A 
COMMUNICATION 
TO THE 
MAYOR OF NEW YORK 
IN REGARD TO THE 
OFFICIAL CHARITIES OF THE CITY, 
FROM 
THEODORE ROOSEVELT, 
JOSEPHINE SHAW LOWELL, 
EDWARD C. DONNELLY, 
'A V 
Com’rs o'tyjfke, State Board of Charities. 
ALBANY, N. Y.: 
JOEL MUNSELL, PRINTER. 
1877. To the Honorable Smith Ely Jr., 
Mayor of New York, 
Sir : 
We feel that it is our duty to protest against the esti- 
mate of expenses of the department of Public Charities 
and Correction for the year 1878. 
We have frequently pressed upon the attention of the 
Commissioners the dangerously overcrowded condition of 
the Lunatic Asylum on Blackwell’s Island and had anti- 
cipated from them a request to the Board of Apportionment 
for an appropriation to buy a farm, upon which inexpens- 
ive buildings for the Chronic Insane could he erected, 
but of this no mention is made in their estimate. 
The Medical Faculty of Bellevue Hospital have repre- 
sented to the Commissioners the necessity of building two 
surgical pavilions connected with that hospital. To this 
suggestion no attention is paid. 
In connection with these and other omissions in the 
estimate of the Commissioners of Public Charities and Cor- 
rection we beg to lay before you, as the responsible head 
of the city of Hew York, a report on the charitable in- 
stitutions under their charge which we have visited in the 
performance of our duty as Commissioners of the State 
Board of Charities. 
In addition to the results of our own observation, wTe 
shall give extracts from reports which have been made by 
others from time to time during the past year in regard 
to these institutions. It is unnecessary to say that w~e 
shall dwell especially upon the evils which exist in them, 2 
as our object is to remedy these through your means, 
although we fully appreciate the many improvements which 
have already been made by the present Commissioners of 
Public Charities and Correction. 
BELLEVUE HOSPITAL. 
The fifth annual report of the “ Visiting Committee for 
Bellevue and other Public Plospitals” opens as follows : 
“ It is now five years since this committee began to visit 
the public hospitals of this city, and for five years its re- 
ports have been monotonous repetitions of complaints of 
bad construction, bad ventilation, bad drainage, lax disci- 
pline, poor food, and insufficient supplies ; while accord- 
ing to these same reports, the officials with whom the 
visitors have dealt, have been uniformly courteous and 
obliging, and ready to listen to all useful suggestions. 
“ Among the reforms most needed are, first, the proper 
distribution of food, linen, drugs, etc.” 
On the 22d day of March 1877, the Grand Jury of the 
Court of General Sessions visited, by a committee, several 
of the institutions under the charge of the department of 
Public Charities and Correction, and in their presentment, 
the following statement is made in regard to this hospital: 
“ Bellevue Hospital is in a most deplorable condition. 
The wards are simply overcrowded, and the atmosphere 
in them is stilling. * * * * A visit to the cellars disclosed 
the same unwholesome atmosphere, where the soil pipes 
were leaking and emitting an insupportable stench.” 
The Hew York County Visiting Committee composed of 
official visitors appointed by the State Board of Charities 
speak as follows in their report dated June 4th 1877, con- 
cerning Bellevue Hospital: 
* * * “We would especially call your attention to the 
position and condition of the cells in Bellevue. 
“ These cells are for the temporary confinement of trou- 3 
blesome, noisy or lunatic patients of both sexes ; they 
occupy the ground floor of two extensions in the rear of 
the main building. There being but six cells for each sex, 
it is often necessary to place two lunatics in one cell. In 
the part assigned to males, there is no provision made for 
giving a bath to the filthy creatures sometimes brought in 
from the streets, and the orderly must resort to such 
cleansing processes as he can command, to render them 
fit for the physician to examine. There is a bath-tub in 
the dark closet in the cells for women, but it is so incon- 
veniently placed, that it is seldom used. Attention has 
often been called to the unfitness of these cells for their 
present use.” 
CHARITY HOSPITAL, BLACKWELL’S ISLAND. 
This hospital contains among its other patients, one class 
very difficult to deal with, those suffering from venereal 
disease. They are often not ill enough to he confined to 
their beds, and are very insubordinate and troublesome ; 
and yet there is no system by which they can he brought 
under discipline. 
There are also many prisoners from the work-house, and 
a few from the penitentiary, employed in the building; 
and these persons, men and women, are to be seen in the 
yards, associating with such patients, men, women, or 
children as are able to be out of the wards. The number 
of prisoners from the work-house so employed on August 
23d 1877, was one hundredand nineteen. Considering the 
character of many of the patients, the freedom of associa- 
tion and the idleness must have a very bad effect, espe- 
cially on the young. 
To a respectable poor person, obliged by illness to enter 
Charity Hospital, no trial could be greater than this forced 
companionship with the vicious and degraded. 
Prisoners from the work-house are also sent into the 
wards, to be treated when suffering from contusions, etc. 4 
The following is an extract from the fifth annual report 
of the Visiting Committee dated January 1877 : 
* * * “ In the ophthalmic ward in Charity Hospital, one 
clean towel a day is given for the whole ward; in the ward 
for skin diseases, one clean sheet weekly is allowed per 
bed; while in the gangrene and erysipelas pavilion the 
orderly has a stock of seven towels for the use of his patients.” 
The following statement is made in the report of the 
chief of staff of Charity Hospital- to the Commissioners, 
January 1877 : 
* * * “ The necessity of putting three patients in two 
adjoining beds constantly arises to a great extent. In a 
sanitary point of view this course is very objectionable, 
particularly in some wards where diseases are expressed 
on the surface of the body. It is also an impediment to 
rapid cure, as in many instances rest and sound sleep are 
of the greatest importance, which boon is, however, not 
attainable by the want of sleeping room.” 
In the presentment of the Grand Jury (March 1877), 
before referred to, occur the following statements in regard 
to Charity Hospital: 
“ At the Island the first place inspected was the small 
out-building, at present used for erysipelas patients. 
The building has a generally dilapidated appearance and 
is improperly ventilated, or rather is not ventilated at all; 
the hoards with iron bars attached for that purpose are 
inadequate. 
“ The baths adjoining these wards and in fact those 
throughout both hospitals were found to be of iron and 
to be both black and rusty and entirely unfit for use ; as 
they now are, they may he a means of spreading instead 
of checking disease.” 
The State Board Visiting Committee report as follows 
in regard to this hospital in June, 1877: 
* * * “ The entire domestic regime of the hospital 5 
shows the want of a thorough matron with capable assist- 
ants. The utter lack of system in the linen and laundry 
department is deplorable. The distribution of the linen 
is left to requisitions made in a hap-hazard way.” 
One marked defect in Charity Hospital, and also in all 
the other institutions of the department, is the poor cook- 
ing, due to the want of competent paid cooks. The com- 
plaint is frequently made that the patients cannot eat the 
food given them because it is so badly cooked. In Charity 
Hospital also the kitchen is much too small. 
ALMS HOUSE, BLACKWELL’S ISLAND. 
The Alms House consists of two institutions, one for 
men and one for women, under one management. 
The inmates, numbering over twelve hundred, are com- 
posed of various classes of the old and infirm, blind per- 
sons, imbeciles, epileptics, and others incapable of caring 
for themselves; many of them having destroyed their 
mental and physical health by excesses. 
The Superintendent, who has charge of this large num- 
ber of persons, receives $1,500 a year, and to assist him 
he has one matron, one assistant matron, one foreman, one 
cook, six orderlies, and three nurses. At almost any part 
of the day, men are to be seen around the women’s build- 
ing and vice versa. In the women’s department, work- 
house prisoners are employed and sleep in the wards with 
the inmates, eat at the same table with them, and some- 
times occasion much trouble, using violence and bad 
language. 
Scurvy made its appearance during the winter in this 
institution. 
The Superintendent in his report to the Commissioners, 
dated February 22d 1877, says: 
“ The number of standing beds in the male and female 
wings being ten hundred and eighty-two, we are forced 
to have beds on the floors all the year round, the number 6 
of floor beds in the winter months sometimes reaching 
three hundred.” 
This institution is called a work-house, and the prisoners 
are committed for various offences, drunkenness, vagrancy, 
disorderly conduct, or because they are homeless. 
Many improvements have been made during the year, 
but much remains to he done. 
There are two methods by means of either of which the 
work-house might be instrumental in diminishing crime. 
If the discipline were very strict and hard labor were 
enforced, many of the inmates might prefer to earn an 
honest living outside ; or were the inmates taught to con- 
trol themselves and to work well and efficiently, a certain 
number might be reformed. Neither course, however, is 
pursued. "With only seven keepers and four matrons no 
real discipline is possible, and the hours of work are so 
short and such slackness in working, especially with the 
men, is allowed, that the labor can have no deterrent effect. 
The proof of the utter failure of the work-house to diminish 
crime is the fact that most of the prisoners have been 
there at intervals for years, that several are committed 
twenty or thirty times every year, and that some of them 
have spent the greater part of their lives within its walls. 
There is no attempt even at classification ; hoys of sixteen 
are confined at night for twelve hours in the same cells 
with old depraved offenders; young girls committed for 
the first time are put into cells with prostitutes and drunk- 
ards. There can be no real industrial training from lack 
of a sufficient number of officers. 
It is a sad fact that all the chances to learn evil afforded 
by depraved company in the streets of New York, are 
concentrated in the work-house and no efforts made to 
counteract them. 
Owing to an insufficient supply of vegetables during the 
work house, Blackwell’s island. 7 
past winter, there were at least two cases of scurvy in the 
institution. The sufferers were old. women, who had each 
been committed to the work-house because of their home- 
lessness and they had each been there several months when 
they were attacked. 
From the work-house comes all the “ help” employed 
in the other institutions. 
On August 23d, 1877, there were transferred: 
Bellevue Hospital,., 47 
Charity Hospital, 119 
Randall’s Island Hospital, 70 
“ “ Farm, 11 
Alms House, 34 
Lunatic Asylum B. I., 35 
Insane Asylum W. I., 85 
Infants Hospital W. I., 58 
Homeopathic Hospital, 64 
Total 523 
Almost all these persons are committed only for ten 
days, an order having been issued by the Commissioners 
that no one committed for a longer period should be trans- 
ferred. There is thus a constant changing about. Pris- 
oners are first sent to the workhouse, then transferred to 
one of the other institutions, then sent back to the work- 
house to be discharged. The reason given for the order 
is that the chances of escape from the other institutions 
are so many that prisoners committed for longer terms 
cannot be trusted. The amount of labor and care en- 
tailed on the officers who have to oversee these men and 
women and force them to work can be imagined. 
LUNATIC ASYLUM, BLACKWELL’S ISLAND. 
This Asylum, the largest in the state, contains over four- 
teen hundred female patients, and the Superintendent, the 
only paid medical officer, receives $1800 a year. There 8 
are, besides the Superintendant and Chaplain, sixty-eight 
paid employees and the amount paid for salaries is $18,250, 
while the amount paid for salaries in the penitentiary, 
where there are nine hundred and forty-two inmates, is 
$43,008. 
At the Willard Asylum, where only chronic cases are 
treated, there were in November, 1876, eleven hundred 
and seventy patients, and the amount paid for house wages 
for that year was $42,801. 
The following extracts from the report of the Superin- 
tendent made to the Commissioners of Public Charities 
and Correction, and dated January 1st, 1877, together with 
extracts from the presentment of the Grand Jury (March, 
1877), and extracts from reports of visitors appointed by 
the State Board of Charities sufficiently describe the 
Asylum. 
From the Annual Report of the Resident Physician of 
the New York City Lunatic Asylum, January 1st, 1877. 
* * * “ The Institution is still much below the average 
standard of excellence in the provision made for the care 
and cure of its unfortunate inmates. ***** Tlie 
Lodge, in which the most excited, noisy and violent of the 
patients are domiciled, was built for the accommodation 
of only sixty-six patients of this class; and it is very poorly 
adapted as a domicile for even this number. It is necessary 
to place no less than one hundred and fifty patients within its 
walls. By day they annoy and excite each other; and at 
night a single noisy patient disturbs many others and may 
disturb all the rest. During the nights of the 1st, 15th, 
and 30th of November, which have been selected at random 
for illustration, there was only a single half hour of qui- 
etude within the building. At all other hours noise enough 
was made by one or more patients to disturb the rest of 
others. 
“ Of the two hundred and twenty-six patients at the Re- 9 
treat, no less than one hundred sleep on beds made up on 
the floor in the corridors. 
“ Of the four hundred and sixteen patients in the main 
building one hundred and eighty-six sleep on heels made 
up on the floor. 
“ The pavilions, which are the least crowded of all the 
asylum buildings, contain flfty-one patients more than 
their estimated capacity. * 
“ With proper accommodations for only nine hundred 
and twenty-six patients, the institution actually contains 
one thousand three hundred and forty, exclusive of those 
who are away on leave of absence. 
“ It is unnecessary in this connection to expatiate on the 
evils attending this state of affairs. It is enough to say 
that it would he an inhumanity to crowd persons who are 
not deprived of the use of their reason together in this 
wholesale manner. And yet the helpless insane are thus 
crowded together. The result is that their chances for re- 
covery are diminished; those who are incurable become 
stupid through neglect and those who are excited and 
noisy disturb each other until the excited wards some- 
times become a veritable bedlam. The most extreme 
and constant vigilance in sanitary measures is required 
to preserve the general health. If this vigilance were 
relaxed for a few weeks only, a frightful epidemic would 
surely ensue. Even with such vigilance a fatal epidemic 
is at any time liable to occur. 
“ It should not be forgotten that the majority of our 
patients do not belong to the pauper class. Eighty-two per 
cent of the patients admitted to this asylum during the year 
1875, and about the same per centage of those admitted 
during the year 1876, were not paupers within any proper 
meaning of the term. They had never been a public 
burden previous to the accession of their insanity, and 10 
there is no reason to suppose that they would ever have 
been such a burden but for their insanity. 
“Instead of the low rate of expenditure at our city 
asylums being commendatory, it is a source of positive 
and universal reproach on the part of those who are 
acquainted with the facts and know anything of what the 
proper care of the insane should be. The mere statement 
of the 2Jer capita of expenditure is sufficient to convince 
them that our patients do not get all they ought to have, 
whether of food, of clothing, of domiciliary space, of 
attendance, or of all these requirements together. 
* * * “ On the recommendation of the medical super- 
intendent, the number allowed on the staff of assistant 
physicians was increased to five.in the month of June. 
This number is none too large for an efficient service. 
Unfortunately, it not unfrequently happens that vacancies 
occur in the staff of assistants at periods of the year when 
it is impossible to supply their places with eligible men, 
so that the service often suffers from this cause. If a 
moderate stipend were paid for the services of assistants 
the institution would be much the gainer.” 
Presentment of the Grand Jury. March 1877. 
FEMALE LUNATIC ASYLUM. 
“ Every ward was overcrowded, especially in the lodge 
containing one hundred and fifty of the worst cases. 
There the rooms were very overcrowded, and in one hall, 
two nurses only were assigned to ninety insane women, 
the number being far too small for the requirements of 
the case. 
“ On inquiry we learned that there was a total number 
of one thousand four hundred patients, with but one 
resident physician, whose staff of assistants and nurses 
was totally inadequate to the needs of so large a number. 11 
“ The small proportion of nurses, as well as the limited 
grounds attached to the building, makes it impossible for 
the patients to obtain the open air and exercise so neces- 
sary for their well-being. 
“This institution is now carried on at the expense of 
$1.66 per week for each patient. The usual estimate of 
the cost of such an asylum is $3, or $3.50 per week. 
These estimates include food, clothing, fuel, wages and 
salaries. 
“ We believe that the authorities are doing all that they 
can with the limited allowance at their command, and we 
urgently recommend that a larger appropriation be made.” 
Report of State Board Visitor. June 4, 1877. 
* * * “ The general condition of the institution re- 
mains much as heretofore, except that it is more crowded 
than ever. The number of inmates on May 24th was 
fourteen hundred forty-five (1445). In the retreat at that 
date, there were eighty-four (84) patients on the first floor 
and twenty-two bedrooms. At night, the most excited 
cases occupy the rooms singly; the rest sleep on the floor 
of the hall outside. Two hundred and fifty (250) patients 
are now crowded into this building, which was built to 
receive sixty-six. * * * There seems no attempt to make 
the meals comfortable. The food is hastily dipped out 
into pans, and carelessly and untidily eaten; and the 
women are not more than ten or fifteen minutes at the 
table. * 
“ While the asylum continues to he so greatly over- 
crowded, and while the attendants are insufficient in num- 
bers and inferior in quality, we cannot hope for any 
material improvement. 
“ An attempt has been made to induce the Commissioners 
FEMALE LUNATIC ASYLUM. 12 
of Charities to send a trained nurse to the sick hall of the 
asylum. There are often very serious cases of illness and 
the nurses of hall 1 (the sick hall) are not among the best 
in the institution ; and there are usually only two of them 
in charge of more than forty patients, eight or ten of whom 
are confined to their beds. 
“ The whole system of appointing nurses is wrong. The 
appointments are made without any test of qualifications, 
and the Superintendent, we understand, has no power of 
removal. Nothing could more utterly destroy discipline.” 
All the institutions above described, with the exception 
of Bellevue Hospital, are situated on Blackwell’s Island ; 
on which is also the penitentiary with over nine hundred 
inmates. 
There are therefore on this comparatively small island 
five large institutions, containing nearly six thousand per- 
sons, or the population of a good sized town. The 
members of this community are drawn from the most 
unfortunate and most vicious of the population of New 
York City and comprise men and women whose health 
is broken down by debauchery of every description ; 
criminals of all grades, from pickpockets of fourteen years, 
to prisoners committed for murderous assaults; lunatics, 
some from respectable homes, some from the lowest dens 
of the city, and every other class of unhappy human beings. 
For the government of this town and its miserable inhabit- 
ants, there is no provision on the island itself. Each in- 
stitution is absolutely independent of all the rest; and the 
impression produced on the casual visitor is that there is 
very little order or system, an impression deepened by 
more thorough acquaintance wfith the institutions. 
The only pretense of any general government of the 
island, consists in the visits of the Commissioners of Public 
Charities and Correction. These visits are usually made 13 
every day by the President and occasionally by other mem 
bers of the board. It is to be remembered, however, that 
there are three other islands as well as the prisons of the 
city to be visited and managed by the Commissioners. 
All the buildings are overcrowded, and in none (except 
the penitentiary) is there a sufficient number of paid 
officers, nor are the salaries usually sufficient to secure a 
proper class of officers. 
Every institution is kept in a low moral condition by 
the presence of work-house helpers, who have to be in- 
dulged in order to get them to work and who associate 
quite freely with all the other inmates. 
In two institutions at least, scurvy has been developed 
within the past six months, owing to want of proper food. 
In Charity Hospital, the penitentiary and the work- 
house, there are often young girls and boys exposed to 
all the degrading and contaminating effects of association 
with drunkards, prostitutes and criminals, and growing 
up to take their places as burdens on the community. 
HOMOEOPATHIC HOSPITAL, WARD’S ISLAND. 
In the report of the chief of staff of this hospital to the 
Commissioners, elated January, 1877, occur the following 
remarks : 
“In the matter of promoting cleanliness in a hospital, it 
is patent to every mind, that in order to accomplish the 
end in view, there is required, first of all, such laborers as 
will perform their duties with patient perseverance and 
with scrupulous neatness. Under the present arrange- 
ment, the menial service of scrubbing the floors, cleaning 
the wood-work, and attending to the bath-rooms, wash- 
rooms and water closets is performed by women detailed 
from the work-house. The demoralizing influence of 
these minor criminals, when thrown promiscously among 
the sick and their attendants has already been brought to 14 
your notice, and the disastrous effects of such evil com- 
munications have been vividly portrayed by those having 
charge of similar institutions in this department. * * * * 
It is in our wards for the sick that we need quiet, tractable 
laborers who will perform the work of cleaning the wards 
without introducing the element of discord, insubordina- 
tion, shiftlessness and profligacy. Nothing can be more 
incongruous and inharmonious than the employment of 
criminal labor in hospital wards, where the sick and 
suffering are brought into daily and hourly contact with 
coarse, brutal and drunken outcasts from the streets and 
brothels of the city.” 
This institution, intended exclusively for men, contained 
according to the official census in January, 1877, seven 
hundred and sixty-three inmates. 
Nothing beyond extracts from the reports of the Medi- 
cal Superintendent is required in regard to this asylum. 
From annual report of Medical Superintendent. Janu- 
ary 1st, 1876. 
“ In my last annual report I referred, at some length, 
to the difficulties under which we labored from the want 
of a satisfactory corps of attendants. These difficulties 
have met no abatement during the year that has elapsed 
since that report was presented. Of the importance to 
the wTell being and success of an institution of a well or- 
ganized and trained staff of attendants, there can be no 
question. ****** 
“ Next to the mental and bodily qualifications which fit a 
man for the post, the essential requisite for a thoroughly 
reliable and competent attendant is, perhaps, length of ser- 
vice. Attendance upon the insane —proper attendance — 
is a duty which cannot he taken up at a moment’s notice 
by men who have spent their lives in other pursuits. It 
INSANE ASYLUM, WARD’S ISLAND. 15 
is a delicate and difficult task, aptitude for which is found 
only in the few, and proficiency in which can come to 
none save after prolonged and faithful practice. Attend- 
ants are not keepers, whose doty is only to guard their 
patients, hut nurses, who have to do with those suffering 
from disease. Hence an attendant can approach a fair 
degree of usefulness only after a lengthened service, after 
he has learned not only all the details of his office in re- 
lation to the care of the insane generally, hut also the 
names and the peculiarities of the special patients in his 
ward. In this respect, our staff' of attendants fails at 
once and conspicuously, for there are in the asylum now 
but two attendants, wrhose appointments antedate the 
commencement of the year. There is constant changing, 
enough in itself to create confusion and seriously to em- 
barrass the working of the institution. During the year 
that has just closed there have been sixty changes in the 
list of attendants and the confusion and embarrassment 
will be further accounted for when we examine the causes 
leading to these changes. Of the sixty attendants who 
retired from the institution, twenty-one did so through 
resignation, and thirty-eight by dismissal. * * * * Re- 
garding the latter I may here say that sixteen were dis- 
missed for intoxication, or bringing liquor into the building, 
five for striking patients, and the remainder for various 
infringements of rules. This will show in itself of what 
class the larger number of those seeking and procuring 
appointments to the places are. The remedy for this, in 
my opinion, is to be sought in two ways, both of them 
dependent upon an increase in the expenditures of the 
institution and therefore for the present, at least, beyond 
the power of your board to apply them. In the first 
placfi, there should be an increase in the number of at- 
tendants ; and in the second place, an increase in the rate 
of compensation allowed them. * * * * 16 
“ As I said last year, an increase in the attendants’ wages 
sufficient to make them a temptation to men who might 
through political influences obtain the positions with no 
idea of properly performing their duties, would he un- 
wise. But a moderate increase, falling short of this end, 
would be desirable. * * * * 
“ A standing obstacle in the way of the proper conduct 
of this institution is the employment of a number of prison- 
ers, male and female, to do most of its work. This is an 
unfortunate result of the association of charitable and 
correctional institutions, and brings into more or less 
close contact with the inmates of the former, men and 
women of the most depraved and worthless class in the 
city. ***** The presence of these people in the asy- 
lum has a constantly and powerfully depreciating effect 
upon its tone and discipline ; and under a new regulation, 
practically limiting the class of prisoners sent here to 
those under sentences of but ten days, there is a constant 
change going on which prevents any successful endeavor 
to enforce order and propriety of conduct.” 
From report of Medical Superintendent, January 1, 1877. 
“ There has been some progress made during the year 
in increasing the efficiency of the corps of attendants. It 
has been enlarged by the appointment of eight men over 
the quota of a year since, so that we have now one at- 
tendant to seventeen patients; and of late there has been 
some little improvement in the class of men seeking and 
procuring appointments. But, with all this, there is still 
much to be desired. In the first place, despite the in- 
crease alluded to, the force must still be considered inad- 
equate. Nominally we have, as I have said, one attendant 
to every seventeen patients, but practically the proportion 
is much less, for every day, upon an average, four attend- 
ants are not available for duty, through absence upon 
leave or sickness, or some such cause; and despite the 17 
improvement in their character which I have acknowledged, 
there is still much to be desired, in that regard also. A 
glance at the records of dismissals of attendants during 
the year, with the causes therefor, will show at once that 
there has been something lacking. Apart from twenty- 
two who have resigned their positions, thirty-six have 
been dismissed for cause. The number of changes thus 
entailed in a single year, would of itself be enough to 
seriously embarrass the discipline and order of an institu- 
tion ; and it will be readily imagined that further embar- 
rassment must arise from the influence of causes leading 
to their dismissal. The offence of thirteen of the attend- 
ants dismissed was intoxication ; of six, ill usage of patients, 
and of the remaining seventeen various other infractions 
of rules. In one instance, the dismissal of an attendant 
for striking a patient, was followed by his arrest, and sub- 
sequent sentence to an imprisonment in the penitentiary 
for three months. 
“ I am aware that any recommendations as to the im- 
provement in the staff of attendants, that I may make to 
your Board are more than likely to fail of being carried 
out, through no want of recognition upon your part of 
their necessity, or indisposition to fulfill them, but owing 
to the inadequate appropriations that have been made for 
the maintenance of the department. I am fully aware 
that the meagre wages ($20 a month) which you are able 
now to pay attendants, and which there is strong reason 
to believe you will be compelled to still further reduce, 
is in itself a weighty obstacle in the way of improvement. 
But I believe it to be my duty to lay before you — and so 
enable you to lay before others with whom the power to 
adequately provide for the insane, and hence the respon- 
sibility for the failure to do so, alike rest — in plain words, 
the deficiencies which are daily apparent to me here, and 
the measures which I believe necessary for their removal. 18 
“In the first place, then I believe that at least fifteen at- 
tendants should be added to the number already employed. 
In the larger wards, where seventy-five or eighty patients 
are confined, wTe have now but three attendants; and when 
we allow for absence from duty for some of the causes 
named, and for temporary absence from the ward, at meal 
times, and upon other necessary occasions, we shall find 
that the greater part of the day, this large number of 
patients is left to the care of but two attendants. * * * * 
Then there should be an attendant for night-duty in each 
ward, or at least in every two connecting wards. As it 
is, after the day attendants retire, the entire building 
(with the exception of the hospital-ward, where there is 
a night-nurse), is left in charge of two watchmen, who 
cannot patrol all the wards with any degree of thorough- 
ness in less than an hour. Hence sickness or disturb- 
ance among the patients in any one part of the building, 
may be quite unknown to the watchman, who maybe per- 
forming duty in another. With the appointment and dis- 
position of attendants which I recommend, prompt atten- 
tion would be given to every patient needing it, and prompt 
interference insured in case of any disturbance, or act of 
violence or attempt at suicide. 
“ But after all, the main thing is to secure proper material, 
out of which to manufacture attendants. Very few of any 
given number of men are fit to be attendants at all, and 
these few must be secured, or all efforts will fail. Men 
who are too old to be active are of no use, and hoys who 
have no steadiness are equally of no use. It is absurd to 
put a man who is uncleanly in his own person in a posi- 
tion where one of his chief duties is to secure scrupulous 
cleanliness in others. Men who are addicted to the use of 
liquor, who are profane or obscene in language, who are 
ill-tempered or wanting in courage or self-control, can 19 
never be made good attendants. In short, attendants 
should be selected solely with regard to their fitness from 
natural disposition and good character, and not with re- 
ference to any other recommendations ; and, in order that 
suitable men may present themselves for selection, a fair 
amount of remuneration must he ottered. 
* * * “As no addition has been made to the capacity of 
the building during the year, it follows that what has been 
said in former reports of its overcrowded condition, is 
more than ever true. This is a very serious drawback to 
the success of the institution, and a source of constant 
danger to its inmates. The sum asked for by your board, 
in order to erect a new wing, and so relieve this over- 
crowding, has been refused by the Board of Apportion- 
ment and a much smaller one substituted, insufficient to 
procure more than the making of the necessary excava- 
tions, and the erection of the foundations.” 
randall’s island. 
On the part of this small island which belongs to the 
city of New York, there is a very large number of institu- 
tions containing various classes of inmates. 
A branch of the penitentiary, where prisoners from 
the penitentiary and from the work-house, employed on 
the farm, are lodged. 
2d. The Infant Hospital, which contains four hundred and 
sixty-five inmates, women with their children and work- 
house women employed in the building. 
3d. The Idiot Asylum school. 
4th. Hospital for girls. 
6th. Hospital for boys. 
6th. Asylum for incurable idiot boys and men. 
7th. Asylum for incurable idiot girls. (In these last five 
buildings there are four hundred and ninety-five inmates.) 20 
8th. A hospital for women to which patients from Charity 
Hospital are sent. 
9th. A hospital for men, to which patients from Charity 
Hospital are sent. 
10th. A public school building, in the attic of which 
the work-house women employed in all the institutions 
(except the Infants’ Hospital) sleep. 
11th. A building to which have lately been sent seventy- 
five insane men from the asylum at Ward’s Island. 
The medical officer, who is superintendent of these 
various institutions, so far as they have any, receives $1,200 
a year. 
The large number of children in Randall’s Island, 
renders the presence of so many persons of had or doubtful 
character, and of infirm mind a great misfortune, espe- 
cially so, because heretofore there has been no proper 
supervision of them. 
As an example of the laxity of supervision the following 
facts are suggestive. An idiot woman employed in the 
kitchen of the asylum school was found to be enciente. 
The matron and head teacher of the school believed that 
the father of her child was one of the work-house prisoners, 
but the President of the Board of Commissioners of Public 
Charities and Correction expressed it as his conviction, 
that one of the idiot pupils was the father. 
Randall’s Island is in fact being used to receive the 
overflow from all the other institutions. The various 
classes of patients are sent from Blackwell’s and Ward’s 
Islands, under the charge of underpaid employees, with 
no responsible person to superintend them. The Medical 
Superintendent is nominally held responsible for their well- 
being; but as there are about twelve hundred persons in all, 
sick, insane, idiots, prisoners and children, and as they 
are scattered through eleven different institutions under 
the care of persons not responsible to him, and whom he 21 
cannot discharge — it is difficult, to imagine an office of 
more responsibilty or less power. 
hart’s island. 
This island, beautifully situated and affording great 
advantages, is, unfortunately, becoming a second Randall’s 
Island, and is used to receive the surplus from other in- 
stitutions. All the buildings on the island are barracks, 
and could be used to classify the inmates, but no such at- 
tempt is made. There are now about three hundred 
patients in the Hart’s Island hospital, under the charge 
of one physician, who receives $1200 a year, and who has 
under him, one watchman, one cook, three orderlies, one 
chief nurse and four nurses. The expense for salaries is 
$3,360 for these eleven persons including the physician. 
There are also about twenty-five work-house women 
who help in the wards, etc., but the physician has no ma- 
tron, no steward, and no assistant physician to share his 
duties. 
Within the past three months about seventy-five insane 
women have been sent from Blackwell’s Island, and 
lodged in the barracks at the opposite end from the hos- 
pital. A few nurses accompany them. 
The barracks used for the insane women are some of 
those which have been occupied by the work-house pris- 
oners transferred from Blackwell’s Island, sometimes to 
the number of four hundred. The warden and keepers 
kept them all employed on improvements, which are be- 
ing made on the island, and as many as five hundred men 
might be constantly at work there, but within a few 
months, the number transferred has much diminished, and 
there were in only about two hundred. 22 
CONCLUSION. 
In reviewing what we have said, of the various charit- 
able institutions, under the charge of the department of 
Public Charities and Correction of the city of Hew York, 
there are several of the evils which disgrace them that 
may be attributed to the want of appropriations large 
enough to carry on these institutions. Among these evils 
may be classed the overcrowding, due to buildings which 
are far too few for the number of persons to be cared for, 
insufficient food, lack of a proper number of attendants 
for the sick and insane, and of keepers for the work-house 
prisoners, etc., etc. 
All these evils would appear to be enough to condemn 
any city which so provided for those dependent upon 
her — but beyond all these, and serving to aggravate each 
one, and making it impossible to improve the condi- 
tion of these institutions, even if sufficient money were 
appropriated for their support, lies the great fundamental 
evil of the system by which they are governed. There is 
no responsible head to any one of these hospitals or 
asylums; no superintendent who has authority to issue 
orders and to punish his subordinates if they are dis- 
regarded; no superintendent wTho can justly be held 
responsible for the w7rong doing of those under him, or 
for the condition of the institution supposed to be under 
his charge. Every employee \n the department, from the 
superintendents down to the cooks, holds his position on 
exactly the same ground, and from exactly the same 
power. Ho one can be removed except by this power, 
and the following extracts from a report made to the Com- 
missioners by one of their superintendents, and printed 
by them in 1875, will show what their practice has been 
in regard to removals. 
* * * “ Those (attendants) who willfully disobey rules 23 
or orders, should secure thereby invariable and immediate 
dismissal. 
“ This would seem to be so much a matter of course that 
any mention of it may appear superfluous, but, unfortu- 
nately the practice has not been so strict in that respect 
as could be wished. I can conceive of no greater miscon- 
duct than deliberate cruelty to an insane person, and 
surely intoxication while upon duty gains added gravity 
from the fact that such duty is performed in the wards of 
a lunatic asylum, and yet flagrant instances of each 
offence have been overlooked, or the offender has been 
allowed to resign under charges, and in the course of a 
short time has been reappointed. The effect of such in- 
stances upon the discipline of an institution and upon the 
authority of its oflicers must of necessity be disastrous. 
I believe it to he essential not only that dismissal should 
promptly follow grave offence, but that such dismissal 
should he fully and fairly understood to he final. The re- 
appointment of a man once dismissed lessens the respect 
of all his associates for the rules of an institution, and one 
such instance will beget many future violations.” 
Under such a system it is inevitable that the subordinates 
in the various institutions, instead of looking to the super- 
intendent for orders and for approval, should regard the 
Commissioners as their immediate superiors, and unfortu- 
nately some of the Commissioners at least regard them- 
selves in the same light. 
The following letter addressed to the Commissioners on 
the 24th of April, 1877, explains our views upon this 
subject. 24 
“ To the Commissioners of Public Charities and Correction, 
New York City. 
“ Gentlemen : 
“ You are doubtless as painfully aware as it is possible 
for any one to be of the incompetency and of the graver 
moral deficiencies of many of the subordinates who have 
been appointed to fill places in the charitable institutions 
under your charge. The more thoroughly we become 
acquainted with the management of these institutions, the 
more firmly are we convinced that under the present system 
of making appointments, an efficient and proper adminis- 
tration of them is impossible. So long as political pressure 
is allowed to have weight with you in the choice of em- 
ployees, so long will the charitable institutions of the city 
be badly managed. 
“ As one means of remedying the evil and introducing a 
better discipline, we would suggest to you that in each 
institution, the superintendent should have full power to 
appoint and remove his subordinates, and that he should 
be held to a strict accountability in regard to them and 
should be responsible for the absolutely good management 
of the institution under his charge. If you would choose 
and appoint your superintendents without regard to their 
political opinions or influence, and with a view to their 
assuming such a responsibility as we suggest, we believe 
that a great change for the better could be made in the 
department. 
“ Respectfully, etc., 
(Signed.) 4‘ Theodore Roosevelt, 
“ Josephine Shaw Lowell, 
Com’rs, etc.” 
The conclusions of the “ Visiting Committee for Belle- 
vue and Other Public Hospitals” after five years’ expe- 
rience are thus expressed in their Fifth Annual Report: 25 
“ The administration of the Department of Public 
Charities and Corrections has properly nothing to do with 
politics; yet, * * * there is not an appointment, from 
that of the Commissioner to the lowest subordinate, which 
may not have a political significance : and while this sys- 
tem lasts, the results must be the same. By this we do 
not mean to imply that the appointments are all neces- 
sarily bad. On the contrary, some are very good; but 
they are good in spite of the system, not in consequence 
of it. The Commissioners are daily and hourly hampered 
by political considerations which ought never to enter into 
their deliberations. 
“ If the Commissioners themselves were appointed irre- 
spective of political opinions, and removed only for cause, 
they would be free to establish that system of administra- 
tion which their experience should prove to be for the 
best interest of the people under their charge. They 
would then be able to train a body of subordinates, chosen 
with reference to their fitness, who, knowing that they 
were appointed during good behavior, would be ambitious 
to do their best; and thus in a few years we should have 
the Public Charities administered wisely and justly.” 
In the hands of the Commissioners of Public Charities 
and Corrections is placed an enormous responsibility. 
They have under their charge almost ten thousand human 
beings, whose moral welfare, as well as physical health, 
depends upon them. 
Should they so govern these unfortunates, that their 
evil propensities would be checked, and all the good that 
is in them encouraged and strengthened, many could be 
saved. In the penitentiary alone, there are three hundred 
and twenty-one young men under twenty years of age, as- 
sociating with criminals old in years and wickedness. 
In every institution under the charge of the department 26 
the comparatively innocent are forced into companionship 
with the low and depraved, they have no encouragement 
to goodness — in many instances, the very persons set over 
them, to control them, are themselves low and vicious. 
In fact, generation after generation is being bred up to 
pauperism and crime, until, in time, we shall he cursed 
with ten times ten thousand paupers and criminals; their 
lives a burden and curse to themselves and to their fellow- 
men. It is not a question of a few thousand dollars, saved 
this year or next year — it is a question of thousands of 
souls degraded and tainted with every form of vice, and 
this in the public institutions of the city of Hew York, and 
under the control of her officials. 
Oct. 20th, 1877. 
(Signed) Theodore Roosevelt, 
Josephine Shaw Lowell, 
Edward C. Donnelly, 
Com’rs of the State Board of Charities.