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I
()dMMISS10I
ON
LUNATIC ASYLUM
'•'-\.
,/t
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OF THE
PROVINCE OF QUEBEOn^
. ' ■ OF
Messrs. DUROCHER AND BOURGOUIN.
">..
1888
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COMMISSION
ON
LUNATIC ASYLUMS
OP THE PROVINCE OF QUEBEC
OF
Messes. DUEOCHER AND BOUEGOUIN.
To THE HONOBABLE A. E. ANGERS.
% Lieutenant-Governor of the
Province of Quebec,
May it please Your Honour.
"While admitting that the report of the Commission on Lunatic
Asylums, signed by the majority of the commissioners and submitted to
you, contains opinions generally which are in accordance with ours on
many subjects, and contains also a number of valuable documents and
interesting information, we, the undersigned, members of the Koyal
Commission, appointed and constituted on the 17th September 1887, under
an act passed in the 32nd year of Her Majesty's Reign, and intituled :
"An act respecting inquiries in public matters," to inquire into the difficul-
ties which had arisen in connection with lunatic astjlums and the putting into
Jorce of the statute respecting such asylums, on the real causes of such difficulties
and the means to be taken to put an end to them, ha'"'e the honour to submit
the following special report in consequence of our dissenting from tho
majority, on certain important points.
After having been sworn, the Commissioners spent the first days in
examining the reports of the visiting physicians, covering the past 12 years,
those of ^he inspectors of prisons and asylums, the correspondence between
the proprietors of the asylums nnd the Government, and, finally, the
reports of the medical boards appointed under the Asylums act of 1885.
The oxaminatiou of these numerous documents necessitated consi-
derable study and occupied several sittings of the Commission.
Provided with the information so obtained, we visited the nsylumS'
of the Province, commencing by lieauport, thmSt-.Teaude Dieu, St«Ferdi-
uand d'Halil'ax, Belmont and finishing with St«Beuoit Joseph Asylum, at
LoDgue-Pointe.
In order to facilitate the holding of so comprehensive an investigation,
the Commission deemed it expedient and advisable to have a notice
published in the knuling newspapers of Quebec and Montreal, asking the
public to make any complaints audsuggestionsto the Commission which
they might deem proper.
Several persons whose names we did not learn, sent ns several ano-
nymous complaints, containing serious charges of immorality against the
proprietors of Beauport asylum and against the principal ollicers of that
institution.
As the Commission was anxicus to ascertain the truth of these
charges, they took every possible means to discover it and gave every
opportunity of bringing forward evidence to throw light upon the-
charges. The persons themselves who were mentioned in these anony-
mous communications, were summoned to appear as witnesses before the
Commission. " The proprietors, officers, keepers and all those specified in
the notices from outsiders, the Government physicians and officers, the
Catholic and Protestant Chaplains, w^ere all called upon to give their
evidence freely and express their opinion respecting the asylums, th^
manner in which they were kept, the conduct of the officers, keepers,
proprietors, house physicians and finally respecting any matter which
might guide the Commission in their investigations and be of interest
to the public, as to the manner in which the insane and idiots are treated
in the various asylums of the Province.
During the interval betvA^een visits to the asylums and the exami-
nation of witnesses, the Commission continued to examine and study the
documents.
Finally, on the 28th February last, Doctors Duchesneau, Duro her and.
Lavoie, and Mr. N. H. Bourgoin, accompanied by a stenographer, Mr»
Boisvert, went to visit several asylums in the United States, namely :
■J}
the iJlizabeth Asylum, at Washinj^ton ; the Mount Hope Asyluco, at Bal-
timore ; two at Philadelphia ; three at New-York aud those of I'rovi*
deuce, Worcester, Uuca aud IJuiFalo. The Commisioners returned bytha-
Province of Ontario aud, on their way, visited the asylums of Loudon^
Toronto dud Kingbtou.
During these visits, wo obtained valuable information ns to thd
keeping' and management of these asylums and brought back a quantity
of books and reports which have been of groat use to us, have placed na
in a position to appreciate the value of our asylums and have served to
show us the improvements which might be made in them.
It is an agroable duty for us to express our thanks to all the officers
of these various asylums, without exception, for the kind and polite-
manner with which they always received us and the willingness with,
which they gave the iul'ormatiou and reports we at^ked of them, Thisi
cordial reception was extended to us everywhere, iu the United States asjv
in the sister Province.
We will now, at once, enter fully into the question to be studied^
following the programme traced out for us.
I. What are the causes op the difficulties which have atmsen'
BETWEEN THE OOVERNMBNT AND THE PROPRIETORS OF THfi
ASYLUMS.
Answer. The chief cause of the present difficulties ii. the act of ISS*
(48 Vict., chap, 34).
As soon as the bill was laid before the Legislature, the proprietors ;
of the asylums at once protested, declaring to the goverumeut of the day
that their contracts would be infringed upon ; that new obligitious were
sought to be imposed on them, etc. They have since continued to pro-
test and have adhered to their contracts.
We will state further on, iu the following replies, whether thes^-
protests were founded or not.
Various circumstances brought about the passing of that act. If.'
will suffice to mention a few of the more important ones. We will not;
go back further than 1883, as, that year, the Government renewed the
Beauport contract for 10 years and consequently acknowledged that there-
were no difficulties such as we are instructed to inquire into.
I
Accusations which more rcBomblcd insinuations than precise or
definite chirgfs havo, lor some years, heen circulated amongst the public
flgainst the asylum.s. For instance, it has been said that the proprietors of
tlio asyhiras sought to make money, to spe<'ulate on the unfortunate, by
keeping in their establishments persons who wore cured or by admitting
Dane people. Tiie charge so brought was exceedingly malicious
towards the proprietors of the asylums.
We may add that it was unfounded, for the proprietors had no
right to dis(harg(X patients. The Government had an olfiecr, entirely
independent ol the proprietors, who alouc could admit or discharge the
patients.
That officer had all thft responsability of admissions and discharges,
and it was uniair for certain newspapers to seek by insinuations to place
that responsibility on other shoulders. If there had been any abuse in
this respect, the public should have blamed the Governm(*ut officials and
no one else. Has there really been any abuse '{ We have been, unable to
find any. The Rose Lynam matter made a great noise and after a law'suit
to which the papers gave great importance and publicity, that person
was handed over by the court to the care of a specially selected guar-
dian. But the report of the expert appointed by the court, Dr Vallee. did
not declare her to be sane. Ho merely expret-sed the opinion
that she <'ould be cared for outside of an asylum and the judgment was
based on that report. It is a publicly known fact that after having libe-
rated, Rose Lynam escaped from the control of her guarditai and com-
mitted acts of excentricity which in the end again rendered judicial
intervention necessary.
Consequently, it is hard to say whether there was any abuse in that
case. The opinions of the doctors who examined Rose Lynam, were
greatly divided. The physician of the proprietors of St Jean do Dieu
was of opinion that she was not insane, the Government physician, Dr
Howard, was of a contrary opinion.
This diversity of opinion continued before the court amongst the
other iihysicians who were examined.
tn any case, every one will admit that the Lynara matter could
not serve as a foundation for the charges against the St Jean de Bieu
asylum, as was afterwards attempted.
Some time afterwards, in 181^4, an English specialist, Dr Tuke, visited
the asylums of this Province and made a report which created a eensa-
I
tion. The English newspapers of Quebec and Montreal, especially,
seemed to endorse all that thiu phyaiciau had said aud took pleasure in
repeating his iusiuuatious.
Dr Tuke came from a country whore the systom of farming out does
not exist, and from tho only «;ouutry iu the world where the non-res-
traint system is generally adopted. Considering that the latest improve-
ment ot contemporary science on the treatment of the insane, lies ia
the Kuglish system, he could not find to his tuiste asylums on a different
system.
l)r Tuke's report is well-known ; it was the subject of a remarkable
criticism from the pen of Dr J. C Tache, of Ottawa,
Until Dr Tuke's visit, the physicians charged by the government
with the supervision of the asylums do not appear to have asked fur any
change or made any complaint ; but then, as il'hrf were afraid of beiujj
held responsible, Dr Howard commenced to make suggestions in connec-
tion with St Jean de Dieu, and to ask for more powers as regards res-
traint and in other respects. It was this same Dr Howard, however,
who had instituted, applied and approved restraint. At the same time
the English papers in Montreal published articles against the farming out
system. It is strange that St-Jean de Dieu should have been the object of
all these insinuations aud accusations And yet it must be admitted that
this is the best kept of all our asylums. How is it, that IJeauport, which
was at that time, the largest establishment, should have been overlooked
and that nearly all the remarks should have been made about St-Jeau.
de Dieu.
For many years, the. Protostants of Montreal or a certain nnrnborof
them, have been desirous of having an asylum for tlie insane of th>'ir
religion, and they are right. Until lately their ellbrts have been un.suo-
cessiul notwithstanding the repeated appeal o£ the newspap.Ts of their
belief.
Did any one]|consider that it was necessary to cry out against St-
Jean de Dieu, iu order to get more subscriptions ? Wo regret to state
that these appeals to Protestant capitalists were sometimes accompanied
by unlbuuded accusations, as, for instance, when it was said that the
Protestant insane were not properly treated, aud l)y criticisms fouudedon
theories alone, such as absolute coudemuatiou of the fanning out system
and even by insinuations, like those above mentioued, that the proprie-
tors of asylums had a right to detain patients who wore cured, which
was not the case.
Th« estahlishmeut of an ftsylum for th© Prot»»«tant insane is a desir-
Able objt'ct, which may be eHected by praiseworthy means and by truth-
ful !i)>in'al8. "We are happy to see that the idea is about to be realized.
M will prevent many recriminations and remove many difftculties, "We
will only refer casually to some other charges, such as the following:
that the Sisters of St-Jean d«» Dieu detained patients eveu after they
"Were discharijed ; that they had their board paid to them; that they
j'detained children of female patients born after the admission of inch
patients and charged their board to the Government ; that they gave
ispoiled pork to patients, etc., etc., because there never was the slightest
louiidatiou for these charges.
Dr Ferreault has stated, in his evidence, that sometimes his pre-
.scriptions could not be carried out. Although we asked him to do so, he
f'ould not give the circumstances, time, name of the persons, etc,, in cen-
ivectiou with these statements.
"We questioned the Sisters ; we examined the prescription book ; wo
iSpeciiiUy questioned the sister in charge of the dispensary and after this
iuvestigatiun we cannot say that Dr Ferreault's statement is proved.
The public agitation which we have mentioned probably led the
Crovernment of 1885 to get the Act, 48 Vict., chap. 84, passed, which is
the <hief cause of the difficulty which still exists between the Govem-
inont and the proprietors of the asylums.
2. Does the act op 1885 exceed the biohts which the Governj
ment acquired in the asylums, bycontbact?
Answer — ^Yes.
The Commission obtained, on this point, the opinion of two eminent
.advocates of t^uebec, Messrs .Tacques Malouiu and C. B. Langlois. The
proprietors of the asylums had themselves consulted several eminent
legal authorities.
It is evident that the act of 1885 has exceeded the rights which
4he Government had acquired under the contracts.
It is evident that, in an agreement, a party cannot be called upon to
perform more than he has agreed to or to accept changes which he has
not contemplated and which have not been provided for.
The pioprittors of asylums objected to the act of 1885 chiefly on two
a desir-
y trwth-
r»»alized.
t's. "We
lowing:
;er they
hat they
of auch
ey gave
slightest
his pre-
do so, he
, in con-
5ok ; we
ifter this
ved.
led the
which is
GoTern-
GovernJ
eminent
is. The
emiueut
its which
id upon to
h he has
ly on two
important points. They say that tho law takes away the treatment from
them ; that the troatmont in au iiiHano asylum compriaes everything or
nearly everything relating to the administration. There cannot be a
separate control over the treatment and another over the administration,
which would mean having two heads lor one body, These two things
cannot be done independently one from the other. The selection of phy-
sicians which the law leaves to the Government, is another source of
complaint, for under the contract, this selection rests with the proprie-
tors. The legal opinions are iu favour of the latter and say that the act
is wrong.
The act 48 Vict., chap. 84, by section 65, gives a recourse to the
asylum proprietors, in the event of the carrying out of the law giving
them occasion to make a claim. This clause could not redeem the act iu
the eyes of the proprietors because, although the article does apply in the
case of changes in the buildings where a special account may be kept, it
is quite impossible to apply it to the thousands o^ details of the treat-
ment, viz : the food, clothing, exercise, labour, re<<^ime, etc., etc. In
order to avoid extravagant expense, all this has to be managed on a well
'Organized system with all the economy consistent with the required
efficiency. But no system can work well if a stranger has the power
from time to time and of his own accord, to suspend or hinder its
working.
The Government is not without guarantees. It may and should
■^exercise all the necessary supervision to ensure the proper observance of
the contract, to see that the patients are properly treated and cared for in
every respect. It may, if necessary, perfect and increase this surper-
vision to make it as detailed as possible.
This right, if properly exercised, should be quite sufficient.
■3. WHAT IS THE OPINION OF THE BELTGIOUS AUTHORITIES BESFEOTINa
Tilld LAW ?
Ansiver. This opinion was publicly expressed at the electoral dis-
cussion of the law in the Autumn of 1886. It does not appear to have
altered since. We will pay no more on this point, merely referring to
the letter* of the bishops who were good enough to reply to our
•questions. Their opinion may be resumed as follows : " This law should,
not he applied."
.8
4. HAS THIS LAW BEEN PUT IN OPERATION ?
Ansvjer. No. The first six sections which contained the important"-
changes to the previous laws have not been applied. They conld not
be because they are the sections which the legal advisers condemn as-
violating the contracts. The medical boards of Saint-Jean-de-Dieu and
Beauport have been uselessly organized, in this sense that the six
physicians who compose them, have merely performed the duties of
the two former visiting physicians. Like the latter, they have only had
to see that the contracts are observed and to sanction the admissions and.
discharges. The asylum proprietors have adhered to their contracts in
accordance with their protests before and after the act. Tlie Proviiice ha$
therefore since 1885 had to pat/, unnecessarily or almost unnecessarily^ six ol/iciab
instead of tivo.
We think that one competent physician in each asylum is sufficient
to see that the stipulations are complied with and to sanction the
admissions and discharges. This officer might have an assistant if.'
necessary.
6. HOW ARE THESE ASYLUMS KEPT?
A. Are they on ':» efficient footing ? B. Are they kept in as satisfactory manner
as can be expected in view of the price paid to the proprietors for each
patient ?
Answer. "We have three lunatic asylums under contract, viz : Beau-
port, Saint-Ferdinand-d'Halifax and Saiut-Jean-de-Dieu.
The following is the result of our observations :
BEAUPORT
The members of the Commission visited the Beauport asylum im
October last (188t).
This asylum consists of two main buildings ; the principal one-
contains the lodgings and offices of the managing officials and the female
patients ; the other is for the male patients.
These buildings, which have been built and enlarged at various
periods, according to the requirements or number of patients, are far
from having all the accommodations and conveniences of modern asylums
built on a plan adapted to the object for which they are intended. The
iirst thing that strikes one is the over-crowding and the too limited^,
space for the number of patients the asylum contains.
W
9
The number of keepers seemed to us to be insufficient and they are
not paid a reasonable remuneration. Moreover, it appears from the
evidence adduced, that these keepers are not constantly at their posts,
being called upon by the proprietors to do work foreign to their duties
as keepers. The result of this is that the supervision is insufficient both
by day and by night, and many accidents happen. This defective
supervision is also the cause of several things occurring which are con-
trary to morality,
Ventilation is imperfect and there is always a bad emell in many
of the wards. The closets and baths are in bad order ; in a word, the
state of cleanliness is not what it should be, especially in the men's
department. Some wards are defective and the cells should be im-
proved.
The food is insufficient and not varied enough ; it is also defective
in qualify. The meals are eaten too hurriedly and here again the super-
vision is insufficient. The result is that some patients have not suffi-
cient time to take their meals. It would be therefore desirable, in their
interest, to have more dining-rooms. These are not suitable, especially
the men's, which is iu the basement, badly lighted and not at all
finished.
Beau-
"u
The clothing is insufficient, especially in "Winter, and it is not
cleanly enough. Restraint is sometimes abused of. It should be
exclusively controlled by the physician.
The chapel is too small and is inadequate for the establishment.
This is also the opinion of the chaplain himself The medical service
is inadequate and almost ttil, because one physician has not time enough
to do all the work which falls on him and which would keep three
physicians occupied. The present incumbent, notwithstanding his will-
ingness, cannot do all the work.
We are also of opinion that there is no unity of action in the
exercise of authority iu this asylum. While admitting that the pro-
prietors have made some improvements necessary for the comfort and
safety of the patients, we think that this asylum might be better kept,
considering the price it receives from the Government for each patient.
Moreover, all these desirable improvements should have been asked for
by the
contracts.
rious Governments which had the right to do so under the
We mentioned above that some things had occurred which were
10
contrary to morality. After a minute investigation we must say, iu
justice to the warden, the proprietors and the principal officers of the
asylum, that they cannot be personally blamed in this respect.
SAINT FERDINAND-D'HALIFAX
After Beauport, we visited the asylum of Saint- Ferdinand-d'HalifaX,
in the county of Megantic, about twenty miles from any railway com-
xnunicatiou.
This asylum is intended only for female idiots and at the time of
our visit, thore were 84. Some of them should not be there because,
properly speaking, they cannot be said to be really idiots. This asylum
can contain from 50 to 60 patients, It is over-crowded and has no
system of ventilation. The cells are narrow, badly lighted and are only
four and a half feet by seven.
We are surprised that the Montreal Medical Board should have
made such high-ilown reports about this asylum, which is the least
suitable in the Province. "We noticed nothing reprehensible la the
manner iu which the patients are kept.
BELMONT.
"We also visited the Belmont asylum, situated a few miles from
Quebec.
It is a private asylum intended especially for ini-brintos. It occupies
a splendid site, but the building is old. Jlowevfr, with some improve-
ments it might be made to contain a i!;v^'-,\t many patients, about a
hundred. There are also some insane patients iu it.
saintbenoit-josi:ph.
After Belmont, we visited the Saint-Benoit-.Toscph asylum, k'^pt by
the Freres de In Cluirite at Lougue Poiure and situated a short distance
from the Saiut-Jean-de-Dieu asylum. Only private patients are admitted.
The buildings are new and jp^endid, The manner in which the
asylum is kept and the discipline leave nothing to be desired.
It can accommodate about 150 patients.
■W3
11
t say, in
3 of the
SAINT-.IEAN-DE-DIEU.
'Halifax,
ay corn-
time of
because,
asylum
L has no
are only
lid have
he least
ia the
les from
occupies
mprove"
about a
ic'^pt by
distance
Imitted.
tch the
"We made a minute inspection of this asylum and spared no pains
to ascertain how it is kept in every respect.
It is the best kept of all oiir asylums, although it has been the
object of more accusations than any other.
It is well situated and surrounded by extensive farms. Althouo-h
built of brick, it has an imj^osing appearance.
An avenue bordered by several rows of trees, leads up to the build-
ings which are nearly half a mile from the main road.
The asylum of Saint-Jean-de-Dieu is unexcelled as regards order
and cleanliness.
"We will say, furthur on, what remains to be done in other respects
to make it equal to the best asylums in the United States.
This asylum commenced as a refuge for idiots in 18tS, Two years
afterwards, the Government obtained the right to send insane there for
the same price as that paid for the idiots viz : $100,00 per head per
annum.
We found this asylum over-crowded like Beauport.
However, considering the amount paid it is oar duty to state that
the Government cannot exact more than it receives. We may even say
that, in many respects, the Sisters do more than they are obliged to do.
Wo noticed that great care is poid to ventilation which is generally
good throughout the wards of St .lean de Dieu. Tlv-i food is wholesome
and abundant ; the keepers are competent and paid a reasonable remu-
neration. They should wear a uniform which would increase their con-
trol over the patients (1).
The clothes supplied to the patients leave nothing to be desired in
any respect. The walls are covered with pictures and look quite gay.
(1) Since our inspection the keepers have been provided with a neat unirorm.
.12
The furniture, and bed clothes are most comfortable both as regard*
quantity and quality. All the beds are provided with improved spring;
mattresses.
There is a library for the patients, while a band and orchestra amuse
them during the long winter evenings. A special professor of music
has charge of this departement. There are also o'her games, such as,
dominoes, draughts, cards, bagatelle, &c. The reverend Sisters are also
in the habit of getting up musical and dramatic entertainments for tha
patients in a large hall set apart for the purpose.
In addition to ordinary inside and household work, there are sewing
rooms and shoemaker's shop, a forge, a bakery, an abattoir, a joiner's
shop, a laundry and a clothing room, in which a good many patients
are at work. In summer time a greater number are employed on the
farm.
The asylum is well lighted. The hot water apparatus for heating
the building, works very well and gives full satisfaction. The dispen-
sary is one of the finest and best supplied we have seen in America.
The store-rooms are full of provisions and there is no lack of dainties.
The supplies of clothes and blankets are the most complete of any
we have seen.
We must specially mention the chapel which surpasses in every res-
pect all those we have seen in any institution of the kind.
Two physicians devote all their time to treating the patients. Dr
Bourque, the head physician, performs his duties in the most competent
manner.
The proportion of cures, considering that this asylum admits idiots
as well as insane, is satisfactory ; we w^ould like, in view of the rapid
increase in the niamber of patients, to see the proprietors secure the
cervices of a third physician.
We are not quite in a position to recommend improvements in that
asylum, inasmuch as the proprietors already do more than they are obliged
to do in proportion to the small price paid to them. If, however, the
Provincecousiders that it can increase the amount allowed for the insane,
we express the opinion that the price given to St Jean de Dieu should be
raised, so as to enable the Sisters to make certain improvements which
they have in view, amongst others to improve their cells, which they
have already commenced to do, so as to coustantly keep up with the
progress of science.
We must admit that they have already, without being asked, made
constant changes and effected considerable improvements. It would be
unreasonable to ask for more, considering the slender resources at their
disposal.
By raising the price per head the Government would probably be
able to give the St .lean Dieu patients the services of another physician
and to have the number of keepers increased so as to allow of work 1 ing
organized on a larger scale, as for extensive industries for instance.
In order to remove existing prejudices, the Government might, in a
new contract, stipulate I'l ttthe physicians should have the control of the
pharmaceutical treatment and restraint and also of diet, in the infirmaries
and should alone decide what patients can and should work ; this, in fact,
is now done. It might also probably, be possible either to get the pro-
prietors of St Jean de Dieu to erect separate buildings for the violent
patients and for the idiots, or to separate, in the asylum itself, the curable
from the incurable. However, we must say that the opinion of special-
ists, all over the world, is greatly divided on that point. Some think
that the separation of the curable from the incurable has a good effect,
while others find that the mixing together of both classes, and even of
the idiots with the insane, produces a greater number of cures.
6. Should any changes be made which, while respectino vested
rights, would make the present system more effective and
oive fuller guarantees to the j't'hlic ?
Answer. — AVe have made a good many important suggestions \n
our preceding answers and we will now complete them with the follow-
ing remarks.
Reninrks on the admissions.
that
ged
the
sane,
d be
^hich
they
There are in the asylums a considerable number of persons who
ehould not be there, but who might have been left with their families or
placed in refuges for the aged. To what must this be attributed ? Is it
to ignorance or misinterpretation of the law, want of decision or of inde-
pendence on the part of the medical boards ?
Under the law as it stands, the medical board has absolute control
over the admissions, even when the patients are sent by the magistrates.
14
"We must therefore conclude that the Government officials have not
applied the law as thoy should have done. They must consequently
bear all the responsibility which it has been unjustly sought to throw
upon the proprietors of the asylums.
We have also observed that there are patients at Government
expense, whose relatives are able to pay their board. Such preference is
unfair and should disappear. Steps should be taken to prevent such
abuses in future and put a stop to those that already exist. The Govern-
ment officials should be made to do their duty with respect to the admis-
sions. If the law had been applied as it should have been, our asylums
would not be overcrowded, the harmless patients would not be so
numerous and w^uld not take the place of those who are entitled to
admission.
As regards admissions, there are two objects to be attained : 1. To
secure the prompt placing in the asylum of patients who are suffering
from the fire-t attacks of the disease, as this has an important effect upon
their cure ; 2. To admit only such idiots and demented persons as are
dangerous, epileptic, a source of scandal or deformed monsters.
Our law as it now stands is quite sufficient in this respect. It has-
only to be applied justly and strictly, paying no heed to the recrimina-
tions of relatives, to solicitations, to political or any other extraneous
iulluences whatsoever.
Remarks on disrfiarf^es.
The Government, through the medical boards, has exclusive control
over the discharges. The visiting physician also had such control. Con-
sequently in thiis also, if there has been any abuse, the public officials ar©
to be blamed and not the proprietors of the asylums.
"We are of opinion that a single physician for each asylum would,
be sufficient for supervision and in this respect, a saving can be effected.
But this physician should retain the absolute right of deciding upon the
discharges, either in consequence of cure, or of improvement or of other
reasons. However, we think that it would be advisable that such phy-
sician should have the opinion of the physician under whose treatment
the patient is and that such opinion should be entered in a book kept at
the asylum. As the latter physician would know the patient better
than any one else, his advice would be useful to the Government officer.
15
Organisation of the Medical Service.
In our opinion the followiug system should 1)fi adopted :
I. The resident physicians to be appointed hy the proprietors and
to be three iu number lor each of the asylums of Beauport and St. Jeau
de Dieu ;
II. The visiting physician tobeappointed by the Government andhave
alone the right to admit and discharge the patients. lie might appoint,
an assistant, if neces.-ary, with the approval of the Government. The
visiting physician should perform all the duties assigned to (he medical
board, with the exception of the treatment of the patients.
III. The inspectors of asylums to continue, with their present duties*
IV. We would further advise, as the crowning part of the system,
and in order to secure its more ellicient working and give fuller security
to the public, that a supervising committee be appointed, such as they
have in the United States, consisting of persons removed from political
influences and charges. The magistrates of the districts of Quebec and
Montreal, the recorders of the two cities, the batonnier-general of the
Bar, the president of tach Faculty of Medeciue selected by the Facility
itself, and the chaplains of the asylums might be ex qlficio members.
The committee should have fhe right of inquiring into the manner
in which the system works throughout all its details, receive complaints,
and make investigations when necessary, settle all dilficulties which
might arise and, in the event of failure to do so, report to the Govern-
ment. It might have a secretary selected from among the visiting
physicians. Its members would receive no remuneration but would be
allowed their travelling expenses. The committee would by by-law^
determine the date and place of its meetings.
Remarks respecting Private Patients.
The relatives of these patients ask nothing from the Government
and the latter does not assist them iu any way. In the regulations res-
pecting the admission and discharge of these patients, two things must
be borne in mind :
1. To prevent sane people from being placed or kept in the asylums ;
16
2. To protect, as far as possible, the rif^hts of the relatives and family
It is therefore necessary to take every reasonable precaution to prevent
abuses which may occur, but not to go beyond that. It if» necessary
that a Government officer should have the right to visit the private
asylums from time to time, to have access to the patients, to question
and examine them and order their discharge if he deems it advi-
sable. However, it is not at all necessary for that purpose that the
names of private patients be sent to the public departments and kept in
the Government recurds. In our opinion this is a useless exaction which
may hurt the feelings of the relatives.
If frequently happens that a young girl, a young mother, a young
man at the beginning of his career or a person of mature age occupying
a high social position, may be compelled by sudden illness to be placed
for some time under the care of the specialists in the asylums. Why
should this fact be made public, be recorded in the public archives ?
There is nothing to justify such a proceeding. An aiHicted father, a hus-
band, wounded in his tenderest aftectious, does not wish his disgrace to be
known and the future of tliose who are dear to him be irretrievably com-
promised, and he is right.
Let the public authority take measures to make sure that no sane
persons are confined in the asyhams but it is not necessary for that pur-
pose to know either the names or the relatives of the patients.
The inspectors of asylums should be charged with this particular
supervision over private patients ; it is within the scope of their functions
The powers of the visiting physician should be confined to seeing to the
execution of the contracts made for public patients.
Several private asylums maybe founded, other than those with which
the Government makes contracts — in fact there are some already — and in
these asylums ihe Government would not have the special officer called
the visiting ^ .ysician.
The inspectors of asylums are therefore, from the very nature and
extend of their duties, the. proper persons to perform that office. It
would also be a good thing to bind them under oaih not to reveal the
names of the patients or family secrets.
Remarks on the method of payment hij municipalities.
The precautions taken by the present law, with respect to the
11
amily
•event
essary
rivatc
estiou
advi-
at the
:ept iu
which
young
apying
placed
Why
hives ?
, a hus-
ce to be
ly com-
no sane
lat pur-
Irticular
nctions
to the
which
-and in.
called
lire and
i^ce. It
^eal the
to the
admission of public patients, soem to us to ba quite sufficient. Never*
theless, we would observe that the law requires the signature of the
tnayor of the locality in which the patient is domiciled. The object of
this is probably that the Government may have its recourse against
the municipality for one-half of the patients' maintenance. This clause
has given rise to various abuses.
In some cases, the mayors have refased, without reason, to sign the
certificate required by law ; in other cases the patients have been sent
inside the limits of an adjoining municipality or town and left at liberty
in the road or public streets. Then, when arrested by the police and
taken to the asylums, their domicile has remained unknown and the
Government has hud no recourse.
Would it not, then, be bettor, that the Government should have
recourse againt the county municipalities and the amount recoverable
be equally distributed among all the parishes of the county '{
Unfortunately, it often happens that the poorest parishes are those
which send the greatt^st number of patients to the asylums and this is
the cause of the fraud practised to evade the law and not have to pay.
We therefore think that by transferring the responsibility from
the parish to the county, these frauds would in a great measure, cease ;
the parishes would not complain so much about the charges and the
mayors would not refa-e to sign. On the other hand, the Government
would have greater facilities for recovering the amounts payable.
The Farming out Si/slem.
Although this subject is not, strictly speaking within the sphere of
the duties of the Commission, it is howver so intimately connected
with it and is of such inportance, that w^o have deem it our duty to
my a word about it.
The farming out system has its detraclros and it has its defenders.
I Its advantages and disadvantages have frequently been discussed and
weighed, but like all other questions of the kind it will never be settled.
Its solution depends upon the particular circumstances iu which the
various countries of the civilized world are placed.
We will therefore state facts and leave th« deductions, as far as
regards this Province, to be drawn for themselves.
18
Tho oslttblishmont and support of luuatic asylums have two fuuda*
mental objects : 1, To obtain the greatest number of cures po^hible, in cu-
rable cases ; 2. With r«'<j;ard to incurable cases, to give to the unlortunates,
whose seclusion is ne< ts^ary in the interests of public salt ly, jjroper
food and care, in vii \v, ;i.s much as possible of their former pnhition.
All unnecessary exp» uses and improvements, which are not likely to
attain these ends in a more ell'ective manner, may be considered useless.
The majority of the patients of the Province come from the poorer
classes. Those whose parents can ali'ord to pay, provide for themselves.
Now, it does not appear that exaggerated luxuryor princely comfort
have any effect on the number of cures amongst these patients. Th6
experiment has been tried in our day.
In some States of the American Union, whore money is plentiful, real
palaces have been built for the insane. They are very fine to look at,
not for the patients, the majority of whom are not ia a condition to do
BO, but for the visitors.
Nevertheless, these palaces do not, as regards cures, do one whit
more than other asylums, which are less wealthy and more modest.
This is shown by the following figures :
A II mini price ATornire of
ASYLUMS 1.1'r lu-iia cures
by hvud
188Y.— Buffalo Asylum $357.00 22.00
Elizabeth " at Washington. . 228.00 26 86
" Mount Hope " at Baltimore. 62.00
" Utica; N.-.Y " 212.00 18.87
« Worcester, Mass, Asylum 185.00 23.49
1886.— Blackwell's Island, N.-Y. Asylum 18.00
" Harrisburg Asylum 205.79 19.00
•• Dixmont " 212.51 3100
" Danville " 180.44 9.00
" Norristown " 198.89 15.00
" Warren " 190.69 13.00
" Friends " 698.00 22.00
" Pennsylvania Hospital for Insane. 509.60 19.00
«* Toronto Asylum 124,90 28.00
'• Loudon " 123 77 35.00
" Kingston " 124.40 20.00
« Hamilton " 131.31 27.00
" Saint-Jean de Dieu Asylum 100.00 82.62
*' Beauport Asylum 132.00 (10.50
19
)0
)0
)0
)0
)0
)0
r
)2
Ihose figures are taken from the last reports which have been sent ue.
Oiiv asylums compare favorably in this table with the asylums in
other countries. It sliould also \n\ obsfrvinl that, in Ontario and in tlie
United States, the idiots are placed in special asylums, while at Beauport
and St-Jean d«' Dieu there are a great many. As the idiots are incurable,
the result is that the statistics of cures, iu our asylums, are very
fttvorablo.
It is a singular thing that of the four Ontario asylums, that of Lou-
don, which is the least in accordance with the newest ideas of great com-
fort, is precisely that which, last year, gave the best results as regards
the number of cuies.
The Kingston asylum is the most perfect, Work is admirably orga-
nized. Some trades are carried on on a large scale by the patients and
yet, last year, the average of cures was very low, 20 percent.
It should also be observed that Mount Hope Asylum, Baltimore,
vrhere the average of cures is the highest, is a private asylum, kept by a
sisterhood of nuns. They take iu only curable patients and the j^rico
charged is very high.
By comparing the amount of annual cost, we must, in order to
thoroughly understand the matter, recollect that the Government has
nothing to expend in the wny of capital ou our asylums.
We should therefore add to the amount of annual expenditure on
the State asylums the amount of interest ou the capital invested, which
would bring up the figure to a larger amount and make the comparison
■till more favorable for our asylums.
The conclusion to be drawn from these statistics is that the system
followed in our Province, is much more economical and yields satisf\iO"
tory results on the score of cures.
The farming out system is followed in several European countries.
It is especially liked in Catholic countries, which have the advantage of
possessing religious communities and whose social condition.conscquently,
Tcssembles that of the Province ot Quebec. There are also some of thn
^^tates of the American Union, which have no public asylums, such, for
instance, as Vermont, Delaware and others, as well as some of the terri-
tories. The Brattleboro Asylum, which does not belong to the State,
receives all the iusauo from Vermout. This asylum has been in exis-
20
tence for fifty years mid hns b fii both nttackcd and praised.
etatisticB are us good an thf other aBylum» of the United States.
It!
What has happened here has been pretty mueh what has happened
in Vermont. In \S12, a joint committee of both IIouseM of that State was
appointed to study the question and report. Its opinion was unfa-
vorable. The discussion continued and in IHTti the Houses appointed
another joint committee to consider the same question. This committee
made an elaborate report which we cannot quote iu full, but wo give
the conclusiou :
" At this point, we may be pardoned for venturing an opinion upon
" the question of the propri«ty of ostabli.shing a State asylum. If one
•' were be erected, its capacity should undoul)tedly be equal to the ac-
** commodation of three hundred patients. According to the best author-
" ities, the expense for buildings, apparatus and appliances, at the lowest
'• estimate, would be. at the rate of one thousand dollars for each patient
** to be accommodated, making the cost, if authority and experience of
" other States are at all reliable, three hundred thousand dollars.
" The cost of (he asylums in Massachusotts, with one or two e^cep-
" tions, have been largely in excess of the above estimate,
" In view of those facts, we do not feel self-sacrificing enough to
" take upon ourselves the burden of attempting to secure the necessary
" appropriation for that purpose." — Annual of the Vermont Asijlim for the
•Insane, page 201.
The question was finally settled in favour of the farming out sys-
tem. The legislature merely increased the price paid for the patients, first
to $8.60 and then to $-).l5 a week, to enable thei)roprielorsof Brattleboro
to keep their institution on the same footing as otlier asylums.
In the Province of Quebec, .'it Si-.Tean de Dieu for instance, the
price paid is not proportionate to wliat is done for the patients. In other
countries, an asylum kept on that footing costs about double the amount,
considering of course the amount of capital invested. It is therefore not
reasonable to recriminate when the price is considen d. The capital iu-
vested at St-.Tean de Dieu is about one million dollars. If we deduct
the interest at 4 per cent on this capital, from the amount paid yearly
to the Sisters, there remains but $00.00 for each patient.
The Sisters have even paid six and seven per cent, on their debt,
which would still more reduce the amount paid for each patient. AYith*.
91
hiT
unt,
not
iu-
Uuct
ebt,
ithr
out tho amount thoy receive from privatfl patieuis, they could not have
4one what they luivo lor Ihi' public patients.
Wo nay w ithout fear of contradictiou, Hmt there In not a single
asylum among thom we have viHited, which can ho kopt on tho same
looting for the same amount. If wn want to exact more from the uuns,
it isbutjuHt to commence by giving them more.
If, however, the Trovince of Quebec should adopt the system of
State Asylums, it would have to invest a capital of two millions of
dollars and consequently to increase the already heavy amount voted for
the insane by au additional expense of about eighty thousand dollars
par annum.
Moreover, the expense per head would probably bo greater than it
now is, for experience has proved that a Government can never manage
as economically as private individuals. AVe may, therefore, say without
exaggeration, that the increase in expenditure would be about one hundred
and lifty and perhaps two hundred thousand dollars per annum, without
any appreciable beuetit for the insane.
We have had a striking example of this in the asylum of St-Johu
Dorchester, a State Asylum kept by the late l)r Howard. Each patient
cost $232.00, to say nothing of the repairs to the buildings and the inte*
rest on capital invested.
It is easy to understand why the Province put an end to this
system. It was an excellent reason for justifying the Government of
the day for having applied to a religious community.
Since we have the advantage of having large religious communities
in our midst, we need not be afraid of having recourse to them for the
relief of the unfortunate insane.
Now^ that our Proteslant triends are about to have au asylum of
their own, all dilliculties will be smoothed over and greater liberty will
be left in this respect to the Catholic majority.
The groat argument used against the farming out system is that the
proprietors are interested in doing the least they can in return for the
ftmount they get. Theorically this is true, but practically the argument
remains without force when the proprietors are a charitable community,
a community of women whose members come from the best of our
Canadian families and have consecrated their lives, ou» of love of God and
of their neighbour, to relieving the misery of their fellow-oreatures. Have
they not proved it and is it necessary to look around upon the wonders
^vhich surround us V AVe see the Sisterhood of Providence, with the
assistance of a very small grant, giving to about three hundred female
deaf-mutes the most complete and the highest education which these
unfortunates can acquire. We see the Brothers of St. Viateur doing the
same for the male deaf-mutes and the Grey Nuns for the blind. In other
countries these institutions would be supported by the Stnte at consider-
able expense.
Who takes care of the foundlings, the orphans, the aged and the
infirm? What remarkable deeds of thaiity are performed by the
a&ylums of the Sisters of Providence, of the (rroy Nuns, of the Sisters of
the Good Shepherd and of so many others, which are scattered about
everywhere ? What grants do they receive and have their zeal and
self-sacrifice slackened in any way for all that ?
Without seeking for examples outside the subject Avith which we
are now dealing, is not Saint-Jean-de-Dieu a convincing proof that the
Sisters are doing, not the least, but the utmost, that they can for the
price paid ? Does the Government not get even more than it has a right
to exact in proportion to the remuneration granted ?
We are bound, in all fairness, to state here that the Sisters of Saint-
Jean-de-Dieu keep twenty-five insane, on an average, gratuitously and
out of pure charity ; that, moreover, they give private rooms and better
accommodation than usual to about twenty-five public pa ients, without
receiving anything extra for it. The latter are persons who have belonged
to the liberal professions or have occupied a superior social position.
Keduced to poverty by the vicissitudes of fortune, a prey to mental
disease, they would suffer, in their lucid moments, if they found themselves
mixed up with the others. Tne Sisters ha, e not waited until requests
were made to show their compassion and to alleviate as much as possible
the misfortune of these poor people. One can readily understand that
such delicate attention and care and a thousand other similar things
have sometimes had a great effect upon the restoration of intell ctual
faculties.
It must not be thought that the State asylums, although the samft
theoretical argument may not 1)9 applied to them, are unassailabli! for
all that, and that they have not given rise to commissions of inquiry.
We have already observed that thty are expensive ; we will further
say that they may and do lend themselves to serious abuses as regards
morality. The same may be said, in this latter respect, of private
asylums under the charge of laymen. However, with a religious com-
munity, this dang'^r is almost entirely removed. In every ward, in
every department, there are religious or nuns, whose presence renders
materially impossible any offence against morality, either on the part of
the keepers or employees, or on the part of the superior officers connected
with the institution. Charges have been made against Beauport in this
respect. No one has ever dreamt of making auy against Saint-Jean-de-
Dieu or Saint-Ferdinaud-d'lIalifax.
)le
lat
Here is another very important consideration which we deem it our
duty to submit frankly and plainly. If the asylums belonged to the
Province, would we not see, as in other public departments, at each
change of Government, the replacing of all the employees who are
not permanent, such as keepers, nurses, &c.? Who, knowing our political
customs, can give a negative answer to this question ? Would even the
higher officers be safe from political vicissitudes ? There is nothing
more opposed to the proper administration of institutions like asylums,
than these periodical changes, this uncertainty as to the morrow. This
is an axiom which does not need demonstration. We do not wish to say
anything against appointments due to politics, but it must be admitted
that, in this respect as in many others, the State is a worse manager
than private individuals ; its selections are not generally as happy as
those made by the latter. Without going beyond the subject with whioh
we are now dealing, have we not S'^en a lumber merchant attain, at one
step, the high position of inspector of prisons and asylums ?
What a private individual can do with, two or three employees, the
State cannot do except with three or four, or perhaps more.
There would therefore be an increase of expenditure as the result
of frequent changes in the staff and of the incapacity of the new-comers.
And yet, in our opinion, the service would not be more efficient ; far
from it.
There are so many other institutions like the schools for deaf mutes
and the blind, the refuges for the age which are supported by public
charity and receive only nominal aid from the Government. Should we
not, while caring properly for the most infirm of our fellow-creatures,
those who are deprived of their reason, avoid incurring too heavy an
expenditure in order to allow the Government to grant suitable aid to
the various institutions whose mission is to relieve other infirmities ?
Do we not find, tor instance, in Montreal, that the number of schools is
entirely inadequate to the requirements of the population and that a
24
great many children can find no room in them ? Must we ignore all these
wants and think only of the insane which are the intirm by for the best
t eated by the State.
It is probable that even, at Beauport and at St. Ferdinand d'HalifaX
three fourths of the patients are better treated and better fed than they
were at home and have many more comforts than they had while with
their families. As regards comfort, food and care, their condition is as
good, if not better, than that of the majority of our population.
We, therefore, as the conclusion of this portion of our report, recom-
mend that the Government take measures to transfer the control of
Beauport Asylum to a religious community, securing the repayment by
annual instalments, or otherwise, of the amount which may be paid.
Amongst other weighty reasons in support of this conclusion, there
are the following ;
1. The Protestants have their asylum and there is no longer any fear
of clashing with religious beliefs ;
2. Since we leave, with confidi-nce, the education of our children,
boys and girls, to religious communities, colleges and convents, we are
equally right in confiding our sick to their care.
3. The members of our religious communites take the vow of cha-
rity and self-sacrifice, have no family to support, no position to aspire to,
they have no other object to fullfiU than to carry out the purposes of the
institution viz : charity, teaching, the care of the sick, etc, etc. What
difference between them and mercenary hands, howsoever devoted they
may be ! For the religious, the work is the object of his life, while he
who serves for pay performs the work as a means of acquiring a position,
of providing for the future.
4. So long as our population shall retain its Catholic feelings, it is
and shall be the duty of a Christian Government not to offend its beliefs
and inclinations, all the more so that the devotedness of our religious
bodies secures considerable economy and a greater safeguard as regards
morality.
6. Let us not imitate those European countries, which seek to secti-
larize every thing, education and charity ; which seek to replace the reli-
gious in asylums by hirelings, banish the Brothers and Sisters from
the schools, as well as every emblem of the faith of our fathers ; which
25
s
s
8
s«H'k, in finp, to replace Charitj' by Philantrophy. The miibrtunate
and the noor rociuire, not only bread, but also consolation to prevent their
robrlling- against their position and to pri'A'ent their letting hatred enter
thi'ir hearts and corrupt their good tseutiments. By this means great
social comniotious are avoided.
6. The Government has the right, under the contract entered into
"with the proprietors ol' Beauport to purchase that asylum I'or a sum to
be determined by experts. It would thereby do away with certain
clauses which have never received the ajiproval of the Legislature or
even of the Executive Conseil, amongst others the unjust clause which
forbids the transfer ofjiatients from one asylum to another and that
which establishes the minimum number of patients at 850 instead of 650.
GENERAL CONCLUSIONS.
I The cause of existing difFieuUies lies in the act of 1885, which
was brought about as the result of certain prejudices among the public.
II The act of 1885 exceeds the rights which the Government has
acquired in these asylums. Its important provisions have not been car-
ried out.
III Tht* asylum of St .Tean-do-Dieu is kept on a better footing than
could be expected in view of the price per head paid to the proprietors
($100 00).
Although the Beauport asylum has, strictly speaking, been kept
according to the letter of tht? contracts, it is nevertheless inferior to St.
Jeau-de-Uicu in many respects,
Con>ideTing the price paid, ($182 00), we cannot pay that the pro-
prietors of Bi'auport could not have improved their asylum to a more
considerable extent. But the various Governments have never availed
themselves of a clause in the contract which allowed them to insist upon
such improvements.
The asylum of St. Ferdinand d'IIalil\vx is small, overcrowded, badly
ventilated and too far from the centres of population and means of rapid
communication.
IV To resume, if the Province is in a position to increase the expen-
diture for the insane, we suggest :
26
1. To pay a higher rate to the Sisters of St. .Tean-de-Dieu in ordt r that
that asylum may, as regards comfort and modern improvements, become
and remain the equal of the best asylums iu America and that the nuas
may en arge their establishment ;
2. To place Beauport under the charge of a religious community,
taking the necessary steps to secure the repayment to the Goveruraeut
of the moneys expended for that purpose ;
8. To transfer the asylum for idiots at St. Ferdinand d'Halifax to
some place possessing easy means of communication such, for instance,
as Somerset, where the same Sisters already have a large establishment ;
4. We recommend that the six officers of the medical boards be
replaced by two visiting physicians or superintendents, since the law
which renders their appointment necessary, cannot be put into execution.
We think that the organization of a committee of supervision, com-
posed as we have above suggested, would have the effect of preventing
many difficulties from arising and of securing the more efficient working
of the whole system.
Finally, we recommend that the act of 1885, which has given rise
to all these difficulties, be at once repealed and that the old one, which
gave more satisfaction, be re-enacted, until the question has been pro-
perly studied and the amendments made which may be deemed necessarys
to improve and perfect the law on lunatic asylums.
The whole respectfully t^ubmitted,
LOUIS B. DUROCHER M I).
Commissioner
Quebec, .3rd July, 1888.
N. H. BOURGOIN.
Commissioner.