298 INSANITY forts of philanthropists. Systematic writers on the subject of insanity have usually dated the commencement of reform from the labors of Pinel, and to that great man too much cred- it cannot be well given. "The year 1792," say Bucknill and Tuke, " will ever be memora- ble in the history of the treatment of the in- sane. In that year the celebrated Pinel liber- ated 53 of the patients confined in the Bicetre from the chains by which it was thought ne- cessary to restrain their fury." Pinel's labors were attended by great results, but he was not the pioneer in modern reformatory treatment of the insane. The subject had received the attention of Benjamin Franklin and others in this country as early as 1750. At the organi- zation of the Pennsylvania hospital at Phila- delphia a department for the care of the in- sane was established, in which the system af- terward advocated by Pinel was successfully practised. An act was passed founding "a hospital for the reception and relief of luna- tics, and other distempered and sick poor." (See annual address before the medical soci- ety of the state of New York, 1868, by Dr. John P. Gray.) The reform in the treat- ment of the insane in England, particularly in regard to restraint and punishments and mode of confinement, forms an interesting chapter in the history of institutions for the insane. Bethlem hospital, or Bedlam, as it was com- monly called, which on various occasions be- came notorious for the ill treatment of the in- sane, was founded and first provided for them with benevolent intentions. In 1547 Henry VIII. took possession of the monastery or hos- pital of St. Mary of Bethlem, and presented it to the city of London, with an order that it should be converted into a house for the recep- tion of lunatics. This building, however, could accommodate only 50 or 60 patients, and there- fore in 1675 a larger one was erected in Moor- fields, capable of receiving 150 patients, and which remained as a hospital till 1814. In 1734 additions were made to Bethlem, and it still proving too small, St. Luke's hospital was established in 1751 by voluntary subscrip- tion. The York asylum was founded also by general subscription in 1777. The manage- ment of the asylums had previously begun to retrograde, but not many complaints were made until the year 1791, when some mem- bers of the society of Friends sent one of their family to the York asylum. The rules forbade any of her friends to see her; suspi- cion of something wrong was aroused, and a new establishment called "the Retreat" was founded by the society, chiefly through the influence of William Tuke, in the spring of 1792, the year in which Pinel caused the luna- tics in the Bicetre to bo liberated from their chains. At the retreat no chains, leg locks, or handcuffs were employed from the opening of the establishment. A patient who had been chained naked for 20 years was admitted ; no restraint except the occasional use of arm straps was employed, and he was soon induced to wear clothes and adopt orderly habits ; and there were many other cases of a like nature. Little was publicly known of the experiment till 1798, when De la Rive visited it, and was so delighted with what he saw that he pub- lished an account of it on his return to France. The publication of a " Description of the Re- treat," by Samuel Tuke, in 1813, attracted still more attention to the institution. The physi- cian of the York asylum took offence at some observations it contained, and a controversy arose which resulted in exposing a number of aggravated cases of bad management in the other asylums, and also in causing the house of commons in 1813 to appoint a committee to investigate the subject, who visited not only Bethlem and York asylums, but many private institutions, and brought a horrible condition of things to light. Among the min- utes of evidence taken before the commit- tee are the following. One witness, Mr. Ed- ward Wakefield, said : " In the year 1808 I heard a physician state to the Rt. Hon. John Foster, that of the insane persons who were sent up to Dublin the treatment of them was so little understood that the accustomed mode was tying them with a cord to the back of a car and forcing them to walk the distance they might have to come ; and this gentleman's expression was, ' I give you my honor that of the insane persons sent up to Dublin almost one in five loses an arm from the tightness of the ligature producing mortification, which renders amputation necessary.' " Dr. Richard Salisbury, a general practising physician, testi- fied : " In one house the number of patients confined is 23, 14 men and 9 women ; 7 of the men and 7 of the women supported at their own expense. One room was on the ground floor, 21 by 16 ft. and 7 ft. high, divided into 6 cells, 9 ft. long and 5 ft. wide, with a passage 3 ft. wide between ; not the least air or light admitted except when the doors are open. The principal door immediately opposite a pig sty and dung heap about 7 ft. distant. Three only of the cells floored with wood, the other three were on the bare earth. A long box, 6 ft. by 2 ft., was used for a bedstead, to which the patient was chained. Some had blankets, some only coarse straw. They were taken out to air once a week, during which time clean straw was supplied when necessary. The patients were so dirty in their persons that on opening the door of the first cell the smell was so of- fensive as nearly to prevent further inspection." The medical treatment in most of the estab- lishments was of the lowest empirical kind. The physician of Bethlem said : " Twice a year, with few exceptions, the patients are bled, and after that they take vomits once a week for a number of weeks, and after that we purge them. That has been the practice for years, long before my time." But it must be remem- bered that although much of the treatment arose from cruelty and negligence, the system
