1885.] 223 [Curwen. 



obtain a clear idea of the work which he performed, and the clear head 

 and generous heart which directed that work. 



The employment of mechanical restraint has in late years received more 

 than usual attention in the reaction from its excessive use in England 

 many years since, and on a subject of such practical importance in the 

 treatment of the insane, it is only just to quote the opinions of one who 

 had the most ample means of testing it, and who, while believing in its 

 use in certain specified cases, rarely, to use the words of Dr. J. C. Buck- 

 nill, of England, carried his theory into practice. His uniform testimony, 

 derived from careful observation and experience, for he had seen its modi- 

 fied use while resident physician of the Friends' Asylum and of the Penn- 

 sylvania Hospital in Pine street, and holding that opinion, not because he 

 had formed it, 'and was reluctant to change it, but simply because he be- 

 lieved that the best interests of a certain class of insane, and that a very 

 limited number required it for their benefit, was, in the language of a reso- 

 lution of the Association of Medical Superintendents of American Institu- 

 tions for the Insane, adopted in October, 1844: "That the attempt to 

 abandon entirely the use of all means of personal restraint, is not sanc- 

 tioned by tlie true interests of the insane." That resolution was drawn 

 by men, who carefully considered the words they used before committing 

 them to paper. 



Dr. Kirkbride discussed the subject in his reports, from the year 1841 

 down to 1877, in which latter year he used the following language as a 

 full summary of his views : " It is an error leading to wrong popular im- 

 pressions, to speak of any hospital for the insane as being conducted 

 without restraint. There is no such thing, and cannot be. Where an in- 

 dividual is placed under the control of another, even where the control is 

 of the gentlest kind, it can hardly be said he is without restraint. What 

 is meant is, not that a hospital is without restraint, but is without me- 

 chanical means of restraint, and these can be omitted anywhere on provi- 

 sion of the proper substitutes. Mechanical restraint is rarely necessary, 

 and only in a few, simple forms, but when it is required, it is a question 

 to be left for the decision of whoever directs the treatment of the patients. 

 No one recognizes more thoroughly than is done here, the impropriety of 

 subjecting the insane to unnecessary restrictions, and that the precise ex- 

 tent to which freedom of action may be carried can only be discovered by 

 careful observation and the study of the peculiarities of every individual 

 patient. The only persons who can properl}'- decide just how for restric- 

 tions shall be carried, and freedom be granted in an institution, are its 

 medical oflicers, who, having all the responsibility for the results, if at all 

 qualified for their positions, may safety be entrusted with the power to de- 

 cide all such questions, which should really be regarded as a part of the 

 treatment of the patients." 



In the matter of occupation, employment and amusement of the inmates 

 of a hospital, Dr. Kirkbride always held advanced opinions, which the 

 great majority of u>en have not yet attained to. He held, and held justly, 



