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"Now that mechanical restraint is discarded, the nurses understand that they will be regarded as incompetent unless they can manage the patients in their charge without resort to violent measures, seclusion and restraint. Intelligent nurses do not complain of such restrictions. They appear ambitious to demonstrate that a trained nurse can manage the insane without the fetters and instruments which are relied upon in such cases by the unprofessional keeper. Certainly, the Non-Restraint rule has advanced a kindly, humane spirit in our wards as no other measures could have done. Nurses have no temptation or power to control patients by threats of punishment. Under such conditions, whatever native tact, art, and persuasive powers the nurse may possess are rapidly developed; and, as a result, more sympathetic, friendly relations are early established between nurse and patient, and the common annoyances and irritations formerly experienced by both parties are largely avoided. The beneficial effects thus ensuing, when considered in the aggregate, are of such magnitude, I am resolved that the Non-Restraint rule shall not be broken except as a last resort, as a life-saving measure."

Since that time, I have been responsible for the custody and treatment of more than six thousand insane persons, not one of whom was restrained with mechanical appliances by my orders or within my knowledge. Because a former superintendent purchased restraining apparatus and experimented with it upon not more than two patients and for a period not exceeding one week, according to reports, the makers of such apparatus continue to circulate a statement that the Danvers Asylum is one of their patrons. I have seen patients who in their quiet moments requested that, in their recurring attacks of excitement, a strait-jacket might be applied. But, in such cases, I have found there existed a morbid, hysterical element, which, when properly treated, did not develop the frenzied periods the patient had come to expect and dread. I have dealt with trying subjects. A native of West India was once transferred to Danvers from another state institution, because, if the nurse who conducted the transfer knew the facts and stated them, "they could not manage her." "But you have had her in restraint," I said. "Oh, yes," the nurse replied, "she has been let out of restraint only two hours a day." This patient was destructive, suicidal, and vicious. She remained in the Danvers hospital three years and nine months, and was never restrained there by the aid of mechanical appliances. In time, she greatly improved; she took her meals for a considerable period in our congregate dining room, and for a time before leaving was granted limited parole of the grounds. I confess that the case of this patient, who was epileptic, therefore hopeless as far as recovery was concerned, was a severe tax upon the mental and physical conditions of both officers and nurses, greater, perhaps, than the results to this single individual warranted. But the Non-Restraint principle, the animus of an ideal hospital regime was at stake, and its preservation was, in my opinion, worth all it cost. Besides, I regard the self-sacrificing care, the sympathy and the patience exercised by the nurses who accomplished such excellent results in this case, as examples of moral heroism, quite as creditable as many that have received public approbation and medals of honor; and who will put a price on moral heroism? Besides, what official or nurse, imbued with proper pride in his or her profession is willing to admit that science, training, and skill have no methods with the insane superior to those instinctively suggested to the mind of an inexperienced, uneducated layman? Too much emphasis cannot be put in the assertion that it is less the machinery employed in mechanical restraint than the spirit of coercion, which its employment fosters, that should be abolished from an insane hospital.

A prominent general practitioner of medicine once remarked to me, "This talk about Non-Restraint is all rot; we use it at times in our general hospital." This gentleman did not appreciate that the relationship existing between patient and nurse in the general hospital differs widely from that necessarily established in the insane hospital. He did not take into account the fact that, in the general hospital, where every act of the nurse is under the constant watch of rational observers, the use of restraint is safe-guarded as it cannot be in the insane hospital wards. Nor did he comprehend this important distinction, that in the general hospital, the chief end to accomplish by restraint is the control of the patient; while in the insane hospital, the prime requisite for the highest success in management is the intelligent self-control of the nurse.

The argument against mechanical restraint applies in large measure to seclusion of the insane. While seclusion is, in some degree, less demoralizing in its effects or its influence upon the nursing staff of an institution, only in rare and exceptional cases, can its employment be remedial or beneficial. If, as Conolly said, "Restraint is Neglect," it is doubly true that seclusion is neglect. If used, it should never be prolonged. As a rule, thirty minutes' seclusion is worth, as a corrective measure, more than twenty-four hours of the same treatment. Next to execution, solitary confinement is the severest doom that legal tribunals can pronounce upon hardened criminals. Solitary confinement is universally considered to be painfully trying to a sane mind. How can it be improving to a deranged man, shut away from associations with human beings, incapable of comprehending the logic of his position, consumed by delusions or burning with revengeful indignation towards the authors of his imaginary wrongs?