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 ISfe, 777 
 
 BUCKNILI 
 
 ASYLUMS IN AMERICA 
 
THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
i 
 
 
NOTES 
 
 ON 
 
 ASYLUMS FOR THE INSANE 
 
 IX 
 
 AMERICA 
 
 > 
 
NOTES 
 
 ON 
 
 ASYLUMS FOR THE INSANE 
 
 IN 
 
 AMERICA 
 
 BY 
 
 JOHN CHARLES BUCKNILL, M.D. LOND. 
 
 F.R.S., F.R.C.P. 
 
 LATE LORD CHANCELLOR'S VISITOR OF LUNATICS 
 
 LONDON 
 
 J. & A. CHURCHILL, NEW BURLINGTON STREET 
 
 1876 
 
K- 
 
 TO 
 CHARLES LOCKHART ROBERTSON, M.D. 
 
 THE FRIEND AND FELLOW-WORKER OF MANY YEARS, 
 THE FOLLOWING PAGES 
 
 giiiratti 
 
 IN AFFECTIONATE ESTEEM 
 
 BY 
 
 THE AUTHOR. 
 
PREFACE. 
 
 THE following Notes, which appeared in the pages 
 of the Lancet during the present year, formed 
 part of a controversy on the treatment of the 
 Insane in the United States, which has now been 
 happily ended by the Editor of the Lancet making 
 the statement in his issue of September 1 6th, that 
 he has " neither said nor implied that there were 
 no good and well-managed asylums in the United 
 States ;" nor has he " stigmatised the alienists of 
 America as ' mad-doctors ' in reproach, and con- 
 demned the whole body of psychologists across 
 the Atlantic for faults in which they do not all 
 participate." The Editor of the Lancet has, 
 moreover, done an act of justice to Dr. Nichols, 
 the President of the Association of Superinten- 
 dents of American Asylums, by publishing the 
 verdict which was unanimously agreed to by the 
 Committee of Inquiry of Congress, whereby Dr. 
 Nichols was acquitted of the grievous but un- 
 founded charges made against him. 
 
 With regard to the manner in which this con- 
 troversy has been conducted, the Author of these 
 
Vlii PREFACE. 
 
 pages is the last man to object to the sharp 
 criticism which he has provoked, and, indeed, 
 when he finds that the greatest fault which his 
 opponent can detect is that he has expressed 
 regret for an omission which, upon inquiry, appears 
 not to be regrettable, he feels that he need not be 
 careful to excuse himself. He is fully aware of 
 the great imperfections of his work and its utter 
 inadequacy to the grand scope of interest which 
 it might have taken namely, to the consideration 
 of the causes, conditions, and treatment of un- 
 sound mind in a vast continent under a newly- 
 developing civilisation. Had he foreseen the 
 necessity of publishing his observations he would 
 certainly have made them more extensive, for to 
 judge of American institutions of any kind from 
 those of the north-eastern States alone is not 
 indeed divining Hercules from his foot, but from 
 his head. This, however, he must say, that so far 
 as his observations did extend he was honestly 
 afforded every facility for making them. His 
 American brethren did not show him the best 
 parts of their institutions, carefully hiding the 
 blots ; but they exhibited to him the unsorted 
 good and bad of their asylums, reserving no dark 
 places or bad cases from his inspection ; frankness 
 of conduct which is not to be met with at all times 
 or everywhere. 
 
 Greatly to his surprise, the Author has been 
 
PREFACE. IX 
 
 accused of writing with the intention of uphold- 
 ing the use of mechanical restraint in America, 
 an error which could only have been due to his 
 having assumed perhaps too readily that his 
 opinions on the subject of mechanical restraint 
 were so well known that their explicit re-statement 
 was not necessary. He feels bound therefore to 
 avow that his opinions on the subject, published in 
 the eighth Report of the Commissioners in 
 Lunacy in 1854, and republished in the "Manual 
 of Psychological Medicine," p. 685 et seq., 3rd 
 ed., remain quite unchanged, and that in all he has 
 subsequently written on the subject he has in- 
 tended to uphold the unqualified opinion that 
 mechanical restraint is an evil and an abuse. His 
 American brethren, indeed, have not fallen into the 
 above mistake, but have strongly felt that these 
 Notes contain no indirect attack upon their em- 
 ployment of mechanical restraint, and he antici- 
 pates that his controversy with them on this sub- 
 ject is not yet quite concluded. One of the most 
 eminent of them, Dr. Isaac Ray, has claimed that 
 this question should be argued on scientific grounds 
 alone, but the Author thinks that this claim is 
 not altogether admissible, unless the term scien- 
 tific be accepted in a wider than its usual sense ; 
 seeing that the coercion of an insane man by 
 means of bonds, although mainly a scientific 
 question, is also in great part a moral and social 
 
X PREFACE. 
 
 one, mixed up as it is with the rights of society 
 over the individual, and with questions of benevo- 
 lence and humanity. It is a matter upon which 
 persons who are not scientific will eventually insist 
 upon having much to say unless it be definitely 
 settled beforehand. 
 
 An important and difficult question has been 
 mooted by the Lancet, in the controversy of which 
 these Notes formed a part, to which the Author 
 confesses that he does not clearly see the whole 
 answer. It arose from the Author writing in 
 strong terms of condemnation of certain asylums, 
 and yet in terms of apology for the medical 
 officers of those asylums. The Lancet, com- 
 menting upon this seeming inconsistency, says : 
 " To hold office under a system which does not 
 give a responsible man fair play, is to commit a 
 crime against common sense. Such an offender 
 must take the consequences." But surely this is 
 rather to cut the knot than to untie it, and the 
 question remains unsolved whether an honourable 
 man may not sometimes better devote his energies 
 to the services of an institution which is bad through 
 no fault of his own, rather than desert his ship 
 prematurely. To determine this question aright, 
 times and circumstances, of which it is difficult 
 for a stranger to judge, must be taken into careful 
 consideration. The facts actually observed by the 
 Author in the City Asylums of New York and 
 
PREFACE. XI 
 
 Philadelphia were, firstly, institutions lamentably 
 deficient of resources through the most reprehen- 
 sible default of the governing bodies ; and, 
 secondly, medical officers manfully at work in 
 their vocation under these adverse circumstances. 
 Whether or no these officials were bound to throw 
 up their appointments, he cannot venture to say. 
 The probability that self-sacrifice would bring 
 amelioration ought, perhaps, to be the pivot of 
 resolve, and it is with deep satisfaction that the 
 Author sees that since his visit such a reso- 
 lution has been come to by one of the gentle- 
 men implicated, Dr. Macdonald, of the New York 
 Men's Asylum, and that it has happily resulted, 
 not in his resignation, but in a reform of the in- 
 stitution, the remarkable details of which will 
 be found in a foot-note to the account of the 
 Author's visit. In this case the main reform was 
 easily attained by the abolition of lay manage- 
 ment and by the addition of ten thousand dollars 
 a year to the allowances for food ; while reform at 
 the still worse asylum at Philadelphia implies 
 nothing less than the erection of new buildings on 
 a new site, which Dr. Richardson may indeed 
 have advocated with the utmost earnestness and 
 persistency and yet not be blameworthy for 
 continuing his work under the miserable disadvan- 
 tages which are imposed upon him. 
 
 In conclusion, the Author begs to state that 
 
Xll PREFACE. 
 
 although he has spoken of these Notes as part of 
 a controversy, they have been written in no con- 
 troversial spirit, but with the simple desire of 
 telling the whole truth as he saw it ; and the 
 proof of this statement seems to him to be 
 afforded by the fact that the arguments of his 
 opponent have been founded almost entirely upon 
 the statements made in these Notes themselves. 
 The Author may have been drawn into some 
 apparent inconsistencies from the feeling which 
 abides with him, that the Superintendents of 
 American asylums are far better men than their 
 present work would indicate ; but this is a ground 
 for hope rather than regret, for inconsistencies of 
 this kind are quite consistent with reality, and the 
 best hope for improvement in all social and scien- 
 tific work rests in the character and qualities of 
 the men who are engaged in it. 
 
 39, WIMPOLE STREET, LONDON. 
 November, 1876. 
 
NOTES 
 
 ON 
 
 ASYLUMS FOR THE INSANE 
 IN AMERICA. 
 
 HAVING been compelled by failing health, in the 
 spring of last year, to rest from official work, and 
 being recommended by medical advisers to seek 
 change of air and scene with as little fatigue as 
 possible, and to prefer travelling by water, I formed 
 the design of sailing to the United States, going 
 up the Hudson to the great lakes, and returning 
 by the St. Lawrence. This design I carried out, 
 with only such deviations as the frank and generous 
 friendliness which I met with from my professional 
 brethren in the States, and their great desire to 
 show me their institutions, rendered me unable to 
 avoid. I had not intended to make anything like 
 a tour for the inspection of American asylums, but 
 it will be readily understood that the above-named 
 influence, united to the deep interest which a man 
 must ever take in a matter which has been to him 
 the subject of life-long study, led me to visit and 
 
NOTES ON ASYLUMS 
 
 narrowly to observe the management of many of 
 these institutions and the treatment of their in- 
 mates ; so that I find I visited altogether thirteen 
 lunatic asylums (ten being in the United States 
 and three in Lower Canada), and two schools for 
 idiot children, besides six institutions for habitual 
 drunkards, on which my remarks must be reserved 
 for a future occasion. 
 
 Of the asylums which I visited in the States 
 two were State asylums, corresponding to our 
 county lunatic asylums ; four were asylums sup- 
 ported out of the municipal funds of large cities, 
 corresponding to our borough asylums ; three were 
 hospitals for the insane, closely corresponding with 
 institutions of the same name in our own country, 
 supported by private benefactions and payments 
 made on behalf of patients, and under the control 
 of boards of managers elected by benefactors ; 
 and one was the Criminal Lunatic Asylum for the 
 State of New York. I did not in the States visit 
 any private asylums corresponding to our licensed 
 houses for the insane, and I was informed that 
 the system of private asylums was developed only 
 to a small extent in that country, and that pro- 
 bably there were not more than some 150 lunatics 
 in the whole of the States confined in houses of 
 that type. I was kindly invited by the proprietor, 
 Dr. Barstow, to visit a private asylum in the 
 neighbourhood of New York, which was said to 
 
FOR THE INSANE IN AMERICA. 3 
 
 be a very good one, but I was unable to make the 
 effort. All three of the asylums which I visited 
 in Lower Canada were, strictly speaking, private 
 asylums that is to say, they were proprietary 
 institutions, although two of them were occupied 
 almost entirely by poor lunatics supported by the 
 public funds of the province. The only private 
 asylum, really so in form and substance, which I 
 visited I found by accident, as it were, form- 
 ing one part of an inebriate institution near 
 Quebec. 
 
 I shall commence with the class of asylums, 
 and, indeed, with the particular institution, of 
 which I saw most viz., the Pennsylvania Hos- 
 pital for the Insane, on the outskirts of Phila- 
 delphia, which seems, in its constitution, manage- 
 ment, and objects, closely to resemble the Friends' 
 Retreat at York. Indeed, it has a yet more 
 striking resemblance, from its intimate connexion 
 with the Society of Friends. I resided six days 
 in the house of Dr. Thomas Kirkbride, the medical 
 superintendent, and enjoyed the largest oppor- 
 tunities of observing the management of the insti- 
 tution. Of course, Dr. Kirkbride is a Friend, 
 though I did not know it until he told me ; but 
 when he took me to the annual meeting of the 
 governors, which was held in the library of the 
 hospital founded by William Penn, I saw some of 
 the brown square-cut coats and broad-brimmed 
 
4 NOTES ON ASYLUMS 
 
 hats which there still form the distinctive costume 
 of this simple, sensible, and humane sect 
 
 The Pennsylvania Hospital for the Insane is 
 situated about two miles from Philadelphia, and 
 occupies a very fine, extensive, and valuable site. 
 The buildings for the men are nearly half a mile 
 from those of the women, and are separated from 
 them by a broad and deep vale with a meadow in 
 it, which is rented by some outside dairyman, and 
 forms a sort of no-man's-land to partition off the 
 two sexes. The buildings are architecturally un- 
 pretentious, but internally they are exceedingly 
 well-arranged and commodious. I cannot say that 
 I saw anything remarkable in the treatment of the 
 inmates, or anything which our Commissioners in 
 Lunacy would have been surprised to find in the 
 management of one of our best English hospitals 
 for the insane. I observed a daily persistent 
 effort to interest and amuse the inmates, a reunion 
 every evening for readings or calisthenic dances, 
 or oxyhydrogen transparencies, or something of 
 that kind, an abundant supply of carriages for 
 driving, mostly within the large grounds, and a 
 general system of watchful care and kindness 
 which I am fain to believe is the rule in our own 
 institutions of this class. A matter which was 
 remarkable to me was to find, in conversation with 
 my most kind-hearted and enlightened friend 
 Dr. Kirkbride, that he was not a non-restraint 
 
FOR THE INSANE IN AMERICA. 5 
 
 man. In common with the great majority of his 
 psychologist brethren in the States, perhaps it 
 would be more correct to say with the whole of 
 them with very few exceptions, he had made up 
 his mind that the total abolition of mechanical re- 
 straint was not advisable in the treatment of the 
 insane. But in the wards of his asylum and I 
 believe I saw every one of his patients I did not 
 observe any kind of mechanical restraint actually 
 employed, and I did observe some cases of lunacy 
 there, and one case in particular, in which I should 
 have expected him to carry his theory into practice, 
 if, indeed, it were not a mere theory. I observed 
 a lady, recently admitted, who was suffering from 
 the most acute and restless form of mania fol- 
 lowing childbirth, and presenting just a case for 
 the imposition of a strait-waistcoat under the 
 old system ; but she was treated by Dr. Kirkbride 
 just as our best men would treat her. She was 
 placed in a low and narrow but comfortable bed, 
 in an airy and cheerful room, a kindly and patient 
 nurse was seated on each side of her, and she was 
 kept in the recumbent position as much as possible, 
 mostly by persuasion and a little by gentle force ; 
 and herein she was submitted to active, anxious ? 
 and skilful medical treatment. And if I saw no 
 cases of mechanical restraint in this asylum, neither 
 did I see any of seclusion. If I may without ir- 
 reverence make a scriptural allusion, I thought that 
 
 B 
 
6 NOTES ON ASYLUMS 
 
 . 
 
 my friend somewhat resembled that man who said 
 he would not go into the vineyard, but went. 
 
 Another hospital for the insane which I visited, 
 and in which I spent a long day, and in which I 
 again had the pleasure of meeting the Board of 
 Management, was the Bloomingdale Asylum, 
 within six miles of New York. It is under the 
 careful and skilful superintendence of Dr. Browne, 
 and my remarks, for the same cause, must be as 
 meagre as those I have made on the Pennsylvania 
 Hospital. I saw no restraint here also, and only 
 one patient in seclusion a case in which, to my 
 mind, it was obviously needful. The situation of 
 Bloomingdale is very beautiful, very near the top 
 of the only hill in the immediate neighbourhood 
 of New York. This city, which has such wonder- 
 ful water privileges, and which on a map gives 
 you the ideal of perfection of a maritime city, has 
 the disadvantage that it possesses no near hills nor 
 coignes of vantage from which you may look down 
 upon its beauties. There are Bunker's Hill and 
 the Dorchester Heights, from which you can see 
 Boston city and harbour. You can survey Balti- 
 more and Chesapeke Bay from the Washington 
 Monument, and Washington from the Capitol ; 
 but there is no place but the Bloomingdale Hill 
 from which you can look down upon the harbours 
 and the grand river of New York, and any stranger 
 not interested in the welfare of insane Americans 
 
FOR THE INSANE IN AMERICA. / 
 
 might derive great pleasure on this account from 
 a visit to Dr. Browne. If he were so interested 
 he would also see a very well managed asylum, 
 which it was to me very pleasant and satisfactory 
 to inspect. I really forget the exact amount of 
 the vast sum which I was told that Bloomingdale 
 was worth from its proximity to the best end of 
 this increasing city, but it was several hundred 
 thousand pounds ; I am afraid to say how many, 
 lest my memory should be treacherous. However, 
 it was something enormous, and there is no in- 
 tention of selling it, and removing the institution 
 further into the country. The proximity to the 
 great city, for the advantage it offers to the friends 
 of the patients and to other visitors to the institu- 
 tion, seems to be thought worth the sacrifice. As 
 the asylum, in common with others of the same 
 class in America, is financially prosperous, this 
 opinion is probably right. Moreover, it may be 
 good policy to keep an institution of this kind, 
 which is to a great extent dependent upon the 
 donations and bequests of wealthy citizens, within 
 the range of constant public observation. 
 
 The McLean Hospital for the Insane at Boston 
 possesses a site almost as valuable as that of 
 Bloomingdale, but it is so near to the ever-growing 
 city, and so cut up with railways either in esse or 
 in posse, that it has to be sold, and the governors 
 have already purchased an estate some twenty 
 B 2 
 
8 NOTES ON ASYLUMS 
 
 miles in the country, whereunto they intend shrotly 
 to remove their institution. The present asylum 
 is an old country-house, bequeathed by the man 
 whose name it bears, and, like many of the older 
 buildings in the States, is constructed in great part 
 of bricks which were made in the old country. It 
 was opened in 1818, or two years before the 
 Lincoln Asylum in England, and has always been 
 conducted in what was thought at the time and 
 place the least repressive manner possible. In 
 1839 the 'distinguished Dr. Bell reported: "It is 
 the successful use of the means put into our hands 
 by the extensive architectural arrangements here 
 provided that has enabled us to dispense almost 
 entirely with restraining measures, or even confine- 
 ment, as evinced by the fact that our ' lodge' or 
 strong-rooms are not called into use more than 
 three or four hours during the year ; that not 
 one per cent, of our whole number is on an average 
 under any constraint." I was taken to the 
 McLean Asylum by my friend Dr. Tyler, who was 
 the resident superintendent of it for a great number 
 of years, and who is now the consulting physician. 
 I did not see all the patients, and therefore I shall 
 abstain from observations on the custom of using 
 restraint or not. One feature of construction 
 which I first observed here, and which I think is 
 objectionable, is the plan of placing noisy and ex- 
 citable patients in what are called " lodge-wards," 
 
FOR THE INSANE IN AMERICA. 9 
 
 apart from the main building. The number of 
 patients whose noise is incessant and annoying is 
 very small, even in a large asylum containing 
 many hundreds of inmates. There might, per- 
 haps, be some reason for providing a small ward 
 out of ear-shot of other patients, since I have 
 known the inmates of a large asylum made mise- 
 rable by one howling lunatic ; but it seems to me 
 that excitable lunatics, being those who most need 
 frequent medical observation, ought, in the arrange- 
 ments of a hospital for the insane, to be brought 
 as near to the medical staff as convenient architec- 
 tural arrangements will permit. 
 
 Another feature of the McLean Hospital which 
 I shall venture to criticise because the institution 
 is about to be removed and rebuilt, is the sepa- 
 rate buildings called pavilions, for wealthy and 
 tranquil inmates. These are fine structures, with 
 spacious, lofty rooms and corridors. Each one 
 accommodates eight patients, four in the first and 
 four on the second floor, and each patient has a 
 sitting-room and a bedroom to himself, both of 
 them large and lofty. It struck me, however, that 
 these patients lived too much by themselves in 
 their own rooms for their therapeutic welfare, and 
 that smaller structures with smaller rooms, and 
 with common rooms for meals and social inter- 
 course, would have been better suited to promote 
 the cheerfulness and happiness of the patients. 
 
10 NOTES ON ASYLUMS 
 
 With us a detached residence in connexion with a 
 hospital for the insane is more like a private house 
 in which one or more lunatics are placed to reside 
 with suitable companions and servants ; and for 
 certain cases this is an excellent variation of plan. 
 A separate ward with solitary chambers, however 
 large and luxurious, is quite a different and, I 
 venture to think, an inferior arrangement. 
 
 Notwithstanding my criticisms on these points 
 of structural arrangement, I was greatly pleased 
 with my visit to the McLean Hospital, which is 
 evidently under very careful and skilful manage- 
 ment ; and, on the whole, I may say that, avoid- 
 ing the restraint question, so far as my observation 
 goes, the management of the hospitals for the 
 insane in the United States is most creditable, 
 both to the liberality of the public and of those 
 who are deputed by the public to manage them, 
 and to the skill, humanity, and devotion of the 
 medical officers upon whom the care and treatment 
 of the insane inmates immediately devolve. 
 
 Before I pass on to another class of institutions 
 for the insane namely, those supported by public 
 funds I shall venture to make a few remarks 
 upon a matter which struck me very forcibly in 
 every asylum which I visited in the States, which 
 is that I nowhere saw any number of patients en- 
 joying out-of-door exercise. At Boston the excuse 
 might be made that the weather was cold, but at 
 
FOR THE INSANE IN AMERICA. I I 
 
 New York, Philadelphia, and Washington, the days 
 of May were bright, sunny, and delicious, and such 
 days with us would have turned out the population 
 of our asylums into the gardens and the grounds, 
 overflowing into the country beyond. I saw 
 nothing of this in the States. At Bloomingdale, 
 on a glorious genial day, I did see some male 
 patients in one of the airing courts, but as a rule 
 the asylum population was persistently within 
 doors, and there were unmistakable signs that this 
 was the habit and custom of the land. The airing 
 courts were untrodden, and the pathways in the 
 fine grounds but little used, like those of some 
 absentee nobleman in our own country. Of course 
 I mean all this as comparative only, for I did see 
 a solitary patient now and then out of doors, but 
 such a sight as one sees on any fine day from 
 the Great Western Railway passing by Han well 
 was totally and conspicuously absent in the 
 States. 
 
 Moreover, in no asylum I visited did I see any 
 adequate provision of sunshades and out-of-door 
 seats, and the result of my observation and inquiries 
 was the conviction that in the United States the 
 patients in the asylums do not enjoy anything like 
 the amount of out-of-door exercise and recreation 
 which it is the common custom to provide for them 
 in this country. I think this remarkable difference 
 is to a great degree due to the habits of the people 
 
12 NOTES ON ASYLUMS 
 
 in the two countries, the Americans, notwithstand- 
 ing their splendid climate, being far less out-of- 
 door folk than we are. In-doors they coddle them- 
 selves with cooked air, and out they do not care 
 to budge, at least for pleasure. When duty or 
 business withdraws them from the stove atmo- 
 sphere of the house, they encase themselves in 
 great coats in bright, blessed weather, when an 
 average Englishman would revel in the fresh, deli- 
 cious air. 
 
 And if the inmates of American asylums do 
 not get an adequate supply of that best and most 
 powerful of tonics, fresh air, out of doors, they 
 certainly do not get it within doors ; for there the 
 universal system of artificial heating and ventila- 
 tion is skilfully carried out, to a pitch which to our 
 sensations is a great discomfort. Everywhere in 
 America the houses and hotels are heated by hot- 
 water or steam pipes to an extent which makes 
 them exceedingly uncomfortable to the average 
 Englishman, who will often sleep with his window 
 open while all the rooms and passages of his tem- 
 porary domicile are filled with the hot, dry, well- 
 fried emanations of the furnace room in the base- 
 ment, combined sometimes with a slight smack of 
 sulphur or of oil, or of some other substance re- 
 specting which there can scarcely be differences of 
 opinion as to whether it is agreeable or not. In 
 the entrance hall of the Boston Asylum I observed 
 
FOR THE INSANE IN AMERICA. 13 
 
 the thermometer marking 85 F. In the best asy- 
 lums the furnace system of warming is carried out 
 very thoroughly. Generally a powerful steam- 
 engine drives a great fan which propels furnace- 
 heated air through passages in the basement, 
 whence it is distributed throughout the building. 
 There can be no doubt that the system is 
 thoroughly efficient, and the only question which 
 arises in my mind is whether it can be good for 
 the patients. I ventured to express my opinion 
 to the contrary at the Congress of the Medical 
 Superintendents of American Asylums at which I 
 had the privilege of attending, and I was asked 
 the temperature at which the wards of English 
 asylums were usually kept. I replied that I thought 
 during winter or spring the temperature of our 
 asylums would certainly not be above 62 F., on 
 which Dr. Kirkbride, the authority of whose 
 opinion in that large meeting was undisputed on 
 all matters, said that 72 F. was the lowest tem- 
 perature at which he should venture to keep his 
 wards, and that he thought his patients would be 
 uncomfortable in feeling and would suffer in health 
 from any temperature below this ; and his opinion 
 certainly seemed to meet with the ready concurrence 
 of his American brethren. Since I have returned 
 I have found by inquiry that in all probability I 
 considerably overstated the average temperature in 
 our asylums, and that 52 F. would have been 
 
14 NOTES ON ASYLUMS 
 
 much nearer the mark. I thought that the in- 
 mates of American asylums did not, as a rule, 
 bear the aspect of good physical health, certainly 
 not as compared with the inmates of our own 
 asylums, and I came to the conclusion that want 
 of out-of-door life, and the habit of breathing an 
 over-dried and over-heated atmosphere by day 
 and by night had much to do with this appearance. 
 I should expect that the effect of this lower range 
 of physical health, if it exists, would be seen 
 rather in a diminished number of cures than in an 
 augmented mortality. The difference of habit in 
 this respect may well be counteracted by other 
 habits in regard to mortality as, for instance, by 
 the immensely greater temperance of the American 
 people than of our own ; but the existence and 
 cure of insanity hang so frequently upon slight 
 modifications of the bodily health that I should 
 not be afraid of staking my professional judg- 
 ment on the accuracy of the opinion that cures 
 would be more numerous in an asylum whose in- 
 mates had the general appearance of robust 
 health, than in another asylum whose inmates, 
 from whatever cause, looked sallow and sickly. 
 
 I may mention " in this connexion," as Ameri- 
 cans say, that the patients in American asylums 
 are not allowed beer or any other fermented or 
 intoxicating beverage as a diet. In judging of 
 this abstention we must bear in mind the won- 
 
FOR THE INSANE IN AMERICA. 15 
 
 derfully temperate habits of the people in the 
 Eastern States, and the fact, of which all observ- 
 ing men, whether they be medical men or not, 
 assure you, that the moderate use of intoxicants 
 cannot be borne with the same impunity in the 
 dry air of America, as to a great extent we enjoy 
 in our moister climate. In this country I think it 
 might be hazardous to abolish the moderate use of 
 beer or wine in the diet of the insane. 
 
 The first asylum supported by public funds 
 which I visited was the asylum for the city of 
 Boston. It is an old and inconvenient structure 
 in a small and cramped site, adjoining, however, 
 the magnificent harbour of Boston, upon which, 
 in summer time, selected parties of the patients 
 make excursions in a steamboat provided for the 
 purpose. The inmates were tranquil, cheerful, and 
 many of them were engaged in various occupa- 
 tions and amusements ; but two of them were in 
 strait-waistcoats. It will be convenient to re- 
 serve what I have to say on this important sub- 
 ject of mechanical restraint until I have to make 
 some concluding remarks. Meanwhile I may ob- 
 serve that this asylum was obviously under careful 
 and skilful management, and restraint was imposed 
 because, in the opinion, erroneous I think, of the 
 superintendent, Dr. Walker, one of the kindest of 
 men, it was considered best for the interests of all 
 his patients that it should be employed. The old 
 
1 6 NOTES ON ASYLUMS 
 
 building 1 is to be replaced at an early date by an 
 adequate one on a good site in the country. The 
 Mayor of Boston favoured me with a view of the 
 plans, which were those of a handsome structure 
 of long extended frontage, and architecturally 
 very imposing ; and this leads me to add a few 
 remarks upon the plans of new asylums, or those 
 under contemplation in the States. The Ameri- 
 cans think much, perhaps too much, of the archi- 
 tectural appearance of their new asylums. The 
 new Boston Asylum is to be one long, straight, 
 and, it must be admitted, imposing structure. The 
 new asylum for New Jersey is a five-storied 
 building, with the mansard roof now in so much 
 favour. The basement and the mansard stories 
 are, it is said, not to be used for patients. Per- 
 haps not at first, but we know by dire experience 
 in our own country what this intention comes to 
 in the long run, when the increase of population 
 presses upon supply of asylum accommodation ; 
 and at New York I saw a great number of luna- 
 tics crowded under the influence of such pressure 
 into very miserable attics. The new asylum for 
 New Jersey is indeed a magnificent building, and 
 very creditable to the liberality of the State 
 authorities, but I should have liked it better if its 
 altitude had been decreased by two stories, and 
 no space had been provided for the possible over- 
 crowding of inmates into parts of the building not 
 
FOR THE INSANE IN AMERICA. I/ 
 
 originally intended for occupation. Our idea of 
 the liberality of the authorities in providing such 
 handsome buildings will be enhanced when we re- 
 flect that the cost of building in the United States 
 is more than one-third greater than it is England, 
 a fact which I state upon the authority of the 
 architect of the New Jersey asylum, by whom it 
 has been carefully investigated. At Buffalo a 
 third asylum for the State of New York is being 
 erected on plans which pleased me extremely. The 
 building is of three, two, and one stories, and the 
 different wards fall back rapidly en echelon, leaving 
 the central offices prominently in advance. The 
 wards are connected with each other by semicircular 
 glass-covered passages only fit for use as passages, 
 and not for occupation. The plans, which have 
 been devised by Dr. John Gray, of Utica, seem to 
 me to combine the advantages of an asylum con- 
 structed in separate blocks with a fine frontage, 
 better than any others which I have seen. The 
 plans of a new asylum for female patients in the 
 district of Columbia have been prepared by Dr. 
 Nichols, which resemble in general idea the plan 
 of the new asylum at Buffalo, but the buildings 
 connecting the blocks are intended to contain a 
 number of single rooms, and I think in this re- 
 spect they are not quite so good, because the dif- 
 ferent blocks will not be so completely isolated 
 from each other. However, this system of separate 
 
1 8 NOTES ON ASYLUMS 
 
 blocks, of which I believe myself to be the ori- 
 ginator, has been for many years a particular 
 hobby of mine, and perhaps the plans of Dr. 
 Nichols provide for as much separation as would 
 content most other alienists. 
 
 The Willard Asylum for chronic lunatics 
 chargeable to the State of New York is a pavi- 
 lion asylum with a large central block for such 
 patients as need to be kept under the immediate 
 observation of the medical officers. I am sorry to 
 say that I did not go over this asylum, but I heard 
 from many of my professional brethren the highest 
 encomiums on its management, and I am informed 
 that the block system gives entire satisfaction. As 
 a receptacle for chronic lunatics it seems to me to 
 be a mistake on account of its remoteness from 
 the great centres of population. It is quite in the 
 west of the immense State of New York, and 300 
 miles from the city, and a considerable distance, 
 125 miles, from the great State Asylum at Utica. 
 A case of puerperal mania, or other acute mental 
 disease, arising at Seneca, would have to be taken 
 past the asylum on a long journey to Utica to be 
 treated. Moreover, the distance from the populous 
 parts of the State must, and, as I learnt on in- 
 quiry, actually does prevent the friends and rela- 
 tions of the patients from visiting them. Difference 
 of opinion has existed among ourselves as to 
 whether it is advisable to separate chronic and 
 
FOR THE INSANE IN AMERICA. JQ 
 
 incurable lunatics from others, but I think we 
 should all agree that it was not desirable to place 
 the Caterham institution at Penzance. 
 
 To return to the subject of asylum plans. The 
 governors of the McLean Asylum at Boston have 
 determined to rebuild their excellent institution, 
 crowded out from the environs of the city, on the 
 separate block or pavilion system, and they have 
 recently sent their accomplished architect, Mr. 
 Folsom, to this country to gather information 
 by the inspection of our institutions. I am afraid 
 that in the matter of this particular form of 
 architecture his opportunities of inspection were 
 but meagre. With the exception of Caterham, 
 Leavesden, and the new asylum for Lancashire 
 at Wigan, I do not know that we possess any 
 institutions constructed on this plan, which, 
 however much it may be advocated- by medical 
 men who have most experience in the manage- 
 ment of establishments for the insane, does not 
 seem to conform with the ideas of display which 
 are native to the minds of architects and their 
 employers. Then something has to be allowed 
 for the appropriateness of climate and locality for 
 special forms of building. The most concentrated 
 asylum I ever visited was that at Genoa, where a 
 mass of lunatics sweltered in a building constructed 
 in the shape of a wheel with many spokes ; and 
 the most perfect specimen of a pavilion asylum I 
 
2O NOTES ON ASYLUMS 
 
 have ever seen was the one at Christiania, where 
 the deep snows of a long and severe winter make 
 the separate blocks cold, dreary, and difficult of 
 access. The plan had, without sufficient fore- 
 thought and allowance, been adopted on foreign 
 recommendation, as the non-restraint system also 
 had been adopted, with the singular modification 
 that the refractory wards were provided with gal- 
 leries for the safety of the attendants. This was 
 seen by me in 1869, and I trust that since that 
 time further experience has suggested important 
 ameliorations. 
 
 The Americans have no central authority of 
 large and general experience, like our Commis- 
 sioners in Lunacy, to guide them in the formation 
 and management of their asylums ; but, in default 
 thereof, they make large use of the special know- 
 ledge of their medical officers, and in this manner 
 they attain a high degree of success, as in the 
 plans before mentioned of Dr. Gray and Dr. 
 Nichols. 
 
 Each State acting on its own laws and judging 
 of its own requirements in the matter of provision 
 for the treatment of the insane, it can be no oc- 
 casion for surprise that great divergence of prac- 
 tice exists. Thus the State of New Jersey, having 
 already an asylum at Trenton accommodating 500 
 insane patients, is now completing the new asylum 
 at Morristown calculated to accommodate 800 
 
FOR THE INSANE IN AMERICA. 21 
 
 lunatics, " the policy of the State being to make 
 ample provision for every insane person in it." 
 In Missouri they have asylum accommodation for 
 1300 inmates, "leaving 700 or 800 without the 
 instrumentalities enlightened humanity has de- 
 vised." In Virginia "we have been unable to 
 keep the gaols clear of ail males : we hope to have 
 
 the gaols clear of females soon Some 350 
 
 or 400 chronic cases are scattered throughout the 
 State at home or in the gaols." In Maryland 
 "the insane population is 750." The State has 
 provided the accommodation for 250, and " 90 or 
 100 are scattered between almshouses and county 
 gaols." In North Carolina " we have nearly I ooo 
 insane of both sexes and all colours, with accom- 
 modation for about 250 of them, if we can call 
 our crowded condition accommodation ;" and so on. 
 I quote from the reports made by the superinten- 
 dents of the different State asylums to the meeting 
 of American superintendents of the insane at Au- 
 burn, the sufficiency of asylum accommodation vary- 
 ing, as it would appear, to a great degree with the 
 wealth and prosperity of the different States. In 
 Ohio, Dr. Gundry stated, 75 per cent, of the 
 general taxation of the State " has been spent in 
 building and supporting the benevolent institutions, 
 in which are included the insane, blind, deaf and 
 dumb, and idiotic." It is abundantly evident, 
 from the reports of these gentlemen, that the 
 
 C 
 
22 NOTES ON ASYLUMS 
 
 people of the country at large, whether they be- 
 long to States which are prosperous and wealthy, 
 like New Jersey, or are depressed and impoverished 
 by war and its results, like North Carolina, are 
 alive to the duty of providing sufficient accommo- 
 dation for their insane, however much in the 
 latter instances performance may lag behind 
 desire. 
 
 There is, however, one painful reflection when 
 one hears of the large sums appropriated to this 
 purpose, and the discouraging remands which 
 exist, that the public money is not expended 
 wisely, nor always even honestly. The President 
 of the Association, Dr. Nichols, remarked on this 
 point that one of the conditions which are "neces- 
 sary to secure State provision for the insane was 
 " confidence on the part of the people and their 
 representatives that the money appropriated to 
 establish and maintain institutions for the insane 
 will be economically and honestly expended. The 
 politicians, it appears to me, bring such enterprises 
 into disrepute by the drafts they make upon the 
 appropriations for the establishment of institutions 
 for the insane, in the shape of advantageous con- 
 tracts and sinecure places for their political sup- 
 porters, by which the cost of such institutions has 
 been greatly enhanced." This I have myself 
 found to be the public feeling. Speaking to an 
 eminent banker in. New York of the state in which 
 
FOR THE INSANE IN AMERICA. 23 
 
 I had found the city asylums, he replied : " I 
 don't know how it is. They have cost enough, 
 but we never know how the money goes. There 
 is always a tap leaking somewhere? 
 
 The law relating to the admission of lunatics 
 into asylums differs somewhat widely in the 
 various States. In New York, formerly, the in- 
 sane were committed by any judge upon the recom- 
 mendation of any two physicians, or persons calling 
 themselves physicians. The new statutes provide 
 that no physician shall certify for committal to 
 an asylum unless he be a permanent resident of 
 the State, has practised his profession for at least 
 three years, and possesses a diploma from an in- 
 corporated medical college. He must also obtain 
 a certificate of qualification from a judge of a 
 Court of Record to whom he is personally known. 
 This law, so much more stringent than our own, 
 will tend to form a class of medical men duly 
 qualified to exercise with knowledge and judgment 
 an important and often difficult social duty. In Mis- 
 sissippi, a law, passed last session, provides that " in 
 the admission of patients the sworn certificate of 
 two physicians, containing a full description and 
 history of the case, shall first be sent to the 
 superintendent, who grants admission to the most 
 deserving." In Illinois also there have been some 
 changes in the laws for admitting patients. All 
 patients are now admitted on the verdict of six 
 C 2 
 
24 NOTES ON ASYLUMS 
 
 men, one of whom must be a physician. These 
 are all new laws on the subject passed in the last 
 session of State Legislatures. 
 
 In the immediate neighbourhood of the Borough 
 Asylum at Boston I visited what we should call 
 the Idiot Asylum, but which there enjoys the 
 more descriptive and accurate appellation of the 
 School for Children of Weak Mind. It is under 
 the control of Dr. Howe, of world-wide reputation, 
 who visits it at all hours of the day and almost of 
 the night, and takes a lively interest in it. The 
 building is a wooden one of one story with a 
 basement, but the rooms are light, airy, and cheer- 
 ful, and I was forcibly struck by the space, com- 
 fort, and convenience of an institution which had 
 paid a very small tax to architects and builders. 
 It is under the immediate superintendence of a 
 matron, with a staff of female teachers. I only 
 saw one male teacher, who instructed and led the 
 boys in their gymnastics, commencing from lessons 
 in simple walking on a plane surface and walking 
 upon a ladder placed horizontally on the floor, and 
 ending in audacious pranks which made me giddy 
 to look at. The children were well fed, well 
 clothed, and in fine health, and they were evidently 
 under the most kind and encouraging treatment. 
 Their mental and physical education appeared to 
 me to be excellent, and the staff of female teachers 
 manifested that enthusiasm in the cultivation of 
 
FOR THE INSANE IN AMERICA. 25 
 
 this thin and poor human soil without which it is 
 impossible that it can be made to bear even the 
 smallest fruit. 
 
 Another institution of the same kind which I 
 subsequently visited was the Asylum for Imbecile 
 and Idiot Children belonging to the State of New 
 York, situated at Syracuse, and under the super- 
 intendence of Dr. Wilbur. This is a good sub- 
 stantial building, with a farm attached, in which 
 the robust boys do a considerable amount of work, 
 which is not only of financial service to the asylum, 
 but affords a most valuable means of training the 
 children to useful work. The painstaking manage- 
 ment of the institution and the skilful treatment 
 and education of the inmates appear to be very 
 similar to those practised at Boston and in our 
 own best asylums. 
 
 They have an admirable institution for the blind 
 at Boston, also under Dr. Howe's superintendence, 
 which I visited for the sake of seeing, in Laura 
 Bridgeman, the greatest triumph of patient skill 
 that has ever been attained, in the education, or 
 rather the development, of a human mind which 
 nature has left in default of its instruments. The 
 history of this most interesting woman, and the 
 system of culture by which, with inexhaustible 
 patience, she was rescued from the dark night of 
 sensationless life, has been written by Dr. Howe 
 himself in his last report, and may be found by 
 
26 NOTES ON ASYLUMS 
 
 English readers in the number for January last of 
 the Journal of Mental Science. When two years 
 old she lost her senses by scarlet fever ; and when 
 found by Dr. Howe at six years of age she was 
 totally blind and deaf, and had only a very indis- 
 tinct sense of smell. She is now an amiable and 
 cheerful woman, with a bright expression of vary- 
 ing intelligence in her pleasing features, and 
 capable of enjoying life by ready intercourse with 
 all who know her language, and with others 
 through them as interpreters. She even speaks a 
 few words vocallyand plainly, as "doctor," "money," 
 &c. ; but the rapidity of her finger talk (which is 
 not that visible sign language in common use with 
 deaf mutes, but the contact of finger-points on the 
 palms and fingers, which is felt, not seen), and the 
 amount of her knowledge, not only of realities, but 
 even of generalised and notional knowledge, are 
 truly astonishing. She started conversation with 
 me by asking questions about Victoria, avoiding 
 the word Queen. Was she a good woman ? Was 
 she not very extravagant ? Was it really true that 
 she kept forty horses ? That must be extrava- 
 gant ; &c. &c. She was greatly interested about 
 the " woman" Victoria, and what I told her about 
 the Queen's simple mode of life outside State 
 requirements. I was told that Dr. Howe had pur- 
 posely abstained from any attempt to impart to 
 her religious notions until he thought her mind 
 
FOR THE INSANE IN AMERICA. 2? 
 
 had become mature enough to accept them ; but 
 that, during his absence in Europe, she began, 
 of her own accord, to make inquiries on the sub- 
 ject, and that she rapidly acquired not only general 
 religious notions, but even possessed herself of the 
 knowledge of the shades of belief which serve to 
 divide and distinguish the different sects of Chris- 
 tians at Boston, and decided for herself which of 
 them was most acceptable to her own mind, and 
 has stuck to her choice. It would seem that in 
 the brain of a New England Puritan the tendency 
 to form religious ideas was an hereditary function 
 which could not be suppressed, though, in early 
 infancy to widen Milton's words " Knowledge 
 at two entrances was quite shut out." Laura can 
 read rapidly and wrjte well. She wrote on a slip 
 of paper for me, in quaint plain characters, " Grace 
 be with you. Laura Bridgeman." Also she can 
 sew, knit, and braid ; occupy herself in simple 
 housework sweeping floors, dusting furniture, 
 making beds ; and in Dr. Howe's words, " in all 
 these things she succeeded so well that she is now 
 capable of earning a livelihood as assistant to any 
 kind and intelligent housekeeper who would accom- 
 modate herself to Laura's ways." AJ together, this 
 poor blind and deaf mute is one of the most culti- 
 vated of human beings, 
 
 Another individual, interesting to the psycho- 
 logist, whom I saw at Boston, was the boy mur- 
 
28 NOTES ON ASYLUMS 
 
 derer Jesse Pomeroy. Alas, that science should 
 have to couple in one common interest beings so 
 unlike as this personification of cruelty whether 
 he be sane or insane with the gentle, affectionate, 
 and suffering woman whom I have just described ! 
 the depraved with the deprived. The Governor of 
 the State asked me to see and examine the boy, 
 although I told him that I should not like, as a 
 foreigner, to express an opinion which might 
 influence the course of justice. Therefore, in com- 
 pany with Dr. E. H. Clarke, one of those culti- 
 vated and sound-thinking men who in America 
 give so high a tone to the profession which they 
 adorn and lead, I went to the gaol, and there 
 thoroughly examined the condemned criminal for 
 nearly an hour. Dr. Clarke and I quite agreed in 
 the opinion we formed as the result of this exami- 
 nation, which opinion it may well be that he, as a 
 citizen of the State, has been called upon to com- 
 municate to the Governor, with whom rests the 
 duty of execution or the prerogative of mercy. A 
 curious law exists in Massachusetts, that no cri- 
 minal shall suffer execution until a year has passed 
 after his condemnation ; and the Chief Justice 
 assured me that the principal reason of this law 
 was to provide against the possibility of new evi- 
 dence turning up "which might tell in the con- 
 demned man's* favour. That, no doubt, would be 
 the reason which would tell most forcibly on the 
 
FOR THE INSANE IN AMERICA. 2Q 
 
 mind of a lawyer ; but I think there may be other 
 reasons which might lead our legislators to con- 
 sider whether an extension of time between con- 
 demnation and execution would not be logical and 
 useful in our own country. The first of these is, 
 that it would provide an opportunity for real pre- 
 paration by change of disposition ; but on this I 
 shall not dwell, as it belongs to religious and 
 moral elements of thought. Another reason, 
 which will seem weighty to psychologists, is, that 
 the Massachusetts law gives time for the thorough 
 investigation of the criminal's state of mind, and 
 would render it impossible for a man to be hanged 
 who was really of unsound mind, unless, indeed, he 
 were hanged as a man of unsound mind, which was 
 avowedly done by Baron Bramwell in the case of 
 Dove. I do not know whether immediate or 
 deferred execution would be the greater punish- 
 ment to the sufferer. This would probably vary 
 with different temperaments and states of mind. 
 An imaginative coward would suffer immensely by 
 the prolonged expectancy of his doom, while to 
 many another condemned man the prorogation of 
 his final penalty would be esteemed a precious 
 privilege, as affording sufficient opportunity to 
 make real peace between his guilty and affrighted 
 soul and his offended God. As- an example to 
 the great majority of evil-doers, it would seem pro- 
 bable that to defer execution would increase its 
 
30 NOTES ON ASYLUMS 
 
 efficacy, for nothing strikes the mind of the cri- 
 minal classes more forcibly than the slow, cold, 
 impassive authority of the law, and nothing ex- 
 cites their imagination so much as the state of the 
 living man condemned to death. A sudden death 
 has few terrors, or we should have no wars, and 
 dangerous employments would have to be more 
 highly remunerated than they are. Jesse Pomeroy's 
 crime or crimes was the murder of two children by 
 torture, inflicted by numerous stabs with a pocket 
 knife. The first murder was only discovered on 
 the 1 commission of the second after the interval of 
 a year. The effect of these crimes on the public 
 mind was such that the women of Boston in very 
 great numbers signed a petition that the criminal 
 might be executed. This strange public act of 
 the women of perhaps the most highly educated 
 and civilised city in the world was no doubt due 
 to the offended feeling of maternity, the victims 
 having been children. 
 
 I cannot quit Boston and its kindly and culti- 
 vated folk, who made my visit there so happy 
 and interesting, without bidding it and them a 
 word of affectionate farewell. They love the old 
 country, though they are proud of having taken 
 the first step to break away from it. I was with 
 them 'when they celebrated the centenary of 
 Lexington, and the remembrance had no bitter- 
 ness. And if they are proud of the past they may 
 
FOR THE INSANE IN AMERICA. 31 
 
 well be so of the present, for on that day I mixed 
 with the great crowd of 150,000 New Englanders, 
 the outpouring of the city and the gathering of 
 the country into the villages of Lexington and 
 Concord, and I sought for, but did not discover, 
 one man the worse for drink. In all that vast 
 crowd, which I may even fairly call a mob, for it 
 was a most disorderly assembly, there were no 
 drunkards nor roughs, and the only policemen to 
 be seen were a few fat, slouching fellows round the 
 President, who could not, however, prevent the 
 mob from stealing his train, so that he had to wait 
 for another. If there had been the average Eng- 
 lish element of roughs and drunkards such a crowd 
 must have ended in a riot, for the people did just 
 what they pleased without interference. They 
 climbed on and jumped off the roofs of railway 
 trains, clambered in at the car windows, rode on 
 the cow-catchers, surged over the roads and 
 through the processions, and yet all in good temper, 
 and stopping short of any positive mischief. All 
 the day long I saw no quarrel or fight, heard no 
 angry words even ; there were no breaches of the 
 people's peace, and the behaviour of this curious 
 crowd was to me the strongest revelation of what 
 sobriety, culture, and self-respect may attain to in 
 the deepest and thickest layers of the population. 
 
 As for Boston itself, I wish we could steal the 
 beautiful old city, and float it over to our shores 
 
32 NOTES ON ASYLUMS 
 
 with its cow-path streets, with its schools where 
 every child is compelled to receive a good edu- 
 cation whether the priest likes it or not, with 
 its population so greedy of knowledge that 
 they work the free libraries as eagerly as ours 
 would be likely to work free gin-shops ; and, 
 above all, with its rich cornice of poets, scholars, 
 and philosophers. Before we unmoored the old 
 place, we should have to drive in from the 
 suburbs Emerson, Longfellow, Eliot, Jarvis, and 
 others ; but Dr. Wendell Holmes, who is poet, 
 philosopher, and scholar, lives in the heart of the 
 city, literally and metaphorically ; he is the raciest 
 of humourists and most genial of citizens. 
 
 The National Asylum for the Insane, under the 
 superintendence of Dr. Charles Nichols, crowns 
 the heights to the eastward of the Anacosta 
 branch of the Potomac, some mile and a half from 
 the Capitol at Washington. It is a fine building, 
 in the castellated style, of red sandstone, with 
 beautiful grounds, which, however, like those of all 
 American institutions, of whatever kind, are not in 
 that trim condition to which English eyes are 
 accustomed. Not much labour is thrown away 
 in America on such unremunerative employments 
 as mowing grass-plots and weeding walks. The 
 gardens, however, are excellent and extensive, and 
 there is a very fine farm, and the best dairy of 
 Alderney and Guernsey cows I ever saw. 
 
FOR THE INSANE IN AMERICA. 33 
 
 The asylum was originally intended to provide 
 accommodation only for the insane of the army 
 and navy and of the district of Columbia, but the 
 insane of the preventive service and of the mer- 
 chant marine have subsequently been admitted. 
 There is proper accommodation for 575 lunatics, 
 but the actual number under treatment was 750 ; 
 yet the wards did not appear to me to be much 
 overcrowded, probably owing to parts of the 
 building not originally intended for occupation 
 having been taken into use. The proportion of 
 men to women patients was seven to two. New 
 buildings for 250 female patients are about to 
 be erected on a site about the third of a mile 
 from the present buildings, the estimated cost, 
 with furniture, being 350,000 dollars, or 28o/. 
 per patient, which does not include ground, 
 or ground work, which in America is called 
 grading. 
 
 Dr. Nichols is assisted by three assistant-phy- 
 sicians, and is under the control of a small com- 
 mittee, including the Surgeon-General of the Army 
 and the medical head of the Navy. The wards 
 were light, cheerful, and cleanly, and were well 
 furnished. Those for the women were especially 
 cheerful and prettily decorated. Among the men 
 just a little military discipline had been preserved, 
 so that they formed in double line and stood at 
 attention when called upon to do so. They were 
 
34 NOTES ON ASYLUMS 
 
 certainly very orderly and tranquil, and, as a con- 
 noisseur in such matters, I liked the look of them. 
 They were, I should say, cheerful and fairly com- 
 fortable, kept in order, but not oppressed. They 
 were well-clad and looked well-fed, and the com- 
 missariat department appeared to me to be very 
 liberally and skilfully administered. Throughout 
 the asylum there was no patient in seclusion, 
 but I counted no less than eight in strait- 
 waistcoats, not one of whom appeared to be 
 suffering from excitement. They were probably 
 patients from whose freedom of motion danger was 
 apprehended. They were sitting quietly enough 
 on the ordinary settles, though I observed that in 
 two or three instances the strait-waistcoat was 
 attached to the back of the bench. I must confess 
 that I did not ask for any explanation as to the 
 employment of this restraint, nor shall I make 
 any remarks upon it in this place beyond the 
 observation that it must have been imposed 
 because it was thought the best mode of treatment. 
 The whole condition of the asylum would at once 
 refute the idea that it was in any degree attri- 
 butable either to negligence or disregard of 
 suffering. Everything in the asylum bespoke 
 minute and skilful care in the treatment of the 
 patients ; and here were eight out of 750 patients 
 under mechanical restraint at the same time. No 
 one in the States enjoys a higher reputation than Dr. 
 
FOR THE INSANE IN AMERICA. 35 
 
 Nichols both as a skilful psychologist and as a 
 humane and thoughtful physician, and therefore I 
 trust he will forgive me if I say that he seems to 
 be the best person I know to ask for explanations 
 why his practice in the use of restraint differs so 
 much from what we consider right in this country. 
 Separate from the main building is a smaller 
 one, occupied by insane patients of the coloured 
 race. There was some amount of boisterous and 
 noisy talk, which was mostly merriment, in these 
 wards, distinguishing them, as might be expected, 
 from those occupied by the sedate Americans. 
 The coloured man in the States is very rarely a 
 negro : he is a man with negro blood in him, that 
 is all. I asked in vain of my friends at Washing- 
 ton, where the coloured element in the population 
 is very large, to point out to me a full-blooded 
 negro. When I pointed out some individual, 
 either in the asylum or the streets, who appeared 
 to me very black and prognathous, I was always 
 told that he was not full-blooded. To see the real 
 negro one must go quite south, and even there he 
 is by no means common. The dark element, 
 however, seems to be readily recognised where, to 
 one ignorant of the marks of race, there is no sign 
 of it. I spent a very pleasant forenoon in examin- 
 ing the school for coloured girls, 700 of them, 
 many of whom were quite fair, and I was, 
 astonished when the head mistress assured me 
 
36 NOTES ON ASYLUMS 
 
 that, with one exception viz., the French teacher, 
 every one in the building, both pupils and 
 teachers, including herself, were coloured people. 
 
 After Washington I visited the Asylum for 
 Criminal Lunatics for the State of New York at 
 Auburn a very well-conducted institution, having 
 only one defect, but that a very great one. It is 
 a prison rather than an asylum, with high walls 
 and small courtyards, adjacent to the great 
 Auburn Penitentiary. The governors are increas- 
 ing its size by the addition of some excellent new 
 wards ; but why they did not remove it from the 
 town into the country, where excellent sites and 
 abundance of land are so easily procurable, it 
 would be difficult to surmise. The inmates of an 
 asylum of this kind are, with very few exceptions, 
 incarcerated for life, and many of them have 
 enough intelligence to enable them to enjoy life if 
 the conditions of life in which they are placed are 
 not made too painful by monotony or repression ; 
 and if they are really innocent of crime on account 
 of insanity, it is quite due to them that their life- 
 long imprisonment should be made as little puni- 
 tive as it is possible to make it, and to do so an 
 institution in the country, with garden, free air, 
 and space, is absolutely indispensable. 
 
 The Lunatic Asylum for the State of New 
 York at Utica, which I visited after leaving 
 Auburn, and where I spent some instructive and 
 
FOR THE INSANE IN AMERICA. 37 
 
 most agreeable days, is better known to the out- 
 side world than any other similar institution in the 
 country. This no doubt is due to some extent 
 to its being the asylum of the Empire State, 
 established in a part of the country long ago 
 settled, and, in comparison to many other parts of 
 the States, of almost ancient civilisation. But to a 
 far greater degree its reputation is due to the genius 
 and enterprise of Dr. John Gray, its well-known 
 superintendent, who has for many years made 
 it a brilliant school of psychology and of mental 
 pathology. Dr. Gray and his assistant-physi- 
 cians edit and publish the American Journal of 
 Insanity an enterprise which has been of 
 the highest value in extending the knowledge 
 of our science. One of his assistants, Dr 
 Theodore Deecke, devotes his time exclusively to 
 pathological investigations ; and is engaged at 
 the present time in producing photographs of cere- 
 bral and spinal sections of wonderful size and 
 accuracy. The positive and relative nature of 
 drugs in the treatment of insanity is another 
 subject which is systematically investigated 
 at Utica ; and, altogether, the utilisation of the 
 material for scientific inquiry which the insti- 
 tution affords presents a remarkable similarity 
 to the great school of mental science which 
 has been founded in Yorkshire by Dr. Crichton 
 Browne. 
 
 D 
 
38 NOTES ON ASYLUMS 
 
 The wards were large, cheerful, and well-fur- 
 nished and decorated. The asylum has been 
 built piecemeal ; but the original building, with its 
 imposing Doric portico of granite, is a lasting 
 testimony to the liberal ideas of its earliest con- 
 structors. A very pleasant feature of the newer 
 wards are the glass rooms in which they terminate. 
 They are the exaggeration of bay-windows, and 
 they not only add greatly to the light and cheer- 
 fulness of the whole ward, but form most comfort- 
 able and agreeable lounging or working rooms. I 
 assisted by my presence at some capital amateur 
 theatricals, in which the actors were patients and 
 attendants, and the audience of lunatics were 
 neither dull nor disorderly. The recreation-room, 
 however, is not worthy of the asylum, and the 
 governors would do well to provide a better 
 one. However, the accommodations all round 
 are excellent ; and if it were possible for us 
 to send our best sample of a large asylum, 
 which has done good work for many years, to 
 the Centenary Exhibition, I doubt whether we 
 could very much crow over the one which the 
 Americans might bring to compete with us from 
 Utica. 
 
 The asylum contains 650 patients, more or less 
 {for I forget the exact number), and I was pleased 
 to find that not one patient was either in restraint 
 or in seclusion. I observed one young man in a 
 
FOR THE INSANE IN AMERICA. 39 
 
 -state of great excitement, suffering, indeed, under 
 the restlessness of the most acute mania. He was 
 under the sole charge of two attendants, who were 
 carefully walking about with him, holding him on 
 each side, and I could not refrain from asking Dr. 
 Gray why he did not order him into mechanical 
 restraint, as it appeared to me just the case in 
 which it would be justifiable if in any. Dr. Gray 
 replied that he did not use restraint,* but I found 
 him indisposed to talk on the subject, as he ad- 
 mitted that his practice was not in conformity 
 with the opinions of his professional brethren, and 
 he evidently preferred to treat his own patients as 
 he thought best without opening a blazing ques- 
 tion. As no one was in restraint in this asylum, 
 neither was there anyone in seclusion, and Dr. 
 Gray informed me that for the last eighteen or 
 twenty years the institution had not possessed a 
 shower-bath. 
 
 On a visit to another institution, which I shall 
 not indicate, I was introduced to a young man 
 who was described to me as the supreme authority, 
 his colleagues engaged in business leaving almost 
 all the power in his hands. He was a politician 
 in the American sense of the word, which is not 
 
 * Dr. Gray says, " This is a mistake. We do use restraint. 
 I said we do not use seclusion, and in this differ from some 
 of my medical brethren." American Journal of Insanity. 
 D 2 
 
40 NOTES ON ASYLUMS 
 
 complimentary, and had begun his official career 
 as night watch in a hospital, and the management 
 of the institution over which he held sway pre- 
 sented a remarkable contrast to that of Utica. 
 We have had, and indeed still have, experience of 
 the same kind in England, but in America there 
 is no central authority like that of the Secretary 
 of State, advised by the Commissioners of Lunacy, 
 to overrule the ignorance or parsimony which may 
 prevail in certain localities. 
 
 The asylums and hospitals which I have hitherto 
 mentioned are obviously conducted with enlightened 
 liberality ; but it will now be my task to describe 
 visits to other large asylums, the condition of 
 which is thoroughly discreditable to the com- 
 munities which are answerable for their great and 
 glaring defects. I say to the communities, for in 
 America no man can wholly shunt the blame of 
 public evil on to his neighbour's track ; and if 
 these things are as I shall describe them in the great 
 cities of Philadelphia and New York, why do not 
 the men and women of those cities cry aloud 
 against such cruel shortcomings in the administra- 
 tion of their charities until the evil is abated and 
 finally removed ? The numerous and excellent 
 chartered hospitals for the insane in the States 
 afford evidence nay, full proof of the worthy 
 feeling of a large portion of the wealthy members 
 of the community towards the mentally afflicted ; 
 
FOR THE INSANE IN AMERICA. 41 
 
 and the costly and commodious State asylums, 
 conducted in a spirit of generous wisdom, testify 
 to a keen appreciation of duty on the part of the 
 population of the country at large. How is it, 
 then, that the insane poor of these most important 
 cities are left in a condition which no American 
 true to his country's honour and to the instincts of 
 his race can think of, if he knows it, without 
 regret and dissatisfaction ? The explanation 
 which I have heard is that the politics of the 
 cities are more corrupt than those of the States, 
 and tend to the selection of coarser instruments of 
 the popular will ; and if this be so, the most help- 
 less and heavily afflicted of their citizens have 
 more to fear from the degradation of authority to 
 its lowest level than any other class, for they have 
 no power in the social scramble. The state of 
 things which I shall now describe will no doubt 
 be thought to justify the severest censures of the 
 medical press, and if I have claimed exemption 
 from some of these censures in the pages of a 
 journal honoured for its long and able advocacy of 
 the rights of the insane to humane and skilful 
 care and treatment, I have only intended to do so 
 on behalf of the skilful and the humane. That I 
 have no wish to shield the evil results of incom- 
 petence or of ill-judged parsimony from their 
 merited exposure and reproof, the following nar- 
 rative will abundantly testify. 
 
42 NOTES ON ASYLUMS 
 
 The insane poor of the city of Philadelphia are 
 maintained in one department of a huge collection 
 of buildings called the Blockley Almshouses, con- 
 taining altogether about four thousand inmates, and 
 consisting of the lunatic asylum, a general hospital, 
 and a poorhouse proper. I was taken over the 
 asylum by Dr. Isaac Ray, who had been one of 
 the governors until, at the last election, he was 
 ejected from office. This asylum, I was informed,, 
 was constructed to contain five hundred insane in- 
 mates, but at the date of my visit last spring it 
 did actually contain eleven hundred and thirty 
 patients, and the overcrowding was consequently 
 frightful. One result of this overcrowding was 
 that, on attempting to make some estimate of the 
 sleeping accommodation, I was informed that at 
 night beds were strewn on the floor in the corridors 
 and on every available space of flooring, so that 
 there was no place without beds, some upon bed- 
 steads, and some upon the floors. I asked Dr. 
 Richardson, the medical superintendent, what the 
 state of the air might be when they opened the 
 doors in the morning. The degree to which it 
 must be hot, fetid, and morbific, is somewhat 
 sickening to think of. I saw many patients in 
 strait-waistcoats, I cannot tell how many, but on 
 the men's side a considerable number ; and the 
 patients there were very noisy and turbulent. I 
 saw no occupation and no means of occupation. 
 
FOR THE INSANE IN AMERICA. 43 
 
 except a few women engaged in needlework. 
 There were no grounds for exercise, nor any 
 airing-court fit to be called such, but only two or 
 three small high-walled spaces bare of all con- 
 venience and comfort. But the separate ward 
 provided for excited female patients, and called, 
 according to American custom, the lodge ward, 
 was the most remarkable feature of this asylum, 
 I was informed that it was constructed to contain 
 nineteen excited patients in single rooms, but that 
 at the time of my visit sixty-five patients were 
 actually " accommodated," as they said, in it. It 
 was intended that each patient should have the 
 use of a single room or cell, the dimensions of 
 which, I learn from the subjoined statement by 
 Dr. Ray, are six feet by ten ; and " these lodging- 
 rooms are occupied at night generally by two and 
 frequently by three persons," and all of them, as I 
 was informed, were regularly put into strait-jackets 
 to prevent mischief during the night. 
 
 The counterpart of the above statement was 
 made by me to the American Association of 
 Superintendents of Asylums, and has been pub- 
 lished in America without contradiction or extenua- 
 tion ; but yet it seems to me so incredible that I 
 must ask to confirm its accuracy by the remarks 
 made by Dr. Ray himself, in a paper read by him 
 before the Social Science Association of Phila- 
 delphia in 1873, in which, speaking of this 
 
44 NOTES ON ASYLUMS 
 
 asylum, he remarks : " How far the first two 
 requisites air and room have been provided in 
 the buildings occupied by the insane at the alms- 
 house, a few facts will show. The space occupied 
 by these patients and their attendants, while 
 within doors, is not, I may safely say, more than 
 half of what is declared by competent authorities 
 to be the lowest limit compatible with the hygienic 
 conditions of a hospital. An accurate calculation, 
 for which I have not the requisite figures at pre- 
 sent, would probably show that one-third of the 
 proper space would come nearer the truth than 
 one-half. Most of the lodging-rooms are six feet 
 by ten, and are occupied at night generally by 
 two, and frequently by three, persons. The rest 
 of the patients are disposed of in large dormitories 
 containing about thirty beds, with a few more 
 placed directly on the floor. Of course these 
 patients disturb one another, as persons less ex- 
 citable would, and for many sound, regular sleep 
 is out of the question. With those in the single 
 rooms the case is still worse, for they not only 
 breathe a highly vitiated air, but they are in 
 danger from the destructive propensities of one 
 another. If homicide is not committed every 
 night in the year, it certainly is not for lack of 
 fitting occasion and opportunity. Twice within 
 the last few months it was prevented by the 
 merest accident. Now, it is well understood by 
 
FOR THE INSANE IN AMERICA. 45 
 
 medical men that if there is one bodily condition 
 more restorative in mental diseases than another, 
 it is sleep, and here we see how it is provided for at 
 the Blockley Almshouses ? .... In regard to 
 means of occupation, the deficiency could scarcely be 
 greater, while its ordinary consequences are ren- 
 dered all the more deplorable by the crowded 
 state of the house. There can be few more 
 pitiable spectacles than that witnessed there every 
 day, of hundreds of men overcharged with nervous 
 excitement, whose restless movements are con- 
 fined to the limits of a narrow hall, and of as 
 many more, silent and depressed, crouching down 
 in corners and by-places all of them worrying 
 one another, and speedily losing from sheer inaction 
 whatever of mind their disease may have left."* 
 
 * From the October number, 1876, of the American Journal 
 of Insanity containing a Report of the Proceedings of the Asso- 
 ciation of Superintendents of American Asylums, it appears 
 that no improvement has taken place in the condition of 
 this wretched and disgraceful receptacle for the insane since 
 my visit last year. Dr. Isaac Ray, indeed, says that, " Now 
 under a storm of agitation raised by the public press, councils 
 put up a series of shanties, totally unsuitable for the purpose, 
 to take in about two hundred more. What we ought to have 
 is strictly a State institution. The insane poor are the wards 
 not of the city but of the Commonwealth. This is the relation 
 which must be assumed before we can expect for the insane 
 the kind of care that they need. As long as the institution is 
 under the charge of our municipal government, just so long 
 will it be a field for jobbery and the meanest parsimony." 
 
 " One dollar and eighty cents per week is the rate at which 
 
46 NOTES ON ASYLUMS 
 
 The asylums for the insane poor of the city of 
 New York are situated upon islands in the har- 
 bour ; the old asylum, now occupied exclusively 
 
 the city of Philadelphia discharges its duty to the insane 
 poor a city which is spending millions of dollars for parks, 
 public buildings, and other things not called for by actual 
 necessity." 
 
 By the Commonwealth I apprehend that Dr. Ray means 
 the State, but, in my opinion, he ought to extend his dictum^ 
 and avow that the insane poor ought to be the wards of the 
 United States, that is to say, of the nation at large, so far, at 
 least, as the provision of some central controlling authority. 
 Dr. Ensor, the Superintendent of the State Asylum for South 
 Carolina, said at this very meeting that financial embarrass- 
 ments of the institution under his charge had resulted "from the 
 reckless extravagance and shameful frauds and peculations 
 on the part of our State administrations. Appropriations 
 have never been promptly paid. As a usual thing they have 
 been diverted into other channels, to gratify the greed of 
 unprincipled and unfeeling politicians, thus compelling the 
 asylum to subsist entirely upon credit for more than two- 
 thirds of every year. Our employds go unpaid from year to 
 year, and the merchants who have fed and clothed our in- 
 mates have had to wait in some instances for years for their 
 money. Often during these years of embarrassment our 
 inmates have been upon the verge of starvation." 
 
 In other States great extravagance in the erection of 
 asylum buildings has been the result of corrupt State manage- 
 ment. There is no reason but a theoretical one why a 
 national Commission of Lunacy should not have the same 
 supervising and regulating power over the separate States in 
 America as the English Lunacy Commission has over the 
 English counties, which are in some instances more populous 
 and wealthy than States, and which have to find the money 
 and the executive administration of asylums for their insane 
 poor. 
 
FOR THE INSANE IN AMERICA. 47 
 
 by female patients, upon Blackwell's Island, and 
 the new asylum for men upon Ward's Island. I 
 visited the men's asylum first, by invitation and 
 in company with some eight or ten superintendents 
 of other lunatic asylums, who had been attending 
 the annual meeting of their specialty. This insti- 
 tution was erected four years ago, at a cost of 
 2oo,ooo/., and was designed to accommodate 434 
 patients, but at the date of my visit, and without 
 any increase of accommodation, 673 patients were 
 crowded into it. Dr. Macdonald is the chief resi- 
 dent physician having the medical charge of the 
 patients, but the main executive duties of the insti- 
 tution are entrusted to a Warden, who is not a 
 medical man, but who is virtually the chief officer. 
 Medical responsibility is therefore at its lowest ebb. 
 Architecturally the asylum, of variegated brick, is. 
 very handsome, but a comparison of its interior 
 with its outward show reminded me of some pre- 
 tentious structures in which ostentation has ex- 
 hausted the means of the builders, and which are 
 significantly called Follies. The corridors were 
 uncleanly, ill-furnished, and gloomy, all the win- 
 dows being thickly protected with prison-like 
 lattice. There were no enclosed grounds or court- 
 yards of any description. Those patients who- 
 were strong and orderly enough to perambulate 
 the island under the charge of attendants got occa- 
 sional exercise in the open air ; but the other 
 
48 NOTES ON ASYLUMS 
 
 inmates were confined to the dismal interior of the 
 building, and I saw no provision of means for 
 occupation or amusement. The patients appeared 
 to me to be ill-cared for, badly clad, and poorly 
 nourished. They lounged listlessly about the un- 
 swept, barely furnished corridors, and were almost 
 as frequently crouching on the floor as seated on 
 a bench. Their clothing was dirty, worn, and of 
 the commonest material, and seemed to me insuffi- 
 cient for the purposes of mere warmth and com- 
 fort. I observed that many of the patients had 
 no stockings or socks between the skin and the 
 shoe-leather. The idea that the patients were 
 poorly nourished was, I own, a mere impression 
 arising from their pallid and emaciated appearance. 
 I know nothing of their dietary, which, indeed, I 
 have found to be a rather mysterious subject in all 
 American asylums. I do not know that I ever 
 met with a printed dietary in any American asylum 
 or asylum report. However, in this instance, when 
 asked, in the presence of the many professional 
 brethren who were with me, what I thought of the 
 asylum, I was bold enough to express the opinion 
 that the patients appeared to me to be badly clad 
 and insufficiently fed, and to ask what the weekly 
 cost might be ; and the answer seemed to justify 
 my boldness, for we were informed that the weekly 
 cost was one dollar and thirty cents, or 4^. 4^., 
 or, if calculated in currency, still less. Now the 
 
FOR THE INSANE IN AMERICA. 49 
 
 weekly cost in the asylum for the State of New 
 York is four dollars and a half ; and, on inquiry, 
 I found that the average weekly cost in the State 
 asylums was not under* four dollars, or i6s., which 
 contrasts liberally with the average cost of mainte- 
 nance in this country of IDS. a week for the county 
 and 1 1 s. 8d. for the borough asylums ; the reason 
 thereof being that the high price of clothing and 
 comforts and the high rate of wages more than 
 counterbalance the low price of food in the States 
 as compared with the like expenses in this country. 
 It may well be that some explanation can be given 
 of the difference in the weekly cost of maintenance 
 between four dollars and fifty cents at the asylum 
 for the State of New York, and of one dollar and 
 thirty cents at this asylum for the City of New 
 York ; for I cannot believe that, however accurate 
 my general impression as to the condition of the 
 patients in the latter institution might have been, 
 the whole of this difference could be so accounted 
 for* 
 
 * At the recent meeting of the Association of Superin- 
 tendents of American Asylums before referred to, Dr. A. E. 
 Macdonald, of the New York City Asylum for men, made the 
 following remarkable statement when called upon by the 
 Chair to give an account of the institution under his charge : 
 
 " Mr. President and Gentlemen, with regard to the institu- 
 tion under my care, I am happy to say that I can report very 
 considerable progress since the last meeting of the Associa- 
 tion. You will remember, possibly, that my statement of its 
 
50 NOTES ON ASYLUMS 
 
 After leaving Ward's Island we visited and 
 thoroughly inspected the Asylum for Female 
 Lunatics on Blackwell's Island, under the guidance 
 of Dr. Parsons, the active and devoted superin- 
 tendent, who informed us that the buildings, which 
 
 condition at that time was not a very flattering one. Having 
 come to the conclusion that this condition was largely due to 
 the fact that the medical officers of the institution had unfor- 
 tunately acquiesced, perhaps too readily, in the method of 
 management that had been in vogue there for some time, I 
 determined for myself to try the experiment of telling the 
 plain truth about the condition of affairs, knowing that it 
 would result in one of two ways, either in the improvement 
 of the institution, or its remaining in its then condition under 
 the management of somebody else than myself. I am happy 
 to say that the response on the part of the commissioners to 
 my representations of the condition of affairs was very prompt 
 and very ample. Dr. Ordronaux, the efficient Commissioner 
 in Lunacy of the State, was called in consultation, and a 
 number of changes were made. The one upon which, as we 
 thought, all others hinged, was an alteration in the manage- 
 ment of the institution. Under the old arrangement the 
 office of Warden existed, and to its incumbent were assigned 
 all the executive duties, leaving to the physician simply the 
 medical treatment of patients. This condition of affairs was 
 altered by placing the institution upon the same footing as 
 the State asylums, and giving the medical Superintendent 
 the sole executive authority. Following this, the most im- 
 portant change was perhaps that in the diet of the patients. 
 The dietary scale was very much increased, both in the 
 number of articles allowed and in the quality of the several 
 articles. It was anticipated that this improvement would 
 entail an increased expenditure of ten thousand dollars a-year, 
 and, in fact, the expenditure upon that account was so in- 
 creased, but a corresponding reduction was rendered possible 
 
FOR THE INSANE IN AMERICA. 5 I 
 
 would suffice for the accommodation of 750 
 patients, were actually made to contain 1200. 
 The patients were better clad and seemed better 
 nourished than the male lunatics. Many of them 
 were occupied with needlework, and their general 
 
 in other branches of the expenditure which more than coun- 
 terbalanced this increase. The change was indeed an actual 
 saving to the institution, from the fact that the physicians 
 were not obliged, as before, to have recourse to the drug 
 store and the liquor closet for what they ought to have found 
 in the larder and kitchen. The patients, being better fed, 
 were less destructive, and required less medicine and stimu- 
 lants, and hence resulted a saving in the cost of clothing and 
 different articles of furniture, and for supplies of medicine and 
 liquors, more than equal to the increased expenditure for pro- 
 visions. During the three months following the adoption of 
 this plan, there was a very marked increase in the comfort 
 of the patients, and in their well-being generally, and their 
 letters to their friends were full of praise of the new order of 
 things. Following the change there was a marked increase 
 in the number of recoveries, and what was more decisive, a 
 decrease in the death-rate of the institution of fifty per cent. In 
 the short time that has elapsed since the change was made, 
 the good results have been so conspicuous that I have very 
 little doubt that at the next meeting of the Association I 
 shall be able to make a report more favourable still. 
 
 " While the patients were not starved with the diet they had 
 formerly they were far from being well fed. The best meal 
 they had was their dinner, that was perhaps pretty good at 
 all times, but for breakfast and supper they simply had dry 
 bread and oatmeal, or something of that kind. We now 
 give them hashed meat and such things for breakfast, and 
 fish and dried beef and other relishes for supper, and tea and 
 good butter at both meals. We have also increased the 
 amount of meat and vegetables." 
 
52 NOTES ON ASYLUMS 
 
 state and aspect was far more satisfactory than 
 that of the inmates of what may perhaps be called 
 the brother institution. The asylum, however, 
 was miserably overcrowded ; even attics imme- 
 diately under the roof, and quite unfit for habita- 
 tion, being densely occupied. The refractory ward 
 was, as usual, at some distance from the main build- 
 ing, and here I found myself in a bewildering 
 tumult of noisy and excited women, many of whom 
 were restrained in strait-waistcoats. I observed, 
 however, that this free use of restraint had not 
 been altogether efficacious in preventing such con- 
 flict as leaves behind the tell-tale marks of black 
 eyes and bruised faces. I regret* that it did not 
 occur to me to ask in this or in any other Ameri- 
 can asylum to be permitted to inspect the register 
 of injuries and accidents ; but if such a record be 
 kept, I think it more than probable that a faithful 
 comparison of it with that which the law imposes 
 on our own institutions would clearly prove that 
 non-restraint does not encourage, nor restraint 
 diminish or prevent, the occurrence of injuries 
 from violence. In this refractory ward there was 
 a peculiar arrangement which I have not seen else- 
 
 * At the Annual Meeting of the Medico-Psychological 
 Association, I ascertained that not one of the members present 
 had ever made such a request in visiting an asylum, and I am 
 therefore bound to believe that this expression of regret on 
 my part was not called for. 
 
FOR THE INSANE IN AMERICA. 53 
 
 where. I found the patients in two parallel gal- 
 leries placed back to back, and glazed the whole 
 length of the outer sides. I think that the width 
 of these galleries did not exceed twelve feet, but a 
 slice of about three feet of the whole length of 
 them vvas cut off from the use of the patients by a 
 substantial rampart of iron bars, strong enough 
 to confine lions and tigers in a menagerie. This 
 formidable construction, I was informed, was 
 intended to prevent the breakage of window-glass.* 
 Miss Dix, whom I had the great pleasure of 
 meeting at Washington, on hearing that I intended 
 to return home by way of Canada, earnestly re- 
 quested me to examine the asylums at Montreal 
 and Quebec, and especially the one at the last- 
 
 * Since the date of my visit Dr. Parsons reports to the Asso- 
 ciation, " Important improvements have been made in the 
 clothing and dietary of this institution. Clothing has been 
 furnished more abundantly and of better quality than here- 
 tofore. The dietary has been greatly improved, both in sub- 
 stance and in modes of preparation. The advantages of the 
 new dietary have been proved by the fact that since its adop- 
 tion the general health of the patients has been improved, 
 and that there have been no diseases among them depending 
 upon imperfect alimentation, whereas previously this has 
 uniformly been the case, especially during the spring and 
 early summer months. An estimate was made that the 
 increase in expenditure would be about thirty per cent., but 
 there has been a very large decrease in the cost of supplies 
 such as in great degree to counterbalance the cost of improve- 
 ment. Twenty-one and a quarter cents a day, per capita, 
 includes the expenditure for everything except new buildings." 
 
 E 
 
54 NOTES ON ASYLUMS 
 
 named city. I made it a point of duty to comply, 
 and it certainly is with a feeling of duty, and not 
 of pleasure, that I now record some observations 
 made at my visit. 
 
 Although Upper Canada and New Brunswick 
 have provided themselves with public asylums at 
 Halifax, Toronto, and London, which enjoy a 
 very high reputation, the great province of Lower 
 Canada possesses no public lunatic asylum, the 
 authorities having been satisfied to contract for the 
 care and treatment of the insane supported from 
 public funds, with the proprietors of private asy- 
 lums at Montreal and Quebec.* The proprietors 
 of the asylum, or rather asylums, at Montreal are 
 the Roman Catholic Sisters of Charity, who ap- 
 pear to have a central point for their organization 
 in America in that city ; at least, I was told so by 
 the sisters whom I found in charge of an inebriate 
 institution at Old Mount Hope, near Baltimore, to 
 which they were adding a kind of private hospital 
 or sanatorium for general patients who could 
 afford to pay 4/. a week. 
 
 * Mr. Langmuir, Inspector of Asylums for the Province of 
 Ontario (Upper Canada) says : "The Province has already 
 spent two millions of dollars in providing structural accom- 
 modation for her insane, and before we will have completed 
 our additions that amount will have been increased to three 
 million of dollars." The Province of Quebec (Lower Canada) 
 has spent nothing for this purpose. 
 
FOR THE INSANE IN AMERICA. 55 
 
 I found the asylum for male patients at Mon- 
 treal in the old cavalry barracks. It was esta- 
 blished in the building which was formerly the 
 gaol of the barracks, for which the good sisters 
 paid a rental of 5o/. a-year. No buiding could 
 well be more gloomy and unfit for the purposes of 
 an asylum than this soldiers' gaol. There was, 
 however, in addition to this old cage, a more re- 
 cent and less obnoxious building, occupied by 
 idiot and imbecile children. I was informed by 
 the sister who conducted me over the institution 
 that it contained 1 60 insane inmates, and that the 
 asylum for female patients under the same manage- 
 ment was about four miles further in the coun- 
 try, and that the asylum for men also was in a 
 short time to be removed to a new house which 
 the sisterhood had built for the purpose, and which 
 was described to me by the sister as being very 
 costly, and a great financial enterprise for them. 
 At the time of my visit numerous wet beds were 
 being refilled with straw in the gloomy and dirty 
 corridors, or rather passages a cause of great 
 offensiveness ; but the interior, if clean as a model 
 prison, must ever be dark and dismal. The court- 
 yard was truly a prison-yard ; yet there was a 
 large shed in it for exercise, a provision which is 
 rare in the States. All the material of care and 
 treatment was bad or absent, and there was ac- 
 tually no medical attendance whatever. The 
 E 2 
 
56 NOTES ON ASYLUMS 
 
 patients were solely under the charge of the 
 sisters, aided by attendants who were their ser- 
 vants, and I was told that they had never been 
 visited by any medical officer. This great defect 
 was about to be remedied to some extent, and, in- 
 deed, a medical officer had already been appointed 
 who was to visit the patients once a week, but his 
 first had not yet been paid. It is true that I did 
 not observe any sick folk among the patients, with 
 the exception of an idiot child, whose hand was 
 inflamed, and evidently painful. I asked the 
 sister what was the matter, and she replied, " Ah, 
 indeed, it is red. I do not know." On examina- 
 tion, it was evident that the metacarpal joints 
 were in a state of scrofulous disease. And yet, 
 notwithstanding all these sad defects, there was 
 something about the place which appealed strongly 
 to my sympathies after ail I had seen in the 
 States. There was no patient either in restraint 
 or seclusion, although there were several to whom 
 I think that my friends in the States would have 
 deemed it dangerous to allow the free use of their 
 limbs ; but these were soothed and tranquillized 
 with gentle words and petting gestures by the 
 sister in charge, in a manner which showed that 
 she was quite accomplished in the art of winning 
 the good-will and calming the excitability of those 
 over whom she was placed in such a singular posi- 
 tion of feminine authority. Altogether I thought 
 
FOR THE INSANE IN AMERICA. 5/ 
 
 that these good women were doing good work, 
 although the circumstances and conditions of it 
 were exceedingly disadvantageous. 
 
 The next asylum I visited was a small private 
 asylum in the neighbourhood of Quebec, kept 
 by Mr. Wickham, and which requires no further 
 notice than the remark that it is combined 
 under the same roof with a home for ha- 
 bitual drunkards, who, however, occupy a different 
 part of the building ; which is a better arrange- 
 ment than that which obtains in some of the 
 hospitals for the insane in the States, where 
 habitual drunkards are to be found in some 
 number intermixed among ordinary lunatics, to 
 whom their association is often irritating and mis- 
 chievous. 
 
 The last asylum I visited in America was the 
 large proprietary institution called the Beaufort 
 Asylum at Quebec. It belongs to two or more 
 physicians residing in Quebec, and contains 814 
 lunatics, supported from public and charitable 
 funds. There being no Poor Law in Canada, it 
 would not be strictly correct to call the inmates 
 pauper lunatics, but they correspond with that 
 class of patients in our country. As an unofficial 
 and unauthorized visitor I feel restrained from ex- 
 pressing opinions upon the management of this 
 institution ; but as these patients are public 
 patients, I do feel myself quite at liberty to state 
 
58 NOTES ON ASYLUMS 
 
 facts which I myself observed at my visit to this, 
 place on the i6th of July last. 
 
 The asylum is situated about four miles from 
 the citadel on the Beaufort Road, and consists of 
 two separate buildings for men and women at a 
 short distance from each other. The women's 
 building has been recently to a great extent re- 
 built: I found numerous workmen busily engaged 
 in completing the roof of the central or entrance 
 pavilion. The officer in charge was the steward, 
 who told me that there was no medical man on 
 the premises at the time of my visit, but that his 
 son, who was a medical student, though not 
 officially connected with the institution, would 
 show me round. The steward or manager apolo- 
 gised for the disorder in which I should find the 
 institution in consequence of the recent recon- 
 struction of a great part of the women's building. 
 He told me that in the preceding January a fire 
 had broken out in the women's wards, and that 
 after that fire seventeen or twenty-seven (I forget 
 which) of the female patients were missing. The 
 remains of eleven of these missing patients were 
 found, but the others were not found or could not 
 be distinguished. At all events, none of them 
 had been heard of since, so that it was supposed 
 that all of them had lost their lives in the fire. 
 
 The women's wards I found crowded and dis- 
 orderly, but the disarrangement caused by the 
 
FOR THE INSANE IN AMERICA. 59 
 
 process of reconstruction might be some excuse 
 for this, and perhaps also for the larger number of 
 patients who were in seclusion. But the seclusion 
 cells, of which there was a large supply, were not 
 newly built, and they bore in their offensive atmo- 
 sphere evident signs of frequent use. I hope that 
 I was either misinformed or that I misunderstood 
 the nurses, as to the length of time that some of 
 these patients had been in seclusion in these dark 
 and offensive cells. 
 
 A shallow brook runs through the small court- 
 yards at the back of the asylum, and in this brook 
 I saw female patients wading ankle deep to cool 
 and amuse themselves ; and two of them had 
 pulled up their clothes above the waist, and the 
 attendants did not interfere with an exposure 
 which was the reverse of decent. 
 
 The building for the male inmates had not 
 been implicated in the fire, and its condition, 
 therefore, may be accepted as nothing unusual. 
 The wards were spacious enough, though bare and 
 cheerless. It was a hot, sultry afternoon, and 
 almost all the inmates were out of doors. I found 
 them all congregated in one small courtyard in a 
 tout ensemble of lunacy not easily to be described. 
 I cannot state with accuracy the size of the court- 
 yard, but it did not appear to me to exceed one 
 hundred yards in breadth by eighty in depth. 
 Whatever its size might be, it was divided into 
 
60 NOTES ON ASYLUMS 
 
 two pretty equal parts by the above-mentioned 
 brook, traversed by a bridge, and the half of the 
 yard furthest from the building and beyond the 
 brook was occupied by a crowd of, as near as I 
 could estimate, about 300 lunatics. The bridge 
 was kept and the crowd was watched by a man 
 lying on the ground in his shirt-sleeves, in whom 
 it was not difficult to recognise an attendant. I 
 was invited by my companion to observe the 
 lunatics from the safe end of the bridge, and for 
 some time I did so. and I must say that I never 
 in my life before saw anything like it. The 
 lunatics appeared to be quarrelling and fighting, 
 without the least control, and there seemed to be 
 no attendants with them whatever. This, how- 
 ever, was a mistake, for after awhile I crossed the 
 bridge, and on inquiry discovered three boyish 
 persons, who announced themselves to be atten- 
 dants. Skirmishes were still proceeding among 
 the patients, and on my asking the attendants 
 why they did not prevent them they gave no 
 reply. Not only were the patients permitted to 
 quarrel and struggle without interference, but I 
 observed several of them lying on the ground with 
 the most indecent exposure of the person. Con- 
 sidering the amount of excitement in this sweltering 
 crowd, there was not much mechanical restraint. 
 I observed two or three men with their wrists in 
 iron rings attached to leathern belts, which is 
 
FOR THE INSANE IN AMERICA. 6 1 
 
 certainly a mild form of restraint, since it leaves 
 the muscles of the arms and chest some freedom 
 of movement. I saw no strait-waistcoats. In 
 front of the men's building there are grounds 
 large enough to make fairly good airing courts, 
 and why they are not so utilised could not be ex- 
 plained. 
 
 Escaping from this mad medley, I asked to be 
 shown the refractory ward, and was conducted to 
 the top story of the building, where I found the 
 ward empty, with the exception of two patients in 
 seclusion. The doors of the cells were fastened 
 with three or four massive iron bolts. On open- 
 ing the first cell I found it occupied by a poor 
 sickly-looking young man, in a dripping wet shirt ; 
 the floor of the cell also was covered with water. 
 I was told that the patient had recently been 
 brought up from the yard, where he had thrown 
 himself into the brook. It would have added to 
 his comfort and the safety of his health, if they 
 had given him a dry shirt when they shut him up. 
 Hearing shouts proceeding from another cell, I 
 asked that the door of that also might be opened ; 
 but I was told that it could not be done, as the 
 cell contained a very dangerous madman indeed. 
 Assuring the attendant that I was no more afraid 
 of such a man than he was, and perhaps not so 
 much, and that to refuse my request would have a 
 bad look, he at last consented to draw the bolts, 
 
62 NOTES ON ASYLUMS 
 
 and beheld a little, shrivelled old man in a state of 
 chronic mania, noisy and troublesome enough no 
 doubt, but no more dangerous than a monkey, as 
 far as I could judge. Mischievous, with his rest- 
 less loquacity he well might be among the dense 
 crowd of lunatics below, and perhaps this was the 
 reason why he occupied his seclusion-cell. 
 
 Surely it is the duty of the Government of 
 Lower Canada to provide public asylums for 
 public lunatics, and not to farm them out either 
 to nuns or physicians. I am told that the respon- 
 sibility of not doing so lies entirely with the 
 Provincial Government, and is in no way shared 
 with the Government of the Dominion, and that 
 the Governments of the Queen of England and of 
 Canada have no power or authority whatever, and 
 no position even from which advice may be ten- 
 dered, on such matters. One cannot but wonder 
 under such circumstances what the state of the 
 insane may be in other colonies and dependencies 
 of our great and scattered empire. 
 
 In publishing Notes upon Asylums for the In- 
 sane in the United States, it will be expected that 
 I should make some remarks upon the extraordi- 
 nary state of medical opinion which permits and 
 defends the use of mechanical restraint in institu- 
 tions otherwise excellent. In doing so I shall 
 endeavour to leave out of the count the condition 
 of the insane in those institutions where political 
 
FOR THE INSANE IN AMERICA. 63 
 
 corruption or stupidity renders it impossible to 
 apply a complex system of treatment which can 
 only be efficacious under an enlightened and liberal 
 management. The pages of The Lancet are not 
 likely to influence the politicians of New York, 
 who think their insane sufficiently well cared for 
 in the asylums I have described ; neither will they 
 have much weight with the gentlemen at Phila- 
 delphia who are in the habit of placing three violent 
 lunatics to sleep (?) in the same cell, prudently 
 enough protecting them in some degree by strait- 
 waistcoats. But it is to be hoped that a fair and 
 frank challenge to the medical superintendents of 
 the State asylums and the hospitals for the insane 
 will be accepted in the friendly spirit in which it 
 is given, and that they will not refuse to show 
 reasons why they adhere to a mode of treatment 
 which in this country is condemned by the almost 
 unanimous voice of the profession and of the 
 public. 
 
 A considerable proportion of poor lunatics in 
 nearly all the States are still detained in the 
 county almshouses, and even in the gaols. In 
 Missouri Dr. Compton states that " a stream of 
 acute and violent cases passes from the gaols to 
 the asylum," as room is made for them in the 
 latter by the discharge of chronic cases to the care 
 of their friends ; and the medical superintendents 
 at the Auburn meeting last year passed a series of 
 
64 NOTES ON ASYLUMS 
 
 resolutions on the detention of lunatics in alms- 
 houses, of which the following words are the 
 preamble : " The condition of the insane in the 
 county almshouses in the different counties of this 
 Commonwealth is such as to excite our most pro- 
 found sympathy, and to arouse in us a determined 
 effort for their comfort and relief." And we learn 
 incidentally from a statement made in the Boston 
 Medical and Surgical Journal for November last 
 that the insane inmates of the almshouse in the 
 vicinity of Chicago are still habitually secured by 
 chains. 
 
 The insufficiency of asylum accommodation, 
 especially in the southern and western States, is 
 no doubt at the present moment rather a social 
 and financial than a medical question. Debt and 
 the increase of population have outrun the deve- 
 lopment of the resources of the country, and the 
 incidence of taxation, general and local, is ex- 
 tremely oppressive. With the continuance of 
 peace and the return of prosperity, the provision 
 of suitable and sufficient accommodation for the 
 care and treatment of all the insane will become 
 an imperative duty with the instructed and humane 
 Americans ; but there can be no doubt that 
 medical opinion will be able greatly to expedite 
 and complete this great and good work, if it is 
 founded upon reasons and facts which will obtain 
 the approval, and command the sympathy, of that 
 
FOR THE INSANE IN AMERICA. 65 
 
 public opinion which is the ultimate and supreme 
 power in the Republic. Nothing is so likely to 
 bring speedy "comfort and relief" to the insane 
 confined in county almshouses as a full recogni- 
 tion of the wide contrast between their miserable 
 condition and what might be their comparative 
 happiness in well-ordered asylums ; and the best 
 direction of the "determined effort" promised by 
 the medical superintendents will certainly be to- 
 wards the realisation of this contrast in the know- 
 ledge and opinion of the general public. 
 
 But, unless I am much mistaken, the super- 
 intendents of asylums in America have a heavy 
 task before them, which will indeed require a 
 determined effort before they can say that they 
 possess the confidence of the public in the same 
 degree to which of late years it has been extended 
 in England to the management of our county 
 asylums and hospitals for the insane. With us, 
 the management of our asylums is open and 
 patent Abuses occur, as they will occur every- 
 where ; but they are remedied, and, if need 
 be, punished, in the most public manner, and the 
 records of them are displayed to the eyes of the 
 world. It is thus that the American journals, in 
 replying to The Lancet's leading article on the 
 American Asylums, have been able to cite so 
 many instances of disaster in our asylum work. 
 But where shall we look for any record of wrong- 
 
66 NOTES ON ASYLUMS 
 
 doing or misfortune which, in the nature of things, 
 must take place in American asylums also ? 
 So far as I know, it does not exist. There is in 
 America no central authority to prosecute and 
 punish such wrong, and no public record of cir- 
 cumstances to lament and avoid. 
 
 Putting altogether out of consideration opinions 
 and sentiments which were expressed to me pri- 
 vately, few things struck me more forcibly in 
 America than the painful sensibility to public 
 opinion which was manifested both at the con- 
 clave of medical superintendents, which I had the 
 great pleasure to attend, and in the published 
 transactions of that held last year. I think I 
 may truly say that nothing of the kind exists with 
 us, and few things would surprise me more than to 
 hear a debate at one of the annual meetings of our 
 Medico-Psychological Association upon the neces- 
 sity of preventing or curtailing the transmission 
 of the letters of patients in asylums cither to their 
 friends or to public authorities, or a discussion 
 in which it was maintained that the absence on 
 leave or the discharge of uncured patients was un- 
 desirable on account of the accusations and com- 
 plaints which such persons were liable to make 
 about their treatment ; and as a final instance of 
 this difference of feeling I may mention that Tim 
 Lancet Commission, which will be generally wel- 
 come to English asylums in proportion to its ability 
 
FOR THE INSANE IN AMERICA. 6/ 
 
 and thorough faithfulness, has been deprecated in 
 the American Journal of Insanity as "an insult 
 to the Commissioners in Lunacy, and the medical 
 staff of every English hospital." 
 
 Pondering these things, and many others with 
 which I should not be justified in occupying space, 
 I have been able to come to no other conclusion 
 than that the great stumbling-block of the Ameri- 
 can superintendents is their most unfortunate and 
 unhappy resistance to the abolition of mechanical 
 restraint. I was told everywhere, except at Utica, 
 that this question was settled in America, and that 
 it would be useless and futile to reopen it. I was 
 informed that, after many minor discussions, a 
 great and final discussion of the whole question 
 had taken place in 1874 at Nashville, and that 
 the superintendents had there unanimously de- 
 cided that the abolition of mechanical restraint 
 was utterly impracticable ; and that the statements 
 of the English on the subject were not to be relied 
 upon. I was again and again informed that the 
 system of non-restraint had proved quite a failure 
 in England, and that we were rapidly returning to 
 the old practices. As such statements were not 
 very agreeable to me, and especially as I found 
 that my contradiction could be met by the pub- 
 lished opinions of some two or three English 
 superintendents who, although no prophets in their 
 own country, are eagerly quoted abroad, I resorted 
 
68 NOTES ON ASYLUMS 
 
 to the somewhat vulgar expedient of offering a bet 
 as an expression, or, if you will, a meter, of my be- 
 lief. Faraday tells us (Lecture on MentalEd uca- 
 tion), that Dr. Wollaston once did the same thing 
 to him, on which " I rather impertinently quoted 
 Butler's well-known lines about the kind of per- 
 sons who use wagers for argument, and he gently 
 explained to me that he considered such a wager 
 not as a thoughtless thing, but as an expression of 
 the amount of belief in the mind of the person 
 offering it." 
 
 With such an illustrious example, I may be 
 permitted to think that my offer of a wager also 
 was not " a thoughtless thing/' and it certainly was 
 not considered a rash one, for, although I repeated 
 it both privately and before many superintendents 
 at Auburn, it was not accepted, and it certainly 
 stopped the talk about our relapse. My offer was 
 a wager of one hundred pounds that any American 
 superintendent should go to England and should 
 have free access to all public asylums there, and 
 that in a search of one month he would not be able 
 to find one patient therein in any form of mechani- 
 cal restraint. 
 
 I have before me a full report of the great dis- 
 cussion above referred to, but the subject is so 
 threadbare in the pages of The Lancet, wherein 
 the great battle was fought in ancient times, that 
 I shall only venture upon a few brief extracts and 
 
FOR THE INSANE IN AMERICA. 69 
 
 remarks. The termination, however, of the dis- 
 cussion is so astounding and instructive, that I 
 really must entreat- The Lancet to find space 
 for it. 
 
 " Dr. Walker, of the Boston Asylum, Vice-Pre- 
 sident of the Association, acting as President in 
 the absence of Dr. Nichols, said : I was gratified 
 when visiting the institutions in England the few 
 I did visit to find that almost universally (cer- 
 tainly in four-fifths of the cases) the superinten- 
 dents expressed themselves in favour of me- 
 chanical restraint, and, singularly enough, the 
 superintendents lay the blame of non-restraint 
 upon the Commissioners in Lunacy, and the Com- 
 missioners in Lunacy throw it back upon the 
 superintendents. They say the superintendents 
 are emulous one of another to report the smallest 
 number of restraints during the year. Certainly 
 in my presence and that of an American medical 
 friend accompanying me, almost without exception, 
 they expressed their preference for mechanical re- 
 straint, and hoped they would have it established 
 there. From an experience of over twenty years, 
 and from a careful and, I hope, by no means super- 
 ficial study of this question, I firmly believe that 
 in the future the practice of our best American 
 asylums now will become the governing rule of 
 Christendom. Dr. Rodman : Did you visit 
 Conolly's asylum ? The President : I did. Dr. 
 
 F 
 
7O NOTES ON ASYLUMS 
 
 Rodman : What is the practice now ? The Pre- 
 sident : That was the only hospital that I visited 
 where I found any difference at all as to mechani- 
 cal restraint. There they were using, so far as I 
 observed, the attendants' hands and the closed 
 room. Dr. Rodman : If the change begins there, 
 and ends there, it certainly must be apparent to 
 every member of this Association that the 
 days of non-restraint have died out. The Presi- 
 dent : They told me that the adoption of non- 
 restraint was not due to Dr. Conolly at all, but 
 through the superintendent of the female de- 
 partment, a modest and retiring man, who at- 
 tempted to abolish mechanical restraint, and suc- 
 ceeded. Seeing the result in his hands, Dr. 
 Conolly adopted it and became its champion and 
 high priest. Dr. Rodman : Dr. Conolly has the 
 credit as the apostle of non-restraint. The Presi- 
 dent : Not only the apostle of non-restraint, but 
 the apostle of humanity too." 
 
 I must resist the strong temptation to treat the 
 above in the manner it invites, but how to treat it 
 seriously I scarcely know. Yet it is a most serious 
 matter, and reveals the true foundation of the 
 American prejudice namely, profound ignorance 
 of what has really been done, and is yet doing, in 
 this country. 
 
 Among all the medical men connected with 
 asylums and the treatment of insanity whom I 
 
FOR THE INSANE IN AMERICA. 71 
 
 met with in the States, amounting to nearly a hun- 
 dred, I only met two who mentioned to me that 
 they had visited our asylums, and had really 
 studied our system, and both of them were ardent 
 admirers of it.* The first of these was Dr. 
 Edward Jarvis, the well-recognised head of his 
 profession, but, alas, now a head enfeebled by age 
 and infirmity. This most able man urged me to 
 travel the States on a mission of reform, which, 
 unfortunately, my own health rendered me quite 
 incapable of doing. The other person was the 
 senior assistant-physician to the McLean Hospital 
 for the Insane, whose name I forget, but who, 
 while earnestly studying the treatment of the in- 
 sane in England, lost his promotion in America. 
 He also had become a thorough convert to our 
 opinions and practice, which I truly hope will not 
 prejudice him in the eyes of his professional bre- 
 thren. 
 
 And here I may very fairly ask why the leaders 
 of medical opinion in America do not come to this 
 country, and really study this most important 
 question fully and conscientiously ? The result 
 would not be doubtful. The leading men of 
 mental medicine in France and Germany did so, 
 and were convinced. The illustrious Griesinger 
 
 * Dr. Isaac Ray's visit to this country, which he refers 
 in The Lancet of May 27th, was I believe, thirty years ago. 
 F 2 
 
72 NOTES ON ASYLUMS 
 
 has told us in noble words how his adverse opinions 
 were changed to joyful astonishment by personal 
 observation of the working of the non-restraint 
 system from one end of England to the other, and 
 that objections to the system proceed entirely from 
 those who have not either practised it or seen it 
 in practice.* Westphal, the eminent successor of 
 this greatest of modern alienists, perhaps never 
 stood in the position to be converted ; no more 
 staunch upholder of the system, however, exists. 
 Morel, of Rouen, also one of the very ablest of the 
 Frenchmen in our speciality, was an enthusiastic 
 convert, and the Americans will do well to peruse 
 his book on the subject, and to compare the faith- 
 ful observations and earnest thought of a great 
 mind with the above facile remarks of their Presi- 
 dent, with which they can scarcely be satisfied. 
 
 But I must not further delay to endeavour to 
 make it apparent whereabouts the Americans are 
 in their opinions and practice. 
 
 The discussion at Nashville was mooted upon 
 an able paper by Dr. Ramsey, and it was con- 
 cluded by the President declaring that the mem- 
 bers of the Association were " essentially a unit 
 upon the question as presented by Dr. Ramsey." 
 This, however, was not quite correct, for an Abdiel 
 was found in Dr. Lett, of Canada, who boldly de- 
 
 * Pathologic und Therapie, pp. 506-8 ; Zweite Auflage. 
 
FOR THE INSANE IN AMERICA. 73 
 
 clared, " So far as my experience goes, I think this 
 is simply a question between good attendants and 
 restraint." Dr. Worthington also came very near 
 to rebellion against the law of the majority when 
 he asserted that in his asylum, the Friends' Asylum 
 at Philadelphia, " since the use of mechanical re- 
 straints has been almost entirely discontinued there 
 has been far less trouble in the management of the 
 patients." The unanimous opinion of the remain- 
 ing members of the Association seems to be ex- 
 pressed in the following words of Dr. Smith, super- 
 intendent of the State Asylum, Missouri. " This 
 question has been freely discussed at previous meet- 
 ings of this Association, and the result was almost 
 entire uniformity of sentiment in all well-conducted 
 American institutions for the insane. No restraint 
 is the general rule, and restraint the exception ; 
 while for many years past the tendency in this 
 country has evidently been to reach the point of 
 least possible restraint, there have been very few, if 
 any, converts to the non-restraint system in the true 
 .sense of tJie term" 
 
 This being the position taken, I shall endeavour 
 to show by their own declarations what the super- 
 intendents of the State Asylums consider the least 
 possible amount of restraint, and the description of 
 cases in which they think themselves justified in 
 employing it. 
 
 Dr. Orpheus Evarts, of the Indiana Hospital for 
 
74 NOTES ON ASYLUMS 
 
 the Insane, said : "I think we are all agreed ; but the 
 question seems to be how much and what kind of 
 restraint is required ? I know of no other object 
 in sending these persons to an insane hospital 
 
 than that of proper restraint When I 
 
 assumed charge of the Indiana Hospital I found 
 perhaps fifteen per cent, of the patients wearing 
 some kind of mechanical restraint. I have re- 
 duced the ratio to not far from two per cent. 
 Below that I find it impracticable to go'' Dr. 
 Green, of the Georgia State Asylum, said : I do 
 not think that all the restraints we employ 
 amount to two per cent, per annum with our 560 
 patients. I certainly concur in the positive and 
 absolute necessity of personal restraint." Dr. 
 Green said that he applies mechanical restraint to 
 four different classes of patients namely, ( i ) to 
 suicidal patients, (2) to "persons who will not re- 
 main in bed," (3) to " persons who persistently 
 denude themselves of all clothing," and lastly (4) 
 "to the inveterate masturbator." Dr. Ramsey, 
 after mentioning that Dr. Bell had reduced re- 
 straints in the McLean Asylum to less than one 
 per cent, so long ago as 1839, said : " Have we 
 not sometimes fallen below it on a plea of 
 economy, or through a willingness to shirk the 
 unceasing, patient, and thoughtful attention a 
 large number of patients in hospital need, and 
 thus brought upon ourselves and the institutions 
 
FOR THE INSANE IN AMERICA. 75 
 
 under our care the odium and pernicious legisla- 
 tion that seem to have sprung out of, or at least 
 to have closely followed, some sharp criticisms 
 in recent publications, and the acrimonious 
 utterances of intense humanitarians, or persons 
 whose mental integrity is at least questionable? 
 And to just such results shall we be ever in 
 danger so long as restraint may be deemed neces- 
 sary, unless with unceasing vigilance we guard 
 against the abuses which with its use are exceed- 
 ingly liable to creep in." A very remarkable 
 passage this, as reasonable as it is forcible and 
 eloquent. Dr. Ramsey thinks that mechanical 
 restraint is " a valuable, if not indispensable, 
 auxiliary in the treatment" (i) of "cases of acute 
 mania characterised by violent destructive and mis- 
 chievous propensities ;" (2) in patients " who wound 
 themselves, creating ulcers that would never heal 
 themselves, unless their hands were confined ;" 
 (3) "it is the only safe course in guarding against 
 the dangerous violence to which the epileptic in- 
 sane are often liable;" (4) "persons whose feelings 
 are greatly perverted exceedingly irascible prone 
 to see insults, or evidence of conspiracy are 
 sometimes little less ferocious than wild beasts, 
 
 and feel little or no regard for human life 
 
 for them seclusion or restraint, for varying periods, 
 seems to be necessary, and, for a small portion of 
 this class, almost continuous ;" (5) "how shall we 
 
?6 NOTES ON ASYLUMS 
 
 treat that so frequently fatal disease, acute delirious 
 mania, if we do not apply restraint to secure 
 recumbency ?" It will be observed that none of 
 the five classes enumerated by Dr. Ramsey as 
 requiring restraint tally with those of Dr. Evarts, 
 so that already we have nine classes of lunatics 
 who need mechanical restraint in America. Dr. 
 Slusser, of the Ohio Hospital for the Insane, adds 
 to the number. " I have met with a class requir- 
 ing restraint not alluded to by the writer, Dr. 
 Ramsey. I refer to those who persistently walk 
 or stand until their extremities become swollen, 
 and they give evident signs of physical prostration. 
 I have no way of controlling such but by tying 
 them down on a seat. If there is any less 
 objectionable mode, I should like to know it. 
 Then we have a class of noisy patients, harmless 
 in every respect, but so loquacious and boisterous 
 that they disturb the whole ward." With this 
 climax we might well conclude this astounding 
 classification, did not other superintendents in 
 their remarks afford us the means of adding to it : 
 for instance, patients needing forced alimentation 
 {Dr. Curwen), patients who butt their heads against 
 the wall (Dr. Forbes and Dr. Kilbourne), and de- 
 lusional cases, who are very quiet, then suddenly 
 rise up and make a violent attack upon somebody 
 (Dr. Carriel) -fourteen classes of the insane alto- 
 gether iv/io absolutely need mechanical restraint in 
 
FOR THE INSANE IN AMERICA. 77 
 
 the State asyhims of America, according to the 
 opinions and practice of their medical superinten- 
 dents. It would be interesting to know how many 
 classes of the insane our American brethren can 
 reckon who do not require this indispensable means 
 of treatment. 
 
 It would be tedious and useless to discuss the 
 need in all these classes with the intention of 
 showing by what means in England patients in- 
 cluded in them would be treated without the use 
 of strait-waistcoats, muffs, camisoles, or locked 
 chairs : are they not written in the pages of The 
 Lancet in the days of the last generation ? I shall, 
 however, as an example, take the remarks made 
 upon one class namely, those patients who de- 
 nude themselves or destroy their clothing to in- 
 dicate the lack of resource, which is one cause of 
 all this employment of restraint We know, by 
 long and large experience, how easy it is to 
 allow a lunatic perfect freedom of all muscular 
 movement and yet to prevent him from strip- 
 ping himself, or from destroying his clothing, 
 by the employment of outer clothes so fashioned 
 that he cannot remove them, and so strong 
 that he cannot easily destroy them. This, with 
 some care on the part of the attendants, is a per- 
 fect and facile remedy. Yet, Dr. Curwen says : 
 " When patients are obstinately bent on destroy- 
 ing their own clothing or that of others, it is 
 
78 NOTES ON ASYLUMS 
 
 safest and best to confine their hands." Dr. East- 
 man says : " At the Worcester Hospital there are 
 a large number of chronic cases, who are very de- 
 structive and prone to denude themselves, and I 
 am obliged to use a good deal of restraint on 
 these accounts." Dr. Shaw says : " I think we 
 have all these cases a persistent desire to destroy 
 clothing particularly. No harm can come from 
 restraint in either of these cases, if properly used, 
 but, on the contrary, much good may be done." 
 Dr. Carriel says : " Then there is a class that de- 
 nude themselves and tear their clothing, when re- 
 straint or seclusion becomes necessary." Dr. 
 Green says : " In the case of persons who persis- 
 tently denude themselves of all clothing, I think it 
 better to put them under restraint than to keep 
 them in their rooms, and accordingly I restrain 
 also that class of patients." 
 
 May we not ask, where is the wonderful inge- 
 nuity and inventive resource of the country if its 
 skilled physicians allow themselves to be so easily 
 defeated by the caprice of madmen who are so 
 readily managed elsewhere ? And so we might 
 go through all the classes, were it worth while to 
 repeat a thrice-told tale, and were not the great 
 book of practical exposition worth infinitely more 
 than all which language can convey a book held 
 open in this country from end to end, with men of 
 large experience and skill, eagerly desirous to- 
 
FOR THE INSANE IN AMERICA. 79 
 
 turn its pages to every earnest student, and in no 
 spirit of arrogance or self-sufficiency, but in the 
 truest desire to show a straighter path and a 
 higher aim in a great department of the great art 
 and science of healing. 
 
 Is it surprising that, at the present time, the 
 management of asylums for the insane in America 
 is the subject of mistrust with the people ? The 
 Americans, who are about the best informed, most 
 inquisitive, and widely travelled people in the 
 world, are not likely to be ignorant of the treat- 
 ment of the insane in other countries, nor to be 
 satisfied with the assurances of an official class 
 that the most enlightened and advanced system of 
 treatment is inapplicable in their own country. 
 The result is a state of public feeling which is well 
 expressed in the quotation which I have already 
 made from the paper of Dr. Ramsey, and which 
 was repeatedly recognised by many speakers in 
 the debate. Flowery words break no bonds ; and 
 such high-faluting assertions as that " in any com- 
 parison of the treatment of the insane in different 
 countries we can but look with pride upon the 
 advanced humanity of our own," must have been 
 felt by Dr. Ramsey somewhat insincere when he 
 uttered it just after the avowal that " the use of 
 mechanical restraint has divided professional 
 opinion in this country, and has deeply stirred 
 public sentiment from time to time, and perhaps 
 
80 NOTES ON ASYLUMS 
 
 has been the cause of much of the popular odium 
 that has been cast upon hospitals for the insane 
 and their directors in some quarters." Sooner or 
 later he and Dr. Curwen will find that the public 
 demand for the abolition of mechanical restraint 
 is no " hue-and-cry of a sensational character," 
 nor " a strong public opinion based more upon 
 feeling than upon knowledge." The Americans 
 are not a people to whom this taunt is likely to 
 apply justly for any length of time, even if it be 
 partially true at the present time, which the suc- 
 cessful resistance of the superintendents would 
 seem to make probable. When full knowledge 
 comes either to the latter or to the public, they 
 will have to vacate this untenable position. 
 
 At the meeting of superintendents held in 1875 
 the discontent and distrust of the public with the 
 management of the American asylums were still 
 more emphatically expressed. The debate was 
 upon a project of law, proposed by a Mrs. Packard, 
 that locked letter-boxes, under the control of the 
 Post Office, should be placed in each asylum ward. 
 This law, going so far beyond our own (25 and 26 
 Viet., cap. iii. sec. 40), which works perfectly well, 
 would no doubt be most objectionable ; but the 
 reasons given by the superintendents for opposing 
 it manifest the deep mistrust of which they are 
 conscious. One asserted : " It seems to me an un- 
 questionable fact that during the last few years 
 
FOR THE INSANE IN AMERICA. 8 1 
 
 American institutions for the insane have been, 
 and perhaps still are, on trial before an alarmed 
 and prejudiced public." Another, and no less an 
 authority than Dr. Isaac Ray, forgetful of the dif- 
 ference between a sane and free man suffering 
 from sickness in his own house and a lunatic in- 
 carcerated in an asylum, lays down the following 
 proposition against the establishment of a central 
 authority : " If the time shall ever come when 
 the Legislature, in its zeal for the public good, 
 shall establish a board of officers to supervise the 
 medical practice of the State, with power to enter 
 every sick man's chamber, to inquire respecting 
 the medicine and diet prescribed and any other 
 matter connected with his welfare, and report the 
 results of their examination to the constituted 
 authorities, then it may be proper to consider the 
 propriety of extending the same kind of paternal 
 visitation to the hospitals for the insane." Dr. 
 Ray thinks that the free and independent action 
 now possessed by the officers of asylums ought 
 not to be disturbed by the intrusive element of 
 official visitation. We do not find in England 
 that the free and independent action of our super- 
 intendents of asylums is much disturbed by the 
 visitation of the Commissioners in Lunacy, but 
 we do enjoy the advantage thereby that no one 
 shall greatly lag behind the knowledge and science 
 of his time in the treatment of his patients with- 
 
82 NOTES ON ASYLUMS 
 
 out his shortcomings being investigated and pub- 
 lished, and the great additional advantage that 
 the general management of our asylums possesses 
 the full confidence of the public. 
 
 With regard to the constantly repeated proposition 
 of American superintendents, that they maintain and 
 defend the use, but not the abuse, of mechanical 
 restraints, I have only to remark that the use of 
 such restraint must always be an abuse whenever 
 and wherever it may be avoided or substituted by 
 a more skilful mode of treatment, inflicting less 
 suffering upon the patients ; and that, at the pre- 
 sent day, the extent to which this can be effected 
 is not a matter which the Americans must be left 
 to discover for the first time from their own expe- 
 rience, since a very moderate amount of honest 
 investigation in this country and on the Continent 
 must convince any candid mind that the propor- 
 tion of lunatics on whom restraint cannot be so 
 avoided is extremely small. 
 
 Our American brethren tell us, indeed, that 
 there is some wonderful peculiarity in the American 
 character which distinguishes it from that of the 
 parent race in the old country in preferring the 
 restraint of instrumental bonds to that of moral 
 influence. President Dr. Walker assured his 
 hearers that this was so. He said : " I suppose 
 if anything has been settled to the satisfaction of 
 the members of this Association it is that, in this 
 
FOR THE INSANE IN AMERICA. 83 
 
 country, our patients, by original temperament, or 
 by some inherent quality in the universal Yankee, 
 will not submit to the control of any person they 
 consider their equal or inferior as readily as to that 
 of mechanical appliances." Dr. Compton also 
 said : " I think an asylum cannot be found in this 
 country, where the first thing a boy learns to read 
 is the Declaration of Independence, and where 
 every youngster learns that he is ' in the land of 
 the free and the home of the brave,' in which 
 restraint will not be found necessary." I shall 
 only remark that the same argument was in the 
 early days of this debate used by the physicians of 
 Germany, as Griesinger states with unsuppressed 
 contempt. And even in Scotland it was said that 
 fatperfervidum ingeninm of its people made many 
 of the insane there only capable of being treated 
 like wild animals. 
 
 With regard to the English, I may observe that 
 the non-restraint system has been practically found 
 to be well adapted to the treatment of the insane 
 of the upper classes, who are as free from the im- 
 putation of servility and submission to beadledom as 
 the glorified citizens of America can themselves be. 
 
 It can, however, scarcely be doubted by those who 
 know even a little of America that the " inherent 
 quality" attributed to the " universal Yankee" of 
 peculiar resistance to moral influences and rebellion 
 against kindly and sympathising treatment is an 
 
84 NOTES ON ASYLUMS 
 
 unjust and unfounded libel upon him. The north- 
 eastern American of the agricultural artisan and 
 labouring classes, may possibly hold himself some- 
 what more stifly on his manhood and citizenship 
 than the subjects of Queen Victoria of equivalent 
 estate, though I somewhat doubt the fact ; but 
 without doubt he is, as a rule, more instructed, in- 
 telligent, and self-respecting. Any Englishman 
 who has mixed in American mobs, as I have done, 
 will have been astonished and somewhat humiliated 
 at the absence of the " rough" element in them, at 
 the self-respect, regard for the rights of others, and, 
 above all, at the sobriety which he has witnessed. 
 And if he has taken the trouble to inquire, he will 
 find that the dirtiest and poorest-looking man he 
 has encountered has received what we should con- 
 sider almost a liberal education. If he looks 
 through the police reports he will be struck with 
 the absence of those brutal assaults upon women 
 and children and <eeble persons which are the pre- 
 sent reproach of our most imperfect civilisation. 
 If he has had the privilege of knowing many 
 Americans at their own hearths, or perhaps I should 
 say stoves, he will have become convinced that the 
 influences of politics, socictctics, and climate, have 
 resulted in the production of a most kindly, friendly, 
 and orderly variety of the Anglo-Saxon race, full 
 of domestic affections and social sympathies, pecu- 
 liarly liable to be led by moral and reasonable 
 
FOR THE INSANE IN AMERICA. 85 
 
 guidance. And these are the men for whom the 
 American physicians declare that bonds of hemp 
 and iron are absolutely indispensable in the treat- 
 ment of their mental maladies, while for the rough 
 Englishman, the dour Scot, and the hartnackig 
 German, they have been proved to be both super- 
 fluous and mischievous ! 
 
 I should hesitate to declare that all races were 
 equally fit for the non-restraint system, and perhaps 
 a house full of maniacal Malays or Kaffirs would 
 be troublesome to manage by moral and reasonable 
 methods. The essence of the non-restraint system 
 is to lead the lunatic by such remains of mental 
 power and coherence as the physician can lay hold 
 upon, and where there has been least mind there 
 will be the slightest means of moral guidance ; but 
 to make the men of the United States an exception 
 because they, more than others, have learned how 
 to rule themselves, is a blundering censure upon 
 their culture and their virtues. 
 
 Moreover, if American patients are independent, 
 ingenious, and bold, and therefore not easily guided 
 and controlled, are not the physicians Americans 
 also, and being possessed of the qualities of their 
 race, do they not stand in the same relation to 
 their patients as the physicians of other countries 
 to their insane countrymen ? Do they not possess 
 the same advantages of courage, culture, and ex- 
 perience, and, above all, that of a sound mind in a, 
 
 G 
 
86 NOTES' ON ASYLUMS 
 
 * Sound body, which qualifies them to undertake the 
 care and treatment of their compatriots who are 
 bowed down by mental infirmity and frequent 
 physical disease ? Verily, we believe that this 
 spread-eagle apology for the bonds of freemen is 
 the most feeble, futile, and fallacious which could 
 possibly be imagined. Another, however, which 
 is worse, I shall leave unanswered, because it does 
 not seem worthy of an answer. It is this, that 
 because in the treatment of insanity certain medi- 
 cines are useful, and are, so to say, -a restraint upon 
 abnormal changes in the organism, therefore the 
 restraint of locked chairs and strait-waistcoats is 
 justified. When such an argument is used, as it 
 was by Dr. Hughes, of St. Louis, the quiver of 
 the logician must be about empty. 
 
 Finally, I must make an apology myself for the 
 uncompromising manner in which I have criticised 
 the utterances and opinions of my professional 
 brethren in this matter. I am seriously afraid that 
 it will cost me some goodwill in quarters where I 
 most earnestly desire to retain it, and if this were 
 not a question of the highest principle with me, on 
 which I should not hesitate to sacrifice, if need be, 
 the most cherished friendships, I would most will- 
 ingly have been silent, or have spoken with bated 
 breath. But that the American nation, whom I 
 have learnt to know only to respect and to love, 
 should remain under the incubus of this professional 
 
FOR THE INSANE IN AMERICA. 87 
 
 prejudice ; that the American superintendents; 
 among whom I count some of my dearest friends, 
 should lag lamentably behind the science of their 
 age ; that the greatest reform in the treatment of 
 mental disease, inaugurated by and among Anglo- 
 Saxons, should be bounded by national barriers, 
 and denied to the largest community of the Anglo- 
 Saxon race this I could not-sit down with a quiet 
 conscience silently to think upon. Far be it from 
 me to dogmatise my psychiatric colleagues in the 
 United States ; but I may be permitted earnestly 
 to entreat them to take a wide and general view 
 of their position in their own social surroundings, 
 and in the wide world of science. My fervent hope 
 for them is that by doing so they will decide to 
 cast behind them a narrow prejudice, and thus be 
 able to reinstate themselves in the front ranks of 
 practical philanthropy, and in the confidence of 
 their compatriots. They are men, as I most will- 
 ingly testify, animated by the highest motives of 
 humanity, but ignorant and mistaken in their appli- 
 cation of means to the furtherance of that great 
 end to which we all press forward namely, to the 
 care and cure of the insane with the least amount 
 of suffering. That they will learn this without 
 much delay I very confidently predict ; that they 
 will sink five fathoms deep their bonds of hemp 
 and iron ; and bring " medicine to a mind diseased" 
 only in the shape of medical and mental influence ; 
 
88 ASYLUMS FOR THE INSANE IN AMERICA. 
 
 that they will jealously guard the enjoyment of all 
 innocent freedom for their patients, and all possible 
 publicity in the management of their institutions, I 
 feel as sure as that they and their countrymen are 
 destined in the ages to be our own great rivals in 
 the race of social and scientific progress in this and 
 in all other matters. In a few years they will look 
 back upon their utterances in defence of mechanical 
 restraint with the same wonderment with which 
 they may now regard all that has been said in 
 defence of domestic slavery, but with no wounding 
 recollections of war and conflict, and then they will 
 forgive me or my memory for that I have written 
 the above words, which may perchance have has- 
 tened this happy change. 
 
 
 
 SaviH. Edwards & Co., Printers, 4, Chandos Street, W.C-