Two Days at Oh eel. 
First Assistant Physicianof the McLean 
GEOKGE T. TUTTLE, M. D., 
Asylum, Somerville, Massachusetts. 
Sprint 
raOM 
THE TWELFTH ANNUAL REPORT OF THE 
STATE BOARD OF LUNACY & CHARITY 
OF MASSACHUSETTS. 
January, 189 L TWO DAYS AT OHEEL. 
George T. Tuttle, M.D., 
First Assistant Physician of the McLean Asylum. 
There is no authentic account of the establishment of a colony 
of the insane at Gheel. The tradition, with some slight variation, 
is as follows: An Irish princess, Dymphna by name, who had 
become a Christian, fled from her home to escape the persecution 
of an unnatural father and in her wanderings came to Gheel. 
The father, having discovered her hiding place, killed her with his 
own hand on the 15th day of May in the year 600. An insane 
person witnessing this act was suddenly restored to reason, and 
hence arose the belief that St. Dymphna, as she was afterwards 
called, wrought miraculous cures of the insane. A shrine was 
erected on the spot where she was beheaded, (one is there at the 
present day), and in the year 1340 a memorial church was 
completed. It stands in the immediate vicinity. It thus early 
became the custom to take the insane to St. Dymphna’s shrine 
to be healed of their infirmities ; and, after the erection of the 
church, a small building near it was devoted to their accommo- 
dation. 
The treatment was rational and based on their idea of the 
pathology. The insane were believed to be possessed of devils, 
which were to be cast out by prayer and other religious ceremo- 
nies. The priests prayed over them, and several times each day 
for nine successive days they were marched around in procession 
outside and inside the church, and each time they passed the 
cenotaph, supposed to contain the body of the Saint, they crawled 
under it; if they were too sick, perhaps too excited, some boy 
was hired to crawl for them ; the well-worn stones attested the 
frequency of this act. If the first nine days did not work a cure, 
the ceremonies were continued for nine more. No doubt many 
were restored to health. It only shows that the “ mind cure,” 
“ faith cure,” “ Christian science,” or whatever one chooses to call 
it, is no new thing. 2 
TUTTLE: 
As the numbers increased it became necessary to lodge them 
in the neighboring houses ; and after the Reformation, with the 
decline in the observance of the religious ceremonies, they were 
placed further and further from the church, in the village, in the 
neighboring hamlets and in the country, till finally they became 
scattered over the whole commune. Thus has grown up, during 
the past twelve or thirteen hundred years, a race of people accus- 
tomed to the presence of the insane in their midst and to their 
care. 
The commune of Gheel, situated on the railroad, about twenty- 
eight miles south-east of Antwerp, is a fertile spot in the midst of 
a barren tract, ten or eleven miles long by eight or nine wide, 
with its chief village near the centre. In the summer of 1889 it 
had a sane population of about ten thousand, and scattered among 
them were seventeen hundred insane; of these, nine hundred 
were in the village, which had a population of five thousand. 
Formerly before there was any efficient supervision, their condi- 
tion was unfortunate ; it was practically that of serfdom, and 
early in the present century it was thought necessary by the cities 
that sent their insane to Gheel to send also some one to look after 
their interests and protect them from abuse. By a process of 
evolution it has come about that Gheel is now an asylum of the 
Belgian government. This became an actual fact in 1851, when 
Dr. Parigot was appointed the first superintendent or medical 
inspector; after him came Dr. Bulckens; and then, in 1875, the 
present incumbent, Dr. Peeters. 
Commitment to this asylum requires an application by some 
responsible person for the admission of the patient, and with it, 
except in one form of application, the certificate of a physician 
not connected with the asylum, signed within two weeks of admis- 
sion. Cases of emergency may be received without the medical 
certificate, which must be furnished within twenty-four hours. 
The administrative organization is as follows; a superior 
commission, which meets quarterly, has general oversight of the 
interests of the colony, and constitutes the board of final appeal; 
the permanent committee, composed of the burgomaster of the 
village, two principal citizens and three physicians, which meets 
each week and has the immediate charge of affairs ; the medical 
inspector; four assistant physicians; six gardes de section, or 
supervisors, each of whom has one-sixth of the commune to over- 
see ; and last, the hole or nourricier, in whose family the insane 
person is placed. It will be seen that the organization is similar 
to that of the McLean Asylum, the superior commission corre- 
sponding to the corporation, the permanent committee to the TWO DAYS AT GHEEL. 
3 
board of trustees, the medical inspector to the superintendent, the 
gardes de section to the supervisors, and the hole and nourricier to 
the nurses. In the village is an infirmary, or closed asylum, with 
accommodations for eighty patients. Thus Gheel is a regularly 
organized asylum where the cottage system is carried out to the 
fullest extent. 
During a stay of two days and a half I visited the Infirmary, 
twenty-seven houses in the main village and eighteen farms, hav- 
ing for a guide a garde de section of many years’ experience and 
a patient for an interpreter. 
All pauper, and occasionally paying, patients are received at 
the Infirmary for observation before being placed in families. 
This most necessary part of the Gheel system, opened in 1862, 
is situated on the outskirts of the village. At the time of my 
visit, July, 1889, it contained sixty-two patients, thirty-one of 
each sex. It is built of brick with a tile roof and presents a very 
neat appearance. It serves as a place of observation for new 
patients, as a receptacle for those who become for any reason 
temporarily unfit for family care, as a hospital for patients with 
acute diseases who require special nursing, and as a place of 
restraint and punishment for those who try to escape. 
The main building is of two stories, all others are of one. The 
male and female departments have a similar construction, and are 
well arranged for the classification of patients. The ground floor 
is devoted to day rooms, kitchen and dining-rooms, and admin- 
istrative purposes generally. The second story is divided into 
dormitories of from six to twelve beds, with two rooms on each 
side for first class or paying patients, and there is a small chapel 
in the centre. The floors of the rooms, except of those for 
paying patients, are unpainted. The rooms are plainly but 
neatly furnished, iron bedsteads with curtains, white spreads, 
rugs on the floor, chairs and wash-stands. There is a “ night- 
chair” in each dormitory containing a large iron pail with a little 
water in it. 
The building running back in the centre, at right angles to the 
main building, has a dining-room at one end, a day room at the 
other, with bathrooms and two sleeping rooms between. Back of 
this building is another, containing a row of seven observation 
cells, and in the end an infirmary ward of twelve beds. These 
observation cells are very strong rooms with a corridor on each 
side; doors opening into one and windows, protected by orna- 
mental iron-work, into the other. They contain no furniture 
except wooden bedsteads and a set stool in the corner, and are 
heated by hot-water pipes which run along the corridor under the 4 
TUTTLEI 
windows ; all other parts of the Infirmary are heated by stoves. 
The infirmary wards are furnished with iron bedsteads, which have 
reservoirs at the bottom made of zinc, into which a vessel slides at 
the side. The mattress is made in three parts. The use of this 
bed suggests lack of proper attention to helpless patients. 
Still further back is a small building of two rooms for very 
excited patients. There are three airing-courts for each sex. The 
windows throughout the Infirmary are strongly guarded, the lights 
are protected with wire netting, and mechanical restraint is freely 
used. A woman in a strong room of the last section wore a cami- 
sole and was fastened to the bed in the following maner : a 
strap attached to an armlet above the elbow was fastened near the 
head of the bed, while the long sleeve of the camisole was carried 
down and fastened at the side of the bedstead near the foot; she 
wore anklets, fastened to each side of the bed by straps, and 
there was a broad linen band across her chest. A man in the 
infirmary ward, apparently dying, was restrained in the same way. 
The women’s department, under the care of six nuns or sisters 
of charity, was scrupulously neat; the men’s department was not 
as clean ; there were only three attendants, and they were rough 
looking and poorly clad ; one was smoking a pipe while on duty 
in the house. There was no nurse in the infirmary ward with the 
three sick patients. There were no night nurses, but the sisters 
and attendants slept in the dormitories with the patients. A few 
of the women were at work in the laundry, but most of the 
patients had nothing to do, and certainly there was little about 
the place to interest them. It was bare and cheerless and one 
could readily believe that they were all anxious to be placed in 
families. 
The permanent board of directors meets at the Infirmary each 
week and among other matters decides what patients shall be 
placed in families. The location of pauper patients is made with- 
out consulting their friends ; while the friends of private patients 
go about the village with the superintendent and select a boarding 
place with his advice. 
In July, 1889, there were nine hundred and ninety-three families 
in which patients were received. The man of the house is the 
responsible person, and is called hote, if he receives a private, 
and nourricier if a pauper patient; he is authorized to care for the 
insane after having made application in due form. 
Most of the insane at G-heel come from Belgium,,with a sprink- 
ling of other nationalities ; and by far the greater number are 
poor people. These pauper patients are divided into three classes 
and pay according to their condition ; “ dirty” patients twenty- TWO DAYS AT GfHEEL. 
5 
four cents a day, “half-dirty” nineteen cents, and “clean” 
patients seventeen cents. Of these sums the board pays the 
nourricier for the first class nineteen cents, for the second four- 
teen, and for the third twelve, the balance being retained for 
expenses of, administration. Private patients pay very different 
sums, from one hundred to a thousand dollars a year, according 
to accommodations, the board retaining eleven per cent, of the 
price. Thus sufficient money is obtained to pay the expenses of 
the Infirmary, which has no fund; the salaries of the physicians 
and the supervisors, to furnish clothing for the paupers, etc. It 
is said that after paying the families, the authorities have about 
twelve thousand dollars for current expenses. 
Gheel is a colony of selected cases, indeed twice selected ; once 
by the physicians who send them, and again at the Infirmary by the 
superintendent. Dr. Peeters complained of the poor judgment of 
the general practitioner in such mattei’S, and, also that the overflow 
from the closed or ordinary asylums usually consisted of their 
worst cases of whom they desired to be rid. If after observa- 
tion of a few days they are found to be unfitted for family life 
they are sent to one of the closed asylums, as, according to the 
law, patients cannot be kept at Ghcel who require continuous 
restraint, who are suicidal, homicidal or incendiary, who would be 
liable to frequent attempts to escape, or whose disease is of such 
a nature as to disturb the tranquillity of the community or offend 
public decency. As a rule only two patients are placed in one 
house and these, always of the same sex, are selected with refer- 
ence to their mental condition. 
The village is about as quiet and uninteresting a place as could 
well be imagined, with no commerce, and no manufactories 
except two breweries, the product of which, considering the num- 
ber of beer shops, might have been for home consumption. The 
principal business appeared to be farming, the care of the insane, 
the sale of wine and beer, with just enough bakers, grocers, shoe- 
makers, tailors, etc., to supply the wants of the people. In the 
centre of the village is a large, long, open place or common, at 
one end of which is a church, and around it are arranged some of 
the principal houses. They are built of brick, covered with ce- 
ment or plaster, and have steep roofs with the eaves toward the 
street. Many .of them have the appearance of being unoccupied, 
since no one is seen at the windows, and the blinds are often 
closed and the front door locked to keep the patients in. 
The whole commune is as flat as Holland. From the central 
square streets run in various directions. In the village they are 
paved in the centre for a space wide enough to allow the passage 6 
TUTTLE: 
of two carts, while from this, narrow strips of pavement extend 
to the doors of the houses, suggesting plenty of mud in wet 
weather. 
Mention has been made of the great number of drinking shops. 
My interpreter of the second day said the patients could go and 
get beer and wine when they had the money. The authorities 
feel keenly the disadvantage of having these wine shops in the 
village, because the patients can get drunk. Quite a number of 
insane men and a few demented old women could be seen wander- 
ing about the streets, but no young or middle-aged women. Many 
children played about the square at evening, but they paid no 
disagreeable attention to the insane. 
The houses in the village in which pauper patients are boarded 
are usually of one story; the best of them have a sitting-room, 
but many of them have only a so-called living-room, in which the 
family cook, eat, and sometimes sleep, while the patients have 
small bed-rooms opening from this. All the ground floors are 
low, laid with tiles and sanded. Everything is crowded into the 
living-room and dirt is the rule. The patients’ rooms usually 
have whitewashed walls, a brick floor, and, for furniture, a small 
mat, a wooden bedstead, a chair, and sometimes a table. As a 
rule the beds are dirty, and covered with a bright-colored spread. 
However plain or poor the house there is a lace curtain at the 
small window, which also sometimes has iron or wooden bars. 
The woman of the house, and usually the patients also, wear 
wooden shoes without stockings in the summer, and their feet and 
legs are very dirty. It must be said, however, that the patients 
get the best the house affords and appear contented, though for 
that matter many are so demented that they would not know one 
place from another; as for the more intelligent, they are doubt- 
less accustomed to nothing better at home. 
The first house visited in the village contained two insane 
women, whose rooms up a steep flight of stairs were perhaps eight 
by ten feet in size. One patient of middle age, her face covered 
with a handkerchief, was lying on the outside of her bed and 
would not speak. The room with its furniture was of the plainest 
sort and was not at all attractive. Besides the bedstead there 
were a low table, a low chair, and at the foot of the bed a bundle, 
possibly of clothing. The prospect from the window was the 
back yard of the house. The other patient, in a similar room, 
was an old woman with granular lids, who was very talkative and 
demented. 
In a one-story house, I found two women, one middle-aged, 
the other old, both demented. They were in the back yard with TWO DAYS AT GHEEL. 
7 
some of the family, where the woman of the house was washing 
clothes ; the old woman was taking care of a baby. The house 
had but one living-room and the small rooms for the patients 
were off the back side ; everything was squalid. This house and 
the next, in which also there were two women, had a back yard in 
common, so that there were practically four patients in one 
house. One of them, quite an intelligent young woman, was 
doing some washing in company with the first-mentioned family ; 
the other, a woman of middle age, was in her room upstairs ; she 
had been there only a short time and said she preferred it to the 
asylum. The stairs in all these houses are so steep that one can- 
not go up except by holding on to a rope, which hangs beside 
them ; they are more like ladders than stairs. 
In the next house were two women, one middle-aged, the other 
older. The latter showed me her room and that of her com- 
panion, upstairs in the end of the house, with a slanting ceiling 
on one side. The rooms had a bad odor, and were not clean. 
In a poor house were two idiotic women, one eighteen years of 
age, the other thirty-four. They had each been several years in 
the village, and had small back rooms with wooden bars to the 
windows. The younger woman was sitting in a chair with a 
wooden bar across the arms of the chair in front of her; they 
were both in the living-room with the family. 
In a hovel off the main street were two women ; one, an epileptic 
thirty-five years old, was seated at the table with the family ; the 
other, an idiot, was in the corner by the door. The rooms of the 
patients were dirty, and the beds absolutely filthy', they consisted 
of loose straw with a three-part straw bed over it. The only dish 
for their dinner was a sort of vegetable soup. 
In another house were two women, thirty-two and 
years of age ; one epileptic and both thoroughly demented. They 
were restrained in chairs with cross-bars in front of them. In 
another house were two women, one thirty-two and the other 
twenty-four years of age ; the latter was in her third place. The 
first room at the left of the entrance was used as a shop where 
needles, thread and other small articles were sold ; opposite this 
was a sort of sewing room with a machine in it; this room had 
the luxury of a board floor. The older patient was working here ; 
the younger was in her room up stairs ; she was considerably 
excited and noisy, and tried to hold the door against the mistress 
of the house and my guide. Both patients’ rooms were very 
small and it was necessary to pass through one to enter the 
other, the ventilation of which was so poor that the air was well 
nigh intolerable. 8 
TUTTLEI 
In a small, poor house, the front room of which was apparently 
a shop where some pork was lying around on tables, was a man 
seventy years of age, who paid one hundred dollars a year. His 
room was in the attic, and the small window was guarded by iron 
bars; the floor was bare and the room was dirty; one had 
to go through the bedroom of the family to reach it. In another 
small house was a man at work cobbling. It is the custom so to 
assign patients that they can work at their trade if they have one. 
A visit was then paid to an old woman who had her room filled 
with all sorts of gimcracks, which she exhibited with great satis- 
faction. She soon produced a money box for contributions, from 
which one would infer that it was the practice to take strangers 
to her. 
The visit to the country was made in a primitive sort of two- 
wheeled cart, which could boast of nothing in the way of springs, 
over roads that, even in summer, allowed onty a slow trot, and 
which at certain seasons must be well nigh impassable. The 
people are farmers in a small way, having a few acres of land 
which they own or hire, and most of them take insane patients as 
an additional means of livelihood. Their cottages are long and 
narrow, of one story, with a thatched roof; the people live in one 
end and the cows, calves, sheep and goats in the other. The 
floors are laid with large, square brick or tiles, and sanded ; there 
is always a fireplace set between the main room and the cow-house, 
eight or ten feet wide, where they burn peat and cook provisions 
for the family and the cows. There were no apparent means of 
heating the rooms except this one fireplace, though my guide said 
that stoves were set up in winter. Food for the cows is cooked 
in large kettles that can be run out on an iron over-head track to 
the cowhouse, which is next to the living-room ; they take great 
care of their cows, which, as may be seen, are members of the 
family. The living-room, into which one enters directly from 
out of doors, serves for kitchen, dining-room, sitting-room and 
sometimes bedroom, though the more prosperous farmer has a 
separate bedroom and sitting-room. Around the walls on shelves 
are arranged dishes and cooking utensils and there is a good 
clock. 
The rooms for patients are generally in the end farthest from 
the cows. The floor is of brick laid in cement and sanded ; the 
walls are whitewashed in pale blue ; a small window, perhaps 
of four panes of glass, sometimes guarded with wooden or iron 
bars, has the inevitable coarse lace curtain, while a wooden bed- 
stead, straw bed, only fairly clean bedding with a bright-colored 
quilt, a small husk mat on the floor beside the bed, a chair and TWO DAYS AT GHEEL. 
9 
rarely a small table, complete the furniture of the room. There 
are no means of heating except through the other rooms. These 
cottages are smoky, dirty, damp and cheerless, and in their cold 
winters must be uncomfortable dwellings. 
In the first house visited there were, by special permission, three 
women, sixty-six, sixty and forty-two years of age, respectively, 
all considerably demented, poorly clad, dirty and unkempt. The 
first had been in the colony twenty years, the second thirty-one 
years and the third two years. Their small rooms had wooden 
bars to the windows. These wooden bars, so frequently seen, 
are hardly strong enough to prevent a determined effort to escape. 
Seven cows, a calf and a goat were in the room next the living- 
room with but a thin door between. There was a bed in the 
living-room. 
In the next house were two women, both old and demented ; 
one had been there since 1863 and the other, who was seventy-five 
years old, since 1867. The cow-house opened from the living- 
room as usual, and in it were seven cows and five calves. The 
hostess took great pride in showing her establishment, especially 
the cows. The two men at the next house were working and 
were not seen. Their rooms were so arranged that the entrance 
to one was through the other. In the fourth house were two men, 
one of whom was sixty years of age and had been in G-heel for 
twenty-four years; this was his second place; the other had 
been in the colony nine years and had also made one move. My 
interpreter said a change in the boarding place was made if either 
the patient or the family was dissatisfied. One must be allowed 
the privilege of doubting whether the wishes of the pauper patients 
are respected in such matters. Wine and beer were sold in the 
kitchen. 
Soon after leaving this house we met a man, evidently demented 
and considerably excited, who was running away ; a woman was 
holding on to him and trying to induce him to go back, among 
other blandishments taking his cap off and putting it on her own 
head. As we came up to them my guide said something to the 
woman, perhaps telling her to let him alone not wanting me to 
see a struggle, for she did so, but looked as if she thought it was 
a strange proceeding, while the man started off at a rattling pace 
up the road. After a moment of irresolution, looking first at us 
and then at the man who was making good time, she clattered 
after him in her wooden shoes. These women, who work in the 
fields, are quite a match for most men, and they are not prevented 
from using their strength by any ideas of false delicacy or pro- 
priety. 10 
TUTTLE: 
In the next house were two female patients, one past middle 
age a paralytic, the other epileptic and demented. In the next 
house, which was a new one belonging to a young couple who had 
two small children, were two young women, one an epileptic; one 
was rocking a baby and the other was assisting in the housework. 
In the seventh house was an idiotic woman, and an epileptic girl 
of ten years ; the latter paid eighty dollars a year and slept in a 
small bed in the living-room beside the woman of the house. 
In the next cottage were two women ; one, thirty-nine years of 
age, very quiet, was taking care of the children, and the other, 
fifty-one, had been at work in the fields and had come in because 
of a shower ; she was somewhat excited, singing and making her- 
self generally disagreeable. There were five cows and two calves 
in the next room. The hostess, thirty-seven years old, had thir- 
teen living children, the oldest being seventeen years of age. 
This place was particularly dirty ; the rain came in under the 
door and made large puddles on the floor, which was taken as a 
matter of course. 
At the next house were two men who had been at Oheel 
for over thirty years. The table was set; the food was brown 
bread spread with curd, and a brown-colored liquid which 
answered for coffee ; nothing else. The woman of the house was 
sick in bed from a recent confinement, and out of her room, which 
was both sitting-room and bedroom, opened both the rooms of the 
patients. The next place was a small farm of about two and a 
half acres, which supported three cows, two calves, a demented 
man who had been there nine years, and an idiotic boy of four- 
teen, who had made five changes in six years. The rooms were 
of the usual size and the windows had only four small panes of 
glass. In the fifteenth house a woman, blind and paralytic, was 
seated in a chair with a cross-bar in front of her ; she was about 
seventy years of age. There were iron bars to the window of 
her room. 
The seventeenth was a rather larger house ; the living-room 
was a beer shop. Two young men were there ; one was very 
talkative and made considerable disturbance ; perhaps for this 
reason he had twice changed his boarding place ; the other was 
demented and quiet. The last house was in the hamlet of Steelen 
and contained two private patients, at a yearly rate of eighty dol- 
lars. One, who was fifty-one years of age, was in his eighth 
place since 1870 ; he spoke a little English, and managed to tell 
me he did not know why his boarding place had been changed ; 
his room was in the attic. The other was fifty-five years of age 
and in his fourth place since 1875. He was excited, in his room, TWO DAYS AT GHEEL. 
11 
and would not allow the door to be opened. Mention of the other 
cottages visited is omitted, as it would be practically a repetition 
of what has already been said. 
Paying patients are lodged chiefly in the village. A little way 
up the street from the Infirmary, in a very good house, with an 
agreeable hostess, was a melancholy Englishman, who would not 
speak. He was a case of circular insanity and was in a period of 
depression. He had a large corner room, and paid six hundred 
dollars yearly. One would expect him to commit suicide, as there 
was no appearance of careful watching. In the room above him 
was a happy Frenchman, who was amusing himself with photog- 
raphy. His room was in ideal confusion ; the bed was not well 
made, and lying around on the chairs and floor were books, 
papers, dirty clothes, etc. 
In a small brick house of two stories was a hostess, who spoke 
English ; she had two old women, one of whom was ninety-four 
years of age, who came from Holland and had been sixty years 
in the colony ; the other was a dement from Brussels, who spent 
, her time in counting her money. Their rooms, up the usual steep 
flight of stairs, were of good size and very neat and clean ; there 
was an extra bed in the old lady’s room for the nurse. The 
hostess had relatives in the United States and talked with me 
very freely, though she was thoroughly loyal to the colony. She 
explained the system of receiving and boarding out patients, the 
rates paid the family and the sums retained by the board, very 
fully and correctly. She said the doctors visited curable cases 
once a week and chronic cases once a month ; that restraint had 
not been allowed for many years; that patients were given 
liberty according to their condition, which was decided by the 
doctor ; that some were not allowed to go out at all, while others 
walked with the family, and some went about the village by them- 
selves ; that occasionally they did try to escape and in such a case 
notice was given at the Infirmary, and the garde de section looked 
them up and the}7 were then returned to the Infirmary; that some 
one was always at the railroad station to see that no patient went 
away on the train, and there was no place for them to go to except 
into the country where, as a matter of common interest, every- 
body was on the watch to catch and return them ; that occasion- 
ally there was a suicide, but if a patient was known to be suicidal 
he was not even kept in the Infirmary, but was sent at once to 
another asylum ; that patients often got excited, but the families 
were accustomed to it and returns to the Infirmary for this cause 
were not at all frequent; and that patients were not allowed in 
the beer shops of the village. 12 
TUTTLE: 
In a comparatively new house of two stories were two young 
men twenty and twenty-two years of age, who had been there 
three and five years respectively, and who paid one hundred 
and sixty and one hundred and eighty dollars a year, the one 
paying the smaller sum occupying a room in the attic. The 
chambers had bare white walls and unpainted floors with a two- 
ply rug by the bed. The hostess kept a dry goods shop on the 
lower floor, and on this floor were two comfortable sitting-rooms, 
in one of which was a piano. Both the patients were out, and it 
was said that they could go where they liked in such a way that 
my inference was that all patients had not this privilege. 
In a bakery, opposite the church of St. Dymphna, were two 
boys fifteen and nineteen years of age. The former, who was out 
of doors, had been there but a short time ; the latter, something 
over two years. They both paid two hundred and forty dollars. 
The older youth was working in the bakery ; he came when called, 
dressed in baker’s cap and apron, and had evidently been working 
in earnest. He was good-looking and quite intelligent, but did 
not seem in good humor, and made some remarks, for which the 
hostess and my guide remonstrated with him. The patients’ 
rooms were of moderate size, with papered walls, fairly well fur- 
nished and with the usual two-ply rug on the floor. 
In one of the better houses of the village I found a woman 
forty-five years of age, who had been in a closed asylum for 
twelve years before coming to Gheel. At the time of my visit 
she was occupied in knitting. She was evidently considerably 
demented, and the hostess said she was sometimes excited. There 
were strong iron bars to the windows of her room, which was up 
one flight, of small size, with papered walls, and a poor, thin rug 
on the unpainted floor. The ground floor was divided into a shop, 
two sitting-rooms, in one of which was a piano, a dining-room, 
and kitchen. The home of my interpreter of the second day, and 
an English dement, was one of the better houses of the village. 
One paid three hundred, the other three hundred and sixty dol- 
lars. Both rooms were large and quite well furnished. By day 
they lived with the family below. 
In a house of fair appearance were two women : one, past 
middle age, was in the kitchen holding the baby ; the other, an 
English woman of perhaps thirty-five years, was in the sitting- 
room ; she was said to be quite an accomplished musician. Sim 
said she had been in the village seven years ; that she came for a 
few months only, and would like to go back to England ; that as 
regarded liberty she could go to church alone, to be sure, but she 
found the life monotonous; that the house was smaller than she TWO DAYS AT GHEEL. 
13 
was accustomed to live in and the piano was very poor. She was 
considerably demented, and talked rapidly and in a low tone. 
Her rate was one hundred and sixty dollars. 
The house of the apothecary was large ; the hall floor was laid 
with marble; it was well finished and furnished. There was 
one woman here who had an excellently furnished bedroom up 
one flight, and a large sitting-room a few doors away to be used 
in common with another patient when she might come. It was 
noticed that the patient had the freedom of the apothecary’s 
shop. 
In a house of large size opposite the old church in the main 
square my interpreter said there were “ two beautiful ladies.” 
The hostess was a very pleasant appearing woman, with great 
tact and patience. On the left of the entrance was a large sitting- 
room or parlor with bare, unpainted floor and a moderate amount 
of furniture ; the wall-paper was of the old style, representing the 
houses and streets of a town. One of the ladies, thirty-one years 
old, came in without invitation ; she showed her exhilaration by 
her manner, conversation, and dress. When quiet she had a 
large bedroom up one flight, with papered walls, unpainted floor, 
a two-ply rug and a fair amount of furniture. Just at that 
time, being excited, she was occupying a small room in the rear 
of the house, in the wall of which over the bed she had broken a 
large hole ; she paid four hundred dollars. While we were in the 
garden she came running out with her case-book, which had been 
accidentally left on the table ; my guide was obliged to join in the 
chase and assist in its recovery. The other patient, nineteen 
years of age, had been there something over a year and paid six 
hundred dollars. She occupied a small room, in which were two 
beds, as she was afraid to sleep alone ; she was walking quietly in 
the garden. When the patients were in this large garden, which 
was in the rear of the house, some one was always present to 
watch them and it was the custom to lock the front door and 
hide the key. 
In the administration of affairs the medical inspector has the 
entire charge of the Infirmary and resides in a cottage on the 
grounds. He makes one daily visit. He also has direction of 
all the medical work and is expected to see every patient in 
the colony at least twice a year. To keep himself informed of 
the progress of affairs he has a daily morning report from each 
of the six supervisors, and a written weekly report from each of 
the four assistant physicians ; and the medical staff have monthly 
meetings for conference. 
The assistant physicians also live in the main village and thus 14 
TUTTLE: 
are obliged to make long drives in visiting some of their patients ; 
they see all acute cases each week and chronic cases once a 
month. Dr. Peeters had advised the location of some of the 
assistants in the outlying hamlets, but this had not been done. 
The superintendent has a yearly salary of fourteen hundred dol- 
lars ; the first assistant physician is paid twelve hundred ; the 
second, a thousand; the third and fourth, four hundred and sixty 
dollars, with lodging for each ; and the supervisors two hundred 
and sixty dollars without lodging. Both physicians and super- 
visors record the date of their visits in a small book kept for each 
patient by the family. This book has on the outside the number 
of the patient; on the inside a page is devoted to name, date and 
place of birth, residence, date of coming to the colony, etc., in 
short, a brief history ; the next page shows the name of family 
and street, date when the patient came, and changes of residence ; 
there usually follow several pages of lists of clothing furnished 
by the asylum, for which purpose my guide said nine dollars a 
year could be expended for poor patients. The remainder of the 
book is devoted to records of visits by doctor and supervisor, 
the doctor’s always in pencil, “ Vu le, etc.” followed by ini- 
tials,— while the supervisors used a stamp with the date only. 
The most of the books seen showed medical visits of about once 
a month. The treatment is chiefly moral and great dependence 
is placed on occupation. 
Some of the advantages of this system of caring for the insane 
are separation from their families and change of scene without 
such a decided change in their usual manner of life ; the good 
effects of home life, such as the presence of children and associa- 
tion with sane people, instead of with perhaps sicker, more filthy 
and more demented patients ; the greater variety of occupation 
that can be supplied ; and above all, freedom. All who are able 
are expected to work ; both men and women labor in the fields ; 
the men sometimes being paid ten, or if they are very indus- 
trious twenty, cents a week; while “the women are given 
some sweets” as an inducement to their more active assistance. 
It is said that seventy-two per cent, are employed. They 
certainly have little protection against the avarice or neces- 
sity of the farmer, who may be disposed to get all he can 
out of them. There is no rule in regard to the number of hours 
of work. Dr. Peeters said that in some closed asylums six hours 
was the rule, in others seven. He thought that at Gheel the time 
for work might be made even longer, especially in summer when 
there is so much more to be done. He said it was a “ difficult” 
matter to regulate, but they did the best they could ; that they TWO DAYS AT GHEEL. 
15 
knew the persons who would be likely to exact too much, and that 
the doctors and supervisors kept as close a watch as they could. 
As to freedom, Dr. Bulckens said that nine tenths of the insane 
at Gheel were entirely free, while Dr. Peeters, in his book,* says 
that all are free and then begins to make exceptions. If a man 
shows a desire to escape, he is not allowed to go about the streets, 
to work, or to church alone, but always with some one of the 
family. He is watched, as the Doctor skilfully puts it, not to take 
his libert}7 from him, but to prevent its abuse. He said that they 
did “ not like to have young women walk in the fields alone;” 
they could go to church, but as a rule it was expected that some 
one should accompany them when they went out. He illustrated 
by saying that the restrictions for all patients were such as a 
mother would use for her children and that, except where the 
relaxing of surveillance would be a crime, the insane were per- 
fectly free. None are allowed, however, to go beyond the limits 
of the village without special permission. 
As to mechanical restraint, he is inclined to think “non-restraint” 
a dream, the complete realization of which is impossible, but that 
at Gheel they come nearer to it than Conolly did. When he took 
charge in 1875, sixty-four out of eight hundred were wearing fet- 
ters or hobbles, (anklets connected by a chain), to prevent escape ; 
now the amount of restraint is slight; no one wears the fetters. 
He said one woman constantly wore mittens because of destruc- 
tive habits, and occasionally the cottagers applied the belt with 
mittens or the camisole, but only on medical prescription ; and 
that one must remember, on seeing several cases at the Infirmary, 
that here were collected the worst cases in the colony, as prac- 
tically only so many out of the whole number were restrained. 
Some try to escape, but if repeated attempts are made the rule 
of sending to a closed asylum is quite strictly enforced. The 
escapes for a series of years are as follows : in 1876, eight; in 
1877, fourteen; in 1878, seven; in 1879, six; in 1880, seven; in 
1881, fourteen; this compares very favorably with some of our 
large asylums. Most of the escapes happen on Sunday or a 
holiday, when the family relax their vigilance. It was said that 
various misfortunes occurred, but that serious accidents were rare, 
and Dr. Peeters thought that in this respect Gheel would compare 
favorably with closed asylums. It is doubtful if visitors can ever 
learn the exact truth about such matters. Since the hole or nour- 
ricier is responsible for the conduct of his patients and for acci- 
dents, it is a question whether the medical inspector hears of many 
* “ Gheel et Le Patronage Familial.” TUTTLE: 
ol the lesser occurrences, but one cannot for an instant think 
that an accidental death, a homicide, suicide or a serious attempt 
at either, an illegitimate birth, or a fire could occur without the 
knowledge of the authorities. 
A complete account of such accidents cannot be given and they 
probably are not recorded. Dr. Peeters in his book says there 
were three accidents in one year; a man got drunk, fell into the 
canal and was drowned ; a woman wandered away and fell into 
the water not a hundred steps from the door of the house ; and a 
paralytic patient escaped on a cold night and was frozen. In 
1878, a woman was killed by accident. It is said that there have 
been in all but three homicides, the last of a burgomaster in 
1844. Unsuccessful attempts have been made ; in 1878 a man 
struck with a scythe a young woman with whom he was working 
in the fields, but the injury was not fatal; this was the only case 
of .which Dr. Peeters had had personal knowledge. 
Between June Ist, 1875, and November 28th, 1879, there were 
three suicides. Dr. Peeters said that some years there were none, 
that this year they had been unfortunate, having had two ; that 
neither of these patients was considered suicidal. He was 
inclined to see what could be done in families with the actively 
suicidal and had just located one such patient in the village. He 
said that an illegitimate birth formerly occurred about once in 
five years, but that there had been two in the last three years ; 
in one case an inhabitant of Gheel was the father, while tire other 
woman escaped and became pregnant outside the commune. 
He also said that as the village increased in size the morality 
diminished and that people of bad character came to the place, 
over whom the asylum had no authorit}?. It appears that Antwerp 
and Brussels, continuing a former practice, still send what are 
known as “free boarders” to Gheel, many of whom are really 
insane and need surveillance. It is a matter of economy for 
these cities of eleven per cent, in the price of board. In 1880 
one of these “ free boarders,” an imbecile man, was found to be 
corrupting the morals of the children ; another was sent to prison 
for some months for attempting to violate an insane woman in 
open day, and a woman became pregnant by another free boarder, 
and on the birth of the child killed it. The doctor very properly 
makes a strong plea to have these people put under the care of 
the asylum if sent to Gheel. 
From 1850 to 1880 no fire occured that could be proved to have 
been caused by the insane. There was one in the latter year. 
As to the results of the treatment at Gheel: One always 
receives figures showing percentages of cures in asylums or hos- 17 
TWO DAYS AT GHEEL. 
pitals with considerable allowance. They are merely opinions at 
the best and one needs to know the man who forms them in order 
to make a proper estimate of the correctness of his conclusions. 
What special motive has he to make a favorable showing? In 
the general hospitals, so far as my observation goes, nearly every 
patient that can walk out is discharged “recovered,” and one 
need not go back many years to find from sixty to one hundred 
per cent, of recoveries in those discharged from the asylums for 
the insane ; one therefore places little dependence on statistics 
showing recoveries at Gheel. Dr. Bulckens for a period of fifteen 
years, from 1860 to 1875, gives a proportion of recoveries of 
twenty-five per cent, of all admissions. To one who knows what 
class of patients are received this estimate seems manifestly too 
high. Dr. Peeters, considering all admissions from 1853 to 
1870, makes twenty-four per cent, of cured and relieved, which 
appears to be a much more reasonable conclusion than that of 
his predecessor. Out of thirteen hundred and thirty-five resident 
insane and three hundred and thirteen admissions, he dis- 
charged forty-eight “cured” in the year 1878. Because 
of the rule excluding excited and suicidal patients Gheel is 
cut off from many curable cases. A very large proportion 
of those resident in the colony are hopelessly insane and, 
according to his statement, nearly seventy per cent, are con- 
sidered incurable at time of admission, as most of them are the 
overflow from the closed asylums. His estimate of the admis- 
sions of the year 1878 is as follows : four and seven-tenths per 
cent, curable; twenty-eight and one-tenth per cent, doubtful; 
sixty-seven and two-tenths per cent, hopeless. The deaths each 
year from 1860 to 1875 are variously reckoned from five to ten 
per cent., calculated upon the number in the colony the first day 
of January. 
Gheel was never so prosperous as it is to-day under the able 
management of Dr. Peeters, who believes thoroughly in the sys- 
tem, but is not blind to its defects. During his administration of 
affairs the medical service has been reorganized, the number of 
patients has largely increased, and their accommodations have 
been improved. Though one finds much to criticise, Gheel should 
be by no means wholly condemned. Dr. Tucker,* who made his 
visit in the winter, in order to see the worst, formed a very 
unfavorable opinion, which he forcibly expressed as follows: 
“ Gheel is an abode of desolation, a lingering survival of remote 
and barbarous ages, a monstrosity in this nineteenth century, and 
* “ Lunacy in Many Lands.” 18 
TUTTLE: 
a humiliating reproach to our modern civilization.” It is not in- 
deed a place where a person of refinement and education could be 
contented and some of the patients from other countries, notably 
England, would be better off at home ; but Dr. Tucker apparently 
confounds the system with the civilization and poverty of the 
people, and had he gone to some of the neighboring places he 
would no doubt have found them living as they do at Gheel. 
It is true that even if the families take as good care of pauper 
patients as circumstances will permit and give them the best the 
house affords, still much is left to be desired in the way of com- 
fort, cleanliness, ventilation and other matters of sanitary value. 
Some important questions also have reference to the kind treat- 
ment of the patients and the regulation of the amount of work 
that may be exacted. With regard to these matters the safety 
of the patients rests largely in the character of the people with 
whom they live ; their supervision is most certainly inadequate. 
The garde de section, who was my guide, visited acute cases in 
his district each week and chronic cases each two weeks. Visits 
of physicians, as has been said, are once a week for curable and 
once a month for chronic cases ; thus the families are left largely 
to themselves, and the certainty of securing kind treatment and 
the regulation of the work of patients are not only “difficult” 
but impossible, so far as supervision is concerned. To be sure, 
kind and proper care is not always secured by espionage and it 
may be that the patients are as well treated as they would be by 
the nurses in a closed asylum, and perhaps also quite as well as 
if in their own homes ; for it must be said that relatives are not 
always to be commended for the kindly care which they give the 
unfortunate members of their families, and that superintendents 
of closed asylums have not yet reached the point where they can 
feel entirely safe concerning the care of their patients. 
The essential qualification of a hote, nourrider, or nurse is a 
kindly, patient disposition, and to this should be added intelli- 
gence which has been well instructed. Certainly there were some 
at Gheel who appeared well fitted for their work, but only an 
intimate knowledge of the people would enable one to give a com- 
petent opinion on such a matter. 
To one accustomed to make visits twice daily on all cases, 
acute and chronic, the rule for medical visits at Gheel seems lax 
indeed, and it must be presumed that visits to certain sicker 
patients are made when necessary and at the discretion of the 
phvsician. 
The liberty which these people enjoy is not as absolute as some 
suppose ; it, is just what one might expect it to be, what it always TWO DAYS AT GHEEL. 
19 
must be, viz., according to the condition of the patient. But this 
relative amount of liberty is a great satisfaction to those who 
have sufficient intelligence to appreciate it, and certainly no sick 
person should be deprived of as much freedom as he can have 
with safety to himself and others. The thoroughly demented 
and idiotic at Gheel should be sent to a closed asylum; liberty is 
nothing to them ; a bathtub would be infinitely more. 
No one claims that all insane can be cared for in this way; the 
ordinary asylum must still continue to receive the great mass of 
pauper patients in all countries, especially during the acute stage 
of the disease, hut with a proper selection of cases and of families, 
and with proper supervision it is a very good way to care for a 
small class of the insane.