complete as possible, it seems advisible that the facts should be elicited by answers to a series of questions, as follows:

Q. What is the length of your experience?

A. Three years as assistant, upwards of thirty years as physician-superintendent.

Q. How many patients are in your asylum?

A. On an average for the first 25 years, 203; for the last five years asylum only licensed for 125; always full, often two or three beyond the complement.

Q. What is the average number of admissions?

A. For 21 years, between 1863 and 1883, the average number of admissions annually was 79; from 1884 to 1888, inclusive, 46. Besides, during each of the last twelve years 34 patients were, on an average, admitted on what are known as "certificates of emergency," and accommodated for a period not exceeding three days, when they were removed to other asylums, the parochial asylum being full. These cases, being usually in the acute stage of their illness, add greatly to the responsibilities of the management.

Q. What has been the average proportion of recoveries, calculated on the admissions, say for the last ten years?

A. 47.3 per cent.

Q. Is every kind of case admitted?

A. Yes; there is no selection.

Q. What was the weekly cost of maintenance in your asylum during the last financial year?

A. 8s. d. This includes repairs and charge for rent.

Q. What is the proportion of day-attendants to patients in your asylum? A. One to 15.8 patients.

Q. What is your practice in the use of mechanical personal restraint? A. No strait jacket, or “side dresses," or anything of that kind has ever been used in my whole experience. Two patients suffering from surgical diseases, one 29 and the other 4 years since, were fixed to their beds by sheets and bandages till these ailments were cured, In a surgical case, at present, one glove is in use. In a small number of highly suicidal cases I have ordered locked canvas gloves at night, the hands being otherwise free. How rarely they are prescribed will be seen from the following list for the three years ending 31st December, 1888, which has been prepared from the statements of the attendants, corroborated by my own recollection, as no record was made; April, 1886, gloves one night; May, 1887, gloves one night; May, 1888, gloves two nights. Two were cases of attempted suicide, the third was strongly disposed to suicide. Q. What is your practice in respect of seclusion?

A. It is seldom used. Five patients were secluded during 1888, the sum of all their seclusions being 31 hours. No one was secluded in 1887. Q. Do you use guards of any kind for the windows or fires?

A. The only guards in use are two nursery ones, quite open at the top, and simply hooked on at the sides. One is over the fire in a parlor where there are many epileptics, the other in the parlor for the most violent There is no guard of any kind over any of the windows. The

cases.

windows are, of course, so fixed on the upper floors that they cannot be opened at the top or bottom above four inches.

Q. How many, if any, homicides have occurred in your experience?
A. None.

Q. How many, if any, suicides have occurred in your experience?
A. None.

Q. How many important injuries to patients have occurred in the course of your experience, in struggles either with attendants or fellowpatients?

A. In ten cases bones were broken, but all were simple fractures. No patient is known to have suffered permanent injury.

Q. How many, if any, attendants have been injured in your experience?

A. Two attendants have each had his shoulder dislocated, but it was easily reduced. These, and one or two temporarily stunning blows on the head, were by far the most serious occurrences. No one was ever permanently injured.

Q. What was the value of the clothing of all kinds destroyed in your asylum last year?

A. 7s. 6d.

Q. What was the value of the glass destroyed in your asylum last year? A. Not more than Is.

Q. What have been the usual entries of the Commissioners in their reports respecting the order and quietude of your asylum?

A. Both have been stated to be satisfactory. There is, of course, occasionally some noise and excitement in the department for the acute

cases.

These details have been obtained by careful examination of the books of the establishment in the haads of Mr. Laing, the Governor of the Asylum and Poorhouse, to whom I am indebted for the trouble he has taken in this inquiry, as well as for his co-operation in the management, especially during late years. The results I believe to be creditable to the principle of non-restraint. I was trained in its practice by my late respected master and friend, Dr. Alex. Macintosh, of Gartnavel Asylum, and I have not yet seen any reason to modify my high appreciation of its wisdom and value. However, we must wait till those who favor the more extended use of restraint tell us their results before determining the question. Meanwhile, any who are in doubt may refrain from arriving at a conclusion.

I may be asked: What are your methods of treatment? I answer: "Nothing special, simply careful individualization-studying and applying the indications of management and treatment in each case-work, outdoor exercise, careful dieting, amusements, and medicinal treatment." In reference to the last of these, I refuse to admit that when a patient is soothed by medicines fitted to allay the irritability of a brain in a state of disease, I am employing “chemical restraint," at least in the offensive sense attached to the expression by some, and especially by those who favor mechanical restraint.

I have only further to express my regret that in this communication I

have been obliged to name gentlemen whom I count among my personal friends. But all personal considerations must be sunk in view of the importance of the question under consideration. Especially do I regret that I have been constrained to refer particularly to Dr. Yellowlees. It is simply because he initiated and took by far the most important part in the discussion at Edinburgh, and is at present the leader in Scotland of what I believe to be a distinctly retrograde movement. He would do well to remember when advocating the cause of restraint or about to order the application of the "side-arm dresses" or the use of the "protection bed," that there is a plate on the foundation-stone of Gartnavel Asylum bearing an inscription which declares that the asylum is erected on the principle of "EMPLOYING NO MECHANICAL PERSONAL RESTRAINT IN THE TREATMENT OF THE PATIENTS."

For the present this will give an introduction to the English discussion of 1888, to which we may again refer. But meanwhile it might be well to see what the practice and sentiment has been in English asylums, where the discussion arose, to which I shall cite a few leading British superintendents.

Dr. CAMPBELL, superintendent of the insane hospital for Cumberland and Westmoreland, in his report for 1888, published in the July number of the Journal of Mental Science, p. 248, states:

"That during the year he had two such exceptional patients; that he had to seclude one, a patient who was so powerful and violent for several periods, and the other a feeble melancholiac, who made such persistent and varied attempts to kill himself that he used mechanical restraint for a long period, and who even then bit off his lower lip as far as he could reach it with his teeth."

Dr. Campbell says of the latter:

"This is only the second patient whom I have had to restrain for other than surgical reasons during the past fifteen years.”

The experience of Dr. HOWDEN, of the insane asylum at Montrose, who has had a very large and varied experience, as reported by him and cited in the October Journal of Mental Science, 1889, p. 429, is of great value in such a discussion as the present.

Dr. Howden says:

"It is better, I believe, as a rule, to treat excitement by good hygienic conditions, good food, unpolluted air, suitable clothing, abundant exer

cise, and even hard work, combined with mental occupation and distraction, than to attempt to repress or conserve energy, whether by mechanical or therapeutic restraint.

"A day's labor, whether on the farm, in the washing house, or scampering on the grass, is a better hypnotic than any narcotic drug with which I am acquainted.

"While expressing this opinion, I am far from ignoring the value of narcotics and of the necessity of employing mechanical restraint in certain cases.

"While maintaining perfect freedom of action, however, unaffected alike by fashion and public prejudice, we must not forget the errors into which our forefathers fell, through prejudice and superstition, though they were probably actuated by motives as humane as we are, nor lose sight of the great principle of non-restraint, (falsely so called,) established by Pinel, Tuke, Hill, Conolly, and others, which has revolutionized the treatment of the insane, so that the modern asylum has the character and aims of a hospital and a sanitarium, rather than a prison or a poor-house."

Dr. Howden adds, referring to the criticisms made in the public press regarding the alleged improper use of restraints in Bethlehem Hospital the year before, and the defense of the system by Dr. Yellowlees before the British Medico-Psychological Association, which is quoted by Dr. Yellowlees in reply, the following:

"In view of the discussion which took place last year in medical circles and in the public press on the use of mechanical restraint in the treatment of the insane, it may not be amiss to place on record a summary of my own practice during a period of thirty years, as a contribution to the subject. In doing so I shall consider seclusion as well as mechanical restraint, Ist, because they are often employed vicariously and conjointly, and, 2d, because I consider that seclusion in a dark room during the day is often a much more objectionable form of restraint than the use of mechanical means for restraining merely the muscles and the hands. "Well, during the past thirty years 4060 cases have been uuder treatment. Of these, 29 men and 26 women have been subjected to the restraint of the strait jacket.

"The reason for employing mechanical restraint with these 55 persons was, in five cases, to prevent injury to the patient or others during attacks of exceptionally violent mania; in nine cases, to prevent self-mutilation and suicide; while, in the remaining forty-one, it was used to prevent the removal by the patient of dressings in surgical treatment."

Dr. Howden also adds, regarding the use of locked gloves under the Scotch system of "Register of Restraint and Seclusion to prevent babies from sucking their thumbs and

patients from pulling out their hair or picking their faces or head with their nails, that, searching, he finds

"In the old daily register, however, there was, and I find entries of, the employment of locked gloves in the cases of three men and one woman, for a total period for the four of 150 hours, during 20 years."

As to seclusion, the doctor makes the following statement, and these reports are of great importance to show the almost entire abolition of mechanical restraint, and seclusion as well, which places the question of its abuse wholly out of question:

"As to seclusion, I find that the number of persons who have been locked into a single bed room during the day in thirty years, was in all 106, of whom 38 were men and 68 women. During the first decennial period, from 1859 to 1869, there were under treatment 1740; of whom six were restrained, and ninety-one secluded. During the second decennial period, from 1869 to 1879, there were under treatment, 1526; of whom seventeen were under restraint, and seven were secluded. During the third decennial period, from 1879 to 1889, there were under treatment 1683; of whom thirty-two were restrained, and eight were secluded."

Dr. THEODORE DILLER was entitled to reply to the discussion of his paper the evening it was read, and did so orally. At my request he submitted a revise of his remarks, which is as follows:

MR. PRESIDENT :

Let me attempt to analyze and classify the expressions of opinion which we have heard.

I think all who have spoken are agreed upon certain points, viz: That if mechanical restraint is ever applied, it ought to be used only by medica] men; that it must never be applied to punish patients, to keep them quiet, or to save trouble for officers or attendants.

The various differences of opinion might be classified under three heads, as exemplified in the practice and views of Drs. Bryce, Pilgrim, and Godding, each of whom has a large number of patients under his care.

1. Dr. Bryce has not restrained a single patient for many years. He admits that cases may occur where restraint would be for the highest good of the patients, but he would not restrain such patients principally or wholly because he holds that the possible benefits which might accrue to those so restrained would be more than counterbalanced by certain baneful effects or impressions produced upon themselves or upon other patients by the restraint.

2. Dr. Pilgrim has not restrained a single patient for a long time, but admits that cases might arise where this measure would be advisable, and would not hesitate to apply restraint in such cases.