—in 
RELATING TO THE 
CARE OF THE CHRONIC INSANE 
BY COUNTIES, 
Issued by tlie State Board of Charities and Reform. 
To Superintendents of tlie Poor and Members of County Boards: 
Gentlemen : There are at present in the state of Wisconsin 
about 1,700 insane .persons under public care. Of these there 
were, as reported to us April 14, 568 in the State Hospital for the 
Insane, 522 in the Northern Hospital for the Insane, and 272 in 
the Milwaukee County Insane Asylum, of whom only 260 were 
from this state. There were thus at that date, 1,850 insane per- 
sons in these three institutions belonging to the state of Wiscon- 
sin. The remainder, or about 350, are in the poor houses and 
jails, mostly in poor houses. The number of the insane in this 
state is increasing faster than the population, and faster than state 
institutions are likely to be built to accommodate them. It is not 
therefore probable that the poor-house3 can ever be emptied of 
their chronic insane. 
Recognizing this fact, the legislature this winter passed a law 
(chapter 233 of the laws of 1881), which provides for the more 
humane care of the chronic insane in poor-houses. According to 
this law, whenever there is insufficient provision for the insane in 
state hospitals and county asylums, the State Board of Charities 
and Reform may establish rules for the care of the chronic insane 
by counties, and the counties which come up to the rules shall 
receive from the state one dollar and a half a week for each insane 
person thus cared for. The law also provides that the accounts 2 
of counties for the care of such chronic insane are to be approved 
by the State Board of Charities and Reform. The State Board of 
Charities and Reform may remove any insane persons from coun- 
ties which do not have proper accommodation for their chronic 
insane, to counties which do properly care for them. Iu such 
case the counties from which the insane are transferred pay the 
same price as they would for the same persons at the state institu- 
tions, and the counties to which they are transferred receive the 
same, and also one dollar and a half a week from the state, mak- 
ing in all three dollars a week and the cost of clothing. 
Acting under this law, the State Board of Charities and Reform 
have adopted the rules for the care of the chronic insane in poor- 
houses which are given on page five of this circular. 
It will be noticed that no rule has been adopted in regard to 
the size or location of buildings for the insane. The circumstan- 
ces of counties and the number and character of their chronic 
insane vary so greatly that no general rule can be adopted. In 
many counties the present buildings with some inexpensive 
changes will be quite enough for the present. The board do not 
believe that the insane need costly buildings as much as they do 
proper attention by those having them in charge. We quote the 
words of one of our members, addressed to the National Confer- 
ence of Charities: 
One of the legal requirements of our Board is to annually inspect the poor- 
houses of the state, for the purpose, among other specified duties, of ascer- 
taining the number of insane inmates, and whether such arrangements are 
made for their care as humanity demands, with power to make recommenda- 
tions only. This requirement, which has been faithfully performed for the 
ninth time, has, 1 am gratified to say, resulted in great practical benefit to 
the insane. It is superfluous to say to this conference of experts that we 
found on our first tours of inspection that humanity had a just claim for 
better arrangements. But being converts to the popular dogma of state hos- 
pitals for all the insane, and not doubting its speedy accomplishment, our 
recommendations for improved poor-house arrangements were all of a tempo- 
rary character, while we annually urged upon the legislature the necessity 
and importance of increasing the hospital accommodations as rapidly as pos- 
sible, then only sufficient for 350 patients. Within the next six years suc- 
ceeding the organization of our Board, the state almost trebled its hospital 
capacity, which was fully occupied without materially diminishing the num- 
ber under poor-house care. During this time, there was under the partial 3 
state supervision, a noticeable improvement in the condition of the latter, 
s pecially in counties having asylum buildings partially separated from the 
poor-house. These facts, taken in connection, led to the belief among the 
members of our board that it was not practicable, nor would it be, under 
efficient supervision, desirable, to furnish state hospitals for the chronic pau- 
per insane; that they would be in better condition mentally and physically 
as inmates of an asylum in connection with a poor-house, where the farm, 
garden, house and barn, would furnish that most effective restorative of this 
class, light employment to all who could be induced to engage in it. Among 
so small a number, and by a little tact on the part of the superintendent, he 
could offer extra inducements by accommodating each one with employment 
suited to his inclination or capacity, which would be impracticable in one of 
our large state hospitals, where the greater part of the labor is, necessarily 
performed by machinery or employes, and the balance is required to be don s 
under a surveillance which renders it so distasteful as to be resisted, or if 
performed, to counteract its good effects; and that the average per capita cost 
of maintenance in the county asylum would be less than one-half that of the 
state hospital. 
We call special attention to the rules 4, 5 and 6, which relate 
to occupation and non-restraint for the insane, and would refer 
you to the same subject as treated of on page 180 of our last 
annual report. 
Counties applying to be placed upon the list to be certified to 
the secretary of state, should be sure that all the insane are prop- 
erly adjudged to be insane, and that they have the evidence of 
such adjudication, as only those who have been declared insane 
by legal authority can be counted for the payment by the state. 
Counties wishing to be placed upon this should, through 
their proper authorities, correspond with the State Board of Char- 
ities and Reform for further information. 
ANDREW E. ELMORE, President 
H. H. GILES. 
W. W. REED. 
J. H. VIVIAN. 
Mrs. E. B. FAIRBANKS. 
A. O. WRIGHT, Secretary. 
Madison, Wis., May 23, 1881. 4 
RESOLUTIONS ADOPTED MAY 23, 1881, BY THE 
STATE BOARD OF CHARITIES AND REFORM. 
Whereas, By chapter 233 of the laws of 1881, it is provided that “when- 
ever it shall appear to the State Board of Charities and Reform that insuffi- 
cient provision has been made for the care and support of the insane in the 
state hospitals and county asylums previously established according to law, 
said board may file with the secretary of state a list of counties in which no 
county asylums exist, and which, in the opinion of said board, possess 
accommodations for the proper care of the chronic insane; and thereafter 
each of said counties so named which shall care for its own chronic insane, 
under such rules as said board shall prescribe, on the properly verified cer- 
tificate of said board to the secretary of state, shall receive the sum of one 
dollar and fifty cents per week for each person so cared for and supported.” 
And whereas, It appears from our last report, and from recent informa- 
tion from the superintendents of the three institutions for the insane, that the 
number of the insane in the state much exceeds the number who can be 
accommodated in the State Hospital, in the Northern Hospital, and in the 
Milwaukee County Insane Asylum; 
Resolved, That the conditions do now exist which call for the action of 
this board under said law. 
Resolved, That the following rules are hereby adopted for the care of the 
chronic insane under county care, and that any county which shall fully 
comply with these rules shall be placed upon the list of counties which 
this board will certify to as entitled to receive the benefits of said board, and 
shall be kept upon that list so long, and only so long, as all these rules shall 
be fully complied with, or such further regulations as the board may here, 
after prescribe. 5 
RULES FOR THE CARE OF THE CHRONIC INSANE. 
1. The buildings or parts of buildings set apart for the insane 
must be sufficiently warmed, lighted and ventilated. They must 
be clean and free from all offensive odors; and in addition to the 
sleeping apartments, they must have an associate day room or 
common sitting room for each sex. 
2. There must be a large airing court or enclosed yard for each 
sex. 
8. There must be a sufficient number of special attendants for 
each sex. 
4. As far as possible regular occupation should be provided for 
the insane, at such kinds of labor as they can be induced to engage 
in. We would specially suggest gardening and farm labor for 
the men, and housework for the women. 
5. Restraints of all kinds, such as shutting up in cells, tying 
the hands with hand-cuffs or “muffs,” or shutting into covered 
beds, should be used only in extreme cases. 
6. A daily record book must be kept showing the persons in 
restraint, the kind of restraint, and the reasons for it. 
7. The overseer of the poor house and his wife and all employes 
who have charge of the insane must be intelligent and humane 
persons of correct habits. 
8. Some experienced physician must be appointed county phy- 
sician, who shall thoroughly inspect the building and patients as 
often as may be necessary, and at least semi-monthly. 
9. The overseer of the poor house and the county physician 
shall report to the State Board of Charities and Reform in such 
form and at such times as the board shall prescribe. 
10. The buildings or parts of buildings set apart for the insane 
shall at all times be open to the inspection of the State Board of 
Charities and Reform, or of any person or persons authorized by 
them. 
11. The State Board of Charities and Reform may at any time 
add to, change or modify these rules as they may deem best for 
the interests of the patients. 6 
THE LAW RELATING TO THE CARE OF THE 
CHRONIC INSANE BY COUNTIES. 
[Published April 8, 1881.] 
CHAPTER 233. 
AN ACT to provide for the humane care of the chronic insane not other- 
wise provided for. 
The people of the state of Wisconsin, represented in senate and assembly, da 
enact as follows: 
Section 1. Whenever it shall appear to the state board of charities and 
reform that insufficient provision has been made for the care and support of 
the insane, in the state hospitals and county asylums previously established 
according to law, said board may file with the secretary of state a list of 
counties in which no county asylums exist, and which, in the opinion of the 
said board, possess accommodations for tae proper care of the chronic in- 
sane; and thereafter each of said counties so named which shall care for its- 
own chronic insane, under such rules as said board shall prescribe, on the 
properly verified certificate of said board to the secretary of state, shall re- 
ceive the sum of one dollar and fifty cents per week for each person so cared 
for and supported, as hereinafter provided. 
Section 2. On the first day of October in each year the county superin" 
tendent of the poor, or other officer having charge of the poor of any county 
on said list, claiming compensation for the care of its chronic insane, shall 
certify to the secretary of state the names of all persons necessarily cared 
for and supported by said county at public cost, the date when said person 
became insane, and the number of weeks each of said insane persons were 
cared for during the preceding year, making affidavit to the same; and if 
such certified statement shall be approved by said board of charities and 
reform the secretary of state shall include the amount which such county 
shall be entitled to receive from the state under the provisions of this act, in 
the next state tax, and on the first day of February thereafter shall place said 
amount to tha credit of said county. 
Section 8. Whenever, in the opinion of said board of charities and re- 
form, any county has not made suitable provisions for the proper and hu- 
mane care of either its chronic or acute insane, the said board may direct the 
removal of either class of said insane to any connty asylum, or to any other 
county possessing suitable accommodations therefor for care and medical 
treatment, as the circumstances may seem to reqnire; and said insane shall 
be so removed at the expense of the county to which they belong. 
Section 4. Any county named in the first section of this act, possessing 
accommodations for a greater number of the chronic insane than reside in 
such county, may receive such additional insane persons as the state board 
of charities and reform may direct to be transferred thereto, from counties 
that do not possess accommodations for the proper care of their own insane,. 7 
nd may include all such persons in the list of insane certified to the secre- 
tary of state, as provided in the second section of this act, and shall receive 
from the secretary of state a credit, to the amount of three dollars per week 
for each such person so received and cared for from another county, and for 
the amount necessarily expended for clothing said person; one dollar and a 
half of the aforesaid amount of three dollars per week, and the amount actu- 
ally expended by such county for clothing such insane person, shall be 
charged by the secretary of state to the eouoty from which such insane per- 
son was sent, acd shall be included in the amount charged in the next state 
tax to said county. 
Section 5. Nothing in this act shall be construed to entitle any county 
to compensation for the care and support of any person not previously 
adjudged to be an insane person, and properly committed as such under the 
laws of this state relating to the commitment of insane persons to the hos- 
pitals of this state; nor shall any county be entitled to compensation for the 
care and support of any insane person not lawfully and necessarily a public 
charge. 
Section 6. Sections one thousand five hundred and two, one thousand five 
hundred and three, one thousand five hundred and four and one thousand 
five hundred and five of chapter sixty-three, revised statutes of 1878, relating 
to the relief and support of the poor, are hereby declared to be applicable 
to insane persons, in the same manner and to the same extent that they now 
apply to other classes unable to maintain themselves, described in section 
one thousand five hundred and two of said chapter. 
Section 12. The property and estate of any insane person, kept in any 
state or county asylum, or kept by any county at public charge under the 
provisions of this act, shall be liable for his support and maintenance and 
chargeable for the payment thereof, and upon failure of the person or per- 
sons having the charge or custody of such property or estate to pay therefrom 
for such support and maintenance, the board of trustees of the hospital or 
asylum, or the chairman of the board of supervisors of the county furnishing 
such support, may apply to the county judge of the proper county to compel 
such payment. In cases arising under the provisions of this section such 
■county judge shall have the jurisdiction and authority conferred by chapter 
sixty-three of the revised statutes, and shall exercise such jurisdiction and 
authority in the manner provided by said chapter, and he may enforce obedi- 
ence to his orders by proceedings as for a contempt. If any order or orders 
made by such judge requiring such payment shall not be complied with 
either of the officers in this section designated, to-wit: such board of trustees 
of any hospital or asylum or the chairman of the board of supervisors of any 
county, may recover in an action against the person or persons having the 
charge or custody of such property or estate brought in the circuit court 
against him or them in his or their representative character, the amount 
■directed to be paid by such order or orders, and any judgment so recovered 
may be satisfied out of such property or estate; such court may, in its discre. 8 
lion direct that the costs in such action, if the plaintiff recovers judgment 
be paid out of such property or estate or by the person or persons having 
the charge or custody thereof. 
Section 13. Any county having chronic insane to be returned or delivered 
to it, under the provisions of this act, may select the persons to be so 
returned; such selection to be made in writing by the chairman of its board 
of supervisors, or the board of trustees of its asylum, and left, together with 
a proper receipt, for the person or persons delivered with the institution from 
which such person or persons shall bereceived. 
Section 14. There is hereby appropriated out of the state treasury, from 
any moneys not otherwise appropriated, a sufficient sum for the purposes of 
this act. 
Section 15. All acts and parts of acts so far as they conflict with the 
provisions of this act, are hereby repealed. 
Section 16. This act shall take effect and be in force from and after its 
passage and publication. 
Approved March 30, 1881. 
(Sections 7 to 11 inclusive, which relate to another subject, are omitted).