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     THE INSANE
IN FOREIGN COUNTRIES 
Gentle as angel's ministry
The guiding hand of love should be,
Which seeks again those chords to bind
  Which human woe hath rent apart—
To heal again the wounded mind,
  And bind anew the broken heart.
                               Whittier. 
 
Frontispiece
                       PINEL  A  LA  SALPETRIERt.



From a Painting by Robert Henry, which was exhibited at the Paris Exposition in 1878. 
THE  INSANE
IN
FOREIGN  COUNTRIES
  WILLIAM P. LETCHWORTH

          i ► i
PRESIDENT OF THE NEW YORK STATE BOARD OF CHARITIES
SECOND EDITION
SEifP$>

    NEW YORK & LONDON


G. P. PUTNAM'S SONS


   fth* Jlnxckerfrocktc frfss 
VVA]
L C<f5i
     Copyright by
WILLIAM P. LETCHWORTH
    Press of
G. P. Putnam's Sons
    New York 
                      TO




                HIS EXCELLENCY




               DAVID B.  HILL




  GOVERNOR  OF THE STATE  OF NEW YORK




                    AND TO




      MY  ASSOCIATE COMMISSIONERS OF




THE NEW YORK STATE BOARD OF  CHARITIES




                      THIS




       VOLUME IS RESPECTFULLY  DEDICATED 
 
CONTENTS
Preface to Second Edition .
Preface  ....
CHAPTER
   I. Introductory and Retrospective
  II. England.....
 III. Scotland.....
  IV. Ireland.....
  V. Continental Countries
  VI. The Colony of Gheel  .
 VII. The Provincial Insane Asylum of Alt-Scher-
        bitz   ......
VIII. Resume.....
     Appendix.....
     Index    .....
PAGE
xiii
 xv
  i
 l5
iog
172
194
239

279
293
365
391 
 
LIST OF  ILLUSTRATIONS
plnel a la salpetriere
Circulating Swing .
Bands and Chains
Norris in Chains
Day-room, Brookwood
Cottage Hospital, Brookwood
dlning-hall, prestwich .
Infirmary Ward, Prestwich  .
Convalescent Ward, Prestwich
Day-room, Prestwich
Burning an Insane Woman as a Witch
Taking  Lunatics to Dublin  .
Belgian Cage.....
Plan of the Colony of Fitz-James .
The Church of  St. Dymphna .
Plan of the Provincial Insane Asylum,  Alt-Scher
    bitz......
Reception Station, Alt-Scherbitz
Observation Station, Alt-Scherbitz
Detention House, Alt-Scherbitz  .
Villa for Patients, Alt-Scherbitz
Villa for Third-class Patients, Alt-Scherbitz 
 
NOTE.
  Since the second edition of " The Insane in Foreign Countries "
was submitted to the publishers, the Lunacy Act of 1890, more
particularly entitled "An Act  to consolidate certain of the En-
actments respecting Lunatics," has passed the English Parliament.
The " Lunacy Acts Amendment Act, 1889," which, as has already
been shown, made many and important  changes  in the English
lunacy system,  is included  in the  Consolidation Act  of 1890.
The chief  alterations recently  effected in the lunacy laws  of
England are set  forth in a cir. ular issued by the Commissioners
in Lunacy  under date of April  16,  1890,  the essential part  of
which is supplemented to this volume. 
 
PREFACE TO SECOND EDITION
  In preparing the second edition of this work the writer has
availed himself of the opportunity to make some slight cor-
rections, and to add some later statistics and  other informa-
tion.
  The Local Government Act (England and Wales  51 and
52  Vict. c.  41), which  passed  Parliament  while the first
edition was  in press, has an important bearing on the man-
agement of county lunatic asylums, the government of them,
in respect to the provision, enlargement, maintenance, man-
agement, and visitation, being transferred from the Courts of
Quarter Sessions  to County  Councils.  These  bodies, like
the Quarter Sessions, are empowered to appoint committees
to supervise and manage the institutions under their care.
  The Lunacy Acts Amendment Act, 1889, which goes into
operation May 1, 1890, effects some important changes in the
English lunacy system.  Attention is directed to what are
considered the principal features of this  Act, which  are set
forth in the Appendix. The Local Government Act  framed
for Scotland will  make no material change  in  the  Scotch
lunacy system, except that those members of District Lu-
nacy Boards who  were formerly chosen by the Commis-
sioners of Supply will be elected by the County Councils,
                          xiii 
xiv          PREFACE TO SECOND EDITION.
a body elected by the rate-payers.   The  members elected
by municipalities  will remain as before.
  Although important changes in the lunacy laws of France
are receiving the attention of the French Government, it will
be seen from the Appendix that the proposed changes are
not likely to be adopted immediately.
  Glen Iris,
   Portageville, P. O., N. Y.,
           1889. 
PREFACE.
  The following pages are the outcome of an investigation of
foreign charitable institutions, pursued without interruption
through  seven months, during which time special attention
was given to the various kinds of provision made for the in-
sane poor.  The information thus collected  is now published,
in the hope of  furthering the elucidation of a subject which
materially concerns not only the State as a whole, but each
one of its citizens.
  For the purpose of securing fulness as well as accuracy,
stenographic notes of visitations and interviews were made.
By this means valuable opinions, expressed by distinguished
specialists with whom the treatment of the mentally diseased
has been a  life-long study,  have been  carefully recorded.
Avoiding,  as far as possible, medical theories and contro-
versies, the writer has striven to convey the results of  his
observations  in  plain,  untechnical language.   His  aim
throughout this whole inquiry has been to ascertain, from
a practical  point  of  view, what  are the  most advanced,
the most humane, and the most  economical methods  of
caring for  the  insane.
  I feel it  a pleasant duty  gratefully  to  acknowledge the
courtesies invariably extended to me by officials of different
ranks in the countries visited.  In many institutions consid-
erable  time was spent in making  examinations,  and the
numerous details considered  made  the task of imparting
information tedious; but a generous spirit  was everywhere
shown  to meet  the object of my visit.   To the permanent
                            XV 
XVI
PREFACE.
Secretary of the  English Local Government  Board, to the
Commissioners and Secretaries of the English and Scotch
Boards of Lunacy, and  to the  Superintendents of the vari-
ous  asylums inspected, I  am  under  special obligations.
  The publication of this work, most of the material for which was collected
a few years since, has been delayed in consequence of a pressure of public
duties.   Meanwhile,  however,  correspondence has been maintained  with
Superintendents of many of the institutions visited ; and information kindly
furnished by them, and the latest that could be obtained from other official
sources, are herein embodied.
                                                       W. P.  L.
  Glen Iris,
    Portageville P. O., N. Y.,
             1888. 
INSANE  IN  FOREIGN  COUNTRIES.
                     CHAPTER  I.

       INTRODUCTORY AND RETROSPECTIVE.

   IN this age of high-pressure living, there is perhaps no sub-
     ject of  more general or more urgent  interest than that
of insanity in its relations to the State.   No reflecting mind
can  be indifferent to the question of  making proper public
provision for the treatment and care of  those afflicted with
an insidious disease from which no measure of intellectual
or physical strength or worldly prosperity affords any certain
immunity—a disease which, prone to  feed upon excitement,
finally transforms the noblest faculties of our race into a
wreck so appalling  that  in its contemplation the human
intelligence becomes bewildered and dismayed.   At no time
in the history of civilization has the importance of this sub-
ject  been more fully acknowledged  ; and  probably  at  no
time  have influences contributory to mental  derangement
been  more  powerful than they are  to-day.   In America,
where, from a variety of causes, there is so much mental ac-
tivity, and where a condition of great prosperity attracts the
surplus population of Europe, there are obvious reasons why
the  various  problems  relating to insanity should receive
most careful attention.  But  before proceeding to the con-
sideration of individual systems it may be well to glance 
2        INTRODUCTORY AND RETROSPECTIVE.

briefly at the past history of the treatment of the insane in
different countries.
  At the outset, we are reminded of the paradoxical saying
of a distinguished writer, that the " ultimate  tendency of
civilization is toward barbarism."  This, strange as it may
appear, seems to have been  exemplified by the  degeneracy
in the methods of caring for and treating the insane in differ-
ent countries, from the  days of antiquity down to the be-
ginning of the present century, and even later.  Among the
ancient Egyptians,  the priests, along with their  supposed
all-potent spiritual agencies, employed for restorative pur-
poses such powerful aids  as the influence of music and the
beautiful in nature and in art, together with healthy recrea-
tion and agreeable occupation.  Later, a member of a Greek
medical school publicly condemned  the  excessive  use of
bodily  restraint in the treatment of the insane.   He advo-
cated the importance of music and kindly treatment, as well
as employment, and advised that patients  be stimulated to
self-regulation of  their mental powers.
  Centuries after those Eastern  philosophers  had  passed
away, during the  Middle  Ages, and down even  to recent
times, we find the idea prevalent in Europe of regarding the
insane  as possessed by demons, which must be  cast out to
effect restoration.   This  absurd superstition  led to  the
adoption of cruel forms of  punishment  and even torture.
The unhappy victims, objects  of  general  abhorrence, were
commonly cast into dungeons, where they were shamefully
neglected.  It seems not a little  remarkable that the won-
derful enlightenment of ancient times respecting this unfor-
tunate  class should have been followed by such  ignorance
as is known to have prevailed during many succeeding cen-
turies.
  That great  efficacy in the cure of mental  diseases was 
HOLY  WELLS.
3
popularly ascribed to spiritual agencies is abundantly shown,
not only  in  legendary lore, but also in reliable historical
records.   Long pilgrimages were made to the shrines of par-
ticular saints, who were believed to have  great influence  in
the work of mental restoration, and where, through exorcism
and prayer,  miraculous cures were claimed to  have been
effected.  This practice was not confined to out-of-the-way
places like Gheel, where St. Dymphna was held in holy rev-
erence, nor was it restricted  entirely to communities on the
continent of Europe.   The  well of St. Winifred, St. Nun's
Pool,  and other wells in the  British  Isles, were resorted
to by devout visitors, who were deeply impressed with a be-
lief in the curative influence of these waters.  At St. Nun's
Pool it was the custom to plunge patients backward  into the
water and drag them  to and fro until their excitement was
subdued. Then they were taken to the neighboring church,
where, if there were signs of recovery, thanks were offered
for their deliverance ; if otherwise, the hydropathic treatment
was continued while there remained any hope.
   In Ireland, there was Glen-na-galt, or the "Valley of the
Lunatics,"  beautifully situated in County Kerry, not  far
from Tralee.  To this vale it was believed that every lunatic
would eventually gravitate if left to himself.  The process
of  cure consisted  in drinking the  cooling waters and eat-
ing the cresses that grew beside the spring.
   In Scotland, many wells were traditionally celebrated  for
similar wonderful properties. It is recorded that, not many
years since, lunatics were denuded and thrice dipped at mid-
night  in  Lochmanur,  in the far north of Scotland.  More-
over, in the  western highlands, the poverty-stricken inhab-
itants, shut  out, as it were, from the influence  of  town or
city, are  still, to  some  extent, swayed by superstitious  no-
tions  that  have  been  handed down from father to son. 
4        INTRODUCTORY AND RETROSPECTIVE.

Whittier alludes  to  the popular belief  in the remarkable
virtues of the well of St. Maree.   After referring to the
soothing and restorative  effects from bathing the  fevered
brow therein, he goes on to say:

                " That holy well of Loch Maree
                  Is more than idle fable."

  Farther south,  in a  picturesque district of the midlands
of Scotland, we learn, on the authority of Sir Walter Scott,
that several wells and springs  were religiously dedicated  to
St. Fillan, and that down  to  very recent  times they were
places  of  pilgrimage  and  offerings, because  the waters
were believed to  be  a potent means of cure  in  cases  of
madness.
  Far into the Middle Ages, the  practice of medicine was
left  to the monks, who ministered alike to soul and body.
In the days of the ancient Greeks, psychology  was recog-
nized as a department of medical  study; but the ignorance
of the Dark Ages affected medical as, indeed, every  other
progressive science, and before the general dissemination of
education had time to show its effects many spurious  reme-
dies and  crude  superstitions  were  incorporated  into the
healing art.  We may smile at the lack of knowledge which
induced our forefathers  to  administer, as  remedies, " open
drinks," in which bitter herbs, ale, and holy  water were  es-
sential ingredients; at the clove-wort wreath enjoined to  be
worn "when the moon was on the wane"; and at the prayers
addressed to the  periwinkle at different stages of the moon.
The following was a more drastic  prescription : " In case a
man be  lunatic, take  a  skin  of mere-swine (in other words
a sea-pig or porpoise), work it into a whip and  swinge  the
man therewith ; soon  he will be  well."  Some  of the old-
fashioned remedies are, however, part of the pharmacopoeia 
SUPERSTITIOUS BELIEFS.
5
of the present day.  Hyoscyamus is  still administered in
disturbed cases.
  Throughout the sixteenth century, and far advanced into
the seventeenth  century, demonology and witchcraft were
generally believed in, and he was a bold man who ventured
to contradict the orthodox opinions of the period.   These
superstitious beliefs were not confined to the illiterate.  No
less  a personage than  James  VI. of Scotland,  afterwards
king of England, wrote a learned dissertation on " Demon-
ology," in which he displayed, perhaps, more zeal than dis-
cretion, by contending that evidence not admissible against
other offenders should be accepted against so-called witches ;
that marks about their persons should be diligently searched
for and " pricked with a long needle," to ascertain whether
they were insensible to pain (such insensibility being unmis-
takable  evidence  of  the  satanical  mark, or " seal of the
devil") ;  and that  their bodies should be floated on water,
as further aids in discovering the guilty.   Towards the close
of the sixteenth century, certain medical authorities began
openly to rebel against these accepted doctrines, whereupon
they were severely censured by the royal James for what he
was  pleased to term their " damnable opinions."
  As late as 1716, a  woman  and her daughter were sen-
tenced  to death at Huntingdon, by an  English  bench of
judges, for " selling their souls  to the devil."  Many such
poor people, it  is hardly  necessary to say, were simply
mentally deranged, and, had they been so fortunate as to
live  in recent times, they would have been humanely  cared
for in some lunatic asylum.    Such  deplorable ignorance
and  superstition,  however,  were  by no means  limited to
England.  In Scotland, also, the practice was common of
putting the insane  to death, under the belief that they were
witches and possessed of an evil spirit.   Instances of similar 
6        INTRODUCTORY AND RETROSPECTIVE.

superstitions  might be multiplied from the records of  our
own and other countries.
  The first asylum of which  we find mention in history
is one said to have been erected by the monks at Jerusalem
in the latter part of the fifth century.  The learned monks
appear to have been  the principal pioneers of this charity
during the  Middle  Ages, though there are evidences that
provision for  the insane was not  entirely neglected by  the
Mohammedans.  Among  European countries, in the fifteenth
century,  Spain, then  a centre  of  learning, seems  to have
taken the lead  in  providing for this class.  The treatment
adopted  in Spain, as  elsewhere, was, however, cruel in  the
extreme, and  was  based  on the general belief that the in-
sane were possessed by evil spirits.   Many were burned to
death,  others were scourged and tortured  in the vain hope
of  expelling the demons and liberating the  victims from the
power  of the Prince  of  Darkness.  It should be  acknowl-
edged  that, amidst all these prevailing errors, the monks
at   Saragossa had  the first faint conception  of  rational
open-air treatment for the mentally deranged to be found in
modern times.
  So great  a  revolution has taken place within the past  few
generations in the methods of caring for the insane  that we
are  scarcely able to realize that a hundred years have  not
elapsed since  persons  of  unsound mind were treated worse
than wild beasts,—everywhere kept under  bolt and bar, or
heavily manacled in cells  and dungeons, the poisoned atmos-
phere of which not only prevented cure, but hastened death.
But a  little  earlier, in some cases they were exhibited in
cages to the  public, at fixed rates, and were irritated  and
tormented  to gratify  a morbid and vulgar curiosity.  As  a
result of this treatment, many who originally were not beyond
hope of  recovery became permanently deranged.  Those 
REFORMS BY PINEL.
7
who were not deemed  dangerous to the public  safety were
left to roam about the country in a neglected and pitiable
condition.   It is difficult to conceive that a century has not
passed since the Herculean labors  of Pinel were needed to
loosen the chains of the miserable occupants of  the Bicetre
in Paris—an  act which, as is  well  known,  revealed to the
world the striking superiority  of  kindly treatment over the
torture, worse than death, to which insane men and women
were at  that time subjected  in  different parts  of Europe.
This marks so important an era in the history of the treat-
ment of the insane that no excuse is necessary for advert-
ing  to some of the attendant circumstances of that great
achievement.
   Pinel,  who had attained some distinction as an alienist,
was appointed, in 1792, to fill the post of superintendent of
the  Bicetre, which then contained upwards of two hundred
male patients, believed not only to be incurable,  but entirely
uncontrollable.  The previous experience of  the physician,
here stood him in good stead.  He had been a diligent stu-
dent of  the authorities of his own and  foreign  countries
on diseases of the mind, and in his earlier years had been ap-
pointed  by the French Government to  report on the condi-
tion of the asylums at Paris and Charenton.  On assuming
the  oversight  of  the Bicetre, he  found  fifty-three  men
languishing in chains, some of whom had been  bound for a
great number of years.  These were regarded by the author-
ities as dangerous and even desperate  characters ; but the
sight of  men grown gray and  decrepit as the result  of  pro-
longed torture  made a  very different  impression  on the
mind of  Pinel.  He addressed appeal  after appeal to the
Commune, craving power to release, without delay, the un-
happy beings under his charge.  The authorities tardily and
unwillingly yielded to the importunity of the physician. An 
8        INTRODUCTORY AND RETROSPECTIVE.

official, who  was deputed  by the  Commune to accompany
the  superintendent  and watch his experiment, no  sooner
caught sight  of the chained  maniacs than he excitedly ex-
claimed : "A/i, ca ! citoyen, es-tn fou toi-meme de vouloir de'chai-
ner de pare Us animaux ? " : The physician was not to be de-
terred, however, from carryingout his benevolent project, and
did not rest satisfied  until all of the fifty-three men had been
gradually liberated from their chains.  Singular as it may ap-
pear, the man who had been regarded as the most dangerous,
and who had survived  forty years  of this severe  treatment,
was afterwards known  as the  faithful and devoted servant of
Pinel.   The  reforms of Pinel were  not confined  to the Bi-
cetre, an establishment exclusively for men, but extended to
the  Salpetriere, an institution for women.  There is, per-
haps, no more touching event in  history than that of this
kind-hearted  and wise physician removing the bands and
chains from the ill-fated inmates of this place of horrors.
  The monstrous fallacy of cruel treatment once fully ex-
posed, the insane came to  be looked  upon  as  unfortunate
human beings, stricken with a terrible disease, and, like other
sick persons,  requiring every  aid which science and benevo-
lent  sympathy could provide for their recovery.  Govern-
mental  inquiries  were  instituted with a view to  the  attain-
ment of better treatment, and in different countries,  almost
simultaneously, the provision of suitable and  adequate ac-
commodation for the  insane was declared  to be  a State
necessity.
  After scientific thought  had at length been turned to the
cure of insanity, many new and strange devices for its treat-
ment were adopted, which  underwent, one after another, the
test  of experiment.   Some of these,  in  our day, are con-
sidered not  only absurd, but  highly injurious, although
  1 Ah, now !  citizen, art thou mad thyself to desire to unchain such animals ? 
.4 
THE DOCTOR THINKS THAT "NO WELL-REGULATED INSTITUTION  SHOULD BE
           UNPROVIDED  WITH THE CIRCULATING SWING."  1818. 
EXPERIMEN TS.
9
originating with men distinguished  for their learning, who
regarded them at the time as most reasonable and efficacious.
An illustration of one of these devices is found in an inven-
tion of  the  medical  superintendent of a  foreign  insane
asylum. It is described in a work published by him in 1818,
in which he gives his observations and experience as follows:
   " The circulating swing erected in  our asylum appears to be
an improvement on the model suggested by Doctor------.  It
is worked by a windlass,  and capable of being revolved  a  hun-
dred times in a minute ; but can with  ease be regulated to the
degree best suited to the  intent.   It is now adapted for one per-
son only instead of four, as had been at first contrived ; the same
movement being seldom admissible for more than one patient.
To the body of the machine is affixed the apparatus for the hori-
zontal position, which, when necessary, may at a moment be ac-
commodated to the purpose.
   " Powerful as this  contrivance  has  hitherto proved, still, in
some cases, where its influence was much sought for, it has had
but trivial  effect, though  put in motion to  its full extent.  The
idiots of the establishment have been permitted to  use it for
amusement without any inconvenience, and the strictly insane
also, during their intervals, with  equal satisfaction.   The latter,
however, on the return of the paroxysms, were  found incapable
of resisting its most gentle rotations  for  five minutes in con-
tinuance.
   " In several cases of  continued insanity of long standing, where
the swing  had been employed as a last  resource, I  have  been
most  agreeably surprised  at the unexpected alteration which
was effected after a few trials.   In some, who, from their dispo-
sition to violence, and  who from necessity were closely confined
to solitary apartments, it had so far  succeeded as not  only to
render them easy of access, but also to induce kind  and gentle
manners, effecting in the  end the most willing service in the daily
occupations of cleansing, and attendance on the sick.   It may be
proper  to  remark  that  those  persons previously to any  such
amendment were invariably affected, from the  disturbance occa-
sioned by the swing, with a smart fever of eight or ten days' dura-
tion, and from which  the favorable  occurrence  here  alluded to
seemed  to have arisen.  I  cannot undertake to  say  that, where 
10        INTRODUCTORY AND RETROSPECTIVE.

the disease had assumed the chronic and uninterrupted form, any
one instance of complete recovery has as yet followed from its use ;
yet as it has thus far established its utility, it is to be presumed
that no well-regulated institution intended for the relief of the
insane will be unprovided with a swing of a proper construction
as a curative  expedient eminently adapted  to the purposes for
which it is so particularly recommended."

  The  same  learned  and  worthy doctor describes a belt
and a leg-chain of his invention, which he considered  great
remedial  agencies, as,  by the use  of  these appliances, pa-
tients under  treatment, however  violent, could  take daily
exercise.

  " To obviate the supposed inexpediency  of freeing maniacal
patients from close confinement, and to provide against the pos-
sibility of their using unrestrained  violence during  this indul-
gence, a broad  strap, made of  strong leather, has been provided,
which embraces the body directly under the axillae.  At the sides
of this strap are affixed other narrower straps, fitted to hold each
arm, so as to be buckled behind, and by which means they are
effectually secured.  The main strap is closed behind with loop-
holes and rings, through which a small iron pin passes, stayed at
top,  and fitted  at bottom  for a padlock.   To prevent the body
strap from slipping down, a loose circular band of leather extends
from the front edge over  the  head and  lodges broadly on the
shoulders, which is also secured behind by a loop-hole and small
strap attached to one of the rings through  which  the pin  is di-
rected.  By this  method  the whole is  preserved from  being
shifted, and it most completely  prevents  the  use of either hand
for any injurious purpose.   The object of  exercise is, however,
sufficiently attained, for which  the open galleries of the institu-
tion  are very well adapted, till at length the patients are permit-
ted, under the same restrictions,  to pass into the open air.
  "A determined perseverance in this plan, sometimes under very
remarkable circumstances, has  had its full reward.  Gangrene of
the lower extremities is no longer known in the asylum.  No pa-
tient is allowed to remain confined to bed during the absence of
fever, or to his apartment,  unless on  the  principle  of  occasional
punishment." 
^1
HljS?
if.!i:n  ^
SHOWING  HOW BANDS AND CHAINS IN THE  PAST  WERE MISTAKENLY USED  AS
                        AUXILIARIES TO  CURE. 
f 
INSANE AS SICK PERSONS.
II
  Perhaps some of the means employed in the early history
of curative treatment do not seem more ridiculous to us than
some of the remedies that we employ will, in after time,
appear to our successors.  It would, therefore, seem the part
of wisdom to be not over-confident in our present methods
of treatment, but to look, with careful inquiry, to new sources
of relief that promise good results.
  Pursuing  the history of  the treatment  of  the insane and
turning our attention  from the Old  World to the New, we
find that, in America, many distinguished philanthropists
have, during the present century, labored with zeal and  en-
ergy to ameliorate the condition of  this  class; and in the
alleviation  of suffering humanity they  have  performed a
noble work.
   The initial point in hospital treatment  of the insane, in
this country, was in 1750,  when there was projected in the
" Province of Pennsylvania " a small hospital, to be located at
Philadelphia, in which the principle of treating the patients
as " sick persons " was recognized.  The Act incorporating
it, passed in 1751, was entitled "An act  to encourage the
establishing of  a hospital  for the  relief of the  sick poor of
this province, and for the  reception and cure of  lunaticks."
This small institution, begun  purely as a curative establish-
ment, in what had  been a private dwelling, was, at its out-
set, dependent  on private subscriptions.  The services of
the visiting  physicians were gratuitous, and medicines were
also furnished free of  charge.  At this time, punishment, in
one form or another, was,  in general  estimation, regarded as
only second in importance to bleeding, purging, and dosing.
Even when, in 1783, the philanthropic Dr. Rush resolved to
relinquish the whips and chains of his day, he still adhered
to  " mild  and  terrifying  modes  of punishment," and, on
paying  a visit to  an insane man, deemed it one of the first
requisites "to look him out of countenance." 
12       INTRODUCTORY AND RETROSPECTIVE.

  The first State asylum erected in this country, and exclu-
sively devoted to the  insane; was opened at Williamsburg,
Virginia, in 1773.  The building was  erected at  a  cost  of
£1,070, and  supplied, also, the  wants of Kentucky, which
had not then taken rank  as a State.   The object of  this in-
stitution, as defined by an act  of  the Legislature, was the
" cure of those whose  cases are not  become  quite desperate,
and  for restraining others  who may be dangerous to so-
ciety."
  In  1817, the Society of  Friends in America, stimulated
by reports  of the good work then being accomplished at the
York Retreat in England, purchased fifty-two acres  of land
at Frankford, near Philadelphia, and  there  opened  a  hos-
pital, the object of which is best expressed in the language
of the projectors, " that the insane might see that they were
regarded as men and brethren."
  The organization of the McLean Asylum, at  Somerville,
Massachusetts,  in 1818, was  another important event  in
respect  to  recognizing the  principle  of  State supervision ;
part  of its board of trustees, charged with weekly visitation,
being appointed directly  by the Governor  of  the State.
Then followed a period of  great reforms, in  which men of
eminence in the medical profession, and philanthropists like
Miss Dix, proposed beneficent measures which received the
hearty approval of State Legislatures.  In  this way insti-
tutions for  the insane  in the United States have, since 1829,
been increased more than tenfold.
  In the State of New York, we find  that the first legisla-
tive  recognition of the necessity of asylum provision for the
insane was in 1801, when  an act was passed  providing  that
lunatics might be admitted into a department of the New
York Hospital, the committing authorities paying for their
maintenance.  State aid was granted  in furtherance of this 
                 PROGRESS OF REFORM.                13

object.  The records of the  Hospital, however, show  that
insane patients had been  admitted  as early as  1797.   In
1808, a separate building, known as the South Hospital, was
also opened  for this class.  Aided still further by special
grants from the Legislature, a branch of the institution de-
voted exclusively to the insane was opened in  1821, under
the name of  the Bloomingdale Asylum.
  In the period which elapsed from 1830 to 1850, great and
rapid advances were made throughout the  United States in
methods  of  caring  for the insane.  The  reforms then ac-
complished attracted the attention of  Europe, and it may
be  said, without any egotism, that they were in  advance of
contemporary  progress in other countries.  But excellence
can be maintained only by continual progress.   It has been
freely asserted that, from the middle of the century up to a
comparatively recent period,  this  country  failed to  keep
pace with the spirit of reform elsewhere manifested.   It is
gratifying to reflect, however, that during the past decade
the advances made here have been as rapid as in the period
between 1830 and 1850.  Should this improvement continue,
it seems not unreasonable to expect that the time is not  far
distant  when the methods  of  caring for  the insane in the
United States will reach a higher standard  than those of any
other country.
  Among the criticisms of British specialists who have visited
asylums in this country are the following : that some, even of
our most modern institutions, are unnecessarily prison-like
in construction ;  that restrictions which are positively hurt-
ful  are still imposed  upon  patients; and  that, in  other
respects, the asylum systems of the United States are more
artificial  and  less natural   or  homelike than  the systems
of some other countries.  It is not to be supposed that these
criticisms apply to all of our asylums, the  statements being 
 14       INTRODUCTORY AND RETROSPECTIVE.

 entirely and admittedly inapplicable  to  some  of our best-
 managed institutions.  But, whatever may be the measure of
 application of these strictures, theyr have been advanced by
 men who, in their own country, are regarded as authorities,
 and should receive careful and candid consideration.
  The writer does not expect that the succeeding pages will
 set at rest controverted points that have been raised respect-
 ing the care and treatment of the insane ;  but he hopes that
 some of the  illustrations given of foreign methods will prove
 helpful to those concerned in the adjustment of questions
 now uppermost in the public  mind and bearing on a subject
of more than  national  importance, affecting, as it does, the
whole human  family. 
CHAPTER II.
                       ENGLAND.

    THE history of the treatment of the insane in England is
      the history of a protracted struggle between the forces
of a humane and enlightened civilization on the one hand, and
of a formidable and unyielding conservatism on the  other.
Before  adverting to the high position which many of the
English asylums have  attained, it  may be well  to  recall
briefly  the gradual  steps by  which this was reached.  In
1547, a  monastic  institution, established some three hun-
dred  years  earlier, and  now  known as  Bethlem  Hospital,
was converted  by  Henry the  Eighth into an asylum, or,
more correctly speaking, a " dungeon-house," for furious
lunatics, in  which capacity it became popularly known as
Bedlam.  This is  the first  public  institution in  England
devoted to  the insane of which we have  any record.  It
was only large enough  to  accommodate  some  sixty pa-
tients, and in 1675 it was removed to Moorfields, where a
building for one hundred and  fifty-two inmates was erected.
Extensive additions were made to the hospital from time to
time, but in 1812 it became  necessary again to change the
site,  and the  more  modern  structure was built  in St.
George's Field.
  The earliest recorded English legislation bearing directly
upon  the insane poor was in  1744,  in  George the  Second's
time,  when any two justices were empowered to  order the
                           15 
i6
ENGLAND.
arrest of pauper lunatics  found  at  large,  and  have them
chained and locked up in " some secure place " within  their
parish of settlement.  Up to  this period, such provision as
had been made for the insane was, however, mainly that of
custodial care for those who were dangerous to be at  large.
  Many of the mentally deranged were to be found wander-
ing about the country in a condition  of pitiable  neglect—a
source of apprehension and annoyance to the public, and an
unwelcome addition to the mendicancy of the time, which is
thus graphically sketched by Shakespeare :
        " The countiy gives me proof and precedent
          Of Bedlam beggars, who, with roaring voices,
          Strike in their numb'd and mortified bare arms
          Pins, wooden pricks, nails, sprigs of rosemary ;
          And with this horrible object, from low farms,
          Poor pelting villages, sheep-cotes, and mills,
          Sometime with lunatic bans, sometime with prayers,
          Enforce  their charity."

  The first asylum in England in which the  curative princi-
ple is distinctly discernible is that of St.  Luke's, erected by
the subscriptions of a few charitable persons in  London, in
1751.  About the close of the  eighteenth  century, there
were in England  not more than five public asylums—mostly
endowed—and only a few  private institutions.
  Down to the  year 1770, Bethlem  Hospital,  which was
then, as now, managed by a board of governors, derived a
considerable revenue in fees from the public exhibition of
the insane, heavily manacled and chained, or kept in cages
of iron.  It would appear  that the visitations on the part of
the curious were  the only kind of inspection to which these
institutions were subject ;  and, until the year 1853, the gov-
ernors of  Bethlem Hospital successfully resisted systematic
governmental supervision. Influenced probably by a national
calamity,  in that the reigning sovereign, George  III., had 
ESTATES OF LUNATICS.
17
several times been attacked by insanity, public attention was
in his day fairly aroused to the necessity for humane  and
more perfect  asylum accommodation and supervision.   In
1774, an act was passed directing the Royal College of Phy-
sicians in London to appoint  a commission, consisting of
five of its Fellows, to visit and license the " mad-houses," as
they were then  termed, situated within the cities of London
and Westminster, or within seven  miles thereof.  The Act
further directed that similar duties should be performed by
the magistrates in their respective districts.
   The custody of the estates of idiots, formerly intrusted to
the feudal superior,  was, in the reign of  Edward II., vested
in the King, and proved no inconsiderable source of revenue
to the crown.   A distinction was made  by law as between
idiots, or " natural fools," and lunatics.   Blackstone defines
an idiot as " one who hath  had no understanding from his
nativity, and  therefore is by law presumed  never likely to
attain any"; and a lunatic  as  "one who hath had under-
standing, but by disease, grief, or  other accident hath  lost
the use of his reason."   In the case of the former there was
forfeiture of the surplus profits  of the estate during the life-
time  of  the idiot, after supplying him with necessaries ; in
the case of  a lunatic, the crown acted as trustee, protecting
his person and property, and accounting to him, if  he re-
covered, for all  profits received, or to his representatives in
the event of his death.   In the case of  idiots the property
was preserved for the benefit of the heirs.  Thus appears to
have originated that care or guardianship of estates of idiots
and lunatics which is still maintained by  the Court of Chan-
cery.
   But whatever of  humane  care  was  manifested,  it  was
apparently confined, as  Chancery care is now  confined, to
those possessed  of estates.  Pauper and criminal  lunatics, 
i8
ENGLAND.
violent,  and dangerous to be at large, were, without  cere-
mony, relegated to the gloomiest confines of jails and work-
houses.1   Even in what were termed asylums, the accommo-
dation included  dark, damp cells, where, as if to accelerate
death, iron  cages, manacles, wristlets, and massive chains
were unrelentingly employed, lacerating and discoloring the
flesh of  the unhappy  victims.  A grave abuse  connected
with these  receptacles for the insane lay  in the fact that
they were resorted to by the powerful and unscrupulous as
conveniences for getting  rid of any relative  who  might hap-
pen to stand in  the way of their selfish aims.  The poorer
classes were crowded to  suffocation in dungeons, bled pro-
fusely, lashed into a state of complete exhaustion, or, as too
frequently happened, were brutally  kicked to death by some
unfeeling attendant,  who, free from supervision, knew that
he might with impunity inflict fatal injury upon any one of
the patients committed to his charge.  This fearful  state of
things is amply substantiated by competent authorities.
  The late Dr. R. Gardiner Hill says :
  " In the early part of the present century, lunatics were kept
constantly chained to walls in dark cells, and had nothing  to lie
upon but straw.   Some  were chained in dungeons, and  were
gagged,  outraged, and otherwise abused.   The keepers visited
them whip in hand, and lashed them into obedience ; they were
also half-drowned in baths  of surprise, and in some  cases semi-
strangulation was resorted to.  The bath of  surprise  was so con-
structed that patients, in passing over a trap-door, fell in.  Some
were chained in wells, and the water made to rise until it reached
the  patient's chin. . .  . Patients in a  state of nudity, women as
well as men, were flogged at particular  periods, chained, strapped
and fastened to iron bars, and even confined in iron cages."
  The cruel treatment  of the times is truthfully illustrated
by the oft-quoted case of Norris, who was an  inmate of Beth-
lem Hospital before that place came to rank, as it now does,
         1 Workhouse in England is synonymous with poorhouse. 
 
NORRIS IN CHAINS 
INHUMAN  TREATMENT.
19
among the better class of English asylums.   It appears that
Norris, in an outburst of passion to which the nature of his
infirmity rendered him momentarily liable, had'struck the
apothecary of the asylum, and for this offence  was kept in
irons for twelve years!  The refinement of torture was in
this instance  reached  by keeping the victim in such  a po-
sition that he could not stand upright !  A reliable authority
thus particularly describes the mode of his restraint:

  " A stout iron  ring was riveted round his  neck, from which a
short chain passed to a ring made to slide upwards or downwards
on  an  upright massive  iron bar inserted into the wall.  Round
his  body  a strong iron bar about two inches wide was riveted ;  on
each side of the  bar was a circular projection, which, being fas-
tened to and inclosing each of the arms, pinioned them close to his
sides.   The waist-bar was secured by two similar bars, which,
passing over his shoulders, were riveted to the waist-bar both be-
fore and behind.   The  iron ring round his neck was  connected
to  his shoulders by a  double  link.   From  each of  these bars
another chain passed to the  ring on the upright iron bar.   His
right leg  was also chained."

  That cruelty of the kind above described should have  been
possible  as late as the year 1815—twenty-three years  after
Pinel's great  reform in France, and  after Tuke's introduc-
tion of humane  principles  at the York Retreat—is almost
beyond  belief.   Yet authentic records show that  Bethlem
Hospital was  by no means the only one where  the patients
were brutally treated.   It was the discovery of similar scan-
dalous practices at the York Asylum—established by general
subscription  in  1777—that led William  Tuke,  in behalf of
the Society  of  Friends, to  found the famous Retreat at
York, long the only English institution of its kind in which
chains, leg-locks, and handcuffs were totally discarded.   The
circumstances leading  to the  establishment of this novelty
in asylum  management were as follows : The Society of 
20
ENGLAND.
 Friends in 1791 sent one of their number, a female patient,
 to  the York  Asylum,  when  it was learned that, by  the
 rules of the institution, none of her relatives would be per-
 mitted to see her.   There was reason to fear that the reports
 then in circulation about the inner workings of this place of
 concealment and confinement were not without foundation,
 and as the result of investigations, the Society resolved to
 erect an independent hospital where moral treatment should
 have precedence over mechanical methods.
  The Retreat  was opened  accordingly  in  the  year  1796.
 One of the first patients admitted was a man who had been
 chained for twenty years.   Under the new re'gime of kind
 and more intelligent treatment, he was at first restricted only
 by  the occasional use of arm-straps, and he soon consented
 to  wear  his clothes,  becoming in  this and other respects
 decent and orderly in  his habits.  The  success attending
 these efforts need not  be  dwelt upon here.
  Meanwhile,  the unenviable notoriety of the York Asylum
 increased  rather than diminished.  Regular official inspec-
 tion there was none  to confirm or  refute  the charges which
 were in circulation regarding the prevailing usages. There
 is hardly an atrocity that could be named, including sexual
 outrage, that is not alleged to have been perpetrated  upon
 the helpless victims then incarcerated in the gloomy cells of
 that prison-like  structure.  Its stone floors were begrimed
 with filth, and its round air-holes, only eight inches in diam-
 eter, exhibited the merest mockery of ventilation.   In con-
 sequence  of complaints made  by members of the Society
 of Friends, an official inquiry was instituted into the  manage-
ment of this and similar misnamed " public " asylums.  It
is authoritatively  asserted  of  the York  institution  that
scarcely had the inquiry terminated,  when the wing of the
asylum which contained the worst cases was purposely  set 
L UNA C Y LEGISLA TION.
21
on fire to destroy evidences of hideous cruelty, and several of
the patients were burned to death.  Statistics of the institu-
tion were found to have  been falsified; 221 patients were
advertised as dead, whereas the number ought to have been
365.  Among other  recorded  instances  of  neglect, it is
stated that the janitors took no measures to protect the in-
sane  under  their  charge  from  the  attacks  of  rats,  which
allowed the  patients neither rest by day nor sleep by night.
  In  1807, a select committee of the House  of Commons in-
quired into the condition  of the lunatic poor, and in the  fol-
lowing year an act was passed providing for the erection of
properly equipped public  lunatic asylums, to be built at the
expense of  the counties or boroughs  throughout England
and Wales.   This and a few subsequent amending acts left
it optional with  the justices or magistrates  to provide such
asylums ; but, in  1828, only seven counties had made  the
requisite provision. By the year 1841, only seven other coun-
ties had complied by furnishing the desired  accommodation.
Meantime, parliamentary  investigations, of which there were
several between  1808 and 1844, revealed a very unsatisfac-
tory state of things.   Many of  the asylums had no medical
attendant;  many, both in and out of London, were seldom
visited, and  great abuses were common.  In 1828, an  act
was passed  empowering  the  Home Secretary  to  appoint,
every year, fifteen commissioners—five  being physicians—
for the  purpose of licensing and visiting the metropolitan
district.   Four years later the Lord  Chancellor was  author-
ized to appoint annually the Metropolitan Commissioners
in Lunacy,  and finally, in  1842, these  commissioners were
empowered  to inspect all the public  and  private asylums
throughout  England and Wales.   They made  a searching
inquiry into  the  condition  of these institutions, and their
report made to  Parliament in  1844 proved of great  value
in shaping subsequent legislation. 
22
ENGLAND.
  The published accounts which had been periodically ema-
nating from the York Retreat were influential in confirming
the doctrine laid down by Pinel, the great French reformer,
that severe forms of  restraint are hindrances, and not helps,
in the  treatment of the insane.  Yet so strong  was the
prejudice against  reform that, when Dr. Hill attempted it in
the Lincoln Hospital in  1838, he was forced to  resign his
office of superintendent.  In the following year Dr. Conplly
was appointed to  the large metropolitan asylum of Hanwell,
in Middlesex.  Having obtained the  reluctant  consent of
the authorities to what was believed to be a dangerous ex-
periment, he boldly adopted those principles of non-restraint
which had been already firmly established by Pinel and Tuke.
So  marked was his  success in this large public asylum set
apart for disturbed cases that  Gloucester  and many other
provincial public  institutions, including even conservative
Lincoln, became  converts to the  new method.  The substi-
tution of humanity for brutality gradually extended, though
much work had  yet  to  be done.  It was commonly con-
sidered, as late as  1842, that old  jails required but little
alteration to make them fit receptacles for the insane.
  The nature of  the provision made  for the insane about
this time  and prior to 1844 was described by  the Earl
of Shaftesbury, Chairman of the English Board of Commis-
sioners in  Lunacy, before a parliamentary inquiry, in 1877,
in these words :
  " I recollect  I used to see as many as thirty, forty, or fifty pa-
tients chained to the wall.  I never knew an attendant go about
who had not leg-locks and hand-locks  to his waist, which were
applied without remorse. I do not mean to say that people in those
days were less humane than we are now, but they were ignorant,
and many of them thought that a madman was a creature so  de-
void of  sense and  feeling that he might be treated not only as  a
beast, but worse than a beast.  I remember, as to  the White 
METHODS OF RESTRAINT.
23
House Asylum in Bethnal Green, it came out in the evidence, and
the physician who was at  the head of it never denied the state-
ment, and as a matter of course he did  not  think there was any
thing inhuman in the fact, that, on Saturday night, from  200  to
220 patients were chained down in their cribs and never visited
again until Monday morning.  There was a crust of bread and a
cruse of water put beside them, and they were left in their filth.
Pauper patients did not then sleep in beds as they do now.  Go
and see them now in their dormitories, you would have no objec-
tion to sleep there yourselves ; but they were then put in cribs
with straw—put in naked,—and there were holes in the bottom to
let the urine pass ;  the rooms were all  constructed with flags or
bricks, sloping down in the centre like a filthy stable with a drain
in the middle,  and there they were lying for hours."
   Among the crying defects of the  time were the improper
crowding together  of  patients, a want of medical care and
proper nursing, unnecessary  coercion  and restraint, and an
absolute  dearth  of  occupation, recreation,  or amusement.
The  methods of  restraint in  common use at  this time
included  iron hand-cuffs connected with chains  to a leather
waist-belt; leathern hobbles locked around the ankles, which
permitted the patient to shuffle his feet, but impeded his
movements so that  he could not walk; iron  hand-cuffs with
chains which passed through  fastening locks at the sides
of heavy " tub-bedsteads " filled with  straw; boots made
of ticking, with rings  and chains  which  passed through
fastening locks at the  bottom of the bedstead.
   By 1845 it had  become evident  that the law allowing
magistrates, at their option, to make asylum provision was
not beneficial in its practical operation.  Accordingly, by an
act  passed in that  year it was made  incumbent upon  the
justices of every county and borough,  within three years, to
obtain  or provide  the necessary accommodation for their
insane.   They were allowed to make this provision either
separately or jointly with other counties or boroughs. This 
24
ENGLAND.
act, modified by subsequent enactments to be hereafter re-
ferred to, forms the basis of the existing system.  The law
made in 1845 superseded all previous legislation on the sub-
ject of the visitation and inspection  of  institutions for the
care of  the insane ; appointed for  life eleven Lunacy  Com-
missioners, three of  whom should be physicians and  three
barristers ;  and directed that all future vacancies should be
filled  by the Lord Chancellor.  The six professional com-
missioners were to be the only paid members, and they were
specially charged with  the  work  of  visiting.   A Secretary
was also appointed, and all  took  the oath of fidelity and
secrecy as administered  by the Lord Chancellor.
  The  commissioners,  acting under a common seal, were
empowered  to  make rules for their guidance in carrying on
their  work ; to visit and  supervise all asylums certified to
receive  the  insane throughout  England  and Wales.  They
were authorized to inspect the books and documents of the
institutions  visited, and, in short, to inquire into all matters
and things pertaining to the physical  or mental condition of
the insane.  Any keeper or superintendent withholding the
required information was made liable to pains and penalties
for  misdemeanor.  They  were required  to make an annual
report to the Lord Chancellor, which in practice is presented
to Parliament.
  In 1852, notwithstanding much previous legislation on the
subject, several counties were still without asylums, and only
four boroughs  had provided separate accommodation.  It
was therefore  found necessary to pass a still more stringent
act  in  1853, making it compulsory on  justices  of every
county or borough to provide for the wants of pauper luna-
tics in their  districts, either separately or by agreement with
others.  The word  "lunatic"  was  expressly  defined  to
"mean  and include  every  person of unsound mind, and 
THE INSANE POOR.
25
every person being an idiot."  The justices were now re-
quired to appoint  committees of  their number  to  erect
asylum buildings or provide needful accommodation;  and it
was  provided that  boroughs  neglecting so to provide or
contract for their pauper lunatics might be annexed (for the
purposes of the Act) to  the adjacent counties, or that the
Secretary of State  might require a county or borough to
provide an asylum.  To meet the case of crowded localities
like the metropolis, where lands and accommodation  might
be difficult to procure within a given area, power was granted
to authorities to erect and  manage asylums outside  their
own county.  The cost of the new arrangement was directed
to be defrayed by  a county  tax.   Borrowing powers were
also conferred upon local authorities,  to  meet  necessary
expenditures.
  The primary intent of the statute in creating county and
borough asylums was to  provide for pauper lunatics.  Other
lunatics, or the pauper lunatics of other counties or boroughs,
may not be admitted to any asylum of this kind until all the
pauper lunatics of the county in which it is situated, or the
counties or boroughs  contributing to it, if any, are accom-
modated.
  The management of the county  and borough asylums is
entrusted to a " Committee of Visitors " appointed annually
by the justices of the counties and boroughs.   This commit-
tee, of whom three constitute a quorum, are empowered to
appoint a paid clerk, who may also  be the clerk of the asy-
lum, and in whose  name they may sue and be sued.   The
committee are likewise  empowered  to  appoint a resident
superintendent,  chaplain, treasurer, and such  other officers
and  servants  as they  may  think  fit.   They  have  also
power to discharge  the same.  Should a nurse or attendant
be discharged, the  cause for  so doing must be reported to 
26
ENGLAND.
 the Commissioners in Lunacy.   Subject to the approval of
 the Home  Secretary, the committee may frame rules  and
 regulations for the government and management of the  asy-
 lum under  their charge, and not  less frequently than once
 during every two months as many as two  members of  the
 committee  are  required to  visit  the asylum together  and
 make a thorough examination of every part, and to see, " if
 circumstances will permit," every patient therein. They are to
 examine all commitment papers received since their last visi-
 tation, also  the books of the asylum, and they are required
 to enter in a book kept for the purpose at the asylum their
 impressions of the condition of the  asylum, the  patients,
 etc.  The   Committee  of Visitors report  annually  to  the
 justices of the county or borough, and a copy of this report
 must be sent by them  to the  Commissioners in  Lunacy.
  The enactment respecting  the maltreatment  of asylum
 patients provides that—
  " If any superintendent, officer, nurse, attendant,  servant, or
 other person employed  in any asylum strike, wound, ill treat, or
 wilfully neglect any lunatic confined therein, he shall be guilty of
 misdemeanor, and shall be subject to indictment for every such
 offence, or to forfeit for every such offence, on a summary con-
 viction thereof before two justices, any sum not exceeding twenty
 pounds nor less than two pounds."
  It is required by  the Act 8 and 9 Vict.  c.  100,  and
 amending statutes, that  every house  in which more than
 one  patient is kept,  whether private or pauper,  must be
 licensed. The  district lying within the distance of seven
 miles from  any  part  of the cities of London and  West-
 minster, or  the  borough of  Southwark, is designated as
 the  " immediate jurisdiction "  of  the  Commissioners  in
 Lunacy,  and within  this district  licenses  are granted  by
them.  Elsewhere such licenses are issued by the justices of
the county  or  borough within which the house is situated. 
STATUTORY REGULATIONS.
27
The justices are  also  required  to appoint three or more
justices and one physician or more to act as local visitors to
the  licensed houses within  their  several  localities.  The
names of these visitors  must be forwarded to the Lunacy
Commissioners. All houses licensed for one hundred patients
or  more  must have a  resident medical  officer.  If, in  any
house licensed for less than  one hundred  patients, there be
no  resident  medical officer, such house  must  be regularly
visited  by a physician, the frequency of his visits being reg-
ulated according  to the number of  patients for which the
house is licensed.
   It is also required that any hospital or part of a hospital
or other  house or institution (not being an asylum) wherein
lunatics  are received  and  supported wholly or in part by
voluntary contributions, or by any charitable bequest or gift,
or  by applying the  excess of payments of some patients for
or  towards the support or benefit of other patients, must be
registered by  the commissioners before patients may be re-
ceived  therein.  After  registry, such institutions, which are
usually governed  by a  committee elected from the contribu-
tors, are designated " Registered  Hospitals."   Every hospi-
tal receiving patients must have a resident medical officer.
   Under the law, private patients are consigned to asylum
care on  the  order of  a relative, friend,  or some person
authorized to place  the patient  under  legal restraint, if
the document be  supported by the certificates of two quali-
fied and registered physicians.    In the case of Chancery
patients, i. e., persons  who  have  been  found  lunatic by
inquisition  on  inquiry before  a   Master  in  Lunacy, an
order  signed  by  the  regularly  appointed  committee  is
sufficient authority  for  the reception  of  such  persons
into  "any  asylum,  hospital,  licensed  house,  or other
house," without a medical certificate.  Paupers are generally 
28
ENGLAND.
sent to an asylum by the order of a justice together  with a
statement of particulars and  a medical certificate.   In the
event, however, of  a pauper  patient not  being able to  be
taken  before  a justice,  an  officiating clergyman  of  the
parish  in  conjunction  with  the relieving  officer or over-
seers,  as  the  case  may be,  can sign the  order  for  his
admission into  an  asylum.   But  in  regard to  commit-
ment  it  is advisable to quote  from  an  official authority.
Secretary Perceval,  of  the English Lunacy  Commission,
has described before a parliamentary committee the present
system of commitment substantially as follows:

  To authorize the confinement of an insane person who has not
been found lunatic by inquisition, in any licensed house or hos-
pital, it is  required that there  should  be a document called an
order,  addressed to the proprietor or superintendent  by some
person connected in some way with  the  lunatic,  and supported
by the certificates of two registered medical  practitioners, ' who
must examine the patients  separately from each  other, and must
each sign a certificate in the form prescribed by act of Parlia-
ment.  Each certificate must state the facts upon which the person
certifying grounds his  opinion, that the  person to be taken in
charge is a lunatic within the meaning of the Act, and that he is a
proper  person  to be placed under care  and treatment.   Those
facts since 1853 are obliged to be divided into two categories :
first, the facts  personally observed by the medical men at  the
time of the examination  ; and,  secondly,  the  facts communicated
to them, if any, by others,  specifying the informant.   The medi-
cal men certifying must have seen the  patient within seven days
prior to his admission.   The certificates are good for seven days
only.  The order must  have been made within a month prior to
admission, and since 1862 the order cannot be made by any per-
son who has not seen the patient within  a month.  The person
who signs the order does it entirely upon his own responsibility ;
he must state some circumstances in connection with the patient,

  1 Under special circumstances a private patient may be  confined upon the
certificate of one qualified practitioner ; but unless two similar certificates be
furnished within three days of admission, the patient must then be discharged. 
ADMISSION.
29
and he must append a statement of particulars giving name, sex,
age, and previous abode of the person, which he must  also sign ;
and the statement must contain  the name  and address of some
relation, if  possible, to whom notice may be sent in the event of
death.  No  person can sign a certificate or order for  the recep-
tion of any  private or other patient into a  licensed  house, if  he
receives any percentage on the payment to be made for his ad-
mission ;  and no medical  man can sign the certificate  for the re-
ception of such a patient into a  house of which he or  his father,
brother, son, partner, or assistant is the proprietor ;  nor can his
father, son,  brother, partner, or assistant sign the same reception
order.  There is no regulation with regard to the position in
which the person who signs the order stands towards the alleged
lunatic.   All the Act says is, that the order must be signed in the
form  given  in the schedule to  the Act.  It may  be signed by a
total stranger if he chooses to take the responsibility ';  all he has
to do is to state :  " I, the  undersigned, hereby  request you to re-
ceive A. B., a lunatic (or an idiot, or a person  of unsound mind,)
as a patient into  your house ;  subjoined is a  statement respect-
ing the said A. B."   And then  there  is  the name of the  person
signing, and there is his occupation and place  of  abode, and his
degree  of relationship (if any)  or other circumstance  of con-
nection  with the patient.  The  order  is not  countersigned  by
any authority.  There is no provision, as there ought, in my opin-
ion, to be, making it the duty of some one to inquire of the per-
son  signing the   order  what  reasons  he  has for  signing, or
if there are  any persons more nearly related  to  the alleged
lunatic   than  himself.   The  sole  safeguard  is  the responsi-
bility incurred  by the  person  signing the   order,  which re-
sponsibility  amounts to the risk  of a civil action  on the part
of any person who  considers  himself aggrieved.  The  person
taking charge  of the alleged lunatic  is  required within twenty-
four  hours   to send  notice  of admission of the  patient  to
the Commissioners in Lunacy,  and  if  he be  the  proprietor
or superintendent of a   licensed house in the  provinces,  he
must  also send notice  to  the  clerk of  the visiting magistrates.
He sends that  notice of admission accompanied by copies  of the
  1 Some measure of  responsibility attaches also to the certifying  medical
man.   In the  case of Hall v. Semple, decided  in 1S62,  the plaintiff obtained
a verdict for ^"150 damages against the defendant, a medical man who " neg-
ligently and culpably " signed a certificate for admission to a private asylum. 
3Q
ENGLAND.
order and of the two certificates under which the patient was ad-
mitted, and he must at the same time make an entry in his admis-
sion-book of  the patient's reception ; then after  two days, and
within seven  clear days from the  reception of the  patient, the
medical attendant, whoever he may be (either the  medical super-
intendent of  the hospital, or asylum, or the proprietor of the
licensed house himself, if a medical man), but in any case the per-
son who has the medical charge of the patients in the house or
asylum, must  send up to the Commissioners in Lunacy what  is
really a third  certificate, stating what the patient is as to his men-
tal and bodily condition.  It is filled up by different medical su-
perintendents with more or less particularity ;  some of them  fill
up the form very fully and carefully, and give a great deal of in-
formation with reference to the  patient ; some fill up the form
by stating that the patient is laboring under " mania " or " demen-
tia " as the case may be.   The words are : " I have this day seen
and examined the patient mentioned in the above notice," that is,
the notice of admission, " and hereby certify that  with respect to
mental state he (or she)" is so and so, " and that  with respect to
bodily health  and condition, he (or she) " is so and so.
  With regard to the amendment of certificates or orders, which
may not  appear to the commissioners to be in proper form, the
nth section  of the Act 16 and 17 Vict, reads as follows: "If
after the  reception of any lunatic it appear that the order or med-
ical certificate, or (if more than one) both or either  of the medi-
cal certificates, upon which he was received, is or are in any re-
spect incorrect or defective, such order and medical certificate or
certificates may be amended by the person signing  the same at
any time within fourteen days after the reception of such lunatic :
provided, nevertheless, that no such amendment  shall have any
force or effect unless the same shall receive the sanction of one or
more of  the commissioners."  That was extended a little further
in 1862 by the 27th section of the 25 and 26 Vict. c. in, which
said :  " Where any medical certificate upon which a patient has
been received into any asylum,  registered  hospital, licensed or
other house, or either of such certificates, is deemed by the com-
missioners incorrect or defective, and  the same are or is not
duly amended to their satisfaction within fourteen days after the
reception," then the commissioners may make an  order for his
discharge. A superintendent or proprietor of a house would be
safe in taking a patient if upon the face of the documents there 
DISCHARGE.
31
was no very gross and palpable omission, such as no facts stated
to have been  observed  by the medical man himself, or a  false
signature to the order.
  A relieving officer or overseer is bound, under heavy penalties,
to remove every pauper lunatic, or every lunatic not under proper
care and control, whether a pauper lunatic or not, whom he  finds
or has notice of  in his district.  That is under the provisions of
the 16 and 17 Vict. c. 97, which is the great Act regulating  all
lunatic asylums and pauper lunacy, sections 67 and 68.  Section
67 imposes upon the relieving officer and medical officer of the
parish or union the duty of removing pauper lunatics to an asy-
lum, and section 68 refers to lunatics wandering at large and not
properly taken care of,  or cruelly treated, and not under proper
care and control.  In the case of paupers the order is the order of
the magistrates, not being a mere request, but an actual order to
the superintendent of the asylum to take the patient in.  It is ac-
companied by a  statement signed  by the relieving officer, saying
what  union  the  chargeability  rests  primarily upon, and it is ac-
companied by a  certificate which is in precisely the same form as
a private certificate, with the  exception that it omits the words
relating  to  a separate  examination, because there is  only  one
certificate.   Another difference is that the notice of admission is
not sent to the commissioners  within twenty-four hours, as is the
case with a private patient, but within seven days.   The medical
superintendent of the asylum sends up his statement of condition
along with the notice of admission of the  pauper patient, which
is signed by the clerk of the asylum on some day after two  days
and within seven days after the admission.   The medical certifi-
cate lasts till the discharge of a patient.

   On the recovery of any private patient, notice  must  be
given to the  person who signed  the order of admission, or
to the one by whom the last payment was made; and if the
patient be  not  removed within  fourteen days, notice must
then  be  given to the  commissioners, and, in  the case  of a
house licensed by justices, to the visitors also.  Any patient,
not a pauper, may be discharged or removed, whether recov-
ered or not, by the order in writing of the person who signed
the order of admission, or, in the event of his death or inca- 
32                     ENGLAND.

pacity, by that  of  some other person  authorized  to  act  in
his stead, unless the medical officer in  charge object  to the
patient's removal on the ground  that  he is  dangerous and
unfit to be at large, in which case the  consent of  the com-
missioners or visitors must be  obtained for his discharge  or
removal; though he may be transferred, under the  control
of an attendant, to some  other establishment.   If there be
no relative or other person qualified to order the removal or
discharge, the commissioners  maytdo so;
  The commissioners are  also empowered to effect the dis-
charge of private  patients for two reasons:  one for  the in-
sufficiency of certificates, if  after commitment they are still
deemed insufficient; and, secondly,  if two  of the commis-
sioners visiting at  intervals of seven days, and with certain
formalities prescribed  by the  Act, come to  the  conclusion
that any person held there, to whom their visits are specially
directed, is detained, in the terms of the Act, without suf-
ficient cause.  "The Commissioners," to use the words  of
Secretary Perceval,  " from their  own observations, some-
times think that a patient ought to be allowed to  go, and
his friends  sometimes  think  that it is not  time  that  he
should be discharged.  It is more in the  case of  pauper
patients that we hear  these complaints than in the  case of
private patients.  A near relation wishes to get the bread-
winner of  the family out of the asylum, or  the husband
wants to  get his wife back, because  he finds it very uncom-
fortable to be living without her, and he wishes  her to  be
discharged whether she is quite cured or not.   These are
the kind of  complaints we get in much larger number than
those  relating to the undue detention of  private  patients."
  The  committees  of  visitors  entrusted  with  the local
management  of county  and borough  asylums  may  dis-
charge a patient, whether recovered  or  not, on the  recom- 
TRANSFER.
33
mendation of the superintendent,  or  they may do  so of
their own authority and against the wish  of the  medical
superintendent,  provided  three of  said  visitors  concur.
Generally, however, they act on the recommendation of the
medical superintendent.  The commissioners have no power
of discharge in  the case of paupers, other than for insuffi-
ciency of certificate.   They may, however, recommend dis-
charge for other reasons.
   Pauper patients (not dangerous) in licensed houses and
hospitals  may be discharged  therefrom by the Board of
Guardians of  any parish or union,  or an officiating clergy-
man of any parish not under a Board of Guardians, with one
of the overseers thereof, or any two justices of the county
or borough  in which such last-mentioned parish is situate.
   The commissioners frequently advise the transfer of  a pa-
tient where there is a difference of opinion between  them
and the superintendent of  a hospital or licensed house as to
the  necessity of confinement.   The  Home Secretary may
discharge absolutely or conditionally any criminal lunatic.
   In 1877, an important investigation was made, by a select
committee of the House of Commons, into the operation of
the lunacy laws so far as  regards the security afforded by
them against violations of personal liberty.  The inquiry
was particularly directed  to what  are known  as  " private
asylums "; viz., thirty-nine metropolitan and sixty-one pro-
vincial licensed  houses kept by their proprietors for profit.
Some grave charges were advanced against these private es-
tablishments, but with no very definite result. It was shown
that English forms of commitment  were susceptible of, and
indeed required, amendment;  yet it  was decided  that  no
abuses of personal liberty were  clearly established by the
evidence.   The committee, in reporting on the evidence,
expressed the opinion  that  frequent and  careful  visita- 
34
ENGLAND.
tion is the  surest mode of  guarding against unduly pro-
longed detention, and advised the more general adoption of
probationary discharge, with  full power in the hands of the
commissioners  to  order  discharge.  It was  stated  before
the committee  that, since 1845, there  had not been more
than ten cases of discharge effected  by the commissioners
under the 76th  section of  8  and  9 Vict. c. 100, which pro-
vides that, if a  patient is to be discharged, and the person
who signed  the order is contumaciously unwilling to  dis-
charge him,  two of  the  commissioners may  examine  the
patient, and, after  two separate visits, with an interval of
seven  days   between  the visits, may discharge  him from
confinement.  Although  it may be true  that only ten  dis-
charges were effected in this  way, nevertheless  it will  be
seen from the following  testimony of the late Chairman of
the Lunacy  Commission, before the parliamentary commit-
tee just referred to, that the moral effect of this law has made
the commissioners  instrumental in releasing large  numbers :

  " In  going the  round of our different houses we saw a number
of patients whom we thought in a fair way of recovery, and who
might safely be taken out, or who at  least should have a chance
of recovering  by the benefit of  a  change, and who should be so
treated by their friends.  We used, as we do now, to enter obser-
vations of that sort in the Patients' Book.  The friends see those
entries, and in a vast number of instances, nay, almost in all, act
upon them. We have been in the habit of writing to the relatives
of the patient, or the person who signed the order, using this argu-
ment :  You must be perfectly aware that  there is a  sore place
between you  and the  patient.  You have signed the order, and
you have put  him in confinement.  It  is very necessary that we
should, if possible, keep up harmony in families.  Will you have
the grace to take the person out ?  If you do not do  it, we shall
be obliged to  resort to  our  powers of liberation ; but we think it
is far better that  the liberation should come  from another quar-
ter, from the  friends themselves, and it will perhaps heal a  sore
place and restore kind feelings.  The result  has  been  that 
PROLONGED DETENTION.
35
scarcely ever any resistance is made ;  our  advice is attended to,
and  hundreds and thousands  are constantly liberated upon that
principle.  We gave leave  of absence during the year  1876, in
the metropolitan licensed houses, to 614 persons ; of these,  131
never came back ;  we never inquired  after them,  and were very
glad that they did not return to the asylum.  The same thing has
been going on in the provincial asylums, both in licensed houses
and in the county asylums,  and in the hospitals ; and in that way
a great number of persons have been set at liberty, and have never
returned to confinement.  A  great many go out on trial, and the
trial has  proved  effective in many cases.  Some have come back,
some have  not come back; and thus  many have  regained their
freedom."

   Notwithstanding the above statement by so  distinguished
an authority, respecting the favorable operation of the Eng-
lish  lunacy  laws, it would  appear  that they  do not  suffi-
ciently guard against  the abuse of unnecessarily prolonged
asylum detention.  The Commissioners in Lunacy, in report-
ing upon the Colney Hatch asylum in 1879, sa^ :

   " During our visit on this occasion the complaints of  unneces-
sary detention are unusually  numerous, and very  numerous also
are the complaints in both divisions that  access  by the patients
to any but  the medical staff is practically denied.   Of course we
cannot affirm the  insanity  of all the patients ; neither  is it  our
province to consider the discharge of any  ; but these complaints
are made to us.  We earnestly trust that the members of the Com-
mittee whose  duty it is to  visit periodically the wards  do  make
those visits  real opportunities for listening to the  patients, hear-
ing their grievances, and reporting thereon to their colleagues in
view to remedy any cause of  complaint.  Many patients in each
division, especially on the women's  side, have told us that they
know  the chairman by sight and are well acquainted  with the
medical officers ; but by no means few, who have been in the asy-
lum  a long period, and who do  not lack intelligence, informed us
that  they knew not that they were visited at intervals by  members
of the Committee for inquiry into their cases.  Some, indeed, knew
that  they were periodically counted in the wards, but denied that
they had then such  opportunity as they desired  for complaint. 
36
ENGLAND.
In  another direction we would also  suggest whether  assistance
could not be given to the  medical staff.   We  allude to the dis-
charge of cases ' relieved ' only.   This must be often a  difficult
question, and must largely depend upon the amount of care and
protection which can be secured for the discharged through their
relatives.  Looking at the vast number of patients, we  think that
the Committee should consider whether some system of  inquiry
could not be organized which might relieve the medical  staff of
labor in this direction.  The medical superintendents have cer-
tainly no leisure, and the task of inquiry into the  circumstances
of a patient if discharged as relieved might possibly be undertaken
by  members of the Committee in rotation, assisted by a clerk.
The result would doubtless be a diminution of the crowd detained
here, a boon to the partially recovered,  and an  economy."

  The commissioners, in again  reporting on this  asylum in
1886, said :
  " We had a great number of complaints as to  undue deten-
tion, and we referred all the  patients to the Committee, telling
them that they alone had absolute power of discharge.  We learn
that the Committee go round once every two months, but some
of the patients told us they were denied speech with them ; but
this we trust is not the case.   The patients also complained  that
the guardians from some of the unions  never came to see them,
and this complaint we learn is well founded, and have to express
a hope that the Committee will urge on the various boards who
neglect their duty in this respect the desirability of making visits
to their patients at certain times."
  As much interest attaches to the practice of  liberating
patients " on  trial,"  it may  be well  to give a few  details
on  this  point.  By the  Act of 1845,  it was  made lawful
for  the proprietor  or  superintendent  of  any  licensed
house, or of any hospital, with the  consent  in writing of
any two of the  commissioners, or, in  the case of a house
licensed by  justices, of  any two  of  the visitors of such
house, to send or take, under proper  control, any patient to
any specified  place  for any  definite  time for the benefit of
his  health.  The consent of the committing party was then 
ABSENT  ON  TRIAL.
37
deemed essential, unless for special reasons the commission-
ers or visitors dispensed with such consent.   In 1855, legis-
lation empowered the superintendent of any registered hos-
pital, with the written sanction  of any two of his committee
of management, to effect the removal of any patient on trial.
In  1862, power was conferred  on the commissioners, on com-
mittees of governors, and on  boards of visitors, of their own
authority, to permit pauper patients in registered  hospitals
or  licensed houses to be absent on trial.   The words of the
section are as follows:

  " Two of the Commissioners, as regards any hospital or any
licensed house,  and two of the committee of governors of any
hospital,  and  two  of the  visitors   of  any  licensed  house,
as  regards   any  licensed  house within  the   jurisdiction  of
visitors, may of their own  authority  permit  any pauper pa-
tient  therein  to  be  absent  from such hospital  or house upon
trial for such period  as  they  may  think  fit,  and may make
or order to be made an allowance to  such  pauper not  exceeding
what would be the charge for him  in such hospital or house, which
allowance shall be charged for him and be payable as if he were
actually in such hospital or house, but  shall be paid over to him,
or for  his benefit, as the said Commissioners  or visitors may di-
rect.   In case any person so allowed to be absent on trial for any
period do not return at the expiration thereof, and a medical cer-
tificate  as to his state  of mind  certifying that his detention as a
lunatic  is no longer necessary  be not  sent to the  proprietor or
superintendent of such licensed house or hospital, he may at any
time within fourteen days after the expiration of the said period
be retaken, as in the case of an  escape."
  The system of visitation by the Commissioners in Lunacy
is as follows : The districts beyond the metropolitan area
are arranged into nine circuits,  which are  divided  between
six  commissioners, alternating  half-yearly  in  their circuits.
All of  the  asylums,  licensed  houses, hospitals, and single
patients are visited by the commissioners every year—some
of them twice a  year, or  oftener.   Workhouses with lunatic 
38                     ENGLAND.

wards are visited annually.  The smaller workhouses con-
taining lunatics are visited once in three years.  The metro-
politan district is divided  into six circuits, visited four times
a year by two commissioners, and twice a year by one com-
missioner, making six visits in the course of the year, besides
frequent special visits in special cases.   The work  of  the
Lunacy Commission is  at present performed by three  un-
paid and  six  professional and paid  commissioners and  a
secretary.  The  latter is assisted by a large staff of  perma-
nent clerks.   The paid commissioners, three of whom must
be physicians and three barristers, receive a salary of  £1,500
each, and the secretary is paid  £800  a  year.   Appointed
by  the Lord Chancellor for Chancery cases are two Masters
(or  judges) in  Lunacy, who are salaried at £2,000 each  per
annum.  There  are also appointed by the Lord Chancellor
three special Visitors receiving each £ 1,500 per annum. They
visit about 1,000 Chancery lunatics, of whom one third are in
private dwellings and the rest in  asylums.  The annual ex-
penditures in connection with the Lunacy Commission  and
the Chancery and Registrar's department  for lunatics exceed
$200,000.  This is exclusive of the cost of visitation by the
inspectors of the Local  Government Board, who supervise
workhouses and outdoor paupers, and are salaried at from
£600 to £1,000 each.  It is also exclusive of the  cost of
visitations by local authorities.
  The number and  distribution of lunatics in England  and
Wales on the  1st  of January, 1887,  according  to  statistics
collected  by the Lunacy Board, are  shown in the table on
the following page.1
  The figures given do not  include " 249 lunatics so found
by  inquisition, living in the immediate charge of their com-
mittees, and 69 male prisoners who have become insane while
undergoing sentences of penal servitude and who  are de-
           1 For later statistical table see Appendix, p. 365. 
                 GOVERNMENT GRANT.               39

tained in  convict  prisons."  Since 1884, criminal  lunatics
have  been provided  for by moneys appropriated by Parlia-
ment.
Where Maintained on	Private.			Pauper.			Criminal.			
January i, 1887.	M. 1 F.		T.	M. 1 F.		T.	M.	F.	T.	Total.
In County and Bor-				|		|				
ough Asylums .	3681 425		793	21,587 26,357|47,944:				21	105	48,842
In Registered Hospi-										
tals .....	1,608,1,489		3.097	103	60	163				3,260
In Licensed Houses:	1									
Metropolitan	S6l	737	1,648	287	507	794				2,442
Provincial.	691	847	r.538	152	200	352	5		5	1,895
In Naval and Mili-										
tary Hospitals and										
Royal India Asy-										
	259	20	279							279
In Criminal Lunatic										
Asylum (Broad-										
							392	139	531	531
In Workhouses :										
Ordinary Work-										
houses. . .				5,217	6,765	11,982				11,982
Metrop 0 1 i t a n										
District Asylums				2,501	2,898	5,399				5,399
Private Single Pa-										
tients ....	186	266	452							452
Outdoor Pauper Lu-										
natics.				2,308	3,5oi 40,288	5,809 72,443				5,809
Total . .	3.973	3,834	7,807	32,155			481	160	641	80,891
   From this table, it will be seen that there were 11,982
lunatics in " ordinary workhouses." As these include a very
large number of the idiot class, the  number of  insane who
are debarred from asylum care is not so large as at first ap-
pears.  In 1874 the State took a  memorable step in grant-
ing four shillings a week towards the  maintenance of  every
pauper  lunatic placed under asylum  care.   This grant, de-
signed to improve the treatment of the  insane, does not in
England or Ireland  extend outside of  asylums.  In Scotland,
however, it is applied to the insane  departments of poor-
houses,  provided the accommodation is approved by the
Scotch Board of Lunacy.  The effect  of the grant has been
to draw into  asylums many chronic cases that were  for- 
40                     ENGLAND.
merly  restricted to the inferior accommodations of  work-
houses.
  What are termed in the foregoing table " private  single
patients " include lunatics of almost every class except desti-
tute paupers.   They are  kept not  only by persons  of the
medical  profession,  but by  others; in  a  number of cases
by  women, some  of whom have  acquired  in  asylums or
elsewhere a knowledge of mental disease.  The price paid
for maintenance and care varies from a pound a  week up to
several hundred  pounds  a  year,  according to  accommo-
dation, medical and other attendance.
  The " outdoor pauper lunatics," numbering 5,809, are those
who are harmless and do not  require treatment in an asylum,
hospital, or licensed house ; and instead  of being sent to the
workhouse are left  under the care of relatives or friends and
receive a certain  allowance from the poor-law guardians for
their maintenance.
  The relation which outdoor pauper lunatics  hold to the
Lunacy  Board is  thus  explained  by Secretary Perceval:
" Pauper lunatics in  private dwellings are, as a  rule, left to
the visitation  of the district medical officer.  This official
and the relieving officer are supposed to be the supervisors
of those patients, and the medical  officer is bound to visit
them  once a  quarter.   He  has a fee of half a crown for
doing  so, and  he reports through the clerks of unions to the
guardians, and to the Commissioners in Lunacy, the names
of all the outdoor lunatic paupers visited by him during the
quarter.  Those lists come up and  are  examined at the
Commissioners'  office, and inquiries  are very  frequently
directed when it appears from the medical man's report that
the condition of the patient is unsatisfactory.  The  medical
officer is obliged to put a certificate  at the bottom of his
return to the  effect that  he has seen and examined all the 
METROPOLITAN  CHRONIC INSANE.
41
above-named patients."  The commissioners have no direct
control over pauper patients boarded out;  they  can only
advise respecting their proper disposal and care.
  It will be seen by the table that 5,399 lunatics are in the
" Metropolitan District Asylums," of which there are three,
namely, Caterham, Leavesden, and Darenth.  The first two
are  exclusively for  the  chronic  insane, and at the  last
are  schools for idiot  children.  These asylums  are under
the control of the Metropolitan Asylums Board, which con-
sists of rate-paying managers, not more than  one third of
whom are appointed by the Local Government Board. The
remainder  are elected by the guardians  of  the poor in the
metropolis.   The Metropolitan   Board  was  designed  to
bring  about a better classification of the dependent classes
by removing  the insane from overcrowded and ill-adapted
workhouses  to  specially constructed  institutions in the
country, with  farms adjoining, and with  medical and other
supervision suited to  their requirements.   This  consolida-
tion of authorities into one central  board has furnished a
striking illustration of the power of combination ; for by this
means  has  been  accomplished,  in  regard to the  chronic
insane of London, a great and humane work, which could
never have been performed singly  by any of the local bodies
now represented on the Board.
   The  three  "Metropolitan District Asylums" are tech-
nically regarded  as workhouses within the  meaning of the
Act  of Parliament,  and  receive  only incurable  cases, or
those not dangerous  to themselves or others.  Like ordi-
nary workhouses, they come more  under the control of
the  Local  Government  Board   (formerly the Poor Law
Board) than  under  the  Commissioners in Lunacy.  The
latter may  make recommendations, but  the Local Govern-
ment Board directs,  in  such establishments. 
42                     ENGLAND.
  By  an act passed in  1862, the  committees  of visitors
having the charge of county and borough asylums, and the
boards of guardians of workhouses, with the consent of  the
Lunacy Commissioners and  the President of the Poor Law
Board, were empowered  to  arrange  for the reception into
workhouses of a limited  number of chronic lunatics.  This
power was intended to meet the  wants of localities where
there  was not sufficient asylum accommodation for " recent
and curable cases,"  and where the workhouse could be certi-
fied to have the requisite accommodation for chronic cases ;
such  accommodation to include a liberal dietary, ample
means of outdoor exercise, medical visitation, paid assistants
and proper nurses.
  A further measure, passed in 1868 with similar intent, pro-
vided that any chronic lunatic transferred from an asylum to
a workhouse should continue a patient on the books of  the
asylum " for and in  respect of all the provisions in the  Lu-
nacy  Acts, so far as they  relate to lunatics removed to
asylums."  But, according to Mr.  Henley, one of the  Local
Government  Board's  inspectors,  this attempt  to  relieve
overcrowded asylums has proved a failure, for the following,
among other reasons :   A patient under  this law, though
transferred to a workhouse, would remain an asylum patient
subject  to  visitation by the  asylum superintendent, who
might give orders,  and  thus introduce a sort of dual man-
agement within the workhouse, imperilling both  harmony
and  efficiency.  The parties  concerned  in the  new  ar-
rangement  embraced four  different and  overlapping  au-
thorities ; viz., the  Commissioners in Lunacy, the  Local
Government Board, the  Board of  Guardians, and the Com-
mittee of Visitors.  The commissioners very properly in-
sisted on standard  requirements  for the  insane,  and  the
presence of so many different elements  led to the  practical
abandonment of the measure. 
                COST OF MAINTENANCE.              43

  The law  prohibits the retention in workhouses of any
pauper lunatic who is dangerous or who requires restraint.
The  Local  Government  Board,  as the  leading central
authority of the State in poor-law matters, is the  supreme
authority in the government of  workhouses.  The  Commis-
sioners in Lunacy, in the exercise of their powers of visita-
tion, may, however, order any lunatic to be received into any
borough or county asylum, or into any registered hospital or
licensed  house, if  it appears to  them  that the case is  not  a
proper one for the workhouse.  The appeal of the guardians
against  such order, if made at all, must be made to the
Home Secretary.   Reports of all workhouse visitations, giv-
ing details of the  condition of the  inmates, their dietary,
general  treatment, etc., are submitted  to the Local  Gov-
ernment  Board,  the Lunacy Commissioners making any
recommendations they see fit.
   It will be seen  from  the  foregoing table that sixty per
cent of all the lunatics of England and Wales under cogni-
zance of the Lunacy Board are  provided  for  in county and
borough  asylums,  the average  weekly per-capita cost of
maintenance  in which,  during the year  1886, was as fol-
lows :
                                          s.1    d.
       County Asylums       .    .         .8    7^
       Borough Asylums      .    .     .    .9    i\
  These  averages include provisions, medicines, clothing,
salaries and  wages, furniture and bedding, and household
requisites; and in some of the borough asylums are also in-
cluded ordinary repairs of buildings, which is the principal
reason of the higher average cost in these institutions.
  The average annual increase among pauper lunatics during
the past twenty  years has  been  1,476, the increase being
  JOne shilling sterling is equivalent to about 24  cents in United  States
currency. 
44                      ENGLAND.
greater than  the proportionate increase  in  the  population.
It is to be  noted, however, that  this increase cannot be at-
tributed  to a greater  proportion of paupers; for statistics
show that  on the  1st of January, 1867,  of  the  population,
4.44 per cent were paupers, and on the 1st of January, 1887,
only 2.91 per cent  were paupers.  In  the opinion of some
authorities, this increase  in the number of pauper lunatics is
not so much  due to an increase of fresh insanity as to the
annual accumulation  of patients under treatment  which
favors longevity.
  The subjoined statistics, from official  returns, serve to
illustrate the proportion  of lunatics and  paupers to the
population in the years 1867 and  1887.
Year.	Lunatics of All Classes.	Pauper Lunatics.	Paupers.1 (Sane and In-sane.)	Population.
1867..... 1887.....	49,0861 43,031 80,891! 72,443		963,200 822,215	21,677,525 28,247,151
   It will be seen from the above figures that, of the lunatics,
there was  I  to every 441  of the population in 1867, and
1  to every 349 in  1887 ; and of the pauper  lunatics there
was 1 to 504 of the population in  1867, and 1 to 389 in 1887.
   Having sketched the salient points of the English lunacy
system, and shown the classification  and distribution of the
insane, also the cost of their maintenance, descriptions  of
some of the English  asylums will now be  given, attention
being directed, with one exception—the York Retreat—to
those designed for the  pauper and indigent class.  The at-
tempt has not been made to describe fully these institutions,
but simply to delineate such features as would indicate their
general character.
  1 The English  statute defines the term "pauper " to mean a person " main-
tained wholly or in part by, or chargeable to any union, parish,  county, or
borough." 
COLNE Y HA TCH.
45
                COLNEY  HATCH ASYLUM.
  This is one of three pauper asylums under the control of
the justices  of  Middlesex—a county having, according to
the last  census,  2,929,678 inhabitants and 80,109 paupers
in a total area of  181,317 acres.  In proportion to size, this
county has not only the largest population, but it is also the
wealthiest portion of the  United Kingdom, yielding a poor-
rate of upwards of eleven  million dollars per annum.   In its
pauper population there  is a larger  percentage of lunatics
than  in  any other county—one in seven of  its rate-aided
poor being insane.
   The asylum  is  situated about six and a half miles  north
of the city of London, and it partially meets the wants of
that part of the metropolis lying north of the Thames.  The
building is a large, inexpensive structure of brick, with slate
roof and stone mouldings, having a main  or central division
of two and a half stories, and wings  of two stories each to
right and left.  From the porter's  lodge  at the outer gate,
the approach is along a gravelled path leading through pleas-
ant grounds.  The estate comprises 160 acres, including lawns,
meadows, and gardens. The encircling walls are hidden by
evergreens.   The asylum  was built in 1851, and is designed
for acute and, presumably, curable cases, including the sui-
cidal and dangerous.   It accommodates upwards of 900 men
and 1,300 women.
  The Committee of Visitors who  manage the asylum con-
sists of eighteen members.  The administration of this insti-
tution is somewhat anomalous, there being one superintend-
ent over the men's and another over the women's  depart-
ment, thus constituting two entirely separate heads.   The
respective administrative  quarters  of these two heads are
situated nearly at the  extreme ends of the extensive range
of buildings. 
46                     ENGLAND.
  Entering the portal on the men's side, the visitor finds his
attention  drawn to a tablet recording the humane  act  of
a popular sovereign in these words : " Her Most Gracious
Majesty Queen Victoria (whom God preserve) was pleased,
in her charity, on the 8th of May, 1849, to found the Victo-
ria  Fund  for the benefit of poor patients leaving this asy-
lum."  The scrupulously clean hall, and stone stairs scoured
with white sand, next attract  attention.   The  interior walls
are not plastered, but thickly coated with  paint of a pleasing
tint;  those of the corridors and wards are finished in two
colors, the dado being darker than the upper portion, which
is relieved by an ornamental border near the ceiling.   The
various sections of the buildings are connected by long cor-
ridors.
  There are 267 single sleeping-rooms.  About 600 patients
sleep in associated dormitories greatly varying in size.  Most
of the bedsteads are of iron pipe and  supported on castors.
Each is furnished with a hair mattress, and there is a plenti-
ful  supply of blankets.   Many have canvas bottoms, which,
by  means of  screws and loops, can be  tightened, or readily
taken off  for cleaning.  On the walls were pictures  and ap-
propriate  mottoes, while on the floors strips of bright carpet
gave a look of comfort to the apartments.   In some of the
dormitories for the more quiet class were  large mirrors.
  One of  the long  sitting-rooms may be  described as  repre-
sentative  of the others.  It  had tinted  walls ornamented
with numerous pictures, and contained cushioned seats, arm-
chairs, and lounges.   On the window-sills  were flowering
plants ; ingeniously arranged aviaries were  also noted, the
birds in which enlivened the room with song, and, at the
same time, amused the patients.  It  being a wintry day,
with  frost and snow, the inmates seemed greatly to  enjoy
the cheerful  open fires, round which many  were comforta- 
COLNE Y HA TCH.
47
bly seated.   Bagatelle  boards, chess, draughts,  and  other
amusements further diverted attention from the dreariness
without.  The smaller sitting-rooms for the quiet and con-
valescent class in what is  termed the day portion  of the
ward were better furnished  than the others.  Here were ob-
served easy lounges, pianos, billiard-tables,  books on centre
tables, carpeted floors, frosted globes to the gas-jets, and a
profusion of  ornamental articles.  The women's  side cor-
responds to the men's  in its  general characteristics,  except
that the number of single rooms is much less.
   The inmates being of the pauper class, they are under a
uniform system  of care and treatment.  In the  opinion  of
those in charge, the  insane, when  given  an opportunity,
effect their own classification, selecting their  associates  by
a  sort  of natural affinity.  The  violent  and suicidal are
under constant  supervision, and  are  kept separate from
others.  Patients are  often quieted by removal from one
ward to  another, the change  of surroundings having  a
pacifying effect.   In the epileptic ward, the bedsteads are
very low, being  only about five inches from the floor, and
have canvas bottoms.
   The women's  infirmary, to which  is attached  a separate
dietary kitchen,  is furnished with every requisite comfort,
including rubber mattresses  that may be filled  with either
air or water for  special cases, invalid chairs, and cushioned
couches on wheels.   The walls of the infirmary  were deco-
rated with  pictures  and flowers.   On the  floor  were rugs
and strips of carpet, and the windows were hung with scar-
let curtains.
   There are three dining-halls for women.  Knives with only
about an inch of cutting edge and common forks are used
at  table, as also ordinary white plates and mugs.  At the
time  of my visit, only about thirty-five per  cent of the men 
48                     ENGLAND.
were employed.  The  weather being unfavorable for out-
door work, a  smaller  number than  usual  were  occupied
about the grounds.   Forty-four per cent of the women were
employed.  A  majority of these were  engaged at needle-
work and in the laundry.  All mending for the institution is
done on the premises, as well as the making of dresses,—
plain, useful sewing being preferred to fancy-work.  For
the excitable, washing by hand is thought the most suitable
form of employment.   Some of the washing,  however, is
done by machinery.  The commodious and well-arranged
laundry, with dining, sleeping, day, and kitchen accommoda-
tions, is, in one sense, a separate department of the institution.
It is under the charge of a superintendent and sixteen paid
servants.  The appliances here  are complete and modern.
In separate rooms the clothes are folded and ironed.  The
laundry is supplied  with several   steam-driven  mangles,
steam-rotary washing-machines, and wringers.  Clothes were
drying in the  adjoining yard.   Many of  the women were
engaged about the wards ;  a few were helping in the kitchen ;
and a  small  force  were picking the filling  of mattresses,
which is taken out and renovated when necessary.
  There is a large  recreation or amusement hall  provided
with piano, orchestra gallery, and stage  for dramatic imper-
sonations,  where  musical and dancing  parties are held.
The evening  entertainments often  bring together  assem-
blages of from five hundred to six hundred patients.
  The  airing-courts, of which there are  several, are large
spaces, with patches of green lawn, shade trees, shrubbery,
flower-beds, and rustic summer-houses,—the whole enclosed
by  a sunken wall  or  haw-haw, thus permitting an  unob-
structed view beyond the  grounds.
  It was stated that restraint is rarely resorted to, and then
only in cases of great destruction of clothing and for surgic- 
COLNEY HATCH.
49
al reasons.   Patients  are commonly secluded in padded
rooms during paroxysms.  Of these rooms, there are eleven
on the men's  and eight on the women's side.  The padded
rooms are each lighted  by barred windows placed high in
the wall, and  are lined to a height of eight feet with strong
canvas stuffed to a thickness of several  inches with cocoa
fibre.  The floor is covered with a thick mattress of canvas
similarly  stuffed.   It was asserted that,  for women, there
were no appliances for mechanical restraint.
   The attendants average one to eleven patients.   The men
are uniformly dressed in blue serge.  Each wears a leathern
belt, to which is attached a bunch of keys, imparting some-
thing of  a  prison-official character to the wearer.  The
women wear drab gowns, white aprons and caps, and  belts
to which  are likewise attached bunches of keys.
   The rooms are warmed generally by open fires, in front
of which  are  strong screens.  This form of heating is sup-
plemented in severe weather by hot-water  pipes.  The coal-
bins  in the women's ward  are  filled from  the  corridors
through  traps, thus avoiding intrusion.
   Under  the windows,  as well as near  the  ceiling, slides
were observed for the purpose of ventilation.   The windows
generally  have iron sashes, with panes 5x6 inches.   Larger
panes are, however, gradually superseding  the smaller ones.
The upper  sashes of the windows are made to  open out-
ward.  One chimney about two hundred  feet high suffices
for the domestic part  of the institution,  including kitchen
and laundry, smaller flues leading thereto from the various
open fires.
   An attractive feature  is a spacious chapel, in which the
resident chaplain of  the Church of  England officiates.  Ro-
man Catholic and Jewish services are also  conducted once a
month—sometimes  oftener. 
5o
ENGLAND.
  The weekly per-capita cost of maintenance here during the
year ending January i,  1887, is reported as gs. ^\d.
  The general impression left upon the mind of the writer
by the visit was, that the size of the institution is incompati-
ble with its curative aims, and its management not in entire
keeping with its object.

                   HANWELL ASYLUM.
  This asylum is famous as having been the place in which,
under public auspices, Dr. Conolly, nearly half a century ago,
demonstrated the practicability of the non-restraint principle
in treating the insane.   In visiting an institution which had
thus become historic, one is actuated by a  strong desire to
know how that great  reform has  stood the test  of  time.
This asylum and Colney Hatch  receive the  violent, trouble-
some, and dangerous cases of the various unions or parishes
attached to the populous metropolitan county of Middlesex.
At  Hanwell   these constitute  about 40 per  cent  of  the
inmates.  Chronic and  harmless cases, as a  rule, are sent to
Banstead.
  The building at Hanwell is  situated some seven  miles
northwestwardly from  the city  of  London.  It is  a  plain
brick structure with slate roof, erected  in  1830, and  origi-
nally designed for from 300 to  400 patients, but since  en-
larged to accommodate  1,800 or  1,900.  Connected with the
institution are 100 acres of land  bordering the  river Brent,
and bounded on the other three sides by a brick wall.  Eighty
acres are under cultivation.
  In administration, this  asylum presents the same incon-
gruity as Colney Hatch, there being two resident medical
superintendents.
  The patients, at the time of my visit, numbered 750 men
and  1,100 women, classified according to their habits  and 
HANWELL.
51
peculiarities.  The more noisy occupied  detached  wards.
The epileptics were in divisions by themselves.  At night
they are closely watched by special attendants, whose move-
ments are marked by means of electric  clocks  that  are  af-
fected by every opening of the door.  The bedsteads for
epileptics are low and have canvas bottoms.   A detached
building is used as a hospital for infectious diseases.  Patients
occupying padded cells are  required to be visited at regular
intervals during the night.   There are on duty at night six
male and twelve female attendants.   Throughout the insti-
tution the attendants average one to every twelve patients.
They  wear a uniform, that  of  the female nurses being dark
dresses and white caps.   The  patients are variously attired.
   Open  fires are used in the  day-rooms as well as the cor-
ridors.   Those  in the day-rooms for quiet patients are pro-
tected by ordinary fenders,  and those in the wards for the
refractory by iron guards.  A complex system of ventilation
at  one time in use has been finally set aside, open fires with
direct ventilation  from the windows, and perforations in the
walls,  being how relied upon, and the results are more satis-
factory.   Thermometers are  hung in  the day-rooms and
corridors, and a record is made of the temperature night and
morning.  In the dormitories, the  rule is " fresh  air and
plenty of blankets."
   On the male and female sides, 30  per  cent of  the patients
were provided with single rooms, which was not deemed in
excess of requirements for a class of  patients many of whom
are restless by night.  Dormitories on the upper floor should,
in Dr. Rayner's opinion, have protected windows;  but for
those on the ground-floor, where the patients are under con-
stant supervision, he preferred  the ordinary kind.
  The interior walls are frescoed and  appropriately deco-
rated—the work of  the  patients.  On the men's side the 
52
ENGLAND.
furniture  appeared  abundant  and  comfortable,  including
lounges, easy-chairs, and pianos.  Pictures on the walls, and
a variety of decorative objects were observed in the day and
other rooms.   In some of the apartments the windows had
handsome curtains.   On the women's  side  the  furnishing
was more  elaborate.  In one of the day-rooms was noticed
a jackdaw, a  pet of  the female inmates, which had  been a
long time on  the  premises.  Many inexpensive yet pleasing
articles  for  adorning the  room  had been  made by the
patients.
  The dining-tables are furnished with table-cloths, ordinary
plates, knives, forks, and spoons.  Comfortable  chairs are
provided.   In the wards for the excitable cases,  the blades
of the knives  have only about an  inch of cutting edge. One
general kitchen supplies the whole establishment.  The tea
is infused, not boiled.  A bag of tea having been put into a
twenty-gallon copper can, boiling water is then turned on;
after infusing ten minutes, milk and sugar are added, and in
five minutes thereafter the tea is  served.  The rule is twen-
ty-three ounces of tea to twenty gallons of water.  This
method of making tea, as may be  inferred, is not given be-
cause it is thought to have special value as a recipe.
  It is the aim of  the management to engage every  patient
in some  kind of  useful  employment.   Patients  are  first
placed under observation and  tested at an  occupation re-
quiring muscular exertion. In cases where there  is any doubt
about a patient, employment is prescribed requiring  muscu-
lar force without the agency of  tools capable  of inflicting
injury.  Working parties are examined  by a physician each
morning  before they go out to work.  The following  is an
official statement of the nature of the employments within
the institution: " Seventy-seven  per  cent of the men and
sixty-six per  cent of the women  are doing some kind of 
HANWELL.
53
work.  In outdoor labor 280 men are engaged, of whom 183
work with  implements, and 97, who are less trustworthy,
without tools.   Employed  in  shops and at trades are  153.
Of  the women, 80 assist in the laundry ;  12 help in the
kitchen;   224 are  employed  at  needle and fancy work;
while 392 are set apart for domestic work in  the female
wards."  It is  the opinion  of Dr. Rayner  that  patients
spending much of their time in the open air are less inclined
to be suicidal.   The theory of treatment here was summed
up as follows: " The  patient should be  well employed  and
allowed plenty of outdoor exercise."  "This," said the Su-
perintendent, " is the great  secret of successful treatment  in
the care of the insane."
  Respecting mechanical restraint, Dr. Rayner made the
statement  that, in the treatment of the insane, he had never
resorted  to mechanical restraint except  by the use of gloves,
and that he used these only in exceptional cases, such as pre-
venting a patient from tearing open a wound.  Neither did he
use any chemical restraint, which, in his opinion, was worse
than mechanical.  During the previous twelve  months, he
thought there had  been prescribed in  this institution only
twenty-four sleeping  draughts.  He considered them " ut-
terly pernicious." Strong, untearable dresses are used when
deemed necessary,  and are  so made as not to  restrain the
limbs.  There are sixteen padded rooms on the men's side,
and about a score on the women's; and in these the floors,
as well as the sides, are cushioned.   All of these apartments
may  be  readily darkened,  the   Superintendent believing
darkness to be desirable for extremely violent patients.  An
attendant is not allowed to attempt to handle a violent pa-
tient until  he can secure the help of a  posse of assistants;
and the rules are rigid as to attendants reporting each in-
stance of  resistance.   When a  case of this  nature is an- 
54                     ENGLAND.

nounced, a body of attendants are immediately sent to the
spot,  and the patient  usually succumbs to the inevitable.
Sometimes, the expedient is resorted to of removing an ex-
cited  patient to another part of the house.  If the case be
decidedly maniacal, the patient is placed in a special apart-
ment  in charge of attendants. In the space of twelve months,
seclusion had been resorted to among the men on  not more
than eight occasions, giving a total of  twenty-three hours;
and among the women ten times, giving a total of twenty-
nine hours.
  The well-kept airing-courts are quite large.  Several of them
have  about  four acres of  ground each;  in  fact,  these
spaces are of such  extent as somewhat to remove the im-
pression of restricted boundaries,  especially as the  walls and
iron fences are ingeniously hidden by trees and shrubbery.
It was a wintry day on which my visit was made, and it was
noted with satisfaction that the men in the yards were  com-
fortably clad, their  clothing including thick woollen capes,
or short cloaks, that came well down over the shoulders and
amply protected the neck, chest, and arms.
  There is a large  amusement hall, in which the patients
hold dancing parties every Monday evening.  In the  sum-
mer, lawn tennis,  skittles, quoits, croquet, and other outdoor
games are freely indulged in.  The quoits are made of rope.
A high wall built around three sides of a square is provided
for  a  favorite hand-ball game.   Picnic parties in summer
are  also frequent.  With pianos,  games, books, and papers,
ample provision seemed to have  been made for  the enter-
tainment of the patients. Sunday services  are regularly held,
and there is morning and evening worship during  the week.
  The average weekly  cost of maintenance here during the
year ending January i, 1887, is given as gs. <\\d. per capita.
Patients from other counties are charged at the rate of 14s. 
HANWELL.
55
  The visit, as already indicated, was one of much interest,
owing to the historical prominence of the place.   Consider-
ing the large number of violent and dangerous insane here
congregated  and the lack of space in some of the depart-
ments, it was gratifying to note the comparative quiet and
order  prevailing throughout the institution.  Much of  this
good  result must  be ascribed to  the large percentage
of patients engaged in  industrial  employments.  In the
course of this  inspection, permission was granted to visit
the wards containing the most disturbed cases ; and through-
out an extended examination no unusual disturbance  met
the  eye or ear in either wards  or airing-courts.  Several
patients were seen  in the refractory wards pacing briskly
to and fro, also  about the grounds without; but no instance
of struggling with attendants and no application of mechani-
cal restraint came under my observation.  There was  con-
clusive evidence that the methods of handling the turbulent
elements of which the asylum is made up are founded upon
humane principles, and that these conduce in a remarkable
degree to good  order, cleanliness, and general contentment.
Nevertheless, it appeared  to  me  that, from  overfulness,
restricted airing-courts and grounds, and  the presence  of
numbers too great for close individual inspection, the asy-
lum could  not  reach those  curative results which the en-
lightened principles  governing it would seem to warrant.
              BANSTEAD LUNATIC  ASYLUM.

  This institution, erected at a cost of .£320,000, was opened
in 1877.  It is  structurally  designed for the reception  of
chronic cases, and, like the  asylums of  Colney Hatch and
Hanwell, is directed  by a Committee of Visitors  appointed
by the justices of Middlesex.  It is located in the county of
Surrey, having been established under the powers of the Act 
56
ENGLAND.
of 1853 already referred to as enabling one county to pur-
chase lands and erect and manage institutions  in another
county.
  The Banstead Asylum occupies a bleak and elevated site
on the Surrey Downs, fourteen miles south of London.   In
connection with the institution are  only  118 acres of land,
with less than 100 acres under cultivation.
  The asylum  is built  of  buff brick, architecturally  embel-
lished with bricks of a darker color.   Its general plan is like
that of Leavesden and Caterham, there being oblong blocks
extending rearward in two  parallel ranges  from either  side of
a central administration building.  The blocks are connected
by one-story brick corridors.   The range on the right as one
enters the building is  for men and the  opposite one for
women.
   Most of the  window-sashes are  of  iron, the  panes meas-
uring 5^- x 11 inches, with  iron bars outside, corresponding
to those of the sash.   The asylum was erected to accommo-
date 1,700 patients; but, notwithstanding the small acreage
of land,  additions  have been made to admit of 300 more
of the insane.
  The resident Medical Superintendent  is assisted by four
medical  officers, also resident. Among  the other salaried
officials are a clerk to the Committee of  Visitors of the asy-
lum, a resident steward and a chaplain, a resident engineer,
and a lady organist.  The  number of attendants in some of
the wards is in the  proportion of one to  twenty patients;
the average proportion throughout the asylum is one to fif-
teen patients.   There was  an unusual  degree of disturbance,
possibly owing to the pressure on accommodation.  The
small  airing-courts were so full of patients as to prevent
healthful recreation.
   Despite the  fact that the building was designed only  for 
BANSTEAD.
57
the chronic  class,  many forms of acute insanity  were in-
cluded  in  the  cases  received.   Little  restraint was  used
except  for surgical  reasons.   Locked  gloves  with  free
thumbs were in  use, and  women were  loosely fastened in
chairs by towels.   The strong dresses worn by  some  were
artfully disguised by fabrics of a bright color ;  and the ordi-
nary clothing, which seemed comfortable, was also selected
with a view to  the  avoidance of dull or sombre hues.
   A large day-room of one  of  the  female wards was  over-
crowded, the patients were very restless, and presented any
thing but an agreeable spectacle.   Some were crouching or
lying on the floor ;  others, with dishevelled hair, were rushing
wildly to and fro.
   In the epileptic ward low bedsteads are provided  with
canvas bottoms, and  the patients are  under  night super-
vision.  Telegraphic communication  connects the office of
 the head physician with every department.   Electric tell-tale
 clocks  check the movements of  the  night attendants, and
 electric fire-bells are provided and arranged so as  to alarm,
 in case of any outbreak, the fire-brigade,  which consists of
 two experienced firemen  assisted by attendants.   The food
 is prepared in  a general kitchen, and conveyed  to the several
 blocks.   The water supply is obtained from a well sunk to
 a depth of 300  feet; its capacity being 60,000 gallons per day.
 The water is hard, and the process of rendering it suitable
 for asylum use is expensive.  The  percentage of inmates use-
 fully employed  here was quite small.  The male patients
 worked chiefly on  the farm and in the  garden ;  a  few were
 occupied at upholstery and other trades,  and as helpers in
the various wards.  The women were  engaged principally at
needlework, ward-cleaning, and in the laundry.
   Amusements  and means  of entertainment  are  not neg-
lected.   A library is provided, out of which  there were in 
58                     ENGLAND.

circulation among the patients,  at  the  time of my visit,
about 600 volumes.   Dramatic entertainments are not un-
frequently held, and it was stated that in pleasant weather
there are occasional picnic excursions.  A band, composed
of  asylum attendants, furnishes music  for  the  weekly
dances and other amusements.  About 450 patients attend
divine service in the chapel.
  The average weekly per-capita cost of maintenance during
the year ending January 1, 1887, was gs. ^\d.
  In this  large and modern  asylum there appeared to be a
straining  after  economy, a  sacrifice  of  essentials, and  a
feeling of  discomfort  and confinement among the  inmates.
The writer was  surprised to find a comparatively new asylum
for  the chronic  insane, who require a large acreage for out-
door employment, built  upon  so small  a tract  of land;
and more surprised to see such an institution assuming the
functions of a hospital for the cure of acute insanity.

LEAVESDEN METROPOLITAN  ASYLUM FOR THE  CHRONIC
                         INSANE.

  This asylum, opened in  1870, is situated in Hertfordshire,
some seventeen miles northwest of London, on a  farm of
eighty-four acres.  It  was  built to  accommodate   1,638
patients, and was subsequently  enlarged to receive 2,000.
The original outlay on lands, buildings, fittings,  and the
necessary  furniture for  its several departments was at the
rate of  about $430 per bed.  Leavesden is  one  of  three
institutions for  harmless pauper lunatics of the metropolitan
asylum  district.   It  is directed  by a committee of  the
Metropolitan Asylums Board, and is visited by the  Commis-
sioners in  Lunacy.  Although in reality an  asylum, it is, as
already  stated,  a  workhouse within   the meaning of the
statute,  and comes immediately under the  supervision of the 
LEA VESDEN.
59
Local Government Board, with whom  rests the framing of
its rules and regulations.
  The number  of inmates January i, 1887, was  885 men
and  1,100 women, being an increase of  five over the number
here at the time of my visit, when the staff and employees
were as  follows: a medical superintendent with two assist-
ants, chaplain, steward, engineer, clerk and matron, steward's
clerk, assistant clerk, assistant matron,  head laundress, work
mistress, two  male head attendants, six  first-class married
attendants with their wives, three first-class ordinary attend-
ants, first-class night attendant, four second-class  night  at-
tendants, eighteen  second-class  ordinary attendants, two
female head attendants, nine first-class ordinary female  at-
tendants, twenty-six second-class ordinary female  attend-
ants, three first-class female night attendants,  four  second-
class female  night  attendants, hall porter, two  first-class
laundry-maids,  seven  second-class  laundry-maids,  cook,
mess-woman, baker, assistant  baker, mess-man,  gate porter,
three store porters, two scullery  men,  two outdoor attend-
ants, coal-carrier, two laundry-men, stoker, earth-closet man,
two gas-men, two tailors, assistant tailor, three  shoemakers,
two upholsterers,  grave-digger,  cowman, assistant  cowman,
three gardeners, two carmen,  four farm laborers, foreman of
works, working  engineer, smith, carpenter, painter, ordinary
laborer, and plumber.
  The asylum  is  built of buff  and red brick.   Ivy on  the
walls adds to the diversity of color and outline, its effect
on  the chapel  being especially pleasing.   The  visitor  is
favorably impressed as he approaches the institution, by the
grounds, laid out in  lawns and  beautified by shrubbery and
flower-beds; while the plant-houses and conservatories sug-
gest thoughts  of summer  even in the coldest and most
dismal weather.  Most of the corridors connect with these 
6o
ENGLAND.
conservatories.   Each  of  the  blocks accommodates 160
patients, the ground-floor being for day use and the upper
one for dormitories.   They are warmed  and ventilated by
open fires, supplemented when necessary by the use of hot-
water coils.
  The general plan of the sleeping apartments is that of the
associated dormitory.   There are  but twenty-eight single
rooms  on the male and  twenty-four on the female side,
the larger proportion being  in the infirmaries.   One of the
dormitories  examined  is  divided  into stalls  by means of
wooden partitions about four feet high.  Each stall contains
two beds, provided with comfortable mattresses and ample
covering.  During the day the bedding is so arranged and
exposed as to facilitate  airing and inspection.  Waterproof
sheeting, laid beneath the lower blanket, is used when neces-
sary.  The bedsteads are of iron, and in most cases have can-
vas bottoms.  The canvas is broadly hemmed, and  is so
adjusted to the bed-frame as to permit of its being tightened
by screws.
  Another dormitory was observed  to contain eighty beds
ranged in  four rows, each person being allowed not less than
400 cubic feet of air-space.  Lavatories and  closets adjoin
the dormitories.  For the epileptics, who numbered over 200
men and nearly 250 women, the beds are only six inches
above the floor.   This class are under close night and day
supervision,  which is checked by electric tell-tale clocks.
  A day-room on the ground-floor contained  comfortable
furniture,  including easy-chairs.  There were also  pictures,
baskets of flowers, and song-birds in attractive cages.  Five
open coal fires in  this large and cheerful apartment serve
both to warm the room and purify the atmosphere.
  In another of the day-rooms a broad belt of bright carpet
along the centre of the floor, and rugs in front of the fires 
LEA VESDEN.
6l
gave a comfortable look to the apartment;  while pictures on
the walls, plaster busts, statuary, and other ornaments height-
ened the pleasing effect.   In the windows were plants and
flowers in rare profusion.   Each of the day-rooms in the fe-
male ward is provided with a piano.  On the men's side the
day-rooms are likewise comfortably furnished and pleasingly
decorated.
  The interior walls  here, as in some other pauper asylums
in England, are not plastered,  but are  painted on the brick
and decorated with stencil-work.  The  upper portion of the
wall is generally covered with silicate, and the dado is painted
a darker shade.  This form of decoration extends to the cor-
ridors.
  Some of the windows have double sashes, with  panes each
16 x 21 inches.  The sashes can be raised and lowered a few
inches for  ventilation.  Most  of  the  windows  have iron
sashes with  panes 6^-x 18 inches.  They are so made as to
be opened six inches at the top.   In a block recently erected,
the windows have two sashes  provided with weights, and
there are outside iron bars.
  The bath-room  is  lined with glazed brick, and has a floor
of figured tile.  Adjoining is  a  comfortable dressing-room
with an open fire-place.  Some of the  baths are curtained,
affording greater privacy.   The arrangements for bathing are
quite elaborate.  The following is a list of the various baths :
cold spray, hot spray, cold wave, hot wave, cold douche, hot
douche, spinal douche, hot shower, cold shower, hot needle,
cold needle.  A  Turkish  bath is used  daily by either male
or female patients.  Dr. Case, the Superintendent,  attaches
considerable  importance to the hydropathic treatment, par-
ticularly  for excited patients and for those who do not sleep
well.
  Food is supplied to the whole  establishment from one 
62
ENGLAND.
general well-arranged kitchen.  Cleanliness  and order were
as conspicuous here as in the other departments of the insti-
tution.  The walls were tinted, the deal tables well scoured,
the tinware brightly  polished,  and  the crockery neatly ar-
ranged on  shelves.  Gas and steam  appliances are used for
cooking, and the food is conveyed  to the wards  on three-
wheeled trolleys.  On the day of my visit there were huge
meat pies for dinner, the top of each being encrusted with
the number of the ward for which it  was destined.   The oc-
cupants of the female infirmary ward  partook of a wholesome
and well-cooked  dinner at a central table,  amply  supplied
with table  furniture,  including  plates, mugs,  salt-cellars,
pepper-boxes, and knives with a cutting edge  of about two
inches.
  The  inmates were  variously  employed.   In the laundry
were seen fifty-five women at work under nine laundry-maids,
and fifteen  men  doing the  heavier  work under the super-
vision of two paid male attendants.  The vegetable garden is
extensive.   The supply of water is  obtained  from a deep
artesian well on the grounds, that yields 60,000 gallons per
day.  Sewage is utilized by distribution on the land.
  Among the means of restraint are leather  gloves.  Strong
dresses, laced down the back, are also used, and occasionally
feeble  patients are tied in chairs.  On both the male and
female sides there  are several  of what are termed  "half-
padded " rooms, and on each side one entirely padded.   It
was said  that excited  patients were sometimes placed  in
darkness  or treated  medicinally.  The violent insane  are
subject to night supervision.   There was no case of seclusion
or restraint within the institution at the time of my visit.
  The  recreation hall for females is  prettily decorated with
light fresco-work.  It  contained  several pieces of statuary
and  ornamental  vases.  In the  windows were flowers  in 
                      LEA VESDEN.                    63

hanging-baskets and song-birds in cages.  Four open fires
protected by screens dispelled the chill of  winter.  Among
the other noticeable articles of furnishing were a piano, com-
fortable chairs, and cushioned lounges.   This spacious apart-
ment, fitted up with a stage and other appointments, was used
as a workroom as well as an entertainment hall.   The weekly
dances here were  said to  be  attended by 120 men  and 140
women, while at the fortnightly special entertainments the
attendance was computed  at 200 men and 240 women.  The
annual  costume ball,  for which dresses are  made on the
premises, is  a source  of  much amusement;  also  the bur-
lesque and dramatic entertainments held from time to time.
In summer, cricket and other outdoor  games are indulged
in.  Walking parties go out in  favorable weather, under the
charge of attendants.   Within the eleven months preceding
my visit there had been  sixty-two walking parties  of men,
numbering twenty-five each, with two attendants, and fifty
parties of women, numbering fifty each, with four attend-
ants.   The  dress of the  patients was warm and sufficient.
Many of the women were seen wearing comfortable scarlet
woollen shawls.  Some of the men were observed in the air-
ing-court on a raw wintry morning wearing over their shoul-
ders deep, heavy  capes with  thick collars, and evidently
enjoying their usual exercise.  A few, as they  walked about,
were contentedly smoking their pipes.
   The chapel of the institution accommodates six  hundred
persons.   The services are generally attended by some four
hundred patients.   The men  and women  sit on opposite
sides of the building, and are about equally represented at
the meetings.  Besides daily  morning and  evening  prayers,
there is a special weekly service for epileptics.
  A library of entertaining literature, in charge of the chap-
lain, is used  by both patients  and attendants, and  is main- 
64                     ENGLAND.

tained by a small annual grant allowed by the committee of
management.  Some years the circulation reaches nearly or
quite 10,000 volumes.  Considering the  extensive  use of
the library, and  the destructive tendency of many of the
patients, it seemed remarkable  that  so few  of the  books
were  injured.   Among  other  evidences  of humane  and
considerate treatment was the  great  attention paid to the
clothing and personal cleanliness of the patients.
  The average weekly cost of maintenance for the half-year
ending September 26, 1887, was ys. $d. per capita.

CATERHAM  METROPOLITAN  ASYLUM  FOR THE  CHRONIC
                         INSANE.

  Like  Leavesden, this institution is exclusively a  recep-
tacle for pauper patients, designed to relieve ordinary asy-
lums of chronic  cases, and to provide better care than the
poorhouse affords.  It is managed by an unpaid committee
of the  Metropolitan Asylums  Board, and  comes  mainly
under  the  supervision  of the   Local  Government Board,
though subject  also to visitation  by  the  Commissioners in
Lunacy.
  The  institution is  pleasantly situated  in  the county of
Surrey, about fifteen miles south  of  London, upon an ele-
vated site commanding a  fine prospect of the surrounding
country.  Connected with it originally were but seventy-two
acres, and  it was found  necessary to purchase additional
land to meet the wants of the institution.
  The  asylum was opened in 1870.   Most of the buildings
have tile roofs, and are plain three-story structures of buff
and red brick.   The several sections are connected, as is fre-
quently the case in Great Britain,  by inclosed one-story cor-
ridors.   Each of the blocks contains about 160  patients,
except  the  infirmary, which  accommodates  not  more  than 
CA TERHAM.
65
ninety.   In accordance with modern ideas, additions made
to the asylum since it was first opened are on the two-story
plan,  the upper floor being reserved for dormitories and the
lower for day use.  The buildings  are constructed with a
hollow  space between  the  inner and  outer  bricks of the
walls.   The number of  single rooms is comparatively small.
The windows of  the  new  buildings have ordinary sashes
and long outside bars.  The sashes open a little way at
both  top and bottom,  and have panes measuring 12 x 18
inches.   In the  older  buildings the panes are 6£ inches
wide.   The  Superintendent,  Dr.  Elliot,  expressed  the
opinion  that iron-grated windows  are not  necessary for
the class  under his charge, and  that tile  roofs are not
desirable.
   At the  time  of my visit the patients  numbered  2,052,
of  whom  945 were  men and   1,107 women.  They were
of  the harmless class.   Notwithstanding their quiet charac-
ter, the number of attendants appeared to be  inadequate.
Relatives,  according  to their means, are  required to con-
tribute  towards  the maintenance  of patients.  There is,
however, but one standard  of  care.  The average weekly
per-capita cost of  maintenance during the  year 1887, inclu-
sive of provisions, clothing,  warming, cleansing, lighting,
salaries, furniture, repairs, and medicines, was 8^.
   In  the infirmary for women  were thirty patients.  The
windows had shades and draped curtains.   The walls were
tinted and  frescoed.  Pictures in considerable variety, bas-
kets of  ferns, bright flowers on the mantels, trailing plants,
and birds in cages contributed to the cheerfulness of the sur-
roundings.   A strip of carpet extended along the middle of
the floor, with lateral  strips between the  beds.  The bed-
steads had  adjustable canvas stretchers, as at Colney Hatch.
The mattresses were of horse-hair, and  were made in three 
66                     ENGLAND.

sections.  The bedding for each patient consisted of linen
sheets,  woollen blankets,  a coverlet, bolster,  and pillow.
The head-boards were covered with white muslin, on which
were Scriptural mottoes worked in  red letters by  the  pa-
tients.   Open fires, some with locked  screen-guards, shed a
happy  glow throughout the apartments.
  For  epileptic patients and others requiring  close atten-
tion the supervision is continuous through  the  twenty-four
hours of each  day.  Six attendants—three  men and three
women—are employed  nightly  for the  oversight  of this
class, which, at the time of my visit)  numbered about  500
patients.   No mechanical  restraint  was in use.   It was
stated that, during the preceding year, it had not been found
necessary to resort to seclusion, nor had any  form of restraint
been applied.  In  that  time, no serious accident  had  oc-
curred to any of  the asylum patients.  There are two pad-
ded rooms, one  on each  side  of the asylum.  These  are
rarely brought into  requisition.  Arm-chairs with  wooden
bars in front are used  for  helpless patients.  There are  no
restraining chairs, in the  ordinary sense of the term.
   The day apartments seemed  tidy and well furnished, al-
though  not so elaborately fitted up as the infirmary ;  yet
here also were observed  flowers  and many objects suggestive
 of home life.  Pianos  form a  feature of almost every day-
 room.   In the upper dormitories pictures were  noticed,  and
 flowers in the curtained  windows.  Four hundred cubic  feet
 of air-space is allotted  to each patient in the  associated
 dormitories, and seven  hundred cubic feet to each in the
 single rooms.  Hoods over the  central gas-jets are so  con-
 structed as to assist ventilation.   There are ventilating flues
 in the walls, and the four open  fires in each ward, or twelve
 to each building, greatly  aid in purifying the atmosphere.
 In  the recreation  hall  hot-water pipes are used.   Water is 
CA TERHAM.
67
obtained from an artesian well.  In addition to the ordinary
bathing arrangements, there is a Turkish bath, and, on the
men's  side, a swimming-bath measuring 20 x 30 feet.   The
food is prepared  in one general kitchen and carried to the
several wards.   The  inmates are employed to  the extent
of their ability—some at  very light tasks.
  The officials wore a uniform  of chocolate color, conspicu-
ous on which were the brass buttons belonging to the livery
of the asylum.   The women attendants wore dresses of a
dark color.  Every attendant wore a leathern belt to which
was  attached a  bundle of keys.  The patients were  vari-
ously  attired, the Superintendent disapproving  of uniform
dresses.   The women wore shawls  of  bright colors, in the
selection  of which the taste of each individual was gratified
as much  as possible.  The rule  is here adopted of substi-
tuting, upon admission, clothes furnished by the institution
for those belonging to the patient.   If the dress originally
worn is claimed by the committing guardian, it is returned ;
otherwise it is given to  the patient  on his discharge, or, in
the event of  death, disposed  of as the management may
direct.
  An  attractive programme of amusements is regularly car-
ried out.  A band of fourteen players drawn from the staff
of attendants contributes to the musical entertainment of
the  patients  at  stated   weekly gatherings.    The  large
amusement hall  presented quite a gala appearance,  being
decorated with flowers and flags  in  great variety.  The fit-
tings   comprised  a stage  and  other  appurtenances,  and,
altogether, the apartment  seemed well adapted  to secure
the purposes for which  it was designed.  Theatrical   per-
formances are frequently held.   Scarcely second in impor-
tance  as a means of entertainment is the trained singing-
class, which holds periodical meetings.  Patients of a literary 
68
ENGLAND.
 turn are  gratified by the use of a library under the charge
 of the chaplain, while  those interested in the current  news
 of the day may direct  their attention to the fourteen  daily
 newspapers placed regularly  on the tables  of  the  reading-
 room.  Various outdoor sports are indulged in, including
 cricket,  football,  and  bowling, for which the grounds are
 specially  adapted.   Indoor games are  also provided.  In
 summer great satisfaction  is derived from  walking parties
 organized under the charge of attendants.
   Chapel accommodation for about six hundred persons is
 provided  in a tasteful building having suitable interior deco-
 rations.   The chaplain holds daily  morning  and  evening
 services,  which  are  attended by  between eighty and  one
 hundred  patients.   At the  Sunday morning service the
 attendance usually numbers about 350.
   The system  of accounting  is  comprehensive, showing,
 since the  opening of  the institution, the  per-capita cost of
 maintenance,  daily averages, price of provisions and other
 necessaries, also salaries and cost  of medicines.  The origi-
 nal  outlay  on lands, buildings, fittings,  and  furniture for
 the accommodation of 1,672 patients, is stated to have  been
 £147,000, or at the rate of about $425 per bed.
   The patients admitted here are, generally speaking, of the
 most enfeebled class.  As  might be expected in an institu-
 tion specially designed  for infirm  and debilitated  chronic
 cases, the mortality is great.
   Within  and without  the asylum were evidences of order
and cleanliness,  among  which were the properly arranged
kitchen, the well-aired dormitories, the scoured stone steps,
and neatly  trimmed lawns.  Although objections  may be
made to the unwieldy size of this institution, and the small
proportion of attendants  to  patients, yet,  as  an  attempt
to bridge  the chasm  between ordinary  asylums and ordi- 
HA Y WARDS HE A TH.
69
nary workhouses by providing humane care  for the chronic
insane, Caterham must be pronounced  encouragingly suc-
cessful.
SUSSEX  COUNTY  LUNATIC  ASYLUM—HAYWARDS  HEATH.

  This asylum opened in 1859, ls under the control of the
county  justices, who appoint  a Committee of Visitors  to
manage its affairs, and, like all similar institutions, is under
the  supervision  of the Commissioners in  Lunacy.  This
county had, according to the  last census, a population of 404,-
027.  Its estimated number of paupers January I, 1887, was
19,175, of whom a little over seven per cent  were lunatics.
  The  institution  is situated  at  Haywards Heath, thirty-
seven miles south of London.  The buildings, of buff and
red brick, are approached  through a broad, well-kept road-
way, having on either side terraced lawns, spacious cricket and
recreation grounds, shrubbery, and flower-beds.  The estate
contains between  two and three hundred  acres, comprising
profitable farm and garden grounds.
  The visitor is here received by a porter in blue and scarlet
uniform,  who  leads the way to the office of the  resident
Superintendent.  The broad  flight of stone steps was cleanly
scoured, and banked on either side with a profusion of potted
flowers and  ferns.  At  the  time of  my  visit there were
upwards  of  800 inmates, the  larger  proportion of whom
were women.  Both acute and  chronic cases are. admitted.
Nearly  all of the  patients are maintained  by the several
unions or parishes of the county; a few are charged to out-
lying districts, or are paid for by their friends.
  The asylum is  mainly of three  stories.  The walls  are
constructed with an air-chamber between the inner and outer
bricks.   In  most  cases  the interior  is not plastered, but
painted directly on the brick.  Plastered walls  are, however, 
JO                     ENGLAND.

preferred.  The  stairs  of  white stone are of easy  ascent.
The windows have iron sashes, and are uniform throughout
the building.   The panes  measure 5  x 10  inches.   Two sec-
tions of the sash, containing two panes each, open outward.
  About two thirds of the patients sleep  in associated dor-
mitories  which have from three  to  twenty-five beds each.
One of those  on the women's  side contained nine beds and
as many comfortable chairs, besides night-chairs.   Strips of
carpet were on the floor, pictures were hung on  the tinted
walls, and the windows had  shades.  There were also mir-
rors, and racks for the towels,  and the dressing-table had a
fancy cover.   The bedsteads  were of polished  wood.  The
bed furnishing included linen  sheets, blankets, a hair mat-
tress, and a pillow to each bed.  On each of the white coun-
terpanes was a  fanciful monogram  embroidered in bright
colors.   The furnishing of the single rooms was similar to
that of  the  associated dormitories.  Iron  bedsteads  were
gradually taking the place of wooden ones.  During the
night the sleeping apartments are visited every hour.  They
are heated by large stoves, and  thermometers are hung on
the walls to register the temperature.
   A ward for a better class of female patients was quite at-
tractive.  The floors were carpeted, the windows had shades,
as well  as curtains.  The walls were papered, and on them
were hung numerous pictures; while the general furnishing
 included cushioned  invalid chairs, a piano, a small library,
 and bagatelle boards.  Birds and plants aided  in giving a
 cheerful  and attractive aspect to the room.  Outside,  on
 one of  the  window-sills, were observed several pigeons;
 on another  sat an old, contented  tabby—all  of them spe-
 cial pets and favorites.   The infirmary ward for  women is a
 pleasant apartment containing thirty-eight beds.
    The two suicidal and epileptic dormitories—one for men 
HA Y WARDS HE A TH.
71
and the other for women—contain each fifty beds.  Those
for suicidal cases are so arranged as to bring all the inmates
under view at once.  Two nurses remain here overnight and
make a record of every incident  that occurs.   The single
rooms for epileptics are  padded, the floor padding being in
three sections.  Shutters are provided  for darkening the
rooms when necessary.  The visits  of the perambulating
night-watch are checked by  a tell-tale clock.
   The dormitories for men are similar  to those for women,
except that the decorations are not  quite so elaborate.  In
one of those for epileptic patients were noticed several  deep
bedsteads.  There are four attendants here to forty patients.
The detached hospital  for men is under the care of a  mar-
ried attendant and his wife.
   Only one corridor throughout the entire building is warmed
by hot-water pipes,  stoves and open  fire-places being the
usual means of heating.  The lighting is by gas.  Thorough
supervision  renders the protection of gas-jets needless.
   The patients of both  sexes are variously attired.  The fe-
male attendants wear brown dresses, black aprons, white col-
lars, and frilled caps with green ribbon.  The male attend-
ants have dark-blue frock-coats with brass buttons, brown
trousers, and caps with leather fronts.  The wages of day
attendants begin at £26 a year and rise to £40  for men ;
those of women begin at £16 and rise  to £30.  In  1883,
when the  housekeeper, who had  been  twenty-five years in
service, resigned on account of failing  health, a pension of
£100 a year was secured for her.
   One general kitchen  supplies food for the whole estab-
lishment.  Three meals per day are allowed ; viz., breakfast
at 8 A.M., dinner at  1  P.M., and supper at 6 P.M., the sexes
dining in different rooms.  In a large apartment with arched
roof and tinted walls the women were seen at dinner.  They 
72                     ENGLAND.

were seated at covered  deal tables, at each end  of  which a
" charge-nurse "  presided.  Crockery, and blunt  knives and
forks  of  the pattern common  to these institutions, were in
use.   Each  patient receives half a pint of beer at dinner,
unless it  is withheld for special reasons.  The diet, which is
fairly liberal, is varied daily, and includes bacon,  roast meat,
pickled pork, Irish  stew, mutton  broth, suet pudding, meat
pudding, bread and cheese, rice, and fresh fruit in its season.
Extras are given to patients as  inducements to work.  These
include tobacco  and snuff.
  Water is  supplied  from  a well which yields fifty gallons
per day for  each inmate.  Fire-hose is at all times readily
accessible in the various departments.  The sewage is used
to fertilize the land connected  with the institution.   Waste
water and sewage run  direct to  the sewage  farm without
intercepting catch-pits  or tanks.   At each  angle in the
sewers there is  an  opening for ventilation and  inspection.
A system of detached closets has been introduced here.
  What is designated as " wet and dry packing " is practised
for medical  reasons, and is the only  form of  mechanical
restraint,  if  such it may be called, in use in this  asylum.
This  treatment  the Commissioners  in  Lunacy regard  as
restraint, and require that it shall be so reported.  Opinions
differ as to its value from a curative point of view.   Locked
coats, dresses, and stockings are occasionally used to prevent
a patient from  scratching or  otherwise  injuring  himself;
but his  arms, hands, and legs remain  free.   Seclusion  is
sometimes resorted to.
  In  this asylum  there  is a  thorough  industrial  system,
and  it is considered of the utmost importance to have a
variety of congenial employments.  For the  men there are
sixteen and  for the  women six different kinds of occupation.
These include the  following:   farm  and garden work, shoe- 
HA YWARDS HEA TH.
73
making,  tailoring,  carpentering,  bricklaying, painting, up-
holstering, mat-making, basket-making, laundry-work,  and
needlework.   Patients  are  also  employed  in the  kitchen,
the  dining-hall, the  store-rooms,  the bath-rooms, and as
ward-cleaners,  house  attendants,  bakers,  engineers,  etc.
The furniture, baskets, mats, and mattresses, as well  as the
clothes, boots, and shoes of the  inmates, are all  made on
the  premises under  the  direction  of  skilled artisans who
work with the patients.   Seventy-six per cent of the  insane
are usefully employed.
   The following is a  complete list of the officers, attendants,
servants, and artisans of  the establishment:  medical  super-
intendent, senior  assistant  medical officer,  junior assistant
medical  officer, chaplain, clerk to visitors, clerk of asylum,
housekeeper, head female attendant, female assistant officer,
storekeeper,  head  male attendant, twenty-three male attend-
ants, twenty-eight female attendants, five male night attend-
ants, five female night attendants, organist and schoolmaster,
office clerk,  seamstress, head  laundry-maid, three  laundry-
maids,  hall  porter,  man  cook,   dairy-maid,  kitchen-maid,
vegetable-room maid, three housemaids,  two farm attend-
ants, house  attendant, bath  attendant,  engineer,   bailiff,
gardener, blacksmith, front ground laborer, tailor, shoemaker,
mat-maker, basket-maker, upholsterer, baker, butcher, under
garden attendant,  carpenter, bricklayer, bricklayer's laborer,
painter and  glazier,  stoker, under stoker,  cowman,  under
cowman, two carters, stockman, and house carter.
   During the  year ending January  I,  1887, the average
weekly per-capita cost of maintenance was Ss. n^d. Pauper
patients  from other counties or  boroughs are charged 14$.,
and all private patients, 16s. per week.
   The wards of this  asylum  are  well supplied with books,
papers, and periodicals.  Eighteen daily  and  fifty weekly 
74                     ENGLAND.

newspapers  and thirty-eight  monthly publications are pro-
vided for the use of the patients.  It is customary to expend
about two hundred dollars yearly in the purchase of books.
Many of the inmates are permitted to  occupy a portion of
their time in writing and in copying selections from literary
works, which are favorite ways of spending time with some of
those who are best educated.   In winter, the chaplain con-
ducts a  school in the large dining-hall, which is attended by
about sixty patients of each sex.  The three Sunday ser-
vices in the chapel are attended  by about six hundred and
fifty of  both sexes.  In/the dining-hall  of each  division the
chaplain reads prayers daily,  at which services there are on
an average about two hundred and fifty men and three hun-
dred women.
  The  extensive airing-grounds  are surrounded by a haw-
haw, so as not to obstruct the view.  In fine weather, parties
of male and female patients not exceeding eighty go out
separately into the country for walking  exercise, each  party
in charge of five or  six attendants.  For the old and infirm,
drives are regularly arranged; and in summer there are pic-
nic excursions to Brighton,  the Crystal Palace,  and  other
favorite resorts.   For the  younger people, cricket and cro-
quet furnish healthful recreation.   The large amusement hall,
in which weekly dances are  held, is fitted up with a  stage,
and is  furnished with a piano and other appurtenances for
theatrical entertainments and  concerts.  A fancy-dress ball
is held during the winter,  which  is largely  attended  by
patients in costume. An average of three hundred of both
 sexes resort to the weekly entertainments.
   Printed  rules of the  institution were  hung  in a con-
 spicuous  place.   They specify the days on which visits may
 be made by outsiders, and  the length of the  visits; pro-
 hibit the bringing in of wine, beer, or spirits, and direct that 
BROOKWOOD.
75
nothing shall be said or done that will depress the patients.
Only under exceptional circumstances is a patient allowed
to be visited until a month has elapsed from the date of his
admission.  Friends are communicated  with in the event of
serious illness.   The  institution was clean and orderly, and
bore evidence  of enlightened management and considerate
treatment of the  class under its care.

     BROOKWOOD ASYLUM, NEAR WOKING, SURREY.
   Brookwood  lunatic asylum, like  Haywards Heath, is  a
type of English county institutions, which differ widely from
the larger metropolitan receptacles already described.   It is
one  of the three asylums for the county of Surrey, and is
designed  mainly for  pauper patients.  This county, which
includes part of the metropolis  south of the Thames, ranks
fourth in  England as regards population, containing, accord-
ing  to the last census, 1,441,017 inhabitants.  On the 1st of
January, 1887, there were in Surrey 42,021 paupers, 11.54
per cent of whom were lunatics.
   Like other county asylums,  the  management  of  Brook-
wood is in the hands of an unpaid Committee of Visitors.
These country gentlemen, most of whom are men of  wealth
and  influence,  serve  generally for a long  term of years, it
being  customary to  re-elect them, unless they  express  a
wish to bear no  longer the responsibilities of  the position.
The Medical  Superintendent  controls the  selection and
retention  of his  subordinates.
   This  asylum, situated  about twenty-eight  miles  south-
westerly from  London, is approached  through highly cul-
tivated  and elaborately  ornamented  grounds.   Its  plain,
substantial, brick buildings  are, for  the  most part, three
stories high. At the  time of my visit, the inmates  numbered
421 men and 629 women, including acute and chronic cases. 
76                     ENGLAND.

  The interior walls of the older portion of the asylum are
unplastered ;  the  newer portion  is plastered  on the brick, a
method which  is preferred by  the  Superintendent.   Gen-
erally, the walls are tinted, and decorated with stencilled
frieze and bordered dado.  A pleasing  effect is thus  pro-
duced at a trifling cost, the work being done mostly by the
patients.
  Dining-rooms, with scrupulously clean sculleries attached,
are provided for the several wards.  These accommodate
from thirty to one hundred patients  each.  The knives and
other table  furnishings  resemble those used in ordinary
housekeeping.  In a large dining-room that  I entered there
were  small tables, accommodating eight persons each.  Its
heating arrangements,  though  in keeping  with  modern
ideas  of ventilation, were  somewhat peculiar.  These  con-
sisted of two chimney-stacks standing near the centre of the
room, and so placed as to apportion equally between them
the space to be warmed and ventilated.  Each stack was
built with two open fire-places back to back.  The windows
had heavy draped curtains, and the appearance of the room
was inviting.  There are  two general kitchens, one for the
older portion of the asylum and  one for the new section.
  Another room worthy of note is that  set  apart for  new
arrivals. It was appropriately furnished with lounges, settees,
and  easy-chairs,  and  made  attractive with pictures  and
statuary.
  The day-rooms for both men  and women  were well fur-
nished.  In  one examined, the tables had fancy covers; on
the comfortable chairs were tidies made by the patients; on
the tables and in the windows were potted plants; and  pict-
ures were hung on the walls, which were suitably decorated.
  In  the dormitories, the bedsteads are  generally of iron,
and  are furnished with  straw and hair  mattresses,  except 
 
 
BROOKWOOD.
77
where woven-wire bottoms are used, in which case the palli-
asse is dispensed with.  The sheeting is unusually thick and
strong.  Narrow borders of blue or red stripe distinguish the
bed linen of the men from that belonging to the women.  In
the older building, the  number  of beds in the dormitories
ranges from three to twenty.   In the new section the dor-
mitories are much  larger, each having as many as  forty beds.
These apartments are warmed by open fires.   In  the female
epileptic ward were ninety-eight patients—some violent and
dangerous.  All were under watchful and systematic super-
vision  by night and  day.   Here,  as in some other wards of
the asylum, was a piano  for the  entertainment  of the pa-
tients, a  leading principle in treatment being to engage the
mind by every possible  means.  The  open fire was only
partially screened, yet it was asserted that no accident from
burning had ever occurred in the institution.
   The new department, intended to accommodate  seventy-
five female patients in each of its four wards, was erected at
a cost of $484  per bed.   The open fires  have no guards of
any kind.  A  small opening may be made in the windows
by means of a lock and key.  Ventilation  is further effected
by flues  and  perforations in the walls.  The panes, twenty
to a window, measure g\ x 16  inches.  Thermometers are
hung in  the  various  wards, and  a  record  of the temper-
ature is  made  at different hours  of the  day.  The aim  is
to maintain a uniform temperature of about sixty degrees
Fahrenheit.  The  single rooms of the asylum, which  are in
the proportion of one room to nine patients, are unlike in
coloring, while the ornamental work is well adapted to please
and  interest  the patients. The  furniture throughout  is
comfortable.
  The bath-room, which  is of modern construction, has a
dado of white glazed  tile.  The  baths are  arranged in stalls. 
78
ENGLAND.
 Before a patient enters the bath it is an imperative rule that
 the temperature of the water, as well as of the atmosphere,
 must  be ascertained by a thermometer and recorded.  The
 temperature of the water must  not be  less than  eighty-
 eight  nor more than  ninety-eight  degrees.   In  the event
 of a thermometer being broken, the orders are peremptory
 that the bath be suspended until another is obtained.
   About five  hundred yards  from the main building is a
 small, conveniently planned cottage hospital furnished with
 modern appliances.  It accommodates sixteen patients, and
 is arranged for the use of both sexes.
   There  is separate  provision for  Church-of-England and
 Roman  Catholic  services, which  were said to be regularly
 and largely attended.
   The average weekly per-capita cost of maintenance during
 the year ending January i, 1887, was gs. 6\d.
   In  this well-ordered institution there was a remarkable
 absence  of ordinary methods  of  restraint.  It was claimed
 with great satisfaction by Dr. Brushfield that he had never
 in his  life ordered or sanctioned mechanical restraint of any
 kind.   He admitted  having  met  occasionally with cases
 in which such  treatment  might have  been beneficial; but
 the risk of abuse was  so great  that he had been led  to dis-
 countenance it entirely.  Seclusion had not  been practised
 under  his re'gime since 1871.    He believed  this practice led
 to  the neglect of some  of  the worst cases ; he therefore
 resolved to depart from it, and he never regretted its aban-
 donment.  On being asked what he meant  by " mechanical
 restraint," Dr.  Brushfield replied :  " The application  of any
 thing that hinders the patient in the  free use of any part
 of his body."   When he had a troublesome case he preferred
to treat it in the ward.  If a patient required seclusion, he
would  be placed in a room with  two  or three attendants; 
 
 
                       BROOKWOOD.                    yg

 but in no case was  a door locked.   In fact, the attendant
 who ventured to lock  a door under  such circumstances
 would  be at  once  discharged.  Formerly  there  was  no
 padded  room ; now there are  two, one  on each side of
 the asylum.   They are rarely used,  being required only
 for  very violent and  epileptic cases.  Special  restraining
 contrivances,  the   Doctor  thinks,  only  increase  excite-
 ment.   He   had  frequently  found it  advantageous  to
 remove a patient from  one ward to another.  He  did not
 classify to any extent, and had no refractory ward.  Classi-
 fication, in  his opinion, might easily  be carried  too far.
 Seclusion he defined ordinarily to mean " keeping a patient
 in  a room with locked  doors."   In  that  sense  he  did not
 permit  seclusion, regarding it as a device for enabling and
 encouraging subordinate officers and  attendants to shirk
 their duty or abuse  the patients.  Each patient is weighed
 on admission and at different times during his  stay in the
 asylum.
   The male attendants are attired in blue suits.   The female
 nurses  wear  dark-green  dresses, white  aprons, and  caps
 trimmed with ribbon.  The attendants throughout the insti-
 tution are in the proportion of one to ten patients.   The
 wages of a first-class  male attendant commence  at ^32, in-
 creasing £1 yearly to a maximum of .£40 per annum, with
 board, lodging, washing, and each year two suits of uniform.
 Second-class  male attendants begin at .£28, increasing in the
 same way to ^32  per annum, with board, etc.,  as stated.
 First-class female attendants  commence with £20  per an-
 num, rising to £26;  and second-class at £16, rising to £20,
with board and minor perquisites.  Since my visit there have
been  some slight changes in  the salaries  and wages.   The
doors of the attendants' rooms have large glass panes and
curtains, the  latter being drawn aside during the day to admit 
8o
ENGLAND.
of ready inspection.  The reports of events during the night
are  minute in  detail.   The day  reports, which must be
submitted before 9 P.M., set forth the extent and kind of
the employments  of the day—if  unemployed, they  state
the  cause—;   also  the  number  taking recreation,  the
number in bed and their  condition, the  number  wearing
locked boots,  strong or special dresses,  acts  of violence,
attempts at suicide, accidents if any, and even the minutest
incident.
  Connected with  the institution are 224  acres of farm and
garden land.  The cultivation  of  this affords healthful em-
ployment for the patients.   As many as eighteen acres are
tilled with the spade.   The gardener is  a skilled  nursery-
man and  florist.   The  farm lands are superintended  by a
resident  bailiff.  In the  farm cottages,  of which  there
are five, reside quiet patients who work in the fields.   The
farm, garden,  and  dairy are highly profitable.  The barren
heath which surrounded the institution in  its early days has
been converted into a  garden  of fertility.  The first  step
taken  was  to lay out a  nursery for the propagation of
plants.  This  eventually repaid all labor expended  upon
it,  by yielding sufficient shrubbery for the  ornamentation
of  the  grounds.  Subsequently it not only supplied the
needs of the  asylum, but proved  a source of revenue from
the sale  of  surplus  plants.   A  large conservatory  upon
which much  care is bestowed adds to  the  attractiveness
of  the institution.  This furnishes throughout  the winter
a plentiful supply of  choice and fragrant flowers  for the
various rooms and wards  of the asylum.  Dr. Brushfield
considers suitable occupation  one of the most important
factors in treatment, and remarks : " So long as the number
of  the employed  is double that of the  unemployed, I am
satisfied." 
BROOKWOOD.
81
  About 120 patients were daily at work under the direc-
tion  of the farm bailiff and the gardener, and  were about
equally divided between  the  two.   Other male  patients
were  occupied  as  follows:   helpers in  wards,   32;  in
kitchen and vegetable  room, 25 ; in domestic  offices,  21  ;
as bricklayer,  1 ;  bakers, 4 ;  upholsterers and polishers, 7  ;
basket-makers,  4;  bookbinders,  4; mat-makers, 3; shoe-
makers, 8 ;  tailor,  1 ;   painters,  7;  plumber,  1 ;   assisting
engineer, 5 ; joiners, 3;  and in the laundry, 8.  Paid artisans
not only oversee,  but  work with  the patients in all the
mechanical departments.   On  the  female side  upwards of
400 were  daily employed.   The following list shows the
occupations: helpers in wards,  144;  sewing and  quilting,
106 ; mending, 42 ; laundry-work, 37;  making men's cloth-
ing, 36; in kitchen and  dining-hall, 26;  knitting and netting,
14;  boot  and shoe ' binding,  4;  assisting  housemaid, 4.
Owing  to  an increasing amount  of  laundry-work,  steam
machinery  had been introduced, although  Dr. Brushfield
favors  washing by hand for the robust and excitable, and
ironing for the depressed.  Since my visit, a separate foul-
linen wash-house has been erected here, with  suitable dis-
infecting and rinsing   tanks.  The  payment of money to
patients as a reward for the labor they perform is regarded
with favor, and has  been attended here,  as elsewhere, with
good results.
  Though a strong advocate of  employment as a legitimate
means  of cure, Dr.  Brushfield did not  push  his theories in
this direction so far, to use  his own language, as to make the
asylum simply "a  well-regulated workhouse."   He regards
every asylum superintendent as " primarily a medical officer
of a hospital for the treatment of insanity, and one who
looks to the treatment  of  the patient  as his first and most
important  duty."   Founded  upon  these solid principles, 
82                     ENGLAND.

Brookwood  has  justly attained a high reputation for thor-
ough as well as economical administration.
  While the importance of useful labor  is properly  recog-
nized, recreation and amusement are by no means neglected.
The large recreation hall, accommodating eight hundred, is
ornamented with  statuary, and  amply supplied  with the
usual appointments of a theatre.  A number  of patients
were seen at work adjusting stage apparatus for a forthcom-
ing entertainment.   Fancy-dress  balls are held  every year.
These were spoken of as a  source  of  much amusement.
They are generally attended by about five hundred patients
and a limited number of the general public.   For  these
interesting  occasions  ladies of  the  district  supply  dress
material, which  is made up by the patients.  At the weekly
musical  meetings two bands perform under the direction of
attendants.   Programmes  for these gatherings  are printed
on the  premises.  Each  ward has at least  one bagatelle
board.  There is a well-stocked library to which  the patients
have access, while  the supply of serial and comic literature
is abundant.
   The deportment of the patients was orderly, and the gen-
eral aspect of contentment was quite marked.  No one was
permitted  to  crouch on the floor or  to remain in any other
unbecoming  position, nor was there any evidence of that
want of self-respect which is allowed  to remain  uncorrected
in some institutions.  In the discharge of the duties devolv-
 ing upon them, the attendants appeared equal to their  as-
 sumed  responsibilities.   Without architectural display or
 other extravagance, comfortable and proper provision  for
 the insane  seemed to be here  attained ;  and appropriate
 as were the fittings and furnishings of this institution, that
 which impressed me most favorably was  the  humane spirit
 pervading its entire administration. 
WAKEFIELD.
83
THE WEST RIDING PAUPER LUNATIC ASYLUM—WAKEFIELD.
  Yorkshire, comprising in its three divisions, or ridings, an
area of 6,067 square miles, is the  largest county  in Great
Britain.  In population it ranks next to Middlesex.  It  had,
according to  the  last  census, 2,894,527 inhabitants.   The
estimated number  of paupers in Yorkshire on  the 1st of
January, 1887, was  75,915.   Of these,  7.43 per cent were
lunatics.  The population of the West Riding, according to
the last  census, was 2,197,811.   The estimated  number of
paupers  in this  division on  January 1,  1887, was 53,803, of
whom 4,247 were lunatics.  The pressure for asylum accom-
modation has been so great  in the West Riding that, since
my visit, the  justices have put  in course of erection a  new
asylum to accommodate 1,310 patients.   It is situated in the
township of Menstone, and has 325 acres  of land, which were
purchased at a cost of £20,720, or upwards of $300 per acre.
The buildings are estimated to cost £188,992, or about $700
per bed.  When this institution  is completed  there will be
three large asylums for the West Riding.  The other two di-
visions of the county have one asylum each.
  The asylum at Wakefield, a  three-story building, accom-
modating about 1,400 patients, cannot be regarded  as a
model structure.  It is built  of brick, and wears the sombre
hue  of  age,  having  been opened in 1818.  Lawns, flower
borders,  grass-plots, and carefully  tilled vegetable gardens
surround the institution.  The estate contains 120 acres of
land.
  The Superintendent, who  occupies a  separate residence,
had, at the time of my visit, five medical assistants.  There
were two chief attendants on the men's  side, with fifty-four
subordinates  for day and  five  for night duty.   On the
women's side there  were two head nurses, with fifty-seven
assistants by  day and five  for  night duty.   The  general 
84
ENGLAND.
average of attendants to patients was one to ten;  in the re-
fractory wards, one to five ; and in the suicidal wards, one to
eight.  The salaries of male attendants ranged from £30 to
£5° a year, in addition to uniforms.   This compensation,
whicJi  is here  considered liberal,  secures long and  reliable
service.  It was officially stated in 1886 that forty male and
twenty-one female attendants had been in the service of the
institution over five years, and that, during the previous year,
only one attendant had been  discharged ; while one, during
the same  period, was retired on a pension.
   As we entered the day-room of the convalescent ward for
women, a patient was playing a lively air on the piano.   The
furnishing included  large  tables,  arm-chairs, a sewing-ma-
chine, book-cases, pictures, and a variety of minor ornaments.
Two open fires, with rails three feet high in front, warmed and
Ventilated the apartment.  There was considerable variety
in  the dresses of the  women.  Ribbon  bands,  generally
green, were worn around the neck and waist.   The attend-
ants were  neatly attired in dresses of blue serge, with white
caps and linen collars;  but there was a jarring jingle of keys
suspended from their leathern belts.
   The dormitory on an upper floor had bay-window projec-
tions, within which were wash-stands and toilet ware.  Sev-
eral good-sized mirrors were hung on the walls.  The wooden
bedsteads are constructed with an inner framework, on which
a canvas bottom  is stretched.   Each bed is supplied with a
hair mattress  and an  abundance of comfortable bedding.
The sheets of  this department are distinguished  by a red
border.  By  means of partitions  four feet high the central
space is divided into stalls ten feet wide, in which the beds
are placed.  Each stall has a strip of carpet on the floor and
a cushioned seat.   The nurses occupy one end of the dormi-
tory, from which  the entire apartment can  be supervised. 
WAKEFIELD.
85
  Several patients were seen wearing dresses buttoned  be-
hind, and occasionally there was one  wearing locked boots.
In the  epileptic ward the patients are by night constantly
under  the supervision  of a regular  watch,  whose attend-
ance is checked by  tell-tale clocks.   Records of tempera-
ture are made by attendants three times during the night.
On the walls of the suicidal ward were noticed many colored
prints, and in front of the open fires screens are used during
the night.
  The refractory ward on the women's side contained arm-
chairs, wooden settees, upholstered lounges, also rugs and
strips of carpet.  There were high railings before the fire.
The pictures were  hung within easy reach.   Single rooms
here have wooden bedsteads with canvas bottoms, a rug by
the side of each bed, and sliding  shutters to the windows.
The floors were cleanly scoured.   To  this, as to the other
wards, a small scullery, closet, and  bath-room are attached.
The occupants  of this refractory ward numbered forty.
Twenty slept in single rooms, eleven  in one dormitory, and
nine in another.  The corridors have  tinted walls decorated
with pictures.
  The general bath-room measures 20x 50 feet, and contains
ten baths ranged on either side of a central passage.  Muslin
curtains adjusted on a framework of gas-pipe posts and rods
are provided, shutting in three sides of the bath.  The heat-
ing is  effected  by means of hot air.  The  windows are of
frosted  glass.  The taps of hot, cold, and waste water, are
under the sole control of the attendant, and  every thing is
kept attractively clean.   In an adjoining apartment  are the
usual appointments of a Turkish bath.   The baths  include
vapor,  sitz, overhead,  needle, shower, and  the ordinary
douche.
  A building  of  recent construction, for convalescents,  is 
86
ENGLAND.
two stories high, and accommodates one hundred and twenty
male  patients.   Here, in the first room entered, were seen
rows of pigeon-holes for boots and shoes.  Adjoining this is
a lavatory furnished with the usual appliances, including
roller-towels  and looking-glasses.  The rooms were warmed
by open fires in front of which were screens 2\ feet high.
Comfortable  couches, cushioned seats, rugs, and  pictures
were  included  in the furnishing.   Five attendants were on
duty here by day, but there was no special night watch.
  The day-rooms on  the men's side contain  pianos, billiard
and bagatelle tables, arm-chairs, and pictures hung on  the
papered  walls.   These rooms are heated by open fires.   In
connection with the men's infirmary is a small glass-covered
conservatory  containing a  choice  collection  of  exotic  and
other plants  and a small aquarium.  The conservatory  is
furnished with  comfortable seats.
  In two  houses detached from the main building  upwards
of fifty chronic and  harmless  insane  are kept.  Want of
accommodation is  felt here as in almost every other asylum
in England.  There are, in all, one hundred single rooms
in the  institution, and on  three  floors  there  are thirty
strong rooms with flush-panelled doors opening outward, so
that they cannot be blocked by the patients.   The  walls of
these rooms are covered with silicate, and  the window-panes
measure 6 x 10  inches. A room on the female side is padded
in sections.  It has a bed  on the floor, and a double-sash
small-paned window protected by a padded shutter adjusted
by weights.  A dormitory on the  first  floor  of the asylum
is allotted to the fire-brigade, which is  composed of attend-
ants  and  patients, who are called out every month, without
previous notice, for training and inspection. Fire  extinguish-
ers were observed about the building.
  The women take their meals in their wards, sometimes as 
WAKEFIELD.
87
many as one hundred dining together.   The general dining-
room for  men  is wide, and measures  one hundred feet in
length.  It  has high  windows, and is  fitted up with a stage
at one end and a gallery at the other,—the apartment serving
the  double  purpose  of dining  and  recreation hall.  The
tables at the time of my inspection were arranged for dinner,
with  linen table-cloths, crockery, and ordinary knives and
forks.   Twenty-two sat at each table.  Before  commencing
the meal,  all stood and sang grace.   The dinner consisted of
boiled beef  and pork, potatoes, carrots, parsnips, and bread,
with  beer brewed on  the premises.   As  many  as three
hundred and sixty dine together in this hall.  After dinner
they remain chatting and singing until it is time to  resume
work.  Meals  are  supplied  from the general kitchen, in
which every thing appeared scrupulously clean.
  Over one thousand of the inmates  are engaged  in some
kind of work.  About two hundred  and fifty are employed
in farm, garden, and other outdoor work.  A peculiar feature
of this  institution is its large department for weaving, this
being an  important industry in the district, and one with
which many of the inmates are familiar. There were twenty-
nine patients employed in the making  of sheeting and other
fabrics.    Fifteen  looms, and a large number of  bobbin
wheels turned by hand, were ranged on two sides of a long
building.    This  department is under the control of  an
artisan  attendant.   In the carpenter's shop, six is about
the  usual number  employed.   Tailoring is an important
branch of the industrial section,  eighteen patients being em-
ployed  at this  trade.  Seven of  the  tailors had  served their
apprenticeship  in  the establishment, and the instructor in-
formed  me that, in his time, seventeen  had learned the trade
after becoming inmates.   The tailor's workroom  is well
adapted to  its  purpose. It is warmed by an open fire and 
88
ENGLAND.
is well lighted.  It contained three  sewing-machines.  The
foreman, who had been  here more than twenty years, said
he  had  never known a patient  to  hurt himself  or others
with the tools used.  Making, as well as repairing, is done
here.   The workers were, at  the  time of my visit, busy  on
a  batch of  strong  linen  rugs,  machine-stitched  in  the
form  of small squares, each rug measuring 2x2^ yards.
These were intended  for night covering for  patients of de-
structive tendencies.  Cloth  of a dark color is used for the
patients' jackets, and  that of a light color for their trousers.
The dark-blue uniforms  worn by the attendants  are made
here.   In the shoe-shop, sixteen  men were  at work making
and repairing shoes.   Various machines are used for cutting
leather, riveting, and  for other work.  The attendant, who
had been here many years, stated that  no casualty had oc-
curred within  his knowledge from misuse of tools.  In the
tinware-room  two  patients were  employed,  and  there was
the same number  in  the plumber's room.   Picking horse-
hair and making mattresses gave  employment to thirty-five
patients in another department.  A  machine for renovating
the hair of  mattresses had been  in use for a number of
years, and was highly approved  by  the  management.   In
the book-bindery,  in  which  were  all the  requisite  appli-
ances, three patients  were  at work, while a  like number
found  employment in the  blacksmith's shop.
  The laundry is a separate department and is presided over
by a  head attendant. It is  extensive, well arranged, and
furnished throughout  with the latest machinery.  Here were
engaged one hundred women  under  five attendants, with a
few laundry-maids.   Six male patients  in an apartment
partitioned off from the female quarters were engaged under
an employee  in doing the heavier  work.   In  washing the
lighter articles a number of hand  machines were used. 
WAKEFIELD.
89
  Of the 1,405 patients here, there were only 181 males and
190 females unemployed.  The men  were not at work for
the following reasons :  sixty-two were too sick or too feeble,
38 were  aged and  infirm,  11  were too low-spirited, 31 too
much excited, 33 had  too  little mind, 6 were able, but un-
willing.  The women were not employed for the following
reasons:  twenty-five were  too sick or too feeble, 37  were
aged and infirm, 3  were too low-spirited, 62 too much ex-
cited, 48 had too little mind, 15 were  able, but unwilling.
  The gas for the establishment is made on the premises.
Water from the town  is used, and there is also  an artesian
well on the grounds.  Attempts to  utilize  the  sewage on
the farm had been unsatisfactory, and it was afterwards dis-
charged into the public sewerage system.
   The old adage, " A  place for every thing and  every thing
in its place," applies to the minutest details of this estab-
lishment.  An  illustration of this was seen in  the  yard,
where are a  few small out-houses, or stores, with an aper-
ture in the door of each, through which waste articles  may
be passed.  The locked doors are labelled ; as, for example,
" Broken Glass," " Old  Tin,"  " Old Lead."   The contents
of these  receptacles are regularly removed.
  It was said  that, in  favorable weather, some six  hun-
dred patients were permitted  to enjoy exercise about and
beyond the grounds.  About five hundred attend worship
every Sunday, the Church-of-England service being the form
used. Nearly seven  hundred, with  about equal numbers of
men and women, were  recorded as  attending  the  weekly
entertainments.
  Very little seclusion is here practised, and  it was said that
mechanical restraint is never resorted to except  for surgical
reasons.   This  is corroborated by  the Commissioners in
Lunacy,  who, in a late  report on the  institution,  remark 
9o
ENGLAND.
that during the year " the use of  mechanical restraint or se-
clusion has in no instance been found  necessary."  On the
death of a patient a post-mortem examination is made, unless,
on  admission, the friends  had filed an objection with the
management.   The average weekly per-capita cost of main-
tenance here for the  year  ending January I,  1887, is given
as 8s. $^d.

  THE SOUTH  YORKSHIRE PAUPER LUNATIC ASYLUM—
                        WADSLEY.
  This asylum, three miles from Sheffield, is a modern insti-
tution compared with that of Wakefield for the same division
of Yorkshire, having been  opened in 1872.  It was built for
the pauper insane, but at the time of my visit it contained a
few paying patients who  had been temporarily received.
The total number of inmates was 1,160, of  whom 660 were
women.  The buildings are situated on a rising  slope over-
looking an extensive  fertile valley.  They are of  brick, with
stone caps and sills to the doors and windows, and the roofs
are of slate.  After passing the porter's lodge near the iron
entrance gate, the visitor proceeds a quarter of a mile along
a gravelled roadway to the asylum buildings.  A substantial
stone church  is an  attractive feature  of the place.  The
broad green lawns are beautified  with  laurel and other ever-
greens,  which  are disposed so as not to obstruct pleasing
views of the surrounding country.
   In the main  entrance hall there was a profusion of plants
in full bloom, that had been brought from the conservatory
and here tastefully arranged.   The greenhouse is large, and
supplies an abundance of bedding plants for the grounds.
   One  of the  day-rooms on  the women's  side,  which may
serve for a general  illustration, presented a cheerful appear-
ance.   It had  a large bay-window and two open fires with 
WADSLE Y.
91
rugs in front.  The floor was carpeted and  the walls were
papered.   Statuary, pictures, hanging-baskets, wicker and
other kinds of easy chairs, contributed  to  the general cozi-
ness.
  In the men's infirmary the windows have double wooden
sashes with panes about 5x15  inches.   On  the floor were
broad  strips of oil-cloth with bright borders.   Easy  seats
were  provided, and a few pictures were hung on the walls.
Adjoining this ward is  a  small conservatory, in which were
seats for patients.
  The refractory wards, like the others,  are suitably fur-
nished, and brightened with  pictures and other decorations.
In connection with  each of these wards are one or two secure
single rooms.   There were no screens in front of  the open
fires.   There are two padded rooms  on the  men's and two
on  the women's  side.  These have double doors,  and the
mattresses are placed on the  floor.  In the  institution at the
time  of  my  visit  there  were about eighty male and  an
equal  number of female  patients of  the epileptic  class.
They were under the special supervision of attendants  by
night as well as by day.
  In addition to a system of  heating by means of hot-water
pipes, fire-places or open grates are in every ward.   Locked
fire-screens are used only in the wards for suicidal and epileptic
patients.    There are a few movable but no fixed guards  to
the windows.  In one corridor was observed an arrangement
to promote the health and comfort of the patients, which is
worthy of general adoption.  This  consisted  of  a  range  of
cupboards with shelves made of slats, under which are pipes
heated by  steam.   Here are  placed the damp garments of
the patients after they return from outdoor work.  A large
lavatory, which adjoins this corridor, is provided with roller-
towels.  These are  hung above coils  of  steam-pipes  to 
g2                     ENGLAND.

facilitate drying.   Satisfactory arrangements for bathing are
connected with each ward.
  The men dine in a spacious hall;  the women  in their
wards. On the day of my visit the dinner consisted of roast
pork  and rice, which seemed  to  be well cooked  and was
apparently relished.  Table-cloths,  crockery, and  ordinary
knives and forks were in use.  The kitchen was clean and
attractive.  Twelve patients were here engaged paring pota-
toes.   In the bakery, aerated  bread is  made.  The  dough is
kneaded  by  steam-power.  Adjoining the  bakery  is  the
brewery  containing  three large vats and all the requisites
for brewing.   Here  is made the beer which is served  out to
the patients at the daily rate of one pint to workers and half
a pint to non-workers.  Since  my visit, the dietary  has been
changed  so  that  only patients working in the hay-field and
the attendants composing the band are furnished with beer.
Water is substituted for it at the patients' mid-day meal.
The attendants generally are allowed is. 6d. per  week to
men and is. per week to women instead of this beverage.
  The laundry is a separate and quite extensive establish-
ment connected with the main building by a corridor.  The
clothes are successively passed into washing, wringing, iron-
ing, and  sorting rooms.   In order  to  furnish desirable  em-
ployment for a certain  class of the insane, the washing is
done by  hand.  Water is obtained from a well, from which
it is pumped into a reservoir that has  a  capacity of 8oo,000
gallons.  The asylum is  also connected with the  Sheffield
water system.
   Employed in various ways were 240 men and 360 women.
In the tailor's shop were nine  patients, including one  epilep-
tic, under a  paid  worker who had been for a number of
years in the place  he then occupied.  He said that  he  had
never experienced any difficulty in  controlling the  patients. 
WADSLE Y.
93
Three sewing-machines were  here in use.   In  the shoe-
maker's shop, which is fitted  up with the usual appliances,
seven men were at work.  In  the  carpenter's shop were
two, and in the painter's shop were four patients—all work-
ing industriously.  Ten men were employed in the upholstery
department.   Dr.  Mitchell,  the  resident Superintendent,
said that within his knowledge no patient in the mechanical
department had ever inflicted  injury upon himself or others.
   About one hundred of the men in favorable weather work
out-of-doors upon the farm and grounds, which contain in all
 193 acres.   About twenty-five acres are irrigated by sewage
distributed from several large  tanks.   Cottages are provided
 for the bailiff and cowman.  With the latter are lodged ten
patients who take their breakfast and tea with him, but dine
with the patients in the general  dining-room.  A portion of
the asylum is two stories high, the upper one being used for
dormitories and the lower one for day-rooms.
   Separate hospital accommodation is provided for men and
women.  Post-mortem examinations are made of the bodies
of about three  fourths of  the patients who die, permission
having first been obtained from friends of the deceased.
   The average of attendants to patients throughout the  asy-
lum  is as one to ten.   The  female  attendants wore black
dresses, with white caps and aprons.  A uniform dress gave a
pauper appearance to the women patients, who were, for the
most  part, attired  in blue print gowns  and  check aprons.
The  male patients were dressed  in  accordance with their
several employments.
  From the terraces of  the airing-courts an  extended view
is obtained beyond the sunken  walls.  The number restricted
to a limited area for outdoor exercise was large.  Comforta-
ble scarlet hoods are worn by female  patients when they are
out-of-doors in cold weather. 
94
ENGLAND.
  The capacious dining-hall, with its three large bay-windows,
is used for purposes of entertainment.   It is provided with a
stage, gallery, and accommodation for a band  which is made
up of sixteen attendants.   On the stage was a good piano.
This hall also serves as a reading-room, having chairs, side-
tables, and  books.   A library, to which the patients  have
access, is  under the direction of the chaplain.  The chapel,
where services are regularly held, accommodates about four
hundred patients.
  A few unteachable idiots are among the inmates of this
institution.   Here, as in many other places, the Superintend-
ent complained  that the large number of  chronic cases hin-
dered his  asylum from properly exercising its curative func-
tions.
  Since my visit to this asylum it has been enlarged, so that
at the date of January  I, 1887, it contained  1,543 patients.
Forty-seven  of  these were private patients, for whom  a
weekly charge of from 14J. to 20.?. was  made.  The average
weekly cost of maintenance during the year ending January
1, 1887, was &s.  \d. per capita.

        LANCASTER COUNTY ASYLUM—PRESTWICH.
  This is  one of four  pauper asylums that meet  the wants
of a  county having  the  largest population of any in  Great
Britain, including, as it does, large centres of  life and indus-
try like Liverpool and Manchester.  According to the last
census, Lancaster contained a population of  3,485,611.  On
the  1st of January, 1887, it was estimated  to have 83,321
paupers, of  whom 10.23 per cent  were  lunatics.   The asy-
lum at Prestwich is  about fifteen minutes' ride by rail in  a
northeasterly direction from the great cotton  manufacturing
city of Manchester.   The buildings, which are of brick with
slate roofs, are for the most part three stories high.  They 
DINING-HALL, PRESTWICH.
MfLIOTYPE PRINTING CO., BOSTON. 
 
PRESTWICH.
95
are surrounded by  ornamental grounds.  Just  inside the
entrance gate is a neatly constructed porter's lodge, which
is a distinctive feature of English asylums.  Indeed, the rules
respecting the porter and his duties are, in many places, as
precisely and clearly laid down as are those for the guidance
of the medical staff.   On approaching the asylum buildings,
one is pleased to see that the windows  are  free from bars.
The patients, dressed in drab moleskin,  the  ordinary attire
of workingmen in this part of the country, were at  work
about the grounds with wheelbarrows, rollers,  and garden
tools.
   At the time of my visit, the resident Superintendent, Dr.
Ley, was assisted by four medical officers.  There were 529
male and 674 female patients ;  and the number of attendants
to patients was one to nine.  An  annexe intended to ac-
commodate about 800 patients was in process of construc-
tion.  This has since been completed and occupied, and the
medical staff of the asylum and the number of attendants
have been increased.   The inmates, January 1, 1887, num-
bered  998 men and 1,161 women, making a total of  2,159
patients.   A very few  of these are private patients, who are
received at a charge  of from 155. to 21s. per week.
  In an inspection of the interior of this  institution one is
gratified from the outset. The various wards are simply but
neatly decorated and appropriately furnished.   In the in-
firmary wards  for  female  patients  were  seen numerous
busts and  pictures, lambrequins and light draped curtains
at the windows, exotic and other  plants about  the rooms,
and tidies upon the chairs.
  The convalescent wards on the women's side are fitted up
similar to the infirmary wards.  The comfortable furniture
and numerous articles for use and ornament recall the home-
like apartments of Brookwood. 
96
ENGLAND.
  In the ward for  very troublesome  or  refractory female
patients were curtains,  lambrequins, upholstered  furniture,
statuary, pictures, busts, and decorations similar to those in
the other wards.  Notwithstanding the class of patients, the
open fires here are only partially screened.  The windows
are large and without bars.  In  connection with  this ward
is a spacious open court, in which is a  small conservatory.
  The furnishing and general arrangements  of  the apart-
ments  for both sexes are very nearly alike, except that the
interior decorations on the women's side are more elaborate
than those on the  men's side.   A large proportion of the
beds have woven-wire bottoms, horse-hair mattresses, scarlet
counterpanes, strong white linen sheets, and two pillows to
each.  For  the single  rooms there are double  doors, the
inner one having an aperture in the panel to facilitate super-
vision.  Open fires throughout, even  in the wards  for sui-
cidal patients, are only partially protected by a guard.  This
method of heating is supplemented by  a system of hot-water
pipes.   The older  windows have iron  sashes with panes 5 x
14 inches ; but wooden sashes with panes 8x12 inches are
gradually superseding them.  The hand-rails in  the  stair-
ways are  sunk in the wall, thus  fulfilling the ordinary pur-
pose of support without projecting.
  In a new dormitory, constructed on modern  and improved
principles, the bedsteads are  of iron  and  have woven-wire
bottoms, upon which are laid block-mattresses made of silk-
waste. Beside each bed was a thick red rug. In the sleeping
apartments for the  epileptics, a low form of bedstead is used.
Near each bed was  a stand fitted with  shelves. A variety of
simple yet tasteful articles ornamented the rooms.
  There are  one or two  padded rooms, which, it was said,
are rarely used.  Seclusion is sometimes resorted  to. In the
event of the failure of moral suasion, a refractory patient is 
INFIRMARY-WARD FOR FEMALE PATIENTS, PRESTWICH,
KEUOTYPE PRINTING CO., BOSTON 
 
PRESTWICH.
97
placed in charge of a staff  of  attendants  large enough to
overcome any resistance.
  The dining-halls of this institution are spacious and are
elaborately furnished.   That for the women accommodates
upwards of three hundred.  At one end is  a stage, indicat-
ing that the place is also available for entertainments.  At
the  opposite extremity is a gallery for the orchestra.  The
dining-tables are regularly arranged  in the body and along
the sides of the hall.  Each table has its spotless linen cover,
and chairs for ten.  The crockery used is  of the  ordinary
table pattern.   Through  the high arched roof of glass there
is admitted an abundance of light. The gas-jets have bright
colored  shades.  Arranged about the hall are numerous life-
sized  busts and figures  and a great variety of  luxuriant
plants and flowers, among which are canary-birds in cages.
A general survey of the  apartment gratifies the eye by a di-
versity of pleasing, yet not costly, objects; while the orderly
arrangement and the  scrupulous cleanliness manifested not
only here, but  throughout the  institution,  give  evidence of
excellent administration.  It is worthy of  special  note that
the ornamentation  of  this beautiful hall, as well as of other
parts of the establishment,  was done by the patients who
worked  with and  were directed by  a  few skilled  artisans.
The dining-hall for men  is somewhat smaller than that for
women,  but is  scarcely less  elaborate in its furnishing and
decorations, both apartments being well adapted to interest
and gratify the patients.   In the infirmary dining-room, the
walls are papered.  Small tables and chairs are used here,
as in the hall just  described.   As would be expected, the
diet in this department is of a better quality.  Beer brewed
on the premises is allowed to all the inmates.  Non-workers
receive half a pint per day, while workers have  double that
quantity. 
98
ENGLAND.
  This institution, like most other English asylums, labors
under the great disadvantage of having a small estate.   Ad-
ditions have been made within a few years at a cost of up-
wards of $1,000 per acre ;  but  even now there are only 150
acres  connected with  the  asylum, fifty-nine  of  which are
covered by buildings, or used as airing-courts or grounds for
exercise.  Twelve acres  of the land are leased at  a high
rental.  At the time  of my visit, about  250 men  worked
either on the land,  in the workshops, or  in  the offices, in
addition to  113  ward-cleaners.   Twenty-nine  insane  men
reside at the farm-house and six in a detached cottage.  Of
the women, upwards of 200 were engaged in attending to
the wards;  38 in the laundry ;  52 in the kitchen and offices;
and 225 at various  kinds of needlework.   All the tailoring,
dressmaking, shoemaking,  and repairing for the establish-
ment are done on the premises.
   In  suitable weather parties of male and female patients in
charge  of attendants take walks beyond the asylum grounds.
Besides the weekly dancing parties,  there are, in winter,
theatrical and other entertainments.
   A chapel in which Church-of-England service is held every
Sunday is conveniently  situated on the grounds.  Mass  is
celebrated weekly within the institution for Roman Catho-
lics, and a Rabbi conducts religious services at stated  times
for the  Jewish patients.
   Of  those admitted to this asylum Dr. Ley has taken  much
pains to tabulate, from time to time, the  causes of insanity,
having  gathered his information from examinations of his-
tories of the patients, and  from inquiry of and correspond-
ence with  the  friends and  relatives.  The facts which he
has thus collected and the  conclusions he has drawn there-
from  are very suggestive.    He says  of  his  investigations
made during the year 1885 : 
WARD  FOR  CONVALESCENT  FEMALE  PATIENTS, PRESTWICH.
rlELIOTVPE PRINTING CO., BOSTON. 
f 
PRESTWICH.
99
  " In about 27 per cent  no cause could be assigned, as nothing
reliable could be ascertained in regard to the antecedents of those
patients.   Classifying the assigned exciting causes as mental and
physical,  the mental  causes  constitute 23  per cent,  and  the
physical about 55 per cent.  Prominent among the former  are
worry, anxiety,  and domestic and pecuniary troubles.  Of  the
physical, intemperance in drink is preeminent, reaching about 25
per cent of all causes,  and next to this come ill-health, epilepsy,
and disorders peculiar to the female sex.   It  will, however, be
observed that a large proportion of cases in which special exciting
causes are assigned, have in addition strong hereditary predispo-
sition  to the disease.  At  least 28 per cent inherited a weakened
nervous organization, too feeble  to resist ordinary exposure, and
prone to  become  deranged  by  various disturbing  influences,
social, religious, or commercial.  The troubles and worries of life
are rarely  powerful enough  of  themselves  to upset  a healthy
brain, and drink and other kindred excesses are far more likely
to derange the bodily health of the individual  and carry him to
the general hospital than bring him to the asylum. The experience
of this and of other asylums  points to  the  fact that  the special
causes usually enumerated as  factors  in the production of insan-
ity  are,  in the  majority of  instances, secondary  to  the  great
fundamental cause—constitutional predisposition."

  The Lunacy Commissioners in one of their reports have
paid  a just  tribute of  praise  to  Dr. Ley for his admirable
management of this institution. As has been pointed out by
them, it would  be difficult to find any asylum  wards  which
equal those of Prestwich in comfort or are more tastefully
decorated.  The objects of art  used for ornamentation come
within the  reach  of patients known to  be wantonly  de-
structive, yet  their  beauty seems to be  a sufficient safe-
guard, and very rarely is any  mischief done to them.  The
Commissioners say:

  " It is satisfactory to add that all these great improvements are
executed   solely by patients' labor, superintended  by skilled
artisan attendants, whilst  all  the furniture, fern-cases, etc.,  are
obtained  by  the  same  means, as  well  as  the busts  and pot- 
 100                    ENGLAND.

 tery which adorn the walls.   We cannot too highly express our
 gratification at the appearance of the wards, and we must add
 that we are astonished to find that all this is done at a per-capita
 cost of no more than 8j. 2d. per week.  We  doubt if any other
 asylum in the country has any thing approaching to the comfort
 and even luxury provided here at such a rate."
       LANCASTER COUNTY ASYLUM—WHITTINGHAM.
   The asylum at Whittingham, opened  in 1873, was planned
 to accommodate 1,100 patients.  It is situated in the country
 about six miles north of Preston.  The buildings are of red
 brick, and are one, two, and three stories in height.   They
 cover a considerable extent  of ground, and are connected
 by one-story corridors.  The original estate contained only
 155 acres of inferior land, which was bought for about $276
 per acre.   Small  additions have  since been made  by pur-
 chase,  and some  land  has been  leased for the use  of the
 asylum.  The building accommodation proving insufficient
 to meet the growing demands upon the institution, it has
 been found necessary  to  erect  an  annexe for the separate
 treatment of chronic  cases.  At the time  of  my visit the
 inmates numbered 1,260, of whom  550 were  men and 710
 were women.  The annexe has since been completed, and at
 the date of January 1, 1887, there were 1,679 patients.
   The  dormitories are on  the associate plan, some of them
 containing  as  many as forty beds.   For greater privacy,
 the beds, which occupy the central space in the room, are
 separated from one another by partitions four and a half feet
 high, so arranged as to form compartments or stalls opening
 towards the windows.   Wooden  bedsteads are  used.  A
 bright rug was spread  in front of each bed.  The bare ap-
 pearance of the walls was somewhat relieved  by painting,
and decorations about  the windows.  The lower sections of
the windows  had screens on the  inside.   Thermometers
were hung in each ward. 
DAY-ROOM FOR REFRACTORY FEMALE PATIENTS, PRESTWICH 
 
WHITTINGHA M.
IOI
  The day-rooms were plainly  furnished.  The walls were
plastered and painted, and brightened by colored stencilling.
They were adorned with illuminated mottoes, pictures, and
plaster casts.  Near the windows were flowers  in hanging-
baskets.   The window-sashes were  hung  with weights and
cords.  On the  floors of the long connecting corridors were
laid strips of carpet.  Though not generally approved in
English asylums, metal ware instead of crockery was used
in the lavatories.  The infirmary was  comfortably and ap-
propriately furnished.   Low beds are provided for epilep-
tics.  They  have a special night-watch.
   There are two padded rooms—one on the men's and one
on the women's  side.  In reply to an  inquiry respecting
restraint, it  was said : " We have no  restraint.  Occasion-
ally we put on gloves, but not very often.   We use no cribs,
nor have we ever  used them."   Dresses buttoned behind
are worn in certain cases.   Sometimes two or three attend-
ants hold a violent patient  rather than seclude him.  Wet
packing is also  occasionally resorted to.   The patients were
well clothed, and there was some variety in the style of
their dresses.
   There  is  a very large  general  dining-room  here, which
serves also as an  amusement hall.  The food appeared to
be sufficient in quantity, and fair in quality.  Crockery and
blunt-pointed steel knives were used at table in the ordinary
dining-room, but not in the refractory  wards.
   The  airing-courts,  to which a large number of patients
 were restricted, are fairly extensive.   Selected parties of
patients in charge of attendants are allowed to go into the
 country for exercise in suitable weather.  There  are long
 walks laid out within  the boundaries  of  the asylum estate,
 besides  ample tennis and cricket grounds.   Athletic sports
 and dances on  the green in summer, and  theatrical enter- 
102
ENGLAND.
tainments and concerts during  the winter months, are in-
cluded  in the routine  of  exercises.  Dr. Wallis  strongly
advocates the providing of  amusements for the insane.   He
says :
  " They lighten the tedium  of the winter months, and make a
pleasant break in the  monotony  of asylum  life  (a thing most
desirable in  itself for both patients and officials), and are  only
second, in my opinion,  to good food,  rest,  and  occupation, in
furthering the recovery of the curable cases, while they reconcile,
to some degree, many hopeless and weary patients to their lot,
and cause them for a time to  forget their troubles.  The prospect
of attending these entertainments acts, too, as a most potent stimu-
lus to good behavior in many of our turbulent and troublesome
patients ; nothing is more likely to bring out their powers of self-
control than the dread of being prohibited  from attending the
next theatrical performance or tea-party.   The reconstruction
and  enlargement of our stage, recently carried out, has enabled
us to undertake successfully more ambitious  plays than here-
tofore."
   On an average,  about 53  per cent  of  the  patients  here
are variously employed.   In order to give  occupation  to  a
certain class of excitable patients, much of the washing is
done by hand, a large number of ordinary wash-tubs being
used for this  purpose.   A considerable  force of  men in
favorable weather work upon the land,.about one hundred
and  fifty acres of  which are devoted to farm and garden
purposes.  The crops raised are oats, hay> and a variety of
vegetables,  including turnips and  potatoes.  The  average
weekly cost of maintenance during the year ending January
1, 1887, was ys. io^d. per capita.
   The method of heating was  in  a transition state.   The
authorities were  trying  the experiment of substituting hot-
water pipes  for  open fires.  The effect was quite marked.
Under  the  new arrangement an  expression  of gloom  was
depicted on the faces of the patients as they stood in their 
BIRMINGHAM.
IO3
comparatively cheerless apartments gazing forlornly upon
the black registers which  had taken the place of the bright
open fires.   It was  manifest that the depression was  felt
even by the  attendants.   On the other  hand, the rooms
where the  open  fires were still in use presented a pleasing
contrast, the glow of the  warm  fire seeming to  impart
cheerfulness to  both patients and attendants.  This  was
the  only place  in  England where I saw any attempt to
economize  by the substitution  of a hot-water system of
heating for open fires, and the  experiment was, to say the
least, discouraging.
   About five hundred patients attend divine service on Sun-
day, separate places being  provided  for Church-of-England
and Roman Catholic worship.
   Here, as in some  other of the huge English  asylums, the
disadvantage  of bringing  together large  numbers  of the
insane was strikingly apparent.

             BIRMINGHAM BOROUGH  ASYLUMS.
   The Winson Green Asylum stands on a somewhat elevated
site in the suburbs of  Birmingham.  The buildings are of
brick and  are  mostly  three  stories high.  The  inclosed
grounds, containing some  forty acres, are well kept.   The
institution is  designed  chiefly  for pauper patients, and  is
 managed  by a  Committee  of  Visitors  appointed  by the
 Council' of Birmingham, of which committee  the Mayor is
 a member.  As in many other English asylums, an excessive
 number of chronic  patients have been found to  interfere
 with  the   curative  functions  of this asylum, and, at  the
   ' By the Act of 1853 and that of 1855, the Councils of boroughs having a
 Quarter Sessions, recorder, and clerk of the peace, by giving notice to one of her
 Majesty's principal Secretaries of  State of  their intention so to do, thereby
 assume all the duties and powers conferred by statute upon the justices of
 boroughs in respect to the erection and management of borough asylums. 
104
ENGLAND.
time of my visit, a new one, designed to accommodate some
eight hundred chronic and imbecile cases, was in process of
erection.  This is situated at Rubery Hill, eight miles out of
Birmingham.  Owing  to  limited  accommodations, it  had
been found necessary to  contract  with other  institutions
for the reception  of  patients.  The  provision  made  here
for the pauper insane is not  inferior  to that  for  indigent
patients of the non-pauper  class.
  The several  wards were  well furnished.   In  the  sleep-
ing apartments, there was noticed in front of each wooden
bedstead a strip of carpet.  The furnishing of each bed  com-
prised  two mattresses and a fair supply of bed-clothes.  The
interior brick walls, although for the most part unplastered,
are pleasingly tinted and  stencilled.   In the sitting-rooms
the  walls were papered and  adorned with  pictures.  The
windows were  provided with lambrequins,  and the floors
covered with linoleum.  In some of the apartments  were
carpets and cushioned lounges.   Epileptic patients are under
special supervision.   There  are two padded rooms in the
institution—one for each sex.   In  the  refractory wards, the
floors  are  of  tile.  The windows  have iron sashes,  with
panes  measuring  5x8  inches.  It was said that mechanical
restraint was resorted to only for surgical reasons or for pa-
tients  inclined  to commit  suicide,  and that  occasionally  it
was found  necessary to have recourse to seclusion.
  Those able to work are provided  with employment to the
extent of their  ability.  Six patients were engaged at  shoe-
making.   One of  the  industries carried  on here is that of
match-box making.  A considerable number were engaged
in keeping the grounds in order.
  The attendants were uniformly dressed, the women wear-
ing dark gowns, and white  caps trimmed with green ribbon.
The dress of the patients seemed fairly comfortable, though 
                     BIRMINGHAM.                  I05

some of the men appeared  too  thinly clad, considering the
severity of the weather.  On the men's side are three con-
fined airing-courts used  respectively by infirmary patients,
idiotic children, and the refractory.  There is also one gen-
eral airing-court.
  The Medical Superintendent,  whose experience extended
over  a period of nearly forty years,  spoke of the  great
changes that had taken place in the treatment of the insane
within the memory of  living men.  He mentioned having
seen as many as fourteen men in a single  room chained to
a wall.  Even the fire-irons were in his earlier days chained
to prevent personal injury.  Then, the bare suggestion of
permitting an insane man to use a knife and fork at meals
would have  filled the mind of  an asylum  superintendent
with consternation.  Spoons even were forbidden, but after
a  time were sanctioned ;  and  opinion gradually  changed
until at length the use of the knife and  fork was  allowed.
" I had long desired," he said, " to banish  from  my practice
slavish adherence to mechanical  restraint in every variety
of form which then obtained ;  but  I was  strongly opposed
by the managing Committee.  Indeed, my repeated appeals
in this direction got me into rather bad favor with them.
It so happened that, during one of their meetings, a patient
was reported to be in a condition of great excitement.   He
had  fortified  himself   so  strongly in  his  room  that no
attendant dared  enter.  I was jocosely asked by the Chair-
man of the Committee to put this  patient  under one of my
non-restraint experiments.   The challenge was accepted.   I
went to the ward, found the  patient strongly barricaded, and
threatening death to all comers.   In  spite of the entreaties
of friends and attendants,  I made my way alone  into the
room beside him.   Knowing his great fondness  for tobacco,
and pretending not to notice his disturbed condition,  I pro- 
io6
ENGLAND.
posed a smoke, at the same time offering him some tobacco.
The ruse was  entirely successful.   The  patient  instantly
calmed, and permitted himself to be disarmed and conveyed
to another  ward.  From  that date,  the  managers  of  the
institution ceased to scoff at the practicability of restraint
by other means than that of irons."
  In this old asylum, unrelieved by many modern improve-
ments,  there  appeared to  be little  worthy  of  imitation.
The yards, or airing-courts,  were small and prison-like;
the amount of land and other requirements  insufficient
for the wants  of a large and populous  district like that of
Birmingham ;  and the attendance quite inadequate to give
effect to the advanced theories of the Superintendent.
  Since  my visit, drill, calisthenic  exercises, and singing
classes have been introduced here.  Their introduction  was
the result of the favorable report of a special committee who
visited  the  Richmond Asylum, Dublin, where these exer-
cises form a part of the educational system introduced by the
late Dr.  Lalor.   Other changes have taken place and  im-
provements have been  made by the new Superintendent,
which  have raised this institution  to a higher  standard.
The asylum at Rubery  Hill has been opened, and January
I, 1887, it  contained  574 patients.  This has relieved  the
overcrowding  at Winson Green, which,  on January 1, 1887,
had  575 patients.  The per-capita average  weekly cost of
maintenance during  the year ending  January  1, 1887, at
Winson Green was Ss. n^d.; at Rubery Hill, Ss. $d.

            THE  FRIENDS' RETREAT—YORK.

  Projected in the spring of 1792  and opened in  1796, the
York  Retreat is memorable as the place where  the non-
restraint principle was first adopted in Great Britain—where
William Tuke, on behalf  of the Society of Friends, coura- 
                THE FRIENDS' RETREAT.            107

geously renounced, as did Pinel in Paris, the use of chains
and manacles in the treatment of the insane.
  This  asylum  is about a  mile  from  the city of York.
An ivy-covered wall  incloses the extensive and somewhat
elevated grounds, which are artistically laid out and carefully
kept.  The Retreat, a private institution, or " registered hos-
pital," is still directed by those who  are, for the most part,
members of the Society  of Friends.   It has a yearly income
of about  $75,000.   The buildings  are old-fashioned, but
wear an aspect of unpretentious comfort.   In the oldest
part, some of  the arrangements  scarcely meet  all modern
requirements.   " The  Lodge,"  a  building  recently erected
for  men, is  constructed on  modern  principles,  and fur-
nished  in a style approaching luxury.   Eight  women oc-
cupy a sumptuously  furnished  detached  residence called
" Bellevue House."  There  is also a neat villa residence for
the reception of a few female patients.
   In the wards of the male and female divisions the beds and
bedding appeared to  be clean and  comfortable,  and  the
apartments were warm and well ventilated.  The corridors,
with tinted  walls  and  bright  embellishments,  were quite
pleasing.   The  windows in  the  oldest portion have  iron
sashes, with panes 6£ x y\ inches ; in the newer portions, the
panes are larger, and the sashes are adjusted by weights and
cords.  The patients have their meals in their several wards.
   A large sitting-room, in which were noticed a fernery and
a variety of other attractions, is  used on Sunday evenings
for religious services, at which are  present those of widely
different beliefs.  Patients to whom it  is proper to extend
the  privilege  are  permitted  to  attend public worship in
the city, in the churches of the  various denominations to
which they  belong.  A new association room suitably fur-
nished  accommodates one hundred and fifty  persons, and
here  lectures  and entertainments  are periodically given. 
io8
ENGLAND.
The female  patients assemble  once a  week  for  reading,
music, games, and social  intercourse.   Permission  is occa-
sionally granted to some  of the patients to  visit places of
amusement in York.
  At the time of my visit, the records showed  153  patients
—64 men and 89 women.   The accommodation afforded is
dependent more upon mental condition than  upon the scale
of payment.  While  some are provided  for gratuitously, the
prices paid for maintenance of others range from trivial sums
to as high as  .£400 per annum.  The average cost of support
is about 325.  per week.
  Two padded rooms—one for each sex—are provided in
case of need.  These  are so  fitted  up as to obviate the
possibility of injury.  Locked dresses are not  used, although
strong garments  are sometimes put on when  patients are
sent to their rooms during paroxysms.  Order prevailed
throughout the asylum, and the surroundings were quiet.
  A feature  of the  management is the " autumnal trip "
made every year to  the sea-side  by patients in  charge of
the Superintendent  or some  of  his staff.   Instead  of, as
heretofore on  such  occasions, procuring  accommodations
in expensive  lodgings,  a house has recently been leased in
Scarborough, where those likely to be benefited by a change
may enjoy the salubrious air of the Yorkshire coast.
  A full inspection  of  the  Retreat, with its detached  cot-
tages,  its artfully screened walls, its  beautiful  recreation
grounds, and its  wealth of flowers within and  without, suf-
fices to convince the visitor that this small and select institu-
tion, which  well-nigh a hundred  years  ago proved such a
powerful factor in educating and elevating public opinion in
England,  retains  to this day much of that progressive spirit
and humanity of  purpose upon which its world-wide reputa-
tion rests. 
CHAPTER  III.
                      SCOTLAND.

     THE  present admirable  Scotch  lunacy system  dates
      from August 25, 1857.  Looking backward from that
time, we see little in  the history of the treatment of the
insane in Scotland that  is worthy of commendation,  if we
except what was accomplished in their behalf through pri-
vate benevolence.  The peculiar  superstitions of the people
at one time  contributed to the record of  cruelties perpe-
trated upon this unfortunate class.
  Allusion has already been made to the fact that the insane
were sometimes put to death under the belief that they were
witches.  The  last instance of this kind in Scotland  is re-
corded by Sir Walter Scott as having  taken place in 1722,
and  is thus  described :  " A  sheriff-depute  of  Sutherland,
Captain  David  Ross,  of Littledean, took  it upon him,  in
flagrant violation of the then established rules  of jurisdic-
tion, to pronounce the last sentence of death for witchcraft
which was ever passed  in Scotland.  The victim was an
insane old  woman,  belonging to the  parish of  Loth, who
had  so little idea of her  situation  as to rejoice at the sight
of the fire which was destined to consume  her.   She  had  a
daughter lame of both hands and feet, a circumstance attrib-
uted to the witches having been used to transform her  into a
pony, and get her shod  by the devil."   It  does  not appear
that any punishment was ever inflicted  for this  cruel  abuse
of  law on  the  person  of a  creature  so  helpless.   Scott
                           109 
no
SCOTLAND.
also relates that the son of the lame daughter, he himself
distinguished by the same  misfortune, was in later years a
beneficiary of the Marchioness of Stafford.
  As an illustration of the inhuman treatment of  the insane
at a later period, one method of incarceration is here given,
as described by Dr. Robert Gardiner Hill:  "At  Inverness,
between the second and third arches of the old bridge, built
in 1685, there is a dismal vault, used first as a jail and after-
wards  as  a mad-house.  This  appalling  place of durance,
where the inmates were between the constant hoarse sound
of the  stream beneath and the occasional trampling of  feet
and rattling of  wheels overhead, existed as late as 1815, and
is said  not to have been abandoned till its last miserable in-
mate, a maniac, had been devoured by rats."
  During the latter part of the  eighteenth and the early part
of the nineteenth century the state of the insane poor was
one of  wretchedness and neglect.  In 1818 there were in all
Scotland only  about two hundred and fifty  insane persons
provided for  in public asylums and about one hundred and
fifty in private  asylums.  Twenty  years later the condition
of this class was not  much improved.  There was a lam-
entable insufficiency  of asylum  accommodation.   Large
numbers of the insane were shut up in  private dwellings,
without official supervision ; others were restricted to poor-
houses with no special provision for their care ; some were
confined in jails;  and a few, including even the violent  and
dangerous, were living alone  or were permitted to roam
about the country.
  While  there  existed a reprehensible  reluctance on the
part of the State to discharge  its obligations to the insane,
it is gratifying  to note some noble manifestations of private
generosity  in their behalf.   The opening of  the Royal Ed-
inburgh Asylum in 1813 was the result of individual effort. 
 
 
BENEVOLENT EFFORTS.
Ill
Here, from  the outset, an intelligent and humane system
of treatment was pursued and an opportunity offered  for
the study of mental diseases.  Murray's Royal Asylum at
Perth was erected out of funds bestowed by the benefactor
whose name it bears.  The Crichton Institute at Dumfries,
opened in 1839, was endowed with upwards of $500,000 left
by Dr. Crichton for charitable purposes.   Previous to 1855
seven chartered asylums, called " Royal," had been founded
by  private  charity, but  no government aid  had  been
granted,  except £2,000  to  the  Royal Edinburgh Asylum
at Morningside.  These institutions had expended on lands,
buildings, and  furniture £352,632, in making provision for
both  pauper  and private patients.  But these generous
efforts were wholly  inadequate to meet  the wants  of the
insane.
  The first  parliamentary legislation  to regulate  the con-
finement and treatment of lunatics in Scotland was the Act
55 George III. c. 69, passed in 1815.  This was followed by
the enactment  of statutes for the same purpose in  1829 and
1841.  These several acts, which may be said to have formed
the Scottish code of lunacy, were so ambiguously framed
and so contradictory in many of their provisions that there
was  great difficulty in  administering them.  It  was not
until  1855 that any effective movement was set on foot
to establish a  humane  and comprehensive lunacy system.
And  here it may be proper  to mention  that the  people
of  Scotland  are  indebted  to the  philanthropic  labors
of Miss  Dix  for originating the great  reform  begun  at
that time.  This estimable lady, in relating to the writer
some of  her  experiences while  endeavoring  to  improve
the condition  of the insane in  foreign lands, told him  of
her  efforts  in  Scotland.  It  appeared from her account
that  she  was  greatly  shocked  at the condition in  which 
I 12
SCOTLAND.
she found  the insane  in that country, and  was much dis-
turbed because of the difficulties she encountered in gaining
desired information.  Finally she was refused admission to
an asylum that she particularly desired  to  visit  at  night, in
order to learn of peculiar abuses that she believed were hid-
den from the public.  She applied to a high official in Edin-
burgh for the privilege denied her by those in charge of the
institution.   Being again  refused, she proceeded at once to
London and  laid  before the Home Secretary the  startling
facts of which she  had  become possessed respecting the sad
condition of  the insane in  Scotland. Notwithstanding the
sturdy opposition made by her conservative  opponents, the
result  was the appointment by Parliament,  on the 3d of
April, 1855, of the  famous Royal Commission,  "to inquire
into the condition  of Lunatic Asylums in Scotland, and the
existing state of the  law  in that  country in reference to
Lunatics and  Lunatic Asylums."
  The feeling aroused led to very earnest  work  on the  part
of the Commissioners,  who were engaged two years in mak-
ing investigations and preparing their report.  This brought
to light the imperfections of existing laws,  exposed the  cru-
elties  to which the insane  were subjected, and  opened the
way for the excellent lunacy system Scotland now enjoys.
  Concerning the  chartered  asylums,  the Commission re-
ported  that  they  were " in many respects in  a highly
satisfactory state," that the management was disinterested,
and that  " the treatment  of the patients was  liberal  and
judicious," and, " on the whole, deserving of commendation."
In these institutions the monotony of asylum  life was broken
by frequent excursions, occasional picnics, concerts, lectures,
evening parties, and dances,  and, in a few, by trips to the
sea-side in summer.   There was  some  adverse criticism
made,  however, on these  asylums.  Some  of  them were 
               GOVERNMENTAL INQUIRY.            113

overcrowded and were  imperfectly warmed and ventilated.
Refractory patients were secluded in  dark cells with stone
floors.   In  the  Montrose asylum dirty and  destructive
patients  were permitted to remain  entirely naked while in
seclusion, loose straw being cast on the  floor for bedding.
Complaint was made of  the  general  insufficiency of land
attached  to  asylums,  the absence  of  outdoor as well as
varied indoor employment, and a lack of  many things now
considered essential in asylums for the insane.
  In  many  of  the  private asylums or licensed houses the
Commission found  the  condition of the insane to  be most
deplorable, the principal aim  of  the  proprietors being to
secure increased  profits.  The patients were crowded  into
small apartments, using the same rooms by day and by night,
with no proper separation of the sexes, and, to save candle-
light, kept in bed the greater part of the  twenty-four hours
during the winter months.  The bedding was usually of a
coarse and cheap description, insufficient in quantity, and
not renewed when filthy.   It was stated that in one asylum
women patients  were  stripped naked at  night,  and  two
and  sometimes three were made to sleep in the same  bed-
frame on loose straw,  in a state  of perfect  nudity.   The
proprietor of  another  establishment,  testifying before the
Commission, admitted that the  floors at night were soaked
with  wet ; that half the dirty  patients slept naked ;  that
seven or  more would sleep together in a state of nudity;
and   yet  he considered this  proper  treatment  for them.
Comment was made on the  undue use  of restraint, the
lack of attendants  and opportunities  for  proper  exercise,
and the insufficiency of food and clothing.
  The condition  of the insane in  the poorhouses was, as
might be imagined, unsatisfactory  in the extreme, and was
the subject of severe criticism. 
U4
SCOTLAND.
  The report, while stating that the details furnished  gave
but an  imperfect  representation of  the  true condition of
the insane outside of institutions,  presented an appalling
picture of the  amount of  misery  suffered by  this  class
throughout Scotland.
  It is true  the law  provided a system of inspection ; but
the officers entrusted  with this duty were strangely derelict,
and the Commission found  it necessary to report that  most
radical measures, amounting to an entirely new system, were
requisite to meet the  urgent needs of the time.
  Public attention was directed to the desirability of build-
ing asylums of moderate size;  to the great benefits of  fresh
air, healthful exercise, and  profitable occupation ; and  also
to the disadvantages attending the then too frequent prison-
like construction of institutions for the insane.    The Com-
mission recommended that asylums  should  be more home-
like  in  appearance;  that  strong wire and  iron  enclosures
should  be abolished; and  that more  attention  should be
paid to the principles of heating and ventilation.
  The outcome of this report was the Act 20 and 21 Vict.
c. 71,  passed August 25, 1857, entitled  "An Act  for the
Regulation of the Care and Treatment of Lunatics, and for
the  Provision,  Maintenance,  and Regulation of Lunatic
Asylums in Scotland."  In accordance with  this memorable
Act, a General Board of Commissioners in Lunacy for Scot-
land  was appointed, and  the  country  was  divided   into
asylum districts.   It  was required that asylums  for the in-
sane poor should  be erected where necessary, and provision
was made for their supervision and control.
  At present the lunatics' of Scotland are provided for in
royal,  district, and parochial  asylums, in the lunatic wards
  1 As in England, the  statutory  meaning of the term lunatic includes every
person of unsound mind and every person being an idiot. 
           ESTABLISHMENTS FOR LUNATICS.        115

of poorhouses, in  private asylums, in private dwellings, in
training-schools for imbecile and idiotic children, and in the
lunatic department of the State Prison at Perth.
   The seven  royal asylums are, strictly speaking, charitable
institutions, managed by unpaid boards, who have no pecu-
niary interest in their  prosperity.  All,  except  Murray's
Royal  Asylum  at Perth,  admit  pauper  as well  as  pri-
vate  patients, the board of the former  being paid by paro-
chial authorities, and that of the latter by friends, from which
sources these  institutions mainly derive their support.
   The district asylums, of which there are twelve, are public
institutions,  and  were built  from  assessments.  They are
managed by  district  boards,  and receive only pauper pa-
tients, unless  there is an excess of accommodation.   Where
there is an excess, it may be used for patients of small means,
who pay but  little more than the rate  paid by the parishes
of the district for their pauper patients.
   The parochial asylums, numbering six, have  been  erected
out of taxes levied upon the parishes to which they belong.
They are managed by parochial boards, and are licensed to
receive both curable and incurable pauper patients.
   There  are  sixteen lunatic  wards of poorhouses having
restricted licenses, in which are received only harmless and
chronic cases.   These wards are, in some instances, separate
from the poorhouses,  and  may  be regarded  as  detached
asylums.
   There are six small private  asylums, kept either by medi-
cal men  or   laymen,  which  are  licensed  by  the  Lunacy
Board to receive a limited number of patients.  The private
asylums receive only private patients, and  are required to
obtain annually a renewal of their licenses.
   Besides the above-named receptacles for lunatics,  both
private and pauper patients are received into private dwell- 
u6
SCOTLAND.
ings under the sanction of the Commissioners in  Lunacy.
Not more than  four  patients  can be admitted into any
private house, and a license, for which no charge is made, is
required if more than one is received.
  The largest asylum in Scotland is designed  to accommo-
date not more than eight hundred patients, the prevailing
opinion being in favor of small institutions.
  In  construction, as well as  in  management, the public
asylums have, during the past few years, lost much of their
institutional  character, and have correspondingly gained in
public estimation.  Walled courts, high fences,  locked doors,
physical or mechanical restraint, and the use of stimulants
and narcotics are, to a great extent, discarded.   Among the
reforms are closer and more intelligent supervision, the sub-
stitution, to  a large degree, of moral  for physical  restraint,
and a great increase of industrial occupations.  Considerable
tracts of land have, during late years, been added to several
of the more important institutions.  Farm labor is found to
be  highly beneficial in the treatment of  curable as well as
incurable patients, besides proving an economical source of
supply to the asylums.
  The headquarters of the General Board of Commissioners
in  Lunacy for  Scotland, which is the  chief authority in
lunacy  matters, are  in Edinburgh.  The Board  consists of
five commissioners, who are  assisted  by a secretary  and a
subordinate force of clerks.  Three of the commissioners, in-
cluding the chairman, are unpaid.  The paid commissioners
are particularly charged with the work of visitation and in-
spection.  They have always  been medical  men, though  it
is not specified by the  statute that they shall be.  Two of
the unpaid commissioners have always belonged to the legal
profession, although this is  not required by law; and  at
 present a baronet, who is also unpaid, represents the laity in 
                 LUNACY SUPERVISION.              \\-j

the capacity of chairman.  There are two Deputy Commis-
sioners, who must be medical men.   Their special duty it is
to visit the insane in private dwellings.
  By the action  of the Legislature large powers  are given
to the Lunacy Board.  These  extend,  in a greater or less
degree, over the care and treatment of all lunatics in public
and private asylums, in the lunatic wards of poorhouses, and
all pauper patients in private dwellings.   The supervision of
the Board also extends to every non-pauper insane person
who is kept in a private  house for profit and  suffers  from
mental disorder of a confirmed character;  or who, whether
kept for profit or not, has been insane for more than a year
and  is subject  to compulsory confinement to the house, to
restraint or coercion of any kind,  or who is suspected by the
Board to have been subjected to  harsh and cruel treatment.
The supervision of the Board also extends to those patients
who are possessed  of property  which  has been  placed in
charge of a judicial factor by a court of  law.
  The Lunacy Commissioners are authorized  to grant, re-
new, or suspend  the licenses of  private asylums, parochial
asylums, and  the lunatic wards  of poorhouses.   They are
empowered to institute inquiries, to summon witnesses with
the concurrence of the Lord Advocate,  to examine them on
oath, and to direct  payment of  their reasonable  expenses.
The paid commissioners inspect  not less than  twice a year
all  chartered, district, parochial, and private  asylums and
all the lunatic  wards of poorhouses, as  also the institutions
for  idiots and  the department  for  insane  criminals  in
the prison at Perth.  The Board  is authorized  to employ
such medical assistance as may be necessary, and is required
to make annually a report of  its work and proceedings to
the Secretary  for Scotland, for transmission  to Parliament.
The Lord Advocate, who is  the  chief law officer for  Scot- 
u8
SCOTLAND.
land, has a right to inspect all the books and  proceedings
of the Board of Commissioners.
  The procedure under the Scotch law in consigning pa-
tients  to asylum care is the same whether the person to  be
admitted is possessed of property or is a pauper, and whether
he is to be placed in a public or in a private asylum.  The
sheriff, who is the highest judicial authority  in each county,
and who is intrusted with the power of taking away personal
liberty, is  the  person  who  authorizes the detention  of
patients in asylums.  It  is  necessary  to obtain the order
of the sheriff1 before  either a private  or a pauper patient
can be permanently received into any asylum.   To secure
this, some person must petition the sheriff to grant such
order,  and he must state the relation in which he stands to
the patient.   The petition must be accompanied by a writ-
ten statement of  particulars  signed by  the applicant.  It
must also be accompanied by two certificates  granted  by
registered  physicians, setting  forth that they have  sepa-
rately examined the patient, and found him to be a lunatic
and  a fit person to be placed in an asylum.  The sheriff's
order  must be  acted  on within  fourteen  days after it is
granted, unless it  is  issued  in the  Orkney or  Shetland
Islands, in which event twenty-one days  are allowed.  The
petition for   the  reception  of a  pauper  patient  into  an
asylum is usually presented to the sheriff by the Inspector
of Poor.
   Within seven days after the  sheriff issues an order for the
reception of a lunatic into any asylum or house, the sheriff's
clerk must send notice thereof to the Lunacy Board, stating
by whom the application was made, to whom the  order ap-
plied,  giving the names of the medical men who signed  the
certificates, the name of the sheriff who granted the order,
     1 Under the statute the term "sheriff" includes sheriff-substitute. 
                      ADMISSION.                   II9

and the  name of the asylum or house to which the patient
is to be admitted.
  Under pressing circumstances, when there is  not time  to
obtain the sheriff's order, a patient may be received into  an
asylum on a certificate granted by one  registered medical
practitioner, declaring  that the person named in the certifi-
cate is of unsound mind, and a proper person to be placed in
an asylum, and  that the  case is one  of emergency.   This
certificate may be  granted  by the  medical  officer  of the
asylum into  which the patient  is to be received.  Within
three days, however, the sheriff's order must be obtained ;
otherwise the detention of the patient becomes illegal, and
he must  be discharged.
  When it comes to the knowledge of an Inspector of  Poor
(the local officer appointed under  the Poor Law to manage
parochial business) that there is a pauper lunatic within  his
parish who has not been " intimated " to the Lunacy Board,
he must within seven days inform the Commissioners.  The
Inspector of Poor must also report the case to the Chairman
of the Parochial Board.
  The insane arc not admitted  into  the  lunatic  wards of
poorhouses unless these departments have been licensed by
the Commissioners in Lunacy, and are governed by rules and
regulations approved by them.  Nearly all of the inmates of
the  lunatic  wards have  been former inmates of asylums,
whence  they have been  transferred by  an  order of  the
 Lunacy Board granted on the petition of the Inspector of
 Poor.  They may, however, be admitted  directly upon  the
 sanction of the Lunacy Board.  Both in the case of transfer
 and of direct admission there must be a medical certificate
 stating  that  the patient is harmless  and  does not require
 asylum  care. This must be given by some other than  the
 medical officer of the poorhouse in  which it is proposed to
 place the patient. 
120
SCOTLAND.
  Patients may also  be admitted into the lunatic wards of
poorhouses on  the order of a sheriff, the usual medical  cer-
tificates having been  obtained ; but  as the sanction of the
Lunacy Commissioners is sufficient in itself and the sheriff's
order does not  do away with the necessity for this sanction,
application for  a sheriff's order is rarely made.
  Insane  persons charged with offences inferring danger to
others, or found in a  state regarded as offensive to decency,
on  petition  of the public prosecutor are tried  before the
sheriff, and, if found  to be insane, are, if he  thinks proper,
committed by him to asylum care.   These constitute a very
small percentage of the insane.
  In  the case of  persons  of property becoming  insane, the
highest legal tribunal, namely, the Court  of  Session, is
petitioned upon  medical evidence  to  appoint  a judicial
factor to take charge of the property of the  patient.   This
having  recourse  to  a legal  tribunal whose sittings are in
Edinburgh proved expensive and troublesome in the case of
very  small estates.   In 1880,  therefore, a law was passed
conferring upon sheriffs or their  substitutes  in  the several
sheriff courts in Scotland  jurisdiction in all such cases where
the yearly value does not exceed £100.
  The commissioners have power to grant orders for access
of friends to patients, and these orders must be respected on
pain of a fine not exceeding £20.
  By a section of  an act passed in 1862, the admission to
asylums of what  are termed " voluntary patients " was per-
mitted ; but it  proved to be so cumbersome that  few availed
themselves of  its  provisions.  In 1866 this section was re-
pealed, and  another  having a like object, but  with fewer
restrictions, was enacted.  Under  the law as it now stands
voluntary patients are not  registered as lunatics, and no
medical certificate is  necessary  for their reception.   The 
VOL UNTAR Y PA TIENTS—DISCHARGE.
121
patient  must  make the  application himself  by letter ad-
dressed to the Lunacy Commissioners specifying the asylum
he  wishes to  enter, and with  their sanction  the  superin-
tendent  is authorized  to admit  the applicant.  After be-
coming  an inmate, the patient is  permitted  to leave the
asylum at any time  by  giving three  days'  notice.  Some
persons admitted as voluntary patients are afterwards found
to  be insane, and while remaining  in  the asylum  may  be
regularly committed by a sheriff's order.
  Respecting  the operation  of this law the  commissioners
say in a  late report:

  " We have for some years been able to state that nothing has
occurred to indicate any difficulty or disadvantage traceable to the
presence of this class of patients in asylums; and we continue to
be of opinion that it is a useful provision of the law which permits
persons who desire to place themselves under care in an asylum
to do so in a way which is not attended with troublesome or dis-
agreeable forms, but which nevertheless affords  sufficient guar-
antee against abuse.  At the visits of the medical commissioners
to asylums all voluntary inmates are seen, and they have then an
opportunity of making  statements in  regard to  their  position,
should they desire to make any.  When there is  reason to sup-
pose that  they in any way fail  to  understand the  conditions  of
their residence, we consider it proper to explain these conditions ;
but we have  never found that  the nature of their position has
been intentionally concealed from them."

  The  manner of  releasing  patients from  asylum care  in
Scotland differs materially  from that of England, and  is
worthy of careful  consideration.  The  Scotch method has
been  succinctly  explained  by  Sir Arthur  Mitchell,  one
of  the  Commissioners  in  Lunacy  for  Scotland, as fol-
lows :

  " The very  fact of  restoration to sanity makes the detention of
a patient illegal.  No particular procedure, however, is laid
down by the law for such a case.  The superintendent simply 
122
SCOTLAND.
discharges the patient as recovered, and gives notice of the dis-
charge to the Board. If the patient thinks that he is still detained,
though he  has reached a state of sanity, he can appeal to the
Board, who can order  his discharge,  on being satisfied by the
certificate of two medical persons, whom they  may think fit to
consult, of  his recovery or sanity.   The Board cannot order the
discharge of  any patient of whose complete restoration or sanity
they are not thus satisfied ; but it is a  provision of  the law that
any person having procured and produced the certificate of two
medical persons, approved by the  sheriff, either of the recovery
of any patient, or bearing that the patient may, without risk of
injury to himself or the public, be set at large,  may petition the
sheriff to  order his  discharge, which  order  the  sheriff is em-
powered to grant.  This procedure relates both to recovered and
unrecovered  patients.   The  Board can  thus  only discharge re-
covered patients, but the sheriff can discharge both recovered and
unrecovered.  The  commissioners and the sheriff alike require
to have the condition of the patient testified to by medical men of
whom they approve.  The commissioners do not act  on their own
opinion, except in so far as it falls to them to  determine whether
there is, prima facie, a case for inquiry ; in other words, whether
medical men should be sent to  examine.
   " Again, the sheriff's order, on which  a patient is received into
an asylum,  is not now of unlimited duration.   It does not remain
in force longer than the ist of January, first occurring after the
expiry of three  years from the date on which it was granted, or
than the first day of January of  each following year, unless the
medical superintendent of the asylum in which the patient is kept
shall on each of the said first  days  of January, or within fourteen
days preceding, grant and transmit to the Board a certificate that,
on a careful review and consideration of the case, he is of opinion
that continued detention is necessary and proper.  This provision
is intended to secure a careful yearly revision of the condition of
patients who have  been three years or more in asylums, and a
formal expression of opinion regarding it, and in the opinion of
the Board it is a provision which  practically  does good.  If the
certificate  is not granted, the  patient is ipso facto discharged ;
the certificate especially declares that the continued detention of
the patient is necessary and proper.
   " Private patients can be taken out of asylums at any time by 
SUPERINTENDENT'S CERTIFICATE.
123
their friends ; but the superintendent, if he thinks the discharge
of the patient would be attended with danger, may appeal to the
public prosecutor to interpose his authority  and deal with the
patient as a dangerous lunatic.  On the other  hand, a superin-
tendent  can force the friends or guardians of a patient, whether
private or  pauper,  to remove him, if he thinks  he has so far
recovered that he may be liberated without risk  to the public or
himself.  If his  opinion  as to the  liberation of  such a patient is
resisted  by the friends or guardians, he can appeal to the Board,
who,  on  satisfying  themselves that  his opinion is correct, can
order the discharge of the patient.  The relations and powers of
parochial authorities in regard to pauper lunatics have,  by the
later amendments of the Scotch Lunacy Acts, been made as  simi-
lar as possible to the relations I have just described as existing
between  private  patients and their  friends.   The removal of
pauper lunatics by parochial  authorities is  not  much more diffi-
cult  than the removal of private patients by their friends  ; but
when any pauper lunatic is removed  as unrecovered, the Board
require information from the  parochial authorities  as to whether
parochial relief  is  still extended to him, and,  if  it is, then the
arrangements made for  the patient's care must be submitted to
the Board for their approval and  sanction.  He  remains under
the jurisdiction of the Board  as a patient in a  private  dwelling-
house, and is visited by the Deputy Commissioners from  time to
time. The return of such a patient to the asylum can be ordered
by the Board at  any time.  In this way no injury can be done to
pauper patients  by  the considerable powers which are given to
parochial boards in regard to their removal from asylums ; on the
other hand, the advantages both to patients and to parochial boards
from these  powers are important."

   Persons committed  as dangerous  lunatics must, by  the
terms of the order  of committal,  be discharged  when re-
covered, but  when  unrecovered  they  cannot  be liberated
without  the authority of the sheriff.
   A  released person considering himself to have been un-
justly confined  is entitled to a copy of his committal papers.
   The certificate of  the superintendent or  medical attend-
ant,  which  is necessary to detain  a patient in an asylum
longer than the " 1st  of January,  first occurring  after the 
I24
SCOTLAND.
expiry of the three  years  from the date  on which  it was
granted, or  than the  first day of January of each following
year," is in accordance with section 7 of  the Act 29 and 30
Vict. c. 51, and is in the following form :

  " I hereby certify, on soul and conscience, that I have, within
a period not exceeding one  month preceding the  date  of this
certificate, carefully reviewed and considered the  cases of  the
patients whose names  are subjoined, and I am of  opinion that
their continued detention in the asylum is necessary and proper
for their own welfare (or, for  the public safety, as the case may
be)."
  Superintendents have power without the  consent  of the
Lunacy  Commissioners to  liberate  patients on trial  for a
term not exceeding  twenty-eight  days.  This practice has
proved  so  beneficial  that  it  is  regarded  with increasing
favor.
  Patients  may, however,  be  liberated on probation  for
longer periods, usually ranging from six to twelve months.
This can be done only by  the consent in  each case of the
Lunacy  Commissioners.  During his absence from the asy-
lum the patient  is subject  to  the  inspection  of the Board,
and  if  a pauper lunatic,  his  name cannot  be taken  off
the  poor-roll.   If necessary, he can at any  time  be returned
to the asylum.   Probationary removals were first authorized
in 1862, and from that time to the close  of  1886 there were
2,982 patients  thus temporarily discharged,  530 of whom
were returned to the asylum  before the expiration  of the
period of probation.
  Respecting this excellent provision of  the Scotch statute,
the Lunacy Commissioners  say:

  " The special use of the statutory discharge on probation is to
permit of the conditional liberation of  patients whose fitness for
permanent discharge cannot be  determined without actual trial, 
PROBATIONARY DISCHARGE.
125
 under the conditions of ordinary life,  for longer periods than
 twenty-eight days.  It is frequently found that patients, who ap-
 pear while in the asylum to have improved so much that they are
 fit for being provided for in private dwellings, become  unsettled
 when the restraints of the asylum are removed.  It is not, how-
 ever, justifiable to retain permanently in the asylum all patients in
 whose cases a possibility of such unsettlement is thought to exist.
 The large majority of patients discharged on  probation  undergo
 no deterioration,  and  many are benefited by the change.  By dis-
 charging patients on probation there is an opportunity for testing
 their fitness for permanent discharge, and at the same  time for
 replacing them in  the asylum without  the expense attending  a
 sheriff's order, if  they prove unfit for permanent  discharge.  We
 continue to be of opinion that in some establishments a more fre-
 quent application of the probationary discharge to patients whose
 fitness for residence in private dwellings may be uncertain would
 lead to a larger number of permanent discharges than takes place
 at present."

   A penalty not exceeding .£100, or imprisonment  not ex-
 ceeding six months, may,  without prejudice to  action for
 damages,  be inflicted  upon  officers  or employees  of  any
 public, private,  or district  asylum or house,  who shall wil-
 fully maltreat, abuse, or neglect any person detained therein
 as  a  lunatic patient.  The public prosecutor  usually deals
 with such cases.   Penalties are recoverable before the sheriff
 for making false statements or returns, or for refusal to give
 information  as required by  law.
   Respecting  medical attendance upon  patients under asy-
 lum care,  it is required that all asylums licensed  for one
 hundred or  more  patients  must have a resident physician;
 those licensed  for more than fifty and less than one hundred
 need  not have a resident medical officer, but they must be
 visited daily by a medical man.   Those asylums licensed for
 fifty or less than  fifty patients must be visited twice  a week
by  a medical man.  The  Lunacy  Board has power to
increase  the number of visits, and it may require  a  resi- 
126
SCOTLAND.
dent physician to be appointed to  any asylum licensed  for
more than fifty patients.  It is provided, however, that the
commissioners may give permission to visit houses licensed
for fewer than eleven patients less frequently than twice a
week, but not less frequently than once in every two weeks.
  Out  of an estimated population of 3,949,393 in Scotland
January 1, 1887, there were  under cognizance of the Lunacy
Board  11,309 lunatics.  This  gives the proportion of luna-
tics to  the whole population as 1  to 349.  In 1867, it was as
1 to 469.  In 1858, the proportion was as 1 to 517.   While
the number of lunatics coming under the supervision of the
Lunacy Board during the period from 1858 to the date of
January 1, 1887, increased, according to the estimate of the
Board, 96 per cent, the growth of the population during
the same  period was only 31 per cent.   The commissioners
state, however, that this increase does  not  necessarily indi-
cate an increasing amount  of mental disease, but that they
consider it due, in  a large measure, to a growing readiness
to place persons more  or less disordered in mind in lunatic
establishments.
  The 11,309 lunatics under  the cognizance  of the Scotch
Lunacy Board on the 1st  of January, 1887, were distributed
as follows : in the seven royal asylums there were 3,184 ; in
the twelve district asylums,  3,142 ;  in private asylums, 128 ;
in parochial  asylums, 1,444; m the lunatic wards of poor-
houses, 857;  in private  dwellings,  2,270; in the  lunatic
department  of the general  prison  at Perth, 56;  and in  the
training institutions for imbeciles  or idiots, 228. Of  the
above  total,  9,514 are  maintained out of  parochial  rates,
1,739 from private sources, and 56  at the expense  of  the
State.
   During the year ending May 14,  1887, the average weekly
per-capita cost of maintenance of  pauper lunatics in  royal, 
           INTERVIEW WITH COMMISSIONER.        12/

district, private, and parochial asylums, and schools for im-
beciles was i Of. \d.; in lunatic wards of poorhouses, Js.; in
private dwellings, $s. lod.
  A government grant of  four shillings per capita per week
towards the maintenance of pauper lunatics has been given
since 1874.  It increased from £59,483  in 1875 to£88,258 in
1887.  The terms of the grant are somewhat peculiar.  It is
not a uniform one  of  four shillings per capita.   When the
actual expenditure for a patient falls below  eight  shillings
per  week, only half the amount expended is allowed by the
government.  In  Scotland  this grant  extends  to  pauper
lunatics  both  in  the  lunatic wards of poorhouses and in
private  dwellings.   Lunatic wards  are distinct sections of
poorhouses.  They must  have the  license of the Board of
Lunacy, and they are  managed in accordance with rules laid
down by the  Board.   An examination of these wards im-
presses one with their superiority to the generality of poor-
house provision, this superiority being  due, perhaps, to the
fact that the poorhouses are under the direction of boards of
intelligent and unpaid managers; yet in no case did it appear
to the writer that  the standard of care was equal to that of
asylums.
  The following information, which further illustrates the
workings of the  Scotch lunacy system and  its somewhat
novel features,  the writer  obtained  in an interview with Dr.
Sibbald, one of the Commissioners:
  " Our Board  is called the General Board of Commissioners in
Lunacy for Scotland.  Each lunacy district has its district lunacy
board.  Each town is  governed by its municipality, which is a
representative  body ; but outside the towns the affairs of each
county are managed by Commissioners of Supply, who are, for
the most part, persons possessed of land over the value of ^100
a year.  The Commissioners of Supply meet twice a year.  They
appoint  committees of  their number to attend to local matters, 
128
SCOTLAND.
and they have in conjunction with the municipalities the appoint-
ment  of District  Boards of  Lunacy.   The District Board of
Lunacy, which  is quite  an independent body, has  to  erect the
district asylum, keep it in repair, and see that there is accommo-
dation for all the lunatic poor of the district.  It does not provide
funds for the maintenance  of the lunatics, because each parish
pays for its own ; but it  fixes the rate of maintenance to be paid
by the parishes, provides the building, furnishes it, appoints its
officers, and is charged with  its entire management.
  " Some of the districts, of which there are twenty, are large and
others small.  Sometimes a portion of a county, sometimes a
county, and sometimes a congeries of  counties forms a district.
The district boards estimate annually what is required to build,
maintain, or enlarge the asylums, and the amount is levied  and
collected, with  our sanction,  by the Commissioners of Supply
and the municipalities.   They  cannot levy without our  approval.
The boards differ in size,—the  smallest numbering seven,  and
the largest twenty-one members.   They are  unpaid.  They can-
not put up a building without  our  approval.  They have a great
deal of  liberty ;  but they  are  under the  influence of public
opinion.   If they were to do any thing which the public thought
wrong, then, at the meeting of the Commissioners of Supply in all
probability they would be turned out and others appointed.   We
are required to make a full  report on these asylums, and our re-
port is printed.
  "At the time the Act of 1857  was passed, certain bodies had
already provided  asylums.  All  of them were  established as
charitable institutions.   They received  a  certain  number of
patients  who could not pay any thing, and also those who de-
sired  to  be admitted and  were willing  to  pay  for  their main-
tenance.   Among  these  charitable foundations  were  the  insti-
tutions at Edinburgh,  Dumfries, Montrose,  Glasgow, and Aber-
deen,—all chartered or royal asylums.
  " There were also, at that time,  some of the larger parishes
which had provided asylums for their poor people.   In terms of
an act of Parliament subsequently passed, those parishes  which
had so  provided were  allowed, if  they  made suitable arrange-
ments, to continue to make provision, if  they desired to do so.
The present Barony Parochial Asylum at Lenzie is one of the out-
growths of that legislation.   It is managed by a committee of the
Barony Parochial  Board under rules and conditions approved of 
INTERVIEW WITH COMMISSIONER.
129
by the General Board  of Lunacy.  They require to apply to us
every year for a license  to keep their asylum open.  If the asylum
was  badly conducted, it would be our duty to refuse the license.
Certain other parish institutions are in the same position, as, for
example, the asylums of Abbey, Paisley, and  Greenock.  These
are  parochial asylums  which provide,  among them, for all  the
parishes of  Renfrewshire, whose district board has consequently
no functions.   It has dissolved itself ; but if these parishes were
to fail to provide for the wants of the county in regard to the in-
sane, the district board could be called into existence, and might
make provision.  The remaining parishes  of Renfrewshire have
made agreement with the three which possess asylums.  Each of
these three, therefore, has a certain number of parishes associated
with it, and forms  practically, though not technically, a little
lunacy district.
   "  In Glasgow you have a very different  class of  patients from
what would be usually found in such a county as Fife, Aberdeen-
shire,  or Inverness-shire.  They are  accustomed to different
kinds of  work, and  they are  generally a rougher class in the
towns.  The lower stratum of a town is generally lower than  that
of a rural district.
   "  With regard to asylums, each patient is  admitted on  appli-
cation to  the sheriff.   A copy of the sheriff's order and relative
documents, together with a report on the mental and bodily con-
dition of  the patient, is sent to our office from the  asylum super-
intendent after the patient has been  admitted.  These documents
and the report are examined  so as  to ascertain  whether the law
has  been  complied with and whether the person is  a proper sub-
ject  for  asylum treatment.   Therefore we have not only the
assurance of the two medical men who  sent the patient, in believ-
ing  him to be insane, but we have the additional assurance of the
superintendent or asylum medical officer.   If  we find the person
described in a manner which does not  clearly  indicate that he is
insane, we  write back asking  the  superintendent whether he
considers him insane.  If the superintendent is  still unable  to
 give a more  definite  opinion,  we  say:   ' Report  again  in a
month.'  If, at the end of that period, he is still unable to certify
 to  the person's insanity,  we   say :  ' Send  him  out.'  We  also
 require from superintendents a report on the physical condition,
 to show whether the patient, on admission, bore marks of having
sustained injuries.   We do not provide a  special form of report. 
130
SCOTLAND.
In case of  injury during confinement, the superintendent  is
required to  report fully as to the nature of  the injury and the
circumstances  under which  it occurred.  If  the report  is not
regarded as  satisfactory, an inquiry is made by one of the com-
missioners.   In all cases where blame is attached to any one the
occurrence is reported to the public prosecutor.
  "With regard to transfers from an asylum, practically, we can
enforce the transfer of a patient should we have reason to believe
that he would be more benefited by being  boarded out or placed
in some other institution ; but the Board would only  interfere for
the purpose of removing a patient to a private dwelling after one
of our visits  of inspection—after  we had seen the patient, and it
appeared to  the commissioner that  he did not seem to require
asylum treatment.   The visiting commissioner would first discuss
the  matter with the superintendent.   If the discussion was not
satisfactory,  the man  would  probably be  visited again or ex-
amined by some one else."

  Family care, or boarding-out, as it is called, is an important
feature of the Scotch system, there being, as  already indi-
cated, about one fifth of the Scottish insane provided for in
this  way.   On the  1st  of  January, 1887, those in private
dwellings numbered 882 males and 1,388 females, being, as
compared with the foregoing year, an increase of 92.  Of the
total, 130 were  private and 2,140  pauper patients.  The
Deputy  Commissioners in visiting these widely scattered
patients, many of whom are in remote parts of the country,
perform  a  laborious  task  unparalleled  in  the  history of
lunacy supervision.
  It is claimed that the boarding-out of pauper  patients in
the  residences  of persons occupying  positions similar to
what the patients would have occupied had they been sane
affords  a convenient outlet for  the  over-accumulation of
chronic cases  in  asylums.   Rural districts  are preferred to
towns for this purpose, because in such localities the patients
more easily obtain healthy  occupation, and have more fresh
air  and liberty.   The weekly cost per capita has been esti- 
BOARDING-OUT.
131
mated at about four shillings below the average asylum cost.
A low rate of maintenance in institutions tends, however, to
lessen the number of patients boarded out.
   The  method of  placing the  insane in families and  the
supervision exercised by the General Board of  Lunacy over
those  boarded  out were thus described by  Commissioner
Sibbald :

   " There are only two or three places in this country where you
can see a considerable aggregation of patients.  We do not con-
sider grouping in large numbers desirable, but prefer that patients
should  be scattered.  One  of  these groups  is at  Kennoway, a
village in  Fifeshire ;  there are others at  Balfron and Gartmore in
the counties of Dumbarton and Perth.   At Kennoway, much has
been done to prevent aggregation increasing ; but it has increased
more than we think desirable.  Each family is examined as to its
suitability for the reception  of cases.  For the particular class to
which it is adapted in this country, the system works well.  The
Glasgow parochial authorities  are among  those who take great
interest in  the  boarding-out of  pauper lunatics.  They send
periodically a committee  of their  number for independent visi-
tation,  and take a  personal interest  in  the condition of the
lunatics.
   " Our general principle is, that, as far as possible, we should
have a system which will provide for each case according to its
requirements.  If a person requires to be placed in an expensive
asylum—one with elaborate  structural arrangements, and where a
great deal of  attention  would  be  bestowed,—he  should be sent
there.   If  patients are  fallen into a condition that makes them
easily managed, and if they do not require very special  arrange-
ments, but, at the same time, are not suitable for a private family,
we think it desirable that they should be provided for in institu-
tions less  elaborately arranged, but where their  wants will be
supplied.   Those  who  do not come under either category, we
desire to see provided for in private homes.   As a rule, patients
boarded out do not include  acute cases.  It is an accident if such
a case is included, or it is when the family are the natural guar-
dians of the patient.   For instance, a man is taken ill, he becomes
a lunatic, requires to be aided from public sources, and  must be
attended to.   His family desire our permission to keep him in a 
132
SCOTLAND.
private house.  If the  case promises to be a short one, and the
patient can  be efficiently treated at home, he is not sent to an
asylum, but remains with his  friends.   Every one who receives
public assistance must be reported to the Board.  If a lunatic is
boarded in a family other  than his own,  he  must be reported ;
but he can  remain in his  own house without being reported,
unless  he is  subjected  to coercion or restraint and  the insanity
has existed more than one year.  If friends  require to exercise
control to deprive him of ordinary liberty, they can do so, even in
his own house, only for twelve months ;  thereafter  he must be
reported, and they must submit to whatever we think is desirable.
Every person among the insane poor who is boarded out is visited
four times a  year by the medical officer  of the  parish, and twice a
year by the Inspector of Poor of the parish.  These visits are all
recorded in  a book kept by the person to whom the house  be-
longs, and  in the record of the visit there is a statement including
several details ; such as, that the patient is satisfactorily provided
for ; that he has every thing he requires ; and  that the conduct of
the guardian appears to be suitable.   This  book contains the six
entries every year.   It is seen  by our Deputy Commissioner when
he makes his visit ; and if the entries are not made, he takes note
of the fact  and  reports  it.  We immediately inquire into  the
reason, and take what steps  seem desirable  to put the thing right.
Not a  month  passes but some action  has to be  taken by  the
Board  either for  the removal of patients  to  the  care  of other
guardians  or for  obtaining  some changes  in  the arrangements
having for their object the improvement of the condition of  the
patients.  When a patient is believed to be  improperly treated by
a guardian we  take steps to  have him removed at once.   The
District Lunacy Board has nothing to do with this part of  the
work.  We deal directly with the officers of the parish  to which
the patient belongs."
   The correspondence of  the Board  in  connection with this
branch of the work  is  very  voluminous.   Each  case is ex-
amined into with  great thoroughness,  and the reports and
papers relating thereto are  separately  filed.  It  appeared
from the records that, in some cases, as  many as six letters a
month had been written.    In one instance, the correspond-
ence extended through a  period of seven  years;  in another 
BOARDING-OUT.
133
case,  that  of a boarded-out female, through fifteen years.
Our informant continued:

  "These reports the Deputy Commissioner takes with him in
going his rounds over the country, and they supply him with a
history of each case.  A few he does not deem it necessary to visit
every year.  Some patients are exempted altogether from visitation.
They  are persons who are known to enjoy an amount of liberty
differing little from what is enjoyed by sane persons, and who live
in comfortable circumstances—where there  is absolute certainty
that the patient is comfortable and well treated.   It may be one
living much in the gaze of the public, about whom there  is no
doubt.  In such a case, we do not say : ' You are a lunatic, and I
come  to inspect you.'  It does not rest with  the Deputy Commis-
sioner, however, to leave off visiting.  The case must be reported
here,  and we may approve or disapprove of  the Deputy Commis-
sioner's proposal to discontinue visits.  Frequent visitations are
made in unsatisfactory cases ;  but we desire to avoid ' red  tape'
in carrying out our arrangements.  We strive to have good reason
for  whatever we do—to have matters properly considered, to
avoid interference where interference can  do no good, and to
spare  no pains where interference  seems likely to be useful."

  The great pressure on asylum accommodation  and the in-
ducements offered by the  lower charge for  support  in  fami-
lies doubtless have much  to do with the extension of the
boarding-out system in Scotland.   The  price paid  for the
maintenance  of paupers  boarded  out is not  uniform, but
depends on  the  locality  and  its proximity to  a  market.
In  justification of  the extremely low  rates paid in some
localities, one of the Deputy Commissioners says:

  " The  Shetland  guardian, who undertakes to maintain an un-
productive  lunatic at the rate of  2s." (say 50 cents) " per week,
may, at first sight, seem to be badly treated, as compared with
the  Lanark guardian, to whom Ss. per week is paid for the main-
tenance of a similar  patient.   When, however, it is  considered
that in the  latter country every article supplied for the use of the
patient  is  a readily  marketable  article,  procurable only  by
exchange for money or marketable labor, and that in the former 
134
SCOTLAND.
the habits of the people and the abundant supply of fish for food
render it almost unnecessary for the  careful guardian to expend
the allowance in anything but  luxuries, the difference is seen to
be only an apparent one."

  As much  interest attaches to the boarding-out system, a
personal inspection was made of a  considerable number of
the cottages in which the insane are received, and it  may
not be out  of place to describe briefly the  homes and sur-
roundings of some of those intrusted to  family care.   Ken-
noway, a small village near the Fifeshire coast, was the first
place visited.  It commands  a pleasing view over the  Firth
of Forth, though distant about three miles from the sea.
The narrow and irregular streets and the antiquated look of
some of the one and two story houses ranged on either side
proclaim the primitive  character of the  place.   Here,  as in
most of the country villages of Scotland, surface drainage
prevails.  Some  of the  dwellings  have  tile   and  others
thatched roofs ;  and, although a fair degree of  cleanliness is
maintained, there are evidences on  every hand that the in-
habitants are unambitious, there being little scope for enter-
prise. They have, apparently, succumbed to the inevitable and
quietly settled down to their cramped surroundings. Trade,
which consists largely  of hand-loom weaving, has been  on
the wane for years,—a circumstance which tends to explain
the decrease of population and  the  moderate rental of the
houses.   Several rent small patches  of ground ; and, besides
the few trades-people and small shopkeepers necessary to  meet
the limited requirements of the place, there are resident in
the village, the  clergyman of the parish, a  medical man, a
schoolmaster,  and an  inspector of poor.  Sheltered by heath-
clad hills from the cold north wind, and secluded, though not
distant  from  the larger centres of population, Kennoway
has apparently been well chosen as  a settlement for the in- 
BOARDING-OUT.
135
sane.   And now let us glance at the  interior of  some of its
cottages as described in my notes.

  (a) Here, in a one-story cottage, plainly built of  stone, and
having a red tile roof, reside an aged married couple—the husband
very deaf.   The wife, it must be confessed, is not over cleanly in
appearance.  The boarders are two female lunatics, one of whom
is abed, and the other walking about in her room, which  is of
goodly size and has an open fire-place.  On the papered walls are
a few pictures,  and the furniture comprises a wooden table and
one or  two  chairs.  The other  and  better furnished  apartment
occupied by the first-mentioned patient contains abed in a recess,
an inclosed closet, an open  grate,  a carpet  on the  floor, and
mahogany chairs  with hair bottoms.  Each boarder is received
at six shillings per week.  The housewife, referring to the patients,
says : " They gie verra little trouble, troke aboot, and are able to
dae ony little thing for themsels."
  (£)  This is an antiquated two-story-and-garret stone cottage with
red tile roof.  It is occupied by a widow who  boards four female
patients.  One  of these is subject to epileptic fits, and keeps her
bed.  The  other,  a  woman nearly fifty-three years of age, has
been  here about  seventeen years.  She  takes her  meals in the
kitchen, which is of fair size, and has a red brick floor and an open
fire-place.   In  the four  other apartments are  open fire-places,
carpeted floors,  hair-bottomed  mahogany chairs, and close-
curtained  wooden bedsteads.  Among  other objects  seen are
flowers and dried grasses, pictures on the walls, Scriptural  mot-
toes, etc.  One of the patients says : " The mistress is verra  kind
to ilka body i' the house, an' we help  her to  keep it in good
order."  Each of the patients is paid for by the parochial board
at the rate of 6s. per week.

  The  buildings, though in good repair, are many of them
old and quaint-looking.   The one last mentioned has corbie-
stepped gables, and above the doorway is a stone panel with
a coat-of-arms in das relief surmounted by  a crown  and bear-
ing date 1712.

  (c)   In this two-story  stone building, which  is occupied by a
widow,  there are  boarded four female patients. Two of  these 
136
SCOTLAND.
occupy separate sleeping-rooms up-stairs, and the other two, who
are from the  Edinburgh asylum, have a room on the lower floor,
in which are two beds.  The latter are upwards of  fifty years of
age, and they occasionally promenade about the large garden in
the rear of the  house or along the not-much-frequented roadway
in front.  One  of them has a  disposition to  work.  Open fire-
places are used, and there is an appearance of cleanliness and a
fair share of comfort.  The patients living up-stairs have their
meals separately conveyed  to their  rooms.  They  have oatmeal
porridge in the  morning, beef broth with potatoes for dinner, and
tea at night.  The housewife assures us, " They 're a' very easy
tae pit up wi'."
   (d)   The tenant of this house is a contractor, who owns a pair
of horses and a couple of  carts.   Two male patients are boarded
here, one sixty  and the other forty-five years of age.  They sleep
in separate beds in a room  up-stairs with low ceiling.   It meas-
ures 17 x 18 feet, and has an open fire-place.   The furnishing is
plain,  but seemingly  comfortable.  The  patients  dine  in  the
kitchen with the contractor and his wife.  Breakfast at  8 a.m.
consists of porridge  and milk ; dinner between 12 and  1 p.m., of
broth with beef or home-cured pork  ; at 6 p.m. tea is served with
bread and butter; about 9 p.m. bread and milk.  On certain days,
for dinner, rice and milk with bread  and potatoes are substituted
for broth.  One of the boarders has been five years in this house,
and is spoken  of as  " a handy sort o' bodie, who gies verra little
trouble and does what he 's  bidden."  The patients are paid for
at the rate of 6s. 6d. each per week.   They find plenty of exercise
in the garden,  and are  said to manifest no disposition " to rin
awa,' bit jist paidle aboot  the street."
   (e)   This is a one-story cottage with red tile roof.  A parapet
wall with iron  top-railing and two iron gates  encloses  the front
plot  of ground, which is  made  attractive  with shrubs, fuchsias,
climbing roses,  and other  flowers.   In this clean and tidy dwell-
ing, tenanted by  an aged  married  couple—the mistress being
about  seventy—are  three  snug-looking apartments.   The  two
female patients  occupy separate beds in a parlor, where an open
fire burns brightly.   The bedding  is comfortable, and the old-
fashioned wooden bedsteads are curtained.  One of the patients
has been here nine and the other seven years.   The latter, nearly
seventy years old, takes her breakfast in bed.  Says the house- 
BOARDING-OUT.
137
wife :  " The tither ane gets up and scrubs the floor and carries
water  frae the well."  The worker thus referred  to  is about
fifty years  of  age.  Their washing, the aged landlady says, is
given  out.
  (/)  In a one-story cottage of two apartments, tenanted by a
maiden lady, are two patients, one of whom is an old woman who
has boarded here for the last eighteen  years.  The landlady, a
weakly person and in humble circumstances, keeps a female ser-
vant to do the housework.   The  interior is not  over cleanly,
though the patients' room seems rather tidier than the rest of the
house.   The elderly patient sleeps in a bed occupying a recess
in the  wall.  The furnishing  is fair.  The patients receive  their
meals together in the kitchen.  One of them  informs us that she
is " quite comfortable an' has jist to gae oot an' tak' a walk doon
the lane when  she likit."
  The patients  living under family care are,  as has been
stated, distributed  over all  the counties in Scotland, and
efforts are made, as far as possible, to prevent any aggrega-
tion in  localities.  Quiet  rural  districts,  however, afford
peculiar  facilities for boarding the insane, and where  such
places are peopled by sober  and industrious  peasants in
humble  circumstances, willing  to receive,  at  a low  rate,
patients  of docile character, it is  not  always easy to prevent
undue accumulation.  The  counties  in  Scotland containing
the largest numbers of patients  in private  dwellings are
Fife,  Perth,  Edinburgh, and Lanark;  where  it is to  the
advantage of the small farmer to board one or two of this
class.  Many are  accommodated and  their labor  utilized
among the crofters of Orkney, Shetland, and other sparsely
populated districts, where  provisions  are  cheaply raised,
and where even the  meagre  allowance  of the parochial
authorities is  an inducement.  Without wearying the reader
by recounting cases in which the details are similar in char-
acter, only two more illustrations of family care will be given,
as witnessed in one of the more remote of these rural dis- 
138
SCOTLAND.
tricts.   The following are taken at random from  the notes
made :

  (a)  In a  plain, two-story, tile-roofed  house  are  two  male
lunatics, one of whom, named Peter, is subject to epileptic fits.
He has been here seven years. The guardian informs us that the
fits to which he is subject come on at intervals of a fortnight, and
that the patient is allowed to go about until the attacks abate.
He is described as a hard smoker, and when disposed to consume
too much tobacco, a portion is withheld. This invariably enrages
him ; but, as the guardian remarks, " He soon calms doon again."
Charlie, the other, has been in this house for about twelve years,
and was formerly boarded with  the father  of his present host.
Neither of the patients ever tried to run away.  Both sleep in a
good-sized back bedroom, in which are  separate iron  bedsteads,
with bedding clean and comfortable. One of the sheets has been
torn somewhat by Peter, and he is reported as sometimes  at-
tempting to destroy his clothing.  On  the  wooden  mantel are
flower-vases with dried grasses and  numerous little ornaments ;
on  the papered walls are  pictures, including a large  portrait of
the great poor-law reformer and eminent divine, Dr. Chalmers.
In  the plainly  furnished kitchen, a grate fire with open range
sends forth a  ruddy glow.  On  the  upper floor  is a front room
ready for other patients.  It is  furnished with  Brussels carpet,
stuffed-bottom  mahogany chairs, a book-case, and a large double,
iron bedstead with a brass top-rail.   There are two-sash windows
with Venetian blinds.  The stairs  leading  to this comfortable
apartment are of varnished pitch-pine, on  which is laid a strip of
colored oil-cloth.  The patients  take their meals with the family
in the kitchen.
   (d)  Here, in  a low, plain stone cottage with red tile roof, an
elderly widow retains as boarders two adult female pauper luna-
tics, who have been in the house about five years ; also a sane girl
about ten years old, but boarded out by the  poor-law authorities
for the past  four years.  The little girl is out on a " berrying "
excursion with other children of the place.   Another of the in-
mates  is a sane blind woman, who has  been boarded out by the
poor-law authorities for the  past six years.  The kitchen pave-
ment laid with concrete cement and the parlor floor  of wood
are clean.   The  furniture  is plain, but  tolerably comfortable. 
A  DEPUTY COMMISSIONER'S VIEWS.        139
The space  within  this  small  one-story cottage seems insuffi-
cient for the requirements of the inmates.  It is a matter of sur-
prise that so  many  dependents differing so materially in  their
mental  and physical conditions should receive common  care
under the same cottage roof.

  Dr.   Fraser,   Deputy  Commissioner,  whose  visitations
during  1884 extended  to 1,073 patients in private dwellings,
says:

  " Every year there is in my experience a  manifest change for
the better in the condition of the insane provided for in private
dwellings.   Any thing like retrogression in  the condition of a
patient  so provided for stirs  up active interference, the end of
which, if the Board fail to bring back a satisfactory condition,
may be  a resort to asylum care and treatment.   There is, and I
fear there always will be, a small number of  the boarded-out
insane, chiefly under the care of  persons bound to them by ties of
kinship, whose condition cannot be regarded as satisfactory.  In
these  cases  the condition in which the guardians  live is some-
times far from being what is  desirable, especially as regards
cleanliness and comfort ; but when there is a kindly treatment
founded on natural affection, it is often thought well not to  insist
on the separation of parents and children, or brothers and sisters,
though  there  may be a slovenliness and want of cleanliness in
the surroundings of the family which are greatly regretted, and
which may be  found to exist in  neighboring houses occupied by
poor rate-payers.
  "As regards the great majority of the insane in private dwell-
ings in my district, I have not  the  least  hesitation in saying that
they are adequately and suitably provided for ; that their general
condition is  a  satisfactory one ; that they enjoy  a more rational,
normal,  and healthy  life than any institution could afford them ;
that they are satisfied with the arrangements made for their care
and comfort;  and that  they would not  exchange their domestic
and other privileges for  any other  treatment of which they may
have had experience.  The evidence of the correctness of  these
views lies in the low mortality which exists among the boarded-
out insane, their  good health and good physical condition, the
rarity of accidents among them, and their general contentment." 
140
SCOTLAND.
  Respecting the  adoption of  the system elsewhere, the
Deputy Commissioner gives it as his opinion that Scotland
has no special advantages for the treatment of the insane in
private dwellings, but that " other  countries possess retired
hamlets  and villages, clean  and  tidy cottages, and  thrifty,
respectable, and matronly housewives, who would  make ex-
cellent nurses for the insane.   The system has been firmly
established in Scotland, and  is  growing  there,  mainly, if
not entirely, because there is  faith in it, and earnest efforts
have been made  to render its  working satisfactory."
  Deputy Commissioner Lawson,  whose visitations in 1884
extended to 879  boarded-out patients,  divides the pauper
patients  visited into four classes.


  " In each  house,  and  with the patient before me, I have
recorded in my visitation book my impression of the satisfactori-
ness or unsatisfactoriness of his care and guardianship.  In doing
so I divided my patients  into four classes, under headings indi-
cating the nature of the provision  made for them, namely, Bad,
Middling, Good, and Very Good.   Of course it is impossible to
insist, in  localities so diverse in their notions of social comfort as
are the counties embraced  in my district, on a uniform standard
of excellence.  We must regard  lunatics, whether in Shetland or
in Roxburghshire, as being under ' Good ' conditions who are as
well provided for as sane people in the same rank of life in their
neighborhood.  Under the heading of ' Very Good' I embrace
cases in which the amount  of care  bestowed on the patients and
comfort enjoyed by them are conspicuously superior  to what
their surroundings would  have  led one to expect.  Under the
term ' Middling' are grouped patients who, though on the whole
sufficiently well provided  for, are neither  in themselves nor in
their  surroundings  so comfortable as similar  patients in the
same district.  They make up the  class in which advice and ex-
postulation are needed, and are generally effective.  Under the
heading ' Bad ' I include patients so unfavorably situated that an
immediate change of guardianship would, apart  from other con-
ditions, be considered advisable." 
POLICY OF THE BOARD.
141
  In summing up, Deputy Commissioner Lawson finds  the
condition of 24.3 per  cent  very good, 60.6 good, 12.2  per
cent middling, 2.9 per cent bad.
  Of 6y non-pauper patients in private dwellings visited, the
same official reports that he " found them, without exception,
suitably provided for, and in a manner in keeping with their
resources.   Many of them are so completely integrated with
the  families, whether  related or unrelated, in which they
live, that visitation is more  or less formal.  In the houses
specially licensed for receiving a limited number of private
patients  and  boarders,  I found the  inmates  and  lodgers
satisfied and comfortable."
  The Scotch Lunacy Board defines its policy in respect to
the boarding-out system  as follows :
  " It is sufficient to say that the policy of the Board, of which
the boarding-out  has  been an outcome, has been to discourage
the unnecessary  or needlessly prolonged  removal of pauper
lunatics from the position  which  they would naturally have oc-
cupied if they had been sane ; and  where  such  removal is re-
quired, either for their own welfare or the public interest, to prevent
the restrictions and other circumstances of  their treatment from
interfering more than is necessary with their  natural mode of  life.
With this  view we have striven to prevent the unnecessary or
inconsiderate removal  of  patients from  their own  homes, to
encourage as far as possible the abatement of the prison features
of asylums,  and  to  stimulate the relegation of patients from
asylums to their  homes when asylum treatment  ceased  to be
beneficial.   In accordance with this, we have encouraged the
transference of patients in asylums for whom asylum treatment
had  become unnecessary to the houses of strangers in their  own
position in life, but only when no  relatives could  be found  able
and  willing to take efficient  care of them.  In this  way the
boarding-out has had the  effect of diminishing the demand for
further asylum accommodation, and has permitted a considerable
number of pauper lunatics  to  live in a way little  removed in its
character from the mode of life which they would have led  had
they not suffered from insanity." 
142
SCOTLAND.
  A considerable number of institutions for the insane were
examined in Scotland, but descriptions of only one each of
several different types of asylums are here given.

  THE BARONY  PAROCHIAL ASYLUM, VVOODILEE, LENZIE.
  This asylum is managed by  an unpaid committee  con-
sisting of ten members of  the local Poor-law Board of the
Barony parish of Glasgow.  It  accommodates upwards of
five hundred  patients, mostly from the  city, a large pro-
portion of whom  are the acute, suicidal, and  dangerous.
The Barony  parish was one of the first in Scotland to  avail
itself of the powers of the Act enabling poor-law authorities
who had already provided  accommodation for their  insane,
to continue to do so under  license of the Commissioners
in Lunacy without  interference from the district boards.
Under the powers thus conferred upon them, the Barony
parochial  authorities erected, at a cost of  about  ^300
per bed, one of the best pauper  asylums  in  Great Britain.
It occupies a healthful and  pleasant country site, ten miles
distant  from Glasgow and three fourths of  a mile  from
Lenzie.  It has attracted much attention  on account of the
amount of liberty extended to the patients, the absence of
locked doors and all kinds of walled enclosures, and the
substitution of well-directed employments for mechanical or
chemical restraint.
  There  are three  hundred  and  eighty-two acres of  land
belonging to the asylum.  Twenty acres are reserved for
exercise and recreation ; the  remainder, as also some leased
land,  making in all  upwards  of four hundred  and  fifty
acres, is worked under a thorough agricultural system, and
affords  outdoor employment to  a large number  of the
insane.  A considerable number of working patients,  with
attendants skilled in farming  and dairying, occupy detached
dwellings on the farm lands. 
                       WOODILEE.                    143

  At the  entrance  to  the  asylum is a neat porter's lodge
occupied by a married attendant and several patients.  The
asylum  buildings, which are of two stories, are artistically
designed  and advantageously disposed.  The  grounds are
tastefully ornamented  with shrubbery and flowers. Nothing
in the  semblance of wall  or enclosure meets the eye, if we
except an iron fence at a distance of ninety yards from the
main building, and  bordering the  Edinburgh  and Glasgow
Railway.  This road extends three quarters of a  mile through
the  asylum grounds,  and  nearly  two hundred trains pass
over it daily.
  The asylum officers consist of a medical superintendent
and  assistant, a chaplain,  clerk to committee, house  clerk
and steward, assistant steward, matron and assistant matron.
There is one attendant to ten patients. The male and female
sides of the building are each divided into four distinct sec-
tions.   Each section  contains  about sixty  beds, and  is in
charge of a chief attendant, under whom are  three subor-
dinates.   At the time of  my visit,  there were in all 476
inmates—241  men and 235 women.
  The lower story of  the  asylum  building is  set apart for
day use; the upper, for night occupation.   In  the dormito-
ries,  the uncarpeted polished pine floors have an appearance
approaching  elegance.  The polish is imparted by using a
compound of beeswax and turpentine, which is  applied with
a soft cloth  fastened  on  a weighted block.  The work of
polishing is done by patients who  cannot otherwise be well
employed.  The walls are tinted and adorned with pictures.
The  air is made fresh  and  pure by opening the windows as
soon as  the rooms  are vacated  by the patients.  By means
of two  large open  coal fires the dormitories are heated and
ventilation is promoted.  The windows of the  upper apart-
ments have neither iron sashes  nor outer guards.   This ar- 
144
SCOTLAND.
rangement, approved by Dr. Rutherford,the Superintendent,
forms part of the free system obtaining  throughout the in-
stitution.  For some  of  t,he single rooms, sliding shutters
are used.   As was found elsewhere in Scotland,  the  beds
were comfortable and bed-clothing abundant. Each bed was
furnished  with a palliasse, hair mattress, two pairs  of heavy
blankets,  sheets and  coverlet,  hair  bolster,  and feather
pillows.  The bedding  is  carefully attended to,  and  the
sheets and blankets for  each division have a distinguishing
stripe.   The strong wooden bedsteads have elastic slats and
substantial head and foot boards.   The beds and bedsteads
are thoroughly renovated every fortnight.  The associated
dormitories  have  each  two small bureaus and chests of
drawers, a double breadth of three-ply carpet  in the centre
of the room, a rug by the side of each bed, besides minor
articles which add to the comfort and cheerful appearance of
the room.  Each associated dormitory has eleven beds.
  In the  fourth division there are eight  single rooms.   Al-
together there are  in the institution one hundred and four-
teen single apartments.  Two strong rooms on either side
have double  doors, and  windows  effectually protected by
sliding wooden blinds.
  The infirmary wards are even more liberally furnished  than
the other  apartments.   The furniture includes Brussels  car-
pets, easy and invalid  mahogany chairs, centre tables, book-
cases, etc.   In the rooms for convalescent patients, the win-
dows have ordinary wooden sash, the panes measuring iox 16
inches.  Epileptics are  separately cared for and closely super-
vised in the infirmary  department.   Here are large  un-
screened open fire-places.  This department has an attract-
ive aviary, in which the patients  seemed much interested.
Suicidal patients are assigned to  the various  wards,  and
over them a special watch is maintained. 
                        WOODILEE.                    145

  The bath-rooms are conveniently arranged, and furnished
with  mirrors, combs, brushes,  etc.  Water is  pumped  to
reservoirs  in  the  towers of the  building, whence  it flows
to every part of  the establishment.   A dial on  the  lower
floor indicates the quantity of water stored.
  Two  sewing or day rooms that I entered on the  ground-
floor  are  likewise cheerful and  well-furnished apartments,
each having a work-table, piano, comfortable lounges, flower
vases, and  other  articles of use and decoration.   The open
fire-places  are made more attractive by bright-colored tiles.
Pleasing outlooks are obtained from the wide bay-windows.
A considerable number of women patients were here  at work,
apparently contented and happy.
  There is a large, tastefully decorated hall with raised plat-
form on which was a piano.  The hall is appropriately fur-
nished  and is used  for entertainments, including weekly
dances, which are  exceedingly  popular with the inmates.
A band composed of attendants and  patients plays  every
Saturday  afternoon,  either in the hall or  out-of-doors, ac-
cording to the weather.   The asylum  is well supplied with
reading matter, consisting of books and cheap publications.
  In the dining-hall I saw about 225 men and nearly as many
women at dinner.  The tables, covered  with  snow-white
linen, were ranged in three  rows or divisions.  There were
chairs for  eight persons at  each table.  On  one side of the
hall were the  men, and on  the  opposite side, the women ;
while the intermediate centre space was occupied  by the at-
tendants.   The table furnishing, except for the suicidal, em-
braced a variety of articles, including casters, water-bottles,
ordinary spoons, knives and forks, soup and dinner plates,
bright metallic  soup-ladles, tureens,  and  salt-cellars.   The
meal, which was well served, comprised Scotch  broth and
dumplings, with meat and a plentiful  supply of vegetables. 
146
SCOTLAND.
The food was nourishing, well cooked, and palatable.  Half
an hour is allowed for the patients'dinner; then follows that
of the attendants, which is partaken of in the  presence of
the patients and while they remain  sitting  at table.  Both
have the same kind of food, except on two days of the week,
when the attendants  have soup and fish for dinner.  The
insane are not permitted to carry food from the table, and
care is taken to remove all the dishes and  knives and  forks
before they leave.  The windows of the capacious  dining-
room are large, and have single panes to each sash.  It was
stated that  but one of these had ever been broken by the
inmates. The Superintendent  said he preferred bringing as
many of the insane as possible into the  dining-hall; for, he
added : " The most difficult as well as the  most important
part of asylum work is for the attendant to learn  the pe-
culiarities of his  patients."  The sick, however, as well as
those who cannot  be trusted  in  the dining-hall, have  their
meals  carried to  them.  Epileptics dine with the other in-
mates.  Two had attacks of epilepsy during the meal.
   The kitchen is of one story, and has a large central  hood,
or  funnel, for carrying off the steam  from the  food  while
cooking.  Thirty brightly polished tea and coffee urns were
observed in  their appropriate places.   The floor was of tile,
enhancing  the neat appearance  of  the  apartment, which,
with  the store-room  adjoining, was orderly  arranged and
carefully kept.  Throughout  the asylum,  every article of
brass or steel, including knobs,  faucets, and spittoons, was
burnished.   In the halls and corridors were laid breadths of
linoleum with bright-colored borders.
   Dr. Rutherford, as already intimated, is one of the fore-
most  advocates of non-restraint, and also of healthful  exer-
cise and employment.   It was stated that there  were no
strait-jackets nor  restraining  dresses — nothing involving 
WOODILEE.
147
mechanical restraint within the  institution.   If violent, a
patient is walked about  until  he calms down ; and, if very
violent, he is placed in charge of two or more special attend-
ants.  Notwithstanding  the  freedom  allowed, few  escape
who are not brought back the same day.
  No fewer than one hundred and forty-eight men were em-
ployed  on the  farm and grounds.  In very  wet  weather,
these men are  placed at work under shelter, but  a slight
shower of rain is not deemed  hurtful.  Patches of ground
alike in size, and an  equal number  of patients, are assigned
to each of the different attendants working in the extensive
gardens, who are thus stimulated  to  compete for the largest
product.  The ground for vegetables is  cultivated chiefly
with the spade.  In managing the laboring force, some tact
appeared  to  be exercised.  As we  approached the  stone-
quarry where a small group were  employed, an Irishman
sprang upon a mound of earth and  broke into loud speech,
accompanied by violent  gesticulation.   No one paying the
slightest attention to him, he soon took up his tools and went
to work.  Seventeen men were occupied as mechanics in the
different workshops  for  various crafts, including shoemak-
ing, carpentering,  tailoring, tinsmith work, gas-fitting, and
blacksmith work.  About forty weakly patients and epilep-
tics were excluded from the working groups.   All, however,
not unfit to labor, are obliged to go with the working parties,
and it is said that example and precept seldom fail to induce
even  the reluctant to work, although nothing in the charac-
ter of punishment  for idleness is  resorted to. The farm
stock at Woodilee included goodly sized herds of cattle and
flocks of sheep.
   The sewage is utilized  on the land.  The original plan was
to have only earth-closets; but these were discarded, owing
to difficulty in keeping them in order. The closets are in pro- 
148
SCOTLAND.
jections from the main divisions.  No sewers enter the asy-
lum  buildings, but terminate just outside the  walls, where
they are trapped near the junction of a ventilating flue.  All
interior pipes are trapped within  the  building, and  are
carried  through the  wall into  the  sewer.   The sewer-
pipes, laid below frost depth, extend to  a large covered vat
some distance from the asylum.   The sewage is there diluted
and forced by steam pumps through iron pipes to hydrants
at elevated points on  the farm, from which it is distributed
over the land by means  of movable troughs.   The fields
thus treated were much  improved.  The main iron sewer-
pipe measures five inches, and  the  others three inches in
diameter.   Intermediate  flues  act as a  protection against
sewer-gas.  The system is highly approved by  the Super-
intendent,  who  thinks that the  immediate distribution of
the sewage obviates any danger to health.
  In affording  employment, the laundry is to the women
what the farm is to the men.  Machinery has been discarded
for washing by hand.  The clothes are dried in the open
air when the weather  permits.   Out of a total of one hun-
dred and forty-five women workers, about thirty were em-
ployed  at laundry work;  sixteen were assisting  in wards ;
thirteen in the kitchen ; two were serving as housemaids;
fifty-nine were doing  needlework;  and  twenty-six were
knitting.
  The  inmates are variously and  comfortably attired.  The
night-dresses in use in the several divisions are, like the bed
linen, distinguished by different colored stripes.  The male
patients generally wear stout corduroy or moleskin trousers.
Male attendants wear uniform  caps  displaying the asylum
badge.  Female attendants are  dressed in black, which con-
trasts well with their clean white ruffed caps, white linen
cuffs, and white aprons. 
                        WOODILEE.                    149

   Night attendants are governed  by rules similar to those
in many other British asylums.  It is the first duty of the
night attendant to ascertain from the  head  attendant  all
names  of  patients who require particular attention in the
administering of medicine or special comforts, and of those
disposed to suicide.  Epileptic and suicidal patients must be
visited every hour during the night, and every patient must be
looked at when the night attendant enters upon his watch at
eight o'clock and again at ten o'clock. Each dormitory must
be visited at regular intervals four times during the night. All
epileptic and paralytic patients  must be examined at each
of these visits, and if  the linen is  wet or soiled, it must  be
changed at once.  The night attendants are further required
to know  all patients of irregular habits.  These must  be
periodically awakened to  attend  to the calls of nature.
Some of them must be called every two  hours; others  only
at midnight or possibly again at two A.M.  It is explained to
the attendants that, with the exception of epileptic patients
in a fit, these precautions, if  strictly observed, should entirely
obviate all wet beds in ordinary cases of chronic mental dis-
ease, and conduce to  cleanly habits by day.   Night attend-
ants are required to make a particular record of  all the inci-
dents that occur, including the manner  in which newly ad-
mitted patients and the sick have passed the night.  To rest-
less patients, the night attendants are urged to give particular
attention.  They are  told that a kind word will  often bring
the patient quiet sleep, while its omission may cause him
to pass  a noisy, restless night with consequent  excitement
next day.  The attendant is also told  that the timid should
have their fears allayed by frequent friendly visits, in the ex-
pectation that sound sleep may be secured to them through
the consciousness of the attendant's presence. Night attend-
ants  are  charged  with the duty  of seeing  that there  is 
'50
SCOTLAND.
nothing done after the inmates have retired to disturb their
rest.  At 5.30 A.M. the night attendants call the day attend-
ants.  Until breakfast-time  the former aid  in dressing and
washing the patients.
  At  the time  of  my  visit,  the  daily  routine  observed
here was  as  follows:  The  morning call  is made at  5.30.
Day attendants superintend the washing  and  dressing of
patients, and see that their  beds are turned down and ex-
posed to the air.  At 6.30 artisans and selected farm and gar-
den patients  begin work, also selected kitchen and laundry
patients.  At 7.30 the  attendants  take  breakfast.   At 8
o'clock the patients have their breakfast.   At 8.30 there is
morning prayer in the  chapel.  At 9 o'clock the working
male  patients are inspected in the court,  and  they  after-
wards go out to labor.  At the same hour the kitchen,
laundry, and  sewing women are set at  work.    At  10.30
o'clock  a medical visitation to the wards  is made.  From
10 to 11, extras  for the sick are issued  from the  kitchen
or stores.  At 12 M.  medicines are dispensed  and given
to the  head  attendant.  At  1  P.M. working patients re-
turn to the wards  and make themselves  tidy for dinner.
At 1.20  o'clock is the patients' dinner, and the  attendants
dine twenty  minutes later.   At  2  the working  patients re-
turn to work.   At 4 o'clock extras  for the sick are issued
and tea is given to laundry  patients.  At 6 o'clock  in sum-
mer working  patients return to their wards.  At 6.20 pa-
tients have  their tea  or supper;  at  6.40  attendants take
their supper.  From 7.30 to 8,  patients go to bed ; all shut-
ters and doors  are  locked, clothing removed from rooms,
and  lights extinguished. A second medical visit is  made
about this hour.  At  8, night attendants enter upon their
duties.   At 10 o'clock all attendants except those on duty
go to bed and the lights are extinguished. The rules set forth 
                       WOODILEE.                   I 5 i

that the hours  of outdoor exercise shall depend upon the
weather and season of the year, and that two hours daily
should  be  spent in the open air  by the  non-working male
and all the female patients.
  Two corridors inclosed with glazed sash extend from each
wing of the asylum  rearward  to  the  chapel on the  lawn.
These  cheerful  promenades, lined with  fragrant flowers,
have the appearance of beautiful conservatories, and afford
pleasant walks in the  most disagreeable weather.  In the
chapel—a  tastefully   built  stone edifice  with  attractive
stained-glass windows—services are conducted every Sun-
day by  a local pastor.  The  men and women occupy differ-
ent sides  of the  building.  There are religious exercises
here  every morning, consisting  of singing,  reading, and
prayer.
  An air of industry pervaded the institution, and thorough
administration was everywhere apparent.   In  a walk about
the grounds with the Superintendent,  a  considerable force
of men were seen grading, planting, and  making  other im-
provements.  Others  were  engaged   on the  lawns  and
grounds, working with little or no manifestation of excite-
ment.  Successful efforts were made to get  the patients in-
terested in their  work. Both patients and attendants labored
together, the latter by example stimulating and encouraging
the former, while taking care to prevent undue exertion on
the part of the patients.
  This asylum was examined with  peculiar interest, for the
reason that it has the  reputation, beyond any other of its
kind in  Great Britain, of making practical application of the
most advanced  theories  respecting non-restraint and per-
sonal freedom.   Of  this  feature  of  the asylum and  its
results,  Dr.  Rutherford says: " The diminution of restraint
is beneficial, inasmuch as it renders the patients more con- 
152
SCOTLAND.
tented,  and makes them practise  self-restraint  more than
they feel disposed to do when  others seem to be doing it
for them.  Besides,  there  is nothing more irritating than
forced restraint.  Many, inside and  outside the  asylum, go
about and work unattended.  Freedom  does not increase
the number of suicides, which have been of very rare occur-
rence here.  Conflicts  with  attendants are also rare ; and
when they do happen, it is generally indoors.   It is the rule
that attendants, under  no  pretext  whatever,  shall leave or
lose sight of a patient without placing him under the care of
another attendant, and the rules are very strict respecting
rude treatment.  If it  becomes  necessary to seclude a re-
fractory patient, the fact  must be  immediately  reported
through the head attendant to the medical superintendent.
Under this system, it cannot be said that the  number of at-
tendants is actually or necessarily increased.  The excess, if
any, is of that  class of  attendants who, by  their work, earn
their wages, and are, as it were,  extra; such, for example, as
artisans and  gardeners. These  attendants work with the
patients, and are generally the  best  workers  in the party.
The patients imitate and follow  the attendant, only he must
be able to handle a pick and shovel better than  they, else they
will work very little—they will simply play at work.  Here,
it is easy to get  such attendants.  The responsibility of the
superintendent is not increased.   Greater vigilance may pos-
sibly be needed on the part of attendants to prevent escapes;
though  under the  system of enlarged liberty more escapes
do  not occur than frequently happened in  the old lock-up
institutions."
  In  respect to  stimulating beverages  and  medical treat-
ment, Dr. Rutherford says: " There is a diminishing use of
wine  and spirits.  Beer is not  used by the patients as an
article of diet.   Forty  gallons  of new milk  are consumed 
                       WOODILEE.                    153

daily.  Sedatives and narcotics are  not  used except where
sleep cannot be otherwise obtained.   Only twelve out of the
total received  draughts  for this purpose last night.  Insanity
is essentially a disease of diminished vitality, and when pres-
ent,  the system  demands invigorating treatment.   Experi-
ence proves that there  is nothing so invigorating as active
outdoor employment and abundance of fresh air."
  Without attempting to decide to  what extent the radical
principles put in practice here are worthy of general adop-
tion, it was evident that  there was  a remarkable  degree of
contentment and cheerful activity.  The visit, on the whole,
left the impression that the Barony Parochial Asylum was con-
ducted with great energy and ability, and that it is  entitled
to the high position it holds among  British institutions.
  The number of  patients registered on the books of the
asylum September 3, 1887, was 531.   They were distributed
as follows : within the main building, 473 ; residing at the
Muckroft  farm, 12 men  and 2 women; at  the new Farm
Steading, 26 men and  2  women ; at Fauldhead, 8 women ;
and at  the Gate Lodge, 6 men.  Two women  were absent
on pass.   The net per-capita  cost  of maintenance, as offi-
cially given,  was Ss. gd.  per week for  the  financial year
ending  May 14,  1887.  The force of attendants  has been
proportionately enlarged  with the increase of numbers.
   Since my visit, Dr. Rutherford  has been called to assume
charge of the  Crichton  Royal  Institution  at  Dumfries, and
has  been  succeeded by  Dr.  Robert Blair.  The  Lunacy
Board, in  reporting  upon  the institution in  1887,  said:
" The ample means of industrial occupation afforded by the
arrangements of this asylum continue to be judiciously taken
advantage  of.  The  patients  were  free  from complaint,
noise, or  excitement, and the  establishment was found  in
excellent  order throughout." 
154
SCOTLAND.
     MID-LOTHIAN AND PEEBLES DISTRICT  ASYLUM.
  This asylum is located  at  Rosewell,  a few  miles  from
Edinburgh, and is easily accessible by rail.  Its site is seven
hundred feet above the  level of the sea, and  commands ex-
tensive and  pleasing views of  the  adjacent  country.  The
asylum was  opened in  1874.   It is managed by an unpaid
district  board.  The Medical Superintendent controls the
selection of  the subordinate staff.
  In the  original estate  there  were  only about   forty
acres.  The  disadvantage of  having so limited  an area led
to the additional purchase of a small farm ; but even with this
the amount  of land is  found to be insufficient.  The  plain
and new-looking two-story buildings of cut stone, having ac-
commodation for about two hundred  patients, were erected
at a cost of £50,000.   The  surrounding grounds are well
kept, and  the  terraced lawns are adorned with  flowers and
shrubbery.  The institution  has, in addition to  the  main
building,  two convenient  and  comfortable cottages for
attendants and patients.
  This asylum provides for  the requirements of the landward
district of Mid-Lothian  and Peebles.  So far, it has had ac-
commodation  to  spare  after  meeting  the  wants of the
district rated for  its support, and accordingly a number of
what  are termed  " out-county"  patients   are  received.
About one fifth of the inmates  are private patients, who are
charged, if residing within  the  district, 1is. 6\d. per week,
and if without, 14s.  " Out-county" pauper patients are re-
ceived at the rate  of 12.?. ^\d. per week.   The rate for pau-
per patients within the  district  is officially given  for the year
ending May 14, 1887, as 10s. \\d.  This includes provisions,
household requisites, medicines, clothing, salaries and wages,
furniture and furnishings, and incidental  expenses.
  The upper  floor is set  apart chiefly  for dormitory pur- 
              MID-LOTHIAN AND PEEBLES.           155

poses.   On  the  lower floor are the sitting or day  rooms,
dining-hall, principal lavatory, a few single rooms, and other
apartments for day use.  The dormitories vary in size, con-
taining from fifteen to thirty beds each, and they, as well as
some of the single rooms, appeared to have insufficient air-
space.  Flowering plants and ferns were about the windows,
which have  plain wooden sashes with panes 8 x 10  inches.
The windows are  ungrated,  and are  generally  without
either shutters or blinds.  The sash  can be lowered at the
top and raised at the bottom about six inches.   Rugs  and
breadths of Brussels  carpet were laid  on the waxed floors.
The tinted walls had bright paper borders.  The bedsteads
were mostly of wood, with head and foot boards.  The mat-
tresses were in three sections.  The bedding was abundant
and comfortable.   Some woven-wire  mattresses that  had
been received on trial were approved.   A lavatory examined
on  the upper  floor was well supplied  with  towels, brushes,
combs, and  mirrors.
  In the dormitories, even in the single  rooms, and in the
apartments  generally, are  fire-places.  These are  supple-
mented by a complete system  of steam-heating with direct
radiation.  Ventilating flues are in the walls.  The lighting
is by gas.  In  some  of the apartments the  gas-jets  have
frosted  globes.  Altogether, there are from thirty to forty
single rooms.   In all of those on the upper floor there are
concealed adjustable shutters, by means of which the win-
dows may be  effectually protected.  It was said  that these
were rarely used.
  One of the  day or sitting rooms  that I  inspected was a
pleasant apartment with a broad and deep bay-window
ornamented with  lambrequins.  The walls were  tinted and
hung with  pictures; the wood casings polished and  var-
nished, and  on the floor were cocoa-fibre rugs with  colored 
i56
SCOTLAND.
borders, and a broad  piece of linoleum extending through
the centre of the  room.  The chairs and  lounges were
upholstered with  enamelled  canvas.  A billiard-table af-
forded a  kind  of recreation  that was  much appreciated
by the patients.  Geraniums and other flowering plants were
here displayed to advantage.
  Adjoining this was  a goodly sized lavatory with floor of
colored tile, highly polished  brass-work, abundance of clean
towels, and mirrors on  the walls of three  sides of  the
apartment.  The infirmary wards were very comfortably fur-
nished.  In the  halls  and corridors the walls were suitably
colored, the ceilings  plainly decorated,  the windows cur-
tained, and along  the waxed floor was a breadth of bright
linoleum with a brass protecting border screwed firmly to the
floor.
  The men and women have their meals in a hall which had
tinted and wainscotted walls, and was furnished with ordinary
chairs, tables  with linen covers,  crockery plates, knives,
forks, and  spoons.  One end of the room was apportioned to
male,  the  other  to female patients, who enter by different
doors.  They were served by attendants, one of whom pre-
sided  at the  head of  each table.  The dinner consisted of
broth, beef, potatoes, and bread.
  The chapel, which  is  also used for entertainments,  has
ornamental interior roof-work, colored glass  windows, and,
considering its purposes, is elegantly fitted up.  A small or-
gan and a piano were on the platform.   This was  covered
with Brussels  carpet,  and a breadth  of the same was  laid
along the  passages, the  clean waxed floor showing at the
sides.   The seats  or   settees  were comfortable  and were
conveniently arranged.
  At one  time much complaint was made about dampness,
which had become apparent on the walls of the day-rooms, 
              MID-LOTHIAN AND PEEBLES.           I 57

dormitories,  and  corridors of both  floors of  the  asylum
building.   To obviate this serious difficulty, an experienced
builder recommended, among  other things,  that  the  ex-
posed portions of the stone walls be painted with sugar-of-
lead and oil,  and that all imperfect stones be  taken  out and
perfect ones  substituted.   His suggestions were acted upon,
and the result was satisfactory.
  There were neither close  nor padded rooms, and it was
said that the principle of  non-restraint was  observed as far
as possible.  In  certain cases, as, for example, soothing a
patient when in a  state  of  great excitement, some such
preparation  as  hyoscyamine,  or perhaps  a subcutaneous
injection of some kind, was resorted to.   Muffs were hardly
ever, and  locked dresses  never,  used.  The attendants at
this asylum were in the proportion of one to twelve patients,
and  their pay was periodically increased according to merit
and length of service.
  Fifty per  cent of the men in  suitable weather are gen-
erally occupied on the farm  or in improving  the grounds.
These appear more  spacious from the absence  of walled
airing-courts.    The  women  are  extensively  employed  at
laundry-work, sewing,  knitting,  and hous,e-cleaning.  The
patients  were not uniformly  dressed.   Their  clothing was
substantial and comfortable.   In winter,  the men who go out
to wrork wear heavy plaids and thick woollen gloves.  Care is
taken to see  that they have water-tight shoes in good order,
and also that their strong fustian clothes are in satisfactory
repair.   In  stormy weather, labor  is  mainly confined  to
the tailor's, shoemaker's, joiner's, and  engineer's workshops.
Here, in the country, in  comparative seclusion and under
proper supervision, a commendable measure of freedom  is
allowed. 
i58
SCOTLAND.
    THE ROYAL  EDINBURGH ASYLUM—MORNINGSIDE.
  Two miles southwesterly from Edinburgh, and just a little
removed from the activities of the picturesque metropolis of
Scotland, is situated the Royal Edinburgh Asylum.  A high
place  is deservedly assigned  to this institution, which, like
every other asylum for the insane in Scotland, is managed
by an unpaid board.  It was organized as a private or char-
tered  corporation, but it has come to serve also the purpose
of a district asylum.  It is under the efficient direction of Dr.
T. S. Clouston, one of the foremost of British alienists.   The
asylum  comprises  three separate  branches,  called  East
House, West House, and Craig House.   A little apart from
these, and  separated from one  another,  are several small
asylum  cottages  partly  hidden  by foliage and surrounded
by  green  lawns and   blooming  parterres.   The  country
prospect, with a  background of heath-clad hills, is pleasing
and extensive.
  The number of  inmates in this, the largest asylum  in
Scotland, averages about eight hundred.  The West House
is  occupied by about  five hundred pauper  patients, and
private patients  who pay low rates for board.  East House,
Craig House, and Myreside Cottage are occupied by patients
paying higher rates.  In addition to the  buildings referred
to, the directors provide, during  the summer months, a sea-
side villa at Cockenzie, a fishing village ten or twelve miles
east of Morningside.   The rate  charged for the support  of
pauper patients from  the district  is £33  10s. per  annum.
The minimum rate for private indigent patients is the same.
Other private  patients are charged £84 and upwards  per
annum.
  This asylum  has a charity  fund of about £25,000, created
by voluntary contributions, the income of which is expended
for the relief of deserving patients in reduced circumstances. 
                     MORNINGSIDE.                  159

About £15,000 of this fund came from the generous bequest
recently made by  Mrs.  Elizabeth Bevan, daughter of Dr.
Andrew Duncan, Junior, who was one of the first Physicians
in Ordinary to the asylum.
  The West House is a plain-looking but substantially built
stone structure standing a little apart from East House.  At
the entrance gate we met, in  charge of attendants, about a
score of women comfortably and variously attired, who were
quietly taking their daily  walk.   Near the shaded avenue,
a considerable number of patients were seen at work with
attendants.   The  well-kept  garden,  neatly trimmed lawn,
carefully raked gravelled walks, and a profusion of flowers
and  shrubbery  in  their  summer  splendor  denoted  well-
directed labor.  Looking over the spacious and highly im-
proved grounds, the eye failed to detect any sign of irksome
restriction  in the form of interior walls  or  other  barriers.
Connected with the asylum proper were about one hundred
and forty acres of land, portions of which  were set apart  for
bowling, lawn tennis, cricket, and other outdoor games.  The
cricketers, organized as a club, were playing a friendly match
with a team from the city.
  On the day of my visit, the dinner for the pauper class con-
sisted of hotch-potch (a wholesome vegetable soup), a liberal
allowance of corned  beef,  with  abundance of  potatoes and
bread.  The poorer class of paying patients received, instead
of corned meat, roast beef with cabbage and other vegeta-
bles.   All were allowed ale, but  some, by special order, re-
ceived milk.   Separate dining-halls are provided for the pau-
per and paying patients.   At  meal-time an attendant is sta-
tioned at either end of each table to apportion and serve the
food.   The hours for regular meals, are—breakfast at eight
A.M., dinner at two P.M., and tea at six P.M.
  Pauper  inmates have  three meals ; non-pauper inmates 
i6o
SCOTLAND.
are allowed  a supper in addition.   Attendants take their
meals in their own rooms  half an hour before the patients
have theirs.  Most of the food is prepared in a general kitchen.
Small diet kitchens adjoin  the apartments for the sick.   In
cold weather the plates are  warmed before serving the meals.
In the culinary department the head female cook is assisted
by three attendants and about eighteen patients.   The large
dining-hall has frescoed ceiling and varnished wooden rafters,
and is lighted from the  roof.  Here are several  rows of  ta-
bles with white linen  covers.  The men and women occupy
opposite sides of  the  hall.  Plates of  earthenware, horn
spoons, knives and forks, pepper-boxes, salt-cellars, mustard-
pots,  and water-bottles  were on  each  table.   The  knives
have only about one and a half inch of cutting edge.  The
floor is  of plain wood, and  it was cleanly scrubbed.  At one
end of  this  dining-hall is a raised platform, the apartment
being occasionally used for concerts and  other entertain-
ments.  There is,  in addition,  a large recreation hall  set
apart solely for  entertainments.  This hall is  handsomely
decorated, and the side-lights have bright-colored shades.
The system of heating  is by hot water.
   The dining-hall for poorer paying patients accommodates
about one  hundred  at  five tables, each of which, with  its
white linen  cloth, was arranged to seat twenty persons.  The
chairs  were of cherry  wood, which  was  highly  polished.
Knives and forks were  used.  Earthen plates, casters, and
water-bottles were on the different  tables.   A mahogany
sideboard and other homelike articles improved  the appear-
ance of  the hall, which was lighted by gaseliers and side-lights.
Throughout the  house one is pleased with the general dis-
tribution of comfortable furniture, the arrangements for dif-
fusing cheerful light,  and the effect of brilliant coloring.
   Patients,  on leaving for work, pass through what is called 
                     MORNINGSIDE.                  l6i

the "shoe-house," against the walls of which are ribbed shoe-
presses with separate divisions for keeping boots and shoes,
one division being assigned to each person.   The  workers
are divided into parties of ten or  twelve, each group  being
in charge of a working attendant.   On  their  return from
labor, the  patients assemble  in a court with  side shelters.
The tools are  restored  to  their places, and  something  like
military order is observed.  Labor is found to be an effective
aid in treatment, and the weather  and circumstances permit-
ting, every male patient is, shortly after  his reception, set
at work in the garden.   During the first three  days he is un-
der close observation.  If a patient proves troublesome and is
disinclined to  work, or disposed to hinder others, he is placed
under the special charge of an attendant.  The whole indus-
trial department is intelligently supervised. The carpenter's
shop  is a well-lighted room,  in which were employed two
paid joiners and four working patients in making and repair-
ing  tables, chairs,  wardrobes, wash-stands, mantel-pieces,
boxes, etc.  Paid workers were also observed in other places
as follows: in  the tailor's shop, employed in making clothing
and bedding, and in the shoemaker's shop, one attendant to
every four patients; in the upholsterer's shop, engaged in mak-
ing straw and hair mattresses, feather pillows, covering chairs,
and  upholstering  old  furniture,  one attendant  to  three
patients ; in the tinsmith  and plumber's shop, two to  the
same number of patients ; and in the bakehouse, two to one
patient. In the smithy,  three patients worked as blacksmiths.
In another division about twenty  patients in charge of two
working  attendants were  picking hair  for mattresses and
pillows.
  In all  of the  mechanical departments ordinary tools  are
used. Implements are carefully kept and must be accounted
for by those using  them.   In  the printing-office were three 
162 v
SCOTLAND.
working patients who not only print the reports and blank
forms used in the  institution, but also a monthly periodical
called the " Morningside Mirror," to which the inmates con-
tribute.   The  windows of  the  workshops  have  ordinary
wooden  sash, the  panes  measuring 6x8  inches.   Not-
withstanding the  freedom here  permitted and the use  of
numerous tools, it was asserted that personal injuries are of
rare occurrence.  The  laundry gives employment to a con-
siderable number of  women,  and  is a well-organized depart-
ment.   For sanitary reasons, the clothes are  dried in the
open air when the weather permits.
  Stores are orderly arranged, and are given out only on ap-
proved requisitions from the  several departments.
  In the  older portions of the  asylum, there  are, in  some
cases, from  forty to fifty patients in an associated dormi-
tory ; in the newer parts, but from six to twenty.   There is
a considerable number of single  rooms.   In  some  of those
occupied  by violent  patients, inside sliding  shutters  are
provided for use at night.  Some of the bed-frames have ad-
justable bottoms of strong  canvas,  and each is  furnished
with a hair mattress.   In addition to other means of heating,
open fires are general.  Dr. Clouston prefers pitch pine  for
flooring, and many of the floors are of this material.  They
are carefully waxed,  and present  a glossy and  even elegant
appearance. In the lavatories there are highly polished heavy
copper basins.   The baths  are  furnished with every con-
venience.   The closets are in structures separate from the
wards,  but connected  by passage-ways.   Except at  a por-
tion of West House,  the open-door system generally prevails,
the doors remaining  unfastened in summer until ten P.M.
  Walled enclosures, or airing-courts, have been  abolished
at this institution.  One of the first things Dr.  Clouston did
after his appointment was to remove the iron gratings re- 
MORNINGSIDE.
163
maining at the windows of East House and take down from
about the  airing-courts the then existing high walls.  The
marks where these unsightly barriers terminated against the
East House may still be seen.  In their place has been sub-
stituted, in some instances, a low stone wall surmounted  by
an  ornamental  balustrade, which  does  not obstruct the
range of vision.   One such limits the recreation grounds for
women at  the East House.
  In the pauper department the means of restraint consists
of gloves and the old strait-jacket, or " polka"; but  these
are so rarely used, it was asserted that, practically speaking,
there was  no mechanical restraint.  Sometimes seclusion is
resorted to in a light  room ; at other  times in a dark apart-
ment.   In each division  of the  West   House  there is a
canvas-padded  room,—one for men and  the  other  for
women.   These are warmed as occasion requires, and may
be lighted from the ceiling.   At the East House were seen
two male patients who had been in close charge of attend-
ants for the previous four days.  One  was  comparatively
quiet ; the other exceedingly boisterous and wild, running
around the  green and shouting, the  watchful guardian all
the while  keeping close by and permitting him to spend his
superfluous energy without injuring himself or others.
  The  training of the  attendants is manifestly  of a high
order, developing  patience and even tenderness.   Before
entering active  service, they are instructed in the duties of
the  various departments.   For cases requiring temporary
attention at their own homes, a trained attendant is some-
times sent outside the institution, but only for short periods,
and at fixed rates.  Patients are brought to the asylum from
the  Edinburgh district  free of charge; from a greater  dis-
tance the  rate is ten shillings per day  for an attendant, with
travelling  expenses.   At the time of my visit, a party was 
164
SCOTLAND.
seen starting from the door of the East House for the sea-
side resort at Cockenzie.   It consisted of two male and ten
female patients, who were comfortably seated in a large open
carriage, and accompanied by one male and one female at-
tendant, besides the driver.  From their dress and general
appearance, they might have been taken for a party of ordi-
nary pleasure-seekers.
  The East House, as already stated, is occupied  entirely
by  paying patients.  In  passing through its various  apart-
ments, one is pleased to note the comfortable and homelike
furnishings, of which  there is  a  great variety.  There are
sofas, lounges, rocking and easy chairs, mirrors, draped cur-
tains, chair-beds for attendants, Brussels carpets, carpet rugs,
solid mahogany dressing-cases and chests of drawers, towel-
rails, basins, stands, and cabinets.   There are also open fire-
places.   On the  men's  side,  are rooms for  billiards and
other games, and pleasant reading-rooms with well-stocked
book-cases.   The dining-rooms at East  House are  small.
In one  fitted  up in oak  and appropriately decorated, six-
teen patients were assigned to  a table.
  In the women's department, the furnishings and fittings
are also  tasteful  and  comfortable, with  possibly a greater
profusion of homelike articles. Green Venetian blinds, white
lace curtains,  mantel-pieces, mirrors  in  gilded frames, gilt
time-pieces under glass shades, carved chimney-pieces,  paint-
ings, flowers, birds, and many ornamental articles were here
seen.  The  windows  have  pleasant  outlooks.  In  chilly
weather  bright copper gas-stoves are used to temper the
atmosphere.  The  whole  department was in charge of  a
matron, and bespoke careful management  as well  as good
taste.  In  few other  asylums visited did  the inmates ap-
proach so near the appearance of sane people in home life.
  In regard to permitting the insane to act  out  their pe- 
                     MORNINGSIDE.                  165
culiar fancies, Dr. Clouston says : " We now discourage and
keep down those outward expressions of insane delusions
that used to give a lunatic asylum its most striking character.
The monarchs crowned with straw, the duchesses in gaudy
spangles, the field-marshals  with grotesque imitations of
military uniform, that  could  be seen in any asylum of old,
have disappeared in outward semblance, just as in the world
at large you may meet an empress and  not know her.   The
public opinion  against  individuality  is  as  strong  now in
asylums  as  in society.  If  the man with  ten  millions of
money, who  is the rightful heir to the throne, affixes the
top of a soda-water bottle to the front of his cap, as a faint
symbol of his position, it  is  at once unfastened.   If the
princess, who is the greatest beauty in Europe, bedecks her-
self with brilliant bits of incongruous  ribbon, it is  quietly
removed at night.  The insane man, like his sane brother,
soon  adapts  himself to  his circumstances, and submits to
rule and  public opinion."
   Since  my visit, some  very  desirable changes  have been
wrought in  Morningside, enabling  the Superintendent to
put in practice some  of his excellent  theories respecting
asylum  management.   A  description  of  the  important
improvements effected in the  West  House may be  best
set forth in  his own words.
   "After the female  wards  Nos. 1, 2, and 3  in  the West
House were  finished and painted and  refurnished to some
extent, the two West House dining-halls were repainted and
decorated in an extremely tasteful and cheerful style.   The
comfort of management, and  the advantage to the patients,
of all that has been done to improve the house, are incalcu-
lable. We are trying to individualize and classify the patients
in the ward for the admission of the rate-paid women, who
are not sick or very weak in body, on the principles adopted 
166
SCOTLAND.
for the care and  cure of the sick and weak in the  hospital
wards.  That implies, first of all, a large staff of attendants
there,  and good  attendants.   This ward consists of three
sections, with two large corridors.  There is much elbow-
room everywhere, the average  floor-space to each patient
being sixty superficial  feet, so that there is no huddling to-
gether of patients.   The  first section  is a workroom  under
the charge of a special  attendant, where every suitable pa-
tient is at once tried, and, if possible, got to do something,
thereby  the  mind being diverted from morbid  thoughts,
while self-control  is practised and tidiness of dress cultivated.
The work-hours are short, with walking  in the grounds be-
tween.  The next division of the ward  is a large, cheerful
saloon with a corridor ten feet wide, where the patients who
are admitted  in a more  excited state, or the very suicidal,
are placed.   Such  patients are put  under the  individual
charge of one or  two attendants, whose  duties are confined
to them alone. Individualization is the key-note in this sec-
tion.   Lastly, there is a smaller sitting-room, with  a corridor
attached,  for a few who are safe to themselves and others,
and do not need so much supervision, and where, in fact, the
sort of patients are apt to be allowed  to sit who  from delu-
sions are specially intolerant of too minute supervision (for
there is an immense  variety in the symptoms of mental dis-
ease that has to be provided for), and are best left alone, for
a time at least.  The sleeping accommodation is also varied,
consisting of two large dormitories, in one of which  every
new patient sleeps for the first few nights at least, and  where
a night-nurse sits  up and makes a written report to me every
morning for the first fortnight, as to how every new patient
has slept. In the next dormitory four attendants  sleep near
the new patients.  Then there are two dormitories for four
patients  each, and two with three beds, and twelve  single 
                     MORNINGSIDE.                  if]

bedrooms.   The whole ward accommodates  forty-three pa-
tients and  their seven attendants.  I look on it as being  of
the utmost importance  how  the new patients are treated
and  cared  for, what first  impressions are made  on their
minds, and how their cases are gone into."
  In a  detached two-story cottage, formerly the residence
of the superintendent,  are  accommodated four ladies who
provide their own attendants.   The immediate surroundings
of the cottage are beautified by rockeries, flowers, shrub-
bery, and  well-kept  walks.  The windows have  each two
large panes of plate glass, and they are provided with inside
shutters, green  Venetian blinds, and white  lace  curtains.
The sashes may be raised or lowered a few inches for venti-
lation.
  Myreside  Cottage, a  cozy-looking, old-fashioned farm-
house, with vine-covered porch and thatched roof, is reached
after a short walk from the  East and  West houses.   It
was successfully converted  from a  private dwelling into a
home  for  male patients.   At the time  of my visit there
resided here nine persons in charge of two male attendants,
who said their duties were not  difficult.  The doors were
unlocked.  A woman cook and  a  scullery  maid  are here
constantly employed.   A room up-stairs  is used as a dining
and sitting room.   Open fire-places assist ventilation.  No
gratings appeared  on  the  windows, nor were there any
visible barriers ; indeed, the  house did not differ from an ordi-
nary rustic dwelling.  At one end of the  cottage, in a small
greenhouse, were  pots  of bright geraniums, carnations, cal-
ceolaria, ferns, etc.  Fruit-trees were trained  closely to the
garden walls.   In  front  there  is  a small lawn  planted with
flowers and ornamental shrubbery.
  As one proceeds along a wooded slope, about a mile from
the  main buildings  an ancient and secluded mansion, sur- 
168
SCOTLAND.
rounded by tall ancestral  trees, arrests his attention.   The
approach to this retreat,  known as Craig House, and  now
used as a receptacle for the  highest class of paying patients,
is  through a  gradually  ascending  avenue bordered with
sycamores,  the rugged arms of which form  a lofty, inter-
lacing arch.  The picturesque appearance of the building is
heightened by its ancient  crow-stepped gables  and lofty
chimney-stacks, its recessed portal, and  the green ivy which
is seen climbing to the topmost peak of the left wing.  From
the lawn  the prospect is  delightful,  embracing  Edinburgh,
the Firth of Forth, and surrounding country, while Arthur's
Seat looms up grandly in the distance.  The place is historic.
On the Borough  Muir below,  a memorial stone  marks the
spot where the Scottish standard was unfurled under James
IV. prior to the disastrous  battle of Flodden  Field.   It is
asserted  that  Scott  took the  hill on  which  Craig  House
stands as the  point  of observation for the following  de-
scription in "Marmion":

            " Still on the spot Lord Marmion stayed,
              For fairer scene he ne'er surveyed.
              When sated with the martial show
              That peopled all the plain below,
              The wandering eye could o'er it go,
              And mark the distant city glow
              With gloomy splendor red ;
              For on the smoke-wreaths, huge and slow,
              That round her sable turrets flow,
              The morning beams were shed,
              And tinged them with a lustre proud,
              Like that which streaks a thunder cloud."

   This mansion, some three hundred years ago, was the seat
of the Carmichaels, a family of distinction in early Scottish
annals.   Here was the home of Lady Carmichael, one of the
four Maries of the ill-fated  Mary  Queen of Scots, and  it  is
asserted that the unfortunate queen herself frequently graced 
                      MORNINGSIDE.                  169

 by her presence  the  halls of  this venerable edifice.   It was
 a favorite hunting-seat of James V., and Cromwell, when in
 Scotland with his Ironsides, made the place  his headquar-
 ters.  Craig House is in keeping with the troublous times in
 which  it originated, having  been designed for shelter and
 defence.   It  is  strongly built, with deep  foundations, and
 some  of  the  walls,  as  seen in the vaulted  kitchen, are
 of great thickness.  Interest  in the place is enhanced by the
 discovery, in later days, of a secret corridor or passage-way
 connecting its subterranean vaults with the fields below.
   It were difficult to describe the  interior of this old-time
 mansion with its rambling halls, hidden nooks, unexpected
 stairways, and numerous rooms,  including spacious  saloons
 that still retain  evidences of their former grandeur.  It is
 much  to the credit of the management that the restorations
 necessary  to its present  use are  in  conformity with the
 period in which  it was built.  The furnishing and accommo-
 dations are on a  scale of the  highest comfort, if not  luxury,
 and quite  in harmony with the external surroundings.  As-
 cending a flight  of richly carpeted  stone stairs, one  notices
 that the carved  oak doors are  strengthened by iron studs,
 and that they have old-style wrought iron hinges and hang-
 ing  iron  handles. The apartment now used  as a  dining-
 room  is an  interesting  part of  the mansion.  The great
 arched fire-place, nine feet wide, with its ancient fire-dogs
 and  bright tile, suggests the generous hospitality of by-gone
 days.  The dark  oak-panelled walls, carved oak mantels and
 furniture, and other appointments are in the style of Holy-
 rood Palace.  Among other decorations, there is painted on
a stone set in the wall  a landscape,  in  which  appears a
castle of mediaeval time, with its moat  and  bridge.   In the
lobby adjoining are quaint old paintings, set in the skilfully
 carved oak panels of the walls. 
170
SCOTLAND.
  The  drawing-rooms  are on  a  corresponding  scale of
elaborate furnishing and  decoration.   These  apartments
command a  fine view of the northeast, and communicate
with a beautiful garden, which is kept in high condition by
the aid of patients drafted  from  the West House.  This is a
most delightful spot. The grounds are terraced and double
banked, and laid out in  the fashion of  a past period.  They
were exquisitely kept,  and planted with shrubs, creepers,
and rare flowers, whose  delicate fragrance  filled the atmos-
phere with sweetness.
  Violent patients are  not received here, and there are no
locks and keys, nor bars and bolts, nor other restrictions on
personal freedom,  except  the  watchfulness  of numerous
attendants.   It should be stated  that the sashes of the upper
windows are so  adjusted as to permit  of being moved only
a few  inches at the top and bottom.  There is an  entire
absence of  gratings  or  inside shutters.  It  has  been found
that patients are  greatly  benefited, when recovering,  by
removing them  from the surroundings unpleasantly associ-
ated with the acute stage of their disease to this retired and
quiet place.  Besides, the  lawn  and woods of Craig House
afford  opportunity for patients from other portions of the
asylum to take air and exercise, numbers of whom enjoy the
shade  and  soothing repose of this elevated sylvan retreat.
Respecting the desirability of change  in surroundings, Dr.
Clouston says :  " Patients  laboring under different  kinds of
mental disorder, even in different phases of the same attack,
are  better treated, and have  a greater  chance of recovery,
through having this variety  of accommodation.  In the acute
stage, a case  needs more of a hospital; in the convalescent
stage, more of an ordinary, cheerful house."
  As I left Craig House in  the soft repose of a dreamy sum-
mer  afternoon, the sunlight breaking through  the surround- 
                     MORNINGSIDE.                  1 7 I

ing foliage,  as the spirit of benevolence in this institution
breaks through  the  shadows of the unfortunate lives that
find  a home and refuge here,  the fitness  of  the  place for
the special  purpose  to which it  is devoted was impressed
upon my mind ; and with a parting look at " the mansion
with  a  strange history," and the grand old trees about it,
I bespoke a blessing on those whose  wise  forethought  had
turned  this  interesting relic of  the past to  its present
beneficent use. 
CHAPTER  IV.
                       IRELAND.

    THE first asylum for the insane in Ireland was founded
      by Dean  Swift, and was  opened in 1745.  Although
nearly a century and a half has elapsed  since its establish-
ment, St. Patrick's  Hospital, of Dublin, still  continues its
work of  mercy, the  expense of  maintaining it being princi-
pally met by the revenue  derived  from its original endow-
ment.   The good example set  by the Reverend Dean did
not, however, stimulate others to the performance of similar
acts of  generosity, nor did it arouse the Government  from
its  indifference to the needs of the insane.   As might be
expected in a country for a long time in an unsettled condi-
tion and suffering  under financial  depression,  the mentally
afflicted  were sadly neglected.   Illustrative of the  misery
of those who were restrained in  their own homes, a member
of the House of Commons, in testifying before a committee
in 1817, said :

  " There is nothing so shocking as madness in the cabin of the
Irish peasant, where  the man is out laboring in the fields for his
bread, and the care of the woman of  the house is scarcely suffi-
cient for attendance on the children.  When  a strong man or
woman gets the complaint, the only way they have to manage is
by making a hole in  the floor of the cabin, not high enough for
the  person to stand up in, with a crib over it to prevent his get-
ting up.  The hole  is about five  feet deep, and they give this
wretched being his food there, and there he generally dies."
                           172 
 
 
                CRUELTY OF OFFICIALS.              173

  Subsequently another witness before a later parliamentary
committee affirmed  that he, too, had  seen cases analogous
to the above.
  It is not to be assumed, however, that such practice pre-
vailed generally throughout Ireland ; and where it did exist,
it should not be regarded as evidence of intentional cruelty.
It must be borne in mind that there was almost an entire
lack of  asylum accommodation ; that a popular prejudice
existed  against what were called " mad-houses"; and that
the  strong  love  of home  and kindred  among the  Irish
people resists the separation  of families.
  But no  excuse can be found for the manner in  which the
insane poor under public care were treated in Ireland in the
early part of the present century.  This is  as justly subject
to censure as was the treatment of the same class in England
or Scotland.   It appears that it was  once the mode in con-
veying lunatics to Dublin to tie them to the back of a car
and compel them to go the entire distance on foot, however
long or short it might be.  This practice is referred to in the
report of a parliamentary commission wherein it is recorded
that a physician of  note said in the year 1808 :  " I give you
my honor that, of  the insane persons sent  up to  Dublin,
almost one in five loses an arm from the tightness of the
ligature producing mortification, which renders amputation
necessary."   Sane and insane were crowded together in the
houses of industry or correction.   Sometimes as many as
three were  chained  in  one bed, and in  some  instances a
chained lunatic and  a  sane pauper  shared a single bed be-
tween them.  With few exceptions, wherever they were con-
fined  there was a  lamentable absence of almost every requi-
site for the peculiar wants of the insane.
  In  1804, the attention of the Government was directed to
the urgent need  of  asylum accommodation  for the insane 
174
IRELAND.
poor in Ireland, but nothing was done in the way of extend-
ing public relief.
  Again, in 1810 the Government made an inquiry into the
wants of the insane in that country, the result of which was
an appropriation by Parliament  for  the building  of  an
asylum at Dublin for the reception of  insane persons from
the whole of Ireland.  This institution, opened in 1815, was
subsequently enlarged, and is now known as  the Richmond
District Lunatic Asylum.
  Before 1810 there  was no regularly  organized asylum  in
Ireland, except that  founded by Dean Swift.   There were
four  houses of industry or correction into which the insane
were received.  These were located at Dublin, Cork, Lim-
erick, and Waterford,  but  they  could  not  properly  be
regarded as asylums.
  The reports  following  successive parliamentary inquiries at
length led the Government to take energetic steps towards
ameliorating the unhappy condition of the insane in  Ireland,
and the important Act  1 and 2 George  IV. was passed  in
1821.  Lunatics at that  time were  not  provided for  except
by laws that were measures of police and public safety.   In
the report of a governmental commission  the legal  status of
the mentally diseased was set  forth  in  the following lan-
guage : " Lunacy was treated as a crime, and the  lunatic
as though he was a malefactor, not merely supposed to have
committed a crime, but  assumed to have  been  convicted  of
it."  The result of all legislation before 1821 was character-
ized  by a committee of the House of Lords  in  1843 as a
"distressing example of human suffering, mistaken  legisla-
tion, and of objectionable practice."  Large  numbers of the
insane, for lack of other accommodation, were confined  in
the various jails of the country.
  The Act of  1821 empowered the Lord-Lieutenant to form 
                  DISTRICT ASYLUMS.               175

districts, to direct the building of a sufficient number of asy-
lums, and when built to appoint governors of these asylums.
The measure  further provided  for the establishment of  a
Board of Control  who  were vested with extensive powers
respecting the building  and management of asylums.  They
were finally, with the concurrence of the Privy Council, em-
powered to frame rules for conducting  such institutions.
With some alterations and amendments this Act forms the
existing system of Irish lunacy administration.
  There were erected, under the Act of 1821,  nine new asy-
lums, for which the sum of .£210,000 was advanced by Gov-
ernment, and which was to be repaid by instalments extending
over a series of years, the money bearing no interest.  The
total  cost of the ten  district lunatic asylums which had been
built  before 1835, amounted to  £332,207.  These provided
for 1,837 beds, at upwards of $876 per  bed.
  From 1843 to 1857  the  number of lunatic asylums in-
creased from ten to sixteen.  The six new buildings, accom-
modating 1,760 patients, were erected at a cost of £261,995,
or about $720 per bed.   The largest of these, that of Cork,
was built to accommodate 500 patients, at a  cost of about
$773  per bed.  A Royal Commission, appointed in 1857, re_
ported  that the district asylums  were to a  great  extent
deprived of their utility as curative hospitals for the insane,
on account of the large number of chronic cases which they
contained, and recommended that other and separate provis-
ion be made for the latter class.
  From 1866  to 1869, six additional asylums were erected
at a total cost of £292,155, giving accommodation for 1,769
patients.  This outlay,  as will  be  seen, was at the rate of
nearly $800 per bed, but  it was  not  made in compliance
with  the  recommendation  of   the  Commission,  the new
asylums having been expensively built as  curative  estab- 
176                     IRELAND.

lishments, thus leaving the country as before  without any
special or separate provision for patients of the probably
incurable  or chronic class.  A Commission of Inquiry  in
1879, after  ful1  investigation,  recommended, inter alia,
that a  certain  number  of the  district  asylums  should
be  set  apart for curative  treatment, and  that the  other
district  asylums should  receive  chronic cases  requiring
special care.  The Commission further recommended that
the inspection of " lunatics at  large,"  instead of being left
to the  constabulary, should be undertaken by dispensary
district medical officers, acting under the lunacy authorities.
The fact  of upwards of 6,000  lunatics living " at large "
among friends and relatives throughout the country, with no
other official oversight than that of constables who collected
statistics respecting them and who were  guided, in a great
measure, by the gossip of the place, was deemed  by the
Commission to be a serious blot on  the lunacy  system.
  The estimated population of  Ireland on the  29th of Sep-
tember, 1886, was 4,889,430.  The number  of lunatics in-
cluding idiots under supervision of the Inspectors of Lunacy
January 1, 1887, was 14,702, being one to every 333 of the
population.  According to the last census (1881), the  popu-
lation  was  5,159,839.  The number of lunatics under the
supervision of the Inspectors at this time was  13,444,  being
one to every 384 of the population.  It will be observed that
these figures show a considerable decrease in  population and
an increase  in the number of lunatics.1
  The distribution of lunatics under  the supervision of the
Inspectors of Lunacy on the  ist of January, 1887, was  as
follows: in  the  twenty-two district or public asylums there
  1 The statistics given here, as well as those in the chapters on England and
Scotland, include only such lunatics as come under the cognizance of the lunacy
commissioners and inspectors. This fact should be kept in mind in considering
the ratio of lunatics to population. 
MAINTENANCE AND ACCOMMODATION.
177
were 10,077, of whom  only a few were paying patients ; in
the poorhouses (workhouses)  scattered over  the  country
there were 3,841 ;  in private asylums, 611 ;  in the  criminal
lunatic asylum at Dundrum, 172 ;  and in jail, 1.  It  was esti-
mated that 7,779 of the insane in district asylums were of the
incurable class, and that about half  of the lunatics  in the
poorhouses were idiots, epileptics, and confirmed imbeciles.
  The average weekly per-capita cost of maintenance in dis-
trict asylums  during the year  ending January 1, 1887, was
Ss.  id., of which four shillings was paid by the Government.
The total amount of  the government grant  for that year
was £99,608 i6.r.  In cost of maintenance are included sala-
ries and wages,  provisions, clothing, bedding, furniture,
household supplies, medicines,  incidental  expenses, " super-
annuations,"  and  repairs and alterations.   In poorhouses
where not more than a bare existence is maintained, the In-
spectors estimate that  the weekly per-capita cost of support-
ing the lunatic poor may be set down at 4s. %\d.
  The provision for chronic cases in Ireland  is still inade-
quate, and hence we find more  than one fourth of the regis-
tered pauper  insane restricted to the unsatisfactory accom-
modations of  the  poorhouses.  The  Inspectors of  Lunacy,
though strongly opposing the common care of insane and
other dependents,  advise, as an expedient to  meet existing
emergencies, that  in each asylum  district a  poorhouse be
selected  in a  central position, with land attached, to which
tranquil  and utterly hopeless cases could be  removed and
separately cared for.  Lunatics in  poorhouses are only in a
minor degree  under the  control of  the Inspectors, the poor-
houses coming under the authority of the Local Government
Board for Ireland, which is the central poor-law authority.
The Inspectors of Lunacy cannot alter the poorhouse dietary,
nor can they order that paid attendants be provided for the 
i78
IRELAND.
insane, though they may direct  the removal of a  pauper
lunatic from the poorhouse to an asylum, should they deem
such removal necessary.  The Local Government Board has
always opposed the conversion, on any large scale, of poor-
houses into receptacles for the insane, on the ground that
this  was never contemplated by the poor-law,  which was
framed only with reference to the relief of the sane poor.
  From an examination made of  a considerable number of
poorhouses in different parts  of Ireland, the writer was con-
vinced that  the  provision therein  for  the insane  was in
almost every  respect  unsuitable.  The patients  occupied
cramped spaces with imperfect ventilation and without the
usual asylum accessories, and there was little or no  oppor-
tunity for employment or recreation.
  There  are  twenty-three private asylums and licensed es-
tablishments.  Some of these are  charitable institutions
supported wholly or in part by voluntary contributions, and
others are kept  by their proprietors for  profit.   Among
those specially worthy of note are  St. Patrick's Hospital,
founded by Dean Swift ; the  Retreat, directed by the  Soci-
ety of Friends; the Stewart Institution ;  the Hospice of St.
Vincent de Paul for females,  which is under the immediate
charge of a religious sisterhood ; and two establishments for
men,  which are  conducted  by  religious fraternities—one
French and the other Belgian.
  The Board of Control, created by the Act I and 2 George
IV., has its office in Dublin Castle.   It consists of five  com-
missioners, three  of whom  are  Commissioners  of  Public
Works.   Two, who are physicians,  are  the  Inspectors  of
lunatic asylums.   The five are joint trustees of the property
of district asylums.  The powers of the  Board pertain more
immediately  to  the purchasing  of land, the  erection and
establishment generally of district asylums, and the furnish- 
                      S UPER VISION.                  179

ing of them.  The outlay made under  the sanction of this
department  since  1830 has  been about $7,250,000.   Sub-
ordinate to the commissioners are a secretary, an architect,
accountant, and a solicitor.  The two Inspectors, with their
assisting clerks, have also an office in Dublin Castle.   Upon
the Inspectors practically devolves the entire work of visita-
tion and supervision of all the lunatic  asylums in Ireland.
They visit each of the public and private asylums four times
a year, besides making special visits to them when necessary.
Their inspections also extend to the one hundred and sixty-
two poorhouses in different  parts of the country.   The  In-
spectors make an  annual report  to the  Lord-Lieutenant,
for presentation to Parliament.
   The boards of governors of district asylums, appointed by
the  Lord-Lieutenant  from among prominent citizens, are
similar in  many respects to the visiting committees appoint-
ed by justices  in England, and like them serve gratuitously.
The boards of governors supervise the financial affairs of the
asylums to which they are appointed, and  hold monthly
meetings for this purpose.
   Among  the points  wherein  the  Irish  lunacy  system
differs  from the  English, the following  may  be  noted:
The resident medical superintendent of an asylum  in  Ire-
land is appointed by  the  Lord-Lieutenant, and discharges
the duties of  his office in conformity  with  Privy  Council
rules.   There is also a visiting physician attached  to  each
asylum, who is  appointed by the Board  of  Governors.   He
visits daily the convalescent cases, and signs jointly with the
resident physician certificates of discharge.  An  anomaly is
found  in magistrates possessing the power to license private
asylums or licensed houses, but having no authority to sus-
pend the licenses, the latter power  being vested in the In-
spectors ; while the Inspectors, not having any voice in the 
i8o
IRELAND.
granting of licenses, rarely meddle with what has been done
by the magistrates.  Then, with  regard to pauper lunatics,
the relieving officer is not called upon, as in England, to re-
port to  the medical  officer  of  his  district  the existence
therein of lunatics or idiots unless they become a charge on
the rates.  No law of  settlement prevails, and  the place of
commitment must bear the  cost of  maintenance.   In the
event of his being convicted of some trivial offence, a  pauper
or other lunatic may,  under a recent  statute,  be confined as
a dangerous lunatic.
  While the law  is similar to that of England as regards
Chancery and private lunatics possessed of property, there is
a considerable difference as regards pauper or  even  paying
patients of  the middle class seeking admission into public
or district asylums.  As already  indicated, nearly all of the
patients in  the twenty-two  district asylums are  paupers.
One of the regulations made by the Privy Council was that
no  paying patient should be  admitted into any district luna-
tic  asylum so long as  there should be  unsatisfied the appli-
cation of any pauper lunatic.
  Most  of  the patients in public asylums are  admitted  in
one of three ways, as follows:  first, by application of the
friends of a lunatic, addressed to  the local Board of Govern-
ors, and accompanied  by a medical certificate, and a certifi-
cate of identification from a clergyman or magistrate stating
that the person to be committed has  not means sufficient to
support  him in a private asylum ; second, in cases of urgency
the resident physician of  an asylum may satisfy himself of
the condition of the patient and admit on the bare certificate
of  a medical man, subject to the approval of the governors
at  their next meeting; third, by the  signed order  of two
magistrates, which is  accompanied by a  medical certificate.
In  the admission of patients to private asylums, two medical 
COMMITTAL BY MAGISTRATES.
181
certificates  and the signed order of a relative or  friend are
necessary.
  The procedure of commitment and manner of conveying
patients to  asylums are open to grave objections, especially
in the case  of so-called " dangerous lunatics" committed  by
magistrates.  During the year ending January I, 1887, sixty-
six per cent of the 2,746 insane received  into district asylums
were admitted in this  manner.   As bearing upon  this sub-
ject, the Inspectors say :

  " Owing to the hasty procedure too frequently adopted, scanty
information, occasionally none whatever, is supplied on the face
of the warrants, beyond the offence committed, or the assumption
of an intention by an irresponsible agent, such as the breaking of
a pane of glass, jumping into  a pool of water, or threatening to
do  violence.  This mode of peopling an asylum, however benev-
olently intended, is upheld  by magistrates at Petty Sessions, who
frequently have no evidence before them beyond the declaration
of  parties anxious to get rid  of troublesome relatives, and  the
opinion of physicians casually called in by them to  cases with
which they  may  have  been unacquainted.  Thus  not only no
reliable information is supplied for the  guidance of  an asylum
physician, but utter  strangers  are occasionally made  chargeable
to  districts  with  which  they have  had no previous  connection.
Independent, too, of an unfair local taxation, it often occurs that
'dangerous  lunatics,' male and female, young and old alike, have
to  be conveyed from distances extending to seventy or eighty
miles, some, mayhap, handcuffed, under a  police escort, to their
destination.   The statute further leads to abuse from magisterial
oversight; scarcely a week passes over without illegal commit-
tals, and the consequent necessity of our  returning them to  the
committing justices for rectification."

  The discharge of patients from a district asylum rests with
the Board  of Governors,  who usually act  upon the  recom-
mendation  of  the superintendent.  The Inspectors are also
vested with the power to  order discharge.
  Connected with Irish asylums are but small areas of land 
182
IRELAND.
 for tillage and pasture, consequently there is a lack of some
 farm products which are  nutritious and highly beneficial to
 the insane.   Especially is this true of  milk, large quantities
 of which are required in institutions of this  kind.   Besides,
 from the insufficiency of land there is not so much outdoor
 employment as  is desirable.   Within  doors, in addition to
 the  usual trades carried  on by men,  such as shoemaking,
 tailoring, carpentering, etc.,  basket-making has  been under-
 taken in a few asylums.
  Notwithstanding  the defects in the Irish  lunacy laws, it
 must be conceded that the administration of the affairs of
 the existing institutions is generally deserving  of commen-
 dation.  The superintendents are efficient, and manifest an
 earnest interest  which extends to every detail of their work.
 A few extracts from  my notes of visitation will suffice to indi-
 cate the general character of the insane asylums of Ireland.

            CORK DISTRICT  LUNATIC ASYLUM.

  This  institution  is  so  situated  as  to  overlook a broad
 expanse of  the  fertile  valley  of the  Lee,  and is  sur-
 rounded by well-kept grounds ornamented with flowers  and
 shrubbery.  The asylum is designed for the insane poor of
 the district of Cork, and has accommodation for nine hun-
 dred and thirty patients.  It is built in a semi-Gothic style
 on  the congregate  plan.   The  four-story central depart-
 ment has  three-story wings to the right and  left, the whole
 presenting an extended front broken by gables.
  The  financial  affairs of the institution are directed  by a
 Board of Governors composed of forty members.  They hold
 monthly meetings, the average attendance at which is about
 ten.  The asylum is under the immediate charge of a resi-
 dent medical superintendent aided by two  medical assist-
ants.  There are also a  regularly  appointed  visiting  and 
CORK ASYLUM.
183
consulting physician, an oculist, and a dentist.   Included in
the house staff are a clerk and his assistant, a matron, house
steward, storekeeper,  band-master, librarian,  and  a  fire-
brigade instructor.
  Aside from single rooms there  are various associated dor-
mitories accommodating from four to twenty patients each.
A preference was shown for the  latter, about two thirds of
the inmates being provided for in this way.  The bedsteads
are  made  of gas-pipe.  Strong  canvas, with  eyelet-holes
around the margins, is laced to the framework,  and forms a
bottom to  the bed.  This arrangement, facilitating  easy
removal and  cleansing, and thereby  affording precautions
against vermin,  was  claimed to  have other  advantages.
Through  the centre of some of  the large dormitories is a
partition  with short  cross-sections forming  two rows of
stalls for  beds.  The  partitions  are  four and a half feet
high, and have an open space beneath.  The windows have
light iron sashes, so adjusted that the upper and lower parts
can  be simultaneously moved to the extent of  four inches.
On  some of the floors was laid bright-bordered oil-cloth or
linoleum.  Large open fire-places  were mainly relied upon
for warmth and ventilation.
   The men and women have their  meals together in a spa-
cious dining-hall  designed to accommodate seven hundred
persons.  This is also used as an  amusement hall, and  it has
a gallery for the band.
   From the several airing-courts  at the rear of the building
one  has a view of the asylum and grounds and of the beauti-
ful valley beyond.  The walls of  the court for men are built
higher at one of the corners for ball-playing, which is here a
favorite pastime.  The yards for  women were made attract-
ive by  beds of flowers, plots of  greensward, and gravelled
walks. 
184                    IRELAND.

  The land connected with the asylum is limited to fifty-
seven acres, only thirty-two of which  are used for farm and
garden purposes, the remainder being taken up by buildings,
yards, and groves.  Seventy-four of the men were engaged in
the cultivation of the ground, mostly by  the  use of the
spade.   During the year preceding my visit there were, on
an  average, forty-six  per  cent of  the  patients usefully
employed.
  It was said that very little restraint was resorted to.   Four
rooms  were padded, both  walls and  flooring, and in  these
very excitable patients were occasionally placed.  The in-
terior construction of these rooms is designed to obviate the
possibility  of  self-injury.   Cribs  were  not  in  use.  There
were, however, box-beds  in which patients were  sometimes
tied.  The bathing arrangements include a Turkish bath.
  Connected with  the  institution are two chaplains—one  of
the Roman Catholic Church, and the other of the Church  of
Ireland.  During the early part  of  1886, a  chapel for the
Protestant inmates was completed and  opened for religious
services.  It is a Gothic structure having colored glass win-
dows,  and  a  tower  with a bell.  The grounds about the
edifice have been  graded, planted, and  otherwise improved
by the aid of the inmates.
  The number of patients  January 1, 1887,  was  476 males
and 449 females.
  Brief as it  was, my visit  to this  institution  proved an
agreeable introduction to Irish asylums.   As I left the place,
the sight presented was particularly pleasing. The patients
were out on the broad and elevated terrace, evidently enjoy-
ing the fine music  of a band composed of asylum attendants.

          BELFAST DISTRICT LUNATIC ASYLUM.

  The inmates of this asylum, as in most similar institutions
in Ireland,  are principally of the dependent class.   Here,  as 
BELFA S T--LE TTERKENN Y.            I 8 5
elsewhere, the  asylum, though primarily designed as a cura-
tive hospital, was  overcrowded  and heavily burdened with
chronic cases.
  The buildings are plain,  substantial brick  structures two
and three stories high, and have pleasant grounds in front.
The asylum  estate, containing  fifty-five and  a half acres, is
inclosed by a  wall.   The buildings, courts, and  recreation
grounds take up thirteen and a  half acres.
  On the male side are sixty single rooms.  Of the associated
dormitories, ten accommodate four patients each ;  and eight,
sixteen patients  each.  The arrangements  for women are
substantially the  same as  those  for  men.  The bedsteads
are  of iron  with strap  bottoms,  over  each of  which  is
placed a thick straw  mat  that protects  the mattress.   At
the foot of each  bed was a semicircular willow basket for
the clothes of the patient.  Special  provision is made for
epileptics.   A night-watch perambulates the building,  and
makes hourly visits to the patients.
  In  a large dining-hall, men  and women sat  at separate
tables.  There were guards to the  open fire-places.
  The employments for men include garden and other out-
door work, shoemaking, carpentering, painting, and tailoring;
for women, needlework, knitting, laundry-work, and house-
cleaning.
  The airing-courts are spacious.   On the men's side accom-
modation  for playing ball  is provided on the plan  already
referred to at Cork. At their amusements, and in their several
occupations, the insane are under watchful supervision. Here,
as at Cork, a band composed mainly of attendants played at
certain hours, for the entertainment of the inmates.

  DONEGAL DISTRICT LUNATIC ASYLUM—LETTERKENNY.
  The above asylum, principally occupied by insane poor, is
pleasantly  situated in the  wild and picturesque  county  of 
186
IRELAND.
Donegal.   At the time of my visit, it contained 298 inmates
under  the  care of Dr.  Joseph  Petit, aided by  thirty-two
subordinate officers,  attendants, and  servants.   Since then
the number of patients has slightly increased, there being
324 inmates on the ist of January, 1887.   Only 110 of these
were women.
  Passing the gateway lodge, which is kept by a patient, one
reaches a block of plain yet commodious buildings fronted
by a broad green  lawn, and commanding an extensive view.
The buildings, though not imposing, are pleasingly varied in
outline, and are constructed so as to afford the inmates the
maximum of sunlight.
  There  are eighty-six  single rooms, six rooms  accommo-
dating three each, and ten associated dormitories containing
each from ten to thirty beds.  The floors were covered with
cocoa matting.  Willow baskets for patients' clothes hung
at the  foot of the bedsteads.  The windows had iron sashes
only in the single  rooms.   The Superintendent  favored
windows constructed so as to enable the patient  when  seated
to  obtain  outside  views.  Open  fire-places were  noticed
in all the principal rooms of the building.  The ventilation
appeared  to be good.
  It was  stated that restraint is reduced to the minimum
in this institution.   There were no patients in seclusion at
the date of my visit.   From the airing-courts, a fine view
of the  adjacent country is obtained.   Dr. Petit  advocated
the total abolition of walls, which he considered not only
unnecessary if there was proper supervision, but positively
injurious to the patient.   He further maintained that free-
dom had  a" salutary  influence  on  attendants,  stimulating
them to  greater attention to duty.
  In the way of industries, many of the men were employed
on  the farm, others at  tailoring, shoemaking,  etc.  The 
RICHMOND ASYLUM.               187
women  were, for the most  part, engaged in sewing  and
housework.
  It was evident, from an inspection  of  the whole institu-
tion, that it was under good  administration.

    RICHMOND DISTRICT LUNATIC  ASYLUM—DUBLIN.

  This is the oldest of the Irish  public asylums, and in its
management ranks among the foremost  institutions of its
kind in either Ireland or Great Britain.  For thirty years it
was under the superintendence of Dr. Joseph Lalor, to whom
it is greatly indebted for its present  advanced position.  At
the time of my visit  Dr. Lalor was assisted by two medical
officers.  There were also a consulting and visiting physician
and a surgeon.   The attendants on the men's side numbered
forty-six and on  the women's side fifty-four.   The patients,
of whom there was a slight excess of women over men, num-
bered  about one thousand.   There were only a very few
paying patients,  who were  received  at  a low  charge for
maintenance.  Among the inmates was a considerable num-
ber of feeble-minded, on whose  educational training  much
attention was bestowed.  The asylum, situated in the midst
of well-arranged grounds, is an  old-fashioned structure on
the congregate plan.
   On entering the spacious dining-hall, used also as a place
of entertainment, one sees  conspicuously placed upon the
wall the good old Celtic motto—"  Cead  Mille  Failte "  (a
hundred  thousand   welcomes).   There  were here  many
evergreen  wreaths left over from the holidays,  which lent
quite a festive appearance to the interior.  Before eating,
grace was sung  to an organ  accompaniment.   The  table
furnishing consisted of an ample supply of crockery, knives
with blunt points, and forks  with short  prongs.   The food
was wholesome, but there was little  variety. 
188
IRELAND.
  The associated dormitories are large and airy, while many
of the single  rooms were each  found to afford  1,200 cubic
feet of air-space.  The mattresses were uncovered and the
bedding folded and laid upon  them  for convenient inspec-
tion.  The ordinary sheeting  was  of  strong  Irish linen.
Epileptic patients sleep in deep  box-bedsteads.  Two nurses
are  on duty at night in each of the large dormitories, and
two are specially charged with the oversight of epileptics.
The night-watch is checked by  tell-tale clocks.  The rooms
for  seclusion were padded with cocoa  fibre, and the edges
of the floor  matting were  bound with leather.  In many
of the day-rooms, a strip of  wood was fastened round  the
margin of the floor to prevent the  furniture  from being
pushed  against the  wall.  Papier-mache' basins were  pro-
vided for violent patients.
  In the day-rooms for women there were many flowers in
hanging-baskets  before the  windows.   The rooms were
cheerful, and comfortably furnished.   From the furniture all
angular corners were rounded  off to prevent injury to  the
patients.  The chairs were of strong hard wood.  Birds in
cages were noticed  in all the day-rooms of the institution.
In the departments for hysterical patients and those suffer-
ing from  melancholia,  there were numerous pictures and
many other objects varying  in  form and color, to attract
and interest the inmates.  The  windows are so constructed
as to open simultaneously at the top and bottom.  Some of
the windows have iron  sashes.   In  all the wards were  seen
open fire-places.
  Respecting the efficacy of employment and training as aids
to the recovery of. persons  suffering  from mental disorder,
Dr. Lalor said : " Employment  of some kind is the agent to
which we should look for the improvement and cure of the
insane."  He has been designated " the father of the school 
                  RICHMOND ASYLUM.               189

system as applied to asylums."  In this connection it should
be mentioned that,  in  addition  to other employees, there
are two  male and  three  female school  teachers, whose
duty it  is to instruct patients in the ordinary rudimentary
branches and in music and drawing.  There are besides ten
" school attendants " who are employed as ordinary attend-
ants, but  who, during school hours,  assist in  school  work.
For the  performance  of these  duties  such  persons are
selected as have had experience as teachers and who, as Dr.
Lalor expresses it, have thus acquired  the habit of exercis-
ing a mastery over the  mind, and a practical knowledge of
regulating the habits and conduct which teaching confers—
advantages  which  not  only come in play during school
hours,  but in the general management of the institution.
The main objects kept in view here are to provide varied
occupations for as many as are  able to work ; to  apply  a
system  of education  that  will divert and strengthen  the
mind ; and to  promote,  by every conceivable means,  the
happiness and welfare  of the inmates.   During the  year
preceding  my visit  no  fewer  than  470  men   and  467
women patients  had  attended  the several  classes.  The
school  is a  kind of kindergarten.  There  are  lessons on
color, subjects  in  natural history are illustrated by pictures
or real objects, and,  in  general, material things are  used to
develop ideas.  The school is conducted in three divisions for
each sex,  and these are subdivided into six classes for males
and  five for  females.   Fifteen minutes at the opening are
given to an " inspection as to cleanliness."  The lessons are
brief, and there are frequent physical exercises and  singing,
with intervals of  outdoor and  indoor  recreation.   The
course  of instruction is varied so as constantly to occupy
the mind and form an agreeable routine for the whole day,
and the exercises of different days are  unlike.   The follow- 
190
IRELAND.
ing table shows to what extent the school system obtains in
this asylum, and partly indicates how the time of the patients
is occupied during a  year:
Occupation of Time.
Reading.............................
Writing on Slates......................
   "   on Copies, from Books or Head-
         lines.......................
   "   from Dictation................
Grammar, Parts of Speech.............
    "    Parsing and Derivations......
Geography, Local  and Descriptive......
          Physical and Historical.....
Natural History, with Illustrations......
Mechanical Powers, from  Models.......
Arithmetic, Notation and Simple Rules. .
          from Ball-frames...........
          Compound Rules...........
          Proportion and Interest.....
          Mental....................
Drawing Class........................
Object  Lessons.......................
Marching to Music....................
Physical Exercises and Drill............
Mixed Concert (bi-weekly).............
Concerts (fortnightly)..................
Attending Singing Classes daily.........
Assist in Teaching....................
Country Walks (weekly)...............
Visiting Zoological and Botanical Gardens.
Assist in Keeping Accounts, Record of Oc-
  cupation Tables, and Copying........
Attending Review  on Queen's Birthday..
Outdoor Recreation (daily).............
Attending Religious In- )      m.   f.
  struction in their Re-[-R.C. 80  141
  spective Churches.    ) I.C.  18   29
Average number		
of patients.		
M.	F.	T.
226	280	506
40	200	24O
IOO	80	180
175	120	295
118	ISO	268
SO	24	54
230	130	360
30	36	66
250	130	380
55	—	55
139	I46	285
43	90	139
142	36	1/8
30	2	32
226	60	286
40	2	42
226	120	346
190	280	470
190	20	210
36	70	106
36	3«	66
54	IOO	154
12	12	24
90	80	170
80	35	"5
6	1	7
132	—	132
293	280	573
[98	170	268
Highest number
during the year.
258  290
 53 ■ 220
120	86
180	130
122	156
32	30
236	140
32	38
256	136
59	—
145	150
46	IOO
147	40
32	4
258	66
45	2
258	130
200	290
200	24
40	74
40	33
60	130
14	14
IOO	108
80	42
8	1
300	290
120	200
   In connection with the asylum are but fifty-four acres  of
land, fourteen of which  are taken up  with buildings, yards,
etc.  The  farm  for the men and the laundry for the women
are valuable outlets for expending the superfluous energy of
the  patients.  Most of the washing  is  done by hand, and
the  garments are dried  in the open  air.   The  clothing  of 
                  RICHMOND  ASYLUM.                191

the filthy patients is, however, washed by machinery in a
special  department.  After  soaking for  six hours  in large
vats, it  is subjected to a high temperature and the action of
chemicals.  The following returns  show the daily average
number of patients employed and unemployed for a year:
Male employment.	Number employed.	Female employment.	Number employed.
Attending School only... Office Work............ Garden and Farm Labor. Smith-work and Engine. . Patients' Dining Hall and Food Van............	143-7 30 123.2 7-5 7-1 9.0 7.6 9.0 4-4 30 1-4 1.0 17.0 55-6 6.2	Attending School only... Darning and Mending. . . Fancy Work............ Learning to Sew, Knit, and Crochet..........	26. 9-48. 130. 135-8. 14. 2. 18. 69. 20.
		Quilting & Machine Work. Assisting in Kitchen and	
		Attending Members of Total Employed Daily. Total.........	
			
Attending Members of Staff.................			479-80.
	398.7 54 3 453-Q		
Total Employed Daily. Total........			559-
   Amusements, books, and periodicals are provided in almost
endless variety.  The following list indicates some of the
kinds of recreation :  billiards, bagatelle, backgammon, cards,
chess, dominoes, draughts, Aunt Sally, happy families, pum-
ble-chook, counties of England,  conjuring, music, singing,
archery, racing games, snap, cricket, football, lawn-tennis,
skittles, nine-pins, walking in the garden, walks to  Phoenix
Park, to the Zoological and Botanical Gardens, and fortnightly
parties.  The number habitually taking part in amusements,
games, and reading during the year previous to my visit was
400 male and  490 female patients.  In one  of  the wards, 
 I92                     IRELAND.

about thirty patients were seated in a circle round an organ,
listening with  rapt  attention to  the  music.  Women were
sewing under a trained teacher in another room.   Some dis-
played not  a little skill in making artificial flowers.  In all
of the departments  of this institution  there  appeared an
unusual  air of  activity without disturbance.  There  was
constantly during the day some kind of amusement, employ-
ment, instruction, recreation, or entertainment.  The whole
system seemed  to be  ingeniously  planned to  attract the
attention of the patients and turn their thoughts from them-
selves, and at the  same time  to inculcate habits  of self-
control.
  It being visitors' day, friends were seen holding free con-
verse with  the  patients.  There  is a rule that no  patient
shall be seen by any visitor until  after a month's  residence
in the asylum.
  In this large institution, there were,  on  the  day of my
visit, only  one man and one woman in seclusion.  It was
said that the refractory are confined  but for  a short time.
Dr.  Lalor expressed his opinion strongly in favor of the
efficacy of sunlight  for secluded cases.  Patients liable to
kick others  wear soft shoes.  Violent  and disturbed women
were, for the  most  part, plainly  dressed in linsey-woolsey.
In the refractory division  some of the patients were pick-
ing cocoa fibre ; others, stuffing and tufting mattresses.  In
this ward, fire-guards were placed in front of the fire-places.
Among  the women  outside, some  were  seen wearing a
crimson  turban-like  head-dress.  This  was  so   tastefully
arranged as to be attractive; nevertheless, it  was a device
humanely designed to  protect epileptic patients from acci-
dental injury.
  The bearing of the attendants appeared to be kind and
considerate.  The salaries of the women ranged from ;£n to 
                  RICHMOND ASYLUM.               193

.£15 per annum, with clothing and food, and those of the
men from ,£18 to £25, beginning  at the lower figures and
increasing to the maximum.
  On the grounds are two churches—one  a large and artis-
tic  structure for Roman Catholics, the other a tasteful build-
ing for those belonging to the Irish Church.  For each of
these and  for the Presbyterian inmates there is  a  regular
chaplain.
  Not content with  discarding old  methods of restraint, Dr.
Lalor also  signalized his advent in this institution by pulling
down  all the interior walls of the yards and airing-courts.
These  are  only some indications of the various ways in
which the asylum management was greatly improved by this
distinguished alienist supported  by an enlightened govern-
ing Board.
  Since my visit here, this eminent philanthropist and true
friend of the insane has passed from  the field of  his useful
and successful labors.  The asylum is now superintended
by  Dr. Conolly  Norman.  On the ist of January, 1887, it
contained eleven hundred and three patients. 
CHAPTER V.
             CONTINENTAL  COUNTRIES.

    TURNING  our attention to  the  insane on the Conti-
      nent of Europe, previous to  the reforms introduced
in the latter part of the eighteenth century, we find that this
wretched class  were subjected, if possible, to even greater
cruelty and neglect than that  under  which they then suf-
fered in the British Isles.   Harmless  lunatics were exposed
to severe and lawless chastisement; the troublesome, when
held in custody, were  confined  in unwholesome  prisons,
where  they were  sometimes placed  under  the  charge of
criminals, who,  with whips and  savage dogs, held barbarous
sway over the helpless objects of their cruelty.  Chains were
considered indispensable; even the garrote was used ; while
privation and uncleanness were characteristics of these for-
lorn places.
  Riel,  in  writing of the  German asylums in  1803,  said:
" They are  madhouses, not merely by reason of their  in-
mates, but more especially because  they are the very oppo-
site of what they are intended to be.  They are neither
curative institutions nor such  asylums for the incurable as
humanity can tolerate.  They are for the  most part verit-
able dens.   Has man so little  respect for  the jewel  which
makes him man, or so little love  for his neighbor who has
lost that treasure, that he cannot extend to him the hand of
assistance and  aid in regaining it ?  Some of these  recep-
tacles are attached to hospitals, others to prisons and houses
                           194 
FORMER ABUSES IN FRANCE.
195
of correction;  but all  are  deficient  in  ventilation, in  the
facilities for recreation ; in short, they are wanting in all the
physical and  moral means necessary to the cure of their
patients."
   In 1818  Esquirol said of the insane in France: " I have
seen them  naked, or covered with rags; with nothing but  a
layer of straw to protect them from  the cold dampness of
the ground on which they lay.  They were kept on food of
the coarsest kind ; they were deprived of fresh air to breathe,
and of water to quench their thirst, and even of the most
necessary things of life.  I have seen them given up to the
brutal  supervision of jailors.  I  have seen them in their
narrow cells, filthy and unwholesome, without air or light,
chained in such  dens  as one might  dislike to confine  fero-
cious beasts in."
   The condition of the insane in the most refined and luxu-
rious of European capitals, just before the changes effected
by Pinel, is thus described by Pariset:   " In spite  of the
reforms attempted under the most humane of  all kings, the
hospitals of the capital were still in a deplorable state of bar-
barity.   The one which presented the most revolting aspect
was the institution of Bicetre.  Vice, crime, misfortune, in-
firmity, diseases  the most disgusting  and  the most unlike,
were  there confounded under one  common service.  The
buildings were unfit  for human  habitation.  Men, covered
with filth, cowered in cells of stone, narrow, cold, damp, with-
out air or light, and furnished solely with a straw bed  that
was rarely renewed, and which  soon became infectious,—
frightful dens where we should  scruple to lodge the vilest
animals.  The insane thrown into these receptacles were at
the mercy of their attendants, and these attendants were con-
victs from prison.  The unhappy patients were loaded with
chains, and  bound like galley slaves.  Thus delivered, de- 
I96            CONTINENTAL  COUNTRIES.
fenceless, to the wickedness of  their guardians, they served
as the butts for  insulting  raillery,  or as  the  subjects of a
brutality so much the more blind as it was the more gratui-
tous.  The injustice of such cruel treatment transported them
with indignation ; while despair and rage,  finishing the work
with their troubled reason, forced from them by day and night
cries  and howlings that rendered  yet more  frightful  the
clanking of their irons.  Some among them more patient or
more  crafty than  the  rest showed themselves insensible to
so many outrages ; but they concealed their resentment only
to gratify it the  more fully.   They watched  narrowly the
movements  of their tormentors, and  surprising them in an
embarrassing attitude,  they dealt  them  blows  with their
chains upon the head  or the stomach, and felled them dead
at their  feet.  Thus  was there ferocity on the one  hand,
murder on the other.
  " At the  Salpetriere were received only such as had under-
gone treatment at Hotel Dieu,—the common and imperfect
treatment which rendered the state of the patients more diffi-
cult and dangerous.  To restrain their fury,  they were crushed
under the same rigors, or rather they were irritated by the
same sorts of violence.  Sometimes enchained naked in the
almost subterranean cells, worse  than dungeons, they  had
their  feet gnawed by rats,  or frozen  by the  winter's cold.
Thus  injured on  all sides, their embittered hearts breathed
only vengeance, and intoxicated  with frenzy  like the Bac-
chantes, they burned to tear in pieces their attendants, or to
destroy themselves  before them."  The reforms effected by
Pinel  at these two dismal  places have  already  been de-
scribed.
  It is gratifying  to every lover of humanity to reflect that
over the  entire Continent great progress  has  been made in
legislation  for the protection of the  insane.   Humane 
 
BELGIAN CAGE. 
                       REFORMS.                    197

methods have  displaced cruel treatment, and with few ex-
ceptions well-equipped asylums have taken the place of cells
and dungeons ; the private religious establishments, useful
in their day, have been almost entirely superseded by public
institutions ;  while advances made  in medical science  are
shown in the greater  effectiveness of the present  curative
treatment  of  the  mentally diseased.  The first asylum in
central Europe established exclusively for the insane  was
opened at Vienna  so recently as 1784.  Curative treatment
as the primary aim of institutions for the insane was soon
after recognized in Germany,  and improved methods of
care for this  class were  generally adopted.   Among  the
notable reforms of recent years were those accomplished in
Belgium.   Following an official  inquiry, the Government, in
1850, made radical changes in its laws affecting the insane.
It virtually re-organized its lunacy system  and abolished
many  grave  abuses that  had  previously existed  in  that
country.  Under the new  system the use of cribs or cages
then  common in  asylums was forbidden.  One  of these
peculiar contrivances  for confining the insane was on exhi-
bition at the  National Fair held at Brussels  in 1880.   It
was  a sort of wooden cage on  short  posts, into which the
food was passed through a small opening in the framework.
   It is, however, neither within the aim  nor the  scope of
this work to follow the progress  of beneficent reforms affect-
ing the insane, nor will an  attempt be  made to describe the
various lunacy systems of continental countries ; but brief
reference will be made to certain features of those of France,
Belgium, and Prussia.
   In France  the insane poor and orphan and abandoned
children are  made  objects of  special care by the State,
which  readily accepts the  obligation  of  supporting them
when relatives are  unable to do so.  The long-established 
198
CONTINENTAL COUNTRIES.
 lunatic asylum at  Charenton is  under the immediate direc-
 tion of the National Government, and  is open to patients
 from all parts of the Republic.  With  this exception, the
 public  institutions for the  insane  are  local  foundations.
 Each of the eighty-seven political divisions of France called
 departments must provide a public institution for persons of
 unsound mind ; or  else, with the approval of the Minister
 of the Interior, make an agreement with a public or private
 asylum in the same or an adjoining department  to  receive
 its insane poor.  The department, aided by contributions
 from the commune in which was the home  of the patient,
 defrays the  expense of maintaining its insane paupers when
 the relatives are unable to meet the charge.  The proportion
 paid  by the  commune depends upon the  amount of  its
 revenue.
  The sanction of the Government is necessary to the estab-
 lishment of a private  asylum, and  the person applying to
 the Prefect for a license to open such an institution must be
 of good moral character.  He must have received  the de-
 gree of  doctor of medicine, or must show that  he  has
 secured the services of a properly  qualified physician  to
 supervise the  medical department of the proposed asylum.
 This physician must be approved by the Prefect, who  may
 at any time, with the concurrence of the Minister of  the In-
 terior,  discharge him.  Before opening any asylum for the
 insane it is  necessary that  the  rules respecting its interior
 management be submitted to the Minister of the  Interior.
  Public and private asylums are periodically inspected by
 a committee consisting of the Prefect of the Department,
 the President of the local Tribunal, the  local Procureur of
 the Republic,  the Judge of the Peace, and the Mayor of the
Commune.   Public  asylums are under  the supervision of a
committee  of  five persons appointed  by the  Prefects,  of 
ADMISSION TO FRENCH ASYLUMS.
I99
whom one retires each year.  They hold meetings monthly,
or oft  ner if necessary.   It  is the duty of  the Procureur of
the A  rondissement to visit  every public asylum in his district
once in six  months and every private asylum once in three
months, or  oftener if he thinks it  necessary.  The asylums
are also visited by the Prefect and other officials who are re-
quired to report  to the Minister of the Interior respecting
the condition and treatment of the insane.
   Patients are consigned to asylum care in two ways.  The
first is compulsory, and  applies to dangerous lunatics  and
all persons who, if at  liberty, might endanger the public
s.afety.  These are dealt with as a measure of police  by the
public authorities—in Paris, by the Chief of Police, and in
the departments  by the Prefects.  In very urgent cases the
Commissioners of Police  or the Mayors are authorized to
take provisional measures for restraint, but the matter must
at the same time be  reported  to the  Prefect.  The second
form  of  admission is  called "placement  volontaire."  By
this method a relative or friend applies to the proper author-
ities for the admission of a lunatic into an asylum.  The
application must be accompanied by a medical certificate
indicating the mental condition of the patient  and stating
that he is insane  and should be confined in an asylum.  The
physician who gives the certificate must not be  a relative of
the patient nor connected with the asylum  to which  he is
committed, and the certificate must be signed within fifteen
days after the physician has seen the patient.
   Every person confined within an insane asylum must be
dismissed therefrom whenever the  physician of the institu-
tion asserts that  a cure has  been  effected.  A  husband or
wife, or more distant connection, or others may demand the
removal of a patient from an insane asylum, and the demand
must be  complied with unless the physician of the establish- 
200
CONTINENTAL COUNTRIES.
ment thinks that the  liberty of the patient would  compro-
mise  public safety and personal welfare, in which tg se he
makes known his apprehensions to the Mayor, who ir medi-
ately forbids  the  dismissal.  The  provisionary prohibitory
order expires in two weeks  unless the  Prefect, who is in-
formed of  the case, gives orders to the contrary.   The  Pre-
fect may at any time demand the  immediate dismissal  of a
patient placed in an insane asylum by the voluntary applica-
tion of friends.
  A peculiarity of  the French and Belgian  lunacy laws is
the liberal  conception of the right of the patient to his lib-
erty—a right  under  the  French code, entitled  that of
"Reclamation," by which a patient himself, or some relative:
or friend, or any person interested in  him, may claim his
discharge  before a  civil court.  Of this unique feature of
jurisprudence, the late Dr. Achille Foville, Inspector-General
of the Department for the  Insane in Paris,  says:

  " Every one placed in a lunatic asylum may claim his discharge
before the civil court as often as he pleases, and at any time. Thanks
to this right, every patient is  at liberty to have his mental  con-
dition examined by the  law of his country, without delay, without
complicated formalities, and without being hindered by pecuniary
considerations. .  . .  This right of claim is evidently the strongest
guarantee which the law can  give to individual liberty.   It is
no less valuable, I am convinced, to asylum physicians.  In my
opinion, it is a very mistaken view which some  of them take, who
regard it as a mark of personal distrust, and wish it to be resorted
to as seldom as possible.  I, on the contrary, think that this pro-
cess  furnishes  alienist  physicians with the best means of mini-
mizing their responsibility, of  clearing themselves from every
imputation  of  abuse of authority, and of  displaying, in all cir-
cumstances, the sincerity of their opinions  and the rectitude of
their conduct."

  A marked peculiarity of the Belgian system of caring for
the insane  is that of boarding them in families under govern- 
            ADMISSION TO BELGIAN ASYLUMS.       201

 mental  supervision,  as in the  colony of  Gheel.   A  new
 colony, Licrneux, similar to Gheel, has recently been begun
 in the Walloon  district, not  far from Liege.  The number
 of insane in the asylums of Belgium on the  ist of  January,
 1886, was  8,986.  This country, which is  one of the most
 densely  populated  in  the world,  contained at  the  date
 named nearly six millions of  inhabitants.
   The  support  of  pauper  lunatics  in Belgium  must be
 defrayed by the  communal treasury in default of sufficient
 charitable  endowments.  If there is proof that the  revenues
 of a commune are inadequate to this purpose, the  province
 is bound to meet the requirement.  There  are three govern-
 ment asylums, having accommodation in all for upwards of
 1,800 patients.  The municipal asylums of Bruges provide
 for about 1,300 insane.   Besides, there are numerous smaller
 hospitals kept by individuals or religious communities.
   Licenses are required from the Government before open-
 ing a public or private  asylum.   One or more medical  men
 must be connected with  the institution, and  the  patients
 must be visited daily.
   A medical certificate signed by a physician not connected
 with the asylum  to which the  patient is committed is requi-
 site to admission.  The certificate  must describe minutely
 all the  peculiar  symptoms of the patient's  insanity, must
 state its  duration, and give particulars as to previous treat-
 ment.   A sealed  statement accompanies the physician's cer-
 tificate,  declaring the  cause  of  insanity and whether  any
 other member of the  patient's family has  been similarly
 afflicted.  The medical certificate may be dispensed with in
 urgent cases, but one must be obtained within twenty-four
 hours after the patient  is received into the asylum.   Certifi-
 cates for the admission of pauper patients  are  made by the
medical officer of the poor. 
202            CONTINENTAL  COUNTRIES.

  Notice of a patient's reception into an asylum must be
forwarded,  not  later than one  day after reception,  to the
Provincial Governor, the Attorney-General of the Arrondisse-
ment, the Cantonal  Judge of the Peace, the Burgomaster of
the Commune, the Committee of Inspection, and the Secre-
tary of the Permanent Commission.  The sixth day after a
patient's reception  into an asylum  the physician transmits
his observations from daily examinations of the case to the
Attorney-General, and eight days thereafter he must inform
the Secretary of the Permanent Commission of  his patient's
condition.  Two medical men, members  of the Permanent
Commission, are required to visit the patient at intervals of
two months during  the first half-year that he is an inmate of
an asylum,  the first  visit to be made within three days after
notice  of commitment, and a copy of the results of their
examinations must  be sent to  the  Secretary of  the Com-
mission.  The second half-year but one visit has to be made
by these officers.  Persons are appointed by the Government
to visit all  asylums  as  follows:   Every three months they
are inspected by the Attorney-General  of the Arrondisse-
ment; every six months by the Burgomaster of the Commune;
every year  by the Provincial  Governor, or by a member of
the Provincial Council nominated by the Governor.  In each
Arrondissement a special committee, composed of  several
members, are required  to visit  annually all asylums coming
under their immediate jurisdiction; and three Government
Commissioners  are  obliged to make an annual report from
personal  observation of all asylums  and every thing relating
to lunacy in Belgium.   Notice  of discharge, containing the
patient's name, a statement of his  mental condition at the
time of discharge, the name of  the  asylum in which he had
been confined,  and of the house in which he  is going  to
reside, must be  sent within twenty-four hours after discharge 
GERMAN ASYLUMS.
203
to the  same persons  to whom notice of  admission was
sent.
  There are no general laws regulating the care of the insane
in Germany, and the manner of providing for them varies in
the different states.  Throughout the  Empire, the institu-
tions for  this class are small as compared with  those  of
England,  the United  States, and  some  other  countries.
Many of  the buildings used for asylums before 1850 were
once  monasteries.   It is  estimated that only about one
third of the insane  in Germany are given asylum treatment,
the  remainder being  considered suitable for  family care.
The number of public institutions for the insane in the Ger-
man  Empire  in 1886 was  103.  Of private asylums there
were 69.   Besides  these there were 29 of what  are called
open  asylums  {pffene Anstalten),  which  receive  cases  of
nervous disease  and the lighter forms of mental disorder.
There  were also 32  private  establishments  for  idiots  or
the  feeble-minded.
   In Prussia, the insane are mostly committed to asylums
according as they  are curable or incurable ;  but  whatever
their mental state, it must be set forth, together with other
facts, in a physician's  certificate, which is accompanied by a
statement of  particulars respecting the family relations of
the  patient, and bearing the signature of the authorities.
Most asylums receive  curable patients upon the request of a
near  relative or  other intimate acquaintance, even though
such  person has no legal authority over  the patient, pro-
vided the  consent  of  the   local  authorities  is  obtained.
Incurable patients are placed  under legal guardianship, and
the petition for  their reception into an asylum is made by
the  guardian or other legal  representative.   In  cases  of
urgent  necessity, however, temporary commitment may be
made without such petition.   Proprietors of private asylums 
204
CONTINENTAL COUNTRIES.
are required  to present to the proper authorities an annual
report respecting the condition of their institutions, to keep
a daily register according to a prescribed form, and to make
a special statement regarding each patient.
  The various provinces have different regulations respect-
ing the reception of incurable paupers into their asylums.
Some receive such free, or the expense is met by funds from
the  general  revenue of the province; others have a fixed
number of free  places, and any demand in excess of  these
must be met by the  community to which the  pauper be-
longs ; still other provinces will  receive incurable paupers
only after the expense of  maintenance has been guaranteed
by the authorities of their places of settlement.   Preference
is given in  the free places to dangerous cases.
  A brief description of a few representative institutions is
here presented, as illustrating different modes of caring for
the insane.   Deserving of special attention are  the colony
system of Clermont en Oise in France, the colony of Gheel
in Belgium, and the  Alt-Scherbitz  asylum in the Province of
Saxony, Prussia.   The two last are separately dealt with in
subsequent chapters.

          GAUSTAD  INSANE ASYLUM—NORWAY.
  In the care of the insane there is little to be gleaned from
Norway, if we accept  as a criterion  the  Gaustad asylum
near Christiania,  the capital of this northern  region.   An
examination  of this  institution produces in the mind of  the
stranger  unpleasant  sensations, and for aught  there  is of
ocular demonstration  to the contrary, it  might have been
built for the  retention of some of those stormy characters of
Scandinavian mythology, whose wild doings  are  familiar to
us through ancient song and saga.  The  massive construc-
tion of the refractory wards seems sufficient to resist  the 
            GAUSTAD ASYLUM--NORWAY.           205

hammer of Thor himself.  Indeed, it is questionable whether
the ponderous weapon  of the  god of  thunder could have
made any sensible impression on any part of these towers of
strength.
  The Gaustad asylum, pleasantly situated among the green
hills,  is  reached after  a  short drive  northwesterly from
Christiania.  This is  one  of the  three  public asylums of
Norway.   It  was established  about  the  middle of  the
present century, since which time those at Rotvold and Eg
have been  erected.  The brick buildings with slate roofs are
mainly of two stories.  There is an administration building,
back of which to the  right and left are two opposite ranges
of blocks connected by corridors.   The women occupy one
side of the asylum and the men the other.  On  the day of
my visit the inmates numbered 168 men and 152 women.
  The several departments were warmed by stoves.  Except-
ing the provision made for first-class patients, the sleeping
arrangements were mostly on the plan of associated dormito-
ries.  The floors and walls were  generally bare  and  the
rooms presented a cheerless aspect.  There appeared, more-
over, to be a lack of supervision, and the treatment seemed
severe. In  one of the  halls nearly half of the men were lying
on the floor. In one of the sitting-rooms not less than twenty
were  in  that position.   There   was  also  a dreary and
neglected appearance  about the small yards or airing-courts,
which are inclosed by high stone walls.
  All of  the outside windows had iron gratings, except in
the refractory rooms,  where the windows were high above
the floor and out of the reach of the patients.  The arrange-
ments for ventilation were faulty.  For discipline, an immense
douche was provided, the  water falling ten or twelve feet
through a one-and-a-half-inch pipe.  In the  refractory ward
the massive bedsteads were of  two-inch  solid oak, as were 
206
CON TINE NTA L CO UN TRIES.
also the tables and  benches, which  were firmly secured to
the  floor by iron fastenings.   The  doors were solid  and
strongly barred.  There were a number of  canvas-padded
rooms.
  Many of the women wore strong  dresses fastened  at the
back.  The garments generally were  of substantial material.
In several  of the yards a  considerable number of women
were lying on the ground.   In the women's workroom some
were engaged  in spinning, sewing, or knitting.  For the use
of the better class  of quiet patients there are ornamental
grounds inclosed by a picket fence about eight feet high.
  The state asylums of  Norway are  controlled by the Min-
ister of  Justice, and the local asylums by the communal
authorities. Many of the insane are boarded out  by poor-
law  committees,  whose proceedings are supervised  by  a
commission.  All persons  of  unsound  mind  have a legal
claim upon the state for relief.  Most of the lunacy legisla-
tion in  Norway, as  well as  in Sweden  and Denmark,  has
been with reference to committal and discharge, and  more
attention has been given to the protection of society than to
the rights of the insane.

        CONRADSBERG INSANE ASYLUM—SWEDEN.
  Some of the  hard  and forbidding  aspects of the Gaustad
asylum in  Norway are noticeable, though in a less marked
degree, in Sweden.  The Conradsberg asylum, on  the out-
skirts of Stockholm, although a modern institution, presents
little that is instructive, whether we view its  external sur-
roundings or its internal furnishing.  Both acute and chronic
cases are here cared for.   The  buildings are of two stories,
with basement, and have lateral wings projecting from  the
central or administrative department.
  This  asylum contained,  on the   day of  my visit,  252 
           CONRADSBERG ASYLUM--SWEDEN.        207

patients—140 men and 112 women.  All who are  able  are
required  to pay, and districts sending patients are  responsi-
ble for their maintenance.   First-class patients are  received
at two kroner? and second class at seventy-five ore1 per day.
The latter live in associated wards, as do also the third class,
who are paid for by the authorities. The dress of the second
and third classes was uniform.  There were  about twenty
first-class patients,  thirty-five of the second  class, and  the
remainder were third-class patients.
   The rooms of the  first class  had no  carpets, and were
plainly furnished ; but here, as in the second-class department,
were settees, also a few pictures on the walls. The bare floors
and scant furnishing do not impress one favorably, though it
must be acknowledged that a condition of scrupulous  clean-
liness  was everywhere observed.  The dormitories of  the
second and third classes contained from three to  eight beds,
with narrow  wooden bedsteads of the French box pattern.
   There are  two refractory wards, one for each sex.  These
contained about  thirty inmates, with one attendant to  every
eight patients.   The  single rooms of the refractory  ward,
like the  larger apartments, have windows so  high as  to  be
above the reach of patients.  The bedsteads were of the box
pattern with sides two inches in thickness, and they were
firmly secured to the floor.  The doors in this ward were very
solid,  being  three  inches  thick.   Apertures were  provided
for observation of the occupants of the single rooms in this
department.   Heating was effected  by means of hot-water
pipes.
   A large, well-lighted, and pleasant apartment was used as
the  women's workroom.   Here  were  two  tables, around
which  patients were busily sewing. In the way of industries,
besides sewing and spinning, something is done  at weaving
       1 A krone (ioo ore) is equivalent to about twenty-six cents. 
208
CONTINENTAL COUNTRIES.
linen.  The men  do a  little at carpentering, shoemaking,
painting, and general repairs.
  There were no padded cells.  No mechanical restraint came
under my observation.   The airing-courts were small and in-
closed by high fences.
  A contracted recreation yard that  I  entered had nothing
cheerful  about  it, and  resembled those of the insane de-
partments of some of our  country poorhouses.  There was
but little grass in  the yard, owing to the constant tread of
feet.  In  a  pavilion  furnished with  benches many patients
were seen lying down.   In the women's department were
some shade  trees, and the patients were here provided with
wooden benches and settees having backs.  In a small, plain-
looking chapel, furnished with  benches without backs, Sun-
day services were held.
  The patients, classified as to mental condition, dined in
association,  except in the case of the refractory, to  whom
the food was conveyed. Wooden spoons were used for the lat-
ter class.  The ordinary dining-rooms are on the  second
floor.  The  tables were  of two-inch hard  wood.   In some
cases knives and forks were furnished, in  others only spoons
were allowed.  The knives, where used, were of the ordinary-
table-knife pattern.  The dinner for the second  and third
class patients consisted of soup made of  barley and vegeta-
bles, fresh beef and potatoes, rye bread and butter.  Their
breakfast was rye  bread  and butter with milk.  It was stated
that the supper would be oatmeal porridge and milk.  Small
beer was allowed to be used freely during the day.
  This asylum, like all others in Sweden, public and private,
is controlled by the government medical authorities.

              ST. HANS HOSPITAL—DENMARK.
  A short ride westerly by rail from Copenhagen brings one
to this well-known institution, which is reputed to hold the 
            ST. HANS HOSPITAL—DENMARK.        2O9

most advanced position of the Danish asylums.   Like that
of Aarhuus  and Vordingborg, it receives  both acute and
chronic patients from allotted districts, while the  asylum at
Viborg is specially designed for chronic insane  of  the whole
kingdom.  Nothing further is  necessary to  admit a patient
into any of these establishments than the certificate of a duly
qualified physician.  There are  no special lunacy laws  gov-
erning asylums, nor is there any systematic or regular govern-
mental inspection or supervision of  the insane.  The St.
Hans Hospital is supervised  by a committee of magistrates,
and is under the  immediate charge of a resident physician
and superintendent,  who is assisted by a strong staff of medi-
cal officers.  At the  time of my visit there were in this insti-
tution 400 men and 340 women divided into  first, second, and
third classes.
   The  buildings are detached, and comprise  a  number of
separate departments.  That devoted to administration pur-
poses  forms one; the hospital for the  treatment of acute
cases, another;  a  third is used  for chronic male patients;
and a fourth is occupied by chronic female patients ; while
the  kitchens and wash-house  are also separate  structures.
The surrounding grounds, embellished  with  flowers and
shrubbery, include  a  park and lake.   There  are  also an
abundance  of shade trees  and an   extensive  system  of
gravelled walks.  The  grounds  belonging  to  the hospital
department  are especially remarkable  for  their  elaborate
ornamentation and careful keeping.  A portion  of the estate,
which contains about ninety acres, borders on the Rceskilde
Fjord.
  The asylum buildings are chiefly  of  three  stories, with
day  and work rooms below, and sleeping-rooms above.   It
was  observed that the sash most generally used was  of  iron
and  had small square panes.   The  institution has about
eighty single rooms; the  remainder  are associated dormi- 
210
CONTINENTAL COUNTRIES.
 tories, with, in some  cases, sixteen beds in a room.   The
 first-class patients occupy single rooms ;  the second small,
 and the  third  larger associated  dormitories.   The single
 rooms are of good size and well lighted.   For the seclusion
 of unquiet patients there are about fifty rooms, the windows
 of which are protected by wooden shutters.   The bedsteads
 were of wood and of the French or box pattern.   The  bed-
 ding was  plentiful, and included a mattress laid on straw.
 The male and  female patients have  their meals apart in
 large dining-halls, and so rigid is the separation  that  two
 kitchens  are  provided—one for  men  and  the  other  for
 women.   Food is conveyed from them to the dining-rooms
 in wagons constructed for the purpose.   There is chapel
 accommodation,  and there are also  pleasant  amusement
 rooms, including a billiard-room and a bowling-alley.   The
 sitting or day rooms were in general supplied with books and
 other reading matter.
  Various plans  are devised to keep all  occupied who are
 able to work.  Among the women were some who objected
 to every employment except knitting, and  their labor in  this
 direction more than met the requirements of the institution.
 It was therefore  directed  that  stockings should be knit not
 only for the inmates,  but also  for sale.  During  the year
 preceding my visit eleven hundred pairs were made in excess
 of the  wants of the institution.  To engage further the in-
 mates in this direction, knit undershirts were substituted for
 a woven fabric previously purchased for them.
  Among the men who  are able  and willing to work are
 many mechanics who are  employed at their various trades.
All the necessary painting, blacksmithing, and carpentering
are done by them, as also the tailoring.  Their labor is  also
made use of  in  constructing  sewers  and water-works, in
draining  the  land, clearing up underbrush, and  making 
            ST. HANS HOSPITAL—DENMARK.         211

gravelled walks ; also in converting the woods belonging to
the hospital into pleasure grounds, and carefully tilling  and
caring for the grounds generally.  The bucket system is in
use here,  and the asylum  waste is utilized to benefit  the
land.   Outdoor work, when the season and weather permit,
is substituted for the regular indoor employment of manu-
facturing  wooden shoes  and paper  boxes;  and by  this
thorough  systemization of  labor the cost of maintenance is
reduced, while the grounds and buildings are beautified  and
improved.
  Beach bathing,  which the patients greatly enjoy, is an
advantage possessed by this institution.   Even those who
most  oppose any prescribed treatment yield more readily to
the strand bathing in summer than to the warm house baths
in winter ; and  the  promenade to and  from  the beach is
looked forward to as one of the  pleasures which the summer
months will bring. On account of limited accommodations at
the beach it is  impossible to bathe all  the patients every
day;  therefore  the  baths  are  divided  into  sanitary  and
ablutionary.  The chronic cases are bathed but once or twice
a week, while those who seem really benefited  receive baths
daily.  The Superintendent,  Dr. Steenberg, says:  "There
have  been abundant occasions  when I  could date the be-
ginning of convalescence, or at least essential  improvement
both  in body and mind, from  the day when the patient
began strand bathing."  The water of the Fjord on which
St.  Hans  Hospital is immediately situated  is clear, but  the
sea bottom near the shore is muddy and rough  with sharp
stones ; therefore it is necessary  to float the  bath-house
some  distance from the shore.  For this reason it is deemed
unsafe to  allow patients who are likely to commit suicide the
use of the shore bath without special  precautions  being
taken. The Superintendent says :  "Although during all the 
212
CONTINENTAL COUNTRIES.
years I have been here but one person has met his death by
drowning, I cannot deny that many a time I am not a little
anxious for patients with acute melancholia to whom I permit
the use of the shore bath on account of its unquestionable
beneficial effect upon the  disease." As  affording facilities
for bathing a larger number  of patients, including some  of
pronounced suicidal tendencies, a bath-yard in the Fjord was
under consideration.
  The institution appeared  to be  well  organized, and the
treatment seemed kind. A large number of attendants were
employed, and it was said that  restraint was  very rarely re-
sorted to.  A highly favorable opinion was derived from the
brief visit made to this asylum.

FRIEDRICHSBERG ASYLUM FOR  THE  INSANE, NEAR  HAM-
                    BURG, GERMANY.
  This large and modern  institution is under the  control
and  direction  of the authorities  of  Hamburg.    At the
entrance to the grounds is a snug porter's lodge, and  near
by is the residence of the chief physician.  A little to the
right is the " Pensionnat," a large building occupied by board-
ers of the first and second  classes.  Farther on to the left is
the principal edifice, which is symmetrically and plainly built
of red brick, the central  structure being three stories and
the lateral portions two stories in height.  The administra-
tive  department occupies a  middle position between the
male  and female sections  of this  building.  In front  is  a
large park used for recreation and  promenades.   Rearward
are cultivated grounds  affording  outdoor industrial employ-
ment for the insane.
  At the time of my visit the  institution contained  1,010
inmates.  These included  acute  and chronic cases.  There
are four classes or grades of  patients, received at rates vary- 
        FRIEDRICHSBERG ASYLUM--HAMBURG.      213

ing according to accommodation.  Apart from these grades
there is a further classification into sections,  as follows:  I.
Incurables;  2. Those curable and able to work; 3. New ar-
rivals ; 4.  Refractory and such as require close supervision.
The plan of  treating curable with incurable insane patients
was disapproved of by the officials.
  For the four classes paying different rates the arrangements
vary. The first class have, according to stipulation, one apart-
ment with mahogany furniture and one attendant  to each
patient. The number and variety of meals being rather singu-
lar, the dietary is given for a single day.   The food  is slightly
changed on three days of the week.  The first breakfast for
this class consists of an allowance of prepared coffee, cream
and sugar, biscuit or rusk. Their second  breakfast  comprises
an  allowance of  soup or tea, butter and extras,  including
meat,  white bread, cheese,  etc.  At noon they partake  of
soup, meat or fish, fowl, game, potatoes and other vegetables.
In  the afternoon  they sit down  to a meal resembling the
first breakfast.   In the evening they have soup or  tea, white
bread, butter, and extras.  During the day they are  allowed
half a bottle of beer with black bread.   Wine is given only
by  medical direction.
  The second class are allowed one attendant and  a room
with varnished furniture to  every  two patients.  Their daily
meals include two breakfasts, as enumerated for the first class,
with the exception of meat and cheese.  At noon and in the
afternoon they again partake of food similar to that for the
first class.   In the evening they have soup or  tea with bread
and butter.   They also receive daily allowances of beer and
bread.  For these classes there is,  on the men's side, a room
with verandah opening into an adjoining garden.  Here are
also provided smoking-room, piano-room, billiard-room, and
bath-room.   On the female  side there is a sitting-room with 
214            CONTINENTAL COUNTRIES.
a verandah opening into a garden.  The other accommoda-
tions here include a ladies' saloon with piano, a small library,
and also facilities for bathing.  There is, besides, a dining-room
capable of  accommodating thirty persons, for the common
use of  ladies and gentlemen.
  The  third class have separate accommodation in the prin-
cipal building, and sleep in associated dormitories containing
from three to six  beds  each.  There  is one attendant to
every ten or twelve patients.  Their  first breakfast consists of
an allowance of coffee with cream and sugar, and white bread;
their second breakfast,  of warm beer or tea, with  bread
and butter.  At noon they have soup, with rice or groats;
four times  a  week, boiled,  and  three times roasted  meat
varied  with fish.  Potatoes are provided every day, and three
times a week other vegetables.   In the  afternoon  they re-
ceive coffee with cream and sugar, and the  usual allowance
of bread and butter.   In the evening, tea or soup is served
with black bread.
  The  fourth class occupy dormitories containing from three
to seventeen beds  each.  Their  dining-rooms are on the as-
sociate plan.  There is one  attendant to every fifteen  pa-
tients.  Their first breakfast consists of coffee with milk and
brown  sugar, and an allowance of white bread. The  second
breakfast for the men  includes beer, bread  and butter;  for
the women, warm  beer, bread and butter.   At  noon  this
class partake of soup similar to that for the  third class. Six
times a week they  have meat; once a week, herrings ; four
times a week, vegetables with pulse or coddled grains; and
potatoes every day.  In the afternoon they have coffee as at
the first breakfast, with bread and  butter.   In the evening
they sit down to tea or soup, with black bread.
  This institution is specially designed  for the care of  pa-
tients  having their residence  in  Hamburg and  suburban 
         FRIEDRICHSBERG ASYLUM--HAMBURG.      215

districts.  So far  as  accommodation permits, however, pa-
tients  of the  first three  classes are  received from other
localities.   The   ordinary  charge  covers board, lodging,
care, medical attendance, supervision,  etc.  An advance of
four weeks'  maintenance  is  required  from  the  first three
classes, besides a  deposit  for extras, such as excursions,
cigars, tobacco, repairs, and  washing.   The patients are
obliged  to   bring with them  clothing  and  linen  plainly
marked.  A duplicate list  of  these articles is made out, one
of which is  returned at the  time of  committal  by way of
receipt.  When suitable and  necessary clothing  is not fur-
nished, the  officers of the institution are authorized to ob-
tain the same  and charge it  to those  responsible for main-
tenance.  If valuables are intrusted to patients  by wish of
friends and  sanction of the physician, the institution gives
no guarantee of  their safety.   Letters to and from inmates
pass through the hands  of the chief physician.
   The day-rooms in the principal  building  are  heated  by
Dutch tile stoves.  The corridors are warmed by hot-water
pipes.  The lighting  is by gas.  From each of the day-rooms
is a passage leading to a  small garden or court.  For pur-
poses  of amusement there are provided  a  bowling-green,
billiard-room, and a large music-hall with pianos.   In all the
departments of  the  female  side there  were pianos.  On
Sundays, the patients, with consent of the chief  physician,
attend divine service in the chapel  of the asylum, which is
provided with separate  entrances  and  accommodation for
the male and  female patients.
   The total  number of attendants  was given as   101, or 51
men and 50 women.   The men enter at a salary of eighteen
marks' per month, rising at the rate  of three  marks every
two months  until  the sum  of  thirty marks is reached.  The
    1 A mark (100 pfennings) is equivalent to about twenty-four cents. 
2l6
CONTINENTAL COUNTRIES.
women attendants  enter at fifteen marks, rising to twenty-
four marks per month.  There are in addition nine principal
gardes, each of whom receives forty-two  marks  per month,
and twenty-six female gardes at thirty-six marks per month.
  In  the first,  second, and  third  departments  ordinary
window-sashes  hung  on hinges are  in  use.   The  panes
measure 10 x 14 inches.  The solitary rooms are  variously
planned.  The blankets used in them were of strong material
and double hemmed. The windows of some of these rooms are
high in the  wall; some are  protected  by wire screen-work ;
others again are grated "with heavy iron bars.  The latter
were noticeable in one of the  sub-departments for the most
violent.  In the refractory wards the patients seemed greatly
disturbed.   Here the glass was of unusual thickness.   There
are asphalt floors in the rooms occupied  by the very filthy.
  A considerable number of the chronic insane are provided
for in eight two-story houses or pavilions, plainly and cheaply
constructed of brick.   In connection  with each is a  small
yard.  Each of  these  buildings contains sixty beds.   Four
gardes sleep in each house on the same floor with the pa-
tients.  The window-panes  are  of a goodly size.   Food  is
brought here from a general kitchen, where it is cooked by
steam.   The buildings are in the midst  of beautiful grounds;
but  the spectacle   of  patients  restricted  to small  yards
produces an unfavorable impression  on the mind of the
visitor.  As one  walks about  the  grounds  and  sees the
patients through iron screen-work or  wooden palings, the
idea of  a park  menagerie  is  disagreeably suggested.   It
was asserted by the management that there was no  " forc-
ing," and that  no mechanical restraint  whatever was re-
sorted to.
  About one hundred inmates were at work on the farm and
in the  garden.  The farm  was stocked  with cows, horses, 
         FRIEDRICHSBERG ASYLUM—HAMBURG.      217

swine, poultry, etc., in the care of which the patients assist.
The barns and sheds are conveniently planned and spacious,
and have large gardens and grounds about them.   There are
also sheds in which the insane perform certain kinds of work
in unfavorable weather.   Two patients were seen at work in
the tailor's shop, in which, it was said, there were sometimes
as many as  six employed.  Three were busy in the cabinet-
shop.   The  other  workers comprised four  upholsterers,
three carpenters, one tinsmith,  five  painters, and two black-
smiths.
   It has already been indicated that there  is a classification
of the patients into social grades.   But the principle of clas-
sification is of much  wider application than would be gath-
ered from the mere mention of four classes.  It extends to
the mental and physical condition of the patients.   The aim
is not only to observe with care the social distinctions and
requirements, but also to provide each of the several classes
and their numerous divisions with separate accommodations
and  conveniences—down even to  a separate  tea-kitchen.
But so complex is this method  of classification that it is ad-
mittedly a source of much embarrassment to the administra-
tion, and, in  consequence, it is carried  out with  difficulty.
The higher grades do not care to be brought in contact with
those whom they consider beneath  them, while the humbler
classes become  envious  of  the better treatment  of those
ranking higher in the social scale, and the poorer patients,
seeing others apparently favored, make demands that cannot
be gratified.
   The  construction of the buildings is, as far as possible,
adapted  to  this principle  of  classification.  On  both the
men's side and the women's side are divisions for the differ-
ent classes—each in a sort of separate dwelling with distinct
living and sleeping accommodations.  The gardens are gen- 
218
CONTINENTAL COUNTRIES.
erally well kept, and the separate tea-kitchens referred to, in
almost every instance, open out upon small parterres.  In all
the principal parts of the institution there was an abundance
of blossoming  plants, and the pleasing combination of out-
door and indoor  attractions  appeared to have a beneficial
influence on the inmates.

     PROVINCIAL INSANE  ASYLUM—HALLE, PRUSSIA.

  This  asylum, which is the older of the two institutions
for the  insane of  the Province of  Saxony, has  accommoda-
tion for 600 patients.  On the day of my visit the inmates
numbered 585, of whom 304  were  men.  Like  that of Alt-
Scherbitz, the  asylum receives both acute and chronic cases.
Its government is also similar.   It is located in the country
near Halle, and, being an old institution, the  buildings, apart
from the new hospital, suggest little that  would be of advan-
tage to those in sympathy with modern progress.
  The land attached to the  asylum does not exceed sixty-
nine English  acres, but  it is brought under  high cultiva-
tion by the inmates.  On  the day of my visit 111 of the
men were  engaged in farming, gardening,  and  other out-
door work ;  18 were working as tailors,  carpenters, masons,
and blacksmiths; and the  same number were  doing house-
work.   Of  the women, 40 were engaged in sewing; 80 at
washing, peeling potatoes, and other domestic work  ; and 12
were  employed  in  the  garden.   Extensive  changes  and
repairs  had been  undertaken.   Work was  progressing  for
the introduction of a new system to utilize  the sewage.  It
was intended  to  distribute it by means  of narrow  trenches
over a  tract  of about four  acres set apart for garden pur-
poses.   All  gas-pipes and  water-pipes were to be  inclosed
within a large  conduit, so as to render them more accessible
for repairs.  The red bricks  used for building were of un- 
PROVINCIAL ASYLUM—HALLE.
219
usual size, being 10 inches long, 4f inches wide, and 2-f inches
thick.  They cost thirty-two marks, or nearly eight dollars,
per thousand.  In a cottage connected with  a farm resided
twenty quiet patients, who  worked in the fields under con-
ditions of greater freedom than the others.
  An interesting department of the asylum is an  infirmary
for female  patients.  This detached one-story building is
capable of accommodating twenty persons,  allowing 1,420
cubic feet of air-space to each inmate.  The bedsteads had
woven-wire  bottoms, and were  provided  with comfortable
mattresses.   The  ventilation, heating,  and all sanitary ar-
rangements were quite complete.  The windows and doors
were without fastenings.  The  warden's room has a large
window overlooking the whole  of the interior, so  that con-
stant watchfulness may be maintained.  The temperature
of the body of each patient in  the infirmary is taken twice
a day and recorded.
   In  the  dormitories of the asylum  proper, the beds were
provided with adjustable head and foot boards.   First-class
patients have single rooms; most  of  the other inmates oc-
cupy associated dormitories.
   In  the  dining-room, at the  close of the meal one of  the
patients rose and reverently returned  thanks.

     BURGHOLZLI  CANTONAL ASYLUM—SWITZERLAND.

  This asylum, opened in 1870,  is situated amidst beautiful
Alpine scenery at  Burgholzli, about three miles from Zurich.
It is  under  the immediate  direction  of a resident Medical
Superintendent, who is aided by three assistant  physicians.
The front or central building is flanked on  either side by
wings  of three stories, all of stone.  There is a  detached
building  accommodating a  limited number of the chronic
insane. 
220
CONTINENTAL COUNTRIES.
  The asylum is designed to accommodate 260 patients, but
at the time of my visit it was overcrowded.  Patients are
admitted to the  asylum upon the  certificate of  a reputable
physician, the consent of a near relative or guardian having
been  obtained.  There must also be a guarantee for  pay-
ment  of the charge for support.  Recent cases  are admit-
ted in preference to chronic, the institution being  intended
for  a hospital for the treatment of acute insanity ; while the
asylum at Rheinau is especially provided for chronic cases.
The two  establishments constitute  the public provision
made by the  canton of Zurich for its insane.  The inmates
are  divided  into  three classes  according  to  payment.
Patients  sent by the authorities  are  charged  sixty-three
centimes per day.  Connected with the asylum are seventy
acres  of land.  Every department has its airing-court  with
high walls.  The yards for first-class patients are in front and
are  laid out  in walks  and embellished with flowers.   The
windows of the buildings have outside  ornamental gratings
and sashes opening on hinges.
  In  the  third-class  dining-halls were solid  oak tables,
benches without backs, and dishes of  glazed iron. Table-
cloths were  in use. First-class  patients  usually take   their
meals in their own rooms.
  The dormitories were furnished with large-sized wooden
French  bedsteads, having slats with  coiled steel  springs at
either end.   For epileptics were provided special bedsteads
having cushioned  sideboards to  prevent the patients  from
falling out  or otherwise  injuring themselves.  For those
showing  a disposition to  tear their clothing the  beds are
covered with oil sail-cloth.  First-class  patients have single
rooms; second-class, quite small associated dormitories ; while
the third-class occupy apartments containing from six to ten
beds. 
          BURGHOLZLI ASYLUM—SWITZERLAND.      221

  Chapel accommodation is provided, and religious services
are held every Sunday.   There is also an amusement hall.
  For violent patients who need special treatment, dresses
of sail-cloth  secured  at the back are used, also  muffs in
exceptional cases.  In each refractory ward  there  were ten
isolating cells.  These were of a goodly size, but the ventila-
tion was imperfect.   The  windows  were about  eight  feet
above the floor, and  the doors were very heavy and solid.
There appeared to be a lack of care of the refractory class.
In  a  cell  in  the  female department, for a  patient whose
habits were said  to be very destructive, there was nothing
but a loose heap of straw for a bed.   Many of the patients
seemed violent and excited.   It was stated that during the
twenty-four hours preceding my visit one male patient  had
been  isolated for  three hours, and one female for five hours.
For the same period thirty women were recorded as having
been  violent  in the  daytime and eighteen during the night,
while there were six men violent by day and seven by night.
Fifteen men and  eight women were allowed the privilege of
walking in the park.
  A peculiarity in the treatment here is the mode  of giving
hot-water baths to refractory patients.   The bath-tubs have
wooden lids, in which are circular apertures for the neck.
The body and  limbs are concealed in the  tub, from which
only the head protrudes, the lid being secured by iron locks.
The water is heated to  the temperature of 950 F.  Under
what  is termed the prolonged  or permanent bath, patients
are kept in water from two to ten hours continuously,  this
treatment  being  intended to act  as a sedative.   In  such
cases  the patients are fed in the bath.  The writer saw  two
men and  one woman undergoing  this treatment.  One of
the former indicated  great exhaustion by  a feeble move-
ment  of his head ;  the other two were violent  and vocifer- 
222
CONTINENTAL COUNTRIES.
ous.  The  scene left  a painful impression.   The day's re-
port showed one man to have been immersed in this way
for three hours, another seven hours, another ten hours, and
one woman eight hours.
  The closets  are  arranged for  the use  of buckets, the
contents of which are  utilized on the farm.
  There are two  attendants to  every fifteen inmates.   A
male attendant acts as night-watch in the men's department,
a female attendant performs a like duty in  the women's
section, and there is  a  general night-watch for the whole
building.  The house  is heated by steam.
  The industrial system is indicated by the following state-
ment : Seventy-eight women were employed at general do-
mestic work ; sixteen  were  found knitting and sewing in a
workroom.   Twenty-two men  were at work  on the  farm,
three at trades, and fifteen at domestic work.   The washing
in the laundry is done mostly by hand, thus giving employ-
ment to some of the excitable patients.
  The increase of insanity  in Switzerland was in  a large
measure attributed to " hereditary  tendency,  intemperance,
intermarriage, bad  nourishment and consequent anaemia."

                LA SALPETRIERE—PARIS.
  This is one of the vast alms-house receptacles for the pau-
pers of Paris,  and it  is set apart  exclusively for  females.
The buildings, with surrounding gardens, courts, and prom-
enades, occupy a space of seventy-four acres.  The whole is
inclosed by a high brick wall.  The  enormous  size of the
institution  may be conceived from the fact that the build-
ings altogether comprise  forty-five  large blocks,  and are
lighted by  more than  five thousand five hundred windows.
Here are the aged infirm, as well  as  defective children, in-
sane persons, epileptics, and idiots.  For the children there 
LA  SALPETRIERE—PARIS.
223
is a special section, and in connection therewith a school.
At  the time of my visit the total population amounted to
6,311, of whom  590 were of  unsound  mind.   Two sections
are occupied  by the insane ;  and these, together with a sec-
tion for  idiots,  constitute one  of the departments of this
institution.   There is one attendant to eight or ten of the
insane.
  In  a large yard with  gravelled  walks and shady trees,
there are twelve small brick buildings, with broad  project-
ing roofs like those  of Swiss chalets.  Each interior is a
single apartment fourteen feet square.  These cottages, fur-
nished with sliding doors, were used for a peculiar class of the
disturbed insane.  The  clean-washed floors were of oak.  The
beds had wire springs and abundant bedding.   In each cot-
tage were too moderate-sized, strongly grated windows with
hinged sashes.   Heating was effected  from  below,  two
furnaces being sufficient to warm the cottages.
   For filthy  cases,  the large  associated dormitories had iron
bedsteads  of the  box pattern,  with drawers  underneath.
Thick straw  mattresses were in use, and in  some cases oil-
cloth formed part of  the bed furnishing.
   There were  numerous cells in  the insane  department.
These had  two openings,  one into an airing-court and
another  into a corridor.  Twelve  feeble imbecile  women,
lightly secured  in arm-chairs, were  seen in  one of the  day-
rooms.  In the bathing department there was a douche, and
the tubs were arranged in separate  stalls.
   Provision is made for entertainments, which include music
and dancing.  During my visit, a large number of  patients
were  seen in  one of the apartments listening to music from
a piano-forte.
   In  one immense  kitchen the cooking is done for the whole
establishment.  The insane eat in a special dining-room.  It 
224
CONTINENTAL COUNTRIES.
was said that wine is allowed at each  meal, also grapes in
their season.  Both of these were seen  on the tables.  An
attractive new dining-hall was in course  of erection.
  This being a very old institution, it has little  to  engage
the attention of the inquirer after modern methods,  though
it  is  interesting as showing the kind  of provision that a
great metropolis has made for the care of some of its depend-
ent classes.   Besides, one is curious to see a place noted  for
its associations with the great reformer Pinel. This is a com-
panion institution to the historically  famous Bicetre.  The
latter is for  male patients, and is similarly managed.

           THE ASYLUM OF STE. ANNE—PARIS.
  By many  French specialists in the treatment  of  mental
disease, this is considered a model institution.  It is situated
near the southern boundary of Paris,  is of modern  construc-
tion, and,  like  many other public edifices of the  city, is
of cut stone.  It is built in  sections with connecting corri-
dors and intervening courts, and  is  plain  in  its exterior.
At  the time of  my visit, the patients numbered upwards of
900, and the sexes were about equally divided.
  All classes of the insane are received at Ste. Anne,  though
the institution is  in  no sense an asylum, but a  reception
house and hospital for the treatment  of  acute insanity.  If,
from  a careful  diagnosis, the patient,  upon admission,  is
found to be suffering  from acute insanity,  he is retained  for
treatment ;  if his disease has become chronic, he is trans-
ferred to some  other  asylum, such  as Vaucluse, Ville Vraz,
or Burge.   The hospital is  supported  entirely by the De-
partment of the Seine, and no  paying patients are received,
the aim being to relieve  those  who  are unable to pay  for
skilful treatment.  One is  impressed with the  feeling that
the medical idea here predominates.   The staff is large, and 
STE. ANNE—PARIS.
225
there is thorough clinical instruction by physicians from the
Paris Faculty of Medicine.  The Sisters of St. Joseph, of
whom there  were forty-two, assisted by day servants, had
charge of the female side.  Each received for her services
twenty-five   francs  per month.  In  the  wards  for quiet
patients there were three attendants to fifty patients ; in the
ward for filthy cases, four attendants to fifty patients ;  and
in  the  refractory ward,  four  attendants to every twelve
patients.
   The sleeping accommodation is on the second floor.  On
the lower floor are dining, sitting, and other  rooms for day
use.  The rooms of  the refractory wards open upon irregular
courts,  the walls of which are partially sunk  so as to afford
glimpses of the country.  The  isolating cells are made very
secure ;  some have window-blinds.   The bedsteads in these
cells were of iron strongly secured to the  floor, and were
made with a central depression and outlet.   Some restrain-
ing chairs for the violent  were  observed placed against the
wall.  There was one  padded  room for men and another
for women.  The airing-courts, which contained many noisy
patients, were cheerless and quite limited in size.   In  con-
nection  with the infirmary is a small court, in which were
flowers and shrubbery.  Roofed galleries are provided, per-
mitting exercise  without  exposure.   The various wards are
heated  by means of pipes laid under perforated iron plates
in the floor.
   In the bath-room the  tubs  were not only separated one
from another, but set away from the walls.  There were here
a plunge bath, a hose for use upon the patients, and a douche
with arrangement for securing  the person while undergoing
treatment.   In one of the rooms of the bathing department
were stationary glazed iron foot-baths.   There were, besides,
arrangements for vapor baths.   A room was specially set 
226
CONTINENTAL COUNTRIES.
apart for washing and shampooing after the use of the vapor
bath.  As in some other French institutions, hydropathy has
a prominent place in the treatment, and there is much re-
liance placed upon it as a means of allaying excitement.
  The wards of this institution are small, which  is desirable
in the treatment of  acute cases.   Many of the apartments,
however, are poorly lighted  from  small airing-courts, and all
are quite plainly furnished.  There appeared to be a lack of
air, light, and room, and the provision generally did not seem
well adapted to secure the best results in curative treatment.

            INSANE ASYLUM  AT CHARENTON.

  This, one of the very old institutions of France, founded in
1642, is in the suburbs of Paris, near the park of Vincennes,
and receives,  as do  French institutions  generally, curable
and incurable patients.  Charenton  has  had  a  troublous
history, having been  several  times destroyed and  succes-
sively restored.  It is said that at  one time it was a  mon-
astery belonging to  the monks of St. Jean de Dieu, who
here undertook the care of the insane.  Following the revo-
lution of 1830 it became, under Louis Philippe, the property
of the State, and was at that time rebuilt of white limestone
pretty much as  it now stands.  The place has interesting
associations  from its connection with the names of Esquirol
and other distinguished alienists who here practised their
profession and wrote many of their valuable works.
  The buildings  occupy a commanding  site on a finely ter-
raced slope.  From the chapel, which  is  above the other
structures,  is  obtained a view of  a  charming landscape
stretching along  the  course  of the Seine.  This  edifice ac-
commodates about  one hundred  persons.  The terraced
airing-courts, of which there are eight in the  male and an
equal number in  the female department, measure each from 
CHARENTON.
227
one hundred to two hundred feet square, and have covered
places for shelter on either side.  From these courts, made
cool by  shade and beautified  by  fountains and flowers,
there are delightful views, which must have a salutary effect
on  the inmates.   Besides  these courts,  there are spacious
grounds shaded by large  trees.   In these open  spaces, at
certain hours of the day in favorable weather, all save  the
refractory take recreation.
  On the day of my visit, the asylum contained 285 men
and 300 women.   Most of the patients are from the middle
class of society and are supported  principally by relatives
or friends.   There are two resident physicians, two medical
assistants, a consulting surgeon, and  an apothecary.  A resi-
dent chaplain of the Roman Catholic Church daily conducts
religious services for such patients as desire to attend.  Sub-
ordinate to  the physician, the  female department is under
the charge of the soeurs religieuses of the order of St. Augus-
tine, who act as attendants and are assisted by servants. The
female servants wear blue dresses with white caps and aprons.
Each of the  Sisters receives twenty-five francs per month.
  That portion of the institution  occupied by the patients
is but two  stories high.  The windows of the upper floor
have gratings with five-inch square spaces; those of  the
ground-floor are without guards.   The asylum is planned so
as to admit  plenty of light.  The  buildings  are warmed by
hot-water pipes.
  Each of the dining-rooms has ten tables, each table  ac-
commodating six persons.  Cushioned benches without backs
were used instead of chairs.   The table furnishing included
crockery, wine-glasses, water-bottles, spoons,  forks, etc.   In
the refractory ward, no knives were used, and its dining-room
benches were uncushioned. Wine is supplied at all the meals.
The diet is regulated by  the price paid. 
228
CONTINENTAL COUNTRIES.
  The dormitories are on the second floor.  Iron bedsteads
measuring about  four feet in width were in use.  The mat-
tresses, made of horse-hair and wool, were laid on coil springs,
and the bedding was good and plentiful.  Patients requiring
special provision had deep box-bedsteads filled with marine
grass.   These had outlets in the  centre.   The uncleanly
occupied a separate one-story building, and had also a sepa-
rate airing-court.   In the dormitories for women,  over the
beds of the quieter patients were  pretty dimity canopies.
  In the bath-rooms, the tubs are arranged so as to be ac-
cessible from all sides.  As at Ste.  Anne's, bathing is an im-
portant factor in treatment.   The baths include medicated,
Turkish, and Roman.  There are also douches and  packs.
  A  comfortably  furnished room,  in which were two long
tables, was provided with cushioned benches and  chairs  at
each side.  This  apartment  is used by the male patients as
a reading-room.   The library is  valuable, and includes the
books and writings of Esquirol, which  he presented  to the
asylum.  Besides  the collection  of medical works, there is
an abundance of  entertaining reading in the form of books,
papers, and magazines.  There are no less than three billiard-
rooms.  In the corridors adjoining these places of  recrea-
tion, a light was  kept burning  for the accommodation  of
smokers.  There  is also  a  spacious  amusement-room  in
which the patients assemble every Sunday from  7 P.M.  to
10 P.M.
  The refractory  wards communicate with a wide corridor
having windows about eight  feet above the floor.  For the
extremely filthy of both sexes,  there are  small  courts  for
seclusion, and into these open a few isolating cells.   Each
of the latter has a cemented floor,  and is warmed by steam.
Box-bedsteads are here used, though in one of the cells on
the men's side, in which the atmosphere was very offensive,
nothing but straw was seen for a bed,  and  the  floor and 
CLERMONT EN OISE.
229
walls were besmeared with  filth, presenting an unsightly
appearance.  Strait-jackets, it  was  stated,  were used  on
an average four or five times a day.  The restraining chairs,
three of which were occupied at the time of my visit, have
cushioned  straps for the feet.   There were no cribs of any
kind.  Even the movable ones, formerly used for  carrying
patients about, had been discarded.  It was asserted here,
as elsewhere, that none were likely to be found in France.
   No  industrial system exists, although inmates who desire
to work in the garden or among the flowers are permitted to
do so, and light needlework is provided for women.
   At the time of my visit patients were received  into  the
institution at  from  1,000  to  1,400 and even 1,800 francs  per
annum.  The  number of attendants average one to about
every  nine patients.   Such of the men as paid 900 francs
extra, and those  of the women who  paid  850  francs extra,
were allowed  a servant as well as a private room, and ante-
room  for servant.  By the payment of a still  higher sum,
a  patient was entitled to  a suite of apartments in addition
to a servant's  room.  The furniture, etc., where no extra fees
were paid, was nearly uniform.   There are about forty single
rooms for each sex.   These are fitted up somewhat elabo-
rately, with mahogany bedsteads and  other corresponding
fui.  :ture.  Many of the apartments have parquet floors and
are highly polished with wax.
   What seemed  remarkable in an institution  possessed of
so many comforts  and having accommodation for so many
private patients, was  the  fact that it had few pictures on its
walls,  though  a tasteful display of bric-a-brac was noticed in
some of the rooms for women.

               CLERMONT EN OISE—FRANCE.
   The asylum at Clermont,  organized  as a  private and in-
dustrial institution, has long attracted attention by reason of 
 23O           CONTINENTAL COUNTRIES.

 its successful plan of colonizing the insane.  It is situated in
 the department of the Oise, thirty-six miles north of Paris.
 Up to the time of my visit it had been managed and superin-
 tended by that distinguished alienist, Dr. Gustave Labitte,
 who was then assisted by his son, Dr. George Labitte.
   There were  about  1,580 patients under  the  care of the
 general management. These were distributed over the three
 departments of the asylum as follows : one thousand, includ-
 ing twenty  epileptic, idiotic, and  insane children, at the
 Clermont central asylum ; about 440 in what is known as the
 colony of Fitz-James; and 140 in a second colony at Villers.
 The central  office at Clermont  is  the headquarters of the
 superintendent, and is  in telephonic  communication with
 Fitz-James and Villers.   Besides receiving insane poor from
 several outlying departments or  districts,  this  institution
 admits boarders on terms arranged  by special contract.   Of
 the total  number of  patients, it was estimated that  about
 319 were boarders and the remainder paupers.
   For the maintenance of the pauper insane the authorities
 paid, at the time of my visit, at the rate of one franc, twenty
 centimes per day.   The indigent insane supported by their
 friends were received at the same rate.  Boarders having pri-
 vate rooms and better fare paid 250 francs per month, or,  if
 they had their own servant, 350 francs per month. Single bed-
 rooms  were allowed to those who paid the higher prices, and
 associated dormitories with  from five to sixteen  beds were
 provided for  those who paid the lower rates.  The boarders,
 many of whom live at Fitz-James, do no work.
  Taking the three departments in order, we begin with the
 central asylum  at Clermont, connected with which are some
 fifty acres of  improved and garden ground.  Both sexes are
here cared for, a strict separation being maintained.  Among
the inmates of the male department were about fifty epilep- 
CLERMONT EN OISE.               231
tics, between eighty and ninety sick and filthy, and 150 quiet
patients, from the last of whom laborers for the grounds are
selected.  Each class occupies a  separate  section provided
with associate  apartments  for sleeping and  eating.  The
arrangements for female inmates are substantially the same
as those for men.  For the quiet class  in  the male  depart-
ment there  are  three attendants to one hundred and fifty
patients ; for the refractory, four to forty ; and for the twenty
children, two attendants.  The  sleeping apartments are so
arranged that the attendants can render  prompt assistance
in case of emergency.   Patients  paid for by the authorities
have  different  sleeping accommodation from that of indi-
gent patients supported by their friends.  The former sleep
in associated dormitories containing forty-five beds each ; the
latter occupy smaller apartments, each  having sixteen beds.
   In the wards for filthy patients, the bedsteads were of the
deep box pattern. The sheets were laid directly on sea grass,
which was changed daily.  In this way,  it was said, the beds
were more easily and cheaply kept clean. The metallic bottom
had a depression in the  centre with  outlet.  A breadth of
carpet was laid on the tile floor beside each bed.  The ques-
tionable practice of  keeping uncleanly  and violent  patients
much  of the time in bed prevailed here.
   The infirmary on  the second  floor, in which are kept all
suspected of suicidal tendencies, as well as the  violent re-
quiring special restraint, has grated windows.  The iron bars
are five and a half inches apart. Ordinarily,  the windows have
four lockable sashes, the two smaller ones  being at the top;
and all are hung on hinges.   In this portion of the building
the bedsteads were of iron.   For restraining excited patients
a  peculiar  method,  and  one  not confined to Clermont, is
practised.  The patient is attired  in a strong dress with long
sleeves  and  legs, the extremities of  which are secured  by 
232            CONTINENTAL  COUNTRIES.

cloth bands to the side and foot boards of the bedstead.  A
band similar to these is attached  to  the  collar of the dress
and fastened to the  head-board, thus holding the patient in
a recumbent position.
  There are ten cells for isolation in the whole establishment,
all of which, at the time of my visit, were  unoccupied.  They
are much  like the other rooms, except that they are made
secure by  wooden blinds.  The floors are of oak and waxed.
The bedsteads here, as in the infirmary, were of iron, box pat-
tern, with  holes at the head, foot, and sides for fastening re-
straining bands when they are considered necessary.  There
were no padded  cells.  There  were  two restraining chairs,
which were said to be seldom used. Narcotics were sometimes
given to allay excitement.  The strait-jacket or camisole was
used in cases of extreme violence.
  The dormitory of a refractory ward  that I inspected had
grated windows.  The  pine floors were  neatly waxed ; the
bedsteads were of iron.  Two attendants slept in an apartment
adjoining  and overlooking the ward.
  On one side of a  room on  the first floor, the windows are
placed high in the wall.  On the opposite side, opening to the
adjoining  court, the windows are lower and double the size
of the others. The furniture was of the plainest description ;
the tables and benches were deal.  Adjoining is a small dor-
mitory for such as are unable to go up-stairs. The objection-
able arrangement of high  windows already described was
seen in a building in course of erection.
  The airing-courts are  surrounded  by high walls and are
thus entirely separated one from the other. They are shaded
by trees, and generally measure from 200 to 300 feet square.
The airing-court  for  boarders  on the female side is very
large, well laid out, and ornamented  with flowers and shrub-
bery.   It  is divided by railings into three portions, occupied 
t
* 
  Church of
cTitz-James
md Workshops.
            EXPLANATION.

      A —Administrative  Section.
a—Director's Residence.
b—For Men Boarders.
c—Ornamented Grounds of this Section.
d—Entrance to the Colony.
e—Siviss Cottage.
           B—Farm Section.
a—Physician s  Residence.
b—Kitchen.
c—For Field Workers.
d— 3 ~ard of this Section.
e—Stables.
f—Baru and Thrashing Machine.
K—Grain Mill.
   Baths.
 .'—Steam-e ne in
 7—Pie-eery.
.{■—Workshops.
I—Coiu-house.
•n—A bbatoir.
n—Barn.
o—Cart-house.
i>—Court-yard.
         C—Little Chateau Section.
           a—For  Women Boarders.
           b—Kitchen, Baths, etc.
           c—Pleasure Grounds.

         D—Laundry  Section for
                   Women.
         a—Habitation of  Overseeing
               Staff.
         b—Habitation of tlie Patients.
         c—Workrooms,  Baths,  an,I
               Drying Room.
         d—Wash-house.
         e—I'at-house.
         /—Court  ivith  Improved
               Grounds.
              PLAN OF THE

COLONY  OF FITZ-JAMES
              CLERMONT. 
              THE cdLONY OF FITZ-JAMES.           233

by the quiet, the unquiet or refractory, and  the uncleanly.
In the centre of that part  of the court which is nearest to
the main building is a detached open pavilion used by the
women patients for sewing and reading.  In the division
for the filthy class, some of the patients were standing or
walking about, some sitting, some squatting,  and some even
lying on the pavement.   There was here a general appear-
ance of untidiness and disorder, doubtless  attributable to a
lack of attendants.
  Some new two-story buildings were in course of erection ;
the upper portions being intended for dormitory purposes
and the ground-floor solely for day use.
  The institution dress for  men in summer includes a blue
blouse worn over a jacket of the same color, dark woollen
pantaloons, and shoes with wooden soles.  In  winter a warm
jacket or  coat is added.  To all except boarders clothing is
furnished by the management.
  At the central asylum of Clermont, it was  said that the
inmates were  employed as  far  as  practicable.  The women
sew  for the institution.  The men are chiefly  occupied in
vegetable gardening.   Two were employed as coopers, four
as cabinet-makers  and joiners,  four  as  painters, two  as
tinsmiths,  seven as bakers, twelve as shoemakers, six  as
mattress-makers, and a few were engaged in making general
repairs.  Reading and assembly rooms are connected with
the institution.
  The colony of Fitz-James, which is about a mile distant
from Clermont, presents to  the stranger  many points of  in-
terest.  Industry, order, and freedom are noticeable through-
out the whole establishment.  There are no enclosing walls.
The two-story buildings of  the administrative  section, sur-
rounded by gardens, parks, and meadows, are plain, and are
planned so as to afford sleeping apartments above and day- 
234
CONTINENTAL COUNTRIES.
rooms below.  Prominent among these buildings is one al-
lotted to boarders, in which are a billiard-room and a library.
Here was also an organ. All the apartments in this building,
including the dining and day rooms, were  comfortably and
tastefully, though  not luxuriously furnished. The  day and
sitting rooms had plush-covered ottomans, cushioned chairs,
and other upholstered furniture.  The number of attendants
was large.  The apartments are arranged so as  to admit of
servants sleeping  in rooms communicating on either side
with the boarders on whom they wait.
  The insane poor sleep in associated dormitories,  contain-
ing from twenty to thirty beds each.  There are no  interior
partitions, and the windows, which are opposite each other,
are kept open not only in summer, but also in winter.  The
bedsteads were  of iron.   The 'bedding consisted  of one
straw and one woollen  mattress, linen sheets, and  woollen
blankets.  In every  case the beds were neatly made  up.
The  clean waxed  floors  added to  the  tidy appearance  of
the apartments.
  A short walk from the main buildings brings one to an
establishment called the " Little Chateau."  Here, under
conditions of much freedom, a number of " lady boarders "
are provided for,  in accordance with the  requirements  of
their  individual preferences and temperaments.
  In another direction from the administrative  section, and
forming a somewhat remarkable colony by itself, is the large
laundry {la section de Be'crel), where  the patients engaged
in laundrying reside.  The laundry buildings are arranged
on two  sides of  a  court, and  the women are effectually
secluded.  This interior space is large,  and made  pleasant
with flowers and greensward.   The rooms  are well  lighted.
They were comfortably though plainly furnished, and tidily
kept.  There was a variety of wholesome food.  The dining- 
THE COLONY OF FITZ-JAMES.
235
room tables were of deal.  Earthen dishes, glasses, and tin
spoons were used.  The laundry machinery is propelled by
steam.  Here all the washing of the establishment is done.
A novel arrangement in laundrying is  found in this depart-
ment.  In a very large room with stone floor is a long and
broad cement  vat, through which flows  a stream of pure soft
water that has been turned from its course for service here.
Those engaged in washing are ranged on either side of this
immense  vat, which  is at  a convenient  elevation from the
floor.  The different  articles are first  laid on the marginal
slope of the trough, rubbed with soap,  and then washed and
rinsed in the flowing stream.  The clothes, when practicable,
are dried  in the open air.  The  most violent of the female
patients who cannot be kept at  work that does not require
muscular  exertion are engaged  in  washing by hand ; others
less excitable  are employed at the machines, or in spreading
the linen  to dry; while the  more delicate are occupied with
folding and smoothing the linen. The grounds here are
sufficiently extensive to afford recreation and considerable
freedom ; at the same time  there  is the seclusion necessary
for the protection of the insane women.
   The colonies of Fitz-James and Villers have upwards of a
thousand  acres of farming land.   The majority of the male
pauper patients are employed at general  farm-work.   They
are divided into groups of ten or fifteen, and are  directed
and assisted by an attendant.   Among so large  a number
there may be  found those adapted to every requirement of
farm industry. By carefully studying the tastes, disposition,
and  ability of each patient, selection  is  made of those  to
whom  can be assigned a specific charge, such as the care of
certain tools.  In this way the land is thoroughly cultivated,
the farm implements  kept  in repair, and the domestic ani-
mals properly cared  for.  Vegetables  in  great variety are 
236            CONTINENTAL COUNTRIES.

produced in quantities sufficient to meet the wants of the
institution.   Dr. Labitte says :  " We have been able  for
many years to raise upon  the  institution grounds, with the
exception  of  an occasional purchase, all  our cattle  and
horses."   In the capacious farm buildings and stock-yards,
which take up five acres, were thirty horses and a large herd
of cows and growing stock.   In the piggery were upwards
of a hundred swine.   Not a little attention is given here to
the breeding of rabbits. Great pains are taken to secure the
best breeds of farm stock, and the care bestowed  upon it is
often  rewarded by prizes taken at exhibitions and fairs.  Dr.
Labitte says :   " The insane patient who lives in the midst
of this progress is proud of the prizes that the farm receives
each year, and of which he can attribute to himself a share.
He shows complacently to visitors the animals he  has raised
and for which he cares."  In connection with the farm build-
ings at Fitz-James there is accommodation for a small colony
of farm laborers, for whom  have been fitted up day-rooms
on the ground-floor, and associated dormitories above.  As
one enters the court around which are arranged  the stables,
sheep-folds, cow-sheds, and  piggeries, he is struck  with  the
neatness and order with which they are  kept.   Among  the
attendants are several practical farmers who work with and
direct the insane.   About the barns was seen a large group
of patients cheerfully preparing for work after their mid-day
meal.   One in a gleeful mood was  setting out for the  field
mounted on one of the work-horses.
   The sewage,  after  being conveyed to vats in the fields,
passes successively through four of them, which are placed at
different elevations for the purpose of separating the liquid
from the solid.   This Dr. Labitte regarded as the best-known
system  of sewage utilization in connection with asylums.
   But agriculture is  not  the only industry of Fitz-James. 
THE COLONY OF FITZ-JAMES.          237
While many of  the patients are occupied on the land, there
are a considerable number chosen, on  account of previous
experience, to work at various trades.   On the farm are two
mills for grinding wheat, a forge and a machine-shop for re-
pairing agricultural  implements,  a mill used  in  making
cement,  a cider manufactory,  a  bakery, an  abattoir, and  a
dairy.  Each of the  flouring mills has three  run of stone.
One is propelled by an engine of thirty horse-power, and the
other by water.   These mills, especially the  one having the
steam-engine, were shown  with much pride.   In  the black-
smith's shop were long rows of horseshoes, all made by the
patients.
   In order  to  make the  classification still more perfect,
simplify attendance, and give the  greatest amount of free-
dom to each class, there are selected for the colony of Villers
only chronic male patients who require little oversight  and
are already accustomed to farm-work.   Although the colony
of Villers is a considerable distance from that of Fitz-James,
the  lands adjoin.  The open-door system  is here fully real-
ized, the operations of the place being conducted with nearly
the  same liberty as in ordinary family life.
   On Sunday  many  of  the patients  attend  mass in  the
village, where a portion of the church is set  apart for them.
Some are trusted to go alone both to church  and to village
festivals.
   The  examination of the  Clermont colonies afforded me
much satisfaction.  There was apparent cheerfulness in the
several divisions, while,  as has already  been  shown,  the
steadiness with  which the  industries are pursued tells favor-
ably in  the economic  results attained.   Nevertheless, the
primary object of labor is  the welfare of the patients.  The
force of example, the fear of being returned  to the  more re-
stricted limits of the central asylum, and the offer of rewards 
238
CONTINENTAL COUNTRIES.
in the shape of money  or  dainty  food are  inducements to
labor; but recourse to coercion is  forbidden.   On  an aver-
age, the time allotted for work does not extend beyond  six
hours per day.   In some departments, as, for  example, the
laundry, the labor is performed by alternate sets of workers.
The  free  and  natural  conditions of life existing at Fitz-
James and Villers  are  marked   characteristics  of these
colonies, nor can one forbear to note the admirable judgment
and  delicate tact  displayed in adjusting  the employments
to the experience, physical capacity, and mental condition
of the patient.  If a working patient betrays  symptoms of
violence or becomes from any cause unmanageable, he is
immediately transferred to the central asylum; and, on the
other hand, whenever  a patient in  the central asylum  be-
comes quiet and tractable, he is removed to the colony and
its industrial system.  There is thus a steady and highly
beneficial  intercourse between the  two  divisions.  With all
the  freedom  here accorded, surprising as  it  may  appear,
there are few attempts to escape, and, indeed, there  are few
casualties  of any description.
  The satisfaction derived from the inspection of  the colo-
nies  of Fitz-James and Villers  did  not extend to the central
institution with its one thousand inmates.  Possibly owing
to the large numbers brought under  one  management  and
the  burdens incident to  the  conducting of its extended
business affairs, the central asylum  at Clermont did not,
as it  appeared  to  the writer,  reach a proper  standard  for
a hospital for the treatment of the acute insane. 
CHAPTER VI.
              THE COLONY OF GHEEL.

    LEAVING the afternoon train from Antwerp, the writer,
      accompanied  by a stenographer familiar  with  the
patois of the place, wended his way for about half a mile
along a street or roadway sparsely lined with plain cottages
to one of the two principal inns of Gheel.  A few steps from
this humble hostlery brought us to the main public square, at
one end of which is the church of St. Amand, and close by is
a lofty cross with a life-size figure of our Saviour.  On the re-
maining three sides of  the square are plain houses or shops,
none of which exceed two stories in height.  Near the church
is a huge, ancient-looking pump which forms a  rendezvous
for the young maids and  children of the town, as well as a
centre for the dissemination of gossipy news.   The farther
end of the green was covered with linen of the villagers
spread out with  great particularity to bleach upon the grass,
indicating the methodical habits of the people.  A  number
of persons having the appearance of  being insane were seen
walking along the street or seated on the  door-steps of the
dwellings.  From this  part  of the staid old town,  we pro-
ceeded along a winding paved road, on either side of which
were brick houses with red tile roofs,  receiving on our way re-
spectful salutations from the villagers. A novel street scene
was that of men in  small cars which were drawn by dogs.
The  first car  noticed had five of these animals abreast;  to
each of two others was attached a pair of dogs. Thus far
                           239 
240
THE COLONY OF GHEEL.
 we had passed a number of small shops devoted to the sale
 of  beer and  tobacco.  About an eighth of a mile from the
 square, the street terminates in  a  long avenue of beautiful
 elms, extending far into  the country, with here and there, on
 either side, larger two-story buildings than we had previously
 seen.  A short walk along this avenue brought us to the In-
 firmary, a large two-story brick  structure with red tile roof,
 standing amid gardens and shrubbery. Occupying a niche in
 the central projecting gable of this building is a life-size figure
 of St. Dymphna, the patron saint  of Gheel.  Having made
 an appointment for the following morning with Dr. Peeters,
 the Head Physician and Director of this institution, we took a
 short route across the cultivated  patches of ground and soon
 reached the church of St. Dymphna, of legendary fame.
  This church is a massive  cruciform structure, chiefly of
 brick, with portals and carved mouldings of stone.   Within
 are numerous tombs and tablets, and  the walls have  paint-
 ings and other decorations in keeping  with  the sacred  char-
 acter of the  place.  As  we entered, through the gathering
 shades of evening, we descried  at the farther extremity a
 starlike light which  burns unceasingly at the shrine of the
 saint.  On one of the church pillars, near the altar, is a cano-
 pied statue of St. Dymphna, and opposite to it on the corre-
 sponding pillar is a sculptured figure of Father Gerebernus,
 the religious guide and protector of the maiden saint.  The
 altar of white marble has sculptured representations of in-
 sane persons  with manacled limbs,  in the act of supplicating
 St.  Dymphna.   The silver shrine,  believed  to contain her
 relics, is elaborately wrought, and is preserved with religious
care.  The tomb of the  saint is elevated  on short pillars,
but sufficiently high to admit of  persons passing under  it
upon their knees. The  stone pavement about it is much
worn  by the feet of weary pilgrims, who,  through many 
 
THE  CHURCH OF  ST. DYMPHNA, GHEEL.




         From an  old picture 
PECULIAR CEREMONIES.
24I
generations, have here sought relief from their afflictions.
On the walls near by are legendary inscriptions relating to
her romantic life.
   In apartments  connected with the church and under the
charge of a resident sacristan is a goodly sized room with tile
floor, and massive beams overhead.  On each side of a large
open fire-place are iron rings in the wall once used to secure
violent patients near  the fire  without endangering  them.
Adjoining this room is one not  so large, which receives light
from the other through a small grated window. The smaller
room, unoccupied at the time  of my visit, and now seldom
used, was furnished with a table and a comfortable bed. Ac-
cording to Esquirol, who visited Gheel in the year 1821 :" It
was formerly the custom for a patient  to be placed, on  his
arrival, for nine successive days in  the  house adjoining the
church, along with a few others, in a room under the  guard
of two old women.  A priest came every day and said mass
and  read  prayers  to them.   Then  those patients  who
were tranquil,  joined  by some children of the  place, went
three times in procession outside and as often inside of the
church during the nine days of treatment.  Each time they
arrived at the tomb of the saint they prostrated themselves
and passed under  it on their  knees.   If a patient was too
furious to allow of this being done, an  inhabitant of  Gheel
and some children were paid to perform the ceremony."
   However incongruous these ceremonies may seem as com-
pared  with our present theories respecting  the insane, we
may not treat with levity the  simple faith  of  those  who,
actuated by a belief in spiritual influences, sought  relief for
themselves or suffering friends at the shrine of St. Dymphna.
The pious custodian in charge  of  the church lamented the
falling off  in the number of pilgrims' visits, a circumstance
attributed  by him in part to  " new-fangled  notions of the 
242
THE COLONY OF GHEEL.
 doctors."  Though faith in the healing powers of the saint
 is weakened,  her memory is  still  honored  by  an annual
 fete held in the month of  May, in  which both sane and in-
 sane take  part.
   Not far from the church of St. Dymphna stands an ancient
 hospital, said  to have been built in the thirteenth century.
 In one  of its walls is a  covered recess, open to the street,
 from which it is  separated by iron bars.   It contains two
 figures, life-size ; one representing a grim warrior,  the other,
 a kneeling and suppliant  maiden  upon  whom his uplifted
 sword is descending.  These figures, it was  said, mark the
 spot where the saint was put to death.
   There are various versions of the interesting legend of St.
 Dymphna, and among them the  following, which is given
 substantially as related to us by an  accredited cicerone, who
 evinced a zealous  interest  in all that affected the good  repu-
 tation of his native town :

  In the  seventh  century  there  lived  in  Erin a king whose
 daughter, like her mother, had acquired fame for her beauty as
 well as her many virtues.   She became a convert to Christianity,
 and shortly after her conversion, her father, tempted by the Evil
 One, so persecuted  his daughter by his unnatural conduct  as to
 drive her to desperation.  She took counsel  of  an aged priest,
 the holy Gerebernus, and with his advice and assistance secretly
 left the country and found a temporary refuge at  the place where
 Gheel now stands.   Here, under the  protection of Father Gere-
bernus, she abode, serving  God by  fasting  and  prayer.  The
king, on discovering that his daughter had fled, was beside him-
self with rage, and sought her everywhere in  his own kingdom.
 Unsuccessful  in these efforts, he extended his search to  other
countries, and  at length came to Antwerp, where, finding  some
pieces of the coin of his own realm, they afforded him a clue,
which, with bribery, led  to  the betrayal of her  secret abiding-
place.  Here he found and  slew  Father Gerebernus, and then,
with his own hand,  put his lovely daughter to death.   God pro-
tected their bodies from the wild  beasts, and  from the fowls of 
THE LEGEND OF ST. DYMPHNA.         243
the air, until they were buried by the people.  When these things
were told about the country, many came, or were brought, to the
graves of the martyrs, and were cured of all manner of diseases,
bodily as well as mental, but particularly the latter.
  The priests,  hearing of  the miracles that were effected,  de-
sired that the bodies should be exhumed, and again buried  with
appropriate ceremonies.  In this attempt, they were astonished
to find that the remains of  Dymphna and  Gerebernus had each
been inclosed in a snow-white stone sarcophagus.   This was re-
garded as a special interposition of the angels.   Afterward, many
came from afar to see the relics of the holy dead.   Among these
strangers were some inhabitants of Xanten on the Rhine, who,
after  remaining  several days at  Gheel, meanly stole the sacred
relics and fled, hotly pursued by the indignant people of Gheel.
Becoming pressed to make good their  escape, the wicked plun-
derers relinquished one of the sarcophagi, and, by mistake, made
off with the remains of Father Gerebernus, leaving the coffin of
the virgin in the  hands of their pursuers.  Their mistake  dis-
covered, the sacrilegious villains  returned and  made an attempt
to  recapture  the coffin of  Dymphna, when lo  ! it  was found to
have become as immovable as the rock on which it lay.  A good
frow, prompted  by a heavenly  vision,  harnessed  her young
heifers,  and,  with them,  drew the sacred relics back to Gheel,
aided by some and mocked by others.  It was  believed  that the
martyred maiden  not  only forgave the murderous deed of her
father, believing him to have been insane, but desired to alleviate
a like madness in others.   Her presence was proclaimed at the
spot, and thither afterward  pilgrims came imploring her interces-
sion.  Miraculous cures were effected, and many of unsound mind
were restored to reason at her shrine.
  As time wore  on,  added our guide,  pilgrims increasingly
flocked  to this  place, and out of their gifts a chapel was at first
erected, and some time in the twelfth century the present church
of St. Dymphna.   It became necessary for the friends of patients
to find in the  neighborhood permanent boarding-places for the
afflicted, and thus was established the colony of Gheel.

                THE SURROUNDINGS OF GHEEL.
  The commune, or what is known as the colony of Gheel,
covers a territory of upwards  of forty square miles.   Its 
244
THE COLONY  OF GHEEL.
greatest  length is about  eleven  miles,  and  its  greatest
breadth a little  short of nine miles.   The  colony  contains
about  three  thousand houses, in  more than one  third of
which lunatics are boarded.   The public affairs of the com-
mune  are  presided  over by  a  Burgomaster.  A  sluggish
stream, called  the Greater  Nethe, flows  through  the flat
country in the  midst of which it is  situated.   The  town
proper, which partakes of the character of  a straggling vil-
lage, is centrally located in the commune, over which, at
intervals, are scattered hamlets, while the whole area of the
country is dotted with farm-houses, having very small  culti-
vated farms or garden fields attached.  The soil is generally
suitable for gardening,  and  for the most part  fairly pro-
ductive, though in some portions light and sandy.  Every
available foot of land is under tillage, not even a path along
the wayside being left uncultivated, and often, on  other than
the principal  roads, there is scarcely driving space  between
the fields.  The parish church of St. Amand and  that of St.
Dymphna form two central points of  settlement,  between
which is the  main business  street of the town, extending a
distance of three eighths of a mile.  In addition to  the long
straight avenue previously referred to, there are several oth-
ers of modern appearance ;  but aside from these, the whole
country about Gheel is a tangled  web of roads  and  lanes,
along which,  at intervals, are farm cottages.
  In no part of the colony is there evidence  of opulence,
or,  indeed, of any thing more  than  middle-class comfort.
Nearly all  the  towns-people  are  farmers  in a small  way,
frugal  and industrious.  Many  of  them  keep little  other
stock than a couple of cows, and, besides  raising  enough to
supply their own wants, eke out a rent with what  they re-
ceive for boarding and attending to the insane.  The women
are not less industrious than the men.   It is no uncommon 
INDUSTRIES—POPULA TION.
245
sight to see females at work in the fields, or driving dogs
harnessed to cars.  It is estimated that some three hundred
or four hundred women are engaged in this  place in lace-
making, their  day's work  of twelve hours yielding them
barely a franc.   In the town are several  tobacco factories
and two breweries.  What was formerly a paper factory,
employing one hundred hands in the manufacture of colored
paper for  the  English  market,  was pointed out to us.   It
had succumbed to the pressure of rival  interests.
   It  may  be well, for purposes of  comparison, and for the
better comprehension of what  follows, to  give here a  few
statistics relating to the insane  in Gheel at different periods
since the latter part of the eighteenth century,  when  the
^number was about  four hundred.
Year.
1803
1812
1821
1840
1855
1868
1869
Patients.	Year.
600	1870
500	1871
400	1873
717	1874
778	1876
1,035	1880
1,072	1885
Patients.
  i>°95
  1,127
  1,230
  1,272
  1,383
  1,630
  1,653
  Prior to  1803, there was no  organized governmental con-
trol, nor any regular system  of  inspection of  the  insane.
The commune, comprising eight  parishes, each having a
church, has nearly 12,000 inhabitants, of whom  about 5,000
live in the  town.   The proportion of insane is about  one to
seven of the whole population of the colony.

            THE INFIRMARY AND ITS FUNCTIONS.
  The infirmary fulfils the  functions of  a central asylum, or
" observation " station, through which all cases received into
the colony must pass, and to which are  returned such as  are
found unsuited to family life,  previous to their being sent 
246             THE COLONY OF GHEEL.

elsewhere for asylum care.   It serves also as a hospital for
such of the insane as require medical treatment, and provides
for those who are subject to periodical paroxysms.  This, as
also the whole of the boarding-out system of the colony, is
under the direction of a Board of Commissioners, including
the Governor of the Province, the Judge of the Canton, the
Burgomaster, the King's Procurator, a physician  appointed
by the Government, and five members chosen by the Minis-
ter of Justice.  This  Commission  has  supervision  of all
matters relating to the general  care of the patients, and
makes a  yearly report to  the  Government.  There is, in
addition to this, a permanent committee upon  which de-
volves the enforcement of the regulations respecting lunatics
in the  colony.  The commune and the medical staff  of the
colony are represented  upon this committee, of  which the
Burgomaster is chairman.   The  committee meet  once a
week, to decide as  to the eligibility of  new arrivals,  and as
to their  distribution in the  colony.   They likewise receive
and pay out money, and adjudicate upon the qualifications
of all  applicants for the boarding of the insane.  For the
latter purpose a registered list is kept of all who  wish to re-
ceive patients.   The Secretary of the committee and of the
Commission also acts as steward of the infirmary.
   The district, or commune, is divided into two medical sec-
tions, each of which is in charge of a chief physician assisted
by a  second medical officer.  The  time of these sectional
physicians is not wholly devoted to the insane, as they have
also a  private practice.  The Medical Director of  the colony,
Dr. Peeters, is  charged  with the duty of general visitation
and inspection.  The sectional physicians or their assistants
are, by rule, required to visit every one of their patients once
a month, and troublesome cases whenever necessary.  Acute
cases are visited at least once a week.   Before 1879 the 
DISTRICT INSPECTORS.
247
doctors of the sections were not required to visit their pa-
tients oftener than three or four times a year.  In addition
to the medical supervising officers there are lour gardes, or
inspectors, appointed by the Minister of Justice, each  hav-
ing an assigned district.  These are charged with  the duty
of visiting the patients boarded  out and examining their
dietary, clothing, and bedding, and inquiring into whatever
relates to their proper care or  treatment.  They  also  take
charge of the transfer of patients to and from the infirmary.
In  addition  to the  four district inspectors  two others are
stationed at  the infirmary, who act under the direction of
the Medical  Superintendent.  Each district inspector is re-
quired to see every patient within the district assigned him
once a  fortnight, and  he is subject to  call  at any time, in
case of violent outbreaks, or where  restraint is necessary.
He reports daily to the head physician ;  and his visits to the
patients, as well as those of the medical  men, are duly re-
corded in register-books, which are kept  in the houses where
the patients  board.  In these books are  inserted particulars
of the name, age, etc., of each  patient, as well as a note of
the clothing  received from the  infirmary.   Besides the offi-
cials already  mentioned, there are in attendance at the in-
firmary five soeurs religieuses of the order of the Norbertines.
There are also three male attendants.
  The infirmary is a plain  but substantial structure, with a
capacity to  accommodate about one  hundred  inmates.
Attached to  the institution are five  acres of ground.   The
insane inmates at the time of my visit numbered twenty-six
males and twenty females.  The two wings of the infirmary
are built  on a similar  plan, each embracing three depart-
ments—the first being for" quiet," the second for " partially
disturbed," and the third for " disturbed " patients.   The men
and women occupy different sides of  the building, both be- 
248
THE COLONY  OF GHEEL.
ing supplied with food  from a common kitchen.  Each de-
partment  contains a dining-room, small hospital, and inner
court.   In each of the courts was a large dove-cot, erected
on a high, central post, for the entertainment of the insane.
  The isolating cells, of  which there were seven for  men and
seven for women, contained wooden bedsteads  of  box  pat-
tern, with head and foot boards, and each was provided with
a chair.  The floors are  of wood.  A hall or corridor extends
on either side of the range of cells, which  are tolerably  well
lighted, and warmed by stoves from  the outside.   One cor-
ridor is used for domestic work, the other  for observation of
the patients. A window, the gratings of which form geomet-
rical figures, opens into  one of the halls.   There is a solid-
panelled door to  each cell.   Each of these small rooms has
openings  to facilitate ventilation.  In a corner of the room
is a tin or iron night-vessel of peculiar pattern, fitting close
against the  seat, and accessible for removal only from the
outside.   In the  third  division there are in addition cells
of similar construction  to those  described, with,  however,
stronger gratings.  There was, on  either side, a padded
room ; but these rooms, it was said, were seldom used.
  There were on the men's side some iron bedsteads thirty-
three inches wide, with panels grained to resemble wood.
Fastened  to the bottom of each of these bedsteads  was
a plate of galvanized iron, about three feet  long, with a
depression converging to a  central  aperture  leading  to a
metallic drawer-like receptacle underneath.  The side-pieces
of the bedstead, ten inches  deep, were  made of sheet-iron,
with  the  edges strengthened by thin iron  bars.   On  each
side  were three loops, used,  when necessary, in connection
with a restraining apparatus.   The bottom mattress of the
bed was made in  three sections.
  In  connection  with a room for the  sick was a  spacious 
MECHANICAL RESTRAINT.
249
porch inclosed with glazed sash, and having a glass  roof  to
admit sunlight.
  Dr. Peeters said it had been found impracticable to dis-
pense with mechanical restraint.  The appliances in use were
as follows: 1.  A broad padded belt, or band, five inches
wide, for locking around the upper part of the arm.  In this
belt is an iron loop through which passes a strap  for secur-
ing the patient to the side of  the  bed.   This, we were told,
could be used without accident, however much the patient
might struggle.  2. Two padded leather bands three inches
broad,  connected in  the centre by a link two inches long.
These are designed  for the ankles of the patient.   To each
is attached a loop of iron through which a strap  is passed
and fastened to either side of  the bedstead.  3.  Two padded
soft leather wrist-bands,  three inches wide, separating the
wrists about eight inches.    Dr.  Peeters said these were
scarcely ever used.  4.  A broad leather belt  for  encircling
the body, with two leather pockets in front for the hands,
which are secured in  their position  by wristlet-straps.  Ex-
tending from this belt across the shoulders, suspender fashion,
are straps which retain in position and relieve the  weight of
the belt, which locks at the back.  This, familiarly known as
la ceinture a bracelets  mobiles, was said to  be preferred by the
patients to the camisole, and was spoken of as " particularly
useful  for such as   incline  to tear  their clothing."   It
should be stated  that  I saw no patients  wearing any  of
these contrivances during my  inspection of the infirmary.

             THE "HOTES" AND " NOURRICIERS."

  The need of some  kind of  governmental supervision and
control over the insane at Gheel became manifest at an early
period.  From the past history of the colony it appears that,
at the beginning of the present century, the " trade " inter- 
250
THE COLONY  OF GHEEL.
est of the peasantry, and of the communal administration in
the keeping of the insane, assumed an objectionable form.
The local administration exercised a sort  of favoritism in
allocating the patients  boarded out, and the favored care-
takers, in return, submitted  to a tax on their land or busi-
ness.   Eventually,  as numbers  increased,  and  the public
became more enlightened on the subject, the communes send-
ing patients  to Gheel  resolved also to send delegates, or
inspectors, charged  with the  duty of watching over the
welfare of those whom the authorities had consigned to
colonial care.   Dr. Parigot, who was appointed to represent
Brussels in this capacity, states that when inspectors were
first appointed, in 1803, the  treatment of lunatics at Gheel
was perhaps even more  cruel than that  of the  negroes he
had seen in South America.
  Under the legislative reform of 1850 the control and ad-
ministration of the colony, so far as it related to the insane,
passed from the communal authorities to the State Govern-
ment, and the changes then made, and those effected by the
law of 1851, led eventually to the erection of the infirmary
building, which was opened in 1862. Previous to 1851 the sys-
tem in operation in the colony was not free from reprehensible
practices.  Severe forms of restraint were then in use.  Dr.
Pliny Earle relates that, during his visit to  Belgium in  1849,
he observed " a patient in the streets of Gheel, with his waist
encircled in an iron  belt, to which his hands were secured by
wristlets," and  that  " in the suburbs, and  among the farm-
houses, several were fettered with iron, the chain  between
the ankles being about eight inches in length, while, in some
cases, the rings round the ankles had abraded the skin and
occasioned bad ulcers."   The  appointment of Dr. Bulckens
as director, in  1856, brought about the gradual abolition of
these unnatural methods of restraint.  Since then the treat- 
HOTES AND NOURRICIERS.           251
ment has been of a  more humane character.   During the
whole period of my visit I did not see a single patient under
any form of mechanical restraint.
  The colony is open to certain classes of the insane for whose
board compensation is made.  In the case of private patients
the price is arranged by special contract with those residents
of the commune  whose  names are on the registered list al-
ready referred  to, and who are approved  by the permanent
committee, as persons likely to give proper attention to the
insane committed to their care.   No house, unless by special
privilege, is allowed to  have, at one time, more than two in-
sane patients. The law excludes the homicidal, suicidal, and
incendiary, those requiring continual restraint, and others un-
fit for family care. If a case is decided by the committee to be
unsuitable, the patient is returned to the  committing party.
About ten  per cent  of  each year's arrivals are so returned.
More women are usually received than men.  The patients are
chiefly from the  provinces of Brabant, Anvers,  and Liege.
There are a few from foreign countries.  It appears that the
increasing  numbers of  the insane have created a pressure
upon asylum accommodation throughout the whole of  Bel-
gium, causing  a greater demand  for cottage provision  at
Gheel.
  At the time of my visit there were in the commune about
238 private boarders, orpensionnaires, as they are called, who
were kept at prices arranged with the hdtes.  This is a term ap-
plied to those who keep paying patients ; those having paupers
are termed nourriciers.  A few of these paying boarders were
received at  as  high as 3,000 francs each per annum, about
thirty were  boarded at 1,200 francs each, and two  hun-
dred  at 400 francs each.  About  forty of the  private
boarders were  foreigners.  The paupers,  numbering 1,400,
were received by  nourriciers at charges fixed annually by the 
252
THE COLONY  OF GHEEL.
 Government.   There are three classes of pauper patients.
 The first, designated as " ordinaires," are those who are in fair
 physical health and who are able to make themselves useful
 to some extent; the second, the "semi-gdteux," are those who
 can do a little work and are at times uncleanly;  the third,
 the "gdteux," are those who  can  do  no  work and are un-
 cleanly in their habits.   The  rates payable per annum  for
 each patient belonging to these different classes were, for
 the  first class, 219 francs; for the second, 255  francs; and
 for the third, 313 francs.
  A certain percentage of the money received for boarding
 patients is reserved by the Government to meet the expenses
 of medical  care, supervision, medicines,  and clothing, and
 for maintaining the infirmary.  The tax is so adjusted as to
 amply meet the expenditures  made for these purposes, and
 varies  in different years.  The sum reserved from the pay-
 ment made for each pauper patient the year preceding my
 visit, for administration expenses, medicines, supervision,
 etc., was 9  centimes per day, and for clothing, 10 centimes,
 making a total of 19 centimes per day, or 69 francs, 35 cen-
 times per annum.   Medicines  are prescribed  by the doctors
 and supplied by the apothecaries of the colony at fixed rates.
  Since my visit the prices paid by communes for the board
 of indigent  patients have been advanced so that the per-
 capita  rate, including  governmental supervision, medical
 visitation, medicine, and clothing, is, for the "ordinaires"
 $1.09,  for the " semi-gdteux,"  $1.22,  and  for the "gdteux"
 $1.43 each per week.  The average cost of maintaining ordi-
 nary patients in asylums for  the  insane  in Belgium is esti-
 mated  at $1.55 per capita per week.
  When a  boarding-house keeper is unwilling  to retain  a
patient on account of violence, or for any other cause, the
matter is brought before the visiting inspector, or garde de 
INSPECTIONS IN  TOWN.
253
section, who reports to the director, and an order is made for
removal to the central station, until provision is made else-
where for the reception of the case.  Such removals are fre-
quently effected, and it  often  happens  that  patients are
transferred from one house to another  in the colony.

            VISITATION OF THE TOWN DWELLINGS.

  The primary aim of  the  writer in  visiting Gheel was to
make an examination of the condition  of the insane in their
cottage homes.   By courtesy of the chief physician, a guide
was furnished who was, at  the time, one of the district in-
spectors, and who had been for many years in the service of
the institution.  The succeeding days, which were  spent in
the company of  this intelligent official, were wholly taken
up  in  going from  house  to house,  and from cottage to
cottage, first through the town and afterwards into the sur-
rounding  country.  As we set out upon our tour, we met
upon the street  two well-dressed, middle-aged persons of
gentlemanly appearance, who, after saluting us, held a few
minutes'  conversation with  our guide.   But  for  a  casual
remark from him,  we probably should  not have  observed
that they were insane.
  It has already been shown that there is considerable differ-
ence in the charges for board.  There is equal diversity in the
character of the houses  and their accommodation.   Between
the low,  thatched house with mud walls, or the  one-story
building with attic loft, occupied by the pauper class, and the
more inviting and more commodious two-story dwelling with
plastered  exterior, where reside the higher-paying  patients,
there are various grades  of buildings.   In the  humbler
dwellings of the town one  generally enters the  principal
apartment of the house, which  serves the various  purposes
of kitchen, sitting, dining, and reception room.  In some of 
254             THE COLONY OF GHEEL.

the houses the  floors  of  these  apartments are on a  level
with the street ; in others they are even  lower, and there
were numerous indications of dampness.  The fuel, of which
less is required than in colder climates, consists here mainly
of bituminous coal,  which gives a clear bright  fire.  The
water is obtained from  wells.  The streets  have surface
drainage.   House slops are used to irrigate the garden.
  Provided with a map of the commune, we proceeded to
inspect some  of the town dwellings.  At the outset, permis-
sion was kindly given  us  to choose  from the entire colony
the houses and localities to be visited.
  Our attention was first turned to one of the better class
of the town  houses—a goodly sized, convenient, two-story
structure.  Here resided  two patients.  One of these,  an
English architect, had gone out.  In his room were evidences
that he  employed part of his time in drawing.  Some studies
from  nature  showed considerable  skill in execution, as did
also some sketches of a humorous character. The apartments
were  clean and  comfortable.  The sitting-room,  which was
used by both  patients, was  furnished with a sideboard, mirror,
and a few pictures.   On the centre of the floor was a rug.
The adjoining dining-room, with sanded tile floor, also showed
some  taste, being hung with suitable pictures.  Each of the
two patients  paid 1,200 francs a  year and provided  his own
clothing.  We have mentioned that the architect patient
was out.  His companion, a man of solitary habits, was still
in bed, although the hour was ten o'clock.  The architect's
sleeping apartment, commanding a front view, had a wooden
floor,  and was furnished with fur rugs and ordinary bedroom
furniture.  The window and French bedstead were curtained.
Here  were all the needed comforts, as well as some of the
elegancies of life.
   On the opposite side of the street was a beer-saloon, and 
A MUSICAL SOCIETY.
255
next to this  a spacious concert-hall, in which a musical so-
ciety held its meetings.  Four or five of the members of this
society were patients, one of whom was the leading violinist
of the orchestra.  The hall was  fitted with galleries, and
lighted with large  chandeliers.  The other furnishing  com-
prised many small tables  and numerous chairs.  This con-
cert-room opened rearward into  a  small pleasure garden.
The usual entrance to the hall was through the  beer-saloon.
The director of the  musical  society was also proprietor  of
the beer-house, and one of the insane boarded with him, pay-
ing 1,000 francs per annum.    This patient  made himself
quite useful about the hall.
  In the front part  of the next  two-story building visited
was a small shop, and in the rear of it a parlor, in which were
two boarders.  At the head  of  a  narrow, steep  staircase,
closed at the top by  a trap-door, was a  small front bedroom.
Here was a French bedstead  of box pattern.   The bed was
good, but not very clean.  There were also in the room a
chair and wash-stand, and a rug before the bed.  The second
bedroom, with an outlook to the  rear, contained  a bed,
chest,  wash-stand, stove,  and garments hung on  hooks.
The foot-board of the bed had been broken by the violence
of the patient.  The house was small.
  Passing to  the adjoining cottage, we found  a reception-
room with a clean tile floor.  The furnishing was plain but
appropriate, and there were flowers in the window.   Here
was heard the homely tick of the  old-fashioned clock on the
kitchen wall.   Altogether the accommodation was good, but
the stairs were steeper and narrower even than  those last
mentioned—seeming to be positively dangerous.   The bed-
room  contained a  French wooden bedstead,  with blankets
clean  and comfortable, and a  feather pillow over another
of wool.   The window was of medium size and grated with 
256             THE  COLONY OF GHEEL.

bars about six inches apart.  A wardrobe and a closet were
in the room and  a rug was before the bed.   In  the second
sleeping-room  the bed was  good, the bare  floor was clean,
and the walls were white. The window was without grating.
Both were back rooms, having outlooks upon a neatly kept
garden and the country beyond.   The patients here paid 600
francs each per annum. The whole house seemed tidily kept.
  The  floor of the kitchen  in  the  next one-story cottage
entered was sanded.   Food was cooking in the old-fashioned
fire-place.   Every thing  here was very plain.  The only pa-
tient, an insane man, was preparing potatoes for dinner, the
other members of the household being out in the fields. We
were told that he was  of an affectionate disposition, and that
when a child  of  the family died a short  time previous, his
grief was inconsolable.  The plates and furniture were clean,
the kettles very  bright,  and  the whole  interior  indicated
good  housewifery.  Off  the kitchen was a moderate-sized
bedroom for the  patient, who paid 255 francs  per annum.
The window of this room had wooden slats.  The bedstead
was of the box pattern, and the bedding sufficient.
  The  next house and the last  mentioned  were under the
same roof, and their accommodation  and housekeeping were
similar. In the day-room, or kitchen, an epileptic patient sat
in a corner behind a table, with a chair in  front of her.   The
housewife was busy preparing cabbage for dinner in the same
apartment.  In the old-fashioned fire-place was a stove.  The
rafters showed overhead.  In the adjoining room was an iron
box-bedstead. The bedding, including two pillows, was clean
and comfortable.  The tile floor was sanded.  The window,
2 x i\ feet, had  hinged  sash, and was protected  by  three
bars.   In a corner, under a bench, was a heap of sand for use
on  the floor.   There were two chairs here, and the clothing
was hung on nails. 
                     LACE-MAKING.                 2$7

  As already  indicated, lace-making is  one of the leading
industries of Gheel.  In some instances this is carried on in
houses  where patients  board.  An  example of this came
under notice in the next house visited, where three girls—
not insane—were thus engaged.  It was  said that the female
insane are  sometimes serviceable  in  this occupation.  One
of two patients  here,  a  young  woman, was seen  walk-
ing  about   outside.  She  complained  that,  as  she spoke
nothing but French, she could neither  understand nor be
understood by the household, all  of whom were  Flemish.
Attractive  in  face and figure, and  evidently of an erotic
disposition, she did not seem suited to the large degree of
liberty  granted her.   When in good humor, she  was said
to be an active  worker.   The second  patient  sat  in the
kitchen, and,  it  was said,  did no work.   Both were  suit-
ably dressed, but wore wooden shoes.  The bedrooms were
tidy, and without gratings or other security at the windows.
One of the patients slept  down-stairs, the other in an attic.
The stairs were both narrow and steep.
  The adjoining  dwelling had better accommodations than
the  one last inspected.  The  housekeeping was of about
the same standard. The mid-day meal had just been placed
upon the table.   There were  for each member of the house-
hold a plate, cup,  fork, and spoon.  An iron dish in the centre
of the table contained the food, which was served out with
a ladle.  Two patients  sat waiting for  dinner.  One had a
plate, spoon, and  fork in her lap.   It was stated  that she
made herself useful peeling potatoes.   Her companion did
no work.  On the lower floor was the bedroom of one of the
patients, which was of fair size, and contained a bedstead  of
box  pattern with plenty  of  bedding.   The  tile floor was
sanded, but it  was not  quite clean.   The window had three
bars.  At one end of the attic was a small bedroom occupied 
258             THE COLONY OF GHEEL.

by the other patient.  Here was a box-pattern bedstead, and
apparently sufficient bedding, though  the   surroundings
were those of poverty.  The stairs were dangerously steep.
  The resident proprietor of the next house, who was not
engaged  in  business, had  returned  to  Gheel after  a nine
years' sojourn in America.   His two-story building, with red
tile roof, had been  recently erected, and evidenced the im-
proved  fortune of  its owner.   Here were  two  private
patients, paying respectively 1,400 francs and 1,000 francs
per  annum. One of the bedrooms  was furnished  with a
French mahogany bedstead, very good bedding, rug, up-
holstered  chairs, table, wash-stand,  etc.   The  other bed-
room, fully carpeted, contained a mahogany bureau and look-
ing-glass.  A commodious front room, well furnished, was
used as a sitting-room by the patients, as well as  by the
family.  The interior woodwork of the  house was painted ;
the  walls were papered;  and  the  apartments, including
the  bedrooms, were  lighted  by  large windows without
gratings  or other  restrictions.   The whole  interior  was
tidily kept, and the atmosphere was pure.  In short, the
surroundings of the patients were seemingly all that could
be  desired.  The  character of  the  housekeeping  was in-
dicated  by snow-white curtains and spotless linen.  One
patient, who, it was said, gave no trouble, had just gone out
to a neighboring inn for a glass of beer.  He had formerly
been a journalist in Switzerland.  His companion, who was
out  walking in the back garden  of the house, was  said
to be at times troublesome, giving many orders and causing
annoyance.  They breakfasted at 7 A.M., dined from  12 to 1
P.M., had  coffee at  3 P.M., and supper at 7 P.M.   The diet
was varied, and the patients were humored in their choice
of food as far as possible.
  A large mansion, built close to the street, cannot fail  to 
DR. BULCKENS.
259
arrest  the attention  of the  visitor  to Gheel.  This  was
formerly  the  residence  of  Dr.  Bulckens,  through whose
humanitarian efforts in the capacity of head director great re-
forms were accomplished throughout the colony, and whose
lamented death occurred in  1876.  The house was occupied
by his daughter,  who received two  patients of  the highest
class.  The broad central hall of this mansion, paved with
black and white marble, opened into grounds at the rear in
which  were flowers, shade-trees, and  convenient  seats.  The
furnishings of the reception, sitting, and other rooms were in
good taste. A  large parlor on the ground-floor was assigned
to one of the patients. The richly carved bedstead and other
mahogany furniture were highly  polished, and  among the
various ornamental objects was a vase containing a luxuriant
ivy.  The patient who used this apartment was,  at the time
of  my visit, in the  kitchen, where he was having  a cup of
coffee  after dinner.  The upper bedrooms and other portions
of the  house were furnished  on a similar scale of comfort and
elegance.  One of the patients, an Englishman, was said to
behave very badly  at  times, using improper language, and
manifesting dissatisfaction by attacking the master of the
house, though his violence never extended to children or to
the hostess.  We were informed  that he rarely broke  any
thing,  never tried to run away, and never molested any of the
servants.  No means of restraint  were resorted to, an effort
being made to calm his excitement by kind treatment.   In
another apartment was a patient whose manners and appear-
ance betokened a gentleman of culture.  In his room was a
collection of books which evinced fine literary taste.  This
patient was said  to be a Polish prince, and this  was his
second sojourn here.  He had  previously left  Gheel appar-
ently cured, but, suffering a relapse, he returned and requested
that he might be  received into the same house. 
260             THE COLONY OF GHEEL.

  Leaving apartments which were exceptional in style and
completeness, we next visited an abode in striking contrast.
Here two girls and  a boy were at play in  the living-room,
or kitchen, the floor of which  was almost level with  the
street.   An older boy sat, tailor fashion, on a table, sewing.
One woman was also busy plying the needle, while another
was engaged in housework.  There were two female patients
here.  The kitchen floor was  laid with brick, and it was
rather dirty.  Some of the house furnishings showed signs of
comfort.  Climbing a very steep flight of stairs, we reached
an attic chamber of large  size, in which was a wooden box-
pattern bedstead that had two  straw  mattresses, one above
the other, clean linen, and two  pillows.  The small window
had hinged sash, and was  protected by four slender wooden
bars.  The  door  had a wooden latch  and  an  outside
bolt. The second bedroom, 9 x  10 feet, contained, like the
first, a good bed, and the floor,  like that of the larger apart-
ment, was clean.   The smaller  room was lighted from a sin-
gle  pane in the roof.  Here were signs of dampness, and
there was no  means  of ventilation.
  In a  narrow alley leading from the main street, and ter-
minating in a  garden plot cultivated  by those living in its
vicinity, we came  upon a low block of several dwellings.
Entering one of these by the  street  door, we found our-
selves  in an  apartment  fulfilling the  several  offices  of
kitchen, sitting-room, and  dining-room  for  a  household
consisting  of a husband, wife,  seven children,  and  two
female patients.  Here the  head  of the household was sit-
ting by the fire with a child  on his knee—the picture of
domestic felicity.   The husband and wife, together with five
of the children, slept in a room scantily lighted from a win-
dow opening  into  the living-room  of  the  house.   This
sleeping apartment was in a state of confusion, being filled 
A TROUBLESOME PATIENT.
26l
with furniture  and clothing.   A steep  flight  of stairs led
from  this  back room to the attic, where  the two insane
women  and the two  eldest  children  slept. The  patients
occupied respectively the  front  and back portions of this
attic, while the  children slept in an intermediate open space.
  In the adjoining cottage  of internal construction similar
to that just mentioned resided  a  man  and his wife, one
child, and two female patients, one  of whom, reputed to be
idle and nervous, was in the habit of beating the mistress of
the house.  It  was said that the next-door neighbor had
sometimes to be called in to assist in restraining her when
violent.  The other patient was also indisposed to work.
Here, as in many other of the  humble abodes, the poverty
of the  mistress denied her the luxury  of  stockings.  Her
wooden shoes caused  an awkward gait and made a clatter-
ing sound  upon the  floor  in walking.   In the living-room,
or kitchen, colored prints  of  saints in  rude  frames were
hung on the wall, upon which were also a crucifix, and a
mirror  surrounded by photographs.  The  husband, wife,
and  child  slept in a  dark  bedroom back  of  the  kitchen.
The floor  of the  latter was sanded.   The patients slept
up-stairs.   In one of their  bedrooms was an iron bedstead,
box pattern, with  temporary foot-board.   The bed looked
comfortable, having  two   pillows,  clean   linen,  and   a
straw mattress, underneath which  was  a tick filled  with
straw.   The floor was  bare,  and the furniture comprised one
chair, a chest, and a short rack for clothes.  The window in
the roof had two panes, each about 9x16 inches.  There
was no  means of ventilation. In  the larger  front attic room
there was  a French wooden bedstead with a  straw bed, a
wool mattress,  and plenty of bed-clothing which was pass-
ably clean.  The other furniture  consisted of a chest and a
rack for clothes. 
262
THE COLONY OF GHEEL.
  The windows of the next house had clean white dimity
curtains.  The occupant, a widow, stated that she had five
children away from home, and residing with her, one son, an
aged father, and two female patients.  One  of the latter, a
middle-aged woman, was  sewing  in  the  front room.   The
other, who was much older, and deaf and dumb, sat idly by
the fire.  She had been here for a great many years, and had
helped the  widow to  rear and  care for her large family.
The proprietress,  for this reason, held her in great  esteem.
In this patient's bedroom we were shown a little basket in a
corner containing two rosy-cheeked dolls.   These, it was
said, received much of the patient's attention, being even
taken to bed by her at night.   We were  also shown a
box of toys  and  trifles used  for  the gratification of the
imaginary children.  The widow was evidently affected in
speaking of  these manifestations  of a motherly  instinct—
apparently  the   only  unbroken   link  obscurely connect-
ing this  poor creature  with  the world  of intelligence.
On the mantel-shelf of the day-room was  the  customary
crucifix,  and  on  the  wall  an  old  pendulum  clock.
Over the door leading to the back room was a figure of the
Virgin,  with two bright silver candlesticks,  one on either
side.  In the attic, two rooms were partitioned off as  bed-
rooms.  Both of these had wooden bedsteads, clean and
comfortable beds, chairs, and clothes-racks. Each was lighted
by a large pane in the roof.   There was no means of ven-
tilation. One of the chamber doors was bolted.  Here, as else-
where in Gheel, the bolt was on the outside of the door of the
patient's sleeping-room.  The register-book showed that the
doctor had made  thirteen visits during the preceding twelve
months.
   Before  leaving this alley we  noticed at its  extremity
an out-house having a number of stalls without doors.  It 
INSPECTIONS IN THE COUNTRY.        263
was for the common use of those in the neighborhood.   It
had a shallow open pit underneath, was in full view of the
passers-by, and gave rise to gross violations of  propriety, an
instance of which came under our observation.
  Entering another cottage, we  found  its  inmates were the
woman of  the house,  her grown-up daughter, and  two
patients—one an adult female, the other an idiot child. The
elder patient had gone out  in charge of the grandchild  of
the mistress.  The idiot child was filthy and required much
attention.  The  house, nevertheless,  looked  clean.  The
grown-up patient was boarded for 219 francs and the child
for 313 francs per annum.   The  former slept in a small, low-
roofed back room, having a small grated window.  The bolt
on  the outside  of the door, it  was said, was never  used.
Bars and bolts were here spoken of as relics of  the past.
  In  another  large cottage resided  a widow  and  three
grown-up daughters.  The occupants were all tidily dressed,
the house was  neatly kept, and the  furnishing was good.
There were  here two patients, each paying  316 francs a
year.  One of these, an old woman, said to be  of uncleanly
habits, had a room on the ground-floor.

                  OUT IN THE  COUNTRY.

  The houses  visited up to this point were  in the town.
Afterwards an examination was  made of the cottages in the
thickly settled  surrounding  parishes.   In  the  inspection  of
this part of the colony a two-wheeled vehicle peculiar to this
country, having seats for four persons, was used.  The roads
in some portions of the outskirts  were found to be even worse
than those in the prairie regions of America,  being in wet
seasons very muddy and almost impassable.   Many of the
houses indicated that the  lives of the occupants were little
else than a struggle  for bare subsistence.  The fuel used in 
264             THE COLONY OF GHEEL.

the daytime for cooking was  mainly brushwood.   In the
evening peat is burned.
  The first farm  cottage  we  examined  was a  one-story
building with straw-thatched  roof.   In one  end  resided
the family, and the  other was used as a stable.   The well
was but a few feet from the door of the house, and about
twenty feet from the stable.  The patients were out, and the
only person in  the house was a woman who was working
in the kitchen.   She wore  no stockings, and her  feet were
protected only by wooden shoes.
  Leaving these ill-conditioned premises, we soon came to a
low building with thatched roof, which, like the former, was
rented.   Here, also, one end was allotted to the family, and
the other to the cattle.  Close to the door of the house was
the manure  pile.   The tile floor was level with the ground,
and damp.   The well was only ten feet from the house and
stable.  The mistress  wore a  dirty  dress, clogs, and no
stockings.  There were two male patients in the kitchen, or
living-room.  One  was  idle, the other was peeling potatoes
near the fire-place.  This was ten feet broad, three feet  deep,
and there was  a  baking-oven  on one side.  As is  usual
in these  farm cottages, the fire was made  on the  hearth.
From a high wooden  crane was  suspended a large kettle
used for boiling food for cattle.  This was so arranged that
the kettle and its contents could be swung  round  to a door
opening from the kitchen into the stable.
  Another  mode  in  Flemish  farm-houses of conveying
cooked food to stock is by means of a semicircular rail near
the ceiling,  extending  from the  kitchen  fire-place to the
stable door, there being thus direct internal communication
between  the culinary and  cattle departments, though at
some sacrifice of pure air.
  The next farm  cottage was owned  by its occupant, and 
PECULIAR CUSTOMS.
265
was in a little better condition.  It, too, had stable commu-
nication with  the kitchen fire-place and a like arrangement
for conveying the food to  the stable.  The floor was little
higher than the ground outside.  The house was occupied
by a man and his wife, six children, and  two patients, both
of whom had just returned from field work on  account of
rain.   The man of  the house and his two boarders wore
wooden shoes without stockings.  The bedrooms were at op-
posite corners of one end of the house.  The beds were com-
fortable, having double mattresses and plenty of bedclothes.
The tile floors were sanded, and in the outer wall there was
a small aperture for the escape of water used in washing the
floor.  Between the sleeping-rooms and the kitchen was the
family room, in which  there was a bed.   On a line stretched
across the  apartment  were  hung  clothes to  dry.   The
family slept in the attic.  In  the  kitchen was seen  the
familiar clock against  the wall, also a baking-oven opening
into the large fire-place.  The fire, made of brushwood, was
in a cresset.   Kettles were suspended by a saw-bar, so that
they could be adjusted at convenience.  Attached  to  the
trunk of an old tree was a wooden crane used for  raising and
lowering the buckets in the well, which was but a few feet
from the door.  The stable, which was under the same roof
with the dwelling-house, contained a calf and a goat.
   The next rented  cottage visited was of similar construc-
tion to the  last.  The  family, including a man, his wife,
and  five  children, were at dinner in the  principal room, or
kitchen.   They were seated at a small square table in  the
centre of the apartment.  The  first part of the meal con-
sisted of a thin soup or porridge of celery and rice, in which
pork had been boiled.   A plate of potatoes and boiled pork
followed the  soup.  The porridge was palatable and  the
bread was good.  Seated at a low side-table, near the door, 
266
THE COLONY OF GHEEL.
were two male patients eating  the food which  had been
served to them.  They were allowed spoons and forks. This
side-table was half covered with soiled garments, including
trousers, overalls, old stockings,  a shawl,  jacket,  etc.  The
patients were dressed in fustian, and wore caps,  stockings,
and wooden shoes.   One worked in the fields, the other in
the house.   They were said  to  give  no trouble, and were
boarded for 219 francs  each  per annum.   A door opened
from the room in which the family  were eating into  the
stable  adjoining, and, as usual under this  arrangement, the
close proximity of the  latter was disagreeably perceptible.
The bedrooms were somewhat larger than usual, one measur-
ing 7x12, the other 9 x  10 feet.  The floors were of tile, and,
in conformity with general custom, a hole through the outer
wall permitted the escape of floor rinsings.   The windows
were small and had hinged sashes secured by iron  bars.  By
night the doors were said  to be strongly bolted on the out-
side.   Each room had a chair and a clothes-rack.  The bed-
ding, though plentiful, was only moderately  clean.  There
was no ventilation.   Close to the house was a large heap of
stable manure, and at a  distance of twelve feet from  it was
the well.  All the family, children included, wore stockings
and wooden shoes.
  The rule  requiring patients to take their  meals  at  the
same table with the hote or nourricier was said to be difficult
to enforce.   A deviation from the regulation, as noticed at
this house, met the strong disapproval of the inspector, who
made note of it in his official journal.
  The next  farm-house examined was, in point  of order
and cleanliness, an improvement on those that have been
described.  Its proprietor worked twenty-five acres of land,
one half of which he rented.  One fifth was in pasture, the
rest in cultivated fields.  His stock comprised eight cows, 
A QUAINT INTERIOR.
267
two calves and three pigs.  The kitchen, or main room, was
large.  The beams overhead were quaintly carved.   There
were rows of metal dishes in racks above the fire-place, and
all metal articles were brightly polished.   The fire-place did
not differ from those already described.  The inmates were
a man and  his wife, seven children, and one male patient,
who was said  to be very good, and who was received at 219
francs a year.   He appeared strong and healthy, was attired
in cloth  cap, fustian  clothes,  and  stockings,  and  wore
wooden shoes.  He did little work beyond peeling potatoes,
for which they said they gave him at times a little money to
spend on Sunday.   In the sitting-room there were pictures on
the walls and canary-birds singing in their cages.  The furni-
ture included  a high antique clock, an  old-fashioned dresser,
and  a large wardrobe.  A lamp placed in a small one-paned
window in the wall, between the sitting-room and the stable,
gave light to  both places.  A long rail and pulley overhead
were  here used,  instead of a crane, for moving the large
kettle from  the kitchen fire into the adjoining stable.   The
patient's bedroom, on the same floor, measuring 9x12 feet,
had  a comfortable curtained  bed, and  a  large two-sash
hinged window  without grating.   Underneath the window
was the usual outlet for water used in cleaning the floor.  The
door was  without  bolts, and the furnishings included a chair
and clothes-rack.   The mid-day meal was preparing.  It con-
sisted  of soup and pork, with  white and  brown bread.  In
the stable, close by the  kitchen, were two cows.
  Passing on to another cottage also occupied by its owner,
we saw,  as  in some  other places  visited, that the  hedges
were well kept, and that in front of the house there was a
plentifully stocked kitchen garden.  This dwelling was larger
than some of those previously visited, and tolerably clean-
looking.   The main room, or kitchen, had a low roof.   There 
268
THE COLONY OF GHEEL.
was a large fire-place here and an iron rail arrangement for
conveying food from the  kitchen fire to the stable, in which
were several cows and a goat.  In the outer wall of  the
kitchen there was an aperture  for letting out the floor rins-
ings.   In a separate sitting-room the walls showed signs of
dampness, being  discolored  to the  extent of nearly  three
feet above  the ground.  The  mistress of the house  wore
stockings with her wooden shoes.   The  only patient, an
old man, was seated in a corner by the fire-place.  He had
on wooden shoes,  but no stockings.  We were informed that
he had been here  nearly half a century.   His sleeping-room
measured 7x8 feet, and was 6£ feet  high.   The furniture
consisted of a wooden bedstead and a chair.  The patient's
clothes were hung on wooden pegs.  The bedding, including
a straw bed  and an  upper mattress,  appeared clean and
comfortable.   The floor was of tile and sanded.  The win-
dow, measuring 20 x 30 inches, had one sash and  no grating.
There  was no  bolt on  the  door.  The walls were tinted.
The register kept here was the  oldest we had yet  seen, show-
ing systematic medical visitation extending back  to the year
1825.
  Another farm dwelling inspected was also occupied by its
proprietor.   The  kitchen was smaller than  those just de-
scribed.  The  floor was only a few inches higher than  the
ground outside.   The door of  the living-room opened into
the stable.   On the walls were several photographs, pictures
of saints, and a  crucifix.  A  quaint old clock,  convenient
clothes-presses, and a lively canary were among the  other
noticeable objects here.  The beams overhead were discol-
ored with  smoke.  Two  female  patients approached  as we
were taking notes.   They were plainly dressed and wore
wooden shoes.  One muttering to herself entered the house
and walked out again.  Both seemed excited, talking loudly 
A  QUIET HAMLET.
269
and violently gesticulating.   In the corner of the kitchen
stood the  manure-fork and  a broom.   A  side room  was
used  both  as  a  sitting  and sleeping room.   The bed-
rooms had tile floors, windows 20 x 30 inches, and each door
had  two  bars  and  a bolt  on  the outside.  In the walls
were holes for the escape  of floor rinsings.  The beds  and
bedding were comfortable.   The  house was, on the whole,
passably clean.  We were told  that during the day the pa-
tients talked incessantly, but that they were quiet during the
night.   Neither of them worked, and belonging to the ordi-
nary class of patients, they were received at 219 francs each
per annum.
   Leaving the foregoing farm cottages, which are situated
far out  in the country, we approached a small hamlet, where
the  spectacle of  a  vehicle  containing two  unannounced
strangers in the company of a garde de  section appeared to
be an event so  unusual as to awaken considerable interest
among  the juvenile portion  of this secluded community.
As we paused to survey a  one-and-a-half-story brick building
before entering  it, a wondering, interested, and barefooted
little crowd gathered about us at  the door.   It consisted of
seven little girls and ten little boys.  At a more respectful
distance stood several adults,  among whom  was a harmless
idiot.
   Entering the roomy kitchen, we found ourselves in what
served the double  purpose of beer-house and dwelling-house.
The fire-place measured about fourteen feet across, or  nearly
the whole breadth of the kitchen, which  forms, as usual, the
principal apartment  in these houses.  A small kitchen grate
was in one corner of the  fire-place, and in  the centre of it,
a cresset for a large kettle.   A door opened from this room
into the stable.  On a long  shelf were brass candlesticks, a
small crucifix, and a row of crockery plates, which were kept 
270             THE COLONY OF GHEEL.

in position against the chimney by a string.  A carved beam
overhead, with joists on either side of the fire-place, support-
ed the roof.  The stable emitted a strong odor.   Only six
feet  from  the  house  was the  family well.   Under the
eaves'  spout  was a vat for rain-water.   A patient whom
we saw walking in the garden paid 400 francs  per annum
for his board.  Ascending a very steep and narrow staircase
terminating at a  trap-door, we reached the bedroom, meas-
uring 10 x 12 feet.  It  had a fair-sized  window  without
grating, a bedstead and a good  bed, a rack  and shelf for
clothes, and one chair.   There was neither carpet nor rug on
the floor.
  Before reaching another cottage we passed on our way
several small, poor-looking houses,  three sides of which were
constructed of loam and stubble, and one side of brick.  The
inspector  stated that the patients' sleeping-rooms were on
the brick-built side.  Up to this point we had occasionally
seen  patients  at work with their guardians in the fields.  The
implements of husbandry seemed rude and  primitive.
  The next farm cottage visited was of one story, and the
tenant rented along with it nearly nine English acres of land.
It had a low  thatched  roof, brick walls, and was  altogether
very ancient-looking.   A  patient  who did  no  work was
standing outside.  He wore woollen stockings and wooden
clogs.  The manure heap  was only twenty  feet from the
kitchen door. The floor of the kitchen was but  very  little
higher than  the  ground  outside.  This  apartment had
a large black  fire-place, the smoke  from which, after making
futile efforts  to escape,  filled the  room.  The sooty rafters
underlying the thatched  roof  showed  overhead.  By the
fireside sat an excited and talkative female  patient of ad-
vanced years.  The chairs, repaired with straw and rope, were
one of many  indications of pinched living.  Altogether, the 
A LANDED PROPRIETOR.
271
condition  was lower than  in any  of the cottages hitherto
visited.  The inmates were a man and his wife, six children,
and two patients.  It  being an  afternoon when there was
no school, three  girls  were at home.  They were all bare-
footed.  One of the bedrooms measured 7x10 feet, and had
a small barred window.  The bed was not so good as the one
we had  last seen,  nor could it be commended for cleanliness.
It was 2 P.M., and the patient had just risen.   The second bed-
room was much the same in appearance, but rather cleaner.
  In  the  next cottage dwelt its proprietor, who cultivated
thirty-two acres  of  his  own land.   The  kitchen garden
was large. In the stable, which connected with the house
and  formed a part of it, were cows and calves, a yoke  of
working oxen, and several pigs.  About  forty  feet  equi-
distant  from the dwelling and the well was a closet without a
door, and two thatched and ruinous-looking structures used
as a shelter for  some  portion of the farm stock, of which
there was more  than  was usually seen on these small  hold-
ings.  A vat  of  dirty water stood  about ten feet from the
house, and only eight feet from the well, which was about the
same distance from  the  door of the  dwelling.  The well-
water presented a green and  impure  appearance.  Over the
well was a wooden pole fastened to the trunk of a tree and
used  for raising and lowering the buckets.   The tile floor
of the  cottage was lower  than the ground outside, the
entrance was dirty, and  the  interior wet with slops.  The
door  between the kitchen and  the  stable  was wide open,
and the low beams overhead  in the kitchen were black with
smoke.  On the  table were the remnants  of the previous
meal, a  quantity of salt, and  a broken  and dirty old  comb.
There were also  in  the room two chairs, a bench without a
back, and  some dirty plates and cooking utensils scattered
about.  The  appearance  of all the inmates indicated great 
272             THE COLONY OF GHEEL.

personal  neglect.  The husband,  wife,  and two patients
wore wooden shoes and dirty stockings, and the daughter
was barefooted.   The  sleeping-rooms were  up-stairs.  One
had  a  small grated  window, and the  box-bedstead had
unbarked sticks across the bottom.  The bed, insufficiently
supplied with clothing, had not been made up, and was partly
wet.   The  other room seemed  a little less  uncomfortable ;
but the bedstead was  smaller, the floor bare,  and an  old
broken chair without a seat was the only additional furniture.
Its  small window was protected by two bars.  Access  to
these rooms was  through an  attic filled  with  rags,  old
furniture, and miscellaneous articles lying about in indescrib-
able  confusion.  Our hostess good-naturedly conducted  us
through her establishment, seemingly  well  satisfied with
her management and flattered  by our  visit.   One  of the
patients was described  as a hard worker; the only work the
other did was to peel potatoes.  These wretched quarters
showed a  scene of uncleanness,  disorder,  and discomfort
within  as  well  as  without, which left  a most unfavorable
impression  upon the mind.   " This," said our honest guide,
" is the dirtiest place in the colony."
  The  last  of  the farm dwellings visited was  occupied  by
its proprietor, and it had attached to  it seven and a half
acres of land.   The thin walls of this cottage were of loam
and  stubble, and the roof was thatched.  At one end was
the stable,  at  the other the  family abode.   The floor was
but four inches above the level  of the  ground outside, and
in the wall  were visible fractures.  In the small apartment,
which  served as kitchen and living-room,  the floor  was of
tile,  the  ceiling low and  black, and the  scanty furniture
included  a  rickety  table.   The housewife wore  wooden
shoes,  and  she was begrimed with  dirt.  Here  were four
children, and one epileptic patient  who did no work and 
SPECIAL PRIVILEGES.
273
seemed disturbed  by our visit.  The patient's bedroom, 10
x 12 feet, had a small window and tile floor.  There  were
two  bars and a bolt on the outside of the door.  It was
entered  through another sleeping-room, from which it had
been partitioned  off.  This  had  an earth floor.  There
were but few of the necessaries and an almost entire lack of
the comforts and conveniences of life.

                   CLOSE OF INSPECTION.
   My  third day at Gheel was  now drawing to a close, and
from the  number of houses  visited, and  the  widely dif-
ferent  circumstances in which  I  found the insane, the
conclusion was  reached that I had seen  enough to form a
correct opinion  as to the care and treatment bestowed  upon
them throughout  the colony.
   As bearing on the general welfare of  the insane in family
care, it  may be  further stated  that those boarded  with
hote or nourricicr  may be assigned work suitable to  their
capacity  or  inclination.  This permission  the  authorities
withdraw if they  find that a patient has been overworked.
Such matters come under the  cognizance of the gardes de
sections,  whose visits are made at  unexpected times.  As an
inducement to  work, money rewards are  sometimes given,
and  we were also informed that tractable and docile patients
have extended  to them desirable privileges, such as attend-
ing church, fairs, or festivals in company with the family.
   Neither hote  nor nourricier is allowed to  use  mechanical
appliances for restraint without the sanction  of the sectional
physician. As  accounting  for the presence of  bolts  and
bars in so many of the houses, it should be  stated that the
care-takers are  by law held  responsible for any damage
a patient may  do,  and for his capture in  the event of
escape. It is claimed that there are few acts  of violence and 
274             THE COLONY OF GHEEL.

that suicides are extremely rare.   A tragic story is told of a
burgomaster of the town who many years ago met his death
at the hands of a patient.  The number of escapes during the
year preceding my visit was  given as twelve, a total which
had not been exceeded during any one of many previous years.
In these cases the runaways were captured and returned, as
might  be expected in a community where the householders
act in such emergencies as a body of police, and render one
another assistance.

     THE COLONY ; ITS ADVANTAGES AND DISADVANTAGES.

  The advantages of the Gheel system are so generally un-
derstood that it  is unnecessary to detail them  here at any
length.  The  natural  conditions  of home  life where the
patient is made one of  the family circle, participating  in its
religious privileges and social enjoyments, the occupation of
mind in farm pursuits as well as indoor industries, the pecu-
niary recognition of labor, and the general  freedom from
restraint may be enumerated as among the incalculable and
unquestionable benefits of the colony.   On the other hand,
there are  some  serious defects,  which cannot  in  any just
estimate be lightly passed over.  These are not so manifest
on the surface, for the simple reason that there is a common
interest to keep in the  background evils which are inherent
in the system and beyond the control of individual effort.
  In considering the Gheel colony as a whole, the fact must
never be lost  sight of that the insane admitted  into the
commune  are  a selected class and are  boarded out under
what may be termed a double recommendation  or certifi-
cate.   In the first place, the committing authorities regard
them as suitable cases for family care, and, again, their fit-
ness  is, as  it were, confirmed, on their passage  through the
observation station.  Yet, as has been shown, many even of 
ADVANTAGES AND DISADVANTAGES.      2?$
this selected class are necessarily returned, no less than ten
per cent of each year's arrivals at the central station being
rejected as unsuitable.  The  Gheel colony,  therefore, does
not present a comprehensive system adapted  to all classes of
the insane.  It was further authoritatively stated that there
were  at Gheel few  curable  patients, most of them having
undergone treatment before reaching the colony.
  The salaries of the sectional physicians are small and their
districts large.  The sixteen  hundred patients of the colony
must be visited once a month and acute cases as often  as
their exigencies  require.   As this  work is in addition  to a
private practice of the  sectional physicians,  its satisfactory
performance must be difficult.  In the inspection of the
cottages,  the register-books were  examined,  and it  was
found that, although there was the  requisite number  of
medical visits, averaging  one a month during  the year,
there were occasionally long intervals between visits.   In
one instance there was no  entry made for ten weeks.
  The  number and  proximity of places where  intoxicating
drinks are sold  indicated  a danger, though it  must be  ad-
mitted  that no case of  actual excess came under my obser-
vation.  The law forbids, under penalty of fine or imprison-
ment, the  sale of brandy or  other spirits to  the insane, yet
these liquors are generally kept for sale  in the public houses.
Wines are too costly to come within the reach of  any large
number of the  patients.   But the only restriction on the
sale of beer is that the insane must not be allowed to drink
" too much." This may be a knotty point to determine when
the definition  is left to the beer-seller, who must make out
of his business the maximum of profit consistent with the
bare  observance of rules.
  The care of the insane is relied upon  by  the people of the
place as their main business or means of money-making.   It 
276             THE COLONY OF GHEEL.

is  therefore liable to abuses common to all undertakings
that are governed by  considerations of  profit  and  loss.
Yet it may be urged that it is the interest of every trader to
maintain a good reputation, and to  avoid acts of cruelty or
neglect, which would not  only injure his own business, but
damage that of the entire  colony.   In this way an esprit de
corps is established, which, no doubt, tends to prevent abuses
of a flagrant character.  There are, however, faults for which
the care-takers cannot justly be held  responsible.   Prices are
made so low by the authorities that it is found impracticable
to meet, in all respects, the  standard regulations.  For ex-
ample, there is a rule which  requires that patients shall  be
supplied with fresh meat  every day ;  but keepers find it
difficult  to observe  this  requirement.   Nevertheless, it
seemed on  the whole  that  the  pauper insane fared  as
well, if not better,  than their guardians.  The advance made
since  my visit in the  prices paid for board of  this  class
it  is hoped has enabled the nourriciers to improve  their
dietary.
   Humble as are the accommodations of the insane at Gheel,
it  is fair to presume  that  they are  equal, in most cases, to
those of  the  homes whence  they  came.  Generally,  the
treatment of the patients in the several houses appeared to
be considerate, and marked by a degree  of proficiency indi-
cating an instinctive and possibly hereditary tact  in dealing
with them, though among the nourriciers were some mani-
festly lacking in qualifications which would be deemed essen-
tial in an asylum attendant.
   Considering  the large extent of territory and the number
of the insane, it is  hardly possible that the supervision can be
so complete as to  insure the due observance of the rules and
regulations established  by the government for their protec-
tion.  The straining after economy, which regulates the rate 
          ADVANTAGES AND DISADVANTAGES.       2']']

of maintenance, as has been shown, affects the quality of the
food, and also influences, prejudicially,  the  nature  of the
medical and other supervision.
  There appeared to be a lack  of intelligent provision for
the  needs  of the patients in regard  to bathing  facilities,
ventilation,  pure water, and other  requisites.  The damp
floors, the primitive methods of  getting rid of floor rinsings,
and  the too frequent proximity of stables and manure heaps
to the farm cottages, show a lamentable indifference  to sani-
tary considerations.
   Incidental to the system is the opportunity for exercising
the tendency, natural in children and young persons,  to trifle
with the insane and  idiotic.   Chaffing was not observed to
such an extent as to produce any great amount of  irritation
in the  patients,  yet  it was  sufficiently manifested in the
streets  to  convince me that the practice was one which
might lead to injurious results.
   In proportion to population the number of idiots  belong-
ing  to Gheel who were not boarders appeared to  be abnor-
mally large.  No statistics  bearing on  this subject  were
obtained, but it would  be interesting  to know whether this
seeming disproportion  is in  any way attributable  to the
presence of  the  insane in such  large numbers among the
general population.   This question assumes some  import-
ance when we  bear in mind  the opinions which have been
expressed upon it by medical men.   No less  an  authority
than Esquirol has made the following forcible  observation :
" To the inmates of a madman's family the  sight of  those
acts which are committed by the insane  may be highly prej-
udicial.  A woman who is enceinte and easily excited would
run  some  risk by living constantly with a  person who  is
mentally  deranged,  and  the  example to  children  and
young ladies  might become a predisposing  cause of men-
tal disease." 
278
THE COLONY OF GHEEL.
  Looking at the commune in  its moral aspect, one cannot
help  thinking  that  the shockingly immodest  exhibitions
which here and there meet  the eye must have a baneful
influence  on the large number of children  of  both sexes
growing up in their  midst.  Nor can one  approve of the
presence of some insane young women in the colony, who,
from their erotic natures, seemed helplessly exposed  under
the circumstances in which they were placed.  That liberty,
so beneficial to many of the mentally afflicted, was, in their
case at least, unwisely bestowed.  It  appears that illegiti-
mate  births  do sometimes occur here among  the insane.
One authority  estimated  these as happening not oftener
than once in  five years ; another maintained that they were
more  frequent.   Any  system, under which such occurrences
are at all possible, is greatly at fault.
  Gheel has  been dealt with at some  length because of its
many points  of interest, and for the additional  reason that
its boarding-out system has presented itself in quite different
aspects to those who have studied its workings.  After a
careful  examination of the  colony, the writer is forced to
the conclusion that the Gheel  system is of  little practical
value to  America,  except as demonstrating that  a  great
amount of freedom is possible in the care of certain classes
of the insane. 
CHAPTER VII.
  THE  PROVINCIAL  INSANE ASYLUM  OF ALT-
                      SCHERBITZ.

      OF the many asylums for the insane in Europe, there is
        none more interesting than that of Alt-Scherbitz,
one  of  the two public institutions that meet  the  require-
ments of  the  Province of Saxony in Prussia.  Here  has
been wrought out a system in which are incorporated some
of the best and most modern methods of caring  for  the
insane in England, Scotland, France, and other countries.
  This  asylum is situated in a fertile valley about a mile
and  a half from Schkeuditz, which  is  its station  on  the
railway line from Halle to Leipzig.  The central buildings,
which comprise the administration department, reception
stations, observation stations, detention houses, hospital for
the bodily  sick, etc., are entirely separate from one another,
having no corridor connection, and are  situated  in the midst
of improved  grounds lying on the left  of the highway lead-
ing to Leipzig.   These are unpretentious brick structures,
with outer  porches.  On the right of  the  highway are  the
domestic and industrial  departments,  the  superintendent's
residence (formerly the Manor House), and scattered cot-
tages for patients.   Near  by is  the small hamlet  of Alt-
Scherbitz,  lying within the asylum estate, which contains
upwards of seven hundred English acres.  This property
cost  the  round  sum of one million marks (about  $240,000).
Ten  of the  cottages in the hamlet are owned by the asylum,
                           279 
280
AL T-SCHERBITZ.
and  are  occupied by  quiet patients.  Others are used as
residences for the workmen connected with the institution.
Through the estate  flows the river Elster, a small stream
with picturesque borders.  On its right bank and about the
superintendent's  residence and the cottages are ornamental
grounds.  On one of  the terraces here  is a  plain monu-
ment, erected, as its inscription shows, by the people of the
Province of Saxony,  in memory of the humane  and  in-
telligent  founder  of the asylum, Professor John  Maurice
Koeppe.   The  object  of the institution, originally planned
for 450 patients, but subsequently enlarged so as to accom-
modate 600, is " the recovery of the apparently curable, also
the reception and care of the incurable and dangerous in-
sane of the province."
  Formerly all the Prussian asylums  for the  insane  were
under  State  control.   Since the  direction  of local affairs
has been intrusted to the provinces,  they have  managed
their own institutions  for the insane, deaf  and dumb, and
blind.  The State, however, still retains its right  of super-
vision  over these institutions.   The  chief officer of the
provincial government  is the " Landes Director," who, with
several  councillors (Landes  Rathe),  directs  the current
affairs  of  the  provincial  government.   For the  disposal
of matters beyond the jurisdiction of  the "Landes Di-
rector " there is a so-called Provincial Committee, which
meets  about every two months, or as necessity demands.
It consists  of  fourteen  members of  the  Provincial As-
sembly.  The latter body is composed of  over one hundred
delegates  from  all parts  of  the province, who  convene
once in two years to consider  and transact the business
of the province.   With it rest the chief  control of the in-
stitution  and the appointment of the medical  director or
superintendent of the asylum.  Reports of the medical work 
I 
EXPLANATION.
Ut.?. i Obtmatiem Station.
                         (  a A.U..lttr.t,o» B.tU.Hf.
  I  Central Institution <  . B.«f.™ smo„.  J £
  2  Kitchen             *•  * a"^'''- ' J'',^,ua^,■
 J  Kitchen dwellings
  4  Laundry dwellings
 j  Laundry
  6  Dairy with diucllings
  7  Horse stable and dwellings
  8  The Director s Residence
  q  Farm-buildings
IO  Assembly-house
II  Brickmaking establishment
12  I 'illage houses, formerly belonging to villagers
ij  Men's Villas
14  Women's Villas
IS  Bath-houses
lb  Pavilions for infirm chronic  cases
17  Residence of one of the  Assistant Physicians
0   U 
              GENERAL  PLAN
                    OF  THE
PROVINCIAL  INSANE  ASYLUM,

  ALT - SCHERBITZ.
             I    I  Institution Buildings,
                   Farm Buildings etc,

Fill    E    1/   T>    S
K  E A U
S  » 
 
ADMINISTRA TION—ADMISSION.
28l
and  of  the administration are made to the chief of the pro-
vincial  government, the " Landes  Director," who  resides at
Merseburg;  likewise statistical reports of the entire result
of  the  management  to the statistical  central  bureau  at
Berlin.   Under the supervision and inspection of the  Pro-
vincial  Committee and the " Landes Director" the affairs of
the  asylum  are administered  by its  Superintendent,  Dr.
Paetz, who  is  appointed for life with the same right  to a
pension as other officers holding life appointments.  He is
assisted by a second, third, fourth, and fifth physician;  also
by  an  accountant, a  secretary,  an  assistant  secretary, a
steward, a house overseer, and  a land overseer.   His juris-
diction covers  all  the medical and economical affairs of the
asylum  and  grounds  or land.  As the chief officer, he ad-
ministers to subordinates the oath of office, and preserves
order and discipline according to rules.  He may be absent
from the institution for three days without permission,  if he
arranges to have his place properly filled ad  interim; and
he may grant to any of his subordinates eight days' leave of
absence.
   The  asylum  must receive all  curable patients, and of the
incurable those who, at the same time, are dangerous or
burdensome to their  families or the public.   Incurable pa-
tients  not  dangerous have  also  been admitted,  and  will
be while the  province  has  sufficient room  in its asylums.
Refusal to receive patients scarcely ever occurs.
   Applications for admission, to which a certificate from the
district physician  is attached, are  sent from the authorities
where  the patient  resides to  the asylum superintendent.
The latter has  the right in all urgent cases, also in all cases of
curable or dangerous patients, to admit without delay.   He
communicates  the proper intelligence  to  the local authori-
ties  and to the friends or relatives of the patient, and makes 
282
AL T-SCHERBITZ.
a  short  report thereon  to the " Landes  Director," which
accompanies the application  for  admission.  In  cases  not
pressing, the asylum  superintendent  transmits  the  applica-
tion for admission received by him to the " Landes Director,"
with  a short discretionary opinion  on what  grounds  the
application was accepted or rejected, and, according to this
submitted opinion, then the " Landes Director " will report
to the local authorities who made application for the  patient.
  The insane are conveyed to the asylum with accompanying
documents setting forth,  among other things, whether  the
friends legally responsible are willing and able  to bear  the
cost of the needed care  in whole or in part, or whether this
is  to  be defrayed  out of means belonging to the  patient.
When there  are particulars which,  in the interest  of  the
patient, his relatives,  or friends, should be kept secret, but
which are necessary to a  perfect understanding of the case
by  the physicians, such particulars  are excluded from  the
admission papers, and are sent separate, in a sealed envelope,
to the superintendent of the asylum.   The rules forbid  the
reception of an insane person who has been exposed to con-
tagious or infectious diseases  until   six  full  weeks have
elapsed after exposure.  Upon the approval of  the superin-
tendent and under his regulations, patients  are allowed  to
have special attendants.
  After making arrangements  with friends of the patient or
others for his support, the superintendent, acting independ-
ently,  makes  absolute  discharge.   When  dangerous  pa-
tients, committed  directly by the local  authorities, have
recovered,  the latter  are  informed.   Discharge  on  trial is
allowed, and in all such cases the relatives, or authorities to
which the insane are chargeable, undertake supervision, and
every three months communicate with the asylum superin-
tendent  respecting  the health  of the patient.   All such 
 
 
CENTRAL INSTITUTION.             283
 reports are signed, not only by the relative or guardian, but
 by a medical authority.   After  two favorable reports, the
 name of the patient is struck off the books of the asylum.
   The  institution  was opened in 1876,  when forty insane
 persons were conveyed to the old farm-house of the Alt-
 Scherbitz  manor.  At the same time the central institu-
 tion buildings were begun.
   Patients of what is termed the  " first class " were admitted
 at a yearly payment of 1,200 marks ($288); patients of the
 " second class "  at 600 marks ($144); and patients of the
 "third  class" at 240  marks ($57.60),  for which  sum  the
 last named are provided with clothing in addition to main-
 tenance.  Any  difference between the  payment  and  the
 actual cost is defrayed by the provincial government.  An
 additional  charge is made for patients received from other
 provinces.
   The two reception  stations of the central institution—one
 for men and one for women—are clinical passage-ways for
 all newly received patients, who are detained  here as  long
 as  they need continual  care  and treatment.  Those  who
 remain  in these stations are usually the acute curable cases,
 the  incurable ones being  soon transferred to other depart-
 ments.
   The observation stations—one  for each sex—are for pa-
 tients who, though not of the  acute class, need  special obser-
 vation because they are not sufficiently capable of self-control
 nor reliable enough for reception in the colonial stations.
  The two detention  houses are  for such  male and female
 patients as it is necessary to restrict because of their being
 restless  or  dangerous, or from the suspicion of their having
 a desire to  escape.
  Centrally situated in the front  of the group constituting
the central institution  is  the administration  building, the 
 284                 ALT-SCHERBITZ.

 houses occupied by  women  being on  the  right side and
 those by men on the  left.  Rearward from this is placed the
 hospital for the  bodily sick, having a department  for  each
 sex.  Near the latter and completely hidden by trees is the
 mortuary.
   The low brick  walls which  inclose the  yards at the rear
 of the detention  houses have sunken panels, and are sur-
 mounted at intervals by  pillars  supporting an architrave.
 They are architecturally designed to conceal their purpose,
 and are screened  by shrubbery and creeping vines  that
 twine gracefully about the pillars.   Except in  the isolation
 rooms,  the windows  of all  the buildings belonging  to the
 central asylum group  have neither bars nor gratings.
   On  the  first floor of the  administration  building  is a
 reception  room,  a  conference room, the  superintendent's
 office,  an  accountant's office, a  treasurer's  office,  and a
 porter's rooms.   On  the  second  floor are  the living  and
 other apartments of  the second physician  and those of the
 accountant.
  The  reception stations,  built  to  accommodate   fifteen
 patients each,  are plain but comfortable buildings, and with-
 in and  without  resemble  private  dwellings.  They  have
 unlocked  doors,  and  there is no  suggestion of irksome
 restraint.   In the  building for women  resides  the  head
 female  attendant; and in that for men, one of  the assistant
 physicians.
  In the observation  stations, each of which is intended to
accommodate  thirty-five  patients, the furnishing was ample
 and  comfortable.   Here, as  in some other  departments,
provision is made for open  fires.   The windows were, with
 one  exception, unlocked, the  exception  being one  with a
lockable sash in a room that was less under the attendant's
eye than the others.  Windows of rooms that are opposite, 
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CENTRAL INSTITUTION.
285
and  are  occupied  respectively  by men and women, have
frosted panes.  The doors  open rearward  to shrubbery-
planted plots, and  in front to wide porches and  the open
grounds.  Fine views, immediate  and distant, are had from
both windows and  porches.  In  one of the rooms on the
women's  side there were two  curtained  couches for the
use  of such  patients  as desired occasional rest.  In the
windows and in other parts of the rooms were bright flowers.
There is also an abundance of health-giving light.  The sit-
ting-rooms had  plain  chairs and  sofas.  Each station has
separate sitting and dining  rooms.  Six single rooms are
set apart for patients of a higher class.  The sleeping apart-
ments in the observation stations  are mostly on the associ-
ate plan and were provided with iron bedsteads, each having
a temporary foot-board, mattress of  straw,  India  fibre, or
horse-hair, over which was placed a second mattress, blanket,
blanket cover, bolster, and pillow.   The oiled wooden floors
were uncarpeted.
  The detention houses, like the  other buildings, have nu-
merous windows, from which there are pleasant  outlooks.
The interiors  are cheerful and are comfortably furnished.
Nearly all of the limited number of patients in the detention
house  for women were  engaged in sewing or knitting, with
an attendant in their midst.  As we entered, a  request was
politely made  to  abstain from  note-taking in the presence
of the patients, it being explained that pains were taken to
occupy their minds, and every thing likely to prove a cause
of disturbance was avoided.
  There are fourteen isolation rooms, which  number is here
considered more than  sufficient for an asylum having six
hundred patients.   They generally stand empty in  the day-
time, and at night  are  used  for sleeping-rooms for restless
patients.  In those  used  for isolating maniacal cases there 
286
AL T-SCHERBITZ.
are inside blinds to the windows.  The isolation apartments
are so distributed that there is in each reception station two
and in each detention department five.  There were formerly
three rooms  for isolation in  each observation station, but
these have not  been used in a number of years for this pur-
pose. The walls shutting off  the grounds from the observa-
tion  court having been found  unnecessary, were removed.
  In the management the tendency is towards an extension
of the liberty of the patient.  Isolation cannot be enforced
without the  consent of the Superintendent, who  said: " It
is avoided in  every possible case."  There were no  cribs in
use,  nor were  there  any  padded  rooms.   Patients  who
show a disposition to tear  off their  clothing are attired
in strong garments buttoned  at the back.   This dress Dr.
Paetz does not regard as a means of  restraint.  He says:
" It does not  hinder the patients from having free use of all
their members, and this  arrangement of the clothing only
prevents its being torn off."   He further says: " Every sort
of restraint by force  is strictly interdicted  as being against
the  fundamental principles of the asylum.   The patients
enjoy the largest imaginable freedom, the asylum represent-
ing the non-restraint  system in its widest sense.  Restraint
is easy to dispense with if one earnestly wishes to dispense
with it."  The  number  of nurses  or attendants averages
about one to  ten patients.  They live with the patients and
lodge in the same dormitories.
  The medical department appeared to be thoroughly sys-
tematized.  Every patient on  arrival at the  institution must
remain  in bed on the  morning  after reception to wait  a
mental and bodily inspection by the whole of the medical
staff. Each physician is required to write out separately his
diagnosis of the case, giving his views of the necessary treat-
ment.  These become matters of record. 
DETENTION HOUSE.  ALT-SCHERBITZ. 
 
COTTAGES OR VILLAS.
287
  Patients who do not occupy the central institution  are
provided  for in  villas  and other dwellings.   Those  for
women are widely separated from those for men.  The super-
intendent's residence and grounds, the asylum kitchen, dairy,
laundry, and farm buildings are between. An assistant phy-
sician resides in one of the cottages belonging to the group
occupied  by male  patients.  There are three classes of cot-
tages, or villas.  The first and second classes are two-story
buildings, and are all well furnished, the quality of furniture
varying according  to the  payment  for  support.   These
buildings  stand at a  distance of about one hundred yards
apart.  From the most of them glimpses are obtained of the
river Elster.  They are separated from each other by neat
low hedges, and attached to some of them  are little gardens.
There  are no guards to any of the windows.   The freedom
of the place is shown  by open doors, which everywhere
meet the  eye.  It was a pleasant summer  day when I was
there, and the patients were passing in and out  without in-
terference, all, however, being under  watchful supervision.
  One of  the large sitting or day rooms entered contained
a circular  sofa in the centre and an ordinary sofa against the
wall.  On the floor were some bright rugs, and the  presence
of flowers and objects of ornamentation lent an air of refine-
ment to the whole interior.  The other furnishing included
mirrors, pianos, wardrobe, writing-desk, sewing-tables, divans,
and chests of drawers.   Lamps were suspended from  the
neatly frescoed ceiling.  The walls were colored.  There are
convenient  store-rooms and closets in the several depart-
ments. The cottages, all of which are constructed to admit
an abundance of sunlight, rest  on  dry, substantial  founda-
tions.
  A third-class two-story cottage accommodating  nineteen
inmates had fewer conveniences than the others, though it 
288
AL T-SCHERBITZ.
was adequately furnished.   On the lower floor is the sitting
or work room, also the dining-room ; and on the upper floor
are the sleeping apartments.  In the cottages' as also in the
central institution ' the arrangements for men are a counter-
part of those for women.   It is the aim  of the management
to have  every thing relating to the care and  treatment  of
the patients conform as  nearly as practicable to home life.
  The institution cottages in the  adjacent hamlet of Alt-
Scherbitz were -next visited.  At one  of  these the patient
had gone out and locked his door, and  the physician would
not  enter the  dwelling without  his  permission.  These
buff-colored  cottages with white mouldings  present a neat
exterior.  On the doors are the names of  the  patients put
on  by themselves.  One, manifesting some classical taste,
had carefully imprinted  in large characters over the door  of
his little  cot  the  word  " Salve."   The  furnishing of these
houses is  simple, yet sufficient for the needs of the inmates.
  Provision for sixty harmless and  infirm  chronic insane  of
each sex  is  made in two cottage  pavilions.  One is on the
right and the other on the left of a  dwelling for an assistant
physician and others connected with this department. These
buildings form a separate group in the neighborhood of the
central institution.  They  are  two-story structures having
associated dormitories on the upper floor.
  There  is one general kitchen for the whole establishment.
The food is  conveyed from   it  to the  several  depart-
ments.  The vehicle containing the mid-day meal, and con-
structed  so  as to  keep the contents warm, was  seen on its

  1 While the plans and illustrations given of  some of the Alt-Scherbitz build-
ings serve the valuable purpose of demonstrating the feasibility of substituting
inexpensive, comfortable structures, something like ordinary dwellings,  for
the generally prevailing massive palatial edifices built on the congregate plan
for the insane, they are not presented as faultless models for asylums in the
United States. 

A VILLA FOR  PATIENTS.  ALT-SCHERBITZ.
3311 
 
             FOOD—HEATING—INDUSTRIES.          289

way from the kitchen to the cottages. Two patients were in
charge of it, one acting as driver and the other occupying a
seat behind.   In the  extensive culinary department twelve
patients were seen at work under the supervision of an at-
tendant.  Besides these general arrangements for the prepa-
ration of  food, it  should  be mentioned  that each domicile
has  its scullery and pantry.   The rule as to food  specifies
that it  be wholesome and well prepared, and, further, that
the dishes and cooking utensils be scrupulously clean.
   The  central department is  warmed  by hot air; in the
isolating  apartments the heating is effected by hot-water
pipes;  in the villas porcelain stoves  are  generally used,
open fires supplementing, to some  extent,  the  system of
heating, and aiding  ventilation.  Water is  elevated by a
force-pump  and distributed  by gravitation.  The  bucket
system is adopted, and all waste is utilized on the farm.
   The farm buildings are  extensive, and a large herd of cows
is kept.   The dairy, quite  an important adjunct, was shown
by those in charge with justifiable pride.  There  is a brick-
yard on the  place, and  from this source has  not  only been
supplied brick used in the erection of asylum buildings, but
a considerable quantity has been marketed.   Other objects
of interest which arrest the eye are a capacious hot-house, a
well-stocked  fish-pond, also an orchard  in which are cherry,
pear, apple, and plum trees.
  Agreeable employment, suited  to  the mental and  bodily
condition of  the patient, with relaxation in the form of out-
door  and indoor games, is strongly enjoined by the man-
agement  as  a means of  cure, and  is carried out  in the
domestic  department, in the several workshops,  in the gar-
den, and in the fields.  I  was informed that from eighty-
five to ninety per cent of  the  patients  were on  the  list of
the employed.   The  women  find  much to occupy their 
290
ALT-SCHERBITZ.
minds and energies in the kitchen, the wash-house, and the
dairy.   Many  work  in the  sewing-room, where wearing
apparel  is made, and where articles for  institution use are
repaired.  Some of them milk the cows  and work  in the
garden or in the fields.   Most  of  the men are occupied  at
agricultural  work  and  at  different trades.   The  few not
engaged in  any form of employment include acute cases
under medical treatment, those physically incapacitated, also
those extraordinarily excited.   " There is," says  Dr.  Paetz,
" no branch  of  agricultural work in which the patients are
not  useful,  and their  use  of implements  has  not been
attended by any accident."   In the brick and tile  yards only
a few paid laborers in addition to  the patients are required
to do the work.  This  is also the case in the other depart-
ments.   In addition  to the insane at  work on the farm
and  in  the  brick-yard, others were  employed  as joiners,
masons, wagon-makers, blacksmiths, carpenters, smiths, shoe-
makers,  tailors, saddlers, bookbinders, stone-masons, painters,
basket-makers, and clerks.
  In furtherance  of their  recovery all the  curable  insane
within  this  institution have equal care  and  consideration.
Excursions for  the benefit of the  health of the inmates are
periodically  made,  and in the case of the  poorer patients the
asylum bears the cost.   Theatrical entertainments, concerts,
dances,  bowling,  and a variety of games  are  among the
varied  means of  recreation  and   amusement.   Particular
attention is paid  to cleanliness of the person and  of the
clothing.  The latter is frequently changed, and the airing
of all apartments is not a matter of hap-hazard, but of rule.
A spacious  swimming-bath  is  provided  for  the  inmates  in
the river Elster.   The correspondence of patients with out-
siders is regulated by the  asylum  superintendent.   The
statute provides that complaints of want of proper care and 
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A VILLA FOR THIRD-CLASS PATIENTS, TWENTV-SIX BEDS.  ALT-SCHERBITZ. 
 
TACT IN MANAGEMENT.
29I
treatment may be made to the " Landes Director," and that
charges of a grave nature may be brought to the attention
of  the  Provincial Committee.  Strangers are admitted  to
the institution  only by permission of the superintendent,
and he may deny the admission of a relative if he thinks the
visit likely to be injurious to the patient.  Care is taken  to
prevent annoyance to the inmates.
   At this  institution one is  favorably impressed  with the
absence  of  barriers,  the  freedom from  restraint, the  kind
treatment accorded the patients, the thorough supervision
of the large numbers occupied in  the various  employments,
the general  atmosphere of cheerfulness  and  quiet, and the
cleanliness and country-life  aspect of the place.  One in-
stance illustrative of the intelligent management may be
cited.   In  the laundry were  observed  a large  number  of
women working at tubs with wash-boards.  A few, however,
stood idle and  listless, with  their untouched work  before
them.   On inquiring of  the  physician why  these patients
were so placed while doing nothing, he replied : " They may
be there for days and not raise a hand to work, but by and
by the mind becomes interested,  a slight effort is put forth,
followed by another and yet another, until, at length,  they
become steady workers, and as a consequence their  health
is greatly improved."   Such careful endeavor  to engage the
mind and induce volition  on  the part of  the insane by  kind
and patient  effort is a fundamental principle of  the  Alt-
Scherbitz treatment.
  Without any attempt at  ambitious architectural display
or costly interior furnishing, there is, apparently, in this in-
stitution every thing essential to the comfort  of the insane.
The whole system of care and treatment seems adapted to
insure highly  satisfactory results ; and yet a stranger pass-
ing along the  highway and catching glimpses  of the asylum 
292
AL T-SCHERBITZ.
buildings  through the trees  and shrubbery, would  hardly
suspect from their unpretentious character and their arrange-
ment upon the estate that the place was a public hospital
and asylum for insane people. 
CHAPTER VIII.
                        RESUME.

 A GENERAL survey of the field of inquiry to which
       the reader's attention has been directed in the fore-
 going pages suggests some thoughts which it may not be out
 of place  to present, with  a  few conclusions drawn not only
 from this examination, but from other extended examina-
 tions of  various  methods of  caring for the insane.

                        LOCATION.
  It has  been found in many instances that essentials to the
 good sanitary condition  of an asylum  and an economical
 administration of its affairs  were overlooked in selecting the
 site ;  and consequently the institution must suffer throughout
 its existence from mistakes  that cannot be rectified.
  The first consideration  in the selection of a site should be
 its healthfulness.  There should be an abundant, never-failing
 supply of pure water, opportunity for  the ready disposal of
 sewage without endangering the health of the inmates or of
 the public by  the pollution  of streams or otherwise, a suffi-
 cient acreage of land, and easy communication by rail or water
 for both  passengers and freight.  The atmosphere should be
pure and salubrious—free from malarial influences and arti-
ficial poisons.   The situation should not be in proximity to
any local nuisance or disturbing element.  Although not al-
ways  practicable  to obtain  without  sacrificing more impor-
tant  advantages, it is desirable that water be supplied from a
                           293 
294                     RESUME.
source sufficiently elevated to ensure its distribution through-
out the various buildings by gravitation.  The supply should
equal at least sixty gallons a day for each inmate.
  Many of the asylums  formerly built for the insane were
established within or adjacent to populous centres, where it
was difficult to obtain sufficient land for gardening and farm-
ing purposes.  This disadvantage led to a change of  policy,
and modern mixed asylums and those  for the chronic insane
are more  generally located in the country and upon con-
siderable tracts of land.  Nevertheless, it seems to be almost
universally the case that additional land is soon required,
and it is frequently impossible to obtain it, even  at an exor-
bitant price.
  In order to overcome some  of the difficulties arising from
lack of sufficient landed estates in connection with institu-
tions  for the insane in England, the Government has made it
practicable for one county to purchase land and establish an
asylum in another county.  It is often  found necessary to
adopt the unsatisfactory plan of leasing ground, sometimes at
inconvenient distances from the asylum property.  From past
experience may be learned the lesson that it is always best,
when founding an asylum, to  secure at the outset sufficient
land.   If more should be purchased than is actually required,
it  could be sold at a profitable advance, as the improve-
ments and high  cultivation would increase its value.  The
area of land  for an institution for the  chronic insane should
not be less than one acre per inmate.  There  are those who
think half this amount is sufficient; but the weight of testi-
mony is  in favor of  the larger acreage.  Some American
authorities place it as high as two and even three acres per
inmate.
  It is conceded that agreeable occupation,  especially em-
ployment  in the open air, greatly contributes  to the health 
LOCA TION.
295
and contentment of the insane;  and  it has been demon-
strated that the rate of maintaining the chronic insane is
lowered as the quantity of land is increased ;  while in some
instances, with a larger acreage,  a higher  dietary stand-
ard  is  attained.  At  Alt-Scherbitz in  Prussia,  Clermont
in France, and the  Willard Asylum in  the  State of New
York, we find extensive vegetable gardens, goodly sized fruit
orchards, wide fields yielding grain, and broad, rich meadows.
The  large herds  of cattle kept  at these places produce
abundant milk, butter, cheese, and  beef, for the consump-
tion of the inmates.
  Another advantage in having a  liberal area of land is
found in the opportunity afforded  for reserving broad spaces
for lawns and shady groves exclusively for  the  exercise and
recreation  of the patients, and for making a wider distri-
bution of the various buildings, which is desirable in effecting
a proper classification of the insane.
  Not only is a large acreage of land desirable,  but its qual-
ity  is of great importance.  That suited to gardening pur-
poses seems best adapted for the uses of  an insane asylum.
The soil should be a warm fertile loam that may be culti-
vated early and late  in the season for doing outdoor work—
one  that soon becomes dry after rain, and is thus suitable
for  recreation the greatest possible  number of  days in  the
year.  It is much  more agreeable to till good land than that
which is poor, and the former will often return for the same
amount of seed and  labor double the harvest of  the latter.
Clay land and that which is stony should be rejected.  Using
the spade  or plough on such, especially the  latter, while
trying the  patience of a  sane man,  irritates the insane.   A
loamy soil by its absorbing qualities takes up impurities,
thus  acting  in  some degree  as  a  disinfectant,  and  pre-
serving a purer and more wholesome atmosphere.   Further, 
296                     RESUME.
when a large outlay in buildings  is contemplated, it is un-
wise to place them on land  other than that in every way
suited to the  purpose  for which it is intended.  The im-
mediate site of all buildings should be  on ground free from
hidden springs, and capable of  quick surface and  effectual
sub-drainage.   A rocky substratum should be  avoided, for
it makes necessary excavations expensive.
  The love of  the  beautiful in  nature is common to man-
kind, and though it may not always be manifest, its peace-
ful  influence is felt, in  a  greater  or less degree, by the  in-
sane  as well as the sane.  Residents of the country, like
those  of  the  city, seek  opportunities for  recreation in
the  summer where nature is  specially alluring, and this
fact should not be lost sight of in selecting places for the care
of the mentally diseased.   A site  commanding an extensive
and varied prospect, that tends to inspire pleasurable emo-
tions in the  mind, should  therefore  be sought.   For a
strictly curative institution—that  is to say, for a hospital  for
the insane, where so large a tract of land as is  requisite  for
an  asylum is  not necessary—nearness to a  city or a large
town is desirable.
  In locating public charitable institutions, the State has not
infrequently accepted donations of land made by local author-
ities or through the voluntary subscriptions of private citi-
zens.  It  has  invariably resulted  that  this temporary gain
has proved a permanent  disadvantage.   By whatever name
we  call it, a gift of this character partakes of the nature of a
bribe, and its acceptance creates the feeling that an equitable
claim is thus  established  for  the  patronage of  the institu-
tion; and, if this  be denied, ill-feeling and embarrassment to
the  management ensue.   The  result  is  more  satisfactory
when the State makes its selection on the merits of the site,
irrespective of local gifts; and it  is certainly more dignified 
BUILDINGS.
297
to do so than to appear  as a suppliant before a portion of
its people.  It  would  be  well  if every State should follow
the example of Illinois, and forbid the free acceptance, by
commissions, of sites for public buildings.

                        BUILDINGS.
  In  making provision for the  insane, we should not over-
look the fact that there are two  general classes or divisions
—the acute and the  chronic.   Respecting the  first,  there
exists, in  a greater or less degree, the expectation of  cure  ;
in regard  to the second, the chance of recovery is reduced, it
may be said, to a bare  possibility.   To the  chronic  class
belongs the great mass of insane under care, variously esti-
mated at  from  four fifths  to seven eighths of the whole.
  Every consideration of humanity demands  that no time
should be lost in applying remedial measures when they are
most efficacious, and that, however elaborate the provision
or expensive the treatment, no effort should be spared to cure
the patient before the disease becomes chronic. Not only
does every principle of humanity require this, but herein is
true economy;  for, if an  insane person can be cured before
the acute  period, which  is  comparatively brief, is passed,
though the treatment be highly expensive, it is cheaper to do
so than to maintain him during the following twelve or more
years of his life in the chronic state, even if it be at  a  low
rate of maintenance.
  Past experience, it appears to me, has demonstrated that
large  mixed institutions  are not  effective agencies in the
cure of  insanity.  In many particulars the requirements of
the acute  insane are more exacting than those of the chronic.
These include  special  structural arrangements, very close
medical attention,  a large corps of  specially qualified  at-
tendants,  and  a prescribed diet.  If a standard  of care 
298                     RESUME.

suitable to the necessities of the acute insane is adopted
by  a large  institution  receiving  both acute  and chronic
cases, it  is unnecessarily expensive  for  the  chronic  in-
sane ; if the standard  is made  only conformable  to  the
needs of  the  chronic,  it is  insufficient for  the acute  in-
sane : and  it has been  found  difficult  to counteract  the
tendency  towards a  uniform standard of care  for both
classes  under the same administration.   Besides,  a great
number of patients increases the business  responsibility of
the superintendent  and demands  attention that should be
given to the medical  department, multiplies  details,  and
finally individuality is lost, and the curative purpose of the
institution, which should be  paramount to every thing else,
cannot be effectually carried out.
  It is the opinion  of the Hon.  Francis Scott, for  twenty
years chairman  of the  Brookwood  Asylum  Board,  that
efficient superintendence is rendered impossible in what he
calls monstrous asylums, and that such institutions are most
unfavorable  to the  treatment and cure of insane patients,
and their  management harassing and  unsatisfactory to the
medical superintendent.   He says: " The  doctors  in large
asylums cannot even know  the  patients  by  sight,  much
less  by name.  The thread  of their history is to them a
tangled skein which they scarcely attempt to  unravel.  The
admixture of a curable  patient with the vast common herd
has a most detrimental effect."
  Dr. Rayner of Hanwell complains  of his large asylum.
He says:  " I cannot see all my patients in  one day."  And
yet this very evil consequent upon  overgrowth was at the
beginning protested against by the English Lunacy Board.
Its Chairman, Lord Shaftesbury, said before the parliamen-
tary committee of 1877 : " My own opinion has  always been,
and from the first time I was acquainted with lunacy I have 
BUILDINGS.
299
always maintained, that three hundred was the outside that
could be well  managed by one superintendent.  There is a
desirable process which the Germans call the individualizing
system.  With more than three hundred it would be impos-
sible that the medical superintendent could personally see
each patient, as he ought to do, several times in the course
of the week.  We had a very long, not to say very angry,
controversy with  Hanwell at the time that they enlarged
their buildings.  We were very averse to that scheme."
   It seems to be necessary that every State should provide
sufficient  accommodation for  its acute  insane  in  small
hospitals, where,  under  influences favoring restoration to
health, recent cases could be made the subject of close study
by skilful alienists, and where  every possible means would
be brought into requisition to effect cure, the ever-recurring
question of expense being a secondary consideration.   Only
in this way can we expect to lessen the steadily increasing
volume of hopeless insanity.
   It must be conceded, however, that it has heretofore been
found  very difficult to  establish  small hospitals, or those
even of moderate  size, especially designed for and adapted
to curative purposes.   After  such  a project has been under-
taken, and the Legislature has decided upon the site for a
hospital, the  work of  building devolves  upon a  Board of
which perhaps not a single  member has made previous study
of the special needs of the  class  to  be provided for.  An
architect is employed who sets out  to design an  imposing
building that  will  stand as an enduring  monument to his
architectural  talent, rather than  one  best adapted for the
care and cure of the insane.  In his attempt to plan a grand
edifice he is encouraged by those representing local interests,
who desire a structure  that will by its stateliness  prove  an
object of admiration to strangers ;  and so, at the outset, we 
300                     RESUME.
sometimes expend vast sums on  immense buildings that
have  the  semblance  of palatial  prisons.  Later  on,  other
difficulties arise.  More accommodation is needed, and while
it is plain that the interests of the insane require  another
asylum  rather than additions to the existing  one,  pride in
administering the  affairs of a large institution,  combined
with influences arising from the benefits of local patronage,
is powerful in swelling the accommodations, regardless of the
purpose of the establishment and  its original plan.   Enlarge-
ment follows enlargement, until the institution finally reaches
enormous dimensions, and whatever principles  of  cure were
had in view at the outset, they  are overwhelmed and ren-
dered impracticable by the aggregation of numbers.
  In  the  dominance  of the  architectural  idea  over  the
medical and moral in  asylum building, we frequently behold
a vast pile of brick  and stone and mortar, in which  are
congregated a great number of mentally diseased persons,
to every  one of  whom  the  surroundings  are unnatural.
Having brought them into abnormal conditions of living, the
human  mind  is taxed to the utmost  to overcome  these
and secure requisites to  health,  including a sufficiency of
light and air.  When  we consider the distress  of  a patient
placed  in  one  of our immense  hospitals built  on  the
congregate plan, and subjected to the disquiet,  unhappiness,
and irritability consequent upon the  herding  together of
masses of people, the  wonder is that we  should attempt his
cure under circumstances that would seemingly cause a sane
person to  lose his reason.
  The plan of a hospital for the acute insane I  would have
include  a central, unpretentious building for  the superin-
tendent.  This should  also contain the offices and  other
apartments  customarily belonging  to  what  is known  as
the  administration  department.   For  the  patients,  there 
BUILDINGS.
301
  should  be cottages so arranged that the  superintendent's
  residence and  central department will  stand between the
  groups  for men and those for women. The cottages should
  be of different  sizes and variously designed, all of them  re-
^sembling private dwellings.  Assistant medical officers should
  reside in some of the cottages with the patients.  There
  should  also  be accommodation in  each  cottage  for the
  necessary attendants.
    Reception cottages should  be built  in  connection  with
  every hospital  for  the acute insane.  A fearful shock is felt
  by  many patients when  first  brought  into  an  immense
  prison-like building, and ushered into a long,  formal hall or
  corridor furnished  with angular wooden  chairs and settees,
  ranged against  the walls much like  the  waiting-room  of a
  railroad station.  Besides, the grating sound of strong locks,
  the sight of heavy  doors, barred windows, and  the  strange-
  acting beings who gather around the new-comer are not likely
  to calm an excited  mind.  First impressions are lasting, and
  should be agreeable.   They are more likely to be so, if the
  patient, when entering a hospital, approaches a pleasant cot-
  tage situated in parklike grounds, and, instead of the formal
  ward with its strange  sights, is  received into  what is appar-
  ently an ordinary dwelling with homelike furnishings.  Thus
  placed, the patient feels more at ease, and the  physician can,
  for  this  reason, get at a better understanding of his  case.
  Explanations as to  what is for his best interest are made, his
  apprehensions allayed, confidential relations established be-
  tween him and  the  physician, and sooner or later, according
  to circumstances, he is transferred to the  proper department.
  One thus entering  a hospital for the insane, I  am assured, is
  far more likely  to  be  reconciled to his confinement, and, if
  curable, is sooner placed  on  the road  to recovery.
    In addition to reception cottages, there should be separate 
302
RESUME.
buildings for convalescing  patients.   These should be like
ordinary dwellings,  and pleasantly situated.   They should
be  comfortably furnished, and have  every attraction that
could agreeably engage  the mind.   It is asserted by a high
authority that, when patients begin to mend, the process of
cure is  rapidly accelerated  by removing  them from the dis-
tressing associations connected with the first period of their
disease to entirely new surroundings.
  If food is conveyed  from a general  kitchen to the several
separate establishments, as  at Alt-Scherbitz, or if each  cot-
tage has its  own  kitchen,  connecting  corridors are  not
necessary.  The latter plan  presents the nearer approach to
family life, and  appears  to  be the more desirable arrange-
ment for hospitals for the acute insane.  In either case there
is no arbitrary rule as to the relative position of the cottages
and the central building, except that the former should not
be  too far away for convenient supervision.  They may be
located with  reference  to the  grade of the  land, to pleasant
outlooks that may  be had from  them,  or to picturesque
effects.   In any event, they should be placed far enough apart
to give  the appearance of retirement  that  may be attained
by the judicious planting of  trees and shrubbery between
them.  If corridors  are  considered necessary,  they should
extend backward  from the  central building and afford com-
munication with such departments as are in the rear  of it,
and thence  to  right and left a  short  distance from  the
cottages, connecting with the rear of each of them by  a
branch section.  An illustration  of the  way in which sep-
arate buildings may  be thus connected is seen in the new
asylum  at Menstone, England.
  Many of the old congregate asylums are so arranged that,
to reach the  most distant parts of the institution from the
administration or central department,  it is necessary to pass 
BUILDINGS.
303
 through every intervening sitting or day room on one of the
 asylum  floors.  Thus a monotonous tramping  is kept up,
 which,  on visiting days especially, is a constant source of
 disturbance  to irritable  and  nervous patients.  In  every
 arrangement  of buildings  such  an annoyance  should  be
 avoided.   A common error in  asylum building is made by
 connecting separate divisions, blocks, or dwellings by means
 of  corridors at either end.  It should be kept in mind that
 the best rooms are at the ends of a building, and they should
 not be spoiled by a corridor entrance at one end and exit at
 the other.  If such passage-ways are deemed necessary, they
 should be so planned that persons may pass from the admin-
 istration building to  any one of the separate buildings with-
 out finding it  necessary to enter any other than the one they
 intend to visit.
   The problem how  to dispose of the chronic insane so that
 they  shall have  suitable  asylum care without  interfering
 with the strictly curative functions of the hospital, has  not
 yet been  satisfactorily solved in England, Ireland, or Scot-
 land ; and the remedial powers of  many otherwise good insti-
 tutions, particularly in  England and  Ireland, are seriously
 interfered with by the excessive accumulation  of chronic
 patients.   The  Visiting  Magistrates  of   Haywards Heath
 Asylum, in one of their reports, say:  " The Committee are
 strongly of the opinion that our county asylums are losing
 the character  and  the objects for which they were primarily
 intended, namely, as  places  for the sanitary treatment and
 cure of insane persons, and  are  becoming  in a great degree
 mere receptacles for  chronic and  imbecile patients who  are
 detained  within their precincts;  and  this  state of affairs
 greatly interferes with the  due separation of the different
 forms of insanity so essential to the alleviation  or the cure
of brain disease."   They further add that county or district 
304
rEsum£.
asylums should  be used " solely for the reception of acute
and violent cases, of those requiring special treatment, and
those affording the hope of cure ; and that provision should
be  made  for the reception  of aged and harmless insane
persons in buildings specially adapted  for  their  comfort
and careful treatment, but constructed  and  conducted at a
considerable less cost than our present asylums, and involving
a much smaller expenditure to the rate-payers."
  In  Scotland,  relief to a  large extent has  been found
in the boarding-out  system.  In England and Ireland,  a re-
sult of overcrowding in institutions  originally  designed
for  curative purposes has been to  bring great  numbers  of
the chronic insane under the unsatisfactory care  of the work-
house.
  The embarrassment arising from  the  overwhelming num-
bers of chronic insane  in mixed  asylums was very great
in every country that I visited.  A similar difficulty is be-
coming formidable in the United States, and there is no
doubt  that it will  continue  to  increase as  the country
grows  older,  unless  a  wise  and  comprehensive policy  is
adopted respecting  this rapidly accumulating  class.  The
weakening of the effectiveness of  curative institutions by
the  continuous increase of chronic cases, and the  insuffi-
cient  provision  for  their care in  pauper establishments,
lead me to conclude that, in order to meet these difficulties,
we must have more institutions of the character of asylums
for  the  chronic  insane*  or  for those  who  have received
thorough  treatment in a well-organized hospital.  In the
asylum, nevertheless, the hope of recovery  should always
be  kept in  mind,  and  the  idea  of  incurability ignored.
Such  institutions  should  not  be  designated  as  chronic
or incurable, but simply as asylums in  contradistinction to
hospitals. 
BUILDINGS.
305
  As already stated, asylums  should be located on consid-
erable tracts of good arable land.  The buildings should  be
simple and  inexpensive.   At the same time, they may  be
made attractive by varied outline and color.  Adjacent  to
the  administration department there should  be sufficient
hospital provision  for those requiring special care.  Beyond
this, there should  be a wide distribution of buildings on the
colony plan.  These, with their surroundings, should be made
to approach as nearly as practicable to ordinary homes.
  While there  are  conclusive reasons why hospitals for the
acute insane should  be  small, these reasons have not the
same force when applied to asylums for the chronic insane.
In fact, there  are  some advantages that may be gained  in
bringing together a considerable number of this class.  The
opportunity is thus afforded  of extended classification,  of
making up groups  of artisans under a master workman, of
purchasing  supplies in large  quantities at low rates, of  re-
ducing the cost of  superintendence, and otherwise lessening
the  expense of maintenance.  But  the almost irresistible
tendency to undue aggregation is a danger that  should  be
carefully guarded against even in providing for the chronic
insane.
  The architecture of British asylums is without elaborate
ornamentation.  The prevailing opinion now seems to be in
favor of two-story buildings for most classes  of  the insane.
Even on the score of economy, little, if any thing, can be said
in favor of a greater height, for although the same roof that
would  be required for a two-story building suffices for the
three-story structure, the  foundation walls of the latter are
necessarily more massive than those of the former, the entire
edifice must be stronger, and additional expenditures in these
directions considerably increase the expense of a three-story
building, so that its per-capita cost of accommodation is nearly 
306                     rEsumE.
or quite the same as that of a two-story structure. As an off-
set to the possibly slight advantage gained in the reduced per-
capita cost of construction, there are the disadvantages arising
from an extra flight of stairs, including the greater difficulty
of escape in case of fire.  The general form of modern con-
struction admits of the upper portion being set apart almost
exclusively for  night use.  The sleeping-rooms are unoccu-
pied during the day, the windows open, and the  bedding
disposed for airing for a considerable time.  By this  arrange-
ment the labor of the women can be utilized in putting in
order  the  men's dormitories, and the change  incident to
separate day and night accommodation   is  conducive  to
healthfulness.
  A mistake,  and one which  the builders  of American
asylums sometimes make, was occasionally found abroad in
the failure to carry up  the cellar  or foundation walls  suffi-
ciently high to allow of a quick descending grade about the
building, so as to carry off the water from  storms that beat
against the walls  above.  From this omission are likely to
result damp foundations, which affect deleteriously  the sani-
tary condition of living apartments.
  The rule of the English Commissioners in Lunacy respect-
ing air-space in asylum buildings having ceilings twelve feet
high is, that the associated dormitories for clean  and healthy
patients shall have fifty superficial feet of floor-space to each
bed, the separate sleeping-rooms  at least sixty-three super-
ficial feet, and that rooms occupied  by sick or bedridden
patients must have larger space with extra means  of venti-
lation, that day-rooms must have not less  than forty square
feet of floor-space to each person, and that a detached hos-
pital for contagious cases must  have fifteen  hundred  cubic
feet of air-space to each bed.
  The  commissioners  recommend  that  to  each  ward  or 
BUILDINGS.
307
group of patients  there be accommodation  for two attend-
ants, that their single rooms measure one hundred feet of
floor-space, and that,  when practicable, their rooms,  with
glazed  doors  for  observation,  be placed  between  two
associated  dormitories ; also that day-rooms for sick, aged,
infirm, and excited patients  should  be on the first floor, and
that no associated  bedrooms contain less than three beds.
  As affording  greater security against  fire, the commis-
sioners advise that ceilings  of rooms next  below the roof
be made of incombustible materials, and that buildings  be
semi-fireproof, or at least so constructed  that a fire occurring
in one part may be extinguished without destroying another
part of  the building;  also that stairs be built of stone, with
square landings, and  the  wall built up with hand-rails  on
each  side.   They insist that  there  must  be  a  sufficient
number  of  stairways,  and that  they be  so placed as  to
afford ready egress in case of fire.
  The commissioners  advise that windows be large ; that in
day-rooms they be not more than three and a half  feet  from
the ground, and in dormitories not more than four feet  from
the floor; that in  single rooms they be stopped so as not to
open more than five inches at top  and  bottom, and that a
portion of them have strong inside shutters so made that
they cannot be forced open nor afford means of commit-
ting suicide by  hanging;  and that doors of single rooms
open  outward  and fold  close  against the wall.   They
are  of the opinion that for about  one seventh of the pa-
tients in an asylum, " infirmary"  accommodation  should  be
provided with abundant  air-space, each  room  having  an
open fire or fires and a small  diet kitchen ;  also that open
fire-places should be built in  all the large rooms, dormitories,
and a portion of the single  rooms, and that there should
be other means of  heating besides that of open fires.   They 
308                     resume.

recommend that  there  be a separate  wash-house  for very
foul  clothes,  and a  room  for  washing  and  drying  the
horse-hair of the mattresses ; that there be an  abundance
of closet and store-room  space, also conveniently  arranged
workshops  well lighted and ventilated.
  Some of  the best English asylums are so constructed that
the sewers  do not enter nor pass under inhabited buildings,
but terminate close to  the  wall in a  ventilating flue after
passing a syphon trap.   In this way it is not possible for
foul odors from the sewers  to contaminate the  atmosphere
of living  apartments.  All soil and waste pipes  are carried
though the outer walls into  the  sewer  and trapped.  As an
additional  safeguard, the  interior pipe  system  is also inde-
pendently ventilated.   The  sewers are so constructed as to
permit of convenient inspection at certain necessary points.
It is thought objectionable to construct flues for ventilating
drains  or sewers in the walls of buildings.  Lavatories, sinks,
and water-closets are frequently placed in projections which
are entered by a  short  corridor having good cross-ventila-
tion.   Supply and waste pipes are of large size, and all those
within  the building are,  as  far as practicable,  exposed to
view.   In some instances the waste from the baths  and lava-
tories is discharged  into automatic flushing tanks, and thus
serves the purpose of flushing the sewers, from which surface
water is excluded.  Great care is taken to have  sewers  and
drains  laid on a solid  bottom, equally graded from point to
point.
  For  greater security against leakage  and for permanency,
as well as for better flushing in consequence of their superior
strength, iron pipes are  coming  into use for sewers in place
of glazed  earthenware.   Iron  pipes are put together  and
secured at  the joints with lead as are water-pipes, and when
used,  will answer to be smaller than those of   glazed tile. 
BUILDINGS.
309
It is  customary  to have all  pipes and sewers  thoroughly
tested before  covering them  in.   Varnished cast-iron pipes
are mostly  used  for water-mains, none of them being less
than  four inches in diameter.  Wrought-iron service pipes
are now commonly used in  place of lead pipes, because they
are cheaper and more easily fitted. When laid under ground,
however, they are incased in wood and protected by asphalt.
   In  many of the  foreign  asylums, in addition to bathing
facilities for each ward or  group of patients, there  is  pro-
vided  for each sex a general  bath-room, adjoining which is
a pleasant dressing-room with open fire.  Bath-tubs are con-
veniently placed  at right angles to the wall and away from
it, so  as to be  accessible from  all sides.  They are sometimes
placed in  curtained stalls, or  are completely secluded by
curtains hung on rods.  The floors and dados of bath-rooms,
sculleries, and water-closets are  generally of glazed bricks or
tile, and on the floors of the bath-rooms is  usually laid some
protection for the  feet.  Turkish  baths are not  uncommon,
and by some  superintendents are thought quite  beneficial to
a certain class of excited and  sleepless patients.   In a few
instances swimming-baths  similar to those  devised  by Dr.
A. E.  Macdonald  of Ward's Island,  New  York City, are
provided.
   Inquiry was made at every place visited  as to the  com-
parative merits of  plastered  and  unplastered interior walls.
It  was found  in a number of large institutions  that  the
walls  were not  plastered,  but painted  directly  upon  the
brickwork.  The opinion of experts, especially of those who
had tried both ways, was largely in favor of the method of
plastering.  The unplastered walls are not so  smooth, are
less easily  kept  clean, and unless  great care is taken,  form
a harbor for vermin.  Besides, to  lay up interior walls in this
way,  better bricks  are required, and more  time  is  taken to 
 310                     resume.

 lay them.   If plastered on the brick, and afterwards painted
 or coated with silicate, the walls have a better appearance,
 and are easily washed.  When a building is completed, little,
 if any thing, has been saved by not plastering.
  It is pleasant to note the prevalence of cheerful open fires
 in the day and sitting rooms, the infirmary wards, and also
 in the  dormitories of English,  Scotch,  and  Irish asylums.
 In  many ordinary wards these  fires are without guards ;
 in others they are partially protected, while in the refractory
 wards they are generally, but not  invariably,  screened  by
 locked  fire-guards.   In the refractory  wards  at  Hanwell,
 those in use were not locked.   So far as I could learn, there
 had been an entire immunity from accident.   Open fires are
 supplemented  by  some  other  method  of  increasing  the
 temperature in  severe  weather, usually that of steam  or
 hot-water heating.
  Outer walls are frequently built with a hollow space be-
 tween the bricks, as a protection against dampness.  There
 are  also flues with registers  near  the  floor  and ceiling,
 which  may be  opened   or  closed as   occasion  requires.
 These flues connect with horizontal air-ducts, communicat-
 ing with a perpendicular shaft in which means of rarefaction
 are  placed.   In some places, as at Berlin, gas-jets are con-
 stantly burning within the wall flues, to facilitate ventilation.
  The elaborate system of flues with great air-passages and
 enormous fans propelled by steam-power, for forcing air into
 the various  apartments, in use in some of our large asylums,
 was nowhere seen, either in Great Britain or on the Continent.
 In  the  construction  of  asylum buildings,  we sometimes
create at great expense a highly artificial condition which
 must  be overcome by expensive contrivances.  In no more
important  particular  is this incongruity manifest than  in
the  matter  of ventilation.  It  would seem  better not  to 
                       BUILDINGS.                   311

depart so widely from natural ways of living, and build our
asylums more as we build our homes.
  Thermometers are  kept in  the various rooms and corri-
dors of many British asylums, and the  temperature is  re-
corded at  stated hours  during the day  and night.   An
incident showing the desirability of this regulation occurred
just  prior to my visit to  one  of  the English asylums.  The
friends of  one of the patients  charged that much suffer-
ing had been caused by  too  low temperature  in some of
the rooms.   The complaint found its way into the news-
papers, and much feeling was aroused against the asylum.
The management obtained the appointment of a committee
composed of citizens and friends of the  patient, to investi-
gate the matter; and  after a  thorough  examination,  all
were perfectly satisfied that the system disproved the charge.
  In  the construction of foreign asylums, the contingency
of fire is  not overlooked, and  the various means of  es-
cape provided appeared to be  sufficient.   For protection
against  fire, British  asylums  have  alarm  signals,  night
patrols, the regularity of whose  movements is recorded
by  tell-tale  clocks,  electric  communication  with  alarm
bells, hydrants conveniently placed on the different floors,
abundance  of  hose ready  for  use,  also  a plentiful  sup-
ply of buckets filled with water.  The keys  to  the hy-
drants are  close at  hand, often  locked  within  a  glass-
covered  recess  in  the  wall.   By this  arrangement  the
inspector can see whether the  key is in  its place ;  and it is
easily accessible in case  of emergency by  breaking  the glass.
Some of the institutions have  fire-engines with the usual
appliances.   A powerful  steam  force-pump  in the engine-
house connects with hydrants  in every  department, and in
many asylums there is a fire-brigade composed of employees,
who  are occasionally called out  and trained.  The attend- 
312
rEsumE.
ants in each section  are  particularly instructed in precau-
tionary measures  against fire.  In case  of its occurrence,
they are charged  to look first to the saving of life and
afterwards to the preservation of property.

               FURNISHING AND  DECORATION.
  That nice appreciation of comfort which is a characteristic
of the  English people is noticeable in the  furnishing of their
best asylums.  It  is seen in the round-cornered furniture,
the absence  of angles and sharp corners  in jambs,  casings,
etc., in cushioned and  easy  chairs for the infirm, the not
infrequent  use  of carpets  to  deaden  sound,  and many
conveniences elsewhere described.
  It can be said of the asylums of Great Britain and Ireland
that the beds are  very comfortable.  The bedding usually
includes  straw and  hair  mattresses, good  pillows, and an
ample  supply of woollen blankets.  For the refractory, the
sheets  are of very  heavy linen strongly hemmed to prevent
their  being  torn.   It was observed  that woven-wire mat-
tresses were coming into use in the convalescent wards for
quiet and  orderly patients.   It is important that the wants
of the  insane should be met  for the night as well as for the
day.   Failure  to  provide them  with good  beds  causes
more  or  less sleeplessness  and unrest   during the hours
allotted to repose, which results in disquiet and excitement
the following day, in the worry of  the attendants, and the
disturbance of the orderly management of the whole asylum.
  Not  only  is there a careful regard for the comfort of pa-
tients,  but some degree of elegance is seen in the furnishing
and fitting up of even pauper establishments in Great Britain.
The wall decorations and the arrangement of artistic objects
designed to  attract attention  and engage  the mind  are
exceedingly praiseworthy.  The interior  embellishments at 
FURNISHING AND DECORATION.         313
Prestwich, Leavesden,  Caterham, and  some  other  institu-
tions for pauper patients  might, perhaps, be the subject of
criticism were it not that the beneficiaries are insane  per-
sons for whom  diversion of  mind  is  necessary, and  that
these pleasing effects are produced by  an ingenious  and
judicious utilization of the patients' labor.
  Even old asylums are made  to conform, as far as practica-
ble, to  modern  ideas respecting an abundance of  sunlight
and cheerful  interiors.  Without doubt there  are many of
the details of asylum  construction and  furnishing that may
be made to exert a healing and otherwise highly beneficial
influence on the minds  of the mentally diseased.  Respect-
ing the  influence of  bright interiors upon  the insane, Dr.
Clouston says :
  " If  persons are  deprived of their reason  and personal
liberty, and taken  away from their homes, too much  can
scarcely be done for  their comfort and happiness, because
nothing can possibly make up to them for what their disease
has necessarily caused them to be  deprived of.  And there
is in most cases  of mental disease a tendency to degeneration
in habits and ways,  which it should be one of the most unre-
mitting efforts of any good asylum, and all connected with
it,  to  counteract.  Nothing  rubs  off  the veneer of good
manners, tidy habits,  cleanly ways,  and  all the little ameni-
ties and considerations for others that mark a  civilized man,
be he gentleman or not, so much as mental  disease.   Those
who come in daily contact with  the  insane,  seeing these
things gone, would  tend insensibly  to treat  them as if they
never existed, or could not be restored, were  not constant
and strenuous efforts made to fight against the tendency.
And if this feeling is given in to, it reacts on the attendant,
and causes degeneration in him too.  One means of counter-
acting this degeneration is undoubtedly  by making the 
314                     RESUME.
rooms and surroundings scrupulously clean and  cheerful,
the painting and wall papers bright and elegant,  the carpets
(if there are any)  tasteful, and the clothing as good as the
person would  wear outside.  If it is clearly seen that much
thought and  care are bestowed on these matters, down to
the minutest detail, in any asylum  for even the worst class
of patients, it  exercises  an influence on  them, and all who
have to do with them, strongly counteractive of the lowering
tendency I have spoken of.   It greatly helps the moral and
medical treatment.  The whole  spirit  of the  institution
should be philanthropic  and medical, not mercenary, prison-
like, or merely disciplinarian."

                        GROUNDS.
  The grounds of foreign asylums are, with few  exceptions,
elaborately laid  out,  and  are  under the  superintendence
of professional resident gardeners.  In the arrangement of
gravelled  walks,  a proper  regard  for   the  happy  effects
of broad  green  lawns  is  usually  shown,  and  these  were
seen closely mown ; while  the  walks and roadways  were
kept with great neatness.   By means of propagating houses
and by the removal  of plants from  the conservatories to
the corridors, halls, and  various  apartments,  and to the
immediate surroundings of  the  asylums  in summer, the
institutions  are most delightfully  brightened and beauti-
fied.  In planting, careful judgment is exercised, and  trees
and shrubbery are disposed so as  to hide  that  which is
unsightly, and to  leave openings commanding  the  widest
possible  prospect of  that  which is pleasing.   It was ob-
served that walls inclosing yards  were almost invariably
hidden by shrubbery or  creepers.   In some places  the  haw-
haw is used instead of a wall where it is undesirable  to
obstruct  the view.  The improvement of  the grounds and 
ORDERLY ARRANGEMENT.
315
keeping them  in high  condition afterwards  is mostly the
work of the patients, for whom it proves  a  healthful and
agreeable occupation.  The vegetable gardens are extensive,
and, through careful tillage and the use of fertilizers from
the  asylum, are made very productive.   The  spade  is
largely used, and the farming is generally thorough and
yields liberal returns.
  In building an asylum much will be saved if, at the outset,
a small piece of land is  set  apart  for a  nursery.  By the
time the grounds are so improved as to be ready for plant-
ing, the trees and shrubs in  the nursery will be sufficiently
matured  for use, and thus  afford a  cheap and abundant
supply of plants always at hand.  The advantage of pursu-
ing this course  has  been shown in the description of Brook-
wood asylum, where, under skilful management, the sterile
heath was soon transformed into beautifully ornamented
grounds.
                 ORDERLY ARRANGEMENT.
  Great particularity is  observed in  nearly all the foreign
asylums, especially  in those  of the British Isles, in respect
to  keeping every  thing  in  its  proper  place.  The  store-
rooms attract  attention  by  the orderly arrangement  of
their contents.   Supplies  are withdrawn from them only by
requisition, and the  books there are kept so as  to show
the stock of each kind of goods on hand.  One cannot but
admire the neatness of the linen-closets, the tidy appearance
of  the dormitories, the  clean aspect of the  kitchen, the
manner of putting  away and housing tools and implements,
and the care with which rubbish is assorted and stored.
  It  was  frequently found  that broken glass, scrap iron,
lead, etc.,  had  separate  locked receptacles of deposit into
which they could  readily be put, but out of which they
could not be taken  except by use of a key.   What is often 
316
RESUME.
regarded  as  waste material is saved  and in  one way or
another turned to profitable account.  In some places even
the bones from the kitchen are pulverized, then  dissolved
and used for fertilizing  the ground.  Most of  the asylums
have a walled  inclosure for depositing unsightly material
only occasionally required for  building and making repairs.
By the  use of these places of storage, every  part of the
grounds is made to present  an  orderly appearance.

                         SEWAGE.
  The disposal of asylum  waste was  a subject  of  careful
inquiry at every place visited.  In the continental asylums,
refuse was utilized for the fertilization of the soil by some
of the various processes   devised  for this  purpose.  At
several  institutions liquid  manure was  conveyed  to  the
land, while solid  matter was  converted  into  compost by
being mixed with  earth, chalk,  and other substances.  A
plan highly spoken of was that of separating the  solid from
the liquid  by means of  a series  of  vats placed at different
elevations  in the  fields,  the waste  being emptied into the
highest,  from which the liquid flows  successively through
the rest of the vats until entirely separated from the solid
matter.   What is termed  the bucket  system  is  common.
The tubs or cylinders  are  daily withdrawn, emptied,  and
renovated.  Their removal  is  effected  from the  outside of
the building.   In  Great  Britain some of the plans adopted
on  the  Continent were in  use,  as  also  other methods
more  expensive.   The  English  Commissioners in Lunacy
recommend  that  sewage be   distributed  in  a  fresh state
over the  land,  by gravitation  through  pipes  or by tubular
drainage.   Indoor portable earth-closets  were used to  a
limited extent, and in some institutions  had been rejected
after trial. 
                  GREATER FREEDOM.               317

  Perhaps on no other subject investigated was there found
a greater variety of conflicting opinions than that relating to
the best means of disposing of asylum  waste.  Situation
sometimes exercised a controlling influence, as in the case of
an asylum located adjacent to a public sewerage system ;  but
where this method of disposal was not available, widely dif-
ferent plans had been adopted, some of them quite expensive,
and once it  was found that one institution was introducing
a  plan  just discarded  by another.  It would  seem that,
where large agricultural operations are conducted in connec-
tion with asylums, the waste  should be used to keep up the
fertility of the soil and supply what is  lost by cropping, as
this is a natural process of compensation invited by the dis-
infecting properties of fresh earth.

                    GREATER FREEDOM.
  There is a strong tendency in the better class of institutions
to do away  with many restrictions which, at one time, were
deemed absolutely necessary  in the  care and management of
the insane.  Especially is this noticeable in Scotland, in the
abolishment of walled airing-courts, and the adoption of
what is termed the open-door system.  In some of the Scot-
tish asylums one may walk through the establishment from
one  end  to the  other  without unlocking  a door.  The
windows  on the  first  floor  of what  are termed  " open-
door "  asylums are not  barred nor grated.   They have
sashes as in ordinary dwellings, and may be opened  at will.
It is said  that  the disuse of  airing-courts  in Scotland first
came  about by accident.   An  old  asylum was undergoing
repairs, and  it became necessary to take down the walls of
one of  its  airing-courts.   The work of  rebuilding  being
temporarily  delayed,  it was  found  meanwhile that it was
possible to  conduct the administration better without them 
318                     rEsumE.

than with them, and the cost of reconstruction was saved.
It having been demonstrated that these prison-like  barriers
were both unnecessary and injurious, other asylums soon set
about removing their enclosures.
  The freer system, which prevails in Scotland, is extending
in other countries.  It is  claimed  by those advocating it,
that the larger liberty given the patients  does not add to
the attempts to escape  nor to  the  number of suicides, the
tendency to self-destruction being thereby  diminished.  Dr.
Joseph  Petit,  Superintendent of the Sligo  District Asylum,
Ireland, after  having introduced the open-door system into
the institution under  his  charge and  having tried it for
several  years,  speaks  highly  of  its  tranquillizing effect
upon  the patients, and regards it as  a decided improve-
ment.   Respecting airing-courts, which he  has  abolished,
he says:
  " Airing-courts were  provided to  guard  against the possi-
bility of escape while the patients took  exercise in the open
air.  In  District Asylums these courts are  usually so placed
as to be bounded on  two  sides  by the buildings.  The
atmosphere in them can  hardly be called open air, and
with  regard to escapes, experience teaches, as might be
expected, that the less the  amount of  restraint the fewer
the escapes.   Another very objectionable  feature about
airing-courts is the bad effect  they have  upon attendants,
who fall into the  error  of supposing that when the patients
are put within the walls of an airing-court they require no
further looking after on the attendants' part.   Judged from
results, I think it will be admitted  that money spent upon
these  enclosures  is not only uselessly but  injuriously ex-
pended.   This last remark is also  applicable  to  boundary
walls, except where the grounds adjoin public roads."
  So  satisfactory has  the absence of  walled  airing-courts 
                    NON-RES TRA INT.                 319

proved that there is no probability of their being adjuncts
to future asylums.

                     NON-RESTRAINT.

  The discarding of  old  and cruel forms of restraint has
been shown to be conducive  to the recovery of  the curable
and to the comfort and happiness of the  incurable insane.
Freed from his bonds, with opportunities for recreation and
employment, the patient  who, in former times,  would have
been a constant source of anxiety to those  having  him in
charge,  is now tractable,  and even serviceable in lessening
the pecuniary burden consequent  upon his care.  To main-
tain  the system  which  produces this result, however, is a
work that taxes all the ingenuity and resources of an intelli-
gent and experienced medical staff supported by well-trained
attendants.   They must be ever vigilant to win the patient
gradually to ways of gentleness if he be violent, and to arouse
his energies and sympathies if he be melancholic.
  The appliances for  mechanical restraint were not found in
foreign asylums to the extent expected.  The crib was  no-
where seen, and my  inquiry for it, in some instances, was
met by  a look of surprise.   Restraining chairs  were some-
times observed,  but muffs and gloves were  only occasionally
seen in use, and it was said that when they were put on it
was usually for surgical reasons. Padded rooms for the seclu-
sion  of maniacal patients were found  in many of the British
institutions.  These  are thickly  cushioned on  sections of
plank, which are removable for purposes  of renovation. The
floor is not  always padded, but  is often  covered with rugs
of thick matting, as at Hanwell and Brookwood.  The num-
ber of such rooms, always few, varies.  In some parts they
are losing  favor.  It  was generally asserted that chemical
had not taken the place of mechanical restraint.   The terms 
320                     rEsumA.

non-restraint and  seclusion,  however, were very differently
used,  and I  found at times that greater restrictions were
resorted to than the  correct meaning of these words would
imply.  As  showing what  some  of the  English  asylum
superintendents mean by restraint, attention  is directed  to
the definition given by Dr.  Brushfield,  late of Brookwood
asylum, in the notes  on that institution.
  From my observations in asylums in Great  Britain and in
this country, I should say that, on the whole, there  was less
restraint there than  here, notwithstanding  the  fact that  in
many asylums  in  the United States it  may  be said to  be
virtually discarded.   There  can  be  no  question that the
theory of  non-restraint, once so thoroughly resisted, is now
coming to be universally accepted ;  and the extent to which
it has been adopted in recent years in our asylums  leads to
the belief  that  the  time  is not far distant  when  what is
commonly understood as  non-restraint  and the open-door
system  will be put  in practice  to  a greater  extent in this
country than it now  is in Great Britain or on the Continent.
  Some who approve of  the system claim  that under  it
the number  of  attendants is not actually or necessarily  in-
creased ; others favoring it concede  that  there  must be a
stronger corps of  attendants, and that  they  must  exercise
greater watchfulness, but confidently assert that the  benefits
arising to the patient more  than  counterbalance the diffi-
culties attending the carrying out of the freer system.   It is
claimed further that a quieter and more orderly administra-
tion is the result;  that there is less destruction of property;
that  more patients  are employed, and  consequently there
are larger industrial products.
  In many of the  British asylums it is the rule that, in case
it becomes necessary to use personal force to remove  a pa-
tient, a sufficient number of  attendants  shall be called in to 
                   MEDICAL OFFICERS.               321

accomplish the object without having a doubtful struggle.
The fact thus made apparent, that opposition would be use-
less, frequently  causes the patient  to  make no resistance
whatever, and the desired  change is effected  without dis-
turbance.  An acute  case, when violent and excited,  is
placed in exclusive charge  of two experienced attendants,
who give the patient several hours' daily exercise in the
open air and watch him carefully in the wards  until his
excitement subsides and one person can  assume the  care
of  him.   Finally, the  other special attendant is relieved,
and the  case  receives ordinary attention.  The late Chair-
man of  the  English  Lunacy  Board, in  speaking of  this
method,  said :
  " It requires a greater number of keepers, or rather attend-
ants, and it requires men of a very different character,—men
of great  forbearance  and patience, men of great  power of
endurance ; for there  is nothing on the face of the earth one
half so provoking as a madman when he  chooses  to be so.
I have  looked  in perfect  astonishment  at  the  character
exhibited by  the attendants in forbearance and moderation,
and at what  they patiently go  through.  To control a vio-
lent patient it requires three or four attendants.  Formerly
they would have put him in leg-locks and left him.   The man
would have become ten times worse, and the whole place
would have been in disorder, because although you chained
a man you could not stop his voice, and he roared and  bel-
lowed in  such a way as few outside people can imagine."

                    MEDICAL OFFICERS.
  The medical staff in foreign asylums  is not so large as in
similar institutions in  the  United States,  and in  some of
them the number of physicians appeared  to  be inadequate.
It was not found in  any  of the asylums visited  that to 
322                     RESUME.
female patients were accorded the medical services of physi-
cians of their own sex, as is the growing and commendable
practice in this country.  The experiment, if such it may be
called, of having two head officers to one institution, as was
twice  observed during my tour of inspection, has not worked
satisfactorily in the  opinion  of  those competent to judge,
although no complaint was made by those in charge.

                      ATTENDANTS.
  The success of  asylum management  is without doubt
largely dependent on the maintaining of a good corps of
intelligent and faithful  attendants.   One who has justly
achieved distinction in the treatment of the insane says: " The
longer I live, the more clear it is to me that good attendants,
well trained, interested  in their work, and proud of their
success in it, with good  heads  on their  shoulders, humane
dispositions, pleasant manners, and ever using  the brains
they  have to  do their work, must be the sheet-anchor of
success in an hospital for the treatment of mental disease."
  An attendant who does not look upon a person  mentally
diseased with  the sympathy with which  he looks upon one
bodily sick has a wrong conception of his relations to the
patient, and is likely to be cruel when meaning only to be
just.  It should never be overlooked by those in charge of
the insane that the latter are not responsible for their acts,
and may be unconscious  of what they are doing.  Failing to
realize this, abusive language  and   personal  indignities
directed  to  the  attendant awaken his  resentment  and a
desire  to discipline  the  patient. Hatred is  thus  inspired.
and a permanent  barrier is created  between  them.  If  the
attendant would  keep in mind  the golden rule—Do unto
others as ye would that they should do unto you—and  im-
agine himself  in the patient's place, and  how he would like 
A TTENDANTS.
323
to be treated if similarly situated, much cruelty would be
avoided and more  of  the insane would recover.   The law of
kindness is universal,  and  is as applicable in the treatment
of the insane as in  the treatment of any other of the help-
less  classes, and should be the guiding  principle in their
care.  Though its influence may  not be immediately per-
ceptible, its subtle power gradually wins its way—producing
quietness where there  was violence and disturbance—and
develops self-control  in both  attendant  and patient.
  As great suffering  may result to the insane from  neglect
as from  intentional cruelty  or systematic  severity.  It is
much easier to seclude or confine a man when restless or
violent  than  it is to make some effort to  employ  him or
divert  his thoughts  from   real  or imaginary troubles.
Separated  from  the world   as  he  is,   it  rests with the
attendant to soothe and comfort ;  or, through indifference,
incompetency, or acts of  petty tyranny, to  exasperate, and
make the daily life of a  patient unendurable, thus deepening
the dark shadows  that have  gathered around  his clouded
reason.
  Much  has been accomplished in rescuing  the  insane from
chains, gloomy cells, and  scourgings ; but  the measure of
reform in  their behalf  will not be  complete until there is
no possibility of  their being subjected  to the  humors of
ignorant, unfeeling, and incompetent attendants.
  The need of persons systematically trained properly to
discharge the  duties  of attendants is felt in  Great  Britain
and  on  the  Continent ;  but  the effort to  provide such
by  affording  preliminary  instruction  does   not  appear
to be so general as in the United  States.   In  connection
with a hospital for female patients  at  Morningside,  there
has  been  established a probationary  ward  and training-
school for all the new-coming female attendants.  Here they 
324                     RESUME.
are taught to regard their patients as they would those of an
ordinary hospital, and they enter upon their duties by learn-
ing to nurse the sick.  Dr. Clouston  says : " If any thing
will produce  a  habit  of  kindness, this will  be likely to do
so."   The plan  of training at  Morningside has proved of
great advantage.  In England, Dr. Wallis, of Whittingham,
has  instituted  a system of training for  attendants  and
nurses, and some other foreign asylums have entered upon
the same undertaking.
  In view of the large numbers to be employed and the pe-
culiarities of the difficult service, the question of how the
evil of incompetent attendants is to be reduced to the mini-
mum is an important  one.   A partial solution will no doubt
be found  in the establishment of training-schools.    By af-
fording through these preliminary instruction, great advan-
tage will  be gained.   Dr.  Stephen  Smith, the  New-York
State  Commissioner  in  Lunacy,  through whose  earnest
advocacy several training-schools for attendants  have been
established  in   the  asylums  under  his supervision, says
that where introduced there has been an  improvement in
the  order and  discipline;  that patients are treated with
more consideration;  the sick  are  better cared for,  self-
reliance cultivated, emergencies more successfully met, the
power of observation on the part of  attendants  quickened,
and changes in  both the mental and physical  condition of
patients more readily appreciated.  The first training-school in
the State of New York was organized by Dr. J. B. Andrews,
Superintendent of the Buffalo State Asylum, and has proved
eminently successful.
  The object of the training-school being to prepare  per-
sons  for competent attendants,  those who have  not  the
natural ability and cannot  acquire fitness  by education are
of course weeded out.  These schools should  be so organ- 
ft                        ATTENDANTS.                    325

      ized that certificates of graduation would be  pretty sure
      evidence of the  competency of those receiving them  for
      the proper discharge of their  duties.  While the training
      should be  both  practical  and theoretical, the instruction
      should not  be so  technical or  difficult  that  the  merely
      intellectual student would be advanced beyond those special-
      ly adapted by nature for their peculiar work.
        It is gratifying  to note  that wherever opportunities have
      been afforded by  the State in its training-schools for acquir-
      ing that knowledge so necessary in the care of the insane, a
      laudable  desire has been  shown on  the part of  attendants
      to increase their capacity for usefulness by the means thus
      provided.
        The wages paid should  be sufficient to induce those pos-
      sessing more  than  average ability  to enter  the  service.
      The plan adopted in England of yearly increasing the com-
      pensation of attendants till the maximum salary is reached
      stimulates them  to faithful endeavor.   The expectation
      that, through serving long and satisfactorily, a government
      pension may be  secured,  is another  incentive to a proper
      discharge of duty.   The granting of pensions to superan-
      nuated officers  and servants is permissible by the statute,
      in the county and  borough asylums of England, the char-
      tered asylums in Scotland, and the district asylums in Ireland.
        Such  persons  should  be employed as  intend to  make
      the  care  of  the  insane a permanent occupation.  They
      should be selected  from those who have  attained mature
      judgment, but have not passed the prime of mental and
      physical vigor ;  they should have good  health and cheerful
      and equable tempers ; they should possess self-control, and
      be able to furnish proof  of  good moral character.
        Further to perfect  and  purify the service, the cause for
      leaving an asylum  should  be reported, in every case, to a 
326
RESUME.
central authority and made  a  matter of  record, and no
attendant should  be employed  without  reference to  the
record.  This practice obtains in England,  where a  regis-
ter is kept by the Lunacy Commissioners of all  discharged
employees, and the cause of their discharge.   In this  coun-
try such a system could be made  more valuable by co-opera-
tion among the different States.
   The great  strain  to which  faithful asylum attendants are
subjected when on  duty makes it but just that they should
have reasonable opportunities for relaxation and recreation
when off duty, and that their accommodations and surround-
ings should be made pleasant.  Their cheerful spirits, which
are  reflected  upon  those under their charge,  should be
fully sustained.   Such arrangements would induce more of
those best adapted  for the service  to enter it.  This  ap-
pears to be the view taken by the superintendent of one of
the  large asylums in England, where, as in this  country,
there is difficulty in  securing and keeping qualified attend-
ants.  Bearing upon  this  subject, Dr. Ley of Prestwich  says:
   " The  great  problem in asylum management  is, how to
obtain good attendants ; and when  obtained, how to  retain
their services.  In every asylum this difficulty, in a greater
or less degree, has  been felt, and in an  institution of this
magnitude, where obviously a greater  proportion of experi-
enced attendants is required, the  difficulty in procuring and
maintaining a staff of trustworthy subordinates has become
a source of never-ending  trouble and anxiety.  No one con-
versant with the working of an asylum can doubt that much
of the success of management, economical and otherwise, is
dependent  upon the  character and reliability of the attend-
ants, who are necessarily entrusted with the immediate care
of the patients.   The comfort, the safety, even the lives of
those under their charge, depend upon the  good conduct, 
NIGHT SERVICE.
1*7
fidelity, and watchfulness of these officials, who are, in point
of fact, the instruments by which all the details of moral
treatment  are brought  into practice.  The service is an
arduous one, and those who  take to it are  generally persons
devoid of all training ;  consequently of the many who apply
only a few are found gifted  with  the necessary qualities of
temper and judgment, without which no  good attendant can
be made.  ...  I think there can be no doubt that, apart
from  the question of salaries, much of the restlessness that
affects  the asylum attendant of the present  day is due to
the fact that his position  is  considered  an inferior one, be-
cause the  accommodation provided and the arrangements
made for his comfort and relaxation are not  equal  to what
persons in  the  same  calling are able  to obtain  in other
branches of the public service.  In all the principal General
Hospitals  and Infirmaries it has been  found necessary, in
order  to attract  applicants  of the  requisite  character  and
intelligence, to deal liberally with their  nursing staff.  Sep-
arate accommodation has been provided, and the comfort
and convenience of the  daily lives of  these officials  have
been considered in  every reasonable  way.  The result has
been that the service is an attractive one, and hospitals and
infirmaries have become serious competitors with asylums in
the female  labor  market. I think  it reasonable to expect
that equal consideration for the  comfort and accommoda-
tion of the attendants would be equally  successful in render-
ing asylum service popular with candidates of character and
ability, to whom the retention of their  situation would be
an object of some consequence."

                       NIGHT SERVICE.
   The  night supervision  of  some of the English asylums is
very  complete.   The  night  staff is under a chief,  and 
328                     rEsumE.
outdoor and indoor patrols are provided.  Epileptic patients
in their separate wards, as  also the suicidal, are the objects
of special and  constant watchfulness.   In  some cases the
attendants occupy a raised platform  commanding a view of
all those  under their  care.   The beds  for epileptics arc
ordinarily but  a few inches  from the floor.  In  the wards
for the filthy  particular attention is paid to the  inmates,
and the bedding is  changed  and the bath  resorted to as
occasion requires.  In some of the foreign asylums, especially
the French, a strict  rule is enforced requiring every patient
to observe a regular  habit  before  retiring.  Each attendant
makes his report to  the medical officer every morning and
delivers his patients in a neat  and satisfactory condition
to the care of  the day officer.  The dormitories are warmed
through the night by open fires, which aid in purifying the
atmosphere.  By means of  electric communication assistance
may be summoned  in  case of an emergency.   The night-
watch is checked by tell-tale  clocks.

                   RELIGIOUS EXERCISES.
   A place for divine worship is found in connection with all
public asylums in the British  Isles.  Although a hall  is
commonly provided for this  purpose, sometimes there is a
separate church edifice quite expensively built, with much
attention  given to architectural details.   It is customary for
men  and  women patients to enter from opposite sides and
sit apart.   A  chaplain regularly  officiates, and the attend-
ance  upon the service in  some asylums is  quite large.
Arrangements are   usually  made  for  conducting  both
Protestant and Roman Catholic services, and at some places
a Jewish  Rabbi also  officiates.   It  was generally  thought
that affording  such  of  the insane as could  properly attend
divine  worship an  opportunity  to  do  so,  was only con- 
                     AMUSEMEN ts.                  3 29

ceding to them a just privilege, and  that the effect  was
salutary.
                       AMUSEMENTS.
  The treatment  of the  insane in some of  the leading
asylums  of  Europe appears to be  in accordance  with  the
views of  Dr. Conolly, who  endeavored " to remove  all causes
of irritation and excitement from  the irritable; to soothe,
encourage, and comfort the depressed ; to repress the violent
by  methods which leave no painful recollections, and in all
cases to  seize  any opportunity of promoting the restoration
of the healthy exercise of  the  understanding and of  the
affections."   In the  application  of these principles,  every
variety of entertainment  that  can divert  the mind or excite
pleasurable emotions is brought into requisition.
  A spacious, cheerfully decorated, and pleasant amusement
hall,  usually  on the ground-floor, is considered  indispen-
sable in  British  asylums.  A  band, generally  made  up
of  asylum  attendants, plays,  at  seasonable  times,   for
the amusement of the patients.  Besides concerts, dances,
and other entertainments,  there  are cricket clubs,  ball play-
ing, etc.   In some institutions an occasional costume ball is
given, in the  long preparation for which the minds of the
patients are diverted. Their tastes in dress are gratified as far
as possible.   In these festivities benevolent persons residing
near the  asylum are  encouraged to participate.  Theatricals
on an elaborate scale are also  gotten up, from  which those
who attend derive much enjoyment.
  Respecting  dancing as a means of entertainment, the  late
Dr. Eames, of the Cork District  Lunatic  Asylum, said:
  " Most essential of all amusements, I think, are  the even-
ing dances, which are held here regularly four nights weekly.
All the patients look forward with pleasure when the day is
over to these two hours of amusement in the recreation hall. 
330                     rEsumE.
I was always of opinion that if this was beneficial to patients
one night weekly, it was four times more  so on four nights.
On the  evenings when there is no dancing, it is impossible
to prevent  the  attendants allowing patients to retire to bed
soon after supper;  there is nothing for either to do, and time
becomes irksome to both.  When the patients go to bed at
this early hour,  they cannot sleep, and thus their night's rest
is spoiled.  On this account I have always insisted upon two
hours being spent in the recreation hall on at least four nights
in the week.  Five hundred  patients generally attend."
  It may be questioned whether evening dancing and music
are desirable so frequently as recommended  by Dr. Eames,
but numerous authorities favor some kind of entertainment
on  the  evening of every secular day, in order to break the
tedious  monotony  occurring between supper and bed-time.
  At Morningside a  special endeavor is made  to  afford
the insane  every possible advantage that  can  be derived
from  frequent and varied amusements and entertainments.
Dr. Clouston says:
  " The treatment of mental disease is in many cases a fight
against  morbid  unsocial ways, degrading tendencies, and idle,
selfish,  listless,  uninterested habits of  mind; and we fight
those by moral means, by employment,  amusement, good
food, fresh  air, exercise, and  good hygienic conditions of life.
  " Amusements are, no doubt, of the greatest service in the
treatment with a  view to the  recovery of insane patients.
They are next to and  supplementary to good food, cheerful
quarters, kind treatment, medical care,  and  suitable employ-
ment.  No one can be present at one of our dances without
being impressed by seeing  how a happy, cheerful state of
mind takes the  place of gloom  in some  patients through this
amusement.  They act on  insane people somewhat  in  the
way they do on sane people, but  the effect is more  marked 
AMUSEMENTS.
331
from  the sharp contrast  between the insanity of expression
and attitude before the  dance and  the sanity (so  far as
it goes and so long as it lasts) during the exercise.  We have to
provide a  great  variety  of  amusements to  suit different
tastes.  No one should continue long enough or recur often
enough to produce satiety.  Different  patients are amusable
in very  different ways and degrees too, just as different sane
people  are.  There  are  many patients  in  such a morbid
brain-condition that they can scarcely be amused or inter-
ested  in any thing, but those are the minority.   Some of the
patients get re-interested in  the amusements to which they
have been accustomed in their former lives; others are taken
with new diversions.  We  train people  to  dance here who
never danced before; to play billiards,  bowls, cricket, tennis,
curling, cards, dominoes, and draughts who had never played
these games in their sane lives.   I  have known many cases
where the interest in a game led directly to  recovery.
   " Most insane people, it must be  admitted, do not  rise to
the enthusiasm which some games excite in ordinary people.
The sanest looking  people on  our  curling  pond during an
exciting game are  not  some  of the officials.   But that
prince  of  all Scotch  games has the power  to  rouse the
dormant seeds of sane enthusiasm  for the time in some of
our patients in a wonderful way.  An old curler seldom  gets
so insane that its enthusiasm  and  its familiar  terms don't
come back to him when he finds himself on the ice.  This
year (1885) we had  a very exciting struggle for  the silver
medal,  which Dr. Batty  Tuke, an old  assistant  physician
here,  most  thoughtfully presented to  our club.   It was felt
by all that  day that  the best  curler  was the best man, quite
irrespective of his social or mental condition.   The day was
fine, the ice good, the pond was  surrounded with crowds of
interested onlookers, and some of the ladies stimulated the 
332                     RESUME.
players by the very outspoken expressions of their hopes as
to whom  they would  like to see successful.   One man, a
keen and fine old curler, had been for some time in a dull
humor.  He  curled  in a dogged but apparently uninter-
ested, unenthusiastic way, not speaking to any one.  Towards
the finish his  score ran  up  fast,  and he did begin  to look
a  little more lively ;  but  when with his last  stone  he
'chappit'  the winner,  and so beat the man by one point,
who had been running him  neck and neck, the old curler's
spirit triumphed  over  the insanity, a  sudden  change came
over him,  and  he became  ' another  man,'  throwing  his
'besom'  into  the air,  curler's fashion.  His whole expres-
sion and attitude changed, as he received the congratulations
of his  friends with smiles, and made an eloquent and appro-
priate  speech on getting the medal.  I could not help think-
ing that if I had  some medicine in the surgery which would
take hold  of my patients' brains as  curling had done in this
case, our recovery-rate would be a larger one."

                      EMPLOYMENT.
   Many foreign alienists lay much  stress on the efficacy of
wisely directed labor in producing a tranquillizing influence
upon cases that seem  amenable  to no other kind of treat-
ment.  Notable illustrations of the beneficial effects of laun-
dry and farm work have been set  forth in the descriptions of
Alt-Scherbitz, Clermont, and Woodilee.  At the last-named
institution from  seventy-five to  eighty per cent of the in-
mates  are said to be employed usefully and profitably.  Here
the presence of skilled artisans and experienced farmers and
gardeners, not  only directing, but working with  the insane,
has been productive of excellent  results.
   The most acceptable  and healthful occupations being
those  of gardening  and  farming, the  English  and  Scotch 
                     EMPLO YMENT.                  333

have an advantage over us, in a climate where it is possible
to send their patients out-of-doors to work or take recrea-
tion  during the greater part of the year.   In Scotland the
benefits of agricultural employment appeared to  be more
highly appreciated than  in  England, nearly all  the  men
capable of  so doing working out-of-doors; while in England
they were  frequently seen in  pleasant weather  engaged at
indoor work, such as ward-cleaning, bed-making, etc.  The
time daily devoted to outdoor labor at Woodilee was  from
one and a half to  two hours longer than in some of the asy-
lums near London.  It was the common opinion that abun-
dance of outdoor recreation and employment was the secret
of tranquil nights and contentment, which lead to  recovery.
  A variety  of employment  should  be  provided, so that
patients  can be  placed  at  work congenial  to  them.   Dr.
Williams, of Haywards Heath, advocates in certain cases a
change  from the  occupation  to which the patient has been
accustomed to  one with which he is unfamiliar.   He says :
" A townbred artisan, such as a tailor, admitted  in a low
state  of bodily health, if sent out daily for a little gentle
employment  in the  garden, generally  becomes  greatly im-
proved  physically, and concurrent with  the physical im-
provement often  comes gradual restoration to reason.   So
also a rustic, tending towards  dementia, if put to work at a
trade, often brightens up considerably ; whereas, if sent out
to work  on the farm or in the  garden,  employment that
he had  been used to from birth, would  set to work  at it
and perform  it mechanically,  and it would be of  but  little
benefit  to  him."
  The laundries,  in  which large  numbers of the  insane in
foreign asylums are  employed, are conveniently  arranged,
and have goodly sized rooms for assorting, mending, and fold-
ing clothes.  Although there is usually sufficient machinery 
334
RESUME.
for washing, there seems to be  a growing tendency  to
do  more  of the work by hand,  in  order  to  make  avail-
able a means by  which  excitable patients  may work off
their superfluous nervous energies.  For a certain  class of
female patients hand washing has been found to be the best
of all employments, and may be used  to a large extent as
a substitute for  seclusion  and restraint.  In one asylum an
entire  plant of washing machinery had been set aside and
hand washing  substituted for  remedial reasons.  It may be
well to consider  whether this course might not be pursued
with advantage in  other asylums where machinery is used.
The experience  of those institutions  in which the  wash-
ing is  done  by hand  seems to  warrant  such  a course.
In the abstract,  washing by machinery is cheaper than by
hand, but when the number of attendants that may be dis-
pensed with in the  refractory wards of an asylum  having a
large laundry operated  by hand  is considered, it is claimed
by some that the last-named method is cheaper.
  The  English Commissioners in  Lunacy  lay  great  stress
upon the desirability of providing occupation for the insane.
They say: " In the treatment of the insane great importance
should be attached to the subject of  their useful employ-
ment.  Our aim constantly  is to  encourage the efforts of
superintendents to  devise suitable occupations, and to induce
their patients to engage in them; and with the view of ascer-
taining as nearly as we can the extent to which  such efforts
have been successful, we have instituted a comparison  of the
results attained in the years 1877 and 1886 respectively." The
Commissioners found that fifty-seven per cent of the patients
in the  county and  borough asylums were employed in 1877
and sixty-two per cent in 1886. In  some English asylums the
proportion employed during the latter year was as low as forty-
five per cent and in others as high as seventy-eight per  cent. 
EMPLOYMENT.
335
  The custom of inducing patients to engage in useful em-
ployment is extending to hospitals and licensed houses, and
the efforts  made  in this direction are encouraging.  At St.
Andrew's Hospital in Northampton, out of 160 gentlemen
at one  time in  the institution,  56 were  occupied in the
summer at farming  and gardening, while  18  worked at
carpentry,  printing, etc.  Respecting the  beneficial effects
of outdoor employment, Dr. Lloyd Francis, who is  con-
nected  with this institution, says:
  " Outdoor labor is looked upon as a therapeutic means of
the highest possible value, and each year adds fresh  evidence
of its efficiency.   It is put to trial in one stage or another of
every case where physical disease or extreme exhaustion does
not contra-indicate. The means of persuasion are necessarily
more limited than in a county asylum ; the bait of certain
privileges and small extra luxuries—ale, tobacco,  and the
like,—so tempting to the pauper, cannot lure  the private
patient, whose diet is  ample and varied, and whose material
comforts no amount  of industry  can increase.   There re-
mains,  then, only argument, moral suasion;  and  hence
oftentimes  much  difficulty  in  overcoming the  irrational
scruples, more especially of young men.  The idea of  dig-
ging, road-making, or wheeling  a barrow  is, even in  the
guise of medical treatment,  at the outset, rather shocking
to the school-boy, the undergraduate, the lawyer, or parson.
He  resents the proposal as an outrage to his dignity ; de-
clares that  he was sent here for rest and remedies, not to do
laborer's work, that such toil is all very well for poor people,
but not for gentlemen—that, in short, he will have none of
it.  His repugnance,  however, generally yields  in time to
reiterated  advice  and the example  of  others,  and,  once
vanquished, seldom revives.
  " The result, in  the immense majority of cases—I might 
336
rEsumE.
say in all,—is beneficial.  Over and over again do we note
instances of  rapid and complete recovery following  steady
application to outdoor work, when other means have signally
failed  and the prognosis has  become  decidedly bad, and,
coincidently  with the mental  improvement, the establish-
ment of physical robustness and vigor such as the patient
has not often previously possessed.  Such patients have the
fresh,  ruddy complexion, fat cheeks, and happy  contented
aspect which one observes in convalescents from typhoid
fever."
  As affecting chronic cases and respecting the comparative
merits of employment and amusement,  Dr. Francis says :
  " In the treatment of chronic insanity, too, outdoor em-
ployment,  though  of necessity  rarely curative,  is  yet of
unquestionable value.   A chronic lunatic of the worst type
—turbulent,  noisy,  destructive, treacherous, violent,  faulty
in habits, an inveterate nuisance—shows marked improve-
ment after a few  months  of steady work.   Sleeplessness
which  drugs have  failed to   influence yields to healthy
fatigue;  he no longer  makes  a scarecrow  of himself by
tearing his clothes;  his opportunities for self-abuse  are
much  curtailed ;  and he relieves  his  angry  feelings by
vicious digs into  the  earth,  or kicks  at his barrow in place
of murderous attacks upon fellow patients  or attendants.
Finally, his appetite  is more  keen, his food better assimi-
lated, and his general health improves.  Now and then such
a patient even attains a state of  fairly permanent  partial
recovery—a placid, contented, feeble-minded condition, it is
true, but still enviable in comparison with his former miser-
able  existence.
  " It may be asked whether outdoor amusements with ath-
letic  exercises would not more agreeably serve the same end.
The  answer must be in the negative.  For one patient who 
                     EM PL O YMEN T.                  337

is capable of taking  part  in outdoor games, at least twenty
can be put to manual work.  An acute  maniac or a dement
can be made nothing of on the cricket  field or tennis lawn,
though he may dig or break stones with  energy and purpose.
Moreover, field sports and athletics are apt to be indulged in
spasmodically—a few hours of violent  exercise and excite-
ment, followed by a  long interval of rest and indolence. .  .  .
The groundwork of  recovery  is found  by experience to be
best laid in steady plodding within the hospital boundaries ;
later, when convalescence is fairly  established, play may
safely  vary  the monotony of work,  or  even be substituted
for it, though frequently  such a patient, recognizing, as he
improves, what a good friend work has been  to him, goes on
quite contentedly."
  For  medical reasons, if for no other,  it would seem that
a  rule  requiring  boarders  or private  patients, as  well as
paupers, to be  in  some way  occupied  or employed, might
be  made applicable in every case where the condition of
the  patient permits. The  ennui and disgust arising from
an  idle, monotonous daily routine of life, even with luxu-
rious living,  are  almost  intolerable  to  a sane person, and
in  the case  of the   insane, who are restricted to  narrow
limits,  frequently lead to  unhappy results.    The  obser-
vance  of the  foregoing  rule  has  proved  so beneficial,
where  enforced, that it should be regarded as one of the
leading principles of  treatment in all hospitals and asylums
for the insane.
  In providing employment, the welfare of the patient, and
not the pecuniary advantage  to  be  derived from his labor,
should be kept constantly in view.   It may  be necessary to
exercise  as  much watchfulness to  prevent  some  patients
from over-exerting themselves as tact  to induce others to
engage in any occupation.   The hours for work should be 
338                    resume.
limited, the whole  industrial  system carefully supervised,
and the instructors or attendants should not act as overseers,
but as companions, working with the insane, thus dignifying
labor by their example.  In every case due regard  should be
had  to the mental and physical condition  of the patient,
which should be  ascertained, as is  done in some asylums,
by a medical inspection made every morning.

                     REMUNERATION.
  The  custom  of making a small remuneration or granting
special favors or privileges for work performed by the insane,
as practised at Fitz-James, Gheel, and some other places, is
spoken of with much satisfaction by superintendents who
have tried the  plan.   It  is based  on the  belief that, al-
though a  man's mental faculties are  impaired, he may still
have understanding enough to appreciate an act of kindness
and justice.  On some points  he  may be perfectly rational
and  intelligent, and may know and sensitively feel, as well
as any  of his sane brethren, that labor should have its reward.
  In the Government Asylum  for insane criminals at Broad-
moor, England, the plan of making money payments was in-
troduced in 1877, and after a fair trial has proved highly
beneficial  to  the  inmates and advantageous to the asylum.
The value of the  labor  performed is estimated  by the hour
or by the piece, one  eighth being credited to  the patient,
which he may expend in harmless luxuries or have sent  to his
family.  Each has a book of forms in which his requisitions
are entered.  The sum paid to the workers amounts to  about
,£300 yearly.
  In France, the principle of  making moderate  money re-
wards to patients who work is sanctioned by the Government.
The Inspector-General of Insane  Asylums in  that country
is of the  opinion that  patients should receive some  slight 
                    REMUNERA TION.                 339

recompense for their labor, and that this might  be in the
gratification of some pardonable whim or in a money pay-
ment on leaving the asylum if cured.   He says : " We have
here a moral means which acts powerfully on  certain natures.
With others the effect is not so marked, but were  no other
result  obtained save that  of  provoking a  childish  joy, it
ought not  to be despised."   The French  system is thus
officially described :
  " Inasmuch as work is considered a therapeutic  agency, it
is necessary to encourage patients to devote themselves to
it with a certain amount of  assiduity.  All work deserves
pay.  The greater part of the insane are aware of that, and
insist that  their work  should be rewarded.  From the first
month a certain proportion is allotted by the physician in
charge to a fund  for the  patient on his discharge.  When
the discharge fund has been attained, the  surplus  goes to
the profit of  the patient, to be devoted to Sunday dress, to
articles of  fancy he may desire to  purchase, or to remit in
whole or in part to his relations.  All these favors become
in the hands of the doctor a therapeutic agency of a certain
importance, and they are a satisfaction to the patients, which
it is right to afford them."
  Compensation would  do away with  the sense of injustice
felt by many of the insane  in being obliged to work while
confined against their will.   Numerous complaints, in some
cases very  bitter ones, have been  made to  me by patients
in insane asylums because  they were  not  paid any  thing
for their services, and  had no privileges over non-workers
and  idlers.   Some recompense would help to make  such
persons contented, and their cheerful spirits would animate
others.   Dr.  Mitchell, of the South Yorkshire asylum at
Wadsley, says that much more might be done for the im-
provement  of  the mental  and bodily health  of the insane if 
340                     rEsumE.

a greater number could be induced to engage in labor.  In
his experience, the lack of compensation to workers stands
in the way of a complete industrial system, many persistently
refusing to work, on the plea that  they have never worked
without remuneration.
                  DRESS AND CLOTHING.
  Foreign asylums are usually kept at a low temperature,
and the degree of heat maintained would, in this country, be
considered insufficient  for the health and comfort of a large
class of patients.  The opinion, however, was generally ex-
pressed by the superintendents of asylums in Great Britain
and Ireland,  that it   is far  better  to  provide  plentifully
warm  and  substantial  clothing  for the patients  than to
keep  their rooms at   a  high temperature.  In  the latter
case they claim that  the  inmates become more  sensitive
to the cold when exposed, and consequently cannot derive
the great benefit which may be secured by regular outdoor
exercise.  Although the winter climate of  England is less
rigorous than ours, the clothing of asylum inmates seemed
to be  more substantial and comfortable than that furnished
patients  here.  Stout  shoes  and warm woollen  socks or
stockings are worn.  High-collared, heavy  cloaks  or capes,
buttoning in front and  extending over the shoulders and
arms, are provided in some of the asylums for patients taking
recreation or country walks  in raw weather.
  Many  asylum  superintendents deprecate uniformity in
dress, and it was pleasing to observe that in the selection of
articles worn by patients, such  as  shawls, capes,  ribbons,
bonnets, etc., their preferences as to color and pattern were
frequently gratified.
                DIETARY AND DINING-ROOMS.
  In some asylums  in England  and  Scotland, where male
and female  patients dine simultaneously in the same  hall, 
              DIETARY AND DINING-ROOMS.          341

the practice is approved by superintendents, on the ground
that it is more  in  accordance with  the ordinary way of
living.   At the  small county asylum at  Haddington,  it
has long been the custom for men  and women to  dine
even  at  the  same table,  and no inconvenience has resulted
therefrom.  Attendants usually preside at the ends of the
tables.  As a  general rule, it  is desirable  that  tables,  each
accommodating  a  limited  number of  classified  patients,
should be provided in the dining-halls.
  Knives, forks, and  spoons are used in the more modern
institutions.   The knives  for  the refractory have frequently
blunt edges, with the exception of about an  inch and a half
near the point.  In Sweden, wooden spoons are provided for
this class of patients.  In most  of the large asylums visited,
the food is conveyed to the dining-rooms  from a general
kitchen.
  It did not  appear that the variety and  quality of  food
common to American asylums were equalled  abroad.  In the
institutions for the dependent insane, the difference was quite
marked,  the  foreign  dietary being far less generous.  The
food  is possibly  as  good  as  the  daily  fare of agricultural
laborers  in the districts from which patients come, but me-
chanics from the  cities find it inferior to that to which  they
have been accustomed.  In the Scotch institutions the accept-
ability and general use of the various preparations of oatmeal
promote  the healthfulness of the patients and  at  the same
time  tend to  reduce the cost of  maintenance.  Much  less
fresh  beef is consumed in foreign asylums than in those of
the United States, and there is not the variety of vegetables
nor the  abundance  of  palatable fruits.  It  should not  be
forgotten that the insane need a nourishing  and liberal diet.
If, with this, they are well employed, they improve  in health
and become more orderly and quiet. 
342
rEsumE.
                  ALCOHOLIC STIMULANTS.
  An American  regards with surprise  the extent to which
alcoholic stimulants are used in foreign asylums.  In Great
Britain and Ireland and some other parts of Europe, their use
is gradually but surely decreasing.  It  is computed that the
quantity consumed in county  asylums in England dimin-
ished fifty per cent in  the  seven years preceding 1883, and
nearly seventy-five per cent in  borough asylums during the
same period.  One  of the managers  of the Brookwood
asylum  asserts that  where  the  use of alcoholic stimulants
is lessened, fewer drugs and narcotics  are found necessary;
and  that  the  substitution of milk in large quantities for
beer, ale,  and spirits  is  attended with  the best  results.
The  English Commissioners in Lunacy state that in English
county  and borough  asylums  the amount  of surgery and
dispensary expenditures is lowest where the consumption of
wines, spirits,  and porter  is smallest.  A superintendent of
one  of  the English asylums assured me that  the giving up
of beer in his own asylum, except for medicinal purposes,
had proved beneficial, the  patients usually eating more, and,
in a  majority of cases, gaining  in weight.  In the  summer
of 1884, Dr. D.  Hack  Tuke, in gathering statistics  on this
subject, found that, out of one hundred returns made  to
him  from  different county and borough asylums and reg-
istered  hospitals,  one half showed the  non-use  of  alcohol
except as administered medicinally, the  officers generally
reporting  that the discipline  of  the  asylum had  at the
same time improved.

                   SOCIAL  DISTINCTIONS.
  The  attempt  to make  a classification based on social
standing is a cause of  great embarrassment in some of the
foreign  asylums.  The inconvenience  resulting  therefrom 
VISIT A TION.
343
was strikingly apparent at Hamburg.  At Halle, even in the
small cottage hospital for  sick women, provision was made
for two classes.  The arrangements necessary to carry out
such  a  system  increase  the  cost  of  care  and  lessen  the
available capacity of the institution, as there may be lack
of space for  one class while there is an excess for another.
The observance of  these  social  distinctions  also stands in
the  way  of  a proper  classification  based  on  the  mental
and bodily condition of the patients.

                        VISITATION.
   In Great Britain and on the Continent the evil of excessive
visitation  by  habitual  sight-seers and  by  people whose
motives are  simply  to  gratify an  idle curiosity  is  not  so
great as in some parts of the United States.  While asylum
visitation is free to those in authority, the admission of the
public is  subject to rule.  Even pauper institutions enjoy
comparative  seclusion.   At Haywards Heath, and also  at
some other  asylums,  friends  are  not allowed to  visit  a
patient  until a month after the  date  of  his admission, and
they are then admonished to say nothing that may depress
or disturb  him.
   It would seem that to the  misfortune  of insanity should
not  be  added the mortification  felt  by a patient  in conse-
quence of  public exposure while under care and treatment.
It sometimes  happens  in our  asylums that  the strange
delusions of an insane person are treated  with  idle jest or
thoughtless ridicule  by visitors, and his excitement thereby
increased.  Visiting by relatives and those actually interested
in the insane should be  permitted under proper  statutory
regulations, to such an extent  as will preserve the confidence
of the public in the asylum  and  further good  administra-
tion ; but  to exhibit  patients  to  curious  visitors  and 
344
RESUME.
point out  their grotesque characteristics, as is sometimes
done, in much the same way that animals are shown in a
menagerie, cannot be considered other than an  outrage  to
them and  an injustice  to their  friends  and relatives.   It
should  not  be forgotten that, in  an asylum, the patient is
entitled to as much of his former privacy as is compatible
with his peculiar mental  condition.

                         LETTERS.
  Respecting the  disposal of letters, always a source  of
more or less embarrassment  in asylum management, an act
of the British Parliament, passed in 1862, requires that  in
England every letter addressed by a  private patient to the
Lunacy Commissioners  must be  forwarded  to them un-
opened.   Those  addressed to others are left to the discre-
tion of  the asylum  superintendent.   Such as  he  thinks
should not be mailed must be brought to the attention  of
the Commissioners in Lunacy, the Visitors, or the Commit-
tee when making  their  next inspection.  The opinion  of
the late Chairman  of  the English Lunacy Board  respect-
ing the  detention of letters was given to the special parlia-
mentary committee of 1877 m the following language :
  " I am inclined to think that the  correspondence is very
fairly carried on ;   that  letters that ought  to  be  sent are
really sent  by the great mass of superintendents.  I cannot
have a doubt that it is so.  All letters that are not  sent are
reserved for the Visitors  or the Commissioners at their next
visit.  On inquiring the  other day I found there were very
few  instances indeed in  which  the Commissioners or the
Visitors upon opening  those letters thought they ought not
to have been kept back.   No doubt the superintendents  of
asylums have very great  power, and they might  keep back
a great number of  the letters that ought to be  forwarded. 
                       LETTERS.                    345

I do not think they do  it,  and I do not think they are
inclined  to do it:  the  responsibility is very serious.  I  do
not  think they keep  back  any correspondence  but that
which they  think  would be positively hurtful;  and such
must, of  course, be detained.   Some of  it is of  the most
blasphemous and  obscene character.  .   .  .
  " There are some patients  who have a positive frenzy for
writing.   I have a correspondent in Sussex House who  fa-
vors me  periodically with some of the longest letters I ever
saw.  They are invariably sent  to me, and I do myself the
honor—I cannot say the  pleasure—of reading them.  The
man boasted to me the other  day that he had written  no
less  than one hundred  and twenty letters within the last
month.   You can  hardly think that all those  could  be for-
warded."
  The statute regulating the  transmission of letters in Scot-
land is as follows  :  " Every letter written by a patient in
any asylum or  house, and addressed to the Board or their
Secretary, or the Commissioners in Lunacy, or any of them,
shall, unless special instructions to the contrary have been
given by such Commissioners, or any of them, be forwarded
to its address unopened ; and  every letter from the  Board
or their Secretary, or such Commissioner or Commissioners,
to any such patient, when marked ' Private ' on the  cover,
shall be delivered to him unopened ;  and every person who
shall intercept  or detain or shall open any such letter with-
out the authority of the patient by whom it is written or to
whom it  is addressed, shall be liable in a penalty not exceed-
ing ten  pounds : provided that the Board shall transmit a
copy of such letter to the superintendent of such asylum or
house if it shall appear to the Board that the contents of the
letter are  of such a nature that it is of importance that the
superintendent should be made  acquainted therewith." The 
346
RESUME.
 superintendent exercises his discretion  in  regard  to  other
 letters.
   In  accordance  with the  law of  Massachusetts, locked
 boxes are placed so as to be accessible to the patients in
 asylums;  and  into  these, letters  can be dropped,  which
 must  be  forwarded  unopened   to the Commissioners  of
 Lunacy and Charity.  The law has been in operation since
 1874,  and the  opinion of one  intimate with  its workings
 during that time is valuable.   Mr. F. B. Sanborn, Inspector
 of Charities for Massachusetts, expresses himself in  favor  of
 the  law.  Although the great mass  of letters that find their
 way into the boxes, he says, are little else than rubbish, by
 their use a legalized means of communication with  the out-
 side world  is secured, which affords satisfaction to  many
 of the insane and  possibly to their friends.
   It would seem that the law should provide  some means
 whereby State supervising authorities and patients can  com-
 municate directly with each other, as in Scotland, and that
 all letters not forwarded to friends of patients by the asylum
 superintendent  should be held for the inspection of the su-
 pervising commissioners, whose duty it should  be to exam-
 ine the same when  next visiting the institution.

                POST-MORTEM EXAMINATIONS.
   There  is  no uniform rule as to the making of post-mortem
 examinations in the English county and borough asylums.
 The general practice is that of communicating with relatives
 or friends in the event of the death  of a patient, sometimes
 stating that an examination will be  necessary ; and,  if there
 is no objection, an autopsy is made.  At St. Luke's Hospi-
tal it is set  forth in the printed form of admission that, un-
less objection shall have been made in writing to the asylum
secretary previous to the decease of  a patient, a post-mortem 
              ADMISSION AND DISCHARGE.           347

examination will be held.  In some institutions very few are
made ; while in  others they are made  in nearly every case.
During the year ending January 1, 1887, out of 5,053 deaths
in the  English county  and borough asylums, 3,649 post-
mortem examinations were made.  The  practice is thought
desirable by the English  Commissioners in Lunacy when-
ever possible, and with the observance of the same rule as to
the consent of friends or relatives of all classes of  patients.
Besides the advantage to be derived  from these examina-
tions in advancing  the  knowledge of the pathology and
treatment of various forms of insanity, the commissioners
deem them desirable as a means of discovering injuries, and
think the evidence of possible maltreatment  that may be
thus obtained is a protection to the insane.

                ADMISSION AND DISCHARGE.
  While every possible precaution should be taken  to guard
against violations of personal liberty, the process of entering
an asylum should not be so hedged in with needless forms
as to  prevent  the speedy admission  of the patient.   The
highest medical authorities concur in the opinion that early
treatment of insanity is essential to the  attainment of suc-
cessful results, and that loss of time is disastrous by making
permanent the departure from  normal action, which, under
favorable conditions, might have been  quickly restored.  To
facilitate the  early entrance of  an insane person into an
asylum, no more publicity should attend the transfer than is
necessary.   An  objection  to the  system of trial by jury is
that the dread of public exposure  incident  to  this  mode  of
procedure frequently delays action by friends of the patient
until special remedial measures come too late.   Besides, the
excitement  experienced  by the patient when forced to ap-
pear  before a court and  jury as in a criminal  process, con- 
348
rEsumE.
 fronted by adverse witnesses whom he had hitherto regarded
 as trusted friends, has often a very damaging effect upon
 him.
  The dividing line  between sanity and insanity is usually
 so imperceptible that it is difficult to fix the  precise period
 when  a  person enters the  first stage of mental  disease.
 Dr. James Coxe  has truly  said:   " As day passes grad-
 ually  into  night, so  does sanity  pass  gradually into
 insanity."   In  beginning treatment  we  should therefore
 come as near to  this uncertain line as practicable.   It  is
 better that we should err by  sending the sufferer to the
 hospital too early  rather than too late, always providing for
 easy  means of egress as soon  as he  is in a condition to
 justify his leaving.  When  the  nature of insanity  and the
 necessity  of special hospital treatment are generally well
 understood, when  the laws  governing admission  and  dis-
 charge come  to be  perfected,  and  when other  desirable
 reforms are effected,  there will  be little, if any, more reluc-
 tance on the part of friends to place a patient in a hospital for
 the treatment of  mental  than one  for  the  treatment  of
 bodily disease.
  It is important that the relations between the patients and
 the superintendent of an  asylum  should be  of  the most
 friendly nature, and that  the latter should enjoy the unre-
 served confidence  of his wards.   This cannot  be the case  if
 the patient thinks that he  is entitled to his  discharge, but
 fancies that it is withheld through the selfishness or caprice
 of the superintendent.  Feeling that a tyrannical power  is
 exercised over him, the patient is irritated whenever he sees
 his  imagined oppressor.   It  has been  my frequent experi-
 ence,  in  passing through the wards  of  an  asylum with the
medical superintendent,  to  hear, on every side, entreaties
to and maledictions against  him, the inmates believing that 
ADMISSION AND DISCHARGE.
349
he held the  key to their freedom and wrongfully  detained
them.  It would appear that the power to grant discharge
should be vested in other authority than the superintendent.
Should he  be relieved of  this  responsibility, he  would
be placed on  a more  friendly footing with his patients and
be able to administer more effectually to their recovery.
  As a safeguard against unnecessarily prolonged detention,
it would  seem desirable that, after a patient had been  in an
institution three  years, an affidavit as to the necessity  o*
his further  care  therein should  be made  yearly by the
authority in which is vested the power of  discharge.   This,
although  perhaps of  little account  as  affecting the num-
bers released,  would doubtless be  a satisfaction to friends
of patients and to the public.
  The power exercised by the Scotch Lunacy Board to dis-
charge upon a certificate of recovery granted by two physi-
cians whom they have called to make a special examination,
is a very satisfactory way of meeting the question  of discharge
in controverted or doubtful cases.   The power vested in the
sheriff (county judge) to discharge upon  a proper certificate
presented to him by two reliable medical men, to the effect
that the patient  is either recovered or is not dangerous  to
himself or the public, makes the exit from an asylum in Scot-
land easy and encourages resort to  early asylum treatment.
  The granting of probationary discharges—that is to say,
permitting a certain class of patients to go out on trial to
their homes, to work for wages, or, under the guardianship
of friends, to the mountains or the sea-side—appears to be at-
tended with good results.  The practice is in favor with the
Scotch Lunacy Board, and in England it is becoming more
prevalent.
  In the disagreeable task of  taking an insane person to an
asylum, the  relatives or friends should participate only when 
350
RESUME.
their doing so would be helpful to the patient; and they
should endeavor to show him  that his going is unavoidable,
and that they deplore its necessity.   Strategy and deceit are
frequently  resorted to in making these transfers, and  it is
an embarrassing task for the superintendent of an asylum to
undeceive the  person  brought  to  his care under such cir-
cumstances.  He is thus placed in an equivocal position,
and at the outset is looked upon  with distrust by the pa-
tient, who  should, for his own sake, have  entire confidence
in the  one with  whom  he is brought into such intimate
relations and  who  is to control  his  future  destiny.  An
insane  person  should never be  deceived, but  first, last, and
always told the truth.   The burden  of  his  complaint is,
that he is the victim of a conspiracy among  his friends.
Believing  himself to be sane, how could an insane man feel
otherwise  than deeply wronged at the treachery of those
whom  he  had  always trusted and  loved ?  His worst  pas-
sions are aroused, and a  sense of desolation and bitterness
adds to the tumult of his disordered mind.  In the transfer
of female patients  to  asylums, the statute should  require
that they have the  protection that the  companionship  of a
competent female  attendant affords.  For obvious reasons,
all transfers should be so arranged as  to avoid, if possible,
reaching the asylum at night.

                  VOLUNTARY PATIENTS.
  In England, a person that has once been an inmate of an
insane  asylum can,  by payment  of board, be re-admitted at
his own request, if this shall be made within five years after
his discharge.   The procedure respecting  the admission of
voluntary patients into asylums in Scotland has already been
described.  So far  as I  could learn, the  operation of the
Scotch law relating to this  class  of patients had proved satis- 
                   SUMMER  RESORTS.                35 I

factory.  In  1881, Massachusetts passed  a  law permitting
persons to enter asylums voluntarily.   During the five years
after the enactment of the statute, there were 261 admissions
under  it, thirty-five of which were re-admissions.   All of
those admitted  except  forty-two had, on January 1, 1887,
been discharged.  During the year  1886, about one third of
the admissions to the McLean Asylum, Massachusetts, were
voluntary.   The admission of this class of patients into in-
sane asylums  tends to do away with the air of mystery and
feeling of dread  with which these institutions are sometimes
invested in the public mind.
                    SUMMER RESORTS.
  It has been  shown that some of the foreign asylums, nota-
bly Morningside and the York Retreat, take their patients in
the convalescing stage, at  seasonable  times, to sea-side re-
sorts.  This praiseworthy custom  is also observed on this
side of the water by the McLean Asylum in Massachusetts
and the Friends' Retreat in Pennsylvania.   The advantages
sought  may also be secured at other places than the sea-
side.  Attractive points  upon the  shores  of our  beautiful
lakes and near  our magnificent rivers, or among the  moun-
tains, would afford the desired change.   Judging from the
beneficial effects which have resulted from a change of scene
and air, it would seem advisable to extend the privilege as
far  as possible to all patients likely to  be benefited thereby.
The removal  need not involve a  large outlay, as suitable
premises could be secured  by rental, and temporary struc-
tures,  or even  tents,  could be made to answer  the  pur-
pose  of shelter.  Such resorts should not be called by any
name suggestive of insanity.
                    CRIMINAL INSANE.
  Separate provision should be made by every State for in-
sane criminals.  The necessity for this is so  apparent,  if con- 
352                     RESUME.

sidered only with reference to the rights of the non-criminal
insane, as seemingly to need  no argument.  What has been
done by the English  Government at Broadmoor and what
New York State is now doing under the  intelligent super-
vision of Dr. Carlos  F. MacDonald, Superintendent of the
State Asylum for Insane Criminals, demonstrate the advan-
tages of  providing separate establishments for  the criminal
insane.
                      BOARDING-OUT.
  The  number of insane  provided  for in private  dwellings
in continental countries  aside  from  Belgium is  not easily
obtainable.  It is  doubtless  considerable.  There is a large
number in family care in  Ireland.   On the 1st of January,
1887, there  were  in  England 5,809 pauper lunatics "not
confined in any asylum,  hospital,  or licensed  house, but
residing  with  relatives   or  others  as  outdoor  paupers."
These  formed 8.02 per cent of the whole number of pau-
per lunatics.   As  idiots  are  included in  the term lunatic,
what proportion were insane cannot be determined from the
statistics given.   During the ten  years  preceding 1887, the
number of outdoor pauper lunatics in England decreased 503.
There is no general system for boarding out the  insane under
governmental supervision either in England or Ireland.
  On the ist of  January, 1877, the insane boarded  in private
dwellings in Scotland numbered 1,418, and  a  decade later
there were 2,140, being an increase of 722.  This  increase may
be  partly due to  the  protection afforded by the watchful
supervision  of the Scotch Lunacy Board—a kind of super-
vision which is essential  to the success of the boarding-out
system.  The opinions of this Board already given and of
the officers connected  with it, who  bestow special attention
on the important work of  visiting the insane placed under
family care, are  worthy of careful consideration. 
                     BOARDING-OUT.                 353

  It is not improbable that, if a searching inquiry were
made into the state of the insane in private dwellings in the
several countries except Scotland, an unsatisfactory condi-
tion, showing much abuse and neglect, would be revealed.
  Among the chronic insane in American asylums there are
doubtless many harmless lunatics who  could be removed
from  asylum to family  keeping,  if a proper and efficient
system of supervision were  extended over them.   As the
country  grows older and  the  dying out of industries in
certain localities causes the  people to resort  to new  expedi-
ents to earn a living, the boarding of the insane will be taken
up  if the way is legally opened  for it.   This has  already
proved to be the case in some parts of Massachusetts, where
the experiment of boarding out on a small scale under the
supervision of the Board of Lunacy and Charity has been
attended, according  to the opinion of the Board, with
satisfactory results.   An advantage derived  by the public
from the boarding-out of the insane is that it is relieved from
the expense of providing and maintaining shelter for them.
The benefits accruing to the insane  are that they are thus
permitted to  enjoy greater freedom and the natural  sur-
roundings and associations of home life.  As  to the question
of economy, if we take the same  standard of diet and bodily
comfort for both asylum and family care, with  a complete
and  efficient method of supervision  in the latter case, the
cost of maintenance in families,  it is believed,  cannot  be
made much, if any,  less than in asylums.
  While it is due the insane that every reasonable  require-
ment of  humanity should be met  in providing for their care
and treatment, we should not overlook the rights of the sane.
Therefore,  in  extending the boarding-out system  in  this
country, as will undoubtedly be  done, it is desirable  to keep
in mind  the welfare  of the communities among which the 
354
rEsumE.
insane are placed and note the effects of the intermingling.
A no less rigorous supervision should be maintained than in
Scotland, and the selection of patients for family care should
be governed by even stricter  rules than those observed  in
that country.

                       POORHOUSES.
  In all the countries visited, an examination was made  of
institutions variously designated as poorhouses, workhouses,
and  alms-houses.  Such of them  as contained insane per-
sons,  either  in  their ordinary wards  or in separate depart-
ments, were carefully inspected, and  the condition of the
insane noted.  It was  found that the provision for their
care did not reach  a  proper  standard.   The workhouse
establishments  in England, primarily designed  for  sane
paupers, have  limited opportunities for special treatment
of the insane.  In many places lunatics are not  separated
from  other  inmates, and where it is done the indoor  space
allotted them  is contracted and  the yards for recreation
small.   From a lack of  trained attendants there  is insuffi-
cient supervision, and other essentials to proper care  are
wanting.
  Respecting the care  of  the insane in  workhouses, the
English Commissioners say: " Boards of guardians are not
always ready to adopt our suggestions as to the employing
of paid attendants to  look after  the imbecile  inmates,  in
cases where their  number appears  to us  to  require such
attention ; nor  can we  always obtain a recognition of the
need for a diet  superior to that which is found sufficient for
the ordinary inmates."   Inspector Henley informed me that,
in the fifty-eight unions under his supervision, there was but
little  separate  care for the insane,  Birmingham  being  the
only one having large separate wards ;  but that in some six of 
                      poorhouses.                  355

the unions there were small wards for epileptics and trouble-
some cases, and that  imbeciles and idiots usually occupy
the common ward, where they are more  likely to  annoy
others than to suffer themselves.  Mr. Henley, who has had
large  experience  as  an inspector of workhouses, is  of the
opinion that workhouse provision, although in separate de-
partments, is wholly unsuited to the needs of the  insane, and
not in keeping with the interests of rate-payers. He strongly
favors separate asylums for this class.
  If,  from the examinations made, one conviction  forced
itself  upon  my mind  more strongly than another,  it was
that poorhouse, workhouse, or alms-house care,  whether  in
common with sane paupers or in separate departments, but
under the same control and management, is not  humane,
and is in many ways unsatisfactory.  In keeping  two  classes
under the sarrwe management, the constant tendency is  to
the adoption  of a  uniform standard of care.   Provision
that would be adequate to the needs of the average poor-
house inmate  is quite inadequate to the necessities of the
insane.
  No statute  can justly place common paupers  and  the in-
sane on  the same plane.  The former  come  under  public
care, in  the majority  of cases, through improvidence,  or
physical  infirmity  caused by  licentious or criminal ways of
life; the latter reach a condition of peculiar helplessness and
dependence from  mental disease,  frequently the result  of
causes for which they are not to blame.  The  insane are
designated by  Blackstone as " the victims of accidental mis-
fortune," which cannot be said, as a rule, of the inmates of a
poorhouse.  It is therefore unjust that the insane should be
denied special care and treatment and that they should be
made to  bear the stigma consequent upon classification and
association with ordinary paupers. 
356
RESUME.
                 LOCAL OR DISTRICT CARE.
  In some of the States of this country there is a strong and
growing public sentiment in favor of  local or district care
for  the chronic insane.   Accepting it  as  a  probability that
local care will continue to  extend as population increases
and the numbers of the chronic insane multiply, and having
in view the fact that many populous localities have  already
elected  permanently to provide for their chronic insane, it
appears to be of very great importance that careful consid-
eration should be given to the kind of provision made for
them, and to  the question of their supervision and manage-
ment.   I am  clearly of the  opinion that when large munici-
palities, populous counties, or congeries  of counties decide
to make local provision for this class, the following principles
should be regarded as fundamental:
   i. The chronic insane should be placed under indepen-
dent, non-partisan boards of  management, the  members of
which should be appointed by one of the courts  for long
terms, and should be unsalaried.   These boards should be
governed, as  near as may be,  by the same rules that govern
boards of managers of State asylums.
   2. Accommodation  entirely separate from that  for sane
paupers should  be provided on considerable  tracts  of good
land, conveniently accessible by rail or water.
   3. The financial and other transactions should  be kept
separate  from  those  relating  to the  relief of  ordinary
paupers.
   4. The standard of  care should be such as to meet the
 approval of State authorities.
   In this way  it is believed a disinterested  and intelligent
 government of these institutions may be  secured,  with the
 advantages  resulting from  accumulating experience, a con-
 tinuous administration, and a uniform policy.  This  cannot 
                     STATE WARDS.                 357

be  the  case  under the present county system, with its fre-
quent  change  of officers and  the recognized  custom  of
making institutions for the  poor in a greater or less degree
mediums for the distribution of political patronage.

                      STATE  WARDS.
  From the information obtained, I am led to believe that in
Europe as well as in the United States the attempt of rela-
tives in moderate circumstances to pay for the board of a
member of the family in  an institution for  the insane  at
the rates charged  often results in great  hardship.  Officials
connected with public relief in  some  of the  States of this
country are aware that it  frequently happens that the efforts
made by a family  to support one of its number in an insane
asylum  have completely pauperized  it and  brought  its
remaining  members, including children of tender age, upon
the public  for support.   In Illinois,  Indiana;  Ohio,  and
Minnesota, where free provision  is  made for  the insane by
the State, such cases of distress and breaking  up of families
do  not  occur.  The law  making the  care  of the insane a
State charge is primarily  based on the principle that when
the tax-paying citizen  becomes insane he is no less entitled
to the special care of the State than the citizen who does not
pay a tax.
  In New York and some other States the asylums, while
ostensibly designed for the dependent class, are open to citi-
zens of the State who are  not dependent. The maintenance
and care of such  become a charge against those liable  for
their support.  This charge is in excess of that made for the
care of  the dependent class.   Many citizens of small means
are unable to bear so heavy a burden,  and they should not
be required to pay more than the rate  charged local author-
ities for the  maintenance and care  of pauper patients.   If 
358                     RESUME.
such a rule were observed, the pecuniary distress incident to
the present system would be greatly alleviated.
  Respecting the policy of providing for the dependent in-
sane, it would seem to be wise for every State to furnish free
hospital treatment  of the kind already described for those
coming under the general term of the acute insane.  If State
care were free to such cases, prompt transfers to hospitals
would be  encouraged and the great  advantages resulting
from early treatment would be more generally secured.
  As to the care of the dependent chronic insane in States
not  having a  free system, it appears to me that this class
might with advantage be  received into State asylums from
local authorities at a very liberal rate fixed by statute—one
that would be less than  it would  cost such authorities to
maintain them at a proper standard of care at home ;  and that
to such municipalities, counties, and districts as should elect
to provide for their own quiet and  harmless chronic insane
a yearly per-capita allowance might be made by the State of
the  difference between the rate fixed by  legislative enact-
ment and the actual cost of home support, but not beyond
what it  had  cost the  State  to  maintain  the  insane in its
chronic asylums, it being provided that the standard of care
be verified by State authorities as equal to State asylum care,
and that the  insane be placed under such separate  local
boards as have already been recommended.  It  will be seen
that the making of an allowance by the State in the manner
proposed would be somewhat analogous to  the action of
Parliament in granting four shillings a week  per capita to
local authorities in  England,  Scotland, and  Ireland  when
providing for their insane a standard of care satisfactory to
the  State—a form of relief that has proved  highly benefi-
cial  to the dependent insane in those countries.
  The extending conditionally of State aid is an acknowledg- 
                   PUBLIC ACCOUNTS.                359

ment of  a  continuous obligation on the part of the State,
and its acceptance by local authorities is a recognition of the
principle of State wardship of the insane.  Deprived as they
are by the laws of  the State of their personal liberty, they
naturally become, in one  sense, her wards, and  should, in
their helpless  and  suffering condition,  be  so regarded.
Whether they occupy buildings owned by the State or those
belonging  to cities or counties, the State should recognize
her obligations  to protect them, and should see that every
requisite to their proper care is afforded them.

                    PUBLIC ACCOUNTS.
  The reports annually presented to the English Parliament
in relation  to the care of  the insane and other dependent
classes, embody a  vast amount  of varied and detailed infor-
mation.  The keeping of  accounts, and the collecting  and
tabulating  of statistics respecting relief afforded  the'se class-
es, involve  careful book-keeping in the charitable institutions,
a considerable outlay for clerical service, and much labor on
the part  of public officials ;  but the practical advantages de-
rived therefrom by  the  Government are so great that the
work is deemed indispensable.
  The methods adopted by several of  the American States
in preparing for legislative bodies needful  information re-
lating to the  care  of  the  dependent classes,  are, in some
respects, superior  to those of Great Britain.  The  system
elaborated  by  Mr. F. H.  Wines, Secretary of  the  Illinois
State Board of Charities, is, with some  slight modifications,
one of the best  of our American methods.   In many States
the lack of a general  system of classifying and  tabulating
the expenditures of  State  charitable institutions is greatly
felt, and the subject is one worthy the attention of legislative
bodies. 
360
RESUME.
   It appears  to  me desirable that  a central Bureau should
classify the disbursements of all the  institutions, in order to
apply a uniform rule in deciding between what are ordinary
and extraordinary expenditures,  etc.  It would  seem  that
the  Legislature of every  State should require each one of
its State charitable institutions to  furnish a central Board
or Bureau with an annual itemized statement of  all its re-
ceipts and disbursements, as also an inventory of its supplies
and other property in such form as the central Bureau might
direct, and  that this Bureau  should be required to classify
and tabulate the information furnished and present it yearly
in printed form, at a specified date, to the Legislature.   The
tables  should be  so arranged as  to be readily comparable.
They should  give, in  addition to the financial statements
usually rendered respecting the receipts  and expenditures
and the number of inmates in each institution, the quantity
per capita of  each article used, the per-capita cost of  each
article consumed, and  the average weekly per-capita cost of
maintenance, as also the average  weekly per-capita cost of
support  of the inmates of each  class of  State  charitable
institutions.
   If this system  were adopted, the Legislature would be
enabled to judge more intelligently of the special  wants of
the several State  institutions and the standard of care be-
stowed upon their inmates.  The  suspicion of extravagance
which occasionally, and very naturally, attaches to some in-
stitutions, in States that have no general system of the kind
described, would  perhaps be done away with, while others
might show an excellence of management that would create
a spirit of emulation tending to general improvement.   By
this  means faults in   administration would also  be  mani-
fest and a remedy could be applied.   Such a plan would not
only prove a satisfaction to the tax-paying citizen and to the 
                      SUPERVISION.                   361

student of social science, but would greatly aid and protect
boards of trustees, and officials in immediate charge.
   It is  not creditable to a State to be unable to show to
its own citizens the interior workings of its charitable insti-
tutions and the cost in detail of maintaining the inmates. A
State neglecting to adopt a comprehensive system of keep-
ing its  accounts and  classifying  its expenditures remains
ignorant as to whether it is in advance of its neighbors or
behind them in respect to the care of its dependent classes.
Besides, it is losing the full benefit  that might be derived
from inventions and improvements that have been  made in
one of its institutions because  they  are not  promptly and
systematically brought to the attention of all the others.

                       SUPERVISION.
   In nearly all the countries visited  there  exists some kind
of supervision  by the  general government over the insane,
either through  boards of commissioners, or officers appointed
for the purpose.  Among  the  various methods that have
been  adopted,  those  of  England and Scotland appear to
be the best.   The English system  of supervision is, how-
ever, cumbersome and  expensive to maintain.  In the United
States the  care  of the dependent classes is  so intimately
connected that some of our State Boards have been  organ-
ized to supervise  not only lunatics, but all  classes requiring
public relief.  The work of these organizations has thus far
been  highly creditable, and they give promise  of becoming
more  useful with increased experience.
   The success of general supervising boards does not depend
so much on the amount of power  they  possess, as upon  the
judicious  exercise  of  the authority with which they  are
invested.   This is well illustrated in the policy of the Scotch
and English  Lunacy Boards,  through which  great reforms 
362                     RESUME.
and  wholesome regulations  have  been  brought  about.
Both of these bodies,  though  active and earnest  in  the
advocacy of humane methods, and watchful in maintaining
a strict  observance of the statutes respecting  the  care and
treatment of the insane,  nevertheless  have sought to carry
their measures by moral suasion rather than by the arbitrary
enforcement of the law.   The late Chairman of the English
Board said :  " I am sure that the success we have  had with
the county asylums has been entirely because we have done
every thing by persuasion, by the force  of experience and
constant observation."
  Supervising State Boards should  be so constituted as to
be non-partisan, and should include members of the medical
and  legal professions and persons  of well-known business
qualifications.   They should  be appointed for long terms.
A Board  should not be so large as  to  be unwieldy.  Its
members should have definite  duties to  perform, including
certain well-defined visitations, and it should have the power
to employ competent deputies, who  should  be constantly
active in making inspections.  The  Board should report an-
nually to the Legislature, giving a full account of  its work,
the  condition of the classes  under  its supervision, with
suggestions  and recommendations  for their  humane and
economical care.  Such Boards  should be  vested  with  the
necessary  statutory powers to protect fully the insane and
further  their interests.
  In every lunacy system there should be kept by the super-
vising Board of Commissioners  a registry of  all the insane
under  official  cognizance, and when a patient is  admitted
to  an  asylum  the  admission  papers   with  the  medical
certificates should  be   forwarded  to the  commissioners.
These  should  be  accompanied by a statement  from  the
asylum  superintendent of the mental and physical condition 
SUPERVISION.
363
of the patient.  It should be practicable for commissioners
to make transfers from one asylum to another, or from asy-
lum  to family care.  They should also be empowered to
correct errors, to make  discharges after special examina-
tions, and  to  prosecute  for abuse of  patients.  In the for-
mation of  supervising Boards, the Scotch system furnishes
profitable  suggestions. 
 
APPENDIX TO  SECOND  EDITION.
ENGLAND.
  The number and distribution of lunatics in England and Wales
on the ist of January, 1889, according to  returns made to the
Lunacy Board, were as follows :
	Private			Pauper.			Criminal.				Total.	
Where Main-tained on January												
												
1, i88y.	M.	F.	T.	M.	F.	T.	M.	F.	T.	M.	F.	T.
In County and												
Borough Asy-												
lums ....	39^	473	869	22,863	27,846	50,709	92	24	116	23,351	28,343	51,694
In Registered												
Hospitals . .	1,767	1,582	3,349	95	66	161	1		1	1,863	1,648	3,5"
In Licensed												
Houses :												
Metropolitan	834	793	1,627	378	497	875				1,212	1,290	2,502
Provincial	600	794	1,394	230	218	448	3		3	833	1,012	1,845
In Naval and Mili-												
tary Hospitals,												
ami Royal India												
Asylum . . .	268	21	289						268		21	289
In Criminal Luna-												
t ic Asylum												
(Broadmoor) .							47i	M7	618	471	i47	618
In Workhouses ;												
Ordinary												
Workhouses				5,266	6,746	12,012				5,266	6,746	12,012
Metropolitan												
DistrictAsy-												
lums . .				2,578	2,919	5.497				2,578	2,919	5.497
Private Single Pa-												
tients ....	187	25S	442							187	255	442
Outdoor Paupers				2,426	3,5°4	5,93°	5^7	171		2,426	3,5°4	5,93°
Totals . .	4,°52	3,9'S	7,97°	33,836	41,796	75,632			738 38,455		45,885	84,340
  The above table shows that upwards of  sixty-one per cent of
the lunatics of  England  and Wales  under cognizance of the
Commissioners in  Lunacy are in county and borough  asylums.
The average weekly per-capita cost of  maintaining the insane in
these institutions during the year 1888 was  :
    In County Asylums.................................  8s.    6f </.
    In Borough Asylums................................  gs.   n§<£
                            365 
366
APPENDIX.
  These  sums include provisions,  medicines,  clothing, salaries
and wages, furniture and bedding, and household requisites.
  The  following statistics from official sources show the propor-
tion of lunatics and paupers to the population in the years 1869
and 1889:
Year.	Lunatics of All Classes.	Pauper Lunatics. 47,002 75,632	Paupers(Sane and Insane).	Populatio
1869 1889	53.177 84,340		1,046,569 22,223,29 817,190 29,015,61	
   From an examination of the above figures it will be seen that
of the  lunatics, there  was 1 to every 418 of the population  in
1869, and 1  to every 344 in 1889 ;  and  of the pauper  lunatics
there was 1  to 473 of  the population in  1869, and  1 to 384  in
1889.
   The material changes effected in the English lunacy system by
the recent Lunacy Act  of Parliament are here given.

            LUNACY ACTS  AMENDMENT  ACT,  1889.

                       Vict. 52 & 53, c. 41.

                ADMISSION  OF PRIVATE PATIENTS.

   Respecting the  admission of  private patients to  receptacles for
the insane this Act makes the following provision  :

  Section (2).   " Subject to the exceptions in this Act mentioned, no person,
not being a pauper or a criminal lunatic  and not being a lunatic so found  by
inquisition, shall be  received and  detained as  a  lunatic in any asylum, hos-
pital, or licensed house, or as a single patient, unless under a reception order
made by a judge of  county courts or magistrate,1  or by a justice of the  peace,
specially appointed as hereinafter provided, having respectively jurisdiction  in
the place where the  lunatic is.   No relative of  the person applying for  an
order under this section or of the lunatic,  or of the husband or wife  of the lu-
natic, shall be capable of making such order.
    The order shall  be obtained upon a private application by petition
accompanied  by a statement of particulars and  by two medical  certificates
on separate sheets of  paper  under the hands of two medical practitioners."

  1 " Magistrate " means  a stipendiary magistrate, and any magistrate appointed to act at any
of the police courts of the metropolis. 
ENGLAND.                           367
  Section (3).  " The petition shall be presented, if possible, by the husband
or wife or by a relative of the alleged lunatic.  If not so presented it shall con-
tain  a statement of the reasons why the petition  is not so presented and of the
connection of the petitioner  with the alleged lunatic, and the circumstances
under which he presents the petition.
  " No person shall present  a petition unless he is at least twenty-one years
of age and has within fourteen days before the presentation  of  the  petition
personally seen the alleged lunatic.
  '' The petitioner shall in the petition undertake that he will personally, or
by some one specially appointed by him, visit the patient once at least in every
six months ;  and the undertaking shall be recited in the order."

  " One of the medical certificates accompanying the petition shall, whenever
practicable, be under the hand of the usual medical attendant if any (being a
medical practitioner) of the alleged lunatic.    If for any reason it is not practi-
cable to obtain a certificate  from such usual medical attendant, the reason
shall be stated in writing by the petitioner  to the judge,  magistrate, or justice
to whom the  petition is presented, and  such statement shall be deemed to be
part of the petition.
  "  No order shall be  made upon a petition under this section, unless  each of
the persons who sign the medical  certificates accompanying the petition shall,
separately  from the other, have  personally examined  the person to whom the
petition relates  not  more  than seven  clear days previously to the date of the
presentation of the petition."
  Section (4).  " Upon the presentation of the petition the judge, magistrate,
or justice shall consider the allegations in  the petition and statement of par-
ticulars and  the evidence  of  lunacy  appearing by the medical certificates, and
whether it is necessary for him personally to see  and examine  the  alleged
lunatic ; and, if he is satisfied that an order may  properly be made  forthwith,
he may make the same accordingly ;   or, if not so satisfied, he shall  appoint
as early a time as practicable,  not being more than seven  days after the
presentation  of the  petition,  for the consideration thereof."
       ********
  " The petition shall be considered  in private, and no  one  except  the pe-
titioner,  the  alleged lunatic  (unless  the judge,  magistrate,  or justice in his
discretion otherwise order), any  one person appointed by  the  alleged lunatic
for   that purpose,  and the  persons signing the  medical certificates accom-
panying the  petition,  shall,  without  the leave  of  the judge,   magistrate, or
justice,  be present  at  the consideration thereof.
  " At  the time appointed for the  consideration of   the  petition the judge,
magistrate, or justice may  make an order  thereon or dismiss the same, or, if
he shall think fit, may adjourn the same  for any period not exceeding  four-
teen  days  for further evidence  or  information, and he  may  give notice to
such persons  as he may think  fit  of the adjourned consideration, and summon
any persons to attend before him.
  " Every judge, magistrate, and justice, and all  persons admitted to be present
at the consideration of any petition for  a receptio/i order, or otherwise having 
368
APPENDIX.
official cognizance of the fact  that a petition has been presented, except the
alleged lunatic and the person appointed by the alleged lunatic  as aforesaid,
shall be bound to keep secret all matters and documents which may come to his
or their knowledge by reason thereof, except when required to divulge the same
by lawful authority."
  Section (5).  " If after a petition has been dismissed another petition is pre-
sented as to the same alleged lunatic, the person presenting such other petition,
so far as he has any knowledge  or information with regard to the previous peti-
tion and its dismissal, shall state the facts relating thereto in  his  petition, and
shall obtain from the Commissioners' at  his own expense, and present  with his
petition, a copy of the statement sent to them  of the reasons for dismissing the
previous petition, and, if he wilfully omits to comply with this sub-section, he
shall be guilty of a misdemeanor."
  Section (6).  " A reception order, if the same appears to  be in conformity
with this Act, shall be sufficient authority for the petitioner  or any person
authorized by him to take the  lunatic and convey him to the place mentioned
in such order and for his reception and detention therein, and  the order may be
acted on without further evidence of the signature or of the jurisdiction of the
person making the order.
  " The order, together with the petition, statement of particulars, and medical
certificates upon which the order was made, shall be delivered or sent by post to
the person on whose petition the order was made, and shall  by him or his agent
be delivered to  the  superintendent or proprietor of the asylum,  hospital,  or
licensed house in which, or to the person by whom, the lunatic is to be received.
  " A reception order shall not continue in  force  unless the lunatic has been
taken or received thereunder before the expiration of seven  clear days  from its
date."
  Section 7.  "The  person upon  whose petition a reception order has been
made shall, with reference  to the  lunatic to  whom the order relates, have and
be subject to all such authorities, powers, obligations, and  liabilities as are by
the Lunacy Acts conferred or imposed upon the person signing an  order for the
reception of a lunatic not being a pauper."

   This Act does not change the existing law  respecting the ad-
mission into asylums, registered hospitals,  or  licensed  houses of
lunatics  or alleged lunatics,  not  paupers, who may  be  found
wandering at large.

   Respecting the right of a patient to be examined by a judicial
officer, section 9 provides  that—
   If a person is received into a receptacle for the insane as a pri-
vate patient without a  statement in the order of admission that
he  has been  personally seen  by  the  magistrate  who  signed the
order of admission,   he   must be informed  in writing  within
twenty-four hours after admission, by the person  taking  him in
               1 ' Commissioners " means Commissioners in Lunacy. 
ENGLAND.
369
charge, that he has a right to have an interview with a magistrate
other than the one who signed the order, unless the person taking
him in charge, within  twenty-four  hours after reception, informs
the Commissioners that the exercise of such right would be preju-
dicial to the patient.  If no such  notice is given, and the patient
within seven days after  his  reception expresses a desire to  see a
judicial  officer, he shall  be taken  before  or visited by a judge,
magistrate, or justice, who must afterwards make a  report  upon
the case to the Commissioners.

  Section 10 of the Act provides for the appointment of judicial
officers to issue orders  for  the reception  of  private patients, as
follows :

  " The justices of every county and quarter sessions borough, at their Michael-
mas quarter and special sessions respectively, to be held in the year one thousand
eight hundred and eighty-nine and in every succeeding year, shall appoint out
of their own body as many fit and proper persons as they may deem necessary
to exercise during the ensuing year within the county and borough respectively,
the powers conferred by this Act upon justices of the peace in relation to orders
for the reception of lunatics not being paupers.  In making such appointments
the justices of every county shall have regard to the convenience of the inhabi-
tants of each petty sessional division thereof."

  By the same section a  like power is conferred  upon the  Lord
Chancellor to make  such appointments,  provided they are not
made by the justices  of the county or borough, and  he is also
empowered  to  increase  the  number of  justices  who can sign
reception orders, if he is  satisfied that the number is insufficient.
The Lord  Chancellor, as well as  the justices of  the  county  or
borough, can fill vacancies caused  by the  death, absence, inabil-
ity, or refusal to act of any justices appointed to make reception
orders.
  Under circumstances  which require that  a lunatic  should be
placed immediately under care and treatment, this Act provides
as follows •
  Section (8).  " In cases of urgency where it is expedient, either for the welfare
of a person (not a pauper) alleged to be a lunatic or for the public safety, that
the alleged lunatic should be forthwith placed under care and treatment, he may
be received and detained in an asylum, hospital, or licensed house, or as a single
patient upon an urgency order, made (if possible) by the husband or wife or by
a relative of the alleged lunatic, accompanied by one medical certificate under
the hand of a medical practitioner. 
370
APPENDIX.
  " No person shall be received under an urgency order under this section un-
less the medical practitioner who signs the certificate  accompanying the order
has personally examined the person to whom the certificate relates not more
than two clear days previously to the reception of such person, and states the
date of such examination in the certificate."

  " An urgency order shall remain in force for seven days from its date ; or if a
petition for a reception order or application to the Judge in Lunacy' is pending,
then until the petition or application is finally disposed of."

  " An urgency  order  shall  have subjoined or annexed thereto a statement of
particulars."

   The medical certificate  accompanying  an urgency  order must
contain a statement " that it  is  expedient for the welfare of the
alleged  lunatic or for the public safety  that he  should forthwith
be  placed  under care  and  treatment,  with  the  reasons for the
statement."

   By section 13 lunatics not paupers and  not wandering at large,
who are thought to be cruelly treated or neglected, are cared for
as follows :

  " Every constable, relieving officer, and overseer of a parish, who has knowl-
edge that any person within the district or parish of the  constable, relieving
officer, or overseer, who is not a pauper and not wandering  at large, is deemed
to be a lunatic and is not under proper care and control, or is cruelly treated or
neglected by any relative or other person having the care or charge of him, shall
within three days after obtaining such knowledge give information thereof upon
oath to a justice specially appointed under this Act."
  The  said justice upon  receiving such information  "may  himself visit  the
alleged lunatic, and shall, whether making such visit or not, direct and author-
ize any two medical practitioners whom he shall think fit to visit and examine
the alleged lunatic and to certify their opinion as  to his mental state, and the
justice shall proceed in the same manner so far as possible, and have as to the
alleged lunatic the same powers, as if a petition for a  reception order had been
presented by the person by whom the information with regard  to the alleged
lunatic has  been sworn.
  " If upon the certificates of the medical practitioners who examine the alleged
lunatic, or after such other and further inquiry as the  justice may think neces-
sary, he is satisfied that the alleged lunatic is a lunatic, and is not under proper
care and control, or is cruelly treated  or neglected  by any relative or other
person having the care or charge of him, and that he is a  proper person to be
  1 '' Judge in Lunacy" means the Lord Chancellor or any Judge of the Supreme Court of
Judicature entrusted for the time being with the care and commitment of the custody of the
persons and estates of idiots, lunatics, and persons of unsound mind. 
ENGLAND.
371
taken charge of and detained  under care and treatment, the justice may, by
order direct the lunatic to be received and detained in any asylum to which, if a
pauper, he might be sent under the Lunatic Asylums Act,  1853, or (where by
that Act authorized) in a hospital or licensed house.  *   *  *
  '' A justice making an order under this section may suspend the execution of
the order for such period not exceeding fourteen days as he may think  fit, and
in the meantime may give such  directions or make such  arrangements for
the proper care and control of the lunatic as he may consider proper.
  '' If either of the medical practitioners who examines an alleged lunatic under
this section certifies in writing that the lunatic is not in a fit state to be removed,
the removal shall be suspended until the same or some other medical practitioner
certifies in writing that the lunatic is fit to be removed."
  The Act does  '' not restrain or prevent any relative or friend from retaining or
taking care of a lunatic as to whom an order might be or has been  made under
this section, if the relative or friend satisfies the  justice  before whom the infor-
mation as to the lunatic has been sworn, that he will be  properly taken care of."


PERSONS DISQUALIFIED FROM  SIGNING  MEDICAL  CERTIFICATES.

  Section (15).  "A medical certificate accompanying a petition for a reception
order or accompanying an urgency order, shall not be signed by the petitioner
or person  signing the urgency order, or by the husband or wife, father or father-
in-law,  mother or mother-in-law,  son or son-in-law,  daughter or daughter-in-
law, brother or  brother-in-law, sister or sister-in-law,  partner  or  assistant of
such petitioner or person."
  Section (16).   " No person  shall be received or detained as a lunatic in any
asylum, hospital, or licensed house, or as a single patient, where any certificate
accompanying the reception order has been signed by any  of the following
persons :
    (a)   The superintendent or proprietor of the asylum, hospital, or house, or
        the person who is to have charge of the single patient :
    (B)  Any person interested in the payments on account of the patient:
    (c)  Any regular medical attendant in  the asylum, hospital, or house :
    (d)  The husband or wife, father or  father-in-law, mother or mother-in-
        law, son or son-in-law, daughter or daughter-in-law, brother or brother-
        in-law,  sister or sister-in-law, or the partner  or assistant of any of the
        foregoing persons.
  " Neither of the persons signing the medical certificates in support of a peti-
tion for a  reception order, shall be the father or father-in-law, mother or mother-
in-law,  son  or son-in-law, daughter or daughter-in-law, brother or brother-in-
law, sister or sister-in-law, or the partner or assistant,  of the other of them.
  " No person shall be received as a lunatic in a hospital under an order made
on the application of, or under a certificate signed by, a member of the managing
committee of the hospital.
  "The superintendent  and proprietor of any asylum, hospital, or house, and
any person having charge of a single patient, who knowingly receives a person as
a lunatic contrary to the provisions of this Act shall be guilty of a  misdemeanor." 
372
APPENDIX.
      PROTECTION  TO  PERSONS  SIGNING  ORDERS,  MEDICAL
                        CERTIFICATES,  ETC.

  Section (12).  " A person who before the passing of this Act has signed or
carried out or done any act with a view to sign or carry out an order purporting
to be a reception order, or a medical certificate that a person is of unsound mind,
and a person who after the passing of this Act presents a petition for any such
order, or signs  or carries out or does any act with a view to sign or carry out an
order purporting to be a reception order, or any report or certificate purporting
to be a report or certificate  under this Act, or does any thing in pursuance of
this Act, shall not be liable to any civil or criminal proceedings, whether on the
ground of want of jurisdiction, or on any other ground, if such person has acted
in good faith and with reasonable care."

                      WILFUL  MISSTATEMENT.

  Section  23 makes it a misdemeanor  for any person to make a
wilful misstatement of a material fact in any petition,  statement
of  particulars, medical  or other  certificate, or reception  order
under the Lunacy Acts or  under this Act.

               DEFECTIVE  MEDICAL  CERTIFICATES.

  Section  n of 16  &  17  Vict. c. 96, and section  27 of 25 &  26
Vict. c.  in,  respecting defective medical certificates, are repealed,
and section  24 of this Act provides that—

  " If any order or medical certificate for the reception of a lunatic shall after
such reception  be found to be in any respect incorrect or  defective, such order
or certificate may, within fourteen  days next after such  reception, be amended
by the person who signed the same.   Nq amendment shall be allowed unless
the  same shall receive the  sanction of the Commissioners, or of some one of
them, and (in the case of a private patient) the consent of the judge, magistrate,
or justice by whom  the order for  the reception of the  lunatic may have been
signed.
  " If the Commissioners deem  any such certificate to be incorrect or defective,
they may, by a  direction in writing, addressed to the superintendent or proprietor
of the asylum,  hospital, or licensed house, or to the person having the charge of
a single  patient, require the same to be amended by the person who signed  the
same, and, if the same be not duly amended to their satisfaction within fourteen
days next after the  reception  of the patient, the Commissioners, or any two of
them, may, if they think fit, make an  order for the patient's discharge."

                  PRIVATE PATIENTS IN  ASYLUMS.
   Section  65 provides that  insane persons not paupers may be
received into asylums which were originally designed for paupers
only, the committee of  visitors being  authorized to  make  such 
ENGLAND.
373
terms as to  payment  and  accommodation as they may think fit.
" All enactments as to the conditions on which such lunatics may
be received into hospitals or licensed houses shall be applicable to
lunatics not  paupers received into such asylums."


CHANCERY PATIENTS [PERSONS FOUND  LUNATIC  BY INQUISITION].

  Section (18).  " Where a person has been found lunatic by inquisition, but
no committee of the person has been appointed, an order under the hand of
one of the Masters in Lunacy shall be sufficient authority for  the reception of
the lunatic into an asylum, hospital, or licensed house, or as a single patient."

   In case of a person found lunatic  by inquisition who is capable
of managing himself but not his property, the following provision
is made by section 48 :

  " If in any case of an inquisition it shall appear that the alleged lunatic is of
unsound mind so as to be incapable of managing his affairs, but that he is capa-
ble of managing himself, and is not dangerous to himself or to others, it may be
specially so found and certified ; and every such special finding and certificate
shall be brought before the Judge in  Lunacy, who shall thereupon make all
such  orders, and direct all  such  acts to  be  done, as may be necessary or
proper relative to the commitment, management, and application of the estate
and effects of the person so found to be of  unsound mind  (including all proper
provisions for his maintenance),  but it shall not be necessary, unless in  the dis-
cretion of the Judge it shall appear proper so to do,  to make any order as to the
custody or commitment of the person."

   In certain cases the  Judge  in  Lunacy  may  set aside the in-
quisition and vary the order for the commitment of the person.

  Section (49).  " In any case  of a person who has been found lunatic by in-
quisition  the Judge  in Lunacy, being satisfied on the  report of the Commis-
sioners or of one of the Lord Chancellor's  Visitors in Lunacy, or on any other
evidence  that the lunatic is  cured, or that  he is capable of managing himself,
and  not  dangerous to himself or  others,  though  incapable of managing his
affairs, may,  if he shall think it desirable that the  ordinary proceedings for a
supersedeas should not be insisted on,  by order supersede the inquisition so far
as the same finds that the lunatic is incapable of managing himself, and rescind
or vary any order for the commitment of the person of the lunatic.
  '' An order under this section may be made on such terms and conditions as
the Judge in Lunacy may think  fit."

   The term of  the  custody of the  person of the lunatic is con-
ditionally limited by section 50. 
374
APPENDIX.
  " The medical attendant of every lunatic so found by inquisition shall, before
the expiration of one, three, and six years respectively from the commencement
of this Act, and before the expiration of every subsequent period of live years
after the expiration of six years from the commencement of this Act, send to the
Masters in Lunacy a report as to the mental and bodily condition of  the patient,
with a certificate under his hand certifying, if it is the fact, that the patient is still
of unsound mind and a proper person to be detained under care and treatment.
  " If, before the expiration of any of the periods hereinbefore mentioned, such
report  and  certificate are not sent to the Masters, they shall inquire as to the
omission, and  unless they are satisfied that the  lunatic is still  of unsound
mind, the order for the commitment of the person of the lunatic as to whom
such report and certificate are not sent shall determine at the expiration of such
period  ; but nothing herein contained shall affect the commitment of  the estate."

 PROVISION FOR  DEALING  WITH PROPERTY  UNDER  THE  VALUE
                              OF  ^200.
  Section (54).   " Where an order is made for the reception of a  lunatic  the
value of whose real and personal property is under two hundred pounds, and no
relative or friend of the lunatic is willing to undertake the management of such
property, any judge of county courts having  jurisdiction in the place from which
the lunatic is sent, may, upon the application of the clerk of the guardians, or a
relieving  officer of the union from which the lunatic is sent, authorize the clerk
or relieving officer, or such other person as the judge shall by his order appoint,
to take possession of and sell and realize the real and personal property of  the
lunatic, and to exercise all the powers which could be exercised by  the legal
personal representative of the lunatic if he were  dead ; and the receipt of  the
person  so authorized shall be a  valid discharge to any person who  pays any
money  or delivers any property of the lunatic to such person."

   The judge may give such directions as  he shall think  fit as to
the application of the property of the lunatic for his benefit, or in
payment of expenses incurred  in his behalf.
   The person acting  under the order of the  judge  shall render
an account of his dealings  with the property of the lunatic to the
judge.

PERSONS DISQUALIFIED  FROM  SIGNING  RECEPTION  ORDERS FOR
                         PAUPER  PATIENTS.
  Section  (19).   " After the commencement of this Act no pauper shall be re-
ceived  as a lunatic into any asylum, hospital, or licensed house under an order
under the hands of an  officiating clergyman and overseer or relieving officer."

       REPORTS UPON  AND  VISITS TO  PRIVATE PATIENTS.
  Section  (29).   " The medical superintendent of  every asylum  or hospital,
and the medical proprietor or attendant of every licensed house, and the medi- 
ENGLAND.
375
 cal attendant of every single patient, shall at the expiration of one month after
 the reception of a private patient prepare and send to the Commissioners a
 report as to the mental and bodily condition  of  the patient, in such form as
 the Commissioners may from time to time direct.
   "The  medical proprietor or attendant of every house licensed by justices
 shall also at the same time send a copy of such report to the clerk of the visitors
 of licensed  houses in the county or borough where the house is situate to be by
 him laid before the visitors.
   " The Commissioners, after receiving the report upon any patient in a licensed
 house within their  immediate jurisdiction, shall make arrangements for a visit
 being paid as soon as conveniently may be to the patient by one or more of the
 Commissioners ; and the Commissioner or Commissioners so visiting shall report
 to the Commissioners whether the detention of the patient is or is not proper.
   " The visitors, after receiving the report, shall, in every case of a private pa-
 tient in a licensed  house in  the county or borough for  which the visitors are
 appointed,  make arrangements for  a  visit being paid by the medical visitor
 (either alone or with one or  more of the other visitors)  to the patient therein
 named for such purpose as aforesaid, as soon as conveniently may be ; and if on
 such visit there shall appear to  be any doubt as to the propriety of the detention
 of the patient, such visitor or visitors shall forthwith report the same  in writing
 to the Commissioners,  who shall thereupon make  all such further inquiries as
 may be necessary to satisfy themselves  whether the patient is properly detained
 as a lunatic, or whether he ought to be discharged, or whether the  case ought to
 be reported to the Lord Chancellor with  a view to an inquisition.
   " In the case of a single patient, the Commissioners, after receiving the report,
 shall either  make arrangements for a visit being  paid as soon as  conveniently
 may be to the patient  therein named by  one or more of the Commissioners, or,
 if no Commissioner  is  available, shall cause a copy of the report to be sent to a
 medical Visitor for the county or borough in which the single patient resides, or
 to some other competent person, and shall direct him to visit the patient therein
 named as soon as conveniently may be.   The Commissioner or Commissioners,
 or other person visiting the patient, shall report to the Commissioners whether
 his detention is or is not proper.
  " The person directed to visit a single  patient under the  last preceding sub-
 section shall for that purpose have all the powers of a Commissioner, and the
 Commissioners may, with the consent of the Treasury, pay to him such reason-
 able remuneration for  his services as they think fit out of any funds which may
 be provided by Parliament to defray the general expenses of the Commissioners.
  " In the case of a private patient in an asylum or hospital the Commissioners,
 after receiving the report, shall  either make arrangements for a visit being paid,
 as soon as conveniently may be, to the patient therein named by one or more of
 the Commissioners, who shall  report to the Commissioners whether the detention
of the patient is or is not proper ; or the Commissioners shall send a copy of the
report to the clerk to the committee of visitors of the asylum, or to the  managing
committee of the hospital, and one  or more members of the committee shall
thereupon, as soon as conveniently may be, visit the patient named in the report,
and report to the committee whether his  detention is or is not proper, and the
committee, or any three of them, may, upon consideration of such last-mentioned 
376                         APPENDIX.
report, by writing under their hands discharge  the  patient, or give such direc-
tions with regard to him as they think fit.
  " If within a month after the reception of any private patient, the asylum,
hospital, licensed or other house into which he was received is visited by one or
more Commissioners or by any visitors, and such patient is there seen  and ex-
amined  by him or them, and the propriety of his detention reported on in like
manner as by this section provided, no special  visit shall necessarily be paid to
such patient after receipt of any such report.
  " If the Commissioners in any case under this section determine that a patient
ought to be discharged they may make an order for his discharge.
  " The reports to be furnished under this section shall be in addition to the
reports or statements which by the Lunacy Acts are required to be furnished."

                LIMITATION OF  RECEPTION  ORDERS.

  The principle of limiting the duration  of reception orders in-
corporated in the Scotch lunacy  law is now engrafted upon the
English lunacy  system.  By section 30 it is  provided that—

  " Any reception  order, whether it  relates  to a pauper or  not, dated after or
within three months before the commencement of this Act, shall expire at  the
end of one year from its date, and any such order  dated three months or more
before the commencement of this Act shall expire at the end of one year after
the commencement of this Act, unless such orders respectively are continued as
hereinafter provided.
  "In the case of any asylum, hospital,  or licensed  house  the Commissioners
may by  order under their seal from time to time direct that the reception orders
of patients detained therein shall, unless continued  as hereinafter provided, ex-
pire on  any quarterly day next after the days on which  the orders would expire
under the last preceding sub-section.
  " An  order for the removal of a patient from one custody to another shall not
be deemed to be a reception order within this section, but the patient  who is
removed shall after removal be deemed to be detained under the original recep-
tion order as a lunatic, and such  order shall  expire in accordance with the pro-
visions of this section unless continued as hereinafter provided.
  "An  order for the reception of a  patient, whether a pauper or not, into an
asylum, hospital, or licensed house, or as  a single patient, shall remain in force
for a  year after the date by this Act, or by  an order of the Commissioners
appointed for it to expire, and thereafter  for two years  and thereafter for three
years, and after the end of such periods of one, two, and three years  for succes-
sive periods of five years, if at the end of each period of  one, two, three, and
five years respectively a special report of the medical  superintendent  of the asy-
lum or hospital or  the medical proprietor or attendant of the licensed house or
of the medical attendant of the single patient as to the  mental and bodily con-
dition of the patient with a certificate under his hand  certifying that  the patient
is still of unsound mind and a proper person to be detained under care and treat-
ment  is sent to the Commissioners in  manner  hereinafter  directed.  Such 
ENGLAND.
377
report shall be sent to the Commissioners not more than one month and not less
than seven clays before the end of each period.
  " The person sending the special report shall give to the Commissioners such
further information concerning the patient to whom the special report relates as
they may require.
  " If, in the opinion of the Commissioners, the special report does not justify
the accompanying certificate, then—
    (a) In the case of a patient in a hospital or licensed house or under care  as
        a single patient, the Commissioners shall make further inquiry, and if
        dissatisfied with the result, they, or any two of them, may by order
        direct his discharge :
    {b) In the case of a patient in an asylum, the  Commissioners shall send a
        copy of the report, with any other information in their possession relat-
        ing to the case, to the clerk to the committee of visitors of the asylum,
        and the committee, or any three of them, shall  thereupon investigate
        the case, and may discharge the patient or give such directions respect-
        ing him as they may think proper.
  " The superintendent of any asylum, and the superintendent or proprietor of
any hospital or house, and any person having charge  of  a single patient, who
detains a patient after  he has knowledge that the order for his reception has
expired, shall be guilty of a misdemeanor.
  " The special reports and certificates under  this section may include and
refer to more than  one patient, and such reports shall be in such form as the
Commissioners may, with the approval of the Lord Chancellor, from time  to
time direct."

DISCHARGE AND TRANSFER BY COMMISSIONERS—ABSENCE ON TRIAL.

   The power of  the Commissioners to discharge patients has been
extended  by section 31, as follows :

  1' Two of the Commissioners, one of whom shall be a medical and the other a
legal Commissioner, may visit a patient detained in any hospital or licensed
house, or as a single patient, and may, within seven days after their visit, if the
patient appears to them to be detained without sufficient cause, make an order
for his discharge."

  The Commissioners are empowered  to order the transfer of a
single patient from the care of one person to that  of  another, or
to any asylum, hospital, or licensed house.
  Section 32 of the new law requires the consent of only one Com-
missioner for the exercise of the  powers conferred by section 86
of the  Lunacy Act, 1845, sections 20  and 22  of the Lunacy Act,
1853, and section 38 of the Lunacy Act, 1862, which  provide for
the  sending or taking of a patient from a licensed house or hos-
pital to a specified place for the  benefit  of his health, for the 
378
APPENDIX.
transfer of  private and single  patients,  and for the  absence of
patients on  trial.

  " The medical superintendent of a hospital, or the medical superintendent or
proprietor of a licensed house, may, of his own authority, permit a patient to be
absent from such hospital or house for a period not exceeding  forty-eight hours
without giving notice of such absence to the Commissioners, and during such
absence the order for reception shall remain in force."

    RIGHT OF EXAMINATION AND  PROVISION  FOR DISCHARGE.

  Section (38).  " An order for the examination by two medical practitioners,
authorized by the Commissioners, of any person  detained as  a lunatic in any
asylum, hospital, licensed house,  or as a  single patient, may be obtained from
the Commissioners upon the application  of  any person, whether a relative or
friend or not,  who shall satisfy the Commissioners that it is proper for them to
grant such order ; and on production to the Commissioners of  the certificates of
the medical practitioners  so authorized, certifying that, after  two separate ex-
aminations with at least seven days intervening between the first and the second
examination, they are of opinion that the patient may, without risk or injury to
himself or the public, be discharged, the Commissioners may order the patient
to be discharged at the expiration of ten days from the date of the order."

        REMOVAL OF  PAUPER PATIENTS TO  FAMILY CARE.

   Section (40). "Where application is made to the committee of visitors of an
asylum by any relative or  friend of a pauper lunatic confined therein that he
may be delivered over to the custody of such relative or friend, the committee
may, upon being satisfied that the application has been approved by the guardi-
ans of the union to which  the lunatic is chargeable, and, in case the proposed
residence is outside the limits of the said union, then also by a justice having
jurisdiction in the place where the relative  or friend resides, and  that the
lunatic will be properly  taken care of, order  the lunatic  to be delivered over
accordingly."

   This  section further provides that the authority liable for the
maintenance of the  patient shall pay to  the  person  assuming
charge  of  him  a  sum for his  maintenance not  exceeding  that
which  it would  cost to maintain the patient in  the asylum from
which  he was  removed.   The  same  section also  requires  that
the medical  officer of the district  of the union  in  which  the
lunatic  is resident shall, within three days  after  each quarterly
visit to the  patient, send to  the visiting committee of the asylum
from which the patient was removed  a  report stating  whether,
in his  opinion,  the lunatic is properly taken  care of and  may
properly remain out  of an asylum. 
ENGLAND.
379
                 POWERS OF VISITING COMMITTEES.
  SECTION (41).   " The members, whether justices or not, of any committee of
visitors appointed for any asylum by a county council, shall have the same powers
and jurisdiction in relation to the transfer and discharge of lunatics as by the
Lunatic Asylum Act,  1853, were  vested in any members of a committee of
visitors appointed under that Act."

  LUNATICS IN FAMILIES  AND IN CHARITABLE AND RELIGIOUS
                           ESTABLISHMENTS.
  Section (42).   " If it comes  to the knowledge of the Commissioners that any
person appears to be without an order and certificates detained or treated as a
lunatic or alleged lunatic by any person receiving no payment for  the charge,
or in any charitable, religious, or other establishment (not being  an  asylum,
hospital, or licensed house), they may require the person by whom  the patient
is detained, or the superintendent or principal officer of the establishment, to
send to them, within or at such time or times as the Commissioners may appoint,
a report or periodical reports by a  medical practitioner of the mental and bodily
condition of the patient,  with all such other particulars  as to him  and his
property as they may  think fit."
  The same  section also provides  " that any one or more of the Commissioners
may at any time visit any such  patients  and report the result of the visit  to the
Commissioners, and may exercise,  with  respect  to  such patient, all  the powers
(except that of discharge) given to them as  to persons confined in any asylum,
hospital, or licensed house, or as  single patients."  And they "may, if they
think fit, transmit any reports received by them, or may report the results of
any inquiries made by them under  this section, to the Lord Chancellor, who may
thereupon  make an order for  the discharge of the patient from the custody in
which he is detained or for his  removal to an asylum, hospital, or licensed house,
or to such other custody as he may think fit."

                           SINGLE PATIENTS.
  In respect to  medical attendance upon  single patients and the visitation of
the same by the Commissioners,  section 34 provides  that "any two Commis-
sioners may direct that the medical attendant of a single patient shall cease to
act in that  capacity, and that  some other person be employed in his  place " ;
that '' one or more of  the Commissioners shall once  at least in every year visit
every unlicensed house in  which  a single patient is detained  as a  lunatic,
and  inquire  and  report to the Commissioners on the  treatment and  state of
bodily and mental health of the patient."
  This section further provides that "in the case of any person having charge
of a single patient, if the Commissioners are satisfied that it is desirable,  under
special circumstances, and for  the interest of the patient, that another patient,
or more  than one other should reside in the same house, that person may, with
the approval of the Commissioners, receive such other patient or patients  on the
same terms and  conditions in all respects as if  each of them were  a  single
patient." 
38o
APPENDIX.
                      VOLUNTARY PATIENTS.
  Section (39).  " The superintendent or proprietor of a licensed house may,
with the previous consent in writing of two of the Commissioners, or, where
the house is licensed by the justices, of two of the justices, receive and lodge
as a boarder for the time specified in the consent any person who is desirous of
voluntarily submitting to treatment ; after the expiration of which time (unless
any further consent shall be in like manner given for the extension thereof) he
shall be discharged.   The superintendent or proprietor of a licensed house may
also, with such previous  consent as aforesaid, receive and  lodge as a boarder,
for the time specified in the consent, any relative or friend of a patient."

   This section further provides that the consent of the Commis-
sioners or justices, as  the  case may be, shall be  given  only upon
application to them by the intending boarder ;  also that a  volun-
tary patient or boarder may leave a licensed house upon giving
to  the  superintendent  in  charge twenty-four hours'  notice  in
writing of his intention so to  do.

                         LICENSED HOUSES.

   By section 56 the extension of accommodation for the purpose
of providing for a greater number of patients in licensed houses is
not permitted, and, in the renewal of licenses, no greater number
of patients can be  received  into any one house than  that for
which it was originally licensed.

                     REGISTERED HOSPITALS.
   Section (58).  " When application is made after the passing of this Act for
the registration of a hospital for the reception of lunatics, the Commissioners may
depute any one or more members of their body, or may employ such person or
persons as they shall think fit, to inspect the hospital and report to them  thereon.
   " If the Commissioners  are of  opinion that the hospital ought  not to be
registered for the reception  of lunatics, they shall  make a written report to a
Secretary of State, stating the reasons for such opinion," and he shall finally
determine whether the hospital shall be registered or not.

   The  managing committee  of a hospital  is required to frame
regulations for the hospital which must  be approved by a Secre-
tary of State.   The certificate of registration issued by the Com-
missioners must specify the total number of patients of each sex
who may be received into the hospital.

   The use of buildings not shown on plans of registered hospitals
is forbidden by section 59, as follows : 
ENGLAND.
381
    No  building in the occupation of the managing committee of a registered
hospital not shown on  the plans sent to the Commissioners pursuant to  any
rules made  by them shall  be deemed  part of the hospital for any purpose
connected with the reception or the care and treatment of lunatics.
  " If the superintendent of a registered hospital knowingly permits any lunatic
to be detained or lodged in any building not shown on the plans of the hospital
sent to the Commissioners he shall be deemed guilty of a misdemeanor."

  Respecting the  auditing of  accounts of registered  hospitals
section 60 provides that—

  " The accounts of every registered hospital which does not submit its accounts
to the Charity Commissioners  shall be audited once a year by an accountant
or other auditor to be  approved by the Lunacy Commissioners,  and shall be
printed.
  " The Lunacy Commissioners may, if they shall think fit, prescribe the form
in which the accounts of any registered hospital are to be kept, and the day of
the year to which they are to be made up."

  Superannuation  allowances to officers  of registered hospitals
are authorized to be granted by managing committees, as follows :

  Section(61).  "The managing committee of any  hospital may grant to any
officer or servant who is incapacitated by confirmed illness, age, or infirmity, or
who has been an officer  or servant in the hospital for not less than fifteen years
and is not less than fifty years old, such superannuation allowance, not exceeding
two thirds of the salary of the superannuated person, with the value of the lodgings,
rations or other allowances enjoyed by him, as the committee may think fit."


  If the Commissioners are of  opinion that the regulations of a
registered hospital  are  not properly carried  out, they  may  give
directions for carrying  out the same.   If after a specified time
their requirements  are not complied with, they may, with  the
consent in writing of a  Secretary  of State, order the  hospital to
be closed.

                      MECHANICAL  RESTRAINT.

  Section (45).  " Mechanical means of bodily restraint shall not be applied to
any lunatic unless the restraint is necessary for purposes of surgical or medical
treatment or to prevent  the lunatic from injuring himself or others.
  " In every case where such restraint is applied a medical certificate shall, as
soon as  it can  be obtained, be signed, describing the mechanical means used,
and stating the grounds  upon which the certificate is founded." 
382
APPENDIX.
   The certificate shall be signed by the medical officer in charge
of the patient.

  " A full record of every case of restraint by mechanical means shall be kept
from day  to day ;  and a copy of the records and certificates under this section
shall be sent to the Commissioners at the end of every quarter."
  " In the application of  this section 'mechanical means' shall be such instru-
ments and appliances  as  the Commissioners may, by regulations to be made
from time to time, determine.
  '' Any person who wilfully acts in contravention of this section shall be guilty
of a misdemeanor."

                       LETTERS  OF PATIENTS.

  Section (46).  "The superintendent or proprietor of every asylum, hospital,
and licensed house, and the person having charge of a single patient, shall for-
ward unopened all letters written by any patient and addressed to the Lord
Chancellor or any Judge  in Lunacy, or to a Secretary of  State, or to the Com-
missioners, or any Commissioner, or to the person who signed the order for the
reception of the patient,  or on  whose petition or application such  order was
made, or to the visitors or any visitor or visiting  committee,  or any member of
the visiting committee of  the asylum, or licensed or other house, in which any
patient writing such letters may be, and  may also at his discretion forward to
its address any other letter if written by a private patient."

   Non-compliance with  the  obligations  imposed by this section
subjects the offender to a  penalty not exceeding twenty pounds
for each offence.

   Section (47).  "Whenever the Commissioners in Lunacy shall so direct there
shall, unless there is no private patient therein, be posted up in every asylum,
hospital, and licensed house, printed notices setting forth—
     (a) The right of every private patient to have  any letter  written by him
         forwarded in pursuance of the last  preceding section ;
     (d)  The right of every private patient to  request a personal and  private in-
        terview with a visiting Commissioner or visitor at any visit which may
        be made to the asylum, hospital, or house.
   " The notices shall be posted in the  asylum, hospital, or house, so that every
private patient may be able to see the same.
   '' The visiting Commissioners or visitors may give directions as to the places
in which such notices are to be posted."


   Default in observing such directions renders the  superintendent
or officer in charge of the patients liable to a penalty not exceeding
twenty pounds. 
ENGLAND.
383
                         RELIGIOUS PRIVILEGES.
  SECTION (77).  " The committee of every asylum  may appoint a minister of
any religious persuasion to attend patients of the religious persuasion to which
the minister belongs and may allow him such remuneration for his services as
they think fit."

                 PROTECTION TO FEMALE PATIENTS.

  SECTION (83).  "It  shall not  be lawful to employ any male person in any
asylum, registered hospital, or licensed house in  the personal custody or restraint
of any female patient; and any person employing a male person contrary to
this section shall be liable to a penalty not exceeding twenty pounds :  Provided
that this section shall not extend to prohibit or impose any penalty on the em-
ployment  of male persons on such occasions of urgency as may, in the judgment
of the superintendent or proprietor, render such employment necessary ; and the
superintendent or proprietor shall in each case report such employment of a male
person to  the visiting Commissioners  or visitors at their next visit."


                     REPORTS BY  COMMISSIONERS.

  Section (74).  "  The Commissioners shall at the expiration  of  every six
months report to the Lord Chancellor the number of visits they have  made and
the number of patients they have seen.
  " They shall also in  or before  the month of June in every year make to  the
Lord Chancellor a report made up  to the end  of the preceding year of  the
condition  of the asylums, hospitals, houses,  and other places visited by them,
and of the care of the patients therein, with such other particulars as they think
deserving  notice.
  '' They  shall lay  copies of the  reports to be made under this section before
Parliament within one month after  the same shall have been made if Parliament
shall be then sitting, or within twenty-one days  after the commencement of  the
next session."

           SALARY AND QUALIFICATION  OF SECRETARY.
  Section (75).  " The salary of the secretary to the Commissioners shall be of
such amount as the Treasury, with the concurrence of the Lord Chancellor, shall
from time to time determine, and every person appointed after  the passing of
this Act to the office of  secretary to  the Commissioners shall be a barrister-at-law
of at least seven years' standing,  and shall for  all purposes be deemed to be a
permanent civil servant of the State."

                   DEFAULTS AND MISDEMEANORS.

  SECTION (85).   "  Any person who makes default in sending to the Commis-
sioners or  any other  person any return, report, extract, copy, statement, notice,
plan, or document, or any information within his knowledge  or obtainable by
him, when required so  to do under this Act or any other Act relating to lunacy, 
384
APPENDIX.
or any rules made under this Act or in complying with the said Acts or rules,
shall for each day  or part  of  a day during which the  default continues be
liable to  a penalty  not exceeding ten pounds, unless a penalty is expressly
imposed by this or any other Act for such default ;  Provided that all or any part
of the cumulative penalties may be remitted by the Court in any case in which
it shall be made to  appear to the satisfaction of the Court that the original
default, or its continuance during any period of time, arose from mere accident
or oversight, and not from wilful or culpable neglect on the part of the person
sued for such penalty.
   "Any person  who obstructs any Commissioner or visitor  in  the exercise of
the powers conferred by this or any other Act relating to lunacy shall for each
offence be liable to a  penalty  not exceeding fifty pounds, and shall also be
guilty of a misdemeanor."


            POWER OF COMMISSIONERS TO MAKE  RULES.

   Section (88).   " It shall be lawful for the Commissioners,  with the approval
of the Lord Chancellor, from time to time, by rules, to prescribe the books to
be kept in asylums,  hospitals, licensed houses, and houses for single patients,
and the entries  to be made therein, and the returns, reports, extracts,  copies,
statements, notices, plans, documents, and information to be sent to the Com-
missioners or any authority or  person, and the persons by whom, the times
within which, and the manner in which, such entries, returns, reports, extracts,
copies, statements, notices, plans, documents, and information are to be made
and sent;  and also by  rules  to  prescribe  forms for  the  purposes aforesaid in
addition to or in substitution for any forms now in use."


 POWER OF  LORD CHANCELLOR TO AMALGAMATE  LUNACY DE-
                              PARTMENTS.

   Section (87).   " The Lord Chancellor may at any time after  the commence-
ment  of  this Act, if it shall seem expedient to him so to do, by any order or
orders under his hand, amalgamate the office of the Masters in Lunacy and
their staff, and the  office of the Lord Chancellor's  Visitors of Lunatics and
their staff, and may amalgamate such offices, or either of them, with the office
of the Commissioners in Lunacy, and may give such directions as he may think
fit for the reconstitution of  the Commissioners in Lunacy, and for the exercise
and performance of  the powers and  duties of the Commissioners, and of the
officers and staff amalgamated respectively under any order under this section.
   " In the event of any such amalgamation, the Lord Chancellor may, with the
concurrence of the Treasury, fix the qualifications and salaries of the members
of the amalgamated office and of the staff attached thereto,  and  may, with
such concurrence, from time to  time increase and  diminish the number of such
members and staff.
   '' An order under  this section shall not be made so as to prejudice the rights
of the Masters, Visitors, and Commissioners respectively holding office  at the
passing of this Act." 
ENGLAND.
385
   The  following forms are prescribed by this Act:

                                  Form  i.
        Petition for an Order for reception  0/ a Private Patient.
  In the matter of A.B. a person alleged to be of unsound mind.
  To His Honour the judge of the county court of                        [or To
             stipendiary magistrate for                      or To
  a justice of the peace for                .]
  The petition of CD. of [1]          in the county of
  1.  I am             [2] years of age.
  2.  I desire to obtain an order  for the reception of A.B. as a lunatic  [3] in the l™*' £*ofes~
          asylum [or hospital or house as the case may be~\ of                   occupation.
 ...        r  n                                                                 I2) At least
situate at  [4J                                                                 twenty-one.
  3.  I last saw the said A .B. at            on the [5]        day of             or person of
                                  .                                           unsound mind.
  4.  I am  the           [6] of the said A.B. [or if the petitioner is not connected [a\ Insert a
with or related to the patient state as follows ;]                                0Uf the^\Ime°n
  I am  not  related to or connected with the said A .B.   The reasons  why this ?"d locality of
   ...                           .                                         the asylum,
petition is  not presented by a  relation  or connection  are as  follows : [State hospital, or
..   n                                                                        licensedhouse,
tHem\.                                                                       or the full
  The circumstances under which this petition is presented by me are as follows : namd' ac*dress'
[Stale them].                                                                 tion of the
                                                                             person who is
  5.  I am not related to or connected with either  of the  persons  signing the to take charge
certificates which accompany this petition  as (where the petitioner is a man) as a single
husband, father,  father-in-law, son, son-in-law, brother,  brother-in-law, partner FY's"'"    da
or assistant, (or where the petitioner is a woman) wife, mother,  mother-in-law, within 14 days
daughter,  daughter-in-law, sister, sister-in-law, partner or assistant.             of the presen-
  6.  I undertake  to  visit  the said A.B.  personally or by  some  one  specially petition.
appointed  by me at least once in  every six  months  while under care and [^ connection
treatment under  the order to be made on this petition.                      or relationship
                                                                             with the
  7.  A  statement of particulars  relating to the  said  A.B. accompanies this patient.
petition.
  If it is the fact add :
  8.  The said A .B. has been received in the                  asylum [or hospital
or house as the case  may be] under an urgency order dated the
  The  petitioner  therefore prays  that  an order may  be  made  in accordance
with the  foregoing statement.
                                 [Signed]
Dated.                                     full Christian and surname.
                                   Form 2.
                         Statement of Particulars.
  Statement of particulars  referred to in the annexed petition [or in the above
or annexed order].
  The following is a statement of particulars relating to the said A .B. [1] :—      [1] If any
              •      .  , y-i,  •   -                v                               particulars
  Name of patient, with Christian name at length.                              are not
         S,                                                                     known, the
   ex and age.                                                                fact is to be
 fMarried, single or widowed.                                                  ??,Statedi
                          .              ,.,    .                              [Where the
 tRank, profession,  or previous occupation (if any).                             patient is in
 . ~  ,. .           .                                                           the petition or
 tRehgious persuasion.                                                        OI.deHr de.
  Residence at or immediately previous to the date hereof.                      scribed as an
                                                                              idiot omit the
 tWhether first attack.                                                        particulars
Age on first attack.
marked t.] 
386
APPENDIX.
 When and where previously  under care and treatment as a lunatic, idiot, or
   person of unsound mind.
tDuration of existing attack.
 Supposed cause.
 Whether subject to epilepsy.
 Whether suicidal.
 Whether dangerous to others and in what way.
 Whether any near relative has been afflicted with insanity.
 Names, Christian names, and full postal  addresses of one or more  relatives  of
   the patient.
 Name of  the person to whom  notice of death is to be sent, and full postal
   address if not already given.
 Name and full postal address of the usual medical attendant of the patient.
                                               (Signed)
  When the petitioner or person sign-
ing an urgency order is not the person
who signs the  statement,  add the
following particulars concerning the
person who signs the statement.
Name with Christian name at length.
Rank, profession,  or  occupation  (if
  any).
How  related to  or otherwise  con-
  nected with the patient.
[i] Address
and descrip-
tion.
[2J Or an idiot
or person of
unsound mind.
[3] Or hospital
or house or as
a single
patient.
[4] To be ad-
dressed to the
medical super-
intendent of
the asylum or
hospital, or
to the propri-
etor or super-
intendent of
the house in
which the
patient is to
be placed.
                                  Form 3.
Order for reception of a private patient to be made by a "Judge of County Courts,
    Stipendiary Magistrate, or  Justice  appointed  under  the Lunacy Acts
    Amendment Act, 1889.
  I, the undersigned E.F., being the Judge of the County Court of
[or the Stipendiary Magistrate for              Justice for            specially
appointed under the Lunacy Acts Amendment Act, 1889] upon the petition of
CD., of [1]            in the matter of A.B., a lunatic, [2] accompanied by the
medical certificates of G.H. and I.J. hereto annexed, and upon the undertaking of
the said CD. to visit the said A .B. personally or by some one specially appointed
by the said CD. once at least in every six months while under care and treatment
under this order, hereby authorize you to receive  the  said A.B. as a patient into
your asylum [3].   And I  declare that I  have [or have not] personally  seen the
said A .B. before making this order.
  Dated
                                    (Signed)    E.F.,
                                              The Judge of the County Court
                                                of
                    [or a  Stipendiary Magistrate, or a Justice for
appointed under the above-mentioned Act.]
  To [4]
Form 8.
[1] Insert
residence of
patient.
[2] City or
borough, as
the case may
be.
[3) Insert pro-
fession or
occupation, if
any.
                     Certificate of Medical Practitioner.

  In the matter of A .B. of [1]              in the county [2] of            [3]
                             an alleged lunatic.
  I, the undersigned CD., do hereby certify as follows :
  1. I am a person registered under the Medical Act, 1858, and I  am in the actual
practice of the medical profession. 
ENGLAND.
387
  2.  On the                day of               18  , at [4] in the county [5] of Ul Insert the

               [separately from any other practitioner] [6], I personally examined na^on°, living

the said A.B. and came to the conclusion that  he is a [lunatic, an idiot, or a per- H!e name°f
     fj*j-ij                                           if   the street,
son ot  unsound mind] and  a proper person to  be taken charge of and detained with number

under care and treatment.                                                     housTo^
                                                                              should there
                                                                              be no number,
                                                                              the Christian
                                                                              and surname
                                                                              of occupier.

  3.  I formed this conclusion on the following grounds, viz. :—                   boVough^as

  (a) Facts  indicating insanity observed by myself at the time of examination be6 °a£
    [7], viz.:—                                                               [6] Omit this
                                                                              where only
                                                                              one certificate
                                                                              is required.
                                                                              [7] If the same
                                                                              or other facts
                                                                              were observed
                                                                              previous to the
                                                                              time of the
                                                                              examination,
  fi\ t-                 , ,    .      .     w                                   the certifier is
  (.b) b acts communicated by others, viz.:—[8]                                  at liberty to
                                                                              subjoin them
  r,,               j.j.     .       ...                                      in a separate
  [If an urgency certificate is required it  must be added here.  See Form 9.]    paragraph.
                                                                              [8] The names

  If the lunatic is to be received as a single patient in a house belonging to or n"mesh(riftian

kept by a medical practitioner under the order of a county court judge, magis- known) of in-

trate, or justice, add the following paragraph :—                              given, with
                                                                              their addresses
  4. I certify that the said A.B. is suffering from unsoundness  of mind of  a tem- and descrip-

porary character [or from decay of mind in old age, or is desirous of voluntarily

submitting to care and treatment, as the case may be],


  5. The  said A.B. appeared to me to be [or not to bel in a fit condition of  bodily
,   , .     .         .         ,    ,.,,.,,      r -,                [9] Strike out
health to  be removed to an asylum, hospital, or licensed house. [9]                this clause
                                                                              in case of a

  6. I give this certificate having first read the section of the Act of Parliament whose removal

printed below.                                                                is no' Pro"
r                                                                             posed.
  Dated                           (Signed)        CD. of [10]                [10] Insert full
                                                                              postal address.

      Extract from section 23 of the Lunacy Acts Amendment Act, 1889.


  Any person who makes a wilful misstatement of any material fact  in any medi-

cal or other certificate or in any statement or report of bodily or mental condition

under the Lunacy Acts, or under this Act, shall be guilty of a misdemeanor.
                                   Form 9.

                   Statement accompanying Urgency Order.

  I certify that it is expedient for the welfare of the  said A.B., [or for the public

safety, as the case may be] that the said A .B. should be forthwith placed under

care and treatment.

  My reasons for this conclusion are as follows : [state them].
                                   Form 12.

                   Order for reception of a Pauper Lunatic.

  I, CD., having called to my assistance E.F. of               , a duly qualified

medical practitioner, and being satisfied that A .B. [describing him] is  a pauper

[in receipt of relief, or in such circumstances as to require relief for his proper care

and maintenance], and  that the said A.B. is a lunatic [or an idiot, or a  person of

unsound mind] and a proper person to be taken charge of and detained under care 
APPENDIX.
and treatment, hereby direct you to receive the said A.B. as a patient into your
asylum [or hospital, or house].  Subjoined is a statement of particulars respecting
the said A .B.
                              (Signed)    CD.,
                                       A justice of the peace for
    Dated the       day of       one thousand eight hundred and
  To the superintendent of the asylum for the county [or borough] of
[or the lunatic hospital of             ; or E.F.              proprietor of the
licensed house of           ; describing the asylum, hospital, or house].
  Note.—Where the order directs the lunatic to be received into any asylum, other
than an asylum of the county or borough in which the parish or place from which
the lunatic is sent is situate, or into a registered hospital or licensed house, it shall
state, that the justice making the order is satisfied that there is no asylum of such
county or borough, or that the asylum thereof is full; or (as the case may be) the
special circumstances, by reason whereof the lunatic cannot conveniently be taken
to an asylum for such first-mentioned county or borough.

  The statement of particulars which must accompany the above order
is the same as that which accompanies the order for the reception of a
private patient (Form 2), except that the name of the union to which
the lunatic is chargeable is inserted,  and the name and postal address
of the usual medical attendant of the patient  are omitted.   The state-
ment is signed by a relieving officer or overseer.
                                Form 13.

             Certificate that patient continues of unsound mind.

  I,                       , certify that A.B., the patient [or A.B., CD., &c,
the patients]  to whom  the annexed report relates, is [or are] still of unsound
mind, and a proper person [or proper persons] to be detained under  care and
treatment.
                               (Signed)
                                      Medical officer of the         asylum,
                                        or  medical   attendant   of   the
                                                 hospital or         house
                                        situate at              , or medical
                                        practitioner visiting the said A .B.
  Dated
                                Form 15.

Order for Reception of a Lunatic not under proper care and control, or cruelly
    treated or neglected, to be made by a Justice appointed under the  Lunacy
    Acts Amendment Act, 1889.

  I, the undersigned CD., being a Justice for                specially appointed
under  the Lunacy  Acts  Amendment Act, 1889,  having caused  A .B.  to  be
examined by two duly qualified medical practitioners, and being satisfied that
the said A.B. is a lunatic not under proper care and control [or is cruelly treated
or neglected by the person having the care or charge of him,] and that he is a
proper  person  to  be taken charge of  and detained under care and  treatment,
hereby direct  you to receive the said A.B. as a patient into your asylum [or 
IRELAND.
389
hospital or house].  Subjoined is a statement of particulars respecting the said
A-B-                      (Signed)
                            A justice of the peace for
                              appointed under the above-mentioned
  Dated                         Act
        To the Superintendent of the Asylum for        ,     , or of the
          lunatic hospital of           , or the proprietor of the licensed
          house at
  The statement of particulars which must accompany the above order
is the same as that which accompanies the order for the reception of a
pauper patient, and is signed by a relieving officer,  overseer, or other
person on whose information the order is made.

                         SCOTLAND.
  On January 1,  1889, there  were  under  the cognizance  of  the
Scotch  Lunacy Board 11,954 lunatics.  The estimated population
of Scotland, July, 1888, was 4,034,156.  This gives the proportion
of lunatics  to the whole population as 1 to 337.  Twenty years
ago it was 1 to 448.
  The  lunatics above mentioned  were,  on the  ist  of January,
1889, distributed as follows : in the royal asylums there were
3,438 ; in the district asylums, 3,269 ;  in private  asylums,  158 ; in
parochial asylums, 1,493 '■> m the lunatic wards of poorhouses, 878 ;
in private dwellings, 2,428 ; in the lunatic department of the gen-
eral prison  at Perth, 57 ; and  in the training institutions for im-
beciles  and idiots, 233.  Of the above, 10,004 were  maintained
out of parochial rates, 1,893 from  private  sources, and  57  at the
expense of  the State.
  The average weekly per-capita cost of maintenance of pauper
lunatics in royal, district, private, and parochial asylums, and in
schools for imbeciles during  the year ending May 14,  1888,  was
gs. g\d.j  in lunatic wards of poorhouses, js. if </./ and in private
dwellings, 5^. nf</.   By comparing these figures with those pre-
viously  given, it will be seen that the  cost of  supporting pauper
lunatics in  Scotland did not vary materially from that of the pre-
ceding year.  It was a little less in the asylums and a little more
in the poorhouses and in private dwellings.
                          IRELAND.
  The number of lunatics in Ireland on the ist of January, 1889,
as given in  the official repoft of Inspector Nugent,  was 15,685.
These were distributed  as follows : in district asylums, 10,825 ;
in private asylums, 609 ; in poorhouses, 4,083 ;  in the criminal
lunatic  asylum, 168.
  The average weekly per-capita cost of maintenance in district 
39°
APPENDIX.
asylums during the year 1888 was 7^. 1 id. In cost of maintenance
are included in Ireland, as heretofore stated, salaries and wages,
provisions, clothing,  bedding, furniture,  household  supplies,
medicines, incidental expenses, superannuations,  and repairs and
alterations.
  The number of insane in Ireland in proportion to the sane
population is large.   Inspector  Nugent attributes  this to emi-
gration.  In his official report  on lunacy made July 2,  1889, he
says :  " The  continued and progressive decrease of the  popu-
lation of this country to the extent of 776,000 individuals within
the present decade, of whom no less than 78,600 emigrated last
year, has materially influenced, as regards Ireland, the proportion
between the sane  and insane.  The result is that  about  36 to
10,000 would  at  present  represent with  us  the proportion of
insane to the sane."  Mr. Nugent does not give the proportion of
lunatics to population, which would enable a comparison  to be
made on this basis with former years.

                          FRANCE.
  No  changes have as yet been  made in the French lunacy
laws of June 30, 1838, and  December 18, 1839, which  still con-
stitute the lunacy laws of France.  The bill making many alter-
ations in  these laws, which  was prepared by the Government a
few years ago and debated by the Senate in  1886 and 1887 and
finally passed by that body, is still pending.  Mr. Whitelaw Reid,
United States Minister at Paris, in a letter  received from him
dated  July 11, 1889, expresses the opinion that the new bill will
not be adopted by the present Chamber. 
INDEX.
Aarhuus, asylum at, 209
Accounts, public, 359, 381
Acute Insane, provision for, 297
Admission of  patients, in England, 27,
  366; in  Scotland, 118; in  Ireland,
  180 ; in  France,  199 ;  in  Belgium,
  201 ;  in  Prussia, 203 ; in Province
  of Saxony, 281 ; in Switzerland, 220 ;
  (Resume), 347
Air-space,  306
Alcoholic stimulants, 342
Alt-Scherbitz  Provincial Asylum, situa-
  tion, central buildings, Manor House,
  cottages,  land, 279 ; grounds, memo-
  rial  of   Professor  John   Maurice
  Koeppe,  object  of  asylum, super-
  vision,  control,  management,  280;
  medical   staff,    officers,   class  of
  patients  received, admission,  281 ;
  discharge,  release  on trial,   282 ;
  classification, rates charged, recep-
  tion stations,  observation   stations,
  detention   houses,  administration
  building, 283 ;  hospital,  description
  of   central  institution   buildings,
  284;  isolation   rooms, 285 ;   non-
  restraint,   strong  dresses,  attend-
  ants,   medical   examination,   286 ;
  villas,  furniture and furnishing, 287 ;
  hamlet, two-story pavilions, kitchen,
  vehicle for  carrying food, 288 ;  heat-
  ing, water, bucket system, farm build-
  ings,  dairy, brick-yard,  hot-house,
  fish-pond,   orchard,   employment,
  289 ;   excursions,  theatrical  enter-
  tainments,  concerts, dances,  bowl-
  ing,  swimming-bath,   correspond-
  ence, 290 ;  visits by  relatives  and
  others,  a fundamental principle in
  treatment, 291
America, early provision  for insane in,
  11 ; initial point of hospital treatment
  in, 11 ;  first State asylum in,  12 ;
  establishment of hospital for insane
  by Society of Friends in, 12
Amusements,  47, 54, 57. 63, 67, 74, 82,
  89, 98, 101,  107, 183,  185,  191,  215,
  223, 228, 234, 290 ;  (Resume), 329

                                     391
Andrews, Dr. J. B., 324
Arthur's Seat, 168
Asylum at Jerusalem, 6
Asylums for the chronic insane, 304, 305
Attendants, 49, 51, 56, 65, 79, 93, 143,
  149,  157, 163,  192,  215,  222,  223,
  229, 234,  286 ; (Resume), 322, 327

Banstead Asylum,  object,   Commit-
  tee of Visitors, 55 ; situation, quan-
  tity of land, buildings, medical staff,
  officers and employees, attendants,
  airing-courts,  56 ;   restraint, dress,
  tell-tale  clocks,  electric  fire-bells,
  fire-brigade, general kitchen, water
  supply, employment, amusements, li-
  brary, 57  ; dramatic entertainments,
  picnic  excursions,  asylum  band,
  dances, chapel,  cost  of maintenance,

Barony  Parochial Asylum   (Lenzie),
  management,    class  of   patients
  received,  situation,  freedom  from
  restraint,  land, farm dwellings, 142 ;
  porter's  lodge,  buildings,  grounds,
  officers, attendants, dormitories, 143;
  single rooms, strong rooms, infirmary
  wards, aviary, 144 ;  bath-rooms,  wa-
  ter distribution, sewing-rooms, enter-
  tainment hall, dances, asylum band,
  reading  matter, dining-hall,  food,
  145 ;  kitchen,  non-restraint,  146 ;
  employment,  tact  in management,
  farm stock, sewerage, 147 ; laundry,
  dress, uniforms, 148 ; rules govern-
  ing night  attendants, 149 ;  daily rou-
  tine,  150 ; glazed corridors, chapel,
  Dr.  Rutherford's views  respecting
  non-restraint, 151 ;  stimulating bev-
  erages, milk,  152 ;  Muckroft Farm,
  Farm Steading,  Fauldhead, cost of
  maintenance,  153
Bath and dressing rooms, 309
Belfast Asylum, class of patients, 184 ;
  chronic  cases,  buildings,  grounds,
  single  rooms,   dormitories, dining-
  hall, employment, airing-courts, ball-
  playing, asylum band, 185 
392
INDEX.
Belgium, reorganization  of lunacy sys-
  tem  in  1850, use of  wooden  cages
  forbidden, 197 ; boarding the insane
  in families, 200 ;  Lierneux,  popula-
  tion,  number  of  insane,  support
  of pauper lunatics, government and
  municipal  asylums,  private estab-
  lishments, admission of patients, 201  ;
  visitation and  inspection,  discharge
  of patients, 202 ;  Gheel (see  G.)
Belt and leg-chain,  10
Bethlem Hospital, 15, 16, 18, 19
Bevan, Mrs. Elizabeth,  159
Bicetre, 7, 195, 224
Birmingham Borough Asylums  :
  Winson  Green, situation,  buildings,
    grounds, management, 103 ;  fur-
    nishings, padded rooms,  refractory
    wards,  restraint,   seclusion,  em-
    ployment,  uniforms,  dress, 104  ;
    airing-courts, experience of an old
    superintendent,  105 ;  calisthenics,
    singing  classes,  cost  of  mainte-
    nance,  106
  Rubery Hill, object,  situation, 104  ;
    cost of  maintenance, 106
Blackstone, 17, 355
Blair, Dr. Robert, 153
Bloomingdale Asylum, 13
Boarding-out, in Scotland,  115, 130;
  in Belgium,  200  ; in  Norway, 206  ;
  (Resume), 352
Board of Control (Ireland), 175, 178
Board of Guardians (England), 42
Boards of Governors (Ireland), 179
Borough Muir,  168
British specialists, criticisms by, 13
Brookwood Asylum (see Surrey County
  Asylum)
Brushfield, Dr., 78, 80,  81
Buildings,   297 ; objections  to large
  mixed asylums, 298 ;  need of small
  hospitals  for the  acute insane, 299  ;
  plan of hospital, 300 ;  reception and
  other cottages, 301 ;  connecting cor-
  ridors, 302 ;  provision for the chronic
  insane,  303 ;  construction of build-
  ings, 305
Bulckens, Dr.,  250, 259
Burgholzli Cantonal Asylum, situation,
  medical staff, buildings, 219 ; admis-
  sion,   object,   classification,   rate
  charged for  pauper  patients, land,
  airing-courts, dining-halls,  dormito-
  ries,  single  rooms,   220  ;  chapel,
  amusement  hall, strong    dresses,
  muffs, refractory ward, isolating cells,
  hot-water baths, 221 ;  bucket system,
  attendants,  heating,   employment,
  causes of insanity in Switzerland, 222
Case, Dr., 61
Caterham Metropolitan Asylum, object,
  management, supervision, situation,
  land, buildings,  64 ;  single  rooms,
  class of patients,  attendants, cost of
  maintenance, infirmary, 65 ; restraint
  and seclusion, padded  rooms,  day-
  rooms, 66 ;  water  supply,  Turkish
  bath, swimming-bath, kitchen, uni-
  forms,  dress  of   patients,   asylum
  band,  amusement  hall,   theatricals,
  singing class,  library,  67 ;  outdoor
  sports, indoor games, walking par-
  ties, chapel, accounts,  original out-
  lay, 68
Charenton   Asylum,  7, 226 ;   class of
  patients, history of institution, build-
  ings, chapel, the Seine, airing-courts,
  226 ; medical staff, Sisters  of St.
  Augustine, uniforms, heating, dining-
  rooms, wine, diet, 227 ;  dormitories,
  hydropathic  . treatment,    reading-
  room,  library, billiard-room,  amuse-
  ment-room, refractory wards, seclu-
  sion, 228  ; restraint, rates of mainte-
  nance,  attendants,  single   rooms,
  bric-a-brac, 229
Chartered or Royal Asylums (Scotland),
  115 .
Chronic Insane, provision  for,  303
Circulating  Swing, 9
Clermont Asylum,  229 ; situation, dis-
  tribution  of  patients, rates  of  pay-
  ment, 230
  Central Institution, 230 ; classifica-
     tion, accommodations, dormitories,
     infirmary,  restraint, 231 ; isolating
     cells, restraining chairs, camisoles,
     airing-courts, 232 ; summer pavil-
     ion, dress, buildings, grounds, 233
  Colony of Fitz-James, 233 ;  billiard-
     room,   library,  furniture,  attend-
     ants,  dormitories, Little  Chateau,
     laundry,  234 ;  land,   agriculture,
     235 ; farm  buildings  and  stock-
     yards,  farm  stock, rabbits, prizes,
     accommodation for farm laborers,
     sewage system,  236 ; employment,
     flouring mills, forge and  machine-
     shop, cement-mill, cider-mill, bak-
     ery, abattoir, dairy, 237
  Colony of Villers, objects, open-door
     system, 237 ; attending church, re-
     wards for work, 237
Clouston, Dr. T. S., 158, 313,  324, 330
Colney Hatch Asylum, 35, 45; situation,
  buildings, porter's lodge, land, class
  of patients, Committee of Visitors, 45;
  Victoria  Fund, interior decorations,
  single rooms,  dormitories,   sitting- 
IND.
  rooms,  46 ;  amusements,  classifica-
  tion, infirmary, dining-halls, employ-
  ment, 47 ;  laundry, amusement hall,
  dancing,  dramatic  entertainments,
  airing-courts, restraint, 48 ; seclusion,
  padded rooms, attendants, uniforms,
  heating, ventilation, chapel, 49 ; cost
  of maintenance, 50
Commission appointed by Royal College
  of Physicians, 17
Commission, Royal (Scotland), appoint-
  ment of,  1855, investigations  by, re-
  port of, 112
Commission,  Royal  (Ireland),  1857,
  appointment of, report of,  175
Commission of Inquiry (Ireland), 1879,
  recommendations of, 176
Commissioners, 1828, appointed to  li-
  cense  and visit  establishments  in
  metropolitan district,  21
Commissioners  in Lunacy  (England),
  appointment of, 24 ;  powers  of,  24,
  384 ; immediate jurisdiction of, grant-
  ing licenses by, 26 ; statement of, re-
  specting unnecessaiy  detention, 35 ;
  visitation  by,  37, 375; salaries  of,
  expenditures of, 38 ; protest of against
  large asylums, 298  ; views of, respect-
  ing workhouse care, 354 ;  reports by,
  383.
Commissioners in Lunacy  (Scotland),
  establishment  of   Board  of, 114;
  powers and duties of, 117
Committee   of  House   of   Commons
  (1807), inquiry of, 21
Committee   of   House  of  Commons
  (1877),  inquiry of, respecting viola-
  tions of  personal  liberty, opinions
  of, 33
Committee  of Visitors  (England),  by
  whom appointed,  25 ;  powers and
  duties of, 25, 32, 375, 379
Conolly, Dr., 22, 50, 329
Conradsberg Asylum, class of patients,
  buildings, 206 ;  rates charged  for
  maintenance,  classification,   dress,
  furniture and furnishings, dormito-
  ries, refractory ward, single  rooms,
  heating, women's  workroom,  indus-
  tries, weaving, spinning, 207 ; airing-
  courts, chapel, dining-rooms, food, 208
Cork District Lunatic Asylum, situation,
  grounds,  object, building, Board of
  Governors, medical staff, 182  ; house
  staff, single rooms, dormitories, fire-
  places, dining and amusement hall,
  airing-courts, ball-playing, 183 ; land,
  employment, restraint, padded rooms,
  Turkish  bath,  chaplains,   asylum
  band,  184
EX-                             393

 County and  Borough Asylums, objects
   of, management of, 25 ; cost of support
   in, 43, 365 ; private patients in,  372
 Court of Chancery, 17
 Coxe, Dr. James, 348
 Crichton, Dr., in
 Crichton Institute,  111
 Criminal Insane, 351
 Criminal Lunatic Asylum (Ireland), 177
 Criminal Lunatics,  discharge of, 33
 Cromwell, 169

 Dark Ages, ignorance in the, 4
 Demonology, 5
 Denmark, lunacy legislation, 206 ; asy-
   lum at Aarhuus,  asylum  at Vording-
   borg, asylum  for the chronic insane
   at Viborg, 209 ;  St.  Hans Hospital
   (see S.)
 Dietary and  Dining-rooms, 340
 Discharge,  (England),   31,  36,   377 ;
   (Scotland), 121 ; of dangerous luna-
   tics, 123;  on trial, on probation,  124 ;
   (Ireland),  181 ; (France), 199 ;  (Bel-
   gium),  200 ;  (Province  of  Saxony),
   282 ; (Resume), 347
 District Asylums (Scotland),  115 ;  (Ire-
   land),  175, 176
 Dix,  Miss, 12, m
 Donegal District Asylum, situation, 185;
   gateway lodge,  buildings,  grounds,
   single rooms, associated  dormitories,
   open fires, restraint, seclusion, airing-
   courts, industries, 186
 Doors, 307
 Dress and Clothing, 340
 Dublin,  asylum at (see Richmond Asy-
   lum)
 Duncan, Dr. Andrew, 159

 Eames, Dr., 329
 Earle, Dr. Pliny, 250
 Edward II., 17
 Eg, asylum at, 205
 Egyptians, ancient, treatment of insane
   by, 2
 Employment, 47,  52,   57,  72, 80, 87,
   92,  98,  102,  104, 147, 157, 161, 184,
   185, 186, 188, 191, 206, 207, 210, 216,
   218,  222,  237, 273,  289 ;  (Resume),
   332
 England, former treatment of the insane
   in, Bethlem Hospital, early  legisla-
   tion, 15 ;  the insane wandering at
   large, St.  Luke's Hospital, inade-
   quate  provision, public  exhibition of
   the insane, 16 ; appointment of com-
   mission by Royal College of Physi-
   cians, estates of idiots, Chancery care,
   17 ; cruel treatment of the  insane, 
394
INDEX.
  case  of  Xorris,  iS :   York  Asylum,
  York Retreat, 19, 20 ; inquiry of Se-
  lect Committee of the House of Com-
  mons, county and borough asylums,
  appointment, inquiry, and report of
  Metropolitan  Commissioners,   21 ;
  provision for the insane prior to 1844,
  22 ; means of restraint,  Act of 1845,
  erection of asylums made obligatory,
  23 ; appointment and powers of Lun-
  acy Commissioners, building asylums
  made compulsory, 24 ;  object  and
  management of  county and borough
  asylums,  25 ;  maltreatment of  pa-
  tients, licensed houses, 26 ; registered
  hospitals,  admission, 27 ;  discharge,
  31 ; transfer, investigation  (1877) by
  Select Committee of  House of Com-
  mons, 33 ; testimony of Lord Shaftes-
  bury, 34 :  complaints of unnecessary
  detention, 35 ;  liberation on trial, 36 ;
  visitation  by Commissioners in  Lu-
  nacy, 37 ;  estimated cost of lunacy
  supervision, number and distribution
  of lunatics, 38 ; lunatics  in  work-
  houses, government grant, 39; private
  single patients, outdoor  pauper luna-
  tics,  40 ;  metropolitan  district  asy-
  lums, Metropolitan Asylums Board,
  Local Government Board, 41 ; trans-
  fer of insane  to workhouses,  42 ;
  supervision  of  workhouses, cost  of
  maintenance in  county and borough
  asylums, increase of pauper lunatics,
  43 ; lunatics, paupers, population, 44 ;
  Colney  Hatch   Asylum   (see C.) ;
  Hanwell Asylum (see H.); Banstead
  Asylum (see B.) ; Leavesden Metro-
  politan Asylum  (see L.) ;  Caterham
  Metropolitan.   Asylum   (see  C.) ;
  Sussex County Asylum (see S.); Sur-
  rey County Asylum (see  S.); West
  Riding Asylum, Wakefield (see W.) ;
  South  Yorkshire Asylum,  Wadsley
  (see S.) ;  Lancaster County Asylum,
  Prestwich,  (see L.) ;    Lancaster
  County  Asylum, Whittingham  (see
  L.); Birmingham Borough Asylums
  (see B.) ;  Friends' Retreat (see F.)
Esquirol, 195, 226, 228, 241, 277

Fire, protection against, 311
Fire-places,  307, 310
Fitz-James,  colony of (see Clermont)
Flodden Field, 168
Foundation  Walls,  306
Foville, Achille, 200
France, cruel treatment of  the  insane
  in the latter part of  the 18th  and
  early part of the 19th centuries, 195 ;
  present provision for the insane, 197 ;
  establishment of asylums made obli-
  gatory, inspection of public and  pri-
  vate asylums, supervision of public
  asylums,  198 ;  official visitation of
  asylums,  admission, discharge,  199 ;
  right   of  reclamation,  opinion  of
  Achille Foville, 200 ;  La Salpetriere,
  (see S.) ;  Asylum of Ste. Anne  (see
  S.) ; Asylum at Charenton (see C.) ;
  Clermont en Oise (see C.)
Francis,  Dr. Lloyd, 335
Frankford, hospital at, 12
Fraser, Dr., 139
Freedom, greater, 317
Friedrichsberg  Asylum,  government,
  porter's lodge, Pensionnat, principal
  building,    park   and    cultivated
  grounds,   class   of  patients,   212 ;
  variety of   accommodation, routine
  of meals, beer, smoking-room, bath-
  rooms, 213  ;  library,  dining-rooms,
  dormitories,  214 ;  clothing,  valua-
  bles, letters, heating, lighting, bowl-
  ing-green, billiard-room, music-hall,
  chapel, attendants,  salaries,   215 ;
  solitary rooms, refractory  wards, as-
  phalt floors,  chronic insane, two-story
  buildings, yards, non-restraint,  em-
  ployment,   farm stock,  216;  farm
  buildings, classification, 217
Friends'  Retreat, 19, 20, 22,  106 ;  non-
  restraint, William Tuke,  Society of
  Friends,  106 ;   situation,  grounds,
  management, income, buildings, The
  Lodge, Bellevue House,  villa resid-
  ence, interior, sitting-room, religious
  services,  association rooms, lectures
  and  entertainments,  107; rates of
  payment,  cost  of  support, padded
  rooms, strong garments,  seaside re-
  sort, 108
Friends'  Retreat, Pennsylvania, 351
Furnishing and Decoration, 312

Gaustad Asylum, 204 ; situation, build-
  ings,   heating,  dormitories,  airing-
  courts,  rooms  for  the   refractory,
  douche, 205 ; padded rooms, strong
  dresses, employment, 206
George II.,  15
George III., attacked by insanity,  16
Germany,  "mad-houses"  in  (1803),
  194 ;  curative  treatment  in,  197 ;
  asylum care, family care, public and
  private asylums, open asylums (pffene
  Anstalteri)  203 ;  Friedrichsberg Asy-
  lum (see  F.);   Provincial  Asylum,
  Halle  (see  H.) ; Provincial Asylum,
  Alt-Scherbitz (see A.) 
IND*
Gheel, 3,  204 ;  town  of, 239 ;  Church
  of St. Dymphna, 240 ;  religious cere-
  monies, 241 ; legend of St. Dymphna,
  242 ;  commune of  Gheel, 243 ; gen-
  eral description  of,  244 ;   the  In-
  firmary, 245 ;  supervision and  medi-
  cal visitation of  the insane,  246  ;
  inspectors, description  of  Infirm-
  ary, 247 ;  means  of restraint,  hdtes
  and nourriciers, 249 ; treatment of,
  the insane prior to 1851, 250;  class
  of patients, rates  of payment,  251  ;
  inspection of  town dwellings,  253  ;
  inspection of  cottages  in  the  coun-
  try,   263 ;  regulations   regarding
  labor,  etc.,   rewards  for   work,
  273 ;  advantages  and disadvantages,
  274
Gifts of land, 296
Glen-na-galt, 3
Gloucester,  22
Government  Grant  (England),  39  ;
  (Scotland), 127 ;  (Ireland), 177 ; 358
Greek Medical School, 2
Grounds,  314

Halle  Provincial Asylum, class of pa-
  tients,  government, location,  build-
  ings, land,  employment,  improve-
  ments, sewerage, gas and water pipes,
  218 ;  farm cottage, infirmary,  sani-
  tary  arrangements, unlocked doors,
  associated dormitories, single rooms,
  219
Hamburg, asylum near (see Friedrichs-
  berg)
Hanwell Asylum, class of patients, situa-
  tion,  buildings,  land,  50 ;  hospital
  for  infectious diseases,  attendants,
  uniforms, ventilation,  thermometers,
  proportion of single rooms, decora-
  tions,  furniture,  51 ;  employment,
  52 ; restraint, strong dresses, padded
  rooms,  53 ; seclusion,  airing-courts,
  clothing,  amusement  hall,  dancing
  parties,   outdoor*  games,   picnics,
  reading matter,  religious   services,
  cost of  maintenance, 54
Haywards Heath, asylum at (see Sussex
  County Asylum)
Henley, Inspector, 42, 354
Henry VIII., 15
Hill,  Dr.  R. Gardiner, 18, 22,  no
Holy Wells, 3
Hospice St. Vincent de Paul, 178
Hospitals, 299, 304
Hotel  Dieu, 196
Houses of Industry (Ireland),  174

Idiot, definition of term, 17
ex.                             39S


Infirmary Accommodation, 307
Insane, The, need  of  public provision
  for,  1 ;   treatment  of  by  ancient
  Egyptians, supposed to be possessed
  by demons, 2 ; provision for by Mo-
  hammedans, provision for and treat-
  ment of in  Spain, 6;  exhibited  in
  cages, 6,  16 ; cruel  treatment  of, 2,
  6, 18, no, 173, 194,  195
Insanity, in the Middle Ages, 2 ; strange
  devices for treatment of, 8
Inspectors (Ireland), 178, 179
Ireland, Dean Swift, St. Patrick's Hos-
  pital,  neglect  of the insane, 172 ;
  cruel treatment,  lack of asylum ac-
  commodation, 173 ;  governmental in-
  quiry, 18 ro,  asylum  built in  Dublin,
  Houses of Industry, successive Parlia-
  mentary inquiries, Act of 1821, legal
  status of the insane prior to 1821,
  provisions of the  Act of 1821, forma-
  tion of districts,  174 ; establishment
  of Board of Control, asylums built,
  government  loan, expenditures,  ap-
  pointment  of  Royal  Commission
  1857,  report of  same, 175 ; recom-
  mendations of Commission of Inquiry
  1879,  lunatics  at large, population,
  number and distribution of lunatics,
  176; cost of maintenance in district
  asylums,  government grant, cost of
  maintenance  in  poorhouses,  inade-
  quate provision for the chronic insane,
  government of lunatics in poorhouses,
  Local Government Board, 177  ; con-
  dition of poorhouses, private asylums
  and licensed establishments,  Board
  of Control, Inspectors, 178 ; visitation
  by Inspectors and reports of, Boards
  of Governors, appointment of medical
  officers,  granting licenses, 179; dan-
  gerous lunatics, admission, 180 ; dis-
  charge,  insufficiency of land, 181 ;
  industries, 182 ;  Cork District Asy-
  lum  (see C.) ; Belfast Asylum (see
  B.) ; Donegal District Asylum (see
  D.)  ;  Richmond District   Asylum
  (see R.)

James IV., 168
James V., 169
James VI. of Scotland, 5
Jerusalem, asylum at,  6
Justices required to provide asylums, 23,
  24 ;  required to appoint committees
  to build asylums and committees to
  manage  same, 25 ;  empowered  to
  grant  licenses, 26 ; required  to ap-
  point Visitors to licensed houses, 27 ;
  order of, 28 ; appointments by, 369 
396
INDEX.
Labitte, Dr. George, 230
Labitte, Dr. Gustave, 230, 236
Lalor,  Dr. Joseph, 106, 1S7, 188, 193
Lancaster County, population,  paupers,
  pauper lunatics, 94
Lancaster County Asylum (Prestwich),
  situation,   buildings,  94;  porter's
  lodge,  dress of patients, annexe, in-
  firmary wards, convalescent wards,
  95 ;  ward for refractory female  pa-
  tients,  single rooms, heating, dormi-
  tory,  padded  rooms, seclusion, 96 ;
  dining-halls, entertainment  hall,  use
  of beer, 97 ;  land, employment, farm-
  house,  detached   cottage,  walking
  parties,  dancing,   theatrical  enter-
  tainments, chapel, causes of insanity
  of inmates, 98
Lancaster County Asylum (Whitting-
  ham), situation, buildings, land,  an-
  nexe,  dormitories,  thermometers,
  100 ; day-rooms, padded rooms, non-
  restraint, strong dresses, wet  packing,
  dining and  amusement hall, airing-
  courts,   walking  parties,  outdoor
  recreation, theatricals, 101 ;  concerts,
  employment, washing by hand, cost
  of maintenance, heating, 102 ;  relig-
  ious services, 103
Land for institutions for the insane, 294
Lawson, Dr.,  140
Leavesden Metropolitan Asylum, situa-
  tion, outlay per capita,  management,
  58 ; officers and employees, buildings,
  conservatories, 59 ; heating, descrip-
  tion of interior, electric clocks,  60 ;
  hydropathic treatment,  61 ;  laundry,
  water supply,  sewage, restraint, pad-
  ded rooms, seclusion, recreation hall,
  62 ; amusements, costume ball, walk-
  ing parties,  dress of patients, chapel,
  library,  63;  cost  of   maintenance,
  64
Lenzie, asylum at (see Barony  Parochial
  Asylum)
Letterkenny,  asylum  at  (see Donegal
  Asylum)
Letters,  290, 344 ; 382
Ley,  Dr., 95, 98, 326
Licensed Houses (England),  26,  380;
  Visitors of, medical attendance at, 27 ;
  order for admission to, notice of ad-
  mission to, 29, 30 ;  (Scotland), con-
  dition of insane in, 113 ;  number of,
  115  ; medical visitation of, 126 ; (Ire-
  land), 178, 179 ;  (France),  establish-
  ment  of, 198  ; (Belgium),  establish-
  ment of, 201
Lierneux, insane colony at, 201
Lincoln  Asylum, 22
Local  Government  Board  (England),
  supervision by, salaries of Inspectors
  of, 38 ;  reports to, 43
Local Government Board (Ireland), 177
Local or District Care, 356
Location, 293
Lochmanur,  3
Loch  Maree, well of, 4
Lord  Chancellor, appointments by, 38,
  369 ;  powers of, 384
Lunacy  Legislation (England),  1744,
  15 ; 1774, 17 ; 1808, 1828, 1832, 1842,
  21 ;  Act of 1845, 23, 34, 36 ;  Act of
  1853, 24, 30, 31 ;  Act of 1862, 30, 37,
  42 ;  1868,  42 ;  Act  of  1889,  366 ;
  (Scotland), 1815, 1829,   1841,  in ;
  Act  of  1857,  114 ; 1862, 1866, 120,
  124 ; 1880, 120 ; (Ireland), 1821, 174 ;
  (Belgium),  1850,  197 ;  (Norway),
  (Sweden), (Denmark), 206 ; (France),
  39°
Lunatic, definition  of term, 17, 24
Lunatics, estates of, 17, 374 ; distribu-
  tion  of  (England),   38,365 ;   (Scot-
  land), 126, 389 ;  (Ireland), 176, 389

Macdonald, Dr. A. E., 309
MacDonald, Dr. Carlos F., 352
McLean Asylum, 12, 351
Mary Queen of  Scots, 168
Masters in Lunacy, salaries of, 38
Medical Certificates, 27, 28, 29,  30, 31,
  37, 119, 120, 122, 123, 129,  179, 180,
  199, 201, 203, 281, 370,  371, 372
Medical Officers, 321
Menstone, asylum at, 83, 302
Metropolitan Asylums Board, 41, 58
Metropolitan Commissioners in Lunacy,
  appointment of, report of, 21
Metropolitan District Asylums, 41
Middle Ages, insanity in, 2 ; practice of
  medicine by monks in, 4 ; asylumsin,6
Middlesex  County, area,  population,
  paupers, 45
Mid-Lothian and Peebles District Asy-
  lum, situation,  management,  land,
  buildings, grounds, cottages,  private
  patients, rates for maintenance, dor-
  mitories, 154; single rooms, heating,
  ventilation, lighting, day-rooms, 155 ;
  billiards, lavatory, infirmary wards,
  dining-hall,  food, chapel, 156 ; pad-
  ded rooms, non-restraint, attendants,
  employment, dress,  157
Mitchell, Dr.,  93,  339
Mitchell, Sir Arthur, 121
Mohammedans, care of insane by, 6
Monks at Saragossa, 6
Morningside, asylum at, 158
Murray's Royal Asylum, in 
IND.
New  York, State  provision for insane
  in,  12
New York Hospital, 12
Night  Attendants,  rules  governing,
  149
Night Service, 327
Non-restraint, 22,  50, 78, 89, 101, 105,
  106, 146, 151, 157,  216, 286;  (Re-
  sume), 319
Norman, Dr. Conolly, 193
Norris, cruel treatment of, 18
Norway, government of  State asylums,
  government of local asylums, board-
  ing-out,  State wards, lunacy legisla-
  tion, 206 ;  Gaustad Asylum (see G.)
Nursery for Plants, 80, 315

Orderly Arrangement,  315
Outdoor Pauper Lunatics, 40

Padded Rooms, 49,  53,  62, 66, 71, 86,
  91, 96, 101, 104, 108,  157, 163, 184,
  188, 206, 225 ; (Resume), 319
Paetz, Dr., 281, 286, 290
Parigot,  Dr., 250
Paris,  7 ; early treatment of insane in,
  195  ; asylums at, 222,  224, 226
Pariset, 195
Parliamentary Investigations, 21
Parochial Asylums (Scotland), 115
Patients, law respecting maltreatment
  of,  26 ;  protection to, 383
Pauper, definition of term, 44
Pauper Lunatics, increase of, 43
Peeters, Dr., 240, 246
Pennsylvania, first hospital for insane
  in,  n
Pensions, 71, 84, 325,  381
Perceval,  Secretary, statements of re-
  specting admission  to  asylums, 28 ;
  undue detention, 32 ; outdoor pauper
  lunatics, 40
Petit,  Dr. Joseph, 186, 318
Pinel, 7, 19,  22, 195, 196, 224
Pipes, supply and waste, 308
Poorhouses  (Scotland), 115, 127 ;  (Ire-
  land), 177  ;  condition  of, 178 ;  (Re-
  sume), 354
Post-mortem  Examinations,  90,  93 ;
  (Resume),  346
Prestwich,  asylum at (see  Lancaster
  County Asylum)
Private Asylums (Scotland), 115;  (Ire-
  land), 178
Private Dwellings (Scotland),  insane
  in,  115
Private Single Patients, 40, 379
Prussia, admission to  asylums  in, pri-
  vate asylums in, 203 ; maintenance
  of the  incurable pauper insane, dan-
LX.                             397


  gerous cases, 204 ;  Provincial Asylum
  (see Halle) ; Provincial Asylum (see
    Alt-Scherbitz)
Psychology,  study by ancient Greeks
  of,  4
Public Accounts, 359, 381

Rayner, Dr., 51, 53, 298
Reforms in continental countries,  196
Registered hospitals,  27, 380 ;  medical
  attendance at, 27
Religious Exercises, 328, 383
Remuneration, 72, 81, 237, 273, ;  (Re-
  sume), 338
Restraint, 23,  48, 53, 57,  62,  66, 72,
  163, 184, 186, 225,  229, 231, 249, 381
Resume,  293 ; Location, 293 ; Build-
  ings,  297 ;  Furnishing and  Decora-
  tion,  312 ;  Grounds,  314 ;   Orderly
  Arrangement,  315  ;  Sewage,  316 ;
  Greater Freedom,  317  ;    Non-re-
  straint, 319 ;  Medical Officers, 321 ;
  Attendants,   322 ;   Night   Service,
  327 ;   Religious   Exercises,  328 ;
  Amusements,  329 ;   Employment,
  332 ;  Remuneration, 338 ;   Dress
  and  Clothing,  340 ;  Dietary  and
  Dining-rooms, 340 ; Alcoholic Stimu-
  lants, 342 ; Social Distinctions, 342 ;
  Visitation, 343 ; Letters, 344 ;  Post-
  mortem Examinations, 346 ; Admis-
  sion and Discharge, 347 ; Voluntary
  Patients,  350 ;  Summer  Resorts,
  351 ; Criminal Insane, 351  ; Board-
  ing-out, 352  ; Poorhouses, 354  ; Lo-
  cal or  District  Care, 356 ;  State
  Wards, 357 ;  Public Accounts, 359 ;
  Supervision,  361
Retreat, The,  178
Rheinau,  asylum at,  220
Richmond  District   Asylum,   medical
  staff, attendants, grounds, building,
  dining-hall,  food,  1S7 ;  associated
  dormitories,   padded  rooms,   day-
  rooms,  employment,  school  system,
  188 ; laundry,  190 ;  table  showing
  employments, amusements,  walking
  parties,  191  ;  seclusion,  dress,  at-
  tendants,  salaries,   192  ;  churches,
  abolishment of airing-courts, 193.
Riel,  194
Rceskilde Fjord, 209
Ross, Captain David, 109
Rotvold, asylum at, 205
Royal College of Physicians, 17
Royal  Edinburgh Asylum,  situation,
  management, rates  for maintenance,
  charity  fund,  158 ;  West  House,
  grounds, cricket club, food,  ale, din-
  ing-halls, 159 ; general kitchen, diet 
DEX.
398                             INI


  kitchens,  recreation  hall,  heating,
  160 ;    shoe-house,    employment,
  printing-office,   161 ;   Morningside
  Mirror, laundry, dormitories, single
  rooms,  open-door   system,   airing-
  courts   abolished,  162 ;   restraint,
  seclusion,  padded  rooms,  trained
  attendants, 163 ; sea-side resort,  East
  House, furniture  and  furnishings,
  open  fires, billiards, reading-rooms,
  books, 164 ;  additions and improve-
  ments,  165 ; cottage for female pa-
  tients,  Myreside Cottage,  167 ; Craig
  House, sycamores,  extended  views,
  seat  of the  Carmichaels, 168 ;  fur-
  niture  and furnishings, dining-room,
  169 ;    drawing-rooms,  ornamental
  grounds,  class  of  patients received,
  freedom from restraint, convalescing
  patients, 170
Rush, Dr.,  n
Rutherford, Dr.,  146,  151, 152,  153

St. Andrew's Hospital, 335
Ste. Anne Asylum, situation, buildings,
  object, medical staff, 224  ; Sisters of
  St. Joseph,  day servants, refractory
  wards,  isolating  cells,   restraining
  chairs, padded rooms, airing-courts,
  roofed  galleries, heating, 225 ;  hy-
  dropathic treatment, 226
St. Dymphna, 3 ;  legend of, 242
St. Fillan, wells of, 4
St.  Hans   Hospital,   near  Rceskilde,
  208 ;  class of patients,  supervision,
  classification,    buildings,  grounds,
  Rceskilde Fjord, single rooms, asso-
  ciated  dormitories,  209 ; seclusion,
  dining-halls,  kitchens,  food-wagons,
  chapel, billiard-room,  bowling-alley,
  reading matter,  employment, knit-
  ting,   210 ;  asylum  waste,  beach
  bathing, 211
St. Luke's Hospital, 16,  346
St. Maree, well of, 4
St. Nun's Pool, 3
St. Patrick's Hospital, 172,  178
St. Winifred, well of, 3
Salpetriere,  8, 196, 222 ; object, build-
  ings, class of patients,  school, 222 ;
  attendants,   cottages,  dormitories,
  cells,    douche,    entertainments,
  kitchen, 223  ;  wine, grapes, dining-
  hall, Pinel, Bicetre, 224
Sanborn, F. B., 346
Saragossa, monks  at,  6
Schools,  74, 106,  188,  223
Scotland,  establishment  of   present
  Lunacy System, superstitions, witch-
  craft, sentenced to death for witch-
  craft, 109 ; imprisonment  at Inver-
  ness,  inadequate  provision,  private
  aid, Royal Edinburgh Asylum,  no ;
  Murray's   Royal  Asylum,  Crichton
  Institute, chartered or royal asylums,
  government  aid,  lunacy legislation
  in 1815,  1829,  1841,  p.  ill ; ap-
  pointment  of  Royal  Commission
  in 1855, investigation by  same, re-
  port of,  112 :  recommendations of
  Commission,  important legislation of
  1857, creation of Board of  Lunacy,
  present provision for the insane, 114 ;
  royal    asylums,   district   asylums,
  parochial  asylums, lunatic  wards of
  poorhouses,  private asylums, insane
  in private  dwellings, 115 ;  desirable
  reforms, General Board of  Commis-
  sioners in Lunacy, 116 ; Deputy Com-
  missioners, powers and duties of the
  Lunacy Board,  117  ; admission of
  patients,  118 ; care  of  property of
  the insane, voluntary patients,  120 ;
  discharge  of patients,  121  ; limita-
  tion of sheriff's order, 122 ; danger-
  ous lunatics,  123 ; liberation on  trial,
  probationary   discharge, 124 ;  pen-
  alty  for maltreatment of  patients,
  medical attendance  in  licensed es-
  tablishments,  125 ; proportion of in-
  sane to population, increase of the
  insane,  distribution of  the  insane,
  how  maintained,  cost  of   mainte-
  nance,  126  ;   government  grant,
  poorhouse    care,    exposition   of
  Lunacy System,  127  ; boarding-out,
  130 ; correspondence, 132 ; rates for
  boarding-out, 133 ; inspection of in-
  sane  in  private  dwellings,  134 ;
  Barony Parochial Asylum  (see B.);
  Mid-Lothian  and  Peebles  District
  Asylum (see M.)  ; Royal Edinburgh
  Asylum (see R.)
Scott, Hon.  Francis, 298
Scott, Sir Walter, 4, 109, 168
Seclusion, 49,  62, 66,  72, 78,  89, 96,
  104,  163,  192, 210,  216,  221,  225,
  228,  232
Sewage, 316
Sewers, 308
Shaftesbury, Earl of, testimony of relat-
  ing to abuses  in asylums, 22 ; state-
  ment of respecting discharge, 34; 298,
  321,  344, 362
Shakespeare, 16
Sibbald, Dr., 127, 131
Sites for institutions for the insane, 293
Smith, Dr. Stephen, 324
Social Distinctions, 342
Society of Friends,  12,  19, 20, 106, 178 
IND
  South  Yorkshire  Asylum,  situation,
    buildings,  porter's  lodge,  church,
    greenhouse,  day-rooms, 90 ; men's
    infirmary,  refractory wards,  strong
    rooms, padded rooms,  heating, 91 ;
    bathing arrangements, food, kitchen,
    bakery,  brewery,   beer,   laundry,
    water   supply,   employment,  92 ;
    land, farm cottages, hospital accom-
    modation,   post-mortem  examina-
    tions,  attendants, uniforms,  airing-
    courts, 93  ;  dining  and  recreation
    hall, library,  chronic  cases, cost of
    maintenance, 94
  Spain,  provision  for  insane  in,  treat-
    ment of insane in, 6
  Spiritual Agencies, 3
  State Aid, 39, 127, 177, 357,  358
  State Provision for the Insane,  12
  State Wards, 357
  Steenberg, Dr., 211
  Stewart Institution, 178
  Summer Resorts, 351
  Superstitions, 4, 109
  Supervision, 361
  Surrey  County, population,  paupers,
    pauper lunatics, 75
  Surrey County  Asylum (Brookwood),
    management,  situation,   buildings,
    75 ;   interior decorations,  dining-
i    rooms,   heating   and   ventilation,
    kitchens, room for new  arrivals, day-
    rooms, dormitories, 76 ;  temperature,
    single  rooms, bath-room,  77 ;  cot-
    tage  hospital, religious  services, cost
    of maintenance, non-restraint, seclu-
    sion,  78 ; padded rooms,  classifica-
    tion, uniforms, attendants, salaries,
    79 ; land, employment,  nursery, con-
    servatory,  80 ;  washing  by  hand,
    remuneration,  81  ;  recreation  and
    amusement, recreation  hall,  fancy-
    dress balls, musical  meetings, print-
    ing, library, 82
  Sussex   County, population,  paupers,
    pauper lunatics, 69
  Sussex   County  Asylum  (Haywards
    Heath), opening, management, situa-
    tion, ornamental grounds, quantity
    of land, class  of patients,  buildings,
    69 ;  dormitories,  wards  for better
    class female patients, infirmary ward,
    suicidal  and  epileptic  dormitories,
    70 ;  padded rooms, detached  hos-
    pital, dress of  patients,  uniforms,
    wages, pension, kitchen, dining-room
    for female patients, 71 ; beer, dietary,
    rewards for work, water supply, fire-
    hose, sewerage, wet and dry packing,
    locked  dresses,  seclusion, employ-
*x.                             399


  ment,  72 ;  skilled artisans, officers
  and employees, cost of maintenance,
  reading matter, 73 ; school, religious
  services, walking parties, drives, pic-
  nic   excursions,    outdoor  games,
  amusement hall, theatricals, concerts,
  fancy-dress ball, rules, 74
Sweden, lunacy legislation, 206 ;  con-
  trol of asylums,  208 ;  Conradsberg
  Asylum (see C.)
Swift, Dean, 172, 174, 178
Swimming-baths, 67, 211, 290, 309
Switzerland, Burgholzli Cantonal Asy-
  lum (see B.)

Thermometers, 311
Training-schools, 324
Transfers, 33, 377
Tuke, Dr.  Batty, 331
Tuke, Dr. D.  Hack,  342
Tuke, William, 19, 22,  106

United States, progress of  reform in,
  13

Valley of Lunatics,  3
Ventilation, 310
Viborg, asylum at, 209
Vienna, early asylum at, 197
Villers (see Clermont)
Virginia, first asylum in, 12
Visitation, 343
Visitors of Chancery patients, 38
Voluntary   Patients  (England),  380;
  (Scotland), 120; (Resume), 350
Vordingborg, asylum at, 209

Wadsley (see South Yorkshire Asylum)
Wakefield (see West Riding Asylum)
Wallis, Dr., 102, 324
West  Riding,  population,   paupers,
  pauper lunatics,  83
West Riding Asylum, buildings, land,
  medical  officers and attendants, 83 ;
  salaries,   uniforms,   pension,  day-
  room,  dress,  dormitory,  84 ;  strong
  dresses, locked boots, refractory ward,
  bath-room, heating, building for con-
  valescing patients, 85 ;  open  fires,
  day-rooms,    conservatory,   single
  rooms, strong rooms, padded room,
  fire-brigade,  86 ;   dining-room  and
  recreation hall, food, general kitchen,
  employment, weaving, tailoring, 87 ;
  book-bindery,  laundry,    88  ;  gas,
  water  supply, sewerage, recreation,
  religious  exercises,  entertainment,
  seclusion, non-restraint,  89 ; post-
  mortem examinations, cost of main-
  tenance, 90 
4<DO                            INDEX.
White House Asylum (Bethnal Green),
  abuses in, 23
Whittier, 4
Whittingham (see  Lancaster County
  Asylum)
Willard Asylum, 295
Williams, Dr., 333
Williamsburg, asylum at, 12
Windows, 307
^Wines, F. H., 359
Witchcraft, 5, 109
Woodilee (see  Barony  Parochial Asy-
  lum)
WTorkhouses, lunatics in, 42, 354
Workshops, 308

York, Friends'  Retreat at, 106
York Asylum, 19 ; abuses in, 20
Yorkshire, population, paupers, pauper
  lunatics,  83

Zurich,  asylum near, 219 
SUPPLEMENT.
   The  following is the essential part of a circular  issued by the
 English Commissioners in Lunacy under  date of April 16,  1890,
 to show the material changes which had recently been effected in
 the English lunacy system :

                          LUNACY ACT,  1890.

                            (53  Vict. c. 5.)

   The alterations introduced into the  Law of Lunacy by the Lunacy Acts
 Amendment Act, passed in the Session  of  1889, were so many and important
 that it appeared  to the Commissioners in Lunacy to be desirable that the chief
 of these  alterations should be brought directly to the notice of the superinten-
 dents and  managers of  Asylums,  Hospitals, and Licensed Houses, and they
 determined, therefore, to issue a circular upon the subject.
   The provisions of the above-mentioned Act, however, and all other subsisting
 enactments on the  subject  of Lunacy,  have now  been  brought together and
 consolidated into one Act, the  Lunacy Act, 1890, which comes into operation
 on the ist May next, and it is to this Act that reference will here be made.  All
persons concerned with  the charge of lunatics  are, however, advised to make
 themselves acquainted fully and  textually with  the  provisions  of the new Act,
 which are numerous and complicated, but most  necessary to be studied.
   The changes introduced  may most conveniently be noticed under separate
 heads.
                   THE ADMISSION  OF PATIENTS.
                            Private Patients.

  On and after ist May,  1890, a private patient cannot, as a  general rule, be
received (except by transfer) into an institution for lunatics without a' reception
order' made by a ' judicial authority.'
  The exceptions are : (1.) A case of  urgency, when a patient may be received
on an ' urgency order '; (2.) the case of a lunatic so found  by inquisition, who
may be received upon the order of the committee of the person, with an office
copy of the order  appointing such committee, or if  no committee has been
appointed, upon the order of a Master in  Lunacy. 
2
SUPPLEMENT.
   ' Institutions for lunatics'  means an Asylum, Hospital, or Licensed House.
   ' Judicial authority' means a county court judge, stipendiary, or Metropolitan
Police,  magistrate, or justice of the peace, appointed in the manner prescribed
by the Act to exercise the power of making reception orders for private patients.

                             Reception Orders,

   The reception order is obtained upon petition presented, if possible, by the
husband or wife or a relative of the patient, with two medical certificates, one
of which shall, whenever practicable, be given by the usual medical attendant of
the patient.   The certificates must be on separate sheets of paper.
   Forms  of the petition, order, statement,  medical certificates,  and  other
necessary documents are given  in the schedule to the Act,  and should be strictly
followed.   A reception order, appearing  on the face of  it to be in conformity
with the  Act, is sufficient authority for  the admission of the patient without
further  evidence of the signature, or of the jurisdiction, of the person making
the order.  The  person receiving the  patient  must, however, see that all  the
requirements respecting reception orders  and certificates appear, on the face of
the documents, to have been complied with.

                              Urgency Orders.

  An ' urgency order' should, when possible, be made by the husband or wife or
a relative  of  the patient.   If not, the connection of the person  signing it with
the patient must be stated.   It must be  supported by one medical  certificate,
which  may  be signed  before  or  after the order, and  the certifying medical
practitioner must have examined the patient not more than two clear days before
his reception.  An urgency order remains in force for seven days from its date,
or, if a petition for a reception order  is pending, until the  petition is finally
disposed of.

                Lunatic not  Under Proper Care and Control.

  The reception order for admission into an Asylum of a lunatic who is ' not a
pauper, and is not wandering at large,' but who ' is not under proper care and
control, or is cruelly treated  or  neglected,' must in future be made by a justice
who is a ' judicial authority.'
  A private patient who has  not been seen by the judicial authority prior to his
making the reception order will be entitled to be taken before, or visited by, a
different judicial authority, unless the medical officer of the institution, within
24 hours after reception, signs, and sends to the Commissioners, a certificate that
the exercise of such right would be prejudicial  to the patient.
  If such  certificate is not given, the patient is, within 24 hours after reception,
to have  notice in writing of the above right, and his  desire in regard to it is to
be ascertained.   If he desires  to exercise  the right, the manager will procure
him to sign a notice to that effect, and  must forthwith send such notice by post
in a prepaid registered letter  to a ' judicial authority,' or to  the clerk of the petty
sessional division or borough where the patient is.  The latter  course will, no
doubt, be usually adopted. 
SUPPLEMENT.
3
                             Pauper Patients.

  The principal changes made with regard to the reception orders for pauper
patients, to be termed in future ' summary reception orders' are the requirement
that the order shall contain a statement that the justice making it is satisfied that
the patient is a pauper in  receipt of relief, or is in such circumstances as to
require relief for his proper  care and maintenance ; and that an order can  no
longer be made by an officiating clergyman and relieving officer or overseer.

          Amendment of Reception  Orders and Medical Certificates.
  A defective order or certificate may within  14 days after the reception of the
patient be amended by the person who signed it.   But the amendment must be
sanctioned by the Commissioners, or one of them, and  in  the case of a private
patient must have  the consent  of  the judicial authority  who made the order.
  The Commissioners may require a certificate to be amended, and if not within
14 days amended to their satisfaction, may discharge the patient.

                       Duration of Reception Orders.

  As well in the case of pauper  as  of private  patients, reception  orders are
made terminable by the Act.  ' Reception order ' means an order or authority,
made or given before or after the commencement of the Act, for the reception
of a lunatic.
   Every  reception  order  dated after,  or  within  three   months  before the
commencement of the Act, i. e., ist May, 1890, will expire at the end  f a year
from its date : and every order dated three monthsor more before ist May,  1890,
will expire on 30th April, 1891, unless, in each case, it is continued by a special
report and certificate by the manager of  the institution in which the patient is
detained.  Orders dated on ist February, 1890, will  fall into the latter category.
   The special report is to be on the mental and bodily condition of the patient,
and the certificate to the effect that he  is  still of unsound mind, and a proper
person to be detained under care and  treatment.  They are to be sent to the
Commissioners not more that a month, or less than  seven days, before the date
on which the order would expire.
   The report and certificate will (unless objected to by the Commissioners) keep
the reception order in force for another  year ; and after such year it may, by a
similar process, be thereafter continued in force for two  years, then  for three
years, and then for successive periods  of five  years, so long as the patient
is detained.
   The special reports and certificates may include and refer to more  than one
patient.
   If, in the opinion of the Commissioners, the special report does not justify the
certificate, and they are not by further inquiry satisfied, they may discharge the
patient.
   The detention of a patient after  the order for his  reception has expired is
made a misdemeanor.
   The foregoing provisions of the Act on this subject do not apply to lunatics
so  found by inquisition. 
4
SUPPLEMENT.
      CARE AND TREATMENT—REPORT AT  END OF  MONTH.

  In addition to the medical statement now sent to the Commissioners after the
admission of a patient, a report of his mental and bodily condition must, in the
case of a private patient, be sent to them at  the expiration of one month after
his reception.   The report must be made and signed  by  the medical officer of
the institution.

                       MECHANICAL RESTRAINT.

  Mechanical means of bodily restraint of a lunatic must in future only be used
' for purposes of surgical  or medical treatment, or to prevent the lunatic from
injuring himself or others.'
  In every case where such restraint is applied a medical certificate shall, as
soon as it can  be obtained, be signed  by the medical officer, describing the
means used, and stating the grounds upon which the  certificate is founded.
  A record of all cases of the use of restraint is to be kept, and c copy of the
records and certificates sent to the Commissioners at the end of every quarter.

                          CORRESPONDENCE.

  Letters written  by patients  and addressed to  the public functionaries and
other persons mentioned in Section  41, must be forwarded,  unopened, by the
manager of the institution, who may also at his discretion forward to its address
any other letter written by a private patient.
  Letters not forwarded need  not, in future, be laid  before visiting Commis-
sioners or visitors.

                     EXAMINATION OF  PATIENT.

  The Commissioners may authorize the examination of a  patient in an  institu-
tion for lunatics by two medical practitioners, and, as a result of such examina-
tion, may order  the discharge  of the  patient.  The exercise of the  powers
conferred by this section is,  however, altogether  in the  discretion  of the
Commissioners.

      ABSENCE ON  TRIAL  OR  FOR HEALTH  AND TRANSFER.

  The consent  of one Commissioner instead of two, as heretofore, will in future
be sufficient for authorizing the absence of a patient from a hospital or licensed
house on trial or for health.   Also for the transfer of a patient from one institu-
tion to another institution, or to single care.
  The  medical officer of a  hospital  or licensed  house may, of  his own
authority, permit a patient to be absent for not more than 48  hours.
  The applications to the Commissioners for leave of  absence must  be accom-
panied by a recommendation  from the medical officer ; and the application for
consent to a transfer must be accompanied by a report by  the medical officer as
to the mental and bodily condition of the patient, and his  fitness for transfer. 
SUPPLEMENT.
5
               BOARDING  OUT  OF  PAUPER  PATIENTS.

  A pauper patient in an Asylum may be delivered into the custody of a relative
or friend upon certain  conditions specified in Section  57 ;  and  the authority
liable for its maintenance is to pay to the person taking charge such  an allowance,
not exceeding the cost  of the patient  in  the Asylum, as  the authority, on the
recommendation of the Committee of the Asylum, may decide.  For every lunatic
so boarded out the guardians will continue entitled to the 4.?. a week  subven-
tion, and the patient may by order of two  members of the Committee  be at
any time brought back to the Asylum.   While boarded out he is  to be visited
quarterly by the medical officer of the union or district in which he resides, who,
after each visit, must report to the Committee of the Asylum.
  A patient so boarded out must necessarily be  continued on the register of
patients of the Asylum,  and not treated as discharged.

                               DISCHARGE.

  Two Commissioners,  one legal, the other medical, will,  in future, be empow-
ered to discharge, after one visit, a patient detained in a hospital or  licensed
house.  They must forthwith serve an order of  discharge, if made, upon the
manager of the institution in which the patient is  detained.
   The notice of the recovery of a patient to be given by the manager of  a hos-
pital  or  licensed house must in future state that, unless the patient is removed
within seven days, he will be discharged ; and, if not so removed, he  must be
discharged accordingly.

                 VISITING  COMMITTEES OF  ASYLUMS.

   Section  169 re-enacts the provisions of  the Local  Government Act,  1888,
which effected the changes in the constitution of Visiting Committees of Asylums
which became necessary by the transfer of the powers of justices to the County
Councils, the corresponding sections of the Local Government Act being repealed.

                     RESTRICTIONS ON  LICENSES.

   No new license can be granted to any person for a house for the reception of
lunatics, except in substitution for another house relinquished.  The number of
patients allowed  by the license for  such substituted house cannot be increased,
nor can any increase be allowed for a house already licensed.
  Joint proprietors  may be allowed to separate,  and each  to have a  licensed
house, the  aggregate number of patients not exceeding, the  number allowed in
the house carried on jointly.
   Licenses of existing establishments may be renewed.

                    BOARDERS  IN LICENSED  HOUSES.

   The manager of a licensed house may, with such previous consent as is men-
tioned in Section 229, receive and lodge as  a boarder for a specified time, with
power of extension, ' any person who  is  desirous of voluntarily  submitting to
treatment,' or any relative or friend of a patient. 
6
SUPPLEMENT.
   Patients and boarders together are not to exceed the number for which the
 house is licensed.   Boarders are to be produced to Commissioners and Visitors
 at their visits.
   A boarder may leave on  24 hours' notice ; and his detention after the  24
 hours have expired will subject  the manager to a penalty of 10/. for every day
 or part of a day of such detention.
   A register of voluntary boarders  must be kept in every hospital and  licensed
 house, and produced to Visiting Commissioners and Visitors.

                               HOSPITALS.

   The Act contains new provisions respecting hospitals, but they are applicable
 chiefly to hospitals to be established, and not  to those already existing.   Some,
 however, apply to the latter, and are important.
   The accounts of  hospitals must  in future be audited  and printed,  and the
 Commissioners may, if they think fit, prescribe the form in which the accounts
 must be  kept.
  Superannuation allowances may  be granted to  officers  and servants of hos-
 pitals, and certain persons are disqualified from serving on the managing com-
 mittee.   Section 237 enables the Commissioners to take steps to  enforce the
 proper carrying out of the regulations of  a hospital.
  No new contract for the reception of pauper patients can be entered into with
 a hospital, but any existing contract may be renewed.

                                ASYLUMS.

  Committees of asylums  may, with the consent  of the  local authorities for
 which the asylums are provided, and with the  approval of a Secretary of State,
 establish departments for private patients, by means of additions to the  asylum,
 either as detached buildings or otherwise ; and private patients may be received
 upon such terms as to payment and  accommodation as the committee think fit.
  Profit  resulting from the reception of private patients  may be applied to a
 building and repair fund, and any surplus is to be carried to the credit of the
 county or borough fund.
  A local authority may provide asylum accommodation for pauper  and private
 patients  together or in separate asylums,  and also separate asylums  for idiots or
patients suffering from any particular class of mental disorder.
  Lands and buildings used for the purposes of an asylum will henceforth be
ratable as other lands and buildings in the same parish, township, or district.
  Lands or buildings becoming unsuitable, or  not required for the  purposes of
an asylum,  may, with the consent of a Secretary of State, be  appropriated by
the local authority for any purposes  for which  the local authority is empowered
to acquire land.
  Where a contract for the reception of pauper patients has, whether before or
after the passing of the Act, been made on behalf of a borough with the com-
mittee of an asylum,  and the contract is determinable by the parties or either of
them, it cannot be determined without the consent of a Secretary of State. 
SUPPLEMENT.
7
  In computing the pension of an officer of an asylum, if he has served in more
than one asylum belonging to the same local authority, the whole of his service
in the several asylums belonging to that authority shall be reckoned as if all the
asylums had been one asylum.
  The council of every administrative county and county borough respectively
constituted under the Local Government Act, 1888, and the council of each of
the boroughs mentioned in the Fourth Schedule to  the  Lunacy Act, 1890,  is a
' local authority ' for the purposes of  that Act.

                                 RULES.

  Power is given by Section 338 to the Commissioners, with the approval of the
Lord Chancellor, to make rules prescribing the books to be kept in institutions
for lunatics, and the entries to be made therein, and as to various other matters. 
 
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