NATIONAL LIBRARY OF MEDICINE
             Washington
Founded 1836
U. S. Department of Health, Education, and Welfare
Public Health Service 
 
 
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HINTS
INTRODUCING AN IMPROVED MODE
TREATING THE  INSANE
The Asylum;
¥,r«a before the Governors of the New-York Hospital, on ifce
         kth of Fourth-month, 1815.
BY THOMAS  EDDY, ^
 One of the Asylum Comm:!'cc.  / ^\j ,,,
        —*—        1
NEW-YORK :
AJ y ^
                            -  4; >•-

PRINTED BY SAMUEL WOOD & SONS,     "~-»-^4, _£ ^
      XO. .'557. PEARL-STREET,

  FOR IHJ: T'SE «>!■' THE GOVERNORS.


            1815. 
 
    HINTS

FOR INTRODUCING
IMPROVED MODE OF TREATING

     THE  INSANE

         IN THE ASYLUM.
  OF the numerous topics of discussion,
on  subjects  relating to the cause of hu-
manity, there is none  which has stronger
claims to our attention,  than  that which
relates to the treatment of the insane.
  Though we may reasonably presume,
this subject was'by no  means overlooked
by the ancients, we may  fairly conclude,
it is deservedly the boast of modern times,
to have  treated it with any degree of sue-
cess.
  It would have been an  undertaking sin-
gularly  interesting and instructive, to trace
the different methods of cure  which have
been pursued in different  ages, in the treat-
                  1 * 
4
rnent of those labouring under mental dt
rangement.  and to mark the various re-
sults with which they wTere attended. The
radical defect, in all the different modes of
cure that have been pursued, appears to be,
that of considering  mania a  physical or
bodily disease, and adopting for its remo-
val merely physical remedies.  Very late-
ly, however, a spirit  of inquiry has been
excited, which has given birth to a new
system  of treatment of the insane; and
former modes of medical discipline have
now given place to that which is general-
ly denominated moral management.
   This interesting subject has  closely en
gaged my attention for  some years, and I
conceive that the further  investigation
of it, may prove highly beneficial to  the
cause of humanity, as well as to science, and
excite us to a minute inquiry,  how far we
may further contribute to the relief and
comfort of the  maniacs placed under our
care.  In pursuing this subject, my views
have been much extended, and my mind
considerably enlightened, by perusing the
writings of  Doctors Creighton,  Arnold,
and Rush ; but, more particularly, the ac-
count of the Retreat  near York,  in Eng-
land.   Under these impressions, I feel
extremely desirous  of submitting to the
consideration of  the Governors, a plan, 
5
to be adopted by  them, for introducing
a system of moral treatment for the luna-
tics  in the Asylum,  to  a greater  ex-
tent  than has  hitherto been in use  in this
country.  The great utility of confining
ourselves  almost exclusively to a course
of moral treatment, is  plain and simple,
and  incalculably interesting to the cause
of humanity;  and perhaps no work con-
tains so many excellent and appropriate
observations  on the subject, as that en-
titled,  The Account of  the  Retreat.  The
author, Samuel Tuke, was an active man-
ager of that establishment, and appears  to
have detailed,  with scrupulous care and
minuteness, the effects of the system pur-
sued towards the patients.  I have  there-
fore, in the course of  the  following re-
marks, with a view of illustrating the sub-
ject  with  more  clearness,  often adopted
the language and opinions of Tuke,  but
having frequently mixed my own observa-
tions with his, and his manner of expression
not  being always adapted to our cir-
cumstances   and  situation, I  have  at-
tempted to vary the  language, so as  to
apply  it to our own institution ; this will
account for many  of the  subsequent re-
marks  not being  noticed as taken from
Tuke's work. 
6
    It is, in the first place, to be observ-
  ed, that in most  cases  of insanity, from
  whatever  cause it  may have  arisen,  or
  to whatever  extent it may  have  pro-
  ceeded, the patient possesses some small re-
  mains of ratiocination and self-command •,
  and although  many cannot be made  sensi-
  ble of the  irrationality of their conduct or
  opinions, yet  they are generally aware  of
  those particulars for which the world con-
  siders them proper objects of confinement.
  Thus it frequently happens, that a patient,
  on his first introduction into the Asylum,
 "will conceal all marks  of mental aberra-
  tion ; and, in some 'instances,  those who
  before have  been ungovernable, have so
  far deceived their new friends, as to make
  them doubt their being insane.
    It is a generally received  opinion, that
*  the insane who are violent,  may be re-
  duced to more calmness and quiet, by ex-
  citing the  principle of fear, and by the use
  of chains or corporal punishments. There
  cannot be  a doubt that the principle of fear
  in the human mind,- when moderately and
  judiciously excited, as it is by the opera-
  tion of just and equal laws, has a salutary
  effect on society.   It is of great use in the
  education oj*  children, whose imperfect
  knowledge and judgment, occasion them 
"7
to be less  influenced by other motives.
But where fear is  too much excited,  and
especially,  when it becomes the chief mo-
tive of action,  it certainly tends to con-
tract the understanding, weaken the bene-
volent affections, and to debase the mind.
It is, therefore, highly desirable, and more
wise, to call into action as much as possi-
ble,  the  operation of superior motives.
Fear ought never to be  induced,  except
when an object  absolutely necessary can-
not be otherwise obtained.  Maniacs are
often extremely  irritable;  every  care,
therefore, should be taken,  to avoid  that
kind of treatment that may  have any  ten-
dency towards exciting the passions.  Per-
suasion and kind treatment, will most gen-
erally supersede the necessity of coercive
means.  There  is  considerable  analogy
between the judicious treatment of child-
ren  and  that of insane  persons.    Locke
has observed, " the great  secret  of  edu-
cation, is in finding out the way to keep
the  child's  spirit   easy, active, and free ;
and yet, at the  same time, to restrain him
from many things  he has a mind  to, and
to draw him to things which are uneasy to
him."  Even with the more violent and
vociferous  maniacs, it will be found best
to approach them with mild and soft  per- 
8
suasion.   Every pains should be taken to
excite in  the patient's mind a  desire of
esteem.   Though  this  principle  may not
be sufficiently powerful to enable them to
resist  the  strong  irregular  tendency of
their disease; yet, when properly cultivate
ed, it may lead  many to  struggle to over-
come and conceal  their morbid propensi-
ties, or at least,  to  confine their deviations
within   such  bounds,  as  do not make
them obnoxious  to  those  alfout  them.
This struggle is highly beneficial to the
patient; by strengthening his mind,  and
conducing to a salutary   habit of self-re-
straint, an object, no doubt, of the greatest
importance to  the  cure of  insanity by
moral means.
  It frequently occurs, that one mark of
insanity, is a fixed  false conception, and a
total incapacity  of reasoning.   In  such
cases, it is generally  advisable,  to avoid
reasoning* with them, as it  irritates and
  * The following anecdotes illustrate the observation before
made, that maniacs frequently retain the power of reasoning to
a certain extent;  and that the discerning physician, may often-
times successfully avail himself of the remains of this faculty in
controling the aberrations of his  patient:—A patient in the
Pennsylvania Hospital, who  called his physician his father.
once lifted his hand to strike him. " What!" said his physi-
cian, (Dr. Rush.) with a plaintive tone of voice, " strike your
father ?" the madman dropped his arm, and instantly  showed
marks of contrition for his conduct. The following was related 
a
rivets their false perception more strongly
on the mind. On this account, every means
ought to be taken to seduce the mind from
unhappy and favourite musings ; and par-
ticularly with melancholic patients ; they
should freely partake  of bodily exercises,
walking, riding,  conversations, innocent
sports, and a variety of other amusements;
they should be gratified with birds, deer,
rabbits, &c.  Of all the modes by which
maniacs may be induced to restrain them-
selves,  regular employment is perhaps the
most efficacious ; and those kinds  of em-
ployment  are  to be  preferred, both on a
moral and  physical  account, which are ac-
companied by considerable bodily action,
most agreeable to  the  patient, and most
opposite to the illusions of his disease.
   In short the patient  should  be  always
treated  as much  like a  rational being
as the state of his mind will  possibly  al-
low.  In order  that he may display  his
to me by Samuel Coates, president of the Pennsylvania Hospi-
tal :—A maniac had made several attempts to set fire to the
Hospital: upon being remonstrated with, he said, " I am a sal-
amander ;"  " but recollect," said my friend Coates, " all the
patients in the house are not salamanders ;" " That is true,"
said the maniac, and never afterwards attempted to set fire to
the Hospital.
  Manv similar instances of. a degree of reason being retain-'
ed by maniacs, and some of cures effected by pertinent and well
directed conversations, are to be met with in the records of
medical writers. 
10
 knowledge to the  best advantage, such
 topics should be introduced as will be most
 likely to interest him ;  if he is a mechanic
 or agriculturalist, he should be asked ques-
 tions relating to his art, and consulted up-
 on any occasion in  which his knowledge
 may be useful.  These considerations are
 undoubtedly very material, as they regard
 the comforts of insane persons ; but they
 are of far greater importance as they re-
 late to the cure of the disorder.   The pa-
 tient, feeling himself of some consequence,
 is induced to support it  by the exertion of
 his reason, and by restraining those dispo-
 sitions which,  if indulged, would  lessen
 the respectful treatment he wishes to  re-
 ceive, or lower his character in  the eyes
 of his companions and attendants.
   Even when it is absolutely necessary to
 employ coercion, if on its removal the pa-
 tient  promises to  control  himself, great
 reliance may frequently be placed upon
 his word, and under  this engagement,  he
 will  be apt to hold a successful  struggle
 with the violent propensities of his disor-
 der.   Great advantages  may  also be de-
 rived, in the moral management  of mani-
 acs, from  an acqaintance  with the  pre-
vious employment, habits,  manners,  and
prejudices  of the  individual:  this  maj? 
11
truly be considered as indispensably ne-
cessary to be known, as far as can be ob-
tained  ; and, as it may apply to each case,
should be registered in a book, for the in-
spection of the Committee of the As)lum,
and the physician ; the requisite informa-
tion should  be procured  immediately on
the admission of each  patient;  the  mode
of procuring it will be spoken of hereafter.
   Nor must we forget to call to our aid, in
endeavouring to promote self-restraint, the
mild but powerful  influence  of the pre-
cepts of our holy religion. Where these
have been strongly imbued in early life,
they become little less than principles of
our nature ; and their restraining power is
frequently felt, even under the delirious
excitement of insanity. To encourage the
influence of religious principles over the
mind of the  insane, may be considered of
great consequence, as a  means of  cure,
provided it be done with great care and cir-
cumspection.   For this purpose, as  well as
for reasons still more important, it would
certainly  be right to  promote in the pa-
tient, as jar as circumstanees would permit,
an attention to his accustomed modes of
paying homage to his  Maker.
   1 n pursuing the desirable objects  above
enumerated, we ought not to  expect too
2 
12
suddenly to reap the good effects of our
endeavours ; nor should we too readily be
disheartened by occasional  disappoint1
ments.  It is necessary to call into action
as much as possible, every remaining pow-
er and principle of the mind, and to  re-1
member, that, " in the wreak of the intel-
lect, the  affections  very frequently sur-
vive."  Hence, the necessity of consider-
ing the degree in which the patient may  be
influenced by moral and rational induce-
ments.
   The  contradictory  features in  their
characters, frequently render it exceeding-
ly difficult to insure the proper treatment
of insane persons;  to  pursue this with
any hopes of succeeding, so that  we may
in any degree  ameliorate their distressed
condition, renders it indispensably neces-
sary that attendants only should be chosen
who are possessed  of good  sense, and1 of
amiable  dispositions, clothed, as much as'
possible with philosophical reflection, and
above all, with that love and charity that
mark the humble christian.
   Agreeably to these  principles,  I beg
leave to suggest the following regulations
to be adopted, in accomplishing the objects
in view.
   1st. No patient shall hereafter be con-
fined by chains. 
13
   2nd. In the most violent states of mania,
die patient should be confined in a room
with the windows, &c. closed, so as nearly
to exclude the light,  and kept confined, if
necessary, in a strait jacket, so  as to walk
about  the  room or  lie  down on the bed
at pleasure ;  or by straps, &c. he may, par-
ticularly if there appears in the patient a
strong determination to self-destruction,
be confined on the bed,  and the apparatus
>:o fixed as to  allow him to turn  and other-
wise change his position.
   3rd. The power of judicious kindness to
be generally exercised, may often be bless-
ed with good effects,- and it is not till after
other  moral  remedies are exercised, that
recourse should be had to restraint, or the
power of fear on the  mind of the patient;
yet it may  be proper sometimes,  by  way
of punishment, to use the shower bath.
   4th.  The common  attendants shall not
apply any extraordinary coercion by way
of punishment, or  change in any degree
the mode of  treatment prescribed by the
physician ; on the contrary, it is consider-
ed as  their indispensable duty,  to seek
by acts of  kindness the  good opinion of
the patients,  so as to govern them by the
influence of esteem rather than of sever-
ity. 
14
  5th. On the first day of the week, the
superintendent, or the principal keeper ot
the Asylum, shall collect as many of the
patients as may appear to them suitable,
and read some chapters in the Bible.
  6th. When it is deemed necessary to
apply the strait-jacket, or any other mode
of coercion,  by way of punishment or
restraint, such  an  ample force should be
employed as will preclude the idea of re-
sistance from entering the mind of the.
patient.
  7th. It shall be the duty of  the  deputy
keeper, immediately  on  a patient being
admitted, to  obtain his name, age, where
born, what has been his employment or oc-
cupation, his general disposition and habits,
when first attacked with mania ;  if it has
been violent or otherwise, the cause of his
disease, if occasioned by religious melan-
choly, or a fondness for ardent spirits, if
owing to an injury received on any part of
the body, or supposed to arise from any
other known cause, hereditary or adventi-
tious, and the  name of the physician who
may have attended him, and his manner of
treating the patient while under his direc-
tion.
  8th. Such of the patients as may be se-
lected by the physician, or the committee 
15
*>f the Asylum, shall be occasionally taken
out to walk or i ide under the care of the
deputy keeper: and it nhall  be also his
duty to employ the patienis in such man-
ner, and to provide  them with such kinds
of amusements and books as may be ap-
proved and directed by the  committee.
  9th. The female keeper shall endeavour
to have the female patients constantly em-
ployed at suitable work ;  to provide prop-
er amusements, books, &c.  to take them
out to walk as may be  directed by the
Committee.
  10th. It shall be the indispensable duty
of the keepers, to have all  the patients as
clean as possible in their persons, and to
preserve great order and  decorum when
they sit down to their respective meal*.
  11th. It shall be the duty of the physi-
cian to keep a book, in which shall be en-
tered an historical account of each patient,
stating his  situation, and  the medical and
moraltreatment  used; which book  shall
be  laid before the Committee, at their
weekly meetings.
   The sentiments and improvements pro-
posed in the preceding  remarks, for the
consideration of the governors, are adapt-
ed  to our present  situation and circum-
stances ; but a further and more extensive 
 improvement  has occurred to  my  mind.
 which I conceive, would very  considera-
 bly conduce towards effecting the  cure,
 and  materially ameliorate the condition,
 and  add to the comfort of the insane ; at
 the same time that it would afford an am-
 ple  opportunity of ascertaining how far
 that disease may be removed  by  moral
 management alone, which it  is believed,
 will, in many instances, be more effectual
 in controling the  maniac, than medical
 treatment, especially, in those cases where
 the disease has proceeded from causes op-
 erating directly on the mind.
  I would propose, that a lot, not less than
 ten  acres,  should  be  purchased by the
 governors, conveniently situated, within a
 few miles of the city, and to erect a sub-
 stantial  building, on  a plan calculated for
 the accommodation  of fifty lunatic pa-
 tients ; the ground to be improved in such
 a manner as to  serve for agreeable walks,
 gardens,  &c. for the  exercise and amuse-
 ment of the patients: this establishment
 might be placed under the care and super-
 intendence of the Asylum Committee, and
 be visited by them once every  week :  a
 particular description  of patients to re-
 main  at  this -Rural  Retreat ;  and  such
others  as  might  appear  suitable ob- 
1?
jects might be  occasionally removed there
from the Asylum.
   The cost  and annual  expense of  sup-
porting this  establishment, are  matters of
small consideration, when we duly  con-
sider the important advantages it would
offer to a portion of our fellow-creatures,
who have such strong claims  on our  sym-
pathy and commiseration.
   But, it is a fact that can be satisfactori-
ly demonstrated, that such an  establish-
ment would not increase  our  expenses ;
 and, moreover, would repay  us even the
 interest of the money that might be nec-
 essary to be advanced, for the purchase
 of the ground and erecting the  buildings.
 The board of the patients (supposing fif-
 ty) would yield two hundred dollars per
 week, or ten thousand four hundred dol-
 lars per annum.
    Supposing  the ground, building, &c.
 to cost #50,000, the interest on this sum, at
 6 per cent, would be $3,000, there would
 yet remain #7,400, for the maintenance
 and support of the  establishment; a sum
 larger than would be  required for that
 purpose.
    We had lately in the Asylum, more
 than ninety patients ;  and,  at  that time,
 had repeated applications to receive an ad- 
18
ditional number;  the Committee  how-
ever, concluded, that as the building was
not calculated to accommodate more than
seventy-five, it would be an act of injustice
to take in any more ; ^ey, therefore, con-
cluded to reduce the number to seventy-
five, and strictly to refuse receiving any
beyond that  number.  This may  serve
clearly to show, that we might safely cal-
culate, that we should readily have appli-
cations to accommodate one hundred and
twenty-five patients.
  This succinct  view of the subject may
suffice, at this time, as outlines of my plan ;
and which is respectfully submitted to the
governors, for their consideration* 
 
 
fSAXE
sYLl'M;
cu>-York U< j,ital, I
h, 1813.
> EDDY
m Committee.
Mc 1.  Hist
    VIZ-
  XI 0            >I THE G0V1 R\OJ


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