I N S A 
St Will be eafily effe&ed; for, where the force of the con- 
tending perfons ts nearly equal, the maftery cannot be 
- obtained without difficulty and danger. 
As management is employed to produce a falutary 
change upon the patient, and to reftrain him-from com¬ 
mitting violence on others and himfelf, it may here be 
properYo enquire upon what occalions,.- and to what ex- 
tent, coercion may be ufed. ..The term coercion has been 
•underftood in a very formidable fenle, and not without 
reafon. It has been recommended by very high medical 
authority, Dr. Cullen, to infliCl corporal punifhment upon 
maniacs, with a view.of rendering them rational by im¬ 
prefling terror. From Dr. Mead’s fedion on madnefs, it 
would appear that in his time flagellation was a common 
remedy for this difqrder. “ There is no difeafe- more to 
be dreaded than madnefs j for what greater unhappinefs 
can befal a man, than to be deprived of his reafon and 
underftanding, to attack his fellow creatures with fury 
like a wild bead, to be tied down and even beat to prevent 
his doing milchief to himfelf or others.’’ Dramatic wri¬ 
ters abound with allufions to the whip, in the treatment 
of madnefs. “ Love is merely a madnefs, and, I tell you, 
deferves as well a dark houfe, and a whip, as madmen do : 
and the reafon why they are not fo punilhed and cured 
is, that the lunacy is fo ordinary, that the whip pel's are 
in love too.”- As you like it: 
. If the patient be fo far deprived of underftanding as to 
be infenflble why he is punifhed, fuch cor region, fetfing 
afide its cruelty, is manifeftly abfurd; and, if his ftate be 
i'uch as to be confcious of the impropriety of his conduCl, 
there are other methods more mild and effectual. Would 
any rational practitioner, in a cafe of phrenitis, or in the 
delirium of fever, order his patient to be l'courged ? he 
would rather fuppofe, that the brain or its membranes 
were inflamed, and that the incoherence of difeourfe and 
violence of action were produced by fuch local difeafe. 
It has been Ihown by repeated difleJtions, that the con¬ 
tents of the cranium, in molt of the inftances that have 
occurred, have been in a morbid ftate. It fliould, there¬ 
fore, be the objeCt of the praCtitioner to remove fuch 
difeafe, rather than irritate and torment the fufterer. 
Coercion fliould only be confidered as a protecting and 
falutary reftraint, to prevent patients from hurting them- 
felves or others; and the contrivance called the fir ait 
zuaijicoat anfwers every purpofe of refraining the patients 
without hurting them. Thefe waiftcoats are made of 
ticken, or fome fuch ftrong fttifF; are open at the back, 
and laced on like a pair of ftays; the fleeves are made 
tight, and long enough to cover the ends of the fingers, 
where they are drawn clofe with a firing like a purfe- 
mouth, by which contrivance the patient has no power of 
his fingers; and, when laid on his back in bed; and the 
arms brought acrofs the cheft, and faftened in_ that pofi- 
tion by tying the fleeve-ftrings round the waift, he has 
no ufe of his hands. A broad ftrap of girth-web is then 
carried acrofs the breaft, and faftened to the bedftead, by 
which means the patient is confined on his back; and, it 
he fliould be fo outrageous as to require further reftraint, 
the legs are fecured by ligatures to the foo.t of the bed ; 
or they may be fecured by being both put into one 
bag not very wide, which may be more eafily fixed than 
the feet themfelves, at leaft without giving pain. 
Mr. Haflam is very fevere upon the mode of treatment 
at private madhoufes: “With refpeCt to .the perfons call¬ 
ed keepers, who are placed over the infane, public hofpi- 
tals have generally very much the advantage: they are 
there better paid, which makes them more anxious to 
preferve their fituations by attention and good behaviour; 
and thus they acquire fome experience of the difeafe. 
But it is very different in the private receptacles for ma¬ 
niacs : they there procure them at a cheaper rate ; they 
are taken from the plough, the loom, or the liable., and 
fometimes this tribe confifts of decayed fmugglers, broken 
excifemen, or difeharged fheriffs’ officers : £ All that at 
home no more can beg or ftealf flow well fuch a de- 
Vot. XI, No. 739. 
N I T Y. 125 
feription of perfons is calculated to regulate and dkeCl 
.the conduCl of an infane"gentleman, may be eafily con¬ 
jectured. If any thing could add to the calamity of men¬ 
tal derangement, it would be the mode which is generally 
.adopted for its cure.” Hajlam, p. 282, note. 
And a little farther on ; “ In fpeaking of coercion, I 
cannot avoid reprobating a practice which has prevailed 
in fome private receptacles for the infane, (but which, it 
is prefumed, will henceforward be difeontinued ;) I mean 
the practice of half-ftifling a noify patient, by placing a 
pillow before the mouth, and forcibly prefling upon it, 
fo as to flop refpiration. It is unneceifary to enquire 
how fuch wanton cruelty came to be introduced; it mult 
have been the fuggeftion of ignorance, and the perpe¬ 
tration of favagenefs and brutality. Sighs, fears, fobs, 
and exclamations, are the unaffected language of paflion, 
and come kindly to our relief in ftates of forrow and 
alarm. The mild and rational practice of Bethlem Hof- 
pital tolerates thefe involuntary ejaculations. It is there 
confidered, that a noify and loquacious maniac has not the 
power to control'his utterance of founds, which, from 
the habitual connexion between idgas and fpeech, muft 
neceftarily follow. It is there oniyYreWed as a fymptom, 
or part of the diforder, and that, 'j/ the caufe cannot be 
fuppreffed, the effeCl fliould not be punifhed.” P. 291. 
Again: “Maniacs in general feel a great averfion to 
become benefited from thofe medicinal preparations which 
praCtitioners employ for their relief; and on many occa- 
fions they refufe them altogether. Prefuming that fome. 
good is to be procured by the operation of medicines on 
perfons fo afi'eCled, and aware of their propenfity to rejeCt 
them, it becomes a proper objeft of enquiry how fuch 
falutary agents may molt fecurely, and with the leaft dis¬ 
advantage, be conveyed into the llomachs of thefe re- 
frail or y fubjeCls. For the attainment of this end, va¬ 
rious inftruments have been contrived; but that which 
has been more frequently employed, and is the raoft de- 
itruClive and devilijh engine of this fet of apparatus, is 
termed a /pouting-boat. It will not be neceftary to fa¬ 
tigue the reader with a particular defeription of this 
coarie tool, except to remark, that it is conltruCted fome- 
what like a child’s pap boat, and is intended to force an 
entrance into the mouth through the barriers of the 
teeth. It is a painful recollection to recur to the number 
of interefting females I have feen, who, after having fuf- 
fered a temporary difarrangement of mind, and under¬ 
gone the brutal operation of {pouting in private receptacles 
for the infane, have been reftored to their friends without 
a front tooth in either jaw. Unfortunately the talk of 
forcing patients to take food or medicine is configned 
to the rude hand of an ignorant and unfeeling fervants 
it fliould always be performed by the mailer or miftrefs 
of the madhoufe, vvliofe reputations ought to be refpon- 
iible for the perfonal integrity of the unhappy beings 
committed to their care.” P.316. Mr. Haflam then de- 
feribes an inftrument of his own invention for this pur¬ 
pofe, with his method of applying it. 
M. Pinel purfues the fubjeCl of humane treatment with 
great ability. “ In lunatic hefpitals, as in defpotic go¬ 
vernments, it is no doubt poflible to maintain, by unli¬ 
mited confinement and barbarous treatment, the appear¬ 
ance of order and loyalty. The ftillnefs of the grave, 
and the filence of death, however, are not to be expeCted 
in a refidence confecrated to the reception of-madmen. 
A degree of liberty fufficient to maintain order, dictated 
not by weak but enlightened humanity, and calculated 
to fipread a few charms over the unhappy exilten.ee of 
maniacs., contributes, in molt inftances, to diminilh the 
violence of the fymptoms, and, in fome, to remove the 
complaint altogether. Such was the lyftem which the 
governor of Bicetre endeavoured to eftablifli on his en¬ 
trance upon the duties of his prel'ent office. Cruel 
treatment of every defeription, and in ail departments of 
the inftitution, was unequivocally prpfcribed. No man 
was allowed to ftrike a maniac even in his own defence, 
K k No 
