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TO THE
LEGISLATURE,
IN BEHALF OF THEDELIV.ERED IY THE UALL OF .ASSEMBLY, WEDNESDAY EVENING, FEBRUARY 6, I8lG,
BY
THOMAS B. ELLIOTT, M. D.,
LATE SENIOR ASSISTANT PHYSICIAN TO THE INDIANA HOSPITAL FOR TJa:E INSANA
---300 COPIES ORDERED PRINTED FOR .. ASSEMDLY,
MADISON:
OA.LKINS & PROUDFIT, PRINTERS. 1856.
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0 ---thore is an order Or mortals on the earth, who do become Old in their youth, and die ere middle age, Without the violence of warlike death; Some perishing of study,
And some insanity.''
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ADDRESS.
j 'Gentlemen of the Senate and .Assembly ef Wiscon8in: • j
It is with feelings of profound gratification that I accept the . honor of a call from one house of your honorable body, to address
you on the subject of insanity.
I come as the voluntary representative of a class of your fellow citizens who have no direct representation on this floor, who, hav ing no voice in the election of any honorable members are con stituents of nobody; and who, being deprived of the right use of their reason, are unable to exercis� their constitutional right of petition for redress of grievances, who cannot give correct expres sion to their wants, whether political, civil, social or personal, many of whom-free white men and women-are in prison and in bonds without a crime.
_During tbe last few years it has been my fortune to be constant ly associated with the insane iri a large state institution, having under treatment during that time, nearly one thousand whose rea son was dimmed 01· extinguished, and I know somewhat of their sufferings, their need of hospital care, and their prospects of res toration to health and citizenship.
Insanity is the most deplorable calamity our Heavenly father permits to Yi,it the human race, the severest punishment that ever follows upon our vicet, our follies or our mis-alliances. You do not know, the human mind cannot conceive, the wretchedness, the misery, and the utter hopeles�mess which many insane persons have to bear. Those who are •with them night and day for months and years can know but a part.
If you have ever passed through the halls of an insane hospital you have had your warmest sympathies, the best feelings of your soul, called forth by the wrecks of the human mind which you beheld there. But that was a mere passing glance, you could know nothing more than the _c_�mntenance and address of the in sane could tell. Then how much deeper must be tho::e sympa thies, could you be with them, arid know the cause of their suffer ings, the height from which they have fallen. We find there the young, the be::rntif'ul in early womanhood "like the rose stricken by the rude blast, drooping and withered." Perhaps she may have intervals of partial rea,on, but they only crush her heart with hopelessness. She looks forward with despair, certainly with but little d0ubt in her own mind, to long years of misery. Such a picture is not pleasant to look upon. But we :find there, in the pride and prime of womanhood, the mother, a dear wife and be loved mother. She who was ever look :d up to with respect, af fection and reverence, whose ever-ready sympathy and love, cen tering in the home circle, radiated, and soothed and comforted the neighborhood.
, She who, like Goldsmith's paEtor,
"Allured to brighter worlds and led the way,"
To see that mind in ruins is a harder picture to look upon. And we see this man-" Man who is a little lower than the angels" one who has been "crowned with glory and honor"_:...a man dis tinguished for strength of mind ; (for the greatest, strongest and best of men fall victims), one who has already done much for hia country, and enjoyed, in a large degree, the confidence of his fe}.
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l,1w citizens ; to see that bright and shining light snddenly extin guished; that great mind brought lower than that of the smallest child in weakness and simplicity. What heart could be so hard that it would not ache with sympathy ?
Again we see in all its helplessness and decrepitude, old age. Those grey hairs be wed down to worse than second childhood; those whom no care or comfort, no kindnees or love, could ever half repay for the years of toil and care they have hao to pass through; to sec them and wish that death might release them from their sufferings ; then indeed may we say it is hard to look upon. Gentlemen, these are sad pictures; but they are true, for I have seen them all and often.
But nuder the blessing of God, through the benevolence of Le gislatures and individual citizens, we are enabled to give comfort, relief and cure to those suffering fellow creatures. \Vo have but one way to do it, an<l that is by judicious hospital treatment. Un der tho kind care and gentle influo,1ces of those fostitutions, I have seen that young and blooming girl, and that blessed mother restored in perfect health and happiness to their families. Aud that proud man! I have seen his bowed form straighten, and the light davm upon his mind like the sunbeams of morning, growing brighter and c1earer, until he would go forth again rejoicing in his former strength and gl'catnesg. Aml also tho3e grey haired ones reatored to health and reason, to make glad the hearts that loved them.
Such, gentlemen, are the blessed and almost every day effects of hospital care and treatment.
I am here to urge the claims of your unfortunate feliow citizens, such as these, upon the state of Wisconsin for care, protection and cure.
It is true that the condition of this numerous and unhappy class of sufferers is already partly known to you by means of urgent and repeated executive messages and legislative reports, anq also
'.through the benevolent exertions and benefactions of some of your . own distinguished citizens. It is true, that an honorable, scienti
'fic, and humane association, the State Medical Society, has again and again memorialized the legisl"ture to become the guardians _ of-these· unfortunate people: that an organization, undet· the sanc
tion of the legislature, was at one time effected for the purpose of --establishing an institution for the insane; but I am informed no ,such organization now exists.
HOSPITALS IN OTHER ST.A.TES,
Other states have citizens whose minds wander in darkness, and some ln which, as I shall have occasion to say to you, the ratio of this affliction to the population is greater than with you.
Let us look for a moment at the means of relief afforded for this disease in other sections of our country. There are now thirty-· eight hospitals or asylums for the cure, ot· custody, of the insane in the United States, nearly all, partly or wholly dependent upon the several states for support, and many of them are organized on a basis to effect the greatest good. They are to be found in the twenty-four following states :
Massachusetts Las five, New York and Pennsylvania each four, Ohio three, two each in Maryland, Virginia and Kentucky, and one each in the states of Maine, New Hampshire, Vermont, Rhode Island, Connecticut, New Jersey, North Carolina, South Carolin'l, Georgia, Indiana, Illinois, Missouri, Tennessee, Mississippi, Loui . siana and California. While in Wisconsin, D..:ilaware, Florida, Texas, Arkansas, Iowa and Michigan the in�ane are still without a home. A state hospital for the insane in Michigan is, however, in process of completion, and Iowa has, I am informed, made some progress toward accomplishing the same object.
In the old world, as with"tlS, disease of the mind is a sure at• tendent on " high civilization," as well as on wretched poverty: and.curative hospitals for the insane abound in England, Ireland,
Sc®tland and France, all the states of Germany, Austria, Italy, and even in Spain.
I am not"then here to solicit you to commence a work of un known value, producing uncertain benefits, and yielding a doubt ful return. The age of experiment bas passed. You have before you two generations of' successful result. The experience of twenty four' of your sister states and of nearly all the states of civilized Europe, who have preceded you in this enterprise of mercy, assures yon that many thousands, through the skilful care afforded in hospitalo for the insane, have been restored to society and useful ness, to reason and happiness.
I CENSUS OF INSANITY.
In a stato like Wisconsin, new and undeveloped, where the vol· ume of population rushes in like a torrent, tho momentum of which no man can estimate; where the undisturbed trade, and unheard warning of the prairie snake this yea;·, is followed next year by that louder rattle warning civilization of tho
" Steam snake gliding white:"
in such a state, the enumeration of the inhabitants of one year is little indication of the population of the next; and tbo census of 1850 becomes quite obsolete in lt56. As regards your insane population, it is presumed by eminent gentlerr,eu, more compe tent to judge than myself, that even your census of last year gives little reliable data.
It is well then to glance at the census of the United States for 1850 and learn the amount of this affliction in our whole country, and thus by comparison, estimate tbe weight of the burden de. vol ving on yon. In its records of this suuject wherever that cen• sus ens, its error is in lesseniug and never in increasing the amount of insanity. The reasons for thic1 are known and demon strable, buts! have not time for them here.
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There were in 1850, according to the govP,rnment record, fifteen thonsaud seven hundred eighty-seven insane, being in the ratio of one insane to every thirteen hundred of tbe popn lation of the country. This ratio-estimating the population of ·wisconsi.n ac cording to the retnrns of your }ate state census at five hundred and fifty thousand-would give you four lmndred twmty th1·e6 as the number of the insane within your borders. In the state of Indiana the United States census reports five hundred sixty three insane: while there really were at that time, including those in the insane hospital, those fur whom applications were on file at the hospital, and others of whom we had offi.(lial information, a number of insane amouuting to eight hundred seventy four-be ing three hundred eleven more than t1ie census reports. Add to these, those in whose behalf no application had ever been made, and of whose existence the officers of tho institution had no of ficial knowledge: by this estimate-made ail accurate as possible, by means of information derived from clerks and othel' officers of counties-tLe insane population of Iu<lia!la :in 1854: was presumed to be not less than twelve hundred-n. ratio of one to every nine hundred inhabitants.
The most trustworthy, and in every respect complete, census of insanity C\'Cr t,ikeu either in this conntry or Enrope, was laid be fore the lcgi�1ature of Massachusetts last year, by that eminent philantlll'opist DJ". Javis, who had been previously appointed one of a commission fur that purpose.
By this commission, the nnmber of lunatics in Massachusetts was found to be two thousand flix hundred and thirty·two; which is one insane arnong every four hundred and twenty seven of the population; being one thousand more imane in that state than tLe U11ited States Marshals were able to discover. These discre• pancies are owing in part to the fact that many families refuse or neglect to report their .domestic afflictions to the government ·officers.
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INSANJD IN WISCONSIN.
If the ratio to the population is the same in Wisconsin that it is in Massachusetts, (viz, one in 427,) the number of insane here would be one thousand two hundred and eighty eight. But the ratio of mental disease here is unquestionably much less than it is there, owi�g to a number of causes. But, making every allow- 1 ance for the fact that yours is a new state, that the insane do not emigrate to any considerable extent, that some of the causes of mental infirmity and disease are not so prevalent here as there,-still, I suppose, no one would allege that I nrngnified your evil by estimating insanity in vVisconsin as about three times loss than in Massachusetts; making the ratio here as one insane person to every twelve hundred of' your population. This estimate would give you four hnndred and fifty-eight insane in the state.
Th:s, then, we may take as at least an unexaggerated statement of the amonnt of' insanity resting upon tho state of "Wisconsin. In whate,·er way we may look at them, these insane persons are a burden npon the state. Tho curable, dnring their limited period of disease, and the incurable, during the remainder of thefr lives, not only cease to produce, but they must eat the bread they du not earn, and consume the substance they do not create, receiving their sustenance from the treasury of the state, or from some of its counties, or from the income or capital of some of its members. The1·e is then no alternative; the state or it-, people will bear this burden, and support these insane, and the evil ia not lessened, or its cost diminished, by keeping it out of sight.
HUMANITY OF HOSPITAL TREATMENT.
Indeed, the evil becomes less formidable the nearer it is ap proached, and the light thrown upon it will surely lighten the burden. That light, being the radiance shining from the record ed ev:dence of nearly every hospital both in this country and Eu· rope, shows that disorders of the brain resulting in insanity, are
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usually serious diseases; and yet, if taken early, and the prope1· Temedies applied and continued, they are amung the most cura•
ble of maladies.
In recent cases, under proper hospital treatment, the recoveries are from seventy-five to ninet-y per cent.
It is an equally woil established fact, founded on the same evi dence, that insanity tends to become constitutional und fixed the longer it is neglected. That the chances of recovery decrease in an inverse ratio "iLh the lapse of time; that although eighty in one hundred may be healed, if the restomtive process be com menced d nring the first year; yet if the disease is allowed to run on untreated for on,J 01· two years, less thun oue half that number will recover; and on this sliding scale of cl1ronic madness, the prospect of the unfortunate patient becomes more and more hope• less during the third and f1rnrth years, m1til after that time his mind might almost be conBidered as blotted. out of existence . .:... Hope bids the man farewell.
Insanity is then usually deemed incurable. Aud although un freqnent recoveries even then take place, they seem to be the offspring of chance, rather than the results of rational calculation and treatment.
The time required for the cure of patieTJts varies from a few months in a majority of cases, to a few years iu extreme cases.
I would that you could now visit with me a well conducted modern hospital for the treatment of insanity, managed in accord ance with the most recent discoveries in phsychological science; could yourselves observe the great importance of prompt treat ment, early isolation from old associations, and the certainty of a speedy cure in the premonitory stage of insanity, where judicious medical and moral treatment is at once adopted: seeing the patients well fed, well clothed, and apparently nearly free from any mental disea�e or excitement: and then compare their condi tion with that of the large body of insane persons k-ept at home,
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undergoing no effective plan of treatment; or secreted in c >t • tages, or lodgings, or pens of the earth; subjected to no medical or moral curative process, or degree of surveillance, apa,·t from that derived from an occa'3ional visit of a me<lical a·.tendant, or the prying cnriosity of thoughtless men.
Compare the calm deportment and thorough comfort of the hos pital patient, with the raving mania of the same man before he became a member uf the hospit.tl family. Sec him in the one case sedate and quiet, controlleJ by the judicious regulations of his physicians, and the pnblic opinion <}f' hi3 fifteen. or twenty thor oughly classified r.ssccintes; (fur politicans will lie interested in learning that tlie pul,lic opiuon, even of a crazy ward, has a po tent idluence), and then see him in his miserable home, or in the alms home, or let out to the lowest bidder; if free, tho terror of' the neighborhood; if coufined, noisy, uncomfortable, iu many cases unclothed, often unwarmed a11<l badly fed, usually unwash ed; breathing the foul atnwsphcrc of a !'lrnroughly unventilated cell ; having for a bed tJ10 cheap luxury of a bundle of straw! but night and day are the same to him : he dnes not sleep. This is the wreck of a man in whose behalf I ask justice at your hands. He has the strongest of all claims-that of hitter misery and ad versity, and which it is your duty, as citizens and legislatora, to cancel.
CONDITION l\"ITHOUT IIOSI'ITAL CARE.
The wretched condition in which many of this class are confined
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is sufficient to excite the warmest sympithics wherever that con-dition fs known. Many are imprisoned for Jife in some filthy cel lar or out-house, without even being permitted to breathe tbe pnreair, which should be free to every human l;eing; without the privilege of ever lieholding the light of tl1e sun, or looking upon the face of nature, deserlc;d by those whom natnre and nature's God designed should be their guardians, denied, perhaps, the pleasure of ever beholding the face of a friend-deprived of all
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social enjoyments, and w0rse than all, condemned to this vegeta tive existellce fol' life, for life! Condemned to live forever with reason utterly dethroned, because denied the means of relief or cure! Such cases, such suffering and deprivation should call forth all the generous feelings-all the sympathies of purn philanthropy -all the charities of true religion. To be devrived of reason is
enough j but to be deprived of proper food and clothing-of the light of Heaven and the balmy breeze-of the attention of friends and all social enjoyments, and, in addition, to know that this is to last for life, without any hope of relief-can we imagine any pun ishment, present or futnre, more terrible?
Thank God, all of your insane are not such as this! But such cases do not exist here iu Wisconsin, as they did in England 300 years ago, before the era of hospitals.
Spenser in the Faery Queen, makes mention of one of them. You see him lying in bis cell, regardless of everything, with a death-like settled gloom upon his countenance,
"Ilis burning eyen, whom bloody streaks did stain, Stared full wide, and threw forth sparkes of fire, And more for rank despight than for great pain, Shaked his long locks, coloured like copper wire, And bit his tawny beard, to show his raging ire."
THE INSANE AT HOME.
An inquiry may here be presented, "cannot these unfortunate beings bu as we11 taken care of, and as successfully treatud by
physicians in the families of their fri()nds or relativE:s, as in any asylum established exclusively for the luuatic ?"
The answer is obvious-tluy cannot. In a majority of cases, insanity occurs in the humbler walk" of life, and among the poo1· er classes of the community. In such cases it is known that the frie11ds of the patient cannot provide such apartme11ts, and other appliances, as are necessar_y to the comfort and saftity of the
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sane, or as are·reqnired for the successful treatment of diseases of the mind. The lung duration of the disease prevents that care ful, steady and persevering m<:dical and moral treatment which experience has shown to be essential in caees of insanity. The fri'ends are unable to employ a physician who will attend con stantly for snch a length of time as is necessary to effect a cure. The physician, by no meaus destitute of charity, humanity or be nevolence, is unable to render such services, and devote his time and attention to such ca:-r:s, to the exclusion of other business without compensation.
But besides and above all this, is the startling fact,that home is the worst possible place for the insane man. There all his mor bid associatiolls centre; there are the scenes which keep active and fan into a flame his wild imaginings. It was there, in the midst of his family, neighborhood, and business affairs, that his mind became disturbed. As a general rule, bis nearest friends are intolerably odious to him; and that .ministering angel, his wife, who was tho light uf his life and the joy of his heart, he can love, cherish, and protect her no lunger. He hates even her loathes the sight of her-perhaps would kill Ler; many do.
He must be rcmwcd from his home and friends, and hnve a complete change in his a-sociates and the objects of his attention. He would himself, in nrnny casee-, go to the ends of the earth to shake off the incubus that weighs upon his brain and poisons the very fount of life, with el'ery healthful moral perception. At home, he can uo m0re sl1ake off this chronic nightmare than you can stop the revolutiuns of the sular system. Often his exbtence is wretched to him, and, in his misery, self destruetion becomes a fixed idea in hi,s mind�-" Any way, any way out of the world r'
It is probablo that half of yonr insane are worse than homeless and friendless. Tlieir friuucls are either too poor to give tl1em even a slender imperfect cam at home, or they are too vio!ent and dangerous to be kept there.
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THEN WIIERE ARE TUEY TO GO f
Your own suffering fellow citizens Lave for years been knockiug for admission into t110 charitable institutions of'sister states, and in most instances knocking in vain! Hardly a week passes but some citizen of Wisconsin applies for �,dmission to the Indiana hospital; but dnty to our own citizens who still want room compels us to re ject the application. And all well regulated ho3pitals in the
United States are full to overflowing. Then where are they to go? Where would we send our wives, onr motuera, o,u daughters, and our sons 1 To the jail and the poor house? There is not a man in this house bnt,would instantly answer no, and shudder at the thought. Then what can we do for them? Nothing less than give them a hospital, where they C'l.U be kindly cared for, and if
not restored, at least retained in comfort. To witness a mind that seemed lost restored to health and usefulnern is no ordinary grati fication, but to tLe philanthropist it is only less than this to see minds that cannot be restored, kept from losing their powers, and the possessors of them from becoming the wretched objects, men· tally and ]Jbysically, to which long continued neglect and ill treat ment can then, and does then, so easily reduce tuem.
ECONOMY OF A HOSPITAL.
I have spoken to you, gentlemen, of the number of the insane in your state, of their condition, of the humanity and necessity of hospital treatment: and now a few words in regaed to the inter• est of the state in the matter, and its economy.
The state has an immediate and direct, as well as a general, in terest in taking care of her insane.
The lunatic, as soon as he becomes such, ceases to create any thing for the general good; he not only does not produce, but is thrown on his friends or the public for support. · The county or the State mu,,t pay Lis expenses, whenever his estate or his friends
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fail to do so; and the public-that is the general treasury-must continue to support him dtiring the wh0le term of his insanity, and that disease, without proper treatment, will extend during life. Calculate how few of the people ot' yonr new State arl' able for a length of time to pay the cost of a friend's insanity, and with what certainty the State will be called on to bear this expen sive responsibility.
The politico-economic question then is, whether you will antici pate the evil, and by a few months treatment in a well regulated hospital, and a small out-lay of 111oney, cu1'e the patient, and make him again self-producing; or whether you will neglect him now, and hereafter, at an expense of hµndreds or thousands, support him for life !
,, The Massachusetts commission remark: "The cost of restoring a lunatic to health and enjoyment, and power of self sustenance, and of contributing to the support of his family, and also to bear• ing his part in the burden of the State, is limited and easily paid in money-the gain is unmeasured. But the cost of life-long lunacy distressing and oppressive to the friends who have the patient in charge, is immeasurable, and not to be paid in money.
:, Ilumanity would admit of no choice between these, and the state which is the guardian of the weak and the friendless should not entertain a moment's doubt as to which to e:hoose.
"Between the expense of supporting for a
few
months, and that of supporting for life, no private economiat, and certainly no po litical economist or etatesman should hesitate."Dr. Kirkbride, of the Pennsylvania hospital for the insane, in late report, alluding to early curative treatment says-" The economy of' su hjecting cases of mental derangment to proper treatment immediately on the occurrence of tho attack has not been generally understood, or no state would have neglected to make adeq11ate provision for the early cure of all who were thus afflicted. Thero can be no question but that every community,
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not having within itself the proper means, would save largely, by
.sending their recent cases tu some well condu.cted insane hospital, nnd retaining them there as long as the1 e was a prol'pect of their restoration. If this was done, a large proportion would in a few months be restored to society, instead of continuing, as is now too apt to be the case, a charge to their friends or tlie public during the remainder of their lives. This is not merely conjecture. By referring to the register of this institution, I find that the actual average cost of supporting the .first twenty successive cases that were discharged cured, from the time of their sdmissiou until their return borne was only ji,fty-two dollars andfiftv cents each. ·While in the first twenty incurable cases that ,vere received in this house, .at the same rate of expense, tho average cost of each was tliree tlwusand jor"tyfve dollars. In the vublished reports of the l\fass. state hospital at Worcester, it is shown from positiv� data that the actual cost to 1he public of maintaining twenty five consecutive cases of recent insanity till their restoration, was only
fifty-six dollars eacli, while the cost in the same number of chronic
.cases already averaged one thousand nine hundred and three dol lars sixty crnts each. The expense in the oneinstance is only-for
,a few months, when tho patient sound in body and 1r,ind returns
to
the care of his family or lrnsinoss."In the other it is a support for life, often a long one, and not nnfrequently, if the individual be the head of a family, the.sup port of n family in _addition. The opinicn of all the chief medical
·officers of institutions for tho insane throughout the U uited States and· Enropo, is unanimous as to the policy of timely ren,edial treatment. Tbi c1ucstiod of its policy and economy is so clearly demonstrated as to need no additional argument. So essential is the importance of early treatment deemed in England, that magis trates and police officers arc by law obliged to search ont and promptly send to some curative hospital every recent insane per son within their respective districts.
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eight insane in your state urgently need hospital care; hut all of those io prisons, all in jails, and a large pn1portion of those who
are supported at home by their friends, especially wlien to this calamitous m11lady is added pov.arty and piuchiug want,-all of these, to the number probably of little less than three hundred, bitterly need hospital treatment or care. A ·1arge number of these cases are permanent, because incurable. The otl,ers arc rapidly becoming s0, although they might now be restored if proper means could he given them. Your popn'1ation is increasing with almost miraculous rapidity, but insanity probauly keeps pace with it, or runs ahead.
Tne canses <•f insanity arc still as ahnn<lant and efficient as ever, and if they aic not obviated or controlled, ti1is year an!l 1he succeeding yc!!.r will produce more insanity than the fast, and those that were before. The next year and the next generation will haYe as largo a ratio in pr0portion to their population to pro vide for as you have now. Pustcrity then cannot bear yonr burden.
Theu build. yollt' hospital for two hundred aud fifty patients, (as
large a number as should crcr be subject to one urganization) aud long before it ia completed more than that number of applicants will be anxiom,ly waiting ti> fill it to overflowing.
If yon want the institution always prosperous) receiving the·
sanction of the warm approbation of all your citizeus, lH•gin at
the very begim1ing by excluding everything of a partizan char
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actor.
The insane cannot be snccessfnlly treated on democratic, re publican. or Arnericau principles, but on rules of management at
once ra1ional5 scitntific and hnmano.
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Place your very Lest men upon bnnrd of cornrmss10ners, " mun of uudou hte<l integrit,y, active btmevolence and thorough-, business habits."
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conducting a large hospital for the above number of patients, varies in different w·estern states, from $100 to $125 :mnvally for each patient.
wno SUOULD BE ADMlTTim.
I wonld not bave you understand me as ad vising that your hos pital should be established only for the reception of curable cases· No, my opinion is far otherwise. Only bo certain to gather with in it all tlie recent cas::s, as the good accomplished there is real and immense and obvions to the comprehension of all your citizens. But the insane in whom the light of reason is forever veiled should not be abandolled to a misery which you cau relieve or mitigate. There is no humanity, little, if any, economy, in re treats or asylums-with a low grade of accommodation--for the hopelessly rnsane. It is no small rnattei· if disease of the mind cannot be completely removed, that the mind shall be kept as far ns possible from the lowest form of mindlessness.
The mo1'al means which are to aid in the restoration of' the cu rable are often efficient in supporting the mental faculties of the really incurable. vVe all know the effect of associc,tion npon our own mental powers and nctivity. We feel in onrwlv1.,s and sec in others that the society of the moral, the educated, and the refined has constantly elevating and improving influence; while the com panic,n�hip 1•f tho profligate, the ignorant, and the drgracled, is
equally sure to gradually bring down the noblest intellect and to
ob;:cnre the finest talents. Su where the min<l is in the acnte stage of dis':'as0, and the sympt0ms are of the milclcr k'ncl, the steady, unrring, and ,iudicions ssmpathy and kindnes:; nf the patients'
physician:i and attendants will often di,sipate the cloud that was
gathering, and wliich, ·without snclt meaus ot' relief, would ere
long have left a ma, k never to be efl'ttced. A/'ter thL JWI iod, whe
the affiicted per20n lias passed thr011gh the carFest st:igrs of hii! malady, nud become perhaps tl,e lifc>-lung resident of an LMpital, symJ_Jathy and kinducs;i arc still efficient; respectful and courteous
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treatment is still appreciated, exercise and labor still bring their best reward ; well-timed conversation, reading, 01· listening to the reading of good books, occasional evening parties, the atttndatice of lectures, ri<ling and walking, visits to objects of interest whe ther of nature or art, labor in the workshop and garden, or on the farm, variety in daily pursuits, good food, well cooked and proper ly served, neatness of person and dress; everything that keeps the mind, as well as the body steadily, actively and pleasantly em ployed, is still productive of beneficial results. While life lasts every case should be considered under treatment-if not to cure at least to keep it from becoming worse. Every year, in all cura
tive hospitals, presents cases that should teach us never to utterly despair; at least to treat all as if there was ho_pe of returning health. Their light, though dimmed, should nev1tr be put out by neglect or bad usage.
Trrn AssoCIATroN OF MEDICAL SuPERINTENDENTS OF AM!l:RICAN HosPrrALS FOR THE INSANE, unanimously adopted, in 1851, a se ries of propositions in reference to the construction of hospitals for the insane ; and as these have already been recognized as au thority by the general, and several of the state, governments, and also by a number of corporate bodies interested in the welfare of those laboring nnder mental disease, I will w far presume on your kindness as to read them bere.*
HOSPITAL CONSTRUCTION.
The marked advances which are year by year being made in medical and moral treatment of the insane, and in the construc tion of hospitals f1Jr their nse, must be grat:fying to every philan thropist and statesman. The new state institutions now in pro gress of completion or erection, will be far in advance c,f most of those that preceded them. Pains are taken that each shall be an improvement in utility and comfort on its predecessor.
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Dr. Kirkbride, a gentleman whoso labors in this department of public charity have been eminently successful, and whose opi nions are received as coming from "one having authority," when writing on the subject of the construction of hospitals, says:
"Public opinion, in most parts of our country, µas not yet arrived at the true standard for fixing the degree of e;;:cellence which should belong to every institution for the insane, whether state, corporate or private. A desire to have them cheaply built,. cheaply furnished aud cheaply managed, without a proper regard for excellence, is still too prevalent.
"These establishments, it is to be remembered, arc generally to·· receive all classes. The best and most useful mombern ·of the community, may require their aid as much and as often as the most wretched children of rni�fortnne ; aud even if all tbeir in mates were the very poorest, humanity and good ccc11omy would equally counsel every provision that aff0rded an additional chance for their restoration.
"It will certainly be found by experience, ill all these institutions, that trne economy consists in avoiding waste of every kind, but at the same time using liberally every means which promises to promote tho gr<'at object for which they were constructed; and that hospitals which combine most excellencies with fewest de fects, which are organized upon the most liberal scale, and offer most advantages to their patients will be cheapest in tlie end, be best appreciated by the afflicted and their friends, aud ultimately give most sati,ifoction to any enlightened community."
Gentlemen, the nature of m_y subject has been sorrowful, yet I have not desired to speak in a spirit of complaint. Tbe blessinge of a wise and merciful Deity far exceed his inflictions. Every source of evil by which humanity suffers has been searched out, and ingenuity has been tasked to devise means of relief or miti g13,tion. Defects of the eye, the ear, the tongue have separate and skillf'u1 attention. The dumb in your state are taught to converse,
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and the blind to read. The poor are supplied with houses of ref uge and soothed by the kindness of charity. And as might be expected, where the voice ot religion is heard, tho widow and the fatherless have been so earnestly regarded as that their affiiction and misery are turned into joy and praise.
And now, gentlemen, the fulness of time bas come when yon should gather the poor mindless wanderer to a home. Your beau tiful state is the fairest of the daughters of the west, and yet there are here more than four hundred men and women to whom its beauty gives no enjoyment. To whom
"The sight of vernal bloom or summer rose, Or flocks, or herds, or human face divine.'' has no charms. Who
'' Love no more
Blithe voice of living thing; muse not again Upon familiar thoughts."
Their very affections of love, and home and childhood are to them either utterly perverted or steeped in the waters of bitter ness. They have lost their way in the world: and it will be your pleasure, as it is yout· solemn duty, to find, and restore them to the pleasant ways they forrnel'ly loved to tread. Meanwhile they are merely passing on, like the shadow over the sun dial, and soon, unknowing of their fate, will vanish from the beautiful earth and alas ! others will take their places.
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APPENDIX.
CONSTRUCTION AND ORGANIZATION OF HOSPITALS .
Report on tlie construction of Ho,7Jiials for tlie Irisane, made by
Standing Committee rf tlie Association of Medical Superin
tenderds of American Institutions.for tlie Insane, at its meeting in I'liiladel_phia, Hay 21st, 1851.
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At the meeting held at Boston, 'June 18th, 1850, tlie standing committee on the construc�ion of hospitals for the insane, was in structed to report to the next meeting a series of propositions rel ative to the· structure and arrangements of .American institutions for the insane that would embody the well ascertained views of the body in reference to many points in regard to which there was no difference of opinion. The twenty-six now reported are of that character, entire unanimity in reference to them was expressed, and they are important as embodying the views of those who have a practical knowledge of the subject. Many other points might have been introduced, but from a conviction that some diversity of sentiment still existed in reference to them. (American Jour
nal ctf Insanity.)
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1. Every hospital for the insane should be in the country, not within less than two miles of a large town, and easily accessible at all seasons.
2. No hospital for the insane, however limited its capacity)
Bhould have less than fifty acres of laud, devoted to gardens and pleasure grounds for its patients. At least one hundred acres should be possessed by every -State hospital, or other institution
for two lnrndred patients, to which number these propositions ap•
ply, unless otherwise mentioned.
3. Means should be provided to raise ten tl10usand gallons of water, daily, to reservoirs that will supply the highe,,tparts ofthe building.
4: No hospital for the insane should be built without the plan having been first submitted to some physician or physicians who have had charge of a similar establishment, or ai e practically ac quainted with all the details of their arrangements, and received ,
bis or their full approbatton.
5. The.highest number that can: witln propriety 'be tr,mted,in one building is two hundred and fifty, while two hundred is a preferable maximum.
6. All such buildings should be constructed of stone or brickt
have slate or metallic roofs, and, as far as possible, be made secure.
from accidents by fire.,
7. Every hospital, having provision for two hundred or more
patients1 should have in it at least eight distinct wards for each
sex-making sixteen classes in the entire establishment.
8. Each ward should have in it a parlor, a corrider, single lodg ing rooms for patients, an associated dormitory, communicating
with a chamber for two attendants, a clothes room, a water closet,
· a dining ryom, a dumb waiter, and a speaking tube leading to the
kitchen or other central pai't of the building.
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9';'No apartments should ever'be provided foe the con'fine'ment of' patirnt$, or as their lodging· rooms, that are not entirely above·
gro'und.
10. No class of rooms should ever be constructed withoutsome kind of window in each. communicating directly with the external atmosphere.
11. No chamber for the use of a single patient should ev.er be le�s than eight by ten feet, nor sl10uld the ceiling of any story oc cupied by patients be less than twelve feet in height.
12. The floors of patients apartments should always be of wood.
13. The stairways should always be of iron, stone, or other in destructible material, ample in size and number, and easy of ac
cess, to afford convenien,t egress, in case of accident from fire.
14. A large hospital should consist of a main central building -..
with wings.
15. The main central building should contain the offices, receiv ing.rooms for company, and apartments entirely prh·ate, for the
superintending physician and family, in case that officer resides in' th� hospital building.
'16. The wings should be so arranged, that if rooms are placed on •both sides of a corridor, the corridors should be furnished at both ends with moveable glazed sashes for, the free admission of both light and air.
17. The lighting should be by gas, on account of its conve- ':
nience, cleanliness, safety and economy.
18. The apartments for washing clothingi &c., should be detach ed from the hospital building.
19. The draining should be under ground, al'ld all the inlets to the sewers should be properly secured to prevent ofiensi ve emana tions.
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20. All hospitals should be warmed by passing au abundance of pure fresh air from the external atmosphere, over J.>ipes or plates containing steam under low pressure, or hot water, the tempera• ture of which does not exgaed 212 degrees F., and placed in the basement or cellar of the building to be heated.
2 l. A complete system of forced ventilation, in connection with the heating is indispensible to give purity to the air of a hospital for the insane, and no expense that is required to effect this obje'ct thoroughly, can be deemed either misplaced or injudicious.
22. The boilers for generating steam for warming tho building should be in a detached structurP, connected with which may be the engine for pumping water, driving the washing apparatus and other machinery.
23. All water closets should as far as possible be made of in destructible materials, he simple in their arrangements, and have a strong downward ventilation connected with them.
24. The floors of bath rooms, water closets and basement storer,, should as far as possible be made of materials that will not ab sorb moisture.
25. The wards for the most excited class shou1d be constructed with rooms on but one side of a corridor, not less than ten feet wide, the external windows of which should be large, and have pleasant views from them.
26. Wherever practicable, the pleasure grounds for a hospital
for the jnsane should be surrounded by asub3tantial wall so placed as not to be unpleasantly visible from the building.
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Report" On tlie organization qf Hospitals.for tlie insane," made
by the standing committee qf the Association r:f Medfoal Super
intendents qf Amerioan Institutions.for tlie Insane, at ,its meet-1;11g in Baltimore, Ma_y 10tli, 1853.
The "Propositions relative to the construction of Hospitals," having met with so universal an approval from all connected with or interested in thu subject, and a want seeming to the association still to remain unsatisfied, a committee was appointed at the meet ing held in New York last year, to draw np a series of proposi tions that should in like manµer embody the well ascertained views of its members in reference to the organization of hospitals for the insane, in regard to which thero was no difference of opin ion. As is stated in onr report of the meeting at Baltimore, pos tea, "each proposition was taken up in detail, and minutely and fairly discussed, before it was :finaliy accepted." As now laid be fore our readers, the ''propositions" may be received as the au thorized exponents of the views of the above association on the organization of hospital;i for the insane " (Amerioan Journal ef
Insanity.)
1. The gvncra1 corrtrulling jlffWC'r should be vested in a hoard of trustees or managers: if of a State institution, selected in such a manner as will be Lkel_y most effectuall_y to protect it frorn all in fluences connected with political measures or political changes; if of a private curporation, by those properly authorized to vote.
2. Tho h,,ard of trustees should not exceed twelve in number, and be composed of individuals possessing the pnblic coufidence, distinguished for liberality, intelligence, and active benevolence; above all pt>litical infinencP, and au]e and willing faitlifully to at tend to tho duties of their station. T!1eir tenure of office should be so arra�iged, that where changes are deemed desirable, the terms
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of not more than one-third of the whole number should expire in one year.
3. The board of trustees should appoint the physician, and on his nomination, and not otherwise, the assistnnt physician, stew ard and rnatr-un. They should, as a board, or by committee, visit and exumiun every part of the institution, at frequent stated inter vals, nut le�s than semi-monthly, and at snch other times as 1hey may d,Jom expedient, and exercise so careful a superviaion over the C'xpenditur-es and general operations of the hospital, as to give to the community a proper degree of confidence iu the correctness of its management.
4. The physician should be the superintendent and chief execu
tive officer of tbe establishment1• Besides being a well edncated
physician, he sl10ul<l possess the mental, physical and social qual ities to fit him for the post. He sbonld eervc dnring good beha� v.ior, reside on, or very near the premises, and his compensation should be so liberal as to enable him to devote his whole time and energies to the welfare of the hospital. He should nominate to the board snitable persons to act as assi;.tant physician, steward and matron ; be should have the entire control of the medical, moral and dietectic treatment of the patients, t.be uureserved power of appointment and discharge of all persons engaged in their care, and should excrciae a g.meml snpervrnion and direction of every departmelit of the institution.
5. The assistant physician, or assistant physicians, where more than one are required, should be graduates of rnedicine, of snch charaeter and qualifications as to be able to represent and to per� form the ordinary duties of the physician during his absence.
6. The steward,\nnclci· the direction of tbe superintending phy•
sician and by his order, should make all purchases for the institu tion, keep the accounts, make engagemwts with, and pay and discharge those employed about the establishment, have a super•
p. 31
vision of the farm, garden and grounds, and perform such other
.
.
dutie� as may be assigned him.
7. The matron, under the direction of the superintcndent,·should have a general supervision of Lhe domestic arrangements of the house, and, under the same directitm, do what she can to promote the comfort and restoration of the patients.
8.
In
institutions containirg more than 200 patients, a secondassistant physician and apothecary shonld be employed, to the
latter of whom other duties, in the male ·wards, may be conveni
ently assigned.
9. If a chaplain is deemed desirable as a permanent officer, he should be selected by the superintendent, and like all others en gaged in the care of the patients, should be entirely under his direction.
10. In every hospital for the imane, there should be one super visor for each sex, exercising a g; neral oversight of all the atten dantc; and patfont,i, and fol'll1ing a n.e<limn of communication between them and the officers.
11. In no iustitution should tho number of persons in immediate attendance on the patients be in a lmver ratio than one attenda!!t for every ten patients; and a much larger proportion ot' attend ants will commonly be desira])lc,.
12. The fullest authority be given lo the superintendent to take every precaution that can guard against file 01· accident within an institution, and to secure this an cft1cient night-watch should alwnys be provided.
13. The sitnati,m and circumstance3 of different i11stitutions may require� consideral)lc numbpr of per.soils to he employed in va1i ous othu positions, but in every hospital, at leaRt all those that have been referred to are Lleemed not only desirable, but absolnto ly necessary, to give all tho advantages that may be hoped for from a liberal and enlightened treatment of the insane.
14. All rersons employed in the care of the insane should be active, vigilant, cheerful, and in good health. They should be of a kind and benevolent disposition, be educated, and in all respects trust worthy, and thei1· compensation should be sufficiently liberal to secure the services of individuals of this description.
