Mechanical Restraint in English Asylums. 
By W. LAUDER LINDSAY^. D., F. R. S. E., 
Physician to the Perth Royal Asylum, (Scotland). 
-oXKo* 
[From the American Journal of Insanity, for April, 1879.] MECHANICAL RESTRAINT IN ENGLISH 
ASYLUMS. 
BY W. LAUDER LINDSAY, M. D., F. R. S. E., 
Physician to the Perth Royal Asylum, (Scotland). 
" Nullius in verba magistri." 
I would follow up what I have already said on 
the subject of Restraint and Non-Restraint in the treat- 
ment of the insane,* by setting forth somewhat in 
detail: 
I. The actual extent to which, and manner in which, 
mechanical restraint is at present used in the public 
ami private asylums of England-that country which 
never ceases boasting of its model management of the 
insane and of hospitals for the insane. 
II. When, in this hot-bed and headquarters of Con- 
ollyism, mechanical restraint is not employed, what are 
its substitutes, and what are the effects of the use of 
these substitutes. 
HI. And what generally are the results of the non- 
use in English asylums of mechanical restraint in cases 
in which the majority of experts throughout the world 
would deem it necessary. 
In the first place I shall address myself to the ques- 
tions, whether, to what extent, and in what forms, 
mechanical restraint is actually View employed in Eng- 
lish asylums notwithstanding all the assertions of Con- 
olly's admirers to the contrary. 
* Vide: I. " The Protection Bed and its Use,'' American Journal of Insan- 
ity, April, 1878, from the Edinburgh Medical Journal, February, 1878. 
II. "The Theory and Practice of Non-Restraint in the Treatment of 
the Insane," American Journal of Insanity October, 1878, from the 
Edinburgh Medical Journal, April and June, 1878. 2 
It so happens that an important official utterance has 
recently been made on the subject-the alleged non-use 
of mechanical restraint in English asylums. The 
British government, with that morbid concern for the 
" liberty of the subjects," which so distinguishes it, 
thought fit, in 1877, to appoint a select committee to 
"inquire into the operations of the lunacy law so far as 
regards the security offered by it against violations of 
personal liberty." In July, of that year, the said com- 
mittee, having meanwhile taken evidence, de omnibus 
rebus et quibusdam aliis^ presented to Parliament a 
voluminous "report" of 587 pages folio, containing inter 
alia certain "minutes of evidence." These minutes of 
evidence give the opinions of all the leading authori- 
ties on "Lunacy Law" in the three kingdoms. But of 
those authorities the opinions and assertions of none 
carry with them anything approaching the weight of 
those of the veteran nobleman, who has so long pre- 
sided over the English Board of Lunacy, viz.: The 
Kight Honorable the Earl of Shaftesbury. 
Of Lord Shaftesbury a contemporary English critic 
on " Lunacy Law Reform,"* speaks as " the great chief, 
to whose opinions no government can refuse deference.'* 
His is a "name illustrious on the roll of benefactors of 
the race of man," we are told. "It is scarcely possible 
to discuss any question in lunacy without reference, 
tacit or expressed, to the actions and opinions of the 
Earl of Shaftesbury. Before the actions of such a man, 
while still among us, criticism must be dumb, lest a 
temperate account may sound like adulation." Before 
a previous Parliamentary Committee (in 1859), he gave 
his evidence "with uncommon courage, knowledge and 
perspicuity." 
* In the British Medical Journal for April, 1879, pp. 566 and 601. 3 
A Scotch critic on the same subject-Lunacy Law 
Reform in England-also refers to that " veteran and ex- 
perienced philanthropist, the Right Honorable the 
Earl of Shaftesbury, who for twenty-five years has acted 
as chairman of the English Lunacy Board, and for 
nearly half a century, has been practically at the head 
of all English lunacy legislation."* 
It is not surprising then that his lordship's state- 
ments on lunacy questions attract an attention and carry 
a weight, which they may not intrinsically deserve. 
Now the Parliamentary Committee of 1877 were 
naturally curious concerning the burning question of 
restraint or non-restraint, and they accordingly made 
certain inquries thereon of the Noble Earl. His 
answers (which are printed on page 543 of the com- 
mittee's report,f which, by the way, is a perfectly public 
or state document), contains the following intelligence, 
purporting to be partly matter-of-fact and partly mat- 
ter-of-opinion, both in reply to query No. 11,335. The 
fact he alleges is this: "Mechanical restraint has been 
abolished in every asylum in the country; and see how 
well we go on?" The opinion which precedes the 
alleged fact is this: " If wTe ever go back to any portion 
of it, it will become universal, and matters will be 
worse^ than they were before." 
Let us leave the value of this opinion and of other 
opinions of the Noble Lord bearing on the same subject, 
until we have guaged the value of the fact, as he states 
it-that mechanical restraint in the asylums of Eng- 
* Dundee Advertiser, September 24,1878. 
f This report is generally known as the Dillwyn Report, or the report of 
the Dillwyn Committee, from the name of one of the leading members of the 
said committee. A great defect in such a report is the want of a full analyt- 
ical index, such as that given by the late Sir James Coxe, in the Scottish 
Lunacy Commission Report of 1856. 
j The italics in this and similar cases are, of course, mine. 4 
land is a thing of the past. If the fact be as stated by 
him, the annual Blue Books of the English Lunacy 
Board, which are regularly signed by "Shaftesbury, 
chairman," ought to be a tabula rasa so far as concerns 
any record of mechanical restraint in English asylums- 
those patterns of superhuman excellence. 
But confining myself to one of these Blue Books- 
the last or thirty-second which bears date August, 1878, 
and which therefore records the incidents in English asy- 
lums of 1877, I find no less than one hundred and 
twenty-three cases* of mechanical restraint reported as 
having occurred in a single year, in a limited number 
of the public asylums of England, under circumstances, 
that is, in which such restraint was least likely to be 
used. For it is not in the public asylums so much 
visited by lunacy commissioners that we look for a de- 
velopment of mechanical restraint, but among the in- 
sane who are not treated in asylums at all.f The 
details, however, concerning the one hundred and 
twenty-three cases of mechanical restraint in English 
asylums reported by "Shaftesbury, chairman," himself,J 
as having occurred in 1877 are of sufficient interest to 
merit tabulation and comment. 
Table I. Showing the names and number of public 
asylums in which mechanical restraint was employed 
in 1877. 
* The number of cases, however, is not always specified by the registers, 
so that the numbers here given must be considerably short of the actual 
number. 
f Of the 68,538 " registered patients " to whom the thirty-second Blue Book 
of the English commissioners refers, only 37,763 were in " county and borough 
asylums." 
J He and "all whom it may concern " will find the details given in the fol- 
lowing pages of the thirty-second Annual Report of the English Lunacy Board : 
141,151,153,155. 160,165,171,179,186,199,207,214, 225,235,238,258,261,265, 
271, 274, 276, 279, 283, 287, 290, 295, 298, 299, 333, 335, 338, 342, 354, 355 and 
365. 5 
I. County Asylums: 
1. Berks. 2. Cheshire, Macclesfield. 3. Cornwall. 4. Cum- 
berland. 5. Derby. 6. Dorset. 7. Essex. 8. Hants. 9. Kent, 
Banning Heath. 10. Lancashire, Whittingham. 11. Middlesex, 
Colney Hatch. 12. Middlesex, Banstead.* 13. Northumberland. 
14. Shropshire. 15. Somerset. 16. Sussex. 17. Warwick. 18. 
Wilts. 19. York, North Riding. 20. York, West Riding, Wake- 
field. 21. York, West Riding, Wadsley. 22. York, East Riding. 
II. Borough asylums, registered hospitals and state 
asylums. 
23. Birmingham. 24. Hull. 25. Ipswich. 26. City of London. 
27. Newcastle-upon-Tyne. 28. Norwich, Infirmary Asylum. 29. 
Norwich, Bethel Hospital. 30. Earlswood, (for Idiots.) 31. Yar- 
mouth, (for sailors.) 32. Royal India Asylum, (for soldiers.) 33. 
Leavesden, (for adult imbeciles.) 
Table II. Showing the assigned reasons for the ap- 
plication of mechanical restraint. 
1. "To prevent her picking her face during an attack of 
erysipelas." 
2. "To prevent self-injury whilst suffering from erysipelas." 
3. "At night to prevent the constant attempts at self-injury." 
4. " To prevent his carrying out persistent efforts to tear open 
the sutures of the wound in a case of cut-throat." 
5. "Exceptionally violent, homicidal, and suicidal tendencies. 
He made a most desperate attempt to kill himself by beating his 
head against the wall." By no means an uncommon occurrence in 
" non-restraint " asylums where grevious wailing is made over the 
so-called " accidents " that every now and again happen under the 
supposed benevolent " system " of treatment. 
6. "Necessitated"-say the commissioners themselves-"by 
her violent and determined suicidal impulse." 
7. " To prevent him from putting his fingers down his throat 
to cause vomiting." 
* Probably it is the influence of Conollyism and of tradition that leads to 
such a marked diversity in practice between the public asylums of the same 
county, Hanwell being still conspicuous for its non-use of mechanical re- 
straint. 6 
8. " To prevent self-mutilation." 
9. " To prevent self-injury." 
10. " To prevent her picking her face." 
11. " To prevent picking her head." 
12. "Murderous propensities." 
13. " Suicidal impulses of a very dangerous description." 
14. "For controlling maniacal excitement." 
15. " Violence." 
16. " Destructiveness." 
17. " Destructive habits." 
18. "To control destructive habits." 
19. " To prevent removal of dressings and bandages." 
20. "Fractured her thigh in a fall." 
21. "Strong and troublesome." 
Table III. Showing the forms of mechanical re- 
straint employed. 
1. " Strait-waistcoat." 
2. " Camisole."* 
3. " Polka with sleeves attached." 
4. " Hands fastened to the sides of the bed by cotton bands." 
5. " Kept in her chaii' by means of a strap passed loosely 
round her waist." 
6. " Hands loosely tied down by flannel bandages whilst in 
bed." 
7. "Hands loosely fastened." 
8. "Hands secured by means of the sleeves of a strong dress 
being sewed up below them and secured either behind her back or 
to her side." 
9. " Sleeves." 
10. "Fastened in bed " at night. 
11. " Packing in wet sheets." 
12. " Dry packing. 
13. " Soft gloves." 
14. " Gloves." 
15. " Hands tied." 
16. " Arms confined." 
* Moreover the Camisole would appear to be, or to have recently been (in 
1876), placed at the command of the ordinary attendants in some of the 
highest-class asylums in England for the affluent insane, e. g., the Manor 
House, (London), and Coton Hill, (Stafford; 30th Report of Commissioners, 
p. 295, and 31st, p. 108. 7 
Table IV. Showing the duration of the application 
of mechanical restraint. 
1. Forty-seven weeks. 2. One hundred and three days. 3. Five 
and one-half weeks. 4. Eighteen days. 5. Thirty-eight hours. 
6. One day. 7. Ten hours. 8. " Through the night." 
Table V. Showing the number of cases of mechani- 
cal restraint in each asylum. 
1. In one asylum, sixteen cases-that is instances of its applica- 
tion in some of the forms mentioned in Table III. 2. In one asylum, 
thirteen cases. 3. In one asylum, ten cases. 4. In three asylums, 
seven cases. 5. In nine asylums, four cases. 6. In three asylums, 
three cases. 7. In five asylums, two cases. 8. In eight asylums, 
one case. 
Table VI. Showing the general reputation or char- 
acter of the asylums in which, or the physicians by 
whom, mechanical restraint is employed. 
1. Whittingham: "We have great pleasure in thus recording 
our opinion* of these proofs of the continued energy and ability 
of the medical superintendent in promoting the best interests of 
the Institution, and the welfare of its inmates." 
2. Wakefield: "We have much pleasure in recording our 
opinion that this important Asylum continues to maintain its high 
position, and that it is managed with great efficiency and ability." 
3. Sussex: "We have much pleasure * * * in 
reporting that the condition of the Asylum and the manner in 
which the patients appear to be treated reflect great credit on the 
committee of visitors and the medical superintendence." 
4. Derby: "We are glad to be able to report very favorably 
of the condition of the asylum and of the skill and energy dis- 
played in its management." 
5. Essex: "We are glad to have this opportunity of again 
expressing a very favorable opinion as to the management of 
* The English Lunacy Commissioners make their official visits in couples, 
one of the two being a physician and the other a barrister. Hence "our 
opinion represents a conjoined medical and legal one, that of both a medical 
and legal lunacy commissioner." 8 
this Asylum, and of the kindness* with which the patients are 
treated." 
6. Hants: A similar testimony is given. 
7. Royal India Asylum: " The condition of this asylum, 
continues to reflect great credit upon the management of Dr. 
Christie." 
8. Yarmouth: "We have the pleasure of repeating the opin- 
ion expressed on many former occasions that this hospital is 
managed with ability, and the good treatment and comfort of its 
inmates are well provided for." 
9. Earlswood : "We have much pleasure in reporting that the 
good organization is everywhere maintained, and that the condi- 
tion and management of the Institution are most creditable to the 
authorities." 
10. Northampton: Too, "continues to be managed with the 
same ability and zeal for the welfare of the inmates, which we 
have been able to report on former occasions." 
11. Bethel Hospital: " We have again the pleasure of express- 
ing our opinion of the kindness with which these patients are 
treated, and of the zeal which is shown for their welfare." 
12. Macclesfield: "We entertain a favorable opinion of the con- 
dition of this Asylum." 
13. Berks: Is " managed with skill and success." 
14. Cornwall: Its condition is ascribed "to the careful and 
intelligent management of Dr. Adams." 
This last table effectually disposes of the equally 
uncharitable and ridiculous assertions, made by Dr. 
Conolly and Lord Shaftesbury, or their admirers, as to 
the necessary connection between the use of mechan- 
ical restraint, and the reign of harshness or cruelty. 
For here w'e have the Lunacy Commissioners, them- 
selves, impregnated as they have been with Conollyism 
for the last twenty-five years at least, proving officially 
that various forms of mechanical restraint are employed 
at the present day, in those English asylums that bear 
the highest reputation at Whitehall, by those physi- 
* I venture to call special attention to this word kindness in reference to 
the vaticinations of its opposite cruelty, so freely ascribed by Conolly or his 
satellites to all employers of mechanical restraint in whatever form or degree. 9 
cians, who are by habit and repute, distinguished for 
their humane^ as well as successful management.* 
In short an analysis of such a Blue Book of the Eng- 
lish Lunacy Commissioiiers,f directed to the discovery 
of the extent to which mechanical restraint really pre- 
vails in the treatment of the insane in England, should, 
once for all, explode the absurdities and tyrannies of 
Conollyism, by demonstrating that the most humane 
and experienced physicians in England consider the 
most humane treatment of the insane, in certain ex- 
ceptional conditions, to be mechanical restraint. 
In the face of such facts as are to be found embodied 
in such a British Government Blue Book, the continued 
assertion that the non-use of mechanical restraint is an 
essential feature in the modern " system " of treatment 
of the insane in England, which system is spoken of as 
the " non-restraint system," is worse than an absurdity; 
it is a mischievous perversion of facts-a deliberate 
misstatement of truth. But the statistics above quoted 
are very far from representing the extent to which 
mechanical restraint, in some of its forms, is really em- 
ployed, at the present day, in the treatment of the in- 
sane in England. 
The number of County Asylums in England is, .... 57 
Of Borough Asylums, 8 
Of Registered Hospitals, 20 
Making a total of, 79 
public asylums, to which exclusively the restraint 
* Mechanical restraint is (or was in 1876), used at York, so long the head- 
quarters of the Tukes, who are credited with the introduction of the " Hu- 
mane " system of treatment into England.-[Thirtieth Report of Commis- 
sioners, p. 299.] 
f If the reader take up, for instance their Thirtieth Annual Report, for 
1876, he will find records of the application of mechanical restraint on pages 
57, 70, 71,134, 148, 150, 165, 168, 178, 192, 198, 202, 211, 217, 229, 238, 249, 
245, 250, 256, 260, 270, 271, 277, 286, 287, 290, 295, 299 and 335. 10 
statistics of tlie commissioners refer. But private asy- 
lums are more numerous in England, than these three 
classes of public asylums put together; they stand in the 
proportion of ninety-nine to seventy-nine. 
If we assume that the proportion of cases of me- 
chanical restraint to be found in a single year, in pri- 
vate asylums, is not likely to be greater than that which 
characterizes public ones, we have to add one hundred 
and fifty-four to one hundred and twenty-three, as rep- 
resenting the probable number of applications of me- 
chanical restraint that occurred during 1877, in the 
private asylums of England. 
With the present strong feeling of the public and 
of Parliament against private asylums,* it will be im- 
possible, however, to get people to believe that the 
instances of mechanical restraint are not greater in pri- 
vatef than in public asylums. The probability, indeed, 
is that at least twice as many instances of the use of 
mechanical restraint occur, within a given period, in 
private, as in public asylums in England, simply be- 
cause the facilities for its employment are at least twice 
as great, and the chances of non-detection twice as 
numerous. Here is a sketch by Lord Shaftesbury him- 
self of the treatment of " single patients " in " private 
houses " in England. " I am quite sure the cruelties that 
are perpetrated when patients are so placed are often- 
times shocking;. * * * * These attendants when 
they want to have a junket, and to go out for their 
amusement do this, * * * * they strapped (their 
patients) down to the bed and left them so twenty, 
* There is, at present, a bill before Parliament, proposing to buy them all 
up so as to convert them into public or State inititutions. 
f Of a patient in one of these private asylums, Dr. Bucknill tells us in the 
Select Committee's Report of 1877, p. 297-" He was tied in his bed and very 
badly treated." This was a " chancery patient," and chancery patients are as 
a rule, wealthy, and can command the best private asylum in England. 11 
thirty or forty hours." * A pretty state of matters in a 
country that has, for a long series of years, had no less 
than two sets of well paid commissioners, with all the 
paraphernalia constituting boards, whose ostensible 
object it is to prevent lunacy abuses in England! 
Besides, the public and private asylums of England 
do not harbor all its insane, while the probabilities of 
the applications of mechanical restraint are obviously 
greatest, by far, in the case of lunatics, imbeciles or 
idiots who have not the advantage of periodical inspec- 
tion by Lunacy Commissioners or Chancery Visitors. 
The relative distribution of " lunatics, idiots and per- 
sons of unsound mind," in England, on 1st January, 
was: 
1. In County and Borough Asylums, 37,763 
2. In Registered Hospitals, 2,778 
3. In Metropolitan Licensed Houses, 2,069 
4. In Provincial Licensed Houses, 2,133 
5. In Naval, Military Hospitals and Royal India 
Asylum, 360 
6. In Broadmoor Asylum, (for Criminal Luna- 
tics), 482 
7. In Workhouses, 11,859 
8. In the Metropolitan District Asylums, (for the 
Chronic cases,) 4,406 
9. Residing with Relatives or others, 6,688 
Total, 68,538 
Now a glance at this table renders it evident that 
mechanical restraint is to be looked for, in the first 
place, in class nine, among lunatics, idiots and persons 
of unsound minds, who are in no kind of asylums at 
all, and yet it is precisely of these six or seven thousand 
persons that we are told nothing by the commissioners; 
it is precisely these unprotected individuals that we 
* Select Committee's Report, 1877, p. 566. 12 
would expect to be the special objects of the State 
care, of the attentions of the Lunacy Boards of White- 
hall and Lincoln's Inn.* 
Nor do the commissioners tell us how restraint stands 
in work-hottsesf or in private asylums.J Indeed they 
give us very little direct information as to the extent 
to which mechanical restraint is used in English asy- 
lums. But they give us the data for inferring a great 
deal. For if, as has been shown, one hundred and 
twenty-three cases of such restraint occur in public 
asylums only, in a single year; if, as has also been seen, 
this is held tantamount, by Lord Shaftesbury and other 
government authorities, to a total absence of a practice 
so dreadful in itself, so fraught with evil, not less to 
those who use it than to those upon whom it is used; 
if, as is probable, one hundred and fifty-four is to be 
taken as representing for private asylums one hundred 
and twenty-three cases in public ones, and if lastly we 
add the probable proportion of instances of mechanical 
restraint that occurred in 1877 among "lunatics, idiots 
o 7 
- f 
* Of the opinion of the medical press of England on the relative value of 
these boards, the following quotation from the British Medical Journal, 
of April 14, 1877, (p. 456), may suffice to give some idea: " The obvious 
remedy is an amalgamation of the Boards of Commissioners and Visitors in 
Lunacy, whereby one board for the visitation of all lunatics will be provided, 
too powerful to be placed under the feet of the Masters in Lunacy, and the 
absurd wasting of public money avoided, which is at present caused by the 
dual action of two sets of officials, discharging, practically the same duties. 
The Commissioners, and the Visitors, cost the country about £27,000 a 
year." 
f Though not in the form of an " entry," similar to the " entries " made in 
the books of public asylums, we are told, (p. 85 of the thirty-second Annual 
Report), that in Headington Workhouse, restraint was resorted to by 
steel handcuffs and by tying down in bed for eigty-seven hours. Dr. Bridges, 
one of the Local Government Inspectors of London Workhouses, confessed 
to the Select Committee of 1877, (Report p. 147), that these houses possess 
strait waistcoats and other means of mechanical restraint. 
$ For their thirty-second report contains no " entries," whatever, relating 
to these places of custody or care. Nor is there any reference to such 
public asylums as those of Jersey or the Isle of Man. 13 
and persons of unsound mind," boarded out in England, 
having no lunacy board supervision of any kind, and 
among the insane occupants of work-houses, it is obvi- 
ously a very low estimate to put the total number of 
cases of mechanical restraint of insane persons in Eng- 
land alone, in the year 1877, at a minimum of three 
hundred. 
Here, then, we have a couple of contemporary Blue 
Books, issued by the same government, relating to the 
same subject, and containing the official utterances 
of the same Noble Lord. In the one he tells us that-■ 
I. "Mechanical restraint has been abolished in every 
asylum in the country," while in the other he furnishes 
us with ample evidence that- 
IL Nevertheless, in 1877, one hundred and twenty - 
three instances of its use occurred in thirty-four of its 
public asylums alone! 
Is it necessary after such a contrast between personal 
assertion or opinion and undeniable facts, to attach any 
value at all to Lord Shaftesbury's peroration on "The 
Greatest Discovery of Modern Times-The Non-Re- 
straint system. * * * The greatest triumph of 
Science and Humanity that the world ever saw ! "* I 
trow not; for such discoveries are 
" Chimeras all, and mere absurdities," 
as Dryden puts it; while according to Burns and men 
of common sense in general- 
" Facts are chiels that winna ding 
And need na be disputed." 
" Ad summan quiquid venit, ad Exitum prope estA 
(" Whatever comes to its height is near its end.") 
* Published on the same page of the Blue Book (p. 543) which contains his 
assertion, anent The Total Abolition of Mechanical Restraint. THE 
AMERICAN JOURNAL OF INSANITY. 
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is issued in July. 
Editor, 
JOHN P. GRAY, M. D., LL. D., Medical Superintendent. 
Associate Editors, 
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S. A. RUSSELL, M. D., J 
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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 
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