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WHAT SHALL WE DO WITH THE
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WHAT  SHALL WE DO WITH THE

         INSANE
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THE   WESTERN   CQ/UNTRY?
                           BY

             EDWARD  JARVIS,  M. D.
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  What  shall we do  with  our insane?  This  is a ques-
tion  that  must  come home  to all of  us, whether  phy-
sicians  or  citizens, and  sometimes  appeal  with  fearful
earnestness  to  our hearts and understandings  for answer.
And are  we ready to give it ?   Every one of us  is liable to
find insanity, in some form or other, in his own family.  Every
physician  may  be called,  at any time,  to see  it among his
friends.   His advice is then pressingly asked—What shall be
done with the patient suffering from moral or intellectual de-
rangement ?
  This is a question—not, indeed, of life or death—for insan-
ity is not a dangerous disease ;  comparatively few need die of
it.  But it is a question of future soundness of reason  and
of correct feelings, or of permanent  insanity.  And whether
our patients or our friends shall be brought back  to mental life
and all  its enjoyments, to usefulness, society, and to happi-
                           1 
2            What shall we do with our Insane 1
 ness; or whether the incubus of  lunacy shall weigh foreTer
 upon their  understandings,  their feelings and  affections  bt
 enchained  or perverted,  and  they  become a  burden upon
 their families, a  terror to society, or perhaps, sinking into
 fatuity, a mockery to the unthinking and the heartless ;  which
 of these shall happen, depends upon us, and our answer to the
 question—What shall be done with the insane?
  Nor is this a rare question.   Jt has been  asked, or it ought
 to be asked,  frequently ; for there were, at the last national
 census, taken in the year 1840, eight hundred and thirty-three
 lunatics and idiots in Kentucky ; eight hundred  and  fifty-one
 inTennesee; five hundred  and sixty-eight  in Indiana; two
 hundred and  twenty-seven in Illinois: two hundred  and sev-
 enty-eight  in Missouri, and thirteen hundred  and sixty in
 Ohio.*  And their claims press, with an  irresistible importu-
nity, upon our professional  skill and upon  our  humanity, to
tell them what they shall do.   And  though our fathers  and
we, hitherto,  have not  told  them, and these insane  patients
have got no relief, and a large portion of them have become
* Statement of the number of Insane in the Western states, taken from
  the last national census, and how supported.
	Whites.		Colored.					
	►d c	hd	hd	c	H		Proportion	
	cr	<	<	cr	p	Populat'n	ofinsaneto	
	o	CD	a	o			population	
Missisippi	14	102	66	16	198	375,651	1 in 1,892	
Louisiana	8	45	37	8	98	351,176	1	' 3,592
Tennesee	103	596	124	28	851	829,210	1	< 974
Kentucky	276	406	110	41	833	777,397	1	' 934
Ohio	363	832	62	103	1360	1,519,467	1	' 1,117
Indiana	110	383	46	29	568	683.314	1	' 1,203
Illinois	25	162	32	8	227	474,404	1	' 2,089
Missouri	44	165	52	17	278	381,102	1	< 1,370
Arkansas	3	14	6	5	28	95,642	1 " 3,415	
	9462705		535	255	4441	5,487,363	1 " 1,235	
The average for all the United States is one to 990. 
Prospects of the Insane.
3
incurable maniacs, or have sunk into hopeless imbecility, yet
we can no longer be silent; we must tell, what shall be done
with the four thousand four hundred and forty-one lunatics and
idiots, that live in the vallies of the Ohio and the Mississippi.
The present  state of medical science will not suffer these any
longer to be  neglected, and still less will it permit, that those,
who hereafter shall become insane, shall have their disease
permanently fixed upon them.
   What then can be  done?  What can we do for them?  As
regards  the future, these  patients  may well be divided into
the hopeless  and hopeful.  In the former class  are included
idiots from birth, and, also, such as have become idiotic in the
progress of the disease, epileptics, and paralytics. But although
these may not  hope for  restoration to health, yet most  of
them may be improved and  rendered more  comfortable  to
themselves, and tolerable  in society.
   To the other class  belong all other  cases—old and recent.
For these, there are three grades of hope ; and  according to
the results of the treatment of these must they ultimately be
classed, though not now.
   1st. Those., who  may be completely restored to health.
   2d. Those, who,  though they may never enjoy perfect san-
ity, yet may be  so far improved, that they can live  peaceably
and quietly among their friends, without interfering with the
safety or comfort of society.
   3d. Those who can obtain neither of the former conditions,
but may, under  the influence and restraints of a hospital gov-
ernment, have their delusions so far modified, and their agita-
ted feelings so soothed, that they may enjoy a calm and con-
tented existence in an asylum, though  they could not bear the
irritations of the world, without distress or raving madness.
   Before the insane fall into either of these classes,  they must
aim at the first; and if they fail  there, they fall successively
into the seeond, and even the third  class,  by  the trial  of
the remedial measures.  Few indeed are the lunatics, who
may not  be  brought into one or  the  other of these classes ;
and if taken  very early in the disease, and  proper measures 
4
Shall we retain the lunatic at home ?
be faithfully used, few will be found, who may not be put in
the first class, as we shall hereafter show.
  Our first  object is  to cure the lunatic.  If this fails, our
second object is to improve him, so that he may live comfort-
ably at home.  And lastly, in default of both these, our third
object is, to find a comfortable resting place for him.   How
shall we obtain these ?
  Shall we retain the  insane at their homes, and  apply such
remedies as we have, and such restraints  as their excitements
and our fears seem to demand?   We have been  trying this
plan  for many years  in Kentucky and  the other Western
states, and have found, in most cases, no better  result than
permanent insanity, sometimes uncontrollable  frenzy, and
even  dangerous madness,  and sometimes irretrievable im-
becility.  And for all purposes of restoration  to  health, of
improvement or  comfort for the maniac, of satisfaction to
friends, or even of public or private  economy, the  old system
of keeping lunatics at their homes, in charge of committees or
of their families,  wandering freely abroad or confined in
strong places, has  been  demonstrated to be worthless, in al-
most  every town and  neighborhood, and,  without  doubt,
within the  observation of every physician.
   The great number of old cases, that were once  recent,  but
have  been  suffered to become chronic, and probably perma-
nent; the  many imbecile that were once rational, and  the
uncontrollably excited maniacs, are melancholy proofs of how
vain were our hopes that the disease might wear itself away,
and how  futile were all our attempts  to cure it with any
means and appliances of a  domestic nature.
   We must, then, try some  other plan.  Home is not  the
place for the cure of the insane. The circumstances and asso-
ciations of  home too often aggravate and perpetuate the men-
tal disorder, rather than soothe and relieve it.  So that now
all medical authorities advise the removal of the patient from
the familiar scenes and associates, among which the disorder
first arose  and grew. 
           The lunatic must be removed from home.         5

   Esquirol  advises, that  the insane be  removed from their
 homes, and confined, for the five following reasons :
   1.  For their own security, and that of their families, and
 for the maintenance of public order.
   2.  To remove them from the influence of external circum-
 stances, which may have produced their disorder, and may be
 likely to protract it.
   3.  To overcome  their resistance to curative  means.
   4.  To subject them to a regimen appropriate to their situa-
 tions.
   5.  To cause them to resume their  intellectual habits.
   The  first of these reasons is sufficiently obvious, and  need
 not be urged here.   The public and the friends of the lunatics
 are careful  enough of their own safety and of the security of
 the latter, to  place them out of harm's way, and beyond the
 means of doing mischief.
   A large portion  of the  cases of lunacy arise directly from
 the trials, difficulties, and misunderstandings of home;  from
 domestic  grief,  from fear of  poverty, and from disappoint-
 ments.   Some are caused  by excessive  labor of body or mind,
 from  hard study or intense application to business, and  from
 unrequited love or thwarted ambition.
   All these  have their origin in matters and circumstances im-
 mediately about their usual abode and haunts.   These causes,
 which at first  excited, next continue  to feed the disorder.  In
order then to cure the disease, we must first remove the cause
 from the patient, or the patient from the cause.  And if that
cause be home or its concomitants, removal  to another place
oi residence must be  the first step toward relief.
   Most cases  of  lunacy are aggravated by the usual and fa-
miliar scenes and persons,  whatever may have  been the origi-
nal cause of  the derangement.  The  insane  are  generally
suspicious of others, or self-distrustful.  The ordinary motives
cease  to influence their opinions or govern their actions.  The
usual reasons do not draw their  confidence.  One  conceives
that  he cannot perform the ordinary duties,  which he  has
hitherto done cheerfully, and  nothing will induce him to at-
                           1* 
6
Insanity aggravated at home.
 tempt them ; and he then is in great distress, because he has
 thus neglected what he knows he ought to do. Another supposes
 that his family are his enemies, and are seeking to injure him.
 Another is peculiarly irritable upon the common topics and
 interests of his neighborhood ; he imagines  that  they impli-
 cate him in wrong or danger, and flies in a passion when they
 are  mentioned, or  avoids allusion  to them altogether.  One
 has  strange conceptions of his relations to his friends and the
 world ; he supposes himself to be a king, and therefore de-
 mands  implicit obedience; or a  prophet, and expects unre-
 served faith in his opinions.  To resist this assumed authority,
 to refuse this undue submission, or to withhold this groundless
 belief, would but aggravate the lunatic's derangement of mind,
 or exasperate the rage of the  maniac,  and is  impossible for
 the  family and friends, without increasing the disorder.  At
 home, with no other restraints than the  family and  friends
 can  usually present, the pationt must have his own way; and
 that way, to say the least of it, is not a good one, and often it
 is a very bad one.  All  the  influences  of home cannot  pre-
 vent this, without exciting the very perversity they attempt
 to repress.   When Mr. Pitt put  king George III., under the
 care of Dr. Willis, in  1789, he was treated successfully, in-
 deed, at his own home.  But Dr. Willis discharged all the
 servants, attendants, lords and  ministers, who had been about
 the king before.   The family were all removed, the furniture
 taken away, and  an entirely new corps of attendants placed
 about the royal patient, and  the palace at Kew furnished  so
 differently, and all the paraphernalia and regimen so thorough-
 ly changed, that  it had  all the seeming of a  removal from
 home ; for  indeed the home  was  removed  from him.  The
 king recovered ;  and  so might our patients, without going
from their own houses, if we could metamorphose those  hou-
ses, and change the  attendants, as Dr. Willis did for the king.
This example is good for us, so far as it shows the necessity
of placing the lunatic among strange men and objects.
  Georget, one of  the ablest of French writers on insanity,
and himself long  devoted  to the observation and cure of this 
EsquiroVs opinion.
7
 disease, says :* " Every physician who has been in the habit
 of attending to lunatics, has, without hesitation, advised the
 separation of such patients,  in  almost all cases, as the first
 condition and  one of  the principal  means of cure.  The in-
 sane ought  to  be removed  from those  objects, which first
 caused their alienation, or which might  have kept  it up or
 aggravated it; from relations and attendants whom they de-
 test, whom  they pretend to command, and whom they will
 not  obey; from  the inquisitive, who would  irritate them by
 useless reasonings, or  by ill-timed raillery.  They ought to be
 removed from  society, and placed in a habitation specially ap-
 propriated to  this purpose, both  for the safety of the public
 and for their own security."
   Esquirol says : " The sensibility of the insane is perverted.
 They no longer have any relations with the external world,
 but  those of a disordered and  consequently painful  nature.
 Every thing irritates  them, distracts them, and excites their
 aversion.  In constant opposition to all that surrounds them,
 they soon persuade themselves that  persons are combined to
 injure them  ;  and neither  understanding what is said, nor
 being able to comprehend the reasonings, that  are addressed
 to them, they misinterpret the most affectionate expressions,
 and  the  wisest counsels; they mistake the mosj: candid, seri-
 ous,  and  tender language, for insults, irony and  provocations,
 and  the most attentive kindness for contradictions.  The regi-
 men and the prohibitions, which are called for, by their situa-
 tion, and to which their  attendants wish to subject them, ap-
 pear to them cruel persecutions."!
  " The  heart of the insane cherishes no feeling  but mistrust;
 he is irritated to anger by every thing  he sees, and  he is so
 timid that he is troubled  as soon as any one approaches him."
" From mistrust, these patients soon pass to fear and hatred  ;
 and  in these new moral  situations, they repel their relations
  * Dictionaire de Medicine. Art. Folie.
  f Esquirol, Observations on the illusions of the Insane.  Liddel's
translation, quoted by Prichard. 
 8        Reports of New Hampshire, Maryland, fyc.

 and friends, and welcome strangers."*  " With these moral
 dispositions, if left in the bosom of his family, the tender son,
 whose happiness used to consist in living  near his  mother,
 and in following his father's counsels, persuaded, that they
 wish to disgust him with his home, in order to drive him from
 it, falls into deepest despair, or  escapes to destroy himself."*
   " In mania or raving madness, the  condition of the patient
 is such as to render the necessity of  confinement obvious to
 common sense, both on account  of the safety of the individual
 and that of his family, without  adverting  to the advantages
 resulting from such a measure in the  promotion of  recovery,
 and in the facility of applying remedies.  In a great  propor-
 tion of the cases of monomania,  the propriety of adopting  the
 same course is  almost equally evident.  The understanding is
 in this disease so disturbed, and the moral affections of the in-
 dividual so perverted, that no alternative seems to be left."t
   " It is now conceded  by all, who are best acquainted with
 the management of the insane, that the first element in their
 moral treatment, is their removal from acquaintances and for-
 mer associations.  One  prominent advantage in such remo-
 val, is  the promotion of the second element of treatment, that
 of withdrawing the mind from its hallucinations, and attract-
 ing it into a new current of  thought.  New objects must be
 presented to the view, new incentives to the mind."J
   It is needless to quote more  authorities upon this subject.
 They would be but repetition of  the same  opinion ;  for  the
observations of all  have convinced them of the same truth.
Within a few years, the  States of New Hampshire, Connec-
ticut,  New Jersey,  Pennsylvania, and Maryland, have  ap-
pointed commissioners to investigate the condition of the in-
sane poor in their  limits.  These commissioners have  made
 reports,|| and all give melancholy proof of our position.  They
show, that of all the pauper lunatics, at their homes,  or con-
fined in  jails, houses of  correction, or poor-houses, none  are
cured, few alleviated, but most become confirmed  in chronic

  * Esquirol,  Observations on the Insane : Liddel's translation,  quoted
by Prhhard.   \ Prichard.  \ Earle, Visit to thirteen Asylums.   || Pris-
on Dis. Soc. Reports. 
           Have we seen insanity cured at home ?          9

insanity.  The able and comprehensive Reports of the Prison
Discipline Society confirm  this opinion.   And that  society,
true to its noble and benevolent purpose, has used its great
influence  to persuade sane men to give their insane brethren
the earliest, and therefore, the best chance of relief in the in-
stitutions  especially built and set apart for them.
  It would seem almost useless to look abroad for any author-
ity  in  this matter, when  we  have  such abundant  proof at
home.   Probably no inhabitant of the Western country, and
very certainly no physician,  has  been so fortunate as not  to
have seen, in his own neighborhood, some lunatics whose in-
sanity  has grown  old and confirmed, from neglect of proper
and efficient means of relief.  These being  retained at their
own homes, and in the bosom of their own families, their dis-
orders have become chronic and perhaps hopelessly incurable.
Such cases are familiar to  us all; and who of  us  has seen a
case of recovery under these domestic influences?  Who  of
us  has  not seen instances of men  changed, either by slow
process, or by sudden transition, from mental soundness  to
mental derangement; from amiable gentleness to  such iras-
cibility of temper, as to make them  almost or even quite in-
tolerable in  their families ?   And while the tender  and affec-
tionate relations and anxious  friends are hoping, that another
day or another month will  remove the hallucination or  wear
the  madness away, and restore the lunatic to his  right  mind
arid to their former confidence, that other day and other month
pass by, and only leave the  alienated patient a little and a lit-
tle more confirmed in his madness.  Their hope dwindles be-
fore the unrelieved, but strengthening disorder: despair suc-
ceeds to hope, and at last comes a bitter reconciliation to this
afflicting dispensation, as men become reconciled, by habit, to
any calamity, which they must endure. Of all these sorrowing
friends that have hoped for this mental healing at home, how
many have been gratified ?  And of all  our  profession, that
have encouraged these distressed relatives to hope, in these
circumstances, how many have found  their promise fulfilled in
the  event? 
10               Exceptions to the general rule.
   The theory of the nature and the process of the disease, the
testimony of all writers upon  insanity,  and of all those par-
ticularly devoted to its cure, and, more  than all, our own ob-
servation prove, that  home is not the place for  the recovery
of the lunatic, and  that separation  from  familiar scenes  and
people is the first and a necessary step toward the accomplish-
ment of this desirable  object."*
   * There are, of course, some exceptions to this general  rule.  There
 may be a few cases, which will  not be benefitted by the removal from
 home.  A very few may even be injured by being brought into the com-
 pany of other lunatics.
   When the disorder  of the understanding is restricted to one or a few
 subjects, and the lunatic has his reason sound and clear on most matters,
 it is not  so easy to determine the question of removal.  Sometimes op-
 position  to the will of a monomaniac, whose insanity is  limited,  may
 even disturb more of  his sound faculties, and increase the insanity, or
 even create general mania.
   If the monomaniac  still retains his affections for, and his confidence
 in his family and relations, it may seem cruel to deprive him of their at-
 tentions.  Nevertheless, if, notwithstanding his attachment to home, the
 subjects of his illusions are about his ordinary affairs, or haunts, or as-
 sociates, it is still best to remove him.
   Esquirol admits, that if the illusion of the insane relates to objects of
 indifference, and excites no strong emotions; if he has no aversions to
 his  home and the persons with whom he lives, although confinement
 may be sometimes useful, it is not absolutely necessary."*  "But if the
 patient,  retaining a  large portion of his intellect, has a strong attach-
 ment  to his relatives, it  is to be feared, that confinement  might aggra-
 vate the disease."!
   Some few melancholic patients  may not be  benefitted by a removal.
 Their dejection and gloom may be aggravated by such change, and par-
, ticularly by the residence among similar patients.
   Yet, after admitting these exceptions, the general rule  of separation
 holds good ; and though, like all rules of medical practice, they are nei-
 ther mathematically exact, nor universally applicable, still the propriety
 of separating the lunatic from familiar persons and things, demands our
 first consideration, in every case; and we should be ever ready to do it;
 for  almost all require it, and  rarely is any one injured by  it.
* Prichard.
t Esquirol. Observations, quoted by Prichard. 
                Shall we imprison the lunatic?            11

   It being then determined that the lunatic should be separa-
 ted from  his  home and  friends, the next question  arises:
 Whither shall  he be sent?   Throughout the civilized world,
 and in Great Britain and America especially, this question has
 been very promptly and practically answered, with regard to
 a portion of lunatics at least.  In all states, until within a few
 years, when a  more enlightened and benevolent policy has in
 some been adopted, and in a few  states, even now, imprison-
 ment  has been, and is  the ready and efficient  means of re-
 straining the furiously mad.   The uncontrollable and the vio-
 lent, those who were dangerous to the public peace, such  as
 committed  assaults upon  the persons  or property of  their
 neighbors, the  bold  maniacs, that  kept fearful  society  in
 trembling awe of them, have been sent at once to the county
jail, to the town work-house, or  to some strong rooms espe-
 cially prepared to hold them fast.  This was a remedy for the
 public, but not for  the patient.  It restrained his hands, but it
 did not  control the wanderings of his  spirit, nor calm the
 madness of his  feelings, nor confine the vagaries of his delu-
 sions.  The utter worthlessness of this sort of confinement is
 most manifestly proved by the commissioners of New Hamp-
 shire, Massachusetts, Connecticut, New Jersey, Pennsylvania,
 and Maryland, in  their very valuable reports upon the state
 and condition of the insane poor—very many of whom had been
 confined in their prisons and houses  of correction for years—
 varying  from one to forty, and not an instance of recovery is
 reported. ■  Not only no cures were obtained, but the report of
Massachusetts says, with striking truth, " Were a system now
devised whose express object it should be, to drive every vic-
tim of insanity beyond the limits of hope, it would scarcely
be within the power of a perverse ingenuity, to suggest one
more infallible than that which for  so many years has been
in practical operation among us."f  So this plan is worse
than useless.
* Prison Discipline Society Reports.
t State Lunatic Hospital Reports, p. 19. 
12             Travel and private boarding.
  Travel—change  of scene  and  occupation—placing the
patient  amid  objects which may  divert  his  thoughts, and
change  the course of his reflections ;  these are found benefi-
cial  in  some  recent cases of partial derangement.*  But  to
say nothing of the great expense which such a course of  treat-
ment must require,  we shall find  but few, that would derive
advantage  from travel.  The  patient  cannot  be  under the
restraints that the cure of insanity requires, nor be kept from
the external influences, that might aggravate the disease, nor
be so well subjected to the suitable remedies.
  It has been the  practice with  some, to send their insane
patients or friends to board with some physician or other ju-
dicious  person's family, remote from home, for the  purpose of
cure. For some cases, in which the patient retained his good
temper, was easily managed, and  required no restraint, this
plan has been  very happily successful.  But most lunatics could
neither be  managed  nor properly attended  to in a private
family.  The needful and convenient means of governing and
managing the insane, are not to be found in any private habi-
tation.  The master of such a house cannot have the authori-
ty, nor  the servants the influence necessary for this purpose.f
Georget says, that from an aversion to sending a lunatic to a
public  hospital, the friends  sometimes send  the  insane to a
house especially destined to receive a single patient, and there
they surround him  with strange  attendants and  servants.
This is  not only very expensive, but it fails of its object. For
it is next to impossible to procure a perfect isolation ; for the
relations and  friends are under strong temptation  to visit the
lunatic, and he very soon discovers that all this household and
  * Prichard.
  t "A private dwelling is ill adapted to the wants and requirements of
such an unfortunate being.  And even if it did contain all that is requi-
site,  still there is little possibility that the  patient could derive much
benefit from persons who are neither acquainted with the proper system
of treatment, nor if they were, could they possibly adopt it, and at  the
same time attend to any other business.  A lunatic demands the whole
time and attention of his guardians."—Hill, on Insane Asylums, p. 7. 
Early Hospitals.
13
preparations are for him, and then he is almost as little gov-
erned as if he were in his own family.*
  This  plan of placing  the insane in private families,  is too
costly for most people, and is not sufficiently successful as a
means of cure, to be advisable as a general rule for even those
who can afford the expense.

  Thus we see, that of  these three modes of treating the in-
sane, the first,  imprisonment, is worse than  useless—even
exceedingly injurious.   The second and third, travel and pri-
vate boarding, are suited to but a small portion of cases; and
are so expensive as to be beyond the reach of that small num-
ber who might be benefitted by  them.

  The only other remedy now proposed, is the  hospital.  In
a precedingf article]we demonstrated, that in the best asylums
insanity was proved to be a very curable disease;  as much so
as fever, pneumonia, or  dysentery.   The power of the asylum
is one grand triumph of  modern science, over what has been
hitherto supposed an unconquerable  derangement; and in its
latest improvement, it is the noblest institution of humanity.
  In Kentucky,  Governor Adair said,  in  1821,  that the old
system of supporting lunatics had proved to be wholly  inade-
quate to purpose  of restoration  of mental soundness.^  This
was a matter of commonest observation, and  familiar  to the
eyes of  all.  In  the establishment of the hospital there was
nothing  to be lost, but every thing to be gained.  The earli-
est  hospitals of Europe did not advance much.  They were
but a better sort of prisons.  But Pinel's|| influence began a
reform in these, which benevolent men elsewhere  have carried
  * Diet. De Medicine, Art. Folie.
  t Insanity and  Insane Asylums, p 7.
  % Message, 1821.
  B See that most interesting account of Pinel's unchaining the lunatics
of the Bicetre, in 1792,  in Browne, Hill, British and Foreign Medical
Review, No. I. p, 236; Pris. Dis. Soc. Reports, and also North Ameri-
can Review, Vol. XIV. p. 103.
                             2 
14             Insane Asylums in the  West.
on  from time to time, as light and love beamed upon them.
These improvements, in  the treatment of insanity, have been
the most rapid within  the last ten years.  Pinel had no con-
ception of the extent, to which his principles would ultimately
grow, nor of the power which they were destined to acquire.
When Governor Adair, in 1821, proposed to this state to es-
tablish a Lunatic Asylum in Kentucky, he said, "if only one
out of twenty of those unfortunate beings, laboring under the
most dreadful of all maladies, should be restored, will it not be
a  cause of gratulation to a  humane  and  generous public?"*
If to the eye of this  benevolent magistrate, the recovery of
one in  twenty lunatics would justify the building and  main-
taining a hospital ; and the probability of cure, amounting to
only one-twentieth of  a  certainty, were reason sufficient  for
sending  a patient from  his  home to  the asylum, how would
his noble heart have rejoiced to  see that this very institution,
which he recommended  with such  feeble  hope,  now cures
eight  times as many of all  that are sent, and  almost twelve
times as many of the recent cases ?f  And still more, that in
the more modern institutions, ten times as many are cured as
he thought would warrant the abandonment  of the old and the
adoption of the new system.
   In the United States,  there are nineteen public and  two
private asylums for the insane.  Four of the former are in the
Western country—at  New Orleans,  Nashville, Tenn., Lex-
ington, Ky., and Columbus Ohio.   All others are beyond the
Alleghany mountains, and can be reached by us only through
a long and tedious journey.  We will now examine the vari-
ous and particular  merits and advantages of each of these
institutions, so far as they concern us of the West.  But be-
fore entering  upon  this examination, it is well  to fix in  our
minds clearly, what  we are to hope for, and what we  may
reasonably expect.
   I. We  hope for complete  restoration  of our patients to
reason.
* Message.  Rep. Journal.      f See Report for 1841. 
Hope of the Lunatic in an Asylum.          15
   II. If this be not attainable, we hope for such amelioration
of the disorder, that the patient may live peaceably and com-
fortably in  his own family and among his own friends.
   III. If, after all, he cannot be rendered safe to be at large,
or at his house,  then we desire that  he have a comfortable
home, where he will neither be exasperated nor neglected.*
   IV. We  desire, that the means used for these purposes, be
of  the gentlest and most  judicious kind; that none of the se-
verity of olden time  be applied; but that  all  the tenderness
and affectionate delicacy  of home be used, in the new abode ;
that restraint be only so far applied as  to prevent self-injury,
or harm to others, and guidance sufficient to direct the wan-
dering thoughts to a  right channel.f
   Judging  by the results of the best asylums, we may reason-
ably  expect the recovery of eighty or ninety out of every
hundred, who have been  insane less than one year;  and the
recovery of ten to twenty in a hundred of those, wmose disor-
der has been of longer continuance.  Or applying the doctrine
of chances, there is eight to nine-tenths of a  certainty, that
any recentj case  will recover, and one  to two-tenths of a cer-
tainty, that any chronic case will be restored.
   If  any case, old or  recent, be  not curable, we  may expect

   * See Dr. Ray's Report on the Maine Asylum, *br 1841.
  t "It cannot be too widely  made known, that in a properly construct-
ed and  well  regulated  asylum,  the  insane  may  be  treated not only
much more  easily and  effectually, but also  much more mildly than at
their own homes."—Report of the  Lincoln, Eng. Asylum, for 1837,
quoted by Hill.
  I "We use the word recent to express those who have been insane one
year and under ;  and old or chronic for those insane over one year.  In
this sense are these terms used by most writers; and in all reports quo-
ted in this article, except those of the Vermont asylum, which include in
the recent class, only such as have been insane six months and under, and
in the chronic class, those who  have been disordered more than six months.
  These terms, "recent," and "old," refer only to duration, and in-
clude all, within their respective limits of time, whatever may have been
the cause of  the malady.  The numbers used here and hereafter to de-
signate the probability of cure, refer only to the average of cases, arising
from all sorts of causes.  But under this average, there must be a great 
16             New Orleans Insane Hospital.
a great probability, that he will be so much improved that the
maniac will cease to rage,  the excitable will be quiet, and the
distrest be comforted, so that they may live in their own fami-
lies, and  be tolerable in society.
  We may  confidently expect, that  this restoration or im-
provement  will be  accomplished by  such gentle means  as
would not shock the feelings of the  tenderest relative.
  Let us now see, in the first place, how far the several  insane
asylums of  our country are  accessible to the people  of the
West; and in the second  place, how well they can fulfil our
expectations of cure, amelioration,  and  gentle treatment  of
our patients.*
  The Insane Asylum at New Orleans is simply a building  in
the yard  of that noble institution, the Charity  Hospital,  of
which it is a branch.  It is  built well, strong, and perhaps con-
venient;  certainly  it will  answer  the purpose of security.
But there is such a  small extent of grounds, so little room for
exercise, so little preparation for labor, amusement, or other
occupation, that surely they have not the  usual,  and what is
elsewhere supposed, the necessary facilities for curing the in-

difference of probability, owing to difference of causes.  Thus insanity
produced by ill health is much more curable than that caused by  mastur-
bation.
  Dr. Woodward, in his seventh report, gives the result of his observa-
tion of a thousand cases, and shows that of the whole number of cases,
recent and  old—
    Arising from ill health.    -    -    -    63 § per cent
    Religious causes  -----  58    ««
    Domestic afflictions -    -   -    -    56 ^   "
    Intemperance      -    -    -    -     -  49 f   "
    Masturbation.....23 \  "   recovered.
  It would be interesting  to know, whether the same relation of cura-
bility holds between these classes, in their  recent and chronic states :
whether the chance or probability of recovery diminishes with the age of
the  disorder, when produced by any one of these causes, more rapidly
than when produced by any other.
  * An account of these asylums was given, for another  purpose, in an
article on Insanity and Insane Asylums, to which the reader is  referred
for a fuller notice of some of them, than is here given. 
            Tennessee and Kentucky Asylums.           17

sane ; and we ought not to expect so much from them as from
others.  This  asylum, however, has as yet  hardly gone into
operation, and we leave it to develope its powers, and to man-
ifest its results ; by these shall it be judged hereafter.  But,
whatever  may be its  success, it is situated at the extreme
South, and  in New Orleans ; and  therefore, as our  lunatic
patients must  stay in a hospital for months or years, until
they recover, this  institution  is only suited to the people of
that latitude, who are  accustomed to the diseases of that cli-
mate, and to the peculiar epidemics of that city.
   The Tennesee Lunatic Asylum is richly endowed  by  the
state, and can  accommodate about a hundred patients. Fur-
ther than this  we are not informed.  We know nothing of its
means and facilities for the management and cure of insanity,
yet we believe the liberal grant from the  government affords
it means of great usefulness  ;  and we trust, that the  reports
will show a success corresponding to our expectations. It is
intended to  receive both  the insane poor and pay patients.
   The Kentucky Lunatic Asylum was established before  the
late discoveries had shown,  how far this disease was control-
lable by attention, skill, and most faithful and tender  watch-
fulness, in  conjunction  with  variety of  occupation.   The
original plan did not include a physician exclusively devoted
to the institution, nor workshops, nor riding nor reading,  nor
a great variety of attendants.  Nor was labor at first designed
as one of the great means of improvement.   A chaplain  and
religious worship was  not then considered necessary for such
an institution.    A physician is  engaged to visit the Asylum
once a day; but his pay for this is so small,  that he  cannot
neglect his general practice,  to spend much time among  the
lunatics.    A  few attendants  are employed, rather to guard
and wait upon  the patients,  than to be their companions to
guide their thoughts or control their feelings.  Since the estab-
lishment of this asylum, the  State has not altered the original
plan, nor provided officers, and attendants, and means,  accord-
ing to the  spirit of this improved age.  But an effort  is now
making in the  legislature  to obtain such farther  grants  and
                           9* 
18
Kentucky Lunatic Asylum.
privileges from the State, as will  place this institution on  as
good  a foundation as the best in the  United States.   When
this shall be done, and a permanent resident physician, a chap-
lain, and a suitable corps of attendants shall  be  provided—
when  sufficient  shops,  lands,  and all other means of labor
abroad, and all facilities  for occupation in  the house, shall  be
obtained,  then, we  doubt not,  this will take rank among the
first institutions of  the country,  and be as desirable an abode
for the lunatics of this and other western states, as any other
asylum is for the insane  of its  region.
   By the reports of  1839 and 1840, we  find, that, counting
the patients received in these  two years, twenty-eight per
cent of the recent cases, and thirteen per cent of the old cases
were cured—counting the number discharged—forty-one per
cent of the new cases, and  thirteen per cent  of the old cases
were cured.
   By the  report for 1841,* we find that the success was greater
* Statement of the stale of the Asylum for 1841.
	Old	cases.		Idiots Epitept		md ics	Recent cases.			Total.
	p	re CD*	o P	P	3	o p	ST	CD 3 cd" VI	o p	
Remaining Jan. 1,1841 Admitted since	49 26	53 12	102 38	16 6	19 4	35 10	2 18	3 6	1 24	142 72
	75	65	140	22	23	45	20	9	29	214
Of whom have died Discharged well Improved	11 5 4	5 5 1	16 10 5	6	3	9	2 11 2	1 6	3 17 2	28 27 7
Remaining Jan. 1, 1842	55	54	109	16	20	36	5	2	7	152
  If the foregoing successlul results of the operation are presented
with the present resources, what happy effects  could  we anticipate,
would the Legislature authorize the Managers to improve  and enlarge
the  means for moral and physical treatment!  We want every variety of
occupation  to divert the mind from its curious and various illusions. 
Kentucky Lunatic Asylum.                19
during that year;  for, counting the discharges, there were, of
the old cases,  twenty-five  per cent cured,  and twelve and  a
half per  cent improved.  And  of the recent cases, there were
seventy-seven per cent cured,  and nine per cent  improved.
Counting the admissions,  there were of the old cases  twenty
per cent cured and ten per cent improved;  and of  the recent
cases there were sixty  per  cent cured and eight per  cent
improved.
   Inconsequence  of the laws of Kentucky allowing the quiet
and the  peaceable to be maintained at their own homes out of
the public  treasury,  and  of considerable  general  prejudice
against hospital establishments, few,  but the worst cases either
of   the  pauper  or  the wealthier classes, are  sent  to  the
asylum.*   These can have,  not  only  much less chance for
Besides agriculture and horticulture, various mechanic operations should
be employed.  Christian worship, libraries, music, dancing, walking
and riding, with complete bathing establishments,  are  unconditionally
required for  thorough success.  Ornamental as well as useful improve-
ment of the grounds and gardens, are considerations not to be forgotten,
as important to render complete such an establishment, for the sick mind.
  With comparative little expense, Kentucky can have a retreat for her
insane, both  a pride to the State and a blessing to a class of human
beings whose condition should enlist the noblest of our feelings."—Dr.
Bush's letter to the Commissioners of the Lunatic Asylum, Jan. 1st, 1842.
  *To corroborate our assertion in our former article on Insaae Asylums,
page 34, that "the most obstinate and incurable cases are selected  out
of all in the State to be sent to  this hospital," we here  add from  Dr.
Bush's letter:
   "This asylum  receives a very large proportion of congenital idiots,
and hopeless cases of epileptics:  all of which class of patients must die
sooner or later,  no rational hope existing to improve or even prolong a
miserable  existence.   Such patients constitute, every year, by far the
greater  proportion of  deaths reported.   A patient,   when received
by  the  commissioners, is  never discharged unless he or she be cured.
So that  many State patients, comprising  idiots, epileptics,  old cases of
all the various forms of insanity, considered the scientific world over as
incurable,  must accumulate  from year to year, and thus constitute a
great proportion  of the  standing residents in the house, while in the
very nature  of things the annual lists of mortality have, in this  fact,
under the most favorable circumstances, an unavoidable increase." 
20
Ohio Lunatic Asylum.
recovery from insanity,  but also a  much greater  chance of
death, in consequence of their broken constitutions, and their
liability to other diseases.
   Nevertheless, with all those difficulties,  the Kentucky asy-
lum offers, even to these unpromising classes, sixty hundredths
of a certainty of cure to a recent case, and twenty hundredths
of a certainty of cure to an  old case.
   This asylum was primarily intended for the insane poor
alone; but, for some years, it has received other patients from
this and other States at the  cost of $2,50 per week.
   The Ohio Lunatic Asylum is exclusively a State institution,
and admits—1st, the poor and the violently troublesome;  2d,
others belonging to Ohio at  the cost of $3 per week.  This is
an establishment of the  first class for usefulness  and benevo-
lence.  It is liberally provided with all means for the amuse-
ment and  occupation  of the patients—with a farm and gar-
den—with shops, and  horses, and vehicles—with books and
papers, games and musical  instruments.   And  the adminis-
tration corresponds to the  physical means.   Dr. Awl,  the
superintendant, is a man singularly  adapted by his skill and
moral character, to direct such  an establishment.   His heart
and his hands are in the cause  of suffering  humanity.   The
doors of his institution  are thrown open to the  poor and  the
distressed,  and his work is carried on as a great  moral enter-
prise, upon the pririciples  of Christian charit}', and  according
to the active and liberal spirit of this enlightened age.*   His
assistant physician, chaplain, ond other co-operators, are men
and women of discretion  and tenderness, and perform their
duty of managing and encouraging the lunatics,  with  the
kindest faithfulness.  Their patients are treated as unfortunate
friends—suffering, but  not  guilty—to be governed, but  not
punished.
  All these means are brought to bear, with admirable effect,
upon  the  disordered  understanding  and  perverted feelings.
The various sorts of labor abroad and in  the house—the reli-
* Reports. 
Ohio Lunatic Asylum.
21
gious services—the  reading—the parties  for  conversation,
music and  dancing,  occupy them,  so that they forget their
illusions.  The frantic have no time  to rage, and their sanity
creeps upon them.  By  these means, they have cured eighty-
five  per cent of the  recent  cases, and forty-one per cent of
the old cases discharged; and therefore we may look for eighty-
five  hundredths of a certainty of cure of an average  recent
case, and forty-one  hundredths of a certainty of a cure of a
chronic case.
   This institution accommodates each  patient with a room,
but is only open to the  residents of Ohio.  There are in that
State thirteen hundred  and sixty lunatics and idiots, of which
four  hundred and  sixty-six are at public charge.   If we deduct
from this total number all  the congenital idiots,  the imbecile,
the paralytic and  epileptic, and those in the last stages of senile
insanity, we  shall  find, without doubt, at least five hundred
lunatics, who may be considered as fair subjects  for the reme-
dial  measures of  the asylum, and of whose restoration much
hope may be entertained.  The public guardians and the pri-
vate friends of these unfortunates should not delay to send
them at once to Columbus, and give them the earliest and best
opportunity for recovery.   That institution, in  its  charitable
provisions, offers  every  inducement for the poor  to come; and
in its elegant arrangements and facilities, it invites  those who
are more accustomed to the comforts and refinements of life.
And if the people of Ohio regard their true interest, and the
good of their alienated  citizens, they will send every hopeful
lunatic at once to their asylum; and in that case it will not
hold them.  Its present accommodations will not admit more
than a quarter of those  who need its  soothing  and  healing
care. But the liberality  of the State that began so  noble a work,
will enlarge it,  so that it may fully answer its great purpose.
   These are all the institutions of the west,  and they cannot
contain a fifth of the lunatics  of the west who ought to be  in
them.  All the other hospitals are beyond the mountains, and
patients have often been carried from this  valley to be healed  in
those eastern asylums.  To which then of these shall we send
our insane? 
22     Pennsylvaniaand Frankford Lunatic Asylums.

  The nearest insane asylum which is open to us, is the Penn-
sylvania Hospital near Philadelphia.  This is an entirely new
institution, though a branch of the old hospital* of that city,
from which it received the insane patients in  1841.
  "This new asylum is  under the superintendence of Dr.
Thomas Kirkbride.  It is indeed a splendid establishment: no
expense that would contribute  to the suitable  accommodation
of the patients, having been spared, in its erection.   It has
a large farm connected with it, of which forty-two acres are
surrounded by a high stone wall.  Under the  care of its intel-
ligent superintendant, this will undoubtedly be one of the best
institutions in  the country."f  This will be  managed on> the
right principles  of kindness, watchfulness, and  occupation.
With all its  facilities for governing and  curing its  inmates,
with  the  high moral and scientific character of its head, and
the discipline and discretion of its other officers and attendants,
this institution makes high  promise of good to its patients, and
holds out  great inducements  for the lunatics  of  this and the
other western States.  Another year will tell, how well it can
fulfil  the great hope we have of it.
   The cost for board and attendance is five dollars per week.
Bond is required for the payment.
   The Friends' Asylum at Frankford  is six miles north of
Philadelphia.  Its farm, gardens,  shops,  houses, carriages,
library, museum, games,  billiard tables, chess and gammon,
serve admirably their purpose of occupying the attentions and
amusing  the feelings of the  insane.   Religious services  are
also valuable auxiliaries to their other means of cure.   The
 buildings  are ample;  they  accommodate   about seventy
 patients,  and these are classified according  to their  sex, and
 to the kind and stage of the disease.   This  asylum is  under
  •The Pennsylvania Hospital is the oldest in the United States.  It was
established in 1752, and received lunatics as well  as other patients.
From 1752 to 1840, thirty-four per cent of lunatics  were cured, inclu-
ding cases of mania a potu previous to 1823.
  f Earle. 
Frankford Asylum for the Insane.           23
 the immediate control of Dr. Pliny Earle, who has been long
 devoted to the interests of insanity and successful in treating
 it.   The  whole administration is  of the mildest  and most
 approved method of modern times.   The officers and attend-
 ants  are men and women of amiable  tempers and  bland
 deportment.  No  severity nor harshness are ever admitted
 there.  Kind words, tender sympathies, and the sweet power
 of love, are  their  means for  controlling the patients.    No
 means are used but such as would be allowable, and even desi-
 rable, in private practice,  in the midst of the most anxious
 relatives of the insane.
  The reports state that, in twenty-four years, forty-two per
 cent of all the cases have been cured.   But  this asylum has
 improved with the age, and the later years have shown better
 success than this general average.   In 1840, of eight who had
 been insane less thau three months, seven recovered, and one
 died.  Of fourteen, who had been insane previously and recov-
 ered, and whose  last attack was of less thrn three months
 standing; nine were cured, and five improved.  Of twenty-one
 insane  from three  to  twelve   months, ten  recovered, eight
 improved,  one remained stationary, and  two died.  Of  ten
 insane from one to  two years,  four were restored to health,
 three were  improved,  two  unimproved, and  one died.  Of
 fifty-five* insane more than two years, three recovered,  eight
 improved, four died, and forty  were stationary.!
  Taking these facts for data,  for our hope of benefit in that
institution, if our patient belong to the first class, he will have
seven-eighths of a  certainty of cure—if to  the second  class,
(i. e. if insane less  than three months,  though not the first
attack of the disease,)  he  may have sixty-four chances in a
hundred for recovery; and if to the  third class, his chance for
recovery will be forty-seven in a hundred;  if to the fourth
class he may  have  forty-hundredths; and  in the fifth class five
hundredths of a certainty of restoration at Frankford.
 » Only seven of these had been insane less than five years, and eight
ess than ten years.
 t Earle.  Report for 1840. 
24
Bloomingdale Asylum.
  In order to be admitted to this asylum, bond must be given
by two persons—one of them at least to be resident of Phil-
adelphia  or its vicinity—to provide suitable clothing, to pay
for all damages done by the patient, and to pay at least four
dollars a  week for  board,  medicine,  and attendance; and to
take the patient away on his discharge, or  bury him at  his
death.
  The Bloomingdale  Asylum  is on Manhattan  island,  six
miles  north  from  New York city, under the charge of Dr
William Wilson.  It receives one hundred and forty patients.
During the twenty years of its operation, it has cured seven-
ty-seven  per cent, of its recent cases, and eleven per cent, of
its old ones.  In  1840, seventy-four per cent, of recent, and
and thirty percent,  of old cases recovered, and nearly six per
cent, died.*
  Such  success  as  this  is evidence  of  good management.
" The first endeavor  is to classify the patients, and assign them
to their proper attendants, who are each responsible for  the
personal cleanliness  of their particular charge.  Twenty at-
tendants  look after one  hundred  and thirty-five lunatics.
These are expected  to interest their patients, in their differ-
ent amusements, accompany them in their walking about the
grounds or in the neighborhood, take charge of them, when
they ride out, and  provide against escape or accident.   All
the patients who are in good health breakfast at seven, dine
at one, and sup at six o'clock.  In the interval between meals,
they are generally  employed in  reading,  walking, riding, or
other amusement or occupation,  and at proper seasons attend
public worship."*
  The directors "find that mild treatment, recreation, read-
ing, and  employment upon diverting objects, with  amuse-
ments of various kinds, riding, walking, playing at games  or
on musical instruments, are much better calculated to remove
gloomy impressions from the mind, than any  course of harsh
treatment."*  We could  add to  these excellent means, labor,
* Report, 1840. 
Connecticut Retreat.
25
which has been most  advantageously employed in other asy-
lums.
  This  asylum is a branch  of the  New York City Hospital.
It has very  rich endowments, and receives ten thousand dol-
lars a year from the state.   Yet, on account of  the very ex-
 tensive and liberal accommodations and facilities for treating
 the patients, the cost  for  board, medicine, and attendance, is
 about $4 50 per week.
   The  Connecticut Refreat  for the Insane, is at Hartford, in
 that  most lovely valley of the Connecticut river.  It  is  now
 under the  care of Dr. Amariah Brigham, who has  been long
 devoted to the philosophy and maladies of the mind.   This
 asylum is furnished with all  the apparatus for employment and
 amusement of the deranged inmates, which benevolence and
 skill  have  suggested.  They have labor on land  and in  shops,
 riding in carriages, games of all sorts, books, newspaper  and
 pamphlet  literature,  parties,  music,  dancing,  and religious
 worship.   Every thing is done by  the watchful attention and
 faithful skill of the superintendent, and his fitting coadjutors,
 to relieve the distress, and to occupy the minds of the patients,
 to withdraw them from their illusions and to soothe the agony
 of their spirits.*
    Beside   Dr. Brigham,  there are  an assistant  physician, a
 chaplain,  thirteen attendants to take charge of seventy-nine
 patients, and four others,  who have  each  the charge of one
  * Report of Trustees.
  The benevolent secretary of the  Prison Discipline Society visited
this hospital, and says :  "We saw the apartments of the men ;  saw and
saluted many of them as we passed through the halls, they appeared
cheerful and courteous, and were glad to see us.  The patients were in
frood condition, with respect to their persons and dress ; the attendants
l>olite, intelligent, and kind ; the furniture, beds and bedding, all clean
und sweet.  The order of the establishment, thus far, was strongly in
favor of improvement and progress toward a high standard.  The super-
intendent showed  much taste and skill, as well  as urbanity, kindness,
and controlling influence over mind, as we proceeded."—  V >c;i Disci-
pline Society Report, 1841. 
26
Vermont Asylum.
 lunatic,  that may  need particular attention, and  ten  other
 assistants to do the household work.
   The whole management of this hospital is of the best kind:
 gentle, firm, watchful and  affectionate ;  and it has  been the
 most successful in the country: twenty-four per cent, of the
 old  cases, and  eighty-four per cent, of the recent cases  have
 recovered, and six per cent, have died there.   Supposing the
 present officers will do as well, (and we  doubt not  they will
 do better,)  we  may expect eighty-four hundredths of a cer-
 tainty of cure  for any average recent case, and twenty-four
 hundredths of a certainty of cure for old cases, that may be
 sent them.   The whole cost of maintenance there is $4 per
 week.
  The Vermont Asylum for the Insane, is also in that beauti-
ful  valley of the Connecticut, in Brattleboro, eighty miles
north of Hartford.  It  is  there  surrounded by the richest
scenery, composed of the grandeur of the mountains, and the
loveliness of the highest cultivation and beauty of the mead-
ows.  Here  nature alone  might  almost  calm  the  maniac's
frenzy, and cheer the drooping heart of the despondent.
  This institution has ample accommodations for a  hundred
lunatics, and  had ninety-five at  the date of  the last report,
October,  1841.  Each  patient has  a separate  room in the
night, and walks and mingles in halls common to the  individ-
uals  of his class  in  the day.  They are occupied with agri-
cultural and  mechanical labor—with public worship and read-
ing—with riding, walking and games : and  though  watched
with the  most assiduous attention, they are never restrained
by physical violence, nor overawed  by harsh or threatening
power.  But it  is made the duty of  each officer and  assistant
to endeavor  to secure the confidence and good will of the pa-
tients.  For this purpose they treat them with the greatest
kindness  and forbearance.1.
  The zeal and discreet energy of the most faithful superin-
tendent,  Dr. William H. Rockwell,  aided  by a worthy body
* Report, 1841. 
McLean Asylum.
27
of associates, have  been singularly successful in curing and
 improving  the  subjects of their charge.  They have  cured
 eighty-nine per cent, of all recent* cases that have been dis-
 charged, and twenty-eight per cent, of the old cases.   If we
 suppose, that those remaining at. the asylum under treatment
 to be as curable as those -discharged, then we may look for a
 probability of cure, amounting  to eighty-nine hundredths of
 a certainty for recent cases, and twenty-eight hundredths of
 a certainty for old cases.   Cost  $2 50 per week.
   The McLean Asylum for the Insane, at Charlestown, Mass.,
 under the charge of Dr. Luther V. Bell, is one of the best en-
 dowed and best managed in the country.  It has been  many
 years  in operation, and has been enabled to adopt every im-
provement, which its officers have discovered, or others have
 suggested.  The high-toned benevolence of its trustees, the
 active observation  of  its  physicians, have sought out all the
 means  for  the occupation  and cure of the  insane, that have
 been used in the 'hospitals of Europe or America.
  The magnificent and convenient architectural arrangements
of the buildings admit of the classification of the patients into
at least  a dozen different families, according to the develope-
ment and  condition  of the disorder,  these  have each  their
proper sitting, sleeping and dining apartments,  &e.f   The
abundant means for the occupation of the alienated—the farm
and  elegant garden, filled with  flowers and shrubs  of every
sort—the shops,  and means for riding  abroad—the library—
the games of chess, gammon, draughts and cards—the musical
instruments—the parties for sewing, dancing, &c.—the relig-
ious  services, and, above all, the ever present and faithful  com-
panionship of the superintendent, the officers and attendants,
all  have the happiest  influence over the vagaries  of  the de-
ranged  intellect, and  the  excitement or depression of the
morbid feelings.
  "The importance of securing the services of an elevated,
* Recent cases here include the insane six months and under.
i Report. 
28
McLean Asylum.
respectable, and cultivated class of persons for the responsible
duty of attending upon the insane, was early recognized in
this institution ; to obtain whcm no trouble or cost was to be
spared.   We have never been obliged to feel the want, which
most writers  upon insanity, and many institutions so feelingly
deplore, of a  proper kind of assistants.   There are, in the in-
terior of New England, a  class of young men and  women of
respectable families, adequate education, and  refined moral
feeling, who are willing to devote themselves for a few years
to this  calling, under the encouragement which  is offered
them, of  a fair pecaniary recompense;  and what is a still
higher inducement, that of knowing, that their services  are
deemed of a highly respectable character.  We  never employ
those in whom we would not place implicit confidence.''*
" The  attendant will  cheer the desponding, check the noisy
or the petulant, turn the thoughts of those occupied in insane
illusions,  into a new  channel; walk,  ride, and  engage in
amusements and employments with them."*  Thus, none but
persons of the sanest minds, the purest principles, and  the
most disciplined habits, the most amiable tempers and bland-
est ntanners,  are allowed there to come in contact with the in-
sane.  The most perfect sanity is brought to bear upon insan-
ity, even in the most casual associations.  None of the harsh
physical restraints, that  once were used in asylums, are there.
None of the stout and hardened warders to stand sentry;  no
reviling taunt, nor chilling authority, are there ;  but the mild-
est persuasion, the most  affectionate watchfulness, and  the
kindest companionship make that the home of the distracted;
they calm the frenzied, and cheer  the disconsolate.
   From its high  reputation, this institution has received very
many difficult and incurable cases;  and on account of its ex-
pensiveness,  the means  and patience of friends get exhausted,
and many patients are taken away, before a full trial is made
of the influence of the hospital over their disease ; and there-
fore more are discharged uncured, or merely improved, in  pro-
portion to the restored, than would be  otherwise.  Yet, even
* Bell's Report, 1840. 
McLean Asylum.
29
with this deduction  from the per centage of recoveries,  this
institution has been  remarkably successful.   Under the man-
agement of its  present able and excellent superintendent, in
the year 1838,  the asylum  cured every recent case that  was
discharged, except such as were taken away before full trial,
and those who died.*   In other years, they had not quite this
degree of success, and, like other asylums,  were obliged to
discharge some voluntarily,  whose cases  resisted all their
efforts at restoration.
   The late reports of this hospital do not discriminate between
the old and recent cases, and therefore we are unable to  give
precisely the results  of these  two classes,  as we  have done
concerning others.  Yet we find that fifty-nine per cent, of all
that were discharged during the last  four years, were cured ;
and of all  under care, less than five per cent, died in each
year.
   For  admission, application  must be made  to Dr. Bell,
Charlestown, or to either of the trustees in  Boston.   When
practicable, they require a description of the patient's disease,
its early manifestation and progress; an account of his habits,
age, social and domestic relations, and of the course pursued
with him  during  his  alienation.   They require  a certificate
from  a physician, that he is  insane; and a written  request
from  his nearest  friend or relative, that he  be admitted  into
the asylum, and lastly, an obligation, signed by two respon-
sible persons, engaging  to pay for clothing, and other  things
necessary for the  health of the patient—for the board  and
wages  of a special attendant, if necessary, and for board and
medical attendance, $4 50 per week, and also to remove the
patient,  when discharged, or pay funeral charges, in case of
death.*
   There are  asylums  at Colombia,  South  Carolina, and at
Milledgeville,  Georgia, from which we have received  no re-
ports ;  we  only  know,  that their states have made liberal
grants  to them.   But whether  their benefits are  confined to
* Report, 1840.
      3* 
30              Dr. While's Asylum, at Hudson.
those states, or whether they are open to us, and therefore
available  to  the  southern  part  of the Mississippi valley, we
cannot tell.   We hope to  receive  their reports and to learn
that their  usefulness is commensurate with their means.*
  Beside  these public hospitals, there  are  some  private insti-
tutions worthy of our consideration.
  Doctors S. and  G. H. White have  one at Hudson, New
York, in which they treated eighty-four patients in 1840, and
discharged forty-eight.   Of these last, eighteen were  recent
cases,  and  twenty-seven chronic,   Of the  former,  fourteen
were cured,  two improved, and two died;  of  the latter, seven
were cured, fifteen improved, and three died—making seventy-
six  per cent, of cures of recent cases, and twenty-six per cent.
of old cases.t   This must be the ground of hope for our  pa-
tients, if  sent  there.  "Family worship  is  continued daily,
and with beneficial  effect on the patients.  We have  no infor-
mation  in regard to labor and amusements,"$ nor of their
other means of cure.
  Dr. Cutter has a private asylum at Pepperel, Massachusetts,
which is furnished with the usual means for labor and amuse-
ment, formed in good hospitals, and is conducted upon  the
best modern principles, and is one of  the best private hospi-
tals for the insane in the country.^
  In this  review of the American asylums, we see that,  twelve
are open to us of the West,|| and four  only of these are within
this valley.   The others are  far distant—the nearest,  that at
Philadelphia, is at  least, three hundred miles from the most
eastern point of our navigation at Pittsburgh.
  To which, then, of these shall we  send our insane?  We
  * The Georgia asylum was intended for one hundred and sixty patients,
and receives both the poor and the rich.
  t Earle.  t Il»'d-
  J Boston Med. and Surg. Journal.
  || The state asylums at Williamsburgh and Staunton, Va., at Worces-
ter, Mass , at Augusta, Maine, at Baltimore, and those at New York
and Boston, are all  exclusively for the states or cities to which they
respectively belong. 
                 General Mew of Asylums.               31

must judge them by their fruits.  We learn from the foregoing
facts,  that the Kentucky asylum offers less probability of cure
than other  better endowed and more improved institutions;
though we  believe the legislature will put it  in the power of
its administration to make this as useful  as any other.   As it
is now, if our patient's means permit a distant removal, and if
they do not live in Ohio, they will do well to cross the moun-
tatns.   Yet, if this  be impossible, the institution at Lexing-
ton is so much better than  all other modes of treating insan-
ity in Kentucky,  that we ought not to hesitate for a moment
to send our patients  to it.
  The Ohio  asylum is all that could be expected or desired,
except in extent; for it cannot contain a quarter of the insane
of that state,  and to all others it  is closed.  With  such a
means  of  cure within reach, it is a matter of astonishment,
that there are not five hundred enjoying its advantages.*
  All of the eight open  institutions east of the Alleghanies,
have  physicians devoted exclusively  to  their inmates.   All
are  managed on  the modern principles  of benevolence and
occupation.  All have religious worship, exercise, and amuse-
ment.   All except those  in New York employ labor;  and we
may feel assured, that in whichever of these we may place
our patients, though far from their natural friends, they will
find friendship, and  tender  attentions, and the faithful skill,
which the  present age has developed.  Yet, if among these
offering each  so great a promise of good, we were to make a
selection, we would prefer the McLean asylum, on account of
the  great and liberal and judicious preparations  for the cure
and the comfort of its residents.  And especially for such, as
have been accustomed to the refinements and luxuries of life,
are the whole material and administration of this  establish-
ment  suited.   But if  long  residence for a term of years be
wanted, or if economy be desired, the Brattleboro asylum is
most  favorable on account of the beauty of its location,  and
  * We are glad to see that there is an effort making, in the legislature
of Ohio, at this moment, to enlarge this asylum. 
32       We should know the character of Asylums.

its  cheapness.  The Hartford asylum has been exceedingly
successful and satisfactory.   As to the others, we leave their
statistics and their history to speak for them, and  these  ac-
counts are honorable to them and cheering to humanity.
   We have been  thus  minute  in  describing these  asylums,
because for want of a definite knowledge  of their merits, and
of a  conviction of the necessity of sending  our  patients to
some one of them, most of  our lunatics  have been suffered
to remain at  home, with only domestic remedies for cure—
the acute cases have become chronic—the curable have grown
hopeless—and now we  have a maniac and imbecile  army
of four  thousand four  hundred and fifty in the valley of  the
Mississippi.
   No class of disorders so certainly yield to proper remedial
measures, as  insanity.   And, on the other hand, none so cer-
tainly become incurable, if neglected.   The  recuperative
powers  of nature have less energy to heal  this than any other
disease ; therefore, more than all others, this should not be left
to heal itself.   We should be as well prepared to treat, or to
furnish  means  of  treating our lunatic patients, as we shoukt
our fever patients.  It would indeed  be singular folly, for.a
physician to wait until  he is called to a case of dysentery or
bronchitis, before  he determines upon the general  principles
of treatment;  and  having seen his cases,  then get his books,
for the  first time, to learn the pathology of his diseases and
the action of his  remedies,  and while he is  reading his les-
sons, permit his acute cases  to rush on to death, or to fast en-
trench themselves in the chronic state!  If this be unfaithful
preparation for the responsibilities, which  we assume,  as  the
advisers of the weak and the disordered, what shall we say to
ourselves, if we are unprepared to advise our friends what
course to pursue with a lunatic, and how they may save him.
before all hope shall be extinguished?
   Suppose a  son  of a family,  that  put  their trust in us for
counsel in sickness, should be taken delirious.   He  becomes
irritable, violent, uncontrollable.   He is suspicious of his best
friends, and abusive of those, whom  he before  loved  most. 
          We should send lunatics to Asylums early.        33

His distressed parents, who had doated on him, and had rested
every hope in him, know not what to do.   In this agony, they
send for us.  We have been their medical guides, in all other
derangements,  and they rely  upon us now, in their present
grief, to tell them what to do.   Shall we  tell  them, that we
ourselves do not know what to do?—that insanity is  mostly
incurable?—that we can  only bleed to  bring down  excite-
ment, or give opium to quiet the nervous agitation?  Shall we
advise the restraint of chains to secure the family from being
injured by him?   Or  confinement to prevent  his running
away?   Or shall we not rather have our minds as well fortified
for this emergency of mental  disorder, as  for the chance of
meeting an attack of cholic or a fractured  limb?
   Having made our selection of an asylum  as the  means
and interests of our patients dictate, we should not hesitate
to send them to it, as early as possible  after  the attack of
theii  disorder.   We must  not be deceived by any fallacious
mildness of the early manifestations of the lunacy; nor think
that because  the symptoms do not grow violent, it is  safe to
wait,  for the  disease may be fast fixing itself within, and be-
coming daily more difficult to be removed.   The derangement,
which at first is only one of function, gradually grows to be
one of structure.  A few days' or weeks' delay may carry the
disorder beyond the point  of  curability.   Where that point
may be, cannot be determined beforehand; but it certainly is
the safest to begin the remedial measures as early as possible.
Dr. Woodward estimates, that the chance for recovery, if taken
within the first three months after the attack,  is  double  of that
in cases which do not begin treatment until the ninth month.
Dr. W.'s tables show, that of cases of one year or less dura-
tion,  eighty-five per cent;  of  cases of from one to two years
standing, fifty-seven per cent; of those of from two to five years
continuance,  thirty-four per  cent; and of such as had been ex-
isting from five to  ten years,  eleven  per  cent  were curable.
Dr. Tuke gives seventy-nine  per  cent of cures of cases less
than three months—forty-four  per cent of  those from three to
twelve months, and twenty-five per cent of those of more than 
34             The insane must not be deceived.
one year's standing; as curable.  The reports of every hospital
give a similar discrepancy between the curability of the recent,
and that of  the old cases, and manifestly prove, that we have
every thing  to gain for our patients, by early attention  to their
cure, and every thing to lose by delay.*
  Having settled the question of removal, this should be done
in all openness and  sincerity.   Deception  should never be
allowed  toward the insane, for any purpose  whatever.   Dr.
Allen says,  "I consider it a point of the first  importance, that
truth should never be  violated.   If we begin by  destroying
confidence,  we  destroy  the basis  on which alone all moral
good can be effected.   It is quite a mistake to suppose, a
system of deceit is necessary for the more quietly accomplish-
ing their removal  from home."t  "I  delicately and candidly
tell them, that they are censidered to  be insane,  that  the dis-
ease has produced some ehange in their usual mode of think-
ing and  feeling;  that the  object of the proposed  visit is for
their good."J  "In this  respect we should  deal with them as
we would with any  reasonable person:  we should tell them,
that as they are deranged, another course is necessary, and it
is for their benefit that we propose to  remove them; and  very
few will object.  But  if they do object to the removal, we can
inform  them,  that their going is a matter quite settled, and
cannot possibly be altered.''||   And even then they will  sub-
mit with much better  grace,  than if  we  deceive  them, and
  * Such lunatics as do not show positive signs of incurability, and
whose disorder offers any chance of cure, should be submitted to treat-
ment  at tne earliest possible  moment.  We cannot commence  too
promptly the use of appropriate means.  There is no doubt that insanity
could  be cured with much more ease, and much more frequently, if our
remedial measures could be applied, at the very onset of the disease.—
Georget, Diet, de Medicine.  Art. Folie.
  "The probability of recovery decreases in proportion to the length of
time which may have elapsed between the period of attack and that of
the removal."—Hill, on Insane  Asylums, p. 9.
  fOn Classification, p. 29.     {Ibid,    yibid. 
                The insane must not be deceived.           35

 pretend we are going to another place, while we are, in reality,
 going to an asylum.
   The directors of these hospitals complain very much of this
 deception, which is frequently practised to induce patients to
 go to them.  Vexed and disappointed to find themselves in a
 place of confinement,  which they did not expect, they are
 excited,  and resist the first efforts at  cure; or they are down-
 cast and sulky,  and refuse to engage in the usual avocations
 for relief.  But in the best asylums this deception is removed
 at once.    Dr. Bell, of the McLean Asylum, says,  "Our first
 care is to have the accompanying friends communicate to  the
 individual, in  our presence, if this  has not been previously
 done, as  it should be, where he is, that he is brought here as
 a deranged person, that his stay will depend upon the judg-
 ment of the physician as to his recovery;  and  he is made  to
 understand, that the extent of his privileges will necessarily
 be dependent on his ability to comply with the rules, and  to
 control himself."   "However well he may appear, or however
 incoherent, this communication  is  substantially  made to him,
 and  no  false representations are permitted to be made from
 this time  henceforward in our intercourse with him.''*  Such
is  the practice of Dr. Woodward, and indeed of every faithful
superintendent of any insane asylum.t   Deception not only
increases  the difficulty of getting our patient to accompany us
to his destination, but lessens the  influence of the institution
over him.J
  * Report, 1839.
  t "No attendant or other person shall attempt to deceive or terrify any
 patient, or violate any promise made."—Rules of the Lincoln Asylum.
  \ It is a great error to suppose, that  a lunatic  cannot see facts and
 truth for himself, or that he can be cheated by false representations.  In
 our pupillage, we saw a most affectionate mother  offer a lunatic son  a
 cup of valerian  tea, saying, "Here's some good tea, my son."  "Is it
 goodl" said the  maniac.   "Yes." "But it is bitter." "No, my son, it is
 sweet."   "Wont it hurt me?"   "No, it will do you good."   "Then,
 mother, if it is good, and sweet, and will do no hurt, let me see you
drink half, and I will drink the rest."  "No, my son, it is good for you, 
36         Want of another Asylum in the West.

  From this examination  we  are  led to the  melancholy con-
fession of the  want of due provision for the comfort and the
cure of the insane sufferers of the western country.   In this
broad and rich valley, from the lakes to the gulf of Mexico—
from the  Alleghanies to the  Rocky Mountains,  embracing a
sane population of more than  five  millions, and lunatic pop-
ulation of more than four thousand, with  no  deficiency of
wealth, skill, or benevolence, we have but four asylums for the
insane.   And  these  could not  contain a tithe  of all, who
might be subjected to their influence, and not a fourth of those
who could  be benefited by them.
  Even these hospitals,  however excellent some of them may
be, are intended primarily for  the poor,  and are therefore pre-
pared and conducted, in a style necessarily more economical,
than the  richer classes would willingly pay for, or could enjoy,
with advantage.   And our pauper lunatics are sufficiently nu-
merous to exclude all others.   To accommodate this unfor-
tunate class,  we  ought tc  have  public  asylums in Indiana,
Illinois,  Missouri, Arkansas  and Mississippi.   And beside
these we want then another asylum  in the  west, one of
more elegant  accommodations than  ought  to  be expected
in  any  State  institution.    The rich  and  the luxurious,
the  refined and  the  cultivated,  are as  liable  to  be bereft
of  their  reason as  their less fortunate brethren.   There
is a manifest propriety in  providing for them  in their sickness,
buildings and comforts somewhat corresponding to what they
enjoy in health.   And we  have no doubt, that an asylum  of
elegance and convenience, similar to the private institutions in
the eastern States, if  established near the great navigable thor-
oughfare of the western  country, would soon  be filled with
patients, and  do an immense service  to society, and save
 many valuable citizens from irretrievable loss.
but not for me."  "Then,  if it is not good for you it is rot good for
me.  You cannot cheat me to believe your nauseous medicine is nothing
but good tea.  I'll nr t touch a drop of it;" and the honest keen maniac
spurned it from him.  What a commentary upon the attempt to govern
insanity by falsehood! 
               Location of an Insane Asylum.            37

  We want a hospital, in the west, to  be planned and  con-
structed,  furnished and  administered,  according to the  best
ideas of the present age.  From its very inception to its  final
operation, nothing should be overlooked or spared, that could
directly or indirectly bear upon the comfort or the cure of the
insane.   Such an asylum should be situated near to the great
thoroughfare of the West, near to the  Ohio or the Mississippi
river, for  the convenient access of patients.   "The situation
chosen  should  be healthy.  It  should possess the advantage
of a dry  cultivated soil, and  an  ample  supply of water; it
should be so far in  the country as to have an unpolluted atmos-
phere,   a  retired and  peaceful neighborhood, and yet be so
near a town, as to  enjoy all the comforts  and privileges, and
intercourse, which  can only be obtained  in  large communi-
ties.''*  Their daily wants can be better supplied,  and the
objects  of interest can be much more  easily and readily varied
in the vicinity of a good market-town, than in the midst of a
sparse population.
  The location should not be a dead flat surface, nor in the
midst of tame  scenery.   But "if  the buildings be placed on
the summit or the slope  of  a rising  ground,  the advantages
are incalculable."t   "To some the beauty of wood and water,
hill and dale, convey grateful impressions."   "To all a suc-
cession  of new, and varied, and healthy impressions must be
imparted, "$    There should be a  large farm  connected with
the establishment, both for cultivation, walks,  and other
means of  exercise,  and also for the convenient distribution of
the buildings.  That acute observer of the means and arrange-
ments of various institutions for the treatment of insanity, and
their effects upon this disease—Louis Dwight—the  Secretary
of the Prison Discipline  Society,  says, there ought to be an
acre of ground to a  patient. ||  Even twice  this  quantity would
not  be  too  much.   For such an asylum as  we propose,
which would accommodate  one hundred and fifty patients,
* Browne, p. 181.     f Ibid.    tIbid-  IIReport, 1841, p. 16.
                           4 
38
Plan of an Asylum.
three hundred acres would be useful for the purposes of agri-
cultural labor, and other exercises, and for the location of the
houses, shops, &c, necessary for the establishment.
  The  architectural arrangement, and distribution of the build-
ings is  of consequence both for the classification and for the fa-
cility of management of the patients. The usual, approved plan
of the  American asylums includes large centre buildings, and
wings running from this to the right and left, and backward,
proportioned to the wants of the institution.   All the offices,
dormitories, and other apartments, are under one roof.   The
asylum at Columbus,  Ohio, one of the  latest and best, is
built upon this plan, and is copied from that excellent institu-
tion at Worcester, Mass.*
  Esquirol prefers separate and low buildings.   He says, that
after having devoted ten years to reflection upon this subject;
having personally examined  all  the French asylums, and the
plans   of many in other countries, and  watched the effect of
the one under his care, and the Saltpetriere, he has come to
the conclusion that  a lunatic  asylum should  not be in a  city.
But it  should be on extensive grounds  with an  eastern expo-
sure.   The land should not  be  wet, yet well supplied  with
water.   He prefers  that there should be a centre building of
one story, for the  officers and  their families.    This should
include the medical and receiving rooms, and apartments for
sitting, eating, sleeping, &c.   On the  one side  of this centre
building,  and running backward from  it in a  perpendicular
direction, should be placed the houses for the  patients.  These
should be separate  structures, and  sufficiently  numerous  for
the classification  of the  patients according  to the  various
kinds and periods of their malady.   The maniacs which are
furious, and those which are  not mischievous; the melanchol-
ies who are noisy, and the quiet; the fatuitous, and the filthy;
the epileptics, and those with other diseases, and the convales-
cent—these several classes should  each have distinct  habita-
tions,  entirely separated from each other.   These dwellings
*For a full description of this, see former article on this subject. 
Dr. Allen's Asylum.
39
should be of various  styles of architecture, for monotony is
wearisome to the lunatic as well as to the sane, and variety in
this  matter is one  means  of occupying the  attention of the
insane.   They  should be of only one story,*  for the greater
convenience of watching and serving the patients, and to pre-
vent the danger of accidents  incident to  upper rooms and
stairways,  and  for the readier access  of  the  inmates to the
yard.   These  houses should  be  built  each with an interior
quadrangular court, and include the sleeping-rooms,  and the
common parlors,  eating-rooms, halls,  offices, baths, for  their
respective classes  of  occupants.  These houses will of course
be built of material and in manner suited to  the patients, that
will occupy them.   The violent will need strong rooms; the
filthy will require  paved floors; the suicidal will  require padded
walls, and the convalescent will enjoy light  and genteel par-
lors as men in  health.!
  Browne says, "Modern establishments,  instead of  present-
ing an interminable succession of wards and corridors under
one roof, generally consist of a number of  separate houses, in
which the patients are distributed according to their disposi-
tions and the features and stage of their  disease."J
  Dr. Allen, the proprietor and manager of  a private asylum
at High Beach,  Norfolkshire, England, says—"I would  have
not only two establishments, but these  sufficiently separated
so as to prevent annoyance; and not only this separation, but
I would have one  to consist of a male and female part, suffi-
ciently separated from each other.   This arrangement I have,
at my own establishments, which consist of Fair-Mead House,
and Leopard's  Hill  Lodge,  for males, and  Springfield for
females, with appendages and  separate cottages.   With two
establishments, we  can  adopt a better and  more complete
method of classification."||   And in all cases  the habitations
  *The French asylums are now principally built of one story."—
Browne, p. 187.
  fEsquirol, Des Maladies Mentales, Tom. II, p. 421.
  {Browne, p. 185.
  ||On Classification, p. 3. 
40             Other materials of an Asylum.
for "the noisy should be placed at a distance from  the quiet
patients, so as not to disturb them by their noise." *t
   A plan of a  very  convenient asylum was devised by Dr.
Lee and published in the Prison Discipline  Society's reports
for 1837.  This consists of a centre building and many short
lateral wings—all parallel with the front,  but each retreating
so far as to allow its central passage-way to open at each end
into the open air.
   To build such an asylum,  with habitations, separated, iso-
lated,  and multiplied according to the kinds  and stages  of
insanity in one hundred and fifty lunatics, would require  at
least three hundred acres of land.   But this  is not  all.  "A
hospital building is but  one item necessary for  the  successful
management of the insane.   In every possible case they should
be employed.  Riding,  amusements, games, walks, and read-
ing, are all useful, and the means for them all  should be amply
provided.   But labor is the very best employment,  and the
only one that can be long continued without satiety.   Provide
fields,  gardens, and workshops for labor, and a chapel for reli-
gious worship on the Sabbath, and you will show to the insane
what you consider them capable  of doing and  enjoying; and
they, in return, will show, by their industry, sobriety, andself-
  * Browne, p. 185.
  f "Pinel earnestly insists upon the necessity of classifying the insane;
of separating those who would be  injurious to each other, and  putting
together such as would be mutually beneficial in their cure.  An asylum
for lunatics should  consist of several establishments, more or less sepa-
rated from each other.  There should be one fer each sex.  There should
be one for the excited,  one for the tranquil, one for the convalescent,
and one for those who have accidental diseases.  It is  well to have one
division for  the filthy,  one for the demented, one  fo.* the furious, and
noisy maniacs, and for  such as cannot be controlled, whom we may send
there for correction. More than all, it is important to separate the sexes,
the convalescents, those who have been  of bad morals or obscene in con-
versation, or licentious in their conduct.   Each division should have a
court planted with trees, and, as far as possible, a garden for the patients
to walk in."—Georget, Did. de Medicine,  Art. Folie.
i 
         Character of the Medical Superintendant.       41

control, that they properly appreciate your confidence, and are
grateful for your efforts to promote their happiness."*   What
these other  means of occupation, labor and amusement are,
we have described in our  account of the best hospitals,  in
this and the preceding article on this subject!   A chapel.
and means for religious exercises, are  now found to be among
the most important influences for the restoration of the reason.
In no condition does the human mind approach its highest per-
fection so nearly as when in the act of worship of the Father
of all Light and Truth.
  Having provided liberally and faithfully the material of the
asylum,  it next behoves us to inquire,—Who should admin-
ister these and manage the insane?   We have before spoken
of the  character  of  the  officers and attendants as they  art
found in the most successful  institutions in our country.  In
those, they are men and women of the healthiest minds, and of
the highest mental and moral discipline, and so numerous.
that one can  give his whole attention to four or five patients,
and if the case requires it, he may devote himself exclusively
to one; for the  grand secret, in the cure of insanity,  is the
power of sanity over it—the influence of the correct mind and
heart over the disordered.
  First, the asylum must have a physician for its superintcri-
dant, who shall give his entire and undivided attention and
companionship to the patients.  This is indispensable.  Browne
sayS—"The opinion was, and perhaps still is,  prevalent,  that
if a building of suitable  dimensions and security were provi-
ded,  and if medical advisers  occasionally saw the  inmates,
all was  done  for the  insane  that could be expected  or that
could be useful.    Every  day's experience shows, that  these
provisions are utterly inadequate to the end  proposed—if that
end  be  recoverv, and not the confinement of the insane."!
  •Woodward, Hospital Report, p. 170.
  f On Insane Asylums.  See also Reports of Ohio, Frankford, Bloom
ingdale, Hartford,Vermont, McLean, and Massachusetts hospitals.
  {Browne, on Insanity, p. 177.
                            4* 
42        Character of the Medical Superintendant.
But there must be a physician ever present, and he well qual-
ified for his station.   He must be a man of skill, self devotion
and  industry.   He  should  be firm  and courageous, yet of
placid temper, and  the gentlest manners.   He must, have  a
quick apprehension to discern the disposition and disorder ol
his patients, and tact to manage them.  He must be benevo-
lent towards man, and have a  strong  love for  the particular
branch of the  profession which he assumes.   "The  basis of
such a character must be  dispositions truly Christian,"  and
"there must exist a benevolent kindness, which shall be so deep
and expansive, as not merely to feel sympathy  for the lunatic
because he is an alien to his  kind, because he is visited with
the heaviest and hardest affliction, which humanity can  bear
and live, but feel an  interest  in  those unreal,  artificial,  and
self-created miseries, with which the distracted spirit is op-
pressed.    And this kindness will be as solicitous to  alleviate
suffering, where it is absurd, and the result of violence and
perversity  of  temper,  as where it  flows  from  misfortune.
There must be a benevolence which will be prepared to make
the lunatic a companion and a friend."*   The physician must
associate with him  on  terms  of reciprocal confidence,  and
mutual forbearance,  of fellow  feeling and rational  counsel.
He  must forget, that an awful but not an impassable gulf  of
obliterated requirements, numbed or lethargic  emotions,  and
darkened reason separates him from  the maniac, but regard
only  the faculties they yet have in common, and make these
the ground work of  their intercourse.   "There must be  that
benevolence which will imitate  the mercy of Him, who  in
curing the broken and bewildered spirit of the demonom aniac,
"took him by the hand and lifted him up."  But this gentle-
ness  must be controlled.  The merely  benevolent  physician
can never be a good practitioner."!   Such  a one may be too
indulgent, and while he is yielding to the tender impulses  of
his heart, and gratifying the temporary  and capricious wants
*Browne, p. 179.    flbid. 
Character of the Medical Superintendant.        43
of his patients, he may be indulging vicious propensities, and
encouraging and feeding those very  delusions that are the
cause of the derangement.  "There must be mingled with this
sentiment of benevolence that highly refined sense of duty,
and that keen perception of right, which guides  even kind-
ness and affection in their ministrations, and which  holds the
balance  as  scrupulously in deciding on  the  moral rights of
lunatics, as in determining the civil  rights of our fellow-citi.
zens."*  The curator of the insane must have "that moral and
physical courage  and firmness,  which confer calmness and
decision in the midst of  danger, and in dealing with the most
furious and unlistening madness, and which imbues the whole
character with a controlling influence, that, with mercy and
justice, governs the turbulent, while it appears to guide them;
and commands the most wild  and ferocious, by the sternness,
and, at the  same time, by the serenity of its orders, showing
neither timidity nor anger.  The intellectual qualifications for
such a trust are high and varied.   They must comprehend a
familiarity  with  the true and  practical philosophy of the
human mind, in order that its diseases may be understood and
controlled, and a  general  acquaintance with  the usages and
workings of society; with the  habits, pursuits, opinions and
prejudices of different classes; with literature  and science, so
far as they contribute to the instruction, amusement,  or hap-
piness of these classes; with every thing, in short, that can be
rendered influential in what may be called adult education, in
the management or modification of character, in order that
as great a number of moral  means  of cure,  of restraining,
persuading, and engaging the  darkened and disordered mind,
mav  be created as pessible.   And finally, there must be as
liberal a professional education as long study and observation
can accomplish;"!  so  as to readily understand the causes of
insanity, and  the influence of the physiological  state of the
animal system over its duration or intensity,  and the  power
♦Browne, p. 179.     fBrowne, pp. 178, 179. 
44
Character of Assistants.
of medicine,  and  of other moral  and  physical  agents over
either of these.   "Such a physician is not a mere drug exhib-
iter,"* but he is a man of high principle and benevolence—of
philosophy and  practical wisdom.  To such a man ought the
whole establishment  to be submitted  for  his care and faithful
administration.   This is the case with almost all  the Ameri-
can, English, Prussian, Austrian, and many French asylums,!
and is found  to be best for the management of the insane.}
  Lastly, comes the provision of suitable stewards, officers,
attendants, nurses, and servants.   What should be  the char-
acter and number of these, may be learned from the frequent
notices and descriptions of them, which we have given in this
and the former  article,§ when speaking of the most successful
assylums.  Suffice  it here to say—that  they should have all
the moral qualifications, and many of the mental accomplish-
ments which we deem necessary for  the  superintending phy-
sician.  This must, in no case, be overlooked, throughout the
whole corps of  attendants.   From the  head, to  the  lowest
cook, sound minds, correct morals, and gentle manners  must
prevail,|| and if possible, all of these should be trained to  their
  * "To the man who conceives, that he can combat mania with the lan-
cet and tartar emetic alone, or who believes that he can exorcise melan-
cholia with a purge, it would certainly be unpardonable folly to commit
the insane."—Browne  p.  178.
  f Esquirol.
  X "It is absolutely necessary, that the physician be empowered with
authority over every person and thing concerned  in the peculiar service
of the patients."—Georget, Diet, de Medicine, Art. Folie.
  See also Esquirol, Des Maladies Mentales, Tom. II, p. 526.  Des Mai-
sons D' Alienes, §111.
  J Insanity and Insane Asylums, pp. 455, 458.
  |] Consult, Brown on Insanity and Asylums for  the Insane, Lecture V.
Esquirol, Des.  Maladies  Mentales,  Tom.  II. p.  530.  Also, Awl's.
Earle's, Rockwell's, Bell's, Woodward's, Ray's, Lee's, and Prison Dis-
cipline Society's Reports,  upon the character of officers and attendants.
  Consult the same, and also Good, Prichard, Georget, and Abercrombie,
upon the value of labor and amusement, and upon the influence  of reli-
gious exercises in the treatment of Insanity; and  likewise, Dr. Bush's
late letter to the commissioners of the Kentucky  Lunatic Asylum. 
Character of Assistants.
45
 employment,  before being entirely trusted with the care or
 service of the  insane.*
    With such provisions of  lands,  buildings, and other mate-
 rials—with such officers and assistants—with religious service
 and  light and  laborious occupation of mind and body—a hos-
 pital might be of  immense  utility  in this valley.   And surely
 there is, within  this wide reach of territory, and among these
 five  millions of inhabitants, intelligence enough to appreciate
 such an  institution;  benevolence  enough to  desire  it, and
 wealth sufficient to create it and put it into successful opera-
 tion.!                           Louisville, February, 1842.

   See Dr. Lee's  beau ideal of a  perfect  asylum, published  iu the Elev-
 enth Report of the Prison Discipline Society for 1836, and also his descrip-
 tion of his own asylum at Charlestown, in the same.
   See a beautiful account of Esquirol's private hospital at Ivry, by Dr.
 Andrew Combe,  published in his  treatise on  " Physiology, applied to
 health and Education," Harpers' edition, p. 356.
   * In many of the establishments in France, the keepers are required to
 have undergone a training previous to their appointment—Brown, p. 184.
 Several about to engage in this service, have resided for some time at
 York to observe  the economy of the house and the management of the
 patients.—Tuke, Description of the York Retreat, p. 12.
   t In addition to the authors and works herein referred to, Dr. Tuke's
 Description of the York Retreat, Miss Martinean's notice of the Hanwell
 Asylum, Conolly's, Spurzheim's, and Combe's works on Insanity, some
 articles in the American Journal of Medical Science, and Dr. Dunglison's
 pamphlets on the Insane Poor of Pennsylvania, may be well consulted, in
 corroboraiion of many of  the statements and opinions  given  in this
 article.              _____________________

   Note.—We are happy to  give testimony here to the great improve-
 ments of the Kentucky Asylum within the last year, under the faithful
 care of Dr. Bush.   The Report for 1841, is more satisfactory than any
 that preceded it, and shows a greater success than in  any former year.
 This account is corroborated  by other and independent sources of infor-
 mation.
   We are informed, that there is no doubt that the Legislature will grant
to this asylum all the facilities  that its warmest friends desire—a well
 paid physician, a sufficient corps of attendants, and lands and shops, for
 the occupation of the patients.   When this shall be done, our own asy-
 lum will be second to none in the country.