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and five minims of tincture of opium. Hisbeer was changed to two ounces of wine. Heis quite comfortable to-day, and sitting up inbed reading the paper. Wound healthy ;granulations from the dura mater and scalpinosculating.

THE STATEMENTS

OF

DRS. CLUTTERBUCK AND J. JOHNSON

ON THE

NON-RESTRAINT OF LUNATICS.

CLINICAL INSTRUCTION TO MEDICAL STUDENTS,ON INSANITY.

To the Editor of THE LANCET.

SiR,-I have read with some surprise theobservations of Dr. Clutterbuck and Dr.

Johnson, at the last meeting of the LondonMedical Society. When Dr. Clutterbuckstates that he thinks the new practice of dis-pensing with restraint empirical, and highlydangerous to the patient and those aroundhim, is he aware that, under that practice,suicides are less frequent, accidents lessnumerous, and attacks upon attendants farmore rare than under the old management ?When he says that the Hanwell system isnot more successful than that practised inany other well-regulated asylum, Does hereally know what the system is? Has heseen the substitutions for mechanical re-straint in use at that asylum ? Has heever visited the place ? Has he readthe published reports? Does he kuow, as

I

stated in the last report, that at this timefrom thirty to forty patients, although incu-rably insane, are now in that asylum in astate of comparative comfort and enjoyment,who were before the establishment of thenew system in constant and galling coercion?Is be aware, to use the language of the re-port, that 11 several patients have been ad-mitted into Hanwell in the course of the yearin restraints, and many more marked withrestraints before admission ;" and z’ that the

management of all these cases has provedperfectly practicable without restraints ?"Has he read the interesting details of nume-rous cases given in Dr. Conolly’s last reportof the beneficial practical consequences ofthe removal of restraints? Has he read theLancaster report? Does he know that theLancaster Asylum, consisting of five hundredand thirty patients, has been conducted forsix months without the use of instrumentalrestraint, although eighteen months ago thequantity inflicted was terrific ? Does he knowthat instrumental restraints are abandoned inmany leading asylums throughout the king-dom; that they are greatly diminished in all-Bethlem included? and above all, Does

he know that the house-surgeon of the Lin-coln Asylum (in which, from intestine (livi-sions and the determined opposition of one ofthe physicians of the establishment, the sys-tem has had the severest trial) has, in aspirit which does him honour, addressed anofficial communication to the committee,stating his conviction of the impolicy of thecourse recently pursued in that asylum ; andthat poor Miss A., whose case, as the" LOOKER-ON" has formerly observed, was adisgrace to the medical profession, is nowreleased from her captivity, and become amanageable patient? I think if Dr. Clut-terbuck had known all these facts, he wouldhave hesitated ere, in such unmeasured terms,he had, ex cathedrti, denounced the system.The statement of Dr. Clutterbuck, that

the restraint effected by gloves or waist-coats would be less irritating to the patientthan the presence of keepers constantlywatching him," must induce an opinion,that he is not familiar with the usagesof asylums, or the Parliamentary inquirieswhich have been made into their manage-ment. The want of watchfulness in theattendants is the chief cause of the dis-orders which occur in the government ofthese houses; and the use of mechanicalrestraint is the great cause of the absence ofwatchfulness : and amongst the most benefi-cial consequences of its abolition, is thenecessity it engenders of unceasing care andvigilance. Besides, assuming- that a mad-man should prefer the torture of a strait-waistcoat to the eye of a keeper, a predilec-tion new to me, is he, therefore, to be in-dulged in it?When Dr. Johnson says, that

11 if the n-ia-gistrates who advocate the non-restraintsystem were to see a patient in a furor, theywould change their opinion," he probablyspeaks truly if he confines his observationsto those magistrates whose philanthropyleads them to support a system founded onthe basis of humanity, but who are practi-cally unacquainted with its details. Thefirst exhibition of a lunatic in a state offuror is undoubtedly a fearful sight, and itis too much the practice, as the LOOKER-ON" can personally testify, for the attendantsin asylums where instrumental restraints arerife, to administer to the fears of the visitorsby affected caution and interference. Butthe question is not, whether a magistratewould be terrified by afuror, but whether asuperintendent ought to be. The assertion ofDr. Johnson that " the system in questionindicates insanity on the part of its sup-porters," is only to be answered by a counter-assertion, that " the system in questionindicates folly on the part of its opponents."The time, Sir, is passed for the system to berailed down by assertions such as these, itcan now only be successfully opposed by

! o-g’MmeKt and fact and at present there isa most lamentable, or, I should rather say, a

330

most glorious, deficiency in these essentialsamongst its opponents. I am, Sir, your obe-dient servant,

A LOOKER-ON.November 29, 1841.P.S.-I look forward with much hope to

the results of the society whose eatablish-ment is noticed in your last Number. Its

numbers at present are few, but it boasts ofmany excellent names, and amongst themsome of the most valuable labourers in our

vineyard. Communications between men of

intelligence and practical knowledge must bebeneficial. It never must be forgotten thatthe abolition of mechanical restraint is an

effect not a cause. To imagine that a lunaticcan be controlled by merely taking off hismanacles, would be as absurd as to imaginean ulcer could be cured by simply taking offthe dressings. The absence of the necessityfor mechanical restraint arises from the pre-sence of the moral system of treatment. I

admire the caution with which the societyare proceeding. The time is not yet arrivedwhen pledges should be required of the

applicability of the system to all cases ;but I entertain no fear of the ultimate

result. BUT WHAT ARE THE STUDENTS DOING J

Why do they not take measures which mustforce upon Bethlem and Hanwell the neces-

sity of establishing courses of clinical andother lectures for their improvement. De-

vonshire is erecting a large county asylum.The subject is under consideration in Shrop-shire, Herefordshire, the East and North

Ridings of Yorkshire, Oxfordshire, and someWelsh counties, and is spreading rapidlythroughout the whole empire. THE" LooKER-ON" CANNOT ASSIST THE STUDENTS IF THEY WILL

NOT ASSIST THRMSELVES ; but he proclaims to

them, that a vast revolution is taking placein the management of asylums, and the qua- lifications required in the superintendents,and that in a very few years the profes.sional man, who can produce testimonialsof a careful attention to this branch of medi-

cal knowledge, will find a path of honour-able practice open to him, of which at pre-

sent, with the want of foresight of youth, hedoes not calculate.

A LOOKER-ON.

THE LANCET.

London, Saturday, December 4, 1841.

DISHONEST INTERPRETATION OF THE TERM

UNTIL we had read the definition of the

term CHENiST-and-DRCGGisT in the by-lawsof the Pharmaceutical Society, we were

freely and willingly inclined to bestow onthe founders of that institution full credit

for being actuated in their proceedings by abold, determined, and independent spirit.Unliesitatingly did we concede to those gen-tlemen the reward which appeared to us tobe their due, for calling into existence an as-sociation which was calculated to advance at

a rapid rate, and in a right direction, thecause of medical science in this country.Every person must admit that the practiceof medicine must be unsatisfactorily con-ducted so long as the science of pharmacy is

imperfect and ill-understood. We therefore

hailed the birth of the new Society with de-

light and satisfaction, because we thoughtwe saw in it a new battery, which might be

brought to bear with great force and effectagainst the evils that flesh is heir to, and a

power that might be worked with prodigiousutility in promoting the success of our philan-thropic establishments. That obnoxious de-

finition, however, still engages our attention.We cannot get rid of it, and it casts a cloudover the character of the Association, whichmight otherwise exhibit only the brightestreflection, arising from honesty of purpose,and a desire to promote the public good.Deeply should we regret to see the greatbody of the medical profession in this coun-

try, and that highly-respectable class of

tradesmen, the chemists and druggists, as-sume, with regard to each other, the front

and bearing of a hostile attitude; and no-

thing, in our opinion, but ignorance, folly, orpresumption, can lead to so disagreeable aresult. Medical practitioners have an un-doubted right to insist that the law shall beenforced against unqualified pretenders tomedical skill. But the druggists, on the one