A memoir of John Conolly, M. D., D. C. L., comprising a sketch of the treatment of insane in Europe and America

Front matter

I YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

The Bequest of CLEMENTS COLLARD FRY

Preface

When the grave has closed over a man, the greater part of whose life has heen devoted to works of benevolence, which have conferred a lasting benefit upon mankind, it is due to his memory that the public should be reminded of what he did, and of how he achieved his high objects.

Such a man was Dr. John Conolly, and it is the purpose of the following Memoir to give an account of his works — especially of that great work, which has ranked him among the benefactors of his race.

Dr. Conolly lived during a remarkable period in the medical history of insanity, — namely between the end of the last century, when Pinel first struck the shackles from the limbs of the lunatic, and the middle of the present century, when he himself put an end to the use of all forms of mechanical restraint in our asylums.

Dr. Conolly 's work was one of years, and

PREFACE.

was beset with difficulties, such as, but for the possession of a rare combination of intellectual and moral qualities, he never could have overcome.

In his endeavours to establish the system of non-restraint in the treatment of the insane, he no doubt received important assistance from fellow-labourers in the same field, — and this he always readily and cordially acknowledged. But it was by his own energetic and j>ersevering labours in Han well Asylum, aided by his eloquent, powerful, and unremitting advocacy of the cause, that he succeeded in placing non-restraint on the firm and enduring basis which it now occupies.

Although his chief object, perhaps, was the care of the pauper lunatic, he lost sight of nothing which could contribute to the well-being and proper treatment of all classes of the insane. His attention, for instance, was long directed to the neglected condition of the idiotic and imbecile ; and the success of his efforts in their behalf is disclosed in the following pages. Nor were his interest and sympathy confined to the unsound of mind, they extended to every measure calculated to pro-

PREFACE.

mote social progress, and to improve the position of the helpless classes generally.

In collecting materials for this Memoir, I have had the valuable assistance of Dr. Conolly's family, and of his sons-in-law Dr. Harrington Tuke and Dr. Maudsley. I am especially indebted for important information to an obituary notice written by Dr. Maudsley. My thanks are also due, in a particular manner, to Dr. Conolly's esteemed friend Monsieur Battel, for the use of many interesting letters ; and I have to acknowledge a like obligation to Dr. Arlidge, and Dr. Langdon Down, — to the latter for his interesting account of the origin and present state of the Asylum for Idiots at Earlswood, and to the former for a valuable notice of the present state of establishments for the treatment of the insane throughout Europe and in the Colonies, and for his assistance on various occasions. To Dr. Arthur Mitchell, I am still more largely indebted for an able notice of Dr. Conolly's writings, as well as for his valuable assistance and advice in reference to many parts of the Memoir.

My best thanks are likewise due to Dr.

PREFACE.

Conolly's valued friend and colleague at Hanwell, Dr. Hitchrnan, for enabling me to fill up an interesting period of Dr, Conolly's asylumlife, and for useful information on many points. To Dr. Conolly's personal friends, Dr. W. A. F. Browne, Sir Charles Hood, Dr. Bucknill, and Dr. C. A. Lockhart Bobertson, my thanks are due, for the friendly manner with which they supplied me with information, which I should have found a difficulty in obtaining elsewhere. Indeed, from Dr. Conolly's numerous friends I always found the greatest readiness to give me any information which they possessed ; and in giving it, they generally expressed their pleasure that his merits and labours were to be again brought before the public.

I must not omit to acknowledge my obligation to Sir James Coxe and Mr. Wilkes for their important notes showing the extent to which non-restraint is actually carried out in the existing asylums of England and Scotland ; nor those I owe to my friend Sir Joseph Oliffe for the trouble he took in procuring for me information regarding the new asylums established in the vicinity of Faris ; and I have still the pleasant duty of expressing my thanks to Dr. Edward

PREFACE. XI

Jarvis for an account of the state of lunacy and of lunatic establishments in the United States. It is gratifying to read Dr. Jarvis's philanthropic and enlightened views as to the treatment of the insane, and to hear of the influence which Dr. Conolly's writings have exercised in promoting the humane treatment of the insane in America.

My own part in the preparation of the Memoir has been a very agreeable one. I can honestly say it has been a labour of love. My long and pleasant friendship with Dr. Conolly, and my natural desire to do justice to his memory, were sufficient incentives to make me undertake the task. As I proceeded with it, the hope arose that by recalling attention to Dr. Conolly's labours in establishing non-restraint, and to the happy results which, in this country, have crowned those labours, the Memoir might have some influence in promoting the extension of the system to other countries. This hope induced me to go more fully into the subject of non-restraint than I had originally intended, and led me to make large extracts from Dr. Conolly's works, I cherish the belief, however, that the history and benefits of that humane

PREFACE.

and enlightened treatment of lunacy which he introduced — told chiefly in his own eloquent words — will interest every reader who sympathises in efforts to ameliorate the condition of the insane, whose deplorable lot may be that of any of us, — for to this greatest of human calamities all are liable.

If what is said in this Memoir should happily lead to a fuller adoption of Dr. Conolly's views by foreign physicians, it will be the realisation of a hope, which has stimulated me to extend and complete, what friendship and admiration led me to think of beginning.

Contents

i.

Early life and education — Officer in a Militia regiment — Marriage — Residence in Prance — Studies medicine — Enters the University of Edinburgh — Eeceives the degree of Doctor of Medicine — Commences to practise medicine in Chichester — His friendship with Sir John Forbes — Removes to Stratford-on-Avon — Practised there for five years — Appointed Professor of Medicine in University College, London Page 1-7

II

Resigned his Professorship in University College after holding it for about four years — Went to reside at Warwick — Practised as a physician at Warwick and Birmingham till appointed Physician to the Middlesex County Asylum at Han well 8-18

III

Dr. Conolly enters on his duties as Resident Physician in Hanwcll Asylum, 1st of June, 1839 — Commenced without delay to remove all mechanical restraints — Reports to the Quarter Sessions on 31st of Oct. that since 21st of Sept. there had not been a single patient, out of upwards of 800 lunatics in the asylum, under any kind of restraint — History of the progress of the non-restraint system for ten years, when it was completely established in Hanwell Asylum — Resigned Office of Resident Physician — Appointed Visiting Physician 19-39

CONTENTS.

IV

Resignation as Resident Physician at Hanwell — Presented by public subscription with a handsome testimonial consisting of a massive piece of silver, and a portrait of himself by Sir Watson Gordon — Presentation by the Earl of Shaftesbury — Dr. Conolly's reply — Address on the inauguration of a statue to Dr. Charlesworth — Dr. Hitchman's account of Dr. Conolly's asylum life when Visiting Physician Page 40-51

The difficulties with which Dr. Conolly was beset, while establishing the non-restraint system in Hanwell Asylum — His letter on the subject to Dr. Bucknill 52-54

VI

Observations on the neglect of practical teaching of insanity — Hospitals and asylums in which such instruction is given — Dr. Conolly's clinical lectures in Hanwell Asylum — Dr. Gull's opinion of these lectures — Visits of students never interfered with the patients — All medical men should be required to attend a clinical course on insanity — Optional subjects of medical instruction generally neglected — Improvement of medical education by the Senate of the University of London .. .. 55-65

VII

In his lectures, and in his Indications of Insanity, Dr. Conolly in the habit of pointing out the assistance of phrenology in the treatmeut of Lunacy — Letter to George Combe — Dr. Andrew Combe's opinion of the value of phrenology in the treatment of insanity — Professor Turner on the convolutions of the brain as separate organs — Late investigations and discussions in Paris on the doctrine of Gall, that the brain is not one but many organs — Dr. Richardson's physiological researches lead to same conclusion — Dr. Andrew Combe's prediction of the future of phrenology 60-72

CONTENTS.

VIII

Importance of a well-directed system of education in developing and strengthening the mental faculties in girls — Desultory character of their studies — Perversion of education more fatal than its omission — Its effects in leading to insanity — Hereditary transmission of insanity — Present educational movement promises to elevate female education Page 73-75

IX

Ready acceptance of non-restraint by Medical Superintendents of asylums — Mr. Gaskell's early efforts in Lancaster Asylum — State of asylums before and after non-restraint — Dr. Anderson's boating excursions with lunatics, continued by Dr. McLeod with same success — Mr. Wilkes and Sir James Coxe on the present state of non-restraint in England and Scotland — Professor Paget's encomium on our County Lunatic Asylums 76-87

X

Defects in organization of our asylums — Medical attendance in many inadequate — Size of asylums often increased to an extent which renders them unsuitable for the protection of chronic and incurable, and totally unsuited for treatment of recent cases — Dr. Conolly's strong objections to such asylums — Superintendents have not time to attend to the treatment of the curable patients, still less to keep records of their cases — Strong remarks of foreign physicians on this subject — Inspection of our public and private asylums barely what is required — Insane in private dwellings, in England and Wales, have scarcely any direct supervision — Overcrowded state of asylums requiring urgent consideration — Close asylums not required for a large proportion of insane — Increase of the number of insane chiefly in the pauper class — Explanation of this — Private dwellings in Scotland for idiots and chronic cases of insanity — success of the system — Reports of Commissioners in Lunacy — Dr. A. Mitchell's work on the insane in private dwellings 88-101 xvi CONTENTS.

XI

Middle-class asylums — One much wanted in the vicinity of London — Dr. Conolly exerted himself, supported by Lord Shaftesbury and others, to establish one, but failed to interest the public — A second attempt some years after had no better success — Later he assisted to establish the Coton Hill Asylum, near Stafford — Barnwood Asylum, near Gloucester, established on the same principle — Although intended chiefly for middle classes these asylums receive patients in affluent circumstances — No one derives any profit from the income — Surplus goes to lighten the payments of]3atients whose means are straitened — No paupers are received — These asylums are an unspeakable boon to clergymen, literary men, governesses, &c. — A class of asylums in Scotland named Chartered Asylums afford admission to both paying and pauper patients Page 102-109

XII

Earlswood, National institution for the protection of the idiotic, and training of imbecile children — For the idea of this asylum the country indebted to Mrs. Plumbe, of London, by whose exertions it was established, aided by Dr. Conolly and Dr. Andrew Reed ; assisted also by Mr. Charles Gilpin, M.P., Mr. Alderman Wise, and Sir George Carrol — Sir John Forbes became a member of the Board, giving Dr. Conolly the advantage of his constant moral support in the progress of the asylum — The lamented Prince Consort laid foundation stone of asylum Jan. 6th, 1853 — Opened by His Royal Highness July 5th, 1855— Other asylums for idiots have since been established — By the Annual Report of Earlswood, 1867, there were 450 inmates, two-thirds males, one-third females, in the asylum — Extensive workshops and various industrial pursuits — 150 acres of kitchen and pleasure grounds — A variety of amusements — Medal obtained by a pupil at Paris Exhibition — Interesting account of Dr. Conolly 's visits to asylum — Dr. Down's resignation as Medical Superintendent — His retirement a great loss to asylum and to science — Meeting at Cambridge in favour of asylum — Speeches of Rev. Mr. Sidney and Dr. Conolly in behalf of the helpless idiot. .. 110-125

CONTENTS. xvii

XIII

Foreign Asylums : France — Dr. Conolly's disappointment that in country of Pinel and Esquirol, non-restraint was not at once accepted — Alienist physicians of Paris have same humane feelings as the English to the insane — Ultimately their treatment will be identical — Great improvement in Paris asylums — Three new asylums lately erected, each containing 600 patients, surrounded by ample grounds for agriculture, gardening, recreation, workshops, &o. — Improvement in departmental asylums in M. Morel's Report — M. Morel's visit to this country — His adoption of non-restraint treatment — Publication of his work on non-restraint — Visit of Dr. Conolly's son to Bicetre — Liberation of a lunatic — Dr. Conolly's last Report by M. Morel. Germany — Dr. Ludwig Meyer — First to introduce non-restraint into Germany — Professor Griesinger an ardent supporter of non-restraint — His reasons for adopting it. Italy — Mechanical restraint adopted in most of the asylums, but in very different degrees — Scarcely used in some asylums — Much used in Florence, in the hospital, when Chiarugi introduced a mild, humane treatment nearly a hundred years ago. Borne — Asylum of, mostly clean, and little restraint used — Aversa — Dr. Miraglia — His treatment mild — Little restraint used — Dr. Tebaldi's adoption of non-restraint — Baron Pisani's excellent asylum at Palermo. Belgium — Belgian asylums chiefly under the care of private individuals and religious associations — Improvements made since appointment of Commission to enquire into state of asylums — More still wanted — First public asylum at Ghent, erected after a plan by Dr. Guislain — Gheel — Its influence on the treatment of the insane with more liberty. Sweden — Government have long directed their attention to improve the condition of the insane — Restraint greatly limited — All mechanical restraint abolished in Malmo asylum under Dr. Saloman for last four years — The humane treatment introduced by Dr. Conolly has produced a remarkable effect on the insane in Sweden, calmness and tranquillity having taken the place of noise and excitement. Norway — Large State asylum lately built near Christiania — Treatment said to be directed with humanity — Restraint still used, the strait-jacket and restraint-chair — Seclusion also much employed — In

b xviii CONTENTS.

Christiania City Asylum restraint employed as a means of punishment as well as treatment, as also seclusion. Holland— Dr. Ewarts first to introduce non-restraint in this country— His successful practice of it at the Asylum of Meerengen. 1 America— General excellence of the asylums— Differ from the public asylums in this country— Containing both paying and pauper patients — General management of asylums, exercise, amusements, lectures, &c, similar to that adopted in our asylums- Much to he admired in condition of their asylums and treatment of the insane— Non-restraint still forms part of their practice— This only to be explained by non-restraint not having been put to the test of experience, but condemned without a trial— Still restraint little adopted— Seclusion more used in America than in England— Dr. Manning's Eeports— Dr. Kirkbride's opinion of non-restraint— The mildness of his treatment— Injurious effects of restraint in an asylum— Dr. Kirkbride agrees in this objection — Other objections to restraint. — Black spot in the treatment of the insane in America is the sad condition of the insane in their workhouses, &c— Excellence of the Association of Medical Superintendents of American Institutions for the Insane — Opinion of the Association on the organization of asylums .. Page 126-156

XIV

Non-restraint established by Dr. Conolly thirty years ago — — Established for twenty-four years in all our asylums — Its advantages admitted by foreign physicians — Still they do not adopt it — Its influence in facilitating the treatment of the insane — Adoption of non-restraint by Dr. Morel, Professor Griesinger, Dr. Ludwig Meyer, Dr. Ewarts, Dr. Tebaldi, and Dr. Salomon — Non-restraint as an inflexible law objected to — Has never been adopted as such — The principle is that mechanical restraint should never be employed without a clear necessity — No such thing as absolute repudiation of restraint — Only had recourse to when there is no better way of attaining the object — Opinions of Medical Superintendents — Assistance of Government required to introduce non-restraint — Difficulties less than

1 See Appendix, p. 249.

CONTENTS.

imagined — Dr. Conolly's progress in introducing non-restraint into Hanwell Asylum — To understand non-restraint, an asylum where it is practised should be visited — M. Morel's system of observation recommended Page 157-166

XV

Dr. Conolly's health began to decline in Hanwell — Suffered from rheumatism and neuralgia — Retired to Lawn House — Continued to practise and write — Letters to M. Battel — His love of French literature — Letter to author of this Memoir — Extract of another letter to the same — His apostrophe on Hanwell Asylum — From December, 1865, his strength continued to fail, and on March 5th, following, had an attack of paralysis, which proved fatal in » few hours 167-175

XVI

Failure of mental energy may be the consequence of the natural decay of the system, or of over mental work, which may occur at any age — Symptoms vary — Dull headache — Restless nights, or unrefreshing sleep — Impairment, or confusion of memory — Inability to concentrate attention — Proneness to irritability — To mental depression — Mental work persisted in tinder such symptoms may lead to derangement of mental faculties — Danger of this increased in persons hereditarily predisposed to insanity — Case of insanity from over brain work — Remedial measures in such cases — Abstinence from mental work — Use of means to improve general health — In all persons, reduction of active mental work after a certain age a means of preserving mental vigour — Persons continuing active mental work till a great age — Explanation — Danger of too early mental work in precocious children — Mode of life suited for them 176-183

XVII

Dr. Conolly, a man of great natural talents and cultivated mind — His views on all subjects of social economy liberal and enlightened — Took an active part in the amelioration of the poor labouring classes — Esteemed in social life for his kind, amiable

b 2

CONTENTS.

disposition — A large practice in his profession — Chief consulting physician in cases of insanity, especially in cases de lunatico inquirendo — Condemns the manner in which medical witnesses gave their evidence — Derogatory to the character of the profession, and injurious to the public— The honorary degree of D.C.L. conferred on him by University of Oxford— Merits of Dr. Charlesworth always acknowledged by Dr. Conolly — His attention first called to the subject of insanity by a visit to a lunatic asylum at Glasgow when a boy— When practising at Stratford had thoughts of establishing an asylum— His great desire to take charge of Hanwell Asylum— Sir Thomas Watson on the merits of Dr. Conolly in his obituary— Guislain's opinion f him— Dr. W. A. Browne's, in presidential address— Baron Mundy's presentation of a bust of Dr. Conolly to College of Physicians — His address — Sir Thomas Watson's reply . . Page 184-193

XVIII

Dr. Conolly, one of the original members of the British Medical and Surgical Association — Dr. Stokes, President of thirty-fifth annual meeting — His view of the objects aimed at by Sir Charles Hastings, and other members, to raise whole character of the profession — Their success has largely added to the scientific reputation of British Medicine and Surgery — This shown by comparing the orations at the more recent annual meetings with those at the early meetings — Letter from Dr. Conolly to Sir Charles Hastings, the founder and animating spirit of the Association — Was an active member of Society for the Diffusion of Useful Knowledge — Wrote several works for Society — His friendship with the President of the Society, Lord Brougham — One of the original members, and once President, of the Ethnological Society — One of the early members of the National Association for the Promotion of Social Science — His valuable papers in the Transactions — His active interest in the Medico-Psychological Association — Was twice President — His interest in Association Journal — Letters to Dr. Buckuill and Dr. Lockhart Robertson — Effects of Dr. Forbes Winslow's Journal in calling attention to the insane — Lord Chancellor's Visitors of Chancery Lunatics 1U4-202

CONTENTS.

XIX

Engaged during early professional life in literary works, chiefly medical, with his friend Sir John Forbes, &c. — British and Foreign Medical Beview — Its influences on medical literature of the time — Dr. Bigelow's opinion of it — Dr. Conolly's most important works, those on mental diseases, construction and management of asylums, and on the non-restraint system — Inquiry concerning the Indications of Insanity — Construction and Organization of Lunatic Asylums — Treatment of the Insane without Mechanical Bestraint — Clinical Lectures on Insanity — Study of Hamlet Page 203-212

XX

Dr. Arthur Mitchell's opinion of Dr. Conolly's position as a medical psychologist — His opinions given almost entire — Had the Indications of Insanity been written for the public, their utility would have been more generally useful — Dr. Conolly's power in analysing the operations of the mind at various periods of life — His view that the proper method of studying insanity was the same as that of investigating other diseases — The deviations from healthy performance of the functions are the same in both cases — The analogy runs through the whole subject— Others have since followed the path pointed out by Dr. Conolly — No one has laid down a sounder method of studying the physiology and pathology of the mind 213-223

Conclusion

In preparation of this Memoir, Dr. Conolly's own language used as much as possible in describing his labours — Completion of his benevolent work greatly due to his self-abnegation, kindly disposition, and great consideration for his fellow-labourers — His success shown in the rapid abandonment of mechanical restraint ■ — Subject at times to a desponding state of mind — This led him to fear lest a reaction might interfere with his labours — His

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anxious hope that no delusive theories would ever lead to the abandonment of non-restraint in the treatment of the insane — His trust that it is destined to endure as long as science is pursued with a love of truth, and a regard for the welfare of man Page 223-225