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 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.