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Thoaa too larga to ba antiraly inciudad in ona axpoaura ara filmad baginning in tha uppar laft hand comar, iaft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrama iiiuatrata tha mathod: Laa cartaa, pianchaa, tableaux, ate., pauvant itra filmte i daa taux da rMuetion diffAranta. Loraqua la document aat trop grand pour *tra reproduit en un aeul ciicli*, 11 aat film* i parti; da Tangle aup*riaur gauche, de gauclie * droite, et de haut an baa. an prenant la nombre d'imagea nAceaaaira. Laa diagrammea auivanta llluatrant la mitliode. 1 2 3 1 2 3 4 5 6 ASYLUM management; By JOSEPH WORKMAN, M. D., Former Medical Superintendent of the Toronto Asylum for the Insane. :a Whether it is an authenticated fact, or only a time- hallowed legend, I do not undertake to decide ; but I have heard it related of invalided or antiquated war horses, that on hearing the trumpeter's call they have ceased to graze, curved their necks, pi'icked their ears, and started off in search of their old comrades, with whom, if found, they have, even riderless, fallen into line. Just thus, here stand I, unsaddled and unbridled, and gaze around me, eager to greet my fellow-troopers of " auld lang syDe ; " but in vain do I search for some, for too many indeed, of the genial faces whose fraternal beaming welcomed my first entrance into your noble Association. Six and twenty years have now passed away since that well remembered occasion, and with them have also passed from your ranks, men who have left sweet and inspiring memories behind them, the recalling of which must be alike grateful to those who knew them, and instructive an'd encouraging to those who had not that pleasure or advantage. Did I feel that I could, in befitting terms, perform the pleasing duty, I might now ask from you the tribute of sorrow- ing veneration, which every member of the specialty *Read before the Association of Medical Superintendents of American Institutions for the Insane, at the annual meeting in Toronto, June, 1881. % of alienism owes to that finest specimen of frank man- hood, catholic brotherhood, and brilliant intelligence, who held the presidency of the Association at the con- vening of our annual re-union in Boston, in the year 1855. To know Luther V. Bell but for an hour, was to love him ; and to enjoy his converse, or hear his sagaciouf? words, for a day, in the discussions of our society, was to become impressed with the conviction that we enjoyed the privilege of listening to a man of powerful mental grasp, of unbending truthfulness, and of gentlemanly urbanity. Such men as he was, are of priceless value in the early years of any co-operative organization ; and it is very gratifying to me to be able to believe that his example has left its influence on your fraternity, and that his spirit still hovers lovingly over all your fortunes. The venerable and sturdy Di*. Rockwell, with his manly bearing and strong good sense, also graced that Boston assemblage. He was a man of few words, but , these were well chosen, and were deferentially listened to. John E. Tvler, afterwards the successor of Dr. Bell, in the McLean Asylum, was another in attendance at the Boston meeting. On that occasion, if I remem- ber aright, he spoke little, but it was impossible to look upon that broad, high forehead, and those sage- searching, thought-beaming eyes, without the conviction that we were in the presence of powerful latent genius. He, too soon, was removed from his sphere of useful- ness, but not before he had earned for himself, and bequeathed to his associates, a reputation which will serve as an incitement to them to emulate his example, and to strive to merit some measure of that honor and public gratitude which, it is pleasing to know, were awarded to him. 8 But now I come to a name which no member of this Association can ever hear uttered without some welling of emotion, some heaving of veneration, a deep sense of professional gratitude, a lofty admiration of great, and modest, and well-employed talents, — and do not deny me the boon of sharing in your most excusable exultation, when I add, national pride^ — for our brother- hood is a republic wider than that of your United States, and far more earnestly anilexational. You all have anticipated my utterance of the name of Isaac May^ the Nestor of our grand humanitarian phalanx, the Solon and Socrates of American rUenistic jurispru- dence, the wise and frank admonitor >. the young, the sage and modest counsellor of the aged, and the sym- pathizing brother of the entire family. Sorely, gentle- men, do I miss his calm, thoughtful, courage-inspiring, and truth-inviting face, from our present gathering. He was a good and faithful servant of the Good Master, and let us trust he has gone home to his reward. If I have been rightly informed his departure was as peace- ful and painless, as his life was modest and beneficent, and in my conception it approached as nearly to a true euthanasia as any child of mortality could pray to realize. To proceed further in the death-roii of your body, and speak of each of the falleii in terms deserved by his merits, and prompted by my feelings, would de- mand more time than you can legitimately award to the detail, and would too long detain me from the ulterior purpose of this paper ; let it suffice that I add to the illustrious names already mentioned, those o*^ M. H. Ranney, William S. Chipley, Thomas F. Green, William M. Comptop, Samuel Shantz, John Fornerden, Alex. S. McDill, George Cook, R. S. Steuart, Francis I. Stribling, W. Litchfield, Henry Landor and John Wad- dell. I presume this list is incomplete, but I can think of no otiier names at present. You will believe that when I look through it, and reflect that not one in it had reached the age to which I have been spared, I contemplate it with much thoughtfulness, and with much thankfulness. How soon some kind memorialist may have to add my name to it, none can say. It is beyond all human probability that I ever shall have another opportunity of appearing among you, but should I now, anticipatively, use the words of the doomed gladiator — '•^ moriturua vos salufo'''' — I flatter myself none of you will wish that their aptness may soon be verified. With your kind permission, I would now avail my- self of this final opportunity of speaking a few words on some matters of much interest to yourselves, to the afflicted ones consigned to your care, and to society at large. I must, however, frankly forewarn you, that my observations may to some of you savor more of the leaven of censorious comment, than of gratifying appro- bation ; yet, remembering the indulgence awarded to me by the Association in past years, with whatever freedom I may have expressed myself on any subject under" discussion, and feeling perfectly confident that the highest recommendation to your polite attention, is your reliance on the sincerity of the speaker, I dismiss from my mind every apprehension of severe criticism,, and addressing you as reflecting and liberal men, who thoroughly comprehend the truthfulness of the proverb, " faithful are the wounds of a friend, but deceitful the kisses of an enemv," I shall endeavor to tell vou, with becoming frankness, what I think of some of the harm- ful exuberances and a few of the defects of your general asylum administration, and I wish it to be kept in mind i i r ( that I desire not to be understood as restricting my disap- proval of existing errors or faults, to institutions south of the great boundary line, but as falling on those of my own land wherever they may chance to present. I start with the general proposition that much gov- ernment is, in all departments of life, a fundamental evil, and too much government is, in all human affairs and relations, a blunder that invariably and inevitably defeats the true purpose of all government. And when government is not only redundant in quantity, but also hurtful in quality, I can conceive no shorter or surer road to anarchy or corporate ruin. It is my belief that no small proportion of American asylums are too much governed, and that some of them have been sadly misgoverned. I am not blind to the fact that in any country which has achieved free popu- lar institutions, and in which all public affairs must be conducted in conformity to the dominant suffrage of the electoral body, there must be great difficulty in con- vincing the multitude that there are some affairs in which they may be lacking in that cautious discrimina- tion and stability of purpose, which are essential to final success, and I freely admit that the conserva- tion of the grand central blessing of national liberty, must have paramount consideration. It rarely* how- ever, happens that consciousness of the possession of power does not prompt to its exercise, and too often power is exercised merely for the sake of demonstrating its possession. In all such instances there will be too much government, and very certainly not a little mis- government. Some of }ou may have heard of the precocious little girl, of eight years, who one morning said to her mother, "Mamma, may I be married?" The surprised dame answered, " What makes you ask that foolish question?" To which the bantam woman 6 rejoined, "O, "because I wish to let the chihlren see a wedding," and just so it is with very many bantam men, "dressed in a little brief authority tliey do strut and cackle most vociferously." If they do not " make the angels weep," they certainly draw huge groans from many a poor devil under their authority. One of the greatest evils connected with the admin- istration of your asylumvS, is that of the uncertainty of the tenure of office by superintendents. It is impossible to glance over the lists of a series of years, without being struck with the appearance of the many new names and the disappearance of old ones presented. It is, how- ever, very gratifying to me to find the names of so many old friends, still lingering in the Eastern and Middle States. I rejoice to see that New England and her old neighbors appear to cherish so much of the conservatism of the motherland. I feel well assured that such institutions as the asylums of Maine, New Hampshire, Massachusetts, New Jersey, Pennsylvania and New York, by their so long retaining their well tried men, have consulted the best interests of the in- sane, and of their whole communities, and I may safely include in this category some others, as those of Hart- ford, Rhode Island, Boston and others, whose superin- tendents retired after long periods of service, carrying with them the strong regrets of their governors and of the public at large. I accept it as an indisputable fact that the incumbents who have thus so long held their positions, have well merited the permanence of their tenure of office; but if this be so, why should the rule not be universal ? Surely the Eastern and Middle States enjoy not any monopoly of good men. That the rule is not universal, some who now hear me, and far too many of those who once heard me, could but too amply and painfully testify. At the close of the last meeting ];■' 4 ■ir r of diis Association attended by me, at Madison, I had the painful intimation of the dismissal from office of a very energetic, and as far as I knew or have since learned, a very efficient superintendent of a western asylum, in his absence at that meeting. Sucli a proced- ure was surely more worthy of the autocrat of all the liussias, than of the governing body of an American State Asylum; and yet I fear it was no isolated in- stance of the capricious and cowardly official murder of a deserving public servant. In Canada, 'fortunately for public officers, and, as I believe, for the public service, every govern- ment appointment, and the majority of import- ant corporate appointments, are understood, and ex- pected to be, as. durable as the good behavior of the incumbents ; which virtually and virtuously is equiva- lent to life-long. I have even heard it said that it requires very strong pressure to effect the dismissal of an* inefficient officei*. It is also a well understood maxim in our departments, that it is the moral duty of the chiefs to defend all their servants, and to see that they shall not suffer from unjust accusations. This system works well, and our men generally work well under it. The man who enters the public service under expectation of this firm tenure, has the very strongest inducement to acquit himself of all its duties zealously, fearlessly and honorably, but he who knov/s not the day he may be turned adrift, and cast, perhaps poor and broken-hearted on the world, has but meagre en- couragement to be either active or honest. Nor can I think that the mitigation of this evil, under the system obtaining in some states, of periodic renewals of lease of office, by repetiaon of election every five, or other number of years, is any very sub- ^ stantial improvement, for it is with you an unfortunate . 8 contiugeney that not only in it expected tliat every man shall exercise hi.s electoral suftrage, })ut wlioever tails to do HO \H sure to be regarded by both the Htiuggling I)arties as a Philistine, and he must suffer decapitation accordingly. If, however, it be true, as I liave heard often asserted by your own people, £Tiat asylum super- intendents, in common with other public functionaries, owe their appointments most largely to political influ- ence and partisan energy, we need not be surprised when we see them floated out of oftice on the same wave on which they swam into it. It would be presumptuous in me to commend for your adoption, anything having no higher prestige than mere British or Canadian usance or merit ; yet, I do believe you would be large gainers by a quiet retrace- ment of your steps, in the matter of important appoint- ments to offices, the good and satisfactory working of which depends, in so large a measure, on matured experience; nor would I have you stop here, But go yet farther, and recommend the expediency, as well as the justice, of awarding to superintendents and other faithful officers, a competent retiring allowance, gradu- ated on their length of service. This is the rule in British and other trans-atlantic asylums. It has become the rule, though in a more limited degree, in this prov- ince, so that every officer or employee is granted a retiring allowance in a lump sum, which is deteiinined by the length of his or her service. The obvious object and tendency of this system, is to induce all engaged in the service, from the chief down to the scullion, to continue long and to behave well in their respective spheres. I regard it as equally just and politic. I must not forget to add here, that although public servants in Canada are not prohibited from exercising their electoral franchise, yet it is recommended to them I i 1 9 1>V tlu'ir siiperiorH, to abstuin from so doing, nnd I have always regarded this exemption from party exposure, , AS a valua))le civil boon. I I would close my observations on this part of my W subject, with the following (^notation from a recent number of an able, popular American journal, and allow me to say that I would not myself presume to speak of the civil service of the United States in similar severe terms: "There is no doubt whatever," says this writer, *'that the work of the country has been and still is incompe- tently done, and no doubt whatever that the ' spoils doctrine,' as it is called in party politics, is the source of incalculable corruption, and incalculable degradation of the civil service." — /ScHImery April, 1881, p. 048. Again this writer says of the unhapj)y exigencies of a public officer: "He is always to feel that he can not keep his place by any excellence of work, or any super- H . lative fitness for it, but only by intriguing, and showing himself ready to do the dirty work of the party on whose good will he depends." The severity of these strictures forbids comment by an outsider. The next evil to which I would allude, as calling for serious consideration, is that of the interference of the j governors or trustees of asylums, with the appointments of assistants of eveiy class or grade; and the same i-emark applies with even greater force to all higher authorities. I assume it as a certainty that every su- perintendent is capable of best judging as to the fitness and competency of all his assistants, and it consists with common sense that he will endeavor to procure and to retain the best he can find ; if not, he is unfit for his position, and the sooner he is released from it the better. T 10 It is, however, a fact which calls for no illustration, that any employee, of whatever grade, who owes his position to the influence of any person above the su- perintendent, or independent of him, can never prove to be a reliable or obedient officer or servant; for he believes and too often knows that his continuance in the service depends more upon the influence that first secured it than on his own good behavior. There no doubt are worthy exceptions to this rule, but they are not so numerous as to disprove it. During my own rather long tenure of office, I had the satisfaction of total non-interference on the part of my superiors, in this relation, and I would fondly hope my successor has had the like experience. I could not desire for him a greater curse than its opposite. An evil of unspeakable virulence in connection with the administration of American asylums, but for which it is just to say the governors or trustees are not ac- countable., is the frequency with which groundless charges of misconduct or mismanagement are brought against the medical staff and their assistants. I need not particularize instances of this grievance, for you are all better acquainted with the details than I can be. So far as I can remember, nearly all these accusations have been the concoctions of discharged, bad servants, or of imperfectly recovered patients, whose lingering insanity has underlain their moral obliquity. It is, how- ever, truly lamentable to observe the extent of popular credence awarded to these caluminators, and it is badly calculated to elevate our, conception of the primal purity of human nature, to find that so many people are anxious to believe evil of their fellow men, and to rejoice more in the hope of verifying iniquity, than of discovering innocence. 11 It is true, that in every instance that has come to my knowledge, the accused have come out triumphantly vindicated ; yet, who but themselves could tell, if indeed human language could depict, the mental agony, the wear and tear of brain and nerve, the writhings of conscious innocence, the " spurns that patient merit of the unworthy takes," all too often endured under an augmenting bodily debilitation which invited the shaft of death, or rendered imperative the relinquishment of office ? Of how many this has been the fate their be- reaved and sorrowing families best could testify. Is there no remedy for this evil? Must its recurrence become a perpetuity in your country? To tell me tJ^ it will recede before the march of a higher popular cul- ture and intelligence, would be but to ignore the fact that yours is the best, or at least the most largely edu- cated nation in Christendom, and to ignore also the yet more pertinent fact, that the pernicious accusations here complained of, rarely, if ever, have their origin among the uneducated portion of the population. They are trumped up by persons possessing more intelligence than moral honesty, and they are cherished into pesti- lent vigor by those who have had but too much education. It occurs to me that your institutions for the insane stand in need of some protecting breakwater that might withstand the force or avert the fury of the wave of popular delusion. That your local boards of trustees have in many instances not proved adequate to this service, will be readily admitted by all who have suf- fered from the defect. It is my belief that a central governmental supervision by one or more well qualified, discreet officers, whose function should be that of vigi- lant and thorough, not merely perfunctory, inspection of the condition and treatment of the patients, and of 12 everything relating to their well-being, and whose duty- it would be to report, at stated periods, to the Gov- ernor of the State, whatever they might deem proper or useful to be made known, might meet your require- ment. It would not be either necessary or advisable that such officers should exercise any immediate control or direction over the financial affairs of ""he institutions, or have any connection with the giving out of contracts, or the buying and selling operations, so long, at least, as your local boards of trustees, deserving of public confidence, continue to be appointed ; for I would, not merely that such inspecting officers be unsuspected of favoritism, but I would place them above all reach of suspicion. As a matter of course, and a means of pro tection to your boards, against unjust accusations or insinuations, all their transactions should be submitted to the inspectors, whose duty it would be to report, faithfully, any observed impropriety. Speaking from my own experience, I do not hesitate to say, that I always regarded this sort of governmental supei'vision, as my best protective against misrepresenta- tion or revengeful slander, and I must add that the only instance in which I suffered from these, occurred before the establishment of our governmental inspector- ship, when a local board failed in their duty of prompt and thorough investigation. I would now crave your attention for a few minutes longer, to a subject of a different character, but of no less public importance tLan the preceding ones, and perhaps, as some of you may fear, of no less practical difficulty. It is the establishment of a thorough system of alienistic medical training, by means of which there would be produced an adequate supply of competent and efficient candidates for the various positions, from time to time becoming vacant in your asylums, and a 13 better knowledge of insanity would be diffused through- out the profession of medicine. I think every experi- enced and closely observant superintendent will admit, that a considerable lapse of time is required to convert a new assistant, however complete may have been his collegiate curriculum, into a useful asylum officer ; and very few can entertain the belief that any course of mere didactic teaching, apart from thorough clinical observance and instruction, can ever meet the require- ments of the position. I am aware that in some of the asylums of America, this matter has had consideration, but not to the extent, nor in the practical direction that I should deem necessary for the end I would recommend to be held in view. I have recently been favored by Professor Tamburini, the director of the Asylum of Reggio Emilia, in Italy, with a number of the Gazzetta del Frenocomio di Reggio^ at the end of which I have read with much gratification, a notice to students of medicine, and graduates, of the practical operation of a system of training which seems to me to give promise of great public utility. I shall here introduce a translation of those portions of the above notice, which appear to me most pertinent to the object I have in view; it reads as follows: " The Asylum of Reggio, from its central position, its material and moral improvements, eftected in late years, and still in pro- gress ; from the large number of patients which it contains, and which constitute an abundant material for practical study ; from its being the seat of clinical psychiatry of the Royal University of Modena, in which all the practical prelections are imparted to students; from the scientific laboratories with which it is fur- nished, rich in instruments and in every means of objective and experimental research; from its being the seat of the direction and editing of the liivistd sperimentale di Freniatria e Medicina Legale^ and consequently from the great number of scientific 14 journalg received in exchange, which enrich its library already copiously supplied with works relating to psychiatry, is now generally recognized as the best adapted institute for theoretic and practical instruction in this science, uniting all the opportuni- ties for a complete education, both in the scientific sphere of the specialty, and the technicalities of management. It has therefore been designated by the Minister of Public Instruction as one of the institutions in which' young men may obtain interne positions, in order to perfect themselves in their studies ; and already several young physicians who here completed their psychiatric studies, have brilliantly distinguished themselves. In order to obtain the position of medical practicant, it is neces- sary to send in application, with diploma of graduation, and all those documents which may show the distinct capacity of the candidate to the Medical Director, with whom rests the nomination. The medical practicants have residence in the asylum, together with free lodgings, food, light, fuel and attendance. Besides the daily visits, and all the clinical and experimental exercises, they are required to attend, assist, ^nd in case of absence, to supply the places of the other medical officers in the treatment of the patients, and the construction of the histories of cases ; to attend the daily clinics, and to keep statistic records in necroscopy; to aid in supervision of the service, and to give assistance in the psychiatric clinique, and in every other requirement of the institu- tion under the instructions of the director. These posts last for not less than six months, and not longer than two years. Practicants are also admitted for shorter periods, without the obligation to serve as the others; but these receive only lodgings in the asylum. Applications may be presented in any month of the year. (Signed,) G. FORNACIARI, President of the Administrative Commission. A. TAMBURINI, Director of the Asylum." It appears to me that the above programme is as liberal and complete as could be desired, and it does high honor to the government of Italy, that it has been induced to initiate a system of instruction so practically meritorious. Whether it would be possible to intro- duce some similar system in this country, I confess I 15 already is now eoretic )ortuni- of the erefore one of sitions, iseveral tudies. am unable to foresee. For many years during my own asylum service I was able to carry out, on a small scale, a kindred arrangement, under which I was permitted to award residence and board to three young men en- gaged in the study of medicine, in addition to my reg- ular assistant physician. Two of these young men were paid moderate salaries, which, by their fidelity and usefulness, they very well merited. I can appeal to my successor, and his confreres^ in the other three asylums of Ontario, whether the services rendered by these young men, since my retirement, have not been, of very great value to the country. It would not be- come me to say more in their praise. It has been with much regret that I have seen my cherished plan aban- doned in all our asylums. I abstain from giving expression to my conjectures as to the reason of our government for making the change. I must, however, declare my belief that it has been a very unwise one, and a step in a retrograde direction, equally injudicious as regards the advancement of practical psychiatry, and unjust as relates to the interests of the medical pro- fession and of humanity. I now bring these, my last words, to a close, begging that you will regard them as those of a parting friend, whose love of your specialty, and high esteem of all its members w^ill endure as long as God may prolong his mental integrity.