30th Congress,—^ f [SENATE.] ' Miscellaneous. 1st Session. No. 150. MEMORIAL D. L. DIX, ;>^^3 A grant of land for the relief and support of the indigent curable and incurable insane in the United States. June 27, 1848. Referred to a Select Committee, and ordered to be printed, and that 5,000 additional copies be printed for the use of the^Benate. To the Senate and House of Representatives of the United States in Con- gress assembled. Your memorialist respectfully asks permission to lay before you what seem to be just and urgent claims in behalf of a numerous and increasing class of sufferers in the United States. I refer to the great and inade- quately relieved distresses of the insane throughout the country. Upon the subject to which this memorial refers, many to whose justice and humanity it appeals are well-informed; but the attention of many has not been called to the subject, and a few, but a very few, have looked upon some features of this sad picture as revealed in private dwellings, in poor- houses, and in prisons. Your memorialist hopes to place before you substantial reasons which shall engage your earnest attention, and secure favorable action upon the important subject she advocates. It is a fact, not less certainly substantiated than it is deplorable, that insanity has increased in an advanced ratio with the fast increasing popu- lation in all the United States. For example, according lo the best re- ceived methods of estimate five years since, it was thought correct to count one insane in every thousand inhabitants throughout the Union. At the present, my own careful investigations are sustained by the judgment and the information of the most intelligent superintendents of hospitals for the insane, in rendering the estimates not less than one insane person in every eight hundred inhabitants at large, throughout the United States. There are, in proportion to numbers, more insane in cities than in large towns, and more insane in villages than among the same number of inhab- itants dwelling in scattered settlements. Wherever the intellect is most excited, and health lowest, there is an increase of insanity. This malady prevails most widely, and illustrates its presence most commonly in mania, in those countries whose citizens pos- sess the largest civil and religious liberty j where, in effect, every indi- Tippui & Streeper, printers. [150] 2 vidual, however obscure, is free to enter upon the race for the highest honors and most exalted stations; where the arena of competition is acces- sible to all who seek the distinctions which acquisition and possession of wealth assures, and the respect accorded to high literary and scholastic attainments. Statesmen, politicians, and merchants, are peculiarly liable to insanity. In the United States, therefore, we behold an illustration of my assertion. The kingdoms of Western Europe, excepting Portugal, Spain, and the lesser islands dependent on Great Britain, rank next to this country in the rapid development of insanity. Sir Andrew Halliday, in a letter to Lord Seymour, states that the number of the insane in Eng- land has become more than tripled in the last twenty years. Russia in Europe, Turkey, and Hungary, together with most of the Asiatic and African countries, exhibit but little insanity. The same is remarked by travellers, especially by Humboldt, of a large part of South America. Those tracts of North America inhabited by Indians, and the sections chiefly occupied by the negro race, produce comparatively very few ex- amples. The colored population is more liable to attacks of insanity than the negro. This terrible malady, the Source of indescribable miseries, does increase, and must continue fearfully to increase, in this country, whose free, civil, and religious institutions create constantly various and multiplying sources of mental excitement. Comparatively but little care is given in cultivating the moral affections in proportion with the intellectual development of the people. Here, as in other countries, forcible examples may be cited to show the mischiefs which result alike from religious,* social, civil, and rev- *Note.—I wish to mark carefully the distinction between true religion and extravagant religious excitements. The one is the basis of every virtue, the source of every consolation under the manifold trials and af- flictions which beset the path of every one in the course of this mortal pilgrimage ; while that morbid state which is created by want of calm, earnest meditation, and self-discipline, by excessive demands upon the physical strength, by protracted attendance upon excited public assem- blies, is ever to be deprecated. The following statistics show how large a part of the patients in some of our best hospitals labor under what is commonly termed religious insanity. 1 offer a pretty full list from the report, for 1843, of the Massachusetts State Hospital, for the sake of com- parison: number of years not recorded : Intemperance - - - - 239 111 health ..... 279 Domestic afflictions - - - - 179 Religious - 148 Property - - - - - 98 Disappointed affections - - - - 64 Disappointed ambition - - - - 33 Epilepsy - - - . - 45 Puerperal - - . - -47 Wounds on the head - - - - 21 Abuse of snuff and tobacco - - - 8 Many cases not recorded for two years previous to 1844. Dr. Woodward remarks, that " the coincidence of this table with the 3 [ 150 ] olutionary excitements. The Millerite delusions prepared large numbers for our hospitals; so also the great conflagrations in New York, the Irish records of other institutions shows, conclusively, that if we have failed in ascertaining causes, we have fallen into a common error." Seven consecutive and valuable reports by Dr. Kirkbride, exhibit the following results in the Pennsylvania Hospital for the Insane. This is not, like the first referred to, a State institution, but has a class of pa- tients from adjacent States, as well as its own State's insane. It will be kept in mind, also, that more than 350 insane patients are in the Blockley almshouse in the vicinity, of which no note is here made. 'In 184W42, admissions 299; of which 238 were residents of Penn- sylvania, viz: 111 health of various kinds Intemperance ... Loss of property - Dread of poverty - Disappointed affections Intense study ... Domestic difficulties - - • Fright at fires, &c. Grief—loss of friends Intense application to business Religious excitement Want of employment Use of opium - ■ - Use of tobacco Mental anxiety ... Unascertained, &c. In 1842-'43, of 439 cases, there were from religious excitement 12 men, 9 women—total 21. In 1843-'44, of 592 cases, religious excite- ment produced of men 17, of women 11—total 28. In 1844-'45, in 769 cases, religious excitement in men 19, in women 16—total 35. In 1846, of 936 cases, of men were, through religious excitement, 22; of women, 20—total 42. In 1817, of 1,196 cases recorded, 26 inen, 24 women—to- tal 50, through religious excitement. Dr. Brigham's first annual report upon the New York State Hospital shows, of 276 cases within the first year, there were through religious excitement, of men 29, of women 21—total 50; besides 5 men and 2 women (total 7) insane through "Millerism." Of 408 patients in 1842,57 became insane through ill health}32 through intemperance, 54 through religious anxiety, 50 through trouble and dis- appointment, and 55 through various minor causes. Of 179 cases received at Bloomingdale in 1842, 19 were from intem- perance, 15 various causes, 15 puerperal, 14 religious excitement, 14 love, 13 trouble. Of 122 cases received in 1842 at Staunton, Va., 33 were ill health, 20 Men. Women. Total. 22 24 46 20 0 20 17 6 23 2 0 2 2 4 6 5 0 5 1 5 6 2 3 5 4 16 20 2 . 0 2 8 7 . 15 9 0 9 0 2 2 2 0 2 4 1 5 0 0 123 299 [ 150 ] 4 riots and firemen's mobs in Philadelphia; and the last presidential elec- tions throughout the country levied heavily on the mental health of its citizens. Abroad, discontents in Scotland, civil and religious; agitations in Wales, social and civil; wide-spread disturbances in the manufacturing and agricultural districts of England; tumultuous and riotous gatherings in Ireland—all have left abiding evidence of their mischievous influence upon the records of every hospital for the insane. France, too, unfolds a melan- choly page of hospital history. Subsequent to the bloody revolution which marked the close of the eighteenth century, the hospitals for the insane were thronged, showing that where the effect of exalted mental excite- ment failed to produce insanity in the parents, it was developed in the children, and children's children—a fearful legacy, and sure I The political disturbances which convulsed Canada, several years since? were followed by like results. In law, idiots are ranked with the insane. I have remarked, throughout our country, several prevailing causes of organic idiocy; of these the most common, and the most surely traced, is intemperance of parents, and the marriage and intermarriage of near relatives and kindred. Abounding examples exist on every side throughout the land. In calculating the statistics of mental aberration, from the best authorities, it is found impossible to arrive at exactly correct results j approximation to facts is all that can be attained. There is less maniacal insanity in the southern than in the northern States, for which disparity various causes may be assigned. Two leading causes, obvious to every mind, is the much larger amount of negro pop- ulation, and the much less influx of foreigners, in the former than in the atter. While the, tide of immigration sets towards the north Atlantic States with almost overwhelming force, one cannot witness the fact and not note its sequence. Our hospitals for the insane are already receiving a .vast population of uneducated foreigners; and most of these, who become the subjects of in- sanity, present the most difficult and hopeless, because the least curable cases. Take for example the ^following records, which are gathered from the city hospitals for the insane poor, passing by for the present all the State and general hospitals: In 1846, the Boston City Hospital for the insane poor received 169 patients; 90 of which were foreigners, 35 natives of other States, and 44 alone resi- dents of the city. Qf the 90 foreigners, 70 were Irish. The New York City Hospital for the insane poor, on Blackwell's island, which went into opera- intemperance, 14 religious anxiety, 12 domestic afflictions, 10 pecuniary troubles. Of 1,247 patients received at the Hartford Retreat, 103 became insane through intemperance, 178 through ill health, 110 through religious anx- iety, 65 through trouble and disappointment, 46 puerperal. Irreligion, and the abuse of religion, are frequently the cause of insan- ity and suicide. Pure religion, more than any other power, tends to ar- rest, and assists to cure insanity. Of this fact there is constant evidence and illustration abroad in society, and within the limits of every well organized asylum. 5 [ 150 ] ttion in 1839, had, in the autumn of 1843, about 300 patients. Of 284 ad- mitted the following year, 176 were foreigners, viz: 112 Irish, 21 English, 27 Germans; and besides these were 38 natives of New York. On the first of January, 1846, there were in the institution 356 patients, of whom 226 were foreigners. In January, 1847, there were 410 insane patients, 328 of whom were foreigners. The cost to the city of supporting this institution, in 1846, was $24,179 67. In the Philadelphia poorhouse hospital, at Blockleyfthere were received in one year 395 insane patients; at the present time there are actually resi- dent there 350 idiots, epileptics, and insane. At the Baltimore city alms- house, there are at the present time more than 85 individuals in various stages of insanity, the whole number of inmates reported being 1,726; of whom 873 are Americans, and 853 Europeans. In the Charity Hospital at New Orleans, in 1845-'46, were above 73 insane; in "1847-'4S there were above 80, chiefly foreigners, and presenting mostly chronic cases. The whole number of patients received at this institution the past year was 8,044: of these, 1,773 were Americans by birth, 6,150 were foreign- ers, and 121 were not recorded. The report of the Commercial Hospital at Cincinnati shows, for 1844-'45, that of 1,579 patients, 85 were insane and idiotic. The report of 1846 ex- hibits the following summary: " Of 2,028 patients, 102 were insane." The last returns show yet an increase of this afflicted class, notwithstanding the enlarged accommodations in the State Hospital at Columbus, and the new buildings for the insane at the excellent asylum for persons in neces- sitous circumstances in the same city. I might adduce additional records, but believe the above are sufficient to extabiish the correctness of my position. Allowing at the present time 22,000,000 inhabitants in the United States, (which is below the estimated number,) and supposing only one in every thousand to be insane or idiotic, we have then 22,000 to take charge of; a majority of whom are in needy or necessitous circumstances. Pres- ent hospital provision relieves (if we do not include those institutions not considered remedial) less than 3,700 patients. Where are the remainder, and what is their condition? More than 18,000 are unsuitably placed in private dwellings, in jails, in poorhouses, and other often most wretched habitations. Dr. Kirkbride, who has carefully reviewed this subject, writes as follows: " In regard to whole numbers, my own inquiries lead me to believe that one in every six or seven hundred inhabitants would be a nearer approximation to correct estimate than one in every thousand, which has heretofore been assumed as the common rule." Accord- ing to the latest Parliamentary returns taken with the report of the Metropolitan Commissioners on Lunacy, which give the numbers of all classes of insane in the hospitals of England and Wales, it is ascertained that in these two countries " there is one insane pauper to every one thou- sand inhabitants alone." The liability of communities to insanity should not, I suppose, be esti- mated by the number of existing cases at any one time; for insanity does not usually hasten the termination of life. Take for example Massa- chusetts, New York, and Virginia, where are found so large numbers of established, long-existing cases. These are counted again and again, every year, every five, or every ten years. A fairer test of the liability of com- [ 150 ] 6 munities to insanity is to be found in the occwring cases in corresponding given periods. There are twenty State hospitals, besides several incorporated hospitals, for the treatment of the insane, in nineteen States of the Union, Virginia alone having two government institutions of State and incorporated hospi- tals. The following is a correct list, omitting several small establishments conducted by privatf individuals, and several pretty extensive poorhouse and prison departments, which cannot, properly-be classed with regularly organized hospitals, being usually deficient in remedial appliances. The first hospital for the insane in the United States was established in Philadelphia, as a department of the Penn Hospital, in the year 1752. This has been transferred to a fine district near the village of Mantua, in the vicinity of Philadelphia, since 1832: number of patients 188. The second institution receiving insane patients, and the first exclusive- ly for their use, was at Williamsburg, Virginia, in 1773: number of pa- tients 164. The third was the Friends' Hospital, at Frankfort, near Philadelphia, in 1817: number of patients 95. The next was. the McLean Hospital, at Charlestown, (now Summer- ville,) in Massachusetts, in 1818. This valuable institution is second J;o none in America. Number of patients ISO. Bloomingdale Hospital, near the city of New York, was established in 1821; number of patients 145: South Carolina Hospital, at Columbia, in 1822; number of patients 74: Connecticut Hospital at Hartford, patients 122, and Kentucky Hospital at Lexington, patients 247, in 1824. In 1845-'46, the legislature of Kentucky passed a bill to establish a second State institution in the Green River country. Virginia Western Hospital was opened at Staunton in 1828; number of patients 217. Massachusetts State Hospital, at Worcester, was opened in 1833, and enlarged in 1843; it has 370 patients. Maryland Hospital, at Baltimore, was founded in 1834; it has the present year 109 patients. Vermont State Hospital, at Brattlebo rough, was opened for patients in 1837, and enlarged in 1846-'47; it has at presenf 320 patients. New York City Hospital for the poor, on Blackwell's island, was occupied in 1838; it is now being considerably enlarged: above 400 patients. The grand jury this month (June, 1848,). have made the following pre- sentment in relation to the Blackwell's island hospital for the insane poor: " We found no less than 425 afflicted children of humanity suffering un- der the most terrible of all privations, and, we observed with regret, less ade- quately cared for than their situation and the dictates of humanity re- quire.'" The same document places before the public the concurrent testimony of Drs. Macdonald, Williams, and Ogden, who in a clear and true report show that "the accommodations for the insane poor of New York city are at present inadequate and miserable; and the imperfect manner of their treat- ment is such as to be a disgrace to the city, which otherwise is deservedly famed for its liberal benevolent institutions. In the present state of affairs it is useless to attempt the recovery of any patients here." The same remark holds good of the department for the insane connected with the commercial hospital in Cincinnati. Well organized hospitals are the only fit places of residence for the in- sane of all classes; ill-conducted institutions are worse than none at all. 7 [ 150] The New York City Hospital for the Insane, and the State hospitals of Georgia and Tennessee, cannot take present respectable rank as curative or comfortable hospitals. Tennessee State Hospital, at Nashville, was opened in 1839. According to an act of the legislature the present year, this hospital is to be replaced by one of capacity to receive 250 patients. In the old hospital are 64 patients. Boston City Hospital for the indigent, which has 150 patients, and Ohio State Hospital at Columbus, were severally opened in 1839. The latter has been considerably enlarged, and has now 329 patients. Maine State Hospital, at Augusta, 1840; patients 130. New Hampshire State Hospital, at Concord, was opened in 1842, and has 100 patients. New York State Hospital, at Utica, was established in 1843, and has since been largely ex- tended, and has 600 patients. Mount Hope Hospital, near Baltimore, 1844-'45; has 72 insane patients. Georgia has an institution for the insane at Milledgeville, and at present 128 patients. Rhode Island State Hospital opened, under the able direction of Dr. Ray, early in 1848. New Jersey State Hospital, at Trenton, 1848. Indiana State Hospital, at Indianapolis, will be opened in 1848. State Hospital of Illinois, at Jacksonville, will be occupied before 1849. The Louisiana State Hospital will be occupied perhaps with- in a year. I repeat that these institution?, liberally sustained as are most of them, cannot accommodate the insane population of the United States who re- quire prompt remedial care. It may be suggested that though hospital treatment is expedient, perhaps it may not be absolutely necessary, especially for vast numbers whose condition may be considered irrecoverable, and in whom the right exercise of the reasoning faculties may be looked upon as past hope. Rather than enter upon a philosophical and abstract argument to prove the .contrary to be the fact, I will ask permission to spread before you a. few statements gathered, without special selection, from amass of records made from existing cases, sought out and noted during eight years of sad, pa- patient, deliberate investigation. To assure accuracy, establish facts beyond controversy, and procure, so far as possible, temporary or permanent relief, more than sixty thousand miles have been traversed, and no time or labor spared which fidelity to this imperative and grievous vocation demanded. The only States as yet unvisited are North Carolina, Florida, and Texas. From each of these, however, I have had communications, which clearly prove that the conditions of the indigent insane differ in no essential degree from those of other States. I have myself seen more than nine thousand idiots, epileptics, and in- sane, in these United /States, destitute of appropriate care and protection ; and of this vast and most miserable company, sought out in jails, in poor- houses, and in private dwellings, there have been hundreds, nay, rather thousands, bound with galling chains,bowed beneath fetters and heavy iron balls, attached to drag-chains, lacerated with ropes, scourged with rods, and terrified beneath storms of profane execrations and cruel blows; now sub- ject to gibes, and scorn, and torturing tricks—now abandoned to the most loathsome necessities, or subject to the vilest and most outrageous viola- tions. These are strong terms, but language fails to convey the as- tounding truths. I proceed to verify this assertion, commencing with the State of Maine. I will be ready to specify the towns and districts where each example quoted did exist, or exists still. [150] 8 In B., a furious maniac confined in the jail; case doubtful from long delay in removing to an hospital; a heap of filthy straw in one corner served for a bed ; food was introduced through a small aperture, called a slit, in the wall, through which also was the sole source of ventilation and avenue for light. Near C, a man for several years in a narrow filthy pen, chained ; con- dition loathsome in the extreme. In A., insane man in a small damp room in the jail; greatly excited; had been confined many years ; during his paroxysms, which were aggravated by every manner of neglect, except want of food, he had torn out his eyes, lacerated his face, chest, and arms, seriously injured his limbs, and was in a state most shocking to behold. In P., nine very in- sane men and women in the poorhouse, all exposed to neglect and every species of injudicious treatment; several chained, some in pens or stalls in the barn, and treated less kindly than the brute beasts in their vicinity. At C, four furiously crazy; ill treated, through the ignorance of those who held them in charge. 47 cases in the middle district, either scattered in poorhouses, jails, or in private families, and all inappropriately treated in every respect; many chained, some bearing the marks of injuries self- inflicted, and many of injuries received from others. In New Hampshire, on the opening of the hospital for the reception of patients, in 1842, many were removed from cages, small unventilated cells in poorhouses, private houses, and from the dungeons of county jails. Many of these were bound with cords, or confined with chains ; some bore the marks of severe usage by blows and stripes. They were neglected and filthy ; and some, who yet remain in remote parts of the State, through exposure to cold in inclement seasons, have been badly frozen, so as to be maimed for life. Details in many cases will not bear recital. In New Hampshire, a committee of the legislature was named in 1832, whose duty it was to collect and report statistics of the insane. Returns were received from only one hundred and forty-one towns: in these were returned the names of one hundred and eighty nine persons bereft of their reason, and incapable of taking care of themselves; ninety men and ninety-nine women. The number confined was seventy-six, twenty-five of whom were in private houses, seven in cells and cages, six in chains and irons, and four in the jails. Of the number at liberty, many had at various times been confined. Many of the facts represented by this com- mittee are too horrible to repeat, and would lead many to the belief that they could not be correct, were they not so undeniably authenticated. The committee remark that from many towns no returns had been made, and conclude their report with the declaration " that they could not doubt that the numbers of the insane greatly exceeded the estimates rendered." Where were these insane ? " Some were in cells or cages; some in out- buildings, garrets, or cellars; some in county jails, shut up with felons and criminals; some in almshouses, in brick cells, never warmed by fire, nor lighted by the rays of the sun." The facts presented to this com- mittee not only exhibit severe unnecessary suffering, but utter neglect, and in many cases actual barbarity. Most of the cases reported, I could authenticate from direct investigation. One very insane woman was confined all winter in a jail without fire ; and from the severity of the cold, and her fixed posture, her feet were so 9 [ 150 ] much injured that it was deemed necessary to amputate them at the ankle, which was accordingly done. " Another female was confined in a garret, where, from the lowness of the roof, and the restrained position, she grew double, and is now obliged to walk with her hands, as well as her feet, upon the floor." I recollect eight cases corresponding with this, produced from similar causes, in other States. A man was confined in a cellar for many years without clothing, and couching in a heap of wet straw, which was from time to time renew- ed; another in a similar condition is chained in an out building; another is at this time (1846) chained to the floor in an out building, glad to pick the bones thrown into his kennel, like a beast: one with sufficient prop- erty, and formerly correct in life, active and happy. This case was re- ported to the committee in 1832, who, summing up their report, state, that u in the extremity of disease, the maniac is withdrawn from observation, and is forgotten. His voice, in his raving, grates not upon tlie ear of the happy. They who have the custody of the wretched being are too prone to forget their duty, and his claims upon them for kindness and forbear- ance. Their sympathy is exhausted, and their kindness becomes blunted by familiarity with misery. They give up the feelings of the friend for the apathy of the jailer." They adopt a common error, that the maniac is insensible to suffering; that he is incurable; and therefore there is no use in rendering the cares his situation demands. A committee reported (in 1836) to the legislature of New Hampshire, that their whole number of returns was 312: the number of towns re- turned having insane, was 141; the whole number of inhabitants in all the towns returned, was 193,569. The number returned as confined, including all in cages, jails, close rooms, by chains and hand-cuffs, &c., was 81. From these statistics, carefully collected, it appears that one in every six hundred and twenty is insane. The committee of 1836 con- clude their report as follows: "Neither the time nor the occasion requires us to allude to instances of the aggravated and almost incredible suffering of the insane poor which have come to our knowledge. We are con- vinced that the legislature require no high wrought pictures of the various gradations of intense misery to which the pauper lunatic is subjected; extending from his incarceration in the cold, narrow, sunless, and tireless cell of the almshouse, to the scarcely more humane mode of 'selling him at auction,' as it is called, by which he falls into the hands, and is exposed to the tender mercies, of the most worthless of society, who alone could be excited by cupidity to such a revolting charge. Suffice it on this point, your committee are satisfied that the horrors* of the present condition of the insane poor of New Hampshire are far from having been exaggerated ; and of oourse they find great unwillingness on the part of those having charge of them to render correct accounts, or to have these repeated to the public." The report of the nine trustees for the hospital, for 1847, states, that from authentic sources they are informed that " in eight of the twenty- four towns in Merrimack county, having an aggregate population of twelve thousand, there are eighteen insane paupers; part supported upon the town farms, and part set up and bid off at auction from year to year, to be kept, and maintained by the lowest bidder." According to the data afforded above, there must be in the State several hundred insane sup- ported on the poor-farms, or put up at auction, annually. *' [ 150 ] 10 In Vermont, the same neglects, ignorance, and sometimes brutal severity, led to like results. Dr. Rockwell, his assistant physicians, and the whole corps of hospital nurses, bear accordant testimony to the sufferings of patients formerly brought to that institution from all parts of the State; and many even now arrive under circumstances the most revolting and shocking, subject to the roughest treatment or the most inexcusable and extreme neglects. I have seen many of these afflicted persons, men of hardy frames and women of great capacity for endurance, bowed and wasted till almost all trace of humanity was lost in grovelling habits, and injuries through severities and privations, which those cannot comprehend who have never witnessed similar cases of misery. Not many counties, if indeed any towns or parishes, but have their own tales of various wo, illustrated in the miseries of the insane. In the eighth annual report of the Vermont hospital for 1844 is the fol- lowing record, which being a repetition in fact, if not almost literal expres- sion of my own notes, I adopt in preference: "One case was brought to the hospital four and a halt years ago, of a man who had been insane more than twelve years. During the four years previous to his admission he had not worn any article of clothing, and had been caged in a cellar, with- out feeling the influence of a fire. A nest of straw was his only bed and / covering. He was so violent that his keeper thought it necessary to cause an iron ring to be riveted about his neck, so that they could hold him when they changed his bed of straw. In this miserable condition he was taken from the cellar and conveyed to the hospital. The ring was at once removed from his neck. He has worn clothing, has been furnished with a com- fortable bed, and has come to the table, using a knife and fork ever since he was admitted. He is most of the time pleasantly and usefully em- ployed about the institution." "Another man, insane for twenty-four years, for the last six years had worn no clothing, and had been furnished with no bed except loose straw. He had become regardless of everyihing that was decent. In less than three months after his admission, he so improved that he wore clothing constantly, kept his bed and room neat, and worked on the farm daily. " Another man, insane more than thirty years, was sold to the lowest bidder. For many years he was cased, and had his feet frozen so that he lost his toes, and endured cruel sufferings which no person in a natural state could have supported. He was five months in the hospital, wore his clothing, was furnished with a comfortable bed, and sat at table with other patients. He was a printer by trade, and for a long time em- ployed himself in setting up type for the newspaper printed at this insti- tution." Another patient, a woman 61 years of age, was taken to the hospital. She had been confined for several years in a half subterranean cage, tec, which was nothing other.than a cave excavated in the side of a hill near the house, and straw thrown in for a bed ; no warmth was admitted save what the changing seasons supplied. Her condition in all respects was neglected and horrible in the extreme." Examples here, as in every /State of the Union, might be multiplied of the insane caged and chained, confined in garrets, cellars, corn-houses, and other out-buildings, until their extremities were seized by the frost, and their sufferings augmented by extreme torturing pain. 11 [ 150 ] In ail the States where the cold of winter is sufficient to cause freezing of the human frame by exposure, I have found many mutilated insane, deprived either of the hands or the feet, and sometimes of both. In Massachusetts we trace repetition of like circumstances. In the fifth annual report of the State hospital, it is stated thnt "many patients have been received into the institution who have been badly frozen; some in such manner as to have lost their limbs—others a part of them." " Within a week from the date of this report, a man was sent who had been confined three years in a cage, where he had been repeatedly badly frozen, and in the la'.e severe weather so much so, that his extremities were actually in a state of mortification when he arrived. He survived but two days." In 1841 and '42, I traced personally the condition of more than five hundred insane men and women in Massachusetts wholly destitute of appropriate care. In one county jail alone there were twenty-eight, more than half of whom were furious maniacs. In another jail, in an adjoin- ing county, were twenty-two neglected creatures. It was to this jail— just presented by the grand jury as a nuisance, a place totally unfit for even temporary use—that a female patient was hastily removed from the poorhouse of D----, in-order, as was said, that she might be more com- fortable—in reality to evade and avoid searching investigations entered upon by strong authority. Said the keeper of one county prison, in which were many insane, com- mitted " not for crime or misdemeanor," but for safekeeping, or because dangerous to be at large, and in default of sufficient hospital provision for the same, " My prison resembles more the infernal regions than any place on the earth !" Almost without interval might be heard furious exclama- tions, blasphemous language, and the wildest ravings, howls, and shrieks. In three towns of one county alone (Essex) I found sixty neglected ca- ses. The returns of 1842 exhibited an aggregate of one hundred and thirty-five in that county. On the 24th of" December, the thermometer below zero, I visited a poorhouse; found one of the insane inmates, a woman, in a small apartment entirely unfurnished: no chair, table, nor bed—neither bundle of straw nor a lock of hay. The cold was intense. On the bare floor crouched the wretched occupant of this dreary place, her limbs contracted, the chin resting immovably upon her knees. She shud- dered convulsively, and drew, as well as she was able, more closely about her the fragments of garments which constituted her sole protection against unfit exposure and the biting cold. But the attendant, as I passed out from this den, remarked that they used " to throw some blankets over her at night." Inquiring my way to another almshouse which I had heard was greatly neglected, I was shown the road, and told that there were " plenty of in- sane and idiot people there." " Well taken care of?" I asked. " Well enough for such sort of creatures." " Any violently insane?" " Yes ; my sister's son is there—a real tiger': I kept him awhile', but it was too much trouble; so I carried him there." "Is he comfortably provided for?" " Well enough." " Has he decent clothes ?" " Good enough." " And food?" " Good enough—good enough." " One word more: has he the comfort of a fire?" "Fire, indeed, fire ! What does a cfazy man want of fire ? he 's hot enough—hot enough without fire !" At another poorhouse I found three confined in stalls, in an out build- [150] 12 ing. The vicissitudes which had marked the life of one of these desolate beings were singular, and may bring instruction to those whose reason now " is the strength of their life," but who are not exempt from this great calamity. H----belonged to a respectable family, possessed good abilities, and was well educated. He removed from I----, in Massachusetts, to Alba- ny, N. Y., where for a considerable period he conducted with ability a popular newspaper. In time, he was elected senator in the State legisla- ture, and was a judge in the court of errors. As a public man he was upright and respected. Insanity was developed while he filled public sta- tions : he was conveyed to the hospital at Worcester; his property was consumed ; and he was finally discharged as altogether incurable ; and being very violent most of the time, he was placed, " for safety," first in the jail at S----, finally removed to that in I----, and thence transferred to the almshouse where I found him. He had even then periods of par- tial restoration to reason, so as to comprehend where he was, and how cared for: inhabiting an unfurnished, dreary, narrow stall, in a dreary building of an almshouse ! In a prison which I visited often, was an idiot youth. He would follow me from cell to cell with eager curiosity, and for a long time manifested no appearance of thought. Cheerful expressions, a smile, frequent small gifts, and encouragement to acquire some improved personal habits, at length seemed to light up his mind to a limited power of perception. He would claim his share in the distribution of books, though he could not read, examine them with delight, and preserve them with singular care. If I read from the Scriptures, he was reverently attentive : if I conversed, he listened earnestly, with half conscious aspect. One morning I passed more hurriedly than usual, and did not speak to him. " Me book ! me book!" he exclaimed, eagerly thrusting his hand through the iron bars of the closed door of his cell. " Take this, and be careful," I said. Sud- denly stooping, he seized the bread which had been brought for his break- fast, and pushing it eagerly through the bars, he exclaimed, in more con- nected speech than was known before, " Here's bread; an't you hungry?" How much might be done to develop even the minds of idiots, if we but knew how to touch the instrument with a skilful hand ! Attempts to cultivate the higher faculties of these creatures, seemingly the merest animals, have been successfully adopted to a moderate extent in France, Germany, and Switzerland, and in the United States the sub- ject has been discussed. Dr. Ray, of the Rhode Island hospital, not long since visited a school for idiots which has been established at the Bicetre, near Paris. He wrrites, that " as early as the year 1828, Femes* made the first attempt in France to develop the powers of idiots, which attempt has resulted in the present school of Voisin, and which exhibits to the aston- ished spectator a triumph of perseverance and skill in the cause of human- ity, that does infinite credit to the heart and understanding of that gentle- man." This testimony is supported by Dr. Conolly, who, visiting the hospitals near Paris, said, " I was conducted to a school exclusively es- * A small volume entitled " Essays upon Several Projects, by Daniel de Foe," London, 1702, contains this remarkable passage : " The wisdom of Providence has not left us without examples of some of the most stupid natural idiots in the world who have been restored to their reason, infused after a life of idiotism ; perhaps, among other wise ends, to confute that sordid supposition that idiots have no souls." 13 [ 150 ] tablished for the improvement of these cases, and of the epileptic, and nothing more extraordinary can well be imagined." Dr. Hay ward, of Boston, who visited, last year, the schools for idiots above referred to, ex- presses the opinion that the great benefits to the unfortunate classes whose good they are designed to promote can hardly be appreciated, and that no pains should be spared to establish similar institutions in the United States. , I visited the poorhouse in W----. In a cage, built under a wood-shed, fully exposed to all passers upon the public road, was a miserable insane man, partially enveloped in a torn coverlet. " My husband," remarked the mistress of the house, " clears out the cage and puts in fresh straw once a week ; but sometimes it's hard work to master him. You see him now in his best estate !" In the adjacent town, at the poorhouse, was a similar case; only, if possible, more revolting, more excited, and more neglected. There were also other persons there in different stages of insanity. In a county jail not distant was a man who had been confined in a close apartment for many years; a wreath of rags invested his body and his neck; he was filthy in the extreme; there was neither table, seat, nor bed; a heap of noxious straw defiled one corner of the room. One case more must suffice for this section: I would that no others could be adduced even more revolting than are these so briefly referred to. In G----, distant from the poorhouse a few rods, was a small wooden build- ing, constructed of plank, affording a single room; this was unfurnished, save with a bundle of straw. The occupant of this comfortless abode was a young man, declared to be incurably insane. He was chained, and could move but a little space to and fro; the chain was connected to the floor by a heavy staple at one end—the other was attached to an iron collar which invested his neck—the device, it seemed, of a former keeper. In summer the door was thrown open, but during winter it was closed, and the room was in darkness. Some months after I saw this poor patient, and after several individuals also had witnessed his sufferings, the authorities who directed the affairs of the poorhouse reluctantly consented that he should be placed under the care of Dr. Bell. The man who was charged to con- vey the patient the distance of rather more than forty miles, having bound and chained him, (I have the impression that, by the aid of a blacksmith, he was released at this time from the torturing iron ring,) conveyed him as far as East Cambridge, arriving at dusk. Instead of proceeding with the patient at once to the hospital, which was distant less than a mile, in Som- erville, he chained him for the night to a post in the stable. After breakfast he was released and carried to the hospital in a state of much exhaustion. While the careful attendants and humane physician were busied in re- moving the strong bands which chafed his limbs, and lacerated the flesh in many places, ne continually endeavored to express his gratitude—em- bracing them, weeping, and exclaiming, "Good men! kind men! Ah, good, kind men, keep me here." After some months of careful nursing, he was so much improved that strong hopes were entertained of his complete restoration. These were crushed by an absolute decision of the overseers of the poor, remanding him to his old prison. Remonstrance was ineffectual. The last account stated an entire relapse, not only to the former state, but to a still more hopeless condition. He had become totally idiotic. In November I visited the poorhouse in F----; weather severe for the [ 150 ] 14 season; no mode of warming the insane. I was conducted to an out- building, sp enclosed as to secure the closest solitude to the patient. He had been returned from the hospital as incurable. He was said to be neither violent nor dangerous, but shut up lest he should run away. The door was opened, disclosing a narrow, squalid, dark, unfurnished cell. In one corner was a heap of straw, in which the insane man was nestled. He raised himself slowly and advanced with unsteady steps. His look was calm and gentle. " Give me those books; Oh, give me those books!" he exclaimed, eagerly reaching his hands for some books I carried. " Do give them to me, do!" he exclaimed, with kindling earnestness. "You could not use them; it is dark with you here." " Oh, give them, do give them !" and he drew a little nearer, lowering his voice to a whisper: "Give them, and Vllpick a hole in the plank, and let in some of God's light!" Just then the master arrived; he said that he purposed getting an iron collar and chain—then he could fasten him in the air sometimes outside. " I had," he added, " a cousin up in Vermont, crazy as a tiger cat; I got a collar made for him. After this, I kept the poorhouse at Groton, and I fastened up a crazy man there: he was fast then. I mean to have one for this fellow. I know how to manage your crazy men." In Connecticut, the estimated number of insane, nearly eight years since, was 542; a number even then below the actual amount, and now very much below the true estimate. Of these, not one-sixth were under hospital treatment five months since: in fact, it is believed that not a ninth part will be found receiving suitable care. The sad case of Rubello is too well known to require repetition. The insane patients in M----no longer drag their heavy chains abroad, when at labor laying stone walls, nor are they in other respects as much abused and abased as formerly. But no county is free from the reproach of having within its limits insane patients needing humane and judicious care. Of the mot miserable neglects in the case of large numbers carried for successive years to the Hartford Retreat, Drs. Brigham, Woodward, and Butler can, even now, bear sad testimony ; and to the observations of med- ical men may be added the evidence of that good man and true friend of sufferers, Rev. T. H. Gallaudet. Rhode Island has nearly or quite four hundred insane, idiots, and epileptics. About 90 recently are receiving the benefit of hospital care, under the enlightened administration of Dr. Ray. In no State, however, have I found more terrible examples of neglect and suffering, from abuse or ignorance, than existed there in the year 1843, and some cases in 1845 -'47. In the jails were many pining in narrow, damp, unventilated dungeons. In the poorhouses were many examples of misery and pro- tracted distress. In private families these conditions were less frequent; but the suffering, through ill-directed aims at securing the patients from escape, was in many instances equally revolting and shocking. Here, as in the five States first referred to, hundreds of special cases might be cited, did time permit. I offer but a single well-known example. In the yard of a poorhouse, in the southern part of the State, I was conducted by the mistress of the establishment to a small building con- structed of plauk; the entrance into a small cell was through a narrow passage, bav« and unlighted. The cell was destitute of every description of furnituie, unless a block of wood could be called such; and on this 15 [ 150 ] was seated a woman—clothed, silent, and sad. A small aperture, open- ing upon a dreary view, and this but a few inches square, alone ad- mitted light and air. The inmate was quiet, and evidently no,t dangerous in her propensities. In reply to my remonstrances in her behalf, the mistress said that she was directed to keep her always close; that other vise she would run away, or pull up the flowers! How is she wanned in winter? I inquired. " Oh, we just heat a stone and give her," was the laconic reply. Your other patient—where is he? "You shall see ; but stay outside till 1 get a lantern." Accustomed to exploring cells and dungeons in the basements and cellars of poorhouses and prisons, I concluded that the insane man spoken of was confined in some such dark, damp retreat. Weary and oppressed, I leaned against an iron door which closed the sole entrance to a singular stone structure, much resem- bling a tomb, yet its use in the court-yard of the poorhouse was not ap- parent. Soon, low smothered groans and moans reached me, as if from the buried alive. At this moment the mistress advanced, with keys and a lantern. '- He's here," said she, unlocking the strong, solid iron door. A step down, and short turn through a narrow passage to the right, brought us, after a few steps, to a second iron door parallel to the first, and equally solid. In like manner, this was unlocked and opened ; but so terribly noxious was the poisonous air that immediately pervaded the passage, that a considerable time elapsed before I was able to return and remain long enough to investigate this horrible den. Language is too weak to convey an idea of the scene presented. The candle was removed from the scene, and the flickering rays partly illuminated a spectacle never to be forgotten. The place when closed had no source of light or of venti- lation. It was about seven feet by seven, and six and a half high. All, even the roof, was of stone. An iron frame, interlaced with rope, was the sole furniture. The place was filthy, damp, and noisome; and the inmate, the crazy man, the helpless and dependant creature, cast by the will of Providence on the cares and sympathies of his fellow man—there he stood, near the door, motionless and silent; his tangled hair fell about his shoulders ; his bare feet pressed the filthy, wet stone floor; he was emaciated to a shadow, etiolated, and more resembled a disinterred corpse than any living creature. Never have-I'looked upon an object so pitiable, so wo struck, so imaging despair. I took his hands and endeavored to warm them by gentle friction. I spoke to him of release, of liberty, of care and kind ness. Notwithstanding the assertions of the mistress that he would kill me, I persevered. A tear stole over the hollow cheek, but no words answered to my importunities ; no other movement indicated conscious- ness of perception or of sensibility. In moving a little forward I struck against something which returned a sharp metallic sound: it was a length of ox-chain, connected to an iron ring which encircled a leg of the insane man. At one extremity it was joined to what is termed a solid chain—namely, bars of iron IS inches or 2 feet long, linked together, and at one end connected by a staple to the rock overhead. " My husband," said the mistress, "in winter rakes out sometimes, of a morning, half a bushel of frost, and yet he never freezes;" referring to the oppressed and life-stricken maniac before us. " Sometimes he screams dreadfully," she added, " and that is the reason we had the double wall, and two doors in place of one : his cries disturbed us in the house!" " How long has he been here?" " Oh, above three years; but then he [150] 16 was kept a long while in a cage first: but once he broke his chains and the bars, and escaped; so we had this built, where he can't get off " Get off! No, indeed; as well might the buried dead break through the sealed gates of the tomb, or upheave the mass of binding earth from the trodden soil of the deep grave. I forbear comment. Many persons, after my in- vestigations here, visited this monument of the utter insensibility and ig- norance of the community at whose expense it was raised. Brutal, wil- fully cruel, I will not call them, black as is the case, and fatal as were the results of their care! But God forbid that such another example of suffer- ing should ever exist to be recorded. New York, according to the census of 1840, had 2,340 idiots and in- sane. I am convinced that this estimate was below the certain number by many hundreds. In 1841, the Secretary of State reported 803 sup- ported at public charge. In 1842, the trustees of poorhouses estimated the number of insane poor then confined in the jails and poorhouses at 1,430. In 1843 I traversed every county in the State, visiting every poor- house and prison, and the insane in many private families. The hospital for the insane at Utica was opened in January, 1843, and during the year received 276 patients, all with the exception of six being residents of the State of New York. On Blackwell's island were above 300 ; at Bloom- ingdale more than 100 : 26 were at Bellevue. Besides these, I found, chiefly in the poorhouses, more than 1,500 insane and idiots, 500 of whom were west of Cayuga bridge. In the poorhouse at Flatbush were 26 in- sane, not counting idiots; in that at Whiteplains were 30 insane; at Al- bany between 30 and 40; at Ghent 18; in Greene county 46. In Wash- ington county poorhouse, besides " simple, silly, and idiotic," 20 insane. Nearly every poorhouse in the State had, and still has, its " crazy house," " crazy cells," u crazy dungeons," or " crazy hall;" and in these, with rare exceptions, the inevitable troubles and miseries of the insane are sorely aggravated. At A----, in the cell first opened, was a madman. The fierce command of his keeper brought him to the door, a hideous object; matted locks, an unshorn beard, a wild, wan countenance, disfigured by vilest unclean- ness; in a state of nudity, save the irritating incrustations derived from that dungeon, reeking with loathsome filth. There, without light, without pure air, without warmth, without cleansing, absolutely destitute of everything securing comfort or decency, was a human being—forlorn, abject, and dis- gusting, it is true, but not the less a human being—nay more, an immortal being, though the mind was fallen in ruins, and the soul was clothed in dark- ness. And who was he—this neglected, brutalized wretch? A burglar, a mur- derer, a miscreant, who for base foul crimes had been condemned, by the jus- tice of outraged laws and the righteous indignation of his fellow-men, to ex- piate offences by exclusion from his race, by privations and sufferings ex- treme, yet not exceeding the measure and enormity of his misdeeds ? No; this was no doomed criminal, festering in filth, wearing wearily out the warp of life in dreariest solitude and darkness. No, this was no criminal— " only a crazy man." How, in the touching language of Scripture, could he have said: " My brethren are far from me, and mine acquaintance are verily estranged from me: my kinsfolk have failed, and my familiar friends have forgotten me: my bone cleaveth unto my skin and my flesh. Have pity'upon me, have pity upon me, for the hand of God hath touched me!" 17 [150] I turned from this sickening scene only to witness another yet more pitiable. In the far corner of a damp, dark dungeon on the right was a human crea- ture—" a woman dreadful bad," said the attendant, who summoned her in harsh tones to " come out:" but she only moved feebly amidst the decay- ing mass, of straw, uttering low moans and cries, expressive both of physi- cal pain and mental anguish. There she lay, seemingly powerless to rise. She, too, was unclothed; and in this dungeon, alone,' in want, and pain, and misery; no pure air, no pleasant light, no friendly hand to chafe the aching limbs, no kind voice to raise and cheer, she dragged out a troubled existence. I know nothing of her history; whether forsaken by able kin- dred, or reluctantly given over to public charity by indigent parents, or taken in, a wandering, demented creature. I only know that I found and left her reduced to a condition upon which not one who reads this page could look but with unmitigated horror. Do you turn with inexpressible disgust from these details? It is worse to witness the reality. Is your refine- ment shocked by these statements? There is but one remedy: the multi- plication of well organized hospitals; and to this end, creating increased means for their support. In the same poorhouse, in the " crazy cellar," were men chained to their beds, or prostrate on the ground, fettered, and painfully confined in every movement. There were women, too, in wretched, unventilated, crowded rooms, exhibiting every horrible scene their various degrees of insanity could create. In B----, the cells in the crazy cellar admitted neither light nor pure air. In T----, the cells for the insane men were in a shocking condition. In A----, were above twenty insane men and women in the poorhouse, mostly confined with chains and balls attached to fetters. "By adopting this plan," said the master of the poorhouse, " I give them light and air, preventing their escape; otherwise I should have too keep them always in the cells." ,A considerable number of women, mostly incurables, were " behind the pickets," in an out-building: there was a passage sufficiently lighted and warmed, and of width for exercise. There was no classifica- tion; the noisy and the quiet mutually vexed each other. One woman was restrained by a barbarous apparatus to prevent rending her clothes: it consisted of an iron collar investing the throat, through which, at the point of closing in front, passed a small bolt or bar, from which depended an iron triangle, the sides of which might measure sixteen or eighteen inches. To thecomersof the horizontal side were attached iron wristlets; thus holding the hands confined, and as far apart as the length of the base line of the triangle. When the hands and arms Were suddenly elevated, pressure upon the apex of the triangle, near the point of connexion at the throat, pro- duced a sense of suffocation; and why not certain strangulation, it was no In 1842, whole expense of twenty-five old cases Average. ------- Whole expense of twenty-five recent cases Average -------- In this institution, in 1843, twenty old cases had cost Average cost of old cases - Whole expense of twenty recent cases till recovered - Average cost of recent cases - In the Massachuseetts State Lunatic Asylum, in 1843, twenty- five old cases had cost --.... Average expense of old cases ----- Whole expense of twenty-five recent cases till recovered Average expense of recent cases In the Ohio Lunatic Asylum, in 1844, twenty-five old cases had cost Average expense of old cases ----- Whole expense of twenty-five recent cases - Average expense of recent cases - In the Maine Lunatic Hospital, in 1842, twelve old cases liad cost -----.. Average expense of old cases ----- Whole expense of twelve recent cases - Average expense of recent cases -_ ... In the Hospital at Staunton, Va., twenty old cases had cost - Average expense of old cases - Whole expense of twenty recent cases Average expense of recent cases - It will be said by a few, perhaps, that each State should establish and sustain its own institutions; that it is not obligatory upon the general government to legislate for the maintenance of State charities, by sup- plying the means of relief to individual sufferers; but may it not be demonstrated as the soundest policy for the federal government to assist in the accomplishment of great moral obligations, by diminishing and arresting wide-spread miseries which mar the face of society, and weaken the strength of communities? Should your sense of moral responsibility seek support in precedents for guiding present action, I may be permitted to refer to the fact of liberal grants of common national property made, in the light of a wise discrimi- nation, to various institutions of learning; also to advance in the new $49,248 00 1,969 00 1,330 50 52 22 50,611 00 2,020 00 1,130 00 45 20 44.782 00 2,239 10 1,308 30 65 41 54,157 00 2,166 20 1,461 30 58 45 35,464 00 1,418 56 1,608 00 64 32 25,300 00 2,108 33 426 00 35 50 41,633 00 2,081 65 1,265 00 63 25 31 [ 150 ] States common school education, and to aid two seminaries of instruction for the deaf and dumb, viz: that in Hartford, Connecticut, and the school at Danville, in Kentucky, &c. But it is not for one section of the United States that I solicit benefits, while all beside are deprived of direct advantages. I entertain no sectional prejudices, advance no local claims, and propose the advancement of no selfish aims, present or remote. I advocate the cause of the much suffering insane throughout the en- tire length and breadth of my country: I ask relief for the east and for the west, for the north and for the south ; and for all I claim equal and proportionate benefits. I ask of the Senate and House of Representatives of the United States, with respectful but earnest importunity, assistance to the several States of the Union in providing appropriate care and support for the curable and incurable indigent insane. I ask of the representatives of a whole nation, benefits for all their constituents. Annual taxation for the support of the insane in hospitals is felt to be onerous, both in the populous maritime States, and in the States and Territories westof the Alleghanies.. Much has been done, but much more remains to be accomplished, as I have endeavored to demon- strate in the preceding pages, for the relief of the sufferings and oppres- sions of that large class of the distressed for whom I plead, and upon whose condition. I am solicitous to fix your attention. I ask for the people that which is already the property of the people; but possessions so holden, that it is through your action alone they can be applied as is now urged. The whole public good must be sought and advanced through those channels which most certainly contribute to the moral elevation and true dignity of a great people.