraint. It is only used in extreme cases of acute 
disease, where repose in bed is considered indispensable, 
or for protection in well pronounced homicidal or sui- 
cidal patients. Some American alienists conduct their 
institutions without even making use of any appliance 
other than careful watching and medicinal agencies. 
Dr. H. P. Stearns, in his report of the Hartford Retreat 
for the year 1877, on page 27 uses the following 
language :—■“ They (waistcoats, wristlet, camisoles, man- 
acles, muffs, etc.), are eminently unscientific, and should 
be dispensed with as far as possible. It has been my 
aim to carefully and earnestly study each case coming 
under my observation with this in view, and I am 
happy to be able to report that we have succeeded in 
passing the year without the use of any of these means 
of mechanical restraint.” 
In my recent brief visit to European institutions I 
saw in use the same mechanical appliances that are 
found in American hospitals, viz.: camisole waists, 
leather wristbands and “ protection beds;” and in one 
asylum the shower-bath—a form of “ mechanical medi- 
cation ” which I have not found in any American asy- 
lum—was in daily use, with good results, according to 
the testimony of the assistant physician. With one 
exception, the medical officers in charge of British asy- 
lums conversed with me freely respecting the moderate 
use of mechanical protection in preference to personal 
seclusion, or manual restraint by attendants. The im- 
pression gained by these interviews and personal in- 
spection of institutions, confirmed the statement already 
made, viz.: that during the past few years a strong and 
general reaction in favor of the moderate use of 4 
mechanical protection in the treatment of the insane 
had taken place. This is conclusively shown in the 
published statements of leading foreign alienists. Thus 
Dr. Blandford, in his excellent manual for students, 
says:—“ At the suggestion of the Commissioners in 
Lunacy, I have employed mechanical restraint.” A 
leading article in the Medical Times, on “The Insane 
and their Management,” referring to acute maniacs, 
insane epileptics, and general paralytics, declares “re- 
straint in some form or other is necessary.” Among 
other well-known names of those who of the 
use, in certain exceptional cases, of some simple form of 
mechanical restraint, may be mentioned Dr. W. A. F. 
Browne, the late Dr. Forbes Winslow, Dr. Murray 
Lindsay and Dr. Ashe, of Dublin. 
In an article on “The Theory and Practice of Non- 
Restraint in the Treatment of the Insane,” published in 
the Edinburgh Medical Journal, April and June, 1878, 
Dr. W. Lauder Lindsay, Superintendent of the Murray 
Royal Institution, at Perth, says:—“Among the general 
results of my own observation, correspondence and 
reading are these: The use of mechanical restraint is 
advocated by at least ninety (90) per cent of physi- 
cians engaged in lunacy practice throughout the world. 
Mechanical restraint forms an occasional feature of 
treatment in those asylums which have the noblest 
history and the highest reputation. In other words, it 
constitutes an essential feature in the most modern, 
most enlightened, most humane treatment of the insane.” 
I have asked your indulgence in making the fore- 
going remarks respecting restraint, because I believe 
the public have been misled by some recent American 
writers and teachers, who have apparently endeavored 
to compliment the foreign, especially the English asy- 
lums, at the expense of our own institutions. After 5 
many years’ experience in the one, and no inconsider- 
able freedom in visiting the other, I would remark:— 
1st. That the foreign institutions are more substan- 
tially constructed than our own; or, in other words, 
that the buildings cost more. This is seen in the stone 
floors, and fire-proof stairways, and thick walls, and 
turreted roofs. 
2d. The foreign asylums are not so well furnished 
as tlie American, and there is less of the liome-like, 
comfortable appearance which many of our institutions 
have. 
3d. Less attention is paid to beating and ventila- 
tion. Many of the English asylums have simply old- 
fashioned fire-places, protected by iron cages; and one 
superintendent told me frankly that he knew nothing 
about ventilation or its principles—“ that belonged to 
the engineer.” 
4th. The same forms of mechanical restraint are in 
use in both countries. The only difference seems to be 
that in England they “ abolish the name but retain the 
thins:—restraint—while here we retain the name, but 
virtually abolish the thing.” In confirmation of this 
statement, I would simply mention the fact that at 
Hanwell, near London, the scene of Connolly’s labors, I 
saw more in the way of “ bolts and bars,” u coercion and 
confinement,” in one day, than can be found in this 
institution in any ten days. And the babel of noise 
and confusion in one of the male wards exceeded any- 
thing in my previous experience. From the moment 
I had passed the well-guarded lodge, by permission of 
the uniformed gate-keeper, through the locked front 
door, had waited twenty minutes in the large, uncar- 
peted and sparsely furnished visitors’ room, until a 
uniformed turnkey was ready to accompany me through 6 
the wards, halls, kitchen and store-rooms, an uncom- 
fortable feeling of restraint and utter helplessness took 
possession of me, and remained with me until I was 
once more outside the high walls. It was the same 
sort of feeling that one experiences in visiting a penal 
institution. Yet this was Hanwell, the scene of Con- 
nolly’s life-work; an institution which has been held 
up as a model to be copied, and about which so much 
has been written. 
Perhaps I have said enough to indicate that I am an 
advocate of the moderate use of mechanical protection 
in the treatment of the insane, or, in other words, to 
employ or apply what I consider the “ best thing for 
a given patient under given circumstances,” without 
reference to the creeds of other people. Each case is 
studied individually. It would be unwise to restrain 
nineteen (19) of every twenty (20) patients, because 
they do not require it. It would be equally unwise 
not to restrain the twentieth, who is destructive, dan- 
gerous and turbulent. Safety and moral discipline 
require it no less than the general good of the large 
majority who are quiet and orderly. 
This properly brings me to speak of the results 
attained in this institution. * By our system of daily 
reports we are able to record the exact number of hours 
or days and the form of restraint to which any patient 
is subjected, and the reason for it. From these tabu- 
lated reports it appears that only thirty-two (32) out 
of three hundred and thirty-five (335) males were sub- 
jected to any form of seclusion or restraint, and the 
whole time amounted to only five hundred and ninety- 
six and one-fourth (5961-4) days, or to express it in 
another way would be to state that one man was 
restrained all the year, and another seven (7) months 
and twenty-one (21) days. This is the sum total of 7 
restraint among men with a daily average present of 
236.11. 
In my last animal report I stated that insane women, 
from habit and inclination, take less out-door exercise, 
are by nature more “ nervous,” and consequently require 
more attention and restraint than men. Among the 
chronic insane there seems to be also a greater pro- 
pensity to destroy clothing and to expose the person. 
Hence our tables show that more individuals of this 
sex were restrained or in seclusion; and the whole time 
amounted to eighteen hundred and eighty-six (1,886) 
days. Using the same form of statement as above, it 
appears that five women were secluded or in restraint 
all the year, and one other for two months and one day, 
with a daily average of 238.06. 
Among the most common causes for its application I 
would mention extreme mischievousness, determination 
to disrobe, repeated attempts at homicide, repeated 
attempts at suicide, maniacal excitement, masturbation, 
and destruction of clothing. One male patient was 
slowly but surely wasting his enfeebled frame by per- 
sistently standing. Here we found a covered bed, or 
as it lias been unjustly called, “the Utica Crib,” of not 
only practical service, but a real necessity. In this 
covered bed the patient could be comfortably kept in a 
horizontal position on a soft mattress, entirely free 
from other restraint.” THE 
AMERICAN JOURNAL OF INSANITY. 
The American Journal of Insanity is published quarterly, at the 
State Lunatic Asylum, Utica, N. Y. The first number of each volume 
is issued in July. 
Editor, 
JOHN P. GRAY, M. D., LL. I)., Medical Superintendent. 
Associate Editors, 
JUDSON B. ANDREWS, M. D., 
EDWARD N. BRUSH, M. I)., 
WILLIAM HAILES, M. D., 
S. A. RUSSELL, M. D., 
Mss is tan t Physic urns. 
THEODORE DEECKE, Special Pathologist. 
TERMS OF SUBSCRIPTION, 
Five Dollars per Annum, in Advance. 
Exchanges, Books for Review, and Business Communications 
may be sent to the Editor, directed as follows: “Journal of 
Insanity, State Lunatic Asylum, Utica. N. Y.” 
The Journal is now at the close of its thirty-fifth volume. It was es- 
tablished by the late Dr. Brigham, the first Superintendent of the New 
York State Lunatic Asylum, and after his death edited by Dr. T. Ro- 
meyn Beck, author of “ Beck’s Medical J urisprudenceand since 1854, 
by Dr. John P. Gray, and the Medical Staff of the Asylum. It is the 
oldest journal devoted especially to Insanity, its Treatment, Juris- 
prudence, &c., and is particularly valuable to the medical and legal 
professions, and to all interested in the subject of Insanity and Psy- 
chological Science