The American System of Public Pro- 
vision for the Insane, and Des- 
potism in Lunatic Asylums. 
ORPHEUS EVERTS, M. D. 
[From the American Journal of Insanity, for October, 1881.] THE AMERICAN SYSTEM OF PUBLIC PRO- 
VISION FOR THE INSANE, AND DES- 
POTISM IN LUNATIC ASYLUMS.* 
ORPHEUS EVERTS, M. D. 
A recognition of the fact that insanity is the result 
of physical disorder, which is not subject to the control 
or influence of will, and therefore constitutes a condi- 
tion of irresponsibility, aroused a naturally strong 
interest in the minds of all thinking people in the wel- 
fare of the insane. This interest culminated, within 
the present century, in a general movement toward a 
public provision for the insane as wards of the State, 
including not only the care and custody of the person, 
but also the treatment of the disease. The various 
States of the American Union, following closely the 
plans adopted by older governments, began to make 
such provision, each for itself, near the middle of the 
century,f and since have carried forward the work with 
* Read before tbe Association of Medical Superintendents of American 
Institutions for tbe Insane, at tbe annual meeting in Toronto, June, 1881. 
f Tbe Pennsylvania Hospital for tbe Insane was founded in 1750, and 
opened on February 11,1752. Tbe Provincial Assembly, after citing tbat 
“ whereas there was frequently in many parts of this province poor, distem- 
pered persons, who languish long in pain and misery under various disor- 
ders of body and mind; and being scattered abroad in different and very 
distant habitations can not have the benefit of regular advice, attendance, 
lodging, diet, and medicine but at a great expense, and therefore often suffer 
for want thereof, which inconveniency might be properly removed by col- 
lecting the patients into one common provincial hospital, properly disposed 2 
increasing earnestness and activity. The provision 
which they have made thus far consists for the most 
part of one or more large hospital buildings in each. 
State, built, officered and equipped, and wholly or in 
part maintained at the public expense. These build- 
ings range in capacity all the way from three hundred 
to a thousand beds, with necessary room in addition 
for all needful officers and employes. 
To these hospitals insane persons are or may be com- 
mitted and admitted in conformity with specific stat- 
utes ordained for the government of the same and the 
protection of insane citizens. The general features of 
construction, organization, and management of these 
institutions are so similar as to constitute a “system,” 
which consists of a “ center building ” for administra- 
tive purposes, and “wings” or extensions variously 
modified and subdivided into wards for the accommo- 
dation and classification of various grades of insane 
patients; and a board of trustees, or managers, ap- 
pointed by the Governor, or Governor and Senate, or 
elected by the Legislature of the State, representing 
the authority of the State; a superintendent appointed 
by the board of managers, or by the Governor, repre- 
senting the authority of the board : subordinate medi- 
cal officers appointed by the board on nomination by 
the superintendent; and assistants of all grades, em- 
ployed directly, or recommended for employment by 
the superintendent. The expenditure of public moneys 
and appointed, where they may be comfortably subsisted and their health 
taken care of at a small charge, and by the blessing of God on the endeavours 
of skilful physicians and surgeons their diseases may be cured and re- 
moved,” founded a “ hospital for the reception and relief of lunatics and 
other distempered and sick poor, without partiality or preference.” 
In 1769, the Asylum for the Insane at Williamsburg, Virginia, was estab- 
lished, and in 1806, the Governors of the New York Hospital founded a 
branch, which was opened July 15, 1808, for the accommodation of the 
insane. 3 
in the erection of these State institutions is limited in 
amount by legislative appropriation, being more or less 
ample, according to the liberality of views or general 
intelligence of legislative assemblies, the state of the 
public treasury, etc., and all expenditures for their sup- 
port are under the managing officers and superintend- 
ents, who represent their respective requirements and 
necessities, and all under the direct sanction of law. 
These institutions thus constructed and organized 
have for many years enjoyed a large share of public con- 
fidence, and have been looked upon by the people with a 
certain degree of pride and satisfaction. Public moneys 
were generally unhesitatingly appropriated for their 
construction and maintenance. Men of 'ability and 
general reputation for benevolence and integrity were 
selected and served as trustees or managers. To be 
selected and appointed medical superintendent was a 
professional distinction and a public honor. The re- 
covery of a large number of insane persons at first 
committed to hospitals, and the improved condition of 
others made more comfortable by hospital treatment, 
magnified the reputation of hospital physicians, and 
exalted these institutions in popular estimation. State 
architecture, and State science for the benefit of the 
insane, did much toward redeeming their condition 
from its low estate, even among friends. The transfer 
of insane persons from local habitations, almshouses 
and prisons to places of such promise and repute, 
afforded relief and satisfaction to families and commu- 
nities of untold value and acceptability. A fresh im- 
petus was given to the study of psychology; psychi- 
atry became an integer of medical science; cerebral 
physiology acquired enlarged importance. Disease of 
the brain and nerves assumed a leading position in the 
literature and practice of medicine. 4 
With the multiplication of States and hospitals, these 
institutions became more and more familiar to the pub- 
lic eye. The number of recoveries and deaths never 
quite equaled the number of insane persons admitted 
to them. A gradual yet inevitable accumulation of the 
chronic and incurable class in hospital populations 
affected their reputation unfavorably as agencies 
of cure. A wonderful increase of population, natu- 
ral and by immigration, produced applicants for public 
care and treatment more rapidly than the States could 
well make provision for them. Besides all this, accom- 
modation was demanded for multitudes of variously 
incompetent persons, who had not previously been 
recognized as insane, or at least not so affected as to need 
hospital care. Insanity itself appeared, on a superficial 
glance, to increase in an undue ratio to population, and 
seemed to be less curable. Large and increasing appro- 
priations to be disbursed by hospital officials did not 
escape the telescopic eyes of the raptores, the vul- 
tures and eagles of partisan politics. Aspirants for 
hospital positions, without especial regard to qualifica- 
tion or fitness of character, became more numerous and 
persistent, and as many of these institutions were 
drifted into the stream of politics, in some States, 
they even came to be looked upon as party spoils. 
Coincident with these and other circumstances, a sus- 
picion found lodgment in the public mind, and was 
cultivated by some, that the merits of these institutions 
never had been quite equal to their pretensions or their 
reputation. This suspicion, perhaps not altogether 
without ground, for hospitals were originally in some 
respects overestimated, multiplied and transformed 
itself, until it has become a formidable accusation, if 
not an organized condemnation of the whole system of 
public beneficence to which it pertains. To impute the 5 
worst characteristics of human nature to those most 
prominently employed in the administration of hospital 
affairs has become to a degree fashionable. To accuse 
managing boards of dishonesty, and medical superin- 
tendents and subordinates of incompetency, or criminal 
neglect of duty and abuse of authority toward help- 
less “ prisoners,” is a common feature of public scandal. 
Benevolent persons who, in their zeal, do not always 
distinguish between feeling and judgment, and are apt 
to accept earnest assertion for indisputable facts, have 
been moved to pity and indignation by the recital of 
such constantly repeated accusations. Men and women 
of intellectual and social distinction who may have 
themselves (unhappily) suffered the humiliation, and 
possibly some errors, of hospital treatment, after appar- 
ently recovering the use of their faculties, have given 
tone and color of veracity to stories of ill-usage, and 
vigorous expression to mental concepts of hospital ad- 
ministration, tinged by memories and imaginations, the 
morbid parentage of which may be unsuspected by 
others or even by themselves. Born agitators and 
“professional reformers,” who live and move upon the 
borderland of insanity, being native there, or revolve 
on their own axes—who are ever intent upon turning 
the world upside down, and having things done some 
other way, no matter what the present way may be—- 
have appropriated all such suspicion, imputation, accu- 
sation and scandal as valuable contributions to their 
magazine of munitions, to be used in a general crusade 
against whatever appears to be established. Professed 
neurologists and flippant neurospasts of the medical 
profession, arrogating to themselves all knowledge of 
psychology and psychiatry, have, by sneers, innuendo, 
and direct assault upon the character and qualification 
of medical officers serving in American hospitals for 6 
the insane, done what they could do toward the dispar- 
agement of hospital reputation. Hungry politicians 
of a low order, on the accession to power of a party 
which they had served, clamorous for “ a change,” have, 
in notable instances, unscrupulously manufactured and 
promulgated accusations and reports as testimony 
against incumbents of hospital places, calculated to 
disquiet and abuse the public mind respecting the 
management of these great charities. Foreign hospi- 
tals and their methods have been extolled and con- 
trasted as in every respect superior to our own. 
The American “system” of provision for the insane 
has been wordily arraigned, by some of these polem- 
icists, who have obtained access to some of the most 
conservative papers and periodicals, and anathematised 
as an “ unparalleled despotism.” The American Asso- 
ciation of Superintendents of Insane Hospitals has 
been denounced by the same class, and on the same 
kind of testimony, as “unscientific and selfish in char- 
acter and purpose,” “a close corporation ” which has 
“ tended to become a power as autocratic and domineer- 
ing in asylum medicine and asylum politics throughout 
the Union, as are the authorities of each institution 
behind their own walls and locks.”* 
An association calling itself national has been gotten 
up ostensibly “for the protection of the insane and the 
prevention of insanity,” but really for the purpose of 
concentrating and organizing hostility to present insti- 
tutions and present methods, so far as they have been 
approved by a majority of those who have been or are 
at present engaged in administering them.f 
* Dorman B. Eaton, JV. A. Review, March, 1881. 
f Dr. Hiram Corson, in a letter to the National Association for the Protec- 
tion of the Insane, at a meeting held in Boston, says of the Association of 
Superintendents of American Institutions for the Insane : “Your counsel 
would he of infinite service in aiding our efforts to counteract the selfish, This organization, which is not without talent and 
is seconded in its movements more or 
less by influential members of the medical and scientific 
press, and a miscellaneous support among the magazines 
and newspapers of the day. They have in some instan- 
ces, under the guise of noticing the meetings of their 
self-constituted protection societies, crept into the edi- 
torial chair of the religious press, and there vented 
themselves of the most gross misrepresentations. 
Such being the state of affairs at the present time, it 
may be well for all persons interested, officially or 
otherwise, in our public provision for the insane, to 
enquire into these matters, and ascertain, if possible, 
the origin and significance of these attacks. In order 
to do this systematically, it may be well to summarize 
what they all say on the subject. While those who 
criticise, complain and cry aloud against the American 
“system” of provision for the insane, do not all make 
the same allegations, do not all indulge the same 
spirit of hostility, do not all affect the same tone and 
temper of assertion, they do all agree in condemning 
present structures and present methods of administra- 
tion; and assert they are unscientific and unsuccessful, 
always contrasting the institutions of America unfavor- 
ably with those abroad. It is said by them that Amer- 
ican hospital buildings are too large,* too palatial, too 
pernicious influence of this association. It may seem strange to you to hear 
me talk thus, but let me ask you what reform in the management of the in- 
sane has originated in that society? What hut the invention and use 
of closer confinement, more means of restraint and seclusion of patients and 
determined resistance to the reforms urged hy philanthropists who have wit- 
nessed how greatly they have ameliorated the miseries and contributed to 
the successful treatment of the insane?”—Medical Record, March 5, 1881. 
*Dr. Crichton-Browne, one of the English Chancery Visitors, before the 
Parliamentary Committee, said : “ I think pauper asylums may very prop- 
erly be raised to 1,000, and that they will then work more efficiently and 
economically. * * * I have held offices in asylums of all sizes, contain- 
ing from 100 up to 1,500 beds, and I think 1,000 the most economical number 8 
expensively constructed; disagreeably monotonous in 
linear extension, and offensively prison-like in aspect. 
That American hospitals for the insane are appropri- 
ately adapted to but one class of patients, whereas 
there are several quite distinct classes of insane persons 
requiring a corresponding variation of general hospital 
provision. That American hospitals for the insane 
are practically inaccessible to the friends and natural 
protectors of their inmates, because of their great size, 
accommodating, each, the population of so large a ter- 
ritory. It has not been said directly, but one might 
legitimately infer from the tone and manner of com- 
plaint that has been made recently, that insanity itself 
has been increased in activity and malignity by the 
construction and occupation of American hospitals. 
“Palatial asylums,” says Eaton,* “constructed and 
furnished at an expense unparalleled in the world, 
and consigned to the almost absolute control of asy- 
lum doctors and trustees, have utterly failed to check 
the disease. * * * Year year since their com- 
if you liave a sufficient staff. * * * I think in an asylum for 1,000 pa- 
tients, one medical superintendent can keep up adequate supervision. Of 
course, of the 1,000 patients, there is a very considerable portion that are 
chronic cases that have been going on for some time, and that do not at all 
times need the special supervision of the medical superintendent. He has 
daily brought under his notice by the subalterns, any case that requires his 
special attention.” To the question; “.In those large asylums, the personal 
responsibility of the chief resident there is delegated to his assistant?” Dr. 
Brown replied: “No ; the responsibility rests entirely with him. 
Q,. Eelatively it must be smaller, and therefore he must depend more 
upon his assistants? A. Yes; but he has a large staff of assistants and 
subordinate officers. Ho is the head of the different departments, and every- 
thing that goes on is brought to his knowledge, I think, even better in a 
smaller asylum, where he is doing much departmental work, and perhaps a 
great deal of drudgery. 
Q.' The new registered hospital in Middlesex contains 2,000 patients, does 
it not? A. Two thousand, and Colney Hatch contains more than 3,000.” 
Speaking of the Lunacy Commissioners, he says: “The Commissioners, 
would, I think, not place it below GOO now.” 
* Op. cit. 9 
pletion, insanity lias more frequently blighted our 
children, more broadly stricken middle life, more 
irresistibly tended to become chronic, more rapidly 
and certainly carried its victims to the grave.” (??) 
But all other criticisms and complaints pale before 
the culminant assertion of “unparalleled despotism” as 
the chief characteristic of administration, inherent in 
the American system of hospital government. A start- 
ling assertion when considered in its “ naked deformity; ” 
overwhelming when clothed in the garments of illus- 
tration. “Let us see,” says the critic, “what this 
American system is, by showing the theory and method 
of governing the Asylum at Utica! ” [One is tempted 
to pause and enquire, Why Utica? but the digression 
might prove more entertaining than the main line of 
investigation.] “Nine trustees, a majority of whom 
must reside within five miles of the asylum, are to gov- 
ern it. They make such bydaws and regulations as 
they deem expedient. They appoint the treasurer and 
the superintendent. They, by approval, determine the 
number of employes, and their salaries. They keep the 
only record of their own doings. They inspect their 
own work. They (or their subordinate, the superin- 
tendent) make all purchases. They audit their own 
bills. They report to the Legislature the only author- 
ized version of their own conduct. Neither their 
report, nor that of their subordinate, the treasurer, is 
required to contain such particulars as would disclose 
extravagance or any other abuses. As private owners 
of the institution, they could not have power more ab- 
solute and irresponsible.” (Power enough, and just the 
power one would suppose, if entrusted to nine good 
and intelligent citizens, to insure a most excellent ad- 
ministration.) “But,” our critic continues, “the author- 
ity of the asylum superintendent is, if possible, more 10 
dangerous and unchecked than that of the trustees. 
O 
He is an autocrat—absolutely unique in this Republic; 
supreme and irresistible alike in the domain of medi- 
cine, in the domain of business, and in the domain of 
discipline and punishment.” (We may rest for a 
moment here, long enough to enquire what has become 
of the nine trustees, with their despotic prerogatives 
and powers in the presence of this one man.) But to 
proceed. “He ” (the superintendent) “is monarch of all 
he surveys from the great palace to the hen-coops, from 
pills to muffs and hand-cuffs, from music in the parlor 
to confinement in the prison-rooms, from the hour he 
receives his prisoner to the hour when his advice re- 
stores him to liberty.” “ This unparalleled despotism,” 
continues our indignant protestant reformer, whose 
vision is by no means periscopic, who sees in the in- 
mates of an insane hospital, at least the inmates of 
Utica, only languishing prisoners pitiably yet help- 
lessly and hopelessly appealing to a heartless monster 
for liberty, “ this unparalleled despotism extending to 
all conduct, to all hours, to all food, to all medicine, to 
all conditions of happiness, to all connections with the 
outer world, to all possibilities of regaining liberty, 
awaits those whose commitments may be easily unjust, 
if not fraudulent, * * * is over prisoners the most 
pitiable of human beings, whose protests and prayers 
for relief their keepers declare, and many good people 
believe, no man is bound to respect.” 
Behold the picture. Who does not recognize at once 
the great mogul of Utica, the head and front of hos- 
pital offending, closing the portals of his palatial prison 
house, as secure as Chillon, upon six hundred and odd of 
the most pitiable of human beings, “prisoners” and vic- 
tims, shutting out all intrusion, trustees, commission- 
ers, friends of the unfortunate, the great Empire State 11 
itself, and there gloating over the anguish of the un- 
happy, and revelling in the enjoyment of his “ unpar- 
alleled despotism ? ” What wonder that Utica has come 
to be regarded by certain valiant knights as the castle 
of an enchanter, whose dread power can only be dissi- 
pated by tearing down its walls ? The artist may deny 
that this picture so accurately drawn, so boldly 
modeled, so strongly lighted, so broadly treated, so 
skillfully handled, so harmonious in tone, so deep and 
jet transparent in color, so judiciously subordinated, so 
perfect in action and so truthful in expression, was in- 
tended for Dr. Gray ! It is among the privileges of 
art, if not the duty of an artist, to paint the possibili- 
ties of which a given combination of features is capa- 
ble, and bring out hidden meanings which may lie be- 
neath the superficial appearances of any subject. And 
the picture thus presented may have been really in- 
tended by the reforming artist to portray the features 
and character of each and every superintendent of an 
American hospital for the insane, however difficult it 
might be for other than an artist whose ideal percep- 
tions are not always, or necessarily, embarrassed with 
material facts, to recognize the likeness. In all due 
charitableness let us so accept it, and not for a moment 
entertain the suspicion that any individual, or associa- 
tion of patriots and philanthropists, would commit the 
folly of assailing the whole line of active force now en- 
gaged in administering the public charities of the 
United States in the interest of the insane, for the sake 
of covering an assault upon, to them, the gorgon-faced 
“ dread Hecate,” who presides over the gloomy and 
mysterious castle-keeps of Utica! 
We need not indeed be harassed by such a thought, 
inasmuch as the herald of opposition to the system, of 
which Utica is but the illustration, has proclaimed the 12 
responsibility of the American Association of Superin- 
tendents for all the defects and errors of the American 
system, and their perpetuation. “A system,” pro- 
nounced as “vicious and defective for the care of luna- 
tics—which excludes light and wisdom from without, 
and breeds and screens abuses within.” A system, 
“compared with which the lunacy administration of 
European States is more economical, more humane, more 
effective for good.” A system which, “ably and adroit- 
ly managed, has lulled and misled public opinion; 
shutting out light by arbitrary methods, defying ex-' 
posure and change by the exercise of a despotic author- 
ity which ought never to have been conferred upon the 
managers .of asylums.” [Eaton.] Yes, that associa- 
tion, organized a generation since by thirteen as noble, 
conscientious, self-sacrificing and intelligent physicians 
as have ever ornamented the profession and humanity 
in this country; that association, without the embar- 
rassment of a constitution or by-law, a rule of order, or 
a binding tenet, composed of men who have sought it 
voluntarily, for their own edification and profit, and the 
enjoyment of that perfect freedom of individual opinion 
and expression on every possible subject of interest 
which has ever characterized its discussions ; that asso- 
ciation is now accused of having corrupted public sen- 
timent, perverted public opinion, lulled public appre- 
hension, hocus-pocused public legislation, “crystallized 
hospital despotism,” and become itself a “crystallization 
of old methods and abuses,” and “an obstacle to re- 
form!” “It is not strictly a scientific nor even an 
orthodox medical society,” says Eaton. “It has no 
analogies, so far as we know, in any other country,” says 
the Journal of Mental and Nervous Disease. “It is a 
combination for mutual support and self-defense,” says 
Eaton. “ A trades1 union rather than a scientific, pro- 13 
Sessional association,” echoes the Journal of Mental and 
Nervous Disease. * * “The members” of which 
“know, and feel compelled to keep, all the secrets of 
partisan favoritism, jobbing and extravagance, of which 
asylum trustees are guilty,” says Eaton. Echo thus 
answers echo. 
A formidable indictment, false or true ! Is it true? 
True in part, but not wholly true ? Is there enough 
truth in it to cast a shadow ? Be it as it may, such ac- 
cusations can not be “ whistled down the wind.” Per- 
sistent accusations, if undenied, become in time as 
effectual, in poisoning the public mind, as if sustained 
by proof. Let us consider these matters candidly. 
But, as a proper continent and basis of observation, 
let us affirm: 
Ist. Insanity, although it may be cosmopolitan in 
character, inasmuch as it is everywhere a manifestation 
of cerebral disorder, is not, Mr. Eaton to the con- 
trary notwithstanding, cosmopolitan in the conditions 
of its successful treatment. 
2d. Public provision for the insane and “lunacy ad- 
ministration ” in the United States, do not differ more 
widely from the provision and administration of Euro- 
pean States, nor contrast less favorably than do other 
and equally important institutions. 
3d. All the peculiarities of the so-called American 
system, which by contrast appear as merits or defects, 
bear some definite and unavoidable relation to necessi- 
ties or policies which are peculiarly American—and of 
a potential character, conspicuous enough, however 
readily overlooked by hasty or superficial observers. 
Standing upon this platform, let us now freely admit 
that American hospital buildings are very large—much 
larger than the expressed opinion of the Association of 
has justified. At the same time we 14 
may as freely assert that in this matter, as in many 
others of a public character, professional opinion has 
often had to yield to the pressure of public policy, 
determined by considerations of real or supposed ne- 
cessities of state. The problem of public provision for 
the insane by the American States, some of tliem habil- 
itated with the sovereignty and responsibilities of States 
but yesterday, has been, how to accomplish the greatest 
good for the greatest number, not in accordance with 
unlimited benevolence and unlimited means, guided by 
unlimited knowledge; but with such means as might 
be available for a given purpose at a given time, and 
in accordance with ever present necessities and limita- 
tions. That large hospital structures, as compared 
with much smaller, are conspicuously economical, can 
not be denied. So that, when considered in relation to 
territory, population, facilities for transportation and 
other present and prospective circumstances, it can not 
well be said that American hospitals for the insane are 
injudiciously capacious. Until now even the older and 
more wealthy States have not found it expedient to 
provide State hospitals for all the insane of all classes 
within their boundaries. Large hospitals furnishing,, 
as they do, a wider range for classifying inmates, are 
more desirable as a limited provision, which must em- 
brace inmates of all classes, than smaller structures can 
be, both in a scientific and an economical sense. Large 
buildings, when properly constructed with regard to 
light, heat, ventilation and water-supply, do not suffer 
in a sanatory sense, by comparison with smaller struc- 
tures. Many of the American hospitals have been 
doubled in capacity after years of occupation, without 
adding to the ratio of mortality by such enlargement. 
Take, for example, our favorite illustration, Utica. 
Omitting the first year of its operation as insignificant, 15 
the capacity of the asylum, as indicated by its average 
population for the next three years, 1844-5-6, was 265. 
The death-rate for that period, on the average popula- 
tion, (acute disease presumably preponderating) was 13 
per centum. Ten years afterward, the capacity of the 
asylum, as indicated by population, was for three years, 
1854-5-6, 405. The ratio of mortality on this in- 
creased population was 9 per centum. Within the 
next ten years the capacity of the asylum increased; 
the daily average population for the three years, 1864- 
5-6, being 598. The ratio of mortality for this period 
was 8 per centum. For the period 1874-5-6, thirty 
years after the first period mentioned, the capacity of 
the asylum was, indicated as before, 663, or more than 
twice as great as in 1844-5-6, with a ratio of mortality 
less than 9 per centum, against that of 13 per centum, 
when the population was not half so numerous. In 
estimating facts at their exact value, it is true that the 
death-rate of insane hospital reports needs to be con- 
sidered in the light of many and varied circumstances. 
But, as these facts adduced are, or might be, corrobor- 
ated by the history of nearly every large insane hos- 
pital in the United States, of ten or twenty years’ 
standing, they may be accepted as conclusive testimony 
in their present relation. 
If the assertion that large hospitals afford greater 
facilities for breeding and concealing abuses, has been 
verified by any instance, it could have been true only 
because of the expenditure of less money, and the em- 
ployment of a smaller force of service in proportion to 
the number of patients accommodated than smaller 
hospitals require, and instead of being a probable fact, 
should have been a practical impossibility. Such a 
fault pertaining, as it must, to a special administration, 
should not be attributed to a system, and the testimony 16 
of results should be accepted as the best evidence of 
good or bad general conditions and management. For 
it is true that any general defect of conditions and 
appliances, including buildings—any diminution of ad- 
ministrative force below a requisite amount—any gen- 
eral neglect of well-ascertained duties of professional 
or personal attention to the insane, including matters 
of discipline, exercise, cleanliness, food, rest, amusement, 
medication and nameless minor matters of address 
contributing to common comfort; to say nothing of in- 
difference to, and toleration of, unauthorized and incon- 
siderate seclusion or restraint of patients for the sake 
of convenience or punishment; or even “heroic medica- 
tion” will soon manifest themselves in the tell-tale 
record, if honestly kept, of hospital mortality. 
The cost of hospital buildings in America, whether 
extravagant or not, can only be decided by first ascer- 
taining what the standard of value should be. If we 
are to consider American hospital building in the light 
of a barren necessity required for the purpose only of 
securing and sheltering the insane as so many unreason- 
ing animals, then indeed they must appear to have cost 
enormously too much. If, however, we may consider 
them in the light of public beneficence, colored by the 
enlightened sentiment of an advanced civilization, 
founded and maintained for the purpose of restoring 
the lost integrity of human reason; succoring and sus- 
taining the helpless, and protecting: society from the 
dangerous, yet irresponsible, and especially if we may 
estimate at its true value the aesthetic influence which, 
by their stately architecture, they have exerted over 
the public mind, an influence which has reached and 
affected the insane mind through impressions made 
while in a state of health, we can not conscientiously 
.and intelligently say their cost, as a system, has been 17 
too great. The cost of particular buildings, owing to 
particular circumstances, should in no wise touch the 
general statement. 
The prison-like appearance of American hospitals for 
the insane is a feature which is more complained of 
by others than by those who are presumed to sutler 
from it. To be “behind the bars,” sentimentally con- 
sidered by sane persons, is a condition from which 
they shrink with abhorrence. But, as a matter of fact, 
the window-guard, if not clumsily or obtrusively con- 
structed, attracts but little attention from the insane. 
Those who complain of “bars,” in an insane hos- 
pital, generally are better off because of them; those 
who have no need of “ bars ” are indifferent respecting 
them. 
A great source of error seriously affecting hospital 
reputation lies hidden in the fact that the changed con- 
dition, circumstances, needs, sensibilities and propensi- 
ties of the insane are forgotten by the outside world 
whenever hospital doors are closed upon them. Even 
the most intimate friends of insane persons, worthy and 
intelligent people, as intelligence is rated, who may 
have exhausted the strength of their own patience and 
affection, vainly endeavoring to calm and control a 
maniacal or suicidal member of the family, as soon as 
they have delivered such member, bruised, perhaps, 
and scarred by ropes or irons or violent handling, 
to the more merciful restraints of an insane hospital, 
they begin to think of him or her as sensitively pining 
“behind the bars.” Or, if wrought upon by some 
“reformer’s” account of hospital cruelties, or a more 
dignified reviewer’s essay on “ despotism in lunatic asy- 
lums,” they may fancy him or her painfully languishing 
in the horrible environments of a “ Utica crib.” Alas, 
unhappy Utica! Parent of all that is disreputable and 18 
offensive in hospital history, when will thy windows be 
opened to the light of wisdom from without? When 
will thy doors cease to slam in the face of pitying 
humanity and humble science! 
But this coarse criticism of hospital architecture is 
but an overcoat to the more interior garments of asy- 
lum despotism called u physical restraints,” which per- 
tain more especially to the 'personnel of administration 
than to hospital architecture. By this token, the use 
or disuse of physical restraints, all hospital administra- 
tion, as well as architecture, is to be recognized as evil 
or good, as successful or unsuccessful, and by no other. 
“ The degree of freedom from physical restraints,” says 
the great North American Reviewer, “ is at once the test 
and measure of good asylum management ” Abolish 
all semblances of physical restraint, remove all bars 
from windows, and all locks from doors of insane hos- 
pitals—destroy all camisoles, muffs, mitts, straps, strong 
rooms, and especially all cribs (which smell of Utica) ; 
domicile your madmen and imbeciles in cosy cottages, 
with pleasant outlook and garden privileges—establish 
for them schools, gymnasiums and work-shops—employ 
only educated saints in sufficient numbers for com- 
panions, teachers and comforters—withdraw all au- 
thority from the medical superintendent to prescribe or 
enforce rules or treatment, not previously suggested and 
approved by officers of “higher grades,” unaccustomed 
to the care and treatment of the insane—appoint a 
series of officials, to watch over and report eachother’s 
doings—remove such appointments from the reach of 
political influences—in short, reconstruct American 
society, abolish human nature, modify the conditions of 
cerebral disorder, and especially change everything rela- 
tive to hereditary traits of character, education and 
habits of thinking, and ring in a millennium of lunacy, 19 
or be denounced as despots and obstructionists; is about 
the alternative presented to the managers of American 
hospitals for the insane at the present time, by men 
who'demaud that the public regard them as wise, and 
all who disagree with them as worse than foolish. 
A further discussion of the use and abuse of re- 
straint in the management of the insane would seem 
to be superfluous, yet it is persistently forced upon us. 
Certain it is, that whatever abuse of restraints is still to 
be found in hospital practice, in American institutions, 
it is not general, nor is it approved by medical 
superintendents, individually or collectively. If we are 
to believe the reports which they make of their own 
conduct, the use of mechanical restraints, exclusive of 
hospital buildings, is reduced to a low figure in Amer- 
ican hospitals, and limited to exceptional cases, where, 
as a matter of professional judgment, such restraint 
is preferable to manual force of attendants, chemi- 
cal restraints, or an unrestrained condition; a matter 
which does not involve the question of humanity, 
any more than does a matter of choosing between 
the use of zinc and iron, quassia and quinine as tonic 
medicines. 
So too, respecting open doors, and the use of cot- 
tages as appendices to general hospitals, furnishing a 
cheaper or a more approjDriate provision for mild, inof- 
fensive, and variously imbecile patients; a class that 
has been gradually accumulating, and will continue to 
accumulate, with the growth of States, and without re- 
gard to the existence of sanatory institutions. There 
is no reason why such provision should not be adopted, 
and certainly no obstruction of a general or formidable 
character is being placed in the wTay of so innocent an 
experiment by “asylum doctors” or others. 20 
But after all we have the question left—the great 
question—“ human nature being as it is,” of personal 
authority in the management of the insane. This “ au- 
tocracy—anomalous and unique in this republic,” 
What of it? The problem of authority, delegated or 
assumed, by which one man may control the actions of 
another, although the one may be wise and self-pos- 
sessed and the other a madman or a fool, is never with- 
out interest to any man born of Anglo-Norman or con- 
sanguineous ancestors. As American citizens we are 
jealous of our unalienable rights, especially the right 
of self-control, and do not readily surrender them with- 
out contest, even though insane. It is true, also, that 
but few men are so generously endowed by nature, and 
so well self-poised by training, as to be safely trusted 
with the autocratic power which, within a certain 
sphere, is essential to the successful management of an 
insane hospital in America. It is for this reason that 
the most learned neuro-psychologist, the vainest neu- 
ropath, the most conspicuous instructor of the feeble- 
minded, or the most conscientiously [misinformed phi- 
lanthropist, is not, necessarily, qualified to superintend 
an insane hospital, or to criticise judiciously the merits 
or the conduct of those who are so qualified. There is 
no other human relation, official or other, like that of a 
medical superintendent of an insane hospital .to its 
population. The conditions of his authority can not all 
be specified, because the conditions vvhich he has to 
meet with authority can not be anticipated. His gov- 
ernment can not be otherwise than largely personal, 
because the conditions requiring government are indi- 
vidual and personal. Large discretionary powers must 
of necessity be delegated to him. Yet, not larger or 
more dangerous than is delegated by common law and 
the statutes to the fathers of families, or the guardians 21 
of wards, in all civilized countries, and for the same 
general reason, viz., the irresponsible condition of those 
who are consigned to him for government. It is true 
that mistakes may be made in the selection of men for 
superintendents. It is probable that the very best are 
not always chosen. But a good administration can not 
be secured through incompetent or even bad officials by 
depriving them of authority to do that which must in 
some way be done—nor need a bad administration be 
expected of competent and exemplary officers because 
invested with discretionary powers. To deny that such 
powers may be and are, sometimes abused through 
ignorance, or lack of the highest order of character and 
qualification, would be to write oneself down “an ass.” 
That errors of administration, errors of professional 
opinion and practice, undetected neglects of duty, de- 
ceptions and concealments, and even exceptional cruelty 
of conduct, may and do occur in rare instances in hospi- 
tals for the sane or insane, may be frankly admitted. 
But such things are incidental to human relations of 
every character. More insane persons are ill-treated, 
injudiciously restrained,neglected and otherwise abused 
while among friends in the family relation, than suffer 
from similar treatment in the least reputable insane 
hospital in America, proportionately considered.* But 
* Dr. Crichton-Browne, English \ isitor in Chancery, says, Parliamentary 
Report, page 73 : “It has fallen to my lot to admit hundreds of lunatics 
covered with bruises, and with broken bones, or with other marks of injury 
and violence. Frequently they are taken to the county asylums, tied up with 
ropes and in strait waistcoats, and restrained in a way that never would be 
tolerated in an asylum at the present time. 
Q. Personal chastisement is not resorted to, I suppose? A. It is never 
heard of in asylums. An attendant may lose his temper and commit vio- 
lence upon a patient, but such a thing as deliberate chastisement is out of 
question in asylums, although it does occur, I believe, amongst private cases 
sometimes. One of my colleagues brought to the knowledge of the board a 
case in which a birch rod was kept for the correction of a private lunatic. 
Q. In those cases you mention in which marks were found upon lunatics. can such incidents be placed beyond the range of pos- 
sibility or probability, in hospital administration, by 
the adoption of new methods? Welcome the day 
when such shall be devised. Sancho Pauza’s gratitude 
to “ the man who invented sleep ” was not greater than 
ours should be for such a consummation. But certain 
it is no such methods have as yet been suggested, 
much less put in practice. English methods, Scottish 
methods, Belgian methods, Grheel itself, with the canon- 
ized bones of St. Dymphna thrown in, have not accom- 
plished so desirable an end. 
The proposition of “American reformers” to convert 
the limited and responsible autocracy of present meth- 
ods into an aristocracy of hospital officials of various 
grades, who, appointed by American methods, would 
become either more despotic and irresponsible by com- 
bining in a common interest, or disastrously weak and 
inefficient by dissensions and antagonism, does not 
promise well to comprehensive and considerate minds. 
It would be folly to attempt to govern insane men 
by such methods—not even by party caucus, and 
stump oratory of the most eloquent could it be 
done. Sane men—those who need to be governed, 
can not be well governed so. Insane men can not 
await cabinet consultations nor the possible dead- 
locks of conflicting differences of opinion. The 
greatest possible wisdom and liberality of govern- 
ment, is not incompatible with large discretionary 
power. The most arbitrary and ungenerous rule may 
be established and exercised by majorities, committees 
.that would not be from ordinary chastisement which was part of the system 
of the asylum, but from the unauthorized assault of an attendant ? A. In 
those that were brought to the asylum the marks were due to assaults by 
relatives and friends. In those cases the marks of flogging have been dis- 
covered.” 23 
of safety, vigilantes and the like in the name of hu- 
manity and liberty. It is not the latent existence of 
force in nature that is significant, bat its applied activi- 
ties. It is not the possession of power that character- 
izes government, but the use which is made of it. And 
it will be found, if closely scrutinized, that the reputa- 
tion, characteristics and success of insane hospitals in 
the United States and elsewhere, correspond to the 
character, ability and attainment of their medical su- 
perintendents, and the manner in which they have been 
sustained in authority by trustees and legislators, rather 
than to the merits or demerits of any prescribed sys- 
tem of administration.* 
Among those who are now most clamorous for struc- 
tural and administrative reformation of American pro- 
vision for the insane, there are persons who are not free 
from suspicion that they are more interested in revolu- 
tionizing present methods than they are in general 
results. There are others, many, who are simply zeal- 
ous and inconsiderate—men who, seeing but one corner 
of a thing, are incapable of comprehending that there are 
necessarily other corners which it would be worth while 
to find out. The inference of hospital critics and re- 
viewers, that managers and medical officers of American 
institutions, are, with a few notable exceptions, selfish, 
dishonest, criminal and despotic, simply because they 
* “ On examining closely the general condition of asylums, those are almost 
always found to he best managed in which the physician is the superin- 
tendent one, and supreme—in which the committee of visitors act only 
through him and with his advice—and in which the appointment and dis- 
missal of all attendants are delegated to him ; and those are found to he 
least satisfactory, in which the responsibility is divided—in which the com- 
mittee of visitors or controlling board meddle in the internal management of 
the institution, and direct themselves, or through other officers, any part of 
it, appoint and dismiss attendants, or clip in any way the authority of the 
medical superintendent.” (Report on Lunatic Asylums by Frederic Norton 
Manning, M. IX, to Her Majesty’s Colonial Secretary for New South Wales.) have an opportunity to be so, “ human nature being as 
it is,” is as narrow-minded and malignant as the most 
orthodox believer in the dogma of “total depravity” or 
the devil himself, the arch-enemy of virtue and the hu- 
man race could desire, and worthy only of the contempt 
of an enlightened people. Yet there are multitudes 
who have been and will be influenced by persistent and 
earnest assertion of inferences, no more accurate or 
philosophical; persons who are always ready to incline 
their ears to receive any imputation of wrong-doing on 
the part of others, especially such as may have become 
more prominent than themselves in any of the more 
reputable walks of life. 
That the Superintendents of American Hospitals for 
the Insane should become conspicuous marks for consti- 
tutional detractors to expend their envious arrows on, 
is not a matter which should astonish the thoughtful. 
That they should be denounced as despots and obstruc- 
tionists by the same class is not to be wondered at. 
Notwithstanding the fact that there are no officers in 
public service whose most trivial acts are so known 
and commented upon and so exposed to misconstruction 
and unfriendly criticism. Notwithstanding legislative 
and judicial investigations, industriously and sometimes 
malignantly prosecuted, have seldom failed to vindicate 
their general conduct. Notwithstanding they have 
kept pace with the progress of science and humanity 
wherever recognized, reserving only a certain self- 
respecting right of independent judgment of what is 
scientific and what is humane. Notwithstanding their 
readiness to conform these hospitals structurally and 
administratively to all modifications of conditions and 
circumstances which may affect hospital population, in- 
cident to natural causes; whether it be the gradual 
diminution of the use of mechanical restraints corres- 25 
ponding with the accumulation of chronic inmates, or 
the overflow of quiet, homeless lunatics no longer re- 
quiring hospital treatment, into detached buildings of 
less expensive character. Notwithstanding they are in 
their associated capacity less dogmatic, dictatorial, or 
limited by fixed ideas, constitution, creed, or code, than 
any other organized society on earth. Notwithstanding, 
in their individual capacities, crippled as they have 
been and always will be, more or less, by the inevitable 
subordination of professional ideas, to the necessities of 
political or pecuniary exigencies, they have accomplished 
general results in their treatment of the insane, which 
compare favorably with the general results of the most 
vaunted hospitals and asylums of the old world. In 
their association they have always maintained the 
widest freedom of discussion, and have had before them 
in the thirty-five years of the existence of the Associa- 
tion all the problems, great and small, which concern 
the whole field of psychological medicine, and no 
adulations, threats or attacks have, or ever will swerve 
them from their course. Their records will show their 
work. 
Compare, for example, the fact that the ratio of re- 
coveries on the whole number of insane persons admit- 
ted to the Pennsylvaia Hospital for the Insane for forty 
years, ending with 1880, as reported by Dr. Kirkbride, 
“in whom,” it may be said, if of any man, “there is no 
guile,” has been forty-five per centum, with the fact 
that the ratio of recoveries, as reported by the honor- 
able Commissioners in Lunacy, for 1880, on the whole 
number admitted to all of the public asylums and 
hospitals in England, idiot institutions excluded, 
for the year, was thirty-eight per centum.* Or, com- 
pare the results of thirty-eight years’ operation of the 
* Journal Mental Science, January, 1881. 26 
asylum at Utica, from its opening to the end of 1880r 
showing a ratio of recoveries on the whole number ad- 
mitted, of thirty-seven per centum, with tbe English 
results above quoted! A showing quite satisfactory 
when it is remembered that this exhibit of American 
results is drawn from a period of forty years, during 
which, if our critics and reviewers are to be believed, 
no progress has been made by Americans; while the 
English showing is from the operation of but one year, 
tbe last of thirty-five, since when English methods and 
practice have been declared by them as steadily pro- 
gressing and improving! 
But, lest some one might think this comparison lim- 
ited and partial, compare the fact that the ratio of 
mortality on the average population in all of the 
English asylums and hospitals for the year 1880, as 
reported by the Lunacy Commissioners of England,. 
\Jour not Mental Science, January, 1881,] was nine and 
sixty-three one hundredths per centum, with the fact 
that the ratio of mortality for the same period, on the 
average population in the Pennsylvania hospital for the 
insane [Official Report, 1880] was seven and seventy- 
five one hundredths per centum, and the fact that the 
ratio of mortality for the same period in the Utica asy- 
lum w~as six and eighty-nine one hundredths per 
centum. 
The uncharitableness of ignorance only would be 
illustrated by an attempt to draw conclusions from 
these facts derogatory to the English system of caring 
for the insane, or to institute invidious distinctions in 
favor of American hospitals. The facts are creditable 
to both English and American institutions. And we 
may frankly confess that which it would be presump- 
tuous and arrogant to deny, that English asylums and 
hospitals and English methods of administration are- 27 
the best possible, considered in relation to English char- 
acteristics, personal and institutional—while we should 
not hesitate to demand for American hospitals and 
methods, in the light of such results, a like respectful 
consideration. American intelligence can be trusted to 
find out and to appropriate whatever is useful or profit- 
able in civilization, and to so far modify or reconstruct 
American institutions of whatever character, political, 
social, educational, or charitable, as to harmonize them 
with the necessities of any given time or combination 
of circumstances. The American people are neither 
obstructive nor obtuse to whatever is good, or advanta- 
geous—nor are they slow to act in the direction of 
their higher perceptions—but not even they can afford 
to fly in the face of established facts or to ignore the 
experience of the ages. 
Cincinnati Sanitarium, June 6, 1881. 28 
DISCUSSION. 
Dr. Workman, following Dr. Everts, read a paper on 
a Some Points on the Management of American Institu- 
tions for the Insane.”* 
The Association then proceeded to discuss the papers 
read by Drs. Everts and Workman, and were called upon 
by the Vice President in turn as they sat in the room. 
Dr, Bucks, of London, Ontario, said : Mr, President, I have 
listened to these two papers with as much pleasure, I think, 
as I have ever listened to any papers read in this Association, 
which is saying a great deal, I have very little indeed to 
say about them, but I just want to make one remark which 
is applicable to both papers. I* think that one of the great 
vices of the human mind is its tendency to what we may 
call finality. In every department of thought and life, and in 
every age there has always been an immense majority of the 
human race in any given state, or in any given country, who have 
thought that the end was reached. This remark is just as appli- 
cable to times of comparative darkness—of thousands or hundreds 
of years ago— as it is to-day, and a very little reflection would 
convince any person that the tendency is as little justified to-day 
as it was in the past. 
In the care and treatment of the insane enormous advance has 
been made, even within the last few years, and if we go back hun- 
dreds of years the advance is so great that we can not estimate it. 
The inevitable tendency is to think that the work is done. 
Now, although we can not see beyond where we are, it is just 
as certain that we are going to advance and go forward, as it is 
that the earth is going to continue to revolve around the sun. 
The direction in which we are going to advance, and the position 
towards which we are advancing, we can not say, but we should 
be very careful, I think, to condemn any suggestion tending 
forwards. I know even during my life that things are done— 
plans are carried out in asylums—that in my recollection would 
not have been thought possible, and the idea of which would have 
been hooted at. Even in my own asylum, I have 180 patients 
who are subject to no restraint, who go about as they please, who 
have all the privileges almost of sane people, and still they are 
just as insane as any other part of the population of my asylum. 
It would not have been thought possible, twenty or fifty years 
in the July Number of the Journal of Insanity. 29 
ago, to maintain lunatics in sucli a way. Not only is this true,, 
but no evil has ever resulted from this increase of freedom, so that 
I am inclined to think more and more that the same freedom could 
be extended, although I might be very much afraid myself to 
extend it. Still I am satisfied that, although I may not do it, it 
will be done. I must say I very much prefer to see new ideas 
encouraged than to see them treated with levity, simply because 
they are new and untried. Of course it is very certain, as every 
one knows, that for every good idea advanced in any department 
of human life, there are a hundred very poor ones. At the same 
time I am inclined myself to look favorably upon every new idea, 
so far at least as to give it full consideration before discarding it, 
and to believe that we have not reached the end of our journey yet. 
Dr. J. Z. Geehaeu, of Harrisburg, Pa., said: I do not think 
I can let this opportunity pass without saying at least a few 
words. I was pleased with the remarks of the gentleman who 
just preceded me (Dr. Bucke). There was much in the papers 
read here this afternoon that I enjoyed. Although I speak 
as a very young member of this Association—and I hesitate to 
speak in this body, particularly in the presence of so many old 
members—yet I wish to add my views to those that Avere ex-- 
pressed by the speaker who preceded me. There is a feeling 
sometimes among men who are engaged in any special Avork that 
they are doing just right, that they have reached the highest 
point of excellence, and that there is no room for progress or 
advancement. Yet 1 believe that in the course of time (particu- 
larly with those who are young) we shall see many things differ- 
ently from what Ave do now, and be able and willing to admit 
ideas that we now consider very absurd. 
In the State from which I represent an institution, there is a 
feeling that something different should be done in connection Avith 
our hospitals. This feeling has manifested itself in such a strong 
manner that the organization of some hospitals has been changed 
to a certain extent. Efforts have been made at different meetings 
of our Legislature to change them still further. This desire for a 
change manifested itself very strongly in the last meeting of the 
Legislature, and there were very animated discussions on the 
organization of our hospitals. Radical changes have been made 
in tAvo of the hospitals in Pennsylvania. Some men engaged in 
hospital work in the State are not in sympathy with them, others 
are, and mean to respect the sentiments thus expressed, to give 
them a fair chance with the hope also that they may be a success, 
and with the determination that they shall be a success. 30 
Dr. T. M. Franklin, of Blackwell’s Island, N. Y., said; I can 
hardly resort to the same apology that Dr. Gerhard has offered in 
advancing his views here—that of extreme youth—but, perhaps I 
may say that, although a new member of this Association, I have 
been so long an interested observer of its workings and spirit, 
that neither of them is new to me. While a student, it was my 
privilege, as guest of Dr. Earle, of Bloomingdale, to be present at 
one of the sessions held by the now famous “ original thirteen ” 
who inaugurated this movement. I think it was the second meet- 
ing—the first having been held at Philadelphia. 
Coming as I do from the State of New York, to which crimes 
against the insane of so many sorts have been attributed by those 
to whom allusion is made in one of the papers to which we have 
listened—belonging to the city of New York, and representing 
its female lunatic asylum—an institution habitually, semi-periodic- 
ally, persistently and maliciously attacked, I can hardly maintain 
silence when the subject of these papers is under discussion. 
We have a managing board, as you all know, politically com- 
posed, but, with its present organization and membership, I believe 
that, during the three years I have been connected with it, all has 
been done for the institution that the commissioners believed their 
peculiar and trying position would permit. As to visiting boards, 
inspecting boards and committees of sundry varieties, we have 
plenty; but we have, worse than all, people given to visitation 
and criticism, who belong to that “border-land” to which allusion 
has been made, and while we all know that “ border-land ” cases 
make us the most trouble, those nominally sane outsiders who are 
not under our control, sometimes behave still worse. 
In regard to the question raised by Dr. Workman, as to the 
possibility of our being protected by boards, I am almost hopeless 
in this matter, I believe that years ago institutions for the insane 
under the control of individual States were not much influenced 
by politics. They are growing to be more and more so influenced. 
Of course the institutions of our large cities are very much so 
hampered. 
As to our boards of management and the best methods of ap- 
pointing them, I believe, sir, that any board composed of three or 
four reliable men (just enough to give vaxaety to judgment) who 
have sufficient intelligence and education to learn how properly to 
investigate and oversee an institution—who are untrammeled— 
who are willing to give due time to the work, and will bring to 
it patient perseverance, who will intend to know wdiat is doing and 31 
to become competent to pass judgment thereupon, will be perfectly 
able, no matter how appointed, to do all that is needful. In other 
words, innate reliability, acquired competency and individual inde- 
pendence, are the requisites. We know that the ordinary “ com- 
mittee of investigation ” on management has not the practical 
knowledge requisite for getting at the state of an institution, and 
the true features of its conduct. We all know that such a body 
goes through an institution and comes out knowing very little of 
the internal workings of that institution. I venture to say that 
any member of this Association would feel, if he had an investiga- 
ting board appointed by a senate or other authority go through his 
institution, that he was not properly inspected. If, then, he had any 
experienced member of this body come later, with power and de- 
termination to inspect his institution, he would think now I shall 
be thoroughly seen. That one man would shortly acquire such 
insight into your condition and management, as would astonish 
anv committee and would do justice. 
Boards and committees, as actually constituted, are sometimes 
hampered by political connections, through which they dare hardly 
break, or by aspirations of some sort which they do not wish to 
jeopardize. No such organization can be relied upon as “a break- 
water” for the medical Superintendent when attacked. I think 
the safety of a superintendent consists mainly in coercing his 
board of management into a familiarity with his doings, in making 
its members conversant with the details of daily movement, in 
taking them as it were into silent partnership in all work, and 
therefore into partial responsibility through knowledge. Then if 
he gets into trouble that board must either stand by him in his 
trouble, or prove recreant to its trust. 
Dr. J. B. Andrews, of Buffalo, N. Y., said: I have but a few 
remarks to make upon the papers which have been read. The 
paper by Dr. Everts is an interesting one, though he has had to 
deal with what has become a somewhat trite subject, the criti- 
cisms upon asylum matters in this country by those who would 
occupy the role of reformers. These criticisms are of the most 
incoherent and impracticable character, and for this reason it is 
impossible to discuss them in a satisfactory manner. The Doctor 
has evidently labored under this difficulty. 
Fault is found with the lunacy laws and the details of their 
administration, with the conduct of the external and internal 
affairs of institutions, and with those who are intrusted with their 
charge. In short, nothing is right or worthy of commendation. 32 
and the most radical changes are demanded. Such wholesale 
criticisms are neither right nor reasonable, and those who make 
them seem actuated by a spirit of destructiveness, and a deter- 
mination to overthrow everything which has grown up as the 
result of practical experience. They are founded largely upon 
loose, and sometimes false statements of comparisons, and upon 
specious reasoning which takes the place of knowledge, while the 
unprovoked attacks upon individuals place them beyond the limits 
which entitle them to any reply. 
Dr, H. P. Mathewson, of Lincoln, Nebraska, said: I was de- 
sirous of meeting with this society, and have been gratified by the 
taking up of this question, which is a very interesting one. It 
appears to me that the successful management of the insane must 
depend largely upon the individual capacity of managers them- 
selves—that person who is sufficiently vigilant to take up each 
case and treat that case as it needs, will best succeed. If we could 
lay down rules for the treatment of the insane, it might be differ- 
ent ; but we may as well expect to lay down rules for everything 
else in the way of treatment. I do not suppose we are going to 
find anything more than general rules for the management and 
treatment of all our cases. If we had a specific for all diseases, 
the practice of medicine would be very easy. So in the manage- 
ment of insane, if we had a specific treatment, the greatest novice 
in the world could succeed. My knowledge of the treatment of 
the insane certainly is limited, but I have learned that we can not 
treat the insane all alike. We have to treat them as individual 
cases, 
I was very much interested in the paper of Dr, Everts. Of 
course I have seen through the papers and in various ways noticed 
the large number of persons in New York, who are agitating a 
different treatment and management of the insane. I know some 
of the leaders, and I am confident that they know as little about 
it as an equal number of inexperienced persons upon any other 
subject. I do not believe they are actuated by honest motives, 
although I may be wrong about that. But one thing we may do 
well to consider, and that is, the proposition that reform “ generally 
comes from the. outside,” and we ought to be willing to accept the 
situation. All suggestions coming honestly and conscientiously, 
we ought to take in good faith. 
For my own part, I do not suppose that persons not accustomed 
to the management of the insane are going to learn all about it by 
theory. It must come mostly from practice and observation. The 33 
person who is determined to be vigilant and cautious, is most 
likely to best succeed. My impression is, that there is an immense 
amount to be learned in the care of insane people. We do not 
have to look back far to see improvements and reform in the care 
of the insane. Doubtless there is a large amount to be done in 
that direction, and I think we ought to go slowly in our criticisms 
in regard to these suggestions. 
I am glad to meet with this Association, and to listen to the 
comparing of different views and facts. I did not come expecting 
that I should add anything, or even to suggest anything that 
would be of use or value, but I am glad to hear every man’s views 
in this society. Every man is strange to me. There is not one 
person here that I have ever seen before; but lam very glad to 
see you, gentlemen, and to make your acquaintance. 
Dr. A. M. Fauntleroy, of Staunton, Ya., said: I have but 
little to say beyond the expression of the pleasure with which I list- 
ened to the reading of the critique by Dr, Everts. It is an 
admirable and biting satire upon the conduct of those self-consti- 
tuted guardians of the insane, whose main business in life seems 
to be that of carping or fault-finding with asylum management. 
Doubtlessly we shall always have trouble as long as there remains 
one of that class of microscopic philanthropists whose “principal 
focal distance ” rarely ever falls within the “ visual field ” of their 
own co7icerns. If nay man takes an asylum, expecting it to be 
“ a bed of roses,” he is very much mistaken. And the only course 
which promises satisfaction to an asylum official, is to be found in 
the conscientious and persistent efforts to secure for those who are 
the tender objects of his solicitude and care, all the means which 
enlightened experience has shown to be most promotive of the in- 
terests and welfare of the insane. 
In the proud consciousness of duty fulfilled, there lies capsulate 
the true psychological antidote to the annoyances which may 
never cease to arise this side of the advent of the millennium. 
Dr. A. P. Reid, of Halifax, Nova Scotia, said: I prefer to listen 
rather than talk in these discussions. There is a pleasure in listen- 
ing to the different gentlemen giving their experiences of asylum 
management, or on any subject bearing on the treatment of insan- 
ity. It appears to me that in thirty or forty years at farthest, we 
have the largest portion of this continent supplied with buildings 
established for the care of the insane, and that we have reached so 
near perfection as to have but little fault found with the manage- 
ment of these institutions, is cause for self-congratulation. I do 34 
not know that we could get any other political machine to run as 
satisfactorily, because asylums for the insane must be considered 
more or less (if not all) under governmental supervision. It ap- 
pears to me that we are in a state of improvement. Insane asy- 
lums have greatly progressed until now they can well be called 
“hospitals for the insane.” I do not believe we will reach the 
highest success in hospital treatment until we get further towards 
the cure of mental diseases. 
I do not suppose that anything causes so much alarm to outsid- 
ers as the so-called “ restraints.” Many, from ignorance, appear 
to act on the assumption that superintendents of hospitals for the 
insane are not governed by feelings common to the race of human- 
ity, whereas, the principles guiding the management of every asy- 
lum I have ever visited, have been how much liberty and pleasure 
can be given to the insane. They desire to give all that is possi- 
ble, having a due regard to the patient’s benefit. I feel quite 
confident that it would be well for the public to know what superin- 
tendents aim at. The business and pleasure of every superintend- 
ent is to give every patient all the liberty possible, consistent with 
proper care and cure. 
Dr. Wm. B. Goldsmith, of Danvers, Mass. I only wish to 
state with reference to Dr. Workman’s paper that I entirely agree 
with him as to the value of an expert supervisory board in the 
care of the insane. Ido not think it would materially change the 
better class of asylums in the United States. In them the inspec- 
tion of such a board would probably be largely a matter of form, 
as it is in institutions of a similar class elsewhere, but I think it 
would aid in securing a more uniformly good care for the insane, 
and render it more difficult for institutions to fall behind, or never 
reach a fair grade of excellence as they may now do in the States 
without general professional notice. I also think that it would be 
a protection to superintendents, and that it could fulfill most im- 
portant duties in cases of patients possessed of property, and in 
rendering a variety of provision for the insane safer. There are 
many instances where the fi'iends or guardians of patients have 
great difficulty in determining how they had best plan and pro- 
vide for their charges, and whether they receive a fair equivalent 
for their outlay. There are also cases where a proper amount of 
the patient’s property is not expended on their care. In these 
matters I think expert authorities should advise or decide. 
Their oversight is also important in rendering a variety of pro- 
vision for the insane safer. Without it I regard much variety of 35 
provision entirely unsafe, for there is no security for good treat- 
ment in private dwellings or asylums unless the amount of money 
involved is sufficient to secure the services of a humane and culti- 
vated man, who has social standing and professional reputational 
station. With supervision I think the private home treatment 
admirable in many cases, without it I think it is to be condemned. 
I do not know whether Dr. Workman appreciates the force of one 
point he made as fully as I do. That is the difficulty of securing 
competent inspectors or commissioners in the States. 
Though the appointment of a properly constituted board meets 
my approval, I regard the appointment of one improperly consti- 
tuted as worse than useless, and the exercise of such authority 
without knowledge as very bad. In many of our States, at 
present, I think it would be found impossible to secure competent 
men to take the field. It is not a position in which a young man 
should win his spurs, but one that requires the experienced and 
judicial mind of mature age, and a proper candidate usually occu- 
pies a more stable position with higher salary than often goes with 
such appointments when our State legislatures govern them. I 
think this difficulty the great one in the United States, but the 
plan is good. 
Dr, Strong. I think it is obvious that we can not conclude this 
discussion at the present sitting, and I would, therefore, suggest a 
recess until 8 o’clock. 
Dr. G undry. I move to adjourn the discussion until to-morrow 
morning. I should like to take part in the discussion, but I can 
not do so this evening. 
On motion, the Association adjourned to 9 a. m., 
Wednesday, June 15. 
June 15, 1881. 
The Association was called to order at 10 a. m., by 
Dr. Callender. 
The minutes of the proceedings of yesterday were 
read and approved. 
The Secretary read a letter from Dr. T. J. Mitchell, 
of Mississippi, expressive of his regret at his inability 
to attend this meeting. 36 
Dr. Callender. On adjourning yesterday the Association had 
tinder consideration and for discussion the papers read by Drs. 
Everts and Workman, and Dr. Hughes was about to take the floor. 
Dr, Charles H. Hughes, of St. Louis, said; I have been a 
member of this Association for a number of years, and have been 
a constant observer of its work. Formerly I looked at the work 
of this Association from the inside of an asylum, I have been 
able, during the last seven years, to take an outside view of its 
workings, and I must say that my observation of the work of this 
body, as referred to in the paper of Dr. Everts, has been as satis- 
factory to me, viewing it from the outside, as it did when I viewed 
it as an asylum superintendent. I have contributed my own ob- 
servation in a practical way, to a verification of most of the prop- 
ositions which have from time to time been promulgated by this 
body, and I have found them to bear the test of experience. In 
fact, it does not occur to my memory that any similar number of 
propositions that have ever been made by any medical body, so 
long existent as this one has been, has been enabled so well to 
stand the test of time. 
Now, there are two ways of viewing the subject of insanity 
and its relations. Metaphysical conceptions—theoretical opinions 
of what insanity ought to be, and of what ought to be done with 
the insane, are generally the first that present themselves to the 
mind of a medical man when his attention is turned to the subject. 
Theoretical conceptions of wdiat insanity ought seemingly to be,, 
frequently lead gentlemen to the formation of opinions as to its 
management and treatment very much at variance with the sug- 
gestions of actual experience. 
Doubtless it has occurred to many a member of this Association 
that, in the beginning of his career upon taking charge of an in- 
stitution for the insane, he has had theoretical conceptions of what 
insanity was, and formed conclusions based upon those theoretical 
conceptions, as to how the insane ought to be managed. And it 
is in the experience of every member of this Association, that ob- 
servation of the insane—familiar intercourse with them—connected 
with those influences which have to do with their welfare, with 
legislation and boards of management—has led each and all of 
us to conclusions with regard to their management different from 
those which were held upon entering the special practical study of 
mental aberration. 
This Association needs no defence, and it never would have 
occurred to me to write a paper in defence of the practical propo- 37 
sitions of this body, because they are the formulated convictions 
of experience. Ido not understand that the paper of Dr. Everts 
lias been offered for that purpose. The point of the paper, that 
this Association has not been obstructive or retrogressive, or not 
progressive, certainly needs no defence. We need but look at the 
history of insanity in this country during the past half a century 
and compare the present ameliorated condition of the insane with 
their past—which has been the work of this Association and the 
work of government through them—for a historical proof of the 
good work that has been done by and through this body. Errors 
have been committed by architects, adornments have been added 
to buildings which have never been suggested by this body, ex- 
penditures have been made not warranted by any of the proposi- 
tions of this Association, and other errors of omission and com- 
mission have been committed for which we are not at all 
responsible. 
Gentlemen, outside of the specialty, are accustomed to point 
with commendable pride to the heroism of medical men in times 
past, to the spectacle of 'V esalius, tor example, making the first 
human dissection at a time, and in an age, when it required 
courage to face a frowning world, triumph over adverse public 
opinion has added no greater laurels to the brow of victorious 
and progressive medicine than that sublime spectacle which took 
place in the dungeon cells of the Bicetre, when our own Pinel, in 
the face of opposition equally as great, struck the shackles from 
the lunatics there confined and recognized those insane persons as 
friends and brothers, casting to the winds tire theoietical dogma 
that they were fiends incarnate, ihis was the work of psychiatry 
and it was the work of our profession. It was the work done 
inside of asylums. There is where it began, inside of the asylum 
circles, and where it has resulted in benefit to the race. It was 
the beginning of that reform in psychiatiy, that practical and 
beneficent form which has been going on fiom the days of Pinel 
to the present time within the asylums. 
The first impression that I received from my intercourse with 
members of this Association in official capacity, was that of their 
earnestness in behalf of the insane, and subsequent repeated 
attendance upon the meetings of the Association and visiting of 
institutions throughout the country impressed me with the fact, 
that if ever there was a set of men alive to the truest interests of 
the insane it was the superintendents of the American hospitals. 
The presence of this body of men was always an inspiration, and 38 
I never went among the members of this Association, either as 
superintendent of an asylum, or since, that I did not acquire an 
enlarged conception of the rights of the insane which I had never 
thought of or heard of outside. If there has been a body in exist- 
ence which has kept constantly in view the rights of the insane, it 
has been this body, and it is that subject which occupies the 
attention of all of us—the rights of the insane. Their right to 
the largest liberty compatible with their welfare, and that higher 
right than liberty, which, if they could speak as others speak, they 
would demand of us the right to that scientifically regulated re- 
straint which conduces to their speediest possible restoration to 
the usefulness of rational life, and any men, or any body of men, 
who are regardless of this right, inflict upon the insane—these 
helpless wards of those who ai'e more fortunate than they—a 
wrong far greater than the deprivation of liberty. 
One could not discuss the propositions of these papers without 
exhausting much more time than the papers themselves occupied. 
The points of Dr. Workman’s paper in the main were points upon 
which this Association is committed as the detrimental influence 
of frequent rotations in office. Political changes in medical 
officers of hospitals for the insane conflict so sadly and so seriously 
with the rights of the insane that the fact needs but to be men- 
tioned to be condemned, because if there is any one right above 
another that the insane would demand of us, could they speak as 
we speak, it is that in the days of their calamity they might 
receive from us, or they might receive from those States, which 
assume to take charge of them in their affliction when they can 
not care for themselves, that ministering medical care which can 
only come from experience and observation, and when asylum 
physicians are changed, as they are in some of the States of this 
Union every two years, it is a farce and a travesty on justice to 
say that the insane man, who is a ward of such a State, is accorded 
his rights when he has to receive only such medical attention. 
The principle of the proper treatment of insanity is somewhat 
akin to the increased experience and skill required to navigate a 
ship, where laws are framed for the purpose of securing life, per- 
sonal safety, not at the hands of novices but experienced seamen. 
How much more important is it that States should be particular to 
see and provide that skill and experience should be furnished to 
the hospitals for the insane, and that the tenure of office of med- 
ical officers of asylums should not be subjected to those changes 
which are dependent upon party exigencies. 39 
In regard to the question of inspectors, there can he no objection 
to an inspection per se in stable governments like Great Britain, 
not subject to those periodical changes which sweep biennially and 
quadrennially over our States and our country, where there would 
be great danger in having one more asylum officer added to this 
large number which are subject to political change. I have no 
objection to medical inspectors of asylums, if they are the right 
kind of men. There can be no valid objection to having institu- 
tions inspected by men of experience. This Association has no 
objection to anything that promises to ameliorate the condition 
and welfare of the insane. It has been the habitual thought of 
almost all the members of this body, so far as I have been able to 
glean it, that if a body of five or seven or nine men in a single 
State of this Union, having but two or three asylums to look 
after, and having but one under their own immediate eye, could 
not be selected by the Governor, by and with the advice and con- 
sent of the Senate, of sufficient probity and character to manage 
the affairs of an asylum, it would be exceedingly difficult to make 
matters much better by adding one more. The objection is 
not to the system of inspection, the objection is to the probable 
inexperience and instability of the inspectorship that would be 
established. 
A system of inspection may be a farce under one manner of 
conducting it and in one country, and work most admirably in 
another. The very same inspector of the hospitals for the insane 
who inspected these asylums, when we were here ten years ago, is 
the very same gentleman who greets us here to-day, and I am sure 
we are all glad to welcome him and glad to know that the asylums 
of this province have an inspector whose tenure of office does not 
depend upon the political changes of ephemeral political parties. 
How would it be with us ? How many Langmuirs should we see 
in our States for a single decade, under our present vicious system 
of rotation in office and spoils to the political "victors? It would 
be perilous to the general welfare of out insane to advocate a gen- 
eral inspector for the insane, unless we could secuie stability in 
office and be assured of adequate qualifications on the part of the 
inspector. 
There are a large number of other points in these interesting 
papers which will be covered by the other gentlemen. lam sure, 
gentlemen, I have occupied more than my share of the time. 
Hr. A. E. Macdonald. I was not permitted the pleasure of 
listening to Dr. Workman’s paper yesterday. As regards the 40 
paper of Dr, Everts, there is but a single point upon which I desire 
to speak to the Association. As I understand the Doctor, he inti- 
mated an opinion that perhaps more should have been done by- 
members of the Association residing in New York and its vicinity, 
in the way of answering the attacks upon asylum management 
throughout the country, for the reason that the persons making 
such attacks were for the most part resident in New York. As a 
representative of the asylum which is perhaps closer than any 
other to the body of gentlemen who have been so industriously 
attacking these institutions, I will say that I have not deemed it 
necessary to meet them in their attacks in any way, except when 
brought before some legally constituted body. 
First of all, I beg to remind you that we are pretty well ac- 
quainted with the gentlemen who make these attacks. We know 
just wdio they are and what they wish to attain, and the weight 
they have in the communities in which they reside. If they have 
more weight with gentlemen in other localities, it comes only from 
that enchantment which distance always lends. 
The attacks, as you are all aware, originated in a body in New 
York, called the “Neurological Society,” and from a paper read 
there some years ago, this great “ reform ” has spread. It was 
my privilege to have been a member of that society previous to 
that attack; as it was also my privilege immediately thereafter to 
resign. I was present at the meeting at which this paper was read. 
In order that you may have some idea of the importance and 
numerical strength of that society, I will tell you that there were 
just thirteen persons in the room, at least three of whom were not 
members of the society; and of whom others, including myself, 
were not entirely in sympathy with the views of that paper. In 
fact, when it became necessary for the chairman to make the 
appointment of a committee of three to carry out the objects of 
the paper, he named one gentleman who got up and said he could 
not very well serve, as he did not belong to the society. 
There are, Mr. President, some four thousand physicians in New 
York and the surrounding cities, I think you can count upon the 
fingers, perhaps of one hand, the members of the profession who 
have taken any active part in this crusade; and of those whom 
you can count, you may judge something of their bias and of their 
importance when I tell you that one of them, the vice president of 
this august body of which I have spoken, was a rejected applicant 
for place at half a dozen asylums; who consequently formed the 
conclusion that there was something rotten within these asylums 41 
that he should reform. If any member thinks it desirable to 
silence him, he might offer him a position. 
Another, of equally exalted rank, revealed a possible personal 
interest when he told a gentleman, whose signature he solicited, 
that the result of the movement might be to secure a position in 
an asylum for himself; and of the few who remain two or three 
• are practitioners who treat the insane at their own homes and who 
are, not unnaturally, strong advocates for home treatment for the 
insane. 
Any agitation regarding the management of insane asylums 
which begets a temporary fear or distrust upon the part of those 
who have insane relatives, and a consequent retention of the latter 
at their homes, brings so much grist to the mills of these gentle- 
men. Ido not, for one, propose to constitute myself an adver- 
tising bureau in their service. 
It is true that the persons of whom I have spoken,sensible of 
their own want of standing with the community, have, by one 
device and another, attracted to their standard a few whom they 
thought capable of strengthening their position, and naturally 
these accessions have been less from the ranks of their own pro- 
fession, where they are known, than from among the laity. 
Perhaps the most prominent of their allies, thus gained, is Mr 
Dorman B. Eaton, to whom Dr. Everts has in his paper particu- 
larly referred. I shall tell you a little incident in regard to that 
gentleman’s attacks upon the asylums, and leave Dr. Everts and 
yourselves to judge what force should attach to his utterances 
and how much is to be gained by trying to meet them in a fair 
and manly way. lam not personally acquainted with Mr. Eaton, 
nor have I, to my knowledge, ever seen him ; but I am told that 
he is a gentleman, who having in his younger days performed 
valuable public service, has reached now an age and a frame of 
mind when he takes upon himself the role of a common scold, and 
generally behaves as though the whole world had been laid at his 
feet with the injunction—“O, reform it altogether.” 
There had been a hearing before a committee of the State 
Senate, appointed to investigate the management of insane asy- 
lums, and an employe of the Ward’s Island Asylum, who had been 
in the service long before I assumed charge, saw fit to make a 
comparison between the management at the time of his appoint- 
ment and of his testimony. This comparison happened to be com- 
plimentary to the present management, and he incidentally cited a 
very undesirable condition of affairs as existing a number of years 42 
before, but now entirely abolished. Now this was not at all the 
material that Mr. Eaton and his confreres wanted; according to 
them, there was no improvement and nothing that was not bad— 
so if Mr. Eaton had read the testimony aright, he would doubtless 
have quietly ignored it, but by some singular mistake or accident, 
or lapse of memory or something, for of course Mr. Eaton would 
not willfully distort or garble, the testimony was so transformed 
that it was made to come from myself instead of the employe, to 
apply to the period of my own administration instead of that of a 
remote predecessor, and so became very fair evidence in favor of 
the urgent need of reform, and consequently such as Mr. Dorman 
B. Eaton could use without affecting his conscientious scruples 
against saying anything at all favorable to the asylums or their 
officers, 
I was foolish enough to do upon that one occasion what Dr. 
Everts suggests might perhaps be oftener done—to meet the 
attack in a less formal way than simply before legally constituted 
bodies, I shall not do it again; and I leave you to judge whether 
or no lam right. I thought that Mr, Eaton differed from his 
associates sufficiently to make an appeal to his sense of justice and 
fair play practicable, and I wrote to him as follows, forwarding 
ray letter only after submitting it to the commissioners of my 
department for their approval : 
New York, April 16, 1881. 
Dorman 13. Eaton, Esq.: 
My Dear Sir; I saw, yesterday, for the first time, an article in 
the North American Review for last month, over your signature, 
in which the following paragraph occurs: 
“ Only last week the present Superintendent of the Ward’s Island 
Asylum gave this testimony before the committee just referred to: 
‘ When I came on the Island, I was more afraid of the keepers 
than the lunatics. The keepers were mostly shoulder-hitters, and 
they made a regular slaughter-house of the place.’ ” 
In view of the possible existence in the peculiar code of asylum 
assailants of some Statute of Limitations under which a falsehood 
becomes equivalent to the truth if uncontradicted for a certain 
period, will you permit “ the present Superintendent of the 
Ward’s Island Asylum” to say to you that neither “last week” 
nor at any other time, neither “before the committee just referred 
to ” (that of, the State Senate) nor in any other presence, did he 
use the words which you put into his mouth, or any others convey- 43 
ing in the remotest degree the same meaning, actual or colorable, 
express or implied; and that what was said of this nature was by 
quite a different person and with reference to quite a different 
period. Ido not assert or assume that the falsehood is your own; 
certain persons for certain personal reasons, have put in circulation 
malicious fabrications regarding the management of insane asy- 
lums, and feeling that their own names would rather discredit 
than strengthen their charges, they have sought the weight of 
other and better names, whose owners have been prejudicial 
enough or weak enough to lend them without due investigation. 
It has been in some such way as this, probably, that you have 
been led to father a deliberate and ingenious misstatement. I 
may be mistaken, but it seems to me that a moral obligation rests 
upon the man who is anxious to say hard things of another, to 
first make sure that they are true things as well as hard, and when 
he avoids obvious and accessible means of enquiry, it appears as 
though he were too anxious to say the hard things to be willing 
to run the risk of learning that they are untrue. 
The asylum on Ward’s Island is within an hour’s journey of 
your office, and access to it, and ample opportunity of examining 
it, could have been obtained at any time. They are still available, 
and though you will scarcely, after this letter, view the asylum 
with any lessening of the prejudice which you have so plainly 
shown, I do not doubt that you will be forced to the conviction, 
though not perhaps to the admission, that much else that you have 
said is, as regards it, as unfounded as the particular assertion 
which I have herein corrected. 
Your obedient servant, 
A. E. MACDONALD, 
Medical Superintendent. 
Mr. Eaton’s answer was as follows: 
2 East Twenty-Ninth Street, 
New York, April 20, 1881. 
My Dear Sir: Yours of the 16th was received last evening. I 
am never willing to do any man injustice, and shall always be 
glad to make redress for any wrong I may have inadvertently 
done. The language referred to by you was reported as a part of 
the testimony in a morning journal, (I am almost certain it was the 
Tintes), of the day after it was taken. I had interviews with two 
of the Senate Committee, and satisfied myself that it was reliable. 
There was wish to say any hard thing. (So in the letter. Mr, Eaton probably meant to say “ there was no wish, &c.,” but strict 
accuracy is perhaps subserved by the omission.) 
Going to the Island would not show me what was said before 
the committee surely. I regret that I have not kept the paper; 
but I am certain the language to be there given and I never saw 
any correction of it, though 1 am a regular reader of the Times. 
It is very likely the testimony was given by the out-warden 
instead of the superintendent, (since I do not question your decla- 
rations), and that I or the editor may have inadvertently attributed 
it to the wrong official. 
If you have suffered injustice, in that particular, which I can 
remedy, I shall be glad to do so, as you may suggest. 
I then believed, as I now do, though only on the basis of gen- 
eral information, that the administration of the asylum had im- 
proved under your charge. 
My first draft, I think, directly suggested that fact, but it was 
not material to state, and the facts I had at hand did not warrant 
a volunteer statement to that effect. 
If you will look a little more calmly at what I did say, you will 
see that it carries a strong inference for improvement. No man. 
can read it without the idea that things are now better, and that 
the writer of the article was willing that inference should be 
drawn. Hoping, therefore, you may think better of my motives 
and of ray care in writing, I am, 
Your obedient servant, 
D. B. EATON. 
To Dr. Macdonald, 
I at once carefully examined again all the newspaper accounts 
of the committee’s investigation, and found that in no one of them 
was the testimony quoted ascribed to me, and that the Times was 
especially far from doing so, as it gave the name of the witness in 
full more than once, “Cyrus Pearsall” and “A. E. Macdonald” 
ought not to be absolutely indistinguishable. 
Two months have passed, and I have seen no outward manifes- 
tation of the spirit of unwillingness to do any man injustice, of 
which Mr. Dorman B. Eaton eloquently writes—nor has he ac- 
cepted my invitation to visit the asylum, though he has found 
time to go to one more remote—that at Flatbush, and to adopt 
and disseminate the cheerful little fiction regarding it as to the 
total abolition of restraint apparatus. So that lam considerably 
strengthened in my belief that there is nothing to be gained by 
following our accusers into places where we are not bound to 45 
meet them, and where ordinary rules of justice and decency do 
not prevail. 
When they have had the temerity to assail us where we could 
properly reply, we have met them very promptly, and I think very 
conclusively. Two years ago they were given the amplest oppor- 
tunity of substantiating their accusations before a Senate Com- 
mittee, and they entirely failed and drew upon themselves a 
scathing rebuke from the committee, upon which they immedi- 
ately turned round and abused it. Another committee has been 
sitting during the past winter, and has asked leave to defer its 
report for another year, so that at least it can not have found need 
for immediate and radical reform. 
I am, for myself, content to leave matters with such committees, 
and to such and other legitimate means of enquiry and defence. 
To follow our accusers into the newspapers and elsewhere is to 
give them what they most desire—notoriety, recognition. They 
are like the man who thought he had gained in social standing 
because he had been kicked by George the Fourth. 
You may judge of the importance that is attached to these 
gentlemen, and their assertions in the community where they are 
best known, by seeing what they have accomplished. If they have 
had any weight it has been in places where they are not known— 
in Wisconsin or Pennsylvania, not in Aew York. For one I cer- 
tainly do not admit that it is incumbent upon us to leave the 
positions to which the public has elevated us, and to go down to 
meet every Tom, Dick and Harry who chooses to throw mud at ns. 
Dr. J. Strong, of Cleveland, Ohio, said; Dr. Macdonald has 
nearly spoiled what I designed to say on this question. X had 
supposed that Mr. Dorman B. Eaton was a man of more conse- 
quence and sense than he is willing to concede to him. ihe 
Doctor has personal knowledge of the man, while I have only im- 
pi’essions of him which I have gathered from his writings. Mr. 
Eaton is certainly a man of considerable prestige in some respects. 
He was selected by the general government, a few years ago, as 
one of a committee to examine into, and, report upon a plan to 
reform and reorganize the civil service of the United States. 
It has been claimed here that the article of Mr. Eaton on the 
“ Despotism of Superintendents of Asylums for the Insane ” refers 
principally to those in the State of New York. Aow there happen 
to bg several asvlums for the insane in this country outside of the 
State of New York. He chose a literary publication of large 
circulation and wide reputation, as an instrument of attack on the American system of treating the insane, generally accompanied 
with unworthy and untruthful thrusts at superintendents of our 
insane asylums in particular. Poison does not always antidote 
itself. Ido not believe that such a tirade, although to some the 
animus of the writer may be apparent, should be passed by un- 
noticed. When the article in the North American Review first 
appeared, I could but look upon it as one of those literary assaults 
that was connived in blissful ignorance of the subject discussed, 
strongly tinged with a fanatical hue, and couched in the language 
of charlatanism. I rejoice that Dr. Everts has pricked the bubble 
and exposed the hollowness of the article in question. We must 
remember that almost everybody reads now-a-days, and it is but 
just and fair that both sides should be presented to the reading- 
public; that the antidote should follow the poison, and in this 
particular instance Dr. Everts has most effectually done so, and I 
thank him for it. 
Now these efforts on the part of pseudo-reformers, as previously 
remarked, do not always antidote themselves. They do, to a cer- 
tain extent, exert an unwholesome influence on the public mind. 
They tend to weaken the public faith in our asylums, and thereby 
impair their usefulness. The dissemination of such views as those 
contained in the article of Mr. Eaton, has the effect to strengthen 
prejudice in the minds of those who are already too prone to 
indulge in unfounded reflections, and uncharitable feelings toward 
asylums. The true philanthropist will do all in his power to en- 
lighten the public mind in relation to the high and holy mission of 
our asylums, and will use his utmost endeavors to neutralize and 
correct tendencies to erroneous ojhnions held in regard to them. 
The charlatan on the other hand, too frequently, as in the pres- 
ent instance, aims to use popular prejudice and credulity to pro- 
mote and carry forward his mischievous work. As a practical 
illustration of the evil which flows from these wicked tirades 
against asylums—based sometimes on ignorance and sometimes on 
malice—let me refer to the very frequent hesitation of friends of 
the insane to send the latter early to an asylum. Now whatever 
tends to weaken public confidence in asylums, strengthens this 
feeling of hesitation of friends of the insane to place the latter 
promptly under asylum treatment which may offer the only means 
of recovery. I need not stop here to dwell upon the priceless 
advantages of early asylum treatment, I desire rather to refer to 
those obstacles wdiich stand in the way of early treatment, and 
hint at the responsibility of those who are instrumental in creating 
such obstacles. Dr. Gundry. Mr. President, I did not have the pleasure of 
hearing the paper of my friend, Dr, Everts, and I shall not allude 
to it at all in what I have to say, except in regard to one or 
two things said since, I heard Dr. Workman’s paper, and to that 
I briefly address myself. I am very thoroughly of the views there 
•expressed, and possibly, with one exception, I might adopt them 
as my own. I believe that the best means of reform is to let the 
light into every place. However much it may cause a temporary 
depression in our case, it will eventually result in a greater and 
more favorable movement in our behalf. All advance movements 
are met with walls of stone before the great asylums themselves. 
We do not make progress in this. We are, by straight lines or by 
curves, going backwards, and 1 recently overheard an intelligent 
friend make a remark to this effect. It is the one great obstacle 
in our profession. He had only just been appointed to an asylum. 
It is only from the fact of going out and looking in, that we get 
the views of others, and it was this fact that enabled him to make 
this expression. 
All reform in asylums came over to the United States through 
the unobtrusive action of Take, and it is to Tuke, really, that we 
owe all the improvements in management which have come down 
to us. It has simply been improving and developing the germinal 
seed that he deposited. It is all very well to recognize the great 
claims of Pinel and others, but we can not avoid recognizing the 
efforts of the family of Takes. They were called to them by cer- 
tain language of a persistent membei before the House of Com- 
mons. So it will not do to argue that the efficacious reforms came 
from within, when, in fact, the greatest reforms have come from 
without. 
The one point which I wish to speak mostly to, of the subjects 
to which Dr. Workman alluded, is the necessity of governmental 
inspection. Xow, do not be carried away with fears. First, I see 
the governmental inspector present, and I shall use the liberty of 
speaking of him as I would not if he were absent. Ihe inspector- 
ship in Canada is not that which is required by our hospitals, 
because the inspector of hospitals here has also the management 
combined in the same person. That is an essential difference. 
The inspector of Canadian institutions is the substitute of the 
boards of management throughout the United States. It is not as 
m Ohio, where each institution is under a separate board of trus- 
tees, Uow, if they were all transferred to one board, that board 
stands in the same relation that the inspector of asylums and in— 48 
stitutions does in Canada, In addition to that, they were subordi- 
nate and responsible to the people. By laws, or some cabinet 
procedure, he is responsible to the State. I believe that is a fair 
statement. The plan has worked well, and it was claimed, yester- 
day, that it enabled them, and no doubt it does enable them, to be 
free from certain political influences, and to be rid of a great many 
anomalies that are found in some United States institutions. If 
the Canadian institutions are free from all such embarrassments, 
they are to be congratulated that they have had the small pox of 
politics; but having got through, it is hardly fair to fire at us, 
who are working through it with the virus among us. Some of 
them will hardly acknowledge that they have had it, hui I will 
show them that they have, to my certain knowledge. But the 
point I wish to speak upon, is governmental inspection. By gov- 
ernmental, I mean rising from the government. That is the most 
certain to be popular in this region. What I wish to say is just 
this. Some boards are constituted with the idea of prominency, 
having no connection with the management of the institution, 
having no power to alter errors of judgment, and no power to 
inspect, rigidly, every inmate in the institution, or the inmate of 
every family who has insane there, not having the right to report, 
or the right to remedy an abuse which exists, by bringing it 
before the notice of the party or parties who have the authority 
or power to remedy it. Of course, there are instances where they 
should have no power in themselves. 
Now, I contend that a board properly constituted of men of 
business experience, medicine and law combined, of such character 
as would command the respect of all the good citizens of the 
State, would stand as a bulwark between the patients and the 
public. It would be a source of protection, really, for the super- 
intendents. The first protection is from that called political influ- 
ence. I amused myself, when the gentleman was speaking, by 
recounting, in my memory, all the names of the gentlemen, in the 
course of my career, who have served as superintendents of hos- 
pitals in one State. I found that twenty-seven superintendents 
have served in the five hospitals of one State, during the time I 
have been connected with this specialty; that there are now living, 
thirteen superintendents. 
Dr. Gray. Name the State. 
Dr. Guxdry. No, sir. I am not going to name anything—• 
that there are thirteen ex-superintendents now living of one State 
who have been in active service. I beg pardon there are fourteen 49 
ex-superintendents on the roll. In one case the board of trustees 
deliberately said that “ the reason we succeed you in the office of 
superintendent, which we do to-day, is that in this State it has 
been the custom of both parties to fill these positions with persons 
in harmony with the political party in power,” and closing with 
the statement that “ we are most sincerely your friends and well- 
wishers,” etc. 
Now that affects one man, but the principle affects all men. 
What protection would that be to the man who succeeded the man 
who was the recipient of that letter? If all the best men in the 
world came, they have to displace the man who had served the 
State long and faithfully. That is a general statement. Now in 
order to make up a statement that the State has suffered no loss, 
these men, personal friends of the gentleman to whom they wrote 
the letter, must necessarily be biased in favor of the man whom 
they had put in the position; and therefore any controversy 
arising, they would be utterly powerless to stem the tide of public 
opinion and be bound by a course proper and right. They would 
be biased to a certain extent. 
Take another case. Suppose trustees, and remember that it is 
not in every State that trustees of the highest character, both 
morally and pecuniarily, are always obtained, that in some States 
we get men who are engaged in the business of making money, 
etc., and not unfrequently bring them from pursuits which make it 
desirable for them that they should be brought in connection with 
the institution for the opportunities afforded. Now suppose a 
majority of such trustees with a friend as superintendent, whereby 
on the one hand you could have the trustees, and on the other the 
laws carried out and respected by the chief medical officer, would 
it be surprising to generate in the minds of such men a prejudice 
against this person with whom they are mingling, or that the other 
trustees could not devise a plan by which that man could be got 
rid of? Then if a change is made what protection is there to the 
person who succeeds ? There is none lam sorry to say. 
A gentleman, one of our body, was unfortunate enough to be 
connected politically with a very aspiring and able man. That 
gentleman unfortunately received the votes of a body for a very 
high office, for which another gentleman holding the executive 
department was an aspirant. It so happened that living in the 
same State was an old gentleman who had long desired and panted 
for the place which this man had long occupied in the asylum. It 
also so haj)pened that this old man had some political influence, 50 
and he had worked it up for this gentleman who Avas defeated for 
this high position in the national councils. And presto, things 
changed. A vacancy occurred in the board of trustees, and it was 
filled up so that the gentleman who had not failed in his efforts 
for his friend, so far as the high position was concerned, was dis- 
placed by the gentleman A\Tho worked for the unsuccessful compet- 
itor. What help to the board can such a man be, or to those Avho 
put him there ? By and by he is shriveled and cast aside as asleep 
and worthless. lam not going to attack any person, lam leaving 
out names, but I stand here personally responsible for every 
statement I make. 
Of course all 1 am talking about refers principally to State 
institutions. There is a class of incorporated institutions also 
which, in my opinion, requires the same supervision and the same 
power to manage as any State institution of the country. There 
are but two institutions that I will refer to that I make an excep- 
tion of, the Pennsylvania Hospital for the Insane in Philadelphia, 
under the care of Dr. Kirkbride, and the Friends’ Asylum. They 
are so intimately connected with a large and influential body of 
religious men, and their boards are so largely composed of the 
best of that honorable sect, that really the society itself stands in 
a certain degree as a wall around them; and there is a conscious- 
ness of the fact that nothing irregular or wrong in these institu- 
tions could be kept one moment, if suspected or thought of, by the 
members of that body, without being discovered and corrected; 
and hence these institutions have, as a wall of fire, that which 
protects them against any vile imaginings that may be carried 
among good thinking people. What the Society of Friends have 
and enjoy is a power which I think a State board of inspectors 
ought to have, and we have more necessity for it than the Society 
of Friends, The management that they have, the power and the 
possibility of protection, is Avhat I contend for in the breast of the 
inspector in every State in our Union, I personally would greatly 
prefer a national board, but I am well aware that it would be im- 
possible for one board to inspect all properly, and that it Avould be 
necessary to have a number of boards, to have the work done 
properly and thoroughly, remembering that in every institution 
the insane ought to be looked after, and properly treated, fed and 
cared for. Then there are private institutions, and persons treated 
at the homes of others, and in poor-houses persons awav from the 
observation of society, who should come under the protection of 
such a board as I speak of. I am aware that It will add to the 51 
expense, but it will add to the protection of the insane, and it will 
add greatly to the protection of those who have the care of the 
insane in our institutions. 
Now, there are certain objections, of course, to all this. It may 
be urged that “ the stream can not rise higher than its source,” 
that in new7 countries and new conditions of society, you will not 
be able to get that which you have in some of the old societies and 
communities. Nevertheless—and this is frequently answered and 
frequently charged—it is surprising how the back is fitted to the 
burden, and how people who at first are thought inadequate to the 
position or to the office, actually do far more in practice, and do 
their duty more freely than we could expect. In these new 
States we would have a number with the interests of society at 
heart—men wdio would soon become accustomed to their duties, 
and do them just as thoroughly as the most highly educated 
people of this country. When we are apprehensive of danger of 
mistakes to be made by others, it is just as well to look and see if 
we have not made some of the same color, and whether we have 
not produced some of the same feeling that we censure. 
None of us are agreed, probably, as to the mode in which 
reform should be carried out, or developed, as some choose to call 
it, or how it should be carried out in our institutions. Some have 
larger liberty than others. Each may have his individual opinion, 
nnd each is entitled to a respectful consideration of that opinion. 
We, as you know, are a staid and selfish race. We have no organ 
to represent us, or we are represented by an organ which is owned 
and controlled by one institution. That journal, being the only 
journal published, until recently, is, to some extent, considered the 
organ of the Association. It unfortunately happens that it has 
assailants, and, therefore, we haye the anomaly, how it conies that 
Utica politics should assume such prominence, both in asylum 
circles and in the councils of the State and nation. Now, I say 
that is unfortunate, because we do not all wish to be held responsi- 
ble for the opinions of that organ, or the editors of that paper. 
The editors of that paper have a perfect right to state what views 
they choose. They have a perfect right to adopt any one of them 
and when they choose; but it strikes me some of the methods 
they use are hurtful to this body. 
The charge is that we are obstructionists. They may think 
like this: Remarks of members of the Association 
& 
meetings are published in that journal, and published for the 
Association. Ergo, it is the organ of the Association. It is false 52 
logic when it is known that the very reverse are the views of our 
people. It is not the fair thing to send out matter through the 
world as conclusive where there are different experiences on the 
subject close at home. It is just that sort of thing that gives a 
color to the charge of these people, that we are obstructionists, 
when the only journal at all identified with us deems it best to do 
this, and occasionally other things in the same way. 
New reforms are of two kinds, conservative and destructive. It 
is well always to look about and see wherein we can set our houses 
in better order, and there to make conservative reforms, which act 
upon the principle both of acting upon new laws which are good, 
and of referring to the principles which have held heretofore. If 
we do not act thus in the nature of God’s providences, we do not 
accept conservative reforms. Destructive reforms cut up and 
sweep away both the good and the bad, until after a season the 
dry land appears, and a harvest is reaped again. It is for this 
reason that I have made my remarks so extended. Ido not shout 
“ Great is Diana of the Ephesians ” by any means ; but I wash to 
say that we should each look into the whole truth, and practice it 
in our lives. The best sort of reform is that made from within, 
and if wre all do that, I do not think it matters who attacks us— 
whether it be the highest or the lowest. I think it better we 
should be sure of our foundations before we attempt to rout the 
supposed enemy, especially as that enemy has taken the offensive. 
We can bear everything as long as wre can say we have never 
blushed before. 
Dr, Guay. Mr. President and Members of the Association: 
In regard to the paper of Dr. Everts, which has been sufficiently 
discussed, the fact that I was named in the paper or referred to as 
a person representing the typical element of this Association, as a 
superintendent, might make it seem proper that I should say 
nothing in regard to it. It is a fact that, thus far in the history 
of these assailments that have been made—if they are to be called 
assailments—or proclamations of reform—if they are to be so desig- 
nated—I have never uttered a word or made a comment. It might 
seem proper that I should still be silent. Dr. Macdonald has said 
that he knows these persons from whom the quotations are made 
by Dr. Everts, and who originated the attacks on asylums—or 
most of them—and he has given you his estimate of their char- 
acter and qualifications. I have never had the personal acquaint- 
ance of Mr. Eaton, and he has never been at the asylum. 
Eew of the persons referred to or who constitute the circle or class 53 
to which Dr. Everts and Dr. Macdonald have especially referred, 
have ever been inside of the institution at Utica. Mr. Eaton, their 
spokesman, has never addressed a line to me on any subject, and I 
have never had any correspondence with any of them. I therefore 
only know them by what I have seen in the newspapers or in the 
pamphlets and various circulars received from time to time, and 
these, I confess, have been many. I stand here to say that I have 
never seen a statement from these persons in any of the news- 
papers or in any pamphlets that I have ever received from any of 
them, that has ever suggested a new or valuable idea. What they 
have uttered of truth, touching asylum management, &c., has been 
the rewording of what was already well known to men of experi- 
ence, or already incorporated, either in the laws, or in the rules and 
regulations of institutions, or in the published propositions of this 
Association. No advice that they have ever given me, I can safely 
say, is worth the paper on which it is written. What they have 
said in regard to me, personally, is on record as they wish it, 
and thgre may rest, as far as lam concerned. What is import- 
ant and valuable for the public to know, concerning the organ- 
ization and government of the State asylums, may be found 
incorporated in the statutes and in the by-laws which are author- 
ized by the statutes. Apart from the personal attacks, the fault- 
finding and complaints have been largely directed against the 
lunacy laws and the regulations organizing and governing the 
State institutions. The general remarks of my friend Dr. Gundry, 
in regard to “asylum reforms,” “favorable movements in our 
behalf,” etc., and “ walls of stone” as against advancement, can 
not apply to the State of New York, for the statutes and regula- 
tions there contain no provisions and lack no guarantees which 
would justify any such inference. He was evidently speaking 
from experience, unless he was iterating simply the sentiments of 
those to whom Dr. Everts has referred, and those of whom lie him- 
self speaks when he reminds the Association that “ they ” have 
the advantage of being on the offensive. Who are “they?” 
The “supposed enemy that has taken the offensive,” and 
who charged “that we are obstructionists?” lie knows them 
and he knows what they think of us. It is true in his 
arraignment he did not seem to like to mention the names 
of States or persons, but after all he mentioned himself, at 
least by implication, as one of the many who had suffered, and he 
fairly disclosed what State he had in his mind—that State being 
Ohio, where the Association of “Protection” to which Dr. Everts 54 
lias referred was christened, if not horn. Notwithstanding the con- 
cealment of names I insist, by this very fact he has intimated, that 
the evils he suggested or hinted at were more widely spread than the 
State of Ohio alone. His intimation is that we of the Association 
ought to answer their complaints whether the things they pro- 
pose have any real substance or not, and ought to welcome them. 
He shakes his head at this. I claim and will here say that only 
such things as require answer should be so met. Mere assertions 
should not be met by argument. Until something is said having 
substance we need no argument, and we know that even one of a 
certain class of persons is said to be wiser than ten men who can 
render a reason. But mere assertions and personal attacks are 
not worthy of argument, and no gentleman is going to defend 
himself against such general detraction. The man who gives 
himself up to personalities and detraction and envy; who makes 
these the basis of any proposition of reform or conceals them 
behind propositions of reform, places himself beyond the pale of 
reputable criticism, and should be left to himself without argu- 
ment or answer, where he will die under the weight of his own 
defamatory work, sooner or later. As far as the truth goes we 
accept it, but, gentlemen, I have never felt that in any of the 
personal assailments of myself, there was any real arraignment of 
this Association. I have never felt it my duty to drag anything 
relating to myself into this Association, or into the Journal, to 
which Dr. Gundry has alluded. This Association is a body not 
especially concerned in any individual; a body that consists to be 
sure of individuals, but only as they represent official life and 
action and offices. It is always concerned primarily with the good 
management of all the institutions of this great country of 
America, that includes the Dominion of Ontario in which we now 
are. It does not intend, therefore, either to build up or to drag 
down, or to defend the mere personal interests of men. It has to 
do with superintendents in their public duties and capacities; it 
has to do with the laws which govern these institutions and the 
great principles which underlie them. It has done great and good, 
work in organizing a wise and humane system, and in laying down 
rules and laws for the founding and government of institutions. 
Its first work was the bringing together men of experience and 
the formulation of scattered knowledge into definite propositions 
for discussion and guidance. These propositions containing the 
united experience of the men who were charged with the care of 
the asylums, public and private, have been added to from time to 55 
time. As Dr. Hughes has forcibly said, the great work of reform 
and advancement has been the work of the men of this Associa- 
tion. They commenced with the problem of organization under 
the illumination of experience, and not the mere vagaries of 
imagination and these men—the fathers whom Dr. Workman has 
so eloquently brought before us in his admirable memoir, were not 
visionaries or idlers ; they were great practical men who organized 
a system, and at the outset laid down a series of propositions upon 
which to base their action and their efforts for genuine reform, 
which embraced the elevation and amelioi’ation of the condition 
of the insane; and history will clearly show that nearly all the 
steps of real progress in this great cause were the results of con- 
sultation and discussion in their annual meetings. Since that time,, 
from year to year, as experience has taught us their work has been 
enlarged, and the series of propositions and special resolutions of 
this body stand now to-day untouched by the sophistry of a single 
one of all the would-be reformers. My friend Dr, Gundry shakes 
his head. I repeat, not a single proposition has been gainsaid or 
overturned. They stand to-day above all contradiction as a part 
of the constitution, so to speak, of this body, and they are inter- 
woven as a part of the fabric of our laws and their practical 
application is felt in all parts of the country. 
Now in regard to one point. I shall dismiss all that relates to 
personal defense in reference to anything contained in Dr. Everts’ 
paper, or in regard to anything that may have been said here. I 
do this especially because of being mentioned from beginning to 
end as the representative object of these attacks. Ido not com- 
plain of this on the part of Dr. Everts. This personality is not 
his work. He has merely reproduced, in a collected way, samples 
of what has been uttered by others. It is only a reproduction, a 
condensation of the utterances of a class of men who for a time 
hold themselves in the public view, and I have nothing further to 
say about them. Their utterances are not new to me or to any of 
us. We have heard them in extenso, and the ideas repeated in all 
forms of expression and in all sorts of places. They have pro- 
duced and reproduced each other’s utterances, so as to make them- 
selves as numerous and universal as possible. They have been 
given a circulation far and wide in every direction, and I am 
willing to take the consequences of leaving them where they are. 
However, I will address myself to some points involved in the 
paper read by Dr. Workman, and to the remarks of Dr. Gundry, 
who seems, for the present, to stand as an apologist for complaints 56 
which have been made from time to time against this Association 
and asylums generally. Dr. Everts’ paper goes to show that these 
“ reformers ” are inimical to this Association, and their statements 
misrepresent its expressed and recorded views. 
The question in regard to the organization of asylums and the 
laws which govern them, as well as their character, the modes of 
appointment of otficers and all management, inspection, visitation 
and internal administration, are legitimate matters of discussion, 
and Dr. Workman has clearly brought out the Canadian system, 
and I shall examine the question of the application of the Cana- 
dian and English systems, so far, at least, as the State of New 
York is concerned. 
Now, inspection, Dr, Gundry seems to intimate, would have 
saved the State he referred, to. He shakes his head. I agree with 
him; hut his language, I think, would hear the signification. He has 
asserted “ political control ” and “ improper trustees ” as the evils 
which have prevailed there. What, I ask him, then, is the element 
of reform which would have saved the twenty-eight revolutions in 
a single State in a few years ? He has not given us the key to this 
extraordinary State policy, hut we should heed the lesson which it 
teaches us, to guard against a similar evil in any other State. If 
we should refuse to take such a lesson from any quarter, we should 
indeed be blind and unwise. Let him show us how such evils 
came about, and what has led that State into such a system of 
government so unwise and short-sighted. Let him admit the 
light into that darkness. This Association is not responsible for 
that State or its policy, or the policy or politics of any State. 
That is a style of government supervision with a vengeance; and 
the vengeance falls, as Dr. Gundry has so feelingly described, 
alike on the faithful and on the faithless. This is reform from 
without. 
But we are told that all the evils that Dr. Gundry and others 
have referred to, are avoided in England; that all we have to do is to 
adopt her laws and her methods, and be at peace; that she is far 
ahead of us with her code of wise laws and wholesome regulations 
that move her charities like clockwork ; that her system combines 
such power and means of inspection and inspectors, that the insti- 
tutions move serenely along without let or hindrance or the 
trouble of legislation or legislative investigations, or any public 
challenge of their fitness or work. Is this so? 
Dr. Gundry. Nobody said that. 
Dr. Gray, Ido not say you did. Buch, however, has been the 57 
tenor of the advice from the “ reformers,” to whom your remarks 
point. Gentlemen, it would be illusive to take refuge in English 
methods against such men. The same class of malcontents are in 
England as here, and the same kind of protection societies and per- 
turbators. Dr. Gundry has referred to Mr. Eaton’s efforts, for 
though he says he does not. intend to give names, still he certainly 
gives Mr. Eaton’s figures of speech; of walls of stone and hedg- 
ings in—about asylums—therefore, he has really referred, by im- 
plication, to New York, and by inference, we may assume that he 
believes in agitation there. Certainly, reform, however needed, 
has not begun in the State Dr. Gundry refers to, unless it consists 
in turning the wheel with the twenty-seven superintendents in the 
hopper, and the man who is safest comes out last. [Laughter.] 
He does not refer to that State by name, however. 
Dr. Gundry. I did not refer to New York, at all 
Dr. Gray. Then I will. 
Dr. Gundry. 1 simply mentioned the Journal. 
Dr. Gray. The Journal will take care of itself. In the State 
of New York is where Dr. Everts paper locates the nidus or the 
Hades—call it what you choose—from whence radiate the “re- 
formers.” That we, in New York, have the choice central spirits, 
and that they are the ones we should have wooed to quiet, by ar- 
gument, Alas, argument! Why not say place? It is said that 
they have called and we have not answered; that we have rejected 
these philanthropists who were endeavoring to cast a gentle man- 
tle of shelter over all superintendents, and who meant no evil; 
wished only to inaugurate a great reform in our behalf; that we 
have actually ignored them. So the Association has, and with 
wisdom, might do so still. As I have before said, they have not 
presented anything, as yet, for this Association to consider; have 
not suggested anything new, or that has not been discussed in this 
body over and over. What work have they themselves done on 
which to claim a hearing? New York was the field for commenc- 
ing operations, which were then to extend into all the States, 
although managers were not political speculators and superintend- 
ents in that State, had not been turned out over and over again, as 
in the State formerly referred to. From their representations, it 
would seem that the public were blind; that they could not see 
the great wrongs committed; that by some sort of magic the 
people had been lulled into a security which was false; that the 
superintendents had thrown a glamor over everything, so that the 
people did not care for the evils, and therefore the officials were 58 
allowed to remain and go on unchecked in their iniquitous wrongs; 
that they were so secure that no charges could affect them; that 
the institutions were so inclosed and secluded that no persons 
could even peep into the windows; that they were so privately 
fortified that they could not be overcome; that there was a ring 
encircling and holding this accumulated power and influence. 
Into this ring only the chosen were admitted, while the empty- 
stomached outsiders, anxious and weary in waiting and hoping, 
were all uncomfortable and unhappy because kept away. [Laugh- 
ter,] In this ring were included all asylum authorities, all the 
numerous managers who were in and all who went in from time to 
time—they were all changed at once into adherents and ring men 
the moment they were brought within this strange and mysterious 
influence. (I see one of them, Mr. Ogden, of the Willard Asylum, 
here.) This magic power extended to any who received appoint- 
ments, no matter what their former position or influence or char- 
acter or place in. State affairs or society. To be sure the managers 
were amongst the most reputable men of the State, occupying the 
high places, judges, lawyers, physicians, bankers, presidents of 
railroads, men of business and of all affairs; but they at once, 
when brought within this magic influence of this ring, were trans- 
formed. Furthermore, the moment the Legislature took hold of 
the matter of insanity and asylums, and the members tried to 
comprehend this same question, they also became infatuated in the 
same way. Who was the magician? What was the magic wand 
that did all this ? The magician was the law and the wand was 
truth and justice. It was the completeness of the law, and the 
untruthfulness of the defamatory assertions. [Applause,] Truth, 
with its illumination standing in contrast with misrepresentation, 
ignorance, malice. The law, with its embodiment of wise, just 
and humane provisions against the foolish utterances of theorists 
and malcontents; New York law; “feeble and incongruous!” Can 
you set argument against words? It would only be beating the 
air. It was no man and no set of men that thwarted these evil 
efforts. When pointed out they fell of their own weakness. When 
legislators came to look at what the law really was, and what the 
practice really was, under the law, and came to inquire into the 
declarations of the assailants, they saw that their assertions were 
without foundation. That is all there was of it. 
We now come to the question of inspection. Dr. Workman has 
very clearly set forth what the inspection and government of the 
Canadian institutions consists in. Dr, Gundry declares that this 59 
would satisfy him. He also admits and even declares that the 
powers and duties of the General Inspector of Canada, Mr. Lang- 
muir, is simply the power and duties conferred upon boards of 
managers in certain of the States. No one has objected to inspec- 
tion, and there is really no essential difference between the Cana- 
dian system and that of New York, (I do not represent other 
States here.) In Canada the inspector is the appointed agent and 
representative of the government in managing, visiting and more 
or less moulding the government of the institutions. Acting thus 
in an advisory way with the superintendents in a common effort, 
and stimulating them by cooperative government aid in all their 
work. 
The boards of managers in the State of New York represent 
the same power. The government of the State asylums is by 
special statute “ vested in the board of managers that is, each 
institution has a board charged with the complete government, 
inspection and visitation. Surely we have in New York, therefore, 
a body of inspectors in the very sense in which Dr. Workman has 
represented them in his paper, equal to all our needs. We have 
sixty men as managers and inspectors of the State asylums, and I 
will say here in regard to this that you can not take one out of 
them and put the stain upon him that Dr. Gundry has put upon 
the managers in the State he alludes to. I have been connected 
for thirty years with one institution, and I have never heard a word 
in regard to contracts or politics in the board there whatever the 
changes have been, nor have I ever heard a trustee or manager 
suggesting political favoritism, or any favoritism, or the appoint- 
ment of any one except under the strictest provisions of law. 
Dr, Gundky, Will the Doctor allow me a single remark ? 
You said the State alluded to was Ohio. 
Dr. Gray. I did not say Ohio. What I did say was that you 
referred to the State of Ohio. 
Dr. Glvxdky. Before the reporters of the press leave I hope 
the reference to that State will be stricken out, because I drew my 
inferences from various States. I did not want to and I do not 
want the Doctor to allow it to refer to any State—so if the report- 
ers will strike that out they will oblige me. If I did seemingly 
refer to Ohio I did not intend it. 
Dr. Gray. He has referred to something within his personal 
knowledge or beyond it. If it is within the State of Ohio he has 
personal knowledge. But whether or not he alluded to that State,, 
such flagrant charges should be located and not asserted to the 60 
disparagement of institutions, and of managers of institutions in 
all the States. Managers are not here to defend themselves, and 
besides, I desire to locate his inferences as far as possible. This 
Association is not for the trial of managers or for the discussion 
of politics. The managers or management of these great institu- 
tions should not be attacked on mere inferences. In every State 
there is a tribunal for these things and they ought to be there 
relegated. Innuendo is not letting in the light. But I will apply 
more fully now what I have said upon this point. I never have 
had a suggestion for an appointment, from the lowest position to 
the highest, from the board of managers or any members of it. 
I have never heard of a ripple towards influencing appointments. 
The lawrs are so complete, so plain, and the duties so well defined 
in regard to everything, every duty, that no man need make a 
mistake unless he does it without regard to the spirit, or letter of 
these laws; and the rules and regulations are definite and clear in 
regard to the respective duties of all officers and all persons em- 
ployed. So much have I said in regard to managers for the reason 
that Dr. Gundry has here assailed them, and in this respect has 
put himself into the shoes of the reformers run mad. I will say 
more. I take it the rule is about the same over the United States 
as to boards of managers. Take the State of New York—and I 
am not afraid to mention my State—these boards are composed of 
lawyers, doctors, and business men of capacity, in every institu- 
tion, who are appointed by the Governor and confirmed by the 
Senate of the State as being suitable persons to assume the trust— 
for it is a position of trust—the carrying out of the statutes look- 
ing after the interests of the State and the welfare of her insane 
citizens. The service is rendered gratuitously. They report 
annually to the Legislature and the reports are open to the inspec- 
tion of legislators, of the Governor, and anybody else who wishes 
to look at them. These managers are amenable to the Governor 
as his appointees. He can arrest them in any evil course at any 
time, bring them before him and suspend them, and the Senate can 
remove them if they do wrong. Has the law here given no 
safeguards ? 
Now as to direct governmental power the Governor can go in 
person, or send any one to represent him, to any State institution 
to inspect and inquire. That has been done in the State of 
New York on the representation of one Chambers, a newspaper 
'Correspondent, as we know very well in regard to Bloomingdale, a 
few years ago; and the Governor did not then confine inquiries to 61 
Bloomingdale. He ordered the commission to go to every institu- 
tion in the State, whether there were complaints or not, to see 
whether any person was improperly confined or detained, or 
whether there were any wrongs existing .to be redressed; that 
board consisted of Dr. Thomas Hun, of Albany, the Attorney 
General of the State, General Barlow, and President Anderson, of 
the Rochester University, who was then President of the State 
Board of Charities. The profession was ably represented by Dr. 
Hun, the State in the Attorney General, and the State Board of 
Charities in its president. That commission went all over the 
State into every institution, public and private. They were un- 
trammeled and impartial men, but they received no credit from 
the class of unhappy “reformers” because they found no evils. 
Dr. Guxdkt. But from the people they did. 
Dr. Gray. The people had never murmured. Those gentlemen 
reported to the Legislature, but the cry soon went up from the 
same class of complainers that somebody had befogged them. 
Now were those men dependent upon the superintendents of the 
various institutions or the managers ? Had they any of the em- 
barrassments referred to concerning inspection or visitation ? No. 
They went through the institutions with independence and a fear- 
less disregard of everything, except the duties they were to 
perform under their appointment. But we not only have the 
Governor with power, but the Comptroller of the State can 
inquire at anytime into the finances of any State institution; can 
himself visit them and examine, or send any person whom he 
chooses, just as the inspector of this province can enter any insti- 
tution. But wre have also a special Commissioner in Lunacy, 
an able lawyer and jurisprudent. He has not been in power for 
a day, but for seven years. He has visited all the institutions 
freely and untrammeled, and has made his reports annually to 
the Legislature. In addition we have the State Board of Charities, 
which has had among its members such able organizers as Hon. 
Theodore W. Dwight, of the Law School, Dr. M. B. Anderson, Presi- 
dent of Rochester University and Hon. J. V. L. Pruyn. Have 
they found the statutes “ weak and incongruous ? ” 
Now it is not to the discredit of the institutions of the State 
of New York, or to the provisions of these statutes, that these 
officers have not turned things upside down every time a clamor 
is made, or some one wants a place as in the case stated by Di. 
Gun dry. But apart from all this the institutions are all under 
the immediate control of the Legislature; they are in every 62 
sense creatures of the law and the managers are legislative 
agents to see that the great trust committed to them is properly- 
discharged. 
One unfamiliar with the law except as expounded by Mr. 
Eaton might imagine that no attention had ever been paid to 
this subject in the State of New York. A few years ago it 
was thought that as our laws in regard to the insane were scat- 
tered over so vast a field—of seventy years or more—that many 
of those coming into office from time to time throughout the 
State could not know what the laws were, and the Legislature 
immediately directed them codified and put into form as a lunacy 
code, and this was ordered to be done by the Attorney General of 
the State, then an eminent lawyer and judge or one who had been 
a judge, and the State Commissioner in Lunacy. This was only 
as far back as 1874. For those who really wish to be informed 
there are no obstacles in the way of information. There is no 
reason for the ignorant and misleading statements as to the 
statutes of New York which have been made such a bugbear and 
outcry. There has been no difficulty, on the other hand, either in 
ascertaining what the system of England is or has been. In 
her provisions for lunacy, apart from her statutes, by reading 
the reports and especially those of the Commissioners in Lunacy 
themselves, the system and practice are readily ascertained. I 
have long taken an interest in the subject, having read most of 
the English lunacy reports, and if the Inspector, the Hon. Mr. 
Langmuir, will allow me to say so, when he was first appointed 
Inspector for Canada and visited our State in his primary inquiries 
into the subject, he gave me quite an impetus to the study of the 
provisions of the English statutes, and I naturally felt interested 
to know how, in working out the great problem of caring for the 
insane, we could utilize the experience embodied in the system of 
England. I found in Great Britain they have not the same laws 
everywhere. The English law differs from that of Ireland or 
Scotland; yet they are all on the order of local self-government. 
They believe as we believe here that people can be found in every 
part of every great State quite competent to manage their local 
affairs, and to guard the interests and rights of their citizens 
whether sane or insane. Dr, Gundry talks about a national board. 
Why, a national board could not enter States in the management 
of beneficiary and charitable affairs. The charities of States are 
their own affairs. 63 
Now, so far as the State of New York has been named, I have a 
right to speak, and especially as Mr. Eaton has set up New York 
as the typical State, the laws of which he seems to hold, are 
enacted for the oppression of the insane, and not for their good. 
If his accusations against the State of New York are not true, his 
whole fabric falls to the ground, for he has made that the repre- 
sentative State. I say this, although my friend, Dr. Gnndry, 
shakes his head, and he probably has read the article of Mr. Eaton 
much more carefully than I have. But the article shows, and 
certainly Dr, Everts has shown, that XJtica was used as the 
illustration. When Mr, Eaton appeared before the Legislature, 
heralded by the free distribution of pamphlets and strips of printed 
matter, setting forth what it was claimed the laws of the 
State were, and the changes needed, without giving the actual 
statutes or even quoting from the mass of statutes, he es- 
pecially endeavored to show that what was lacking was a 
large body of commissioners like the Lunacy Commission of 
England, with their powers and their duties and the class of 
men who there occupied those positions; that short of such a 
commission and such power and such men, we were a failure, 
and should not and could not succeed. I also listened to his ver- 
bal argument and to the remarks of those with him, and had all 
taken down. Among the main points put forth was, that in Eng- 
land this large board had great wisdom, and especially power 
to guard against abuses and to right wrongs; that in the great 
private and public institutions there, the power lodged in this 
board had not only an influence that was wonderful by their 
very majesty, but they had the power of giving speedy redress; 
on the other hand, that in New York, all this was wanting; the 
logical inference being that we were weak in all that in which 
they were strong; that the English board had lawyers for legal 
affairs, physicians for medical matters and business men for ordin- 
ary affairs; the logical inference being that our Managers, Com- 
missioner in Lunacy, &c,, were not such men. He failed to say 
that under the Statutes of New York, no delay is ever necessary; 
that our laws are such that our courts can be applied to and 
are always sitting at our very doors; he might have said that 
in justice and in truth, but he did not. He might also, had 
he simply opened his eyes to the facts before him, have said 
that in the several boards of managers of the asylums in 
New York, we have precisely the same class of men, lawyers, 
physicians and business men, as there are in the English Com- 64 
mission, but he did not.* Without going specifically into the 
matter, I might add that when one came to look at his decla- 
rations, it was apparent that his representation of the powers and 
duties of the English Commission was misleading, and it was easy 
for the Legislature to see by consulting the English Statutes, that 
they had no such power as he pretended. Lord Shaftesbury, who 
had been for fifty years at the head of that commission, said, before 
the Committee of Parliamentary, in 18V7, (and could Mr, Eaton 
have been ignorant of this ?) “ we, in visiting asylums, have no 
power at all, except to examine and report.” He declared, em- 
phatically, “we have never exercised any authority; we have 
never had any to exercise, and it would be most unadvisable to 
give us any authority.” His Lordship further declared that in 
regard to supervision, inspection and visitation of asylums, he 
would rather increase local authorities, because they had great ad- 
vantages in knowing the character of the patients, the character 
of the superintendent, and can judge far better, and added: 
“Above all things, they have the power in their hands.” Was 
Lord Shaftesbury right, or Mr. Eaton wrong ? 
The only “ incongruous ” thing shown by Mr. Eaton was in the act. 
converting the Inebriate Asylum at Binghamton into an asylum 
for the chronic insane, which, he said, “ Gives no sphere of duty 
whatever to the Commissioner in Lunacy.” It is proper to say 
that this enactment was subsequent to the lunacy code, and while 
an attack was being made on the State Commissioner in Lunacy— 
an attempt to obliterate the office. 
* “ We see, therefore, with what sedulous care this law has provided for 
the three distinct varieties of experience and ability upon this National 
Board of Commissioners. Five men of affairs to supply business capacity— 
three barristers, learned in the law and experienced in the courts of justice, 
to keep the Board within legal limits—three physicians and surgeons, to 
supply medical and surgical science and skill. The prestige and capacity 
which such a body brings to the investigation of lunatic asylums, and the 
weight which its recomendations naturally carry, must be obvious without 
more words upon the subject.” 
“ The statutory directions for visitations, inspections and investigations on 
the part of the Commissioners are in the highest degree stringent and par- 
ticular, and the power given to make them efficient is most ample. * * * 
Their power further extends to visitations, inspections and taking effective 
measures for relief in cases where the insane suffers wrong in jails, work- 
houses and other places in the kingdom.” 
“No one can read it without a painful sense of the defective, feeble and 
incongruous laws of New York upon the same subject.” 
DORMAN B. EATON. 65 
Touching England’s state institutions, in regard to visitations, 
rules, regulations, &c., the Commissioners have nothing to do with, 
them. Their state institutions, those for the army, for the navy, 
&c., are visited once a year by the Commissioners, by courtesy, 
while all the rules and regulations for their government are under 
the departments which they represent; not made by the Commis- 
sioners at all, but by the managing boards, precisely as under the 
Statutes of New York. But there are certain other institutions 
called, in English law, asylums, which are the borough and county 
institutions, similar to our State institutions. Are they organ- 
ized or managed or controlled by the Commissioners of Lunacy 
there? Not at all. Those institutions have their own laws and 
they have their local boards and local visitors, and then they have 
inspection once a year by the Commissioners, but without power, 
as the Commissioners say, exc'ept to visit and report. They are 
visited precisely as the institutions of New York are visited by the 
Commissioner in Lunacy and by the State Board of Charities, and 
the institutions are governed and controlled by their local or man- 
aging boards, just as the State asylums are in New York by the 
boards of managers. Now, you come to still another class of 
English institutions, called hospitals for the insane, and I desire to 
say that I am adhering rigidly to what the law there says, and not 
to newspapers, these institutions, which are similar to Blooming- 
dale, New York, and the Pennsylvania Hospital for the Insane, are 
described as hospital buildings, or part of a hospital or house not 
being an asylum, where lunatics are received by benevolent contri- 
butions in part or in whole, or by charitable bequests, and where 
some persons pay more than their support, the balance going to 
the charitable care of all. Here the Commissioners in Lunacy 
have no control. They visit them just as the Commissioner in 
Lunacy does in New York, but with a good deal less power than he 
has. What public institutions have they in England further where 
insane are kept ? They have work-houses, and within the walls of 
the work-houses of England there are now over 16,000 insane. 
The Commissioners in Lunacy simply visit them all, but they 
have no control over them. They are absolutely under the local 
authorities.* The English statutes do not even require certificates 
of insanity for the commitment of the insane to these work-houses. 
* Lord Shaftesbury says: “In respect to the county asylums and to 
work-houses we are merely a body to inspect and to report. We have no 
authority at all except in the special case of finding lunatics therein who 
ought to be sent to asylums.” 66 
Where is all the talk, therefore, about the weakness of New York 
law, and about the superiority of England over the State of 
New York? England herself has made no pretentions to this. 
Now, the work-houses are represented as asylums the same as our 
city asylums and county asylums may be so represented. They 
are all independent institutions and governed as local institutions, 
and they are scattered all through England precisely as the 
chronic insane poor are in the poor-houses of our States and in our 
municipal institutions. Now, are we better off or worse off in 
respect to the supervision or visitation of this class of institu- 
tions than England is? We really exercise more State power 
directly over them than England has yet done over her simi- 
lar institutions. Why, the local authorities in the State of 
New York, the counties, can not take care of the chronic insane 
among the helpless, ordinary poor as they do in England, without 
having a license to do so from the State Board of Charities, or a 
direct legislative permissive act in each case, and our Commis- 
sioner in Lunacy must accept the character of the buildings in 
which they are proposed to be kept by the counties. 
Now, in regard to private asylums, Mr. Eaton, before the legisla- 
tive committee, said: with a great Board of Commissioners, they 
could regulate the capacity of such institutions and all that sort of 
thing in England and Wales, while in New York there was no one 
fo look after them. In England and Wales there are about one 
hundred private institutions. In New York there are not over 
five, all told, and they contain—leaving out Bloomingdale, an 
old chartered institution—a mere handful of patients, and these 
institutions are licensed by the State Commissioner in Lunacy, 
and visited and inspected by him. Did Mr. Eaton know this? 
The English Commissioners in Lunacy are charged with the 
duty of licensing and inspecting certain private asylums, and in 
some sense representing the interests of the insane poor who are 
kept within the control of such institutions. For they are allowed 
to receive pauper insane, and the Statutes of England declare 
them to be private asylums where private or pauper insane are 
taken for care and treatment as a speculation by the proprietors. 
It is but reasonable that the State should step in as a police to 
guard and protect the civil rights of the patients there, so that 
when the government has granted this privilege to the citizen of 
speculative care of its helpless ones their civil rights may, never- 
theless, be constantly guarded by the State as represented by 
these Commissioners. They do not and can not license any insti- 67 
tution beyond thirteen months, and in order to keep that continued 
watchfulness over them they axe visited six times a year, or as 
often as is necessary, to see that they serve the very purposes for 
which they were created; but their State institutions and the 
corporate and borough asylums which are allied to our State and 
municipal institutions are not regulated by the Commissioners, for 
all their duties are simply visitorial and advisory, and they are all 
regulated and governed by the local Commissioners which repre- 
sent our boards of managers and trustees, and there these boards, 
justices and visitors of the various places make the appointments 
precisely as they are made in New York by managers and com- 
missioners. Even the authority of licensing by the English 
Commissioners in Lunacy is limited to a metropolitan area within 
seven miles around London, Westminster and Southwark, which 
does not embrace half the private institutions. Throughout all 
the rest of England and Wales they are licensed by the justices 
of the counties or boroughs at quarter or general sessions. Talk 
about national boards and national interference with States ! In 
England they are such sticklers for local authority that no justice 
is permitted to visit any institution except that which he has him- 
self licensed. There the Commissioners can not even revoke a 
license. This can only be done by the Lord Chancellor, Within 
the metropolitan district the licensed houses receive six visits of 
the Commissioners. Outside of this district they receive the same 
number from the local visitors appointed by the justices and two 
visits a year by the Commissioners, whereas the lunatic hospitals 
receive but one visit a year from the Commissioners. 
Thus it will be seen what respect the English government pays 
to the principle of local government, in all matters where there 
is taxation for the support of individuals in her institutions; and 
also to another great principle of having the real powers that 
govern and direct her charitable affairs so near the institutions to 
be governed that they will not only know all about them, but 
where they can be instantly called in case of emergency. 
Why should the New York statutes so resemble the English stat- 
utes ? The organic law of lunacy of the State of New York to organ- 
ize its system of State institutions was drawn by some of the ablest 
lawyers of the State—at the head of these John C. Spencer, assisted 
by that able jurisprudent, Dr. Beck, who was for many years one of 
the managers of the Utica Asylum. These men did not fail to con- 
sult any wholesome provision already in existence in England or 
elsewhere, and gave them therefore all the safeguards that they 68 
could. No great changes have been made in the English statutes 
or in the organization and management of English institutions 
since that time setting out guarantees for the safety and liberty of 
the subject or the humane care of the insane that we have not rec- 
ognized; certainly there are none existent now that outstrip the 
safeguards provided by the statutes of the State of New York, 
In the report of the Parliamentary Committee of 1877, to which 
allusion has been made, it is declared that New York, in the leg- 
islation of 1874, has carefully guarded against improper commit- 
ments, and that in no other State besides New York, is the 
approval of a court, in regard to medical certificates, necessary, 
thus guaranteeing entire safety and certainty as to medical cer- 
tificates and their judicial approval in the commitment of the 
insane to her institutions. 
Dr. Gundey. They made a mistake. There are other States. 
Dr. Geay. lam stating now what the Parliamentary Commit- 
tee said, as well as talking to the proposition which Dr. Gundry 
himself urged we were not meeting—the proposition for advance- 
ment, for he claimed really that we were going backwards. I de- 
sire to show that whatever State is going backwards, New York 
is not. It may be asked whether the laws of New York really afford 
the guarantees we claim as to the rights of her citizens. In ad- 
dition to the fact that the law requires that the certificate shall be 
made by medical men having certain qualifications, which qualifi- 
cations are to be approved by a court of record before they can ex- 
amine an insane person for commitment, the judge or court 
before approving any certificate, may in his discretion, call a jury 
to decide as to the insanity. Are rights not guaranteed ? But we 
really may ask is the removal of an insane person to a hospital the 
taking away of rights? They are sent to institutions simply be- 
cause they are sick. There is no right taken away permanently. 
A distinguished justice once said in a case where the question 
came up as to the right of commitment to an asylum of a wife by 
her husband: “It is not a right taken away from this woman, 
but is a right given to her, a right that she shall be treated prop- 
erly and be defended against her disease and herself.” Neverthe- 
less it is eminently proper that the best possible guarantees shall be 
given by the profession as is done in the State of New York. 
What are the guarantees that the law demands before a man shall 
present himself as a medical examiner to commit an insane person 
in the State of New York ? Every physician before he can act as an 
examiner in lunacy for the commitment of an insane person to any 69 
place is required to be a graduate of some regularly incorporated 
institution, a citizen of the State, a permanent resident of the 
State; he shall have practiced at least three years in his pro- 
fession ; he shall be a man of reputable character, and all 
this shall be shown to the satisfaction of a court of record before 
such court can certify him as a legal examiner. With the certi- 
fication of such a record he has the right and authority to examine. 
Now he must also personally examine the patient, and within a 
reasonable time before commitment, the law fixing this time within 
ten days of sending the person to the asylum. But the law goes 
still further. Unwilling to leave even the form of such certificate 
to the caprice of the physician it declares that the certificates they 
sign shall be made in accordance with a form prescribed by the 
Commissioner in Lunacy, and the medical examiner is not only 
required to give an opinion setting forth the insanity, but also 
to state the grounds upon which that opinion rests, in the body 
of the certificate, and this certificate is required to be under oath, 
and there must be two of them in every case, and these certificates, 
as before stated, must have the approval, in writing, of the judge 
of the county where the patient resides or of a justice of the Supreme 
Court. Is there any other State that gives such guarantees as to 
the rights of citizens ? Among the important questions which were 
brought before the Parliamentary Committee already referred to, 
was that of medical certificates. In England but one certificate is 
required, and the qualification demanded of the physicians are by 
no means up to the requirements of the statute of New York, and in- 
stead of the judicial approval of the New York certificates the 
English certificates simply require to be ratified or approved by 
the Commissioners. On the question of judicial approval Lord 
Shaftesbury was rather opposed to it, and on the ground that such 
approval would carry with it the protection of the physician; that 
he would be protected from prosecution for this professional act by 
the judge’s approval, all of which would be so and very properly. 
If a medical man is called upon to discharge such an act towai'ds 
his fellow-man he should be protected, and in fact the large re- 
sponsibility of commitment of the insane under certificates rests 
directly with the medical profession, which certainly would not 
be less careful, anticipating such judicial action. 
Now 1 submit that these points embodied in the statutes of 
New York represent everything in the British statutes that are of 
value in the government of institutions and the commitment and 
detention of persons therein; that all that is beneficial and useful 70 
is represented in the statutes of New York as fully as those in any 
realm or government in this world. Ido not deem it neccessary 
to defend the statutes. They are records to be read by all men if 
they choose to read. I have said thus much mainly out of compli- 
ment to the able paper of my friend, Dr. Workman, and to meet 
the questions of Dr. Gundry and only incidentally to show that 
the foundation upon which the assertions of Mr. Eaton and others 
were made was not sound. Mr. Eaton really answered himself as 
Dr. Everts has shown. 
It is safe to say that had Mr. Eaton and those for whom he was 
spokesman, and those who appeared with him, been as industrious 
and persevering in the study of the law, and in informing themselves 
of the various provisions that really existed touching the institu- 
tions, as well as their workings and management, as they were 
in the opposite direction, in building up their baseless theories 
and in personal attacks, they might have accomplished some good 
to themselves if not to others. It was only after Mr.. Eaton had 
failed to impress the Legislature with his rejwesentations and in- 
terpretations of the statutory provisions of New York, that he 
resorted to the North American Review to pour out his wrath 
and grievances to a wider audience. However, as Dr. Everts has 
sufficiently shown, with regard to the pamphleteers generally, the 
coarse manner of the attack, the crudity of their ideas, and the gross 
personalities together presented evidence of an animus well calcu- 
lated to antidote any evil in the minds of unprejudiced and intelli- 
gent readers. Still it may be true that the iteration and 
re-iteration, uncontradicted, of the most baseless scandal may 
injure institutions, as we know it does the reputations of individ- 
uals. Dr. Macdonald has given an illustration of Mr. Eaton’s 
style of inquiry and fairness. 
Gentlemen, I have detained you too long. I did not intend to 
say a word upon this subject and should not have said anything but 
that the matter was taken up really by our friend Dr. Gun dry. 
Now a word in regard to the Journal op Insanity, which seems 
to disturb him. When it can not take care of itself it will have to 
go to the wall. [Laughter and applause]. For their own opin- 
ions its editors are fesponsible and not the Association. Members 
of the Association are responsible for their own utterances. Dr. 
Gundry has said that it was not the organ of this body. No one 
has claimed this. It has published for a number of years the 
official proceedings of the Association under a resolution of this 
body, and it has faithfully carried out the provisions of that reso- lution. It has never made a comment upon any part of the pro- 
ceedings of the Association or upon the remarks of any member 
therein contained. The editor of the Journal is a member of this 
Association, and has never felt himself hampered in any way by 
any relations he has held to the Journal, and in no instance has 
he ever dragged it before the Association for favor or disfavor, 
and he will not be led now into any controversy or any reply to 
the attempted strictures of Dr. Gundry. 
Dr. Workman. I have no desire—having read my paper yes- 
terday—to introduce an apple of discord; but Ido not regret now 
that I did read that paper. It has given me the pleasure of hear- 
ing some very eloquent speeches. 
I think Dr. Gray’s observations tend to confirm what I ad- 
vanced yesterday in regard to our governmental system of inspec- 
tion. The difference between Dr. Gray’s plan and mine is simply 
this: Mine would be only the one man power, or it might be two 
or three for a whole State, while the New York system has a 
large board of inspection and management for their institutions. 
The Doctor has certainly proved that the institutions of New 
York have been well taken care of; and one proof of this is that 
he has been for thirty years in one institution. Had a different 
plan existed, and the work of the inspector became a tenure, I 
think we should have seen a dozen Dr. Grays in Utica since he has 
been there. I think the more administrative and inspection power 
the better. I know that our friend Mr. Langmuir, who has for 
some fourteen years filled the office of inspector, and has now a 
number of institutions under his care, finds them more efficiently 
worked than ever and his time most thoroughly taken up. I 
think, however, it would be much better for him to have an asso- 
ciate. The difference between the criminal insane and insane not 
criminals, is such that to have the supervision of both devolve 
upon Mr, Langmuir so different in their character, is not as desir- 
able as it would be to have them separated. I do not think the 
other institutions of this country should be under the same man- 
agement as a criminal institution. When the act was being framed 
for an inspector I wrote to a member of the Assembly relative to 
the expediency of this. He wrote to me the way matters stood 
and that he would have voted for it after advocating it the way it 
then was, but as I was a candidate for the office he certainly would 
support my suggestion, I did not know that I was a candidate 
until then. 
With regard to the sixty gentlemen who visit and govern the State institutions in the State of New York, I would ask Dr. Gray 
if they act as a Board of Inspection. 
Dr. Gray. Each institution has its own board, and the boards 
vary in number from nine to thirteen. Each institution has on its 
board the elements necessary for government and inspection—men 
of financial management, lawyers and physicians. 
Dr. Workman. But as I have just said, the best evidence of 
the efficiency of your system is the permanence of the officials of 
your State—to which I alluded yesterday, and the same may be 
said of some of the States of New England. But how is it in the 
west and southwest ? If I should go there next year I should miss 
half of them; and if after ten years, I do not know that there 
would be a grease spot left. 
Dr. Gray. In what I have said I only claim that we are fully 
abreast with the best of them; but I do not by this intend to 
claim that we are not going to do still better. We know there 
are always possible elements inherent out of which we may make 
advancement in perfecting all laws and organization. In these 
problems of State policy, as in all great social questions, institu- 
tions and their organization are matters of growth, and we are not 
standing still, but we have grown steadily and intend to grow 
more in every way toward perfection. 
Dr. Gujstdry. As I supposed, Dr. Gray does not propose to ad- 
mit all the powers of English boards, particularly the power to 
require a transcript of the history of every commitment into every 
institution. It is required that notice of every admission shall be 
sent to them within ten days. 
Dr. Gray. In New York we have on this very point all the 
safeguards of English law, and more too. This question of 
certificates for commitment and power of approval was a point 
especially considered in the legislative codification of our Lunacy 
Laws in 1874. As I have already shown, the power of r*eview 
and approval of the certificates is given to the county judges 
and justices of the Supreme Court, The certificates must be 
in a form prescribed by the State Commissioner in Lunacy, 
and must be approved in writing by a justice of the Supreme 
Court, or by the county judge of the county in which the luna- 
tic resides, and must accompany the patient and be filed in the 
hospital as a permanent record with the history of the case. The 
New York statute goes farther than the English in regard to 
certificates of commitment and power of review and approval. 
First, in requiring that the medical examiners shall have certain 73 
qualifications—shall be graduates of incorporated medical colleges, 
practitioners of not less than three years, permanent residents oi 
the State, and men of reputable character. Medical examiners 
must have an attest of these qualifications by a court of record be- 
fore they are entitled to -examine and make a certificate. Each 
examiner must make the certificate under oath, which must recite 
his qualifications and state the date of examination, and give the 
ground of his opinion, and must give also the name of the judge or 
justice under whose attestation he acts as an examiner. Again 
the justice or judge who finally reviews and approves the certifi- 
cate before commitment, may, if he sees fit, summon a jury to de- 
cide as to the question of lunacy, but under no circumstances can 
a commitment be made unless with the judicial approval of the 
certificate in its form and substance. These I submit, are greater 
safeguards where the court appears with power of full inquiry into 
the case, and where he can call the physician before him or the pa- 
tient either before commitment, than the sending of a transcript to 
commissioners who know nothing of the case further than the 
paper discloses, and this after the lunatic is actually admitted. 
As to the history of the case, the New York statute specifically 
directs that it shall be entered in a book kept for the purpose and 
written up from time to time. Ido not know of a single provision 
of the British Lunacy Laws of any practical bearing that we have 
not incorporated, and some of them we have greatly improved 
upon, and this is an instance. THE 
AMERICAN JOURNAL OF INSANITY. 
The American Journal of Insanity is published quarterly, at the 
State Lunatic Asylum, Utica, N. Y. The first number of each volume 
is issued in July. 
Editor, 
JOHN P. GRAY, M. D., LL. D., Medical Superintendent 
Associate Editors 
EDWARD N. BRUSH, M. I)., 
SELWYN A. RUSSELL, M. 1)., 
ELI E. JOSSELYN, M. D., 
G. ALDER BLUMER, M. D., 
y Assistant Physicians. 
i 
THEODORE DEECKE, Special Pathologist. 
TERMS OF SUBSCRIPTION, 
Five Dollars per Annum, in Advance. 
Exchanges, Books for Review, and Business Communications 
may be sent to the Editor, directed as follows: “Journal of 
Insanity, State Lunatic Asylum, Utica, IST. Y.” 
The Journal is now in its thirty-eighth volume. It was es- 
tablished. by the late Dr. Brigham, the first Superintendent of the 
New York State Lunatic Asylum, and after his death edited by Dr. T. 
Romeyn Beck, author of “Beck’s Medical Jurisprudenceand since 
1854, by Dr. John P. Cray, and the Medical Staff' of the Asylum. It is 
the oldest journal devoted especially to Insanity, its Treatment, Juris- 
prudence, &c., and is particularly valuable to the medical and legal 
professions, and to all interested in the subject of Insanity and Psy- 
chological Science,