Report

Daniel Hack Tuke wrote a letter about his visit to Siegburg Asylum to his psychiatrist father, Samuel, who was a long-time associate of the asylum's Director, Dr Jacobi.

Extract

'And so we have really got to Siegburgh and seen today the Asylum and its venerable Director who however still enjoys good health and tolerably clear mental faculties.

I found the condition of the Asylum and its inmates very much what I had expected, tho' I certainly should have been much disappointed had I expected to find a model institution. That it assuredly is not; not only as respects the building (an unavoidable circumstance) but also the patients, for whose condition the same apology cannot be made. I am not disposed to take the amount of "Restraint" in an Establishment as indicating necessarily the degree of moral government exercised therein but I cannot believe that it all was true that might to be done, the condition of the low wards at Siegburg would be what it is at present. There were 5 men and 8 women restrained either by strait waistcoat or coercion chairs; and notwithstanding this I could not but contrast the noise, and the expression of the patients with the comparative quiet and the aspect of the inmates of the corresponding wards in the Hanwell Asylum, where there are 1,000 instead of 190 patients, the number at present in Siegburg. On conversing with Dr Jacobi on the subject, I found his opinions quite fixed, apparently not likely to change, nor is it likely that they will at his age.

Associated with all this mechanical restraint I do no doubt that there is notwithstanding a thorough feeling of kindness towards the patients, and that the system of treatment pursued is not the result of harshness or negligence, but of a conscientious belief that it is the best, and I think I may add a want of acquaintance with the non restraint system as practiced in England.

Thou will remember that Dr Jacobi in his work separates the insane into six or seven classes; he has however modified his views in regard to classification, and has only 3 main classes now - the noisy and dirty - the tranquil - the convalescent. There are also three classes as to payment - the highest paying 500 Dollars per an., the lowest 150. There are only about 25 patients who pay for themselves, all the rest being Paupers.

Dr Jacobi does not publish any report, and only gave general estimates in regard to the statistics of cures, deaths etc. He states the number of cures not to exceed half (of the admissions) and Siegburg only proposes to take curable patients and to send them out in about 3 years if no improvement has taken place. One or two have been as long as 6 [years] in the Establishment. When Dr was in England he took an English lady back with him, who remained 6 years unimproved, but got perfectly well in the 7th year and has remained well since. As to deaths the annual number averages about 16 - about 8 per cent, but these remarks are too general to be much use. A very large proportion are under medical treatment, Dr Jacobi believing Insanity to be very clearly connected with any disease under which the Individual may be labouring, in however slight a degree, as affects one of the chest, stomach etc and he assured me that about 100 - more than half - were more or less under a course of medicine.'