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I. COMMITMENT, DETENTION, CARE AND TREAT- 
MENT OF THE INSANE 

II. CARE AND TRAINING OF THE FEEBLE-MINDED 

III. THE PREVENTION AND REPRESSION OF CRIME 



Commitment, 

and Treatment of the 
Insane 



BfilNG A REPORT OF 


THE FOURTH SECTION OF THE INTERNATIONAL CONGRESS 
OF CHARITIES, CORRECTION AND PHILANTHROPY, 
CHICAGO, JUNE, 1893 


EDITED BY 


G. ALDER BLUMER, M. D. 

Superintendent of Utica State Hospital 

A. B. RICHARDSON, M. D. 
Superintendent of Columbus Asylum for Insane 


BAIiTIMORE 

THE JOHNS HOPKINS PRESS 
LONDON 

THE SCIENTIFIC PRESS, LIMITED 
428 Strand, W. C. 

1894. 


THE WORLD’S CONGRESS AUXILIARY OF THE WORLD’S COLUM- 
BIAN EXPOSITION. 


The International Congress op Charities, Correction and 
Philanthropy. 

PRESIDENT : 

RUTHERFORD B. HAYES. 

FIRST VICE-PRESIDENT: SECOND VICE-PRESIDENT: 

FREDERICK H. WINES. ROBERT TREAT PAINE. 

GENERAL SECRETARY: 

ALEXANDER JOHNSON. 

COMMITTEE OF ORGANIZATION: 

FREDERICK H. WINES, JOHN G. SHORTALL, Mrs. J. M. FLOWER. 
NATHANIEL S. ROSENAU, Secretary. 


SECTION IV. 

Commitment, Detention, Care and Treatment of 

THE Insane. 


chairman: 

G. ALDER BLUMER, M. D. 
Superintendent of Utica State Hospital, Utica, N. Y. 


secretary: 


WELLCXDME INSTIT^ rintendent of Columbus Asylum for Insane, Columbus, O. 

LIBRARY 


Coll. 


Call 

No. 


welMOmec 


Trnrr 


A. B. RICHARDSON, M. D. 


Copyright, 1894, by The Johns Hopkins Press. 




CONTENTS. 


'^^RESEfr 
^'g.V^ERNES 



PAOB. 


The Lunacy Administration of Scotland. By T. S. Clouston, M. D. . . 1 

Discussion, page 176. 

The Treatment of Degenerative Psychoses. By Jules Morel, M. D — 13 

Discussion, page 186. 

I, — On the Increase of Insanity. II. — Private Lunatic Asylums. By 

W. J. Corbet, Esq 29 

Discussion, page 179. 

The Future of Asylum Service. By A. Campbell Clark, M. D 68 

Discussion, page 173. 

Reform in the Treatment of the Insane. By D. Hack Tuke, M. D., 

F.R. C.P., LL.D 66 

Discussion, page 18i. 

The Irresponsibility of the Insane Under the Laws of France. By 

Dr. Victor Parant 69 

Discussion, page 183. 

Statistics of Insanity in New South Wales Considered With Reference 

to the Census of 1891. By Chisholm Ross, M. D 81 

A Case of Insanity Consecutive to Ovarosalpingectomy. By Dr. E. 

Regis 91 

Care of the Insane in Finland. By Emil Hougberg, M. D 100 


Porposed Change of the Legal Status of the Insane, in Accordance with 
our Present Knowledge of the Nature of Insanity, for the Purpose 


of Securing for Them More Rational and Efficient Treatment. By 
Stephen Smith, M. D 104 

What Improvements Have Been Wrought in the Care of the Insane by 

Means of Training Schools. By C, B. Burr, M. D 124 

Discussion, page 169. 

The Care of the Insane in Canada, By C. K. Clarke, M. D 134 

Discussion, page 175. 

On the Care of Epileptics. By Frederick Peterson, M. D 139 


The Commitment, Detention, Care and Treatment of the Insane in 

America. By G. Alder Blumer, M. D 149 

Discussion, page 187. 


Proceedings 


168 




THE LUNACY ADMINISTRATION OF SCOTLAND 

1857—1892. 


BY T. S. CLOUSTON, M. D., 

Physician-Superintendent, Eoyal Edinburgh Asylum, Morningside, Scotland ; 
Lecturer on Mental Diseases Edinburgh University. 


Before the year 1857 the insane in Scotland were supervised 
and legally protected by the sheriffs of each county, who visited 
the asylums within their jurisdiction and attended to all complaints 
of undue detention or improper treatment. The sheriff in Scot- 
land is a local judge with large powers, and he is always a trained 
lawyer and has a life tenure of office. At various times within the 
previous eighty-five years there had been erected in Scotland seven 
asylums, all with royal charters, hence called “ Royal Asylums,” 
but all originating in local philanthropic efforts, and in no way sub- 
ject to royal control or receiving government assistance. They 
were all situated near the larger towns of the kingdom and were all 
governed by local boards of management, who appointed the officers, 
visited the institutions and saw the patients. No local rates or 
assessments were or could be raised for their erection, but they 
all, after completion, took in a certain proportion of rate-paid or 
“pauper” patients paid for by their parishes, as well as “private ” 
patients who were paid for by their relatives or out of their own 
means. In addition to these royal asylums there were many pri- 
vately owned asylums where both pauper and private patients 
were boarded. The poorhouses also bad some insane and imbecile 
inmates of the more quiet sort, and scattered through many of 
the poorer and more outlying portions of the country were a large 
number of insane persons boarded with private families; often- 
times very small sums of money indeed being paid for their main- 
tenance, and no supervision being exercised over them at all. 
There was no central authority in the kingdom whose duty it was 
to exercise a general supervision over the insane or their guardians. 

After the passing of the English Lunacy Act of 1845, under 
Lord Shaftesbury’s philanthropic initiative, more than one attempt 
was made to pass a similar act for Scotland, especially in 1848, 
but without success till 1857. 


2 


THE LUNACY ADMINISTRATION OF SCOTLAND. 


In 1855, Miss Dix, who had in America done much for the 
insane, came to Scotland and by her exposure of the cruel neglect 
of the pan pel- iiisane in some of the smaller private asylums, 
roused the government of the day to a[>point a royal commission 
of enquiry into the treatment of the insane and the state of the 
law. This commission had the a<lvantage of having Mr. Gaskell 
and Mr. Campbell, two of the permanent English Commissioners 
in Lunacy on its staff, and also of having Dr. James Coxe as its 
most active local member, who, it is understood, drew up its report. 
It issued an admirable and exhaustive report early in 1857 showing 
the urgent need of legislation to remedy abuses, to erect public 
asylums, and to provide a central authority for the regulation 
and supervision of the insane of all classes. 

The present lunacy act for Scotland was at once passed in 1857. 
A few short amending acts have since been passed supplementary 
to the provisions of that act, but not making any essential change 
in its principles. The act made provision in the first place for 
the appointment of a “ General Board of Commissioners in Lunacy 
for Scotland ” for the general sujiervision of the insane in that 
kingdom, to see that asylums were provided by the local author- 
ities and out of the local rates where none previously existed, and 
generally to see that the provisions of the statute were executed; 
but not to administer the asylums themselves, or to act as an 
executive body in anything relating to the insane. The sheriffs 
and medical men were left to send the insane to asylums; the 
local authorities were to form themselves into “ District Boards ” 
to build and to govern the new asylums to be erected under the 
act. The parish authorities and the local inspectors of poor were 
to take the initial steps as to the sending of patients to asylums 
who needed to go there. The directors of the existing royal 
asylums that had all come well out of the enquiiy by the royal 
commission and their physician-superintendents were to be left to 
govern them and to be responsible for their condition and for the 
treatment of their patients. Indeed, the commission was granted 
little power over them except to visit and report and call for 
returns. The constitution of the general board was a composite 
one. JJiere was to be a chairman unpaid, but with considerable 
powers, and it was clearly intended that a man of recognised 
position in the country should fill the office. There were to be 
two other unpaid commissioners who have always been lawyers. 


BY T. S. CLOUSTON, M. D. 


3 


But the chief work of the board was to fall on two paid commis- 
sioners. It was in the appointment of the last that the wisdom 
of the government of the day and of subsequent governments who 
filled up vacancies was shown, d'he best known public asylum 
superintendent of the time in Scotland, Dr. W. A. F. Browne, a 
recognised authority in that department, a specialist, an author of 
repute, an administrator who himself had that intimate knowledge 
of mental disease and of the insane and their requirements only to 
be acquired byA'esidence among them, and Avho had been in the 
van of progress, was selected as one. The other was Dr. James 
Coxe, not a specialist, but a man who had shov^n himself to be a 
medical author of a most practical and physiological turn of mind, 
and who, as a member of the preliminary royal commission, had 
studied the whole subject carefully in its wide bearings both in 
England and on the continent of Euro|>e. Two deputy commis- 
sioners were appointed, under a section of the act, to visit and 
supervise the single insane boarded out in private families, and 
they were carefully selected, one of them being Dr. Arthur 
Mitchell, now Sir Arthur Mitchell, the present senior commissioner. 
It is quite clear that this selection of the commissioners was the 
most important matter after the passing of the act, and here were 
men with an ideal experience, with a secure tenure of office, with 
a great public and philanthropic work before them, and with a new 
reputation to make. They were face to face with varied forms of 
provision for the insane, with very good institutions and very bad 
ones, with successes and abuses. The lunac}^ act clearly pointed to 
the development of local interest in the insane and of local responsi- 
bility : and the commissioners showed sufficient wisdom and knowl- 
edge of human nature to set about developing local pride in local 
institutions, and a healthy rivalry between the different asylums and 
the various modes of providing for the insane. They had to meet 
a body of men at the head of the royal asylums of acknowledged 
authority in their department who were earnestly trying to do their 
best for their patients. How they should meet and how they should 
treat these men was one of the points on which their success and 
their usefulness to the insane obviously and greatly depended. 
They had to do in certain matters with the boards of those asylums, 
consisting often of men of great local influence, giving their time 
gratuitously to the service of the insane. They had to do with 
the new coupty rating boards who were to erect asylums, where 


4 


THE LU]SACY ADMINISTRATION OF SCOTEAND. 


they did not already exist, and govern them when erected. The 
greatest power given to the general board was to erect asylums and 
assess the counties for them if the county authorities were abso- 
lutely recalcitrant ; but this power has never been used or even 
threatened. They had to do with the authorities in each parish 
who attended to the poor and initiated all steps for dealing with 
their insane, and these authorities were the governors of the poor- 
houses and responsible for the single insane who were boarded out. 
In addition to these, they had to do with the insane who had prop- 
erty to see that they were well treated by their relations and got 
the beneht of their means for their own comfort and advantage. 
In very few instances were these powers made autocratic, so that 
much room was left for convincing, for persuading and for edu- 
cating all those in any way directly responsible for the insane. 
Certain clauses of the act constituted the board as the arbiter 
between local bodies if disputes or opposing interpretations 
of the meaning of the statute should arise. They were empow- 
ered to institute books, and schedules, and form|5 which should be 
uniform for all asylums, and their use binding on all. If the 
statutory forms of admission were legally complied with, they had 
no direct power of discharging a patient from an asylum. No 
power was given them to be a roving commission to go about 
asylums and judge for themselves as to the sanity of the patients, 
and to discharge them if they considered them sane. When such 
was their opinion about a case they had to call in two independent 
medical men to examine the patient and to report to the board ; 
on that report only they could act and order his discharge. As 
the sheriff had to grant all orders for the admission of patients 
into asylums, a power of discharge was vested in him as well as 
in the board, but only on the report of two medical men. The 
real authority for the discharge of patients when they were well 
enough to leave an asylum was to be the physician-superintendent. 
A clause rendered it lawful to treat recent cases of insanity with- 
out sending them to asylums, and not necessarily in their own 
houses, for six months, with a view to recovery, without any formal 
medical certification and with no judicial order whatever. The 
board was allowed to grant authority for the transfer of a patient 
from one asylum to another and for “liberation on probation ” for 
any period under twelve months. 

Such being the general provisions of the Scottish Lunacy Act 


BY T. S. CLOUSTON, M. D. 


5 


and the powers of the lunacy board, the most important questions 
for the publicist now to enquire into are the following — During tht 
thirty-five years of its continuance has it worked smoothly and well? 
Have the insane been benefited? Has its general policy conformed 
to the circumstances of the country and given satisfaction to its 
inhabitants? Has the board taken a large and common-sense view 
of its duties, and not a narrow, pedantic, and purely official view? 
Has the public confidence in the lunacy administration of the 
country increased? Has it prevented or reduced the lunacy scares 
and sensations so liable to occur in most countries? Has it di- 
minished lunacy lawsuits which usually have their origin and their 
success in an ignorant public feeling of distrust and suspicion that 
justice is not being done? Has it strengthened the hands of the 
physicians to asylums in their most difficult relationship to their 
patients, to the relatives of their patients, and to the public ? 
Has it aided asylum authorities by judicious advice, and, where 
necessary, by vigorous backing up? Has it given the country the 
full benefit of its unique experience in all state questions relating 
to insanity? Has it been a steady educator of the public in all 
matters relating to mental disease, so that hurtful prejudices have 
been diminished, and the “reproach of madness” lessened in the 
public mind? Has it sweetened and mollified the opinion of men 
in regard to insanity so that pity and sympathy have taken the 
place of fear and aversion to any considerable extent? Has its pol- 
icy been progressive, willing to follow scientific progress, and ready 
to adopt the lessons of experience? Has it taken pains to find out 
new modes of treatment and management and to be itself a learner 
whenever any benefit to the insane was to be gained thereb}^? Has 
it endeavoured to be always just and fearless in its dealings with all 
that it had to do with, whether the demented pauper patient, or 
the humble inspector of poor of a small country parish or the coun- 
cils of the great counties and cities in Scotland? Has it gathered 
together a body of reliable and apposite statistics that will help the 
nation in its dealings with the problem of insanity in the future? 

I have been in asylum practice now for thirty-three years, the first 
three j’^ears of which were spent in Scotland in the early years of 
the board’s existence, and I knew the general condition of the insane 
in Scotland then, in and out of asylums. I was then ten years in 
England and had the great advantage of an experience of the work- 
ing of the English ljunacy Act and the English Lunacy Commission, 


6 


THK LUNACY ADMINISTRATION OF SCOTLAND. 


1 have since been twenty years at the head of the Royal Edinburgh 
Asylum, where my position is largely independent of any authority 
except the public and my own board, and I know the condition of 
the insane in Scotland now and of the public opinion there in regard 
to insanity. I have read all the thirty-four Annual Reports of the 
Board. I should, therefore, be in a reasonably good position to give 
an independent answer to these questions and to point out some 
lessons from the history of Scottish Lunacy Administration under 
the Act of 1857. Without hesitancy, I answer all these queries in 
the affirmative, and I shall adduce a few facts to sliow that I am 
not mistaken. 

The whole of the poor insane in Scotland are now provided for 
suitably, but not at all uniformly, either in public institutions or in 
private houses living a domestic life along with the inmates of these 
houses, 'fhis has been largely the work of the Board under the 
powers of the act. They are all under the general supervision and 
regular inspection of the Board through its medical commissioners 
and their deputies. The very different symptoms of the different 
forms of insanity have been taken into account and the insane classi- 
fied into three great groups, and a fourth group is now being segre- 
gated, a different kind of provision being made for each of them. 

The acute and curable cases, the dangerous, the troublesome, those 
difficult to manage and those needing much medical treatment are 
all in asylums. This forms the first and largest group which is 
rapidly now in Scotland being sorted up into two, viz., the recent, 
the curable, the acute, the infirm and all those needing much nurs- 
ing and intimate medical study and care which are being placed in 
special ‘ ‘ Hospital Blocks” detached from the main parts of the 
asylums, these blocks having special nursing staffs, a special dietary, 
and special kinds of wards and rooms. The more chronic and indus- 
trious asylum patients are retained in the ordinary wards, forming 
the second asylum class. The second general group, or we may now 
call it the third, is formed by the lunatic inmates of the poorhouses. 
These consist entirely of chronic quiet cases, who are placed in small 
numbers in special wards set aside for them, the “lunatic wards.” 
The accommodation is cheaper than in asylums and the whole 
cost of each patient less, yet thfey have what their mental condition 
and general circumstances need. The fourth group consists of 
chronic and harmless weak-minded patients who are boarded with 
private families in cottages over many of the country districts of 


HY T. S. (JLOUSTON, M. D. 


7 


« 

Scotland. Tliey have much liberty and individual attention, and 
live the life of the country people in whose houses they reside. They 
don’t need much medical attention and are, therefore, only visited 
ordinarily once a month by a doctor. The Board, the local author- 
ities, and the asylum physicians have gradually been finding out the 
kind of cases that are suitable for these different kinds of treatment 
and accommodation, the Board giving a solidarity to the working of 
this system that it could not have otherwise had. The poorhouses had 
mostly some spare accommodation not needed for ordinary paupers 
and this was utilised for their “lunatic wards,” thus saving the cost 
of additions to asylums and avoiding the too great accumulation of 
chronic cases in one institution, and giving more chance of the 
new and curable cases being individualised and medically treated. 
At first the Board evidently did not look with favour on the poor- 
house ward for lunatics of any kind ; but they incited the local 
authorities to remedy their defects, and they discovered that 
there were cases for whom these wards, when improved, supervised 
and provided with skilled nursing, were suitable. 

It is still more interesting and instructive to pass in review the 
“ Boarding-out System” for the chronic insane, for which Scot- 
land has become famous and has set an example followed in other 
countries. The Board at first did not look with favour on the 
system : but Dr. Arthur Mitchell, who has really done more than 
any one else to develop it, rid it of its defects and, taking advant- 
age of its capabilities for good, soon began to see in his work as 
deputy commissioner that certain of the insane could be made 
comfortable and happy at a small cost, as inmates of cottages, 
boarded with the cottagers in certain parts of Scotland. In the 
report of the board for I 860 he went carefully into the subject, 
laying down broad princi[)les and pointing out dangers, showing 
the suitable localities, conditions and patients. Subsequently in 
1864 he published a small work on “ The Insane in Private Dwel- 
lings.” Certain villages in Scotland have fair houses, respectable 
inhabitants, and no industries, where some of the quieter insane 
can find real homes, can mingle in family life and can thus be 
made happier in their lives than when aggregated in the necessarily 
artificial life of pauper asylums. Strict and constant supervision 
by the deputy commissioners and the local authorities is 
needed and careful selection has to be made of suitable cases, 
and this is provided for by the board. In Scotland, at the present 


8 


THE LUXACY ADMINISTRATION OF SCOTLAND. 


time, there are 8,871 patients or 70 per cent, of the whole in asylums ; 
875 or 7 percent, in poorhouse wards and there are 2,560 or 20 per 
cent, boarded out in private families. Had all the two latter classes, 
amounting to 3,435, been placed in asylums, the cost of buildings 
would have been something like £700,000. Only 163 or 1-^ per 
cent, are now in private asylums. 

The history of the relationship of the commissioners to 
the asylum physicians in Scotland is a question well worthy 
of study by those who desire to understand how an in- 
specting government authority, with very limited power of 
directly carrying its recommendations, may influence for good an 
executive authority without impairing its vigour of action, its power 
of initiative, or causing undue irritation. To say that no fric- 
tion or irritation on either side has ever arisen would not be true. 
To say that one side has always been in the right would be incred- 
ible, as human nature is constituted. The commissioners on their 
side endeavoured to back up the authority of the asylum physi- 
cian. When reform or advance was needed they tried to have it 
come through him. They almost never appealed over his head to 
the asylum board. They mostly recognised that the daily irritation 
and wear and tear of meeting his patients was a strain on the doc- 
tor far worse to bear than the strain on them from their occasional 
visits to institutions. They did not conceal that to do a thing 
is much more diflicult than to recommend its being done. They 
did not demand or expect perfection and they were not too exact- 
ing about small things or details. They did not, as a rule, go in 
for fads or small irritating and non-essential recommendations. 
They tried to enter fairly into men’s special difliculties. Whilst 
always trying to do full justice to the patients’ grievances and 
views, they did not assume that these were of necessity the whole 
truth. In their personal relations with the doctors, they studiously 
cultivated a friendly and courteous manner, for the most part 
avoiding all martinet ways or unduly suspicious procedures. They 
were willing, nay eager, to notice improvements and advances, to 
give full credit to those who originated them and to spread them 
to other institutions. I may adduce a few examples. From the 
very beginning the commissioners, more especially Sir James Coxe, 
were observant and commendatory of every arrangement that pro- 
moted more freedom among the patients in asylums, that made 
their lives more domestic, and that promoted employment. A 


BY T. S. CT.OUSTOX, M. D. 


9 


large number of the patients in asylums were at first wholly or 
partly confined to enclosed “ airing courts ” for their out-door exer- 
cise. Dr. Sibbald, now one of the Commissioners, then superinten- 
dent of the Argyll Asylum, disused his airing courts altogether, 
sending ^11 his patients into the grounds and on the farm. The 
success of this experiment showed that undoubtedly airing courts 
had been too much used and might be attended with marked disad- 
vantages to the patients, which their disuse largely overcame. The 
commissioners at once went in for an anti-airing court crusade, 
giving Dr Sibbald full credit for the suggestion, and now few air- 
ing courts in the old sense are used in Scotland. Dr. Batty Tuke 
at the Fife asylum put handles on many of his ward doors so 
that the patients in these wards could go out and in as in an ordi- 
nary house or hospital, and called this the “open door system.” 
The Commissioners very soon saw that there had been too much 
locking up and advocated more “open wards.” All over Scotland 
every asylum has now half or more of its wards with “ open doors” 
in this sense. Dr. Rutherford at the Argyll, Lenzie and Dumfries 
asylums in succession adopted a system of management, more free, 
apparently more risky, but more trustful towards the patients than 
any asylum doctor had ventured to adopt before ; and the Commis- 
sion soon took up the good points of his system and advocated 
them all over Scotland. Even though some sei-ious accidents did 
happen in the course of these experiments towards making the 
lives of patients in asylums more like those of men and women in 
their homes, the commissioners backed up the doctors and took a 
fair share of the odium and risk. More recently I reconstructed 
our former “ refractory wards ” and converted them into hand- 
somely furnished and bright “Hospitals” for recent cases, for the 
sick and for those patients who needed special bodily nursing, intro- 
ducing into these wards a special nursing staif and more markedly 
medical arrangements than had existed before in asylums. The 
Commissioners approved of this as an advance in asylum arrange- 
ments and as being for the good of the insane, and they have advo- 
cated it all over Scotland, so that there are now finished or building 
at six asylums such “Hospitals.” Above all every royal asylum 
in Scotland has of recent years rebuilt, extended, or modernized 
itself sua sponte^ the commissioners freely using the experience 
thus gained for the general benefit. 

The Commissioners have always more or less, and of recent years. 


10 


THE LUNACY ADMINISTKATION OF SCOTLAND. 


distinctly more, re(*ognised the spirit of et^prit de corps in our de- 
partment of the medical profession with its subtle but strong and 
pleasant effect in softening personal differences, in heightening self- 
respect, and in creating personal regard. They constantly attend 
medical meetings where subjects connected with insanity are to be 
discussed. They comrnoidy try to get things put right through the 
process of convincing by facts and the example set by others rather 
than official reprijiiands. They want eveiy asylum doctor in Scot- 
land to feel that in many respects Scotland is ahead in the treatment 
of the insane and that he must help to keep up his country’s credit, 
and this is not done in a patronising or offensive manner. They 
recognise that it is a great scientific as well as an administrative 
problem which the Commissioners and asylum physicians have to 
solve together; and the spirit of modern science tends to produce 
a fellowship of enthusiasm in ail who are earnestly engaged in its 
work. Asylum administration without the spirit of modern science 
must be a barren and unfruitful pursuit, as well as an uninteresting 
if not repulsive employment. If the Scottish system of lunacy 
administration has been in any v/ay successful, it has undoubtedly 
been largely due to the fact that medicine and law were allocated 
their proper places on the Commission. The medical Commis- 
sioners visit the patients and the institutions; the legal Commis- 
sioners sit at the Board meetings and give the benefit of their 
legal knowledge. 

With all their suaviter in modo^ however, the Scotch Board can 
exhibit the fortiter in re and have exercised their statutory author- 
ity vigorously when the occasion demanded it, and do not hesitate 
to take the public along with them in carrying any important 
point. They have had several very important differences with 
asylum Boards of Directors and j)hysicians and have fought 
out the matters in dispute sharply. They have not always been 
in the right on all points, but such differences have now almost 
ceased. 

On the other hand, the asylum physician-superintendents have 
gradually come to recognise how great a help to them in their work 
the Commissioners are. Tlu^y see that where personal liberty is 
involved the public and the law must step in witli etficient safe- 
guards and that such safeguards must be independent and outside 
of asylum influences altogether. They have come to recognise 
that in this way only will the public have full confidence in them 


nv r. s. ( LousTox, m. d . 


11 


and their work. They have, therefore, loyally accepted the posi- 
tion and endeavour to satisfy the Commissioners in every reasonable 
wa}^ that the real interests of the insane are safe in their hands. 
They arc disposed to take advantage of the wide general experi- 
ence of the commissioners and to ask for counsel and help in their 
difficulties, a spirit which they always find appreciated and cor- 
dially met. The irksomeness to human nature of being inspected 
and looked after is thus greatly done away with. They know 
that when they do their best they will get credit for it ; that when 
unavoidable mischances arise they will be fairly and not suspici- 
ously treated; that their individual ideas and efforts will be appre- 
ciated though they may not be (juite in the routine lines. They 
have come to look on the Commissioners as a great bulwark and 
protection to them, exposed as they are to the suspicions and mis- 
interpretations of the public that is necessarily ignorant of their diffi- 
culties. Their comfort in their work and in life is thus increased. 
Some men are by temperament very jealous of official control 
or supervision and are irritated and often embittered by it. 
Our Commissioners have been on the whole large-minded in deal- 
ing with such men so long as their work was well done. When 
an asylum superintendent once gets his own Directors or the 
Commissioners on the brain it is all up with his future official 
happiness. He gets suspicious of everything they do, thinks 
of nothing else and becomes too thin skinned to work comfort- 
ably with. Our Commissioners have not been unmindful of 
this phase of human nature, trying their best to avoid giving 
occasion for it. Men who will not recognise that their work is 
a greater thing than their feelings cannot always be propitiated, 
however. 

One possible reason of the success of the Scotch system 
of lunacy administration has probably been the smallness of 
the country, which enabled the commissioners to know each asy- 
lum and its local circumstances well, and to know almost every 
patient. Sir Arthur Mitchell, now the senior medical commis- 
sioner, did a very valuable service to several of the old royal asy- 
lums by investigating their histories, bringing out the conditions 
of their origin and their original, raison cV etre; this information 
coming from an impartial authoritative source helping to get these 
institutions out of difficulties they had got into, and saving expensive 
fights before the law courts. At the present time the whole sys- 


12 


THE LUNACY ADMINISTRATION OP SCOTLAND. 


tern works with smoothness, while the insane are nowhere bet- 
ter taken care of, and our institutions are every year visited 
and are commonly praised and held up as examples by distin- 
guished and impartial Ausitors from all parts of America and 
Europe. 

Since the 1857 act came in we have never had any important 
lunacy law suit in Scotland, and it is certain that the Scotch 
people have great confidence in their system of lunacy administra- 
tion, as is evidenced, amongst other ways, by what is constantly 
said of it in their great newspapers. 


i 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


BY JULES MOREL, M. D., 

Medical Superintendent, Hospice Guislain, Ghent, Belgium. 


For nearly three years I have been daily occupied with the 
medico-psychological examination of prisoners and young offend- 
ers in the reformatories of Belgium. As my experience has 
enlarged, I have felt the high importance of what I like to 
call my mission and the happy results that may follow from 
it in behalf of those deprived of intelligence and moral sense. I 
called attention to the great importance of this examination 
before the psychological section of the British Medical Association 
in 1892,* and there offered the following conclusions: 

Mrst . — That every prison with a population of, for instance, one thousand 
or more convicts should have a special ward in which one could take proper 
care of all the criminals who have become insane during their detention and 
are susceptible of recovery. 

The treatment of the criminal and curable lunatics in a separate building 
of a prison seems to me to have great advantages. On their discharge these 
unhappy men could not have the stigma of having been in a lunatic asylum 
and consequently it would be easier for them to reconquer an honorable place 
in society^ The special lunatic asylums for criminals ought only to be 
opened for those whose mental condition would not allow of rational treat- 
ment in the division of the prison called the lunatic ward ; they should also 
receive the insane criminals whose incurability is more or less established. 

Second . — That each prison, and a portion in each ward destined for crim- 
inals having become lunatic, ought to have a special staff of attendants 
with the necessary qualities, instruction and education required to treat 
rationally the convicts who become insane. 

Third . — That all convicts belonging to the class called imbeciles ought 
to receive special physical and mental care. They ought not to be dis- 
charged before the end of the duration of their imprisonment, because, it 
is this class of degenerates that furnishes the great contingent of recidivists. 
One ought also to group in this class those criminals who, by their former 
way of living, have weakened their body and mind. 

Fourth . — That society does not take sufficient care to preserve malefac- 
tors from relapse. In the present state of things, and almost generally, the 


♦The Psychological Examination of Prisoners, in “The Journal of Mental Diseases.” 
January, 1893. 


14 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


old criminals feel themselves abandoned by those who ought to protect 
them in a social point of view ; very often they are obliged to look for 
hospitality in lodgings inhabited by the lowest class of society. It is 
not easy for them to find work again, consequently they are obliged to 
spend most of their time in these houses of ill-repute. With the little money 
they have they begin to drink ; they make the acquaintance of bad people, 
and by and by they begin to attempt, or are provoked to commit new crimes. 

The psychological examination has often proved that these individuals 
on leaving the prison cured, as mucli as possible, physically and morally, 
if they are obliged to follow the course Ave have described, soon again de- 
cline mentally, and, above all, lose their Avill and their self-respect. 

1 read also, before the Congress of Anthropology held in 
Brussels a few days afterwards, a pa]>er “On the Nature of the 
Incorrigible,”* and asserted: 

That anthropologists cannot classify the incorrigible without having re- 
course to the science of pathology. Degeneracy may involve at the same 
time the physical and the psychical state, but it may vary greatly and pre- 
dominate in one or the other of tlie two states. Lombroso’s school has de- 
voted too little of its attention to the opposite etiology which considers the 
amelioration of man. After having studied the so-called incorrigible as 
well among children as among youth, we concluded : In order to give to 

the theory of incorrigibility some standing, some scientific value, it would 
be necessary to be able to bring forward certain specimens as having passed 
through all the different systems of treatment and education. The proof 
of incorrigibility in tnen who, psycliically, present no hereditary taint, is, 
therefore, yet to be made. . . 

The reformation of so-called incorrigibles should be attempted in the 
reformatories and prisons; it should be continued even outside of these in- 
stitutions. ... If every countiy had the good fortune to have a law for the 
protection of childhood; if the authorities had sufficient latitude to remove 
the children from parents and tutors incapable or unworthy; if the govern- 
ments would organize methodically a system of education for these unfor- 
tunate creatures, in a very few years we should see criminality decrease to 
a. considerable extent. 

To-day, and in consequence of the kind invitation of your 
worthy President, Dr. G. Alder Blumer, I have the honour to offer 
to the section on the Commitment, Detention, Care and Treat- 
ment of the Insane, of the World’s Congress of Chicago, tlie ben- 
efit of my unintermitting study, lioping that the alienists of the 
New World will be pleased to accept favorably these few lines. 
Indeed, in what other part of the world could we meet more ex- 
tended ideas of charity than in the United States ? Is it not in 

* The Monthly Summary, 1883, Elmira No. 2, and Bulletin de la Sooiete de Medicine 
Mentale de Belgique, 1892. 


BY JULES MOREL, M. D. 


15 


this country that one ever says ami repeats: No State or nation 
was ever ruined by the greatness of her charities ? The Lord 
seems rather to prosper tliose [>eoples who are most generally 
charitable toward the helpless and the unfortunate. 

I submit these lines to your learned aj)preciation and 1 should 
feel myself well rewarded if the elite of the American alienists 
who favour me with their kind attention, could also favour me 
with the expression of their opinions concerning the (piestion of 
the unfortunates predisposed to insanity and criminality either by 
heredity or by acquired diseases or bad education. 

During my later studies 1 had the good fortune to make 
the acquaintance of the excellent Oerman book of Dr. Koch, 
Medical Superintendent of the Lunatic Hospital of Zwiefal- 
ten, entitled: “Die Psychopathischen Minderwertigkeiten.” * 

This title of “Psychopathic Depreciations” is given by Dr. 
Koch to a very large number of these psychical manifestations, 
so varied in their nature and intensity which, without belonging to 
the class of mental diseases proper, cannot, nevertheless, be recon- 
ciled with the idea of j)erfect mental sanity. Under this head 
of psychopathic depreciation we meet cases perhaps better known 
in mental science as premonitory symptoms of insanity, incom- 
plete recoveries, nervous temperament, hereditary neuroses, obses- 
sional insanity, hereditary madness, neurasthenia, neuropathic 
constitution, etc. 

Koch prefers his single denomination and, in preparing his 
work, his aim was to call the attention not onlji^ of the medical 
world but of all persons interested in pedagogy, law, and morals. 
In order to make his book, or rather the importance of it, 
better known, he made several divisions and subdivisions of his 
ps^^'chopathic depreciations; he took a special care to establish 
evidence of pathological shades corresponding to functional altera- 
tions of the brain and the nervous system; he made two great di- 
visions, congenital, mostly hereditary, and acquired. Each of 
these conditions were divided into three others : psychopathic pre- 
disposition, psychopathic defect, and degeneration. A few words 
are necessary to define these conditions as we meet them in the 
different cases of mental vreakness of which I have to speak: 
Congenital predisposition in psychopathic depreciation may be 
latent or evident. It is characterized by an exaggerated sensibil- 


* Baumbur^. Published by Otto Maier: 1893. 


16 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


itv accompanied with a lack of activity’' or of energy of the 
nervous system. 

In the psychopathic congenital defect we have anomalies of the 
psychical excitability, exaggerated excitability, rapid weakness 
(irritable weakness), want of balance in the mental faculties, an 
exaggerated individualism, a want of uprightness and judgment, 
inconsistency in the conduct, eccentricities, singularities, obses- 
sions, and periodicity in these symptoms. Also Koch speaks^ of 
eccentrics, desequilibrated, overscrupulous and capricious per- 
sons, foolish, misanthropes, redressers of wrongs, reformers of 
society, etc. 

The congenital degeneration is characterized among other psy- 
chological deficiencies by a mental weakness, now in the province 
of the intelligence, now in the department of the moral sense, and 
at other times in both the intellectual and moral spheres. 

The acquired psychopathic depreciation may natural^ depend 
upon a predisposing etiology and in this case heredity will be the 
most important. It is needless to mention the efficient causes be- 
fore this learned body ; tliey are, moreover, too numerous. Great 
caution is to be used here in order not to confuse this depreciation 
with neurasthenia and the first symptoms of general paralysis. 

In the psychopathic acquired defect the learned German alienist 
distinguishes the idiopathic blemish from that resulting from a 
vitiated constitution from intoxications, infections and nervous 
diseases, railway-brain, onanism, puberty and pregnancy. 

The acquired degeneration is, like the congenital degeneration, 
a pathological condition, an intellectual or a moral weakness. It 
may be the consequence of an uncured insanity, of infectious dis- 
eases, of cerebral traumatism, etc. We may call it a specific 
degeneration when it follows alcoholism, senility, epilepsy or any 
other chronic neurosis. 

The above quoted divisions and symptoms make it clear 
why Dr. Koch is not a partisan of Lombroso. We also have 
only to mention the results of the last Anthropological Congress, 
held in Brussels last year, to prove how the Italian school has lost 
a great deal of its prestige. This may be of importance before 
entering upon the practical part of my subject. 

What I am now advancing is not new to competent alienists, 
who are daily called to give their opinion in doubtful cases, and, 
consequently, in cases of psychopathic depreciation. But how 


BY JULES MOREL, M. D. 


17 


often does it not happen that patients and their friends only take 
the advice of their family doctor who, many times, knows 
scarcely anything about mental diseases; who, generally, even 
when he knows of the results of heredity and acquired predisposi- 
tion, is incompetent to properly advise his patients, because he 
never passed a medico-psychological examination when taking his 
degree, or never had the opportunity to practice to any extent in 
mental diseases. 

How difficult it seems, and certainly is, in general practice to 
recognise the diminution of the force of resistance in nervous dis- 
eases! How little attention is given to the question of predis- 
position or heredity! How often the predisposed are living 
under bad influences ! 

The treatment of all psychopathically depreciated individuals 
and consequently their preservation from the evils that threaten 
them, ought to begin in their earliest infancy. Let us first avoid 
assuming hereditary predisposition when either insanity or a serious 
nervous disease has been stated to have occurred only once in the 
parents. Too often such a conclusion is adopted and hope of re- 
covery in the descendants is given up, because one of the parents 
or the grandparents was aftected with insanity, for instance at the 
period of puberty, of pregnancy, even of senility or by reason 
of another organic disease of the brain. A preliminary examin- 
ation of the insane needs to be made before one is enabled to 
judge in regard to an appearance of heredity. It is only after a 
careful examination that one can believe and sometimes prove the 
existence of heredity. The proof will be beyond doubt when in 
parents and in their children stigmata of anatomical and psychical 
degeneration are abundantly found. 

Whatever may be the prognosis after examination, the alienist 
need not always despair, except in cases of idiocy in a very high 
degree and of extreme dementia. The physical and mental 
training in the special asylums for imbeciles and idiots give such 
splendid results that we can not imagine how parents, and, espe- 
cially, those charged with heredity, are not encouraged and ad- 
vised by their doctor and friends to try, from the first year of the 
child’s life, special measures for their preservation. If a good 
and persevering physical and psychical management of the w^eak- 
minded gives such admirable results in asylums, it would be still 
better if the child could be trained from the earliest period of its 


B 


18 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


life. This subject is ignored bj^ the public, and in every case 
not sufficiently appreciated. Great efforts should be made to 
call the attention of all educators to this capital point. * 

For cases of simple congenital predisposition it is impossible to 
give here a full description of the prophylactic treatment. It 
will be sufficient to mention that indications and directions are in 
this matter very numerous, and that patients ought to be under 
the care of a physician possessing an extensive knowledge of this 
subject. In many of these cases it is of urgent importance that 
the family doctor be assisted by an alienist, as very often the 
judgment and the science of two medical men are not too much 
to save a child for the remainder of his life. 

The cases of psychopathic defect must be taken into serious con- 
sideration as we are now living in the century of the neuropathies 
and nervous weaknesses. Here the duties of an alienist and of the 
medical men in general are very important. First of all we have 
to try and preserve the patients of a nervous, or of a weak con- 
stitution. It need not be said that we have to oppose their marri- 
age, as nothing exactly proves their hereditary tendencies. How- 
ever, advice is to be given to them, they ought to know in what 
state of health they are living, they must be informed of the 
great danger of the matrimonial union with a person of the same 
tendencies and especially when consanguinity exists between them. 

The greatest care is to be given to children of this class. 
Experience, already, has led to the conclusion, that mental and 
physical overwork increases this defect; that young brains must 
not be overexcited with pernicious thoughts. The will of the 
children ought to be cultivated and strengthened, and conse- 
quently their mind should be regularly educated. The bodily 
exercises should be regular and not exhausting; the digestive 
functions should never be artificially stimulated in any way to 
increase unduly the assimilation of the food. The development 
of the intelligence, the sensibility and the physical training 
ought to be looked after in the same waj^ Consequently special 
attention should be given to the schooling and education. 

Again, it is not possible to give here all the special directions. 
It would lead us too far, and, moreover, it would not be possible 
to give them completely, as they vary so much according to 
the individual under care. Nevertheless, we must know that 
physicians and parents or educators ought to understand each 


HY JULES MOREL, M. I). 


19 


Other, and, once a plan of living is laid down, it ought to be 
followed and watched every day. The success depends on this. 
Let us not forget the great influence of hygienic conditions (air, 
light, food, dress, habitation, sleep, muscular exercises, etc.), for, 
without them, the efforts made for mental training are useless. 

When putting these orders into execution, we not only prevent 
an increase of the congenital tare, but also we perceptibly amend 
the psychopathic depreciation that no doubt in the usual way of 
living would certainly become worse. The object very often thus 
secured is double: aggravation lias been prevented, amelioration 
has been obtained. 

But how^ frequently the efforts are unsuccessful, because either 
the family doctor, and the educator have no time to superintend 
the treatment and often also are unable, for many reasons, to 
individualise the treatment as they ought. Therefore we can- 
not sufficiently appreciate the high value of well organized special 
boarding-schools for the weak-minded. 

The special aim, says Koch, is to teacli the patient and to 
enable him to govern himself, to repose confidence in himself. 
To reach this end, a great deal of patience is required of him 
who undertakes this treatment; he has to exercise himself to win 
this patience ; he must know how to divide the time for work and 
the time for rest. For many of these mentally depreciated sub- 
jects, variety is wanted as well for the physical work as for the 
mental training. 

Those charged with the application of these remedies and exer- 
cising good judgment, are soon enabled to distinguish those 
cases that are the most favourable, from those that are the most 
difficult; they can soon sajq that a favourable remedy for the one 
may be noxious for another and vice versa. The use of tonics, 
spirits, cold baths, etc., and even hypnotism, may be tried, but 
great caution is to be exercised and these remedies should never 
be employed or prescribed except by medical men. 

What has just been said proves the superiority of good special 
institutions. All those connected with them have very delicate 
and difilcult duties to perform. As the end to be attained is 
unique, all the teachers and other persons belonging to the institu- 
tion should do all they can, to co-operate with and to fulfil the 
instructions of the medical staff. 

Even the subjects of congenital psychopathic depreciation in a 


20 


TUE TREATMEInT OF DEGEJ^ERATIVE PSYCHOSES. 


high degree, as for instauce, those suffering from obsessions with- 
out delusions, are not inaccessible to successful treatment. In 
those cases, naturally the most important part belongs to the med- 
ical treatment as in most mental diseases the more serious cases, 
dating from the first youth, and aggravated in proportion to the 
age, are more difficult to be completely cured. However, we can 
often stop the progressive evolution, and patients can be amelior- 
ated in such a way that the improvement makes their life very 
bearable. How often since attention has been called to neuras- 
thenia, the so-called American disease, but existing in all civilized 
countries of the world, have these sufferings, these formerly in- 
curable nervous exhaustions, been cured! 

The same results may be obtained with the intelligent but 
psychopathically depreciated subjects. Almost daily we see these 
successes when patients are enabled to understand the nature of 
their sufferings, to discern that their disease does not belong to 
insanity, that it will never lead to a mental disease. This under- 
standing is one of the best of all anodynes ; it reminds me of what 
one day the celebrated Professor Bonders of Utrecht (Holland) 
told to one of his patients suffering from an hyperaesthesia of the 
optic nerves of a neurasthenic origin: “ What science cannot, 

often time and hygiene can, realize.” The intelligent patient had 
received from this learned man the assurance of his sight; a 
good hygiene and mental rest did soon afterwards produce a cure. 

Is not this the best proof that the jjsychopathically depreciated 
ought to give their entire confidence to the person of their doctor’s 
choice, who has, so to say, to nurse and to help them according 
to the medical directions ? 

The acquired psychopathic depreciations, of either the first 
or second degree, may also exist from the first years of the child’s 
life. Already we have said that neurasthenia can be confounded 
with it. These depreciations, in proportion to their intensity, 
are successively characterized by a state of fatigue, and even a 
nervous or mental exhaustion accompanied with physical weakness 
and functional trouble in one or more organs of sense, — by a 
pathological debility of the intelligence, and impaired memory es- 
pecially for recent facts, a difficulty of comprehension and of bring- 
ing up ideas and judgment, — often together with other troubles, 
fears, despairs, especially in cases of intoxications by morphine, 
cocaine, bromides, coffee, etc., in cases also of passive cerebral 


BY JULES MOKEL, M. D. 


21 


hyperaemia, traumatic neurosis, etc. — and increased by irritability 
and excitability when the troubles arise from onanism, puberty 
or other period of transformation in the sexual life. In the 
highest degree, when there is nearly no hope of recovery, the pa- 
tient is in a lingering state for the remainder of his life. These 
cases are met with in cerebral traumatism, in organic cerebral dis- 
eases, and as a consequence of many infectious diseases. In this 
degree we have modifications of the character, and in the sphere 
of the sensibility and the will. These troubles are still more 
marked in hypochondria and hysteria. 

As to its treatment, many prescriptions are the same as for the 
congenitally depreciated we spoke of. It is a capital duty to begin 
to fight, from the first symptoms, against predisposing and occa- 
sional causes, because if you prevent aggravation, }mu make recovery 
possible. Especially in these depreciations, the alienist ought to 
utilize all his science and prove that only mental science is insuffi- 
cient to cure such patients. Not only has he to guide the intel- 
lectual life, the life of sensibility and will ; he has also to remedy 
the morbid somatic conditions, to superintend the general regime : 
times of work and rest, air, light, dressing, preservation from 
alcoholic and other excesses. 

So doing, following the scientific prescriptions, not only one 
increases the force of resistance of the patient, but also of future 
generations. Often one succeeds in increasing the power of com- 
manding one’s self, of renouncing certain factitious wants and pas- 
sions, enlarging the feeling of duty, understanding the aim why 
he is born, and what holy mission he has to fulfil upon earth. 
The intelligent man has always to have in mind that he has to 
improve himself, to try and benefit his fellow creatures and so 
he fulfils before society and the Lord the most important of 
his duties. Medical men, parents or educators, have always to 
think about these essential principles, and when they do not reach 
the wanted results at home, they have to commit their patients to 
proper special institutions, but never to those where care and 
education is given by routine. 

In the highest degree of congenital depreciation we have the 
real mental degeneration. Persons suifering from this defect are 
better known under the name of degenerated or weak-minded. 
Many of them are found in lunatic asylums; the greatest part 
-enjoy tlieir liberty but the po])ulation of the prisons and of the 




THE TEEATMENT OF DEGENERATIVE P*SYOHOSES. 


reformatories count a certain number of them. In order not to 
repeat, we will include in the same division the acquired psycho- 
pathic depreciations, also degenerates or weak-minded, as in a 
medico-psychological view the treatment may be said to be nearly 
the same. 

We all know that a great difference exists in the mental state 
of health of the degenerates. Some degenerates are dis- 
tinguished by a great dehciency iii the intellectual sphere, some 
others are characterized by a great want of moral power, others 
finally have deficiencies in both the intellectual and the moral 
spheres. 

Although many degenerates are hopeless as regards treatment, 
a great number, a proportion of nearly sixty pei' cent., is suited 
to be submitted to a mental training. According to Shuttleworth 
and Seguin, if a complete cure may be considered as impossible, 
many of the most serious and disagreeable symptoms can, never- 
theless, be removed. The degenerates, inaccessible to kindness, 
to severity and to every kind of treatment, are individuals, so says 
Koch, Avhose pathological lesions are identified with physiological 
wickedness. Kotwithstanding this, some of them often show one 
side on which they can be taken, especially when they are kept 
away from noxious influences and when they are brought into a new 
medium. This fact is to be verified in well organized lunatic 
asylums; seemingly hopeless weak-minded cases, after a certain 
time of training, are often enabled to learn a handicraft or a trade 
and to return to their family. 

Some weak-minded of the lowest degree, if unable to reach this 
so-called perfection, can still be made useful and happy, although 
they must meet certain difficulties in the course of their existence. 
These results can be obtained, but before attaining them a great 
deal of courage and energy is requisite. Courage and energy 
should be applied, great should be the patience and persistence as 
long as some hoj>e remains. Do not even despair with morally 
insane. Meynert, Von Krafft-Ebing, Koch and others of the 
best known alienists have succeeded, after a certain period of 
treatment, in attaining more or less great and permanent results. 
What nature really refused cannot be given to a degenerate; but 
sometimes it happens that something can be added to what al- 
ready exists, and very often more natural qualities can be dis- 
covered in an individual than was to be hoped. 


BY JULES xMOREL, M. D. 


23 


The qualities required for the training of degenerates are so 
numerous that it is very seldom parents and relations possess them ; 
often they are unable to form for themselves any correct opinion 
of the mental state of their weak-minded charges ; often too, the 
intellectual powers of the relations are insufficient, and often also 
they refuse to be good aids because thej" cannot believe in the 
good results of a rational treatment. And without a gradual 
education the mental deterioration of the degenerates increases 
without interruption. For all these reasons we have scarcely any 
hope of amendment if the weak-minded are kept in their families. 

Happy are the degenerates confined in season in a good lunatic 
asylum or in special schools for weak-minded and even in reform- 
atories. Some are to be found in the prisons. The most fortu- 
nate are those who encounter on their way medical advice rather 
than a judge! The staff of the lunatic asylums, or better still the 
staff of the asylums for idiots and imbeciles, know their mental 
deficiencies, and the medical superintendent keeps them under 
proper care as long as they are unable to join their family. 

The reformatories and even the prisons mostly receive the neg- 
lected or abandoned degenerates, who have become criminals. 

Can a happy modification of the degenerated be obtained in 
lunatic asylums ? Does a reformatory suffice to amend the psy- 
chical lacunae of the weak-minded offenders ? And I mention only 
the prisons, as a recollection, because in the present situation of 
the penitentiary system I don’t believe very serious improvements 
can be reached in these institutions. 

I make haste to say that at the present time we possess several 
well organized asylums with special sections for children, which 
have all the desired means to ameliorate the mental state of the 
weak-minded, but only upon condition that they should be sent 
to them wlien tlieir age and the degree of their intellectual powers 
still give some hope for their return into' society. 

I have seen many lunatic asylums. I know all those of Bel- 
gium and several of France, Germany, Austria, Holland and Eng- 
land. I have been surprised to ascertain that, in most of these 
asylums, little attention is given to the education of patients of 
no more than fifteen or twenty years of age. In asylums with 
special sections for idiots and imbeciles, it is a rule that the 
children leave the school at the age of about fifteen years for the 
workshop where they have to learn a trade suited to their phys- 


24 


THE TREATMENT OF DEGENERATIVE RSTOHOSES. 


ical and intellectual strength. At about this age it is thought 
that sufficient experience has been gained with the feeble-minded 
and that one may then conclude as to a favourable or unfavour- 
able prognosis. 

The foregoing observations must be applied to the training of 
children in most reformatories. If instruction and moral training 
of the young offenders is what medical science requires at the 
present time, I should say that pupils of reformatories are more 
happily trained than the children in many of the special sec- 
tions of lunatic asylums. In Belgium the pupils generally leave 
the reformatories between their eighteenth and twenty-first year. 
In many European reformatories, perhaps also in some Ameri- 
can, the pupils are allowed to leave sooner and even without a 
previous determination as to whether they are weak-minded or 
not. 

Daily experience proves this is a great mistake. If the old 
pupil is weak-minded, if he has the misfortune to be fatherless or 
motherless, if his father, his mother is disqualified or unable to 
give a good education to their child, all that has been done in 
his favour in the industrial school or in the reformatory is lost, 
the boy may be considered as abandoned. 

Is this not one of the inconveniences of the reforming school? 
It is only in case a pupil should have proved, during all his stay 
in one of these institutions, that he has been an idiot absolutely 
unable to assimilate the least notion of a training, instruction or 
profession, that care is taken by sending him to an asylum. 

Moreover, generally, it is considered in the reformatories 
that when a pupil has succeeded in mastering the primary 
instruction, or the first principles of a trade, he is prepared 
and ready for taking care of himself and associating with his 
fellow creatures, and is able to know his duties. He is set 
free and takes his liberty when the door of the institution is 
opened to him. If he belongs to the class of the degenerates, 
what good can one expect from him on his return into society ? 
The reformatory may have it registered that he 'was a boy of a 
bad disposition, indifferent, undisciplined, immoral, in one word 
he had a bad record. No good report can be given of him. 

What ought he to do without any adequate protection ? Mem- 
bers of the committee of patronage dare not and cannot intro- 
duce him into a workshop or into any other business; certainly 


15 Y JULES MOREL, M. T). 


25 


they cannot do so without blushing. He who deserves perhaps the 
highest commiseration does not receive the slightest protection! 
And this because the managers of some reformatories have not 
the good fortune to have chosen a competent man who, in this 
case, would have been enabled to discern the psychological situa- 
tion of this probably weak-minded individual. 

My aim is not to make known the splendid results of many re- 
formatories. These results only appertain to their normal popu- 
lation. These institutions receive but young offenders; usually 
they have but one programme, no selection or rational classifica- 
tion is made between the pupils, be they intelligent or not. I 
think the time has come that all offenders, young and old, but es- 
pecially those of the reformatories, ought to be mentally examined 
if, after a few weeks of their detention, some doubt arises con- 
cerning their psychical conditions. It ought to be taken in con- 
sideration that many offenders are born from parents with 
congenital or acquired and consequently hereditary mental taints; 
that their children, not being born in a normal physiological con- 
dition, come to the reformatories because of the tare of degenera- 
tion thej^ have inherited or acquired and because of the bad 
education they received from their unworthy or incapable 
ancestors. Therefore they ought to be classified according to the 
degree of their mental capacity, and special treatment ought to be 
prescribed for those who move every one’s pity. Double chari- 
table work would then be realized. Efforts should be made 
toward raising up the unfortunate, not only in his own, but also in 
society’s interest. 

With these modifications introduced into the reformatories 
much better results ought to be obtained from the beginning and 
at the entrance of the inmates; careful psychological examination 
should be made from time to time if any reason should exist for 
it, as, for instance, insufficiency of progress obtained, suspicion 
as to their mental faculties, bad conduct, etc. 

Since the service of mental medicine has been introduced in 
the Belgium prisons and for the undisciplined pupils of the re- 
formatories, we are almost daily occupied with this, in so many 
respects, difficult question. We have examined more than five 
hundred young and old offenders, we have taken up their case at 
the moment the condition of their intelligence seemed suspicious 
to the managers at the same time, as no good medico-psycholog- 


26 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


ical exaiiiiiiatioii can be made without inquiring of the patholog- 
ical conditions that could have contributed, in the course of the 
existence of the offenders, to trouble their mental faculties, we 
directed our investigations to the nature of their education and 
their passions, we wanted to know the conduct of their par- 
ents, their uncles and aunts, brothers and sisters, and, further 
still, the nervous and mental diseases of their relatives; in a 
word, we sought for all the information that could be called upon 
for the proposed end. 

1 have dwelt too long upon the reformatories, but it ought to 
be remembered that in Belgium we have no good asylums for 
imbeciles. Usually these weak-minded remain free and very 
often they are either neglected or abandoned by their parents; 
they become delinquents and then, when young, the government 
keeps them in reformatories. So it is explained how so many de- 
generates are found in these institutions. If this fact were known 
sufficiently, no doubt a rational treatment could be undertaken in 
these schools as well as in the asjdums for imbeciles. One would 
begin naturally with the treatment of the congenital tare and 
with this often the progress of the depreciation or degeneration 
would be stopped ; it would be neutralized or even diminished. 

Special principles of the treatment of the degenerates are very 
numerous. One ought to remember that manj^ of them are so 
weak-minded that even their organs of sense have but the slightest 
education. The educator has to know this; it is of capital im- 
portance. He has to systematically study these senses, and the 
degree of their functions; and when necessaiy, he has to classify 
his weak-minded cliarges according to the degree of their degener- 
ation. The educator has also to study their moral nature and their 
natural feelings. He should try and discover their natural disposi- 
tions and take them into consideration in the education he has to 
give; he must utilize them because they can help in the choice he 
has to make of their profession. 

These few suggestions point in favor of an early treatment of 
the degenerates. They also prove how the interference of the 
educator should be slow and prudent, and, as the natural disposi- 
tions of the weak-minded are limited, one ought not to make haste 
and attempt too much for fear of exhausting their mental power. 
The nature and the degree of the progress to be made will vary 
considerably according to the qualities of him who has the charge of 


/ 


IJY .lULKS iViOllEL, M. D. 


27 


their irnproveineiit. ^I'he very important thing is for the. teacher 
to win tlie confidence of his patient, and to assure himself at the 
same time that the patient reciprocates his confidence. Moreover, 
the teaclier has to know the limits of this confidence in order not 
to destroy the object he wishes to attain. 

It is natural that in the course of the treatment, and especially 
in the beginning, there should be disappointments, but one must 
not lose his courage if disappointments are met; and one ought 
never to make known, by words or otherwise, in the presence of 
the degenerates, that any hope is lost. Experience teaches us 
every day that we have never completely to despair and that, by 
persevering, many disappointments are largely compensated for 
by brilliant results. One cannot guess at the might of the com- 
bined action of kindness, j^atience, perseverance, justice and equity. 
One ought to so work the mind of the degenerate as to extract 
from him something useful, and the least occasion ought not to 
be lost to prove what we wish to obtain from him. 

What I just said argues in favour of the individualization of the 
treatment. When enquiring after the natural disposition of the 
degenerate, as well for his instruction as for his future profes- 
sional teaching, we ought to try and develop at the same time 
his character. 

To attain these results, the teacher must evidently not con- 
sider himself as having the same situation as a teac'-her of the 
lower classes. His mission is much higher, and, because of the 
numerous difficulties he will find on his way, and of the superior , 
qualities he ought to possess, he will have to stay a longer time 
with his pupils. 

Unhappily in most countries, there are not sufficient asylums 
for imbeciles and consequently for degenerates. Even supposing 
families can avail themselves sufticiently of the institutions, 
parents, and especially poor parents, are not to be readily sepa- 
rated from their children when they are idiots, or morally insane, 
except by superior force. The other children, the imbeciles, go 
to school, they make no progress, and very often are a hindrance 
to the class. The teachers, seeing no results are obtained, neglect 
them, or do not trouble themselves with them any more ; then they 
are really abandoned. If the teacher gives them an excess of 
kindness and patience, it will be at the expense of the better 
pupils. 


28 


THE TREATMENT OF DEGENERATIVE PSYCHOSES. 


All these facts being taken in consideration, why should govern- 
ments not undertake the creation of special institutions for weak- 
minded children? Such institutions, if well organized, would 
certainly diminish the population of the reformatories, and also 
the population of lunatic asylums and prisons. There, doubtless, 
most of them would be enabled to receive some education. 

The creation of a law forfeiting parental control on account of 
incapacity or unworthiness would soon fill up and multiply such 
institutions. It is in these schools for the weak-minded that the 
alienist will be enabled to obtain undeniably brilliant results 
and to separate, at a certain moment, the degenerates beyond any 
hope of becoming suitable for society, or noxious for themselves 
in a moral point of view. 

The incurable degenerates often go from a lunatic asylum to a 
prison and vice versa. Dr. Koch wishes to see them brought 
together at a certain age, also in a special institution. We com- 
pletely agree with him on this important question. Governments 
ought to afford protection for all the degenerates who after a 
certain time of treatment are considered as hopeless for society; 
they want protection as well for themselves as for the public se- 
curity. They should not be admitted for any fixed time but for 
as long as public security, morality and order may demand it. 


ON THE INSANE. 


BY W. J. CORBET, ESQ., 

Ex-M. P. County Wicklow, Ireland, Member of the Royal Irish Academy, 


Part I. — On the Increase of Insanity. 

Mr. Chairman, Ladies and Oentlemen : 

The invitation with which I have been honored, to visit the 
World’s Columbian Exposition as a member of the International 
Congress of Charities, Correction and Philanthropy, and to 
contribute a paper on the insane, is most highly appreciated by me. 

Finding it impossible to attend in person, I willingly respond 
to the latter part of the invitation. 

As one who has devoted much time and attention, under pecu- 
liarly favouring circumstances, to the study of the statistics of 
insanity, and being impressed with the fact that the malady is in- 
creasing at a rapid rate, it seems to me that no more fitting time 
or opportunity could arise for drawing attention to so grave and 
serious a social problem than this which is offered by the great 
International Congress now assembled in the magnificent cit})^ of 
Chicago, a city which has drawn within itself the products of 
civilization, from every clime, to an extent never before equaled, 
and where at this moment the mental powers of mankind, the 
genius and intellect of the human race, are represented more fully 
than in any other place upon the earth. 

Writing in the Fortnightly Review of January last, on the 
increase of insanity, I expressed the hope that, in the event of failing 
to impress its importance on the English Official Mind “ a confer- 
ence outside official circles should be held by qualified independent 
and disinterested men to consider the subject.” At that time I had 
no thought of how wide and far reaching a platform was about 
to be provided for the discussion, or how soon my humble efforts to 
bring it on were to be rewarded with success. It may be taken for 
granted that the public at large have little knowledge, unless in a 
vague and general way, of the extent to which insanity prevails, or of 
the extent to which the care and proper custody of the insane has been 
studied, investigated, discussed and written about during the last 


30 


ON THE INCREASE OF INSANITY. 


half century. The subject is in itself so painful and uninviting 
that only philanthropists, specialists and official persons take much 
interest in it. The general public, from natural repugnance, avoid 
the distressing topic. Madness, be it in the individual, the family 
or the multitude, is so full of affliction that everyone not immedi- 
ately concerned, either philanthropically or otherwise, with the care, 
custody, or superAUsion of the insane, wishes to pass it by, to hide 
it, to cover it up, and, if possible, to put it away out of sight and 
out of mind altogether. Hence, as just said, few people have any 
comprehensive knowledge of the facts, or of the enormous amount 
of research latterly bestowed upon them. Tlie field of inquiry is a 
dismal region from which most people turn away with feelings of 
fear and aversion wishing it to remain a terra incognita. The 
psychological aspects are said to be so inscrutable as to baffle the 
researches of the ablest and most profound scientists. But of this 
I am not qualified to treat, my only claim being to some knowl- 
edge of the statistics of insanity. 

Before entering on the consideration of* the two questions I 
propose to discuss, namely “The Increase of Insanity” and 
“ Private Lunatic Asylums Kept for the Personal Profit of their 
Owners,” I desire, in connection with the foregoing observations, 
to mention a few of the most remarkable books, with which I am 
acquainted, issued from the press in recent years by persons emi- 
nently qualified to write on lunacy. 

The first perhaps in importance is entitled “Legislation on In- 
sanity ” a collection of all the lunacy laws of the States and Terri- 
tories of the United States to the year 1883, inclusive, with the 
laws of England on insanity, legislation in Canada on private 
houses, and important portions of the lunacy laws of Germany, 
France, Belgium, Russia, etc. The work, which contains over 
1,100 pages, is best described in the words of the learned author, 
George L. Harrison, LL. D., late President of the Board of Chari- 
ties of Pennsylvania, in his preface: “This volume presents the 

facts and materials for a ‘ Comparative Anatomy ’ of almost all 
civilised legislation on this subject. Instead of a volume of 
reasonings and appeals, it lays before the community and throws in 
the way of legislators a complete collection of the legislation of 
all our States and Territories, and of the most important legisla- 
tion of England and other foreign countries in regard to the care 
of the insane.” 


BY \V. .1. CORBET. 


31 


In iiiy opinion the value of this volume as a hook of reference 
on the laws of insanity can hardly be over-estimated, while the 
all too brief preface, or introduction, -contains ample evidence, in 
the comments and suggestions, compressed within the sliort space 
of sixteen pages, of the profound knowledge possessed by the 
author and of his deep feelings of sympathy for the insane. 

Doctor Frederick Norton Manning, of New South Wales, who 
w^as commissioned by his government to visit the lunatic asylums 
of the world, with a view of introducing the most approved 
methods of housing and treating the insane into Australia, has 
given the result of his investigations in an exhaustive report of 
300 pages, presented to the Colonial Legislature in 1868, which 
contains a large amount of varied information of the highest 
interest and value. 

Another important volume also dates from New South Wales, 
entitled “Lunacy in Many Lands” published in 1888, twenty 
years after Doctor Manning’s Report. It is compiled by Doctor 
G. A. Tucker, of Sydney, who devoted much time to visiting 
lunatic asjdums in various countries. He has given his experiences 
in perhaps the most remarkable and comprehensive book ever 
written on the subject. Extending to over 1,500 pages, it con- 
tains as Dr. Tucker says, p. 1,564, “ EA^ery scrap of information 
collected during three 3 mars and a half visitation of lunatic 
as}dums throughout the world.” This enormous amount of matter 
is skilfully treated, admirablj" arranged and carefully indexed for 
easy reference. One other work 1 desire specialh^ to name, which, 
although not devoted exclusively to lunacy, includes a valuable 
contribution on the subject. This important Avork, in five large 
volumes, namel}" “A System of Practical Medicine b}^ American 
Authors,” edited In" William Pepper, M. D., LL. D., assisted bj^ 
Louis Starr, M. D., was published in Philadelphia, by Lea Brothers 
& Co., in 1886. The fifth volume, which alone runs to over 1,300 
pages, is exclusively devoted to diseases of tlie Neiwous System 
and includes a special article on Mental Diseases by Charles F. 
Folsom, M. D. I have cited these works to indicate briefly the 
profound interest that has been, and is being, taken in the matter 
and to impress, if I can, upon the many the A"ital importance of 
the subject as evidenced b^" the immense amount of labour, time 
and thought bestOAved upon it by the few ; that is to say, by those 
who are aware of the gravity of the issues at stake and the neces- 
sity of doing all that human wisdom can devise, to arrest, if it can 


32 


0]S THE INCREASE OF INSANITY. 


be arrested, the spread of insanity, and to ameliorate as far as 
possible the condition of the insane. 

First in point of order I take the increase of insanity. It is to be 
regretted that, so far as I am aware, no successful attempt has been 
made to get together a universal return of the insane throughout the 
world, at stated periods, so as to ascertain with some degree of ac- 
curacy the rate at which the increase of insanity has been proceed- 
ing generally. In the year 1874 I tried to collect materials for 
such a return. Circulars and printed forms were issued with 
that object. The Earl of Derby, tlien Secretary of State for For- 
eign Affairs, courteously consented to cause them to be circulated, 
through the Foreign Office, in the countries for which they were 
intended. In due course returns, more or less complete, were fur- 
nished from various countries in Europe and States in America. 

The English Lunacy Commissioners, when applied to, did not seem 
disposed to encourage my inquiries and, as I have reason to believe, 
through their interposition, an intimation was conveyed to me, from 
a quarter I was then bound to defer to, which prevented me from 
carrying my researches any further. Had my hand not been stayed, 
an amount of valuable information, on the general statistics of in- 
sanity, not previously existent in concrete form, would probably 
have been collected. The attempt may be in the recollection of some 
of the members of this Congress as from some of the States of 
America, as well as from several European Countries, the returns 
asked for were kindly and promptly furnished. Owing, however, to 
their incompleteness, and to the fact that I was unable to carry out 
my inquiries to the end, it is not possible to use the fragmentary in- 
formation received for the purpose of this paper. It may, neverthe- 
less, be interesting to note that during the twenty years embraced in 
the partial returns furnished, namel}^, from 1853 to 1873, the act- 
ual numbers show a regular annual increase as if influenced by the 
natural law of Genesis. I refer to the incident now in the hope that 
some better qualified and more fortunate investigator may under- 
take the task which I failed to carry out to a successful issue. 

>Not having the necessary materials, therefore, at hand to enable 
me to summarize, in tabular form, the statistics of insanity at stated 
periods in other countries, I am forced to fall back upon the sta- 
tistics for England, Ireland and Scotland, which may probably be 
taken to illustrate, with the help of such other information as we 
possess, at least approximately, what has been occurring through- 


BY W. J. CORBET. 


33 


out the world in regard to the progressive increase of the malady. 

Of the large actual augmentation of numbers the figures given 
from year to year on official authority leave no doubt whatever. 
The theory promulgated by the majority of the Lunacy Commis- 
sioners, with resolute persistency, in the face of facts and figures 
that should convince the most casual observer to the contrary, is 
that, apart from the increase proportionate to the growth of the 
population, the increase is only ‘‘apparent” and consists of the 
ingathering of pre-existing cases, which hitherto escaped official 
cognizance, and the prolongation of the lives of the chronic insane 
by reason of the greater care taken of them now than formerly. 
In using these statistics as an example of what is probably happen- 
ing in other countries, it is only fair to let the Commissioners be 
heard in their own words, in this connexion, so that their respect- 
ive views may be considered on their merits. The English Com- 
missioners (15th Report, p. 75) say, “ During the ten years from 
the 1st of January, 1849, to the 1st of January, 1859, the number 
of patients in the various asylums of England and Wales have 
advanced from 14,560 to 22,853; this increase has been princi- 
pally in public asylums. In county and borough asylums the 
advance has been from 6,494 to 15,845, making an increase of 
9,351 ; in lunatic hospitals from 1,195 to 1,992, making an increase 
of 857. The great increase which has taken place in the number 
of patients in asylums is limited almost entirely to pauper and 
criminal patients.” The figures here given do not include work- 
house lunatics 7,963, or 5,920 others located elsewhere. 

In a table ‘ ‘ showing the number and distribution of all reported 
lunatics” the total in England and Wales at this date, viz., in 1859, 
is put at 36,762. At that time, thirty-three years ago, the Lunacy 
Commissioners were evidently convinced of, if not alarmed at, the 
increase of numbers, and accordingly in the same report, (pp. 77, 84) 
they assign the following as the causes of what they all along insist 
on describing as “ an apparent increase.” 

“1. To the more complete collection of annual returns, formerly 
very defective in this respect. 

2. To the detection and registration of cases formerly left 
unnoticed. 

3. To the removal of a larger proportion of patients, when 
they are exposed to causes of death, into asylums, favouring the 
prolongation of life. 

4. To the effect of sanitary regulations in asylums, of improved 
c 


34 


ON THE INCREASE OF INSANITY. 


diet, and of various means of sustaining the health and promoting 
the longevity of the entire body of inmates. 

5. To a like effect on those out of asylums, from the removal 
of large workhouses to more healthy sites, and from the medical 
visitation of such of the insane paupers as are in neither work- 
houses nor asylums.” 

The great solicitude here shown by the Commissioners to account 
for, and minimize, the embarrassing “apparent increase” shows 
how seriously they would regard an actual increase if such had, in 
their opinion, taken place. It is to be noted that the five causes 
given by them for the augmentation, are reducible to three, namely, 
improved returns, prior to 1859, improved diet and improved san- 
itary regulations. 

Note also that these influences were for some years previously in 
operation and must consequently have spent their force by drawing 
all, or nearly all, cases of lunacy existing at that time, within the 
scope of official cognizance, or, to put it perhaps more clearly, 
the limit of numbers would then have been reached and the ominous 
word “increase” which runs through the whole series of official 
reports from beginning to end, would cease. But what is the fact? 
Why this, that as shown in a table of figures, in the Commission- 
ers’ forty-sixth report, (pp. 7, 8, 9) the numbers have risen from that 
time to this by regular annual average increments of over 1,500 
until they have reached the enormous aggregate at which they 
noAV stand, namely, 87,848. 

Now as to Scotland, the Commissioners, who first entered on their 
functions 'in 1858, when the total number of insane under official 
cognizance stood at 5,748, following the lead given by their fellow 
Commissioners in England, attempt to explain the “apparent 
increase ” in a similar way. In their Thirty-fourth Report (p.LVII) 
they say : 

We have had since 1858 a net increase of 6,975 in the number of 
lunatics jurisdiction of the Board, or 120 per cent. The increase of 
the population during the same period has been only 38 per cent. 
They go on to say: 

“1. That the increase of pauper lunacy is much beyond what 
would naturally result from the increase of population. 

2. That it cannot be attributed to accumulation resulting from 
longer periods of residence of pauper lunatics in asylums. 

3. That it is only in a very slight degree due to the lowering 
of the death rate. 


BY W. J. CORBET. 


35 


4. That there is no reason for believing it to be due to an in- 
creased tendency to insanity in the community. 

5. That it is not due to any one cause but to many causes opera- 
ting with different degrees of force in different localities and under 
different social conditions.” 

This mode of accounting for an increase of 120 per cent, is rather 
oracular and leaves us more in the dark than ever. On a former 
occasion when the insane in Scotland had reached to little over one- 
half of their present numbers the Commissioners endeavoured to 
explain the “apparent increase” by an equally oracular utterance 
saying in their Fourteenth Report, that it was “ascribable to the 
growth of lunacy or at any rate to the increased numbers of 
lunatics in asylums.” 

Then as to Ireland. In the departmental report presented to 
Parliament for 1891 “ The Inspectors of Lunatics” (I don’t know 
why they are not designated Commissioners as well as the English 
and Scotch officials, their duties being identical in every way) having 
referred to the effects of emigration taking away the strong and 
healthy and leaving behind the weak and infirm to swell the numbers 
of the insane, proceed as follows, “ hence it is safe to assume that the 
present number of the insane in Ireland properly belongs to a much 
larger population than that which now exists. However, making 
allowance for this cause, which tends to show an apparent increase 
of insanity, we are still driven by the facts before us to conclude that 
the large increase of lunacy has been absolute as well as relative.” 
The Report goes on to say, “ the rapid increase of insanity in the 
country, in the face of a diminishing population, ought therefore to 
engage the attention of all who take an interest in the social and 
material progress of Ireland, in order to ascertain how far such 
increase can be stayed by any means within the power of the State.” 

This is a highly important pronouncement and one, let us hope, 
that may not prove fruitless. 

In a paper read, nineteen years ago, before the “Statistical and 
Social Inquiry Society of Ireland” I quoted from a rei^ort on the 
“Relation of Education to Insanity” by Doctor Edward Jarvis, of 
Dorchester, Massachusetts, which was embodied in the Report of the 
United States Commissioner of Education for 1871, as follows: 

“The successive reports, upon whatever source or means of 
information procured, all tend to show an increasing number of 
the insane. In the United States, Great Britain, Ireland and 
other civilised nations, so far as known there has been a great in- 


36 


ON THE INCREASE OF INSANITY. 


crease of provision for the insane within forty years and a very 
rapid increase within twenty years. Hospitals have been built seem- 
ingly sufficient to accommodate all the lunatics within their respective 
States, counties, or districts. These have been filled, and then 
crowded and pressed to admit still more. Tliey have been suc- 
cessively enlarged, and then other institutions created, and filled 
and crowded as the earlier houses were.” Doctor Jarvis has thus 
described with singular accuracy what has been taking place here. 
Since that time the insane, as will b(3 seen from the tables given 
below, have all but doubled, and the cry is — still they come. In 
every successive Report of the Commissioners, concurrently with 
the increase of numbers, records of the erection of new asylums 
and of the enlargement of old are to be found. In the Forty -fifth 
Report (pp. 43, 44), having given a history of the additions, al- 
terations and improvements in 1890, they say, under the head of 
“ Insufficiency of Asylum Accommodation,” “ The additions enu- 
merated above have done something but not enough to meet the 
ever-increasing demand for asylum accommodation, which in sev- 
eral counties is yet very inadequate. That there should be a con- 
stant tendency towards deficiency, taking a general view of the 
country, is not surpising when we remember that the average 
annual increase in the lunatics treated in the County and Borough 
Asylums during the ten years ending 1st January, 1891, has been 
1,368.” 

Under the same heading, in the next issue, they are still more 
emphatic. They say, “The pressure for asylum room, which in 
our last Report we mentioned as existing in so many counties, 
continues, we regret to say, in undiminished severity and we do 
not find that County Councils are more prompt than their prede- 
cessors who had the control of asylums in adopting measures of 
relief. We will notice in alphabetical order the counties in which 
the insufficiency of accommodation was, at the visitation of the 
past year, most apparent.” They then enumerate over a score of 
counties and cities, including the city of London, in which the 
provision is still altogether inadequate, the existing asylums over- 
crowded, and the pressure for admission urgent. Their comments 
on the condition of the London district may be taken as an exam- 
ple of all the rest. They say, (Forty-sixth Report, p. 53) “The 
difficulty of finding accommodation anywhere for London patients 
to which we referred in our Report for 1890 continued to be felt 
last year in equal intensity: nor can we report now that any 


r>y W. J. CORBET. 


37 


further action has been taken by the London County Council to 
make the necessary permanent provision for the insane poor 
beyond advertising for an estate as a site for another asylum. 
The additions to Cane Hill are now available, but we believe the 
Claybury Asylum will require at least another year for its comple- 
tion. These two extensions will provide for 2,800 patients, but 
there will^ be still left boarded out a sufficient number to fill 
another asylum of considerable capacity, while there can be little 
hope of any diminution of the annual increment of insane paupers 
for whom provision must be made.” 

I have written elsewhere on several occasions during the last 
twenty years pointing out that, account for it how we may, 
as time progresses, the stream of insanity broadens and deepens 
continually. The great central fact stares us in the face, it can- 
not be hidden, no effort of obscurantism can conceal it. The fig- 
ures given from official records indisputably prove it. The omin- 
ous word “increase” is written large upon every page of the annual 
reports for the last forty years, and it is surprising how the commis- 
sioners apparently fail to see the significance of their own figures or 
of the emphatic language they themselves have used. 

Through the favour of the “State Commissioners in Lunacy” 
New York, T have just received a copy of their third annual report, 
being for the year 1891, from which I gather that the same tendency 
to increase exists in America as with us. In Chapter 3 (p.209) 
it is stated that “ in appropriations for the insane the State has 
never kept pace with the actual increase of its insane population.” 
On p. 381, Chapter 29, it appears that the number of registered in- 
sane in the State on October 1st, 1891, was 16,648, a net increase 
over the preceding year of 642. 1 merely glance at this fact in pass- 

ing, not having the means of ascertaining the circumstances elsewhere 
or whether the increase is general throughout the other States of 
America. But to return to my illustration. From what small be- 
ginnings the system has developed, during this century, into its pres- 
ent great yjroportions may be gathered from the fact that a return 
presented to Parliament in 1807 put the number of the insane then 
in England at 2,248, (Report of Commissioners, 1846). The Re- 
port proceeds: “The numbers became gradually better known, 

partly owing to individual inquiries, until the year 1827, when the 
ascertained number of pauper lunatics exceeded 9,000; whilst on the 
1st day of January, 1847, the number returned was 18,814.” This 
relates to England only. 


38 


ON THE INCREASE OF INSANITY. 


With regard to Ireland, so insignificant were the numbers believed 
to be when the question of providing special asylum accommoda- 
tion for the insane was first mooted, that the celebrated Dean Swift,, 
under whose Avill the first lunatic asylum was established, b}^ charter 
granted by George the Second in the year 1747, thought it doubt- 
ful whether a sufficient number of insane persons could be found tO' 
occupy the building, as appears from the following words of the 
charter: “And if a sufficient number of ideots (sic) and lunatics 

could not be readily found, he (Dean Swift) directed that incurables 
should be taken into the said Hospital to supply such deficiency ; but 
that no person labouring under any infectious disease should be ad- 
mitted into the same.” 

As regards Scotland the first report of the Commissioners was pre- 
sented to Parliament in 1858, when the number then under official 
cognizance was 5,748. But lest it might be thought I wish, in re- 
viewing the movement of the insane, to minimise the original num- 
ber by going back too far, and thus make the increase appear greater 
by contrast, the year 1862 will be the point of departure. The fol- 
lowing tables show the development from that time to the present : 


(Table No. 1.) 


Date. 

Counti-y. 

Number of in- 
sane under offi- 
cial cognizance. 

Population 
at large. 

Ratio of insane 
per 1,000. 

Actual increase 
of numbers in 
each decade.* 

1862 

England, 

41,129 

20,336,476 

2.02 



Ireland, 

8,055 

5,798,967 

1.36 



Scotland, 

6,341 

3,062,294 

2.01 



Total, 

55,525 

29,197,737 

1.81 


1872 

England, 

58,640 

23,074,600 

2.54 

17,511 


Ireland, 

10,767 

5,368,696 

2.04 

2,712 


Scotland, 

7,606 

3,399,226 

2.27 

1,265 


Total, 

77,013 

31,842,522 

2.41 

21,488 

1882 

England, 

75,072 

25,798,922 

2.90 

16,432 


Ireland, 

13,444 

5,294,436 

2.54 

2,677 


Scotland, 

10,355 

3,695,456 

2.80 

2,749 


Total, 

98,871 

34,788,814 

2.84 

21,858 

*1891 

England, 

87.848 

29,403,346 

3.01 

12,776 


Ireland, 

16,689 

4,704,750 

3.54 

3,245 


Scotland, 

12,799 

4,025,647 

3.17 

2,444 


Total, 

117,336 

38,133,743 

3.07 

18,465 


♦The figures for 1831 embrace a period of nine years only, the figures for 1892, to con>* 
plete the decade, not being yet available. 


BY W. J. CORBET. 


39 


This table of figures shows how the fixed stock of the insane at 
the end of each decade had risen by thousands, while the ratio of 
the insane to sane rose at the same time from 1.81 to 2.41-2.84 and 
3.07. The following table shows that concurrently wdth this 
augmentation the admissions, discharges, and deaths, have gone on 
increasing in proportion, w^hile the increase of expenditure has 
fully kept pace with the increase under every other head. For 
shortness I compare the figures of 1862 and 1891 as an illustration 
combining the Returns of England, Ireland and Scotland together. 


(Tabij3 No. 2.) 



1882 

1891 

Increase in 
10 years. 

Admissions 

18,862 

23,091 

4,229 

Discharges 

12,630 

14,946 

2,316 

Deaths 

6,133 

8,300 

2,167 

Total 

18,763 

23,246 

4,483 

Cost of Maintenance 

£2,491,685 

£3,069,870 

£578,685 

Cost of land and buildings to 1878 
and 1888 respectively, extracted 

1878 

1888 

Increase for 
land and build- 
ings ill 10 years. 

from Returns ordered by Parlia- 
ment 

£9,603,231 

£15,250,435 

£5,647,204 


Now as to the cause, or causes, of the accumulation of numbers. 
No doubt increased asylum accommodation, improved methods of 
obtaining returns, improved sanitary regulations in asylums, im- 
proved dietary and other means of sustaining health and promoting* 
longevity, together wdth the attraction of the State Grant in aid, ac- 
count for what may be quite properly described as an “apparent in- 
crease” or an ingathering of pre-existing cases. But these causes 
were terminable, they exhausted themselves, more or less many years 
ago ; yet the annual increment continues not only undiminished but 
ever increasing in volume. For some years the Commissioners have 
suspended the publication of the assigned causes of insanity and I 
am therefore unable to give the figures. I can say, however, from 
other data, that hereditary influence largely predominates over all 
other exciting causes. 

In Doctor Charles F. Folsom’s article on Mental Diseases, printed 
in volume V of the work already mentioned, it is stated (p. 113): 
“Among the predisposing causes heredity includes nearly or quite 
75 percent, of all cases and is easily first; in considering which, not 
only the immediate parents are to be taken into account, but also 


40 


ON THE INCREASE OF INSANITY. 


the collateral branches, grand-parents, uncles, aunts, sisters, broth- 
ers, and cousins, for hereditary insanity often skips one generation 
and even appears sometimes first in the child, and then later in the 
parent.” On this point I may be permitted to quote another 
name whose authority will hardly be disputed. Darwin (Descent 
of Man, Vol. I. pp. 110, 111), says, “ I have elsewhere so fully 
discussed the subject of inheritance that I need here hardly add 
anything. A greater number of facts have been collected with 
respect to transmission of the most trifling, as well as of the most 
important characters in man than in any of the lower animals; 
though the facts are copious enough with respect to the latter. 
So in regard to mental qualities, their transmission is manifest in 
our dogs, horses, and other domestic animals. Besides special 
tastes and habits, general intelligence, courage, bad and good 
temper, etc., are certainly transmitted. With man we see similar 
facts in almost every family ; and we now know through the ad- 
mirable labours of Mr. Galton that genius, which implies a wonder- 
fully complex combination of high faculties, tends to be inherited ; 
and on the other hand it is too certain that insanity and deteriorated 
mental ponders likewise run in the same families. ” The italics are 
mine. 

If time permitted, quotations might be multiplied to any extent 
to prove that insanity is transmitted from generation to generation. 
The writings of such eminent scientists as Esquirol, Morel, Moreau, 
Forbes- Winslow, Bucknill, Maudsley, Tuke, and numerous others 
contain overwhelming evidence of the sad truth. As shown on 
Table No. 2, the discharges from the lunatic asylums of England, 
Ireland, and Scotland taken together, reach near to 15,000 in a 
single year. The exact figures for 1891 are 14,946 as against 12, 
630 in 1882. The total numbers of persons of all classes discharged 
recovered and not recovered, in ten years, namely, from 1882 to 
1891 inclusive, reach the enormous aggregate of 133,195. 

These are stupendous figures — taken in connection with the 
established fact of hereditary transmission they shed a lurid light 
on the })rogressive increase of insanity. Could the history of these 
hundred and thirty-three thousand persons be traced, or of the 
hundreds of thousands discharged between 1852 and 1882, it doubt- 
less would be found that most of them were merged again in the 
general body of the community. That the married resumed their 
positions, that many, perhaps a majority, of the single, entered 


BY W. J. (JORBKT. 


41 


the matrimonial state, and very likely led blameless and useful lives 
to the end of their days. But what of posterity? Has the 
inexorable law of heredity asserted itself? Have the children of 
such parents been insane, or, in turn become the parents of luna- 
tics? I am afraid the question, in the majority of cases, must be 
answered in the affirmative. It is only necessary to glance at the 
conditions under which the insane existed, or rather pined away 
and died, some fifty or sixty years ago, for a solution of the prob- 
lem of increase by heredity. Referring to the “ enormities ” exist- 
ing in public as well as in private asylums previous to 1827, 
the Commissioners in their report for 1846 say they comprised 
‘ ‘ Almost every species of cruelty, insult, and neglect to which 
helpless and friendless people can be exposed when abandoned to 
the charge of ignorant, idle and ferocious keepers acting without 
conscience or control.” 

In Wynter’s Curiosities of Civilization, when contrasting the treat- 
ment of the insane in past times with that which is adopted at pres- 
ent, he says : ‘ ‘ Supposed to be degraded to the level of beasts, as 

wild beasts they were treated. Like them, they were shut up in 
dens, littered with straw, exhibited for money, and made to growl 
and roar for the diversion of the spectators who paid their fee. 
No wonder (he adds) that Bedlam should have become a word of 
fear : no wonder that in popular estimation the bad odour of cen- 
turies should still cling to its walls, and that the stranger, tempted 
by curiosity to pass beneath the shadow of its dome, should enter 
with sickening trepidation. But now, instead of the howling mad- 
house his imagination may have painted it, he sees prim galleries 
filled with orderly persons. Scenes of cheerfulness and content 
meet the eye of the visitor as he is conducted along well-lit corri- 
dors, from which the bars and gratings of old have vanished. He 
stops, surprised and delighted, to look at the engravings of Landseer’s 
pictures on the walls, or to the busts on the brackets. He beholds 
tranquil persons walking around him, or watches them feeding the 
birds which abound in the aviaries fitted up in the depths of the 
ample windows.” 

This description of the modern public asylum ap})lies equally to all 
countries with which I am acquainted. 

From the nature of the treatment the insane were subjected to in 
the earlier half of the century, longevity was out of the question, re- 
covery all but impossible, they died and the danger of hereditary 


42 


ON THE INCREASE OF INSANITY. 


transmission died with them. Since the period just referred to the 
change in everything relating to the care and treatment of the insane 
has been marvellous. Asylums furnished with every modern appli- 
ance for convenience, comfort and even luxury, have been provided. 
Amusements, theatricals, concerts, in-door and out-of-door occu- 
pations, everything, in short, that sympathy for human sutfering 
could suggest, has been generously provided at an enormous, and an- 
nually increasing, expenditure of public money, to replace the evil 
system of former days. Concurrently with this beneficent change, 
the cure of the malady has received no less attention than the kindly 
treatment of the patients. Speaking at a meeting of the Medico- 
Psychological Association in London twenty years ago, the Pres- 
ident in the course of his address said, “The special aim of the physi- 
cian is to heal disease, not merely to care for the incurable. The 
most diligent heed to one duty will not excuse neglect of the other. 
Let your journal bear witness that this society has neglected neither. 
It teems with new remedies and new combinations of those that are 
old. During the last ten years many drugs have been added to the 
pharmacopoeia, and the experience of every year adds to our knowl- 
edge of their efticiency.” It is a sad reflection that the outcome of 
all these beneficent efforts and designs is a continuous annual 
increase of lunacy in these kingdoms. 

That intemperance is only second to heredity as a cause of crowd- 
ing our lunatic asylums with inmates should not be left unnoticed. 
On a former occasion I drew special attention to this phase of the 
question making use of the Budget Speech of Mr. Goschen, Chancel- 
lor of the Exchequer in 1890, to show the enormous proportions of 
the drink bill and how its evil effects are felt. He said, “The 
£2,500,000 of excess of revenue of which I have spoken have been 
due to an extraordinary rush to alcohol pointing out how the re- 
ceipts from useful and necessary articles of consumption, tea, coffee, 
etc. , did not come up to the estimates, he continued : But when you 
come to alcoholic drinks, I frankly admit there is a very different tale 
to tell. The net receipts from all alcoholic drink is £29,268,000.” 
(That is $140,486,400). What must the deluge of drink be when 
the mere tax upon it annually reaches to such a prodigious sum ! Mr. 
Goschen went on: “The committee will notice that this consumpt- 
ion has been universal. Some have rushed to the beer barrel, others 
have rushed to the spirit bottle, and others to the decanter. All 
classes seem to have combined in toasting the prosperity of the coun- 


BY W. J. CORBET. 


43 


try, and have largely increased the revenue,” a sally received by 
the House with loud laughter. Mr. Goschen, however, felt the terri- 
ble significance of what he rightly called “These stupendous and 
sensational figures” observing, it was a circumstance “which must 
be deplored by almost everyone for many reasons, and which places 
uj^on the Government and upon the House an increasing liability to 
deal with the question of the consumption of alcoholic drinks.” 
Three years have since passed, but nothing has been done*. The alco- 
holic brain-poisoning goes on just as before, contributing its thous- 
ands of victims annually to swell the population of lunatic asylums, < 
prisons, and poor-houses, to add to the seething mass of the morally 
depraved, and to increase the general death-rate of the kingdom. 

In closing, I desire to say that inasmuch as the conclusions 
at which I have arrived unfortunately differ very widely from 
tliose of the official authorities in England and Scotland, 
though not in Ireland, and as I have dealt unreservedly 
with what I consider to be erroneous opinions aud false deduc- 
tions ; it is only just to state that the vast improvement of the 
lunatic asylum system is entirely due to the unwearied exertions of 
the lunacy departments in these Kingdoms persevered in through a 
long series of years. Two of the most earnest reformers and res- 
olute workers forfeited their valuable lives in the discharge of pub- 
lic duty. Doctor Francis White, for many years head of the Irish 
Lunacy Department met his death through a railway accident while 
on a tour of inspection ; and Mr. Lutwidge, an English Commis- 
sioner, was stabbed to death by a criminal lunatic at Fisherton 
House Asylum. I wish to add, that the efforts of the departments 
have throughout been well seconded by the medical officers con- 
nected with the various public asylums, many of whom are men of 
high professional attainments. 


44 


PRIVATE LUNATIC ASYLUMS. 


Part II. — Private Lunatic Asylums. 

In the whole range of reforms affecting our social system, during 
the last half century, perhaps one of the greatest has been in 
the housing and treatment of the lunatic poor in Great Britain 
and Ireland. Prior to the year 1889 over fifteen million pounds were 
spent by a humane and generous public in providing asylums for 
them. The current expenses of their maintenance are met by an 
outlay from public sources of three million pounds annually. Every- 
thing calculated to “minister to a mind diseased,” to promote 
personal comfort, or relieve human suffering, is amply, even 
munificently, placed at their service. 

But though the lunatic poor have thus won the sympathy of 
this philanthropic age, strange to say the condition of the middle 
classes and of the rich who pay well, sometimes lavishly, for 
maintenance, in licensed houses kept for profit, is practically unal- 
tered. Royal Commissions and Select Committees have time and 
again sat in judgment upon these proprietary asylums. Hosts of 
witnesses have testified against them. Volumes of evidence of 
the most damnatory character, have been printed. Pyramids of 
parliamentary reports have been piled up. Acts of Parliament 
passed without number. Yet the evil system survives and flour- 
ishes, like rank tropical vegetation, annually renewed, augmented, 
extended, and fertilized out of the proceeds of its own luxuriant 
rottenness. It will continue to flourish as long as the evil prin- 
ciple inherent in it is permitted to exist. What I want to urge is 
that the wealthy classes, when insanity supervenes, are far less 
favourably circumstanced than the insane poor, who have nothing 
to excite the cupidity of those whose capital is invested in the 
business of private lunatic asylum keeping. I do not for a 
moment suggest that all proprietors of private asylums, or even a 
majority of them, are venal unscrupulous men, acting from a spirit 
of avarice; very far from it. I have known many who were 
good, kind, philanthropic, conscientious, and deserving of the 
confidence reposed in them. It is the original sin of the system 
under which, for pecuniary consideration, not only the unsound 
but frequently the sane are shut up, and kept in the custody of 
speculators, who carry on a trade in lunatics, that excites my aver- 
sion and deadly hostility. Forty years ago, or more, public 


BY W. J. CORBET. 


45 


attention was called to the enormities perpetrated in proprietary 
asylums. Instance after instance of horror was adduced. The 
press reported continually appalling cases of misconduct on the 
part of proprietors and their servants, to some of which I will now 
refer. About this time a case of extraordinary turpitude was 
brought before the superior courts in Ireland, the medical 
proprietor of a private asylum being defendant. It transpired 
that a lady patient placed under his care had fallen a victim to his 
immorality. The offspring of the crime, a son, grew up in the 
asylum and was kept in durance there. The case got wind some- 
how — an action at law was the result — when all the miserable 
details were made public and created a sensation of a very painful 
character. The wretched father had to acknowledge his guilt in 
open court. 

The lady was undoubtedly insane, a fact that should have kept 
her sacred in the eyes of the person in whose power and under 
whose protection she had been placed. The most extraordinary 
feature in this melancholy case is that besides being the proprietor 
of a private lunatic asylum Dr. H. (I purposely withhold his name 
for he is long dead and to mention it might give pain somewhere) 
was a leader of his fraternity and held public appointments of trust 
in Dublin. When the Act 5 and 6 Vic. C. 123 was passed, provid- 
ing that no patient should be received into a private lunatic asylum 
without an order and Medical Certificates, he it was who cham- 
pioned the proprietors in their objections. 

I have before me a pamphlet w^ritten by him, published in 1843, 
and addressed to the late Sir Robert Peel. It is mainly a protest 
against official interference, especially against inspection of the Asy- 
lums which were then under the surveillance of the Prisons depart- 
ment. He says (at p. 40) “For more than 30 years I have been 
physician to all the criminal prisons of Dublin ; during the whole of 
which period, besides the occasional visits of the Inspectors General, 
the Local Inspector was required to visit each prison twice a week at 
least, and on these occasions to see every department and inmate of 
of the Gaol. Did these frequent visits of the Inspectors prevent or 
abolish the many notorious abuses that prevailed, and prevailed too, 
in many instances, to their knowledge and with their reprobation? 
They did not, nor could they succeed in the great objects calling 
for their interference, until the character of the gaoler was elevated, 
until a superior class of men was selected for that office, and salaries 


46 


PRIVATE LUNATIC ASYLUMS. 


attached thereto, such as gentlemen could accept. Then indeed 
commenced the reformation ; so that now, and for many years past, 
the Prisons of Dublin, and of the country at large, are no longer the 
vile and abominable nurseries of vice and crime that they had been 
and such as I had long known them.” 

Here then was this canting hypocrite who, at the time of writing, 
had the guilt on his soul of a revolting crime that subsequently 
brought him to the bar of justice, setting himself up as the advocate 
of virtue and the censor of morals. 

“ Could this mean peace, tlie calmness of the good 
Or guilt grown old in desperate hardihood.” 

For one such instance of depravity that comes to light how many 
are never heard of. As in this case, however, accident sometimes 
opens the door and reveals the horrors within. Other remarkable 
cases have from time to time come under public notice in which the 
sane have either been immured in proprietary asylums, licensed 
under statute to receive lunatics, or attempts on their liberty have 
been made. Sometimes a Police Court is the medium of exposing a 
case of kidnapping; sometimes a sensational trial before Her 
Majesty’s judges. During the twelve years I had a seat in Parlia- 
ment it fell to my lot to bring forward several such cases. 

The motives by which people are actuated in calling in the aid 
of a private lunatic asylum proprietor illegitimately in certain 
cases are various. The avaricious or impecunious next of kin 
takes advantage of some escapade committed by a rich relative 
and makes his conduct a peg to hang a charge of lunacy upon. 
With the aid of Medical Certificates, easily procurable for a 
consideration, he establishes a case of insanity, j^laces his relative 
under the care of an accommodating proprietor, paying a good 
pension out of the victim’s funds, and so enters into the enjojnnent 
of the property himself. Needless to say it is not the interest of 
either of the parties to such a nefarious transaction that the 
“patient” should ever be discharged. 

In other cases the motive is revenge, punishment for misconduct., 
reckless extravagance, dissipation, acts of immorality or “disgracing 
the family name.” 

Now it is an enraged husband who takes this method of paying off 
an inconstant or troublesome wife. Now a jealous wife serving out 
a faithless husband. Again a distracted parent who tries to reform 


BY W. J. CORBET. 


47 


a profligate and incorrigible child by confinement as a lunatic. Be 
tlie motive what it may there is no doubt, on the evidence before us, 
that numbers of pei’sons of perfectly sound mind have been incarcer- 
ated in private lunatic asylums, and, shocking as the reflection is, 
doomed to spend their lives there. 

The following cases show how the private lunacy Acts can be, 
and are, perverted to evil uses. The first example is the well-known 
case of Mrs. W. , a lady of singular ability, distinguished for the vers- 
atility of her gifts, and a])parently fond of publicity. She had, it 
appeared, incurred the displeasure of her husband. No charge of 
impropriety was ever made against her; her chief offence being, ac- 
cording to the reports, belief in spiritualism, and, what is occasion- 
ally a feminine peculiarity, a desire to have her own way. Her hus- 
band thereupon thought a lunatic asylum the proper place for her. 

The certificates and order for her detention were prepared in due 
form. The son of the former proprietor of a private as 3 dum came 
with carriage and keepers to carry her off ; — £550 a year was the sti- 
pend agreed upon and great was the anxiety to secure so rich a prize. 
The lady, however, was too clever and the attempt failed. Tlie 
case became a “ cause celebrey It was tried for five days, before 
Mr. Baron Huddleston and a special London juiy, as reported in the 
Times 14th to 19th March, 1884. The learned Baron in giving 
judgment dwelt on “the astonishing fact that, with an order and a 
statement signed hy paupers and two certificates signed by men 
wdiose only qualification need be the possession of diplomas and the 
fact that they were not related to the keeper of an asylum to which 
a patient was to be sent, any body might be shut uj) in a private 

asylum He regretted to think that the plaintiff could have 

no redress for the serious inconvenience to which she had been put, 
but being clearly of the opinion that such was the case he must hold 
that she must be non-suited.” 

It is as certain as aiyThing can be that if the Doctor succeeded 
in capturing the lady when, accompanied by male and female 
keepers, he went to her house for the purpose, she would have been 
shut hp and perhaps driven really mad by association wdth lunatics. 
The former proprietor of the asylum to which the lady was to be 
brought was an eminent pln^sician, and writer on diseases of the 
mind, who would have been the last person to lend himself to such 
an outrage. In the next case it was an angry wife who put the 
machinery of the lunacy law in motion and with better success. 


48 


PRIVATE LUNATIC ASYLUMS. 


The facts as they came out on the trial were of an exceedingly pain- 
ful character. Mr. M. was a fine looking young man of the “ fast ’’ 
type. His wife was his senior in years, and not handsome, rather 
the reverse. From whatever motive, the unfortunate young man was 
seized and confined in a private lunatic asylum for over two years. 
He was debarred from all communication with the world outside 
but eventually succeeded in getting into communication with a 
friend through whose interposition he was brought up, on a writ 
of habeas corpus, and discharged. The case created at the time 
an immense sensation. The following sensible remarks upon it are 
extracted from The Irish Times and deserve to be quoted : 

“We have not the remotest idea of passing censure upon the system or 
management of any private lunatic asylum or of attributing by implication 
motives for the conduct of any parties in this most extraordinary and pain- 
ful case. But we feel called to express our opinion that private lunatic asy- 
lums should not be tolerated in a free state. They are very costly, they 
are very secret, and they are altogether unnecessary. 

The state alone should have the power of depriving man or woman of 
liberty. The evidence which should of right be required before a man is 
shut out from light and life and society in a private asylum would, if true, 
entitle him to the direct protection of the state. If well furnished apart- 
ments, if obliging attendants, if luxurious food are recommended as means 
of cure it would be very easy to provide all these in a public institution under 

the direct and constant surveillance of responsible Goverment Officers 

Private Asylums are opened and maintained, not through any peculiarly phil- 
anthropic concern for the insane, but for the sake of profit as a commercial 
speculation, but no private individual should be entitled to trade on the in- 
sanity of his fellow man. ” 

A few years ago the case of Mr. C. PI. who was forcibly abducted 
and placed in an asylum, was brought before Parliament by 
the writer. An action for wrongful detention had been brought 
in the superior courts. 

The following are the comments of Mr. Baron Huddleston who 
tried the case, as reported in the London Times of 24th February, 
1885: 

“ Somebody — who it was we do not know, and everybody repudiates it — 
somebody sent the policeman and the other man with the blacksmith to break 
open the door and take him away. Somebody had hired a carriage to take 
him and two men to go with him. Somebody had caused this to be done 
without any order, or any previous inquiry ; or any personal examination ; 
without any of the conditions prescribed by the statute to authorize the 
exercise of the jurisdiction, the applicant was put into a carriage and carried 
away to the asylum. ” 


BY W. J. CORBET. 


49 


If time permitted, cases of the kind could be multiplied to any 
extent, but it is not necessary. 

Thus far I have been dealing with private lunatic asylums in my 
own way and from my own knowledge, giving such examples as 
are calculated to support the opinions I hold. We now come to 
much more important witnesses — the highest in authority that could 
be produced. The first in importance is the late Earl of Shaftes- 
bury, a nobleman who held a prominent position in the House of 
Lords and was conspicuous above all for his large-hearted philan- 
thropy. He was chairman of the Lunacy Board from its first form- 
ation in 1845, and his experience was therefore unequaled. 

In the year 1859 he was under examination for six days before a 
Select Committee of the House of Commons “ appointed to inquire 
into the oi:>eration of the acts of Parliament and Regulations 
for the care and treatment of lunatics and their property.” 

His Lordship condemned private asylums in the most unqualified 
terms. It may be said he exhausted the resources of the English 
language in reprobating them, as the following quotations show. 
Asked (question 82) as to the element of profit involved he said, inter 
alia^ “ I consider that that is the cardinal point upon which every- 
thing turns. That the system should rest on the principle of profit 
I think is not only objectionable but intolerable.” In the course 
of his reply to question 101, he said: “I feel strongly that the 

whole system of private asylums is utterly abominable and indefen- 
sible.” Replying to question 494, Lord Shaftesbury made, the fol- 
lowing statement, still further emphasizing his utter detestation of 
the odious system : 

“It is the result of very long experience in these matters that a large 
proportion of the difficulties of legislation, and almost all the complications 
we have to contend with, or to obviate, arise from the principle on which 
these licensed houses are founded. The licensed houses are founded upon 
the principle of profit to the proprietor, and the consequence is that any 
speculator who undertakes them having a view to profit is always eager to 
obtain patients and unwilling to discharge them ; and he has, moreover, the 
largest motive to stint them in every way possible during the time they are 
under his care. Now, this must be borne in mind, I do not intend to cast 
any reflection on" the medical profession. I know that when I have urged 
arguments of this kind I have been told that I entertained most undue 
suspicious of that great profession. I have no suspicion of them as medical 
men; but my suspicions are of these medical men only when they are pro- 
prietors of lunatic asylums into which lunatics are taken for profit 

Even supposing that you gave them full credit for care and for proper treat- 

D 


50 


PRIVATE LUNATIC ASYLUMS. 


ment from a desire to do their duty, nevertheless they must, with a view to 
making a profit, take the utmost payment they can exact; and of course 
within proper limits the}^ give the smallest amount of treatment, and go to 
the smallest expense that would be consistent with the discharge of their 
duty, and therefore there is this vicious principle of profit that runs through 

the whole this, to a certain extent, must be the case even with many 

of the best intentioned proprietors.” 

In reply to question 504 his Lordship said : 

“I know that nothing can be more attentive, more minute, or more con- 
scientious than the care that some of these proprietors take, but we have no 

security : they are here to-day and they may be gone to-morrow 

the license by the death of one proprietor may pass into the hands of another 
and he might act upon totally different principles and j^ou have ever to 
contend with that vicious principle of profit. ” 

Lord Shaftesbury went on to say : 

‘ ‘ There are some cases in which the patients are paying from £400 to £500 
and £600 a year; and the loss of one or two of those patients would be a dead 
loss, a loss of the most serious kind, and one that would fall very heavily 
upon the condition of an establishment ; for the proprietor is by no means 
secure that another patient, able to pay an equal amount, will come to take 
the place of the one he has lost. I remember one instance, not very long 
ago, where a patient was paying no less than £1,300 a year, and I am certain 
that the expense of that patient in the House was not £300 a year ; so that 

was £900 a year clear profit to the medical man in that case, when 

£1,200 is paid, 1 say there is the strongest possible temptation to retain that 
patient.” 

In the course of his reply to question 507 Lord Shaftesbury 
said : 

“When I look into the matter I see that this principle of profit vitiates 
the whole thing ; it is at the bottom of all those movements that we are 
obliged to counteract by complicated legislation, and if we could but remove 
that principle of making a profit we .should confer an inestimable blessing 
on the middle classes.” 

His Lordship then proceeded to explain the method by which he 
proposed to get rid of private lunatic asylums, saying : 

“ That brings me to the great point, viz., the establishment, I will not say 
of public asylums, but hospitals or asylums, at the public cest for the reeep- 
tion of all classes of lunatic patients .... if you had establishments of that 
kind, asylums, or public hospitals, I should like to say chartered asylums, 
you would find that they would be precisely the reverse of those I have men- 
tioned. First of all, there would be a total absence of that motive which 
constitutes the vicious principle of the present licensed houses, there would 
be no desire or view to profit of any sort. ” 


BY W. J. CORBET. 


51 


Lord Shaftesbury then entered into details showing how the 
system of state or chartered asylums contemplated could be founded 
and worked, as self-supporting institutions. 

The next witness against the private lunatic asylums system is 
one whose name is not unknown in the United States, Doctor John 
Charles Bucknill, than whom no higher authority on lunacy matters 
could be found. He was exhaustively examined before the Select 
Committee of 1859 and gave unqualified approval to the superces- 
sion of private asylums in the manner recommended by Lord 
Shaftesbury. It would be impossible to compress the evidence 
into the space of a paper such as this. Suffice it to say that the op- 
position to proprietary asylums, which was initiated by Lord 
Shaftesbury, includes the names of Bucknill, Mortimer Granville, 
Conolly, and many others. 

Doctor Bucknill’s work on “The Care of the Insane, etc.,” 
published in 1880, had for its object, as he writes, to “hasten the 
inevitable hour when the public will declare that the most helpless 
and pitiable of their fellow subjects shall no longer be confined and 
detained as a profitable private business.” 

In an article in the Nineteenth Century Magazine for February, 
1885, Doctor Bucknill again attacks the system. He says, (p. 264) : 
“ The suspicion and distrust of private asylums is not now founded 
on the belief that their inmates are treated with cruel violence. It 
may perhaps even be said that it is founded entirely upon the be- 
lief that persons are admitted into them who ought not to be 
admitted, that they are not treated with a view to promote their 
recovery ; and that they are detained long after they ought to be 
set at liberty.” 

Again he says, (p. 275) : “Imprisonment, bringing pecuniary 
profit to the person who holds the keys, is inconsistent with modern 
notions of justice ; and private asylums founded and conducted on 
this principle must be abolished. ‘ Delenda est Carthago.’ ” 

Doctor Bucknill winds up this able article as follows : 

“The Committee of 1877 was rather remarkable, inasmuch as having been 
granted on the demand of a member of the House opposed to private 
asylums, it was dominated to a great extent by members entertaining a very 
different opinion and v^ho knew more about the subject and were more in- 
terested in it. One most influential member of the committee was actually 

the proprietor of the largest private asylum in the country it is not 

surprising, under these circumstances, that the recommendations of the Com- 
mittee were feeble and temporising perhaps neither the legislature 


52 


PRIVATE LUNATIC ASYLUMS. 


nor the public were ripe at that time for the abolition of private asylums by the 
simple process of refusing all renewal of licenses; but it may safely be 
foretold, that if the promised Bill does not provide in some decided way 
for such abolition, it will either fail to become law or, as law, it will fail to 
endure,” 

Doctor John Conolly, for some years the resident Medical 
Superintendent of Han well, after five years’ (experience as “ Inspec- 
ting Physician of the Lunatic Houses for the County of Warwick,” 
wrote, as stated in Doctor Bucknill’s book already mentioned, “ his 
first eloquent, humane, and thoughtful work on insanity. ” Doctor 
Bucknill says, (p. 59) : 

“Doctor Conolly grounded his maxims of reform upon facts which he 
adduced and summarised in the following conclusion : ‘That the present 

regulations regarding the insane are at once inefficient for the protection of 
the insane themselves, and dangerous to the public; that it results from them 
that some are improperly confined, and others improperly at large.’ 

Other evils, arising out of the present manner of providing for lunatics 
are that they are often confided to persons who are unacquainted with bodily 
and mental disorders, and who neglect such treatment as might conduce ta 
recover}'^ ; that it is the interest of such persons to keep patients under their 
care who ought not to be so confined.” 

Doctor Bucknill continues: 

“Nothing which Doctor Conolly overwrote does more credit to his head 
and his heart than these opinions on a subject that was to make his name 
famous; early opinions it is true, and published before advancing years and 
personal interests had made him indulgent to the evils he had denounced. ” 

This allusion is to the fact that Doctor Conolly ultimately be- 
came a |3rivate lunatic asylum proprietor himself and Avas chosen to 
represent the fraternity, on whose behalf he gave evidence before 
the Select Committee of 1859, having a few years before laid down 
the maxim that “every lunatic asylum should be the property of 
the State and be controlled by public officers.” 

Doctor Conolly, speaking for the proprietors, said in the course 
of his examination: “There is a general feeling on the part of 
medical men belonging to asylums that they are somewhat unworth- 
ily estimated ; that they are supposed more peculiarly to be under 
the influence of mercenary considerations than they deserve to be 
considered.” (Question 1,986.) 

In reply to a previous question (1,936 ) as ,to his knoAvledge of 
private asylums, he said: “I am acquainted with several; I am 

intimately connected Avith two. I am part proprietor of tAvo ; and 


BY W. J. CORBET. 


53 


in my own house I receive six ladies.” It is sad to think how 
even the good and generous are blinded by self-interest. As Lord 
Shaftesbury put it in his reply to question 82 — “It is the cardinal 
point upon which everything turns.” Had not Doctor Conolly 
become a proprietor himself he would doubtless have continued 
hostile to the system. 

Dr. J. Mortimer Granville, a London physician of high stand- 
ing, and eminent in his profession as a specialist in lunacy, was 
examined at length before the Select Committee of 1877. Having 
stated that the private asylums did all the work before public 
asylums existed, and should be given credit for it, he said; 
“Nevertheless I think the time has possibly egme when their 
work might be continued by them under a better system.” 
(Question 8,993) Asked — “ Supposing you were goingto establish a 
system for the regulation of lunacy, would you admit the existence 
of private asylums into your scheme?” Answer — “ I would not.” 
Doctor Granville’s proposal was to buy out the interests of the 
proprietors on a valuation of the receipts for a certain number of 
years and to reconstitute the asylums under State officers, paying 
the money now paid to the proprietors into a central fund. 
Subsequently writing on the escape of a “patient” from a lunatic 
asylum, that had been the subject of heated discussion in the 
London papers. Doctor Granville said : “It is a cruel and most 
dangerous law which enables any man to commit another to 
prison without trial or habeas corpus, on the mere certificate of 
two medical men, ‘ Neither of whom need,’ as I wrote more than 
20 years ago, ‘ have seen a genuine case of mental disease, read a 
page of any book, or heard a lecture or been asked a question at 
any examination on the subject ’. . . . it is sickening to have to 
repeat these assertions again and again; I made them before the 
Select Committee of 1877, and I shall continue to give them ex- 
pression without fear or favour until a 'baneful and oppressive 
law is changed.” 

Speculation on unfulfilled contingencies is not always barren or 
useless. One may therefore be permitted to consider what would have 
been the consequences to society generally, to the sane as well as the 
insane, if the views held by suc-h unimpeachable authorities had pre- 
vailed, and the “abominable and indefensible system” been swept 
away root and branch. At any rate we would have been spared 
many hideous scandals, and much human suffering would have been 


54 


PRIVATE Li; RATIO ASYLUMS. 


avoided. From that day to this the evil system lias not been grap- 
pled with. It is painful to reflect how often the labours of Royal 
Commissions and Select Committees prove fruitless, and how evi- 
dence of the most damnatory character is watered down in the 
Reports made to Parliament. 

The terrific indictment framed by Lord Shaftesbury in 1859 
against private lunatic as^dums, sustained by witnesses of the high- 
est authority, should in the ordinary course have led to the imme- 
diate abolition of the system ; but the clique of proprietors was too 
cunning or too strong, and haAung succeeded in capturing Doctor 
Conolly and making him, instead of a powerful opponent, a power- 
ful advocate, they had not much difficulty in putting a wet blanket 
on the proceedings. After the lapse of eighteen years the farce of 
another Select Committee was re-enacted, and, as Doctor Bucknill 
has told us, in his article already referred to, dominated by mem- 
bers in favour of private asylums, with “the proprietor of the larg- 
est private asylum in the country ” on the Committee. Of course 
under such circumstances the ridiculous farce could only end 
in the one way. Nothing was done; the Government stood stock 
still. 

The late Mr. Dillwyn, M. P., who was a member of the Commit- 
tee of 1877, and took a life-long interest in the well-being of the 
insane, made an effort to deal with the evil as a private member by 
introducing, in 1881, a Bill “ to amend the laws relating to the cus- 
tody and treatment of lunatics,” but it never got beyond a second 
reading. In the course of his speech introducing the Bill, Mr. Dill- 
wyn quoted the evidence given by Lord Shaftesbury in 1887 to the 
effect that “he had seen no reason to change any of the opinions 
which he had expressed in 1859 as regards the objectionable prin- 
ciple of persons having an interest in the retention of lunatics being 
intrusted with the care of them.” During the debate Mr. Court- 
ney, then Under Secretary of State for the Home Department, said, 
speaking on behalf of the Government, “The gradual suppression 
of private asylums .... was a subject of the highest interest. . . He 
hoped that the private asylums would in the course of time die 
out. There was no vested interest in them.” (Hansard, 3rd Series, 
Vol. CCLXI). The theory of dying out is absurd as long as they 
are permitted to drive a roaring trade sanctioned, protected, and 
licensed by Government authority. The idea must be regarded as 
one of Mr. Courtney’s flights of imagination. As well expect a. 


BY W. J. CORBET. 


55 


blast-furnace to burn itself out while plentifully supplied with fuel. 
There is only one way to do it — stop the supply. 

Another attempt to deal with the question was made by the 
member for North Shropshire, Mr. Stanley Leighton, who, on 25th 
April, 1882, moved a resolution “ That ail lunatics ought to be com- 
mitted to the keeping of the State.” He said, “He did not wish to 

speak harshly of persons but only of the principle he could 

not help speaking strongly of a system that encouraged speculation 
and large expenditure in licensed houses with a view to the profit of 
their owners.” Mr. Sclater-Booth, now Lord Basing, contributed 
a remarkably able and exhaustive speech to the debate saying : 

“The ideal system they ought to aim at was a system by which lunatics 
belonging to the wealthy and middle-class families might have the ample 
security which the poor enjoyed in i^auper asylums — namely the security 
that it was not in the interest of any human being in the asylum to retain 
them in it one minute after they were cured. In a public asylum the inter- 
est of all the officials was to discharge the patients as soon as possible ; but 
in the private asylums this state of things was reversed, and his view was 
that no lunatics should be entrusted to those who were pecuniarily interested 
in their maintenance.” 

Mr. Sclater-Bootli pointed out that it was not the intention of the 
mover of the resolution to relieve the better class of lunatics from 
maintaining themselves and that they need not be maintained at the 
cost of the public. The incomes of the opulent insane classes now 
flowing into the coffers of the proprietors of private asylums, in- 
creasing the wealth of the capitalist or enriching the adventurous 
speculator, would, if administered under Government authority, 
maintain all the private lunatics in the country in comfort and even 
luxury in special institutions managed by qualified persons, whose 
only pecuniary interest in connection wdth them would be their sal- 
aries. The next attempt to grapple with the subject in Parlia- 
ment was made by the writer, who introduced a Bill “To 
alter and amend the law relating to private lunatic asylums 
in Ireland and to make other and more suitable provision for 
paying patients.” The vested interests of proprietors in Ire- 
land are so trifling, compared with English interests, I thought the 
measure would not be strongly opposed and that if the thin end of 
the wedge was inserted it could afterwards be driven home. The 
introduction of the Bill, however, was the signal for an outburst 
of indignant opposition on the part of the propidetors who saw in 
my action the beginning of the end. The Bill was “ blocked ” and, 


56 


PRIVATE LUNATIC ASYLUMS. 


though re-introduced session after session for several years, it never 
got beyond the first reading stage. 

Meanwhile the revision and consolidation of the whole lunacy 
law of Great Britain was undergoing the tedious process of 
incubation. The evidence given to the Select Committees of 1859 
and 1877 was sat upon and hatched in the official incubator until 
the year 1890 the only result, in regard to proprietary asylums, 
being a very nasty addled egg indeed. The advocates of reform 
fully expected that a system so abhorrent, so universally, author- 
itatively, and justly condemned would have been effectively dealt 
with and that private lunatic asylums would either be taken over 
by the State or abolished in some other way. Now, not only was 
this not done but the very reverse. The system of lunatic asylum 
keeping for profit, profit being the “fons et origo malorum” has 
been perpetuated under the Act of 1890, and perpetuated in an 
infinitely worse form than before. Section 207 specially enacts that 
every license may on its expiration be renewed “to the former 
licensees, or any one or more of them, or to their successors in 
business and subsection 6 of the same clause provides that “no 
new license shall be granted to any person for a house for the re- 
ception of lunatics.” What is the effect of this? Simply that it 
perpetuates the condemned system. It gives a new lease forever 
to the eighty -five private lunatic asylums now in existence, enhances 
their proprietorial value, and, by prohibiting the issue of new 
licenses, gives a monopoly of the trade to the present proprietors 
and “to their successors in business” for all time. Who is 
responsible for this outrage on humanity? The Lord Chancellor 
and those who, under his direction, framed the Bill had necessarily 
to be guided by that department of the State which controls and 
supervises lunacj^ affairs. It must then be assumed that either the 
Lunacy Commissioners approved of, or at least did not protest stren- 
uously enough against, the continuance of the evil. In spite of the 
accumulated evidence of half a century Mammon has triumphed. 
How it was managed is a mystery that could only be explained 
by the Jay Gould of private lunatic asylum capitalists. 

While writing I have received a copy of the Third Annual Report 
of “The State Commissioners in Lunacy, New York.” The State 
care of the insane of the poorer classes, as well as of those who are 
able to pay either wholly or in part for their maintenance, is mani- 
festly the right thing, and it is not surprising to find “better results 


BY W. J. CORBET. 


57 


at less aggregate cost can be secured than any town or county or 
other municipality could be expected to secure.” The following 
paragraph from the Report (p. 269) indicates the method in which 
the Lunacy Commissioners of New York desire to see lunatics be- 
longing to the wealthy classes cared for: “ It may be that in some 

more advanced stage of public sentiment upon this subject the State 
will, in view of the dreadful nature of the malady of insanity, en- 
large its views and extend its philanthropy so far as to be willing 
to provide for all insane persons within its borders, irrespective of 
their pecuniary condition ; ” meaning, no doubt, to provide suit- 
able care and treatment in State asylums, under the management 
of State officials for rich people, the expense to be borne by the 
patients themselves or by their relatives. 

The world at large owes very many debts of gratitude to America. 
Her initiative has conferred incalculable benefits on the human 
race in various ways. If by the exercise of those high mental 
faculties for which the nation is distinguished; if through “the 
power of thought, the magic of the mind ” she can devise means to 
arrest the spread of insanity, and to abolish private lunatic asylums 
keeping for profit, America will confer a boon upon humanity 
unsurpassed by the greatest of her achievements. 

In bringing my humble contribution to the proceedings of this 
great International Congress to a close, I desire to assure this 
distinguished assembly that if I have been instrumental in letting 
in a ray of light, however feeble, on the sad subject dealt with, 
the privilege accorded to me is an ample reward. 


THE FUTURE OF ASYLUM SERVICE. 


BY A. CAMPBELL CLARK, M. D. , 

Medical Superintendent of Glasgow District Asylum, Bothwell, Scotland. 


Reform is always in the air — the spirit of unrest is always 
abroad, and we pin our faith to the old shibboleth “a change for 
the better” — a faith which is “the substance of things hoped for, 
the evidence of things not seen.” Faith and Hope are the abiding 
well-springs which keep the energy of reform alive and patient 
and persevering, and the history of our asylum service 
abundantly proves it. We have been waiting and working for 
years, and as faith without works is dead, I take this opportunity, 
so graciously alforded me, to address this representative Congress 
on certain matters of practical and vital interest to the success 
of asylum management and treatment. These refer to asylum 
service, the machinery of asylum administration. It is not my 
purpose to deal with the prime levers of this machinery, the 
central or state executive, the local boards, or even the principal 
officers. These might well be discussed without going much 
beyond the mark, but the machinery which really drives the asy- 
lum routine is chiefly located in the lower official strata, and to 
this I beg your brief attention. The attendant and nursing staff 
constitute our fundamental reliance in the work of asylums. They 
are to asylums what the engineer and signal man are to our railway 
system, and the best executive, the most competent superin- 
tendent, is nothing without them. They are the custodians of 
lives, the vital circumstances, for weal or woe, of our patients; 
and we have to reckon up this human equation of factors and 
results. 

Asylum medicine is not dealt out by pills and potions alone. 
We are told that mind and body act and react on each other. 
That is true; but in this age of cast-iron materialism on the one 
hand and speculative psychology on the other, we are apt to lose 
sight of the prosaic fact that minds act and react on each other. 
Even the benighted subjects of mental disease have glimmerings of 
consciousness, and are receptive of impressions and influences from 


KY A. CAMPBELL CLARK, M. D. 


59 


minds stronger and clearer than their own, and from the surround- 
ings which these minds create for them. Asylum wards are all 
the time the scene of a mental conflict, the grinding wear and 
tear of the insane mind on the sane, and the influence, good, bad 
and indifferent, of the sane on the insane. Mental or physical 
breakdown is not uncommon in our attendants and nurses, — they 
are weak in numbers, and strain tells. On the other hand, their 
influence can never be fully and accurately estimated — they are 
the effective machinery of discipline and routine, but how can 
we calculate the effect of this on individual patients? Disci- 
pline and routine are good things where the higher faculties of 
mind are perverted or suspended; but our purpose now is to dem- 
onstrate the importance of personal influence on individual minds. 
Discipline and routine have become fixtures of old standing in our 
asylums ; but the application of mind to mind, the focusing of 
individual cases, the recognition of each personal identity in the 
asylum wards, constitute the rational scientific basis of medical 
treatment. 

Tlie question now comes. Is this object attained? My answer 
is No, but we are driving towards it. The identity of some 
patients is lost in a negative existence — they may be driven like 
sheep, but the identity of others is so pronounced that they force 
themselves on your attention. It is easier to individualise such 
cases, for there is something to go on. As a matter of fact, 
attendants do individualise some cases without prompting: but 
the majority are treated en masse. To individualise seems 
hopeless wear and tear of body and mind in many instances, but 
good attendants teach us the lesson not to despair, and wonderful 
recoveries are recorded from time to time after years of asylum 
hopelessness. I take it, therefore, that we should overhaul our 
machinery, and see whether our nursing staff cannot generate in 
greater measure curative magnetism of mind on mind, a keener 
faculty of observation, and a higher sense of responsibility for 
the care and cure of the insane. 

This brings me to the question of the material of asylum service, 
the problem of efficient mental nursing. Physique was the para- 
mount idea in the past, an idea by no means disparaged to-day, 
but no longer paramount. Moral worth, intelligence, education, 
training are factors of the highest importance to-day, and the 
personnel of our nursing staff is perceptibly changing for the 


60 


THE FUTURE OF ASYLUM SERVICE. 


better. It appears to me, however, that this process of evolution 
should be carefully scrutinised at the present time, that prolific 
offshoots in certain directions should be judiciously pruned, 
and that we should not be too much carried away by appearances. 
The time will come when those who have not moved with the times, 
and some who have, will put such pertinent questions as these : 
What are the fruits of this new order of things? Are your recov- 
eries more, your accidents, escapes and deaths less? Is the general 
well-being of the insane improved? Are the amenities of asylum 
life increased? You will observe that I say nothing about reduced 
appropriations and rates: — that should be the last consideration, 
provided honest reform in asylum service is achieved. I say, then, 
that these questions will come to the front sooner or later, and no 
jesthetic show of sweet girl graduates, no mere parade of training 
school results will satisfy our level-headed citizens. “By their 
fruits ye shall know them”. 

If it be granted that results may be improved, it may be ac- 
cepted also that this necessitates a revision of the methods from 
which these results accrue, and this, of course, includes the backbone 
of the whole thing, our nursing staff and its work. What reform 
is here possible? or, to state it differently, where are the defects in 
the nursing staff and its work? My argument may brieflj^ be out- 
lined as follows: A. The defects of our nursing staff are three- 

fold: defects of (a) quantity, (b) quality, and (c) organisation. 
B. The defects of Nursing Work are the natural result of the 
foregoing, but they are also due to (a) large wards, (b) lack of per- 
sonally conducted cooperation of superior officers; (c) the same 
monotonous grind from week to week. I might go further, 
but the kernel of my argument is there in a nutshell. I trust I 
shall not weary you by saying a few words on the several points 
now raised. I shall do so as shortly as possible. 

The present number of attendants or nurses, properly so-called, 
is one to ten, twelve, or fifteen patients. If these are all chronic 
negative cases, this is quite enough. All that is wanted is care. 
But I am speaking of recent acute and curable cases ; and for such 
the number is too small. The hours of duty are too long, and the 
nurses are not officially attached to particular patients. When you 
consider that nurses are in the wards, or with the patients elsewhere 
for fourteen hours a day, the idea of their energies being concen- 
trated acutely on their patients all that time is preposterous — their 


BY A. CAMPBELL CLARK, M. D. 


61 


work must necessarily become automatic and routine in character. 
Individual responsibility for individual patients does not go much 
beyond the muster and the roll call. There are exceptions of 
course ; but I state the aggregate result, and ask you what better 
you could expect under the circumstances. The remedy is, first of 
all, a larger staff, but if I dare to say so, the ratepayer is thrown 
at my head. The poor ratepayer is much maligned, he is held up 
to us as a chronic growler, a being without the soul of charity in 
his composition. I believe this is a libel on the majority of our 
citizens. Well then, to stick to the point you ask me. How 
would I propose to remedy this? My proposition is this : You 
cannot have an eight hours day in asylums for reasons too lengthy 
to discuss : but you can give much larger leave, and you can have 
a larger percentage of nurses on duty. There are many ways of 
considering the means whereby hours may be shortened, if a larger 
staff is provided. 

Now for the question of qualitj^ A mistaken notion is 
that above all things we want more style, and higher educa- 
tion. This is a delusion most disastrous for asylums. We want 
the born mental nurse, a I'ara avis: but there is no sufficient 
supply of this commodity in the market, and we must take the 
next best we can get, and try to make the most of what is elastic 
and adaptable in human nature. Placed in the balance against 
a bright, sunny temper and obliging disposition mere education 
would be found wanting, and the parade of education some- 
times made in asylums as a feature of their nursing, though 
very fetching, and in itself a recommendation, is not the one thing 
most needful for the study and cure of mental disease. Well then, 
sunshine in our attendants and nurses is dependent largely on sun- 
shine in the conditions of their existence, and on sunshine in their 
surroundings. We do not realise that they also are under more 
or less restraint as well as their patients. They are eternally keep- 
ing down the “Old Adam,” sitting upon themselves so to speak, 
for many insane people would rile a saint, not to speak of a 
human being. In a word, don’t keep them so long in harness at 
a time, feed them well, groom them well, increase the attractions 
of their work, make them as healthy and happy as the nature of 
their work will allow, and the sunshine you thus create will radi- 
ate from them right into the lives of their patients. 

My third point is Organization. The aim of an ideal organi- 


62 


THE FUTURE OF ASYLUM SERVICE. 


zation is to expend energy without waste or fruitless result, and 
in proposing a larger scheme of organization, a reconstruction 
and elaboration of our present system, I have carefully kept this 
object in view. In the first place I would point out that the 
night supervision and nursing of the insane is woefully insufficient. 
You will find in most asylums one attendant responsible for the 
care of one hundred or more lunatics at one time. While the day 
officers and staff slumber and sleep, he stands alone, the one respon- 
sible sane official. The night care we trust to Providence, and a 
half of one per cent, of sanity, and this fact increases the anxieties 
of the responsible heads of the establishment, who are therefore 
never absolutely out of harness. We cannot have short watches as 
on board ship ; but with numerical strength increased, we can assign 
for night duty a larger staff with a supervisor or chief, and do away 
with the humiliation and degradation of the tale-clock system,*which 
at its best can be tampered with. At present night service is shorter 
than day service; but it is continuous. I would make night 
service longer, and day service shorter ; but I would break the night 
service in two parts, allowing one hour’s suspension of duty 
between. In small asylums it would be the duty of the supervisor 
to relieve the subordinates in turn — he would thus be more practi- 
cally acquainted with the night work. In large asylums a reliev- 
ing officer would be told off for this duty. Once a month I would 
allow night attendants off duty from Saturday morning till Monday 
night. I would have the night staff, with the assistance of the junior 
day [staff, responsible for the morning toilet, &c., of the patients, 
and for seeing them to bed at night; so that the work of the senior 
day staff wonld not exceed twelve hours. The leave of the day staff 
I have not touched on ; but it should be much more liberal than 
at present. The patients should be detailed in small groups for 
special written observations, and each nurse should have a group, 
and a note-book for that group. Nurses should exchange groups 
every three months, so that a fresh interest is continually kept up, 
fresh observations are possible, and the patients come under new 
influences. I would change patients from one ward to another, 
oftener than is done at present. I would have the superior officers 
direct and assist the nurses in observation and treatment. The 
lunacy laws impose a tremendous amount of clerical work on asy- 
lum medical officers, thus restricting the exercise of the true func- 
tion of medicine in asylums. I would have medical officers and 


BY A. CAMPBELL CLARK, M. D. 


63 


supervisors more in the wards collaborating with the nurses and 
forming more and more a collective investigation committee on 
the patients. I might warp and woof this skeleton of reform which 
I have set up, until it is perfectly clothed ; but time presses, and it 
may seem to you that I have gone far enough, and am merely 
sketching an asylum Utopia never to be realized. Ten years ago 
I pleaded for a conjoint scheme of special training for asylum 
attendants and nurses without much encouragement to hope for 
its fulfillment in the near future. Yet to-day in the old 
country this scheme is an accomplished fact, and in America at the 
McLean Asylum, Boston, at Buffalo, at Utica, and in many other 
asylums throughout the world the reform grows apace. Therefore 
I am emboldened to lay down the views which I enunciate to-day. 

The defects of nursing work are, as already stated, the natural 
result of the defects in the nursing staff : but they are also aggra- 
vated by three factors which I shall take in order. Firsts large 
wards. Elephantine asylums, and worse still elephantine w^ards, are 
self complacent monuments of public charity when they first break 
upon the gaze of the stranger; but let him take time to analyse 
his deeper impressions, as he may do on a second visit — a first 
visit gives a blurred sensation — and he recognises three things (1) 
that a great gulf is fixed between the sane and insane, (2) that it 
is a case of the shepherd and the sheep, (3) that for the sane 
leaven to leaven the unleavened mass of insanity in so large a 
crowd is a superhuman, paralysing task. When you want a quiet 
confidential talk with another man, when you want to consult with 
or advise him, you don’t think a crowded public room or a 
public function the place and season for such a purpose. You 
want to get him in a quiet corner all by himself. On the 
othei hand, w^hen a humble supplicant for mercy, kindness, help or 
some other exhibition of Christian charity watches for his oppor- 
tunity he does not seek the benefactor in the thick of a crowd, 
when he is likely to be urgently engaged with other affairs. A 
quiet corner will also suit his purpose best. And so in our asy- 
lums, though we dread quiet corners as places of suicidal contem- 
plation, they are really quite the opposite if we look at the matter 
aright. Blunt knives in asylums suggest suicide more than sharp 
ones. Unbroken straight lines of gallery walls in asylums invite 
gnawing suspicions of confinement and imprisonment. We want 
day-rooms broken up — coteries — cliques, if you will, but presided 


64 


THE FUTURE OF ASYLUM SERVICE. 


over and regulated by sane people. In small parties there is confi- 
dence — not in large ; and in confidence won and discreetly used, we 
have one of the secrets of successful asylum treatment. Second. 
There is the lack of “ personally conducted ” cooperation of asylum 
offi(jers. I have already referred to the excessive clerical work, and I 
may add the red tapeism of asylum administration. Kursing of indi- 
vidual cases lacks inspiration from the superior officers. I confess 
that instead of frequently inspiring my nurses, they oftener inspire 
me. At the present moment I am reminded of a case to cure 
which I have labored assiduously for two years, and for which the 
attendant has labored more. I am ready to give up hope now; 
but the attendant won’t allow me. Just a week ago he gave me 
a fresh inspiration, he suggested that there might really be some- 
thing wrong with the patient’s stomach besides mere lack of 
energy to account for his positive refusal of food — his breath was 
offensive. I washed the stomach out. He is, therefore, being indi- 
vidualised in a new direction, and already he is more active, bright- 
er, and on the whole better. He may not recover, but this new treat- 
ment will help him, if there is a chance at all. Third. There is 
the same monotonous grind from w'eek to week. So long as work 
is interesting, and not pushed to over-strain, it cannot be monoto- 
nous. From what has been already said, you can see that the 
evil now stated is a curable one. A continuous round of fresh 
outlets for energy and observation, a daily programme of varieties 
for patients and nurses, convalescent homes a few miles away for 
both, more domesticity, and individualising home life, tea parties 
in the wards, more fusion with the outside world. These are a 
few of the many suggestions that may profitably be discussed 
here. 

And now, gentlemen, before I close this somewhat rambling 
sketch of the problems of a great and beneficent service, let me 
ask your consideration of two of the latest evolutions of asylum 
reform now clearly discernible on the horizon. These are (1) 
the formation of a mental nursing association, and (2) a provident 
or pension scheme. If linked together under the patronage of 
asylum boards of management, they can only be followed by one 
result — decided success. If initiated and carried on without the 
help of asylum administrators, the result will not be so gratifying — 
indeed it may be disastrous. The day of pensions as they exist in 
the English and Scotch Royal asylums is gone by. What is now 


BY A. CAMPBELL CLARK, M. D. 


65 


by law established may remain, but the legislature will undertake 
no fresh liabilities of this kind. Heaven (in other words, asylum 
managers) may be expected to help those who help themselves — 
dollar for dollar put by for a rainy day. That’s the principle 
which the railway systems of the old country recognise, and it is 
the only possible one for asylums. By such means a really good 
asylum stalf is secured and maintained in efficiency, while a reason- 
able prospect for the future is held out to them. Here also is the 
foundation of a mental nursing association which may be expected 
to work loyally, and not as a mere trades union. It should have 
its own weekly newspaper, managed by representatives of all 
classes of asylum service. 

I regret that space forbids my going further : but hope that in 
this short paper, I have given you some thoughts that are worthy 
of consideration. Such an opportunity as the present for the 
discussion of such questions must prove one of the abiding monu- 
ments of the great World’s Fair at Chicago; and I am sure the 
exchange of sentiments now being called forth will advance mate- 
rially the cause of asylum service reform. 


B 


REFORM IN THE TREATMENT OF THE INSANE. 


BY D. HACK TUKE, M. D., F. R. C. P., LL. D., 
Hanwell, London, England. 

Formerly Visiting Physician to the York Retreat. 


Mr. President and Gentlemen : 

Had I not been requested to refer on this occasion to an import- 
ant event in the history of the insane, which has recently been 
celebrated in England, I should not have ventured to do so, from 
the fear that some might think that it had already received 
sufficient attention, and that its importance was over-estimated. 

But in truth granting that the present standard of the manage- 
ment and treatment of persons of unsound mind is on the whole 
highly satisfactory in the United States and in Europe, it ought 
certainly not to be regarded as either useless or dull to cast a 
glance at the beginning of the movement which has ultimately 
developed, step by step, if not by leaps and bounds, into the 
present humane and, with some exceptions, efficient condition of 
management of the class now referred to, at least as regards public 
asylums. I do not include almshouses. 

The event of which I speak as so important was celebrated in 
the city of York last year, because it was the Centenary of the 
projection of the Retreat in that place by William Tuke, who 
besought members of the philanthropic Society of Friends to 
support the undertaking and ultimately succeeded in his endeavor.* 
Everyone knows and, therefore, it would be wearisome to reit- 
erate, the neglected state of the insane and, worse than that, the 
actual cruelty to which they were formerly subjected. It was the 
clear conception and the painful sense of the barbarous methods 
by which they were coerced, the conviction that this was inhuman 
and therefore wrong, that led to a definite attempt to make a 
radical reform, in the face of prejudice, ignorance and opposition 
of the most determined character, and to the foundation of an 
institution which for the first time bore the name of “The 
Retreat.” 

* The steps by which this movement was carried out successfully are given in the 
writer’s “Reform in the Treatment of the Insane,” 1892. J. & A. Churchill, London. 


BY I). HACK TUKE, M. D. , F. K, C. P. , LL. I). 


67 


Indomitable pluck, the stern sense of duty, a dogged persever- 
ance in the right course could alone conquer the manifold abuses 
by which the old system was hedged about, and, much more than 
that, succeed in holding up an example of a reasonable and benevo- 
lent mode of treatment. It is extremely easy now to look back on 
that experiment and see that it was calculated to succeed ; it was so 
simple ; it went so directly to the bottom of the evil ; but before 
the experiment was tried and when it was being tried, it must have 
caused some misgivings and fear lest it would after all end in 
failure. Had not judgment as well as humanity, had not common 
sense as well as pity, had not profound depth of feeling as well as 
mere sympathy actuated this great revolution, there might have 
been nothing more than a transitory emotion, a spasmodic move- 
ment, which would never have exercised the wide, far-reaching 
and beneficent influence which, as a matter of fact, it did exercise 
and exercises still. The extremely practical character of this re- 
form is proved by the critical observation of the effects of what 
was then the routine medical treatment of the insane, the discov- 
ery that it was altogether injurious, and that a directly opposite 
treatment was surprisingly beneficial. It has been often said that 
while the moral treatment pursued at the Retreat was admirable, 
the medical treatment was neglected if not despised. I wish to 
emphasize the fact that this is altogether a mistake. The moral 
tone was no doubt in happy contrast to that elsewhere adopted, 
but the refusal to follow blindly the monstrous treatment then 
fashionable among medical men, coupled with the adoption of a 
more rational method, was a remarkable feature of the experiment. 
Speaking generally, it was the substitution of tonic and stimula- 
ting remedies for depressants (including periodical bleeding) which 
marked the new system of treatment at the York Retreat. 
Another advance made at that time was the knocking off of the 
fetters by which the insane were bound (a bold measure independ- 
ently adopted by Pinel in Paris) and the endeavor to restrain 
dangerous actions by gentle methods of repression. The doctrine 
of non-restraint was not, it is quite true, adopted. It may, how- 
ever, be granted that the avoidance of manacles at the Retreat in 
any form or shape and the strenuous endeavor to calm the violent 
patient by kindly words and sympathetic action, quickly led to a 
very slight resort to restraint of the limbs, and ultimately to the 
entire abolition of straight-waistcoats and the like. If it is an 


68 


KEFORM IN THE TREATMENT OF THE INSANE. 


honor to have gone to the extreme of abjuring all mechanical 
restraints whatever, that honor must be awarded to Charlesworth, 
Hill and Conolly, and not to the York Retreat. 

That the Retreat was fortunate enough to effect an extaordinary 
change of opinion and practice throughout England, and more 
widely, is attested by innumerable competent authorities. Among 
these are American specialists who have loudly proclaimed the value 
of the example set by the Retreat a century ago. It has happened 
to many reformers that their work has been slighted or even ques- 
tioned, but there has always been the most generous appreciation 
of the work done at the Retreat. There is, therefore, happily, 
no claim on its behalf to defend, and no occasion for disputation. 
All that is necessary is to bring out in strong relief the enormous 
contrast between the old and cruel and unscientific method of treat- 
ment and that which was inaugurated at the Retreat a century 
ago with a success only equaled by its simplicity. 

And all this was done when the city in which the story is re- 
vived to-day had no existence, and the site on which it stands was 
a primeval forest. It may be said that there is no lesson to learn 
from the deed which was so courageously done in the year 1792, 
but from this I must be allowed to entirely dissent, for it would 
not only be ungracious and unthankful to forget an historical fact 
of this kind so pregnant with great results and benevolent ends, 
but if no lesson were taught, men would lose by so much the in- 
centive to good works arising from the knowledge that success 
attended efforts made with great singleness of purpose, with no 
eye to fame or human praise, and without any pecuniary benefit, 
but the very reverse — expenditure of money, loss of time, much 
anxiety and even contumely and abuse. Similar battles have to 
be fought at the present day in the contest with ignorance, 
indifference, sordid interests and even inhumanity, and in this 
conflict, the modest yet determined, and as it proved, victorious 
struggle of the last century cannot but nerve the combatants in 
the Holy War of humanitarianism and scientific progress in what- 
ever country it may be fought. 


THE IRRESPONSIBILITY OF THE INSANE UNDER 
THE LAWS OF FRANCE. 


BY DR. VICTOR PARANT, 

Medical Director of the Maison de Sante of Toulouse, France. 


The legal provisions which govern the question of the irrespon- 
sibility of the insane under the F rench laws meet almost completely 
the scientific requirements and the best established views of mental 
medicine. It has seemed to me that it would be not without in- 
terest to enter here upon the principal considerations that the subject 
allows. 

It is universally admitted that a person in a condition of mental 
alienation is irresponsible for his actions. But if we all are 
agreed as to this principle, all do not interpret it in the same 
manner, and according to nativity and opinion one is led here to 
allow it too great an extension, and to restrict it unduly there. 

These divergences are due to the different ideas as to mental 
alienation and what is to be understood by that condition. Some 
recognize as insane only those who are altogether incoherent and 
extravagant and have altogether lost their intelligence, and would 
only give the benefit of irresponsiblity to those who are incapable 
of understanding anything whatever. 

Others recognize the existence of insanity wherever they find 
hallucinations or delusive ideas, without sensible disturbance of 
action, but they refuse to consider the lunatic irresponsible if he 
can still take account of the compass and the value of his acts, if 
he recognizes the difference between what is allowable and what 
is forbidden, between right and wrong. 

Still others make a distinction between the acts that are in 
direct relation with the delusions, and those that are performed 
entirely without reference to them. 

Others finally, and with altogether opposite opinions, call every 
one insane, and consequently irresponsible, who may be a little 
odd, eccentric or ill-balanced, whoever presents the slightest 
mental anomaly or imperfection. They even go so far, by a 
singular interpretation of facts, as to say that crime and insanity 


70 


THE IRRESPONSIBILITY OF THE INSANE. 


proceed from the same elements, and that there is no fundamental 
dilference between the criminal and the lunatic. 

These diverse opinions, of which the ones extend too far and 
the others restrict unduly the domain of mental alienation, are 
alike incompatible with the teachings and most correct notions of 
science. 

What, then, is mental alienation? 

The first point to be considered is that mental alienation is a 
disease, we might add that it is before all and especially a disease 
of the physical organism. There is not one condition of mental 
disease in which we cannot recognize bodily suffering, and the 
symptoms on which we can, with most certainty, make our 
diagnosis are bodily symptoms, sensory disturbances, excitement 
or depression of the functions, nervous exaltation or obtunding 
of the senses, alterations of the muscular activity or of the 
nutritive functions. These principal symptoms and others still, 
which are met with in various combinations in conditions of 
insanity, bear witness to the part played by the suffering of the 
organism. 

I may add, as a complement of Avhat I have said, that in order 
to cure a mental disorder, it is necessary, first of all, to cure the 
diseased body. Any treatment directed solely to the mental 
troubles is condemned to absolute and certain failure. 

A second and not less important point to be considered, and yet 
one that is too universally ignored, is that in insanity the disor- 
ders of the intelligence have only a secondary importance, and 
that when we meet them it does not mean that the intelligence is 
itself diseased. The appearances in this regard are altogether de- 
ceptive. The exact fact which it is essential to bear in mind is 
that the morbid process interferes with the functioning of the men- 
tal faculties, whose normal manifestations are thus suspended or 
embarrassed. The mind is unable to enter into regular relations 
with the outside world, but it continues to live its own life often 
much better than we suppose. 

To be convinced of this, it is enough to study attentively cer- 
tain cases of mental disease, of the nature of which there can be 
no doubts, for example, simple conditions of maniacal or melan- 
cholic delirium. Although the patients seem very wild, they have 
often, and under diverse conditions, a very clear knowledge of 
their condition and of whatever goes on around them, as well as 


BY DR. VICTOR PARANT. 


71 


of their own actions. Those who live with the insane have con- 
stant proofs of this fact. 

When the patients recover, or during lucid intervals of their 
disease, in which they can recover possession of themselves, they 
themselves testify, and their words need not be doubted, that, in 
spite of contrary appearances, their mental faculties were adapted 
with exactness to the conditions of their own consciousness and the 
phenomena of the external world. In spite of their unreasoning 
attitude and their extravagant talk, they had full knowledge of 
what was going on around them ; they realized the absurdity, the 
malignity or the danger of their acts ; they sometimes have a fixed 
determination to do a wickedness, they suffer from not being able 
to control or escape from their delirious obsessions, their evil ten- 
dencies, but cannot prevent themselves from submitting to all the 
demands. Their will is suppressed or restrained, their intelligence 
only manifests itself in unreason, but both continue to exist in 
their own life and to keep in themselves their integrity. 

It is well, while mentioning these phenomena, traces of which 
are to be found, in various degrees, in all conditions of mental 
disease, to remark that if a definition of insanity is required, we 
may say that it is a disease of the organism in consequence of 
which the normal relations of the intelligence with the external 
world are changed, suspended or destroyed; indicating also, in as 
clear a manner as possible, that insanity is not, properly speaking, 
a disease of the mind. 

It follows, therefore, that we are not to seek the really charac- 
teristic symptoms of mental alienation in the normal or abnormal 
manifestations of the intelligence. By so doing we would be 
liable, like the great mass of the public; to fall into formal and ab- 
solute error. No more should we affirm or deny the existence of 
insanity from certain manifestations of the will, since these, 
varying in form and intensity, occur in very many of the insane. 

Insanity is not essentially recognized by any of the mental 
troubles to which it gives rise. What really characterizes it with 
certainty is the sum total of the symptoms from which it is evident 
that the presumably deranged individual has not his customary 
control of himself, that he has lost his free will. His intelligence 
and his will may be more or less conserved, but sometimes their 
external manifestations are obscured or altered, sometimes they 
are enfeebled or destroyed, at other times again they are subjected 


72 


THE IRRESPONSIBILITY OP THE INSANE. 


to the influence of forces developed in the physical organism 
which dominate them and from which it is impossible for them to 
escape. 

Failing to understand insanity in this light, which is absolutely 
correct, one is liable to be grossly deceived and to fail to recog- 
nize it where it actually exists. By the same error one may be 
led to consider as responsible unfortunates who are really not 
so at all. 

In medico-legal cases, where the irresponsibility of the insane 
is in question, we should therefore use these general data as a 
basis in order to estimate the value of acts and to determine 
whether the individual is or is not responsible. But as the 
estimation of irresponsibility has to be made according to 
prescribed formulae enacted in the laws, it follows that the law 
should be regarded as good, which, while specifying that it 
applies only to confirmed insanity, formulates its rules in a general 
manner, and does not support them by too restricted or exclusive 
data. 

The French law appears to us to realize these conditions quite 
fully and to merit the attention of anyone interested in the legal 
medicine of insanity. In the words of Article 64 of the Penal 
Code : ‘ ‘ There is no crime or misdemeanor when the accused 

was in a state of dementia at the time of commission of the act, 
or where he was under the control of a force he was not able to 
resist. ” 

The word “Dementia,” here employed, has been the cause of 
some errors of interpretation. This is so because the term in its 
stricter sense signifies the abolition or profound diminution of the 
mental faculties. Dementia, properly so-called, is the final result 
of most insanities and not insanity in general. There is, there- 
fore, a possibility here for error. 

For a long time, however, the word has been used in a more 
general sense, and it is understood in the same way by all, jurists 
and physicians, that in legal medicine it signifies mental alienation. 

While we agree in giving the term dementia a signification con- 
formed to the circumstances, we likewise have to decide what is 
to be understood by mental alienation. This is not quickly de- 
cided and presents some real difticulties. It should be recog- 
nized, however, that the fault is in mental medicine itself, which 
had not, in the beginning of the century, definitely determined 


BY DR. VICTOR PARANT. 


73 


what was insanity, and which gave too great an importance to the 
mental troubles, leaving in the shade the bodily disorders, the 
importance of which, however, it did not entirely ignore. In 
originating the doctrine of monomanias, alienists put all the 
world against themselves and their science. Men could hardly 
understand how, and did not want to admit that a predominant 
idea, an exceptional tendency, however exclusive, could constitute 
insanity, and they regarded as mere suppositions of which the law 
could not take account, the insanities which, under the names of 
pyromania, kleptomania, etc., consisted only in impulsions to 
arson, theft, murder or other unlawful or criminal acts. The 
evolution of mental pathology and the progress of the science, 
however, have shown that behind the impulsion there is not only 
the fixed and predominating idea, but also a group of physical 
disorders, more or less marked, the recognition of which is always 
possible, that these characterize clearly the disease of the organ- 
ism and the mental symptoms are absolutely dependent upon 
them. From this it has been made more clear in what alienation 
consists. 

Some questions have also arisen lately in regard to the condi- 
tions of insanity in which^the intelligence still preserves in various 
degrees its external manifestations. But it is understood that, 
while these manifestations seem regular, they are not really normal, 
since they are embarrassed by morbid impressions that give rise to 
delusive ideas mingling with rational mental functioning. French 
jurists are to-day aware that if mental alienation is attended by 
disorders of the mind, these are only the contrecoup of bodily 
ailments that may not be sufticiently generalized to prevent the 
exercise of certain normal moral and intellectual aptitudes. It 
matters little whether the individual has still the knowledge of the 
world around him or the memory of past events, it is of small im- 
portance whether he is able to discern right and wrong or can 
premeditate his acts and appreciate their bearings, or, lastly, 
whether in some respects he speaks, reasons or acts as might a 
person of sound mind. What is to be ascertained is the existence 
of a mental disease, whatever may be its symptoms and their 
intensity ; and if account is properly taken of deficiencies of reason 
we are more and more impressed with the important truth, 
that it is necessary to estimate a man’s insanity, not by what ration- 
ality remains in him, but by what is lacking. 


74 


THE IRRESPONSIBILITY OF THE INSANE. 

The terms themselves of Article 64 of the French penal 
code, have also contributed to clear the minds of French jurists, 
and the closing words of that article, where it says that an 
individual is irresponsible if he is constrained by a force which 
he cannot resist, were well devised to relieve their doubts and 
misgivings. 

It is true that we must not ignore the fact that in the mind of 
the lawmaker this provision applied just to persons undergoing ex- 
ternal compulsion, as where one is forced to act under the influence of 
threats and pressure from others. The close relations, however, 
of these conditions of irresponsibilty should be taken in consider- 
ation, and whether or not it was intended by the lawmakers, they 
have given a very well-defined indication of the data for estimating 
the irresponsibility of the insane. 

This indication is especially valuable in those conditions when 
the insane person, in spite of his mental disorder, preserves, 
nevertheless, more or less perfectly manifested, his intelligence or 
consciousness of his acts, and often also his will which he cannot 
utilize. He is in this case able to feel his condition, his mental 
integrity is sufficient for him to understand that he ought not to 
do the irrational acts he is forced to do ; his will would resist but 
cannot, being dominated by the disease. He is therefore in the 
same condition as the hypnotized subject when the slumber is not 
yet deep enough to deprive him of all consciousness of himself ; 
he then hears the orders given him, realizes the absurdity of the 
acts suggested to him to perform, wishes to resist the suggestion 
but cannot, as he has no more control of himself; his will is 
oppressed, dominated, constrained, and the action commanded he 
carries out in spite of himself. 

For the provisions of tlie French law to be complete, it 
should also aim at cases where the will is not oppressed or 
dominated by impulsions or irresistible force, but is inactive, 
inert or impotent. Such is especially the condition in certain cases 
of melancholia when the patients have no power to act, they 
understand, nevertheless, what they ought to do but are reduced 
to impotence by want of action of the will. Since, however, 
cases of this kind more rarely commit unlawful or criminal acts, 
excepting suicide, it is a matter of less importance that the law 
has not foreseen them; furthermore they can be^ included in the 
general mass of cases of mental alienation. 


r.Y DR. VICTOR PARANT. 


' 75 


In its main deteraiinations, therefore, the French law is simple 
and categorical. It is applicable to all the clearly recognized 
conditions of mental alienation. Without excluding this or that 
case where the individual, though insane, has retained to a greater 
or less extent his mental faculties, it declares that from the 
moment when the insanity begins he should be declared irrespon- 
sible for his acts. 

In conformity with these provisions, the magistrates charged 
with administering the law, whenever they have to do with a 
presumed case of insanity, call in the aid of physicians, the only 
competent persons in such matters, ask them to investigate and 
declare whether or not insanity exists, and according to their con- 
clusions the question of responsibility is decided. 

There is a class of persons that attracts much attention at the 
present time ; they are those who without being really insane are 
yet not perfectly sound in mind. What should be their position 
before the law? Ought they, as regards responsibility, to be 
classed with normal individuals or with the insane, or should we 
devise for them some special rule of treatment? 

A doctrine has been brought forward in regard to these cases 
which is called that of partial responsibility, a seductive doctrine 
at first sight, but one which studied with care cannot fail to 
appear erroneous. It claims, in fact, to measure the degree of 
responsibility according to the degree of soundness and of mental 
force of the individuals. This is evidently impossible; and, 
moreover, were it practicable, who could be intrusted to do it? 
the physicians ? they are competent only for investigation of 
disease: the magistrates? if they are, as a rule, more ' practiced 
than physicians in analyzing the psychic condition of men, they 
have not the competence required to determine whether the 
relations between the physical and the moral exist in their normal 
condition. In both there is a lack of the means of certain and 
complete estimation. Moreover, had they the means, how could 
they find the true amount of responsibility belonging to this or 
that individual? To pretend to do this is to claim the impossible, 
and to talk of partial responsibility is really to be satisfied with 
mere words. 

We cannot ignore the fact, nevertheless, that the man who is 
not perfectly normal, whose mental and moral faculties have not 
been able, on account of the vices of his organism, to reach their 


76 


THE IKEESPONSIBILITY OF THE INSANE. 


regular expansion, ought not to be judged as severely as one who 
is normally constituted and well-balanced. His responsibility 
cannot be as seriously involved and he has a title to commiseration 
and indulgence. 

The French law affords a very simple method of treating 
such persons according to their deservings; it permits the 
allowance of what are called attenuating circumstances. In fact 
they are not insane, strictly speaking, they are responsible; 
but if having committed a crime or unlawful act, they should 
he punished, the penalty they merit should be mitigated, softened, 
less severe than that for a man in possession of normal mental 
faculties. 

The various provisions are wise and conform at once with the 
rules of social morals and the founded requisitions of medico- 
mental science ; they are at the same time very simple, although 
applying to all cases, and they deserve to be proposed as a model 
of their kind. They have also a solid basis, establishing the 
principle of irresponsibility on the well assured existence of a 
mental disease. 

Any other method of estimation is insufficient and conducive 
to grave errors. 

We have already shown, when speaking of those cases where 
the patients who, with all the signs of being fully insane, some 
of them agitated, disordered, incoherent or extravagant, others, 
on the contrary, weakened, dominated by depressing preposses- 
sions, terrifying delusions, and extreme anxiety, have, neverthe- 
less, consciousness enough of themselves to understand at once 
their condition, the nature of their act, the seriousness of their im- 
pulses, the absurdity of their delusions, and are, notwithstanding 
all this, incapable of avoiding them. 

If individuals in this condition have committed a crime or mis- 
demeanor, having understood what they were doing, having felt all 
the horror of the act, and tried to avoid it knowing its evil nature, 
ought they to be held responsible? and even if some of these 
patients have done wrong intentionally and even with a sort of 
pleasure in it, as we see some of them do, should they be punished? 
We should limit ourselves to pitying them. The benefit of irre- 
sponsibility should be extended to all the insane whoever they are, 
and even when they liave retained openly or in a latent condition 
a greater or less extent of their mental powers. 


BY DR. VICTOR PARANT. 


77 


We find, indeed, combined in the insane under very different 
aspects according to the surroundings, the country and the times, 
elements that haA^e been invoked as bases or evidence of their 
responsibility for their actions. 

One of the most important of these elements is the ability to 
discern good and evil. (1). In some countries, notably in 
England, this ability is regarded as the absolute sign of responsi- 
bility. The question asked is, was the person convicted of an 
unlawful act or crime capable of knowing that the act was wrong 
and that it was forbidden by the moral law or by human law? If 
the answer is “yes,” he is declared responsible and punished. 
There are lawyers who have even gone so far as to say that in 
such a case an insane person should be punished more severely than 
a man of sound mind, so that the chastisement should have on him 
a deeper impression. They did not trouble themselves to ask if 
the will of the patient was free, if he was master of his actions, if, 
in spite of his ability to recognize good and evil, he was able 
to choose freely between them. Lastly, if they had not been im- 
pelled to do Avrong by ideas arising from a disease that had 
falsified and altered their natural healthy judgment. There are 
many, even among the most disturbed and extravagant of the 
insane, even among the delirious maniacs, who know that their 
actions are wrong. Some are abusive, insulting and filthy 

in their language, fully knowing it is wrong. There are others 
who are violent, seek to do injury, go as far as to commit 
very serious offences, even murder, and know very well what 
they are doing, that they are transgressing and are in opposi- 
tion to human laws. Some of them do not hesitate to com- 
mit criminal acts, hoping thus, being brought before the 

courts, to be enabled by their crime to make public the 

miseries, the misfortunes and the imaginary persecutions of 
which they believe themseh^s the victims, and justify one by 
the other. 

Together with the capacity to recognize right and wrong, we 
may place the ability of premeditation. It is not rare to see the 
insane, even among those whose minds are profoundly affected 
and weakened, essentially demented even, meditate the act they 
wish to commit for days, months and even years prior to its com- 
mission. Long premeditated attempts at suicide are common, the 
same is true of homicidal attempts, without mentioning attempts 


78 


THE IRRESPONSIBILITY OF THE INSANE. 


of a minor character. This ability to premeditate enables certain 
of the insane to foment conspiracies among themselves, the results 
of which may be very serious. And when we consider that in 
order to prepare their machinations, to dissimulate, to use strat- 
egy, and improve the favorable opportunity the insane exhibit 
sometimes marvellous cunning, we ought to either deny the 
insanity or admit that premeditation is no more than the capacity 
of knowing right and wrong, to be made an index of the responsi- 
bility for acts. 

The insane, moreover, act according to intellectual processes 
analogous to those of persons of sound mind, they are often 
guided by definite motives that their disease makes them consider 
as legitimate and from which they regulate their actions. It is in 
obedience to such motives, very precise, if not well considered, 
that certain imbeciles become incendiaries. The great majority 
of suicides do the act in order to escape moral distresses by 
which they feel themselves tormented. Revenge is an active in- 
citement of very many insane homicides, especially those having 
delusions of persecution, who hope to obtain by the death of their 
supposed enemy relief from their troubles. 

We should also bear in mind that the insane are not illogical, 
and that their mode of reasoning, like many of their other habits, 
is analogous to that of sane individuals. A man, whoever he may 
be, forms his ideas, his opinions, his judgments, from external im- 
pressions and according to the analysis, conscious or otherwise, 
that he makes of them to himself. But, in order that these may 
be normal, certain essential conditions must be fulfilled, viz. : 
that the senses perceiving the external impressions, the brain that 
receives them, the inmost functions that elaborate and trans-'^ 
form them to be transmitted, in turn, under the form of acts 
and words, in other words, the entire organism must be in condi- 
tion to furnish correct ideas to the mind and permit it to perform 
its functions perfectly and regularly. This is the mens sana 
in corpore sano, the soundness of mind based essentially on sound- 
ness of the entire organism. 

But what makes the fundamental difference between the man 
of sound mind and the insane is not the unlikeness of their 
methods of intellectual action or their moral tendencies, it is not 
the difference of their mental capacities, it is the abnormality of 
the forrnation'and intimate perception of sensorial impressions, 


BY DR. VICTOR PARANT. 


79 


and the morbid irregularity in the manner of appreciating these 
impressions. Both sane and insane form their mental conceptions 
from the data supplied by the general or special sensibility ; but the 
one is able to correct such of the data as are false, while the other 
is incapable and conforms blindly to the errors arising in the dis- 
order of his senses. It is not incorrect to say that the lunatic is 
self-deceived, but it is a serious error to assimilate his mistakes 
with those of a sane man. 

It is under these conditions that the insane person draws from 
his false premises and his morbid condition the conclusions that 
they permit, and shows them more or less strictly logically in his 
manner. We can also see logic in the formation of his ideas and 
his reasonings, in his acts, and in the evolution of his delusions. 
But we also find throughout the action of his disease and therefore 
it is not here that we are to seek the signs of moral or legal 
responsibility. 

Similar considerations will apply to other analogous elements, 
like the consciousness of his condition, memory, and intellectual 
activity, none of which are incompatible with indubitable and 
confirmed insanity. 

None of these, therefore, can be made the index of irresponsi- 
bility. This should rather be sought for in the conditions which, 
according to the case and the form of insanity, destroy or impair 
the moral and mental faculties, and which cause, in the last 
analysis, the individual to be deprived of the control of his 
actions, of his free will, so that he can be, properly speaking, 
insane. This condition is the disease in every case of insanity, 
and whoever is a subject of mental disease, whatever it may be, 
should be considered irresponsible for his actions. 

This is the position taken by the French law. It con- 
siders only one thing, the condition of mental disease, the 
individual affected with a disorder of this kind, whatever may 
be the form or the degree of intensity of the insanity, is 
irresponsible. 

This principle is simple, relatively easy of application, it 
fits all the cases to which it is addressed, and conforms to 
the rules of human morals, which attribute responsibility for 
actions only to such individuals as are in actual and full pos- 
session of themselves and of their free will. It merits universal 
application. 


80 


THE IRRESPONSIBILITY OF THE INSANE. 


If it is desired, without changing the spirit of the French 
law, which is excellent, to complete it and to formulate in 
terms more in conformity to scientific language, it might be 
stated as follows : There can be no crime or misdemeanor 

when the accused was in a condition of mental disease at 
the time of the act, when he was compelled by a force which 
he could not resist, or when his will was destroyed by his morbid 
condition. 


STATISTICS OF INSANITY IN NEW SOUTH WALES 
CONSIDERED WITH REFERENCE TO THE 
CENSUS OF 1891. 


BY CHISHOLM ROSS, M. D. , 
Hospital for the Insane, Gladesville, N. S. W. 


Statistics on any subject are usually, but not necessarily, dry and 
uninteresting. A statement, however, of the proportion of insanity 
to the population, the nationality of the insane, their ages, condi- 
tion as to marriage, religious profession, and death rate, may be of 
value if only as a standard for future comparison. 

According to the census taken on the 5th of April, 1891, in New 
South Wales, the population was 1,132,234, made up as under; 


Table I. 


POPULATION. 

MALES. 

FEMALES. 

TOTAL. 

General population (exclusive of Chinese 
and Aborigines) 

594,448 

515,350 

1,109,798 

Chinese; {a) Full blood 

13,133 

156 

13,389 

(Z>) Half castes 

423 

445 

867 

Aborigines: {a) Full blood 

2,896 

2,301 

5,097 

(b) Half castes 

1,663 

1,520 

3,183 

Total population on April 5, 1891, . . 

612,562 

519,672 

*1,133,334 


Turning to the statistics of insanity, we find that on December 
31st, 1891, there were 3,134 registered insane persons in the colony, 
made up of 1,912 males and 1,222 females, or showing a proportion 
of 1 insane person to every 361, or 2.77 per 1,000 of the general 
population. On referring to the statistics of 1881, ten years ago, 
it appears that the population of tiie colony as ascertained by census 
was then 751,468, and that the number of insane persons under 
ofticial cognizance on December 31st of that year was 2,218, being 
1 in 338, or 2.95 per 1,000, so that whilst the number of insane per- 
sons increased during the ten years by the large number of 916, 

• The figures used in this paper are the census returns of New South Wales taken on 
April 6th 1891, and the statistics of insanity on December 31st, 1891, in the Report of the 
Inspector General of the Insane. 

F 


82 STATISTICS OF INSANITY IN NEW SOUTH WALES. 

they were proportionately fewer in relation to the population 
at the close of 1891 than at the same period in 1881, ten years 
■earlier. 

During the ten years 1881-1890 the proportion of registered in- 
sane persons in England increased from 1 in 352, or 2.84 per 1,000 
to 1 in 343 or 2.91 per 1,000. In Scotland, during the same period, 
the proportion increased from 1 in 370 or 2.70 per 1,000 to 1 in 
335 or 2.98 per 1,000, and in Ireland there was an increase of from 
1 in 386 or 2.59 per 1,000 to 1 in 288 or 3.46 per 1,000. 


TEAR. 

Population of 
New South 
Wales cen- 
sus April 5. 

Total number 
of insane in 
New South 
Wales 31st 
December. 

PROPORTION OF INSANE TO POPULATION IN 

New South 
Wales. 

England.* 

Scotland.* 

Ireland.* 

1881.. 
1890. . 

751,468 

2,218 

1 in 338 or 2.95 
per 1,000. 

1 in 352 or 2.84 
per 1,000. 

1 in 343 or 2.91 
per 1,000. 

1 in 370 or 2.70 
per 1,000. 

1 in 335 or 2.98 
per 1,000. 

1 in 386 or 2.59 
per 1,000. 

1 in 288 or 3.46 
per 1,000 

1RQ1 

! 1 1.^9 934 

3,134 

1 in 361 or 2.77 
per 1,000. 

1 





From the above calculations it will be seen that : The propor- 

tion of^the insane to the population in this colony is smaller than 
in either England or Scotland and remarkably so compared with Ire- 
land. To account for the high percentage of the insane under certi- 
ficate in Ireland, a committee on Lunacy Administration appointed 
by the Lord Lieutenant set forth in a report published in 1891, that 
■“the persons who have emigrated from Ireland consist almost 
entirely of those who are sound in mind and body. Emigrants 
have always been of this class; but it is more true of them now 
than formerly, because in so many of the countries to which they go 
■emigration of weakly persons is prohibited. There is an exodus of 
the strong and sound but the infirm, the insane, the imbecile, the 
idiotic, the deaf mute and the blind are left at home. Emigration 
thus leads to an undue proportion of defective persons of all sorts 
to population in the districts or countries from which it is taking 
place.” 

While the proportion of insane in relation to the population in 
all parts of the United Kingdom is increasing — slowly as regards 
the two divisons of Great Britain and somewhat rapidly as regards 


*The figures for Great Britain and Ireland are taken from 1881-1890, as the returns for 
1891 are not yet available. 


BY CHISHOLM ROSS, M. 1). 


83 


the sister island — the proportion to population in New South Wales 
has been practically stationary, and on the whole has rather dim- 
inished than increased during the ten years under consideration. 

On the whole it must be conceded that the statistics of insanity 
in New South Wales compare not unsatisfactorily with the statis- 
tics of the United Kingdom, but it must be borne in mind that in 
new countries the general conditions of life are usually more favor- 
able to mental soundness. 

In these colonies there is but little real poverty, the number of 
large cities is not great, so that overcrowding and consequent in- 
sanitation are less common, heredity has not had time to exert its 
full evil effect, mental poverty through want of training and edu- 
cation is rare, the Australian born is unemotional to an unusual 
degree, life is not taken very seriously, self-reliance even to self- 
assurance is their possession, and the climate of almost all the col- 
onies undoubtedly tends itself to the acquiring and keeping up of 
physical and therefore, to a large extent, of mental health. 

On the other hand, it is certain that a large proportion of the in- 
sane in New South Wales are importations, no prohibition being 
in force to prevent their introduction — as obtains in most if not all 
of the other Australasian colonies. 

In almost all countries, and especially in those with a settled 
population, the proportion of insane women in relation to the female 
population is greater than the proportion of men in relation to the 
male population, and it is interesting to compare the statistics of 
England and Wales with those of New South Wales in this 
particular. 

In England and Wales in 1890 the proportion of insane to pop- 
ulation was, for males 2.70 per 1,000, and for females 3.11 per 
1,000; whilst in New South Wales the proportion was, for males 
3.12 per 1,000, and for females 2.35 per 1,000. This remarkable 
difference is best shown in tabular form thus : 


Proportion of Insane to Population per 1,000. 



MALES. 

FEMALES. 

New South Wales 

3.12 

2.35 

England and Wales 

2.70 

3.11 


To account for the larger proportion of insane women in 
England it is held : 


84 


STATISTICS OF INSANITY IN NEW SOUTH WALES. 


First. That the physiological crises of a woman’s life, such as 
the onset of menstruation and the menopause, especially the latter, 
are responsible for much mental disturbance, and in addition to 
these pregnancy and childbiilh are decided factors in starting 
mental disorder. 

Second. That insane women live longer under asylum care, 
being less subject to general paralysis and the more rapidly 
destructive insane lesions, and less affected by urinary and other 
complications, which tend to shorten life in insane persons. Thi» 
is plainly shown by statistics in this colony as well as elsewhere, 
and as a conseipience there is, as time goes by, a greater accumu- 
lation of chronic cases among the female asylum populations. 

What then is the explanation of the smaller proportion of insane 
women in this colony? 

It is probably to be sought : 

First. In the circumstance that for many years, each of which 
contributed its quota of insane persons to our asylum propulation, 
the proportion of males in the general population largely outnum- 
bered that of females, and the residuum of these years, the chronic 
and incurable cases, largely males, still remains. 

This cause is even now, to some extent, in operation, as the excess 
of males over females in the general population was shown by the 
census of 1891 to be 92,890. 

Second. In the peculiar struggles and trials of early colonial 
life to which men are particularly subjected, to the lonely life of 
the shepherd, to the excitement of gold mining, and to the greater 
stress and strain consequent on ambition and enterprise, which, 
falling more heavily on men everywhere, are particularly incident 
to this sex, and are combined with much hardship in the ordinary 
processes of bread- winning, owing to the peculiar conditions of 
early colonial life. 

The relative proportion of insane women is slowly increasing — 
in 1861 the proportion of insane males to the general population 
was 2.63, the proportion of insane females was 1.32 only, or 
relatively two of the former to one of the latter, whilst the 
proportion in 1891 had risen to 3.12 for males and 2.35 for fe- 
males, or relatively 3 to 2. 

There is reason to believe that in less than another thirty years 
the relative proportions in New South Wales will have assimilated 
to those in England and Wales. 



r.Y CHISHOLM ROSS, M. D. 


85 


The native countries or the nationality of the population of 
New South Wales taken at the census of 1891 and the close of the 
year 1881, and the coni})arisons as to insanit}^ are shown in the 
accompanying tables. 

The population of Australian, of ib-itish, of French, of German, 
and of Chinese birth are given separately, and other nationalities 
are classified together; the number of insane is given under the 
separate nationalities, and tlie proportion of insane per 1,000 
calculated for eacli. 


1881 

I POPULATION. 1 

1 

NTJMBER OP INSANE 
UNDER CARE. 

PROPORTION OP IN- 
SANE PER 1,000 TO 
THE POPULATION. 

BIKTUPLACE. 

Male. 

1 

Female, i 

"x 1 

o 1 

H 1 

1 Male. 

j Female. 

1’otal. 

1 1 

Male. 

1 

! S 

X 

s 

ii. 

Total. 

Hew Soutli Wales 

2.33,515 

2,32,044 

465,.5.59 

1 371 

2a5 

1 656 

1.58 

1 1.23 

1.40 

Other British Colonies 




1 






and possessions 

27,339 

I 26,936 

48,275 

1 33 

22 

1 55 

1.20 

; 1.09 

1.13 

England and Wales. . . 

70,787 

1 39,887 

110,674 

478 

226 

1 704 

6.75 

! 5.66 

6.36 

Scotland 

15,828 1 

9,251 

25,079 

105 

.50 

1 1.55 

6.59 

5.40 

6.18 

Ireland 

36,494 1 

32,698 

69,192 

414 

390 

1 804 

11..37 

11.92 

11.63 

France 

1,205 1 

I 292 

1,497 

14 

4 

, 18 

11.61 

17.12 

1 12.06 

Germany - 

5,367 j 

2,154 

7,521 

49 

14 

1 63 

9.13 

6.03 

8.37 

China 

10,141 1 

64 

10,205 

66 

0 

i 66 

6..50 

0.00 i 

! 6.46 

Other Countries 

9.5.35 1 

2,288 

11.823 

108 

15 

i 123 

11.32 

6..55 

1 10.40 

1 89 1 . 

1 





1 


: 


New South Wales { 

1 

1 

36.3,495 I 

361,520 

72.5,015 

701 

.5il7 

1.2;38 

i 1.92 

1.48 

1.72 

Other British Colonies 





1 



, 1 


and possessions 

55,. 575 

44,496 

100,071 

118 

.57 

175 

2.12 1 

! 1.28 ! 

1.74 

England and Wales. . . 

95,849 I 

58,380 

154,229 

1 617 

287 

904 

1 6.43 

4.91 

5.86 

Scotland 

23,026 , 

13,795 

.36,821 

131 

64 

195 

5.68 

4.63 

5.29 

Ireland 

39,449 1 

35,602 

75,051 

1 .559 

467 

1,026 

14.17 

13.11 

13.67 

Prance 

1,585 

445 

2,030 

1 19 

7 

26 

11.98 

15.73 

12.80 

Germany 

6,976 

2,.589 

9,565 

81 

22 

103 

11.61 

8.49 

10.76 

China 

13,048 ! 

109 

13,1.57 

84 

0 

84 

6.43 

0 00 

6 38 

Other Countries 

13,.5.59 j 

2.736 

16,295 

181 

27 

208 

13..34 

9.86 

12.76 


In the annual rej)ort of tlie Inspector General of the insane for 
the year 1882, the figures given in the census of 1881 were re- 
served in connection with the statistics of insanity at the close of 
that year, and it was pointcsl out that “the very small percent- 
age of Australian born population (i. e. insane population) is to 
be accounted for by the fact that insanity is a disease most com- 
mon in middle and old age, and is rare in childhood and youth, to 
which period of lift* one-third of the population mainly, if not en- 
tirely, of Australian birth, belong.” 

It would appear from statistics that mental disease or disorder 
occurs Icvss fretpiently in childhood than between the ages of 
fifteen to thirty years, the vast majority occuri-ing between twenty- 
five and fifty; in other words, during full manhood and woman- 


86 


STATISTICS OF INSANITY IN NEW SOUTH WALES. 


hood, the period of marriage, of stress and strain, in fact, of men- 
tal and reproductive power. In more detail, the most frequent 
age at which insanity appears, is probably between twenty and 
thirty ; the tendency is rather less between thirty and forty ; and 
between forty and fifty it begins to diminish still further. In the 
report above cited it is also pointed out that “the high proportion 
of foreign born patients appears due partly to the admission of 
the waifs and strays of all nations to our hospitals, the ports of 
other Australian colonies being to a large extent closed to them, 
and partly to the peculiar isolation of foreigners in an English 
speaking community — an isolation which tends to mental dis- 
turbance.” 

The statistics for 1891 do not difi'er very materially from those 
for 1881 in the proportion of insane to the population. The chief 
points of difference are a small increase in the proportion of those 
of Australian birth, and a small decrease in the proportion of those 
born in England and Scotland — together with a considerable in- 
crease in the already large proportion of those born in Ireland, 
Germany and “other countries.” 

These changes are more clearly seen in the following tabular 
form : 


BIHTUPI.ACE. 

PROPORTION OF IN- 
SANE PER 1,000 TO 
POPULATION. 

! 

INCREASE. 

..... 

DECREASE.. 

1881 

1891 

Hew South Wales 

1.40 

1.72 

.32 


Other British Colonies and possessions. 

1.13 

1.74 : 

.61 


England and Wales 

6.36 

5.86 

1 i 

.50 

Scotland 

6.18 

5.29 


.89 

Ireland 

11.63 

13.67 

2.04 


Prance 

12.06 

12.80 

.74 


Germany 

8.37 

10.76 

2.39 


China 

6.46 

6.38 


.08 

Other Countries 

10.40 

12.76 

2.36 



During the ten years the number of insane persons of Austral- 
ian birth has almost exactly doubled those of English and of Irish 
birth, which have each increased by about 200, and those of 
foreign nationality which have increased by 150. At the close 
of 1891 there were 421 persons of foreign nationality in the 
asylums of New South Wales. These constitute upwards of one- 
fourth of the entire asylum population, although the proportion 
of foreigners to the general population is less than one-twenty- 


BY CHISHOLM ROSS, M. D. 


87 


seventh. It is clear that what was mentioned in the report of the 
Inspector General for the year 1881 as “the admission of the waifs 
and strays of all nations” still continues. 

A remarkable feature in the statistics for 1891 is the very large 
proportion of insane persons of Irish nationality — which stands at 
13.67 per 1,000 of the Irish born population. It is considerably 
more than double the proportion for England and Scotland, and is 
more than seven times as large as the proportion for New South 
Wales. No less than 1,026 persons of Irish birth were under 
asylum care at the close of 1891, being more than one-fourth of 
the total number of the insane in the colony, whilst the proportion 
of persons of Irish birth form only one-tifteenth of the total 
population of the colony. 

These facts would seem to contradict the opinion of the Com- 
mittee on Lunacy Administration in Ireland before mentioned, 
because if only the strong and sound emigrate from Ireland why 
should they as immigrants become so liable to mental trouble ? 

It is indeed a curious fact that whilst the proportion of insane 
to population in Ireland is 3.46 per 1,000, the proportion of insane 
to the population of Irish birth in New South Wales is 13.67 per 
1,000, which would seem to indicate that the restless and mentally 
unstable have emigrated in much larger relative proportion than 
those strong and sound of mind. This is also the conclusion 
which must be come to in examining the statistics relating to Eng- 
land and Scotland. Why should the proportion of insane to 
population in the people of these nationalities in New South Wales 
' be more than double what it is in England and Scotland? 

I It is worthy of note in passing how favorably the Chinese com- 
pare with other foreigners, the proportion of insane to popula- 
tion being 6.38 per 1,000, or about the same as the proportion for 
England and Wales. This comparatively low proportion is the 
more remarkable as the number of insane Chinamen now under 
asylum care represents the accumulation of many years during 
which the general Chinese population was much larger than it is 
at present. 

According to the census of 1891 the aborigines of the colony num- 
bered 8,280, made up of 5,097 of full-blood and 3,183 half-caste. 
Of the insane at the close of that year there were but 8 of aboriginal 
blood, viz. : full-blood, 2 males, 1 female ; half-caste, 4 males, 1 
female. In relation to the total aboriginal population the percent- 


88 


STATISTICS OF INSANITY IN NEW SOUTH WALES. 


age of tlie insane of both full and half-blood is just short of 1 per 
1,000. In 1881 it was 2.83 per 1,000. All observers are agreed 
that insanity in the primitive and uncivilized aboriginal was a very 
rare affection. Perhaps this rarity was more apparent than real, 
because like most savage people the natives (black) were wont to 
kill the demonstrative maniac, whilst the quieter forms of mental 
trouble either ended in the subjects of them being neglected and 
allowed to die, or if melancholic to commit, if they so wished, sui- 
cide. At any rate insanity would appear to have been compara- 
tively rare till the Europeans came with their civilizing methods. 
Then the ratio of insane rose in keeping witli the contact of this 
civilization till in 1881, as before stated, it amounted to 2.83 per 
1,000 of the aboriginal population an<l has again fallen to about 1 
per 1,000 in 1891. 

The ages of the insane in 1881 and 1891, as given in the follow- 
ing table, are interesting as showing, as has alreadj’ been pointed 
out, that insanity is most frequent between 30 and 50 years, when 
the strain and battle of life are most pressing. In the earlier years 
of life, notwithstanding a considerable amount of congenital idiocy 
or imbecility, the percentage of insanity is small, not reaching 3 per 
cent, at any age before 20 years. From the age of 20 to 30 the per- 
centage is about 15 per cent., rises to 23 per cent, between 30 and 
40, and to 25 per cent, between 40 and 50, when it rapidly falls. 

A comparison of the statistics for the years 1881 and 1891 shows 
but little variatioD in the percentages, except that there is some 


decrease in the ages between 5 and 20 and some increase 
20 and 30. 

between 

AGES. 

PATIENTS UNDEK 
CARE. 

PERCENTAGE. 

1882 1 

1891 

• 1882 

1891 

1 to 5 vears ; 

4 i 

1 

.14 

1 .02 

5 to 10 years 

30 

18 

1.09 

j .45 

10 to 15 years 

42 

39 

1.53 

.98 

15 to 20 years 

95 1 

98 

3.46 

' 2.47 

20 to 30 years 

397 1 

671 

14.46 

i 16.94 

30 to 40 years 

643 

913 

23.44 

1 23.06 

40 to 50 years «. 

693 

968 

25.26 

! 24.45 

50 to 60 years 

475 ! 

702 

17.31 

1 17.73 

60 to 70 years 

256 

379 

9.33 

1 9.57 

70 to 80 years 

93 

145 

3.02 

i 3.66 

80 to 90 years 

15 

24 

.54 

i .60 

90 years and upwards 

0 

1 ; 

0 

! .02 


BY CHISHOLM IlOSS, M. I). 


89 


Witli regard to the conditions as to marriage as shown in 
the following tables — taking the years 1881 and 1891 — two some- 
what important differences appear. The proportionate number 
of the single has increased and of the “unascertained” de- 
creased, the married showing 2. 54 per cent, more at the end of the 
decade. This may probably be accounted for by the fact that of 
late years more care has been taken to ascertain definitely the social 
condition of the insane on their admission to the hospitals, making 
it not unlikely that many of the unascertained were single. 


SOCIAL CONDITION. 

PATIENTS UNDER 
CARE. 

PERCENTAGE. 

1881 

1891 

1881 

1891 

Single 

1,240 

2,188 

49.90 

55.26 

Married i 

1 656 

1,146 

26.40 

28.94 

Widowed | 

i 162 

272 

6.52 

6.87 

Unascertained i 

> 426 i 

! 353 1 

17.14 

8.91 


Social Condition per 1,000 of Population. 


Single males 

Single females. . . . 
Married males. . . 
Married females . . 
Widowed males. . 
Widowed females 


3.81 per cent. 
1. 70 per cent. 
3.06 per cent. 
3.83 per cent. 
6.21 per cent. 
6.47 per eent. 




The religious profession of the insane under care during the 
years 1882 and 1891 with the percentages are given below. 

With two exceptions tliere is little to call for comment. The 
total percentage of Protestants has increased in the decade by 
2.11 j>er cent. ; the Roman Catholics decreased, .38 per cent. A 
comparison of the insane of these two denominations in proportion 
to the total population of the colony shows that of Protestants the 
number per 1,000, was 1.92; of Roman Catholics, 1.28; of the 
individual Protestant bodies the Presbyterians, Wesleyans, and 
Lutherans all show an increase, and especially those tabled as 
“ Other Protestant denominations,” whilst the Church of England 
alone shows a decrease. The remaining sects, ex(*epting the un- 
ascertained, call for no comment. 

As stated in connection with the social condition as to mar- 
riage, Ac., the figures for 1891 are probably more correct than 
those at the commencement of the decade, because of greater care 


90 


STATISTICS OF INSANITY IN NEW SOUTH WALES. 


in eliciting facts on the admission of the patients into the hospitals. 
This would apply with equal if not greater force with regard to 
“ religious professions,” as all patients are expected to attend the 
ministrations of the respective chaplains, who are attached to each 
of the hospitals. 


KEITGIOITS I’ROFESSION. 

PATIENTS UNDER 
CARE. 

PERCENTAGE. 

1882 

1891 

1882 

1891 

Protestants ; 

Church of England 

i 1,191 

1,645 

43.41 

41.55 

Presbyterian 

1 143 

248 

5.21 

6.26 

Wesleyan 

70 

126 

2.55 

3.18 

Lutheran 

50 

' 76 

1.82 

1.92 

Other Protestant denominations 

47 

154 

, 1.70 

3.89 

Roman Catholics 

1,045 

: 1,493 

i 38.09 

37.71 

Pagan 

67 

; 81 

: 2.44 

2.04 

Hebrew 

19 

26 

1 .69 

.65 

Mahommedan 

! 5 

’ 6 

! .18 

.15 

Unascertained 

' 106 

: 104 

' 3.86 

2.62 


It remains to indicate briefly the death rate and to compare it 
with that of England, in 1881 in New South Wales the percent- 
age of deaths among the total average number of the insane 
was — males 6.76, females 5.61, a total of 6.32 per cent., reaching at 
the end of the decennial period, males 8.42, females 5.65, a total 
of 7.40 per cent., which latter, with one exception, was the highest 
of the period, and was due probably to the prevalence of epidemic 
influenza either directly or to its complications and sequelae. In 
England the death rate of the insane at the close of the year 1890 
was, males 11.45, females 7.97, a total of 9.57 per cent., or 2.17 
per cent, more than that of New South Wales. As might be ex- 
pected, the rate of mortality among insane persons who suffer from 
a serious malady is much higher than among the sane, and the dif- 
ference between the rate in England and New South Wales is 
largely a matter of climate, insane people being very susceptible 
to the prolonged or intense cold. Besides, lung troubles are much 
more common in the less temperate latitude of England. Nor 
does it necessarily follow that insanity itself accounts for the 
whole of the shortening of life, inasmuch as the circumstances 
which have induced the malady may have also injured the consti- 
tution and curtailed the life of the patient independently of mental 
disease. 


A CASE OF INSANITY CONSECUTIVE TO 
OVAKOSALPINGECTOMY. 


HY DR. E. REGIS, 

Professor of Mental Diseases in the Medical Faculty of Bordeaux. 


Little attention has been given in France up to the present, to 
the surgical treatment of insanity, and I believe that the ablation 
of the ovaries has never been practiced there on insane females 
for a therapeutic end. It is different in other countries, especially 
in the United States, where oophorectomy has attained consider- 
able extension in the asylums. In any case the question of the 
ablation of the ovaries as a curative measure in psychoses has be- 
come to our American confreres a living question and almost an 
irritating question, if we can judge from the perusal of the Janu- 
ary number of the American Journal OF Insanity, which contains 
a series of notes and very suggestive documents on the subject. 
If I am not mistaken, the majority of the alienists of the country 
are inclined to deny any favorable influence on the mental condition 
from the operation, and some of them do not hesitate to consider 
it as an inexcusable, inhuman, and illegal mutilation. This is 
notably the opinion of Dr. Thomas G. Morton, surgeon of the 
Pennsylvania Hospital and president of the Committee on 
Lunacy of the Board of Public Charities of Pennsylvania, 
and also that of Thomas W. Barlow, legal member of the 
Committee. Both of these condemn therapeutic ovariotomy 
in the insane as an illegal and unjustifiable action, that ren- 
ders the operators liable to criminal prosecution when performed 
in cases where it was not required for the purpose of saving life. 
Thus, as the editor of the interesting American Medical Review 
very justly remarks, we have here at once a medical question or 
one of treatment, and a legal one or one of professional deontology. 
I will say nothing of this latter, which evidently will vary accord- 
ing to the country and the environment, and will limit myself to 
saying that in France, where the physicians are before all amen- 
able to their consciences, if an alienist, after having taken the 
best advice by consultation, and obtained the consent of friends. 


■1 


92 


INSANITY FOLLOWING O VAROSALPINGECTOMY. 


having, in short, surrounded himself with all needful guarantees, 
should decide upon any operation M^hatever on one of the patients 
under his care, it is probable that the administrative or judicial 
authorities would protect him, at least from formal abuse. Still 
it is well to remark here that oui* temperament, in spite of legends 
more or less justified, guards us to a certain extent against the 
tendencies to surgery d outrcvice, and that with us the Inspectors 
General have never exercised their authority, as in America, to 
prevent asylum physicians from operative experimentation uj)on 
or mutilation of their patients. 

The important side of the question, and that which is before all 
others, is its medical side, that is to say, the point of knowing 
what will be the effect, in any particular case, of the removal of 
the ovaries and tubes on the mental condition of an insane woman. 
Here, onlj^ the facts can give an answer. But, at the present 
time, these facts are too few and not sufficiently positive to allow 
us to draw any conclusion whatever, and we find ourselves provis- 
ionally in the presence of two absolutely contradictoiy opinions: 
(1) On the one hand, that of Dr. Alice Bennett, in charge of the 
female department of the Norristown Asylum, who has obtained, 
out of six cases of ablation of the annexes by abdominal section, 
three cases of cure, physical and mental ; one case of cure of phys- 
ical trouble with very marked amelioration of the mental condition 
and jirobability of future recovery ; in one case of epilepsy of puer- 
peral origin, the cure of the convulsions without corresponding 
mental improvement; and, finally, one case of death from periton- 
itis six days after the operation ; (2) on the other hand, the opinion 
of Dr. Thomas G. Morton, who holds that oophorectomy is not 
only incapable of any good effects in a pre-existing psychic dis- 
order, but also that it may itself, in predisposed individuals, cause 
neuroses and even insanity. I recall, in this connection, that at 
the session of the Societe Medicale des Hopitaux, Paris, November 
18th, 1892, Professor Debove reported a case of hysteria developed 
in an ovariotomized female, and that in the discussion that followed, 
M. Desnos declared that he had seen two cases of mental derange- 
ment following oophorectomy. It seems, therefore, that the sur- 
gical ablation of the ovaries in the female is a two-edged weapon, 
acting good or ill according to the case, restoring soine to reason 
and causing insanity in others. 

I have never myself performed or witnessed the operation of 


liY DK. E. REGIS. 


93 


ovariotomy for a therapeutic end, either mental or simply surgical, 
in the insane, and consequently am unable to dispute its possible 
results as affecting the progress of mental disease. On the other 
hand, I owe to the kindness of my distinguished confrere and 
friend. Dr. Loumeau, the 0 })portunity of recently observing a very 
interesting case of insanity following the removal of the ovaries 
and tubes. Although the patient in question is still under observ- 
ation and treatment, I can now and for this Congress give a state- 
ment of her case as follows : 

Observation. 

Madam X. . . ., Jewess, aged 39, is a person of average intelli- 
gence, but of strong good-sense ; is well developed physically, and 
has a rather, remote collateral heredity of mental alienation. Her 
father died at 68, from grief caused by the accidental death 
of one of his sons. One of her sisters died of a cancerous 
disease of the uterus at 38. She has herself had no serious diseases 
and presents no signs of alcoholism or syphilis. Married at the 
age of 19, she had first, three miscarriages, and then two children, 
both living and in good health. 

As a result of a former miscarriage, nine years since, she began 
to have trouble with her sexual organs. Here I leave the de- 
scription of the case to Dr. Loumeau, whose words I adopt literally 
in the surgical history of this interesting case : 

“ The patient had suffered since that period from dysmenorrhoea, 
abdominal pains, and multiple peritonitis, and had been treated on 
numerous occasions by cauterization of the os uteri. I saw her 
for the first time in April, 1890. She was then unable to walk or 
even to stand erect. Her abdomen was voluminous, bloated, and 
painful. By vaginal touch there was perceived a warm peri-uterine 
swelling sensitive to pressure. By rectal touch there was found 
a retro-uterine tumor protruding into the rectum, the lumen of 
which it sometimes completely obliterated, painful, pulsatile and 
fluctuating, and causing rectal tenesmus and a flow of glairy 
sanguinolent fluid from the anus. 

“For thirty months there was prescribed absolute dorsal 
decubitus, hot intravagirial injections, vaginal dressings, fre- 
quent baths, repeated vesication of the abdomen, but intra- 
uterine treatment was an impossibility on account of an irre- 
ducible retroflexion. In October, 1892, the abdomen was flat 


94 INSANITY FOLLOWING OYAROSALPINGECTOMY. 

and soft throughout, except above the pubis and in the iliac region 
where there persisted a painful swelling. The patient intelligent, 
trustful, and docile anticipated with pleasure the operation pro- 
posed to her as a chance of recovery. 

“ Operation. — Laparotomy, performed October 20, 1892, with 
the aid of MM. Monod, surgeon of the Hospital, and Duclos, 
externe. Prior catheterization of the bladder with withdrawal of 
thirty grams of limpid urine. Median incision of the abdominal 
wall of four lingers in length ; peritoneal adhesions uniting the 
abdominal wall to the uterus and forming a thick tissue form- 
ation that had to be dissected and removed in order to reach the 
anterior base of the uterus and the annexes. Total ablation of the 
ovaries and tubes, anterior hysteropexia by Leopolds’ method. 

Walls sutured and dressed. Catheterization with a glass tube, i 

after closure of the wound, produced only a few drops of blood j 

which led to the suspicion of a wound of the bladder that had | 

passed unperceived during the operation. Immediate re-opening 
of the abdomen. I found that a large flap had been taken from 
the bladder, corresponding to the free portion of the reservoir. 

There remained only the portion adherent to the uterus and 
and the vagina, and it was impossible to make a suflicient cavity 
by suturing the parts remaining. I sewed the peritoneum above , 
to that which remained of the bladder, in such a way as to form 
a pouch closed on all sides in which I marsupialized the vesical 
stump, to the abdominal wall. Then I inserted the Perier-Guyon 
tubes as after a classic hypogastric section. Total duration of the 
operation, one and a half hours; chloroform used, one hundred 
grams. 

“ Examination of the Removed Organs . — Tubes and ovaries in- | 

creased in size, congested, but showing no cyst, abscess, or blood i 

extravasations. On section the ovaries showed a series of little a 

whitish points that had the appearance of tubercles. The histo- f 

logical examination, entrusted to the professor of pathological I 

anatomy of the faculty, has not yet been made. ? 

Results . — Very simple. The temperature never exceeded 37.5 f 

(C). All the sutures were removed November 3d, also the hypo- | 

gastric tubes, and I inserted a fixed Malicot sound into the bladder ‘ 

through the urethra. The cicatrization was complete above the 
pubis, by December 15th. Micturition took place normally by 
the urethra, but not more frequently than before the operation, 


1 


r.Y DK. E. REGIS. 


95 


according to the statement of the patient, since for a long time, 
she added; she was obliged to be constantly urinating, and could 
get away only a few drops each time, a fact to which she had not 
previously called my attention. This pre-operatory frequency of 
micturition is readily explained by the diminutions of the capacity 
of the bladder due to the adhesions which had fastened the organ 
to the abdominal wall and the anterior face of the uterus. 

“The menses never reappeared after the operation, and the 
uterus retained its normal position insured by the hysteropexia. 
Sexual desire lost, absolute frigidity. Abdomen lax and soft. 
The patient could walk without feeling the least fatigue. At 
present. May 27, 1893, micturition occurs on an average about 
once every three hours, the bladder can tolerate about 360 grains 
of liquid, which seems extraordinary considering the small amount 
of material that served for the repair of the visical reservoir.” 

Such in a surgical point of view, is the history of M. Loumeau’s 
case, which he proposes to make the subject of a special paper 
in which full details will be reported, on account of its numerous 
points of interest. We will now turn to its mental aspects. 

On the 28th of October, 1892, eight days after the operation, 
Madam X. . . ., who had not seemed in any way abnormal so far, 
was taken rather suddenly with mental disturbances that first 
appeared in the resemblance of a toxic delirium characterized by 
hallucinations of a terrifying nature. She saw Beharzin in his 
bed, she saw death heads, and spectres, and believed that various 
persons, notably the physicians who had attended her, were hidden 
behind the curtains or in the chimney. After some days these 
symptoms disappeared, but the mental disorder in changing be- 
came more serious and the patient progressively passed into a 
sort of mental confusion and intellectual and physical torpor 
with melancholic delusions and hallucinations. She imagined that 
she had evil ideas, that she thought and said evil things, without 
desire or power to do otherwise. If she thought of any one, or 
any one spoke before her of any acquaintance or friend, or if she 
simply perceived any one, eveji for the first time, immediately 
some malevolent suggestion in regard to them would arise in her 
mind. Even if any one addressed her or even spoke in her hear- 
ing some words pronounced became fixed in her mind and gave 
rise against her will to an automatic current of reflexions of the same 
nature. This distresses her to the utmost, the more since she pro- 


90 INSANITY FOLLO W IN(i O VAROSALPlN(4ECTOMY. 

tests tliat she has always been an honoralile woman, incapable of 
the least evil speaking or action. Under the influence of her 
mortification at being tiie plaything of reprehensible ideas against 
which she strives vainly, she has ceased all work, lost her appetite 
and sleep, and almost desires death; in short she has fallen into a 
state of true melancholia, but always j)reserving, neveitheless, a 
certain degree of consciousness of herself and lucidity. Occasion- 
aWj she is excited and restless, falls into fits of abusive anger and 
strikes her children and abuses herself, beating her head and cry- 
ing out: “What is that you say?” “What are jmu thinking 
of?” “ It is shocking.” Again she stays for hours inert and pas- 
sive, on her chair, as if absorbed in thought. This mental con- 
dition is gradually becoming wmrse, and the first time 1 saw the 
patient, March 14, 1893, I found her distracted, semi-stupid, 
hardly replying to any one, acting as if she were a stranger to 
those about her, and solely occupied in her own thoughts. Exam- 
ining her closely I found that she did not really utter the com- 
promising words as she believed she did, but that she formed them 
internally in a purely mental language. There was in her case 
the first degree of those psycho-motor verbal hallucinations so well 
described by M. Seglas in a recent series of papers. When, in 
fact, the idea of any of these malevolent or insulting suggestions 
occurs, with which she reproaches herself, the stimulation of the 
cortical centre for speech that accompanies it is such that 
the suggestion tends to reproduc.e itself in articulate form, that is to 
say in a moral hallucination ; but the articulation here does not 
pass the first stage, namely, its purely internal formulation, while 
in many cases it goes, as we are aware, as far as to the external 
but silent productions of the movements of speech, and occasion- 
ally even as far as to their audible utterance (verbal impulsions). 
The patient has at the same time some psycho-sensorial auditoiy 
hallucinations. She hears whispers, coming either from the floor 
above or from outside, but these confused and not readily appre- 
ciable voices are very far from having with her the same import- 
ance as the internal voices, the psycho-motor hallucinations. 
These really represent the predominant element of her insanity, 
the object of her constant thoughts, and these keep her in a per- 
manent state of melancholy, destruction and fear. At certain 
times she goes, as we have seen, so far as to beat her head to pre- 
vent the evil thought, and she has arrested her breathing by 


BY DR. E. REGIS. 


97 


puffing out her abdomen and closing her lips in the effort to choke 
off this internal mental echo that is so painful to her. She is made 
to eat with difficulty, and struggles against going to meals; she 
is constipated and sleepless. 

It was* in this state that I found Madam X If her mental 

disorder was of some interest by itself, this was greatly increased 
by the fact of its special origin. While recognizing the large 
part played by heredity as a predisposing cause, it is evident that 
what was really the immediate cause of the disorder was the sur- 
gical operation by complex action of the physico-moral traumatism, 
the anaesthetic agent, and principally perhaps through the biolo- 
gical modifications brought about in the organism by the suppres- 
sion of such important organs as the ovaries, such as those we 
know take place after ablation of the thyroid. Therefore it 
occurred to M. Loumeau and myself, that, as there were no con- 
tra-indications, it might be advantageous to try in this patient 
the effect of subcutaneous injections of ovarian extract, as a num- 
ber of times the injection of thyroid extract had been employed 
with success in myxoedema, either spontaneous or operative. 
In order to avail ourselves of this mode of treatment, with all de- 
sirable guarantees, we called in the kind assistance of Dr. Ferre, 
professor of experimental medicine of the medical faculty, who 
took on himself the preparation of the ovarian liquid with the car- 
bonic pressure filter of Arsonval, and of practicing the injections 
under the most strict antiseptic conditions. 

The injections, commenced April 5th, have been continued daily, 
and we may say without interruption up to the present, given in 
the dorsal region in doses varying between and 2^ cubic centime- 
tres of a 10 percent, solution; they have never been followed by 
painful symptoms or any injurious local or general reaction. I offer 
here, almost in his own words, the detailed notes that my excel- 
lent friend Professor Ferre has communicated to me as he made 
them from day to day : 

“April 5, 1893, injection in the intra scapular region of ^ c. c. 
of ovarian extract from a sow, 10 per cent, strength, prepared accord- 
ing to the directions of Brown-Sequard and Arsonval, filtered under 
a carbonic acid pressure of 56 atmospheres. 

April 6 : Injection of f c. c. April 7 : Injection of 1 c. c., no 

accident, fever, cephalalgia, or pain in the ovarian region. April 
8 : Injection of 1 c. c. The patient begins to show interest 

Q 


98 


INSAJ^ITY FOLLOWING OVAROSALPINGECTOMY. 


in her affairs. Less rudeness and fits of anger, melancholia de- 
creased. She occupies herself with her children. The obsession 
ideas unchanged. April 9: No injection. April 10: 1 c. c. 

The patient occupies herself more. The obsessions seem a little 
less intense, she corrects them herself. April 11 and 12, 1 c. c. 
Madam X. . . . , who is a piano teacher, has begun heiTessons again 
and they seem to interest her. While she still has them, she is 
not SO much absorbed in her delusive conceptions ; still has fits of 
anger. She proposed to her daughter to give her a piano lesson, 
a thing she had not done for a long time. She goes to the table 
willingly and takes part in conversation there, and gives sensible 
directions in her housekeeping. The delusions are persistent. 
April 13, 14, i 5, 1 c. c. Condition unchanged. April 16 and 
17: No injection. April 18: Injection of 1 c. c. The improve- 

ment is maintained in spite of the omission of the injections for 
the two preceding days. 

April 19 and 20, to May 3. Injection of 1 c. c. of liquid each 
day. The physical health, the mood, and the general disposition 
continued to be modified for the better. 

May 3. Patient has been more excited. Was given an in- 
jection of 1-j c. c. May 4, 5 and 6, 2 c. c., excitement diminished. 

May 7 to 18. The injections are pushed to 2 c. c. The im- 
provement persists and increases in all respects, except as regards 
the psycho-motor hallucinations, which seem only slightly reduced 
in intensity. An attack of excitement was even produced on the 
18th, and the injections were therefore reduced to 1 c. c. on the 
20th. May 21 and 22. No injection. 

May 23. Injection of 1-J- c. c. Since the 20th the patient has 
not appeared so well, seems more disturbed. 

May 24. Injection of 1^ c. c. more calm. May 25, 26, and 27. 
Injection 1^ c. c. of liquid. Improvement continues and increases. 

Ml resume^ under the influence of the treatment, the daily ex- 
citement of the patient has to a large extent, been relieved. She 
has taken up her professional occupations with pleasure, she attends 
to her household affairs, is interested in her family, her strength 
seems to have increased ; only her delusions and hallucinations, 
though diminished in intensity and frequency, are still very 
marked.” 

My personal observation of the evolution of the mental condition 
of Madam X .... , whom I have regularly watched during the whole 


BY DR. E. REGIS. 


99 


duration of the treatment agree with those of Professor Ferre. It 
is certain that a very notable amelioration has been produced, and 
that this improvement involves all the nervous and organic 
functions, and, likewise, extends to the intellectual and affective 
faculties which were before, so to speak, annihilated; they act at 
present in a correct, regular and normal fashion. The obsessions 
and the hallucinations themselves are less absorbing and have a less 
systematized character, as the patient shows by saying ‘ ‘ that she is 
more right, ” and ‘ ‘ that she is able now to think of other things. Her 
husband and her maid also find her much improved.” Before, they 
say, there was no living with her, she was so insupportable. She 
raced from one room to another crying out ‘ ‘ Mon Dieu, Mon Dieu,” 
she had fits of passion, beat the children and made scenes in the 
street. Now she is quiet, eats well, occupies herself in her lessons 
without being distracted, manifests affection for her family, in 
short, is much more peaceable and reasonable, and had two excel- 
lent days (Tuesday and Wednesday) during the past week. 
Nevertheless, she is always much troubled with suggestions of 
€vil thoughts and, not knowing whence they come, she lays them 
to her maid and the neighbors whom she abuses occasionally in a 
rather coarse way. This is the dark spot in the case, since the 
persistence to such an extent of these morbid symptoms does not 
permit us to affirm, notwithstanding the great improvement in all 
other respects, the possibility of complete recovery. The patient 
will be watched, however, till the outcome of the disorder is defin- 
itely established. 

Summing up ; whatever may be the final issue of the present 
state of affairs, the case offers none the less, in a mental point of 
view, numerous peculiarities worthy of attention, the chief of 
which are : 

(1) The outbreak of insanity in a predisposed individual as a 
result of the surgical ablation of the ovaries and tubes. 

(2) The nature of the treatment employed, and which consisted 
almost exclusively of the daily injection of ovarian extract, in the 
d.ose of i to 2-|- cubic centigrams of a 10 per cent, solution, and 
which, while absolutely harmless in spite of its duration, has caused 
such relatively favorable results, both physical and mental. 


CARE OF THE INSANE IN FINLAND. 


BY EMIL HOUGBERG, M. D., 

First Assistant Physician, Lappvik Asylum for the Insane, Helsingfors, Finland. 


The history of the work in behalf of the insane in Finland is 
but a brief one. In 1687 seven places, to which number subse- 
quently eighteen more were added, Avere established at the hospi- 
tal in Kronoby in the Wasa Government District, a hospital 
originally intended exclusively for lepers. In 1771 the hospital in 
Sjahlo, likewise established exclusively for lepers and built in 
1619 during the reign of the Swedish King Gustavus (II) Adol- 
phus, was transformed into an asylum for the insane and supplied 
with forty places. In these old asylums the patients were sub- 
jected to a very poor treatment indeed. They were, in fact, sent 
there only as a means of preventing the danger and mischief con- 
nected with their being at large. By degrees, however, the more 
modern, humane and less constrained methods of treatment of the 
insane, as introduced by the never-to-be-forgotten Pinel, found 
their way from the nurseries of culture to distant Finland. 

The 1st of July, 1841, the inauguration day of the Lappvik 
Lunatic Asylum near Helsingfors, may well be considered as the 
turning point in the history of the care of the insane in Finland. 
Albeit the construction of this asylum does not, of course, in 
every way meet the requirements of modern treatment and care, it 
was a vast improvement on the old system. As originally built it 
contained ninety places. In 1877, however, it was enlarged and 
will now accommodate one hundred and twenty patients. Here 
medical students of the Helsingfors University are given the op- 
portunity of studying the various mental diseases and their 
treatment. 

Shortly after the opening of Lappvik asylum the one at Kronoby 
was closed and its patients transferred to Lappvik. At about the 
same time four places for lunatics were established in connection 
with the public Government hospitals in each of the county towns, 
and here the lunatics from the adjacent districts were to receive 


BY EMIL HOUGBERG, M. D. 


101 


temporary treatment and care, to be, as soon as possible, trans- 
ferred to Lappvik. For many years Lappvik and the Sjahlo 
asylums were the only hospitals of the kind in Finland, and to 
Sjahlo chronic sufferers only were admitted. In consequence of 
the yearly increase in the number of lunatics and the unsatisfac- 
tory results of their treatment outside the asylum, a committee 
was appointed by the Government on December 20th, 1859, with 
instructions to work out a plan for the reorganization of the 
Oommitment, Detention, Care and Treatment of the Insane. 

The report and the propositions of the committee did not meet 
with the approval of the Government, chiefly on account of the 
heavy expenditure involved. On the other hand, the proposi- 
tions of another subsequent committee, appointed by the Govern- 
ment on the 13th of May, 1873, were carried out. 

The main points of these propositions were : 

First. In each of the county towns receiving-asylums, each 
provided with twenty places, were to be established for the pur- 
pose of receiving lunatics of the adjoining districts, suffering 
from acute mental disease. 

Second. Two combined treatment or so-called central asylums 
to be established in suitable localities near the county towns, 
Kuopio and Tammerfors. These asylums each to be supplied 
with places for 100 patients suffering from acute mental disease 
and 300 to 400 suffering from chronic mental disease. 

Third. The Lappvik asylum to be maintained as a “ mixed ” 
one, and Sjahlo as an asylum for chronic lunatics and epileptics. 

In consequence of these propositions of the committee being 
approved by the Government, the decree of the 7th February, 
1840, re the commitment, detention, and care of the insane became 
obsolete and had to be revised. Accordingly a committee was 
appointed for this purpose on the 15th June, 1881; and on the 
28th May, 1889, the new decree was issued. 

In 1881-82 the receiving asylums at Abo, Wasa, Uleaborg, 
Wiborg and St. Michel were opened, each supplied with twenty 
places, excepting the one at St. Michel where the number of 
places was twelve only. 

The next largest asylum in Finland, the one at Fagernas near 
Kuopio, was opened in 1884, and supplied with one hundred and 
twenty places. It has since been considerably enlarged and will 
now accommodate about 350 patients. 


102 


CARE OF THE INSANE IN FINLAND 



Besides* the Sjahlo asylum, where at present chiefly female 
chronic lunatics are treated (there are now flfty-three places), we 
have in Finland another asylum, the one at Kexholm, where lunatic 
criminals and male lunatics suffering from chronic mental disease 
are taken care of. This asylum was established in 1889 with 132: 
places. 

The third large asylum, which, in accordance with the propo- 
sition of the committee, was to be established near Tammerfors, is 
in progress in so far that its site has been decided upon. It will 
be built in a very suitable place with fine scenery and within 
about seven kilometres of Tammerfors. This asylum will accom- 
modate about 350 patients (220 acute and 130 chronic lunatics) 
to start with, but is intended for in all about 800 patients (220» 
acute and 580 suffering from chronic mental disease). 

As will be seen from this, we may hope shortly to be able to- 
care properly for about 1,100 lunatics in the public governmental 
asylums. Agreeably to the latest decree relating to the relief of 
the poor, every parish is bound to maintain a poor-house, and in 
each of these shall be a few places for lunatics suffering from 
chronic mental disease. Unfortunately, by far the greatest num- 
ber of lunatics in Finland are still treated at their homes. 

According to the census of 1880, there were in Finland at that 
time 4,380 lunatics, equal to one lunatic to every 470 persons. 
At the close of the year 1891, the population of Finland amounted 
to 2,412,135, and the number of lunatics to 6,430, equal to one 
lunatic in 375 persons. Of these 6,430 lunatics (3,488 males and 
2,942 females) at the close of 1891, only 500 (7.7 per cent.) were 
treated in the public asylums, 525 (8 per cent.) in the poor-houses; 
and 5,405 (83.7 per cent.) privately. These figures clearly point 
out the necessity of a greater number of lunatic asylums in Finland. 

The total expenditure in behalf of the lunatic asylums in Finland 
in 1891 amounted to: 

For Receiving- Asylums *Fiun. Marks 58,134 18 

“ Lappvik “ “ “ 109,685 55 

“ Fagernas “ “ “ 93,990 81 


Sjahlo 

Kexholm 


31,727 20 
58,619 46 


Total F. mks 


352,157 20 


* 1 mark=25 cents. 


BY EMIL HOUGBERG, M. D. 


103 


The total expenses per diem and patient amounted to : 


For the Receiving-Asylums 2 mk. 49.6 pfn. 

“ “Lappvik “ 2 “ 36.2 “ 

“ “ Fagernas “ 2 “ 15.8 “ 

“ “Sjahlo “ 1 “ 42.0 “ 

“ “ Kexholm “ 1 “ 82.2 “ 


During the year 1891 the total number of lunatics treated in 
public asylums amounted to 891. Of these 453 had been carried 
over from 1890, the number of fresh entries during 1891^being 
438; 412 were discharged in 1891 and 479 carried over in 1892. 

Since the abolishment of the Board for the Care of the Insane, 
by decree of the 29th of January, 1878, the entire superintend- 
ence has been placed in the hands of the Medical^Department of 
Finland. 


PROPOSED CHANGE OF THE LEGAL STATUS OF TPIE 
INSANE, IN ACCORDANCE WITH OUR PRESENT 
KNOWLEDGE OF THE NATURE OF INSANITY, 
FOR THE PURPOSE OF SECURING FOR 
THEM MORE RATIONAL AND EFFI- 
CIENT TREATMENT. 


BY STEPHEN SMITH, M. D., OF NEW YORK, 

Member of the State Board of Charities; Formerly State Commissioner in Limacy. 


The lunacy laws of the States of the United States are, for the 
most part, an incongruous mass of legal verbiage, incapable of 
explanation or judicial construction. They are in the main an 
elaboration of the laws of a century ago with scarcely a recogni- 
tion of the great advances which have been made in our knowl- 
edge of insanity. Notwithstanding the many improvements which 
have been made in providing for the physical comfort of the insane, 
there is apparent running through our lunacy laws the dominant 
idea of the criminality of insanity. Commitment and detention, 
and even care and treatment are still subordinated to this ancient 
prejudice of our legislators. We are still governed by the common 
law of England which declares that “ it is only a person of unsound 
mind and dangerous to himself and others that may be restrained 
of his liberty by another.” States are making better and better 
provision for the security and well-being of the insane while in 
custody, but they are doing absolutely nothing directly to restore 
the insane to health. Every improvement in asylum care is chiefly 
made for the purpose of safe detention and not for cure. As a 
result the insane in custody are constantly increasing, while the 
number of cures among them is at its minimum. 

The whole drift of discussion in regard to the insane is in the 
direction of larger and better accommodations for the chronic 
insane. We scarcely ever hear of new methods of curing them 
or great success in treatment. As a consequence the States are 


BY STEPHEN SMITH, M. D. 


105 


burdened with taxation to provide for the accumulating masses of 
insane. Millions of dollars are annually expended to provide 
additional accommodations for the rapidly increasing chronic 
insane, and scarcely a farthing for the express purpose of effect- 
ing a speedy cure of the acute insane by remedial measures. 

It is surprising how completely the one idea of the construction 
of asylums and the methods of managing the details of their 
affairs absorb even the best medical officers and how little thought 
is given to the critical study of individual patients with a view to 
their^l’prompt treatment and recovery. The reports of superin- 
tendents, of boards of trustees and lunacy commissioners, abound 
with the details of new constructions, the results of good farming 
and gardening, the economies, the receipts and expenditures, but 
scarcely a word is said of improved methods of treatment and 
the remarkable number of recoveries by new processes of treat- 
ment. A writer in a journal devoted to mental science has said 
while commenting on the Reports of the English Lunacy Com- 
mission, “These reports (blue books) show that, on the whole, 
there is an immense amount of thought, and care, and effort on 
the treatment of the insane by all who have to do with them. 
Year by year the efforts towards a more perfect system of 
treating and managing them moves steadily in all but one 
direction. That spasmodic and individual efforts are made in 
this direction is true, but on the whole the medical treatment of 
the diseases which are comprised under the term insanity stands 
still as compared with the asylum buildings, general managing, 
&c., * **. Three books about a disease with nothing medical in 
them. Everything that concerns the treatment of those laboring 
under this disease professedly gone into, not a word about medi- 
cines! Talk of modern skepticism — ^the reports of the commis- 
sioners and the reports in lunacy are the finest examples of medical 
skepticism extant; for they don’t 'deny, deride or damn with faint 
praise, — they simply ignore the whole science and its professors. 
It may be that this will be better in the long run for the medical 
treatment of insanity, but it is hard to see it if its practical effect 
is to encourage asylum doctors to ignore the medical aspects 
of patients and sink into a state of lethargic indifference to the 
unsolved problems in brain pathology, diagnosis and therapeutics 
that daily come before them.” 


106 


MOEE EATIONAL TEEATMENT FOE THE INSANE. 


Severe as this criticism of English lunacy administration is, 
it applies with full force to our own methods. We have built 
upon the same faulty foundations and have reared the same anom- 
alous superstructure. Our popular conceptions of insanity being 
false, the entire system of treating the insane is defective and 
unworthy of civilization. We will first notice the predominant 
ideas which govern the present treatment of the insane in the 
United States preliminary to a discussion of the reforms which 
this paper is designed to advocate. 

1. When a person is alleged to be insane our laws place him 
in the category of persons who have been accused of a civil offense. 
In many of the States the term “The accused” is employed in the 
statutes when such persons are referred to. This feature of our 
laws is a relic of the old method of arresting the violent and distur- 
bed insane under the common law of England. This conception of 
the nature of insanity has been and still is productive of infinite 
injury to the insane. The legitimate influence of such ideas up- 
on officials who have the first contact with the insane is to render 
them harsh and even cruel. In many States the insane must ap- 
pear in court like common criminals, and be subjected to cruelties 
and abuses which greatly aggravate their diseases.* 

2. The same idea predominates in the determination of the 
question of the existence of insanity. In most of the States medi- 
cal men perform but a minor part even in the examination of the 
alleged insane person, and in some States they are not even present 
except by accident. The motive for the enactment of such laws 
is to conform to the old principle that an accused person must be 
tried by his peers. Even in those States which require the exam- 


*The highest court of Pennsylvania held that, “No man can be deprived 
of his liberty without the judgment of his peers and it matters not to the 
law whether the alleged cause of detention is insanity or crime. Unless 
there is danger to the public, or to the patient or to his estate, he should not 
be in duress pending the investigation, nor indeed alter its conclusion, 
though adverse to him.” Commonwealth vs. Kirkbride, 2 Brewst., (Pa.) 

The following opinion was given by a Massachusetts Court : ‘ ‘ The mere 

fact that a man is insane does not autliorize his arrest and confinement with- 
out a warrant, if he is not dangerous to himself and others.” Look vs. Dean, 
108 Mass., 116. 

Judge Cooley, of Michigan, holds that, “The law of no free country can 
tolerate a condition of things under which a person innocent of crime and 


BY STEPHEN SMITH, M. D. 


107 


ination to be made by physicians, the ultimate decision of the 
question of the existence of insanity falls upon the justice within 
whose jurisdiction “the accused” resides. 

3. Again we have the same idea asserting itself when insanity 
is found to exist. The physicians have no other voice in deciding 
as to the destination of the patient than that of recommending, 
and in many States even that function falls entirely upon the jus- 
tice before whom the case is brought. 

4. There is also prevalent in every community an idea that 
the insane have certain personal rights which are liable to be taken 
from them in the act of commitment and during custody. It is 
suspected that they may not be insane and are spirited away to an 
asylum for some sinister purpose, such as to obtain property, 
to prevent the revelation of the crimes of others of which they alone 
are cognizant, &c. This idea has its origin in the imagination of 
insane persons who have been confined in asylums. The examin- 
ation during six years of the ten to fifteen thousand insane in cus- 
tody in the State of 'New York. did not discover a single case of 
commitment or detention for the purpose of defrauding the insane, 
or of depriving them of rights to their harm, and in the interests 
simply of other parties. And yet during that period I investi- 
gated hundreds of cases of alleged conspiracy against the inmates 
of asylums. 

5. The belief that the insane are cruelly treated in as}dums is 
universal. This opinion is based on the occasional instances of the 
improper treatment of the inmates of asylums made public, and 
on the statements of the insane who have been in custody. The 

threatening no injury to himself or to others, can be restrained of his liberty 
and no person be responsible for the injury he sutlers. To admit the pos- 
sibility would be to concede that arbitrary imprisonment under some cir- 
cumstances is lawful; and that would be to concede that regulated and 
practical freedom does not exist!” Van Deusen vs. Newcomer, 40 Mich., 90. 

These decisions of the higher courts of the States can be greatly multiplied, 
and with rare exceptions they recognize only the dangerous character of the 
insane as sanctioning the right of confinement or restraint. In this regard 
our courts are simply following the common law of England and the pre- 
cedents of the English courts. It is stated that “By the common law of 
England it is only a person of unsound mind and dangerous to himself or 
others that may be restrained of his liberty by another.” 

“ Such is taken to be the law from the case in Br. Abr. down to the last 
case on the subject.” Lord Campbell. 


108 


MORE RATIONAL TREATMENT FOR THE INSANE. 


latter source of information is very unreliable for the insane usu- 
ally regard every effort to maintain order and discipline in an 
institution of which they are residents as an abuse of their rights 
and privileges. Every rule or regulation which in any manner 
applies to them is taken as an abuse and every personal effort to 
induce them to bathe, to exercise, to eat, to retire to bed or to 
rise at a given hour, is reported as an assault. While it cannot 
be denied that attendants often use more force than is absolutely 
necessary to effect their purpose, it is, nevertheless, true, that 
wanton cruelty to the insane in asylums rarely if ever occurs in 
this country. On the contrary, I have far more often been sur- 
prised at the patience of attendants under the most aggravating 
circumstances, than at the evidences of a disposition to resent the 
acts of the insane. 

6. The belief in the incurability of insanity affects the public 
and the medical profession alike. The efforts of recent writers to 
discredit the statistics of recovery made by asylum superintend- 
ents has influenced unfavorably the application of remedial 
measures. There is not indeed in the United States an institution 
for the insane which has been thoroughly equipped with a view 
to the absolute cure of all who might be admitted to its wards. 
All of these establishments are constructed, organized, and man- 
aged as asylums, not as hospitals, as custodial and not as curative 
institutions. The physician visits the “ halls” not “ wards,” in 
the most apathetic and perfunctory manner. The most recent 
case attracts little more attention than the old, and in none does 
he anticipate any immediate change. Time and surroundings are 
the elements on which he most implicitly relies. How different is 
the conduct of the physician and assistants who visit the wards of 
a general hospital ! Every new patient is an inspiration which the 
entire medical staff feels and searching examination is at once 
made, the precise nature of the disease determined and the exact 
condition of the diseased organ discovered and recorded. On the 
basis thus established the treatment is vigorously carried on to the 
termination of the case. Every day the examination is repeated 
to learn precisely what progress the disease has made and Avhat 
change, if any, should be directed in the treatment. In the one 
case the medical officer is not aiming to cure his patient, but is 
anticipating a possible recovery if time and circumstances are 
favorable ; in the other the physician, confident of the cure of his 


BY STEPHEN SMITH, M. D. 


109 


patient in the shortest possible time, is aggressive and attentive to 
every condition likely to aid him in his heroic struggle. 

From the preceding review it is apparent that the insane occupy 
a false position in our civil administration and thereby do not 
receive that care and treatment which promotes their highest 
interest. Though sick people, requiring prompt and skilful treat- 
ment, they are treated as offenders against the law, and condemned 
to a course of custodial care which ministers to their physical 
comfort but does little directly to restore -them to health. 

The reform which will place the insane on a proper basis must 
be radical. The status of the insane must be entirely changed. 
Every vestige of ancient prejudice and superstition in regard to 
them must be effaced and a new era begin in the history of lunacy 
legislation. Even the old and offensive terms “insane” and 
“lunatics,” “insanity ” and “lunacy ” should be as obsolete in use 
as they are in meaning.* The new era must be ushered in with 

*The following extracts show the various definitions of the term “ insane 
and “lunatic” in different States: 

‘ ‘ The words ‘ insane person ’ shall he construed to include every idiot, 
non-compos and lunatic person.” Laws of Delaware. 

“The term ‘insane’ as used in this act includes any species of insanity 
or mental derangement. ” Laws of Dakota. 

“The words ‘insane person’ and ‘lunatic’ shall include every idiot, non- 
compos, lunatic, and insane person.” District Columbia definitions, U. S. 
Revised Statutes. 

“The words ‘insane person ’ include idiots, lunatics, distracted persons 
and persons of unsound mind. ” Laws Iowa. 

“The words ‘insane person’ may include an idiotic, non-compos, lunatic 
or distracted person. ” Laws Maine, Rhode Island. 

“ The words ‘ insane person ’ and ‘ lunatic ’ shall include every idiot, non- 
compos, lunatic, insane and distracted person.” Laws Massachusetts. 

“ The terms ‘ insane or insane persons’ * * include every species of insan- 
ity, and extend to every deranged person, and to all of unsound mind, other 
than idiots.” Laws Michigan, New Jersey, New York. 

‘ ‘ The term ‘ insane ’ * * includes every species of insanity, but does not 
include idiocy or imbecility.” Laws Minnesota. 

“The terms ‘insane’ and ‘lunatic’ * * include every species of insanity 
or mental derangement. ” Laws Missouri, Nebraska, Ohio. 

“The terms ‘lunatic,’ ‘insane,’ non-compos mentis, include all persons of 
unsound mind.” Laws Tennessee. 

“The word ‘lunatic’ * * shall be construed to include every insane 
person who is not an idiot. The words ‘insane person’ include every one 
who is an idiot, lunatic, non-compos, or deranged.” West Virginia. 

The law of Wyoming is quite unique as it defines a person of “sound 
mind” and not an “insane person,” as follows: — “A person shall be con- 
sidered of sound mind who is neither an idiot nor lunatic, nor affected with 
insanity, and who hath arrived at the age of fourteen years, or before that 
age, if such person know the distinction between good and evil.” 


110 


MOKE RATIONAL TREATMENT FOR THE INSANE. 


the universal recognition of the now demonstrated fact that the 
class of persons hitherto known as “insane,” are simply and only 
sick people; that the alleged rights of the “ insane ” are the same 
as the rights of other sick persons, viz., the right to be restored 
to health, and that to accomplish this one supreme object every 
other consideration must be subordinated.* * 

The object of this paper is to advocate and outline a system of 
State lunacy laws which shall have as its fundamental idea that the 
insane are persons suffering from cerebral disease, and demand that 
care and treatment which will most certainly and effectually restore 
the curable to health and will best promote the well-being and use- 
fulness of the incurable. As a logical necessity it follows that if 
the insane are simply sick people they should come completely 
under the jurisdiction and management of the medical profession. 
From the incipiency of the disease to its termination, the insane 
person is a patient and in his treatment should be entirely amenable 
to the restrictions and conditions which the physician may impose 
as a part of his treatment. 


* The following opinions of authorities in different countries are but a 
few of the many which could be quoted to this effect : 

“ Insanity, mental alienation, is a cerebral affection, ordinarily chronic, 
without fever, characterized by disorders of perception, intelligence and the 
will.” Esquirol (French). 

“ A cerebral affection, idiopathic or sympathetic, destroying the individual’s 
moral liberty, and constituting a derangement of his acts, tendencies and 
sentiments as well as a general or partial disorder in his ideas.” Morel 
(French). 

“Insanity being a disease, and that disease being an affection of the brain, 
it can therefore only be studied in a proper manner from the medical point 
of view. The anatomy, physiology, and pathology of the nervous system and 
the whole range of special pathology and therapeutics, constitutes preliminary 
knowledge most essential to the medical physiologist. All non-medical 

* * conceptions of insanity are, as regards its study, of the smallest value. ” 
Griesinger (German). 

“A chronic disease, free from fever, in which the ideas and the acts are 
under the control of an irresistible power, a change taking place in the man- 
ner of feeling, conceiving, thinking and acting peculiar to the individual, in 
his character and in his habits. ” Guislain (Belgian). 

‘ ‘ Insanity is a condition in which the intellectual faculties, or the moral 
sentiments, or the criminal propensities — any one or all of them — have their 
free action destroyed by disease, whether congenital or acquired. He will 
not go far wrong if he regard insanity, as a disease of the brain {idiopathic or 
sympathetic) affecting the integrity of the mind * * .” Bucknill and Tuke 
(English). 

“ A manifestation of disease of the brain characterized by a general or 
partial derangement of one or more faculties of the mind and in which, while 
consciousness is not abolished, mental freedom is weakened, perverted or 
destroyed.” Hammond (American). 


BY STEPHEN SMITH, M. D. 


Ill 


The only question which can arise as to the proj)riety of a complete 
surrender of the insane to the management of medical men is as to 
the right of depriving them of their personal liberty without due 
process of law, or, in other words, without some form of judicial 
inquiry and sanction. As we have already shown, this relic of an- 
cient jurisprudence has been and still is seriously obstructive of all 
efforts to elevate the care of the insane and place it on the same 
basis as that so judiciously and advantageously applied to personal 
suffering from other diseases. But in an enlightened period and in 
this republic, so little governed by precedents and by obligations 
to the civil jurisprudence of the past, we ought to recast our laws 
in the light of modern ideas, the deductions of scientific inquiry, 
and the demands of a more enlightened philanthropy. Influenced 
by these considerations the insane should be placed on the same 
footing before the law as are persons suffering from other diseases 
requiring isolation in the interests of both the public and the pa- 
tients themselves. They should be committed, as is the latter class, 

entirely to the care and treatment of medical men. From the laws 
relating to persons suffering from contagious diseases, therefore, we 
ma}’’ gather useful hints in modifying our laws relating to the insane. 
The right of the State to authorize and compel the removal of 
persons suffering from certain forms of disease to places pro- 
vided for their care and treatment, and there to detain them 
for such length of time as is necessary for their recovery, is recog- 
nized and more or less stringently enforced in all of the States.* 
All health authorities are thus empowered to remove and restrain 
persons suffering from contagious diseases unless they can be so 
secluded at home that the public welfare is not imperilled. This 
management of persons having contagious diseases is committed 
entirely to the discretion of medical men. No trial by jury, nor 
appearance in court, nor order of a judge, nor even the sworn cer- 
tificate of a physician, is for obvious reasons, required for their com- 
mitment to custody, and yet the same necessity exists, so far as 

* An early practice, sanctioned by law, in the case of lepers in England, 
“directs that such diseased, should be ‘seen and diligently examined by 
certain discreet and lawful men who have the best knowledge of such 
disease, ’ and if he be found to be a leper ‘ then without delay ’ he is to be 
carried away, and removed from the communication of his neighbors to a 
solitary place to dwell there, as the custom is, lest by his common con- 
versation damage or peril should happen to the said men. ” — Weightman, Med. 
Practitioner's Legal Guide. 


112 


MORE RATIONAL TREATMENT FOE THE INSANE. 


there is danger that without judicial sanction a person innocent 
of a contagious disease might be dragged from his home and in- 
carcerated in a pest house, as in the commitment of the insane. It 
follows that when we change the status of the insane to that of the 
sick we must take cognizance of the fact that the diseases of the 
insane are peculiar, and, like contagious diseases, though in a dif- 
ferent sense, may require for the public safety the isolation and 
restraint of those afflicted by it. But in determining the questions 
as to the nature of the disease, and the special care which each in- 
dividual person should have, only medical knowledge and experience 
will avail anything, and hence should be implicitly relied on. The 
whole process of examination, commitment, treatment in hospitals, 
and discharge should be entirely medical without any interposition 
of the courts. 

A system of laws designed to give full force and effect to the 
principle that the insane should be classed with persons suffering 
from diseases amenable to treatment, should declare explicitly the 
changed status of the insane and the full intent and purpose of the 
laws relating to thdm. The first section might take the following 
form : 

From and after the passage of this act^ every person in this 
State who has heen^ or who may be^ adjudged insane'^"' or 

lunatic^’’ in accordance with laws heretofore or now existing^ 
shall he classified as a sick person and shall he known and desig- 
nated as a person suffering from a ^'‘cerebral disease ff it being 
the intent and purpose of this act to secure to the so-called insane 
all of the rights and privileges of the sick compatible with the 
special form of “ cerebral disease''"’ from which they are suffering^ 
and to place them under such care and treatment^ and under such 
conditions as will tend more effectually to restore them to healthy 
or^ if incurable^ to promote^ as far as possible^ their personal 
comfort^ good health and usefulness. 

In general practice every family has its physician who attends 
upon all occasions of sickness, and who is, therefore, constantly 
familiar wdth the health of its members, and as a consequence is 
the first to detect the nature of every disease which appears. In 
the enforcement of health laws against contagious diseases the 
family physicians or general practitioners are chiefly relied on for 
the earliest report of the existence of a contagious disease in a 


BY STEPHEN SMITH, M. D. 


113 


family and also in a community. It is made his duty to report 
every such case to the health authorities immediately on detecting 
the nature of the disease. Thereupon a sanitary medical officer 
forthwith visits the person alleged to be suffering from a conta- 
gious disease and confirms or not the diagnosis of the family 
physician. If it is so confirmed the sanitary officer determines 
whether the case can be properly cared for and treated at home, 
and, if not, he directs the sick person to be taken to the proper 
contagious disease hospital. 

A similar provision can be made in the examination and commit- 
ment of the insane. For this purpose there should be in every 
community a class of medical men who are qualified to act promptly 
as examiners in every case of alleged insanity. These we shall find 
among the general practitioners, and usually they first recognize 
the existence of insanity in a family. The plan would be to 
recognize these physicians in the statute as official medical examin- 
ers, and give validity to their certificates, wffien made in the form 
prescribed by law. "fhe following section would make this 
provision : 

For the purpose of this act every physician in this State who is 
of good moral character^ a graduate {having a diploma) of a 
legally chartered medical college and in the actual practice of 
his profession^ shall he a medical examiner^ and his certificate 
made in accordance with the f orm p>r escribed in this act shall have 
full force and effect for ten days subsequent to the examination of 
the person for whom it is made. 

Following out the method of naanaging contagious diseases the 
first step in the process of inquiry into the facts relating to an 
alleged insane person would be to summon a medical examiner, if 
he is not already the attending physician, to make a personal exam- 
ination of the patient. The law in many States requires the certi- 
ficates of two physicians in every case of commitment, but as 
neither is an expert it would be better to have the certificate of 
one examiner endorsed or amended by an expert as herein proposed. 
The medical examiner would very frequently be the attending 
physician. There is not only no impropriety in allowing the 
attending physician, if a qualified examiner, to make the first cer- 
tificate but there is a manifest advantage in this respect, viz., that 
he is already very familiar with the antecedents of the patient, 

H 


114 


MORE RATIONAL TREATMENT FOR THE INSANE. 


and, perhaps, of all the circumstances connected with the devel- 
opment of the disease. This section will make the necessary- 
provision for the examination of the patient : 

Whenever any medical examiner certifies that a person is suffer- 
ing from a disease of the brain^ characterized by a general or 
partial derangement of one or more faculties of the mind (per- 
ception^ intellect^ emotions^ will) and in which^ while consciousness 
is not abolished^ mental freedom is weakened^ perverted^ or 
destroyed* and that for his recovery^ or the safety of himself 
and others^ he should be placed under the care^ treatment^ and 
control of the superintendent of an asylum^ he shall as soon 
as practicable transmit said certificate to the superintendent of the 
asylum to which said person is to be removed. 

In private practice it is customary when a physician has a 
patient whom he is desirous of sending to a hospital to notify the 
hospital authorities of the fact, with the name and residence of 
the patient, in order that a physician of the hospital may visit 
the patient and examine as to the nature of the disease, the pro- 
priety of admitting him to the wards and attending to his removal. 
The same method should be pursued in the case of the commit- 
ment of the insane. There are three important reasons for this 
provision in the law. 1. An expert in the diagnosis of insanity 
is brought in to review the opinion of the examiner and confirm 
it or set it aside. This action gives triple security against 
the possibility of error or fraud. 2. Having large and immediate 
experience as to the special necessities in the care and treatment of 
all forms of insanity, this expert can better determine the con- 
ditions under which the individual case should be treated, viz., 
whether at home, in a family, or in an asylum. 3. It is of the 
utmost importance that the insane should be removed to an asylum 
by an officer of the institution, rather than by friends, or a 
local officer as a constable or a policeman. One of the greatest 
sources of cruelty to the insane is their removal to an asylum by 
friends, or rude or coarse town or city officials. By this arrange- 
ment the patient, whether timid, feeble and excited, or resentful 
and resisting would be placed, in the quiet of his home, in charge 
of an officer and his assistant skilled in the management of all 

* Hammond’s definition of insanity is selected because he is an American 
authority. 


BY STEPHEN SMITH, M. D. 


116 


classes of insane, and the transfer would be made without any 
disturbing incidents. 

Two features of this plan will be contested. First, it will be 
maintained that the medical attendant should have no part or 
authority in the proceedings lest he may be in the conspiracy of 
the relatives or friends of the patient to secure the commitment of 
a sane person to an asylum. This reflection upon the integrity of 
medical men is refuted by the daily experience of every one who 
has the care of the insane, and only needs to be mentioned to 
be emphatically denied in every medical circle. Second, there is 
a prejudice against allowing a physician having any official con- 
nection with an asylum to take any part in the commitment of the 
insane to that institution. The assertion is made that medical 
officers are so liable to be influenced by their great desire to have 
their asylum full of patients that they might connive at commit- 
ting sane people. This assertion is as baseless as the former, and 
has not a particle of evidence to sustain it. On the contrary in 
general practice the medical officer sent out from the hospital 
very often does not favor sending the patient to whom he is sent 
to his hospital. We are certain that, in the scheme which we are 
unfolding, the asylum medical officer, sent out to verify the 
diagnosis, and sanction the recommendations of the medical ex- 
aminer, will prove to be the most valuable aid in determining the 
question as to the destination of the patient and in his removal to 
the asylum. We propose the following section: 

Wheiiever the superintendent for the time being of any asylum 
receives the certificate of a medical examiner as provided in the 
last section^ he shall forthwith send a medical officer^ with 
an attendant of the same sex as the patient^ who shall loithout 
delay proceed to the residence of the person for whom the certificate 
is made and personally examine him. apart from the medical ex- 
aminer; he shall have power to administer oaths in this examin- 
ation^ to subpoena witnesses^ and to take further testimony; if he 
verify the correctness of the certificate of the medical examiner^ 
and endorse the same in writing^ the certificate so verified shall be 
his warrant for the removal of thepatient to the asylum and his 
detention therein for one day. ^ 

On the arrival of a patient at an asylum he or she should 
be examined by one of the physicians as soon as possible with a 


116 


MORE RATIONAL TREATMENT FOR THE INSANE. 


view to the approval of the certificate. This section would be 
necessary : 

As soon as possible^ and within twenty-four hours^ after the 
arrival of the patient at the asylum^ one of the physicians shall ex- 
amine him for the purpose of determining the correctness of the cer- 
tificate^ and if he approve it he shall do so in writing^ and the cer- 
tificate so ap>proved and endorsed by the superintendent shall be the 
warrant for detaining the patient in the asylum until discharged 
as hereinafter provided. The certificate so approved aiid endorsed 
shall be filed in the asylum., and a copy shall be forwarded ta 
the committee on lunacy of the State Board of Charities., within 
one week of the admission of the patient., by the superintendent. 

The scheme which has thus far been developed would secure to 
the insane a quiet examination at his home by the medical exam- 
iner, probably his medical attendant ; the verification of the cer- 
tificate of this examination, with little delay and no disturbance, 
by an expert physician from the asylum ; his removal from home 
to the asylum by the same physician and his attendant with the 
least possible excitement. But at the threshold of the asylum 
he encounters his evil genius in its most unquestionable form. 
Though he has thus far escaped being regarded and treated as a 
criminal he enters an institution for the treatment of a disease of 
the brain in the construction and management of which the leading 
thought evidently was to create a custodial rather than a curative 
establishment. The colossal stone or brick buildings, the massive 
architecture, the long and monotonous halls, the grated windows, 
the aggregation of patients, are all frightfully suggestive of a 
prison to the victim of brain disease. And it is true that in the re- 
ception of patients, and in the general arrangements for their care 
and treatment, the prison rather than the hospital methods are the 
leading features. 

It is idle to anticipate any adequate reform in our care and 
treatment of the insane without a radical change both in the con- 
struction and management of the institutions to which they are 
committed. They must be made primarily curative, and second- 
arily,. custodial, in their appointments. In the older States, with 
their costly asylums, this reform, carried to its complete realiza- 
tion, might prove impracticable, but in the new States, about to 
create a system of lunacy administration, the hospital idea could 


BY STEPHEN SMITH, M. D. 


117 


be readily adopted and perfected. In the older States much can 
be done to realize the proposed reform if an effort is properly made 
in the construction of new asylums and, as far as possible, in 
the arrangement of existing asylums, to secure to the curable 
cases every condition necessary to recovery, and to the more 
prolonged or chronic cases, every condition necessary to 
health, comfort and usefulness. For this purpose the future 
asylums should -be organized nearly on the basis of a general 
hospital, viz, : (1) the classification of patients according to their 
sexes ; (2) according to their diseases ; (3) according to the stage 
cf their diseases; (4) a department for convalescents, and (5) 
for incurables. The asylum thus organized would require ample 
grounds and each division should have buildings adapted to the 
wants of the patients. The entire establishment in the construc- 
tion and arrangement of its buildings could have the appearance 
of a village with its tasteful and isolated residences; its church, 
schools, and places of amusement ; its varied industries ; and its 
outlying gardens and farms. Such an asylum will be complete 
only when the multiplication of the divisions of its service is so 
extended that every patient, whether curable or incurable, will find 
a place precisely adapted to secure to him the highest degree of 
physical and mental health, and the largest measure of usefulness 
in industrial pursuits. Although the details of construction and 
organization would be according to no fixed plans, and each new 
asylum would vary from the general type, yet the main feature 
should be embodied in the statute in order to guard effectually 
against the extravagance of architects and builders. This section 
at least might be useful : 

Every asylum hereafter established in this State shall have an 
amount of land of not less than one acre to each patient^ either in a 
single or in separate plots. The service of every asylum shall have 
the following among other divisions., viz.., {1) for men; {2) for 
women; (S) for acute diseases; (f) for convalescents ; (5) for in>- 
<iurahles. These several divisions shall he so separated and located 
as to give the largest possible opportunity for subdivisions of the 
divisions into groups according to the necessities of patients. In 
the location and plans of buildings., due regard must be had to the 
requirements of the patients in each division and subdivision., and 
as far as practicable the buildings shall be cottages not exceeding 
two stories in height., and accommodating not to exceed thirty 


118 


MORE RATIOXAE TREATMENT FOR THE INSANE. 


patients in each ; the total cost of all structures shall not exceed 
$500 p>er patie/nt. It is the intent and purpose of this section of 
the act to organize the asylum so as to create a community^ replete 
with home-life^ and that in the divisions of the service^ in the loca- 
ation and plans of buildings^ and in their construction there shall 
he such ample provision for the classification of patients according 
to their sexes^ and the stage and peculiarities of their diseases^ that 
each may have that personal care and treatment necessary for his re- 
covery^ and that there may be only that association of patients 
with each other essential to their comfort and improvement. 

To meet these changed conditions the medical staff must be 
organized on a somewhat different basis from' that now existing. 
There must be a superintendent who should be a thoroughly equip- 
ped medical officer, qualified by education and experience to preside 
over the entire establishment. There should be attending physi- 
cians, not less than one to each one hundred patients in the cura- 
tive divison of the institution whose duty should be the medical 
care and treatment of each case from the arrival of the patient to 
the termination of the disease. Finally the immediate care of the 
patient in carrying out the treatment should be intrusted to first and 
second assistant phj’-sicians, one of each to every one hundred acute 
cases. These latter physicians should be recent graduates from 
the colleges, having a service of six months in each grade, with 
salaries sufficient to attract the best class men. 

The following section would define the construction of the 
medical staff. 

The medical staff shall consist of a superintendent., attending 
physicians., and first and second assistant physicians., each one of 
whom shallbe a graduate of a chartered medical college and of 
a good moral character. The superintendent shall have had exr- 
perience in the management of similar institutions and shall be 
appointed by the board of trustees; the attending physicians shall 
have had at least one year'*s experience in asylum practice and 
shall be appointed by the superintendent with the consent of the 
hoard; the first and second assistant physicians shall be recent grad- 
uates of medical colleges and shall be appointed in like manner 
as the physicians. The superintendent shall have entire charge 
of the asylum subject to the ndes and regulations of the board; 
the physicians shall have entire supervision of the medical care 


BY STEPHEN SMITH, M. D. 


119 


and treatment of the patients under the direction of the superin- 
tendent; the first and second assistant physicians shall have the 
care and treatment of the patients in the wards under the direction 
of the physicians^ and shall, when directed by the superintendent, ' 
visit and accompany to the asylum any person of whom the 
superintendent has been notified by a medical examiner as here- 
tofore provided. ~ 

In the new States we propose the full development of the general 
hospital plan of organization for the insane. This would involve 
the establishment of the following departments : 

1. The reception ward or hospital is intended for the examin- 
ation of patients before they are sent to the wards for treatment. 
The physician is enabled in this service to determine the special 
nature of the disease of the patient on entering, and thus to send 
him at once to that ward where he will have appropriate treat- 
ment. Important as is the reception hospital or ward of a gen- 
eral hospital, it is far more useful in a hospital for the insane for 
the reason that in large numbers of cases admitted it is impossi- 
ble to determine on a single examination what the nature of the 
cerebral affection is and whether, indee^ in many cases insanity 
really exists. Time, therefore, for accurate observation and re- 
peated examinations may be required before the real condition of 
the patient can be determined. While a small building, or even 
a ward of the hospital, may afford accommodation for the recep- 
tion branch of a general hospital, a hospital for the insane would 
require a larger and more varied structure. It should have 
several apartments so separated that the inmates are not brought 
in contact, and all its appointments, external and internal, should 
be suggestive to the person who enters it of a quiet, orderly home. 
The physicians to this hospital should be the attending physicians 
to the main hospital. 

2. The hospital for acute diseases, having due regard to san- 
itary conditions, is always conveniently located for the attendance 
of competent practising physicians. Hence they are placed in the 
salubrious quarters of the suburbs of cities and large villages. 
So we must locate hospitals for the insane if we fully develop a 
scheme of treating them as sick people. Every large city would 
have its well appointed hospital, and smaller communities their 
cottage hospital, for the insane. 


120 


MOEE RATIONAL TREATMENT FOE THE INSANE. 


The construction, arrangement and equipment of these hospitals 
would differ from general hospitals only as special hospitals are 
modified to meet the wants of the special diseases treated in them. 
Doubtless the feature in the treatment of all shades of insanity in 
the acute form which most deserves attention, and which is now 
most neglected, is that individualism in care, so much insisted 
upon by Conolly, and which can only be secured by the isolation of 
each patient from other insane persons, and the constant attention 
of one or more thoroughly competent attendants. In this manner 
also medical treatment can be made to accomplish infinitely better 
results for there could be that precision in the administration of 
remedies and careful observation of effects essential to their suc- 
cessful employment. Far more successful also would be those 
accessories to the mental health of the insane due to pleasant sur- 
roundings, diverting scenes, reading, and conversation, due to the 
kindly and timely offices and influences of qualified companion- 
attendants. The hospital for the acute insane should, therefore, 
have ample accommodations for the individual care and treatment 
of patients. A group of assorted cottages, each adapted to the 
condition and necessities of patients suffering from different forma 
of insanity, would be better than a single large structure ; and 
lawns, groves, walks and drives would be better than wards and 
halls. 

The organization of the management need not differ from the 
general hospital. There may be a resident physician whose duty 
it is to exercise a general direction of the affairs of the institu- 
tion, but usually he has only supervisory power over the medical 
treatment of the patients. This latter duty would devolve en- 
tirely upon the visiting staff, which is composed of physicians 
actively engaged in practice. The immediate medical care of the 
patients in the wards should devolve upon a resident staff of 
young physicians who are recent graduates, and who have a fixed 
term of service. A corps of trained attendants would complete 
the medical organization. 

3. The convalescent department of the general hospital is 
located in the country, and a convenient place is selected which is 
specially adapted to the rapid and complete recovery of the 
patients. It is under the same general management as the hos- 
pital, and has its own resident medical staff and corps of attend- 


BY STEPHEN SMITH, M. D. 


121 


ants. In like manner the hospital for the insane should have its 
convalescent department located and equipped for the early and 
complete restoration of all who are transferred to it. Its peculi- 
arities would be, ample lands for diversified exercise and employ- 
ment, rural sights and rural sounds to charm and delight the 
senses ; cottage dwellings as various and isolated as appear in the 
neighboring village ; groves, forests, landscape, river, and lake. 

4. The home for incurables is organized so as to provide for 
the comfort and usefulness of the inmates. Such an institution 
for the insane might well be a part of the convalescent depart- 
ment, but so separated that there would be no necessary com- 
mingling of patients. The arrangements for a colony, on 
productive farm lands, with its varied industries, schools, churches 
and other conditions of a rural community, would be the distin- 
guishing feature of this branch of the service. 

The plan of organizing institutions for the treatment of the in- 
sane above outlined differs so essentially from that now followed 
that the innovation will, doubtless, be regarded as impracticable 
even in new States. But the question may well be asked : If 

centuries of treatment of insanity by the present method has re- 
sulted in the cure of scarcely one-third of the patients, is it not 
time to consider the propriety of adopting those methods of treat- 
ing the insane which are so successful in the cure of other dis- 
eases ? It is certain that there would be many positive advantages. 
1. The hospitals for the acute insane would be near the homes 
of the relatives of the insane. This fact would lead to early treat- 
ment, which is of the greatest importance. 2. The hospitals 
would be small, as they would be entirely devoted to the acutely 
insane. There would thus be more individualism of patients 
which would prove of the greatest importance in treatment. 

3. The medical care of the patients would be confided to physi- 
cians who are compelled, by the requirements of their daily duties 
in practice, to be thoroughly familiar, not only with the most 
recent teachings of science in their specialty, but with the prac- 
tical application of all newly discovered facts and remedies. 

4. Not less important is the selection of a resident staff from the 
recent graduates, and giving to its members a limited term of ser- 
vice. A constant succession of the ablest graduates thus pass 
through the hospital, giving to the service that activity and energy 


122 


MORE RATIONAL TREATMENT FOR THE INSANE. 


which such young practitioners always bring from the schools, 
and carrying with them into their professional lives a practical 
knowledge of insanity, and creating an intimate relation between 
the profession at large and hospitals for the insane. 5. Finally, 
hospitals thus situated and organized would be far less liable to be 
objects of suspicion by the communities in which they are located, 
for the leading medical men of the vicinity would be officially re- 
sponsible for the care of the inmates and the general manage- 
ment. The hospital would also be accessible to the public under 
the same rules that govern general hospitals. 

The discharge of patients from a hospital for the insane should be 
in principle the same as from general hospitals. Each patient 
discharged should either be recovered, or in such state, that neither 
the patient, nor the public will be injured or endangered by his 
freedom. The attending physician is the most competent to decide 
the question of discharge, and his written decision, approved by 
the superintendent, should be required. If the patient prove in- 
curable, the attending physician, with the approval of the super- 
intendent, should determine whether the patient should be dis- 
charged to his friends, or transferred to the Home. 

It is important, finally, that there should be competent State 
supervision by qualified and responsible officers. In most of the 
States that supervision will best be secured through State Boards 
of Charities. These Boards have long had general powers of visi- 
tation, and investigation of the public charities, and hence are 
qualified for the duties here contemplated. The best example of 
an organization of a State Board of Charities for work in this field 
is found in Pennsylvania where a committee of the Board is espe- 
cially organized for that duty. The following are the provisions 
of the law creating the committee ; 

There shall be three additional members added to the board of 
public charities^ one of whom shall be a member of the bar of at 
least ten years'" standing^ and one a practicing physician of at 
least ten years" standing. * * * board shall appoint a 

committee of five to act as a committee on lunacy. The two pro- 
fessional ynembers appointed under this act shall be members of 
that committee; and three shall constitute a quorum. 

This committee should be required to make thorough inspections 
of all asylums, public or private, sufficiently frequent to be- con- 


BY STEPHEN SMITH, M. D. 


123 


stantly familiar with all of their operations. They should receive 
copies of all papers of commitment to the asylums and keep them 
on file and on eacli visit the medical and legal members should 
personally examine all patients admitted since the last visit. 
The committee should have supervisory powers chiefly, but 
should be able to correct abuses by a summary process. Its 
annual report should make a complete exhibit of the operations 
of all of the asylums of the State and their condition, with 
recommendations for their improvement. 

We have thus sketched in outline some of the leading features 
of a reform in the care and treatment of the insane the importance 
of which was more and more impressed upon me during the period 
of my official visitation of the asylums of the State of ^^”ew York. 
The sketch is of course very imperfect in detail and can only be 
elaborated into a system of laws by the skilled hand of the legis- 
lator. The paper is, however, submitted in its present form, in 
the hope that it may contain suggestions which will lead to a 
profitable discussion. 


WHAT IMPROVEMENTS HAVE BEEN WROUGHT IN 
THE CARE OF THE INSANE BY MEANS OF 
TRAINING SCHOOLS? 


BY C. B. BURE, M. D., 

Medical Superintendent of tbe Eastern Michigan Asylum, Pontiac, Mich. 


It is the practically universal testimony of those engaged in car- 
ing for the insane, in asylums having training schools for attend- 
ants, that work in connection with these schools, systematically 
pursued and carried forward diligently and thoroughly, has been 
productive of great good ; that through it a higher class of service 
has been secured, and a more exalted ideal of usefulness has been 
realized. The movement to establish training schools for attend- 
ants and emphasize the hospital idea in American asylum work 
was successfully inaugurated by Dr. Edward Cowles, Superintend- 
ent of the McLean Hospital, Somerville, Mass., in 1882. In 1884 
a training school was organized in connection with the Buffalo State 
Hospital; in 1886, one in connection with the Illinois Eastern 
Hospital for the Insane at Kankakee, 111., and in 1887, one at the 
Willard State Hospital, New York. 

The impetus created by the enthusiasm and earnestness of these 
early and prominent workers, and the success which attended 
their efforts toward the attainment of the high purposes in view, 
have been felt all along the line. No less than nineteen American 
institutions (see below) now possess systematically organized 
and thoroughly equipped training schools for attendants, and for 
them there may be justly claimed a special and important place 
in psychiatry. Their creation has been the logical outcome of a 
desire for improvement in asylum service on lines similar to 
those developed through nurses’ training schools in general 
hospitals, and the necessity for their existence in promoting 
modern methods in the care of the insane has been generally 
recognized. 

At a time when restraint was much employed in the management 
of suicidal, violent and disturbed patients, the necessity for recog- 
nition of the operations of the insane mind as a guide to tactful 


BY C. B. BUER, M. D. 


125 


management, was less than in these modern days, where little or no 
mechanical restraint is applied, where open-door and parole privi- 
leges ai’e extensively given, and where nursing, systematic exercise, 
employment, diversion and personal attention have displaced the 
ancient repressive regulations and appliances. In granting greater 
privileges to patients and according them that extension of lib- 
erties which approximates institution-life to home-life, the physi- 
cian is helpless without the assistance and co-operation of the 
skilled attendant. The latter must be quick to detect change in 
mental operations, departure from habitual conduct or develop- 
ment of tendencies w'hich demand an abridgment of privileges. 
To stimulate this discriminating ability, to teach the attendant 
how to read the mind of his patient, to develop his perceptive and 
reflective faculties, — all these are necessary. The attendant 
must learn how to place himself in close harmony with his patient, 
and be quick to apprehend the reasons for any new or unusual 
manifestations he displays. He should be among the first — per- 
haps the first — to note the signs pointing to a termination of 
morbid mental action and return of natural habits and impulses. 
The future of his patient may depend upon this prompt recogni- 
tion and the steps taken to promote it. The early signs of improve- 
ment, revealed darkly at first, but penetrating like a gleam of 
sunshine through the cloud of obscurity which has overhung his 
previous mental operations, must be seized upon and quickened, 
that the struggling reason may not be impeded in its efforts to 
re-assert supremacy. 

In discussing the question of the relation of the higher training 
of attendants to the practical problems of psychiatry, and in re- 
plying to the question, “ What improvements have been wrought 
in the care of the insane by means of training schools? ” much is 
involved. That they have promoted the recovery of patients is, I 
believe, an indisputable fact ; this being due to — 

First. — Their increasing the adaptability and resources of the 
attendant. 

Mental training in useful lines broadens the horizon, develops the 
resources, and adds to the fund of knowledge from which to draw 
in the exigencies and emergencies of life. That the highest degree 
of efficiency in work may be attained, it is pre-eminently necessary 
that the reason for it should be understood. Under such circum- 
stances it is more enthusiastically undertaken and more successfully 


126 


IMPROVEMENTS IN THE CARE OF THE INSANE, 


carried out. Explicit direction may be successfully followed in a 
machine-like manner where the path is clear and the end foreseen 
from the beginning, its accomplishment depending merely upon 
the expenditure of a certain amount of labor in definite lines. 
In the very delicate relation which he bears to the insane 
patient, however, too many exigencies arise to permit on 
the part of the physician a clear conception of the case from the 
first, and detailed instruction as to its hour-to-hour management. 
A general direction, for example, to the effect that his patient 
shall in pleasant weather take exercise in the open air, may be fol- 
lowed by the attendant in an automatic manner and in accordance 
with precedent, good results ensuing. It is doubtful, however, if 
the same amount of benefit will accrue to the patient as will 
follow a clear conception in the mind of the attendant of the ulti- 
mate purposes of the direction : that is to say, the effect of exer- 
cise upon the organic functions, the influence upon the circula- 
tory and nervous system, and the psychical stimulation which 
may be introduced into this commonplace and every-day perform- 
ance. In this connection there are matters which the thoughtful 
and trained attendant will take into constant account, of which 
the thoughtless and unskilled will be heedless. Is the patient’s 
physical condition at this moment such that he can endure without 
dangerous fatigue the contemplated walk? Are his delusions more 
active? Will they interfere with his comfort in going out, or cre- 
ate trouble on his return? How may emergencies of this kind be 
met should they arise? Is he morbidly sensitive, and is his objec- 
tion to going out due to the company with which he will be asso- 
ciated in his walk, or to the apprehension he may have of meeting 
strangers? What tactful management will overcome these scruples? 
Is his nervous system in such condition that he can bear the heat 
of the sun? Does he show any evidence of disturbance of the cir- 
culatory or respiratory system which would contraindicate his going 
out? Are his present objections based upon real physical illness, 
or do they arise from delusions? How can the walk be planned to 
introduce some healthful mental stimulation and diversion and 
thus interrupt or change the morbid mental currents? That the 
trained attendant is constantly asking himself questions similar to 
these, every-day experience indicates. He regulates the patient’s 
walk by his condition. If any doubt exists as to the reality of the 
symptoms of which the patient complains, and upon which he bases 


BY C. B. BURR, M. D. 


127 


his objection to exercise, he accords him the benefit of the doubt. 
If he finds his patient sensitive and discovers that he prefers to re- 
main in-doors because of dislike to a large company, he plans to go 
out with him alone, or, reporting the fact to the physician, assists 
in making some arrangement which will overcome the scruples and 
meet the wishes of the patient. Had he in health a special interest 
in certain out-door employments, he aims to re-excite this interest by 
skillful allusion and opportune suggestion. Is he weighed down 
by distressing and anxious thoughts, his attendant aims, by timely 
conversation, to direct his mental operations into healthy channels, 
or by golden silence and unexpressed sympathy to share his burden. 

To prescribe rest in bed for a patient who is apparently vigor- 
ous and able to put forth much muscular effort in morbid lines 
strikes the inexperienced and untrained attendant as a strange mis- 
application of methods ; whereas knowledge of the pathological 
state of the brain in excitement, of the danger lurking in undue ex- 
ercise, and of the relation between sensory stimulation and im- 
pulsive acting, promptly places the trained attendant in sympathy 
with the course adopted. He appreciates the influence of posture 
in the management of the case, and recognizes the importance of 
the withdrawal of disturbing influences which tend to keep excite- 
ment alive. He gives the plan his co-operation intelligently, and 
not in a half-hearted, irresolute or grudging manner. 

The mental discipline which the training school affords develops 
the perception, reason and judgment of the attendant, increases 
his self-control and tolerance, and brings him near to his patient’s 
point of view. There was brought to my notice the case of a 
patient of dangerous propensities and great irritability, who con- 
stantly clamored for his discharge from the institution and for 
protection from his fancied persecutors. Against the physicians, 
who, in their dealings with him, were compelled to resort to frank 
conversation in explanation of their reasons for detaining him in 
the institution, he had contracted a strong antipathy. With the 
attendant, on the contrary, whom he did not hold accountable for 
his detention, and whom he recognized as merely the agent of 
some one else, he was on the best of terms — this due mainly to 
the judicious character of the attendant’s management. Without 
concurring in the patient’s delusion that his bad symptoms were 
due to the machinations of enemies, he was accustomed to express 
sympathy with him in his sufferings: to say “That’s too bad,” 


128 


IMPROVEMENTS IN THE CARE OF THE INSANE. 


“ I hope that won’t happen again,” “I will see when I can what 
I can do to help you,” and then to divert him by conversation on 
other subjects. That rancor, ill-feeling and contention are, by 
methods such as these, rendered less common, and that through 
them the highest ideal of the relation of attendant to patient — 
that of companion, counsellor and friend — is realized, is beyond 
dispute. 

“I have been doing a great injustice,” said a member 

of the training school to me recently. “He is what I called 
stubborn and contrary in everything; and although, of course, 
I knew he was insane, I thought he acted that way because it 
was natural for him, and that he resisted so much because he had 
always been contrary. I have become at times vexed and pro- 
voked with him, and am satisfied that I have not treated him 
with the consideration which I should. I have not been harsh, 
but hasty and inclined to scold, and held him in a measure account- 
able for his conduct. Since your lecture of yesterday on Forms 
of Disease I can see that the reason why he resists doing things 
which he is requested to, is because of delusions, and because 
eifort of any kind is wearing upon him and distressing to him. 
I believe cases of this kind should be better understood : that the 
attendant should know the reason why his patient’s conduct is 
such as it is. It makes matters easier all round, and I am satisfied 
that I shall have much more toleration for the peculiarities of 
patients in future, because I know more about why they do dis- 
agreeable things, and don’t act in a reasonable way.” 

Caution, prudence, coolness and quickness of perception — all so 
necessary to meet the emergencies encountered in dealing with the 
insane — are increased by mental training. Under the most care- 
ful management the suicidal patient will occasionally elude vigil- 
ance and find some means for the execution of his purpose. What 
happens in the case of one found hanging, for example? If an 
inexperienced attendant discovers that this accident has occurred, 
he is too often paralyzed through mental shock, or his first impulse 
is to fly. As in one case which came under my personal knowl- 
edge, the attendant was powerless to act, being overwhelmed by 
the terror which the dreadful sight occasioned. On the contrary, 
what took place in a similar case under the management of a train- 
ing school graduate? A patient found hanging to his door-hinge 
by means of a mattress wire was promptly lifted down from this 


BY C. B. BURR, M. D. 


129 


perilous position. The attendant retained perfect coolness and 
composure. Did he send for the medical officer, in the meantime 
acting a passive part himself? IsTot at all. He dispatched help 
for the physician ; and although the lungs had ceased to act and 
the patient’s life was nearly extinct, he was able to apply artifi- 
cial respiration so successfully that by the time the doctor arrived 
upon the scene, respiration was re-established and the danger 
passed. How comforting and satisfactory the feeling to those 
who had taken the pains to supply the information which per- 
mitted this to be done. On the contrary, how replete with humil- 
iation and self-reproach the mental review of the first-named case. 
How the thought obtrudes itself, that in failing to give the train- 
ing necessary to meet such an emergency, we share accountability 
for the melancholy result. 

In the matter of hall cleanliness and hall decoration favorable re- 
sults follow instruction in surgical and hygienic principles and 
cultivation of the aesthetic sense. Cleaning is looked upon as less 
a drudgery when its hygienic importance is apprehended. It then 
becomes asepsis and acquires a new dignity. Attention to patients, 
to their physical needs and to their personal appearance is less 
onerous and burdensome when the attendant realizes that in so 
simple a matter as adjusting a tie, or sewing up a rent, he is 
participating in the moral treatment of the patient and supplying 
an aid to recovery. Beautifying and ornamenting halls is a labor 
of pleasure when the high psychiatrical purpose, the appeal to the 
aesthetic sense, the supplying healthful psychical stimulation, and 
the introduction of pleasant mental impressions are appreciated 
at their value. The attendant, realizing that in substituting order 
and neatness for untidiness and disorder he is furnishing a direct 
aid to recovery, feels the work of personal attention less onerous 
and appreciates to a greater extent than ever before the importance 
of the factor which his work supplies. With the distinct idea in 
view that a motive to self-control even though operating effectually 
for but a brief period of time at first may eventually become a step- 
ping-stone to self-control of an habitual and permanent character, 
he is led to encourage attendance upon entertainments and chapel 
services, and to avail himself of every means to supply such motives 
as may tend to restoration of complete ascendency of the will. 

Second. — The more general dissemination of correct inf urination 
regarding the nature and treatment of mental disease. 

j 


130 


IMPROVEMENTS IN THE CARE OF THE INSANE. 


There are being constantly sent from hospitals for the insane 
trained attendants, who for one reason and another leave the service 
to take up other avocations. Many engage in the work of private 
nursing and the care of insane patients in their homes, lead useful 
lives, and are the means of alleviating a vast amount of suffer- 
ing. In addition to the services of this class, however, the com- 
munity at large derives benefit from the experience in the manage- 
ment of the insane of those who are engaged in other employments. 
Their knowledge of the why and the wherefore pertaining to 
mental disease ; their ability to discriminate in a measure between 
forms of insanity ; their practical and theoretical acquaintance with 
the management of patients, will render them of much assistance in 
cases of insanity occurring in their neighborhoods. Their services 
will from time to time be called into requisition in the temporary 
management of cases at home, and their asylum training will render 
this service skilled and intelligent. It happens, occasionally, that 
patients are unnecessarily transferred to an institution because of 
failure to correctly estimate a case, or because of inability on the 
part of friends to supply the proper aids to recovery. A skilled at- 
tendant, under competent medical advice, can here be of assistance, 
and it will be found in future years that the asylum training school 
has accomplished an efficient and very important work in supplying 
knowledge which may be made available in the treatment of 
patients at home. As Dr. Cowles well says: “It should be under- 

stood that it is regarded here as a part of the duty of the asylum 
to the public, which it was created to serve, to qualify young 
women and men to be nurses with special fitness for the home 
treatment of patients in cases of nervous disease, or of impending 
or confirmed mental disorder.” 

Third. — Emphasizing the importance of general nursing in the 
management of the insane. 

Teaching the physical basis of morbid mental manifestations, 
retires so-called “mental disease” to obscurity. In the contem- 
plation of insanity as symptomatic of disturbed or perverted 
brain action, a distinct advance occurs in the lay mind. The at- 
tendant in looking upon insanity from this point of view, perhaps 
for the first time realizes the importance of applying to its treat- 
ment those measures adapted to bodily illness in general. In 
insanity to as great extent as in any other illness is skilled nursing 
important. Indeed, the difficulties encountered by the nurse are 


BY C. B. BURR, M. D. 


131 


perhaps greater in cases of delirious excitement, than in any 
other illness. The element of resisting, of opposing necessary 
attentions, is here to be overcome. 

To say nothing of the incalculable advantage to the patient of 
skilled nursing, the information derived from careful observation 
of symptoms, and the confidence growing out of the judicious 
application of remedies are of the highest value to the medical 
officer. With this support he feels more than ever a sense of 
courage and fearlessness, and prescribes with the perfect assurance 
that his prescription will be intelligently followed. He knows, 
for example, if it becomes necessary to administer a hot bath, 
that every precaution will be taken : that sufficient help will be 
present to prevent accident, that the temperature of the water will 
be ascertained previous to the patient’s immersion, and that any 
untoward symptoms developing in consequence of the remedy, or 
incident to its application, will be promptly recognized and re- 
ported. The physician will frequently have occasion to prescribe 
an enema for an excited patient. The delicate duty of adminis- 
tering it may, in the hands of the inexperienced, be clumsily per- 
formed. It may result in injury, and too frequently will, if not 
carefully given, fail of the purpose for which it was prescribed. 
The trained attendant, however, having in mind the importance 
of ascertaining the temperature of the enema, knowing the ana- 
tomical relations of the parts, realizing the impediment which 
an overloaded rectum will offer to the insertion of the syr- 
inge nozzle, understanding the position of the patient which will 
favor successful introduction and retention of the enema, and hav- 
ing all the details of the work in hand, will accomplish his object 
without injuiy to the patient and without intensifying his excite- 
ment by misdirected exhibition of force or bungling manipulation. 

If, as is the case sometimes with operative procedures however 
simple, untoward symptoms do develop, and accidents arise which 
cannot be foreseen or prevented with the exercise of ordinary judg- 
ment and skill, what a relief for the physician to feel that the un- 
favorable outcome of the operation was in no way attributable to 
him for failure to impart the necessary instructions as to its 
details. 

Dr Cowles remarks in this connection: “ There is another im- 

portant reason for giving every nurse as broad a training as pos- 
sible in the general principles and practice of all nursing; just as 
the physician should receive a general education in the profession 


132 


IMPROVEMENTS IN THE CAKE OF THE INSANE. 


of medicine before be limits himself to a specialty. The danger 
and evil of all asylum work is routine practice — limitation to one 
line of observations — to the neglect of bodily diseases in general. 
It is true that the majority of the population of all asylums is in 
various stages of dementia. It may be true also that, as an emin- 
ent alienist says, ‘ not only the nurses but the medical staff suffer 
from a tendency to the lowering of mental tone because of the con- 
stant association with defective minds.’ To counteract such ten- 
dencies everything possible should be done to amplify the hospital 
idea in the work. The teaching of bodily nursing in a training 
school excites the interest not only of the nurses, but of the med- 
ical staff in all the manifestations of bodily disorders that can be 
found, and lends value to the practical care of all morbid condi- 
tions. Routine and monotony kill interest when the aim is not 
beyond the simple care of many incurables. This is the bane of 
asylum work.” 

Fourth. — It is probable that training schools have been pro- 
ductive of good by lengthening the service of attendants; although 
this is difficult of demonstration. The following tabulation will 
be found of interest in this connection : 


NAME OF INSTITUTION. 

STATE OR 
PROVINCE. 

Date of organization. 1 

1 

Number of graduates. 

Number of graduates 
still in the employ of 
the institution. 

Number of graduates 
in asylum or institu- 
1 tion work elsewhere. 

Number of graduates 
engaged in private 
i nursing. 

Number of graduates 
engaged in general 
hospital service, 

McLean Hospital 

Massachusetts. 

1882 

116 

20 

4 

44 

14 

Buffalo State Hospital 

New York. 

1881 

67 

14 

3 

20 

4 

eminty Asylum 

New York. 

1886 

32 

7 

2 

9 


Kankakee Asylum 

Illinois. 

130 

60 

5 

3 


Willard State Hospital 

New York. 

1887 

42 

22 



Kingston Asylum 

Ontario. 

1888 

16 

8 

1 


1 

Miduletown Hospital 

New York. 


35 

26 


2 


Danvers Asylum 

Massachusetts. 

1889 

13 

7 


1 


St Peter’s Asylum 

Minnesota. 


39 

30 

1 

1 


Wf'st.I>f>ro Asylnin 

Massachusetts. 

kk 

14 

4 

1 

8 


Rnp.hpstpir Asylum 

Minnesota. 


17 

14 

2 


TnHpppndPTip.p, Asylum 

Iowa. 

(.b 

24 

20 

3 



TTtip.fl. Sf.a.tp, TTnspita.l 

New York. 

1890 

59 

41 

2 



Rochester State Hospital 

New York. 

27 

26 




Tflf^stfirn Mip.higa.n Asylum 

Michigan. 


21 

14 

1 



St. Lawrence State Hospital. . . . 

New York. 

1891 



Michigan Asylum for the Insane. 

Michigan. 







Cleveland Asylum 

Ohio. 







Toronto Asylum 

Ontario. 















Total 



652 1 

1 313 

23 

90 

19 


Foot Note.— The following institutions have lectures and courses of study, but have 
not regularly organized training schools, and do not issue diplomas: Retreat for the 
Insane, Hartford, Ct.; Western Pennsylvania Hospital, Dixmont; Central Indiana Hos- 
pital, Indianapolis; Asylum for the Insane, Hamilton, Ontario; State Hospital for the 
Insane, Warren, Pa. 


BY C. B. BURR, M. D. 


133 


It will be seen from the foregoing that a large percentage of 
training school graduates remain in asylum work, and the showing 
in respect to the number engaged in private nursing, and in the 
work of general hospitals is peculiarly gratifying. Assuming, how- 
ever, as has been alleged, that the training school does not promote 
permanency of service in asylums, it has still done great good in 
the lines indicated in the foregoiug pages. To quote from the 
remarks of Trustee Baldwin at the first graduating exercises at 
the’ Eastern Michigan Asylum : 

“ The time employed by you in this undertaking has not been 
lost time. The knowledge you have acquired is more estimable 
than silver or gold ; it can never be taken from you ; it is a foun- 
tain from which you can continuously draw without reducing the 
quantity — in fact, the more you use it, the more it will accumu- 
late, the more valuable it becomes. It is such as every head of a 
family ought to possess — every intelligent man or woman in the 
land — yet, here you have acquired it without loss of time, with- 
out expense. You have vastly increased your usefulness, and 
laid deep the foundations and opened wide the door for future 
acquisitions. ” 

A word as to the field of study in connection with asylum 
training schools. In the majority enumerated above there are 
taught anatomy, physiology and hygiene, general nursing, surgi- 
cal nursing, obstetrical gynaecological nursing, mental physi- 
ology and pathology, including the management of the insane, 
emergencies, the principles of sanitation, sepsis and antisepsis, 
physical culture, massage, the preparation of special diet and 
cooking for the sick. Certainly a broad, foundation is laid for 
usefulness in instruction of this character. 


THE CARE OF THE INSANE IN CANADA. 


BY C. K. CLARKE, M. D., 

Medical Superintendent of the Kingston Asylum, Ontario. 


The Province of Ontario has always been looked upon as the 
most progressive part of Canada, and in the care of the insane 
this Province has endeavoured to keep up with the advance of science 
and in a few respects has possibly led. The development of the 
State care under the intelligent eye of that accomplished alienist, 
Dr. Workman, is a chapter in history known to too few, but the 
influence of this remarkable man has been felt for many years and 
a great deal that is best in the present asylum system can be 
traced to his thoughtful foresight. Non-restraint has been 
accepted as a principle in nearly all of the Ontario institutions and, 
in two, at least, has been an accomplished fact for ten years. 

I believe in one institution the long sleeved jacket is still used 
at times, but beyond this there is nothing that can be called re- 
straint. At the same time all of the superintendents are agreed that 
while non-restraint is admirable, the case might occur in which 
restraint would prove of value and should be adopted. 

Dr. Bucke, of London Asylum, who has always been a progressive 
man, was the first to adopt non-restraint some ten years ago, and 
was closely followed by Dr. Metcalf, of Kingston. 

These facts are of interest and should be recorded, as at that 
time nearly every institution in America ridiculed non-restraint as 
an impossible fad, and those who adopted the system were looked 
upon as “cranks” and imbeciles. 

The Asylums of Ontario are State institutions in the most complete 
sense of the word ; and, in all but a few wards in Toronto, patients 
are cared for at the expense of the Government. 

When the}^ are able to contribute to their support, a rate that 
covers the bare cost of maintenance is charged. 

The Province furnishes asylum accommodation for about three 
thousand insane persons, and another institution is being erected 
at Brockville on the St. Lawrence River. 

Ontario has never been lavish in her expenditure on buildings, 
and, it is possible, has gone to an extreme in economy in this 
matter. 


BY C. K. CLARKE, M. D. 


135 


There has been a good deal of doubt in regard to the most 
desirable style of hospital to erect, but now it seems to be accepted 
that a central building with detached cottages is the most 
convenient institution for the purposes of the Province. 

Mimico is composed of several cottages and affords a refuge for 
chronics chiefly, — the other asylums are on the plan before men- 
tioned. 

If Ontario has had any particular merit, it has been in the way 
of substituting employment for restraint, and that this has been 
successfully done, a visit to almost any of the hospitals will show. 
In the institution over which I preside the occupation of patients 
has been regarded as a most important matter and, as the Super- 
intendents of London and Hamilton asylums are firm believers in 
employment, possibly a description of the methods followed in 
Kingston may apply to a great extent to the other hospitals referred 
to. In Toronto the patients are from a different class; the 
grounds are limited and different conditions generally obtain so 
that varied occupations cannot be followed as in the other asylums. 

In Kingston the idea has been not only to furnish plenty of oc- 
cupation but variety as well, and it is the aim of those in charge to 
find the particular employment that is likely to prove suitable to 
each case. With this end in view there have been established the 
following industries : 

Cabinet making, upholstering, broom making, weaving, shoe- 
making, laundry work, painting and decorating, farming, stone 
cutting, carpentering, brush making, bookbinding, tinsmithing, 
tailoring, blacksmithing, gardening, quarrying, sewing and 
knitting. 

In addition, those who care for music are instructed in the band 
room, — a school is carried on and the patients who cannot be trusted 
outside are regularly instructed in gymnastics. 

The physical culture classes reach the highest development in 
wards that were formerly designated, refractorjL These wards 
are now as orderly as any in the asylum and the word 
refractory has lost its meaning. Different forms of drill 
such as dumb bell, extension movements, marching, &c., with 
parallel bar exercise are adopted by the men, while the women are 
drilled to music in one large class and go through Barbell exercise, 
hoop drill, &c. 

The brass band of twenty-two is made up chiefly of patients, the 


136 


THE CAEE OE THE INSANE IN CANADA. 


majority of whom have been taught music since admission to the 
asylum. A qualified instructor has charge of the band and gives 
his whole time to the care and development of his patients. This 
brass band plays well and, outside of its use as furnishing employ- 
ment, is a valuable addition to our resources in the way of provid- 
ing music for indoor and outdoor concerts. 

The school is modelled after that in the Utica asylum and is 
appreciated by the women who attend it. 

It has been found possible to do a great deal by patients’ labor, 
and last year a fine stone cottage for thirty farm patients was put 
up almost entirely by their work, and the success of this experiment 
has induced us to launch out on a bigger undertaking. 

At the time of writing the stone for our infirmary 64x72 is 
being quarried and dressed by our patients. It has not been 
decided yet whether they will undertake the erection of such a 
large building ; but if it is decided that we shall do the work, I am 
satisfied that the result will be satisfactory. The chief idea governing 
the extensive system of employment is to furnish each patient with 
work that is attractive to himself. In addition, hours are short, 
and we have a system of rewards in the way of lunches that answers 
admirably. 

On the whole, the insane of the Province of Ontario are well and 
liberally cared for by the Government and the asylums enjoy the 
confidence of the general public to such an extent that actions for 
illegal detention of sane persons do not occur, and newspaper 
discussions over so-called atrocities are unheard of. 

The people realize the value of the service to the general public, 
and when it is so clearly understood that it cannot be in the inter- 
rest of any one to detain a sane person, scandals do not occur. 

All sick patients, both male and female, are nursed by trained 
hospital nurses in properly equipped infirmaries, and in Kingston 
all nurses are trained, not only in the nursing and care of the in- 
sane, but in medical and surgical nursing as well. The hospital 
idea is carefully taught and all nurses are made to understand that 
patients under their care are sick people and must be treated 
as such. In order to carry out this idea to its legitimate conclu- 
sion, separate hospital buildings are to be erected in connection 
with each asylum, and the day is not distant when acute cases 
will be treated in small buildings on the hospital plan. 

Foreigners, as a rule, regard Canada as a small country with a 


BY C. K. CLARKE, M. D. 


137 


population centralized within a limited territory. Although the 
population is small, say five millions, it is scattered over an im- 
mense territory" from the Atlantic to the Pacific, and each Prov- 
ince cares for its own insane. As a matter of fact the asylum 
system of Quebec is the one that is generally attributed to the 
whole of Canada, because its defects have brought it into glaring 
prominence. Since the advent of the new asylum in Montreal 
and the disastrous fire in Longue Pointe, a better state of things 
has come about, but until the Quebec Government assumes 
absolute control of the care of the insane, the system will be open 
to grave criticism. The Protestant Asylum at Montreal is a non- 
restraint institution and conducted on modern principles. 

New Brunswick, Nova Scotia and Manitoba, have always kept 
up with the times and their institutions are, I believe, admirable. 

About Prince Edward Island and British Columbia I am not in 
a position to speak from actual knowledge, but I have every reason 
to believe that they are well conducted. 

Since Dr. Hack Tuke wrote his interesting but bitterly crit- 
icized brochure on the Insane of the United States and Canada, 
steady advances have been made, and it is only a question of 
time as to when 'Quebec must fall in line with the other Provinces 
and give up the farming out system. 

Canada is behind the times in the matter of the care of the criminal 
insane, and I regret to have to chronicle the fact that the general 
public has not yet learned to regard insanity as a disease that may 
be the cause of crime. As long as the legal definition of insanity 
is so crude and imperfect, and the newspapers hold up the bogy 
called the “insanity dodge,” we may look for little or no improve- 
ment in this line. In this respect of course we are not much worse 
than our neighbors, who believe that as a general policy the hang- 
ing of so-called ‘ ‘ cranks ’ ’ is very convenient in the way of ridding 
the world of certain dangerous elements. Of course they are 
not prepared to carry the argument to its legitimate conclusion 
and apply it generally. 

In Canada it is, I regret to say, a difficult matter for an insane 
criminal guilty of murder to escape the death pejualty, and within 
a comparatively recent period several men with well marked brain 
disease have been hanged. We have no provision for the special 
care of the criminal insane and will not require it until popular 
ignorance disappears. Many of our legal lights assert that in 


138 


THE CARE OF THE INSANE IN CANADA. 


Canada we make no mistakes regarding the “ insanity dodge” as 
we hang all murderers sane and insane. It will not be 
many years before a complete change of sentiment will take 
place regarding this matter, just as it is developing in 
England where public opinion is not as bitter as it is with us. 

Leaving this unpleasant feature of the discussion, the care of the 
insane in most of the Canadian Provinces may be said to be all that 
could be desired, that is, leaving Quebec out of the question, and 
even there the advance toward a better condition of affairs has 
commenced. Ontario, being the wealthiest Province, has of course 
been able to outstrip the others and has found it comparatively 
easy to carry the burden of the care of her insane, and has never 
shirked the duty. She too had the advantage of an illustrious 
pioneer in the shape of Dr. Workman, who introduced and developed 
a system characterized by kindness and gentleness. Just as the 
York Retreat in England exercised a beneficial influence, the 
teachings of Dr. Workman have silently proved a means of 
untold good in Ontario. 


ON THE CARE OF EPILEPTICS. 


BY FEEDERICK PETERSON, M. D. , OF NEW YORK CITY, 

Professor of Nervous Diseases in the University of Vermont ; Instructor in Nervous and 
Mental Diseases at the College of Physicians and Surgeons, New York; 
Attending Physician to the New York Hospital for Epileptics ; 

Pathologist to the New York City Asylum for the Insane. 


The care of epileptics really includes their medical treatment as 
well as all other kinds of help extended to them. But medical 
care, such as it is, has been given to them for some thousands 
of years, and yet without adding much to the happiness of 
individuals under treatment, or accumulating much evidence of 
positive value concerning medication in epilepsy. Our results 
have been, indeed, almost valueless ; for, with all our dosing with 
bromides, borax, belladonna, and so on through the alphabetical 
index of the pharmacopeia, it is extremely doubtful if in ordinary 
practice, one per cent, of the cases of idiopathic epilepsy are cured. 
Beside the practical incurability and hopelessness of the disease, 
its victims have suffered untold sorrows in the way of negli- 
gence and ill-treatment at the hands of the communities in which 
they live. 

It is a peculiarity of this disease that the seizures may be 
momentary or may last for a few minutes only, recurring sometimes 
frequently, sometimes daily and sometimes months apart, thus rob- 
bing the sufferers of their consciousness and faculties for brief 
periods of time at long or short intervals. Between the attacks 
they may be as rational and as well qualified for all the vocations, 
duties and social privileges of life as any other human being. 

These facts do not concern a few only of the members of the com- 
munity. Epilepsy is a wide-spread disorder and it has been calcu- 
lated that one person in five hundred is thus afflicted. Thus, there 
would be in the neighborhood of one hundred and thirty thousand 
such unfortunates in the United States alone, and over twelve 
thousand in the State of New York. Even supposing this percent- 
age to be exaggerated to a very great extent and that the actual 
ratio were one to one thousand, the number of epileptics would 
still be enormous arid would constitute a large part of our defective 
classes. 


140 


ON THE CAEE OF EPILEPTICS. 


Outside of the efforts, thus far comparatively futile, of physi- 
cians to alleviate their purely physical infirmities and to reduce the 
number and severity of the attacks, nothing has been done until 
late years to provide for their mental development and to meet the 
peculiar conditions of life which they are called upon to en- 
dure. Thus no general hospital will receive such cases for 
treatment, because of the incurable and unpleasant nature 
of their malady. While much of the time thoroughly capable 
of acquiring an education, they are debarred for obvious 
reasons from the schools; the churches are closed to them; 
very few care to employ epileptics in shops, stores or offices or are 
willing to teach them trades. Few epileptics are at liberty to 
enjoy the companionship of their fellows, who are rather inclined 
to shun their unfortunate brethren. Thus, every avenue for 
mental or moral development, for occupation, for association with 
the rest of mankind is closed to them. They are even burden- 
some to their families. It is little wonder then that many of 
them grow up dull and ignorant, intellectually feeble, morally 
depraved, irritable in temper with tendencies to retrogression and 
degeneration rather than to advance. A few of them become 
insane and are sent to insane asylums. Others are not insane 
but, ill-adapted for existence under such miserable conditions, 
drift to the only homes offered to them, the alms-house. The 
alms-house and the asylum are the only refuge when abandoned 
by their friends. In the State of New York for instance, where 
there are twelve thousand epileptics, some four hundred or more are 
in insane asylums and some six hundred in the county poor-houses. 
The rest of them are scattered throughout the State in their own 
families among the rich and the poor in ratio to population and to 
the relative proportion of these classes. Many are so slightly 
affected that they are able in spite of their seizures to pursue 
some of the ordinary vocations of life. Thus I know personally of a 
doctor, clergyman, several book-keepers, a bank president, a stock 
broker, several clerks, some dressmakers, shoemakers, masons and 
a telegraph operator, who are epileptics, and yet able to carry on 
useful pursuits, albeit under adverse conditions. To all of us are 
familiar certain well-known historical or literary characters in 
whom epilepsy failed to restrict the development of their genius 
.such as Caesar, Napoleon, Moli^re, Petrarch, Dostojewsky and 
others. 


BY FREDERICK PETERSON, M. D. 


141 


It would seem, therefore, from the above facts that, although 
there is such a thing as epileptic insanity, the proportion of insane 
epileptics to sane epileptics is very small, much less than ten per 
cent., taken at the utmost, and that this ratio may be reduced by 
affording these unfortunates such opportunities for mental and 
moral development as are enjoyed by other and more happily 
situated citizens; and not only may the percentage be reduced, 
but the comfort and prosperity of all epileptics be increased by 
proper provision on the part of the State or through private chan- 
nels such as institutions of a peculiar character adapted to their 
peculiar needs. A large public hospital is very far from meeting 
their requirements; for, as has already been shown, medicinal 
treatment is uncertain and unpromising. Insane asylums should 
receive but very few, and alms-houses none at all. What is de- 
manded is an institution on the community or village plan, where 
medical treatment (such as it is) may be given to every member 
and where every sort of education, employment and social privi- 
lege commensurate with his needs and conditions may be extended 
to every beneficiary. 

The colony system only can attain this object. A colony for 
epileptics is not an impracticable scheme proposed by visionaries. 
It is already an accomplished fact. The Bethel Epileptic Col- 
ony at Bielefield in the province of Westphalia, near Hanover, 
Germany, was founded by Pastor von Bodelschwingh, over 
twenty-five years ago. He purchased a small farm with one 
house and, with four epileptics as a beginning, established 
a charity, which for nobility of conception and success in its re- 
sults has nowhere, an equal. It seemed to its beneficent founder 
feasible to create a refuge where sufferers might be cured if cura- 
ble, might have a home if recovery were impossible, might learn 
trades and the great majority become educated, useful and indus- 
trious citizens. From that small beginning there has been a 
gradual evolution of his idea until now there are over one thou- 
sand epileptics, resident in some sixty or more houses, scattered 
irregularly but picturesquely over a large farm. Everyone who 
visits this unique colony is deeply impressed with the happiness, 
contentment and prosperity everywhere apparent among the inhab- 
itants of this little epileptic world. He sees that it is no longer 
an experiment and the previously unanswerable objections to such 
aggregations are, by its success, answered and silenced. At the 


142 


ON THE CARE OF EPILEPTICS. 


time of my visit to Bielefield, in 1886 , there were but eight hund- 
red and twenty-five epileptic patients. The employments were 
numerous and varied. A school provided instruction for some 
one hundred and fifty pupils of both sexes. All branches were 
taught. The dairy and the farm and garden occupied the 
attention of the greatest number of the patients, especially as 
a large trade in vegetable and flower-seeds was carried on by the 
colony. 

Among the shops for epileptic workmen were those for cabinet- 
makers, painters, varnishers, printers, bookbinders, blacksmiths 
and foundrymen, tailors and shoemakers; and, among the stores, 
were a grocery, pharmacy, book-store and a seed-store. The car- 
penters aided in the building and furnishing of new houses. Plans 
and drawings for new buildings were made in the architect’s room. 
Epileptics were employed in all the departments of indus- 
try relating to building. Books were printed and bound 
and sold here, especially, popular works for moral and religious in- 
struction. The illumination of mottoes for hospital wards and 
school-rooms and the coloring of picture cards were features 
of the work performed; washing, cooking, knitting, sewing and 
fancy work employed many. A bureau had been established for 
the collection and sale of museum objects, such as antiquities, ar- 
ticles of ethnographic and historic interest, autographs of distin- 
guished people, coins, stamps, bronzes, gems, engravings, etc., and 
specimens from the animal, vegetable and mineral kingdoms. For 
men alone there were over thirty different callings. 

The houses presented great diversity of architecture and posi- 
tion. They were well separated, generally enclosed in individual 
gardens, surrounded by fences, hedges and many trees, and alto- 
gether exhibited the home-likeness of a country village with little 
or nothing to suggest the restraints or discomforts of large institu- 
tions. There was one small cottage set aside for such cases as 
should be mildly insane, but bad cases of actual insanity were sent 
to insane asylums. Everything had been thought out carefully 
for the perfect evolution of this little social world, not only the multi- 
plicity and details of occupations which would give each member of 
the community his choice of callings but even the avocations, games, 
amusements and entertainments that might tend to divert his 
mind from the contemplation of his misfortunes. And since my 
visit the colony has continued to expand, to develop new and val- 


BY FREDERICK PETERSON, M. D. 


143 


liable features and to confer its blessings upon large numbers of 
persons afflicted with this disease. 

Taking Bielefield as a model, nine other similar epileptic colo- 
nies have been established in Germany, one in Zurich, in Switzer- 
land and one in Holland. Most of these are not conducted by 
the State, but are under the jurisdiction of private or church 
charities. None of them are altogether self-supporting but some 
of them approach very near to it. 

It should be stated that before the founding of the Bethel Col- 
ony at Bielefield, a somewhat similar institution, though on a 
much smaller scale, Avas begun in France in the village called La 
Force, near Lyons. Over forty years ago a noble clergyman 
named John Bost established this institution, and it is in a flourish- 
ing state, doing a vast amount of good and redounding to the 
credit of its creative genius. 

It has been found in all of these colonies that no harm is done by 
bringing epileptics into contact with each other. They feel on an 
equality with their fellows in such a place, losing that sense of iso- 
lation and singularity which they cannot but observe in the ordin- 
ary world as separating them from the rest of mankind. They 
enjoy caring for each other and being kind and helpful to their fel- 
low-sufferers. It has been noted, too, that the number of seizures 
almost always diminishes upon entering upon the new and hopeful 
and encouraging life begotten by the busy community. 

Within tAvo or three years interest has been awakened in other 
countries in the matter of provision for epileptics, notably so in 
America and England, where their peculiarly sad condition had 
neither been noted nor considered. In 1890 Ohio took steps to- 
ward the establishment of an institution for epileptics, a Commis- 
sion, consisting of Messrs. J. L. Yance, C. C. Waite and one 
other having been appointed by Governor Campbell, pursuant to 
an Act of the Legislature, to select a site and prepare plans for the 
purpose. Of A^arious sites examined, one at Gallipolis seemed 
best adapted for the project and here a tract of one hun- 
dred acres was presented to the State by the citizens for the 
institution. To the writer, who was consulted upon the subject 
of site and plans, this seemed to be the best location offered; 
for, although an insufflcient space for a large institution, there 
was plenty of land adjacent which could be subsequently added 
to the original tract. Contrary to the ad\dce of the writer 


144 


ON THE CAEE OF EPILEPTICS. 


the architect felt obliged, probably owing to the demand of the 
community of Gallipolis for an institution of striking proportions, 
to group the buildings on a symmetrical plan, such as is frequently 
carried out in the public establishments for the insane. The Ohio 
epileptic hospital is built on the pavilion or cottage plan, a large 
number of these being grouped about the centre or administration 
building. It will therefore not meet in this important particu- 
lar the requirements of a colony for epileptics, although in respect 
to provisions for school-buildings, shops and the like, an effort 
has been made to fit the institution for the particular kind 
of care needed by this class. The name of the institution 
for epileptics in Ohio is also unfortunately chosen, for it is 
called ‘ ‘ The Asylum for Epileptics and Epileptic Insane. ” The cor- 
ner stone was laid with appropriate ceremonies November 12, 1891, 
an interesting address and historical review being given by General 
Roeliff Brinkerhoff , President of the Ohio State Board of Charities. 
Three of the buildings were completed and made ready for occupancy 
in 1892 and nine additional cottages are now |in course of con- 
struction, the last legislature having made a liberal grant for the 
purpose. 

In California detached buildings are being erected upon the 
grounds of the California Home for Feeble-minded in Sonoma 
County, with the view of accommodating the epileptics dependent 
upon the State for pleasant quarters. 

Active measures are being carried out also in Massachusetts, Penn- 
sylvania, Wisconsin and Illinois, for the purpose of securing State 
care and separate provision for the same class of unfortunates. 

Next to Ohio, the State of New York has manifested the most 
interest in her epileptic dependents and in the winter session of 
1 891-2 a law was passed by the legislature making the State Board 
of Charities a commission to select a site and prepare plans for an 
institution for epileptics. The law was authoritative in requiring 
the tract of land secured for the purpose to be four hundred acres 
or more in extent, and the whole scheme of buildings to be arranged 
on the colony or village plan. A committee of the State Board 
of Charities, consisting of Messrs. Oscar Craig, William P. Letch- 
worth, and Peter Walrath, has been busy all of the past summer 
and autumn (1892) in examining a large number of localities which 
they were invited to inspect by the officers of various counties. In 
their report made to the legislature on Wednesday, January 11, 


BY FREDERICK PETERSOK, M. D. 


145 


1893, the State Board of Charities unanimously recommended for 
the proposed colony a site in Livingston County, consisting of over 
eighteen hundred acres, the property of the “ Shakers,” now known 
as the Sonyea Society of United Christian Believers. The Shakers 
have dwindled in numbers to such an extent that they decided to 
give up this colony and rejoin the mother colony near Watervliet, 
N. Y. The land is beautifully situated in the Genesee Valley, 
near the town of Mt. Morris and in one of the finest regions of the 
State. It is exactly fitted to meet the wants of a model colony for 
epileptics. It is traversed by two streams. One of these, the 
Cashauqua Creek, flows through the middle of the land in a deep 
gorge with a fall of one hundred feet. This gorge and creek are of 
immense advantage for the complete separation of the sexes in free 
colony life. The supply of water is abundant and the conditions 
for good sewerage, perfect and adequate in every respect. The 
Western Kew York and Pennsylvania Railroad runs through the 
land and two great trunk lines, the Erie Railway and the Delaware 
and Lackawanna Railroad, are within a mile of the proposed colony. 
The soil is exceedingly fertile and well adapted for all manner of 
agriculture, horticulture, the production of berries and fruits for 
canning industries and the raising of garden produce and seeds of all 
kinds. It has some stone and brick-clay, which will prove useful 
in the development of certain forms of out-door employments. It 
already contains scattered buildings for the accommodation of three 
hundred patients. 

The law which was introduced at the last session of the New 
York Legislature embodied provisions for the purchase of this 
tract of land, and also for the methods of management, government 
and admission of patients to the colony. As some of these may 
be useful to those interested in the establishment of similar institu- 
tions, a few of the chief points will be mentioned here : 

The name of the institution is “The Sonyea Colony.” Thus 
any direct reference to its object is avoided in the title. The 
word “Sonyea” is an old Indian word, meaning sunshine, 
and is historical in that this point was once the site of an ancient 
Indian village of the same name. For the present all insane epi- 
leptics are to be excluded, but, probably, ultimately there will be 
some building for the insane, especially for such as become mentally 
deranged temporarily while residents of the colony, since their 
removal from the happy influences of the community system to an 

K 


146 


ON THE CARE OF EPILEPTICS. 


asylum for the insane would be very depressing and tend to retard 
rather than promote their recovery. 

There will be nine managers appointed by the Governor, two of 
whom are to be women and two to be physicians. They are to 
represent the eight judicial districts of the State of New York, an 
additional member to represent the City of New York. 

The colony is to have a medical superintendent, steward, matron, 
and such teachers and other assistants as are necessary. 

The main object of the colony is to provide for the indigent 
epileptics of the State, but private patients will also be admitted to 
an extent to be determined by the Board of Managers. Epileptics 
of all ages are to be received and cared for ; minors are detained by 
authority delegated by the parents or guardians ; adults are free 
to go or remain, as they choose, there being no deprivation of 
liberty of any kind by methods of legal commitment, such as are 
necessary in asylums for the insane. The charge for maintenance 
of indigent patients is to be borne by the State and a limit of $230 
per annum per capita is established by the law. But it is expected 
that the colony will eventually become, to a very great extent, self- 
supporting. Patients that become insane are to be sent to asylums 
in the districts from which they came, in accordance with the 
lunacy statutes. A special pathologist to reside in the community 
and devote his sole attention to the discovery of the causes and 
cure of epilepsy is one of the features ultimately contemplated in 
connection with this great institution. 

This bill was, unfortunately, vetoed by Gov. Flower for reasons 
best known to himself and the humane measures for the relief of 
the thousand epileptics already upon public charge in New York 
State is therefore postponed for a year or two. 

The care of the epileptic population is then to be summarized 
as follows : 

All are to be treated in accordance with the usual regulations 
as to diet, hydrotherapy and medicinal agencies with the hope 
that in this way between one and six per cent, of them may be 
cured and the disorder in a larger per cent., ameliorated. 

Out-of-door employment in agriculture and kindred pursuits is 
to be provided in abundance. All manner of trades and occupa- 
tions are to be carried on in an epileptic community, organized on 
the village plan. Facilities for education are to be afforded to al- 
most every extent. 


BY FREDERICK PETERSON, M. D. 


147 


Amusement and entertainment and the enjoyment of social in- 
tercourse are to be privileges from which no epileptic will 
hereafter be debarred. 

In this way the happiness of a large number of these miserable 
creatures will be materially increased in spite of the distressing dis- 
ease which they are called upon to suffer, usually for the whole of 
their lives : and though remedial agents applied to their malady may 
prove inefficient, their fate can never be as wretched or hopeless 
as it has been throughout the world heretofore. 

Although it is not given to every epileptic to decribe his own 
sufferings, as Dostojewsky does in his novel “The Idiot,” or to de- 
light the world with music as did the epileptic, Handel, or with 
Comedy as did Moliere, or with Poetry as did Petrarch, or with 
military exploits as did Caesar and Napoleon, or with Religion as 
did Mahomet and St. Paul, still it is a consolation to those afflicted 
with this malady to know that epilepsy and genius may coexist 
and that the possession of the disease does not necessarily lead to 
mental and moral degeneration. The patient may not reach the 
highest position among mankind, but, under the new dispensation, 
he will not be withheld from any attainment in education nor pre- 
vented from exercising all of his capabilities for his own support 
and for his own welfare and happiness. 

Literature. 

Peterson, Frederick, M. D,, The Bielefleld Epileptic Colony, New York 
Medical Record, April 13, 1887. 

Peterson, Frederick, M. D., The Colonization of Epileptics, Journal of 
Nervous and Mental Disease, December, 1889. 

Peterson, Frederick, M. D., A Plea for the Epileptic, State Charities Record, 
June, 1890. 

Vance, J. L., Waite, C. C. (Commissioners) and J. W. Yost (Architect): 
Report of Commission to Select Site and Prepare Plans for the Accom- 
modation of the Epileptic and Epileptic Insane, to the Governor of the 
State of Ohio, December 31, 1890. 

Peterson, Frederick, M. D., State Provision for Epileptics: Address of 
Chairman of Health Department, American Social Science Association, 
at Saratoga meeting, September, 1891. 

Peterson, Frederick, M. D., State Care of Epileptics, New York Sun, Janu- 
ary 11, 1891 ; Stryker, Rev. Peter: A Much-needed Philanthropy, Illus- 
trated Christian Weekly, January 31, 1891. 

Peterson, Dr. F., and Jacoby, Dr. G. W. : The Care of the Epileptic, Report 
of Sub-committee of State Charities Aid Association, State Charities 
Record, February, 1891. 


148 


ON THE CARE OF EPILEPTICS. 


Brinkerhoff, Gen. R., Address on Laying Corner-stone of the Asylum for 
Epileptics at Gallipolis, Ohio, Ohio State Journal, November 13, 1890. 
Ewart, Dr. Theodore C., Colonization of Epileptics, Journal of Mental 
Science, June, 1892. 

Peterson, Frederick, M. D., Outline of a Plan for an Epileptic Colony, New 
York Medical Journal, July 23, 1892. 

Peterson, Frederick, M. D., The Care and Colonization of Epileptics, 
Journal for Nervous and Mental Disease, August, 1892. 

Taylor, Dr, Madison J., The Care of Epileptics, University Medical Maga- 
zine, 1891-2. 

Drs. Henry Stedman, W. N. Bullard and L. W. Baker in this country, 
have also contributed to the movement for better care for epileptics, especi- 
ally in their State of Massachusetts. 

A Colony of Mercy, by J. Suter. New York: Dodd, Mead & Co., 1893. 

The Epileptic and Crippled. Charity Organization Series. London: 
Swan Sonnenschein & Co,, 1893. 


THE COMMITMENT, DETENTION, CARE AND TREAT- 
MENT OF THE INSANE IN AMERICA. 


BY G. ALDER BLUMER, M. D., L. R. C. P. Edin., 
Medical Superintendent of the Utica State Hospital, Utica, N. Y. 


It was once said of Francis Bacon, Lord Verulam, that he 
rose above the horizon of knowledge high enough to take 
a wide view of the whole field without going so high as to 
lose sight of any of its details. Such a view of human knowl- 
edge in general is one that would be most appropriate to, and 
indeed greatly facilitated by, this occasion of a grand Interna- 
tional Columbian Exposition, designed to furnish both object 
lessons and detailed information upon almost every subject of 
human interest. 

But non omnes omnia: and in view of the necessary limitation of 
human faculties there has to be infinite division of labor in the 
various departments of human research and investigation. Nearly 
all these departments of knowledge concern in a greater or less 
degree the interests of civilization and the comfort and welfare of 
mankind; but that in which we are at present actively engaged 
yields to none in the difiiculty and abstruseness of its studies or 
the momentous issues to society of the labors and resources 
expended upon it. 

If the poet said “The proper study of mankind is man,” it 
must be admitted that this marvellous human organism has this in 
common with the external world of nature, that it yields up the 
mysteries of its working only to the most patient and unremitting 
toil, if, indeed, in some departments it yields them up at all: for it 
must not be forgotten that the crucial questions of our specialty 
lie in that borderland of psychology and physiology as to 
which Prof. Tyndall, in his famous Belfast address, said 
that “ the passage from physics to the phenomena of conscious- 
ness is unthinkable.” 

It is not necessary, however, that I should point out in this 
presence the many signs of definite results gained or likely to be 


150 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

gained by the studies of recent years in this department. The 
specific topics assigned me on this occasion are the Commitment, 
Detention, Care and Treatment of the Insane. 

COMMITMENT. 

Two facts are now almost universally recognized in our profes- 
sion, if not universally acted upon by the public, as is certainly 
desirable. 

Firsts that insanity is always a disorder or disease of the human 
organism; second^ that it is a disease that very speedily, if not 
taken at the onset, “takes a set” in the human system, or, as we 
say, becomes chronic and difficult, if not impossible, to cure. 

The general conviction of insanity as a disease is shown in the 
modern tendency to change the old name, lunatic asylums, to that 
of hospitals for the insane by legislative enactment. No longer 
are they looked upon merely as places of custody and restraint of 
liberty for fear of the harm their inmates may do when at large, 
but as institutions for treatment and cure of disease with the 
application of medical science and under the direction of the best 
medical skill and judgment to be had. With this hospital con- 
ception of our institutions, recognized by law, their privileges 
should be accessible to all the unfortunate victims of this disease 
as their right on the shortest possible notice without let or 
hindrance arising from compulsory compliance with irksome, 
unnecessary and sometimes humiliating legal requirements. 
Immediate treatment is of higher obligation than any mere 
documentary and elaborate forms of law. The natural reluctance 
of the patient to admit his insanity and the dread of publicity 
with a sense of shame or quasi disgrace on the part of friends and 
family are all sufficient causes of delay in a case without adding 
to them a series of legal proceedings which, even to an ordinary 
outsider, bear too much the stamp of a criminal prosecution, and 
in the ordinary patient only serve to exacerbate his disease. Too 
much of our legislation seems to be based on the assumption of 
improper motives on the part of friends and relatives, as if it 
were to be expected that cruelty and inhumanity, instead of being 
the rare exception, should be the normal rule and state of things 
in civilized society. But a system of statutes founded on this 
supposition would be an insult not only to the community in 
general, but especially to the medical profession. Self-interest, 


BY G. ALDER BLUMER, M. D., L. R. C. P. 151 

if no higher consideration, would make both family and physician 
alike chary of depriving a person of his liberty. No superin- 
tendent could have any motive to connive at an improper commit- 
ment, and even assuming the possibility of a corrupt official at the 
head of an institution, any conspiracy would have to involve 
many others both inside and outside of the institution. 

As to this matter of improper commitment. Lord Shaftesbury, 
before the special commission of parliament on lunacy laws in 1877, 
who at that time had been permanent chairman of the British 
Lunacy Commission thirty-two years, held the following language : 
“I am ready enough to believe that when temptation gets hold of 
a man’s heart he is capable of doing anything. But, I am happy to 
say. Providence throws so many difficulties in the way of these 
conspiracies that I believe conspiracies in ninety-nine cases out of 
a hundred to be altogether impossible. The number of certificates 
that liave passed through our office since 1859 amounts to more 
than one hundred and eighty-five thousand, and of all those certifi- 
cates I do not think so many as half a dozen have been found 
defective. I am quite certain that out of the one hundred and 
eighty-five thousand there was not one who was not shut up upon 
good prima facie evidence that he ought to be under care and 
treatment.” And I am sure that all lunacy commissioners and 
practical alienists on this side of the Atlantic could bear similar 
testimony to that furnished by the experience of European coun- 
tries. But on this subject undoubtedly there is urgent need of 
greater uniformity in legislation. And as to the mode in which 
this uniformity is to be brought about Pliny Earle wrote in the 
American Journal of Insanity for July, 1868 : “ The most that 
can be done is to affirm and reiterate some general principle that 
commends itself to intelligent approbation and to leave it to make 
its way among men of sense and influence, as all good general 
principles will, until it becomes the common sense of the com- 
munity.” Dr. Stephen Smith also in a paper before the National 
Conference of Charities * has made an able plea for unification of 
State laws and has shown how much can be accomplished for this 
cause by “affirmation and reiteration.” Commenting upon the 
commitment of the insane by the examination and decision of 
physicians, which method obtains in the States of New York, 
New Hampshire, Georgia, Texas, Connecticut, Vermont, Pennsyl- 


*See Amkrican Jourkal op Insanity, October, 1892. 


152 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

vania, Rhode Island, Tennessee and the District of Columbia, Dr. 
Smith says : “In the commitment of the insane on the decision 

of medical men alone we have the highest development of this pro- 
ceeding yet placed on the statute book. The true nature of 
insanity is fully recognized and the insane are removed from 
the category of criminals, and placed among that class of sick 
persons requiring only medical care and treatment.” In some 
States (Mississippi, Texas, Wyoming and others) a public patient 
is committed on the verdict of a jury of laymen, no medical 
examination being required. This, to say the least, is a semi- 
barbarous method and involves the cruelty of making sick persons 
objects of curiosity and ridicule among public spectators. In Illin- 
ois, Kansas and Minnesota commitment is on the verdict of a 
mixed jury of laymen and physicians. The law requires that at 
least one physician shall be on the jnry. This is only a shade less 
barbarous. 

Dr. W. W. Godding says on this subject, “In considering the 
question of the existence of insanity the presence of a jury is not 
only not required but is often an embarrassment which defeats 
the ends of justice and causes harm and suffering to the insane. 
In aiding the court to form a correct opinion a jury could not be 
of service in any case where commitment is recommended by qual- 
ified physicians for the care and treatment of the insane.” 

In 1889 the jury law of commitment of Illinois had been in 
operation twenty-two years. From data obtained by Dr. Chapin* 
in that year it appeared that the average number of persons 
annually declared insane in that State was 1,500, and that the 
whole expense attending the proceeding in each case did not fall 
far below $20. On this basis, the services of 9,000 jurymen are 
annually required to guard in this manner the personal liberty of 
the citizens of Illinois at an expenditure of $30,000. The whole 
number of jurymen summoned since the passage of the law may 
be estimated approximately at 234,000 at a total cost to the State 
of over $700,000. 

In the State of New York a sworn certificate of two physicians 
is required. Such physicians must be of reputable character, 
graduates of incorporated medical colleges, permanent residents 
of the State, in actual practice at least three years, and not con- 

* President’s Address, Association of Medical Superintendents, Journal or Insanity, 
July, 1889. 


BY G. ALDER BLUMER, M. D. , L. R. C. P. 


153 


nected with the hospital to which the patient is to be committed. 
These qualifications must be certified to by a judge of a court of 
record, and the names of all such qualified examiners must be on 
file with the State Commission in Lunacy. There must be a 
personal examination of the patient by the physicians, and the 
certificate must bear date of not more than ten days prior to 
commitment. The certificate must finally be approved by a judge 
of a court of^record of the county or district in which the patient 
resides, who may at his discretion institute further inquiry or take 
proofs on calling a jury under the common law. 

This process, which has been largely adopted in its essential 
features in recent lunacy legislation elsewhere, perhaps interposes 
as little hindrance or delay as any legal process can to the prompt 
and speedy commitment of the insane person to the care and 
treatment which he immediately needs. There is a vastly greater 
number of persons utterly lost to society and deprived of the 
capabilities of ordinary life by the shameful neglect and hindrance 
of those who should know better in the first and early stage of 
this disease than by all the mistakes or the undetected evil 
intentions of improper commitment that were ever known. If 
it had ever been possible to convince the public of this truth so as 
by law to prevent that fatal procrastination with which many 
wait until more violent symptoms have set in, and if the vast mass 
of chronic insanity which now crowds our institutions had been 
put under that treatment within three months of the attack, it is 
safe to say at least that our present plant for the insane would 
hardly have needed enlargement. The saving of human lives and 
human minds to the community would have been enormous. 

DETENTION. 

The question of detention is, of course, simply a medical ques- 
tion of the continuance of the care and treatment. In nearly 
every case we have ever known of a discharge on a writ of habeas 
corpus the judicial certificate of sanity, whether arrived at by the 
court’s personal observation or by witnesses of miscellaneous char- 
acter before it, was such as might have replaced the medical cer- 
tificate required by law at the time of the patient’s commitment. 
The subsequent history of such cases has seldom been calculated 
to add confidence in such decisions. With State Commissions in 
Lunacy, State Boards of Charities, local Boards of Managers, and 


154 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

Other supervisory bodies acting as a check upon medical officers^ 
it is not likely, indeed it is impossible, that the just claims of 
patients to be restored to liberty could be unrecognized. In fact 
the tendency is now-a-days, in view of the crowded condition of 
our institutions, to err, not on the side of caution, but rather to 
discharge patients from custody before their mental health has 
been fully re-established. 

Here, of course, it will be pertinent to consider the functions 
of such Boards as the British and American Commissioners in 
Lunacy. It is evident that the office of such Boards should be 
in the main simply supervisory. It is difficult to overestimate 
the benefit that may accrue to the service from the exercise of a 
proper central supervision. But the too industrious exercise of de- 
tailed and minute executive powers would be bound to give rise 
to much friction and practical difficulties. The scope of medical 
judgment should be left as wide as possible, while the necessities of 
the mechanical plant and maintenance may perhaps derive vigor 
and completeness from outside direction. On this subject Lord 
Shaftesbury (before quoted), before the same parliamentary com- 
mission, delivered his opinion as follows : “If you want to increase 
the visitations of the asylums, I would increase the visitation by 
the Visitors [in America, Managers] and by the House Committee. 
They have very great advantages because they know the character 
of every patient, and they know the character of the superintend- 
ent, and they can judge far better than any strangers can. Then, 
above all things, they have the power in their hands. We, in vis- 
iting asylums, have no power at all. We have only to examine 
and report. And it is very undesirable that we should have fur- 
ther power. It would only cause a great deal of bad blood and 
opposition, and I am sure that the success we have had with the 
County Asylums [in America, State Asylums] has been entirely 
because we have done everything by persuasion, by the force of 
experience and constant observation, and we have never exercised 
any authority. We never had any to exercise, and it would be 
most unadvisable to give us authority.” If the superintendent is 
to be merely a medical clerk, subject to some remote central 
authority, the grade of such officers must sulfcr in the appointment 
of men whose ambition would scarcely be satisfied with such meagre 
opportunity for exercise of individual ability, skill and judgment 
in the conduct of a hospital. It would have a tendency to cramp 


BY G. ALDER BLUMER, M. D., L. R. C. P. 


155 


\ 


rather than develop. A stunted uniformity is not the law of 
progress. What Dr. Godding has called “ the day-book and 
ledger plan ” of caring for the insane can never promote the 
growth of an enlightened system of public charities, though it 
may answer the ends of a centralized bureaucracy under an 
imperial government. This kind of thing almost always 
degenerates into a dull perfunctory round of duties, such as 
Dickens mercilessly caricatures under the symbol of red tape, in 
which nobody is supposed to know anything except what lies in 
his own immediate line. 

It is particularly for this reason also that we must deprecate 
politics in asylum management as the greatest evil of the day in 
the administration of State charitable institutions. In the political 
world the emoluments of office have usually been regarded as of 
more importance than the responsibilities and work of the office 
itself. In the rivalry of political parties it is extremely difficult to 
restore the moral standard of a true proportion between the honors 
and emoluments of office and the conscientious discharge of the 
work and duties expected of it. 

In this matter of politics in charitable institutions, I regret to 
have to say that this State of Illinois has furnished a palmary 
example of the mischief. The notion that medical officers of 
hospitals for the insane are the pensioners of a party and not the 
servants of the whole people seems to die hard. It may be true 
that in this State the course of the Republican party during the 
long period of its dominance has afforded some excuse for such a 
course so far as one wrong may be said to justify another, but so 
far only. Within recent years the superintendent of one of the 
hospitals for the insane in this State was driven out of office with 
little or no pretense of concealment of the fact that the ground of 
his dismissal was his lukewarmness in partisanship, and, but for 
the fear of disregarding obligations imposed by considerations of 
tact and good taste at this time, one might instance more recent 
examples. We expose ourselves constantly to the ridicule of the 
entire civilized world outside of our own country in seeming to 
entertain the idea that a man’s political views have anything to do 
with his professional competency. It is the view that the salaries 
of these officers are not primarily the reasonable compensation for 
honest and faithful discharge of their professional duties, but the 
reward of their activity in an entirely different field that allows 


156 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

people to view with approval or indifference such changes entirely 
without regard to the merits either of those who are turned out or 
those who are put in. The pernicious effect of such a policy is so 
plain that we should feel that we were insulting the intelligence of 
our hearers by arguing the question. Men whose aspirations are 
for professional eminence and usefulness will hesitate about accept- 
ing positions in which such qualities count for nothing. Even if 
competent men are secured, they are sure, in a State in which 
parties are pretty evenly balanced, under such a system to be 
turned out before they have acquired the experience that will 
enable them to do their best work. The inevitable tendency 
under such conditions is to the filling of the offices by men 
whose only object is to make money out of them and who, 
knowing that the time is short, will “make hay while the sun 
shines.”* 

It is largely on the same lines that we may speak here of the 
Boards of Managers or Trustees of our State Hospitals. The 
kind of men desirable for such positions are such as we would call 
men of affairs with sufficient knowledge of what the public 
requires, and especially the quality of benevolence and sympathy 
with common humanity. On no account should the offices be 
salaried. But it is not difficult to find men in every community 
willing to give their honorary'' services as their contribution to the 
cause of charity. Moreover it is a vast benefit to the various 
localities of the State where these institutions are situated to 
develop as widely as possible the local spirit of unselfishness and 
practical benevolence and to enlist the interest and pride of many 
localities in the honor of the State in the support of its numerous 
charities. The local Managers too are able to gain a more intimate 
knowledge of the detailed affairs of such an institution, standing 
between the superintendent and the public, and are able to give 
such information to outside inquirers in regard to internal condi- 
tions as an occasional visiting officer from a distance could not 
render. It is evident that the more sordid politician can have no 
use for such a place and position or no claim upon the Governor of 
the State to appoint him to it. To constitute Boards of Managers in 
such a manner would only be a stepping-stone to the fatal policy of 
abolishing such local trusteeship altogether and establishing in its 

* See “Are Asylum Physicians Party Pensioners ? ” American Journal op Insanity, 
April, 1893. 


BY G. ALDER BLUMER, M. D., L. R. C. P. 


157 


place a sort of official oligarchy at the seat of government to 
administer the charitable system of the State on a plan too much 
assimilated to that of its penal system. 

Under this same general division of the subject, let me refer to 
the enlightened policy of New York in the inclusion of medical 
appointments at State Hospitals in the Civil Service system by re- 
quiring competitive and non-competitive examinations as a condition 
sine qud non to preferment. Although the latter plan may not be 
always satisfactory in results, it being difficult or impossible to 
test by examination the moral and all-around fitness of a candidate 
for appointment, yet great improvement is likely to follow from 
the recent adoption of a medical interne system under a scheme 
recently suggested by the New York State Commission in Lunacy 
and promulgated by the Civil Service Commission. Under this 
arrangement a medical superintendent may appoint “physicians 
who are graduates of not more than two years’ standing, of a 
legally chartered medical college, such as is recognized by the 
University of the State of New York, such appointees to be known 
and designated as Medical Internes, the number of such medical 
internes not to exceed two in any one hospital.” 

It is perhaps unfortunate from the scientific point of view — 
science having nothing to do with State boundaries — that candi- 
dates for the medical service in the State of New York should be 
required to show a residence of at least one year in the State. It 
would seem that the hona fide intention of the candidate to reside 
in the State should be sufficient. The present restriction practi- 
cally excludes from medical service in the State of New York, in 
a department of work in which it is desirable to procure the 
highest talent, all residents of other States, no matter how ' 
extraordinary their qualifications. 

By a recent act of the legislature all the insane in the State of 
New York are made the wards of the State and the dependent 
class are all provided for in the hospitals which are arranged for all 
classes of cases both chronic and acute. The policy of asylums 
for chronic cases exclusively is now abandoned and all her institu- 
tions are now what have been called “mixed asylums.” After 
half a century of endeavor. New York has all but succeeded in 
making provision for all her dependent insane. In the kind of 
construction followed under this new law, which limits the per 
capita cost for new buildings to five hundred and fifty dollars, 


158 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

including furniture, the State of 'New York has realized the force 
of Dr. Godding’s dictum, picturesquely expressed in an address 
before the Conference of Charities a few years ago: “There is 
to be less laying of corner-stones with appropriate ceremonies, but 
more ordinary brick- work; building to anticipate rather than 
follow the needs of the insane, and so, with no flourish of 
trumpets, but silently keeping step in the march of human brother- 
hood round the world.” But there is some danger that in the 
vast mass of chronic insanity acute or recent cases may be 
neglected. The next step should be improved provision for the 
recoverable insane. The best efforts of the medical and nursing 
staff should be concentrated in the hospital block upon hopeful 
cases. The rude touchstone of expense should not for a moment 
be considered as a test of the desirability of such provision, but, on 
the contrary, nothing should be omitted, whether in construction 
or equipment, that makes for the recovery of our patients in the 
incipiency of their disease. Such a service should embrace all the 
adaptable features of the modern general hospital and have placed 
at its disposal the picked nurses of the institution. It should have 
facilities for classification sufiiciently minute to provide, if 
necessary, for the isolation of individual cases. It might also con- 
' tain an observation ward into which all new cases, with few 
exceptions, could be first admitted. Preferably such a hospital 
block should be situated near the main building within easy access 
of the medical officers, so as to insure frequent visitation through- 
out the day. Given such enlightened provision, one might easily 
conceive cases of insanity admitted to its wards and going on to 
rapid recovery without subjecting them to a contact with the great 
mass of chronic insanity, which so often has such a depressing 
effect upon recent cases. I understand that this idea is now being 
carried out on a scale of magnificence unparalleled in this country 
in the new building now in course of erection at Waverly near 
Boston, to take the place of the old McLean Hospital at Somer- 
ville. The first State institution to thus provide for its public 
insane will probably be that to be erected at Massillon, Ohio. 

In this connection one might mention the out-patient depart- 
ment for mental cases, in conjunction with the Pennsylvania Hos- 
pital for the Insane. This service was begun in October, 1885, in 
the building known as the out-patient department of the Pennsyl- 
vania Hospital at Eighth and Spruce streets, Philadelphia. It was 


BY G. ALDEll BLUMER, M. D., L. R. C. P. 


159 


suggested to Dr. Chapin by the fact that there were frequent 
applications for admission to the department for the insane of 
patients presenting an early physical impairment and nervous 
prostration culminating in insanity. They were mostly young 
men and women engaged in mills or in stores. It seemed 
that many of these persons, with proper attention and advice, 
could have escaped the attack of insanity. It was believed 
that in a city with a population of one million there were many 
cases of incipient insanity, if they could only be reached, that 
might be relieved without treatment in a hospital for the insane. 
In every dense population there are, of course, many such cases. 
There is also a necessity for a place where information about the 
commitment of the insane and about the insane may be furnished. 
This service has been rendered by the four assistant physicians of 
the Pennsylvania Hospital for the Insane, serving three months 
alternately, on two afternoons of every week. The number of 
new cases of the class for whom the service is designed that have 
come to this out-patient department has averaged about thirty 
yearly and the number of visits made by each patient six. Soon 
after the service was established a similar one was begun in several 
places in the city of Philadelphia. When the proposition to estab- 
lish this out-patient department was first discussed it was expected 
that a large number would apply, as it seemed it might meet a 
much needed want. This expectation seems scarcely to have been 
realized by the experience of eight years, but it mus't be borne in 
mind as an incident of the establishment of new dispensary services 
elsewhere that the popularity of a new department increases slowly. 
Every year a number of patients have been cured and saved a 
journey to the hospital for the insane. It is found to be a con- 
stant embarrassment, however, that the persons applying are poor 
and have no money to spend on good food, medicines, rest, change 
of scene, etc. On the whole, the Board of Managers of this enter- 
prise feel encouraged to continue what is believed to be a good 
work, as the more thought that is given to it seems to lead to some 
new field of promise for unfortunate, hard overworked persons 
who are poor and apt to succumb to mental strain. 

I take pleasure in entering somewhat into detail on this subject, 
not so much in order to claim priority for outside dispensary work 
for the Pennsylvania Hospital for the Insane, but because it seems 
to be little known, and a recent article on the subject refers to, 


160 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

as something new, work in England of a similar kind that was 
undertaken subsequently to the dispensary service of Philadelphia. 
Alas! it happens too frequently in New York City that when her 
physicians sweep the horizon of recent achievement they find it 
convenient to wear a green patch over the eye that rests on 
Philadelphia. 

I may refer here also to the desirability of a system of paroles 
or leave of absence as a means of testing the patient’s mental poise 
before final discharge. Yery often patients do very well under 
the discipline and routine of a hospital, but may relapse when 
again subjected to the conditions at home under which the attack 
arose. This plan saves the expense and annoyance of a re- com- 
mitment, besides having a restraining influence upon the patient. 
There is no statutory provision for a furlough in the State of New 
York. 

The draft of a bill for an act to revise the law relating to the com- 
mitment and detention of the insane in Illinois, which bill is the 
result of an exhaustive study of the lunacy acts of all the States 
and Territories, and in its present form has received the endorse- 
ment of both the judiciary committees of the 37th General 
Assembly, wisely provides for furloughs as follows: “Authority 

is also vested in the Trustees to release patients on parole for any 
term not exceeding three months, and if not returned to the in- 
stitution within that period, a new order of commitment from the 
county judge shall be necessary in order to the readmission of any 
such paroled patient to the institution.” By the terms of this 
section, the authority to discharge may be delegated by the 
Trustees by a formal vote, entered of record, to the Superintend- 
ent, under such regulations as they may see fit to adopt. A simi- 
lar law in operation in the Province of Ontario has proved of 
inestimable advantage to the insane. 

Boarding out . — Is it adapted to this country? On the whole, 
I believe the experience of Massachusetts has been favorable, 
although the difficulties of proper supervision must be vast. It 
has been rather forcibly objected that the rights of another gen- 
eration are sacred, and that “it is an outrage to shadow the 
susceptible years of childhood with a lunatic sitting on the hearth- 
stone,” but the experience of a quieter and less restless civiliza- 
tion than ours, such as that of Scotland, may furnish a different 
experience on this subject. 


BY G. ALDEK BLUMER, M. D., L. R. C. P. 


161 


Correspondence of Patients . — Correspondence of patients ha& 
always been a quoestio vexata with us in New York. The maxi- 
mum of freedom is allowed consistent with the welfare of the 
patient and of society. In New York the following rule of the 
State Commission in Lunacy obtains: 

“Ordered: 

1. That each insane patient be permitted to write to some 
relative or friend once in two weeks, and oftener if necessary, in 
the discretion of the medical superintendent. In the case of 
patients unable for any cause to write, the medical superintendent 
must direct some proper person to write for such patients at suita- 
ble intervals, if they so desire. All letters must be forwarded 
at once, unless they are obscene, profane, illegible or too in- 
coherent to be understood, and the postage must be furnished 
by the institution, if relatives or friends are unable to provide 
the same. 

2. All letters detained because of obscenity, profanity, or for 
other reasons, must be forwarded at once to the office of the 
State Commission in Lunacy, and reasons for the detention 
must be briefly stated in each case by endorsement^? upon the 
envelope. 

3. All letters addressed to the Governor, Attorney- General, 
Judges of Courts of Record, District Attorneys or the State 
Commissioners in Lnnacy, must be forwarded at once, without 
examination.” 

In practice this rule has been found to act fairly well except 
where patients, availing themselves of the privileges under Sec- 
tion 3, send letters to unauthorized correspondents as enclosures 
within an envelope whose sanctity of seal is respected because 
addressed to one of the public officers therein enumerated. Every 
institution has its patients bent upon making mischief, some of 
whom may always be relied upon to bear this Section in mind. 
In connection with this matter, and along with the rule above 
cited laid down by the State Commission in Lunacy, we quote their 
remarks in their third annual report: “All who are engaged in 
the care and treatment of the insane, know how often it happens 
that the language of insane persons, particularly women, who, 
when sane, are most exemplary in speech and conduct, becomes, as 

L 


162 CARE AND TREATMENT OF THE INSANE IN AMERICA. 


a result of their disease, vulgar, profane and even obscene ; and 
that these unfortunate tendencies are quite as liable to manifest 
themselves in the writings of such patients as in their oral ex- 
pressions ;’^'hence, to permit them to freely expose their morbid men- 
tal aberrations to whomsoever they may elect, would be a cruel, if 
not a brutal, wrong to the patients themselves as well as to their 
friends. In fact, all who are practically familiar with the subject, are 
aware of the importance of protecting such patients from their own 
insane follies, by detaining letters of the kind referred to. It 
would not be difficult to imagine the sense of humiliation, shame 
and disgrace which a naturally modest and refined man or woman, 
on recovering from an attack of insanity, would experience upon 
knowledge of the fact that, while in a state of mental irresponsi- 
bility, he or ’she had been allowed to thus expose and parade his or 
her mental vagaries to the outside world, through letters to chance 
acquaintances or perhaps to entire strangers. 

Then, too, the relations of the insane — parents, wives, hus- 
bands, brothers and sisters — ought to be spared the annoyance 
and chagrin which the enactment of such a law would impose 
upon them. 

Moreover, instances have been known where poisonous drugs, 
and even dangerous weapons, have been surreptitiously trans- 
mitted to patients by the mistaken kindness of friends, although it 
may be stated that this probably has rarely occurred, except in the 
cases of persons confined upon ‘criminal orders.’ It also fre- 
quently occurs that in efforts to escape, persons of means who are 
visited by insanity, address communications, or would do so if per- 
mitted, to all sorts of people, inviting them for a moneyed consid- 
eration to aid them to escape, and thus innumerable law suits and 
difficulties have arisen. It is clear, therefore, that some regula- 
tions upoi the subject should be provided, whether by statute or 
by the order of some executive body, may be a question.”* 


* [Note.— Since this paper was read, Assistant Attorney-General Thomas, of the Post 
Office Department, has delivered an opinion on this subject to the New York State 
Commission’in Lunacy, under date February 8, 1894, as follows: “As per request made 
by Assistant Attorney-General Whitney I have to enclose herewith a copy of the ruling 
referred to in the newspaper clipping presented by you, covering the disposition of mail 
matter addressed to prisoners confined in county jails and awaiting trial upon indictment. 

The specific case passed upon, wherein the question of delivery of mail matter to 
insane persons was considered, has reference to a person certified to be non compos by 
several physicians and confined in a county asylum, but whose status as a sane person 
had not been passed upon by a court and jury. 

As a general rule, it may be stated that if a person has been adjudged insane by a 
court of competent jurisdiction, by which a conservator or manager of his business or a 


BY G. ALDER BLUMER, M. D. , L. R. C. P. 


163 


CARE AND TREATMENT. 

Under the head of care, we may say that the most notable 
advance of recent years in our specialty has been the establishment 
in many of our institutions of training schools for nurses and 
attendants, and the employment therein of those who have had the 
benefit of this special course of instruction. Wherever honestly 
tried, the results have practically exceeded the most sanguine antic- 
ipation. Although this subject properly belongs to another section 
•of this Congress, and has also been treated in a separate paper by 
Dr. Burr, it may be proper to refer to Dr. Cowles’ paper at the 
Seventeenth General Conference of Charities at Baltimore in 1890, 
which shows the far-reaching benefits of the system among the gen- 
oral community and the practical aid it is to the medical profession. 
Of course, it is not a matter of mere by-play and amusement, and 
it is most important to cultivate the spirit of earnestness and 
thoroughness in this kind of work and not to be satisfied with the 
mere tinsel of graduating exercises and other superficialities. 

Too much cannot be said of the modern method of caring for 
the helpless insane on the congregate plan in large dormitories, day 
rooms and service rooms especially adapted for the management of 
this otheiwise troublesome class of cases. In the first place, much 
has been gained by removing such patients from the general wards, 
where they were an eyesore and offense to their less demented 
fellows, and, in so far, a hindrance to recovery among the recover- 
able insane who were forced into an association with them. Now, 
with suitable structural arrangements, and a special corps of 
nurses to wait upon such patients hand and foot night and day, it 
is astonishing how much has been accomplished to create habits of 
order and cleanliness, and how much the general welfare of the 
whole hospital has been promoted. To those members of the Con- 
gress who are interested in the care of this class of patients, I may 


guardian of his person has been appointed, all mail matter addressed to such person 
should be delivered to such conservator, manager, or guardian or according to the 
latter’s direction. In case a person be adjudged insane or an imbecile by a court, and 
he be confined in an asylum by order of a court and there be no conservator, or man- 
ager of his business, or guardian of his person lawfully appointed, then mail matter ad- 
dressed to such person may be delivered to the keepers of the asylum. 

The jurisdiction of the Post Office Department as a carrier over such mail matter may 
be said to cease when such delivery is effected. Of course, it must be recognized that 
the authorities of such institutions are required to exercise a proper discretion in the 
matter of delivering mail to inmates, and in preventing the transmission of letters in- 
tended for delivery by such inmates, to outside parties, especially so, when the interests 
or recovery of patients might be endangered or the safe administration of the affairs of 
the institution interfered with.”] 


164 CARE AND TREATMENT OF THE INSANE IN AMERICA. 

Bay that in the Anthropological Building of the World’s Fair 
may be found a model of such a group of infirmary buildings 
erected at Utica, N. Y., under the State Care Act, and opened 
in the fall of 1892. The model was made accurately to the scale 
of one-quarter of an inch to the foot by a patient of the institution. 

The word “treatment” almost invariably suggests to the lay 
mind the idea of drugging. It is hard to dislodge the calomel 
and jalap conception of treating disease by the introduction of 
nauseous compounds into the corpus vile of the hapless patient. 
It is a relic of the same mediaeval mysticism that gave point to the 
caustic satire of Moliere’s medical comedies and enabled Sganar- 
elle to expel his “peccant humors” and that, in recent times, has 
put much gold into' the pockets of certain shrewd practitioners, 
however little of the precious metal may have found its way under- 
neath the skin of the habitual drunkard. Mats nous avons chang4 
tout cela. So great an authority as Dr. Clifford Allbutt said two 
years ago,* in discussing the proposed hospitals for the treatment of 
the insane, suggested by the London County Council, “The fact 
is, gentlemen, this desire to reinstate treatment by medicine is a 
retrograde tendency. Modern therapeutics are marked, not by 
the multiplication of medicines, but by a gradual restriction of 
their field.” And to those general practitioners whose cry is for 
more physic for the insane, he would put the awkward query, why 
they so constantly fail to cure their insane patients outside of an 
asylum, and how it happens that even those of them who have 
seen much of insanity are the first to impress upon people the 
futility of such outside treatment and the need of early removal 
to an institution for the insane. 

True, great advance has been made in the line of sedative and 
hypnotic remedies as the result of painstaking research, but, using 
the .word “treatment” in its most comprehenvsive sense, the most 
marked progress has been made in securing for the patient the 
environment, physical, mental and moral, proper to his restoration. 
Uo longer the victim of drastic experiment in pharmacodynamics, 
greater attention is now paid to his diet and personal hygiene. He 
is better “groomed” if one may use the expression, than ever be- 
fore. Conspicuous and pre-eminent among these modern methods 
of treatment is the provision of systematic and diversified occupa- 

* The Proposed Hospitals for the Treatment of the Insane, Journal of Mental Science, 
October, 1891. 


BY G. ALDER BLUMER, M. D., L. R. C. P. 


165 


tion. The idea is probably as old as the disease itself. Fifty 
years ago, Dr. Brigham, the first superintendent of the Utica 
State Hospital, a man far in advance of his age, had his shops in 
oonsiderable variety, and his contemporary, that great man lately 
deceased, Pliny Earle, also promulgated sound views on this sub- 
ject. So long ago as 1867,* he ridiculed the idea of a mollycod- 
dling optionalism in the application of this potent agency for the 
patient’s cure, and the deference of the physician, supposed to be 
rational, to the judgment of the patient known to be irrational. 
Then, as now, there were patients who at a certain stage of their 
disorder could be cured by labor and apparently by nothing else — 
patients who, in the absence of suitable occupation, became 
apathetic and incurable and often dragged out their lives listless 
and imbecile by reason of the neglect to provide this kind of 
treatment. The query suggested itself to Dr. Earle then, “Why 
is it that the onlj" medicament which, as it is believed, will effect 
a cure, is not prescribed and administered?” And this same 
•question is to-day being propounded to progressive Managers and 
Superintendents all along the line. The answer may perhaps be 
found in the niggardliness of State legislatures to provide proper 
workshops for this kind of treatment, but, more frequently, I 
believe, the explanation lies in the timidity of superintendents to 
urge, if not coerce, those patients whose objection lies in the often 
beard excuse, “I did not come here to work. If I can work here, 
I can work at home and be paid for my labor.” ISTeither prop- 
osition is necessarily true, coming from the lips of an insane 
patient. As a matter of fact, much work can be done by patients, 
under proper supervision, in a well organized hospital, that would 
be impossible of performance outside, and labor, like virtue, is 
its own reward. 

I would here dwell upon the advisability of finding, and obtain- 
ing sanction for the use of, a market for the surplus product of 
patients’ labor, and thus enable them to^ contribute to their own 
support while being maintained at public expense. Any hospital 
with a mass of able-bodied patients at its command can soon 
:accumulate a surplus of mats, brooms, brushes, willow-ware, and 
the like. The strong and fearless arm of philanthropy should 
protect institutions against a bullying at the hands of ignorant 
selfishness when organized labor interferes with the proper treat- 
ment of afflicted humanity. 


* See Journal op Insanity, October, 1867. 


\ 


166 CARE AND TREATMENT OP THE INSANE IN AMERICA. 

Opportunity may also be taken here to refer more particularly 
to the great value of printing and book-binding as avenues of 
useful and congenial laboi* for nimble-fingered women. This- 
occupation meets very nicely the requirements in furnishing mental 
as well as physical stimulus to the insane. Hospitals for the insane 
might be permitted to do not only all their own printing, but also- 
much of the printing required by the State elsewhere and now 
done at public expense. They might, perhaps, print and bind 
Transactions of Congresses such as this. If I may be pardoned 
for referring again to the Utica State Hospital, I might state 
that the institution has a printing office measuring 26 feet by 
69 feet 6, in which as many as ten women patients have been em- 
ployed in typesetting during the present year. This office has- 
already outgrown its quarters. Nothing in the way of occupation- 
has furnished more satisfactory results than this department, and 
I am convinced that much saving could be accomplished to the 
State and incalculable benefit provided for its patients by 
establishing a printing office and book-bindery in every large 
institution for the insane throughout the country, provided always 
that such facilities as I have indicated be extended either by the 
State or private encouragement. In thus extending the usefulness 
of shops, it would not be necessary to “breast and buffet the 
breakers of public opinion.” Public opinion never arrays itself 
against the sick and the oppressed. It would only be necessary to 
point out the way. Public opinion would take up the cry, and 
such cruel demagogism as would antagonize the movement would 
meet with public execration. Then, the ghost once laid, there 
would be no excuse anywhere for failure to have recourse to- 
restorative labor in every asylum in the land, and it would no- 
longer be necessary for superintendents of hospitals to “ annoint 
their consciences with the balsamic oil of belief that of two evils 
they choose the less.”* The State of Michigan, generally in the 
forefront in progressive movements, has decreed by act of the 
legislature that her superintendents shall provide employment for 
patients. Here is a provision that the State of Illinois might well 
introduce into the draft of her new lunacy bill. 

When we refiect upon the effects soon discernible in the nervous 
system in men who retire from business late in life, often result- 
ing in fatal collapse, it is entirely consonant that persons who- 
have been accustomed to more or less steady occupation all their 


Pliny Earle, loc. cit. 


BY G. ALDER BLUMER, M. D., L. R. C. P. 


167 


lives should not be completely cut off and sequestrated from it, so 
long as they have bodily vigor sufficient to be called into play. 
There can be no doubt that such exercise, both physical and mental, 
in due proportion, exerts a wholesome inffuence upon those parts 
of the organism which are disordered and tends to the restoration 
of healthful functions. 

In short, for the public mind to form a clear conception of what 
is best among all these points of treatment or hygienic manage- 
ment, it requires that the public mind should be more fully 
enlightened as to the nature of the disease of insanity itself, until 
it shall no longer be looked upon as a supernatural visitation or 
some strange and unaccountable happening for which confine- 
ment and restraint are the only remedy, but as a disease 
which has its causes either in the hereditary diathesis of the 
individual or the accidents, abuses or the sanitary sins of life, 
and must be dealt with on the common sense principles of resti- 
tution and repair Avhen the evil has not passed the boundaries of 
a salvable vitality. Such a presentation of the subject adpopulum 
has hitherto been a great desideratum which, it seems to me, has 
been amply supplied by the Secretary of the Board of State 
Commissioners of Public Charities of the State of Illinois, the 
distinguished Vice-President of this Congress, in the second chap- 
ter of their twelfth biennial report, published within the last 
month, and which chapter, I here take occasion to say, is well 
worthy of being printed as a tract for general circulation for the 
better information of the public on this department of organized 
charity. 


PROCEEDINGS. 


The sessions of Section IV, on Commitment, Detention, Care and Treat- 
ment of the Insane, were held in Room XXII of the Memorial Art Palace, 
Chicago, 111. The opening meeting was called to order by the Chairman of 
the Section, Dr. G. Alder Blumer, of Utica, N. Y., at 2.30 p. m., Monday, 
June 12, 1893. 

Dr. Blumer. Ladies and Gentlemen — As long ago as the days of 
the Babylonian Empire, founded by that mighty hunter who set 
himself to investigate how far and by what means his human wit 
could subjugate the brute forces of this planet upon which his race 
had recently been planted, it was expressly predicted that after the 
lapse of ages — in latter days — men should run to and fro in the earth and 
knowledge should be increased. Of these results it is needless to conjecture 
which is first in the order of time. The increase of knowledge has given 
leaps and bounds to the means of locomotion, while this phenomenal gather- 
ing and its world accumulation of objective exhibits sufficiently testifies how 
this universal circulation of humanity constantly adds to the vast sum of 
human knowledge. 

Ladies and Gentlemen, it is not our immediate neighbors, our own kith 
and kin alone, it is not our own blood and race alone — it is not the people of 
our own language and nationality alone that we welcome here on this occa- 
tion. It is the votaries of knowledge from every clime — that knowledge 
which is the beneficent blessing of mankind that we greet here to-day where 
the “westward star of empire” is tarrying now for this “whole boundless 
continent of ours,” for to-day we may excusably feel as if our American 
patriotism were cosmopolitan. 

Neither is it for the mighty demonstration of mechanical and engineering 
power — the innumerable handiwork of inventive genius — the countless tro- 
phies of a boundless commerce and an inexhaustible industry, or the be- 
witching phantasmagory of human skill and genius in the endless creations 
of Fine Art and Literature we come to contemplate. What we welcome 
here to-day with heartiest greeting are the representatives of humanity in its 
highest sense — those departments of science that are devoted to the study of 
human ills, the alleviation of human suffering, the amelioration in every way 
of human conditions. 

Assyria, Egypt, Greece and Rome had their vast achievements of human 
labor, their monuments of wealth, of commerce, architecture, art, and mil- 
itary glory. What are all these to the victories of science over every form of 
human disability? What are the bursting coffers of commerce to the benign 
gifts of philanthropic science, to the welfare of mankind both in body and 


PROCEEDINGS. 


169 


mind — our true wealth, according to the original meaning of that sterling 
Saxon word? 

Most heartily then I welcome you as fellow -workers in that field of charity 
and philanthropy which has been assigned to Section IV of this Inter- 
national Congress, viz.. The Commitment, Detention, Care and Treatment 
of the Insane. 

Dr. Blumer. None of the gentlemen whose names appear on the pro- 
gramme of the first session being here, except Dr. Burr, Superintendent 
of the Hospital for the Insane at Pontiac, Michigan, I will call upon him to 
read his paper upon “ What Improvements have been Wrought in the Care 
of the Insane by Means of Nurses’ Training Schools?” (See page 124). 

Discussion. 

Dr. Bannister. In regard to the training of attendants upon the insane, 
I might call attention to one or two practical points, where the system, as I 
observed it, lacked absolute perfection. I have not observed the tendency 
to make the attendants more permanent employes of the hospital. The 
training is of decided advantage to the attendants, many of whom find it 
comes into play in outside work and they leave the institution to do better 
elsewhere for themselves. Moreover, something more than training is re- 
quired to make a good attendant, and I have seen bright graduates of the 
training school necessarily discharged. In view of such events, I have 
thought it might be a good thing if the diploma of the training school 
bore a statement that it was not, of itself, necessarily a certificate of fitness 
for the duties of an attendant. 

Another point, from which I found some inconvenience, could probably 
be remedied. Only as many attendants are employed as are required to take 
charge of the patients. Their time off duty is considered by them as a part 
of their pay, or as a perquisite, and complaint was sometimes made to me 
that this was trenched upon, though I cannot say always justly. I have 
noticed, however, that it was not always easy to arrange training school 
details and still leave the wards properly manned, and give the patients 
their regular outings. I have seen a great many benefits from the establish- 
ment of training schools, and do not wish anything I say now to be taken 
as criticism of the system. 

Dr. L. L. Rowland, Medical Superintendent of the Oregon State Insane 
Asylum. Although an asylum superintendent of only two years’ ex- 
perience, I feel that I ought to say something in this connection. It is not, 
however, m}'^ expectation to impart instruction; for the object of my pres- 
ence is to obtain information. Nevertheless, replies to suggestions or even 
objections, are oftentimes the best teachers. It may not be deemed im- 
proper, therefore, to call such into requisition. 

We, too, have been urged to establish a similar school of instruction in 
connection with the work of our institution. But our experience with 
trained attendants from other institutions has been neither encouraging 
nor by any means satisfactory. Perhaps these are of the “floating popula- 


170 


PROCEEDINGS. 


tion” who “go west.” If so, we, who are within sixty miles of the Pacific 
Ocean, are likely to have the services of just such nurses tendered ns. How- 
ever this may he, these “trained attendants” seem too often to he controlled 
hy the impression that they can legitimately he rough with our patients. 
Very largely the discharges from our asylums are for cruelty to patients. 
I am sorry to say that these persons, with others, have had to go for 
just such improper conduct. Too frequently, with their other acquire- 
ments, they have learned the “tricks of the trade.” On the contrary, how- 
ever, we obtain from you some most excellent trained nurses, who never 
have occasion to make an excuse or an apology. They are masters of their 
calling; they give perfect satisfaction, so far as such is practicable. I wish, 
however, that some means could be ascertained and applied by which trained 
nurses could be suitably impressed that they must not be rough or cruel to 
patients. For with us, if an attendant strikes a patient, however plausible 
the explanation or elaborate the apology, he is regarded as cruel. This the 
people rightfully will not tolerate. Therefore, it is currently understood 
that he who strikes a patieut “must go.” 

Now, another thought: If we could find the time for teaching our own 
nurses in our own institution, it would be especially beneficial to us ; for 
we have attendants who have been there ever since the first establishment 
of the institution. With us no nurse is removed excepting for cause. Of 
course, simple inefficiency may be a sufficient cause. It is true, I believe 
somewhat with the gentleman last on the floor, that attendants are born, 
not made by training. Nevertheless, this may be said of doctors and ministers 
and teachers, as well as of poets. At the same time, we all believe in 
trained or educated ministers, doctors and nurses. We have received, it is 
cheerfully admitted, great benefit from the training schools established by 
you, for which, I trust, we are deeply grateful. 

Dr. C. B. Burr. How many attendants has Dr. Rowland engaged, who 
came to him with diplomas ? 

Dr. Rowland. I do not remember the number. It is earnestly hoped, 
I desire to add, that these remarks will not be taken in the spirit of un- 
friendly criticism. They are meant to urge ouly that nothing short of 
mental and moral education of persons adapted by nature to this peculiar 
w-ork can afford suitably qualified attendants. All else are mere approxi- 
mations to the proper standard. 

Now, if we could adopt something whereby we might distinguish be- 
tween the good and the bad — the worthy and the unworthy — those 
that are in character truly professional, and those that are inher- 
ently quacks, endowed with only “tricks of the trade,” what a won- 
derful blessing it would be ! But such a consummation is perhaps too much 
to hope for at present. Possibly, if attendants could, through their respec- 
tive superintendents, obtain associational protection, similar to that afforded 
the physician and surgeon, by a sort of disfellowshiping of worthless wander- 
ers, we might have something of a remedy. 

Dr. Richardson. Mr. Chairman: The discussion has taken such a 
course, that I feel that I should like to say a word in reference to my posi- 
tion on the subject. 


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171 


Some years ago I became very much interested in the subject of tact in the 
management of the insane. Now tact is something which, while it is a 
characteristic of the individual, yet is much developed by training, Tact 
alone, unless it is educated tact, unless it is experienced tact, amounts to 
but very little. Any asylum superintendent knows, in the first place, that 
there is a very great difference among attendants as to how rapidly and how 
readily and how thoroughly they learn their duties. He also knows that 
for the first three months of their stay with him his attendants do not give 
him very much benefit. They are without experience and consequently 
they can be of but very little use to him. I am afraid that the practice 
which the superintendent has evidently followed of getting his attendants 
from other institutions gives us the key to his opinion of training schools, 
and trained nurses. Good nurses do not leave their owu institutions. Any 
institution will so treat its own trained nurses that they would not want to 
leave. If they leave to go into other institutions, there must be some other 
explanation of it. They leave to go into other work, they leave to get rid 
of work — they get married, but if they leave to go to other institutions, 
there is some reason back of it. I have made it a rule never to employ an 
attendant that has been in another institution. My experience has taught me 
that when an attendant leaves one institution to go to another, you want to 
be very chary about taking his statements about the cause of his leaving. 
Now tact is important in the treatment of the insane and a great feature in 
an attendant, but it is just as important a factor in the man that lays out 
the work of training the attendant. Some of the trained nurses have pos- 
sibly been failures because they have not had the right kind of trainers. 
You cannot make this training very technical. If you do, you spoil the 
effect. You make an attendant think he is a doctor. He must always be 
taught that he is a nurse, and that what he knows about the insane is simply 
the laws of nursing in relation to the insane, that he is not a doctor or pro- 
fessional man; simply a. nurse. 

I cannot think that this training makes a nurse cruel, but it will not make 
a cruel attendant kind. A cruel attendant has semething cruel in his nature 
and you can never make him kind. Any man who will deliberately ill treat 
an insane man has something cruel in his very nature and all the training you 
can give him will not alter him, and he should never be entrusted with the 
care of the insane. 

Dr, Burr. I know the location of quite a good many — about four hun- 
dred and twenty-five of the six hundred and fifty-two graduates of Ameri- 
can training schools. Of these, three hundred and thirteen are employed 
in the institutions from which they graduated. All that are known to be 
engaged in asylum work elsewhere arc twenty-three of the whole number of 
graduates. Asylum men always feel an interest in their old employes, 
those who have done good and faithful service, and are very apt to keep a 
watch upon them, very apt to know where they are. I am much astonished 
that so many of them have got so far West. 

Now there is nothing inherent in training school instruction in the work 
of training schools, that should make a person unkind or severe. There is 
everything, on the contrary, to soften the asperities of his nature, if they 


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exist, and to take away the little roughnesses from his character. I know 
that bad men and women, those who are unkind, become attendants. I be- 
lieve, however, that in his work as teacher the superintendent gets an ac- 
quaintance with the attendants, with their habits and characteristics, which 
he could not otherwise acquire. I think in this way he learns about them, 
as he could not otherwise. He cannot know his attendants as he formerly 
knew them as an assistant physician, as he saw them every day and talked 
with them familiarly about their patients. It is only in some such close re- 
lation as this that he can know personally about their individuality and 
training. As I say, there are bad attendants, as there are incompetent 
physicians and incompetent members of any profession. But this mental 
training, if it is good for anything at all, will tend to develop the pleasant 
side of character. 

I know that the training school takes time, as Dr. Bannister well says. 
But I believe that it is time well spent. I do not believe that the medical 
officers who are engaged with me in this work begrudge the time given to it. 
It is with them a means of growth. There is something about the work 
that is helpful to the teacher, as well as to the student. The physicians 
have never regarded it as time thrown away, and have been interested in the 
school ever since it was started. As to taking attendants away from their 
duties, it seems to me that if that is so, it is the fault of the school. Work 
can be so laid out that the work upon the halls is not interfered with. Our 
lecture days, for example, are Tuesdays and Thursdays ; lectures and quiz - 
zes for an hour in the afternoon, besides an occasional talk or lecture in the 
evening for an hour after the patients retire ; and the attendants have accus- 
tomed themselves to those conditions. We have not seen that it interferes 
with the work on the halls. There has been no complaint on the part of the 
attendants because they have been deprived of leave of absense. I very 
much regret the Doctor’s experience with graduated nurses. 

I agree fully with Dr. Richardson that the attendant who leaves one 
asylum with the purpose in view of going to another is not of the best qual- 
ity. One leaves, perhaps, because he had got tired of the work and thinks 
that there might be another field for him to enter, and then concludes that 
after all, perhaps, the asylum field is as congenial to him as anything he 
can do. Such an attendant is an entirely different person. The ‘•'asylum 
tramp,” the man who goes from one institution to another, is most emphat- 
ically a man to be avoided. I am not in the habit of engaging attendants 
who have seen service in other institutions, but hereafter, I shall make an 
exception in favor of the graduates of training schools, provided they bring 
with them their diplomas properly endorsed and renewed, as it were, by a 
statement of the faculty of the institution from which they come. The 
superintendent must exercise his judgment and make all inquiries possible 
about the men he expects to engage, and then, if matters turn out badly, it 
'Simply means another failure, such as are too often encountered in the pro- 
fessional world and elsewhere. For my part, I am not able to see what pro- 
tection the country has from incompetent physicians to which the Doctor 
referred. 

When the school was organized, we permitted admission to it to be elect- 


PROCEEDINGS. 


173 


ive with the attendants who had been there a long time. A large num- 
ber signed for it and attended the first course. Of that number, twenty-one 
graduated. Some came up for graduation, but failed. As it is now ar- 
ranged, we require all attendants at some period of their asylum work to 
take one course of lectures. We do not require anybody to join the gradu- 
ating class, but he must take at least one course of lectures. 

Now, as to the course of instruction and economy of time. Our subjects 
are thus arranged: One instructor takes subjects that are related in their 

nature : such as osteology, fractures, bandaging, exercise, massage ; — another 
the respiratory system, foreign bodies in the air passages, drowning, 
nursing, pulmonary diseases: — the circulatory system, haemorrhage, shock, 
syncope. The work is carried on in that way ; taking the subjects consecu- 
tively retains the interest and does not produce a chaotic effect upon the 
student. In lecturing upon one subject one day and upon another very 
foreign to the first the next day, confusion is apt to arise. We try to 
avoid this by careful systematizing. 

Dr. Blumer. We have a very good system in New York, — a black list 
of discharged attendants which is issued from the office of the State Com- 
mission in Lunacy. Any superintendent in the country may procure a copy 
of such a list from the Commission. 

One reason why the Doctor has had such a poor experience is, perhaps, 
that he offers larger wages than any other superintendent in the West. 
And so men and women go out there, not from any sense of duty, but from 
a mere mercenary view of the loaves and fishes to be had on the Pacific 
slope. 

In the absence of its author. Dr. A. Campbell Clark, of the Glasgow Dis- 
trict Asylum, Bothwell, Scotland, the Secretary, Dr. Bichardson, read 
“ The Future of Asylum Service. ” (See page 58). 

Discussion. 

Dr. B. D. Eastman. There are some very interesting points in the paper 
just read. The asylum superintendent, or the superintendent of a public 
asylum, stands in many respects in one of the most trying places of the 
times. On the one hand, the great public are demanding that everything 
shall be done in the best possible way, and his own efforts are in the same 
direction. On the other hand the Legislature “sits down” upon his aspir- 
ations. When his appropriation bill comes up for consideration, the chair- 
man of the committee on appropriations cuts it down. If twenty -two dol- 
lars a month is asked for wages of a kitchen man, it is cut down to sixteen 
and a half. 

Another point in relation to the matter is the character of the persons who 
are willing to be attendants at the wages paid. We are obliged to select 
attendants from those who apply for such work. They are often unedu- 
cated persons, lacking a high appreciation of the amenities of social life and 
accukomed to speak roughly to each other. We have to do the best we can 
with such material. Besides, the work is very trying to those who at first 


174 


PROCEEDINGS. 


doing well, sometimes wear out and get irritable. By and by their temper 
gets the best of them and they commit some act which necessitates their dis- 
charge. In short, the superintendent is surrounded by pitfalls and difficul- 
ties on every side. If we could only bring some means to bear upon our 
legislators and make them understand what our requirements are, I think 
we could get them to do what we ask. It is not so much the rate payer 
who is responsible for all this parsimony as it is the legislator who wants to 
show that his session of the legislature appropriates so much less than some 
previous one. 

Dr. Burr. I have been deeply interested in Dr. Clark’s paper and feel 
that the points that he has given are of great importance. One thing that 
impressed me was the question of the staff getting above the grind and the 
routine of their daily work, which he speaks of with so much emphasis. 
It is of the greatest importance that the mind of the medical o.fficer should 
be free and that his physical strength should be equal to the exacting 
work which his relations with patients impose; that when he goes on 
his rounds he should be cheerful. This is impossible if he is worn 
out with the constant routine of duty. We have been very fortunate 
in our State in relieving the medical staff of much of the work which, 
when I became medical superintendent, devolved upon them (note-making, 
correspondence, etc.) By utilizing the services of a stenographer for this 
work, the manual work no longer comes upon the staff. This is of the 
greatest advantage to the medical officer. 

I was a little troubled about what Dr. Eastman said in reference to the 
character of attendants. It does not seem to me that his remarks do that 
loyal, earnest body of men and women justice. I don’t think the Doctor 
meant that the application should be general. I know that with us attend- 
ants are, as a rule, of high character. They do not come from the highest 
walks of life, to be sure, but they compare favorably with people the world 
over. I believe that the average attendant, with us, has more consideration 
for the feelings of his patients, more interest in him, more downright sym- 
pathy for him, and does more honest work looking to that patient’s future 
than relatives, as they average. The attendant has more toleration and 
sympathy for his patient’s shortcomings than the friends, if the patient 
comes from the lower walks of life. I speak for a class that is often un- 
justly censured. I dislike to have any expression go forth that would make 
it appear that attendants are of an inferior character — a class that, in my 
experience, is earnest, loyal, and possessed of much more than the average 
intelligence. 

Dr. Richardson. This is a subject very interesting to us because it is one 
of the most practical with which we have to deal ; this question of getting 
the best service out of attendants, because they are the main spokes of the 
wheel. Without good attendants, we can do nothing, and only with them 
can we be assured that we are doing our duty toward the insane. We can- 
not feel easy while we are in the charge of an institution unless we know 
that we have good attendants upon whom we can depend. As Dr. Clark 
says, no amount of training can take the place of the selection of the right 
material for attendants. I have been, unfortunately, in charge of two asy- 


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175 


lums, and my experience illustrates the difficulty of securing good attendants. 
The first institution was in a small town, and we got all our attendants from 
the country. The wages which we paid were sufficiently large to distinguish 
this class from the ordinary domestics, almost as good as the country school 
teacher gets, if you consider board and washing. We got a very good class 
of country boys and girls, as good as I ever saw. They had not learned 
the tricks of city life, either in the asylum service or in other service, be- 
cause the same tricks obtain in both cases, and the social status which that 
particular asylum employment gave them was looked upon by them 
as a step upwards. That I always found to be an advantage. Whenever 
we had to employ an attendant who thought it a humiliation, had seen 
something better, and had to come down to that, I found it very difficult to 
get the right sort of material. If you get the right kind of material and the 
right sort of home training, unsophisticated though he may be, uneducated 
though he may be, you can make a good attendant out of him. Now the 
difficulties are to give them the right kind of training. Training schools 
help that to a great extent, but there is a great deal that we have to do out- 
side of the training school. There is a great deal in the example of the pre- 
siding genius of the institution, that can never be imparted in any other 
way. All the blanks and reports that you can make out can never take the 
place of the example and of the influence of the superintendent of the insti- 
tution upon his employes. And, as Dr. Clark has stated, there are a great 
many directions in which reform is necessary. 

I was glad to see that Dr. Clark complained of the same things that we 
complain of over here. I thought that Great Britain was so far in advance 
of us and had had so much longer experience, and yet he complains of the 
same troubles that we have here. 

I am sure that when this paper is read, when it is published in the pro- 
ceedings, it will be a sourse of proflt to everyone. 

Dr. Blumer. I want to say one word in criticism of Dr. Clark’s excel- 
lent paper. He speaks somewhat disparagingly of “ telltale clocks. ” Now, 
in my opinion, it is no reflection upon the service of an institution. It is 
simply a mechanical contrivance to take cognizance of human frailty. 
Moreover, it seems to me that Dr. Clark’s very argument that the clock is 
capable of being tampered with, is a suggestion that, in those asylums in 
which tampering occurs, the detective system should be introduced immedi- 
ately and be made as efficient as possible. 

The next paper read was one by Dr. C. K. Clarke, Superintendent of 
the Rockwood Asylum at Kingston, Ontario, Canada, on the “Care of the 
Insane in Canada. ” In the absence of Dr. Clarke, the Ipaper was read by 
the Secretary, Dr. A. B. Richardson. 

Discussion. 

Dr. E. E. Duquet, Superintendent of the Asylum at Longue Pointe, 
Quebec. It was not my intention to discuss this paper, but as Dr. Clarke 
makes some remarks about the Province of Quebec, I wish to say a few 
words in answer. 


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PROCEEDINGS. 


It has been my good fortune to visit the asylum at Kingston. And I 
must say that I have been pleased with what I have seen there. I have 
visited quite a number of asylums in England and on the continent of 
Europe, as well as in the United States, and I may say that I have seen 
no better managed asylum than that at Kingston. 

The organization of the insane asylums in Quebec was commenced after 
that of Ontario. The asylum at Quebec, which was very severely criticized 
by Dr. Hack Tuke, has changed' hands “lately and a distinguished alienist. 
Dr. Vallee, has been placed at its head. He is engaged by the Government 
though the system is the same, the insane are farmed out, as before. Dr. 
Vallee is at work introducing the necessary improvements. 

As far as the Protestant 'Asylum at Verdun is concerned, it is and has 
been a well kept asylum since it has been opened. Dr. Burgess is a very 
efficient officer, he conducts it on the non-restraint system, and I think it is 
as well managed as any asylum in Canada. 

At Longue Pointe, too, we were very severely criticised by Dr. Tuke, but 
I think if Dr. Clarke were to call and see us now, he would find a great im- 
provement. Since the fire, temporary buildings have been erected on the 
pavilion system. Though not as well organized as the asylum at Kingston, 
still we can claim that we have done a great deal in the right direction within 
the last few years. 

I was very much pleased with the paper by Dr. Clarke. 

The announcement was made of an invitation to the members of the Con- 
gress to visit the Chicago Hospital for Women and Children, at the corner 
of Polk and West Adams Sts., on Friday afternoon, June 16th, between the 
hours of four and six o’clock. 

On motion, the section adjourned at 4.05 p. m. until Tuesday morning at 
10.30 o’clock. 

The second session of the Section was called to order at 10.45 a. m., on 
Tuesday, June 13, 1893, by the Chairman. 

The Secretary, Dr. A. B. Richardson, read the paper of Dr. T. S. 
Clouston, the Physician-Superintendent of the Royal Asylum, Edinburgh, 
Scotland, on “The Lessons to be Learned from the Lunacy Administration 
of Scotland, 1857 — 1892.” (See page 1). 

Discussion. 

Dr. Blumer. I am sure you have all shared with me in the pleasure of lis- 
tening to the excellent paper by Dr. Clouston. If there are any remarks to 
be made upon the paper an opportunity will now be given. 

Dr. H. P. Stearns, Superintendent of the Hartford Retreat, Hartford, 
Conn., then spoke as follows: Mr. Chairman: — It was my good fortune 
early in my experience of asylum life to examine to some extent the system 
which has been so clearly and concisely presented to you in the paper to 
which you have just now listened. It was also my good fortune to study 


PROCEEDINGS. 


177 

somewhat in detail the system of asylum management in Scotland as repre- 
sented by Dr. Clouston himself, in the Royal Edinburgh Asylum, to which 
he had then just recently been appointed; and it gives me pleasure in this 
connection to express my great indebtedness to him for his courtesy and 
kindness. 

It occurs to me that one of the most important elements as explanatory of 
the great success that has attended the Scottish lunacy system consists in 
what Dr. Clouston has called attention to near the close of his paper, namely: 
the smallness of the country and the density of its population. These con- 
ditions have enabled the commission to work with intelligence and to exer- 
cise such influence over the asylums in the different counties as would be 
impracticable in a country like the United States, In this country such 
a system could be adopted only in the very largest States like New York, 
Pennsylvania or Ohio; or in States where the number of the insane is quite 
large. Such a system in the smaller States, where the insane number only 
one, two or three thousand, would be impracticable from the expense that 
would necessarily attach to the organization and conduct of such a board. 
And even in the largest States, it seems to me there would exist danger of 
more friction than in some other countries. This arises partly from the con- 
ditions of society and partly from the limited tenure of office which exists 
in many States. The nature of the duties of the superintendent also some- 
times leads to sensitiveness in relation to supervision to any great extent by 
parties outside. In this respect we can learn a lesson from what has been 
told us by Dr. Clouston in reference to the character of the supervision ex- 
ercised by the Lunacy Commissioners in Scotland. 

Another of the more important things that has been attained by the com- 
missoners is the publicity that they give to the details and working of in- 
stitutions for the insane. Misapprehension and suspicion are likely to arise 
in the minds of many people in relation to any public work that is carried 
on in the dark. By means of a properly constituted board of commissioners 
the whole system becomes a public matter and the public is taken into the 
confidence, so to speak, of those who are impartial in their relations to these 
institutions. 

Another point of importance is the permanency of office. This pertains not 
only to the members of the commission but also to the superintendents of the 
asylums. It has enabled the board to carry out a policy in reference to the 
matter of psychiatry. It has enabled it to lift it far above the realm of pol- 
itics and to develop a rivalry among the superintendents in securing the best 
results. How entirely futile it is to expect any such benefits to psychiatry 
wherever the tenure of office is temporary, such as exists in some of our 
States, we are all able to appreciate. It seems to me, Mr. Chairman, that, 
as we in America have made progress in the management of our institutions, 
wc have proceeded along the same lines as those which have been followed 
so successfully in Scotland and which have been so concisely stated by Dr, 
Clouston in his paper. (Applause). 

The question was asked by a lady in the audience as to whether the 
boarding-out system was not in vogue in Massachusetts forty years ago ? 


M 


178 


PROCEEDINGS. 


To this Dr. Stearns said : The home system of New England is com- 
paratively recent, and has been adopted since 1879. 

Dr, Hitchcock, of the State Board of Lunacy and Charity of Massachu- 
setts: Massachusetts has taken a prominent stand in regard to the board- 

ing-out of the insane, no other State having adopted the system, as yet, I 
believe. We have met with some opposition and a great deal of delay. It 
has been in use some eight years — since 1885, Before that there was no- 
such system. They were all kept in the public institutions, and we are 
trying to push the system for all it is worth. To-day w^e have about one 
hundred and seventy “boarders” out of the — say — six thousand three 
hundred insane in the State, Though we modeled it after the Scottish sys- 
tem, we find it very difficult to get places for boarding them out. The 
great difficulty is, that the patients who are fit to board out are the patients 
whom the superintendents really need to “help” in their own hospitals. 
Many people are willing to take these patients, but we can not find enough 
patients who are safe to recommend for boarding out. Only last week we 
heard of an insane patient boarding out who was chasing a girl around the 
streets with a knife. Such cases, of course, set us back. Whether the 
Scotch are more decent people, kinder and better men and women, or less 
excitable, I don’t know. We can not find suitable patients enough to sup- 
ply places which can be secured, and we are obliged to take back a great 
many that are not suitable. 

We do not have trouble with the superintendents. If there is anything 
that does not suit us in our visits, we go to the superintendent. If he can 
not be reached quietly or without trouble, we go to the Trustees. 

In the matter of open wards, nearly every State hospital has one or more 
of these open wards and allows the patients to go out pretty much at will. 
All our superintendents are pushing this matter as far as possible. But, 
for some reason or other, our superintendents are unable to open as many 
doors as they would wish, perhaps the type of insanity is too excitable, or 
certainly self-control is so far gone that it is not safe. 

Col. Henry Stone, of Boston. I notice the expression in this paper, 
“ single persons boarded out. ” What does it mean ? 

Dr. Blumer, It means single persons, not bachelors or spinsters, but 
single individuals in one family. 

Dr. Blumer. Of the numerous eminent foreigners who have shown an 
interest in this Congress no one has been more sympathetic than Mr. W. J. 
Corbet, of Delgany, County Wicklow, Ireland, ex-member of the British 
Parliament. He is a publicist of wide reputation in Ireland and wrote, as 
some of you will remember, a remarkable article for the Fm'tnightly BevieWy 
for January last, on “The Increase of Insanity.” After reading the article, 

I wrote to him asking his co-operation in this Congress. He expressed 
great regret at not being able to be present at this Congress and very 
kindly sent us a double paper on “The Increase of Insanity; The Abolition 
of Private Asylums.” He attributes the increase of insanity, not so much 
to heredity, as is ordinarily claimed, but to that doctrine to which Professor 


PROCEEDINGS. 


179 


Peabody so eloquently alluded yesterday, namely, “The survival of the 
unfit." 

The paper was read by the Secretary, (See page 29). 

Discussion. 

Col. Henry Stone, of Boston. It occurred to me, sir, in listening to 
that paper on the increase of insanity, that one fact, or what seems to me 
a fact, is omitted, that I am surprised was not noticed : that is, that very 
many persons who are now considered as insane were not so considered 
fifty years ago. There is a large percentage of persons in asylums to-day 
who, fifty years ago, would not have been there. Many of us who are fifty 
years old or over can remember people who now would be confined in insane 
asylums but who, at that time, were considered only queer or eccentric. 
There is much more readiness to put people in asylums than formerly. The 
odium once attaching to insanity has largely passed away. 

Dr. Blumer. While that is true Col. Stone, you may remember that he 
made allusion to it in the passage : ‘ ‘ They assign the following as a cause : 

increased registration." 

Col. Stone, I am not disputing the fact that there is a considerable 
increase in insanity. The reports of the State of Massachusetts and else- 
where clearly indicate that. 

Dr. Gorton, of Providence, R. I. Mr. President: I am very grateful 
for the privilege of listening to so interesting a paper as the one before us, 
nnd I desire to pay my tribute of respect to its author for the careful and 
painstaking account of lunacy matters in Great Britain, w^hich he has given 
us. I have not the data at hand, nor have I the time to procure them, 
which would enable me to discuss exhaustively in any sense, the various 
conclusions of the paper. My recollection of the statistics of our own 
country is not sufficiently accurate to enable me to base any statements 
upon them, but I will venture some remarks upon lunacy statistics in 
general. 

A few years ago, while preparing a report of the Butler Hospital for the 
Insane, I took occasion to study the question of the increase of insanity in 
modern times, to see, if possible, whether the many allegations of lay 
writers and of certain physicians who had expressed themselves upon the 
subject were safe and reliable guides to the formation of an opinion upon 
it. I found it necessary to go much farther in the investigation than the 
compilation and analysis of the tables of the lunacy boards and asylum re- 
ports, to get any sort of idea as to the relative increase of insanity in the 
population. Undoubtedly the reports above mentioned, taken for a series 
of years, bear out to some extent the conclusions of the author of the paper 
and apparently show’^ that insanity is pretty rapidly increasing, and from 
such a showing the temptation is irresistible to predict the direct state of 
things for the future unless medical science shall devise some remedy for 
the threatening ill, beyond anything yet made available in its prevention or 
its cure. But a deeper study, one going into vital statistics in general will 
be apt to, somewhat at least, dispel the fear awakened by a study of lunacy 


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PROCEEDINGS. 


statistics alone. These Tvill show that the number who die insane is not so 
much greater in proportion to those dying sane, than was the case even 
twenty -five years ago, as to arouse any serious fear as to the rate at which 
insanity as an indirect or direct cause of death is increasing. Then, too, 
statistics prove that the average duration of life is greater now than ever 
before, and gradually increasing, a condition due in great part undoubtedly 
to the very rapid advance in sanitary science in modern times, by which 
mortality from preventible diseases in infancy and childhood have been de- 
cidedly diminished. To go further, we may make the assumption, that 
insanity while only one of the diseases by which the increased adult popu- 
lation is destroyed, is the one, from the nature of the disease, the statistics 
of which are kept by themselves, and are thus likely to be magnified in 
their relation to kindred disorders having a common origin, but which do 
not alfect the mind or cause the seclusion before death of the individuals 
affected. Indeed, it has seemed to me that if w’e go on to protect and nur- 
ture the weakly, to rid ourselves of the infectious diseases, and to remove 
as far as may be the dangers of accidental death, we must expect an 
increase in those diseases due to the wear and tear and stress inseparable 
from the struggle for existence, and from the demands of an ever widening 
environment, which, no matter how desirable, reacts as much as it can be 
made to yield. Much more might be said in this line, but let it suffice at 
present to say that it is probably true that insanity is increasing yearly, but 
by no means so much more rapidly than kindred disorders due to common 
causes, as a mere study of lunacy statistics might lead one to suppose ; that 
this increase as the writer of the paper infers is due to natural and inevita- 
ble causes, and must, therefore, be expected; that no refinement or develop- 
ment of medical skill or knowledge will ever be sufficient wholly to check 
this increase, or to accomplish the cure of a much larger proportion of the 
insane than at present; and finally that, organized as it is and demanding 
from its members what it does, modern society must be willing, not only to 
protect itself by foreseeing its dangers, but to cheerfully care for its drift- 
wood, let the effort cost what it may. 

Regarding that portion of the paper devoted to private asylums, I believe 
I may safely say that its criticisms have no application in this country. Our 
institutions here, though, perhaps, managed for private gain, to some ex- 
tent are as open to the inspection of public officials as those of the State, 
and are pretty generally presided over by men of long and careful training, 
of high professional attainments, and of the strictest personal honor. 

Dr. Bannister. There are two ways of investigating the increase 
of insanity. Thus we may take the number of tlie insane actually ex- 
isting at two separate dates and compare them, or we may consider only the 
number of insane coming up annually as compared to the annual increase of 
population in general. I do not see that the author of the paper mentioned 
this last way of making a compilation of statistics, and yet there may be 
quite a difference in the statistics obtained by these two methods. 

There have been several hundred jury trials per annum, with a verdict of 
insanity, in Illinois during the past ten years. lam not sure what the figures 
are, but many of them were re-trials of old cases, and many recovered or 


PROCEEDINGS. 


181 


died before reaching the asylum. A large part of our increase, as far as it is 
an increase, is due, I think, to the inability of a certain class of people to 
keep up with the advanced civilization as it exists. An instance of that is 
the effect which all these new inventions and new discoveries make on the 
population of our asylums. Of course, we see this mostly in the color of 
their delusions and in the form of their insanity, but, of course, it may have 
had something to do with the causation of their insanity. In this country, 
and especially in this State (Illinois) a very large proportion of the insane are 
not natives. Fifty per cent, are foreign born. Some years ago, I made 
some investigations in regard to this matter, in conjunction with Dr. Hek- 
toen. We came to the conclusion that it was not because the foreign coun- 
tries sent to us their mentally enfeebled population, but that the new condi- 
tions under which the immigrants lived in their struggle for life in this 
country was the cause. It was a change of environment, not a necessary 
defect in the individuals themselves ; if they had been properly situated, or 
situated as their ancestors had been, they might have escaped. 

We had in the Kankakee Hospital patients from every county in the 
State for a long time. Then afterwards we restricted our patients to a cer- 
tain number of counties, and took all kinds of patients from those counties, 
both acute and chronic. One county, with an almost exclusively native 
population, could never keep its quota half full, while many others, largely 
settled by foreigners, were overflowing and nearly fifty per cent, over their 
quota all the time. 

Speaking of intemperance, it is perhaps a more prominent cause in our 
foreign born than in our native population. Some years ago the brewers of 
this country sent out a pamphlet showing that the use of alcohol, especially 
beer (but they included every kind of intoxicant), was not contributory to 
the increase of insanity. They gave statistics from different institutions in the 
country. I doubted the correctness of these statistics and wrote to a number 
of the superintendents mentioned and obtained quite different statements from 
some of them. One of them reported the following fact as characteristic: 
Two counties, one mainly settled by native Americans and English, and 
without saloons, the other with a large proportion of foreigners, and full of 
saloons, were in his district, and while the first was hardly represented in 
the institution, the other was always in want of room there. 

Dr. Stearns. Mr. Chairman : It seems to me that this question con- 

cerning the relative increase of insanity and population must be one that is 
extremely difficult to determine; judging simply from the fact that eminent 
individuals who have made it a study for years are not yet agreed in refer- 
ence to it. I rise only to suggest an element of probability in determining 
it. And that is whether the conditions which are ordinarily regarded as favor- 
able to the production of insanity are in more active operation at the present 
time than they were thirty or fifty years ago. Are the habits, customs and 
modes of living in cities and large towns more conducive to degeneration 
of brain tissue and resultant insanity than those which exist among rural 
populations? Are sexual abuses and the use of alcohol more prevalent now 
than formally? If so, are there favorable influences and conditions which 
did not exist formally but which are now in operation and which more than 
counterbalance them? 


182 


PROCEEDINGS. 


A lady member of the Congress remarked that in the asylum at Dunning, 
Illinois, the majority of the female patients are farmers’ wives. Their 
insanity is caused by hard work and childbearing. The matron so informed 
her. 

Dr, Stearns. That quite corresponds with the experience which I have 
had. With no class of persons is worry, anxiety and mental strain more 
commonly experienced than with the wives and housekeepers among the 
farming population of New England. 

Dr. B. D. Eastman, of Topeka, Kansas. As I am from a particularly 
agricultural section of the country, the State of Kansas, I may say a word 
or two in relation to the causes of insanity affecting an agricultural popula- 
tion. A j’-ear or two ago we had a convention of teachers in our State. One 
of the members of this convention came to me saying that he had under- 
stood that a very large proportion of the female patients in our asylum were 
farmers’ wives, and he asked why it was so. I told him that one reason 
might be that we had more farmers’ wives than any other class of women 
in the State, which he declared had never occurred to him, I admit that the 
wrear and tear of such life is very great and not infrequently causes farmers’ 
wives to give way under the stress. Their lives are more isolated than are 
those of their husbands. But I am not prepared to admit that the propor- 
tion of insanity in our State is any larger among the farmers’ wives than it 
is among the wives of other poor and struggling classes. 

On motion, the meeting was adjourned at 12.45 p. m., until two o’clock 
Wednesday afternoon. 

The third session of the Section was called to order by the Chairman at 
2.40 p. M., on Wednesday, June 14, 1893. 

The first paper of the afternoon, that written by Dr. D. Hack Tuke 
of Hanwell, London, England, on “ Reform in the Treatment of the Insane,” 
was read by Dr. H. P. Stearns of Hartford, Conn, (See page 66). 

Discussion. 

Dr. Stearns said: Mr. Chairman: Perhaps I ought to say just a 

word in this connection for it happens to me to be superintendent of 
the first institution for the insane, which, so far as I know was named 
after the York Retreat. It is now* three quarters of a century and more 
since the first steps were taken in the State of Connecticut to establish 
an institution for the insane, and with much effort on the part of the Con- 
necticut Medical Society, the members of which were pioneers in this great 
work, funds were collected from benevolent people sufficient to establish one. 
It is the oldest of the kind in this country, which is used exclusively for the 
insane, with two exceptions. The Bloomingdale Asylum, the Pennsylvania 
Hospital and the McLean Asylum at Somerville, Mass., are simply adjuncts 
of general hospitals. But the Retreat has always been devoted wholly to 
the treatment of the insane and without any connection with a general hospi- 
tal. The treatment which was begun and the great success which was at- 


PROCEEDINGS. 


183 


tained at the York Retreat were fully understood by Dr. Todd, who was the 
first superintendent, and it was by him that the system referred to by Dr. 
Tuke in his paper, was first instituted in this country, and in the Hartford 
Retreat. And the reports written by Dr. Todd, make it very clear that we 
have not advanced very far at the present time beyond what he attained in 
this respect in the early days of the Hartford Retreat. 

The next paper was one written by Dr. Victor Parant, Medical Director 
of the Matson de Sante, Toulouse, France, which, in the absence of the 
author, was read by the Secretary of the Section, Dr. A. B. Richardson. 
The subject was “The Irresponsibility of the Insane under the French 
Laws.” (See page 69). 

Discussion. 

Dr. Bannister. I may say that I think the paper shoVs clearly that the 
French law has two definite conditions of responsibility which ouiTaw has not, 
unless we except the dictum of the Judges, as to the test of the knowledge of 
right and wrong, which has been claimed to be the sole test. It still, how- 
ever, leaves every case of insanity to be decided for itself. In that respect 
there is, of course, every chance for questions to be raised. 

The paper also calls attention to the consciousness of the insane of their 
own condition and their ability to reason correctly. I think it is more the 
rule than the exception that the insane have some sort of a conception of their 
condition. 

As regards the doctrine of the absolute irresponsibility of the insane, I 
have always taken a different view from those set forth in this paper. Some 
years ago I read a paper before a society in this city, in which I set forth three 
conditions of moral irresponsibility for crime: First, Incapacity to judge of 
the nature of an act in its moral and legal nature. Second, Absolute inabil- 
ity to control conduct. Third, -When, through mental disorder, the moral 
sense of the individual is caused to be in opposition to that of his fellownien 
and the law. 

I knew a gentleman once who was a good citizen, carried on large busi- 
ness interests, and who was also, I think, an honest and sincere Christian, who 
suffered from very decided delusions of persecution which involved a num- 
ber of people about him, and who believed in the injuries those people were 
doing him as strongly as he believed in his own existence. He knew it was 
not right for him to take the law in his own hands, and he controlled him- 
self during his life. I don’t think he could have done it simply from the 
utilitarian notion that he would be better off for doing it, but his own sense 
of moral responsibility came to his aid. Should we deny that moral respons- 
ibility in his case? 

Again, let us suppose a man of thoroughly criminal impulses who has all 
his life delighted in doing wrong and yet was clear-headed and rational. 
Suddenly he is afllicted with some form of insanity which affects him on cer- 
tain points, not bearing on his conduct, nor affecting his judgment in other 
matters. He commits crimes just as he did before. He does not control him- 


184 


PROCEEDINGS. 


self any more or less than he did prior to his insanity. Does this make him 
irresponsible, when practically he has not changed in any respect? I sup- 
pose that some of the ablest medical jurists of this country and elsewhere 
believe more or less in the partial responsibility of the insane. I do not think, 
nevertheless, that we have any right to go so far as to make a man suffer the 
extreme penalty of the law, if there is even a slight degree of mental aber- 
ration, or if any doubt exists as to his perfect sanity. Some of the ablest 
opponents of the doctrine of partial responsibility, for instance, Jules Falret, 
have laid down certain conditions of insanity in which partial responsibility 
applies, such as convalescence from insanity, certain conditions of epilepsy, 
alcoholism, imbecility, etc. 

Dr. Eastman. The practical point in this matter, which everyone present 
who has had any experience in, or ever had anything to do with expert tes- 
timony in court, realizes, is the difficulty of getting at the true inwardness 
of any particular case in which they may testify, for the reason that the ex- 
pert is not allowed to state fully and fairly his opinion in the case, but is 
asked his opinion upon a hypothetical question. Last fall I was engaged 
in a case where homicide had been committed ; the trial was in Lincoln, Neb- 
raska. The circumstances of the case were, in short, that a man who lived 
in Utah sent his wife away on a visit. She stopped awhile in Nebraska 
and afterwards in Chicago, where she was betrayed. The husband learned 
of it upon joining her in that city. He left Chicago for Lincoln, and, upon 
reaching Lincoln, shot the man who had been the cause of the trouble. At 
the trial wherein I was examined as an expert for the defence, a long and 
complicated hypothetical question was read from manuscript, rehearsing all 
the circumstances of the case in detail, following it out step by step, and in- 
cluding the statement and testimony of the person on trial, that he did not 
visit Lincoln for the purpose of shooting the man, that he did not know the 
circumstances of the trip, that he had hallucinations of sight and so on; and 
the query put, w^as that man sane or insane? Of course, there was but one 
answer, he was insane. On the other hand, the question, as asked by coun- 
sel on the opposing side, left out all the indications of insanity, and the an- 
swer necessarily was that, under these new conditions, he was sane. 

Two years ago I was called in a case where a woman had drowned her own 
child. There were two questions asked me. The counsel on the one side 
asked me, if the woman drowned her child under such and such circumstaces, 
was she sane or insane? She was insane. The counsel on the other side 
then asked me if only such and such circumstances were present, was she 
sane or insane when she committed tlie deed? Of course, the answer was, 
she was sane. 

If the question of sanity or insanity in such cases could be brought before 
a commission, to be thoroughly investigated and reported upon, the cause 
of justice would be much better served than it is at present. 

Dr. Duquet. In France the system is quite different from that in this coun- 
try, for the examination of persons accused of murder. If there is any sup- 
position that the person on trial is insane, the judge names one physician 
who is attached to the court as a physician expert. This physician examines 
the accused, and if there is not time to give a final decision, very often 


PROCEEDINGS. 


185 


the trial is put back, the person has sometimes been sent to the asylum to 
be kept where the superintendent or a physician may make the examination. 
The physician named to conduct the examination makes a report and it is 
read to the judge. 

Dr. Eastman. Some such method as that is what is needed in this country. 
It would necessarily have to be provided for under each of our State gov- 
ernments. 

Dr. Stearns. I am sure we are all agreed in having experienced much 
pleasure from the reading of this valuable paper sent to us by the very emi- 
nent alienist, Dr. Victor Parant. I am also confident that we fully agree 
with him in many of the positions taken; for instance, in relation to the iiU’ 
portance regarding insanity as merely a symptom of physical disease. That 
we can always recognize this physical disease or understand its nature, I 
am not so sure. To determine the quality of those changes in the physio- 
logical activities of the brain which lead to the formation of delusions must 
be difficult even for those who have had long experience. 

The complement of this statement, namely, that “any treatment directed 
solely to the mental troubles is condemned to absolute and certain failure," 
may possibly be also questioned by some. Since the time of the immortal 
Pinel we have been taught to regard the moral treatment of insanity as of 
the highest importance. This can be hardly regarded as physical in char- 
acter because addressed to the intelligence through the senses. 

Article 64 of the French Code quoted by Dr. Parant seems to cover the 
ground of irresponsibility as well as any I can recall. It will be observed 
that the element of the incapacity of the subject determines the question of 
responsibility. The importance of recognizing this test in legal cases can- 
not be overestimated. If always done it would obviate much of the discus- 
sion and uncertainty which generally arise when peculiarities of mental con- 
duct only are recognized as evidence. 

The plan of determining the sanity or insanity of persons in whom the lat- 
ter is suspected, by selecting a council of physicians to decide the question, 
before proceeding with the trial, cannot be too highly commended. It is fol- 
lowed only to a very limited extent, so far as I know, in any portion of the 
United States. The procedure of employing experts by legal counsel on 
both sides, when a person is being tried for his life, often proves to be well 
calculated to bring discredit upon medical experts and produce obscurity 
rather than shed light on the question at issue. , 

There is only one other portion of this excellent paper to which I will call 
special attention at this time. This relates to that class of persons who in 
this country arc sometimes called “cranks" — “those who without being 
really insane are yet not perfectly sound in mind." The course of pro- 
cedure with such cases under the French laws is extremely interesting and 
important. While they cannot be regarded as irresponsible — responsibility 
being the legal test of insanity — yet they cannot justly be regarded as fully 
responsible. The tyranny of organization has modified it. The French law 
recognizes that there exist what may be regarded as “extenuating" conditions. 
In this country there is no middle ground for such persons to occupy. They 
must be considered as either sane and fully responsible, or, on the other hand, 


PROCEEDINGS. 


tSG 


as insane and wholly irresponsible. In the one case justice may be violated 
and in the other leniency may be abused. 

Without further remarks on this valuable paper, I am sure I voice the sen- 
timents of all present in saying that we extend to Dr. Parant our warmest 
thanks for sending it to us on this occasion. 

Dr. Blumer. I have here a paper by Dr. Jules Morel, of Ghent, 
Belgium, on “The Treatment of the Psychopathic Depreciation,” as he calls 
it. It might perhaps be called “The Treatment of the Degeneracies of 
Evolution.” (See page 13). The paper is quite long, and in view of the im- 
patience of many to visit the Fair grounds, I think it might be well for us- 
either to read it b57^ title, or to ask Dr. Bannister, who has read the paper,, 
to briefly outline its purport. 

Discussion. 

Dr. Bannister. It is a plea for the better examination of indi- 
viduals who are inmates of reformatories and prisons, and also for the 
proper government and care of the weakminded who have grown up in the 
country and are not properly cared for by the authorities. The main point 
I note, in reading the paper, is the great injustice that is done to this class 
in the sentencing of them to prisons and reformatories. Society, of course, 
needs protection, but it should not be done at the expense of individuals 
who need to be defended from individual wrong and who are not to blame 
for their weakness. That is the class which he mentions. 

His paper is largely a plea for better and more numerous schools for im- 
beciles, and especially criminal imbeciles. The best results, he admits, are- 
obtained from such schools drawing their inmates from an enlightened class 
of the population, but if these few are better cared for, it is at the expense 
of those who are more ignorant. 

He also recommends the installation of insane wards in all the large pris- 
ons, the proper selection of alienist physicians to take charge of them, 
keeping the criminal asylums for the care of the incurable cases of insanity 
that grise in the prison population, etc. 

Dr. Blumer. If there is no objection, the remaining papers of this 
Section will be read by title. 

They are as follows: “Statistics of Insanity in New South Wales Consid- 
ered with Reference to the Census of 1891,” by Dr. Chisholm Ross, New- 
castle, N. S. W. (p. 81) ; “ The Care of Epileptics, ” by Dr. Frederick Peterson, 
of New York City (p. 139); “A Case of Insanity Consecutive to Ovarosal- 
pingectomy,” by Dr. E. Regis, Professor of Mental Medicine, Bordeaux, 
France (p. 91) ; “Care of the Insane in Finland,” by Dr. Emil Hougberg, 
Helsingfors, Finland (p. 100); “ Proposed Change of the Legal Status of the- 
Insane, in Accordance With our Present Knowledge of the Nature of In- 
sanity, for the Purpose of Securing for Them More Rational and Efficient 
Treatment,” by Dr. Stephen Smith, of New York (p. 104). 

I wish to extend my official and personal thanks to all who have attended 
these meetings and who have taken part in the discussion. It argues a great 


PROCEEDINGS. 


187 


deal for the zeal of those who have come here when there have been so 
many outside attractions on the Fair Grounds. I thank you all sincerely. 

Thelheeting was adjor.rned at 4.05 p. m. until Saturday morning at 10 
o’clock. 

By arrangement, the closing session of the International Congress was 
held on Friday evening instead of on Saturday morning. The meeting was 
called to order by the President, Rev. F, H. Wines, at 8 o’clock. 

The first speaker of the evening was Mr. Lewis, of the Prisons Section, 
who spoke on “Imprisonment and its Substitutes — The Parole System,” 
after which Dr. Blumer Chairman of Section IV, delivered his address on 
“Commitment, Detention, Care and Treatment of the Insane.” (Page 149). 

Discussion. 

Dr. Wines. Dr. Blumer has rendered the State of Illinois certainly a 
great service in pointing out the weakness of the commitment of lunatics, 
and whoever gives that law a black eye is the friend of the insane. 

Mr. J. S. Appel, of Colorado, arose and said : I would like to make a cor- 
rection. I would like to state that the new lunacy law of Colorado goes into 
effect on the eighth day of next month. It remodels the entire system of 
commitment, care and treatment, etc., and the law is based on the most ad- 
vanced theories that are in practice in older States and as advocated by lead- 
ing alienists. It includes a statutory provision for parole also. I therefore 
hope that Dr. Blumer will omit Colorado from the list of States that main- 
tain, as he says, a barbarous system. 

Dr. Blumer. I am very much obliged for the correction and will take 
pleasure in making it in my paper. 

Mr. Wright. During the past session of the Legislature a law was passed 
providing for commitment by medical examination and doing away 
with the jury system; and also providing for the boarding out of a limited 
number of insane by the Trustees. So the Doctor will please remove the 
name of Wisconsin from the list of barbarous States. 

Dr. Walk, of Philadelphia. I do not wish to make a correction. I wish 
to say in regard to the out-patient department at Philadelphia, that it has 
been recently proposed that patients suffering from incipient mental disease 
have two of those dispensaries connected with the Pennsylvania Hospital, 
and they have found it hard to arrange treatment. They should be admit- 
ted to Homes for Convalescents. It is hoped that in that way they may be 
successfully treated by dispensary practice. 


INDEX TO PAPERS ON THE COMMITMENT, DETEN- 
TION, CARE AND TREATMENT OF THE INSANE. 


Airing-court system, disused, 9. 

Alienation, mental, 69; as a disease, 
70 ; treatment of, 70; cause of, 70 ; 
under the French law, 75. 

Allbutt, Clifford, 164. 

America, a service to humanity, 57 ; 
the care and treatment of the insane 
in, 149-167 ; commissioners in lu- 
nacy, 154. 

Appel, J. S., on the new lunacy law of 
Colorado, 187. 

Asylum Board, 10. 

Asylum for epileptics and epileptic 
insane, 144. 

Asylum, insane, arrangements of, 9-10. 

Asylum, lunatic, 23, 44 ; need of, for 
degenerates, 27 ; insufficiency of 
accommodation, 36; J. M. Gran- 
ville’s system for, 53 ; the future of 
service, 58-65; fundamental reli- 
ance of, 58 ; medicine, 58 ; wards, 
described, 59; attendants in, 59; 
administration in, 62 ; reform of, 
60-64 ; latest evolution, 64-65 ; 
Lappvik lunatic, loi ; politics and 
management of, 155. 

Asylum physicians and superintend- 
ents, lO-II. 

Attendants in lunatic asylum, number 
of, 60 ; quality of, 61 ; reform of, 
59-64; defects of, 63-64; training 
schools for, 124, 169, 173 ; the results 
of mental training of, 125-129; 
physical training of, 130 ; trained, 
169-173; N. Y. system of dis- 
charged, 173. 


Bacon, Francis, 149. 

Banister, Dr., on training of attend- 
ants, 169 ; on increase of the in- 
sane, 180. 

Bennett, Alice, 92. 

Bethel epileptic colony, the, 141-142. 

Blumer, G. Alder, 14 ; on care and 
treatment of the insane in America, 
149-167 ; introductory address by, 
168-169. 

Board of Commissions in Lunacy, the, 

154. 

Board of Managers in state hospital, 
the, 156. 

Boarding system, for insane, 7. 

Brigham, Dr., 165. 

Brinkerhoff, Roeliff, 144. 

Browne, W. A., 3. 

Bucke, Dr., 134. 

Bucknill, John Charles, on private 
lunatic asylum, 51 ; and J. Conolly, 
52. 

Burr, C. B., on improvements in the 
care of the insane, 124-133; on 
trained attendants, 171-173, 174. 

Canada, care of the insane in, 134-138; 
and criminal insane, 137. 

Clark, A. Campbell, on the future of 
asylum service, 58-65. 

Clarke, C. K., on the care of the 
insane in Canada, 134-138. 

Clouston, T. S., on the lunacy ad- 
ministration of Scotland, 1-12. 

Colorado, the new lunacy law of, 187. 

Commitment, the, of the insane, 150- 


INDEX. 


190 

153; improper, 151 ; by examina- 
tion, 151 ; “semi-barbarous method” 
of, 152 ; N. Y. law, 152 ; advantage 
of speedy, 153. 

Connecticut, institution for the insane 
in, 182. 

Conolly, John, and J. C. Bucknill, 52 ; 
on private lunatic asylum, 52. 

Corbert, W. J., on the insane, 29-57. 

Courtney, Mr., 54. 

Cowles, Edward, 124; on training 
nurses, 130. 

Coxe, James, 2. 

Craig, Oscar, 144. 

Darwin, “ Descent of Man,” quoted, 
40. 

Degenerates, classes of, 22 ; training 
for, 23 ; the principles of the treat- 
ment of, 26 ; need of asylums for, 
27 ; the results of training in insti- 
tutions, 28; Dr. Koch’s treatment 
of incurable, 28. 

Degeneration, the congenital, 16 ; ac- 
quired, 16. 

Degenerative psychoses, the treat- 
ment of, 13-27, 186. 

Dementia, defined, 72. 

Depreciation, the congenital, 21. 

Detention of the insane, J53-162. 

Dillwyn, Mr., 54. 

Duquet, E. E., on the insane asylum 
in Quebec, 176. 

Dix, Miss, work in Scotland, 2. 

Earle, Pliny, 151 ; quoted, 151, 165. 

Eastman, B. D., on asylum superin- 
tendent, 173; on the causes of in- 
sanity among agricultural districts, 
182; on irresponsibility of the in- 
sane, 184. 

England, proportion of insane persons 
in, 82, 83 ; causes of the larger pro- 
portion of female insane in, 83-84; 
death rate of insane, 90. 

English Commissioners in Lunacy, 154. 


Epileptics, the care of, 139-148; 
peculiarity of, 139 ; number of, in 
the U. S., 139; neglected, 140; 
need of institution for, 141 ; colonies, 
143 ; colonies in the U. S., 143, 144 ; 
the Ohio hospital for, 144; the care 
of, summarized, 146; literatures on, 
147-148. 

Examiners, medical, of insanity, 113. 

Faith, and hope, 58. 

Finland, care of the insane in, 100- 
103; history of work for the insane 
in, 100; lunatics, 102; expenditure 
of lunatic asylum in, 102. 

Folsom, Charles F., 31. 

France, irresponsibility of insane un- 
der the law of, 6, 72, 74-76. 

Giddings, W. W., 152; quoted, 158. 

Gorton, Dr., on lunacy statistics, 179. 

Goschen, Chancellor of Exchequer, 42. 

Granville, J, Mortimer, on private 
asylums, 53. 

Harrison, George L., legislation on 
insanity by, 30 ; the value of his 
book, 31. 

Hitchcock, Dr., on boarding out the 
insane, 178. 

Hospital, plan, for insane, 119-121; 
advantages of, 121-122 ; N. Y. plan, 
157; for the insane in N. Y., 157; 
work of the patients in, 165. 

Hougberg, Emil, on care of the insane 
in Finland, 100-103. 

Humanity, universal circulation of, 168. 

Idiots, the results of training for, 17; 
need of boarding schools for, 19. 

Illinois, the jury law of commitment 
in, 152; politics in charitable insti- 
tutions of, 155 ; revision of laws, 160. 

Imbeciles, and insane, 186. 

Incorrigible, nature of the, 14 ; refor- 
mation of, 14. 


INDEX. 


IQI 


Insane, the treatment of, 6, 59, 64 ; 
classification of, 6 ; boarding system 
for, 7 ; examination of, 17 ; W. J. 
Corbert on the, 29-57 ; the subject of, 
30 ; old method of treatment of, 41 ; 
modern treatment of, 41 ; influence 
of the sane upon, 59; reform in the 
treatment of, 66-68; irresponsibility 
of, 69, 72, 74, 75, 76, 183-184; not 
illogical, 76; difference between 
sane man and, 78 ; population and, 
82; the population and female, 83; 
ages of, 88; religious profession, 
89; death rate of, 90; care of, in 
Finland, 100-103 ; more rational 
treatment for, 104-123 ; present 
treatment criticized, 104-105 ; defi- 
nitions of, 109, foot-note ; examina- 
tion and commitment, 113, 114, 115 ; 
reception of, into an asylum, 116; 
hospit41 plan for, 119-121; number 
of cured, 121 ; improvements in the 
care of the, 124-133; the care of 
the, in Canada, 134-138 ; care of, 
in Province of Ontario, 134; the 
commitment of the, 150-153; im- 
proper commitment of, 151; de- 
tention of the, 153-162 ; boarding 
out, 160, 178; care and treatment 
of, 163-167. 

Insane asylum, evils of present sys- 
tem, 116; reform, 117-118; con- 
struction of the medical staff, 118. 

Insanity, Dr. Koch’s divisions of, 15; 
hereditary predisposition of, 17 ; the 
increase of, 32-43; subject of, 30; 
G. L. Harrison’s legislation on, 30; 
hereditary oause of, 40; intemper- 
ance as cause of, 42, 181 ; andlunacy, 
69; legal definition of, 69; crime 
and, 70, 72 ; symptoms of, 70 ; treat- 
ment of, 70; defined, 71, 72; con- 
ditions of, 73; -examination of, 73 ; 
statistics of, in South Wales, 81-90; 
a case of, consecutive to ovarosalp- 
ingectomy, 91 ; surgical treatment of, 


91-99; under law, note, 106-107; 
existence of, 106; incurability of, 
108; as a disease, 110-112; treat- 
ment as a disease, 112-113, 150, 152 ; 
true nature of, 152; and jury, 152; 
treatment of and the public, 167 ; as 
a physical disease, 185. 

Intemperance, as cause of insanity, 
42, 181. 

Ireland, inspectors of lunatics in, 35 ; 
the first lunatic asylum, 38 ; immi- 
grants of, 87. 

Irresponsibility, of the insane, 69-70, 
183-184; index of, 79. 

Jarvis, Edward, relation of education 
to insanity, quoted, 35. 

Jury, and insanity, 152; law of com- 
mitment of 111., 152. 

Kankakee Hospital, the, 181. 

Kexholm Asylum, 102. 

Kingston, system of caring for the 
insane, 135. 

Koch, Dr., psychopathic depreciations 
by, 15 ; and Lombroso, 16 ; his treat- 
ment of weak-minded, 19. 

La Force, 143. 

Lappvik Lunatic Asylum, 100. 

Leighton, Stanley, 55. 

Letchworth, William P., 144. 

Lunatics, treatment of curable, 13; 
ward, 13 ; causes of increase of, 33 ; 
in Finland, 102; definitions of, 109, 
foot-note. 

Lunatic asylums, 23, 33 ; inspectors of, 
in Ireland, 35 ; as hospital. 

Lunacy, the administration of Scot- 
land, 1-12; the English commis- 
sioners in, 2 ; act for Scotland, 2 ; 
board in Scotland, 2-4 ; literature 
of, 30-32 ; a cause of, 42 ; legisla- 
tion of Great Britain, 56; legal defi- 
nition of, 69; statistics, 179. 

Lunacy commissioners, relation to 


192 


INDEX. 


physicians, 8 ; W. J. Corbert and the 
English, 32; report quoted, 33; 
report criticized, 104-105 ; Amer- 
ican, 154. 

J.,unacy laws of the U. S., 104 ; reform 
of, 111-112; on examination of the 
patient, 1 14. 

Manning, Frederick Norton, 31. 

Metcalf, Dr., 134. 

Mind, normal, essential conditions of, 
78. 

Mitchell, Arthur, 3, 7, 10. 

Montreal, Protestant asylum at, 137. 

Morel, Jules, on the treatment of de- 
generative psychoses, 13-27. 

Morton, Thomas G., 91. 

New York, state commissioners in 
lunacy, 37 ; the report of, 37, 56 ; 
state institution for epileptics, 144- 
147; commitment law of, 152; system 
of hospital, 157 ; hospital for the 
insane, 157-158; correspondence of 
patients in the hospital, 161 ; sys- 
tem of discharged attendants, 173. 

Nurses, training schools for, 130, 163. 

Nursing, the problem of mental, 59; 
reforms of staff, 60 ; defects of staff, 
60; defects of work, 60, 63-64; im- 
portance in training, 130. 

Ohio epileptic hospital, 144. 

Ontario Asylum, 135. 

Ontario, Province of, and care of the 
insane in, 134; institution, 134. 

Open-door system, 9. 

Organization, ideal, 61. 

Parant, Victor, on the irresponsibility 
of the insane under the law of 
France, 69-80. 

Pennsylvania Hospital for the Insane, 
the out-patient department of, 158. 

Pepper, William, 31. 

Peterson, Frederick, on the care of 
epileptics, 139-148. 


Politics, in asylum management, 155. 

Predisposition, congenital, treatment 
of, 18. 

Prisons, in Belgium, 25. 

Private lunatic asylum, 44 ; evil of, 
44-48 ; Lord Shaftesbury against, 
49-50; J. C. Bucknill against, 51- 
52 ; J. Conolly on, 52 ; J. M. Gran- 
ville on, 53 ; Uillwyn on, 54 ; wit- 
nesses against, 55. 

Psychopathic defect, treatment of, 18. 

Psychopathic depreciation, by Dr. 
Koch, 15-16; the acquired, 20; 
treatment of, 21. 

Quebec, system, 137 ; the insane asy- 
lum in, 176. 

Regis, E., 91. 

Reform, in the treatment of the insane, 

66 - 68 . 

Reformatories, education in, 24; in 
Belgium, 26. 

Responsibility, partial, 75 ; and in- 
sanity, 69-78. 

Retreat, first named, 66. 

Richardson, A. B., on trained attend- 
ants, 171. 

Ross, Chisholm, on statistics of in- 
sanity in New South Wales, 81. 

Rowland, L. L., on trained attendants, 
169. 

Royal asylums, i. 

Scotland, the lunacy administration 
of, 1-12, 177 ; the lunacy adminis- 
tration in, before 1857, i ; Miss 
Dix’s work in, 2 ; Lunacy Act for, 
2-4; the first report of commission- 
ers, 38. 

Scottish Lunacy Act, 2-4. 

Shaftesbury, Lord, i ; on private 
lunatic asylum, 49-50 ; on improper 
commitment of the insane, quoted, 
151 ; on the Boards of Commis- 
sioners in Lunacy, 154. 

Sjahtb Asylum, 102. 


INDEX. 


193 


Smith, Stephen, on more rational 
treatment for insane, 104-123; 
quoted, 151. 

Sonyea Colony, the, 145. 

South Wales, population of, 81 ; 
insane in, 83; proportion of insane 
in, 83; causes of smaller proportion 
of female insane, 84. 

Starr, Louis, 31. 

Stone, Henry, on the increase of the 
insane, 179. 

Stearns, H. P., on Scottish system, 
176-177 ; on Conn. Retreat for the 
Insane, 182. 

Thomas, Assistant Attorney General, 
on correspondences of patients, 
162-163, foot-note. 

Training schools, for attendants, 124, 
163; improvement in the care of the 
insane by the means of, 125-129; 
and the public, 130 ; advantages of, 
125-132 ; field of study in, 133. 


Toronto, system of caring for the 
insane, 135. 

Tucker, G. A., lunacy in many lands 

by, 31- 

Tuke,- Batty, 9. 

Tuke, D. Hack, on reform in the 
treatment of the insane, 66-68 ; 
cited, 137. 

Tuke, William, 66. 

Tyndall, John, quoted, 149. 

United States, the, lunacy law of, 104, 
106. 

Utica State Hospital, 164, 165, 166. 

Waite, C. C., 143. 

Walrath, Peter, 144. 

Weak-minded, need of boarding- 
schools for, 19; Dr. Koch’s treat- 
ment of, 19; kinds of, 21-22. 

White, Francis, 43. 

Workman, Dr., 134. 


York Retreat, 66-68; reforms in, 67. 



r 






Care and Training of the 
Feeble-minded 


BEING A REPORT OF 


THE EIGHTH SECTION OF THE INTERNATIONAL CONGRESS 
OF CHARITIES, CORRECTION AND PHILANTHROPY. 
CHICAGO, JUNE, 1893 


EDITED BY 

GEORGE H. KNIGHT, M. D. 

Superintendent of Connecticut School for Imbeciles 


BALTIMORE 

THE JOHNS HOPKINS PRESS 
LONDON . 

THE SCIENTIFIC PRESS, LIMITED 
428 Strand, W. C. 

1894 


THE WORLD’S CONGRESS AUXILIARY OF THE WORLD’S COLUMBIAN 

EXPOSITION. 


The International Congress of Charities, Correction and 
Philanthropy. 

president : 

RUTHERFORD B. HAYES. 

first vice-president : second vice-president : 

FREDERICK H. WINES. ROBERT TREAT PAINE. 


GENERAL SECRETARY : 

ALEXANDER JOHNSON. 

COMMITTEE OF ORGANIZATION : 

FREDERICK H. WINES, JOHN G. SHORTALL, Mrs. J. M. FLOWER. 
NATHANIEL S. ROSENAU, Secretary. 


SECTION VIII. 

The Care and Training of the Feeble-minded. 

CHAIRMAN : 

GEORGE H. KNIGHT, M. D., 

Superintendent of State School for Imbeciles, Lakeville, Connecticut. 

SECRETARY : 

GUSTAVUS A. DOREN, M. D., 

Superintendent of Institution for Feeble-minded Youth, Columbus, Ohio. 


Copyright, 1894, by the Johns Hopkins Press. 


r 


TABLE OF CONTENTS. 

PACK 

General Session : 

The Colony Plan for all Grades of the Feeble-minded. By George 

H. Knight, M. D 5 

State Care of the Feeble-minded. By A. C. Rogers, M. D 8 

Pathological Conditions Accompanying Mental Defects in Children. 

By A. W. WiLMARTH, M. D 14 

Discussion 16 




THE FRIEDENWALD CO., PRINTERS, 
BALTIMORE, MP. 


ItttjCfttatiotiat ^angvcss af 
^avxtction aufl 


Eighth Section. 

THE CARE AND TRAINING OF FEEBLE- 
MINDED CHILDREN. 


GENERAL SESSION. 

Thursday, June 15, 1893, 8 p. m. 

Rev. Frederick H. Wines, LL. D., vice-president of the Con- 
gress, called the section for the Care and Training ' of Feeble- 
minded Children to order and introduced as chairman of the meeting 
M. Prosper van Geert, of Antwerp, Belgium. 

Dr. George H. Knight, superintendent of State School for 
Imbeciles, Lakeville, Connecticut, read the following paper : 

THE COLONY PLAN FOR ALL GRADES OF THE 
FEEBLE-MINDED. 

GEORGE H. KNIGHT, M. D. 

There is nothing new to advance in considering the cause of the 
feeble-minded from the charitable side. We have to go over practi- 
cally the same ground so often, always with the hope of going a step 
farther in the creation of a just public sentiment, that the members of 
the National Conference might well think our motto was the old one 
ending “ Here a little and there a little.” 

Our work must of necessity be many-sided. The children, always 
children no matter what the age, demanding our best efforts, are 
usually neglected, often abandoned, always dependent. 

Unlike the normal child, one of feeble mind finds his best develop- 
ment in an institution, for there alone can he get that most necessary 


6 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


factor in the happiness and development of every human being, com- 
panionship. 

The methods in use for developing to the highest possible extent 
a feeble mind, too often in a feeble body as well, are the methods 
used in the development of the normal child, but intensified. 

Example is much farther above precept with the imbecile than 
with his brighter brother, and he gains from imitation and contact 
with his own kind that which his limited intelligence could never 
originate. 

At every discussion upon child-saving work we are impressed 
afresh with the difference which must always exist between the 
methods in the training of the normal and the feeble-minded child. 
I do not wish to be understood as undervaluing the influences of 
home-training, decidedly not of that indescribable quality called 
“ mothering,” an instinct, by the way, which even imbecility cannot 
deaden — nor is this instinct of tenderness wholly confined to girls. 

I shall never forget an object-lesson in this given by one of the 
older boys during the early days of our Minnesota institution. The 
population of the state was largely foreign, bringing into the institu- 
tion Swedes, Norwegians, German and French children, all of whom 
had the difficult lesson of a new language to learn. One night at 
dusk a mother brought and left with us a small boy of seven, dumb, 
but capable of hearing, and understanding no language but his native 
one, French. Each member of the family tried in turn to tempt him 
to eat his supper. We tried milk, and bread and milk, bread and 
butter, bread with syrup, with sugar, with apple sauce, everything 
that a child of that age was supposed to like, but without success. 
Finally he was put to bed, still sobbing, and when after a time he 
grew quiet and the matron went in to see that he was all right, she 
found that the biggest boy in the dormitory had taken him into his 
own bed and the little fellow had fallen asleep in his arms, com- 
forted by that language of kindness which needs no interpreter. The 
next morning we found that plain bread was the only thing the child 
was accustomed to, and that we had spoiled his supper by trying to 
change his habits too suddenly. 

The instinct of protection and kindness shown by this big boy is 
by no means an unusual quality in that grade of feeble-mindedness 
which we classify as bright imbecility, and in developing this trait by 
training such cases into care-takers for the smaller and more helpless 
children we serve the double purpose of making these dependents 


KNIGHT. 7 

producers, and also of giving them the standing of useful members 
of the institution family. 

Our experience as superintendents has taught us that the imbecile 
can be developed best where he can be made useful. He gains in 
self-respect in a position of trust, in kind if not in degree with his 
more fortunate brother. Out in the world the relentless force of 
competition would drive him to the wall and keep him there, literally 
a cumberer of the ground, a source of pauperism, and if he were 
bright enough to be made a tool in the hands of the unscrupulous, a 
source of crime. 

There is no market for imbecile labor outside institution walls, 
except in rare cases where charity and humanity cause some one to 
take an oversight of an individual case. No homes are opened to 
the abandoned imbecile. No one is eager to adopt the burden into 
his own family. There is absolutely no such thing possible as the 
placing-out of imbecile children, except for gain. We must then have 
institutions for this class, both for their own sakes and for the sake of 
the community. The problem that is constantly before us is how 
shall we make such institutions best serve the purpose for which they 
are established. 

We think we see the most hopeful future in the adoption of the 
colony plan, where the child of the lowest grade, the idiot — that 
unfortunate, often born so repulsive that even the ties of blood can- 
not lighten the burden of any but the mother — finds his one chance 
of development in the custodial department. 

The epileptic finds here his place, with medical care which gives 
him perhaps a hope of improvement, or lacking that, the oversight 
which keeps him from bodily harm, the amusement or occupation 
which brightens his life, and the shelter which removes him from the 
curiosity and the pity of his fellows. 

The bright imbecile with harmless instincts or tendencies finds in 
this colony home a market for his labor. He is no longer a pauper, 
a state charge ; he can at least earn his board and clothes, and he can 
care for and help to entertain and make happy his fellows who are 
less fortunate than himself. 

The brightest imbecile of all, the moral imbecile, who gives us 
many of our criminals, finds in the restraint of the institution a safe- 
guard, a restraint unwillingly borne, hard to enforce, difficult to 
maintain wusely, but more necessary for the ultimate public good 
than the public has yet any conception of. 


8 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


Most important of all, the outcome of the colony plan is the fact 
that when we have found a method which shall care for the custodial 
case, whom no one wants, and the epileptic, who becomes a custo- 
dial by degrees unless his disease is arrested, and the bright imbecile 
who can be taught to help his weaker brother, and the moral imbe- 
cile who can have the outlet of occupation and the safeguard of 
restraint and constant oversight, and most necessary of all, and most 
difficult to procure for him and his depraved tendencies, that charity 
which suffereth long and is kind — when we have brought this about 
we shall have made the tremendous gain of preventing among imbe- 
ciles that disgrace to our civilization, the reproduction of their own 
kind. 

The colony plan is not a vision, but a well-defined working plan, 
proving itself by actual experience every day. In its successful out- 
come lies our hope of progress in the future of this work, which, so 
far as our end of the “ Problem of Charity ” is concerned, must of 
necessity be, not “ the survival of the fit,” but always “ the revival of 
the unfit.” 

Dr. A. C. Rogers, superintendent. State School for Feeble- 
minded, Faribault, Minnesota, read the following paper: 

STATE CARE OF THE FEEBLE-MINDED. 

A. C. ROGERS, M. D. 

These figures upon the cardboard* are our excuse for calling you 
together to-night, to consider with us the best means of dealing with 
the feeble-minded. Those of us engaged in their care and training 
are always at a disadvantage in presenting their claims, because we 
are their paid retainers. Their misfortune happens to be our means 
of sustenance. We are conscious that a calm judgment must elimi- 
nate from our testimony all personal interest. With this understand- 
ing, let us state the facts as we understand them, holding ourselves 
open to conviction, if better methods than ours can be suggested. 

Speaking for the United States, and using the figures for 1890, the 
facts are these : 

First . — We have approximately 95,000 feeble-minded persons 
among our 63,000,000 people, or one to every 660 of the general 
population. 

*See page 13. 


ROGERS. 


9 


Second . — These defective children seem to be no respecters of 
family station or caste. They come to the homes of the rich and 
poor alike. The learned and the illiterate share alike in this misfor- 
tune. They are found in the dense population of the cities, amid the 
ceaseless noise and smoke of manufacturing traffic and transportation, 
and they are not strangers to the rural homes where nature revels in 
sunshine and songs of birds. 

Third . — In general it is a fact that the advent of a feeble-minded 
child into a family brings a burden of sorrow and care which has 
not its equal upon the calendar of domestic afflictions. 

Fourth . — It is a fact, with some rare exceptions, that from the time 
a feeble-minded child arrives at the age when normal children walk 
and talk, it is better for the child, the family and the neighborhood 
that it be cared for by those trained for that kind of work. A well 
organized institution with twenty-five trained persons can care for 
and train one hundred feeble-minded persons more easily than a 
whole family can care for one such person, under ordinary circum- 
stances, without attempting any systematic training whatever. 

Fifth . — It is a fact that all mankind is growing in the knowledge 
and practice of that greatest of all virtues, charity — charity in that 
true sense which Webster gives as the first and principal meaning, 
namely, “ That disposition of heart which inclines men to think 
favorably of their fellow-men and to do them good.” 

Sixth . — The advantage of insurance is a fact of common business 
experience. Men gladly contribute at regular intervals to a common 
fund from which they can individually be indemnified for loss of 
property or limb, or their families for loss of life. 

Seventh . — Every family in the land into which children are liable 
to be born faces the possibility of having one or more defective ones 
among the number. 

Now with these seven important facts before us, we are ready to 
advocate state care for the feeble-minded. We would not for a 
moment be understood as discouraging private enterprise in this 
direction ; but any enterprise that is at all comprehensive requires 
large capital. Private care of the feeble-minded necessitates wealthy 
patrons or an income from extensive endowment. As the great 
mass of children of our land are of poor parentage, or parentage of 
mediocre means, so the great majority of feeble-minded children are 
of similar parentage and hence ineligible to private care. If a few of 
our millionaires can be led to see the good which some of their 


lO 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


money could do in endowing homes for all classes of the feeble- 
minded, by the influence which this Congress wields, or otherwise, 
it will be “ a consummation devoutly to be wished.” May God hasten 
the day of its realization ! What we do urge is universal effort to 
bring this class under the care which every interest of humanity 
demands that it should have. 

Following now as corollaries from the proposition stated are these 
facts : 

First . — The state can accomplish what private enterprise cannot, 
simply because it can readily furnish the means. Counties might 
unite and accomplish practically the same results, if they could agree 
upon some fair adjustment of the necessary support, responsibility 
and oversight. We will not argue over the particular means if the 
work is only comprehensive. The machinery of state government 
is well adapted to handle these matters, and hence in practice will, 
we believe, generally be called upon to do so. The principle involved 
in both cases is the same. 

Second . — The state can bring together a sufficient number of chil- 
dren to make the institution accomplish its best work, because with 
large numbers will come better classifications, and the reduction of 
expense to a minimum consistent with the character of work done. 
I think all who have had experience with the feeble-minded will 
testify that these children are happier and more teachable when care- 
fully arranged into convenient groups; and economy of administra- 
tion demands that each group, whether under the care of a teacher 
or companion, be as large as possible consistent with the most effi- 
cient attention of the care-taker. The colony system has been almost 
necessarily developed by this matter of classification, and it meets 
with universal approval wherever it is clearly understood. 

Third . — The state can secure harmony and uniformity of action 
among the various agencies, auxiliary or indispensable to successful 
working of organized effort for the feeble-minded ; the determining 
of eligibility ; the keeping in view the fact that it is not necessary 
that every feeble-minded person should be in an institution ; the 
collection of data bearing upon causation, and the application of 
means tending to the comparison and harmonizing of methods 
employed for training ; the lessening of the causative influences are 
among the things that at once suggest themselves in this connection. 

Fourth . — State care of the feeble-minded is after all a practical 
system of insurance which guarantees to every parent of a common- 


ROGERS. 


I I 

wealth a home for any child of this kind which may come to his fire- 
side through no known violation of natural laws upon the part of 
either parent, a home where such a child can receive a degree of 
care which no mother can give without neglecting those children 
who are to engage in the active affairs of life, and the direction of 
whose destiny she alone can properly supervise. 

Finally, the state can better afford financially to care for its feeble- 
minded in well organized institution colonies than to neglect them. 
The question of comparison of per capita expense for the care of public 
wards involves two variable elements in particular, namely, character 
of treatment and data from which expense is estimated. The char- 
acter of treatment will depend not altogether upon the disposition of 
the management, but more especially upon the culture, sentiments 
and general financial ability which characterize the community. 
Paupers can be maintained at a cost of seventy-five cents per week 
in county poorhouses, and idiots can be “farmed out” for seventy- 
five dollars per year. I regret to say that one of our noble sister 
states still reflects discredit upon her otherwise fair name, by per- 
mitting this latter state of affairs to exist. At the present price of 
the necessities of life, do you want the reputation in your respective 
communities of imparting the kind of care which these figures 
indicate? 

The only way to compare cost of maintenance intelligently, quality 
and all details being equivalent, is to consider the interest upon per- 
manent investments, with every item of food, lodging,clothing, instruc- 
tion, amusement, medical and general attendance. When com- 
parisons are made on this basis, state care will, I believe, be found 
in every case to exceed but little the average cost of the ordinary 
county care of our poor. For the sake of illustration I turn to the 
published report of the board of charities of a neighboring state, the 
only one accessible at this writing, and I find the following facts for 
1891, namely : First . — The per capita cost of the poor varied in the 
different counties from nothing (where sales from farms exceeded cost 
of maintenance) to $11.13 week, the average for the state being 
$2.71, excluding interest on investments and medical attendance. 
Adding these latter items the average becomes $4.03. Second . — The 
cost per capita of the school for feeble-minded, in the same state for 
the same year, was $3.52, exclusive of clothing, transportation of 
inmates to school, and interest on investments. Adding the latter 
items the average becomes $4.50. This gives a difference of 47 


12 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


cents in favor of the poorhouse care of paupers, as against the syste- 
matic care and training of feeble-minded in an institution well 
equipped with schools, shops, farm and garden. It is only fair to 
our cause to add that in this particular case the institution is com- 
paratively new and has hardly begun to reap the financial advantage 
which follows from the employment extensively of trained inmates. 
This feature eventually becomes a very important characteristic of 
every institution organized upon the colony plan. These figures are 
suggestive, and while they will not correspond in detail in every state, 
I trust you will follow up this line of investigation in your respective 
states, and I have no fear that the results will strengthen our 
present deductions. 

. Now let us face the problem squarely. If it is good for one state 
to establish training schools, it is good for every state to do the same. 
I imagine I can hear a protest arise in many quarters when the sug- 
gestion is made of establishing training schools and state homes for 
95,000 feeble-minded persons. The undertaking does seem vast. 
Assuming a reasonable deduction for the number of persons that can 
be cared for best at their homes and in private institutions, we will 
suppose provision to be made for an army of 84,000, each state taking 
care of its respective quota, in well equipped institutions built of the 
best material and with the best modern appliances, and with at least 
one acre of land to each inmate. For all this we will allow $600 per 
bed, which you will all agree is ample ; add six per cent, of this amount 
to the average per capita expense of maintenance under existing 
circumstances, and we will find that the enormous expenditure of 
$16,500,000 will be annually required to do the work. These figures 
almost stagger us, but they must be considered from all standpoints 
and estimated by comparison with other things with which we are 
familiar before their proper bearing upon us as individuals can be 
appreciated. $16,500,000 would nearly reproduce the World’s 
Columbian Exposition, but it would represent only one of the smaller 
items of the budget which Congress annually passes for its numer- 
ous dependencies. This amount would be equivalent to a direct tax 
of about 26 cents per individual, or $1.45 per voter in our federal 
elections. A tax of $i on all real and personal property assessed at 
$1460 would supply the means required. Practically, however, our 
taxes for such purposes are indirect, and we can estimate this sum 
of money by another method. In 1891 the United States received 
as internal revenue tax on smoking and chewing tobacco, exclusive 


ROGERS. 


13 


of the various forms of manufactured tobacco, cigars, cigarettes, etc., 
over $18,325,000, or enough to carry on our enterprise and drop over 
$1,750,000 into a permanent endowment annually. 

After all, you will, I think, agree with me that the premium upon this 
insurance is not excessive. In the meantime what are these insurance 
companies doing with this premium? They are not simply relieving 
you of the care of your child ; they are doing more for its interests 
and happiness than you can do yourself. They are organizing farms, 
workshops and industries adapted to the utillization of the forces 
which they are developing. They are reducing to a minimum the 
possibility of increasing the number of this class of unfortunates by 
multiplying their own offspring, for a fountain can never rise above 
its source ; and to stop this one cause of misery alone would well 
repay the state for a vast outlay of money. 

CENSUS OF FEEBLE-MINDED IN THE UNITED STATES. 


{Compiled from the enumerators' returns, taken June i, 1890.) 


Alabama 


Nebraska 

959 

Arizona 

13 

Nevada. 


Arkansas 


New Hampshire 

779 

California 

880 

New Jersey 


Colorado 


New Mexico. . . . 


Connecticut 


New York 


Delaware 


North Carolina 

3597 

District of Columbia, 


North Dakota 

135 

Florida 


Ohio 


Georgia 


Oklahoma 

34 

Idaho 

55 

Oregon 


Illinois 


Pennsylvania 

8753 

Indiana 

5568 

Rhode Island 

488 

Iowa 


South Carolina 


Kansas 


South Dakota 


Kentucky 


Tennessee. 

3590 

Louisiana 


Texas 


Maine 


Utah 


Maryland 


Vermont 


Massachusetts 


Virginia 


Michigan 


Washington 


Minnesota 


West Virginia 

1430 

Mississippi 


Wisconsin 


Missouri 

3881 

Wyoming 

14 

Montana 





Total in United States 95>57i 


14 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


Dr. A. W. WiLMARTH, of Norristown, Pennsylvania, read the 
following paper : 

PATHOLOGICAL CONDITIONS ACCOMPANYING 
MENTAL DEFECTS IN CHILDREN. 

A. W. WILMARTH, M. D. 

It is my purpose this evening to avoid, so far as may be possible, 
technical terms and tedious statistics, and to state briefly the material 
changes found in the nervous system of our charges and their bear- 
ing on their care. 

It is a curious and interesting study, as we walk through the rooms 
of an institution for the feeble-minded, to note the facial expression 
and shape of the heads of the children we meet. Take first the small- 
headed or microcephalic imbecile. We shall find him perhaps fairly 
bright and alert. He will learn quite readily sometimes, but finds 
his capacity far below that of the normal intelligent child. We shall 
see a child with a large head, well formed, but he is slow in move- 
ment and slow in mentality; another with large head of more 
globular shape, indicating the presence of water or hydrocephalus ; 
many other children whose outward appearance gives us no clue to 
a defective brain condition. 

Let us look a little closer into these material conditions with those 
coexisting within the skull, and the bearing they may have on the 
child’s mental condition and his care. But first we shall have to 
glance at the structure of the organ of will and thought — the brain. 
So far as we need regard it, we may look on it as consisting of small 
bodies, 'termed cells, possessing a distinct vitality, which enables them 
to receive impressions through the organs of sense and store them 
away as memories, or to send out impulses as motions ; to revive 
and connect these memories in the process of thought. These cells 
are arranged in groups, each group presiding over a particular 
faculty, and are intimately connected together by numerous fibres 
and firmly held in place by the supporting tissue (or neuroglia) in 
which they rest. Three things are essential to their perfect action 
and the consequent mental health of the subject: 

1. They shall be sufficiently numerous and well developed. 

2. They shall have a large and constant supply of blood to keep 
them well fed and active. 

3. They shall be healthy. 


WILMARTH. 


15 


In a majority of our children we shall find some one or more of 
these conditions violated. The so-called microcephalic imbecile, with 
his small brain, illustrates the first class. All parts of his brain are 
undersized and will never give him sufficient mental power to com- 
pete with society in these days of active struggle for existence. W e 
may find instead of the whole only a portion of the brain undevel- 
oped or lacking. Or the child may have a large and finely shaped 
head and yet suffer under essentially the same condition, for we shall 
find the size due to an increase in the neuroglia or supporting struc- 
ture, while the brain cells, the active elements through which the 
mind finds expression, are few or poorly developed. In this class 
we shall find the offspring of weak-minded parents, also of those 
whom vice has robbed of their health and strength, who have only 
a weakened vitality to transmit to their offspring. 

As a result of the second condition, simple cases are comparatively 
rare, most of them merging with the third condition, which we will 
briefly consider. It was formerly thought that a majority of the 
feeble-minded were simply suffering from a suspended development; 
that their dormant faculties could be aroused by special training, 
and a condition more nearly approaching a healthy mentality be 
attained. Probably in more than fifty per cent, of the feeble-minded 
imbecility or idiocy is the result of actual disease. * It is probably 
true that disease will more readily attack a brain which is inherently 
weak from hereditary causes ; but it is just as true that infantile 
meningitis, the rupture of a vessel from violence or convulsion, or 
other disease, will not only destroy a portion of the organ, but will 
check the complete development of the whole in children of families 
with the cleanest history. The diseases which cause these results 
are too numerous to describe here. 

A sadder class even than these are the children who are bright, 
perhaps precocious, until well into childhood. An epileptic spasm, 
or beginning failure of mental power, or, possibly, lapse in the moral 
nature, arouses the friends’ attention to impending trouble. In such 
cases, unless early improvement occurs, they are liable to lapse into 
idiocy, or more happily find, after many months, release by death. 
In many such cases a steady decay of the active brain elements is 
found; in others, nothing at all. Grave changes have no doubt 
occurred, but they are beyond our present powers of perception. 

What shall we say of that troublesome member of our feeble- 
minded communities, the so-called moral imbecile? Though proven 


i6 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


a theoretical impossibility by able reasoners, he is an incorrigible 
reality in all institutions for the feeble-minded. This moral deficiency 
is generally, but not always, associated with mental defect. It is a 
disputed question whether the condition rests on material defect in 
the brain. That tendency to crime is hereditary I think no one will 
deny. That more or less complete loss of moral stability is the 
prominent feature in many cases of brain disease or injury leading to 
insanity, is equally certain. On these grounds we have been accus- 
tomed to look on these unfortunates as blameless victims of inherited 
or acquired infirmity, and to extend them care, that the public might 
be protected from their evil impulses, and they from the severe 
measures which the public in self-protection would be obliged to 
adopt. 

I trust these few remarks will enable us to better comprehend the 
needs of our institutions : why they must combine a school, with 
peculiar facilities for teaching those slow to learn because of some 
practical loss of their organ of mind, a hospital for those suffering 
from actual disease, and a place of detention for those who, through 
no fault of their own, come into our world handicapped by evil 
impulses developing without the higher moral instinct of self-control. 

Dr. Hyde, of New Orleans. — I would like to ask the gentleman 
from Minnesota, Dr. Rogers, what methods he employs to raise 
these children. 

Dr. Rogers. — I am sure there are others who can explain the 
methods better than I ; but the first great object is to attract the child, 
and the best means in the world for attracting a child is to gain its 
love and affection. It is perhaps for this reason more than any other 
that the majority of teachers in schools for feeble-minded are ladies. 
And a great deal of pains is taken to select only those who are natu- 
rally sympathetic. Starting with that, a teacher must use her 
ingenuity to discover the means of reaching a particular child. No 
two children in a feeble-minded school are alike any more than they 
are in public schools. Individual training must be given a much 
larger place in feeble-minded institutions than in public schools, from 
the very fact that the progress in each case is necessarily so slow. 
Concert exercises are used to arouse general interest. Some children 
are very nervous and excitable ; they must be dealt with in the 
calmest mannner possible. Often when there are outbursts of excite- 
ment, they must be led away from other children and placed in 
some quiet room without any disturbing influence until this excite- 
ment passes away. Others again are of the stolid, indifferent kind. 
They must be worked with almost constantly and stimulated by all 
kinds of devices, mechanical and otherwise. In our schools to-day 


DISCUSSION. 


T7 

we follow more nearly the methods of the kindergarten of the public 
schools than the teachers of those schools originally did. There 
were many special pieces of apparatus used in the early institutions, 
such as the one at Syracuse and the one at South Boston, now 
Waverly, that are not in much use to-day. One thing was the bal- 
ancing-board. Children with a sluggish disposition would be placed 
upon a board much like a see-saw, and would learn to protect and 
poise themselves to prevent a fall upon the floor. Another method 
is to place the child against the wall and gradually force his feet so 
that the centre of gravity is in front of the child, and he will fall 
unless he steps forward to catch himself. The kindergarten method 
proper requires considerable modification for these children. The 
weaving and sewing and the other various occupations cannot be 
carried out perfectly. I think Dr. Fernald can explain that method 
better than I. 

Dr. Walter E. Fernald, superintendent of State School for 
Feeble-minded, Waverly, Massachusetts. — It seems to me that the 
pioneers in this work anticipated the new education. The methods 
followed in schools for feeble-minded are the same as those used in 
public schools for teaching normal children. The methods of the 
kindergarten, the methods of systematic physical training, manual 
training, the utilization of bright colors, were the methods used in 
our work forty years ago, and those are the methods used to day in 
the public schools. Dr. Rogers did not speak particularly of manual 
training. We use manual training, the teaching of the children to 
do things, not only for its intrinsic value, but for its educational value. 
One of our methods for attracting the attention of a child is to get 
him to pick up stones. I think that is the most elementary study 
in our school, and it is unnecessary to say that in Massachusetts we 
never get out of raw material. 

Dr. Hyde. — It appears to me that separating the feeble-minded 
children from the others is not the correct thing to do. We know 
that at a tender age children learn more in a kindergarten from 
imitation than teaching. You show a child a ball. You do not say 
it is round ; you make him see it is soft and he feels it. A little baby 
or a child in a kindergarten learns from example. Would it not be 
better, on a small scale, to take those unfortunate children and put 
them with others so that they could learn from and imitate them, 
instead of crowding them all together ? 

Dr. Fernald. — The experience of the teachers in this work has 
been that the feeble-minded, more than other children, need com- 
panionship of other children. The word idiot means to be alone, 
and the feeble-minded child is never so much alone as when he is in 
a public school with normal children; and they are infinitely happier 
with their own kind, as normal people are happier when they are 
with people of their own understanding. 

Dr. Hyde. — I had in my charge 150 children, and two of them 
were half-witted. They were not idiots, but they did not have the 


i8 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


mental faculties that the others had, and I expected that they would 
seek each other’s company, but they did not. I always observed 
that they looked for children who were different from themselves. 

Dr. Fernald. — But those children might have been of the oppo- 
site extremes of mental defect. In an institution of some four hun- 
dred inmates it is possible to classify and grade the children so that 
pupils of the same mental grade may be together. We feel to-day 
that one of the advantages of our institution is the grading and 
classifying of the children. It is my experience that they almost 
always select children of their own mental condition. Individual 
teaching of a feeble-minded child has never been entirely satisfactory. 
I know of many cases where wealthy parents have employed our 
tutors to give their entire time to their child, and in almost every 
case those children have come back to us; and when they have not, 
I think I have invariably ascertained that they did not do as well as 
they did in school with other children. 

Dr. Hyde. — Do you know of any practical book on the way to 
raise feeble-minded children? 

Dr. Fernald. — I do not. 

The Chairman. — We have one more speech, by Mr. Alexander 
Johnson, and then the meeting will be open for discussion. 

Mr. Alexander Johnson, superintendent-elect of State School 
for Feeble-minded Youth, Fort Wayne, Indiana. — I want to call Dr. 
Rogers’ attention to the doubtfulness and the difficulty of statistics. 
I think I have before this time quoted on the floor of these confer- 
ences the saying of Lord Beaconsfield that there is nothing so falla- 
cious in facts as figures, and I believe those figures on the wall are 
fallacious. It seems incredible to me that the state of Indiana can 
be fourth among the states of the Union in the number of its feeble- 
minded. It seems also equally incredible that Ohio should be the 
second and Pennsylvania first. I challenge the accuracy of those 
figures. These figures are taken from the census reports, from the 
enumerators’ returns. The state of Indiana, according to the United 
States census figures, did not increase from 1880 to 1890 very materi- 
ally, while the feeble-minded increased something like 75 or 100 per 
cent., and the insane diminished 7 per cent. The United States 
statistics for Indiana’s insane and feeble-minded showed a decrease of 
7 per cent, of insane in ten years. During that time the insane insti- 
tutions had increased 120 per cent. I don’t believe those figures are 
accurate. I think they are entirely incorrect. The difference between 
1880 and 1890 is evidently in the way that the counting was done, 
for I do not believe we have such a terrible number of feeble-minded 
in Indiana. If that number on the board were accurate, 5568, at the 
rate that Dr. Rogers proposes we should care for them, we should 
have to invest $4,154,400 in providing accommodations for them, 
and it would cost US$1,113,600 to support them. Our entire state 
revenue would have to be doubled. But I do not think that is 
necessary. Why should it cost us so much more to take care of the 


DISCUSSION. 


19 


adult imbeciles and feeble-minded than it does in the state of Wis- 
consin to take care of the adult insane ? Why cannot we look forward 
to taking care of our feeble-minded brethren on a more economic 
basis ? As far as the young children are concerned, and the prelimi- 
nary training, I am in favor of spending every dollar on that part of 
the work that can be wisely expended. I do not believe in spoiling 
a good ship, as they say, for the sake of a bucket of tar. I do not 
believe in stinting one dollar which will make a child grow up into 
a more self-supporting man or woman. But when we get up to the 
higher grades we do not need palaces and $800 per capita for houses 
and furniture or anything like that. We do not have it in our poor 
asylums, and we have poor asylums which are very comfortable and 
clean and nice and cost less than $i per capita per week, taking in 
the produce from the farms, and some of them are entirely self- 
supporting. 

Dr. F. M. Powell, superintendent of State Institution for Feeble- 
minded Children, Glenwood, Iowa. — The question of economy has 
come up. I do not think the superintendents will differ very much 
from the gentleman from Indiana. In all these organized institu- 
tions, especially where they have advanced in numbers sufficiently 
to classify them, you will find the different buildings which we term 
the colony plan. During the last two years we built a frame building 
a short distance from the main educational building and we have 
domiciled there 25 boys. They have been through the school 
department, yet they are not capable of going out into the world 
to care for themselves ; they must have supervision, and the majority 
of them have no homes to go to. These boys live there, sleep there 
and dine in their cottage, having their own w'ay. They do the work 
on the farm, and work in shops and in various places about the insti- 
tution, so that in course of time, when the institution becomes larger 
and there are more of them, we shall be able to reduce the per capita 
expense, and in fact we are doing so, and that is as far as we can go. 
This class of individuals do not need the class of costly buildings 
that have been referred to, but there is a question often asked by 
parents, namely, “Do you ever cure them?*’ We can say “No” 
almost invariably. Occasionally there are children that drift in there 
who ought not to be there. If they are feeble-minded, it is because 
they have had no opportunity to develop, and they are developed 
and sent out as self-supporting. Superintendents generally agree 
that from 10 to 20 per cent, only are sent out as capable of caring 
for themselves. My own convictions are that this is too large a 
percentage and that we have made mistakes in sending them out. I 
remember some years ago, through the importunities of parents and 
friends, I sent out a number of boys and girls, and the results of 
sending them out made me extremely careful about sending others 
out. Since then one of the governors of Iowa wrote a number of 
letters to the board and spofc to me personally, insisting that we 
had children there who must be sent out. I told him to pick and 


20 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


send them out, and I would make a record of it and report the results 
later ; but he never dared to do it. There would have been a history- 
following that would not have been very pleasant to him. I am 
growing more to feel the necessity of detaining them, for it cuts off 
27 per cent, of the cause — a sufficient reason in itself. 

Dr. L. L. Rowland, superintendent of State Insane Asylum, 
Salem, Oregon. — We are just beginning, but we have 850 patients. 
Five miles from the asylum we have what we call a hospital and 
cottage farm where we are now preparing to keep about 300. A part 
of my mission here is to inspect asylums and be able to report some- 
thing to the board. It is believed that of the 75 whom we have kept 
there, more than half will accomplish about as much as the same 
number of hired men ; and they are there to stay, they are among the 
incurables. More than half of our teamsters are patients. I ought 
to state, however, that these patients are not of the class I have just 
mentioned ; they are changing. They beg for the privilege of having 
teams, and they take quite as good care of them as our hired men. 
We have with these 850 patients 1200 acres of land, in round num- 
bers. When we had 1025 our legislature added to them, and 1 can 
say for one legislature that they have done all that they have been 
asked to do. I think the solution of this matter lies in the fact of 
having large farms in connection with shops as they have here at 
Kankakee. I believe with Gen. Brinkerhoff that many of them 
would be self-supporting. Ours are fully so. Within one year we 
have cut down the per capita to a figure that has never been known 
in the institution before. 

Dr. Bell. — It has occurred to me that this is one of the causes of 
the increase of feeble-minded. These young men and women pass 
out of the institutions and go to battle with the world, and they 
intermarry. 

Dr. George H. Knight, of Connecticut. — There are no correct 
figures with regard to that part of the subject. Epilepsy I have been 
able to follow up somewhat, and the offspring of epileptics are gener- 
ally subject to epilepsy. We know, however, that the old adage 
that “ like produces like ” is pretty nearly true, and therefore imbe- 
ciles should never be allowed to marry. I know of one epileptic 
woman, an inmate of a poorhouse, who was allowed to marry a 
farmer who wanted somebody to keep house for him, and the result 
was sixteen children. Fortunately seven died, but the remaining 
nine were defective, some being epileptic, and others mentally deficient 
in varying degrees. Now we have custodial cases of girls who are 
child-bearing, or capable of child-bearing; we have the brighter 
classes of imbeciles whom our town-folks permit to marry ; we have 
the moral imbecile, who, if allowed to go astray, increases our 
criminal class ; and the epileptics. These are the four classes to 
apply our preventive work to. We shall get our best results from 
this preventive work, and only on these lines are we going to get 
any results. There are so many unscrupulous men who would take 


DISCUSSION. 


21 


advantage of a feeble-minded girl that we cannot afford to send them 
out to work as servants. 

Dr. Frederick H. Wines. — I stand here to speak for the idiots 
because, more than any other class of human beings, they need a 
champion. What is an idiot? Most people do not know. What 
is the difference between an insane person and an idiot ? An insane 
man or woman in the last stages of insanity, suffering from dementia, 
is an imbecile. An idiot is an imbecile also. The imbecility of the 
one cannot be distinguished except by an expert. But the physio- 
logical history of these two persons is very different. An insane 
imbecile has grown to maturity, has attained the perfection of his 
faculties of body and mind, such as they were, and then through 
some accident or misfortune the balance of those faculties has been 
lost and the patient has deteriorated physically and mentally. But 
an idiot is a person who has never been fully developed, whose imbe- 
cility originated in infancy or in early childhood. It may have been 
the effect of a cause which operated before the birth of the child, or 
of a cause which operated in early childhood ; but in either case the 
cause was one that produced its natural effect before the child reached 
mental and physical maturity, and so stopped his development. Now, 
with this definition of idiocy in mind, I think you must see that idiots 
are very closely allied to two other classes of beings. In the first 
place, to the animal creation. We all have an animal side, and a 
spiritual or intellectual side. The more our spiritual side is developed, 
the nearer we come to the angels ; the less it is developed, the nearer 
we are to the brutes ; and the spiritual or intellectual side not having 
been developed in the idiot, he is so closely allied to the brute crea- 
tion that he is less to be pitied than you think. A great deal of 
sympathy is wasted upon him. He does not suffer half so much as 
is commonly supposed. A lamb, a bird or a kitten does not suffer 
from the lack of higher intelligence. They are not human, and 
therefore they do not know what the intellectual life is. Just so the 
idiot does not suffer in consequence of his lack of qualities which he 
never had and knows nothing about. On the other hand, the idiot 
is very closely allied to a baby, because, if he has not developed, he 
is still an infant, and he remains an infant all his life. His condition 
is one of perpetual childhood. I have seen grown men and women 
who were idiots crawl around on all fours, because they had never 
learned to walk or never could or would learn. I have seen grown 
idiots playing with sticks and straws like little children. They appeal 
to our sympathy on account of their helplessness, just as babies do. 
They are affectionate, like babies ; and it is the responsiveness of 
their affections which overcomes in our minds the sense of disgust 
often awakened at the sight of their motions and gestures. They 
need care and attention all their lives long. Now, many of them will 
always be custodial cases. You might just as well think of turning 
a baby out of the house as an idiot. But some idiots can be made 
self-supporting, just as an animal can be. I can take a horse and 


22 


CARE AND TRAINING OF THE FEEBLE-MINDED. 


make it earn money, but it cannot earn money for itself. I can make 
an idiot earn money for me, but he cannot earn it for himself. I can 
protect that idiot, as I can a child, but the idiot cannot protect himself. 
If he could protect and support himself, he would not be a true idiot. 
So, where a family is in circumstances to take care of its own idiots, 
well and good; it is far better that they remain where they have the 
benefit of natural parental affection. But the great mass of families 
with idiotic children cannot do it. The parents are frequently of a low 
grade themselves, or they are too indulgent. There are a thousand 
reasons why they cannot do it. For this reason idiots have to be 
collected together, under the charge of trained attendants, and held, 
as has been said to-night, for life. While something has been said 
with regard to error in the census statistics of idiocy, I do not 
believe that the figures given in the census overestimate the number 
of idiots in the community ; I believe that they underestimate the 
number. There are no more insane people than idiots. The reverse 
is probably true. While we are doing a great deal for our insane, 
idiots need care just as much as they ; but we are doing very little 
for them, and from my point of view it is not fair. Therefore I would 
like to put it into the mind of the public that the demand for the care 
of the idiots has not been met. The public needs to be aroused to 
a sense of its obligation to take care of them. They are hidden 
from sight. Parents with an idiot child do not let anybody know it 
if they can avoid it. I have known instances where the family doctor 
did not know there was an idiot child in the house, because its 
parents were ashamed of It. The children cannot speak for them- 
selves, and their parents will not. Somebody else must. 

Dr. Rogers. — The figures which I used to show the cost of state 
care were merely hypothetical. Our buildings only cost about $500 
a bed, including everything inside and outside of the building. 

The Chairman. — I told Mr. Johnson I thought that was but an 
hypothetical case when he said you laid yourself open to contradiction 
on your statistics. 

Adjourned sine die. 


INDEX TO PAPERS ON CARE AND TRAINING 
OF THE FEEBLE-MINDED. 


Beaconsfield, Lord, quoted, i8. 

Charity, defined, 9. 

Colony plan, for the feeble-minded, 
5-8 ; benefits of, 7 ; outcome of, 8. 

Feeble-minded, and an institution, 
5-6, 9, 19 ; methods in training, 6, 
16, 17, 18, 22 ; state care of the, 8-13; 
census of, in the U. S., 8, 13, 18 ; 
family of, 9 ; cost of maintenance of, 
II, 12, 18, 19, 22 ; and poor, 11-12 ; 
state and care of, 13; physical ex- 
amination of, 14 ; structure of brain 
of, 14; causes of, 15-16; classified, 
14-15; protection against, 16; pri- 
vate training of, 18 ; statistics of, 
18 ; buildings for, 19 ; sent out, 19. 

Fernald, Dr. Walter E., on method of 
teaching feeble-minded, 17. 

Hyde, Dr., and Dr. Fernald, 17-18. 

Idiocy, defined, 21 ; and insanity, 21 ; 
and lower animal, 2i ; and baby, and 
public, 22. 


Imbecile, moral, 7, 16; microcephalic, 
15; classified, 14-15 ; causes of, 16. 

Johnson, Alexander, on statistics, 18. 

Knight, George H., on the colony 
plan for all grades of the feeble- 
minded, 5-8. 

Minnesota Institution, quoted, 6. 

Powell, F. M., on economy, 19. 

Rogers, A. C., on state care of the 
feeble-minded, 8-13. 

State care, of the' feeble-minded, 
A. C. Rogers on, 8-13 ; and private 
care, 9-10; benefits of, 10, ii, 12; 
and colony system, 9. 

Wilmarth, A. W., on pathalogical 
conditions accompanying mental 
defects in children, 14. 

Wines, Frederick H., on idiocy, 21-22, 



THE; 


Prevention and Repression 
of Crime 


BEING A REPORT OF 


THE FIFTH SECTION OF THE INTERNATIONAL CONGRESS 
OF CHARITIES, CORRECTION AND PHILANTHROPY, 
CHICAGO, JUNE, 1893 


EDITED BY 

FREDERICK H. WINES, LL. D. 


BALTIMORE 

THE JOHNS HOPKINS PRESS 
LONDON 

THE SCIENTIFIC PRESS, LIMITED 
428 Strand, W. C. 

1894 


THE WORLD'S CONGRESS AUXILIARY OF THE WORLD’S COLUMBIAN 

EXPOSITION. 


The International Congress of Charities, Correction and 
Philanthropy. 

president : 

RUTHERFORD B. HAYES. 

FIRST VICE-PRESIDENT : SECOND VICE-PRESIDENT : 

FREDERICK H. WINES. ROBERT TREAT PAINE. 


general SECRETARY: 

ALEXANDER JOHNSON. 


COMMITTEE OF ORGANIZATION : 

FREDERICK H. WINES, JOHN G. SHORTALL, Mrs. J. M. FLOWER. 
NATHANIEL S. ROSENAU, Secretary. 


SECTION V. 

The Prevention and Repression of Crime and the 
Punishment and Reformation of Criminals. 

CHAIRMAN : 

CHARLTON T. LEWIS, 

President of New York State Prison Association. 

SECRETARY : 

Rev. JOHN L. MILLIGAN, 

Secretary of National Prison Association. 


Copyright, 1894, by the Johns Hopkins Press. 


TABLE OF CONTENTS. 

PAGE 

Address of the Chairman, Charlton T. Lewis 5 

Some Studies of Inebriate and Pauper Criminals. By T. D. Crothers . lo 

The Philosophy of Crime. By C. H. Reeve 28 

;^ew Theories of Criminology. By Baron Garofalo 48 

The Parole System. By Frederick H. Wines 57 

Work for Discharged Female Prisoners at St. Lazare. By Mme. Marie 

Marshall 67 

The Bertillon System for Identification of Criminals. By Major Robert 

W. McClaughry 75 

Criminal or Delinquent Children. With a Sketch of Burnham Industrial 

Farm. By W. M. F. Round 84 

The Uses of Imprisonment. By Charlton T. Lewis 95 


V 


THE FRIEDENWALD CO., PRINTERS, 
BALTIMORE, MD. 


gttt^trnatijonal ^onQxtss of ©liatitios, 
©otrvccfiott aufl gMlautTttro^jg. 


Fifth Section. 

THE PREVENTION AND REPRESSION OF 
CRIME AND THE PUNISHMENT AND 
REFORMATION OF CRIMINALS. 


FIRST SECTION MEETING. 

Monday, June 12, 1893, 2 p. m. 

The Fifth Section of the International Congress of Charities, Cor- 
rection and Philanthropy met, Mr. Charlton T. Lewis, president 
of the New York State Prison Association, in the chair. 

The Chairman. — The special subject which this section of the 
Congress has met to consider is the prevention and repression of 
crime, and the punishment and reformation of criminals. This vast 
field of thought and of experience is all before us. In order that our 
deliberations upon the subject may be of any value, it is necessary 
that >we should formulate a plan for the development of our ideas. 
We have had most impressively explained to us to-day how the 
great spirit of charity moving in mankind has become the glory of 
our own times, not by acting through unregulated impulse and 
controlling men by inspiration, but by the government of wisdom, the 
counsel of intellect, instructed by experience, and if we are to accom- 
plish anything with the thoughts which we bring together here, it 
must be in a systematic manner. 

On the other hand, we who have been charged with the responsi- 
bility of inviting you to meet in this place for this purpose have been 
driven by two considerations, to try an experiment almost unheard 
of in similar undertakings. F'irst, the time at our disposal has been 


6 


PREVENTION AND REPRESSION OF CRIME. 


SO short that it was impossible, if we had wished to do so, to provide 
elaborate essays prepared on paper to be read before you ; and 
second, we have a profound conviction that closet thoughts, elab- 
orated in private, formulated on paper, and then read before us, with 
the scattered application which the working of so many minds in 
different places would necessarily bring, is not and can not be the 
most profitable method of employing our time. We have believed 
that, if we could bring together here a number of minds devoted to 
the consideration of these questions, and if these minds would 
earnestly go to work upon the burning question of the times, upon the 
living thoughts which are stirring men through the world to-day in 
connection with this question, then, by the friction of these minds, one 
upon another, we could develop every strong truth that lies in them 
and accomplish far more than by any cut-and*dried preparation. 
We have believed, therefore, that the wiser way is to come together 
for a real conference, for discussion ; each of us to contribute his 
best thoughts in order that they may be compared with the best 
thoughts of others — cut to pieces, if you please, but at any rate 
treated honestly, manfully and candidly by the other minds that are 
here — so that the truth upon which we finally unite may remain with 
us as a possession and a heritage. And after our conference, if it is 
as fruitful as we hope it shall prove, we shall not only be each of us 
more deeply interested, but the proceedings of this congress will 
prove a worthy contribution to the world’s thought. 

Now, this is the outline of the plan before us; and in this plan I 
ask your earnest co-operation. 

Our subject is the methods adopted by society in dealing with 
crime and the criminal classes, with a view to the elimination of crime 
as a social factor. Now', the method in which society has treated 
crime heretofore is one with which all of you are more or less 
familiar. But we are awakening in this age to the conviction that 
the treatment of crime by society hitherto has been controlled by a 
narrowness of thought, a limitation of experience, an imperfection of 
grasp of the subject, which has permeated all penal legislation. 
There is now stirring in the general mind, among prison managers, 
among legislators in all countries, and above all in those minds w'hich, 
how'ever misjudged by the world at large, however written down as 
cranks and fanatics, as trimmers, as obstructionists, as mere unprac- 
tical philosophers, are yet the compass-needles that point the way 
everywhere to the world’s progress — I mean the minds of noble- 


LEWIS. 


7 


hearted philanthropists — a sense that we are on the eve of one of the 
greatest social revolutions which mankind has ever experienced, and 
that this revolution will be a reorganization of society, a reconstitu- 
tion of law, a reformation of the courts, a reconstruction of the entire 
system of dealing with crime. The time therefore is ripe for our 
deliberations. 

The treatment of crime by society, when you consider it histori- 
cally, originated, of course, in necessity. That is to say, society 
was compelled to protect itself against crime, and the imprison- 
ment, the whole fabric of penal law, was founded on that necessity. 
But associated with it was another element which lies in human 
nature itself and is one of its most powerful natural instincts, the 
instinct of vengeance. The idea of retribution is natural to the mind 
of man. Wherever we find crime disturbing society and interfering 
with the rights of mankind, causing pain, sorrow and distress, and 
threatening to destroy the very social organization itself, there we 
find the moral indignation of men stirred against it; and that indig- 
nation finds expression in the attempt, by way of retaliation, to inflict 
suffering upon the guilty. The necessity of self-protection on the 
part of society and the instinct of retribution are the two elements 
which underlie the penal codes of the world. 

As we have heard to-day (and I have never heard it more impres- 
sively, more philosophically and more beautifully expressed than it 
was in the address of Dr. Peabody in the general meeting this morn- 
ing), a new principle is now taking hold of society. Mankind has 
always been charitable, in a sense. Charity has always been a part 
of the religions professed by men, above all of the Christian religion, 
the name of whose founder is love. But charity has assumed a new 
aspect within the last two generations, and to-day the discussion of 
crime and punishment finds a place in the programme of this Con- 
gress of Philanthropy, of Charities and Corrections. The intimate 
association of these two is suggested by the very title of this 
assembly. 

As the president of the National Prison Association remarked to 
me but five minutes ago, it was at first thought desirable to hold no 
meeting of that association this year except as a section of the Con- 
gress of Charities. What does that mean? It- means that the busi- 
ness of society in protecting itself against the criminal, in warring 
against crime, in striking the blow of vengeance at the criminal, has 
given place to the work of charity to the criminal. It has become a 


8 


PREVENTION AND REPRESSION OF CRIME. 


department of human philanthropy, aiming to do good to all men as 
we would they should do good unto us. 

You are aware that hitherto there have been but two recognized 
methods of dealing with criminals: imprisonment and execution. 

Now, if you shut a man up and keep him under lock and key, you 
prevent him from committing crime. He no longer has the power 
to ravage and lay waste. But imprisonment in its origin had no 
such purpose. It originated in the necessity of holding men who 
were wanted to appear at a certain time. That is all. Its use as a 
form of punishment for crime is of comparatively recent date. Even 
in the middle ages such ideas of the punishment of crime as we have 
developed were wholly unknown. It is a growth of these modern 
times. It is a growth, allow me to say, in the form in which it exists, 
the most inadequate, the most supremely absurd, the most contradic- 
tory, of all social principles, and has less reason than any other insti- 
tution upon the face of the earth. Is there anything more ludicrous, 
if it were not too painful to be a subject of laughter, than to see a 
grave and dignified judge, a man learned in the law, a man conse- 
crated by his office to impartiality, and entrusted by law with the 
lives, the property, and the destinies of his fellow-citizens, the inter- 
preter of law, the embodiment of the noblest idea and highest 
abstraction which the mind of man has yet grasped — to see such a 
man, who ought to be the first man of his race to-day, sitting on his 
bench day after day, in the face of the community, and doing — what ? 
He has dragged before him offenders of various sorts. One man 
has picked a pocket, another has been found drunk in the street, 
another has broken into his neighbor’s house and stolen a lot of 
books ; another is a professional burglar who gains his livelihood by 
that means, it is his business. The business of this learned, upright 
judge, this embodiment of law, is to consider a few minutes and then 
say, “ Ten days for the drunkard, thirty days for the pickpocket, 
five years for the new burglar, twenty years for the professional 
burglar.” The sentence is a guess, and he awards these various 
terms of imprisonment for what? As retribution for crime? Is 
society repaying these men for what they have done? Is it 
inflicting on them exact, equal justice ? No man ever sat in a 
court of justice wha could say for one moment that there is the 
remotest approximation to equity in the distribution of punishment 
for offenses. But the evil does not lie in the judicial errors inseparable 
from the ignorance of the judge, and which would be inseparable 


LEWIS. 


9 


<rom it, I was going to say, if he were Omniscience itself. It lies in 
the fact that there is no basis for his judgment. There is no possibility 
of equity in the case. God himself could not distribute sentences, 
under our penal laws, with any approach to justice, because there is 
no relation whatever between the penalties provided by the law and 
the offenses against which these sentences are pronounced. Im- 
prisonment is not a retribution for the offense. But unless you 
believe that the imprisonment is retribution, that it can be appor- 
tioned at so many days, months or years, for such a crime, of such 
a degree, and further, that degrees of crime can be determined by a 
court and jury, and the deserts of men measured by days and weeks ; 
unless you accept all these absurdities, not one of which has any foun- 
dation in reason or proof, you must admit that the whole fabric of 
our penal law, so far as it provides for imprisonment, is founded on 
unreason. In almost every state in the Union the prisons, as a whole, 
are not merely a shame and a reproach, but they form the great 
school of crime, the great manufactory of criminals, where men are 
trained to be the enemies of their kind. 

Now, many men, all over the world, are beginning to think that 
some substitute for imprisonment, in a very large number of cases, 
may be found. Attempts have been made to find it. Statutes based 
on this idea begin to be enacted. If we can here collate and com- 
pare the suggestions on this point which have been made, we shall 
unquestionably derive very much instruction from the discussion. 

Among the questions before us are the treatment of confirmed 
criminals whom society sees no possible chance of saving, and the 
death penalty for deliberate murder. A second topic in which deep 
interest is felt by many is the Bertillon system of identification of 
criminals, which I trust will be considered not merely with reference 
to its utilitarian possibilities, but also as a scientific device. The 
county jails, as they exist in the United States, are a leading question 
of legislation in almost every stale in the Union. 

As a fourth subject of discussion I suggest the question of a pos- 
sible substitute for imprisonment; the recent devices tried in New 
Zealand, in Massachusetts and in Great Britain — the parole and 
personal surveillance ; or can any other substitute be found of still 
greater value ? 

On motion of General Brinkerhoff it was Resolved, That the 
chair, the secretary, and Col. Chas. E. Felton, of the local committee, 
be an executive committee to arrange a programme of papers and 
discussions day by day, and announce the same. 


lO 


PREVENTION AND REPRESSION OF CRIME. 


T. D. Crothers, M. D., Superintendent of the Walnut Lodge 
Hospital, Hartford, Connecticut, then read the following paper : — 

SOME STUDIES OF INEBRIATE AND PAUPER 
CRIMINALS. 

T. D. CROTHERS. 

This class of inebriates are quite numerous in all the large cities 
and manufacturing towns, and are also prominent in seaports, and 
on the frontier of civilization, and yet, as a class, they have never 
been studied. They form a conspicuous element of the great under- 
stratum of the dangerous classes, and permeate all ranks of society, 
from the hovel to the palace. They occupy an uncertain and anom- 
alous position in the estimation of the public, and are either regarded 
as debased criminals and paupers, requiring severe punishment, or 
as insane, and only partially responsible. 

A careful study of the literature of inebriety reveals the startling 
fact that many of the theories and deductions of inebriety are based 
on the superficial observations of criminal drunkards. 

To illustrate: The superintendent of an insane asylum who has a 
number of this class under treatment, finding the alcoholic symp- 
toms disappearing and the criminality prominent, denies the disease 
theory of inebriety. In the same way, the penitentiary and alms- 
house physician, seeing only vicious symptoms in the inebriates 
under his care, reaches the same conclusion. The judge on the bench, 
the lawyer in court, and the daily press, each form a theory of inebriety 
from this basis, which they put forth with confidence, and thus the 
public have the most complex and erroneous views. Up to this time, 
no general study of inebriety has been made which includes all 
classes, hence this confusion of both theory and treatment. 

The student of any phase of insanity, who has seen many cases of 
melancholy, or dementia, and who builds up a theory of cause, 
pathology, and treatment based on these cases, announcing authori- 
tatively that it comprehended them all, would be in error. In this 
way, much of the literature of inebriety is based on the imperfect 
studies of particular classes, and especially the classes we are to con- 
sider in this paper. 

A comprehensive study of the whole subject from a higher stand- 
point is essential before the great underlying laws and principles 
governing this disorder can be discovered. In a study of this class. 


CROTHERS. 


I I 

two divisions naturally present themselves, with distinctive causes, 
which, although they run parallel, yet are quite different in many 
respects. 

The first class are the inebriate criminals, which become so by 
conditions of surrounding and accidents, and from special external 
predisposing causes. 

The second class always begin with physical degeneration of the 
brain and nerve-centers — either arrested development, or general 
perversion of function and structure. They are born criminals or 
inebriates. In the latter class, the criminal and insane diathesis is 
always present ; in the former, the neurosis is not marked, but may be 
frequently masked for a long time and then break out suddenly. 

Before we enter upon a special study of these classes it will help 
us to note some of the general symptoms which appear to the ordi- 
nary observer. As a class they are the “ fast men, such as gamblers, 
speculators, traveling men, showmen, patent-right swindlers, dealers 
in alcohols and tobacco,” etc. Lower down they are bar-room loafers, 
hack-drivers, low workmen, street tramps, and beggars, etc. As 
criminals they commit crimes against property, and rarely against per- 
sons ; always acting under a diseased impulse, which ignores every- 
thing but the selfish gratification of the body. As inebriates they 
drink impulsively, without any special exciting cause, or remain sober 
an indefinite time without special reason or purpose. Frequently they 
have strong mental and physical capacities, coupled with great defects, 
and with more or less power of concealment. Hence they often take 
advantage of all those who come in contact with them. As a rule, 
they are treacherous, cowardly, and sensitive, full of impulsive delu- 
sions, and governed by no motives except the lowest, and those of 
the present moment. Audacity is another common symptom; 
cupidity, and strong dislike for work, and general disgust for regular 
living. Improvidence is also prominent in nearly all conditions. 

As patients coming to inebriate asylums, they are almost always 
very much reduced in both mind and body, either having delirium 
tremens or are on the verge of it. At first they are. extremely 
penitent, and give much promise of permanent recovery. But in a 
few days all is changed ; they lapse, becoming low intriguers, exhibit- 
ing a* wilful cunning and disregard for the rights of others that is 
deplorable. They abuse all privileges, drink and procure spirits for 
others, respect nothing but force, and are most difficult and trouble- 
some patients. Such are some of the general facts of the symp- 
tomatology. 


12 


PREVENTION AND REPRESSION OF CRIME. 


If, now, we inquire more particularly into the history and causes, 
we shall find the first group quite prominent; namely, those cases 
in which inebriety seems to spring from conditions of surroundings 
or accident, and from special external predisposmg causes ; always 
associated with criminality arid often an inherited insane neurosis. 

One of this family group may be illustrated in the following case : 
C. D., born and reared in a very careful manner, by strong-minded, 
exemplary parents, surrounded by every good influence which wealth 
and social standing could bring. His father was a banker and spec- 
ulator, leading a life of more or less excitement, although perfectly 
temperate. His mother was neuralgic, and of a sensitive, excitable 
disposition. He was in no way difl'erent from other boys up to six- 
teen years of age, when his parents both died within a year, and he 
came into possession of a large amount of property. 

He fell into the hands of some sharpers, who rushed him through 
a short career of dissipation, both robbing and entangling him with 
a gang of gamblers and thieves. 

From this time he became an accomplice of gamblers and thieves 
and three-card monte men, alternately drinking and associating with 
the lowest of this class. At twenty-two he served two years in prison 
for burglary. At twenty-six, twenty-nine, and thirty years of age he 
served short sentences for swindling and drunkenness. 

Then his friends placed him in an inebriate asylum, as a periodical 
inebriate. He did well until he regained physical strength, when he 
displayed the most audacious criminality, reasoning and acting from 
the lowest motives; bringing in spirits and becoming intoxicated for 
the purpose of committing violence ; when the drink craving was 
over, exhibiting great penitence ; and all the time stealing and appro- 
priating whatever he could find. All sense of right and wrong seemed 
absent. His entire study seemed to be to secure the fullest gratifi- 
cation of every emotion and passion. He drank .constantly, and 
when restrained became revengeful, and was the centre of intrigue, 
defying all efforts to control him, unless by physical force. He was 
not passionate, or very irritable, but fawning and penitent, and at the 
same time taking advantage of every opportunity to both drink and 
steal. He was discharged, and went back to his old circle of sur- 
roundings, and is now serving a sentence of five years for larcefiy. 

This is a strongly marked case, where accident of conditions and 
surroundings produced a criminal inebriate from an organization 
with large passions and only average moral and mental powers. He 


CROTHERS, 


13 


may have inherited a weak, impulsive, nervous system from his 
parents ; this, with bad surroundings at a very susceptible period of 
life, would only follow a natural law in developing this way. 

Another case, ivith more marked predisposing influences, has fallen 
under my observation. H. O. — Father a clergyman, and very eccen- 
tric; mother very irritable and passionate, sometimes doing violence; 
the grandfather on his mother’s side was drunken ; some of his 
father’s family were of doubtful reputation. Both parents dying 
when he was five years of age, he was taken by an exemplary farmer 
and brought up in excellent surroundings and influences, and was in 
many respects a model young man ; a member of a church, with a 
quiet manner and easy disposition, inclined to melancholy. At 
eighteen he went to the city as a clerk in a large house. Here he 
fell into bad company and drank, and finally proved to be a defaulter 
and was sent one year to prison. On coming out he went back to 
the city and became a barkeeper, leading an irregular life of drink-, 
ing and general dissipation. From this time he became an accom- 
plice of thieves, receiver of stolen goods, and traveled about the 
country in the interest of criminals, and apparently with no business. 
At length he was convicted of bank robbery and sentenced for five 
years. After serving this sentence he w’as employed as an auction 
clerk and runner. Sometimes he would remain for months sober, 
then drink very hard, commit some violence, be arrested, and serve 
a short sentence. He was brought to an inebriate asylum, suffering 
from delirium tremens. Recovery was slow, and he seemed very 
penitent, giving much promise of permanent recovery. A few weeks 
later he was caught surreptitiously selling liquor to patients, which 
he had stolen from the railroad freight depot. All disguise was 
thrown off, and he boldly, from this time, defied all authority, stole and 
planned all sorts of means to procure liquor and money, rarely drink- 
ing himself so that it could be noticed. He submitted to restraint, 
when it was sustained by force, without opposition, seemed to pos- 
sess no delusions except to gratify a malicious spirit and the lowest 
cravings of his nature. He was expelled, and on his way to New 
York was arrested for highway robbery and sent to prison, where he 
died of consumption a few months later. 

This case was more positively the result of inheritance thayi the 
first. Had he remained on the far^n, he would probably have lived 
a correct life ajid been a good citizen, but a change of circum- 
stances and conditions made him a criminal inebriate. The diathesis 
was present, and its peculiar train of exciting causes developed it. 


14 


PREVENTION AND REPRESSION OF CRIME. 


A presentation of some of the more general causes at work will 
make our treatment of the subject clearer. 

The conditions and surroundings which develop inebriate crim- 
inals exist in all our large cities. 

They are bad sanitary conditions, with irregular, unhealthy living, 
sleeping in bedrooms insufficiently lighted and ventilated, and living 
on bad, unnutritious food, also in a bad mental atmosphere. Add to 
this the continual indulgence of all the impulses and passions, in sur- 
roundings full of the contagions of bad examples, and the result is 
inevitable. There is here a constantly widening perversion from the 
natural standard of mental and physical health. Exhaustion and 
drinking begin early, followed by degeneration which affects the 
entire organism. Ambition dies out except for the most selfish grati- 
fication. Criminality grows out of these surroundings as naturally 
as weeds spring up in a neglected garden. The evils they suffer from 
perpetuate themselves and grow more and more rank. All effort to 
rise to better conditions of living and acting involve the exercise of 
powers which are either wanting or are feebly developed, or long 
ago crushed out by the predominance of other elements. As crim- 
inals, they always lack the boldness of experts; usually they are fol- 
lowers acting under the guidance of others, and are sneak-thieves, 
petty swindlers, gamblers — ready to engage in any scheme that will 
furnish sources of gratification to their passions without much danger 
or special labor. As inebriates, they drink insanely for a time, 
governed by circumstances and conditions. If we examine this class 
more minutely, we shall find that they divide again into two groups, 
and as such may be studied practically in our asylums. 

The first class come from bar-rooms and low haunts of every 
character ; they usually are without any fixed employment^ and have 
been reared in idleness. 

Originating in the middle and wealthy classes, or in those inherit- 
ing large amounts of property, they have grown up without any 
fixed purpose in life. Not unfrequently they have squandered their 
patrimony, and been placed in positions where all efforts to help 
themselves have more or less resulted in failures. 

They are ordinarily marked by their weak mind and unbalanced 
judgment, suffering from neurosaland mental troubles, and filled with 
delusions of oppression and wrong at the hands of others. Conscious 
that society is at war with them, and that its methods antagonize the 
full play of their passions, they accept the situation and never seek to 


CROTHERS. 


15 


change or vary the conditions. But they rapidly become beggars^ 
criminal paupers, robbing their relatives and friends; also lapsing 
into communists, full of all the small vices, ready at any moment to 
aid in crime, or take advantage of any weakness, licentious and 
drunken at all times, and resorting to the lowest devices to gratify 
their impulses. Syphilis and general degeneration are common ; 
improvidence, fawning, and audacity are marked. In many cases 
they possess an average or superior brain power, probably coupled 
with a defective moral force and general want of control. From 
accident of surroundings all the lower elements of nature are devel- 
oped. They are more prominent as inebriates than as criminals, and 
often do criminal acts under the cover of apparent drunkenness. 
This class are the skeletons haunting their friends continually for 
money and support, rarely committing noted crimes, but always in 
centres of low dissipation. 

The second group are made up of clerks^ traveling men, peddlers, 
gamblers, and sivindlers of all kinds. They are higher up than the 
last class, and possess a degree of activity which -is evidence of a 
more active brain-power. Quack doctors, police-lawyers, defaulters, 
and patent swindlers are of this class. They most frequently inherit 
an unbalanced organism, a distinct or obscure neurosis, and have a 
family history of insanity, epilepsy, inebriety, syphilis, criminality, 
cancer, and consumption. 

Like the first class, they are largely the outgrowth of the sur- 
roundings, originating in bad sanitary and moral influences in early 
life. The worst phases of this class are seen on the frontier, as 
miners, speculators and gamblers, or in business centres of large 
cities, as brokers, agents and middle-men, who are ready, with any 
excitement or excuse, to defy law and order. As communists and 
railroad rioters they have attracted much attention for some time. 
Frequently they are filled with delusions of wealth and power, are 
superstitious of fate and chance, and alternate between hope and 
despair. Failure follows in nearly all circumstances of life, and is 
attributed to others and the wrongs they suffer at their hands. 
While complaining bitterly of the dishonesty of others, they con- 
tinue to cheat and drink in an aimless, impulsive way. Not unfre- 
quently they use stimulants to conceal the real motive, and to shield 
them from the consequence of crime. During the past two years 
they have appeared in the temperance work in great numbers, and 
have been noted as defaulters in coffee-house enterprises, and as 


i6 


PREVENTION AND REPRESSION OF CRIME. 


lecturers recounting their experience and soliciting help to build up 
again, etc. With a degree of sharpness and low cunning that is rarely 
obscured by drink, they have found the various temperance move- 
ments of the day a field for the fullest play of all their talents, which 
they are not slow to occupy. They may be truthfully called the tem- 
perance tramps of the day. As inebriates they are noted for their 
marked periods of sobriety, and the unexpected insane-like relapse. 
After the fullest gratification of the disordered impulses, they stop 
short and seem to recover. They commit crime in this impulsive, 
unreasoning way, confusing courts and juries as to the motive present. 
In asylums and in prisons they are always the most hopeful, and are 
sure to create sympathy, and gather about them friends whom they 
sooner or later victimize. 

In both of these groups the surroundings and predisposition to 
criminality and inebriety are about equally developed ; sometimes 
one predominates over the other, and in some cases they exhibit 
much skill in concealing the one or the other ; chronic suspension or 
enfeeblement of* the will and moral power is present in all cases. 
They never realize anything but the fullest gratification of all their 
faculties as the ideal of life, and criminality and inebriety are the 
best means to this end. Like all the other classes, they suffer from 
neurosal disorders, such as exhaustion and chronic disease. In the 
second general division, most of the cases mherit a special degen- 
eration of the nerve -centers. Either from a no7i- development or a 
general perversioyi of functioyis and structure, they are both born 
hiebriates and criminals. 

This class are usually marked in every community ; their irregu- 
larities of living and mental peculiarities, as well as physiognomy, 
cannot be mistaken. They appear as inebriates in all grades of 
crime, and are seen in prisons, hospitals and workhouses all over 
the world ; although they are not so commonly seen in inebriate 
asylums as the first class, yet they are frequently studied in courts 
of law and insane asylums, as types of all inebriates. Not unfre- 
quently they are moral imbeciles, that drift up and dow*n the world 
like ships without a rudder or purpose. In a study of the general 
symptomology, the irregularities of life and want of physical devel- 
opment are prominent. They are commonly noted by a large, 
coarse frame, or an overgrown head and imperfectly developed 
body; angular projection of the face, such as the eyes, nose and 
mouth, out of all proportion; the presence of moles or freckles, the 


CROTHERS. 


17 

hair thick and coarse, or thin and straggling, etc. The entire body 
seems to be stamped with signs of imperfect development and 
degeneration. In some cases all these external signs are wanting. 
This class of men are found in the lowest stratum of society, perform- 
ing the most menial work, or higher up, they are soldiers, sailors, 
barkeepers and adventurers, highwaymen, burglars, etc., following 
civilization like parasites, the most lawless and dangerous of men. 
They are also seen along the line of rivers, canals, and on the sea- 
boards, etc. They are committed for crime against both person and 
property, and constitute over 6oper cent, of all the inmates of prisons 
and jails. Not unfrequently they occupy places of trust high up in 
society, and when tempted fall precipitately, and puzzle experts and 
judges to determine between insanity and criminality, and the 
measure of responsibility. 

The inheritance of disease is more marked in this class than all 
others. Dr. Stevenson remarks, “ There can be no question but that 
heredity exists in the mental as well as the physical world, and that 
* the diminished stability of organism and perversion of physical func- 
tion are transmitted with as much certainty as the germs of disease ; 
that the brain structure receives certain tendencies from inherit- 
ance, which bind it down or control its future, or that it has a certain 
capacity for impressions and energy of organism which goes with it 
always after.” 

This expresses clearly the doctrine of heredity which is now 
accepted as a well established fact. The inebriety of this class is of 
the same order of neurosis as insanity, and depends upon some 
molecular change of nerve-tissues, which, coming down from parent 
to child, fixes the moral and physical character with much certainty. 
In other words, it is a symptom of physical degeneration of the 
nerve-centres, an outward expression of an inner condition of devel- 
opment like that which generates low and vulgar ideas, having their 
counterpart in brutal instincts and words ; always connected more 
or less with diseased and undeveloped nerve-structures. All this is 
confirmed by clinical histories of numerous families where, for gen- 
erations, the criminal insane and inebriate neurosis has developed 
in one or more of the family. 

Such persons possess a distinct neurosis, which manifests itself 
either in inebriety, insanity, epilepsy, criminality or pauperism ; or, 
very commonly, two or more combined in one. 

Many of these cases are purely psychical, marked only by special 


l8 PREVENTION AND REPRESSION OF CRIME. 

symptoms which are often in themselves very obscure, and some- 
times associated with much intellectual vigor and genius, and display 
of great strength and weakness. The impairment or loss of the 
higher moral faculties, leaving the intellectual clear, is a field of much 
obscurity, and beyond the fact that such is the case, little is known. 

With this brief statement of the general facts, which seem to indi- 
cate the condition of organism and origin of these cases, we shall pass 
to a special consideration of some of the groups. First are those in 
which the inebriety seems more prominent than the criminality . They 
are seen quite frequently at inebriate asylums. Usually suffering 
from general exhaustion, they recover slowly, and entertain delusions 
amounting to delirium at times. They are very penitent during this 
time, and exhibit a humility and determination to reform that is 
almost abject. On recovery, they become sensitive, assuming and 
boastful, and all the low criminal tendencies come out prominently. 
They interfere and meddle with a malicious spirit, creating trouble 
everywhere ; are extremely slanderous and boastful, delighting in 
low stories and low thoughts ; complain bitterly of deprivation of 
their liberty ; find fault with everything ; and are changeable in dis- 
position and insolent beyond measure. They are untruthful to an 
extreme degree, and have no respect for their word or the judgment 
of others. They drink at all times and places, using all kinds of 
intrigue to accomplish this end. They will steal anything from their 
best friends, such as articles of clothing, furniture, and even food 
from their families and children to procure drink. Nothing can 
exceed the degradation and suffering which they relentlessly inflict 
on their nearest relations to gratify this one object. 

In an asylum they are always running away, drinking and bringing 
liquor for others, stealing articles for the pawnshop, and often not 
drinking to intoxication, but aiding others beyond that point. They 
are often the agents of more designing men, who take advantage of 
their situation when drinking to stimulate them to crime, which they 
are ever ready to engage in. In all situations they are continuously 
criminal in thought and act; and inebriates at every opportunity. 
After a wretched life from the station-house to the jail or prison, and 
the low haunts of large cities, always hunted dow n like beasts of the 
chase, they become exhausted and suicidal, either dying by their 
own hands or going into the insane asylums. 

The second class are more prominent as criminals than inebriates. 
They are cool and calculating, totally destitute of any moral sense. 


CROTHERS. 


19 


They drink at times very hard, then remain sober under the press of 
circumstances for a long time. As an illustration: one of this class 
drank nothing for over two years (although in centres of great 
temptation), that he might get in position to accomplish a crime. 
When this was over he was very intemperate. Often they are vic- 
tims of vicious, uncontrollable passions and impulses, over which 
they are powerless. Epilepsy, insanity and pauperism are common 
phases. They are wanting in pity or lasting kindly sentiment, 
have little or no natural reason to check them, and never seem to 
realize the evil which follows their acts, or the suffering they cause 
others. Turning against their best friends on the slightest pretext, 
they have no affection for any one except the most selfish; when 
this is broken, they treat all as enemies. 

Prudence is wanting in nearly every one of this class, and is only 
stimulated and controlled by selfish interest or fear of punishment. 
In some cases, violent passions such as hatred and revenge seem to 
control, or be the motive power in drinking. In the asylum, nothing 
but force, with locks and bars, will make any impression. Some- 
times they remain sober for a long time and seem to recover, but the 
criminal cunning of their nature and want of kindly sentiment are 
always apparent. Often they cloak all their diseased impulses to 
accomplish some purpose, and exhibit great skill — appearing in the 
r 61 e of reformed men, gathering about them a wide circle of influen- 
tial and credulous friends; then, all unexpectedly, victimizing them 
all, and relapsing as both a criminal and drunkard. They are, in all 
cases, on the borderland of insanity, and both talk and act like insane 
men. Audacity is one of the most prominent mental traits of this 
class, and is always of a low grade — usually the blind impulse of a 
low, unreasoning man. These cases are usually the result of certain 
conditions of inheritance, from which recovery is difficult. They are 
sooner or later crushed out in the march of events. 

There is another class not so prominent, but more familiar to 
managers of inebriate asylums, who combine many of the symp- 
toms of both of these classes. Inheriting the unbalanced organism, 
and frequently the special criminality of the last class, they are, like 
the first class, creatures of their surroundings, and moulded by con- 
ditions of life and success. Always combinations of great ambition 
and weakness — impulsive and unreasonable at times, full of great 
expectations and constant failures. At one time drinking hard or 
committing petty crime, thoroughly discouraged and reckless, then 


20 


PREVENTION AND REPRESSION OF CRIME. 


buoyant with hope and daring schemes for the future. Without 
prudence or judgment, they always fail, then resort to stimulants to 
drown their feelings, or in reaction from the change. They are sober 
men in the high-tide of expectation, when all is clear and the path 
smooth, but from the first obstacle or discouragement drink precipi- 
tately. When they come to the asylum they are melancholy and rave 
against fate, and after a time have high expectations of getting well, 
but never work for it, trusting it all into the hands of their friends. 
Although planning for the future, they seem to be governed by the 
knowledge of their past failures, and relapse on the slightest temp- 
tation or source of irritation. After a few weeks’ residence in an 
asylum they clamor to be released, and make all their surroundings 
very disagreeable, often relapse and get turned away, go to another 
asylum, and react the same scenes over. In the meantime they try 
various methods for cure, keeping their friends buoyed up with hope 
that is never realized. At any time they are plunged into the 
deepest melancholy, and not unfrequently commit suicide. If they 
commit crime, it is of a petty character and against property. They 
are usually filled with delusions that they can do what others cannot, 
and will escape where others fail. 

These cases come from good families and surroundings generally ; 
and are often sporting-men, and politicians, and followers of new 
movements and new creeds of religion, or active patrons of lotteries 
and games of chance, buyers of chances in Wall street and pools at 
a horse-race. If they wfin anything, they drink in elation, and when 
drunken grow melancholic for a time and want some one to help 
them get well. These cases end often in paralysis, epilepsy and 
suicide. Such are some of the most prominent facts which a study 
of these classes reveals. 

We come 7iow to the practical consideratioji of treatment. Here 
we find the majiagement of inebriates passing through the same 
stages as that of insanity. The care of the insane was for many 
years without system and classification, and this was and is one of 
the greatest obstacles in the successful treatment of this class. The 
testimony of writers and observers is unanimous in condemning the 
system which places all classes of insane together. The effect on the 
mind, by contact with others of a different form of disease, is not 
unfrequently the starting-point of a condition more or less chronic. 
The general want expressed by all observers is facilities for a more 
perfect classification, so that the surroundings shall aid and not 
present any obstacles in recovery. 


CROTHERS. 


21 


In an examination made some years ago of the almshouses in 
New York state, the fact was demonstrated that a large per cent, of 
the inmates were born and bred in those places. From want of 
proper classifications, conditions of surroundings had sprung up 
which produced annually a large number of paupers, or so infected 
others that they could never rise from their surroundings. 

If classification is the indispensable condition of the successful 
management of these institutions, how much more so in inebriate 
asylums ! Here our patients suffer from both a physical and 
psychological disorder, requiring more than locked wards or agree- 
able rooms. 

We must add to our physical treatment and forced abstinence, pro- 
tection from contagious moral forces that intensify and destroy all 
healthy growth towards the higher levels of life. The want of this 
proper classification diminishes the practical results of all our asy- 
lums, and gives credence to diverse theories and deductions. Our 
authenticated statistics of thirty-three per cent, as permanently cured 
should be doubled, and the public should recognize in inebriate 
asylums the most practical charities of the age. 

In our struggle against the skepticism and credulity of an ignorant 
public, we are prevented from making proper classification by want 
of facilities and means. The acute and chronic cases are forced upon 
us, and we can make but little division except from some pecuniary 
standard. Our asylums must be self-supporting, and we cannot dis- 
criminate between the patients of a state institution or an endowed 
asylum. Hence the acute, chronic, criminal, insane, epileptic, and 
pauper inebriates are seen side by side in all our institutions. All 
the bad effects of contagion and the perils of temptation, with the 
difficulties of management, are increased to a high degree. 

We are confirmed in this statement by the experience of all 
observers, that every asylum for inebriates in this country is suffer- 
ing, more or less, from the presence of this criminal class. The 
liberty of these asylums, and the kindly appeals to the higher moral 
nature of the patient which they often do not possess, or have feebly 
developed, make no impression, but rather give opportunity for 
more easy deception and imposition on the good-will of those about 
them. Appeals to the religious sentiment of this class not unfre- 
qu^ntly give them a kind of education which they are quick to take 
advantage of in the future, developing into religious impostors who 
never fail to use this power to their advantage. 


22 


PREVENTION AND REPRESSION OF CRIME. 


If the restraints are imperfect we lose the confidence and co-opera- 
tion of the patient, and stimulate his mind into opposition and con- 
stant endeavors to thwart and destroy its effects. Unless our dis- 
cipline is thorough and stimulating in all its parts, and rigorously 
enforced, we are educating these men into methods of intrigue, and 
building up contagious forces, increasing the difficulties of manage- 
ment, and lowering our reputation in the public estimation. 

“ The sharp discipline of military asylums, filling the mind with 
new duties and ambitions, employing the energies in physical labors, 
is particularly fitted to strengthen and develop the feeble impulses, 
and to control the diseased longings — this is the basis of reform. 
Military discipline, and occupation of both body and mind, indicate 
the most hopeful promise for the future.” 

These statements apply especially to criminal inebriates. If we 
admit patients of this class, we must have the means to enforce obedi- 
ence and make relapse difficult. They must be separated from 
others and placed under a rigid military discipline, which will have 
care of all their habits and surroundings, punishing for all violations 
with certainty and exactness, and under no circumstances relaxing 
the military surroundings in less than two to four years. 

There is another class of patients, called repeaters, who are com- 
pounds of criminals and pauper inebriates, although quite frequently 
wealthy, or having wealthy friends. They go from one asylum to 
another, like tramps, and bring odium on all, disobey the rules, are 
sources of infection and annoyance to the management, and are often 
taken as types of all others. Without facilities for classification, or 
means to enforce long residence or total abstinence, we are throwing 
away time and opportunity in all efforts to help or reform this class 
of inebriate criminals. There would be more hope for criminals in 
the present system of punishment in jails and penitentiaries, if the 
sentences were made for years instead of months. The English 
prison reports indicate a number recovered from inebriety among 
those of this class sentenced for a period of years. The danger of 
the present system is that short sentences intensify and fix their con- 
dition, isolating and building up a dangerous class, from which 
recovery is rare. This is owing to the imperfect system of classifi- 
cation, by which all are treated alike and without regard to marked 
differences of intellect, development and character. 

We repeat, the inebriate criminal must be classified and treated 
by distinct methods. He must be separated from the ordinary 


CROTHERS. 23 

patients of an asylum ; and only by this means can we show the 
public the true value of our work. 

The time has arrived when we must be estimated by different 
standards than that set up by the self-important lunacy specialists, 
or the superintendents of insane asylums, based on superficial studies 
of the pauper and criminal inebriate; or the authoritative dictum of 
the judge, founded on scientific quotations from books more or less 
obsolete, or perhaps the imperfect study of some case of a chronic 
character. The public must realize that inebriety cannot be under- 
stood and managed successfully except by continuous study in 
asylums, in the hands of competent men. 

We stop here, only adding that our work is a pioneer one, and 
that, stretching out in every direction, are divisions and topics of this 
subject which we must study and understand before we can build up 
model asylums, and manage them with the success that it is possible 
to attain. 

A r6sum6 of what we wish to make prominent is included in the 
following : 

1. This class of inebriate criminals are numerous, and are gener- 
ally studied as types of all others ; and, unfortunately, they furnish 
the basis upon which much of the literature of inebriety is founded. 

2. They are composed of several classes, more or less distinct, 
requiring a comprehensive study of conditions and surroundings. 

3. As patients in inebriate asylums they are extremely difficult to 
manage, often bringing odium upon the asylum, and receiving little 
benefit from it. 

4. In the treatment they should be classified and put under a strict 
military discipline, in which labor is a part of the treatment, and this 
continued for months or years. 

5. A removal and classification of this class in our asylums will 
increase the per cent, of recoveries largely ; also a more thorough 
study of the different classes of inebriety will reveal many facts, and 
clear away much of the confusion at present existing. 

The following are some general conclusions which are supported 
by the latest teachings of science and experience along this line of 
study : 

I. Inebriate hospitals must take the place of jails and station- 
houses. Such places are dangerous in their mental and physical 
surroundings, by intensifying the degeneration, and removing the 
patient beyond hope of recovery. They are in many cases literal 


24 


PREVENTION AND REPRESSION OF CRIME. 


training stations for mustering in armies of chronic maniacs that 
never desert or leave the ranks until crushed out forever. 

2. Special inebriate hospitals should receive only the incurable 
inebriates and make them self-supporting, and build them up phys- 
ically and mentally. They would relieve the taxpayer and relieve 
society of untold burdens of sorrow and misery. 

3. Other inebriate hospitals should receive the recent cases, and 
place them in the highest conditions of enforced health and vigor, 
and thus return a large number to health and sobriety again. 

4. Inebriate hospitals can and should be self-supporting when once 
established. They should be managed on scientific business prin- 
ciples, like military training schools. 

5. Inebriate hospitals should be built from the money raised by 
taxes on the sale of spirits, on the principle that every business should 
be obliged to provide for the accidents which grow out of it. 

6. These are the realities which every inebriate hospital is approach- 
ing and which all experience points out as practical and literal in 
the near future. 

7. The inebriate hospitals of to-day are only in the infancy of their 
work, contending with great opposition and prejudice, misunderstood, 
condemned, and working against innumerable obstacles. 

Col. Charles E. Felton, of Chicago. — I cannot discuss the able 
paper of Dr. Crothers as I would wisl\; but if I understand him, he 
would treat inebriety as a disease, and would classify his patients, and 
send some to hospitals and some to prisons. That has been the 
practice many years. There are thousands now in prisons, and but 
dozens in hospitals, however. The thousands and the dozens should 
change places in numbers, if inebriety is a disease. The word 
disease covers a very broad field, as applied to inebriety. Simpli- 
fied, it is a state of the living man in which the natural functions 
of the organs are interrupted or disturbed either by abnormal or 
defective action of mind or body. The cause may have been from 
heredity, hence, in a layman’s mind, constitutional; or from self- 
formed habits; and its appearance may be periodic or occasional, or 
continuous or chronic. There is nothing criminal in inebriety; but 
it may become so offensive to the public eye and sense of decency 
as to be called a vice. Such it often is. 

The difficulty comes when you attempt to classify (offenders) 
patients. The laws do not do that, nor can they. Policemen, nor 
courts even, are intelligent upon the subject ; hence, prisons receive 
thousands of persons who do not belong in them ; and it is unfortu- 
nate that the present trend of public opinion, or rather of sentiment, 
is toward punishing these diseased persons with the same severity 
they would apply to criminals. 


i 


PROCEEDINGS. 2 ^ 

The doctor suggests an ideal hospital, and methods for its sup- 
port ; but from all experience in management, even of industrial 
prisons, it is found that the industries will not furnish sufficient 
income to pay the expense of management, nor will license moneys 
be appropriated to that use. The expense must be paid by our tax- 
payers ; and that fact deters the carrying out of his ideal method. 

I am opposed to laws which authorize long imprisonment for the 
so-called offense of inebriety. To my mind, they are inhuman. 
The laws of Massachusetts and of Connecticut would not be toler- 
ated in this part of the country. The seeming safeguards are well 
enough on paper, but notwithstanding those safeguards, great injus- 
tice will often be done. The disposition of the authorities to enforce 
the law will be such that prisons will be filled with persons, a large 
portion of whom, if confined at all, should be confined in hospitals 
specially intended for the care of those so-called diseased human 
beings. The odor of a prison is demoralizing, its name is offensive, 
and a moral (reformative) effect from imprisonment in one can not 
be obtained. The policy in vogue in some other states of making 
prisons mere catch-basins for inebriates, under very short periods of 
duration of imprisonment, is also wrong. It is generally believed that 
at least fifty per cent, of the prisoners in city prisons are sentenced 
for intoxication or drunkenness. They may have been convicted 
under an omnibus city ordinance for an offense classed as “ drunk 
and disorderly,” but that comes from the way they have been booked 
when brought to a police station by an unintelligent or officious 
officer with a star upon his breast. Inebriates, crazed people, 
epileptics, e/ al., come under that head, and the word of the officer 
generally controls the court. “Drunk and disorderly” covers a 
multitude of sins. Why not require the diagnosis at the station- 
house, and charge the prisoner with the real offense he commits ; 
and if he should receive two years’ sentence for his crime, so declare ? 
But inebriety is not a crime. ’ 

In New York state formerly, and possibly now, the state law 
against public intoxication fixed as penalty a fine of ten dollars and 
costs ; and in default of payment, imprisonment in a workhouse or 
county penitentiary for the term of ten days. That was a just law, 
and cases were tried before police justices and justices of the peace. 
But the state legislature also authorized city councils to pass ordi- 
nances against that and other vices ; and as a consequence, the 
offense of inebriety, under other names, is often punished, or was, 
when I lived in that state, by imprisonment for sixty days or more. 
Offenders were arrested in the night; watchhouse justice’s court 
was held at or before daylight in the morning ; prisoners tried by a 
justice whom a city council appointed, and a “ Black Maria ” conveys 
its load to a city workhouse as early as nine o’clock, and there the 
subject is bathed, hair and whiskers removed, prison garments 
substituted for citizen’s habit, and at ten o’clock sharp he enters 
the workshop of the prison. That course is as intolerable as is the 


26 


PREVENTION AND REPRESSION OF CRIME. 


Massachusetts system, save that the imprisonment is not as long. 
Reform them both, and if you can do so, so classify your “suspects” 
before sentencing them to institutions that no great injustice will be 
done The administration of the system is equally objectionable and 
should be changed. 

During more than twenty-seven years as superintendent of prisons 
for misdemeanants, I had occasion to know of the injustice often 
done through the ignorance of policemen and the indifference of 
justices at police courts; and the relief came only by immediate 
release after the facts became known. It was not by “ parole,” 
where certain officials had completed a long and tedious investigation 
as to facts or fictions, but by “ release by order of the Mayor ” of the 
city upon my recommendation. I believe in pardons, and a reason- 
able use of the power to release by a governor or by a mayor, as the 
offense may suggest ; and I have faith in a judicious parole system 
for criminals, if their acts can be controlled while at large; but I do 
think it wrong to treat as criminals those who offend only as 
inebriates, and equally wrong to make cesspools of city prisons by 
committing thereto nearly every class of the vicious, under the more 
respectable name of inebriates. Make hospitals for the better and 
more hopeful class, if inebriety is the cause of their ailment. 

Dr. Crothers. — I think I am misunderstood. Last year 675,000 
were arrested in the United States charged with drinking and petty 
crimes. My point is that it is wrong to send drunkards to penal 
institutions. I claim that they are diseased. Examine one hundred 
of them and you will find that eighty have inherited the disease, — 
neurotic heredity ; ten or fifteen more have a history of brain injury 
beginning before the drink curse came on ; and eight or ten more 
suffer from a real contagion, mental contagion. They are men who 
have drifted into unfavorable surroundings, and by reason of sus- 
ceptible nervous organization took on the exact conditions of their 
surroundings, which they could hardly escape. In that one hundred 
there are not five per cent, whose habit cannot be traced back to 
physical causes. They are properly subjects not for vengeance but 
sympathy ; and, instead of workhouses, they should be sent to hos- 
pitals and to institutions where labor will form a part of the treatment. 

Rev. J. H. Nutting, of Rhode Island. — At what time is this habit 
likely to develop, by heredity or otherwise? 

Dr. Crothers. — Perhaps the two epochs in life, 15 and 25, are the 
most critical periods. There are critical periods along that line any- 
where from 15 to 25. The emotions and the intellect vary widely at 
that time; so do circumstances, and environment may play its part. 

Dr. Lewis. — Is it not true that environment has more to do with 
the matter than heredity? 

Dr. Crothers. — Not in my experience. 

Mrs. Agnes L. d’Arcambal, of Detroit. — Michigan has made 
one step towards the solution of that question, or at least our Gov- 
ernor has created quite a sensation, by signing what they call there. 


PROCEEDINGS. 


27 


I am sorry to say, the “jag” bill. For the first offense drunkards 
have the choice of being sent to the workhouse or sent to some place 
for cure at the expense of the county, if the man is too poor to pay 
for treatment. 

Mr. Brown. — There is a statute in France or was, shortly after 
the Franco- Prussian war, which provided that for the first offense the 
drunkard should be simply taken to his house, if his residence could 
be ascertained from his address book or from the man himself. 
There he was left. The next morning an officer called (not in uni- 
form), and brought a little envelope admonishing him not to be found 
in that condition on the streets again. If arrested for public intoxi- 
cation a second time, he received a notice to present himself at the 
bureau of the commissary of police, where, in the presence of the 
commissary and his clerk alone, he was again admonished not to 
appear in that condition again. The third time he was publicly 
admonished in court, and it was adjudged that, if he should become 
drunk again, he was not in a moral condition or in a mental or phy- 
sical condition to be amenable to the restraints of law ; so that on the 
next arrest he was sent on sentence to a maison de santt and not to 
a prison. He was virtually adjudged to have become an insane man, 
and sentenced, on an indeterminate sentence, to be kept until he was 
cured. This was in 1873 I inclined to think that the 

law still remains in operation. 

The section adjourned. 


SECOND SECTION MEETING. 


Tuesday, June 13, 1893, 10.30 a. m. 

The Chairman. — Mr. C. H. Reeve, of Plymouth, Indiana, will 
open the session. 

Mr. Reeve then read the following paper : — 

THE PHILOSOPHY OF CRIME. 

C. H. REEVE. 

What is crime? 

It is the manifestation by a human being of a mental impulse, in 
some act which has been forbidden by the declaration of other human 
beings, in pursuance of certain human customs called government. 

What is a mental impulse ? 

It is thought created by impressions made on the physical and 
mental organisms through the senses, by the environment of the 
individual, prompting to some action. 

The character of the impressions and the character of the resultant 
thoughts are dependent upon the material character and arrange- 
ment of the organisms on which the impressions are made. Primarily, 
the character of that material is inherited ; thence on, it is modified 
by life environment. Primarily also, the arrangement of organs is 
inherited, and thence on they are modified in action, singly and in 
combination, by environment. Impressions constantly made by the 
environment educate — first to instinctive action, later to thought; 
and from constant impressions from outside, and reaction by com- 
bined thought, comes an energy — reciprocal in action — which we 
call “mind”; and within the operations of that mind-energy is 
created the impulse that gives existence to the thought that prompts 
every human act. 

It follows, beyond the possibility of question, that whatever hap- 
pens to the individual is a natural outgrowth and unavoidable result 
of his organism and environment on the plane of action where they 
have placed him up to the moment of the happening. Had his 
organism been different in material or in order of arrangement, or 
his environment from birth onward to that time been any different, 


REEVE. 


29 


he would not have received the same impressions, been prompted to 
the same acts, or been in that place at that time, and subject to what 
then occurred to affect him. 

Therefore, crime is one of the factors in, created by, and an out- 
growth of, evolution. One among other outgrowths that come in the 
processes of the evolution that occurs in the progress of man from a 
condition of barbarism to enlightenment and civilization. Begin- 
ning with the earliest intellectual perception relating to government, 
passing on through the tribal forms up to the highest imperial forms, 
and onward to the broader developments of enlightened republics 
such as the one under which we live, the evolution of conditions 
which have created a conception of relations which we call ethics, has 
not produced such changes in the physical and mental organisms as 
to eradicate those that are common to the savage ; and enough of 
the material conditions remain in many human organisms that existed 
in the original savage, to receive impressions and create impulses 
prompting to acts of savagery. 

The idea of right and wrong has no fixed standard and never did 
have; and the perception of the necessity for one is manifested alone 
in arbitrary standards, changing constantly as practical knowledge 
increases or decreases, or as what we call civilization changes. 

Man has come from a state of animal existence where he fought 
with beasts and the strongest of his own species for life, and in time 
reached a condition where he consorted with others as an aggregate, 
in clans and tribes ; and rude ideas of superiority of claims, of indi- 
vidual and tribal rights grew up, maintained by force. A certain 
degree of sympathy and pity was born of the maternal instinct, and 
of this came revenge where offense was given ; being on a higher 
plane than the mere animal disposition to combat. This is the 
beginning of what we call moral sense. Later, with a sense of prop- 
erty and local habitation, came the necessity for protection, for more 
fixed government, and ultimately a rude perception of right and 
wrong in a moral sense, but relating only to material gain. In all of 
the philosophies, all of the religions, to become possessors of a “land 
flowing with milk and honey” has been the great desideratum ; and 
the results of experience were crystallized into instructions for living 
and conduct to secure and enjoy that end. The promises put into 
the mouths of all the gods were of the bestowal of material benefits. 

This love of property, of material acquisition and possession, of 
enjoyment of animal pleasures, such as adorned the person, pleased 


30 


PREVENTION AND REPRESSION OF CRIME. 


the physical senses, gratified appetites, ambitions and pride, with a j 
desire for protection and power in that possession, were the ruling 3 

impulses, and the ideas of right and wrong were born of the efforts 5 

to secure that possession and power, and related to it. In the palmiest J 
days of Rome it was right and moral for a man to take the life of his 
wife, child and servant. To-day, in autocratic governments, where 
some of the rulers are men of the highest civilized education the 
world can give, polygamy is right, and life, liberty and property are 
at the will of the supreme ruler. There is still no fixed and perma- 
nent standard of right and wrong. 

In the rising scale from the barbarian nations to the highest civili- 
zation of America, the standards in all are arbitrary and there is no 
fixed standard of crime other than locally. In every nation and 
every grade of moral impulse common to them all, the savage and ^ 

the civilized mingle and move side by side. What is crime by the ( 

standard and laws of one is no crime by the standard and laws of 
another. What is moral and permissible by the perceptions of right 
and wrong with one is immoral and forbidden by another. And ^ 

when we come to people of one locality — the United States for J 

instance — the same facts exist ; that is, those having the highest t 

civilization, as well as those having the lowest, differ among them- I 

selves as to right and wrong, as to what is moral and what is | 

immoral. Hence we come to the end, to the limit of possibility in I 

civilization, which is this. Existing conditions, constantly chang- • 

ing, have evolved all forms of existing government, and these are 
constantly changing. Under the government for the time being ‘ 
formal declarations are made, called laws. With us, a municipal law 
is defined as being “ a rule of action prescribed by the supreme power 
in the state, commanding what is right and prohibiting what is 
wrong.” Every person is presumed by the law to know what these 
rules are. A violation of those which prescribe a penalty for viola- 
tion is called crime. But these rules are being modified, changed, 
repealed, and new ones enacted constantly, and only for the time are 
they a standard of right and wrong. The same must be said of the 
theological standards. In the Greek Catholic church the priests 
must all marry. In the Roman Catholic church none may marry; 
and in most other things are like variations, and changes are 
constant. 

The object of the law is to secure to mankind justice. The nearer 
it accomplishes that end the higher the civilization. With change in 


i 


REEVE. 


31 


conditions the changes occur in the laws and in what constitutes 
crime. Hence crime is, and must continue to be, only a factor in, 
and one of the changing outgrowths of evolution, the changes which 
the conditions attending an aggregate of human beings undergo in 
the progress from barbarism to civilization, and in maintaining that 
civilization when it is reached. 

The philosophy of crime demonstrates this isolated and embarrass- 
ing truth. It forces us to abandon all of our preconceived notions 
of it and regard as largely erroneous our modes of dealing with it. 
Logically, it calls upon us to review our ideas and dogmas and 
teachings as to what we call morals, and to begin and pursue the 
study of the philosophy of morals, which is “ the science of duty ; 
the science which treats of the nature and condition of man as a social 
being, of the duties which result from his social relations, and the 
reasons on which they are founded.” This includes the local environ- 
ment. What may be the duty in one nation or under one govern- 
ment, may not be, or may be impossible in or under another. 

A few words as to the possible limitation of crimes. 

The love of property, of gain, of luxurious indulgence, is as strong 
in men now as it ever has been ; and without the restraints of law 
there would be little scruple as to methods in their acquisition in the 
majority of individuals. There are none now in many. 

The savage spirit of revenge is as active as it ever was in certain 
human organisms, and the disposition to gratify it is seen in crimes 
against the person that shock us at every turn. The desire of gain 
overrides all other thoughts with many, and the wholesale taking of 
life and cruel mangling of bodies of persons toward whom there are 
no feelings whatever, is resorted to, to gratify it ; as in train wreck- 
ing, arson, infernal machines, explosives, and in other ways. Some 
who are criminally inclined are restrained by municipal law, but more 
disregard it. Many know little of what it commands or prohibits. 
Such as cannot be restrained by fear of such penalties as the law 
prescribes cannot be restrained by moral force, for there is little or 
no perception in them of right and wrong from a moral point of 
view. 

To have government with liberty we must have public order and 
safety ; and to have these the criminal element must be kept under 
restraint. Neither moral nor statute law nor education has availed 
so far to restrain it. It increases out of proportion to increase of pop- 
ulation. It costs nearly three times more each year for the conduct 


32 


PREVENTION AND REPRESSION OF CRIME. 


of criminal procedure than it does to conduct the national govern- 
ment, leaving out the pensions, which are gratuities, not expenses. 
The total is nearly a half-billion of dollars. That leaves but one 
means for limitation, and philosophy as well as economy dictates the 
immediate use of that means. It is the imprisonment of all offenders, 
the abolition of all provisions for so-called punishment by the state, 
and a recognition of the operation of natural forces, as we have to do 
in meeting the results in other cases, such as a war of the elements, 
epidemics, insanity, sickness, etc. 

Every criminal impulse is evidence of an abnormal condition of 
the mental organism. It may be a result more or less of an abnor- 
mal condition of the physical organism. Whatever the cause or 
condition, the person is a menace to order, to government, and so to 
liberty. In cases of danger, when it is possible, we put the cause of 
menace in a place and condition where it will cease to be dangerous. 
So here. Take the dangerous subject into custody and put him in a 
place and condition where he will not be dangerous. That places 
two limitations in operation. It prevents crime by him, and the pos- 
sibility of abnormal posterity through him. The social and political 
sea is purified so far. We exercise the power to take life, and claim 
the right. We may as justly exercise the power of depriving one of 
liberty for life, and in every case of a confirmed criminal diathesis, 
or any other case of abnormality, where hereditary transmission of a 
vicious condition may follow, it should be made impossible. 

Once in custody, an effort should be made to learn the cause of 
the offender’s abnormal condition. If it can be removed and he be 
made fit for liberty, restore it to him. If not, the matter remains one 
of public safety, and restraint should continue. The demands of 
justice do not stop with him. They go through and beyond him 
and reach the public beyond, whose peace and order his liberty 
would menace. By and under license miscalled liberty, we permit 
him to come among us. This makes us responsible for him, and 
we are morally bound to take care of him and protect others against 
him. 

His disappearance in prison, never to return, would exert a force 
upon others a thousandfold greater as a preventive than any idea 
or practice of punishment could do or ever did. The possible limi- 
tations of crime will thus be reached, so far as the idea of punish- 
ment now in force can do it, carried to a legitimate end by this 
modification. 


REEVE. 


33 


But the law can go further. It now encourages and sanctions the 
rearing of criminal organisms. ^ It licenses the marriage of the vile 
and degraded, and of others wholly unfit for the relation; including 
felons in the jail and demented paupers in the poorhouse. Judicial 
officers and consecrated ministers of the church perform the cere- 
monies to make the union legal. In this, both the state and the 
church, as well as their agents, are severally guilty of injuries against 
society a thousand times greater than are the crimes of any criminal 
they license and unite in marriage. By statutory enactment the law 
can forbid all such marriages, and put under restraint the offenders 
as it does any other criminals. It can remove the offspring of 
criminals from their environment and put them under charge of state 
guardians, where the influence and training will tend to create 
healthy mental conditions, prompting to order, and to a greater or 
less extent limit criminal acts by these. With such prohibition by 
those unfit to rear children as is possible, the isolation of offenders, 
the custody and training of the tainted offspring that does come, the 
making of personal liberty dependent on obedience to statutory law, 
the teaching of that law in our schools, and asexualization of the 
incurably vicious, we shall reach the limitations of restraint of crimes, 
and a few generations will see society as free from criminals as we can 
make it. 

A few words as to reformation of criminals. 

What is reformation ? 

That depends on the condition of the criminal. It is the creation 
of what is lacking, the modification of what is in excess, the increase 
of what is insufficient, and the adjustment of all that exists or can 
be supplied in harmonious relations. It is taking an abnormal, or 
ill-balanced, or defective organism, physical or mental or both — and 
one generally implies the other — and making a balanced one out of 
it, so that impressions upon it through the senses will create moral 
impulses and thoughts, as well as practical ones ; enabling it to adapt 
itself to social surroundings, preserve order, and make a living. 

How can it be accomplished ? 

In one way only. By finding the level and extent of the percept- 
ive and conceptive capacity of the subject, and educating it up to a 
moral and practical level of perception and conception. As we do 
not take a watch to a blacksmith for adjustment, nor a wagon to a 
jeweler for repairs, so we should not take a criminal to one who is 
not qualified to reform him. It would be useless to take one with no 


34 


PREVENTION AND REPRESSION OF CRIME. 


moral perception, no emotional nature, to a chaplain. Each must 
go first to one skilled in anatomy, physiology, pathology, medicine 
and hygiene ; then to one who is a skilled alienist and versed in 
psychological phenomena; lastly, to skilled educators; and this will 
include the moral instructor, and the religious teacher if the subject 
has moral sense, reverence, and emotional elements, and an industrial 
teacher. Each subject will require treatment varying more or less 
in some respects from any other. He must be taught not only to 
observe order by understanding his relations to the state, to society 
and his fellowmen in all conditions, but how to make a living. 
Unless this can be done, he will not be reformed. 

The subject of crime and criminals is purely a matter of business 
in government. Government alone can protect against them and 
take care of them. Neither sentiment nor charity enter into the sub- 
ject until the criminal is rendered harmless. Then what is called 
humanity may be given as full play as may be consistent with the 
public welfare. 

Reformation, to be effective, must begin with the statutory laws 
relating to civil conditions ; especially marriage, divorce, immigra- 
tion, naturalization, individual and corporate franchises, prosecutions 
and defense in the courts, inquests by grand juries, public prosecu- 
tors, penal offenses, the disposition of convicts, prisons and some 
others. The whole penal code as now existing must be wiped out, 
the idea of punishment by the state be abrogated, and a new statute 
on the subject of crime and criminal proceedings be substituted. 
Provision should be made for teaching social science in the schools. 

The state must specifically declare what shall be regarded as a 
criminal act. That liberty shall be conditional on obedience to the 
law. That violation of the law shall forfeit the right to liberty. That 
on conviction the sentence shall be to imprisonment for safety. The 
character of restraint shall be dependent on the facts in each case as 
disclosed on the trial ; and the court shall use all means of inquiry 
available to disclose every material fact, as well in relation to the 
character and condition of the accused as to his guilt ; and the record 
shall go to the prison with him. There he is to be put into proper 
employment by the state. If he becomes fit to have liberty, it can be 
so found by a proper tribunal and he be set free. Until so found he 
should remain. Those who prove to be incurable or unreformable 
should be rendered incapable of perpetuating their infirmities, so 
they will be that far harmless if they escape. The prisons should be 


REEVE. 


35 


SO remodeled and constructed as to admit of justice and practical 
efforts in the final disposition of the inmates, as well as for reforma- 
tory measures. To permit the least harmful, the most dangerous, 
the various grades as they may be found, to be so distributed as to 
make the prison a community as tolerable in all respects as such a 
community can be made, considering what they would be if at large. 
This will afford justice to the accidental and the unintentional 
offender; the weak-minded, lacking will-power and not vicious ; and 
the ones amenable to moral force and so reformable. 

The history of crime began with that of the creation, according to 
the biblical records. Without cause, the first two created human 
beings became criminals ; trespassers first, then thieves and hypo- 
crites ; and the Creator drove them from his presence, cursed for all 
time, and the earth cursed for their sake. Of their first two children, 
one slew the other and became a murderer, and he was driven out, 
cursed and marked. We may take the religious history of any and 
of all nations, of any and of all periods, including the Jewish and 
Christian — which most nearly concern us — and we will find that with 
all the preaching, praying, and so-called religious endeavor, crime 
has gone on steadily increasing. Criminal cruelty, .recklessness and 
bestiality have become worse and worse, until the so-called Christian 
superintendents and employes in some institutions have been found 
indulging in practices too revolting to name. Innumerable crimes 
occur in the prisons themselves, w'hile in some, where the state fixes 
determinate penalties, revolt, insurrections, murders and escapes are 
a common occurrence. 

It should be conclusively evident to all observing philanthropists 
that God has given man the means and the law, and expects him to 
reap the benefits of observance and the consequences of disregard, 
without any special interference on His part with the operation of 
the natural forces inherent in matter as created by Himself. There- 
fore the question before us becomes one of the continued increase of 
crime under existing methods, to the final destruction of order and ' 
civilization in time, or a recognition of the philosophy of crime and 
the possible limitations of it by the prevention of the breeding and 
rearing of criminal elements ; while we isolate such as come in spite 
of efforts to prevent, as soon as their impulses prompt a criminal act, 
and render them harmless if they cannot be reformed. Just as we 
isolate the first case of infectious or contagious disease dangerous to 
others, and all other cases as they appear, and keep them isolated 


36 PRl^VENTION AND REPRESSION OF CRIME. 

until safety is assured by complete cure or final dissolution. And as 
we fumigate and purify the premises infected, in like manner seize 
and try to purify the offspring of the criminal ; and if we cannot suc- 
ceed, then make them harmless. Morally, there neither is nor can be 
any individual right or liberty that is paramount to that of the com- 
munity or state ; and the lesser must be and remain subordinate to 
the greater, if we are to retain civilization or to progress in enlight- 
enment. 

Those of us who know the law must teach it to those who do not, 
when that is possible. Those who cannot learn and obey it must be 
made harmless to themselves as well as to others. This is the very 
essence of religion and the practice of the charity which Paul pre- 
sents as the greatest factor in religion. 

The use of the intellect in elevating ourselves and our fellowmen 
on to higher planes of ethical life and living, and removing all elements 
obstructive of effort in that direction, dealing with realities as they 
are, and not as imagination or pity would make them, is following the 
example Deity has set for us, and which is always before us. 

ADDENDUM. 

In view of a possible misunderstanding of the foregoing paper, I 
have decided to add a few explanatory words. The subject for the 
day was, “ The nature and causes of crime,” ” the idea of retribution 
in treatment of crime,” “the deterrent effect of punishment,” “refor- 
mation — how far the principle acts in treatment of crime.” 

These propositions involved the whole philosophy of crime. Take 
notice, the subject is crime ; not ethics, or offenses against morals 
or conscience, etc. 

No act is crime until it is made so by the supreme power. No 
violation of the moral code or the commandments is crime in the 
sense here considered unless municipal law has said it shall be a 
crime. 

God made a garden, put Adam and Eve in it and declared what 
they should not do. They trespassed on the tree they were forbidden 
to touch. They stole away the fruit, then acted the hypocrite, lied, 
and tried to deny it. God made no compromise with them. He 
said nothing of punishment. He said they should die — that is, 
civilly. They should go out, and under a new government. And he 
turned them out, never to return. That is, he put them into a prison 
from which there was no escape, and where labor was to continue for 


REEVE. 37 

life. They abused liberty, and were a menace to the first govern- 
ment and the liberty there, that of the garden. 

So with Cain, He did not kill him, He banished him — another 
form of civil death. He put him on probation for life. This is the 
example set by God for the first offenders who knowingly violated 
the first commands of the supreme power. 

Here is a state. It declares arson to be a crime. One is convicted 
of arson. Follow the rule. Let him die a civil death and be banished 
from society to prison and be put at suitable work. If in time he 
develops such faculties as demonstrate that he will obey the law, 
restore him to society. That is more mercy than God showed 
Adam. If not — like Cain, let him remain in prison. 

Right and wrong are considered in the view of crime. There is 
no fixed standard, it changes often. A few decades since, 150 
offenses were punished by death ; now, only three — treason, piracy, 
murder. Soon, the death penalty will disappear. It is not a ques- 
tion of morals or conscience, but of statute ; and statute is the formu- 
lated expression as law of the public opinion. That opinion is the 
outgrowth of the civilization of a locality. Massachusetts is unlike 
North Carolina, both are unlike Louisiana, etc. 

Mental organism is the existence and arrangement of brain ganglia, 
as supported by anatomical and physiological organisms. Envir- 
onment is the surroundings, from conception until birth, and thence 
on to death; affecting the material, the formation, the arrangement 
of the organisms first, and making impressions on them, creating 
mind and impulse to action ever after through life. 

One born without faculties for moral perception and conception 
will be animal, unless after-impressions can create this moral per- 
ception and conception. The dominant faculties will prompt the 
impulses and the actions. 

If they prompt to acts which the law calls crimes, the person will be 
a criminal when convicted. The whole subject must be considered 
and dealt with as a fact. First, let him, on conviction, “ surely die,” 
like Adam under God’s judgment, a civil death. Cast him out from 
his fellows, imprison him. Learn his origin and environment, and 
physical and mental organism, as far as possible. If by any means 
he can be given any needed, lacking faculties, to assure moral per- 
ception and obedience, give him liberty. If not, let him die in 
safety, and prevent any chance of posterity by him. 

No act can be done without a mental impulse. If that impulse is 


38 


PREVENTION AND REPRESSION OF CRIME. 


one of intention to violate a statute, that intention makes it crime. 
If there be no such intention it is involuntary crime ; but the subject 
may be a menace to order and to liberty. In either case he should 
be under restraint. 

It is claimed there is a “Word of God,” a Biblical standard of 
right and wrong. Grant it, but it is not fixed, and is arbitrary and 
temporary, and has many hundred constructions. Any violation of 
any one of the constructions is not crime, unless the statute says it 
shall be. It is crime we are dealing with, not morals. 

Morals, justice, charity, sentiment, religion, etc., come in when the 
law has acted, when the offender is seized and convicted. Exist- 
ing methods resort to what is called punishment. This paper goes 
on the theory of safety first, reform next, believing punishment to be 
a barrier to reform. Civil death is punishment while it envelops 
the criminal. But it should be considered purgatorial probation, 
during which he is being purged, reformed. If the mental and physical 
organisms are such that permanent moral perception and conception 
cannot be created in the criminal by training, he should remain civilly 
dead. If they can be created, with will power to follow their 
impulses, he may be civilly resurrected, that is, go back to society, 
liberty and civil life. 

The paper deals with crime, punishment, etc., as matters of fact. 
If we wish to take up the subject of morals we must enter the domain 
of metaphysics, and that is not the question here considered. 

Further. In the law a man is not a criminal until convicted by 
due process of law; then he becomes a criminal. The paper deals 
with criminals. The treatment proposed relates to these and to their- 
progeny. The law has no control of a person until it takes him into 
custody, and it can so take him for crime only on due charge, on 
oath. Even then it presumes him innocent of the charge until he is 
convicted on proof beyond a reasonable doubt. When this is done, 
then the theories of the paper become applicable as to him. As to 
reformation, it must begin with the statutes. 

The Secretary. — There is present in the room a lady, an officer 
appointed to assist in the carrying out of the probation law of Massa- 
chusetts, and I would be very glad if you would invite her to say a 
few words. 

The Chairman. — The new law of probation for criminals, which 
went into effect in its present form, July i, 1891, in the state of Massa- 
chusetts, has been hailed by thinking men all over the country as a 


PROCEEDINGS. 


39 


step in the direction of a general reform of our penal law. We are 
fortunate enough to have present with us this morning Miss Todd, 
of Boston, who has had, under the law referred to, and, I believe, 
under the preceding law, of which it is an extension, an experience, 
a knowledge of which would be of the highest value to us ; and it 
will be a gift to us if she will favor us with some account of her 
experience and observation in connection with the paper which we 
have just heard read. 

Miss H. M. Todd, Probation Officer, Boston. — This is so entirely 
unexpected that I am afraid I shall not be able to tell you what 
I would like to tell you of this work. My work is just one year old. 
Probation work in Boston is of long standing, beginning fourteen 
years ago with a single probation officer. Under the new law 
relating to drunkenness the probation officer had six assistants 
provided, to investigate the cases of those released from arrest 
for the offense of drunkenness and, at the discretion of the judge, 
placed on probation. In May, 1892, a special law was passed pro- 
viding for the appointment of a woman to investigate the cases of all 
women coming before the court on criminal charges. I visit the 
House of Detention, under the court-house, where all women under 
arrest are detained in the care of women. I receive from the matron 
a list of these women with their various aliases. I visit each of them 
personally, talk with her about her life, her circumstances, and the 
circumstances of her arrest. In many cases I am utterly helpless ; 
but where I feel that I can be of any use I make special visits. I 
see the arresting officer, learn from him as much as possible of the 
case, and then talk with the judge. Where I see fit to recommend 
any woman for probation, if she has been proven guilty, she is put 
on probation on my recommendation. If there is a doubt as to her 
guilt, she is put on trial, and the case is either decided, or continued 
to enable me to make further investigation. In many cases we find 
it very necessary to make outside investigation to learn as much as 
possible of the prisoner’s character and home life, and whether this 
is her first offense or whether she is a criminal of long standing. 

Since I began my work as probation officer I have had some 200 
women in my care. A large part have done well. I am not prepared 
to give statistics. I have had some pitiful cases. I have now in my 
care a woman who has been arrested time and time again for drunk- 
enness. She has been sentenced, her children have been taken away 
from her, and now, during a probation of lour months, she has been 
entirely free from drink. I have visited her at all hours of the day 
and night and can see no indication of indulgence in liquor. A 
gentleman who has had former dealings with this woman said to me 
that he thought it the most hopeful case of the kind he had ever 
seen. I also have girls arrested for night-walking and for disorderly 
conduct. As a rule, I find young girls arrested for these offenses 
rather hard to deal with, from the fact that they are not yet tired of 
the life. There is a sort of glamour about it, and unless we can get 


40 


PREVENTION AND REPRESSION OF CRIME. 


hold of them at the very beginning, it seems almost impossible to 
bring any influence to bear. 1 remember a girl arrested for the first 
time. The officer told me he knew very little of her except that he 
had seen her on the streets at night. He knew nothing of her home. 
She lived some little distance outside of the city proper, and he did 
not know how to notify her family. He thought the best thing to do 
was to arrest her. We talked with her, and it seemed to me a proper 
case for probation. I therefore recommended it. She plead guilty ; 
there was no trial ; we saved her from exposure. I don’t think she 
realized where she was drifting. It is nearly or quite a year ago since 
I took charge of this girl. I don’t think there is the slightest danger 
of her ever going back again to her former life. The great value of 
the work, of course, depends upon taking young persons in the first 
stage of a criminal career. They are practically under sentence, 
having to report to us at stated times during their probation. I visit 
them, or try to, as often as once a week, not in an inquisitorial spirit, 
but in a purely friendly way; and it seems to be a help. My experi- 
ence in this line of work is not very extended, but it has been most 
satisfactory. 

The Chairman. — As I understand it, the law which went into 
effect July i, 1891, extended the principle of probation to a very 
much larger class of criminals than it had been applied to before. 

Miss Todd. — The law of July, 1891, simply related to cases of 
drunkenness. 

The Chairman. — Was there not another statute of probation 
which went into effect at the same time ? 

Miss Todd. — Yes, sir, including all classes of criminals ; probation 
to be allowed at the discretion of the judge. 

The Chairman. — Is it your impression that that law is a success? 
Does it diminish crime, or tend to do so? If so, kindly explain the 
principle on which it works. 

Miss Todd. — I should say decidedly that it has tended to diminish 
crime — at least it will, in time. But it is too new, and there are too 
few of us to do the work, to enable me to speak definitely on that 
phase of the matter just yet. The term of probation is altogether 
too short. In the superior court it is one year, and the probationers 
report every month and are visited during the month. In the muni- 
cipal court it is only five weeks, which may be extended from time 
to time. That is a possible disadvantage, owing to the fact that pro- 
bationers are required to report to the court at the end of each five 
weeks. This familiarizes them with the court-room, which I think 
is bad, because it makes them feel that it is no disgrace to come into 
court. But the judges are beginning to extend the term of proba- 
tion. Prisoners can be surrendered to the court at any time during 
their probation. They know that they are still in the custody of the 
court, awaiting sentence. The number of surrenders is still large, 
but we hope to diminish it. 

The Chairman. — You are aware that the development ofimpris- 


PROCEEDINGS. 


41 


onment, as a general form of treatment of criminals, under statute 
law, has gone on without serious modification until within the last few 
years. Efforts have recently been made, timidly in Great Britain, 
somewhat more boldly in New Zealand, and now on a very large and 
complete scale in Massachusetts, to find a substitute for imprison- 
ment which should give prisoners a more natural life, surround them 
with the influences of civilized society, and thus prevent the unna- 
tural, degrading, public slavery which is the only form in which 
treatment can be applied to them in prison. This suggestion stands 
in striking contrast with the philosophy of treatment of criminals in 
the paper submitted by Mr. Reeve. It seems to me that the con- 
trast between the two suggests reflections of the highest importance. 
If Miss Todd, who is a conipetent person, would consent to write for 
this section an exposition of the probation law from this point of view 
and a criticism of its practical working, it would be a valuable con- 
tribution to the literature of the subject and a service to the cause we 
represent. 

Miss Todd. — I should be very glad to do so, if I can find the 
time. 

Not all our probationers are in their own homes. Some go 
to private institutions for a certain term and then to their own 
homes. For others we get work away from the city. If the home 
seems a proper place we allow them to go there. 

Mr. Reeve. — If at the end of the term of probation there is no 
improvement in these creatures, what is done with them ? 

Miss Todd. — They are surrendered to the court and sentenced. 

Mr. Reeve. — That is, to punishment by the state? 

Miss Todd. — Yes, sir. 

Mr. M. M. Mangasarian, of Illinois. — I would like to ask Mr. 
Reeve a question concerning his definition of crime. A crime, he 
says, is some act forbidden by the government. Some of the greatest 
men have been criminals according to this definition. Jesus was a 
criminal; he did things forbidden by government. William Lloyd 
Garrison was a criminal ; he did things forbidden by the govern- 
ment. It would seem to me more correct to say that a crime is an 
act or an attempt to commit an act with the intent to satisfy some 
desire at the expense of society ; an act which endangers society. 

Once more, I would like to ask him to explain himself when he 
says that “ without cause ” the first two created human beings 
became criminals. That is a very strange assertion. I never knew 
anything to happen without a cause. 

And on the same page Mr. Reeve says that crime, cruelty, reck- 
lessness, etc., have become worse and worse, until the so-called 
Christian officers of some institutions have been found indulging in 
abuses too revolting to name. I would ask him to tell us what he 
means by that. 

Judge M. D. Follett. — I don’t think we ought to criticise Mr. 
Reeve too much, but I would like to know if he has any standard of 


42 


PREVENTION AND REPRESSION OF CRIME. 


right and wrong. He hasn’t given us any this morning. No stand- 
ard of morality ! No standard by which to judge crime except that 
of the law ! It seems to me that he has a mistaken philosophy of 
government. The law is but the expression of what the community 
believes it to be. When you pass any statute it is not enforced | 

unless the popular consensus of opinion backs it up. What is Mr. j 

Reeve’s basis? Why didn’t he begin with the statement in the 
latter part of his paper, that God has given us the law? Where is 
it ? He says that it is not in conscience. Where do we find it, then ? • 

If Mr. Reeve’s position is right, what is the use of the Massachusetts 
system of probation ? I would rather undertake to upset the whole 
of Mr. Reeve’s philosophy than to reform a criminal, if we have no 
other ground of ‘hope of reformation than that which he admits. 

There is no government we can violate except God’s. When Jesus 
says “ Thou shalt love the Lord thy God with all thy mind, soul, 
strength and heart, and thy neighbor as thyself,” is that true ? Why, 
there is no other basis of law — none. 

Crime is not founded on human law. The basis of crime is 
deeper. The law of righteousness is written in the very nature and 
constitution of man. Mr. Reeve says that if you would make a boy 
good you must create in him a principle. Is that true? Can Miss 
Todd create in one of her probationers a principle that did not 
already exist there ? Not at all. She don’t pretend to. Mr. Scott, 
of the Massachusetts Reformatory, don’t pretend to create anything. 

He restrains the evil in his prisoners and encourages the good. I 
meet a friend and treat him rudely. Is there any law against that ? 

None, except what is in my constitution or education. It is not 
statutory law which says “ Thou shalt do no murder.” Ohio has 
not any such law. “ Thou shalt not steal ” ? Ohio has no such law. 

The statute declares that if you do so and so you are guilty of 
murder and are to be punished accordingly. The moral condem- 
nation of murder and of theft is anterior to the statute, and the 
statute rests upon it. The moral sense cannot be created, though it 
may be educated and developed. I have never seen a criminal so 
low but he had some good in him. I have never yet seen a man so 
good that he didn’t have something bad about him. 

Rev. J. H. Nutting, Chaplain of Public Institutions, of Rhode 
Island. — The essay proceeds upon the supposition that crime is the | 

outgrowth of total depravity on the part of the criminal. The gentle- t 

man spoke of criminals who have no emotional nature and are < 
devoid of moral sense— “ moral perception,” he says. Now I have 
not had to do with rascals so long as Brother Reeve, perhaps, but I 
have had to deal with some, and I have yet to find a criminal in 
whom I haven’t found, after knowing him for three years, some moral 
perception and a good deal of the emotional nature. That is fact, not 
theory. There are under my charge men in whom I have not found 
this, but I have not known them for years yet. It is there. 

Again, what hope is there for reformation or improvement in the 


J 


PROCEEDINGS. 


43 


case of an individual who is without an emotional nature and without 
moral perception ? What is the use of putting him on probation? 
He has none of the elements to which we must appeal in any 
effort for his reformation. I have found no such men, but if I did 
find one, contrary to all my natural impulses, I should advocate the 
restoration of the penalty of death in the state which I represent. 

Again, Mr. Reeve says, in so many words, that crime is and must 
continue to be a factor in the world ; and then he proceeds to say 
that every criminal impulse is an evidence of an abnormal condition 
of the mental organism. What is a normal condition? Is it a condi- 
tion in harmony with the consensus of opinion which framed the 
statute law ? and is only that which is in harmony with this opinion 
a normal condition ? Then, as the gentleman said, William Lloyd 
Garrison was a criminal ; and I venture to say that every individual 
here is a criminal, according to that definition. 

Dr. H. F. Lewis, of Chicago. — I am in accord with the statement 
that every criminal impulse is evidence of an abnormal condition of 
the mental organism, if we understand by mental organism the gray 
matter of the brain. But if you take the psychological view of it, 
then of course I must dissent. ‘With regard to heredity, we have 
evidence for concluding that, should a child born of criminal parents 
be situated in an environment in conformity to the usual customs, 
the major customs of the community, that child would be what we 
call moral, in the same degree as any other child in the community ; 
but if he is reared in an environment not in accord with the major 
conduct of the community, then on that account, in that kind of 
environment, it will not accord in conduct with the majority of the 
community. Hence I agree with the criticism of Mr. Mangasarian, 
and would not say that one who violates a statute is a criminal, but 
one who knowingly does an intentional injury to another. 

The Secretary. — I would like very much to hear from Dr. Sims 
on this subject. 

Dr. P. D. Sims, of State Board of Health, Chattanooga, Tennessee. 
— I don’t think I can add anything to the suggestions already made. 
In the main, I indorse the spirit of the paper. The answer to the 
question what is crime is not very well defined in my mind. The 
dividing line between the criminal and non-criminal classes is not a 
clean-cut one. It is hard to tell where crime begins and innocence 
ceases. 

As to the philosophy of crime, a number of elements enter into the 
combination that we call a criminal life or character. There is no 
doubt that many of these elements are hereditary. We inherit the 
color of our skin, the color of our hair, the general form of the body. 
Is it more unreasonable to speak of inheriting traits of character? 
But we do not get the whole of our character by heredity, any 
more than we do the whole of our health. A strong, well developed 
child is born into the world, with the promise of long life. Put that 
child into a sanitary environment, let all of his surroundings be con- 


44 PREVENTION AND REPRESSION OF CRIME. 

ducive to health and vigor, and he grows up into a vigorous, 
healthy man. Take that same child and put him into an unhealthy 
environment ; let him live in constant violation of the laws of health ; 
and you destroy him. I imagine that the psychological nature is 
governed by analogous laws. I don’t think you can entirely eradicate 
the traits of character that a boy inherits from his parents and from 
generations back. Some hereditary traits may appear which were 
dormant in his parents but which existed in his fore-parents. 

Now, notwithstanding that we cannot get rid of this hereditary 
depraved element entirely, it is our duty, the duty of society and 
of civilization, to throw around every man (around ourselves, if you 
please) every possible influence calculated to eliminate the bad and 
develop the good. We are, none of us, all bad, and we are none of 
us all good. Many men offend against statutory law, and are, in the 
eye of the law, criminals, liable to be disciplined with a view of correc- 
tion, or excluded from society. But a man may commit an act con- 
trary to statutory law and yet not be in mind and heart a criminal. 
A moral criminal is a man who commits an act which his inherent 
sense of right condemns. If his inherent sense of right condemns 
that act, he is a criminal in his own. eyes, a criminal in the sight of 
moral law. But if it is an act that he regards as not morally wrong, 
and yet which is wrong in the eyes of the law, then he is a criminal 
in the sight of the law. Now, if we can throw around such a man, 
or I should say such a boy, influences which tend to develop his 
ideas of morality, and which assist him to gain control of his will ; if 
we can put into him a will to do what is right and not to do what is 
wrong, then you have started that boy on the road to a pure and 
upright life. 

Mr. D. T. Moore, of Chicago. — A word was said regarding the 
standard of right and wrong. Allow me to say that I have never 
found any standard except that contained in the Word of God. 

One suggestion in connection with the reformation of bad men: 
hide your force behind love if you want to succeed. 

Rev. J. H. Nutting. — With respect to heredity, I think it has 
much to do with the outcome of matters in this world, whether we 
believe in a world to come or not. But no man doubts that the 
heredity of each of us is a mixed heredity. There are antagonistic 
elements in every individual. We must strengthen by education and 
culture that which is good, and repress that which tends to evil; and 
in the end we make a man. Do not say that a man is an automaton 
because of his ancestry. The power to will is in every man. Some- 
times you must wait a good while before you find that strong emo- 
tional quality in a criminal, that moral perception for which you 
seek ; but you will find it. I found it in a case which I would like to 
relate if there w'ere time. The man of whom I speak was the repro- 
bate of the prison. Every guard was on the watch for him, every 
guard feared him, until his throat was cut by a fellow-criminal. Then 
he learned that he would be treated with kindness for the sake of his 


PROCEEDINGS. 


45 


humanity, and the discovery woke him up. He said afterwards that 
he had never supposed there were any good people in the world* 
When he told me his history, I didn’t wonder. If I had started out 
that way I think I would have done about as he did, or worse. Let 
us be careful when we speak of heredity to dismiss from our minds 
the thought that there can come to any one from his parentage an 
unmixed evil nature. It is impossible. 

Mr. H. C. Nutting. — Mr. Reeve, as I understand him, advises us 
to take persons with pronounced tendencies to crime and separate 
them from the rest of mankind, in order that they may not themselves 
commit crimes nor leave a posterity to follow them. But you have 
no right to restrain any man except in the interest of justice. You 
cannot say that because a man has committed a crime, or shows a 
criminal tendency, he shall therefore be permanently restrained* 
Imprisonment can only attach to crime as its just and lawful penalty; 
it must follow the act. To treat a man of sane mind otherwise is to 
overthrow the foundations of society. Therefore I think that his 
theory is simply in the air. We punish a man for what he has done. 
The only way in which we may bring other forces to bear upon him 
is along the line of the probationary scheme mentioned, by which we 
do not at all abrogate the power to punish vested in the state, but we 
do temper justice with mercy, which we have a right to do. 

The Chairman. — The great difficulty with government by law is 
that it can only deal with the outward act, while the laws of nature 
and of God perpetually deal with character and motives. Hence 
the confusion of thought which characterizes so many attempts at 
reasoning on this subject. In dealing with crime by law or by 
organized charity it is not necessary for us to confine our attention 
to either of these two aspects of crime. We must needs frame some- 
thing like a practical compromise between them. It seems to me 
that the essayist presents but one side of the question. We know 
from observation apd from practical experience that not all crime is 
congenital, that not all criminals belong to a type which can be 
discriminated by heredity or constitution as a distinct class from the 
rest of the human race. Take any ordinary man, educated in moral 
principles and with a moral nature as good as that which belongs to 
the average citizen of probity and usefulness; that man may, by 
circumstances, be brought under a temptation so strong that his will 
is powerless to resist it. He violates the law. He is a criminal for > 
the time being. How are you going to distinguish him from the 
man who commits the same act in consequence of an impulse 
born with him, which taints his whole character and renders him 
incapable of reformation ? How are you to distinguish between 
congenital and sporadic crime, crime which is the expression of a 
man’s nature, and crime which is forced upon him by circumstances ? 

Mr. Reeve. — The whole discussion has proceeded on the basis of 
ethics and not of law. The subject under consideration is the pre- 
vention and limitation and punishment of crime. Crime is the viola- 


46 


PREVENTION AND REPRESSION OF CRIME. 


tion of the law. There may be moral offenses, offenses against the 
laws of God and society, against the conscience and the heart ; but 
they are not crimes, so long as they are not forbidden by human 
statutes. Now, what is the philosophy of crime, thus defined ? A 
man who is so villainous that he violates the law knowingly and is a 
danger to the public must be put away. You must put your hand 
on him as you would on a mad dog or a leper or a small-pox 
patient ; put him where he can do no harm. In putting him there, 
exhaust every means of information to learn who he is, where he 
came from, what has been his environment, what is his intelligence, 
his degree of moral perception, his idea of God, of religion, of 
society. Let the record go to the prison with him. There let the 
physician examine him to see if there is any physical defect, and 
repeat the examination from day to day until he finds his physical, 
mental and moral level. Find if there is anything you can build on. 

In a case of physical disease, the physician often finds some constitu- 
tional peculiarity or acquired habit that he cannot reach with any 
remedy at his command. So it is with this abnormal criminal char- 
acter. A character is abnormal which is not balanced. If the pris- 
oner’s moral, physical and intellectual forces, his perceptions and 
conceptions were balanced, he would have the capacity and find the 
way to adapt himself to his environment. And what is his environ- 
ment? It begins at the hearthstone and follows him through life. 

Who made it ? He didn’t make it. It was made for him, just as his 
brain and nervous structure were made for him. Impressions are 
made upon that organism by those who have charge of him from 
the time of his birth until he reaches maturity. They develop his 
character, his impulses are in accord with his character, and his acts I 
follow his impulses. It is not a question of ethics. | 

Take a child when it is first born and separate it from humanity ^ 
and it will know nothing about ethics. What is education but the 
acquisition of knowledge? How can you get any benefit from it? ^ 

By making practical use of it. What is practical use ? Its applica- t 

tion to the surroundings in which you may be placed ; a practical * 
man takes advantage of his opportunities. You must make such use 
of your education as will benefit society, because what is best for 
society is best for you. 

Where is my friend. Judge Follett of Ohio? I have a little shot 
for him on the matter of a permanent standard of right and wrong. 

It is but a few years since the greater the truth the greater the libel. 

I might libel anybody, and the more truth I told about him the 
greater my punishment, and if indicted, I was not permitted to prove 
the truth of my statements in self-justification. How is it to-day? It 
is the reverse. What was the standard of right and wrong then ? 

The greater the truth, the greater the wrong done. Now you are 
justified in the publication, if it is true. It is no wrong at all. You 
may say anything you have a mind to about a man, if you can 
prove it to be true. That is the new standard in the criminal code. 


J 


PROCEEDINGS. 


47 


But the civil code sets up still another standard. If you plead justi- 
fication, you can’t go into court under the rules of the civil law and 
prove your case by preponderance of testimony. You must prove 
it beyond a reasonable doubt. That standard will also be changed 
in a few years. When I say there is no fixed standard of right and 
wrong, I mean that the changing standards upon the statute books 
reflect the changing opinions and impulses of humanity. 

A man with a criminal diathesis cannot be prevented by ethical 
considerations from committing crime. He has no perception of 
right and wrong. When you find out what he is and who he is, put 
him in prison, make him as comfortable as you can, and try to find 
his moral level. If you can educate him up to a conception of his 
responsibility to society, do it. If you can’t, keep him under restraint, 
as you would a small-pox patient, a leper, or a mad dog, until he 
ceases to be dangerous, whether cured or otherwise. That is all 
there is in the philosophy of dealing with crime, and the failure to 
distinguish between an ethical wrong and a conviction for crime 
under the statute has led to this whole discussion. 

The section adjourned. 


THIRD SECTION MEETING. 

Wednesday, June 14, 1893, 2.30 p. m. 

The Chairman. — Our first paper this afternoon will be by Baron 
Garofalo, a member of the Italian Congress and an author of some 
note. His paper will be read by Mr. Round. 

Mr. W. M. F. Round. — Baron Garofalo, I remember, took a 
prominent part in the Prison Congress at Rome and has been con- 
nected with the administration of justice. He is himself a magistrate, 
a member of the Legislature of Italy, and he has written one or two 
extremely suggestive works on this topic. 


NEW THEORIES OF CRIMINOLOGY. 

BARON GAROFALO. 

During the last ten years many writers have applied themselves 
to questions of criminality. Such studies have excited universal 
interest, because everywhere in civilized countries, or even in half- 
civilized countries, the organization of crime makes progress and 
threatens the peaceful activities of life. Swindling, theft, and even 
assassination, have become real professions, favored as they are by 
the aggregation of population in great towns, by the wonderful 
rapidity of communication, and by new scientific inventions, and 
facilitated by the weakness, the disconnected efforts, and the indif- 
ference of governments and popular sentiment in the treatment of 
criminality. 

As I have said elsewhere, neither laws nor governments care 
enough for such questions, nor employ adequate means to counteract 
the new strength of criminal associations ; nor do they protect with 
sufficient vigor injured citizens against unrighteous neighbors. 

In all civilized nations, killing, except in self-defense, should be 
unknown save in memory of old and savage times. The more 
manners are softened and life is eased, the more hideous and dismal 
becomes the sight of murder, fire and plunder. Those who have 
not examined the statistics of crime commonly believe that such 
crimes are rare and do not demand vigorous effort to suppress 
them, but a study of statistics lessens the sense of public security. 


GAROFALO. 


49 


It is shocking to learn that even in the most civilized countries of 
Europe there are yearly some thousands of murders, that from i88i 
to 1887 the average number of murders for each year was, in Austria 
689, Hungary 1231, Spain 1584, Italy 3606, Germany 577, France 
847, Belgium 132, Holland 35, England 31 1, Scotland 60, Ireland 
129; total, 9208. Statistics are not at hand for other countries; it 
is said that in Greece the annual murders are supposed to reach 
1000, and a newspaper in the United States estimates the number 
there at 3000. These last two figures are but approximate, of 
course, but they are probably within the truth. 

In the matter of crimes against property, I can only give for a few 
nations the number of those accused of thefts and robberies, namely, 
Belgium 11,000, France 46,000, Germany 146,000, England 50,000 
and Italy 125,000. It is certainly no exaggeration to say that every 
year millions of dollars are stolen from honest people, and that 
robbery is often more lucrative than honest labor. Let us illustrate 
this by some known figures. In Italy alone, in 1889, there were 
1372 convictions of theft or embezzlement of sums amounting to 
2,458,578 francs. Assuming that the number of the guilty was 
greater by one-third than of the crimes, the proceeds must have been 
shared by 1829 persons, and the average share of each was 1343 
francs. But it is known that not more than a third of those guilty 
of theft are detected and arrested, and a third of those prosecuted 
are acquitted for want of sufficient proof. It is fair to infer, therefore, 
that the average profits of each thief are at least 4000 francs. When 
we remember that the average workman hardly ever possesses at 
one time much more than his weekly wages, we are forced to the 
painful conclusion that the gains of the thief are commonly greater 
than those of the honest laborer. But this estimate takes no account 
of the vast sums acquired by swindling, embezzlement, fraudulent 
bankruptcy and breaches of faith, amounting every year to untold 
millions of francs, which represent profit and luxury to the criminal, 
privation and want to the honest victim. 

But all this mass of wrong, suffered by the best part of the popula- 
tion, for the gain and enjoyment of the worst, are not enough to 
awaken the community to the shameful infirmity of our civilization, 
and to the necessity of devising remedies. Parliamentary debates 
are full of political trifles, but are commonly silent on this great 
demand for statesmanship. Lawmakers and rulers think that they 
have no more to do in suppressing crime, when once a police force 


i 

50 PREVENTION AND REPRESSION OF CRIME. 

has been charged with its detection, and statutes passed for its pun- 
ishment. Very few citizens indeed give careful thought to the 
question how far these agencies are efficient in preventing and 
suppressing crime. 

A principal cause of the weakness of the state in its dealings with 
criminals is to be found in the false view commonly entertained of 
the real problem to be solved. Until of late, the science of the 
subject was regarded as the exclusive province of the legal profes- 
sion, to whom civilized governments have generally assigned the 
whole duty of framing penal laws and of administering them. 
Certain propositions were assumed as indisputable, and practical 
inferences were drawn from them, and enforced, without previous 
experimental study. The laws were founded on the classification, 
not of criminals, but of crimes ; not of offenders, but of individual 
acts, according to the supposed extent of the injury they inflict. 
The inductive or experimental method, by which all other sciences 
have attained their progress, was left untried by the authors of these 
codes. The necessary result has been that their theories, however 
logical and consistent they may appear, have no practical value, and 
utterly fail to meet the needs of society. 

It would seem that the first step in such studies should be 
an investigation of the most suitable measures for the daily struggle 
in which every nation finds itself against its internal enemies ; but 
we cannot know the fitness of measures any more than that of 
weapons until they have been tested. Knowledge of the criminal, 
who is the enemy, should evidently precede any theory in the 
matter ; and this, in the preparation of penal codes, seems to have 
been quite forgotten. The criminals themselves seem to have been 
the last thing studied by the authors of penal laws. No wonder then 
that the latter missed their aim, and are now obliged to witness the 
undisturbed growth of criminality. 

The new theory to which I have given the name of Criminology 
(Mr. Ferri calls it Criminal Sociology) is confined to those infrac- 
tions of right only which are everywhere in civilized nations consid- 
ered crimes, that is to say, those acts which hurt the deepest feelings 
of man, especially his feelings of benevolence and equity. I have 
put aside those injuries which proceed from bad education or rough- 
ness rather than from wickedness. Having so chosen the natural 
crimes y as I call them, I have tried to study those persons who alone 
are likely to commit them, and to ascertain if possible the cause of 


GAROFALO. 


51 


each crime; whether it be a degenerate feeling, to be imputed to 
psychical heredity, or a bad education; or alcoholism, or moral 
insanity, or moral paralysis; a passion or epilepsy; ignorance or 
superstition. 

Thus I have tried to divide criminals into classes, discriminating 
them by typical characteristics, especially those indicating a peculiar 
moral anomaly. Lombroso applied himself to discovering physical 
and pathological anomalies. Many of these are still doubtful, and I 
am obliged in studying Lombroso to question the exactness of 
his observations concerning the physiognomies of murderers and 
thieves. Certainly no one would think that these characteristics, 
other things being equal, would suffice to distinguish criminals from 
other people, though they undoubtedly reveal a peculiar organiza- 
tion of mind and feelings which is likely to produce a criminal 
character. It is indisputable that these two classes of criminals are 
easily distinguished by their countenances. 

But the most important part of our research is the study of criminal 
psychology, which has convinced us that a great proportion of crim- 
inals are incapable of reformation. Thus a rude blow has been given 
to the theory of correction founded upon the possibility of improving 
criminals, and mitigating punishment in the hope of reformation. 
There are certainly several classes of criminals, especially the very 
young, for whom moral improvement may be hoped. In these 
cases, however, it is not by imprisonment or penal servitude that 
any success can be gained. 

Whenever criminals are clearly shown to be anomalous and unre- 
formable, it is the duty of society to eliminate them by the death 
penalty, unless they be proved insane, and then to imprison them 
for life. So long as there exists such a monstrous thing as murder, 
the death penalty cannot be put wholly aside, and the nations 
which have abolished it have made a lamentable mistake. 

As concerns the other and less dangerous classes, punishment 
must be shaped in a manner wholly different from our present systems 
of penalties. Temporary imprisonment is of no avail for alcoholism, 
bad education or general moral neurastheny, the origin of mis- 
chievous tendencies. They will return as soon as the penal servitude 
is ended and the prisoner finds himself free again under the same 
environment as before the trial. As nothing is altered about him, 
and his old friends and companions are still the same, he will soon 
forget his punishment and renew his old life. So it happens that 


52 


PREVENTION AND REPRESSION OF CRIME. 


thousands of thieves, swindlers and counterfeiters dwell in every 
large town. They assemble fearlessly in public houses which are 
well known to the police. They have no means of support but 
crime, and every one knows that they cannot be arrested and so 
rendered harmless, because they are not detected in the actual 
commission of crime. 

A good service would be rendered to society could a means be 
found to prevent a fortuitous delinquent from becoming an habitual 
one. Instead of imprisoning him for a time, if he be not of a 
dangerous type, it would be of far more avail to convince him, 
by his own experience, that a mischievous activity is less profitable 
for him than an honest one. Therefore the delinquent should be 
obliged to make restitution of all that he has stolen and amends 
for the harm he has done. He should, moreover, be obliged to 
pay something for the trouble he has given to the injured and to 
society. If he has no money he should be made to work, for the 
benefit of the wronged party. No rest should be granted to him 
until his victim be indemnified. He might be obliged to work his 
life long, but if he shows a willingness to pay his debt he may enjoy 
freedom. Otherwise he ought to be confined, not in prison, but in a 
public workhouse, and his confinement should only end when he has 
accomplished his duty. The duration of his punishment would thus 
depend upon his activity and assiduity in work. No guilty man 
could then hope to enjoy the fruit of his crime, as he might quietly 
do under our present laws, which grant him freedom as soon as his 
term of punishment is over. Herbert Spencer, explaining his general 
views of penal law, proposed that imprisonment should cease as soon 
as full reparation is made ; but this proposition must be confined to 
cases in which the delinquent does not belong to the dangerous class. 

Psychological observations give us the means of discerning 
between such criminals as are thoroughly incapable of life in society, 
and those who may become fitted for it. In the last case, imprison- 
ment could be remitted when the wronged party is fully indemnified, 
or when the delinquent exhibits his ability and purpose to make such 
indemnification. 

Habitual offenders, when very young, should be confined in 
colonies or workhouses. Not^ however, for any fixed time, but 
until their moral reformation is ascertained. As for those who are 
no longer in their youth, there is nothing to be hoped from them, 
and the only remedy is to convey them to remote and savage coun- 


GAROFALO. 


53 


tries where they should be abandoned forever. In all cases confine- 
ment in prisons for a previously fixed time can have no other effect 
than to allow the rascals to live at the charge of the state. 

It is impossible to give in a short article the detailed scheme of 
the penal system which a scientific criminology would propose. 
Its general principles may, however, be understood by the following 
brief explanation : Rather than consider in itself the single act of 
crime, the new criminology would value it as the expression of a 
criminal character; and rather than give every crime a fixed penalty, 
it would try to render the delinquent harmless by influences adapted 
to his nature. As the criminal would be described as an anomalous 
being whose actions might be foreseen, the new criminology may be 
reproached with denying the free will of man and overthrowing the 
idea of moral responsibility, which, as they say, justifies penalty. 
Let me remark, on the contrary, that penalty cannot be founded 
upon moral responsibility. Indeed, the consciousness of our free 
will does not go so far as to permit us to think that we have 
the power of feeling at a given moment differently from what we 
really feel. Our character is shaped, indeed, by a series of prece- 
dent facts, the most of which are unknown or forgotten by us 
at the moment when the determination to act takes place. We 
choose then to do what we think most suitable, but our choice is 
determined by our own kind of thinking and feeling. Add to this 
our bodily constitution and the influence of exterior circumstances 
on our peculiar temperament. This must be acknowledged by any 
one whether he be a believer in free will or not. Therefore, to 
found responsibility upon free will leads logically to the consequence 
that no one is thoroughly responsible for his own actions. How 
would it be possible, indeed, to appreciate the numberless circum- 
stances which may influence our will ? 

To consider penal responsibility as an effect of free will, and to 
proportion punishment to moral responsibility, is indeed a very 
dangerous theory. Society ought to be grateful to the criminolo- 
gists for having put aside the theories of penal philosophy which 
the jurists have taught until now, and upon which our penal laws 
are based. Uninitiated people could not understand the absurdity 
of conclusions to which the jurists have come, in presuming to 
classify the circumstances avoiding or lessening responsibility. On 
the ground of extenuating circumstances, advocates have excused the 
most atrocious crimes. Drunkenness, alcoholism, epilepsy, hysterics. 


54 


PREVENTION AND REPRESSION OF CRIME. 


and all kinds of passion, ignorance, poverty, moral insanity (which is 
nothing else but absence of moral sense), everything has seemed a 
good excuse, especially in France and Italy, where the penal laws 
agree more than in England with the ideas of the theoretical jurists. 
They have gone so far in Italy as to defend habitual crime, because 
it is said that the guilty man, having been demoralized by the shame 
of prison and the bad example of his fellow-prisoners, has less moral 
force to resist temptation, and his will is therefore not free to avoid 
new crime. 

From their point of view the jurists are perfectly right, since 
such circumstances lessen the moral responsibility ; but they are 
quite wrong when they forget the social side of the question, that 
is to say, the necessity for a civilized nation to fight criminality what- 
soever may be its causes or its excuses. Therefore, responsibility 
must not be considered as proceeding from free will. The author of 
a crime must always be held responsible for it whenever it results 
from his own character, whether due to heredity and education or to 
environment. What we need to know in order to hold the culprit 
responsible is only that his nature is prone to criminal actions. 

The idea that punishment should be in proportion to the gravity 
of the crime is another dogma of the jurists’ theory which on experi- 
mental ground proves inadequate. There is no sure criterion for 
the relative gravity of crimes, and if there were, it would have no 
practical importance. It is almost useless to graduate criminal acts 
according to their presumed gravity, and it is impossible to graduate 
the penalties correspondingly. What is required is to compare the 
perversity of the different criminals. To appreciate this, the acts 
must certainly be inquired into ; but their gravity represents only 
one element in the diagnosis. Instead of this criterion the new 
criminology puts forward another, namely, that of the possibility 
of adapting the guilty to social life. In every case of crime there 
should be sought the solution of the following problems: What 
is the degree of perversity of the guilty? What is the degree of 
adaptability to social life which he may still be presumed to possess ? 
Thus only would penal science be useful to society, because when 
we foresee what we have to expect from the criminal it will be easier 
to find the means of restraining him. Such a criterion leads to 
consequences very different from the current penal theories of jurists. 
We condemn the subtle distinctions which many jurists have made 
between the accomplished and the attempted crime, when the latter 
is equally malicious and dangerous. 


GAROFALO. 


55 


Several things that are reckoned as extenuating circumstances are 
for us, on the contrary, a reason for making the penalty more severe, 
such as, for instance, drunkenness; and on this subject we plainly 
agree with the English law. Besides, the absence of premeditation 
is not a reason for mitigating the penalty for murder. The worst 
criminals may commit a murder without premeditation, and the 
contrary too may sometimes happen. 

It is of no less importance to consider how false are the ideas of 
the jurists about trial. If what I have already said applies more 
especially to the penal theories predominating in France, Italy and 
Germany, many of the laws of procedure are derived from England, 
and we must admit it is not the best gift that this great nation has 
made to the world. It seems to me that the system of public accusa- 
tion and the institution of juries are survivals of a past age. 

The judicial contest between a prosecutor and an advocate is 
something like the Middle Age “judgments of God,” in which 
weapons were substituted for rhetorical insinuations and cavilling. 
Only a patient, undisturbed inquiry by a justice who will impartially 
examine the accused, the party wronged and the witnesses, can give 
certainty . in the discovery of the truth. 

So far as the discovery of the truth is concerned, judicial debate 
generally proves prejudicial, because a momentary impression pre- 
vails over common reason. 

The publicity of such debates operates besides in a very unhappy 
way on popular morality, as it may initiate simple and inexperienced 
souls in all kinds of evil and monstrous deeds. The newspapers 
co-operate unhappily in this lamentable work. According to my 
views, for every offender there should be an inquiry made by public 
officers. This inquiry should be ex officio controlled by a justice, 
and renewed as long as there is doubt, or the accused pleads his 
innocence. When by all due means the fact is undoubtedly ascer- 
tained, there is no impropriety in suppressing the debate between 
the parties. 

What remains to be done is to make a diagnosis almost as for a 
disease. It is necessary to examine whence the culprit’s peculiar 
kind of criminality proceeds, what its symptoms are, and what may 
be foreseen in regard to its further development. Lawyers have 
nothing to do here. There is no occasion for accusation or defense, 
nor for talk either of severity or of mercy. 


S6 


PREVENTION AND REPRESSION OF CRIME. 


There is but one thing to be sought, a suitable means of repres- 
sion, that is to say, means to render the criminal harmless if he be 
dangerous, and to force him to indemnify the wronged party if his 
crime is one against property. This should be the business of mag- 
istrates chosen from competent students of anthropology, psychol- 
ogy, statistics, penology and criminology. 

Juries are quite inconsistent with an improved system. The jury 
is an old institution which may formerly have been useful for political 
reasons, but at present it is inconsistent with the prevailing idea 
of our time, the necessity that every kind of work be done by those 
who have special fitness for it. Public officers no less than private 
workmen need special training and special studies. 

Why should an exception be made of juries ? How can a body 
of untrained laymen be supposed best able to decide upon the 
cause of death, when murder is suspected, or whether an accused 
person is insane or incapable of reform, or how he should be treated 
to secure his reformation? Why not entrust such inquiries to 
persons who have special knowledge and training? Juries are gen- 
erally ignorant and impressionable. They have given almost every- 
where the most lamentable results. Besides, they are often cowardly 
and weak. In some of the provinces of Italy, for instance, it is very 
difficult to get brigands condemned by them. In some others they 
owe allegiance to and obey the mandates of political schools. In 
France, as M. Tarde says, they let themselves be influenced by a 
spirit of contradiction, by party feeling, by the press, or by the 
audience. According to the statement of M. Silvelo, the acquittal 
of wealthy culprits is almost sure. It seems that in Russia when a 
jury is composed of countrymen, anybody accused of stealing horses 
may be sure of being condemned. On the contrary, he who is 
accused of perjury has a great probability of acquittal. It has been 
remarked besides that in all countries juries are particularly merciful 
towards the kind of crimes that happen the most often and which 
therefore require energetic repression. In America those summary 
executions called lynchings are the best demonstration of the insuf- 
ficiency of legal proceedings. Often in England much fault has 
been found with juries, and threats have often been supposed to 
influence them. M. Tarde remarks that when a government wishes 
to secure the execution of laws it is necessary to put juries aside. 

Permit me, in conclusion, to say that the time has come, I believe, 
to transform, in all its parts, judicial procedure, in order that trials 


WINES. 


57 


may cease to be theatrical plays, and become quiet investigations of 
the criminal’s temperament, mental, moral and physical, and an 
application of the remedies suggested by the new experimental 
science of Criminology . 

The Chairman. — Remarks upon this paper are now in order. 
There being none, the section will be addressed by Dr. Wines. 

THE PAROLE SYSTEM. 

FREDERICK H. WINES, LL. D. 

I have been asked to say a few words with regard to the parole 
system. 

The parole, sometimes called ticket-of-leave, is the conditional 
liberation of a prisoner, prior to the expiration of the sentence pro- 
nounced upon him by the court. It differs from a pardon, inasmuch 
as a pardon is an absolute release. It differs from the shortening of 
sentence under the operation of what are called “ good time ” laws, 
because, after a prisoner has earned the commutation of his sentence 
by good conduct while in prison, he is then absolutely released. But 
under the parole system he is placed out in the world merely to be 
tested. The state reserves to itself the right to rearrest him, reincar- 
cerate him, and compel him to serve out the unexpired term of his 
sentence, in case he violates the conditions of his parole. 

Now, this form of release is essentially a modification of the sen- 
tence originally pronounced. It is, therefore, like all other forms of 
change of sentence, antagonistic to the public impression that the 
penalty of crime is and must be a fixed quantity. If it were possible 
for us to measure crime on the one hand and punishment on the 
other, and so to adjust punishment to actual guilt that the operation 
of the criminal law should be absolutely equitable, there would be 
no room for pardon, which is the remission of penalty, or for the 
abridgment of sentences as a reward for good conduct in prison, or 
for the parole system. If the sole basis of the criminal law is retri- 
bution, both human and divine justice require that the penalty of 
violated law should be exacted from the offender, and no sentence 
once pronounced should be subject to modification by the act of any 
branch of the government, legislative, judicial or executive. 

Accordingly we find that the parole system has made its way with 
the greatest rapidity and confidence in countries where the idea that 


58 


PREVENTION AND REPRESSION OF CRIME. 


retribution is the sole purpose of the criminal law has been most 
thoroughly exploded. Where the retributory character of the penal 
code is most insisted upon, there the people, the courts, and the doctors 
of law in universities are reluctant to accept the parole in theory. 
Even where it has been put in practice, in a number of European 
countries, where advanced ideas of penology are not yet accepted, 
the parole is in practice a very perfunctory affair. It is granted to a 
very few prisoners, under many restrictions and with great difficulty, 
more as a matter of favor than as a matter of right, and it bears no 
fixed, invariable relation to the good conduct of the prisoner or to his 
reformation — his surrender to the ameliorating influences brought to 
bear upon him in the hope of qualifying him for rehabilitation as a 
citizen. 

In this country the parole system has been attacked by. the 
supreme court of the state of Michigan as contrary to the constitu- 
tion, on the ground that it is an interference with the exclusive juris- 
diction of the courts, which alone have the right to determine the 
degree of guilt and fix the penalty, in amount as well as in kind. The 
sentence pronounced by the court cannot be diminished or set aside, 
except by the executive, in the form of a pardon. The conditional 
liberation is either a pardon or not a pardon. If it is a pardon, then 
the Governor alone has constitutional power to issue a ticket-of-leave. 
But if it is not a pardon, such issue is neither in his power nor in the 
power of any one else. That is a possible legal view of the question, 
but it appears to me narrow and inadequate. It is certainly technical. 
The courts, in the majority of the states, do not hold it. 

The ticket-of-leave is not a pardon. It has none of the elements 
of a pardon, except the shortening of the term of incarceration. But 
a pardon is an absolute release, which conditional liberation is not. 
In fact, under proper criminal legislation, every sentence for crime 
includes in itself the possibility of its being shortened. In nearly 
every state in the American Union, sentences are imposed subject 
to the operation of a statute of commutation, which provides that the 
convict may abbreviate the duration of his term of imprisonment by 
submitting to the rules of discipline established for his government 
while in prison. This is an acknowledgment of the principle that a 
court may pronounce a sentence which is flexible and adjustable. 
Our so-called “ good time ” laws declare that the prisoner’s term shall 
be arbitrarily shortened b}'^ from one to ten days in a month, or by a 
month in a year, or by one-half of the time after the expiration of a 


WINES. 


59 


given number of years. The parole law declares that the prisoner’s 
sentence can be shortened, at the discretion of the prison authorities, 
within certain limits, when they are satisfied that discipline has per- 
formed its work and that it is safe to discharge him. In the one case, 
the privilege of commutation is part of the sentence ; in the other, the 
privilege of parole is part of the sentence. The sentence is not set aside 
in either case. If the statute of parole is an invasion of the jurisdiction 
of the court, so is the commutation law. Both are founded upon the 
expression of the popular will by an authority higher than the courts, 
namely, the legislature ; and if one is unconstitutional, it is difficult 
to see why the other is not equally a violation of the constitution. I 
believe that the parole system is neither an infringement upon the 
prerogative of the executive — the prescriptive right of pardon, nor an 
interference with the judiciary by abrogating a sentence pronounced 
by the courts. The courts in pronouncing sentence under that law 
pronounce a sentence which contains in itself a certain reservation ; 
and that reservation being the same for all prisoners without dis- 
tinction, there is no inequality in the actual sentences. 

Now then, with regard to the connection between the parole and the 
indeterminate sentence. This connection seems to me to be vital. 
Under any system of definite time sentences the parole is an anomaly. 
It is hard for me to reconcile it to my inner consciousness of the 
harmony and fitness of things. But if the indeterminate sentence is 
substituted by law for the time sentence, then the parole becomes at 
once an essential element or feature of the new system, because the 
indeterminate sentence presupposes that a percentage at least of con- 
victed criminals is corrigible. It presupposes that the discipline of the 
prison will be organized and carried on with reference to their refor- 
mation, and that it will be adapted to secure their reformation. It 
proceeds upon the assumption that this reformation will, at some time 
or other prior to the expiration of the term of incarceration, take 
effect, and that the fact that it has taken effect will be apparent to 
experts — either to the prison officers themselves (if the power of 
parole is lodged in them), or to some judicial tribunal (if the power 
is lodged in a court which acts upon the evidence submitted to it by 
the prison officials). The test of reformation can only be the con- 
duct of the prisoner. Any number of tests may be applied to him 
while he is still in prison, but the supreme test is after he has left the 
prison and has resumed his place among other men, where he 
is exposed, as the rest of us are, to the temptations of ordinary 


6o 


PREVENTION AND REPRESSION OF CRIME. 


life. Until the exhaustion of all the tests prescribed by law in or out 
of prison, the convict is still in the constructive custody of the gov- 
ernment, even though temporarily at large. 

The parole system therefore means that the prisoner, after having 
been tested as thoroughly as he can be tested in a state of incarcer- 
ation, shall be tested in a state of partial liberty ; and, if he endures 
that test, he shall then be granted his absolute libertj^, to continue 
his part in the work and struggle of life, just as he would have done 
if he had never been incarcerated. His citizenship is completely 
restored. 

In this system the indeterminate sentence is the first element, 
reformatory discipline the second, and conditional liberation the 
third. The three are logically and inseparably connected. While I 
accept it as heartily and advocate it as earnestly as any man can, in 
the sense of an ideal to be striven after, I have at times, and can not 
refrain from expressing, grave fears as to its practical operation^ 
arising not from anything in the system itself, but from my appre- 
hension that in practice it may not be carried out in its true spirit, 
purport and intent. 

In the first place, wherever the power to remit penalty is lodged, 
there is something valuable which can be given away on the one 
hand or which may be sold on the other. Not even the Governor 
of a state is always free from the imputation of having granted 
pardons to convicts from improper motives, for a consideration — not 
necessarily for a pecuniary consideration, it may be for a political 
consideration. It is doubtful whether any governor who is a thor- 
ough-going, thorough-paced politician does not sometimes recognize 
the expediency, from his point of view, of pardoning the friend of 
some influential politician, who is a central factor in some combina- 
tion, either legislative or political, the success of which the governor 
desires. Where the governor himself is absolutely free from the 
imputation of having made an improper use of the pardoning power, 
it is certain that convicts often pay money to other parties for the 
purpose of securing their influence with the governor, and such 
influence is sometimes brought to bear upon his mind without his 
knowledge, so that the ends of justice are frustrated through pecu- 
niary corruption. But governors stand very high in the public con- 
fidence, much higher than an average member of the legislature ; as 
high, or nearly as high, as many judges. They are supposed to 
occupy a position so far above the ordinary temptations which beset 


WINES. 


6i 


other men that they are practically incorruptible, and we do not 
^suspect that pardons are freely bought and sold in the market. It 
would, however, be very much more easy to be corrupt in the matter 
of commutations of sentence than of pardons, because commutations 
of sentence do not attract the public attention which pardons do. 
There is never the outcry against them that there is against pardons. 

Now, the prison officer, if the power of virtual remission of sentence 
is confided to him under the parole system, (the sentence of the 
prisoner being indeterminate), is in a position where, if he is a cor- 
rupt man, he can very easily enrich himself. The danger therefore 
is that the political warden of a political prison, destitute of previous 
experience, with no special fitness for the position, but receiving it as 
a reward for political services, may chance to be a man who would 
think it right and proper to take bribes, in some form or other, for 
granting the certificates of character upon which paroles are based. 

I feel, as my father felt, and as he often expressed himself, that the 
indeterminate sentence and the parole system imply the complete 
surrender, abandonment and overthrow of the entire system of 
political appointments in the government of prisons, and I am fearful 
that, if the new system were introduced in a state where political cor- 
ruption is rife, where the penitentiary is under the control of politi- 
cians, and the public acquiesce in such control, the introduction of 
this system would lay the foundation for a form of corruption of 
which we have heard little or nothing heretofore, and which would 
not be possible under the definite sentence. 

But that constitutes a very small part of the ground of my appre- 
hension with regard to its general and premature adoption. There 
is the further danger that ignorant legislators, when requested 
and urged to adopt it, will so tinker with the bill introduced by some 
man who really understands the question, as to destroy the system 
itself in the very law which creates it. Take, for instance, the Ohio 
law. It is defective, in that it allows the friends of prisoners to make 
application to the prison authorities for the parole of prisoners. 
There is reason to believe that, in its practical administration, paroles 
are largely granted as the result of outside influence, in response to 
political pressure, with very slight regard to the record of the prisoner 
in the penitentiary. If so, this defect in the law is fatal. The whole 
system is so complicated, the parts of it are so interwoven with each 
other, and the action of this part so depends on the action of that, 
that it can be compared only to a powerful and ingenious piece of 


62 


PREVENTION AND REPRESSION OF CRIME. 


mechanism which can be successfully operated by the engineer, but 
not by an ignoramus or one not an expert. No ! our legislatures* 
•are, in the first instance, liable to destroy the system by their failure 
to plan it properly, so that all its parts are well balanced, inter- 
dependent, related to each other; and then, supposing the law to 
have been wisely and well framed, there is the further danger that 
the men appointed to administer it will not comprehend it, and will 
not administer it in its true spirit and intent. 

The state of Illinois has passed a law creating an adult reforma- 
tory in connection with the reform school for boys at Pontiac. I am 
a little afraid to sa}^ — I don’t quite dare to speak out and say all that 
I think with regard to that law and with regard to its administration, 
for fear that I might speak unguardedly and do some one an injus- 
tice. But the law and the operation of the law are, to my mind, very 
unsatisfactory. 

If you have a man at the head of your prison who is not a discip- 
linarian, who is not an educator, whose moral character is not all it 
should be, whose life is not an inspiration, and whose example is not 
wdse and salutary, how can you successfully administer any reform- 
atory system ? The difficulties in the way of the administration of 
the parole system, under the indeterminate sentence, are so great 
that, if a wise and experienced man were to go even to that model 
institution — for we regard it as a model, and claim that it is a model 
institution — the reformatory at Elmira, and explore undercurrents 
not open to public view, but which exist; if he could fully realize 
the embarrassments with which Mr. Brockway has to contend, and 
know all the expedients and devices by which he overcomes those 
difficulties, encourages himself when he feels like giving up in despair, 
and encourages his prisoners when they are ready to give up, he 
would discover that, even for a man with a touch of genius like him, 
so devoted, so brilliant, so earnest, the administration of that system 
is a fearful tax. Multiply Elmira, take it as a model, imitate it, and 
then put in charge of them fifty or one hundred men in charge of 
similar institutions, picked up from ordinary life without training, 
without experience, and given their positions as a reward for political 
services by politicians who have political ambitions which they hope 
to gratify by these appointments. How is the system to be well 
administered under such conditions? 

And yet as a theory, as an ideal, every principle upon which it 
rests is a sound principle, and the combination of them is as perfect 


WINES. 


63 


as anything human can be. The principle that the prisoner is to be 
treated according to his individuality is sound. The principle that 
the treatment to be accorded him is to be directed to his weak points 
is also sound. If his body is his weak point, deal with him physically. 
If his mind is his w'eak point, deal with him mentally. If it is his 
heart (and generally that is the weak spot), deal with him morally. 
Deal with him as an individual, a man, a whole man, and never forget 
that any man may be uplifted, even the most hopeless. The whole 
process of reformation is one of education, of development, of com- 
plete development, of symmetrical development, especially of develop- 
ment of the power of self-direction and self-control. You must test 
the development of character in these persons. You can test it in 
the ways in which Mr. Brockw^ay says it can be tested. You can 
test it by mental progress in education, by physical growth in size 
and power, by the increased earnestness with which the prisoner 
does his work. These are sound tests ; and when the reformed man 
is fit to go out, no longer a menace to society and there is hope 
that he will earn an honest living and take his part in the work of the 
world, he ought to be released. But there ought to still be a hand, 
a strong hand, upon him, so that you can grasp him and bring 
him back. These, in a word, are the Elmira principles. No fault 
can be found with them. But only a wise man can apply them effec- 
tively in dealing with convicts. The work is one of great difficulty : 
and the longer I think about it, the more deeply I ponder it, the 
more deeply I appreciate it. 

It was my pleasure to lecture to the students of the University of 
Madison, Wisconsin, last winter, on crime and criminals. I did not 
fully express the thought in my mind. I showed them that human 
retribution is a failure, as the whole history of the world proves ; that 
punishment does not always punish. I might have added that refor- 
mation does not always reform, and that prevention does not always 
prevent. The struggle in which we are engaged is gigantic, her- 
culean. We are endeavoring to roll up the stone of Sisyphus, and it 
is forever rolling back upon us. It is like the struggle of the medical 
profession with disease and death. I look at the physician with 
admiration. Here is a man who is fighting a lost battle. He knows 
that it is a lost battle. There is not a patient on his entire list who 
will not die, in spite of all his wisdom, his skill, his energy; and yet 
he fights on, because he knows that even though he cannot put an 

end to death, he can at least alleviate the pain of life ; he can pro- 

• 4 


64 


PREVENTION AND REPRESSION OF CRIME. 


long life a very little ; and the small success that comes to him is his 
compensation for the struggle, sacrifice and endurance which char- 
acterize the noble men in one of the noblest of all professions. 

It is so with regard to all social evils. I think it is so with regard 
to all moral delinquencies. We fight a battle in which the victories 
are not so marked nor so numerous as the failures. Nevertheless, 
we have much to inspire us, to encourage us and keep us from faint- 
ing by the way; and we must cultivate hope, we must do the best 
we can. We do not expect any social evil to be eradicated by any 
radical or mechanical process. The tares will grow with the wheat ; 
if we undertake to root up the tares suddenly, we are apt to root up 
the wheat with it. We must therefore exercise a wise patience, and 
trust largely to the ameliorations which come only with time and the 
gradual uplifting of humanity. The slow reformation of society will 
come by the processes of nature and the will of Almighty God, 
rather than by any effort which we have the strength to put forth. 
Still we must continue to put forth that effort. The parole system 
is the ideal system, and the promise of the future, in the advance- 
ment of prison discipline, lies wholly along its lines. 

Mr. Round. — The scheme of the Elmira Reformatory originated 
with the Prison Association of New York, as you very well know. 
The charter, which has never been changed, was written by the presi- 
dent of the Prison Association, the late Dr. Dwight. I know of no 
man who has watched and studied more carefully the practical 
development of this scheme than the chairman of the executive 
committee of the Prison Association of New York, who is here 
to-day, and is now also the president of the Prison Association of 
New York. I should be very sorry if we, for the sake of keeping 
our chairman in the chair, should lose the present opportunity of 
hearing from the president of the Prison Association. 

The Chairman. — Mr. Wines’ remarks suggest a wide range of 
discussion, on which very much might be said that would be of value, 
if we had time to go into it. They lead directly up to a question of 
vast importance, which is beginning to occupy the minds of all those 
who are concerned with the subject of penal law, and which is des- 
tined to be the center of earnest controversy for years to come, with 
a view to the entire reconstruction of the principles and processes 
by which society deals with criminals. We have not done with 
Mr. Wines. I want to draw out his views upon that question. 

But, before doing that, I want to say one word about the diffi- 
culty which he has pointed out in the administration of the parole 
system. I cannot but regard the indeterminate sentence as the 
greatest reform which has ever been wrought in the administration 


PROCEEDINGS. 


65 


•of penal law ; and he agrees with me, inasmuch as he gives it his 
complete concurrence and sympathy, so far as the principle and 
theory of it are concerned. He has unquestionably pointed out 
difficulties in the practice. What do those difficulties amount to? 
Simply this: that theimaterials for the administration of it do not 
yet exist in human nature. We do not know where or how to lay 
our hands upon the men who will administer it. Jesus Christ, when 
He came into this world, did not know where to lay His hands upon 
the men who should preach the gospel, and in getting His apostles 
He got a Judas. Was that any reason why He should not appoint 
apostles and send them out to preach His word ? New occasions 
teach new duties. Demands create the men who are to fill them. 
If it were not for that, all hope of reform and of progress in the world 
would die. Let us set up the system in its integrity, in its purity, 
and then call upon God to help us find or to make the men who will 
administer it. 

Mr. Wines has told us what the parole system may do. If this 
system is to come, what does it mean? That during certain stages 
■of subjection to law as a discipline, men are better off, have a better 
chance of reformation and a better chance of becoming good citizens, 
if they are not subjected to prison influences, but are superintended 
by society at large, under such influences as a Christian society can 
bring to bear. That prison life is an unnatural life, and that it tends 
to degrade human nature by the very fact of confinement and by its 
associations. Now these facts are the secret of the power of the 
parole system. We can go a step further and say that, for the 
ordinary treatment of crime, the probation system in its widest 
extent is the future system of dealing with criminals. Precisely on 
that point I am anxious, on account of Mr. Wines’ scholarship and 
long observation, to hear the impression which this thought makes 
upon his mind. 

Dr. Wines. — Mr. Chairman, if I understand (and I think I do) the 
point of your remarks, I sympathize very strongly with the view you 
have expressed, the necessity of hoping on, hoping ever, working 
on, working ever. A negro preacher, in expounding his belief, once 
said: “ Brethren, if the Lord tells you to butt through a stone wall, 
butt! The butting is yours, the going through it is the Lord’s!” 
We must butt at the wall of ignorance and prejudice and selfishness. 
Whether we butt through it is God’s secret, which He will reveal at 
His own time; but our duty is plain. 

Some years ago I visited Dr. Felix Adler’s great school for the 
children of workingmen, in New York, and was greatly interested 
in the methods by which, through the development of the manual 
faculties, he was cultivating character. I said : “ Dr. Adler, I should 
like to see this method introduced into all the public schools in the 
country.” “Oh,” he said, “you can not do that.” “Why not?” 
“ You have not the teachers, and you can not get them.” “ But,” I 
replied, “ we can make them.” “Yes, in the course of time, but it 


66 


PREVENTION AND REPRESSION OF CRIME. 


will take a generation. My teachers have been developed at 
immense expense, and they are ideal, exceptional men and women.” 
Nevertheless, Dr. Adler’s school for the children of workingmen, as 
an ideal institution, has exerted great influence upon the education 
in this country, and will modify it still further.^ So with Mr. Brock- 
way, of Elmira. No matter what the imperfections of his system or 
of its administration may be, he has undoubtedly built up the most 
inspiring prison in the world, which no man can visit and come away 
from without feeling that he has gained an ideal and sentiments which 
he never cherished before. The strength of the opposition to him 
proves the power of his leadership. 

But to come nearer to the point, your inquiry, as I understand it, 
looks forward to the ultimate abolition of the prison. There is a 
great deal in it. We have tried cutting people’s heads off and it 
did no good. We have tried burning them and torturing them, and 
that did no good. We have tried shutting them up in prison, and 
that did not do any good. We are now trying to reform them. But 
that will not do as much good as we think it will ; and by and by we 
shall probably come to the conclusion that many of these men had 
better have been left alone. God and human society would have done 
more for them than we can do, under the conditions in which the 
government has placed them. Mr. Brockway’s friend. Dr. Thos. K. 
Beecher, humorously calls him “ a little tin god on wheels” — a special 
providence in his prison. But no man is large enough to be a god 
or a providence, even in a little community like that of the Elmira 
Reformatory. He is bound to make mistakes, which God does not 
make. I would rather trust large numbers of my criminal friends 
outside of the prison than inside. I do not see that society itself 
would be any worse off. Many men are punished too much. We 
convict too many of them rather than too few. We do not accom- 
plish what we think we do, and by and by there will be a great 
reaction. 

Baron Garofalo’s paper suggested to my mind the thought that I 
don’t know what business the government has to form character ; 
what right a set of men who call themselves the government, who 
happen to be for the time being in political power, have to come to 
me and say, “ Here is the ideal character and you must conform to 
it. If you have a different ideal, I will take you and put you where 
you will be pressed into the shape which I want you to assume. In 
spite of all your resistance and your outcries, I will keep you there 
until I have either made you over or killed you.” If we can eradi- 
cate the criminal character, so much the better. But we have no 
right to take a man, because wc do not like his character, and mold 
that character over to suit ourselves. That was the practice in the 
Middle Ages, and the Inquisition grew out of it. We do not want 
to subject our prisoners to a moral inquisition. 

Mr. Charles F. Coffin, of Chicago. — I have listened with great 
interest to these remarks. After having studied the parole system 


MARSHALL. 


67 


and reformatory system pretty thoroughly, it was my privilege to 
read an article by Mr. Wines, in which he described the Elmira 
Reformatory, at a meeting held in the Mansion House, in London. 
I mention it to show the difference in nationalities. It was listened 
to with attention, but the views expressed were criticised in a very 
severe and decided manner, and the fact is that, while the paper itself 
was greatly admired in England, the reformatory idea has scarcely 
entered the English mind. We find it hardly anywhere. Their 
theory is that of reformation by punishment, and that no prisoner 
should be discharged without having undergone severe punishment. 

Dr. Wines. — That they should be intimidated before they are 
discharged. 

Mr. Coffin. — Yes; and their prisons are all severe. I thought, 
as Mr. Wines was speaking, how different it is to address a sympa- 
thetic audience, one that grasps and accepts this principle, from 
facing an audience which merely listens, but entertains a polite dis- 
belief in the truth of the arguments advanced. I am thoroughly 
satisfied that, as we are at present situated, we are doing the best we 
can, and that the reformatory system is the only one that we can 
adopt with any great hope of success. I do not know whether we 
shall ever get so far as to do away with all prisons and all matters of 
this kind. 1 believe Dr. Wines has got that far. 

Dr. Wines. — No; I say that we are moving in that direction. 

The Chairman introduced Madame Marie Marshall, of 
Paris. 

Madame Marshall. — I shall now speak to you of the work which 
my friend, Madame Isabel Bogelot, of Paris, has been doing among 
the discharged prisoners from the prison of Saint Lazare, in Paris. 

Madame Marshall then read the following paper : 

WORK FOR DISCHARGED FEMALE PRISONERS AT 
ST. LAZARE. 

MME. MARIE MARSHALL. 

It was in 1870, when but one thought, one care seemed to be in 
the minds of all the people in France, that one woman. Mile, de 
Grandpr^, the niece of the prison chaplain, listening with her heart 
to the cries of woe heard from everywhere, took special notice of the 
miseries confined in that prison of St. Lazare — to us, women, far worse 
than was the fortress of La Bastille, inasmuch as it is not the victims 
of a reigning despot that are there imprisoned, but that behind the 
iron bars of St. Lazare are found the victims of the most criminal 
law that the spirit of evil could suggest to a human mipd, the state 
regulation law for vice. In St. Lazare, up to that date, every woman 


68 


PREVENTION AND REPRESSION OF CRIME. 


or girl convicted of the smallest offense, of whatever nature it might 
be, was placed there daily in contact with the worst of its inmates. 

The girl of sixteen whose only crime was to be friendless, desti- 
tute, and thus reduced to beg for alms in the streets of the capital, 
was at once locked up between those walls where the contaminating 
influence of vice of the worst kind permeated all who found there a 
worse shelter than the street, for no care had yet been taken of their 
miserable condition. The poor woman, arrested and found guilty 
because she took from the baker shop one loaf of bread to save her 
little ones from starvation, when no more work could be found, and 
the father was either gone to eternal rest or was a degraded prey to 
intemperance — that woman, honest even through the fault committed 
with such a motive, became too often a complacent listener to those 
tales of easy work and good pay, told by her cynical companions, thus 
bringing back to her wretched home a depraved mind and becoming 
a most dangerous example to her children. Besides its vitiated, 
immoral atmosphere, St. Lazare was a sort of quarantine for all the 
diseases that are a fit but loathsome accompaniment to vice; and 
contagious diseases made their deadly way in the ranks of the poor 
creatures living in so frightful a promiscuousness. After Mile, de 
Grandpr^ had begun her visits to the female prisoners in St. Lazare, 
and had taken a well deserved rest, the committee of men and women 
who took up the noble work begun have been so active that great 
improvements have been made in that deplorable prison system. 

Since 1889, St. Lazare has been devoted only to the seclusion of 
prostitutes under penalty or under medical treatment. Women con- 
demned for offenses of a common nature to not more than two months’ 
penalty are sent to the prison of Nanterre near Paris; others, serving 
out sentences from two months to one year, are transferred from the 
police depot to the prison of Doulleus, until the d^partement de la 
Seine has built a special prison for those unfortunates. The girls 
are being cared for in the main police depot by matrons, both lay 
and religious, and after judgment of the cases are placed in special 
quarters until given over on probation to the many institutions now 
existing for reformatory purposes. The boys are kept in one large 
quarter of the prison for men. La Roquette, and actually a large 
establishment is being erected in the country of Montesson for such 
young defaulters, where agriculture and various trades will be wisely 
used as reformatory means, and where, let us hope, the government 
will grant free access to the religious instructors of every creed or 
denomination as the case may require. 


MARSHALL. 


69 


Abandoned little waifs are now placed in many benevolent institu- 
tions and in the state schools, and since two years a certain number 
. of small homes, called families, have been founded through pri- 
vate initiative, where, also under the care of a motherly matron, the 
children of prisoners are cared for up to thirteen years of age, when 
commences the apprentice training. Many abandoned children are 
sent to country homes, where they unfortunately cannot be adopted 
as your little waifs are here, but where at least they are brought up 
away from city influences; for it becomes more and more a difficult 
problem to solve with us, how to keep the country folks from over- 
crowding our large cities. 

But although so much is being done to better the moral and 
material condition of women prisoners, of girls destitute and friend- 
less, of precocious criminals, and of poor abandoned little waifs, the 
prison of St. Lazare as well as the police station depot are the con- 
stant care of Mme. Bogelot, helped in her work by Mme. de Morsier 
and a staff of men and women who have, through their energetic 
influence and example, been the means of inspiring another band of 
Protestant women to start also a visiting committee with a patron- 
” age for discharged female prisoners. 

To understand what difficulties are encountered in that redeeming 
work among those liberated women, and how hard it is to even make 
them hope they can begin life anew, this cruel word of a peasant will 
prove how the weaker sex, as it is called, is considered in the old 
countries. A pastor is congratulating a good peasant in his country 
parish on the birth of his first child. “ Oh,” said the peasant, “ there 
is little cause for me to rejoice ; ’tis not a child that’s come to us, it 
is a girl !” And again another illustration, from a higher step of the 
social ladder. Being asked whether he was pleased that his second 
born was a girl, a noble baron answered indifferently, “ Oh ! yes, it 
is amusing, a little girl; one can dress her up.” That theory 
shows how our sex is too often considered in all classes of an old 
society. And it makes us better understand that in high or low 
circles, woman, thus despised, brutally treated, even sold — yes, she 
is often sold in our civilized countries — or so adulated, spoiled and 
•otherwise ruined morally, loses all sense* of her own responsibility. 
To protect and redeem these poor victims of a society so unjust, 
when they leave the depressing walls of the prison, Mme. Bogelot, 
who has so correctly explained her views on solidarity of human 
interests in the Women’s Congresses, has made appeal to all good 


70 


PREVENTION AND REPRESSION OF CRIME. 


wills, to all benevolent institutions, and has herself created what she 
calls petiis asiles temporaires — small temporary shelters, where, not 
institution but family life makes the unfortunate women soon feel 
that they’^can breathe freely of that sweet air of love and liberty that 
will heal many moral wounds. Women are taken there for a few 
days according to need, and thence sent to country or town, placed 
out to do honest work through the kind interference of the good wills 
referred to already. How many before were thrown back into the same 
offense for which they had been condemned, only for the lack of 
decent clothing, which prevented their looking out for work ! Mme. 
Bogelot and her co-workers have redeemed many, only through that 
simple means, better clothing. Others have been visited, their cases 
inquired into, and at their liberation were rejoiced beyond expression 
to find out that the dear folks at home, whom they never hoped to see 
again, were awaiting anxiously the return of the prodigal child — 
always thanks to the mission of love of our friends. Or again, we see 
the girl mother, whose child is sheltered with proper judgment, while 
she is placed out in an honest, charitable family, where she earns 
enough for the board of her own little one. Another, a consump- 
tive, is sent out to the sanitarium for such, and an old vagrant woman ' 
receives shelter in a home for the aged, where she will end her days 
in peace. 

But little money is needed to do so much good and do it so well. 
It is through understanding thoroughly the word solidarity, and 
putting -it in practice, that these noble men and women have in hand 
all possible means of helping out their unfortunate sisters. 

Solidarity is the golden key that opens to our friends all the doors 
they need opened before the unfortunate victims of an old conven- 
tionalism which tends to become fainter every day. The means 
placed in our friends’ hands are numerous and cover the whole 
country. I refer you to the Woman’s Building in the World’s Fair, 
where have been placed large charts made under the supervision of 
the government, showing the statistics of this work of love. And at 
this door, the public is cordially invited to take the literature con- 
cerning what this society has done and is doing. 

And to end, let me say that it means well for a country when her 
children, with little or no money, but with a spirit of love and true 
solidarity, have been able, since only a few years, to save so many of 
their most wretched fellow-creatures from falling again into the abyss 
where they had been thrown, more than once, in spite of themselves. 


PROCEEDINGS. 


71 


I should be happy to hear what of such work is done in this country, 
for the woman prisoner when released must not be allowed to fall back 
again ; all chances must be given her for redemption. A neglectful 
indifference in that matter becomes a sin, which we women shall have 
to account for. 

May we not hear these words spoken to us: “I was a stranger, 
and ye took me not in: naked, and ye clothed me not: sick, and in 
prison, and ye visited me not.” But may it be ouf joy to hear : 
“ Naked, ye clothed me : I was sick, and ye visited me : I was in 
prison, and ye came unto me. Come, ye blessed of my Father, 
inherit the kingdom prepared for you from the foundation of the 
world.” — Matthew xxv. 

The Chairman. — I see a lady who is probably as well able as any 
one in the United States to give us some information as to the oppor- 
tunities accorded to American women who have broken the law. 
Will Mrs. Ellen C. Johnson, of the Massachusetts Reformatory 
for Women, South Framingham, allow us to hear a word on this 
subject from her ? 

Mrs. Johnson. — While Mr. Wines was speaking, a few thoughts 
came to my mind which I wished I had the courage to utter. In the 
first place, I think that, whatever we try to do, we must believe in 
our work. We must work with full faith that we are doing the right 
thing, and that we can accomplish what we undertake. Sometimes 
a woman comes to my prison who is said to be very bad — incorrigible. 
Within the last year I have been told by the clerk of a Salem court, 
(Mr. Andrews, who has written several articles in the Forum in 
regard to the subject): “This woman, Mrs. Johnson, is perfectly 
incorrigible. I wish you would have her transferred at once. We 
sent her to you because there appeared nothing else to do with her, 
but I hope that to-morrow morning you will have her transferred to 
some other prison, because she is not a subject for reform.” That I 
did not believe. I knew his feeling for me was kind, but it seemed 
to me that he had a very wrong idea. I treated this woman as all 
our prisoners are treated. I did not give her the idea for one moment 
that I did not believe that she was going to be a reformed woman, a 
true woman, and a good one. I did not have that idea myself about 
her for a moment. The consequence was that she passed through 
her prison the same as the others, losing not a single credit-mark, 
doing all that was expected of her from the very beginning, and she 
was sent to another state, to work in a family where she has remained 
now almost a year, doing perfect work. I received a letter, only a 
short time since, from the lady with w'hom she is working, thanking 
me for sending her so efficient and useful a woman. 

I think that is the secret of successful work. There is a divine 
germ in every human heart, if we only have faith in it. 


72 


PREVENTION AND REPRESSION OF CRIME. 


So many things can be said in regard to this work. I cannot give 
it to you in any systematic or scientific way. It is only in a common 
sense sort of a way that the work is done in our prison. We meet 
the women as we meet other people from the outside. I never get 
the histories of the women. When they cross the threshold the cur- 
tain drops on all that is past. We treat them as our friends. We 
expect nothing from them but good, and we very rarely meet with 
anything else. They are anxious to do all they can to become useful 
women. I have many applications for them, more than I can supply. 
Every woman who goes out from the prison can go directly to work, 
if she will; and very rarely one refuses to go. 

Our great object is not to make the prison delightful, as many 
have said, because they find the prison rather pleasant to visit. The 
discipline, I think, is severe. It is a very hard thing for a woman 
who has never had any systematic training in her life, to come into 
that prison, to live up to the mark and never lose a credit mark from 
the beginning to the end. But the diverting of her life from her old 
ways and giving her an insight into things that she has never known 
or had an opportunity to think about, prevent her from thinking 
about the life that she has led and of her experiences in the past. 

The Chairman. — Will you be kind enough to tell us what class 
of women are sent to your reformatory ? 

Mrs. Johnson. — I think they cover every class that are convicted 
and sentenced for a term longer than one year. 

Miss. Leavins. — Are all women sentenced for over one year in 
Massachusetts sent to your prison ? 

Mrs. Johnson. — No; I am sorry to say that some of our judges 
are inclined to accommodate the masters of our houses of correc- 
tion, who visit the courts and say, “ I wish you would send that 
woman to me, I need her in my institution very much to do my 
housework,” and she is sent there. 

Mrs. M. Fullerton, Association for Improving the Condition of 
the Poor, New York City. — I am engaged in general relief work in 
New York city, and, of course, I often have women come to me who 
have been discharged from the different prisons. The imprisonment 
of a woman is sometimes the culmination of her disgrace. During 
her imprisonment kind ladies visit her, and in that way families are 
sometimes reunited. I can think of at least half a dozen who have 
been restored to their families in this way. 

Mrs. D’Arcambal, of Detroit, Michigan. — We have no prison for 
women in Michigan; but we have an industrial home, where our 
girls are sent, beside a workhouse in Detroit, with good matrons 
and friends who take girls and find places for them as soon as 
possible. Many girls are sent there, however, who have no right to 
be there. They are about to become mothers, and must find another 
situation or be sent to another institution. We make an effort to 
induce and enable them to keep their children and to care for them. 
We have places where we can take care of little children for a very 
small sum. The mothers get good places, where they are well 


PROCEEDINGS. 


73 


remunerated, and pay for the child’s board. As soon as a child is 
old enough to be put in a home, if the mother chooses she can make 
that disposition of her child. 

Rev. Gr/VHAM Taylor, of Chicago Theological Seminary. — I 
would like to add something in regard to the work of a church of 
which I was pastor, situated in the city near the Connecticut State 
Prison. We found it necessary in dealing with the under classes to 
take a representative of the church to the police court; and for years 
a representative of that and another church have taken turns in 
attending the police court every morning, conferring with the pris- 
oners before they come to trial, remaining during the session, and often 
having first offenders committed to us by having their sentences sus- 
pended on condition that they will do as we say, or allow us to be 
their friends. Then, when any of the boys get into trouble — we have 
mostly to do with the men — and are sentenced to state prison, we 
are pretty sure to see them just before they are transferred from the 
county jail to the state prison. We make frequent visitations at the 
prison, especially to see the men who are to be discharged the next 
month. 

As chairman of the committee on visitation and discharge of pris- 
oners of that association, I had a great opportunity to do visitorial 
work among the men who came out the month after. A large num- 
ber of them came straight to this church. It mattered not what had 
occurred, they were received ; and these things were given them : 
First, a friend ; second, return home, if he had a home to which we 
could restore him ; a new environment, a place to be. We built a 
room out from that church, a men’s club room, and into it these men 
were introduced and lost just as quickly as possible in the crowd of 
other men there. Nothing ever was said as to their past lives, 
except that which escaped from their own lips, and this new environ- 
ment remolded or remade the man. 

Of course we had disappointments, but the dark shadows were 
cast, in these exceptional cases, by very bright light. I wish to say 
that 1 know of no such blasphemy against Almighty God as to say 
that these men can not be saved. This blasphemy against human 
nature strikes at the divine fatherhood. I am glad to acknowledge 
that some of the dearest friendships that I have in the world to-day 
are with the men in whom I have acquired a kind of a property 
interest, and whose lives are additions to the world in which I have 
been glad to live. In regard to these men holding out : in the course 
of twelve years 54 men were taken into the community of that church, 
many of whom came from the very lowest depths of inebriety and 
crime, and of those 54 men I can put my hand on 50, and many of 
them are in positions of great trust. 

I remember one young man against whom I was warned by the 
police force of the city as a man thoroughly bad, unworthy of any 
care or interest. The pathetic history of that man was this : 
His first crime, so-called, was to lose his mother. Then he was 
arrested for having property in his possession that he did not steal. 


74 


PREVENTION AND REPRESSION OF CRIME. 


His father put him out of the house for coming back after the jail 
commitment. Said he, “ If father was agin me, I was agin every- 
body.” For ten years he was in the state prison, with scarcely six 
weeks’ interim between jail or prison sentences. From the very first 
hour that a brotherly hand and a higher mind were laid firmly on 
that man he never once disappointed us, and to-day he is in charge 
of the running gear of the cash department of the largest store in the 
city, and has risen steadily in the estimation of all the people with 
whom he has been associated in business. That man has a home of 
his own. 1 can multiply these cases indefinitely. 

I sat in a club in Chicago not long ago and heard a physician 
carry the hereditary idea of crime to this extent, that there are no 
so-called criminals who are not moral lunatics. He believed that 
their will plays absolutely no part whatever in their destiny. It was 
my privilege to cite a series of cases where I had sat in a prison office 
and seen a third or fourth term man come out to be examined by 
this committee, caught by a new purpose, possessed of that purpose 
and simply remade by it. I know that there is such a thing as 
hereditary influence ; but I believe that there is power in a new envir- 
onment of personality largely to modify that hereditary influence 
and make men over again. I am. frank to say as a Christian that, 
properly applied, by a new social environment and by personal influ- 
ence, the old gospel is the very power of Almighty God to save these 
men in this world and the world to come. And that gospel teaches 
me that, if I want that new world myself, I must give it to every man 
who can be persuaded to take it. 

Mr. Hastings H. Hart, secretary of State Board of Corrections 
and Charities, St. Paul, Minnesota. — There was one remark of 
Mr. Wines which it seems to me ought not to pass without question. 
He expressed a doubt whether the state has a right to mold char- 
acter. I cannot let that pass unchallenged. It must be admitted 
that the state has no right to assume a prerogative which the Creator 
does not assume, the control of the human will. But certainly the 
state has the right, for instance in the case of insane persons, to 
restrain an insane person of his liberty until such time as, in the best 
judgment of physicians, he is competent to be given his liberty. It 
seems to me that that is what we do in the public prison. We say 
to the prisoner, “ We are fallible judges, but we propose to confine 
you in prison until such time as, according to our best judgment, you 
have attained a character safe for the community to allow you to go 
at large.” For the state to undertake arbitrarily to force character 
into a certain mold, I will admit, is indefensible. But I believe that 
the state has a right to say, “Admitting the possibility of doing you 
injustice, and the probability of inflicting some hardships, neverthe- 
less the public good justifies us in declining to set you at liberty until 
such time as you conform to such a reasonably high standard of 
character as we believe to be necessary for the protection of the 
community.” If this be treason, make the most of it. 

The section adjourned. 


FOURTH SECTION MEETING. 

Friday, June i6, 10.30 a. m. 

The Chairman. — Our first business this morning, and it will be a 
very great pleasure to us all, will be to listen to Major Robert W. 
McClaughry, chief of police of the city of Chicago, on the identi- 
fication of criminals. I have the pleasure of introducing to you the 
Major. 

THE BERTILLON SYSTEM FOR IDENTIFICATION OF 

CRIMINALS. 

ROBERT W. MCCLAUGHRY. 

I came here this morning to talk to you a few moments and 
describe, as best I can under the circumstances, the system for the 
identification of criminals known as the Bertillon system. It takes 
the name of its inventor, Alphonse Bertillon, of Paris, and it is by far 
the most complete system yet devised. It is based upon the fact 
that certain of the bony structures of the human frame do not change 
after the man is twenty or twenty-one years of age. The measure- 
ments of no two persons are the same in all respects. There is as 
much variety in respect to the human figure as in respect to the 
human countenance. Now, if we can hit upon some plan by which 
measurements of any individual can be taken with a reasonable 
degree of accuracy after twenty years of age, these measurements 
will be the same wherever he may be found, and thus we shall be 
able to establish his identity. 

Suppose that John Smith is arrested in New York for a burglary, 
serves his time in Sing Sing and is discharged. He does not want 
to go back to the city of New York, if he proposes to lead a criminal 
life thereafter, so he strikes out for the West. He comes perhaps to 
Buffalo, or Detroit, or Chicago, where he again commits crime and 
is again arrested. At the place where arrested he poses as a first 
offender, and as criminals on the average are young men, he can 
easily do that. I have had third, fourth, and fifth-term criminals 
come back to me even from the different cities in the state of Illinois, 
and come up smiling and tell me how they deceived the judge and 


76 


PREVENTION AND REPRESSION OF CRIME. 


even the police into the belief that they were first offenders, by some 
story of their early days — Sunday-school experiences and that sort 
of thing. They know how to deceive the very elect in these matters^ 
If John Smith’s measure has been taken in New York city and 
reported to a central bureau of information (say Chicago, as that is 
the centre of the universe just now), and the measure is there 
recorded, when John Smith comes to Detroit and is arrested there, 
and his measurements again taken and telegraphed to the central 
office, it will not take two minutes to return the information that 
John Smith, although his name may have been given as Peter Jones 
in Detroit, is the same person who was arrested in New York for 
burglary and served a term at Sing Sing ; thus giving to the Detroit 
court information upon which it can safely proceed to class John 
Smith as an habitual criminal and punish him accordingly. He may 
go from thence to San Francisco and be there arrested and measured 
again, and if the information is telegraphed to the central office at 
Chicago, all we have to do is to look through the records and we 
find that William Brown of San Francisco is the same original John 
Smith, and we can telegraph back the fact that he served terms at 
Sing Sing and at Jackson, Michigan, for crime. 

The advantage of this must be obvious to you all. It will enable 
the courts of justice to deal with these men as they deserve, instead 
of committing them, time after time, in every state in the Union, as 
first offenders and giving them the lightest sentence known to the 
law ; for the most dangerous men that the authorities and the courts 
have to deal with are those men who are the best calculators and 
most able to deceive people as to their identity and real character. 

Now I want to explain to you briefly how we get at this. We first 
take the head measurement, or the length of the head from the root 
of the nose, as it is called, to the farthest point on the cranium ; then 
the width of the head ; then the length of the forearm, of the middle 
finger, of the little finger, of the left foot, of the right ear, and the 
width of the right ear. You will be surprised to see how much dif- 
ference exists in these organs in different people. Then we measure 
the height, standing in the position of a soldier, and sitting on a chair, 
and those measures, of course, we follow up by describing the color 
of the eye, the contour and shape of the nose, and the marks and 
scars upon the body, noting the anatomical divisions of the human 
frame, locating each mark and scar accurately and measuring it 
exactly, and giving full particulars, so that we may clinch the identi- 


m’claughry. 


77 


fication of the man. The measurements I have stated are sufficient 
to identify the person wherever he may be arrested. As I have said, 
this system enables the authorities to indict and punish under the 
habitual criminal act, and thereby exclude dangerous criminals from 
society. 

In order not to take up your time I will have a man measured. 
Of course, when we measure a man in the identification room he is 
required to divest himself of his clothing. These are the caliper- 
compasses [showing instruments] with which the measurements of 
the head are made — the length and width of the head. This is the 
scale by which the measurements of the ear, of the forearm, little 
finger and foot are made; and with the scales on these boards, when 
properly fitted to the wall, we take the height, the trunk measure- 
ment and the measurement of the outstretched arms. 

To show you how little photographs alone can be depended on I 
present you with quite a number.* The measurements of this man, 
taken in a dozen ditferent places, from Chicago to Paris, and by 
different persons, do not vary in any respect beyond one or two 
millimeters, which is such a slight variation as not to interfere with 
the identification. No matter how that young man might get him- 
self up, either in Paris or in San Francisco, he would be recognized 
through the central bureau of information as the party measured and 
described. The measurements are entered on this card. On the 
back of the card is a space for writing the history of the man, where 
he has been convicted, where he has served, and all about him ; and 
on these lower lines we give a full description of the marks and 
scars found on his person. Photographs alone can not be depended 
on, although they are valuable as an adjunct to identification, and are 
always taken where it is possible to do so. 

Now we will measure a subject. I will ask one of my assistants, 
detective Smith, to be measured. If I had known that I would be 
asked to talk on this subject I should have had illustrations prepared. 
In the French government building at the World’s Fair, in the 
eastern section of it, you will find large photographs illustrating the 
various phases of this system, and generally you will find a gentle- 
man there who will cheerfully give full explanations of them.f 

* The speaker showed the audience about a dozen photographs of the same 
man taken at different places, no two photographs resembling each other. 

t Major McClaughry then proceeded to measure one of his assistants, using 
the Bertillon instruments. 


78 


PREVENTION AND REPRESSION OF CRIME. 


The caliper is placed in the cavity at the root of the nose. In 
anthropological measurements for determining the diameter of the 
head, the point of departure is just between the eyebrows. That 
makes a few millimeters difference from our measurement. The sub- 
ject is required to lean forward on the left foot, so as to prevent any 
trickery in giving the length of the foot. In measuring the forearm, 
place the left arm on the table and lean forward. 

The most wonderful thing about this system is the classification. 
You ask me what we do with these cards. Here is John Smith’s 
card, giving his photograph and description. We take a hundred 
thousand of these and file them in the central bureau. How will you 
find that one ? By an analysis and arrangement which I will attempt 
to describe to you. The measurement of the head, from the smallest 
up to eighteen centimeters and nine millimeters, is called “small 
length”; from nineteen up to nineteen-four is “medium length,” and 
then from nineteen-five up to the largest is “ large length ” of head. 
Now, we first sort the cards according to that description into three 
groups : small, medium, and large lengths of head. Here are nine 
boxes containing probably three hundred of these cards — descrip- 
tions of three hundred different people. Three of them contain 
“small length” cards, three “medium length,” and three “large 
length.” Each of these divisions is subdivided again according to 
the width of the head ; from the smallest up to fourteen-nine is 
called “small width,” from fourteen-nine up to fifteen centimeters 
and three millimeters is called “ medium width,” and from fifteen- 
four to the largest is called “large width” of head. When we 
write John Smith’s description we put the card first in one of 
these divisions, then in one of the cross divisions, taking out 
that box, which is again further divided by these yellow cards 
according to the length of the finger, foot and forearm, and the 
height. We place John Smith’s card in one of these compart- 
ments, because no one else will measure exactly as he does, 
and we find his card in that compartment. By this system of 
classification we are enabled in a very few moments to determine 
where the party described by the measurements is ; and let me say 
that, unless this John Smith again commits a crime, he can never be 
found. This is in no sense a rogues’ gallery where the pictures are 
on exhibition. There is no index. Nobody can find Mr. Smith, 
unless he discovers himself again by a second measurement and is 
reported to the bureau. I wish to impress that point upon you. If, 


m’claughry. 


79 


having been convicted, measured and described according to the 
Bertillon system, this man forsakes crime and leads an honest life, 
no man can go to the bureau and find him. The system protects the 
man who proposes to do well, at the same time it protects society. 

Now, for convenience of illustration, I have had printed a partial 
list of the descriptions that are in this cabinet. We can handle a 
hundred thousand or two hundred thousand just as easily as these. 
On this list you will find the descriptions in figures, and the names 
at the left. If you will call out any description as I give you oppor- 
tunity, you will see whether I can find the card which answers to 
that description.* 

We take the photographs in two positions, front and profile. As 
a rule the prisoner is shaven closely. 

Let me say concerning the measurements, that any person who is 
qualified to become a reasonably good carpenter and can take meas- 
urements with the accuracy required to make a fair carpenter and 
cabinetmaker, can learn so to take the measurements that there need 
be no discrepancies that will invalidate the identification. 

It is a rare occurrence where men are identical in as many as eight 
measurements. They are often identical in two, three or four. We 
find two men, for instance, who will measure alike as to outstretched 
arms ; but in height, length of fingers and length of ear, or other 
measurements, they will be found to vary considerably. We measure 
many persons whose outstretched arms give a greater length than 
their height of body, and others two or three centimeters short of 
that. We have never found two measurements exactly alike in 
every particular. Three hundred thousand have been taken in France 
and no two of them are identical. When we take such a large cabinet 
we multiply the subdivisions. There can be no possibility of failure 
in fact, in all our experience there has never been such an approach 
to identity of the measurements of two men as to render the identi- 
fication of either of them doubtful or ambiguous. 

M. Bertillon informs me that in gathering the vast cabinet he has 
in Paris he had some difficulty in that respect, at the start, several 
years ago. It grew out of inaccuracy in the measurements. When 
the government finally adopted the Bertillon system of identification 

* Cards were then distributed to the audience, containing the descriptions of 
several noted characters in figures. The figures on the cards being called by 
the audience, the speaker in every instance put his hand upon the photograph 
of the criminal in the cabinet, and announced his name as given on the cards. 


8o 


PREVENTION AND REPRESSION OF CRIME. 


and placed him at its head, he sent thoroughly drilled persons to the 
different cities of the republic and throughout the counties and 
parishes, who explained the system to the authorities, and trained 
them in the manner of taking these measurements, and impressed 
upon them the necessity of taking them accurately. 

In this country and in Paris the system is used for the identification 
of persons in a business way. For instance, a man who goes from 
Chicago to Paris and takes a letter of credit on a bank there, has us 
take his Bertillon measurements. It is placed on the letter of credit 
and the house is advised of it. He can identify himself, so that his 
draft will be paid without further identification, by stepping into 
M. Bertillon’s office. We take measurements in many cases. 
Many persons carry with them their measurements. 

In answer to inquiries, the speaker said : “ The only change that 
M. Bertillon has found is in the height. The settling of the vertebrae 
would cause a slight change in height. There is an allowance made 
for that, and that does not invalidate the measurements. Disease 
may effect shrinkage of tissues, but not of bones. We make allow- 
ance sometimes in extreme cases in taking the measurements of fleshy 
people, but we take the measurements so accurately that we are sure 
we have the measurements of the bony structure. If a person should 
again be measured while very fleshy, of course the operator would 
then make due allowance; so that the identification would be com- 
plete. I might say in passing that very few criminals are fleshy. 
They are Pharaoh’s lean kine, all of them.” 

Dr. James W. Walk, general secretary of Society for Organ- 
izing Charity, Philadelphia. — I would like to answer the question 
whether disease can affect the bony structure, as a physician. There 
are certain diseases of the osseous structure that might modify the 
.length of the forearm ; but those diseases are of a kind which are so 
serious that it is not likely that any one after his health is so broken 
would be able again to follow a criminal career. He would need 
hospital care. 

Major McClaughry. — I was going to say that M. Bertillon pro- 
vides for that. The disease would make such a marked difference 
in the man as would lead the subsequent operator to note the fact. 
If the measurements were so nearly alike in many particulars as ta 
cause a doubt in the mind of the operator as to which the man was, 
the particularity with which we locate and describe the marks and 
scars would clear up the doubt. 

A Member. — Another question is about the absolute maturity of 
the bone. Is that to be taken into consideration ? 

Major McClaughry. — That is a fact after twenty-one years of 


PROCEEDINGS. 


8l 


age. I understand that there are exceptions, but they are like a 
white blackbird, they are lew, and merely prove the rule, 

A Member. — How many colors of the eye are there ? 

Major McClaughry. — 1 cannot tell you. There are many. I 
thought I had M. Bertillon’s book with me, containing a chart 
giving a classification of colors, but I neglected to bring it. 

A Member. — I have in print, taken by George M. Porteous, in 
1889, the ten distinct measurements of Major R. W. McClaughry, 
and since it would be something of a test, I will ask him to submit 
to remeasurement. Mr. Porteous who took the measurements at 
that time is here and can take them again.* 

Major McClaughry. — The cost of the appliances is about $25. 
Michigan, Pennsylvania, Illinois, Massachusetts, the Dakotas, I 
think, Kansas, and Minnesota have provided for taking measure- 
ments. The prisons and the police are working together. We have 
a large collection of measurements in Chicago, which seems to be by 
common consent the central office; but this system will reach its full 
development and prove of greatest benefit to the people of the whole 
country when the general government shall establish a central bureau 
of information at Washington, to which all parts of the country shall 
make reports. Measures are being taken to that end. It should be 
managed like the Postoffice Department or the Weather Bureau. 

Capt. Edward S. Wright, warden of Western State Peniten- 
tiary, Allegheny, Pennsylvania. — I will give you two or three points 
illustrating further what the Major has said. Last fall, accom- 
panied by my daughter, I went to M. Bertillon’s office in Paris. They 
take on an average about one hundred and fifty descriptions each 
day. The morning we were there, there were six operators at work. 
They were all in uniform, such as you may see at the exhibit at the 
French Government Building, World’s Fair. I want to call your 
attention to one use which Major McClaughry has not touched upon. 
The apparatus there is different from any in the United States. It 
is arranged so that they take the description of bodies that are found, 
and take them just as they are found. They take all the surround- 
ings. The possibilities for the police are very suggestive. The 
morning we were there, there were a great many present, and in the 
afternoon we went back ; they brought a young man in and M. Bertillon 
said, “ This seems to be a man whose description we -have.” My 
daughter took the card, and in an instant four or five clerks climbed 
up and brought three other cards and laid them down. She spoke 
in French and asked him if he had been in prison before. “ No, 
never,” said the young man. “Simply in Paris?” “Yes.” She 
then said, “In Brussels — ^Jones.” She looked again, and in Mar- 
seilles he had been in prison under some other name, but not in 
Paris. She then read the three descriptions and handed them to 

* He came up and measured Major McClaughry, and the new measurements 
’Corresponded exactly with those he had taken in 1889. 


82 


PREVENTION AND REPRESSION OF CRIME. 


M. Bertillon, and he was identified then and there as a person who 
had been convicted three times. 

This gentleman, who gave us so much time, told me many very 
interesting things connected with the work, and he appreciates very 
highly the manner in which the system has been taken up in the 
United States. 

He has in his office four or five pictures, and the most prominent 
of them is that of Major McClaughry. He said that to him the most 
convincing proof of the success of his work is the fact that the Eng- 
lish pickpockets, the most dangerous of all thieves, have become an 
almost unknown quantity in Paris. They used to arrest dozens in a 
month ; now they rarely arrest one. He asked the last man, “ Why 
don’t you come to Paris?” He said, “ Do you think we are fools? 
Do you think we are going to have our pictures taken ? ” “ No,” he 
continued, ” we know a good thing, and we go to the United States 
instead.” 

I tried to get M. Bertillon to come here, but for the want of 
funds he could not come. He could have procured a four months’ 
vacation if he had had funds. We endeavored to get them through 
our association, but we 'appear to have come to an untimely death 
last year and have no money. 

The matter in the United States is in a state of quietus now, and 
the only way, it seems to me, to make it active is to get the national 
government to take hold of it and make it a bureau in the Depart- 
ment of Justice. I have seen several members of Congress and I 
am promised aid in that direction. I think they will introduce a bill 
at the next session to establish a bureau in the Department of Jus- 
tice, and then all the papers and reports will be made a part of the 
monthly system which the United States now adopts. I know of no 
one to whom we are more indebted than to Major McClaughry, and 
I hope that he will continue this active work. 

In London I visited Scotland Yard. There they do not adopt 
this system, but instead of that they have a cumbrous year-book, 
giving the marks and all that ; but through jealousy, although they 
admit the Bertillon system is the best, they do not apply it. I do 
not know that you can spend a more interesting morning than to go 
to the French Exhibit at the World’s Fair, and I think you will 
acknowledge that in this matter the French have taught us two 
points. 

The Chairman. — We are very much obliged to these gentlemen. 
There are still three points in connection with this subject on which 
it would be absorbingly interesting, I am sure, to us all present to be 
enlightened ; but the subject is so vast and comprehensive that it is 
absolutely impossible to exhaust it in one short session. The first 
point to which I refer is the fact that the basis of this entire system 
is strictly and absolutely scientific. It partakes of the nature of an 
exact science. Major McClaughry has described eleven measure- 
ments. Now, if you will examine these measurements you will see 


PROCEEDINGS. 


83 


that the range of each, at a minimum, gives us at least thirty distinct 
points on the scale which can be readily distinguished in measure- 
ment with sufficient variety to avoid mistakes by an expert, and all 
of these within the range of measurement of what may be called an 
average man. Taking the eleven measurements and using them, 
you see at once that the number of different men who can be classi- 
fied under this system, without the danger of confusing any two of 
them, would be precisely the eleventh power of thirty. Now if you 
calculate the eleventh power of thirty as I have done, if I am not 
mistaken, you will find that it is 17,714,700,000,000,000, or about 
eight hundred times the estimated population of the globe. That is 
the first point to which 1 call your attention. 

The second point is that this system is not limited in its applica- 
tion to criminals, but that it is beginning to develop important bear- 
ings on the study of anthropology. What future light such measure- 
ments, classified, may throw upon the races of men, upon the 
development of men from age to age, upon the laws of change in the 
bony structures under different conditions of life, is a question of 
great importance. 

The third question is one on which we should be pleased to hear 
from Major McClaughry. It relates to the practical work of taking 
these measurements ; whether there are any of them in which the 
tricks are more confusing than in others, and whether on this account 
it is necessary that experts take them in a particular way rather than 
that they be taken by amateurs and carelessly. 

Major McClaughry. — I think only in two points, the length of 
arms and the height ; and they used to practise a little on the foot 
measurement, but by requiring them to stand on the foot, leaning 
forward, we prevent that. There are no measures in which they can 
trick the operator. It is only requisite that the operator be reason- 
ably careful, and any man who can take the measurements requisite 
for a fair carpenter or joiner, with the exercise of reasonable care, 
will not make a failure in his measurements 

A Member. — I would like to ask what class of criminals you take. 

Major McClaughry. — We take the measurements of those who 
have been held over to court or convicted of any crime that may be 
punishable by imprisonment in the county jail or penitentiary. 

The Chairman. — If there are no further questions to be asked, 
I am sure the section will join with me in returning to Major 
McClaughry our most cordial thanks, and also to Mr. Wright for 
his interesting address. 

Mr. Wm. M. F. Round, directqr of the Burnham Industrial Farm, 
Canaan Four Corners, New York, will now speak on crime and 
education. 


84 


PREVENTION AND REPRESSION OF CRIME. 


CRIMINAL OR DELINQUENT CHILDREN. 
With a Sketch of Burnham Industrial Farm. 


W. M. F. ROUND. 

It is only within the last quarter of a century that there has come 
to be fully and g^enerally recognized a direct and most important 
relationship between the education of the child and the prevention of 
criminality. 

Hitherto, criminals have been regarded quite as a class apart; 
somehow they became criminals; but how, few have stopped to 
inquire, either for the cause of their appearance in the body politic, 
or as to the potency of means for their repression or removal. They 
have been left to the treatment of old systems, regardless of the 
futility of these systems, in the fact that the criminal class increased 
out of all proportion to the increase in population. 

There has been an expensive and cumbersome penal machinery, 
for which the taxpayer has paid somewhat grumblingly, while he 
has made but little effort to ascertain the primary causes of crime 
increase, or given but scant consideration to the warnings of 
specialists. 

But the menace is becoming too alarming in these days, and its 
dangers so pervasive of all classes of society, that the public con- 
science is at last awakening to its duty, and the public mind seeking 
for protective measures, with an energy heretofore unknown. 

It is a significant fact in this whole matter, perhaps the most 
significant fact, that the growth of criminality has gone alongside 
with the growth of our much-vaunted educational system. It has 
been a frequent object of inquiry with intelligent citizens whether 
there could possibly be any relationship between the two ; and there 
are many to-day who stand in amazed incredulity if the relation- 
ship is asserted, and wonder how it can be, that if all children are 
properly taught to read, write and cipher, with a few extensions of 
these accomplishments, they ever can fall into crime. Respectable 
parents shudder at the mention of any relationship between the 
jail and the schoolhouse, between the seminary and the penitentiary. 
Yet criminologists are every year feeling more and more that the 
accident of heredity is less to be regarded as a cause of crime than 
defects in educational methods. It is a most natural thing that such 
defects are most apparent in institutions where delinquent and way- 


ROUND. 


85 


ward children are gathered for training, and yet in many such insti- 
tutions, old educational methods are still adhered to, and any innova- 
tions upon them are regarded with distrust. Advocates of new 
methods are regarded as innovators, if not as “ cranks,” and the 
natural conservatism of humanity is never more apparent than in its 
treatment of educational experiments, however honestly they may be 
made, or however plainly they may be based on established facts 
and generally accepted principles. Those who have been in the 
vanguard of penological progress during the last ten years have had 
to fight for standing year by year, and step by step, not a point 
having been gained without a battle ; but they have had the courage 
of their convictions, and thank God ! the troops have had to come up 
to the colors and the colors have never gone back to the troops. 
This is likely to be the case in the application of a new set of methods 
to the educational elimination of crime tendencies in the young, 
though heretofore most promising experiments have often been 
regarded with distrust. 

This brief introduction may serve as an apology for my bringing 
into this influential assemblage some account of an experiment in 
new educational methods designed to supplement the old methods, 
— with a special view to the correction of criminal tendency in young 
boys; and to speak of work which has been too much spoken of already, 
and too much praised for one in so early a stage of its progress. 
I refer to the work at the Burnham Industrial Farm, at Canaan 
Four Corners, New York. For whom is it designed? What is it 
for? What are its principles ? What are its methods? What are 
its present and what its promised results? These questions I shall 
try to answer, in the hope that the wisdom of such a body or the 
interest of those who read this report may find suggestions to offer 
toward perfecting a plan, the imperfections of which are only too 
apparent to those who are zealously engaged in its promotion, and 
who welcome honest and kindly criticism from whatever quarter it 
may come. 

In the announcement of this paper the subject was in some way 
connected with the expression “criminal children.” Against this 
expression I wish at once to enter a most earnest protest. There 
are no criminal children. Criminality in the special sen^e must have 
certain factors. Among these are : 

1. Motive. 

2. A sense of moral responsibility. 


86 


PREVENTION AND REPRESSION OF CRIME. 


3. A knowledge of relationship to law. 

4. A conscious defiance of law and of generally accepted benefi- 
cent social conditions. 

5. A recognition by the law. 

Crime is crime because the good order and general welfare of the 
community being promoted and protected by certain restraints, 
adopted by the consent of the community, these restraints are con- 
sciously violated in the selfish interest of the individual. This 
thought must be kept clearly in mind lest we confuse crime with sin, 
— if I may be pardoned for introducing so old-fashioned a word 
into so modern an assemblage. 

I hold that there are no criminal children, because, since all the 
factors that I have named must be present to constitute a criminal 
diathesis, and since they are never or almost never all present in the 
criminal actions of children, or their relation to the social structure, 
1 do not believe that we should put the brand of criminality upon 
a child, even in our common speech. Moreover, in its relation to 
law the child cannot be a criminal, because the law on its part does 
not recognize the social, legal or moral responsibility of the child. 
It is one of the infamies of law that it permits through all the 
calendar of shame, as embodied in our penal code, the child, the 
minor, to be regarded as a criminal ; treating him on a basis of moral 
responsibility, while denying him its rights. It classes him with 
adult criminals, convicts him, sends him to prison, but does not 
permit him to hold property, to make a contract, or to vote, or to 
marry without the consent of a legal guardian. Surely there is no 
equity in this : no reason in common law why we should call a child 
a criminal. Therefore I prefer, and I insist upon the preference, that 
wayward children should be so called; “delinquent children ” may 
not be an objectionable term, but let us have no criminal stigma 
upon the holy name of childhood. 

To step from the abstract to the concrete. I have found in the 
history and methods of the Burnham Industrial Farm — the system 
of which I have had some share in shaping — both an illustration of 
my position as taken above, and a proof that educational institutions, 
pure and simple, are needed for the care of delinquent children, who 
in nine cases»out of ten owe their delinquency to circumstances of 
environment, impressions of their surroundings, and who simply 
need to be educated out of badness into conditions that make for 
righteousness. 


ROUND. 87 

Every boy who is brought to the farm is examined along the 
whole line of the definition cited above. Let me cite a brief case. 

J. B. is sent to the Farm. It is said that he is a liar and a thief. 
He is thirteen years of age and small for his years. A pale com- 
plexion. Hesitates in speech. Comes wearing a bright necktie, a 
cheap finger-ring ; his fingers are browned at the ends with tobacco. 
Almost every question put to him must be twice put before he com- 
prehends it. There is no ascertainable hereditary taint. His environ- 
ment has been entirely respectable. His mother is a wage-earner. 
The boy has always been to public school. Let us test his case by 
the factors laid down above and see wherein we may gather light for 
his treatment. 

Motive. His motive for stealing was a gratification to his vanity 
and appetites. He bought finery and candies with the money he 
stole. He had a clouded sense of moral responsibility, but was 
little governed by it. He had a sense of relationship to law, and 
threats of having him arrested had only kept him in check. This 
boy was clearly a budding thief, but I deny that he was a criminal, 
because he had not been in a condition of life to know the value of 
higher motives. He had seized upon the only motive that his 
environment furnished him. He had not moral discernment suf- 
ficient to grasp other motives. He was a child in criminality ; and 
a child in criminality is not a criminal any more than a child in law 
is a citizen. There should be no giving the boy over to the ranks 
of criminality until his full manhood had been attained, his educa- 
tion fully perfected (for the state undertakes to educate every child), 
the restraints of minority all tried, and it had become certain that 
with a fully matured mind he had deliberately chosen crime as his 
mode of life. 

We tried to find out from the boy I have in mind if he had any 
consciousness of his relation to law, any idea of his relation to 
society. There was but a feeble perception. He had a fear of 
punishment, but no sense of the beneficence of law. The brother 
. who brought him to us said that the only way that he could keep 
him in check was to threaten to arrest him. The boy knew that all 
his brother’s earnings were required to support his family, and yet 
he persistently stole from him. What could we do with such a boy ? 
What did we do? His case will illustrate the general plan of pro- 
cedure for the entire Farm. 


88 


PREVENTION AND REPRESSION OF CRIME. 


Every boy when he leaves the Farm must meet the ordinary con- 
ditions of life, therefore we make the conditions of life at the Farm as 
nearly as possible like the social conditions outside, but intensify and 
impress them upon him until they mould his character. One of the 
first thing’s that a boy will have to do when he goes out into the 
world — that is, such boys as we have — is to earn his living. If he 
enjoys any of the luxuries of life he must earn them, or somebody 
must earn them for him. We say to him, “ Everybody gets the 
pleasures of life according to the work that he does, therefore we will 
pay you from the moment you get here, and you need expect very 
little except what you earn.” 

Then we give our boys ten mills a day, and thereby we have at 
last found a use for the decimal fraction of a cent. What he gets is 
actual currency to him, and he receives small tickets representing 
ten, twenty-five, fifty or one hundred mills. He is provided with 
nothing but the simplest fare. All the luxuries of life, or such as the 
Farm affords, he must buy with his earnings. He may have bread, 
but he cannot have butter unless he buys it. He may have berries, 
but he cannot have sugar to eat on them unless he buys it, and he 
cannot buy these things unless he earns his mills. He can buy straps 
for his skates, and base-balls, and he can buy lost articles at auction, 
which are sold to the highest bidder. All articles found lying about 
are confiscated ; for we hold that it is right to try to teach our boys 
a proper sense of the conservation of property. Every Saturday 
night all these confiscated articles are sold at auction to the highest 
bidder. A boy can give money for charity ; he can put money in 
the missionary collection on Sunday — that is, his mills, which are 
redeemed at the office. He must earn a certain number of mills, or 
at least he must not lose a certain number of mills, in order that he 
may win his promotion from the inmate grade to that of the cadet 
grade. Then we have a fourth class, the pauper class. If a boy 
does not work he belongs to the pauper class. He is given the 
coarsest kind of food, and every other boy in the institution is taxed 
ten mills a week for his maintenance. The result is that of every 
one hundred boys, we have ninety-nine special policemen who see 
that the hundredth is not idle. A strong moral force is brought to 
bear upon him to make him take his part in the work of life. There 
has never been but one pauper, and he was only a pauper for forty- 
eight hours. It is a singular fact that most of the boys come to us 
from the public schools with an entire sense of helplessness. Their 


ROUND. 


89 


minds are trained to multiply single numbers, to read and to write, 
but they have no training of the hand, and no conception of the 
relationship between labor and life. 

One of the characteristics of our boys is a want of moral courage, 
even where they display wonderful physical courage. Fear should 
not be a dominant motive in an institution for governing boys ; in 
the early stages of a boy’s development the appeal to fear is neces- 
sary until he can comprehend higher motives ; but after having 
attained a certain moral condition the appeal to fear should be dis- 
carded. How much does a boy fear physical punishment who will 
hold out his hand and allow another boy to pour a teaspoonful of the 
strongest nitric acid over it ? A boy who did that was repeatedly 
whipped at first to make him behave himself. We have changed 
the treatment in his case, and, although he is not a thoroughly good 
boy, he is improving fast. Last winter he ran away. He went to 
New York. I knew he was in one of three places. At the approach 
of Christmas I wrote to him at all three places : 

Dear Charlie : — Christmas will be here three days hence, and 
when I go into the chapel there will be no pleasure for me if you are 
not there. If you want to make me a Christmas present, please come 
back.” 

On receipt of the letter that boy went to my wife in New York and 
borrowed of her the money with which to pay his fare back to the 
Farm. On Christmas Day, as I was sitting in my room, with the 
thermometer outside ten degrees below zero, I heard a knock at the 
door, opened it, and there stood this great, tall, splendid boy, who 
had walked from Pittsfield, ten miles, to get back to the Farm. 

We could not have whipped him back. If he had been driven 
from- the Farm by physical torture I am sure that he would not have 
come back. He was very deficient in moral courage, and he feared 
to face his comrades. 

How shall we develop the sense of moral responsibility? It is 
forced upon us by the shame which follows sin and crime, by the 
rewards which follow living honestly with our neighbors, by the 
thrill of pleasure that comes from living in a state of interdependence 
and mutual helpfulness. I think it can be taught in any institution. 
I know that our boys often come to us, as in the case of the boy 
already spoken of, with a very feeble sense of moral responsibility. 
We try to make them feel that they are a part of the body politic. 
They have the right to vote punishments — not all punishments ; but, 


90 


PREVENTION AND REPRESSION OF CRIME. 


when the system is complete, all the employes and officers trained 
as they should be, and as I hope they will be, I do not intend that 
any boy shall receive severe punishment except by a vote of his 
comrades and teachers. That day has not yet come, but I am 
bound to say that no punishment has been inflicted by the vote of 
the boys without full, frank, free discussion ; and it has been my 
duty very many times to reduce the punishment ordered by the boys 
themselves. 

I have said that we teach them that they must earn their living by 
honest labor. We do not teach any trade, but we teach the rudi- 
ments of a trade. We have a small printing shop, carpenter shop, 
knitting shop, and broom shop. Some boys look upon society as a 
great, gigantic machine, of which they are not exactly a part. Such a 
boy imagines that he has simply to open his mouth three times a day 
for society to put a spoon full of food into it ; that society is bound 
to provide him with every suit of clothes that he wears, whether he 
earns it or not, and if society fails to feed and clothe him properly, 
society is to blame. That boy is institutionalized. There is no 
hope for him until he is made to feel that he must take part in life 
as a wage-earner, and support himself by money honestly earned. 
We try to instill into the boys, as far as we are able, the habit of 
labor. That is where our public school system fails. The habit of 
labor grows. Have you ever thought what a strong thing habit is? 
If once you get a boy to earn his living regularly, and feel that he 
must earn it or he won’t have it, that if he wants the pleasures of life 
he must work or he won’t have them, the sense of obligation to 
labor becomes to him an uplifting force. On the other hand, take 
the criminalized boy. A criminal boy only seventeen years of age 
once came to our office, a pickpocket known throughout the country. 
He was converted and began to live an honest life. Afterward he 
said to me, “ You have no idea how, when I go into a street car and 
see a woman foolishly exposing her pocketbook, there comes over 
me an intense feeling that I must take it from her, and then follows 
a hot flush all over my body at the thought of the temptation I have 
escaped.” Good and bad habits are equally strong. The boy is 
safe who awakes from sleep and says, “Give me my bath; I must 
eat and be at work who works all day, feeling a thrill of pleasure 
in the sight of the growing product of his labor, and at night goes 
tired to bed. That boy is comparatively free from temptation, 
and if he does that every working day in the year, the habit of toil 
thus engendered will save him from almost any temptation. 


PROCEEDINGS. 


91 


The Burnham Industrial Farm is only an experimenti It has had 
a great burden to bear. Its officers are all unpaid young men who 
are in training for the highest and best of vocations, the reform of 
humanity. The first thing that we had to contend with in establish- 
ing the institution was to find somebody to run it ; but we have estab- 
lished there a training school where young men learn to do by 
doing, and in the name of Christ fit themselves for institutional work. 
Never have I seen such zeal as on their part. They are on duty 
from five o’clock in the morning until nine o’clock at night, with no 
vacation, patiently bearing privations and hardships, animated and 
sustained by the desire to teach and uplift these boys. The cause 
in which they have enlisted, that of child-saving, is an honorable and 
noble profession for any man to enter. I have known our Brothers 
to go without proper clothing in order that other boys might be 
admitted ; and I look forward ta the day when this little normal 
training school at the Burnham Industrial Farm will reach a point of 
usefulness when, if any one wishes to find a competent, honest, 
trained, consecrated employ^ for any institution, we shall be able to 
supply him. 

So, you see, the Burnham Farm has a two-fold purpose, that of 
saving boys, and that of training men for other institutions. 

Three of our Brothers of St. Christopher have finished a course 
of training of three years and six months and are now ready to go 
out ; but if we had fifty instead of three we could not begin to supply 
the demand. 

I shall be very glad to answer any questions. 

A Member. — What is the age of these young men? 

Mr. Round. — The oldest Brother, with the exception of myself, 
is 28. The others are 27, 24, 22 and 21. 

A Member. — Do these young men teach ? 

Mr. Round. — They do. We have an admirable school. 

A Member. — Do you have any female employes ? 

Mr. Round. — We have a laundress ; but she is not going to stay, 
since we now have a Brother who has begun to learn the laundry busi- 
ness. f He also has charge of the musical department.) 

About two and a half years ago we received a letter from a woman 
in the West. She was fifty-four years old and had spent her days 
in teaching, and wanted to give the remainder of her life to work 
for boys. Her motive was the same as that which animates our 
Brothers. She inquired if she could be of any service at the Burn- 
ham Industrial Farm. She came to us and was known as Sister 
Frances. She remained with us, and was a daily and hourly bene- 


92 


PREVENTION AND REPRESSION OF CRIME. 


diction to us, every moment of her stay. She taught school, she 
looked after the boys, and we thought it would be a good thing to 
establish a Sisterhood of St. Christopher as well as a Brotherhood 
of St. Christopher. But Sister Frances was called away to the sick 
bed of her sister, and it was thought wise not to attempt the organ- 
ization of a sisterhood until we might hope for the return of Sister 
Frances. I wish to say that I would not have it at the Farm itself. 
I should remove it, and not put the very young boys under the 
charge of young men. 

A Member. — You do not think it desirable or necessary to have 
any woman employe about your institution ? 

Mr. Round. — I think it undesirable and unnecessary, except that 
I would have one or two good middle-aged women to exercise the 
motherly function of comforting and caring for boys in moments 
when they need special attendance. My wife is there sometimes, 
but she has no official connection with the institution. 

A Member. — You said that you thought it desirable to put the 
younger boys under the charge of the Sisterhood. At what age 
would you draw the line? 

Mr. Round. — When a boy passes the age when his acts are purely 
mischievous, and begins to act in deliberate defiance of established 
laws. Very many boys pass through a period of moral depravity 
between the ages of twelve and fifteen years. I would not allow a 
boy of depraved instincts to pass through that period in company 
with other boys. I would remove him the moment I discovered by 
his chart that he had dropped at all in his morals. It is a question 
of judgment. You cannot make any hard and fast rule. We hope 
to have something extremely plain, in the way of a chart for every 
boy, that will show at a glance what the boy’s moral condition is. 
We hope to have a chart by the irregular line upon which we can keep 
track of a boy. At first he makes up his mind that he will obey the 
rules and learn something. He starts out almost on a straight line. 
By and bye he commits some wrong act, gets discouraged, and 
drops right down. You see a very sharp oblique line leading to the 
bottom of his chart. Then he begins to climb back. From that 
period his course is invariably marked by a series of waves, with less 
and less depression, until his conduct record finally becomes an 
almost straight line. There is therefore sensible reason for calling a 
delinquent man or boy a “ crook,” and for the criminal to say he is 
going “ straight ” when he gets on the right track. 

After a half-hour of more questioning, Mr. Round concluded his 
remarks. 

Mr. Ira Otterson, superintendent of the Boys’ Reform School, 
Jamesburg, New Jersey. — I think the audience has been detained 
quite long enough. We have all been so intensely interested in the 
account given of this excellent institution that it seems unnecessary 
for me to say anything. When I came to this Congress I did not 
come loaded up with ideas and with a feeling that if I did not have 


PROCEEDINGS. 


93 


the opportunity to express them I would explode, and that if the 
public did not hear them it would collapse. I came to listen. I 
have highly appreciated the papers and discussions in some of the 
other sections. But, since listening to Mr. Round, I want to say 
something of our work in the New Jersey institution, which is an 
institution solely for delinquent children. No child can be received 
into our institution who has not been committed to it by a justice of 
the supreme court, or at least by a law judge, and, in counties of the 
first class, by the presiding judge. No associate judge or police 
magistrate is allowed to make out a commitment. All classes and 
grades of offenders may be committed, except those charged with 
murder. The limits of age are eight and sixteen years. Sometimes 
these limits are stretched both ways. I received a boy who, it was 
stated in open court, was only six years of age. 1 received another 
boy upon whose warrant of commitment it was stated that he was- 
fifteen, but when I questioned him he said that he was nineteen, but 
that he had given his age as fifteen thinking the court would let him 
off. I wish it had let him off and that the authorities had sent him 
immediately back where he belonged ; he came from Ireland, and 
had been here about three weeks when he was arrested for stealing 
and sent to our institution. We kept him. He was a keen, shrewd, 
ignorant criminal, but he hoodwinked his officer sufficiently to gain 
his release ; and, a very short time after, he wrote a letter to the 
secretary of our board, who does business in New York. It was 
written from the Hudson County Jail, which is in New Jersey just 
across the river from the city of New York. He wrote that he was 
in trouble, that he had been arrested upon a false charge, and he 
wished this trustee would come and see him and act as his friend at 
court. He told a story about his grandfather having left him an 
immense amount of money, which he had buried, and if he could 
get a furlough he would get it, pay his fine and be free. He got 
off, was soon arrested a second time and sent to the state prison at 
Trenton. He is now where he belongs, and where he ought to 
remain for his natural life. 

All of our boys are not of that class. I can only give you a few 
instances. A number of years ago I received two brothers from a 
remarkable family. The father was a dealer in old junk, and in his 
perambulations many were his depredations on henroosts, etc. He 
had the soubriquet of “ Dutch Henry.” After a time the older 
brother was released, did pretty well for a while, and came to visit 
me, bringing a proud-looking young woman whom he introduced 
as his wife. He had a good team of horses, and he said, “I thought 
I would run down and see you and my brother” — not the second 
brother, but the third and youngest. This man poured poison in 
his younger brother’s ear and he decamped. The boy had been 
out but one day when he broke into the postoffice and there com- 
mitted larceny. I recaptured him, but he eloped again, committed 
another robbery and was again brought back. I placed him in the 


94 


PREVENTION AND REPRESSION OF CRIME. 


family to which he belonged, gave him two days in solitary confine- 
ment for reflection, and the next evening brought him before all the 
boys of his family. On the table was a big pile of law-books and 
papers, and I opened a court, constituting myself judge, jury and 
advocate. I read aloud all the laws governing the school, including 
the charter, and the section of the statutes authorizing the superin- 
tendent to return to the county jail for a new trial any boy found 
incorrigible. During all this time I made John stand facing the 
other boys: After these preliminaries I said: “This boy has violated 
every rule of the school, as is well known to you. He has brought 
disgrace upon the institution, upon this family, and upon me. He 
has violated the laws of the state previous to his coming here, and 
every time that he has escaped. Each of those violations would 
warrant sending him to state prison. I am unwilling to decide the 
case. I have presented both sides of the question to you boys, and 
I want every one of you to give his opinion of what I ought to do. I 
will take a vote whether to give him another chance or to return him 
to the court with the strong probability that these charges will be 
brought against him and that he will be sent to the state prison for a 
long term. If there is any boy who does not understand the ques- 
tion, let him ask further explanation before putting it to a vote.” No 
one asks a question. The culprit stands, with tears streaming down 
his face, watching me intently. I called the names of the boys, who 
voted yes or no. When I came to his brother Jacob I said, “Jacob, 
I cannot ask you as a brother to vote. We will excuse you.” He 
dropped his head on his arm and sobbed. 

The vote stood 23 against keeping him to 12 in his favor. I 
announced the decision, and it seemed as if the ceiling would fall on 
us. I said, “John, do you understand the verdict?” “Yes, sir.” 
“ John, dare you meet me half way and take my hand and say that, 
if I will give you another trial, you will give us no more trouble, but 
will try to be a good boy ?” “Yes, sir.” I took his hand. I said, 
“ Boys, the vote stands 23 to 12. I count 13; so it is 23 to 25. 
John is going to stay.” I left that boy, when I came here, driving a 
team ; I send him anywhere; and from that time, which was a year 
and a half ago, he has been reproved but once, and that was for using 
tobacco. That is one boy. 

The section adjourned. 


GENERAL SESSION. 


Friday, June i6, 1893, 8 p. m. 

Dr. Wines presiding. 

The President. — As announced in the programme, the subject 
for to-night is the prison question. But we have decided, instead of 
having another general meeting to-morrow morning for the discus- 
sion of insanity, to combine this evening’s meeting with to-morrow 
morning’s meeting, so as to give you a whole day’s rest. I take 
pleasure in introducing as the first speaker Mr. Charlton T. 
Lewis, of New York, who will speak on the uses of imprisonment. 

THE USES OF IMPRISONMENT. 

CHARLTON T. LEWIS. 

Permit me to ask you, at the beginning of my remarks, to note 
that I am not here in any sense as a teacKer, but simply as an inquirer 
after truth ; and if, in the course of what I say, I should, for the sake 
of brevity and emphasis, at times express with considerable positive- 
ness notions which may seem somewhat new and strange to you, 
please set it down to my ignorant eagerness for instruction. 

The history of imprisonment is yet to be written. I know many 
noble men and women who are familiar with all that has been done 
by the spirit of Christianity, the spirit of faith and love and hope, for 
the amelioration of the condition of prisoners and the improvement 
of penal law, since the days of John Howard, when the prisons of the 
world were a disgrace to humanity — a disgrace greater than they are 
to-day, if such a thing is possible. But I have never met a student 
of thjs subject who had gone back of that time and who could tell 
me anything of the origin of prisons, of the historical meaning of 
the origin of prisons, of the historical meaning of the plan of impris- 
onment now practised by all civilized nations. Where did the 
practice originate? What was its purpose in the beginning? If we 
could ascertain what principle in human nature or what condition of 
society first led to the establishment of prisons, and how they have 
been developed, we might get some valuable light upon the use of 
imprisonment. In my feeble way I endeavored to pick up that 


96 


PREVENTION AND REPRESSION OF CRIME. 


information from a g^reat variety of books by ancient writers and 
general historians. I propose to give you some of the leading con- 
clusions to which my mind has been led. 

It seems that in the ancient times there was no imprisonment in the 
sense in which it is practised to-day. For instance, no mention of it is 
made in the penal law of Moses, and nothing was known about it at 
that time. In the New Testament and in Greek literature there is an 
occasional reference to imprisonment, but the word for it in Greek is 
precisely the word for bondage. It means to take a man and put 
him in chains, to fetter a man, when it is necessary to restrain him. 
The Romans cast some of the apostles into prison, but for what pur- 
pose ? Did they attempt thus to punish them ? Such an idea 
never entered their minds. Every prisoner was detained for a defi- 
nite purpose. He was held for trial, or to keep him out of the way 
of somebody who was his enemy ; but imprisonment as a penalty 
inflicted by law for crime did not exist. Prisons existed in the 
middle ages, but they were a sort of appendage of feudal power. 
Noblemen with castles always had prisons in them. Kings had 
prisons, into which they could throw their prime ministers, or wives, 
or anybody they could get hold of, and keep them there until they 
saw fit otherwise to punish them. But the idea of imprisonment as a 
penalty had not dawned upon the world. 

When do we find it ? Not until the eighteenth century. Before 
that time, the punishments inflicted for crime were almost altogether 
of a different character. Sometimes men were mutilated. Our 
Anglo-Saxon ancestors had a great fondness for cutting up the 
human frame. They were the veritable ancestors of the greatest 
surgeons of modern times. They took poor devils up on the 
public way and cut off their ears, and put out their eyes, and split 
their noses, and chopped off their hands, and sometimes their feet; 
and if they had not done anything that required such horrible treat- 
ment, they put them in the stocks or in the pillory and invited the 
boys to throw stones at them ; or they had the public hangman 
come and whip them. They would fine a man of noble blood half 
his possessions, if he were guilty of crime. But until comparatively 
recent years imprisonment for crime was unknown. 

How did the idea arise ? The prisons were originally used for 
the custody of men convicted of crime, and to confine anybody 
whom the law wished to hold for a certain purpose until a particular 
time. As the humanitarian spirit grew, men gradually revolted at 


LEWIS. 


97 


the idea of torture, and they began to think that the prisons them- 
selves were punishment enough ; and God knows that some of them 
were the worst punishment that mortals could endure. At first men 
began to be left in prison indefinitely, and then the term was fixed 
by law for long periods, and then for shorter periods ; and the laws 
themselves began to be modified, in a more humane spirit, so that 
imprisonment, which was considered as more humane than the pen- 
alties common in more ancient times, took the place of them nearly all. 

This is the historical origin and growth of penal codes, until now 
we find grave jurists sitting in counsel, in different countries of the 
world, studying, in what they call a scientific spirit, the formation of 
a penal code of imprisonment. Why, the idea of applying science 
to the distribution of imprisonment as a penalty for crime has been 
carried to such an extent that in the recent parliament of Italy, 
when they undertook to frame a penal code, the question came up 
whether or not capital punishment should be abolished. It had 
been practically abolished for several years by the action of the 
government itself. But the question of capital punishment for 
aggravated crimes has never been debated with such fullness and 
vigor as it was in the Italian parliament, and the argument which 
at last seems to have decided the question in favor of the entire 
abolition of the death penalty was, I think I may say, the strangest 
argument that ever prevailed in a body of civilized men.' I am in 
sympathy with the movement for the abolition of capital punishment. 
But I want you to note the argument that prevailed with those men. 
It was this. They said : The first requirement of a “ scientific ” 
penal code is that all penalties shall bear a certain proportion one 
to another, so that, when the court has precisely ascertained in 
mathematical expression the degree of guilt of the prisoner, and 
knows that it is precisely twice or three times the guilt of another 
prisoner, it shall be the duty of the court to inflict a penalty math- 
ematically proportionate to the guilt. Now the introduction of 
■capital punishment into such a code as that is impossible. You 
cannot say that to cut a man’s head off or to hang him is just tw ice 
or three times so much imprisonment, or is adapted to twice or 
three times the amount of guilt that imprisonment for a given 
number of years would be. There is no proportion between a term 
of incarceration and death ; therefore under a “ scientific ” code 
capital punishment drops out entirely. That, I say, was the last 
xesult of penal science in the great council of Italy, in discussing the 


98 


PREVENTION AND REPRESSION OF CRIME. 


question of the penal code. Now, if there ever was a reductio ad 
absurdum, that is it. 

Let us look at it a little. The Italian code is a good example. I 
wish I had time to present some of its leading features. Every con- 
ceivable crime that any man can commit against society, and a good 
many crimes besides which I think most of you would say are 
utterly inconceivable, are there defined with the utmost minuteness. 
They are graded and proportioned with reference to degrees of 
aggravation on the one hand, and of mitigation on the other ; and a 
proportionate rate of punishment, measured by time and kind of 
imprisonment, is prescribed for each of them. As a code, it is the 
most astonishing work of the human mind. What does it assume as 
a starting-point? That when a man is convicted of crime, the 
evidence upon which he is convicted being before the court, it is prac- 
ticable for the court to form an estimate of the degree of his guilt 
susceptible of mathematical expression ; and that when a number of 
men are convicted of different crimes, in different degrees, it is prac- 
ticable for the court to distinguish their varying desert in such a way 
as to bring them under the different articles of the code, and with 
strict and impartial justice to assign to each of them the precise kind 
and amount of imprisonment which his deed merits. 

You and I are too familiar with term sentences for crime to realize 
at once their utter and astounding absurdity. The history of human 
nature is strewn with absurdities. If there is one dismal fact in life, 
it is the vast and amazing capacity of the human mind for delusion 
and fanaticism. But I am free to say that there is not in history a 
delusion, an expression of fanaticism, an institution, the absurdity of 
which transcends this. We employ our best men, educated men, 
highly trained lawyers of incorruptible mind and heart, the picked 
men of the community, to sit as judges on the bench and there to 
undertake a task which God himself could not accomplish, because 
it is a contradiction in terms. We ask them to find the just propor- 
tion between the penalties imposed and the demerit of offenses and 
of the men who committed them, on the basis of the evidence in 
virtue of which they are convicted. But the testimony is inadequate. 
Are human judges omniscient? We expressly forbid them to go out- 
side of the record. If a judge were omniscient it would only be by 
defying the law which placed him upon the bench that he would dare 
to import into his judgment any element but that which has found its 
way, through the quarreling and quibbling of counsel and of wit- 


LEWIS. 


99 


nesses, to the record. And on the basis of that, is he to sit in judgment 
upon the intellect, the character, the life, the future of his fellow-man 
and decree what his fate shall be ? This is what we require and 
expect of him. 

One or two of the absurdities involved in this system are so obvi- 
ous that I want to call your attention to them. In the law not only 
of Italy, but in the law of Illinois, of Ohio, of every state of this 
Union, you will discover on examination that the tacit assumption 
is made that, if two men commit the same illegal act, their guilt is 
equal. One may be an hereditary, habitual, incorrigible criminal, 
every impulse of whose nature is to war against society, every 
breath of his soul hatred, supremely selfish, corrupt, vile, without 
an ennobling thought, without a lofty aspiration, a being destined, 
you may say, from his cradle to wallow in corruption ^nd to spread 
the moral pestilence of his nature among his fellow-men ; the other 
perhaps is a man all of whose sources of character as they lay in his 
ancestry may be of the highest, whose life may have been pure and 
noble, until circumstances crushed it, who has succumbed to a 
terrible temptation, and now the shame, the degradation, the utter 
despair brought upon him by detection may have overwhelmed 
him not merely with sorrow but with a sincere repentance, so that, 
of all the impossibilities of the future, the greatest impossibility 
would be that that man should ever commit a crime again. ‘ But 
the guilt of these two, in the act defined by law as a crime, and 
proved by the evidence, is equal. The same sentence is pronounced 
against both, the same treatment is dealt out to them, and justice 
is so coldly, cruelly blind as to shut her eyes to the distinction 
between them. Or it may be that one man is old and has not five 
years, in the natural course of events, to live, while another has a 
long life before him and is just entering upon it. But their offenses 
bear the same name, and the same term of imprisonment for the 
same offense is decreed by the law against each of them. Is it the 
same penalty ? 

To one man the prison is a living tomb. To another it is a refuge. 
But the law deals out to both the same term of imprisonment. The 
thought is so utterly repulsive to every mind capable of right think- 
ing on social subjects that I cannot understand how it is possible to 
tolerate it. It is a burning disgrace to our boasted civilization that 
this traditional method of dealing with crime is permitted to remain 
on our statute-books. 


iOO 


PREVENTION AND REPRESSION OF CRIME. 


I will not enter upon any argument founded upon abstract justice. 
There is no conception of justice that has any application to the case. 
None is called for, because it would be impertinent. Society or the 
state, that is to say, the body of us who have not yet been convicted 
of crime, has no business to set itself up in the place of God and 
claim the right to inflict justice upon our fellow-men. We have 
nothing to do with it. What we have a right to do as an organized 
society is to protect ourselves, to protect our own rights against 
infringement. That we are bound to do. We must protect our 
lives, our property, our families and friends, and the good order of 
society on which these all depend. In order to protect it we must 
reform, if possible, and if reformation is impossible, extirpate the 
elements in society which threaten it. That is the rule by which 
we must be governed, and that is the extent and limit of our right 
and duty in the matter. The only question is a practical question. 
How shall we best accomplish this end ? How shall we best extir- 
pate criminality from the community ? By removing it from the 
individual soul? or by removing from society the individuals who 
cannot be reformed? 

Imprisonment suggests itself naturally and at once as a convenient 
method of putting out of the way those whom we wish to put out of 
the way, to restrain, to prevent from carrying on their warfare against 
society. 

Now, if we must imprison men, what should be the duration of 
imprisonment? I think you will agree with me, since none of you 
have objected thus far, that the attempt to apportion fixed periods 
of time to men as an equivalent for their crimes is a humbug and a 
wrong. The first thing is to sweep that out of existence. Until 
every vestige of it disappears from our statute-books we have no 
basis for a “ scientific penal code. Then, if we retain imprisonment, 
by what method of measurement can it be made most useful ? It is 
not necessary for me before this audience to point out in detail the 
advantages of the indeterminate sentence. If it is the duty of society 
to shut a man up because he cannot be safely trusted to be at large, 
then it is the duty of society to shut him up until he can be trusted 
to be at large. If we must put a man in prison because we cannot 
trust him out of jail, then let us keep him there until he can be 
released without danger to society. Is there any other rule that we 
can apply to the case? That is the whole meaning of the indeter- 
minate sentence. There is no doubt in the mind of any thinking 


LEWIS. 


lOI 


man who has studied the subject that, scientifically, the indeter- 
minate sentence is the only sentence for crime which ought under 
any circumstances and in any community to be adopted. 

I am well aware that in the attempt to embody it in law and to 
carry it out in practice difficulties are encountered which are stu- 
pendous. It is impossible to exaggerate them. The work of a judge 
and a jury is in nowise diminished in importance, in difficulty 
and in delicacy by this form of sentence. On the other hand, the 
task involved in the administration of prisons by officials on whom 
is imposed the responsibility of deciding when and to what extent 
any person is fit for freedom, is so enormously increased that it 
seems almost hopeless, in the present condition of mankind, to find 
men capable of exercising such a trust. But there is a demand for 
them, and the history of the past proves that every moral demand 
once recognized wdll be met. I believe that the time will come when 
society can be organized on that basis, when the indeterminate sen- 
tence can be made universal, and that men can be found who will 
enforce it honestly, ably and successfully. The large way of justice 
is in this world forever strewn with the small injustices which bring 
out all its splendor by way of contrast. We are enabled to look 
forward to another world, where we hope that all injustice will be 
rectified, by this very contrast between the big justice and the little 
injustices in this world which is the highest stimulus to faith in God. 

But I earnestly wish to impress upon you another thought of still 
greater consequence. It is that imprisonment is in its own nature 
one of the greatest evils that can be inflicted upon a man, in that 
it deprives him of the enjoyment of human society, thus imbittering 
his life. The loss of pleasure, of satisfaction, is a minor thing; the 
greater loss is that of intellect, of soul ; it is the belittling of man- 
hood. The immediate, inevitable effect on that man is to make him 
forever after a smaller and meaner being. He is less of a man 
than he otherwise would have been. It is a cruelty which is prac- 
tised on a large scale by every nation of the world. But it is a 
cruelty so great, and in the vast majority of cases so unnecessary, 
that I think the mind of the world is awakening to it to-day. If 
any conviction has been ground and burned into my own mind by 
spending a considerable part of the last twenty years within prison 
v/alls, for the sake of studying this question, it is, that if a generation 
ago, every prison on the face of the earth had been annihilated and 
no new ones built, the world would be better to-day. The injury 


102 


PREVENTION AND REPRESSION OF CRIME. 


done to mankind by letting prisoners loose, as we call it, and guard- 
ing ourselves against them as best we may, is incomparably less than 
the evil wrought by the prison system. Nine-tenths of the prisons 
in the United States to-day are manufactories of the criminal classes. 
They are universities of crime. They are places where souls are 
educated in all villainies, in all corruption, in all hatred to their fellow- 
men, and in all warfare against society. This is particularly true of 
the county jails of this country. If there were not a county jail in 
the United States, the prospects for civilization would be far better 
than they are. 

The President. — Touch on the solitary question. 

Mr. Lewis. — That is a subject to which I have devoted less atten- 
tion. The solitary system, as it was originally devised, has no exist- 
ence in this country. In a very modified form it is practised in the 
Eastern Penitentiary of Pennsylvania. The solitary system in a very 
severe form is found in the prisons of Great Britain and of some of 
the continental nations of Europe. In England, imprisonment is 
absolutely solitary for a certain time. All felons sentenced to five 
years or more of imprisonment are for the first nine months kept in 
solitary confinement. By reducing the period of solitary confine- 
ment to nine months, after a long series of experiments, the British 
statesmen who have studied the subject say that they have eliminated 
most of the insanity, excessive depression of spirits, breaking down 
of health and manhood, that are the common result of long terms of 
solitary confinement. 

But either solitary or congregated imprisonment is an unnatural 
life. It is not the life which citizens lead. No man who has not 
been much in prisons and observed them with care can imagine the 
wide difference. The associations of prison life are not society. 
Men work side by side as a penalty for crime, with no fellowship, no 
true companionship. Usually to the degree in which he is suscept- 
ible of social pleasure and pain, the prisoner is by his prison life 
degraded and incapacitated for human sympathy. 'Those who are 
called good fellows in prison are ordinarily the most abandoned, and 
are getting ready to continue their depredations on society when 
they go out into the world. The poit^t I want to urge upon you is, 
that imprisonment itself in the aggregate is a great evil, and, if it be 
any way possible, we should diminish the volume of it. That is the 
question of the day. And it is one on which new light is coming to 
us from various quarters. 


LEWIS. 


103 


In the year 1869 M. de Girardin, who was once the editor of a Paris 
journal, a publicist of g^reat breadth and comprehension of mind, 
published a long series of articles in his newspaper, in which he pro- 
posed that every important citizen of France, or of any other nation 
in which his proposed system should be applied, should be presumed, 
by virtue of his prominence and ability, to have public spirit enough 
to undertake to be the guardian and protector of at least one con- 
demned criminal, if one should be assigned to him ; and that as soon 
as a man was convicted of crime, unless he were a criminal mono- 
maniac and uncontrollable, he should be assigned to some citizen 
who would be responsible for his appearance when called for, who 
would undertake to give him employment, and secure to him the 
opportunity to earn his living as a free man so long as he should 
behave himself, with such opportunities for moral and intellectual 
education as he might be capable of enjoying and improving. This 
system as elaborated by him was in the abstract very fascinating, 
and an attempt was made to enact it into a law. But, about the 
time when it was discussed in Paris, the war with Germany broke out. 
Soon after that war, de Girardin went on a tour around the world. 
Wherever he went he advocated this favorite idea of his. Among 
other places, he visited New Zealand and there impressed the idea 
on the statesmen of that infant colony with such effect that they 
embodied it to a certain extent in their probation law. Thence it 
spread to Great Britain, where a probation law has since been 
adopted; and now, in Massachusetts, a probation law went into 
effect July i, 1891, whose working, as far as I can learn, seems to 
be of the greatest value. The principle of the Massachusetts law 
is that prisoners shall be assigned, upon conviction, not to the 
custody of citizens in general, but to the custody of particular 
officers appointed by the court, who will care for them, find them 
employment, watch over their conduct, and produce them when 
wanted; and those probation officers, at least in the city of Boston, 
are doing a remarkable work. Have we not in this system of 
probation the hint of a method by which a substitute for imprison- 
ment may ultimately be found ? Is it not possible that, at some not 
distant day, we may dispense with our strong stone walls and iron 
bars, and refrain from shutting up mankind behind them, there to 
corrode and destroy itself? that we may let men come out among 
men, receive the influences of society without danger to ourselves, 
and in that way work out the spirit of criminality from among men? 


104 


PREVENTION AND REPRESSION OF CRIME. 


If society can so organize itself as to bring all its own healthy force 
to bear upon criminality, not incarcerated in prispn but distributed 
through the community, with a chance to work itself out into moral 
health, there is a better hope for the future, at least for those who 
have been born without our advantages. 

Various classes of men are studying this prison question. Many 
disregard it altogether, frown upon it, and are offended if it is 
brought to their notice. They consider it so painful that they are 
not willing to fix their eyes upon it. They want to look at some- 
thing more beautiful. Others think that the panacea for all the 
moral ills which afflict society, especially for its crimes, is to be 
found in some form of moral or religious enthusiasm, some particular 
idea of good which they cherish, and which, they think, if brought 
to bear upon prisoners, would reform them altogether. Others still 
think that nothing is needed but rigid scientific study, especially of 
the doctrine of heredity, which will result in classing all criminals 
with the insane, explain away all difficulties, and settle the penolo- 
gical controversy. But these are practical questions, and we must 
look at them on every side. We must gather light from every 
quarter, before we can form views that will be sound and stand the 
test of time. For 

“ Beauty, good and knowledge are three sisters 
That dote upon each other, friends to man. 

Living together under the same roof. 

And never can be sundered without tears. 

And he that shuts out Love in turn shall be 
Shut out by Love, and on her threshold lie 
Howling in outer darkness. Not for this 
Was common clay ta’en from the common earth, 

Moulded by God, and tempered with the tears 
Of angels, to the perfect state of man.” 

A paper was then read on the Treatment of the Insane by Dr. 
G. Alder Blumer. 

Adjourned. 


INDEX TO PAPERS ON THE PREVENTION AND 
REPRESSION OF CRIME. 


Adler, Felix, his school, 65. 

Bagelot, Mme., 69. 

Beecher, Thos. K., on Z. R. Brockway, 

66 . 

Bertillon, Alphonse, 75. 

Bertillon System, the, 9, 75-82 ; ex- 
planation of, 75 ; advantage of, 
76; methods of identification, 76; 
method of measurement, 78-80 ; cost 
of appliances, 81 ; as scientific sys- 
tem, 82. 

Black Maria, 25. 

Brinkerhoff, General, 9. 

Brockway, Z. R., work of, 66. 

Burnham Industrial Farm, 86,91-94; 
character of, 86; method of teach- 
ing, 87-88, 90 ; promotion in, 88 ; 
punishment in, 89. 

Charity, and religion, 7. 

Chicago, prison visitation in, 73; and 
care for discharged prisoners, 73. 

Child, not criminal, 86. 

Civilization, and law, 30. 

Coffin, Charles F., 66. 

Commutation, and pardon, 61. 

Commutation law, 59. 

Crime, treatment of, 6, 8, 45 ; and 
society, 7; protection of society 
against, 7 ; punishment for, 8 ; the 
philosophy of, 28-38 ; defined, 28, 
30, 36, 41, 43, 46, 86 ; causes of, 29, 
32, 42, 84; fixed standard of, 30; 
limitation of, 31-32 ; and church, 
33; restraint of, 32-33; subject of. 


34; history of, 35, 36; involuntary, 
38 ; basis of, 42 ; hereditary cause 
of, 44, 74 ; statistics of, 49 ; and 
government, 49-50, 73 ; natural, 50 ; 
classification, 51 ; and education, 
84-91. 

Criminal, treatment of, 9, 51, 52, 56 ; T. 
D. Crothers on some studies of in- 
ebriate and pauper, 10-24 ; and 
inebriates, ii; reformation of, 
33; method of reformation of, 33; 
subject of, 34 ; and honest laborers, 
49; identification of, 75-82 ; exami- 
nation of, 76-77; boy, 90; society 
and, 100. 

Criminal act, 34. 

Criminal psychology, study of, 51, 52. 

Criminal sociology, 50. 

Criminality, and inebriety, 10, 16, 18 ; 
factors of, 85. 

Criminologists, service of, 53. 

Criminology, Baron Garofalo on new 
theories of, 48-57 ; importance of, 
48, 57 ; first step in, 50 ; criterion of, 

54. 

Crothers, T, D., on some studies of 
inebriate and pauper criminals, 
10-24. 

D’Arcambal, Mrs. Agnes, 27, 72. 

De Girardin, 103. 

De Grandpre, Mile., 67 ; and St. La- 
zare prison, 68. 

Delinquent children, 86; method of 
teaching, 87. 

Delinquents, punishment of, 52. 


io6 


INDEX. 


De Morsier, Mme., 69. 

Disease, effect upon bone, 80. 

Drunkards, and inebriates, 26. 

Education, and crime, 84-91 ; new 
method of, 85. 

Elmira Reformatory, principles, 63. 

Evolution, of society, 29. 

Families^ 69. 

Felton, Chas. E., 9; on treatment of 
inebriety, 24-26. 

Female discharged prisoners, care for, 
72. 

Female prisoners, work for discharged 
at St. Lazare, 67-71 ; difficulties in 
redeeming, 69; expenses for, 70; 
treatment of, 72 ; care for, 72. 

Follett, M. D., 41. 

Fullerton, Mrs. M., 72. 

Garofalo, Baron, on new theories of 
criminology, 48-57. 

Good-time laws, 58. 

Idea, ethical, of man, 29. 

Impressions, causes of, 28 ; character 
of, 28. 

Imprisonment, 8-9, 25 ; substitute for, 
9; temporary, 51; Charlton Lewis 
on the use of, 95-104 ; history of, 
95; and bondage, 96 ; origin of idea 
of, 96; distribution of, 96 ; present 
system of, 99 ; defined, 100 ; dura- 
tion of, 100; evil of, loi. 

Impulse, mental, defined, 28; crimi- 
nal, 43. 

Incarceration, 60. 

Indeterminate sentences, 59 ; and pa- 
role, 59, 60 ; dangers of, 61. 

Inebriates, and criminals, 10-24 ; places 
of, 10 ; study of, 10, 23 ; and crimi- 
nality, 10, 16, 18 ; literatures on, 
10; classes of, ii, 14, 21, 23; 
general systems of, 11-18; history 
and causes of, 12, 14-15; criminal. 


12, 22; kinds of, 12-13; imbeciles 
and, 16 ; external signs of, 16-17 ; 
inheritance of, 17, 19; groups of, 
18-20 ; treatment of, 20-23, 24 ; and 
insane, 20; need of proper classifi- 
cations of, 20-21 ; discipline of, 22; 
and asylum, 23 ; hospitals for, 23- 
25; difficulty of classification of, 
24 ; and drunkards, 26. 

Inebriety, and criminality, 10, 16, 18 ; 
as a disease, 24 ; time of develop- 
ment of, 26. 

Insane, and inebriate, 20 ; need of 
proper classification of, 20-22. 

}ag bill, 17. 
ai Is, county, 9. 

Johnson, Mrs. Ellen C., on women 
prisoners, 71. 

Jurists, and penalties, 54, 56; Euro- 
pean, 56 ; faults of, 56. 

La Roquette, 68. 

Law, against public intoxication, 25; 
French against drunkards, 27 ; 
municipal, defined, 30, 42 ; and civ- 
ilization, 30; object of, 30; of pro- 
bation, 39-40; statutory, 42; penal, 

54. 

Lewis, Charlton T., on the plan of con- 
ference, 5-6; on difficulties of'parole 
system, 64-65 ; on Bertillon system, 
82; on the use of imprisonment, 
95-104. 

Lewis, H. F., 43. 

Liberty, 32. 

^mbroso, 51. 

angasarian, M. M., on definition of 
crime, 41. 

Marshall, Mme. Marie, on work for 
discharged female prisoners at St. 
Lazare, 67-71. 

McClaughry, Robert W., on the Ber- 
tillon system for identification of 
criminals, 75-82. 


INDEX. 


107 


Moore, D. T., 44. 

Moral, standard, 30; philosophy, 31, 
46. 

Murders, statistics of, 49; neglected, 
50. 

Nanterre, prison of, 68. 

New Jersey Reform School for Boys, 
93-94; method of reformations in, 

93-94. 

New Zealand, the probation law of, 
103. 

Nutting, H. C., 45. 

Nutting, J. H., 26, 42 ; on heredity, 44. 

Offender, inquiry of, 55. 

Offender, habitual, treatment of, 52. 
Otterson, Ira, on New Jersey Reform 
School for Boys, 93-94. 


Probation, law of, 39-40, 65 ; office, in 
Boston, 39; value of, 40 ; effect of 
the law, 41 ; system of New Zealand, 
103 ; of Mass., 103. 

Property, the love of, 29, 31. 

Prosecutor, and advocate, 55. 

Punishment, capital, 97 ; unequal, 99. 

Punishment of crime, form of, 8 ; ideas 
of, 8; and judge, 8; distribution of, 8. 

Reeve, C. H., on the philosophy of 
crime, 28-38. 

Reformation, of criminals, 33, 42; 
defined, 33; social, 64. 

Repeaters, 22. 

Retribution, human, 63. 

Revolution, social, 7. 

Round, N. M. F., 48; on crime and 
education, 84-91. 


Pardon, system of, and commutation, 
61. 

Parole, defined, 57; and pardon, 57-58; 
and “good time” laws, 57; laws, 
59 ; and indeterminate sentences, 59. 

Parole system, the, Frederick H. 
Wines on, 57-64 ; benefit of, 58 ; and 
Michigan court, 58 ; legal view of, 
58; defined, 60; divisions of, 60; 
practical operation of, 60 ; dangers 
of, 61-62; of Ohio, 61; under 
proper conditions, 62 ; principle of, 
62 ; difficulties, 63-64. 

Peabody, Francis G., 7. 

Penal codes, elements of, 7, 8 ; origin 
of scientific, 97 ; Italian, 98 ; scien- 
tific, 100. 

Penal system, principles of, 53. 

Penalties, 9; death, 51. 

Pontiac, 62. 

Prison, and criminals, 9 ; history of, 
95 ; importance of question, 104. 

Prisoners, tests of, 63. 


Scotland Yard, 82. 

Sims, P. D., 43. 

Society, and crime, 7. 

Solidarity, 70. 

Solitary system, the, 102. 

Standard, ethical, 29, 30, 37, 42, 46 ; of 
crime, 30 ; theological, 30. 

Stevenson, on inheritance of inebriate, 
17. 

St. Lazare, prison of, 67. 

Taylor, Graham, 73. 

Ticket-of-leave, 58. 

Todd, Miss Hannah M., on the law of 
probation, 39-40. 

Tramps, temperance, 16. 

Waifs, in France, 69. 

Walk, James W., 80. 

Wines, Frederick H., on the parole 
system, 57-64. 

Wright, Edward S., oq.^tEe’^^tillon 
system, 8 1-82 ; on 1^6tla»i¥afdVS2v' 


LIBRARY 






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