Humane treatment versus means of control: coercive measures in Norwegian high-security psychiatry, 1895-1978.

This article analyses the use of coercive measures in two national institutions for high-security psychiatry in Norway - Kriminalasylet (Criminal Asylum) and Reitgjerdet - during the period 1895-1978. Historical study of coercion in psychiatry is a fruitful approach to new insight into the moral and ethical considerations within the institutions. We approach the topic through a qualitative study of patient case files and ward reports from the institutions' archives, as well as a comprehensive quantification of the coercive measures used. The data show shifting considerations of humane treatment and changes in the respect for human dignity in the institutions' practices. They also show that technological developments, such as the introduction of new psychopharmaceuticals, did not necessarily lead to higher standards of treatment.

A review of isolation practices and procedures in healthcare settings.

The notion of 'isolation' in infectious diseases refers to the possibility of people known or suspected to be infected from the wider population, and has historically been used to control and prevent the spread of infectious diseases. Isolation practices in healthcare settings evolved over the 20th century resulting in a focus on the disruption of known routes of potential transmission. There was renewed attention to infection prevention and control (IPC) in the UK at the turn of the 20th century after high-profile reports acknowledged the importance of IPC as a key indicator of high-quality clinical care, and the impact of healthcare-acquired infections. There has been a shift away from isolation wards towards isolation in single rooms on general wards. For infections that are spread by the airborne, droplet or contact routes, placing the patient in single-room isolation is considered to be an important component of transmission-based precautions (TBPs). However, in practice isolation is complex and a number of challenges are involved in implementing IPC procedures.

[Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966)]. / Zwangsmaßnahmen in der Kinder- und Jugendpsychiatrie in der Nachkriegszeit am Beispiel der Pflege- und Beobachtungsstation des Psychiatrischen Landeskrankenhauses Weissenau (1951-1966).

Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966) The patient admissions at the children's ward of the State Psychiatric Hospital Weissenau in the years 1951, 1956, 1961 and 1966 were analyzed regarding documented coercive measures. Shortage of staff, mainly inadequately skilled personnel, a mixing of age groups in the patient cohort, neurological and psychiatric disorders and of patients who were in need of nursing and of those who needed treatment constituted the general work environment. Coercive measures against patients, mostly disproportionate isolations, were a constant part of daily life on the ward. This affected in particular patients who had to stay longer at the hospital and whose stay was financed by public authority. The uselessness of such measures was known, which can be seen e. g. in the Caretaker's Handbook of that time and the comments in the patient files. The situation still escalated in some cases (for example by transfer to an adult ward). For a long time, coercive measures against patients were part of everyday life at the children's ward of the Weissenau; the actual figures are suspected to be much higher.

Figures and Institutions of the neurological sciences in Paris from 1800 to 1950. Part IV: Psychiatry and psychology.

We present a short historical review on the major institutions and figures who contributed to make Paris a renowned centre of physiology and neurology during the XIXth and the first half of the XXth century. We purposely chose to focus on the period 1800-1950, as 1800 corresponds to the actual beginning of neurosciences, and as 1950 marks their exponential rise. Our presentation is divided into four chapters, matching the main disciplines that have progressed and contributed most to the knowledge we have of the brain sciences: anatomy, physiology, neurology, and psychiatry-psychology. The present article is the fourth of the four parts of this review, which deals with the chapter on psychiatry and psychology. When the French Revolution occurred, only a few institutions were taking care of the mentally ill. In the Paris area, these included Maison Royale de Charenton, Les Petites Maisons, and one of the departments of larger hospitals such as Hôtel-Dieu, the Salpêtrière Hospital and Bicêtre Hospital. One of the founders of psychiatry in Paris at that time and thereafter was Philippe Pinel (1745-1826) who was the first to distinguish insane/alienated patients from misfits, beggars, and other vagabonds. During the first half of the XIXth century, his student Jean-Étienne Esquirol (1772-1840) also played a major role with his treatise on mental diseases and the 1838 law and the creation of asylums in all parts of France. Alienists were in general caregivers and learned by themselves. In contrast, at the academic level, the emerging disciplines psychiatry and neurology were very close to each other in the second half of the XIXth century, the best example being Jules Baillarger (1809-1890). The actual development of psychiatry and psychology and the foundation of psychoanalysis later in the XIXth century and in the first half of the XXth century owed much to several European doctors and scientists, particularly those from British institutions and from German-speaking universities in Central Europe. In France, important advances were once again initiated in Paris by Jean-Martin Charcot (1825-1893) and some of his pupils who renewed the concept of hysteria and the use of hypnosis. Sainte-Anne Hospital was created in 1867. This new institution located in the southern part of Paris became (and is still) one of the most important places in France for the treatment, research and teaching of mental diseases. Thereafter started new disciplines such as clinical psychology and neuropsychology; the scientific basis of psychology and notably the psychopathology hypothesis were established. A major revolutionary step occurred in Paris in the early 1950s with the discovery of neuroleptics and the birth of psychopharmacology. Here we present the biographical sketches of the most important Parisian scientists of these disciplines from that era, Philippe Pinel, Jean-Étienne Esquirol, Théodule Armand Ribot, Pierre Janet, Henri Louis Charles Piéron, Henry Ey, Jean Delay, Henri Laborit and Henri Hécaen.

[Prof. Masao Ota was interested in Kaisyun Hospital of Kumamoto].

From among the materials of Masao Ota, in the Library of Tokyo University, a letter (1931) was found from Isamu Miyake, prof. of Dermatology, Kumamoto Medical College. Its contents was some information on Kaisyun Hospital (The Kumamoto Hospital of the Resurrection of Hope, leprosy hospital), A calendar (the 1930s) of Kaisyun Hospital was also found in Riddell & Wright's Memorial Museum. This calendar was written in English, and it was to ask for the British and American sponsors to contribute. It includes a lot of articles related to leprosy like Riddell's article. Some new findings related to leprosy at that time were recognized from this calendar.

Koch's postulates, carnivorous cows, and tuberculosis today.

With Koch's announcement in 1882 of his work with the tubercle bacillus, his famous postulates launched the rational world of infectious disease and an abrupt social change--strict patient isolation. The postulates, so successful at their inception, soon began to show some problems, particularly with cholera, which clearly violated some of Koch's requirements. Subsequent studies of other diseases and the discovery of entirely new ones have so altered and expanded the original postulates that they now are little but a precious touch of history. The present additions and replacements of the original concepts are skillful changes that several authors have devised to introduce new order into understanding complex viral and prion diseases. In 1988, this knowledge, with the totally rational response of the British population and its cattle industry, was critical in promptly blocking the threatened epidemic of human prion disease. In contrast, the recent upsurge of tuberculosis (TB) in the worldwide AIDS epidemic in developing countries, and the sudden increase in metabolic syndrome in wealthy ones, suggests the need for focused sociobiologic research seeking ways to affect the damaging lifestyle behavior of many less educated populations in both settings. The world awaits an equivalent of Koch's Postulates in sociobiology to explain and possibly avert large self-destructive behaviors.

[Peculiar history to formation of 'Freely recuperate zone' in the National Sanatorium Kuryu Rakusen-en, Gunma, Japan (relation between the 'Old Yunosawa-ward' and 'Freely recuperate zone' in the National Sanatorium Kuryu Rakusen-en)].

Hansen's disease sufferers had been visiting the hot spring, Kusatsu-Spa, in Gunma, Japan, for Toji (which means 'hot springs treatment' in Japanese) since the middle ages, as it was known reportedly for a long time to be effective in curing the disease. In 1869, Kusatsu-Spa was hit by a massive fire. The innkeepers, who suffered devastating damages, were trying to reconstruct the economy quickly by promoting the medical benefits of the hot spring. This made many Hansen's disease patients to visit and of which many stayed on a long term bases. They would use the hot spring with ordinary visitors. And, they had received the treatment of the spotted moxa cautery with the hot-spring treatment. Later on, Kusatsu- Spa became well known throughout Japan and as the numbers of ordinary visitors increased, they voiced their concerns in sharing the hot spring with the Hansen's disease patients. Therefore, the innkeepers decided to move the patients to another district called Yunosawa and suggested to make a special village of just the patients. In 1887, the representative of the patients came to an agreement with the mayor of Yunosawa to establish a treatment centre there. Yunosawa became part of an administrative area of Kusatsu Town. The area seemed to become a local-governing area mainly shaped by Hansen's disease sufferers and the first legal residential area where Hansen's disease sufferers were given citizenships and may convalesce freely. However, in 1931, leprosy prevention law was passed, and the Japanese government built a new medical treatment centre of Hansen's disease, 4km away from Kusatsu- Spa, which is called National Sanatorium Kuryu Rakusen-en. After deliberations with the representative of the Hansen's disease patients living in the Yunosawa area and the governor of Gunma Prefecture, who received the order from the Japanese government to move them, had agreed to the mass relocation in 1941. This is how Yunosawa had closed its 55 years history and many Hansen's disease patients had moved to the National Sanatorium Kuryu Rakusen-en. The 'Freely recuperate Zone' within the centre houses affluent patients who had enough funds to build their own houses. I was able to hear from many residential People who have historical knowledge of the above and would like to report it here.

[Learning from the history of leprosy--looking back at one hundred years of medicine at the leprosaria].

This year is the centennial anniversary of the five national leprosaria in Japan. It means that the official accommodation of leprosy patients who were wandering on the streets started in 1909. At that time, the existence of these leprosy patients on the streets was considered as a national shame and also an evidence of falling behind the Western cultured countries. Japanese people and the government were hypersensitive of such notoriety, especially from the Western countries. Some doctors, politicians and bureaucrats were really concerned about the situation and made great efforts to establish the leprosy separation law. It was implemented in 1907, but it took two more years for the preparation of the sanatoria for accommodation. The leprosy separation law has persisted until 1996. It has been revised to the leprosy segregation law in 1931, and to the leprosy isolation law in 1953. Although the law underwent two revisions, the main ideology of isolation has been abundant for almost ninety years. This law has been infamous for its misery and pointed out to be abolished by the WHO. This paper will focus attention on the doctors, politicians and bureaucrats who have worked for the institution of this cruel law, and also discuss the reason why this law had prevailed.

Infection and citizenship: (not) visiting isolation hospitals in mid-Victorian Britain.

Local authority provision for the sequestration of infectious people mushroomed in Great Britain from the mid-1860s. By the First World War, more than 750 isolation hospitals contained almost 32,000 beds for infectious patients, most of whom were children. Trips to an isolation hospital were problematic because visitors might contract infection there and spread it to the wider community. Various strategies sought to minimise this risk or eliminate it altogether. This chapter argues that the management of isolation hospital visitors was typical of Victorian public health's tendency to regulate people's behaviour. By granting rights to, and conferring responsibilities on, the relatives of patients, visiting practices enshrined notions of citizenship that sought to govern 'through' the family.

[The compulsory isolation of Hansen's disease patients: memories of the elderly]. / Isolamento compulsório de portadores de hanseníase: memória de idosos.

From 1924 to 1962, Brazil used compulsory internment of Hansen's disease patients as one of the ways of controlling the disease in the community. After this policy ended, many patients continued to live in these units. The former Asilo Pirapitingui, now the Hospital Dr. Francisco Ribeiro Arantes, is the only old-style asylum for the socially determined internment of those suffering from Hansen's disease. Through recorded and transcribed interviews of eight of those remaining, we sought to learn their history and the meaning of this isolation in their lives. The thematic analysis of the discourse enabled identification of the following analysis categories: Hansen's disease; internment day-to-day life; the institution; current health conditions; and staying in the institution after the end of compulsory internment.

[The religious imaginary of Hansen's disease patients: a comparative study of former inmates of the asylums of São Paulo and current Hansen's disease patients]. / O imaginário religioso de pacientes de hanseníase: um estudo comparativo entre ex-internos dos asilos de São Paulo e atuais portadores de hanseníase.

The article analyzes the religiosity of Hansen's disease patients who lived during two distinct treatment periods of the sick: that of internment in asylums and the current practice. Ten semi-structured interviews focused on health, religion and Hansen's disease, broaching the ways the two groups faced religion. In the former inmate group, the presence of institutionalized religion was noted, which served the purposes of vigilance and isolationist therapeutics. Present day Hansen's disease patients still feel the stigmatic weight of'leprosy" in certain situations. Five questionnaires were also given to DHDS health professionals, who presented their considerations concerning the patient's religion and the treatment.

[Review of the time "Kaishun Byoshitsu" was founded: is the date "1899" correct?].

It has been an accepted story until today that in 1899 Kensuke Mitsuda's efforts led to the founding of "Kaishun Byoshitsu", an isolation ward for leprosy patients in Japanese modern times first located in the Tokyo City Yoikuin (poorhouse). But, in this paper, the author has collected as many documents that describe the details of the foundation of "Kaishun Byoshitsu" as possible, and thoroughly further reexamined definite sources regarding the time when it was founded. The documents are classified into the following four by the author, [A]: Kensuke Mitsuda himself, [B]: the persons concerned with Mitsuda, [C]: the persons involved in Yoikuin, and [D]: general researchers. These classifications [A] to [D], are further divided into two insistences, according to whether the founding date was claimed to be in 1899 or in 1901 in [D]. Insistences are exhibited in [B] for "in 1899" and in [C] for "in 1901", respectively. However, there was no conclusive "definite source" clearly specified in the above-mentioned classifications [A] to [D]. Additionally, in the most reliable classification [A], there is no actual reference to the founding date. Therefore, the author has reached the conclusion that at least the claim that the founding date was 1899, though it has become an accepted story, is not based on any solid evidence.

[Kensuke Mitsuda and his memory of the "Kaishun Byoshitsu" days: why did he not clearly state the time of its foundation?].

The author, in a previous paper, has argued that there is no hard evidence to show that the foundation of the "Kaishun Byoshitsu" in the Tokyo City Yoikuin (poorhouse) was in 1899. In developing the conclusion, this article, first, estimates the correct time of the founding the facility and, second, analyzes the reasons for confusing the verbal evidence of Kensuke Mitsuda that led to the prevalence of the incorrect story. As to the former, it is an undoubted fact that the founding year was 1901 or 1902, as the author has checked the career of Koto Ishiwata, a nurse who exclusively served the Kaishun Byoshitsu, and the documents which shows a historical change in layout and floor space of its rooms. As for the latter, by reviewing "the medical staff" system of the yoikuin (poorhouse), the author shows the background of Mitsuda's unfortunate days when he served there. The author finally suggests that Mitsuda's inferiority feelings about his misfortune might have caused his disordered testimonies, in other words, "an artificial memory".

Damien de Veuster (1840-1889): A life devoted to lepers.

Father Damien de Veuster, or Saint Damien of Molokai (1840-1889), was one of the pioneers of the holistic approach to care provision for leprosy patients and contributed to the overcoming of the patients' social stigmatization. He devoted his life to the lepers living in America's only leper colony, on the Hawaiian island of Molokai, where people with leprosy were required to live under government-sanctioned medical quarantine. Father Damien gained practical skills in caring for the sick, eagerly learning wound cleansing, bandaging techniques, and drug administration from a nurse. Mahatma Gandhi said that Father Damien's work had inspired his own social campaigns in India.

Leprosy: disease, isolation, and segregation in colonial Mozambique. / Lepra: doença, isolamento e segregação no contexto colonial em Moçambique.

Drawing on documents produced between the early nineteenth and mid-twentieth centuries, mainly medical reports, this paper indicates the prevailing conceptions in the colonial medical community and local populations about leprosy, its manifestations, and how to deal with it. It focuses on the tensions concerning the practice of segregating lepers and its social and sanitation implications. To comprehend the roots of the discourses and strategies in the Portuguese and colonial medical environment, the trajectory of the definitions of isolation, segregation, and leprosy are traced, as are their use in or absence from the writings of missionaries, chroniclers, and doctors in Angola and Mozambique as of the second half of the seventeenth century.

'Greater good' versus civil liberties in the United States: Tuberculosis and Seattle's Firland Sanatorium.

As far back as the late 1700s, peoples in the United States were developing ways to control infectious disease without infringing on Constitutional rights. Despite acknowledgement that an infected person has certain civil liberties, the history of public health law shows that, in many instances, infectious disease isolation and quarantine proved to be scientifically questionable at best. I examine an historical example of such questionable relationship between public health and civil liberties: the locked ward at Firland Sanatorium in Seattle, Washington. Mandatory quarantine at Firland began in the late 1940s and lasted until the facility closed in the early 1970s. Can examining this history enhance understanding of the relationship between "the greater good" and an individual's civil liberties?

[Leprosy and medicine I--proposal of an isolation policy and its background].

The leprosy policy of Japan began from when the government enacted "law No. 11 (The leprosy prevention act)" in 1907 (Meiji 40) and several leprosy sanatoriums were built and the patient who wanders about was received. Then, in rise of totalitarianism, the isolation policy of Japan gained national support under a slogan "Patient Relief", and it would become the big factor to which enactment of "Leprosy Prevention Law" in 1931 (Showa 6) and leprosy policy changed to segregation which aimed at internment of all leprosy patients. From today's research on the leprosy policy of Japan, it is internment of all leprosy patients, whole life isolation, social defense and neglect of patients' human-rights and led to many tragedy of patient. However, there is little research which can reply clearly to the question of whether the leprosy policy of Japan was really original and what the factors of led to the formation of the segregation policy. This paper focuses on the relation between leprosy policy and medicine, and from this, I make clear the similarity, or peculiarity of the isolation policy between Japan and the vest of the world, and clarify the factors of progress of the absolute isolation policy. The processes are historical and medical historical the verification of the relation between the formation of the national medicine and the progress of the isolation policy of Meiji Era, the proposal of the isolation policy by Dr. Keizo Dohi, Dr. Shibasaburo Kitasato, and Dr. Masatsugu Yamane, and the application by Dr. Kensuke Mitsuda, the decision to enact this policy and its support by the Health and Medical Bureau and the Department of the Interior, as well as many factors.

"Not a shack in the woods": architecture for tuberculosis in Muskoka and Toronto.

This paper explores architecture as a primary source in the history of tuberculosis. In comparing five Ontario sanatoria built between 1897 and 1923, we identify a range of types and a growing resemblance of ex-urban TB sanatoria to urban hospitals. Existing literature on Canadian TB hospital architecture suggests the endurance of picturesque architecture, but the cottage plan was only one of the types deemed appropriate for consumptives in the early 20th century, even in Muskoka. Furthermore we argue that urban and ex-urban TB ideologies actually coalesce about 1923, best illustrated in the boldly modern architecture of Muskoka's new Gage pavilion.