Insanity and the Care of the Insane. 
CLARK BELL, Esc* 
PRESIDENT OE THE MEDICO-LEGAL SOCIETY OF THE CITY OF 
NEW YORK. 
Insanity lias been styled, and perhaps justly, the 
disease of civilization. 
The greatest peril incurred, in the higher cultivation 
of the human intellect, is the danger of its derangement. 
Stimulation or pressure, upon the delicate organism 
of the brain, oftentimes puts it out of order and, like 
the intricate mechanism of the Geneva watch, one 
broken cog, or the presence and pressure of even a hair’s 
weight, will derange its movement and impair its 
efficacy. 
Man, in his original state, nearest to Nature, the 
savage, the uncivilized ; like the lower animals, knows 
little if anything of Insanity. We may, therefore, with 
entire truth, say of Insanity, that it is a fruit and product 
of what we call Civilization. 
Dr. Heber Newton calls it the scourge of the 
educated, the refined, the successful, the religious, the 
very Nemesis of the Nervous System. 
I. 
Read before the Medico-Legal Society of New York, March 9, 188? INSANITY AND THE 
Historically considered, it is but recently, within the 
lives of men now living, that Insanity has been regarded, 
as it now seems to be generally recognized, as a state 
due to a diseased condition of the brain. 
Science in this century has asserted, and substantially 
demonstrated, that the brain is the organ of what we 
call the mind, the seat and centre of thought, voli- 
tion, will, and the intellectual faculties. 
Shakespeare says : “ who shall minister to the mind 
diseased,” but modern Science says, that it is not the 
mind which is diseased, but the diseased brain, which re- 
flects its distemper, in the working and action, of the 
mind. 
Whether we examine earlier histories, traditions, 
ancient writers, or even the sacred writings, the madman, 
from the remotest periods, in all ages, among all nations 
and peoples, has been regarded by the large majority of 
mankind prior to our century or era, as one afflicted of 
God, or possessed by an unclean spirit. 
The new testament scriptures, seem to have warranted 
such a view, and the church since Christ, especially 
throughout its earlier history, has inclined to this belief. 
The influence of the moon, among the ancients was 
so generally allied to madness, that it gave the almost 
universal name of lunatic, to the victim, and lunacy, to 
the state or condition into which, the foul fiend threw 
the sufferer. 
The Insane thus became objects of aversion, suspicion 
and even abhorrence, to mankind, and there can be no 
doubt, that all other sources of human misery and suffer- CARE OF THE INSANE. 
3 
ing, are as a rush light to the sun, when compared to 
what has been borne, endured and suffered, by the 
wretched insane, throughout all the ages. 
As science now regards Insanity, this is the darkest 
record in human history against mankind ; because, with- 
out excuse or palliation, it has shutout, from even its 
sympathy, these innocent victims of disease, has con- 
signed them to living deaths, more terrible than any- 
thing written in the Inferno of Dante, and stricken out 
of these suffering lives, even the very word uh(ype.'>'1 
England has had its traditions, its superstitions, its 
shrines, its healing waters, its marvellous cures. 
Scotland's healing wells are celebrated in verse. 
Scott says, in Marmion— 
“ Then to St Fillian’s blessed well, 
Whose Spring can frenzied dreams dispel. 
And the crazed brain restore.” 
St. Romans’ Well was a phice of great renown for the 
cure of lunatics, and our own poet, Whittier, has 
immortalized in verse, the well of St. Maree, in Ross- 
shire, situated on a small island of Loch-Maree. 
“ And whoso bathes therein his brow 
With care or madness burning, 
Feels once again his healthful thought, 
And sens'1 of peace returning. 
“ Oh ! restless heart and fevered brain— 
Unquiet and unstable. 
That holy well of Loch Maree 
Is more than idle fable.” 
The colony at Gheel, dating back more than 1,000 
years, owes its existence, and I nitty say, its marvellous 4 
INSANITY AND TIIE 
success, to the universal belief in the efficacy, and cura- 
tive powers of the shrine and church, which has been the 
Mecca, towards which, for so many centuries, faith has 
led the pilgrim, children of the Church, to seek its cura- 
tive powers at the shrine of St. Dymphna. The best 
authorities date the erection of this church in the 12th 
century, but it is beyond question that a chapel, on the 
site of this church, preceded its erection for more than 
one century at the least. 
At the tomb of the Saint at Gheel, it is idle to deny, 
marvellous cures were wrought, and, if as Dr. Hack 
Tuke, in speaking of it, says: “ it was the representative 
of the Ecclesiastical treatment of mental diseases,” it is 
well worthy the consideration of scientists and medical 
men to-day, to inquire and determine, how, and how far 
the psychical and psychometrical effect of well authenti- 
cated cases of marvellous cures, could beneficially affect 
the disordered minds of the 16th, 17tli and 18tli cen- 
turies, who came to this shrine to be healed. 
Dr. Hack Tuke, in his remarkable work “History of 
the Insane in the British Islands,” gives at length many 
accounts of the superstitions, and peculiar beliefs of the 
early Britons, concerning insanity in England and Scot- 
land, which would well repay perusal, to those who de- 
sire to know the actual condition of the insane on those 
Islands, at the commencement of the present century ; 
and the changes that have been wrought there in the 
condition, care and treatment of the insane. 
In speaking of Insanity, the first natural and perti- 
nent inquiry is, what is Insanity ? CAKE OF THE INSANE. 
This is a question, that most of the abler writers and 
alienists, have attempted to answer. 
I have for some years been a careful student on this 
subject, and have thought it would not be uninterest- 
ing, to collect the opinions of such of the earlier and 
modern writers, as have published their views and opin- 
ions, as well as of those who are regarded as author- 
ities, in our own time, and who are most conversant with 
the subject. 
At lirst blush it would not seem at all difficult, to de- 
fine insanity, so that it would at once, not only be clearly 
recognizable, but susceptible of marked and well defined 
characteristics. 
Bear with me, while I give you some of the many 
definitions I am collecting. 
The fact, however, is, that very few, if any two, agree 
upon a definition, and it is safer to say that Insanity 
can not be defined at all, by any definition acceptable 
alike to lawyers, judges and physicians. 
The reason is, that among medical men, Insanity is 
now regarded as a disease, a physical disorder, and the 
want of knowledge at the present moment among scien- 
tists, of the minute anatomy of the brain, as well as its 
physiology, and pathology, renders it exceedingly diffi- 
cult for medical men themselves, to unite in a definition 
which can accurately define, and scientifically describe, 
that disease. 
Legally considered, Insanity under the law, in so 
far as it relates to responsibility for conduct, for acts de- 
nominated as crimes, when committed by those not insane: 6 
INSANITY AND TIIE 
does not under the laws of English speaking countries, 
rest upon the question of whether the brain is diseased ; 
so much as it does upon how far the perpetrator, is able 
to control his action, upon his knowledge of, and capacity 
to distinguish or discriminate between right and wrong, 
in the commission of the act, and his knowledge and 
appreciation of its nature, consequences and punishment. 
The medical man, of course, can only when sufficiently 
educated, speak of the disease as he finds it, and describe 
it, and its manifestations. 
The legal mind can apply the principles of law to 
the given case, and in human history there seems as yet 
literally to be no real parallels among the insane. No 
two cases exactly alike, each case seems almost to be a 
law only unto itse f. 
Let us listen to a few definitions, from some of those 
whose opinions, all would unite in saying, ought to be 
entitled to weight upon such a question. 
I will quote a few, from the older and the more 
modern authors, from the dead, as well as the living, 
students of insanity. . 
Judge Brocton. 13th Century. “ A. madman is one who does not 
understand what he is doing, and wanting mind and reason, differs little 
from the brute.” 
Dr. Geo. M. Beard. “ Insanity is a disease of the brain, in which 
mental co-ordination is seriously impaired.” 
Dr. John Connolly. The celebrated man who was the Pinel of 
England, thus defines insanity: 
“Insanityis the impairment of anyone or more of the faculties of the 
mind, accompanied with or inducing a defect in the comparing faculty.” 
Prof. Combe. “ It is a prolonged departure, and without an adequate 
external cause, from the state of feeling, and modes of thinking, usual to the 
individual who is in health; that is, the true feature of disorder of the 
mind.” CARE OF THE INSANE. 
7 
“ A morbid action in one, in several, or in the whole of the cerebral 
organs; and, as its necessary consequence, functional derangement in one, 
in several or in the whole of the mental faculties, which these organs 
subserve ” 
Dr Cullen. 1. “ Madness is an impairment of the judging faculties. 
2. “A lesion of the intellectual faculties without pyrexia 
and without coma.” 
Gopeland. “ Insanity is a deviation or perversion of the natural and 
healthy state of the mind, as manifested either by the moral emotions and 
conduct, or by a partial or general disorder of the intellectual powers and 
understanding.” 
Loud Coke. “A lunatic lunaticus, is one who has sometimes his under- 
standing and sometimes not. Qui gaudet lucidis intei'vallis, and therefore he 
is called non rompos mentis, so long as he has not understanding.” 
Lord Chief Justice Cockburn. (p. 361, Med-Leg. Journal, Dec., 
1884; Vol. 2, No. 3): “As the law, as expounded by the Judges in the 
House of Lords, now stands, it is only when mental disease produces 
incapacity to distinguish between right and wrong, that immunity from 
the penal consequences of crime is admitted. The present bill introduces 
a new element, the absence of the power of self-control. 
“ I concur most cordially in the proposed alteration of the law, having 
been always strongly of opinion that, as the pathology of insanity abun- 
dantly establishes, there are forms of mental disease in which, though the 
patient is quite aware he is about to do wrong, the will becomes overpow- 
ered by the force of irresistible impulse ; the power of self-control when 
de troyed or suspended by mental disease becomes, I think, an essential 
elem nt of responsibility. 
“ Sir James Stephen proposes that a jury should be allowed to return 
three verdicts—(1) Guilty ; (2) Guilty, but the power of his self-control was 
diminished by insanity ; (3) Not Guilty, on the ground of insanity.” 
Manuel de Biran “The insane cannot be classed among the moral or 
the intelligent; he lias neither reason nor conscience, because he has not the 
power of will. He neither judges nor thinks; he is neither a man, nor an 
animal; he is simply a living machine, to whom we cannot attribute.” 
“ Je ne suis plus nieme en droit, 
d’Attribuer une fime comme la mieune.” 
Esquirol. “La folie estune affection Cerebrale ordinairement chroni- 
que, sans fifivre, et caracterisee par des disordres de la sensibilite, de l’in- 
telligence et de la volonte.” 
Lord Euskine. 1800, in Hadfleld case. “ Delusion, when there is no 
frenzy or raving madness, is the true character of such insanity as implies 
irresponsibility.” INSANITY AND THE 
The great Belgian Alienist Gruislan, to whom a statue 
is about to be erected by his admiring compatriots, says : 
Guislan. ‘ ‘ Insanity is a derangement of the mental faculties, 
morbid, apyrixial and chronic, which deprives man of the power of think- 
ing and acting freely as regards his happiness, preservation and responsi- 
bility.” 
Dr. Guy. “ Every person who is insane must be regarded as wholly 
irresponsible. The law of England should be assimilated to the law of 
France in the declaration : ‘ II n’y a ni crime, ni delit lorsque le prevenu 
etait un etat de demence une temps de Taction.’ ” 
Locke. “ The madman is one who reasons correctly, from false 
premises.” 
Again—“ Madmen do not appear to have lost the faculty of reasoning, 
but having joined together some ideas very strongly, they mistake them for 
truths, aud err as men do who argue from wrong principles. ’ 
Lelut. “ The insane person is one, who suffers from a disorder of the 
passions and will, of which he is unconsious, characterized by a lesion in the 
association of ideas.” 
Monro, Henry, M. D. “ Insanity is simply a disease of the nervous 
instrument of the mind.”—Insanity, by Henry Monro, M. D. (Introductory 
Chap., p. 7). 
Mansfield, (Lord Chief Justice,) 1812. (Trial of Bellingham for 
shooting Percival.) “ If a person laboring under mental derangement, were 
capable in other respects of distinguishing right from wrong, he could not 
be excused for any act of atrocity which he might commit. ” He held also, 
‘‘that it must be proved beyond all doubt, that at the time he committed 
the atrocious act, he did not consider that murder was a crime against the 
laws of God and nature.” 
Morel, Dr. “ Insanity is a cerebral affection, idiopathic or sympathetic, 
destroying the in Hvidual’s moral liberty, and constituting a derangement of 
his acts, tendencies and sentiments, as well as a general or partial disorder 
in his ideas.” 
Merlin. “ Le fou ‘dit il* ills ne peuvent, remplir la distinction 
humaine.” 
Pagan. “ The loss of control over our actions, which insanity implies, 
is that which renders the acts which are committed during its continuance 
undeserving of punishment.” 
The name, perhaps, held in highest veneration among 
American Alienists of the recent past is Isaac Ray, he 
says: 
Isaac Ray, M. D. “ Liberty of will and action is absolutely essential CARE OF THE INSANE. 
9 
to criminal responsibility, unless the restraint upon either, is the natural and 
well known result of immoral or illegal conduct.” 
“ Culpability supposes not only a clear perception of the consequences 
of criminal acts, but the liberty unernbarassed by disease of the active 
powers, which nature has given us, of preserving that course which is the 
result of the free choice of the intellectual faculties.” 
Chief Justice Tinpal (1843) (McNaughton case for murder of Mr. 
Orummond.) The jury must consider whether “at the time the act was 
committed, the accused had that competent use of his undeistanding, as that 
he knew that he was doing by the very act itself, a wicked and wrong thing.” 
Spuuziieim. “ Insanity is a condition of disease of the brain, in which 
the patient is unconscious of his disease, and lacks the capacity of dis- 
tinguishing the diseased functions.” 
K. Swayne Taylor, “ The terms : insanity, lunacy, unsoundness of 
mind, mental derangement, mental disorder, madness, and mental alienation 
or aberration, have been indifferently applied 1o those states of disordered 
mind, in which a person loses the power of regulating his action and conduct 
according to the ordinary rules of society.”— Taylor's Med. Juris., vol. ii., 
p. 476. 
Justice Tracy (1723). “ An insane man is one who does not know 
what he is doing, no more than an infant, a brute or a wild beast.” 
Of living authorities, I will cite a few : 
The celebrated JohnC. Bucknill, one of the most dis- 
tinguished and honored of British Alienists. 
Dr. Bucknill. 1. “ Insanity is incapacitating weakness or derange- 
ment of mind, caused by disease." 
2. “ Insanity is a condition of the mind in which 
a false action of conception or ju Igment, a defective power of the will, 
or au uncontrollable violence of the emotions and instincts have separately 
or conjointly been produced by disease.” 
Dr. Huggard. “ Insanity is a mental disorder, which renders a person 
incapable of conforming to the exigencies of Society.” 
Jamieson. V Had the lunatic, at the time of committing the deed, a 
knowledge that it was criminal, and such a control over his actions as 
ought if it existed, to have hindered him from committing it ?” 
Maudsley. “ The determination of responsibility, in cases where 
lunacy is alleged, depends on whether a connection can or cannot be traced 
iK'tween existing disease and the act.” 
Judge Calvin E. Pratt. “ Insanity exists where a diseased brain 
manifests itself in abnormal action of the mind.” 
Prof. John, J. Reese. “It is the want of the control of the will, 10 
INSANITY ANI) THE 
and not the want of ability to discriminate between right and wrong, which 
must be regarded as the true test of mental unsoundness.” 
Sir James Fitz, James Stephen. “ Sanity exists when the brain and 
nervous system, are in such a condition that the mental functions of feeling, 
and emotion and willing, can be performed in their regular aud usual manner. 
Insanity means a state in which one or more of the above-named mental 
functions is performed in an abnormal manner, or not performed at all by 
reason of some disease of the brain or nervous system.” 
“ A man, who by reason of mental disease, is prevented from controll- 
ing his own conduct, is not responsible for what he does.” 
“ If it is not, it ought to be the law of England, that no act is a crime, 
if the person who does it is, at the time when it is done, prevented either by 
defective mental power, or by any disease affecting his mind from controll 
ing his own conduct, unless the absence of the power to control has been 
produced by his own default.” 
Dr. Andrew H. Smith, one of the Vice-Presidents of 
the Medico Legal Society, says in reply to my inquiry: 
Smith, Andrew H., M. D. “ Insanity is that condition in which tli6 
functions of the brain, as the organ of the intellect are unnaturally performed. 
This definition includes delirium, and the various forms of intoxication, 
these being merely temporary forms of insanity.” 
“ With the legal consequences of regarding intoxication as a form of 
insanity, science has nothing to do. The safety of Society may require 
that certain insane persons shall be put to death ; but they are none the less 
insane.” 
“ A man is to be held responsible for an act, if he is so far conscious of 
its nature, as to endeavor to escape its consequences. When a delusion is 
shown to have been present, if the matter of belief if true, would not have 
justified the act, the responsibility remains. If, for example, a man kills 
another under the delusion that his own life is threatened, he is not respon- 
sible ; but if he kills him because he fancies he has received an injury from 
him, he is responsible. There can be no rule of universal application ; each 
case must be adjudged for itself, subject to the above general principles 
Perhaps exception might be taken to the word unnaturally in the above 
definition. An act would be natural to a person born with an imperfect 
mental organization, which would be natural to persons in general. It is 
by comparison with this general standard that each case must be judged. 
The practical difficulty would occur in cases on the border ; but that is a 
difficulty inherent in the nature of the case, and which a definition could 
not remove.”., OAKK OF THE INSANE. 
11 
Dr. Henry P. Stearns, of Hartford, an Alienist of 
distinction, replies to my inquiry : 
Steakns, Henky P., M. D. “ Insanity for Medico Legal purposes, is 
an incapacitating derangement of the mind caused by disease.” 
“ I am not acquainted with u short, and also perfectly satisfactory 
medical definition of Insanity. The test of criminal responsibility would be, 
where the parties suffered, from an incapacitating derangement of the mind 
caused by disease.” 
That careful student and good lawyer Mr. Austin 
A bbott says, in reply : 
Austin Abbott. “ I do not think we have attained a knowledge of 
the subject of mental derangement, adequate to enable us to form a single 
definition, that will be a satisfactory guide in the application of the law. 
The definitions which abound in the books appear to me, to be useful and 
indispensable instruments, of analysis and discussion; but the difficulty of 
framing one which shall be generally applicable in law is this: in the 
medical sense, the term means such organic or functional derangement of 
the brain, or affecting the brain, as to require medical treatment, or regi 
men lor the benefit of the subject, or segregation for the safety of others 
or both.” 
“ In legal usage, the term means, when used in reference to civil 
rights and liabilities, such derangement as incapacitates the sub 
ject from free and intelligent volition or consent, where freedom 
and intelligence are considered with reference to the nature of the act, for 
the performance of which the law requires them, and as the degree or 
character of freedom and intelligence varies with the class of acts in 
question, the test of legal capacity varies.” 
“ In respect to criminal responsibility, the test now applied under the 
decisions of the Court of Appeals in this State is, in my judgment, the 
correct one, for reasons which I indicated in a discussion in the Medico- 
Legal Society, which 1 believe is reported in the Medico-Legal Journal.” 
That test is : the capacity to distinguish between right and wrong at 
the time of, and with respect to the act in question. 
The reasons for excluding the proposal to inquire for the power of 
choice, are briefly these : that there are as yet no means of ascertaining the 
non-existence of the power of choice, except through the declaration of 
the accused ; and that declaration could be truly made in the common 
ease of excessive passion, or other inordinate desires ; and that it is the 
just function of the criminal law to develope the power of self restraint, 
where it would otherwise not exist, by inflicting punishment for not ex 
ercising it. In other words, it appears to be true in a large class of cases 12 
INSANITY AND THE 
at the present day, as doubtless it is historically, and in the training of 
animals, as well as of human beings, that just punishment for doing acts 
known to be forbidden, is a means of creating and developing the power 
to resist impulses to do them, which otherwise would be irresistible. 
Charles P. Daly, Chief Justice. (Common Pleas, 1873. Trial of 
Ceo. Francis Train.) “ Defendant’s Counsel, Mr. Bell, correctly states the law- 
in this State, as laid down in People rs. Freeman, 4 Denio, p. 9. ‘That 
one capable of rightly comprehending his own condition in reference to 
the proceeding against him, and of conducting his defense in a rational 
manner is not insane within the meaning of the rule, though on some other 
subjects his mind may be deranged.’ ” 
Brewster, (Judge). Commonwealth vs Haskell, (2 Brewster, 401). 
“ The true test in all cases lies in the word ‘power.’ Has the defendant in 
a criminal case Ihe power to distinguish right from wrong, and the power 
to adhere to the right and avoid the wrong ? ’’ 
T. K. Buckham, M.D. “Insanity is a diseased or disordered con- 
dition or malformation of the physical organs, through which the mind 
receives impressions or manifests its operations, by which the will and 
judgment are impaired, and the conduct rendered irrational.” 
“ Insanity being the result of physical disease, it is a matter of fact to 
be determined by medical experts, not a matter of law to be determined by 
legal tests and measures.” (Buckham on Insanity, p. 72.) 
Ex Surrogate D. C. Calvin. “ Whenever any function of the 
mind is so far diseased as to dominate the will, in the commission of the 
particular act, there is no criminality.” 
Dr. Ferrier. That the brain is the organ of the mind no one doubts, 
and that w hen mental aberations of whatever nature are manifested, the 
brain is diseased, we take as an axiom.—Mind and Brain, (Land.) 1879, p. 
364. 
German Code. “ An act is not punishable when the person at the 
time of doing it was in a state of unconsciousness, or of disease of the 
mind, whereby free volition was prevented.” 
British Alienists. At the annual meeting of the British Associa 
tion of Medical Officers of Asylums and Hospitals for the Insane, held in 
London, July 14, 1864, present rifty-four medical officers, it was unani- 
mously 
Brsolved.—“ That so much of the legal test of the mental condition of 
an alleged criminal lunatic as renders him a responsible agent, because he 
knows the difference between right and wrong, is inconsistent with the fact 
well known to every member of this meeting; that the power of distinguish- 
ing between right and wrong exists very frequently among those wdio are 
undoubtedly insane, it is often associated with dangerous and uncontrollable 
delusions.” CARE OF THE INSANE. 
Pliny Earle. “ You ask me for my ‘ idea of the best definition of 
insanity.’ After studying the subject for years, I at length became con- 
vinced that, with our present knowledge, the disease, or disorder, is insus- 
ceptible of definition, and hitherto I have had no reason to doubt the ac- 
curacy of that conclusion, as every attempted definition is a failure. I 
discard them all; and, in my opinion, there is no one of them sufficiently 
good to be adopted for use, either hy the medical profession or by the 
Courts of Judicature. Anyone of them would embarrass rather than 
facilitate the action of the legal tribunals. Insanity may be described, but 
not defined; and it appears to me that, for the easiest attainment of the 
ends of truth and justice, it is by far the better way for both lawyers and 
physicians to avoid all attempts at definition. As another evidence of your 
skill in propounding conundrums, you ask what, in my judgment, ‘should 
be the legal test of criminal responsibility for acts committed by persons 
suffering from any form of mental disease.’ As there is no perfect defini- 
tion of insanity, so there is no test, no experimentum crusts for it. The 
most obvious reason for exculpation differs widely in different cases. The 
congenital idiot, or the man in the very lowest form of acquired dementia, 
commits homicide in a fit of auger. Here, ignorance of all human law, 
with incompetence to acquire a knowledge of it, is the sufficient excuse. 
An epileptic, in a violent maniacal paroxysm, kills a man. In this case 
there is entire unconsciousness of the act, and this is the patent reason for 
his exemption from responsibility. But a majority of the insane retain, to 
a greater or less extent, their knowledge of human laws, and they do not, 
when awake, lose their consciousness. They even ‘know right from 
wrong ’ in the abstract; or, as a rule of general application. But a person 
in this condition falsely imagines that another person is doing him injury, 
perhaps seeking his life. Under this belief he takes the life of that other 
person. Here the only possible ground for release from criminal responsi- 
bility appears to be this—that although the homicide ‘ knew right from 
wrong’ as a general principle, he could not perceive it as applied to his 
own case. This delusion destroyed his moral perception. And here, as 
it appears to me, we have arrived at what comes the nearest of anything 
to what you seek. It is, at any rate, a test of wide, if not of uni- 
versal, application.” 
Elliott F. Shepard. “ The strict Latin definition of insanity 
affords the best explanation of the meaning of the word and idea, and that 
is ‘unsoundness.’ Any disease of the body is reported to, and has an 
effect upon the brain. When the brain -thus becomes so disturbed, or 
weakened, or diseased, as to cease to afford a proper support to the soul or 
spirit in its control of the will, this unsoundness is manifested more or less 
in the words or actions of the individual. The vigor of the brain, like that 
of the rest of the body, may be affected without being destroyed, and so 14 
INSANITY AND THE 
may the vigor and control of the spirit over the will; and the account- 
ability of the individual before a human tribunal for his words and actions 
ought not to be denied or excused for anything less than a substantially 
entire suspension of the will power. It would be as reasonable to excuse 
man from the payment of his promissory note because he had the tooth- 
ache, or from performing any contract because he was sick, as to excuse 
him for inflicting injury or violence upon the persons of others, because 
his mind was partially weakened. Undoubtedly, the criminal lawyers 
have carried the defence of insanity to an unreasonable point in behalf of 
their clients ; and undoubtedly, the security of society at large demands, that 
absolute security should be afforded to every individual in the peaceable pos 
session of his person. Those who carry themselves back to the condition of 
savage life, by attacking others from motives of revenge, jealousy, cupidity, 
antipathy, or any other reason, would meet only with even-handed justice, if 
they were to meet with that other condition of savage life—swift retribu- 
tion in kind. As in Christian communities, mercy has tempered this theory 
of equal-handed justice, the retribution is to be visited only after a due 
adjudication; but no exculpations should be allowed to prevail in civilized 
society that ought not also to prevail in the savage state. The moral color 
line, which is so much dwelt upon in judicial decisions, upon defences of 
insanity, is a very flexible one, and dangerous to the public in proportion 
to its flexibility. Substantially, that line is as follows : If the man has un 
derstanding enough to know that a certain act is wrong, and then does it, 
he is to be punished. If not, not. And as the understanding is very 
easily muddled, this rule has doubtless often cleared the guilty. If a horse 
should kill a man, that horse ought to be slain. And it has been asked, If 
a man is reduced to the condition of a brute, and kills a man, should not 
also the slayer be slain ? And, under such circumstances, would the hang- 
ing of a man produce any greater injury than the killing of a horse ? 
Well, those are questions to which our knowledge of the spirit and of 
eternity is too deficient to enable us to make a satisfactory answer. The 
sentiment in America and England seems to be, that the wisest plan, 
instead of adopting any cast iron rule, is to leave the decision in each case 
to the judgment of twelve good men of the country, and I do not know 
that any better plan will ever be found under human government.” 
One should be admonished of the unwisdom of 
attempting definitions. I will give what I should an- 
swer, if called upon as a witness, to give my own 
opinion, as to insanity, and responsibility, as follows : 
Olakk Bell. “Insanity cannot be exactly defined medically, from 
lack of present knowledge of its pathology. Legally considered, it may be CAKE OF THE INSANE. 
15 
regarded as a disease of the brain or nervous system, which prevents the 
free exercise of volition.” 
“ The test of responsibility under the law fora criminal act, when the 
defense of insanity is interposed, should be, clear knowledge of its nature, 
consequences and penalty, with volition unimpaired by disease of the brain 
or nervous system.” 
“ If a man commits a crime, understanding its nature and penalty, under 
the law he is responsible, unless suffering from a disease of the brain or 
nervous system, which prevents the free exercise of his will power. If 
acting under a delusion which dominates his volition, he is not responsible 
for his act. He is the victim of his disease.” 
Vid. also p. 413, Dec. No. M. L. Journal, 1884. Vol. 2, No. 3. 
II. 
THE CARE OF THE INSANE. 
/. Should they he confined in hospitals f 
2. Mechanical restraints. 
3. The best methods of care, both as to incurables, 
and acute or doubtful cases. 
SHOULD THEY BE CONFINED IN HOSPITALS ? 
Civilization decided this question in the affirmative 
ex parte long ago. Debate has been closed upon it, 
for over a century. 
The alleged reasons were twofold : 
a. That society was bound in self-defense to in- 
carcerate and restrain the insane, to prevent the 
commission of offenses or crimes, by the insane, 
who are beyond the restraining influence of 
human punishments. 16 
INSANITY AND THE 
b. That the insane themselves had a moral, if not 
legal, claim on society, to provide and care for 
them in their affliction, to the best of its 
ability. 
The present century has witnessed the most wonder- 
ful changes, in the actual condition of the inmates of 
Asylums for the Insane, I may safely say, in all coun- 
tries. It would be imposible for me to adequately de- 
scribe to you, the frightful, horrible wrongs, inflicted 
upon the insane, almost everywhere, not only in English 
Asylums, but in French, and almost all European and 
American Institutions, particularly almshouses, at the 
beginning of our century. 
In my own time, I have seen, in this State, in a 
county almshouse, a woman confined in a dark cell, 
naked, without one shred of clothing, without any bed, 
but straw to lie upon, no covering, and smeared with 
her ordure. So kept, because her keepers believed that 
she could not be clothed, as she would, as they 
thought, destroy all clothing and covering, and she was 
so confined because she was regarded as dangerous to 
approach. Her food was passed into her, as to an animal, 
and her actual state and condition, was worse than 
swine kept by the ordinary, and not the humane and 
careful farmer, and this was not thirty years ago. 
Read the testimony of that English nobleman, 
who was for more than thirty years Chairman of the 
Lunacy Commission of England, in the evidence 
he gave before the Select Committee of the British 
Parliament as late as March 14th, 1859 (pp. 64 and CARE OF THE INSANE. 
17 
65, Minutes of Evidence, § 569 ; and p. 35, same Min- 
utes, §§ 304, 306, 307). 
This was the evidence of that grand English charac- 
ter, the Earl of Shaftesbury, of whom Mr. Sheil said, 
in the British Commons: “ That this noble lord had 
added nobility even to the name of Asiiley, and that 
he had made humanity one of ‘ Shaftesbury’s’ char- 
acteristics.” 
A few years ago, Dr. Alice Bennett, the gifted Super- 
intendent in charge of the Female Department of the 
State Hospital for the Insane at Norristown, Pa., states 
that: 
‘‘ YVhen eighteen woman were sent to her Institution 
from one of the almshouses in Philadelphia, that had 
been burned, ten of these women came to her in cami- 
soles, and one had chains upon her feet, all of which she 
at once removed” (Medico-Legal Journal, I., 
p. 293). 
In many of the English Almshouses and Asylums, 
chains and rings were on every bed-post and at every 
table, in rlie early part of the present century. 
We may say in America that the misery of the 
English Almshouse, was our inheritance from the mother 
country. Asylums for the Insane did not exist in the 
American States, until a quite recent period, with 
the single exception of that at Williamsburgh, Va., 
founded in 1773. 
The Friends’ Asylum was established in Philadelphia 
in 1817, forty-two years later, which was succeeded 18 
INSANITY AND THE 
later by those at Somerville, Mass. ; Bloomingdale, N. 
Y., and Hartford, Conn. 
There could have been scarcely one single ray of 
light, upon the condition of the insane in this country, 
until near the close, of the first quarter, of the present 
century. 
In the exposition made by the celebrated D. Hack 
Tuke, in his recent work, “The Insane in the United 
States and Canada,” (H. K. Lewis, London,) 1885, of his 
visitation made as late as August, 1884, to Longue 
Pointe Asylum, Quebec (pp. 198, 194, 195, 196), he 
speaks of incredible abuses borne there by the insane 
patients. 
It was just before and at the beginning of the present 
century, that Pinel began his great work at the 
Bicetre at Paris. At the same time, or shortly 
before, the elder Tuke was laying the founda- 
tions at York Retreat in England for a government 
of kindness and love rather than of fear and force. 
These two were working unknown to each other. Then 
came the era of the magnificent work of Dr. John 
Connolly in England, and later, of Joseph Guislan in 
Belgium, that led up through a series of struggles which 
culminated in England, in the Bills of 4th and 8th 
August, 1845, under the splendid leadership of the 
Earl of Shaftesbury, which have been aptly styled, 
“The Magna Charta of the Liberties of the Insane.” I 
mean the Acts of 1845, as amended later in 1853. 
Here was laid upon solid and secure foundations, the 
complete system, of a permanent and able Lunacy Com- CARE OF THE INSANE. 
19 
mission, with powers of visitation and supervision over 
asylum management, Superintendents, and officers, 
Statutory enactments, that have been far in advance of 
our American legislation, upon these subjects in any of 
the American States. 
With this grand forward and upward march, came in 
France, Great Britain, Belgium and the German speak- 
ing countries, the abolition of chains, mechanical 
restraints, and the new doctrine of love, tenderness, 
care and humanity, in the treatment of the insane in the 
great institutions of Continental Europe, and Great 
Britain. 
Not so in America. We did not keep step to the 
march or music, of that grand advance. 
True, we had our great names who deserved to stand 
in the same glorious galaxy, with as shining lustre, 
Isaac Ray, Pliny Earl, Luther V. Bell, and their con- 
freres of to-day, l)r. J. C. Shaw, of Flatbush Asylum ; 
Dr. W. W. Godding, of Washington ; Dr. Alice Ben- 
nett, of Pennsylvania ; Dr. P. M. Wise, of Willard ; 
Dr. J. B. Andrews, of Buffalo; Dr. A. E. Macdonald, 
Superintendent Institution for Insane of New York City ; 
Dr. W. B. Fletcher, of Indiana Asylum ; Dr. Bryce, of 
Alabama; Stearns, of Connecticut ; Carlos MacDonald, 
of Auburn ; Buckinaster, of Wisconsin ; McClellan, of 
Illinois ; Dr. Trautman, of Ward’s Island, New York 
City, and others too numerous to name here. 
That every insane person, should not be confined in a 
hospital, must now be conceded by all. 
If a lunatic is harmless, whether curable or incurable, 20 
INSANITY AND THE 
an asylum is probably not, the best place for that per- 
son. In many respects, the best asylum, would be almost 
the worst place, for the patient, in such a case. 
If the restraints, and the feeling of imprisonment, and 
of force, which pervade and are a concomitant of 
asylum life, and proper discipline (because asylums 
cannot be successfully maintained without discipline, 
and good discipline too), are not an aid to recovery; and 
if recovery is what is regarded as most desirable, a hos- 
pitable or asylum, is not the safest or best means to ob- 
tain the desired result, in a large proportion of cases. 
The law of commitments in this State, does not dis- 
criminate between the harmless and violent, or between 
homicidal or suicidal cases. 
If the State Commissioner in lunacy, would exercise 
the powers conferred upon him by our law, and recon- 
struct the form of the affidavit of physicians, more like 
the English plan—if it required that the examinations by 
the physicians, should be made separately and not to- 
gether—if the physician should becompelled to discrimi- 
nate in his affidavit between what he observed himself, 
and what he was told by others, if he was obliged 
to give the sources of information derived from 
others, state in detail, the nature, character and 
manifestations of insanity, their duration, whether 
first, second or third attacks, and so describe them as 
to indicate, whether confinement in an asylum or hos- 
pital, was not only necessary, but offered the best chance 
of their recovery, we could, under our present statute, 
make a great advance from our present state. CAKE OF THE INSANE. 
21 
The glaring defect in our system, is : That we have 
no Board or officer, with authority or power, over 
Superintendents, or officials, as the English Commis- 
sioners have. 
Our Lunacy Commissioner in New York is powerless 
to dismiss, and as for visitation, after English ideas, he 
could not personally visit each insane person confined 
in this State once in four years, when, as under the 
English System, each insane person should be person- 
ally seen, conversed with, and inspected by some one 
member of the Board, three or four times in each year. 
As all our Communities and States stand committed, to 
Hospitals for the Insane in this Country, we have, in 
all the American States, or nearly all, gone headlong, 
and at almost a galop, into the most lavish, profuse, 
and prodigal expenditure of money in the construction 
of Hospitals for the Insane. The outlay has in many in- 
stances, been simply prodigious, and some of our great 
Institutions are of the most expensive and pretentious 
character, very impressive, and even splendid in their 
architecture and surroundings. This has not been an 
unmixed evil. It has resulted in good in many ways. 
We care for those things which cost us much, and most 
for those which cost us most. The equipment of a 
first-class and expensive palace, must needs be on a 
scale commensurate with its mission and purpose. Su- 
perintendents of Asylums under our System have not 
been the leaders in, or causes of, the lavish expendi- 
tures, in building these structures. 
They have asked for increased and better facilities, 22 
INSANITY AND THE 
for a larger medical force, for increased and better paid, 
and more competent attendants, and in ratio to their 
success, in obtaining these demands, has been the 
standard of the morale of the inmates, within their in- 
stitutions. 
This brings us face to face with the second question. 
HI. 
MECHANICAL RESTRAINTS. 
The position of the Alienists of Great Britain and Con- 
tinental Europe, standing practically as a united pha- 
lanx,in favor of, and practising the abolition of mechani- 
cal restraints, for now more than a quarter of acentury, is 
in strange, not to say remarkable, contrast with the di- 
vided ideas of the American Alienists, and asylum sup- 
erintendents, upon this question in the quite recent past. 
Dr. Henry Maudsley told me on the occasion of his 
last visit to this country, that he never used a camisole 
in his life, and that no such implement was ever in use, 
in any asylum with which he was connected. 
I doubt if such a thing as a crib could be found in 
any public institution in Great Britain, France, Ger- 
many or Belgium. 
Permit me to give extracts from the evidence of cer- 
tain asylum superintendents and alienists before a Legis- 
lative Committee in this State, May 6, 1879, regarding 
Mechanical Restraints not ten years ago. 
Dr, Nichols, Superintendent of Bloomingdale Asylum : 
“ I do not use the crib at Bloomingdale. I do not consider it a barbar- 
ous method of restraint. It was in use at Utica when I was an assistant CARE OF THE INSANE. 
23 
there; and, therefore, I have had some personal knowledge of it. I think 
there are some patients who can be restrained in a horizontal position, and 
their rest and sleep obtained better by its instrumentality than by any other 
means. * 
“ Dr. Ordronaux—I would like to ask Dr. Nichols a question. Here is 
an extract from a paper* giving an interview with Dr. Hammond, which 
♦Cincinnati Daily Inquirer, November 18tb, 1878. 
contains the following ; 
“ Reporter—Can you give me an example of the confinement of a 
patient in a crib having ended fatally ? 
“ Dr. Hammond—A very recent one. A patient was sent to the 
Bloomingdale Asylum by a very distinguished physician of this city. 
Do not mention his name; but in case this statement is called in ques- 
tion, he is ready to come forward and support it publicly. The pa- 
tient was put into a crib the same night that he entered the asylum, 
and the same night he died—died in the crib. 
“ Reporter—What was the predisposing cause of his death ? 
“ Dr. Hammond—Congestion of the brain ; you know very well, 
or you did know when you were a boy, that if you stoop down with 
your head between your legs your head feels dull. How much 
greater must be the compression if a man’s head is already congested, 
and he is compelled to remain in a recumbent position ? It is simply 
a question of mechanics.’’ 
“ Dr. Nichols, have you known of the case here described ? 
“ Dr. Nichols—No such case has occurred since the institution has 
been under my charge.” 
Dr. Chapin, then Superintendent of Willard Asylum 
“We have not introduced the crib into the asylum ; I do not con- 
sider it a barbarous means of restraint; we have as substitute what is 
known as the Wyman bed-strap; I do not think there is much objec- 
tion to the crib for patients who are much debilitated ; it is mostly 
used in acute cases in my experience ; the average death rate in the 
asylum is six per cent.; restraint has always been more necessary for 
men than women ; the record of restraint upon the day of my leaving 
home was for the previous twenty-four hours, five woman among 754; 
the number of men restrained was twenty-seven among 655; the 
amount of restraint, I think, has been very much reduced by having a 
daily report made of it, by inquiring of attendants, and noticing the 
daily report; the restraint used in our asylum is the muff and the 
camisole ; the camisole is a jacket made of endless sleeves; the piuft is 
a leather instrument with two bands, encircling the wrist, from which 
the patient is unable to withdraw his hands.’’ 24 
INSANITY AND THE 
Dr. S. H. Talcott, Superintendent, Middletown 
Asylum : 
“ Restraint has never been used except at the instance of myself or 
one of the assistant physicians; we have 171 patients; we have the 
restraint or crib bed ; we have, at the present time, a patient who 
sleeps in one of these beds ; I do not consider it as barbarous or in- 
human ; I consider it as an exceedingly proper thing to use in some 
cases where patients would be likely to destroy themselves.’’ 
Dr. J. M. Cleveland SuperintHtidenf, Poughkeepsie 
Asylum : 
“We have not used the crib within a year; we dispensed with 
it, owing to the prejudice which seemed to be increasing in the com- 
munity against its use ; I think it is a form of restraint which should 
be used at times, but I think it should be used very cautiously ; I 
think some patients would be seriously injured by its use ; I think it is 
the most humane form of restraint possible for patients who are con- 
stantly out of bed, who would not sleep, and who would exhaust 
themselves.” 
Dr. Gray, Superintendent, Utica Asylum : 
“ Restraint is only applied by order of the physicians; the restraints 
we use are the camisole, restraint belt; and occasionally the muff; these 
have all been described in the annual reports of the asylum made 
to the Legislature, and their uses fully explained ; in regard to the 
crib, I found it in use when I went to Utica, having been introduced 
by Dr. Brigham in 1846, who was then superintendent; it was not at 
that time as comfortable as now ; the only thing I did was to make it 
more comfortable and easy for sick patients, and I always believed it to 
be a very humane method of treatment for certain cases who are feeble 
and anaemic, in securing a horizontal position, and for feeble persons 
who would get up at night and stand till exhausted, or put their heads 
out of the windows and expose themselves ; it is a long time since we 
have used what Dr. Chapin has described as the bed-straps; it was a 
question with me whether to use the bed-strap or the crib ; in my 
judgment, from the use of both, I incline to the use of the crib; this 
should always be prescribed by a medical officer, and it is—just as the 
medicines are.” 
Dr. Wm. A. Hammond : 
“ £). Look, doctor, at the eleventh paragraph, which reads : * Is 
the superintendent consulted whenever forcible restraint is required, CAKE OF THE INSANE. 
and is the duration, manner, and result of this mechanical restraint 
duly recorded in a book kept for the inspection of the Commissioner 
in Lunacy and of the courts?” Do you know of any asylums in 
which the superintendent is not consulted ? 
“ A. I know he is not at Bloomingdale ; I know it is not so at 
Ward’s Island ; nowhere else of my own knowledge. 
“ Q. The thirteenth paragraph reads : ‘ Did you ever employ the 
barbarous and injurious means of restraint known as a crib ? ’ What 
do you know of that matter ? 
“ A. I know the crib is employed in a number of institutions. 
“ Q. Do you consider it a ‘ barbarous and inhuman means of re- 
straint ? ’ 
“ A. I most certainly do. 
" Q. Is it considered, by the medical profession, to be a barbarous 
and inhuman means of restraint ? 
“ A. Yes, sir. 
“ Q. By the medical profession as a whole ? 
“ A. I think so, sir. 
“ £). Do you know, as a matter of fact, that there is not an asylum 
superintendent in this State who considers it as ‘ barbarous and in- 
human ? ’ 
“ A. I think they consider it quite the contrary, and there is where 
they are wrong; I think the medical profession generally is opposed 
to them on this subject. 
“ Q. Is it your opinion that the majority of medical experts in this 
country consider the use of the crib bed as ‘ barbarous and inhuman ? ’ 
“ A. Most decidely ; of course, you know, it is quite impossible to 
obtain the number of medical men who are, or who are not, in favor 
of it ; you might, perhaps, get a hundred to say that it was not cruel, 
and I could get a hundred on the other side. 
“ £). You seem to use this expression : ‘ Do you ever employ the 
barbarous and inhuman method of restraint known as a crib,’ as if 
the medical profession and the public so generally regarded it ? 
“ A. I never mentioned the subject of the use of this restraint to a 
physician, outside of a lunatic asylum, who did not disapprove of it ; 
not only is this true, but it has been condemned by some of the most 
eminent alienists of the world ; 1 do not believe the superintendents 
use it from any purpose to he inhuman. 
“ A. Do you think you could obtain, from any conscientious super- 
intendents using the crib, an affirmative answer to the question : ‘ Is 
the crib barbarous and inhuman ? ’ 
“ A. I think, if I employed it, I would hardly say it was barbarous 
or inhuman ; I think myself that that paragraph is too strongly word- 
ed ; so far as the idea is concerned, I fully indorse it ; I do not mean 26 
INSANITY AND THE 
to say that these gentlemen use it from any idea of being barbarous or 
inhuman. 
“ Q. Would you not consider it a fair conclusion by a layman, in 
reading this paragraph, that the use of the crib was barbarous and in- 
human ? 
“ A. 1 could not say about that. 
“ Q. Did you ever see a patient restrained by a crib ? 
“ A. Yes, sir. 
“ Q. How many times? 
“ A. Two or three times. 
“ Q. Did you know anything about the condition of the patients 
who weie restrained ? • 
“ A. No ; but I know pretty positively, as well as I know anything 
else, that a patient died in a crib, in an asylum not far from New 
York City. 
“ Q. Did you know anything of the antecedents of the case ? 
“ A. No, sir ; but I know, from my knowledge of humanity, that 
the crib is a barbarous and inhuman mode of treatment; have you 
ever seen the crib ? 
Senator Goodwin—I have. 
Dr. Hammond—Then you have seen its dimensions ; it is not as 
big as a wild-cat’s cage ; perhaps as wide as this table, about two feet 
six inches high, and shut in at the top with iron bars, with a spring 
lock attached ; in this the patient is put upon his back ; he cannot 
rise to a sitting posture ; I know that nothing can be more injurious 
than that for an acute case ; this is exactly what allows conjestion of 
the brain to take place with the utmost facility ; it is like a child 
crib, except that the patient is locked up in it. 
“ Q. Is there any great difference between the use of the bed-strap 
and the use of the crib ? Can a person rise who is confined to bed 
with straps ? 
“ A. Probably not ; no, sir ; 1 think that is just as bad, or almost 
as bad, as the crib ; there is this difference : you may strap a man in 
bed in a sitting posture; in the crib, no matter how much blood there 
is in the patient’s head, he i» obliged to lie down. 
“8- You say that the crib is ‘ barbarous and inhuman.’ Is that 
not simply a difference of opinion ? Do you take the fact of its being 
used as an evidence of mismanagement in an asylum ? 
“ A. I should not like to say that it was ; it is evidence of a bad 
practice and bad management, but not mismanagement. 
“ Q. Any system, then, that is practiced in an asylum, which does 
not coincide with your views on the management of insane, you regard 
as a bad practice ? 
“ A. I do. CA liE OF TII?: INSANE. 
“ £)• Would you consider the fact of a difference of opinion exist- 
ing in regard to the use of restraint to be a subject-matter for a memor- 
ial to the Legislature ? 
“ A. Decidedly so ; the practice should be restrained by law. 
“ £). Do vou think that a legislative committee composed of laymen 
would be a proper body to determine the question as to whether a 
certain system should or should not be adopted in asylums? 
“ A. No, sir ; they would not be a competent body to say whether 
or not the crib should be used ; the Legislature should appoint a com- 
mittee to investigate the management of the asylums of the State of 
New York ; if they find, after receiving the evidence of medical men, 
it is not a good thing, let them do away with it ; I do not think that 
any of these gentlemen would be competent to advise the Legislature 
in this matter ; if this committee had the power to act upon the 
matter, I should know better what opinions to express ; if this Com- 
mittee was the one which was charged with the duty of investigating 
asylums. 
Dr. VV. J. Morton : 
“ I think restraint is applied without the consultation of the Super- 
intendent at Ward’s Island; nowhere else, to my knowledge; I also 
think the use of the crib is barbarous and inhuman. 
“ Q. Doctor, if it was sworn to by every one of the superintendents 
of insane asylums in this State, whose experience ranged from twenty- 
five years to five, that, in their judgment, the use of the crib was not 
barbarous or inhuman, would it have any effect upon your mind ? 
“A. Not the slightest. 
“ Q. Suppose these physicians were to tell you that this crib was 
the best mode of bringing about a certain desirable condition of mind 
and body in the patients, and that this was their experience after a 
study of some twenty-five years, would that make any impression 
upon your mind ? 
“ A. I should prefer to take my own judgment. 
“ Q- Where there is a difference of opinion in the profession, upon a 
point like this, would you consider it as a matter of legislative in- 
quiry ? 
“ A. I think this is more than a difference of opinion ; I think that 
the majority of physicians are opposed to this violent means of re- 
straint. 
“ Q. Have you ever talked with any physician connected with a 
lunatic asylum of the State upon the use of the crib ? 
“ A. It has been spoken of between Dr. Macdonald and myself while 
in the wards; with no one else; I never have spoken to a physician 
out of the State. 28 
INSANITY AND THE 
Q. Your opinion, then, is formed upon your own idea? 
A. From what I have seen ; one case is as good as a dozen.” 
Now, as a piece of not quite cotemporaneous literature, 
let me quote from the report of the Engisli Lunacy Com- 
missioners, to the Lord High Chancellor, made to the 
English Parliament in 1844, and printed before the pas- 
sage of the Memorable Bills, but one of the ablest State 
papers, ever yet presented i«i any country, in the move- 
ment for Lunacy Reform. See what this celebrated Com- 
mission with Lord Ashley, chairman, recommended, 
and after specifying every asylum in Great Britain 
thereupon the subject closes with the following : 
“ Whatever may be 'he means or forms of control exercised over the 
persons of patients, or whatever the degrees in which the application of 
this control may be varied in different, Asylums, we have the gratification 
of reporting to your Lordship that in every public and private Asylum in 
the kingdom, which is well managed, bodily restraint is not permitted, ex- 
cept in extreme cases, and under the express sanction of a competent 
superintendent. The unanimous opinion of the medical officers and super- 
intendent of these public and private Asylums is, that the diminution of 
restraint in the treatment of lunatics has not only lessened the sufferings, 
but has improved the general health and condition, as well as promoted 
the comfort of the insane. We entirely concur in this opinion. * * * * * 
again :— 
“The Medical Officers and Superintendents who adhere to the system 
of absolute non-coercion, never using mechanical restraint, even in cases 
of extreme violence argue : 
“ 1st. That their practice is the most humane, and most beneficial to the 
patient; soothing instead of coercing him during irritation; and en- 
couraging him when tranquil, to exert his faculties, in order to acquire 
complete self-control. 
“ 2. That a recovery thus obtained, is likely to be more permanent than 
if obtained by other means ; and that in case of a tendency to relapse, the 
patient will, of his own accord, be more likely to endeavor to resist any 
return of his malady. 
“3. That mechanical restraint has a bad moral effect; that it degrades 
the patient in his own opinion ; that it prevents any exertion on his part ; 
and thus impedes his recovery. CARE OF THE INSANE. 
“ 4. That experience has demonstrated the advantage of entirely 
abolishing restraint, inasmuch as the condition of some Asylums, where it 
had been previously practised in a moderate and very restricted degree, 
has been greatly improved, with respect to the tranquility and the appear- 
ance of cheerfulness among the patients in general, after all mechanical 
coercion has been discontinued. 
“ 5. That mechanical restraint, if used at all, is liable to great abuse 
from keepers and nurses, who will often resort to it for the sake of avoid- 
ing trouble to themselves ; and who, even when well disposed towards the 
patient, are not competent to judge of the extent to which it ought to be 
applied. 
“ 6. That the patient may be controlled as effectually without mechan- 
ical restraint, as with it; and that the only requisites for enabling the Su- 
perintendents of Asylums to dispense with the use of mechanical restraint, 
are a greater number of attendants, and a better system of classification 
amongst the patients ; and that the additional expense thereby incurred 
ought not to form a consideration where the comfort of the patients is con- 
cerned.” 
Is if, not a marvel that the English Asylums and Lu 
nacy Commissioners, as early as 1844, before the passage 
of their grand law, were nearly half a century in advance 
of some of our Asylum superintendents in America, in 
1879 ? 
The Utica influence, however, was felt, and as it seems 
to me, put back the shadow upon the dial, of the pro- 
gress of Lunacy Reform in America for almost a decade. 
But truth advances with stately steps. Her march, 
although in time triumphal, is sometimes painfully 
slow. Asylum superintendents, one after another, year 
after year, are leaving off the use of Mechanical Re- 
straints. I clip from the Utica Observer, of January 
21st, 1887, the following statements made by Dr.Blumer, 
the recently appointed Superintendent of the State 
Asylum at Utica, to that journal, which, I think, 
looks, like the beginning of the end of Mechanical 30 
INSANITY AND THE 
Restraint, in State Institutions, in New York, and, in- 
deed, in American Institutions everywhere. 
Dr. Blumer is reported to have said: 
The intro luctiou of non-restraint, in the treatment of the insane, has long 
been, one of my in >st cherished schemes. There is, in my mind, not the 
slightest question, as to the superiority of this new system. New, did I 
say ? Let me read to you what Dr. Conolly, the father of non-restraint, 
said over forty-seven years ago : 
“I was physician to the Han well Asylum about fourteen years. The 
number of patients was generally 900. After the 21st of September, 1839, 
no form of mechanical restraint, was employed with my knowledge, or my 
sanction, by night or by day, until my resignation in 1862, except in a few 
surgical cases, for the temporary security of the patient. Recollecting the 
state of some private asylums, which I visited officially thirty years ago, I 
feel perfectly assured, that the amended treatment practiced since that 
period, an 1 especially the disuse of mechanical restraint of all kinds, has 
been productive, of an incalculable amount of advantage to the insane. The 
general tranquility, comfort and satisfaction visible, in all well conducted 
asylums, public and private, attest this in the strongest manner. Fewer 
accidents occur ; revenge is seldom excited in the minds of the patients, 
scenes of violence are seldom or never witnessed, the patients manifest no 
terror ; and on recovery,' retain no sense of degradation ; often after leav- 
ing the asylum coming to it again, as voluntary visitors to associates and 
friends, of whose good offices they are fully sensible. 
“ Signed, J. Conolly, M. D.” 
The good seed, scattered by Dr. Conolly has fallen, much of it,in barren 
places, but to-day the old mode of treatment, is condemned by the foremost 
alienists. By non-restraint I do not mean the absolute discontinuance of 
mechanical appliances under all circumstances whatsoever. No man who 
is not a fanatic on the subject, could possibly declare a priori, that there 
was no extreme case among the manifold phases of insanity, in which the 
application of restraint, might not be justifiable. Such cases, however, are 
extremely rare and generally where the restraint is applied for so-called 
“ surgical reasons.” I have yet to learn that any Superintendent, who has 
once faithfully and conscientiously, tried the system of non-restraint, has 
shown any disposition to return to the old method. 
The principle of non-restraint is no new thing in Utica, though it has not 
always been rigorously lived up to. There have been times before in the 
history of this asylum, when not a single patient has been in restraint. It 
has always been claimed, that the minimum of restraint was used, but CAKE OF THE INSANE. 
31 
when its use is practically prohibited, there can be no question as to what 
that minimum means. 
As regards the “ Utica crib,” I am willing to admit, that there are eases 
in which its use is justifiable. Such cases are very infrequent, however, 
and, in view of the great reproach that attaches to the so-called “Utica crib,” 
I think we are consulting the interests of the greater number, when we 
abandon its use entirely, and substitute an alternative method of treatment, 
say the detailing of special attendants, to watch special cases, by night and 
by day. Over a year ago, a great number of covered beds were sent to the 
storeroom, and it was not found necessary, to return them to the wards. 
The non-restraint system, is in practical operation in many State 
Asylums, throughout the country, with the most satisfactory results. I may 
mention in this State, the Asylum for the Insane at Ward’s Island, which 
I visited last Sunday, and where I found 1,702 patients, aud where no one 
was restrained. Dr. Trautman, the Superintendent, informed me, that for 
a period of four years, he had not had occasion to use it. Similar testimony 
comes from Dr. Carlos F. McDonald, at the Asylum for Insane Criminals 
at Auburn, and Dr. J. B. Andrews, of the Asylum at Buffalo, is also an 
advocate of the new method. At the Willard Asylum for the Insahe, 
under the able administration of Dr. Wise, with a population of over 1,800 
patients, occasion arose for the use of restraint in the cases of but four in 
dividual patients during the year just closed. Let me read what the Sup 
erintendeut says in this connection : 
“ It has been found expedient and desirable, to reduce the use of me- 
chanic il restraint,;by the substitution of attendants, willing and able to give 
patients, their personal care instead, and the occasion for its use does not 
now exist, except in rare instances.” 
In the Alabama Insane Hospital, at Tuscaloosa, which I visited last fall, 
and where I found over 700 patients, I was told by the Superintendent, Dr. 
Bryce, that mechanical restraint had, for the four years past, been entirely 
discontinued in his institution, and in his report, which I have just re- 
ceived, he re affirms in the most emphatic manner, all that he has previously 
claimed in behalf of the new departure. 
IV. 
BEST METHODS OF CAKE OF THE INSANE. 
How shall the insane be cared for? What changes 
are needed in our present Asylum System ? 32 
INSANITY AND THE 
What shall be done with the harmless, the inoffen- 
sive, but incurable insane? 
These are the problems of the hour. 
As not every insane person is benefited, by being 
placed in an asylum, our minds are turning to the ex- 
ample of the Colony for thelnsaneat Gheel, Belgium. 
The experience of ten centuries has shown the utility, 
the beneficence, the humanity, of this grand, this 
splendid effort. 
Belgium is behind no country in the ability, the 
talent, the earnestness, and the intelligence of her alien- 
ists. 
Whatever may be said by the alienists of other coun- 
tries, I have never heard the name of one Belgian who 
did not speak in praise of the Colony at Giieel. 
The Government has determined to found another 
Colony, and lias done so recently at Liernieux, after 
the plan of Gheel. 
Oudert, whose death was chronicled in the Decern 
ber number of the Medico Legal Journal, has linked 
his name indissolubly with this great work. 
How will this System of Family Care of the Insane 
work in America? What would be the effect on 60 
per cent, of the present inmates of Asylums, if they 
could be removed into homes (one, two or three in a 
family), where they would be kept and cared for, by the 
women of the household, have no bolts, bars or 
other asylum restraints, and be free from that feeling 
of incarceration and imprisonment, which is upper- 
most In the mind of the insane, and stands oftentimes 
so much in the way of their cure ? CAKE OF THE INSANE. 
33 
A word about Giieel. It is a village in which nearly 
every inhabitant takes from one to three insane per- 
sons, to take the whole care of. 
These people, their fathers and mothers before 
them, for centuries, have had the care and charge of the 
insane, as members of their families. The system is 
family life, and that, for the insane, has its charm, and 
doubtless is the secret of its efficacy and success. The 
utmost liberty of action, is given, no bolts, bars, res- 
traints ; none whatever. Each inmate conies and goes 
as he pleases. The cures are wonderful and remarkable. 
In 1885, there were 1,653 patients in Giieel living thus 
in private families. Dr. Peeters, one of the most com- 
petent of the Belgian Physicians, is Medical Superin- 
tendent of the Colony, and he has an able corps of 
assistants. The Government has named seven Com- 
missioners, who are Supervisors, and the Governmental 
Inspector General of Insane Institutions has also, as we 
believe, this Colony under his supervision. 
There are two clinics, each in charge of a medical 
man,and six visiting attendants. Care, food and clothing 
is left to the family in which the lunatic resides. Dr. 
I). Hack Tuke reports in his Journal (Journal Mental 
Science, January, 1886, p. 481), the result of his personal 
observations on a visit made in September, 1885. The 
town (Kempenland) has a population of 11,000, the vil- 
lage of 5,000. There are 3,025 homes, of which 1,100 
receive lunatics. 
There are 160 ITotes who take charge of the better 
class or paying patients, and there are about 1,000 34 
INSANITY AND THE 
“ nourriciers” or those who take charge of the insane. 
The people are mostly small farmers. 
The colony is divided into two sections, over each of 
which is placed one medical man and an assistant, and 
under these sectional physicians are six “guards,” or 
what may be called visiting attendants. 
One of the most difficult problems of asylum life is to 
know how to successfully manage the insane of filthy 
habits. Dr. Take says, in this regard, of Gheel, that 
Dr. Lentz, superintendent of the asylum at Tournai, 
said to him “ to place those of dirty habits in the family 
of a care taker or nurse, is to remedy every incon- 
venience.” 
The highest sum paid by a private patient was £200 a 
year. The scale of such payments is £16, £20, £28, £40, 
£48, £80, £96, £120, £144, depending on the accommo- 
dations furnished. 
The cost to the government of the indigent patients 
is divided into three classes. The clean, the dirty and 
the semi dirty. The first pay8d. per day, of which 6d. 
goes to the nurse for board. The second class pay lOfd. 
per day, of which 9£d. goes to the nurse. The semi 
dirty pay 9d., of which 7d. goes to the nurse. 
Belgian pays lid. per day for her inmates in her in- 
sane asylum, so that the Colony at Gheel is to her an 
economy. 
The new Colony at Liernieux was founded because 
at least 2,000 of Belgian insane in institutions as Mr. 
Oudart contended, would be better off in such a Colony, 
and the government would save the difference, besides CARE OF THE INSANE. 
35 
obviating the necessity of constructing new asylums at 
great cost, and leave more room for the inmates when 
these were removed. 
At Gheel, 12% of the insane are furnished employ- 
ment ; nearly 400 men and nearly 100 women were em- 
ployed on the little farms and in the fields, while many 
more of the women were working indoors, and in 
making lace. Among the men, some work as masons, 
painters, carpenters, tailors, care being taken by Dr. 
Peeters that there shall be plenty of occupation ; “yes, 
fatigue, rarely; overwork, never;” and that all service 
merits remuneration. 
Notwithstanding the unusual freedom and liberty of 
action, no homicide has occurred since 1850, thirty-six 
years. Only one instance where a patient had offered 
violence to the daughter of his care keeper. Since 1878 
no fire has occured at Gheel, attributed to the act of any 
patient! 
Suicides are very rare, and as to illegitimate births, 
only three or four in the whole colony in 10 years ! In 
one of these cases, due to an oversight in allowing an 
insane woman of known erotic tendencies to be placed 
in same house with an epileptic, both of the troublesome 
class. Dr. Chas. W. Pilgrim corroborates Dr. Hack 
Tuke, as to fires, homicides, suicides and illegitimate 
births, but claims that patients with known homicidal, 
suicidal or dangerous tendencies are not sent to Gheel 
(Amer. Journal of Insanity, July, 1886, pp. 320, 321). 
No restraint can be used without Dr. Peters’ per- 
mission. 36 
INSANITY AND THE 
I have had under observation for some time, 
cases of inmates of institutions, regarded by able 
physicians as not only Chronic Insane, but of the most 
destructive and violent types, while closely confined, 
who changed their whole demeanor and conduct the 
moment their restraints were removed. Freedom from 
restraint and from confinement, seems almost to have 
worked a cure in itself. They became peaceable, 
tractable and capable of self-control. Most superin- 
tendents must see similar results in their experience. 
1)r. Wise, the able superintendent at Willard Asy- 
lum has closely observed it, and mentioned it to me. 
The value of out of door work, especially upon farms, 
or in agricultural pursuits, cannot be over estimated. 
The Superintendents of our large asylums, recognize the 
value of this wonderful aid in the care of the insane, 
and in their control and cure. Dr. E. A. Macdonald, 
Superintendent of the New York City Institutions for 
the Insane, was asked : “ Where are your violent cases, 
Doctor ?” 
“There they are, at work, digging and casting off 
that earth,” pointing to a group of laborers leveling the 
ground. 
No matter how excited a lunatic is, he will work out 
of it, if furnished with hoe and shovel ! The new pro- 
visions for the New York City Insane, look to a large 
farm and constant, regular out door employment, as 
one of the best agents and auxiliaries in the matter. 
Massachusetts is ambitious not to be behind in this 
great work. CARE of the insane. 
37 
She passed in 1885, an act, authorizing her State 
Board of Lunacy and Charity to arrange for boarding 
out lunatics of the chronic class. 
(Chap. 385, Law of Mass., 1885.) 
Through the kind courtesy of F. B. Sanborn, of 
Boston,Secretary of her Board of Lunacy and Charity, I 
have received the circulars sent out last year, to the 
subordinate officials in that commonwealth, introducing 
the new system. 
Thus has the begining of the new departure been 
made. The seed has been sown here in New York, and 
should take root,during the present session of the Leg- 
islature. 
It has worked well in Scotland, and the experiments 
in Germany are promising. 
We are on the eve of important forward movements 
in America, for the welfare of the Insane and a general 
improvement in their condition, as well as their care 
and treatment. 
The English Lunacy Commissioners, commenced, in 
1885, some work of this character. They report that 
seven idiot boys out of the Sussex Asylums, were 
placed in adjacent cottages, and boarded out, while 62 
patients from this asylum, were discharged, either re- 
lieved or improved, to work-houses or care of friends. 
They also report that on January 1, 1885, there were 
in England and Wales, 5,896 pauper lunatics, boarded 
out in private houses, or living with relatives and 
friends, being above 8.28 per cent, of the whole number 
of pauper lunatics in these countries. The Superin- 38 
INSANITY AND THE 
tendents of English Asylums in same year, reported 
that 4,000 of their patients could, with propriety, be 
transferred to pauper workhouses. 
The experiment in Scotland shows, that in 1885-1861, 
pauper patients were in private dwellings, but only 926 
of these are boarded with strangers. Kennoway, in 
Fifesiiire, is a place where considerable numbers are 
placed in Scotland, but there is not in Scotland any 
colony at all comparable to that of Gtieel. 
In Scotland, these patients are not concentrated in 
one place, as at Gtieel, but are scattered all over the 
Kingdom. The Scotch Commissions place it on the 
true ground. 
They make this arrangement for their patients, “ Be- 
cause treatment in asylums is forced on us, * * and 
if there is a class of the Insane, for whom asylums 
are not necessary, it becomes a duty to endeavor to pro- 
vide for them in other and more ways.” (Report of 
Scotch Lunacy Com., 1885, p. 131.) 
These practical Scotchmen mean, that as a matter of 
both duty and economy, it is better to arrange for the 
boarding out, of quiet, inoffensive, harmless, chronic 
and incurable insane in private families, with proper 
supervision, and suitable medical care, than to either 
crowd them into asylums, or build new asylums for 
them. 
In America we are still in the era, of building asylums, 
but we are on the eve of calling a halt, and asking our 
Superintendents, to report how many quiet and harmless 
insane, could safely be placed in private families, to do CARE OF TIIE INSANE. 
39 
light work, and have plenty of air, exercise and freedom 
of action. 
Music has exercised a wonderful curative and tran- 
quilizing power over the disordered intellect, to which 
much greater stress was given by the ancients, than 
with us. 
The sweet strains of delicious music, will quiet the 
most excited and raving maniac,a thousand-fold quicker 
and more completely, than any of the barbarous appli- 
ances of chains, or force in any form, and cheerful and 
merry companions, pleasant surroundings, and good 
cheer, will restore the light of reason, better than medi- 
cines, or bolts or bars. 
These aids were better understood by physicians of 
the past, than of the present, and asylum superinten- 
dents who will study attentively, the influence of these, 
aids to diseased brains, will be astounded at the results 
they will meet. Amuser toujours amuser should be 
the motto of asylums. 
V. 
CORPORAL PUNISHMENT OF THE INSANE. 
I think such an idea is an outrage upon our civ- 
ilization. 
It is clearly in violation of the existing laws to pun- 
ish an insane person for any reason, much less for an 
0 
offense. 
If, by the law, an insane person is held not respons- 
ible before the law, for his acts, how can he under the 
law, be made a legitimate subject of punishment \ 40 
INSANITY AND THE 
“ If anyone is to be struck in an asylum, let the at- 
tendant or keeper, be the anvil, not the patient,” said 
the talented Theodore Meynert, of Vienna. 
An attendant or keeper who,under any circumstances, 
struck an insane patient, should be at once discharged, 
and then punished. 
The brutality of attendants is proverbial. Superin- 
tendents should keep a very watchful eye upon them, 
and the morale should be raised, and the standard of 
excellence advanced. 
One good attendant, is worth two poor ones. One 
kind attendant, with savoir faire, is worth two brutal 
ones, with the idea of coercion by brute force. 
VI. 
INSANITY AND CRIME. 
LEGISLATION. 
At the root of all reform, at its fountain head, and 
source, stands the Legislature—the law making power. 
It must work from enlightened public sentiment, and 
upon intelligent inquiry. The advance was made in 
England, by Parlimentary Inquiries. It can probably 
be only done so here, or can be so best done. 
In Pennsylvania, Governor Hoyt, named a commis- 
sion without legislative enactment, and requested them 
to report to him, as Governor. 
He made their report, the basis of his executive recom- CAKE OF TIIE INSANE. 
41 
raendation, to the Legislature of Pennsylvania. From 
this, came the new Pennsylvania law, by far the best on 
any of our American Statute Books. 
We should ask the Legislature, to name a commis- 
sion, if our own Governor does not name one. The 
Lunacy Statutes need practical changes. No one pre- 
tends, to defend the sections upon commitment, of the 
insane. 
These statutes as they now stand upon our Statute 
Books, violate natural rights, and conflict with the 
organic law. , 
As to insanity and chime, the law should advance 
with the progress of science, pari passu. It is a dis- 
grace to our civilization, to hang the insane who com- 
mit homicides. 
Seventy per cent, of the inmates of asylums, can 
discriminate between right and wrong, and know 
that such and such an act, is against the law, and will 
bring punishment. 
Under the law, as charged by the Court, in Guiteau 
case, he would have been held guilty by any jury. 
When reason is so far unbalanced, that the liberty of 
the citizen, threatens the life, the property or the 
security of others, society has the undoubted right, to 
suspend the personal liberty of the citizen, but this can 
only be done, by due process of law, and in a judicial 
proceeding. 
It is a simple mockery of justice to say, that on an af- 
fidavit of two physicians, who may have never seen a 
case of insanity, a citizen can be placed in an asylum, as 42 
INSANITY AND THE 
insane for five days, without the order of a Court, or 
Judge. 
A Judge should be required, either by statute or pub- 
lic sentiment, never to sign such a commitment, without 
he has had a preliminary examination, satisfactory to 
his mind judicially, that the person charged is not only 
insane,but that he is a proper case, to go to the asyl um. 
In every case, where the slightest doubt exists, the Judge 
should pass in the same manner, that he would on habeas 
corpus, sued out by one charged with wrongful irnpris 
onment. 
The legal mind, should be brouglit nearer to the medi 
cal view of insanity, and tests-of responsibility will fol- 
low in true sequence. Proper care and confinement, 
in an asylum for insane criminals, so called, is much 
better for our civilization, and far more so for a lunatic, 
than the scaffold. 
Executions, at best, are horrible pictures, no matter 
from what angle the light falls upon them, or through 
whatever colored medium may we regard them. 
It is a glaringly, horrid, and lurid spectacle in this age, 
so near the close of the 19tli century, to see erected near 
the tribunals of a free people a scaffold, on which the 
law suspends, from a mistaken or distorted notion of its 
own majesty, the dangling form of a lunatic bereft of 
reason, as punishment for a supposed crime. 
I think it was Charles Sumner, who said 25 
years ago, “ that he knew no sadder sight, than a 
woman for sale, upon the auction block.” 
The war has effaced that picture from our vib\ CAKE OF THE INSANE. 
43 
washed it away with rivers of blood. To me, it is far 
more revolting, after the advancing light, which science 
has thrown upon the subject, for a quarter of a century 
since the Massachusetts Senator spoke, to see the le- 
galized judicial killing, of the Insane, for alleged homi- 
cides ! 
That the revolution which will efface the latter, may 
be as bloodless, and yet as complete, must be the hope, 
of all philanthropic hearts.