1880 The Treatment Of The Insane by William A. Hammond

“In all ages of the world, the most monstrous abuses have found their defenders among good and noble-minded people; and this is especially true of those acts which a subsequent period regards as outrages against the individual, but which at the time were defended by many on the ground of expediency, the advantage of the country, the glory of God, the progress of humanity, or the ultimate good of the person injured. Thus, the gladiatorial exhibitions of ancient Rome were looked upon as politic amusements, which tended to excite harmless emotions to the exclusion of more dangerous sentiments. The Duke of Alva, and others of his type, professed to be actuated by a laudable desire to put down rebellion; and it is entirely within the range of possibility that they were kind and loving fathers and friends. Witches and heretics were burned at the stake or drowned in the flood at the instigation of tender-hearted women, and by judges of gentle bearing, who honestly thought they were serving God and society; and the insane were loaded with chains, beaten and subjected to many other corporeal sufferings by the orders of learned and humane men, who sincerely believed that they were acting in accordance with the most benevolent instincts, – as in fact they probably were. But as time passes on the acts of those who have preceded us are seen in their true light, and judged by a higher standard. The human nature of to-day is more advanced than the human nature of yesterday, and what were deemed to be great truths then are seen to be vile errors now. It denounces the dungeon, the lash, and the fetters for lunatics, but it clings tenaciously to the strap, the camisole, and the Utica crib. It looks back with horror to the time when the insane were flogged as a therapeutical measure “to beat the devil out of them,” but regards with complacency and even favor the forcible feeding of the poor creatures by ignorant and brutal attendants, and the consequent life-long injury or death of the victims. That those who come after us will regard our conduct in these matters very much as we do that of the mad-house keepers of less than a century ago is not a matter for doubt. Already the revolution has begun.

Holding Chair

Holding Chair – Illustration by Etienne Equirol’s Des maladies mentales considérées sous les rapports médicale hygiénique et medico-legal (Paris 1838), at: Diseases Of The Mind: Highlights of American Psychiatry through 1900. http://www.nlm.nih.gov/hmd/diseases/debates.html.

Few, even among those who have given some attention to the subject, know the depth of wretchedness to which within a comparatively short period the lunatic was consigned, and which, even at the present day, is in some places scarcely lessened. Dr. Conolly, (1) whose advanced ideas of science and humanity led to the uniform adoption in England of the “non-restraint” system of treatment, speaking only thirty years ago on this subject, says: “Very few physicians of education were to be found, until a recent period, devoting themselves to mental disorders. Those occupied in asylums were chiefly distinguished by an eccentricity and a roughness which, unfitting them for other professional vocations, made them willing to undertake to treat mad people. By such persons, ill-educated, prejudiced, and without any resources but methods of violence, and who had never studied the forms and treatment of mental disorders, all attempts to ameliorate the condition of the insane were bitterly and unscrupulously opposed with every effort and every contrivance of vulgar minds. Meantime, the outside walls of an asylum were regarded with awe; the shrieks issuing from it made night hideous; the frantic creatures enclosed in their dens furnished appalling subjects for the artist or the novelist; squalor and dirt, and famine and ferocity were everywhere to be met with.” And now in the latter half of the nineteenth century we find that the methods which Conolly so vigorously denounced, and to the abolition of which he gave his life, are in full use in almost every asylum in the United States; that the attempts to improve the condition of the insane are opposed, as in his day, by those who have the charge of them; that dens are still in existence, chains still employed, blows still inflicted, systematic flogging still practised, the strait-jacket still used as a means of restraint; and that these agencies of subjection are supplemented by The Utica Crib. , – an apparatus not only inhuman, but one which no person possessing a competent knowledge of the physiology of the brain and the pathology of insanity would venture to introduce into the wards of a lunatic asylum.

Dress Camisole - Esquirol Bench

Dress Camisole-Esquirol Bench – Illustration by Etienne Equirol’s Des maladies mentales considérées sous les rapports médicale hygiénique et medico-legal (Paris 1838), at: Diseases Of The Mind: Highlights of American Psychiatry through 1900. http://www.nlm.nih.gov/hmd/diseases/debates.html.

I do not mean to be understood as saying that all these various measures for punishing and subduing a maniac are sanctioned by those in authority. No superintendent, so far as I know, approves of his patients being knocked down, beaten, or put in irons; but, nevertheless, these things and even worse are perpetrated in American institutions for the insane, either through the ignorance, the negligence, or the indifference of their superintendents; and others equally bad are done with their full knowledge and approval. Doubtless many of the outrages against humanity which are committed in our asylums are the direct result of the system by which their officers are appointed. But this only makes the matter worse. If it were individuals only with which those who have undertaken the task of ameliorating the condition of the insane had to contend, the contest would be neither long nor doubtful; but there are trustees and commissioners, and legislatures and political parties to meet, who have an interest – one which appeals with great force to the average American mind: the love of patronage – in keeping things as they are.

Now let us see what kind of atrocities are permitted by the system which prevails throughout this country. In this survey, it will not be necessary to go back farther than two or three years, or to refer to more than a few examples of the number which have been unearthed by legislative committees, casual visitors, and newspaper reporters, or which have been revealed by mere accident.

Within about a year four homicides occurred in the New York City lunatic asylum on Ward’s Island. In one of these a patient was beaten to death by an attendant; in another, an attendant was killed by a patient; in the third, a patient was thrown off the wharf and drowned by another patient; and in the fourth, one lunatic was ordered to give a hot bath to another, not only insane, but paralyzed. After getting him into the bath-tub he turned on the hot water and walked away leaving the poor wretch actually to be boiled to death. In the asylum at St. Peter, Minnesota, a patient who refused to eat had his mouth filled with food by a nurse, and the mess pushed down into his stomach with the handle of a knife, while another nurse held him down. On one occasion he ran away, yelling that they wanted to kill him. He was caught and laid on a bench; one attendant held his hands, and sat across his body; another attendant and a patient helped to hold him; his mouth was plugged to prevent his closing it. The food (soup) was poured in from a pitcher; his breath was heard to “gurgle” as the soup went into his windpipe, and in five minutes he was dead.

Force Feeding

Force Feeding

Owing to an erroneous idea that the food is poisoned, to some other delusion, or to a determined intention to commit suicide, it frequently happens that lunatics refuse to eat. The operation of forcible feeding is a delicate one, requiring anatomical skill; and yet it is one which in American asylums is often left to be performed by ignorant and brutal attendants, a physician not even being present. Thus, at the Bloomingdale Asylum in New York, a lady while being fed by a nurse had the soft parts of the roof of her mouth torn away by the spoon being rammed violently down her throat. From the testimony taken in this case, preliminary to a suit for damages, and which has not yet been published, I make the following citations:

Mrs. Cochran says she saw both Jane Eaton and Jane Gordon, nurses in Bloomingdale, forcibly feeding a patient. They had a wooden wedge which they put into her mouth, and then they fed her with a spoon (folio 93). Dr. Choate says it is done by attendants in asylums (folio 119). Jane Eaton, a nurse, puts on the camisole without instructions from the physician (folio 125). Was told to use force in feeding (folio 127). Used a spoon or a wedge to force open the mouth. “The most difficult person I ever had to feed” (folio 132), – and yet the duty was left to a nurse; the doctor was never present when she was fed (folio 133). The nurse does not always report to the physician when she uses the camisole. Has seen blood come from Mrs. N’s mouth when she was feeding her (folio 138). Was taken naked from her room to the bath-room (folio 146). The doctor says forcible feeding is delegated to an attendant (folio 150).

Last winter, rumors in regard to the bad management of the Longview Asylum, in Ohio, became so prevalent that the legislature appointed a committee to investigate them. From the report made on the subject I make the following extracts: –

According to the testimony of several eye-witnesses, a punishment frequently and sometimes gleefully resorted to by attendants in this asylum is one known as “taking down.” “Taking down,” in the words of the testimony, consists in tripping or throwing the patient to the floor, holding her down (for “taking down” is a female punishment; the men being usually knocked down) with the knee on the chest, while another employé gags the patient, and still another holds the patient’s hands. The patient is held down till she is quite weak and exhausted, becomes purple in the face, and the breath is almost gone.

Another punishment is to make a “spread eagle” of a patient. This consists in stripping a patient to nakedness, and making attendants whip him with wet towels. This is a punishment inflicted for a refusal to work. It is described as very painful, and is practised because it leaves no marks.

There is testimony as to ducking, kicking, beating, black eyes, and other marks of cruelty. It is in evidence that weak patients are overworked, and all inmates have not been properly fed and cared for. Hard work has been needlessly compelled in a room in which the mercury stood at one hundred and twenty degrees. The use of “cribs” and the “strong room” is shown. Loathsome vermin in loathsome numbers have been allowed to accumulate upon the bedding, the apparel, and the person of patients. All of these things and others told with a painful plainness is the testimony that is made part of this report.

The report then goes on to speak of the profanity of the attendants; that “the superintendent has been guilty of inattention to his duties and gross neglect;” and that the evidence “seems to the committee to destroy entirely the suggestion that the various hideous things were done without his knowledge and consent.” The Ohio legislative committee appears to have performed its work thoroughly; and it is the more to be commended for this, inasmuch as the superintendent was appointed on political grounds, and the majority of the committee was of the same political faith as this official.”


1880 The Utica Crib

It is so interesting to read original documents from the nineteenth century. It gives us a great insight into how people viewed the “insane.” The following articles feature Dr. William A. Hammond, who fought to remove all mechanical restraints, including the infamous “Utica Crib,” from New York State Insane Asylums. The first article was written by Dr. Hammond in March of 1880 and was published in The International Review. The second article from the Utica Morning Herald and Daily Gazette published on November 25, 1879, argues that Dr. Hammond was making “reckless and wholesale charges,” it also refers to the inmates as “unfortunate creatures” as if they were not human beings. What I discovered was that the Utica Crib was invented by Dr. M.H. Aubanel, of the Marseilles Lunatic Asylum in 1845, and was introduced at the New York State Lunatic Asylum at Utica in 1846 by Dr. Amariah Brigham, the first Medical Superintendent.

On November 29, 1886, Dr. John P. Gray, died. He had held the position as Medical Superintendent at Utica for several years. On December 14, 1886, Dr. George Alder Blumer was appointed as the new Medical Superintendent. On September 30, 1887, Dr. Blumer proudly reported: “Mention should be made in this connection of the so-called ‘Utica Crib,’ generally known in this hospital under the less suggestive euphemism of ‘covered bed.’ I am happy to report that we have been able to dispense with these restraint-beds, and that on January 18, 1887, all that remained of them were removed from the wards.”

Utica Crib 1

Utica Crib 1


“Now let us take a brief review of the treatment of lunatics as regards mechanical restraint in this country. While it is certainly true that there are lunatic asylums, the superintendents of which are actuated by a desire to keep the number of restraint cases at a minimum, there is not one in which mechanical restraint in some form or other is not employed, and in some the proportion equals that at Hanwell before Dr. Conolly instituted his reform measures. In the New York City lunatic asylum on Ward’s Island, for instance, there is a daily average of over twenty patients kept in mechanical restraint, and twenty-five in seclusion. The means employed are strait-jackets or camisoles, muffs for the hands, some kind of contrivance to restrain the motion of the legs, chairs in which refractory lunatics may be confined, and last, but by no means least, the “Utica crib.” The object in view in using most of these contrivances is readily apparent from their designations; but the crib probably requires a brief description. It is constructed somewhat after the manner of a child’s crib, having like it barred sides and ends; but in addition it is furnished with a lid also of bars or slats on hinges, and fastening with a spring or lock. It is so arranged that the inmate is unable to open it when it has been closed upon him. The space between the body of the lunatic imprisoned in this cage and the lid does not exceed twelve inches, and is probably less. The consequence is that he must lie at full length, and this sometimes for many hours at a time. For those maniacs whose cerebral bloodvessels are full to repletion, the enforced position of recumbency is in the highest degree prejudicial; for those whose brains are anaemic it is not required, as they will lie quiet enough without being thus imprisoned. It is a matter of experience that patients who were previously maniacal while in the crib, dashing themselves with violence against the bars like a wild lion in its cage when first confined, have become entirely quiet and composed when taken from the cage and allowed to sit or stand; and yet its use is held to tenaciously by many superintendents, and long papers are written in its defence. It is true that it is not found in some institutions. There has never been one at Willard, none at Flatbush; and since the agitation for lunatic-asylum reform, it has been discontinued at Bloomingdale, Poughkeepsie, and perhaps other asylums; and even at Ward’s Island the lids have been taken off.”
(SOURCE: The International Review, The Treatment Of The Insane by William A. Hammond, Volume VIII, March 1880, New York: Barnes & Company, Page 236).

Utica Crib 2

Utica Crib 2


“Some notion of the utter wantonness of DR. WILLIAM A. HAMMOND’S statements regarding the lunatic asylums of this state may be obtained from the report of the senate committee, elsewhere published this morning, and the letter of SENATOR GOODWIN, the chairman of that committee, addressed to the editor of this journal. In respect to HAMMOND’S assertion that the investigation SENATOR GOODWIN conducted was one-sided and unfair, it appears from this document – in which all the evidence taken is published in full – that DR. HAMMOND and all the physicians who signed his petition were invited to appear before this committee, and furnish all the evidence in their possession regarding their alleged abuses in the conduct of the state asylums. It is their own fault – the fault more especially of DR. HAMMOND – if they did not make a case; and their failure to do so was admitted by themselves in the testimony here published. The evidence of DR HAMMOND, who makes these reckless and wholesale charges in the New York Herald, is especially noteworthy, as showing his total ignorance of the management of our insane asylums. He was asked if he had ever visited any of the insane asylums; yes, he had visited the Utica asylum twelve and eight years ago – on which latter occasion he merely entered the office; the Po’keepsie asylum four years ago – which was before it was fairly in operation; the Blackwell’s Island asylum – but not during the day of the present superintendent there; and the Bloomingdale asylum, but not since DR. NICHOLS has been in charge there. This was the basis of his personal knowledge of the asylums – and it of course appeared in the investigation, that he knew nothing at all. DR. HAMMOND was not able to make a single allegation, either upon personal knowledge or hearsay, which indicated any basis for the investigation he then demanded. His nearest approach was his denunciation of what he called the “Utica crib” – a contrivance or the confinement of violent lunatics which was invented by AUBANEL, the superintendent of the Marseilles insane asylum in France, and introduced into the Utica asylum, among others, in 1846, by DR. BRIGHAM, and which has been fully described by DR. GRAY in his annual reports to the legislature – notably in the eighteenth report. Even in respect to this crib, so-called, DR. HAMMOND was compelled to admit that the question whether this method of restraint was more objectionable than others was “a matter of opinion.”

The answers of DR. HAMMOND to two questions put to him in this inquiry will be interesting to our readers in Utica. To the question – “How long were you at the Utica asylum?” he answered, “I don’t think I should be warranted in making any observations upon that institution.” – and again, “Utica is the asylum I know least about.” To the question that he knew that the two asylums of which he made the loudest complaint were under the control of the board of charities of New York city, DR. HAMMOND answered: “I believe they are; my personal views do not concern any of the state asylums; I only believe in a general way that this matter ought to be investigated.”

Utica Crib 3

Utica Crib 3

 THE UTICA CRIB. The Covered Bed at the State Asylum for Restless Patients – A Herald Reporter Comfortable within what Dr. Hammond declares a “Barbarous Device.”

The unfortunate creatures who become insane suffer but little or nothing within the walls of humane state institutions when compared with the great anxiety and pain of loving parents and friends over their afflictions. Justice to the friends of the insane in the New York state asylum located in this city demands that nothing be added to their trouble by permitting unfounded reports regarding the care of the insane to go uncontradicted. Such sensations are cruel and unjust, whether they are prompted by malice or ignorance of facts. DR. WILLIAM A. HAMMOND, of New York, in an interview with a reporter of the Sunday Herald, of that city, took occasion to refer to what he is pleased to call “the Utica Crib,” the covered bed in use in the state asylum for the insane in this city, and in what are known as model asylums of America and Europe. When asked to describe the “Utica crib,” DR. HAMMOND said:

“It is a bed like a child’s crib, with slatted sides, eighteen inches deep, six feet long and three feet wide. It has a slatted lid which shuts with a spring lock. A lunatic put in it can barely turn over. There is not as much space between the patient’s head and the lid as if he were in a coffin. He is kept in the crib at the will of an attendant, the key being in the possession of the latter and not of a physician. Patients have sometimes died in these cribs. DR. MYCERT, who is an authority, says the crib is a most barbarous and unscientific instrument because there is already a tendency to a determination of blood to the brain in excited forms of insanity which is increased by the horizontal position in the crib and the struggles of the patient. The crib was introduced by the superintendent of the Utica asylum. The padded room could always be substituted for the crib.”

Following this is what purports to be a cut of the Utica crib. Any one of the thousands who visit the state asylum every year and are shown the covered bed in use at that institution will bear us out in saying that the picture looks as much like the bed as a peach crate does like a cradle. The cut looks like a chicken-hatching machine, and is simply a burlesque upon the truth, for which there is no possible excuse.


A reporter of the Herald visited the asylum, yesterday, and requested permission to examine one of the cribs which he had frequently seen in visits to the asylum. DR. GRAY cheerfully gave the permission, and the reporter had an opportunity of selecting one of five or six of the covered beds or “barbarous devices,” for actual experiment. Simply removing his outer coat he got into the crib, which was in condition for use, and the lid was closed down upon him. As the reporter is nearly six feet in height, and weighs two hundred and seventy six pounds, and larger in every respect than any patient in the asylum, it will be admitted that this test was a fair one. When the lid was closed the occupant laid with perfect comfort upon either side and upon his back. When lying upon his left side the position was sufficiently easy to permit him to write his description of the covered bed if he had chosen to do so. The hands and arms could be put between the smooth wooden rounds which formed the slatted top, and there was a perfect circulation at the sides and top. The bed was easy and comfortable and there was an abundance of room for lifting the head from the plump pillow so that the lower end of the bed could be seen with ease. In short the reporter found that he could roll and toss about at will as easily as he could in his own bed at home, but he could not get out of it – and this is the humane plan of the device which is styled “barbarous” – as will be seen hereafter.


The covered bed or “Utica crib” is simply an ordinary hospital bed to all intents and purposes. It is made of smoothly finished and varnished wood with a woven wire bottom and slatted sides, like a child’s cradle. The one tested contained a mattress thicker than the ordinary ones, a plump soft pillow, clean and comfortable sheets, blankets and counterpanes. In the sides there are twenty wooden rollers, in the ends eight and in the cover seven rollers of smooth hard wood. The cover is attached to hinges which permit its entire removal at any time. The beds are frequently used without the cover by patients and attendants. A few months ago a venerable Utica patient got into one of these covered beds and permitted a reporter of the Herald to close it tightly to note its workings. The patient moved about easily in it and conversed cheerfully. When asked how he liked to sleep in this bed he replied: “Oh, I like it very much. I am often disturbed in my sleep. When I occupy this bed I rest easily, for I know where to find myself in the morning. Without such restraint, I might do myself some harm during the night.”

The patient, tho’ insane at intervals, really had more sense than those who denounce what they appear to know little about. Covered beds, patterned after those in use at the state asylum, are used in St. Elizabeth’s and other hospitals of Utica and thro’out the state, and they are daily seen and examined by visitors. So simple and harmless is the contrivance that parents, after seeing them, inquire, “Why would not this be a good plan to prevent our babies from falling out of their cradles?” It certainly would.


The covered beds are used to secure the excited and restless patients, the requisite quiet and sleep in a horizontal position, that are absolutely necessary for their recovery. Insane people are sick people. When a sane person is sick his physician directs that he shall lie in bed, and a sensible invalid always obeys the orders of his physician. When an insane person requires rest he may be ever so much disposed to obey the doctor and lie in bed, but his mind is disordered and his will is gone so that he can not control his own actions. The result is he is liable to exhaust himself by getting in and out of bed at frequent periods, risking chances of falls and exposure to cold. Epileptics and paralytics are apt to fall out of open beds and receive severe injuries.

If such beds are not used, other more objectionable systems would have to be put into practice, such as the “bed strap,” for holding excited patients in the ordinary beds, or the forcible holding of the patient by attendants. This latter method better deserves the title of barbarous than does the covered bed system. No one or two attendants can hold an excited patient in a bed without using a force that must be more or less cruel and the marks of their grasp will not fail to be undeniably imprinted upon the delicate arms, body or limbs of the invalid. Insane people are endowed at times with extraordinary strength and the utmost exertions of strong men are required to quiet them. The use of the strap is harsh and at times injurious.


The crib, or covered bed for restless patients, is not a new device and was not introduced by the superintendent of the state asylum at Utica as DR. HAMMOND alleges. It was devised in France by DR. AUBANEL of the Marseilles lunatic asylum, in 1845, and described in the Annales Psychologniques of the year. DR. BRIGHAM, in 1846, introduced the crib bedstead into the Utica asylum, and was described in the American Journal of Insanity in that year. In 1852, DR. WILLIAM WOOD, medical official of Bethlem hospital, England, improved upon the crib bed, and gave a description of the same in Winslow’s Journal of Psychological Medicine. This bed was like a child’s crib but the covering was of webbing. In 1854 the AUBANEL bed was abandoned in the Utica asylum and the present one was put into use, resembling DR. WOOD’S, with this exception – the sides were made with rounds like an ordinary child’s crib instead of with boards like the English bed, and a round slatted corner in place of webbing, which powerful patients could easily displace.


The covered bed is spoken of as the “box bed” or “locked bed,” by DR. LINDSAY, in an article on dipsomania, in the Edinburgh Medical Journal, of October, 1808, in which he says: “Its use renders him quiescent for the time, while it maintains warmth and does not prevent free ventilation. I have repeatedly tried it in various forms, and have no doubt as to its having prolonged several lives and prevented many accidents that would have been sacrificed or that would have occurred under the customary arrangements of many or most other asylums. Such is my opinion of its usefulness, that I think it should find place not only in every lunatic asylum, but in every general hospital, for I remember the difficulties that used to occur in the fever and delirium tremens wards of the Royal Infirmary of Edinburgh, and the impossibility of dealing with occasional patients other than by mechanical restraints of the nature of strait-waistcoats and strapping to bed.”

In the Edinburgh Medical Journal of February, 1878, DR. LINDSAY, M.D.,R.S.E., and physician to the Murray royal institution at Perth, published another article commending the covered beds in the highest terms as invaluable for preventing injuries – adding, however, “a lid in the case of patients who would scramble out of bed with sides merely. The kind of bed that I have found most useful is the following, and I venture to recommend some such bed to the attention of the medical profession generally because I am satisfied it is very much wanted in all departments of medical, surgical and obstetric practice.”

Then follows the description of forms of beds all alike, or closely resembling what is called by DR. HAMMOND “Utica crib,” but which is styled by DR. LINDSAY “the protection bed,” a term he says “happily applied to it many years ago by DR. BROWNE of Dumfries, when he was one of her majesty’s commissioners in lunacy for Scotland, and who had occasion to see such beds in use here during his official inspections. Moreover, he had himself, when at the head of Dumfries asylum used beds of a somewhat similar kind. And in America such beds are, and have long been in common use in its hospitals for the insane.”

Finally he adds: “The general result of the use of the protection bed in some of its forms, as compared with the orthodox modes of dealing with the classes of patients already described, is this – in my opinion – that it is directly and decidedly conservative of life and health, and preventive of injury and disease.”

The above is high authority in approval of the covered bed from professional and practical men who have daily opportunities of testing its merits. Laymen or friends of those who are confined in asylums can examine these beds in the Utica asylum and judge for themselves whether they are “barbarous” or “cruel devices” as has been alleged.


DR. HAMMOND, in his interview with the New York Herald reporter, makes the important announcement that sometimes patients die in covered beds or “Utica cribs.” Can not DR. HAMMOND, without particular effort, recall many instances where sane and insane patients have died in ordinary beds which have no sides or covers?”
(SOURCE: Reprinted from Utica Morning Herald and Daily Gazette. Wednesday, November 25, 1879).

1880 The Treatment Of The Insane by W.A. Hammond