THE CARE OF THE INSANE IN THE 
STATE OF NEW YORK, 
HISTORICALLY CONSIDERED. 
By STEPHEN SMITH, M. D., 
State Commissioner in Lunacy. 
[From the American Journal of Insanity, for July, 1886.] THE CARE OF THE INSANE IN THE STATE 
OF NEW YORK, HISTORICALLY 
CONSIDERED/ 
BY STEPHEX SMITH, M. D., 
State Commissioner in Lunacy. 
We have been invited to attend the graduating 
exercises of the first class of the Training School for 
Attendants connected with the Buffalo State Asylum 
for the Insane. The occasion is one of no ordinary 
interest and importance. It is the first event of the 
kind in the history of the public care of the insane.f 
It begins a new era in the progress of the great reforms 
which have characterized this century in the improve- 
ment of the methods of ministering to the wants and 
necessities of this unfortunate class. 
The full significance of these exercises can not be 
appreciated without understanding the past history of 
the management of the insane in this State. During 
the century of the existence of the State, now about to 
close, we may find every phase of care of this class of 
dependent poor, from the most barbarous to the most 
intelligent and benevolent. We need not go beyond 
the limits of our own commonwealth to find illustra- 
tions of the care of the insane in every period of the 
world's history. They have been treated as demoniacs; 
have been classed with the lowest grade of criminals; 
have been regarded as paupers, requiring the custody 
of the almshouse; and, finally, they have been taken in 
* An address delivered before the first Graduating Class of the Training 
School for Attendants at the State Asylum for the Insane, Buffalo, N. Y., 
April 20, 1886. 
f Since this address was delivered it has been reported that a class of 
trained attendants graduated from a school in Massachusetts, in March of 
this year. 2 
their true character as sick people, requiring hospital 
care and attendance. Costly structures have been 
erected for their special purposes and uses, and they 
have been treated with the utmost tenderness. 
The first law placed upon the statute book of the 
State of New York, relating to the treatment of the 
insane, was enacted in 1788, now nearly a century 
ago. This law gives us a vivid impression of the con- 
dition of the insane at that period, and of the state of 
public opinion in regard to them. The Act was 
entitled "An Act for apprehending and punishing dis- 
orderly persons," and was as follows: 
Whereas, There are sometimes persons who, by lunacy or 
otherwise, are furiously mad, or are so far disordered in their 
senses that they may be dangerous to be permitted to go abroad; 
therefore, be it enacted that it shall and may be lawful for any 
two or more justices of the peace to cause to be apprehended and 
kept safely locked up in some secure place, and, if such justices 
shall find it necessary, to be there chained, if the last place of 
legal settlement be in such city, or in any town within such 
county. 
This short but expressive act is prefaced with the 
significant phrase, "We, the People of the State of 
New York, represented in Senate and Assembly, do 
enact as follows." It stands, therefore, as the embodi- 
ment of the highest and best sentiment of the people 
of this State, regarding the insane, at the commence- 
ment of its organized civil existence. It was the 
popular opinion that only those insane who were 
"furiously mad," or so far "disordered in their senses" 
as to be "dangerous to be permitted to go abroad," 
needed public care; and these poor wretches were to 
be taken into custody, not to benefit them by the 
ministrations of benevolence and humanity, but to 
protect society from their acts of violence. The quality 
and the grade of care which they were to receive were 3 
well defined in the Act, viz., they were to be " kept 
safely locked up in some secure .place," and if their 
custodians found it necessary, they were directed to 
have them chained there. That this law was rigidly 
enforced the current history of the times affords 
abundant evidence. The lunatic in public care was 
found in every jail, despised even by the criminals with 
whom he was associated, and in the vast majority of 
cases he was chained. A contemporary medical writer, 
of New York, speaking of the methods of confining 
the insane, says: 
Everything that met the view of the exiled sufferer, about to 
enter them, was suited to convey the idea of confinement and 
restraint, and that he was to be immured in and subject to the 
hardships of a prison; an impression of lasting and pernicious 
tendency. lie was, indeed, there shut up from the world, 
separated from his friends, and covered from the light of day; 
and amidst the aggravated horrors of a dungeon, the chains which 
riveted his ghastly figure to the ground, bound also in everlasting 
night, the distinguishing attribute of his being. In such a 
situation, without an effort to revive the suspended energies of his 
mind, with nothing to awaken him to a sense of his human nature 
without a ray of consolation, of affection, or of sympathy to 
beam upon him, he remained a neglected, forgotten, and 
abandoned prisoner. Thus forlorn, the whole plan and system of 
his custody, were of a nature to drive him to despair, and to the 
hopeless, the awful condition of irremediable madness. 
The public care of the insane in this State has been 
quite closely modelled on that of England, and to the 
latter country we must refer for many of the more 
important features of our laws on lunacy administra- 
tion. This first Act of our State Legislature was 
exactly copied from the vagrant laws of England. It 
was the first Act of Parliament relating to the custody 
of the insane, and was passed in 1744, forty-four years 
before it was adopted in this State. The impulses 
towards reform were however earlier felt in the mother 4 
country, and were more active and persistent than in 
the colonies. 
If we examine the current events in the history of 
lunacy reform in England we find that at the time this 
law was enacted, in 1744, there were the first faint 
indications of a popular recognition of the relations of 
the insane to the State. The condition of the insane 
was most deplorable. They were arrested without 
warrant and confined in private mad-houses without 
the possibility of escape. Their treatment was of the 
most cruel and barbarous character. No supervision 
whatever was exercised over either public or private 
institutions. The famous Bethlehem, or Bedlam 
Asylum, as it was popularly called, was the great 
institution of the period, and the condition of its 
inmates was beginning to attract popular attention. 
DeFoe had already described in scathing language 
the private mad-houses, and the methods of incarcera- 
ting the insane in them. The condition of the patients 
in Bedlam and in the mad-houses was from time to 
time made public, and excited much discussion. 
Hogarth sketched the appearance of the insane, in 
their cells, lying in the straw; while other artists 
figured the inmates undergoing various kinds of 
torture. But in spite of the efforts of a few 
philanthropists no further legislation was secured 
until 1774, when England took the first step in the 
direction which she has steadily pursued from that 
date, and which has placed her in the first rank of the 
civilized nations of the world in the care.of the insane. 
At the period of the enactment of the law of 1788, 
by the State of New York, there were neither public 
nor private asylums for the insane within her borders. 
There was, therefore, no agitation of the question of 
the care of the insane. The only insane recognized 5 
were those who were furiously mad and dangerous to 
be at large. The Legislature sought to protect society 
against this class, and found in the English Vagrant 
Act, of 1744, nearly half a century earlier, the formula 
of law for effecting its object. There was nothing in 
the English Act of 1774 which was applicable to the 
condition of the insane in New York, for they were 
not in asylums, nor mad-houses, but were in private 
care or in the pauper establishment. Nothing seems 
to have occurred to change the status of the insane 
until the year 1791, when the New York hospital was 
opened for patients, and the first cases admitted are 
supposed to have been insane. This seems to have 
been the first provision in this State for the insane out- 
side of the jails and the almshouse. The treatment of 
the insane in this hospital was little better than in the 
poor-houses and jails. Writers of that period still 
speak of the cells and chains of the maniacs. The 
attendants were but little above the common order of 
poor-house keepers, or jailers, and there was as yet but 
slight agitation of the question of the improvement of 
the condition of the insane. It was at this time that 
the famous York Retreat of England, under the 
management of the Society of Friends, began to attract 
attention. A new policy was adopted in this institu- 
tion. The inmates were regarded as susceptible of 
control and good government by humane measures. 
The old system of restraint was abandoned, and moral 
influences substituted. The result surprised England. 
This asylum became a model of good order, freedom 
from excitement, and absence of the old and familiar 
forms of restraint. The value of good attendants was 
here recognized. Many patients entered the wards 
who had been chained for years in other asylums, but 
who were soon made tractable under the influence of 6 
kind, intelligent and humane attendants. A visitor to 
the Retreat states that " They sometimes have patients 
brought to them frantic and in irons, whom they at 
once release, and by mild arguments and gentle acts 
reduce almost immediately to obedience and orderly 
behaviour." It is said by the historian • that the 
experiment at York Retreat would have failed had not 
the superintendent succeeded in securing attendants 
who were kind and gentle, and willing to perform 
their duties in a humane spirit. 
The fame of this institution spread throughout 
England, and into European States, and gradually its 
influence moulded the lunacy system of Great Britain. 
In time the reports of the Retreat began to penetrate 
this country and awaken a new sentiment in the minds 
of the more philanthropic. It was not, however, until 
1806 that any improvement was made in the care of 
the insane, though it is doubtless true that there was 
more or less agitation of the subject during the 
interval. 
That there was an increasing interest felt in the care 
of the insane in this State is seen in the resolution of 
the Governors of the New York Hospital, in 1806, to 
erect a new building for the insane owing to the 
defective accommodations of the old building for this 
class of inmates. They appealed to the Legislature for 
aid, and that body appropriated the necessary sum 
with the following preamble to the Act, which is 
interesting, as it gives expression to a very advanced 
opinion of the needs of the insane: 
It has become necessary, on account of the increasing number 
of patients in the hospital in the city of New York, to enlarge the 
same, by erecting additions thereto, for the more convenient 
accommodation of the sick and disabled, and particularly, to 
provide suitable apartments for the maniacs, adapted to the 
various forms and degrees of insanity. 7 
This is the first public recognition in this State of 
the fact that there are various forms and degrees of 
insanity which require the classification of the insane, 
in suitable apartments. 
The new building was in due time erected, and was 
called the " Lunatic Asylum." This asylum continued, 
in active operation from 1808 to 1821, when the 
present Bloomingdale Asylum took its place. There 
are many evidences of the value of the experience 
gained in this institution, and of the influence which 
its management exerted upon the public mind. It led 
to the first effort of the State to make special provision 
for the insane poor, hitherto confined to poor-houses. 
This Act was passed in 1809, as follows: 
That it shall and may be lawful for the overseers of the poor of 
any city or town, by and writh the consent of the common council 
of such city, or of two justices of the peace of the county in 
which such town shall be, whenever any poor person legally 
settled in such city or town, and maintained at the public charge, 
who was or who shall become lunatic or insane, to contract with 
the governors of the New York Hospital in the city of New York, 
fox- the maintenance and care of such lunatic on such terms as 
they may deem meet, and to transport such lunatic to the said 
hospital. 
For thirty-four years this asylum, which in 1821 was 
removed and became the Bloomingdale Asylum, was 
the only institution in the State having the character of 
a public custodial institution for the insane. It was 
always under the best management, and the basis of its 
success has ever rested on the efficiency of its officers, 
and the high grade of its attendants. 
For nearly a quarter of a century, viz.: from 1808 to 
1827, this State presented the singular anomaly of con- 
fining its insane in jails, poor-houses, and a small asylum 
of a very high order of management. In the jails they 
were still treated as criminals, and were generally 8 
chained, as directed by the law of 1788. In the poor- 
houses, or almshouses, the chronic insane congregated, 
and were subjected to every possible degree of cruelty 
and neglect. In the asylum of the New York Hospital 
they were treated in the most humane manner, by the 
best class of officers and attendants. Of the excellent 
management of this asylum there is much contemporary 
evidence, but no better testimony can be given than is 
furnished by one of the early superintendents in his 
annual report. He says of the asylum: 
The order and internal economy and government of the New 
York Lunatic Asylum have justly placed it in the highest rank 
among the best institutions of our country; and the most im- 
proved establishments of the kind in Europe do not afford a 
source of higher congratulation on the benefits they have afforded 
to the most afflicted of our race. 
Referring to the past, he says: 
The period is not remote, when a variety of circumstances con- 
spired to render the very name of a mad-house a subject of terror 
and dismay. The prevailing opinion of the friends of its unhappy 
tenants was, that they were placed within its walls, not as in a 
situation, where they might by lenity and kind treatment, be 
restored to the blessings of health and reason, but as in a place of 
safe keeping; disabled from injuring themselves and others; 
where, from the supposed nature of their disorder, they neither 
deserved nor would receive the compassion of their keepers, and 
where they would inevitably languish and die. 
Of what an asylum should be he gives the following 
very enlightened opinion: 
Asylums for the insane ought no longer to be viewed as places 
of personal security merely, but the temporary abode of a class 
of fellow beings, having the strongest claims to our sympathy 
and regard; furnished with the means of comfort, amusement, 
and employment adapted to the circumstances of their condition 
and the nature of their disease. 
Referring to the Bloomingdale Asylum, then in the 
process of erection, he suggested, "that while it is of 9 
much importance that it be so constructed as to convey 
no idea but that of comfort, it may also admit of a 
classification of the patients during the day, according 
to their sex, condition of life, and various states of 
derangement, in separate apartments of convenient 
dimensions." He also recommended a " distinct build- 
ing for the most raving arid noisy, who should be con- 
stantly under the inspection of a'faithful, humane and 
discreet attendant." "A convalescent," he adds, "should 
at all times be separated from the more insane." * * 
"The furious maniac * * ought at times to be 
released from his chain and his cell, to be led forth to 
the refreshing influence of an untainted air, and the 
liberty of such exercise as may promote so free and 
equal circulation." * * " When released," it is ad- 
vised that "he should not associate with the deranged." 
* * "It is only by thus extending the freedom of the 
violent that we can ascertain the changes their malady 
may have undergone. Neglect in performing so im- 
perative a duty is a negative act of unpardonable 
cruelty, which there are strong reasons to believe, 
has often doomed to immeasurable suffering many a 
wretched inmate of a lunatic asylum." He advises 
that in the new asylum two large apartments be appro- 
priated for the sick of the two sexes, each having an 
attendant by night as well as day. 
He gives the following reasons for these views: 
" With such a provision, the sufferer, in whose mind 
the light of reason had been long extinguished, might, 
during that gleam of intellect, which frequently attends 
the closing scene of life, be made to know that he is a 
human being meriting and receiving the compassion 
and kind offices of his fellows." The labor and amuse- 
ment question he discusses as follows: "I would 
recommend that in all their recreations, whether of 10 
labor, or skill, or amusement, they should be separated 
from each other, and classed, as far as circumstances 
will admit, with the sane, engaged in similar amuse- 
ments and pursuits. It has been found that such 
employments and recreations as require the most bodily 
exertion, have been the most beneficial." 
On restraint he held the following opinions: 
The means of safekeeping by bars and bolts, and cords and 
chains, are abundant, and easily obtained; but it should be the 
supreme object of those who have assumed the supreme responsi- 
bility of governing the insane, to restore to their reason and to 
society the greatest possible number of these afflicted beings; and 
we have no hesitation in believing, that this will be most certainly 
accomplished by strict attention to a moral regimen. The greatest 
improvements in the treatment of madness have been of this 
nature; and the most approved physical agents of modern times 
were familiar to our remotest ancestors. With such views, the 
recovery of the deranged is not to be forgotten in the mazes of 
abstract research, nor in those wild speculations on the nature of 
the reasoning faculty, under the influence of which it is often 
difficult to determine where the greatest alienation exists, whether 
in the patient, or in him who has the care of him. 
Finally, it is interesting to notice liis opinions of the 
qualifications of attendants upon the insane: 
Those appointed should be reasonable, humane, moral and relig- 
ious, possessing stability and dignity of character; mild and 
gentle in theii temper and deportment, but resolute in their pur- 
poses, and of great self-command ; never attempting by ill-directed 
efforts of superior strength to subdue the unconscious violence of 
their charge; of just and sagacious observation, and endued with 
clear and unclouded minds; so compassionate and of such 
intelligence, as not only to take an interest in the unhappy lot of 
the objects of their trust, but to be able to assist them in the 
recovery of their reason. In their ordinary visits they should 
approach the insane with an air of gentleness and kindness,, 
expressive of concern for their unhappy condition, a deportment 
which will not fail to augment their respect and confidence on 
occasions requiring a more stern and distant intercourse- 11 
They should watch, with discriminating and unwearied attention, 
those favorable moments of drawing them from their hallucina- 
tions, their fantasies and wanderings, which frequently occur in the 
intermissions of many cases, both of madness and melancholy. 
The blunders of the ignorant and unskilful in the treatment of 
bodily disease, are generally of rapid effect, and may soon end in 
the death of their victim; but in the management of the insane, 
they are of slow, deep, and lasting consequence. 
These remarkably dear statements on the manage- 
ment and construction of asylums for the insane, and 
of the proper qualifications of attendants, were pub- 
lished seventy years ago. They show that there were 
in New York, at that early day, men who had the most 
thoroughly correct views of the care and treatment of 
the insane, and of the proper qualification of attend- 
ants. It can not be doubted that these opinions had a 
wide dissemination among the leading citizens, many of 
whom were governors of the hospital. It is certain 
that the tone of public feeling towards the insane was 
now undergoing a marked change, for in 1827 the 
Legislature took the important step of passing an Act 
that " No lunatic shall be confined in any prison, gaol, 
or house of correction, or confined in the same room 
with any person charged with or convicted of any 
criminal offense." By this law the insane in this State 
were forever separated from the criminal classes. Thus 
one class of attendants on the insane, which had held 
sway for fifty years, were dismissed from the service. 
But the reform did not end with this act of leg- 
islation. On the contrary, it assumed a more im- 
portant phase. The more advanced members of the 
medical profession took the position that not only are 
the insane not criminals, but that they are sick persons 
who require hospital care for the purpose of recovery. 
This opinion gained ground, and finally became so 
prevalent that, in 1836, the State Medical Society 12 
memorialized the Legislature on the subject, using the 
following language: 
The time has arrived when we are called upon to discharge the 
uncancelled obligations of religious, moral and social duty to that 
portion of our fellow-citizens, whose appeal to our sympathies, 
justice and humanity is the strongest claim which can, under any 
circumstances, be made by any portion of our population. 
The memorial concluded by urging the Legislature 
to make provision for the erection of a proper asylum, 
for the support and medical treatment of the insane, 
with a view to their restoration to health, reason, their 
friends, and the community. The Legislature passed an 
Act establishing the State Lunatic Asylum at Utica. 
This asylum was completed so far as to be organized in 
1842. By this Act the policy of the State became 
fixed in favor of regarding insanity as a disease which 
required prompt medical care and treatment. This 
reform was a vast improvement upon the past care of 
the acute insane. Every effort known to science was 
to be put forth to restore the acute insane to health. 
The asylum was organized under the ablest physician 
of this country, and the highest grade of attendants 
was secured. The value of that institution to the 
State in rescuing the acute insane from chronic insanity 
can not be estimated. 
But important as was this new departure, it did not 
disturb the large population of chronic insane who 
were still under the care of the almshouse keepers, nor 
did it in any respect improve their condition. Investi- 
gations by the State a quarter of a century after the 
opening of the Asylum showed that the condition 
of the insane in the poor-houses was most deplorable. 
They were treated in the same barbarous and cruel man- 
ner as in the earliest periods. Men and women were 
found chained to the place where they had remained 13 
from youth to old age. Then began a new effort which 
culminated in the organization of one of the most 
valuable and important State charities in the world, the 
Willard Asylum. This institution was especially 
designed to remove the insane from the poor-houses, 
and prevent their accumulating in these county resorts. 
Although it did not effect completely that object, it 
did lead to a reform, even in the care of the insane in 
these primitive institutions. Public attention was now 
directed to them; the State began a system of inspec- 
tions, and with the publicity which was thus given to 
their condition, the needed changes progressed rapidly. 
Better attendants were accorded the insane, better food 
and clothing were supplied; better accommodations 
were secured; restraint diminished, or ceased altogether. 
To-day there is not a poor-house in the State in which 
the insane have not comfortable quarters, good food 
and clothing, little or no restraint. 
Standing as we now do, on the threshold of the 
centennial of this State, and estimating the future of 
the insane by the light of past reforms and improve- 
ments, the coming century is full of promise, and bright 
with hope and anticipation. Although the agitation 
for lunacy reform began in England, and was most 
intense in that country, yet the reforms which were 
from time to time effected in her lunacy laws, and in 
the management of her asylums, were practically 
adopted and applied in this State. The history of that 
agitation in this State, as well as in England, is the 
history of the social progress of the people. There is 
no more striking illustration of the refining and 
elevating influences which have gradually moulded the 
public conscience into forms which give expression to 
the higher sentiments of philanthropy, than the remark- 
able changes which have occurred in the relations of 14 
the State to the insane during the century of the 
existence of this commonwealth. One hundred years 
ago no one was recognized as sufficiently insane to 
require care or custody who was not furiously mad, 
and too dangerous to be at large; to-day insanity 
is recognized as a disease, having a great variety of 
expressions, and demanding treatment in its several 
stages by competent medical men. One hundred years 
ago the insane were arrested as common criminals, were 
incarcerated in jails, were tried by juries and were con- 
demned to imprisonment with the same formality as 
the indicted and convicted felon ; to-day no person can be 
lawfully declared insane, and be removed from his 
home, unless he is first examined by two physicians 
who have been approved by the court as competent 
examiners in lunacy, who must give the facts on which 
they base their opinions in a written certificate, verified 
under oath; nor can such person be held in custody on 
this certificate more than five days, unless it is approved 
and signed by a judge of a court of record within that 
period. One hundred years ago the insane, when duly 
convicted by a jury were incarcerated in cells and 
dungeons with criminals, and if necessary were chained; 
to-day the State of New York has provided for the 
insane residences, erected on the choicest available sites, 
and endowed them with every known convenience and 
appliance for their recovery and personal comfort. One 
hundred years ago cruelties and outrages in the per- 
sonal treatment of the insane were of public notoriety, 
but they elicited no remonstrance, nor did they create 
a ripple of agitation; to-day the faintest rumor of unkind 
treatment of the insane, or even of restraint by the 
mildest means, arouses popular indignation as does no 
other tale of wrong or cruelty. 
From this review it is apparent that the office of 15 
attendant upon the insane has advanced in character 
and importance in proportion as our views of the nature 
of insanity have improved. While they were regarded 
as criminals the common jailer was the care-taker, 
when they were believed to be innocent but trouble- 
some persons, they were placed in charge of the alms- 
house keeper; when it was established that they were 
sick persons, hospitals were erected for their care and 
treatment, competent physicians appointed to cure their 
maladies, and the highest class of nurses selected to 
attend them. The grade of care has, therefore, been 
steadily advancing until to-day a far better class of 
attendants are in charge of the insane than at any 
former period. The commencment of this reform in 
the selection of attendants, undoubtedly dates from the 
opening of the Utica Asylum. This being a curative 
hospital every condition favoring the highest grade of 
treatment was adopted. That the superintendents of 
that institution have always sought to maintain a thor- 
oughly competent class of attendants, appears evident 
from the rules and regulations governing the conduct of 
its officers. Every other State asylum has, in turn, 
adopted the same high standard, and many of the large 
county asylums have followed the example of the parent 
institution. Thus the reform has spread until in every 
asylum in the State there is now a careful scrutiny of 
the qualifications of all applicants for the position of 
attendant. The following extract from the book of 
instruction of attendants of the State Lunatic Asylum, 
may now be regarded as the prevailing sentiment in 
reference to the character and obligations of attendants 
in all of our asylums: 
This asylum has been erected at great expense by the State, that 
the insane may have a safe retreat, in the care of those who have 
learned the best mode of managing them, and where they may 16 
have every chance of recovery. The first impulses of insanity are 
often met at home and amongst friends, by resistance and opposi- 
tion. The apparent difference in the conduct and feelings of their 
friends, excites collision, arouses the passions, and awakens the 
prejudices of the victims of delusion. They now feel that those 
whom they loved, have turned against them-that their friends 
purposely thwart all their plans, oppose all their desires, and resist 
what they conceive to be their own best efforts to promote the 
happiness of both. 
For these reasons it becomes desirable that they should be 
removed to the care of strangers, whose efforts to make them 
comfortable, they often acknowledge and appreciate more correctly. 
From strangers they will also submit to requirements without a 
murmur, which would excite the greatest hostility to friends. 
In the various departments, all have daily much to do with the 
inmates of the asylum, and some devote their whole time to their 
care. It becomes all seriously to consider how this duty shall be 
performed; what discipline of feeling and what subjugation of 
temper there shall be that the "law of kindness" may be 
administered to its full extent, and in its proper spirit. 
Every person employed in the asylum, in any capacity whatever, 
must perform the duties assigned conscientiously, and to the 
entire satisfaction of the managers, of the superintendent, and of 
those in immediate authority. 
No individual is worthy of a place in such an institution who 
labors for wTages only. Duty, a desire to improve the condition of 
all within the sphere of influence, to increase the happiness and 
lessen the sufferings of each and all the inmates, should be the 
governing motive of daily conduct. It must never be forgotten 
that we are dealing with fellow creatures, who, being deprived of 
reason, are not responsible for their conduct. The regulating power 
of moral action is withheld from them; hence they are capricious, 
passionate, and often violent. They often also misjudge, and are 
led astray by perverted senses or by delusions of the understand- 
ing, which carry them far from the proprieties of rational conduct. 
It is because they are unable to control themselves, and 
because they do not readily acquiesce in the directions of their 
friends, that many of these individuals are placed in the asylum. 
Here they are to have every comfort and every reasonable 
indulgence, which individually or collectively, will promote their 
best good. Here they look for sympathy and counsel, for 
assistance in their various troubles and perplexities. We should 17 
enter into their feelings, and show our willingness to spend our 
time and strength to promote their happiness, and recovery to 
health. 
To withhold what may reasonably be required is to do them 
injustice, and disregard duty. To treat them with neglect, or with 
unkind and hasty language, or in any way to tantalize them, or to 
recriminate or to return violent or abusive words, is to do them 
injury. 
Persuasion with a proper spirit, will generally be followed by 
a quiet acquiescence in all reasonable requirements. Much depends 
upon the manner of intercourse with the insane. We should 
never be cold and insensible to their wants-never hasty and 
impatient in our intercourse-never turn a deaf ear to their 
representations-never treat them with neglect, nor with feelings 
of superiority; but mingle with them in kindness, address them 
with respect, and we shall secure their confidence, which is 
necessary to their best care. 
No stronger appeal could be made to the higher and 
better feelings, to impress a sense of moral obligations, 
than is embodied in this short admonition. It was the 
keynote to a reform which has elevated the status of 
attendants upon the insane to its present high position. 
When I began my official inspection of the institu- 
tions for the insane in this State, I entertained no very 
friendly opinion or sentiments toward their manage- 
ment. And especially did I regard the attendants as a 
class of men and women probably much below the 
average of the nurses in hospitals with which I was 
connected. I should be recreant to my sense of justice 
did I not, in this place, and in this presence, bear 
willing and emphatic testimony to the generally good 
character of attendants in the State and metropolitan 
asylums. They form a corps of workers numbering 
about 1,000, who in intelligence, moral character and 
devotion to duty, are worthy of the confidence of the 
community. I have seen them in every capacity, and 
have tested them by every suitable method, night and 18 
day, and I know of no class of employees who could 
have better sustained the scrutiny. It is true that there 
are individual exceptions, as must necessarily be the 
case in every profession or occupation, but as a body 
of men and women, engaged in a special calling, they 
are the peers of the best grade of hospital nurses and 
attendants. 
As an example of the thoroughness with which 
attendants now perform their duties, I wrould state that 
during one year I examined the clothes, the person, and 
the bed of every so-called filthy patient in the asylums 
of this State, and found but one bed not wholly clean 
and in good condition. 
My originally unfavorable opinion of attendants grew 
out of my unfamiliarity with the peculiarly respons- 
ible and difficult duties which they have to perform. 
And I think the public criticism of attendants would 
be greatly modified and mitigated if the nature of these 
duties were better understood. If we but consider the 
first and primary rule in asylum management, we can 
readily understand how a conscientious and careful 
attendant may have all his acts misconstrued especially 
by patients. The first and highest duty of the 
attendant is to maintain good order, and discipline. 
Good order is not more necessary to the comfort of the 
patients than to their recovery. Discipline in the orderly 
attendance to duties, is the first lesson to impress 
upon the insane. And yet, in the very nature of in- 
sanity, we find the most violent antagonism to both 
order and discipline. The early popular definition of in- 
sanity in this State, as we have seen, was "disordered 
in his senses." The first recognizable insane act is 
usually that of disorder. Then follows a disposition 
to wander and great intolerance of restraints of any and 
all kinds, and from every source. Friends now fail to 19 
exert any influence over them, or if they attempt to do 
so the insane violently resist, and conceive the most 
intense hatred of their best and nearest relatives. No 
one but an attendant can fully realize the difficulty of 
controlling the morbid impulses of such a patient when 
first introduced upon a ward. He has thus far gratified 
every wish or purpose, and thereby his will to do as he 
pleases has gained strength and determination. Every 
effort is employed to induce him to comply with the 
rules of the asylum, such as to go to the table when the 
bell rings; to go to bed and rise ata given hour; to 
make his own bed; to wash before meals. All these 
rules he refuses to comply with, resorting to the most 
violent demonstrations towards those who attempt to 
compel him to obey. How shall such a man be brought 
to obedience-perhaps the very first step towards 
recovery ? Reasoning does not influence him; to allow 
him to disobey only intensifies his obstinacy. The only 
alternative now recognized is manual force. He is over- 
come by superior strength, and the first link in the 
chain of disorderly thoughts and feelings is broken. 
The attendants have done their duty according to the 
manual. They have done their duty well and faithfully, 
according to the rules and regulations of asylums, and 
have not abused their trusts. But patients in their 
insane state very naturally construe these efforts as 
gross forms of abuse. I have many a time seen attend- 
ants lift paralytics from their filthy beds, and carry 
them to the bath tub, as gently as their struggles would 
permit, while these patients would call on me to witness 
the cruelties to which they were subjected. The same 
scene is often repeated when attempts are made to 
induce patients to eat, to walk out, to make their beds. 
It may, I think, be stated that, in the nature of the 
case, no institution where the insane are held in custody, 20 
has ever been, nor perhaps ever will be, popular with the 
insane. There are many who will leave it restored to 
their right minds, profoundly grateful for the care 
and-attention which they have received; but there 
is'another larger number who will leave it unimproved, 
and who will never fail to entertain the most hostile 
feelings towards all engaged in its management. There 
are asylums in this State where all the ministrations are 
inspired by the purest and most self-sacrificing religious 
sentiment. In these institutions the superintendent, 
attendants, and subordinates are all selected with 
reference to their special fitness for their duties. The 
immediate attendants upon the patients are women of 
culture and refinement, and life-long devotion to unre- 
quited charity. And yet, in these asylums, I have list- 
ened to tales of cruelty, neglect, and improper treatment 
of the most aggravating description. But many a recov- 
ering patient has informed me that the first step in 
his restoration was the act of being brought to 
orderly habits in the daily routine of ward life. 
I do not wish to be understood as asserting or implying 
that attendants never abuse patients. Unfortunately 
that is too true as the dismissals from asylum service 
prove. Nor do I wish to be understood as in any 
sense apologizing for cruelties to the insane. On the 
contrary all such offenses when proven should be 
punishable as assaults upon the person; I would only 
ask that common justice be meted out to those who 
perform their duties, often most disagreeable, conscien- 
tiously, and in accordance with rules which they have 
promised faithfully to obey. If we consider that in the 
arrangements of asylums an attendant must always be 
on the ward, and always on call, that many of their 
duties are of the most menial character, that they are 
constantly subjected to indignities and often assaults, that 21 
they are largely debarred from social privileges, we gain 
but a faint impression of the daily life of an attendant. 
In one of my reports I attempted to give the daily 
routine of duties of attendants, from their rising to their 
retiring. A gentleman of high standing, who had 
hitherto been prejudiced against attendants, expressed 
his astonishment, after its perusal, that men and women 
could be found who would perform such duties at any 
price, and especially at the prices now paid. It is 
gratifying to know that this asylum is about to grade 
the wages of attendants, and thus to have a much more 
equitable system of payments. It is by this means that 
the best service can be secured. 
Great as has been the improvement in the character 
of attendants, and it has been remarkable, there has 
always been apparent an absence of that special train- 
ing which is essential to the full development of the 
qualifications for their special duties. Aptitude for any 
department of work is necessary to success, but with- 
out special training aptitude avails little in fields where 
skilled labor is required. In the care of the sick 
aptitude for nursing has hitherto been regarded as the 
only qualification. But within ten years to aptitude 
has been added training by a systematic course of 
instruction, and the result is that the old grade of 
nurses have been completely driven from the field. 
And if the nurse of one sick of a physical disease, is so 
much improved by training, how infinitely more 
important is it that those who are to minister to a 
mind diseased, should have special training. The 
power which an apt and trained attendant exerts over 
the insane is oftentimes marvelous. In many instances 
I have seen skilled attendants remove the restraint, 
from violent patients, who had resisted every known 
measure of securing good behavior, and from the first 
perfectly control them. I can not, therefore, too much 22 
commend this first effort to thoroughly prepare attend- 
ants for their duties. In fact I have no doubt that within 
a decade, no attendants will be employed in the State 
asylums of this State, who have not their certificates 
of graduation from a Training School. When that 
period arrives we shall doubtless witness improvements 
in the management of the insane which will relieve 
asylums of that suspicion and prejudice, on the part of 
the public, now so prevalent. 
We may, I think, divide the care of the insane in this 
State, during the century, into three periods. The first 
period was that of mechanical force, when the jailer- 
attendants enforced obedience by chain and scourge. 
But the jailer-attendant with chain and scourge has 
long since passed into merited oblivion. The second 
period was that of manual force. We are passing 
through that phase of evolution now, and it has until 
recently seemed the very highest degree of develop- 
ment attainable. The amiable and able Dr. Connolly, 
a powerful advocate of the abolition of mechanical 
restraint in England, as strongly advocated manual 
force. T|ie struggles of an obstinate patient with his 
attendants, and their final mastery over him, was 
regarded by this great alienist as in the highest sense 
curative. But there are striking evidences that a new 
era is at hand, the third of the series. This period will 
be that of mental force, or the power which a trained 
and skilled attendant will exercise over the disordered 
senses, whether by soft words and gentle persuasion, or 
by the imperious tones of a master. In the organiza- 
tion of this school, and in the graduation of this class, 
we witness, not only the dawn of that new period, but 
the fulfilment of its promise. 
For the graduating class I have only words of praise 
and encouragement. From the preceding review it is 
apparent that your occupation has gradually developed. 23 
from humble beginnings to the rank of an honorable and 
useful profession. You are no longer called upon to 
act the part of a custodian of a criminal, but to be the 
skilful, intelligent, gentle guide of an erring mind. 
Instead of restraining the wandering feet with chains, 
and the violent hands with manacles, your office will 
be to direct those feet to paths of order and discipline, 
and those hands to useful labor. Your greatest meas- 
ure of success will not be won by physical prowess, but 
by the triumph of a sound, healthy, and well ordered 
mind, over the shattered forces of a mind diseased. 
You are the pioneers in this great reform, and on your 
conduct and character its success will largely depend. 
Your position and your future progress will be closely 
scrutinized, both by friends and foes. If success crown 
your efforts, your reward, will be great. You will 
stand as the representatives of one of the most benefi- 
cent reforms in the history of the care of the insane. 
Mr. President: The inauguration of this Training 
School for Attendants will, I believe, more signally 
and effectually establish the reputation, in the distant 
future, of the Buffalo State Asylum for the Insane, 
than any other act or event in its history. Already we 
hear from many asylums the notes of preparation to 
follow your example. To be the pioneer of a far-reach- 
ing reform, not only in the original conception of its 
underlying principles, but in the organization and per- 
fection of the system or scheme by which its benefits 
are to be secured, is the highest honor to which man 
can attain. It is, then, with no ordinary pleasure, and 
with a profound sense of duty, that in this public 
capacity, and on this auspicious occasion, I acknowl- 
edge the obligations of the State, of every citizen 
interested in the best care and treatment of the insane, 
and of the insane themselves, to the founders and pro- 
moters of this school. 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, 
G. ALDER BLUMER, M. D., L. R. C. P., 
CHARLES W. PILGRIM, M. D., 
OGDEN BACKUS, M. D., 
CHARLES G. WAGNER, S. B., M. D., 
Assistant Physicians. 
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, addressed as follows: "Journal of 
Insanity, State Lunatic Asylum, Utica, N. Y." 
The Journal now enters upon its forty-third volume. It was 
established 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 Jurisprudence;" and since 
1854, by Dr. John P. Gray, and the Medical Staff of the Asylum. It is 
the oldest journal in America devoted especially to Insanity, its 
Treatment, Jurisprudence, &c., and is particularly valuable to the 
medical and legal professions, and to all interested in the subject 
of Insanity and Psychological Science.