This is a postscript to Dr. Lucy Ozarin’s article in the March 17 History Notes column describing the conflict between American and British psychiatrists in the 1870s about the use of restraint.

While the British attempted to avoid use of mechanical restraint, they did utilize restraint by attendants. Dr. Bucknill, visiting from England, described with approval the patient care at the Pennsylvania Hospital: The patient "was placed in a low and narrow but comfortable bed, in an airy and cheerful room, a kindly and patient nurse was seated on each side of her, and she was kept in a recumbent position as much as possible, mostly by persuasion and a little by gentle force. . . ."

The American position was that mechanical restraint was "more reliable, less annoying, and more humane than the hands and eyes of attendants." The American psychiatrists supported their thesis by citing details from the annual report of the British Commissioners in Lunacy about deaths and injuries to patients, staff, and even one of the commissioners, killed by a patient with a sharpened nail.

Henry Pinsker, M.D.

Teaneck, N.J.