REPORT 
OE THE 
PHYSICIAN 
OB THE 
NEW-YORK 
LUNATIC ASYLUM,, 
ADDRESSED TO A 
COMMITTEE OF ITS GOVERNORS, 
AND 
PUBLISHED AT THEIR. REQUEST 
New- York: 
PRINTED BY SAMUEL WOOD & SONS, 
1818. To Thomas Franklin, Jacob Slurred, and 
Cornelius Dubois, Esquires, chairman, 
and members of the committee of the 
New- York Lunatic Asylum. 
Gentlemen, 
AS your monthly records exhibit 
regular returns of the patients, and you have 
by long and assiduous attention become fa- 
miliar with the management of the asylum 
o 
and its dependencies, it can hardly be ex- 
pected, that under a more general view of 
the institution, I shall be able to add to your 
knowledge of its important interests. But 
as with the privilege of your example, and 
of co-operating with you in your benevo- 
lent design, there cannot, it is hoped, be any 
misconception of the motives which govern 
me, I beg leave to lay before you, in the 
form of tables, a statement of cases admitted 
from the 13th of September last to this date. 4 
(a period of eight months) with their results, 
and of others received prior to that month, 
and within the same time discharged ; refer- 
ring you, for a more particular account, to 
the accompanying volume, which contains 
their histories, in so far as it has been prac- 
ticable to obtain them, and their medical 
treatment. I shall take the liberty to add 
some general observations on lunatic asy- 
lums, and on the treatment of insanity, hav- 
ing an exclusive reference to the comfort, 
convenience, and cure of the unfortunate 
persons labouring under that most awful 
malady. 
The number of admissions in the period 
refered to, is thirty-eight, of which twenty- 
eight were males, and ten females. Of the 
former, there have been discharged cured, 
thirteen, improved three ; two by request, 
and two have died. Of the eight remaining 
in the house, four are much improved, three 
have been recently admitted, and one is a 
man sixty-eight years of age, labouring un- 
der that species of insanity, which sometimes 
occurs in advanced life, from a diminu- 
tion of perception and memory, and is ter- 
med amentia senilis. It is to be observed, that T. H. who, on the 25th of October, was 
entered on the minutes of the committee 
as relieved only, was discharged cured. Of 
the ten female patients, one has been dis- 
charged cured, one an improper object, three 
by request, and one has died. Of the re- 
maining four, one was admitted the 18th, one 
the 27th of March, one the 24th of April, 
one the 12th instant; and they are all nearly 
in the state in which they came in. During 
the time stated, of patients who were in the 
house previous to the first of September, 
there have been cured one male, and one fe- 
male ; four males and one female have died, 
three males and two females have been dis- 
charged by request, and one male as an im- 
proper object; the females and two of the 
males, improved. The cases which ended 
fatally were of long standing, connected 
with palsy, epilepsy, consumption and dropsy. 
The whole number cured since the 13th 
of September, is fourteen, twelve of whom 
were males, and two females. In the same 
time, there have been relieved, and much 
improved, five; discharged by request, 
twelve; as improper objects, two; and eight 
have died. 6 
The number of patients now in the house 
is seventy-seven, of whom forty-nine are 
males, and twenty-eight females. Fourteen 
males, and nine females are variously and 
usefully employed in such occupations as 
appear to be the best adapted to their several 
cases, deriving in this manner, more benefit 
perhaps, than the establishment, under its 
present arrangements, could otherwise afford 
them. 
It is desirable that early measures should 
be taken to discharge C. H. whose case you 
are acquainted with, and to enable him to 
return to his connections in Scotland, who, 
lam informed, are respectable people. His 
confinement appears to have a tendency to 
revive, and it may perpetuate the disorder 
from which he is fast recovering, and which, 
for its entire cure, may require nothing but 
his enlargement. Should he, from his pre- 
sent restraint, unfortunately relapse into the 
dreadful state in which he was admitted, it 
is not difficult to foretel to what a series of 
painful reflections so deplorable an event 
would give rise. 
W. M. a custom house patient, as he is 
called, labouring under palsy, is an improper 7 
object of our attention. The means adap- 
ted to his cure, would be more advantageous-? 
ly applied in the hospital. 
There are several old cases of both sexes 
in the house, of whose recovery there exists 
but a faint probability; and there are others 
in a course of improvement. 
Accompanying the tables of cases, is a 
list of names, showing, annexed to each, as 
nearly perhaps as the difficulty and obscuri- 
ty of the subject admits, their supposed 
causes. How far such an exposition may 
or may not be useful, it is not pretended to 
determine. I shall hazard one remark on 
the occasion, that religious terror, arising 
from erroneous perceptions, is much more 
frequently the effect than a cause of men- 
tal derangement. 
It will be evident to you, that from any 
pharmaceutical course that has been pursued 
in the treatment of our patients, there is but 
little to boast. Medicine indeed, has been 
rarely given, except when strongly indica- 
ted by such symptoms of bodily disease, as 
were supposed instrumental in exciting, or 
had been connected with the disorder of the 
mind. Under such circumstances chiefly. 8 
do we rely on its efficacy: but we do not 
believe in the specific power of any drug 
in curing madness. Although mercury has 
been given to a number of our patients, there 
is but one instance in which it was consider- 
ed that the recovery was the result of its 
use, and that was the case of J. L. G. dis- 
charged the 31st of March. 
Mild cathartics, and warm bathing, have 
long appeared to me of more general utility 
than any other means employed as phys- 
ical agents, in the treatment of insanity, and 
the latter, in an especial manner, in melan- 
cholic cases. Drastic purges, unless when 
particularly demanded, have been of far less 
benefit. 
Blood-letting, judiciously used, in violent 
paroxysms, has on many occasions been of 
great efficacy, but is of far less general 
application than is often supposed; and, 
without the most accurate discrimination, 
will be productive of much mischief. 80 
far as I have been able to judge, local bleed- 
ing, as it is termed, has not that advantage 
over the general operation, as to justify the 
trouble of performing it; and lam almost 
led to pronounce it a more than useless resort- 9 
Incases of mental disorder. Very ample 
experience does not dispose me to think 
more favourably of setons in the neck. 
Blistering the head, the back of the neck, 
or between the shoulders, has also been of 
<» 
doubtful effect; and more dependence has 
been placed on the same operation on remot- 
er parts. 
In three old cases, the actual cautery has 
been applied in its fullest extent, to the 
head, in the manner proposed and practised 
by Monsieur Valentin, a French surgeon, 
of reputation, as I am told ; and al- 
though succeeded by exfoliations of the 
outer table of the scull, the result has not 
justified a repetition of so severe a remedy. 
As a means of temporary mitigation, un- 
der a furious paroxysm, accompanied by 
strong arterial action and increased heat, the 
shower bath has been usefully applied. 
Though it is not to be supposed that any 
case of madness is to be removed by its ope- 
ration, as has often occurred in certain 
statesof febrile disease, much advantage may 
be derived from its proper application. 
The means of safe keeping by bars and 
bolts, and cords and chains, are abundant. 10 
and easily obtained; but it should be the 
supreme object of those who have assumed 
the responsibility of governing the insane, 
to restore to their reason, and to society, the 
greatest possiye number of these afflicted 
beings : and we have no hesitation in be- 
lieving, that this will be the most certainly 
accomplished by stiict 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 degree of mental alien- 
ation exists, whether in the patient, or in 
him who has the care of him. 
The order and internal economy and go- 
vernment of the New-York Lunatic Asy- 
lum, have justly placed it in the highest rank 
among the best institutions of our country ; 
and the most improved establishments of the 
kind in Europe, do not afford a source of 11 
higher congratulation on the benefits they 
have afforded to the most afflicted of our 
race. The period is not remote, when a va- 
riety of circumstances conspired 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 bles- 
sings of health and reason, but as in a place 
of safe keeping, disabled from injuring them- 
selves and others ; where, from the supposed 
nature of their disorder, they neither deserv- 
ed, nor would receive the compassion of 
their keepers, and where they would inevita- 
bly languish and die. Thanks to the wisdom 
and humanity of the times in which we live, 
lunatic asylums have not only excited the 
attention of the benevolent every where, 
but have also been a subject of legislative 
investigation in one of the most enlightened 
countries of Europe. It was on inquiry 
discovered in England, that the contribu- 
tions which had been made with a liberal 
hand towards their support, both in town and 
country, where shamefully misapplied, and 12 
lavished on those, who, by neglect and cruel- 
ty, had merited and received the severest 
reprehensions of an abused public. Under 
their former structure, every thing that met 
the view of the exiled sufferer , about to en- 
ter 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. He 
was indeed there shut up from the world, se- 
parated from his friends, and covered from the 
light of day ; and, amidst the aggravated hor- 
rors of a dungeon, the chains which rivetted 
bis ghastly figure to the ground, bound also 
in everlasting night, the distinguishing attri- 
bute of his being. In such a situation, with- 
out an effort to revive the suspended en- 
ergies of his mind, with nothing to awaken 
him to a sense of his human nature, without 
a ray of consolation, of affection, or of sym- 
pathy to beam upon him, he remained a neg- 
lected, forgotten, and abandoned prison- 
er. Thus forlorn, the whole plan and sys- 
tem of bis custody, were of a nature to drive 
him to despair, and to the hopeless, the aw- 
ful condition of irremediable madness. 13 
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 em- 
ployment, adapted to the circumstances of 
their condition, and the nature of their dis- 
ease. 
In the superior and general superintend- 
ence of such an institution, I would take 
the liberty to recommend, for the most ob- 
vious reasons, permanency of appointment, 
when justified by the qualifications of the 
elected. The appointed should be reasona- 
ble, humane, moral and religious, possessing 
stability and dignity of character ; mild and 
gentle in their temper and deportment, but 
resolute in their purposes, 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 compas- 
sionate, 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 as- 
sist them in the recovery of their reason. 14 
In their ordinary visits, they should ap- 
proach the insane with an air of gentle- 
ness 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. They 
should watch, with discriminating and un- 
wearied attention, those favourable mo- 
ments of drawing them from their halluci- 
nations, their fantasies and wanderings, 
which frequently occur in the intermissions 
of many cases, both of madness and melan- 
choly. 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. 
In the arrangement and structure of the 
asylum now erecting, whether as connected 
with this house, or as a separate establish- 
ment, I beg leave to suggest, that while it 
is of much importance that it be so con- 
structed as to convey no idea but that of 
comfort, it may also admit of a classifica- 
tion of the patients during the day, accord- 
ing to their sexes, condition of life, and va- 15 
rious states of derangement, in separate a- 
partments of convenient dimensions. This 
is an object of such moment, that although 
requiring an additional number of attend- 
ants, appears to be deserving of serious con- 
sideration ; and it is confidently believed, 
that its advantages would amply repay any 
additional expence which might arise from a 
variation of form. It is also recommended, 
that a distinct building be provided for the 
most raving and noisy, who should be con- 
stantly under the inspection of a faithful, 
humane and discreet attendant. 
A convalescent should at all times be se- 
parated from the more insane. While per- 
mitted to see in the countenances and con- 
duct of those who are around him, multipli- 
ed examples of the deplorable state from 
which he is emerging, what can be more a- 
dapted to overthrow his feeble and yet tot- 
tering intellect I 
The furious maniac, who from occasional, 
but remote acts of violence, may have re- 
quired the most rigid restraint, ought at 
times to be released from his chain and his 
cell; to be led forth to the refreshing influ- 
ence of an untainted air, and the liberty of 16 
such exercise, as may promote so free and 
equal a circulation, as shall counteract that 
morbid structure and disorganization, what- 
ever their nature, which confirm and pro- 
long his disease, and finally render it incu- 
rable. When released, it is advised that he 
should not associate with the deranged, but 
continue under the eye of an attendant, both 
capable and willing to improve every ad- 
vantage of his meliorated condition. 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 imperious a duly, is a ne- 
gative act of unpardonable cruelty, which, 
there are strong reasons to believe, has often 
doomed to immeasurable suffering, many a 
wretched inmate of a lunatifc asylum. What 
must be the feelings of that being, who, 
month after month, and year after year, fet- 
tered with chains, and shut up in darkness, 
yet possessing the powers of intellect, is in- 
capable of rousing the sympathy of his keep- 
ers, and can contemplate in the grave only, 
the termination of his suffering ? With 
what an aggravated sense of horror must 
we view his forsaken condition, if at the 17 
same time, he is cut off from the cheering 
light and consolations of the Gospel, the 
blessed refuge of the afflicted ? It is sta* 
ted, that at the house of correction at Ken- 
dal in England, a maniac, who had lucid 
intervals of nine or ten months duration, was 
confined in a solitary cell for ten whole 
years, without occupation, and without see- 
ing a human being but those who brought 
him food. 
In the arrangements of the new asylum, 
it is presumed that considerable advantage 
would be derived from an exclusive appro- 
priation of two large apartments for the sick 
of the two sexes, having allowed to each an 
attendant, who should remain with them 
during the night as well as the day. With 
such a provision, the sufferer, in whose mind 
the light of reason had been long extin- 
guished, 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 compas- 
sion and kind offices of his fellows. With- 
out such accommodation, many do, and 
must unavoidably die unseen. 
There is perhaps nothing of more real 
importance to the comfort and recovery of 18 
the sick and insane, as respects the internal 
provisions of the house, than a plentiful 
supply of water. At this establishment, 
some difficulty and delay have attended the 
prescriptions for tepid bathing, an applica- 
tion not only of great utility in many cases 
of mental disorder, but essential also for 
washing and purify ing the skin, and promo- 
ting that cleanliness which is so necessary to 
health, as well as comfort, in every situation. 
Where the quantity of this most necessary 
article is abundant, conveniences, under the 
usual calls of nature, may be so constructed 
and arranged in some of the apartments, and 
especially in those of the sick, as that their 
contents may be removed by a stream of 
water, conveyed by pipes in the walls of the 
building, passing constantly through them. 
It appears to me that the marble floor of 
the hall of the basement story of this house, 
without possessing any particular advantage 
from its material, produces a degree of 
dampness, not only uncomfortable, but. 
hurtful to the persons who daily occupy it 
In our colder seasons. 
The expediency, propriety, and utility, of 
public worship, cannot be too strongly in- 19 
culcated, under proper regulations and 
restrictions, in every building appropriated 
to the reception of persons labouring under 
mental disease. 
With respect to the amusements and vari- 
ous occupations of the deranged, as a means 
of arresting their wanderings, and thereby 
contributing to their recovery, many useful 
remarks may be found in some of the pub- 
lications on insanity. I would recommend, 
that in all their recreations, whether ot 
labour, of skill, or amusement, they should 
be separated from each other, and classed, 
as far as circumstances will admit, with the 
sane, engaged in similar amusements and 
pursuits. It has been found that such em- 
ployments and recreations as require the 
most bodily exertion, have been the most 
beneficial. 
It is submitted to the committee, if a full 
supply of the succulent vegetables of the 
season, would not be a reasonable, as it is 
considered a proper and salutary indul- 
gence, to the patients of this institution. 
I cannot. Gentlemen, close this long re- 
port, without an apology for so great a 
trespass on your time, and expressing to you 
my high sense of the support afforded me 20 
in the arduous duties of my appointment, as 
well by your example, as by a prompt acqui- 
escence in the means which have been occa- 
sionally proposed for the benefit and com- 
fort of the patients of the asylum. For 
your uniform tokens of personal respect 
and kindness, I beg you to receive my 
warmest acknowledgments. 
To Mr. Wilson, the superintendent, I am 
much indebted for his faithful attendance, 
and ready co-operation with me under the 
various circumstances in which his services 
have been required. To Doctor Joshua 
Fisher, for his able assistance in every de- 
partment of duty claiming my attention, we 
are under the highest obligations; and for 
the polite and friendly aid, on various emer- 
gencies, of Doctor Campbell, the house phy- 
sician, I cannot adequately express my 
thankfulness : and it is with no ordinary 
emotions that I acknowledge the respectful 
civilities of the superior and subordinate of- 
ficers generally, of the New-York Hospital. 
I am with much respect, 
Gentlemen, your obliged, 
and obedient servant 
WILLIAM HANDY. 
Asylum 15th May, 1818,