NATIONAL LIBRARY OF MEDICINE
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           ACCOUNT
               OF

  THE RISE. AND PROGRESS


     THE  ASYLUM,
Proposed to be Established, near Philadelphia.
              FOR THE
        RELIEF OF PERSONS
   DEPRIVED OF THE USE OF THEIR REASON.
              WITH AN
       ABRIDGED ACCOUNT^r^,
                OF     >  1

    THE   RETREL
                              JR\,
A SIMILAR INSTITUTION NEAR YORK, IN ENGLAND.
       PHILADELPHIA:
PUBLISHED BY KIMBER AND CONRAD,
      WO. 93, MAHKKT STREET.
        Merritt, Printer.

           1814. 
 
ACCOUNT, &c.
AT  the annual meeting  of  the  Contributors
to the Asylum for the Relief of Persons depriv-
ed of the use of their Reason, held in the Third
Month, 1814, an Account  of the Rise and Pro-
gress  of the Institution was directed to be pub-
lished, for the information of Friends.
   Proposals were  made to the Yearly Meeting
in 1811, from two of the Quarterly Meetings,
"to make provision for  such  of  our membtis
as may be deprived of  the  use of their reason ;"
the consideration  of which subject  being refer-
red to a committee, they nv.ule a report thereon J
which was adopted  by the meeting in  the  suc-
ceeding year.   And the following plan  and  pro-
posals were spread  amongst  Friends in conse-
quence of this conclusion.


       PLAN OF AN  ASYLUM,

For the Relief of Persons  deprived of the
             use of their Reason.

   THE Committee appointed  by the Yearly
 Meeting, held at  Philadelphia,  to take under
 consideration the subject respecting a provision 
4
for such of our members  as  may be deprived
of the use of their Reason, reported,
   " That, considering the peculiar circumstan-
ces of this  afflicted class of  our members, as
well as the  relief of their families  and friends,
they believed that  the  establishment proposed,
under direction of such members of our Yearly
Meeting as might be willing to contribute there-
to, would be beneficial."
   And the Yearly Meeting having adopted this
Report, in the Fourth Month last, a number
of Friends met at Philadelphia to deliberate on
the most suitable means of carrying the  same
into effect.  They have accordingly agreed upon
a  Plan, and form  of  Subscription Papers, the
distribution  of which  was committed to the fol-
lowing Friends :
   Thomas Scattergood,  Emmor Kimber,
   Jonathan Evans,      Thomas Wistar,
   Ellis Tarnall,         Samuel Poxvel Grifjitts.
   Isaac Bonsall,
   It appears very desirable that an  institution
should  be formed, in  a retired situation, with
the  necessary medical assistance, and wholly
under the care and notice of Friends, for the
relief and accommodation of  persons  thus af-
flicted ; including members and professors with
us, of every  description, with  respect to  pro-
perty.  This would serve to alleviate the anxie-
ty of their  relatives, to tranquillize the  minds
of the afflicted  in their  lucid intervals, and
would, moreover, tend to facilitate their reco-
very.
   It  is therefore  proposed,  that, if proper en-
couragement be  given, a  sufficient quantity of 
                       5

 land  he purchased near  Philadelphia,  and a
 building erected  thereon, which may accommo-
 date, at least, fifty persons.
   The institution to be established and support-
 ed by legacies, donations, and subscriptions; to
 be promoted amongst Friends.
   Any  Monthly Meeting,  belonging to  our
 Yearly  Meeting, contributing two hundred dol-
 lars,  and every  individual subscribing ten dol-
 lars per annum, or  fifty dollars at one time ; be-
 ing and continuing a member of our religious
 society, shall be  considered members of the in-
 stitution.
   All annual subscriptions under ten dollars, or
 sums contributed under  fifty  dollars,  shall be
 considered as donations.
   The members shall meet,  annually,, at  Phila-
 delphia,  on  the fourth day preceding  the third
 Sixth-day of the week, in the Third Month, and
 choose,  from amongst the subscribers, members-
 of our Yearly Meeting, twenty persons as a com-
 mittee to manage all the affairs of the institu-
 tion.  At these annual meetings, a report of the
 last year's proceedings shall be produced by the
 committee.   Every Monthly Meeting contribu-
 ting as above, shall have the  right of appointing
 an agent, who may appear and act on their be-
half at these meetings.
   Every Monthly Meeting which has  contribu-
ted two hundred dollars,  and every individual
 who has  contributed  fifty dollars, whilst con-
 tinuing a member of our religious society, may
recommend one  poor patient,  at  one  time, on
the lowest terms  of admission.
   It is believed that the establishment  of  an in-
 stitution of this  kind will  meet with the gene-
                      A.2. 
                      6

ral  approbation  of Friends ;  and they are ac-
cordingly invited to contribute their aid, as it
embraces all classes of the society, and is  meant
to afford relief in one  of the most distressing
maladies that human nature is subject to.
  The first  general meeting of the subscribers
will be held  in  Philadelphia, at the Mulberry
Street meeting house,  at seven  o'clock  in the
evening, on the fourth  day of the week preced-
ing the next Yearly Meeting.
  Jonathan  Evans, of Philadelphia, will re-
ceive the contributions until a  treasurer is ap-
pointed.
  Philadelphia, Twelfth Month, 5th, 1812.

  In pursuance  of these  proposals, the  first
Meeting of the  Contributors was held in  Phila-
delphia, on the  fourteenth  day  of the  Fourth
Month  1813, and at the next  meeting  in the
Sixth Month, the following  Constitution  was
adopted.

           CONSTITUTION.

  We the subscribers,  members of the Yearly
Meeting of  Friends  held  in  Philadelphia, de-
sirous to provide for the suitable  accommoda-
tion of that afflicted  class of our fellow mem-
bers and professors with us, who are or may be
deprived of the  use of their reason, as well as
the relief of their families and friends ; have as-
sociated for the purpose of establishing an Asy-
lum for their reception,  which  is intended to
furnish,  besides the requisite  medical aid, such
tender sympathetic attention and religious over^
sight, as may soothe  their agitated minds and 
7
thereby,  under  the divine  blessing,  facilitate
their restoration to  the enjoyment of this inesti-
mable gift.  For which  purpose the following
articles of association have been agreed upon.

                ARTICLE I.

  The Association shall  be known by the name
and  title of " the Contributors to the  Asylum
for the Relief of persons  deprived of  the use of
their Reason."

               ARTICLE II.

  Any Monthly Meeting belonging to the Year-
ly Meeting of  Friends  held  in Philadelphia,
contributing two hundred dollars, and every in-
dividual  subscribing ten  dollars per annum, or
fifty dollars at one time, and  being and con-
tinuing  members  of the  Religious  Society of
Friends, shall be considered members of this
Association ;  and a Monthly Meeting so con-
tributing,  shall  have the right to appoint  an
agent, who may appear and act at the meetings
of the Association on their behalf.

               ARTICLE  III.

  The contributors shall meet annually, at Phi-
ladelphia,  on the Fourth-day preceding the third
Sixth-day  of the week in the Third Month, and
choose from amongst themselves twenty Mana-
gers, a Treasurer and Clerk j who shall continue
in  office for one year, and until others shall be
appointed. They shall also transact at this meet-
ing such business of the Institution as may appear
necessary. 
8
               ARTICLE  IV.

  The  Managers shall meet at least once  in
every month, and  eleven of them  shall be  a
board to transact business.   They shall appoint
one  of  their number  to  act as  Clerk.   They
shall  choose and appoint the physicians :  they
shall also appoint the superintendant and matron
of the Asylum,  and prescribe their duties, and
shall have the controul of all other officers and
assistants whom it may be necessary to employ
in the service  of the  Institution.  They  shall
fix  the  salaries  of  the persons  employed, and
the  rates to be paid for patients;  and all monies
drawn from the Treasurer shall be by  their or-
der, and signed by the  Clerk, which orders  shall
be his vouchers. They shall make  such rules
and  regulations for the domestic and general
government of the  establishment, as may from
time to  time  appear requisite.  The  minutes of
their  proceedings,  with a summary  statement
thereof, shall be laid before  the contributors at
their annual meeting in the Third Month.  They
may call  special meetings  of the association,
whenever, in their judgment, it appears  neces-
sary.

               ARTICLE  V.

  The Treasurer shall  receive all the monies of
the  Institution,  and pay them to the orders  of
the  Board of Managers ; who shall examine and
settle his accounts, and produce the same to the
annual meeting of the  Association in the Third
Month.   He shall keep regular accounts, to be 
9
at all  times  subject to  the  inspection  of the
Board of Managers.

              ARTICLE  VI.

  Every Monthly Meeting which has contribu-
ted two  hundred dollars, and every individual
who has contributed fifty dollars in one payment,
whilst continuing a member of the religious so-
ciety of  Friends, may recommend one poor pa-
tient at one time  on the lowest terms of  admis-
sion.   Application for admission  shall be made
first to one of the Physicians for examination,
and then to the  Managers; or to such of them
as they may appoint for that purpose, by whom
all  orders  for admission shall be granted; and
when they find it difficult to  agree on the pro-
priety of admitting the applicant,  the case  shall
be referred to the decision  of   the Board  of
Managers.

              ARTICLE VII.

  The estate  of  the Contributors, acquired for
the  purposes of this Institution, shall be convey-
ed to twelve of their number to be held in trust,
who shall be appointed at an  annual or special
meeting of the Association.

             ARTICLE  VIII.

  No alteration in these Articles  shall be made
except at a stated Annual Meeting of the Asso-
ciation.  And no change shall at any time  be
made which shall infringe on the right  hereby
vested in Monthly Meetings, or individuals, to 
10
recommend patients on the lowest terms of  ad-
mission.

  A tract of land about five miles distant from
Philadelphia, and  one mile westward of Frank-
ford,  containing  fifty two acres, has been  pur-
chased, and  the  premises conveyed to twelve
of the Contributors in trust for the  Institution.
The land  is of good quality, in an  high and
healthy situation, with a considerable proportion
of wood and well supplied with water.
  A Committee, in conjunction with the Mana-
gers,  is entrusted with the charge  of erecting
the requisite buildings as soon  as  practicable.
And it appears by the report of this  Committee,
that such progress has been  made in procuring
materials and engaging workmen, that the house
will probably be carried up  and roofed, in  the
early part of the ensuing  autumn.
  A view of the proposed  building is  prefixed
to the  present publication.   The unavoidable
extension of the front, arises from the necessity
of affording comfort and convenience to the  pa-
tients, by procuring a free admission of light and
air.  This important consideration will lead, in
the first instance,  to  more expense, hut we do
not doubt will be  fully counterbalanced by  the
advantages resulting from it.
  A list of Contributors,  and  a statement of the
amount of Contributions  and  Donations, as  far
as they have been ascertained, is subjoined.
  Although the subscriptions already made af-
ford a satisfactory evidence of the interest gene-
rally taken in this Institution, yet we look for-
ward with a degree of confidence, in the contin-
ued liberality of Friends,  to assist in carrying on 
11
and  completing  the intended  design.   Our
Treasurer, John Hallowell, of Philadelphia, and
the Agents of the Monthly Meetings, will  re-
ceive the subscriptions and donations of  Meet-
ings and individuals : and the following form of
a legacy is recommended to those who may be
inclined to make bequests, by will.

          FORM OF LEGACY.

   / give  and bequeath  to  A. B. and B. C. in
trust for the use of an Institution near Philadel-
phia, known by the name  of " The Contributors
to the Asylum, for the relief of Persons deprived
of the use of their Reason" the sum of
                            to  be  paid  by the
said Trustees to the Treasurer, for the time be-
ing, of the said Institution.
 MONTHLY MEETINGS THAT HAVE SUBSCRIBED
              TO THE ASYLUM.

Philadelphia Monthly |Samuel B^
  Meeting,          J              '  s
Ditto, for the North-jJh Scattergood.
  em District,       J
Ditto, for the South-1 wmiam Evans,
  era District,       J
Radnor,               Joseph George.
Exeter,               Thomas Lightfoot.
Abington,             John Moore.
By berry,              Ezra Townsend.
Horsham,             Gove Mitchell.
Gwynnedd,           * # * * # *
Solebury,             Oliver Paxson.
Wrightstown,          John Watson, jr. 
12
Middletown,
Falls,
Chester,
Darby,
Goshen,
Concord,
Wilmington,
Uwchlan,
Kennet,
London Grove,
Fallowfield,
New Garden,
Duck Creek,
Evesham,
Haddonfield,
Chester, N. Jersey,
Woodberry,
Pilesgrove,
Salem,
Maurice River,
Wm. Richardson, jr.
John Brown.
Francis Wisely.
Edward Garrigues.
Jonas Preston.
William Trimble.
Evan Lewis.
Isaiah  Kirk.
Edward Temple.
Joseph  Pennock.
Isaac Pennock.
Enoch Lewis.
Daniel Cowgill.
Joseph  Gardiner.
Joseph  Kaighn.
John Collins.
Paul Cooper.
David Tatum.
William F. Miller.
Isaac Townsend.
CONTRIBUTORS TO  THE  ASYLUM.
Charles Allen*
Joshua Ash.
William Abbott.
Joel Atkinson.
John B. Ackley.
Samuel  Austin.
Andrew Ashton.
Isaac Bonsall.
Samuel Bettle.
Clement  Biddle, jr.
Titus Bennett.
John Biddle.
Philip S. Bunting.
Joseph Bacon.
William  Brown.
Thomas  Barnes.
Jacob Ballanger.
  * The Persons whose residence is not particularly desig-
nated, live  within the limits of the  Philadelphia Monthly
Meetings. 
13
Edward Bonsall.
Henry Bowman, Rad-
  nor  Monthly Meet-
  ing.
John F. Bunting, Dar-
  by.
Joseph Bassett, Salem.
John Bishop.
John Cooke.
Caleb Cresson, jr.
John E. Cresson.
James  Cresson.
John H. Cresson.
Joseph Cresson.
Joseph Crukshank.
Caleb Carmalt.
Solomon W. Conrad.
Charles Comly.
Sharon Carter.
Angus Cameron.
Samuel Canby, jr.
Joseph Clark.
Samuel Canby,   Wil-
  mington.
William Carpenter, Sa-
  lem,
Ann Dawes.
Benedict Dorsey.
Sally  N.  Dickinson,
  Wilmington.
Jonathan Evans.
John Elliott.
Daniel Elliott.
Joshua Emlen.
Elizabeth Evans.
Anne Emlen.
Hannah Elliott.
Cadwalader Evans.
John C. Evans.
Joseph Evans.
David Evans, jr.
Jonas Eyre, Chester.
Samuel  Emlen, Bur-
  lington.
William Folwell.
Charles C. French.
Jonathan Fell, jr.
Esther Fisher.
John Folwell, Burling-
  ton.
Nathan Dunn.
Benjamin Davis.
Isaac Davis.
Evan Davis.
Elizabeth  and  Anna
  Guest.
Samuel P. Griffitts. 
14
Philip Garrett.
Stacy Gillingham, Ab-
  ington.
William Garrigues.
Edward  Garrigues,
  Darby,
William Gibbons, Wil-
  mington.
George W. Gibbons.
Samuel Griscom.
Robert Haydock.
William Haydock.
John Hallowell.
Eden Haydock.
Samuel Haydock.,
Samuel E. Howell.
Benjamin Hornor.
Abraham Hilyard.
John G. Hoskins.
William Hallowell, jr.
Ephraim Haines.
Joseph Hartshorne.
John Hutchinson.
Richard Humphreys.
Israel Howell.
Hannah HoUingsworth.
Nathan Harper, Abing-
  ton.
John Hunt, Darby.
Benjamin Johnson.
Jacob Johnson.
Josiah Johnson.
Benjamin Jones.
Jacob Justice.
Isaac C. Jones.
George  Justice.
Joseph Justice.
Isaiah Jeanes.
David Jones.
Thomas C. James.
Jesse Jones, Uxvchlan.
Rowland Jones, Bur-
  lington.
Emmor Kimber.
Thomas Kimber.
Thomas Kite.
Joseph Kirkbride.
George Knorr.
William Kinsey, Ab-
  ington.
Samuel Lippincott.
Joshua Longstreth.
Isaac T.  Longstreth.
Susanna Longstreth.
Samuel Longstreth.
Samuel N. Lewis.
Hannah Lewis.
Hannah Lewis, jr.
Mary Lewis.
Mary Lisle. 
Margaret Lisle.
Thomas Loyd, jr.
John Lancaster.
Moses Lancaster.
Joseph Lea.
Jonathan Leedom.
Clement Laws.
Ludawick Laws.
Isaac Lawrence.
Thomas Lee, Exeter.
Martha  Lancaster,
  Falls.
Thomas Lea, Wilming-
  ton.
Evan Lewis, Wilming-
  ton.
Ann Latimer, Wilming-
  ton.
Abraham Lower.
Thomas Martin.
James Martin.
Anne Mifflin.
Sarah Moore.
Israel Maule.
Gabriel  Middleton.
Samuel  Middleton.
Stephen Maxfield.
Isaac W. Morris.
John Morton.
Aaron Musgrave.
Thomas W. Morgan.
Lloyd Mifflin.
Phebe Morris.
5  \

 Ann Mifflin.
 Richard  M'llvaine,
   Darby.
 Hugh M'llvaine, Dar-
   by.
 John M'llvaine, Ches-
   ter.
 Josiah Miller, Salem.
Joseph P. Norris.
Thomas Norton.
Samuel Noble.
Martha Newbold.
John  Newbold,  Ches-
  ter.
James Oldden, jr.
Elliston Perot.
John Paul.
Joseph M. Paul.
Isaac Pearson.
Abraham  L. Pennock.
Joseph Parrish.
Joseph Price.
Caleb Peirce.
Isaac Paxson.
William Paxson.
Thomas Parker.
Joseph  Parker. 
16
Edward Parker.
Sarah Pennock.
Abigail Physick.
Sarah Pcmberton.
Henry Pemberton.
William Penrose.
William Price.
Thomas W. Pryor.
Isaac  Peirce.
George Pryor.
Ann P. Paschall, Dar-
  by.
Levis Passmore, do.
Samuel Painter, Con-
  cord.
Robert  L.  Pitfield,
  Burlington.
Joseph Rotch.
Joseph Ridgway.
Nathaniel Richardson.
Joseph Richardson.
William R. Rodman.
Edward Randolph.
George F. Randolph.
Jacob Rodgers.
John Richardson.
George W. Robinson.
Rachel Richards.
Samuel Richards, S. S.
Thomas Scattergood.
Joseph Scattergood.
James Smith.
Abel  Satterthwaite.
Isaac  Smedley.
John  D. Smith.
George R. Smith.
Joseph Sansom.
James Sellers.
Daniel Smith.
Stephen Simmons.
James Starr.
James Starr, jr.
Caleb Shreve.
Leonard Snowden*
Samuel Smith.
Joshua Sharpless, jr.
Mary Starr.
Richard Sermon.
James Sleeper.
John Simmons.
Charles E.  Smith.
Samuel Story.
Samuel Smith.
Samuel Shinn.
Joseph Shoemaker.
Nathan Smith.
Edward Simmons, jr.
Stephen W. Smith.
Abraham    Sharpless,
  Concord.
William Seal, Wilming-
  ton,
Samuel Swayne, Lon-
  don-Grove.
Samuel Shoemaker.
Stephen Smith, 
17
Jonah Thompson.
John Tomlinson.
Benjamin Tucker.
Charles Townsend.
Joseph Thomas.
Jonathan Thomas.
James Truman.
Joseph Trotter.
Nathan Trotter.
Isaac Thomas.
John   R.    Thomas,
  Uwchlan.
Joseph  Tatnall,  Wil-
  mington.
James Vaux.
Roberts Vaux.
Ann Vaux.
Nicholas Wain.
Thomas Wistar.
Caspar Wistar.
Barthlomew Wistar.
Sarah Wistar.
Hannah Wistar.
Edward Wilson.
George Williams.
Jonathan Willis.
William Wilson.
Joseph White.
Joseph Warner.
William Widdifield.
Hannah West.
Thomas Williams.
George Woolley.
Benjamin Williams.
Alexander  Wilson.
John Ware.
Charles Wharton.
William Wharton.
Jacob S. Wain.
Nicholas Wain, jr.
Elizabeth Wain.
Phebe  Wain.
Reed Williams.
Jesse Waterman.
Samuel West, Chester.
William Wright, Sads-
  bury.
Thomas Webster,  Ab-
  ington.
Jesse  Walton,   do.
Joel Woolman,  do.
Isaac Whitelock, do.
Yeamans  Gillingham,
  do.
Nathan   Shoemaker,
  do.
John Wistar, Salem.
 Ellis Yarnall.
 Nathan Yarnall.
 Benjamin  H. Yarnall.
 William Yardley.


 Henry M. Zollickoffer.
2 
18
      CONTRIBUTIONS AND DONATIONS.

  The Treasurer has received,
  In  contributions from. Monthly
Meetings                           $5,995 75
  In contributions from members of
the  Institution                      17,040 00
  Donations from individuals          1,135 00
Amount.       24,170  75
  The following sums of  money
have  been paid by the Treasurer.
  For fifty-two acres of
ground,                 6,764  06
  On  account  of the
building, &c.            2,041  04
  Balance remaining in
the  Treasurer's hands,
Third Month, 12th, 1814, 15,365  65
24,170 75
  From the estimates already made,  it appears
that a considerable sum of money will be wanted,
in addition to the balance on hand, to complete the
proposed  establishment.   The necessity of ren-
dering the building secure from fire, will increase
the expense ; and we trust that these considera-
tions will induce friends to be liberal in their sub-
scriptions.
   An abridged account of the proceedings of
Friends  relative to the  Retreat near  York, in
England, is added, in order to convey correct in-
formation of the nature of the  proposed estab-
lishment, the  views of both institutions being
nearly the same. 
        DESCRIPTION




               OF






THE  RETREAT,




     AN INSTITUTION NEAR YORK,




  FOR INSANE  PERSONS




             OF THE




      SOCIETY OF FRIENDS.




\BRIDGED FROM THE ACCOUNT PUBLISHED,







         BY SAMUEL TUKE. 
 
PREFACE.
  THE Establishment which is described
in the following pages,  though on  a small
scale, has so far met the approbation of many
judicious persons, who have had an opportu-
nity of minutely inspecting its internal econo-
my and management, that I have been induc-
ed to attempt such a representation, as it is
hoped will be useful to those who are engag-
ed in similar institutions.
  Contemplating the loss of reason as  pre-
eminent in the catalogue of human afflictions;
and believing that the experience of the Re-
treat throws some  light on the means of its
mitigation, and also that it has demonstrated,
beyond  all contradiction, the superior effica-
cy,  both in respect of cure and security, of a
mild system of treatment in all cases of men-
tal  disorder, an account of  that experience
has long appeared to me, due to the public.
  If it should be thought to afford satisfacto-
ry evidence  in favour of a more mild system 
XXII
PREFACE.
of treatment, than has been generally adopt-
ed ;  if it should  also prove, which I flatter
myself it will, the practicability of introduc-
ing such a system into establishments for the
insane poor,  whose situation has in general
been too pitiable for words to describe,  I
shall esteem myself peculiarly happy in this
publication.
  The  interests  of humanity and science,
alike call upon us to communicate freely the
discoveries we make,  or the failures which
happen to us, in a pursuit so intimately con-
nected with the happiness of our species.
  I hope that my partiality for the establish-
ment which I have endeavoured to describe,
and my wish to present its objects and regu-
lations to  the public eye, have not indue  d
me to deviate from that candour and r,obri<  y
of representation, which the reader ho   t
right to  expect.   I am not conscious of sue:.-.
a deviation :  but I well know that strong at-
tachments, unless carefully guarded,  ..re i.pt
to impose  upon our judgment.   That this,
however, has not been the case in the present
instance, I am encouraged to believe, from
the very favourable and commendatory cha-
racters,  which have been given of the Institu-
tion,  by several well informed and impartial
persons, by  whom it has been visited, and
minutely examined.*
         ■%.
  * It may be proper to observe, that,  though the
patients are never exhibited to gratify the curiosity 
PREFACE.             XXiii
   To support the statements given  in this
work of the modes  of treatment at the Re-
treat, a few respectable testimonies in its fa-
vour are given in an Appendix.  lam, how-
ever, far from imagining that this Asylum is
a perfect model for others,  either in regard to
construction or management.  If several im-
provements have been successfully introdu-
ced,  it is probable that many others remain
unattempted.

of visitors, yet professional persons, or those peculi-
arly interested in the subject, are permitted  at all
seasonable hours, to visit every fiart of the establish-
ment.  It would be well if this plan were generally
adopted in other institutions of this nature, as the
uncertainty of visitors arriving would be some check
upon neglect, or improper conduct.
  It may also be proper to state, that several per-
sons about  to engage  in the superintendence  of
similar establishments, have made a temporary re-
sidence in York, and have been permitted by the
Committee  of the Retreat to observe daily the
economy of the house,  and the mode of managing
the patients. 
 
        DESCRIPTION

                or

THE  RETREAT,  &c.
            HISTORICAL ACCOUNT.

  THE  origin of the Institution  which  forms
the subject of the following pages, has much the
appearance of accident.   In the year 1791, a fe-
male, of the Society of  Friends,  was placed  at
an establishment for insane persons, in the vicini-
ty of the city of York ;  and her family, residing
at a  considerable distance, requested  some of
their acquaintance in the city to visit her.  The
visits of  these  Friends were  refused,  on the
ground of the patient not being in a suitable state
to be seen by  strangers : and, in a few weeks
after  her admission,  death put a period to her
sufferings.
   The circumstance was affecting, and naturally
excited  reflections on the situation of insane per-
sons, and on the probable improvements which
might be adopted in establishments of this nature.
In particular, it was conceived that peculiar ad-
vantage  would be derived to  the Society of
Friends,  by having an Institution of this kind
under their own  care, in  which a milder and
                       c 
26
more appropriate system of treatment, than that
usually practised, might be adopted ; and where,
during lucid  intervals, or the state of convales-
cence,  the patient  might enjoy the society of
those who were of similar habits and opinions.
It was  thought, very justly, that the indiscrimi-
nate mixture, which must occur in large public
establisments, of persons of  opposite  religious
sentiments  and practices ; of the  profligate  and
the virtuous ; the profane and the serious ; was
calculated to check the progress of returning rea-
son, and  to fix, still deeper, the melancholy and
misanthropic  train of ideas, which, in some des-
criptions  of insanity,  impresses the mind.    It
was believed  also, that  the general treatment of
insane persons was, too  frequently, calculated to
depress and degrade, rather than to awaken the
slumbering reason,  or correct its wild hallucina-
tions.
   In one of the  conversations to  which the cir-
cumstance before-mentioned  gave rise,  the pro-
priety of attempting to  form an Establishment
for persons of our own Society, was suggested to
William  Tuke,   whose feelings  were  already
much interested in the subject, and whose perse-
vering mind rendered him peculiarly eligible to
promote such an undertaking.   After mature re-
flection, and several consultations  with  his most
intimate friends* on the subject, he was decid-
edlv of opinion,  that  an Establishment for  the
insane of  our  own Society, of every class in re-
gard to property, was both eligible and highly de-

  * Among  the  most early and strenuous friends of  this
Establishment, T wish to particularize the name of the ex-
cellent. Lindley Murray; to  whose steady endeavours, for
promoting its welfare, the institution is much indebted. 
27
sirable.  It was necessary to excite a general in-
terest in the Society on the subject. He therefore,
after the close of the Quarterly Meeting at York,
in th-i Third Month, 1792, requested Friends
to allow him to introduce to them a subject, con-
nected with the welfare of the Society.   He then
stated the vit-ws which  he,  and those whom he
had consulted, had taken of this subject; the cir-
cumstance  which had given rise to  their interest
respecting  it, and the conviction  which had  re-
sulted in their minds, in favour of an Institution
under the  government of Friends, for the care
and  accommodation of their own Members, la-
bouring under that most afflictive dispensation—
the loss of reason.
  Few objections  were  then made, and several
persons appeared to be impressed with the im-
portance of the subject, and the propriety of the
proposed measure.  The friends with whom  the
proposal originated, were  requested to prepare
the outline of a  plan, for the  consideration of
those who might attend the next Quarterly Meet-
ing.   Several objections, however,  on a variety
of grounds, soon afterward appeared.   Many
Friends  were acquainted with but few, if any,
objects  for such  an Establishment;  and they
seemed to  forget  that there might  probably be
many cases with which  they were not acquaint-
ed.   Some were  not sensible that any improve-
ment could be made in the treatment  of the in-
sane ; supposing that the privations, and severe
treatment, to which they were generally exposed,
were necessary in their unhappy situation ,•  and
others, seemed rather averse to the concentration
of the instances of this  disease amongst us. 
28
   It was nqt, however, at all surprising that con-
siderable diversity of opinion, should prevail up-
on a subject which  was entirely new, and for-
eign to  the  general inquiries of those to ivhom
it was  proposed ;  and we must not forget that
there was a respectable number,  who duly ap-
preciated the advantages likely to accrue to the
Society from  the  proposed Establishment, and
who cordially engaged in the  promotion  of the
design.   To  these persons, and to the  steady
exertions of its chief promoter, whose  mind was
not to be deterred by ordinary difficulties, the
Society of Friends may justly be  said  to owe
the advantages it derives from this admirable
Institution.
  Some  have  thought that accommodations for
so many as thirty patients, should not have been
aimed at: But it is obvious, that the quantity of
ground  for  exercise, ought not to  be much,  if
any, less lor fifteen  than for thirty; that kitch-
ens, parlours,  and almost all parts of the build-
ing, except the number of patients' rooms,  ought
to be nearly the same;  and that it would make
little difference with respect to Physicians and do-
mestic Managers : so that to accommodate the
proposed number, would not only lessen the ex-
pense of each  patient, but extend the benefits  of
the Institution to Friends at a greater distance.
   It hath been said, that there are already ma-
ny public Institutions of the kind, which  render
this unnecessary.    But  it is  evident,  besides
what has been remarked on  this head,  in the
former publication, tint several peculiar and im-
portant advantages, will accrue from an Institu-
tion confined to ourselves.  For as the disorder
is a mental  one, and  people of regular conduct*. 
29
and even religiously disposed minds, are not ex-
empt  from  it, their confinement  amongst per-
sons in all respects strangers, and their promiscu-
ous exposure to such company as is mostly found
in public Institutions of this kind,  must be pecu-
liarly disgusting, and consequently augment their
disorder.   Nor is this idea  merely chimerical;
for it is well known, that the situation of divers
Members of our Society,  hath  from this cause,
been unspeakably  distressing.   A circumstance
which,  it needs no  arguments  to prove, must
greatly  retard, if  not totally prevent their cure.
   Friends who think the object worthy their at-
tention, may be encouraged  to  promote  it, not
only on a principle of charity to  the  poor,- but
even  of compassion to those in easy  and afflu-
ent circumstances ;  who  will  doubtless think
themselves  benefited, though they mav pay am-
ply for  it.   Those who have embarked in this
undertaking, have not been  influenced by inte-
rested views, nor are they requesting or desiring
any favours for themselves.   A maladv, in ma-
ny instances, the most deplorable that human na-
ture is  subject to, hath  excited their  sympathy
and attention ; and they invite such Friends  as
approve of their design, to coroperate with them
in an  Establishment, which  hath  for  its object,
the mitigation of misery, and the  restoration  of
those, who  are lost to civil and religious socie.r
tv : in the prosecution whereof,  they humbly re-
ly on the favour oi HIM,  whose tender mercies
are over all  his works.
   kk In  the  short  time that this Institution has
been  established,  there  has  appeared abundant
cause to convince us of the necessity there was
for it:  for a considerable disadvantage not only
                     e  2 
30
 seems to  have been sustained,  in many cases,
 from unskilful  private confinement;  but there
 has also been particular occasion to  observe the
 great loss, which individuals of our Society have
 sustained, by being put under the care of those,
 who are  not only strangers  to  our principles,
 but by  whom  they  are  frequently mixed with
 other patients, who  may  indulge themselves in
 ill language, and other exceptionable practices.
 This often seems to leave an  unprofitable effect
 upon the patients' minds,  after they are restored
 to the use  of their reason, alienating from those
 religious attachments which they had before  ex-
 perienced ; and, sometimes,  even  corrupting
 them with vicious  habits, to which  they had
 been strangers.
   In describing the  particular benefits  of this
 undertaking, it seems proper to mention that of
 occasionally using the patients to such employ-
 ment, as may be suitable and proper for them, in
 order to relieve the languor of idleness, and pre-
 vent the indulgence of gloomy sensations.  The
 privilege of attending religious meetings, when
 they are fit for it, and of having occasionally the
 visits of suitable Friends at the  house, may be
justly esteemed of no inconsiderable importance.
 These  considerations,  added to those  which
 have already been mentioned, and that of the fre-
 quent attendance of Women  Friends appointed
 every month, by a Committee which meets in the
 house, appear  to give this Institution peculiar
 advantages, in the view of Friends; and to war-
 rant the promoters of it in expecting the  support
 and encouragement of the Society.
   Experience  has  this  year abundantly con-
 vinced us,  of the advantage to be derived from an 
31
early attention to persons afflicted with disorders
of the mind.
  This consideration will,  we  hope, encourage
the friends of those who are, or may be afflicted
with this  malady, to remove  them early,  and
place them under proper care and treatment.
  DESCRIPTION AND APPROPRIATION OF THE
            GROUNDS AND HOUSE,

  THE  Retreat is situate on an eminence,  at
the distance of about half a mile from the eas-
tern gate of the city of York.   It commands a
very delightful prospect, extending, on the south,
as far as the eye can reach, over  a wooded, fer-
tile plain; and terminating on the north and east,
by the Hambleton Hills and the  Wolds;  which
are seen, in some places, at the distance of about
twenty-five miles.
  The situation combines nearly  all the circum-
stances, which are usually considered favourable
to longevity ;  and the almost uniform health  of
the family,  has confirmed the general observa-
tions on this subject.
  In the erection of the building, economy and
convenience have been chiefly consulted.
  There are  eleven acres of land belonging  to
the Institution.   This little  farm is chiefly oc-
cupied in the  growth of potatoes, and the sup-
port of the  cows, which supply the family with
milk and butter.
  The garden is on the north side of the  house,
and contains  about one  acre.   This  furnish-
es  abundance of fruit and vegetables.   It also
affords an agreeable place for  recreation and 
32
 employment, to many of the patients ; being di-
 vided by gravel-walks, interspersed with shrubs
 and flowers,  and sheltered  from the  intrusive
 eye of the passenger,  by a  narrow  plantation
 and shrubbery.
   On the south side of the house, are the courts
 for the different classes of patients.  The circular
 wall which encloses the male and female patients'
. courts, are about eight feet high; but as the ground
 declines from the house, their apparent height is
 not so great; and the view from them of the
 country is consequently not so much obstructed,
 as it would be if the  ground was  level.  I can-
 not, however, forbear observing, that the courts
 appear to be too small, and to admit of too little
 variety, to invite the patient to  take  exercise.
 The boundary of his excursion is always before
 his eye ;  which must have a  gloomy  effect on
 the already depressed mind.  This might be con-
 sidered as a serious  defect, if it was  not gene-
 rally compensated, by taking such patients as are
 suitable, into the garden ; and by frequent ex-
 cursions into the city or the  surrounding coun-
 try, and into the fields of  the Institution.   One
 of these is surrounded  by a walk,  interspersed
 with trees and  shrubs.
   The  superintendent has also endeavoured to
 furnish a source of amusement, to those patients
 whose walks  are necessarily more circumscrib-
 ed, by supplying each of the courts with a num-
 ber  of  animals;  such  as  rabbits,  seagulls,
 hawks, and poultry.   These creatures  are ge-
 nerally very familiar with the patients : and it
 is believed that they are not only the means of in-
 nocent pleasure ; but that the intercourse with
 them, sometimes tends to awaken  the social and
 benevolent feelings. 
33
   An apartment is used, when necessary, for the
entire seclusion of a violent patient.  It is fur-
nished  with a  bed, securely  fastened  to  the
ground.   Light is, in great measure, but not en-
tirely excluded;  and care is  taken to  have the
room properly ventilated.
   This room also affords an opportunity of tem-
porary confinement, by way of punishment,  for
any very offensive acts, which it is thought the pa-
tient had the power to  restrain ; but this very
rarely occurs ; and I am happy to say, the apart-
ment is frequently unoccupied; or in other words,
there is not, on an average, from any cause, one
male patient in a state of seclusion during the day.
   The attention which is due to the comfort of
the insane, and  the degree in  which it is com-
patible with their security,  appear to have been,
till very recently,  objects of little general consi-
deration.   It is not, therefore, to  be supposed,
that  the  Retreat, which has now  been erected
seventeen years, and which was originally intend-
ed for only thirty patients, should be a perfect
model  for establishments  of this kind; though
every care was exercised in its first  construction.
Indeed, it is hardly probable, as the class of per-
sons,  in different establishments, must be vari-
ous,  that the arrangements in any one, can  be
precisely followed in another.
   The promoters of this Institution, as they ob-
served in one of their early Reports, could not
be supposed to be superior to those disadvanta-
ges,  to which the want of  experience naturally
exposed them.   When it is also considered, that
they were unable to form any probable opinion,
of the proportions of the different classes of pa-
tients ; and that the number has, unhappily,  so
much exceeded  their expectations,  it will not be 
34
surprising, that the building has several  imper-
fections, but rather that it possesses so many ad-
vantages.
   It has been already  observed, that the aspect
of a place of confinement  is prevented,  by the
substitution of cast iron  window frames  for the
bars, which, in similar places,  usually guarded
the avenues of  light.  This contrivance unites
the advantages of security,  neatness, and durabi-
lity.  There are not in this house any cells un-
der ground.   All the rooms, except  three which
derive their light from aa adjoining gallery,  have
glass windows.   Iron bars and shutters, are too
often substituted for glazed windows, in rooms
appropriated to  the insane.  The obvious conse-
quence is, that the air, however cold, cannot be
kept out of the apartment, without the entire ex-
clusion of light.
   One circumstance, which I much regret, in the
construction of  this  building* is, that there are
rooms  on both sides of the galleries ; for,  though
a  large portion  of light is  admitted, by the  "win-
dow at each extremity of  the building, yet, the
galleries on the ground floor, at  least, are rather
gloomy.
   I observe with pleasure, in a  very ingenious
account and plan of a new asylum at Glasgow*
that the galleries  have rooms on one side, and
windows on the  other.   This cannot fail to give
an air of cheerfulness, highly desirable in such
establishments.

  * " Remarks on the Construction of Public Hospitals," by
Win. Stark, Esq. architect.  This work, as well as  " Obser-
vations  on the Treatment of Lunatics," by Robert Rcid,
Esq. architect, deserves the attention of those who are en-
gaged in such undertakings. 
35
   Many errors in the construction, as well as in
the management, of asylums for the insane,  ap-
pear to arise from excessive attention to.safety.
People, in general, have the most erroneous  no-
tions of  the  constantly outrageous behaviour, or
malicious dispositions, of deranged persons;  and
it has, in too many instances, been found conve-
nient to  encourage  these false  sentiments, to
apologize for the treatment of the unhappy suf-
ferers, or admit the  vicious neglect of their at-
tendants.*
   In  the construction of such places, cure and
comfort ought to be as much considered,  as se-
curity ; and,  I have no  hesitation in declaring,
that a system  which, by limiting the power of
the attendant, obliges him not to neglect his  du-
ty, and makes it his interest to obtain the good
opinion of those under  his care,  provides more
effectually  for  the safety of the keeper, as well
as  of the  patient, than all  " the apparatus of
chains, darkness,  and anodynes."
            MEDICAL  TREATMENT.

   UNDER the head " Medical treatment," as
practised in the Retreat, some may possible in-
quire, what are the means employed in mortifi-
cations,  arising from cold and confinement ?  '< a
calamity, which," says a writer before alluded to,

  * T once accidentally visited a house for insane persons, in
which security was made & primary object.  Here I saw three
of u.e keepers, in the middle of the day, earnestly employed
in—playing at cards ! 
36
a irequently  happens to the helpless insane, and
to bed-ridden patients; as my attendance in  a
large work-house,  in private  mad-houses, and
Bethlem Hospital, can amply testify."*
  Haslam  also  observes,  that the patients  in
Bethlem Hospital,  " are particularly subject to
mortifications of the feet;  and this  fact  is so
well established from former accidents, that there
is an express order of the  house,-that every pa-
tient, under  strict  confinement, shall  have his
feet examined every morning and evening in the
cold weather, by the keeper, and also have them
constantly  wrapped in flannel; and those who
are permitted to go  about, are always to be found
as near to the fire  as they can get, during the
winterseason."f
  Dr. Pinel  also confesses, that " seldom has a
whole year elapsed, during which no fatal acci-
dent has taken place, in the Hospital de  Bicetre,
(in France,)  from the action of cold upon the ex-
tremities."
  Happily, in the Institution I am now describ-
ing, this calamity is hardly  known; and no in-
stance of mortification has occurred,  in which it
has been, in any degree connected with  cold or
confinement.   Indeed  the patients  are  never
found to require such a degree of restraint, as
to prevent the  use  of considerable exercise, or
to render it  at all  necessary to keep their  feet
wrapped in flannel.
  It will be proper here to observe, that the ex-
perience of the Retreat, fully  confirms  the opi-
nion of several respectable modern writers, that

  *  Crowther, p. 61.
  f Observations on Madness, p. 84. 
37
maniacs  are  by no means exempted from the
common effects of cold ; and  it is to  be hoped,
for the sake of humanitv,  that the opposite opi-
nion, alike barbarous and absurd,  will be entire-
ly exploded.   The apothecary to  Bethlem Hos-
pital, after stating that the patients are not ex-
empt from the usual  effects of severe cold, ob-
serves very justlv: *'from the great  degree of
insensibility  which  prevails,  in some states of
madness, a degree of cold  would scarcely be felt
by such persons, which would create uneasiness
in those  of  sound  mind; but experience  has
shown that the}- suffer equally  from severity of
weather.   When the mind is  particularly engag-
ed on any subject, external circumstances affect
us less, than when unoccupied.  Every one must
recollect, that in following up a  favourite pur-
suit, his fire has burned out  without his  being
sensible  of the  alteration  of  temperature ; but
when the performance has been finished,  or he
has  become indifferent to it from fatigue, he then
becomes sensible to cold, which he had not expe-
rienced before."
   The supporters of this opinion, also generally
observe,  that insane  persons  commonly endure
hunger without injury.  The latter sentiment is
no less at variance with  the  experience  of the
Retreat, than the former.  Some of the  patients,
more especially the melancholies and convales-
cents, besides their  four usual meals in  the day,
require the intermediate refreshment of biscuit,
with a glass of wine or porter; and attention of
this kind is considered almost essential  to the
recovery of many patients.       <
                       o 
38
   " General propositions," says Dr. Pinel, " have
been too often advanced in regard to the capaci-
ty of maniacs to bear extreme hunger with impu-
nity.   I have known several, who were voraci-
ous to a great degree, and who languished, even
to fainting, from want,  or deficiency of nourish-
ment.   It is said'of an Asylum at Naples, that a
low spare diet is a fundamental principle of the
Institution.   It would be difficult to  trace the
origin  of so singular a prejudice.  Unhappy ex-
perience, which I  acquired during seasons of
scarcity, has most  thoroughly  convinced me,
that insufficiency of food, when it does not alto-
gether extinguish the vital principle, is not a lit-
tle calculated  to exasperate and prolong  the
disease."*
   I would not have dwelt  so long upon these
mistaken  opinions,  if they had not furnished a
specious pretext for much practical barbarity;
and I am, therefore, anxious to see them ranked
with the marvellous stories of the Phoenix and
the Salamander.
   Where various means are employed, it is dif-
ficult  to say which is  the operative  one; but,
whatever may be the means  used, there is great
reason to believe that a clear dry air,  which the
situation of the Retreat affords in an eminent de-
gree,  will facilitate  their  operation, and be fa-
vourable to the recovery of insane persons.  To
reason again from analogy ; the general effect of
fine air upon  the animal spirits, would induce us
to expect especial benefit  from  it,  in  cases  of
mental depression ;  and to pay all due respect to
the physician, who,

  * Dr. Davis's translation of " PincTa Treatise on Insani
ty," p. 31. 
39
       " Gives melancholy up to Nature's care,
       And sends the patient into purer ah."

  Several instances have occurred, in which me-
lancholy patients have been very much improv-
ed by their journey to the Retreat; and it is the
decided opinion of the manager  of this Institu-
tion, that, in such cases, close confinement is, of
all things, the most detrimental.
             MORAL TREATMENT.

  WHATEVER theory we maintain in regard
to the remote causes of insanity, we must consi-
der moral treatment,  or management,  of very
high importance.
  If we adopt the opinion, that the disease origi-
nates in the mind, applications made immediate-
ly to it, are obviously the most natural;  and the
most likely  to be attended with success.  If, on
the  contrary, we conceive that mind is incapable
of injury or destruction, and that, in all cases of
apparent mental derangement, some bodily dis-
ease, though unseen and unknown, really exists,
we  shall still readily admit, from  the  reciprocal
action of  the two parts of our system upon each
other, that the greatest attention is necessary, to
whatever is calculated to affect the  mind.
  It is a matter of no small difficulty,  to convey
more than the general principles which influence
the  conduct of those,  who  have  the  manage-
ment of the insane.   It is unhappily, in great
measure true, that  " the address which is ac-
quired by experience, and constant intercourse 
40
with maniacs, cannot be communicated :  it may
be  learned ;  but it must perish with its  posses-
sors."  It appears, however, to me,  that a free
detail  of different modes of management, can
hardly fail to increase our stock of correct gene-
ral  principles, on this important subject.
  Insane  persons  generally possess a degree of
control over their wayward propensities.   Their
intellectual, active, and moral powers, are usual-
ly  rather  perverted than  obliterated;  and  it
happens,  not  unfrequently, that  one  faculty
only is affected.   The disorder is sometimes
still more partial, and  can  only be detected by
erroneous views, on one particular subject.  On
all others, the mind  appears to retain its  wonted
correctness.
  The same partial perversion, is found to ob-
tain in this disease with regard to the affections.
Though it frequently happens, that indifference
or disgust towards the tenderest connexions,  is
an  early  and distressing symptom of insanity ;
when,
          ——--------"forgotten quite,
          All former scenes of dear delight,
          Connubial love, parental joy ;
          No sympathies like these his soul employ;"

yet the existence of the benevolent affections, is
often strongly evidenced, by the patients'  attach-
ment to those who have the immediate  care of
them,  and who treat them with  judgment and
humanity.  The apothecary to  Bethlem  Hos-
pital says,* " I can truly declare, that by gen-
tleness of manner, and kindness 6f treatment,  I
have seldom  failed to obtain the confidence, and
conciliate the esteem,  of insane  persons;  and
              * Observations, p 293, 
41
have succeeded  by these  means  in  procuring
from them respect and obedience."  The super-
intendents of the Retreat give precisely the same
evidence ; and I firmly believe, that a large ma-
jority of the instances, in which the malevolent
dispositions are peculiarly apparent,  and are con-
sidered  as  characterizing the  disorder,  may
readily be traced to secondary causes ; arising
from the  peculiar circumstances of the patient,
or from the mode of management.
   A patient confined  at home,  feels naturally a
degree  of resentment, when those whom he ha3
been accustomed to -command, refuse  to obey
his orders, or attempt to restrain him.   We may
also, I  conceive, in part, attribute to similar se-
condary causes, that apparent absence  of the so-
cial  affections, and  that sad indifference to  the
accustomed  sources of domestic   pleasure,  of
which we have just been speaking.   The unhap-
py maniac is frequently unconscious of his own
disease.  He is unable to account for the change
in the conduct of his wife,  his children, and his
surrounding friends.   They appear to him cruel,
disobedient,  and ungrateful.  His disease aggra-
vates their conduct in his view, and  leads him to.
numerous unfounded  suspicions.   Hence,  the
estrangement of his  affections may frequently be
the natural consequence, of either the proper and
necessary, or  of the  mistaken  conduct of his
friends towards him.
   In such cases,  the judicious kindness of others
appears generally to* excite the gratitude and af-
fection, of the patient.  Even in those deplora-
ble instances where the  ingenious  humanity of
the  superintendent  fails to conciliate,  and  the
jaundice-like disease changes the very aspect of
                       B  2 
4 -J
nature, and represents all mankind as the leagued
enemies of the patient,  the existence of the so-
cial affections, has often been strikingly evidenc-
ed, by attachment to some of the  interior  ani-
mals.
  There are, undoubtedly, cases in which the
disorder is chiefly marked by a mischievous ma-
levolent disposition;  but of these, very few have
occurred at the Retreat. There have, however,
been many patients,  in  whom these dispositions
have been occasionally conspicuous, or easily ex-
cited by improper treatment.
   If the preceding sketch is correct, it would not,
I apprehend, be difficult to infer  theoretically,
the general  principles  of  moral treatment and
management; but I  have happily little occasion
for theory, since my province is to relate, not on-
ly what ought to be clone, but also what, in most
instances, is actually performed.
   The  moral treatment of the insane, seems to
divide itself  into three parts ; and under these,
the  practices of the  Retreat may  be  arranged.
We shall therefore inquire,
   I. By what means the  power of the patient
to control the disorder, is strengthened and as-
sisted.
   II. What  modes  of coercion  are  employed,
when restraint is absolutely necessary.
   III.  By what means the  general  comfort of
the insane is promoted.
OF THE MEANS OF ASSISTING TME PATIENT TO
              CONTROL HIMSELF.

  WE have already observed, that most insane
persons have a considerable degree of self com- 
43
mand ; and that the employment and cultivation
of this remaining power, is found to be attended
with the  most  salutary effects.   Though many
cannot be made sensible  of the  irrationality  of
their conductor opinions; yet they are general-
ly aware of those particulars, for which the world
considers them proper objects of confinement.
Thus it frequently happens, in the Institution we
are describing, that a patient, on his first intro-
duction,  will conceal all marks of mental aberra-
tion.   Instances have  occurred, in which the
struggle  has been  so successful, that persons,
who, on undoubted authority, have been declared
to be unmanageable at home; and to have shown
very  striking marks of insanity; have not,  for
a  very considerable  time,  exhibited sufficient
symptoms  of the disorder,  to enable the physi-
cian to declare them, non compos mentis.  Doubt-
less the idea that their early liberation, for which
most are anxious,  and their treatment during
their confinement, will depend, in great measure,
on their  conduct, has a tendency to produce this
salutary  restraint, upon their wayward propensi-
ties.   Hence, also,  the idea seems to have arisen,
that madness in all its forms, is capable of en-
tire control, by a sufficient excitement of the
principle of fear.   This speculative opinion,
though every day's experience decidedly contra-
dicts it,  is the best apology which can be  made
for the barbarous practices that  have often pre-
vailed in the treatment  of the insane.
   The principle of fear, which is rarely decreas-
ed by  insanity, is considered as  of great impor-
tance in the management of the patients.  But it
is not allowed to 'be excited, beyond that degree
which naturally arises from  the necessary regu- 
44
lations of the family.  Neither  chains nor  cor**
poral punishments are tolerated, on any pretext,
in this establishment.   The  patients, therefore,
cannot be threatened with these severities;  yet,
in all houses established for the  reception of the
insane, the general comfort of the patients ought
to be considered;  and those who  are  violent,
require to be separated from the more tranquil,
and  to be prevented,  by some means, from of-
fensive  conduct, towards their  fellow-sufferers.
Hence, the  patients  are  arranged into class-
es, as much as may  be, according to the degree
in which they approach to rational or  orderly
conduct.
   They  quickly perceive, or if not, they are in-
formed on the first occasion,  that their treatment
depends, in great measure, upon their conduct.
Coercion thus flowing as a sort of necessary con-
sequence, and being executed in a manner which
marks the reluctance of the attendant, it seldom
exasperates the violence of the patient, or produ-
ces that feverish and sometimes furious irritabi-
lity, in which the maniacal character incompletely-
developed ;  and under which all power of  self-
control is utterly lost.
   There cannot be a doubt that the principle of
fear, in the human mind,  when moderatelv  and
judiciously excited,  as it is  by  the operation of
just  and  equal  laws, has a salutary effect upon
society.  It is a principle  also of great use in the
education of children, whose imperfect  know-
ledge and judgment, occasion them to  be  less
influenced by other motives.   But where fear is
too  much  excited,  and  where it  becomes the
chief motive of action, it  certainly tends to  con- 
45
tract the understanding, to weaken the benevo-
lent affections, and to debase the mind.  As the
poet of liberty has well sung,

       --------,----------« All constraint,
       Except what wisdom lays on evil man,
       Is ev il; hurts the faculties, impedes
       Their progress in the road of science, blinds
       The eye-sight of"discovery ; and begets,
       In those that suffer it, a sordid mind,
       Bestial, a meagre intellect, unfit
       To be the tenant of man's noble form."
                     cowper's task,  book v.

  It is therefore wise to excite, as much as pos-
sible, the operation of superior motives; and
fear ought only to be induced, when a  necessary
object cannot otherwise be obtained.   If this is
the true  scale of estimating the degree in which
this principle is,  in general, to be employed, it
is found, at the Retreat, equally applicable to the
insane.
 "That the  continual or frequent excitement  of
the sensations of  fear,  should " bid melancholy
cease to mourn," is an idea too obviously absurd
in theory, to require the refutation of experience.
There has,  however, unhappily been  too  much
experience on  this subject; and hence we may
perhaps, in great degree, explain, why melancho-
ly  has been considered so much less susceptible
of  cure  than  mania.   To the mild system of
treatment adopted at  the Retreat, I  have no
doubt we  may partly  attribute, the happy re-
covery  of so large a portion of melancholy pa-
tients.
   Is  then the violent excitement of the princi-
ple of fear,  better adapted to  enable the maniac
to control  his wanderings,  and to suppress his 
46
emotions ?   Is it not well known,  that the pas-
sions of many maniacs,  are extremely irritable >
and when once excited, are not all moral means
to subdue  them, as ineffectual as the attempt
would be to quench, by artificial means, the fires
of Etna ?
  If it  be true, that oppression makes a wise
man mad,  is it to  be supposed that stripes, and
insults,  and  injuries,  for which the  receiver
knows no cause, are calculated to make a mad-
man wise ? or  would  they  not exasperate  his
disease, and excite his resentment ? May we not
hence most clearly perceive,  why furious mania
is almost a stranger in the Retreat?  why all the
patients wear clothes, and are generally induced
to adopt orderly habits ?
   The superintendent of this  Institution is fully
of opinion, that a  state of furious mania is very
often excited by the mode of  management.  Of
this  opinion, a  striking illustration occurred in
this Institution,  some years ago.  A patient, of
rather a vindictive  and  self-important character,
who had previously conducted himself with to-
lerable propriety, one day, climbed up against a
window, which  overlooked  the  court where  he
was  confined, and  amused  himself  by contem-
plating  the interior of the room.   An attendant,
who had not been long in office, perceiving his
situation, ran hastily towards  him, and, without
preamble,  drew him to the  ground.   The pa-
tient was highly incensed ; a scuffle immediately
ensued, in which he succeeded in throwing his
antagonist;  and had not the loud vociferations
of this attendant alarmed the family, it is proba-
ble that he  would have paid for his rash con-
duct, by the loss of his life.  The furious state 
47
«f the patient's mind did not continue long; but,
after this circumstance, he  was more vindictive
and violent.
  In some instances,  the  superintendent has
known  furious mania temporarily induced, by
the privations  necessary  on a relapse,  after a
considerable lucid interval, during which the pa-
tient hid  enjoyed many privileges, that were in-
compatible with his disordered state.  Here we
may suggest the expediency, where it is possi-
ble, of employing such of the attendants  to con-
trol the patient during his paroxyms, as  had lit-
tle  intercourse with  him in his lucid interval.
Instances of furious mania have been, however,
very rare ; but a considerable number of patients
have  been admitted, who were reported  to have
been so furiously insane, as to require constant
coercion.
  The evidence of attendants,  who have been
employed, previously  to  the  admission  of pa-
tients into the Retreat, is not considered a suffi-
cient reason for  any  extraordinary restraint;
and  cases have occurred, in which persuasion
and kind treatment, have superseded the necessi-
ty of any coercive means.
  Some years ago, a man about thirty-four years
of age, of almost  Herculean  size  and figure,
was brought to the house.  He had been afflict-
ed several times before ; and so constantly, dur-
ing the present attack, had he been kept, chain-
ed, that  his clothes were contrived to be taken
off  and put on by means of strings, without re-
moving  his manacles.   They were,  however,
taken off, when he entered the  Retreat, and he
was usivicd into the  apartment,  where  the su-
perintendents were supping.   He  was calm; his 
48
attention  appeared to be  arrested by his  new
situation.   He was desired to join in  the repast,
during which he behaved with tolerable proprie-
ty.   After it was concluded, the superintendent
conducted him to his apartment, and told him
the circumstances on which his treatment would
depend ; that  it was his anxious wish  to  make
every inhabitant in the house, as comfortable as
possible ;  and  that he sincerely  hoped the  pa-
tient's  conduct would render it unnecessary for
him to have recourse to coercion.  The maniac
was sensible of the kindness of his  treatment.
He promised to restrain himself, and  he so com-
pletely succeeded, that, during his stay,  no co-
ercive  means  were ever employed towards him.
This case affords a striking example  of the ef-
ficacy of mild  treatment.   The patient was fre-
quently very vociferous, and threatened his at-
tendants,  who in their defence were very desir-
ous of restraining him by  the jacket.  The su-
perintendent,  on  these occasions, went  to  his
apartment; and though the first sight of him
seemed rather to increase the patient's irritation,
yet  after  sitting some time quietly beside him,
the  violent excitement subsided, and he would
listen with attention to the persuasions and argu-
ments  of  his friendly visitor.
   After such  conversations,  the patient was ge-
nerally better  for some days or  a week ;  and in
about four months he was  discharged perfectly
recovered.
   Can it  be doubted, that, in this case, the dis-
ease had been greatly exasperated by the mode
of  management ? or  that  the subsequent  kind
treatment, had a great tendency to promote his
recovery ? 
49
  It may  probably be  urged,  and I am very
well aware of  it,  that  there is a  considerable
class  of patients, whose eccentricities  may,  in
great measure,  be controlled ; and who may be
kept in subjection and apparent orderly habits,
by the strong excitement of the principle of fear.
They may be made to obey their keepers, with
the greatest promptitude ; to rise, to sit, to stand,
to walk, or run at their pleasure ;  though only
expressed  by a look.   Such an obedience, and
even  the appearance of affection, we not unfre-
quently see in the poor animals  who are exhibit-
ed  to gratify  our curiosity  in natural  history ;
but who can avoid reflecting, in observing such
spectacles,  that the  readiness  with which  the
savage  tyger  obeys his  master,  is the  result  of
treatment  at which humanity would  shudder;
and shall we propose by such means,

         " To calm the tumult of the breast,
         Which madness has too long possest;
         To chase away the fiend Despair,
         To clear the brow of gloomy Care ;
         Bid pensive melancholy cease to mourn,
         Calm Reason reassume her seat;
         Each intellectual power return ?"

   If those who are friendly to what may be term-
ed  the terrific  system  of  management,  could
prove,  that, notwithstanding it may fix for life,
the misery of a large  majority of the melancho-
lies ; and'  drive many of the more irritable ma-
niacs to fury or desperation ; yet  that it is still,
in its  operation upon a large scale, adapted to
promote the cure of  insanity,  they would have
some apology for its indiscriminate adoption.  If,
on the contrary,  a statement of the proportion
of  cures  in the Retreat, shall sufficiently prove
                        E 
50
the superior efficacy of mild means, would not
those, who are  adopting an  opposite  line of
treatment, do well to  reflect on the awful  res-
ponsibility which attaches to their conduct ?  Let
us all constantly remember, that there is a Being,
to whose eye darkness is light; who sees the in-
most recesses of the dungeon,  and who  has  de-
clared, '* For the sighing  of the  poor,  and the
crying of the needy, I will  arise."
   From  the view  we have now taken of the
propriety of exciting  fear,  as  a  mean  of pro-
moting the cure of insanity,  by enabling the pa-
tient to control himself,  it will, perhaps, be al-
most  superfluous to  state as our opinion, that
the  idea, which  has too  generally  obtained, of
its being  necessary to commence an acquaint-
ance with lunatics, by an exhibition of strength,
or an appearance of austerity,  is utterly errone-
ous.   The sentiment appears allied to that cruel
system, probably dictated  by indolence  and ti-
midity, which has so long prevailed, and unhap-
pily  still prevails, in many  receptacles for the in-
sane.
  There is much analogy between the judicious
treatment of children, and that of insane persons.
Locke has observed,  that " the great secret of
education, lies in  finding 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."   It  is  highly desir-
able  that the attendants on lunatics  should pos-
sess  this influence over their minds ; but it will
never be obtained  by austerity and rigour ;  nor
will  assumed consequence, and airs of  self-im-
portance,  be generally more  successful. 
sr
  Much familiarity with  maniacal patients,  on
their first introduction to a new situation, is not
thought, in general, to be adviseable. It might, in
some instances, have a tendency to lessen that au-
thority, which is, occasionally, necessary for the
attendant to exert.  There may also be a few ca-
ses  in which a distant,  and somewhat important
manner, may  be assumed with advantage ;  but,
generally speaking, even with regard to the more
violent  and  vociferous maniacs, a very different
mode  is  found  successful; and they  are  best
approached with  soft and mild persuasion.  The
superintendent assures  me,  that in these cases,
he has found  it peculiarly necessary to speak to
th epatient in  a kind, and somewhat low tone of
voice.   So true are the maxims of antiquity.

    " A soft answer turneth away wrath."—Solomon.
    ------------------- " Soft speech
    " Is to distemper'd wrath, medicinal."—Eschylus.

  It must, however, be understood, that the  per-
suasion,  which is  extended  to the patients, is
confined to those points which affect their liber-
ty or comfort.  No advantage has been found to
arise from reasoning with them, on their parti-
cular hallucinations.   One of the distinguishing
marks of insanity, is a fixed  false conception,
which  occasions an almost total incapacity of
conviction.    The  attempt,  therefore, to refute
their notions, generally  irritates them, and rivets
the  false perception more strongly  on  their
minds.    There have been a few instances,  in
which,  by some striking  evidence, the maniac
has  been driven from his favourite absurdity ;
but  it has uniformly been succeeded by another
equally irrational. 
52
  In  regard to melancholies,  conversation  on
the  subject of their despondency, is found to be
highly injudicious.  The very opposite method
is pursued.   Every means is  taken  to seduce
the  mind from  its favourite but unhappy mu-
sings, by bodily exercise, walks, conversations,
reading,  and other innocent recreations.  The
good effect of exercise, and of variety of object,
has  been very  striking in several  instances at
this  Institution.   Some years ago, a patient
much afflicted with melancholic and hypochon-
driacal symptoms, was admitted by his own  re-
quest.   He had walked from home,  a distance
of 200 miles, in company with a friend, and on
his  arrival, found much less  inclination to con-
verse on the absurd and melancholy views of his
own state, than he had previously felt.
  This patient was by trade a gardener, and the
superintendent immediately perceived, from the
effect of this journey,  the propriety of keeping
him employed.   He  led him  into the garden,
and conversed with him on the subject  of horti-
culture ; and  soon found that the patient pos-
sessed very superior knowledge of pruning, and
of the other departments of his art.   He pro-
posed several improvements in the  management
of the  garden,  which were  adopted,  and  the
gardener was desired  to furnish him  with full
employment.   He soon, however, showed a re-
luctance to regular exertion,  and a  considerable
disposition to wandering, which had been one of
the previous  features of his complaint.  The
gardener was repeatedly charged to encourage
him in labour,  and to prevent his leaving the
premises.  But, unhappily, the superior abilities
* f the patient, hud excited a jealousy in the g;tr- 
53
dener's mind,  which made him dislike his  as-
sistance ;  and  it may therefore be  presumed,
that he obeyed  his  instructions  very imper-
fectly.
  The poor man rambled several times from  the
grounds of the  Institution ;  which, in his state
of  mind, excited considerable  anxiety in  the
family.  Of course it became necessary to con-
fine him  more within doors.   He frequently,
however,  walked  out; and  the superintendent
took  many opportunities to  attend him into  the
fields or garden,  and to  engage him for a time
in steady  manual labour.   As his disorder  had
increased, it became difficult to induce him to
exert himself;  but even  in this state, when he
had been some time employed, he seemed to for-
get  his distressing  sensations  and ideas,  and
would  converse  on  general toprc8 with great
good sense.
  In this truly pitiable case, the superintendent
several times tried  the  efficacy of long walks,
where the greatest variety and attraction of cir-
cumstances were presented ; but neither these,
nor the conversation which he  introduced, were
able to draw the patient so effectually from  the
t4 moods of his own mind," as regular persever-
ing labour in the garden.  It is not improbable,
however,  that the superior manner  in which  the
patient was able  to execute  his work, produced
a degree  of self-complacency which had a salu-
tarv effect ; and that, had  his education enlarg-
ed  his cui iositv, and encouraged a taste and  ob-
servation  respecting  the  objects of nature  and
art, he might  have  derived much greater  ad-
vantage,  as many patients  obviously do,  from,
variety of conversation  and scenery.
                     E 2 
54
   The  circumstances of this patient did not al-
low him a separate attendant, and the engage-
ments of the superintendent were too numerous
and important, to permit him to  devote to  this
case  the time and  attention  which it seemed to
require.  He  has frequently expressed  to  me,
the strong feelings  of regret, which were excit-
ed in his mind, by the unsuccessful treatment of
this  patient; the  case certainly  points out the
great importance of exercise and  labour, in  the
moral treatment of insanity, more especially in
cases of melancholy.
  This  patient, after remaining several years in
the house,  died of an acute  inflammation of the
bowels.  His  situation for  a considerable time
previously to his death, was most deplorable,  and
has often reminded me of  the affecting descrip-
tion,  which our great  poet gives of the state of
our  first father,  after  his  expulsion  from  the
happy seat of primeval innocence :

     ----——--------" On the ground,
     Outstretch'd he lay, on the cold ground, and oft
     Curs'd his creation, death as oft accus'd
     Of tardy execution."

  The  female  patients in the Retreat, are em-
ployed, as much as possible,  in sewing, knitting,
or domestic affairs; and  several  of the  conva-
lescents assist the attendants.  Of all the modes
by which the patients may be induced to restrain
themselves, regular employment is  perhaps the
most generally efficacious ;  and those  kinds of
employment are doubtless  to be preferred, both
on a moral  and physical account,  which  are ac-
companied hy  considerable  bodily action ; that
are most agreeable  to the patient,  and which are
most opposite to the illusions of his disease. 
55
   In an  early part of this  chapter, it is stated,
that the patients are  considered capable of ra-
tional and honourable inducement; and though
we allowed fear a considerable place in the pro-
duction of that restraint, which the patient ge-
nerally exerts on his  entrance into a new situa-
tion ; yet the  desire of  esteem is considered, at
the Retreat,  as operating, in general,  still more
powerfully.  This  principle in the human mind,
which doubtless influences, in  a great degree,
though often secretly, our general manners; and
which operates with peculiar force on  our intro-
duction into  a  new  circle  of acquaintance, is
found to  have  great  influence,  even  over the
conduct of the insane. Though it has obviously
not been sufficiently powerful to enable them en-
tirely to resist the  strong  irregular tendencies
of  their disease ; yet  when properly cultivated,
it  leads many to struggle  to conceal  and over-
come their morbid propensities ; and,  at least,
materially  assists them in confining their devia-
tions, within  such bounds, as do not make them
obnoxious to the family.
  This struggle is   highly  beneficial  to the pa-
tient, by strengthening his mind, and conducing
to a salutary habit of self-restraint;  an object
which experience points out as of the  greatest
importance, in  the cure of  insanity  by  moral
means.
  That fear  is not  the only motive, which ope-
rates in producing  self-restraint in the minds of
maniacs, is evident from its being often  exercis-
ed in the presence of strangers, who are merely
passing through  the house;  and which, I pre-
sume, can only be accounted for, from that desire
of esteem, which has been stated to be a power-
ful motive to conduct. 
56
   It is probably from encouraging the action of
this principle, that so much advantage has  been
found in this Institution, for treating the patient
as much  in  the manner of a rational being, as
the" state of his mind will possibly allow.   The
superintendent is  particularly attentive to this
point, in his conversation with the patients.   He
introduces such topics as he knows will most in-
terest them ;  and  which, at the  same  time, al-
lows them to display  their  knowledge to  the
greatest advantage.  If the patient is an agricul-
turist, he asks him questions relative to his art;
and frequently consults him upon any  occasion
in which his knowledge may be useful-  I have
heard one of the worst patients in the house,
who, previously to his indisposition,  had been a
considerable  grazier, give very  sensible  direc-
tions for the treatment of a diseased cow.
   These  considerations are  undoubtedly very
material,  as they regard the comfort of insane
persons ; but they are of far greater importance,
as they relate  to the cure of the disorder.   The
patient feeling himself of some consequence, is
induced to support it by the exertion of his rea-
son, and by restraining those dispositions, which,
if indulged,  would  lessen the respectful treat-
ment he receives ; or lower his character in the
eyes of his companions  and attendants.
   They who are unacquainted with the charac-
ter of insane  persons, are very apt to converse
with them in  a childish, or, which is worse, in
a domineering manner; and hence it has been
frequently remarked by the patients at the Re-
treat, that a  stranger  who  had  visited  them,
seemed to imagine they were children.
   The natural tendency of such treatment is,  to
degrade the mind of the  patient,  and to make 
57
him  indifferent to those moral feelings, which,
under judicious  direction and encouragement,
are  found capable, in  no  small  degree, to
strengthen the  power  of  self-restraint;  and
which render  the resort  to  coercion, in many
cases, unnecessary.  Even when  it is absolutely
requisite to employ coercion,  if the patient pro-
mises to  control himself  on its removal,  great
confidence is  generally placed upon his word.
I  have  known patients,  such is their sense of
honour and moral obligation, under this kind of
engagement, hold, for  a long time, a successful
struggle  with the violent propensities of their
disorder;  and such  attempts ought to be  sedu-
lously encouraged by the  attendant.
   Hitherto we  have chiefly  considered  those
modes of inducing the  patient  to control his
disordered propensities, which arise from an ap-
plication  to the  general  powers of  the mind ;
but considerable advantage may certainly be de-
rived,  in this  part of moral management, from
an acquaintance with the previous habits, man-
ners, and prejudices of the individual.  Nor must
we forget to call to our aid, in endeavouring to
promote self-restraint, the mild but powerful in-
fluence of the  precepts  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 fre-
quently  felt,  even under the delirious excite-
ment of insanity.  To encourage  the influence
of religious principles over the mind of the in-
sane, is considered  of  great  consequence, as  a
mean of cure.   For this purpose,  as well as for
ethers, still more important, it is certai^y right 
58
to promote  in the patient,  an attention  to  his
accustomed modes  of paying homage  to  his
Maker.
   Many patients  attend the religious meetings
of the Society, held in the citv ;  and  most  of
them are assembled,  on a first day afternoon ; at
which  time the  superintendent  read* to them
several chapters  in the Bible.   A profound si-
lence generally  ensues ; during which,  as well
as at the time  of reading, it is very gratifying to
observe  their  orderly  conduct, and the  degree
in which those, who are much disposed to action,
restrain their different  propensities.
   In pursuing these  desirable objects, let not the
inexperienced, but judicious  attendant,  expect
too immediate effects from his endeavours, or be
disheartened by occasional disappointment.  Let
him bear in mind, what the  great Lord Bacon
has admirably said,  that " It  is order,  pursuit,
sequence, and interchange of application, which
is mighty in nature ; which, although it require
more exact knowledge in prescribing, and more
precise obedience in  observing,  yet  is  recom-
pensed with the magnitude of effects."*
   I am sensible that what is here stated, is but
an imperfect view of  the principles and  modes,
by which self-restraint is induced at the Retreat.
To  particularize all the principles of the mind,
which may be  usefully excited  in  promoting
this salutary  object, would be an enumeration
of our intellectual powers and  affections.   I will
only further observe upon this head, by  way of
general summary, that the  attendant on  the in-
sane,  ought sedulously to  endeavour  to  gain
* Works, 8vo edition, vol. i. p. 12 j 
59
'their confidence  and esteem ;  to arrest their at-
tention,  and fix  it on  objects opposite to their
illusions;  to call into action, as much as possi-
ble, every  remaining power and principle of the
mind; and to remember  that, in  the wreck  of
the intellect, the affections not unfrequently sur-
vive.
         OF THE MODES OF COERCION.

  With regard to the second point, the necessi-
ty of coercion, I have no hesitation  in saying,
that it will  diminish or increase, as  the moral
treatment of the patient is more or less judicious.
We cannot, however,  anticipate that the most
enlightened and ingenious  humanity, will  ever
be  able  entirely to  supersede the necessity of
personal restraint.
  Coercion is considered, as the  ingenious au-
thor of  " Observations  on  Madness" says  it
should be,  "only as a protecting and  salutary
restraint."    The  mode of it ought to be  sub-
ject to the consideration of its effect on the mind
of  the insane.   Some  means of  coercion  have
obviously a greater tendency than others, to ir-
ritate or degrade  the feelings.  Hence, the use
of  chains has never been permitted in the  Re-
treat.  In  the  most  violent states of mania, as
the  author  just quoted observes, "the patient
should be kept alone, in a dark* and quiet room;
so  that he may not be affected by  the stimulus
of light or sound ;  such abstraction more readi-

  * Our superintendent prefers a gloomy, to an entirely
dark apartment. 
60
ly disposing to sleep.  As in this violent state,
there is  a strong propensity  to associate ideas,
it is particularly important to prevent the acces-
sion of such as  might be  transmitted  through
the  medium of the senses."*'  The patients of
this  class, who are not disposed to injure them-
selves, are merely confined by the  strait-waist-
coat ; and left to walk about the room, or lie
down on the bed, at pleasure.   But in those  des-
perate cases of melancholy, attended with ttedium
vitse, in which there is a strong determination to
self-destruction, it  becomes necessary to confine
the  patient,  during the night, in a  recumbent
posture.   For  this purpose,  the  superintendent
has  invented  a  very simple  apparatus, which
answers all the purposes of security ;  and allows
the patient to turn and otherwise change his pos-
ture in bed.
  It  has been  suggested,  that in cases of high
mania, the violent excitement would be  best re-
duced, by indulging it in the greatest practicable
degree.  The  experience  of  the  Retreat, leads
to an opposite  conclusion ;  viz. that such a de-
gree of restraint as would not be materially pain-
ful,  in a state  of calmness, has a  tendency to
abate the paroxysm.   The association  between
mental and bodily action, and the degree  in which
the latter is  well  known tg  excite the  former,
sufficiently illustrate the cause of this fact.
  Except in the case of violent  mania, which
is far from being a frequent  occurrence at the
Retreat, coercion, when requisite, is considered
as a necessary evil; that  is, it is  thought ab-
stractedly to have a tendency to retard  the  cure
  * The necessity for this mode of treatment is very rare at
the Retreat. 
61
by opposing the influence of the moral remedies
employed.  It is therefore used very sparingly ;
and  the superintendent has often assured me,
that  he would rather run some risk, than have
recourse to  restraint, where it was not absolute-
ly necessary ;  except in those cases where it was
likely to have a salutary moral tendency.
  I feel no  small satisfaction in stating upon the
authority of  the  superintendents, that  during
the last year,   in which  the  number of  patients
has generally been sixty-four, there has not been
occasion to  seclude, on an average, two patients
at one time.  I am  also able to  state,  that al-
though it is occasionally necessary to restrain by
the waistcoat, straps, or other means, several
patients at one time ; yet that the average num-
ber so restrained does not exceed four, including
those who are secluded.
  The safety  of those who attend upon the In-
sane, is certainly an object of great importance;
but it is worthy of  inquiry whether  it may not
be attained, without materially interfering with
another  object—the  recovery of the  patient.
It may also deserve inquiry, whether the exten-
sive  practice of coercion, which obtains  in some
Institutions, does not arise from erroneous views
of the character of insane persons ;  from  indif-
ference to their comfort j or from having ren-
dered  coercion necessary by  previous unkind
treatment.
  The power  of judicious kindness over this un-
happy class of society, is  much greater than is
generally imagined.
  In no  instances has  this power been more
strikingly displayed ; or exerted,  with more be-
neficial effects, than in those deplorable cases in
                       r 
62
which  the  patient refuses  to  take  food.  The
kind persuasions  and ingenious arts of the su-
perintendents, have  been singularly  successful
in overcoming this  distressing symptom;  and
very few instances now occur  in which it is ne-
cessary to  employ violent  means for supplying
the patient  with food.
  Some  patients  who  refuse  to partake of the
family meals,  are induced to eat by being taken
into the larder, and there allowed to help them-
selves.  Some are  found willing  to eat when
food is left with  them in their rooms, or when
they can obtain  it unobserved by their atten-
dants.   Others, whose determination is stronger,
are frequently induced, by repeated persuasion,
to take a small quantity of nutritious liquid;  and
it is equally true in these, as in general cases,
that every  breach of resolution  weakens  the
power and  disposition to resistance.
  Sometimes,  however, persuasion  seems to
strengthen  the unhappy  determination.  In one
of these cases, the attendants were completely
wearied  with their endeavours ; and on remov-
ing the food, one of them took a piece of the
meat which had  been repeatedly offered to the
patient,  and threw  it under  the fire-grate; at
the same time, exclaiming,  that she should not
have  it.   The  poor  creature,  who  seemed
governed by the  rule of contraries, immediate-
ly  rushed  from her seat, seized the meat from
the  ashes, and devoured it.   For a short  time,
she was induced to eat, by the attendants avail-
ing themselves of this contrary disposition ; but
it was soon rendered unnecessary, by the re-
moval of this unhappy feature of the disorder.
   The attendants at the  Retreat, feel themselves
in  no danger of injury from the  patients,  who 
63
are unconfined; many  of whom, previously to
their admission, have been accustomed to much
severity.  No instance  has occurred of any se-
rious  injury being  done by a patient, to  any of
the attendants ;  and at no period has there been
manifested a general spirit of dissatisfaction, or
a tendency to revolt.
   The  common attendants  are not allowed to
apply any extraordinary coercion to the patients,
by way of punishment, or to change, in any de-
gree,  the usual mode of treatment, without the
permission of the superintendents.   This  limi-
tation to their power is of the utmost importance,
as it  obliges them  to seek the  good opinion of
the patient, and to  endeavour to govern  rather
by the influence of esteem than  of severity.
   When  it  is deemed necessary to apply the
strait-waistcoat, or any other mode of coercion,
to a  violent patient, such an ample force is em-
ployed, as precludes the idea of resistance from
entering the  patient's mind ;  and hence,  irrita-
tion,  or additional  excitement, is generally, in a
great degree, prevented.
   Where such force cannot be obtained, and the
case  is urgent,  courage and confidence will ge-
nerally overcome the violence of the patient; for
the  opinion  appears to'be well founded, that
maniacs are  seldom truly courageous.   The su-
perintendent was one day walking in a field ad-
jacent to the house, in company with  a  patient,
who  was apt to be  vindictive  on very slight oc-
casions.   An exciting circumstance  occurred.
The  maniac retired a  few paces, and seized  a
large stone, which he   immediately held up,  as
 in the act of throwing at his  companion.  The
 superintendent, in no  degree ruffled, fixed his 
64
eye upon  the patient, and in a resolute tone  ot
voice, at the same  time advancing, commanded
him  to lay down the stone.   As  he approached,
the hand  of the lunatic gradually sunk from  its
threatening position, and permitted the stone to
drop to the  ground.   He then submitted to  be
quietly led to his apartment.
   I conceive it useless to enter into more minute
details of the modes of coercion and restraint,
since experience alone can  fully teach the best
means of exercising them ;  and the attendant
who possesses a good understanding, and has
taken a just view of the character of the insane,
will soon perceive for himself, the necessary de-
gree, time,  and mode  of coercion, which  those
who are  placed  under  his care require.  But
they who have had an opportunity of observa-
tion,  and they only, can  conceive the  difficulty
of  entirely subduing   the  vindictive  feelings,
which the inconsistent,  but often half rational,
conduct of the patient, frequently  excites  in the
minds of the inferior attendants.
   It is therefore an object of the  highest impor-
tance, to infuse into the minds of these persons,
just sentiments, with regard to the poor objects
placed under their care ; to impress upon  them,
that  " coercion is only to be considered as  a pro-
tecting and  salutary restraint;"  and to remind
them, that the patient  is really under  the  influ-
ence of a disease, w hich deprives  him of respon-
sibility ;  and  frequently leads him into expres-
sions and conduct the most  opposite to his cha-
racter and natural dispositions.
   But even this view of the subject is not ex-
empt from  danger; if the  attendant does not
sufficiently consider the degree in which the pa- 
                      65

tient may he influenced by moral and rational in-
ducements.   These  contradictory  features in
their character,  frequently render it exceedingly
difficult to  insure the proper  treatment  of de-
ranged persons.  To consider them at the same
time both as brothers, and as  mere automata;
to applaud  all they do right;  and pity, without
censuring,  whatever  they do  wrong, requires
such  a habit  of philosophical reflection,  and
Christian charity, as  is certainly difficult to  at-
tain.
OF  THE MEANS OF PROMOTING THE GENERAL
          COMFORT OF THE INSANE.

  THE comfort of the patients is therefore con-
sidered of the highest importance, in a curative
point of view.  The study of the superintendents
to  promote it with all the assiduity of parental,
but judicious attention, has been,  in numerous
instances,  rewarded  by an  almost filial  attach-
ment.  In their conversation with the patients,
they adapt themselves to their  particular weak-
ness ; but, at the same time, endeavour to draw
them insensibly from the  sorrow,  or the  error,
which marks the disease*
  The female superintendent, who possesses an
uncommon share of benevolent activity, and who
has the chief management of the female patients,
as well as of the domestic  department, occasion-
ally gives a general  invitation  to  the  patients,
to a tea-party.  All  who attend, dress in their
best clothes, "and vie with each other in polite-
ness and  propriety.  The best  fare is provided,
and the visiters are treated with all the attention
                     F  2 
66
»i strangers.   f he  evening generally passes in
the greatest harmony and enjoyment.   It rarely
happens  that  any unpleasant circumstance  oc-
curs ; the patients control in a wonderful degree,
their different propensities ; and the scene is at
once curious, and affectingly gratifying.
   Some of the patients occasionally pay visits to
the friends in the city ; and female visiters are
appointed every month by  the committee, to pay
visits to those of their own sex; to converse with
them, and to propose to the superintendents, or
the Committee,  any improvements  which  may
occur to them.   The visiters sometimes take tea
with the patients, who are much gratified  with
the attention of their friends, and mostly behave
with  propriety.
   It will be necessary here to mention, that the
visits of former intimate friends, have  frequent-
ly been attended  with  disadvantage to the pa-
tients;  except when convalescence  had  so far
advanced,  as to afford a prospect of a speedy re-
turn to  the bosom of society.   It is,  however,
very  certain, that as soon as reason  begins to
return, the conversation of judicious, indifferent
persons,  greatly increases  the  comfort, and is
considered almost essential to  the recovery of
many patients.   On this  account, the  conva-
lescents of every class, are frequently introduced
into the society of the rational parts  of the fami-
ly.  They are also  permitted to sit up till the
usual time for the family  to retire to  rest, and
are allowed as  much  liberty  as their state of
mind, will admit.
   Those who have had the opportunity  of ob-
serving the restoration  of reason, will  be aware,
that  she does not,  in general,  at once, resume 
67
4ier lost empire over the mind.  Her approach
resembles rather the gradual influx of the tide ;
she seems to struggle to advance, but again and
again is compelled to recede.   During this con-
test, the judicious attendant, may prove the most
valuable  ally of reason; and render to her the
most essential assistance, in the recovery of her
lawful throne.
   In some cases, however, the cloud which en-
velopes the mind is  suddenly dispersed, and the
patient seems to awake at once as out of a dream.
In others the  progress of recovery  is gradual
and uniform.
   As indolence has  a natural tendency to weak-
en the mind,  and to induce  ennui and discon-
tent, every  kind of rational  and innocent em-
ployment is encouraged.
   The attendant will soon perceive  what kind  of
employment or amusement,  is best adapted  to
the  different patients under his  care.  He will
observe that those of the most active and excit-
ing  kind, will be best adapted to the melancholy
class,  where they can be induced to engage  in
them; and that the more sedentary employments,
are  generally preferable for  the  maniacal class.
No strict rule, however, can properly be laid
down  on this subject;  and the inclination of the
patient may generally  be indulged, except the
employment he desires obviously tends to foster
his disease.  The means of writing, ,are, on this
account, sometimes  obliged to be withheld from
the  patient, as  it would only produce continual
essays on his peculiar notions ; and  serve to  fix
his  errors more completely in his  mind.   Such
patients  are, however, occasionally indulged, as 
63
it is found to give them temporary satisfaction ;
and to make them more  easily led into suitable
engagements.
  There certainly requires considerable  care in
the selection  of books for the use  of the insane.
The works of imagination are generally,  for  ob-
vious reasons, to be avoided ;  and such  as  are
in any degree connected  with  the peculiar  no-
tions of the patient, are decidedly  objectionable.
The various  branches  of the mathematics and
natural science, furnish the most useful class of
subjects on which to emploj' the minds of the in-
sane ; and they should, as much, as possible, be
induced  to pursue one subject steadily.   Any
branch of knowledge with which the patient  has
been previously acquainted, may  be resumed
with greater ease; and his disposition to pursue
it will be encouraged, by the competency  which
he is able to exhibit.
  I met with a striking instance, of the  advan-
tage of  attention to this point, some years ago.
It was related to me by a person of great respec-
tability,  who was himself  the  subject  of  the
case.   He stated, that a few years before that
time, his mind had been greatly depressed with-
out  any  apparent  cause.   The  most  dismal
thoughts continually haunted his  mind,  and he
found the greatest difficulty, in confining his at-
tention, for the shortest time, to  one subject.
He felt entirely indifferent to his  business and
his family ; and, of course, he neglected them.
It was with  great difficulty he  was induced to
take sufficient food to support life.  His  body
became emaciated, and his mind more and more
enfeebled. 
69
  In this state, as he was one day musing upon
his  miserable condition,  he perceived, by the
faint glimmerings of remaining reason, the still
worse state to which he must be reduced, if he
continued to  indulge  his gloomy reflections and
habits.  Alarmed with the prospect of the future,
he  resolved  to  exert the power which he still
possessed to control  his  unhappy  dispositions,
and to regain the habit of attention.   For this
purpose, he  determined,  immediately to  apply
himself to mathematics, with which he had been
well acquainted  in his youth, and also to adopt
a more liberal regimen.
  The first  attempt  to  go through the easiest
problem, cost him indescribable labour and pain.
But he persisted in the endeavour; the difficul-
ty of fixing his attention gradually lessened ; he
overcame his tendency to abstinence ;  and very
shortly recovered the use of his faculties and his
former temper of  mind.
  Perhaps few persons, in the situation which I
have described,  would have had  the courage to
form such resolutions ;  and still  fewer, the for-
titude to  perform them.   The  case,  however,
certainly points out what may possibly be  done ;
and how important it is,  in a curative point of
view, to encourage the patient in steady mental
pursuit.
  The managers of this Institution, are far from
imagining that they have  arrived  at a state of
perfection in the moral treatment of insanity.  If
they have made  any considerable approaches to-
wards it, their progress has only  served to con-
vince them how  much  more may  probably be
effected ; and to fill them with regret, that so lit-
tle  ingenuity has  hitherto been  exerted  to in- 
70
crease the  comforts of insane persons.   There
is  no doubt, that if the same exertions were
used for this purpose, as are frequently employ-
ed  to amuse the vain, the frivolous, and  the
idle,  many more gleams  of comfort would be
shed  over the  unhappy existence of lunatics ;
and the proportion of cures would be still ma-
terially increased.
  OF THE RULES OF  THE ESTABLISHMENT, &.C

  The object of the  Retreat, being to furnish a
comfortable shelter for insane persons,  as  well
as to  promote their  recovery, its original rules
made no distinction  between old and recent ca-
ses ; and did not, in any degree, limit the time
of patients  continuance  in the house.  The  only
restriction relates to idiots; and this appears to
have  been  generally  understood  as applying,
chiefly, to cases of original absence of intellect.
   In  these respects, the  circumstances of  this
establishment, differ  materially  from  those of
some of our largest public  institutions.
   It appears, from the statement of the master
of St. Luke's Hospital, made before a Commit-
tee of the House of Commons, that, in this In-
stitution, " The average number of patients  at
one time is 300;" and that " the average num-
ber of incurable  patients,  in  the house at  one
time, is 115."  All patients are discharged from
this Asylum at the end of the first year; and if
not then recovered, may be  entered" on the in-
curable list, to be admitted when a vacancy  of-
fers ; but it  appears that only a certain number
of this class of patients are  permitted to be in the 
71
house  at one time.   The rules of this hospital
do not admit patients " troubled  with  epileptic
or convulsive fits."
  By the following  quotation from Haslam, it
appears, that  the rules of Bethlem  Hospital
guard  against the  admission of old cases ;  " Al-
though patients who have been affected with in-
sanity  more than a year, are not admissible into
the hospital, to continue there for  the usual time
of trial  for cure,  viz.  a twelvemonth; yet, at
the  discretion  of  the Committee, they may be
received into it from Lady-day to Michaelmas ;
at which latter period they are  removed.  In
the course of the last twenty years, seventy-eight
patients of this description have been received."
   There are, however,  a number of patients in
Bethlem, who have been there many years ; and
I  therefore conclude, that  a certain proportion
is permitted, as in St. Luke's, to  remain on the
incurable establishment.  But, as  Haslam states,
that from the  year  1784 to  1794, out of 1664
cases  admitted, 1090 were  discharged  uncured,
I  presume  that the  number  of patients in this
hospital,  who  have been afflicted with insanity
more than a year, is comparatively very  small.
   A large  majority of the cases admitted into
the  Retreat, have not been recent.  In several
instances, the  disorder  had existed from  fifteen
to twenty years  previously to their admission;
and, of course, no reasonable hope could  be en-
tertained of the  patient's recovery.  The total
proportion of cures cannot, therefore, be expect-
ed  to be large.   I  will not, however, omit to
 mention, that the number of  these must have
been fewer, if the rules had limited the time of
continuance in the house, as is the case in the 
72
two  charitable  Institutions  above  mentioned.
But, it must also be  observed, that several  pa-
tients who have been  insane at the expiration of
twelve months, have remained in the house from
three to six months longer on probation, or at
their own request, until  a suitable situation  of-
fered for them.
  Others, who have been apparently well at  the
end  of twelve  months,  have relapsed  before
they quitted the house ; and 1 cannot avoid at-
tributing to the premature discharge of  insane
persons, many of the  relapses which  occur after
they leave the places provided for  their care.
Several of the symptoms which mark the dis-
order in its incipient state, also mark an advan-
ced  stage of  convalescence.   In either  case,
though no absolute act of insanity  is committed,
the mind is unable to bear that stimulus  or  ex-
ertion, which would even be salutary to it, in a
state of perfect sanity. 
APPENDIX.
  THE Author hopes he shall be justified in presenting the
reader with the sentiments of some respectable persons, who
tiave carefully inspected the Retreat.  His view in doing so,
is to confirm the testimony which he has given in the pre-
ceding pages, of the practices of this Institution, and which
might be suspected of partiality, if it were not  supported
by the evidence of disinterested persons, who were quali-
fied to judge on the occasion.
  In the year 1798, Dr. Delarive, of  Geneva,  after having
examined  a great number of public and private establish-
ments of a similar nature, visited the  Retreat. It was then
in its infancy;  but, the Doctor was  so far pleased with the
general management, as to write a very favourable  descrip-
tion  of it, in  a letter addressed to the editors of "The
British  Library."  This letter afterwards appeared on the
Continent  in  a separate form,  from  a copy of which the
following extracts are made.
  After describing  the  evils which  have  existed in  the
treatment  of the insane in public hospitals, which he ob-
serves would lead one to  suppose, that  madmen were em-
ployed  in tormenting other madmen, he says, "The  res-
pectable society  of  Quakers have  at length  endeavoured
to remedy these evils ; it has been desirous of securing to
those of its members, who should have the unhappiness to
lose  their  reason, without  possessing a fortune adequate
to have recourse  to  expensive establishments, all the re-
sources of art, and   all  the comforts of life, compatible
with  their situation.   A  voluntary subscription furnished
the  funds ; and, about two years  since,  an establishment,
which appears to unite many advantages,  with  all possi-
ble  economy,  was founded near the city of York.
  " If the mind shrinks for a moment at the aspect of this
terrible disease,  which seems calculated  to humble  the
                           G 

 reason of man ; it  must afterwards feel pleasing emotions,
 in considering all that an  ingenious benevolence has been
 able  to  invent, to cure and comfort the patients afflicted
 with this malady.
  " This house  is  situated a mile from York, in the midst
 of a fertile and cheerful  country;  it presents  not the idea
 of a prison, but rather that of a'large rural farm.  It is sur-
 rounded  by  a garden. There is no bar  or  grating to the
 windows, their place is  supplied  by a means of which I
 shall afterwards give an  account."
  After a general view of the economy of the Retreat, and
 the general treatment of  the patients, the Doctor thus con-
 cludes his  letter:  " You will perceive,  that  in the moral
 treatment of the insane,  they do not. consider them as ab-
 solutely  deprived  of reason ; or, in other words, as  inac-
 cessible  to  the  motives  of fear, hope, feeling and honour.
 It appears that they consider them rather as children, who
 have too  much strength, and who make a  generous use of it.
 Their punishments and rewards must be immediate,  since
 that which  is distant has  no effect upon them.  A new sys-
 tem of education must be adopted 4o give a fresh course
 to their ideas.  Subject them at first;  encourage them  af-
 terwards, employ them, and  render their  employment
 agreeable by attractive means.   I think that if we could
 find still stronger means to excite feelings  of benevolence
 in their minds, we should accelerate their recovery by the
 agreeable emotions which  accompany.jdA  the  affections.
 But it is evident, that every needless restraint excites in
 them the vindictive passions, to which  they are but too
 prone, and prolongs the continuance of the disease."
  A few years since, W. Starke, Esq. architect, of Glasgow,
 who was engaged  to prepare a plan of an Asylum for that
city and the West of Scotland, visited the  Retreat.  The fol-
 lowing extract is made from his valuable  " Remarks on the
 Construction and Management of Lunatic Asylums," pub-
lished in the year 1810.  " In some Asylums, which I have
visited, chains are fixed  to every table, and to every bed-
 post ; in  others, they are not to be found within the walls.
 The idea of inflicting corporal punishment is held in abhor-
ence; and rods or whips are considered as engines of power,
too dreadful to be committed to the hands of servants, who   *
 may soon convert them into instruments of oppression.
  In such asylums, however, there are no  appearances of in-
 subordination.   The whole demeanour of the patients, on the
contrary, is most remarkably submissive and orderly.  The
one to which I especially allude, the  Retreat, or  Quaker Asy-
lum, near York, it may be proper to meution, is occupied by a 
75
description of people, whose usual habits in life are highly
regular and exemplary;  but the chief cause of its superiority
will  be found to lie in the government of the Asylum.  It is
a government of humanity and of consummate  skill, and re-
quires no aid from the arm of violence, or the exertions of
brutal force.
  At the Retreat, they sometimes have  patients brought to
them, frantic, and in irons,  whom they at once release, and,
by mild arguments and gentle arts, reduce almost immedi-
ately to obedience and orderly behaviour. A great deal of
delicacy appears in the attentions paid to the smaller feelings
of the  patients.  The iron bars, which guarded the windows,
have been avoided, and neat  iron sashes, having all the ap-
pearance of wooden ones, have been substituted in their
place; and, when I visited them, the managers were occupied
in contriving how to get rid of the  bolts  with which the  pa-
tients are shut up at night, on account of their harsh ungrate-
ful sound, and of their communicating to the Asylum  some-
what of the air and character of a prison.
  The effects of such attentions, both  on the happiness of
the patients, and the discipline of the Institution, are more
important than may at first view be imagined.   Attachment
to the  place and to the managers, and an air of comfort  and
of contentment, rarely exhibited within the precincts of such
establishments,  are consequences  easily discovered in  the
general demeanour of the patients.
  THE following testimony  is extracted from an account
lately published of the Lunatic Asylum at Edinburgh; and
we are authorised to state, that it comes from the pen of Dr.
Duscan, senr. who visited the Retreat in the year 1812, after
having seen most of the Institutions of a similar nature  in
Britain.
  That the government of the insane requires a certain de-
gree of restraint, both for the safety of the individual and  of
others, no one can doubt.  But very different opinions have
been entertained with regard to the utmost degree of coer-
cion, which is necessary  in any case.  Now, however, this
point may be considered as in some degree settled by  expe-
rience   The fraternity denominated Quakers  have demon-
strated, beyond contradiction, the very great advantage re- 
76
stilting from a mode of treatment in cases of insanity, much
more mild than was before introduced into almost any Luna-
tic Asylum, either at home or abroad.  That fraternity, who
have been long and justly celebrated for charity and humani-
ty, have established in the neighbourhood of the city of York,
The Retreat, as they term it, a building appropriated to de-
ranged members of their own community.  In the manage-
ment of this Institution, they have set an example which
claims the imitation, and deserves the thanks, of every sect
and every nation.  For, without much hazard of contradic-
tion from those acquainted with the subject, it may be assert-
ed, that the Retreat at York, is  at  this moment the  best
regulated establishment in Europe, either for the recovery of
the insane, or for their comfort, when they are in an incurable
state.
  Dr. Natjbi, president of the Maltese Hospital, after care-
fully inspecting the Retreat in the present year, gave the fol-
lowing testimony respecting it:
  " I am very glad to have been at York, to observe the Re-
treat there kept by the Society of Friends. This house, or
Retreat,  for the trouble in  mind, I think is one of the best
things I saw in England on the same subject;  and having ob-
served many others on the Continent, I dare say that it is the
best in all the world.   The situation of the building out of
the town, a large garden around it, the propriety of the rooms,
the cleanliness of the patients, the way which  they are kept,
as for dressing, as for feeding them, is very  remarkable to be
observed."*
* Dr. N. had studied the English language, only nine months.
THE  END, 
   A copy of the first
annual report of the Asylum,
lacking the title page, pub-
lished in 1818 under title:
Further information of the
progress of the Asylum ...
was formerly bound with this
181b, "Account."  It was re-
moved in I960 and bound
separately. 
 
wz