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INSANITY, AND HOSPITALS FOR THE INSANE.

(Prepared for the National Almanac by PLINY EARLE, M.D.)

THE able Superintendent of the Census, J. C. G. | bers which form the basis of the subjoined table Kennedy, Esq., has furnished us, in advance of of the insane and the idiotic in the several States publication by the Government, with the num-and Territories, according to the Census of 1860.

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them of the healthy use of those mental faculties which are the prerogatives of man alone, and which, to him, are the greatest blessing conferred by the ever-loving Father and Creator of the human race.

them will be obvious upon a moment's reflection. I and worse than all the other consequences, divests But the influence exerted by them, together with the fact that both the insane and the idiotic were included together, no specification of the numbers of each, respectively, being made, was such that in reference to these persons the census of 1840 was so incomplete and so inaccurate as to be worse than useless: it led to error. The two subsequent ones are undoubtedly far more nearly accurate. Upon looking over the foregoing table, however, it appears to us that some errors have arisen from a want of observance of the true difference between insanity and idiocy. According to the technical, medical definition, an idiot is a person whose mental faculties have been, from birth, of a very low grade; while an insane person is one in whom those faculties have become disordered or impaired subsequently to the time of birth.

Among the first suggestions which, in a reflecting mind, would follow the knowledge of this sadly important fact, are the following. Whence comes this disorder? What are its causes? What is the proper method of its treatment? By what measures can it be prevented? To these propositions we propose to address ourselves, not, perhaps, very systematically, but with the endeavor that it shall be in a manner by which the present state of knowledge in regard to them may be fairly expressed.

The word "Insanity," although derivatively a broadly comprehensive generic term, adaptable to unsoundness of either body or mind, and perhaps of any other thing whatsoever, has become specific by usage, signifying unsoundness of mind alone. Of all the terms in use having the same

and not unpleasant to the ear. "Craziness" is rude and harsh, and is more properly applicable to material substances than to the mind. "Lunacy"-a word originating in an unenlightened age, when it was supposed that mental disorders were produced through the agency of the moonexpresses, philologically, an untruth; and “madness" is extensively employed synonymously with "anger." We would reject the three. The term

Persons of naturally fair, or even superior, mental faculties, may have those faculties so far impaired by disease that they rank but little if any higher in the scale of intellect than idiots. Their disorder is then, properly speaking, imbecility, dementia, or amentia, and not idiocy. This true dis-signification, it is the best, being brief, expressive, crimination, as has been before hinted, we believe to have been overlooked by some of the officers who took the last census. It will be observed that in Vermont the number of idiots is reported as but a minute fraction more than one-third as large as the number of the insane, while in Michigan the number of idiots is about thirty-three per centum greater than that of the insane. In other words, while in Vermont there is but one idiot to three insane persos, in Michigan there are four."mental alienation" is better than either of the Why should idiocy be four times as frequent, in relation to insanity, in Michigan as it is in Vermont? In latitude, climate, race, and the habits and customs of the people, there is no very great difference. In short, we know of no agent or infuence whence such a discrepancy could arise; and hence we doubt its actual existence, preferring to believe that it is merely made apparent by a want of adherence, by the marshals of the Census, to the distinction which we have mentioned.

It is not our intention, however, to enter at length into a discussion of either this question or some others suggested by the table. Our purpose is, taking that table as a text from which we may widely depart, to lay before our readers some information in regard to insanity, the insane, and the hospitals for their treatment, which we trust will be both interesting and useful. To say nothing of idiots, the census, as we have perceived, imparts to us the knowledge, startling, indeed, to any one whose attention may never before have been directed to the subject, that within the territory of the United States there were, in 1860, twentyfour thousand persons afflicted with a disorder which, in most cases, debars them from social intercourse, destroys their power of usefulness to their fellow-men, renders them a burden to either their friends or the public, and, more than this,

last preceding three, but it lacks brevity; and "mental disease" is open to one serious objection. It conveys the idea of disease of the mind. Now, the word "mind," in its common acceptation, is synonymous with "soul," or the spiritual element of man. But it is difficult to believe that this element can be diseased. Its nature is such as to elevate it above the sphere of that proneness to decay and to destruction which is implied by the word "disease." Hence we would say "mental disorder," in preference to "mental disease."

We assume, therefore, that insanity is not a disease of the mind, but that it is the sequence or effect of a disease or a diseased action of the brain, the organ through which the operations of the mind are manifested. The manifestations of mind are disordered, perverted, insane, because the material organ has lost its power of developing them in the normal or healthful condition. If, in a mill propelled by water, a few cogs in the primary gearing be destroyed, the machinery will act irregularly,-insanely, if we may use the term in this connection,-although the water which is the moving power is still as pure and runs with a current as strong and as equable as ever.

The bodily disease of which insanity is a consequence may be in the brain, or in some other internal organ, as, for example, the liver; and the

brain acts disorderly through sympathy with that are more likely to produce exhaustion and debility other diseased organ, the principle being the same than manual occupations, not alone because the as in a case of severe headache produced by a dis- brain is more active in the former than in the latordered stomach. When the disease is in the ter, but also because there is less of that physical brain, if it is organic, that is, if a portion of the brain exercise which is necessary to preserve the vigor has been destroyed or permanently changed in its of body without which severe or protracted mencondition, the insanity is incurable, because the tal labor cannot safely be prosecuted. Of manual disease of the brain cannot be cured. But if the employments, those of a sedentary kind and those disease of the brain be merely functional, simply in which the laborer is subjected to unwholesome a diseased action of the organ, the insanity is gene- air are more likely to produce it than those in rally curable. If the disease be in the liver, and which there is free exercise in a pure atmosphere. the disordered action of the brain arise from sym- It is not, however, the regular employments of pathy with that organ, then the insanity will be mankind which are the most prolific causes of incured by whatever will cure the disease of the sanity. It is rather those habits, customs, and liver, and the disease of the liver will be cured by other influences which minister to his appetites, the same medicines which would cure it if there stimulate his passions, and most powerfully opewere no insanity. All these facts, and many others rate upon his sentiments. These, more than any of a like character, are additional proofs that in- thing else, either exhaust or depress the vital or sanity is not a disease of the spiritual element. nervous energy. Intemperance of all kinds, deWhence comes insanity? He who should an- | bauchery, self-abuse, all high popular excitements, swer this question by saying, "It is the product of whatsoever may be the subject,-these excite and civilization," would not thereby fall into a serious error. Certain it is that among the aborigines of America, as well as among other savage races and people, the disorder is exceedingly rare, although not absolutely unknown. And it is no less certain that, as a general rule, as a people advance through the several intermediate stages between barbarism and civilization, mental disorders become more and more frequent among them, apparently keeping pace with that advance, and reaching their maximum only when that people have attained the highest point of enlightenment.

exhaust the nervous energy; and grief, anxiety, troubles, difficulties, and disappointments greatly depress it. To these influences, then, we may rightfully look as among the most powerfully exciting causes of the disorder in question.

Now, although the alleged causes of insanity, as published in the reports coming from the hospitals for the insane, cannot be relied upon as entirely accurate, or, perhaps, as very nearly accurate, on account of the frequent difficulty of positively ascertaining the cause, in individual cases, yet they may be regarded as approximations towards the truth. As an evidence, therefore, of the position we have taken, we quote, from Dr. Kirkbride's Report of the Pennsylvania Hospital for the Insane, the ten causes to which are assigned the largest numbers of the cases which have been treated at that institution. They are as follows:Ill health of various kinds.. Intemperance... Mental anxiety..... Grief, loss of friends, &c... Puerperal state........... Loss of property.

Religious excitement..............

601

243

237

193

152

140

137

87

57

50

Agreeably to the well-known law of physiology that the more an organ is healthfully used the more it becomes developed, the average brain of the civilized man has become larger than that of the savage, and, having thus lost its natural relative proportion to the body, and being called more frequently and energetically into action, its power is more likely to be used to exhaustion, and hence it is more liable to disease. The manifold artificial habits and customs of civilization tend to increase this liability, until the enlightened man beholds, as it were, the chasm of insanity yawning before him at every hour and at every step. But, with this general liability produced by the cultivation of all the concomitants of civilized life, what, if any, are the particular agencies which, more than others, operate in the production of insanity? To this proposition it may first be an- The whole number of cases to which causes are swered that, inasmuch as insanity is almost uni- assigned in the report is 2220; and 1897, or about formly a disorder connected with bodily debility, six-sevenths of the whole, are placed under the a fact apparently never learned until within the ten heads above mentioned. It will be perceived last half-century, it necessarily follows that all that the largest number (601) are attributed to customs, habits, occupations, or other agencies "ill health." It may be assumed as an undoubted whatsoever which exhaust the power of the brain truth that in a large proportion of these cases and nerves, bringing the body to a weakened con- the "ill health" originated in some of the several dition, may thus become the origin of mental dis- debilitating influences to which, in the other cases order. Such influences are, indeed, the ramified in the table, the mental disorder is directly asroot from which insanity actually springs. And signed. The ill health was merely the antecedent civilized life is full of them. Intellectual pursuits of the insanity, an intermediate condition between

Domestic difficulties...
Disappointed affection....
Masturbation......

the cause of the mental disorder and that disorder | Worcester. The first two institutions are near itself. the two principal cities in the country, and reWe shall now copy from the "History and Sta-ceive from them a very large proportion of their tistics of the Bloomingdale Asylum," New York, patients, while the last is near the centre of a the ten causes most prominent by their numbers, State, and the largest part of its patients are deomitting that of “injury from falls," which is ac- rived from the agricultural and other laborious cidental, not of constant operation. As the table classes of the population. is much more minute in detail than that of Dr. Kirkbride, we have also grouped together the cases attributed to various diseased conditions of the body, and placed them all under the general termill health."

Ill health...

Pecuniary difficulties........
Intemperance.....
Puerperal state.....

Religious excitement...

Domestic trouble....

Death of relatives.....
Disappointed affection.......
Masturbation.......
Application to study...

237

133

117

99

93

65

43

38

37

But, to return to our main point, it will be seen that all the causes mentioned in the three foregoing tables are such as exhaust, debilitate, or depress the vital or nervous energy.

Before leaving this part of our subject, it is important to remark that he who attempts thoroughly to investigate the sources of mental disorder at the present day will soon become convinced that, to a large extent, its foundation is laid in early life, by the faulty or pernicious practices too often followed in the education and the rearing of the young. The stimulating drinks of the table, the late hours, the excitements of society and of popular assemblies, in all of which here more than in any other country they are indulged, the confinement and the hot-house forcing of the brain in the studies of the school, and the neglect to promote physical exercise to the degreo necessary for that development of the body which will enable it to maintain a healthy equilibrium The next authority to which we refer is the re- with the mind,-all these assist in creating a nerport of Dr. Bemis, of the Massachusetts State Hos-vous irritability and a generally abnormal condipital at Worcester. The number of cases to which causes are here assigned is 3197. The ten having the highest numbers are subjoined.

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The whole number of cases reported in the work from which we quote is 1186; and 892, or nearly four-fifths of them, are included under the ten foregoing heads.

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tion of the body which greatly expose the individual to attacks of bodily disease and of mental disorder. The brain is brought into such a state that a slight exciting cause, either physical, intellectual, or moral, may drive it into that diseased action the effect of which is insanity.

What is the proper method of treatment in mental disorders? Let not our sensitive reader fear, from the announcement of this proposition, that we are about to lead him into the unsavory atmosphere of drugs and medicines, of pills and powders. We shall deal in generals alone, not in details; and we treat the subject even thus far rather for the purpose of correcting some errors

The number assigned to these ten causes is 2316, which have gained a credence somewhat extener more than two-thirds of the whole.

Now, it is a remarkable fact, remarkable even to one who for many years has been conversant with the subject of insanity, that of the ten causes taken from each of the authorities mentioned, nine are actually identical in the three. The tenth is, from the Pennsylvania Hospital, “mental anxiety;" from the Bloomingdale Asylum, "application to study;" and, from the Massachusetts State Hospital, "excessive labor." This discrepancy may arise from the position of the several hospitals, as we shall soon mention in connection with another dissimilarity. Although nine of the causes are the same in the three tables, their relative numbers are somewhat different. Thus, the proportion of cases assigned to pecuniary difficulties is much larger at the Pennsylvania Hospital and the Bloomingdale Asylum than at the Hospital at

sive, than for any other object whatever.

Experience has proved, beyond the necessity of a further discussion of the subject, that the method of treating the insane which presents the greatest hope and probability of their restoration is that which is pursued in the modern hospitals expressly erected for the purpose. This being assumed, the great importance of those institutions becomes at once apparent; and hence we propose briefly to treat of their origin, as well as of their plan of treatment.

Until within the last hundred years, the treatment of the insane, even in civilized countries, was perhaps generally more barbarous and less calculated to effect their restoration than it was among the Egyptians two thousand years ago. The public receptacles for them were either jails or buildings equally strong, where they were con

fined in cells, and a large proportion of them were either fettered, manacled, or chained to the wall or the floor. Since the year 1792, however, a revolution has taken place upon this subject, which, in the extent of good which it has accomplished, the remarkable amelioration of the condition of the recipients of its benefits, scarcely has a parallel in the history of philanthropic beneficence. This change was begun, in the year just mentioned, by Dr. Pinel, in Paris, France, and by William Tuke, of York, England. The former released from their chains a large number of insane persons in the Bicêtre Hospital, and through the exertions of the latter a hospital for the mild and enlightened treatment of persons suffering from mental disorder was erected at York. Since that period the system has been adopted in nearly all the European nations.

So far as we are informed, the first specific legislative provision for the curative treatment of the insane in a public establishment in this country was in the year 1751, when the charter of the Pennsylvania Hospital was granted, expressly providing that persons with mental disorder should be received. For nearly three-quarters of a century a part of that hospital was devoted to them, and in 1843 the remaining inmates of that class were transferred to a separate branch erected for the special purpose, and called the "Pennsylvania Hospital for the Insane.".

The first distinct establishment for the insane in the then British colonies in America was at Williamsburg, Virginia. It was opened before the Revolutionary War, during that war was vacated and occupied as barracks, was afterwards reconverted to its original purpose, and still remains in operation.

ing any necessity for entering into further details in regard to their establishment.

A hospital at Austin, Texas, was in progress of construction in 1857, and Dr. J. C. Perry had been appointed as its superintendent. We have no more recent information in regard to it.*

The whole number of patients remaining in the hospitals at the time of the last received accounts is 10,859. Hence the capacity of the present public institutions of the country may be stated at eleven thousand. There are several private establishments for the treatment of the insane, but, being comparatively small, their aggregate means of accommodation would not essentially increase that number.

The number of insane persons in the country being, according to the census, about twenty-four thousand, it appears that there are accommodations in the hospitals for less than one-half of them. No less than thirteen thousand are debarred from the benefits of those establishments, and must be otherwise provided for. Where are they? A large number are in the poor-houses of counties and towns, some are in prisons, and doubtless many remain with their relatives or friends. We have the evidence, only too abundant, that a number, far from inconsiderable, are still subjected to the privations and severities of cells, cellars, hovels, strait-jackets, manacles, and other means of coercion and restraint, such as, with the present state of knowledge of the proper treatment of insane persous, should only be known as the abolished barbarisms of a by-gone time.

Notwithstanding, then, the wonderful progress in the foundation of hospitals within the last thirty years, there yet remains abundant necessity for more of them. The field for active philanthropy is still broad in this direction. The opportunity for the exercise of liberality, either individual or by the commonwealth,-a liberality certain of achieving a benefit commensurate with the desires of the donor,-continues open. That there may be generous hearts with willing hands to seize it, must be the prayer of every lover of his race.

The "Asylum for the Relief of Persons deprived of the Use of their Reason," near Frankford, and now within the city limits of Philadelphia, Pa., was the first hospital of its kind erected in this country after a knowledge of the labors of Pinel, Tuke, and their coadjutors had crossed the Atlantic. The founders of that hospital were guided by the same spirit which stimulated their fellow-philanthropists in Europe, and adopted the same en- The treatment of patients at the hospitals for lightened general principles of treatment. The the insane is composed of two classes of curativo establishment was opened for the reception of pa- agents, and hence is said to consist of the medical tients in 1817. Since that time a widely dissemi-and the moral treatment. The medical treatment nated interest in the insane has been aroused, the number of our hospitals has been constantly and, at periods, rapidly augmenting, their architecture has been remarkably improved, their internal arrangements made more convenient, their comforts increased, their means and facilities for treatment greatly enlarged, and the treatment itself so far mitigated in austerity that the use of the old methods of mechanical bodily restraint and coercion has been almost wholly abolished. In the table on the next page, the principal hospitals for the insane in the United States are arranged in the chronological order of their opening, thus prevent

Since the above was written, we have received from the Hon. A. J. Hamilton a letter, from which the following is an extract:

"November 22, 1862.
* The Insane

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Asylum of Texas, at Austin, has been open for about two years. The present superintendent is Dr. J. M. Steiner. There are some sixty patients. Besides the usual appropriations by the Legisiature for its support, it has an endowment of twenty-five leagues of land (110,700 acres), which will in the future prove amply competent for the building and support of a magnificent institution, worthy of our great State."

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