IMAGE EVALUATION TEST TARGET (MT-3} 4 id. 1.0 I.I ■iilM 125 |50 "^ B^H 2.0 lU liO 1.8 1.25 |U 1.6 .« 6" ► m V] Jt 7 >> '/ >!!^ Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 SJ ,\ 00 <> rv 4h ".^ 6^ 9>>l CIHM/ICMH Microfiche Series. CIHIVI/ICIVIH Collection de microfiches. Canadian Institute for Historical Microreproductions / Institut Canadian de microreproductions historiques d Technical and Bibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6ti possible de se procurer. 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Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Un des symboles suivants apparaftra sur la dernidre image de cheque microfiche, selon le cas: le symbole — »> sig.iifie "A SUIVRE ', le symbols V signifie "FIN". Les cartes, planches, tableaux, etc., peuvent dtre filmds 6 des taux de reduction diffdrents. Lorsqc? le document est trop grand pour dtre reproduit en un seul clichd, il est fiimd 6 partir de Tangle supdrieur gauche, de gauche 6 droite, et de haut en bas, en prenant le nombre d'images nicessaire. Les diagrammes suivants illustrent la mithode. ; 1 2 3 1 2 3 4 5 6 Wrinkles In Ancient Asylum Reports. BT DANIEL CLAUK. M. D., Turonto, CaDuda. SImerCcan Journal of Snsanftji, Jnniiary, 1890. UTTICA, N. V. Z^. m MH i I 1> r|i |iim iw . iii ni> i M i ^ 1( fi i |» .?Sl il < > 'I '^ \ ! . A"!*"; WIUNKLKS IN AXCIKNT ASY^LlJ>r IJKPOllTS.* i llY DANrrOI, CI.AKK, M. I)., Mcfllfiil SuperlntondcDt Asylum lor tho Insane, Toronto, Canada. This jtajKT is road with ii good deal of trepidation and misgiv- ings. The writer is not sure but tlie members of tliis learned assembly may resent the attemi)t to palm off upon them old and dead issues, when newness and originality are the order of the day. Brethren are beseeched to have patience and forbearance while tho exhuming proeesis is going on. It is possible that after tho resur- rection has taken place, you may mercifully consign the writer and his manuscript to a dime museum as rare specimens of fossil- ized humanity and of musty records, upon which might be labelled: " J.et the dead j)a9t bury its dead." In the midst of the reading of so many able papers and of keen discussion by members it may not, however, be out of place to rest a short half hour in listening to my wondrous tale of antiquity from the banks of tho Nile and from tho days of yore. Incredu- lity may turn its nose skywai'd at my recital; skepticism may disdainfully curl its uj)per lip at my simple story; scorn may point at me its long, gaunt finger ; ignorance with accustomed effrontery may hiss out its impotent impertinences, but, I am sure, the expe- rienced, wise, practical and tolerant n.embers of this Association — to whom I cling with fraternal affection — will accord to the translator that due meed of praise which justly belongs to inde- fatigable labor, scholastic endowment and truthful narration. Let me here parenthetically say, I am not the arclucologist whose praises I am modestly sounding in this connection. Now, to ray story, which you will agree with me is more wonderful than "The Arabian Nights Entertainments," or is that of the sleeping youths of Ephesus. It is not apocryphal, nor mythical, nor a vision of the night, but was doubtless a verity in tho history of the early Egyptians. A few years ago Ilameses I and llamesea II were exhumed from their sarcophagi in the home of their fathers. The latter is said to have been the gentleman who endeavored to make expert brick manufacturers out of the male population of tho Israelites, ♦ Read at the forty-third annual meeting of the Association of Medical Superin- tendents of American Institutions for tho Insane, held at Newport, B. I., June 18-20.1889. ^ . J!.. } If !(■■ I .s*:^.'- '^ \ 1 .1 '> 2 who were merely visiting the semi-uquatic Kgypt. It was a mean advantage tliat was taken of" these vagrant desceiulanta of- Abraham, and showed a sad viohition of the laws of hospitality. After nearly four thousand years have passed the dila|)idated, swathed, perfiimed and slirivelled corpora of these Pharaohs have been shovelled up and made to do duty as curiosities to be stared at by the i(/nobiIe ijuh/its of A. D. 1889. These task-masters refused clay to the brick-makers, but time has had its revenges, and now their own clay is doing service as anti(pie specimens of humanity. The first Raniescs met with an accident to his skull — if the exhumers of His majesty are to be believed. Sections of his parietal and frontal bones on the left side were cleft in twain. The lethal weapon may have been a tomahawk, a battle axe, a Highland claymore, or a dragoon sabri'. Possibly some of the ancestors of the (Jvieen of Sheba had something to do with caus- ing this savage indentation in the head of Pharaoh. They were neighbors, and like some such, were far from being as friendly as adjacent nations should l)e. Tiie records say that the king was not doomed to make his exit at once from this terrestrial ball, but that this slight unpleasantness in his head caused such outbursts of monarchical n)ania as to necessitate his being sent to a temple for safe-keeping. It is very probable that the Pyramids were intended as hospitals for the insar.e of this noted dynasty, and that the chambers in their deepest recesses were made dense and dark to keep out lunar influences. Of course empty sarcophagi were placed in these reception rooms to warn these royal maniacs that they were mortal, and to show them where they must shortly lie, if they did not behave themselves in their tantrums. When Rameses I died in due season, his notorious son gathered up all asylum reports of all the land, written on papyrus in various languages, of which the Aryan, Cuneiform, Chaldaic, and Coptic were the most frequently used. It seems they would have nothing to do with Hebrew after the Red Sea episode, which seemed to create national disgust at the Israelitish emigrants and their language. The mummy of the defunct monarch was found wrapped in these interesting asylum records, as they seemed to be of no general use in those apostate days, any more than they are now, except to supply wrapping or powder paper for the medical practitioner or grocer in some sequestered village or rural hamlet. This wastefulness and carelessness in the use of invaluable docu- ments, upon which busy brains had expended much time, great mental energy and exuberant verbal offshoots indigenous to that 3 us a mean •laiita of- wpitality. apidated, Lolis lijivo X' stared v-mastcrs ■a, Americanus and Canadensis. It will bo noticed how similar are the names of these three divisions to those now in use. We are miserable imitators after all, and monkey-like (vide Darwin) show the copying propetisity of cnir (puidrumanous ancestors. These countries were situated by the Great Sea, the Red Sea and on both sides of the Sacred River. They were full of insane people and divers kinds of mentally defective. The papyric manuscripts show than on an average one was tlus iiicapal)le for every 450 jjersoiis of the hundreds of millions of its inhabitants. This is a startling state- ment to make to our sane and level-headed race. Were we in such a deplorable condition as this indicates, our panic-stricken cry would be "Who then can be saved?" The translator further says, that the writers of these ancient reports show in their productions a diversity of style, opinions, speculations and idiosyn- crasies which are in striking contrast to the unanimity of to-day. This shows how ranch our civilization has led to mental uniformity and stagnant concord in comparison to these independent thinkers, many of whom degenerated into hobby-riders and cranks, who ■were both disputatious and childishly dogmatic for such a logical age. It is only fair to say on the other hand, that these Egyptian superintendents were thorough, radical, energetic and industrious in their work. These prehistoric fragments give evidence of men of executive ability of no mean order. Such ■were not merely medicine men. They not only gave varied nostrums in comparison to which the witches' broth, immortalized in Macbeth, would be a delectable dish, but they had also to see to it when beef-steak was done to a turn ; when a mess of pottage ■was boiled enoucfh; how much water normally belonged to milk, and how much came from the cisterns or Father Nile; why the bread made from flour of excellent ■wheat, such as Joseph and his brethren raised, and that without being winter-killed, had more i: speciHc gravity Mild less porosity tliaii was good lordigt-stioii ; why Boston baked benns and pork, })iiiiipkin pic, com cake, biickwlieut pancakes, cii»tartrife a}j;ain>t lhes«' plajfucs of Kj^ypt. |{y a sort of dial)olie sMceession Ihise seoiU'L^es art' not yet Htaye(l, which have slioweil a robust vitality unparalleled in liistory. In tlie time of IJameses IT a medical system spranj^ into exist- ence bised on strictly scieniiiii) principles. It was founded by a ))liilosopher of n pute. lie asserted with a t^ood deal of emphasis that all diseases weri' coiui'.iered in an absolute manner by specitio ntnedies. This law of exactitude raised the :irt of the practice of medicine at once into the liiijh plane of ^eiencl■ aiitl if adopted ])iit an end to hypothesis and empiricism. One of the test.s to ^•rove this now doctrine was the capacity <»r power of certain medical au;eiits to produce in a healthy body certain unfiiling eij^nsand symptoms analogous to tliose generated in varied diseases. It was found that when such were assorted and classified in a sort of paralleli>m each medieval agent was the true lemetly for tliose jtathological condiiions thus associated. Herein was a great law enunciated from which there could be no .appeal, ft was formu- lated in the (Vicixuu '^ slut ilia siini/iOna curd/itur.'" Not only so, but it was asserted with a good deal of dogmatism that tho jjotency of remedies was iiiteusilied in proportion to their attenua- tion : the more divided, the more effective, and so on y ii suit of n|ioslolic' siiccLSHiui) a:i inrniitosiiiial rctniiaiit rcniaiiiK in that land of iniiiiiiiiics and crocodiU'S to this day. 'IMn-y liavo lakt n I'or a crest a sareo|>hai;UH with a iiiuiniiiy raiii- jtant in it. The niotto is end)la/;uned on the dusty casket in let- ters so iiioniiiU'iit as to bo easily read all down the aujes Nit (leftperdtidinn. The founder (d' this uiinute system had u jjood deal to <1() with the insane, hence these leniaiks are i;ertiiane to the sidiject matter. It is worthy of note here that some p;reat military man in one of the provincoH had made a tliscoveiy in iindint; :i uni({ue cure for insanity. It consisted in putting the atHicted under blue <;lass. ^\s miyht be expected a learned discussion at once arose as to tho varied eflects on the human body (d" eh; mical, thermal and actinic, solar rays and especially upon nerve tissue. Speculation ran rifo over tliis strange doctrine of thera|'.(Ulics and it is worthy of nolo that few of the learned psychologists of that age raised a doubt as to its elllcacy. Ily a sort of law of selection those alllicted with the '• blues" were |»ut into and cured in blue rooms. Those having mania were struck dumb and mentally ]»aralyzed at the surrouiul- ing blueness. Blue glass did wonders, while the blue sky of nature liad in a sense " to pale its iiieillctual lires.'' This sond)re color acted as a sedative, a so|>oiilicj a tonic and jiossibly a cathartic. l'seudo-j)hilosopliers wrote learned treatises on the wonderfid etlect of this occult color. Such did not dogmatically assert that tho iiumar ova were roused to unusual activity under its influence but they gravely asserted that tho egg of another of the species biped felt its vivifying agency and the potential chicken becanu' an actuality lying on the kitchen table while being made leady to consist of the duality of ham and eggs. Even the rice, the lotus, the sacred cat, the Holy Hull and the lethargic crocodile felt its diffusible stimulation; so saith these authentic records. It might be well for our ai rrilxins wiTo liijjlily rwomriiciKlcMl a:* a eurc fi)r rnaiiia. Tlicy wcro |ir('scril)(' ifohiii!^ iiflerovaiio«'(!oiit notoriety anioiiLC ll'i' li/Hohlc I'lthins. In this •bailie priticipiility manuscripts were T'liuiil written in ('oplie, wlii<'Ii dedareil that a ineiliea! savant had lelvcd into an investigation of the ultimate elements of nature. He was as familiar with the |iiimitive atoms and moleenles of mat- ter a^ they elu-l Ted toLretlier Ity natural scdectioii as he was with the uiemlicrs (d' his own family. Me knew their sha|i(', whether f^ijuarc, spheroidal, oldate or t riai);.;iilar. He k:iew their t^roup- inuis, ndations, ailinitiex, Ipidiavior, mishohavior, espeeially in a suhtle Itody called the ethyl series a ditru-iihle stimulant which was then mncli used as a mediciiie. Ivuowinjj; so well its secrt't history lie warned his 8<'ii.'iitiHc and meiliciil hrethreii of thu had effects of this mis('liief-mak(r on livinic tissue, especially hriin siihstance. As Copernicus, jJruno, Keph'i' and (Jalileo had watched with eai^or interest the plaiietarj' systems as they made the grand march in "a wihleniesis of harmony," so had he similarly tr.iced those atoms and molecules of ethyl pirates as they raided in their devastatiiig ccurse th.'outi'h intervascular and intircellular spuH's, along nerve lihns, on the paricties of nerve cells or in the sangiiineous streams of life. The proofs of his theory were fouii'^ in the death rates and recoveries. He could make these Huctuate upwards aiilies sarcastically to the ignorance ancj verdancy of the questioner, and showed with lofty scorn that he despised these premises of the syllogisni. He dealt only with the intuit ions wMch suggested conclusions of d priori order. As an exam))le oc this Jovine j)Ower he did not hesitate to calculate among his reco 'ories the so-called " improved " patients, a classification which might meanmuch or nothing — so that by this latitudinarian grou|)ing he might be able to establish a verdict against the indicted ethyl atoms and molecules. In justice to this theorist it should be said that the days of logic had not yet I I't: r>4 8 dawned and tlio Aloxandnaii library was only " in tlic o^ood tinio comint'j." It must always bo renu'mbored that some oriijinal thinkers .ire ahead of tneir asj^e in rteondite discovery, and it ill becomes limited and lazy intelleels to throw ri licnle, sarcasm and cuttinpf irony at the heads of those who arc thirsting for and should receive posthumous if not antehunjous fame and immor- tality. The ijraphic di'scription i^iven of the life and death coiitliet between a molecule of alcohol and a molecule of lu-rve tissue wouhl make the fortune of a modern novelist or of a t ranseendenlal and fleshly i)oet. The alcohol monad seizes — speakini; after the manner of ordinary mortals — the nerve unit by the throat. The unit is plucky and takes as its motto: "No surrender.'" The assailant is as jicrlinaeions as a bulldouf ami as aij'jjressive as a Cainida thistle. The defender of the citadel of life forlirtes every part with en jx rpctiut. \\ the same time it is an interesting study to see in these records the psychological work- ings of our revered brethrei, at this early ej)ocli in the history of our race. This one illustration shows hotv aj)t they were to theorize on insutficient data. They conM perform clever acts of jugglery ■with tigures, tal-les aniion in a room, or a sedative, restraint V If so, then is not a locked bed- room, a secured ward, or a high wall also restraint ? Is not a lunatic restrained in a sense wln'u he is curljcil from hiiving his own sweet will to the same extent as have the sane V As usunl this shorter catechism, with all the reasons annexed, f'.;rbidden and required, showed inquisiliveness more about adiiinilion thae about a fact. The war went on over this matter of misundert landing, not to say misconstruction, until the mighty nation was quenched in eternal night, and the burning question is not yet solved. The lialr-splitting tendeiuy over petty and unimportant details seems to be inherent in the human race, and the old silliness of calling a weakly sentiment a princlj)le has had much vitality, it is ever thus. At tlie same time and between the same combatants the question of healthfulness in relation to work by the insane cropped up to the surface. Was it good for all classes of the insane to labor? Should the auiiimic work or rest ? Should all work who may desire to do so, whether physically sick or well .- Does work increase the morbid activity of the maniac and intensify it through increased physical exhaustion, or doe.> it work along physiological lines and in the end lend to S(joth his frenzy and tone up his sys- tem ? What is work? Is it empU)yment which is intelligent and useful or is it oidy an aimless and automatic ?xertion ? Is -carry- ing stones from one pile to another and vice versa work, or can this term be applied to walking tournaments up and down the ward ? Some asylum statisticians were accused of including these excesses under the head of work. They were also wickedly charged wilh calling an hour's work or even the vulgar fraction of an hour as equivalent to a day's work. These insinuations were so monstrous 11 I (|iit'Htion. II oi'horod- '/.sv;/ of tho (■iH'iatioiis cDiioiiiy as iiit, to put classi'S by lie here cxliaustefl place over i»nmi(lrmu restraint ? ii«iioii ill a •ckeil bed- Is not a li.fviug his As iisinl ;i.1deii ami (liai! about It laudinj^, 1 (ji'.ouched ved. Tiio ails seems F calling a it is over latants tho 10 cropped I insane to work A'ho )oe8 work it through 'siological |) his sys- liij;ent and Is 'iarry- )r can tliis ho ward ? excesses rged witli in hour as nonstrous that they looked like the spleen fif envious C()-l'il)orers rather than the statements of tiibular faets. \Ve Pharisees can thank (lod wo are not like those miserable sinners in hiding facts by playing upon words. In this eoiiMeetion, il, may not bo out of place to note that the IJegister (reneral of Wiiniesi's II was instructed by tho potentate to give him comjiarativo evidence of the value of tho work of tho various medical savants in charge of t' asylums. lie set to work with great care and circumspection, as, in those diys, did his Avork not prove satisfactory to this autocrat, where juries, /I'lltntx (ujrpus and the />iU of vhjhtx wcio unknown, ho wcuild liavo been minus his head some doleful day and not even have the pleasure of being mummified. His first difliculty arose in endeavoring to compare tiie death rates in Memphis, Thebes, Zoan or Regiopolis. Tiiey varied very miirh and ranged from thi'oa to fifteen ^^('/wvv^Y. Were lie to test the medical skill of Drs. Efiendi, Ik'ii Alimoud, Ayoub and Bey Ahmed by the mortuiry list, then would tho most renowned of this medical (piartette sutler in reputation. Some asylums were in malarial districts and hotbeds of fever; some were supplied with tlie physical oft'-seourings of jiestiferous, filthy and degenerate human swarms of crowde as tlicy low ye tlie trumpet blow." Dr. Kflendi questions such methods and eschews them as he would Dlabolus of sulphurous fame, as being of that kind which " Lead to bewilder and dazzle to blind." Dr. Hen Alimoud, of Memphis, is ot nnother ty])e of inan. Ho is sanguine, impetuous and of that go-alieaditive style so prevalent in those ancient <^ the asylum recoveries because such had not been fornndly discharged. At this early |)eiiod ethics were at a low ebb. To-day we do not indulge in such statistical cooking. In some parts of this great land of the Pliaraohs political feelings ran very high. It was often of red hot intensity which set up a wholesome ebullition ending very often in clariKciition. This was to be expected in any free country where discussion is necessary to open up and ventilate all sides of subjects affecting the weal or woe of a people. As is often the case in the bitterness of argu- 13 iiitof^rity I'lOIll |)llt- IK'IIC;' Ilia of r:i|iiil uiiilicr of cw of his hoii. His iK«'. lie ;ir iiis:iiio uriii intense was their fealty to their own friends that asylum oflicers, who were engaged purely in works of mercy, were obliged to vacite their charges as often as the respective par- ties in turn gained the ascen(hincy. These devoted men nught bo kind, capable, honest, earnest and apt workers in their self-denying hibois; they might even have spent the best years of their lives in the service without reproach, yet if they did not sound the party shibboleth, had not the accepted earmark or the brand O. K. burned by i)arty leaders into the occipito- frontalis muscle they were unceremoniously Imstled out of their beloved work to give way to — it might be — incompetent novices whose qualifications consisted of proficient stutnp oratory or cunning wire-pulling in " ways that were dark." To the credit of that great people this pernicious Bystem was not extensively ))racticed and existed largely above the great river aiul near the mountain of the Moon or more properly speaking the Lunar Mountains. In striking contrast to this degrailing system are tlie more just and universal methods of to-da^' found in the civil service. No political elements ever ^ ter into our selections. We would repudiate the insinuation with the scorn it would richly deserve. Loving kindness, capacity, enthusiasm in such work, aptitudes and professional skill always determine the appointments to asylum charges in this ninteenth century and in this Chri .'iidom. Herein are we wise beyond our revered ancestry, and the insane are gainers by this conservi.tive policy of adopting a standard of merit and fitness and not of political usefulness and subserviency. Our daily prayer should bo " We thank Thee our common Father on behalf of J* *" « : I i u the insane, tliat (his Christian age is free from tlie Ej^ypti.m doc- trinc aii<] practice of political deciioii ami reject ion irrcs|tective of worth and wisdom, ignorance and inconipetency, u iri'-pnlling and worm-crawling/' Another of the minor difhcnlties they had to contend against was the class of friends of many of the congenitally insane w!io were themselves on the borderland of meiitiil alienation. Tiio jiervonsness, the low inlellcc^liiality, the natural suspiciousness, the lack of ordinary judgment and discretion, the animal dognni- tism and the asymmetrical mental development in many such who came honestly by all these untoward charactL'ristics and were handica])ped thereby gave untold trouble to medical otHcers who of necessity came into daily intercourse with this cla^s. In fact so unreasonable and unreasoning were many such outside relatives that they gave to officers and attendants a sort of waking night- mare to se(! them approach. They were torments in the oft re})etitions of their (piestionings, opinions ami senseless importuni- ties. Clinics, wise sayings, hypothetical possibilities, and even posi- tive assertions were thrown away on these unfortunates, and with a patience which even Job might have envied these encores of daily occurrence were borne with exemplary e(]uanimity even by the most nervous or even irrascible of asylum chieftains. Xow-a- days that state of things does not exist. The inti'lleelual exalta- tion of our people forbids tin; assumption tlial such extra-mural classes exist of the stamp and standard I have described. Fortius exemption we might sing with vim and unction a 7c JJeum Lcntdamus. One or two of the Egyptian asylum reports com])lain bitterly of the press of that day. It is said sarcastically that there existed five classes of newsi)apers, viz.: the good, the indillerent, the bad, the very bad and the vile. The last three classes did all they could to bring public institutions into disrepute, however well coinlucted. The jieisonal spleen in some was diabolical ; in otlu is the motive was not so much " nialice aforethought " as the existence of a morbid sensatiomilisni in the readers who sought alter such pabu- lum, hence it j)aid to provide exirivagan/as. Molehills were magnified into mountains; tlu' delusions of the insane were taken as facts; the imagination of the anient reporter was drawn upon to such an extent as almost to bankrupt it. Medical officers and attendants were looked upon and described as hideons ogres and monsters of iniquity. Evidence which would be ruled out of any well constituted court was presented as damning testimony of mi 15 |tli,iii (loo pc'ctivo of iiUinj^ :iml tul njjjiiiiist iisano who lion. Tiio ifiousiicss, lill (loirillil- siicli wlio and were tliccrs wlio s. In fact le rt'lativi'S cin<^ niglit- in tl)e oft iniportuni- 1 oven posi- !, anil with 'es of daily en by the ). No\v-a- nal exalta- xtra-niural Korthig Tc Ihion atrocities. The eliief oflicer« were thus torniciitcd to such an extent by those vampires of society as would have excite